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Geriatrics
Special Issues
Medical Disorders and Cognition in the Elderly
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Medical Disorders and Cognition in the Elderly

A special issue of Geriatrics (ISSN 2308-3417).

Deadline for manuscript submissions: closed (30 April 2016) | Viewed by 53076

Special Issue Editor

Dr. Joaquim Cerejeira

E-Mail Website
Guest Editor
Serviço de Psiquiatria, Centro Hospitalar Universitário de Coimbra, Praceta Mota Pinto, 3000-075 Coimbra, Portugal
Interests: delirium; depression; cognitive impairment; healthcare service organization

Special Issue Information

Dear Colleagues,

In clinical practice, there is a significant overlap between medical and cognitive disorders. Thus, elderly patients with dementia represent up to 42% of the admissions in acute medical wards, mainly with urinary or respiratory infections, and these individuals have markedly higher mortality during hospitalization. More than 50% of these patients will develop delirium, which is independently associated with a higher risk of long-term cognitive impairment, acceleration of dementia, and reduced time to permanent institutionalization and to death. Accumulating epidemiological, clinical and pre-clinical data suggest that both chronic and acute medical conditions can have a major impact in the brain of elderly subjects, eliciting cognitive dysfunction and exacerbating the progression of dementia. Additionally, a number of medications used to treat medical conditions are implicated in reversible cognitive dysfunction (e.g., anticholinergic drugs, corticosteroids, analgesics). Reversely, recent studies have unveiled that the nervous system exerts an important regulatory role over the innate immune response to illness or injury, it being likely that an ongoing neurodegenerative process can alter the physiological responses to regain homeostasis during acute illness. Full understanding of the pathophysiological mechanisms underlying this bidirectional association is crucial to reduce the risk of cognitive decline in elderly subjects with medical comorbidities and to improve the outcome of medical disorders in patients with cognitive dysfunction. This Special Issue of Geriatrics aims to publish relevant research and review articles studying the relationship between medical disorders and cognitive function.

Topics to be covered include, but are not restricted to:
-          Prevalence and impact of medical comorbidities in dementia/delirum
-          Special needs of patients with dementia/delirium in health care services
-          The impact of dementia in self-management of chronic medical conditions
-          The impact of acute medical conditions in delirium and dementia progression
-          Homeostatic adaptations to medical illness in dementia/delirium
-          The impact of medications in cognitive function
-          The relation between dysfunction of peripheral organs and cognitive function
-          Preventive and therapeutic interventions

Dr. Joaquim Cerejeira
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Geriatrics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • delirium
  • dementia
  • cognitive function
  • anticholinergic drugs
  • diabetes
  • heart failure
  • renal failure
  • infection
  • inflammation
  • electrolyte imbalance
  • dehydration
  • mortality
  • functional decline
  • frailty
  • health care services

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Published Papers (7 papers)

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Research

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190 KiB  
Article
Effects of a 12-Week Municipal Dementia Prevention Program on Cognitive/Motor Functions among the Community-Dwelling Elderly
by Tadahiko Kamegaya, Haruyasu Yamaguchi and Long-Term-Care Prevention Team of Isesaki City Community General Support Center
Geriatrics 2016, 1(3), 18; https://doi.org/10.3390/geriatrics1030018 - 18 Jul 2016
Cited by 2 | Viewed by 6859
Abstract
In a rapidly aging society, like that in Japan, it is imperative to establish strategies to prevent dementia. We investigated the effects of a dementia prevention program, conducted as part of a municipality’s long-term care prevention project, on cognitive/motor functions among the community-dwelling [...] Read more.
In a rapidly aging society, like that in Japan, it is imperative to establish strategies to prevent dementia. We investigated the effects of a dementia prevention program, conducted as part of a municipality’s long-term care prevention project, on cognitive/motor functions among the community-dwelling elderly. Participants underwent a physical activity program involving muscle training and aerobic exercise, once a week, for 12 weeks. Cognitive and motor tests were performed twice, before and after the intervention. Thirty participants, aged 75.7 ± 6.7 years, were included in the analysis. Scores from the immediate word memory task were significantly increased (23.0 ± 7.8 vs. 25.7 ± 6.5) after the program. Scores from the Yamaguchi Kanji Symbol Substitution Test were also significantly increased (36.2 ± 13.1 vs. 40.1 ± 14.1). Time spent during the 5 m maximum walking speed test was significantly shorter after the program (3.4 ± 0.8 vs. 3.0 ± 0.7 s), whereas the daily walking distance increased significantly (1.9 ± 1.5 vs. 3.1 ± 2.2 km). Participants showed improvement in some aspects of their cognitive/motor function and walking distance per day. Therefore, this program can be regarded as a practical community-based healthcare activity. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
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475 KiB  
Article
Associations between Intra-Individual Variability of Reaction Time and Cognitive Function in Cognitively Normal Senior Adults: Still beyond Good or Bad?
by Hanna Lu, Sandra S. M. Chan and Linda C. W. Lam
Geriatrics 2016, 1(2), 13; https://doi.org/10.3390/geriatrics1020013 - 3 Jun 2016
Cited by 9 | Viewed by 6438
Abstract
Background: Intra-individual (IIV) of reaction time (RT), as the short-term fluctuations of RT-based performance, has been reported to be susceptible to cognitive ageing. The current study aimed to examine IIV of RT and its relationships with cognitive performance in cognitively normal senior adults. [...] Read more.
Background: Intra-individual (IIV) of reaction time (RT), as the short-term fluctuations of RT-based performance, has been reported to be susceptible to cognitive ageing. The current study aimed to examine IIV of RT and its relationships with cognitive performance in cognitively normal senior adults. Methods: We evaluated 137 community-dwelling elderly (mean age: 72.41 ± 3.99) with a comprehensive neuropsychological battery and a RT-based test. Intraindividual coefficient of variation of reaction time (ICV-RT) was used to evaluate the IIV. Pearson’s correlation and hierarchical multiple regression analyses were employed to assess the relationships between IIV and the scores of cognitive function. Results: Advancing age was accompanied with declined cognitive function and increased IIV. ICV-RT was negatively correlated with the score of Montreal Cognitive Assessment Hong Kong version (HK MoCA) across three types of flanker. Hierarchical multiple regression showed that ICV-RT was a significant predictor of HK MoCA (β = −0.294, p = 0.001). Conclusion: Increased IIV is consistently associated with and contributed to the age-related decline of cognitive performance in senior adults. The utility of IIV in predicting further deterioration should be carefully postulated with prospective studies. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
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394 KiB  
Article
Prognosis of Early-Onset vs. Late-Onset Mild Cognitive Impairment: Comparison of Conversion Rates and Its Predictors
by Miguel Tábuas-Pereira, Inês Baldeiras, Diana Duro, Beatriz Santiago, Maria Helena Ribeiro, Maria João Leitão, Catarina Oliveira and Isabel Santana
Geriatrics 2016, 1(2), 11; https://doi.org/10.3390/geriatrics1020011 - 25 Apr 2016
Cited by 44 | Viewed by 7977
Abstract
Background: Despite having the same histopathological characteristics, early-onset and late-onset Alzheimer’s disease (AD) patients show some distinct clinical and neuropsychological profiles. Early Onset Mild Cognitive Impairment (EOMCI) is a less characterized group. The aim of this study is to characterize MCI probably due [...] Read more.
Background: Despite having the same histopathological characteristics, early-onset and late-onset Alzheimer’s disease (AD) patients show some distinct clinical and neuropsychological profiles. Early Onset Mild Cognitive Impairment (EOMCI) is a less characterized group. The aim of this study is to characterize MCI probably due to AD in terms of the clinical, genetic, Cerebrospinal fluid (CSF) biomarkers profile and conversion rate of EOMCI, compared to the late-onset form (LOMCI). Methods: 159 MCI patients were divided in two groups: 52 EOMCI (onset < 65 years) and 107 LOMCI (onset ≥ 65 years). We investigated differences in neuropsychological scores, clinical variables, ApoE genotype, CSF biomarkers (Aβ42, t-Tau and p-Tau) in both groups. Conversion was ascertained during follow-up. Results: EOMCI showed a longer duration of symptoms prior to the first evaluation (EOMCI = 4.57 vs. LOMCI = 3.31, p = 0.008) and scored higher on the subjective memory complaints scale (9.91 vs. 7.85, p = 0.008), but performed better in brief cognitive tests (27.81 vs. 26.51, p < 0.001 in Mini-Mental State Examination; 19.84 vs. 18.67, p = 0.005 in Montreal Cognitive Assessment) than LOMCI. ApoE genotype distribution and CSF biomarker profile were similar in both groups, as was the conversion risk. Lower Aβ42 (Hazard ratio (HR): 0.998, 95% Confidence Interval (CI) = [0.996–1.000], p = 0.042), higher t-Tau levels (HR: 1.003, 95%CI = [1.000–1.005], p = 0.039) and higher scores in the Alzheimer Disease Assessment Scale-Cognitive (HR: 1.186, 95%CI = [1.083–1.299], p = 0.002) increased the risk of conversion. Discussion: Despite differences in memory performance and memory complaints, EOMCI and LOMCI seem to represent indistinct biological groups that do not have a higher risk of conversion to AD or differ in risk factors for conversion. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
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446 KiB  
Article
Potential Influence of Aspirin on Neopterin and Tryptophan Levels in Patients with a Delirium
by Angelique Egberts, Durk Fekkes, Gijsbertus Ziere, Tischa J. M. Van der Cammen and Francesco U. S. Mattace-Raso
Geriatrics 2016, 1(2), 10; https://doi.org/10.3390/geriatrics1020010 - 31 Mar 2016
Cited by 3 | Viewed by 5908
Abstract
In an in vitro study, it was found that aspirin might decrease neopterin production and tryptophan degradation. The aim of the present study was to evaluate the possible association between aspirin use and mean neopterin and tryptophan levels in patients with and without [...] Read more.
In an in vitro study, it was found that aspirin might decrease neopterin production and tryptophan degradation. The aim of the present study was to evaluate the possible association between aspirin use and mean neopterin and tryptophan levels in patients with and without a delirium and whether the use of aspirin is associated with a decreased prevalence of delirium. Neopterin and tryptophan levels were determined previously in acutely ill admitted patients aged ≥65 years. The possible influence of aspirin on mean levels of neopterin and tryptophan was investigated with univariate analysis of variance in adjusted models. Eighty-three patients were included; 22 had a delirium. In patients without a delirium (no aspirin (n = 31) versus aspirin (n = 27)), mean neopterin levels were 47.0 nmol/L versus 43.6 nmol/L (p = 0.645) and tryptophan levels were 33.1 µmol/L versus 33.9 µmol/L (p = 0.816). In patients with a delirium (no aspirin (n = 13) versus aspirin (n = 9)), mean neopterin levels were 77.8 nmol/L versus 71.1 nmol/L (p = 0.779) and tryptophan levels were 22.4 µmol/L versus 27.3 µmol/L (p = 0.439). No difference was found in the distribution of aspirin users between patients with and without a delirium. In this study, we found that the use of aspirin had no significant effect on mean levels of neopterin and tryptophan. However, the raw data suggest that there might be a potential influence in patients with a delirium. Aspirin use was not associated with a decreased prevalence of delirium. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
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Review

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376 KiB  
Review
Delirium Diagnostic and Screening Instruments in the Emergency Department: An Up-to-Date Systematic Review
by José Mariz, Teresa Costa Castanho, Jorge Teixeira, Nuno Sousa and Nadine Correia Santos
Geriatrics 2016, 1(3), 22; https://doi.org/10.3390/geriatrics1030022 - 1 Sep 2016
Cited by 25 | Viewed by 12160
Abstract
Background: Emergency care systems are at the core of modern healthcare and are the “point-of-entry/admission” into the hospital for many older/elderly patients. Among these, it is estimated that 15% to 30% will have delirium on admission and that over 50% will develop it [...] Read more.
Background: Emergency care systems are at the core of modern healthcare and are the “point-of-entry/admission” into the hospital for many older/elderly patients. Among these, it is estimated that 15% to 30% will have delirium on admission and that over 50% will develop it during their stay. However, appropriate delirium diagnostic and screening still remains a critical area of need. The goal of this review is to update the field, exploring target areas in screening methods for delirium in the Emergency Department (ED), and/or acute care units, in the older population. Methods: A systematic review was conducted to search screening/diagnostic methods for delirium in the ED and/or acute care units within the ED. Results: Seven different scales were identified. Of the identified instruments, the Confusion Assessment Method (CAM) for the Intense Care Unit (CAM-ICU) was the most widely used. Of note, a brief two-step approach for delirium surveillance was defined with the Delirium Triage Screen (DTS) and the Brief Confusion Assessment Method (bCAM), and the diagnostic accuracy of the Richmond Agitation-Sedation Scale (RASS) for delirium had a good sensitivity and specificity in older patients. Conclusion: The CAM-ICU appears as the potential reference standard for use in the ED, but research in a global approach of evaluation of actual and past cognitive changes is still warranted. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
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191 KiB  
Review
Current and Future Perspectives of Liaison Psychiatry Services: Relevance for Older People’s Care
by Elizabeta B. Mukaetova-Ladinska
Geriatrics 2016, 1(1), 7; https://doi.org/10.3390/geriatrics1010007 - 3 Mar 2016
Cited by 2 | Viewed by 6159
Abstract
A large number of people admitted to medical wards have co-morbid mental health problems, and these predominantly include depression, dementia and delirium. An additional one third of medically ill patients remain in hospitals with undetected and, therefore, undiagnosed mental health problems. The comorbidity [...] Read more.
A large number of people admitted to medical wards have co-morbid mental health problems, and these predominantly include depression, dementia and delirium. An additional one third of medically ill patients remain in hospitals with undetected and, therefore, undiagnosed mental health problems. The comorbidity of mental and physical illnesses leads to poor health outcomes, prolonged inpatient stays and use of inpatient resources, involvement of various affiliated health services, introduction of medications and discharge to long-term facilities, including residential and nursing 24-h care, increased both readmission rates and mortality. The establishment of Liaison psychiatry services to meet the needs for people with mental health problems admitted to medical wards is a priority for many acute health Trusts. This has an economical background in terms of cost-savings, especially in relation to the older adults, with decreasing readmission rates and quicker hospital discharges. In the current review, we address the latest policies regarding Liaison psychiatry services; especially those for older people with dementia and delirium, and discuss their future shaping. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
208 KiB  
Review
Cognitive Impairment in Hospitalized Seniors
by Monidipa Dasgupta
Geriatrics 2016, 1(1), 4; https://doi.org/10.3390/geriatrics1010004 - 5 Jan 2016
Cited by 10 | Viewed by 6864
Abstract
Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization [...] Read more.
Cognitive disorders are highly prevalent in hospitalized seniors, and can be due to delirium, dementia, as well as other disorders. Hospitalization can have adverse cognitive effects, and cognitive dysfunction adversely affects hospital outcomes. In this article, the literature is reviewed on how hospitalization affects cognitive function and how cognitive impairment affects hospital outcomes. Possible interventions in cognitively impaired hospitalized seniors are reviewed. Full article
(This article belongs to the Special Issue Medical Disorders and Cognition in the Elderly)
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