21 research outputs found
Delirium and dementia with Lewy bodies: distinct diagnoses or part of the same spectrum?
No full textDementia with Lewy bodies (DLB) is recognised as the second most common form of dementia in older people. Delirium is a condition of acute brain dysfunction for which a pre-existing diagnosis of dementia is a risk factor. Conversely delirium is associated with an increased risk of developing dementia. The reasons for this bidirectional relationship are not well understood. Our aim was to review possible similarities in the clinical presentation and pathophysiology between delirium and DLB, and explore possible links between these diagnoses. A systematic search using Medline, Embase and Psychinfo was performed. References were scanned for relevant articles, supplemented by articles identified from reference lists and those known to the authors. 94 articles were selected for inclusion in the review. Delirium and DLB share a number of clinical similarities, including global impairment of cognition, fluctuations in attention and perceptual abnormalities. Delirium is a frequent presenting feature of DLB. In terms of pathophysiological mechanisms, cholinergic dysfunction and genetics may provide a common link. Neuroimaging studies suggest a brain vulnerability in delirium which may also occur in dementia. The basal ganglia, which play a key role in DLB, have also been implicated in delirium. The role of Cerebrospinal fluid (CSF) and serum biomarkers for both diagnoses is an interesting area although some results are conflicting and further work in this area is needed. Delirium and DLB share a number of features and we hypothesise that delirium may, in some cases, represent early or \u27prodromal\u27 DLB. Further research is needed to test the novel hypothesis that delirium may be an early marker for future DLB, which would aid early diagnosis of DLB and identify those at high risk
Review of delirium in patients with Parkinson\u27s disease
No full textParkinson\u27s disease (PD) is common and has a number of associated neuropsychiatric disturbances. Of these, delirium has historically been under-recognised. Delirium is an acute disturbance of attention and awareness that fluctuates, and is accompanied by an additional disturbance of cognition. As delirium is known to carry a particularly poor prognosis in terms of morbidity and mortality, and the relationship between delirium and dementia is becoming better defined, we completed a literature review of delirium in the context of PD. A literature search was completed using the databases PubMed, Embase and Ovid Medline. PubMed (1945-2014) was searched in September 2014; Embase (1974-2014); and Ovid Medline (1946-2014) in October 2014. The search terms \u27delirium\u27 and \u27Parkinsons\u27 in combination were used. Large studies using a robust definition of delirium were lacking in PD. There is the suggestion that PD is a risk factor for delirium and that delirium negatively impacts upon the motor symptom trajectory. Deficits in the neurotransmitters dopamine and acetylcholine are implicated in the pathophysiology of delirium in PD. Systemic inflammation also appears to have a role. Treatment of delirium in PD should include medication review and cautious use of atypical antipsychotics where pharmacological treatment is indicated. Of the atypical antipsychotics studied, quetiapine has the least extrapyramidal side effects. Evidence suggests a specific link between delirium and PD but well-designed clinical studies to evaluate the prevalence, impact and treatment of delirium in PD are required. Given the potential to improve outcomes through delirium prevention we conclude that delirium in PD is an area worthy of further study
Experience and opinions on post-graduate dementia training in the UK: a survey of selected consultant geriatricians
No full textIntroduction people with dementia are more likely to come into contact with a geriatrician than any other hospital specialty. Whilst it is known that there are some geriatricians with a special interest in dementia, it is unclear how this group of clinicians gained experience, and what their opinions are on current training. Methods we obtained a list of geriatricians known to have an interest in dementia care (known as dementia champions) from the British Geriatric Society Dementia and Similar Disorders Special Interest Group. We contacted 100 \u27dementia champions\u27 with an invitation to respond to a questionnaire relating to their role, experience and opinions on current training in dementia within geriatric medicine. Results fifty-five geriatricians responded. Ninety-one per cent were consultant physicians, and 71% were not involved in outpatient diagnostic services. Fifty-six per cent reported that their experience was via clinical attachments with old age psychiatry, and 47% regarded themselves as \u27self-taught\u27. The majority felt that current training was inadequate with a need for more structure and time spent on attachments, less geographical variation, more training at undergraduate level and throughout other specialties and better collaboration with psychiatry. Discussion this is the first survey of the views of geriatricians leading on dementia care in acute hospitals within the UK. It gives a useful insight into how they have gained their own experience, and their opinions on how training may be improved. Equipped with the right training and expertise in diagnosis and management of dementia perhaps geriatricians may feel more confident in taking a lead in dementia care
Plasma alkaline phosphatase is elevated in Alzheimer\u27s disease and inversely correlates with cognitive function
No full textAlkaline phosphatase is present on neuronal membranes and plasma alkaline phosphatase activity increases in brain injury and cerebrovascular disease, suggesting that plasma alkaline phosphatase may partly reflect neuronal loss. As neuronal loss occurs in Alzheimer\u27s disease (AD), we hypothesised that alterations in plasma alkaline phosphatase activity may correlate with cognitive impairment. Plasma alkaline phosphatase activity was measured in the longitudinal Oxford Project to Investigate Memory and Aging (OPTIMA) cohort (121 AD patients, 89 mild cognitive impairment (MCI) patients and 180 control subjects). Plasma alkaline phosphatase activity was significantly higher in the AD patients relative to the controls (p<0.001). In the MCI patients, plasma alkaline phosphatase was at a level in between that seen in control and AD subjects, consistent with the clinical status of this group. Furthermore, plasma alkaline phosphatase activity inversely correlated with cognitive function (assessed by the Cambridge Examination for Mental Disorders (CAMC0G)) in controls (z= −2.21 p=0.027), MCI (z= −2.49, p=0.013) and AD patients (z= −3.61, p=0.0003). These data indicate that plasma alkaline phosphatase activity is increased in AD and inversely correlates with cognitive function regardless of diagnostic status
Experience and opinions on post-graduate dementia training in the UK: A survey of selected consultant geriatricians
No full textIntroduction: People with dementia are more likely to come into contact with a geriatrician than any other hospital specialty. Whilst it is known that there are some geriatricians with a special interest in dementia, it is unclear how this group of clinicians gained experience, and what their opinions are on current training. Methods: We obtained a list of geriatricians known to have an interest in dementia care (known as dementia champions) from the British Geriatric Society Dementia and Similar Disorders Special Interest Group. We contacted 100 'dementia champions' with an invitation to respond to a questionnaire relating to their role, experience and opinions on current training in dementia within geriatric medicine. Results: Fifty-five geriatricians responded. Ninety-one per cent were consultant physicians, and 71% were not involved in outpatient diagnostic services. Fifty-six per cent reported that their experience was via clinical attachments with old age psychiatry, and 47% regarded themselves as 'self-taught'. The majority felt that current training was inadequate with a need for more structure and time spent on attachments, less geographical variation, more training at undergraduate level and throughout other specialties and better collaboration with psychiatry. Discussion: This is the first survey of the views of geriatricians leading on dementia care in acute hospitals within the UK. It gives a useful insight into how they have gained their own experience, and their opinions on how training may be improved. Equipped with the right training and expertise in diagnosis and management of dementia perhaps geriatricians may feel more confident in taking a lead in dementia care. 
Inpatient-level care at home delivered by virtual wards and hospital at home: a systematic review and meta-analysis of complex interventions and their components
No full textUsing scores from the 4AT delirium detection tool as an indicator of possible dementia: a study of 75 221 older adult hospital admissions.
No full textINTRODUCTION: Overall dementia diagnosis rates are substantially below true rates. Hospital admissions of older people involve cognitive and functional assessments relevant to dementia diagnosis. These assessments could be harnessed to contribute to identifying patients for further assessment. Yet relationships of inpatient cognitive tests with known dementia are unclear. The 4AT (www.the4AT.com) assesses for delirium (Scores 4-12) and also cognitive impairment via embedded cognitive tests (Scores 1-3). We investigated relationships between 4AT scores and clinical dementia diagnoses. METHODS: We included participants aged ≥65 years admitted as a medical emergency to three hospitals from 4 January 2016 to 4 January 2020, who had the 4AT performed on admission. Clinical dementia diagnosis was ascertained from linked primary care, hospital discharge and community prescribing data. RESULTS: Of 75 221 admissions, 62 188 (82.7%; 33 625 unique patients; mean age 80.2 years; 55.8% female) had a 4AT on admission. Of these, 9948 (16.0%) had a recorded clinical dementia diagnosis at the time of admission, with a further 1197 (1.9%) receiving a new diagnosis at discharge. Of admissions with dementia, 9669/11 145 (86.8%) had a 4AT score ≥1 on admission, compared to 14 994/51 043 (29.4%) without dementia.4AT ≥1 had a sensitivity of 0.87 (95% CI 0.86-0.87) and a specificity of 0.71 (0.70-0.71) in relation to clinical dementia diagnosis. 4AT ≥4 showed sensitivity of 0.50 (0.50-0.51) and a specificity of 0.88 (0.88-0.88). CONCLUSIONS: 4AT scores were associated with clinically diagnosed dementia. These results suggest that routinely collected 4AT scores could be leveraged in conjunction with other clinical indicators to identify patients with possible undiagnosed dementia who could undergo further inpatient diagnostic assessment and/or post-discharge specialist follow-up
Distinct cognitive phenotypes in Alzheimer\u27s disease in older people
No full textBackground: Alzheimer\u27s disease (AD) is considered to be a disorder predominantly affecting memory. It is increasingly recognized that the cognitive profile may be heterogeneous. We hypothesized that it would be possible to define distinct "cognitive phenotypes" in older people with AD. Methods: Participants from three individual studies were included, consisting of 109 patients with a diagnosis of probable AD, and 91 age-and gender-matched control participants. All had demographic and cognitive assessment data available, including the Cambridge Cognitive Examination of the Elderly (CAMCOG). The CAMCOG scores and sub-scores were further analyzed using hierarchical cluster analysis and factor analysis. Results: Three clusters were identified. The scores loaded onto three factors representing the domains of attention, praxis, calculation, and perception; memory; and language comprehension and executive function. The main difference between the clusters related to degree of memory impairment. The composite score for memory between the clusters remained significantly different despite adjustment for illness duration and age of onset (p < 0.001). Conclusions: These data suggest clinical heterogeneity within an older group of people with AD. This may have implications for diagnosis, prognosis, response to currently available treatments, and the development of novel therapies
Cognitive phenotypes in Alzheimer\u27s disease and genetic variants in <em>ACE</em> and <em>IDE</em>
No full textAlzheimer\u27s disease (AD) is generally considered to be a disorder primarily affecting memory. It is increasingly recognized that the clinical presentation or “cognitive phenotype” is variable. The apolipoprotein E ε4 (APOE ε4) allele has been associated with an amnestic presentation, but does not appear to fully explain the high prevalence of family history within this group. We examined polymorphisms in the genes ACE and IDE in relation to cognitive phenotype. In this study 276 participants with AD were categorized into 1 of 4 cognitive phenotype classifications: typical, amnestic, language, and posterior. Family history and possession of the APOE ε4 allele were most prevalent in the amnestic group. Of the 10 genetic variants of IDE, and the 3 genetic variants of ACE studied, only ACErs4291 and ACErs1800764 were nominally associated with the amnestic presentation
The association between delirium and falls in older adults in the community: a systematic review and meta-analysis
No full text\ua9 The Author(s) 2024. Published by Oxford University Press on behalf of the British Geriatrics Society. OBJECTIVE: Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years. METHODS: We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle-Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis. RESULTS: We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns. CONCLUSIONS: We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations
