Delirium in older people after proximal femoral fracture repair: role of a preoperative screening cognitive test.

OBJECTIVE: Preoperative cognitive impairment has been identified as a major risk factor for postoperative delirium in older people. The aim of this study was to evaluate whether a validated and rapid screening cognitive test - COgnitive Disorder EXamination (CODEX) - performed preoperatively before proximal femoral fracture repair, was associated with a risk of postoperative delirium. STUDY DESIGN: We performed an observational prospective cohort study in orthopedic surgery department of a French hospital. PATIENTS: We included patients aged 70years or older undergoing proximal femoral fracture repair and who were free of known dementia and delirium at the preoperative phase. METHODS: Before surgery, the anesthesiologist realized the CODEX based on three-word recall test, simplified clock drawing and if one of these tasks was abnormal, spatial orientation was assessed. Delirium was routinely sought on postoperative day 3 (D3) using the Confusion Assessment Method by the geriatrician. RESULTS: Among the 52 included patients, seven (13.5%) had delirium on D3. All seven patients were among the 25 patients with abnormal CODEX results. None of the 27 patients with normal CODEX results had postoperative delirium. Abnormal CODEX was significantly associated with the risk of postoperative delirium in univariate analysis and after adjustment for age (odds ratio [OR]: 13.33; 95% confidence interval, [95%CI]: 1.85±∞; P<0.003). CONCLUSION: Abnormal preoperative rapid screening test CODEX is independently associated with postoperative delirium in older people undergoing hip fracture surgery and free of known dementia.

Neuropsychiatric symptoms in elderly inpatients: a multicenter cross-sectional study.

BACKGROUND/AIMS: We determined the prevalence of neuropsychiatric symptoms in geriatric rehabilitation patients to compare neuropsychiatric symptoms between patients with and without dementia, and to evaluate associations linking severity of cognitive impairment and neuropsychiatric symptoms. METHODS: In February 2009, we studied patients aged 75 years or older who had been admitted to four geriatric rehabilitation units in the Paris area. The twelve Neuropsychiatric Inventory items and four neuropsychiatric subsyndromes defined by the European Alzheimer's Disease Consortium were evaluated. RESULTS: Of the 194 patients, 149 (76.8%) had dementia, and 154 (79.4%) had exhibited at least one neuropsychiatric symptom during the past week. Agitation was the most common neuropsychiatric symptom in the group with dementia (36.9%) and depression in the group without dementia (35.6%). The dementia group had significantly higher prevalences of hyperactivity (p < 0.001) and delusions (p = 0.01) than the non-dementia group. In the dementia group, severity of cognitive impairment was associated with hyperactivity (p = 0.01) and psychosis (p = 0.02). CONCLUSION: The prevalence of neuropsychiatric symptoms among geriatric rehabilitation patients was high but not higher than in elderly outpatients.

[Status epilepticus in the elderly patients. A retrospective study of 63 in-patients]. / Etat de mal épileptique de la personne âgée. Etude rétrospective de 63 patients hospitalisés.

INTRODUCTION: Status epilepticus is quite frequent in the elderly but rarely studied despite the poor functional prognosis and significant mortality. METHODS: We retrospectively evaluated the clinical manifestations and electroencephalogram findings observed over a two-year period in 63 consecutive inpatients aged over 70 years presenting status epilepticus. The variables studied included age, sex, the number of concomitant chronic active diseases, previous neurological disorders, brain lesions on CT or MRI, the use and withdrawal of medications and outcome. RESULTS: The incidence of status epilepticus was 1%; two-thirds in women and one-third in men. The mean age was 83 years. Complex partial status epilepticus was noted in 91% with predominant features of confusion (89%), impairment of consciousness (75%) or psychiatric symptoms (46%). Etiologies were often multifactorial and acute symptomatic. Etiology was metabolic in 60%, drug-induced in 51%, demential in 44%, cerebrovascular in 37%, infectious in 30% and other neurological disorders in 28% of the cases. Antiepileptic drugs used to treat status epilepticus were benzodiazepine (60%), often in association with lamotrigine (51%), valproate (46%) or phenytoin (25%). Maintenance of an antiepileptic drug was found in 70% of cases. Complications were loss of autonomy (86%), malnutrition (67%), infections (51%), dementia (30%), pressure sores (14%), and recurrent epilepsy (13%). Mortality was 32% of cases and it was higher in men. CONCLUSION: These findings have shown some special features of status epilepticus among the elderly but other prospective studies are needed to confirm these results and to identify optimal management to decrease mortality, and improve the poor functional prognosis.

[The establishment of geriatric intervention group and geriatric assessment at emergency of Henri-Mondor hospital]. / Mise en place de l'équipe d'intervention gériatrique et de l'évaluation gériatrique aux urgences de l'hôpital Henri-Mondor.

BACKGROUND: The official French demographic previsions are a growing number of the older than 75 years elderly people. The Emergency services face this demographic evolution. We describe the establishment of the geriatric intervention group at the emergency of the Henri-Mondor university hospital at Creteil (France) and analyse the results of the geriatric assessment at the short unit care during the first four months. METHODS: We analysed the results of the geriatric assessment of 206 patients during the first four months, by considering the final unit care. The geriatric assessment evaluates functional abilities, cognitive status and thymic function with elderly people validated tests and subjective assessment of nutrition status and the sensorial functions. RESULTS: The statistical analysis of the geriatric assessment results was significant among the different hospitalized groups of patients, for the cognitive status, the nutritional risk and the walk and standing evaluation. CONCLUSION: The results of the geriatric assessment at emergency showed cognitive impairment and gait abnormality in elderly patients were at risk of hospitalization.