Screening Positive for Cognitive Impairment: Impact on Healthcare Utilization and Provider Action in Primary and Specialty Care Practices.

BACKGROUND: Alzheimer's disease, the most common cause of dementia, goes unrecognized in half of patients presenting to healthcare providers and is associated with increased acute care utilization. Routine cognitive screening of older adults in healthcare settings could improve rates of dementia diagnosis and patterns of healthcare utilization. OBJECTIVE: To evaluate the impact of screening positive for cognitive impairment on provider action in primary and specialty care practices and patient healthcare utilization. DESIGN: Individuals asymptomatic for cognitive impairment completed cognitive screening with the Mini-Cog (MC). Outcomes included MC screen-positive rates, provider follow-up actions, and healthcare utilization for all participants over a period of 36 months (18 months prior to and following MC screening). Data were extracted from the electronic medical record (EMR). Healthcare provider interventions and healthcare utilization for screen-positive and -negative groups, before and after screening, were compared. PARTICIPANTS: Primary and specialty care patients (n = 787) aged ≥ 65 without history of cognitive impairment seen in HealthPartners, an integrated healthcare system in Minnesota and Western Wisconsin. KEY RESULTS: In primary care and neurology practices combined, over the entire 36-month study window, individuals screening positive showed 32% higher rates of ED visits (p < 0.05) pre and post-screening compared to those screening negative. Screen positive also showed 39% higher rates of hospitalizations pre-screening (p < 0.05) and 58% higher rates post-screening (p < 0.01). While screen-detected cognitive impairment was associated with some relevant provider follow-up action in 32% of individuals, subsequent healthcare utilization did not change between the 18-month pre- and post-screening periods. CONCLUSION: Despite being associated with higher rates of healthcare utilization, screening positive on the MC led to a change in provider action in a minority of cases and did not reduce post-screening healthcare utilization. Screening for cognitive impairment alone is not sufficient to alter patterns of provider practice or patient healthcare utilization.

Human lipocalin-1 association with 3H-testosterone and 3H-estradiol.

PURPOSE: Topical androgens and estrogens have been studied for use in treating ocular conditions such as dry eye. The aim of this study was to identify proteins from normal human tears that associated with exogenously added sex steroid hormones. One of the major proteins in ocular tears is lipocalin-1. It binds a variety of lipids and other hydrophobic molecules and is proposed to function as a carrier protein or a lipid scavenger. METHODS: Normal human tears were incubated with (3)H-testosterone or (3)H-estradiol. Labeled tear proteins were separated on a Q Sepharose Fast Flow (QFF) Hi Trap strong anion exchange column with a step gradient of NaCl. (3)H-testosterone or (3)H-estradiol was measured in aliquots of eluted fractions using scintillation counts, and the remainder of each sample was gel electrophoresed and silver stained. In separate experiments, (3)H-steroid-labeled tear proteins were electrophoresed in 15% polyacrylamide gels and excised from the gels. Tritium content of the proteins was measured in a scintillation counter. Immunoblots with antibodies to lipocalin-1 verified the migration of lipocalin-1 in the gels. RESULTS: (3)H-steroid labeled tear proteins were found in the 0.15 M NaCl fractions of QFF strong anion exchange columns. 18 kD lipocalin-1 (among other tear proteins) eluted in the 0.15 M NaCl fraction. Excision of labeled tear proteins from 15% polyacrylamide gels indicated that radioactive label was associated with an 18 kD protein. Immunoblots verified that lipocalin-1 migrated as an 18 kD protein. CONCLUSIONS: The sex steroid hormones testosterone and estradiol associated with 18 kD lipocalin-1 in human tears.

Antibodies to endogenous tear protein in normal human tears.

PURPOSE: To identify endogenous tear proteins immunoselected by antibodies from normal human ocular tears. MATERIALS AND METHODS: Proteins were immunoselected from normal human tear samples without the addition of primary antibodies. Captured proteins were electrophoresed in polyacrylamide gels and silver stained. Human tears were also used as primary antibodies on immunoblots of tear proteins. RESULTS: Lysozyme, lipocalin-1, and lactoferrin were immunoselected from normal human tear samples without the addition of primary antibodies. Antibodies from normal tears recognized lysozyme on immunoblots of tear proteins. CONCLUSION: Normal human ocular tears contain antibodies to endogenous tear protein.

Secretoglobins: lacrimal gland-specific rabbit lipophilin mRNAs.

PURPOSE: RNAs encoding secretoglobin subunits, also known as lipophilins, are found in rabbit lacrimal glands. Some secretoglobins in other species are tissue- and/or sex-specific, whereas other secretoglobins are expressed in a variety of tissues of both sexes. In this study the tissue-specific and sexual dimorphic expression patterns of rabbit lacrimal gland lipophilins AL, AL2, BL, CL, and CL2 were determined. METHODS: RNAs from male and female rabbit lacrimal glands were compared in a differential display analysis, and a new rabbit lacrimal gland secretoglobin, lipophilin AL2, was identified. Next, RNAs from male and female rabbit harderian, lacrimal, mandibular, sublingual, and parotid glands and from liver, kidney, pancreas, testis (male), ovary, and mammary gland (female) were isolated, electrophoresed in agarose gels, and transferred to nylon membranes. cDNA probes encoding the lipophilins AL, AL2, BL, and CL/CL2 were hybridized to the RNA in the blots. RESULTS: Rabbit mRNAs encoding the lipophilins AL, AL2, BL, CL, and CL2 were detected only in the lacrimal gland. Lipophilin AL2 mRNA was detected only in male rabbit lacrimal gland. CONCLUSIONS: In the rabbit, several lipophilins were expressed only in the lacrimal gland.