Clinical features of mild cognitive impairment differ in the research and tertiary clinic settings.

OBJECTIVE: Comparative analysis of subjects with mild cognitive impairment (MCI) diagnosed in a primary research setting and those seen in a tertiary care memory disorders clinic. METHODS: Subjects who received a diagnosis of MCI between July 1, 2005, and December 31, 2006, in a longitudinal research study of normal cognition (n = 48) and patients diagnosed in a tertiary care referral clinic (n = 34) were evaluated using similar methodologies. Comparative analyses of detailed medical, neurological and neuropsychological data are presented. RESULTS: The diagnosis of MCI was not accepted by 13 of 48 subjects (27%) classified as MCI in the primary research setting. Nondegenerative, potentially treatable causes of cognitive decline were found in 3 of 34 subjects (9%) seen in the tertiary referral clinic and in 11 of 35 subjects (31%) identified as MCI in the primary research setting (p = 0.02, Fisher's exact test). MCI subjects identified in the primary research setting were older than those referred to the memory clinic (mean +/- SD, 79.7 +/- 7.0 vs. 71.5 +/- 9.0 years, p < 0.0001, t test) and had more years of education (16.0 +/- 3.2 vs. 13.6 +/- 4.2 years, p < 0.01, t test). MCI subjects in the primary research setting appeared to be in a milder stage of disease, characterized by higher Mini-Mental State Examination scores (28.2 +/- 1.8 vs. 25.7 +/- 1.8, p < 0.0001), and a tendency towards single domain involvement, predominantly memory (mean number of domains involved, 1.0 vs. 2.5, p < 0.0001). More advanced stages of MCI, seen in the tertiary referral population, had additional involvement of attention (p < 0.0001, Fisher's exact test) and visuospatial domains (p < 0.0002, Fisher's exact test). Semiquantitative grading of hippocampal and medial temporal lobe atrophy did not differ between groups (p = 0.81, Mann-Whitney U test). CONCLUSIONS: The diagnosis of MCI may be unwelcome in naïve persons. Remedial causes of MCI should be actively investigated. Demographic and clinical characteristics of MCI differ between research subjects and patients referred to a tertiary care clinic.

Nutritional assessment in the elderly: biochemical analyses.

OBJECTIVE: To describe briefly the anthropometric, biochemical, clinical, and dietary components of a complete nutritional assessment and to examine four common nutritional concerns in the elderly and the biochemical tests that aid in the identification and treatment of these disorders. DATA SOURCES: Clinical expertise/practice, recent professional journals, and textbooks. STUDY SELECTION: Not applicable. DATA EXTRACTION: Clinical practice and literature review. DATA SYNTHESIS: Biochemical assays are one aspect of a complete nutritional assessment that provides valuable information in the determination of an individual's nutritional status and the identification of any nutrient deficiencies or excesses. As part of this nutritional assessment, specific biochemical tests are ordered to substantiate further or to rule out nutrient deficiencies or excesses gleaned from the clinical, dietary, and anthropometric components of the complete nutritional assessment. CONCLUSION: Given the increased potential for nutritional problems in the elderly, a comprehensive nutritional assessment should be performed as a routine part of elderly care. This assessment includes anthropometric measurements, biochemical assays, a clinical examination for signs of deficiencies or excesses, and a complete dietary evaluation to determine current intake and make necessary recommendations.

Case report of zinc deficiency in an elderly woman.

Zinc deficiency is not an uncommon nutritional disorder in the elderly. It should be suspected in patients who have conditions associated with zinc deficiency (Table 1) or who have one of the potential causes of zinc deficiency (Table 2). A low serum-zinc level indicates zinc deficiency unless an acute phase response is present. The acute-phase response should be suspected in a patient with an acute illness. A C-reactive protein level is helpful in identifying the acute-phase response. Our initial treatment of zinc deficiency centers on increasing dietary zinc. Often, however, because of other common problems of geriatric patients such as dementia or depression, the patient is unable to alter his or her diet. Then, zinc supplementation may be required. Copper, iron, and lipoprotein status should be monitored if long-term zinc supplementation is needed because they may be effected by the zinc supplementation.

Evaluating fire safety in older persons through home visits.

The evaluate elders' risk factors for fire injury, we performed in-home assessments on our Geriatric Clinic clients. Nearly two-thirds of the subjects had physical impairments that could compromise escaping a fire. Fire safety equipment often was suboptimal. Nearly three-fourths of our subjects were not worried about fire injury, yet all had at least one fire injury risk factor. Fire safety knowledge was poor. Apathy was common, with fewer than one-third of our subjects complying with our recommendations.