Psychological and Functional Impact of COVID-19 in Long-Term Care Facilities: The COVID-A Study.

OBJECTIVE: To analyze the psychological and functional sequelae of the COVID-19 pandemic among older adults living in long term care facilities (LTCFs). DESIGN: Cohort longitudinal study SETTING ANT PARTICIPANTS: A total of 215 residents ≥ 65 years without moderate-to-severe cognitive impairment, living in five LTCFs in Albacete (Spain). MEASUREMENTS: Baseline on-site data were collected between March - June 2020 and three-month follow-up between June to September 2020. Symptoms of depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disturbances were measured as psychological variables. Disability in basic activities of daily living (BADL), ambulation and frailty were assessed as functional variables. Differences were analyzed in relation to level of comorbidity and test positivity for COVID-19. RESULTS: At baseline, residents with COVID-19 presented worse functionality, higher frailty levels and malnutrition risk compared to non-COVID-19 residents. At three-month follow-up, higher rates of clinically significant depressive symptoms (57.7%), anxiety symptoms (29.3%), PTSD symptoms (19.1%) and sleep disturbances (93.0%) were found among residents regardless of COVID status. Thus, among 215 residents, 101 (47%) experienced a decline in BADL from baseline to the 3-month follow-up (median functional loss = 5 points in Barthel Index). In multivariate analyses, COVID-19 status did not explain either the functional or the ambulation loss. By contrast, residents with low comorbidity and COVID-19 presented higher PTSD symptoms (effect 2.58; 95% CI 0.93 to 4.23) and anxiety symptoms (effect 2.10; 95% CI 0.48 to 3.73) compared to the low comorbidity/non-COVID19 group. CONCLUSION: COVID-19 pandemic was associated, after three-months, with high psychological impact in older adults in LTCFs., specifically with higher post-traumatic stress and anxiety symptoms. Functional decline did not differ in relation to COVID-19 status but could be related to isolation strategies used for pandemic control.

Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial.

OBJECTIVES: To compare the benefits of a short-term occupational therapy intervention (OTI) when added to the conventional treatment model (CTM) in the functional recovery of patients admitted to an acute geriatric unit (AGU). STUDY DESIGN: Non-pharmacological randomized clinical trial. 400 patients were randomized to OTI (n = 198) or CTM (n = 202) group. Mean age 83.5. Interventions included needs assessment, iatrogenic prevention, retraining in activities of daily living, and instructions for caregivers in three groups of patients defined a priori (cardiopulmonary disease, stroke, other conditions) 5 days a week, 30-45 min a day. MAIN OUTCOME MEASURE: Recovery of ≥ 10 Barthel index points by discharge. Secondary outcome was the reduction in confusional episodes. RESULTS: The adjusted relative risk (RR) of functional recovery in the OTI group was 1.16 (95%CI 0.91-1.47). In participants with cardiopulmonary disease was 1.57 (95%CI 1.06-2.32), number needed to treat (NNT) 5. Participants with other conditions assigned to OTI had a reduction in acute confusional episodes; RR 0.48 (95% CI 0.26-0.87), NNT 7. CONCLUSIONS: Although overall there were no significant differences, patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU, may benefit from a short-term OTI.

Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete / Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study

IntroducciónLa aterosclerosis subclínica se ha asociado con morbimortalidad cardiovascular, pero no se ha analizado su relación con limitación funcional como antesala de la discapacidad.Material y métodosEstudio longitudinal sobre 171 mayores de 64 años con alto nivel funcional. Edad media 73,7 años, 110 mujeres. Se les realizó eco-Doppler carotídeo al inicio del estudio determinando la presencia de placas y la suma del diámetro axial máximo de todas las placas (SDP) y fueron seguidos 12 meses. Analizamos la asociación entre aterosclerosis subclínica y limitación funcional valorada con el timed up and go (TUG) al año, ajustada por covariables sociodemográficas, funcionales, afectivas, cognitivas y factores de riesgo cardiovascular.ResultadosTreinta y siete sujetos (21,6%) realizaron el TUG un 20% más lentamente al año que al inicio, 30 con placa (30,7%) y 7 sin placa (9,5%) (p=0,001). Aquellos con placa tuvieron un mayor riesgo ajustado de enlentecer el TUG más del 20% que aquéllos sin placa (OR: 5,8; IC del 95%: 2,2–15,8). Los que enlentecieron el TUG más del 20% tuvieron una SDP 1,48mm mayor (3,34 vs. 1,85; IC del 95%: 0,52–2,44). Por cada aumento de 2mm en la SDP, los sujetos tuvieron un riesgo ajustado 1,9 veces mayor de realizar el TUG más lentamente al año (IC del 95%: 1,4–2,5).ConclusiónLa aterosclerosis subclínica es un predictor independiente de limitación funcional al año en ancianos con alto nivel funcional(AU)

IntroductionSubclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined.Material and methodsA longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables.ResultsAt 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2–15.8]. SDP was 1.48mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52–2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4–2.5].ConclusionSubclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults(AU)

Cardiovascular risk factors are associated with subclinical atherosclerosis in high functioning older adults.

BACKGROUND: The prevalence of subclinical atherosclerosis and its relationship with cardiovascular risk factors (CVRFs) is not well known in high functioning older adults. These data can help to decide if the implementation of preventive measures is necessary in this population. OBJECTIVE: To determine the prevalence and progression of subclinical atherosclerosis in high functioning older adults, the relationship between subclinical atherosclerosis and CVRFs, and the influence of the CVRFs on subclinical atherosclerosis progression. METHODS: Longitudinal cohort study. 246 high functioning older adults without clinical atherosclerotic disease. All subjects underwent carotid Doppler ultrasound at entry and 176 at 24 months. RESULTS: Plaque was observed in 146 (59.3%) subjects at baseline. CVRFs showed a linear relationship to the presence of plaque: plaque was observed in 32% of subjects with no CVRFs, 54.2% with 1 factor, 61.6% with 2 factors, and 69.3% with 3 or more (p=.001). Only hypertension was independently associated with the presence of plaque (OR 2.0; 95% CI 1.2-3.6; p=.013), adjusted for CVRFs. At 24 months, new plaque was observed in 20 (11.4%) subjects and carotid intima-media thickness had increased 0.02 mm per year. Subjects with plaque at baseline had a higher risk of greater total carotid plaque diameter at 2 years (OR 58.0; 95% CI, 19.7-170.5; p<.001), adjusted for all other CVRFs. CONCLUSIONS: Subclinical atherosclerosis is common in high functioning older adults and is associated with the classic CVRFs. Controlling these factors could be helpful in reducing atherosclerosis in older patients.

[Subclinial atherosclerosis as a predictor of functional limitation at one year in high-functioning older adults: the Albacete study]. / Aterosclerosis subclínica, un predictor de limitación funcional al año en ancianos con alto nivel funcional: estudio Albacete.

INTRODUCTION: Subclinical atherosclerosis is associated with cardiovascular morbidity and mortality, but its relationship with functional limitation as a precursor of disability has not been determined. MATERIAL AND METHODS: A longitudinal cohort study was performed in 171 high-functioning community-dwelling adults aged more than 64 years old (mean age 73.7 years, 110 women). All received a carotid ultrasound examination at the beginning of the study. Subclinical atherosclerosis was determined by the presence or absence of atherosclerotic plaques and the sum of the diameters of all the plaques (SDP) in the carotid bilateral tree. Subjects were followed-up at 12 months. The association between subclinical atherosclerosis and functional limitation was assessed with the Timed Up and Go test (TUG) at entry and at 1 year, adjusted by demographic, functional, affective, cognitive and cardiovascular risk factors as covariables. RESULTS: At 1 year after baseline, 37 subjects (21.6%) performed the TUG 20% more slowly: 30 with plaque (30.7%) and seven without plaque (9.5%) (p=0.001). Those with plaque had an adjusted increased risk of performing the TUG 20% more slowly than those without plaque [OR 5.5, 95% CI 2.2-15.8]. SDP was 1.48 mm greater in subjects with more than 20% slowing on the TUG [3.34 vs 1.85; 95% CI 0.52-2.44]. For each 2-mm increment in the SDP, subjects had a 1.9-fold greater adjusted risk of performing the TUG 20% more slowly at 1 year [95% CI 1.4-2.5]. CONCLUSION: Subclinical atherosclerosis is an independent predictor of functional limitation at 1 year in high-functioning older adults.

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU9

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU)

Differentiation between mild cognitive impairment and Alzheimer's disease using the FMLL mini-battery.

AIM: To construct and validate a mini-battery to discriminate between Alzheimer's disease (AD) and mild cognitive impairment (MCI) in patients seen at a hospital memory clinic. METHODS: In a cohort of 310 subjects (137 with MCI and 173 with AD), the area under the receiver operating curve (AUC) was used to select the neuropsychologic diagnostic test battery subtests with the best overall performance, namely, the Mini-Mental State Examination (MMSE, 0.715), Logical Memory II (LMII, 0.721), Verbal Fluency Test (0.747), and Lawton index (0.742). A mini-battery test was constructed with the following formulation: FMLL = [(Fluency Test/17 + MMSE/30 + LMII/32 + Lawton/8)/4] x 100. Another cohort of 87 subjects with MCI and 100 with AD was used to validate the mini-battery and to calculate the psychometric properties. RESULTS: The concurrent validity with Reisberg's Global Deterioration Scale was r = 0.792 (p < 0.001). Cronbach's alpha internal consistency was 0.6358. The AUC to diagnose MCI or AD was 0.879 (95% CI: 0.832-0.927; p < 0.001). Specificity for MCI diagnosis was 0.9 when FMLL scores were above 59% and 1 when scores were above 76%. CONCLUSION: The FMLL mini-examination is a useful tool to differentiate between MCI and AD in patients seen in a memory clinic.

[Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease]. / Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer.

INTRODUCTION: To describe the neuropsychiatric symptoms (NPS) in elderly patients with either mild cognitive impairment (MCI) or Alzheimer's disease (AD) and their relevance in the differential diagnosis between the two entities. MATERIAL AND METHODS: A total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities. RESULTS: Sixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4-5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3-18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3-4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5-6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7-23.4; p<0.01). CONCLUSIONS: NPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities.