Characterizing the long-term cognitive impairment following delirium episodes: A call to action.

The possible link between delirium and a long-term cognitive impairment is significant for patients, carers, and clinicians. To make progress, we need urgently novel advances in understanding the neural substrates underlying this cognitive impairment and any accompanying behavioral symptoms.

Follow-up services for delirium after COVID-19-where now?

Delirium is a common presentation in older inpatients with coronavirus disease 2019 (COVID-19), and a risk factor for cognitive decline at discharge. The glaring gaps in the service provision in delirium care, regardless of aetiology, after a hospital admission pre-existed the pandemic, but the pandemic arguably offers an opportunity now to address them. Whilst a delirium episode in itself is not a long-term condition, the context of it may well be, and therefore patients might benefit from personalised care and support planning. There is no reason to believe that the delirium following COVID-19 is fundamentally different from any other delirium. We propose that the needs of older patients who have experienced delirium including from COVID-19 could be addressed through a new model of post-acute delirium care that combines early supported discharge, including discharge-to-assess, with community-based follow-up to assess for persistent delirium and early new long-term cognitive impairment. Such a drive could be structurally integrated with existing memory clinic services. To succeed, such an ambition has to be flexible, adaptable and person-centred. To understand the impact on resource and service utilisation, techniques of quality improvement should be implemented, and appropriate metrics reflecting both process and outcome will be essential to underpin robust and sustainable business cases to support implementation of delirium care as a long-term solution.

The two cultures of health and social care might perhaps be brought together by assets.

Arguably, there are two sides to the frailty "coin," with only one culture dominated by deficits. Certainly, as cells age, they develop deficits as a result of the accumulation of unrepaired cellular and molecular damage; however, the factors that make people well or healthy are important in defending against deficits and building up resilience, and need to be routinely discussed with patients. I argue that all health and social care professionals should feel confident in exploring assets or more "positive aspects" of living, and this common language could even drive integration between person-centered services.

The need for specialist nurses in dementia care.

Abstract Rahman S, Harrison Dening K (2016) The need for specialist nurses in Dementia awareness is on the increase but, in many cases, tangible improvements in care are yet to be seen. As specialist nurse roles have improved patient care and outcomes in other specialties--most notably cancer care--this article looks at their impact and asks whether there is a need for such roles in dementia care, to what extent patient and carer experiences might be improved, and how health and social care might come together with policy makers and third-sector organisations to secure positive change.

Quality of life in Parkinson's disease: the relative importance of the symptoms.

A body of literature now exists, which demonstrates that idiopathic Parkinson's disease (PD) has a major negative impact on quality of life (QoL), and that depression and cognitive impairment are among the main predictors of poor QoL in this disorder. Relatively little work has been done to assess the differential contribution of the specific symptoms of PD to QoL, which was the aim of this study. One hundred thirty patients with PD completed a booklet of questionnaires, which included the PDQ39 as a disease-specific measure of QoL, a symptom checklist, a mobility checklist, as well as patient ratings of disease stage and disability. The results indicated that the contribution of physical, medication-related, and cognitive/psychiatric symptoms to QoL can be significant. Sudden unpredictable on/off states, difficulty in dressing, difficulty in walking, falls, depression, and confusion were PD symptoms, which significantly influenced QoL scores. Among the mobility problems associated with PD, start hesitation, shuffling gait, freezing, festination, propulsion, and difficulty in turning had a significant effect on QoL scores. In addition to depression and anxiety, the major predictors of QoL were shuffling, difficulty turning, falls, difficulty in dressing, fatigue, confusion, autonomic disturbance particularly urinary incontinence, unpredictable on/off fluctuations, and sensory symptoms such as pain. The implications of these results for the medical management of PD are discussed.

Methylphenidate ('Ritalin') can ameliorate abnormal risk-taking behavior in the frontal variant of frontotemporal dementia.

The frontal variant of frontotemporal dementia is a significant neurological condition worldwide. There exist few treatments available for the cognitive and behavioural sequelae of fvFTD. Previous research has shown that these patients display risky decision-making, and numerous studies have now demonstrated pathology affecting the orbitofrontal cortex. The present study uses a within-subjects, double-blind, placebo-controlled procedure to investigate the effects of a single dose of methylphenidate (40 mg) upon a range of different cognitive processes including those assessing prefrontal cortex integrity. Methylphenidate was effective in 'normalizing' the decision-making behavior of patients, such that they became less risk taking on medication, although there were no significant effects on other aspects of cognitive function, including working memory, attentional set shifting, and reversal learning. Moreover, there was an absence of the normal subjective and autonomic responses to methylphenidate seen in elderly subjects. The results are discussed in terms of the 'somatic marker' hypothesis of impaired decision-making following orbitofrontal dysfunction.

Associative and recognition memory for novel objects in dementia: implications for diagnosis.

It has been demonstrated that patients with dementia of the Alzheimer's type show particular difficulties with a task that measures memory for object locations [R. Swainson et al. (2001) Dement. Geriatr. Cogn. Disord. 12, 265-80]. The present study followed on from this report by asking whether the deficits seen in dementia of the Alzheimer's type were specific to this condition, or whether they would also be seen in another common neurodegenerative syndrome, frontotemporal dementia. To investigate this important issue, we examined memory for object-location pairs and visual recognition memory for novel patterns using two tests, the Paired Associates Learning and Matching to Sample tasks, from the Cambridge Neuropsychological Testing Automated Battery. The performance of a subset of the patients with dementia of the Alzheimer's type described by Swainson et al., selected on the basis of age and education, was compared with matched groups of frontal variant frontotemporal dementia, semantic dementia and control subjects. In contrast to the patients with dementia of the Alzheimer's type, who showed significant impairment on both memory tests, the two frontotemporal dementia groups did not perform significantly poorer compared with control subjects on nearly all memory measures, other than 'memory score' from the paired associates learning task. These findings confirm that tests of episodic memory, especially for the location of objects in space, may be useful in the early diagnosis and differentiation of dementia of the Alzheimer's type.