Attention, vigilance, and visuospatial function in hospitalized elderly medical patients: relationship to delirium syndromal status and motor subtype profile

ABSTRACTBackground:The early and effective detection of neurocognitive disorders poses a key diagnostic challenge. We examined performance on common cognitive bedside tests according to differing delirium syndromal status and clinical (motor) subtypes in hospitalized elderly medical inpatients.Methods:A battery of nine bedside cognitive tests was performed on elderly medical inpatients with DSM-IV delirium, subsyndromal delirium (SSD), and no delirium (ND). Patients with delirium were compared according to clinical (motor) subtypes.Results:A total of 198 patients (mean age 79.14 ± 8.26) were assessed with full syndromal delirium (FSD: n = 110), SSD (n = 45), and ND (n = 43). Delirium status was not associated with differences in terms of gender distribution, age, or overall medication use. Dementia burden increased with greater delirium status. Overall, the ability to meaningfully engage with the tests varied from 59% for the Vigilance B test to 85% for Spatial Span Forward test and was lowest in patients with FSD, where engagement ranged from 32% for the Vigilance B test to 77% for the Spatial Span Forwards test. The ND group was distinguished from SSD group for the Months of the year backwards, Vigilance B, global VSP, Clock Drawing test, and Interlocking Pentagons test. The SSD group was distinguished from the FSD group by Vigilance A, Spatial Span Forward, and Spatial Span Backwards. Regarding differences among motor subtypes in terms of percentage engagement and performance, the No subtype group had higher ratings across all tests. Delirious patients with no subtype had significantly lower scores on the DRS-R98 than for the other three subtype categories.Conclusions:Simple bedside tests of attention, vigilance, and visuospatial ability are useful in distinguishing neurocognitive disorders, including SSD from other presentations.

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Attention, vigilance and visuospatial function in hospitalized elderly medical patients–relationship to delirium syndromal status and motor subtype profile

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.595 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S490-S490

Author(s):

C. Daly

Keyword(s):

Neurocognitive Disorders ◽

Cognitive Tests ◽

Medical Patients ◽

Diagnostic Challenge ◽

Clock Drawing Test ◽

Spatial Span ◽

Visuospatial Function ◽

Subsyndromal Delirium ◽

Function Test ◽

B Test

ObjectiveThe early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how nine bedside cognitive tests perform across the spectrum of delirium and motor subtypes.MethodsThe performance on a battery of nine bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neurocognitive disorder and in different motor subtypes of patients with delirium.ResultsOne hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test. The ability to engage with testing was higher for those in the no subtype group.ConclusionsSimple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

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Attention, Vigilance and Visuospatial Functioning in Hospitalised Elderly Medical Inpatients – Relationship to Delirium Syndromal Status and Motor Subtype Profile

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2243 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S232-S232

Author(s):

C. Daly

Keyword(s):

Cognitive Disorder ◽

Neurocognitive Disorders ◽

Cognitive Tests ◽

Diagnostic Challenge ◽

Spatial Span ◽

Visuospatial Function ◽

Subsyndromal Delirium ◽

Function Test ◽

Medical Inpatients ◽

B Test

ObjectiveThe early and efficacious detection of neurocognitive disorders poses a key diagnostic challenge. We examined how bedside cognitive tests perform across the spectrum of delirium and motor subtypes.MethodsThe performance on a battery of bedside cognitive tests were compared in elderly medical inpatients with DSM-IV delirium, subsyndromal delirium, and no neuro cognitive disorder and in motor subtypes.ResultsOne hundred and ninety-eight patients (mean age 79.14 ± 8.26) were assessed with no delirium (n = 43), subsyndromal delirium (n = 45), and full syndromal delirium (n = 110). The ability to meaningfully engage with the tests varied from 59% for vigilance B test to 85% for Spatial Span forward test and was found to be least in the full syndromal delirium group. The no delirium group was distinguished from the delirium groups for all the tests and from the full syndromal delirium group for the vigilance B test and global visuospatial function test. The subsyndromal delirium group differed from the full syndromal delirium group in respect of global visuospatial function test, spatial span backwards and vigilance A tests. Patients with full syndromal delirium were best identified using the interlocking pentagons test and clock drawing test whereas those with subsyndromal delirium were best identified using interlocking pentagons test and months backwards test. Those with subsyndromal delirium were significantly better in their ability to engage than those with full syndromal delirium.ConclusionsSimple bedside tests of attention, vigilance, and visuospatial ability are useful to help to distinguish neurocognitive disorders namely subsyndromal delirium from other presentations.Disclosure of interestThe author haS not supplied his/her declaration of competing interest.

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A pilot study of performance among hospitalised elderly patients on a novel test of visuospatial cognition: the letter and shape drawing (LSD) test

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2016.33 ◽

2016 ◽

Vol 34 (3) ◽

pp. 169-175 ◽

Cited By ~ 1

Author(s):

D. White ◽

O. A. Williams ◽

M. Leonard ◽

C. Exton ◽

D. Adamis ◽

...

Keyword(s):

Elderly Patients ◽

University Hospital ◽

Strong Positive Correlation ◽

Visuospatial Ability ◽

Visuospatial Function ◽

Conventional Tests ◽

Medical Inpatients ◽

Significant Impairment ◽

Bedside Tests ◽

Moca Score

ObjectivesConventional bedside tests of visuospatial function such as the clock drawing (CDT) and intersecting pentagons tests (IPT) are subject to considerable inconsistency in their delivery and interpretation. We compared performance on a novel test – the letter and shape drawing (LSD) test – with these conventional tests in hospitalised elderly patients.MethodsThe LSD, IPT, CDT and the Montreal Cognitive Assessment (MoCA) were performed in 40 acute elderly medical inpatients at University Hospital Limerick The correlation between these tests was examined as well as the accuracy of the visuospatial tests to identify significant cognitive impairment on the MoCA.ResultsThe patients (mean age 81.0±7.71; 21 female) had a median MoCA score of 15.5 (range=1–29). There was a strong, positive correlation between the LSD and both the CDT (r=0.56) and IPT (r=0.71). The correlation between the LSD and MoCA (r=0.91) was greater than for the CDT and IPT (both 0.67). The LSD correlated highly with all MoCA domains (ranging from 0.54 to 0.86) and especially for the domains of orientation (r=0.86), attention (0.81) and visuospatial function (r=0.73). Two or more errors on the LSD identified 90% (26/29) of those patients with MoCA scores of ⩽20, which was substantially higher than for the CDT (59%) and IPT (55%).ConclusionThe LSD is a novel test of visuospatial function that is brief, readily administered and easily interpreted. Performance correlates strongly with other tests of visuospatial ability, with favourable ability to identify patients with significant impairment of general cognition.

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Disease burden and unmet needs for prevention of venous thromboembolism in medically ill patients in Europe show underutilisation of preventive therapies

Thrombosis and Haemostasis ◽

10.1160/th11-03-0168 ◽

2011 ◽

Vol 106 (10) ◽

pp. 600-608 ◽

Cited By ~ 20

Author(s):

Sharon Welner ◽

Maria Kubin ◽

Kerstin Folkerts ◽

Sylvia Haas ◽

Hanane Khoury

Keyword(s):

Venous Thromboembolism ◽

Care Delivery ◽

Risk Groups ◽

Considerable Proportion ◽

Medical Illness ◽

Medical Patients ◽

Vte Prophylaxis ◽

Medically Ill ◽

Medical Inpatients ◽

Clear Identification

SummaryIt was the aim of this review to assess the incidence of venous thromboembolism (VTE) and current practice patterns for VTE prophylaxis among medical patients with acute illness in Europe. A literature search was conducted on the epidemiology and prophylaxis practices of VTE prevention among adult patients treated in-hospital for major medical conditions. A total of 21 studies with European information published between 1999 and April 2010 were retrieved. Among patients hospitalised for an acute medical illness, the incidence of VTE varied between 3.65% (symptomatic only over 10.9 days) and 14.9% (asymptomatic and symptomatic over 14 days). While clinical guidelines recommend pharmacologic VTE prophylaxis for patients admitted to hospital with an acute medical illness who are bedridden, clear identification of specific risk groups who would benefit from VTE prophylaxis is lacking. In the majority of studies retrieved, prophylaxis was under-used among medical inpatients; 21% to 62% of all patients admitted to the hospital for acute medical illnesses did not receive VTE prophylaxis. Furthermore, among patients who did receive prophylaxis, a considerable proportion received medication that was not in accord with guidelines due to short duration, suboptimal dose, or inappropriate type of prophylaxis. In most cases, the duration of VTE prophylaxis did not exceed hospital stay, the mean duration of which varied between 5 and 11 days. In conclusion, despite demonstrated efficacy and established guidelines supporting VTE prophylaxis, utilisation rates and treatment duration remain suboptimal, leaving medical patients at continued risk for VTE. Improved guideline adherence and effective care delivery among the medically ill are stressed.

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A novel digital clock drawing test as a screening tool for perioperative neurocognitive disorders: A feasibility study

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13756 ◽

2020 ◽

Author(s):

Richard A. Buckley ◽

Kelly J. Atkins ◽

Erika Fortunato ◽

Brendan Silbert ◽

David A. Scott ◽

...

Keyword(s):

Feasibility Study ◽

Screening Tool ◽

Neurocognitive Disorders ◽

Clock Drawing Test ◽

Digital Clock ◽

Clock Drawing ◽

Drawing Test

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Risk-assessment models for VTE and bleeding in hospitalized medical patients: an overview of systematic reviews

Blood Advances ◽

10.1182/bloodadvances.2020002482 ◽

2020 ◽

Vol 4 (19) ◽

pp. 4929-4944

Author(s):

Andrea J. Darzi ◽

Allen B. Repp ◽

Frederick A. Spencer ◽

Rami Z. Morsi ◽

Rana Charide ◽

...

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

Systematic Reviews ◽

Risk Of Bias ◽

Clinical Expertise ◽

Medical Patients ◽

Vte Prophylaxis ◽

Risk Assessment Models ◽

Medical Inpatients ◽

Overview Of Systematic Reviews

Abstract Multiple risk-assessment models (RAMs) for venous thromboembolism (VTE) in hospitalized medical patients have been developed. To inform the 2018 American Society of Hematology (ASH) guidelines on VTE, we conducted an overview of systematic reviews to identify and summarize evidence related to RAMs for VTE and bleeding in medical inpatients. We searched Epistemonikos, the Cochrane Database, Medline, and Embase from 2005 through June 2017 and then updated the search in January 2020 to identify systematic reviews that included RAMs for VTE and bleeding in medical inpatients. We conducted study selection, data abstraction and quality assessment (using the Risk of Bias in Systematic Reviews [ROBIS] tool) independently and in duplicate. We described the characteristics of the reviews and their included studies, and compared the identified RAMs using narrative synthesis. Of 15 348 citations, we included 2 systematic reviews, of which 1 had low risk of bias. The reviews included 19 unique studies reporting on 15 RAMs. Seven of the RAMs were derived using individual patient data in which risk factors were included based on their predictive ability in a regression analysis. The other 8 RAMs were empirically developed using consensus approaches, risk factors identified from a literature review, and clinical expertise. The RAMs that have been externally validated include the Caprini, Geneva, IMPROVE, Kucher, and Padua RAMs. The Padua, Geneva, and Kucher RAMs have been evaluated in impact studies that reported an increase in appropriate VTE prophylaxis rates. Our findings informed the ASH guidelines. They also aim to guide health care practitioners in their decision-making processes regarding appropriate individual prophylactic management.

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In-hospital symptomatic venous thromboembolism and antithrombotic prophylaxis in Internal Medicine

Thrombosis and Haemostasis ◽

10.1160/th08-11-0748 ◽

2009 ◽

Vol 101 (05) ◽

pp. 893-901 ◽

Cited By ~ 18

Author(s):

Mauro Campanini ◽

Mauro Silingardi ◽

Gianluigi Scannapieco ◽

Antonino Mazzone ◽

Giovanna Magni ◽

...

Keyword(s):

Internal Medicine ◽

Venous Thromboembolism ◽

Bed Rest ◽

Primary Study ◽

Medical Patients ◽

Antithrombotic Prophylaxis ◽

Increased Risk ◽

Medical Inpatients ◽

Hospital Acquired ◽

Heterogeneous Setting

SummaryHospitalised medical patients are at increased risk of venous thromboembolism (VTE), but the incidence of hospitalisation-related VTE in unselected medical inpatients has not been extensively studied, and uncertainties remain about the optimal use of thromboprophylaxis in this setting. Aims of our prospective, observational study were to assess the prevalence of VTE and the incidence of symptomatic, hospitalisation-related events in a cohort of consecutive patients admitted to 27 Internal Medicine Departments, and to evaluate clinical factors associated with the use of thromboprophylaxis. Between March and September 2006, a total of 4,846 patients were included in the study. Symptomatic VTE with onset of symptoms later than 48 hours after admission (”hospital-acquired” events, primary study end-point) occurred in 26 patients (0.55٪), while the overall prevalence of VTE (including diagnosis prior to or at admission) was 3.65٪. During hospital stay antithrombotic prophylaxis was administered in 41.6٪ of patients, and in 58.7% of those for whom prophylaxis was recommended according to the 2004 Guidelines of the American College of Chest Physicians. The choice of administering thromboprophylaxis or not appeared qualitatively adherent to indications from randomised clinical trials and international guidelines, and bed rest was the strongest determinant of the use of prophylaxis. Data from our real-world study confirm that VTE is a relevant complication in patients admitted to Internal Medicine Departments, and recommended tromboprophylaxis is still under-used, in particular in some patients groups. Further efforts are needed to better define risk profile and to optimise prophylaxis in the heterogeneous setting of medical inpatients.

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Significance of extremely elevated ferritin level in medical inpatients

Open Medicine ◽

10.2478/s11536-013-0256-4 ◽

2014 ◽

Vol 9 (1) ◽

pp. 115-120

Author(s):

Moshe Vardi ◽

Tahani Hogerat ◽

Sarit Cohen ◽

Shai Cohen

Keyword(s):

Medical Service ◽

Hematological Malignancies ◽

Ferritin Level ◽

General Medical Service ◽

Blood Transfusions ◽

Medical Patients ◽

Prognostic Utility ◽

Medical Inpatients ◽

One Year ◽

Clinical Conditions

AbstractThe diagnostic and prognostic utility of extremely elevated ferritin values in hospitalized medical patients is lacking. We aimed to determine the clinical significance of ferritin levels ≥ 1000 ng/mL in adults hospitalized in the general medical service. We scanned the hospital laboratory database for ferritin values ≥ 1000 ng/mL, and evaluated the medical history, diagnoses, and survival of patients hospitalized in the general medical service. We compared the characteristics and outcomes of patients with values up-to versus above 2,999 ng/mL. Ferritin samples ranging from 1,003 to 12,170 ng/mL from 422 patients in the lower and 94 in the higher ferritin groups were included. Malignancy, repeat blood transfusions and recent chemotherapy were more prevalent in the higher ferritin group (p=0.003, p=0.002, and p<0.001, respectively). Infection (58.7%), chronic kidney disease (22.0%), and solid or hematological malignancies (21.6% and 17.1%, respectively) were the leading conditions associated with elevated ferritin. One-year survival was low, and significantly lower in patients in the higher ferritin group (10.8% vs. 16.9%, p=0.004). In conclusion, extremely elevated ferritin values in patients admitted to the general medical service are associated with multiplicity of clinical conditions and poor outcome.

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