David A Scott Lis Evered. Department of Anaesthesia and Acute Pain Medicine St Vincent s Hospital, Melbourne University of Melbourne
|
|
- Aldous Boyd
- 5 years ago
- Views:
Transcription
1 David A Scott Lis Evered Department of Anaesthesia and Acute Pain Medicine St Vincent s Hospital, Melbourne University of Melbourne
2 This talk will include live polling so please be sure to have the meeting app downloaded! Android: iphone: Access code: PeriSIG18
3 Aims: Understand the new terminology and definitions for perioperative neurocognitive disorders (PND) Differentiate between delayed neurocognitive disorder (dncr) and Postoperative Delirium (POD) Identify risk factors for PND Understand simple screening tools for cognition and delirium screening Learn the basics of scoring screening tools and how to interpret the results
4 POCD is a research diagnosis Neuropsychological battery Rey AVLT Trails A&B Pegboard CERAD COWAT DSST POCD = sd on 2 tests or cumulative z-score sd
5 Recommended terminology for the cognitive impairment associated with anaesthesia and surgery which is consistent with other medical disciplines including neurology, psychiatry and gerontology
6
7 2013 DSM-5: Neurocognitive Disorders (NCD) Disorders where the primary clinical deficit is in cognitive function Mild NCD NIA-AA: MCI Objective decline in cognition (1-2 SD below controls/norms) Preserved ADLs Cognitive concern Not delirium nor otherwise explained Major NCD Objective decline in cognition ( 2 SD below controls/norms) Decline in ADLs Cognitive concern NIA-AA: Dementia Not delirium nor otherwise explained
8
9 Postoperative Cognitive Dysfunction (POCD) PerioperativeNeurocognitive Disorders (PND) Subtle change in cognition Defined on a battery of cognitive tests Decrease in a test of 1.96 SD (controls) Decrease in 2 tests out of battery (5-10) Measured at time intervals after surgery Occurs following cardiac surgery, noncardiac surgery and sedation Only known predictors are age, IQ and subtle baseline cognitive impairment Subtle change in cognition Defined on at least one cognitive test Decrease in a test of 1-2 (mild); 2 SD (major) (controls/norms) Decrease in one domain Measured over the lifespan Occurs in population 65y or more Only known predictors are age, IQ and subtle baseline cognitive impairment Subjective deficit required IADL assessment (function)
10 Aims: understand the new terminology and definitions for perioperative neurocognitive disorders (PND) Differentiate between delayed neurocognitive disorder (dncr) and Postoperative Delirium (POD) Identify risk factors for PND Understand simple screening tools for cognition and delirium screening Learn the basics of scoring screening tools and how to interpret the results
11 Pre-op Cognition Anaesthesia/Surgery EMERGENCE Perioperative Neurocognitive Disorders Uneventful recovery days weeks months years Delirium or not POCD Early dncr POCD Late Postoperative NCD Dementia NCD Elderly 5 60% 10 50% 10-15%
12 Cognitive function Perioperative Neurocognitive Disorders POCD/NCD 0 Preoperative Perioperative period: Delirium Cognitive nadir day 30-90
13 Time-course of Cognitive change Early POCD/dNCR and Delirium Delirium in Elderly patients 30 65% Orthopaedic arthroplasty 5-14% Orthopaedic # NOF 35 65% Cardiac & Vascular Surgery 37 52% ICU 19 82% 7d 4w 6w 3m 12 m 5y 7.5y Shaw 1987 Newman 2001 Van-Dijk 2002 Liu 2009 Rodriguez 2010 Royse 2011 Evered 2016 DECS 2014 Colak 2014 Shaw 1987 non ISPOCD 1998 non Steinmetz 2010 non Evered 2011 non Ballard 2012 non Radtke 2013 non Chan 2013 non Silbert 2014 Scott 2014 non
14 Perioperative Cognitive Disorders What s the difference between POCD/dNCR and Delirium? Features / characteristics Risk Factors
15 Early postoperative neurocognitive signs and symptoms POCD / dncr Emergence excitation Delirium? Confusion Fluctuating conscious state Disorganised thinking Fluctuating conscious state Memory problems Forgetfulness Acute onset Executive functions Concentration Acute onset Planning / high level thinking Agitation on ward Inattention Acute onset Agitation on ward
16 MMSE? Mini-mental State Examination Orientation, instructions, language, attention Max 30, impairment < 24 [7-8 min] ceiling effect decreases sensitivity for MCI easier to use in more impaired patients Sensitivity Specificity MMSE 66% 97% NOT = POCD / dncr / POD
17 Delirium - DSM 5 Criteria 4 3
18 Delirium screening & diagnosis 4AT 3D-CAM CAM CAM-ICU Marcantonio E, Inouye S. Ann Intern Med. 2014;161:
19 Delirium The extent of the problem Affects > 50% of hospitalised elderly patients It is NOT a transient inconvenience Adverse outcomes Acute & Long term Costs average of US$26,000 per patient est. US$164 Billion (2011) Delayed discharge Complications Dependency Dementia Death Preventable in up to 40% of inpatients Inouye, Marcantonio 2016 Alzheimer s & Dementia epub
20
21 Impact: POCD/NCD Increased mortality at 1y and 7.5 y (Monk et al; Evered et al) Delayed discharge (Silbert et al) Decreased return to work (Steinmetz et al) Decreased quality of life at 5y (Newman et al)? Increased risk of MCI / dementia? Anaesthesia associated with AD pathology
22 Long-term consequences of POCD 701 patients followed up for median 8.5 years Cognition assessed at Baseline, 1 week, 3 months post operative No 3 Mo No 1 week 3 Mo 1 week Survival OR 1.63 [ ] Labour market disengagement OR 2.26 [ ] Denmark: Steinmetz J et al ISPOCD Group Anesthesiology 2009; 110:548 55
23 Delirium, Cognition and Dementia Non-cardiac surgery SAGES 70y n=560 Cardiac surgery 70y n=225 Baseline adjusted Delirium 46% Risk lower baseline MMSE 24% Baseline actual 24% Inouye, S Alz and Dementia 2016; 12(7): Saczynski et al N Engl J Med 2012; 367(1): 30-39
24 Aims: Understand the new terminology and definitions for perioperative neurocognitive disorders (PND) Differentiate between delayed neurocognitive disorder (dncr) and Postoperative Delirium (POD) Identify risk factors for PND (POCD / dncr / POD / NCD) Understand simple screening tools for cognition and delirium screening Learn the basics of scoring screening tools and how to interpret the results
25 POCD and Delirium Risk Factors POCD / dncr POD Increasing age Lower education / IQ Preoperative cognitive impairment Increasing age Cognitive Impairment Comorbidities Drugs Frailty Polypharmacy / Alcohol / Benzodiazepines Functional impairment / Lack of mobilisation Sensory deficits / lack of orientation Visual / Auditory Prior events Bladder catheter Complications Type of surgery Pain Sleep disruption
26 Aims: factors for PND Understand simple screening tools for cognition and delirium screening earn the basics of scoring screening tools and how to interpret the results Learn the basics of scoring screening tools and how to interpret the results
27 Screening versus diagnosis Population screening versus selective screening Not diagnostic Ideally Easy to administer / do Inexpensive High negative predictive value Caution with use of result false positive effect Should lead to further and more specific testing
28 Baseline Clinical Evaluation Routine clinical interview Diagnosis of Pre-dementia, MCI, Dementia Risk for pre-existing cognitive impairment Vascular disease Family history Genetic (ApoE) if known Prior head injury Age Cognitive risk Any memory problems Level of education Partner / informant information
29 Neuropsychological Testing MCI/Dementia Informant Memory Orientation Judgement /Problem solving Community affairs Home/hobbies Personal care Subject Memory Orientation Judgement/problem solving Subjective complaint or concern patient / family / clinician Functional assessment ADLs / IADLs
30 What we need is.. Quick, easy to administer, reliable screening tools for Cognitive screening Delirium screening
31
32
33 Clock Drawing scoring for Mini-cog 0 or 2 points Response Question 1
34 Clock Drawing scoring for Mini-cog 0 or 2 points Answer: 0 Response Question 1
35 Clock Drawing scoring for Mini-cog 0 or 2 points Response Question 2
36 Clock Drawing scoring for Mini-cog 0 or 2 points Answer: 2 Response Question 2
37 Clock Drawing scoring for Mini-cog 0 or 2 points Response Question 3
38 Clock Drawing scoring for Mini-cog 0 or 2 points Answer: 0 Response Question 3
39 Clock Drawing scoring for Mini-cog 0 or 2 points Answer: 0 2 0
40 Montreal Cognitive Assessment Screening test for MCI ( < 10 min) Max 30, impairment < 26 (or 24) [10-12 min] Multiple domains Greater sensitivity to detect MCI and mild AD than the MMSE Sensitivity Specificity MMSE 66% 97% MoCA 94% 42% Available in multiple languages Not good for change detection even over a 6- month period
41 Clock Drawing Instruction: I want you to draw the face of a clock, put in all the numbers, and set the hands to 10 past 11.
42 MoCA clock scoring Scoring: One point is allocated for each of the following three criteria: Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g., slight imperfection on closing the circle); Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face; Roman numerals are acceptable; numbers can be placed outside the circle contour; Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand; hands must be centred within the clock face with their junction close to the clock centre. A point is not assigned for a given element if any of the above-criteria are not met.
43 Clock Drawing scoring for MoCA 3 points max Contour Numbers Hands Response Question 4
44 Clock Drawing scoring for MoCA Answer: 3 3 points max Contour Numbers Hands Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g., slight imperfection on closing the circle); Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face; Roman numerals are acceptable; numbers can be placed outside the circle contour; Response Question 4 Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand; hands must be centred within the clock face with their junction close to the clock centre.
45 Clock Drawing scoring for MoCA 3 points max Contour Numbers Hands Response Question 5
46 Clock Drawing scoring for MoCA Answer: 1 3 points max Contour Numbers Hands Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g., slight imperfection on closing the circle); Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face; Roman numerals are acceptable; numbers can be placed outside the circle contour; Response Question 5 Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand; hands must be centred within the clock face with their junction close to the clock centre.
47 Clock Drawing scoring for MoCA 3 points max Contour Numbers Hands Response Question 6
48 Clock Drawing scoring for MoCA Answer: 1 3 points max Contour Numbers Hands Contour (1 pt.): the clock face must be a circle with only minor distortion acceptable (e.g., slight imperfection on closing the circle); Numbers (1 pt.): all clock numbers must be present with no additional numbers; numbers must be in the correct order and placed in the approximate quadrants on the clock face; Roman numerals are acceptable; numbers can be placed outside the circle contour; Response Question 6 Hands (1 pt.): there must be two hands jointly indicating the correct time; the hour hand must be clearly shorter than the minute hand; hands must be centred within the clock face with their junction close to the clock centre.
49 Clock Drawing scoring for MoCA Answer: 3 1 1
50 TICS - Telephone Interview for Cognitive Status 1. Participant s name. (2) 2-6. Orientation. (5) 7. Participant s home address. (5) 8. Counting Backward from 20 to 0. (2) 9. Word List. (10) 10. Subtracting Serial 7s. (5) Miscellaneous questions (3) Repeat phrases (2) Current Monarch and Prime Minister s name (4) 18. Finger Tapping. (2) Opposites (2) 21. Delayed recall (10) Maximum score = 50 >38 Probable subjective memory complaint Possible MCI < 19 Possible Alzheimer s Disease
51 Screening tests MMSE MiniCOG MoCA TICS Sensitivity Specificity MMSE 66% 97% MiniCOG 76% 73% MoCA 94% 42% TICS 83% 82% 4-AT 3D-CAM
52 We all know delirium when we see it don t we? Hyperactive Hypoactive Mixed Sub-syndromal Hyperactive Mixed Hypoactive Overall Cardiac + 12% 11% 77% 23.5% + BAG-RECALL substudy Whitlock A&A 2014
53 Delirium has an Acute and Fluctuating Course cardiac non-cardiac 5 0 d1 am d1 pm d2 am d2 pm d3 am d3 pm d4 am d4 pm d5 am d5 pm
54 Delirium screening & diagnosis 4AT 3D-CAM CAM CAM-ICU Marcantonio E, Inouye S. Ann Intern Med. 2014;161:
55 Sensitivity Specificity 4AT 90% 84% 3D-CAM 95% 94%
56 Summary There is a new recommended nomenclature for Perioperative Neurocognitive Disorders POD dncr Key risk factors are Age, IQ, Pre-existing cognitive impairment Screening, applied correctly, identifies at-risk individuals but is not a diagnosis Simple screening tools are available A team approach to perioperative cognitive care is needed
AGED SPECIFIC ASSESSMENT TOOLS. Anna Ciotta Senior Clinical Neuropsychologist Peninsula Mental Health Services
AGED SPECIFIC ASSESSMENT TOOLS Anna Ciotta Senior Clinical Neuropsychologist Peninsula Mental Health Services Issues in assessing the Elderly Association between biological, psychological, social and cultural
More informationPostoperative cognitive dysfunction a neverending story
Postoperative cognitive dysfunction a neverending story Adela Hilda Onuţu, MD, PhD Cluj-Napoca, Romania adela_hilda@yahoo.com No conflict of interest Contents Postoperative cognitive dysfunction (POCD)
More informationCan Depth of Anesthesia Monitoring Alter the Incidence of Mortality, POCD or Delirium?
Can Depth of Anesthesia Monitoring Alter the Incidence of Mortality, POCD or Delirium? John C. Drummond, M.D., FRCPC Professor of Anesthesiology, University of California, San Diego; Staff Anesthesiologist,
More informationPOCD: What is it and do the anesthetics play a role?
POCD: What is it and do the anesthetics play a role? Deborah J. Culley, M.D. Associate Professor Harvard Medical School Brigham & Women s Hospital Conflicts of Interest NIH/NIGMS/NIA ABA: Director ABMS:
More informationOverview. Case #1 4/20/2012. Neuropsychological assessment of older adults: what, when and why?
Neuropsychological assessment of older adults: what, when and why? Benjamin Mast, Ph.D. Associate Professor & Vice Chair, Psychological & Brain Sciences Associate Clinical Professor, Family & Geriatric
More informationNEUROPSYCHOMETRIC TESTS
NEUROPSYCHOMETRIC TESTS CAMCOG It is the Cognitive section of Cambridge Examination for Mental Disorders of the Elderly (CAMDEX) The measure assesses orientation, language, memory, praxis, attention, abstract
More informationCase Presentation. Cognition: changes with Normal Aging? Synonyms
Case Presentation 78 yr old new patient presenting for new PCP after discharge from hospital stay Discharged 3 days ago Summary : admitted with new atrial fibrillation, with history of DM, CHF. In hospital,
More informationDelirium assessment and management. Dr Kim Jeffs Northern Health
Delirium assessment and management Dr Kim Jeffs Northern Health What do you need to know? Epidemiology How big is the problem? Who is at risk? Assessment Tools for diagnosis Prevention Evidence base Management
More informationPreventing Postoperative Cognitive Decline in the Elderly
Preventing Postoperative Cognitive Decline in the Elderly Alex Bekker, M.D., Ph.D Professor and Chair Department of Anesthesiology Rutgers New Jersey Medical School "My brain, that's my second favorite
More informationGeriatric Screening in Five Minutes or Less: Skills Stations
Geriatric Screening in Five Minutes or Less: Skills Stations Charlotte A. Paolini, D. O., CMD June 14, 2014 (Special thanks to Sarah Hallen, M.D., for allowing the use of her materials for this presentation.)
More informationCognitive Screening in Risk Assessment. Geoffrey Tremont, Ph.D. Rhode Island Hospital & Alpert Medical School of Brown University.
Cognitive Screening in Risk Assessment Geoffrey Tremont, Ph.D. Rhode Island Hospital & Alpert Medical School of Brown University Outline of Talk Definition of Dementia and MCI Incidence and Prevalence
More informationCognitive Assessment 4/29/2015. Learning Objectives To be able to:
Supporting the Desire to Age in Place: Important Considerations for the Aging Population AGENDA 8:45 9:00 AM Geriatric Principles Robert L. Kane, MD *9:00 9:55 AM Cognitive Assessments Ed Ratner, MD 10:00
More informationPostoperative Cognitive Disorders: Does Anesthesia Harm the Brain?
Postoperative Cognitive Disorders: Does Anesthesia Harm the Brain? Terri G. Monk, M.D. Professor Department of Anesthesiology Duke University Medical Center Durham, North Carolina, USA Association of Anesthesiologists
More informationDEMENTIA, THE BRAIN AND HOW IT WORKS AND WHY YOU MATTER
OVERCOMING THE CHALLENGES OF MANAGING CHRONIC DISEASES IN PERSONS WITH DEMENTIA DEMENTIA, THE BRAIN AND HOW IT WORKS AND WHY YOU MATTER LEARNING OBJECTIVES Be familiar with the diagnostic criteria for
More informationDelirium in the hospitalized patient
Delirium in the hospitalized patient Jennifer A. Tarin, M.D. Department of Hospital Medicine Geriatric Health Safety Chair Colorado Permanente Medical Group UCLA Reynolds Scholar Delirium Preventing delirium
More informationDelirium Pilot Project
CCU Nurses: Delirium Pilot Project Our unit has been selected to develop and implement a delirium assessment and intervention program. We are beginning Phase 1 with education and assessing for our baseline
More informationAlzheimer s disease dementia: a neuropsychological approach
Alzheimer s disease dementia: a neuropsychological approach Dr. Roberta Biundo, PhD Neuropsychology Coordinator at Parkinson s disease and movement disorders unit of San Camillo rehabilitation hospital
More informationCOGNITIVE DYSFUNCTION IN THE ELDERLY PATIENT QUIZ #34
COGNITIVE DYSFUNCTION IN THE ELDERLY PATIENT QUIZ #34 M. ANGELE THEARD, MD STAFF ANESTHESIOLOGIST LEGACY EMANUEL MEDICAL CENTER PORTLAND, OR QUIZ TEAM: SHOBANA RAJAN, MD SUNEETA GOLLAPUDY, MD VERGHESE
More informationStrategies to minimize delirium for hip fracture patients
Strategies to minimize delirium for hip fracture patients Stephen L Kates, M.D. Professor and Chairman Department Date of Orthopaedic Surgery Delirium incidence Up to 61% of hip fracture patients get delirium
More informationDelirium. Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta
Delirium Geriatric Giants Lecture Series Divisions of Geriatric Medicine and Care of the Elderly University of Alberta Overview A. Delirium - the nature of the beast B. Significance of delirium C. An approach
More informationAging: Tools for Assessment
Aging: Tools for Assessment Eugenia L. Siegler, MD Mason Adams Professor of Geriatric Medicine Weill Cornell Medicine New York, New York San Antonio, Texas: August 21 to 23, 2017 Learning Objectives After
More informationCHAPTER 5 NEUROPSYCHOLOGICAL PROFILE OF ALZHEIMER S DISEASE
CHAPTER 5 NEUROPSYCHOLOGICAL PROFILE OF ALZHEIMER S DISEASE 5.1 GENERAL BACKGROUND Neuropsychological assessment plays a crucial role in the assessment of cognitive decline in older age. In India, there
More informationDementia and Primary Care. A Structured Team Approach UNE/MGEC Conference June 2014
Dementia and Primary Care A Structured Team Approach UNE/MGEC Conference June 2014 First Proviso I have no actual or potential conflict of interest in relation to this program or presentation. Second Proviso
More informationCan aspirin slow cognitive decline and the onset of dementia? The ASPREE study. Mark Nelson on behalf of ASPREE Investigators
Can aspirin slow cognitive decline and the onset of dementia? The ASPREE study. Mark Nelson on behalf of ASPREE Investigators ASPREE Randomized, double-blind, placebo-controlled trial for extending healthy
More informationDisclosures. Post operative Delirium. Set up audience participation. Delirium Definitions. Incidence of Delirium
Post operative Delirium Disclosures IP for monitoring technology licensed to Medtronic Ken Brady, MD Pediatrics, Anesthesia, Critical Care Texas Children s Hospital Baylor College of Medicine Set up audience
More informationQuality ID #291: Parkinson s Disease: Cognitive Impairment or Dysfunction Assessment National Quality Strategy Domain: Effective Clinical Care
Quality ID #291: Parkinson s Disease: Cognitive Impairment or Dysfunction Assessment National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE
More informationDelirium and cognitive impairment in the perioperative
Delirium and cognitive impairment in the perioperative period Richard Sztramko Assistant Professor, McMaster University Divisions of Geriatrics and General Internal Medicine Disclosures Chief Medical Officer
More informationDelirium in Older Persons: An Investigative Journey
Delirium in Older Persons: An Investigative Journey Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy Family Chair
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2017 Liza Genao, MD Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity Very much under-recognized
More informationThe Long-term Prognosis of Delirium
The Long-term Prognosis of Jane McCusker, MD, DrPH, Professor, Epidemiology and Biostatistics, McGill University; Head, Clinical Epidemiology and Community Studies, St. Mary s Hospital, Montreal, QC. Nine
More informationScreening for Cognitive Impairment
Screening for Cognitive Impairment Screening for Cognitive Impairment. Educational Consultant Pearson April 27, 2017 Presentation Title Arial Bold 7 pt 1 Agenda What is Cognitive Impairment? Implications
More informationDELIRIUM. Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine
DELIRIUM Sabitha Rajan, MD, MSc, FHM Scott &White Healthcare Texas A&M Health Science Center School of Medicine Disclosure Milliman Care Guidelines - Editor Objectives Define delirium Epidemiology Diagnose
More informationAcute cognitive failure and delirium: screening
Acute cognitive failure and delirium: screening instruments for research and clinical practice Augusto Caraceni Director Palliative Care, Pain therapy and rehabilitation Fondazione IRCCS National Cancer
More informationIncidence and Risk Factors for Cognitive Dysfunction in Patients with Severe Systemic Disease
The Journal of International Medical Research 2012; 40: 612 620 Incidence and Risk Factors for Cognitive Dysfunction in Patients with Severe Systemic Disease FM RADTKE 1,a, M FRANCK 1,a, TS HERBIG 1, N
More informationRecognizing Dementia can be Tricky
Dementia Abstract Recognizing Dementia can be Tricky Dementia is characterized by multiple cognitive impairments that cause significant functional decline. Based on this brief definition, the initial expectation
More informationDelirium. Dr. John Puxty
Delirium Dr. John Puxty Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors, causes and main
More informationIdentification of Cognitive Impairment in HIV patients. Belinda Vicioso MD FACP, AGSF Jose Garcia Professor of Medicine UTSW
Identification of Cognitive Impairment in HIV patients Belinda Vicioso MD FACP, AGSF Jose Garcia Professor of Medicine UTSW New emphasis on cognition Why? Common in our patient population Often overlooked
More informationDo you know. Assessment of Delirium. What is Delirium? Which syndrome occurs more commonly in elderly populations? a. Delirium b.
Assessment of Delirium Marianne McCarthy, PhD, GNP, PMHNP Arizona State University College of Nursing and Health Innovation What is Delirium? Delirium is a common clinical syndrome characterized by: Inattention
More informationDelirium and Dementia. Summary
Delirium and Dementia Paul Kettl, M.D., M.H.A. Summary DELIRIUM Acute brain failure Identify cause (meds, infection) Treat sx Poor prognostic sign DEMENTIA Chronic brain failure AD most common cause Often
More informationDSM-5 MAJOR AND MILD NEUROCOGNITIVE DISORDERS (PAGE 602)
SUPPLEMENT 2 RELEVANT EXTRACTS FROM DSM-5 The following summarizes the neurocognitive disorders in DSM-5. For the complete DSM-5 see Diagnostic and Statistical Manualof Mental Disorders, 5th edn. 2013,
More informationNeuropsychological Evaluation of
Neuropsychological Evaluation of Alzheimer s Disease Joanne M. Hamilton, Ph.D. Shiley-Marcos Alzheimer s Disease Research Center Department of Neurosciences University of California, San Diego Establish
More informationDelirium in Hospital Care
Delirium in Hospital Care Dr John Puxty 1 Learning Objectives By the end of the workshop participants will be able to: Appreciate the main diagnostic criteria for delirium. Describe common risk factors,
More informationPreop risk stratification & postop management in elderly cancer patients
Preop risk stratification & postop management in elderly cancer patients laudia Spies Klinik für Anästhesiologie und Intensivmedizin ampus Virchow-Klinikum und ampus harité Mitte U N I V E R S I T Ä T
More informationPerioperative Care of Older Adults
Perioperative Care of Older Adults SARAH A. WINGFIELD, MD AND THOMAS O. DALTON, MD UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DIVISION OF GERIATRIC MEDICINE We have no disclosures. Objectives -Recognize
More informationPerioperative Care of Older Adults
Perioperative Care of Older Adults SARAH A. WINGFIELD, MD AND THOMAS O. DALTON, MD UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER DIVISION OF GERIATRIC MEDICINE We have no disclosures. Objectives -Recognize
More informationSummary of Delirium Clinical Practice Guideline Recommendations Post Operative
Summary of Delirium Clinical Practice Guideline Recommendations Post Operative Intensive Care Unit Clinical Practice Guideline for Postoperative Clinical Practice Guidelines for the Delirium in Older Adults;
More informationAssessment Toolkits for Lewy Body Dementia
Study : Assessment Toolkits for Lewy Body Dementia There are two toolkits, depending on whether the patient is presenting with a primary cognitive problem or with cognitive decline in the context of established
More informationDelirium. A Plan to Reduce Use of Restraints. David Wensel DO, FAAHPM Medical Director Midland Care
Delirium A Plan to Reduce Use of Restraints David Wensel DO, FAAHPM Medical Director Midland Care Objectives Define delirium Describe pathophysiology of delirium Understand most common etiologies Define
More informationNUMERATOR: All patients with a diagnosis of Parkinson s Disease who were assessed for cognitive impairment or dysfunction in the past 12 months
Quality ID #291: Parkinson s Disease: Cognitive Impairment or Dysfunction Assessment for Patients with Parkinson s Disease National Quality Strategy Domain: Effective Clinical Care Meaningful Measure Area:
More informationDavid A Scott Associate Professor St Vincent s Hospital Melbourne
David A Scott Associate Professor St Vincent s Hospital Melbourne 2012 Controlled Quiet? Stress-free What is Anaesthesia? Balanced General Anaesthesia Hypnosis Analgesia Amnesia Muscle Relaxation General
More informationMontreal Cognitive Assessment (MoCA) Overview for Best Practice in Stroke and Complex Neurological Conditions March 2013
Montreal Cognitive Assessment (MoCA) Overview for Best Practice in Stroke and Complex Neurological Conditions March 2013 1 MoCA 2 Overview of the MoCA Takes approximately 15 minutes to administer Requires
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationThe Use of MoCA and Other Cognitive Tests in Evaluation of Cognitive Impairment in Elderly Patients Undergoing Arthroplasty
Article The Use of MoCA and Other Cognitive Tests in Evaluation of Cognitive Impairment in Elderly Patients Undergoing Arthroplasty Geriatric Orthopaedic Surgery & Rehabilitation 2016, Vol. 7(4) 183-187
More informationDelirium in the ICU: Prevention and Treatment. Delirium Defined Officially. Delirium: Really Defined. S. Andrew Josephson, MD
Delirium in the ICU: Prevention and Treatment S. Andrew Josephson, MD Director, Neurohospitalist Service Medical Director, Inpatient Neurology June 2, 2011 Delirium Defined Officially (DSM-IV-TR) criteria
More information3/6/2019 DIAGNOSIS OF DEMENTIA IN THE OUTPATIENT SETTING FINANCIAL DISCLOSURES LEARNING OBJECTIVES
DIAGNOSIS OF DEMENTIA IN THE OUTPATIENT SETTING MILTA LITTLE, DO, CMD DUKE UNIVERSITY SCHOOL OF MEDICINE FINANCIAL DISCLOSURES Dr. Little has no relevant financial disclosures to report Dr. Little will
More informationDementia and Driving Checklist
6 Dementia and Driving Checklist 1. Questions to Ask the Patient and Family Patient Have you noticed any change or decreased confidence in your driving skills Have you had any accidents (or minor fender
More informationCOGNITIVE ALTERATIONS IN CHRONIC KIDNEY DISEASE K K L E E
COGNITIVE ALTERATIONS IN CHRONIC KIDNEY DISEASE K K L E E Attention Problem Solving Language Cognitive Domains Decision Making Memory Reasoning The Cardiovascular Health Cognition Study shows higher S
More informationDelirium. A Geriatric Syndrome. Jonathan McCaleb, MD, CMD, HMDC UNSOM, Assistant Professor of Medicine Geriatrics / Hospice & Palliative Medicine
Delirium A Geriatric Syndrome Jonathan McCaleb, MD, CMD, HMDC UNSOM, Assistant Professor of Medicine Geriatrics / Hospice & Palliative Medicine Introduction Common Serious Unrecognized: a medical emergency
More informationExploration of a weighed cognitive composite score for measuring decline in amnestic MCI
Exploration of a weighed cognitive composite score for measuring decline in amnestic MCI Sarah Monsell NACC biostatistician smonsell@uw.edu October 6, 2012 Background Neuropsychological batteries used
More informationTHE ROLE OF ACTIVITIES OF DAILY LIVING IN THE MCI SYNDROME
PERNECZKY 15/06/06 14:35 Page 1 THE ROLE OF ACTIVITIES OF DAILY LIVING IN THE MCI SYNDROME R. PERNECZKY, A. KURZ Department of Psychiatry and Psychotherapy, Technical University of Munich, Germany. Correspondence
More informationChapter 01 Introduction
Chapter 01 Introduction Defining the Elderly There is no universally accepted age cut-off defining elderly. This reflects the fact that chronological age itself is less important than biological events
More informationDelirium in the Elderly
Delirium in the Elderly ELITE 2015 Mamata Yanamadala M.B.B.S, MS Division of Geriatrics Why should we care about delirium? It is: common associated with high mortality associated with increased morbidity
More informationCOGNITIVE IMPAIRMENT IN
COGNITIVE IMPAIRMENT IN THE HOSPITAL SETTING Professor Len Gray April 2014 Some key questions How common is cognitive impairment among hospitalised older patients? Which cognitive syndromes are associated
More information5 older patients become. What is delirium? (Acute confusional state) Where We ve Been and
Update on Delirium: Where We ve Been and Where We re Going Sharon K. Inouye, M.D., M.P.H. M PH Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy
More informationDelirium and dementia: The best of friends, the worst of enemies David Meagher
Delirium and dementia: The best of friends, the worst of enemies David Meagher Professor of Psychiatry, UL Graduate-Entry Medical School Two Sumo Wrestlers Two great heavyweights Generalised Cognitive
More informationInformation Gathering Obtaining history is the most critical first step Patient-provided history may not be reliable Need info from relatives, friends
ASSESSING COMPETENCE Michael A Hill MD UNC Psychiatry 2008 Information Gathering Obtaining history is the most critical first step Patient-provided history may not be reliable Need info from relatives,
More informationAssociation between delirium and cognitive change after cardiac surgery
British Journal of Anaesthesia, 119 (2): 308 15 (2017) doi: 10.1093/bja/aex053 Cardiovascular CARDIOVASCULAR Association between delirium and cognitive change after cardiac surgery A. C. Sau er 1, *, D.
More informationClearing the Mind: A Nursing Assessment tool for the recognition and monitoring of delirium. Jac Mathieson Peter MacCallum Cancer Institute
Clearing the Mind: A Nursing Assessment tool for the recognition and monitoring of delirium Jac Mathieson Peter MacCallum Cancer Institute Overview Introduction to delirium The need for a nursing assessment
More informationDelirium Prevention: The State-of-the-Art & Implications to Improve Care in our State
Delirium Prevention: The State-of-the-Art & Implications to Improve Care in our State Jonny Macias, MD & Michael Malone, MD Aurora Health Care/ University of Wisconsin School of Medicine & Public Health
More informationThe experiential impact of cognitive function tests upon men with dementia and their carers
The experiential impact of cognitive function tests upon men with dementia and their carers Dr Edward Tolhurst Lecturer in Health Research 5 th November 2015 Research overview Qualitative study into the
More informationCapacity and Older Adults. Kenneth I. Shulman
Capacity and Older Adults Kenneth I. Shulman Increased Requests for Contemporaneous Assessments of Testamentary Capacity Increase in challenges to testamentary capacity Demographics/Economics Prevalence
More informationDisentangling Delirium and Dementia
Disentangling Delirium and Dementia Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley F. Levy Family Chair Director, Aging
More informationHollis Day, MD, MS Chief, Geriatrics BMC
Hollis Day, MD, MS Chief, Geriatrics BMC Mari-Lynn Drainoni, PhD Associate Professor, Department of Health Law Policy and Management, BUSPH Co-Director, Evans Center for Implementation and Improvement
More informationTable e-1. MCI diagnosis criteria used by articles included in AAN MCI guideline. MCI diagnosis criteria used by included articles
Memory complaint Cognitive complaint Memory impairment Cognitively impaired Relatively preserved general cognition Intact ADL No dementia CDR 0.5 Table e-1. MCI diagnosis criteria used by articles included
More informationALZHEIMER S DISEASE OVERVIEW. Jeffrey Cummings, MD, ScD Cleveland Clinic Lou Ruvo Center for Brain Health
ALZHEIMER S DISEASE OVERVIEW Jeffrey Cummings, MD, ScD Cleveland Clinic Lou Ruvo Center for Brain Health Prevalence AD: DEMOGRAPHY AND CLINICAL FEATURES Risk and protective factors Clinical features and
More informationPostoperative Delirium and Sleep Apnea
Postoperative Delirium and Sleep Apnea Sakura Kinjo, MD Clinical Professor Anesthesia Medical Director, Orthopaedic Institute University of California, San Francisco Objectives Discuss possible risk factors
More informationCognitive decline after anaesthesia and critical care
Cognitive decline after anaesthesia and critical care Dafydd Gwilym Lloyd BSc (Hons) MBChB MRCP FRCA Daqing Ma MD PhD Marcela Paola Vizcaychipi MB BS MD EDICM FRCA Matrix reference 1A01, 2A03, 2C05 Key
More informationPaying for Dementia Care. Mary Ann Forciea MD Clinical Professor of Medicine Division of Geriatric Medicine University of Pennsylvania Health System
Paying for Dementia Care Mary Ann Forciea MD Clinical Professor of Medicine Division of Geriatric Medicine University of Pennsylvania Health System Audience: Possible concerns about dementia care in my
More informationDelirium. Quick reference guide. Issue date: July Diagnosis, prevention and management
Issue date: July 2010 Delirium Diagnosis, prevention and management Developed by the National Clinical Guideline Centre for Acute and Chronic Conditions About this booklet This is a quick reference guide
More informationDEMENTIA? 45 Million. What is. WHAT IS DEMENTIA Dementia is a disturbance in a group of mental processes including: 70% Dementia is not a disease
What is PRESENTS DEMENTIA? WHAT IS DEMENTIA Dementia is a disturbance in a group of mental processes including: Memory Reasoning Planning Learning Attention Language Perception Behavior AS OF 2013 There
More informationEmergency Geriatrics. Essentials in Caring for Older Patients CCFP(EM) FCFP
Emergency Geriatrics 101 Essentials in Caring for Older Patients Don Melady BA MD MScCH(c) Don Melady BA MD MScCH(c) CCFP(EM) FCFP Ten Things I know about Old People in the ED Learning Objectives At the
More informationA Fresh View of Cognitive Disorders in Older Adults: New Classification and Screening Strategies
A Fresh View of Cognitive Disorders in Older Adults: New Classification and Screening Strategies Lynda Mackin, PhD, AGPCNP-BC, CNS University of California San Francisco School of Nursing 1 Alzheimer s
More information5 older patients become delirious every minute
Management of Delirium: Nonpharmacologic and Pharmacologic Approaches Sharon K. Inouye, M.D., M.P.H. Professor of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Milton and Shirley
More informationDementia. Aetiology, pathophysiology and the role of neuropsychological testing. Dr Sheng Ling Low Geriatrician
Dementia Aetiology, pathophysiology and the role of neuropsychological testing Dr Sheng Ling Low Geriatrician Topics to cover Why is dementia important What is dementia Differentiate between dementia,
More informationGeriatric screening tools in older patients with cancer
Geriatric screening tools in older patients with cancer Pr. Elena Paillaud Henri Mondor hospital, Créteil, France University Paris-Est Créteil CONFLICT OF INTEREST DISCLOSURE I have the following potential
More informationDelirium and Dementia in Acute Care. Megan Walsh, CRNP, PMHNP-BC Bloomsburg University Geisinger Health System Villanova University
Delirium and Dementia in Acute Care Megan Walsh, CRNP, PMHNP-BC Bloomsburg University Geisinger Health System Villanova University Disclosures O Nothing to disclose Objectives O Understand the differences
More informationHousekeeping. Agenda. Brian Taylor s Disclosures. Why is this topic important? 10/24/2016
Housekeeping Welcome to Hearing Loss and Dementia: Current Trends and Opportunities Presenter: Brian Taylor, AuD Senior Director of Clinical Affairs Hypersound This presentation is being recorded CE credit
More informationFalls: Cognitive Motor Perspectives
Falls: Cognitive Motor Perspectives Joe Verghese, MBBS, MS. Integrated Divisions of Cognitive & Motor Aging (Neurology) & Geriatrics (Medicine) Albert Einstein College of Medicine, Bronx, NY joe.verghese@einstein.yu.edu
More informationFunction and Cognition in Older Adults ASHLEY HALLE, OTD, OTR/L JO MARIE REILLY, M.D. CHERYL RESNIK, PT, DPT
Function and Cognition in Older Adults ASHLEY HALLE, OTD, OTR/L JO MARIE REILLY, M.D. CHERYL RESNIK, PT, DPT Why Assess Elderly for Cognition? u Understand baseline cognitive level, potential cognitive
More informationDesigning a Game-Based Cognitive Assessment for a Tablet. Tiffany Tong
Designing a Game-Based Cognitive Assessment for a Tablet by Tiffany Tong A thesis submitted in conformity with the requirements for the degree of Master of Applied Science Graduate Department of Mechanical
More informationDementia in the acute hospital setting what should we be doing and who should be doing it?
Dementia in the acute hospital setting what should we be doing and who should be doing it? Sarah Pendlebury Consultant Physician and Associate Professor NIHR Oxford Biomedical Research Centre Departments
More informationMild Cognitive Impairment or Mild Neurocognitive Disorder: Implications for Clinical Practice. Hypothesized Key Players in the Pathogenesis of AD
AD is a Neurodegenerative Disease as Seen in the PET Scan and is Characterized by Amyloid Plaques and Neurofibrillary Tangles Mild Cognitive Impairment or Mild Neurocognitive Disorder: Implications for
More informationThe Person: Dementia Basics
The Person: Dementia Basics Objectives 1. Discuss how expected age related changes in the brain might affect an individual's cognition and functioning 2. Discuss how changes in the brain due to Alzheimer
More informationAnaesthesia for the Over 75s. Chris Edge
Anaesthesia for the Over 75s Chris Edge Topics to be Covered Post-operative cognitive management Morbidity and mortality General anaesthesia a good idea or not? Multiple comorbidities and assessment of
More informationObjectives. The Problem. The Problem. The Problem. Assessing the Older Driver
Assessing the Older Driver Objectives Practical office evaluation. Testing and reporting Dementia and driving Strategies for counseling On-line resources Amelia Gennari, MD Director of Ambulatory Care
More informationDementia and Alzheimer s disease
Since 1960 Medicine Korat โรงพยาบาลมหาราชนครราชส มา Dementia and Alzheimer s disease Concise Reviews PAWUT MEKAWICHAI MD DEPARTMENT of MEDICINE MAHARAT NAKHON RATCHASIMA HOSPITAL 1 Prevalence Increase
More informationWHI Memory Study (WHIMS) Investigator Data Release Data Preparation Guide April 2014
WHI Memory Study (WHIMS) Investigator Data Release Data Preparation Guide April 2014 1. Introduction This release consists of a single data set from the WHIMS Epidemiology of Cognitive Health Outcomes
More informationGeriatrics and Cancer Care
Geriatrics and Cancer Care Roger Wong, BMSc, MD, FRCPC, FACP Postgraduate Dean of Medical Education Clinical Professor, Division of Geriatric Medicine UBC Faculty of Medicine Disclosure No competing interests
More informationImproving the quality of care of patients with delirium
Improving the quality of care of patients with delirium Alasdair MacLullich MRCP(UK), PhD Professor of Geriatric Medicine University of Edinburgh Scotland How are we doing now? We are doing badly. Difficult
More informationDelirium. Dr. Lesley Wiesenfeld. Deputy Psychiatrist in Chief, Mount Sinai Hospital. Dr. Carole Cohen
Delirium Dr. Lesley Wiesenfeld Deputy Psychiatrist in Chief, Mount Sinai Hospital Dr. Carole Cohen Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre Case Study Mrs B
More information