pinecone/core-2020-05-10-deduplication huggingface dataset:
In-hospital death according to dementia diagnosis in acutely ill elderly patients: the REPOSI study.

The aim of the study was to explore the association of dementia with in-hospital OBJECTIVE:The aim of the study was to explore the association of dementia with in-hospital death in acutely ill medical patients.\ud
METHODS:\ud
Thirty-four internal medicine and 4 geriatric wards in Italy participated in the Registro Politerapie SIMI-REPOSI-study during 2008. One thousand three hundred and thirty two in-patients aged 65 years or older were enrolled. Logistic regression models were used to evaluate the association of dementia with in-hospital death. Socio-demographic characteristics, morbidity (single diseases and the Charlson Index), number of drugs, and adverse clinical events during hospitalization were considered as potential confounders.\ud
RESULTS:\ud
One hundred and seventeen participants were diagnosed as being affected by dementia. Patients with dementia were more likely to be women, older, to have cerebrovascular diseases, pneumonia, and a higher number of adverse clinical events during hospitalization. The percentage of patients affected by dementia who died during hospitalization was higher than that of patients without dementia (9.4 versus 4.9%). After multiadjustment, the diagnosis of dementia was associated with in-hospital death (OR = 2.1; 95% CI = 1.0-4.5). Having dementia and at least one adverse clinical event during hospitalization showed an additive effect on in-hospital mortality (OR = 20.7; 95% CI = 6.9-61.9).\ud
CONCLUSIONS:\ud
Acutely ill elderly patients affected by dementia are more likely to die shortly after hospital admission. Having dementia and adverse clinical events during hospital stay increases the risk of death
Mental and psychological conditions, medical comorbidity and functional limitation: differential associations in older adults with cognitive impairment, depressive symptoms and co-existence of both

[Abstract] Objective: Cognitive impairment and depressive symptoms are common among the geriatric population
but the co-occurrence of both is rarely studied. The purpose of this study was to identify and compare the
factors associated with three groups of elderly people: those assessed with cognitive impairment alone
(COG), depressive symptoms alone (DEP) or co-existence of both (COG-DEP).
Methods: The cross-sectional study included 600 community-dwellers ages 65 and older. All participants
underwent a comprehensive evaluation. Global cognition was measured by the Mini-Mental State
Examination (MMSE) and depressive symptoms were defined by the Geriatric Depression Scale (GDS).
Specific chronic illnesses relevant to the Charlson comorbidity index (CCI) were self-reported. Functional
status was evaluated by the Katz’ basic (ADL) and Lawton’s instrumental (IADL) activities of daily
living scales.
Results: COG-DEP was explained by IADL dependence (OR: 11.9, 95% CI: 4.59–30.78), ADL
dependence (OR: 11.5, 95% CI: 5.59–23.69), cerebrovascular disease (OR: 3.6, 95% CI: 1.48–8.68),
congestive heart failure (OR: 3.4, 95% CI: 1.77–6.59) and diabetes (OR: 2.6, 95% CI: 1.30–5.18), but it
was best predicted by functional limitations in the adjusted model. Being functionally dependent and
medically ill with shorter life expectancy was shown to significantly increase the odds of being DEP.
Functional limitation in IADL was without distinction associated to COG, DEP and COG-DEP.
Conclusion: The present results on COG, DEP and COG-DEP show the particular relevance of certain
medical comorbidities and functional limitations to those three distinct groups of elderly people
Burden of cirrhosis on older Americans and their families: Analysis of the health and retirement study

Prevalence of cirrhosis among older adults is expected to increase; therefore, we studied the health status, functional disability, and need for supportive care in a large national sample of individuals with cirrhosis. A prospective cohort of individuals with cirrhosis was identified within the longitudinal, nationally representative Health and Retirement Study. Cirrhosis cases were identified in linked Medicare data via ICD‐9‐CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes and compared to an age‐matched cohort without cirrhosis. Two primary outcome domains were assessed: (1) patients' health status (perceived health status, comorbidities, health care utilization, and functional disability as determined by activities of daily living and instrumental activities of daily living), and (2) informal caregiving (hours of caregiving provided by a primary informal caregiver and associated cost). Adjusted negative binomial regression was used to assess the association between cirrhosis and functional disability. A total of 317 individuals with cirrhosis and 951 age‐matched comparators were identified. Relative to the comparison group, individuals with cirrhosis had worse self‐reported health status, more comorbidities, and used significantly more health care services (hospitalizations, nursing home stays, physician visits;  P  < 0.001 for all bivariable comparisons). They also had greater functional disability ( P  < 0.001 for activities of daily living and instrumental activities of daily living), despite adjustment for covariates such as comorbidities and health care utilization. Individuals with cirrhosis received more than twice the number of informal caregiving hours per week ( P  < 0.001), at an annual cost of US $4700 per person.  Conclusion:  Older Americans with cirrhosis have high rates of disability, health care utilization, and need for informal caregiving. Improved care coordination and caregiver support is necessary to optimize management of this frail population. (H EPATOLOGY  2012;55:184–191
The potential of case management for people with dementia: a commentary

Background A recent review of studies of case management in dementia argues that lack of evidence of cost-effectiveness should discourage the use of this approach to care. We argue that that this is too conservative a stance, given the urgent need throughout the world to improve the quality of care for people with dementia and their caregivers. We propose a research agenda on case management for people with dementia.  Method A critical comparison was made of the studies identified in two systematic reviews of trials of case management for dementia, with selective inclusion of non-trial studies and economic evaluations.  Results Our interpretation of the literature leads us to four provisional conclusions. First, studies with long follow-up periods tend to show delayed relocation of people with dementia to care homes. Second, the quality of life of people with dementia and their caregivers may also influence the likelihood of relocation. Third, different understandings of what constitutes case management make interpretation of studies difficult. Fourth, we agree that the population most likely to benefit from case management needs to be characterised. Earlier intervention may be more beneficial than intervening when the condition has progressed and the individual's situation is highly complex. However, this runs counter to some definitions of case management as an administrative, professional, and systemic focus on people with high needs and where expensive support is accessed or in prospect.  Conclusions More work needs to be carried out in a more focused way in order to establish the value of case management for people with dementia. Since care home residence is such a sizeable contributor to the costs of dementia care, studies need to be long enough to capture possible postponed relocation. However, case management studies with shorter follow-up periods can still contribute to our understanding, since they can demonstrate improved quality of life. Future research should be built around a common, agreed definition of types of case management
Burden associated with the presence of anosognosia in Alzheimer's disease

Objectives: Anosognosia is the lack of deficit awareness, and it is a common symptom in patients with Alzheimer¿s disease (AD). The objective of this study was to assess the relationship between anosognosia and caregiver burden. Methods: This was a cross-sectional, analytical study of patients who were diagnosed with AD and their caregivers. Anosognosia was evaluated using the Experimenter Rating Scale, and caregiver burden was evaluated using the Burden Interview (BI). Using the BI¿s comprehensive scoring and each of its five factors as dependent variables, we adjusted six linear regression models to determine the effect of anosognosia on caregiver burden. Results: The sample consisted of 124 patients and 124 caregivers. The mean patient age was 78.9 years (SD = 6.9); the mean caregiver age was 59.7 years (SD = 13.6), and 66.6% of the caregivers were women. The prevalence of anosognosia was 24.2% (95% confidence interval = 16.7¿33.3). The degree of caregiver burden was associated with the degree of anosognosia (r2 = 0.426; standardised beta [bs] =0.346; p<0.001), which explained 14.7% of the variance. For the BI factors, the Experimenter Rating Scale was associated with physical and social burden (r2=0.452; bs=0.378; p<0.001), relationship of dependence (r2=0.301; bs= 0.203; p = 0.010) and emotional stress (r2=0.212; bs = 0.227; p=0.014). Conclusions: The presence of anosognosia in patients with AD is an independent factor that increases caregiver burden by increasing physical wear, social isolation, dependence and tension related to patient care
Dementia care costs and outcomes: a systematic review

Objective: We reviewed evidence on the cost-effectiveness of prevention, care and treatment strategies in relation to dementia. Methods: We performed a systematic review of available literature on economic evaluations of dementia care, searching key databases and websites in medicine, social care and economics. Literature reviews were privileged, and other study designs were included only to fill gaps in the evidence base. Narrative analysis was used to synthesise the results. Results: We identified 56 literature reviews and 29 single studies offering economic evidence on dementia care. There is more cost-effectiveness evidence on pharmacological therapies than other interventions. Acetylcholinesterase inhibitors for mild-to-moderate disease and memantine for moderate-to-severe disease were found to be cost-effective. Regarding non-pharmacological treatments, cognitive stimulation therapy, tailored activity programme and occupational therapy were found to be more cost-effective than usual care. There was some evidence to suggest that respite care in day settings and psychosocial interventions for carers could be cost-effective. Coordinated care management and personal budgets held by carers have also demonstrated cost-effectiveness in some studies. Conclusion: Five barriers to achieving better value for money in dementia care were identified: the scarcity and low methodological quality of available studies, the difficulty of generalising from available evidence, the narrowness of cost measures, a reluctance to implement evidence and the poor coordination of health and social care provision and financing
Suicidal ideation in family carers of people with dementia: A pilot study

Objective The objective of this pilot study was to gather preliminary evidence on suicidal ideation in family carers of people with dementia. Methods An online, cross-sectional survey was conducted with 120 family carers, the majority of whom were located in Australia and USA. The survey included measures of suicidality, self-efficacy, physical health, depression, hopelessness, anxiety, optimism, caregiver burden, coping strategies and social support. Results Twenty-six percent of carers had contemplated suicide more than once in the previous year. Only half of these had ever told someone they might commit suicide and almost 30% said they were likely to attempt suicide in the future. Carers who had contemplated suicide had poorer mental health, lower self-efficacy for community support service use and greater use of dysfunctional coping strategies than those who had not. In a logistic regression, only depression predicted the presence of suicidal thoughts. Conclusions A significant number of people might contemplate suicide while caring for a family member with dementia. Although more research is required to confirm this finding, there are clear implications for policy and clinical practice in terms of identifying and supporting carers who are already contemplating suicide.Griffith Health, School of Nursing and MidwiferyFull Tex
Establishing robust cognitive dimensions for characterization and differentiation of patients with Alzheimer's disease, mild cognitive impairment, frontotemporal dementia and depression

The diagnosis of mild cognitive impairment (MCI) and dementia requires detailed neuropsychological examinations. These examinations typically yield a large number of outcome variables, which may complicate the interpretation and communication of results. The purposes of this study were the following: (i) to reduce a large data set of interrelated neuropsychological variables to a smaller number of cognitive dimensions; (ii) to create a common metric for these dimensions (z-scores); and (iii) to study the ability of the cognitive dimensions to distinguish between groups of patients with different types of cognitive impairment.; We tested 1646 patients with different forms of dementia or with a major depression with a standard (n = 632) or, if cognitively less affected, a challenging neuropsychological battery (n = 1014). To identify the underlying cognitive dimensions of the two test batteries, maximum likelihood factor analyses with a promax rotation were conducted. To interpret the sum scores of the factors as standard scores, we divided them by the standard deviation of a cognitively healthy sample (n = 1145).; The factor analyses yielded seven factors for each test battery. The cognitive dimensions in both test batteries distinguished patients with different forms of dementia (MCI, Alzheimer's dementia or frontotemporal dementia) and patients with major depression. Furthermore, patients with stable MCI could be separated from patients with progressing MCI. Discriminant analyses with an independent new sample of patients (n = 306) revealed that the new dimension scores distinguished new samples of patients with MCI from patients with Alzheimer's dementia with high accuracy.; These findings suggest that these cognitive dimensions may benefit neuropsychological diagnostics
Efficacy of pain treatment on mood syndrome in patients with dementia: a randomized clinical trial

<p>Background: Depression is common in nursing home (NH) patients with dementia, and often clustered
with anxiety and other mood symptoms. An association between pain and depressive symptoms has
been reported, but the impact of pain management on depression and other mood symptoms has
not been investigated.</p><p>Objective: Secondary analyses of a cluster randomized clinical trial examine the response of
dementia-related mood symptoms to a Stepwise Protocol of Treating Pain.</p><p>Method: Three-hundred fifty-two patients with moderate and severe dementia and significant behavioural
disturbances, related to 60 clusters (i.e. clusters defined as single independent NH units) in 18
NHs of Western Norway, were included. All patients in the intervention group received individual daily
pain treatment with paracetamol, extended release morphine, buprenorphine transdermal patch or
pregabaline for 8 weeks, with additional follow-up assessment 4 weeks after completion of the
intervention. Clusters randomized to control received usual treatment. A mood cluster consisting of
depression, anxiety, sleep disorders, apathy and appetite items from the Neuropsychiatric
Inventory-Nursing Home (NPI-NH) was the primary outcome.</p><p>Results: Analysed by Mann–Whitney U-tests, Stepwise Protocol of Treating Pain conferred significant
benefit in treatment of the NPI-NH mood cluster (F = 13.4, df = 1;299, p&lt;0.001) and depression
(F = 2.0, df = 1;301, p = 0.025). Further analyses highlighted improvements in apathy (F = 5.3, df = 1;300,
p = 0.017), night-time behaviours (F = 3.1, df = 1;301, p = 0.050), and appetite items (F = 11.6, df =
1;301, p = 0.005), but not irritability (p = 0.092) and anxiety (p = 0.125).</p><p>Conclusion: Mood symptoms including depression significantly improved with pain treatment,
emphasizing the importance of more rigorous treatment of pain in agitated people with dementia.
Findings have potentially immediate clinical relevance.</p
The utility of the Edinburgh Depression Scale as a screening tool for depression in Parkinson's disease

Objective :\ud
\ud
This study aimed to evaluate the Edinburgh Depression Scale (EDS) as a screening tool for use in a Parkinson's disease (PD) population. Many commonly used depression scales include items relating to somatic symptoms that also occur in PD, which could potentially result in inaccurate reporting of depressive symptoms. The EDS is a scale that incorporates no somatic items.\ud
Method :\ud
\ud
One hundred twenty patients attending specialist PD clinics were assessed using a standardised diagnostic interview (Present State Examination—Schedules for Clinical Assessment in Neuropsychiatry) to establish a diagnosis of DSM-IV depression. They later completed the EDS with another researcher who was blind to the results of diagnostic interview. A receiver operating characteristic curve analysis was carried out to identify the optimal threshold score on the EDS and the Brief EDS to identify any depressive disorder or major depression. The performance characteristics at a range of thresholds were compared.\ud
Results :\ud
\ud
A cut-off score of 10/11 gave maximal discriminant validity, with 74% sensitivity, 92% specificity and 64% positive predictive value for the identification of any depression according to DSM-IV criteria.\ud
Conclusions :\ud
\ud
This study suggests that the EDS is both a valid and potentially useful instrument that can be used as a quick self-completion questionnaire for screening for depression in people who have PD.Peer-reviewedPost-prin
An exploration of worry content and catastrophic thinking in middle-aged and older-aged adults with and without Parkinson's disease

Objective: Worry is a common and distressing problem in Parkinson’s disease(PD). However, little is known about the nature and content of worry in PD and how it might differ to non-PD populations. The study aimed to explore the content and nature of worry in middle and older aged adults with and without PD.\ud
\ud
Method: 4 groups of participants: 20 PD patients(10 high worry, 10 low worry) 19 middle and older aged adults(10 high worry, 9 low worry) completed the Catastrophising Interview(CI) for three worry topics. Worriers were classified(high/low) based on Penn State Worry Questionnaire scores. Data were analysed using Framework Analysis.\ud
\ud
Results: High worriers showed a greater diversity of worry topics than low worriers. Health worries differentiated high and low worriers in the non-PD sample but were common across all PD participants. The CI revealed that the root concern of worry was often different to that initially described. In particular, PD high worriers were more likely to express underlying concerns about negative self-perception and death/severe incapacity. \ud
\ud
Conclusion: The CI was able to identify the root cause of worry, demonstrating the value of this technique in the exploration and treatment of worry and psychological distress. Exploring worry content may help to distinguish patients with problematic worry, with worries about self-perception and death/severe incapacity characteristic of high worriers. Therapeutic interventions designed to alleviate problematic worry and distress in PD need to take account of the realities of living with PD and the potentially realistic nature of worries which may appear catastrophic in a healthy population
Period, birth cohort and prevalence of dementia in mainland China, Hong Kong and Taiwan: a meta-analysis

$\textbf{Objective:}$ There have been dramatic societal changes in East Asia over the last hundred years. Several of the established risk factors could have important period and cohort effects. This study explores temporal variation of dementia prevalence in mainland China, Hong Kong and Taiwan taking study methods into account.

$\textbf{Methods:}$ Seventy prevalence studies of dementia in mainland China, Hong Kong and Taiwan were identified from 1980 to 2012. Five period groups (before 1990, 1990 ~ 1994, 1995 ~ 1999, 2000 ~ 2004 and 2005 ~ 2012) and five birth cohort groups (1895 ~ 1909, 1910 ~ 1919, 1920 ~ 1929, 1930 ~ 1939 and 1940 ~ 1950) were categorised using the year of investigation and 5-year age groups. Pooled prevalence by age, period and birth cohort groups was estimated through meta-regression model and meta-analysis taking diagnostic criteria and age structure into account.

$\textbf{Results:}$ After adjusting for diagnostic criteria, the study age range and age structure, the prevalence of dementia in the older population aged 60 years and over fluctuated across periods but not reaching signifi- cance and were estimated as 1.8%, 2.5%, 2.1%, 2.4% and 3.1% for the five periods from pre-1990 to 2005 ~ 2012. A potential increasing pattern from less to more recent birth cohort groups was found in the major studies using older diagnostic criteria with wider differences in the age groups over 70 years.

$\textbf{Conclusions:}$ This study found no significant variation across periods but suggested a potential cohort effect. The influence of societal changes might moderate early life experiences across different generations with substantial impact on mental health in older age.There is no specific funding contributing to this study. Yu-Tzu Wu received a PhD scholarship 
from the Cambridge Trust, University of Cambridge. Fiona E. Matthews and A. Matthew 
Prina were supported by the Medical Research Council [grand number U105292687 and 
MR/K021907/1]This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1002/gps.414
Exploring the cost-effectiveness of a one-off screen for dementia (for people aged 75 years in England and Wales)

Objective: This paper examines the numbers of people with dementia who could be diagnosed and the likely cost-effectiveness of a one-off screen for dementia for people aged 75 years in England and Wales.  Methods: The study uses static decision modelling to compare a one-off screen for dementia with a no-screen scenario. Estimates for the model were drawn from systematic reviews, high-quality studies and government and administrative sources. A panel of experts also advised the study.  Results: An estimated 3514 people could be diagnosed as a result of screening, 2152 of whom would otherwise never receive a diagnosis. The study identified societal economic impact of between £3 649 794 (net costs) and £4 685 768 (net savings), depending on assumptions.  Conclusions: Our analysis suggests that screening could be cost-effective, especially as treatments and social care interventions become more effective and if diagnosis by current routes remains low or occurs later than is optimal. This study was, however, limited by available evidence and a range of quality of life benefits, cost savings and potential harms could not be quantified. It was also beyond the scope of this study to consider dynamic factors such as repeat screening, mortality, disease trajectories or trends in the numbers of people with dementia. A larger study would be needed for this, involving more complex and innovative approaches to generating estimates for modelling. We did not compare population screening for people aged 75 years to other methods for increasing diagnosis rates