Background Physical frailty, cognitive impairment, and symptoms of anxiety and depression frequently co-occur in later life, but, to date, each has been assessed separately. The present study assessed their patterns in primary care patients aged ≥60 years. Material/Methods This cross-sectional study evaluated 263 primary care patients aged ≥60 years in eastern Croatia in 2018. Physical frailty, cognitive impairment, anxiety and depression, were assessed using the Fried phenotypic model, the Mini-Mental State Examination (MMSE), the Geriatric Anxiety Scale (GAS), and the Geriatric Depression Scale (GDS), respectively. Patterns were identified by latent class analysis (LCA), Subjects were assorted by age, level of education, and domains of psychological and cognitive tests to determine clusters. Results Subjects were assorted into four clusters: one cluster of relatively healthy individuals (61.22%), and three pathological clusters, consisting of subjects with mild cognitive impairment (23.95%), cognitive frailty (7.98%), and physical frailty (6.85%). A multivariate, multinomial logistic regression model found that the main determinants of the pathological clusters were increasing age and lower mnestic functions. Lower performance on mnestic tasks was found to significantly determine inclusion in the three pathological clusters. The non-mnestic function, attention, was specifically associated with cognitive impairment, whereas psychological symptoms of anxiety and dysphoria were associated with physical frailty. Conclusions Clustering of physical and cognitive performances, based on combinations of their grades of severity, may be superior to modelling of their respective entities, including the continuity and non-linearity of age-related accumulation of pathologic conditions.
This paper reviews the Case-based reasoning (CBR) approach and its usability in the medicine and presents a new concept on how to improve its adaptation phase. We use the CBR as a supporting method for decision support like diseases diagnostics or therapy identification. We investigated existing approaches, studies, and research works to solve one of the most critical problems in the CBR cycle -adaptation, which is often done manually by the experts in the relevant field. Based on the findings and our experiences with medical diagnostics through suitable data analytical methods, we proposed a new solution to solve this challenge. This approach is based on a comparison of the stored decision rules with the new one related to the current case. This comparison can result in three alternative states: (1) case base contains a similar case, and relevant rule can be applied. (2) The new case is very different from the stored ones, so the input from participated experts is needed, and a new rule will be stored. (3) The new case is partially similar satisfying adaptability conditions, in such a situation we adopt related decision rule to the new conditions under the supervision of the expert. We plan to experimentally test and verify this concept within available medical samples from our previous experiments.
A single Mild cognitive impairment (MCI) is a transitional state between normal cognition and dementia. The typical diagnostic procedure relies on neuropsychological testing, which is insufficiently accurate and does not provide information on patients' clinical profiles. The objective of this paper is to improve the recognition of elderly primary care patients with MCI by using an approach typically applied in the market basket analysisassociation rules mining. In our case, the association rules represent various combinations of the clinical features or patterns associated with MCI. The analytical process was performed in line with the CRISP-DM, the methodology for data mining projects widely used in various research or industry domains. In the data preparation phase, we applied several approaches to improve the data quality like the k-Nearest Neighbour, correlation analysis, Chi Merge and K-Means algorithms. The analytical solution´s success was confirmed not only by the novelty and correctness of new knowledge, but also by the form of visualization that is easily understandable for domain experts. This iterative approach provides a set of rules (patterns) that meet minimum support and reliability. The extracted rules may help medical professionals recognize clinical patterns; however, the final decision depends on the expert. A medical expert has a crucial role in this process by enabling the link between the information contained in the rules and the evidence-based knowledge. It markedly contributes to the interpretability of the results.
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