Characteristics and Real-Life Outcomes of Dementia and Cognitive Impairment at a Geriatric Clinic

Abstract

<b><i>Background:</i></b> Various patterns of dementia care have been developed in different settings, depending on the availability of healthcare resources and facilities. The purpose of this study was to examine the epidemiology and characteristics of dementia care at a geriatric clinic, a field that has been subject to little prior evaluation. <b><i>Methods:</i></b> A retrospective chart review was undertaken of cohort patients with cognitive impairment who had received a diagnosis and were still on active follow-up at a geriatric clinic. A total of 892 patients were included. In addition, 203 geriatric patients with no cognitive impairment who attended the clinic during the study period were sampled as a control. <b><i>Results:</i></b> The main diagnoses of dementia were Alzheimer’s disease (AD) (40.1%), vascular dementia (16.9%), unspecified dementia (16.3%), mixed dementia (9.0%), AD with cerebrovascular disease (8.7%), and Parkinson’s disease dementia (6.1%). Atypical dementia was presented in 3.0% of cases. There were 178 patients with mild cognitive impairment, 20 with vascular cognitive impairment, and 18 with subjective cognitive decline. Other comorbidities were found in 97% of the subjects. Patients with cognitive impairment had a higher total number of other geriatric syndromes and higher percentages for delirium, falls, immobility, loss of appetite, and incontinence. Potentially reversible causes of dementia were found in 11.3% of the cases. Acetylcholinesterase inhibitors were administered to 61%, whereas 23.5% received an NMDA receptor antagonist. The need for a change in the antidementia medication was identified for 10.7% of the subjects; the major cause was adverse drug side effects. Nonpharmacological therapy only was administered to 52.4% of the people with dementia who had behavioral and psychological symptoms. <b><i>Conclusions:</i></b> Mixed brain pathologies, comorbidities, and the coexistence of other geriatric syndromes are common at geriatric clinics. Holistic, integrated, and continuous care are needed to improve the outcomes of patients with more complicated comorbidities.

Prevalence, risk factors and effectiveness of falls prevention interventions for adults living with Mild Cognitive Impairment in the community: A systematic review and meta-analysis

“…Three studies were included twice in the analyses because data were collected both retrospectively and prospectively. 32,36,44 Eleven studies were not included in the analysis of prevalence due to the following reasons; duplicate fall history information, [24][25][26]29 chart audit, 69 based on 'if the participant had ever fallen', 60 based on if the participant had fallen in the last 24-months, 67 falls in the past 32-months, 61 prospective falls over 24-months 34 and reported on two or more falls. 31,59 The most common method of falls prevalence data collection was retrospectively over 12 months and was collected with a single survey question or during an interview.…”

Impact of Comorbidity Burden on Cognitive Decline: A Prospective Cohort Study of Older Adults with Dementia

“…Dementia is a complex neuropsychiatric syndrome. Although Alzheimer’s disease (AD) is considered the most common type of dementia [1], diagnosis for cognitive impairment can be very diverse and the underlying brain pathology is usually mixed [2]. Moreover, the number of comorbidities increases with age, and it is known that the majority of older adults have 2 or more comorbidities [3].…”