Category: Nevin Manimala

Dent Med Probl. 2021 Dec 31. doi: 10.17219/dmp/133664. Online ahead of print.

ABSTRACT

BACKGROUND: Postoperative pain is one of the main complications following impacted mandibular third molar (IMTM) surgery.

OBJECTIVES: The aim of this study was to assess the effect of the local application of bupivacaine on reducing early postoperative pain following IMTM surgery.

MATERIAL AND METHODS: A prospective, single-blinded, randomized controlled study was conducted on 40 patients who had undergone the surgical removal of an IMTM under local anesthesia. In the study group (n = 20), absorbable gelatin sponge (AGS) soaked in 3 mL of 0.5% plain bupivacaine hydrochloride was locally applied in the post-extraction socket. In the control group (n = 20), AGS soaked in 3 mL of normal saline was used. Pain intensity was assessed using a pain numerical rating scale (NRS) 4 and 12 h postoperatively. The variables were compared between the 2 groups and probability values <0.05 were considered statistically significant.

RESULTS: The pain scores in the study group were significantly lower than those recorded in the control group at 4 h postoperatively (p = 0.003), whereas the difference in the pain scores between the 2 groups 12 h after surgery was not statistically significant (p = 0.443).

CONCLUSIONS: The local application of bupivacaine is effective in reducing postoperative pain 4 h after the surgical extraction of IMTMs without any significant complications.

PMID:34971304 | DOI:10.17219/dmp/133664

Alzheimers Dement. 2021 Dec;17 Suppl 8:e053406. doi: 10.1002/alz.053406.

ABSTRACT

BACKGROUND: The COVID-19 pandemic has made it necessity that rehabilitation services are provided remotely to patients. These process required a transformation in healthcare. The aim of this study was investigate the effectiveness of the home-based online supervised exercise program in Alzheimer’s disease (AD). To our knowledge, this is the first study to report the results of real-time supervised physical exercise telerehabilitation program in AD.

METHOD: Eighteen subjects with early-middle stage of AD were randomised into 2 group as telerehabilitation group (TG; mean age: 77.7 ± 5.29 years; 7 Female, 3 Male) and control group (CG; mean age: 78.5 ± 7.07 years; 5 Female, 3 Male). Our primary outcome was Mini-Mental State Examination (MMSE), seconder outcomes were Timed Up&Go (TUG), One-leg Balance Test (OLBT), Functional Independence Measure (FIM), Geriatric Depression Scale-Short Form (GDS). The 6-week motor-cognitive dual-task exercise training was performed online and under the supervision of physiotherapist through videoconference. No physical or cognitive intervention was applied to the control group for 6 weeks. Subjects were assessed before and after the treatment. In statistical analysis, the change in the outcome scores was calculated (∆ = last measurement-first measurement), the difference between the groups was performed with the Mann Whitney-U Test in SPSS 22.0. Trial’s protocol is registered with Clinicaltrials.gov under number NCT04606251.

RESULT: There was a significant difference between TG and CG in favor of TG in MMSE, TUG, FIM and GDS (p<0,05); There was no significant difference between groups in OLBT (p>0,05). Statistical results have been showed in Table 1. No safety problem was observed during the treatment. All subjects were completed the study, there was a high adherence to treatment.

CONCLUSION: Physical exercise treatment with telerehabilitation was feasible, safe and well-accepted by people with early-middle stage of AD. Online-supervised exercise program can improve cognitive function, functional mobility, independence and reduce depressive symptoms.

PMID:34971285 | DOI:10.1002/alz.053406

Alzheimers Dement. 2021 Dec;17 Suppl 8:e052545. doi: 10.1002/alz.052545.

ABSTRACT

BACKGROUND: Despite the rapidly rising incidence of cognitive impairment, no current medications have proven effective for mild cognitive impairment (MCI). The Integrated dementia clinic at Dongguk University Ilsan Hospital is a nationally recognized Korean-Western (KW) clinic that provides the integrated medical service via co-consultation by both neurologists and Korean medicine neuropsychologists.

OBJECTIVE: The purpose of this study is to examine whether the integrated KW treatment prevents cognitive decline in patients with MCI as measured by changes in the Mini Mental State Examination (MMSE) scores over time.

METHOD: We retrospectively examined the medical records of patients from May 2015 to June 2020. Of 19 patients who were diagnosed as MCI, twelve MCI patients underwent MMSE at their initial visit to the clinic and at least once more over a period of up to 5 years. These twelve MCI patients divided into two groups: MMSE improvement group vs. MMSE worsening group. We performed the Wilcoxon rank sum test to compare the group achieving improvement in MMSE to decrease in MMSE. We also used the same test to assess the difference in the median length of follow-up between the two groups.

RESULT: The prevalence of MCI seen during the review period was 23% (19/82). The baseline characteristics of patients with MCI were shown in Table 1. Among those twelve MCI patients who received integrated KW treatment, 67 % (8/12) of them achieved improvement in MMSE score, which was statistically significant (p-value = 0.008) compared to those showing a decrease in MMSE score while the length of follow-up was not significantly different between the two groups. The detailed treatment and changes in MMSE presented in Table 2. For treatment from Western medicine, anticonvulsants were most commonly prescribed, and donepezil was given to 63%. Acupuncture (100%), Moxibustion (100%), and herbal medicine (Gagam-sohabhwangwon: 6/8,62.5 %) were most prescribed Korean medicine.

CONCLUSIONS: This study demonstrates, for the first time, that integrated KW treatment positively affects cognitive function in MCI patients with increases in MMSE scores over time. Further research with a larger data set, needs to be conducted to validate the effectiveness of integrative approach.

PMID:34971275 | DOI:10.1002/alz.052545

Alzheimers Dement. 2021 Dec;17 Suppl 8:e054804. doi: 10.1002/alz.054804.

ABSTRACT

BACKGROUND: The uniform standardized neuro-cognitive test is a challenge for the primary care physician due to time constraints, interpretation, and clinical use in the daily practice for dementia care.

METHOD: The DMAC was given to 318 patients presenting with memory loss in the disease group and 33 patients in the control group. The DMAC was given between 35-55 minutes after the pre-screening test. Each domain test was bundled to give a comprehensive average score of each domain in percentage: as the person’s ability to recruit neurons in the neural circuit to perform the cognitive task. The test was given individually. The domains tested include visual, auditory, delayed recall, attention, executive, number recall, disinhibition, and working memory.

RESULTS: Statistical analysis with a series of t-Tests showed the diseased group (n-318) had significantly lower scores than the control group (c-33) with confidence interval of 95% in the following domains: visual (p < 0.001), auditory (p < 0.001), delayed recall ( p < 0.001), disinhibition (p < 0.001), attention (p < 0.001), executive function (p < 0.001), numerical recall ( p < 0.001), and working memory (p < 0.001). The average sensitivity of the DMAC across these eight domains was 84.75% while the average specificity was 59.56%.

DISCUSSION: Neuropsychological test batteries have limitations as it takes 4 to 6 hours, which is not possible for the dementia group due to a short attention span and score interpretation is a challenge due to t-score and z-score reporting and selection bias of test battery. In an effort to create a comprehensive, reliable, and simple test for cognitive evaluation by a primary care physician under a controlled environment, we have created a digital mobile cognitive assessment test (DMAC) for memory loss patients with 8 common domains with simple interpretation and guidance to cognitive therapy within one software package. The DMAC has an inbuilt prescreening questionnaire to eliminate and standardize the patient selection.

CONCLUSION: The DMAC is an ideal cognitive test in an outpatient primary care setting as the results are also translated into cognitive therapy & training in simple digital media.

PMID:34971268 | DOI:10.1002/alz.054804

Alzheimers Dement. 2021 Dec;17 Suppl 8:e053351. doi: 10.1002/alz.053351.

ABSTRACT

INTRODUCTION: Neuroplasticity can only occur in an ideal body condition and establish a new synaptic connection with repeated stimulations in weak cognitive domains or circuits.

METHOD: A Two-phase study was planned as a course of memory loss treatment in an outpatient clinic for a period of 3 years. 49 of 72 acquired brain injury and dementia patients completed X≥14 sessions of cognitive therapy intervention within the period of 2-4 months. Patients selected for intervention had mild severe memory loss on MoCA Score [(9-24)/30]. The first phase of intervention was the correction of nutraceutical status and sleep optimization. The second phase of the intervention was individualized cognitive therapy (CT) by trained cognitive therapists after the Digital Mobile Assessment of Cognitive test (DMAC) was given before and after an intervention. The domains included visual, auditory, delayed recall, attention, executive, number recall, disinhibition, language, and working memory.

RESULTS: Statistical analysis of n-49 with confidence interval 95%, series paired t-tests showed in the post-intervention group, on average, scores were higher as follows: Visual domain 4.89% to 13.74% (p < 0.001), Auditory domain 8.35% to 19.72% (p < 0.001), Delayed recall 21.34% to 33.95% (p < 0.001), Disinhibition Frontal domain 6.89% to 21.80% (p < 0.001), Attention domain 9.33%, 26.12% (p < 0.001 ), Executive domain 9.81%, 23.06% ( p < 0.001), Number domain 5.22% to 17.91% (p < 0.001), and Working memory 2.96%, 29.85% (p = 0.01).

DISCUSSION: Dr. Eric Kandel, Nobel Laureate, showed that damaged neurons can synapse after repeated neuron stimulation. Physical therapy is a standard of practice after acquired brain injury, but cognitive impairment evaluation is often ignored. The systematic approach to body optimization for learning and cognitive therapy can change the course of cognitive decline in dementia or acquired brain injury.

CONCLUSION: The significant improvement in mild to severe dementia in short-term memory or patients’ ability of memory retention improved 22% to 34% in the intervention group provides statistically significant evidence that a systematic approach to cognitive therapy can reverse the course of cognitive decline.

PMID:34971240 | DOI:10.1002/alz.053351

Alzheimers Dement. 2021 Dec;17 Suppl 8:e054527. doi: 10.1002/alz.054527.

ABSTRACT

BACKGROUND: It is estimated that up to 40% of Alzheimer’s Disease and Related Dementias cases can be prevented or delayed by addressing modifiable factors including those that influence vascular risk (hypertension, obesity, smoking, physical activity, diabetes). Prevention may be particularly important in the vascular dementia subtypes. Despite the supporting evidence, the rates of medical therapy to reduce vascular risk are not well described.

METHOD: We assessed the utilization of statins, aspirin, and blood pressure (BP) medications in adults age ≥65 years cared for at NYU Langone Health, as recorded in the electronic health record. We included two cohorts: cohort 1 included patients who were diagnosed with vascular dementia (VaD) at NYU Langone Barlow Center for Memory Evaluation between January 1, 2015 and June 24, 2019. Cohort 2 extended the inclusion to seniors with VD diagnosis by any NYU Langone physician. Definitions for vascular dementia, the covariates assessed, and medications that we included in each category are shown in Tables 1-3.

RESULT: We included 419 and 3745 patients in cohort 1 and cohort 2, respectively. Table 4 shows the characteristics and medication adherence in cohorts 1 and 2. In cohort 1, the prescription rates for statins, aspirin, and BP medications were 66%, 66%, 70%. In cohort 2, the rates for statin, aspirin, and BP medications were 56%, 46%, and 65%, respectively. The differences between prescription rates in cohort 1 and 2 for the three medication groups were statistically significant (p<0.05).

CONCLUSION: Our analysis of the utilization of cardiovascular medications among patients with vascular dementia illuminates potential gaps both among patients who receive care at specialty clinics, as well as the overall population with vascular dementia. The rates of medication utilization are higher for patients under the care of cognitive neurologists. Electronic health records can help identify large cohorts of patients who may benefit from improved access to preventative measures including cardiovascular medications.

PMID:34971267 | DOI:10.1002/alz.054527

Alzheimers Dement. 2021 Dec;17 Suppl 8:e057784. doi: 10.1002/alz.057784.

ABSTRACT

OBJECTIVE: The study aims to investigate the difficulties in communicating and application of communication skills of nurses wearing Personal Protective Equipment (PPE) when interacting with persons with cognitive impairment.

METHOD: A web-based questionnaire survey was conducted among 500 registered nurses of the digital researching company in Japan in March 2021. Participants were asked to rate their difficulty in communicating with persons with cognitive impairment while under the use of PPE using a 4-point Likert scale. Further, they answered the Communication Skill Index (CSI) to evaluate the application of communication skills when interacting with a person with cognitive impairment. The CSI consists of 23 items, each ranging from 1 to 4. A high CSI score suggests frequent application of communication skills. The relationship between these factors were analyzed statistically using the Student’s t-test and Spearman’s correlation coefficient test.

RESULTS: The study participants’ mean age, proportion of women, and mean length of working experience were 40.0±9.9, 83.2%, and 14.8±9.7 respectively. All participants used facemasks, 31.2% of them used safety glasses, and 13.2% of them used medical gowns while caring for persons with cognitive impairment. The mean score of the communication difficulty was 2.6±0.8, and 55.6% of the participants found it difficult to communicate with persons with cognitive impairment while under the use of PPE. Further, participants using safety glasses and medical gowns had significantly higher communication difficulty than those who only wore facemask (p<0.05). The mean score of total CSI was 72.7±11.3, and the mean score of each item ranged from 2.6 to 3.6. “Use other words to reflect what the person with cognitive impairment has said” was the lowest, while “speak slowly” was the highest. A significant correlation was found between communication difficulty and total CSI score, and a score of 6 on CSI items, such as “use a gesture” and “ask only one question at once” (P<0.05).

CONCLUSION: Majority of the nurses wearing PPE find it difficult to communicate with persons with cognitive impairment. Thus, they must consciously apply their communication skills.

PMID:34971211 | DOI:10.1002/alz.057784

Alzheimers Dement. 2021 Dec;17 Suppl 8:e057818. doi: 10.1002/alz.057818.

ABSTRACT

BACKGROUND: The suspension of memory services during the COVID-19 pandemic delayed dementia diagnosis and access to early intervention. Some services responded to the challenge by developing a remote memory assessment pathway to comply with reduced social contact measures to protect vulnerable patients. The aim of the study was to establish whether remote model is considered a satisfactory experience within the context of the COVID-19 pandemic and to understand the factors associated with patient and carer satisfaction of remote pathway.

METHOD: 73 participants recruited from patients referred to memory clinic in West Sussex, who were assessed over a video or telephone. Participants completed an 11-item questionnaire capturing satisfaction across a range of elements, contextual items (the impact of the pandemic, loneliness, previous experience of using teleconference technology and diagnosis), as well as 3 dimensions from Patient Experience Questionnaire. Descriptive statistics are reported at a whole sample level, separated by patient and carer status. A hypothesis driven set of bivariate analyses (Spearman’s rank) was used to understand the association between overall satisfaction and key independent factors across the whole sample.

RESULTS: 73 participants were typically older adults (M=68.5, SD=13.3) and female (n=40, 54.8%). The patient was more likely to be older, feel lonely within the past week and to have used video call software when compared to the carer (p> 0.05). Participants were generally satisfied with the remote pathway with 95.8% (n=69) agreeing or strongly agreeing with the statement “Overall, I was satisfied with the assessment”. Patients and carers did not significantly differ on any satisfaction response, apart from the ease of use of technology, in which carers were more likely to find the technology easy to use (U= 432.5; p=0.01). Worry about contracting COVID and communication experience was positively associated with overall satisfaction, whilst perceived communication barriers were significantly negatively associated with overall satisfaction.

CONCLUSIONS: Remote memory assessment was a positive and satisfactory experience for most patient and carers. The remote pathway should be considered as an option available during and beyond the pandemic to improve access and patient choice of assessment modality.

PMID:34971221 | DOI:10.1002/alz.057818

Alzheimers Dement. 2021 Dec;17 Suppl 2:e058406. doi: 10.1002/alz.058406.

ABSTRACT

BACKGROUND: Traumatic brain injury (TBI) has been related to dementia, but the impact of life-course TBI on dementia remains unclear. We aimed to examine the association between lifespan TBI and dementia, and to explore whether genetic and early-life environmental factors contribute to this association.

METHOD: Within the Swedish Twin Registry,35,312 dementia-free twins (mean age 62.78 years) were followed for up to 18 years.Life-course TBI was assessed based on information from the SwedishNational Patient Registry (NPR) and participants were divided into five groups according to age at TBI occurrence (≤39, 40-49, 50-59, 60-69, and ≥70 years). Dementia and cardiovascular disease (CVD, including heart disease and stroke) diagnoses were ascertained based on medical records in the NPR and the SwedishCause of Death Register. Data were analyzed using generalized estimating equation (GEE) and conditional logistic regression.

RESULT: In multi-adjustedGEE model, the odds ratios (ORs, 95% confidence intervals [CIs]) of dementia were 1.29 (1.05-1.60) for TBI at any age, 1.01 (0.54-1.89)for TBI at ≤39 years, 1.11 (0.65-1.88) for TBI at 40-49 years, 1.66 (1.13-2.45) for TBI at 50-59 years, 1.84 (1.24-2.74) for TBI at 60-69 years, and 0.86 (0.55-1.34) for TBI at ≥70 years, respectively. In the conditional logistic regression, the OR (95% CI) of dementia for TBI at any age was 1.59 (1.04-2.45). The difference in ORs from the two models was not statistically significant (P =0.40). In joint exposure analysis, the multi-adjusted OR (95% CI) of dementia was 1.46 (1.04-2.04) for participants with TBI but no CVD and 2.64 (1.63-4.29) for those with both TBI and CVD (reference: absence of both TBI and CVD). There was significant additive (attributable proportion0.48, 95% CI 0.17-0.78) and multiplicative interactions (OR1.98, 95% CI 1.09-3.60) betweenTBI at 50-69 years and CVD on dementia.

CONCLUSION: TBI, especially occurring at age 50-69 years, is associated with increased risk of dementia, and the risk becomes greater in people with CVD.Genetic and early-life environmental factors may not account for the TBI-dementia association.

PMID:34971186 | DOI:10.1002/alz.058406

Alzheimers Dement. 2021 Dec;17 Suppl 12:e058614. doi: 10.1002/alz.058614.

ABSTRACT

BACKGROUND: People living with dementia (PLWD) have an increased susceptibility to developing adverse physical and psychological events. Internet of Things (IoT) technologies provides new ways to remotely monitor patients within the comfort of their homes, particularly important for the timely delivery of appropriate healthcare. Presented here is data collated as part of the on-going UK Dementia Research Institute’s Care Research and Technology Centre cohort and Technology Integrated Health Management (TIHM) study. There are two main aims to this work: first, to investigate the effect of the COVID-19 quarantine on the performance of daily living activities of PLWD, on which there is currently little research; and second, to create a simple classification model capable of effectively predicting agitation risk in PLWD, allowing for the generation of alerts with actionable information by which to prevent such outcomes.

METHOD: A within-subject, date-matched study was conducted on daily living activity data using the first COVID-19 quarantine as a natural experiment. Supervised machine learning approaches were then applied to combined physiological and environmental data to create two simple classification models: a single marker model trained using ambient temperature as a feature, and a multi-marker model using ambient temperature, body temperature, movement, and entropy as features.

RESULT: There are 102 PLWD total included in the dataset, with all patients having an established diagnosis of dementia, but with ranging types and severity. The COVID-19 study was carried out on a sub-group of 21 patient households. In 2020, PLWD had a significant increase in daily household activity (p = 1.40e-08), one-way repeated measures ANOVA). Moreover, there was a significant interaction between the pandemic quarantine and patient gender on night-time bed-occupancy duration (p = 3.00e-02, two-way mixed-effect ANOVA). On evaluating the models using 10-fold cross validation, both the single and multi-marker model were shown to balance precision and recall well, having F1-scores of 0.80 and 0.66, respectively.

CONCLUSION: Remote monitoring technologies provide a continuous and reliable way of monitoring patient day-to-day wellbeing. The application of statistical analyses and machine learning algorithms to combined physiological and environmental data has huge potential to positively impact the delivery of healthcare for PLWD.

PMID:34971120 | DOI:10.1002/alz.058614