scholarly journals LO57: Validation of the Ottawa 3DY in community seniors in the ED

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S47 ◽  
Author(s):  
C. Bédard ◽  
P. Voyer ◽  
D. Eagles ◽  
V. Boucher ◽  
M. Pelletier ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Mental Status ◽  
Medical Condition ◽  
Previous History ◽  
Altered Mental Status ◽  
Initial Interview ◽  
Nursing Facility ◽  
Trained Research Assistant ◽  
History Of

Introduction: Cognitive dysfunction is getting more common in geriatric emergency department (ED) patients, as the number of seniors visiting our EDs is increasing. ED guidelines recommend a systematic mental status screening for seniors presenting to the ED. As the existing tools are not suitable for the busy ED environment, we need quicker and easier ways to assess altered mental status, such as the O3DY. The purpose of this study is to assess the effectiveness of the French version of the O3DY to screen for cognitive dysfunction in seniors presenting to the ED. Methods: This is a planned sub-study of the INDEED project, which was conducted between February and May 2016 in 4 hospitals across the province of Québec. Inclusion criteria were: patients aged ≥65, with an 8-hour ED stay, admitted on a care unit, independent or semi-independent in their activities of daily living. Exclusion criteria were: patient living in a long-term nursing facility, with an unstable medical condition, pre-existing psychiatric condition or severe dementia, a delirium within the 8-hour exposure to the ED. A trained research assistant collected the following data upon initial interview: socio-demographic information, cognitive assessment (TICS-m), functional assessment (OARS) and delirium screening (CAM). The O3DY was also administered at initial interview and during patient follow-ups, as well as the CAM. Results: This study population was composed of 305 participants, of which 47.7% were men. Mean age was 76 years old (SD: 10.8). Nine of these participants had a previous history of dementia. 151 of these participants (47,04%) had a negative O3DY and 154 (47,98%) a positive O3DY at the initial encounter. When compared to the CAM, the O3DY presents a sensitivity of 85.0% (95% CI [62.1, 96.8]) and a specificity of 57.7% (95% CI [51.8, 63.6]) for prevalent delirium. When compared to the TICS, the O3DY presents a sensitivity of 76.7% (95% CI [66.4, 85.2]) and a specificity of 68.1% (95% CI [61.3, 74.3]) for cognitive impairment. The combined measure presents a sensitivity of 76.7% (95% CI [66.6, 84.9]) and a specificity of 68.4% (95% CI [61.7, 74.5]). Conclusion: A negative result to the O3DY indicates the absence of prevalent delirium or undetected cognitive impairment. The O3DY could be a useful tool for the triage nurses in the ED.

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

scholarly journals Altered Mental Status and a Retro-auricular Mass

2006 ◽  
Vol 33 (3) ◽  
pp. 317-319
Author(s):  
Lauren M. Segal ◽  
Angela Walker ◽  
Eric Marmor ◽  
Errol Stern ◽  
Mark Levental ◽  
...  
Keyword(s):  
Eye Movements ◽  
Glasgow Coma Scale ◽  
Emergency Room ◽  
Mental Status ◽  
External Auditory Canal ◽  
Posterior Wall ◽  
Altered Mental Status ◽  
Facial Paresis ◽  
Coma Scale ◽  
History Of

A 29-year-old woman was found lying unconscious in the shower. There was a two-day history of headache and dizziness. In the emergency room, she was initially stuporous (Glasgow Coma Scale 10/15), afebrile, bradycardic and hypertensive. She exhibited roving, conjugate eye movements, left facial paresis (including frontalis), left ptosis, diffuse hypotonia, extensor plantar responses bilaterally and a 1.5 cm warm, fluctuant mass with surrounding erythema behind the left ear (Figure 1). Otoscopy revealed a bulge in the posterior wall of the left external auditory canal.

Cognitive Function in Patients with Multiple Sclerosis: Impairment and Treatment

2004 ◽  
Vol 6 (1) ◽  
pp. 9-22 ◽  
Author(s):  
Stephen M. Rao
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Impairment ◽  
Cognitive Dysfunction ◽  
Disease Duration ◽  
Cognitive Domains ◽  
Neuropsychological Dysfunction ◽  
Visuospatial Abilities ◽  
Assessment And Treatment ◽  
Neurologic Disability ◽  
History Of

Cognitive impairment is common in multiple sclerosis (MS), with up to 65% of patients exhibiting some type of neuropsychological dysfunction. The cognitive domains most affected by MS are learning and memory, attention, information processing, visuospatial abilities, and executive functioning. It is difficult to detect cognitive dysfunction in patients with MS during routine neurologic examinations because conventional measures of neurologic disability are not sensitive enough to detect cognitive impairment. Furthermore, cognitive dysfunction is only weakly correlated with the type of MS, disease duration, or physical disability. However, brain imaging studies show that a relatively strong correlation exists between cognitive dysfunction and overall lesion burden and brain atrophy in MS. This paper reviews the natural history of cognitive dysfunction, areas of cognition affected, the correlation between MRI measures and cognitive dysfunction, issues related to neuropsychological assessment, and treatment of cognitive impairment with disease-modifying MS drugs.

Psychiatric Phenomena in Alzheimer's Disease. III: Disorders of Mood

1990 ◽  
Vol 157 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Alistair Burns ◽  
Robin Jacoby ◽  
Raymond Levy
Keyword(s):  
Alzheimer’S Disease ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Previous History ◽  
Ventricular Enlargement ◽  
Trained Observer ◽  
History Of ◽  
Interhemispheric Fissure ◽  
History Of Depression

Of 178 patients with AD, at least one depressive symptom was reported by 63%, 24% were rated as being depressed by a trained observer, and 43% were considered depressed by their relatives. Ten per cent had a previous history of depression. Elevated mood was rare, occurring in only six patients (3.5%). Subjects with depressive symptoms had less cognitive impairment and less ventricular enlargement on CT compared with those without symptoms. Widening of the interhemispheric fissure was associated with symptoms of mania but was inversely related to presence of depressive symptoms.

scholarly journals 714. Invasive Fungal Infection Caused by Curvularia Species in a Patient with Intranasal Drug Use: A Case Report

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S456-S457
Author(s):  
Bakri Kulla ◽  
Jason Pham ◽  
McKenna Johnson
Keyword(s):  
Case Report ◽  
Head And Neck ◽  
Mental Status ◽  
Sphenoid Sinus ◽  
Altered Mental Status ◽  
The United States ◽  
Fungal Sinusitis ◽  
Invasive Fungal Sinusitis ◽  
History Of ◽  
Curvularia Species

Abstract Background Invasive fungal infections (IFIs) are uncommon infections that account for approximately 27.2/100,000 cases per year in the United States. One form of IFI is chronic invasive fungal sinusitis (CIFS). If untreated, invasion into neighboring structures may cause altered mental status, seizures, strokes, proptosis, and intracranial complications. Case Report An afebrile 43-year-old female with a history of polysubstance abuse presented to the ED due to altered mental status, left sided facial droop, right sided hemiparesis, and slurred speech. The patient was somnolent but arousable to stimuli and appeared acutely ill. The patient’s mother reported a history of cocaine abuse, which was confirmed on urine toxicology. A CT head and neck with contrast revealed subacute basal ganglia lacunar infarcts and a left sphenoid opacity with scattered hyperintensities and erosive changes [Figure 2]. One month prior, she had been diagnosed with a left superior pole kidney mass and a left-sided enlarged periaortic lymph node containing multiple noncaseating granulomas and GMS stains positive for fungal hyphae [Figure 1]. The patient underwent nasal endoscopy with tissue biopsy. Tissue showed necrotizing invasive fungal sinusitis with granuloma formation and foreign-body giant cell reaction. Fungal speciation of the tissue culture showed Curvularia species was placed on IV voriconazole. While the infection stabilized, her neurologic deficits did not significantly improve. She was discharged to inpatient rehabilitation. Figure 1. Coronal and axial view of left upper pole kidney mass with perinephric fat stranding. Figure 2. MRI brain CTA Head and Neck with contrast in axial plane showing multifocal infarcts likely represent complications of fungal basilar meningitis secondary to the left sphenoid sinus disease. Imaging also shows irregular erosive change at the anterior aspect of the sella turcica, through the planum sphenoidale, and bony defect of the sphenoid sinus. Methods Results Conclusion Intranasal use of cocaine causes vasoconstriction to elicit sinonasal tissue ischemia. With extended use, chronic mucosal inflammation can occur that can result in sinonasal osteocartilaginous necrosis and potential for infection. CIFS is infrequently diagnosed and its indolent nature with progression over weeks or months can make diagnosis and treatment difficult. The most frequent fungal species identified are the Aspergillus species, but Curvularia species have been found as well. CT and MRI scanning can be suggestive, but are not sufficiently specific or sensitive. The main forms of interventional modalities include surgical debridement and antifungal therapy to maximize survival Disclosures All Authors: No reported disclosures

scholarly journals A Case Report of Steroid Responsive Nivolumab-Induced Encephalitis

2017 ◽  
Vol 24 (5) ◽  
pp. 107327481772906 ◽  
Author(s):  
Kaja Richard ◽  
Jacqueline Weslow ◽  
Stephanie L. Porcella ◽  
Sowmya Nanjappa
Keyword(s):  
Mental Status ◽  
Checkpoint Inhibitors ◽  
Early Recognition ◽  
Signs And Symptoms ◽  
Altered Mental Status ◽  
Oral Steroid ◽  
Gradual Improvement ◽  
Stage 4 ◽  
History Of ◽  
Intravenous Steroids

Nivolumab (Opdivo) approval for the treatment of non-small cell lung cancer (NSCLC) prompts recognition of its future use in various cancers. Although rare, occurring in 1% to 3% of treated cases, nivolumab along with other immune checkpoint inhibitors are associated with immune-related encephalitis. With its prospective use, nivolumab-induced encephalitis illustrates the necessity of early recognition and successful management to decrease morbidity and mortality. We describe a treated case of nivolumab-induced encephalitis. A 74-year-old male with a history of stage 4 squamous NSCLC presenting with insidious altered mental status following his first dose of nivolumab. After an extensive workup that proved negative, the patient received intravenous steroids with gradual improvement of mental status. Patient subsequently returned to baseline and was discharged with oral steroid taper. Nivolumab-induced encephalitis is a diagnosis of exclusion with nonspecific signs and symptoms. Immediate recognition of patients prescribed nivolumab chemotherapy could potentially prevent fatal complications of neurotoxicity.

scholarly journals Atypical symptoms with typical signs in a patient with Propionibacterium acnes related mitral valve endocarditis

2021 ◽  
Vol 9 (6) ◽  
pp. 1790
Author(s):  
Rashid Hameed ◽  
Noshine Irrum ◽  
Pankaj Saxena ◽  
Muntaser D. Musameh
Keyword(s):  
Infective Endocarditis ◽  
Propionibacterium Acnes ◽  
Medical Condition ◽  
Previous History ◽  
Causative Organism ◽  
Atypical Symptoms ◽  
Prosthetic Valves ◽  
History Of ◽  
Atypical Presentations ◽  
High Level

Infective endocarditis (IE) is a serious medical condition associated with an increase in morbidity and mortality if not treated promptly and adequately. The clinical outcome depends on the early diagnosis and aggressiveness of the causative organism. Patients usually present with typical features suggestive of Infective endocarditis but in some circumstances the presentations are atypical, and if not diagnosed and treated, may lead to serious consequences. We present a case of atypical presentations of infective endocarditis caused by Propionibacterium acnes organism with no classical features of endocarditis and had symptoms suggestive of urinary tract infection. The diagnosis of IE can be very difficult in patients with atypical clinical presentation, particularly caused by low-pathogenicity organisms. Appropriate clinical assessment and high level of suspicious especially in the patients with previous history of infective endocarditis or having prosthetic valves in situ is crucial.

scholarly journals MO154ASSESSMENT OF MILD COGNITIVE IMPAIRMENT IN PRE-DIALYSIS CHRONIC KIDNEY DISEASE AND ITS ASSOCIATION WITH INFLAMMATION AND CHANGES IN MRI: WHAT THE EYES DON´T SEE

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Leopoldo Antônio Pires ◽  
Ana Laura Maciel de Almeida ◽  
Marilise Paraizo ◽  
Debora Dias ◽  
José Otávio Correa ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Kidney Disease ◽  
Linear Regression ◽  
Previous History ◽  
Cortical Atrophy ◽  
Tnf Alpha ◽  
Inclusion Criteria ◽  
History Of

Abstract Background and Aims Mild cognitive impairment (MCI) consists of a decline of one or more cognitive domains, independent of functional impairment. There are common pathophysiological factors between chronic kidney disease (CKD) and MCI. The aim of this study was to evaluate the association of MCI in pre-dialysis CKD with inflammation markers and alterations of image exams (Nuclear Magnetic Resonance-MRI). Method Cross-sectional study, were evaluated non-dialysis CKD patients in categories 1 to 5 in a secondary care clinic, from 2013 to 2015. Inclusion Criteria: age ≥ 21 and ≤ 65 years and having signed the informed consent form. Non-inclusion criteria: previous history of stroke, degenerative and infectious diseases of the CNS, presence of delirium and / or psychotic disorders, previous history of mental retardation and cranioencephalic trauma, visual and auditory disorders that prevented the tests, HIV and / or AIDS, contraindication or intolerance to MRI. The project was approved by the Research Ethics Committee. MCI was assessed using the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR), using the CKDEPI formula. Socio-demographic and clinical data were collected from medical records. Laboratory data were collected a maximum of 3 months after the MoCA evaluation, as well as the measurement of IL4, IL6, IL17, TNF alpha and hs-CRP. The brain MRI scans were performed in a Siemens Avanto high-field device (1.5 Tesla), without the use of paramagnetic contrast. Fazekas scales were used to quantify white matter lesions, MTA scale to quantify hippocampal involvement, ACG scale for global cortical atrophy. Statistical analysis a descriptive analysis was performed, followed by a comparison of abnormal vs normal MoCA among all variables with the relevant tests; MoCA and eGFR were also correlated with all variables. Finally, we performed a linear regression using MoCA as a dependent variable, adjusting for relevant confounding variables. Results 111 patients were invited, 80 were included in the neuropsychological assessment and 56 patients performed all stages of the study. The mean age was 56.3 ± 8.3 years, 51.8% had an altered MoCA. Comparing those with altered vs normal MoCA, we observed that there were fewer years of schooling (p = 0.04), greater use of diuretics (p = 0.04) and AAS (p = 0.002); in addition to higher levels of IL6 (p = 0.02) and IL17 (p = 0.05) among those with altered MoCA. There was no correlation between MoCA and eGFR. MoCA correlated with IL6 (R-0.201, p = 0.04). There was a correlation between eGFR (IL4 (R- -0.467, p = 0.005; IL6 (R- -0.652, p <0.001); IL17 (R- -0.554, p = 0.001), TNF alpha (R- -0.684, p <0,001). There was no correlation between the findings in MRI and eGFR or MoCA. In a linear regression model, the variables IL17 and IL6 were independent predictors of lower values of MoCA (CI -0.031 to -0.002, p = 0.002; CI-0.012 to -0.001, p = 0.002). Conclusion The prevalence of changes in MoCA in this population was 51.8%, the eGFR was correlated with inflammation, MoCA was negatively correlated with IL6. There was no association between MRI findings and eGFR or inflammatory variables, and eGFR was not a predictor of MoCA values, while IL17 and IL6 were.

scholarly journals Ethnic Differences in Attending a Tertiary Dementia Clinic in Israel

2021 ◽  
Vol 11 ◽  
Author(s):  
Polina Specktor ◽  
Rachel Ben Hayun ◽  
Natalia Yarovinsky ◽  
Tali Fisher ◽  
Judith Aharon Peretz
Keyword(s):  
Health Care ◽  
Cognitive Impairment ◽  
Ethnic Differences ◽  
Previous History ◽  
Behavioral Changes ◽  
Racial Groups ◽  
Functional Abilities ◽  
Health Care Interventions ◽  
History Of ◽  
Normal Cognition

Introduction: Variations in lifestyle, socioeconomic status and general health likely account for differences in dementia disparities across racial groups. Our aim was to evaluate the characteristics of Arab (AS) and Jewish (JS) subjects attending a tertiary dementia clinic in Israel.Methods: Retrospective data regarding subjects attending the Cognitive Neurology Institute at Rambam Health Care Campus between April 1, 2010, and April 31, 2016, for complaints of cognitive decline were collected from the institutional registry. AS and consecutive JS, aged ≥50 years without a previous history of structural brain disease, were included.Results: The records of 6,175 visits were found; 3,246 subjects were ≥50 years at the initial visit. One hundred and ninety-nine AS and consecutive JS cases were reviewed. Mean age at first visit was 68.4 ± 8.8 for AS and 74.3 for JS (p < 0.0001). Mean education was 7.7 ± 4.8 years for AS and 11.3 years for JS (p < 0.0001). Mean duration of cognitive complaints prior to first visit did not differ between the groups. Initial complaints of both ethnicities were failing memory (97%) and behavioral changes (59%). Functional impairment was reported by 59% of AS and 45% of JS (p = 0.005). MMSE on first evaluation was 19.2 ± 7 for AS and 23.1 ± 5.9 for JS; p = 0.001. Alzheimer's disease was diagnosed in 32% AS and 23% JS, mild cognitive impairment in 12% AS and 21% JS. Normal cognition was diagnosed in 2% AS and 9% JS; p = 0.0001.Conclusions: Compared to JS, AS attend a tertiary clinic when their cognitive impairment already affects their functional abilities providing a comprehensive benchmark for social health care interventions to reduce disparities.

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