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Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

ABSTRACT: In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants speci?cally examined questions of who should be screened for cognitive impairment and how they should be screened in medical settings. This is important in the context of an acute illness given that the presence of cognitive impairment can have signi?cant implications for care and for the management of concomitant diseases as well as pose a major risk factor for dementia. Participants arrived at general principles to guide future screening approaches in medical populations and identi?ed knowledge gaps to direct future research. Key learning points of the summit included: recognizing the importance of educating patients and healthcare providers about the value of assessing current and baseline cognition;emphasizing that any screening tool must be appropriately normalized and validated in the population in which it is used to obtain accurate information, including considerations of language, cultural factors, and education; andrecognizing the great potential, with appropriate caveats, of electronic health records to augment cognitive screening and tracking of changes in cognitive health over time.

SUBMITTER: Perry W

PROVIDER: S-EPMC6183165 | biostudies-other | 2018 Jun

REPOSITORIES: biostudies-other

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Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

Perry William W Lacritz Laura L Roebuck-Spencer Tresa T Silver Cheryl C Denney Robert L RL Meyers John J McConnel Charles E CE Pliskin Neil N Adler Deb D Alban Christopher C Bondi Mark M Braun Michelle M Cagigas Xavier X Daven Morgan M Drozdick Lisa L Foster Norman L NL Hwang Ula U Ivey Laurie L Iverson Grant G Kramer Joel J Lantz Melinda M Latts Lisa L Ling Shari M SM Maria Lopez Ana A Malone Michael M Martin-Plank Lori L Maslow Katie K Melady Don D Messer Melissa M Most Randi R Norris Margaret P MP Shafer David D Silverberg Nina N Thomas Colin M CM Thornhill Laura L Tsai Jean J Vakharia Nirav N Waters Martin M Golden Tamara T

Innovation in aging 20180601 2

In December 2017, the National Academy of Neuropsychology convened an interorganizational Summit on Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients in Denver, Colorado. The Summit brought together representatives of a broad range of stakeholders invested in the care of older adults to focus on the topic of cognitive health and aging. Summit participants speciﬁcally examined questions of who should be screened for cognitive impairment and how they should be sc ...[more]

PMID: 30480142

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Project description:A detailed gait analysis (e.g., measures related to speed, self-affinity, stability, and variability) can help to unravel the underlying causes of gait dysfunction, and identify cognitive impairment. However, because geriatric patients present with multiple conditions that also affect gait, results from healthy old adults cannot easily be extrapolated to geriatric patients. Hence, we (1) quantified gait outcomes based on dynamical systems theory, and (2) determined their discriminative power in three groups: healthy old adults, geriatric patients with- and geriatric patients without cognitive impairment.For the present cross-sectional study, 25 healthy old adults recruited from community (65 ± 5.5 years), and 70 geriatric patients with (n = 39) and without (n = 31) cognitive impairment from the geriatric dayclinic of the MC Slotervaart hospital in Amsterdam (80 ± 6.6 years) were included. Participants walked for 3 min during single- and dual-tasking at self-selected speed while 3D trunk accelerations were registered with an IPod touch G4. We quantified 23 gait outcomes that reflect multiple gait aspects. A multivariate model was built using Partial Least Square- Discriminant Analysis (PLS-DA) that best modelled participant group from gait outcomes.For single-task walking, the PLS-DA model consisted of 4 Latent Variables that explained 63 and 41% of the variance in gait outcomes and group, respectively. Outcomes related to speed, regularity, predictability, and stability of trunk accelerations revealed with the highest discriminative power (VIP > 1). A high proportion of healthy old adults (96 and 93% for single- and dual-task, respectively) was correctly classified based on the gait outcomes. The discrimination of geriatric patients with and without cognitive impairment was poor, with 57% (single-task) and 64% (dual-task) of the patients misclassified.While geriatric patients vs. healthy old adults walked slower, and less regular, predictable, and stable, we found no differences in gait between geriatric patients with and without cognitive impairment. The effects of multiple comorbidities on geriatric patients' gait possibly causes a 'floor-effect', with no room for further deterioration when patients develop cognitive impairment. An accurate identification of cognitive status thus necessitates a multifactorial approach.

Dataset Information

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

Publications

Population Health Solutions for Assessing Cognitive Impairment in Geriatric Patients.

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