Search

Introduction: Frailty, a measure of biological aging, has been linked to worse COVID-19 outcomes. However, as the mortality differs across the COVID-19 waves, it is less clear whether a medical record-based electronic frailty index (eFI) that we have previously developed for older adults could be used for risk stratification in hospitalized COVID-19 patients. Objectives: The aim of the study was to examine the association of frailty with mortality, readmission, and length of stay in older COVID-19 patients and to compare the predictive accuracy of the eFI to other frailty and comorbidity measures. Methods: This was a retrospective cohort study using electronic health records (EHRs) from nine geriatric clinics in Stockholm, Sweden, comprising 3,980 COVID-19 patients (mean age 81.6 years) admitted between March 2020 and March 2022. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the Clinical Frailty Scale, and the Hospital Frailty Risk Score. Comorbidity was measured using the Charlson Comorbidity Index. We analyzed in-hospital mortality and 30-day readmission using logistic regression, 30-day and 6-month mortality using Cox regression, and the length of stay using linear regression. Predictive accuracy of the logistic regression and Cox models was evaluated by area under the receiver operating characteristic curve (AUC) and Harrell's C-statistic, respectively. Results: Across the study period, the in-hospital mortality rate decreased from 13.9% in the first wave to 3.6% in the latest (Omicron) wave. Controlling for age and sex, a 10% increment in the eFI was significantly associated with higher risks of in-hospital mortality (odds ratio = 2.95; 95% confidence interval = 2.42–3.62), 30-day mortality (hazard ratio [HR] = 2.39; 2.08–2.74), 6-month mortality (HR = 2.29; 2.04–2.56), and a longer length of stay (β-coefficient = 2.00; 1.65–2.34) but not with 30-day readmission. The association between the eFI and in-hospital mortality remained robust across the waves, even after the vaccination rollout. Among all measures, the eFI had the best discrimination for in-hospital (AUC = 0.780), 30-day (Harrell's C = 0.733), and 6-month mortality (Harrell's C = 0.719). Conclusion: An eFI based on routinely collected EHRs can be applied in identifying high-risk older COVID-19 patients during the continuing pandemic. [ABSTRACT FROM AUTHOR]

Introduction: While alcohol overconsumption is regarded as a risk factor for Alzheimer's disease, the specific relationship between alcohol consumption and cognitive impairment remains unclear and poorly understood. Our primary objective is to investigate whether alcohol consumption is associated with lower cognitive performance at an early phase of the development of cognitive impairment (mild cognitive impairment [MCI] stage) and second to present the clinical and demographic characteristics depending on the grade of alcohol consumption. Methods: This is a cross-sectional observational study, including 251 subjects with the diagnosis MCI, having caregiving contact with Memory Clinic, Karolinska University Hospital, under year 2015. We compared subgroups with different levels of alcohol consumption, concerning social parameters, cognitive, radiological, laboratory profile as well as comorbidities and burden of drugs. Results: Mini-mental State Examination score was not associated with alcohol consumption. Light to moderate drinkers were significantly higher educated. There were significantly more subjects using antianxiety medications among heavy drinkers in comparison with light to moderate drinkers. Finally, never/rare drinkers had significantly lower levels of erythrocyte mean corpuscular volume in their blood tests. Discussion/Conclusion: Alcohol consumption was not correlated with a more pronounced cognitive deficit or a distinct clinical severity at an early stage of cognitive impairment apart from higher usage of antianxiety medications. We are planning to follow up all individuals to ascertain if heavy drinkers have a different outcome compared with the other groups. [ABSTRACT FROM AUTHOR]

Introduction: While alcohol overconsumption is regarded as a risk factor for Alzheimer's disease, the specific relationship between alcohol consumption and cognitive impairment remains unclear and poorly understood. Our primary objective is to investigate whether alcohol consumption is associated with lower cognitive performance at an early phase of the development of cognitive impairment (mild cognitive impairment [MCI] stage) and second to present the clinical and demographic characteristics depending on the grade of alcohol consumption. Methods: This is a cross-sectional observational study, including 251 subjects with the diagnosis MCI, having caregiving contact with Memory Clinic, Karolinska University Hospital, under year 2015. We compared subgroups with different levels of alcohol consumption, concerning social parameters, cognitive, radiological, laboratory profile as well as comorbidities and burden of drugs. Results: Mini-mental State Examination score was not associated with alcohol consumption. Light to moderate drinkers were significantly higher educated. There were significantly more subjects using antianxiety medications among heavy drinkers in comparison with light to moderate drinkers. Finally, never/rare drinkers had significantly lower levels of erythrocyte mean corpuscular volume in their blood tests. Discussion/Conclusion: Alcohol consumption was not correlated with a more pronounced cognitive deficit or a distinct clinical severity at an early stage of cognitive impairment apart from higher usage of antianxiety medications. We are planning to follow up all individuals to ascertain if heavy drinkers have a different outcome compared with the other groups. [ABSTRACT FROM AUTHOR]

Background/Aims: The use of structural brain imaging [computed tomography (CT)/magnetic resonance imaging (MRI)] and the analysis of cerebrospinal fluid biomarkers are included in the guidelines for the diagnosis of dementia. The influence of variables such as age, gender and disease severity on the use of MRI, CT and lumbar puncture (LP) for the differential diagnosis of dementia and the consonance with the recommendations of the Swedish national guidelines were investigated. Methods: From the National Swedish Dementia Registry (SveDem), 17,057 newly diagnosed dementia patients were included in our study, with the majority from specialist care units (90%). Results: In the diagnostic workup, a CT was performed in 87%, MRI in 16% and LP in 40% of the cases. Age (p < 0.001) and cognitive status (p < 0.001) significantly influenced the use of MRI, CT or LP. Older patients with severe dementia were often investigated with CT. LP and MRI were used more often when less common dementia disorders were suspected. Conclusion: Our findings indicate that age, severity of cognitive impairment and the type of dementia disorder suspected are determinants for the choice of CT, MRI or LP. The majority of the dementia workups in specialist care units follow the recommendations of the Swedish national guidelines where CT is performed as a basic workup, and MRI and LP are chosen when extended workup is needed. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background/Aims: We aimed to study whether there are differences between dementia disorders and the use of anti-dementia drugs and antipsychotics (neuroleptics) in a large population of dementia patients. Methods: Information about dementia disorders was obtained from the national Swedish Dementia Registry (SveDem) 2007-2010 (n = 7,570). Multivariate logistic regression analysis was performed to investigate the association between dementia disorders and the use of anti-dementia drugs and antipsychotics, after adjustment for age, sex, residential setting, living alone, MMSE score and number of other drugs (a proxy for overall co-morbidity). Results: More than 80% of the Alzheimer's disease (AD) and 86% of dementia with Lewy bodies (DLB) patients used anti-dementia drugs. Women were more likely than men to be treated with cholinesterase inhibitors. A higher MMSE score was positively associated with the use of cholinesterase inhibitors, but negatively associated with NMDA receptor antagonists and antipsychotics. Use of antipsychotics was 6% overall; however, it was 16% in DLB patients with an adjusted odds ratio of 4.2 compared to AD patients. Conclusion: Use of anti-dementia drugs in AD was in agreement with Swedish guidelines. However, use of antipsychotics in DLB patients was high, which might be worrying given the susceptibility of DLB patients to antipsychotics. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aims: We examine the dementia assessment with focus on age and gender differences. Methods: Data from the national quality database, Swedish Dementia Registry (SveDem), including 6,937 dementia patients diagnosed during 2007-2009 at memory clinics were used. We have studied the use of investigations for dementia diagnostics such as cognitive tests, blood and cerebrospinal fluid analyses, electroencephalography, radiological examinations and assessments of functions. Severity of cognitive impairment was assessed with the Mini Mental State Examination (MMSE). Results: There was a significant decrease in the number of total tests used in the elderly group (>75 years) when compared with the middle-aged group (65-75 years) and younger patients (<65 years). The oldest group was examined with 4 of 11 possible tests, the middle-aged group had 5/11 tests performed and the youngest age group 6/11 tests. There was also a significant gender difference in the diagnostic workup, however, mostly attributable to age. The number of tests positively correlated with the level of cognition assessed by the MMSE. Conclusion: We show here for the first time the impact of age, gender and MMSE score on the dementia diagnostic workup in a large memory clinic patient population in one country. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]