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Background Benzodiazepine prescription is common among the Irish patient cohort. 23% of medical card holders have been prescribed a benzodiazepine or Z-drug, with a third of these being for a period longer than three months. This is despite these drugs being associated with addiction, falls, cognitive and psychomotor impairment, mood disorder, sleep automatism and drug interactions. We performed an audit looking at the repeat prescriptions of patients attending a geriatric day hospital. Methods The repeat prescriptions of all patients currently enrolled at a day hospital were analysed for benzodiazepines or Z-drugs. Medical records were then analysed to look for indication and whether these patients were currently attending psychiatric services. Subsequent to this, notices were placed in the patient consult room in direct line of sight of the registrar reminding them to consider weaning these drugs and detailing the negative side effects and guidelines for weaning from the Canadian National Pain Centre. Results 59 patients were enrolled at the day hospital when the audit was performed. 11 (19%) had either a benzodiazepine or Z-drug as part of their repeat prescription (benzodiazepine-5, Z-drug-5, both-1). The most common benzodiazepines prescribed were diazepam and clonazepam (2 patients on each). Of those prescribed a benzodiazepine, none were currently being weaned. Of those on benzodiazepines, 4 of 6 had a documented psychiatric diagnosis, and 1 of 6 had documented that they were currently attending psychiatric services. A re-audit three months later showed no change in those prescribed benzodiazepines (5/59), and a non-significant increase in those on Z-drugs (9/59, p=0.26). Conclusion This audit showed a significant number of patients attending our day hospital are being prescribed long term benzodiazepines or Z-drugs, and highlights that this setting is an opportune time and place to establish a supported program to wean people off these medications. [ABSTRACT FROM AUTHOR]

Introduction The Motoric Cognitive Risk Syndrome has highlighted the link between cognitive and motor performance, and the associated incremental higher risk of developing dementia. There is considerable debate regarding what aspects of cognition (working memory, executive function, attention) are most associated with gait changes. This study investigates the relationship between mobility scores and cognitive profiles in individuals with Mild Cognitive Impairment (MCI) specifically with regard to executive performance and amnestic/non-amnestic profiles. Method Participants diagnosed with MCI, (Clinical Dementia Rating scale global score of ≤0.5, sum of boxes score ≤ 4.0), attending a regional specialist memory service had a three-meter Timed Up and Go (TUG) gait assessment and multi-domain neuropsychiatric assessment undertaken. Amnestic neuropsychiatric profile was defined as Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) delayed memory subset score < 1SD i.e. ≤16th centile below norm for age/education. Executive function performance was assessed using the Executive Interview (EXIT-25) where higher scores reflect poorer executive performance. Results Data was reviewed for 161 patients with MCI; 53% (86/161) women. 80% (129/161) had an amnestic neuropsychiatric profile, mean age 73.8 ± 7.2 (51–94). 20% (32/161) had non-amnestic MCI, mean age 74 ± 7.07 (60–87). There was no significant difference in TUG results between amnestic and non-amnestic MCI patients (11.2 ± 3.3 vs 10.7 ± 3.1 p = NS). There was a significant increase in TUG values with worsening executive function performance [EXIT-25 score 0–9 (88/161) mean TUG = 10.5 ± 3.3 seconds vs EXIT-25 score 10–14 (43/161) mean TUG =11.9 ± 2.8 seconds vs EXIT-25 score 15–25 (30/161) mean TUG = 12.1 ± 3.9 seconds; p = 0.021] which persisted after controlling for age, gender and other relevant cofactors. Discussion Reflective of the importance of frontal lobe integration to the respective tasks, subtle differences in gait performance are associated with executive function performance regardless of predominant amnestic or non-amnestic MCI profile. [ABSTRACT FROM AUTHOR]

Introduction People with mild cognitive symptoms often require diagnostic clarity and with the advent of disease modifying therapies for Alzheimer's disease (ad), establishing diagnostic accuracy for amyloid and tau pathology in ad will become more clinically relevant. CSF biomarker analysis via lumbar puncture (LP) is the most accurate and cost-effective means of establishing ad pathology. Despite their clinical validation, few centres offer LP biomarker analysis, frequently citing patient intolerance and reluctance as factors. This study aimed to assess memory clinic patients' tolerance of LP as a diagnostic tool in the work-up of memory symptoms. Method A consecutive sample of patients offered CSF analysis as part of their diagnostic plan in a tertiary memory service of a University Teaching Hospital were included. After clinician discussion, an LP for ad biomarker detection is offered to all patients with amnestic/non-amnestic mild cognitive impairment, or those with atypical motor-cognitive symptoms in this service. Results 119 patients offered an LP from 2019–2020 were contacted, fifty-four (45%) of whom participated in this study. The average age was 70.1 (±7.5) years, 50% female. Forty-two (42/54, 78%) had an LP performed. More women declined an LP than men (8/12, 66%). Almost all of those who had an LP, (38/42, 90.4%) thought it yielded useful information. Side effects included mild back pain relieved with simple analgesia (11/42, 26%) and headache (3/42, 7%). There were no incidences of neurological sequelae or requirements for dural patch. Of the 12/54 (22%) who declined CSF analysis; reasons included pre-existing back pain (3/12, 25%), needle phobia (3/12, 25%), and only 2/12, (16%) declined because they did not wish to know the results. Conclusion This study highlights high levels of acceptance of CSF analysis when offered as part of routine care, with infrequent side effects. Most patients found the clinical information yielded was useful. [ABSTRACT FROM AUTHOR]

Introduction: Fear of falling (FOF) is associated with a range of adverse health outcomes including increased risk of falls1, and more rapid decline in physical and cognitive function2. We aim to determine the prevalence of FOF amongst ambulatory community dwelling older adults attending an Age-Related Day Hospital, and to describe it’s associations with cognition, mood disorders, frailty and mobility measures. Methods: A retrospective chart review was conducted on 50 patients attending the Day Hospital. Baseline demographics collected include comorbidities, medications, and falls history. Objective mobility measurements include the Timed Up and Go (TUG) test and grip strength. Patients were divided into two groups based on their answer to the question, “Are you afraid of falling?” Differences between groups were compared using chi-squared test. Results: The average age of Day Hospital attendees was 85 (SD X). 62% were male.Three quarters of patients experienced a recent fall, and half admitted to FOF. Those with FOF were more likely to be dependent in personal care (27% vs 16%, p=0.15) and use a walking aid (69% vs 58%, p=0.02). They were also more likely to be prescribed psychoactive medications (53% vs 45%, p=0.42), and have a diagnosis of anxiety (4% vs 0%, p=0.03). Conclusions: Both having a falls history and FOF is prevalent in our Day Hospital population. FOF is associated with high physiological risk of falling, increased dependency, and anxiety. Standardization of mobility measures and potential screening for cognitive and mood disorders in patients with FOF will aid in further development of targeted interventions. [ABSTRACT FROM AUTHOR]

Background: A scholarly focus on informant history is recent in geriatric medicine, mostly focused on cognition and syncope. Gait disorders are common in older people and accurate diagnosis facilitates treatment. As there is a disparity between self-rated and ‘objective’ estimates of health among older people, and gait disorders often co-exist with cognitive impairment, there may be a significant difference between patient and informant narratives of gait disorder. We investigated the existence and extent of this disparity. Methods: As no suitable informant measure could be sourced from the biomedical literature, inquiry with senior academic physiotherapists or through appeals on social media relating to physiotherapy, a mobility scale was designed. We included all patients with a gait disorder at serial outpatient clinics. Exclusion criteria were absence of gait disorder and dementia of sufficient severity to be unable to participate in the consent process. Paired t tests and Fischer exact test were used to analyse the data. Results: Of 45 participants (mean age 79.8; 50% men), 35 (77.7%) had MCI or dementia. Twenty two (47.8%) informants considered an acute event precipitated an acute deterioration in mobility. Twenty seven informants (60%) had a fear of the older person falling compared to 9 (20%) of patients (p=0.0002). Patient and informant impression of point on mobility scale differed (t=3.61, p=0.0003). Although Informants reported more falls (mean of 1.36 vs 0.91) in the previous year (t=1.63, p=0.055) this did not achieve statistical significance. Conclusions: Our findings demonstrate a discrepancy between patient and informant narratives of level of mobility, and point to the benefit of obtaining an informant history of loss of gait stability, mobility and falls. In addition, perceptions of fear of falling may be of assistance in managing risk and independence. [ABSTRACT FROM AUTHOR]