| 1 | Delirium,insulin-like growth factor I,growth hormone in older inpatients显示文摘BACKGROUND Delirium is a common disorder in elderly medical inpatients with serious adverse outcomes and is characterized by sudden onset,disturbance in attention,awareness,consciousness and cognition,and often with behavioural disturbances.Central to understanding delirium,is understanding mechanisms by which body and brain wellbeing are linked and in particular how brain responses to bodily homeostatic stress is mediated.A number of studies have investigated the relationship between insulin-like growth factor I(IGF-I)and delirium in medically ill hospitalised patients with conflicting results.However,none have investigated growth hormone(GH)which is related to IGF-I via negative feedback.AIM To investigate the relationship between serum levels of IGF-I and GH,and the occurrence of delirium.METHODS Prospective,longitudinal,observational study.Consecutive elderly inpatients(aged 70+),were assessed twice weekly with Montreal cognitive assessment(MoCA),Confusion assessment method(CAM),Acute Physiology and Chronic Health Evaluation II.Delirium was defined using CAM.Previous history of dementia was evaluated with the Informant Questionnaire on Cognitive Decline in the Elderly.IGF-I and GH levels were estimated with the ELISA method.Generalized estimating equations(GEE)model was applied for the first five assessments to analyze those longitudinal data.RESULTS The sample consisted of 198 participants(mean age 80.63±6.81;range 70-97).Of these 92(46.5%)were females.Eighty six(43.4%)were identified with a history of dementia.Incident or prevalent delirium during hospitalisation was identified with CAM in 40 participants(20.2%).Evaluation of missing values with Little's MCAR test indicated that they were missing completely at random(MCARχ2=12.24,u:9,P=0.20).Using GEE for the analysis we found that low MoCA scores,low levels of IGF-I and high levels of GH were significantly associated with any delirium(prevalence,incident,or fluctuating,during the study period(Waldχ2=12.231;u:1,P<0.001,Waldχ2=7.196,u:1,P=0.007,Waldχ2=6.210;:u:1,P=0.013 respectively).CONCLUSION The results show that low levels of IGF-I,high levels of GH and low scores in cognition are independently associated with the occurrence of any delirium during the hospitalisation of medically ill older people.The results of the study supports the hypothesis that deficits in the immunoreactivity of the brain(low cerebral reserve)may be associated with delirium. | Dimitrios Adamis Iulian Coada Piet Eikelenboom Che-Sheng Chu Karen Finn Vincent Melvin John Williams David James Meagher Geraldine McCarthy | 2020 | World Journal of Psychiatry2020，10，9： | 0 |
| 2 | Months backward test:A review of its use in clinical studies显示文摘AIM: To review the use of the Months Backwards Test(MBT) in clinical and research contexts.METHODS: We conducted a systematic review of reports relating to the MBT based upon a search of Psych INFO and MEDLINE between January 1980 and December 2014. Only reports that specifically described findings pertaining to the MBT were included. Findings were considered in terms of rating procedures, testing performance, psychometric properties, neuropsychological studies and use in clinical populations.RESULTS: We identified 22 data reports. The MBT is administered and rated in a variety of ways with very little consistency across studies. It has been used to assess various cognitive functions including focused and sustained attention as well as central processingspeed. Performance can be assessed in terms of the ability to accurately complete the test without errors('MB accuracy'), and time taken to complete the test('MB duration'). Completion time in cognitively intact subjects is usually < 20 s with upper limits of 60-90 s typically applied in studies. The majority of cognitively intact adults can complete the test without error such that any errors of omission are strongly suggestive of cognitive dysfunction. Coverage of clinical populations, including those with significant cognitive difficulties is high with the majority of subjects able to engage with MBT procedures. Performance correlates highly with other cognitive tests, especially of attention, including the digit span backwards, trailmaking test B, serial threes and sevens, tests of simple and complex choice reaction time, delayed story recall and standardized list learning measures. Test-retest and inter-rater reliability are high(both > 0.90). Functional magnetic resonance imaging studies comparing the months forward test and MBT indicate greater involvement of more complex networks(bilateral middle and inferior frontal gyri, the posterior parietal cortex and the left anterior cingulate gyrus) for backwards cognitive processing. The MBT has been usefully applied to the study of a variety of clinical presentations, for both cognitive and functional assessment. In addition to the assessment of major neuropsychiatric conditions such as delirium, dementia and Mild Cognitive Impairment, the MBT has been used in the assessment of concussion, profiling of neurocognitive impairments in organic brain disorders and Parkinson's disease, prediction of delirium risk in surgical patients and medication compliance in diabetes. The reported sensitivity for acute neurocognitive disturbance/delirium in hospitalised patients is estimated at 83%-93%. Repeated testing can be used to identify deteriorating cognitive function over time.CONCLUSION: The MBT is a simple, versatile tool that is sensitive to significant cognitive impairment. Performance can be assessed according to accuracy and speed of performance. However, greater consistency in administration and rating is needed. We suggest two approaches to assessing performance- a simple(pass/fail) method as well as a ten point scale for rating test performance(467). | James Meagher Maeve Leonard Laura Donoghue Niamh O'Regan Suzanne Timmons Chris Exton Walter Cullen Colum Dunne Dimitrios Adamis Alasdair J Maclullich David Meagher | 2015 | World Journal of Psychiatry2015，5，3： | 0 |
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