Improved Evaluation and Management of Cognitive Impairment: Results of a Comprehensive Intervention in Long-term Care
Journal of the American Medical Directors AssociationPublished 24 October 2005
Cynthia Barton, Bruce L. Miller, Kristine Yaffe
Citations24
SJR quartileQ1
SJR score1.43
SNIP1.45
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Initial results confirmed the underdiagnosis and undertreatment of CI in the authors' long-term care facility and resulted in increased identification of etiology and improved plans for management of patients with CI.
Abstract
Initial results confirmed the underdiagnosis and undertreatment of CI in our long-term care facility. Our intervention with educational programs, increased documentation of cognitive status, and consultation resulted in increased identification of etiology and improved plans for management of patients with CI.
Keywords
MedicineHealth Professions
Journal of Psychiatric Research“Mini-mental state”
86,858 Citations1975Marshal F. Folstein, Susan E. Folstein +1 more
A simplified, scored form of the cognitive mental status examination, the “Mini-Mental State” (MMS) which includes eleven questions, requires only 5-10 min to administer, and is therefore practical to use serially and routinely.
Journal of the American Geriatrics SocietyThe Mini‐Mental State Examination: A Comprehensive Review
5,133 Citations1992Tom N. Tombaugh, Nancy J. McIntyre
The purpose of this paper is to provide a comprehensive review of information accumulated over the past 26 years regarding the psychometric properties and utility of the Mini‐Mental State Examination (MMSE).
Archives of General PsychiatryThe Mini-Mental State Examination
1,904 Citations1983Marshal F. Folstein
The Mini-Mental State Examination was designed as a clinical method for grading cognitive impairment and produces a score that can be used to follow the course of patients or as a case detection technique after cutoff scores are established.
NeurologyPractice parameter: Management of dementia (an evidence-based review) [RETIRED]
1,722 Citations2001Rachelle S. Doody, J E Stevens +9 more
The LancetEfficacy of rivastigmine in dementia with Lewy bodies: a randomised, double-blind, placebo-controlled international study
1,183 Citations2000Ian G. McKeith, Teodoro del Ser +7 more
Rivastigmine 6-12 mg daily produces statistically and clinically significant behavioural effects in patients with Lewy-body dementia, and seems safe and well tolerated if titrated individually.
JAMAPatient and Caregiver Characteristics and Nursing Home Placement in Patients With Dementia
898 Citations2002Kristine Yaffe
Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia and interventions directed at delaying placement, such as reduction of caregiver burden or difficult patient behaviors, need to take into account the patient and caregivers as a unit.
The LancetLong-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial
896 Citations2004Carol A. Courtney
Donepezil is not cost effective, with benefits below minimally relevant thresholds, and more effective treatments than cholinesterase inhibitors are needed for Alzheimer's disease.
Annals of Internal MedicineA Predictive Model for Delirium in Hospitalized Elderly Medical Patients Based on Admission Characteristics
865 Citations1993Sharon K. Inouye, Catherine M. Viscoli +3 more
The focus of this study was to better define host or baseline vulnerability factors that would assist clinicians in identifying, at admission, those patients with a high risk for developing delirium during hospitalization.
The GerontologistReliability Estimates for The Minimum Data Set for Nursing Home Resident Assessment and Care Screening (MDS)
752 Citations1995C. Hawes, Jack Morris +4 more
The process of testing the reliability of the MDS items in 13 nursing homes in five states demonstrates that MDS data gathered in a research effort attain reliabilities that make such data useful.
Journal of Pain and Symptom ManagementPain in cognitively impaired nursing home patients
628 Citations1995Bruce A. Ferrell, Betty Ferrell +1 more
It is concluded that cognitive impairment among elderly nursing home residents present a substantial barrier to pain assessment and management, Nonetheless, most patients with mild to moderate cognitive impairment can be assessed using at least one of the available bedside assessment scales.
PubMedEfficacy of cholinesterase inhibitors in the treatment of neuropsychiatric symptoms and functional impairment in Alzheimer disease: a meta-analysis.
515 Citations2003Nhi‐Ha Trinh, Jennifer Hoblyn +2 more
It is indicated that cholinesterase inhibitors have a modest beneficial impact on neuropsychiatric and functional outcomes for patients with AD and future research should focus on how such improvements translate into long-term outcomes such as patient quality of life, institutionalization, and caregiver burden.
Archives of Internal MedicineThe Detection of Dementia in the Primary Care Setting
507 Citations2000Victor Valcour, Kamal Masaki +2 more
Dementia is often unrecognized and undocumented in private practice settings and recognition and documentation rates increased with advancing stage of disease.
Journal of the American Geriatrics SocietyDementia as a Risk Factor for Falls and Fall Injuries Among Nursing Home Residents
473 Citations2003Carol van Doorn, Ann L. Gruber‐Baldini +8 more
To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries.
Journal of General Internal MedicineBarriers to excellent end-of-life care for patients with dementia
423 Citations2004Greg A. Sachs, Joseph W. Shega +1 more
The most important and persistent challenges to providing excellent end-of-life care for patients with dementia are discussed, including dementia not being viewed as a terminal illness; the nature of the course and treatment decisions in advanced dementia; assessment and management of symptoms; the caregiver experience and bereavement; and health systems issues.
NeurologyDonepezil in vascular dementia
381 Citations2003David Wilkinson, Rachelle S. Doody +6 more
Donepezil-treated patients demonstrated significant improvements in cognition and global function compared with placebo- treated patients, and donepezil was well tolerated.
Journal of the American Geriatrics SocietyA Randomized, Double‐Blind, Placebo‐Controlled Study of the Efficacy and Safety of Donepezil in Patients with Alzheimer's Disease in the Nursing Home Setting
370 Citations2001Pierre N. Tariot, Jeffrey L. Cummings +5 more
The safety and efficacy of donepezil in the management of patients with Alzheimer's disease residing in nursing home facilities is evaluated.
NeurologyPractice parameter: Management of dementia (an evidence-based review)
352 Citations2001Barry Oken
The uncorrected, first-pass data analysis revealed no significant beneficial effect of vitamin E and there were no significant effects on cognitive measures in the study, certainly raising the possibility that any poorly defined effect of Vitamin E on the outcome measure may have nothing specifically to do with AD.
Journal of the American Geriatrics SocietyDonepezil Is Associated with Delayed Nursing Home Placement in Patients with Alzheimer's Disease
314 Citations2003David Geldmacher, George Provenzano +3 more
The relationship between donepezil treatment and time to nursing home placement (NHP) for patients with Alzheimer's disease (AD) is assessed.
Journal of the American Geriatrics SocietyEarly Diagnosis of Alzheimer's Disease: Clinical and Economic Benefits
303 Citations2003Bennett P. Leifer
Early intervention is the optimal strategy, not only because the patient's level of function will be preserved for a longer period, but also because community‐dwelling patients with AD incur less societal cost than those who require long‐term institutional placement.
The GerontologistThe Prevalence of Dementia in a Statewide Sample of New Nursing Home Admissions Aged 65 and Older
302 Citations2000Jay Magaziner, Pearl S. German +6 more
Results suggest that the level of medical supervision provided in nursing homes may not be required for some residents with dementia, and there was considerable overlap in the comorbid status of demented and nondemented admissions.
The LancetPrevalence of dementia in institutional care
192 Citations2002Fiona E. Matthews, Tom Dening
Dementia prevalence in residential and nursing care homes was 62% (52-71), and was slightly higher in women than in men, with no increase by age, which has implications for the type of care that institutions provide.
Journal of the American Geriatrics SocietyThe Validity of the Minimum Data Set in Measuring the Cognitive Impairment of Persons Admitted to Nursing Homes
173 Citations2000Ann L. Gruber‐Baldini, Sheryl Zimmerman +2 more
This study examined the construct validity of two cognitive scales from the federally mandated Minimum Data Set (MDS) of the nursing home Resident Assessment Instrument.
Annals of Internal MedicineImproving Adherence to Dementia Guidelines through Education and Opinion Leaders
120 Citations1999David Gifford, Robert G. Holloway +5 more
A randomized, controlled trial to evaluate a multifaceted, evidence-based educational program to enhance the adoption of practice recommendations for the care of patients with dementia that were endorsed by the American Academy of Neurology (AAN) and local opinion leaders.
Journal of the American Geriatrics SocietyThe Incremental Effect of Dementia‐Related Problem Behaviors on the Time to Nursing Home Placement in Poor, Frail, Demented Older People
98 Citations2003Victoria Phillips, Sadhna Diwan
To examine the incremental effect of dementia‐related problem behaviors (DRPBs) on the risk of and time to nursing home placement (NHP) in poor, frail, demented older people.
NeurologyBehavior and treatment in frontotemporal dementia
92 Citations2001Richard Perry, Bruce L. Miller
The authors review the behavioral changes seen in frontotemporal dementia and describe pharmacologic interventions for these behavioral syndromes.
International Journal of Geriatric PsychiatryChallenging behaviours in nursing home residents with dementia: a randomized controlled trial of multidisciplinary interventions
73 Citations2002Janet Opie, Colleen Doyle +1 more
To test the premise that individually tailored psychosocial, nursing and medical interventions to nursing home residents with dementia will reduce the frequency and severity of behavioural symptoms.
Humana Press eBooksEarly Diagnosis of Alzheimer’s Disease
55 Citations2000Kirk R. Daffner, Leonard F. M. Scinto
Alzheimer Disease & Associated DisordersHow Well Are Clinicians Following Dementia Practice Guidelines?
43 Citations2002Craig S. Rosen, Helen C. Chow +5 more
Clinicians' choices of medications for cognition, mood, and behavior problems were broadly consistent with current practice guidelines and suggest possible priorities for quality improvement efforts.
Journal of the American Geriatrics SocietyDementia Diagnostic Guidelines: Methodologies, Results, and Implementation Costs
38 Citations2000Cornelia Beck, Marisue Cody +3 more
Five guidelines and four consensus statements on specific diagnostic recommendations, specialist referral recommendations, and costs of recommended diagnostic procedures were compared and summarized to facilitate the diagnostic process for dementia.
JAMAEfficacy of Cholinesterase Inhibitors in the Treatment of Neuropsychiatric Symptoms and Functional Impairment in Alzheimer Disease
37 Citations2003Nhi‐Ha Trinh, Subhanjoy Mohanty +2 more
American Journal of Geriatric PsychiatryA Pilot Program of Improved Methods for Community-Based Screening for Dementia
32 Citations2001Janet M. Lawrence, Donald A. Davidoff +3 more
Two cognitive screening instruments, the Mini-Mental State Exam and the Seven-Minute Screen, were compared and it was suggested that the 7MS and the MMSE may have different sensitivities and specificities for the detection of early dementia.
Drugs & AgingDonepezil
30 Citations2003David Goldsmith, Lesley J. Scott
Donepezil 5 or 10mg once daily provided significant improvements in cognition, as determined by the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog), relative to placebo, after 24 weeks in patients with VaD.
Journal of the American Geriatrics SocietyDONEPEZIL FOR NURSING HOME PATIENTS WITH DEMENTIA: A REINTERPRETATION OF THE EVIDENCE ‐ (Letter referred to the authors of the original paper)
9 Citations2003Michael A. Steinman, Kenneth E. Covinsky
This study shows no evidence of benefit in the treatment of behavioral problems in nursing home patients with dementia, and the authors are too quick to dismiss the lack ofbenefit in activities of daily living—an important metric for patients and caregivers.
Alzheimer Disease & Associated DisordersEvaluation of the Diagnosis and Management of Cognitive Impairment in Long-term Care
6 Citations2003Cynthia Barton, Bruce Miller +1 more
Although depressive and behavioral symptoms were frequently diagnosed and interventions initiated, the diagnosis and management of cognitive impairment were often imprecise or absent, so that greater numbers of patients can benefit from recommended strategies.
Journal of the American Medical Directors AssociationNew Approaches to Treatment of Dementia: Optimizing Resident Function and Caregiver Efficiency
2 Citations2002Eric C. Tangalos, Marc Agronin
The provider’s goal should be to improve the course of the disease and treat associated psychiatric conditions, according to Dr. Agronin, who noted that only half of patients with dementia have been diagnosed and only a quarter are actually being treated for the disease.