M. Kuzuya

Risk factors for the discontinuation of home medical care among low-functioning older patients

ObjectivesOlder patients receiving home medical care often have declining functional status and multiple disease conditions. It is important to identify the risk factors for care transition events in this population in order to avoid preventable transitions. In the present study, therefore, we investigated the factors associated with discontinuation of home medical care as a potentially preventable care transition event in older patients.MethodsBaseline data for participants in the Observational study of Nagoya Elderly with HOme MEdical (ONEHOME) study and data on the mortality, institutionalization, or hospitalisation of the study participants during a 2-year follow-up period were used. Discontinuation of home care was defined as admission to a hospital for any reason, institutionalization, or death. Univariate and multivariate Cox hazard models were used to assess the association of each of the factors with the discontinuation of home care during the observational period. The covariates included in the multivariate analysis were those significantly associated with the discontinuation of home care at the level of P<0.05 in the univariate analysis.ResultsThe univariate Cox hazard model revealed that a low hemoglobin level (< 11g/dL), low serum albumin level (< 3g/dL), higher Charlson Comorbidity Index score, and low Mini Nutritional Assessment Short Form score (< 7) were significantly associated with the discontinuation of home care. A multivariate Cox hazard model including these four factors demonstrated that all four were independently associated with home-care discontinuation.ConclusionsThe present results demonstrated that anemia, hypoalbuminemia, malnourishment, and the presence of serious comorbidities were associated with the discontinuation of home medical care among low-functioning older patients.

Neuroanatomical Correlates of Error Types on the Clock Drawing Test in Alzheimer’s Disease Patients

We sought to identify the relationship between regional cerebral blood flow (rCBF) and error types on the Clock Drawing Test (CDT) in patients with Alzheimers disease (AD).

Cognitive Dysfunction in Urban-Community Dwelling Prefrail Older Subjects

ObjectivesA number of studies have reported that frailty is cross-sectionally associated with cognitive decline and is also a risk for future cognitive decline or dementia; however, there have been only a few studies that focus on the association between prefrailty and cognitive dysfunction. In the current study, we investigated the association between prefrailty and cognitionDesignA cross-sectional study of the data obtained at registration in a randomized control trial.SettingToyota, Japan.ParticipantsCommunity-dwelling older subjects (male 54.6%) who had cognitive complaints.MeasurementsA battery of neuropsychological and physical assessments were performed. Prefrailty was defined as exhibiting one or two of the five Fried criteria (weight loss, exhaustion, weakness, slow gait speed and low physical activity). We performed a multiple regression analysis to investigate the associations of cognitive performance with prefrailty, adjusting for the factors that were significantly different between the robust and prefrailty groups. To assess the cognitive attributes that were significantly associated with prefrailty, logistic analysis was performed to see if one specific criterion of the five frailty criteria was associated with cognitive performance.ResultsThe study subjects included 183 prefrail and 264 robust individuals. The prefrail subjects with cognitive complaints were older, less educated, more depressive, and more likely to have diabetes mellitus than the robust subjects. The prefrail subjects had lower performance in a wide-range of cognitive domains, and after adjustments for age, education, depressive mood, and diabetes mellitus, prefrailty was associated with a decline in delayed memory and processing speed. Among the components of the Fried criteria, slow gait speed and loss of activity were significantly associated with slow processing speed as assessed by the digit symbol substitution test.ConclusionThe current results demonstrated that prefrailty was associated with worse memory and processing speed performance, but not with other cognitive domains.

Differences in neuropsychological performance according to neuropsychiatric symptoms in patients with Alzheimer's disease

P4-327 MONTREAL COGNITIVE ASSESSMENT (MOCA) POPULATION-BASED STUDY OF RUSSIAN ELDERLY OksanaMakeeva, Valentina Markova, Irina Zhukova, Zarui Melikyan, Larisa Minaycheva, Stepan Buikin, Elena Osinova, Marina Abushaeva, Olga Botkina, Nelly Musina, Elena Starinskaya, Natalia Zhukova, Yuka Maruyama, Michelle McCart, Heather MacDonald, Lawrence Whitley, Heather Romero, Kathleen Hayden, Brenda Plassman, Kathleen Welsh-Bohmer, Neuropsychology Testing Center, Tomsk, Russia; 2 Siberian State Medical University, Tomsk, Russia; Moscow State Lomonosov University, Moscow, Russia; Tomsk Clinical Psychiatry Hospital, Tomsk, Russia; Zinfandel Pharmaceuticals, Kamakura, Japan; 6 Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, North Carolina, United States.