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Elderly Drivers with Cognitive Impairment


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41. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope

recovery. The presumed mechanism is cerebral hypoperfusion. , There should not be clinical features of other nonsyncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness (ie, pseudosyncope). , Loss of consciousness A cognitive state in which one lacks awareness of oneself and one’s situation, with an inability to respond to stimuli. Transient loss of consciousness Self-limited loss of consciousness can be divided into syncope and nonsyncope (...) age of 62 years (all age >45 years), 364 reported an episode of syncope in their lifetime; the estimated prevalence of syncope was 19%. Females reported a higher prevalence of syncope (22% versus 15%, P <0.001). The incidence follows a trimodal distribution in both sexes, with the first episode common around 20, 60, or 80 years of age and the third peak occurring 5 to 7 years earlier in males. Predictors of recurrent syncope in older adults are aortic stenosis, impaired renal function

2017 American Heart Association

42. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

and hypercapnea, intrathoracic pressure swings, and increased sympathetic nervous activity that accompanies disordered breathing during sleep. Individuals with OSA often feel unrested, fatigued, and sleepy during the daytime. They may suffer from impairments in vigilance, concentration, cognitive function, social interactions and quality of life (QOL). These declines in daytime function can translate into higher rates of job-related and motor vehicle accidents. Patients with untreated OSA may be at increased (...) exclude the possibility of OSA. Specificity tends to be lower, resulting in a higher number of false positives that further limit the utility of these clinical or morphometric rules and models in the diagnosis of OSA. It should also be noted that some of these studies were conducted in focused populations (e.g., commercial drivers, elderly, bariatric surgery patients, etc.), thus limiting generalizability. The following discussion has been organized to review the data by questionnaire or clinical

2017 American Academy of Sleep Medicine

43. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable (...) adult CHD (ACHD) admissions to an intensive care unit, abnormal thyroid, creatinine, and bilirubin tests were highly pre- dictive of both intensive care unit and hospital mortal- ity. 19 Furthermore, comorbidities can be costly. A recent study demonstrated renal insufficiency as a primary driver of high resource use for ACHD hospitalizations, which account for only 10% of the admissions but make up one third of the total hospital charges. 20 The impact of noncardiac comorbidities on both car- diac

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2017 American Heart Association

44. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

and Obesity e28 5.2.2. Sodium Intake e29 5.2.3. Potassium e29 5.2.4. Physical Fitness e29 5.2.5. Alcohol e29 5.3. Childhood Risk Factors and BP Tracking e31 5.4. Secondary Forms of Hypertension e32 5.4.1. Drugs and Other Substances With Potential to Impair BP Control e32 5.4.2. Primary Aldosteronism e32 5.4.3. Renal Artery Stenosis e34 5.4.4. Obstructive Sleep Apnea e34 6. Nonpharmacological Interventions e35 6.1. Strategies e35 6.2. Nonpharmacological Interventions e35 7. Patient Evaluation e38 7.1 (...) . Racial and Ethnic Differences in Treatment e61 10.2. Sex-Related Issues e61 10.2.1. Women e62 10.2.2. Pregnancy e62 10.3. Age-Related Issues e63 10.3.1. Older Persons e63 10.3.2. Children and Adolescents e64 11. Other Considerations e64 11.1. Resistant Hypertension e64 11.2. Hypertensive Crises—Emergencies and Urgencies e65 11.3. Cognitive Decline and Dementia e68 11.4. Sexual Dysfunction and Hypertension e69 11.5. Patients Undergoing Surgical Procedures e69 12. Strategies to Improve Hypertension

2017 American Heart Association

45. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

as attributable to CVD, selection of the single most likely underlying cause can be difficult when several major comorbidities are present, as is often the case in the elderly population. It is useful, therefore, to know the extent of mortality attributable to a given cause regardless of whether it is the underlying cause or a contributing cause (ie, the “any-mention” sta- tus). The number of deaths in 2014 with any mention of specific causes of death was tabulated by the NHLBI from the NCHS public-use

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2017 American Heart Association

46. Benign Paroxysmal Positional Vertigo (BPPV)

of falls, depression, and impairments of their daily activities. Persistent untreated or undiagnosed vertigo in the elderly leads to increased caregiver burden with resultant societal costs including decreased family productivity and increased risk of nursing home placement. Among an estimated 7.0 million elderly individuals reporting dizziness in the prior 12 months, 2.0 million (30.1%) reported vertigo, and there were 230,000 office visits among the elderly with a diagnosis of BPPV (...) canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial

2017 American Academy of Otolaryngology - Head and Neck Surgery

47. Obstructive Sleep Apnea in Adults: Screening

OSA include cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. Detection Evidence on the use of validated screening questionnaires in asymptomatic adults (or adults with unrecognized symptoms) to accurately identify who will benefit from further testing for OSA is inadequate. The USPSTF identified this as a critical gap in the evidence. Benefits of Early Detection and Intervention or Treatment The USPSTF found (...) , but the applicability of this evidence to screen-detected populations is unknown. The USPSTF found inadequate evidence on whether treatment with CPAP or MADs improves other health outcomes (mortality, cognitive impairment, motor vehicle crashes, and cardiovascular or cerebrovascular events). The USPSTF also found inadequate evidence on the effect of treatment with various surgical procedures in improving intermediate or health outcomes. Harms of Early Detection and Intervention or Treatment The USPSTF found

2017 U.S. Preventive Services Task Force

48. Rehabilitation of Lower Limb Amputation

with LLA is influenced by a variety of factors that include, but are not limited to, level of amputation, cognitive impairment, physical conditioning, social support, comorbidities, and psychological factors.[20] Amputations caused by vascular disease generally occur in aging populations with numerous other comorbidities such as cardiovascular disease, hypertension, renal 3 See Veterans Health Administration Directive 1410, Prevention of Amputation in Veterans Everywhere. Available at: https (...) Care 23 VII. Discussion of Recommendations 24 A. All Phases of Amputation Rehabilitation 24 B. Perioperative Phase 31 C. Pre-Prosthetic Phase 39 D. Prosthetic Training Phase 40 VIII. Knowledge Gaps and Recommended Research 46 A. Training programs 46 B. Rehabilitation dosing 47 C. Patient factors and considerations 47 D. Cognitive assessment 47 E. Perioperative LLA interventions 47 VA/DoD Clinical Practice Guideline for Rehabilitation of Individuals with Lower Limb Amputation September 2017 Page 4

2017 VA/DoD Clinical Practice Guidelines

49. Diagnosis and Treatment of Low Back Pain

to remain active, and providing information about self-care options. Strong for Reviewed, Amended 7. For patients with chronic low back pain, we suggest adding a structured education component, including pain neurophysiology, as part of a multicomponent self-management intervention. Weak for Reviewed, New-added C. Non-pharmacologic and Non-invasive Therapy 8. For patients with chronic low back pain, we recommend cognitive behavioral therapy. Strong for Reviewed, New-replaced 9. For patients with chronic

2017 VA/DoD Clinical Practice Guidelines

50. Management of Opioid Therapy (OT) for Chronic Pain

beliefs and expectations about chronic pain and its treatment.[36] Patients with chronic pain may also experience worsened quality of life, mental health, immune system function, physical function, sleep, employment status, and impaired personal relationships.[3,42-44] Worsening of some of these factors (e.g., quality of life, change in employment status) seems to also be associated with pain severity and the presence of psychiatric comorbidities.[45,46] Patients with chronic pain report psychological (...) of controlled substances ? Intolerance, serious adverse effects, or a history of inadequate beneficial response to opioids ? Impaired bowel motility unresponsive to therapy ? Traumatic brain injury ? Pain conditions worsened by opioids (e.g., fibromyalgia, headache) ? True allergy to opioid agents (that cannot be resolved by switching agents) a. Significant Risk Factors • Duration and dose of OT: See Recommendation 2 for more guidance on duration of OT and Recommendations 10-12 for more guidance on dosing

2017 VA/DoD Clinical Practice Guidelines

51. Dyslipidaemias

subtilisin/kexin type 9 PPAR-α peroxisome proliferator-activated receptor-α PROCAM Prospective Cardiovascular Munster Study PROSPER Prospective Study of Pravastatin in the Elderly at Risk PUFA polyunsaturated fatty acid RAAS renin–angiotensin–aldosterone system RCT randomized controlled trial REACH Reduction of Atherothrombosis for Continued Health REDUCE-IT Reduction of Cardiovascular Events with EPA-Intervention Trial REVEAL Randomized Evaluation of the Effects of Anacetrapib Through Lipid modification (...) RR relative risk RYR red yeast rice 4S Scandinavian Simvastatin Survival Study SALTIRE Scottish Aortic Stenosis and Lipid Lowering Trial, Impact on Regression SAGE Studies Assessing Goals in the Elderly SCORE Systemic Coronary Risk Estimation SEAS Simvastatin and Ezetimibe in Aortic Stenosis SFA saturated fatty acid SHARP Study of Heart and Renal Protection SLE systemic lupus erythematosus SPARCL Stroke Prevention by Aggressive Reduction in Cholesterol Levels STEMI ST elevation myocardial

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2016 European Society of Cardiology

52. Atrial Fibrillation

. , , Contemporary studies show that 20–30% of patients with an ischaemic stroke have AF diagnosed before, during, or after the initial event. , , White matter lesions in the brain, cognitive impairment, – decreased quality of life, , and depressed mood are common in AF patients, and between 10–40% of AF patients are hospitalized each year. , , Table 3 Cardiovascular morbidity and mortality associated with atrial fibrillation AF = atrial fibrillation; LV = left ventricular. Table 3 Cardiovascular morbidity (...) Concomitant atrial fibrillation surgery 69 11.4.2 Stand-alone rhythm control surgery 71 11.5 Choice of rhythm control following treatment failure 72 11.6 The atrial fibrillation Heart Team 72 12 Hybrid rhythm control therapy 74 12.1 Combining antiarrhythmic drugs and catheter ablation 74 12.2 Combining antiarrhythmic drugs and pacemakers 74 13 Specific situations 74 13.1 Frail and ‘elderly’ patients 74 13.2 Inherited cardiomyopathies, channelopathies, and accessory pathways 75 13.2.1 Wolff–Parkinson–White

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2016 European Society of Cardiology

53. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

. The quality of nutrition may influence the timing of puberty by several months even in the absence of obesity. A review of observational studies shows a delay of puberty onset in young girls with higher intakes of vegetable protein and lower intakes of animal protein. Nutrition and anemia In Canada, an estimated 3% of primary school-aged children are anemic. More are iron deficient. Iron deficiency has been associated with impaired cognitive and physical development. The supplementary pages in the Greig (...) dysfunctional long-term relationships later in life. Parenting initiatives such as cognitive stimulation and emotional support are effective measures for primary prevention of bullying. Cognitive stimulation and attending to early cognitive deficits such as language problems, imperfect causal understanding and poor inhibitory control are helpful strategies, possibly because children with these deficits also have decreased competence with peers (which can, in time, lead to them to exhibit bullying behaviours

2016 Canadian Paediatric Society

54. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset

, arthritis and cardiovascular disease, as well as obesity, are all associated with forms of disability. Frailty can be either physical or psychological frailty, or a combination of the two, and can occur as a result of a range of diseases and medical conditions. This guidance uses the deficit model of frailty that adds up a person's impairments and conditions to create a measure of risk and severity (Morley et al. 2013). This model includes comorbidity and disability as well as cognitive, psychological (...) and dementia, disability and frailty. Show how a wide range of domestic, leisure and work activities can help people to be physically active and explain how even modest increases in physical activity, at any age, can be beneficial. Include information on how physical activity: reduces the risk of illness in both the short and long term, preserves memory and cognitive ability, reduces risk of falls and leads to a healthier old age, improving wellbeing and quality of life is enjoyable and can have social

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

55. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

. Its main causes include falls, motor vehicle accidents, assaults, alcohol consumption and sports injuries. Cranial trauma may lead to a temporary or permanent impairment of cognitive, physical, or psychosocial functions. They represent one of the most critical public health problems around the world with an estimated annual incidence rate in Europe of 262 per 100 000 population. 1 Populations more at risk of cranial trauma include children below 4 years of age, young adults (aged below 25 (...) ) and the elderly (aged over 75). 1 There is a distinction between mild (or light), moderate and severe cranial trauma. Such distinction is most often based on the Glasgow Coma Scale (GCS): a 3 to 15-point scale used to assess patients’ level of consciousness and neurologic functioning after a head injury (see Table 1). Mild cranial trauma (mCT) often defined as GCS 13-15 is by far, the most frequent, accounting for as many as 71% to 98% of cases and is the subject of interest of this review. 5 Biomarkers

2016 Belgian Health Care Knowledge Centre

56. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

and appetite may decrease, leading to weight loss and frailty, with increased insulin sensitivity. Cognitive decline and visual impairment may make self-management decisions more difficult. The risks of hypoglycaemia (particularly neurological damage and falls) are increased in this age group. Many people with type 1 diabetes will have decades of experience in managing their condition – such knowledge cannot be passed on to carers and the loss of independence and the control of their diabetes can be very (...) distressing. Factors affecting diabetes management in older people ? Co-morbidities and geriatric syndromes including depression ? Impaired cognition leading to insulin errors, missed meals and reduced ability to identify and manage hypoglycaemia ? Visual, hearing and functional impairment ? Poly-pharmacy ? Falls and fractures ? Vulnerability to hypoglycaemia There is no evidence on which to base guidance for management of type 1 diabetes in older people. The emphasis should be on individualising

2016 Association of British Clinical Diabetologists

57. An Official ATS Statement: Impact of Mild Obstructive Sleep Apnea in Adults

drivers, including 56 with mild OSA, found the mean ESS was 7.4 in those with mild OSA versus 6.8 in those with no OSA, but there was no statistical comparison of mild versus no OSA (65). In a Swedish study of middle-aged women, including 128 with mildOSA,theprevalenceof EDSde?nedas ESS greater than or equal to 10 was similar in those with mild OSA (36%) and no OSA (37%) (49). Although the prevalence rates of EDS and involuntarily falling asleep during the daytime on the basis of speci?c questions (...) ). In summary, a limited number of population-based and clinic-based studies providecon?ictingdataregardingtheriskof MVAs associated with mild OSA. Quality of life. Three large population- based cross-sectional studies evaluating the impact of mild OSA on quality of life were identi?ed. One study in elderly men (1,009 with mild OSA) and another in elderly women (178 with mild OSA) failed to show any association between mild OSA and the Functional Outcomes of Sleep Questionnaire (FOSQ) score (32, 33

2016 American Thoracic Society

58. Acute Myocardial Infarction in Women

-Hispanic white women, black and Hispanic women have more comorbidities (eg, DM, hypertension, HF, and obesity) at the time of presentation with AMI. , , , At the time of presentation, 60% of older black women and 54% of younger black women have a clustering of ≥3 risk factors. The high prevalence of comorbidities is the hypothesized driver of higher rates of MI and a significant contributor to poorer long-term outcomes in black women. , , In the Corpus Christi Heart Project, rates of hospitalization (...) with atherosclerosis regression. CAS plays a significant role in the development of an AMI via thrombin generation resulting in thrombus formation and impaired fibrinolytic activity resulting in thrombus preservation. In patients with ACS from the Coronary Artery Spasm in Patients With Acute Coronary Syndrome (CASPAR) study, ≈25% had no obstructive culprit lesion on coronary angiography. CAS was present in almost 50% of the patients who underwent acetylcholine provocative testing. Provoked CAS is an independent

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2016 American Heart Association

59. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

achieve weight loss or should it be used chronically in the treatment of obesity? 103 Q7.4. Are there differences in weight-loss drug efficacy and safety? 104 Q7.5. Should combinations of weight-loss medications be used in a manner that is not approved by the U.S. Food and Drug Administration? 108 Q8. Are there hierarchies of drug preferences in patients with the following disorders or characteristics? 108 Q8.1. Chronic kidney disease 108 Q8.2. Nephrolithiasis 109 Q8.3. Hepatic impairment 110 Q8.4 (...) . Hypertension 111 Q8.5. Cardiovascular disease and arrhythmia 113 Q8.6. Depression with or without selective serotonin reuptake inhibitors 115 Q8.7. Anxiety 118 Q8.8. Psychotic disorders with or without medications (lithium, atypical antipsychotics, monoamine oxidase inhibitors) 119 Q8.9. Eating disorders including binge eating disorder 121 Q8.10. Glaucoma 123 Q8.11. Seizure disorder 124 Q8.12. Pancreatitis 124 Q8.13. Opioid use 125 Q8.14. Women of reproductive potential 126 Q8.15. The elderly, age =65

2016 American Association of Clinical Endocrinologists

60. Guidelines for adult stroke rehabilitation and recovery

are well established in clinical practice and constitute a standard of care that is unlikely to be directly tested in a randomized, clinical trial, for example, the provision of physical therapy (PT) to early stroke survi- vors with impaired walking ability. Thus, practice guidelines such as this one will likely rely on a mixture of evidence and consensus. It is hoped that the relative proportion of recom- mendations based on rigorous evidence will grow over time. This guideline uses the framework (...) of the International Classification of Functioning, Disability, and Health (ICF) 3 ; (4) Sensorimotor Impairments and Activities (treatment/interventions), focused on the activity level of the ICF; and (5) Transitions in Care and Community Rehabilitation, focused primarily on the participation level of the ICF. Published guidelines are, by their very nature, a reflection of clinical practice at a particular point in time and the evidence base available. As new information becomes available, best practice can

2016 American Academy of Neurology

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