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Elderly Drivers with Cognitive Impairment

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81. Care at the Scene: Research for ambulance services

and injuries. But the majority of 999 calls are not traffic accidents and heart attacks. More typical- ly, calls involve people with complex and ongoing health problems experiencing a crisis. This could be an elderly person with heart failure and diabetes having had a fall, someone with lung disease experiencing breathlessness or a person at risk of suicide ringing in distress. Patient needs have become more complex, there is an ageing population and the number of 999 calls has risen. At the same time (...) arrangements. It is sometimes difficult to know which option is best. And we need to understand what encourages people to choose one service over another. The question of where patients go is addressed in part of an NIHR review looking at published research on drivers for increased demand for emergency care (Turner 2015, NIHR published study one). The reasons were complex and difficult to synthesise from the 38 relevant papers, but included issues such as access to, and confidence in, primary care

2016 NIHR Dissemination Centre - Themed Reviews

82. Influencing the trajectories of ageing

, declines are markedly faster in the overweight and obese. 14 By comparing otherwise similar individuals with contrasting muscle quality, Dr Ferrucci and colleagues identified 8 Katsimpardi L, et al. (2014). Vascular and neurogenic rejuvenation of the aging mouse brain by young systemic factors. Science 344(6184), 630–634. 9 Smith LK, et al. (2015). ß2-microglobulin is a systemic pro-aging factor that impairs cognitive function and neurogenesis. Nat Med. 21(8), 932–937. 10 Bjedov I, et al. (2010 (...) ). Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 44(1), 162–165. The Academy of Medical Sciences 12 Two complementary approaches are most commonly used to identify and quantify frailty. The frailty index approach identifies generalised frailty and involves determining the proportion of deficits experienced by an individual, which include the following: the presence of long-term conditions; physical, cognitive or sensory impairments

2016 Academy of Medical Sciences

83. Briviact - brivaracetam

% of epilepsy cases), and generalised seizures which represent approximately 30 % of cases. In the remaining 10 % the classification is uncertain. Partial seizures used to be subdivided in Type IA simple partial seizures (consciousness not impaired), Type IB complex partial seizures (with impairment of consciousness) and Type IC partial seizures evolving to secondarily generalised seizures (ILAE 1981). However, such classification for focal seizures was subsequently abandoned by ILAE and later reports (...) recommended instead description of manifestation or degree of disability (Berg et al. Epilepsia, 2010). The lifetime risk of developing epilepsy (defined as a history of epilepsy regardless of the frequency of seizures or use of antiepileptic medication) is between 3% and 5%, with the highest incidence reported in neonates, young children, and the elderly (Banerjee et al, Epilepsy Research, 2009). The prevalence of active epilepsy is estimated at 5-8 per 1000 people in high-income countries and 10 per

2016 European Medicines Agency - EPARs

84. CVD Prevention in Clinical Practice

-reactive protein HYVET Hypertension in the Very Elderly Trial ICD International Classification of Diseases IMT intima–media thickness INVEST International Verapamil-Trandolapril Study LDL-C low-density lipoprotein cholesterol Lp(a) lipoprotein(a) LV left ventricle/left ventricular LVH left ventricular hypertrophy MET metabolic equivalent MHO metabolically healthy overweight/obesity MI myocardial infarction MUFA monounsaturated fatty acids NGO non-governmental organization NHS National Health Service (...) . bus drivers and pilots, may be reasonable,as is screening for CV risk factors in women before prescribing combined oralcontraception, although there are no data to support the beneficial effects.Beyond this, systematic CV risk assessment in adults <40 years of age with noknown CV risk factors is not recommended as a main strategy due to the lowcost-effectiveness. Systematic CV assessment may be considered in adult men>40 years of age and in women >50 years of age or post-menopausal with noknown CV

2016 European Society of Cardiology

85. 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

2016 European Society of Cardiology

86. 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

2016 European Society of Cardiology

87. 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

88. Meningitis - bacterial meningitis and meningococcal disease

bacterial meningitis has fallen in recent years, there has been no change in the rate of complications [ ; ]. Common complications include [ ]: Hearing loss (33.6%) Seizures (12.6%) Motor deficit (11.6%) Cognitive impairment (9.1%) Hydrocephalus (7.1%) Visual disturbance (6.3%) A systematic review of data from 3408 people with a history of pneumococcal meningitis found that multiple sequelae were reported in a significant proportion (about 20%). The most common multiple impairment combinations were (...) cognitive deficit plus hearing loss (39.1%) and cognitive deficit plus motor impairment (21.1%) [ ]. The all-cause risk of major sequelae was twice as high in Africa (25.1%) and Southeast Asia (21.6%) compared with Europe (9.4%) [ ]. Prognosis What is the prognosis of acute bacterial meningitis? Pneumococcal meningitis is associated with a poorer outcome than meningitis caused by Neisseria meningitidis and Haemophilus influenzae type b (Hib) [ ]. In children aged up to 18 years with bacterial meningitis

2019 NICE Clinical Knowledge Summaries

89. Epilepsy

, if appropriate. Specialist advice should be sought for a person with confirmed epilepsy with: Poor seizure control or poorly tolerated treatment. Previous prolonged or recurrent seizures, who have not been prescribed emergency treatment for use in the community, if appropriate. Possible cognitive impairment. A seizure-free history for the last 2 years, who would like to consider tapering or withdrawal from drug treatment. Plans for pregnancy. Have I got the right topic? Have I got the right topic? From birth (...) . [ ] Background information Background information Definition What is it? A seizure is the transient occurrence of signs or symptoms due to abnormal excessive or synchronous neuronal activity in the brain [ ]. Seizures can manifest as a disturbance of consciousness, behaviour, cognition, emotion, motor function, or sensation [ ; ]. An isolated seizure can be caused by toxic, metabolic, structural, and infectious factors and should not be confused with epilepsy [ ]. Focal seizures — originate in networks

2019 NICE Clinical Knowledge Summaries

90. Dementia

Dementia Dementia - NICE CKS Share Dementia: Summary Dementia is a clinical syndrome of deterioration in mental function which interferes with activities of daily living (ADLs). It affects more than one cognitive domain (for example memory, language, orientation, or judgement) and social behaviour (for example, emotional control or motivation). Early (or young) onset dementia is generally defined as dementia that develops before 65 years of age. Mild cognitive impairment is cognitive impairment (...) ) can delay or prevent the onset of dementia. Early diagnosis of dementia is important for treatment of reversible causes and advance planning while a person still has mental capacity. Dementia should be suspected if any of the following are reported by the person or their family/carer: Cognitive impairment leading to memory problems (such as difficulty learning new information), dysphasia and dyspraxia, disorientation to time and place and impairment of executive function (such as difficulty

2019 NICE Clinical Knowledge Summaries

91. Chronic obstructive pulmonary disease

are the complications? Disability and impaired quality of life — progressive breathlessness can lead to reduced mobility, and the person becoming increasingly housebound. Depression and anxiety — these common comorbidities of COPD and are often undiagnosed [ ]. Cor pulmonale (right heart failure secondary to lung disease) — caused by pulmonary hypertension as a consequence of hypoxia. Frequent chest infections. Secondary polycythaemia — overproduction of red blood cells due to hypoxia. Type 2 respiratory failure (...) — caused by increased airway resistance. Lung cancer — COPD may increase the risk of lung cancer. However, it is not clear whether this is due to common risk factors, such as smoking, involvement of susceptibility genes, or impaired clearance of carcinogens [ ]. [ ] Diagnosis Diagnosis of chronic obstructive pulmonary disease Diagnosis - COPD Diagnosis of chronic obstructive pulmonary disease There is no single diagnostic test for chronic obstructive pulmonary disease (COPD). Make a diagnosis of COPD

2019 NICE Clinical Knowledge Summaries

92. Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies

assessment for (hypo)manic symptoms is essential. Cognitive impairment in mood disorders. The issue of cognitive impairment in mood disorders has been recognised for many years, particularly in the elderly in whom the phenomenon has been described as pseudodementia. However, while it has been clear for some time now that episodes of mood disturbance are associated with significant cognitive impairment, two issues are becoming increasingly clear. Firstly, it is clear that in recurrent mood disorders some (...) degree of cognitive impairment remains between episodes. This is the case in both unipolar depression (Bora et al., 2013) and bipolar disorder (Baune and Malhi, 2015; Bourne et al., 2013). Secondly, this impairment is clinically significant in terms of overall functioning, once again in both unipolar and bipolar disorders (Malhi et al., 2007; Porter et al., 2015; Withall et al., 2009). Therefore, this is an issue which is receiving increasing attention with research into both pharmacological

2015 Royal Australian and New Zealand College of Psychiatrists

93. Benzodiazepine and z-drug withdrawal

appropriate, and managing withdrawal symptoms. Outcome measures Outcome measures No outcome measures were found during the review of this topic. Audit criteria Audit criteria No audit criteria were found during the review of this topic. QOF indicators QOF indicators No QOF indicators were found during the review of this topic. QIPP - Options for local implementation QIPP - Options for local implementation The risks associated with hypnotics, such as falls, cognitive impairment, dependence and withdrawal (...) . These symptoms may mimic the original anxiety disorder. Z-drug withdrawal symptoms include insomnia/sleep disturbance, anxiety, depression, impaired concentration, abdominal cramps, palpitations, and perceptual disturbances (such as hypersensitivity to physical, visual and auditory stimuli). The risk of withdrawal symptoms increases with longer use, higher dosage, and higher potency. Other effects of long-term use of benzodiazepines include: Cognitive effects, anxiety, agarophobia, emotional blunting

2019 NICE Clinical Knowledge Summaries

94. Bipolar disorder

episodes. Incomplete recovery leads to an increased risk of relapse, greater functional impairment, and reduced quality of life. Evidence suggests that, over time, episodes may become more frequent with shorter intervals in between. Some people may experience chronic, subsyndromal symptoms, most commonly of depression. Bipolar disorder appears to be associated with progressive deficits in cognition and functioning, even during periods of remission. Mortality is higher among people with bipolar disorder (...) is severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, or which includes psychotic features. A hypomanic episode is similar to a manic episode except that a diagnosis only requires that symptoms have lasted for 4 days, is not severe enough to cause marked impairment in social or occupational functioning or necessitate hospitalization, and there are no psychotic features. A depressive episode is a period of at least 2 weeks during which

2019 NICE Clinical Knowledge Summaries

95. Atrial fibrillation

with 82,476 participants). AF is also associated with reduced quality of life: AF can result in reduced exercise tolerance and impaired cognitive function. A systematic review of 49 studies found that people with AF have significantly poorer quality of life than healthy controls, the general population, and people with coronary heart disease. The risks from AF are thought to be similar to those from or AF. Anticoagulation treatment reduces the risk of stroke by about two-thirds. [ ; ; ; ; ; ; ] Diagnosis (...) less than 65%. Two INR values higher than 5 or one INR value higher than 8 within the past 6 months. Two INR values less than 1.5 within the past 6 months. Note: some adults with AF on long‑term warfarin can be supported to self‑manage with a coagulometer. For further information, see the NICE guideline . For people with poor anticoagulation control on warfarin: Correct factors contributing to poor control, if possible, such as: Impaired cognitive function. Poor adherence to prescribed treatment

2019 NICE Clinical Knowledge Summaries

96. Heart failure - chronic

Heart failure - chronic Heart failure - chronic - NICE CKS Share Heart failure - chronic: Summary Heart failure is a complex syndrome in which the ability of the heart to maintain the circulation of blood is impaired as a result of a structural or functional impairment of ventricular filling or ejection. This results in symptoms including breathlessness, fluid retention, and fatigue; and signs including basal crepitations, and peripheral oedema. Heart failure is classified into two main (...) , and impaired renal function. The text has been updated to replace the Liverpool Care Pathway with new standards of care that have been issued by the Leadership Alliance for the Care of Dying People ( ). March 2014 — minor update. The text on the use of ivabradine in people with heart failure has been updated. Ivabradine is now only contraindicated in people who have acute or unstable heart failure. December 2013 — minor update. Prescribing information has been updated in line with the Summary of Product

2019 NICE Clinical Knowledge Summaries

97. Better Endings: Right care, right place, right time

an ‘extra layer of support’ for the frail elderly with advanced non-malignant conditions at points of unstable/deteriorating symptoms and concerns. We will see how well the new service compares with usual care in improving the older people’s well-be- ing, reducing carers’ burden and any differences in the services used and costs.” For more information on this NIHR funded evaluation: NIHR oNGoING sTuDy FIVE Over a fifth of deaths now happen in care homes. An NIHR funded study was able to assess the expe (...) wishes. “our research explores the challenges and drivers of the project implementation, its impact on patient care, and patient and professional views on data sharing. We are finding that patients and lay carers strongly support data sharing and it is well used by local GPs and practice man- agers. Challenges include getting different information systems to interact, changing well-es- tablished patterns of work, and managing information governance. There are also difficulties of access in key

2015 NIHR Dissemination Centre - Themed Reviews

98. Diabetes Care

if patient presents with depression, falls, cognitive impairment, perceptual difficulties, or urinary incontinence. Use sulfonylureas (especially glyburide) with caution as the risk of hypoglycemia increases with age. Generally, initial doses can be half of those for younger people and increased more slowly. Monitor postural blood pressure. Consider less strict glycemic targets (7.1 - 8.5% A1C) if the individual has limited life expectancy, high functional dependency, extensive disease or multiple co (...) -morbidities etc. Consider a cognitive assessment before initiating insulin. See the - Cognitive Impairment: Recognition, Diagnosis and Management in Primary Care for assessment tests. Pregnancy Contraception and pre-pregnancy planning in all patients with diabetes is encouraged. Identify patients with previous gestational diabetes. These patients can develop type 2 diabetes and special attention prior to next pregnancy and in later life, is necessary. See the CDA guide on women of child-bearing age

2015 Clinical Practice Guidelines and Protocols in British Columbia

99. 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

100. Parkinson's disease

for elderly people with Parkinson's disease is 2–5 times higher than for age-matched controls. People with early-onset disease may have a later onset of motor complications and cognitive impairment. The risk of dementia is 2–6 times higher in people with Parkinson's disease than in healthy controls. The complications of Parkinson’s disease include: Motor complications (usually related to the use of anti-parkinsonian medication), such as immobility, slowness, communication difficulties, motor fluctuations (...) disease every 3.3 years [ ]. Prognosis What is the prognosis? Typically, Parkinson's disease is slowly progressive, but the rate of progression is variable [ ]. Factors such as older age at onset and longer disease duration have been independently associated with a higher prevalence of motor and non-motor complications in a retrospective study (n = 401) [ ]. People with early-onset disease may have a later onset of motor complications and cognitive impairment [ ]. Life expectancy is reduced

2018 NICE Clinical Knowledge Summaries

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