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Objective: To examine the in-hospital mortality rate, and its risk factors, for patients with dementia admitted to hospital., Study Design: We constructed an observational cohort study through data linkage of three Dutch national registers: the hospital discharge register (HDR), the population register (PR) and the national cause of death register. Patients with dementia in the HDR aged between 60 and 100 years registered between 1 January 2000 and 31 December 2010 were included., Main Outcome Measures: Risk factors for in-hospital mortality were investigated using multivariable Cox proportional hazard regression models that included sex, age, marital status, ethnicity, somatic comorbidity, type of dementia and urgency of admission., Results: 40,500 patients were included in the cohort. The overall in-hospital mortality rate was 11.1%. Factors that significantly increased the mortality risk were: male sex (adjusted hazard ratio (HR) 1.52, 95%-confidence interval (95%-CI) 1.43-1.63), higher age (adjusted HR 1.03, 95%-CI 1.03-1.04), living with a partner (adjusted HR 1.39, 95%-CI 1.30-1.49), acute admission (adjusted HR 2.16, 95%-CI 1.97-2.36) and Alzheimer's disease (adjusted HR 1.21, 95%-CI 1.13-1.29). Cardiovascular disease was the most common cause of in-hospital mortality., Conclusions: This nationwide study found several independent risk factors for the in-hospital mortality of patients with dementia, including male sex, higher age, living with a partner, acute admission, and Alzheimer's disease. These risk factors should be taken into account by clinicians and caregivers as they will indicate whether patients are at risk of a more unfavourable outcome during hospital admission., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Objective: Knowledge about factors predicting functional disability in mild cognitive impairment (MCI) and dementia would help health care providers to identify those patients who are at high risk of functional disability. Previous research is scarce and focused on only a small number of possible predictors. The aim of this study was to identify predictors of functional disability in patients with MCI and dementia., Study Design: Cross-sectional cohort study., Main Outcome Measures: Data from patients who visited a memory clinic between 2011 and 2015 were evaluated. The Disability Assessment for Dementia (DAD) was used to assess functional disability. Patients diagnosed with MCI or dementia and with a DAD score available were included. This led to the inclusion of 474 patients. Univariate analyses with a broad range of variables were performed to detect factors that had a significant relationship to the DAD score. Age, gender and variables with a p-value of 0.1 or lower in the univariate analyses were taken into a multivariable analysis. This multiple linear regression analysis was performed to determine which variables were independently associated with the DAD score., Main Results: Our multivariable model explained 42% of the variance in the DAD score. Independent predictors of the DAD score were age (B=0.03, 95%CI=0.002-0.05), gender (B=-0.43, 95%CI=-0.78 to -0.07), score on the Clinical Dementia Rating scale (CDR) (B=1.53, 95%CI=1.07-1.99 for CDR 1, B=2.93, 95%CI=2.28-3.58 for CDR 2, B=3.96, 95%CI=2.65-5.27 for CDR 3) and level of physical activity (B=0.56, 95%CI=0.05-1.07)., Conclusion: Older age, male gender, higher CDR score and lower levels of physical activity are independent predictors of functional disability in MCI and dementia., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Introduction: The influence of vascular risk factors (VRFs) on the rate of cognitive decline in patients with established dementia is unclear. This study aims to examine the association between VRFs and the rate of cognitive decline in patients with Alzheimer's disease (AD)., Methods: Data were obtained from patients visiting a memory clinic between 2004 and 2012. VRFs were determined at baseline and included hypertension, hypercholesterolemia, diabetes mellitus, overweight and smoking. Continuous values of blood pressure, total cholesterol, glucose level and body mass index were also obtained. Mini-Mental State Exam (MMSE) scores were obtained at baseline and during follow-up visits. The association between VRFs and the annual change in MMSE scores was analysed with a multivariable linear mixed model adjusted for age, sex and the aforementioned VRFs., Results: From 174 patients (mean age 78.3 years), with a follow-up time up to 5.8 years (mean 1.1 year), in total 447 MMSE scores were obtained. The multivariable analyses showed an association between age as well as systolic blood pressure and a decline in annual rates of change in MMSE scores of -0.05 (95% confidence interval (CI): -0.09 to 0.00) and -0.01 (CI: -0.03 to 0.00), respectively. For all other VRFs, including sex, patients did not show a significant difference., Conclusion: This study did not find an association between preventable vascular risk factors and cognitive decline in patients with AD, except for systolic blood pressure. As the association between systolic blood pressure and decline in MMSE was small, clinical relevance may be limited., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background and Objective: Vascular risk factors (VRF) are associated with a higher incidence of dementia. However, the relationship with disease progression is unclear. This review examined the association of VRF (hypertension, hypercholesterolemia, diabetes mellitus, overweight, smoking or multiple VRF) and cognitive decline in patients suffering from dementia., Methods: Literature was searched in four databases (Pubmed, Embase, Cochrane, PsychInfo) and 1779 articles were identified. This resulted in a total of 20 articles which were included., Results: Twelve studies on hypertension (HT) were inconsistent about the association with cognitive decline. For hypercholesterolemia (HC) 2 (out of 7) studies were associated with increased cognitive decline, as were both (2/2) studies which researched LDL-cholesterol. Articles were inconclusive about the effect of diabetes mellitus (DM): five (out of 13) found less cognitive decline, 2 found more cognitive decline, and 6 found no significant effect of DM. Overweight (BMI>25 kg/m(2)) was associated in 2/4 studies with a slower rate of cognitive decline, while the other 2 studies found no effect. All studies (5/5) that researched smoking did not find a significant effect. Four studies (out of 7) that looked at multiple VRF found faster cognitive decline, and 3/7 found no effect., Discussion: The results of this review suggest an association between LDL-cholesterol and the progression of dementia, while inconsistent results were found for other VRF. Additional prospective cohort studies and experimental studies should be performed to better understand the causal contribution of VRF on cognitive decline in dementia., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Falls in the elderly are common and often serious. The aim of this study was to examine the association between the use of different classes of psychotropic medications, especially short acting benzodiazepines, and the frequency of falling in elderly. Study design This retrospective cohort study was performed with patients who visited the day clinic of the department of geriatric medicine of the University Medical Center Utrecht in the Netherlands between 1 January 2011 and 1 April 2012. Measurements Frequencies of falling in the past year and medication use were recorded. Logistic regression analysis was performed to assess the relationship between the frequency of falling in the past year and the use of psychotropic medications., Results: During this period 404 patients were included and 238 (58.9%) of them had experienced one or more falls in the past year. After multivariate adjustment, frequent falls remained significantly associated with exposure to psychotropic medications (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.17-3.28), antipsychotics (OR 3.62; 95% CI 1.27-10.33), hypnotics and anxiolytics (OR 1.81; 95% CI 1.05-3.11), short-acting benzodiazepines or Z-drugs (OR 1.94; 95% CI 1.10-3.42) and antidepressants (OR 2.35; 95% CI 1.33-4.16)., Conclusions: This study confirms that taking psychotropic medication, including short-acting benzodiazepines, strongly increases the frequency of falls in elderly. This relation should be explicitly recognized by doctors prescribing for older people, and by older people themselves. If possible such medication should be avoided for elderly patients especially with other risk factors for falling., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background and Purpose: This review reports on the association between chronic kidney disease (CKD) established with glomerular filtration rate (GFR) and brain lesions established with MRI or CT., Methods: Literature was searched combining synonyms of kidney function, brain lesions and terms for the definitions thereof, and MRI or CT. This resulted in 1507 articles, of which 20 were finally included., Results: Cross-sectional studies found an association between GFR and white matter lesions (WML) with 7 out of 11 associations significant (odds ratios (OR) GFR, continuous variable: 0.84-0.89 per 10 ml/min/1.73 m(2)). Most significant results were found in studies including subjects from the general population. GFR was associated with silent cerebral infarcts (SCI) with 9 out of 12 associations significant (OR GFR, continuous variable: 0.96-0.99 per ml/min/1.73 m(2)). Brain atrophy was reported significant 4 out of 5 associations (OR GFR, continuous variable: 0.64 per 10 ml/min/1.73 m(2)). Additionally, 2 follow up studies were included. One established that serum creatinine at baseline is a significant predictor of the presence of SCI; the other that the presence of SCI at baseline is a significant predictor of a decrease in GFR., Conclusion: The results from this review show that CKD is associated with brain lesions. These brain lesions include WML, SCI and brain atrophy. This finding is of clinical importance because these brain lesions are predictive of stroke, cognitive decline and dementia. Additional follow up studies should be performed to better understand the causative pathway and to establish whether screening and preventive programs are beneficial., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)