The Charted Care Collection (06/01/2021)

[ photo by Styves Exantus ]

The Chartered Care Collection (06/01/2021)

The Chartered Care Collection provides a review of the latest, pertinent publications from the medical literature on aging. I have selected interesting articles that describe some of the most current research that may be relevant to the loved one in your care. Each article will be referenced if you desire to read more of the study, but I will give a brief synopsis of each study so you are aware of the latest research. Let’s get to The Collection!

The Chartered Care Collection

Another month has passed, and it is time to look back at a few selected journal articles on the latest research in function and mobility. 

The first article I read, published in the journal Lancet Public Health, looked at factors in the long-term risk of dementia. The study looked at 850,000 women in the UK born from 1935 to 1950. These women were followed for ten years. Of the 850,000 women, 33% were engaged in at least one social or cognitive activity. These activities included participation in three or more specific groups: adult education, volunteering, or participating in art, craft or music groups. Of those that participated in one or more of those three groups, the risk of dementia was greatly reduced in the first five years and moderately reduced in years six to ten. The results of this study were not a huge surprise to me, but I thought it was important to reiterate just how valuable ongoing learning and social interaction is for everyone as we age.

(Related blog posts: Caring For Dementia Caregivers, Memory Care For Dad)

The next study I found interesting looked at imaging of the cerebellum (section of the brainstem) in identifying those who eventually developed dementia. There is a large portion of people with Alzheimer’s disease that show deposits of amyloid (a protein) on PET scans. However, in 15 to 20% of patients who clinically test positive for dementia, there is no significant pathology shown on PET scans.

This study looked at a group of people aged 50 years or greater who showed signs of mild cognitive impairment on neuropsychological testing but did not have evidence of amyloid deposition on PET scans. The participants underwent MRI scans of the brain. Of all the participants (102), 38% were given a full diagnosis of dementia in just under two years. Those that converted to diagnosis of dementia and those that did not were then compared. Both groups had a similar number of vascular risk factors for dementia and depression scores. The group that converted to dementia, however, showed significant cerebellar gray matter volume loss in comparison to the group that did not convert to dementia.

Oftentimes, the articles I report on provide scientific evidence to support behaviors that should be eliminated or started in order to preserve function in life as we age. This article does not necessarily provide that, however, I found it an interesting study to help to answer, in some part, the WHY? When wondering why some develop dementia and others do not.

(Related blog posts: Taking Care Of Elderly Parents At Home, What Is Geriatric Psychiatry?)

Another study that hits an area near and dear to my heart is the impact of rehabilitation start time. This study was completed by a research group in Japan. In those who had an ischemic stroke, rehabilitation started on days one and day two provided for a better functional outcome at discharge from rehabilitation than those whose rehabilitation started on days three through six. It was a similar finding for those with hemorrhagic strokes, however, their best outcomes were when rehabilitation was started on day two. This rehabilitation applies even when our loved ones are still in the acute care hospital. Early mobilization is beneficial and almost always worth pushing for when your loved one is in the hospital.

(Related blog posts: Where Do You Go After Acute Rehab?, Recovery After Stroke)

The final study I wanted to mention jumped in to postoperative knee pain after joint replacement. I have a large number of patients who have undergone total knee replacements in their past. Some report wonderful pain relief after the surgery, but some, unfortunately, report continued knee pain despite the surgery. This study by Peter Skrejborg and colleagues analyzed 80 patients who had received total knee replacement five years prior. They were asked to report their pain at that point. They were placed in a high pain group or a low pain group based on their numerical pain scale rating. Each participant then had their serum high-sensitivity C-reactive protein levels drawn (hs-CRP). Those in the high pain group had statistically significant elevated serum hs-CRP when compared to those in the low pain group. More research will need to be done to determine what leads to the elevation in some and not in others, but this is a great start in the search for answers to why some people do better after a total joint replacement than others. 

(Related blog posts: Should I Get A Knee Replacement?, What To Expect After Knee Replacement)

That sums it up for the Chartered Care Collection for this month. Feel free to read each of these articles in full, and feel free to leave your comments or questions below!

References:

Floud S., et al. Cognitive and Social Activities and Long-Term Dementia Risk: The Prospective, UK, Million Women Study.  Lancet Public Health. 2021, February 1; 6(2): E116-E123.

Lee, J., et al. The Cerebellum Could Serve as a Potential Imaging Biomarker of Dementia Conversion in Patients with Amyloid Negative Amnestic, Mild Cognitive Impairment. Euro J Neurol. 2021. https:/doi-org.proxy.library.emory.edu/10.1111/ene.14770.

Otokita, S., et al. Impact of Rehabilitation Start Time on Functional Outcomes After Stroke. J Rehab Med. 2021, January; 53(1): 1-8.

Skrejborg, P., et al. Patients with High Chronic Postoperative Knee Pain 5 Years after Total Knee Replacement Demonstrate Low Grade Inflammation, Impairment of Function and High Levels of Pain Catastrophizing. Clin J Pain. 2021, March; 37(3): 161-167.

Share your thoughts on these articles in the Comments section.

© 2021 Jessica Kluetz, DO