Gender differences in challenging behaviors,management and outcomes in elderly patients with delirium

BACKGROUND： Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE： To explore gender differences in challenging behaviors, management and outcomes in age-matched elderly patients with delirium.DESIGN, TIME AND SETTING： A retrospective cohort study was performed in the Bankstown-Lidcombe Hospital, Sydney, Australia, from October 2008 to April 2009. METHODS： Patients, aged 65-90 years, diagnosed with delirium according to the International Classification of Diseases （ICD）-10 in the Psychogeriatric Unit of Bankstown Lidcombe Hospital from January 2002 to October 2008 were reviewed. All the patients were measured according to the Confusion Assessment Method upon admission. Those who developed delirium during hospitalization were excluded.MAIN OUTCOME MEASURES： Cause of delirium, wandering, aggression, duration of delirium, physical restraint, use of antipsychotic medicine, recovery from delirium, discharge back home, length of stay, one-to-one nursing care, falls and absconding rate.RESULTS： The 131 age-matched delirious patients comprised 54 males and 77 females. The behavioral disorders of wandering [odds ration （OR） = 2.612, 95% confidence interval （CI） = 1.26 -5.413, P = 0.009] and aggression （OR = 2.243, 95% CI = 1.028 - 4.891, P= 0.04） were more frequent in males than in females. More males received one-to-one nursing care （OR = 4.114, 95% CI = 1.355 - 12.491, P = 0.008）, were more likely to receive antipsychotic medications （OR = 2.24, 95% CI = 1.095-4.583, P = 0.021） and more likely to be physically restrained （OR = 2.07, 95% CI = 1.02-1.02, P = 0.043） compared with female patients. All absconding patients （3/131, 2.3%） were male. In addition, male patients displayed a greater falling rate compared with females （OR = 4.57, 95% CI= 1.519-13.722, P = 0.004）.CONCLUSION： There are gender differences in challenging behaviors, management and outcomes in elderly delirious patients. Males with delirium display more challenging behaviors that require physical restraint and pharmacological management including wandering and aggression; males also abscond and have a higher rate of falls compared with female patients.

Uptake and mitochondrial dysfunction of alpha-synuclein in human astrocytes, cortical neurons and fibroblasts

The accumulation and aggregation of alpha-synuclein(α-syn)in several tissue including the brain is a major pathological hallmark in Parkinson’s disease(PD).In this study,we show that α-syn can be taken up by primary human cortical neurons,astrocytes and skin-derived fibroblasts in vitro.Our findings that brain and peripheral cells exposed to α-syn can lead to impaired mitochondrial function,leading to cellular degeneration and cell death,provides additional evidence for the involvement of mitochondrial dysfunction as a mechanism of toxicity of α-syn in human cells.

Mortality Trend and Predictors of Mortality in Dysphagic Stroke Patients Postpercutaneous Endoscopic Gastrostomy

Background：Percutaneous endoscopic gastrostomy （PEG） feeding is widely used in stroke patients suffering from persistent dysphagia;however,predicting the risks and benefits of PEG insertion in the individual patient is difficult.The aim of our study was to investigate if candidate risk factors could predict short-term mortality risk in poststroke patients who had PEG tube insertion for persistent dysphagia.Methods：This was a retrospective study of 3504 consecutive stroke patients admitted to two metropolitan hospitals during the period January 2005 to December 2013 and who also underwent PEG insertion for feeding due to persistent dysphagia.Results：A total of 102 patients were included in the study.There were 22 deaths in 6 months after insertion of PEG tubes and 20 deaths of those occurred within 3 months post PEG.Those who survived beyond 6 months showed significantly lower mean age （75.9 ± 9.0 years vs.83.0 ± 4.9 years,P 〈 0.001）,a lower mean American Society of Anesthesia （ASA） score （3.04 ± 0.63 vs.3.64 ± 0.58,P 〈 0.001） compared to nonsurvivors.In multiple Logistic,age （P =0.004,odds ratio [OR] =1.144;95% confidence interval [CI]：1.044-1.255）;ASA （P =0.002,OR =5.065;95% CI：1.815-14.133） and albumin level pre-PEG insertion （P =0.033,OR =0.869;95% CI：0.764-0.988）were the independent determinants of mortality respectively.Conclusions：We propose that age,ASA score and albumin level pre-PEG insertion to be included as factors to assist in the selection of patients who are likely to survive more than 3 months post PEG insertion.

Mini-review on initiatives to interfere with the propagation and clearance of alphasynuclein in Parkinson’s disease

In this mini-review,we summarize recent findings relating to the prion-like propagation ofα-synuclein(α-syn)and the development of novel therapeutic strategies to target synucleinopathy in Parkinson’s disease(PD).We link the Braak’s staging hypothesis of PD with the recent evidence from in-vivo and in-vitro studies for the prion-like cell-to-cell propagation ofα-syn(via exocytosis and endocytosis).The classical accumulation of aggregatedα-syn in PD may result from an increased production or a failure in the mechanisms of clearance ofα-syn.We discuss novel agents,currently in clinical trial for PD including the ones that impact the aggregation ofα-syn and others that interfere withα-syn endocytosis as a means to target the progression of the disease.