Geriatric Orthopedics and Challenges with Mild Cognitive Impairment
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GERIATRIC ORTHOPEDICS (C QUATMAN AND C QUATMAN-YATES, SECTION EDITORS)
Geriatric Orthopedics and Challenges with Mild Cognitive Impairment Vikrant Tambe 1 & Ciandra D’Souza 1 & Daniel Ari Mendelson 1,2,3 Accepted: 29 October 2020 / Published online: 13 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To examine the literature to identify the optimal methods to manage patients with mild cognitive impairment (MCI) in the perioperative period. Recent Findings Several studies have identified the risk of delirium and other postoperative complications in patients with dementia and other cognitive disorders. Recent studies have shown a significant impact in performance on measures assessing processing speed and inhibitory function which can continue to have their effect after several years of surgery. Little research has been published that specifically focuses on elderly patients with mild cognitive impairment. Summary An optimal treatment plan cannot be formed based on the available literature. Since the elderly with cognitive disorders such as MCI and dementia typically are accompanied by multiple comorbidities as well as impaired mobility, the physician should focus not only on treating the orthopedic problem but also on the patient. Further research on this specific topic is needed. Keywords Mild cognitive impairment . Perioperative geriatrics . Orthopedic surgery . Early dementia . Surgical outcomes . Postsurgical recovery
Introduction Mild cognitive impairment is prevalent in older adults. MCI represents an intermediate stage between normal aging and the development of pathologic aging and dementia [1]. Patients with MCI suffer from moderate memory impairment due to deficits in attention and cognitive flexibility but do not fulfill the diagnostic criteria of dementia [2]. The diagnosis of MCI was based on (1) impairment in one of the four cognitive domains; (2) cognitive concerns by the subject, informant, examining nurse, or physician; (3) essentially normal functional activities; and (4) absence of dementia (based on This article is part of the Topical Collection on Geriatric Orthopedics * Daniel Ari Mendelson [email protected] 1
Division of Geriatrics & Aging, Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
2
Department of Medicine, Highland Hospital, Box 58, 1000 South Avenue, Rochester, NY 14620, USA
3
AGS CoCare: Ortho, American Geriatrics Society, New York, NY, USA
published criteria). MCI has two main types—amnestic and non-amnestic [3]. Amnestic MCI (MCI-A), in which memory impairment predominates, is a precursor of clinical Alzheimer’s disease (AD) [3, 4]. Non-amnestic forms of MCI most commonly affects executive function and are not well studied but are associated with fewer negative outcomes compared to MCI-A. Due to its fluctuating course, many people with MCI are overlooked as having normal cognition; however, they remain at risk of developing dementia. Annual preval
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