Abstract:
OBJECTIVE:To describe the prevalence of cognitive impairment among elderly primary care patients and to compare diagnostic evaluations and use of health services among patients with and those without cognitive impairment. DESIGN:Prospective cohort study. SETTING:Academic primary care group practice. PATIENTS:3954 patients aged 60 years and older who completed the Short Portable Mental Status Questionnaire during routine office visits. MEASUREMENTS:Demographics and comorbid illness at baseline, diagnostic evaluations for cognitive impairment, use of standard and preventive health services, use of psychoactive drugs, and death in the year after the screening date. RESULTS:The prevalence of cognitive impairment among all patients aged 60 years and older at baseline was 15.7%; 10.5% had mild impairment and 5.2% had moderate to severe impairment. Patients with moderate to severe impairment were significantly older than patients with no impairment (76.2 years and 67.4 years, respectively), were more likely to be black (85.8% and 61.3%), had fewer years of education (7.3 years and 9.2 years), and were more likely to have cerebrovascular disease (20.4% and 6.3%) and evidence of undernutrition (30.6% and 16.9%). Dementia was recorded as a diagnosis for less than 25% of patients with moderate to severe cognitive impairment, but patients with documented impairment were more likely to have been evaluated for reversible causes. In the year after screening, patients with moderate to severe impairment were more likely than those with no impairment both to be hospitalized (29.1% and 16.5%) and to visit the emergency department (55.8% and 38.5%) but had fewer outpatient visits (6.0 and 7.6) and greater mortality (8.2% and 2.8%). CONCLUSIONS:Cognitive impairment is associated with increased use of health services and increased mortality. Patients with undocumented cognitive impairment were significantly less likely to be evaluated for reversible causes. Research is needed to determine if better documentation of cognitive impairment would improve not only diagnostic evaluations but also patient management, counseling, and outcomes.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Callahan CM,Hendrie HC,Tierney WMdoi
10.7326/0003-4819-122-6-199503150-00004subject
Has Abstractpub_date
1995-03-15 00:00:00pages
422-9issue
6eissn
0003-4819issn
1539-3704journal_volume
122pub_type
杂志文章abstract:BACKGROUND:The fecal immunochemical test (FIT) is a common method for colorectal cancer (CRC) screening, yet its acceptability and performance over several rounds of annual testing are largely unknown. OBJECTIVE:To assess FIT performance characteristics over 4 rounds of annual screening. DESIGN:Retrospective cohort s...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M15-0983
更新日期:2016-04-05 00:00:00
abstract::The question of whether initial treatment is necessary in relatively asymptomatic patients with stage III and IV non-Hodgkin's lymphomas of favorable histologic types was studied by retrospective analysis. Two groups of patients were studied: [1] 44 nonprotocol patients, followed since 1963, in whom initial treatment ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-90-1-10
更新日期:1979-01-01 00:00:00
abstract::9-(1,3-dihydroxy-2-propoxymethyl) guanine (ganciclovir) was used to treat 41 patients (median age, 37 years) with the acquired immunodeficiency syndrome and cytomegalovirus gastrointestinal infection. Sites of infection were the colon in 31, the esophagus in 5, the rectum in 4, and the small bowel in 1. Patients recei...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-107-2-133
更新日期:1987-08-01 00:00:00
abstract::Medicine has long sought to match diagnostic and treatment approaches to the particular needs and risks of individual patients. The decreasing cost and increasing ease of genetic sequencing have propelled the rise of precision medicine. Precision medicine aims to use genetic and other information to provide care tailo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M18-0425
更新日期:2019-05-07 00:00:00
abstract:PURPOSE:To compare the efficacy, safety, and cost-effectiveness of low-molecular-weight heparin with standard heparin for the prevention of deep vein thrombosis after total hip arthroplasty. DATA IDENTIFICATION:Studies were identified by MEDLINE search and review of bibliographies of retrieved articles. Hospital resou...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-119-11-199312010-00008
更新日期:1993-12-01 00:00:00
abstract::The following principles of appropriate antibiotic use for adults with acute pharyngitis apply to immunocompetent adults without complicated comorbid conditions, such as chronic lung or heart disease, and history of rheumatic fever. They do not apply during known outbreaks of group A streptococcus.1. Group A beta-hemo...
journal_title:Annals of internal medicine
pub_type: 指南,杂志文章,实务指引
doi:10.7326/0003-4819-134-6-200103200-00019
更新日期:2001-03-20 00:00:00
abstract::Two hundred forty previously healthy military personnel with nonstreptococcal upper respiratory infections were prospectively studied to define the incidence and clinicopathologic characteristics of possible virus-associated glomerulonephritis. Nine patients without preceding streptococcal infection had erythrocyte ca...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-91-5-697
更新日期:1979-11-01 00:00:00
abstract::Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-150-10-200905190-00011
更新日期:2009-05-19 00:00:00
abstract:BACKGROUND:Bhutan implemented a national program for human papillomavirus (HPV) vaccination in 2010 involving girls aged 12 to 18 years and achieving nearly 90% coverage. OBJECTIVE:To estimate HPV vaccine effectiveness in a city in Bhutan. DESIGN:2 cross-sectional surveys, 2011-2012 and 2018. SETTING:2 hospitals in ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-2849
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND:Resistance to activated protein C due to the factor V R506Q (Leiden) mutation is the most common clotting abnormality in patients with venous thromboembolism. OBJECTIVE:To evaluate the risk for venous thromboembolism associated with the factor V Leiden mutation or with resistance to activated protein C in t...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-130-8-199904200-00004
更新日期:1999-04-20 00:00:00
abstract::The coexistence of chronic idiopathic thrombocytopenic purpura and myasthenia gravis has been infrequently reported. We report another case and show the coexistence of autoantibodies to the platelet glycoprotein IIb and IIIa complex and the acetylcholine receptor. Autoantibody levels were followed during 8 weeks of tr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-6-829
更新日期:1984-06-01 00:00:00
abstract:BACKGROUND:Experts consider health information technology key to improving efficiency and quality of health care. PURPOSE:To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. DATA SOURCES:The authors systematically searched the English-lang...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-144-10-200605160-00125
更新日期:2006-05-16 00:00:00
abstract::Individual differences in metabolism of the sulfonamides may predispose patients to idiosyncratic reactions. Sulfonamides are metabolized by N-acetylation (mediated by a genetically polymorphic enzyme) and oxidation to potentially toxic metabolites. We examined 6 patients who had severe reactions to sulfonamides and c...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-105-2-179
更新日期:1986-08-01 00:00:00
abstract::The sharp rise in drug abuse in the past decade has led to the development of new sources of information on drug-abuse trends. These include surveys, drug-related emergencies, drug-abuse treatment, hepatitis rates, and various types of law enforcement information. This paper summarizes data currently available for her...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-83-3-402
更新日期:1975-09-01 00:00:00
abstract::Forty patients with systemic lupus erythematosus randomly received inactivated bivalent (A/NJ and A/Victoria) influenza vaccine or saline in a double-blind study. During 20 weeks of follow-up, no deterioration in major organ function or increase in disease flares was observed in the immunized group as compared with th...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-88-6-729
更新日期:1978-06-01 00:00:00
abstract::Polysaccharide vaccines against diseases caused by Neisseria meningitidis serogroups A and C meningococci are now licensed in the United States. They are prepared as monovalent and as bivalent antigens. This statement summarizes available information on these antigen and offers guidance regarding their role in the con...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:
更新日期:1976-02-01 00:00:00
abstract:OBJECTIVE:To determine in female tennis and squash players the effect of biological age (that is, the starting age of playing relative to the age at menarche) at which tennis or squash playing was started on the difference in bone mineral content between the playing and non-playing arms. DESIGN:Cross-sectional study. ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-123-1-199507010-00003
更新日期:1995-07-01 00:00:00
abstract::HemoQuant, an assay based on heme-derived porphyrin, quantifies both total fecal hemoglobin ant that fraction already converted to porphyrin by gut flora (the intestinal converted fraction). Recovery by HemoQuant of blood added to stools exceeded 99% and was not affected by ascorbic acid, iron, or other additives. Hem...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-101-3-297
更新日期:1984-09-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the clinical variables affecting outcome after balloon aortic valvuloplasty. DESIGN:Longitudinal follow-up of consecutive case series. PATIENTS:Consecutive sample of 36 patients with severe calcific aortic stenosis, and without active infection or left ventricular mural thrombus. INTERVE...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-110-6-421
更新日期:1989-03-15 00:00:00
abstract::Sixty-eight patients clinically suspected of having (33), or at high risk for (35), deep venous thrombosis were studied with contrast venography, radiofibrinogen leg scanning, and impedance plethysmography as well as ventilation and perfusion lung scans. Thrombosis limited to the veins in the calf of the leg (unilater...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-94-4-439
更新日期:1981-04-01 00:00:00
abstract:BACKGROUND:Studies suggest that vitamin D supplementation may reduce cancer and fracture risks. PURPOSE:To examine the benefits and harms of vitamin D with or without calcium supplementation on clinical outcomes of cancer and fractures in adults. DATA SOURCES:English-language studies identified from MEDLINE and the C...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析,评审
doi:10.7326/0003-4819-155-12-201112200-00005
更新日期:2011-12-20 00:00:00
abstract::Experimental findings in animals and epidemiologic studies in humans provide strong evidence that hypertension promotes the onset and progression of atherosclerosis. However, effective antihypertensive therapy has not consistently reduced the incidence of cardiac events in the major trials of treatment for mild hypert...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,评审
doi:10.7326/0003-4819-110-12-1017
更新日期:1989-06-15 00:00:00
abstract:BACKGROUND:Mounting evidence indicates that subclinical thyroid dysfunction has important clinical effects and prognostic implications, supporting the view that it is not a compensated biochemical change sensu strictu. PURPOSE:To review clinical information on the effects of subclinical thyroid dysfunction on the hear...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-137-11-200212030-00011
更新日期:2002-12-03 00:00:00
abstract:STUDY OBJECTIVE:To determine the efficacy of the addition of ifosfamide to cisplatin plus etoposide (VIP), or vinblastine (VeIP), in patients with recurrent germ cell tumors. DESIGN:Nonrandomized, prospective phase II trial. SETTING:Tertiary referral university hospital. PATIENTS:Fifty-six of fifty-eight entered pat...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-109-7-540
更新日期:1988-10-01 00:00:00
abstract::Simulation is a versatile technique used in a variety of health care settings for a variety of purposes, but the extent to which simulation may improve patient safety remains unknown. This systematic review examined evidence on the effects of simulation techniques on patient safety outcomes. PubMed and the Cochrane Li...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-158-5-201303051-00010
更新日期:2013-03-05 00:00:00
abstract:OBJECTIVE:To evaluate the amount of variation in in-hospital mortality and length of intensive care unit (ICU) stay that can be accounted for by clinical data available at ICU admission. DESIGN:Inception cohort study. SETTING:Forty-two ICUs in 40 hospitals, including 26 hospitals that were randomly selected and 14 la...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-118-10-199305150-00001
更新日期:1993-05-15 00:00:00
abstract::Given the low mortality and morbidity of the severe acute respiratory syndrome (SARS) compared with other public health scourges, is the attention devoted to it misdirected? The SARS experience has provided at least 4 enduring lessons. First, by providing a test of the capacity of each part of the public health system...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-139-7-200310070-00011
更新日期:2003-10-07 00:00:00
abstract::During a 21/2-year period, studies were done on 14 patients with chronic renal failure to evaluate pleural effusions which we believe were secondary to the uremic process. The patients with uremic pleural effusions closely resembled those in the group with chronic renal failure as a whole with respect to diagnosis and...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-82-3-362
更新日期:1975-03-01 00:00:00
abstract:PURPOSE:To review epidemiologic studies on the association between homocyst(e)ine level and risk for cardiovascular disease and the potential benefits of homocysteine-decreasing therapies. DATA SOURCES:Computerized and manual searches of the literature on total homocysteine levels and cardiovascular disease. STUDY SE...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
doi:10.7326/0003-4819-131-5-199909070-00008
更新日期:1999-09-07 00:00:00
abstract:BACKGROUND:Fibromyalgia is a common chronic pain condition for which patients frequently use acupuncture. OBJECTIVE:To determine whether acupuncture relieves pain in fibromyalgia. DESIGN:Randomized, sham-controlled trial in which participants, data collection staff, and data analysts were blinded to treatment group. ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-143-1-200507050-00005
更新日期:2005-07-05 00:00:00