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Article: Frailty and Inflammatory Bowel Disease: A Scoping Review of Current Evidence.

Fons, Anne / Kalisvaart, Kees / Maljaars, Jeroen

2023 Volume 12, Issue 2

Abstract: Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty ... ...

Abstract	Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty assessment methods, the prevalence of frailty, risk factors for frailty and the prognostic value of frailty in IBD. A scoping literature search was performed using the PubMed database. Frailty prevalence varied from 6% to 53.9%, depending on the population and frailty assessment method. Frailty was associated with a range of adverse outcomes, including an increased risk for all-cause hospitalization and readmission, mortality in non-surgical setting, IBD-related hospitalization and readmission. Therefore, frailty assessment should become integrated as part of routine clinical care for older patients with IBD.
Language	English
Publishing date	2023-01-09
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662592-1
ISSN	2077-0383
ISSN	2077-0383
DOI	10.3390/jcm12020533
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Article ; Online: Recipe for primary prevention of delirium in hospitalized older patients.

Vreeswijk, Ralph / Maier, Andrea B / Kalisvaart, Kees J

Aging clinical and experimental research

2022 Volume 34, Issue 12, Page(s) 2927–2944

Abstract: Delirium is an acute fluctuating syndrome characterized by a change in consciousness, perception, orientation, cognition, sleep-wake rhythm, psychomotor skills, and the mood and feelings of a patient. Delirium and delirium prevention remain a challenge ... ...

Abstract	Delirium is an acute fluctuating syndrome characterized by a change in consciousness, perception, orientation, cognition, sleep-wake rhythm, psychomotor skills, and the mood and feelings of a patient. Delirium and delirium prevention remain a challenge for healthcare professionals, especially nurses who form the basis of patient care. It also causes distress for patients, their caregivers and healthcare professionals. However, delirium is preventable in 30-40% of cases. The aim of this article is to summarize the delirium risk models, delirium screening tools, and (non-pharmacological) delirium prevention strategies. A literature search of review articles supplemented by original articles published in PubMed, Cinahl, and Cochrane between 1 January 2000 and 31 December 2020 was carried out. Among the older patients, delirium is a common condition with major consequences in terms of mortality and morbidity, but prevention is possible. Despite the fact that delirium risk models, delirium screening scales and non-pharmacological prevention are available for the development of a hospital delirium prevention programme, such a programme is still not commonly used on a daily basis.
MeSH term(s)	Humans ; Delirium/diagnosis ; Delirium/prevention & control ; Delirium/etiology ; Cognition ; Caregivers ; Affect ; Primary Prevention
Language	English
Publishing date	2022-09-22
Publishing country	Germany
Document type	Journal Article ; Review
ZDB-ID	2104785-6
ISSN	1720-8319 ; 1594-0667
ISSN (online)	1720-8319
ISSN	1594-0667
DOI	10.1007/s40520-022-02249-y
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Article: Development and validation of the delirium risk assessment score (DRAS).

Vreeswijk, Ralph / Kalisvaart, Imke / Maier, Andrea B / Kalisvaart, Kees J

European geriatric medicine

2020 Volume 11, Issue 2, Page(s) 307–314

Abstract: ... the DRAS was compared (AUC, sensitivity and specificity) to 3 instruments (Inouye, Kalisvaart, VMS rules ...

Abstract	Purpose: Development and validation of a delirium risk assessment score. Predisposing risk factors for delirium were used, which are easily assessed at hospital admission without additional clinical or laboratory testing. Methods: A systematic literature search identified ten risk factors: acute admission, alcohol use > 4 units/day, cognitive impairment, ADL impairment, age > 75 years, earlier delirium, hearing/vision problems, number of medication ≥ 5, number of morbidities > 2 and male. The DRAS was developed in a mixed patient population (N = 842) by the use of univariate and multivariate analyses and -2 log-likelihood calculation to weigh the risk factors. Based on the sensitivity and specificity, a cutoff score was calculated. The validation was performed in 3 cohorts (N = 408, N = 186, N = 365). In cohort 3, the DRAS was compared (AUC, sensitivity and specificity) to 3 instruments (Inouye, Kalisvaart, VMS rules). Results: The delirium incidence was 31.8%, 20.3%, 15.6% and 15.1%. All risk factors were independently predictive for delirium, except male. The multivariate analyses excluded morbidities. The final DRAS consists of 8 items; acute admission, cognitive impairment, alcohol use (3 points), ADLimpairment/mobilityproblems (2 points), higher age, earlier delirium, hearing/vision problems, and medication (1 point). The total score is 15 points and at a cut-of score of 5 or higher the patient is at risk of developing a delirium. The cutoff was at 5 or more points, AUC: 0.76 (95% CI 0.72-0.79), sensitivity 0.77, specificity 0.60. Validation cohorts AUC was 0.75 (95% CI 0.96-0.81), 0.76 (95% CI 0.70-0.83) and 0.78 (95% CI 0.70-0.87), sensitivity 0.71, 0.67 and 0.89 and specificity 0.70, 0.72 and 0.60. The comparison revealed the highest AUC for the DRAS. Conclusion: Based on an admission interview, the delirium risk can be easily evaluated using the DRAS shortlist score of predisposing risk factors for delirium in older inpatients.
MeSH term(s)	Aged ; Delirium/diagnosis ; Hospitalization ; Humans ; Infant, Newborn ; Male ; Prospective Studies ; Risk Assessment ; Risk Factors
Language	English
Publishing date	2020-01-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2556794-9
ISSN	1878-7657 ; 1878-7649
ISSN (online)	1878-7657
ISSN	1878-7649
DOI	10.1007/s41999-019-00287-w
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Article ; Online: Deficits in geriatric assessment are important in relation to fatigue in older patients with Inflammatory Bowel Disease.

Fons, Anne B / Asscher, Vera E R / Stuyt, Rogier J L / Baven-Pronk, A Martine C / van der Marel, Sander / Jacobs, Rutger J / Mooijaart, Simon P / Eikelenboom, Piet / van der Meulen-de Jong, Andrea E / Kalisvaart, Kees J / Jeroen Maljaars, P W

Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver

2024

Abstract: Background: No previous study has investigated fatigue in older patients with Inflammatory Bowel Disease (IBD).: Aims: To describe the prevalence of fatigue in older patients and compare it to the prevalence in younger patients with IBD, and to ... ...

Abstract	Background: No previous study has investigated fatigue in older patients with Inflammatory Bowel Disease (IBD). Aims: To describe the prevalence of fatigue in older patients and compare it to the prevalence in younger patients with IBD, and to determine factors associated with fatigue. Methods: A prospective, multicenter cohort study, including older- (≥ 65 years) and younger patients with IBD (18-64 years). A geriatric assessment was performed in older patients to measure deficits in geriatric assessment (DiG). Fatigue was defined by one item from the short Inflammatory Bowel Disease Questionnaire. Active disease was defined as the presence of clinical or biochemical disease activity. Results: Fatigue prevalence in the 405 older patients varied between 45.4% (71/155) in active disease to 23.6% (60/250) in remission. Fatigue prevalence in 155 younger patients was 59.5% (47/79) and 57.4% (89/155), respectively. Female sex, clinical disease activity, use of immunomodulators and presence of DiG were associated with fatigue in older patients with IBD. Conclusions: Fatigue prevalence is lower in older patients with IBD compared to younger patients with IBD, but increases when active disease is present. Clinicians should be aware that fatigue is a relevant symptom in older patients with IBD, as it is associated with DiG.
Language	English
Publishing date	2024-02-17
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1459373-7
ISSN	1878-3562 ; 1125-8055
ISSN (online)	1878-3562
ISSN	1125-8055
DOI	10.1016/j.dld.2024.01.196
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Article ; Online: The effect of the anticholinergic burden on duration and severity of delirium in older hip-surgery patients with and without haloperidol prophylaxis: A post hoc analysis.

Tillemans, Monique P H / Butterhoff-Terlingen, Madelon H / Stuffken, Rutger / Vreeswijk, Ralph / Egberts, Toine C G / Kalisvaart, Kees J

Brain and behavior

2021 Volume 11, Issue 12, Page(s) e2404

Abstract: Background: Anticholinergic acting drugs have been associated with delirium in older patients.: Objective: To examine the association between the anticholinergic burden (ACB) and the duration and severity of delirium in older hip-surgery patients ... ...

Abstract	Background: Anticholinergic acting drugs have been associated with delirium in older patients. Objective: To examine the association between the anticholinergic burden (ACB) and the duration and severity of delirium in older hip-surgery patients with or without haloperidol prophylaxis. Methods: Older patients with a postoperative delirium following hip surgery from a randomized controlled trial investigating the effects of haloperidol prophylaxis on delirium incidence were included in this study. The ACB was quantified using two different tools, the Anticholinergic Drug Scale and an Expert Panel. Using linear regression, the association between the ACB and delirium was analyzed. Results: Overall delirium duration and severity were not significantly associated with the ACB. Also, no statistically significant differences were found in delirium duration or severity between the placebo and haloperidol treatment groups for the ACB groups. The protective effect of haloperidol on delirium duration and severity however tended to be present in patients with no or a low ACB but not or to a lesser extent in patients with an intermediate to high ACB. Conclusions: The ACB was not significantly associated with delirium duration or severity. Haloperidol prophylaxis tended to shorten delirium duration and decrease delirium severity in patients with no or a low ACB. To further explore the influence of anticholinergic acting drugs on delirium duration and severity and the effect of concomitant haloperidol use, additional research with a higher haloperidol dose, a larger study population, and ACB quantification taking drug exposure into account is warranted.
MeSH term(s)	Aged ; Cholinergic Antagonists/adverse effects ; Delirium/epidemiology ; Delirium/prevention & control ; Haloperidol/adverse effects ; Humans
Chemical Substances	Cholinergic Antagonists ; Haloperidol (J6292F8L3D)
Language	English
Publishing date	2021-11-10
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	2623587-0
ISSN	2162-3279 ; 2162-3279
ISSN (online)	2162-3279
ISSN	2162-3279
DOI	10.1002/brb3.2404
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Article ; Online: Preoperative Cerebrospinal Fluid Cortisol and the Risk of Postoperative Delirium: A Prospective Study of Older Hip Fracture Patients.

Witlox, Joost / Adamis, Dimitrios / Koenderman, Leo / Kalisvaart, Kees / de Jonghe, Jos F M / Houdijk, Alexander P J / Maclullich, Alasdair M J / Eikelenboom, Piet / van Gool, Willem A

Dementia and geriatric cognitive disorders

2021 Volume 49, Issue 6, Page(s) 604–610

Abstract: Background: Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol ... ...

Abstract	Background: Ageing, depression, and neurodegenerative disease are common risk factors for delirium in the elderly. These risk factors are associated with dysregulation of the hypothalamic-pituitary-adrenal axis, resulting in higher levels of cortisol under normal and stressed conditions and a slower return to baseline. Objectives: We investigated whether elevated preoperative cerebrospinal fluid (CSF) cortisol levels are associated with the onset of postoperative delirium. Methods: In a prospective cohort study CSF samples were collected after cannulation for the introduction of spinal anesthesia of 75 patients aged 75 years and older admitted for surgical repair of acute hip fracture. Delirium was assessed with the confusion assessment method (CAM) and the Delirium Rating Scale-Revised-98 (DRS-R98). Because the CAM and DRS-R98 were available for time of admission and 5 postoperative days, we used generalized estimating equations and linear mixed modeling to examine the association between preoperative CSF cortisol levels and the onset of postoperative delirium. Results: Mean age was 83.5 (SD 5.06) years, and prefracture cognitive decline was present in one-third of the patients (24 [33%]). Postoperative delirium developed in 27 (36%) patients. We found no association between preoperative CSF cortisol levels and onset or severity of postoperative delirium. Conclusions: These findings do not support the hypothesis that higher preoperative CSF cortisol levels are associated with the onset of postoperative delirium in elderly hip fracture patients.
MeSH term(s)	Aged ; Aged, 80 and over ; Delirium/cerebrospinal fluid ; Delirium/diagnosis ; Delirium/etiology ; Delirium/physiopathology ; Female ; Hip Fractures/cerebrospinal fluid ; Hip Fractures/surgery ; Humans ; Hydrocortisone/cerebrospinal fluid ; Hypothalamo-Hypophyseal System/physiopathology ; Male ; Pituitary-Adrenal System/physiopathology ; Postoperative Complications/cerebrospinal fluid ; Postoperative Complications/diagnosis ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology ; Prospective Studies ; Risk Factors
Chemical Substances	Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2021-03-02
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1026007-9
ISSN	1421-9824 ; 1013-7424
ISSN (online)	1421-9824
ISSN	1013-7424
DOI	10.1159/000512984
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Article ; Online: Acute response to cholinergic challenge predicts long-term response to galantamine treatment in patients with Alzheimer's disease.

Baakman, Anne Catrien / Gavan, Carmen / van Doeselaar, Lotte / de Kam, Marieke / Broekhuizen, Karen / Bajenaru, Ovidiu / Camps, Laura / Swart, Eleonora L / Kalisvaart, Kees / Schoonenboom, Niki / Lemstra, Evelien / Scheltens, Philip / Cohen, Adam / van Gerven, Joop / Groeneveld, Geert Jan

British journal of clinical pharmacology

2022 Volume 88, Issue 6, Page(s) 2814–2829

Abstract: Aims: Cholinesterase inhibitors (CEIs) have been shown to improve cognitive functioning in Alzheimer's disease (AD) patients, but are associated with multiple side effects and only 20-40% of the patients clinically improve. In this study, we aimed to ... ...

Abstract	Aims: Cholinesterase inhibitors (CEIs) have been shown to improve cognitive functioning in Alzheimer's disease (AD) patients, but are associated with multiple side effects and only 20-40% of the patients clinically improve. In this study, we aimed to investigate the acute pharmacodynamic (PD) effects of administration of a single dose of galantamine on central nervous system (CNS) functioning in mild to moderate AD patients and its potential to predict long-term treatment response. Methods: This study consisted of a challenge and treatment phase. In the challenge phase, a single dose of 16 mg galantamine was administered to 50 mild to moderate AD patients in a double-blind, placebo-controlled cross-over fashion. Acute PD effects were monitored up to 5 hours after administration with use of the NeuroCart CNS test battery and safety and pharmacokinetics were assessed. In the treatment phase, patients were treated with open-label galantamine according to regular clinical care. After 6 months of galantamine treatment, patients were categorized as either responder or as non-responder based on their minimental state examination (MMSE), neuropsychiatric inventory (NPI) and disability assessment in dementia (DAD) scores. An analysis of covariance was performed to study the difference in acute PD effects during the challenge phase between responders and non-responders. Results: A single dose of galantamine significantly reduced saccadic reaction time (-0.0099; 95% CI = -0.0195, -0.0003; P = .0430), absolute frontal EEG parameters in alpha (-14.9; 95% CI = -21.0, -8.3; P = .0002), beta (-12.6; 95% CI = -19.4, -5.3; P = .0019) and theta (-17.9; 95% CI = -25.0, -10.0; P = .0001) frequencies. Relative frontal (-1.669; 95% CI = -2.999, -0.339; P = .0156) and occipital (-1.856; 95% CI = -3.339, -0.372; P = .0166) EEG power in theta frequency and relative occipital EEG power in the gamma frequency (1.316; 95% CI = 0.158, 2.475; P = .0273) also increased significantly compared to placebo. Acute decreases of absolute frontal alpha (-20.4; 95% CI = -31.6, -7.47; P = .0046), beta (-15.7; 95% CI = -28.3, -0.93; P = .0390) and theta (-25.9; 95% CI = -38.4, -10.9; P = .0024) EEG parameters and of relative frontal theta power (-3.27%; 95% CI = -5.96, -0.58; P = .0187) on EEG significantly distinguished responders (n = 11) from non-responders (n = 32) after 6 months. Conclusions: This study demonstrates that acute PD effects after single dose of galantamine are correlated with long-term treatment effects and that patients who demonstrate a reduction in EEG power in the alpha and theta frequency after a single administration of galantamine 16 mg will most likely respond to treatment.
MeSH term(s)	Alzheimer Disease/complications ; Alzheimer Disease/drug therapy ; Cholinesterase Inhibitors/adverse effects ; Cognition ; Galantamine/adverse effects ; Humans ; Nootropic Agents/pharmacology ; Nootropic Agents/therapeutic use ; Treatment Outcome
Chemical Substances	Cholinesterase Inhibitors ; Nootropic Agents ; Galantamine (0D3Q044KCA)
Language	English
Publishing date	2022-01-26
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	188974-6
ISSN	1365-2125 ; 0306-5251 ; 0264-3774
ISSN (online)	1365-2125
ISSN	0306-5251 ; 0264-3774
DOI	10.1111/bcp.15206
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Zs.A 1118: Show issues

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Article ; Online: The impact of MRI combined with visual rating scales on the clinical diagnosis of dementia: a prospective study.

Verhagen, Martijn V / Guit, Gerard L / Hafkamp, Gerrit Jan / Kalisvaart, Kees

European radiology

2015 Volume 26, Issue 6, Page(s) 1716–1722

Abstract: Objectives: Dementia is foremost a clinical diagnosis. However, in diagnosing dementia, it is advocated to perform at least one neuroimaging study. This has two purposes: to rule out potential reversible dementia (PRD), and to help determine the ... ...

Abstract	Objectives: Dementia is foremost a clinical diagnosis. However, in diagnosing dementia, it is advocated to perform at least one neuroimaging study. This has two purposes: to rule out potential reversible dementia (PRD), and to help determine the dementia subtype. Our first goal was to establish if MRI combined with visual rating scales changes the clinical diagnosis. The second goal was to demonstrate if MRI contributes to a geriatrician's confidence in the diagnosis. Methods: The dementia subtype was determined prior to and after MRI. Scoring scales used were: global cortical atrophy (GCA), medial temporal atrophy (MTA), and white matter hyperintensity measured according to the Fazekas scale. The confidence level of the geriatrician was determined using a visual analogue scale. Results: One hundred and thirty-five patients were included. After MRI, the diagnosis changed in 23.7 % (CI 17.0 %-31.1 %) of patients. Change was due to vascular aetiology in 13.3 % of patients. PRD was found in 2.2 % of all patients. The confidence level in the diagnosis increased significantly after MRI (p = 0.001). Conclusions: MRI, combined with visual rating scales, has a significant impact on dementia subtype diagnosis and on a geriatrician's confidence in the final diagnosis. Key points: • MRI with visual rating scales changes the dementia subtype diagnosis significantly. • MRI is essential in demonstrating vascular disease as a cause of dementia. • All suspected dementia patients should undergo an MRI with visual rating scales. • MRI improves a geriatrician's confidence in the diagnosis of the dementia subtype. • MRI remains essential during the workup of dementia to exclude reversible causes.
MeSH term(s)	Aged ; Alzheimer Disease/diagnosis ; Atrophy/pathology ; Dementia/diagnosis ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Neurodegenerative Diseases/pathology ; Neuroimaging/methods ; Prospective Studies ; Temporal Lobe/pathology ; Visual Analog Scale
Language	English
Publishing date	2015-08-29
Publishing country	Germany
Document type	Journal Article ; Observational Study
ZDB-ID	1085366-2
ISSN	1432-1084 ; 0938-7994 ; 1613-3749
ISSN (online)	1432-1084
ISSN	0938-7994 ; 1613-3749
DOI	10.1007/s00330-015-3957-z
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Article: Prevention of delirium in the elderly.

Kalisvaart, Kees / Vreeswijk, Ralph

Revista espanola de geriatria y gerontologia

2008 Volume 43 Suppl 3, Page(s) 19–24

Abstract: The incidence of delirium in the elderly in general hospitals is up to 20 to 65%. Delirium is associated with high mortality, increased morbidity, increased need for nursing surveillance, longer hospital stays and a high rate of institutionalization ... ...

Abstract	The incidence of delirium in the elderly in general hospitals is up to 20 to 65%. Delirium is associated with high mortality, increased morbidity, increased need for nursing surveillance, longer hospital stays and a high rate of institutionalization following discharge. Delirium is not recognized by clinicians in one- to two-thirds of all cases and is commonly overlooked or misattributed to dementia, depression, or senescence; confusional states in the hospitalized elderly are considered the rule, rather than the exception and cognitive function is rarely assessed. For prevention of delirium it is necessary to look for patients "at-risk" for delirium and to use instruments for screenings and severity. Also should the medical and nursing staff be made aware of prodromal symptoms for delirium, indicating a delirium is developing. Prevention requires multidisciplinary action with pharmacological and non pharmacological interventions (multifactor intervention). A pro-active consultation team (doctors and nurses) resulting in good basic medical- and nursing care have the best results concerning the prevention of delirium, reducing delirium incidence with more than 25%.
MeSH term(s)	Aged ; Biomedical Research/trends ; Delirium/prevention & control ; Forecasting ; Humans ; Primary Prevention
Language	English
Publishing date	2008
Publishing country	Spain
Document type	Journal Article ; Review
ZDB-ID	605609-x
ISSN	1578-1747 ; 0211-139X
ISSN (online)	1578-1747
ISSN	0211-139X
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Article ; Online: What patients want to know, and what we actually tell them: The ABIDE project.

Fruijtier, Agnetha D / Visser, Leonie N C / Bouwman, Femke H / Lutz, Rogier / Schoonenboom, Niki / Kalisvaart, Kees / Hempenius, Liesbeth / Roks, Gerwin / Boelaarts, Leo / Claus, Jules J / Kleijer, Mariska / de Beer, Marlijn / van der Flier, Wiesje M / Smets, Ellen M A

Alzheimer's & dementia (New York, N. Y.)

2020 Volume 6, Issue 1, Page(s) e12113

Abstract: Background: We studied to what degree and at whose initiative 25 informational topics, formerly identified as important, are discussed in diagnostic consultations.: Methods: Audio recordings of clinician-patient consultations of 71 patients and 32 ... ...

Abstract	Background: We studied to what degree and at whose initiative 25 informational topics, formerly identified as important, are discussed in diagnostic consultations. Methods: Audio recordings of clinician-patient consultations of 71 patients and 32 clinicians, collected in eight Dutch memory clinics, were independently content-coded by two coders. The coding scheme encompassed 25 informational topics. Results: Approximately half ( Conclusion: Most patients received information on approximately half of the important informational topics. Providing the topic list to patients and care partners beforehand could allow consultation preparation and stimulate participation.
Language	English
Publishing date	2020-12-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	2832891-7
ISSN	2352-8737 ; 2352-8737
ISSN (online)	2352-8737
ISSN	2352-8737
DOI	10.1002/trc2.12113
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