@article{ref1,
title="Cognitive impairment is very common in elderly patients with syncope and unexplained falls",
journal="Journal of the American Medical Directors Association",
year="2017",
author="de Ruiter, Susanne C. and de Jonghe, Jos F. M. and Germans, Tjeerd and Ruiter, Jaap H. and Jansen, René W. M. M.",
volume="18",
number="5",
pages="409-413",
abstract="OBJECTIVES: To evaluate the prevalence of cognitive impairment (CI), including mild CI and dementia, in elderly patients with syncope and unexplained falls. In this population, we compared the use of the Mini-Mental State Examination (MMSE) with a cognitive screening test that assesses executive dysfunction typical of subcortical (vascular) CI, that is, the Montreal Cognitive Assessment (MoCA). <br><br>DESIGN: Observational cohort study. SETTING: Outpatient fall and syncope clinic. PARTICIPANTS: Consecutive patients aged ≥65 years with syncope and unexplained falls without loss of consciousness. MEASUREMENTS: Baseline characteristics, functional status, MMSE, MoCA, and magnetic resonance imaging scans of the brain. MAIN OUTCOME: prevalence of CI, comparing the MMSE with the MoCA. CI was defined as an MMSE/MoCA score <26. SECONDARY OUTCOMES: MMSE/MoCA overall and subdomain scores, Fazekas and medial temporal lobe atrophy scores. <br><br>RESULTS: We included 200 patients, mean age 79.5 (standard deviation 6.6) years (Syncope Group: n = 101; Fall Group: n = 99). Prevalence of CI was 16.8% (MMSE) versus 60.4% (MoCA) in the Syncope Group (P < .001) and 16.8% (MMSE) versus 56.6% (MoCA) in the Fall Group (P < .001). Prevalence of CI did not differ between the Syncope Group and Fall Group with either method. Executive dysfunction was present in both groups. <br><br>CONCLUSION: CI is as common in elderly patients with syncope as it is in patients with unexplained falls, with an overall prevalence of 58%. The MMSE fails as a screening instrument for CI in these patients, because it does not assess executive function. Therefore, we recommend the MoCA for cognitive screening in older patients with syncope and unexplained falls.<br><br>Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1525-8610",
doi="10.1016/j.jamda.2016.11.012",
url="http://dx.doi.org/10.1016/j.jamda.2016.11.012"
}