{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T15:32:43Z","timestamp":1790350363615,"version":"4.1.0"},"reference-count":50,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T00:00:00Z","timestamp":1775779200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["T32AG000212"],"award-info":[{"award-number":["T32AG000212"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["23\/13888\u20101"],"award-info":[{"award-number":["23\/13888\u20101"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000957","name":"Alzheimer's Association","doi-asserted-by":"publisher","award":["23AARFD\u20101028868"],"award-info":[{"award-number":["23AARFD\u20101028868"]}],"id":[{"id":"10.13039\/100000957","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Delirium predicts adverse outcomes in older emergency department (ED) patients, but many acutely ill patients without delirium have underlying cognitive impairment that goes unrecognized. Whether cognitive impairment screening improves risk prediction beyond delirium remains uncertain. We compared practical bedside screening strategies for delirium, cognitive impairment, or both for predicting 90\u2010day functional decline and mortality in older adults admitted from the ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective cohort comprising patients aged \u2265\u200965\u2009years admitted from the ED of a large hospital in S\u00e3o Paulo, Brazil. Trained professionals screened for delirium using the brief Confusion Assessment Method (bCAM) and for cognitive impairment using the 10\u2010point Cognitive Screener (10\u2010CS). Patients were classified as having normal cognition (bCAM negative, 10\u2010CS &gt;\u20095), delirium (bCAM positive), or cognitive impairment without delirium (bCAM negative, 10\u2010CS \u2264\u20095). Blinded investigators assessed decline in basic activities of daily living (ADL) and mortality within 90\u2009days of admission. Fine\u2010Gray models (death as a competing risk) and Cox models estimated associations with outcomes, adjusting for sociodemographic and clinical factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 830 patients (mean age\u2009=\u200980\u2009\u00b1\u20099\u2009years; women\u2009=\u200947%), 427 (51.5%) had normal cognition, 171 (20.6%) had delirium, and 232 (27.9%) had cognitive impairment without delirium. Among delirium\u2010negative patients with cognitive impairment, 52% had no documented dementia diagnosis or reported memory problems. Compared with normal cognition, cognitive impairment without delirium was associated with 90\u2010day functional ADL decline (sub\u2010HR\u2009=\u20091.60; 95% CI\u2009=\u20091.03\u20132.49) and mortality (HR\u2009=\u20092.31; 95% CI\u2009=\u20091.18\u20134.51), with risks similar to those observed in delirium. A staged strategy (bCAM first, then 10\u2010CS if bCAM negative) showed higher discrimination than delirium\u2010only or 10\u2010CS\u2010only screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cognitive impairment without delirium is common, often unrecognized, and predicts 90\u2010day adverse outcomes in older patients admitted from the ED. A brief staged screening strategy integrating delirium assessment with cognitive impairment testing among delirium\u2010negative patients may enhance early detection of cognitive vulnerability and support care planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70378","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:06:33Z","timestamp":1775804793000},"page":"1294-1303","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Two Brief Steps, Better Foresight: Cognitive Screening and Adverse Outcomes in Older Adults Admitted From the Emergency Department"],"prefix":"10.1111","volume":"74","author":[{"given":"Gabriel Stanziola","family":"de Moraes","sequence":"first","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE) Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9347-0519","authenticated-orcid":false,"given":"Thiago Junqueira","family":"Avelino\u2010Silva","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE) Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Laboratorio de Investiga\u00e7ao Medica Em Envelhecimento (LIM\u201066), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo  Brazil"},{"name":"Division of Geriatrics, Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth E.","family":"Covinsky","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Medicine University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2603-7157","authenticated-orcid":false,"given":"Christopher R.","family":"Carpenter","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0565-0918","authenticated-orcid":false,"given":"Mfon E.","family":"Umoh","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Gerontology, Department of Medicine Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian V.","family":"Morinaga","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE) Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8544-1635","authenticated-orcid":false,"given":"Pedro K.","family":"Curiati","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE) Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7467-1745","authenticated-orcid":false,"given":"M\u00e1rlon Juliano Romero","family":"Aliberti","sequence":"additional","affiliation":[{"name":"Geriatric Emergency Department Research Group (ProAGE) Hospital S\u00edrio\u2010Liban\u00eas  S\u00e3o Paulo S\u00e3o Paulo Brazil"},{"name":"Laboratorio de Investiga\u00e7ao Medica Em Envelhecimento (LIM\u201066), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina Universidade de Sao Paulo  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"key":"e_1_2_10_2_1","first-page":"1","article-title":"Emergency Department Visits Among Adults Aged 60 and Over: United States, 2014\u20132017","volume":"367","author":"Ashman J. J.","year":"2020","journal-title":"NCHS Data Brief"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12873\u2010020\u201000341\u2010y"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2022.05.058"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916\u2010017\u20100899\u20100"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19494"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18126"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2022.02.024"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afab214"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.02.008"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14935"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13573"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afx149"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17581"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17745"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2022.03.019"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glab156"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2020.01.010"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/07317115.2016.1201714"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19052"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12635"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2017.10.017"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1963.03060120024016"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glz109"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.19\u20103\u2010260"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa240"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2013.05.003"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4282"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afw084"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532\u20105415.1999.tb05204.x"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19374"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4348"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14166"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa183"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1177\/21514593211001047"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.1128"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.16803"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2025.02.003"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afx174"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnurstu.2019.02.005"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.12067"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.55740"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18631"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2024.03.016"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18091"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12569"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70287"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2024.12.002"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19490"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.12993"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70378","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jgs.70378","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.70378","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T05:18:32Z","timestamp":1780031912000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.70378"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":50,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/jgs.70378"],"URL":"https:\/\/doi.org\/10.1111\/jgs.70378","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]},"assertion":[{"value":"2025-08-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}