Deep vein thrombosis among patients with mild cognitive decline

Deep vein thrombosis among patients with mild cognitive decline | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Deep vein thrombosis among patients with mild cognitive decline Haruo Nishijima, Shota Seino, Eri Shibuya, Naoko Nakahata, Chieko Suzuki, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6131734/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The prevalence of deep vein thrombosis (DVT) is high in patients with severe major neurocognitive disorders and motor deficits. However, it is unknown whether patients with mild cognitive decline without major motor deficits have an increased risk for DVT. Recently, Nakanishi et al. proposed the Himi score to evaluate DVT risk in frail elderly individuals. The score accounts for the independence level in daily life among patients with dementia, graded as I/II, III, IV and M, as an assessment item. In the present study, we investigated DVT prevalence among patients with mild cognitive decline. Participants were recruited from the patients who visited our outpatient clinic between August 2022 and February 2023. To be eligible for enrollment, patients were required to be diagnosed with mild cognitive impairment or early-stage major neurocognitive disorder and able to walk independently. Individuals were excluded if they had an active malignancy, had a bed rest time of more than 24 h owing to an external injury within 3 months before the study, received general anesthesia, or had undergone central venous access catheter insertion within 3 months before the study. Overall, written informed consent was obtained from 22 patients. Clinical data, including the Mini-Mental State Examination and Alzheimer’s Disease Assessment Scale-Cognitive scores, were collected. Physical examinations were performed to evaluate the following symptoms in the lower extremities: pain, edema, erythema, varicose veins, and Homan’s sign. We calculated the Wells score and Padua Prediction score, which are well-established for evaluating DVT risk. We also calculated the Himi score. Whole-leg vein ultrasonography was performed to detect DVT in 12 patients with leg symptoms or elevated blood d-dimer levels. DVT was detected in two of the 22 participants (9%). Although the DVT prevalence in the general population is unknown, our pilot study results may reflect increased prevalence of DVT in patients with mild cognitive decline without major motor impairment. Neither patient with DVT had a major risk for DVT according to the Wells and Padua Prediction scores. In contrast, two patients had high Himi scores, suggesting that low activities of daily living owing to cognitive decline are associated with DVT. Our data suggest that the Himi score is useful for detecting potential DVT risks in elderly individuals without apparent motor deficits or other major risk factors. Geriatrics & Gerontology Internal Medicine Introduction The prevalence of deep vein thrombosis (DVT) is high in patients with severe major neurocognitive disorders (dementia) and motor deficits [ 1 ]. Major neurocognitive disorders are risk factors for DVT [ 2 , 3 ]. However, it is unknown whether patients with mild neurocognitive disorders or mild cognitive impairment (MCI) without major motor deficits have an increased risk for DVT. Cognitive deficits may lead to reduced activities of daily living, which is a possible risk factor for DVT. Recently, Nakanishi et al. proposed the Himi score to evaluate DVT risk in frail elderly individuals [ 3 ]. The Himi score includes the level of independence in daily life among patients with dementia, graded as 0, I–IV and M as an assessment item. The grades were allocated as follows: grade 0, no cognitive impairment irrespective of activities of daily living; grade I, independence at home and community with slight cognitive impairment; grade IIa and IIb, independence by support with some hindrances; grade III: nurse-care requirement, with difficulty in communicating or problem behaviors; grade IV: regular nursing care required; and grade M: specialized medical care required because of serious mental or physical problem behaviors (please refer to the definition provided by Nakanishi et al.) [ 3 ]. Method In the present report, we investigated the DVT prevalence among patients who visited our department and were diagnosed with MCI or an early-stage major cognitive disorder. The study was performed in accordance with the tenets of the Declaration of Helsinki (as revised in Brazil 2013, available at https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ ), and was approved by the ethics committee of Hirosaki University Graduate School of Medicine (authorization number, 2020 − 181). Participants were recruited from among patients who visited our outpatient clinic between August 1, 2022, and February 28, 2023. To be eligible for enrollment, patients were required to be diagnosed with MCI or early-stage major cognitive disorder, defined as a score of 0.5 or 1 point on the Clinical Dementia Rating scale [ 4 ], and able to walk independently. Patients were excluded from the present study if they were under 20 years old, had received antithrombotic therapy, had an active malignancy, had a bed rest time of over 24 hours owing to an external injury within 3 months, received general anesthesia, or undergone central venous access catheter insertion within 3 months before the start of the study. Overall, written informed consent for study participation was obtained from 22 patients. Clinical data, including the Mini-Mental State Examination [ 5 ] and Alzheimer’s Disease Assessment Scale-Cognitive scores [ 6 ], were collected. Physical examinations were performed to evaluate the following symptoms in the lower extremities: pain (spontaneous or oppressive), edema, erythema, varicose veins, and Homan’s sign (calf pain induced by dorsiflexion of the foot). Blood tests including d -dimer level estimation were performed. We then calculated the Wells score [ 7 ] and Padua Prediction score [ 8 ], which are well-established scores for evaluating DVT risk. We also calculated the Himi score, which has recently been proposed for evaluating DVT risk in the elderly [ 3 ]. Whole-leg vein ultrasonography was performed to detect DVT in 12 patients with leg symptoms or elevated d -dimer levels (> 1.0 µg/ml). Results DVT was detected in two of the 22 participants (9%): a 79-year-old man with MCI having thrombosis in bilateral popliteal veins and an 89-year-old woman with an early-stage major cognitive disorder having thrombosis in bilateral soleal veins. Both of the two patients underwent anticoagulant therapy and the DVT disappeared. The demographics and characteristics of the two patients with DVT and the other 20 patients are shown in Table 1 . Table 1 Demographics and characteristics of the two patients with DVT and the other 20 patients. Patients, not detected with DVT (n = 20) Patient 1 with DVT Patient 2 with DVT DVT location - Bilateral, central (popliteal veins) Bilateral, peripheral (soleal veins) Age, years 77.6 ± 3.7 79 89 Sex Female 11 (55%) Male Female Diagnosis Mild cognitive impairment 14 Mild cognitive impairment Early-stage major cognitive disorder Early-stage major cognitive disorder 6 MMSE score 24.1 ± 2.4 25 23 ADAS-COG score 12.0 ± 5.2 Not available 6.6 Clinical Dementia Rating 0.5 15 0.5 1 1 5 ≥ 2 0 Daily life independence level with dementia Ⅰ 14 Ⅱa Ⅱb Ⅱa 2 Ⅱb 4 ≥Ⅲ 0 Body mass index 21.8 ± 4.0 26.0 20.8 Habit of regular physical exercise* Yes 9 (45%) Yes No Previous venous thrombosis Yes 0 No No Limb paralysis or gait disturbance Yes 0 No No Leg symptoms** Yes 5 (25%) No Yes (positive Homans’ sign) d -dimer value (µg/ml) 1.0 ± 2.3 10.9 1.9 Elevated d -dimer value (> 1.0 µg/ml) Yes 3 (15%) Yes Yes HbA1c (%) 5.8 ± 0.5 5.7 6.8 Total cholesterol level (mg/dl) 211 ± 28 233 215 Wells score 0 19 0 0 1 1 ≥ 2 0 Padua Prediction Score 0 1 1 1 1 16 2 2 ≥ 3 0 Not available 1 Himi score ≤ ―1 0 4 3 0 11 1 2 2 6 3 1 ≥ 4 0 Values are shown as average ± standard deviation values or the number of patients. ADAS-COG, Alzheimer’s disease assessment scale-cognitive; CDR, Clinical Dementia Rating; DVT, deep vein thrombosis; HbA1c, glycosylated hemoglobin; MMSE, Mini-Mental State Examination *Regular physical exercise indicates exercise on two or more days in a week for 30 minutes or more per day. **Leg symptoms include pain (spontaneous or oppressive), edema, erythema, varicose veins, and Homans’ sign. Discussion Although the prevalence of DVT in the general population is unknown, our findings suggests that DVT risk can be elevated in patients with mild cognitive decline without major motor impairment. Neither of the two patients with DVT had a major risk for DVT according to their Wells and Padua Prediction scores. High risk for DVT is defined as a Wells score of ≥ 3 points [ 7 ] or a Padua prediction score of ≥ 4 points [ 8 ]. Neither of the two patients with DVT had scores higher than the cut-off Wells and Padua Prediction scores. In contrast, two patients had high Himi scores (4 and 3 points), suggesting that low activities of daily living owing to cognitive decline are associated with DVT. The Himi score is a unique parameter because it includes the degree of deterioration of activities of daily living due to cognitive impairment. The adjusted odds ratio for DVT associated with moderate and high Himi scores (≥ 2 and ≥ 3 points, respectively) were 4.2 and 23.7, respectively [ 3 ]. Our cases suggest that the Himi score is useful for detecting potential risks of DVT in elderly individuals without apparent motor deficits or other major risk factors. A limitation of the present report was the small number of participants, because of which we could not perform statistical analyses. Moreover, we did not perform ultrasonography in 10 participants without leg symptoms or elevated D-dimer levels. DVT could have been detected in more patients if all participants underwent ultrasonography. A larger study is warranted to confirm the DVT risk in patients with mild cognitive decline. Declarations Funding We have no financial support in the present study. Competing interests The authors have no relevant financial or non-financial interests to disclose. Ethics approval This study was approved by the ethics committee of Hirosaki University Graduate School of Medicine (authorization number, 2020-181). Informed consent Written informed consent was obtained from all the participants. Data, Materials and/or Code availability The data that supports the findings of this study are available from the corresponding author, HN, upon reasonable request. Authors’ contributions HN: study concept, collecting the data, analyses, and writing the original draft. SS, ES, NN, CS: collecting the data and reviewing the manuscript. MT: Study concept, reviewing the manuscript, supervision of the study. Acknowledgements We thank Ms. Tomomi Tsushima and Ms. Miho Daimaruya for providing compassionate nursing care to our patients. We would also like to thank Editage (www.editage.com) for English language editing. References Ohmori H, Kanaoka Y, Murata Y, et al.: Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities, Especially Diagnosis and Prevention of Recurrence for Chronic Thrombosis-Serial Changes of Sonography and D-Dimer. Ann Vasc Dis. 2015, 8:290-296. 10.3400/avd.oa.15-00102 Arpaia G, Ambrogi F, Penza M, et al.: Risk of venous thromboembolism in patients nursed at home or in long-term care residential facilities. Int J Vasc Med. 2011, 2011:305027. 10.1155/2011/305027 Nakanishi K, Kanda T, Kobata T, Mori M, Yamada S, Kasamaki Y: New score including daily life independence levels with dementia is associated with the onset of deep vein thrombosis in frail older adults. Geriatr Gerontol Int. 2020, 20:414-421. 10.1111/ggi.13873 Morris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993, 43:2412-2414. 10.1212/wnl.43.11.2412-a Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12:189-198. 10.1016/0022-3956(75)90026-6 Rosen WG, Mohs RC, Davis KL: A new rating scale for Alzheimer's disease. Am J Psychiatry. 1984, 141:1356-1364. 10.1176/ajp.141.11.1356 Wells PS, Anderson DR, Bormanis J, et al.: Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997, 350:1795-1798. 10.1016/S0140-6736(97)08140-3 Barbar S, Noventa F, Rossetto V, et al.: A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010, 8:2450-2457. 10.1111/j.1538-7836.2010.04044.x Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6131734","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":422515053,"identity":"22103f20-3aa4-47a7-892c-3be7f6595115","order_by":0,"name":"Haruo Nishijima","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYBACAwglwWDAzJBwgIHBBshhbDxAipY0kJYGYrTAGYfBJF4t5uxnn0l83GFhb87O8PDQjZrzdmvbDwNtqbGJxqXFsifdTHLmGYnEnc0MCYdzjt1O3nYmEajlWFpuAy6HHUhjk+Ztk0gwOAzSwnY72ewAUAtjw2HcWs4/A2uxh2j5dy7Z7PxDAlpuQGxh3ADSktt2wM7sBiFbbjxjtpzZJpEI0dKXnGB2A2hLAj6/nE9jvPGxrc7e4PyZ5M853+zszc6nP3zwocYGpxYkwJMAIhPBKhMIKwcB9gMg0p44xaNgFIyCUTCSAADAYmWnp0WBfAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-1065-664X","institution":"Hirosaki University","correspondingAuthor":true,"prefix":"","firstName":"Haruo","middleName":"","lastName":"Nishijima","suffix":""},{"id":422515054,"identity":"4a3e7f8e-032b-41ce-bf5a-5dc6be33b6e3","order_by":1,"name":"Shota Seino","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Shota","middleName":"","lastName":"Seino","suffix":""},{"id":422515055,"identity":"412f8872-bd47-4e05-82f0-e5a1f1ef6233","order_by":2,"name":"Eri Shibuya","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Eri","middleName":"","lastName":"Shibuya","suffix":""},{"id":422515056,"identity":"d5ecc697-4727-44d5-95cc-bb99414155e1","order_by":3,"name":"Naoko Nakahata","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Naoko","middleName":"","lastName":"Nakahata","suffix":""},{"id":422515057,"identity":"6b36c279-50ab-442c-98b9-438f2a1d82dc","order_by":4,"name":"Chieko Suzuki","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Chieko","middleName":"","lastName":"Suzuki","suffix":""},{"id":422515058,"identity":"b0180d02-e851-4603-a527-cb929ec8cfb3","order_by":5,"name":"Masahiko Tomiyama","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Masahiko","middleName":"","lastName":"Tomiyama","suffix":""}],"badges":[],"createdAt":"2025-02-28 23:49:23","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-6131734/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6131734/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":77669702,"identity":"54322d0f-8f10-4653-9215-a5e3a328e3aa","added_by":"auto","created_at":"2025-03-04 06:41:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":451727,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6131734/v1/5c77aacd-0eef-437c-abea-ae13e52396fa.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eDeep vein thrombosis among patients with mild cognitive decline\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe prevalence of deep vein thrombosis (DVT) is high in patients with severe major neurocognitive disorders (dementia) and motor deficits [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Major neurocognitive disorders are risk factors for DVT [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, it is unknown whether patients with mild neurocognitive disorders or mild cognitive impairment (MCI) without major motor deficits have an increased risk for DVT. Cognitive deficits may lead to reduced activities of daily living, which is a possible risk factor for DVT. Recently, Nakanishi et al. proposed the Himi score to evaluate DVT risk in frail elderly individuals [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The Himi score includes the level of independence in daily life among patients with dementia, graded as 0, I\u0026ndash;IV and M as an assessment item. The grades were allocated as follows: grade 0, no cognitive impairment irrespective of activities of daily living; grade I, independence at home and community with slight cognitive impairment; grade IIa and IIb, independence by support with some hindrances; grade III: nurse-care requirement, with difficulty in communicating or problem behaviors; grade IV: regular nursing care required; and grade M: specialized medical care required because of serious mental or physical problem behaviors (please refer to the definition provided by Nakanishi et al.) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eIn the present report, we investigated the DVT prevalence among patients who visited our department and were diagnosed with MCI or an early-stage major cognitive disorder. The study was performed in accordance with the tenets of the Declaration of Helsinki (as revised in Brazil 2013, available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/\u003c/span\u003e\u003cspan address=\"https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), and was approved by the ethics committee of Hirosaki University Graduate School of Medicine (authorization number, 2020\u0026thinsp;\u0026minus;\u0026thinsp;181). Participants were recruited from among patients who visited our outpatient clinic between August 1, 2022, and February 28, 2023. To be eligible for enrollment, patients were required to be diagnosed with MCI or early-stage major cognitive disorder, defined as a score of 0.5 or 1 point on the Clinical Dementia Rating scale [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and able to walk independently. Patients were excluded from the present study if they were under 20 years old, had received antithrombotic therapy, had an active malignancy, had a bed rest time of over 24 hours owing to an external injury within 3 months, received general anesthesia, or undergone central venous access catheter insertion within 3 months before the start of the study. Overall, written informed consent for study participation was obtained from 22 patients.\u003c/p\u003e \u003cp\u003eClinical data, including the Mini-Mental State Examination [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and Alzheimer\u0026rsquo;s Disease Assessment Scale-Cognitive scores [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], were collected. Physical examinations were performed to evaluate the following symptoms in the lower extremities: pain (spontaneous or oppressive), edema, erythema, varicose veins, and Homan\u0026rsquo;s sign (calf pain induced by dorsiflexion of the foot). Blood tests including \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ed\u003c/span\u003e-dimer level estimation were performed. We then calculated the Wells score [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and Padua Prediction score [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], which are well-established scores for evaluating DVT risk. We also calculated the Himi score, which has recently been proposed for evaluating DVT risk in the elderly [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Whole-leg vein ultrasonography was performed to detect DVT in 12 patients with leg symptoms or elevated \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ed\u003c/span\u003e-dimer levels (\u0026gt;\u0026thinsp;1.0 \u0026micro;g/ml).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDVT was detected in two of the 22 participants (9%): a 79-year-old man with MCI having thrombosis in bilateral popliteal veins and an 89-year-old woman with an early-stage major cognitive disorder having thrombosis in bilateral soleal veins. Both of the two patients underwent anticoagulant therapy and the DVT disappeared. The demographics and characteristics of the two patients with DVT and the other 20 patients are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographics and characteristics of the two patients with DVT and the other 20 patients.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003ePatients, not detected with DVT\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePatient 1 with DVT\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePatient 2 with DVT\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDVT location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBilateral, central\u003c/p\u003e \u003cp\u003e(popliteal veins)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBilateral, peripheral\u003c/p\u003e \u003cp\u003e(soleal\u0026nbsp;veins)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e77.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eFemale 11 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMild cognitive\u003c/p\u003e \u003cp\u003eimpairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMild cognitive impairment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEarly-stage major\u003c/p\u003e \u003cp\u003ecognitive disorder\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eEarly-stage major\u003c/p\u003e \u003cp\u003ecognitive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e24.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADAS-COG score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e12.0\u0026thinsp;\u0026plusmn;\u0026thinsp;5.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eClinical Dementia Rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDaily life independence level with dementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eⅠ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eⅡa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eⅡb\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eⅡa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eⅡb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;Ⅲ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e21.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHabit of regular physical\u003c/p\u003e \u003cp\u003eexercise*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes 9 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious venous thrombosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimb paralysis or\u003c/p\u003e \u003cp\u003egait disturbance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeg symptoms**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes 5 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003e(positive Homans\u0026rsquo; sign)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ed\u003c/span\u003e-dimer value\u003c/p\u003e \u003cp\u003e(\u0026micro;g/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e1.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElevated \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ed\u003c/span\u003e-dimer value\u003c/p\u003e \u003cp\u003e(\u0026gt;\u0026thinsp;1.0 \u0026micro;g/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eYes 3 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e5.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal cholesterol level\u003c/p\u003e \u003cp\u003e(mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e211\u0026thinsp;\u0026plusmn;\u0026thinsp;28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWells score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003ePadua Prediction Score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot available\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eHimi score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le; ―1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eValues are shown as average\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation values or the number of patients.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eADAS-COG, Alzheimer\u0026rsquo;s disease assessment scale-cognitive; CDR, Clinical Dementia Rating; DVT, deep vein thrombosis; HbA1c, glycosylated hemoglobin; MMSE, Mini-Mental State Examination\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Regular physical exercise indicates exercise on two or more days in a week for 30 minutes or more per day.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e**Leg symptoms include pain (spontaneous or oppressive), edema, erythema, varicose veins, and Homans\u0026rsquo; sign.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlthough the prevalence of DVT in the general population is unknown, our findings suggests that DVT risk can be elevated in patients with mild cognitive decline without major motor impairment. Neither of the two patients with DVT had a major risk for DVT according to their Wells and Padua Prediction scores. High risk for DVT is defined as a Wells score of \u0026ge;\u0026thinsp;3 points [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] or a Padua prediction score of \u0026ge;\u0026thinsp;4 points [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Neither of the two patients with DVT had scores higher than the cut-off Wells and Padua Prediction scores. In contrast, two patients had high Himi scores (4 and 3 points), suggesting that low activities of daily living owing to cognitive decline are associated with DVT.\u003c/p\u003e \u003cp\u003eThe Himi score is a unique parameter because it includes the degree of deterioration of activities of daily living due to cognitive impairment. The adjusted odds ratio for DVT associated with moderate and high Himi scores (\u0026ge;\u0026thinsp;2 and \u0026ge;\u0026thinsp;3 points, respectively) were 4.2 and 23.7, respectively [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Our cases suggest that the Himi score is useful for detecting potential risks of DVT in elderly individuals without apparent motor deficits or other major risk factors.\u003c/p\u003e \u003cp\u003eA limitation of the present report was the small number of participants, because of which we could not perform statistical analyses. Moreover, we did not perform ultrasonography in 10 participants without leg symptoms or elevated D-dimer levels. DVT could have been detected in more patients if all participants underwent ultrasonography. A larger study is warranted to confirm the DVT risk in patients with mild cognitive decline.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have no financial support in the present study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics committee of Hirosaki University Graduate School of Medicine (authorization number, 2020-181).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from all the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData, Materials and/or Code availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that supports the findings of this study are available from the corresponding author, HN, upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHN: study concept, collecting the data, analyses, and writing the original draft.\u003c/p\u003e\n\u003cp\u003eSS, ES, NN, CS: collecting the data and reviewing the manuscript.\u003c/p\u003e\n\u003cp\u003eMT: Study concept, reviewing the manuscript, supervision of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank Ms. Tomomi Tsushima and Ms. Miho Daimaruya for providing compassionate nursing care to our patients. We would also like to thank Editage (www.editage.com) for English language editing.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOhmori H, Kanaoka Y, Murata Y, et al.: Deep Vein Thrombosis in Patients with Severe Motor and Intellectual Disabilities, Especially Diagnosis and Prevention of Recurrence for Chronic Thrombosis-Serial Changes of Sonography and D-Dimer. Ann Vasc Dis. 2015, 8:290-296. 10.3400/avd.oa.15-00102\u003c/li\u003e\n\u003cli\u003eArpaia G, Ambrogi F, Penza M, et al.: Risk of venous thromboembolism in patients nursed at home or in long-term care residential facilities. Int J Vasc Med. 2011, 2011:305027. 10.1155/2011/305027\u003c/li\u003e\n\u003cli\u003eNakanishi K, Kanda T, Kobata T, Mori M, Yamada S, Kasamaki Y: New score including daily life independence levels with dementia is associated with the onset of deep vein thrombosis in frail older adults. Geriatr Gerontol Int. 2020, 20:414-421. 10.1111/ggi.13873\u003c/li\u003e\n\u003cli\u003eMorris JC: The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993, 43:2412-2414. 10.1212/wnl.43.11.2412-a\u003c/li\u003e\n\u003cli\u003eFolstein MF, Folstein SE, McHugh PR: \u0026quot;Mini-mental state\u0026quot;. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975, 12:189-198. 10.1016/0022-3956(75)90026-6\u003c/li\u003e\n\u003cli\u003eRosen WG, Mohs RC, Davis KL: A new rating scale for Alzheimer\u0026apos;s disease. Am J Psychiatry. 1984, 141:1356-1364. 10.1176/ajp.141.11.1356\u003c/li\u003e\n\u003cli\u003eWells PS, Anderson DR, Bormanis J, et al.: Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet. 1997, 350:1795-1798. 10.1016/S0140-6736(97)08140-3\u003c/li\u003e\n\u003cli\u003eBarbar S, Noventa F, Rossetto V, et al.: A risk assessment model for the identification of hospitalized medical patients at risk for venous thromboembolism: the Padua Prediction Score. J Thromb Haemost. 2010, 8:2450-2457. 10.1111/j.1538-7836.2010.04044.x\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Hirosaki University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6131734/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6131734/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe prevalence of deep vein thrombosis (DVT) is high in patients with severe major neurocognitive disorders and motor deficits. However, it is unknown whether patients with mild cognitive decline without major motor deficits have an increased risk for DVT. Recently, Nakanishi et al. proposed the Himi score to evaluate DVT risk in frail elderly individuals. The score accounts for the independence level in daily life among patients with dementia, graded as I/II, III, IV and M, as an assessment item. In the present study, we investigated DVT prevalence among patients with mild cognitive decline. Participants were recruited from the patients who visited our outpatient clinic between August 2022 and February 2023. To be eligible for enrollment, patients were required to be diagnosed with mild cognitive impairment or early-stage major neurocognitive disorder and able to walk independently. Individuals were excluded if they had an active malignancy, had a bed rest time of more than 24 h owing to an external injury within 3 months before the study, received general anesthesia, or had undergone central venous access catheter insertion within 3 months before the study. Overall, written informed consent was obtained from 22 patients. Clinical data, including the Mini-Mental State Examination and Alzheimer’s Disease Assessment Scale-Cognitive scores, were collected. Physical examinations were performed to evaluate the following symptoms in the lower extremities: pain, edema, erythema, varicose veins, and Homan’s sign. We calculated the Wells score and Padua Prediction score, which are well-established for evaluating DVT risk. We also calculated the Himi score. Whole-leg vein ultrasonography was performed to detect DVT in 12 patients with leg symptoms or elevated blood d-dimer levels. DVT was detected in two of the 22 participants (9%). Although the DVT prevalence in the general population is unknown, our pilot study results may reflect increased prevalence of DVT in patients with mild cognitive decline without major motor impairment. Neither patient with DVT had a major risk for DVT according to the Wells and Padua Prediction scores. In contrast, two patients had high Himi scores, suggesting that low activities of daily living owing to cognitive decline are associated with DVT. Our data suggest that the Himi score is useful for detecting potential DVT risks in elderly individuals without apparent motor deficits or other major risk factors.\u003c/p\u003e","manuscriptTitle":"Deep vein thrombosis among patients with mild cognitive decline","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-04 06:33:48","doi":"10.21203/rs.3.rs-6131734/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3049505-2f6b-48df-9341-27ebcd637d27","owner":[],"postedDate":"March 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":45041050,"name":"Geriatrics \u0026 Gerontology"},{"id":45041051,"name":"Internal Medicine"}],"tags":[],"updatedAt":"2025-03-04T06:33:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-04 06:33:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6131734","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6131734","identity":"rs-6131734","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}