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1.
Exp Brain Res ; 241(6): 1633-1642, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37170028

RESUMO

Sustained integration of sensory inputs over increased temporal delays is associated with reduced cognitive and physical functioning in older adults and adverse outcomes such as falls. Here, we explored the relationship between multisensory integration and a clinically relevant measure of balance/postural control; Sit-to-Stand Time, the efficiency with which an older adult can transition between a seated and a standing posture. We investigated whether temporal multisensory integration was associated with performance on the Five-Times Sit-to-Stand Test (FTSST) in a large sample of 2556 older adults (mean age = 63.62 years, SD = 7.50; 55% female) drawn from The Irish Longitudinal Study on Ageing (TILDA). K-means clustering was applied to FTSST data, yielding three clusters characterised by fast (mean = 10.88 s; n = 1122), medium (mean = 14.34 s; n = 1133) and slow (mean = 18.97 s; n = 301) sit-to-stand times. At wave 3 of TILDA, older adults participated in the Sound Induced Flash Illusion (SIFI), a measure of the precision of temporal audio-visual integration, which included three audio-visual stimulus onset asynchronies (SOAs): 70, 150 and 230 ms. Older adults with the slowest sit-to-stand times were more susceptible to the SIFI at the longest SOA (230 ms) compared to the shortest SOA (70 ms) relative to those with the fastest times (p = 0.02). Older adults who take longer to repeatedly transition from a seated to a standing posture exhibit an expanded temporal binding window for audio-visual events, supporting a link between multisensory perception and balance/postural control in ageing.


Assuntos
Ilusões , Percepção Visual , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Masculino , Percepção Auditiva , Estudos Longitudinais , Estimulação Luminosa , Envelhecimento/psicologia
2.
J Gambl Stud ; 2023 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-37943393

RESUMO

A large body of previous research has provided support for the role of attentional bias as a maintaining factor in addiction. This systematic review aimed to investigate the extent and nature of attentional bias as a phenomenon which exists within problem gamblers. Studies were identified through searches of three databases (MedLine, PSYCHINFO, and Web of Science) and examination of the reference lists of the final studies meeting criteria for inclusion. The scope of the review included empirical studies making experimental comparisons of problem gamblers and non-problem gamblers across a range of attentional paradigms. A comparison of effect sizes was conducted across studies comparing problem to non-problem gamblers within and between attention paradigms. Twenty-two studies were reviewed systematically across ten experimental paradigms. Attentional bias was demonstrated in 16 of the 22 studies, with attentional bias effects varying across paradigms. Quality assessment revealed two main limitations across studies: lack of a priori power analysis, and failure to control for gambling frequency as a possible confounding variable. Findings support the role of attentional bias as a potential maintaining factor in problem gambling behaviour, in line with evidence for substance addiction. Recommendations for future studies are outlined alongside a discussion of clinical implications.

3.
J Exp Child Psychol ; 215: 105336, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34906765

RESUMO

Spatial demonstratives (this and that in English) convey distance relative to speaker (within reach vs. out of reach) and object characteristics such as ownership. Previous studies indicate that object characteristics affect adult demonstrative choice, for example, greater use of this for owned objects. Here, production of spatial demonstratives was studied developmentally to identify when demonstrative production is sensitive to both distance and ownership. In two experiments, 7-year-olds, 11-year-olds, and adults completed an object location memory task, and a language task eliciting this or that to indicate an object. Results indicate that adult-like demonstrative production starts around 7 years of age and continues to develop beyond 11 years. Nonlinguistic spatial memory did not vary significantly across age groups. Spatial demonstratives encode both semantic and spatial object characteristics throughout development, revealing the fundamental importance of semantic factors for demonstrative production.


Assuntos
Idioma , Percepção Espacial , Adulto , Humanos , Semântica , Memória Espacial
4.
Klin Monbl Augenheilkd ; 239(4): 610-614, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35472817

RESUMO

PURPOSE: For the elderly in nursery homes, a visit to the ophthalmologist is a burden, which might lead to undertreatment. We have recently started offering a novel ophthalmological service combining onsite examination and telemedical interpretation for patients with limited access to ophthalmological care. This study summarises the frequency of findings of treatable eye diseases after the first year of operation in participants who dropped out from regular ophthalmological control. METHODS: Participants' clinical characteristics, frequency of service utilisation, and findings were extracted from the system and analysed. RESULTS: Of 1946 residents approached, 540 (27.7%; 1080 eyes) signed up for the service. A complete examination was possible in 412 persons (813 eyes) and partially possible in the remaining 128. The mean age of the examined participants mean age was 83.9 years (SD 9.7), and they were predominantly female (69.8%). The majority had a diagnosis of dementia (54.5%) and 20.2% had diabetes mellitus requiring treatment. The median care level (ranging from 0 - 12) was 7 (interquartile range 6 - 9), corresponding to a care need of 121 - 140 min/d. The mean best-corrected decimal visual acuity was 0.55 (SD 0.24). For 164 eyes (15.2%), the current spectacle correction was insufficient. An untreated cataract was present in 145 eyes (13.4%), 89 eyes (8.2%) were receiving glaucoma treatment, and 7 eyes had a decompensated glaucoma. Dry age-related macular degeneration (AMD) appeared in 276 eyes (25.6%), 12 eyes (1.1%) had wet AMD, and 24 eyes (11.0%) among patients with diabetes showed signs of diabetic retinopathy. Other pathologies were uncommon. CONCLUSION: Residents of nursery homes, who are unable to attend regular ophthalmological control, show various treatable ophthalmological conditions, including cataracts, glaucoma, and retinal pathologies. Screening with a novel telemedicine service allows for the identification of treatable conditions and careful planning and referral of patients to appropriate clinics having the necessary infrastructure for this particular population.


Assuntos
Catarata , Retinopatia Diabética , Glaucoma , Telemedicina , Idoso , Idoso de 80 Anos ou mais , Catarata/epidemiologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/terapia , Feminino , Glaucoma/diagnóstico , Glaucoma/epidemiologia , Glaucoma/terapia , Humanos , Masculino , Casas de Saúde , Suíça/epidemiologia
5.
J Child Lang ; : 1-13, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36330682

RESUMO

Demonstrative words are one of the most important ways of establishing reference in conversation. This work describes Spanish-speaking children's demonstrative production between ages 2 to 10 using data from the CHILDES corpora. Results indicate that children feature all demonstratives in their lexicon - however, the distal term is scarce throughout development. Moreover, patterns of demonstrative use are not adult-like at age 10. We compare adult and child data to conclude that children's development of demonstrative production is largely protracted. Adult use of the distal demonstrative is higher than in young children, although both older children and adults use the medial term ese more than any other demonstratives. In contrast, younger children use proximals relatively more frequently than older children and adults. Suggestions for future research and theoretical implications for the Spanish demonstrative system are discussed.

6.
J Intern Med ; 289(1): 97-115, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32613681

RESUMO

BACKGROUND: SARS-CoV-2 coronavirus infection ranges from asymptomatic through to fatal COVID-19 characterized by a 'cytokine storm' and lung failure. Vitamin D deficiency has been postulated as a determinant of severity. OBJECTIVES: To review the evidence relevant to vitamin D and COVID-19. METHODS: Narrative review. RESULTS: Regression modelling shows that more northerly countries in the Northern Hemisphere are currently (May 2020) showing relatively high COVID-19 mortality, with an estimated 4.4% increase in mortality for each 1 degree latitude north of 28 degrees North (P = 0.031) after adjustment for age of population. This supports a role for ultraviolet B acting via vitamin D synthesis. Factors associated with worse COVID-19 prognosis include old age, ethnicity, male sex, obesity, diabetes and hypertension and these also associate with deficiency of vitamin D or its response. Vitamin D deficiency is also linked to severity of childhood respiratory illness. Experimentally, vitamin D increases the ratio of angiotensin-converting enzyme 2 (ACE2) to ACE, thus increasing angiotensin II hydrolysis and reducing subsequent inflammatory cytokine response to pathogens and lung injury. CONCLUSIONS: Substantial evidence supports a link between vitamin D deficiency and COVID-19 severity but it is all indirect. Community-based placebo-controlled trials of vitamin D supplementation may be difficult. Further evidence could come from study of COVID-19 outcomes in large cohorts with information on prescribing data for vitamin D supplementation or assay of serum unbound 25(OH) vitamin D levels. Meanwhile, vitamin D supplementation should be strongly advised for people likely to be deficient.


Assuntos
Enzima de Conversão de Angiotensina 2/metabolismo , COVID-19/etnologia , Etnicidade , SARS-CoV-2 , Trombose/etiologia , Deficiência de Vitamina D/etnologia , COVID-19/metabolismo , Comorbidade , Saúde Global , Humanos , Fatores de Risco , Trombose/etnologia , Trombose/metabolismo , Deficiência de Vitamina D/metabolismo
7.
J Gambl Stud ; 37(3): 817-835, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33326060

RESUMO

The belief that one is in a worse situation than similar others (Relative Deprivation) has been associated with involvement in a range of maladaptive escape behaviors, including excessive risk taking. Yet not everyone scoring high on measures of relative deprivation makes maladaptive choices. We hypothesized that hope may ameliorate the negative effects of relative deprivation. In two laboratory-based experiments using a novel risk-taking task (N = 101) we show that hope reduces risk-taking behavior in relatively deprived participants. A third study (N = 122) extended the moderating effect of hope on relative deprivation to real-world risk behavior; increased hope was associated with decreased likelihood of loss of control of one's gambling behavior in relatively deprived individuals. Nurturing hope in relatively deprived populations may protect them against maladaptive behaviors with potential applications for harm reduction.


Assuntos
Jogo de Azar , Jogo de Azar/psicologia , Humanos , Assunção de Riscos
8.
Neuroimage ; 216: 116128, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31473349

RESUMO

Spatial demonstratives are powerful linguistic tools used to establish joint attention. Identifying the meaning of semantically underspecified expressions like "this one" hinges on the integration of linguistic and visual cues, attentional orienting and pragmatic inference. This synergy between language and extralinguistic cognition is pivotal to language comprehension in general, but especially prominent in demonstratives. In this study, we aimed to elucidate which neural architectures enable this intertwining between language and extralinguistic cognition using a naturalistic fMRI paradigm. In our experiment, 28 participants listened to a specially crafted dialogical narrative with a controlled number of spatial demonstratives. A fast multiband-EPI acquisition sequence (TR = 388 m s) combined with finite impulse response (FIR) modelling of the hemodynamic response was used to capture signal changes at word-level resolution. We found that spatial demonstratives bilaterally engage a network of parietal areas, including the supramarginal gyrus, the angular gyrus, and precuneus, implicated in information integration and visuospatial processing. Moreover, demonstratives recruit frontal regions, including the right FEF, implicated in attentional orienting and reference frames shifts. Finally, using multivariate similarity analyses, we provide evidence for a general involvement of the dorsal ("where") stream in the processing of spatial expressions, as opposed to ventral pathways encoding object semantics. Overall, our results suggest that language processing relies on a distributed architecture, recruiting neural resources for perception, attention, and extra-linguistic aspects of cognition in a dynamic and context-dependent fashion.


Assuntos
Idioma , Imageamento por Ressonância Magnética/métodos , Percepção Espacial/fisiologia , Vias Visuais/diagnóstico por imagem , Vias Visuais/fisiologia , Estimulação Acústica/métodos , Adulto , Atenção/fisiologia , Feminino , Humanos , Masculino , Lobo Parietal/diagnóstico por imagem , Lobo Parietal/fisiologia , Desempenho Psicomotor/fisiologia
9.
Diabet Med ; 37(8): 1299-1307, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31770459

RESUMO

AIMS: Orthostatic hypotension is a recognized complication of diabetes, but studies examining prevalence in diabetes are limited. The aim of this study was to ascertain the prevalence of orthostatic hypotension and the pattern of orthostatic BP response in a cohort of people with diabetes aged ≥ 50 years, embedded within the Irish Longitudinal Study of Ageing. METHODS: Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) ≥ 20 mmHg or drop in diastolic blood pressure (DBP) ≥ 10 mmHg at 30 s after standing. Diabetes was defined by self-report but cross-checked against HbA1c and medication records. Multilevel mixed effects linear regression models were used to compare orthostatic BP in people with and without diabetes. RESULTS: Some 3222 people were included, 7% (213 of 3222) of whom had diabetes. Prevalence of orthostatic hypotension in the group with diabetes was 22% (46 of 213) vs. 13% in those without diabetes; χ2 = 12.43; P < 0.001. Multilevel models demonstrated prolonged recovery of DBP in people with diabetes, with only 41% (87 of 213) returning to baseline by 60 s. Logistic regression models demonstrated that diabetes was associated with a significantly increased likelihood of orthostatic hypotension (odds ratio 1.84, 95% confidence interval 1.30-2.59; P = 0.001) and this remained robust after controlling for covariates. CONCLUSION: Over one-fifth of older people with diabetes had orthostatic hypotension. Recovery of DBP is related to dynamic changes in total peripheral resistance and impairment of this baroreflex-mediated response may explain the higher prevalence in diabetes. Given the prognostic implications when co-existing with diabetes, orthostatic hypotension may represent a potentially modifiable risk factor for adverse outcomes in late-life diabetes.


Assuntos
Diabetes Mellitus/epidemiologia , Hipotensão Ortostática/epidemiologia , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Humanos , Vida Independente , Irlanda/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade
10.
EMBO Rep ; 19(6)2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29661858

RESUMO

The production of type I interferon (IFN) is essential for cellular barrier functions and innate and adaptive antiviral immunity. In response to virus infections, RNA receptors RIG-I and MDA5 stimulate a mitochondria-localized signaling apparatus that uses TRAF family ubiquitin ligase proteins to activate master transcription regulators IRF3 and NFκB, driving IFN and antiviral target gene expression. Data indicate that a third RNA receptor, LGP2, acts as a negative regulator of antiviral signaling by interfering with TRAF family proteins. Disruption of LGP2 expression in cells results in earlier and overactive transcriptional responses to virus or dsRNA LGP2 associates with the C-terminus of TRAF2, TRAF3, TRAF5, and TRAF6 and interferes with TRAF ubiquitin ligase activity. TRAF interference is independent of LGP2 ATP hydrolysis, RNA binding, or its C-terminal domain, and LGP2 can regulate TRAF-mediated signaling pathways in trans, including IL-1ß, TNFα, and cGAMP These findings provide a unique mechanism for LGP2 negative regulation through TRAF suppression and extend the potential impact of LGP2 negative regulation beyond the IFN antiviral response.


Assuntos
Imunidade Inata/genética , RNA Helicases/metabolismo , RNA de Cadeia Dupla/imunologia , RNA Viral/imunologia , Peptídeos e Proteínas Associados a Receptores de Fatores de Necrose Tumoral/antagonistas & inibidores , Viroses/imunologia , Animais , Fibroblastos , Regulação da Expressão Gênica , Células HEK293 , Humanos , Interferon Tipo I/genética , RNA Helicases/genética , Transdução de Sinais/genética , Peptídeos e Proteínas Associados a Receptores de Fatores de Necrose Tumoral/metabolismo , Viroses/genética
11.
Br J Nutr ; 124(6): 602-610, 2020 09 28.
Artigo em Inglês | MEDLINE | ID: mdl-32329423

RESUMO

The uncertainty surrounding high intakes of folic acid and associations with cognitive decline in older adults with low vitamin B12 status has been an obstacle to mandatory folic acid fortification for many years. We estimated the prevalence of combinations of low/normal/high vitamin B12 and folate status and compared associations with global cognitive function using two approaches, of individuals in a population-based study of those aged ≥50 years in the Republic of Ireland. Cross-sectional data from 3781 men and women from Wave 1 of The Irish Longitudinal Study on Ageing were analysed. Global cognitive function was assessed by the Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). Prevalence estimates for combinations of vitamin B12 (plasma vitamin B12 < or ≥258 pmol/l) and folate (plasma folate ≤ or >45·3 nmol/l) concentrations were generated. Negative binomial regression models were used to investigate the associations of vitamin B12 and folate status with global cognitive function. Of the participants, 1·5 % (n 51) had low vitamin B12 (<258 pmol/l) and high folate (>45·3 nmol/l) status. Global cognitive performance was not significantly reduced in these individuals when compared with those with normal status for both B-vitamins (n 2433). Those with normal vitamin B12/high folate status (7·6 %) had better cognitive performance (MMSE: incidence rate ratio (IRR) 0·82, 95 % CI 0·68, 0·99; P = 0·043, MoCA: IRR 0·89, 95 % CI 0·80, 0·99; P = 0·025). We demonstrated that high folate status was not associated with lower cognitive scores in older adults with low vitamin B12 status. These findings provide important safety information that could guide fortification policy recommendations in Europe.


Assuntos
Envelhecimento/fisiologia , Cognição , Ácido Fólico/sangue , Vitamina B 12/sangue , Idoso , Transtornos Cognitivos/sangue , Transtornos Cognitivos/etiologia , Estudos Transversais , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
12.
Ir Med J ; 113(5): 81, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32603576

RESUMO

Background Recent research has indicated that vitamin D may have immune supporting properties through modulation of both the adaptive and innate immune system through cytokines and regulation of cell signalling pathways. We hypothesize that vitamin D status may influence the severity of responses to Covid-19 and that the prevalence of vitamin D deficiency in Europe will be closely aligned to Covid-19 mortality. Methods We conducted a literature search on PubMed (no language restriction) of vitamin D status (for older adults) in countries/areas of Europe affected by Covid-19 infection. Countries were selected by severity of infection (high and low) and were limited to national surveys or where not available, to geographic areas within the country affected by infection. Covid-19 infection and mortality data was gathered from the World Health Organisation. Results Counter-intuitively, lower latitude and typically 'sunny' countries such as Spain and Italy (particularly Northern Italy), had low mean concentrations of 25(OH)D and high rates of vitamin D deficiency. These countries have also been experiencing the highest infection and death rates in Europe. The northern latitude countries (Norway, Finland, Sweden) which receive less UVB sunlight than Southern Europe, actually had much higher mean 25(OH)D concentrations, low levels of deficiency and for Norway and Finland, lower infection and death rates. The correlation between 25(OH)D concentration and mortality rate reached conventional significance (P=0.046) by Spearman's Rank Correlation. Conclusions Optimising vitamin D status to recommendations by national and international public health agencies will certainly have benefits for bone health and potential benefits for Covid-19. There is a strong plausible biological hypothesis and evolving epidemiological data supporting a role for vitamin D in Covid-19.


Assuntos
Infecções por Coronavirus/mortalidade , Pneumonia Viral/mortalidade , Deficiência de Vitamina D/epidemiologia , 25-Hidroxivitamina D 2/sangue , Betacoronavirus , COVID-19 , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Suplementos Nutricionais , Europa (Continente)/epidemiologia , Política de Saúde , Humanos , Inflamação/fisiopatologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Prevalência , SARS-CoV-2 , Índice de Gravidade de Doença , Vitamina D/fisiologia
14.
Osteoporos Int ; 30(10): 2099-2117, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31201482

RESUMO

We identified demographic, health and lifestyle factors associated with falls in adults aged 50-64 years from Australia, The Netherlands, Great Britain and Ireland. Nearly all factors were associated with falls, but there were differences between countries and between men and women. Existing falls prevention programs may also benefit middle-aged adults. INTRODUCTION: Between ages 40-44 and 60-64 years, the annual prevalence of falls triples suggesting that middle age may be a critical life stage for preventive interventions. We aimed to identify demographic, health and lifestyle factors associated with falls in adults aged 50-64 years. METHODS: Harmonised data were used from four population-based cohort studies based in Australia (Australian Longitudinal Study on Women's Health, n = 10,641, 51-58 years in 2004), Ireland (The Irish Longitudinal Study on Ageing, n = 4663, 40-64 years in 2010), the Netherlands (Longitudinal Ageing Study Amsterdam, n = 862, 55-64 years in 2012-13) and Great Britain (MRC National Survey of Health and Development, n = 2987, 53 years in 1999). Cross-sectional and prospective associations of 42 potential risk factors with self-reported falls in the past year were examined separately by cohort and gender using logistic regression. In the absence of differences between cohorts, estimates were pooled using meta-analysis. RESULTS: In cross-sectional models, nearly all risk factors were associated with fall risk in at least one cohort. Poor mobility (pooled OR = 1.71, CI = 1.34-2.07) and urinary incontinence (OR range = 1.53-2.09) were consistently associated with falls in all cohorts. Findings from prospective models were consistent. Statistically significant interactions with cohort and sex were found for some of the risk factors. CONCLUSION: Risk factors known to be associated with falls in older adults were also associated with falls in middle age. Compared with findings from previous studies of older adults, there is a suggestion that specific risk factors, for example musculoskeletal conditions, may be more important in middle age. These findings suggest that available preventive interventions for falls in older adults may also benefit middle-aged adults, but tailoring by age, sex and country is required.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes por Quedas/prevenção & controle , Fatores Etários , Estudos de Coortes , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Fatores de Risco , Fatores Sexuais , Incontinência Urinária/complicações , Incontinência Urinária/epidemiologia
15.
Qual Life Res ; 28(2): 429-439, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30209723

RESUMO

PURPOSE: To test whether ill-health is associated with a decrease in quality of life (QoL) over time and if positive social circumstances are beneficial to QoL, using the shorter form CASP-12 in a sample drawn from a nationally representative cohort of older adults. To do so, the association between factors from a number of life domains and QoL was investigated. METHODS: Data were from the first three waves of The Irish Longitudinal Study on Ageing, a prospective nationally representative study of community dwelling older adults in the Republic of Ireland. QoL was measured using the shorter form CASP-12 and the latent growth curve method was used to describe within- and between-person variation in longitudinal QoL trajectories. RESULTS: There was considerable variation in QoL scores cross-sectionally and longitudinally. QoL did not decline linearly with age but increased from age 50 and peaked at 68 years before declining in older age. QoL differed significantly between individuals and decreased over time. A variety of demographic, health, and social characteristics were associated with changes in QoL over time. These included cohabiting; self-rated health; functional limitations; fear of falling; mental health; loneliness; social networks; social activities; caring for grandchildren; income; and death of a spouse. CONCLUSIONS: Changes in QoL over time were not merely a function of ageing, or declining health but resulted from factors from a variety of domains with loneliness and social participation particularly important. Policies concerned with successful ageing and QoL among older adults must consider social circumstances as well as physical and psychological well-being.


Assuntos
Envelhecimento/psicologia , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
16.
Clin Auton Res ; 29(4): 427-441, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31076939

RESUMO

PURPOSE: The average adult stands approximately 50-60 times per day. Cardiovascular responses evoked during the first 3 min of active standing provide a simple means to clinically assess short-term neural and cardiovascular function across the lifespan. Clinically, this response is used to identify the haemodynamic correlates of patient symptoms and attributable causes of (pre-)syncope, and to detect autonomic dysfunction, variants of orthostatic hypotension, postural orthostatic tachycardia syndrome and orthostatic hypertension. METHODS: This paper provides a set of experience/expertise-based recommendations detailing current state-of-the-art measurement and analysis approaches for the active stand test, focusing on beat-to-beat BP technologies. This information is targeted at those interested in performing and interpreting the active stand test to current international standards. RESULTS: This paper presents a practical step-by-step guide on (1) how to perform active stand measurements using beat-to-beat continuous blood pressure measurement technologies, (2) how to conduct an analysis of the active stand response and (3) how to identify the spectrum of abnormal blood pressure and heart rate responses which are of clinical interest. CONCLUSION: Impairments in neurocardiovascular control are an attributable cause of falls and syncope across the lifespan. The simple active stand test provides the clinician with a powerful tool for assessing individuals at risk of such common disorders. However, its simplicity belies the complexity of its interpretation. Care must therefore be taken in administering and interpreting the test in order to maximise its clinical benefit and minimise its misinterpretation.


Assuntos
Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Pressão Sanguínea/fisiologia , Frequência Cardíaca/fisiologia , Guias de Prática Clínica como Assunto/normas , Posição Ortostática , Adulto , Feminino , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/fisiopatologia , Masculino , Decúbito Dorsal/fisiologia
18.
J Intern Med ; 282(6): 468-483, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28564488

RESUMO

Over the past 30 years, noninvasive beat-to-beat blood pressure (BP) monitoring has provided great insight into cardiovascular autonomic regulation during standing. Although traditional sphygmomanometric measurement of BP may be sufficient for detection of sustained orthostatic hypotension, it fails to capture the complexity of the underlying dynamic BP and heart rate responses. With the emerging use of noninvasive beat-to-beat BP monitoring for the assessment of orthostatic BP control in clinical and population studies, various definitions for abnormal orthostatic BP patterns have been used. Here, age-related changes in cardiovascular control in healthy subjects will be reviewed to define the spectrum of the most important abnormal orthostatic BP patterns within the first 180 s of standing. Abnormal orthostatic BP responses can be defined as initial orthostatic hypotension (a transient systolic BP fall of >40 mmHg within 15 s of standing), delayed BP recovery (an inability of systolic BP to recover to a value of >20 mmHg below baseline at 30 s after standing) and sustained orthostatic hypotension (a sustained decline in systolic BP of ≥20 mmHg occurring 60-180 s after standing). In the evaluation of patients with light-headedness, pre(syncope), (unexplained) falls or suspected autonomic dysfunction, it is essential to distinguish between normal cardiovascular autonomic regulation and these abnormal orthostatic BP responses. The prevalence, clinical relevance and underlying pathophysiological mechanisms of these patterns differ significantly across the lifespan. Initial orthostatic hypotension is important for identifying causes of syncope in younger adults, whereas delayed BP recovery and sustained orthostatic hypotension are essential for evaluating the risk of falls in older adults.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Frequência Cardíaca , Hipotensão Ortostática , Postura , Fatores Etários , Sistema Nervoso Autônomo/fisiopatologia , Monitorização Ambulatorial da Pressão Arterial/instrumentação , Monitorização Ambulatorial da Pressão Arterial/métodos , Medicina Baseada em Evidências , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/epidemiologia , Hipotensão Ortostática/fisiopatologia , Países Baixos/epidemiologia , Valor Preditivo dos Testes , Prevalência , Prognóstico , Valores de Referência , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo
19.
Int J Geriatr Psychiatry ; 32(6): 664-674, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-27246181

RESUMO

OBJECTIVE: Scant evidence is available on the discordance between loneliness and social isolation among older adults. We aimed to investigate this discordance and any health implications that it may have. METHOD: Using nationally representative datasets from ageing cohorts in Ireland (TILDA) and England (ELSA), we created a metric of discordance between loneliness and social isolation, to which we refer as Social Asymmetry. This metric was the categorised difference between standardised scores on a scale of loneliness and a scale of social isolation, giving categories of: Concordantly Lonely and Isolated, Discordant: Robust to Loneliness, or Discordant: Susceptible to Loneliness. We used regression and multilevel modelling to identify potential relationships between Social Asymmetry and cognitive outcomes. RESULTS: Social Asymmetry predicted cognitive outcomes cross-sectionally and at a two-year follow-up, such that Discordant: Robust to Loneliness individuals were superior performers, but we failed to find evidence for Social Asymmetry as a predictor of cognitive trajectory over time. CONCLUSIONS: We present a new metric and preliminary evidence of a relationship with clinical outcomes. Further research validating this metric in different populations, and evaluating its relationship with other outcomes, is warranted. Copyright © 2016 John Wiley & Sons, Ltd.


Assuntos
Envelhecimento/psicologia , Solidão/psicologia , Isolamento Social/psicologia , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Estudos Transversais , Inglaterra , Feminino , Humanos , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão
20.
Age Ageing ; 46(6): 1006-1010, 2017 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-28985288

RESUMO

Introduction: atrial fibrillation (AF) and orthostatic hypotension (OH) share common risk factors such as age, hypertension and cardiovascular (CV) disease. The autonomic nervous system (ANS) also plays a role in the pathogenesis of both AF and OH. The aim of this study is to assess whether individuals with AF are more likely to have OH than those without AF. Methods: data from wave 1 of The Irish Longitudinal Study on Ageing were used. Beat-to-beat blood pressure was measured during active stand lasting 110 s. OH, defined as a drop in systolic blood pressure (SBP) ≥20 mmHg or a drop in diastolic blood pressure ≥10 mmHg at 30, 60 and 90 s was assessed. Initial OH (IOH) was assessed as a drop in SBP ≥40 mmHg or a drop in diastolic BP≥20 mmHg. Results: in total 4,408 participants aged ≥50 had active stand and electrocardiogram data suitable for analysis. AF was identified in 101 of these. Logistic regression found participants with AF were more likely to have OH at 30 (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.24-3.06) and 60 (OR 2.13, 95% CI 1.18-3.87) seconds, and IOH (OR 1.81, 95% CI 1.21-2.70). The association between IOH and OH at 30 s remained significant following adjustment for confounders (age, sex, baseline HR, education, BP, smoking, frailty, beta blocker (BB) use, anti-hypertensive use (excluding BBs) and number of CV conditions). Conclusion: OH is more common in individuals with AF, this may reflect the role of the ANS in both AF and OH.


Assuntos
Envelhecimento , Fibrilação Atrial/epidemiologia , Hipotensão Ortostática/epidemiologia , Fatores Etários , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Sistema Nervoso Autônomo/fisiopatologia , Pressão Sanguínea , Distribuição de Qui-Quadrado , Eletrocardiografia , Feminino , Frequência Cardíaca , Humanos , Hipotensão Ortostática/diagnóstico , Hipotensão Ortostática/fisiopatologia , Irlanda/epidemiologia , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Estudos Prospectivos , Fatores de Risco
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