RESUMEN
BACKGROUND AND PURPOSE: Motoric cognitive risk syndrome (MCR), which is the juncture of subjective cognitive complaint and slow gait speed, is a pre-dementia stage. The aims of the study are (i) to compare characteristics between individuals who have MCR defined using slow walking speed and/or increased five-times-sit-to-stand (FTSS) time as its motor component(s); and (ii) to characterize the association of MCR and its various motor components with incident dementia including Alzheimer disease and non-Alzheimer dementia in the participants of the Epidémiologie de l'Ostéoporose (EPIDOS) study. METHODS: This prospective and observational cohort study selected 651 participants recruited from the EPIDOS study in Toulouse (France). MCR was defined as the association of subjective cognitive complaint and slow gait speed and/or increased FTSS time in participants without either dementia and mobility disabilities at baseline. Individuals with dementia were prospectively diagnosed during the physical and neuropsychological assessments included in the 7-year follow-up. RESULTS: The prevalence of MCR was around 7% when using an exclusive motor criterion, either slow gait speed or increased FTSS time, and was 20.9% when MCR subgroups were pooled. MCR was positively associated with incident dementia regardless of its type, and with Alzheimer disease in the slow gait speed MCR subgroup [odds ratio (OR) > 2.18 with P ≤ 0.037] but not with non-Alzheimer dementia. No significant association between incident dementia and MCR defined using increased FTSS time was shown. CONCLUSIONS: Our findings confirm that MCR is associated with incident dementia and that slow gait speed is the appropriate motor criterion for detecting dementia risk.
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Trastornos del Conocimiento/epidemiología , Demencia/epidemiología , Marcha/fisiología , Velocidad al Caminar/fisiología , Anciano , Anciano de 80 o más Años , Cognición/fisiología , Trastornos del Conocimiento/psicología , Estudios de Cohortes , Demencia/psicología , Femenino , Francia/epidemiología , Humanos , Incidencia , Masculino , Pruebas Neuropsicológicas , Prevalencia , Síntomas Prodrómicos , Estudios ProspectivosRESUMEN
BACKGROUND AND PURPOSE: Cognitive impairment, slow walking speed and motoric cognitive risk syndrome (MCR) have separately been associated with an increased risk for mortality in the short term. The aim of the study was to examine the association of MCR and its components [i.e. subjective cognitive complaint (SCC) and slow walking speed] with short-, medium- and long-term mortality in older community-dwellers. METHODS: In all, 3778 participants from the Epidémiologie de l'Ostéoporose (EPIDOS) study were selected. MCR was defined as the combination of slow walking speed and SCC in participants without major neurocognitive disorders. Deaths were prospectively recorded using mail, phone calls, questionnaires and/or the French national death registry at 5, 10, 15 and 19 (end of follow-up period) years. RESULTS: Over the follow-up of 19 years, 80.5% (n = 3043) participants died. Slow walking speed and MCR were associated with mortality [hazard ratio (HR) 1.20 with P = 0.004 for slow walking speed and HR = 1.26 with P = 0.002 for MCR at 10 years; HR = 1.27 with P ≤ 0.001 for slow walking speed and HR = 1.22 with P = 0.001 for MCR at 15 years; HR = 1.41 with P ≤ 0.001 at 19 years for slow walking speed and MCR]. There was no association between SCC and mortality. Kaplan-Meier distributions of mortality showed that participants with MCR and slow walking speed died earlier compared to healthy participants and those with SCC (P < 0.001). CONCLUSIONS: Slow walking speed and MCR were associated with an increased risk for mortality at the medium and long term, whereas no association was found with SCC.
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Trastornos del Conocimiento/mortalidad , Trastornos del Movimiento/mortalidad , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/psicología , Disfunción Cognitiva , Estudios de Cohortes , Progresión de la Enfermedad , Femenino , Francia/epidemiología , Humanos , Estimación de Kaplan-Meier , Masculino , Trastornos del Movimiento/psicología , Pruebas Neuropsicológicas , Análisis de Supervivencia , Síndrome , Velocidad al CaminarRESUMEN
BACKGROUND: With the rapid growth of elderly patients visiting the Emergency Department (ED), it is expected that there will be even more hospitalisations following ED visits in the future. The aim of this study was to examine the age effect on the performance criteria of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. METHODS: Based on an observational prospective cohort study, 1117 older patients (i.e., aged ≥ 65 years) ED users were admitted to acute care wards in a University Hospital (France) were recruited. The 10-items of BGA were recorded during the ED visit and prior to discharge to acute care wards. The top third of LHS (i.e., ≥ 13 days) defined the prolonged LHS. Analysis was successively performed on participants categorized in 4 age groups: aged ≥ 70, ≥ 75, ≥ 80 and ≥ 85 years. Performance criteria of 10-item BGA for the prolonged LHS were sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]). The ANNs analysis method was conducted using the modified multilayer perceptron (MLP). RESULTS: Values of criteria performance were high (sensitivity> 89%, specificity≥ 96%, PPV > 87%, NPV > 96%, LR+ > 22; LR- ≤ 0.1 and AUROC> 93), regardless of the age group. CONCLUSIONS: Age effect on the performance criteria of the 10-item BGA for the prediction of prolonged LHS using MLP was minimal with a good balance between criteria, suggesting that this tool may be used as a screening as well as a predictive tool for prolonged LHS.
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Urgencias Médicas/epidemiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Evaluación Geriátrica/métodos , Hospitales Universitarios/estadística & datos numéricos , Tiempo de Internación/tendencias , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Incidencia , Masculino , Alta del Paciente/tendencias , Estudios Prospectivos , Curva ROCRESUMEN
BACKGROUND AND PURPOSE: Motoric cognitive risk (MCR) syndrome is a pre-dementia syndrome. There is little information on the cognitive profile of individuals with MCR syndrome and its overlap with mild cognitive impairment (MCI) syndrome. This study aimed to examine and compare the cognitive performance of non-demented older community dwellers with and without MCR and MCI syndromes. METHODS: A total of 291 non-demented individuals were selected from the Gait and Alzheimer Interactions Tracking study, which is a cross-sectional study. All participants were referred to a memory clinic. Individuals with and without MCR were separated into those with and without MCI. Cognitive performance was measured using the scores of the Mini Mental Status Examination, Frontal Assessment Battery, Free and Cued Selective Reminding Test, Trail Making Test part A and B, and Stroop test. RESULTS: The prevalence of MCI was 40.1% and that of MCR was 18.2%, with a higher prevalence of MCI in MCR group compared with the non-MCR group (47.2% vs. 39.5%). Individuals with MCR and MCI syndromes had poorer cognitive performance in all domains compared with those without MCR (P < 0.005), except for the ratio part III: part I of the Stroop test (P = 0.345). The association between cognitive performance and MCR syndrome was worse on the Mini Mental Status Examination score [effect size, -0.57 (95% confidence interval, -1.02 to -0.12)] and Trail Making Test part B [effect size, 0.59 (95% confidence interval, 0.14-1.04)] in individuals with MCR and MCI syndromes. CONCLUSIONS: Motoric cognitive risk syndrome is associated with low global cognitive performance. Association of MCR and MCI syndromes is characterized by a worse cognitive performance.
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Trastornos del Conocimiento/diagnóstico , Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Marcha/fisiología , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/epidemiología , Disfunción Cognitiva/epidemiología , Estudios Transversales , Demencia/epidemiología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Prevalencia , Factores de RiesgoRESUMEN
BACKGROUND AND PURPOSE: Dementia is a leading cause of dependence amongst the aged population. Early identification of cognitive impairment could help to delay advanced stages of dependence. This study aimed at assessing the performance of three neuropsychological tests to detect cognitive disorders in elderly subjects with memory complaints. METHODS: The EVATEM study is a prospective multicentre cohort with a 1-year follow-up. Subjects with memory complaints were selected during preventive health examinations, and three neuropsychological tests (five-word, cognitive disorders examination, verbal fluency) were administered. Two groups were identified in memory clinics: (i) cognitively healthy individuals (CHI) and (ii) mild cognitive impairment or demented individuals (MCI-DI). Cross-sectional analyses were performed on data at inclusion. The relationship between the diagnosis of MCI-DI/CHI and the neuropsychological tests was assessed using logistic regressions. The performance of the neuropsychological tests, individually and combined, to detect cognitive disorders was calculated. RESULTS: Of 585 subjects, 31.11% had cognitive disorders (MCI, 176 subjects; DI, six subjects). Amongst the three tests studied, the odds ratio for MCI-DI was higher for the five-word test <10 [odds ratio 3.2 (1.81; 5.63)]. The best performance was observed when the three tests were combined: specificity 90.5% and sensitivity 42.4% compared to respectively 89.2% and 28.3% for the five-word test. CONCLUSIONS: Despite the poor sensitivity of the five-word test, it seems to be the most adapted for the diagnosis of MCI-DI in older adults with a memory complaint, in prevention centres, taking into account its high specificity and its rapid administration compared to the other tests.
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Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Vida Independiente/estadística & datos numéricos , Trastornos de la Memoria/diagnóstico , Pruebas Neuropsicológicas , Anciano , Anciano de 80 o más Años , Disfunción Cognitiva/epidemiología , Estudios Transversales , Demencia/epidemiología , Femenino , Estudios de Seguimiento , Francia/epidemiología , Humanos , Masculino , Trastornos de la Memoria/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: The differences in gait abnormalities from the earliest to the later stages of dementia and in the different subtypes of dementia have not been fully examined. This study aims to compare spatiotemporal gait parameters in cognitively healthy individuals, patients with amnestic mild cognitive impairment (MCI) and non-amnestic MCI, and patients with mild and moderate stages of Alzheimer's disease (AD) and non-Alzheimer's disease (non-AD). METHODS: Based on a cross-sectional design, 1719 participants (77.4 ± 7.3 years, 53.9% female) were recruited from cohorts from seven countries participating in the Gait, Cognition and Decline (GOOD) initiative. Mean values and coefficients of variation of spatiotemporal gait parameters were measured during normal pace walking with the GAITRite system at all sites. RESULTS: Performance of spatiotemporal gait parameters declined in parallel with the stage of cognitive decline from MCI status to moderate dementia. Gait parameters of patients with non-amnestic MCI were more disturbed compared to patients with amnestic MCI, and MCI subgroups performed better than demented patients. Patients with non-AD dementia had worse gait performance than those with AD dementia. This degradation of gait parameters was similar between mean values and coefficients of variation of spatiotemporal gait parameters in the earliest stages of cognitive decline, but different in the most advanced stages, especially in the non-AD subtypes. CONCLUSIONS: Spatiotemporal gait parameters were more disturbed in the advanced stages of dementia, and more affected in the non-AD dementias than in AD. These findings suggest that quantitative gait parameters could be used as a surrogate marker for improving the diagnosis of dementia.
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Enfermedad de Alzheimer/fisiopatología , Amnesia/fisiopatología , Disfunción Cognitiva/fisiopatología , Demencia/fisiopatología , Trastornos Neurológicos de la Marcha/fisiopatología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Amnesia/complicaciones , Disfunción Cognitiva/complicaciones , Estudios Transversales , Demencia/complicaciones , Femenino , Trastornos Neurológicos de la Marcha/etiología , Humanos , Masculino , FenotipoRESUMEN
BACKGROUND: Previous meta-analyses to determine the efficacy of vitamin D supplementation to prevent falls in the elderly have shown mixed results. Inconsistencies might depend on the dose of supplements, suggesting that serum 25-hydroxyvitamin D (25OHD) concentration could influence the risk of falling. Our objective was to systematically review and quantitatively analyse the relationship between serum 25OHD concentration and the occurrence of falls. METHODS: A Medline search was conducted in December 2013, with no date limit, using the Medical Subject Heading terms 'Vitamin D' OR 'Ergocalciferols' OR 'Vitamin D deficiency' combined with 'Accidental Falls' OR 'Gait disorders, neurologic' OR 'Gait apraxia' OR 'Gait' OR 'Recurrent Falls' OR 'Falling'. Fixed and random-effects meta-analyses were performed to determine the following: (i) the effect size of the difference in 25OHD concentration between fallers and nonfallers and (ii) the risk of falling according to serum 25OHD concentration. RESULTS: Of the 659 retrieved studies, 18 observational studies - including ten cross-sectional and eight cohort studies - met the selection criteria. All were of good quality. The number of participants ranged from 80 to 2957 (44-100% women); 11.0% to 69.3% were fallers. Serum 25OHD concentrations were 0.33 × SD lower in fallers compared to nonfallers [pooled effect size 0.33; 95% confidence interval (CI) 0.18-0.47]. The risk of falls was inversely associated with serum 25OHD concentration [summary odds ratio (OR) 0.97; 95% CI 0.96-0.99]. The association between falls and hypovitaminosis D varied according to the definition used; the summary OR for falls was 1.23 (95% CI 0.94-1.60) for 25OHD <10 ng mL(-1) , 1.44 (95% CI 1.17-1.76) for 25OHD <20 ng mL(-1) and 0.95 (95% CI 0.81-1.11) for 25OHD <30 ng mL(-1) . CONCLUSIONS: Fallers have lower 25OHD concentrations, notably more often <20 ng mL(-1) , than nonfallers. These findings help to determine the profile of target populations that would most benefit from vitamin D supplements to prevent falls.
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Accidentes por Caídas/prevención & control , Evaluación Geriátrica , Deficiencia de Vitamina D/complicaciones , Vitamina D/sangre , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Intervalos de Confianza , Estudios Transversales , Suplementos Dietéticos , Femenino , Humanos , Incidencia , Masculino , Evaluación de Necesidades , Pronóstico , Valores de Referencia , Medición de Riesgo , Resultado del Tratamiento , Deficiencia de Vitamina D/diagnósticoRESUMEN
BACKGROUND: Hypovitaminosis D, a condition that is highly prevalent in older adults aged 65 years and above, is associated with brain changes and dementia. Given the rapidly accumulating and complex contribution of the literature in the field of vitamin D and cognition, clear guidance is needed for researchers and clinicians. METHODS: International experts met at an invitational summit on 'Vitamin D and Cognition in Older Adults'. Based on previous reports and expert opinion, the task force focused on key questions relating to the role of vitamin D in Alzheimer's disease and related disorders. Each question was discussed and voted using a Delphi-like approach. RESULTS: The experts reached an agreement that hypovitaminosis D increases the risk of cognitive decline and dementia in older adults and may alter the clinical presentation as a consequence of related comorbidities; however, at present, vitamin D level should not be used as a diagnostic or prognostic biomarker of Alzheimer's disease due to lack of specificity and insufficient evidence. This population should be screened for hypovitaminosis D because of its high prevalence and should receive supplementation, if necessary; but this advice was not specific to cognition. During the debate, the possibility of 'critical periods' during which vitamin D may have its greatest impact on the brain was addressed; whether hypovitaminosis D influences cognition actively through deleterious effects and/or passively by loss of neuroprotection was also considered. CONCLUSIONS: The international task force agreed on five overarching principles related to vitamin D and cognition in older adults. Several areas of uncertainty remain, and it will be necessary to revise the proposed recommendations as new findings become available.
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Trastornos del Conocimiento/tratamiento farmacológico , Trastornos del Conocimiento/etiología , Suplementos Dietéticos , Guías de Práctica Clínica como Asunto , Deficiencia de Vitamina D/complicaciones , Vitamina D/administración & dosificación , Comités Consultivos , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/tratamiento farmacológico , Enfermedad de Alzheimer/prevención & control , Trastornos del Conocimiento/fisiopatología , Consenso , Demencia/tratamiento farmacológico , Demencia/prevención & control , Femenino , Estudios de Seguimiento , Evaluación Geriátrica , Humanos , Cooperación Internacional , Masculino , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Vitamina D/sangreRESUMEN
OBJECTIVES: Orthostatic hypotension, a condition that mostly affects 'oldest-old' (i.e. ≥80 years) adults, is primarily explained by age-related dysfunction of blood pressure control. Vitamin D may contribute to blood pressure control. The aim of this study was to determine whether vitamin D deficiency is associated with orthostatic hypotension in oldest-old adults. DESIGN: Cross-sectional analysis at baseline of the EPIDOS study. SETTING: Five French areas. PARTICIPANTS: A total of 329 community-dwelling oldest-old women (mean age 83.3 ± 0.2 years). MAIN OUTCOMES MEASURES: Orthostatic hypotension was defined as a systolic blood pressure drop of ≥20 mmHg and/or a diastolic blood pressure drop of ≥10 mmHg within 3 min of standing. Vitamin D deficiency was defined as a serum 25-hydroxyvitamin D (25OHD) concentration ≤10 ng mL(-1) . Covariates included in the models were age, body mass index, diabetes mellitus, supine mean arterial pressure, number of drugs taken per day, use of antihypertensive or psychoactive drugs, cognition, quadriceps strength, current smoking, alcohol consumption, serum concentrations of parathyroid hormone, calcium and creatinine and season of testing. RESULTS: Diastolic orthostatic hypotension was observed more often among women with vitamin D deficiency (19.2%) compared to those without (10.0%; P = 0.03). There was an inverse linear association between 25OHD concentration and change in diastolic blood pressure after 3 min of standing (adjusted ß = -0.07, P = 0.046). Similarly, 25OHD deficiency was associated with orthostatic hypotension [adjusted odds ratio (OR) 3.36, P = 0.004], specifically with diastolic orthostatic hypotension (adjusted OR 3.81, P = 0.003). CONCLUSIONS: 25OHD deficiency was associated with orthostatic hypotension in oldest-old women, due to a greater drop in diastolic blood pressure on standing. This finding may lead to better understanding of the pathophysiology of falls in oldest-old adults with vitamin D deficiency.
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Hipotensión Ortostática/etiología , Deficiencia de Vitamina D/complicaciones , Anciano de 80 o más Años , Presión Sanguínea/fisiología , Estudios Transversales , Femenino , Humanos , Hipotensión Ortostática/sangre , Hipotensión Ortostática/fisiopatología , Estudios Prospectivos , Vitamina D/análogos & derivados , Vitamina D/sangre , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/fisiopatologíaRESUMEN
BACKGROUND AND PURPOSE: Morphological brain changes related to hypovitaminosis D have been poorly studied. In particular, the age-related decrease in vitamin D concentrations may explain the onset of white matter abnormalities (WMA) in older adults. Our objectives were (i) to investigate whether there was an association between serum 25-hydroxyvitamin D (25OHD) concentration and the grade of WMA in older adults and (ii) to determine whether the location of WMA was associated with 25OHD concentration. METHODS: One hundred and thirty-three Caucasian older community-dwellers with no clinical hydrocephalus (mean 71.6 ± 5.6 years; 43.6% female) received a blood test and a magnetic resonance imaging scan of the brain. The grades of total, periventricular and deep WMA were scored using semiquantitative visual rating scales from T2-weighted fluid-attenuated inversion recovery images. The association of WMA with as-measured and deseasonalized 25OHD concentrations was evaluated with the following covariates: age, gender, body mass index, use of anti-vascular drugs, number of comorbidities, impaired mobility, education level, Mini-Mental State Examination score, medial temporal lobe atrophy, serum concentrations of calcium, thyroid-stimulating hormone and vitamin B12, and estimated glomerular filtration rate. RESULTS: Both as-measured and deseasonalized serum 25OHD concentrations were found to be inversely associated with the grade of total WMA (adjusted ß = -0.32, P = 0.027), specifically with periventricular WMA (adjusted ß = -0.15, P = 0.009) but not with deep WMA (adjusted ß = -0.12, P = 0.090). Similarly, participants with 25OHD concentration <75 nM had on average a 33% higher grade of periventricular WMA than those with 25OHD ≥75 nM (P = 0.024). No difference in average grade was found for deep WMA (P = 0.949). CONCLUSIONS: Lower serum 25OHD concentration was associated with higher grade of WMA, particularly periventricular WMA. These findings provide a scientific basis for vitamin D replacement trials.
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Leucoencefalopatías/sangre , Leucoencefalopatías/patología , Vitamina D/análogos & derivados , Anciano , Estudios Transversales , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Neuroimagen , Vitamina D/sangreRESUMEN
BACKGROUND: Regression tree (RT) analyses are particularly adapted to explore the risk of recurrent falling according to various combinations of fall risk factors compared to logistic regression models. The aims of this study were (1) to determine which combinations of fall risk factors were associated with the occurrence of recurrent falls in older community-dwellers, and (2) to compare the efficacy of RT and multiple logistic regression model for the identification of recurrent falls. METHODS: A total of 1,760 community-dwelling volunteers (mean age ± standard deviation, 71.0 ± 5.1 years; 49.4 % female) were recruited prospectively in this cross-sectional study. Age, gender, polypharmacy, use of psychoactive drugs, fear of falling (FOF), cognitive disorders and sad mood were recorded. In addition, the history of falls within the past year was recorded using a standardized questionnaire. RESULTS: Among 1,760 participants, 19.7 % (n = 346) were recurrent fallers. The RT identified 14 nodes groups and 8 end nodes with FOF as the first major split. Among participants with FOF, those who had sad mood and polypharmacy formed the end node with the greatest OR for recurrent falls (OR = 6.06 with p < 0.001). Among participants without FOF, those who were male and not sad had the lowest OR for recurrent falls (OR = 0.25 with p < 0.001). The RT correctly classified 1,356 from 1,414 non-recurrent fallers (specificity = 95.6 %), and 65 from 346 recurrent fallers (sensitivity = 18.8 %). The overall classification accuracy was 81.0 %. The multiple logistic regression correctly classified 1,372 from 1,414 non-recurrent fallers (specificity = 97.0 %), and 61 from 346 recurrent fallers (sensitivity = 17.6 %). The overall classification accuracy was 81.4 %. CONCLUSIONS: Our results show that RT may identify specific combinations of risk factors for recurrent falls, the combination most associated with recurrent falls involving FOF, sad mood and polypharmacy. The FOF emerged as the risk factor strongly associated with recurrent falls. In addition, RT and multiple logistic regression were not sensitive enough to identify the majority of recurrent fallers but appeared efficient in detecting individuals not at risk of recurrent falls.
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Accidentes por Caídas , Accidentes por Caídas/estadística & datos numéricos , Afecto , Anciano , Envejecimiento/psicología , Estudios Transversales , Minería de Datos , Miedo , Femenino , Francia , Humanos , Modelos Logísticos , Masculino , Oportunidad Relativa , Polifarmacia , Estudios Prospectivos , Recurrencia , Análisis de Regresión , Factores de Riesgo , Estadísticas no ParamétricasRESUMEN
Slow gait is ubiquitous among older adults and predicts cognitive decline and progression to dementia. Age-related structural brain changes could be responsible for abnormal gait. The purpose of this study was to determine whether brain lateral ventricle volume, a measure of brain atrophy, was associated with gait velocity among older adults with mild cognitive impairment (MCI), while considering the effects of age and brain vascular burden. Twenty community-dwellers with MCI, free of hydrocephalus, aged 76 years (69/80) [median (25th/75th percentile)] (35 % female) from the 'Gait and Brain Study' were included in this analysis. Quantitative gait performance was measured while steady-state walking at self-selected pace with a 6-m electronic portable walkway (GAITRite). Brain ventricle volume was quantified using semi-automated software from three-dimensional T1-weighted magnetic resonance imaging. Age, white matter hyperintensity burden and Mini-Mental State Examination score were used as potential confounders. Median gait velocity was 118.7 cm/s (104.4/131.3). Median brain ventricle volume was 39.9 mL (30.0/46.6) with the left ventricle being slightly larger than the right (P = 0.052). Brain ventricle volume was inversely associated with gait velocity (adjusted ß = -0.63, P = 0.046). Volume of both the ventricular main bodies and the temporal horns correlated inversely with gait velocity (respectively, P = 0.009, P = 0.008). Left ventricle volume correlated with decreased gait velocity (P = 0.002) while right ventricle did not (P = 0.068). Slower gait velocity was associated with larger brain ventricle volume in our sample of people with MCI independent of age, cerebrovascular burden and cognitive worsening. This result may help elucidate the trajectories of cognitive and gait declines in people with MCI.
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Encéfalo/patología , Disfunción Cognitiva/complicaciones , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/patología , Marcha/fisiología , Ventrículos Laterales/patología , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Imagenología Tridimensional , Imagen por Resonancia Magnética , Masculino , Escala del Estado Mental , Persona de Mediana EdadRESUMEN
BACKGROUND AND PURPOSE: To validate a Short Form of the Mini-Mental State Examination (SMMSE) as a screening test for dementia in older ambulatory individuals followed in a memory clinic for a memory complaint. METHODS: A total of 202 cognitively healthy individuals, 100 individuals with a mild cognitive impairment and 304 demented individuals sent for a memory complaint by their primary care physician to a memory clinic were prospectively included in this cross-sectional study. They were randomized into derivation (n = 303) and validation (n = 303) groups. The SMMSE score was built from six memory items of MMSE, with a score ranging from 0 to 6 (i.e. best performance). RESULTS: The receiver operating characteristic curve showed an area under the curve of 0.98 for the derivation group and 0.97 for the validation group without differences between curves (P = 0.254). The cut-off between the sensitivity and the specificity of the SMMSE score for clinically diagnosed dementia was ≤4. The performance of the SMMSE for the diagnosis of dementia was high in the derivation and validation groups: sensitivity at 93.1% and 93.8%, specificity at 93.8% and 90.5%, positive predictive value at 94.3% and 90.1%, negative predictive value at 92.5% and 94.0%, likelihood ratio of positive test at 14.9 and 9.8 and of negative test at 0.07 and 0.07, respectively. CONCLUSIONS: The Short Form of the Mini-Mental State Examination was a good screening test for dementia in older individuals followed in a memory clinic for a memory complaint. The next step should be the confirmation of its discriminative value in older primary care patients.
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Demencia/diagnóstico , Tamizaje Masivo/métodos , Trastornos de la Memoria/etiología , Anciano , Área Bajo la Curva , Demencia/complicaciones , Femenino , Humanos , Masculino , Trastornos de la Memoria/diagnóstico , Pruebas Neuropsicológicas , Curva ROC , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To compare cognitive inhibition performance between people with early-onset (EOD) or late-onset depression (LOD) and controls, and between women and men with LOD. METHODS: On the basis of a case-control design, global executive performance (Frontal Assessment Battery); verbal (Hayling), attention (Stroop), and motor (Go/No-Go) components of cognitive inhibition; mental shifting (Trail Making Test parts A and B); and updating in working memory (Wechsler Adult Intelligence Scale) were assessed in 40 participants (10 depressed women with LOD (i.e., ≥60 years old), 10 depressed women with EOD (i.e., <60 years old), 10 healthy women and 10 depressed men with LOD (i.e., ≥60 years old)). RESULTS: Older depressed women, irrespective of age of depression onset, had greater cognitive inhibition impairments (attention and verbal component) compared with healthy women. LOD was significantly associated with the attention component of cognitive inhibition impairment, unlike EOD (p = 0.026). No executive differences were found regarding age of first-onset depression in older depressed women, and between women and men with LOD. CONCLUSION: Cognitive inhibition impairment, and more specifically its attention component, was the main characteristic of depression in the studied sample of older adults, independently of gender and age of depression onset. It is essential to perform similar studies in both genders in view of future tailor-made therapeutic modalities.
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Trastornos del Conocimiento/psicología , Trastorno Depresivo/psicología , Factores de Edad , Edad de Inicio , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Factores SexualesRESUMEN
BACKGROUND: Low serum 25-hydroxyvitamin D (25OHD) concentrations have been associated with dementia. The association with mild cognitive impairment (MCI) has not yet been explored. Our aim was to examine the association between vitamin D status and MCI status amongst older community-dwellers with subjective memory complaint. METHODS: Ninety-five non-demented Caucasian community-dwellers with subjective memory complaint (mean, 71.1 ± 6.4 years; 54.7% women) included in the Gait and Alzheimer Interaction Tracking (GAIT) study were categorized into two groups according to Winblad et al. consensus criteria [i.e., subjects with MCI or cognitively healthy individuals (CHI)]. Serum 25OHD concentration was divided into quartiles, the fourth quartile corresponding to the highest 25OHD concentration. The cross-sectional associations between 25OHD concentrations and MCI were modeled using logistic regressions. Age, gender, body mass index, number of comorbidities, education level, Mini-Mental State Examination score, Frontal Assessment Battery score, Geriatric Depression Scale score, creatinine clearance, and season tested were considered as potential confounders. RESULTS: Compared to CHI, patients with MCI (n = 43; mean, 71.4 ± 5.6 years; 34.9% women) had lower mean serum 25OHD concentrations (P = 0.006) and belonged more often to the lower quartiles compared to the highest quartile (P = 0.03). Increased serum 25OHD concentration was associated with a lower risk of MCI [adjusted odds ratio (OR) = 0.96, P = 0.002]. Accordingly, lower quartiles of 25OHD were positively associated with MCI whilst using the highest quartile as reference (adjusted OR = 25.46, P = 0.002 for the first quartile; adjusted OR = 6.89, P = 0.03 for the second quartile; and adjusted OR = 10.29, P = 0.02 for the third quartile). CONCLUSIONS: Low 25OHD concentrations were associated with MCI status in older non-demented community-dwellers with subjective memory complaint.
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Disfunción Cognitiva/sangre , Disfunción Cognitiva/epidemiología , Deficiencia de Vitamina D/sangre , Deficiencia de Vitamina D/epidemiología , Vitamina D/sangre , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Disfunción Cognitiva/diagnóstico , Estudios Transversales , Femenino , Humanos , Masculino , Deficiencia de Vitamina D/diagnósticoRESUMEN
BACKGROUND/AIMS: To measure the Timed Up and Go (TUG), imagined TUG (iTUG), and the difference of time between these two tests (delta time) in 20 patients with relapsing-remitting multiple sclerosis (RRMS) and 20 healthy age-matched controls and to examine whether an association with cognitive functions, motor impairment, and behavioral changes can be determined. METHODS: The mean ± SD of TUG, iTUG and delta time were used as outcomes. Spatiotemporal gait parameters were recorded by a 12-camera optoelectronic system during straight walking at usual self-selected speed. Cognitive functions were assessed by a standardized neuropsychological examination. RESULTS: Patients performed the TUG slower than the controls (10.00 ± 1.70 s vs. 8.71 ± 1.04 s, p = 0.01, respectively). The TUG was correlated with gait parameters, cognitive functions, and behavior, whereas delta time was correlated only with cognitive functions. CONCLUSION: TUG represents an interesting test to reveal subtle deficits in RRMS patients with low disability and is related to motor, cognitive, and behavioral functioning. Combining with the TUG, delta time could easily give additional information on specific cognitive functions in the assessment of patients with RRMS.
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Cognición/fisiología , Prueba de Esfuerzo/métodos , Marcha/fisiología , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Pruebas Neuropsicológicas , Adulto , Femenino , Humanos , Masculino , Actividad Motora/fisiología , Esclerosis Múltiple Recurrente-Remitente/fisiopatología , Esclerosis Múltiple Recurrente-Remitente/psicologíaRESUMEN
BACKGROUND: Gait disorders in patients with idiopathic normal pressure hydrocephalus (iNPH) share similar characteristics found in pathologies presenting with higher-level gait disorders that have been specifically associated with gait changes during walking while simultaneously performing an attention-demanding task (i.e. dual tasking). The current study assessed the effect of cerebrospinal fluid (CSF) tapping on quantitative gait modification during single and dual tasking in patients with a suspicion of iNPH. METHODS: Of 53 patients suspected of iNPH, 18 have been included in this study. Gait analysis during single- and dual-task condition (walking and backward counting) before and after tapping of 40 ml CSF has been performed. RESULTS: Gait speed (P < 0.01) and stride length (P < 0.05) were significantly improved during dual-task conditions after CSF tapping compared to the gait performance before spinal tapping, without such improvement for gait parameters during single-tasking. CONCLUSION: Dual-tasking condition better reveals gait improvement after CSF tapping than single-tasking in patients suspected of iNPH.
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Trastornos Neurológicos de la Marcha/terapia , Hidrocéfalo Normotenso/terapia , Punción Espinal/métodos , Anciano , Anciano de 80 o más Años , Presión del Líquido Cefalorraquídeo/fisiología , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/psicología , Trastornos del Conocimiento/terapia , Función Ejecutiva/fisiología , Femenino , Marcha/fisiología , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Hidrocéfalo Normotenso/complicaciones , Hidrocéfalo Normotenso/fisiopatología , Masculino , Persona de Mediana Edad , Desempeño Psicomotor/fisiología , Estudios Retrospectivos , Caminata/fisiologíaRESUMEN
BACKGROUND: Hypovitaminosis D has been cross-sectionally associated with dementia and stroke. The objective of this longitudinal study was to determine whether serum vitamin D deficiency at baseline could predict the onset of non-Alzheimer dementias (NAD) within 7 years among older women. METHODS: Forty high-functioning older women (78.4 years, 76.4/82.0; median, 25th/75th percentile) from the EPIDOS Toulouse study were divided into two groups based on vitamin D deficiency (i.e., serum 25-hydroxyvitamin D <10 ng/ml) at baseline. At the end of the 7-year follow-up period, women matching the DSM-IV but not the NINCDS-ADRDA criteria were diagnosed with NAD while those matching the NINCDS-ADRDA criteria were considered to have Alzheimer's disease (AD). Subtle cognitive impairments at baseline, cardiovascular risk factors and Parkinson's disease were used as potential confounders. RESULTS: NAD was reported in 6 women (82.8 years, 80.6/86.0) after 7 years of follow-up. More NAD were observed in women with vitamin D deficiency (p = 0.023). There was no between-group difference regarding the onset of AD (p = 0.332). We found an association between vitamin D deficiency at baseline and the onset of NAD (adjusted odds ratio = 19.57, p = 0.042). Conversely, vitamin D deficiency was not associated with AD (p = 0.222). CONCLUSION: Baseline vitamin D deficiency predicted the onset of NAD within 7 years among older women.
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Demencia/diagnóstico , Deficiencia de Vitamina D/diagnóstico , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Demencia/complicaciones , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Francia , Humanos , Modelos Logísticos , Estudios Longitudinales , Oportunidad Relativa , Valor Predictivo de las Pruebas , Estudios Prospectivos , Factores de Riesgo , Vitamina D/sangre , Deficiencia de Vitamina D/complicaciones , Vitaminas/sangreRESUMEN
BACKGROUND: The "Program of Research on the Integration of Services for the Maintenance of Autonomy" (PRISMA-7) is the reference tool for the assessment of older patients visiting the emergency departments (EDs) in the province of Quebec (Canada). This study aimed to examine 1) whether the PRISMA-7 high-risk level for disabilities was associated with the length of stay in ED and in hospital, and hospital admission; and 2) performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR]) of the PRISMA-7 high-risk level for the length of stay in ED and hospital, and hospital admission in older ED users. METHODS: A total of 12,983 older ED users of the Jewish General Hospital (Montreal, Quebec, Canada) were recruited in this observational and prospective cohort study. All enrolled participants had a PRISMA-7 assessment upon their arrival at ED. The length of stay in ED and hospital, and hospital admission were used as outcomes. RESULTS: A PRISMA-7 high-risk level was associated with an increased length of stay in ED and hospital (ß ≥2.1 with P≤0.001 and Hazard ratio (HR)= ≥1.2 with P≤0.001) as well as in hospital (HR=1.27 with P≤0.001) in patients on a stretcher. All performance criteria were low (i.e., <0.78). Patients with a PRISMA-7 high-risk level were discharged significantly later from ED and hospital compared to those with low-risk level (P=0.001). INTERPRETATION: A PRISMA-7 high-risk level was associated with a long length of stay in ED and hospital, and hospital admission in patients on a stretcher but had poor performance criteria for these adverse events, suggesting that it cannot be used as a prognostic tool in older ED users.