الملخص
Resumen Introducción: La polifarmacia inapropiada en adultos mayores con demencia es un problema de salud pública global. En este artículo se describen las indicaciones y se dan pautas para la deprescripción de potenciadores cognitivos (inhibidores de acetilcolinesterasa y memantina) y psicofármacos en pacientes con demencia. Materiales y métodos: Esta es una revisión narrativa a partir del estado del arte sobre la deprescripción en el anciano con demencia. Resultados: La deprescripción no significa limitar esfuerzos terapéuticos, por el contrario, consiste en una estrategia de prevención cuaternaria para reducir el riesgo de reacciones adversas e identificar escenarios donde el beneficio clínico es marginal. Para esto, es necesario rastrear activamente a pacientes con demencia con indicación de deprescripción (falta de respuesta clínica adecuada, desaparición del beneficio con el uso prolongado, estadio de demencia grave o fase terminal). Discusión: Los procesos de deprescripción varían según el grupo farmacológico e incluyen disminuciones progresivas de la medicación, así como el seguimiento y la monitorización para evitar el empeoramiento clínico. Se requiere de programas de educación médica en deprescripción para estudiantes y profesionales en ejercicio, especialmente en servicios de atención primaria en áreas rurales o dispersas, lo cual configura un llamado urgente a la neurología, la psiquiatría y la geriatría. Conclusión: El proceso de deprescripción en el paciente con demencia puede implementarse bajo criterios específicos y de una forma organizada.
Abstract Introduction: Inappropriate polypharmacy in older adults with dementia is a global public health problem. This article describes the indications and gives guidelines for the deprescription of cognitive enhancers (acetylcholinesterase inhibitors and memantine), and psychotropic drugs in patients with dementia. Materials and methods: This is a narrative review article based on the state of the art on deprescribing in the elderly with dementia. Results: Deprescribing does not mean limiting therapeutic efforts; on the contrary, it consists of a quaternary prevention strategy to reduce the risk of adverse reactions and identify scenarios where the clinical benefit is marginal. For this, it is necessary to actively track patients with dementia with an indication for deprescription (lack of adequate clinical response, disappearance of benefit with prolonged use, severe dementia, or palliative phase). Discussion: Deprescribing processes vary depending on the pharmacological group and include progressive reductions in medication, as well as follow-up and monitoring to avoid clinical worsening. Medical education programs in deprescribing are required for students and practicing professionals, especially in primary care services in rural or dispersed areas, which constitutes an urgent call for neurology, psychiatry, and geriatrics. Conclusion: The deprescription process in patients with dementia can be implemented under specific criteria and in an organized manner.
الملخص
RESUMEN Introducción: Producto de la transición demográfica, en todo el mundo ha aumentado la proporción de adultos mayores, lo que se refleja en un aumento de la prevalencia del trastorno neurocognitivo mayor (TNM). Este fenómeno resulta especialmente importante en países de ingresos bajos y medios como Colombia, dados los importantes costos económicos y sociales que acarrea. El objetivo es analizar la asociación entre variables socioeconómicas y sociodemográficas y el deterioro cognitivo en adultos mayores colombianos. Métodos: Se evaluaron los registros de 23.694 adultos mayores de 60 arios encuestados para SABE Colombia 2015, que utilizó un muestreo estratificado por conglomerados y fue representativa de la población adulta mayor de 60 años. Este instrumento evaluó el deterioro cognitivo mediante la versión abreviada del Mini Mental (AMMSE) y recolectó información sobre múltiples variables socioeconómicas y sociodemográficas. Resultados: Se consideró con deterioro cognitivo al 19,7% de los adultos mayores incluidos en la encuesta con puntuaciones < 13 en el AMMSE. Hubo una mayor prevalencia de deterioro cognitivo en mujeres (21,5%) que en varones (17,5%). Las variables socioeconómicas mostraron un impacto en la prevalencia de deterioro, en especial estar trabajando actualmente (OR = 2,74; IC95%, 2,43-3,09) como factor de riesgo y haber cursado al menos primaria como factor protector (OR = 0,30; IC95%, 0,28-0,32). Esta asociación se comportó de manera diferencial según el sexo. Conclusiones: Se evidencio una asociación entre factores socioeconómicos y sociodemográficos con el deterioro cognitivo en adultos mayores colombianos. Pese a lo anterior, se sugiere un impacto diferencial dependiente del sexo. © 2022 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.
ABSTRACT Introduction: Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyze the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults. Methods: The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables. Results: 19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score < 13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (OR = 2.74; 95%CI, 2.43-3.09) as a risk factor and having attended primary school as a protective factor (OR = 0.30; 95%CI, 0.28-0.32), differentially according to gender. Conclusions: An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.
الملخص
Geriatric giants account for the five most prevalent morbidities that cause immense decline in functional capacity and decreased quality of life. Immobility, instability leading to falls and fractures, incontinence, impaired cognition (dementia) and iatrogenesis affect majority of the ageing elderly leading to dependency, caregiving and associated burden among caregivers. Concept of non-pharmacological interventions in dementia care: interventions that involve non-pharmacological (non-medicinal) measures, have proven benefits to the people living with dementia (PLWD). music therapy, nature therapy that involves nature walks and living amidst natural spaces, have shown to have immense biophilia effects on the various organ systems in the human body. Immense health benefits have been documented among PLWD: dawn phenomenon is a clinical phenomenon where the PLWD experiences agitation, aggression and loud speech in the evenings associated with dementia. Out of all the seven studies published, there were significant improvements in mood, reduction in aggressive behavior, improving anxiety symptoms, reducing caregiver burnout and improving overall quality of life of the people living with dementia and their caregivers. With promising results among various interventional studies across the world, NPI is an important intervention with minimal to nil side effects with long term benefits on frequent administration.
الملخص
Arnold Pick described a series of cases with progressive aphasia, behavioural disorders, and dementia. The post-mortem examination revealed on macroscopy, beside diffuse brain atrophy, also circumscribed (lobar) atrophy of the temporal and/or frontal lobes. The histopathology was not provided. Such kind of cases were soon named after the author, being known for a time as 'Pick's disease', coming to constitute a new nosological group. A time later after the original description, Alois Alzheimer and Oskar Fischer completed microscopic examination of similar cases, where the first author found, on silver impregnation, spheric neuronal inclusions, he named 'argentophilic ball' inclusions, while the second one identified complex cortical changes he named 'spongiform cortical wasting', and additionally a type of swollen cell that was named 'ballooned neuron'. Such microscopic changes became the first histopathological markers of this group of diseases.
Arnold Pick descreveu uma série de casos apresentando, de modo progressivo, afasia, transtornos de comportamento e demência. O exame pós-morte revelou à macroscopia, além de atrofia cerebral difusa, também atrofia circunscrita (lobar) dos lobos temporais e/ou frontais. A histopatologia não foi fornecida. Tal tipo de casos foi logo denominado segundo o autor, sendo conhecido por um período como 'doença de Pick', vindo a constituir um novo grupo nosológico. Algum tempo após a discrição original, Alois Alzheimer e Oskar Fischer perfizeram exame microscópio de casos semelhantes, onde o primeiro autor encontrou inclusões neuronais esféricas à impregnação pela prata, que denominou de 'bola argirofílica', enquanto o segundo identificou alterações corticais complexas às quais denominou 'perda cortical espongiforme', além de um tipo de célula tumefeita que chamou de 'neurônio balonizado'. Tais alterações microscópicas tornaram-se os primeiros marcadores histopatológicos desse grupo de doenças.
الملخص
The purpose of the study is to develop new proposals for improving criminal procedural legislation in the field of conducting remote investigative actions with disabled persons, taking into account their physiological and functional characteristics. Research material and methods: This study is based on an analysis of the norms regarding the criminal procedural legislation of the Republic of Kazakhstan and a number of foreign states that regulate the procedure for conducting remote investigative actions - as well as scientific publications on the research topic in the field of psychology and medicine. An integrated approach involves considering the studied phenomena of communication during an investigative action as a set of interconnected and interdependent elements, i.e., consideration of the issue from the medical, psychological and legal points of view. Situational and systemic types of analysis, complex sociological analysis, diagnostics and forecasting investigative situation were also used. Methods of analysis and synthesis, induction, deduction, methods of qualitative and quantitative analysis were employed to clarify the legal essence of the studied phenomenon. Findings: practical recommendations aimed at improving and developing the performance of remote investigative actions involving persons with disabilities (further FWDs) y creating optimal conditions for the transfer of verbal, medical, and psychological information, as well as technical and forensic support for conducting RIAs. The following conclusions were made: in order to improve the current legislation, it is advisable to consider the issue of developing and including a special norm in the legislation, taking into account the characteristics of the communicative competencies of persons with disabilities. This norm regulates the procedure for conducting investigative actions involving the mute, deaf, blind and other persons with disabilities.
El objetivo del estudio es elaborar nuevas propuestas de mejora de la legislación procesal penal en el ámbito de la realización de actuaciones de investigación a distancia con personas con discapacidad, teniendo en cuenta sus características fisiológicas y funcionales. Material y métodos de investigación: Este estudio se basa en un análisis de las normas relativas a la legislación procesal penal de la República de Kazajstán y de una serie de Estados extranjeros que regulan el procedimiento para llevar a cabo acciones de investigación a distancia -, así como publicaciones científicas sobre el tema de investigación en el campo de la psicología y la medicina. Un enfoque integrado implica considerar los fenómenos estudiados de comunicación durante una acción de investigación como un conjunto de elementos interconectados e interdependientes, es decir, considerar la cuestión desde los puntos de vista médico, psicológico y jurídico. También se utilizaron los tipos de análisis situacional y sistémico, el análisis sociológico complejo, el diagnóstico y la previsión de la situación de investigación. Se emplearon métodos de análisis y síntesis, inducción, deducción, métodos de análisis cualitativo y cuantitativo para aclarar la esencia jurídica del fenómeno estudiado. Conclusiones: recomendaciones prácticas destinadas a mejorar y desarrollar la realización de acciones de investigación a distancia en las que participen personas con discapacidad (en adelante - RIA) y crear condiciones óptimas para la transferencia de información verbal, médica y psicológica, así como apoyo técnico y forense para la realización de las RIA. Se llegó a las siguientes conclusiones:con el fin de mejorar la legislación actual, es aconsejable considerar la cuestión de desarrollar e incluir una norma especial en la legislación, teniendo en cuenta las características de las competencias comunicativas de las personas con discapacidad. Esta norma regula el procedimiento para llevar a cabo acciones de investigación en las que estén implicadas personas mudas, sordas, ciegas y otras personas con discapacidad.
O objetivo do estudo é desenvolver novas propostas para aprimorar a legislação processual penal no campo da realização de ações investigativas remotas com pessoas com deficiência, levando em conta suas características fisiológicas e funcionais. Material e métodos de pesquisa: Este estudo baseia-se em uma análise das normas relativas à legislação processual penal da República do Cazaquistão e de vários países estrangeiros que regulamentam o procedimento para a realização de ações investigativas remotas, bem como em publicações científicas sobre o tópico de pesquisa no campo da psicologia e da medicina. Uma abordagem integrada envolve a consideração dos fenômenos estudados de comunicação durante uma ação investigativa como um conjunto de elementos interconectados e interdependentes, ou seja, a consideração da questão dos pontos de vista médico, psicológico e jurídico. Também foram usados tipos de análise situacional e sistêmica, análise sociológica complexa, diagnóstico e previsão da situação investigativa. Métodos de análise e síntese, indução, dedução, métodos de análise qualitativa e quantitativa foram empregados para esclarecer a essência legal do fenômeno estudado. Resultados: recomendações práticas com o objetivo de aprimorar e desenvolver o desempenho de ações investigativas remotas envolvendo pessoas com deficiência (mais adiante - FWDs), criando condições ideais para a transferência de informações verbais, médicas e psicológicas, bem como suporte técnico e forense para a realização de RIAs. Foram feitas as seguintes conclusões: para aprimorar a legislação atual, é aconselhável considerar a questão do desenvolvimento e da inclusão de uma norma especial na legislação, levando em conta as características das competências comunicativas das pessoas com deficiência. Essa norma regulamenta o procedimento para conduzir ações investigativas envolvendo pessoas mudas, surdas, cegas e outras pessoas com deficiência.
الموضوعات
Humans , Kazakhstan , Legislation , Forensic Sciencesالملخص
Objective: Adapt functional mobility and muscle strength tests for older people with dementia to be performed remotely in the home environment; determine intra-rater and inter-rater reliability of functional mobility and strength tests for older people with dementia; and correlate the performance on the physical tests executed remotely and the Timed Up and Go (TUG) test, which was validated remotely in healthy older people. Methods: We included 43 people with dementia. The Short Physical Performance Battery (SPPB), TUG, TUG Dual Task (TUG-DT), and 30-Second Sit-to-Stand Test (SST30s) were performed through videocalls. Test performance was documented to facilitate the subsequent determination of inter- and intra-rater reliability. The intra-rater reliability was determined at a 2-week interval from the real-time videocall to analysis of the recording. Results: Intra-rater reliability ranged from good to excellent for all tests performed (ICC 0.8621.000). Inter-rater reliability values were fair for gait speed (ICC = 0.223), moderate for some of the SPPB items (ICC = 0.7060.801), good for the SPPB two-foot balance (ICC = 0.860) and the SPPB total score (ICC = 0.831), and excellent for the rest of the tests. Conclusion: Functional mobility and muscle strength tests proved reliable and feasible for remote, at-home assessments of older people with dementia when assisted by their respective caregivers, providing an additional alternative for assessment of this patient population. (AU)
الموضوعات
Humans , Aged , Aged, 80 and over , Telemedicine , Motor Skills , Dementia , Muscle Strengthالملخص
Objective: To evaluate the impact of a multicomponent physical exercise program on clinical variables associated with the glymphatic clearance system, sleep-awake patterns, and cognitive function in individuals with mild cognitive impairment or mild Alzheimer's disease. Methods: This is a single-center parallel randomized controlled trial involving pre- and post-intervention assessments. The intervention consists of a 12 (±3)-week multicomponent aerobic and resistance physical exercise program of moderate intensity divided into 2 groups: an experimental group (undergoing multicomponent training) and a control group (no intervention). Eligible participants are those diagnosed with probable mild cognitive impairment or mild Alzheimer's disease. Expected results: Anticipated outcomes suggest that the multicomponent training protocol, incorporating both aerobic and resistance physical exercises at a moderate intensity, will yield improvements in glymphatic clearance dynamics, sleep-awake parameters, and performance on cognitive, functional, and behavioral tasks among eligible patients. Relevance: The need to move beyond cognitive clinical testing justifies our trial, which proposes an assessment employing neuroimaging techniques and the analysis of biomarkers present in cerebrospinal fluid in conjunction with clinical tests for physical and cognitive assessment. (AU)
الموضوعات
Humans , Aged , Aged, 80 and over , Exercise , Alzheimer Disease , Glymphatic Systemالملخص
Introducción: La enfermedad de Alzheimer, constituye un problema sanitario y social de gran magnitud; precisa de diagnóstico y terapéutica precoces. Se realizó una búsqueda de artículos sobre factores de riesgo y biomarcadores de la enfermedad en las bases de datos PubMed/Medline, Scopus, Scielo y Lilacs, y mediante el buscador Google académico; desde el año 2017 hasta el 2023, en idioma español, inglés y portugués. Objetivo: Analizar los factores de riesgo y los biomarcadores de la enfermedad de Alzheimer. Desarrollo: Los principales factores de riesgo encontrados son edad avanzada, menor educación, poca actividad física, hábito de fumar, consumo excesivo de alcohol, hipertensión arterial, diabetes, obesidad, depresión, pérdida o disminución de la audición, aislamiento social, los traumas craneales y la contaminación ambiental. Los biomarcadores fundamentales son: los marcadores que se utilizan en los estudios de neuroimágenes como la PET Amiloide, PET tau, PET FDG; y en LCR y plasma: Aß42, Aß42/Aß40, p tau 217, p tau 181, GFAP, y neurofilamentos de cadena ligeras. Conclusiones: Se requieren estudios longitudinales, a partir de la presencia de los factores de riesgo asociados a biomarcador, desde edades pregeriátricas en pacientes sanos, que tengan como salidas el deterioro cognitivo y el desarrollo de la demencia, para construir un modelo de predicción(AU)
Introduction: Alzheimer's disease is a health and social problem of great magnitude; it requires early diagnosis and therapy. A search for articles on risk factors and biomarkers of the disease was conducted; in the databases PubMed/Medline, Scopus, Scielo and Lilacs, and through the Google scholar search engine; from 2017 to 2023, in Spanish, English and Portuguese. Objective: To analyze the risk factors and biomarkers of Alzheimer's disease. Development: The main risk factors found are advanced age, lower education, little physical activity, smoking, excessive alcohol consumption, high blood pressure, diabetes, obesity, depression, hearing loss or decrease, social isolation, head trauma and environmental pollution. The fundamental biomarkers are: markers used in neuroimaging studies such as amyloid PET, tau PET, FDG PET; and in CSF and plasma: Aß42, Aß42/Aß40, p tau 217, p tau 181, GFAP, and light chain neurofilaments. Conclusions: Longitudinal studies are required, based on the presence of risk factors associated with biomarkers, from pregeriatric ages in healthy patients, which have cognitive impairment and the development of dementia as outputs, to build a prediction model(AU)
الموضوعات
Humans , Biomarkers , Risk Factors , Alzheimer Disease , Forecasting/methods , Amyloid , Social Isolation , Smoking , Longitudinal Studies , Positron-Emission Tomography/methods , Depression , Diabetes Mellitus , Environmental Pollution , Sedentary Behavior , Neuroimaging/methods , Cognitive Dysfunction , Binge Drinking , Hearing Loss , Hypertension , Obesityالملخص
Epidemiological surveys show that the incidence of age-related dementia and cognitive impairment is increasing and it has been a heavy burden for society, families, and healthcare systems, making the preservation of cognitive function in an increasingly aging population a major challenge. Exercise is beneficial for brain health, and FDNC5/irisin, a new exercise-induced myokine, is thought to be a beneficial mediator to cognitive function and plays an important role in the crosstalk between skeletal muscle and brain. This review provides a critical assessment of the recent progress in both fundamental and clinical research of FDNC5/irisin in dementia and cognitive impairment-related disorders. Furthermore, we present a novel perspective on the therapeutic effectiveness of FDNC5/irisin in alleviating these conditions.
الملخص
Os autores relatam a experiência do processo de desenvolvimento do protótipo de um aplicativo sobre higiene bucal de idosos com demência, com atenção especial aos que apresentam disfagia, voltado à orientação dos seus cuidadores. Objetivou, também, descrever o papel desta experiência como estratégia de ensino interprofissional e de inovação social a estudantes de Odontologia e Fonoaudiologia. Realizou-se estudo qualitativo do tiporelato de experiência, com informações originadas de narrativas verbais e registro escrito e iconográfico dos autores dessa pesquisa, bem como de relatos escritos de duas revisoras do protótipo do aplicativo ambas especialistas em Gerontologia. Para o protótipo, utilizou-se o site SeuApp.com, sem necessidade de programação, gerando formato de aplicativo e site para desktop e celular. O produto foi desenvolvido em três fases, concluído com êxito, e avaliado positivamente pelas pareceristas. Seu conteúdo incluiu informações escritas e iconográficas, estáticas e dinâmicas, referentes à importância e "passo a passo" da higiene bucal, suas relações com saúde e disfagia, e cuidados específicos diante dessa, além de um "Guia do Aplicativo" e "Feedback". A experiência relatada demonstrou que a construção do aplicativo se deu com êxito e avaliação positiva por pareceristas, com contribuição social almejada. Os discentes e docentes de Odontologia e de Fonoaudiologia envolvidos ampliaram suas habilidades na inovação e nas competências interprofissionais. Mais estudos sobre a inovação na graduação em saúde são requeridos, por se tratar de uma área em expansão no mercado, tendo grande contribuição para atualização dos profissionais da saúde (AU).
Los autores relatan la experiencia del proceso de desarrollo del prototipo de una aplicación sobre higiene bucal para personas mayores con demencia, con especial atención a aquellas con disfagia, con el objetivo de orientar a sus cuidadores. También tuvo como objetivo describir el papel de esta experiencia como estrategia de enseñanza interprofesional e innovación social para estudiantes de Odontología y Logopedia. Se realizó un estudio cualitativo del tipo relato de experiencia, con informaciones provenientes de relatos verbales y registros escritos e iconográficos de los autores de esta investigación, así como relatos escritos de dos revisores del prototipo de la aplicación, ambos especialistas en Gerontología. Para el prototipo se utilizó el sitioweb SeuApp.com, sin necesidad de programación, generando un formato de aplicación y sitio web para escritorio y celular. El producto fue desarrollado en tres fases, completado con éxito y evaluado positivamente por los revisores. Su contenido incluía información escrita e iconográfica, estática y dinámica, referente a la importancia y el "paso a paso" de la higiene bucal, sus relaciones con la salud y la disfagia, y los cuidados específicos ante esta, además de una "Guía de Aplicación" y "Comentarios". La experiencia relatada demostró que la construcción de la aplicación fue exitosa y fue evaluada positivamente por los revisores, con la contribución social deseada. Los estudiantes y profesores de Odontología y Logopedia involucrados ampliaron sus habilidades en innovación y competencias interprofesionales. Se requiere más estudios en innovación en la graduación en salud, ya que es un área en expansión en el mercado, con un gran aporte para la actualización de los profesionales de la salud (AU).
The authors report the experience of developing the prototype of an application on oral hygiene for elderly individuals with dementia, with special attention to those with dysphagia, aimed at guiding their caregivers. The purpose was also to describe the role of this experience as a strategy for interprofessional education and social innovation for dentistry and speech-language pathology students. A qualitative study of the experience was conducted, gathering information from verbal narratives and written and iconographic records of the researchers, as well as written reports from two reviewers of the application prototypeboth experts in Gerontology. The website SeuApp.com website was used for the prototype, which required no programming, generating an application format and a website for desktop and mobile. The product was developed in three phases, successfully completed, and positively evaluated by the reviewers. Its content included written and iconographic information, static and dynamic, regarding the importance and step-by-step process of oral hygiene, its relationships with health and dysphagia, and specific care in the face of the latter, along with an "App Guide" and "Feedback." The reported experience demonstrated that the application's construction was successful and positively evaluated by reviewers, thus achieving the intended social contribution. Dentistry and speech-language pathology students and faculty involved expanded their skills in innovation and interprofessional competencies. Given itsexpanding presence in the market and significant contribution to the ongoing education of healthcare professionals, further studies on innovation in health education are required (AU).
الموضوعات
Humans , Male , Female , Oral Hygiene , Caregivers , Dementia , Mobile Applications , Professional Competence , Students, Dental , Students, Health Occupations , Aged , Deglutition Disorders , Qualitative Research , Quality Improvementالملخص
RESUMEN Los inhibidores de la bomba de protones (IBP) son los medicamentos más potentes para inhibir la secreción gástrica ácida, y se utilizan en el tratamiento de la mayor parte de las afecciones inflamatorias de la mucosa gástrica. Forman parte de los fármacos más recetados y sobreprescritos en todo el mundo; por ejemplo, en los Estados Unidos, según la Encuesta nacional de salud y nutrición, casi duplicaron su uso en los adultos de 40 años de un 4,9 % hasta un 8,3 %, entre los años 1999 a 2012. Aunque, en general, se consideran bien tolerados, algunos estudios epidemiológicos ―que extraen información a partir de grandes bases de datos― han reportado una serie de efectos adversos asociados con su uso prolongado, entre los cuales están el deterioro cognitivo, la enfermedad renal crónica, el infarto de miocardio, el accidente cerebrovascular, las fracturas óseas e incluso la muerte, entre otros. El objetivo fue realizar una revisión narrativa de la literatura acerca de los efectos del uso crónico de los IBP sobre el deterioro cognitivo en los adultos mayores. Se revisaron artículos a partir de una búsqueda en las bases de datos Pudmed, Scopus y Scielo con las palabras clave y términos Mesh/DeCS relacionados tanto en inglés como en español. Los efectos secundarios a nivel neurológico inducidos por el uso crónico de los IBP pueden estar relacionados indirectamente con la presencia de alteraciones sistémicas secundarias (deficiencia de magnesio y vitamina B12) o con efectos directos sobre el funcionamiento neuronal después de pasar a través de la barrera hematoencefálica. Si bien se han descrito varios mecanismos neurobiológicos por medio de los cuales los IBP podrían favorecer el desarrollo de la demencia ―que comprenden el funcionamiento de la proteína tau, la acumulación de beta amiloide (βA) y la deficiencia de cobalamina, entre otros―, la mayor parte de la evidencia clínica disponible no ha encontrado una asociación significativa entre el uso de los IBP y el riesgo de demencia o el deterioro cognitivo. Para establecer de una manera más clara los efectos clínicos adversos del uso crónico de los IBP, en especial, en el funcionamiento cerebral, se necesitan estudios de cohorte bien diseñados, con tamaños de muestra grandes y periodos de seguimiento prolongados, con un método confiable para ajustar los factores de confusión estandarizados y, además, realizar análisis por subgrupos.
ABSTRACT Proton pump inhibitors (PPIs) are the most potent drugs to inhibit gastric acid secretion, being used in the treatment of most inflammatory conditions of the gastric mucosa. They are among the most prescribed and overprescribed medications worldwide; for example, in the United States, according to the National Health and Nutrition Examination Survey, they almost doubled their use in adults aged 40 years and older from 4.9 % to 8.3 % between 1999 and 2012. Although they are generally considered well tolerated, some epidemiological studies extracting information from large databases have reported a number of adverse effects associated with their prolonged use, including cognitive impairment, chronic kidney disease, myocardial infarction, stroke, bone fractures and even death, among others. The objective was to conduct a narrative review of the literature on the effects of chronic use of PPIs on cognitive impairment in older adults. Articles were reviewed based on a search in the PubMed, Scopus and SciELO databases using both English and Spanish keywords and related MeSH/DeCS terms. Neurological side effects induced by chronic PPI use may be indirectly related to secondary systemic disorders (magnesium and vitamin B12 deficiency) or to direct effects on neuronal functioning after passing through the blood-brain barrier. Although several neurobiological mechanisms by which PPIs could favor the development of dementia-which involve Tau protein function, beta-amyloid [βA] accumulation and cobalamin deficiency, among others-have been described, most of the available clinical evidence has not shown a significant association between PPI use and the risk of dementia or cognitive impairment. To establish the adverse clinical effects of chronic PPI use more clearly, especially on brain functioning, well-designed cohort studies with large sample sizes and long follow-up periods, with a reliable method to adjust for standardized confounders, as well as subgroup analyses are needed.
الملخص
ObjectiveTo systematically evaluate the safety of Tianzhi granules used in the treatment of mild-to-moderate vascular dementia. MethodA randomized， double-blind， double-simulated， positive drug/placebo parallel controlled multi-center phase Ⅳ clinical trial and an open multi-center phase Ⅳ clinical trial of Tianzhi granules in the treatment of mild-to-moderate vascular dementia were conducted. Safety data of 1 492 patients were included and analyzed according to inclusion and exclusion criteria. The main evaluation measures were the incidence rate of adverse events/adverse reactions， laboratory indicators， vital signs， and electrocardiogram （ECG） results. ResultA total of six adverse events possibly related to the test drug occurred in 520 patients of the double-blind trial， and the symptoms were all mild and recovered. The incidence of adverse events was not statistically different among Tianzhi granules， donepezil， and placebo groups. Nine adverse events possibly related to the test drug were observed in 972 patients of the open trial， and the symptoms were mild and recovered. Laboratory tests （blood routine， urine routine， liver function， kidney function， and coagulation） and vital signs were compared before treatment （baseline） and after treatment of 12 and 24 weeks， respectively. There was no statistical significance in the main indicators before and after treatment. In the double-blinded trial， there was no significant difference in safety indicators between different groups before and after treatment. The most frequent adverse reaction was gastrointestinal discomfort， with an incidence rate of 6.64‰. ConclusionAdverse reactions occasionally occur in patients using Tianzhi granules， and it is safe to use Tianzhi granules to treat mild-to-moderate vascular dementia clinically.
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Objective To understand the changing trend of dementia disease burden attributed to high BMI in China from 1990-2019, and to provide a basis for the development of dementia prevention and control strategies. Methods Using data from the Global Burden of Disease Study 2019(GBD2019)，the changes in disease burden were analyzed using indicators such as deaths, disability adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs) and their standardized rates. The differences between sexes and age groups were compared. Joinpoint regression model was used to analyze the trend of changes in the disease burden of dementia attributable to high BMI in China. Results From 1990 to 2019, the burden of dementia disease attributed to high BMI continued to increase, with 20,300 more deaths, 404,200 more DALYs, and more than a four-fold increase in both mortality and DALYs rates. The overall burden of disease was greater for women than for men, but the rate of increase in the burden of disease was higher for men than for women. The disease burden in the age group of 80 and over was significantly higher than in other age groups. Conclusion Attention should be paid to people with high BMI, especially for the prevention and control of dementia risk in older age groups with high BMI. Active countermeasures should be taken to control the occurrence of dementia.
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Objective To explore the relationship between haptoglobin gene polymorphism and disease se-verity and susceptibility in senile vascular dementia patients.Methods A total of 80 patients with senile vas-cular dementia admitted to the hospital from February 2018 to February 2023 were selected as the vascular de-mentia group,and 80 stroke patients with non-vascular dementia admitted to the hospital during the same pe-riod were selected as the control group.The genotype distribution and allele frequency of haptoglobin gene were measured using polymerase chain reaction with sequence-specific primers,and their relationship with the severity and susceptibility of vascular dementia patients was analyzed.Results The proportion of history of hyperlipidemia and diabetes mellitus and the levels of total cholesterol and triglyceride in vascular dementia group were higher than those in control group,the differences were statistically significant(P＜0.05).The distribution of genotypes was in Hardy-Weinberg equilibrium(P＞0.05).The frequency of haptoglobin 2-2 genotype and haptoglobin 2 allele in vascular dementia group were higher than those in control group,and the differences were statistically significant(P＜0.05).There were significant differences in the scores of mini-mental state examination and hachinski ischaemic score among patients with vascular dementia with different haptoglobin genotypes(P＜0.05).Multivariate Logistic regression analysis showed that the carrier of hapto-globin 2-2 genotype and the carrier of haptoglobin 2 allele were independent risk factors for vascular dementia(P＜0.05).Conclusion Haptoglobin 2-2 genotype and haptoglobin 2 allele distribution frequency are associ-ated with the occurrence of vascular dementia after stroke,and those with high frequency of haptoglobin 2-2 genotype and haptoglobin 2 allele distribution suffer a severe disease,which can provide reference for early i-dentification and assessment of vascular dementia.
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Objective To observe the effect of catgut implantation at acupoint(CIAA)on the learning and memory function,hippocampal microangiogenesis,and the mRNA and protein expression of angiopoietin-1(Ang-1)/vascular endothelialgrowth factor(VEGF)and its receptor TEK tyrosine kinase(TIE2)/VEGF receptor 2(VEGFR2)in rats with vascular dementia(VD).To explore the mechanism of catgut implantation at acupoint in preventing and treating VD.Methods Using a random number table,VD rats were divided into a model group,a nimodipine group,and an catgut implantation at acupoint group,and a sham operation group was set up,with 10 rats in each group.On the 7th day after surgery,the treatment groups were given catgut implantation at acupoint and nimodipine gastric lavage for 21 days.After treatment,Morris water maze behavioral test was performed.HE staining was used to observe hippocampal CA1 tissue.CD34 immunohistochemical staining was used to detect hippocampal microvascular density(MVD).Real-time PCR and Western blotting were used to detect the mRNA and protein expression of Ang-1/VEGF and its receptor TIE2/VEGFR2 in the hippocampus.Results Compared with the model group,the average escape latency of the other groups was significantly shortened,and the target quadrant residence time was significantly prolonged(P<0.01,P<0.05).Compared with the model group,the number of nucleolus and well-formed pyramidal cells in hippocampal CA1 area of the catgut implantation at acupoint group and the nimodipine group increased in varying degrees,and they were arranged more closely,with only a few cells scattered and swollen.In the sham surgery group,a few CD34 positive cells were scattered.The treatment groups had more closely distributed CD34 positive cells with significant staining compared to the model group.The MVD of the model group was significantly higher than that of the sham surgery group(P<0.01).Both nimodipine group and catgut implantation at acupoint group had higher MVD than the model group(P<0.05,P<0.01).Compared with the sham surgery group,the mRNA and protein expression of Ang-1/VEGF and its receptor TIE2/VEGFR2 in the model group increased significantly(P<0.01,P<0.05).Compared with the model group,both nimodipine group and catgut implantation at acupoint group had higher mRNA and protein expression of Ang-1/VEGF and its receptor TIE2/VEGFR2(P<0.01,P<0.05).Conclusion Catgut implantation at acupoint can improve the learning and memory abilities in VD rats,promote hippocampal microvascular angiogenesis,which may be related to the up-regulation of Ang-1/VEGF and its receptor TIE2/VEGFR2 mRNA and protein expression.
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BACKGROUND:The number of hip fracture patients with dementia is increasing with an aging population,posing challenges for surgical treatment. OBJECTIVE:To determine the effect of dementia on postoperative complications in older patients with hip fractures. METHODS:Patients aged over 60 years old with hip fractures from 2000 to 2019 at Chinese PLA General Hospital were included.Dementia patients with a preexisting diagnosis of dementia at admission were identified.Each dementia patient was matched,for age±5 years,gender,and fracture type with 10 non-dementia patients.The differences in postoperative complications were compared between the two groups,including pneumonia,respiratory failure,gastrointestinal bleeding,urinary tract infection,surgical site infection,deep venous thrombosis,pulmonary embolism,angina pectoris,arrhythmia,heart failure,myocardial infarction,stroke,and death.The impact of dementia on major complications was evaluated using multivariate conditional logistic regression. RESULTS AND CONCLUSION:A total of 2 887 patients were included,of whom 125(4.3%)were dementia patients and matched with 1 243 non-dementia patients.The average age of dementia patients was(80.6±7.4)years;64.8%were female;53.6%were intertrochanteric fractures,and 46.4%were femoral neck fractures.Major complications occurred in 25(20.0%)patients with dementia and 123(9.9%)patients without dementia(P<0.01).The risk of major complications was 200.0 per 1 000 persons(95%CI,139.3-278.6)in dementia patients and 99.0 per 1 000 persons(95%CI,83.6-116.9)in non-dementia patients.Multivariate conditional logistic regression showed that a 2-fold risk of major postoperative complications after hip fracture surgery was found in dementia patients than in those without dementia(adjusted OR,2.11;95%CI,1.08-4.10).The results show that dementia is an independent risk factor for postoperative complications in elderly patients with hip fractures.Appropriate preoperative risk assessment and corresponding preventive and therapeutic measures should be given to this vulnerable population to mitigate postoperative complications.
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Objective To investigate the impact of nursing interventions based on Kales conceptual model on agitated behaviours of dementia patients.Methods A total of 80 dementia patients were randomly divided into two groups using a random number table.Patients in the control group(n=40)received routine care,while those in the observation group(n=40)received the nursing interventions based on Kales concept model on top of the routine care.The agitated behaviours and quality of life of the two groups were compared before,2 weeks and 4 weeks after the intervention.Results The repeated measures ANOVA showed statistically significant differences in three time points in terms of the time effect,inter-group effect and interactive effects on the scores of agitations and quality of life(all P<0.05).After the intervention,the score of agitations in the observation group was significantly lower than that of the control group(P<0.05),and the score of quality of life in the observation group was significantly higher than that in the control group(P<0.05).Conclusion The nursing interventions based on Kales conceptual model is effective in reducing agitations of dementia patients and improving the quality of life.
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Objective To explore the research status and hot highlights in the field of Alzheimer's disease nursing,and provide reference and direction for future research.Methods The high-level articles on Alzheimer's disease nursing during 2012 to 2022 were collected from Web of Science core database,were analyzed and visualized by the CiteSpace 5.8.R3C software.Re-sults 956 articles were included in the Web of Science core database.The demand and focus on AD nursing research increased year by year.United States America had the largest number of articles(175 articles),followed by France(43 articles)and Chi-na(31 articles).Minnesota University and Harvard Medical School had the largest number of articles(11 articles).The authors'analysis shows that BRUNO VELLAS,an academician of the French Academy of Sciences,had the largest number of articles.Keyword co-occurrence analysis shows that the research in the past decade mainly focuses on"nursing home","people"and"quality of life","long-term care"and"exercise therapy"may become the key research directions in the future.Conclusion Domestic scholars should improve the social security system of long-term care,promote"people-oriented"humanistic nursing services and develop appropriate sports training programs in the future.
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Objective To analyze the status and development direction of acupuncture treatment for vascular dementia from 2003 to 2023;To provide reference for related research.Methods Relevant literature on acupuncture treatment for vascular dementia was retrieved from CNKI,Wanfang Data,and VIP from January 2003 to September 2023.NoteExpress 3.7.0 and CiteSpace 5.7.R5 software were used to analyze keywords,authors,research institutions,and visualize knowledge maps.Results A total of 934 articles were included in the analysis,showing a slow fluctuating upward trend in publication volume.The study involved 653 authors,with prolific contributors such as Lai Xinsheng,Liu Zhibin,and Niu Wenmin.It included 449 research institutions,with prominent contributors being the First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Heilongjiang University of Chinese Medicine,and Guangzhou University of Chinese Medicine.Additionally,635 keywords were identified,forming 23 clusters.High-frequency keywords included"cognitive function","rats",and"hippocampus".Conclusion The protection and repair of nerves by acupuncture,the improvement of cognitive function,the comprehensive treatment mode,and the prevention of vascular dementia may be the research hotspots and trends in this field.
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Objective To construct a domain knowledge graph of dementia care,so as to provide the foundation and guarantee for the next intelligent application based on the knowledge graph.Methods A top-down approach was adopted to construct a domain knowledge graph of dementia care.Firstly,the ontology concept is constructed from the top level,namely the schema layer of knowledge graph.Then,instances are filled,and knowledge extraction is carried out from the existing data sources,and the extracted entities and relationships are filled into the pattern layer ontology database to complete the data layer construction of the knowledge graph.Finally,the"entity relationship entity"triplet data was input into the Neo4j graph database for storage.Results In this study,the personalized care plan set of 1 012 dementia cases was used as the corpus to construct a domain knowledge graph of dementia care.The knowledge graph takes people with dementia as the core,and unfolds,one by one,around basic characteristics,care problems,and care plans in a standardized"entity-relationship-entity"triplet format,forming a large knowledge network,which contains a total of 1 522 specific dementia care knowledge entities and 8 kinds of inter-entity relationships.Conclusion The domain knowledge graph of dementia care constructed in this study clearly and intuitively shows the global pedigree and logical path of knowledge,which provides an efficient and intelligent basic guarantee for the browsing,retrieval and application of dementia care knowledge,so as to realize personalized and intelligent management of people with dementia,break through the bottleneck of lack of professionals,improve the health outcomes of people with dementia,promote the implementation of inclusive pension services,and promote healthy aging.