Balance and Gait: Associations With Cognitive Impairment and Dementia in Individuals With Down Syndrome.

BACKGROUND: Atypical aging in Down syndrome (DS) is associated with neuropathological characteristics consistent with Alzheimer disease. Gait abnormalities have been shown to be associated with an increased risk of dementia for the general population. The aim of this study was to determine whether gait disorders are associated with worse cognitive performance and dementia in adults with DS. METHODS: We evaluated 66 individuals with DS (≥20 y of age), divided into 3 groups: stable cognition, prodromal dementia, and dementia (presumed Alzheimer disease). Each individual was evaluated with the Performance-Oriented Mobility Assessment (POMA), Timed Up and Go test, and Cambridge Examination for Mental Disorders of Older People with Down's Syndrome and Others with Intellectual Disabilities (CAMDEX-DS), in addition to a comprehensive clinical protocol to ascertain the occurrence of medical or psychiatric comorbidities. RESULTS: The score on the POMA-Gait subscale score and body mass index were found to be independent predictors of prodromal dementia and dementia ( P <0.001 for both). With the exception of perception, all cognitive domains correlated with the POMA-Total score ( P <0.05). CONCLUSION: A lower POMA-Gait score increases the chance of prodromal dementia and dementia in adults with DS. Unlike other research, in this study higher body mass index was also found to increase the chance of prodromal dementia and dementia. In those individuals, applying the POMA could facilitate the early diagnosis of dementia, help identify fall risks, and promote the adoption of geriatric interventions focused on improving functional mobility.

ARE THERE DIFFERENCES IN LAPAROSCOPIC GASTRECTOMY MORBIDITY AND MORTALITY BETWEEN YOUNG AND OLDER?

BACKGROUND: Due to the longer life expectancy and consequently an increase in the elderly population, a higher incidence of gastric cancer is expected in this population in the coming decades. AIM: To compare the results of laparoscopic GC surgical treatment between individuals aged<65 years (group I) and ≥ 65 years (group II), according to clinical, surgical, and histopathological characteristics. METHODS: A observational retrospective study was performed by analyzing medical charts of patients with gastric cancer undergoing total or subtotal laparoscopic gastrectomy for curative purposes by a single oncologic surgery team. RESULTS: Thirty-six patients were included in each group. Regarding the ASA classification, 31% of the patients in group I was ASA 1, compared to 3.1% in group II. The mean number of concomitant medications in group II was statistically superior to group I (5±4.21 x 1.42±3.08, p<0.001). Subtotal gastrectomy was the most performed procedure in both groups (69.4% and 63.9% in groups I and II, respectively) due to the high prevalence of distal tumors in both groups, 54.4% group I and 52.9% group II. According to Lauren's classification, group I presented a predominance of diffuse tumors (50%) and group II the intestinal type (61.8%). There was no difference between the two groups regarding the number of resected lymph nodes and lymph node metastases and the days of hospitalization and mortality. CONCLUSION: Laparoscopic gastrectomy showed to be a safe procedure, without a statistical difference in morbidity, mortality, and hospitalization time between both groups.

Are there differences in laparoscopic gastrectomy morbidity and mortality between young and older? / Há diferenças na morbimortalidade da gastrectomia laparoscópica entre jovens e idosos?

ABSTRACT Background: Due to the longer life expectancy and consequently an increase in the elderly population, a higher incidence of gastric cancer is expected in this population in the coming decades. Aim: To compare the results of laparoscopic GC surgical treatment between individuals aged<65 years (group I) and ≥ 65 years (group II), according to clinical, surgical, and histopathological characteristics. Methods: A observational retrospective study was performed by analyzing medical charts of patients with gastric cancer undergoing total or subtotal laparoscopic gastrectomy for curative purposes by a single oncologic surgery team. Results: Thirty-six patients were included in each group. Regarding the ASA classification, 31% of the patients in group I was ASA 1, compared to 3.1% in group II. The mean number of concomitant medications in group II was statistically superior to group I (5±4.21 x 1.42±3.08, p<0.001). Subtotal gastrectomy was the most performed procedure in both groups (69.4% and 63.9% in groups I and II, respectively) due to the high prevalence of distal tumors in both groups, 54.4% group I and 52.9% group II. According to Lauren's classification, group I presented a predominance of diffuse tumors (50%) and group II the intestinal type (61.8%). There was no difference between the two groups regarding the number of resected lymph nodes and lymph node metastases and the days of hospitalization and mortality. Conclusion: Laparoscopic gastrectomy showed to be a safe procedure, without a statistical difference in morbidity, mortality, and hospitalization time between both groups.

RESUMO Racional: Devido à maior expectativa de vida, e consequentemente aumento da população de idosos, é esperada uma maior incidência de câncer gástrico nesta população nas próximas décadas. Objetivos: Comparar os resultados do tratamento cirúrgico por via laparoscópica do câncer gástrico entre pacientes com idade <65 anos (grupo I) e ≥65 anos (grupo II), de acordo com características clínicas, cirúrgicas e histopatológicas. Métodos: Foi realizado um estudo retrospectivo, observacional baseado na análise de prontuários médicos de pacientes com câncer gástrico, submetidos à gastrectomia total ou subtotal laparoscópica com finalidade curativa, por uma única equipe de cirurgia oncológica. Resultados: Foram avaliados 36 pacientes em cada grupo. Em relação à classificação ASA, 62,1% dos pacientes do grupo I eram ASA 1 comparado a 3.1% no grupo II. O número médio de medicações concomitantes do grupo II foi superior ao grupo I (5±4,21 x 1.42±3,08, p<0.001). A gastrectomia subtotal foi o procedimento mais realizado nos dois grupos (69,4% e 63,9% nos grupos I e II respectivamente) devido a maior prevalência de tumores distais em ambos os grupos, 54.4% grupo I e 52.9% grupo II. De acordo com a classificação de Laurén, no grupo I houve predomínio de tumores difusos (50,0%) e no grupo II do tipo intestinal (61,8%). Não houve diferença entre os dois grupos em relação a quantidade de linfonodos ressecados e de linfonodos positivos para metástases, assim como o tempo de permanência no CTI, dias de hospitalização e mortalidade. Conclusão: A gastrectomia por via laparoscópica é procedimento seguro, sem haver diferenças em morbidade, mortalidade e tempo de internação entre pacientes jovens e idosos.