RESUMEN
Sometimes there is doubt as to whether or not anticoagulants should be initiated, and if so which ones, in patients with atrial fibrillation and advanced age, increased frailty, or fall risk, kidney, or liver impairment, alcohol abuse, uncontrolled hypertension, or a history of major bleeding. These subgroups have increased risk of haemorrhage as well as thromboembolism. Treatment with anticoagulants is indicated in the vital elderly, preferably with direct oral anticoagulants as demonstrated by robust data. The available study results for the other subgroups may not be (fully) generalisable to clinical practice. In such patients, a comprehensive risk assessment is therefore advised; as is discussing the pros and cons of (not) using anticoagulants and of both type of anticoagulants. Only in exceptional cases is it justified not to use anticoagulants.
Asunto(s)
Anticoagulantes/uso terapéutico , Contraindicaciones de los Medicamentos , Hemorragia/etiología , Guías de Práctica Clínica como Asunto , Accidente Cerebrovascular/tratamiento farmacológico , Tromboembolia/etiología , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Alcoholismo/complicaciones , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Contraindicaciones , Femenino , Fragilidad/complicaciones , Hemorragia/inducido químicamente , Humanos , Hipertensión/complicaciones , Enfermedades Renales/complicaciones , Hepatopatías/complicaciones , Masculino , Anamnesis , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Tromboembolia/inducido químicamenteRESUMEN
BACKGROUND: Neurofilament (NF) proteins are major cytoskeletal constituents of neurons. Increased CSF NF levels may reflect neuronal degeneration. OBJECTIVE: To investigate the diagnostic value of CSF NF analysis to discriminate in relatively young dementia patients between frontotemporal lobe degeneration (FTLD) and early onset Alzheimer's disease (EAD; onset < or = 65 years of age), and in elderly dementia patients between dementia with Lewy bodies (DLB) and late onset AD (LAD; onset > 65 years of age). METHODS: In CSF of 28 FTLD, 37 EAD, 18 DLB and 33 LAD patients, and 26 control subjects, we analysed NF light chain (NFL), phosphorylated NF heavy chain (pNFH), amyloid beta42 protein (Abeta42), total tau and tau phosphorylated at threonine 181 (p-tau181). RESULTS: CSF NFL levels were higher in FTLD patients compared with EAD patients (p<0.001), and diagnostic accuracy of p-tau181 and Abeta42 analysis improved with addition of NFL analysis (sensitivity 86%, specificity 100%). CSF pNFH levels were elevated in DLB, LAD and FTLD compared with controls (p<0.05) but no significant differences were found between the dementia groups. CONCLUSIONS: In the diagnostic workup of relatively young dementia patients, CSF NFL levels may play a role in the discrimination between FTLD and EAD, especially in combination with Abeta42 and p-tau181 analysis.
Asunto(s)
Enfermedad de Alzheimer/líquido cefalorraquídeo , Demencia/líquido cefalorraquídeo , Enfermedad por Cuerpos de Lewy/líquido cefalorraquídeo , Proteínas de Neurofilamentos/líquido cefalorraquídeo , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Péptidos beta-Amiloides/líquido cefalorraquídeo , Estudios de Casos y Controles , Demencia/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Enfermedad por Cuerpos de Lewy/diagnóstico , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Proteínas tau/líquido cefalorraquídeoRESUMEN
Near infrared spectroscopy (NIRS) is a non-invasive method to monitor cerebral haemodynamics. Used either alone or in combination with other non-invasive methods such as transcranial Doppler sonography, this technique is well suited for use in cerebrovascular research in ageing. Reproducibility of NIRS, however, has only been determined in neonates and adults. We applied controlled desaturation (the O(2)-method) to measure the cerebral blood volume (CBV) with NIRS in 16 healthy subjects aged 65 to 88. This method uses deoxygenated haemoglobin (the concentration of which is manipulated by desaturation) as an intravascular tracer for NIRS. We determined repeatability (between tests interval: 2 min), short-term reproducibility (intervals of 20 and 40 min) and long-term reproducibility (interval > 2 weeks). We found a coefficient of variation (CV) of 12.5% for repeatability and a CV of 11.7% for short-term reproducibility. The CV for long-term reproducibility was 15%. We conclude that NIRS can reproducibly measure CBV in subjects aged 65 and older, using the O(2)-method. In this group of healthy subjects, this method was well tolerated.
Asunto(s)
Determinación del Volumen Sanguíneo/métodos , Volumen Sanguíneo/fisiología , Encéfalo/irrigación sanguínea , Encéfalo/fisiología , Oxihemoglobinas/análisis , Espectrofotometría Infrarroja/métodos , Anciano , Anciano de 80 o más Años , Circulación Cerebrovascular/fisiología , Femenino , Evaluación Geriátrica/métodos , Humanos , Masculino , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
In this article different aspects of chronic heart failure in old age are described. We mainly focus on the place of beta-blocker therapy in chronic heart failure. Beta-blockers are recommended for the treatment of stable chronic heart failure with left ventricular systolic dysfunction. There is additional information from recent studies that there is proven efficacy for beta-blocker therapy in patients with heart failure up to the age of 80 years. For patients with heart failure aged 80 and over the evidence to prescribe beta-blockers is limited. However, it is known that also in very elderly patients beta-blocker therapy is well tolerated. In patients with heart failure with preserved systolic ventricular function there is still no evidence that there is a beneficial effect of beta-blockers. It is still not clear if there are differences between beta-blocking agents. Of all beta-blockers, only bisoprolol, carvedilol, nebivolol and metoprolol CR are proven effective in stable chronic heart failure with impaired left ventricular systolic function and can be recommended in elderly patients on standard treatment with diuretics and ACE inhibition.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Antagonistas Adrenérgicos beta/efectos adversos , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Femenino , Humanos , Masculino , Resultado del Tratamiento , Disfunción Ventricular Izquierda/tratamiento farmacológicoRESUMEN
In a study on non-invasive assessment of pulmonary capillary wedge pressure (PCWP), we sought a method to increase PCWP non-invasively. We hypothesized that inflation of an anti-G garment was suitable to increase PCWP non-invasively in healthy elderly subjects. In 20 subjects, aged 70 +/- 4 years (mean +/- SD), before, immediately after, and 4 min after anti-G garment inflation to 52 mmHg, PCWP and mean pulmonary artery pressure (MPAP) were measured with a Swan-Ganz catheter, and mean arterial blood pressure (MAP) with Finapres, in supine and semi-recumbent position. Supine, PCWP (mmHg, mean +/- SD) increased from 9.9 +/- 2.1 to 15.5 +/- 3.9** immediately after inflation and 13.4 +/- 3.7** at 4 min; semi-recumbent from 8.9 +/- 2.0 to 17.5 +/- 3.3** and 14.7 +/- 2.9** (*P<0.05, **P< 0.001 versus before inflation). MPAP (mmHg) increased after inflation: supine 16.9 +/- 2.3 to 22.3 +/- 4.6** and 20.6 +/- 3.9** and semi-recumbent 15.7 +/- 2.8 to 24.3 +/- 5.1** and 22.5 +/- 3.5**, suggesting that increased preload was the primary effect of anti-G garment inflation. Supine MAP (mmHg) increased from 96.0 +/- 11.3 to 101.4 +/- 13.4** and 100.5 +/- 12.7* and semi-recumbent from 102.0 +/- 8.9 to 108.3 +/- 11.4** and 106.0 +/- 11.3*, suggesting an effect of increased afterload as well. The latter was supported by an increase in total peripheral resistance (d s cm(-5)) from 1346 +/- 299 to 1441 +/- 384 after 4 min (P = 0.057) and from 1461 +/- 341 to 1532 +/- 406 (P = 0.054), supine and semi-recumbent respectively, while cardiac output remained unchanged. Complications did not occur. We conclude that in healthy elderly subjects, anti-G garment inflation is a safe, non-invasive, method to induce a significant increase in PCWP. Our findings justify its application in future studies in which non-invasive temporary increase in PCWP is required.
Asunto(s)
Trajes Gravitatorios , Presión Esfenoidal Pulmonar/fisiología , Anciano , Análisis de Varianza , Presión Sanguínea/fisiología , Gasto Cardíaco/fisiología , Femenino , Humanos , Masculino , Postura/fisiología , Presión , Valores de Referencia , Factores de Tiempo , Resistencia Vascular/fisiologíaRESUMEN
Ever since inflammatory mediators were detected in and around amyloid plaques in the brain of patients with Alzheimer's disease, there has been great interest in the inflammatory hypothesis and the possibility of treating Alzheimer's disease with anti-inflammatory drugs. Various epidemiological studies have now demonstrated that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is indeed associated with a reduced risk of developing Alzheimer's disease. The effect of NSAIDs in Alzheimer's disease is probably mediated by activation of the peroxisome proliferator-activated receptor-gamma. Administration of NSAIDs in a mouse model of Alzheimer's disease appears to suppress amyloid plaque formation and inflammatory mediators. These findings suggest that NSAIDs may also be able to slow down Alzheimer's disease progression. So far, only one small clinical trial has shown that treatment with NSAIDs significantly delayed cognitive decline in Alzheimer's disease patients. Large randomized double-blind placebo-controlled trials are needed to provide definitive evidence that NSAIDs have a therapeutic effect on Alzheimer's disease.