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OBJECTIVE: A high office blood pressure (BP) is associated with cognitive decline. However, evidence of 24-h ambulatory BP monitoring is limited, and no studies have investigated whether longitudinal changes in 24-h BP are associated with cognitive decline. We aimed to test whether higher longitudinal changes in 24-h ambulatory BP measurements are associated with cognitive decline. METHODS: We included 437 dementia-free participants from the Maracaibo Aging Study with prospective data on 24-h ambulatory BP monitoring and cognitive function, which was assessed using the selective reminding test (SRT) and the Mini-Mental State Examination (MMSE). Using multivariate linear mixed regression models, we analyzed the association between longitudinal changes in measures of 24-h ambulatory BP levels and variability with cognitive decline. RESULTS: Over a median follow-up of 4 years (interquartile range, 2-5 years), longitudinal changes in 24-h BP level were not associated with cognitive function (Pâ≥â0.09). Higher longitudinal changes in 24-h and daytime BP variability were related to a decline in SRT-delayed recall score; the adjusted scores lowered from -0.10 points [95% confidence interval (CI), -0.16 to -0.04) to -0.07 points (95% CI, -0.13 to -0.02). We observed that a higher nighttime BP variability during follow-up was associated with a decline in the MMSE score (adjusted score lowered from -0.08 to -0.06 points). CONCLUSION: Higher 24-h BP variability, but not BP level, was associated with cognitive decline. Prior to or in the early stages of cognitive decline, 24-h ambulatory BP monitoring might guide strategies to reduce the risk of major dementia-related disorders including Alzheimer's disease.
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Background: Twenty-four-hour and nighttime blood pressure (BP) levels are more strongly associated with cardiovascular risk than office or daytime BP measurements. However, it remains undocumented which of the office and ambulatory BP measurements have the strongest association and predictive information in relation to the presence of type I, or arteriolosclerosis type, cerebral small vessel diseases (CSVD). Methods: A subset of 429 participants from the Maracaibo Aging Study [aged ≥40 years (women, 73.7%; mean age, 59.3 years)] underwent baseline brain magnetic resonance imaging (MRI) to visualize CSVD, which included log-transformed white matter hyperintensities (log-WMH) volume and the presence (yes/no) of lacunes, cerebral microbleeds (CMB), or enlarged perivascular spaces (EPVS). Linear and logistic regression models were applied to examine the association between CSVD and each +10-mmHg increment in the office and ambulatory systolic BP measurements. Improvement in the fit of nested logistic models was assessed by the log-likelihood ratio and the generalized R 2 statistic. Results: Office and ambulatory systolic BP measurements were related to log-WMH (ß-correlation coefficients ≥0.08; P < 0.001). Lacunes and CMB were only associated with ambulatory systolic BP measurements (odds ratios [OR] ranged from 1.31 [95% confidence interval, 1.10-1.55] to 1.46 [1.17-1.84], P ≤ 0.003). Accounted for daytime systolic BP, both the 24-h (ß-correlation, 0.170) and nighttime (ß-correlation, 0.038) systolic BP measurements remained related to log-WMH. When accounted for 24-h or daytime systolic BP levels, the nighttime systolic BP retained the significant association with lacunes (ORs, 1.05-1.06; 95% CIs, ≥1.01 to ≤ 1.13), whereas the 24-h and daytime systolic BP levels were not associated with lacunes after adjustments for nighttime systolic BP (ORs, ≤ 0.88; 95% CI, ≥0.77 to ≤ 1.14). On top of covariables and office systolic BP, ambulatory systolic BP measurements significantly improved model performance (1.05% ≥ R 2 ≤ 3.82%). Compared to 24-h and daytime systolic BP, nighttime systolic BP had the strongest improvement in the model performance; for WMH (1.46 vs. 1.05%) and lacunes (3.06 vs. ≤ 2.05%). Conclusions: Twenty-four-hour and nighttime systolic BP were the more robust BP measurements associated with CSVD, but the nighttime systolic BP level had the strongest association. Controlling ambulatory BP levels might provide additional improvement in the prevention of CSVD.
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BACKGROUND: Neuropsychiatric symptoms play an important role in diagnosing and clinical follow-up of cognitive impairment and dementia. OBJECTIVE: We investigated the relationship between neuropsychiatric symptoms, cognitive impairment, and dementia in Hispanics. METHODS: We included 529 participants (age ≥40 years) from the Maracaibo Aging Study with standardized neuropsychiatric assessments, including the Neuropsychiatric Inventory (NPI). Based on the Clinical Dementia Rating and the Mini-Mental State Examination scores, participants' cognitive status was categorized into normal cognition, mild/moderate, and severe cognitive impairment. Diagnosis of dementia was established in a consensus conference. Statistical analyses included multivariable logistic regression models and area under the curve (AUC). RESULTS: The mean age of participants was 59.3 years, and 71.8%were women. The proportion of dementia was 6.8%. Disturbed sleep, anxiety, and depression were the most common neuropsychiatric symptoms in the study sample. In crude analyses, the proportions of hallucinations, aberrant motor behavior, agitation/aggression, apathy, delusions, irritability, eating disturbance, depression, and euphoria were differently distributed among cognitive status groups (pâ<â0.05). After accounting for confounders, aberrant motor behavior and agitation/aggression remained significantly associated with cognitive impairment and dementia (pâ<â0.05). The inclusion of the NPI domains significantly improved the AUC to discriminate severe cognitive impairment and dementia compared to a basic model that included sex, age, education, alcohol, obesity, serum glucose, total cholesterol, hypertension, and stroke. CONCLUSION: Neuropsychiatric symptoms are associated with severe cognitive impairment and dementia. The addition of NPI items to the global cognitive assessment might help early detection of dementia in primary care settings.
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Envejecimiento/psicología , Hispánicos o Latinos/psicología , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Escalas de Valoración Psiquiátrica , Adulto , Anciano , Envejecimiento/patología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Estudios Transversales , Demencia/diagnóstico , Demencia/epidemiología , Demencia/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Trastornos Mentales/diagnóstico , Persona de Mediana Edad , Estudios Prospectivos , Venezuela/epidemiologíaRESUMEN
BACKGROUND: Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-É4 and blood pressure (BP) levels, remains uncertain among Hispanics. OBJECTIVE: To investigate the association of APOE-É4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics. METHODS: 1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test. RESULTS: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-É4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-É4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-É4. CONCLUSION: In this Hispanic population, both APOE-É4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.
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Enfermedad de Alzheimer/genética , Apolipoproteína E4/genética , Presión Sanguínea/genética , Ritmo Circadiano/genética , Demencia/genética , Genotipo , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/etnología , Demencia/diagnóstico , Demencia/etnología , Femenino , Humanos , Incidencia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores de Riesgo , Venezuela/etnologíaRESUMEN
INTRODUCTION: There are few longitudinal studies of dementia in developing countries. We used longitudinal data from the Maracaibo Aging Study to accurately determine the age- and sex-specific incidence of dementia in elderly Latin Americans. METHODS: The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) was used to diagnose dementia, which was classified as Alzheimer's disease, vascular dementia, or other. Age- and sex-specific incidence was estimated as the number of new cases of dementia divided by person-years (p-y) of follow-up. RESULTS: The incidence of all dementia diagnoses was 9.10 per 1000 p-y (95% confidence interval [CI] 7.13-11.44; 8026 total p-y), 5.18 for Alzheimer's disease (95% CI 3.72-7.03; 7916 total p-y), and 3.35 for vascular dementia (95% CI 2.19-4.91; 7757 total p-y). DISCUSSION: Among Maracaibo Aging Study participants younger than 65 years, the incidence of dementia was higher than that of US Whites. Among individuals older than 65 years, the incidence was comparable to the mean of previous incidence estimates for other populations worldwide.
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Envejecimiento , Demencia/epidemiología , Evaluación Geriátrica , Factores de Edad , Anciano , Anciano de 80 o más Años , Apolipoproteína E4/genética , Planificación en Salud Comunitaria , Demencia/diagnóstico , Demencia/genética , Femenino , Humanos , Incidencia , América Latina/epidemiología , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pruebas NeuropsicológicasRESUMEN
Latin America and the Caribbean (LAC) have limited facilities and professionals trained to diagnose, treat, and support people with dementia and other forms of cognitive impairment. The situation for people with dementia is poor, and worsening as the proportion of elderly in the general population is rapidly expanding. We reviewed existing initiatives and provided examples of actions taken to build capacity and improve the effectiveness of individuals, organizations, and national systems that provide treatment and support for people with dementia and their caregivers. Regional barriers to capacity building and the importance of public engagement are highlighted. Existing programs need to disseminate their objectives, accomplishments, limitations, and overall lessons learned in order to gain greater recognition of the need for capacity-building programs.
América Latina e Caribe (ALC) têm instalações e profissionais treinados para diagnosticar, tratar e apoiar as pessoas com demência e outras formas de comprometimento cognitivo limitado. A situação para as pessoas com demência é pobre, e piora quando a proporção de idosos na população em geral está se expandindo rapidamente. Revisamos as iniciativas já existentes, com exemplos de medidas tomadas para fortalecer a capacidade e melhorar a eficácia dos indivíduos, organizações e sistemas nacionais que fornecem tratamento e apoio às pessoas com demência e seus cuidadores. As barreiras regionais ao reforço das capacidades e a importância do engajamento público são realçados. Os programas existentes precisam divulgar seus objetivos, realizações, limitações e lições globais aprendidas a fim de obter maior reconhecimento da necessidade de programas de capacitação.
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Humanos , Planes y Programas de Salud , Demencia , Enfermedad de Alzheimer , Asistencia MédicaRESUMEN
Latin America and the Caribbean (LAC) have limited facilities and professionals trained to diagnose, treat, and support people with dementia and other forms of cognitive impairment. The situation for people with dementia is poor, and worsening as the proportion of elderly in the general population is rapidly expanding. We reviewed existing initiatives and provided examples of actions taken to build capacity and improve the effectiveness of individuals, organizations, and national systems that provide treatment and support for people with dementia and their caregivers. Regional barriers to capacity building and the importance of public engagement are highlighted. Existing programs need to disseminate their objectives, accomplishments, limitations, and overall lessons learned in order to gain greater recognition of the need for capacity-building programs.
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BACKGROUND: Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. METHODS AND FINDINGS: The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. CONCLUSIONS: Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development.
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Mortalidad , Factores Socioeconómicos , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte , China/epidemiología , Enfermedad Crónica/epidemiología , Enfermedad Crónica/mortalidad , Estudios de Cohortes , Países en Desarrollo , Femenino , Humanos , India/epidemiología , América Latina/epidemiología , Estudios Longitudinales , Masculino , Modelos de Riesgos Proporcionales , Población Rural , Factores Sexuales , Población UrbanaRESUMEN
BACKGROUND: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. There is a limited literature linking short legs and small skulls to an increased risk for cognitive impairment and dementia in late life. METHODS: One phase cross-sectional surveys were carried out of all residents aged over 65 years in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru (n = 14,960). The cross-culturally validated 10/66 dementia diagnosis, and a sociodemographic and risk factor questionnaire were administered to all participants, and anthropometric measures taken. Poisson regression was used to calculate prevalence ratios for the effect of leg length and skull circumference upon 10/66 dementia, controlling for age, gender, education and family history of dementia. RESULTS: The pooled meta-analyzed fixed effect for leg length (highest vs. lowest quarter) was 0.82 (95% CI, 0.68-0.98) and for skull circumference 0.75 (95% CI, 0.63-0.89). While point estimates varied between sites, the proportion of the variability attributable to heterogeneity between studies as opposed to sampling error (I2) was 0% for leg length and 22% for skull circumference. The effects were independent and not mediated by family history of dementia. The effect of skull circumference was not modified by educational level or gender, and the effect of leg length was not modified by gender. CONCLUSIONS: Since leg length and skull circumference are said to remain stable throughout adulthood into old age, reverse causality is an unlikely explanation for the findings. Early life nutritional programming, as well as neurodevelopment may protect against neurodegeneration.
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Demencia/patología , Pierna/anatomía & histología , Cráneo/anatomía & histología , Anciano , Anciano de 80 o más Años , Antropometría , China/epidemiología , Estudios Transversales , Cuba/epidemiología , Demencia/diagnóstico , Demencia/epidemiología , Países en Desarrollo/estadística & datos numéricos , República Dominicana/epidemiología , Femenino , Humanos , India/epidemiología , Masculino , México/epidemiología , Estado Nutricional , Perú/epidemiología , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Venezuela/epidemiologíaRESUMEN
BACKGROUND: The proportion of the global population aged 60 and over is increasing, more so in Latin America than any other region. Depression is common among elderly people and an important cause of disability worldwide. AIMS: To estimate the prevalence and correlates of late-life depression, associated disability and access to treatment in five locations in Latin America. METHOD: A one-phase cross-sectional survey of 5886 people aged 65 and over from urban and rural locations in Peru and Mexico and an urban site in Venezuela. Depression was identified according to DSM-IV and ICD-10 criteria, Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm and EURO-D cut-off point. Poisson regression was used to estimate the independent associations of sociodemographic characteristics, economic circumstances and health status with ICD-10 depression. RESULTS: For DSM-IV major depression overall prevalence varied between 1.3% and 2.8% by site, for ICD-10 depressive episode between 4.5% and 5.1%, for GMS-AGECAT depression between 30.0% and 35.9% and for EURO-D depression between 26.1% and 31.2%; therefore, there was a considerable prevalence of clinically significant depression beyond that identified by ICD-10 and DSM-IV diagnostic criteria. Most older people with depression had never received treatment. Limiting physical impairments and a past history of depression were the two most consistent correlates of the ICD-10 depressive episode. CONCLUSIONS: The treatment gap poses a significant challenge for Latin American health systems, with their relatively weak primary care services and reliance on private specialists; local treatment trials could establish the cost-effectiveness of mental health investment in the government sector.
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Trastorno Depresivo/epidemiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/economía , Femenino , Estado de Salud , Humanos , Clasificación Internacional de Enfermedades , Masculino , México/epidemiología , Perú/epidemiología , Prevalencia , Escalas de Valoración Psiquiátrica , Salud Rural , Factores Socioeconómicos , Salud Urbana , Venezuela/epidemiologíaRESUMEN
BACKGROUND: 1) To report site-specific normative values by age, sex and educational level for four components of the 10/66 Dementia Research Group cognitive test battery; 2) to estimate the main and interactive effects of age, sex, and educational level by site; and 3) to investigate the effect of site by region and by rural or urban location. METHODS: Population-based cross-sectional one phase catchment area surveys were conducted in Cuba, Dominican Republic, Venezuela, Peru, Mexico, China and India. The protocol included the administration of the Community Screening Instrument for Dementia (CSI 'D', generating the COGSCORE measure of global function), and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) verbal fluency (VF), word list memory (WLM, immediate recall) and recall (WLR, delayed recall) tests. Only those free of dementia were included in the analysis. RESULTS: Older people, and those with less education performed worse on all four tests. The effect of sex was much smaller and less consistent. There was a considerable effect of site after accounting for compositional differences in age, education and sex. Much of this was accounted for by the effect of region with Chinese participants performing better, and Indian participants worse, than those from Latin America. The effect of region was more prominent for VF and WLM than for COGSCORE and WLR. CONCLUSION: Cognitive assessment is a basic element for dementia diagnosis. Age- and education-specific norms are required for this purpose, while the effect of gender can probably be ignored. The basis of cultural effects is poorly understood, but our findings serve to emphasise that normative data may not be safely generalised from one population to another with quite different characteristics. The minimal effects of region on COGSCORE and WLR are reassuring with respect to the cross-cultural validity of the 10/66 dementia diagnosis, which uses only these elements of the 10/66 battery.
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Demencia/epidemiología , Pruebas Neuropsicológicas/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Comparación Transcultural , Estudios Transversales , Escolaridad , Humanos , India/epidemiología , América Latina/epidemiología , Masculino , Valores de Referencia , Factores SexualesRESUMEN
La enfermedad de alzheimer (EA) es un desorden neurodegenerativo y la isoforma 4 de apolipoproteína E (ApoE) es mundialmente aceptada como un factor de riesgo para el desarrollo de alzheimer esporádico. La EA se ha asociado con infecciones por Chlamydophila pneumoniae (ChP) debido a que inhibe la respuesta inmune del huésped generando infecciones crónicas. El objetivo fue detectar el ADN de ChP en líquido cefalorraquídeo (LCR) de pacientes con diagnóstico clínico de alzheimer provenientes de distrito metropolitano de caracas. Se analizaron (7) muestras de LCR de pacientes con diagnóstico clínico de EA y el grupo control estuvo constituido por (13) muestras de LCR de pacientes con otras enfermedades neurológicas (OND) no demencia. A los cuales se les determino la isoforma de ApoE, se amplificaron los genes para OmcA y 16Sribosomal de ChP. La frecuencia de apoE isoforma 4 en los pacientes con EA fue (0,57) en contrste con el grupo control donde la frecuencia fue de (0,31). En todas las mustras analizadas se obtuvo una ausencia de la banda correspondiente a Chlamydophila pneumoniae. La mayor probabilidad es que la bacteria no se encontrara en el LCR de los pacientes. Pero existe la posibilidad de que ADN de ChP no estuviese en suficiente cantidad como para ser detectado por las técnicas empleadas. Además, debemos considerar que el protocolo de extracción es un punto crítico. Finalmente, los pacientes con diagnóstico clínico de EA y en particular del género femenino tienen mayor frecuencia de tener una copia de ApoE isoforma 4 en su genotipo.
Alzheimer's disease (AD) is a neurodegenerative disorder and the isoform 4 of apoliporotein E (ApoE) is world accepted as a risk factor for developing sporadic alzheimer. The AD has been associated with infections by Chlamydophila pneumoniae (ChP) because it inhibits the host immune response causing chroic infections. To detected ChP DNA in cerebrospinal fluid (CSF) of patients with clinical diagnosis lf alzheimer's from the metropolitan district of caracas. We analyzed (7) CSF samples from patients with clinical diagnsis of AD and control groups consisted of (13) CSF samples from patientes with other neurological diseases (OND) no dementia. To with the determined the isoform of ApoE genes were amplified for OmcA and 16Sribosomal of ChP. The frecuency of ApoE isoform 4 in AD patients was (0.57) in contrast to the control group where the frequency was (0.31). All samples were obtained an absence of the band corresponding to Chlamydophila pneumoniae. The greater likelihood is that the bacteria is not found in the CSF of patients. But there is the possibility that DNA was no ChP insufficient quantity to be detected by the techniques employed. Furthermore, we most consider the extraction protocol is a critical point. Finally, patients with clinical diagnosis of Ad and in particular the female are more often have a copy of ApoE isoform 4 in its genotype.
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Humanos , Masculino , Adulto , Femenino , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/sangre , Enfermedades Neurodegenerativas/complicaciones , Enfermedades Neurodegenerativas/sangre , Isoformas de Proteínas/química , Isoformas de Proteínas/sangre , Análisis Químico de la Sangre , Disfunción Cognitiva , HematologíaRESUMEN
Studies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis...(AU)
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Humanos , Anciano , Demencia/diagnóstico , Demencia/epidemiología , AncianoRESUMEN
BACKGROUND: Studies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis. METHODS: We undertook one-phase cross-sectional surveys of all residents aged 65 years and older (n=14 960) in 11 sites in seven low-income and middle-income countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Dementia diagnosis was made according to the culturally and educationally sensitive 10/66 dementia diagnostic algorithm, which had been prevalidated in 25 Latin American, Asian, and African centres; and by computerised application of the dementia criterion from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). We also compared prevalence of DSM-IV dementia in each of the study sites with that from estimates in European studies. FINDINGS: The prevalence of DSM-IV dementia varied widely, from 0.3% (95% CI 0.1-0.5) in rural India to 6.3% (5.0-7.7) in Cuba. After standardisation for age and sex, DSM-IV prevalence in urban Latin American sites was four-fifths of that in Europe (standardised morbidity ratio 80 [95% CI 70-91]), but in China the prevalence was only half (56 [32-91] in rural China), and in India and rural Latin America a quarter or less of the European prevalence (18 [5-34] in rural India). 10/66 dementia prevalence was higher than that of DSM-IV dementia, and more consistent across sites, varying between 5.6% (95% CI 4.2-7.0) in rural China and 11.7% (10.3-13.1) in the Dominican Republic. The validity of the 847 of 1345 cases of 10/66 dementia not confirmed by DSM-IV was supported by high levels of associated disability (mean WHO Disability Assessment Schedule II score 33.7 [SD 28.6]). INTERPRETATION: As compared with the 10/66 dementia algorithm, the DSM-IV dementia criterion might underestimate dementia prevalence, especially in regions with low awareness of this emerging public-health problem.
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Demencia/epidemiología , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Vigilancia de la Población/métodos , Distribución por Edad , Anciano , Anciano de 80 o más Años , China/epidemiología , Estudios Transversales , Demencia/clasificación , Femenino , Humanos , India/epidemiología , América Latina/epidemiología , Masculino , Prevalencia , Índice de Severidad de la Enfermedad , Distribución por SexoAsunto(s)
Femenino , Duodenitis/patología , Gastritis/patología , Helicobacter pylori , Infecciones por Helicobacter/patología , Uremia/patología , Adolescente , Adulto , Anciano , Distribución de Chi-Cuadrado , Enfermedad Crónica , Duodenitis/epidemiología , Duodenitis/microbiología , Endoscopía Gastrointestinal , Resumen en Inglés , Gastritis/epidemiología , Gastritis/microbiología , Infecciones por Helicobacter/epidemiología , Helicobacter pylori/aislamiento & purificaciónRESUMEN
La dispepsia no ulcerosa es una entidad clinica frecuentecaracteizada por síntomas gastrointestinales crónicos altos, en ausencia de lesiones orgánicas demotrables por radiología, sonografía y endoscopia. Estudiamos simultáneamente el vaciamiento gástrico y la contracción vesicular en 10 pacientes con dispepsia no ulcerosa y en 10 controles sanos después de la ingestión, en sesiones sucesivas, de 500 cc de solución salina isotónica y de 500 cc de dieta líquida mixta hipercalórica e hiperosmótica. Los registros se realizaron mediante ultrasonografía en ayuno y cada 15 a 30 minutos después de la ingestión de la solución correspondiente, hasta finalizar el vaciamiento gástrico. Se demostró que con la comida líquida mixta, los pacientes con dispepsia no ulcerosa, presentaron retardo significativo del vaciamiento gástrico e hipoquinesia vesicular con cotracción deficiente y llenado lento. Los estudios dinamicos ultrasonográficos son útiles para valorar los pacientes con dispepsia no ulcerosa
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Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Dispepsia/fisiopatología , Vesícula Biliar/fisiopatología , Vaciamiento Gástrico/fisiología , Dispepsia , Soluciones IsotónicasRESUMEN
Estudiamos el vaciamiento gástrico de líquidos en 80 sujetos voluntarios sanos del sexo masculino (edad promedio 19.9 ñ 1.6 años) mediante ultrasonografía de tiempo real. Realizamos múltiples cortes del antro a intervalos regulares (15-30 minutos) hasta completar el vaciamiento gástrico después de la ingestión a 500 ml de 8 diferentes dietas líquidas ensayadas: salina isotónica, glucosada al 50%, glucosada al 5%, proteínas 40 g, proteínas 20 g, grasas 40 g, 20 g y mixta (carbohidratos, proteínas y grasas). Cada dieta fue administrada a 10 sujetos e identificamos 3 tipos de vaciamiento gástrico: lento (117 ñ 12 minutos) en los que recibieron las dietas mixta, glucosada al 50%, proteinas 40 y 20 g; intermedio (83 ñ 9 minutos) con la glucosada al 5%, grasas 40 y 20 g; y rapido (40 ñ 6 minutos) con la salina isotónica. La dieta mixta tuvo el vaciamiento gástrico más lento (210 ñ 6 min). Nuestros resultados concuerdan con los conocimientos actuales de la fisiología motora del estómago y demuestran la utilidad de la ultrasonografía para el estudio del vaciamiento gástrico de líquidos
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Adolescente , Adulto , Humanos , Masculino , Alimentos Formulados , Vaciamiento Gástrico/fisiología , Tránsito Gastrointestinal/fisiología , Ultrasonografía , Grasas de la Dieta/administración & dosificación , Proteínas en la Dieta/administración & dosificación , Solución Hipertónica de Glucosa/administración & dosificación , Probabilidad , Antro Pilórico , Antro Pilórico/fisiología , Solución Salina Hipertónica/administración & dosificaciónRESUMEN
Presentamos el caso de un paciente con un timoma de aspecto histológico no agresivo que se manifestó clínicamente como una miastenia gravis. Tres años después de su extirpación quirúrgica completa dió metástasis a hígado sin evidencia de recidiva tumoral en el tórax. Las metástasis extratorácicas son poco comunes y la miastenia gravis de origen tímico se presenta entre el 25 al 50% de los casos. Revisamos la literatura disponible y analizamos sus características clínico patológicas y ensayos terapéuticos
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Persona de Mediana Edad , Masculino , Humanos , Neoplasias Hepáticas/secundario , Miastenia Gravis/etiología , Timoma/complicaciones , Neoplasias del Timo/complicaciones , Neoplasias Hepáticas , Mediastino , Timoma , Timoma/patología , Timoma/cirugía , Neoplasias del Timo , Neoplasias del Timo/patología , Neoplasias del Timo/cirugía , Tomografía Computarizada por Rayos XRESUMEN
La encefalopatía de Wernicke, se debe al déficit de tiamina, relacionándose principalmente con alcoholismo y malnutrición. Clasicamente se considera diagnóstica la triada constituída por alteraciones de conciencia, transtornos motores oculares y ataxia. Estudios recientes demuestran que el 80