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1.
Nihon Ronen Igakkai Zasshi ; 56(4): 525-531, 2019.
Artículo en Japonés | MEDLINE | ID: mdl-31761859

RESUMEN

An 84-year-old woman who had diabetes mellitus and atrial fibrillation presented to our hospital with appetite loss and difficulty in standing up. Her cervical, axillary, and mediastinal lymph nodes were swollen. At first, malignant lymphoma was suspected, but positron emission tomography-computed tomography and cervical lymph node biopsy did not support this diagnosis. She was admitted to our hospital 41 days after the first consultation because of appetite loss and fever. We suspected a disorder related to Epstein-Barr virus infection because Epstein-Barr virus-encoded small RNAs were found in the lymph node. She was diagnosed with Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis (EBV-HLH) based on the diagnostic criteria of the Japanese Society for Pediatric Infectious Diseases. Her symptoms, including appetite loss and fever, were alleviated after the administration of prednisolone (20 mg per day). She was discharged 90 days after admission. At two weeks after discharge, she was readmitted for respiratory failure, and died five days after readmission.To the best of our knowledge there are no previous reports of EBV-HLH in patients over 80 years of age, and the optimal treatment strategy is unknown. This case suggested that prednisolone may alleviate the symptoms of EBV-HLH. When a patient presents with swollen lymph nodes, clinicians should keep the possibility of EBV-HLH in mind.

2.
Nihon Ronen Igakkai Zasshi ; 56(2): 188-197, 2019.
Artículo en Japonés | MEDLINE | ID: mdl-31092785

RESUMEN

AIM: We aimed to investigate the relationship between the frequency at which patients went out and the reduction of meal intake among older outpatients who did not require care. METHODS: The subjects were outpatients of ≥65 years of age who visited the department of geriatric medicine in our hospital for the first time. We analyzed 463 subjects (male, n=184; female, n=279), after excluding patients who had dementia, required care, lived in a nursing home, or had an acute disease.The outcome measure was the reduction of meal intake (a moderate or higher decrease in the patient's meal intake in the past 3 months). The independent measure was homebound status (going-out less than once a week). The covariates were sex, age, number of medications, and Kihon Checklist (categories of undernutrition, oral function, physical function, and mood). A logistic regression analysis was performed. RESULTS: The average age was 79.6±5.9 years in men, 79.9±6.1 years in women. Among the participants, 104 (22.5%) had a homebound status. In the logistic regression analyses, a homebound status was significantly associated with a reduction in meal intake, even after adjustment for potential confounding factors, including depressive mood and a low physical function (OR: 2.0; 95% CI: 1.1-3.6). CONCLUSIONS: A homebound status in older outpatients was related to a decline in their meal intake, independent of depressive mood and a low physical function. A reduction in meal intake leads to a lack of energy and results in malnutrition. Our results suggest that assessing the frequency at independently living older outpatients go out is important for the early prevention of malnutrition.

3.
Brain ; 141(5): 1470-1485, 2018 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-29522156

RESUMEN

Biomarkers useful for the predementia stages of Alzheimer's disease are needed. Electroencephalography and magnetoencephalography (MEG) are expected to provide potential biomarker candidates for evaluating the predementia stages of Alzheimer's disease. However, the physiological relevance of EEG/MEG signal changes and their role in pathophysiological processes such as amyloid-ß deposition and neurodegeneration need to be elucidated. We evaluated 28 individuals with mild cognitive impairment and 38 cognitively normal individuals, all of whom were further classified into amyloid-ß-positive mild cognitive impairment (n = 17, mean age 74.7 ± 5.4 years, nine males), amyloid-ß-negative mild cognitive impairment (n = 11, mean age 73.8 ± 8.8 years, eight males), amyloid-ß-positive cognitively normal (n = 13, mean age 71.8 ± 4.4 years, seven males), and amyloid-ß-negative cognitively normal (n = 25, mean age 72.5 ± 3.4 years, 11 males) individuals using Pittsburgh compound B-PET. We measured resting state MEG for 5 min with the eyes closed, and investigated regional spectral patterns of MEG signals using atlas-based region of interest analysis. Then, the relevance of the regional spectral patterns and their associations with pathophysiological backgrounds were analysed by integrating information from Pittsburgh compound B-PET, fluorodeoxyglucose-PET, structural MRI, and cognitive tests. The results demonstrated that regional spectral patterns of resting state activity could be separated into several types of MEG signatures as follows: (i) the effects of amyloid-ß deposition were expressed as the alpha band power augmentation in medial frontal areas; (ii) the delta band power increase in the same region was associated with disease progression within the Alzheimer's disease continuum and was correlated with entorhinal atrophy and an Alzheimer's disease-like regional decrease in glucose metabolism; and (iii) the global theta power augmentation, which was previously considered to be an Alzheimer's disease-related EEG/MEG signature, was associated with general cognitive decline and hippocampal atrophy, but was not specific to Alzheimer's disease because these changes could be observed in the absence of amyloid-ß deposition. The results suggest that these MEG signatures may be useful as unique biomarkers for the predementia stages of Alzheimer's disease.


Asunto(s)
Enfermedad de Alzheimer/complicaciones , Mapeo Encefálico , Encéfalo/fisiopatología , Disfunción Cognitiva/etiología , Magnetoencefalografía/métodos , Síntomas Prodrómicos , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico por imagen , Péptidos beta-Amiloides/metabolismo , Análisis de Varianza , Compuestos de Anilina/farmacocinética , Encéfalo/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Progresión de la Enfermedad , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas , Tomografía de Emisión de Positrones , Escalas de Valoración Psiquiátrica , Tiazoles/farmacocinética
5.
Geriatr Gerontol Int ; 16(6): 709-15, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26171645

RESUMEN

AIM: The Kihon Checklist is extensively used in Japan to identify elderly persons who are at risk of requiring support/care. We aimed to determine whether or not the Kihon Checklist can estimate frailty status defined by the Cardiovascular Health Study criteria. METHODS: This cross-sectional study evaluated the Kihon Checklist and activities of daily living based on self-records maintained with the assistance of nurses in a convenience sample of 164 elderly outpatients who lived without care or support. Body composition was measured using dual energy X-ray absorptiometry. Physical functions, nutritional status, cognitive function and depressive mood were assessed using standardized evaluations. Frailty status was evaluated using the Cardiovascular Health Study frailty criteria. RESULTS: The total Kihon Checklist score closely correlated with validated assessments of physical functions, nutritional state, cognitive function, depressive mood and the number of frailty phenotypes defined by the Cardiovascular Health Study criteria (ρ = 0.655, P < 0.001). The area under the receiver operating characteristics curves for the evaluation of frailty status was 0.81 for prefrailty and 0.92 for frailty. The sensitivity and the specificity were 70.3% and 78.3% for prefrailty, and 89.5% and 80.7% for frailty at total Kihon Checklist scores of 3/4 and 7/8, respectively. CONCLUSION: The Kihon Checklist is a useful tool for frailty screening. Analyzing the results of this self-reporting questionnaire, together with other more high-tech screening modalities, will cost-effectively improve the quality of life for many elderly individuals in a timely manner. Geriatr Gerontol Int 2015; ●●: ●●-●●.


Asunto(s)
Lista de Verificación/métodos , Anciano Frágil , Evaluación Geriátrica/métodos , Debilidad Muscular/epidemiología , Aptitud Física/fisiología , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Incidencia , Japón , Masculino , Debilidad Muscular/diagnóstico , Músculo Esquelético/fisiopatología , Curva ROC , Medición de Riesgo , Sensibilidad y Especificidad
6.
J Dermatol ; 43(4): 436-8, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26364579

RESUMEN

Drug-induced akinesia is a potential cause of pressure ulcers. However, pressure ulcers that are caused by drug-induced akinesia are not considered an adverse drug reaction (ADR). We propose that drug-induced pressure ulcers (DIPU) are pressure ulcers that are caused by an external force that is experienced after drug administration, and we considered resolution of these ulcers after drug discontinuation to be a supportive finding. In this report, we reviewed the medical records of pressure ulcer cases from a 300-bed hospital. Among 148 patients, four patients with pressure ulcers met the criterion for DIPU. In these cases, the suspected DIPU were related to treatment with olanzapine, fluvoxamine, valproic acid, clotiazepam, triazolam and rilmazafone. These drugs were administrated to manage the patients' behavioral and psychological symptoms that accompanied dementia. The DIPU in these patients were categorized as stage IV according to the National Pressure Ulcer Advisory Panel criteria. Discontinuation of the causal drugs led to significant improvements or complete healing of the pressure ulcers, and the patients subsequently recovered their mobility. Therefore, we propose that DIPU are potential ADR that have been overlooked in clinical practice. Thus, recognition of DIPU as an ADR may be important in preventing and appropriately managing pressure ulcers among elderly patients.


Asunto(s)
Enfermedad de Alzheimer/tratamiento farmacológico , Depresores del Sistema Nervioso Central/efectos adversos , Enfermedad por Cuerpos de Lewy/tratamiento farmacológico , Úlcera por Presión/etiología , Anciano , Anciano de 80 o más Años , Depresores del Sistema Nervioso Central/uso terapéutico , Femenino , Humanos , Japón , Masculino , Úlcera por Presión/prevención & control , Estudios Retrospectivos
8.
Geriatr Gerontol Int ; 14 Suppl 2: 28-34, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24650063

RESUMEN

AIM: The National Center for Geriatrics and Gerontology has begun to provide educational support for family caregivers through interdisciplinary programs focusing on patients in the early stage of dementia. These interdisciplinary programs have established two domains for the purpose of "educational support": cure domains (medical care, medication) and care domains (nursing care, welfare). In the present study, we examined the learning needs and post-learning attitude changes of patients and their families who participated in these programs in order to assess the effectiveness of an interdisciplinary program of educational support in each of these domains. METHODS: A total of 170 participants (51 dementia patients, 119 family members) were included in the study. Data were obtained from electronic health records, and through a written survey administered before and immediately after each program. RESULTS: A high percentage of patients and family members desired knowledge about the progression and symptoms of dementia, as well as measures to prevent progression, both of which fall under the medical care content. For patients, education in the medical care content increased their motivation to live. For families, education in the medical and nursing care contents promoted their understanding of dementia, while education in medication and welfare contents improved their skills for handling dementia patients and their symptoms. CONCLUSION: Both patients and family members expressed a need to learn medical care content, including the progression and disease symptoms of dementia, and methods to prevent the progression of dementia symptoms. Their responses showed that learning medical care was effective for understanding dementia. We suggested that medical care content was the core of interdisciplinary educational support for early-stage dementia patients and their family members.


Asunto(s)
Actitud del Personal de Salud , Cuidadores/educación , Demencia/rehabilitación , Geriatría/educación , Grupo de Atención al Paciente , Educación del Paciente como Asunto/métodos , Desarrollo de Programa/métodos , Anciano , Familia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Japón , Masculino
9.
Arch Gerontol Geriatr ; 58(1): 130-3, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24035002

RESUMEN

We surveyed the care burden of family caregivers, their satisfaction with the services, and whether their care burden was reduced by the introduction of the LTCI care services. We randomly enrolled 3000 of 43,250 residents of Nagoya City aged 65 and over who had been certified as requiring long-term care and who used at least one type of service provided by the public LTCI; 1835 (61.2%) subjects returned the survey. A total of 1015 subjects for whom complete sets of data were available were employed for statistical analysis. Analysis of variance for the continuous variables and χ(2) analysis for that categorical variance were performed. Multiple logistic analysis was performed with the factors with p values of <0.2 in the χ(2) analysis of burden reduction. A total of 68.8% of the caregivers indicated that the care burden was reduced by the introduction of the LTCI care services, and 86.8% of the caregivers were satisfied with the LTCI care services. A lower age of caregivers, a more advanced need classification level, and more satisfaction with the services were independently associated with a reduction of the care burden. In Japanese LTCI, the overall satisfaction of the caregivers appears to be relatively high and is associated with the reduction of the care burden.


Asunto(s)
Cuidadores/psicología , Costo de Enfermedad , Anciano Frágil , Necesidades y Demandas de Servicios de Salud/economía , Seguro de Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/economía , Estrés Psicológico , Anciano , Anciano de 80 o más Años , Cuidadores/economía , Femenino , Servicios de Atención de Salud a Domicilio/economía , Humanos , Japón , Masculino , Estudios Retrospectivos
10.
Geriatr Gerontol Int ; 14(1): 206-11, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23647510

RESUMEN

AIM: To examine the efficacy of rehabilitation for elderly individuals with dementia at intermediate facilities between hospitals and home, based on the policies for elderly individuals to promote community-based care at home and dehospitalization. METHODS: Participants were older adults with dementia newly admitted to intermediate facilities. A total of 158 in the intervention group who claimed Long-Term Care Insurance for three consecutive months, and 54 in the control group were included in the analysis. The interventions were carried out in a tailor-made manner to meet individual needs. The personal sessions were carried out three times a week for 3 months after admission by physical, occupational or speech therapists. Outcome measures were cognitive tests (Hasegawa Dementia Scale revised [HDS-R] and Mini-Mental State Examination), and observational assessments of dementia severity, activities of daily living (ADL), social activities, behavioral and psychological symptoms of dementia (BPSD) using a short version of the Dementia Disturbance Scale (DBD13), depressive mood, and vitality. RESULTS: Significant improvement in the intervention group was shown in cognitive function measured by HDS-R (interaction F[1, 196] = 5.190, P = 0.024), observational evaluation of dementia severity (F[1,198] = 9.550, P = 0.002) and BPSD (DBD13; F[1,197] = 4.506, P = 0.035). Vitality, social activities, depressive mood and ADL were significantly improved only in the intervention group, although interaction was not significant. CONCLUSIONS: Significant improvement by intervention was shown in multiple domains including cognitive function and BPSD. Cognitive decline and worsening of BPSD are predictors of care burden and hospitalization, thus intensive rehabilitation for dementia was beneficial for both individuals with dementia and their caregivers.


Asunto(s)
Actividades Cotidianas , Conducta/fisiología , Cognición/fisiología , Demencia/rehabilitación , Servicios de Salud para Ancianos , Anciano , Anciano de 80 o más Años , Demencia/epidemiología , Demencia/psicología , Femenino , Estudios de Seguimiento , Humanos , Japón/epidemiología , Masculino , Pruebas Neuropsicológicas , Prevalencia , Encuestas y Cuestionarios , Resultado del Tratamiento
11.
Conf Proc IEEE Eng Med Biol Soc ; 2013: 5813-6, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24111060

RESUMEN

With the aim of providing computer aided diagnosis of dementia, we have developed a non-invasive screening system of the elderly with cognitive impairment. In our previous research, we have studied two data-mining approaches by focusing on speech-prosody and cerebral blood flow (CBF) activation during cognitive tests. On the power of these research results, this paper presents a prosody-CBF hybrid screening system of the elderly with cognitive impairment based on a Bayesian approach. The system is constructed by SPCIR (Speech Prosody-Based Cognitive Impairment Rating) based cutoff as the 1st screening, and, as the 2nd screening, two-phase Bayesian classifier for discriminating among elderly individuals with three clinical groups: elderly individuals with normal cognitive abilities (NC), patients with mild cognitive impairment (MCI), and Alzheimer's disease (AD). This paper also reports the screening examination and discusses the cost-effectiveness and the discrimination performance of the proposed system for early detection of cognitive impairment in elderly subjects.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Corteza Cerebral/irrigación sanguínea , Trastornos del Conocimiento/diagnóstico , Disfunción Cognitiva/diagnóstico , Habla/fisiología , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/complicaciones , Enfermedad de Alzheimer/fisiopatología , Teorema de Bayes , Presión Sanguínea/fisiología , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/fisiopatología , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Espectroscopía Infrarroja Corta
12.
Nihon Ronen Igakkai Zasshi ; 50(4): 491-3, 2013.
Artículo en Japonés | MEDLINE | ID: mdl-24047661

RESUMEN

Palliative care improves the quality of life of patients and their families facing problems associated with life-threatening illnesses by promoting the prevention and relief of suffering. Palliative care in Japan has been developed mainly for cancer patients. At the National Center for Geriatrics and Gerontology, an end-of-life care team (EOLCT) has been developed to promote palliative care for patients without cancer. In the first 6 months of its operation, 109 requests were received by the team, 40% of which were for patients without cancer or related disease, including dementia, frailty due to advanced age, chronic respiratory failure, chronic heart failure, and intractable neurologic diseases. The main purpose of the EOLCT is to alleviate suffering. The relevant activities of the team include the use of opioids, providing family care, and giving support in decision-making (advance care planning) regarding withholding; enforcement; and withdrawal of mechanical ventilators, gastric feeding tubes, and artificial alimentation. The EOLCT is also involved in ongoing discussions of ethical problems. The team is actively engaged in the activities of the Japanese Geriatric Society and contributes to the development of decision-making guidelines for end-of-life by the Ministry of Health, Labour and Welfare. The EOLCT can be helpful in promoting palliative care for patients with diseases other than cancer. The team offers support during times of difficulty and decision-making.


Asunto(s)
Cuidados Paliativos/normas , Grupo de Atención al Paciente/normas , Cuidado Terminal/normas , Anciano , Anciano de 80 o más Años , Humanos
13.
PLoS One ; 8(4): e61483, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23585901

RESUMEN

BACKGROUND: To examine the effect of multicomponent exercise program on memory function in older adults with mild cognitive impairment (MCI), and identify biomarkers associated with improvement of cognitive functions. METHODOLOGY/PRINCIPAL FINDINGS: Subjects were 100 older adults (mean age, 75 years) with MCI. The subjects were classified to an amnestic MCI group (n = 50) with neuroimaging measures, and other MCI group (n = 50) before the randomization. Subjects in each group were randomized to either a multicomponent exercise or an education control group using a ratio of 1∶1. The exercise group exercised for 90 min/d, 2 d/wk, 40 times for 6 months. The exercise program was conducted under multitask conditions to stimulate attention and memory. The control group attended two education classes. A repeated-measures ANOVA revealed that no group × time interactions on the cognitive tests and brain atrophy in MCI patients. A sub-analysis of amnestic MCI patients for group × time interactions revealed that the exercise group exhibited significantly better Mini-Mental State Examination (p = .04) and logical memory scores (p = .04), and reducing whole brain cortical atrophy (p<.05) compared to the control group. Low total cholesterol levels before the intervention were associated with an improvement of logical memory scores (p<.05), and a higher level of brain-derived neurotrophic factor was significantly related to improved ADAS-cog scores (p<.05). CONCLUSIONS/SIGNIFICANCE: The results suggested that an exercise intervention is beneficial for improving logical memory and maintaining general cognitive function and reducing whole brain cortical atrophy in older adults with amnestic MCI. Low total cholesterol and higher brain-derived neurotrophic factor may predict improvement of cognitive functions in older adults with MCI. Further studies are required to determine the positive effects of exercise on cognitive function in older adults with MCI. TRIAL REGISTRATION: UMIN-CTR UMIN000003662 ctr.cgi?function = brows&action = brows&type = summary&recptno = R000004436&language = J.


Asunto(s)
Amnesia/terapia , Atrofia/terapia , Encéfalo/fisiopatología , Disfunción Cognitiva/terapia , Terapia por Ejercicio , Anciano , Anciano de 80 o más Años , Amnesia/sangre , Amnesia/patología , Amnesia/fisiopatología , Atrofia/sangre , Atrofia/patología , Atrofia/fisiopatología , Atención , Biomarcadores/sangre , Encéfalo/patología , Factor Neurotrófico Derivado del Encéfalo/sangre , Colesterol/sangre , Cognición , Disfunción Cognitiva/sangre , Disfunción Cognitiva/patología , Disfunción Cognitiva/fisiopatología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Memoria , Pruebas Neuropsicológicas
14.
J Am Med Dir Assoc ; 14(7): 479-84, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23415841

RESUMEN

OBJECTIVES: Physicians are uncertain about what medical services should be provided to older and/or disabled patients. Better understanding of health outcome prioritization among health care providers and recipients may help the process of decision- and policy-making. For this purpose, surveys were conducted on priorities of health care outcomes for the elderly. DESIGN: Survey research. SETTING: Four groups of health care providers and four groups of health care recipients. PARTICIPANTS: A total of 2512 health care providers and 4277 recipients. MEASUREMENTS: Questionnaires were sent to more than 8000 health care providers and more than 9000 health care recipients: geriatricians, physicians who commonly see older patients or work in long term care facilities, staff members and participants in adult day care, patients in outpatient geriatric clinics, family members of patients with dementia, and community-dwelling older adults. The questionnaire asked the subjects to rank 12 measures of health care outcomes. RESULTS: The mean response rate was 49%. All health care provider groups considered "improvement of quality of life" the most important. In contrast, in health care recipient groups, "effective treatment of illness," "improvement of physical function," and "reduction of carer burden" were given high priority, whereas "improvement of quality of life" was perceived as less important. All the groups, including health care providers and recipients, ranked "reduction of mortality" the least important, followed by "avoiding institutional care." Stratification analysis showed that the results did not differ by sex, nursing care level, or the existence of relatives who required nursing care, whereas age slightly influenced the order of high-ranked measures. CONCLUSION: Priorities of health care services and their differences between providers and recipients should be taken into account in the health care of older patients and the design of health care policies and research.


Asunto(s)
Actitud del Personal de Salud , Familia , Prioridades en Salud , Pacientes , Anciano , Anciano de 80 o más Años , Geriatría , Servicios de Salud para Ancianos , Humanos , Japón , Encuestas y Cuestionarios
16.
Geriatr Gerontol Int ; 13(1): 77-82, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22672724

RESUMEN

AIM: Functional status of those who have very mild cognitive impairment have not been sufficiently investigated. In the current study, we analyzed the characteristics of functional awareness in older adults who had cognitive impairment and were at high risk of requiring support/care (termed as specified elderly at high risk for care needs in the long-term care insurance scheme). METHODS: The answers of a health check, which is provided by the local municipal government for those aged 75 years or older who have not been certified as eligible for care services, were analyzed. The differences of the variables between the two groups regarding yes/no answers to each of three cognition-related questions were analyzed. Then, a multiple logistic analysis was carried out to investigate the association of yes/no answers of the three cognition-related questions and the awareness of functional decline. RESULTS: The participants who had cognitive impairment had greater awareness of functional declines. Multiple logistic regression analysis showed that subjective memory impairment and disorientation were significantly associated with a wider range of awareness of functional decline. CONCLUSIONS: Subjective cognitive impairment was associated with a wide range of awareness of functional decline in older adults at high risk for care need.


Asunto(s)
Actividades Cotidianas/psicología , Trastornos del Conocimiento/psicología , Evaluación Geriátrica/métodos , Necesidades y Demandas de Servicios de Salud , Tamizaje Masivo , Anciano , Distribución de Chi-Cuadrado , Femenino , Humanos , Modelos Logísticos , Masculino , Riesgo , Factores de Riesgo , Estadísticas no Paramétricas , Encuestas y Cuestionarios
17.
Geriatr Gerontol Int ; 13(1): 83-9, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22672014

RESUMEN

AIM: The detection of the early stages in amnesic mild cognitive impairment (aMCI) is considered important in diagnosing progression to Alzheimer's disease. The current study sought to investigate differences in cognitive function between control subjects with no memory loss (control), and subjects in the early stage of aMCI (EMCI) and late stage of aMCI (LMCI). METHODS: A total of 100 community-dwelling older adults aged 65 years and over were recruited from 1543 potential subjects. Subjects were classified into three groups based on the degree of objective memory impairment; control (n=29), EMCI (n=34) and LMCI (n=37). Multiple neuropsychological tests were carried out to examine cognitive function. RESULTS: The EMCI individuals showed lower cognitive function relative to controls; not only in logical memory, but also in letter fluency (P<0.05). There were no significant differences in neuropsychological scores between the EMCI and LMCI groups, except for category fluency and logical memory. In addition, the EMCI subjects' logical memory score showed a significant relationship with letter fluency, category fluency and digit span backward test performance (P<0.05). CONCLUSIONS: These results suggest that the application of multiple neuropsychological tests might be useful in diagnosing older adults with EMCI and LMCI.


Asunto(s)
Amnesia/diagnóstico , Disfunción Cognitiva/diagnóstico , Evaluación Geriátrica/métodos , Anciano , Amnesia/fisiopatología , Análisis de Varianza , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Disfunción Cognitiva/fisiopatología , Demografía , Progresión de la Enfermedad , Femenino , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo , Pruebas Neuropsicológicas
18.
Gan To Kagaku Ryoho ; 39 Suppl 1: 1-2, 2012 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-23268882

RESUMEN

It is unclear how hospitals should support a patient's decision to return home to die. Thus, we retrospectively examined the usefulness of support from an End-Of-Life Care Team in such difficult decision making. The subjects included non-cancer patients and the elderly. Our results suggest that the burden of making difficult decisions decreases with support from End- Of-Life Care Teams.


Asunto(s)
Toma de Decisiones , Grupo de Atención al Paciente , Cuidado Terminal , Encuestas y Cuestionarios
19.
Aging Clin Exp Res ; 24(5): 423-9, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22395286

RESUMEN

BACKGROUND AND AIMS: Many studies have suggested that social network, leisure activity, and physical activity can have protective effects against dementia and Alzheimer's disease. However, previous studies have not examined the relationship between daily activities and brain atrophy in older adults. This study aimed to explore what kind of daily activities were associated with atrophy of the medial temporal area including the entorhinal cortex (MTA-ERC) in older adults. METHODS: In total, 122 older adults (aged 65 and over) with subjective memory complaints or a Clinical Dementia Rating of 0.5 underwent magnetic resonance imaging, and MTA-ERC atrophy was assessed by the voxel- based morphometry method. Based on magnetic resonance imaging data, the subjects were divided into atrophy and non-atrophy groups. Daily activities were assessed using a 20-item questionnaire (e.g., instrumental activities of daily living, social activities), and we compared activity participation between the groups. RESULTS: The atrophy group (n=37) showed significantly lower participation in 4 out of 20 activity items (cleaning, intellectual activity, culture lessons, and using a personal computer) than the non-atrophy group (n=85). Summed scores of these 4 items (range from 0 to 4) were significantly associated with MTA-ERC atrophy even after adjustment for age, sex, education status, and Mini-Mental State Examination score. CONCLUSIONS: In conclusion, MTAERC atrophy was associated with cognitive activities or household-related activities requiring planning.


Asunto(s)
Envejecimiento , Atrofia/fisiopatología , Disfunción Cognitiva/fisiopatología , Lóbulo Temporal/fisiopatología , Actividades Cotidianas , Factores de Edad , Anciano , Anciano de 80 o más Años , Algoritmos , Mapeo Encefálico/métodos , Cognición , Femenino , Humanos , Funciones de Verosimilitud , Imagen por Resonancia Magnética/métodos , Masculino , Probabilidad , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
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