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2.
Artículo en Inglés | MEDLINE | ID: mdl-33539505

RESUMEN

BACKGROUND: Delirium prevalence increases with age and is associated with poor outcomes. We aimed to investigate the prevalence and risk factors for delirium in older patients hospitalized with COVID-19, as well as its association with length of stay and mortality. METHODS: Retrospective study of patients aged ≥ 65 years hospitalized with COVID-19. Data were collected from computerized medical records and all patients had delirium assessment at admission. Risk factors for delirium as well as the outcomes mentioned above were studied by two-group comparison, logistic regression and Cox proportional-hazard models. RESULTS: Of a total of 235 Caucasian patients, 48 (20.4%) presented with delirium, which was hypoactive in 41.6% of cases, hyperactive and mixed in 35.4% and 23.0%, respectively. Patients with cognitive impairment had a nearly four times higher risk of developing delirium compared to patients that were cognitively normal before SARS-CoV-2 infection (OR 3.7; 1.7-7.9 95% CI, p=0.001). The presence of delirium did not modify the time from symptoms' onset to hospitalization nor the length of stay in acute care, but it was associated with an increased risk of dying (HR 2.1; 1.2-3.7 95%CI; p=0.0113). CONCLUSION: Delirium was a prevalent condition in older people admitted with COVID-19 and pre-existing cognitive impairment was its main risk factor. Delirium was associated with higher in-hospital mortality. These results highlight the importance of early recognition of delirium especially when pre-morbid cognitive comorbidities are present.

3.
BMC Geriatr ; 21(1): 52, 2021 01 14.
Artículo en Inglés | MEDLINE | ID: mdl-33446113

RESUMEN

BACKGROUND: Stroke in the course of coronavirus disease (COVID-19) has been shown to be associated with more severe respiratory symptoms and higher mortality, but little knowledge in this regard exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke in geriatric patients hospitalized with COVID-19. METHODS: A monocentric cross-sectional retrospective study of 265 older patients hospitalized with COVID-19 on acute geriatric wards. 11/265 presented a stroke episode during hospitalization. Mortality rates and two-group comparisons (stroke vs non-stroke patients) were calculated and significant variables added in logistic regression models to investigate stroke risk factors. RESULTS: Combined ischemic and hemorrhagic stroke incidence was 4.15%. 72.7% of events occurred during acute care. Strokes presented with altered state of consciousness and/or delirium in 81.8%, followed by a focal neurological deficit in 45.5%. Ischemic stroke was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke increased by more than seven (OR 7.44; 95% CI 1.75-31.64; p = 0.007) and five times (OR 5.19; 95% CI 1.50-17.92; p = 0.009), respectively, the risk of stroke. Each additional point in body mass index (BMI) reduced the risk of stroke by 14% (OR 0.86; 95% CI 0.74-0.98; p = 0.03). In-hospital mortality (32.1% vs. 27.3%; p > 0.999) and institutionalization at discharge (36.4% vs. 21.1%; p = 0.258) were similar between patients with and without stroke. CONCLUSION: Incident stroke complicating COVID-19 in old patients was associated with active smoking, previous history of stroke, and low BMI. Acute stroke did not influence early mortality or institutionalization rate at discharge.


Asunto(s)
Coronavirus , Accidente Cerebrovascular , Anciano , Estudios Transversales , Humanos , Incidencia , Estudios Retrospectivos , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología
4.
Rev Med Suisse ; 17(722): 136-139, 2021 Jan 20.
Artículo en Francés | MEDLINE | ID: mdl-33470570

RESUMEN

COGERIA, a cantonal program is the fruit of a close collaboration between the Geneva General Directorate of Health and the major health and social partners in the canton. The program aims to improve inter-professional care for the frail elderly and to adapt their care pathways in close collaboration with their primary care physicians and home healthcare providers. Launched in May 2019, the program includes more than 283 beneficiaries and 152 primary care physicians in collaboration with the home healthcare providers in the Servette and Meyrin areas. Preliminary results show a possible trend towards a decrease in hospitalizations, as well as major satisfaction from beneficiaries and the COGERIA partners.


Asunto(s)
Anciano Frágil , Hospitalización , Anciano , Humanos , Satisfacción Personal
5.
Swiss Med Wkly ; 150: w20446, 2020 12 14.
Artículo en Inglés | MEDLINE | ID: mdl-33382449

RESUMEN

AIMS OF THE STUDY: Hydroxychloroquine and lopinavir/ritonavir have been used as experimental therapies to treat COVID-19 during the first wave of the pandemic. Randomised controlled trials have recently shown that there are no meaningful benefits of these two therapies in hospitalised patients. Uncertainty remains regarding the potential harmful impact of these therapies as very early treatments and their burden to the health care system. The present study investigated the length of hospital stay (LOS), mortality, and costs of hydroxychloroquine, lopinavir/ritonavir or their combination in comparison with standard of care among patients hospitalised for coronavirus disease 2019 (COVID-19). METHODS: This retrospective observational cohort study took place in the Geneva University Hospitals, Geneva, Switzerland (n = 840) between 26 February and 31 May 2020. Demographics, treatment regimens, comorbidities, the modified National Early Warning Score (mNEWS) on admission, and contraindications to COVID-19 treatment options were assessed. Outcomes included LOS, in-hospital mortality, and drug and LOS costs. RESULTS: After successful propensity score matching, patients treated with (1) hydroxychloroquine, (2) lopinavir/ritonavir or (3) their combination had on average 3.75 additional hospitalisation days (95% confidence interval [CI] 1.37–6.12, p = 0.002), 1.23 additional hospitalisation days (95% CI −1.24 – 3.51, p = 0.319), and 4.19 additional hospitalisation days (95% CI 1.52–5.31, p <0.001), respectively, compared with patients treated with the standard of care. Neither experimental therapy was significantly associated with mortality. These additional hospital days amounted to 1010.77 additional days for hydroxychloroquine and hydroxychloroquine combined with lopinavir/ritonavir, resulting in an additional cost of US$ 2,492,214 (95%CI US$ 916,839–3,450,619). CONCLUSIONS: Prescribing experimental therapies for COVID-19 was not associated with a reduced LOS and might have increased the pressure put on healthcare systems.


Asunto(s)
Antivirales/uso terapéutico , /epidemiología , Hidroxicloroquina/uso terapéutico , Lopinavir/uso terapéutico , Ritonavir/uso terapéutico , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antivirales/administración & dosificación , Antivirales/efectos adversos , Niño , Preescolar , Comorbilidad , Combinación de Medicamentos , Quimioterapia Combinada , Gastos en Salud , Mortalidad Hospitalaria/tendencias , Humanos , Hidroxicloroquina/administración & dosificación , Hidroxicloroquina/efectos adversos , Lactante , Tiempo de Internación/estadística & datos numéricos , Lopinavir/administración & dosificación , Lopinavir/efectos adversos , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos , Ritonavir/administración & dosificación , Ritonavir/efectos adversos , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Terapias en Investigación/métodos , Adulto Joven
7.
J Am Med Dir Assoc ; 21(11): 1546-1554.e3, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33138936

RESUMEN

OBJECTIVE: To determine predictors of in-hospital mortality related to COVID-19 in older patients. DESIGN: Retrospective cohort study. SETTING AND PARTICIPANTS: Patients aged 65 years and older hospitalized for a diagnosis of COVID-19. METHODS: Data from hospital admission were collected from the electronic medical records. Logistic regression and Cox proportional hazard models were used to predict mortality, our primary outcome. Variables at hospital admission were categorized according to the following domains: demographics, clinical history, comorbidities, previous treatment, clinical status, vital signs, clinical scales and scores, routine laboratory analysis, and imaging results. RESULTS: Of a total of 235 Caucasian patients, 43% were male, with a mean age of 86 ± 6.5 years. Seventy-six patients (32%) died. Nonsurvivors had a shorter number of days from initial symptoms to hospitalization (P = .007) and the length of stay in acute wards than survivors (P < .001). Similarly, they had a higher prevalence of heart failure (P = .044), peripheral artery disease (P = .009), crackles at clinical status (P < .001), respiratory rate (P = .005), oxygen support needs (P < .001), C-reactive protein (P < .001), bilateral and peripheral infiltrates on chest radiographs (P = .001), and a lower prevalence of headache (P = .009). Furthermore, nonsurvivors were more often frail (P < .001), with worse functional status (P < .001), higher comorbidity burden (P < .001), and delirium at admission (P = .007). A multivariable Cox model showed that male sex (HR 4.00, 95% CI 2.08-7.71, P < .001), increased fraction of inspired oxygen (HR 1.06, 95% CI 1.03-1.09, P < .001), and crackles (HR 2.42, 95% CI 1.15-6.06, P = .019) were the best predictors of mortality, while better functional status was protective (HR 0.98, 95% CI 0.97-0.99, P = .001). CONCLUSIONS AND IMPLICATIONS: In older patients hospitalized for COVID-19, male sex, crackles, a higher fraction of inspired oxygen, and functionality were independent risk factors of mortality. These routine parameters, and not differences in age, should be used to evaluate prognosis in older patients.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria/tendencias , Neumonía Viral/mortalidad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Comorbilidad , Femenino , Predicción , Geriatría , Humanos , Masculino , Pandemias , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos
8.
Aging Clin Exp Res ; 2020 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-33063292

RESUMEN

BACKGROUND: Fear of falling is highly prevalent in older adults and associated with numerous negative health events. The main objective of this study was to validate a scale to assess fear of falling, based on performance in real situation (Perform-FES), in a hospitalized geriatric population. METHODS: In this cross-sectional study, 55 patients (mean age: 85.3 years; 58% women) hospitalized in a geriatric hospital in Geneva (Switzerland) were enrolled. The Perform-FES scale was administered to all patients in conjunction with four other fear of falling scales. We determined the floor and ceiling effects, internal consistency, reliability, construct validity, and discriminative power of the Perform-FES scale. RESULTS: The Perform-FES scale did not demonstrate any significant floor or ceiling effect. It had a good internal consistency (Cronbach's alpha = 0.78) and an excellent reliability (intraclass correlation coefficient = 0.94). Regarding convergent validity, good correlations were shown between the score obtained on the Perform-FES scale and those obtained on other fear of falling scales. Also, the Perform-FES scale was able to discriminate patients with severe functional impairments (area under the ROC curve = 0.81) and had significantly better discriminating performance than other fear of falling scales. CONCLUSION: Findings suggest that the Perform-FES scale has good psychometric properties and may be a relevant tool to assess fear of falling in a geriatric hospitalized population. Future research should focus in particular on assessing the sensitivity to change and the predictive value of this scale in longitudinal studies, and its validity in other populations.

9.
PLoS One ; 15(9): e0239606, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32997689

RESUMEN

OBJECTIVE: The diagnosis of pneumonia based on semiology and chest X-rays is frequently inaccurate, particularly in elderly patients. Older (C-reactive protein (CRP); procalcitonin (PCT)) or newer (Serum amyloid A (SAA); neopterin (NP)) biomarkers may increase the accuracy of pneumonia diagnosis, but data are scarce and conflicting. We assessed the accuracy of CRP, PCT, SAA, NP and the ratios CRP/NP and SAA/NP in a prospective observational cohort of elderly patients with suspected pneumonia. METHODS: We included consecutive patients more than 65 years old, with at least one respiratory symptom and one symptom or laboratory finding suggestive of infection, and a working diagnosis of pneumonia. Low-dose CT scan and comprehensive microbiological testing were done in all patients. The index tests, CRP, PCT, SAA and NP, were obtained within 24 hours. The reference diagnosis was assessed a posteriori by a panel of experts considering all available data, including patients' outcome. We used area under the curve (AUROC) and Youden index to assess the accuracy and obtain optimal cut-off of the index tests. RESULTS: 200 patients (median age 84 years) were included; 133 (67%) had pneumonia. AUROCs for the diagnosis of pneumonia was 0.64 (95% CI: 0.56-0.72) for CRP; 0.59 (95% CI: 0.51-0.68) for PCT; 0.60 (95% CI: 0.52-0.69) for SAA; 0.41 (95% CI: 0.32-0.49) for NP; 0.63 (95% CI: 0.55-0.71) for CRP/NP; and 0.61 (95% CI: 0.53-0.70) for SAA/NP. No cut-off resulted in satisfactory sensitivity or specificity. CONCLUSIONS: Accuracy of traditional (CRP, PCT) and newly proposed biomarkers (SAA, NP) and ratios of CRP/NP and SAA/NP was too low to help diagnosing pneumonia in the elderly. CRP had the highest AUROC. CLINICAL TRIAL REGISTRATION: NCT02467092.


Asunto(s)
Proteína C-Reactiva/análisis , Neopterin/sangre , Neumonía Bacteriana/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Proteína Amiloide A Sérica/análisis , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Proteína C-Reactiva/normas , Femenino , Humanos , Masculino , Neopterin/normas , Neumonía Bacteriana/patología , Polipéptido alfa Relacionado con Calcitonina/normas , Sensibilidad y Especificidad , Proteína Amiloide A Sérica/normas
10.
BMJ Open Respir Res ; 7(1)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32561512

RESUMEN

OBJECTIVES: Death or hospital readmission are frequent among patients surviving acute hypercapnic respiratory failure (AHRF). Severity scores are not valid to predict death or readmission after AHRF. Gait speed, a simple functional parameter, has been associated with hospital admission and death in the general population. The purpose of this study is to highlight an association between gait speed at hospital discharge and death or readmission among AHRF survivors. DESIGN: Secondary analysis of a prospective cohort study. SETTINGS: Single Swiss tertiary hospital, pulmonary division. PARTICIPANTS: Patients were prospectively recruited to form a cohort of patients surviving AHRF in the intensive care unit between January 2012 and May 2015. OUTCOME MEASURE: Gait speed was derived from a 6 min walking test (6MWT) before hospital discharge. All predictive variables were prospectively collected. Death or hospital readmission were recorded for 6 months. Univariate and multivariate analyses were performed to evaluate the association between predictive variables and death or hospital readmission. RESULTS: 71 patients performed a 6MWT. 34/71 (48%) patients died or were readmitted to the hospital during the observation period. Median gait speed was 0.7 (IQR 0.3-1.0) m/s. At 6 months, 66% (25/38) of slow walkers (gait speed <0.7 m/s) and 27% (9/33) of non-slow walkers died or were readmitted to the hospital (p=0.002). In univariate analysis, gait speed was associated with death or readmission (HR 0.41; 95% CI 0.19 to 0.90, p=0.025). In a multivariate model adjusted for age, gender, body mass index, forced expired volume, heart failure and home mechanical ventilation, gait speed remained the only variable associated with death or readmission (multivariate HR: 0.35; 95% CI 0.14 to 0.88, p=0.025). CONCLUSION: This study suggests that a simple functional parameter such as gait speed is associated with death or hospital readmission in patients surviving AHRF. TRIAL REGISTRATION NUMBER: NCT02111876.

11.
J Alzheimers Dis ; 73(4): 1467-1479, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31929155

RESUMEN

BACKGROUND: Cortical superficial siderosis (cSS) is a hemorrhagic marker of blood-brain barrier disruption detected in brain MRI. Together with cerebral microbleeds (CMB), they are recognized as a small vessel disease marker associated with cerebral amyloid angiopathy. OBJECTIVE: This study aims to determine the prevalence and the characteristics of cSS in a memory clinic population. METHODS: Cross-sectional retrospective analysis of 613 patients from Geneva University Hospitals memory clinic. All patients underwent standardized brain MRI and neuropsychological assessment with diagnosis confirmed by an expert. The presence of cSS was visually assessed and classified as focal (restricted to 3 sulci) or disseminated within the correspondent topography. CMB were classified according to the Microbleed Anatomical Rating Scale. RESULTS: cSS was detected in 26/613 patients (4.2%), classified as disseminated in 5/26 cases (19%). Alzheimer's disease (AD) and AD associated with a significant vascular component were the diagnoses more frequently related to cSS (18/26; 69%). Patients with cSS had an increased prevalence of both hypertension (81% versus 57%; p = 0.015) and WMH burden (p = 0.012). The overall prevalence of cerebral microbleeds (69% versus 32%; p < 0.01), as well as their mean number (0.69±0.47 versus 0.32±0.46; p < 0.01) were both increased in patients with cSS. In the logistic regression model, the presence of 5 or more CMB (OR 11.35; 95% CI 4.68-27.55; p < 0.01) and hypertension (OR 3.31; 95% CI 1.19-9.15; p = 0.021) were significantly associated with cSS. CONCLUSIONS: cSS is observed in patients diagnosed with AD and AD with a vascular component, being independently associated with multiple CMB and hypertension.

12.
Eur J Nucl Med Mol Imaging ; 47(2): 247-255, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31792573

RESUMEN

PURPOSE: The A/T/N model is a research framework proposed to investigate Alzheimer's disease (AD) pathological bases (i.e., amyloidosis A, neurofibrillary tangles T, and neurodegeneration N). The application of this system on clinical populations is still limited. The aim of the study is to evaluate the topography of T distribution by 18F-flortaucipir PET in relation to A and N and to describe the A/T/N status through imaging biomarkers in memory clinic patients. METHODS: Eighty-one patients with subjective and objective cognitive impairment were classified as A+/A- and N+/N- through amyloid PET and structural MRI. Tau deposition was compared across A/N subgroups at voxel level. T status was defined through a global cut point based on A/N subgroups and subjects were categorized following the A/T/N model. RESULTS: A+N+ and A+N- subgroups showed higher tau burden compared to A-N- group, with A+N- showing significant deposition limited to the medial and lateral temporal regions. Global cut point discriminated A+N+ and A+N- from A-N- subjects. On A/T/N classification, 23% of patients showed a negative biomarker profile, 58% fell within the Alzheimer's continuum, and 19% of the sample was characterized by non-AD pathologic change. CONCLUSION: Medial and lateral temporal regions represent a site of significant tau accumulation in A+ subjects and possibly a useful marker of early clinical changes. This is the first study in which the A/T/N model is applied using 18F-flortaucipir PET in a memory clinic population. The majority of patients showed a profile consistent with the Alzheimer's continuum, while a minor percentage showed a profile suggestive of possible other neurodegenerative diseases. These results support the applicability of the A/T/N model in clinical practice.

14.
Gerodontology ; 36(2): 125-133, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30623472

RESUMEN

OBJECTIVE: This study aimed to evaluate the prevalence of various oral hygiene tools amongst hospitalised elders and to associate their cognitive status with the prevalence of tools and oral hygiene status. MATERIALS AND METHOD: Elderly hospitalised participants were included in the study and underwent a brief clinical intra-oral examination. A semi-structured questionnaire evaluated the awareness and personal possession of the various oral hygiene tools. Participants' personal information and various clinical parameters including DMF (T) index, plaque index, CPITN index, denture plaque and calculus index were collected. Mini-Mental State Examination (MMSE) scores were retrieved from the medical records. Linear regression models were applied for statistical analyses (P < 0.05). RESULTS: A total of 100 hospitalised elders (age = 84.5 ± 6.9 years; ♀ = 72, age = 84.9 ± 7.2 years; ♂ = 28, age = 83.3 ± 5.8 years) participated in this study. Awareness was high for manual toothbrush (100%), electric toothbrush (86%), dental floss (79%), interdental brush (44%), interdental stick (55%) and mouthwash (75%), but was low for tongue scraper (9%), while the prevalence of use was 93%, 17%, 27%, 21%, 29%, 39% and 4%, respectively. Linear regression models revealed plaque scores were lower when more hygiene tools were used by the participants (P = 0.0059). Participants with high MMSE scores had lower plaque scores (P = 0.0004) and possessed more oral hygiene tools (P = 0.0203). CONCLUSION: Poor oral hygiene is often noticed in institutionalised elders and might be related to a lack of knowledge about existing oral hygiene tools. These may help optimising oral hygiene, especially in cognitively impaired elders. Oral hygiene tools should be prescribed according to the patient's need, functional and cognitive status.


Asunto(s)
Dispositivos para el Autocuidado Bucal , Higiene Bucal , Anciano , Estudios Transversales , Índice de Placa Dental , Humanos , Prevalencia , Encuestas y Cuestionarios
15.
Rev Med Suisse ; 14(626): 2003-2006, 2018 Nov 07.
Artículo en Francés | MEDLINE | ID: mdl-30422419

RESUMEN

Age-related changes in mental health are an important concern in today's world. Researchers have investigated the effects of video games on mental health for the past 30 years but research on the cognitive impact of smartphones is just beginning. Studies have shown contradictory results and need to be interpreted with caution. Users should be made aware of current knowledge on their potential risks and benefits, without demonizing these relatively new technologies. They should learn how to take advantage of the great potential of these modern devices (they can for example enhance curiosity, sense of purpose and creativity) without becoming enslaved by them.


Asunto(s)
Cognición , Teléfono Inteligente , Juegos de Video , Humanos , Salud Mental
16.
Gerontology ; 64(6): 521-531, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30032145

RESUMEN

BACKGROUND: The global number of centenarians is still strongly growing and information about the health and healthcare needs of this segment of the population is needed. This study aimed to estimate the prevalence of frailty among centenarians included in a multinational study and to investigate associated factors. METHODS: The 5-COOP study is a cross-sectional survey including 1,253 centenarians in 5 countries (Japan, France, Switzerland, Denmark, and Sweden). Data were collected using a standardized questionnaire during a face-to-face interview (73.3%), telephone interview (14.5%), or by postal questionnaire (12.2%). The 5 dimensions of the frailty phenotype (weight loss, fatigue, weakness, slow walking speed, and low level of physical activity) were assessed by using self-reported data. Factors associated with frailty criteria were investigated by using multivariate regression models. RESULTS: Almost 95% of the participants had at least 1 frailty criterion. The overall prevalence of frailty (3 criteria or more) was 64.7% (from 51.5% in Sweden to 77.6% in Switzerland), and 32.2% of the participants had 4 or 5 criteria. The most frequent criteria were weakness (84.2%), slow walking speed (77.6%), and low level of physical activity (72.5%), followed by fatigue (43.8%) and weight loss (23.8%). Factors associated with frailty included data collection modes, country of residence, gender, living in institution, depression, dementia, disability, falls, and sensory impairments. CONCLUSIONS: This study shows that reaching 100 years of age rarely goes without frailty and sheds light on factors associated with frailty at a very old age.


Asunto(s)
Fragilidad , Accidentes por Caídas/estadística & datos numéricos , Actividades Cotidianas , Anciano de 80 o más Años , Estudios Transversales , Depresión/diagnóstico , Depresión/epidemiología , Fatiga/diagnóstico , Fatiga/epidemiología , Femenino , Anciano Frágil/estadística & datos numéricos , Fragilidad/diagnóstico , Fragilidad/etiología , Fragilidad/fisiopatología , Fragilidad/psicología , Evaluación Geriátrica/métodos , Evaluación Geriátrica/estadística & datos numéricos , Humanos , Cooperación Internacional , Limitación de la Movilidad , Embarazo , Prevalencia , Investigación Cualitativa
17.
Alzheimers Dement ; 13(9): 1013-1023, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28263741

RESUMEN

INTRODUCTION: Hippocampal volume is a core biomarker of Alzheimer's disease (AD). However, its contribution over the standard diagnostic workup is unclear. METHODS: Three hundred fifty-six patients, under clinical evaluation for cognitive impairment, with suspected AD and Mini-Mental State Examination ≥20, were recruited across 17 European memory clinics. After the traditional diagnostic workup, diagnostic confidence of AD pathology (DCAD) was estimated by the physicians in charge. The latter were provided with the results of automated hippocampal volumetry in standardized format and DCAD was reassessed. RESULTS: An increment of one interquartile range in hippocampal volume was associated with a mean change of DCAD of -8.0% (95% credible interval: [-11.5, -5.0]). Automated hippocampal volumetry showed a statistically significant impact on DCAD beyond the contributions of neuropsychology, 18F-fluorodeoxyglucose positron emission tomography/single-photon emission computed tomography, and cerebrospinal fluid markers (-8.5, CrI: [-11.5, -5.6]; -14.1, CrI: [-19.3, -8.8]; -10.6, CrI: [-14.6, -6.1], respectively). DISCUSSION: There is a measurable effect of hippocampal volume on DCAD even when used on top of the traditional diagnostic workup.


Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/patología , Trastornos del Conocimiento/etiología , Diagnóstico por Computador , Hipocampo/patología , Enfermedad de Alzheimer/líquido cefalorraquídeo , Enfermedad de Alzheimer/complicaciones , Péptidos beta-Amiloides/líquido cefalorraquídeo , Trastornos del Conocimiento/diagnóstico por imagen , Diagnóstico Diferencial , Progresión de la Enfermedad , Europa (Continente) , Femenino , Fluorodesoxiglucosa F18/metabolismo , Humanos , Masculino , Pruebas Neuropsicológicas , Fragmentos de Péptidos/líquido cefalorraquídeo , Tomografía de Emisión de Positrones , Tomografía Computarizada de Emisión de Fotón Único , Proteínas tau/líquido cefalorraquídeo
18.
Swiss Med Wkly ; 147: w14407, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28322422

RESUMEN

Because of the worldwide aging of populations, Alzheimer's disease and other dementias constitute a devastating experience for patients and families as well as a major social and economic burden for both healthcare systems and society. Multiple potentially modifiable cardiovascular and lifestyle risk factors have been associated with this disease. Thus, modifying these risk factors and identifying protective factors represent important strategies to prevent and delay disease onset and to decrease the social burden. Based on the cognitive reserve hypothesis, evidence from epidemiological studies shows that low education and cognitive inactivity constitute major risk factors for dementia. This indicates that a cognitively active lifestyle may protect against cognitive decline or delay the onset of dementia. We describe a newly developed preventive programme, based on this evidence, to stimulate and increase cognitive activity in older adults at risk for cognitive decline. This programme, called "BrainCoach", includes the technique of "motivational interviewing" to foster behaviour change. If the planned feasibility study is successful, we propose to add BrainCoach as a module to the already existing "Health Coaching" programme, a Swiss preventive programme to address multiple risk factors in primary care.


Asunto(s)
Enfermedad de Alzheimer/prevención & control , Cognición , Disfunción Cognitiva/prevención & control , Promoción de la Salud , Factores Protectores , Envejecimiento/psicología , Reserva Cognitiva , Humanos , Estilo de Vida , Entrevista Motivacional/métodos , Factores de Riesgo , Suiza
19.
Nutrition ; 34: 124-129, 2017 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-28063507

RESUMEN

OBJECTIVE: Low muscle mass has been associated with increased morbi-mortality and should be identified for optimizing preventive and therapeutic strategies. This study evaluates the prevalence of bioelectrical impedance analysis (BIA)-derived low muscle mass in older persons using definitions found through a systematic literature search and determines the link between body mass index (BMI) and low muscle mass. METHODS: We performed a systematic search of trials involving ≥100 persons that derived low muscle mass from BIA and reported cut-offs for low muscle mass normalized for body height or weight. These cut-offs were applied to all adults ≥65 y who underwent a BIA measurement at Geneva University Hospital between 1990 and 2011 (N = 3181). The association between BMI and low muscle mass was evaluated through multivariate logistic regressions. RESULTS: We identified 15 cut-offs based on the fat-free mass index (FFMI), skeletal muscle index (SMI), or skeletal muscle percentage (SMP). Depending on the definition, the prevalence of low muscle mass was 17% to 68% in women and 17% to 85% in men. The risk of low muscle mass increased with a BMI <18.5 kg/m2 when using cut-offs based on FFMI (odds ratio [OR] ♀ 14.28-24.04/♂ 25.42-50.64) or SMI (OR ♀ 3.56-4.56/♂ 7.07-8.87) and decreased with a BMI ≥25 kg/m2 (FFMI: OR ♀ 0.03-0.04/♂ 0.01-0.04; SMI: OR ♀ 0.18-0.25/♂ 0.14-0.18). The opposite association appeared between BMI and cut-offs based on SMP. CONCLUSION: The prevalence of low muscle mass varies widely depending on the definition, especially in persons with BMI <18.5 or ≥25 kg/m2.


Asunto(s)
Índice de Masa Corporal , Músculo Esquelético/fisiología , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Anciano , Composición Corporal , Peso Corporal , Impedancia Eléctrica , Femenino , Humanos , Modelos Logísticos , Masculino , Análisis Multivariante , Prevalencia , Estudios Retrospectivos
20.
Curr Alzheimer Res ; 14(2): 186-197, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27334943

RESUMEN

PET/MRI tomographs represent the latest development in hybrid molecular imaging, opening new perspectives for clinical and research applications and attracting a large interest among the medical community. This new hybrid modality is expected to play a pivotal role in a number of clinical applications and among these the assessment of neurodegenerative disorders. PET and MRI, acquired separately, are already the imaging biomarkers of choice for a comprehensive assessment of the changes occurring in dementias (major cognitive disorders) as well as in their prodromal phase. In this paper we review the current evidence on the use of integrated PET/MRI scanners to investigate patients with neurodegenerative conditions, and in particular major neurocognitive disorders. The number of studies performed is still limited and shows that the use of PET/MRI gives results overall comparable to PET/CT and MRI acquired independently. We also address the challenges for quantitative aspects in PET/MRI, namely attenuation, partial volume and motion correction and the use of semi-quantitative approaches for FDG PET image analysis in this framework. The recent development of PET tracers for the in vivo differential diagnosis of dementias, able to visualize amyloid and tau deposits, suggests that in the future PET/MRI might represent the investigation of choice for a single session evaluation of morphological, functional and molecular markers.


Asunto(s)
Fluorodesoxiglucosa F18 , Imagen por Resonancia Magnética , Trastornos Neurocognitivos/diagnóstico por imagen , Tomografía de Emisión de Positrones , Radiofármacos , Humanos , Imagen Multimodal , Trastornos Neurocognitivos/metabolismo
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