Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 51.187
Filtrar
1.
Stud Health Technol Inform ; 268: 61-76, 2020 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-32141879

RESUMEN

This chapter presents two case studies where the dominant narrative was subverted, one by citizen participants and one by researchers. Subversion, as a questioning and challenging stance, in the context of co-creation supports the discovery of new pathways for healthy behaviours even in modest projects. We also illustrate how emotion-led and interest-based design is used to increase adoption by end-users. Here we explore the development of an active ageing portal for a local council and the use of 'Kira' the robot to promote social interaction between older adults living with dementia.


Asunto(s)
Envejecimiento , Anciano , Demencia , Estado de Salud , Humanos , Narración , Tecnología
2.
Isr Med Assoc J ; 22(3): 178-184, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147984

RESUMEN

BACKGROUND: The authors reviewed the two most common current uses of brain 18F-labeled fluoro-2-deoxyglucose positron emission tomography (FDG-PET) at a large academic medical center. For epilepsy patients considering surgical management, FDG-PET can help localize epileptogenic lesions, discriminate between multiple or discordant EEG or MRI findings, and predict prognosis for post-surgical seizure control. In elderly patients with cognitive impairment, FDG-PET often demonstrates lobar-specific patterns of hypometabolism that suggest particular underlying neurodegenerative pathologies, such as Alzheimer's disease. FDG-PET of the brain can be a key diagnostic modality and contribute to improved patient care.


Asunto(s)
Encéfalo/diagnóstico por imagen , Demencia/diagnóstico por imagen , Epilepsia/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones/métodos , Encéfalo/patología , Demencia/patología , Epilepsia/patología , Humanos
3.
Medicine (Baltimore) ; 99(10): e19048, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32150051

RESUMEN

This study aimed to evaluate the risk of dementia after distal radius, hip, and spine fractures.Data from the Korean National Health Insurance Service-National Sample Cohort were collected for the population ≥ 60 years of age from 2002 to 2013. A total of 10,387 individuals with dementia were matched for age, sex, income, region of residence, and history of hypertension, diabetes, and dyslipidemia with 41,548 individuals comprising the control group. Previous histories of distal radius, hip, and spine fractures were evaluated in both the dementia and control groups. Using ICD-10 codes, dementia (G30 and F00) and distal radius (S525), hip (S720, S721, and S722), and spine (S220 and S320) fractures were investigated. The crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of dementia in distal radius, hip, and spine fracture patients were analyzed using conditional logistic regression analyses. Subgroup analyses were conducted according to age, sex and region of residence.The adjusted ORs for dementia were higher in the distal radius, hip, and spine fracture group than in the non-fracture group (adjusted OR = 1.23, 95% CI = 1.10 -1.37, P < .001 for distal radius fracture; adjusted OR = 1.64, 95% CI = 1.48 - 1.83, P < .001 for hip fracture; adjusted OR = 1.31, 95% CI = 1.22 - 1.41, P < .001 for spine fracture). The results in subgroup analyses according to age, sex and region of residence were consistent.Distal radius, hip, and spine fractures increase the risk of dementia.


Asunto(s)
Demencia/epidemiología , Fracturas Óseas/complicaciones , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Demencia/etiología , Femenino , Servicios de Salud para Ancianos , Fracturas de Cadera/complicaciones , Humanos , Revisión de Utilización de Seguros , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Fracturas Osteoporóticas/complicaciones , Fracturas del Radio/complicaciones , República de Corea/epidemiología , Factores de Riesgo , Fracturas de la Columna Vertebral/complicaciones
5.
Brain Nerve ; 72(3): 227-238, 2020 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-32152256

RESUMEN

Mokichi Saito (1882-1953) was born in Yagamata in 1882. After he graduated from junior high school, he was adopted by the Saito family. He started writing songs from the time he was in school. He eventually became a doctor, and soon after that, he published his first work, "Red Light." While studying in Europe, he wrote "The Brain Map in Progressive Dementia." After returning to Japan, he composed several songs. She was a best mother for her children. I have written his story because he had a peculiar character, even according to his wife.


Asunto(s)
Demencia , Médicos , Europa (Continente) , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Japón , Música , Escritura
6.
Brain Nerve ; 72(3): 241-250, 2020 Mar.
Artículo en Japonés | MEDLINE | ID: mdl-32152257

RESUMEN

Dysregulation of the gut microbiome is associated with several life-threatening conditions, and might therefore represent a useful target for the prevention of dementia. However, the relationship between the gut microbiome and dementia has not yet been fully elucidated. Here, we recruited outpatients visiting our memory clinic to participate in this study. Information for patient demographics, various risk factors, and daily activities was collected, and cognitive function was assessed using neuropsychological tests and magnetic resonance imaging scans. Fecal samples were obtained, and the gut microbiome was assessed by terminal restriction fragment length polymorphism (T-RFLP) analysis, one of the most well-established and reliable 16S ribosomal RNA-based methods for classifying gut microbiota. Multivariable logistic regression models were used to identify factors independently associated with dementia and mild cognitive impairment. Graphical modelling was used to illustrate mutual associations. We analyzed 128 eligible patients (female: 59%, mean age: 74.2±8.7 years, mean Mini Mental State Examination score 24). Multivariable analyses showed that enterotype I and enterotype III bacteria were strongly associated with dementia, independent of traditional dementia biomarkers. Further studies investigating metabolites of gut microbes are needed to determine the mechanism underlying this association.


Asunto(s)
Cognición , Demencia/microbiología , Disbiosis/fisiopatología , Microbioma Gastrointestinal , Anciano , Anciano de 80 o más Años , Bacterias/clasificación , Heces/microbiología , Femenino , Humanos , Masculino , ARN Ribosómico 16S/genética
8.
Lancet ; 395(10225): 698-708, 2020 02 29.
Artículo en Inglés | MEDLINE | ID: mdl-32050090

RESUMEN

BACKGROUND: Observational studies have suggested that accelerated surgery is associated with improved outcomes in patients with a hip fracture. The HIP ATTACK trial assessed whether accelerated surgery could reduce mortality and major complications. METHODS: HIP ATTACK was an international, randomised, controlled trial done at 69 hospitals in 17 countries. Patients with a hip fracture that required surgery and were aged 45 years or older were eligible. Research personnel randomly assigned patients (1:1) through a central computerised randomisation system using randomly varying block sizes to either accelerated surgery (goal of surgery within 6 h of diagnosis) or standard care. The coprimary outcomes were mortality and a composite of major complications (ie, mortality and non-fatal myocardial infarction, stroke, venous thromboembolism, sepsis, pneumonia, life-threatening bleeding, and major bleeding) at 90 days after randomisation. Patients, health-care providers, and study staff were aware of treatment assignment, but outcome adjudicators were masked to treatment allocation. Patients were analysed according to the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT02027896). FINDINGS: Between March 14, 2014, and May 24, 2019, 27 701 patients were screened, of whom 7780 were eligible. 2970 of these were enrolled and randomly assigned to receive accelerated surgery (n=1487) or standard care (n=1483). The median time from hip fracture diagnosis to surgery was 6 h (IQR 4-9) in the accelerated-surgery group and 24 h (10-42) in the standard-care group (p<0·0001). 140 (9%) patients assigned to accelerated surgery and 154 (10%) assigned to standard care died, with a hazard ratio (HR) of 0·91 (95% CI 0·72 to 1·14) and absolute risk reduction (ARR) of 1% (-1 to 3; p=0·40). Major complications occurred in 321 (22%) patients assigned to accelerated surgery and 331 (22%) assigned to standard care, with an HR of 0·97 (0·83 to 1·13) and an ARR of 1% (-2 to 4; p=0·71). INTERPRETATION: Among patients with a hip fracture, accelerated surgery did not significantly lower the risk of mortality or a composite of major complications compared with standard care. FUNDING: Canadian Institutes of Health Research.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Intervención Médica Temprana/métodos , Fijación Interna de Fracturas/métodos , Hemiartroplastia/métodos , Fracturas de Cadera/cirugía , Complicaciones Posoperatorias/epidemiología , Tiempo de Tratamiento/estadística & datos numéricos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/mortalidad , Comorbilidad , Delirio/epidemiología , Demencia/epidemiología , Diabetes Mellitus/epidemiología , Femenino , Fracturas del Cuello Femoral/epidemiología , Fracturas del Cuello Femoral/cirugía , Fracturas de Cadera/epidemiología , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Mortalidad , Isquemia Miocárdica/epidemiología , Casas de Salud , Reducción Abierta/métodos , Hemorragia Posoperatoria/epidemiología , Modelos de Riesgos Proporcionales , Características de la Residencia/estadística & datos numéricos , Sepsis/epidemiología , Resultado del Tratamiento
11.
JAMA ; 323(8): 764-785, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096857

RESUMEN

Importance: Early identification of cognitive impairment may improve patient and caregiver health outcomes. Objective: To systematically review the test accuracy of cognitive screening instruments and benefits and harms of interventions to treat cognitive impairment in older adults (≥65 years) to inform the US Preventive Services Task Force. Data Sources: MEDLINE, PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials through January 2019, with literature surveillance through November 22, 2019. Study Selection: Fair- to good-quality English-language studies of cognitive impairment screening instruments, and pharmacologic and nonpharmacologic treatments aimed at persons with mild cognitive impairment (MCI), mild to moderate dementia, or their caregivers. Data Extraction and Synthesis: Independent critical appraisal and data abstraction; random-effects meta-analyses and qualitative synthesis. Main Outcomes and Measures: Sensitivity, specificity; patient, caregiver, and clinician decision-making; patient function, quality of life, and neuropsychiatric symptoms; caregiver burden and well-being. Results: The review included 287 studies with more than 280 000 older adults. One randomized clinical trial (RCT) (n = 4005) examined the direct effect of screening for cognitive impairment on patient outcomes, including potential harms, finding no significant differences in health-related quality of life at 12 months (effect size, 0.009 [95% CI, -0.063 to 0.080]). Fifty-nine studies (n = 38 531) addressed the accuracy of 49 screening instruments to detect cognitive impairment. The Mini-Mental State Examination was the most-studied instrument, with a pooled sensitivity of 0.89 (95% CI, 0.85 to 0.92) and specificity of 0.89 (95% CI, 0.85 to 0.93) to detect dementia using a cutoff of 23 or less or 24 or less (15 studies, n = 12 796). Two hundred twenty-four RCTs and 3 observational studies including more than 240 000 patients or caregivers addressed the treatment of MCI or mild to moderate dementia. None of the treatment trials were linked with a screening program; in all cases, participants were persons with known cognitive impairment. Medications approved to treat Alzheimer disease (donepezil, galantamine, rivastigmine, and memantine) improved scores on the ADAS-Cog 11 by 1 to 2.5 points over 3 months to 3 years. Psychoeducation interventions for caregivers resulted in a small benefit for caregiver burden (standardized mean difference, -0.24 [95% CI, -0.36 to -0.13) over 3 to 12 months. Intervention benefits were small and of uncertain clinical importance. Conclusions and Relevance: Screening instruments can adequately detect cognitive impairment. There is no empirical evidence, however, that screening for cognitive impairment improves patient or caregiver outcomes or causes harm. It remains unclear whether interventions for patients or caregivers provide clinically important benefits for older adults with earlier detected cognitive impairment or their caregivers.


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Cuidadores , Disfunción Cognitiva/terapia , Demencia/tratamiento farmacológico , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Guías de Práctica Clínica como Asunto , Sensibilidad y Especificidad
12.
JAMA ; 323(8): 757-763, 2020 02 25.
Artículo en Inglés | MEDLINE | ID: mdl-32096858

RESUMEN

Importance: Dementia (also known as major neurocognitive disorder) is defined by a significant decline in 1 or more cognitive domains that interferes with a person's independence in daily activities. Dementia affects an estimated 2.4 to 5.5 million individuals in the United States, and its prevalence increases with age. Objective: To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on screening for cognitive impairment, including mild cognitive impairment and mild to moderate dementia, in community-dwelling adults, including those 65 years or older residing in independent living facilities. Population: This recommendation applies to community-dwelling older adults 65 years or older, without recognized signs or symptoms of cognitive impairment. Evidence Assessment: The USPSTF concludes that the evidence is lacking, and the balance of benefits and harms of screening for cognitive impairment cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in older adults. (I statement).


Asunto(s)
Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Tamizaje Masivo , Anciano , Disfunción Cognitiva/terapia , Demencia/terapia , Diagnóstico Precoz , Humanos , Vida Independiente , Tamizaje Masivo/efectos adversos , Pruebas Neuropsicológicas , Sensibilidad y Especificidad
13.
Z Gerontol Geriatr ; 53(2): 138-144, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32048012

RESUMEN

BACKGROUND: The majority of acute care hospitals are not prepared for people with dementia with acute diseases in need of treatment. This results in an increased likelihood of the personnel being overtaxed. Dementia is the most frequent reason that hospital personnel administer sedating medication and use restraining measures. OBJECTIVE: The aim of this study was to investigate factors that influence the (inappropriate) use of sedating medication and physical restraints for patients with dementia in acute care hospitals. METHODS: A non-randomized case control study, including two internal medicine wards was conducted in Hamburg, Germany. In the intervention group a special care concept was implemented focussing on patients with dementia, while the control group received regular care without a special dementia care concept. Logistic regression models were conducted to investigate associations between factors, such as age, severity of dementia, conspicuous behavior, Barthel index and type of treatment and the use of sedating medication and physical restraint measures. RESULTS: Challenging behavior (odds ratio, OR = 1.32) and treatment in the control group (OR=1.94) were significantly associated with the use of sedating medication. A low Barthel index, longer periods of hospitalization and treatment in the control group were significantly associated with a higher probability of the implementation of physical restraining measures. DISCUSSION: The use of sedating medication as well as physical restraining measures varied greatly between the intervention and control groups. This is in line with other studies that came to similar results and suggests that multiple components of special care concepts can explain these differences. These include architectonic design and spatial aspects as well as dementia-specific training of employees and an appropriate personnel complement. Such interventions can also reduce agitation and behavioral problems of patients. The avoidance of sedation and restraining measures is also positively associated with an increase in the quality of life of patients with dementia.


Asunto(s)
Demencia/terapia , Hipnóticos y Sedantes/uso terapéutico , Restricción Física , Estudios de Casos y Controles , Demencia/complicaciones , Alemania , Humanos , Prescripción Inadecuada , Calidad de la Atención de Salud , Calidad de Vida
14.
Medicine (Baltimore) ; 99(5): e18492, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000359

RESUMEN

BACKGROUND: There are differences among the outcomes regarding cognitive impairment in heart failure (HF) because the evidence is fragmented and sample size is small. Therefore we aimed to systematically review and analyze the available evidence about the association between HF and dementia. METHODS: In the present study, we searched for articles published until August 2019 in the following databases: PubMed, Web of Science, EMBASE, Medline and Google Scholar. The pooled multivariate odds ratio (OR) or relative risk (RR) and 95% confidence intervals (CI) were obtained by the use of STATA 12.0 software. RESULTS: The meta-analysis showed a positive association between HF and risk of all-cause dementia (OR/RR = 1.28, 95% CI 1.15 to 1.43, I = 70.0%, P < 0.001). Additionally, the study showed no significant association between HF and risk of Alzheimer's disease (AD) (OR/RR = 1.38, 95% CI 0.90 to 2.13, I = 74.8%, P = 0.008). CONCLUSION: In conclusion, HF was associated with an increased risk of developing dementia. In addition, large scale prospective studies are essential to explore the associations between HF and risk of AD.


Asunto(s)
Demencia/etiología , Insuficiencia Cardíaca/complicaciones , Humanos , Pronóstico , Factores de Riesgo
15.
Medicine (Baltimore) ; 99(5): e18919, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000401

RESUMEN

Previous studies have suggested that patients with psychotic or mental disorders are relatively pain insensitive, resulting in difficulties in the diagnosis of acute intra-abdominal diseases requiring emergency surgeries. We aimed to evaluate whether central nervous system (CNS) or mental disorders are associated with perforated appendicitis in patients with acute appendicitis.We conducted a population-based case-control study using Taiwan's National Health Insurance Research database. Patients aged >18 years who had been hospitalized with a diagnosis of acute appendicitis between 2000 and 2013 were identified. After 1:1 matching for age and sex, 2792 patients with perforated appendicitis (case group) and 2792 patients with nonperforated appendicitis (control group) were included. CNS disorders, mental disorders, pain control medication, and several comorbidities were analyzed for the odds of appendiceal perforation with 95% confidence interval (CI) using the multivariable logistic regression model.Schizophrenia and dementia were associated with a high risk of appendiceal rupture in patients with acute appendicitis, with an adjusted odds ratio of 2.01 for dementia (95% CI: 1.19-3.39, P = .009) and 4.8 for schizophrenia (95% CI: 1.62-14.19, P = .005). Other factors, such as other CNS disorders, comorbidities, and pain control medication, were not associated with the risk of perforated appendicitis.Dementia and schizophrenia are associated with perforated appendicitis in patients with acute appendicitis. This might be owing to altered pain perception, difficult symptom expression, and delayed hospitalization. Further studies are still needed to determine the underlying mechanism and confirm the causality.


Asunto(s)
Apendicitis/epidemiología , Demencia/epidemiología , Esquizofrenia/epidemiología , Adulto , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Percepción del Dolor , Riesgo , Adulto Joven
17.
Medicine (Baltimore) ; 99(5): e18608, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32000366

RESUMEN

BACKGROUND: The number of dementia patients in the world is large, and the number of dementia patients will continue to rise in the future, which will bring a heavy social and economic burden. No interventions have been found to cure dementia. Medication can delay the progression of the disease and impose an economic burden. Some non-drug therapies often require the care of the caregiver. Probiotics, prebiotics, and synbiotics may intervene in dementia through microbiota-gut-brain axis (MGBA). However, their effectiveness and safety are still obscure and deserve further investigation. The purpose of this study is to assess the effect and safety of probiotics, prebiotics, and synbiotics in treating dementia. METHODS: We will summarize and meta-analyze randomized controlled trials (RCTs) of probiotics, prebiotics, and synbiotics for the treatment of dementia. RCTs comparing probiotics, prebiotics, and synbiotics with blank control, placebo or conventional therapies will be included. RCTs comparing probiotics, prebiotics, and synbiotics plus conventional therapies with conventional therapies alone will also be included. The following electronic databases will be searched: PubMed, Cochrane Library, EMBASE, CNKI, CBM, VIP, and WAN FANG DATA. The methodological quality of RCTs will be assessed using the Cochrane risk assessment tool. All trials included will be analyzed according to the criteria of the Cochrane Handbook. Review Manager 5.3, R-3.5.1 software will be used for publication bias analysis. Grading of Recommendations Assessment, Development and Evaluation (GRADE) pro-GDT web solution will be used for evidence evaluation. RESULTS: This review will evaluate the effects of probiotics, prebiotics, and synbiotics on cognitive function, behavioral and psychological symptoms of dementia, quality of life (QOL), functional performance in activities of daily living, and compliance with the intervention and safety in patients with dementia. CONCLUSIONS: This review will provide clear evidence to assess the effectiveness and safety of probiotics, prebiotics, and synbiotics for dementia.OSF registration number: DOI 10.17605/OSF.IO/2Q3AK.


Asunto(s)
Demencia/dietoterapia , Prebióticos , Probióticos/uso terapéutico , Humanos , Revisiones Sistemáticas como Asunto
18.
HNO ; 68(3): 143-149, 2020 Mar.
Artículo en Alemán | MEDLINE | ID: mdl-32030453

RESUMEN

The aging of society observed during the past century in industrialized countries has not only led to a longer life expectancy, but also an increased frequency of age-related diseases and multimorbidity. In addition to dysphagia and vertigo, sensory deficits such as olfaction and hearing disorders are common in elderly persons and have a significant influence on quality of life. Alzheimer's disease is the most common form of dementia. Epidemiological studies have recently shown that disorders of olfaction and hearing are not only associated with dementia, but also represent specific risk factors for development and progression of the disease. Recognition and adequate treatment, e.g., of hearing loss, by otorhinolaryngologists is thus assuming an increasingly important role, not only to preserve patients' quality of life, but also to reduce the risk of developing dementia in the future.


Asunto(s)
Demencia , Pérdida Auditiva , Anciano , Demencia/complicaciones , Demencia/terapia , Progresión de la Enfermedad , Trastornos de la Audición , Pérdida Auditiva/etiología , Pérdida Auditiva/terapia , Humanos , Calidad de Vida
19.
Community Dent Health ; 37(1): 59-64, 2020 Feb 27.
Artículo en Inglés | MEDLINE | ID: mdl-32031342

RESUMEN

OBJECTIVE: To clarify the association between multiple tooth loss and dementia. BASIC RESEARCH DESIGN: Case-control study based on the claims data from National Health Insurance Research Database (NHIRD). Patients were divided into two groups: the dementia groups and non-dementia group. For each case patient, one control patient was randomly selected and frequency matched by age (per 5 years) and sex. The case group comprised patients newly diagnosed with dementia, and the index date was the the date of dementia diagnosis, which became the baseline for comorbidity and age calculations. RESULTS: Among the 43,026 individuals, patients with dementia had a significantly higher extraction density at ages 60-69 (p ⟨ 0.0001) and 70-79 (p = 0.04) years compared with control patients. CONCLUSIONS: This population-based retrospective study demonstrated an association between tooth loss and dementia. Patients in Taiwan with more tooth extraction experience are likely to have an increased risk of dementia.


Asunto(s)
Demencia , Pérdida de Diente , Anciano , Estudios de Casos y Controles , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Taiwán
20.
BMJ ; 368: m650, 2020 02 20.
Artículo en Inglés | MEDLINE | ID: mdl-32079582
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA