ABSTRACT
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.
ABSTRACT
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.
Subject(s)
Humans , Health Programs and Plans , Dementia , Alzheimer Disease , Medical AssistanceABSTRACT
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.
Subject(s)
Humans , Male , Adult , Female , Alzheimer Disease/diagnosis , Alzheimer Disease/blood , Neurodegenerative Diseases/complications , Neurodegenerative Diseases/blood , Protein Isoforms/chemistry , Protein Isoforms/blood , Blood Chemical Analysis , Cognitive Dysfunction , HematologyABSTRACT
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)
Subject(s)
Humans , Aged , Dementia/diagnosis , Dementia/epidemiology , AgedSubject(s)
Female , Duodenitis/pathology , Gastritis/pathology , Helicobacter pylori , Helicobacter Infections/pathology , Uremia/pathology , Adolescent , Adult , Aged , Chi-Square Distribution , Chronic Disease , Duodenitis/epidemiology , Duodenitis/microbiology , Endoscopy, Gastrointestinal , English Abstract , Gastritis/epidemiology , Gastritis/microbiology , Helicobacter Infections/epidemiology , Helicobacter pylori/isolation & purificationABSTRACT
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
Subject(s)
Adult , Middle Aged , Humans , Male , Female , Dyspepsia/physiopathology , Gallbladder/physiopathology , Gastric Emptying/physiology , Dyspepsia , Isotonic SolutionsABSTRACT
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
Subject(s)
Adolescent , Adult , Humans , Male , Food, Formulated , Gastric Emptying/physiology , Gastrointestinal Transit/physiology , Ultrasonography , Dietary Fats/administration & dosage , Dietary Proteins/administration & dosage , Glucose Solution, Hypertonic/administration & dosage , Probability , Pyloric Antrum , Pyloric Antrum/physiology , Saline Solution, Hypertonic/administration & dosageABSTRACT
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
Subject(s)
Middle Aged , Male , Humans , Liver Neoplasms/secondary , Myasthenia Gravis/etiology , Thymoma/complications , Thymus Neoplasms/complications , Liver Neoplasms , Mediastinum , Thymoma , Thymoma/pathology , Thymoma/surgery , Thymus Neoplasms , Thymus Neoplasms/pathology , Thymus Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
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