RESUMO
BACKGROUND: Contrary to early case-control studies that suggested smoking protects against Alzheimer disease (AD), recent prospective studies have shown that elderly who smoke may be at increased risk for dementia. OBJECTIVE: To examine prospectively the effect of smoking on cognition in nondemented elderly. METHOD: In a multicenter cohort, the European Community Concerted Action Epidemiology of Dementia (EURODEM), including the Odense, Personnes Agées Quid (Paquid), Rotterdam, and Medical Research Council: Ageing in Liverpool Project-Health Aspects (MRC ALPHA) Studies, 17,610 persons aged 65 and over were screened and examined for dementia. After an average 2.3 years of follow-up, 11,003 nondemented participants were retested. Excluding incident dementia cases and those without baseline information on smoking gave an analytical sample of 9,209 persons. Average yearly decline in Mini-Mental State Examination (MMSE) score was compared among groups, adjusting for age, sex, baseline MMSE, education, type of residence, and history of myocardial infarction or stroke. RESULTS: MMSE score of persons who never smoked on average declined 0.03 point/year. The adjusted decline of former smokers was 0.03 point greater and of current smokers 0.13 point greater than never smokers (p < 0.001). Higher rates of decline by smoking were found in men and women, persons with and without family history of dementia, and in three of four participating studies. Higher cigarette pack-year exposure was correlated with a significantly higher rate of decline. CONCLUSION: Smoking may accelerate cognitive decline in nondemented elderly.
Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Demência/diagnóstico , Demência/epidemiologia , Fumar/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Dinamarca/epidemiologia , Progressão da Doença , Feminino , Seguimentos , França/epidemiologia , Humanos , Masculino , Países Baixos/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Distribuição por Sexo , Reino Unido/epidemiologiaRESUMO
The hypothesis that a low educational level increases the risk for Alzheimer's disease remains controversial. The authors studied the association of years of schooling with the risk for incident dementia and Alzheimer's disease by using pooled data from four European population-based follow-up studies. Dementia cases were identified in a two-stage procedure that included a detailed diagnostic assessment of screen-positive subjects. Dementia and Alzheimer's disease were diagnosed by using international research criteria. Educational level was categorized by years of schooling as low (< or =7), middle (8-11), or high (> or =12). Relative risks (95% confidence intervals) were estimated by using Poisson regression, adjusting for age, sex, study center, smoking status, and self-reported myocardial infarction and stroke. There were 493 (328) incident cases of dementia (Alzheimer's disease) and 28,061 (27,839) person-years of follow-up. Compared with women with a high level of education, those with low and middle levels of education had 4.3 (95% confidence interval: 1.5, 11.9) and 2.6 (95% confidence interval: 1.0, 7.1) times increased risks, respectively, for Alzheimer's disease. The risk estimates for men were close to 1.0. Finding an association of education with Alzheimer's disease for women only raises the possibility that unmeasured confounding explains the previously reported increased risk for Alzheimer's disease for persons with low levels of education.
Assuntos
Doença de Alzheimer/epidemiologia , Escolaridade , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Projetos de Pesquisa Epidemiológica , Europa (Continente)/epidemiologia , Feminino , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Fatores SexuaisRESUMO
OBJECTIVE: To study the difference in risk for dementing diseases between men and women. BACKGROUND: Previous studies suggest women have a higher risk for dementia than men. However, these studies include small sample sizes, particularly in the older age groups, when the incidence of dementia is highest. METHODS: Pooled analysis of four population-based prospective cohort studies was performed. The sample included persons 65 years and older, 528 incident cases of dementia, and 28,768 person-years of follow-up. Incident cases were identified in a two-stage procedure in which the total cohort was screened for cognitive impairment, and screen positives underwent detailed diagnostic assessment. Dementia and main subtypes of AD and vascular dementia were diagnosed according to internationally accepted guidelines. Sex- and age-specific incidence rates, and relative and cumulative risks for total dementia, AD, and vascular dementia were calculated using log linear analysis and Poisson regression. RESULTS: There were significant gender differences in the incidence of AD after age 85 years. At 90 years of age, the rate was 81.7 (95% CI, 63.8 to 104.7) in women and 24.0 (95% CI, 10.3 to 55.6) in men. There were no gender differences in rates or risk for vascular dementia. The cumulative risk for 65-year-old women to develop AD at the age of 95 years was 0.22 compared with 0.09 for men. The cumulative risk for developing vascular dementia at the age of 95 years was similar for men and women (0.04). CONCLUSION: Compared with men, women have an increased risk for AD. There are no gender differences in risk for vascular dementia.
Assuntos
Doença de Alzheimer/epidemiologia , Demência Vascular/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Estudos Transversais , Demência Vascular/diagnóstico , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Risco , Fatores SexuaisAssuntos
Doença de Alzheimer/genética , Apolipoproteínas E/genética , Variação Genética , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alelos , Feminino , Genótipo , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To investigate the risk of AD associated with a family history of dementia, female gender, low levels of education, smoking, and head trauma. BACKGROUND: These putative factors have been identified in cross-sectional studies. However, those studies are prone to bias due to systematic differences between patients and control subjects regarding survival and how risk factors are recalled. METHODS: The authors performed a pooled analysis of four European population-based prospective studies of individuals 65 years and older, with 528 incident dementia patients and 28,768 person-years of follow-up. Patients were detected by screening the total cohort with brief cognitive tests, followed by a diagnostic assessment of those who failed the screening tests. Dementia was diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. (revised), and AD was diagnosed according to National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Incident rates and relative risk (95% CI) express the association of a risk factor for dementia. RESULTS: Incident rates for dementia and AD were similar across studies. The incidence of AD increased with age. At 90 years of age and older the incidence was 63.5 (95% CI, 49.7 to 81.0) per 1,000 person-years. Female gender, current smoking (more strongly in men), and low levels of education (more strongly in women) increased the risk of AD significantly. A history of head trauma with unconsciousness and family history of dementia did not increase risk significantly. CONCLUSION: Contrary to previous reports, head trauma was not a risk factor for AD, and smoking did not protect against AD. The association of family history with the risk of AD is weaker than previously estimated on the basis of cross-sectional studies. Female gender may modify the risk of AD, whether it be via biological or behavioral factors.
Assuntos
Doença de Alzheimer/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Fatores de RiscoAssuntos
Humanos , Encefalopatias , Hipertensão , Transtornos Cerebrovasculares , Hemorragia Cerebral , Demência , IdosoAssuntos
Humanos , Idoso , Encefalopatias , Hemorragia Cerebral , Transtornos Cerebrovasculares , Demência , HipertensãoAssuntos
Doença de Alzheimer/tratamento farmacológico , Acetilcolinesterase/metabolismo , Envelhecimento , Doença de Alzheimer/etiologia , Peptídeos beta-Amiloides , Encéfalo/enzimologia , Encéfalo/patologia , Bloqueadores dos Canais de Cálcio/efeitos adversos , Bloqueadores dos Canais de Cálcio/uso terapêutico , Antagonistas Colinérgicos/farmacologia , Antagonistas Colinérgicos/uso terapêutico , Aminoácidos Excitatórios , Humanos , Inflamação/patologia , Estresse Oxidativo , Receptores Muscarínicos/efeitos dos fármacos , Receptores Nicotínicos/efeitos dos fármacosRESUMO
We describe a Spanish adaptation and standardization of the Alzheimer's Disease Assessment Scale (ADAS) carried out as part of a prospective, coordinated study performed simultaneously in two Spanish health centers. Three diagnostic groups were defined: 21 healthy volunteers (normal group); 22 patients with cognitive deterioration but no dementia (CDND group); and 20 patients with Alzheimer type dementia (ATD group). The subjects were examined at the start of the study and after 3 and 6 months. The mean cognitive ADAS scores were significantly different in the 3 groups (F = 67.2, p = 0.0001), as follows: normal group, 7.6 +/- 2.1; CDND group, 12.4 +/- 4.5; and ATD group, 21.0 +/- 4.7. Likewise, the ADAS proved sensitive to the course of deterioration in the ATD group, while the other groups' scores improved. We conclude that the ADAS, and in particular the cognitive subscale, is useful for evaluating ATD patients, especially in the early phases of deterioration. It discriminates between ATD and CDND patients well.
Assuntos
Doença de Alzheimer/diagnóstico , Testes Neuropsicológicos/normas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , TraduçõesRESUMO
In order to evaluate the relationship between perfusion brain SPECT and specific cognitive functions as well as the possible influence of the illness severity on them, 34 patients clinically diagnosed as probable Alzheimer disease (AD) and 12 elderly controls were studied. AD patients were subdivided according to severity as 16 mild AD and 18 moderate AD. Neuropsychological battery of CERAD protocol and a semiquantitative analysis of 99mTc-HMPAO-SPECT images was carried out in all groups. With regard to the regions affected in SPECT, involvement of temporo-parietal cortex were of most use in discriminating between AD patients and controls, but only temporal hipoperfusion distinguished mild disease from controls. Memory and praxis impairment correlated with temporo-parietal perfusion. Frontal involvement seemed to be a discriminator of disease progression, nevertheless, a significant correlation was present between memory and frontal hipoperfusion indicating the diffuse and sometimes heterogeneous distribution of AD pathology.
Assuntos
Doença de Alzheimer/diagnóstico por imagem , Córtex Cerebral/diagnóstico por imagem , Testes Neuropsicológicos , Tomografia Computadorizada de Emissão de Fóton Único , Idoso , Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Córtex Cerebral/irrigação sanguínea , Progressão da Doença , Feminino , Lobo Frontal/irrigação sanguínea , Lobo Frontal/diagnóstico por imagem , Humanos , Masculino , Transtornos da Memória/diagnóstico por imagem , Transtornos da Memória/etiologia , Pessoa de Meia-Idade , Lobo Parietal/irrigação sanguínea , Lobo Parietal/diagnóstico por imagem , Índice de Gravidade de Doença , Tecnécio Tc 99m Exametazima , Lobo Temporal/irrigação sanguínea , Lobo Temporal/diagnóstico por imagemAssuntos
Antibacterianos/uso terapêutico , Antiparkinsonianos/uso terapêutico , Bromocriptina/uso terapêutico , Eritromicina/uso terapêutico , Doença de Parkinson/tratamento farmacológico , Psicoses Induzidas por Substâncias/etiologia , Idoso , Interações Medicamentosas , Feminino , Humanos , Doença de Parkinson/psicologiaAssuntos
Doença de Alzheimer/diagnóstico , Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/etiologia , Biomarcadores/líquido cefalorraquidiano , Humanos , Testes Neuropsicológicos , Tomografia Computadorizada de Emissão , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XAssuntos
Comportamento Animal/efeitos dos fármacos , Dopaminérgicos/toxicidade , Agonistas de Dopamina/farmacologia , Intoxicação por MPTP , Receptores de Dopamina D1/agonistas , Receptores de Dopamina D2/agonistas , Animais , Antiparkinsonianos/farmacologia , Tolerância a Medicamentos , Feminino , Indóis/farmacologia , Macaca fascicularis , Masculino , Movimento/efeitos dos fármacos , Oxazinas/farmacologia , Fenantridinas/farmacologiaAssuntos
Transtornos de Enxaqueca/diagnóstico , Adolescente , Adulto , Fatores Etários , Idade de Início , Idoso , Encéfalo/fisiopatologia , Criança , Pré-Escolar , Diagnóstico Diferencial , Ergotamina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos de Enxaqueca/fisiopatologia , Fatores Sexuais , Sumatriptana/uso terapêutico , Vasoconstritores/uso terapêuticoAssuntos
Encéfalo/fisiopatologia , Artérias Cerebrais/fisiopatologia , Transtornos de Enxaqueca/fisiopatologia , Encéfalo/irrigação sanguínea , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Neurotransmissores/química , Agonistas do Receptor de Serotonina/uso terapêutico , Sumatriptana/uso terapêuticoRESUMO
We investigated the prevalence of dementing disorders in the city of Pamplona, Spain, using a door-to-door two-phase approach. We first administered the Cambridge Examination of Mental Disorders of the Elderly (CAMDEX) to all survivors, as of March 1, 1991, of a probability sample of the total population identified in 1989 (n = 1,127). Using specified diagnostic criteria, the study neurologists extensively investigated those subjects who screened positive on CAMDEX. We found 194 subjects affected by dementia, 119 had Alzheimer's disease; 51 vascular or mixed dementia, and 16 secondary dementia. The prevalence of both dementia and Alzheimer's disease increased steeply with advancing age and was consistently higher in women. The prevalence of combined vascular and mixed dementia increased less rapidly with age, and was generally higher in men. Alzheimer's disease was the most common type of dementia. Our prevalence figures for dementia and Alzheimer's disease are similar to those previously reported in Europe.