Cambios en la marcha asociados con demencia por cuerpos de Lewy: una revisión narrativa de la literatura / Gait changes associated with Lewy body dementia: a narrative review of the literature

RESUMEN INTRODUCCIÓN: La demencia por cuerpos de Lewy (DCL) es una enfermedad neurodegenerativa con alta prevalencia y a menudo subdiagnosticada. En las demencias pueden presentarse alteraciones en la marcha que potencialmente permitan identificar su subtipo y dar una orientación clínica, diagnóstica y terapéutica temprana. Esta revisión narrativa de la literatura busca revisar los cambios de la marcha que se han descrito asociados con DCL. MATERIALES Y MÉTODOS: Se realizó una revisión de la literatura sobre la relación de las alteraciones de la marcha con la DCL. Se seleccionaron los siguientes parámetros de búsqueda mediante el buscador Scopus: ((falls and dementia and gait and (evaluation or analysis))). Los datos se ordenaron según relevancia y se obtuvieron 267 resultados. Igualmente, se hizo una búsqueda en PubMed, para a la que se introdujeron los términos (gait and lewy-body-disease), y no se utilizaron otros filtros; se obtuvieron 139 resultados. Se hizo una selección no sistemática de los artículos para llevar a cabo una revisión narrativa acerca de los cambios en la marcha asociados con DCL. RESULTADOS: Las alteraciones en la marcha pueden tener un valor predictor importante en la DCL. Los pacientes con demencias no debido a EA o causas vasculares muestran un deterioro de la funcionalidad física más rápido comparado con pacientes con EA y sin problemas cognitivos. La priorización incorrecta de las tareas, evidenciada en la EP, también es observable en los pacientes con DCL, y se asocia con el paradigma de doble tarea en el paciente con trastorno neurocognitivo mayor. El congelamiento de la marcha, también conocido como bloqueo de la marcha, se ha asociado con mayor progresión de la alteración cognitiva. Los pacientes con DCL también presentan un mayor compromiso en el tiempo de balanceo y la variabilidad de duración de la zancada, como también peor desempeño en ritmo y variabilidad de la marcha, e inestabilidad de la marcha, con posturas inadecuadas. CONCLUSIONES: Existe una relación entre la DCL y las caídas en el adulto mayor. En este grupo de edad, los cambios en la marcha y en las pruebas de desempeño podrían tener una utilidad clínica como factores asociados a con DCL, así como con las caídas. Al parecer, existe una variación característica entre los parámetros de la marcha y los subtipos de demencias que puede tener un valor como marcador diagnóstico. Se requieren más estudios con respecto a este tema puesto que hay escasa evidencia disponible hasta el momento, lo cual impide definir con mayor precisión las alteraciones más sensibles de cada dominio de la marcha que permitan diferenciar el envejecimiento normal del patológico.

ABSTRACT INTRODUCTION: Lewy body dementia is a highly prevalent neurodegenerative disease and often goes unnoticed due to little knowledge about it. In dementias there may be gait alterations that potentially allow the identification of its subtype and provide early clinical, diagnostic, and therapeutic guidance. This narrative review of the literature aims to review gait changes that have been described as associated with Lewy body dementia. MATERIALS AND METHODS: A literature review was carried out on the relationship of gait disturbances and LBD. The following search parameters were selected using the Scopus search engine: ((falls and dementia and gait and (evaluation or analysis))). The data were ordered according to relevance, obtaining 267 results. Likewise, a search was made in PubMed, using the terms (gait and lewy-body-disease), and no other filters were used, obtaining 139 results. A non-systematic selection of literature was made to carry out a narrative review about the changes in gait associated with LBD. RESULTS: We found that gait disturbances may have an important predictive value in LBD. Patients with dementias not due to AD or vascular causes have a faster deterioration of physical function compared to patients with AD and without cognitive problems. The incorrect prioritization of tasks evidenced in PD is also observable in patients with LBD and is associated with the "dual-task" paradigm in patients with major neurocognitive disorder. Freezing of gait, also known as motor block or "freezing of gait" has been associated with a greater progression of cognitive impairment. Patients with LBD also show greater compromise in swing time, stride duration variability, poorer performance in gait pace and variability, and gait instability with inappropriate postures. CONCLUSIONS: We observe that there is a relationship between LBD and falls in the elderly. Changes in gait and performance tests could have clinical utility as factors associated with LBD as well as falls in the elderly. There appears to be a characteristic variation between gait parameters and dementia subtypes that may have value as a diagnostic marker. More studies are required on this subject since there is little evidence available to date, which makes it impossible to define with greater precision the most sensitive alterations in each domain of gait that make it possible to differentiate normal from pathological aging.

COVID-19 related mortality in older adults: analysis of the first wave in Colombia and Mexico.

OBJECTIVE: The aim of this study is to describe the mortality among older adults in the first wave of COVID-19 in Colombia and Mexico. METHODS: This is an observational, prospective study on data obtained from open data sets that are publicly available on the websites of the health ministries of the respective countries. COVID-19 cases, age, sex, date to mortality, and mortality itself were analyzed with Kaplan-Meier curves and Cox regressions. RESULTS: Data on 1 779 877 individuals were analyzed, 58.2% from Mexico, with a higher frequency of men for both countries, and 11.7% were older adults. Survival curves show a continuous increase in mortality for Mexico, with higher rates for older adults, while for Colombia the mortality was observed up to 50 days of the follow-up. Finally, hazard ratios were higher for older adults in both countries. Colombia implemented a rigid curfew for older adults, and the effect on mortality is clear from the survival curves. CONCLUSIONS: This finding shows the potential benefit that public policies could have on older adults.

COVID-19 related mortality in older adults: analysis of the first wave in Colombia and Mexico

[ABSTRACT]. Objective. The aim of this study is to describe the mortality among older adults in the first wave of COVID-19 in Colombia and Mexico. Methods. This is an observational, prospective study on data obtained from open data sets that are publicly available on the websites of the health ministries of the respective countries. COVID-19 cases, age, sex, date to mortality, and mortality itself were analyzed with Kaplan-Meier curves and Cox regressions. Results. Data on 1 779 877 individuals were analyzed, 58.2% from Mexico, with a higher frequency of men for both countries, and 11.7% were older adults. Survival curves show a continuous increase in mortality for Mexico, with higher rates for older adults, while for Colombia the mortality was observed up to 50 days of the follow-up. Finally, hazard ratios were higher for older adults in both countries. Colombia implemented a rigid curfew for older adults, and the effect on mortality is clear from the survival curves. Conclusions. This finding shows the potential benefit that public policies could have on older adults.

[RESUMEN]. Objetivo. El propósito de este estudio es describir la mortalidad en personas mayores durante la primera ola de la COVID-19 en Colombia y México. Métodos. Se trata de un estudio prospectivo observacional realizado sobre la base de la información obtenida de los conjuntos de datos abiertos disponibles públicamente en los sitios web de los ministerios de salud de estos países. Se analizaron los casos de COVID-19, la edad, el sexo, la fecha de mortalidad y la propia mor- talidad con curvas de Kaplan-Meier y regresiones de Cox. Resultados. Se analizaron los datos de 1 779 877 personas, 58,2% de México, con una mayor frecuencia de hombres en ambos países y 11,7% de los cuales eran personas mayores. Las curvas de supervivencia muestran un incremento continuo de la mortalidad en México, con las tasas más altas en personas mayores, mientras que en el caso de Colombia se observó la mortalidad hasta 50 días durante el seguimiento. Por último, las razones de riesgo fueron mayores en las personas mayores de ambos países. Colombia puso en marcha un estricto toque de queda para las personas mayores y su efecto sobre la mortalidad resulta patente en las curvas de supervivencia. Conclusiones. Estos resultados muestran los posibles beneficios de las políticas públicas dirigidas a las personas mayores.

[RESUMO]. Objetivo. O objetivo deste estudo é descrever a mortalidade entre idosos na primeira onda de COVID-19 na Colômbia e no México. Métodos. Este é um estudo prospectivo observacional com dados obtidos de conjuntos de dados aber- tos disponíveis publicamente nos sites dos ministérios da saúde dos respectivos países. Foram analisados casos de COVID-19, idade, sexo, tempo até a morte e mortalidade em si, usando curvas de Kaplan-Meier e regressões de Cox. Resultados. Foram analisados dados de 1 779 877 indivíduos, 58,2% deles do México, com uma maior frequência de homens nos dois países; 11,7% eram idosos. As curvas de sobrevida mostram um aumento contínuo da mortalidade no México, com taxas mais altas para idosos, ao passo que na Colômbia a mortali- dade foi observada dentro de um período de até 50 dias de acompanhamento. Além disso, nos dois países as razões de risco foram mais altas para idosos. A Colômbia implementou um toque de recolher rigoroso para os idosos, e o efeito sobre a mortalidade é evidente com base nas curvas de sobrevida. Conclusões. Este achado demonstra o potencial benefício que as políticas públicas poderiam ter para os idosos.

ASSOCIATION OF DEPRESSIVE SYMPTOMS AND SUBJECTIVE MEMORY COMPLAINTS WITH THE INCIDENCE OF COGNITIVE IMPAIRMENT IN OLDER ADULTS WITH HIGH BLOOD PRESSURE.

PURPOSE: High blood pressure is a relevant risk factor for vascular damage, leading to development of depressive symptoms and dementia in older adults. Moreover, subjective memory complaints are recognized as an early marker of cognitive impairment. However, it has been established that subjective memory complaints could also be a reflection of depressive symptoms. The objective of this paper is to assess the impact of depressive symptoms and subjective memory complaints on the incidence of cognitive impairment in older adults with high blood pressure. METHODS: This is a secondary analysis of the Mexican Health and Aging Study, a representative cohort composed by individuals aged ≥ 50 years. Participants with cognitive impairment in 2012 were excluded since the outcome was incident cognitive impairment in 2015. Four groups were created according to depressive symptomatology and subjective memory complaints status, analyses were stratified according to blood pressure status. The odds incident cognitive impairment was estimated through logistic regression models. RESULTS: A total of 6,327 participants were included, from which 6.44% developed cognitive impairment. No differences were seen regarding the development of cognitive impairment in participants without high blood pressure. However, increased risk was evident in those with both high blood pressure and depressive symptoms (OR=2.1, 95% CI 1.09 - 4.09, p =0.026) as with high blood pressure, depressive symptoms and subjective memory complaints (OR=1.91, 9% CI 1.4 - 3.2, p= 0.001). CONCLUSION: Individuals with high blood pressure have a higher risk of developing incident cognitive impairment when depressive symptoms and/or subjective memory complaints are present. Our results suggest that a sequence of events related to altered cerebral vascular dynamics is possible.