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1.
Environ Health Prev Med ; 25(1): 64, 2020 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129280

RESUMO

BACKGROUND: The burden of dementia is growing rapidly and has become a medical and social problem in Japan. Prospective cohort studies have been considered an effective methodology to clarify the risk factors and the etiology of dementia. We aimed to perform a large-scale dementia cohort study to elucidate environmental and genetic risk factors for dementia, as well as their interaction. METHODS: The Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD) is a multisite, population-based prospective cohort study of dementia, which was designed to enroll approximately 10,000 community-dwelling residents aged 65 years or older from 8 sites in Japan and to follow them up prospectively for at least 5 years. Baseline exposure data, including lifestyles, medical information, diets, physical activities, blood pressure, cognitive function, blood test, brain magnetic resonance imaging (MRI), and DNA samples, were collected with a pre-specified protocol and standardized measurement methods. The primary outcome was the development of dementia and its subtypes. The diagnosis of dementia was adjudicated by an endpoint adjudication committee using standard criteria and clinical information according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised Edition. For brain MRI, three-dimensional acquisition of T1-weighted images was performed. Individual participant data were pooled for data analyses. RESULTS: The baseline survey was conducted from 2016 to 2018. The follow-up surveys are ongoing. A total of 11,410 individuals aged 65 years or older participated in the study. The mean age was 74.4 years, and 41.9% were male. The prevalence of dementia at baseline was 8.5% in overall participants. However, it was 16.4% among three sites where additional home visit and/or nursing home visit surveys were performed. Approximately two-thirds of dementia cases at baseline were Alzheimer's disease. CONCLUSIONS: The prospective cohort data from the JPSC-AD will provide valuable insights regarding the risk factors and etiology of dementia as well as for the development of predictive models and diagnostic markers for the future onset of dementia. The findings of this study will improve our understanding of dementia and provide helpful information to establish effective preventive strategies for dementia in Japan.


Assuntos
Demência/epidemiologia , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/etiologia , Doença de Alzheimer/genética , Demência/etiologia , Demência/genética , Meio Ambiente , Feminino , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco
2.
J Korean Med Sci ; 35(42): e383, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33140593

RESUMO

Multiple neurological complications have been associated with the coronavirus disease-19 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2. This is a narrative review to gather information on all aspects of COVID-19 in elderly patients with cognitive impairment. First, the following three mechanisms have been proposed to underlie the neurological complications associated with COVID-19: 1) direct invasion, 2) immune and inflammatory reaction, and 3) hypoxic brain damage by COVID-19. Next, because the elderly dementia patient population is particularly vulnerable to COVID-19, we discussed risk factors and difficulties associated with cognitive disorders in this vulnerable population. We also reviewed the effects of the patient living environment in COVID-19 cases that required intensive care unit (ICU) care. Furthermore, we analyzed the impact of stringent social restrictions and COVID-19 pandemic-mediated policies on dementia patients and care providers. Finally, we provided the following strategies for working with elderly dementia patients: general preventive methods; dementia care at home and nursing facilities according to the activities of daily living and dementia characteristics; ICU care after COVID-19 infection; and public health care system and government response. We propose that longitudinal follow-up studies are needed to fully examine COVID-19 associated neurological complications, such as dementia, and the efficacy of telemedicine/telehealth care programs.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Demência/epidemiologia , Serviços de Saúde para Idosos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Atividades Cotidianas , Idoso , Betacoronavirus , Encéfalo/fisiopatologia , Cuidadores , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Infecções por Coronavirus/complicações , Cuidados Críticos , Demência/complicações , Humanos , Hipóxia , Sistema Imunitário , Inflamação , Casas de Saúde , Pneumonia Viral/complicações , Medicina Preventiva , Saúde Pública , Fatores de Risco , Isolamento Social , Telemedicina
6.
Isr J Health Policy Res ; 9(1): 50, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023673

RESUMO

Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) constitute a worldwide public health crisis. In light of the AD/ADRD epidemic now existing within the global COVID-19 pandemic, the need for global action to improve dementia care is greater than ever. The article collection "Dementia- an Interdisciplinary Approach," in the Israeli Journal of Health Policy and Research (IJHPR) highlights the need for interprofessional approaches to improving outcomes for people living with dementia and their care partners, as well as the complexities of conducting dementia care research.


Assuntos
Demência/terapia , Política de Saúde , Pesquisa sobre Serviços de Saúde , Publicações Periódicas como Assunto , Demência/epidemiologia , Humanos , Israel/epidemiologia
7.
JAMA ; 324(14): 1439-1450, 2020 10 13.
Artigo em Inglês | MEDLINE | ID: mdl-33048152

RESUMO

Importance: The evidence for palliative care exists predominantly for patients with cancer. The effect of palliative care on important end-of-life outcomes in patients with noncancer illness is unclear. Objective: To measure the association between palliative care and acute health care use, quality of life (QOL), and symptom burden in adults with chronic noncancer illnesses. Data Sources: MEDLINE, Embase, CINAHL, PsycINFO, and PubMed from inception to April 18, 2020. Study Selection: Randomized clinical trials of palliative care interventions in adults with chronic noncancer illness. Studies involving at least 50% of patients with cancer were excluded. Data Extraction and Synthesis: Two reviewers independently screened, selected, and extracted data from studies. Narrative synthesis was conducted for all trials. All outcomes were analyzed using random-effects meta-analysis. Main Outcomes and Measures: Acute health care use (hospitalizations and emergency department use), disease-generic and disease-specific quality of life (QOL), and symptoms, with estimates of QOL translated to units of the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (range, 0 [worst] to 184 [best]; minimal clinically important difference, 9 points) and symptoms translated to units of the Edmonton Symptom Assessment Scale global distress score (range, 0 [best] to 90 [worst]; minimal clinically important difference, 5.7 points). Results: Twenty-eight trials provided data on 13 664 patients (mean age, 74 years; 46% were women). Ten trials were of heart failure (n = 4068 patients), 11 of mixed disease (n = 8119), 4 of dementia (n = 1036), and 3 of chronic obstructive pulmonary disease (n = 441). Palliative care, compared with usual care, was statistically significantly associated with less emergency department use (9 trials [n = 2712]; 20% vs 24%; odds ratio, 0.82 [95% CI, 0.68-1.00]; I2 = 3%), less hospitalization (14 trials [n = 3706]; 38% vs 42%; odds ratio, 0.80 [95% CI, 0.65-0.99]; I2 = 41%), and modestly lower symptom burden (11 trials [n = 2598]; pooled standardized mean difference (SMD), -0.12; [95% CI, -0.20 to -0.03]; I2 = 0%; Edmonton Symptom Assessment Scale score mean difference, -1.6 [95% CI, -2.6 to -0.4]). Palliative care was not significantly associated with disease-generic QOL (6 trials [n = 1334]; SMD, 0.18 [95% CI, -0.24 to 0.61]; I2 = 87%; Functional Assessment of Chronic Illness Therapy-Palliative Care score mean difference, 4.7 [95% CI, -6.3 to 15.9]) or disease-specific measures of QOL (11 trials [n = 2204]; SMD, 0.07 [95% CI, -0.09 to 0.23]; I2 = 68%). Conclusions and Relevance: In this systematic review and meta-analysis of randomized clinical trials of patients with primarily noncancer illness, palliative care, compared with usual care, was statistically significantly associated with less acute health care use and modestly lower symptom burden, but there was no significant difference in quality of life. Analyses for some outcomes were based predominantly on studies of patients with heart failure, which may limit generalizability to other chronic illnesses.


Assuntos
Demência/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/terapia , Cuidados Paliativos/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/terapia , Qualidade de Vida , Idoso , Viés , Doença Crônica , Demência/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Razão de Chances , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Avaliação de Sintomas/estatística & dados numéricos
8.
J Water Health ; 18(5): 722-727, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33095195

RESUMO

Although dementia affects roughly 50 million people worldwide, its etiology is largely unknown. Recent studies have found a link between hypermagnesemia, hypomagnesemia, and increased risk of dementia. In this study, we explore the link between serum magnesium levels and the prevalence of dementia following the adoption of desalinated water (DSW) in Israel. DSW contains no magnesium, and relying on it for drinking water can lead to an increased incidence of hypomagnesia. Our objective was to analyze in a treat-control context how the switch to desalinated drinking water affected serum magnesium concentrations and the prevalence of dementia. We selected two cities which differed in terms of their access to underground aquifers but were otherwise similar. Rehovot has no underground water and uses over 90% DSW, whereas Kfar Saba relies almost entirely on its own aquifers. The cities are otherwise relatively similar in terms of their demographic composition. Using medical records for all subjects insured by the Maccabi Health Services in Rehovot (n = 23,991) and Kfar Saba (n = 20,541), we examined mean serum concentrations of Mg in the period prior to desalination (2001-2006) and post-desalination (2007-2018). Dementia prevalence is taken from 2007 to 2020 for the same coverage population. Serum magnesium levels were significantly lower in Rehovot following the switch to DSW (2.067 ± 0.21 pre-desalination and 2.059 ± 0.216 post-desalination, p < 0.01). In contrast, serum magnesium levels increased in Kfar Saba, which continued to rely on groundwater (2.008 ± 0.179 vs. 2.067 ± 0.206, p < 0.01). The prevalence of dementia was similar in the two cities (488/20,541, 2.37% in Rehovot and 613/23,991, 2.55% in Kfar Saba). In this ecological study, the adoption of DSW was associated with a significant decrease in serum magnesium concentrations. However, this change was not associated with a higher prevalence of dementia. While this association study cannot rule out some effect of hypomagnesemia on dementia morbidity, it suggests that the effect, if it exists, is relatively small.


Assuntos
Demência , Água Potável , Cidades , Demência/epidemiologia , Humanos , Israel/epidemiologia , Magnésio , Água do Mar
9.
Epidemiol Psychiatr Sci ; 29: e176, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33077022

RESUMO

AIMS: To investigate the association between parity and the risk of incident dementia in women. METHODS: We pooled baseline and follow-up data for community-dwelling women aged 60 or older from six population-based, prospective cohort studies from four European and two Asian countries. We investigated the association between parity and incident dementia using Cox proportional hazards regression models adjusted for age, educational level, hypertension, diabetes mellitus and cohort, with additional analysis by dementia subtype (Alzheimer dementia (AD) and non-Alzheimer dementia (NAD)). RESULTS: Of 9756 women dementia-free at baseline, 7010 completed one or more follow-up assessments. The mean follow-up duration was 5.4 ± 3.1 years and dementia developed in 550 participants. The number of parities was associated with the risk of incident dementia (hazard ratio (HR) = 1.07, 95% confidence interval (CI) = 1.02-1.13). Grand multiparity (five or more parities) increased the risk of dementia by 30% compared to 1-4 parities (HR = 1.30, 95% CI = 1.02-1.67). The risk of NAD increased by 12% for every parity (HR = 1.12, 95% CI = 1.02-1.23) and by 60% for grand multiparity (HR = 1.60, 95% CI = 1.00-2.55), but the risk of AD was not significantly associated with parity. CONCLUSIONS: Grand multiparity is a significant risk factor for dementia in women. This may have particularly important implications for women in low and middle-income countries where the fertility rate and prevalence of grand multiparity are high.


Assuntos
Doença de Alzheimer/epidemiologia , Demência/epidemiologia , Paridade/fisiologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Psiquiatria Geriátrica , Humanos , Incidência , Vida Independente , Pessoa de Meia-Idade , Gravidez , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Fatores de Risco , Fatores Socioeconômicos
10.
PLoS One ; 15(9): e0238690, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915845

RESUMO

BACKGROUND: There is a need for outcome measures with improved responsiveness to changes in pre-dementia populations. Both cognitive and motor function play important roles in neurodegeneration; motor function decline is detectable at early stages of cognitive decline. This proof of principle study used a Pooled Index approach to evaluate improved responsiveness of the predominant outcome measure (ADAS-Cog: Alzheimer's Disease Assessment Scale-Cognitive Subscale) when assessment of motor function is added. METHODS: Candidate Pooled Index variables were selected based on theoretical importance and pairwise correlation coefficients. Kruskal-Wallis and Mann-Whitney U tests assessed baseline discrimination. Standardized response means assessed responsiveness to longitudinal change. RESULTS: Final selected variables for the Pooled Index include gait velocity, dual-task cost of gait velocity, and an ADAS-Cog-Proxy (statistical approximation of the ADAS-Cog using similar cognitive tests). The Pooled Index and ADAS-Cog-Proxy scores had similar ability to discriminate between pre-dementia syndromes. The Pooled Index demonstrated trends of similar or greater responsiveness to longitudinal decline than ADAS-Cog-Proxy scores. CONCLUSION: Adding motor function assessments to the ADAS-Cog may improve responsiveness in pre-dementia populations.


Assuntos
Doença de Alzheimer/fisiopatologia , Cognição/fisiologia , Disfunção Cognitiva/fisiopatologia , Marcha/fisiologia , Idoso , Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Demência/fisiopatologia , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Índice de Gravidade de Doença , Estatísticas não Paramétricas
12.
Aging Clin Exp Res ; 32(10): 2133-2140, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32918696

RESUMO

BACKGROUND: COVID-19 outbreak has led to severe health burden in the elderly. Age, morbidity and dementia have been associated with adverse outcome. AIMS: To evaluate the impact of COVID-19 on health status in home-dwelling patients. METHODS: 848 home-dwelling outpatients with dementia contacted from April 27 to 30 and evaluated by a semi-structured interview to evaluate possible health complication due to COVID-19 from February 21 to April 30. Age, sex, education, clinical characteristics (including diagnosis of dementia) and flu vaccination history were obtained from previous medical records. Items regarding change in health status and outcome since the onset of the outbreak were collected. COVID-19 was diagnosed in patients who developed symptoms according to WHO criteria or tested positive at nasal/throat swab if hospitalized. Unplanned hospitalization, institutionalization and mortality were recorded. RESULTS: Patients were 79.7 years old (SD 7.1) and 63.1% were females. Ninety-five (11.2%) patients developed COVID-19-like symptoms. Non COVID-19 and COVID-19 patients differed for frequency of diabetes (18.5% vs. 37.9%, p < 0.001), COPD (7.3% vs. 18.9%, p < 0.001), and previous flu vaccination (56.7% vs. 37.9%, p < 0.001). Diabetes and COPD were positively associated with COVID-19, whereas higher dementia severity and flu vaccination showed an inverse association. Among COVID-19 patients, 42 (44.2%) were hospitalized while 32 (33.7%) died. Non COVID-19 patients' hospitalization and mortality rate were 1.9% and 1.2%, respectively. COVID-19 and COPD were significantly associated with the rate of mortality. DISCUSSION/CONCLUSIONS: A high proportion of adverse outcome related to COVID-19 was observed in home-dwelling elderly patients with dementia. Active monitoring though telehealth programs would be useful particularly for those at highest risk of developing COVID-19 and its adverse outcomes.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Demência/epidemiologia , Demência/mortalidade , Nível de Saúde , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Idoso , Betacoronavirus , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pandemias
13.
N Z Med J ; 133(1522): 112-127, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994621

RESUMO

Dementia is recognised to be one of the most challenging diseases facing society, both now and in the future, with its prevalence estimated to increase substantially by 2050. The potential contributions of age-related sensory deficits have attracted little attention until recently, when a landmark study suggested that hearing loss could be a greater risk factor for dementia than hypertension, obesity, smoking, depression, physical inactivity or social isolation. Over the last decade, evidence has been gradually accumulating to suggest that the other part of the inner ear, the balance organs or 'vestibular system', might also be important in the development of cognitive dysfunction and dementia. Increasing evidence suggests that dizziness associated with vestibular dysfunction, a common reason for patients consulting their GPs, increases the risk of cognitive dysfunction, including dementia, and our understanding of the basic neurobiology of this sensory system supports this view. This paper aims to review and critically evaluate the relevant evidence.


Assuntos
Disfunção Cognitiva , Demência , Tontura , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/complicações , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/fisiopatologia , Demência/complicações , Demência/epidemiologia , Demência/fisiopatologia , Tontura/complicações , Tontura/epidemiologia , Tontura/fisiopatologia , Perda Auditiva , Humanos , Fatores de Risco , Doenças Vestibulares
14.
PLoS One ; 15(9): e0237676, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946449

RESUMO

OBJECTIVES: Proton pump inhibitors (PPIs) are commonly prescribed for prevention and treatment of gastrointestinal conditions or for gastroprotection from other drugs. Research suggests they are linked to increased dementia risk. We use linked national health data to examine the association between PPI use and the development of incident dementia. METHODS AND FINDINGS: A population-based study using electronic health-data from the Secure Anonymised Information Linkage (SAIL) Databank, Wales (UK) from 1999 to 2015. Of data available on 3,765,744 individuals, a cohort who had ever been prescribed a PPI was developed (n = 183,968) for people aged 55 years and over and compared to non-PPI exposed individuals (131,110). Those with prior dementia, mild-cognitive-impairment or delirium codes were excluded. Confounding factors included comorbidities and/or drugs associated with them. Comorbidities might include head injury and some examples of medications include antidepressants, antiplatelets and anticoagulants. These commonly prescribed drugs were investigated as it was not feasible to explore all drugs in this study. The main outcome was a diagnosis of incident dementia. Cox proportional hazard regression modelling was used to calculate the Hazard ratio (HR) of developing dementia in PPI-exposed compared to unexposed individuals while controlling for potential confounders. The mean age of the PPI exposed individuals was 69.9 years and 39.8% male while the mean age of the unexposed individuals was 72.1 years and 41.1% male. The rate of PPI usage was 58.4% (183,968) and incident dementia rate was 11.8% (37,148/315,078). PPI use was associated with decreased dementia risk (HR: 0.67, 95% CI: 0.65 to 0.67, p<0.01). CONCLUSIONS: This study, using large-scale, multi-centre health-data was unable to confirm an association between PPI use and increased dementia risk. Previously reported links may be associated with confounders of people using PPI's, such as increased risk of cardiovascular disease and/or depression and their associated medications which may be responsible for any increased risk of developing dementia.


Assuntos
Demência/induzido quimicamente , Inibidores da Bomba de Prótons/efeitos adversos , Idoso , Estudos de Coortes , Demência/epidemiologia , Feminino , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/prevenção & controle , Humanos , Masculino , Modelos de Riscos Proporcionais , Inibidores da Bomba de Prótons/uso terapêutico , Fatores de Risco , País de Gales/epidemiologia
15.
PLoS One ; 15(9): e0236400, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970677

RESUMO

This study investigates the use of deep learning methods to improve the accuracy of a predictive model for dementia, and compares the performance to a traditional machine learning model. With sufficient accuracy the model can be deployed as a first round screening tool for clinical follow-up including neurological examination, neuropsychological testing, imaging and recruitment to clinical trials. Seven cohorts with two years of data, three to eight years prior to index date, and an incident cohort were created. Four trained models for each cohort, boosted trees, feed forward network, recurrent neural network and recurrent neural network with pre-trained weights, were constructed and their performance compared using validation and test data. The incident model had an AUC of 94.4% and F1 score of 54.1%. Eight years removed from index date the AUC and F1 scores were 80.7% and 25.6%, respectively. The results for the remaining cohorts were between these ranges. Deep learning models can result in significant improvement in performance but come at a cost in terms of run times and hardware requirements. The results of the model at index date indicate that this modeling can be effective at stratifying patients at risk of dementia. At this time, the inability to sustain this quality at longer lead times is more an issue of data availability and quality rather than one of algorithm choices.


Assuntos
Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Aprendizado Profundo , Demência/epidemiologia , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Redes Neurais de Computação , Fatores de Risco
16.
Medicine (Baltimore) ; 99(36): e22141, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899101

RESUMO

The aim of this case-control study was to evaluate the association between chronic rhinosinusitis (CRS) and neurodegenerative dementia in a large representative Korean population. The ≥ 50-year-old population was selected from the Korean Health Insurance Review and Assessment Service - National Sample Cohort from 2002 to 2015. A total of 17,634 neurodegenerative dementia patients were matched in a 1:4 ratio with 70,536 control participants for age, sex, income, and region of residence. Neurodegenerative dementia was defined using the ICD-10 codes G30 and F00. CRS was identified based on the ICD-10 code J32. Among the cohort, we selected participants who were treated ≥ 2 times and those who underwent head and neck computed tomography. The odds ratio (OR) for CRS in patients with dementia was analyzed using a conditional logistic regression model. Subgroup analyses were conducted according to age and sex. There was no difference in the prevalence of CRS with/without nasal polyps between the dementia (1.1%) and control (1.2%) groups (P = .825). CRS with/without nasal polyps was not significantly associated with dementia (adjusted OR = 0.96, 95% CI = 0.82-1.13, P = .653). In the subgroup analyses according to age and sex, the adjusted ORs for CRS with/without nasal polyps were not higher in the dementia group than in the control group. Previous CRS was not associated with neurodegenerative dementia in the Korean population.


Assuntos
Doença de Alzheimer/epidemiologia , Pólipos Nasais/epidemiologia , Sinusite/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Demência/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Características de Residência , Fatores de Risco , Fatores Sexuais
19.
Neurology ; 95(14): e1941-e1950, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-32732296

RESUMO

OBJECTIVE: To test the hypothesis that orthostatic hypotension (OH) might cause cerebral hypoperfusion and injury, we examined the longitudinal relationship between OH or orthostatic symptoms and incident neurologic outcomes in a community population of older adults. METHODS: Cardiovascular Health Study participants (≥65 years) without dementia or stroke had blood pressure (BP) measured after lying down for 20 minutes and after standing 3 for minutes. Participants reported dizziness immediately upon standing and any dizziness in the past 2 weeks. OH was defined as a drop in standing systolic/diastolic BP ≥20/≥10 mm Hg. We determined the association between OH or dizziness with (1) MRI brain findings (ventricular size, white matter hyperintensities, brain infarcts) using linear or logistic regression, (2) cognitive function (baseline and over time) using generalized estimating equations, and (3) prospective adjudicated events (dementia, stroke, death) using Cox models. Models were adjusted for demographic characteristics and OH risk factors. We used multiple imputation to account for missing OH or dizziness (n = 534). RESULTS: Prior to imputation, there were 5,007 participants (mean age 72.7 ± 5.5 years, 57.6% women, 10.9% Black, 16% with OH). OH was modestly associated with death (hazard ratio [HR] 1.11; 95% confidence interval 1.02-1.20), but not MRI findings, cognition, dementia, or stroke. In contrast, dizziness upon standing was associated with lower baseline cognition (ß = -1.20; -1.94 to -0.47), incident dementia (HR 1.32; 1.04-1.62), incident stroke (HR 1.22; 1.06-1.41), and death (HR 1.13; 1.06-1.21). Similarly, dizziness over the past 2 weeks was associated with higher white matter grade (ß = 0.16; 0.03-0.30), brain infarcts (OR 1.31; 1.06-1.63), lower baseline cognition (ß = -1.18; -2.01 to -0.34), and death (HR 1.13; 1.04-1.22). CONCLUSIONS: Dizziness was more consistently associated with neurologic outcomes than OH 3 minutes after standing. Delayed OH assessments may miss pathologic information related to cerebral injury.


Assuntos
Encéfalo/patologia , Cognição/fisiologia , Tontura , Hipotensão Ortostática , Idoso , Demência/epidemiologia , Tontura/fisiopatologia , Feminino , Humanos , Hipotensão Ortostática/fisiopatologia , Masculino , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
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