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1.
Medicine (Baltimore) ; 99(5): e18919, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000401

RESUMO

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.


Assuntos
Apendicite/epidemiologia , Demência/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção da Dor , Risco , Adulto Jovem
2.
Medicine (Baltimore) ; 99(2): e18741, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914092

RESUMO

Inappropriate care for patients with cognitive dysfunction in the hospital could worsen quality of care and medical service satisfaction.All elderly participants were recruited from acute wards of 5 departments in an university hospital. They were administered the Chinese version of Ascertain Dementia 8 (AD8) at admission and the Nursing Service Satisfaction Questionnaire before discharge.A total of 345 participants completed the study. There were 91 (26.4%) participants with AD8 ≥ 2, the cut-off value of high risk of dementia. The prevalence was much higher than prior community-based reports. The Nursing Service Satisfaction Score was significantly lower in AD8 ≥ 2 than in AD8 < 2 (56.99 ±â€Š0.94 vs 60.55 ±â€Š0.48, P < .01).Using AD8 in hospital-based screening might be more efficient than in the community in terms of cost-effectiveness due to higher positive rate and easier approach to diagnostic facilities. AD8 ≥ 2 is also an indicator to identify care dissatisfaction among inpatients. By identifying patients with cognitive dysfunction, such as its related communication barriers, care systems could be tailored for more friendly services.


Assuntos
Demência/diagnóstico , Demência/enfermagem , Programas de Rastreamento/métodos , Satisfação do Paciente , Inquéritos e Questionários/normas , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Demência/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Reprodutibilidade dos Testes
3.
Psychiatr Prax ; 47(1): 16-21, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31671469

RESUMO

OBJECTIVE: In Germany, the number of patients with dementia is expected to increase from 1.7 (2017) to more than 3 million people (2050). Preventive and therapeutic measures target at early stages of dementia such as mild cognitive impairment (MCI). Aim of the study is to compare prevalence rates of MCI and dementia over time. METHODS: The study was based on the complete nation-wide outpatient claims data of the panel doctors services according to §â€Š295 SGB V. We identified prevalent patients with MCI (PwMCI) and with dementia (PwD) in the years 2009 to 2016 treated by general practitioners or neuropsychiatric specialists. RESULTS: The number of prevalent PwMCI/PwD increased from 50,760/1,014,381 (2009) to 166,919/1,416,319 (2016) and the corresponding prevalence rates from 0.13 % to 0.42 % (MCI) and from 2.52 % to 3.55 % (dementia), resp. CONCLUSION: Despite the significant prevalence gain, the number of PwMCI identified in outpatient health claims data is much lower than the expected number of 2,8 to 3,7 million people at the population level. Therefore, we anticipate a further increase in the number of PwMCI being treated in the outpatient sector over the coming years.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Feminino , Alemanha/epidemiologia , Setor de Assistência à Saúde , Humanos , Masculino , Testes Neuropsicológicos , Pacientes Ambulatoriais , Prevalência
4.
Tidsskr Nor Laegeforen ; 139(16)2019 Nov 05.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31686490

RESUMO

BACKGROUND: The prevalence of depression among older people amounts to 1-5 % at the diagnostic level. Depression in older people may be chronic and is associated with an increased risk of dementia. No longitudinal studies have been conducted of depression in older people in Norway. MATERIAL AND METHOD: We have undertaken a multi-centre longitudinal observation study of 160 patients aged 60 years and above who had been treated for depression in departments of old-age psychiatry at specialist healthcare services in Norway. The patients were followed up on four occasions over a three-year period. RESULTS: Of the 131 patients who completed the study, 24 (18.3 %) were free from depression and depressive symptoms at the points of follow-up after discharge, while 55 (42.0 % showed depressive symptoms and 51 (38.9 %) had suffered at least one serious relapse or had remained continuously ill with a depressive condition. The proportion of persons with dementia increased from 14 out of 160 (8.8 %) at the start of the study period to 40 out of 131 (30.5 %) after three years. INTERPRETATION: Older people with depression who have been treated in departments of old-age psychiatry in specialist healthcare services have an unfavourable prognosis regarding the course of their depression and development of dementia over a three-year period.


Assuntos
Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Demência/epidemiologia , Escolaridade , Feminino , Seguimentos , Psiquiatria Geriátrica , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Estado Civil , Serviços de Saúde Mental , Testes de Estado Mental e Demência , Noruega/epidemiologia , Prognóstico , Recidiva , Resultado do Tratamento
5.
Brain Nerve ; 71(11): 1236-1244, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31722309

RESUMO

Recent papers of amyotrophic lateral sclerosis/parkinsonism-dementia complex in the Kii peninsula, Japan (Kii ALS/PDC), published since 2015, were reviewed The studies included transition element of scalp hair analysis, dopaminergic PET study, review of life style changes in the high incident area, neurotoxic BMAA analysis, a clinical report of a migration case, comprehensive neuropathological study, cerebellar tau pathology, nitrative stress in the central nervous system study, optinurin pathology in the spinal cord, and tau PET study. Tau PET was advocated to be a new useful tool for diagnosis, even in the early stage of ALS/PDC with tauopathy. The etiology of Kii ALS/PDC remainds unknown. There are patients and healthy residents within the same environment in the high incidence foci, therefore it is difficult to explain this result by exposure to environmental factors alone. From the genetic viewpoint, rare-disease and rare-variant model may be applied to Kii ALS/PDC. Because there was an immigrant who was diagnosed neuropathologically, and a drastic decrease of the prevalence in the past several decades in the high incident area, it is feasible that Kii ALS/PDC is a multifactorial disease caused by both risk genes and environmental factors. Identifying risk genes and environmental factors for Kii ALS/PDC may contribute to the prevention of neurodegenerative diseases.


Assuntos
Esclerose Amiotrófica Lateral/epidemiologia , Demência/epidemiologia , Transtornos Parkinsonianos/epidemiologia , Humanos , Japão/epidemiologia
7.
BMC Public Health ; 19(1): 1442, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675931

RESUMO

BACKGROUND: This study explored the relationship between community social capital and cognitive impairment, with a focus on the buffering role of community social capital in the association between educational disadvantage and cognitive impairment in community-dwelling older adults in Japan. METHODS: We used data from two population-based, cross-sectional surveys targeting people aged ≥65 years in a suburban city of the Tokyo metropolitan area (n = 897; 49.8% men; average age = 74.4 years). Social capital included social support (emotional and instrumental support) and the strength of social networks (neighborly ties). To create district-level social capital indicators, we aggregated individual responses on social capital within each district. The Mini-Mental State Examination, Japanese version was used for the assessment of cognitive function. RESULTS: Using multilevel logistic regression analysis, we found that lower amounts of district-level emotional and instrumental support were associated with a greater likelihood of cognitive impairment among men. For women, district-level emotional support was associated with a greater likelihood of cognitive impairment. Additionally, a strong district-level social network buffered the relationship between low education and cognitive impairment in both sexes. CONCLUSIONS: Community social capital appears to have a protective role in determining cognitive function in old age. Our findings may facilitate the development of new community-based strategies to combat dementia.


Assuntos
Disfunção Cognitiva/prevenção & controle , Escolaridade , Características de Residência/estatística & dados numéricos , Capital Social , Idoso , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Demência/epidemiologia , Demência/prevenção & controle , Feminino , Humanos , Vida Independente , Masculino , Análise Multinível , Rede Social , Apoio Social , Tóquio/epidemiologia
9.
BMC Neurol ; 19(1): 244, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640594

RESUMO

BACKGROUND: Activated Vitamin D has anti-inflammatory properties and adequate 25-hydroxyvitamin D [25(OH)D] concentrations may be important for neurocognitive function and protection against neurologic injury. We examined whether mid-life 25(OH) D concentrations were associated with later-life performance on neuropsychological testing, functional ability, depressive symptoms, and incident dementia. METHODS: We studied 13,039 white and black ARIC participants who had serum 25(OH) D measured mid-life at visit 2 (1990-1992). Over the next ~ 20 years through visit 5 (2011-2013), participants underwent 3 additional in-person visits, annual telephone calls, and hospitalization surveillance. An extensive battery of neuropsychological outcomes were assessed at visit 5 using standardized protocols. Incident dementia was ascertained through a formal algorithm that included data from in-person cognitive testing, telephone interviews, hospital discharge codes, and death certificate codes. Diagnoses of dementia were adjudicated by expert clinician committee. For the primary cognitive analyses, we imputed for missing covariates and outcomes and used linear regression to evaluate non-concurrent cross-sectional associations of mid-life 25(OH) D (visit 2) with late-life neuropsychological outcomes (visit 5). We also used Cox regression models to examine associations of mid-life 25(OH) D and incident dementia. RESULTS: In mid-life, the mean (SD) age of participants was 57 (6) years, 57% were women, and 24% black. Mean (SD) 25(OH) D was 24.3 (8.6) ng/mL; 33% had deficient (< 20 ng/mL), 44% intermediate (20- < 30 ng/mL), and 23% sufficient (≥30 ng/mL) 25(OH) D concentrations. Association between mid-life 25(OH) D and late-life performance on neuropsychological testing were mostly null. There was no significant association with functional ability or depressive symptoms. Results were similar in a sensitivity analysis using complete-case data (no imputation). However, after a median follow-up of 20 years, low 25(OH) D concentrations were associated with increased risk for incident dementia (p = 0.01 for trend across categories), with HR of 1.26 (95% CI 1.06, 1.49) for participants with deficient 25(OH) D, compared to sufficient concentrations. CONCLUSION: In this community cohort, mid-life serum 25(OH) D concentrations were associated with incident dementia but not with performance on neuropsychological testing, functional ability, or depressive symptoms, 20 years later. Whether serum 25(OH) D concentrations are causally related to dementia or confounded by poorer health status remains uncertain. TRIAL REGISTRATION: Registered on clinicaltrials.gov NCT00005131 .


Assuntos
Demência/epidemiologia , Vitamina D/análogos & derivados , Afro-Americanos , Idoso , Estudos de Coortes , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Vitamina D/sangue
10.
Einstein (Sao Paulo) ; 18: eAO4752, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664323

RESUMO

OBJECTIVE: To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic. METHODS: A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015. RESULTS: A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer's disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007). CONCLUSION: Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.


Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Brasil/epidemiologia , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Escolaridade , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-31546803

RESUMO

Non-communicable diseases (NCD) and disability are both common, and increasing in magnitude, as a result of population ageing and a shift in disease burden towards chronic conditions. Moreover, disability and NCDs are strongly linked in a two-way association. People living with NCDs may develop impairments, which can cause activity limitations and participation restriction in the absence of supportive personal and environmental factors. In other words, NCDs may lead to disabilities. At the same time, people with disabilities are more vulnerable to NCDs, because of their underlying health condition, and vulnerability to poverty and exclusion from healthcare services. NCD programmes must expand their focus beyond prevention and treatment to incorporate rehabilitation for people living with NCDs, in order to maximize their functioning and well-being. Additionally, access to healthcare needs to be improved for people with disabilities so that they can secure their right to preventive, curative and rehabilitation services. These changes may require new innovations to overcome existing gaps in healthcare capacity, such as an increasing role for mobile technology and task-sharing. This perspective paper discusses these issues, using a particular focus on stroke and dementia in order to clarify these relationships.


Assuntos
Demência/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças não Transmissíveis/epidemiologia , Pobreza
12.
Clin Interv Aging ; 14: 1371-1377, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31534322

RESUMO

Background: Women with Parkinson's disease (PD) are more likely to be older, have greater disease severity and comorbidities, and yet are less likely to receive care from a neurologist, as compared with men with PD. Within the PD population, homebound individuals are a particularly vulnerable group facing significant barriers to care, yet within this understudied population, sex-related differences have not been reported. Purpose: To identify and describe differences in homebound men and women with advanced PD and related disorders, participating in an interdisciplinary home visit program. Patients and methods: This was an exploratory analysis of homebound patients seen between February 2014 and July 2016 using data collected via in-person interviews and chart review. Results: We enrolled 85 patients, of whom 52% were women. PD was the most common diagnosis (79%), followed by dementia with Lewy bodies (5%), and other atypical parkinsonism (16%). Men were more likely to have a PD dementia diagnosis than women (17.1% vs 2.3%, p=0.03). Women were more likely to live alone (18.1% of women had no caregiver vs 2.4% of men, p=0.05). Conclusion: The role of the caregiver in facilitating safe aging-in-place is crucial. Among homebound individuals with advanced PD, women were far more likely to live alone. The absence of a spouse or care partner may be due in part to variable sex-based life expectancies. Our findings suggest that homebound women with advanced PD may face greater barriers to accessing support.


Assuntos
Demência , Pacientes Domiciliares , Vida Independente , Doença de Parkinson , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Comorbidade , Demência/epidemiologia , Feminino , Humanos , Masculino , Doença de Parkinson/epidemiologia , Caracteres Sexuais
14.
Artigo em Inglês | MEDLINE | ID: mdl-31480270

RESUMO

BACKGROUND: Studies have linked some bacterial infections with an increased likelihood for development of dementia. However, there is a paucity of data on the relationship between dementia and leptospirosis. In view of this, we conducted a retrospective cohort study to determine whether leptospirosis is a risk factor for dementia. METHODS: Data were collected from the Taiwan National Health Insurance Research Databases (2000-2010) to investigate the incidence of and risk factors for dementia in patients with leptospirosis. Patients with leptospirosis who did not have a history of dementia were enrolled in the study. For each leptospirosis patient, four controls were randomly selected after frequency matching of age, sex, and index date. Cox proportional hazard regression models were used for the analyses of dementia risk. RESULTS: A greater risk of dementia was observed in the leptospirosis cohort than in the non-leptospirosis cohort both in patients without any comorbidity (adjusted HR (aHR) = 1.23, 95% CI = 1.06-1.43) and with a comorbidity (aHR = 2.06, 95% CI = 1.7-2.5). Compared with the non-leptospirosis cohort without these comorbidities, the leptospirosis cohort with ≥2 comorbidities exhibited a significantly increased risk of dementia (aHR = 6.11, 95% CI = 3.15-11.9), followed by those with any one comorbidity (adjusted HR = 3.62, 95% CI = 1.76-7.46). CONCLUSIONS: Patients with leptospirosis were at a 1.89-fold greater risk of subsequent dementia, but potential genetic susceptibility bias in the study group is a major confound.


Assuntos
Demência/epidemiologia , Leptospirose/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Taiwan
15.
J Forensic Leg Med ; 68: 101859, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31476524

RESUMO

There is a paucity of literature on sexual violence against older adults, particularly in the U.K. This work aims to identify and describe the characteristics of alleged sexual assault and subsequent forensic medical examination (FME) for older clients presenting to a large sexual assault referral centre (SARC) in Manchester over a ten-year period. A retrospective analysis of forensic case notes was conducted for all clients (n = 39) who had attended for an FME between 2007 and 2017, and who were aged 70 or over at the time of the alleged assault. The average age of clients was 83 years, all were white, and 95% were female. Two populations were identified: a less frail population who had been assaulted at home by an alleged stranger with greater physical violence alleged, and a frailer population, with a greater incidence of dementia (77%), who were alleged to have been assaulted by a care-giver or fellow resident in a place of care. We note the need for flexibility in the site of FME, the underrepresentation of minority populations in SARC attendees, and difficulties with description of events by clients. We identify several patterns of non-age related anogenital and body examination findings, and offer recommendations for sexual assault services on how they may better cater to older populations.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criminosos/estatística & dados numéricos , Demência/epidemiologia , Violência Doméstica/estatística & dados numéricos , Maus-Tratos ao Idoso/estatística & dados numéricos , Feminino , Idoso Fragilizado , Humanos , Masculino , Competência Mental , Pessoa de Meia-Idade , Exame Físico , Encaminhamento e Consulta , Estudos Retrospectivos , Reino Unido/epidemiologia , Populações Vulneráveis , Adulto Jovem
16.
Med Care ; 57(10): 766-772, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31415343

RESUMO

BACKGROUND/OBJECTIVES: Pneumonia readmissions have significant quality of care and policy implications for patients and health care providers. Research indicates that initiatives to decrease readmissions should target high-risk subgroups. Older adults with dementia have an increased risk of pneumonia and subsequent hospitalizations, suggesting that they may be at high-risk of pneumonia readmissions. The purpose of this study was to determine if associations between patient factors and readmission rates differ for older adults with and without dementia who were hospitalized for pneumonia. DESIGN: This was a retrospective study of secondary data. PARTICIPANTS: A nationally representative sample of 389,198 discharge records was extracted from the 2013 Nationwide Readmission Database. MEASURES: Differences between groups were analyzed using χ and t tests. A generalized linear model was utilized to examine associations between patient factors and pneumonia readmissions. RESULTS: Significant differences were found (P<0.001) when comparing patient characteristics of older adults with and without dementia who were readmitted. Older adults with dementia had a readmission rate of 23.5% and were 2.9 times more likely to be readmitted (odds ratio; 95% confidence interval, 1.93, 4.40) than older adults without dementia. Associations were calculated using a generalized linear model with dementia included as an interactive effect. Dementia significantly modified (P<0.05) the relationship between pneumonia readmissions and 4 factors; (a) discharge disposition, (b) chronic conditions, (c) risk of mortality, and (d) median household income. CONCLUSIONS: Classifying older adults with dementia as a high-risk subgroup for pneumonia readmissions is supported by the findings of this study. Development of strategies to reduce pneumonia readmissions that are tailored to individuals with dementia should be considered.


Assuntos
Demência/epidemiologia , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Bases de Dados Factuais , Demência/microbiologia , Feminino , Humanos , Modelos Lineares , Masculino , Razão de Chances , Pneumonia/psicologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
17.
West Afr J Med ; 36(2): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385606

RESUMO

OBJECTIVE: There is paucity of information on delirium in sub-Saharan Africa (SSA) particularly in the older persons (>60 years of age), leaving questions about the burden of the disease in an environment with lower health care standards. In this article, we set out to determine the frequency, precipitants and symptomatology of delirium in elderly patients admitted into medical wards in a teaching hospital in South-West Nigeria. METHODS: This was a descriptive study involving a pre-planned sample of one hundred and fifty patients aged 60 years and over, assessed for cognitive impairment and delirium using the previously validated IDEA cognitive screen, and the Confusion Assessment Method (CAM) respectively. Diagnosis of delirium was made using the CAM and DSM-IV criteria. RESULTS: Delirium was diagnosed in 32 patients giving a frequency of 21.3% (95%CI: 14.7-30.0%). Patients with delirium were significantly older (p<0.05). A quarter of the patients had dementia. Hypertension was a notable co-morbid condition. All the patients had altered sleep wake cycle, inattention, disorientation, and altered consciousness. Neurological diseases were the most common precipitant. There was a good agreement between the DSM-IV and CAM diagnoses. CONCLUSION: Delirium is common in hospitalised elderly patients particularly those with neurological diseases. Co-morbidities like hypertension, dementia, and depression should be looked for in delirious elderly patients.


Assuntos
Disfunção Cognitiva/diagnóstico , Confusão/diagnóstico , Delírio/diagnóstico , Demência/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Comorbidade , Confusão/psicologia , Delírio/epidemiologia , Delírio/psicologia , Demência/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Hipertensão/epidemiologia , Entrevista Psiquiátrica Padronizada/estatística & dados numéricos , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos , Nigéria/epidemiologia , Transtornos do Sono-Vigília/epidemiologia , Centros de Atenção Terciária
18.
Neuropsychology ; 33(6): 760-780, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31448945

RESUMO

OBJECTIVE: Alcohol use disorder (AUD) is a complex, dynamic condition that waxes and wanes with unhealthy drinking episodes and varies in drinking patterns and effects on brain structure and function with age. Its excessive use renders chronically heavy drinkers vulnerable to direct alcohol toxicity and a variety of comorbidities attributable to nonalcohol drug misuse, viral infections, and accelerated or premature aging. AUD affects widespread brain systems, commonly, frontolimbic, frontostriatal, and frontocerebellar networks. METHOD AND RESULTS: Multimodal assessment using selective neuropsychological testing and whole-brain neuroimaging provides evidence for AUD-related specific brain structure-function relations established with double dissociations. Longitudinal study using noninvasive imaging provides evidence for brain structural and functional improvement with sustained sobriety and further decline with relapse. Functional imaging suggests the possibility that some alcoholics in recovery can compensate for impairment by invoking brain systems typically not used for a target task but that can enable normal-level performance. CONCLUSIONS: Evidence for AUD-aging interactions, indicative of accelerated aging, together with increasing alcohol consumption in middle-age and older adults, put aging drinkers at special risk for developing cognitive decline and possibly dementia. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Envelhecimento/psicologia , Alcoolismo/psicologia , Encéfalo/diagnóstico por imagem , Alcoolismo/diagnóstico por imagem , Alcoolismo/epidemiologia , Alcoolismo/fisiopatologia , Encéfalo/fisiopatologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Comorbidade , Demência/epidemiologia , Neuroimagem Funcional , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética , Testes Neuropsicológicos
19.
J Clin Nurs ; 28(23-24): 4504-4512, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31429131

RESUMO

AIMS AND OBJECTIVES: This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). BACKGROUND: A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. DESIGN: Cross-sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. METHODS: In total, 226 older adults with dementia were recruited through convenience sampling at 15 long-term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen-Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination and the Barthel Index, respectively. RESULTS: Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. CONCLUSION: Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. RELEVANCE TO CLINICAL PRACTICE: The findings could serve as a valuable reference for long-term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.


Assuntos
Atividades Cotidianas , Demência/epidemiologia , Incontinência Urinária/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Demência/psicologia , Depressão/diagnóstico , Depressão/epidemiologia , Feminino , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Humanos , Masculino , Casas de Saúde/estatística & dados numéricos , Prevalência , Testes Psicológicos , Qualidade de Vida , Taiwan , Incontinência Urinária/psicologia
20.
Medicine (Baltimore) ; 98(34): e16931, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441882

RESUMO

Several studies have shown that statin users have a lower risk of new-onset dementia (NOD) compared nonusers. However, other studies have shown opposite results. In this study, we investigated the association between the use of statins and the development of NOD.This was a longitudinal cohort study using data from claim forms submitted to the Taiwanese Bureau of National Health Insurance. The study included patients with NOD and non-NOD subjects from January 2002 to December 2013. We estimated the hazard ratios (HRs) of NOD associated with statin use, whereas nonuser subjects were used as a reference group.A total of 19,522 NOD cases were identified in 100,610 hyperlipidemic patients during the study period. The risk of NOD, after adjusting for sex, age, comorbidities, and concurrent medication, was lower among statin users than nonusers (HR 0.95, 95% CI [confidence interval] 0.94-0.96; P < .001). The adjusted HRs for NOD were 1.53 (95% CI, 1.45-1.62), 0.63 (95% CI, 0.57-0.71), and 0.34 (95% CI, 0.30-0.38) when the cumulative defined daily doses ranged from 28 to 365, 366 to 730, and more than 730 relative to nonusers, respectively.We concluded that statin use is associated with a decreased NOD risk. The protective effect of statins for NOD seemed to be related to high exposure to statins. This study also highlights that high exposure to statins has a dose-response effect on lowering NOD risk.


Assuntos
Cognição/efeitos dos fármacos , Demência/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Comorbidade , Demência/epidemiologia , Relação Dose-Resposta a Droga , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Estimativa de Kaplan-Meier , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia
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