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1.
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
2.
Adv Gerontol ; 32(4): 664-667, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31800198

RESUMO

The article presents the results of the analysis of the needs of long-lived people with disabilities in medical and social care, reflects the problems that arise in this contingent of persons when it is necessary to address the issues of medical and social rehabilitation. A medical and social examination of 238 long-lived patients undergoing inpatient treatment in a geriatric medical organization was carried out. The most frequent deviations from the norm in laboratory and instrumental methods of research are revealed. Screening of «Age is no obstacle¼, which revealed the presence of cognitive disorders and depression in a significant number of investigated and their dependence on others. Emphasized the importance of participation of bodies of social protection of the population in solving the problems of the aged.


Assuntos
Pessoas com Deficiência , Problemas Sociais , Idoso , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/reabilitação , Depressão/epidemiologia , Depressão/reabilitação , Pessoas com Deficiência/estatística & dados numéricos , Humanos , Problemas Sociais/estatística & dados numéricos
3.
Medicine (Baltimore) ; 98(49): e18248, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804354

RESUMO

Dementia among elderly is a serious problem worldwide. This study was conducted to estimate the prevalence and associated risk factors of dementia and mild cognitive impairment (MCI) in nursing homes (NHs) and common communities (CCs) among elderly in China.A cross-sectional survey was conducted in 4 communities across 12 cities in Southern China from May to November of 2014. Qualified psychiatrists and trained nurses carried out relevant diagnosis, assessments, interviews, and information collection. Screening test of mini-mental state examination was conducted among participants firstly, then confirmed diagnosis was carried out among the ones with positive results. Student t test, χ test, univariate, and multivariate logistic regression analysis were conducted to analyze data.A total of 2015 participants aged 65 or older were included in the final analysis; 908 came from NHs while 1107 came from CCs. The crude prevalence rates of dementia and MCI were 22.0% and 15.8%, respectively among all the participants. Dementia prevalence was 42.4% among those living in NHs, which was significantly higher than that of 5.3% in CCs (P < .0001). There were more moderate and severe dementia in NHs compared with CCs (P < .0001). It showed that older age, illiterate compared with high level of education (adjusted odds ratio, AOR = 3.32, 95% CI: 1.53-7.21), heavy drinking (AOR = 1.51 (1.00-2.24), having a medical history of diabetes (AOR = 1.41, 95% CI: 1.02-2.33), and stroke (AOR = 1.21, 95% CI: 1.01-1.23) were associated with dementia in NHs, and middle socioeconomic status might be a protective factor for dementia (AOR = 0.33, 95% CI: 0.21-0.51).The problem of senile dementia in NHs is much more serious than our estimation, and there are not enough trained nursing staffs in NHs. More population-based strategies in NHs, including conducting cognitive screening accompanied with routine physical examination among elderly population, carrying out related primary prevention policies and public health services, and paying attention to some modifiable associated risk factors such as heavy smoking and drinking are needed.


Assuntos
Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/epidemiologia , Vida Independente , Casas de Saúde , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Prevalência , Fatores de Risco
4.
Georgian Med News ; (294): 83-87, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687955

RESUMO

The aim of the research was to investigate the relationship between cerebral microembolization and the development of postoperative cognitive impairment in patients after coronary artery bypass grafting with and without prophylactic administration of nitroglycerin at the end of artificial blood circulation. The study included 72 patients (43 male and 29 female) who had ACBPS using an ABCA. The patients were randomized into two clinical groups. The number of patients in the control group was 34 patients, in the study group - 38 patients. The study of the cognitive sphere was performed using a battery of clinical tests that included MSA and MMSE scales, Trail-making test, Grooved Pageboard, fine hands-motor test, 10 words test by AR Luria, Wexler's test, Schultz tables. The assessment was carried out on a day before the intervention and on the fifth day after the surgical intervention. It was shown that by all patients undergoing aorto-coronary bypass syrgery microembolization within the cerebral blood flow had been determined. The vast majority of microemboli is formed at the beginning of artificial blood circulation, at the moment of clamping aorta, as well as during the restoration of effective cardiac activity. Intraoperative microembolization of cerebral blood flow in excess of 750 microemboli leads to clinically significant deterioration of the brain functions in the early postoperative period. When used as a peripheral vasodilator, nitroglycerin, at a dose of 8-10 µg/kg*min in high (120-130%) volume perfusion rate, decreases the number of microemboluses in the basin of СМА by 2.4%.


Assuntos
Aorta/diagnóstico por imagem , Substitutos Sanguíneos , Ponte Cardiopulmonar/efeitos adversos , Disfunção Cognitiva/etiologia , Ponte de Artéria Coronária/efeitos adversos , Embolia Intracraniana/psicologia , Infarto do Miocárdio/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar/métodos , Circulação Cerebrovascular , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico por imagem , Embolia Intracraniana/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/sangue , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle
5.
Medicine (Baltimore) ; 98(48): e18189, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770275

RESUMO

Sparse is the research on the relationship between iron metabolism and mild cognitive impairment (MCI) in adults aged over 60 years with non-alcoholic fatty liver disease (NAFLD). The soluble transferrin receptor (sTfR), serum iron (SI), serum ferritin (SF), transferrin (TRF) and hemoglobin (HB) are indicators of iron metabolism.This study examined whether iron metabolism is associated with cognitive impairment in older individuals.A cross-sectional study was held in patients from a Chinese center. Individuals with NAFLD aged over 60 years were included if they did not have excessive alcohol intake and were free of stroke or dementia. Their cognitive function was assessed by the same neurologist. 3.0T H proton magnetic resonance spectroscopy (H-MRS) was performed to evaluate the hippocampus of the participants without contraindication. t test and Chi-square test were used to analyze the data. Binary logistic regression was used for correlation analysis.Fifty four (54%) of participants were diagnosed with MCI by the psychiatrist. MCI was significantly associated with higher sTfR after adjustment of all the covariates (OR = 2.565, 95%CI: 1.334∼4.934; P = .005). No statistically significant associations were observed between MCI and age or blood glucose or choline (Cho) /creatine (Cr) of theright hippocampus head.Increased age and low levels of sTfR and HB were associated with MCI in NAFLD individuals aged over 60 years.


Assuntos
Disfunção Cognitiva , Hemoglobinas/análise , Hipocampo/diagnóstico por imagem , Ferro , Hepatopatia Gordurosa não Alcoólica , Receptores da Transferrina/sangue , Idoso , China/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/metabolismo , Correlação de Dados , Estudos Transversais , Feminino , Ferritinas/análise , Humanos , Ferro/sangue , Ferro/metabolismo , Espectroscopia de Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/metabolismo , Hepatopatia Gordurosa não Alcoólica/psicologia , Transferrina/análise
6.
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
7.
J Frailty Aging ; 8(4): 192-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637405

RESUMO

INTRODUCTION: Physical frailty (PF) appears to be associated with low cognitive performance and mild cognitive impairment (MCI). This review evaluated and synthesized the evidence of studies investigating the association between PF and MCI, the prevalence of both conditions and the rate of conversion of healthy older adult to one of them during the follow-up. METHODS: A systematic review was performed according to the PRISMA recommendations in the Pubmed, SciELO and LILACS databases. Five studies were eligible according to inclusion and exclusion criteria. RESULTS: Regarding the study design, cross-sectional studies prevailed. Most studies showed a positive association between PF and MCI. Moreover, PF seems to predict a worse cognitive trajectory among participants with MCI and it is associated to a higher risk of developing MCI. CONCLUSION: Our findings suggest a significant association between PF and MCI. Further longitudinal studies are needed to better explore causality.


Assuntos
Disfunção Cognitiva/epidemiologia , Fragilidade/epidemiologia , Idoso , Estudos Transversais , Idoso Fragilizado , Humanos , Prevalência
8.
Z Gerontol Geriatr ; 52(Suppl 4): 229-242, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31628611

RESUMO

BACKGROUND: Older people represent a risk group for acquiring or further development of delirium during hospitalization, therefore requiring suitable nonpharmacological delirium interventions. OBJECTIVE: This scoping review analyzed nonpharmacological intervention programs for older inpatients with or without cognitive decline on regular or acute geriatric wards to present the range of interventions. METHODS: A systematic literature search was conducted using scientific databases. A total of 4652 records were screened by two independent reviewers, leaving 81 eligible articles for full-text screening and 25 studies were finally included. Inclusion criteria were older patients ≥65 years in regular or acute geriatric wards and nonpharmacological multicomponent interventions. RESULTS: More than a half of the included studies (14, 56%) recruited patients with pre-existing cognitive decline as part of the study population and 12% focused exclusively on patients with cognitive decline. On average 11 intervention components were integrated in the programs and two programs included full coverage of all 18 identified components. CONCLUSION: Only few programs were described for older inpatients and even fewer regarding pre-existing cognitive decline. The low numbers of interventions and data heterogeneity restricted the assessment of outcomes; however, delirium incidence, as reported by two thirds of the studies was reduced by nonpharmacological multicomponent interventions.


Assuntos
Disfunção Cognitiva/epidemiologia , Delírio/epidemiologia , Delírio/terapia , Hospitalização/estatística & dados numéricos , Pacientes Internados/psicologia , Tempo de Internação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/psicologia , Delírio/psicologia , Feminino , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Masculino , Prevalência , Fatores de Risco , Resultado do Tratamento
9.
Z Gerontol Geriatr ; 52(Suppl 4): 212-221, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31628613

RESUMO

BACKGROUND: Older general hospital patients, particularly those with cognitive impairment, frequently experience adverse events and other care complications during their stay. As these findings have so far been based on small and selected patient samples, the aim of the present study was to provide reliable data on a) the prevalence of adverse care issues (summarized under the term care challenges) in older general hospital patients and on b) associated patient-related risk factors (e.g. cognitive impairment). METHODS: A cross-sectional representative study comprising 1469 patients aged ≥65 years from 33 randomly selected general hospitals in southern Germany (GHoSt). Data collection included the use of different data sources, e.g. structured interviews with responsible nursing staff concerning care challenges and procedures for determining the patients' cognitive status. RESULTS: Care challenges were statistically significantly (p < 0.001) more often reported for patients with dementia and/or delirium (87.5%) and mild cognitive impairment (47.9%) compared to cognitively unimpaired patients (24.6%). Adjusted odds ratios suggested cognitive impairment, impaired activities of daily living, receiving long-term care and unplanned admission as significant patient-related risk factors for care challenges. Furthermore, the occurrence of such issues was associated with the application of physical restraints, support from relatives, prescription of psycholeptics and specialist consultations. CONCLUSION: The findings suggest a strong impact of different degrees of cognitive impairment on challenges in care. The results might help to design appropriate training programs for hospital staff and other interventions to prevent or reduce critical situations.


Assuntos
Disfunção Cognitiva/epidemiologia , Serviços de Saúde para Idosos/organização & administração , Hospitais Gerais/estatística & dados numéricos , Assistência de Longa Duração , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/terapia , Cuidados Críticos , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Masculino
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.
Med Sci Monit ; 25: 6820-6835, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31507272

RESUMO

BACKGROUND This study aimed to identify the clustering of comorbidities, cognitive, and mental factors associated with increased risk of pre-frailty and frailty in patients ≥60 years in a primary healthcare setting in eastern Croatia. MATERIAL AND METHODS There were 159 patients included in the cluster analysis who were ≥60 years and who underwent four-month follow-up. The first cluster contained 50 patients, the second cluster contained 74 patients, and the third cluster contained 35 patients. Clinical parameters were identified from electronic health records and patient questionnaires. Laboratory tests, anthropometric measurements, the number of chronic diseases, the number of prescribed medications were recorded. Frailty was determined using the five criteria of Fried's phenotype -model. Levels of anxiety and depression were recorded using the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS), and the Mini-Mental State Examination (MMSE) score assessed cognitive impairment. Logistic regression models were used to identify predictors of frailty and pre-frailty. RESULTS Three overlapping clusters of phenotypes predicted frailty, and included obesity (n=50), multimorbidity with mental impairment (n=74), and decline in renal function with cognitive impairment (n=35). The predictors of outcome included increasing age, number of chronic diseases, inflammation, anemia, anxiety, and cognitive impairment, and reduced muscle mass. CONCLUSIONS In patients ≥60 years in a primary healthcare setting, multimorbidity predictors of pre-frailty and frailty included a decline in cognitive function and renal function.


Assuntos
Fragilidade/epidemiologia , Saúde Mental , Atenção Primária à Saúde , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Análise por Conglomerados , Disfunção Cognitiva/epidemiologia , Comorbidade , Depressão/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fenótipo , Fatores de Risco
12.
Acta Neurol Scand ; 140(6): 429-434, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31498424

RESUMO

OBJECTIVES: Short-term follow-up studies after a subarachnoid haemorrhage (SAH) have shown impaired cognition, fatigue, depression and anxiety, but less is known regarding long-term consequences. The aim of this study was to investigate health outcomes in persons 7 years after SAH. MATERIALS AND METHODS: This is a descriptive cohort follow-up study of persons with non-traumatic SAH treated at Sahlgrenska University Hospital, Gothenburg, Sweden. The follow-up was conducted 7 years post-treatment and included home visits using forms and questionnaires about health outcomes; the Barthel Index (BI), modified Rankin Scale (mRS), National Institutes of Health Stroke Scale (NIHSS), Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA) and Multidimensional Fatigue Inventory (MFI). RESULTS: Seven years post-SAH, 33 persons fulfilled the inclusion criteria, of whom 18 (55%) participated (median age 63 years). Cognitive impairment was present in 11 participants, assessed with the MoCA, where the item of delayed recall was most difficult. The majority (n = 16) were independent in activities of daily living (ADL), and few (n = 3) had physical symptoms according to the NIHSS. However, three participants were free from disability according to the mRS. Nearly, half of the participants had symptoms of anxiety (n = 8). Three had symptoms of depression and more than half experienced fatigue. CONCLUSION: The physical function and independency in ADL is high among long-term SAH survivors. Despite this, only a few were completely free from disability, and the main problems 7 years after SAH were cognitive impairment and anxiety.


Assuntos
Atividades Cotidianas , Recuperação de Função Fisiológica , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/psicologia , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos , Suécia
13.
Neurology ; 93(14): e1348-e1359, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31484713

RESUMO

OBJECTIVE: To determine which pathologic process could be responsible for the acceleration of cognitive decline during the course of multiple sclerosis (MS), using longitudinal structural MRI, which was related to cognitive decline in relapsing-remitting MS (RRMS) and progressive MS (PMS). METHODS: A prospective cohort of 230 patients with MS (179 RRMS and 51 PMS) and 59 healthy controls was evaluated twice with 5-year (mean 4.9, SD 0.94) interval during which 22 patients with RRMS converted to PMS. Annual rates of cortical and deep gray matter atrophy as well as lesion volume increase were computed on longitudinal (3T) MRI data and correlated to the annual rate of cognitive decline as measured using an extensive cognitive evaluation at both time points. RESULTS: The deep gray matter atrophy rate did not differ between PMS and RRMS (-0.82%/year vs -0.71%/year, p = 0.11), while faster cortical atrophy was observed in PMS (-0.87%/year vs -0.48%/year, p < 0.01). Similarly, faster cognitive decline was observed in PMS compared to RRMS (p < 0.01). Annual cognitive decline was related to the rate of annual lesion volume increase in stable RRMS (r = -0.17, p = 0.03) to the rate of annual deep gray matter atrophy in converting RRMS (r = 0.50, p = 0.02) and annual cortical atrophy in PMS (r = 0.35, p = 0.01). CONCLUSIONS: These results indicate that cortical atrophy and cognitive decline accelerate together during the course of MS. Substrates of cognitive decline shifted from worsening lesional pathology in stable RRMS to deep gray matter atrophy in converting RRMS and to accelerated cortical atrophy in PMS only.


Assuntos
Córtex Cerebral/diagnóstico por imagem , Disfunção Cognitiva/diagnóstico por imagem , Disfunção Cognitiva/psicologia , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/psicologia , Adulto , Idoso , Atrofia/diagnóstico por imagem , Atrofia/epidemiologia , Atrofia/psicologia , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Imagem por Ressonância Magnética/tendências , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/epidemiologia , Estudos Prospectivos
14.
Clin Interv Aging ; 14: 1343-1352, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413555

RESUMO

Purpose: This study was aimed at determining the presence of cognitive frailty and its associated factors among community-dwelling older adults from the "LRGS-Towards Useful Aging (TUA)" longitudinal study. Patients and methods: The available data related to cognitive frailty among a sub-sample of older adults aged 60 years and above (n=815) from two states in Malaysia were analysed. In the LRGS-TUA study, a comprehensive interview-based questionnaire was administered to obtain the socio-demographic information of the participants, followed by assessments to examine the cognitive function, functional status, dietary intake, lifestyle, psychosocial status and biomarkers associated with cognitive frailty. The factors associated with cognitive frailty were assessed using a bivariate logistic regression (BLR). Results: The majority of the older adults were categorized as robust (68.4%), followed by cognitively pre-frail (37.4%) and cognitively frail (2.2%). The data on the cognitively frail and pre-frail groups were combined for comparison with the robust group. A hierarchical BLR indicated that advancing age (OR=1.04, 95% CI:1.01-1.08, p<0.05) and depression (OR=1.49, 95% CI:1.34-1.65, p<0.001) scored lower on the Activity of Daily Living (ADL) scale (OR=0.98, 95% CI:0.96-0.99, p<0.05), while low social support (OR=0.98, 95% CI:0.97-0.99, p<0.05) and low niacin intake (OR=0.94, 95% CI:0.89-0.99, p<0.05) were found to be significant factors for cognitive frailty. Higher oxidative stress (MDA) and lower telomerase activity were also associated with cognitive frailty (p<0.05). Conclusion: Older age, a lower niacin intake, lack of social support, depression and lower functional status were identified as significant factors associated with cognitive frailty among older Malaysian adults. MDA and telomerase activity can be used as potential biomarkers for the identification of cognitive frailty.


Assuntos
Disfunção Cognitiva/epidemiologia , Idoso Fragilizado/estatística & dados numéricos , Fragilidade/epidemiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Cognição , Estudos Transversais , Dieta , Feminino , Humanos , Vida Independente , Estilo de Vida , Modelos Logísticos , Estudos Longitudinais , Malásia/epidemiologia , Masculino , Saúde Mental , Pessoa de Meia-Idade , Niacina/sangue , Estresse Oxidativo/fisiologia , Desempenho Físico Funcional , Fatores Socioeconômicos , Telomerase/metabolismo
15.
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
16.
Artigo em Inglês | MEDLINE | ID: mdl-31408955

RESUMO

We aimed to investigate the association between loneliness and cognitive impairment among older men and women in China. Data for 6898 eligible participants aged 65 years and older were derived from the latest two waves (2008/2009 and 2011/2012) of the Chinese Longitudinal Healthy Longevity Survey. A logistic regression analysis was performed to determine whether the association between loneliness at baseline and the risk of cognitive impairment at follow-up varied by sex, with adjustment for social-demographic variables, social isolation, lifestyles, and health status. The rates of baseline loneliness and follow-up cognitive impairment were both higher among women than men. Loneliness at baseline was significantly associated with cognitive impairment at follow-up among elderly men (OR = 1.30; 95% CI 1.01-1.69), even after adjusting for potential confounding variables; however, a similar association was not observed among elderly women (OR = 0.98; 95% CI 0.81-1.19). Multiple imputations were applied to address missing data. Although elderly women more frequently reported feelings of loneliness, the impact of loneliness on cognitive impairment was significant among elderly men but not elderly women. Interventions designed to decrease the incidence of loneliness may be particularly beneficial for the reduction of cognitive impairment among elderly Chinese men.


Assuntos
Disfunção Cognitiva/epidemiologia , Solidão/psicologia , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Disfunção Cognitiva/psicologia , Feminino , Humanos , Estudos Longitudinais , Masculino
17.
BMC Neurol ; 19(1): 195, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416438

RESUMO

BACKGROUND: Previous studies have shown that obstructive sleep apnea (OSA) is associated with a higher risk of cognitive impairment or dementia in the elderly, leading to deleterious health effects and decreasing quality of life. This systematic review aims to determine the prevalence of OSA in patients with mild cognitive impairment (MCI) and examine whether an association between OSA and MCI exists. METHODS: We searched Medline, PubMed, Embase, Cochrane Central, Cochrane Database of Systematic Reviews, PsychINFO, Scopus, the Web of Science, ClinicalTrials.gov and the International Clinical Trials Registry Platform for published and unpublished studies. We included studies in adults with a diagnosis of MCI that reported on the prevalence of OSA. Two independent reviewers performed the abstract and full-text screening, data extraction and the study quality critical appraisal. RESULTS: Five studies were included in the systematic review. Overall, OSA prevalence rates in patients with MCI varied between 11 and 71% and were influenced by OSA diagnostic methods and patient recruitment locations (community or clinic based). Among studies using the following OSA diagnostic measures- self-report, Home Sleep Apnea Testing, Berlin Questionnaire and polysomnography- the OSA prevalence rates in MCI were 11, 27, 59 and 71%, respectively. In a community-based sample, the prevalence of OSA in patients with and without MCI was 27 and 26%, respectively. CONCLUSIONS: Based on limited evidence, the prevalence of OSA in patients with MCI is 27% and varies based upon OSA diagnostic methods and patient recruitment locations. Our findings provide an important framework for future studies to prospectively investigate the association between OSA and MCI among larger community-based cohorts and implement a standardized approach to diagnose OSA in memory clinics. PROSPERO REGISTRATION: CRD42018096577.


Assuntos
Disfunção Cognitiva/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Adulto , Idoso , Disfunção Cognitiva/etiologia , Humanos , Masculino , Prevalência , Apneia Obstrutiva do Sono/complicações
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.
Geriatr Psychol Neuropsychiatr Vieil ; 17(3): 279-289, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31449046

RESUMO

The objective of this study was to compare in general practice, patients aged 65 years and over: the MMSE, screening tools for cognitive disorder recommended by the HAS and the Codex. METHOD: 53 patients were included between June and October 2017 at La Charmille general practice in Limpiville in rural areas during an observational study. Patients over 65 years of age were included following a consultation with their general practitioner. The MMSE and the Codex were compared on their results, intrinsic variables, the time of handover. Geriatric comorbidity factors are compared between groups of patients "with" and "without" cognitive disorders detected. RESULTS: Of the 53 patients, 94% CI 95% [4.10; 20.25] had cognitive impairment, at an average age of 74.15 years. The predominance is female with 30 patients (57%). The passage time of the Codex is on average 1min 43s, significantly faster (p = 4,29*10-26) than the time of passing the MMSE 4min 51s on average. There is a better satisfaction of the Codex compared to the MMSE (p = 1.675*10-6) with an average digital scale score of 7.3 against 6.3 respectively. There is no significant difference between population with cognitive and non-cognitive impairment and geriatric comorbidity factor due to selection bias. CONCLUSION: Codex appears to be a rapid, reliable, reproducible cognitive impairment screening tool adapted to the general practice consultation format. An important axis to work, awareness, education of doctors at the university and continuing education on the screening and management of dementia syndromes and fragility.


Assuntos
Disfunção Cognitiva/diagnóstico , Avaliação Geriátrica/métodos , Testes de Estado Mental e Demência , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Comorbidade , Feminino , França/epidemiologia , Humanos , Masculino , Programas de Rastreamento , Estudos Prospectivos , Reprodutibilidade dos Testes , População Rural , Sensibilidade e Especificidade
20.
Artigo em Inglês | MEDLINE | ID: mdl-31430886

RESUMO

Studies related to air pollution exposure and neurocognitive disorders, specifically cognitive impairment, among older adults are limited. We investigated the association between short-term and long-term exposure to ambient air pollution (i.e., particulate matter with an aerodynamic diameter of <10 µm and ozone) and the effects of their interaction on cognitive function in a community-dwelling, free-living elderly population. Study participants were in a multiple-wave representative sample, namely the Taiwan Longitudinal Study on Aging (n = 2241). In four surveys between 1996 and 2007, their cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). We estimated air pollution from 1993 to 2007, including daily concentrations of PM10 and O3 from air quality monitoring stations, based on the administrative zone of each participant's residence. Generalized linear mixed models were used to examine these associations after adjusting for covariates. We found that long-term exposure to PM10 and O3 was significantly associated with cognitive impairment (OR = 1.094, 95% CI: 1.020, 1.174 for PM10; OR = 1.878, 95% CI: 1.363, 2.560 for O3). The joint effect of exposure to PM10 and O3 was associated with cognitive impairment (p < 0.001). Co-exposure to ambient PM10 and O3 may deteriorate cognitive function in older adults.


Assuntos
Poluentes Atmosféricos/toxicidade , Poluição do Ar/efeitos adversos , Disfunção Cognitiva/etiologia , Exposição Ambiental/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Exposição Ambiental/análise , Feminino , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Ozônio/análise , Ozônio/toxicidade , Material Particulado/análise , Material Particulado/toxicidade , Estudos Prospectivos , Fatores de Risco , Taiwan/epidemiologia , Fatores de Tempo
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