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1.
Cephalalgia ; 40(13): 1410-1421, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33146036

RESUMO

OBJECTIVE: To define headache characteristics and evolution in relation to COVID-19 and its inflammatory response. METHODS: This is a prospective study, comparing clinical data and inflammatory biomarkers of COVID-19 patients with and without headache, recruited at the Emergency Room. We compared baseline with 6-week follow-up to evaluate disease evolution. RESULTS: Of 130 patients, 74.6% (97/130) had headache. In all, 24.7% (24/97) of patients had severe pain with migraine-like features. Patients with headache had more anosmia/ageusia (54.6% vs. 18.2%; p < 0.0001). Clinical duration of COVID-19 was shorter in the headache group (23.9 ± 11.6 vs. 31.2 ± 12.0 days; p = 0.028). In the headache group, IL-6 levels were lower at the ER (22.9 (57.5) vs. 57.0 (78.6) pg/mL; p = 0.036) and more stable during hospitalisation. After 6 weeks, of 74 followed-up patients with headache, 37.8% (28/74) had ongoing headache. Of these, 50% (14/28) had no previous headache history. Headache was the prodromal symptom of COVID-19 in 21.4% (6/28) of patients with persistent headache (p = 0.010). CONCLUSIONS: Headache associated with COVID-19 is a frequent symptom, predictive of a shorter COVID-19 clinical course. Disabling headache can persist after COVID-19 resolution. Pathophysiologically, its migraine-like features may reflect an activation of the trigeminovascular system by inflammation or direct involvement of SARS-CoV-2, a hypothesis supported by concomitant anosmia.


Assuntos
Infecções por Coronavirus/complicações , Cefaleia/virologia , Pneumonia Viral/complicações , Adulto , Idoso , Betacoronavirus , Biomarcadores/sangue , Infecções por Coronavirus/imunologia , Feminino , Cefaleia/epidemiologia , Humanos , Inflamação/sangue , Inflamação/virologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/imunologia , Sintomas Prodrômicos , Estudos Prospectivos
2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5575-5579, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019241

RESUMO

The diagnosis and treatment of psychiatric disorders depends on the analysis of behavior through language by a clinical specialist. This analysis is subjective in nature and could benefit from automated, objective acoustic and linguistic processing methods. This integrated approach would convey a richer representation of patient speech, particularly for expression of emotion. In this work, we explore the potential of acoustic and prosodic metrics to infer clinical variables and predict psychosis, a condition which produces measurable derailment and tangentiality in patient language. To that purpose, we analyzed the recordings of 32 young patients at high risk of developing clinical psychosis. The subjects were evaluated using the Structured Interview for Prodromal Syndromes/Scale of Prodromal Symptoms (SIPS/SOPS) criteria. To analyze the recordings, we examined the variation of different acoustic and prosodic metrics across time. This preliminary analysis shows that these features can infer negative symptom severity ratings (i.e., SIPS-Btotal), obtaining a Pearson correlation of 0.77 for all the subjects after cross-validated evaluation. In addition, these features can predict development of psychosis with high accuracy above 90%, outperforming classification using clinical variables only. This improved predictive power ultimately can help provide early treatment and improve quality of life for those at risk for developing psychosis.


Assuntos
Transtornos Psicóticos , Fala , Acústica , Adolescente , Humanos , Sintomas Prodrômicos , Transtornos Psicóticos/diagnóstico , Qualidade de Vida
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 2540-2543, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018524

RESUMO

Clinical and biological changes during the prodromal stages of dementia are both complicated and expensive. A biomarker for cognitive reserve exposure would be highly useful as a dementia risk predictor, but has eluded researchers. Speech, which exhibits disfluencies due to dementia, is a good candidate as it is easy to collect and non-invasive. However, previous studies have only looked at the impact of dementia on speech after diagnosis. Here we extend our previous work that showed paralinguistic features extracted from audio recordings of older participants completing the LOGOS episodic memory test can be used to discriminate between high vs low cognitive reserve, hence low vs high risk of dementia. Specifically, we use the clinically validated Lifetime of Experiences Questionnaire (LEQ) to refine our ground truth estimate of cognitive reserve instead of an abridged version. Also, we improve the generalizability of our system by using feature warping to normalize across speakers. Our k-nearest neighbours (KNN) based classifier achieved an accuracy of 84% when trained with paralinguistic features alone and 91% with paralinguistic and episodic memory features.Clinical Relevance- This establishes efficacy of using speech from older participants completing the LOGOS episodic memory test to estimate risk of dementia.


Assuntos
Reserva Cognitiva , Demência , Memória Episódica , Demência/diagnóstico , Humanos , Sintomas Prodrômicos , Fala
4.
PLoS One ; 15(9): e0239484, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956392

RESUMO

OBJECTIVE: To assess and compare the involvement of choroidal thickness (CT) in patients with mild cognitive impairment (MCI) and dementia due to Alzheimer's disease (AD) defined by amyloid PET and healthy controls (HC). METHODS: Sixty-three eyes from 34 AD patients [12 eyes (19.0%) with dementia and 51 eyes (80.9%) with MCI], positive to 11C-labelled Pittsburgh Compound-B with positron emission tomography (11C-PiB PET/CT), and the same number of sex- and age-paired HC were recruited. All participants underwent enhanced depth imaging optical coherence tomography (EDI-OCT) assessing CT at 14 measurements from 2 B-scans. Paired Student t-test was used to compare CT measurements between MCI, dementia and sex- and age-paired HC. A univariate generalized estimating equations model (GEE) test was performed to compare MCI and dementia individually with all HC included. RESULTS: Compared with HC, eyes from patients with positive 11C-PiB PET/CT showed a significant CT thinning in 5 selected locations (in foveal thickness in vertical scan, in temporal scan at 1500µm, in superior scan at 500µm and in inferior scan at 1000µm and 1500µm, p = 0.020-0.045) whilst few significant CT reduction data was reported in MCI or dementia individually versus HC. However, the GEE test identified significant CT thinning in AD compared with all HC included (p = 0.015-0.046). CONCLUSIONS: To our knowledge, the present study is the first measuring CT in eyes from MCI and dementia eyes positive to 11C-PiB PET/CT reporting a significant trend towards CT thinning in MCI patients which became more pronounced in dementia stage. We support further investigation involving larger and prospective OCT studies in AD population characterized with available biomarkers to describe whether choroidal vascular damage occurs specifically in prodromal stages of AD.


Assuntos
Doença de Alzheimer/patologia , Amiloide/análise , Corioide/ultraestrutura , Disfunção Cognitiva/patologia , Sintomas Prodrômicos , Tomografia de Coerência Óptica , Idoso , Doença de Alzheimer/diagnóstico por imagem , Compostos de Anilina , Antropometria , Área Sob a Curva , Radioisótopos de Carbono , Estudos de Casos e Controles , Disfunção Cognitiva/diagnóstico por imagem , Estudos Transversais , Progressão da Doença , Diagnóstico Precoce , Feminino , Humanos , Masculino , Neuroimagem , Variações Dependentes do Observador , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Reprodutibilidade dos Testes , Tiazóis
5.
Invest Ophthalmol Vis Sci ; 61(10): 29, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32797198

RESUMO

Purpose: This systematic review aimed to determine currently reported clinical and prodromal ocular symptoms in patients with coronavirus disease 2019 (COVID-19). Methods: An online article search was performed in PubMed and EMBASE. Altogether 15 studies (retrospective, prospective, or case studies) involving 1533 patients with COVID-19, reporting on ocular symptoms, and with outcome data available were identified. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines were followed. Study-specific estimates (incidence rates of ocular symptoms in patients with COVID-19) of cases were combined using one-group meta-analysis in a random-effects model. Results: Of all included studies, 11.2% (95% confidence interval, 5.5-16.9; 78/1526 cases) reported ocular symptoms. The most common ocular finding was conjunctivitis. Prodromal ocular symptoms occurred in 12.5% (13/104 cases) of patients with COVID-19. Positive real-time polymerase chain reaction results were obtained for 16.7% (10/60 cases) of conjunctival samples and 0% (0/17 cases) of tear samples. Twelve ocular conjunctival swab samples tested positive for SARS-CoV-2. Ten cases were from subjects showing ocular symptoms (16.7%, 10/60 cases), and the remaining two cases were from subjects without ocular manifestation (1.8%, 2/113 cases). Limitations included the short study period, small sample size, findings were limited to the Asian population, only seven articles included ophthalmologic examination details, and there is currently no consensus on COVID-19 management. Conclusions: Ocular symptoms may occur in the presymptomatic phase as a prodromal symptom (12.5%, 13/104 cases), suggesting the possibility of viral transmission from the conjunctiva.


Assuntos
Conjuntivite Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Sintomas Prodrômicos , Síndrome Respiratória Aguda Grave/diagnóstico , Técnicas de Laboratório Clínico/métodos , Conjuntivite Viral/diagnóstico , Infecções por Coronavirus/diagnóstico , DNA Viral/análise , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Síndrome Respiratória Aguda Grave/epidemiologia
6.
Proc Natl Acad Sci U S A ; 117(35): 21546-21556, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32817525

RESUMO

The tremendous heterogeneity of the human population presents a major obstacle in understanding how autoimmune diseases like multiple sclerosis (MS) contribute to variations in human peripheral immune signatures. To minimize heterogeneity, we made use of a unique cohort of 43 monozygotic twin pairs clinically discordant for MS and searched for disease-related peripheral immune signatures in a systems biology approach covering a broad range of adaptive and innate immune populations on the protein level. Despite disease discordance, the immune signatures of MS-affected and unaffected cotwins were remarkably similar. Twinship alone contributed 56% of the immune variation, whereas MS explained 1 to 2% of the immune variance. Notably, distinct traits in CD4+ effector T cell subsets emerged when we focused on a subgroup of twins with signs of subclinical, prodromal MS in the clinically healthy cotwin. Some of these early-disease immune traits were confirmed in a second independent cohort of untreated early relapsing-remitting MS patients. Early involvement of effector T cell subsets thus points to a key role of T cells in MS disease initiation.


Assuntos
Esclerose Múltipla/genética , Esclerose Múltipla/imunologia , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Metilação de DNA , Feminino , Predisposição Genética para Doença/genética , Humanos , Masculino , Pessoa de Meia-Idade , Sintomas Prodrômicos , Gêmeos Monozigóticos/genética
7.
BMJ Case Rep ; 13(7)2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32641443

RESUMO

This is a case of a patient who presented with an urticarial rash 48 hours before developing symptoms of fever and a continuous cough. She subsequently developed angioedema of her lips and hands before testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Urticarial rashes occurring 48 hours before other symptoms of COVID-19 infection have been documented. This case demonstrates the importance of heightened awareness that not all urticarial rashes represent spontaneous urticaria and as a consequence, this may result in misdiagnosis and ultimately delayed diagnosis. This is the first reported case in the literature of urticaria with angioedema as a prodromal phenomenon of COVID-19.


Assuntos
Angioedema , Clorfeniramina/administração & dosagem , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Prednisona/administração & dosagem , Terfenadina/análogos & derivados , Urticária , Angioedema/diagnóstico , Angioedema/etiologia , Angioedema/fisiopatologia , Antialérgicos/administração & dosagem , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Sintomas Prodrômicos , Terfenadina/administração & dosagem , Resultado do Tratamento , Urticária/diagnóstico , Urticária/etiologia , Urticária/fisiopatologia
9.
Rev. Asoc. Méd. Argent ; 133(2): 29-33, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1119931

RESUMO

La Sociedad Fleishner define el signo del halo invertido o signo del atolón como un área focal redondeada con la densidad de un "vidrio esmerilado", rodeada por un anillo más o menos completo de consolidación. Este signo fue descrito inicialmente en pacientes con neumonía organizada criptogénica por Voloudaki y Kim. Ha sido descrito en: 1) enfermedades infecciosas (la paracoccidioidomicosis, la aspergilosis, la mucormicosis y virales), 2) síndromes linfoproliferativos (la granulomatosis linfomatoidea), y 3) enfermedades inflamatorias no infecciosas ni neoplásicas (el síndrome de Churg-Strauss, la neumonía intersticial no específica y la granulomatosis de Wegener).


The Fleishner Society defines the inverted halo sign or Atoll sign as a rounded focal area with a "ground glass" density, surrounded by a more or less complete ring of consolidation. This sign was initially described in patients with organizing cryptogenic pneumonia by Voloudaki and Kim. It has been described in: 1) infectious diseases (paracoccidioidomycosis, aspergillosis, mucormycosis, and virals), 2) lymphoproliferative diseases (lymphomatoid granulomatosis), and 3) non-infectious and neoplastic inflammatory diseases (Churg-Strauss syndrome, non-specific interstitial pneumonia, and Wegener's granulomatosis).


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/diagnóstico , Tomografia Computadorizada Multidetectores , Diagnóstico por Imagem , Reação em Cadeia da Polimerase , Pandemias , Sintomas Prodrômicos , Betacoronavirus
10.
Fortschr Neurol Psychiatr ; 88(6): 403-415, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32557468

RESUMO

Huntington's disease was an important example for discussing the problem of predictive genetic testing. Like other movement disorders, it includes non-motor symptoms and a prodromal phase. As a rapidly progressive monogenetic disease, it is an important model disease for the study of neurodegenerative pathomechanisms and one of the first movement disorders for which causal therapies seem to be reachable.


Assuntos
Doença de Huntington , Testes Genéticos , Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/genética , Doença de Huntington/fisiopatologia , Doença de Huntington/terapia , Sintomas Prodrômicos
12.
Nat Med ; 26(7): 1037-1040, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32393804

RESUMO

A total of 2,618,862 participants reported their potential symptoms of COVID-19 on a smartphone-based app. Among the 18,401 who had undergone a SARS-CoV-2 test, the proportion of participants who reported loss of smell and taste was higher in those with a positive test result (4,668 of 7,178 individuals; 65.03%) than in those with a negative test result (2,436 of 11,223 participants; 21.71%) (odds ratio = 6.74; 95% confidence interval = 6.31-7.21). A model combining symptoms to predict probable infection was applied to the data from all app users who reported symptoms (805,753) and predicted that 140,312 (17.42%) participants are likely to have COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Notificação de Doenças/métodos , Aplicativos Móveis , Pneumonia Viral/diagnóstico , Sintomas Prodrômicos , Autorrelato , Smartphone , Adulto , Idoso , Betacoronavirus/fisiologia , Sistemas Computacionais , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/patologia , Tosse/diagnóstico , Tosse/epidemiologia , Notificação de Doenças/normas , Dispneia/diagnóstico , Dispneia/epidemiologia , Fadiga/diagnóstico , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/normas , Modelos Biológicos , Transtornos do Olfato/diagnóstico , Transtornos do Olfato/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/patologia , Prognóstico , Índice de Gravidade de Doença , Distúrbios do Paladar/diagnóstico , Distúrbios do Paladar/epidemiologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
13.
J Korean Med Sci ; 35(13): e142, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: covidwho-31389

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea. METHODS: All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness. RESULTS: The median age was 40 years (range, 20-73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required supplemental oxygen therapy, but no one needed mechanical ventilation. Lymphopenia was more common in severe cases. Higher level of C-reactive protein and worsening of chest radiographic score was observed during the 5-7 day period after symptom onset. Viral shedding was high from day 1 of illness, especially from the upper respiratory tract (URT). CONCLUSION: The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Idoso , Doenças Assintomáticas , Proteína C-Reativa/análise , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Tosse/etiologia , Diarreia/etiologia , Febre/etiologia , Humanos , Linfopenia/etiologia , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Faringite/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Sintomas Prodrômicos , Radiografia Torácica , Reação em Cadeia da Polimerase em Tempo Real , República da Coreia , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
J Korean Med Sci ; 35(13): e142, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32242348

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea. METHODS: All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness. RESULTS: The median age was 40 years (range, 20-73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required supplemental oxygen therapy, but no one needed mechanical ventilation. Lymphopenia was more common in severe cases. Higher level of C-reactive protein and worsening of chest radiographic score was observed during the 5-7 day period after symptom onset. Viral shedding was high from day 1 of illness, especially from the upper respiratory tract (URT). CONCLUSION: The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Adulto , Idoso , Doenças Assintomáticas , Proteína C-Reativa/análise , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico por imagem , Tosse/etiologia , Diarreia/etiologia , Febre/etiologia , Humanos , Linfopenia/etiologia , Masculino , Pessoa de Meia-Idade , Oxigenoterapia , Faringite/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Sintomas Prodrômicos , Radiografia Torácica , Reação em Cadeia da Polimerase em Tempo Real , República da Coreia , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Neurology ; 94(19): e2026-e2036, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32291295

RESUMO

OBJECTIVE: To study the macrostructural and microstructural MRI correlates of brain astrocytosis, measured with 11C-deuterium-L-deprenyl (11C-DED)-PET, in familial autosomal-dominant Alzheimer disease (ADAD). METHODS: The total sample (n = 31) comprised ADAD mutation carriers (n = 10 presymptomatic, 39.2 ± 10.6 years old; n = 3 symptomatic, 55.5 ± 2.0 years old) and noncarriers (n = 18, 44.0 ± 13.7 years old) belonging to families with mutations in either the presenilin-1 or amyloid precursor protein genes. All participants underwent structural and diffusion MRI and neuropsychological assessment, and 20 participants (6 presymptomatic and 3 symptomatic mutation carriers and 11 noncarriers) also underwent 11C-DED-PET. RESULTS: Vertex-wise interaction analyses revealed a differential relationship between carriers and noncarriers in the association between 11C-DED binding and estimated years to onset (EYO) and between cortical mean diffusivity (MD) and EYO. These differences were due to higher 11C-DED binding in presymptomatic carriers, with lower binding in symptomatic carriers compared to noncarriers, and to lower cortical MD in presymptomatic carriers, with higher MD in symptomatic carriers compared to noncarriers. Using a vertex-wise local correlation approach, 11C-DED binding was negatively correlated with cortical MD and positively correlated with cortical thickness. CONCLUSIONS: Our proof-of-concept study is the first to show that microstructural and macrostructural changes can reflect underlying neuroinflammatory mechanisms in early stages of Alzheimer disease (AD). The findings support a role for neuroinflammation in AD pathogenesis, with potential implications for the correct interpretation of neuroimaging biomarkers as surrogate endpoints in clinical trials.


Assuntos
Doença de Alzheimer/metabolismo , Doença de Alzheimer/patologia , Córtex Cerebral/metabolismo , Córtex Cerebral/patologia , Adulto , Precursor de Proteína beta-Amiloide/genética , Encéfalo/patologia , Radioisótopos de Carbono/metabolismo , Deutério/metabolismo , Feminino , Heterozigoto , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mutação , Neuroimagem , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons , Presenilina-1/genética , Sintomas Prodrômicos , Selegilina/metabolismo
18.
Neurology ; 94(19): e2014-e2025, 2020 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-32321763

RESUMO

OBJECTIVE: To use network science to model complex diet relationships a decade before onset of dementia in a large French cohort, the 3-City Bordeaux study. METHODS: We identified cases of dementia incident to the baseline food frequency questionnaire over 12 years of follow-up. For each case, we randomly selected 2 controls among individuals at risk at the age at case diagnosis and matched for age at diet assessment, sex, education, and season of the survey. We inferred food networks in both cases and controls using mutual information, a measure to detect nonlinear associations, and compared food consumption patterns between groups. RESULTS: In the nested case-control study, the mean (SD) duration of follow-up and number of visits were 5.0 (2.5) vs 4.9 (2.6) years and 4.1 (1.0) vs 4.4 (0.9) for cases (n = 209) vs controls (n = 418), respectively. While there were few differences in simple, average food intakes, food networks differed substantially between cases and controls. The network in cases was focused and characterized by charcuterie as the main hub, with connections to foods typical of French southwestern diet and snack foods. In contrast, the network of controls included several disconnected subnetworks reflecting diverse and healthier food choices. CONCLUSION: How foods are consumed (and not only the quantity consumed) may be important for dementia prevention. Differences in predementia diet networks, suggesting worse eating habits toward charcuterie and snacking, were evident years before diagnosis in this cohort. Network methods, which are designed to model complex systems, may advance our understanding of risk factors for dementia.


Assuntos
Demência/psicologia , Comportamento Alimentar/psicologia , Dinâmica não Linear , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Sintomas Prodrômicos
19.
Neurology ; 94(17): 743-755, 2020 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-32241955

RESUMO

The prodromal phase of dementia with Lewy bodies (DLB) includes (1) mild cognitive impairment (MCI), (2) delirium-onset, and (3) psychiatric-onset presentations. The purpose of our review is to determine whether there is sufficient information yet available to justify development of diagnostic criteria for each of these. Our goal is to achieve evidence-based recommendations for the recognition of DLB at a predementia, symptomatic stage. We propose operationalized diagnostic criteria for probable and possible mild cognitive impairment with Lewy bodies, which are intended for use in research settings pending validation for use in clinical practice. They are compatible with current criteria for other prodromal neurodegenerative disorders including Alzheimer and Parkinson disease. Although there is still insufficient evidence to propose formal criteria for delirium-onset and psychiatric-onset presentations of DLB, we feel that it is important to characterize them, raising the index of diagnostic suspicion and prioritizing them for further investigation.


Assuntos
Doença por Corpos de Lewy/diagnóstico , Sintomas Prodrômicos , Humanos
20.
Neurology ; 94(23): e2448-e2456, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32345729

RESUMO

OBJECTIVE: To examine the association between fractures and Parkinson disease (PD) during the 5-year prodromal phase as compared to controls. METHODS: We performed a population-based case-control study of Medicare beneficiaries in the United States from 2004 to 2009. We identified 89,632 incident PD cases and 117,760 comparable controls 66-90 years of age in 2009. PD case status was the outcome, and noncranial fracture the independent variable. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for association between fracture and PD in yearly time intervals prior to PD diagnosis/control reference date, after adjusting for covariates. RESULTS: There were 39,606 total fractures (25.4% cases, 14.3% controls) over the 5 years prior to the PD diagnosis/control reference date. PD was positively associated with fractures even after adjusting for age, sex, race/ethnicity, Charlson comorbidity index, alcohol use, tobacco use, and osteoporosis. The association between PD and fracture was evident at yearly time windows prior to PD diagnosis/control reference date. The association between PD and each type of fracture strengthened as the PD diagnosis/control reference date approached (all time interaction p values ≤0.02). Among beneficiaries with a mechanism of injury, the majority were attributed to falls (74.6% cases, 72.8% controls). CONCLUSION: Fractures occur more commonly during the prodromal period of PD compared to controls, especially as diagnosis date approached, suggesting that patients with PD may experience unrecognized motor and nonmotor symptoms.


Assuntos
Fraturas Ósseas/epidemiologia , Doença de Parkinson/complicações , Sintomas Prodrômicos , Acidentes por Quedas , Acidentes de Trânsito , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/epidemiologia , Estudos de Casos e Controles , Comorbidade , Intervalos de Confiança , Grupos Étnicos/estatística & dados numéricos , Feminino , Fraturas Ósseas/etiologia , Humanos , Modelos Logísticos , Masculino , Medicare/estatística & dados numéricos , Modelos Teóricos , Razão de Chances , Especificidade de Órgãos , Osteoporose/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Fumar/epidemiologia , Estados Unidos/epidemiologia , Violência
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