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1.
Med Clin North Am ; 105(6): 1033-1045, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34688413

RESUMO

Subclinical thyroid disease is frequently encountered in clinic practice. Although overt thyroid dysfunction has been associated with adverse clinical outcomes, uncertainty remains about the implications of subclinical thyroid disease. Available data suggest that subclinical hypothyroidism may be associated with increased risk of cardiovascular disease and death. Despite this finding, treatment with thyroid hormone has not been consistently demonstrated to reduce cardiovascular risk. Subclinical hyperthyroidism has been associated with increased risk of atrial fibrillation and osteoporosis, but the association with cardiovascular disease and death is uncertain. The decision to treat depends on the degree of thyroid-stimulating hormone suppression and underlying comorbidities.


Assuntos
Tomada de Decisão Clínica , Doenças da Glândula Tireoide/epidemiologia , Fatores Etários , Fibrilação Atrial/epidemiologia , Doenças Cardiovasculares/epidemiologia , Transtornos Cognitivos/epidemiologia , Comorbidade , Humanos , Hipertireoidismo/epidemiologia , Hipotireoidismo/epidemiologia , Osteoporose/epidemiologia , Fatores de Risco , Doenças da Glândula Tireoide/sangue , Tireotropina/sangue , Tiroxina/sangue
2.
Arq Neuropsiquiatr ; 79(7): 565-570, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34468501

RESUMO

BACKGROUND: Cognitive decline is a common condition, but is still underrepresented in studies conducted in developing countries. OBJECTIVE: To calculate the prevalence of cognitive decline and depression in an elderly community-dwelling population in a city in southern Brazil. METHODS: We calculated the prevalences of dementia, cognitive impairment with no dementia (CIND) and symptoms of depression in an elderly population relying on the public healthcare system. This epidemiological study in Pelotas, Brazil, was conducted within the primary care setting. It included 299 older adults (mean age = 69.75 ± 7.6 years) who presented low levels of education (mean = 4.16 ± 3.17 years of education). They underwent cognitive screening and their medical records were analyzed. RESULTS: Among these older adults, 142 (47.5%) presented cognitive decline: 104 (34.8%) matching the cognitive criteria for CIND and 38 (12.7%) matching the cognitive criteria for dementia. Among all the individuals who completed the cognitive screening, 141 (48.4%) were positive for symptoms of depression, of whom 99 (34%) did not have any previous diagnosis in their medical records. CONCLUSION: There was high prevalence of cognitive impairment among these older adults in a primary care setting. A large number of older adults were found to have symptoms of depression without any diagnosis.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Demência , Idoso , Brasil/epidemiologia , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Humanos , Pessoa de Meia-Idade , Prevalência , Atenção Primária à Saúde
3.
Eur J Epidemiol ; 36(10): 1043-1054, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34370136

RESUMO

To examine the association of baseline body mass index (BMI) and BMI change with cognitive impairment among older adults in China. The study included data from the Chinese Longitudinal Healthy Longevity Study, a national community-based prospective cohort study from 2002 to 2018. Baseline BMI and BMI change were available for 12,027 adults aged older than 65 years. Cognitive impairment was defined as Chinese version of the Mini Mental State Examination score lower than 18. Multivariable Cox proportional hazard model was used. Among 12,027 participants (mean age was 81.23 years old and 47.48% were male), the proportion of underweight, normal, overweight and obese at baseline was 33.87%, 51.39%, 11.39% and 3.34%, respectively. During an average of 5.9 years' follow-up, 3086 participants (4.35 per 100 person-years) with incident cognitive impairment were identified. Compared with normal weight group, adjusted hazard ratio (AHR) for cognitive impairment was 0.86 (95% CI 0.75-0.99) among overweight group, whereas corresponding AHR was 1.02 (95% CI 0.94-1.10) in underweight and 1.01 (95% CI 0.80-1.28) in obese participants. Large weight loss (< -10%) was significantly associated with an increased risk of cognitive impairment (AHR, 1.42, 95% CI 1.29-1.56), compared to stable weight status group (-5% ~ 5%). In the restricted cubic spline models, BMI change showed a reverse J-shaped association with cognitive impairment. BMI-defined overweight, but not obesity, was associated with a lower risk of cognitive impairment among elderly Chinese adults, while large weight loss was associated with an increased risk. These findings are consistent with weight loss in the prodromal phase of dementia.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Índice de Massa Corporal , Peso Corporal , Transtornos Cognitivos/epidemiologia , Cognição/fisiologia , Estatura , China/epidemiologia , Transtornos Cognitivos/psicologia , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Prospectivos , Medição de Risco
4.
J Psychiatr Res ; 140: 545-550, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34182240

RESUMO

The impact of the Neurofibromatosis type 1 (NF1) on cognition have been subject to much clinical investigation, but environmental modifiers of disease expression have not yet been systematically investigated. The aim of this paper is to determine the role of demographic and environmental factors such as age, sex, socioeconomic status, parental NF1 status and neurological complications on the cognitive, behavioural and academic outcomes in NF1. Participants included 206 children aged 4-18 years seen within the Manchester clinical research NF1 service. Multiple linear regression models were used to study the effect of the hypothesized predictor variables on cognitive, behavioural and academic outcomes. Relative to population norms, 80% of the NF1 sample demonstrated significantly lower scores in at least one cognitive, behavioural or academic domains. Family history of NF1 and lower SES were independently associated with poorer cognitive, behavioural and academic outcomes. Neurological problems such as epilepsy and hydrocephalus were associated with lower IQ and academic skills. Cognitive and behavioural phenotypes emerge commonly via a complex interplay between genes and environmental factors, and this is true also of a monogenic condition such as NF1. Early interventions and remedial education may be targeted to risk groups such those with familial NF1, families with lower SES and those with associated neurological comorbidities.


Assuntos
Transtornos Cognitivos , Neurofibromatose 1 , Criança , Cognição , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Intervenção Educacional Precoce , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/epidemiologia , Pais
5.
Psychiatry Res ; 302: 114015, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34062477

RESUMO

The worldwide outbreak of CoronaVirus Disease appeared in 2019 (COVID-19) has forced millions of people into social isolation. Past research has documented negative psychological effects of self-isolation during health crises, in terms of stress, anger or depressive symptoms, but overall ignored psychotic symptoms and cognitive problems. The present study (n = 211) examined the relationship between the conditions of self-isolation - that is, duration, living space, frequency of social interactions - and psychotic symptoms and cognitive problems during the COVID-19 outbreak. The frequency of both psychotic symptoms and cognitive problems was associated with time since last conversation, with time since the person last left home and with smaller living space. Participants who reported an increase of psychotic symptoms and cognitive problems during the period of the pandemic also showed higher levels of symptoms. Although social isolation is an effective method for preventing the COVID-19 from spreading, for some individuals it is associated with an increased risk of developing psychotic symptoms.


Assuntos
COVID-19/psicologia , Transtornos Cognitivos/epidemiologia , Transtornos Mentais/epidemiologia , Pandemias , Isolamento Social/psicologia , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
6.
Ann Neurol ; 90(2): 266-273, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34105176

RESUMO

OBJECTIVE: X-linked adrenoleukodystrophy (X-ALD) is a rare genetic disorder characterized by progressive demyelination ranging from mild myelopathic forms (adrenomyeloneuropathy [AMN]) to severe cerebral variants (adult cerebral adrenoleukodystrophy [ACALD]). The aim of this study was to compare cognitive function in adult-onset X-ALD phenotypes. METHODS: Cognitive function in various domains (intelligence, attention, memory, executive function, and processing speed) was assessed in 172 adults (117 with AMN, 30 with arrested ACALD, and 25 with acute ACALD) using comprehensive neuropsychological batteries. Phenotype differences were examined by analyses of variance. RESULTS: X-ALD phenotypes significantly differed in nonverbal intelligence, sustained attention, verbal encoding, nonverbal recognition, and processing speed (ps < 0.050). No group differences emerged regarding verbal intelligence, verbal retrieval and recognition, and executive function (ps > 0.050). Specifically, patients with acute ACALD showed severe cognitive deficits compared to AMN and normal data, with largest effects on processing speed. Contrary, cognition was overall intact in patients with AMN, independent of sex and corticospinal tract involvement, and those with arrested ACALD showed mild cognitive dysfunction, particularly in verbal encoding and processing speed. INTERPRETATION: Cerebral demyelination in patients with X-ALD causes white matter dementia, mainly characterized by an extreme slowdown in processing speed associated with deficits in attention and learning. Most patients with AMN show intact cognitive function. Future prospective, longitudinal studies with more sensitive imaging techniques are required to clarify whether early mild cognitive dysfunction found in some patients with AMN may be associated with subtle myelin abnormalities that do not yet appear as white matter lesions on cerebral MRI (cMRI) but have the potential to serve as early predictors of later cerebral progression. ANN NEUROL 2021;90:266-273.


Assuntos
Adrenoleucodistrofia/diagnóstico por imagem , Adrenoleucodistrofia/psicologia , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/psicologia , Cognição/fisiologia , Fenótipo , Adolescente , Adrenoleucodistrofia/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
7.
Sci Rep ; 11(1): 12187, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34108532

RESUMO

To determine whether there are differences in measures of cognitive function between second and third trimester pregnant women compared to non-pregnant controls. This prospective study comprised 40 pregnant and 40 non-pregnant women, 20-40 years old, native-Hebrew speakers who were recruited from the outpatient clinics during a period of nearly 2 years. The patients underwent cognitive and affective evaluation. The performance on the three following tests: difficult and total items of Verbal Paired Associates, the Digit Span-forward and the Naming Objects and Fingers test scores were significantly better among non- pregnant women. All the other test results were similar between the two groups, including the depression scores. On multivariate linear regression analysis, after adjusting for age and years of education , Verbal Paired Associates total score (p = 0.04), and Naming Objects and Fingers (p = 0.01) remained significantly associated with pregnancy, but not Digit Span (p = 0.09). Our study demonstrates an impairment in memory among pregnant women. Furthermore language skills, particularly naming, were also impaired, a finding which has not been previously described.


Assuntos
Transtornos Cognitivos/epidemiologia , Idioma , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Israel/epidemiologia , Gravidez , Estudos Prospectivos , Adulto Jovem
8.
Artigo em Russo | MEDLINE | ID: mdl-34037349

RESUMO

OBJECTIVE: To assess the frequency and severity of cognitive impairment as well as its correlations with clinical characteristics in remitted patients with bipolar disorder (BD). MATERIAL AND METHODS: Eighty-five patients with BD type I (64 patients) and BD type II (21 patients) in remission were examined (average age 36.6±5.7). Affective symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and Young's Mania Rating Scale (YMRS). Cognitive impairment was assessed using the Brief Neuropsychological Cognitive Examination (BNCE). RESULTS: Cognitive impairment was revealed in 43.5% of the patients. The frequency and structure of cognitive impairment in patients with BD type I and type II did not differ. The patients with cognitive impairment were characterized by decreased speed of mental processes, decreased working memory and attention deficit. The correlation of the total BNCE score with the age of the patients, duration of the disease, total HDRS and YMRS scores was revealed. CONCLUSION: The results demonstrate the affective nature of cognitive deficit in the patients. Cognitive impairment in remitted patients with BD is a significant therapeutic target.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno Bipolar , Transtornos Cognitivos , Disfunção Cognitiva , Adulto , Transtorno Bipolar/complicações , Transtorno Bipolar/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Humanos , Testes Neuropsicológicos
10.
J Psychiatr Res ; 138: 535-540, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33990024

RESUMO

Cognitive dysfunction is a major predictor of functional outcomes, and loss of occupational functioning is usually linked with a higher cost of illness. However, the association between cognitive impairment and consumption of health resources has not been studied in bipolar disorder to date. This study aims to examine this relationship. This is an observational, retrospective study of a representative sample of euthymic outpatients between 18 and 55 years, fulfilling DSM 5 criteria for bipolar disorder and recruited at a catchment area in Spain. Cognitive performance was screened with the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S), and several variables of health resources consumption during the previous year were registered. A total of 72 patients were assessed. Cognitive impairment according to the SCIP-S was significantly associated with the number of scheduled clinical appointments (p < 0.005) and hospital admissions (p < 0.04) but not with other health resources consumption variables. These results need to be interpreted with caution given that neither a control group nor a comprehensive, objective neuropsychological battery were used. However, despite these limitations, this study shows that in euthymic outpatients with bipolar disorder, those with suspected cognitive impairment had consumed a higher number of health resources over the previous year. These preliminary results may foster similar studies on the relationship between mental healthcare resource use and cognitive dysfunction in bipolar disorder and other psychiatric disorders.


Assuntos
Transtorno Bipolar , Transtornos Cognitivos , Disfunção Cognitiva , Serviços de Saúde Mental , Transtorno Bipolar/complicações , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/terapia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/epidemiologia , Humanos , Testes Neuropsicológicos , Pacientes Ambulatoriais , Estudos Retrospectivos , Espanha/epidemiologia
11.
J Rehabil Med ; 53(6): jrm00205, 2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-33948672

RESUMO

OBJECTIVE: To examine the temporal evolution of subjective cognitive complaints in the long-term after stroke, and to identify predictors of long-term subjective cognitive complaints. METHODS: Prospective cohort study including 395 stroke patients. Subjective cognitive complaints were assessed at 2 months, 6 months and 4 years post-stroke, using the Checklist for Cognitive and Emotional consequences following stroke (CLCE-24). The temporal evolution of subjective cognitive complaints was described using multilevel growth modelling. Associations between CLCE-24 cognition score at 4 years post-stroke and baseline characteristics, depression, anxiety, cognitive test performance, and adaptive and maladaptive psychological factors were examined. Significant predictors were entered in a multivariate multilevel model. RESULTS: A significant increase in subjective cognitive complaints from 2 months up to 4 years (mean 3.7 years, standard deviation (SD) 0.6 years) post-stroke was observed (p≤0.001). Two months post-stroke, 76% of patients reported at least one cognitive complaint, 72% at 6 months, and 89% at 4 years post-stroke. A higher level of subjective cognitive complaints at 2 months and lower scores on adaptive and maladaptive psychological factors were significant independent predictors of a higher level of subjective cognitive complaints at 4 years post-stroke. CONCLUSION: Post-stroke subjective cognitive complaints increase over time and can be predicted by the extent of subjective cognitive complaints and the presence of adaptive and maladaptive psychological factors in the early phases after stroke.


Assuntos
Transtornos Cognitivos , Acidente Vascular Cerebral/complicações , Idoso , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo
12.
J Alzheimers Dis ; 81(4): 1737-1747, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33998540

RESUMO

BACKGROUND: Data on the association between multimorbidity and subjective cognitive complaints (SCC) are lacking from low- and middle-income countries (LMICs). OBJECTIVE: To assess the association between multimorbidity and SCC among adults from 48 LMICs. METHODS: Cross-sectional, community-based data were analyzed from the World Health Survey 2002-2004. Ten chronic conditions (angina, arthritis, asthma, chronic back pain, depression, diabetes, edentulism, hearing problems, tuberculosis, visual impairment) were assessed. Two questions on subjective memory and learning complaints in the past 30 days were used to create a SCC scale ranging from 0 (No SCC) to 100 (worse SCC). Multivariable linear regression and mediation analyses were conducted to explore the associations. RESULTS: A total of 224,842 individuals aged≥18 years [mean (SD) age 38.3 (16.0) years; 49.3% males] constituted the final sample. Compared to no chronic conditions, the mean SCC score was higher by 7.13 (95% CI = 6.57-7.69), 14.84 (95% CI = 13.91-15.77), 21.10 (95% CI = 19.49-22.70), 27.48 (95% CI = 25.20-29.76), and 33.99 (95% CI = 31.45-36.53) points for 1, 2, 3, 4, and≥5 chronic conditions. Estimates by sex and age groups (18-44, 45-64,≥65 years) were similar. Nearly 30% of the association between multimorbidity (i.e.,≥2 chronic conditions) and SCC was explained by psychological factors (i.e., perceived stress, sleep problems, anxiety symptoms). CONCLUSION: Multimorbidity is associated with SCC among adults in LMICs. Future studies should investigate whether addressing psychological factors in people with multimorbidity can improve cognitive function, and whether screening for SCC in individuals with multimorbidity can be a useful tool to identify individuals at particularly high risk for future cognitive decline.


Assuntos
Transtornos Cognitivos/epidemiologia , Cognição/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Países em Desenvolvimento , Feminino , Saúde Global , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Prevalência , Adulto Jovem
13.
J Korean Med Sci ; 36(20): e138, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34032031

RESUMO

BACKGROUND: Chronic kidney disease (CKD) has a negative impact on growth and development in children and is a risk factor for neurocognitive impairment; however, there is limited research on the cognitive function of children and adolescents with CKD. This study therefore aimed to investigate the mean intelligence and risk factors for low intelligence in children and adolescents with CKD. METHODS: Eighty-one patients with CKD under 18 years old were included in the KoreaN cohort study for Outcomes in patients With Pediatric Chronic Kidney Disease (KNOW-Ped CKD). Participants completed either the Wechsler Intelligence Scale for Children (6-16 years), or Wechsler Adult Intelligence Scale (> 16 years). RESULTS: The mean full-scale intelligence quotient (IQ) was 91 ± 19; 24.7% of participants scored a full-scale IQ below 80. Participants with a short stature (height Z scores < -1.88), failure to thrive (weight Z scores < -1.65), more severe CKD stage (≥ IIIb), longer duration of CKD (≥ 5 years), and those who were Medicare or Medicaid beneficiaries, had significantly lower mean full-scale IQs. CONCLUSION: On linear regression analysis, the association between the full-scale IQ, and longer duration of CKD and growth failure, remained significant after controlling for demographic and clinical variables. It is therefore necessary to investigate cognitive impairment in pediatric patients with CKD who exhibit growth failure or for a longer postmorbid period. It is believed that early interventions, such as kidney transplantation, will have a positive effect on IQ in children with CKD, as the disease negatively affects IQ due to poor glomerular filtration rate over time. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02165878.


Assuntos
Transtornos Cognitivos/epidemiologia , Cognição/fisiologia , Inteligência , Qualidade de Vida , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/psicologia , Adolescente , Criança , Pré-Escolar , Transtornos Cognitivos/diagnóstico , Estudos de Coortes , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Testes de Inteligência , Masculino
14.
Lancet Neurol ; 20(6): 448-459, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33901427

RESUMO

BACKGROUND: Post-stroke cognitive impairment (PSCI) occurs in approximately half of people in the first year after stroke. Infarct location is a potential determinant of PSCI, but a comprehensive map of strategic infarct locations predictive of PSCI is unavailable. We aimed to identify infarct locations most strongly predictive of PSCI after acute ischaemic stroke and use this information to develop a prediction model. METHODS: In this large-scale multicohort lesion-symptom mapping study, we pooled and harmonised individual patient data from 12 cohorts through the Meta-analyses on Strategic Lesion Locations for Vascular Cognitive Impairment using Lesion-Symptom Mapping (Meta VCI Map) consortium. The identified cohorts (as of Jan 1, 2019) comprised patients with acute symptomatic infarcts on CT or MRI (with available infarct segmentations) and a cognitive assessment up to 15 months after acute ischaemic stroke onset. PSCI was defined as performance lower than the fifth percentile of local normative data, on at least one cognitive domain on a multidomain neuropsychological assessment or on the Montreal Cognitive Assessment. Voxel-based lesion-symptom mapping (VLSM) was used to calculate voxel-wise odds ratios (ORs) for PSCI that were mapped onto a three-dimensional brain template to visualise PSCI risk per location. For the prediction model of PSCI risk, a location impact score on a 5-point scale was derived from the VLSM results on the basis of the mean voxel-wise coefficient (ln[OR]) within each patient's infarct. We did combined internal-external validation by leave-one-cohort-out cross-validation for all 12 cohorts using logistic regression. Predictive performance of a univariable model with only the location impact score was compared with a multivariable model with addition of other clinical PSCI predictors (age, sex, education, time interval between stroke onset and cognitive assessment, history of stroke, and total infarct volume). Testing of visual ratings was done by three clinicians, and accuracy, inter-rater reliability, and intra-rater reliability were assessed with Cohen's weighted kappa. FINDINGS: In our sample of 2950 patients (mean age 66·8 years [SD 11·6]; 1157 [39·2%] women), 1286 (43·6%) had PSCI. We achieved high lesion coverage of the brain in our analyses (86·9%). Infarcts in the left frontotemporal lobes, left thalamus, and right parietal lobe were strongly associated with PSCI (after false discovery rate correction, q<0·01; voxel-wise ORs >20). On cross-validation, the location impact score showed good correspondence, based on visual assessment of goodness of fit, between predicted and observed risk of PSCI across cohorts after adjusting for cohort-specific PSCI occurrence. Cross-validations showed that the location impact score by itself had similar performance to the combined model with other PSCI predictors, while allowing for easy visual assessment. Therefore the univariable model with only the location impact score was selected as the final model. Correspondence between visual ratings and actual location impact score (Cohen's weighted kappa: range 0·88-0·92), inter-rater agreement (0·85-0·87), and intra-rater agreement (for a single rater, 0·95) were all high. INTERPRETATION: To the best of our knowledge, this study provides the first comprehensive map of strategic infarct locations associated with risk of PSCI. A location impact score was derived from this map that robustly predicted PSCI across cohorts. Furthermore, we developed a quick and reliable visual rating scale that might in the future be applied by clinicians to identify individual patients at risk of PSCI. FUNDING: The Netherlands Organisation for Health Research and Development.


Assuntos
Disfunção Cognitiva/etiologia , Disfunção Cognitiva/patologia , Acidente Vascular Cerebral/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Encéfalo/patologia , Isquemia Encefálica/complicações , Mapeamento Encefálico/métodos , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Feminino , Humanos , Infarto/patologia , AVC Isquêmico , Modelos Logísticos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prognóstico , Reprodutibilidade dos Testes , Acidente Vascular Cerebral/epidemiologia
15.
Rev Bras Enferm ; 74(1): e20200649, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33886930

RESUMO

OBJECTIVES: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. METHODS: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. RESULTS: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. CONCLUSIONS: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.


Assuntos
Atividades Cotidianas , Sintomas Comportamentais/epidemiologia , Transtornos Cognitivos/epidemiologia , Cognição/fisiologia , Hanseníase/complicações , Transtornos Mentais/epidemiologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
16.
J Alzheimers Dis ; 81(2): 699-710, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33814428

RESUMO

BACKGROUND: Larger, more active social networks are estimated to be associated with lower risks of cognitive decline. However, roles of various social relationships in a broad social network in protecting against cognitive decline remain to be elucidated. OBJECTIVE: We aimed to investigate how social roles within a social network and number of social network members are associated with cognitive decline. METHODS: Six waves of National Health and Aging Trends Study (2011-2016, NHATS) were utilized to examine the development of mild cognitive impairment (MCI) and probable dementia determined using validated criteria. Multivariable-adjusted multi-state survival models were used to model incidences and transitions, jointly with misclassification errors. RESULTS: A total of 6,078 eligible NHATS participants were included (average age: 77.49±7.79 years; female: 58.42%; non-Hispanic white: 68.99%). Multivariable-adjusted analyses revealed that having more social network members was associated with lower hazards of conversion from MCI to probable dementia (adjusted Hazard Ratio; aHR = 0.82; 95%confidence intervals; 95%CI = [0.67-0.99]), meanwhile having at least one college-educated family member within a social network was associated with lower incidence of probable dementia (aHR = 0.37 [0.26-0.51]). Having at least one friend within a social network was associated with a lower hazard of incidence of probable dementia (aHR = 0.48 [0.33-0.71]), but a higher risk of mortality in the MCI group (aHR = 2.58 [1.47-4.51]). CONCLUSION: Having more social network members, having at least one friend, and having at least one college-educated family member within a social network, were associated with lower risks of incidence of dementia or conversion from MCI to dementia.


Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de Risco , Rede Social
17.
J Alzheimers Dis ; 81(2): 751-768, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33843672

RESUMO

BACKGROUND: There is growing consensus that non-genetic determinants of dementia can be linked to various risk- and resiliency-enhancing factors accumulating throughout the lifespan, including socioeconomic conditions, early life experiences, educational attainment, lifestyle behaviors, and physical/mental health. Yet, the causal impact of these diverse factors on dementia risk remain poorly understood due to few longitudinal studies prospectively characterizing these influences across the lifespan. OBJECTIVE: The Initial Lifespan's Impact on Alzheimer's Disease and Related Dementia (ILIAD) study aims to characterize dementia prevalence in the Wisconsin Longitudinal Study (WLS), a 60-year longitudinal study documenting life course trajectories of educational, family, occupational, psychological, cognitive, and health measures. METHODS: Participants are surveyed using the modified Telephone Interview for Cognitive Status (TICS-m) to identify dementia risk. Those scoring below cutoff undergo home-based neuropsychological, physical/neurological, and functional assessments. Dementia diagnosis is determined by consensus panel and merged with existing WLS data for combined analysis. RESULTS: Preliminary findings demonstrate the initial success of the ILIAD protocol in detecting dementia prevalence in the WLS. Increasing age, hearing issues, lower IQ, male sex, APOE4 positivity, and a steeper annualized rate of memory decline assessed in the prior two study waves, all increased likelihood of falling below the TICS-m cutoff for dementia risk. TICS-m scores significantly correlated with standard neuropsychological performance and functional outcomes. CONCLUSION: We provide an overview of the WLS study, describe existing key lifespan variables relevant to studies of dementia and cognitive aging, detail the current WLS-ILIAD study protocol, and provide a first glimpse of preliminary study findings.


Assuntos
Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Demência/psicologia , Transtornos Cognitivos/diagnóstico , Envelhecimento Cognitivo/fisiologia , Disfunção Cognitiva/diagnóstico , Escolaridade , Feminino , Humanos , Estudos Longitudinais , Masculino , Prevalência
18.
PLoS One ; 16(4): e0249651, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33882068

RESUMO

Preservation of cognitive function is one of the major concerns in contemporary ageing societies. At the same time, overweight and obesity, which have been identified as risk factors for poor health development, have been increasing in many countries all over the world. This study examines the relationship between bodyweight change and cognitive decline in old age and it aims to determine whether and how changes in body mass index (BMI) affect the development of cognitive functioning in old age. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE), covering four waves between 2006 and 2016 with 58,389 participants from 15 countries aged 50+, we estimated asymmetric fixed effects models by gender, adding possible confounding variables such as age, grip strength, health conditions, and physical activity. Additionally, we investigated possible heterogeneity in the BMI-cognition relation. We found a positive association between BMI change and change in cognitive performance, which was dominantly driven by BMI decrease. Weight loss was typically negatively related to cognition, particularly at low levels of BMI and mainly due to health conditions affecting both bodyweight and cognitive performance. Weight gain was, on average, not significantly related to cognitive performance; only respondents with preceding weight loss profited from small increases in BMI. Our analyses provide no support for an "obesity paradox" in cognition, according to which higher weight preserves cognition in old age. The association between weight change and cognitive performance in older age is based on weight changes being related to illness and recovery.


Assuntos
Envelhecimento/fisiologia , Peso Corporal/fisiologia , Disfunção Cognitiva/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Trajetória do Peso do Corpo , Cognição/fisiologia , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/metabolismo , Europa (Continente)/epidemiologia , Função Executiva/fisiologia , Exercício Físico , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Sobrepeso/epidemiologia , Fatores de Risco , Fatores Socioeconômicos
19.
Neurology ; 96(19): e2395-e2406, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33766994

RESUMO

OBJECTIVE: To assess the prevalence, timing, and functional impact of psychiatric, cognitive, and motor abnormalities in Huntington disease (HD) gene carriers, we analyzed retrospective clinical data from individuals with manifest HD. METHODS: Clinical features of patients with HD were analyzed for 6,316 individuals in an observational study of the European Huntington's Disease Network (REGISTRY) from 161 sites across 17 countries. Data came from clinical history and the patient-completed Clinical Characteristics Questionnaire that assessed 8 symptoms: motor, cognitive, apathy, depression, perseverative/obsessive behavior, irritability, violent/aggressive behavior, and psychosis. Multiple logistic regression was used to analyze relationships between symptoms and functional outcomes. RESULTS: The initial manifestation of HD is increasingly likely to be motor and less likely to be psychiatric as age at presentation increases and is independent of pathogenic CAG repeat length. The Clinical Characteristics Questionnaire captures data on nonmotor symptom prevalence that correlate specifically with validated clinical measures. Psychiatric and cognitive symptoms are common in HD gene carriers, with earlier onsets associated with longer CAG repeats. Of patients with HD, 42.4% reported at least 1 psychiatric or cognitive symptom before motor symptoms, with depression most common. Each nonmotor symptom was associated with significantly reduced total functional capacity scores. CONCLUSIONS: Psychiatric and cognitive symptoms are common and functionally debilitating in HD gene carriers. They require recognition and targeting with clinical outcome measures and treatments. However, because it is impossible to distinguish confidently between nonmotor symptoms arising from HD and primary psychiatric disorders, particularly in younger premanifest patients, nonmotor symptoms should not be used to make a clinical diagnosis of HD. TRIAL REGISTRATION INFORMATION: ClinicalTrials.gov Identifier: NCT01590589.


Assuntos
Transtornos Cognitivos/epidemiologia , Doença de Huntington/epidemiologia , Internacionalidade , Transtornos Mentais/epidemiologia , Transtornos das Habilidades Motoras/epidemiologia , Testes Neuropsicológicos , Adulto , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Doença de Huntington/diagnóstico , Doença de Huntington/psicologia , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos das Habilidades Motoras/diagnóstico , Transtornos das Habilidades Motoras/psicologia , Estudos Retrospectivos , Fatores de Tempo
20.
Acta Diabetol ; 58(7): 845-858, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33723650

RESUMO

AIMS: Previous studies have evaluated long-term metabolic and neurocognitive outcomes in offspring of women with diabetes. However, many studies did not differentiate between different types of diabetes. We aimed to specifically evaluate both metabolic and neurocognitive outcomes in offspring of women with type 1 diabetes mellitus (OT1D). METHODS: We conducted an extensive literature search on PubMed between February 2020 and September 2020. We performed a scoping review including 12 retrospective cohort studies, 15 prospective cohort studies, one case-control study and one cross-sectional study, comparing long-term metabolic and neurocognitive outcomes between OT1D and a control group. RESULTS: OT1D had a higher body mass index and an increased risk for overweight and obesity compared to offspring of mothers without diabetes. A limited number of studies showed a higher risk for (pre)diabetes, higher rates of non-alcoholic fatty liver disease and metabolic syndrome in OT1D. Index offspring had in general similar intelligence and academic achievement as control children but a higher risk for attention deficit and hyperactivity disorders. Data were conflicting concerning the increased risk for autism spectrum disorders. There is limited evidence suggesting that female offspring have more often unfavorable metabolic parameters, while male offspring are more at risk for hyperactivity/impulsivity. CONCLUSION: Maternal type 1 diabetes mellitus is associated with an increased risk of several metabolic complications and neurobehavioral disorders in the offspring. Increased attention for long-term complications in this population is needed. Further research is needed to evaluate whether improved glycemic control in pregnancy can reduce these long-term complications.


Assuntos
Filho de Pais Incapacitados , Diabetes Mellitus Tipo 1 , Gravidez em Diabéticas , Efeitos Tardios da Exposição Pré-Natal/metabolismo , Efeitos Tardios da Exposição Pré-Natal/psicologia , Índice de Massa Corporal , Criança , Filho de Pais Incapacitados/psicologia , Filho de Pais Incapacitados/estatística & dados numéricos , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Feminino , Humanos , Masculino , Doenças Metabólicas/epidemiologia , Doenças Metabólicas/etiologia , Síndrome Metabólica/epidemiologia , Síndrome Metabólica/etiologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Obesidade/epidemiologia , Obesidade/etiologia , Sobrepeso/epidemiologia , Sobrepeso/etiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fatores de Risco
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