Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.489
Filtrar
1.
Lakartidningen ; 1162019 Oct 07.
Artigo em Sueco | MEDLINE | ID: mdl-31593288

RESUMO

Late and moderately preterm infants, born between 32+0/7 and 36+6/7 gestational weeks, comprise more than 80 % of all preterm infants and account for almost 40 % of all days of neonatal care. While their total number of days of care has not changed, an increasing part of their neonatal stay (from 29 % in 2011 to 41 % in 2017) is now within home care programmes. Late and moderate preterm birth is often complicated by respiratory disorders, hyperbilirubinemia, hypothermia and feeding difficulties. These infants also have an increased risk of perinatal death and neurologic complications. In the long run, they have higher risks of cognitive impairment, neuropsychiatric diagnoses and need for asthma medication. As young adults, they have a lower educational level and a lower average salary than their full-term counterparts. They also have an increased risk of long-term sick leave, disability pension and need for economic assistance from society.


Assuntos
Nascimento Prematuro , Corticosteroides/administração & dosagem , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtornos Cognitivos/epidemiologia , Educação Especial/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido Prematuro , Tempo de Internação , Pneumopatias/epidemiologia , Masculino , Transtornos Mentais/epidemiologia , Gravidez , Nascimento Prematuro/economia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/mortalidade , Nascimento Prematuro/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Fatores de Risco , Tempo
2.
Hypertension ; 74(5): 1172-1180, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31542965

RESUMO

Blood pressure variability (BPV) has been shown to have predictive value over blood pressure (BP) levels alone in stroke patients. We assessed whether BPV predicts cognitive and functional decline in Alzheimer disease, using data from a randomized trial (NILVAD [A European Multicentre Double-blind Placebo-controlled Phase III Trial of Nilvadipine in Mild to Moderate Alzheimer's Disease]). Patients with mild-to-moderate Alzheimer disease were included if they had ≥3 office BP measurements available to determine visit-to-visit BPV. Day-to-day BPV was assessed using home BP measurements in a subsample. The variation independent of mean was used to calculate BPV. Outcomes were change in Alzheimer's Disease Assessment Scale-cognitive subscale-12 and Disability Assessment for Dementia after 1 and 1.5 years. A total of 460 patients aged 72.1 (SD=8.1) years, with mean BP of 134.0/75.1 (10.9/6.3) mm Hg were included. After 1 year, patients in the highest quartile of BPV had deteriorated more on Alzheimer's Disease Assessment Scale-cognitive subscale compared with patients in the lowest quartile (systolic: ß, 2.24 [95% CI, 0.11-4.38], P=0.040; diastolic: ß, 2.54 [95% CI, 0.33-4.75] P=0.024). This association was still present after 1.5 years (systolic: ß, 2.86 [95% CI, 0.35-5.36], P=0.026; diastolic: ß, 3.30 [95% CI, 0.67-5.93], P=0.014). There was no effect of visit-to-visit BPV on Disability Assessment for Dementia. Day-to-day BPV was available for 46 patients. Significant associations were observed between day-to-day BPV and deterioration on Alzheimer's Disease Assessment Scale-cognitive subscale (systolic: P=0.036) and Disability Assessment for Dementia (systolic: P=0.020; diastolic: P=0.007) after 1 year, but not after 1.5 years. All associations were adjusted for potential confounders, including intervention group. In conclusion, this post hoc analysis indicates that higher visit-to-visit and day-to-day BPV might be associated with progression of Alzheimer disease. Targeting BPV may be a future target to slow decline in patients with Alzheimer disease. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02017340.


Assuntos
Doença de Alzheimer/fisiopatologia , Anti-Hipertensivos/uso terapêutico , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Nifedipino/análogos & derivados , Idoso , Doença de Alzheimer/epidemiologia , Determinação da Pressão Arterial/métodos , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/fisiopatologia , Intervalos de Confiança , Progressão da Doença , Método Duplo-Cego , Feminino , Humanos , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Análise Multivariada , Nifedipino/uso terapêutico , Prognóstico , Medição de Risco , Índice de Gravidade de Doença
3.
Cochrane Database Syst Rev ; 8: CD013047, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31425631

RESUMO

BACKGROUND: Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is concern about the possible long-term effects of radiotherapy, especially on neurocognitive functioning. OBJECTIVES: To evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after diagnosis); and to write a brief economic commentary. SEARCH METHODS: We searched the following databases on 16 February 2018 and updated the search on 14 November 2018: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library; MEDLINE via Ovid; and Embase via Ovid. We also searched clinical trial registries and relevant conference proceedings from 2014 to 2018 to identify ongoing and unpublished studies. SELECTION CRITERIA: Randomised and non-randomised trials, and controlled before-and-after studies (CBAS). Participants were aged 16 years and older with cerebral glioma other than glioblastoma. We included studies where patients in at least one treatment arm received radiotherapy, with or without chemotherapy, and where neurocognitive outcomes were assessed two or more years after treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. We assessed the certainty of findings using the GRADE approach. MAIN RESULTS: The review includes nine studies: seven studies were of low-grade glioma and two were of grade 3 glioma. Altogether 2406 participants were involved but there was high sample attrition and outcome data were available for a minority of people at final study assessments. In seven of the nine studies, participants were recruited to randomised controlled trials (RCTs) in which longer-term follow-up was undertaken in a subset of people that had survived without disease progression. There was moderate to high risk of bias in studies due to lack of blinding and high attrition, and in two observational studies there was high risk of selection bias. Paucity of data and risk of bias meant that evidence was of low to very low certainty. We were unable to combine results in meta-analysis due to diversity in interventions and outcomes.The studies examined the following five comparisons.Radiotherapy versus no adjuvant treatmentTwo observational studies contributed data. At the 12-year follow-up in one study, the risk of cognitive impairment (defined as cognitive disability deficits in at least five of 18 neuropsychological tests) was greater in the radiotherapy group (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.02 to 3.71; n = 65); at five to six years the difference between groups did not reach statistical significance (RR 1.38, 95% CI 0.92 to 2.06; n = 195). In the other study, one subject in the radiotherapy group had cognitive impairment (defined as significant deterioration in eight of 12 neuropsychological tests) at two years compared with none in the control group (very low certainty evidence).With regard to neurocognitive scores, in one study the radiotherapy group was reported to have had significantly worse mean scores on some tests compared with no radiotherapy; however, the raw data were only given for significant findings. In the second study, there were no clear differences in any of the various cognitive outcomes at two years (n = 31) and four years (n = 15) (very low certainty evidence).Radiotherapy versus chemotherapyOne RCT contributed data on cognitive impairment at up to three years with no clear difference between arms (RR 1.43, 95% CI 0.36 to 5.70, n = 117) (low-certainty evidence).High-dose radiotherapy versus low-dose radiotherapyOnly one of two studies reporting this comparison contributed data, and at two and five years there were no clear differences between high- and low-dose radiotherapy arms (very low certainty evidence).Conventional radiotherapy versus stereotactic conformal radiotherapyOne study involving younger people contributed limited data from the subgroup aged 16 to 25 years. The numbers of participants with neurocognitive impairment at five years after treatment were two out of 12 in the conventional arm versus none out of 11 in the stereotactic conformal radiotherapy arm (RR 4.62, 95% CI 0.25 to 86.72; n = 23; low-certainty evidence).Chemoradiotherapy versus radiotherapyTwo RCTs tested for cognitive impairment. One defined cognitive impairment as a decline of more than 3 points in MMSE score compared with baseline and reported data from 2-year (110 participants), 3-year (91 participants), and 5-year (57 participants) follow-up with no clear difference between the two arms at any time point. A second study did not report raw data but measured MMSE scores over five years in 126 participants at two years, 110 at three years, 69 at four years and 53 at five years. Authors concluded that there was no difference in MMSE scores between the two study arms (P = 0.4752) (low-certainty evidence).Two RCTs reported quality of life (QoL) outcomes for this comparison. One reported no differences in Brain-QoL scores between study arms over a 5-year follow-up period (P = 0.2767; no raw data were given and denominators were not stated). The other trial reported that the long-term results of health-related QoL showed no difference between the arms but did not give the raw data for overall HRQoL scores (low-certainty evidence).We found no comparative data on endocrine dysfunction; we planned to develop a brief economic commentary but found no relevant economic studies for inclusion. AUTHORS' CONCLUSIONS: Radiotherapy for gliomas with a good prognosis may increase the risk of neurocognitive side effects in the long term; however the magnitude of the risk is uncertain. Evidence on long-term neurocognitive side effects associated with chemoradiotherapy is also uncertain. Neurocognitive assessment should be an integral part of long-term follow-up in trials involving radiotherapy for lower-grade gliomas to improve the certainty of evidence regarding long-term neurocognitive effects. Such trials should also assess other potential long-term effects, including endocrine dysfunction, and evaluate costs and cost effectiveness.


Assuntos
Antineoplásicos/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Glioma/terapia , Lesões por Radiação/complicações , Radioterapia/efeitos adversos , Antineoplásicos/uso terapêutico , Transtornos Cognitivos/epidemiologia , Humanos , Radiocirurgia , Radioterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Mayo Clin Proc ; 94(8): 1582-1588, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31378232

RESUMO

Older drivers are putting more miles on the road during their "golden years" than generations prior. Many older adults have safe driving habits, but unique age-related changes increase the risk for crash-related morbidity and mortality. Generalists are poised to assess and guide older adults' driving fitness. Although there is no uniformly accepted tool for driving fitness, assessment of 5 key domains (cognition, vision, physical function, medical comorbidities, and medications) using valid tools can help clinicians stratify older drivers into low, intermediate, and high risk for unsafe driving. Clinicians can then make recommendations about fitness to drive and appropriate referrals for rehabilitation or alternative transportation resources to optimize mobility, independence, and quality of life for older adults.


Assuntos
Acidentes de Trânsito/prevenção & controle , Envelhecimento/psicologia , Condução de Veículo/psicologia , Aconselhamento/métodos , Clínicos Gerais , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/estatística & dados numéricos , Transtornos Cognitivos/epidemiologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Papel do Médico , Medição de Risco , Segurança , Transtornos da Visão/epidemiologia
5.
BMJ ; 366: l4466, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391161

RESUMO

OBJECTIVE: To quantify the association between major surgery and the age related cognitive trajectory. DESIGN: Prospective longitudinal cohort study. SETTING: United Kingdom. PARTICIPANTS: 7532 adults with as many as five cognitive assessments between 1997 and 2016 in the Whitehall II study, with linkage to hospital episode statistics. Exposures of interest included any major hospital admission, defined as requiring more than one overnight stay during follow-up. MAIN OUTCOMES MEASURES: The primary outcome was the global cognitive score established from a battery of cognitive tests encompassing reasoning, memory, and phonemic and semantic fluency. Bayesian linear mixed effects models were used to calculate the change in the age related cognitive trajectory after hospital admission. The odds of substantial cognitive decline induced by surgery defined as more than 1.96 standard deviations from a predicted trajectory (based on the first three cognitive waves of data) was also calculated. RESULTS: After accounting for the age related cognitive trajectory, major surgery was associated with a small additional cognitive decline, equivalent on average to less than five months of aging (95% credible interval 0.01 to 0.73 years). In comparison, admissions for medical conditions and stroke were associated with 1.4 (1.0 to 1.8) and 13 (9.6 to 16) years of aging, respectively. Substantial cognitive decline occurred in 2.5% of participants with no admissions, 5.5% of surgical admissions, and 12.7% of medical admissions. Compared with participants with no major hospital admissions, those with surgical or medical events were more likely to have substantial decline from their predicted trajectory (surgical admissions odds ratio 2.3, 95% credible interval 1.4 to 3.9; medical admissions 6.2, 3.4 to 11.0). CONCLUSIONS: Major surgery is associated with a small, long term change in the average cognitive trajectory that is less profound than for major medical admissions. The odds of substantial cognitive decline after surgery was about doubled, though lower than for medical admissions. During informed consent, this information should be weighed against the potential health benefits of surgery.


Assuntos
Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/epidemiologia , Hospitalização/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Adulto , Idoso , Transtornos Cognitivos/etiologia , Disfunção Cognitiva/etiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
6.
Neurología (Barc., Ed. impr.) ; 34(6): 353-359, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185452

RESUMO

Introducción: La neurofibromatosis tipo 1 (NF1) es un síndrome neurocutáneo frecuente que en muchos casos se asocia a dificultades cognitivas específicas que habitualmente no son tenidas en cuenta en el seguimiento médico de estos pacientes. Objetivo: Trazar el perfil cognitivo de pacientes con NF1 detectando trastornos en funciones superiores asociados al mismo. Identificar motivos de consulta de pacientes pediátricos con NF1 en relación con su desempeño escolar. Métodos: Trabajo descriptivo transversal. Se evaluó neuropsicológicamente a 24 pacientes con NF1 con edades comprendidas entre los 5 y los 16 años de edad. Resultados: Los motivos de consulta más frecuentes fueron: problemas atencionales (58,33%), aprendizaje (25%), coordinación motora (25%) y lenguaje (0,8%). Si bien el estudio reveló que el 96% de los pacientes tenía compromiso en al menos una de las áreas evaluadas, solo el 83,34% de los padres las refirieron. El 58,33% presentó trastorno por déficit de atención con hiperactividad (TDAH), el 33,33% trastorno de aprendizaje no verbal (TANV), el 20,83% dificultades en aspectos expresivos del lenguaje, el 8,33% coeficiente intelectual (CI) limítrofe, el 4,16% retraso mental y el 4,16% no mostró dificultades. Conclusiones: Existe alta frecuencia de trastornos en funciones superiores en niños con NF1. Aunque muchos padres detectan dichos trastornos, se ha observado que otros son subestimados. Consideramos conveniente que todos los niños con NF1 cuenten con una evaluación neuropsicológica a fin de poder detectar dificultades existentes en cada caso y así poder elaborar una estrategia de rehabilitación cognitiva precoz y efectiva


Introduction: Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome often associated with specific cognitive deficits that are rarely monitored during follow-up of these patients. Objective: The purpose of our study is two-fold. First, we aimed to describe the cognitive profile of patients with NF1 and detect disorders in higher brain functions associated with the disease. Second, we identified the reasons for consultation associated with school performance in these patients. Methods: We conducted a descriptive cross-sectional study of 24 paediatric patients (ages 5 to 16) with NF1 who underwent neuropsychological assessment. Results: The most frequent reasons for consultation were attention deficits (58.33%), learning disorders (25%), poor motor coordination (25%), and language impairment (0.8%). Although 96% of the patients displayed impairments in at least one of the assessed areas, only 83.34% of the parents had reported such impairments. Attention-deficit/hyperactivity disorder was present in 58.33% of the patients, whereas 33.33% had nonverbal learning disabilities, 20.83% had expressive language disorder, 8.33% had borderline intellectual functioning, 4.16% had mental retardation, and only 4.16% showed no cognitive impairment. Conclusion: Higher brain functions are frequently impaired in paediatric patients with NF1. Although many parents report such disorders, they can go undetected in some cases. Neuropsychological assessment is recommended for all paediatric patients with NF1 to detect cognitive impairment and provide early, effective rehabilitation treatment


Assuntos
Humanos , Masculino , Feminino , Criança , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos da Linguagem/diagnóstico , Transtornos de Aprendizagem/diagnóstico , Neurofibromatose 1/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estudos Transversais , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Transtornos da Linguagem/epidemiologia , Transtornos de Aprendizagem/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos
7.
S Afr Med J ; 109(7): 526-534, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266581

RESUMO

BACKGROUND: Alcohol use in South Africa (SA) is increasing. The World Health Organization (WHO) states that SA is the third-largest drinking population in Africa, with the highest rate of fetal alcohol syndrome in the world. Internationally, parental drinking during childhood is a risk factor for poor child mental health, behavioural problems and weaker educational outcomes in middle childhood. However, parental alcohol use in Africa is under-researched, and much of the literature on maternal alcohol consumption is restricted to clinical and pregnancy samples. OBJECTIVES: To investigate alcohol use and hazardous drinking (HD) among mothers/primary caregivers of children aged 7 - 11 years in a rural SA cohort. We explored risk factors for drinking and the association between HD and child behaviour/cognition. METHODS: The primary outcome measure was the WHO Alcohol Use Disorder Identification Test (AUDIT) using the standardised cut-off for HD (≥8). Secondary measures were the Patient Health Questionnaire Depression Scale (PHQ-9), Patient Health Questionnaire General Anxiety Disorder Scale (GAD-7), Parenting Stress Index, short form (PSI-36), Child Behaviour Checklist (CBCL, parent reported), Kaufman Developmental Assessment Battery (KABC-II) for child cognition, and Neuropsychological Assessment Battery, 2nd edition, subtests (NEPSY-II) for executive function. We compared characteristics of those drinking/not drinking, using χ2 tests, and modelled outcomes on parenting stress, cognitive outcomes and CBCL scores for children using logistic regression analysis. We grouped mothers/caregivers engaged in HD to examine its effect on parent/child outcomes using t-tests to test for significant differences. RESULTS: Of 1 505 women (1 266 mothers and 239 caregivers) with 1 536 children, 12% reported consuming alcohol and 3% reported HD. Higher maternal/caregiver age (31 - 40 years, adjusted odds ratio (aOR) 0.57 (95% confidence interval (CI) 0.4 - 0.9); >41 years, aOR 0.30 (95% CI 0.2 - 0.5)), education (matriculation, aOR 0.49 (95% CI 0.3 - 0.9); post matriculation, aOR 0.30 (95% CI 0.1 - 0.6)), and a stable relationship with the father (aOR 0.6 (95% CI 0.4 - 1.0)) were associated with no alcohol use. Food insecurity increased the odds of alcohol use (aOR 1.52 (95% CI 1.1 - 2.1)), while parental mental health (parenting stress, anxiety) and child mental health problems were associated with approximately double the odds of consuming alcohol in univariate analysis. Children of HD mothers/caregivers had higher mean scores for psychological problems (CBCL total score: no HD (mean 45.0) v. HD (mean 48.9); p=0.029) and lower cognitive scores (KABC Learning Scale: no HD (mean 14.3) v. HD (mean 12.8); p=0.017). CONCLUSIONS: While HD rates were low, maternal/caregiver alcohol use negatively impacted on parenting and children's behavioural/cognitive outcomes. International evidence suggests that integrated approaches engaging parents and families may be more effective for parent-child outcomes than individual psychiatric or medical care for the parent on their own.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos do Comportamento Infantil/epidemiologia , Transtornos Cognitivos/epidemiologia , Mães/psicologia , Adulto , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/psicologia , Cuidadores/psicologia , Criança , Estudos de Coortes , Feminino , Abastecimento de Alimentos , Infecções por HIV/complicações , Humanos , Masculino , Saúde Mental , Transtornos do Neurodesenvolvimento/complicações , Testes Neuropsicológicos , Poder Familiar/psicologia , População Rural , África do Sul/epidemiologia , Estresse Psicológico/etiologia , Inquéritos e Questionários
8.
J Autism Dev Disord ; 49(10): 4339-4345, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31267284

RESUMO

Extreme prematurity is known as a risk factor for autism spectrum disorder (ASD). However, the association between prematurity and ASD, for children born moderately and late preterm (MLPT) and those born early term (ET), is less established. This retrospective study aimed to characterize the phenotypic characteristics (i.e. behavioral profile and cognitive abilities) of 254 children with ASD, between 3 and 15 years of age, born MLPT (19 children), ET (60 children) and full term (175 children). MLPT and ET births do not modify ASD symptomatology, but modify cognitive development. The results highlight that incomplete gestation, i.e., MLPT or ET, has a negative impact on both verbal and nonverbal cognitive abilities, in children with neurodevelopmental vulnerability.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtornos Cognitivos/epidemiologia , Recém-Nascido Prematuro/psicologia , Nascimento Prematuro/epidemiologia , Adolescente , Transtorno do Espectro Autista/psicologia , Criança , Pré-Escolar , Cognição , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro/crescimento & desenvolvimento , Masculino , Gravidez
9.
Mayo Clin Proc ; 94(8): 1516-1523, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31280871

RESUMO

OBJECTIVE: To compare the Short Test of Mental Status (STMS) with the Montreal Cognitive Assessment (MoCA) for predicting and detecting mild cognitive impairment (MCI). PARTICIPANTS AND METHODS: Participants from the community-based Mayo Clinic Study of Aging (MCSA) (November 24, 2010, through May 19, 2012) and an academic referral Alzheimer's Disease Research Center (ADRC) (March 16, 2015, through September 5, 2018) were analyzed. All participants were evaluated using a standardized neuropsychological battery, and a multidisciplinary consensus diagnosis was assigned. The MCSA and ADRC samples included 313 and 106 stable cognitively normal (CN) participants, 72 and 8 CN participants at baseline who developed incident MCI or dementia, 114 and 96 participants with prevalent MCI, and 25 and 132 participants with dementia, respectively. RESULTS: There were no statistically significant differences between the 2 tests in 6 of 7 diagnostic comparisons across academic referral and community populations. The STMS had a better area under the curve (0.90; 95% CI, 0.87-0.93) for differentiating prevalent MCI from CN participants in the MCSA cohort compared with the MoCA cohort (0.85; 95% CI, 0.81-0.89; P=.01). In addition, 53% of the stable CN participants (222 of 419) scored less than 26 on the MoCA, with specificity of 47% for diagnosing prevalent MCI. CONCLUSION: We provide evidence that the STMS performs similarly to the MoCA in a variety of settings and neurodegenerative syndromes. These results suggest that the current recommended MoCA cutoff score may be overly sensitive, consistent with previous studies. We also provide a conversion table for comparing the 2 cognitive tests.


Assuntos
Envelhecimento/fisiologia , Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Testes de Estado Mental e Demência , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Área Sob a Curva , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Diagnóstico Diferencial , Progressão da Doença , Feminino , Avaliação Geriátrica/métodos , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Minnesota , Testes Neuropsicológicos , Valor Preditivo dos Testes , Prevalência , Curva ROC , Estudos Retrospectivos , Medição de Risco
10.
NeuroRehabilitation ; 44(4): 531-544, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31256093

RESUMO

BACKGROUND: Virtual reality (VR) technology may provide an effective means to integrate cognitive and functional approaches to TBI rehabilitation. However, little is known about the effectiveness of VR rehabilitation for TBI-related cognitive deficits. In response to these clinical and research gaps, we developed Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE), an intervention designed to improve cognitive performance, driving safety, and neurobehavioral symptoms. OBJECTIVE: This pilot clinical trial was conducted to examine feasibility and preliminary efficacy of NeuroDRIVE for rehabilitation of chronic TBI. METHODS: Eleven participants who received the intervention were compared to six wait-listed participants on driving abilities, cognitive performance, and neurobehavioral symptoms. RESULTS: The NeuroDRIVE intervention was associated with significant improvements in working memory and visual search/selective attention- two cognitive skills that represented a primary focus of the intervention. By comparison, no significant changes were observed in untrained cognitive areas, neurobehavioral symptoms, or driving skills. CONCLUSIONS: Results suggest that immersive virtual environments can provide a valuable and engaging means to achieve some cognitive rehabilitation goals, particularly when these goals are closely matched to the VR training exercises. However, additional research is needed to augment our understanding of rehabilitation for driving skills, cognitive performance, and neurobehavioral symptoms in chronic TBI.


Assuntos
Condução de Veículo/psicologia , Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/reabilitação , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/reabilitação , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Atenção/fisiologia , Lesões Encefálicas Traumáticas/epidemiologia , Doença Crônica , Transtornos Cognitivos/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Memória de Curto Prazo/fisiologia , Pessoa de Meia-Idade , Projetos Piloto , Realidade Virtual
11.
Clin Interv Aging ; 14: 925-933, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31190778

RESUMO

Introduction: The factors that influence the rehabilitation process among older adults remain unclear. The aim of the study was to assess the acceptance of illness and related factors (socio-demographic data, cognitive status, depression symptoms and functional status) among patients living in a nursing home who are undergoing rehabilitation. Sample and methods: A total of 119 elderly patients were examined, of whom 96 were included in the research project. All participants were assessed using the following tests: Mini Mental State Examination, Acceptance of Illness Scale, Geriatric Depression Scale and Barthel Index. Tests were conducted at two time points, the first upon admission to the ward and the second after 3 months of regular rehabilitation. Results: The study group showed relatively low scores for illness acceptance. After 3 months of rehabilitation, the acceptance of illness had significantly improved, but still remained at a low level. The results showed a relationship between acceptance of illness and patients' depression symptoms, functional status and cognitive status. Conclusions: The results suggest that assessment of the acceptance of illness among patients living in Nursing Home is important during treatment and rehabilitation process; however, further studies are necessary.


Assuntos
Atitude Frente a Saúde , Transtornos Cognitivos/epidemiologia , Depressão/epidemiologia , Nível de Saúde , Casas de Saúde/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Testes de Estado Mental e Demência , Fatores Socioeconômicos
12.
BMC Public Health ; 19(Suppl 4): 462, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196017

RESUMO

BACKGROUND: Motoric cognitive risk (MCR) syndrome is characterized by slow gait and memory complaints that could be used to predict an increased risk of dementia. This study aims to determine the MCR syndrome and its risk factors among low-income (B40) older adults in Malaysia. METHODS: Data from TUA cohort study involving 1366 older adults (aged 60 years and above) categorized as low-income were analysed, for risk of MCR syndrome based on defined criteria. Chi-square analysis and independent t test were employed to examine differences in socioeconomic, demographic, chronic diseases and lifestyle factors between MCR and non-MCR groups. Risk factors of MCR syndrome were determined using hierarchical logistic regression. RESULTS: A total of 3.4% of participants fulfilled the criteria of MCR syndrome. Majority of them were female (74.5%, p = 0.001), single/widow/widower/divorced (55.3%, p = 0.002), living in rural area (72.3%, p = 0.011), older age (72.74 ± 7.08 year old, p <  0.001) and had lower years of education (3.26 ± 2.91 years, p = 0.001) than non-MCR group. After adjustment for age, gender and years of education, participants living in rural area (Adjusted OR = 2.19, 95% CI = 1.10-4.35, p = 0.026), with obesity (Adjusted OR = 3.82, 95% CI = 1.70-8.57, p = 0.001), diabetes (Adjusted OR = 2.04, 95% CI = 1.01-4.11, p = 0.046), heart disease (Adjusted OR = 2.50, 95% CI = 1.00-6.20, p = 0.049) and cancer (Adjusted OR = 6.57, 95% CI = 1.18-36.65, p = 0.032) were associated with increased risk of MCR syndrome. CONCLUSION: Only 3.4% of older adults from low-income group were identified as having MCR syndrome. Women, those living in rural areas, had obesity, diabetes, heart disease and cancer were more likely to have MCR syndrome. Further investigation on MCR as a predementia syndrome will help in development of preventive strategies and interventions to reduce the growing burden of dementia, especially among individuals with low socioeconomic status.


Assuntos
Transtornos Cognitivos/epidemiologia , Demência/epidemiologia , Pobreza/psicologia , Idoso , Transtornos Cognitivos/psicologia , Estudos de Coortes , Demência/psicologia , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Síndrome
13.
BMC Public Health ; 19(Suppl 4): 541, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196019

RESUMO

BACKGROUND: Socioeconomic factors and nutritional status have been associated with childhood cognitive development. However, previous Malaysian studies had been conducted with small populations and had inconsistent results. Thus, this present study aims to determine the association between socioeconomic and nutritional status with cognitive performance in a nationally representative sample of Malaysian children. METHODS: A total of 2406 Malaysian children aged 5 to 12 years, who had participated in the South East Asian Nutrition Surveys (SEANUTS), were included in this study. Cognitive performance [non-verbal intelligence quotient (IQ)] was measured using Raven's Progressive Matrices, while socioeconomic characteristics were determined using parent-report questionnaires. Body mass index (BMI) was calculated using measured weight and height, while BMI-for-age Z-score (BAZ) and height-for-age Z-score (HAZ) were determined using WHO 2007 growth reference. RESULTS: Overall, about a third (35.0%) of the children had above average non-verbal IQ (high average: 110-119; superior: ≥120 and above), while only 12.2% were categorized as having low/borderline IQ (< 80). Children with severe obesity (BAZ > 3SD), children from very low household income families and children whose parents had only up to primary level education had the highest prevalence of low/borderline non-verbal IQ, compared to their non-obese and higher socioeconomic counterparts. Parental lack of education was associated with low/borderline/below average IQ [paternal, OR = 2.38 (95%CI 1.22, 4.62); maternal, OR = 2.64 (95%CI 1.32, 5.30)]. Children from the lowest income group were twice as likely to have low/borderline/below average IQ [OR = 2.01 (95%CI 1.16, 3.49)]. Children with severe obesity were twice as likely to have poor non-verbal IQ than children with normal BMI [OR = 2.28 (95%CI 1.23, 4.24)]. CONCLUSIONS: Children from disadvantaged backgrounds (that is those from very low income families and those whose parents had primary education or lower) and children with severe obesity are more likely to have poor non-verbal IQ. Further studies to investigate the social and environmental factors linked to cognitive performance will provide deeper insights into the measures that can be taken to improve the cognitive performance of Malaysian children.


Assuntos
Transtornos Cognitivos/epidemiologia , Obesidade Mórbida/psicologia , Pobreza/psicologia , Classe Social , Índice de Massa Corporal , Criança , Desenvolvimento Infantil , Pré-Escolar , Cognição , Transtornos Cognitivos/etiologia , Feminino , Humanos , Renda , Testes de Inteligência/estatística & dados numéricos , Malásia/epidemiologia , Masculino , Inquéritos Nutricionais , Estado Nutricional , Obesidade Mórbida/epidemiologia , Pais , Prevalência , Inquéritos e Questionários
14.
J Clin Neurosci ; 66: 209-219, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31085075

RESUMO

BACKGROUND: Traumatic brain injury (TBI) can causes numerous cognitive impairments usually in the aspects of problem-solving, executive function, memory, and attention. Several studies has suggested that rehabilitation treatment interventions can be effective in treating cognitive symptoms of brain injury. Virtual reality (VR) technology potential as a useful tool for the assessment and rehabilitation of cognitive processes. OBJECTIVES: The aims of present systematic review are to examine effects of VR training intervention on cognitive function, and to identify effective VR treatment protocol in patients with TBI. METHODS: PubMed, Scopus, PEDro, REHABDATA, EMBASE, web of science, and MEDLINE were searched for studies investigated effect of VR on cognitive functions post TBI. The methodological quality were evaluated using PEDro scale. The results of selected studies were summarized. RESULTS: Nine studies were included in present study. Four were randomized clinical trials, case studies (n = 3), prospective study (n = 1), and pilot study (n = 1). The scores on the PEDro ranged from 0 to 7 with a mean score of 3. The results showed improvement in various cognitive function aspects such as; memory, executive function, and attention in patients with TBI after VR training. CONCLUSION: Using different VR tools with following treatment protocol; 10-12 sessions, 20-40 min in duration with 2-4 sessions per week may improves cognitive function in patients with TBI. There was weak evidence for effects of VR training on attention post TBI.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/terapia , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/terapia , Terapia Cognitivo-Comportamental/métodos , Terapia de Exposição à Realidade Virtual/métodos , Atenção/fisiologia , Lesões Encefálicas Traumáticas/psicologia , Cognição/fisiologia , Transtornos Cognitivos/psicologia , Função Executiva/fisiologia , Humanos , Memória/fisiologia , Projetos Piloto , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento
15.
BMC Med ; 17(1): 98, 2019 05 21.
Artigo em Inglês | MEDLINE | ID: mdl-31109328

RESUMO

BACKGROUND: Acute kidney injury (AKI) is a recognized complication of pediatric severe malaria, but its long-term consequences are unknown. METHODS: Ugandan children with cerebral malaria (CM, n = 260) and severe malaria anemia (SMA, n = 219) or community children (CC, n = 173) between 1.5 and 12 years of age were enrolled in a prospective cohort study. Kidney Disease: Improving Global Outcomes (KDIGO) criteria were used to retrospectively define AKI and chronic kidney disease (CKD). Cognitive testing was conducted using the Mullen Scales of Early Learning in children < 5 and Kaufman Assessment Battery for Children (K-ABC) second edition in children ≥ 5 years of age. RESULTS: The prevalence of AKI was 35.1%, ranging from 25.1% in SMA to 43.5% in CM. In-hospital mortality was 11.9% in AKI compared to 4.2% in children without AKI (p = 0.001), and post-discharge mortality was 4.7% in AKI compared to 1.3% in children without AKI (p = 0.030) corresponding to an all-cause adjusted hazard ratio of 2.30 (95% CI 1.21, 4.35). AKI was a risk factor for short- and long-term neurocognitive impairment. At 1 week post-discharge, the frequency of neurocognitive impairment was 37.3% in AKI compared to 13.5% in children without AKI (adjusted odds ratio (aOR) 2.31 [95% CI 1.32, 4.04]); at 1-year follow-up, it was 13.3% in AKI compared to 3.4% in children without AKI (aOR 2.48 [95% CI 1.01, 6.10]), and at 2-year follow-up, it was 13.0% in AKI compared to 3.4% in children without AKI (aOR 3.03 [95% CI 1.22, 7.58]). AKI was a risk factor for CKD at 1-year follow-up: 7.6% of children with severe malaria-associated AKI had CKD at follow-up compared to 2.8% of children without AKI (p = 0.038) corresponding to an OR of 2.81 (95% CI 1.02, 7.73). The presenting etiology of AKI was consistent with prerenal azotemia, and lactate dehydrogenase as a marker of intravascular hemolysis was an independent risk factor for AKI in CM and SMA (p < 0.0001). In CM, AKI was associated with the presence and severity of retinopathy (p < 0.05) and increased cerebrospinal fluid albumin suggestive of blood-brain barrier disruption. CONCLUSIONS: AKI is a risk factor for long-term neurocognitive impairment and CKD in pediatric severe malaria.


Assuntos
Lesão Renal Aguda/epidemiologia , Transtornos Cognitivos/epidemiologia , Malária/complicações , Malária/epidemiologia , Insuficiência Renal Crônica/epidemiologia , Lesão Renal Aguda/complicações , Lesão Renal Aguda/psicologia , Criança , Pré-Escolar , Transtornos Cognitivos/etiologia , Estudos de Coortes , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Malária/patologia , Malária/psicologia , Malária Cerebral/complicações , Malária Cerebral/epidemiologia , Masculino , Prevalência , Estudos Prospectivos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/psicologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Uganda/epidemiologia
16.
BMC Public Health ; 19(1): 585, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096943

RESUMO

BACKGROUND: In an ageing world facing an epidemic of chronic diseases, there is great interest in the burden of multimorbidity on individuals and caregivers, yet no studies have examined the longitudinal association between multimorbidity and care dependence in low and middle income countries. Mental and cognitive disorders are associated with dependence but little is known about their role in the pathway to dependence in the context of multimorbidity. This study aims to determine (1) the association of multimorbidity with the onset of care dependence in older adults, accounting for mortality and controlling for sociodemographic factors, and (2) the independent effects of physical multimorbidity, mental and cognitive disorders. METHODS: A population-based cohort study of people aged 65 years and older in six countries in Latin America, and China. Data on chronic conditions and sociodemographic factors were collected at baseline. Multimorbidity was ascertained as a count of up to 15 mental, cognitive and physical health conditions. Dependence was ascertained through informant interviews at baseline and follow-up. We used competing risk regression to assess the association between multimorbidity and the onset of care dependence, acknowledging the possibility of dependence-free death. We also assessed the independent effects of physical multimorbidity and depression, anxiety and dementia individually. RESULTS: 12,965 participants, with no needs for care at baseline, were followed up for a median of 3.0-4.9 years. Each unit increase in multimorbidity count increased the cumulative risk of dependence by 20% in the fully adjusted model. Age was the only variable to confound this relationship. Physical multimorbidity was associated with only a modest increased risk of care dependence. Dementia, depression and anxiety were independently associated with incident care dependence at every level of physical multimorbidity, and depression and anxiety attenuated the effect of physical multimorbidity. CONCLUSION: Multimorbidity consistently predicts care dependence with little variation between countries. Physical multimorbidity imparts a lower risk than multimorbidity with mental and cognitive disorders included. Mental and cognitive disorders independently increase the risk of care dependence. Comprehensive and holistic assessment of disorders of body, brain and mind can help to identify older people at high risk of care dependence.


Assuntos
Cuidadores/estatística & dados numéricos , Doença Crônica/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Multimorbidade , Pobreza/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , China/epidemiologia , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Demência/epidemiologia , Depressão/epidemiologia , Feminino , Humanos , Renda , América Latina/epidemiologia , Estudos Longitudinais , Masculino , Análise de Regressão
17.
Int J Public Health ; 64(5): 731-742, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31032531

RESUMO

OBJECTIVES: We aimed to estimate health expectancies at age 65 based on physical and cognitive function in 2001-2002 and 2011-2012 and project future needs for carers from 2021 to 2041. METHODS: Data from the Elderly Health Centres (EHCs) of the Department of Health of the Government of Hong Kong comprising of people aged 65 years or older who enrolled between 2001 and 2002 (EHC 2001-2002) and between 2011 and 2012 (EHC 2011-2012) provided proportion estimates for physical impairment (assessed by independence in activities of daily living) and cognitive impairment (assessed by Abbreviated Mental Test/Mini-Mental Status Examination and self-reported doctor diagnosis of dementia). Health expectancies (years lived with/without physical and/or cognitive impairment) were calculated by Sullivan's method. The proportions of physical and/or cognitive impairment were used to project future needs for carers. RESULTS: Between 2001-2002 and 2011-2012, years lived without physical/cognitive impairment decreased for men but increased for women, both of which were less than the increases in total life expectancy. Men assessed in 2011-2012 (classified as EHC 2011-2012) lived more years with physical and/or cognitive impairment than those assessed in 2001-2002 (classified as EHC 2001-2002), and women in EHC 2011-2012 lived more years with physical impairment, but fewer years with cognitive impairment than those in EHC 2001-2002, and women enrolled in EHC 2011-2012 lived more years with physical impairment, but fewer years with cognitive impairment than those in EHC 2001-2002. As populations age, the number of carers needed is expected to increase from 344,000 in 2021 to 629,000 by 2041, or an increase of 82.9%. Sensitivity analyses excluding the participants who had been assessed in 2011-2012 from EHC 2001-2002 gave similar estimations. CONCLUSIONS: Increased life expectancy was not accompanied by an increase in years lived without physical/cognitive impairment. These findings suggest that people will live longer but could be more dependent, which would have considerable implications for elderly service needs in Hong Kong.


Assuntos
Transtornos Cognitivos/epidemiologia , Expectativa de Vida/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Previsões , Hong Kong/epidemiologia , Humanos , Masculino , Fatores Socioeconômicos
18.
Maturitas ; 123: 45-54, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31027677

RESUMO

BACKGROUND: Motoric cognitive risk syndrome (MCR) is a pre-dementia stage, which associates slow walking speed with subjective cognitive impairment (SCI). MCR's clinical utility for the prediction of dementia and its pathophysiology are unclear. The aim of this systematic review and meta-analysis is to examine the association of MCR with incident cognitive impairment, cognitive performance and brain structures. METHODS: A systematic search was conducted using the Medical Subject Heading terms "Walking" and "Cognition disorders" combined with the terms "Subjective cognitive impairment", "Subjective cognitive decline" and "Motoric cognitive risk". A total of 11 studies were included in the systematic review and meta-analysis: 3 studies had dementia as the outcome, 3 studies had cognitive performance as the outcome, 4 studies had brain structures as the outcome and one study examined the incidence of both major neurocognitive disorders and cognitive impairment. RESULTS: MCR was found to be associated with incident cognitive impairment (pooled hazard ratio (HR) = 1.70, 95% CI, 1.46-1.98 with P-value <0.001) and dementia (pooled HR = 2.50, 95% CI, 1.75-2.39 with P-value <0.001). MCR was also found to be associated with low grey matter volume involving the premotor and the prefrontal cortex, and lacunar lesions in the frontal lobe. No significant association was found with white matter abnormalities. CONCLUSION: MCR predicts cognitive impairment and dementia, suggesting that it may be used as a screening syndrome for dementia in a primary care setting. Its significant association with both low grey matter volume and lacunar lesions makes its pathophysiology unclear and suggests multiple pathways.


Assuntos
Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Sintomas Prodrômicos , Velocidade de Caminhada , Encéfalo/patologia , Cognição/fisiologia , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/diagnóstico por imagem , Autoavaliação Diagnóstica , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/patologia , Humanos , Incidência , Testes Neuropsicológicos , Tamanho do Órgão , Modelos de Riscos Proporcionais , Fatores de Risco , Síndrome
19.
Soins ; 64(833): 52-54, 2019 Mar.
Artigo em Francês | MEDLINE | ID: mdl-30879634

RESUMO

The decision-making process in a nursing home is complex. In view of the prevalence of cognitive disorders and the importance of the role of carers, the personal choice becomes more of a shared decision. The legal framework, while favourable, remains under-used and could be improved.


Assuntos
Tomada de Decisões , Casas de Saúde , Assistência Terminal , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/terapia , Humanos
20.
Eur Psychiatry ; 58: 80-86, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30875582

RESUMO

BACKGROUND: A large variation in cognitive performance exists between European regions. However, it is unclear how older Europeans differ in the rate of cognitive decline. METHODS: We analysed data from 22 181 individuals (54% women; median age 71) who participated in the Survey on Health, Ageing and Retirement in Europe. Cognition was measured using tests on verbal fluency, immediate and delayed recall. We used linear regression and linear mixed effects regression to examine regional differences in the level of cognitive performance and the rate of cognitive decline. RESULTS: Scandinavians had the highest baseline cognitive scores (mean standardized overall cognitive score 0.3), followed by Western Europeans (mean 0.2), Central and Eastern Europeans (mean 0.1) and individuals from Mediterranean countries (mean -0.4). These differences persisted even after adjustment for sociodemographic and clinical characteristics. The annual cognitive decline in Scandinavia (0.59%) was approximately two times greater than in Western Europe (0.28%), Central and Eastern Europe (0.25%) and Mediterranean countries (0.23%). DISCUSSION: There are substantial differences in cognitive performance as well as rates of cognitive decline among the elderly throughout European regions. This might be explained by differing levels of cognitive reserve.


Assuntos
Transtornos Cognitivos/epidemiologia , Cognição , Disfunção Cognitiva/epidemiologia , Nível de Saúde , Idoso , Envelhecimento/psicologia , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/diagnóstico , Estudos de Coortes , Europa (Continente)/epidemiologia , Feminino , Geografia/estatística & dados numéricos , Avaliação Geriátrica , Humanos , Modelos Lineares , Masculino , Estudos Prospectivos , Inquéritos e Questionários
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA