RESUMO
BACKGROUND: The aim of this study was to develop and validate a functional ability index (FAI) that incorporates aspects of intrinsic capacity and environmental factors of older individuals based on the World Health Organization framework of healthy ageing. METHODS: Data of 7016 participants ≥60 years participating in the baseline survey of China Health and Retirement Longitudinal Study was used for the development and internal validation of the FAI. External validation was performed in a separate cohort of 1295 older individuals aged ≥60 years. Functional independency was considered the primary outcome and additional proxies of healthy ageing were considered as secondary outcomes. Cluster dendrogram was used to identify the distinct hierarchical clusters of all included variables for inclusion in the FAI. Backward elimination logistic regression model was implemented to identify the most significant variables associated with independency to be included in the FAI. RESULTS: The FAI score ranged from 0 to 19 and individuals having FAI ≥ 12 were more likely to be independent and at lower risk of negative outcomes. For each unit increase in the FAI the risk of having independency increased by 30%-58% cross-sectionally in the two cohorts, whilst the 2-year risk of independency increased by 20%. The FAI demonstrated a C-statistic of 0.73 (95% confidence interval, 0.72 and 0.75) for the primary outcome. CONCLUSIONS: The FAI we developed effectively measured the functional ability status of community dwelling older individuals. FAI could serve as a tool for evaluating older individual's functional ability in routine health assessment.
Assuntos
Atividades Cotidianas , Estado Funcional , Avaliação Geriátrica , Humanos , Idoso , Masculino , Feminino , Avaliação Geriátrica/métodos , Pessoa de Meia-Idade , Estudos Longitudinais , Reprodutibilidade dos Testes , China/epidemiologia , Envelhecimento Saudável , Fatores Etários , Idoso de 80 Anos ou mais , Valor Preditivo dos TestesRESUMO
BACKGROUND: Fragmentation of services increases health and social care burden as people live longer with higher prevalence of diseases, frailty and dependency. Local evidence for implementing person-centred integrated care is urgently needed to advance practice and policies to achieve healthy ageing. OBJECTIVE: To test the feasibility and impact of World Health Organization's (WHO) Integrated Care for Older People (ICOPE) approach in China. DESIGN: A randomised controlled trial examining the feasibility of implementing ICOPE approach, evaluating its impact on health outcomes and health resource utilisation. SETTING: Primary care setting in urban and suburban communities of Chaoyang District, Beijing, China. SUBJECTS: Community-dwelling older adults screened as at-risk of functional declines and randomised into intervention (537) and control (1611) groups between September 2020 and February 2021. METHODS: A 6-month intervention program following WHO's ICOPE care pathways implemented by integrated care managers compared to standard available care. RESULTS: After 1 to 1 propensity score matching, participants in intervention and control groups (totally 938) had comparable baseline characteristics, demonstrated feasibility of implementing ICOPE with satisfaction by participants (97-99%) and providers (92-93%). All outcomes showed improvements after a 6-month intervention, while statistically significant least-squares mean differences (control-intervention) in vitality (Mini-Nutritional Assessment Short Form to measure vitality, -0.21, 95% CI, -0.40-0.02), mobility (Short Physical Performance Battery to measure mobility, -0.29, 95% CI, -0.44-0.14) and psychological health (Geriatric Depression Scale five items to measure psychological health, 0.09, 95% CI, 0.03-0.14) were observed (P < 0.05). CONCLUSIONS: It is feasible to localise and implement WHO's ICOPE approach in regions with fragmented resources such as China. Preliminary evidence supports its acceptance among key stakeholders and impact on health outcomes.
Assuntos
Sobrecarga do Cuidador , Prestação Integrada de Cuidados de Saúde , Humanos , Idoso , China/epidemiologia , Organização Mundial da Saúde , Procedimentos ClínicosRESUMO
BACKGROUND: Intrinsic capacity is the combination of individual physical and mental abilities, reflecting the aging degree of the older adults. However, the mechanisms and metabolic characteristics of the decline in intrinsic capacity are still unclear. AIMS: To identify metabolic signatures and associated pathways of decline in intrinsic capacity based on the metabolite features. METHODS: We recruited 70 participants aged 77.19 ± 8.31 years. The five domains of intrinsic capacity were assessed by Short Physical Performance Battery (for mobility), Montreal cognition assessment (for cognition), 30-Item Geriatric Depression Scale (for psychology), self-reported hearing/visual impairment (for sensory) and Nutritional risk screening (for vitality), respectively. The serum samples of participants were analyzed by liquid chromatography-mass spectrometry-based metabolomics, followed by metabolite set enrichment analysis and metabolic pathway analysis. RESULTS: There were 50 participants with a decline in intrinsic capacity in at least one of the domains. A total of 349 metabolites were identified from their serum samples. Overall, 24 differential metabolites, 5 metabolite sets and 13 pathways were associated with the decline in intrinsic capacity. DISCUSSION: Our results indicated that decline in intrinsic capacity had unique metabolomic profiles. CONCLUSION: The specific change of acyl carnitines was observed to be a feature of decline in intrinsic capacity. Dysregulation of the pentose phosphate pathway and of arginine and ornithine metabolism was strongly associated with the decline in intrinsic capacity.
Assuntos
Arginina , Carnitina/análogos & derivados , Via de Pentose Fosfato , Humanos , Idoso , Metabolômica/métodos , China , OrnitinaRESUMO
Lower-lignin (LoL) varieties of alfalfa (Medicago sativa L.) have been developed in recent years, and have the potential to positively impact animal performance. The objective of this study was to evaluate the effects of increasing the proportion of LoL alfalfa hay in diets fed to lactating dairy cows. Research plots were planted with a conventional variety (CON; Dairyland Hybriforce 3400), and 2 LoL varieties (LLG; 54HVX42 and LLB; Aflorex HiGest 460). After harvest, the LoL varieties were blended in equal proportions for feeding. Twelve multiparous Jersey cows (100 ± 4 d in milk) were used in a 3 × 3 Latin square with 3 periods of 28 d. Cows were assigned to 3 diets containing 0 (CNTRL), 16.1 (MdLL), and 32.2% (HiLL) of the diet DM as LoL alfalfa hay, which replaced CON. The CON alfalfa had average CP, NDF, and lignin contents (DM basis) of 20.5 ± 1.15, 42.1 ± 1.37, and 6.81 ± 0.57%, respectively, while the LoL alfalfa averaged 19.8 ± 0.75, 39.9 ± 1.56, and 6.07 ± 0.28%, respectively. No difference was observed in DMI (20.4 ± 0.61 kg/d). No difference in milk yield was observed, averaging 31.0 ± 1.02 kg/d across treatments. Similarly, no difference was observed in ECM yield (averaging 36.2 ± 1.43 kg/d). Feed conversion (ECM/DMI) tended to increase linearly with LoL alfalfa inclusion (1.74 to 1.80 ± 0.03). No difference was observed for milk fat yield and content (1.39 ± 0.075 kg/d and 4.51 ± 0.219%) or milk protein yield and content (1.06 ± 0.041 kg/d and 3.43 ± 0.096%). Total methane production quadratically decreased from CNTRL to MdLL then increased to HiLL (441, 389, 412 ± 18.2 L/d, respectively). No differences were observed on total-tract digestibility of DM (averaging 67.2 ± 0.55%) and NDF (averaging 50.9 ± 1.56%). No difference was observed in the concentration of DE, ME or NEL was observed averaging 2.82 ± 0.021, 2.51 ± 0.027, and 1.72 ± 0.030 Mcal/kg respectively. Our results suggest that replacing CON alfalfa with LoL alfalfa has no effects on milk production, milk composition, or nutrient digestibility but may improve feed efficiency.
RESUMO
Parkinson's disease (PD) is the second most common neurodegenerative disorder after Alzheimer's disease. Ageing is considered to be the greatest risk factor for PD, with a complex interplay between genetics and the environment. With population ageing, the prevalence of PD is expected to escalate worldwide; thus, it is of utmost importance to reduce the burden of PD. To date, there are no therapies to cure the disease, and current treatment strategies focus on the management of symptoms. Older adults often have multiple chronic diseases and geriatric syndromes, which further complicates the management of PD. Healthcare systems and care models necessary to address the broad needs of older PD patients are largely unavailable. In this New Horizon article, we discuss various aspects of PD from an ageing perspective, including disease management. We highlight recent advancements in PD therapies and discuss new care models with the potential to improve patient's quality of life.
Assuntos
Doença de Parkinson , Humanos , Idoso , Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Doença de Parkinson/terapia , Qualidade de Vida , EnvelhecimentoRESUMO
BACKGROUND: Gait disturbance is an important risk factor for falls in Parkinson's disease (PD). Using wearable sensors, we can obtain the spatiotemporal parameters of gait and calculate the gait variability. This prospective study aims to objectively evaluate the gait characteristics of PD fallers, and further explore the relationship between spatiotemporal parameters of gait, gait variability and falls in PD patients followed for six months. METHODS: Fifty-one PD patients were enrolled in this study. A seven-meter timed up and go test was performed. Gait characteristics were determined by a gait analysis system. Patients were followed monthly by telephone until the occurrence of falls or till the end of six months. The patients were categorized into fallers and non-fallers based on whether fell during the follow-up period. Gait parameters were compared between two groups, and binary logistic regression was used to establish the falls prediction model. In the receiver-operating characteristic curve, area under the curve (AUC) was utilized to evaluate the prediction accuracy of each indicator. RESULTS: All subjects completed the follow-up, and 14 (27.5%) patients reported falls. PD fallers had greater gait variability. The range of motion of the trunk in sagittal plane variability was an independent risk factor for falls and achieved moderate prediction accuracy (AUC = 0.751), and the logistic regression model achieved a good accuracy of falls prediction (AUC = 0.838). CONCLUSIONS: Increased gait variability is a significant feature of PD fallers and is more sensitive to detect PD patients at high risk of falls than spatiotemporal parameters.
Assuntos
Doença de Parkinson , Acidentes por Quedas , Marcha , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Equilíbrio Postural , Estudos Prospectivos , Estudos de Tempo e MovimentoRESUMO
Background: Frailty is known to be highly prevalent in older hemodialysis (HD) patients. We studied the prevalence of frailty and its associated factors in Chinese HD patients. We further studied if frailty could predict survival in HD patients. Methods: This is a prospective study involving patients receiving maintenance HD in the dialysis center of Xuanwu Hospital, Beijing. Study subjects were enrolled from October to December, 2017 and followed up for two years. Demographic data, comorbidities and biological parameters were collected. Frailty was assessed using the Fried frailty phenotype at baseline. Cox regression analysis was performed to identify the relationship between frailty and mortality in HD patients. Kaplan-Meier was plotted using the cutoff value obtained by ROC curve to evaluate survival rates in different frailty status. Results: Total of 208 HD patients were enrolled with a mean age of 60.5±12.7 years. According to the frailty criteria, at baseline the prevalence of robust, pre-frail and frail in HD patients was 28.7%, 45.9%, and 25.4%, respectively. The two-year all-cause mortality was 18.8% (39/207) and underlying causes of death included coronary artery disease (CAD), cerebrovascular disease (CVD), hyperkalemia, severe infection, malignant tumor and others. Survival curve showed the patients with frailty score ≥4 to have significantly shorter survival time as compared to patients with frailty score ≤ 3. Frailty predicted two-year mortality when frailty score ≥4 with a sensitivity of 70% and a specificity of 83.67% with an AUC of 0.819. Frailty score was positively associated with age and ratio of ultrafiltration volume to dry weight, while negatively associated with levels of serum albumin, uric acid and diastolic blood pressure after HD. Conclusions: Our results confirm frailty to be very common among HD patients and severity of frailty was a significant predictor of mortality for HD patients. Factors such as age, malnutrition and low blood pressure are the factors to be associated with frailty. Interdialytic weight gain inducing excessive ultrafiltration volume is an important risk factor.
Assuntos
Fragilidade/epidemiologia , Falência Renal Crônica/mortalidade , Diálise Renal/efeitos adversos , Adolescente , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Fragilidade/diagnóstico , Fragilidade/etiologia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Curva ROC , Fatores de Risco , Taxa de Sobrevida , Adulto JovemRESUMO
OBJECTIVES: To evaluate and compare the efficacy of National Early Warning Score, National Early Warning Score 2, Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment on predicting in-hospital death in patients with coronavirus disease 2019. DESIGN: A retrospective, observational study. SETTING: Single center, West Campus of Wuhan Union hospital-a temporary center to manage critically ill patients with coronavirus disease 2019. PATIENTS: A total of 673 consecutive adult patients with coronavirus disease 2019 between January 30, 2020, and March 14, 2020. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data on demography, comorbidities, vital signs, mental status, oxygen saturation, and use of supplemental oxygen at admission to the ward were collected from medical records and used to score National Early Warning Score, National Early Warning Score 2, Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment. Total number of patients was 673 (51% male) and median (interquartile range) age was 61 years (50-69 yr). One-hundred twenty-one patients died (18%). For predicting in-hospital death, the area under the receiver operating characteristics (95% CI) for National Early Warning Score, National Early Warning Score 2, Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment were 0.882 (0.847-0.916), 0.880 (0.845-0.914), 0.839 (0.800-0.879), 0.766 (0.718-0.814), and 0.694 (0.641-0.746), respectively. Among the parameters of National Early Warning Score, the oxygen saturation score was found to be the most significant predictor of in-hospital death. The area under the receiver operating characteristic (95% CI) for oxygen saturation score was 0.875 (0.834-0.916). CONCLUSIONS: In this single-center study, the discrimination of National Early Warning Score/National Early Warning Score 2 for predicting mortality in patients with coronavirus disease 2019 admitted to the ward was found to be superior to Rapid Emergency Medicine Score, Confusion, Respiratory rate, Blood pressure, Age 65 score, and quick Sepsis-related Organ Failure Assessment. Peripheral oxygen saturation could independently predict in-hospital death in these patients. Further validation of our finding in multiple settings is needed to determine its applicability for coronavirus disease 2019.
Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Estado Terminal/mortalidade , Escore de Alerta Precoce , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Idoso , Pressão Sanguínea , COVID-19 , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pandemias , Prognóstico , Estudos Retrospectivos , Medição de Risco , SARS-CoV-2RESUMO
Background: Progressive supranuclear palsy (PSP) is a progressive neurodegenerative brain disease which has been rarely described in association with hyperkinetic symptoms. Here, we report a case of PSP that was presented with hyperkinetic movement disorder, hemiplegic dystonia, and other clinical features that overlap with behavioral variant frontotemporal dementia (bvFTD) and corticobasal syndrome (CBS).Case presentation: A 63-year-old female presented to our hospital with a history of frontal lobe symptoms, impaired cognition, hyperkinetic movement disorders, dystonia, and frequent falls. Her magnetic resonance imaging (MRI) scan showed atrophy of midbrain and right temporal lobe. [18F]FDG PET result revealed reduced 18F-FDG uptake with obvious laterality (right > left). [18F]THK5317 PET scan showed evident increased uptake in the brain stem and basal ganglia. Treatment with Tiapride significantly improved hyperkinetic symptoms, but other motor symptoms were not alleviated. Three years later, the patient could hardly walk even with assistance.Conclusion: PSP can present hyperkinetic movement disorders and asymmetry in image that widen the existing phenotypic spectrum.
Assuntos
Distonia/etiologia , Hemiplegia/etiologia , Hipercinese/etiologia , Paralisia Supranuclear Progressiva/complicações , Paralisia Supranuclear Progressiva/diagnóstico , Distonia/diagnóstico , Distonia/fisiopatologia , Feminino , Hemiplegia/diagnóstico , Hemiplegia/fisiopatologia , Humanos , Hipercinese/diagnóstico , Hipercinese/fisiopatologia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons , Paralisia Supranuclear Progressiva/patologia , Paralisia Supranuclear Progressiva/fisiopatologiaRESUMO
Introduction: Mitochondrial DNA polymerase gamma (pol γ) encoded by POLG plays an indispensable role in the process of mitochondrial DNA replication and repair. The mutation of POLG can result in mitochondrial dysfunction leading to a broad spectrum of disease.Methods: We report a 29-year-old Chinese female presented with levodopa-responsive parkinsonism, external ophthalmoplegia and optic atrophy. We conducted clinical, molecular iconographic, histological and genetic analyses on this patient.Results: Sequencing of the POLG gene revealed compound heterozygote mutations of a novel c.2693T > C (p.I898T) mutation in exon17 and c.2993C > T (p.S998L) in exon19. The mutation c.2693T > C (p.I898T) has never been reported. Also our patient's cardinal symptoms are rare and different from other cases which have been reported.Conclusion: This finding of ours has broadened the spectrum of phenotype caused by the mutation of POLG.
Assuntos
DNA Polimerase gama/genética , Oftalmoplegia Externa Progressiva Crônica/genética , Atrofia Óptica/genética , Transtornos Parkinsonianos/genética , Adulto , Idade de Início , Feminino , Humanos , Mutação de Sentido Incorreto , Atrofia Óptica/patologia , FenótipoRESUMO
In this study, we investigated the cross-sectional association of Self-perceived health (SPH) with frailty phenotype. A total of 4632 participants of the Beijing Longitudinal Study of Aging II (mean age 75.4 ± 6.8years) were categorized into having good, fair, and poor SPH. Individuals were compared according to their frailty status (i.e., frail and prefrail vs robust) with SPH rating. The association of SPH with respect to the five components of frailty phenotype was further investigated. Older adults who were frail had lower odds of having good SPH (OR=0.64). Whereas frail and prefrail individuals had higher odds of having poor SPH (OR=6.26,OR=2.09 respectively). Having low education, polypharmacy, ADL and IADL disability, cognitive impairment, and depression was associated with a higher likelihood of having poor SPH. All components of frailty except weight loss was associated with poor SPH. SPH may serve as a tool to identify frail or prefrail individuals in the community.
Assuntos
Fragilidade , Idoso , Estudos Transversais , Idoso Fragilizado , Avaliação Geriátrica , Humanos , Vida Independente , Estudos LongitudinaisRESUMO
Two new chemically stable triazine- and phenyl-core-based crystalline porous polymers (CPPs) have been synthesized using a single-step template-free solvothermal route. Unique morphological diversities were observed for these CPPs [2,3-DhaTta (ribbon) and 2,3-DhaTab (hollow sphere)] by simply altering the linker planarity. A detailed time-dependent study established a significant correlation between the molecular level structures of building blocks with the morphology of CPPs. Moreover, a DFT study was done for calculating the interlayer stacking energy, which revealed that the extent of stacking efficiency is responsible for governing the morphological diversity in these CPPs.
RESUMO
In this work, three novel pyrene cored small conjugated molecules, namely 1,3,6,8-tetrakis(6-(octyloxy)naphthalene-2-yl)pyrene (PY-1), 1,3,6,8-tetrakis((E)-2-(6-(n-octyloxy)naphthalene-2-yl)vinyl)pyrene (PY-2) and 1,3,6,8-tetrakis((6-(n-octyloxy)naphthalene-2-yl)ethynyl)pyrene (PY-3) have been synthesized by Suzuki, heck and Sonogashira organometallic coupling reactions, respectively. The effects of single, double and triple bonds on their optical, electrochemical, and thermal properties are studied in detail. These are all materials fluorescent and they have been used in organic light-emitting diodes (OLEDs) and their electroluminescent properties have been studied.
RESUMO
Galleria mellonella, the greater wax moth has always been an important pest against honeybees and has remained a nightmare for beekeeping farmers. Management of G. mellonella in live honeybee colonies is very difficult because most current management practices can destroy whole honeybee colonies. In the present study, experiments were conducted to isolate and characterize Bacillus thuringiensis from infected greater wax moth cadavers and to evaluate their biocontrol ability against G. mellonella. The bioefficacy of these isolates has been evaluated against greater wax moth along with the standard strain HD-1. Among all the strains tested, NBAIR BtGa demonstrated higher efficacy compared to other strains, with an LC50 value of 125.17 µg/ml, whereas HD-1 exhibited a significantly higher LC50 value of 946.61 µg/ml. Considering the economic importance of NBAIR BtGa we performed whole genome sequencing of this strain resulting in the identification of a genome size of 5.96 Mb consisting of 6888 protein-coding genes. Gene ontology analysis categorized these genes into three groups based on their roles, i.e., biological functions (2169 genes), cellular components (1900 genes), and molecular functions (2774 genes). Through insecticidal toxicity-related genes (ITRG) profiling of our strain across the genome by Bt toxin scanner and cry processor resulted in the identification of several Cry proteins namely Cry1Ab11, Cry1Ia44, Cry1Aa2, Cry2Af1, Cry1Da2, Cry1Eb1, Cry1Ab5, Cry1Cb2, Cry1Ac2. Besides Cry proteins, other ITRG genes, viz. Vip3Bb2, Zwittermicin A resistance proteins, Chitinase C, Mpp46Ab1, immune inhibitor A, Bmp1, Vpb4Ca1, and Spp1Aa1 were also reported, which show toxicity against lepidopteran pests. The studies were also conducted to test the biosafety of Bt toxins against honeybee larvae and adults, which showed strain NBAIR BtGa was more than 99% safer for honeybee larvae as well as adults. Thus, the data generated ascertains its effectiveness as a biocontrol agent and it can be used further for the development of bio formulation for the management of G. mellonella in honeybee colonies.
RESUMO
Background: Gait disturbance is a vital characteristic of motor manifestation in α- synucleinopathies, especially Parkinson's disease. Subtle gait alterations are present in isolated rapid eye movement sleep behavior disorder (iRBD) patients before phenoconversion; it is yet unclear, if gait analysis may predict phenoconversion. Objective: To investigate subtle gait alterations and explore whether gait analysis using wearable sensors is associated with phenoconversion of iRBD to α-synucleinopathies. Methods: Thirty-one polysomnography-confirmed iRBD patients and 33 healthy controls (HCs) were enrolled at baseline. All participants walked for a minute while wearing 6 inertial sensors on bilateral wrists, ankles, and the trunk (sternal and lumbar region). Three conditions were tested: (i) normal walking, (ii) fast walking, and (iii) dual-task walking. Results: Decreased arm range of motion and increased gait variation (stride length, stride time and stride velocity) discriminate converters from HCs at baseline. After an average of 5.40 years of follow-up, 10 patients converted to neurodegenerative diseases (converters). Cox regression analysis showed higher value of stride length asymmetry under normal walking condition to be associated with an early conversion of iRBD to α- synucleinopathies (adjusted HR 4.468, 95% CI 1.088- 18.349, pâ=â0.038). Conclusions: Stride length asymmetry is associated with progression to α- synucleinopathies in patients with iRBD. Gait analysis with wearable sensors may be useful for screening, monitoring, and risk stratification for disease-modifying therapy trials in patients with iRBD.
Assuntos
Análise da Marcha , Polissonografia , Transtorno do Comportamento do Sono REM , Dispositivos Eletrônicos Vestíveis , Humanos , Transtorno do Comportamento do Sono REM/fisiopatologia , Transtorno do Comportamento do Sono REM/diagnóstico , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Análise da Marcha/instrumentação , Sinucleinopatias/fisiopatologia , Sinucleinopatias/diagnóstico , Progressão da Doença , Doença de Parkinson/fisiopatologia , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/etiologia , Transtornos Neurológicos da Marcha/diagnósticoRESUMO
Background: While multiple system atrophy (MSA) presents with high heterogeneous motor and nonmotor symptoms, the associations between clinical phenotypes and prognosis are unclear. Objective: We aimed to evaluate clinical phenotypes of MSA using data-driven approach and measure the impact of phenotypes on survival and bedbound status. Methods: 193 MSA patients were recruited from Xuanwu Hospital Capital Medical University, whose history, motor and non-motor symptoms were examined using cluster analysis. Ninety-five participants were followed-up via telephone after a mean of 31.87 months. We employed Kaplan- Meier analysis to examine survival and performed Cox and logistic regression analyses to identify factors associated with survival and bedbound status. Results: We identified four clinical profiles of MSA: cerebellar symptom-dominant, sleep and mood disorder-dominant, rigid akinetic-dominant, and malignant diffuse. The overall median survival was 7.75 years (95% CI 7.19-8.31). After adjusting for years from symptom onset to diagnosis, age and sex, patients in the malignant diffuse and rigid akinetic-dominant clusters had greater risk of death than sleep and mood disorder-dominant cluster. Furthermore, patients in the malignant diffuse and rigid akinetic-dominant clusters had higher risk of being bedbound than cerebellar symptom-dominant cluster. Conclusions: The malignant diffuse and sleep and mood disorder-dominant were identified besides the two classical subtypes, parkinsonism, and cerebellar symptom-variant. Patients with rigid-akinetic motor profiles have a worse prognosis than cerebellar symptom-dominant profiles in general. Diffuse symptoms, especially postural instability, and cognitive alterations at diagnosis, indicate rapid functional loss and disease progression. The different profiles and prognoses might indicate varied underlying pathological mechanisms.
Multiple system atrophy (MSA) is a complex disease that can affect both movement and non-movement functions of patients. However, we do not know much about how these different symptoms relate to how the patient's health might change over time. In this study, we looked at 193 MSA patients to learn more about if the patients can be distinguished into different subgroups at diagnosis and if the subgroups might be associated with their survival and ability to move in the future. We found four main subgroups of patients: group 1 characterized by the dysfunction of cerebellum (a part of the brain), group 2 characterized by sleep and mood problems, group 3 characterized by rigidity and slow movements, and group 4 with diffuse symptoms mentioned above. After tracking 95 patients for nearly 32 months, we found that those characterized by rigidity and slow movements, and those with diffuse symptoms had a higher chance of dying compared to those characterized by sleep and mood problems. Group 3 and 4 also had a higher chance of becoming unable to move out of bed. This suggests that patients with severe symptoms of rigidity and slowness at diagnosis tend to have a worse outlook than those without. And if multiple MSA symptoms are found when the patient is diagnosed, especially trouble with thinking, are also signs that the disease is getting worse quickly. By understanding these disease patterns, we can better tailor treatments and provide better support for people with MSA.
Assuntos
Atrofia de Múltiplos Sistemas , Humanos , Atrofia de Múltiplos Sistemas/diagnóstico , Atrofia de Múltiplos Sistemas/mortalidade , Atrofia de Múltiplos Sistemas/classificação , Masculino , Feminino , Pessoa de Meia-Idade , Prognóstico , Idoso , Transtornos do Sono-Vigília/etiologia , Fenótipo , Transtornos do Humor/diagnóstico , Análise por ConglomeradosRESUMO
Objective: To determine whether the brain-derived neurotrophic factor (BDNF) Val66Met polymorphism is associated with cognitive impairment (CI) in community-dwelling Chinese older adults, and to investigate whether this relationship is modified by the Apolipoprotein E (APOE) É4 allele. Methods: The study is a secondary analysis of 703 participants aged ≥60 years randomly enrolled from the Beijing Longitudinal Study of Aging II prospective cohort. The education-adjusted Mini-Mental State Examination and the Clinical Dementia Rating Scale were used to measure the cognitive performance of the subjects. The main effects and interactions (additive and multiplicative) of the BDNF Met and the APOE ε4 alleles on CI were estimated by logistic regression models. Results: In total, 84 out of 703 older adults aged ≥60 years old had CI. No significant difference was observed in the risk of CI between participants with the BDNF Met allele and that of subjects without the BDNF Met allele (p = 0.213; p = 0.164). Individuals carrying both the BDNF Met and APOE ε4 alleles had an almost 1.5-fold increased odds of CI compared with carriers of the BDNF Met allele but without the APOE ε4 allele. The additive association indicated a positive interaction of both BDNF Met and APOE ε4 alleles with wide CIs (p = 0.021; p = 0.018). Conclusion: The results suggest that the APOE ε4 allele may be a potential modifier for the association of the BDNF Val66Met polymorphism with CI in community-dwelling older adults.
RESUMO
BACKGROUND: Vibrotactile stimulation has been studied in its efficacy of reducing freezing of gait (FOG) in patients with Parkinson's disease (PD). However, the results are still controversial. We evaluated the efficacy of a newly developed vibrotactile foot device on freezing severity and gait measures in PD patients with FOG. OBJECTIVE: To evaluate the efficacy of vibrotactile foot device on PD patients with FOG. METHODS: Thirty-three PD patients with FOG were examined during their "off" medication state. The efficacy of the vibrotactile foot device was evaluated using a gait protocol comprising walking trials with vibrotactile stimulation "off" and "on." Walking trials were videotaped for the offline rating by two movement disorder specialists. The Opal inertial sensor unit (128 Hz; Mobility Lab; APDM Inc., Portland, OR, USA) was used for quantitative gait analysis. RESULTS: The results demonstrated 33.1% reduction in number of FOG episodes (P < 0.001) and 32.6% reduction of freezing episodes (P < 0.001). Quantitative gait analysis showed a significant increase in step length (P = 0.033). A moderate negative correlation was observed between the change of percent time frozen and age (r = -0.415, P = 0.016). 73% of participants reported minimal to substantial improvement in walking with this vibrating stimulation delivered by the vibrotactile foot device. CONCLUSIONS: The vibrotactile foot device is an efficient device that could significantly reduce freezing severity and provide gait regulation to patients with PD experiencing frequent freezing. It could potentially be used in the home environment for improving the quality of life.