RESUMO
Cognitive impairment is one of the most common causes of reduced quality of life in older people. The aim of the study to evaluate impact of functional status, physical health and cognitive functions in women aged 55-64 years old. The study included 250 women aged 55-64 years (mean age 59,3±2,9 years). Socio-demographic and economic factors, functional and cognitive status were analyzed, the presence and prevalence of geriatric syndromes and their association with social, demographic and economic characteristics, risk factors for the development of chronic non-communicable diseases were studied. The prevalence of cognitive impairments was independently associated with education level, low income of patients, diabetes mellitus, glomerular filtration rate, and vertebral artery diameter. In this case, the level of education was a protective factor.
Assuntos
Disfunção Cognitiva , Qualidade de Vida , Idoso , Cognição , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Feminino , Estado Funcional , Avaliação Geriátrica , Humanos , Prevalência , Fatores de RiscoRESUMO
In recent years, more and more works have appeared that with age, classic risk factors that negatively affect the prognosis (cardiovascular diseases) lose their influence on life expectancy. The study aimed to assess the influence of cardiovascular diseases and their risk factors and structural and functional characteristics of the heart on three-year survival in people 95 years and older. The study involved 69 patients 95 years and older (98±1,9 years), 61 (88,4%) were women. After 36 months, data were obtained on the participants' status of life: 25 (36,2%) were alive, and 44 (63,8%) died. Based on the regression analysis results, it was determined that risk factors and history of cardiovascular diseases were not associated with 3-year survival. With a 3-year follow-up, the risk of death increases three times with a decrease in diastolic blood pressure less than 75 mm/Hg, 7,8 times with a decrease in left ventricular ejection fraction below 62%, and 4,9 times with an increase in the end-diastolic size of the right ventricle by more than 2,9 cm.
Assuntos
Doenças Cardiovasculares , Insuficiência Cardíaca , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Prognóstico , Fatores de Risco , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Senile asthenia syndrome (SAS) is a geriatric syndrome characterized by age-associated decline of the physiological reserve and function in multiple systems, which results in higher vulnerability to effects of endo- and exogenous factors and a high risk of unfavorable outcomes, loss of self-sufficiency, and death. Generally, SAS is observed in elderly patients with comorbidities. In cardiovascular diseases, SAS is associated with a poor prognosis, including a higher incidence of exacerbation and death both during acute events and in chronic disease. However, SAS is often not taken into account in developing diagnostic and therapeutic programs for managing elderly patients with cardiovascular diseases (CVD). This article analyzes available scientific information about SAS, algorithms for SAS diagnosis, and the scales that may be useful in developing individual plans for management of elderly patients with CVD.
Assuntos
Doenças Cardiovasculares , Geriatras , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Prova Pericial , Avaliação Geriátrica , Humanos , Federação Russa/epidemiologiaRESUMO
OBJECTIVE: To assess the eï¬ect of moxonidine on bone metabolism and bone mineral density (BMD) in postmenopausal patients with arterial hypertension (AH) and osteopenia. MATERIALS AND METHODS: A randomized, open, clinical trial included 114 postmenopausal patients with AH. All participants were evaluated bone metabolism), BMD, telomerase activity (TA). Randomization was carried out into 2 groups (moxonidine and bisoprolol therapy) using simple envelopes. After 12 months of therapy, a dynamic examination was performed. RESULTS: Both groups showed a positive eï¬ect of both moxonidine and bisoprolol on hypertension during treatment both as monotherapy and in the group of patients receiving combined antihypertensive therapy: a decrease in SBP and DBP in the 1st group was 13.6% and 12.8% respectively, and in the 2nd group - 13.7% and 15% respectively, while achieving normal values. In most patients of group 1, normalization of body weight was noted in comparison with group 2 (23.4% and 17.4%, respectively, p = 0.043), delta of body weight in the moxonidine group was -1.89%. The increase in the processes of bone formation in the form of increased markers of OC and Osteoprotegerin and a statistically signifcant increase in TA in patients receiving moxonidine were revealed, while in women who took bisoprolol there were no dynamic changes in bone metabolism rates, there was a tendency for a decrease in BMD and a signifcant decrease in AT. CONCLUSIONS: Te detected pleiotropic eï¬ect of moxonidine on bone metabolism and replicative cell aging processes will reduce the risk of development or progression of osteopenia and osteoporosis in postmenopausal women with AH.
Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Doenças Ósseas Metabólicas , Hipertensão , Imidazóis/uso terapêutico , Osteoporose Pós-Menopausa , Idoso , Anti-Hipertensivos/administração & dosagem , Densidade Óssea/efeitos dos fármacos , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/tratamento farmacológico , Doenças Ósseas Metabólicas/fisiopatologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/tratamento farmacológico , Imidazóis/administração & dosagem , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/tratamento farmacológico , Osteoporose Pós-Menopausa/fisiopatologiaRESUMO
Although geriatric syndromes are widespread, they often remain undiagnosed leading to the development of adverse outcomes. For the prompt detection of the most common geriatric syndromes in primary care we have created seven issues related to weight loss, vision and hearing impairments, falls, mood disorder, cognitive impairment, urinary incontinence, and the difficulties in walking. We believe that using of these questions will allow physicians to focus on addressing the important health problems associated with age and will produce the selection of patients for comprehensive geriatric assessment.
Assuntos
Avaliação Geriátrica/métodos , Médicos de Atenção Primária , Atenção Primária à Saúde , Acidentes por Quedas , Idoso , Transtornos Cognitivos/diagnóstico , Perda Auditiva/diagnóstico , Humanos , Transtornos do Humor/diagnóstico , Transtornos dos Movimentos/diagnóstico , Incontinência Urinária/diagnóstico , Transtornos da Visão/diagnóstico , Redução de PesoRESUMO
For screening frailty in daily practice, we developed the questionnaire relating issues of weight loss, impaired vision and hearing, injuries related to falls, mood decline, cognitive impairment, urinary incontinence, and mobility difficulties. 356 outpatients from Moscow were included in the study (mean age 74,9±6,1 years, women - 80,4 %). Patients were interviewed using the questionnaire and underwent a comprehensive geriatric assessment. The phenotype model of frailty was determined by L. Fried criteria, the frailty index model - by K. Rockwood criteria. ROC-analysis demonstrated a satisfactory agreement between the result of the survey by the questionnaire and assessment the phenotype model of frailty and the frailty index model (AUC=0,765 and 0,731, respectively). The results statistically significantly correlated with the assessment of the phenotype model of frailty and the frailty index model (Spearman correlation = 0,4 and 0,41, p<0,001). Optimal characteristics of the questionnaire for the frailty screening were consistent to cut-off ≥3 and ≥ 4 points. We propose to use a cut-off ≥ 3 point, since it corresponds to a higher value of sensitivity (85,7 and 93,3 % compared with the phenotype model of frailty and the frailty index model respectively). The proportion of patients who scored ≥ 3 points (58,4 %) indicates a high prevalence of geriatric syndromes among outpatients in Moscow.
Assuntos
Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Inquéritos e Questionários , Idoso , Feminino , Idoso Fragilizado , Humanos , Masculino , MoscouRESUMO
The article gives a brief description of the frailty syndrome and comprehensive geriatric assessment. We describe two classical models - a model of the phenotype and the index of the frailty. The basic questionnaires for frailty syndrome screening in outpatient practice, as well as research on the validation of these questionnaires are presented. The results of comparative studies of questionnaires for frailty screening are shown.
Assuntos
Assistência Ambulatorial/métodos , Fragilidade/diagnóstico , Avaliação Geriátrica/métodos , Idoso , Indicadores Básicos de Saúde , Humanos , Programas de Rastreamento/métodos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Dementia is one of the main challenges to modern society. According to estimated data, as of 2019, there were 1.949.811 people living In Russia with dementia of various etiology. At the same time, there have been no large epidemiological studies of dementia in the Russian Federation. The article provides an overview of the available data on the epidemiology of cognitive impairment (CI) In Russia given from various sources. Not only estimated, but also available clinical data were analyzed. In general, the obtained prevalence values for CI are comparable to global values. Thus, in an epidemiological study of people over 60 years of age in a separate district of Moscow, the prevalence of dementia was 10.4%, Alzheimer's disease 4.5%. A study of outpatients aged 60 years and older showed a high prevalence of both dementia and non-dementia CI at general medical appointments (incidence of dementia 7.8%, MCI 49.6%). It has been shown that the problem of non-dementia CI is already relevant in people of pre-retirement age (the prevalence of non-dementia CI in patients 55-64 years old is 36.8-44.8%). Unique data obtained in a population of institutionalized centenarians (prevalence of dementia 69%), as well as data on the relationship of CI with both somatic and demographic factors are presented.
Assuntos
Disfunção Cognitiva , Demência , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Alzheimer/epidemiologia , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Moscou/epidemiologia , Prevalência , Federação Russa/epidemiologiaRESUMO
The prevalence of older people in Russian population increases rapidly. Therefore, the concept of healthy aging is becoming crucial in Russia and all over the world, and thus disability prevention is one aspect of this issue. Aim: To assess a possible association between geriatric syndromes, comorbidities, and mortality rate among frail patients who receive home medical care in Moscow. Materials and methods: The study included 450 patients with home medical care provided by the State Budgetary Healthcare Institution "Diagnostic Center No. 3 of the Moscow Health Department" from June 2019 to April 2021. Physical health, functional, cognitive, social and emotional statuses were evaluated by comprehensive geriatric assessment (CGA). The mortality rate after 1 year was assessed. Results: The all-cause case mortality rate in patients during the observation period was 22.4%. There was no difference in age and comorbidities in survivors and deceased patients, but the latter group had more geriatric syndromes. The association between risks of mortality and anemia and some geriatric syndromes, such as malnutrition and hearing impairment, total dependence (Barthel index less than 60) was observed.
RESUMO
Aim of the study was to assess effect of fenofibrate on lipid blood composition, markers of inflammation and the state of vascular wall in patients with type 2 diabetes mellitus (DB2). We randomized 73 patients with DB2 in 2 groups. Patients of group one (n = 34) in addition to hypoglycemic and lipid lowering therapy with statins received fenofibrate (145 mg/day), patients of control group (n = 38) received standard therapy. We assessed effect of selected therapy on lipids, endothelium dependent vasodilatation (EDVD) in a test with reactive hyperemia of brachial artery, intimaAmedia thickness of common carotid arteries, levels of CAreactive protein (CRP) and uric acid, parameters of stiffness of arterial wall. At the end of the study we found in the fenofibrate group significant lowering of mean levels of total cholesterol, low density lipoprotein cholesterol, CRP, uric acid. We also noted more significant elevation of EDVD, improvement of parameters of arterial wall thickness. The use of fenofibrate in a daily dose 145 mg in patients with DB2 at the background of traditional hypoglycemic, antihypertensive, and lipid lowering therapy corrects effectively lipid disturbances and normalizes function of endothelium and parameters of vascular wall stiffness. This substantially decreases risk of vascular complications of DB2.
Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Fenofibrato/uso terapêutico , Hipolipemiantes/uso terapêutico , Adulto , Idoso , Proteína C-Reativa/análise , Interpretação Estatística de Dados , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Fenofibrato/administração & dosagem , Fenofibrato/farmacologia , Humanos , Hipolipemiantes/administração & dosagem , Hipolipemiantes/farmacologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Fatores de Tempo , Ácido Úrico/sangue , Vasodilatação/efeitos dos fármacosRESUMO
Cardiovascular catastrophes (myocardial infarction and stroke occur relatively rarely during pregnancy, but they are menacing complications that frequently result in a fatal outcome. The global pattern of vascular catastrophes determines the need for applying an interdisciplinary approach to this problem and for combining the efforts of different specialists, such as obstetricians, gynecologists, cardiologists, neurologists, and therapists. To study the causes of gestational cardiovascular events and the mechanisms of their development, to devise methods for their diagnosis, prevention, and therapy are a topical problem in the present-day medical practice. The same etiological factors may cause both ischemic and hemorrhagic complications, as well as their coconcomitant forms.
Assuntos
Infarto do Miocárdio , Complicações Cardiovasculares na Gravidez , Acidente Vascular Cerebral , Adulto , Síndrome Antifosfolipídica/complicações , Feminino , Humanos , Mutação , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/genética , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/prevenção & controle , Infarto do Miocárdio/terapia , Equipe de Assistência ao Paciente , Gravidez , Complicações Cardiovasculares na Gravidez/etiologia , Complicações Cardiovasculares na Gravidez/genética , Complicações Cardiovasculares na Gravidez/mortalidade , Complicações Cardiovasculares na Gravidez/prevenção & controle , Complicações Cardiovasculares na Gravidez/terapia , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/genética , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/terapiaAssuntos
Doenças Cardiovasculares , Endotélio Vascular/efeitos dos fármacos , Taxa de Filtração Glomerular/efeitos dos fármacos , Ventrículos do Coração/efeitos dos fármacos , Ramipril/farmacologia , Inibidores da Enzima Conversora de Angiotensina/farmacologia , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/prevenção & controle , Endotélio Vascular/patologia , Ventrículos do Coração/patologia , Humanos , Prevenção SecundáriaRESUMO
AIM: To study heterogenic forms of LDLP and LP(a) in blood serum of patients with cholelithiasis (CL) and gallbladder cholesterosis (GBC). MATERIAL AND METHODS: Native gradient (3-12%) electrophoresis in polyacrylamide gel, rocket immunoelectrophoresis with antibodies to apo(a) were made in 20 patients with CL and 20 with GBC, 13 controls without gastrointestinal disease. Correlation of retardation factor (Rf) of LDLP and LP(a) with blood lipids, cholesterol (C) and triglycerides (TG) levels, body mass index (BMI) and age was studied. CL and GBC risk factors were analysed basing on a retrospective assessment in random representative samples of patients (100 CL and 100 GBC patients). RESULTS: There was a shift of the main peak in LDLP spectrum in the direction of smaller particles in GBC (Rf = 0.171 +/- 0.003) which was significant in comparison with CL group (Rf = 0.146 +/- 0.004, p < 0.001) and control (Rf = 0.114 +/- 0.013, p < 0.05). The analysis of LDLP Rf distribution in patients with different C levels has shown that LDLP small particles can occur in a normal C level: 75% in GBC and 50% in CL groups. Prevalence of small dense LDLP was recorded in both groups (87.5% cases) in hypercholesterolemia. Compared to control, LP(a) concentration was significantly elevated both in GBC (23.7 +/- 4.9 mg/dl) and CL (15.7 +/- 4.4 mg/dl) patients (control--7.5 +/- 1.4 mg/dl, p < 0.01), p > 0.5 in comparison between the groups. The correlation analysis found no correlations between LP9(a), other lipids, BMI and age in both study groups while Rf of LDLP correlated with C and TG levels (r = 0.596 and r = 0.226, respectively, p < 0.05), age and BMI (r = 0. 533 and r = 0.363, respectively, p < 0.05) in CL and did not correlate in GBC. CONCLUSION: A C level in CL changes with age and BMI while in GBC high LDLP C level was caused by other factors. No correlation of LP(a), LDLP Rf with age, body mass and blood lipids indicates that the above factors are independent in development of GBC.
Assuntos
Colelitíase , LDL-Colesterol/sangue , Vesícula Biliar/fisiopatologia , Hipercolesterolemia/complicações , Hipercolesterolemia/fisiopatologia , Adulto , Índice de Massa Corporal , Colelitíase/sangue , Colelitíase/complicações , Colelitíase/fisiopatologia , Eletroforese , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Triglicerídeos/sangueRESUMO
It is known that glucose disturbances contribute to micro- and macrovascular complications and vascular aging. Telomere length is considered to be a cellular aging biomarker. It is important to determine the telomere length role in vascular structural and functional changes in patients with diabetes mellitus. We conducted a cross-sectional observational study in a high-risk population from Moscow, Russia. The study included 50 patients with diabetes and without clinical cardiovascular disease and 49 control group participants. Glucose metabolism assessment tests, measuring intima-media complex thickness and determining the presence of atherosclerotic plaques, pulse wave velocity measurement, and telomere length measurement were administered to all participants. Vascular changes were more dramatic in patients with diabetes than in the control group, and the telomeres were shorter in patients with diabetes. Significant differences were found in the vascular wall condition among diabetes patients, and there were no substantial differences in the arterial structure between patients with 'long' telomeres; however, there were statistically significant differences in the vascular wall condition between patients with 'short' telomeres. Vascular ageing signs were more prominent in patients with diabetes. However, despite diabetes, vascular changes in patients with long telomeres were very modest and were similar to the vascular walls in healthy individuals. Thus, long lymphocyte telomeres may have a protective effect on the vascular wall and may prevent vascular wall deterioration caused by glucose metabolism disorders.
RESUMO
The heterogeneity of serum low-density lipoproteins (LDL) was studied in patients with cholelithiasis (CL) and gallbladder cholesterolosis (GBC). Native gradient (3-12%) polyacrylamide gel electrophoresis was used, followed by densitometric scanning and analysis; a correlation analysis of the levels of cholesterol levels, the body-mass index (BMI), and age was made. Various heterogeneity of LDL was revealed in CL and GBC. In the group of patients with GBC, the subfraction spectrum of LDL was characterized by a predominance of minor dense particles of LDL (Rf = 0.171 +/- 0.003), which significantly differed from that in the patients with CL (Rf = 0.146 +/- 0.004) and the controls (Rf = 0.144 +/- 0.013, p < 0.05). The increased levels of total cholesterol were associated with the changes in the subfraction spectrum of LDL with a moderate correlation (r = 0.596 and r = 0.343, respectively). However, a correlation was found between the variability of LDL, BMI, and age (r = 0.533 and r = 0.363, respectively) whereas in GBC it was absent (r = 0.148 and r = 0.117). The findings suggest that the minor dense subfractions of LDL are a risk factor for GBC irrespective of age and body mass. The modified minor particles of LDL more rapidly penetrate than other LDL fractions into the gallbladder tissue, where the gallbladder wall is intensively captured by macrophages, and participate in the formation of foamy cells. In CL, the increase in total cholesterol levels is not followed by so marked changes in the structure of LDL. The much lower proportion of minor dense particles that are components of LDL is a cause of the low entry of apolipoproteins into the gallbladder wall in CL as compared with GBC.