Progress on Prevention and Treatment of Cerebral Small Vascular Disease Using Integrative Medicine / 中国结合医学杂志

Cerebral small vessel disease (CSVD) is a senile brain lesion caused by the abnormal structure and function of arterioles, venules and capillaries in the aging brain. The etiology of CSVD is complex, and disease is often asymptomatic in its early stages. However, as CSVD develops, brain disorders may occur, such as stroke, cognitive dysfunction, dyskinesia and mood disorders, and heart, kidney, eye and systemic disorders. As the population continues to age, the burden of CSVD is increasing. Moreover, there is an urgent need for better screening methods and diagnostic markers for CSVD, in addition to preventive and asymptomatic- and mild-stage treatments. Integrative medicine (IM), which combines the holistic concepts and syndrome differentiations of Chinese medicine with modern medical perspectives, has unique advantages for the prevention and treatment of CSVD. In this review, we summarize the biological markers, ultrasound and imaging features, disease-related genes and risk factors relevant to CSVD diagnosis and screening. Furthermore, we discuss IM-based CSVD prevention and treatment strategies to stimulate further research in this field.

Factores intrínsecos y extrínsecos asociados con caídas en adultos mayores: estudio de casos y controles en México / Intrinsic and extrinsic factors associated with falls in older adults: a case-control study in Mexico

Resumen Antecedentes: Las caídas tienen un origen multifactorial. Objetivo: Estimar el riesgo de caídas y su asociación con algunos factores intrínsecos y extrínsecos en adultos mayores. Métodos: Estudio de casos y controles que incluyó pacientes de ambos sexos con edades ≥ 60 años. Los casos fueron pacientes que ingresaron al servicio de urgencias de un hospital de segundo nivel, con diagnóstico de lesión o fractura secundaria a una caída; los controles fueron pacientes que acudieron a unidades de medicina familiar. El análisis estadístico que se realizó fue descriptivo, bivariante y multivariante. Se utilizó el programa SPSS versión 22.0. Resultados: Se incluyeron 342 pacientes (171 casos y 171 controles). La edad promedio fue 76.1 ± 8.8 años, el 66 % fueron mujeres y por autorreporte el 97.1 % tenían enfermedades crónicas. Se observaron diferencias en el índice de masa corporal, en la proporción de casos con deterioro cognitivo, uso de dispositivos para caminar y dependencia para realizar actividades básicas e instrumentales de la vida diaria. El análisis multivariante ajustado reveló asociación entre el evento caída con deterioro cognitivo y dependencia para realizar actividades instrumentales de la vida diaria. Conclusiones: El deterioro cognitivo y la dependencia para realizar actividades instrumentales de la vida diaria se asociaron al riesgo de caer.

Abstract Background: Falls have a multifactorial origin. Objective: To estimate the risk of falls and their association with some intrinsic and extrinsic factors in elderly. Methods: Case-control study that included individuals of both genders aged ≥ 60 years. Cases were patients who were admitted to the emergency department of a secondary care hospital diagnosed with injury or fracture secondary to a fall; the controls were patients who attended family medicine units. Descriptive, bivariate and multivariate statistical analysis was carried out. The SPSS program, version 22.0, was used. Results: Three-hundred and forty-two patients were included (171 cases and 171 controls). Mean age was 76.1 ± 8.8 years, 66 % were women and 97.1 % had self-reported chronic diseases. Differences were observed in body mass index, in the proportion of cases with cognitive impairment, use of walking devices and dependence to perform basic and instrumental activities of daily living. Adjusted multivariate analysis revealed an association between the fall event and cognitive impairment and dependence to perform instrumental activities of daily living. Conclusions: Cognitive impairment and dependence to perform instrumental activities of daily living were associated with the risk of falling.

Cognitive impairment related to arterial stiffness in cardiovascular disease patients with severe periodontitis / Deterioro cognitivo relacionado a la rigidez arterial en pacientes con enfermedad cardiovascular y periodontitis grave

ABSTRACT Severe periodontal disease (SPD) associated with systemic peripheral inflammation, cognitive impairment (CI) and arterial stiffness (AS) has been recognized. The aim of this study was to investigate whether CI and arterial stiffness (AS) occur in cardiovascular disease (CVD) patients with SPD. A crosssectional case-control study included hospitalized patients with CVD. Demographic characteristics, CVD and atherogenic risk factors were recorded. SPD was diagnosed by clinical and radiographic dental examinations. Dental clinical attachment level (CAL) and CAL % were recorded. A Mini-Mental State Examination test (MMSE) assessed cognition, a MMSE score of < 27 was set as the cut-off point of CI; a score > 27 was considered as no CI. Patients were categorized into: MMSE<27 (cases) and MMSE>27 (controls). AS was evaluated by pulse wave velocity (PWV). Serum VCAM-1 levels were determined in a random sample. Results: This study comprised 91 patients (cases, n=26; 29.6%; controls, n=65, 71.4%); aged 73±8 vs. 73±7 years, respectively (p=0.73), of whom 53.8% and 36.9% respectively, were women; SPD was found to be a risk factor for CI; the presence of SPD increased the risk for MMSE <27 by an average 5.39 times (model 1). PWV was associated with MMSE < 27 in the three models. The risk of having MMSE < 27 increased an average of2.404-fold for each 1-unit increase in PWV SPD and AS had significant and independent associations on the risk for development CI. MMSE negatively correlated with CAL% (r=0.69) and PWV (r=0.70). PWV positively correlated with CAL% (r=0.67). Serum VCAM-1 levels were higher in SPD with lower MMSE scores. In conclusion, SPD increases the risk of development of cognitive decline in CVD patients. PWV was directly associated with the risk of cognitive decline. These findings denote a significant opportunity to improve periodontal health in order to avert CI in CVD patients.

RESUMEN La enfermedad periodontal severa (EPS) podría estar asociada a la rigidez arterial (RA) y al deterioro cognitivo (DC). Se realizó un estudio transversal de casos y controles y se investigó la presencia de RA y DC en pacientes con enfermedad cardiovascular (ECV) y EPS. En pacientes hospitalizados con ECVse registraron las características demográficas y factores de riesgo aterogénicos. El DC se diagnosticó a través del Mini-Mental State Examination (MMSE). Punto de corte: MMSE<27 (casos); puntaje >27 ausencia de DC (controles). La EPS fue diagnosticada clínica y radiográficamente. Se registraron el nivel inserción clínica (NIC) y NIC %. La RA fue evaluada a través de la velocidad de onda de pulso (VOP). VCAM-1 sérico se determinó en una muestra aleatoria. Se incluyeron 91 pacientes (casos,n=26; 29.6%; controles,n=65, 71.4%); edad promedio: 73±8 vs. 73±7 años, respectivamente (p=0.73); % de mujeres: 53.8 vs. 36.9, respectivamente y EPS (n=54) y ausencia de EP (noEP) en 37. MMSE< 27 en 26 pacientes; 23 de ellos, con EPS. La presencia de EPS aumentó el riesgo de MMSE< 27 en 5.39 veces (modelo 1). La VOP se asoció a MMSE< 27 (Modelo 1, 2 y 3). El riesgo de MMSE< 27 incrementó en promedio en 2.40 veces por cada aumento de unidad de VOP. EPS y RA mostraron asociaciones significativas e independientes sobre el riesgo de DC. MMSE se correlacionó negativamente con NIC % (r=0.69) y POV (r=0.70); y POV, positivamente con NIC % (r=0.67). Los niveles séricos de VCAM-1 fueron más elevados en presencia de EPS y puntajes bajos de MMSE. Puede concluirse que en pacientes con ECV y EPS, el aumento en RA incrementaría el riesgo de DC. Estos hallazgos enfatizan la necesidad de promover y mantener la salud bucal para evitar el DC en pacientes con ECV.

Factores predictores de mortalidad en ancianos frágiles / Predictive mortality factors in frail elderly

Introducción: El estado de fragilidad es un síndrome, caracterizado por disminución de la resistencia y de las reservas fisiológicas del adulto mayor. Está relacionado con la ocurrencia de efectos adversos para la salud como: caídas, discapacidad, hospitalización, institucionalización y muerte. Objetivos: Determinar factores pronóstico para mortalidad en pacientes ancianos frágiles. Método: Estudio observacional, de tipo longitudinal, desarrollado desde diciembre del 2017 a noviembre del 2018. La muestra estuvo conformada por 50 ancianos frágiles, que ingresaron en el servicio de medicina interna del Hospital Militar Central "Dr. Carlos J. Finlay" y que fueron seguidos por 12 meses luego de haber sido dados de alta. Resultados: La mortalidad estuvo en el orden de 62 por ciento (IC: 48-76). Por regresión logística y después de ajustar por edad y sexo, resultaron variables independientes asociadas a mortalidad en ancianos frágiles: discapacidad (OR = 13), mala autoevaluación de salud (OR = 6,5) y deterioro cognitivo (OR = 4,3). Conclusiones: Los resultados de este estudio proporcionan evidencias para apoyar el uso como predictores de mortalidad en ancianos frágiles, la presencia de deterioro cognitivo, discapacidad y mala autopercepción de salud(AU)

Introduction: The state of frailty is a syndrome, characterized by decreased resistance and physiological reserves of the elderly. It is related to the occurrence of adverse health effects such as: falls, disability, hospitalization, institutionalization and death. Objectives: To determine prognostic factors for mortality in frail elderly patients. Method: Longitudinal type and observational study, developed from December 2017 to November 2018. The sample consisted of 50 frail elderly, who were admitted to the Internal Medicine service of the Hospital Militar Central "Dr. Carlos J. Finlay" and were followed for 12 months afterwards of having been discharged. Results: Mortality was in the order of 62 percent (CI = 48-76). After logistic regression and adjusting for age and sex, independent variables were associated with mortality in frail elderly people: disability (OR = 13), poor health self-assessment (OR = 6.5) and cognitive impairment (OR = 4.3). Conclusions: The results of this study provide strong evidence to support the use as predictors of mortality in frail elderly people, the presence of cognitive impairment, disability and poor health self-perception(AU)

Frailty and cognitive performance in older adults living in the community: a cross-sectional study

Abstract Background Cognitive impairment and frailty are important problems affecting the elderly population. Frail elderly present worse overall cognitive performance. Objective The aim of this study was to investigate general and domain-specific cognitive performance among non-frail, pre-frail, and frail elderly persons. Methods This is a cross-sectional study in which 267 elderly persons living in São Carlos, SP were divided into three groups according to the frailty criteria defined by Fried et al. Cognitive performance was evaluated with a battery of cognitive tests covering domains such as memory, attention, language, and executive functioning. A multinomial logistic regression analysis adjusted for age, gender, and education was performed to evaluate the association between performance in cognitive domains and levels of frailty. Results Frailty was significantly associated with lower scores on the global cognitive test (RRR = 0.86; IC 95% 0.78-0.96; p < 0.01), word list memory (RRR = 0.92; IC 95% 0.86-0.99; p = 0.02), and figure list recognition (RRR = 0.78; IC 95% 0.62-0.99; p = 0.04). Pre-frailty was associated with lower scores on the word list memory (RRR = 0.92; IC 95% 0.86-1.00; p = 0.04) and naming test (RRR = 0.82; IC 95% 0.69-0.99; p = 0.03). Discussion Frailty syndrome can influence general cognition and specific domains such as memory and language. Prospective studies will be fundamental to evaluate the causal relation between frailty and cognition.

Do you know this syndrome? Schimmelpenning-Feuerstein-Mims syndrome

Abstract Nevus sebaceous is the most common type of organoid epidermal nevus, often located on the face, following the Blaschko's lines and with alterations in the ipsilateral central nervous system. Distinct disorders can be distinguished by the type of association with epidermal nevus. Schimmelpenning-Feuerstein-Mims syndrome is a rare multisystem disorder characterized by sebaceous nevus associated with extracutaneous abnormalities affecting the brain, eyes and bones. We report the case of an 8-year-old female patient with a yellowish verrucous plaque on the left temporal area extending ipsilaterally to the cervical region, combined with cicatricial alopecia, periocular nodule, and epibulbar tumors.

Association of malnutrition-inflammation-cardiovascular disease with cognitive deterioration in peritoneal dialysis patients / 北京大学学报(医学版)

OBJECTIVE@#To investigate the relationship between malnutrition-inflammation-atherosclerosis (MIA) syndrome and deterioration of global and specific domains of cognitive function in peritoneal dialysis (PD) patients.@*METHODS@#This was a multi-center prospective cohort study. The PD patients who met the inclusion criteria were examined with general and specific cognitive function between March 2013 and November 2013. The patients were divided into MIA0, MIA1 and MIA2 groups, according to items of "Yes" for whether or not having cardiovascular disease, serum albumin≤35 g/L or high-sensitive C-reactive protein (hs-CRP) ≥3 mg/L. After 2 years, the patients maintained on PD would be repeatedly measured with cognitive function. The Chi-square test, One-way ANOVA, Kruskal-wallis H rank sum test were used to compare the differences of clinical characteristics, biochemical data, and global and specific cognitive function parameters among the three groups at baseline, and two years later, respectively. The Bonferroni method was applied to adjust the significance level for further comparison between each two different groups. The change of score in each cognitive parameter of global and specific domains was used as dependent variable. Age, gender, education level, depression index, body-mass index, diabetes mellitus, serum sodium levels and MIA (MIA0 was control, MIA1 and MIA2 as dummy variables) were all included in the multivariable linear regression models to analyze the risk factors of the deterioration of cognitive function. The analysis for each cognitive domain was adjusted for the baseline score of the corresponding cognitive parameter. All the analyses were performed using SPSS for Windows, software version 25.0 (SPSS Inc., Chicago, IL).@*RESULTS@#Over two-year follow up, the prevalence of cognitive impairment increased from 20.0% to 24.7%, absolute decrease of 3MS scores were more significantly decreased in MIA2 (-3.9±12.0 vs. 1.1±6.7, P<0.01) and MIA1 group (-2.3±11.8 vs. 1.1±6.7, P<0.05) than those in MIA0 group respectively. Specific cognitive functions, included executive function (trail-making tests A and B, P=0.401, P=0.176), immediate memory (P=0.437), delayed memory (P=0.104), visuospatial skill (P=0.496), and language ability (P=0.171) remained unchanged. Advanced age, lower education, diabetes mellitus and depression were all correlated with the deterioration of one or more cognitive domains, and the patients having one item of MIA syndrome were prone to develop the deterioration of 3MS (P=0.022). Furthermore, the patients having two or more items of MIA syndrome were more likely to develop the deterioration of not only 3MS (P <0.001), but also delayed memory, visuospatial skill, and language ability (P=0.002, P=0.007, P=0.004, respectively).@*CONCLUSION@#Patients with one item or above of MIA syndrome were at high-risk for the deterioration of global cognitive function. The more MIA syndrome items there were, the more specific cognitive domains deteriorated.

Association between BDNF G196A (Val66Met) polymorphism and cognitive impairment in patients with Parkinson's disease: a meta-analysis

Brain-derived neurotrophic factor (BDNF) is widely expressed in the central nervous system and prolongs the survival of dopaminergic neurons in the substantia nigra. Several studies have recently investigated the association between BDNF G196A (Val66Met), a single nucleotide polymorphism influencing cognitive processes, and cognitive impairment in Parkinson's disease (PD), but with contradictory findings. Thus, this meta-analysis was performed to clarify the possible association. Relevant studies were identified by a systematic search of PubMed, Embase, and China National Knowledge Infrastructure (CNKI) databases. The strength of the association was evaluated using crude odds ratios and 95% confidence interval. Finally, six studies involving 532 cases and 802 controls were included. Our analyses suggested the G196A (Val66Met) polymorphism was significantly associated with cognitive impairment in PD, especially in Caucasian populations. In conclusion, BDNF G196A (Val66Met) is confirmed to be a risk factor for cognitive impairment in PD.

Deterioro Conductual Leve (MBI), Deterioro Cognitivo Leve (MCI) y desarrollo de la demencia: implicancias diagnósticas y clínicas / Mild Behavioral Impairment (MBI), Mild Cognitive Impairment (MCI) and development of dementia: diagnostic and clinical implications

Tanto el Deterioro Conductual Leve (MBI) y el Deterioro Cognitivo Leve (MCI) han sido identificados como estados o fases predemenciales. Estas entidades constituyen factores de riesgo para el desarrollo de las demencias y en muchos casos, una manifestación temprana de las mismas. En este contexto, los síntomas neuropsiquiátricos que caracterizan al MBI no solo podrían presentarse concurrentemente con el MCI, sino también antes de su aparición o incluso sin que este se llegara a presentar. Esta aparición selectiva del MBI sigue representando un gran desafío en términos de la comprensión de su etiología y el sustrato neurobiológico que podría compartir con el MCI. En este artículo se presentan las características centrales del MBI, los criterios que se emplean para su diagnóstico, las relaciones que guarda con el MCI y sus posibles biomarcadores, para discutir algunos aspectos relacionados con su diagnóstico clínico

Prevalência e transição para a fragilidade em idosos com alteração cognitiva em uma coorte de um ano / Prevalence and transition to frailty in older adults with cognitive impairment: a 1-year cohort study

Alteração cognitiva e fragilidade são frequentemente encontradas em idosos e parece haver uma relação entre elas. Entretanto, pouco se sabe sobre a prevalência e a transição para a fragilidade nos idosos com alteração cognitiva, principalmente para a população brasileira. O objetivo do estudo foi avaliar a prevalência e a transição entre os estados de fragilidade em um grupo de idosos com alteração cognitiva em uma coorte prospectiva de um ano. Neste estudo de coorte foram avaliados 59 idosos comunitários com alteração cognitiva (≥ 65 anos). O indivíduo frágil foi identificado por apresentar pelo menos três dos seguintes critérios: perda de peso não intencional, fraqueza da força de preensão palmar, exaustão, lentidão na marcha e baixo nível de atividade física. Quando o indivíduo apresentou um ou dois critérios, foi considerado pré-frágil; quando não apresentou nenhum critério, foi considerado não frágil. A função cognitiva foi avaliada pelo Mini Exame do Estado Mental e a gravidade, pela Clinical Dementia Rating Scale. Do total de 59 idosos avaliados na linha de base, 28 (47,5%) eram frágeis, a mesma quantidade era de pré-frágeis e apenas 3 idosos eram não frágeis. Em 12 meses, verificou-se uma transição para fragilidade de 33,3%. Este estudo mostrou que a prevalência de fragilidade é alta entre os idosos com alteração cognitiva e, em um período de 12 meses, novos casos de fragilidade ocorreram entre os idosos com alteração cognitiva. Entretanto, mais estudos são necessários para investigar com melhor precisão uma relação existente entre o declínio cognitivo e a fragilidade

Cognitive impairment and frailty are often found in older people, and they appear to be related to each other. However, little is known about the prevalence and transition to frailty in older adults with cognitive impairment, especially in the Brazilian population. The present study aimed to determine the prevalence and transitions between frailty states in a cohort of older adults with cognitive impairment followed prospectively for 1 year. A cohort of 59 community-dwelling older adults (aged ≥ 65 years) with cognitive impairment was evaluated. Individuals were classified as frail by the presence of 3 or more of the following criteria: unintentional weight loss; reduced grip strength; exhaustion; slowness; and low physical activity level. Individuals meeting 1 or 2 criteria were classified as prefrail, and those meeting 0 criteria as nonfrail. Cognitive function was assessed by the Mini-Mental State Examination, and severity, by the Clinical Dementia Rating scale. Of 59 older adults evaluated at baseline, 28 (47.5%) were classified as frail, 28 (47.5%) as prefrail, and only 3 (5%) as nonfrail. Over 12 months, 33.3% of participants transitioned from prefrail to frail. The present study showed a high prevalence of frailty in older adults with cognitive impairment and, within 12 months, new cases of frailty were identified in this population. Therefore, more research is needed to further investigate the relationship between cognitive decline and frailty.

Chronic migraine patients show cognitive impairment in an extended neuropsychological assessment / Pacientes com migrânea crônica apresentam déficits cognitivos em uma avaliação neuropsicológica estendida

ABSTRACT The objective of the present study was to assess the presence of cognitive deficits in patients with chronic migraine, and to assess the main factors that trigger cognitive disorders, such as comorbidities or the use of medications. Methods: Chronic migraine and control groups were interviewed in a case-control study. The frequency and intensity of the headache, medication used and associated comorbidities were determined. All patients were submitted to an extended neuropsychological assessment. Results: The chronic migraine group (n = 30) had a worse performance in the Montreal Cognitive Assessment Test (p = 0.00), Verbal Fluency (p = 0.00), Stroop (p = 0.00), Clock Drawing Test (p = 0.00), Digit Span (p = 0.00) and Matrix Reasoning (p = 0.01). After statistical adjustment by linear regression, migraine continued to be the only relevant factor in the poorer performance in the Montreal Cognitive Assessment, Verbal Fluency, Clock Drawing and Stroop tests. Conclusion: Patients with chronic migraine have cognitive deficits in multiple tasks, regardless of the presence of comorbidities or the use of medications.

RESUMO O objetivo do presente estudo foi avaliar a presença de déficits cognitivos em pacientes com migrânea crônica e avaliar os principais fatores que desencadeiam transtornos cognitivos, como comorbidades e uso de medicações. Métodos: Pacientes com migrânea crônica (n = 30) e controles foram entrevistados, em um estudo caso-controle. A frequência e intensidade da cefaleia, medicações utilizadas e comorbidades associadas foram determinadas. Todos os pacientes foram submetidos a uma avaliação neuropsicológica estendida. Resultados: Os pacientes com migrânea crônica apresentaram uma pior performance no Montreal Cognitive Assessment (p = 0.00), Fluência Verbal (p = 0.00), Teste de Stroop (p = 0.00), Teste do Relógio (p = 0.00), Subteste Dígitos (p = 0.00) e Raciocínio matricial da WAIS-III (p = 0.01). Após ajuste estatístico através de Regressão Linear, a migrânea se manteve como único fator relevante para pior desempenho em MoCA, Fluência verbal, Teste do relógio e Teste de Stroop. Conclusão: Pacientes com migrânea crônica apresentam déficits cognitivos incluindo múltiplas tarefas, independentes da presença de comorbidades e uso de medicações.

Performances on the Timed Up and Go Test and subtasks between fallers and non-fallers in older adults with cognitive impairment / Performances no teste Timed Up and Go e subtarefas em idosos com comprometimento cognitivo, caidores e não caidores

ABSTRACT This work aimed to compare performances on the Timed Up and Go (TUG) test and its subtasks between faller and non-faller older adults with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). A prospective study was conducted, with 38 older adults with MCI and 37 with mild AD. Participants underwent an assessment at baseline (the TUG and its subtasks using the Qualisys ProReflex system) and the monitoring of falls at the six-month follow up. After six months, 52.6% participants with MCI and 51.3% with AD fell. In accordance with specific subtasks, total performance on the TUG distinguished fallers from non-fallers with AD, fallers from non-fallers with MCI and non-fallers with MCI from non-fallers with AD. Although no other difference was found in total performances, non-fallers with MCI and fallers with AD differed on the walking forward, turn and turn-to-sit subtasks; and fallers with MCI and non-fallers with AD differed on the turn-to-sit subtask.

RESUMO O objetivo deste trabalho foi comparar o desempenho do Timed up and go test (TUG) e suas subtarefas entre idosos caidores e não caidores com comprometimento cognitivo leve (CCL) e doença de Alzheimer (DA) leve. Um estudo prospectivo foi conduzido, com 38 idosos com CCL e 37 com DA leve. Foi realizada uma avaliação inicial (TUG e subtarefas por meio do sistema Qualisys Pro Reflex) e um monitoramento de quedas por 6 meses. Após 6 meses, 52.6% pessoas com CCL e 51.3% com DA caíram. Em concordância com subtarefas específicas, a performance total do TUG distinguiu caidores de não caidores com DA, caidores de não caidores com CCL e não caidores com CCL de não caidores com DA. Embora nenhuma outra diferença foi encontrada na performance total do TUG, não caidores com CCL e caidores com DA apresentaram diferenças nas performances das subtarefas marcha ida, retornar e virar-se para sentar; e caidores com CCL e não caidores com DA diferiram na subtarefa virar-se para sentar.

Association between cognitive function and parameters of echocardiography and coronary artery angiography / Associação entre a função cognitiva e parâmetros de ecocardiografia e angiografia da artéria coronária

ABSTRACT We aimed to determine whether there is an association between cognition and the results of echocardiography and angiography, based on neuropsychological assessments. Methods: We assessed the cognition of 85 patients who had recently undergone coronary artery angiography. We calculated the Gensini score for the coronary artery disease index. We also performed echocardiography to find indices of cardiac functioning. Results: The lower left ventricular ejection fraction correlated with lower scores on visuospatial, executive function, processing speed/attention and verbal memory capacities (p ≤ 0.05). A higher Gensini score and left atrial size correlated with lower executive function and processing speed/attention (p ≤ 0.05). In the group of patients with an impaired cognitive state, higher Gensini scores correlated with decreased processing speed/attention (p = 0.01) and the e' index was associated with lower capacity of executive function (p = 0.05). Conclusion: Decreased processing speed/attention and executive function may correlate with cardiac dysfunction and coronary artery disease. The Color Trail Test may be considered for simple screening for cognitive problems in elderly patients with coronary artery disease or diastolic dysfunction.

RESUMO O objetivo deste estudo é encontrar associação entre cognição e resultados de exames ecocardiográficos e angiográficos, com base em avaliações neuropsicológicas. Método: Foi avaliada a cognição de 85 pacientes que foram submetidos a angiografia coronária. O escore de Gensini foi calculado para o índice de doença arterial coronariana (DAC). Foi realizado também, o exame ecocardiográfico a fim de descobrir os índices de funcionamento cardíaco. Resultados: A fração de ejeção do ventrículo inferior esquerdo está correlacionada com a baixa pontuação na capacidade visual e espacial, função executiva, velocidade de processamento/atenção e memória verbal (p ≤ 0,05). Alto escore de Gensini e tamanho do átrio esquerdo correlacionados com baixa função executiva, velocidade de processamento/atenção (p ≤ 0,05). No grupo de pacientes com estado cognitivo prejudicado, alto escore de Gensini correlacionado com diminuição da velocidade de processamento/atenção (p = 0,01) e índice e' associado a baixa capacidade da função executiva (p = 0,05). Conclusão: Diminuição da velocidade de processamento/atenção e da função executiva pode estar correlacionado a disfunção cardíaca e DAC. O Color Trail Test pode ser considerado para uma triagem simples de problemas cognitivos em pacientes idosos com DAC ou disfunção diastólica.

Síndrome da fragilidade e o comprometimento cognitivo em idosos: revisão sistemática da literatura / Frailty syndrome and cognitive impairment in older adults: a systematic literature review

O processo de envelhecimento é universal, contínuo, heterogêneo, de caráter lento e complexo. Dentre os possíveis danos do processo de envelhecimento destaca-se o comprometimento cognitivo e a síndrome da fragilidade. O objetivo deste estudo foi sintetizar o conhecimento sobre a associação entre a síndrome da fragilidade e o comprometimento cognitivo do idoso. Para este estudo, foi adotado o referencial do The Joanna Briggs Institute (2017) e dentre os modelos propostos por este Instituto e considerando os objetivos deste estudo, optou-se pela revisão sistemática de etiologia e fatores de risco, que se desenvolveu em nove passos. O primeiro é a elaboração do protocolo. O segundo foi a formulação da questão de estudo e teve como referência a estratégia PEO. No terceiro foram definidos os critérios de inclusão e exclusão. Posteriormente, no quarto passo, foi realizada a busca dos artigos com a utilização das seguintes bases de dados: National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin-American and Caribbean Center on Health Sciences Information (LILACS) e a Excerpta Medica Database (EMBASE), além da busca manual, tendo como resultado uma amostra inicial de 3024 estudos. A seguir, no quinto passo, foi realizada a seleção dos artigos, após serem excluídos os duplicados, houve a seleção por título e resumo e leitura na íntegra dos artigos selecionados. Tais ações foram realizadas por três revisores, sendo incluído um total de 10 artigos no estudo e posteriormente a avaliação crítica. O sétimo passo se refere à extração dos dados, seguida de síntese e análise e, por último a apresentação dos resultados. Os estudos incluídos apresentaram diferentes definições operacionais sobre a síndrome da fragilidade. A definição mais utilizada foi o Fenótipo da Fragilidade, utilizada em nove estudos. Já a avaliação do comprometimento cognitivo foi realizada por instrumentos validados para cada população de estudo, dos quais destaca-se o Mini Exame do Estado Mental (MMSE), uma vez que esteve presente em cinco estudos. Sobre as associações entre a síndrome da fragilidade e o comprometimento cognitivo, três estudos identificaram a associação por meio da medida de Odds Ratio (OR) e de quatro estudos foi possível estabelecer a relação pela análise do Relative Risk (RR). Assim, foram realizadas duas meta-análises entre a síndrome da fragilidade e o comprometimento cognitivo. Na primeira, pela comparação do OR, demonstrou-se que os idosos frágeis apresentam 1,24 mais chance de apresentarem comprometimento cognitivo em relação aos não frágeis. Já, na segunda metaanálise, realizada através do RR, os resultados encontrados não foram estatisticamente significantes. Assim, os resultados sugerem que a ausência da uniformidade entre os estudos para avaliar a síndrome da fragilidade e o comprometimento cognitivo, compromete a comparação entre os resultados. Tornase evidente a necessidade de desenvolver outras pesquisas na área que unifiquem a avaliação dessas duas condições de saúde, tendo em vista sua relevância para a prevenção de desfechos adversos de saúde

The aging process is universal, continuous, heterogeneous, with a slow and complex character. Possible and noteworthy damages of the aging process include cognitive impairment and the frailty syndrome. The objective of this study was to synthesize knowledge about the association between the frailty syndrome and cognitive impairment in older adults. In this study, the authors adopted the framework of the Joanna Briggs Institute (2017) and among the models proposed by this institute, and considering the objectives of this study, a systematic review of etiology and risk factors was chosen and developed in nine steps. The first step was the protocol creation. The second step was the formulation of the study question, which was based on the PEO strategy. At a third moment, inclusion and exclusion criteria were defined. Next, at the fourth step, articles were searched in the following databases: National Center for Biotechnology Information (NCBI/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Latin-American and Caribbean Center on Health Sciences Information (LILACS) and the Excerpta Medica Database (EMBASE), in addition to a manual search as well, which resulted in an initial sample of 3,024 studies. At the fifth step, the articles were selected, once duplicates were removed, and later there was a second selection by title, abstract, and reading of the full texts selected. These actions were conducted by three reviewers, who reached a total of 10 articles to be included in the study. The seventh stage consisted of the data extraction, followed by its synthesis and analysis, and, at last, the presentation of the results. The included studies presented different operational definitions regarding the frailty syndrome. The most commonly used definition was the Frailty Phenotype, which was used in nine studies. The cognitive impairment evaluation was conducted by means of tools previously validated to each study population, among which the Mini-Mental State Examination (MMSE) stood out, for being present in five studies. Regarding the associations between the frailty syndrome and cognitive impairment, three studies identified an association by means of the Odds Ratio (OR) measurement, and in four studies it was possible to establish a relationship by the Relative Risk (RR) analysis. Thus, two meta-analyses were conducted between the frailty syndrome and cognitive impairment. The first, by comparison of the OR, showed that frail older people had 1.24 higher chances of presenting cognitive impairment in relation to non-frail individuals. In the second meta-analysis, performed through the RR analysis, the results found were not statistically significant. Therefore, the results suggest that the absence of uniformity among the studies to assess the frailty syndrome and cognitive impairment compromises their comparison. Hence, there is a clear need for developing further research in the area to consolidate the assessment of these two health conditions, considering their relevance to preventing adverse health outcomes

Cognitive deficits in chronic pain patients, in a brief screening test, are independent of comorbidities and medication use / Déficits cognitivos em pacientes com dor crônica, em uma avaliação breve de triagem, são independentes de comorbidades e uso de medicações

ABSTRACT Objective To describe and analyze cognitive aspects in patients with chronic pain and a control group without pain. Method A case-control study was conducted on 45 patients with chronic pain and on 45 control subjects. Data including pain diagnosis, comorbidities and medication used, were evaluated. Cognitive tests, such as the Montreal Cognitive Assessment (MoCA), Verbal Fluency Test, Clock Drawing Test and Stroop Test, were applied. Results Patients with chronic pain showed a poorer performance, as shown by the scores of the MoCA test (p < 0.002), Verbal Fluency Test (p < 0.001), Clock Drawing Test (p = 0.022) and Stroop Test (p < 0.000). Chronic pain variable (p = 0.015, linear regression model) was an independent factor for results obtained with the MoCA. Conclusion Patients with chronic pain showed a poorer performance in a brief screening test for cognitive impairment not related to confounding variables, as comorbidities and pain-medication use.

RESUMO Objetivo Descrever e analisar aspectos cognitivos em pacientes com dor crônica e um grupo controle sem dor. Método Um estudo de caso-controle foi conduzido em 45 pacientes com dor crônica e 45 controles. Dados incluindo diagnóstico da dor, comorbidades e medicações utilizadas foram avaliados. Foram aplicados testes cognitivos, tais comoMontreal Cognitive Assessment, Teste da Fluência verbal, Teste do relógio e Teste de Stroop. Resultados Pacientes com dor crônica apresentaram uma pior performance, em scores do MoCA (p < 0.002), Fluência verbal (p < 0.001), Teste do relógio (p = 0.022) e Stroop (p < 0.000). Dor crônica (p = 0.015, modelo de regressão linear) foi um fator independente para os piores resultados obtidos no MoCA. Conclusão Pacientes com dor crônica apresentaram uma pior performance em uma avaliação breve para comprometimento cognitivo, não relacionada a variáveis confundidoras, como comorbidades e medicações utilizadas para dor.

Effectiveness of individual and group interventions for people with type 2 diabetes / Efetividade das intervenções individual e em grupo junto a pessoas com diabetes tipo 2 / Efectividad de las intervenciones individual y en grupo en personas con diabetes tipo 2

OBJECTIVE: to compare the effectiveness of two educational interventions used by a healthcare provider in the monitoring of individuals with type 2 diabetes mellitus (T2DM), regarding knowledge of the disease, impact on quality of life and adoption of self-care actions. METHODS: comparative, longitudinal, prospective study performed with 150 subjects with type 2 diabetes, analyzed according to the type of participation in the program (individual and/or group). Participants of the individual intervention (II) received nursing consultations every six months and those of the group intervention (GI) took part in weekly meetings for three months. Data were collected through four questionnaires: Identification questionnaire, Problem Areas in Diabetes Questionnaire (PAID), Summary of Diabetes Self-Care Activities Questionnaire (SDSCA) and the Diabetes Knowledge Scale (DKN-A). Data were analyzed using the Friedman and Mann Whitney tests, considering a statistical significance of p ≤ 0.05. RESULTS: there was an increase in knowledge about the disease in the II (p<0.003) and GI (p<0.007), with reduction of the impact on the quality of life in the II (p<0.007) and improvement in self-care actions in the GI (p<0.001). CONCLUSION: in both intervention models improvements were observed in the indicators, over the six month monitoring period. .

OBJETIVO: comparar a efetividade de duas intervenções educativas, utilizadas por uma operadora de saúde, no acompanhamento ao indivíduo com diabetes mellitus Tipo 2 (DM2), quanto ao conhecimento sobre a doença, impacto na qualidade de vida e adoção de ações de autocuidado. MÉTODOS: estudo comparativo, longitudinal, prospectivo, realizado com 150 indivíduos com diabetes tipo 2, analisados conforme a modalidade de participação no programa (individual e/ou em grupo). Os participantes da intervenção individual (II) realizaram consultas de enfermagem a cada seis meses e os da intervenção em grupo (IG), reuniões semanais por três meses. Os dados foram coletados mediante quatro questionários: Questionário de identificação, Questionário de Impacto na Qualidade de Vida em Diabetes (PAID), Questionário de Autocuidado em Diabetes (QAD) e Questionário de Conhecimento do Diabetes (DKN-A). Os dados foram analisados utilizando-se o Teste de Friedman e o Teste de Mann Whitney, considerando significância estatística para p ≤ 0,05. RESULTADOS: verificou-se aumento do conhecimento sobre a doença na II (p<0,003) e na IG (p<0,007), redução do impacto na qualidade de vida na II (p<0,007) e melhora das ações de autocuidado na IG (p<0,001). CONCLUSÃO: em ambos os modelos de intervenção foram observadas melhoras dos indicadores, ao longo dos seis meses de acompanhamento. .

OBJETIVO: comparar la efectividad de dos intervenciones educativas, utilizadas por una operadora de planes de salud, en el acompañamiento al individuo con diabetes mellitus Tipo 2 (DM2), sobre al conocimiento de la enfermedad, impacto en la calidad de vida y adopción de acciones de autocuidado. MÉTODOS: estudio comparativo, longitudinal, prospectivo, realizado con 150 individuos con diabetes tipo 2, analizados conforme la modalidad de participación en el programa (individual y/o en grupo). Los participantes de la intervención individual (II) realizaron consultas de enfermería a cada seis meses y los de intervención en grupo (IG), reuniones semanales por tres meses. Los datos fueron recolectados mediante cuatro cuestionarios: Cuestionario de identificación, Cuestionario de Impacto en la Calidad de Vida en Diabetes (PAID), Cuestionario de Autocuidado en Diabetes (CAD) y Cuestionario de Conocimiento de la Diabetes (DKN-A). Los datos fueron analizados utilizando el test de Friedman y el test de Mann Whitney, considerando significación estadística para p ≤ 0,05. RESULTADOS: se verificó aumento del conocimiento sobre la enfermedad en la II (p<0,003) y en la IG (p<0,007), reducción del impacto en la calidad de vida en la II (p<0,007) y mejoría de las acciones de autocuidado en la IG (p<0,001). CONCLUSIÓN: en los dos modelos de intervención fueron observadas mejorías de los indicadores, a lo largo de los seis meses de acompañamiento. .

Chromosomal microarrays testing in children with developmental disabilities and congenital anomalies / Análise cromossômica por microarray em crianças com deficiências de desenvolvimento e anomalias congênitas

OBJECTIVES: Clinical use of microarray-based techniques for the analysis of many developmental disorders has emerged during the last decade. Thus, chromosomal microarray has been positioned as a first-tier test. This study reports the first experience in a Chilean cohort. METHODS: Chilean patients with developmental disabilities and congenital anomalies were studied with a high-density microarray (CytoScan(tm) HD Array, Affymetrix, Inc., Santa Clara, CA, USA). Patients had previous cytogenetic studies with either a normal result or a poorly characterized anomaly. RESULTS: This study tested 40 patients selected by two or more criteria, including: major congenital anomalies, facial dysmorphism, developmental delay, and intellectual disability. Copy number variants (CNVs) were found in 72.5% of patients, while a pathogenic CNV was found in 25% of patients and a CNV of uncertain clinical significance was found in 2.5% of patients. CONCLUSION: Chromosomal microarray analysis is a useful and powerful tool for diagnosis of developmental diseases, by allowing accurate diagnosis, improving the diagnosis rate, and discovering new etiologies. The higher cost is a limitation for widespread use in this setting. .

OBJETIVO: O uso clínico de técnicas baseadas em microarrays para a análise de transtornos de desenvolvimento tem surgido durante a última década. Assim, o microarray cromossômico tem sido posicionado como um teste de primeiro nível clínico. Relatamos a primeira experiência em uma coorte chilena. MÉTODOS: Pacientes chilenos com atraso de desenvolvimento e anomalias congênitas foram estudados com um microarray de alta densidade (CytoScan(tm) HD Array, Affymetrix, Inc., Santa Clara, CA, EUA). Pacientes tiveram estudos citogenéticos anteriores, ou um resultado normal ou de uma anomalia não bem caracterizada. RESULTADOS: Foram analisados 40 pacientes selecionados por dois ou mais critérios, incluindo: anomalias congênitas maiores, dismorfismo facial, atraso de desenvolvimento e deficiência intelectual. Uma variante do número de cópia (CNV) foi encontrada em 72,5% dos pacientes, enquanto que uma CNV patogênica foi encontrada em 25% dos pacientes e uma CNV de significado clínico incerto foi encontrada em 2,5% dos pacientes. CONCLUSÕES: A análise cromossômica microarray é uma ferramenta útil e poderosa em transtornos de desenvolvimento, permite um diagnóstico preciso, melhora a taxa de diagnóstico e descobre novas etiologias. O custo mais elevado é uma limitação para um uso difundido em nossa realidade. .

Fasting does not induce gastric emptying in rats

PURPOSE: To evaluate the effect of fasting on gastric emptying in mice. METHODS: Twenty-eight mice were distributed into three study groups: a normal group (N=4): normal standard animals; a total fasting group (N=12): subjected to food and water deprivation and a partial fasting group (N=12): subjected to food deprivation only. The fasting groups were subdivided into three subgroups of four animals each, according to the date of euthanasia: 24, 48 and 72 hours. Was analyzed: the gastric volume, degree of the gastric wall distention and the presence of food debris in gastrointestinal tract. RESULTS: The mean gastric volume was 1601 mm3in the normal group, 847 mm3in total fasting group and 997 mm3in partial fasting group. There was difference between the fasting groups in any analyzed period (p<0.05). Regarding the presence of food debris in the gastrointestinal tract and the degree of distension of the stomach, there was no difference between the groups that underwent total or partial fasting (p>0.05). CONCLUSION: Total fasting or only-solids deprivation does not induce gastric emptying in mice. .

Development and Clinical Validity of a Mild Vascular Cognitive Impairment Assessment Tool for Korean Stroke Patients

PURPOSE: The present study was conducted to develop a mild vascular cognitive impairment (MVCI) assessment tool for patients with stroke and to examine its validity, reliability, and clinical adequacy. METHODS: Items of this tool were developed based on previously verified cognitive assessment tools. Face, content, and criterion (concurrent) validities, optimal cut-off score for differentiation of MVCI and normal cognitive function, clinical adequacy, internal consistency, and inter-rater reliability of the assessment tool were determined in 60 stroke patients at a university hospital located in Incheon, South Korea. RESULTS: The devised MVCI assessment tool contains 20 items which were designed to assess seven cognitive domains: orientation, memory, language, attention, reasoning/abstraction, visuospatial perception, and executive function/problem solving. Content, face, and construct validities were well supported. Clinical adequacy testing revealed that the overall probability of correctly discriminating MVCI using the MVCI assessment tool for stroke was 90.0%, which was statistically significant. Furthermore, a score of 23 was found to be the optimal cut-off score for MVCI. Internal consistency and inter-rater reliability were also well supported. CONCLUSIONS: The findings of this study indicate that the developed MVCI assessment tool for stroke could serve as a clinically useful tool for detecting MVCI and for properly assessing degree of cognitive impairment in stroke patients.