Trastornos del ánimo y demencia: aspectos clínicos y estudios complementarios en el diagnóstico diferencial / Mood disorders and dementia: clinical aspects and complementary studies in the differential diagnosis

Los trastornos del ánimo en el adulto mayor, especialmente aquellos de inicio tardío son difíciles de diferenciar de la demencia en su etapa inicial, dado que existe un traslape sintomático. Esto puede llevar a errar o a retrasar el diagnóstico e impedir la entrega de un tratamiento adecuado. Para el diagnóstico diferencial es fundamental obtener una historia rigurosa tanto del paciente como de la familia, un examen mental y neurológico. Se complementa con un estudio neuropsicológico y con biomarcadores de demencia. Hoy en día se dispone de nuevas técnicas de diagnóstico precoz en la demencia como la volumetría de hipocampos, el PET/CT F18-FDG y PET de amiloide, beta-amiloide y proteína Tau en el LCR, entre otras, que ayudan en casos complejos de diagnóstico diferencial. Este artículo de revisión reúne elementos clínicos y estudios complementarios, con el objetivo de ayudar al psiquiatra en la tarea de diferenciar ambos cuadros.

Mood disorders in the elderly, especially those with late onset are difficult to differentiate from Dementia in its initial stage, given that there is a symptomatic overlap. This can lead to miss or delay the diagnosis and subsequently prevent an appropriate treatment. For the differential diagnosis it is essential to obtain a rigorous history of both the patient and the family, a mental and neurological examination. It is complemented with a neuropsychological assessment and with biomarkers of Dementia. Nowadays, new early diagnosis techniques are available in Dementia such as hippocampal volumetry, PET/CT F18-FDG and PET of amyloid, beta-amyloid and Tau protein in the CSF, among others, which help in complex cases of differential diagnosis. This article reviews clinical elements and complementary studies that help the psychiatrist in the task of differentiating both disorders.

A case report of 29 year old male patient with breast carcinoma: diagnosed on fine needle aspiration cytology

Breast cancer has been considered a female dominated disease. Carcinoma of male breast is a rare disease representing 1% of all breast cancers and less than 1 % of all cancers in men. The mean age at presentation is mainly in sixties. We here present a case of male breast cancer presented at very young age of 29 years, diagnosed on fine needle aspiration which was confirmed later on histopathological examination.

Estado de salud general y perfil biopsicosocial de adultos mayores sanos o excepcionales de Santander, Colombia / General state of health and psychosocial profile of healthy or exceptional elderly of Santander, Colombia

Resumen El presente trabajo tuvo como objetivo evaluar el estado de salud general y perfil biopsicosocial de un grupo adultos mayores sanos o excepcionales del departamento de Santander. La muestra estuvo compuesta por 50 adultos mayores autopercibidos como sanos, de un rango de edad de 75 años en adelante y pertenecientes a las diferentes provincias del departamento. Se emplearon como instrumentos el Mini-Mental State Examination, la Escala de Barthel, el Cuestionario de salud general de Goldberg y el Mini nutricional Assesment. En los resultados encontrados se evidenciaron medias altas en el nivel cognitivo, independencia en las actividades de la vida diaria (AVD), estado nutricional y buena autopercepción de salud mental, bienestar psicológico general, funcionamiento social y afrontamiento. Esto evidencia un perfil biopsicosocial alto, relacionado a factores diferenciales en este grupo de adultos con elevado nivel de longevidad, lo cual abre paso a en los adultos clasificados como viejos-viejos; y además brinda una evidencia de la posibilidad de envejecer exitosamente, con salud y calidad de vida.

Abstract This study aimed to evaluate overall health and biopsychosocial profile of a healthy or exceptional elderly group in Santander, Colombia. The sample consisted of 50 self-perceived healthy older adults, with ages 75 and older, and coming from different provinces of Santander. Data were collected with the Mini-Mental State Examination, the Barthel Scale, Goldberg's General Health Questionnaire and the Mini nutritional Assessment. Results showed high means in the cognitive dimension, independence in Activities of daily living (ADLs), nutritional status and good self-rated mental health, general psychological well-being, social functioning and coping. This suggests a high biopsychosocial profile, related to differential factors in this group of adults with high level of longevity, which opens the way to exploring the positive dimensions in older adults, and it also provides evidence of the possibility of successful, healthy life in old age with a good quality of life.

Effectiveness and maintenance of behavior change and exercise programs on depressive symptoms in older adults / Efetividade e manutenção de programas de mudança de comportamento e de exercícios físicos sobre os sintomas depressivos de idosos

The aim of the study was to compare the effectiveness and maintenance of two health promotion programs on depressive symptoms (DS) of older adults. The research was conducted with the network of primary health care in a southern capital of Brazil. In total, 119 older adult participants were allocated into different groups: behavior change (BCG; n=40), exercise (EG; n=51) and control (CG; n=28), assessed at baseline (A1) and followed-up at three (A2), six (A3) and twelve months (A4). BCG attended "VAMOS Vida Ativa Melhorando a Saúde" (in English, Active Living Improving Health) program while EG attended aerobic gymnastic sessions. The DS were measured by the Geriatric Depression Scale (GDS-15) and level of physical activity (LPA) through accelerometers. Results show that only BCG reduced the number of older adults with high DS (A1=9; A2=4) and this reduction was maintained after six (A3=3) and twelve months (A4=4). Six older adults became physically active (BCG=3; EG=2; CG=1) after the intervention. However, there was no LPA maintenance after six and twelve months, once the frequency of insufficiently active older adults increased or was similar to baseline. When comparing DS, an interaction was found between group and assessment (F=2.94, p=0.01) for BCG, highlighting the reduction (A1=4.0; A2=2.5) and maintenance (A3=2.6; A4=2.8) of mean DS in this group. The results indicate that behavior change programs may bring benefits to the mental health of older adults and the VAMOS program seems to be a viable option for older adults in the community.

Objetivou-se comparar a efetividade e a manutenção de dois programas de promoção da saúde sobre os sintomas depressivos (SD) da população idosa. A pesquisa foi desenvolvida no âmbito da rede de atenção primária à saúde de uma capital do sul do Brasil. Participaram 119 idosos alocados nos grupos: mudança de comportamento - GMC (n=40), exercício físico - GEF (n=51) e controle - GC (n= 28), avaliados no baseline (A1), após três (A2), seis (A3) e 12 meses (A4). O GMC participou do "VAMOS ­ Vida Ativa Melhorando a Saúde" e o GEF de aulas de ginástica. Os SD foram avaliados pela Geriatric Depression Scale (GDS-15) e o nível de atividade física (NAF) por acelerômetro. Os resultados indicam que após a intervenção, somente no GMC houve redução do número de idosos com SD elevados (A1=9; A2=4) e essa redução se manteve após seis (A3=3) e doze meses (A4=4). Em relação ao NAF, após a intervenção, seis idosos tornaram-se fisicamente ativos (GMC=3; GEF=2 e GC=1). Todavia, não foi observada manutenção do NAF após seis e doze meses, uma vez que a frequência de idosos insuficientemente ativos aumentou ou foi semelhante ao baseline. Na comparação dos SD, identificou-se interação grupo versus avaliação (F=2,94, p=0,01) para o GMC, destacando redução (A1=4,0; A2=2,5) e manutenção (A3=2,6; A4=2,8) das médias dos SD nesse grupo. Os resultados sinalizam que programas de mudança de comportamento podem oportunizar benefícios à saúde mental dos idosos e que o programa VAMOS mostrou-se uma possibilidade viável de desenvolvimento no contexto comunitário para esta população.

Effect of Aging On Short Term Heart Rate Variability.

Background: Heart rate variability has been considered as an indicator of autonomic nerve function status. Few works have been done to assess the heart rate variability in normal healthy subjects in different countries. Objectives: To assess the cardiac autonomic nerve function status in healthy Bangladeshi population of different age groups by analyzing time domain measures of Heart Rate Variability. Methods: This cross sectional study was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from the period of July 2012 to June 2013. For this purpose, a total number of 180 healthy subjects were selected with the age ranging from 15-60 years of both sexes. All the study subjects were divided into 3 different groups according to age (Control 15-30 years; middle age 31-45 years; older age 46-60 years). Each group included 60 subjects of which 30 were male and 30 were female. The subjects were selected from different areas of Dhaka city by personal contacts. HRV parameters were recorded by a 4 active channels, RMS Polyrite-D-2 machine For statistical analysis, one way ANOVA, unpaired Student’s ‘t’-test and Pearson’s correlation coefficient test were performed. as applicable. Results: Systolic blood pressure (SBP), diastolic blood pressure (DBP) were significantly (p<0.001) higher in older group in comparison to control & middle age group. Again RR interval and RMSSD (p<0.001), were significantly lower in older age group (p<0.05) compared to control & also to middle age group. But HR was found significantly higher (p<0.05)in both middle and older subjects than control and also in older (p<0.05) compared to middle age. Correlation analysis showed moderate negative correlation of mean R-R with age in middle age whereas significant negative correlation for RMSSD both in middle and older age subjects.. Conclusion: In this study, markedly decreased cardiac parasympathetic function were found with aging process.

Risks and benefits of colonoscopy in patients aged 80 and older: a prospective study / Riscos e beneficios da colonoscopia apos os 80 anos de idade: trabalho prospectivo

OBJECTIVE: this study aims to compare colonoscopy results in patients aged 50-79 and those aged 80 and older. PATIENTS AND METHODS: a total of 533 diagnostic colonoscopies performed from August 2011 to January 2012 were evaluated in a prospective study analyzing age, ASA classification, comorbidities, endoscopic findings, time to reach the cecum, number of complete examinations, difficulties and complications. Chi-square test was used to compare categorical data whereas Student's t test to compare means. A p value < 0.05 was considered significant. RESULTS : 479 patients were in Group A - age 50 to 79, whereas 54 were in Group B, 80 versus older. The following results are shown for Group A and B, respectively: age 63 ± 8 versus 84 ± 4 years. ASA 1 difficult examination: 58 (21 %) versus 12 (27%) p > 0.05, ASA > 2 difficult examination: 41 (20%) versus 6 (60%) p < 0,05. Comorbidities 255 (53%) versus 36 (66%) p > 0.05. Complete colonoscopy in 450 (94%) versus 45 (83%), p < 0.01. Difficulties in 99 (20%) versus 32 (40%), p < 0.01. Complications in 1 (0.2%) versus 3 (5%) p < 0.01. Diverticulitis/ sequelae in 3 (0.6%) versus 3 (5%) p < 0.01. CRC in 42 (8.7%) and 10 (18.5%), p < 0.05. Adenoma in 130 (27 %) versus 15 (27%), p > 0.05 Time to reach the cecum was 39 ± 10 minutes for difficult procedures and 13 ± 9 for the easy ones. CONCLUSION : age 80 and older is associated with more adverse events during colonoscopy. (AU)

OBJETIVO: avaliar riscos em colonoscopia após 80 anos de idade. PACIENTES E MÉTODOS : entre agosto de 2011 e janeiro de 2012 realizamos colonoscopias em 533 pacientes. Grupo A: idade entre 50 e 79 e Grupo B > de 80 anos. PARÂMETROS ANALISADOS: ASA, comorbidades, achados endoscópicos, tempo de chegada ao ceco, número de exames completos, dificuldade e complicações. Usamos teste Qui-quadrado para comparar proporção e teste t de Student para média e desvio padrão. p < 0,05 foi considerado significativo. Este é um estudo prospectivo. RESULTADOS: 533 pacientes sendo 479 do Grupo A e 54 do Grupo B. Resultados seguem a sequência A e B. Idade 63 ± 8 e 84 ± 4. ASA 1, exame difícil 58 (21%) e 12 (27%) p > 0,05 > ASA 2 difícil 41 (20%) e 6 (60%) p < 0,05. Comorbidades 255 (53%) e 36 (66%) p > 0.05. Exame completo 450 (94%) e 45 (83%) p < 0,01 Difícil 99 (20%) e 32 (40%) p < 0,01 Complicações 1 (0,2%) e 3 (5%) p < 0,01 Normal 149 (31%) e 5 (9%) p < 0,01 Diverticulite/sequela 3 (0,6%) e 3 (5%) p < 0,01. CCR 42 (8,7%) e 10 (18,7%) p < 0,05. Adenoma 130 (27%) e 15 (27%) p > 0,05. Tempo em minutos 39 ± 10 para os difíceis e 13 ± 9 para os fáceis. CONCLUSÃO : a idade de 80 anos constitui um risco para a realização de colonoscopia. (AU)

Caracterização da saúde bucal de idosos em uma instituição beneficente de longa permanência de João Pessoa-PB, Brasil / Caracterización de la salud bucal de ancianos residentes en una institución benéfica de João Pessoa-PB, Brasil / Characterization of the buccal health of elderly in an beneficent institution of the long stay of João Pessoa-PB, Brazil

Introdução: a população idosa está crescendo em números proporcionais se tornando necessário maior cuidado de sua saúde. O objetivo deste estudo foi descrever a situação epidemiológica do estado de saúde bucal dos idosos na cidade de João Pessoa - PB, Brasil. Métodos: foram analisados 55 idosos em longa permanência na instituição da cidade de João Pessoa. Os idosos foram interrogados sobre o quotidiano e hábitos pessoais e logo foram validadas as condições bucais por um especialista. A avaliação insere a condição dos dentes e a necessidade e o uso da prótese dentária. Foram coletados os dados em um formulário e analisados no SPSS(Chis quadrado ou exato do Fisher). Resultados: se verificou que 16 (29,0 porcento) das pessoas têm 60-70 anos e 39 (71,0 porcento) mais de 70 anos de idade. Estimativas do sexo evidenciaram que 43 (78,2 porcento) são mulheres e 12 (21,8 porcento) são homens. Os idosos reportaram ter marcado a última visita ao dentista ao menos um mês 2 (3,7 porcento), nos últimos 6 meses 4 (7,3 porcento) e mais de um ano 49 (89,0 porcento). A prevaência de edentulismo foi de 35 (63,6 porcento). Outros têm uma média de 6,1 dentes por indivíduo. O uso de prótese geral removível se observou em 40,0 porcento dos idosos e de prótese parcial removível em 9,1 porcento. Um total de 78 porcento dos idosos presissam de algum tipo de prótese dentária. Conclusões: os idosos tratados ficam carentes de atenção odontológica, necessitando reabilitação protética(AU)

Introducción: la población de ancianos está creciendo en números proporcionales, por lo que es necesario mayor cuidado de su salud. El objetivo de este estudio fue describir la situación epidemiológica del estado de salud oral de los ancianos en la ciudad de João Pessoa - PB, Brasil. Métodos: se analizaron un total de 55 ancianos en una larga estancia, en la institución de la ciudad de João Pessoa. Los ancianos fueron interrogados acerca de información personal, los hábitos personales y a continuación, se llevó a cabo la evaluación de condiciones bucales por un solo examinador. La evaluación incluyó la condición de los dientes y la necesidad y el uso de prótesis dental. Se recogieron los datos en un formulario y analizados en SPSS (Qui-cuadrado o exacto de Fisher). Resultados: se verificó que 16 (29,0 por ciento) de las personas tienen 60-70 años y 39 (71,0 por ciento) más de 70 años de edad. En cuanto al sexo, se encontró que 43 (78,2 por ciento) son mujeres y 12 (21,8 por ciento) son hombres. Los acianos reportaron haber realizado la última visita al dentista al menos un mes 2 (3,7 por ciento), en los últimos 6 meses 4 (7,3 por ciento) y más de un año 49 (89,0 por ciento). La prevalencia de edentulismo fue de 35 (63,6 por ciento). Los demás tienen una media de 6,1 dientes por individuo. El uso de prótesis totales removibles se observó en el 40,0 por ciento de los ancianos y de prótesis parciales removibles en 9,1 por ciento. Un total de 78 por ciento de los ancianos necesitan de algún tipo de prótesis dental. Conclusiones: los ancianos evaluados están carentes de atención odontológica, por lo que necesitan de rehabilitación protética(AU)

Introduction: The elderly population is increasing, so it is necessary to pay more attention to their health status. The objective of this study was to describe the epidemiologic situation of the oral health conditions of the older people in João Pessoa-PB, Brazil. Methods: Fifty five aged persons, who were institutionalized in a long-care center in João Pessoa, were studied. They were inquired about personal data, habits, and then the oral conditions were assessed by a single examiner. The evaluation included the tooth conditions, the requirement and the use of dentures. Data were recorded in a form and analyzed by SPSS (Fisher's Chi-square or exact value). Results: It was observed that 16 (29.0 percent) of these people were aged 60-70 years and 39 (71.0 percent) above 70 years. Regarding sex, 43 (78.2 percent) were females and 12 (21.8 percent) males. Two old people reported having gone to the dentist's at least one month ago (3.7 percent); 4 (3.7 percent), did it in the last 6 months and 49 (89.0 percent) over one year ago. Thirty five were edentulous (63.6 percent). The rest had 6.1 teeth per individual as average. The use of complete removable denture was seen in 40 percent of the elderly and of partial removable dentures in 9.1 percent. A total of 78 percent of the studied elderly needs some kind of denture. Conclusions: The evaluated elderly are lacking odontological care, so they require denture rehabilitation(AU)

Consideraciones del adulto mayor en UTI / Considerations of the major adult in ICU

En nuestro país, el grupo de pacientes Adultos Mayores (sobre 65 años) ha tenido un crecimiento explosivo en los últimos años, reflejo de la expectativa de vida que ha aumentado casi 10 años desde 1981 a la fecha. Con mayor frecuencia, el grupo etario en cuestión requiere ingreso a Unidades más complejas. Estudios internacionales estiman que los adultos mayores ocupan en promedio más de la mitad de los días cama de las Unidades de Tratamiento Intensivo (UTI) a nivel mundial y están cobrando relevancia en la Medicina Intensiva dada particularidades específicas que presentan para su manejo en estas unidades. En Chile, existen escasos datos acerca de ingresos y mortalidad en este grupo de pacientes en las UTI. El objetivo de esta revisión es mostrar datos epidemiológicos de la realidad local en relación a pacientes admitidos en la UTI del Centro de Pacientes Críticos (CPC) de Clínica Las Condes (CLC).

In our country the group of patients older than 65 years had a significant and explosive increment in the last years, reflecting the increased life expectancy which grew almost 10 years since 1981 until to date. With increasing frequency this older group required admission to critical care units. International studies estimate that this older group of patient occupies as an average more than half of the ICU days worldwide, therefore they are having great relevance because of the special needs for their care. In Chile, there are only scarce data about admission and outcome of these group of patients in the ICU's. The aim of this review is to describe some epidemiological data about the local reality of this group of patients admited in to the ICU of our Center for Critically Ill Patients at Clínica Las Condes.

Violencia doméstica en la tercera edad / Domestic violence at the older age

La violencia doméstica es tan antigua como la humanidad. Se reconoce la violencia infantil, contra la mujer y al anciano El último grupo està conformado por una población en ascenso por las mayores expectativas de vida de los últimos años dadas, entre otros factores, por los avances médicos actuales y los estilos de vida saludables. Cuba tiene actualmente el 13 por ciento de la población con 65 años y màs y según estimados, para el 2020 existiràn por primera vez màs ancianos que niños. Por ello, en los próximos años habrà que seguir de cerca el trato a este grupo poblacional. Es de esperar que se incremente el abuso contra el anciano y el impacto de este abuso sobre la salud debe ser considerado. La gama de maltratos que puede sufrir el anciano incluye fundamentalmente, el abuso físico, emocional, financiero, sexual, por negligencia y la negación a brindarle ayuda. Garantizarles condiciones de vida que les ofrezcan independencia, protegerlos jurídicamente, crearles espacios adonde acudir para reclamar por las violaciones que pudieran sufrir y brindarles información a ellos y a la sociedad sobre las formas en que se puede manifestar el maltrato, son acciones que deben cumplirse con exactitud y que contribuirían a la prevención de la violencia

Domestic violence is as old as the origin of mankind. Infant violence and violence against the woman and the old person are well known. The older people group represents a growing population due to higher life expectancies in the last few years encouraged by the present medical advances and healthier life styles. Nowadays, 13 percent of the Cuban population is 65 years and over; but according to estimates, the elderly will outnumber the children for the first time in 2020. Therefore, one must closely watch the treatment to this population section in the forthcoming year. It is expected that elder abuse grows, so the impact of abuse on health should be taken into account. Mistreatment of the elderly mainly includes physical, emotional, financial, sexual abuse, negligence and denial of assistance. Providing them with living conditions that encourage independence, protect them from the legal viewpoint, creating adequate sites where they may claim for possible violations and giving them and the society information on the various forms of abuse are all actions that should be fully taken since they will contribute to the prevention of violence

Clinical Analysis of Outcome for Ruptured Intracerebral Aneurysm with Hematoma

This author analysed 34 cases of aneurysmal rupture which had a hematoma in ventricle, intracerebral and subdural space except subarachnoid space. All the patient had been treated in Chonbuk National University Hospital from Aug. 1. 1984 to Aug. 30. 1990. Among the 34 cases, 24 cases were treated with surgery and 10 cases conservatively. The result of operation showed favorable outcome(Good recovery, Moderately disabled);8 cases(33.3%) and unfavorable(severely disabled, vegetative state);5 cases(20.8%). Mortality rates were 70%(7/10) in nonoperative cases and 45.8%(11/24) in operative cases. The data for 34 cases were correlated with outcome by using Chi-square test and t-test. Mortality and morbidity were increased in patients with hypertension, poorer clinical grades at the time of admission or surgery, larger amounts of intracranial hematoma, and older age. From the overall results, the removal of hematoma and simultaneous clipping aneurysmal neck is necessary to obtain a good outcome.

Clinical Analysis of Outcome for Ruptured Intracerebral Aneurysm with Hematoma

This author analysed 34 cases of aneurysmal rupture which had a hematoma in ventricle, intracerebral and subdural space except subarachnoid space. All the patient had been treated in Chonbuk National University Hospital from Aug. 1. 1984 to Aug. 30. 1990. Among the 34 cases, 24 cases were treated with surgery and 10 cases conservatively. The result of operation showed favorable outcome(Good recovery, Moderately disabled);8 cases(33.3%) and unfavorable(severely disabled, vegetative state);5 cases(20.8%). Mortality rates were 70%(7/10) in nonoperative cases and 45.8%(11/24) in operative cases. The data for 34 cases were correlated with outcome by using Chi-square test and t-test. Mortality and morbidity were increased in patients with hypertension, poorer clinical grades at the time of admission or surgery, larger amounts of intracranial hematoma, and older age. From the overall results, the removal of hematoma and simultaneous clipping aneurysmal neck is necessary to obtain a good outcome.