Mortalidad asociada al trastorno neurocognitivo y dependencia en personas mayores de 55 años. Revisión sistemática / Mortality associated with neurocognitive disorder and dependence in people over 55 years of age. Systematic review

Introducción El creciente envejecimiento poblacional trae consigo un aumento de la incidencia del trastorno neurocognitivo (TNC) así como diversas situaciones generadoras de dependencia. Objetivo Analizar mediante una revisión sistemática la relación que existe entre TNC y dependencia con el riesgo de mortalidad en personas mayores. Métodos Se realizó una búsqueda bibliográfica de los estudios longitudinales publicados en Pubmed y Scopus abordando la relación entre TNC, dependencia para las actividades básicas de la vida diaria (ABVD) y mortalidad publicados entre los años 1995 y 2021 De los 1040 artículos encontrados, se seleccionaron 10 estudios. Resultados Se observó que las cohortes de personas mayores con TNC presentaron riesgo de mortalidad asociado a la afectación de las ABVD (test de Barthel) y a las puntuaciones de Mini-Mental State Examination siguiendo una tendencia lineal significativa. Otros factores asociados al riesgo de mortalidad fueron: niveles bajos de educación, vivir solo y presentar fragilidad. Es clara la vinculación entre los tres términos utilizados en la búsqueda de este trabajo y, sin embargo, destaca que haya pocos estudios longitudinales que los analicen conjuntamente. Conclusiones Los resultados hallados subrayan la importancia de realizar evaluaciones del estado cognitivo y funcional mediante escalas validadas, ya que ambas áreas se asocian con la mortalidad. La evaluación de la dependencia y de la función cognitiva en adultos mayores debe considerarse tanto en la investigación como en la práctica clínica, ya que aportarían información sobre su posible relación con la mortalidad. (AU)

Introduction The increasing aging of the population brings with it an increase in the incidence of neurocognitive disorder (NCD) as well as various situations that generate dependence. Objective To analyze by means of a systematic review the relationship between NCD and dependence with the risk of mortality in the elderly. Methods A bibliographic search of longitudinal studies published in Pubmed and Scopus addressing the relationship between NCI, dependence for basic activities of daily living (ADL) and mortality published between 1995 and 2021 was performed. Of the 1040 articles found, 10 studies were selected. Results It was observed that cohorts of elderly people with NCI presented mortality risk associated with ABVD impairment (Barthel test) and Mini-Mental State Examination scores following a significant linear trend. Other factors associated with mortality risk were low levels of education, living alone, and frailty. Conclusions The results underline the importance of performing assessments of cognitive and functional status using validated scales, since both areas are associated with mortality. The link between the three terms used in the search for this work is clear, but it is noteworthy that there are few longitudinal studies that analyze them together. The assessment of dependence and cognitive function in older adults should be considered in both research and clinical practice as it would provide information on their possible relationship with mortality. (AU)

Mortalidad asociada al trastorno neurocognitivo y dependencia en personas mayores de 55 años. Revisión sistemática / Mortality associated with neurocognitive disorder and dependence in people over 55 years of age. Systematic review

Introducción El creciente envejecimiento poblacional trae consigo un aumento de la incidencia del trastorno neurocognitivo (TNC) así como diversas situaciones generadoras de dependencia. Objetivo Analizar mediante una revisión sistemática la relación que existe entre TNC y dependencia con el riesgo de mortalidad en personas mayores. Métodos Se realizó una búsqueda bibliográfica de los estudios longitudinales publicados en Pubmed y Scopus abordando la relación entre TNC, dependencia para las actividades básicas de la vida diaria (ABVD) y mortalidad publicados entre los años 1995 y 2021 De los 1040 artículos encontrados, se seleccionaron 10 estudios. Resultados Se observó que las cohortes de personas mayores con TNC presentaron riesgo de mortalidad asociado a la afectación de las ABVD (test de Barthel) y a las puntuaciones de Mini-Mental State Examination siguiendo una tendencia lineal significativa. Otros factores asociados al riesgo de mortalidad fueron: niveles bajos de educación, vivir solo y presentar fragilidad. Es clara la vinculación entre los tres términos utilizados en la búsqueda de este trabajo y, sin embargo, destaca que haya pocos estudios longitudinales que los analicen conjuntamente. Conclusiones Los resultados hallados subrayan la importancia de realizar evaluaciones del estado cognitivo y funcional mediante escalas validadas, ya que ambas áreas se asocian con la mortalidad. La evaluación de la dependencia y de la función cognitiva en adultos mayores debe considerarse tanto en la investigación como en la práctica clínica, ya que aportarían información sobre su posible relación con la mortalidad. (AU)

Introduction The increasing aging of the population brings with it an increase in the incidence of neurocognitive disorder (NCD) as well as various situations that generate dependence. Objective To analyze by means of a systematic review the relationship between NCD and dependence with the risk of mortality in the elderly. Methods A bibliographic search of longitudinal studies published in Pubmed and Scopus addressing the relationship between NCI, dependence for basic activities of daily living (ADL) and mortality published between 1995 and 2021 was performed. Of the 1040 articles found, 10 studies were selected. Results It was observed that cohorts of elderly people with NCI presented mortality risk associated with ABVD impairment (Barthel test) and Mini-Mental State Examination scores following a significant linear trend. Other factors associated with mortality risk were low levels of education, living alone, and frailty. Conclusions The results underline the importance of performing assessments of cognitive and functional status using validated scales, since both areas are associated with mortality. The link between the three terms used in the search for this work is clear, but it is noteworthy that there are few longitudinal studies that analyze them together. The assessment of dependence and cognitive function in older adults should be considered in both research and clinical practice as it would provide information on their possible relationship with mortality. (AU)

[Mortality associated with neurocognitive disorder and dependence in people over 55 years of age. Systematic review]. / Mortalidad asociada al trastorno neurocognitivo y dependencia en personas mayores de 55 años. Revisión sistemática.

INTRODUCTION: The increasing aging of the population brings with it an increase in the incidence of neurocognitive disorder (NCD) as well as various situations that generate dependence. OBJECTIVE: To analyze by means of a systematic review the relationship between NCD and dependence with the risk of mortality in the elderly. METHODS: A bibliographic search of longitudinal studies published in Pubmed and Scopus addressing the relationship between NCI, dependence for basic activities of daily living (ADL) and mortality published between 1995 and 2021 was performed. Of the 1040 articles found, 10 studies were selected. RESULTS: It was observed that cohorts of elderly people with NCI presented mortality risk associated with ABVD impairment (Barthel test) and Mini-Mental State Examination scores following a significant linear trend. Other factors associated with mortality risk were low levels of education, living alone, and frailty. CONCLUSIONS: The results underline the importance of performing assessments of cognitive and functional status using validated scales, since both areas are associated with mortality. The link between the three terms used in the search for this work is clear, but it is noteworthy that there are few longitudinal studies that analyze them together. The assessment of dependence and cognitive function in older adults should be considered in both research and clinical practice as it would provide information on their possible relationship with mortality.

New European Union Regulations Related to Whole Slide Image Scanners and Image Analysis Software.

Whole slide imaging (WSI) scanners and automatic image analysis algorithms, in order to be used for clinical applications, including primary diagnosis in pathology, are subject to specific regulatory frameworks in each country. Until May 25, 2018, in the European Union (EU), in vitro diagnostic (IVD) medical devices were regulated by directive 98/79/EC (in vitro diagnostic medical device directive [IVDD]). Main scanner vendors have obtained a Conformité Européenne mark of their products that in Europe were classified as General Class IVDD, so that conformity is only based on a self-declaration of the manufacturer. This contrasts with the initial classification of the US Food and Drug Administration (FDA) of WSI system as Class III medical devices, although the first digital pathology WSI system to be cleared by FDA was classified as Class II, with special controls. Other digital pathology solutions (automated cervical cytology slide reader) are considered of higher risk by US and European regulations. There is also some disparity in the classification of image analysis solutions between Europe and the United States. All IVD-MDs must be approved under the new European regulation (in vitro diagnostic medical device regulation) 2017/746 after May 26, 2024. This means the need of a performance evaluation, including a scientific validity report, an analytical performance report, and a clinical performance report. According to its clinical use (e.g., screening, diagnosis, or staging of cancer), a WSI slide scanner can be now classified as Class C device. A special regulation is applied to companion diagnostics. The new EU regulation 2017/746 contemplates the use of standard unique identifiers for medical devices and the creation of a European database on medical devices (Eudamed). Existing validation studies and clinical guidelines already available in the literature are a sound basis to avoid that this new regulation becomes a barrier for digital pathology development in Europe.