Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study.

Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing. Objective: To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up. Methods: Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years. Results: The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up. Conclusion: There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.

Dada a importância da síndrome demencial e de seus impactos na população, cresce o interesse em estudar os fatores de risco modificáveis para a demência. Objetivo: Comparar a prevalência de fatores de risco para demência em adultos de meia-idade e pessoas idosas, em um período de dois anos, e identificar quais fatores de risco na avaliação de base predizem o declínio cognitivo na avaliação de acompanhamento. Métodos: Estudo longitudinal e quantitativo, com avaliação de acompanhamento após dois anos, realizado com 200 participantes com 45 anos ou mais, cadastrados na Atenção Básica. Nas avaliações de base (2018/2019) e de acompanhamento (2021) foram coletados dados sociodemográficos, foram feitas avaliação cognitiva e avaliação dos fatores de risco para demência (escolaridade, perda auditiva, traumatismo craniano, hipertensão arterial, uso de álcool, obesidade, tabagismo, sintomas depressivos, isolamento social, inatividade física, diabetes mellitus). Os dados foram comparados pelo teste de McNemar. Modelos de regressão logística multinominal individuais foram conduzidos para identificar quais fatores estavam associados ao declínio cognitivo após dois anos. Resultados: Os percentuais de baixa escolaridade, traumatismo craniano e tabagismo mantiveram-se os mesmos nas duas avaliações. Houve aumento significativo da prevalência de hipertensão arterial (de 55,0 para 62,0%) e inatividade física (de 58,5 para 74,5%), e redução significativa do isolamento social (de 25,5 para 18,0%). Participantes com sintomas depressivos na avaliação de base apresentaram maior risco de declínio cognitivo no acompanhamento. Conclusão: Houve aumento das prevalências de hipertensão arterial e inatividade física; e redução do isolamento social. Sintomas depressivos predizem declínio cognitivo.

Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study / Monitoramento de fatores de risco para demência em adultos de meia-idade e pessoas idosas: um estudo longitudinal

ABSTRACT. Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing. Objective: To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up. Methods: Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years. Results: The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up. Conclusion: There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.

RESUMO. Dada a importância da síndrome demencial e de seus impactos na população, cresce o interesse em estudar os fatores de risco modificáveis para a demência. Objetivo: Comparar a prevalência de fatores de risco para demência em adultos de meia-idade e pessoas idosas, em um período de dois anos, e identificar quais fatores de risco na avaliação de base predizem o declínio cognitivo na avaliação de acompanhamento. Métodos: Estudo longitudinal e quantitativo, com avaliação de acompanhamento após dois anos, realizado com 200 participantes com 45 anos ou mais, cadastrados na Atenção Básica. Nas avaliações de base (2018/2019) e de acompanhamento (2021) foram coletados dados sociodemográficos, foram feitas avaliação cognitiva e avaliação dos fatores de risco para demência (escolaridade, perda auditiva, traumatismo craniano, hipertensão arterial, uso de álcool, obesidade, tabagismo, sintomas depressivos, isolamento social, inatividade física, diabetes mellitus). Os dados foram comparados pelo teste de McNemar. Modelos de regressão logística multinominal individuais foram conduzidos para identificar quais fatores estavam associados ao declínio cognitivo após dois anos. Resultados: Os percentuais de baixa escolaridade, traumatismo craniano e tabagismo mantiveram-se os mesmos nas duas avaliações. Houve aumento significativo da prevalência de hipertensão arterial (de 55,0 para 62,0%) e inatividade física (de 58,5 para 74,5%), e redução significativa do isolamento social (de 25,5 para 18,0%). Participantes com sintomas depressivos na avaliação de base apresentaram maior risco de declínio cognitivo no acompanhamento. Conclusão: Houve aumento das prevalências de hipertensão arterial e inatividade física; e redução do isolamento social. Sintomas depressivos predizem declínio cognitivo.

Role of hydrogen sulfide in ventilatory responses to hypercapnia in the medullary raphe of adult rats.

NEW FINDINGS: What is the central question of this study? There is evidence that H2 S plays a role in the control of breathing: what are its actions on the ventilatory and thermoregulatory responses to hypercapnia via effects in the medullary raphe, a brainstem region that participates in the ventilatory adjustments to hypercapnia? What is the main finding and its importance? Hypercapnia increased the endogenous production of H2 S in the medullary raphe. Inhibition of endogenous H2 S attenuated the ventilatory response to hypercapnia in unanaesthetized rats, suggesting its excitatory action via the cystathionine ß-synthase-H2 S pathway in the medullary raphe. ABSTRACT: Hydrogen sulfide (H2 S) has been recently recognized as a gasotransmitter alongside carbon monoxide (CO) and nitric oxide (NO). H2 S seems to modulate the ventilatory and thermoregulatory responses to hypoxia and hypercapnia. However, the action of the H2 S in the medullary raphe (MR) on the ventilatory responses to hypercapnia remains to be elucidated. The present study aimed to assess the role of H2 S in the MR (a brainstem region that contains CO2 -sensitive cells and participates in the ventilatory adjustments to hypercapnia) in the ventilatory responses to hypercapnia in adult unanaesthetized Wistar rats. To do so, aminooxyacetic acid (AOA; a cystathionine ß-synthase (CBS) enzyme inhibitor), propargylglycine (PAG; a cystathionine γ-lyase enzyme inhibitor) and sodium sulfide (Na2 S; an H2 S donor) were microinjected into the MR. Respiratory frequency (fR ), tidal volume (VT ), ventilation ( V̇E ), oxygen consumption ( V̇O2 ) and body temperature (Tb ) were measured under normocapnic (room air) and hypercapnic (7% CO2 ) conditions. H2 S concentration within the MR was determined. Microinjection of the drugs did not affect fR , VT and V̇E during normocapnia when compared to the control group. However, the microinjection of AOA, but not PAG, attenuated fR and V̇E during hypercapnia in comparison to the vehicle group, but had no effects on Tb . In addition, we observed an increase in the endogenous production of H2 S in the MR during hypercapnia. Our findings indicate that endogenously produced H2 S in the MR plays an excitatory role in the ventilatory response to hypercapnia, acting through the CBS-H2 S pathway.

Avaliação da sarcopenia em idosos em extrema longevidade utilizando diferentes métodos e sua relação com o desempenho cognitivo / Evaluation of sarcopenia in older adults in extreme longevity using different methods and its relationship to cognitive performance

A sarcopenia é altamente prevalente nos idosos, gerando desafios individuais e sociais para a saúde pública, o que torna o rastreio da mesma fundamental. Objetivo: Avaliar a relação entre massa muscular esquelética (MME) e circunferência da panturrilha (CP), índice de massa corporal (IMC) e desempenho cognitivo de idosos em extrema longevidade. Método: Pesquisa transversal e quantitativa com n=69 idosos com idade igual ou maior que 90 anos, atendidos no Sistema Único de Saúde. Coletaram-se dados sociodemográficos e antropométricos. O índice de massa muscular (IMM) foi calculado com base na MME, a qual foi estimada pela fórmula de Lee e colaboradores. A definição de sarcopenia utilizada foi a proposta por Janssen e colaboradores. Foi feita a medida da CP, calculado o IMC, e o desempenho cognitivo foi avaliado pelo teste de Fluência Verbal (FV). A relação entre as variáveis foi analisada pelo teste de correlação de Spearman. Resultados: Todos os idosos foram considerados com sarcopenia severa de acordo com o IMM. Pela CP, 39,4% dos homens e 52,8% das mulheres apresentaram valores indicativos de sarcopenia; e pelo IMC, 33,3% dos homens e 36,1% das mulheres possuem baixo peso corporal. As únicas variáveis que apresentaram relação significativa e direta foram IMC e CP, para homens e mulheres. Conclusão: Não foi identificada correlação entre MME e CP, IMC e desempenho cognitivo. Sugere-se que a avaliação da sarcopenia em idosos longevos seja realizada utilizando métodos mais fidedignos. A elevada prevalência da sarcopenia realça a urgência de um olhar direcionado ao grupo de idosos longevos

Sarcopenia is highly prevalent in older adults, and generates several individual and social challenges for public health, which makes screening it fundamental. Objective: To evaluate the relationship between skeletal muscle mass (SMM) and calf circumference (CC), body mass index (BMI) and cognitive performance of older adults in extreme longevity. Method: A cross-sectional and quantitative research was carried out with n = 69 elderly people aged 90 years or older, treated at the Unified Health System. Sociodemographic and anthropometric data were collected. The muscle mass index (MMI) was calculated based on the SMM, which was estimated by the formula of Lee and collaborators. The definition of sarcopenia used was proposed by Janssen and collaborators. CC was measured, BMI was calculated, and cognitive performance was assessed by the Verbal Fluency (VF) test. The relationship between the variables was analyzed using Spearman's correlation test. Results: All older adults evaluated were considered to have severe sarcopenia according to the MMI. According to the CC, 39.4% of men and 52.8% of women had indicative values ​​for sarcopenia; and by BMI, 33.3% of men and 36.1% of women have low body weight. The only variables that showed a significant and direct relationship were BMI and CC, for men and women. Conclusion: No correlation was found between SMM and CC, BMI and cognitive performance. The evaluation of sarcopenia in long-lived elderly should be carried out using methods that are more reliable. The high prevalence of sarcopenia highlights the urgency of looking at the group of extreme longevity

Involvement of endogenous central hydrogen sulfide (H2S) in hypoxia-induced hypothermia in spontaneously hypertensive rats.

Spontaneously hypertensive rats (SHR) display autonomic imbalance and abnormal body temperature (Tb) adjustments. Hydrogen sulfide (H2S) modulates hypoxia-induced hypothermia, but its role in SHR thermoregulation is unknown. We tested the hypothesis that SHR display peculiar thermoregulatory response to hypoxia and that endogenous H2S overproduced in the caudal nucleus of the solitary tract (NTS) of SHR modulates this response. SHR and Wistar rats were microinjected into the fourth ventricle with aminooxyacetate (AOA, H2S-synthezing enzyme inhibitor) or sodium sulfide (Na2S, H2S donor) and exposed to normoxia (21% inspired O2) or hypoxia (10% inspired O2, 30 min). Tb was continuously measured, and H2S production rate was assessed in caudal NTS homogenates. In both groups, AOA, Na2S, or saline (i.e., control; 1 µL) did not affect euthermia. Hypoxia caused similar decreases in Tb in both groups. AOA presented a longer latency to potentiate hypoxic hypothermia in SHR. Caudal NTS H2S production rate was higher in SHR. We suggest that increased bioavailability of H2S in the caudal NTS of SHR enables the adequate modulation of excitability of peripheral chemoreceptor-activated NTS neurons that ultimately induce suppression of brown adipose tissue thermogenesis, thus accounting for the normal hypoxic hypothermia.

Hydrogen sulfide inhibits preoptic prostaglandin E2 production during endotoxemia.

Hydrogen sulfide (H(2)S) is a gaseous neuromodulator endogenously produced in the brain by the enzyme cystathionine ß-synthase (CBS). We tested the hypothesis that H(2)S acts within the anteroventral preoptic region of the hypothalamus (AVPO) modulating the production of prostaglandin (PG) E(2) (the proximal mediator of fever) and cyclic AMP (cAMP). To this end, we recorded deep body temperature (Tb) of rats before and after pharmacological modulation of the CBS-H(2)S system combined or not with lipopolysaccharide (LPS) exposure, and measured the levels of H(2)S, cAMP, and PGE(2) in the AVPO during systemic inflammation. Intracerebroventricular (icv) microinjection of aminooxyacetate (AOA, a CBS inhibitor; 100 pmol) did not affect basal PGE(2) production and Tb, but enhanced LPS-induced PGE(2) production and fever, indicating that endogenous H(2)S plays an antipyretic role. In agreement, icv microinjection of a H(2)S donor (Na(2)S; 260 nmol) reduced the LPS-induced PGE(2) production and fever. Interestingly, we observed that the AVPO levels of H(2)S were decreased following the immunoinflammatory challenge. Furthermore, fever was associated with decreased levels of AVPO cAMP and increased levels of AVPO PGE(2). The LPS-induced decreased levels of cAMP were reduced to a lesser extent by the H(2)S donor. The LPS-induced PGE(2) production was potentiated by AOA (the CBS inhibitor) and inhibited by the H(2)S donor. Our data are consistent with the notion that the gaseous messenger H(2)S synthesis is downregulated during endotoxemia favoring PGE(2) synthesis and lowering cAMP levels in the preoptic hypothalamus.

Cannabidiol-treated rats exhibited higher motor score after cryogenic spinal cord injury.

Cannabidiol (CBD), a non-psychoactive constituent of cannabis, has been reported to induce neuroprotective effects in several experimental models of brain injury. We aimed at investigating whether this drug could also improve locomotor recovery of rats submitted to spinal cord cryoinjury. Rats were distributed into five experimental groups. Animals were submitted to laminectomy in vertebral segment T10 followed or not by application of liquid nitrogen for 5 s into the spinal cord at the same level to cause cryoinjury. The animals received injections of vehicle or CBD (20 mg/kg) immediately before, 3 h after and daily for 6 days after surgery. The Basso, Beattie, and Bresnahan motor evaluation test was used to assess motor function post-lesion one day before surgery and on the first, third, and seventh postoperative days. The extent of injury was evaluated by hematoxylin-eosin histology and FosB expression. Cryogenic lesion of the spinal cord resulted in a significant motor deficit. Cannabidiol-treated rats exhibited a higher Basso, Beattie, and Bresnahan locomotor score at the end of the first week after spinal cord injury: lesion + vehicle, day 1: zero, day 7: four, and lesion + Cannabidiol 20 mg/kg, day 1: zero, day 7: seven. Moreover, at this moment there was a significant reduction in the extent of tissue injury and FosB expression in the ventral horn of the spinal cord. The present study confirmed that application of liquid nitrogen to the spinal cord induces reproducible and quantifiable spinal cord injury associated with locomotor function impairments. Cannabidiol improved locomotor functional recovery and reduced injury extent, suggesting that it could be useful in the treatment of spinal cord lesions.