[Sleep in patients of a memory clinic : Clinical characteristics of the discrepancy between subjective and objective assessment]. / Schlaf bei Patienten einer Gedächtnissprechstunde : Klinische Charakteristika der Diskrepanz zwischen subjektiver und objektiver Erfassung.

BACKGROUND: Dementia is often accompanied by sleep disturbances, whereby the diagnostics with subjective procedures and objective methods can produce discrepant results. The frequency and clinical characteristics of patients, whose subjective sleep efficiency was unimpaired and was in contrast to an objectively conspicuous sleep efficiency in the sense of an overestimation, were investigated in a memory consultation. METHODS: On 2 consecutive days, patients underwent guideline-oriented diagnostics for dementia (including mini-mental status examination, MMSE and clinical dementia rating, CDR), supplemented by a subjective (Pittsburgh sleep quality index, PSQI) and objective (overnight actigraphy) sleep assessment. Overestimation of sleep efficiency was defined as a subjective sleep efficiency (SSE) of ≥85% with an actigraphic sleep efficiency (ASE) of <85%. RESULTS: Of 45 patients (74.4 ± 7.8 years; 26 f/19 m; CDR < 1: n = 16, CDR = 1: n = 28; diagnostic groups according to ICD-10: F0: n = 39, F3: n = 5, Z03.x: n = 1) 10 showed an overestimation of sleep efficiency, who showed a lower MMSE score and a higher proportion of patients with a dementia syndrome (CDR = 1) when compared with the other three groups of SSE and ASE ≥85% (n = 17), SSE and ASE <85% (n = 9) and SSE <85% with ASE ≥85% (n = 9). Binary regression showed that MMSE remained an important predictor for overestimation of sleep efficiency. CONCLUSION: Cognitive deficits in memory clinic patients appear to contribute to a poorer perception and/or an underreporting of objectively disturbed sleep. This could promote false negative subjective screening results in a diagnostic process in which a comprehensive sleep assessment is not routinely considered.

Fatores associados à demência em idosos / Factors associated with dementia in elderly

Resumo Analisar os fatores associados à demência em idosos atendidos em um ambulatório de memória da Universidade do Sul de Santa Catarina (Unisul). Estudo transversal com análise de dados de prontuário no período de 01/2013 a 04/2016. O desfecho foi o diagnóstico clínico de demência. As variáveis de controle foram: nível sérico de vitamina D na época do diagnóstico, sexo, cor da pele, escolaridade, idade, diabetes tipo 2, hipertensão arterial e depressão. Foi realizada análise bruta e ajustada com regressão logística. Amostra de 287 idosos, com predominância de idade entre 60 e 69 anos (48,78%), sexo feminino (79,09%), cor da pele branca (92,33%). A média de anos de estudo foi de 6,95 anos (DP ± 4,95) e da vitamina D 26,09 ng/mL (DP ± 9,20). A prevalência de idosos com demência foi de 16,72%. Dentre as morbidades a depressão foi a de maior prevalência seguida pela hipertensão arterial. Estiveram independentemente associadas à demência: vitamina D (OR = 0,92 IC 95% 0,88;0,97), depressão (OR = 4,09 IC95% 1,87;8,94), hipertensão arterial (OR = 2,65 IC95% 1,15;6,08) e indivíduos com idade igual e maior que 80 anos. A prevalência de demência foi alta, e houve associação de níveis mais baixos de vitamina D com diagnóstico de demência. Sendo a vitamina D um fator modificável, abrindo importantes perspectivas para políticas de saúde pública.

Abstract We analyzed the factors associated with dementia in the elderly attended at a memory outpatient clinic of the University of Southern Santa Catarina (UNISUL). This is a cross-sectional study with data analysis of medical records from January 2013 to April 2016. The outcome was the clinical diagnosis of dementia. The control variables were: serum vitamin D level at the time of diagnosis, gender, skin color, schooling, age, type 2 diabetes, hypertension, and depression. We performed a crude and adjusted analysis with logistic regression. The sample consisted of 287 elderly, with the predominance of age between 60 and 69 years (48.78%), female (79.09%) and white (92.33%). The mean number of years of study was 6.95 years (SD ± 4.95) and mean vitamin D was 26.09 ng/mL (SD ± 9,20). The prevalence of elderly with dementia was 16.72%. Depression was the most prevalent (42.50%) among the morbidities, followed by hypertension (31.71%). The following were independently associated with dementia: vitamin D (OR = 0.92, 95%CI, 0.88;0.97), depression (OR = 4.09, 95%CI, 1.87;8.94), hypertension (OR = 2.65, 95%CI, 1.15;6.08) and individuals aged 80 years and over (OR = 3.97 95%CI, 1.59;9.91). Dementia prevalence was high and diagnosed dementia was associated with lower levels of vitamin D. Vitamin D is a modifiable factor, opening up essential perspectives for public health policies.