Falls Risk, Circadian Rhythms and Melatonin: Current Perspectives

Aging is associated with weakening of the circadian system. The circadian amplitude of most physiological variables is reduced, while the circadian phase becomes more labile and tends to occur earlier with advancing age. As the incidence of falls in older persons could follow circadian variations, a better understanding of conditions in which falls occur can lead to the implementation of countermeasures (such as adjusting the scheduling of hospital staff, or changing the timing of anti-hypertensive medication if falls are related to undesirable circadian patterns of blood pressure and/or heart rate). This includes knowing the times of the day, days of the week, and times of the year when falls are more likely to occur at home or in the hospital. Additionally, the links between aging processes and factors associated with an increased risk of developing autonomic dysfunction are well established. A strong association between heart rate variability indexes and aging has been shown. Circadian rhythms of autonomous nervous system activity may play important role for maintenance of orthostatic tolerance. Whether one is concerned with disease prediction and prevention or maintenance of healthy aging, the study of circadian rhythms and the broader time structure underlying physiopathology is helpful in terms of screening, early diagnosis and prognosis, as well as the timely institution of prophylactic and/or palliative/ curative treatment. Timing the administration of such treatment as a function of circadian (and other) rhythms also could lead to reduction of falls in older persons. Finally, a prominent circadian rhythm characterizes melatonin, which peaks during the night. The circadian amplitude of melatonin decreases as a function of age, raising the questions whether such a decrease in the circadian amplitude of melatonin relates to a higher risk of falls and, if so, whether melatonin supplementation may be an effective countermeasure. This narrative review assesses the relationships between fall risk and the potential role circadian rhythms and melatonin play in mitigating this risk. We aim to provide healthcare workers adequate information about fall risk in older persons, including the potential role of the circadian rhythms and/or melatonin, as well as to lay foundations for future fall prevention interventional studies.Fil: Goswami, Nandu. University of Graz; AustriaFil: Abulafia, Carolina Andrea. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Vigo, Daniel Eduardo. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Moser, Maximilian. University of Graz; AustriaFil: Cornelissen, Germaine. University of Minnesota; Estados UnidosFil: Cardinali, Daniel Pedro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentin

Executive functioning in cognitively normal middle-aged offspring of late-onset Alzheimer's disease patients

Episodic memory deficits are traditionally seen as the hallmark cognitive impairment during the prodromal continuum of late-onset Alzheimer's disease (LOAD). Previous studies identified early brain alterations in regions subserving executive functions in asymptomatic, middle-aged offspring of patients with LOAD (O-LOAD), suggesting that premature episodic memory deficits could be associated to executive dysfunction in this model. We hypothesized that O-LOAD would exhibit reduced executive performance evidenced by increased errors and decreased strategy use on an episodic memory task. We assessed 32 asymptomatic middle-aged O-LOAD and 28 age-equivalent control subjects (CS) with several tests that measure executive functions and the Rey Auditory Verbal Learning Test (RAVLT) to measure memory performance. All tests were scored using both traditional and process scores (quantification of errors and strategies underlying overall performance). T-tests were used to compare performance between both groups and Spearman correlations were implemented to measure associations between variables. O-LOAD participants exhibited decreased executive performance compared to CS as it relates to initiation time (Tower of London), mental switching (Trail Making Test B), and interference effects (Stroop Word-Color condition). Traditional RAVLT measures showed a poorer performance by O-LOAD and RAVLT process scores revealed increased interference effects on this group. Positive correlations (r s ) were found between the executive measures and several RAVLT measures for O-LOAD but not for CS. In conclusion, O-LOAD participants exhibited early subtle cognitive changes in executive processing. Observed memory difficulties may be associated in part to executive deficits suggesting an interplay between memory and executive functions. Process score impairments were observed earlier than clinical decline on neuropsychological scores in this at-risk cohort and might be useful cognitive markers of preclinical LOAD.Fil: Abulafia, Carolina Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Fiorentini, Leticia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Loewenstein, David A.. University of Miami; Estados UnidosFil: Curiel Cid, Rosie. University of Miami; Estados UnidosFil: Sevlever, Gustavo. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Nemeroff, Charles B.. University of Texas at Austin; Estados UnidosFil: Villarreal, Mirta Fabiana. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; ArgentinaFil: Vigo, Daniel Eduardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Biomédicas; ArgentinaFil: Guinjoan, Salvador Martín. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires; Argentin

Peeling Skin Syndrome - Relato de Caso

Peeling skin syndrome (PSS) is a rare genodermatosis of autosomal recessive inheritance caused by mutations in CDSN, TGM5 or CHST8, depending on the type of disease. It is characterized by localized or generalized superficial peeling of the skin, with or without erythema and itching. Concerning to the generalized form, Heiko Traupe proposed distinction between noninflammatory (type A) and associated with congenital erythroderma (type B). Mevorah described the type C, with features similar to type B. Noninflammatory type is characterized for continuous spontaneous clearance areas of stratum corneum, which begins at birth or during childhood. We describe a 19 year’s old male patient, with skin peeling of the neck, trunk and upper limbs since childhood and a similar dermatoses in the family.Peeling skin syndrome (PSS) é uma genodermatose rara, de herança autossômica recessiva causada por mutações nos genes CDSN, TGM5 ou CHTS8 dependendo do tipo da doença. É caracterizada por descamação superficial da pele, localizada (acral) ou generalizada, com ou sem eritema e prurido. Relativamente à forma generalizada, Heiko Traupe propôs distinção entre o tipo A, não inflamatório, e o tipo B, associado à eritrodermia congênita (inflamatória). Mevorah descreveu o tipo C que possui características mais próximas ao B. O tipo generalizado não inflamatório é caracterizado por áreas de eliminação espontânea e contínua do estrato córneo, com início no nascimento ou durante a infância. Descrevemos o caso de um paciente masculino de 19 anos, com descamação no pescoço, tronco e membros superiores desde a infância e história de patologia semelhante na família

Heart rate variability and mild cognitive impairment in parkinson’s disease

Abstract: Heart rate variability (HRV) is an index of autonomic control of the heart.1 Evidence suggests loss of sympathetic innervation of the heart takes place in early stages of Parkinson’s disease (PD) and is independent of orthostatic hypotension.2,3 Information about the relationship between HRV and mild cognitive impairment in PD (PD-MCI) is scarce.4 We assessed the association between short-term HRV and MCI in participants of a larger observational crosssectional study of fear of falling. The local ethics committee approved the study, and patients provided written informed consent. Patients without dementia with idiopathic PD and stable medication regimen were included, excluding those with cardiac, liver, or kidney diseases and medications (eg, betareceptor blockers) that affect HRV. Patients were examined during ON state

Sturzrisiko, zirkadiane Rhythmen, Vagusaktivität und Melatonin

Altern ist mit einer Verringerung der Schwingungsamplitude des Tagesverlaufs von physiologischen Variablen verbunden. Die Häufigkeit von Stürzen folgt bei älteren Menschen einem Tagesgang. Darüber hinaus sind die Zusammenhänge zwischen Alterungsprozessen und Faktoren, die vegetative Störungen begünstigen, gut bekannt. So konnte ein starker Zusammenhang zwischen Messgrößen des vegetativen Nervensystems und Alterung gezeigt werden. Insbesondere die Vagusaktivität nimmt ab dem 20. Lebensjahr ab. Die Aktivität des autonomen Nervensystems und ihre zirkadiane Veränderung können eine wichtige Rolle für die Aufrechterhaltung der Blutdruckregulation beim Aufstehen spielen. Ein besonders markanter Tagesrhythmus wurde für Melatonin nachgewiesen, das während der Nacht den Höhepunkt seiner Ausschüttung erreicht. Die zirkadiane Tagesamplitude von Melatonin nimmt mit dem Alter ab, was die Frage aufwirft, ob diese Abnahme mit einem höheren Sturzrisiko zusammenhängt.Fil: Goswami, Nandu. Medical University Of Graz; AustriaFil: Abulafia, Carolina Andrea. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Vigo, Daniel Eduardo. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; ArgentinaFil: Moser, Maximilian. Medical University Of Graz; AustriaFil: Cornelissen, Germaine. University of Minnesota; Estados UnidosFil: Cardinali, Daniel Pedro. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires". Instituto de Investigaciones Biomédicas. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Biomédicas; Argentin

Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome

An exploratory study of sleep-wake differences of autonomic activity in patients with mild cognitive impairment: the role of melatonin as a modulating factor

Abstract: Purpose: The objective of the present study was to assess sleep-wake differences of autonomic activity in patients with mild cognitive impairment (MCI) compared to control subjects. As a post-hoc objective, we sought to evaluate the mediating effect of melatonin on this association. Patients and Methods: A total of 22 MCI patients (13 under melatonin treatment) and 12 control subjects were included in this study. Sleep-wake periods were identified by actigraphy and 24hr-heart rate variability measures were obtained to study sleep-wake autonomic activity. Results: MCI patients did not show any significant differences in sleep-wake autonomic activity when compared to control subjects. Post-hoc analyses revealed that MCI patients not taking melatonin displayed lower parasympathetic sleep-wake amplitude than controls not taking melatonin (RMSSD −7 ± 1 vs 4 ± 4, p = 0.004). In addition, we observed that melatonin treatment was associated with greater parasympathetic activity during sleep (VLF 15.5 ± 0.1 vs 15.1 ± 0.1, p = 0.010) and in sleep-wake differences in MCI patients (VLF 0.5 ± 0.1 vs 0.2 ± 0.0, p = 0.004). Conclusion: These preliminary findings hint at a possible sleep-related parasympathetic vulnerability in patients at prodromal stages of dementia as well as a potential protective effect of exogenous melatonin in this population