Actions to be taken for improving functional prognosis in dementia

The growing incidence of dementia has led to an increased need for specialized care and higher health and social costs. Functional decline is the main cause of dementia complications. Per definition, dementia diagnosis and severity stratification require a certain degree of functional impairment [1]. Therefore, it is important to determine strategies to prevent functional deterioration in both, general population and especially people with dementia. The number of older adults with some degree of disability will triple by 2050 due to the increase in the aging population and the prevalence of age-related diseases that lead to functional impairment [2]. Therefore, functional impairment and disability in old people are increasingly becoming a major public health concern. Furthermore, functional impairment severely impairs quality of life and consumes a large proportion of the public health resources, creating an important burden for health care systems. It is well known that functional loss and disability in dementia are the main consequences of cognitive decline. Therefore, most of the efforts in dementia management have been directed to stop or reverse cognitive decline. However, functional loss and disability are also the consequence of other conditions that are common in old age and comorbid with dementia, such as frailty, sarcopenia, malnutrition, falls, pulmonary or cardiovascular diseases, polypharmacy, depression, and neuropsychiatric symptoms (NPS) [3].Q3Q2The growing incidence of dementia has led to an increased need for specialized care and higher health and social costs. Functional decline is the main cause of dementia complications. Per definition, dementia diagnosis and severity stratification require a certain degree of functional impairment [1]. Therefore, it is important to determine strategies to prevent functional deterioration in both, general population and especially people with dementia. The number of older adults with some degree of disability will triple by 2050 due to the increase in the aging population and the prevalence of age-related diseases that lead to functional impairment [2]. Therefore, functional impairment and disability in old people are increasingly becoming a major public health concern. Furthermore, functional impairment severely impairs quality of life and consumes a large proportion of the public health resources, creating an important burden for health care systems. It is well known that functional loss and disability in dementia are the main consequences of cognitive decline. Therefore, most of the efforts in dementia management have been directed to stop or reverse cognitive decline. However, functional loss and disability are also the consequence of other conditions that are common in old age and comorbid with dementia, such as frailty, sarcopenia, malnutrition, falls, pulmonary or cardiovascular diseases, polypharmacy, depression, and neuropsychiatric symptoms (NPS) [3].https://orcid.org/0000-0001-5680-7880https://scholar.google.com/citations?view_op=search_authors&mauthors=carlos+alberto+cano-gutierrez&hl=es&oi=aohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000054895&lang=esRevista Nacional - Indexad

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Objectives We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5-year follow-up. Methods This is a longitudinal analysis of a Norwegian cohort study entitled “The Dementia Study of Western Norway” (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD-ADep). Linear mixed-effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale—2, and cognition measured with the Mini-Mental State Examination. Results Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD-ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. Conclusions BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.publishedVersio

Factores asociados con el deterioro funcional en adultos mayores mexicanos

Introducción. El deterioro funcional está relacionado con muchos resultados adversos. Objetivo. Explorar la relación de los factores sociodemográficos, médicos y psicológicos con la incidencia del deterioro funcional en los adultos mayores mexicanos. Materiales y métodos. Se analizaron los datos de las cohortes de 2012 y 2015 de la encuesta del Estudio Mexicano de Salud y Envejecimiento. Se excluyeron los participantes con discapacidad funcional en el período de referencia (2012). Se evaluó de forma individual el deterioro funcional en las actividades básicas de la vida diaria (AVD) y en las instrumentales (AIVD). Resultados. Se encontró que el dolor, las comorbilidades, el nivel educativo, el estatus socioeconómico y la depresión se asociaban independientemente con el deterioro de las AVD. El deterioro de las AIVD se asoció con la edad, la educación deficiente, las comorbilidades, la depresión y el deterioro cognitivo. Conclusiones. La edad, el sexo, el estado financiero, el nivel educativo, el dolor y el número de comorbilidades se asociaron con la incidencia del deterioro funcional. El dolor tuvo una mayor asociación con la incidencia del deterioro funcional en las AVD a los tres años, en comparación con el deterioro cognitivo. El estudio del deterioro funcional por dominios permitió recabar información más detallada para determinar los factores que pueden intervenirse con el objetivo de reducir la incidencia del deterioro funcional y la dependencia.publishedVersio

Gait speed as a mediator of the effect of sarcopenia on dependency in activities of daily living

Background Sarcopenia in older adults is strongly associated with an increase in dependency in activities of daily living (ADL) and with a decline in gait speed. Interestingly, gait speed has been shown to independently predict mortality. In this context, our study aimed to explore the mediator role of gait speed on the relationship between sarcopenia and dependency in ADL. Methods A cross-sectional study was conducted in Colombia, 19 705 older adults with a mean age of 70 years, 55.6% women, 16.1% with sarcopenia, and 14.7% mild, moderate, or severe dependency in ADL, according to ‘SABE Survey 2015’. Sarcopenia was assessed by calf circumference and ADL dependence through the Barthel Index. Gait speed was measured over a distance of 3 m. The association between sarcopenia condition and gait speed and dependency level was analysed by linear regression adjusted by covariates. To examine whether gait speed mediated the association between sarcopenia and dependence components of physical function, simple mediation models were generated using ordinary least squares with the macro PROCESS version 3.2, adjusted for age, sex, and body mass index (BMI). Results Significant differences (P < 0.05) were found in gait speed and dependency in ADL between the sarcopenia and nonsarcopenia groups after adjusting for age, sex, and BMI. BMI was significantly higher in the non-sarcopenia group whereas dependency was significantly higher in the sarcopenia group (19.6% vs. 13.8%). Results from mediation model regression analysis indicated a significant and direct detrimental effect of sarcopenia on dependency in ADL (β = 0.05; P < 0.001), and a significant indirect effect of gait speed on the direct effect ( 0.009 to 0.004). Conclusions The negative effect of sarcopenia on functional dependence was mediated by the gait speed. Therefore, gait speed may positively influence the detrimental effect of sarcopenia for dependency, after adjusting for age, gender, and BMI. Consequently, physical exercise should be promoted and focused to circumvent the gait speed decline associated with age in older people with sarcopenia

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Objectives We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5-year follow-up. Methods This is a longitudinal analysis of a Norwegian cohort study entitled “The Dementia Study of Western Norway” (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD-ADep). Linear mixed-effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale—2, and cognition measured with the Mini-Mental State Examination. Results Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD-ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. Conclusions BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.publishedVersio

Statin and risk of falls in the elderly : a sytematic review of the literature

Antecedentes: La alta incidencia de eventos cardiovasculares en la población anciana ha demostrado la eficacia de las estatinas en la reducción de la mortalidad por eventos coronarios; sin embargo, se han producido efectos adversos, tales como mialgia, miopatía, mionecrosis, sin mencionar las caídas como consecuencia de dano˜ muscular con el uso de estatinas. Objetivo: El objetivo de este estudio es realizar una revisión sistemática para evaluar la literatura sobre la asociación entre el uso de estatinas y el riesgo de caídas. Métodos: Las bases de datos que se incluyeron (PubMed y SCOPUS) con artículos publicados entre enero de 2000 y mayo de 2016. Los términos MESH utilizados para la búsqueda fueron «FALLS» AND «STATIN». Los estudios seleccionados incluyeron cohortes de población de la comunidad (> 50 anos) ˜ y fue analizado siguiendo las recomendaciones metodológicas SIGN (Scottish Intercollegiate Guidelines Network), ya que no se encontró ningún estudio controlado aleatorizado. Resultados: En el estudio de Ham et al. el uso de estatinas ha demostrado ser un factor protector para la presencia de caídas. En el segundo estudio realizado por Scott et al. se encontró un aumento del riesgo de caídas (p = 0,029) y un deterioro de la fuerza muscular y la calidad del músculo (valor de p = 0,033 y 0,046, respectivamente). En el tercer estudio Haerer et al. se encontró un mayor riesgo de caídas (p = 0,63). Conclusiones: La evidencia disponible no permite determinar la asociación entre el uso de estatinas y el riesgo de caídas, aunque sí se encontró asociación con el compromiso de algunos determinantes de la función muscularQ3Artículo original317-321Background: With the high incidence of cardiovascular events in the elderly population the effectiveness of statins in reducing mortality from coronary events has been demonstrated. However, there have been adverse effects, such as myalgia, myopathy, myonecrosis, not to mention the falls as a result of muscle damage with statin use. Objective: The purpose of this study is to conduct a systematic review to assess the literature on the association between statin use and the risk of falls. Methods: The databases that were included PUBMED AND SCOPUS, with articles published from January 2000 to May 2016. The MESH terms used for the search were “FALLS” AND “STATIN”. Selected studies included cohort populations from the community (> 50 years old), and analysed using the Scottish Intercollegiate (SIGN) methodology guidelines, as no randomised controlled study was found. Results: In the study by Ham et al., statin use was shown to be a protective factor for presence of falls. In the second study by Scott et al., there was an increased risk of falls (P = .029) and an impairment in muscle strength and quality muscle (P = .033 and P = .046, respectively). In the third study Haerer et al., found an increased risk of falls (P = .63). Conclusions: The association between use of statins and risk of falls could not be determined with the available evidence, although an association with the involvement of some determinants of muscular function was foun

Body mass index, performance on activities of daily living and cognition: analysis in two different populations

Background With this study, we aim to determine the associations of the different categories of the body mass index (BMI) with activities of daily living (ADL) and cognitive performance in two different populations living in the community; Colombian and South Korean older adults. Methods We performed a cross-sectional analysis of two surveys separately; The Survey on Health, Well-Being, and Aging in Colombia (SABE) (n = 23,343) and the Korean Longitudinal Study of aging (KLoSA) (n = 4556). Participants older than 50 years were selected from rural and urban areas achieving a representative sample. Here we investigated the association between BMI categories with function using zero-inflated negative binomial regressions, and with cognition using logistic regression models. Results After adjustment, in Colombia, underweight was associated with an impaired score on the Mini-mental State Examination (MMSE) and worse performance in the instrumental activities of daily living (IADL). Also, being overweight was associated with a better score on the MMSE and the IADL. For both outcomes education level significantly influenced the predictions. In South Korea, there were no significant associations for cognition, IADL, or basic activities of daily living (BADL). Conclusions In the Colombian population, underweight, was associated with reduced cognitive performance and daily functioning. Additionally, being overweight but not obese was associated with better cognition and daily functioning. In South Korea, there were no significant associations between BMI and cognition, IADL, or BADL.publishedVersio

Motoric Cognitive Risk Syndrome: Prevalence and Cognitive Performance. A cross-sectional study

Background Motoric Cognitive Risk Syndrome (MCR) is a predementia stage where slow gait speed and subjective memory complaints are present. The purpose of this study was to estimate the prevalence of MCR and assess its relationship with sociodemographic factors and chronic conditions. Methods This is a secondary analysis of the SABE Colombia study conducted in 2015. The analytic sample consisted of 17·577 participants. After determining MCR prevalence, logistic regression was performed to examine the correlates of MCR. Findings The prevalence of MCR was 10·71 %. The median age was 71 years and women composed 74·63 % of the MCR group. After adjusting for confounding variables MCR was associated with increasing age (OR 1·69, CI 1·43 - 1·92), no or low education (OR 1·99, CI 1·67- 2·37), MMSE (OR 0·93, CI 0·91 - 0·95) and chronic conditions such as mental disorders (OR 1·36, CI 1·11-1·67), history of myocardial infarction (OR 1·24, CI 1·04 - 1·47), hypertension (OR 1·23, CI 1·08 - 1·40) and diabetes (OR 1.18, CI 1.01 – 1.37). Interpretation This study found a prevalence of 10·71 % of MCR in Colombian older adults. Additionally, MCR was associated with chronic conditions and sociodemographic factors identified in prior studies. These results increase the awareness of a novel predementia stage whose identification can be performed by clinicians in the outpatient clinic, minimizing the cost of a full neuropsychologic evaluation performed in a memory clinic.publishedVersio

Confirmed SARS-CoV-2 infection and mortality : associated factors in hospitalized people 75 and older

Introducción: La infección por COVID-19 en adultos mayores plantea desafíos en los sistemas de salud y la atención clínica por parte de la salud personal. Objetivo: Describir los factores asociados a la mortalidad en personas de 75 años y más con COVID-19 en un alto hospital de alta complejidad en Bogotá, Colombia. Métodos: Estudio observacional, analítico y retrospectivo, incluyendo 509 pacientes de 75 años y más hospitalizados con COVID-19. Resultados: el 40,47% fallecieron durante la estancia hospitalaria. Se encontró que a menor tiempo de inicio de los síntomas al ingreso, frecuencia respiratoria superior a 20 respiraciones por minuto, trombocitopenia, lactato deshidrogenasa elevada y el dímero D elevado se asociaron con una mayor mortalidad hospitalaria. Conclusiones: Existe asociación entre la mortalidad y la presencia de disnea, fiebre y delirio. Resultados paraclínicos con lactato deshidrogenasa > 350 (U/L), presencia de dímero D elevado mayor de 1.000 μg/L, así como un cociente PaO2/FiO2 con una mediana menor de 90, se asociaron con mayor mortalidad. Palabras clave: Infecciones por coronavirus, SARS-CoV-2, adulto mayor, mortalidadQ3Q3Introduction: COVID-19 infection in the elderly posed challenges in health systems and clinical care by health personnel. Objective: To describe the factors associated with mortality in persons aged 75 and older with COVID-19 in a high complexity hospital in Bogotá, Colombia. Methods: Observational, analytical and retrospective study, including 509 patients aged 75 and older hospitalized with COVID-19. Results: 40.47% died during hospital stay. It was found that a shorter time of symptom onset at admission, a respiratory rate greater than 20 breaths per minute, having thrombocytopenia, elevated lactate dehydrogenase and elevated D-dimer were associated with higher in-hospital mortality. Conclusions: There is an association between mortality and the presence of dyspnea, fever and delirium. Paraclinical results with lactate dehydrogenase >350 (U/L), the presence of elevated D-dimer greater than 1,000 μg/L, as well as a Pa02/Fi02 ratio with a median of less than 90, were associated with higher mortality. Keywords: Coronavirus infections, SARS-CoV-2, elderly, mortalityhttps://orcid.org/0000-0002-8584-3191https://scholar.google.com/citations?user=ns-9aAgAAAAJ&hl=es&oi=aohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001337521Revista Internacional - No indexadaS

Self-reported glaucoma prevalence and related factors, contribution to reported visual impairment, and functional burden in a cross-sectional study in Colombia

Objetivo Describir la prevalencia autorreportada de glaucoma en adultos mayores colombianos, enfatizando los factores de riesgo más importantes y las alteraciones funcionales de la vida diaria asociadas. Métodos Este es un análisis secundario de la encuesta de Salud, Bienestar y Envejecimiento realizada en el año 2015. El diagnóstico de glaucoma se obtuvo del autoinforme. Las variables funcionales se evaluaron mediante cuestionarios de actividades de la vida diaria. Se realizó un análisis descriptivo seguido de modelos de regresión bivariados y multivariados ajustando por variables de confusión. Resultados La prevalencia autoinformada de glaucoma fue de 5,67%, con mayor tasa en mujeres, OR 1,22 (1,13–1,40) p = ,003, mayor edad OR 1,02 (1,01–1,02) p < ,001, y con educación superior OR 1,38 (1,28 –1.50) p < .001. El glaucoma se asoció de forma independiente con diabetes OR 1,37 (1,18–1,61) p  < ,001 e hipertensión 1,26 (1,08–1,46) p = ,003. También mostró correlaciones estadísticamente significativas con mala SSR OR 1.15 (1.02–1.32) p < .001, discapacidad visual autoinformada 1.73 (1.50–2.01) p < .001 y deterioro en el manejo del dinero OR 1.59 (1.16–2.08) p = .002, compras de comestibles OR 1.57 (1.26–1.96) p < .001 y preparación de comidas OR 1.31 (1.06–1.63) p  = .013 y haber tenido caídas en el último año OR 1.14 (1.01–1.31) p = 0.041. Conclusión Nuestros hallazgos sugieren que la prevalencia autoinformada de glaucoma en adultos mayores en Colombia es más alta que los datos informados. El glaucoma y la discapacidad visual en adultos mayores representan un problema de salud pública, ya que el glaucoma se asoció con resultados adversos como pérdida funcional y riesgo de caídas, afectando la calidad de vida y su participación en la sociedad.Q2Q2Purpose Describe the self-reported prevalence of glaucoma in Colombian older adults, emphasizing the most important risk factors and associated daily-life functional alterations. Methods This a secondary analysis of the Health, Wellness, and Aging survey conducted in the year 2015. Diagnosis of glaucoma was obtained from self-report. Functional variables were assessed through activities of daily living questionnaires. A descriptive analysis followed by bivariate and multivariate regression models adjusting for confounding variables was conducted. Results Self-reported prevalence of glaucoma was 5.67%, with higher rate in women, OR 1.22 (1.13–1.40) p = .003, older age OR 1.02 (1.01–1.02) p < .001, and with higher education OR 1.38 (1.28–1.50) p < .001. Glaucoma was independently associated with diabetes OR 1.37 (1.18–1.61) p  < .001 and hypertension 1.26 (1.08–1.46) p = .003. It also showed statistically significant correlations with poor SRH OR 1.15 (1.02–1.32) p < .001, self-reported visual impairment 1.73 (1.50–2.01) p < .001, and impairment in money management OR 1.59 (1.16–2.08) p  = .002, grocery shopping OR 1.57 (1.26–1.96) p < .001 and preparing meals OR 1.31 (1.06–1.63) p  = .013 and having had falls during the last year OR 1.14 (1.01–1.31) p = 0.041. Conclusion Our findings suggest the self-reported prevalence of glaucoma in older adults in Colombia to be higher than reported data. Glaucoma and visual impairment in older adults represent a public health concern, since glaucoma was associated with adverse outcomes like functional loss and risk of falling, affecting the quality of life and their participation in society.https://orcid.org/0000-0001-5680-7880https://scholar.google.com/citations?view_op=search_authors&mauthors=carlos+alberto+cano-gutierrez&hl=es&oi=aohttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000054895Revista Internacional - IndexadaS