Muscular function as an alternative to identify cognitive impairment : a secondary analysis from SABE Colombia

Antecedentes: La identificación del deterioro cognitivo se basa tradicionalmente en la pruebas neuropsicológicas y biomarcadores que no están ampliamente disponibles. Este estudio tuvo como objetivo establecer la asociación entre la función motora (velocidad de la marcha y fuerza) y el rendimiento cognitivo en el Mini-Examen del Estado Mental, a nivel mundial y por dominios. Un objetivo secundario fue calcular un punto de corte para la velocidad de la marcha y la prensión manual. fuerza para clasificar a los adultos mayores como con deterioro cognitivo. Métodos: Este es un análisis secundario de SABE Colombia (Salud, Bienestar & Envejecimiento), encuesta realizada en 2015 sobre salud, bienestar y envejecimiento en Colombia. Este estudio utilizó modelos de regresión lineal para buscar un asociación entre la función motora y el rendimiento cognitivo. La precisión del motor las mediciones de función en la identificación del deterioro cognitivo se evaluaron con el receptor curvas características de funcionamiento (ROC). Este estudio también analizó otros aspectos clínicos y variables sociodemográficas. Resultados: La velocidad de la marcha se asoció con la orientación (r2 = 0,16), idioma (r2 = 0.15), recordar memoria (r2 = 0.14), y contando (r2 = 0,08). Del mismo modo, la empuñadura la fuerza se asoció con la orientación (r2 = 0,175), idioma (r2 = 0.164), recordar memoria (r2 = 0.137), y contando (r2 = 0,08). Para diferenciar a los adultos mayores con y sin deterioro cognitivo, se tuvo un punto de corte de velocidad de la marcha de 0,59 m/s. un área bajo la curva (AUC) de 0,629 (0,613–0,646) y un agarre débil (resistencia por debajo de 17,5 kg) tenía un AUC de 0,653 (0,645-0,661). los puntos de corte para la fuerza de agarre y la velocidad de la marcha fueron significativamente mayores en los participantes masculinos. García-Cifuentes et al. Función muscular y deterioro cognitivo Conclusiones: La velocidad de la marcha y la fuerza de prensión se asocian de manera similar con la desempeño cognitivo, exhibiendo la asociación más extensa con la orientación y dominios lingüísticos del Mini-Examen del Estado Mental. Velocidad de marcha y prensión cualquier médico puede medir fácilmente la fuerza, y demuestran ser útiles para la detección herramientas para detectar el deterioro cognitivo. Palabras clave: velocidad de la marcha, fuerza de prensión manual, deterioro cognitivo, biomarcador, demencia preclínica, motora disfunciónQ2Q2Background: Identification of cognitive impairment is based traditionally on the neuropsychological tests and biomarkers that are not available widely. This study aimed to establish the association between motor function (gait speed and handgrip strength) and cognitive performance in the Mini-Mental State Examination, globally and by domains. A secondary goal was calculating a cut-off point for gait speed and handgrip strength to classify older adults as cognitively impaired. Methods: This is a secondary analysis of SABE Colombia (Salud, Bienestar & Envejecimiento), a survey that was conducted in 2015 on health, wellbeing, and aging in Colombia. This study used linear regression models to search for an association between motor function and cognitive performance. The accuracy of motor function measurements in identifying cognitive impairment was assessed with receiver operating characteristic (ROC) curves. This study also analyzed other clinical and sociodemographical variables. Results: Gait speed was associated with orientation (r2 = 0.16), language (r2 = 0.15), recall memory (r2 = 0.14), and counting (r2 = 0.08). Similarly, handgrip strength was associated with orientation (r2 = 0.175), language (r2 = 0.164), recall memory (r2 = 0.137), and counting (r2 = 0.08). To differentiate older adults with and without cognitive impairment, a gait speed cut-off point of 0.59 m/s had an area under the curve (AUC) of 0.629 (0.613–0.646), and a weak handgrip (strength below 17.5 kg) had an AUC of 0.653 (0.645-0.661). The cut-off points for handgrip strength and gait speed were significantly higher in male participants. Conclusions: Gait speed and handgrip strength are similarly associated with the cognitive performance, exhibiting the most extensive association with orientation and language domains of the Mini-Mental State Examination. Gait speed and handgrip strength can easily be measured by any clinician, and they prove to be useful screening tools to detect cognitive impairment.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=nullRevista Nacional - Indexad

Prodromal dementia with lewy bodies and recurrent panic attacks as the first symptom : a case report

La demencia de inicio psiquiátrico con cuerpos de Lewy (DLB) puede incluir síntomas de depresión, alucinaciones, ansiedad y apatía. Aquí, reportamos un paciente con DLB con ataques de pánico recurrentes como su primer síntoma 5 años antes de un diagnóstico de base biológica de probable DCL. Proporcionamos una descripción ampliada de la presentación clínica y curso de DCL de inicio psiquiátrico a demencia en una mujer de 83 años. Este caso ilustra el diagnóstico erróneo común de DLB y la demora en tener un diagnóstico clínico y evaluación de biomarcadores para el diagnóstico estructurado. Con una descripción detallada de la clínica. presentación de este caso, las estrategias de tratamiento empírico y las perspectivas del paciente, Nuestro objetivo es concienciar a los médicos sobre los ataques de pánico dentro de la DCL de inicio psiquiátrico. Palabras clave: demencia con cuerpos de Lewy, ataques de pánico, reporte de caso, demencia prodrómica con cuerpos de Lewy, síntomas neuropsiquiátricosQ2Q2Psychiatric-onset dementia with Lewy bodies (DLB) might include symptoms of depression, hallucinations, anxiety, and apathy. Here, we report a patient with DLB with recurrent panic attacks as her first symptom 5 years before a biological-based diagnosis of probable DLB. We provide an extended description of the clinical presentation and course from psychiatric-onset DLB to dementia in an 83-year-old woman. This case illustrates the commonmisdiagnosis of DLB and the delay of having a detailed clinical and biomarker assessment for structured diagnosis. With a detailed description of the clinical presentation of this case, the empirical treatment strategies, and the patient perspectives, we aim to make clinicians aware of panic attacks within the psychiatric-onset DLB. Keywords: dementia with Lewy bodies, panic attacks, case report, prodromal dementia with Lewy bodies, neuropsychiatric symptomshttps://orcid.org/ 0000-0001-5832-0603https://scholar.google.es/citations?hl=es&user=MrICwaMAAAAJhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659Revista Nacional - Indexad

Serum TCA cycle metabolites in Lewy bodies dementia and Alzheimer's disease: Network analysis and cognitive prognosis

Se han documentado anomalías en el ciclo del ácido tricarboxílico (TCA) en la demencia. A través del análisis de redes, los metabolitos del ciclo TCA podrían reflejar indirectamente anomalías conocidas relacionadas con la demencia en las vías bioquímicas, y los metabolitos clave podrían estar asociados con el pronóstico. Este estudio analizó los metabolitos del ciclo de TCA como predictores del deterioro cognitivo en una cohorte de demencia leve y exploró las posibles interacciones con el diagnóstico de demencia con cuerpos de Lewy (LBD) o enfermedad de Alzheimer (EA) y el genotipo APOE-ε4. Se incluyeron 145 pacientes con demencia leve (LBD = 59; AD = 86). Los metabolitos del ciclo de TCA en suero se analizaron al inicio del estudio y se realizaron redes de correlación parcial. El rendimiento cognitivo se midió anualmente durante 5 años con el Mini-examen del estado mental. Los modelos Tobit de efectos mixtos longitudinales evaluaron cada metabolito de referencia como predictor del deterioro cognitivo a los 5 años. Se exploraron las interacciones APOE-ε4 y de diagnóstico. Los resultados mostraron concentraciones de metabolitos comparables en LBD y AD. Las redes corregidas de pruebas múltiples mostraron coeficientes más grandes para una correlación negativa entre piruvato-succinato y correlaciones positivas entre fumarato-malato y citrato-isocitrato tanto en LBD como en AD. En la muestra total, los modelos mixtos ajustados mostraron asociaciones significativas entre la concentración inicial de citrato y las puntuaciones longitudinales del MMSE. En los portadores de APOE-ε4, el isocitrato inicial predijo las puntuaciones del MMSE. Concluimos que, en la demencia leve, las concentraciones de citrato sérico podrían estar asociadas con el deterioro cognitivo posterior, así como las concentraciones de isocitrato en los portadores de APOE-ε4. La regulación a la baja de la actividad enzimática en la primera mitad del ciclo TCA (deshidrogenasas descarboxiladoras), con regulación al alza en la segunda mitad (solo deshidrogenasas), podría reflejarse indirectamente en las redes de metabolitos del ciclo TCA sérico.Q2Abnormalities in the Tri-Carboxylic-Acid (TCA) cycle have been documented in dementia. Through network analysis, TCA cycle metabolites could indirectly reflect known dementia-related abnormalities in biochemical pathways, and key metabolites might be associated with prognosis. This study analyzed TCA cycle metabolites as predictors of cognitive decline in a mild dementia cohort and explored potential interactions with the diagnosis of Lewy Body Dementia (LBD) or Alzheimer's Disease (AD) and APOE-ε4 genotype. We included 145 mild dementia patients (LBD = 59; AD = 86). Serum TCA cycle metabolites were analyzed at baseline, and partial correlation networks were conducted. Cognitive performance was measured annually over 5-years with the Mini-mental State Examination. Longitudinal mixed-effects Tobit models evaluated each baseline metabolite as a predictor of 5-year cognitive decline. APOE-ε4 and diagnostic interactions were explored. Results showed comparable metabolite concentrations in LBD and AD. Multiple testing corrected networks showed larger coefficients for a negative correlation between pyruvate – succinate and positive correlations between fumarate – malate and citrate – Isocitrate in both LBD and AD. In the total sample, adjusted mixed models showed significant associations between baseline citrate concentration and longitudinal MMSE scores. In APOE-ε4 carriers, baseline isocitrate predicted MMSE scores. We conclude that, in mild dementia, serum citrate concentrations could be associated with subsequent cognitive decline, as well as isocitrate concentrations in APOE-ε4 carriers. Downregulation of enzymatic activity in the first half of the TCA cycle (decarboxylating dehydrogenases), with upregulation in the latter half (dehydrogenases only), might be indirectly reflected in serum TCA cycle metabolites' networks.https://orcid.org/0000-0001-5832-0603https://scholar.google.com/citations?user=MrICwaMAAAAJ&hl=enhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0001429659Revista Internacional - IndexadaS

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Sector bancario y coyuntura económica. El caso colombiano 1990 - 2000

Continuando con la línea de investigación de la política coyuntural de la empresa, se busca realizar un estudio del sector bancario colombiano. El punto de partida es que existen ciertos elementos del sector bancario que lo diferencian de los demás sectores de la economía: su dinámica está determinada por el comportamiento de los demás agentes económicos (empresas, gobierno, sector externo, familias), la política monetaria y crediticia, la competencia de otros intermediarios y la asimetría de la información. Esto significa que la actividad bancaria es quizás la más expuesta a las fluctuaciones coyunturales del sistema económico, dado que alteraciones significativas e imprevistas en el comportamiento de los agentes se transmitirán inmediatamente al desempeño bancario. Además de profundizar en el estudio de la política coyuntural de la empresa se presenta una descripción de la evolución del sector bancario en la década de los noventa y se realizan tres ejercicios empíricos: una aplicación del Modelo CAMEL para el sector bancario y un análisis de la sensibilidad coyuntural de los bancos privados colombianos para el periodo 1990 - 2000, por medio de los modelos Logit y de Panel Data. Los resultados indican que, en efecto, la influencia de las variables y políticas macroeconómicas es alta sobre los balances de las entidades bancarias.

Evaluation of metrics for the performance of wireless networks of mobile robots in the framework of Industry 4.0

Las aplicaciones de robótica móvil actuales en el marco de la industria 4.0 requieren emplear una red de robots para garantizar la comunicación entre diferentes agentes robóticos. Según algunos autores, se plantean retos a nivel de red de robots dado que se presentan retrasos en la transmisión de datos debido al gran flujo de información y a los ruidos que se pueden presentar. Por tanto, existen diferentes métricas de rendimiento que permitan evaluar el desempeño de los robots y de la red de robots, pero a la hora de realizar la evaluación de una red de robots no se tiene claro cuál de las diferentes métricas emplear. En este artículo se propone una evaluación de métricas de rendimiento a partir de una selección de características, con el fin de apoyar la toma de decisiones que permitan seleccionar las métricas más adecuadas según la aplicación. Se espera que con esta solución los investigadores puedan seleccionar las métricas que requieren para la evaluación de redes de robots en el marco de la industria 4.0.Current mobile robotics applications within the framework of Industry 4.0 require the use of a network of robots to ensure communication between different robotic agents. According to some authors, there are challenges at the robot network level given that there are delays in data transmission due to the large flow of information and the noise that can occur. Therefore, there are different performance metrics that allow evaluating the performance of robots and the robot network, but when evaluating a robot network it is not clear which of the different metrics to use. This article proposes an evaluation of performance metrics based on a selection of characteristics, in order to support decision-making that allows selecting the most appropriate metrics according to the application. It is expected that with this solution, researchers will be able to select the metrics they require for the evaluation of robot networks in the framework of Industry 4.0

Prevent dementia : a public health challenge in Colombia

Al editor: En la presente carta se pretende sensibilizar al lector sobre la magnitud e importancia de ver a la demencia como prioridad en salud pública en Colombia. Se plantea la necesidad de intervenciones efectivas, en especial, en prevención secundaria como punto decisivo en la modificación de la historia natural de la enfermedad. Se exponen los datos del contexto epidemiológico nacional más reciente, brindando al lector un panorama sobre la importancia del problema en el país y la urgencia de direccionar las intervenciones de acuerdo con las necesidades propias de nuestra población. Luego de analizar las diez primeras causas de muerte en el mundo, se encuentra que la demencia es la única que carece de tratamientos curativos o modificadores (1). Su prevalencia mundial es de 35,6 millones de personas afectadas y se estima que para el año 2050 aumentará a 150 millones de casos (2,3). Metaanálisis de estudios multicéntricos en Latinoamérica, China e India han estimado que el riesgo instantáneo de muerte en un paciente con demencia es 2,8 veces el de un paciente sin demencia (HR = 2,80, IC 95 % = 2,48-3,15) (4,5). En consecuencia, se ha puesto en marcha una activa respuesta para afrontar esta enfermedad, empleando programas dirigidos a la reducción de factores de riesgo cardiovascular y promoción de la actividad física, en aras de reducir la incidencia de demencia. Para interpretar el panorama nacional y contrastarlo con las cifras antes presentadas, se requiere una mirada detenida en varios de sus determinantes.Revista Nacional - Indexad

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

Q1Abstract 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.https://orcid.org/0000-0001-5832-0603https://orcid.org/0000-0001-8260-9108https://orcid.org/0000-0003-4214-0266https://orcid.org/0000-0002-1652-5042https://orcid.org/0000-0001-5680-7880Revista Internacional - Indexad

Hippocampal subfields and decline in activities of daily living in Alzheimer's disease and dementia with Lewy bodies

Background: Hippocampal atrophy is presented in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Cognition, dual-tasks, muscular function, goal-related behaviors and neuropsychiatric symptoms are linked to hippocampal volumes and may lead to functional decline in activities of daily living. We examined the association between baseline hippocampal subfield volumes (HSv) in mild AD and DLB, and functional decline. Materials & methods: 12 HSv were computed from structural magnetic resonance images using Freesurfer 6.0 segmentation. Functional decline was assessed using the rapid disability rating scale score. Linear regressions were conducted. Results: In AD, HSv were smaller bilaterally. However, HSv were not associated with functional decline. Conclusion: Functional decline does not depend on HSv in mild AD and DL