Qualidade de vida e funcionalidade em indivíduos pós-AVE crônico residentes do município de Araranguá - SC

TCC(graduação) - Universidade Federal de Santa Catarina. Araranguá. Fisioterapia.RESUMO Objetivo: Descrever a qualidade de vida e funcionalidade de indivíduos pós AVE crônico no município de Araranguá - SC e verificar a presença de correlação entre dados obtidos através dos instrumentos WHODAS 2.0 e SIS 3.0. Métodos: Foram incluídos no estudo indivíduos adultos de ambos os sexos, com diagnóstico clínico de AVE crônico, com tempo de acometimento superior a seis meses, que foram avaliados através da Escala de Rankin Modificada (ERM), Mini Exame do Estado Mental (MEEM), World Health Organization Disability Assessment Schedule (WHODAS 2.0) e Stroke Impact Scale (SIS 3.0). Resultados: Foram avaliados 53 participantes do estudo, com média de idade de 68,73 anos (± 10,18), com tempo médio de AVE de 6,73 anos (± 5,81). Na SIS 3.0, “funcionalidade da mão” (34,15±33,35) foi o domínio de maior acometimento, o instrumento WHODAS 2.0 apresentou o domínio “atividades de vida” (67,98%) com média mais alta, significando maior incapacidade. Foram encontradas correlações significativas entre os domínios dos dois instrumentos, sendo a correlação entre “locomoção” (SIS 3.0) e “mobilidade” (WHODAS 2.0); e “atividades básicas e instrumentais da vida diária” (SIS 3.0) e “autocuidado” (WHODAS 2.0) as mais altas. Conclusão: Pode-se concluir que os indivíduos pós AVE crônico residentes de Araranguá, que participaram deste estudo, apresentaram comprometimento em todos os domínios da funcionalidade, com maior incapacidade nas atividades de vida. Além disso, observou-se comprometimento na qualidade de vida especialmente na funcionalidade da mão. Também foi observada a correlação entre a qualidade de vida e a funcionalidade.ABSTRACT Objective: To describe the quality of life and functionality of individuals after a chronic stroke in the city of Araranguá - SC and verify the presence of correlation between data obtained through the instruments WHODAS 2.0 and SIS 3.0. Methods: Adult individuals of both sexes, with a clinical diagnosis of chronic stroke, with an onset of more than six months, who were evaluated using the Modified Rankin Scale (RMS), Mini Mental State Examination (MMSE) were included in the study, World Health Organization Disability Assessment Schedule (WHODAS 2.0) and Stroke Impact Scale (SIS 3.0). Results: 53 study participants were evaluated, with a mean age of 68.73 years (± 10.18), with a mean stroke time of 6.73 years (± 5.81). In SIS 3.0, "hand functionality" (34.15±33.35) was the most affected domain, the WHODAS 2.0 instrument presented the domain "life activities" (67.98%) with higher mean, meaning greater inability. Significant correlations were found between the domains of the two instruments, with the correlation between “locomotion” (SIS 3.0) and “mobility” (WHODAS 2.0); And “basic and instrumental activities of daily living” (SIS 3.0) and “self-care” (WHODAS 2.0) were the highest. Conclusion: It can be concluded that the individuals after chronic stroke residing in Araranguá, who participated in this study, showed impairment in all domains of functionality, with greater incapacity in life activities. In addition, there was an impairment in quality of life, especially in the functionality of the hand. The correlation between quality of life and functionality was also observed

A multifactorial approach for understanding fall risk in older people

OBJECTIVE: To identify the interrelationships and discriminatory value of a broad range of objectively measured explanatory risk factors for falls. DESIGN: Prospective cohort study with 12-month follow-up period. SETTING: Community sample. PARTICIPANTS: Five hundred community-dwelling people aged 70 to 90. MEASUREMENTS: All participants underwent assessments on medical, disability, physical, cognitive, and psychological measures. Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period. RESULTS: Univariate regression analyses identified the following fall risk factors: disability, poor performance on physical tests, depressive symptoms, poor executive function, concern about falling, and previous falls. Classification and regression tree analysis revealed that balance-related impairments were critical predictors of falls. In those with good balance, disability and exercise levels influenced future fall risk-people in the lowest and the highest exercise tertiles were at greater risk. In those with impaired balance, different risk factors predicted greater fall risk-poor executive function, poor dynamic balance, and low exercise levels. Absolute risks for falls ranged from 11% in those with no risk factors to 54% in the highest-risk group. CONCLUSIONS: A classification and regression tree approach highlighted interrelationships and discriminatory value of important explanatory fall risk factors. The information may prove useful in clinical settings to assist in tailoring interventions to maximize the potential benefit of falls prevention strategies

Qualidade de vida e funcionalidade em indivíduos pós-AVE crônico residentes do município de Araranguá - SC

TCC(graduação) - Universidade Federal de Santa Catarina. Araranguá. Fisioterapia.Objetivo: Descrever a qualidade de vida e funcionalidade de indivíduos pós AVE crônico no município de Araranguá - SC e verificar a presença de correlação entre dados obtidos através dos instrumentos WHODAS 2.0 e SIS 3.0. Métodos: Foram incluídos no estudo indivíduos adultos de ambos os sexos, com diagnóstico clínico de AVE crônico, com tempo de acometimento superior a seis meses, que foram avaliados através da Escala de Rankin Modificada (ERM), Mini Exame do Estado Mental (MEEM), World Health Organization Disability Assessment Schedule (WHODAS 2.0) e Stroke Impact Scale (SIS 3.0). Resultados: Foram avaliados 53 participantes do estudo, com média de idade de 68,73 anos (± 10,18), com tempo médio de AVE de 6,73 anos (± 5,81). Na SIS 3.0, “funcionalidade da mão” (34,15±33,35) foi o domínio de maior acometimento, o instrumento WHODAS 2.0 apresentou o domínio “atividades de vida” (67,98%) com média mais alta, significando maior incapacidade. Foram encontradas correlações significativas entre os domínios dos dois instrumentos, sendo a correlação entre “locomoção” (SIS 3.0) e “mobilidade” (WHODAS 2.0); e “atividades básicas e instrumentais da vida diária” (SIS 3.0) e “autocuidado” (WHODAS 2.0) as mais altas. Conclusão: Pode-se concluir que os indivíduos pós AVE crônico residentes de Araranguá, que participaram deste estudo, apresentaram comprometimento em todos os domínios da funcionalidade, com maior incapacidade nas atividades de vida. Além disso, observou-se comprometimento na qualidade de vida especialmente na funcionalidade da mão. Também foi observada a correlação entre a qualidade de vida e a funcionalidade.Objective: To describe the quality of life and functionality of individuals after a chronic stroke in the city of Araranguá - SC and verify the presence of correlation between data obtained through the instruments WHODAS 2.0 and SIS 3.0. Methods: Adult individuals of both sexes, with a clinical diagnosis of chronic stroke, with an onset of more than six months, who were evaluated using the Modified Rankin Scale (RMS), Mini Mental State Examination (MMSE) were included in the study, World Health Organization Disability Assessment Schedule (WHODAS 2.0) and Stroke Impact Scale (SIS 3.0). Results: 53 study participants were evaluated, with a mean age of 68.73 years (± 10.18), with a mean stroke time of 6.73 years (± 5.81). In SIS 3.0, "hand functionality" (34.15±33.35) was the most affected domain, the WHODAS 2.0 instrument presented the domain "life activities" (67.98%) with higher mean, meaning greater inability. Significant correlations were found between the domains of the two instruments, with the correlation between “locomotion” (SIS 3.0) and “mobility” (WHODAS 2.0); And “basic and instrumental activities of daily living” (SIS 3.0) and “self-care” (WHODAS 2.0) were the highest. Conclusion: It can be concluded that the individuals after chronic stroke residing in Araranguá, who participated in this study, showed impairment in all domains of functionality, with greater incapacity in life activities. In addition, there was an impairment in quality of life, especially in the functionality of the hand. The correlation between quality of life and functionality was also observed

Sex Differences in 6-Year Progression of White Matter Hyperintensities in Non-Demented Older Adults: Sydney Memory and Ageing Study

Objectives: To examine sex differences in the associations between vascular risk factors and 6-year changes in the volume of white matter hyperintensities (WMH), and between changes in WMH volumes and changes in cognitive performance, in a cohort of non-demented older adults. Methods: WMH volumes at 3 time-points (baseline, and 2- and 6-year follow-up) were automatically quantified in participants of Sydney Memory and Ageing Study (N = 605; age range = 70-92 years; 54.78% female). Linear mixed models were applied to examine the effects of vascular risk factors and cognitive consequences of the progression of WMH, as well as the sex moderation effects in the associations. Results: Total (TWMH), periventricular (PVWMH), and deep (DWMH) WMH volumes increased by 9.47%, 7.70%, and 11.78% per year, respectively. No sex differences were found in WMH progression rates. After Bonferroni correction, increases in PVWMH volumes over time were associated with decline in global cognition, especially in visuospatial and memory domains. Men with more increases in PVWMH volumes over time had greater declines in visuospatial abilities. Moreover, higher average TWMH volumes across time-points were associated with poorer average performance in processing speed and executive function domains across time. Higher average PVWMH volumes across time-points were also associated with worse average performance in the executive function domain over time, among women but not men. Conclusion: The findings highlighted sex differences in the associations between WMH progression and cognition decline over time, suggesting sex-specific strategies in managing WMH accumulations in ageing. Keywords: Cerebral small vessel disease, white matter hyperintensities, sex differences, brain ageing, cognitive decline

People with mild cognitive impairment are at increased risk of serious injury

Introduction Data-linkage studies using administrative hospital data have shown that people with dementia have double the rate of injury-related hospitalisations and poorer health outcomes than those without. No previous research has explored whether people with mild cognitive impairment are also at increased risk of serious injury requiring hospitalisation. Objectives and Approach A major barrier to the use of administrative hospital data for undertaking research focusing on people with MCI is that MCI cannot be reliably identified from ICD-10 coded administrative data. To overcome this limitation, hospitalisation and death data was linked to data from participants (community-dwelling 70-90 year olds) enrolled in the population-based longitudinal Sydney Memory and Ageing Study (MAS). MAS participants underwent comprehensive neuropsychological assessments at baseline, then 2, 4 and 6 years’ follow-up to accurately determine cognitive status at each time-period. Linkage to hospital records allowed identification of injury-related hospitalisations and outcomes for the 2-year period following each assessment. Results There were 335 injury-related hospitalisations for the 867 participants; 222 (25.6%) participants had at least one injury-related hospitalisation. After adjusting for age-and-sex, participants in a state of MCI had 1.7 (95%CI 1.2-2.4) times higher odds of an injury-related hospitalisation than participants in a state of normal cognition, whilst participants with dementia had 2.3 (95%CI 1.2-4.4) times higher odds. There was no difference in odds between participants with MCI and dementia. Of the 116 hospitalisations for people with MCI, the majority (79.3%) were due to falls. Non-fracture head injuries (25.9%), upper limb and trunk fractures (13.8% respectively) were the most common injury type. There were no differences in injury type, mean length of stay, or 30-day mortality between people with normal cognition, MCI and dementia. Conclusion/Implications Older people with objectively defined MCI are at higher risk of injury, predominantly as a result of falls, than their cognitively intact peers. Falls-risk screening and fall prevention initiatives may be indicated for people with MCI. Further research is required to determine which cognitive domains contribute to this increased risk

Difference in distribution functions:A new diffusion weighted imaging metric for estimating white matter integrity

Diffusion weighted imaging (DWI) is a widely recognized neuroimaging technique to evaluate the microstructure of brain white matter. The objective of this study is to establish an improved automated DWI marker for estimating white matter integrity and investigating ageing related cognitive decline. The concept of Wasserstein distance was introduced to help establish a new measure: difference in distribution functions (DDF), which captures the difference of reshaping one's mean diffusivity (MD) distribution to a reference MD distribution. This new DWI measure was developed using a population-based cohort (n=19,369) from the UK Biobank. Validation was conducted using the data drawn from two independent cohorts: the Sydney Memory and Ageing Study, a community-dwelling sample (n=402), and the Renji Cerebral Small Vessel Disease Cohort Study (RCCS), which consisted of cerebral small vessel disease (CSVD) patients (n=171) and cognitively normal controls (NC) (n=43). DDF was associated with age across all three samples and better explained the variance of changes than other established DWI measures, such as fractional anisotropy, mean diffusivity and peak width of skeletonized mean diffusivity (PSMD). Significant correlations between DDF and cognition were found in the UK Biobank cohort and the MAS cohort. Binary logistic analysis and receiver operator characteristic curve analysis of RCCS demonstrated that DDF had higher sensitivity in distinguishing CSVD patients from NC than the other DWI measures. To demonstrate the flexibility of DDF, we calculated regional DDF which also showed significant correlation with age and cognition. DDF can be used as a marker for monitoring the white matter microstructural changes and ageing related cognitive decline in the elderly

Classifying MCI Subtypes in Community-Dwelling Elderly Using Cross-Sectional and Longitudinal MRI-Based Biomarkers

Amnestic MCI (aMCI) and non-amnestic MCI (naMCI) are considered to differ in etiology and outcome. Accurately classifying MCI into meaningful subtypes would enable early intervention with targeted treatment. In this study, we employed structural magnetic resonance imaging (MRI) for MCI subtype classification. This was carried out in a sample of 184 community-dwelling individuals (aged 73–85 years). Cortical surface based measurements were computed from longitudinal and cross-sectional scans. By introducing a feature selection algorithm, we identified a set of discriminative features, and further investigated the temporal patterns of these features. A voting classifier was trained and evaluated via 10 iterations of cross-validation. The best classification accuracies achieved were: 77% (naMCI vs. aMCI), 81% (aMCI vs. cognitively normal (CN)) and 70% (naMCI vs. CN). The best results for differentiating aMCI from naMCI were achieved with baseline features. Hippocampus, amygdala and frontal pole were found to be most discriminative for classifying MCI subtypes. Additionally, we observed the dynamics of classification of several MRI biomarkers. Learning the dynamics of atrophy may aid in the development of better biomarkers, as it may track the progression of cognitive impairment

Interfering with DNA Decondensation as a Strategy Against Mycobacteria

Tuberculosis is once again a major global threat, leading to more than 1 million deaths each year. Treatment options for tuberculosis patients are limited, expensive and characterized by severe side effects, especially in the case of multidrug-resistant forms. Uncovering novel vulnerabilities of the pathogen is crucial to generate new therapeutic strategies. Using high resolution microscopy techniques, we discovered one such vulnerability of Mycobacterium tuberculosis. We demonstrate that the DNA of M. tuberculosis can condense under stressful conditions such as starvation and antibiotic treatment. The DNA condensation is reversible and specific for viable bacteria. Based on these observations, we hypothesized that blocking the recovery from the condensed state could weaken the bacteria. We showed that after inducing DNA condensation, and subsequent blocking of acetylation of DNA binding proteins, the DNA localization in the bacteria is altered. Importantly under these conditions, Mycobacterium smegmatis did not replicate and its survival was significantly reduced. Our work demonstrates that agents that block recovery from the condensed state of the nucleoid can be exploited as antibiotic. The combination of fusidic acid and inhibition of acetylation of DNA binding proteins, via the Eis enzyme, potentiate the efficacy of fusidic acid by 10 and the Eis inhibitor to 1,000-fold. Hence, we propose that successive treatment with antibiotics and drugs interfering with recovery from DNA condensation constitutes a novel approach for treatment of tuberculosis and related bacterial infections

Applying generalizability theory to examine assessments of subjective cognitive complaints: whose reports should we rely on - participant versus informant?

OBJECTIVES: This study aimed to apply the generalizability theory (G-theory) to investigate dynamic and enduring patterns of subjective cognitive complaints (SCC), and reliability of two widely used SCC assessment tools. DESIGN: G-theory was applied to assessment scales using longitudinal measurement design with five assessments spanning 10 years of follow-up. SETTING: Community-dwelling older adults aged 70-90 years and their informants, living in Sydney, Australia, participated in the longitudinal Sydney Memory and Ageing Study. PARTICIPANTS: The sample included 232 participants aged 70 years and older, and 232 associated informants. Participants were predominantly White Europeans (97.8%). The sample of informants included 76 males (32.8%), 153 females (65.9%), and their age ranged from 27 to 86 years, with a mean age of 61.3 years (SD = 14.38). MEASUREMENTS: The Memory Complaint Questionnaire (MAC-Q) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). RESULTS: The IQCODE demonstrated strong reliability in measuring enduring patterns of SCC with G = 0.86. Marginally acceptable reliability of the 6-item MAC-Q (G = 0.77-0.80) was optimized by removing one item resulting in G = 0.80-0.81. Most items of both assessments were measuring enduring SCC with exception of one dynamic MAC-Q item. The IQCODE significantly predicted global cognition scores and risk of dementia incident across all occasions, while MAC-Q scores were only significant predictors on some occasions. CONCLUSIONS: While both informants' (IQCODE) and self-reported (MAC-Q) SCC scores were generalizable across sample population and occasions, self-reported (MAC-Q) scores may be less accurate in predicting cognitive ability and diagnosis of each individual

Age-Related Changes of Peak Width Skeletonized Mean Diffusivity (PSMD) Across the Adult Lifespan: A Multi-Cohort Study

Parameters of water diffusion in white matter derived from diffusion-weighted imaging (DWI), such as fractional anisotropy (FA), mean, axial, and radial diffusivity (MD, AD, and RD), and more recently, peak width of skeletonized mean diffusivity (PSMD), have been proposed as potential markers of normal and pathological brain ageing. However, their relative evolution over the entire adult lifespan in healthy individuals remains partly unknown during early and late adulthood, and particularly for the PSMD index. Here, we gathered and analyzed cross-sectional diffusion tensor imaging (DTI) data from 10 population-based cohort studies in order to establish the time course of white matter water diffusion phenotypes from post-adolescence to late adulthood. DTI data were obtained from a total of 20,005 individuals aged 18.1 to 92.6 years and analyzed with the same pipeline for computing skeletonized DTI metrics from DTI maps. For each individual, MD, AD, RD, and FA mean values were computed over their FA volume skeleton, PSMD being calculated as the 90% peak width of the MD values distribution across the FA skeleton. Mean values of each DTI metric were found to strongly vary across cohorts, most likely due to major differences in DWI acquisition protocols as well as pre-processing and DTI model fitting. However, age effects on each DTI metric were found to be highly consistent across cohorts. RD, MD, and AD variations with age exhibited the same U-shape pattern, first slowly decreasing during post-adolescence until the age of 30, 40, and 50 years, respectively, then progressively increasing until late life. FA showed a reverse profile, initially increasing then continuously decreasing, slowly until the 70s, then sharply declining thereafter. By contrast, PSMD constantly increased, first slowly until the 60s, then more sharply. These results demonstrate that, in the general population, age affects PSMD in a manner different from that of other DTI metrics. The constant increase in PSMD throughout the entire adult life, including during post-adolescence, indicates that PSMD could be an early marker of the ageing process