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

Factores asociados a vivir solo en personas mayores de 60 años en Bogotá, Colombia

Objective: to identify the factors related to living alone and the magnitude of its effect on the adult population over 60 years old living in community in the city of Bogotá. Methods: cross-sectional study with secondary analysis of the Health, Well-being, and Aging Survey (SABE) - Bogota 2012. Measurements of central tendency were calculated, the means were compared with Student's t-test, the final model was adjusted for age, gender, and the odds ratios (OR) and their CI 95% were calculated to estimate the power of the relation. Results: out of the 2,000 people who participated in the SABE survey, 252 (12.6%) lived alone. The average age was 71.32 years; 64.68% were women (n = 163). The average schooling was 6.19 years (SD 0.31). When making the bivariate analysis, a statistically significant relation was found between living alone and being independent for basic and instrumental activities of daily living, absence of dementia, and good self-perception of health condition. In the logistic regression model, not having a partner (OR 4.91 CI 95% [3.61-6.68]), absence of dementia (OR 2.77 CI 95% [1.94-6.16], poor self-perception of nutritional condition (OR 1.7 CI 95% [1.24-2.33] and female gender (OR 1.37 CI 95% [1.03-1.91] were significantly associated with the possibility of living alone in people over 60 years. Conclusions: this study found that in people living alone there is not only an association with not having a partner, but also with having a good cognitive state, being a woman, and a poor self-perception of the nutritional condition.Objetivo: identificar los factores asociados a vivir solo y la magnitud de su efecto en la población adulta mayor de 60 años que residen en comunidad en la ciudad de Bogotá. Métodos: Estudio de corte transversal con análisis secundario de la encuesta Salud, Bienestar y Envejecimiento (SABE) - Bogotá 2012. Se calcularon medidas de tendencia central, las medias se compararon con la prueba t de Student, el modelo final se ajustó por edad, sexo y se calcularon las odds ratios (OR) y sus IC95% para estimar la fuerza de la asociación. Resultados: De las 2000 personas que participaron en la encuesta SABE, 252 (12,6%) vivían solas. El promedio de edad era de 71,32 años; el 64,68% eran mujeres (n=163). La escolaridad promedio fue de 6,19 años (DE 0,31). Al realizar en análisis bivariado, se encontró asociación estadísticamente significativa entre vivir solo y ser independiente para las actividades básicas e instrumentales de la vida diaria, la ausencia de demencia, tener buena autopercepción del estado de salud. En el modelo de regresión logística no tener pareja (OR 4,91 IC 95% [3,61-6,68]), ausencia de demencia (OR 2,77 IC 95% [1,94-6,16], mala autopercepción del estado nutricional (OR 1,7 IC 95% [1,24-2,33] y el sexo femenino (OR 1,37 IC 95% [1,03-1,91] se asociaron de forma significativa con la posibilidad de vivir solo en personas mayores de 60 años. Conclusiones: Este estudio encontró que vivir solo se asoció con no tener pareja, tener un buen estado cognoscitivo, ser mujer y con mala autopercepción del estado nutricional

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

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

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

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

Relative handgrip strength diminishes the negative effects of excess adiposity on dependence in older adults : a moderation analysis

Q1Adultos mayoresThe adverse effects of fat mass on functional dependence might be attenuated or worsened, depending on the level of muscular strength. The aim of this study was to determine (i) the detrimental effect of excess adiposity on dependence in activities of daily living (ADL), and (ii) whether relative handgrip strength (HGS) moderates the adverse effect of excess adiposity on dependence, and to provide the threshold of relative HGS from which the adverse effect could be improved or worsened. A total of 4169 participants (69.3 ± 7.0 years old) from 244 municipalities were selected following a multistage area probability sampling design. Measurements included anthropometric/adiposity markers (weight, height, body mass index, waist circumference, and waist-to-height ratio (WHtR)), HGS, sarcopenia “proxy” (calf circumference), and ADL (Barthel Index scale). Moderation analyses were performed to identify associations between the independent variable (WHtR) and outcomes (dependence), as well as to determine whether relative HGS moderates the relationship between excess adiposity and dependence. The present study demonstrated that (i) the adverse effect of having a higher WHtR level on dependence in ADL was moderated by relative HGS, and (ii) two moderation thresholds of relative HGS were estimated: 0.35, below which the adverse effect of WHtR levels on dependency is aggravated, and 0.62, above which the adverse effect of fat on dependency could be improved. Because muscular strength represents a critically important and modifiable predictor of ADL, and the increase in adiposity is inherent in aging, our results underscore the importance of an optimal level of relative HGS in the older adult population.Revista Internacional - Indexad