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Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and de-mentia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst...
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Atrial fibrillation (AF) confers a 2-to-3-fold increased risk of developing cognitive dysfunction and de-mentia, independent of age and past stroke. The purpose of study was to identify risk factors for developing dementia amongst AF patients in India. This was a single-centre, prospective, observational study wherein recently diagnosed, treatment naive, persistent non-valvular AF patients were enrolled. All patients were screened for dementia using the Mini-Mental state exam. Amongst a total of 108 pa-tients enrolled, 40 (37%) had dementia. The most common cognitive deficits were in attention and calculation followed by memory deficits. Factors independently contributing to dementia were advanced age, female sex, presence of diabetes, elevated pulmonary artery pressures and a lower serum albumin.(c) 2022 Cardiological Society of India. Published by Elsevier, a division of RELX India, Pvt. Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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Importance Frailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response ...
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Importance Frailty is common among older patients with acute decompensated heart failure (ADHF) and is associated with worse quality of life (QOL) and a higher risk of clinical events. Frailty can also limit recovery and response to interventions. In the Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial, a 3-month innovative, early, transitional, tailored, multidomain physical rehabilitation intervention improved physical function and QOL (vs usual care) in older patients with ADHF. Objective To evaluate whether baseline frailty modified the benefits of the physical rehabilitation intervention among patients with ADHF enrolled in the REHAB-HF trial and to assess the association between changes in frailty with the risk of adverse clinical outcomes on follow-up. Design, Setting, and Participants This prespecified secondary analysis of the REHAB-HF trial, a multicenter randomized clinical trial, included 337 patients 60 years and older hospitalized for ADHF. Patients were enrolled from September 17, 2014, through September 19, 2019. Participants were stratified across baseline frailty strata as assessed using modified Fried criteria. Data were analyzed from July 2021 to September 2022. Interventions Physical rehabilitation intervention or attention control. Main Outcomes and Measures Primary outcome was the Short Physical Performance Battery (SPPB) score at 3 months. Clinical outcomes included all-cause hospitalization or mortality at 6 months. Results This prespecified secondary analysis included 337 participants; 181 (53.7%) were female, 167 (49.6%) were Black, and the mean (SD) age was 72 (8) years. A total of 192 (57.0%) were frail and 145 (43.0%) were prefrail at baseline. A significant interaction was observed between baseline frailty status and the treatment arm for the primary trial end point of overall SPPB score, with a 2.6-fold larger improvement in SPPB with intervention among frail patients (2.1; 95% CI, 1.3-2.9) vs prefrail patients (0.8; 95% CI, -0.1 to 1.6; P for interaction = .03). Trends consistently favored a larger intervention effect size, with significant improvement among frail vs prefrail participants for 6-minute walk distance, QOL, and the geriatric depression score, but interactions did not achieve significance. Conclusions and Relevance In this prespecified secondary analysis of the REHAB-HF trial, patients with ADHF with worse baseline frailty status had a more significant improvement in physical function in response to an innovative, early, transitional, tailored, multidomain physical rehabilitation intervention than those who were prefrail.
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Objective. As in many other countries, caries decline in Germany has left pockets of persisting caries prevalence. This study aims to assess the benefit of a 10-year community-based prophylaxis program, focused on regular toothbru...
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Objective. As in many other countries, caries decline in Germany has left pockets of persisting caries prevalence. This study aims to assess the benefit of a 10-year community-based prophylaxis program, focused on regular toothbrushing with fluoridated toothpastes or gels and involving institutions noted as having the highest caries levels. Materials and methods. The caries data (d(3)mft/D3MFT) was extracted from the results of the compulsory school entry examinations in Greifswald/ Germany (2003/2004-2012/2013) involving similar to 280 6-7-year-olds each year. Data from schools that include children with the highest caries levels and coming from low-SES families were analyzed independently and used for comparisons. Additionally, caries trends from Greifswald were compared to data from representative national surveys (2004-2009). Results. Data from 2871 children were available for analysis. The baseline d(3)mft value (2003/2004) was 3.2 +/- 3.8; the d(3)-component corresponded to 70% of the index. The latest caries data (2012/2013) showed a strong reduction (43.8%) in caries prevalence (d(3)mft = 1.8 +/- 2.5). Similarly, the SiC-Index declined significantly from 2003/2004 (7.9 +/- 2.3) to 2012/2013 (4.8 +/- 2.3; p < 0.001). Nevertheless, in all analyzed years the d3mft values and the SiC-Index were significantly higher in the institutions that included children coming from lower-SES families (p < 0.05). The amount of caries reduction between 2004 and 2009 corresponded to 38% in Greifswald as compared to 13% in Germany. Conclusions. This strategy involving a combination of regular toothbrushing and fluoride application has achieved an overall substantial caries reduction, thereby indicating that caries-control strategies for heterogeneous risk groups can be highly successful as setting approach. However, activities targeting high risk groups still need to be strengthened.
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Background:In the last three decades, the relationship between depression and cognition in geriatric patients has been a popular topic among researchers and clinicians. Clinical and epidemiological research has focused on the iden...
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Background:In the last three decades, the relationship between depression and cognition in geriatric patients has been a popular topic among researchers and clinicians. Clinical and epidemiological research has focused on the identification of risk factors that could be modified in pre-dementia syndromes, at a preclinical and early clinical stage of dementia disorders, with specific attention to the role of depression. The objective of this work was to determine the relationship between depressive disorder and cognitive deterioration in institutionalized older adults.Methods:In this descriptive, correlational study, data were gathered from two nursing homes in the province of Jaen (Spain), from a random sample of 140 older adults (70 nondependent and 70 dependent). The variables were measured using comprehensive geriatric assessment, the Cambridge Cognitive Test (CAMCOG), and the Geriatric Depression Scale (GDS).Results:Depression was correlated with cognitive level in the nondependent older adult sample (r= -0.471,p= 0.004). Age was inversely associated with the score obtained in the CAMCOG of the nondependent older adult sample (r= -0.352,p= 0.038). The functional capacity in several activities of daily living was correlated with the score obtained in the CAMCOG in each of the two groups. Depression was more prevalent in the dependent than in the nondependent older adults (82.85 vs. 57.14%). No association was observed between institutionalization time and the score obtained on the cognitive and affective scales (GDS and CAMCOG) in both groups (GDS-nondependent,r= -0.209,p= 0.234; CAMCOG-nondependent,r= 0.007,p= 0.967; GDS-dependent,r= 0.251,p= 0.152; CAMCOG-dependent,r= -0.021,p= 0.907).Conclusion:Depressive symptomatology is associated with cognitive deterioration. Depression is prevalent in institutions that care for older, more dependent adults.
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The objective of this study was to describe trends over time in HIV prevalence, sexually transmitted infections (STIs) and sexual behaviour among women in Moshi urban, Tanzania. Two cross-sectional studies were conducted in 1999 a...
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The objective of this study was to describe trends over time in HIV prevalence, sexually transmitted infections (STIs) and sexual behaviour among women in Moshi urban, Tanzania. Two cross-sectional studies were conducted in 1999 and in 2002–04 among women attending three primary health-care clinics. They were interviewed and screened for HIV and STIs. There was a significant decrease in HIV prevalence (11.5–6.9%). The decline was greatest among women aged 15–24 years. Syphilis, trichomoniasis, bacterial vaginosis, genital ulcers and reported STI symptoms also decreased significantly over the three-year inter-survey period. The proportion of women reporting casual sex decreased and knowledge of STI symptoms and health-care seeking behaviour improved. Herpes simplex virus type 2, genital warts, age at sexual debut, age at first pregnancy and condom use remained unchanged. In conclusion, decline in curable STIs and casual sex partners may partly explain the observed decline in HIV seroprevalence. Both STIs and sexual behaviour should be monitored in HIV sentinel surveillance. There remains a gap between knowledge of preventive behaviour and actual preventive practices.
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Objectives The novel concept of subjective cognitive decline (SCD) in Parkinson's disease (PD) refers to subjective cognitive impairment without concurrent objective cognitive deficits. This study aimed to determine the prevalence...
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Objectives The novel concept of subjective cognitive decline (SCD) in Parkinson's disease (PD) refers to subjective cognitive impairment without concurrent objective cognitive deficits. This study aimed to determine the prevalence and affective correlates of SCD in de novo PD patients. Materials and Methods A total of 139 de novo PD patients underwent comprehensive neuropsychological evaluation. PD patients with SCD (PD‐SCD) did not meet the diagnostic criteria for mild cognitive impairment in PD (PD‐MCI) based on the Movement Disorder Society Level II Criteria and were defined by a Domain‐5 Score?≥1 on the Non‐Motor Symptoms Questionnaire. Affective symptoms were measured using the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). Results In de novo PD cohort, the prevalence of SCD was 28.1%. PD‐SCD patients performed significantly better than PD‐MCI patients on tests of five cognitive domains. The more commonly affected domains in PD‐SCD patients were memory (28.2%) and attention/working memory (25.6%). Multivariable linear regression analysis revealed that PD‐SCD was significantly associated with both HAMD (β?=?4.518, 95% CI?=?0.754–8.281, p?=?.019) and HAMA scores (β?=?4.259, 95% CI?=?1.054–7.464, p?=?.010). Furthermore, binary logistic regression analysis revealed that higher HAMD (OR?=?1.128, 95% CI?=?1.019–1.249, p?=?.020) and HAMA scores (OR?=?1.176, 95% CI?=?1.030–1.343, p?=?.017) increased the risk of PD‐SCD. Conclusions Our findings suggest that SCD is highly prevalent in de novo PD patients. The presence of PD‐SCD is suggestive of an underlying affective disorder.
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Question Does the epsilon 2 allele remain protective against beta-amyloid (A beta) accumulation in the presence of the epsilon 4 allele? Findings In this cross-sectional study of 4432 older participants without cognitive impairmen...
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Question Does the epsilon 2 allele remain protective against beta-amyloid (A beta) accumulation in the presence of the epsilon 4 allele? Findings In this cross-sectional study of 4432 older participants without cognitive impairment, apolipoprotein E epsilon 2 (APOE epsilon 2) was associated with a reduction in both the overall and age-dependent level of A beta in the presence of epsilon 4, with A beta levels in theAPOE epsilon 24 group (n = 115) increasing at significantly less than half the rate with respect to increasing age compared with theAPOE epsilon 34 group (n = 1295). Meaning The protective outcome of carrying an epsilon 2 allele in the presence of an epsilon 4 allele against A beta accumulation may inform future development of disease-modifying Alzheimer disease therapies. Importance Although the most common recent approach in Alzheimer disease drug discovery is to directly target the beta-amyloid (A beta) pathway, the high prevalence of apolipoprotein E epsilon 4 (APOE epsilon 4) in Alzheimer disease and the ease of identifying epsilon 4 carriers make theAPOEgenotype and its corresponding protein (apoE) an appealing therapeutic target to slow A beta accumulation. Objective To determine whether the epsilon 2 allele is protective against A beta accumulation in the presence of the epsilon 4 allele and evaluate how age and theAPOEgenotype are associated with emerging A beta accumulation and cognitive dysfunction. Design, Setting, and Participants This cross-sectional study used screening data from the Anti-Amyloid Treatment in Asymptomatic Alzheimer Disease Study (A4 Study) collected from April 2014 to December 2017 and analyzed from November 2019 to July 2020. Of the 6943 participants who were a part of the multicenter clinical trial screening visit, 4432 were adults without cognitive impairment aged 65 to 85 years who completed a fluorine 18-labeled (18F)-florbetapir positron emission tomography scan, hadAPOEgenotype information, and had a Clinical Dementia Rating of 0. Participants who were taking a prescription Alzheimer medication or had a current serious or unstable illness that could interfere with the study were excluded. Main Outcomes and Measures A beta pathology, measured by 18F-florbetapir positron emission tomography and cognition, measured by the Preclinical Alzheimer Cognitive Composite. Results A total of 4432 participants were included (mean [SD] age, 71.3 [4.7] years; 2634 women [59.4%]), with a mean (SD) of 16.6 (2.8) years of education and 1512 (34.1%) with a positive A beta level.APOE epsilon 2 was associated with a reduction in both the overall (standardized uptake value ratio [SUVR], epsilon 24, 1.11 [95% CI, 1.08-1.14]; epsilon 34, 1.18 [95% CI, 1.17-1.19]) and the age-dependent level of A beta in the presence of epsilon 4, with A beta levels in theAPOE epsilon 24 group (n = 115; epsilon 24, 0.005 SUVR increase per year of age) increasing at less than half the rate with respect to increasing age compared with theAPOE epsilon 34 group (n = 1295; 0.012 SUVR increase per year of age;P = .04). The association between A beta and decreasing Preclinical Alzheimer Cognitive Composite scores did not differ byAPOEgenotype, and the reduced performance on the Preclinical Alzheimer Cognitive Composite inAPOE epsilon 4 carriers compared with noncarriers was completely mediated by A beta (unadjusted difference in composite scores between epsilon 4 carriers and noncarriers = -0.084,P = .005; after adjusting for 18F-florbetapir = -0.006,P = .85; after adjusting for 18F-florbetapir and cardiovascular scores = -0.009,P = .78). Conclusions and Relevance These findings suggest that the protective outcome of carrying an epsilon 2 allele in the presence of an epsilon 4 allele against A beta accumulation is important for potential treatments that attempt to biochemically mimic the function of the epsilon 2 allele in order to facilitate A beta clearance in epsilon 4 carriers. Such a treatment strategy is appealing, as
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Objectives: Delirium is known to contribute to increased rates of institutionalization and mortality. The full extent of adverse outcomes, however, remains understudied. We aimed to systematically assess the discharge destinations...
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Objectives: Delirium is known to contribute to increased rates of institutionalization and mortality. The full extent of adverse outcomes, however, remains understudied. We aimed to systematically assess the discharge destinations and mortality risk in delirious patients in a large sample across all hospital services. Design: Pragmatic prospective cohort study of consecutive admissions to a large health care system. Setting and Participants: A total of 27,026 consecutive adults (>18 years old) with length of stay of at least 24 hours in a tertiary care center from January 1 to December 31, 2014. Methods: Presence of delirium determined by routine delirium screening. Clinical characteristics, discharge destination, and mortality were collected. Calculation of odds ratios (ORs) with logistic regression with adjustment for age, sex, and Charlson comorbidity index (CCI). Results: Delirium was detected in 19.7% of patients (5313 of 27,026), median age of delirious patients was 56 years (25-75 interquartile range = 37-70). The electronic health record (DSM-5-based) delirium algorithm correctly identified 93.3% of delirium diagnoses made by consultation-liaison psychiatrists. Across services, the odds of delirious patients returning home was significantly reduced [OR 0.12; confidence interval (CI) 0.10-0.13; P < .001]. Rather, these patients were transferred to acute rehabilitation (OR 4.15; CI 3.78-4.55; P < .001) or nursing homes (OR 4.12; CI 3.45-4.93; P < .001). Delirious patients had a significantly increased adjusted mortality risk (OR 30.0; CI 23.2-39.4; P < .001). Conclusions and Implications: This study advances our understanding of the discharge destination across all services in adults admitted to a large hospital system. Delirium was associated with reduced odds of returning home, increased odds of discharge to a setting of higher dependency, and excess mortality independent of comorbidity, age, and sex. These findings emphasize the potentially devastating outcomes associated with delirium and highlight the need for timely diagnosis and hospital-wide management. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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Mild cognitive impairment associated with Parkinson's disease (PD) is a risk factor for the development of dementia. Despite the importance of early identification of mild cognitive impairment in PD, its prevalence and clinical co...
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Mild cognitive impairment associated with Parkinson's disease (PD) is a risk factor for the development of dementia. Despite the importance of early identification of mild cognitive impairment in PD, its prevalence and clinical correlates are still debated. The present meta-analysis provides a robust estimate of prevalence rate of mild cognitive impairment in PD according to the Movement Disorder Society clinical criteria and to explore the differences between PD patients with and without mild cognitive impairment in demographic, clinical, and neuropsychiatric features. A systematic literature search was performed up to April 2019 using PsycInfo (PROQUEST), PubMed, and Scopus. From 4706 titles and abstracts, 41 studies were selected (n = 7053 patients). Pooled mild cognitive impairment prevalence was 40% on a total sample of 7053 PD patients (95% confidence interval = 36-44; Q = 490.14, P < 0.0001; I-2 = 91.84%) with a higher frequency for the multiple domain subtype (31%; 95% confidence interval = 23-41, Q = 93.24; P < 0.0001; I-2 = 92.49%). Meta-regression analysis revealed that stage of PD moderate prevalence estimates of mild cognitive impairment (beta = 2.80; P = 0.008). Mild cognitive impairment in PD was associated with older age, lower education, longer disease duration, higher levodopa equivalent daily dose, more severe motor symptoms, and postural instability/gait difficulty motor subtype, poorer quality of life, higher levels of apathy, and depression. The present meta-analysis indicated that mild cognitive impairment in PD is a frequent cognitive status deserving to be early detected by means of standardized cognitive assessments in clinical practice. (c) 2019 International Parkinson and Movement Disorder Society
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