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Is Cognition a Determinant of Health Related Quality of Life in Community Dwelling Non Demented Elderly?  [PDF]
Motassem S. Amer, Rania M. El Akkad, Heba S. Hassan
Advances in Aging Research (AAR) , 2014, DOI: 10.4236/aar.2014.35044
Abstract: Quality of life (QOL) is an important topic in social and medical sciences, it has a multidimensional nature and is influenced by many factors. Aim of the Work: In this study we want to assess the impact of cognitive impairment on the health related quality of life (HR-QOL) of community dwelling non demented elderly. Subject and Method: 115 non demented elderly, 60 years and older recruited from outpatient geriatric clinic at Al Mansoura General Hospital, Dakahlia, Egypt. Each participant underwent, comprehensive geriatric assessment, assessing cognitive function using the mini-mental state examination (MMSE) and montreal cognitive function test, assessing the health related quality of life (HR-QOL) by the RAND-36 health survey. Results: We found that the elderly with impaired cognition by both MMSE and Montreal test were significantly older; the ones with lower education, with more depressive symptoms, had more functional impairment and had lower HR-QOL scores than the elderly with normal cognitive function, after controlling for confounders still cognition was a determinant of HR-QOL. Also by linear correlation coefficient a significant correlation between HR-QOL and age, function, cognition and depression was found. Conclusion: Cognition affects significantly HR-QOL of the elderly, so we can say that interventions targeting cognition in the elderly can significantly improve their QOL.
Gait analysis in demented subjects: Interests and perspectives  [cached]
Olivier Beauchet,Gilles Allali,Gilles Berrut,Caroline Hommet
Neuropsychiatric Disease and Treatment , 2008,
Abstract: Olivier Beauchet1, Gilles Allali2, Gilles Berrut3, Caroline Hommet4, Véronique Dubost5, Frédéric Assal21Department of Geriatrics, Angers University Hospital, France; 2Department of Neurology, Geneva University Hospital, France; 3Department of Geriatrics, Nantes University Hospital, France; 4Department of Internal Medicine and Geriatrics, Tours University Hospital, France; 5Department of Geriatrics, Dijon University Hospital, FranceAbstract: Gait disorders are more prevalent in dementia than in normal aging and are related to the severity of cognitive decline. Dementia-related gait changes (DRGC) mainly include decrease in walking speed provoked by a decrease in stride length and an increase in support phase. More recently, dual-task related changes in gait were found in Alzheimer’s disease (AD) and non-Alzheimer dementia, even at an early stage. An increase in stride-to-stride variability while usual walking and dual-tasking has been shown to be more specific and sensitive than any change in mean value in subjects with dementia. Those data show that DRGC are not only associated to motor disorders but also to problem with central processing of information and highlight that dysfunction of temporal and frontal lobe may in part explain gait impairment among demented subjects. Gait assessment, and more particularly dual-task analysis, is therefore crucial in early diagnosis of dementia and/or related syndromes in the elderly. Moreover, dual-task disturbances could be a specific marker of falling at a pre-dementia stage.Keywords: gait, prediction of dementia, risk of falling, older adult
Oxidative Stress and Inflammation in Renal Patients and Healthy Subjects  [PDF]
Diana M. Lee, Kenneth W. Jackson, Nicholas Knowlton, Joshua Wages, Petar Alaupovic, Ola Samuelsson, Aso Saeed, Michael Centola, Per-Ola Attman
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0022360
Abstract: The first goal of this study was to measure the oxidative stress (OS) and relate it to lipoprotein variables in 35 renal patients before dialysis (CKD), 37 on hemodialysis (HD) and 63 healthy subjects. The method for OS was based on the ratio of cholesteryl esters (CE) containing C18/C16 fatty acids (R2) measured by gas chromatography (GC) which is a simple, direct, rapid and reliable procedure. The second goal was to investigate and identify a triacylglycerol peak on GC, referred to as TG48 (48 represents the sum of the three fatty acids carbon chain lengths) which was markedly increased in renal patients compared to healthy controls. We measured TG48 in patients and controls. Mass spectrometry (MS) and MS twice in tandem were used to analyze the fatty acid composition of TG48. MS showed that TG48 was abundant in saturated fatty acids (SFAs) that were known for their pro-inflammatory property. TG48 was significantly and inversely correlated with OS. Renal patients were characterized by higher OS and inflammation than healthy subjects. Inflammation correlated strongly with TG, VLDL-cholesterol, apolipoprotein (apo) C-III and apoC-III bound to apoB-containing lipoproteins, but not with either total cholesterol or LDL-cholesterol. In conclusion, we have discovered a new inflammatory factor, TG48. It is characterized with TG rich in saturated fatty acids. Renal patients have increased TG48 than healthy controls.
Inflammation but Not Endothelial Dysfunction Is Associated with the Severity of Coronary Artery Disease in Dyslipidemic Subjects  [PDF]
Christian F. Rueda-Clausen,Patricio López-Jaramillo,Carlos Luengas,Maria del Pilar Oubi a,Victoria Cachofeiro,Vicente Lahera
Mediators of Inflammation , 2009, DOI: 10.1155/2009/469169
Abstract: Introduction. Endothelial dysfunction and inflammation play a key role in the development of atherosclerosis. The present study evaluated endothelial function, inflammatory parameters, and carotid intima-media thickness (IMT) in dyslipidemic patients with or without coronary artery disease (CAD). Methods. Metabolic profile and inflammatory parameters were determined in dyslipidemic patients with (
Systemic Inflammation and Lung Function Impairment in Morbidly Obese Subjects with the Metabolic Syndrome  [PDF]
Astrid van Huisstede,Manuel Castro Cabezas,Erwin Birnie,Gert-Jan M. van de Geijn,Arjan Rudolphus,Guido Mannaerts,Tjin L. Njo,Pieter S. Hiemstra,Gert-Jan Braunstahl
Journal of Obesity , 2013, DOI: 10.1155/2013/131349
Abstract: Background. Obesity and asthma are associated. There is a relationship between lung function impairment and the metabolic syndrome. Whether this relationship also exists in the morbidly obese patients is still unknown. Hypothesis. Low-grade systemic inflammation associated with the metabolic syndrome causes inflammation in the lungs and, hence, lung function impairment. Methods. This is cross-sectional study of morbidly obese patients undergoing preoperative screening for bariatric surgery. Metabolic syndrome was assessed according to the revised NCEP-ATP III criteria. Results. A total of 452 patients were included. Patients with the metabolic syndrome ( ) had significantly higher blood monocyte (mean 5.3 versus 4.9, ) and eosinophil percentages (median 1.0 versus 0.8, ), while the total leukocyte count did not differ between the groups. The FEV1/FVC ratio was significantly lower in patients with the metabolic syndrome (76.7% versus 78.2%, ). Blood eosinophils were associated with FEV1/FVC ratio (adj. B ?0.113, ). Conclusion. Although the difference in FEV1/FVC ratio between the groups is relatively small, in this cross-sectional study, and its clinical relevance may be limited, these data indicate that the presence of the metabolic syndrome may influence lung function impairment, through the induction of relative eosinophilia. 1. Introduction Obesity is an increasing worldwide problem that has taken on epidemic proportions [1]. Cross-sectional studies have shown a positive association between obesity and asthma [2]. Weight loss in obese asthma patients improved morbidity and lung function [3]; however, the mechanisms underlying the relationship between asthma and obesity are unclear. It is suggested that low-grade systemic inflammation associated with obesity plays a role. The metabolic syndrome is a common metabolic disorder that may result from the increasing prevalence of obesity. Metabolic syndrome is a cluster of cardiometabolic risk factors characterized by abdominal obesity, insulin resistance, and chronic systemic inflammation [4]. Positive associations with lung function impairment have been reported for components of the metabolic syndrome, such as hypertension [5], type diabetes mellitus [6, 7], low-density lipoprotein cholesterol [8], and overall obesity [9]. In recent large cohort studies, it has been shown that there is also a relationship between lung function impairment and the metabolic syndrome [10–12]. However, all the aforementioned studies included overweight as well as normal weight subjects and were therefore not specifically
Sex playing with the mind: effects of oestrogen and testosterone on moon and cognition
ALMEIDA, OSVALDO P.;
Arquivos de Neuro-Psiquiatria , 1999, DOI: 10.1590/S0004-282X1999000400028
Abstract: women now spend more than 1/3 of their lives in a state of oestrogen deprivation as a result of increased life expectancy. a similar, but milder, hypogonadal state has been described for elderly men. this paper aims to review the available literature on the effects of both oestrogen and testosterone on mood and cognition. oestrogen replacement therapy of postmenopausal women is associated with improvements in measures of well being and decline in depression scores. in addition, oestrogen seems to augment the response of postmenopausal women with major depression to antidepressant treatment. most studies designed to investigate the impact of oestrogen on cognition indicate that replacement therapy is associated with better performance on neuropsychological tests, particularly in measures of verbal memory and fluency. the data also supports claims that oestrogen replacement therapy reduces the risk of alzheimer's disease in later life and improves response of patients to anticholinesterase treatment. data on the effects of testosterone is sparser. preliminary findings suggest that testosterone therapy may improve mood when used in isolation or in association with oestrogen. the effects of testosterone on cognitive functioning are less clear - some studies indicate that the administration of testosterone to non-demented subjects is associated with better visuospatial functioning and deterioration of verbal skills. in summary, gonadal hormones seem to modulate various aspects of mental functioning. if future studies prove this to be true, hormone replacement therapy should have a major impact on the physical and mental health of older people in the years to come.
Sex playing with the mind: effects of oestrogen and testosterone on moon and cognition
ALMEIDA OSVALDO P.
Arquivos de Neuro-Psiquiatria , 1999,
Abstract: Women now spend more than 1/3 of their lives in a state of oestrogen deprivation as a result of increased life expectancy. A similar, but milder, hypogonadal state has been described for elderly men. This paper aims to review the available literature on the effects of both oestrogen and testosterone on mood and cognition. Oestrogen replacement therapy of postmenopausal women is associated with improvements in measures of well being and decline in depression scores. In addition, oestrogen seems to augment the response of postmenopausal women with major depression to antidepressant treatment. Most studies designed to investigate the impact of oestrogen on cognition indicate that replacement therapy is associated with better performance on neuropsychological tests, particularly in measures of verbal memory and fluency. The data also supports claims that oestrogen replacement therapy reduces the risk of Alzheimer's disease in later life and improves response of patients to anticholinesterase treatment. Data on the effects of testosterone is sparser. Preliminary findings suggest that testosterone therapy may improve mood when used in isolation or in association with oestrogen. The effects of testosterone on cognitive functioning are less clear - some studies indicate that the administration of testosterone to non-demented subjects is associated with better visuospatial functioning and deterioration of verbal skills. In summary, gonadal hormones seem to modulate various aspects of mental functioning. If future studies prove this to be true, hormone replacement therapy should have a major impact on the physical and mental health of older people in the years to come.
Associations of airway inflammation and responsiveness markers in non asthmatic subjects at start of apprenticeship
Valérie Demange, Pascal Wild, Denis Zmirou-Navier, Paul Tossa, Abraham Bohadana, Annick Barbaud, Christophe Paris
BMC Pulmonary Medicine , 2010, DOI: 10.1186/1471-2466-10-37
Abstract: Rhinoconjunctivitis, asthma-like symptoms, FEV1 and AR post-Methacholine Bronchial Challenge (MBC) test results, FENO measurements and EP were all investigated in apprentice bakers, pastry-makers and hairdressers not suffering from asthma. Multiple Correspondence Analysis (MCA) was simultaneously conducted in relation to these groups and this generated a synthetic partition (EI). Associations between groups of subjects based on BHR and EI respectively, as well as risk factors, symptoms and investigations were also assessed.Among the 441 apprentice subjects, 45 (10%) declared rhinoconjunctivitis-like symptoms, 18 (4%) declared asthma-like symptoms and 26 (6%) suffered from BHR. The mean increase in AR post-MBC test was 21% (sd = 20.8%). The median of FENO values was 12.6 ppb (2.6-132 range). Twenty-six subjects (6.7%) had EP exceeding 14%. BHR was associated with atopy (p < 0.01) and highest FENO values (p = 0.09). EI identified 39 subjects with eosinophilic inflammation (highest values of FENO and eosinophils), which was associated with BHR and atopy.Are any of the identified markers predictive of increased inflammatory responsiveness or of development of symptoms caused by occupational exposures? Analysis of population follow-up will attempt to answer this question.There are many tests for investigating Occupational and non-Occupational asthma (OA). Traditionally, attention has been focused on airway obstruction indicators such as Forced Expiratory Volume in 1 second (FEV1), Airway Resistance (AR) and measurement of non-specific Bronchial Hyperresponsiveness (BHR). More recently, airway inflammation indicators have gained acceptance, including induced sputum cell counts or Fractional Exhaled Nitric Oxide (FENO)[1].In patients with mild to moderate asthma, FENO has been found to correlate with BHR, reversibility of airway obstruction, serum Eosinophil Cationic Protein (ECP), blood eosinophilia[2] and AR parameters post methacholine[3]. Among adolescents in clinical
Roflumilast attenuates allergen-induced inflammation in mild asthmatic subjects
Gail M Gauvreau, Louis-Philippe Boulet, Christine Schmid-Wirlitsch, Johanne C?té, MyLinh Duong, Kieran J Killian, Joanne Milot, Francine Deschesnes, Tara Strinich, Richard M Watson, Dirk Bredenbr?ker, Paul M O'Byrne
Respiratory Research , 2011, DOI: 10.1186/1465-9921-12-140
Abstract: 25 subjects with mild allergic asthma were randomized to oral roflumilast 500 mcg or placebo, once daily for 14 days in a double-blind, placebo-controlled, crossover study. Allergen challenge was performed on Day 14, and FEV1 was measured until 7 h post challenge. Methacholine challenge was performed on Days 1 (pre-dose), 13 (24 h pre-allergen), and 15 (24 h post-allergen), and sputum induction was performed on Days 1, 13, 14 (7 h post-allergen), and 15.Roflumilast inhibited the allergen-induced late phase response compared to placebo; maximum % fall in FEV1 (p = 0.02) and the area under the curve (p = 0.01). Roflumilast had a more impressive effect inhibiting allergen-induced sputum eosinophils, neutrophils, and eosinophil cationic protein (ECP) at 7 h post-allergen (all p = 0.02), and sputum neutrophils (p = 0.04), ECP (p = 0.02), neutrophil elastase (p = 0.0001) and AHR (p = 0.004) at 24 h post-allergen.This study demonstrates a protective effect of roflumilast on allergen-induced airway inflammation. The observed attenuation of sputum eosinophils and neutrophils demonstrates the anti-inflammatory properties of PDE4 inhibition and supports the roles of both cell types in the development of late phase bronchoconstriction and AHR.ClinicalTrials.gov: NCT01365533Asthma is characterized by the presence of cough, wheeze, dyspnea, reversible airway obstruction and airway hyperresponsiveness. Eosinophils are cells recognized to be a key feature of allergic asthma [1], however patients with severe asthma have increases in both eosinophils and neutrophils in their sputum [2]. Furthermore, severe asthma exacerbations are associated with bronchial mucosal eosinophilia and neutrophilia, as well as upregulation of CXC chemoattractants and their receptors [3]. Although current asthma therapies such as corticosteroids are effective in inhibiting eosinophilic inflammation through Th2 suppression, they may enhance neutrophil accumulation into the airways and until now therapies th
Anticonvulsants in the treatment of aggression in the demented elderly: an update  [cached]
Amann Benedikt,Pantel Johannes,Grunze Heinz,Vieta Eduard
Clinical Practice and Epidemiology in Mental Health , 2009, DOI: 10.1186/1745-0179-5-14
Abstract: Introduction Complex psychopathological and behavioral symptoms, such as delusions and aggression against care providers, are often the primary cause of acute hospital admissions of elderly patients to emergency units and psychiatric departments. This issue resembles an interdisciplinary clinically highly relevant diagnostic and therapeutic challenge across many medical subjects and general practice. At least 50% of the dramatically growing number of patients with dementia exerts aggressive and agitated symptoms during the course of clinical progression, particularly at moderate clinical severity. Methods Commonly used rating scales for agitation and aggression are reviewed and discussed. Furthermore, we focus in this article on benefits and limitations of all available data of anticonvulsants published in this specific indication, such as valproate, carbamazepine, oxcarbazepine, lamotrigine, gabapentin and topiramate. Results To date, most positive and robust data are available for carbamazepine, however, pharmacokinetic interactions with secondary enzyme induction limit its use. Controlled data of valproate do not seem to support the use in this population. For oxcarbazepine only one controlled but negative trial is available. Positive small series and case reports have been reported for lamotrigine, gabapentin and topiramate. Conclusion So far, data of anticonvulsants in demented patients with behavioral disturbances are not convincing. Controlled clinical trials using specific, valid and psychometrically sound instruments of newer anticonvulsants with a better tolerability profile are mandatory to verify whether they can contribute as treatment option in this indication.
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