Luciana Cristina Matos Cunha

Fatores que predispõem ao declínio funcional em idosos hospitalizados

INTRODUCAO: O aumento da expectativa de vida e uma realidade mundial e determina maior prevalencia de doencas cronicas e maior demanda pelos servicos de saude, incluindo os hospitalares. Atualmente, estudos tem focalizado o declinio funcional e suas consequencias - demanda por recursos materiais e humanos, institucionalizacao e hospitalizacao. O objetivo foi a revisao critica da literatura disponivel sobre os fatores de risco associados ao declinio funcional em idosos hospitalizados. METODOLOGIA: Pesquisa nas bases de dados MEDLINE, LILACS e SCIELO, nos idiomas ingles e portugues, entre 2000 e 2007, utilizando as palavras-chave hospital, elderly, functional status, aged e functional decline e referencias bibliograficas dos artigos selecionados. RESULTADOS: Satisfizeram os criterios de inclusao 31 publicacoes. Apos leitura critica do ABSTRACT, os 15 artigos mais relevantes foram selecionados. CONCLUSAO: O declinio funcional pode ocorrer antes, durante e/ou apos a hospitalizacao. Idade avancada, comprometimento funcional previo, deficit cognitivo, iatrogenias, gravidade da condicao clinica e historico de quedas foram os fatores de risco mais citados. A capacidade funcional, como marcador de saude desse grupo, merece maior investigacao.

Presbivertigem como causa de tontura no idoso

BACKGROUND dizziness is a frequent complaint in the geriatric population and has a negative impact in the life quality of these individuals. AIM to correlate the types of dizziness and alterations in the caloric test and to verify the frequency of presbyvertigo in an elderly population with dizziness. METHOD The records of 132 patients aged over 60 and with balance disturbance were reviewed. These patients were evaluated in the Otoneurology Service of the Clinical Hospital of the Federal University of Minas Gerais between the years of 1998 and 2007. The variables considered for analysis were: epidemiologic data, clinical history, associated diseases and the result of the caloric test. Patients with positional and central vertigo were excluded from the analysis. RESULTS The research sample consisted of 120 patients, with an average age was of 70 years, being 71% (n=87) of sample women. Vertigo with the duration of a few minutes and of a daily frequency was the most frequent type of dizziness. In relation to the caloric test, normal results were observed in 73% of the sample. Altered results included unilateral weakness (14%), bilateral weakness (10%) and hyperactive caloric response (3%). Correlating the caloric test with the type of dizziness, bilateral weakness was associated with postural instability (p=0.006; IC=2 - 419). CONCLUSION dizziness in elderly has many causes. Bilateral weakness of the vestibular function can be related to presbyvertigo and must be considered in aged individuals who present unbalance. Metabolic, psychiatric, disautonomic, orthopedic, visual and proprioceptive disturbances may be the cause of dizziness in aged individuals who present normal vestibular evaluation.

A comparison of survival, pneumonia, and hospitalization in patients with advanced dementia and dysphagia receiving either oral or enteral nutrition

ObjectivesThis study aimed to evaluate the survival rate, pneumonia incidence, and hospital admissions among elderly patients with advanced dementia and to compare these outcomes between patients receiving enteral and oral nutrition.DesignAn observational, prospective, non-randomized, and unblinded study, with a minimum follow up of 6 months.SettingInpatient wards as well as ambulatory and emergency units run by a Brazilian university.ParticipantsDysphagic elderly patients aged ≥60 years with advanced dementia (classified as at least 7A according to the Functional Assessment Staging [FAST]). Both patients with gastrostomies and nasogastric feeding tubes were included in the alternative feeding group.MeasurementsFollowing informed consent, a complete clinical examination was performed upon recruitment, and the primary caregiver was interviewed. Data concerning the major outcomes described above, as well as other demographic and clinical information, were recorded at admission and during follow-up phone calls. Survival analysis was performed using a Kaplan-Meier curve and a stepwise Cox regression analysis.ResultsSixty-seven elderly patients were recruited: 36 (53,7%) for oral feeding and 31 for alternative feeding (n=28 nasogastric tube). Of these, 57 (85.1%) were classified as at least FAST 7C. They were, on average, 84.79 years old, mostly women (85.1%), and with a low level of education (2.9 years). Mortality at 3 months was 11.1% among the oral feeding group and 41.9% among the alternative feeding group (p=0.004). At 6 months, the mortality rate increased to 27.8% and 58.1%, respectively (p=0.012). The following variables persisted in the regression model at the end of the analysis: feeding route (p =.018; RR = 2.33; CI: 1.158-4.667), duration of dementia (p =.014; RR =.88; CI:.786-.974) and number of pressure ulcers (p =.007; RR = 1.250; CI: 1.063-1.470). A higher incidence of aspiration pneumonia was observed in the alternative feeding group (p=0.006), but no difference in the number of hospital admissions was detected between the groups (p=0.365).ConclusionThe use of alternative feeding, along with the number of pressure ulcers were associated with an increased risk of death in elderly patients with advanced dementia. A higher incidence of aspiration pneumonia was also observed in the alternative feeding group. The number of hospital admissions was not different between the feeding routes.

Validade da prova calórica monotermal em comparação à estimulação bitermal

BACKGROUND the use of monothermal caloric testing as a screening tool for vestibular asymmetry has been considered as an alternative to bithermal caloric testing. AIM to evaluate the effectiveness of monothermal stimulation when compared to bithermal stimulation in the diagnosis of labyrinth asymmetry. METHOD the results of 389 vectoelectronystagmography, performed between 1998 and 2007, were analyzed. Monothermal stimulation at 30°C and 44°C with unilateral weakness (UW) cut-off at 20% and 25% was compared to bithermal stimulation with cut-off at 25% (gold standard). The analysis was aimed at finding which kind of monothermal caloric test (30°C or 44°C) and which kind of cut-off (20% or 25%) presented the highest specificity and sensitivity values in comparison with bithermal caloric testing. RESULTS sensitivity and specificity of monothermal caloric tests were: 84% and 80%, at 30°C with UW at 20%; 78% and 90%, at 30°C with UW at 25%; 81% and 78%, at 44°C with UW at 20%; 76% and 85%, at 44°C with UW at 25%. CONCLUSION monothermal caloric testing with 30°C stimulus presented the highest sensibility and specificity values in comparison to the results obtained with bithermal stimulation. However, no significant difference was observed between such values and those obtained with 44°C stimulus. In all of the analyses, monothermal testing presented low sensitivity. Thus, the abnormal result of bithermal caloric testing might be seen as normal in monothermal stimulation. The use of monothermal testing as a screening tool is better recommended for individuals whose medical history suggests a low probability of vestibular disease.

Contribution of Galvanic Vestibular Stimulation for the Diagnosis of HTLV-1-Associated Myelopathy/Tropical Spastic Paraparesis.

Background and Purpose Galvanic vestibular stimulation (GVS) is a low-cost and safe examination for testing the vestibulospinal pathway. Human T-lymphotropic virus 1 (HTLV-1)-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that affects the vestibulospinal tract early in its course. This study compared the electromyographic (EMG) responses triggered by GVS of asymptomatic HTLV-1-infected subjects and subjects with HAM/TSP. Methods Bipolar galvanic stimuli (400 ms and 2 mA) were applied to the mastoid processes of 39 subjects (n=120 stimulations per subject, with 60 from each lower limb). Both the short latency (SL) and medium latency (ML) components of the EMG response were recorded from the soleus muscles of 13 healthy, HTLV-1-negative adults (56±5 years, mean±SD), and 26 individuals infected with HTLV-1, of whom 13 were asymptomatic (56±8 years) and 13 had HAM/TSP (60±6 years). Results The SL and ML EMG components were 55±4 and 112±10 ms, respectively, in the group of healthy subjects, 61±6 and 112±10 ms and in the HTLV-1-asymptomatic group, and 67±8 and 130±3 ms in the HAM/TSP group (p=0.001). The SL component was delayed in 4/13 (31%) of the examinations in the HTLV-1-asymptomatic group, while the ML component was normal in all of them. In the HAM/TSP group, the most common alteration was the absence of waves. Conclusions A pattern of abnormal vestibular-evoked EMG responses was found in HTLV-1-neurological disease, ranging from delayed latency among asymptomatic carriers to the absence of a response in HAM/TSP. GVS may contribute to the early diagnosis and monitoring of nontraumatic myelopathies.

Increased N200 and P300 latencies in cognitively impaired elderly carrying ApoE ε‐4 allele

To compare the results of neuropsychological tests, evoked potentials N200 and P300 and polymorphisms of ApoE and BDNF rs6265 between patients with normal cognition and those with mild cognitive impairment (MCI) and Alzheimers dementia (AD).

Vestibular evoked myogenic potential (VEMP) with galvanic stimulation in normal subjects

INTRODUCTION The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. AIM To describe VEMP generated by GVS. METHODS In this cross-sectional clinical study, VEMP was generated by 2 mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. RESULTS SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. CONCLUSION The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.Introduction: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. Aim: To describe VEMP generated by GVS. Methods: In this cross-sectional clinical study, VEMP was generated by 2mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. Results: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. Conclusion: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.

Potencial evocado miogênico vestibular (VEMP) com estímulo galvânico em indivíduos normais

INTRODUCTION The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. AIM To describe VEMP generated by GVS. METHODS In this cross-sectional clinical study, VEMP was generated by 2 mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. RESULTS SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. CONCLUSION The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.Introduction: The vestibular evoked myogenic potential (VEMP) generated by galvanic vestibular stimulation (GVS) is related to the vestibulo-spinal pathway. The response recorded from soleus muscle is biphasic with onset of short latency (SL) component around 60 ms and medium latency (ML) component around 100 ms. The first component reflects otolith function (sacule and utricle) and the last deals with semicircular canals. Aim: To describe VEMP generated by GVS. Methods: In this cross-sectional clinical study, VEMP was generated by 2mA/400 ms binaural GVS, frequency of 5-6 ms that was recorded from soleus muscles of 13 healthy adults, mean age 56 years. The subjects remained standing, head turned contralateral to the GVS applied to the mastoid. Thirty GVS were applied to the mastoid in the position cathode right anode left, followed by 30 in inverted position. SL and ML were measured. Results: SL and ML components were recorded from both legs of all participants and were similar. The average of SL component was 54 ms and of ML was 112 ms. Conclusion: The components SL and ML of the VEMP response in soleus were reproducible and are useful measures of vestibular-spinal function.

Contribution of galvanic vestibular stimulation for the diagnosis of HAM/TSP

Galvanic vestibular stimulation (GVS) is a low-cost and safe exam that tests the vestibulospinal pathway. HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) is a slowly progressive disease that precociously affects the vestibulospinal tract. This study compared electromyographic (EMG) responses triggered by GVS between asymptomatic individuals infected with HTLV-1 and those with HAM/TSP.

P300 Evoked Potential and Risk of Mild Cognitive ImpairmentProgression to Alzheimers Dementia: A Literature Review

Introduction: Great efforts have been made to develop diagnostic methods for precisely screen patients with mild cognitive impairment (MCI) who will progress to dementia. Many biomarkers have been studied for that. However, their high costs, small availability and need for invasive procedures sometimes make these biomarkers of limited usefulness. With the advantages of its low cost and being non-invasive, the P300 evoked potential (EP) is one methods under investigation. Objective: To assess whether the P300 evoked potential can estimate the risk of MCI progression to Alzheimer’s dementia (AD). Methods: Review of the PubMed database using the descriptors: “evoked potentials”, “Alzheimer’s disease” and “mild cognitive impairment”. Results: We selected eight among 929 articles after applying the exclusion criteria. From the articles we concluded that the electrode placed at the parietal region is the most effective and that the latency increase and amplitude decrease of the electrode reading are related to the higher risk of progression from MCI to a diagnosis of AD. Most of the selected studies sustain P300 EP to estimate the progression risk from MCI to AD. However, the low number of studies, small sample size and heterogeneous results are pointed as important limitations. Conclusion: The P300 represents a promising method to estimate the likelihood of the MCI progression to AD. However, more studies are needed to support P300 for daily clinical practice.