Marco Túlio Gualberto Cintra

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.

Ascorbic acid, alpha-tocopherol, and beta-carotene reduce oxidative stress and proinflammatory cytokines in mononuclear cells of Alzheimer's disease patients.

Abstract Objectives The in vitro effect of a vitamin complex in generating and reducing oxidative species in peripheral blood mononuclear cells (PBMNC) and plasma of patients with Alzheimers disease (AD) and healthy subjects (HS) was evaluated. Methods Two concentrations of a vitamin complex ([A] and [20A]) with ascorbic acid, alpha-tocopherol, and beta-carotene were incubated with either mononuclear cells or plasma. The generation of oxidizing species was measured in a luminol-dependent chemiluminescence assay and the reducing response by the MTT dye reduction assay. The levels of cytokines (interleukin [IL]-1β, IL-6, and IL-4) were measured by sandwich enzyme-linked immunosorbent assay. Results Our results demonstrated that the increase in the vitamin complex concentration reduced the reactive oxygen species (ROS) production and enhanced cellular reduction capacity in cells of AD patients in concentration [20A]. Plasma reduction capacity rose significantly for both groups (AD and HS). Concentration [A] did not alter the IL-1β production, increased IL-4 production in both groups and lowered IL-6 production in AD cells. Concentration [20A] increased pro-inflammatory cytokines (IL-1β and IL-6) and decreased IL-4 production by PBMNC of HS leading to a pro-inflammatory status. Discussion The antioxidant vitamin complex was effective in reducing oxidative stress in PBMNC of AD patients by lowering ROS production, improving cellular antioxidant capacities and modifying cytokine induced inflammation.

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.

A Reanalysis of Cognitive-Functional Performance in Older Adults: Investigating the Interaction Between Normal Aging, Mild Cognitive Impairment, Mild Alzheimer's Disease Dementia, and Depression

Depressive symptoms are associated with cognitive-functional impairment in normal aging older adults (NA). However, less is known about this effect on people with mild Cognitive Impairment (MCI) and mild Alzheimers disease dementia (AD). We investigated this relationship along with the NA-MCI-AD continuum by reanalyzing a previously published dataset. Participants (N = 274) underwent comprehensive neuropsychological assessment including measures of Executive Function, Language/Semantic Memory, Episodic Memory, Visuospatial Abilities, Activities of Daily Living (ADL), and the Geriatric Depression Scale. MANOVA, logistic regression and chi-square tests were performed to assess the association between depression and cognitive-functional performance in each group. In the NA group, depressed participants had a lower performance compared to non-depressed participants in all cognitive and functional domains. However, the same pattern was not observed in the MCI group or in AD. The results suggest a progressive loss of association between depression and worse cognitive-functional performance along the NA-MCI-AD continuum.

18F-FDG PET/CT ON THE DIFFERENTIAL DIAGNOSIS BETWEEN MILD COGNITIVE IMPAIRMENT AND MILD ALZHEIMER'S DISEASE

Background: Previous structural and functional MRI studies support the hypothesis that the preclinical state of Alzheimer’s disease is distinct from normal aging. The aim of this study was to use diffusion tensor imaging (DTI) measures in order to determine the existence of white matter microstructural differences in preclinical Alzheimer’s disease subjects. Additional objective was to elucidate whether high cognitive reserve also has an influence on white matter changes, and thus aid preclinical Alzheimer’s disease subjects to tolerate a more advanced stage of white matter degeneration. Methods: Thirty-eight subjects with normal cognition were included. Nineteen were in the preclinical Alzheimer’s disease stage, with decreased cerebrospinal fluid amyloid-b (Ab 42,<500 pg/ml). Nineteen matched participants with normal Ab 42 levels were included as a control group. Fractional anisotropy, radial diffusivity, axial diffusivity and mean diffusivity maps were calculated for each participant using the eigenvalues extracted from the diffusion tensors. Voxel based analyses of DTI measures maps were performed using the Tract Based Spatial Statistics. Results:We encountered increases in axial diffusivity in preclinical Alzheimer’s disease relative to controls in corpus callosum, corona radiata, internal capsule and superior longitudinal fasciculus bilaterally, and also in the left fornix, left uncinate fasciculus and left inferior fronto-occipital fasciculus. However, no differences were found in other diffusion tensor imaging indexes. Interestingly, we found significant associations between axial diffusivity values and A b 42 levels (not with total tau or phospho-tau); cognitive reserve score was also positively associated with axial diffusivity exclusively in the preclinical Alzheimer’s disease group. The axial diffusivity index presented good sensitivity (84%) and specificity (79%) for discriminating preclinical Alzheimer’s disease from controls (area under the curve: 0.87). Conclusions: The results suggest that early white matter changes in preclinical Alzheimer’s disease can be detected by DTI. The finding of axial diffusivity alteration together with preserved fractional anisotropy and radial diffusivity indexes in the preclinical Alzheimer’s disease group may indicate that A b 42 levels may be associated with subtle axonal changes, while white matter integrity is still widely preserved. In addition, cognitive reserve seems to act as a buffer for these early white matter changes, preserving cognitive functioning in patients with more advanced structural damage.

The GAB2 and BDNF polymorphisms and the risk for late-onset Alzheimer's disease in an elderly Brazilian sample

BACKGROUND Evidences suggest that GAB2 and BDNF genes may be associated with Alzheimers disease (AD). We aimed to investigate the GAB2 rs2373115 and BDNF rs6265 polymorphisms and the risk of AD in a Brazilian sample. METHODS 269 AD patients and 114 controls were genotyped with Real-time PCR. Multifactor dimensionality reduction (MDR) was employed to explore the effects of gene-gene interactions. RESULTS GAB2 and BDNF were not associated with AD in our sample. Nevertheless BDNF Val allele (rs6265) presented a synergic association with the APOE ε4 allele. A multiple logistic regression demonstrated that the APOE ε4 allele and years of education were the best predictors for AD. In ε4 non-carriers sex, education and hypertension were independently correlated with AD, while in ε4 carriers we did not observe any association. The findings were further confirmed by bootstrapping method. CONCLUSIONS Our data suggest that the interaction of BDNF and APOE has significant effect on AD. Moreover in absence of ε4, female sex, low level of education and hypertension are independently associated with AD. Interventions aimed to prevent AD should focus on these factors and also taking into account the APOE alleles.

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).

EVALUATION OF PLATELET P-SELECTIN IN PATIENTS WITH ALZHEIMER'S DISEASE AND FRONTOTEMPORAL DEMENTIA

Background: Alcadeina (Alca) is a member of alcadein family composed of Alca, Alcb and Alcg, which is largely expressed in brain neuron and prone to form a tripartite complex with APP mediated by cytoplasmic neural-specific adaptor protein X11like (X11L). p3-Alca is generated from Alca by cleavage of aand g-secretases, and secreted into cerebrospinal fluid (CSF) and then into blood as does Ab from APP. The p3-Alca35 exists in CSF as a major species, as like as Ab40, while p3-Alca38 is minor as like as Ab42. p3-Alca is non-aggregatable so easily detected in CSF and plasma by sELISA (Hata 2009). To establish an effective AD diagnosis, we verified p3-Alca38/35, a ratio of p3-Alca38 to p3-Alca35. Methods: Previously, we showed the plasma level of p3-Alca35 using sELISAwith p3-Alca35 specific antibody (Omori 2014). To measure p3-Alca38/35 level, we tried to prepare new antibody raised to p3-Alca38 with higher affinity. Using cell surface display method, p3-Alca38 chimeric protein was expressed on cell surface and the cells were immunized. Several clones generating antibody specifically react to p3Alca38 were isolated, and we developed new sELISA system to quantify p3-Alca38 with higher sensitivity. Results:We first characterized the new sELISA systems to quantify p3-Alca38. With a combination of sELISA to quantify p3-Alca35, both p3-Alca35 and p3-Alca38 in body fluid were quantified. The levels p3Alca38/35 ratio in MCI and AD subjects showed a tendency increasing along with cognitive impairment degree compared to non-demented controls. The p3-Alca38/35 ratio significantly increased along with the increase of Ab42/40 ratio in vitro, while in vivo, the significant increase of p3-Alca38/35 correlated with the significant decrease of Ab42/40. Conclusions:Our study suggested that p3-Alca38/35 can be an effective biomarker of AD not only in CSF but also in plasma, which indicates a qualitative change of g-secretase activity. Further studies with samples from various cohorts (for example, with chronologically chasing and taking samples) will be performed to confirm the efficiency of p3-Alca38/35 as a biomarker to find prodromal and/or early stage MCI/AD subjects who shows an altered/attenuated g-secretase activity.

Remission of Cognitive Deficits in Parkinson's Disease: Recovery from a Nonamnestic Mild Cognitive Impairment or Psychiatric Symptoms Remission?

Mild cognitive impairment is a clinical condition more frequent in patients with Parkinsons disease than in general population. The nonamnestic presentations, usually characterized by executive dysfunction, are most prevalent. We present a case report of a Parkinsons disease patient diagnosed with nonamnestic mild cognitive impairment that showed complete remission of cognitive symptoms after one year. We discuss the possible causes for the remission, focusing on the treatment of medical conditions such as a major depressive episode and vitamin B12 deficiency, in addition to the change of pharmacological treatment. In a third assessment, cognitive performance remained normal. The case report highlights the importance of controlling clinical comorbidities on the assessment and followup of mild cognitive impairment, especially on Parkinsons disease.