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Li Y, Xin J, Fang S, Wang F, Jin Y, Wang L. Development and Validation of a Predictive Model for Early Identification of Cognitive Impairment Risk in Community-Based Hypertensive Patients. J Appl Gerontol 2024:7334648241257795. [PMID: 38832577 DOI: 10.1177/07334648241257795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
Objective: To investigate the risk factors for the development of mild cognitive dysfunction in hypertensive patients in the community and to develop a risk prediction model. Method: The data used in this study were obtained from two sources: the China Health and Retirement Longitudinal Study (CHARLS) and the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 1121 participants from CHARLS were randomly allocated into a training set and a validation set, following a 70:30 ratio. Meanwhile, an additional 4016 participants from CLHLS were employed for external validation of the model. The patients in this study were divided into two groups: those with mild cognitive impairment and those without. General information, employment status, pension, health insurance, and presence of depressive symptoms were compared between the two groups. LASSO regression analysis was employed to identify the most predictive variables for the model, utilizing 14-fold cross-validation. The risk prediction model for cognitive impairment in hypertensive populations was developed using generalized linear models. The model's discriminatory power was evaluated through the area under the receiver operating characteristic (ROC) curve and calibration curves. Results: In the modeling group, eight variables such as gender, age, residence, education, alcohol use, depression, employment status, and health insurance were ultimately selected from an initial pool of 21 potential predictors to construct the risk prediction model. The area under the curve (AUC) values for the training, internal, and external validation sets were 0.777, 0.785, and 0.782, respectively. All exceeded the threshold of 0.7, suggesting that the model effectively predicts the incidence of mild cognitive dysfunction in community-based hypertensive patients. A risk prediction model was developed using a generalized linear model in conjunction with Lasso regression. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve. Hosmer-Lemeshow test values yielded p = .346 and p = .626, both of which exceeded the 0.05 threshold. Calibration curves demonstrated a significant agreement between the nomogram model and observed outcomes, serving as an effective tool for evaluating the model's predictive performance. Discussion: The predictive model developed in this study serves as a promising and efficient tool for evaluating cognitive impairment in hypertensive patients, aiding community healthcare workers in identifying at-risk populations.
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Affiliation(s)
- Yan Li
- Shanxi Medical University, Taiyuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Jimei Xin
- Shanxi Medical University, Taiyuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Sen Fang
- Shanxi Medical University, Taiyuan, China
- Department of Geriatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Fang Wang
- Shanxi Medical University, Taiyuan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan, China
| | - Yufei Jin
- Shanxi Medical University, Taiyuan, China
- Department of Geriatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Lei Wang
- Shanxi Medical University, Taiyuan, China
- Department of Geriatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
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2
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Lauretani F, Longobucco Y, Ferrari Pellegrini F, De Iorio AM, Fazio C, Federici R, Gallini E, La Porta U, Ravazzoni G, Roberti MF, Salvi M, Zucchini I, Pelà G, Maggio M. Comprehensive Model for Physical and Cognitive Frailty: Current Organization and Unmet Needs. Front Psychol 2020; 11:569629. [PMID: 33324282 PMCID: PMC7725681 DOI: 10.3389/fpsyg.2020.569629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023] Open
Abstract
Aging is characterized by the decline and deterioration of functional cells and results in a wide variety of molecular damages and reduced physical and mental capacity. The knowledge on aging process is important because life expectancy is expected to rise until 2050. Aging cannot be considered a homogeneous process and includes different trajectories characterized by states of fitness, frailty, and disability. Frailty is a dynamic condition put between a normal functional state and disability, with reduced capacity to cope with stressors. This geriatric syndrome affects physical, neuropsychological, and social domains and is driven by emotional and spiritual components. Sarcopenia is considered one of the determinants and the biological substrates of physical frailty. Physical and cognitive frailty are separately approached during daily clinical practice. The concept of motoric cognitive syndrome has partially changed this scenario, opening interesting windows toward future approaches. Thus, the purpose of this manuscript is to provide an excursus on current clinical practice, enforced by aneddoctical cases. The analysis of the current state of the art seems to support the urgent need of comprehensive organizational model incorporating physical and cognitive spheres in the same umbrella.
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Affiliation(s)
- Fulvio Lauretani
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Yari Longobucco
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Aurelio Maria De Iorio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Chiara Fazio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Raffaele Federici
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Elena Gallini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Umberto La Porta
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giulia Ravazzoni
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Maria Federica Roberti
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy
| | - Giovanna Pelà
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Maggio
- Geriatric Clinic Unit, Medical Geriatric Rehabilitative Department, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
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Song DY, Wang XW, Wang S, Ge SQ, Ding GY, Chen XY, Chen YR, Liu HM, Xie XM, Xing WJ, Li D, Zhou Y. Jidong cognitive impairment cohort study: objectives, design, and baseline screening. Neural Regen Res 2020; 15:1111-1119. [PMID: 31823892 PMCID: PMC7034269 DOI: 10.4103/1673-5374.266070] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The risk of dementia increases in patients with cognitive impairment. However, it is not clear what factors contribute to the onset of dementia in those with cognitive impairment. In this prospective cohort study, we will investigate the every-five-year incidence of cognitive impairment and prognostic factors for cognitive impairment. The Jidong cognitive impairment cohort was established from April 2012 to August 2015, during which we recruited 5854 healthy participants (55.1% male) older than 45 years (mean, 57 years). Participants received a health examination in the Staff Hospital, Jidong Oilfield Branch, China National Petroleum Corporation. Baseline data and blood samples were collected. Cognitive impairment was evaluated using the Mini-Mental State Examination, and was defined as a Mini-Mental State Examination score of less than 24. Dementia was assessed using the criteria of Diagnostic and Statistical Manual of Mental Disorders (Fourth edition), the International Working Group criteria, and the Mini-Mental State Examination score. The follow-up will continue until December 2024, during which a prognostic model will be constructed. The primary outcome is the presence/absence of dementia and the secondary outcome is quality of life. Baseline screening results showed the following: (1) Cognitive impairment was apparent in 320 participants (5.5%). These participants will be excluded from the Jidong cohort study, and the remaining participants will be followed up. (2) Of the 320 participants with cognitive impairment, there was a significantly higher prevalence of illiteracy than other education levels (35.9%, P < 0.05). Age, arterial hypertension, alcohol consumption, and passive smoking differed significantly between the cognitive impairment and healthy groups (P < 0.05). Multivariate logistic regression models showed that age (odds ratio [OR] = 1.059, 95% confidence interval [CI]: 1.044–1.074) and arterial hypertension (OR = 1.665, 95% CI: 1.143–2.427) were risk factors for mild cognitive impairment. With the increase of educational level (illiteracy, primary school, junior high school, high school, university, and above), cognitive impairment gradually decreased (OR < 1, P < 0.05). (3) This cohort study has initially screened for several risk factors for cognitive impairment at baseline, and subsequent prospective data will further describe, validate, and evaluate the effects of these risk factors on cognitive impairment and dementia. These results can provide clinical evidence for the early prevention of cognitive impairment and dementia. The study was approved by the Ethics Committee of Kailuan General Hospital of Tangshan City and the Medical Ethics Committee, Staff Hospital, Jidong Oilfield Branch, China National Petroleum Corporation on July 12, 2013 (approval No. 2013 YILUNZI 1).
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Affiliation(s)
- Dai-Yu Song
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China; School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xian-Wei Wang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Sa Wang
- Department of Neurology, The Affiliated Wenling Hospital of Wenzhou Medical University, Wenling, Zhejiang Province, China
| | - Si-Qi Ge
- Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, Beijing, China
| | - Guo-Yong Ding
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Xue-Yu Chen
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Yan-Ru Chen
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Hua-Min Liu
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Xiao-Mei Xie
- Staff hospital of jidong oilfield, Caofeidian district, Tangshan, Hebei Province, China
| | - Wei-Jia Xing
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Dong Li
- School of public health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, Shandong Province, China
| | - Yong Zhou
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
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Foucault G, Duval GT, Simon R, Beauchet O, Dinomais M, Annweiler C. Serum Vitamin D and Cingulate Cortex Thickness in Older Adults: Quantitative MRI of the Brain. Curr Alzheimer Res 2019; 16:1063-1071. [DOI: 10.2174/1567205016666191113124356] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 10/15/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Background:
Vitamin D insufficiency is associated with brain changes, and cognitive and
mobility declines in older adults.
Method:
Two hundred and fifteen Caucasian older community-dwellers (mean±SD, 72.1±5.5years;
40% female) received a blood test and brain MRI. The thickness of perigenual anterior cingulate cortex,
midcingulate cortex and posterior cingulate cortex was measured using FreeSurfer from T1-weighted
MR images. Age, gender, education, BMI, mean arterial pressure, comorbidities, use of vitamin D supplements
or anti-vascular drugs, MMSE, GDS, IADL, serum calcium and vitamin B9 concentrations,
creatinine clearance were used as covariables.
Results:
Participants with vitamin D insufficiency (n=80) had thinner total cingulate thickness than the
others (24.6±1.9mm versus 25.3±1.4mm, P=0.001); a significant difference found for all 3 regions. Vitamin
D insufficiency was cross-sectionally associated with a decreased total cingulate thickness (β=-
0.49, P=0.028). Serum 25OHD concentration correlated positively with the thickness of perigenual anterior
(P=0.011), midcingulate (P=0.013) and posterior cingulate cortex (P=0.021).
Conclusion:
Vitamin D insufficiency was associated with thinner cingulate cortex in the studied sample
of older adults. These findings provide insight into the pathophysiology of cognitive and mobility declines
in older adults with vitamin D insufficiency.
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Affiliation(s)
- Gonzague Foucault
- Department of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, Angers, France
| | - Guillaume T Duval
- Department of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, Angers, France
| | - Romain Simon
- Department of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, Angers, France
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Mickael Dinomais
- School of Medicine, Health Faculty, University of Angers, France
| | - Cédric Annweiler
- Department of Geriatric Medicine, Angers University Hospital, Angers University Memory Clinic, Research Center on Autonomy and Longevity, UPRES EA 4638, University of Angers, Angers, France
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Ziso B, Larner AJ. Codex (Cognitive Disorders Examination) Decision Tree Modified for the Detection of Dementia and MCI. Diagnostics (Basel) 2019; 9:E58. [PMID: 31159432 PMCID: PMC6628135 DOI: 10.3390/diagnostics9020058] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 11/20/2022] Open
Abstract
Many cognitive screening instruments are available to assess patients with cognitive symptoms in whom a diagnosis of dementia or mild cognitive impairment is being considered. Most are quantitative scales with specified cut-off values. In contrast, the cognitive disorders examination or Codex is a two-step decision tree which incorporates components from the Mini-Mental State Examination (MMSE) (three word recall, spatial orientation) along with a simplified clock drawing test to produce categorical outcomes defining the probability of dementia diagnosis and, by implication, directing clinician response (reassurance, monitoring, further investigation, immediate treatment). Codex has been shown to have high sensitivity and specificity for dementia diagnosis but is less sensitive for the diagnosis of mild cognitive impairment (MCI). We examined minor modifications to the Codex decision tree to try to improve its sensitivity for the diagnosis of MCI, based on data extracted from studies of two other cognitive screening instruments, the Montreal Cognitive Assessment and Free-Cog, which are more stringent than MMSE in their tests of delayed recall. Neither modification proved of diagnostic value for mild cognitive impairment. Possible explanations for this failure are considered.
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Affiliation(s)
- Besa Ziso
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK.
| | - Andrew J Larner
- Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK.
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Brangier A, Celle S, Roche F, Beauchet O, Ferland G, Annweiler C. Use of Vitamin K Antagonists and Brain Morphological Changes in Older Adults: An Exposed/Unexposed Voxel-Based Morphometric Study. Dement Geriatr Cogn Disord 2018; 45:18-26. [PMID: 29486479 DOI: 10.1159/000485793] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/24/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Vitamin K antagonists (VKAs) are commonly used for their role in haemostasis by interfering with the vitamin K cycle. Since vitamin K also participates in brain physiology, this voxel-based morphometric study aimed to determine whether the duration of exposure to VKAs correlated with focal brain volume reduction in older adults. METHODS In this exposed/unexposed (1: 2) study nested within the GAIT (Gait and Alzheimer Interactions Tracking) cohort, 18 participants exposed to VKA (mean age 75 ± 5 years; 33.3% female; mean exposure 2,122 ± 1,799 days) and 36 matched participants using no VKA (mean age 75 ± 5 years; 33.3% female) underwent MRI scanning of the brain. Cortical grey and white matter volumes were automatically segmented using statistical parametric mapping. Age, gender, educational level, history of atrial fibrillation, type of MRI, and total intracranial volume were included as covariables. RESULTS The duration of exposure to VKA correlated inversely across the whole brain with the subvolumes of two clusters in the grey matter (right frontal inferior operculum and right precuneus) and one cluster in the white matter (left middle frontal gyrus). In contrast, the grade of white matter hyperintensities did not differ according to the use of VKA. CONCLUSION We found focal atrophies in older adults exposed to VKA. These findings provide new insights elucidating the effects of VKAs on brain health and function in older adults.
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Affiliation(s)
- Antoine Brangier
- Department of Geriatric Medicine and Memory Clinic, Angers University Hospital, UPRES EA 4638, University of Angers, Angers, France
| | - Sébastien Celle
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne, Saint-Etienne, France.,EA 4607 "SNA EPIS" Faculté de Médecine J. Lisfranc UJM, PRES Université de Lyon, Lyon, France
| | - Frédéric Roche
- Service de Physiologie Clinique et de l'Exercice, CHU Saint-Etienne, Saint-Etienne, France.,EA 4607 "SNA EPIS" Faculté de Médecine J. Lisfranc UJM, PRES Université de Lyon, Lyon, France
| | - Olivier Beauchet
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Québec, Canada
| | - Guylaine Ferland
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, Québec, Canada
| | - Cédric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Angers University Hospital, UPRES EA 4638, University of Angers, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario, Canada
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Brangier A, Ferland G, Rolland Y, Gautier J, Féart C, Annweiler C. Vitamin K Antagonists and Cognitive Decline in Older Adults: A 24-Month Follow-Up. Nutrients 2018; 10:E666. [PMID: 29794977 PMCID: PMC6024671 DOI: 10.3390/nu10060666] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/29/2018] [Accepted: 05/14/2018] [Indexed: 12/12/2022] Open
Abstract
Vitamin K participates in brain physiology. This study aimed to determine whether using vitamin K antagonists (VKAs), which interfere with the vitamin K cycle, were (i) cross-sectionally associated with altered cognitive performance, and (ii) independent predictors of cognitive changes in older adults over 24 months. Information was collected on the use of VKAs (i.e., warfarin, acenocoumarol, and fluindione) among 378 geriatric outpatients (mean, 82.3 ± 5.6 years; 60.1% female). Global cognitive performance and executive functions were assessed with Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) scores, respectively, at baseline and after 12 and 24 months of follow-up. Age, gender, body mass index, mean arterial pressure, disability, gait speed, comorbidities, atrial fibrillation, stroke, carotid artery stenosis, leukoaraiosis grade on computed tomography (CT) scan, psychoactive drugs, antidementia drugs, blood-thinning drugs (i.e., anticoagulants other than VKAs, antiplatelet medications), serum creatinine levels, and vitamin B12 concentrations were considered as potential confounders. Using VKAs was associated with lower (i.e., worse) FAB score at baseline (adjusted β = -2.1, p = 0.026), and with a decrease in FAB score after 24 months (adjusted β = -203.6%, p = 0.010), but not after 12 months (p = 0.659). Using VKAs was not associated with any change in MMSE score at baseline (p = 0.655), after 12 months (p = 0.603), or after 24 months (p = 0.201). In conclusion, we found more severe executive dysfunction at baseline and incident executive decline over 24 months among geriatric patients using VKAs, when compared with their counterparts.
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Affiliation(s)
- Antoine Brangier
- Department of Geriatric Medicine, University Memory Clinic; Research Center on Autonomy and Longevity (CeRAL), University Hospital, F-49933 Angers, France.
| | - Guylaine Ferland
- Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada.
| | - Yves Rolland
- Department of Geriatric Medicine, Institut du Vieillissement, University Hospital, INSERM-U1027, F-31000 Toulouse, France.
| | - Jennifer Gautier
- Department of Geriatric Medicine, University Memory Clinic; Research Center on Autonomy and Longevity (CeRAL), University Hospital, F-49933 Angers, France.
| | - Catherine Féart
- Institut de Santé Publique, d'Épidémiologie et de Développement ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Université Bordeaux, F-33000 Bordeaux, France.
| | - Cedric Annweiler
- Department of Geriatric Medicine, University Memory Clinic; Research Center on Autonomy and Longevity (CeRAL), University Hospital, F-49933 Angers, France.
- Health Faculty and UPRES EA4638, University of Angers, F-49100 Angers, France.
- Robarts Research Institute, The University of Western Ontario, London, ON N6A 5B7, Canada.
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8
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Lourenco J, Serrano A, Santos-Silva A, Gomes M, Afonso C, Freitas P, Paul C, Costa E. Cardiovascular Risk Factors Are Correlated with Low Cognitive Function among Older Adults Across Europe Based on The SHARE Database. Aging Dis 2018; 9:90-101. [PMID: 29392084 PMCID: PMC5772862 DOI: 10.14336/ad.2017.0128] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 01/28/2017] [Indexed: 12/24/2022] Open
Abstract
Increased life expectancy is associated with a high prevalence of chronic, non-communicable diseases including cognitive decline and dementia. The purpose of this study was to evaluate the prevalence of cognitive impairment using three cognitive abilities (verbal fluency, numeracy and perceived memory) and their association with cardiovascular risk factors in seniors across Europe. Data from participants in wave 4 of the SHARE (Survey of Health, Ageing, and Retirement in Europe) database was used. Cognitive performance in perceived memory, verbal fluency and numeracy was evaluated using simple tests and a memory complaints questionnaire. Clinical and sociodemographic variables were also studied for potential associations. Standardised prevalence rates of cognitive impairment based on age and gender were calculated by country. The prevalence of cognitive impairment was 28.02% for perceived memory, 27.89% for verbal fluency and 20.75% for numeracy throughout the 16 evaluated countries. Years of education, being a current or former smoker, number of chronic diseases, diabetes or hyperglycemia, heart attack and stroke were all independent variables associated with impairment in the three studied cognitive abilities. We also found independent associations between physical inactivity and verbal fluency and numeracy impairment, as well as hypertension and perceived memory impairment. Lower performance in the evaluated cognitive abilities and higher memory complaints are highly prevalent, have a heterogeneous distribution across Europe, and are associated with multiple factors, most of which are potentially preventable or treatable, especially cardiovascular risk factors.
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Affiliation(s)
- Joana Lourenco
- 1Family Health Unit of Pedras Rubras, Maia, Portugal.,2Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal.,3Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | | | - Alice Santos-Silva
- 4UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Marcos Gomes
- 4UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Claudia Afonso
- 2Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Paula Freitas
- 5Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Porto, Portugal.,6Faculty of Medicine, University of Porto, Porto, Portugal
| | - Constanca Paul
- 3Center for Health Technology and Services Research (CINTESIS), Porto, Portugal.,7Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
| | - Elisio Costa
- 4UCIBIO, REQUIMTE and Faculty of Pharmacy, University of Porto, Porto, Portugal
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Delphin-Combe F, Bathsavanis A, Rouch I, Liles T, Vannier-Nitenberg C, Fantino B, Dauphinot V, Krolak-Salmon P. Relationship between anxiety and cognitive performance in an elderly population with a cognitive complaint. Eur J Neurol 2016; 23:1210-7. [DOI: 10.1111/ene.13004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- F. Delphin-Combe
- Clinical and Research Memory Center of Lyon; Hôpital des Charpennes; Hospices Civils de Lyon; Lyon France
| | - A. Bathsavanis
- Clinical and Research Memory Center of Lyon; Hôpital des Charpennes; Hospices Civils de Lyon; Lyon France
| | - I. Rouch
- Clinical and Research Memory Center of Lyon; Hôpital des Charpennes; Hospices Civils de Lyon; Lyon France
- Neurology Unit; University Hospital of Saint-Etienne; Saint Etienne France
| | - T. Liles
- University Catholique of Lyon; Lyon France
| | | | - B. Fantino
- Division of Geriatric Medicine; Department of Neuroscience; Angers University Hospital; Angers France
| | - V. Dauphinot
- Clinical and Research Memory Center of Lyon; Hôpital des Charpennes; Hospices Civils de Lyon; Lyon France
| | - P. Krolak-Salmon
- Clinical and Research Memory Center of Lyon; Hôpital des Charpennes; Hospices Civils de Lyon; Lyon France
- University Lyon I; Lyon France
- INSERM U1028; CNRS UMR5292; Lyon Neuroscience Research Center; Lyon France
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Vannier-Nitenberg C, Dauphinot V, Bongue B, Sass C, Bathsavanis A, Rouch I, Deville N, Beauchet O, Krolak-Salmon P, Fantino B. Performance of cognitive tests, individually and combined, for the detection of cognitive disorders amongst community-dwelling elderly people with memory complaints: the EVATEM study. Eur J Neurol 2015; 23:554-61. [PMID: 26518736 DOI: 10.1111/ene.12888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 09/02/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Dementia is a leading cause of dependence amongst the aged population. Early identification of cognitive impairment could help to delay advanced stages of dependence. This study aimed at assessing the performance of three neuropsychological tests to detect cognitive disorders in elderly subjects with memory complaints. METHODS The EVATEM study is a prospective multicentre cohort with a 1-year follow-up. Subjects with memory complaints were selected during preventive health examinations, and three neuropsychological tests (five-word, cognitive disorders examination, verbal fluency) were administered. Two groups were identified in memory clinics: (i) cognitively healthy individuals (CHI) and (ii) mild cognitive impairment or demented individuals (MCI-DI). Cross-sectional analyses were performed on data at inclusion. The relationship between the diagnosis of MCI-DI/CHI and the neuropsychological tests was assessed using logistic regressions. The performance of the neuropsychological tests, individually and combined, to detect cognitive disorders was calculated. RESULTS Of 585 subjects, 31.11% had cognitive disorders (MCI, 176 subjects; DI, six subjects). Amongst the three tests studied, the odds ratio for MCI-DI was higher for the five-word test <10 [odds ratio 3.2 (1.81; 5.63)]. The best performance was observed when the three tests were combined: specificity 90.5% and sensitivity 42.4% compared to respectively 89.2% and 28.3% for the five-word test. CONCLUSIONS Despite the poor sensitivity of the five-word test, it seems to be the most adapted for the diagnosis of MCI-DI in older adults with a memory complaint, in prevention centres, taking into account its high specificity and its rapid administration compared to the other tests.
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Affiliation(s)
| | - V Dauphinot
- Centre Mémoire de Ressources et de Recherche (CMRR) Lyon, Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France
| | - B Bongue
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (CETAF), Saint-Etienne, France.,Laboratory EA4607 SNA-EPIS, PRES Lyon, Jean Monnet University of Saint Etienne, Saint Etienne, France
| | - C Sass
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (CETAF), Saint-Etienne, France
| | - A Bathsavanis
- Centre Mémoire de Ressources et de Recherche (CMRR) Lyon, Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France
| | - I Rouch
- Centre Mémoire de Ressources et de Recherche (CMRR) Lyon, Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France.,CMRR de Saint Etienne, Service de Neurologie, CHU de Saint Etienne, Saint Etienne Cedex, France
| | - N Deville
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (CETAF), Saint-Etienne, France
| | - O Beauchet
- Centre Technique d'Appui et de Formation des Centres d'Examens de Santé (CETAF), Saint-Etienne, France.,Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France
| | - P Krolak-Salmon
- Centre Mémoire de Ressources et de Recherche (CMRR) Lyon, Hôpital des Charpennes, Hospices civils de Lyon, Villeurbanne, France.,Inserm U1028, CNRS UMR5292, Lyon Neuroscience Research Center, Brain Dynamics and Cognition Team, Lyon, France.,University Lyon 1, Lyon, France
| | - B Fantino
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, Angers, France.,Filiéris, Caisse Autonome Nationale de la Sécurité Sociale dans les Mines, Paris, France
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Age-Related Vitamin D Deficiency Is Associated with Reduced Macular Ganglion Cell Complex: A Cross-Sectional High-Definition Optical Coherence Tomography Study. PLoS One 2015; 10:e0130879. [PMID: 26090872 PMCID: PMC4474669 DOI: 10.1371/journal.pone.0130879] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 05/26/2015] [Indexed: 01/06/2023] Open
Abstract
Background Vitamin D deficiency is associated with smaller volume of optic chiasm in older adults, indicating a possible loss of the visual axons and their cellular bodies. Our objective was to determine whether vitamin D deficiency in older adults is associated with reduced thickness of the ganglion cell complex(GCC) and of the retinal nerve fibre layer(RNFL), as measured with high-definition optical coherence tomography(HD-OCT). Methods Eighty-five French older community-dwellers without open-angle glaucoma and patent age-related macular degeneration(mean, 71.1±4.7years; 45.9%female) from the GAIT study were separated into 2 groups according to serum 25OHD level(i.e., deficient≤25nmol/L or sufficient>25nmol/L). Measurements of GCC and RNFL thickness were performed using HD-OCT. Age, gender, body mass index, number of comorbidities, dementia, functional autonomy, intracranial volume, visual acuity, serum calcium concentration and season of testing were considered as potential confounders. Results Mean serum 25OHD concentration was 58.4±26.8nmol/L. Mean logMAR visual acuity was 0.03±0.06. Mean visual field mean deviation was -1.25±2.29dB. Patients with vitamin D deficiency(n=11) had a reduced mean GCC thickness compared to those without vitamin D deficiency(72.1±7.4μm versus 77.5±7.5μm, P=0.028). There was no difference of the mean RNFL thickness in these two groups(P=0.133). After adjustment for potential confounders, vitamin D deficiency was associated with reduced GCC thickness(ß=-5.12, P=0.048) but not RNFL thickness(ß=-9.98, P=0.061). Specifically, vitamin D deficiency correlated with the superior medial GCC area(P=0.017) and superior temporal GCC area(P=0.010). Conclusions Vitamin D deficiency in older patients is associated with reduced mean GCC thickness, which can represent an early stage of optic nerve damage, prior to RNFL loss.
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12
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Annweiler C, Bartha R, Karras SN, Gautier J, Roche F, Beauchet O. Vitamin D and white matter abnormalities in older adults: A quantitative volumetric analysis of brain MRI. Exp Gerontol 2015; 63:41-7. [DOI: 10.1016/j.exger.2015.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/05/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
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Vitamin D-related changes in intracranial volume in older adults: A quantitative neuroimaging study. Maturitas 2015; 80:312-7. [DOI: 10.1016/j.maturitas.2014.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/18/2014] [Accepted: 12/19/2014] [Indexed: 01/01/2023]
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14
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Verghese J, Annweiler C, Ayers E, Barzilai N, Beauchet O, Bennett DA, Bridenbaugh SA, Buchman AS, Callisaya ML, Camicioli R, Capistrant B, Chatterji S, De Cock AM, Ferrucci L, Giladi N, Guralnik JM, Hausdorff JM, Holtzer R, Kim KW, Kowal P, Kressig RW, Lim JY, Lord S, Meguro K, Montero-Odasso M, Muir-Hunter SW, Noone ML, Rochester L, Srikanth V, Wang C. Motoric cognitive risk syndrome: multicountry prevalence and dementia risk. Neurology 2014; 83:718-26. [PMID: 25031288 PMCID: PMC4150127 DOI: 10.1212/wnl.0000000000000717] [Citation(s) in RCA: 303] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Our objective is to report prevalence of motoric cognitive risk syndrome (MCR), a newly described predementia syndrome characterized by slow gait and cognitive complaints, in multiple countries, and its association with dementia risk. METHODS Pooled MCR prevalence analysis of individual data from 26,802 adults without dementia and disability aged 60 years and older from 22 cohorts from 17 countries. We also examined risk of incident cognitive impairment (Mini-Mental State Examination decline ≥4 points) and dementia associated with MCR in 4,812 individuals without dementia with baseline Mini-Mental State Examination scores ≥25 from 4 prospective cohort studies using Cox models adjusted for potential confounders. RESULTS At baseline, 2,808 of the 26,802 participants met MCR criteria. Pooled MCR prevalence was 9.7% (95% confidence interval [CI] 8.2%-11.2%). MCR prevalence was higher with older age but there were no sex differences. MCR predicted risk of developing incident cognitive impairment in the pooled sample (adjusted hazard ratio [aHR] 2.0, 95% CI 1.7-2.4); aHRs were 1.5 to 2.7 in the individual cohorts. MCR also predicted dementia in the pooled sample (aHR 1.9, 95% CI 1.5-2.3). The results persisted even after excluding participants with possible cognitive impairment, accounting for early dementia, and diagnostic overlap with other predementia syndromes. CONCLUSION MCR is common in older adults, and is a strong and early risk factor for cognitive decline. This clinical approach can be easily applied to identify high-risk seniors in a wide variety of settings.
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Affiliation(s)
- Joe Verghese
- Authors' affiliations are listed at the end of the article.
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15
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Annweiler C, Annweiler T, Bartha R, Herrmann FR, Camicioli R, Beauchet O. Vitamin D and white matter abnormalities in older adults: a cross-sectional neuroimaging study. Eur J Neurol 2014; 21:1436-e95. [PMID: 25041065 DOI: 10.1111/ene.12511] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/26/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Morphological brain changes related to hypovitaminosis D have been poorly studied. In particular, the age-related decrease in vitamin D concentrations may explain the onset of white matter abnormalities (WMA) in older adults. Our objectives were (i) to investigate whether there was an association between serum 25-hydroxyvitamin D (25OHD) concentration and the grade of WMA in older adults and (ii) to determine whether the location of WMA was associated with 25OHD concentration. METHODS One hundred and thirty-three Caucasian older community-dwellers with no clinical hydrocephalus (mean 71.6 ± 5.6 years; 43.6% female) received a blood test and a magnetic resonance imaging scan of the brain. The grades of total, periventricular and deep WMA were scored using semiquantitative visual rating scales from T2-weighted fluid-attenuated inversion recovery images. The association of WMA with as-measured and deseasonalized 25OHD concentrations was evaluated with the following covariates: age, gender, body mass index, use of anti-vascular drugs, number of comorbidities, impaired mobility, education level, Mini-Mental State Examination score, medial temporal lobe atrophy, serum concentrations of calcium, thyroid-stimulating hormone and vitamin B12, and estimated glomerular filtration rate. RESULTS Both as-measured and deseasonalized serum 25OHD concentrations were found to be inversely associated with the grade of total WMA (adjusted β = -0.32, P = 0.027), specifically with periventricular WMA (adjusted β = -0.15, P = 0.009) but not with deep WMA (adjusted β = -0.12, P = 0.090). Similarly, participants with 25OHD concentration <75 nM had on average a 33% higher grade of periventricular WMA than those with 25OHD ≥75 nM (P = 0.024). No difference in average grade was found for deep WMA (P = 0.949). CONCLUSIONS Lower serum 25OHD concentration was associated with higher grade of WMA, particularly periventricular WMA. These findings provide a scientific basis for vitamin D replacement trials.
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Affiliation(s)
- C Annweiler
- Department of Neuroscience, Division of Geriatric Medicine, University Memory Clinic, Angers University Hospital, Angers, France; UPRES EA4638, University of Angers, UNAM, Angers, France; Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Annweiler C, Montero-Odasso M, Bartha R, Drozd J, Hachinski V, Beauchet O. Association between gait variability and brain ventricle attributes: a brain mapping study. Exp Gerontol 2014; 57:256-63. [PMID: 24971908 DOI: 10.1016/j.exger.2014.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND It remains unknown which brain regions are involved in the maintenance of gait dynamic stability in older adults, as characterized by a low stride time variability. Expansion of lateral cerebral ventricles is an indirect marker of adjacent brain tissue volume. The purpose of this study was to examine the association between stride time variability and the volume of sub-regions of the lateral cerebral ventricles among older community-dwellers. METHODS One-hundred-fifteen participants free of hydrocephalus from the GAIT study (mean, 70.4±4.4years; 43.5% female) were included in this analysis. Stride time variability was measured at self-selected pace with a 10m electronic portable walkway (GAITRite). Participants were separated into 3 groups based on tertiles of stride time variability (i.e., <2.0%; 2.0-2.8%; >2.8%). Brain ventricle sub-volumes were quantified from three-dimensional T1-weighted MRI using semi-automated software. Age, gender, Cumulative Illness Rating Scale for Geriatrics, Mini-Mental State Examination, Go-NoGo, brain vascular burden, 4-item Geriatric Depression Scale, psychoactive drugs, vision, proprioception, body mass index, muscular strength and gait velocity were used as covariates. RESULTS Participants with the highest (i.e., worst) tertile of stride time variability exhibited larger temporal horns than those with the lowest (P=0.030) and intermediate tertiles (P=0.028). They also had larger middle portions of ventricular bodies than those with the intermediate tertile (P=0.018). Larger temporal horns were associated with increase in stride time variability (adjusted β=0.86, P=0.005), specifically with the highest tertile of stride time variability (adjusted OR=2.45, P=0.044). CONCLUSIONS Higher stride time variability was associated with larger temporal horns in older community-dwellers. Addressing focal neuronal losses in temporal lobes may represent an important strategy to prevent gait instability.
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Affiliation(s)
- Cedric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, University Memory Clinic of Angers, UPRES EA 4638, University of Angers, UNAM, Angers, France; Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, St. Joseph's Health Care London, Gait and Brain Lab, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada; Center for Functional and Metabolic Mapping, Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
| | - Manuel Montero-Odasso
- Department of Medicine, Division of Geriatric Medicine, Parkwood Hospital, St. Joseph's Health Care London, Gait and Brain Lab, Lawson Health Research Institute, University of Western Ontario, London, Ontario, Canada
| | - Robert Bartha
- Center for Functional and Metabolic Mapping, Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - John Drozd
- Center for Functional and Metabolic Mapping, Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Vladimir Hachinski
- Department of Clinical Neurological Sciences, University Hospital, University of Western Ontario, London, Ontario, Canada
| | - Olivier Beauchet
- Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, University Memory Clinic of Angers, UPRES EA 4638, University of Angers, UNAM, Angers, France
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Samelli AG, Rondon S, Oliver FC, Junqueira SR, Molini-Avejonas DR. Referred speech-language and hearing complaints in the western region of São Paulo, Brazil. Clinics (Sao Paulo) 2014; 69:413-9. [PMID: 24964306 PMCID: PMC4050326 DOI: 10.6061/clinics/2014(06)08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 12/11/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints. METHOD This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions. RESULTS Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment. CONCLUSIONS The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.
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Affiliation(s)
- Alessandra Giannella Samelli
- Communications Sciences and Disorders and Occupacional Therapy, Physiotherapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silmara Rondon
- Communications Sciences and Disorders and Occupacional Therapy, Physiotherapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fátima Correa Oliver
- Communications Sciences and Disorders and Occupacional Therapy, Physiotherapy, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Simone Rennó Junqueira
- Departamento de Odontologia Social, Faculdade de Odontologia, Universidade de São Paulo, São Paulo, SP, Brazil
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