Economic burden of physical inactivity in hospitalizations due to dementia: a Brazilian nationwide study

Physical activity trajectories and their determinants in older adults with subjective cognitive decline: Results from a national cohort study

OBJECTIVES

This study aims to investigate the trajectories of physical activity among older adults with subjective cognitive decline and explore the determinants influencing these trajectories within a national cohort.

DESIGN

Cohort study.

METHODS

We used data from a national cohort called the China Health and Retirement Longitudinal Study and included 1063 participants. The short international physical activity questionnaire was used to measure the moderate-to-vigorous physical activity, and group-based trajectory modeling was applied to explore the moderate-to-vigorous physical activity trajectories. The predictors were selected based on the social-ecological model. Multinomial logistic regression was conducted to identify the predictors of physical activity trajectories.

RESULTS

Our findings reveal three trajectories of physical activity among older adults with subjective cognitive decline: the rapid decline group (10.35 %), stable inactive group (80.62 %), and rapid growth group (9.03 %). Several determinants emerged as significant predictors influencing these trajectories, including age, smoking status, body mass index, number of comorbidities, mobility activities of daily life, marital status, family size, frequency of social activities, and residence.

CONCLUSIONS

Our study highlights the predominance of the stable inactive group among older adults with subjective cognitive decline, emphasizing the need for targeted interventions. Addressing some modified determinants, such as smoking status, body mass index, number of comorbidities, mobility activities of daily life, family size, frequency of social activities, and residence is crucial for promoting physical activity in this population.

Physical inactivity and dementia in Brazil: a call to action

ABSTRACT. Low- and middle-income countries will house two-thirds of cases of dementia in the world by 2050, while the incidence is decreasing in some high-income countries. In Brazil, one in four cases of dementia can be attributable to physical inactivity. Considering the projected prevalence of dementia by 2050 in Brazil, well-coordinated task forces are needed to improve awareness of non-pharmacological approaches in order to reduce the current and projected burden of dementia in the country. In this study, we discussed the current scenario and perspectives of physical inactivity and dementia in Brazil.

Exploring the Recent Trends in Management of Dementia and Frailty: Focus on Diagnosis and Treatment

Dementia and frailty increase health adversities in older adults, which are topics of growing research interest. Frailty is considered to correspond to a biological syndrome associated with age. Frail patients may ultimately develop multiple dysfunctions across several systems, including stroke, transient ischemic attack, vascular dementia, Parkinson's disease, Alzheimer's disease, frontotemporal dementia, dementia with Lewy bodies, cortico-basal degeneration, multiple system atrophy, amyotrophic lateral sclerosis, and Creutzfeldt-Jakob disease. Patients with dementia and frailty often develop malnutrition and weight loss. Rigorous nutritional, pharmacological, and non-pharmacological interventions generally are required for these patients, which is a challenging issue for healthcare providers. A healthy diet and lifestyle instigated at an early age can reduce the risk of frailty and dementia. For optimal treatment, accurate diagnosis involving clinical evaluation, cognitive screening, essential laboratory evaluation, structural imaging, functional neuroimaging, and neuropsychological testing is necessary. Diagnosis procedures best apply the clinical diagnosis, identifying the cause(s) and the condition(s) appropriate for treatment. The patient's history, caregiver's interview, physical examination, cognitive evaluation, laboratory tests, and structural imaging should best be involved in the diagnostic process. Varying types of physical exercise can aid the treatment of these disorders. Nutrition maintenance is a particularly significant factor, such as exceptionally high-calorie dietary supplements and a Mediterranean diet to support weight gain. The core purpose of this article is to investigate trends in the management of dementia and frailty, focusing on improving diagnosis and treatment. Substantial evidence builds the consensus that a combination of balanced nutrition and good physical activity is an integral part of treatment. Notably, more evidence-based medicine knowledge is required.

Ethnoracial disparity among patients with dementia during COVID-19 pandemic

We aim to examine the effect of the COVID-19 pandemic on the ethnoracial disparities in hospitalizations due to dementia and its related outcomes, in Brazil. A longitudinal panel study was carried out with data extracted from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS). We assessed the number of hospital admission per 100,000 inhabitants, mean inpatient spending, and inpatient mortality rate due to dementia during the first semester of 2019 and 2020. Data were stratified by geographic region and ethnoracial groups (black, mixed, and white) based on skin color. We observed an overall reduction in hospital admissions, mean inpatient spending, and mortality rate between the first semester of 2019 and 2020. However, the reduction of hospitalization rates among black and mixed people was 105.3% and 121.1% greater than in whites, respectively. Mortality rate was decreased by 9% in whites and was increased by 65% and 43% in the black and mixed population, respectively. In the first semester of 2020, black and mixed patients had a higher risk of losing their lives due to dementia than white people. This disparity was not observed in the same period of 2019. In 2020, the inpatient mortality ratio reached the highest values among black individuals in all regions but the North (no data available). Since the beginning of the COVID-19 epidemic in Brazil, ethnoracial disparity in hospital admissions and mortality rates due to dementia has been heightened. Governmental actions and policies to mitigate this indirect effect of the pandemic on the Brazilian population are urgent.