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Mimenza-Alvarado AJ, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla A, Martínez I, Moreno M, Reyes-Sánchez AA, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Sotelo J, Verástegui E, Vilar-Compte D, Toussaint S. [Clinical research and the pharmaceutical industry]. GAC MED MEX 2023; 159. [PMID: 36857554 DOI: 10.24875/gmm.22000279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 03/03/2023] Open
Affiliation(s)
- Alberto J Mimenza-Alvarado
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Miguel A Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Judith Domínguez-Cherit
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Sergio Islas-Andrade
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Armando Mansilla
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Iris Martínez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Alejandro A Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Luisa L Rocha-Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Guillermo J Ruiz-Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Diana Vilar-Compte
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
| | - Sonia Toussaint
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina, Ciudad de México, México
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Islas-Andrade S, Rocha-Arrieta LL, Arrieta O, Celis MA, Domínguez-Cherit J, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Moreno M, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, Verástegui E. Cannabinoides y su uso terapéutico. GAC MED MEX 2023. [DOI: 10.24875/gmm.22000184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Aguilar-Navarro SG, Carbajal-Silva JC, Palacios-Hernández MGI, Gutiérrez-Gutierrez LA, Avila-Funes JA, Mimenza-Alvarado AJ. Asociación entre los niveles de vitamina B<sub>12</sub> y el deterioro cognitivo en personas mayores. GAC MED MEX 2023. [DOI: 10.24875/gmm.22000187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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Aguilar-Navarro SG, Carbajal-Silva JC, Palacios-Hernández MGI, Gutiérrez-Gutierrez LA, Ávila-Funes JA, Mimenza-Alvarado AJ. Association between vitamin B 12 levels and cognitive impairment in older adults. GAC MED MEX 2023; 159:32-37. [PMID: 36930548 DOI: 10.24875/gmm.m22000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Whether vitamin B12 deficiency is associated with cognitive impairment remains controversial. OBJECTIVE To determine the association between vitamin B12 serum levels and cognitive performance. METHODS Two-hundred and forty-one adults aged ≥ 60 years who had serum vitamin B12 serum levels measurement were included. Physical and cognitive evaluation was carried out, and three groups were formed: normal cognition (NC), mild cognitive impairment (MCI) and dementia. Vitamin B12 levels were classified as sufficiency (> 400 pg/mL), subclinical deficiency (201-400 pg/mL), and absolute deficiency (≤ 200 pg/mL). Multivariate linear regression analysis was used to evaluate the association between cognitive function and vitamin B12 levels after controlling for confounding variables. RESULTS Mean age was 81.4 ± 8.0 years; 68% were females; 17.8 % and 39.8% had absolute and subclinical vitamin B12 deficiency, respectively; 80 individuals (33%) met the criteria for MCI, and 70 (29%), for dementia. Those with MCI and dementia had lower vitamin B12 levels in comparison with those with NC after adjusting for age, gender and educational level (p = 0.019). CONCLUSIONS A statistically significant association was observed between global cognitive performance and levels of vitamin B12.
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Affiliation(s)
| | | | | | - Lidia A Gutiérrez-Gutierrez
- Department of Neurology and Psychiatry. Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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Mimenza-Alvarado AJ, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Lifshitz A, Mansilla A, Martínez I, Moreno M, Reyes-Sánchez AA, Rocha-Arrieta LL, Argüelles GJR, Sotelo J, Verástegui E, Vilar-Compte D, Toussaint S. Clinical research and the pharmaceutical industry. GAC MED MEX 2023; 159:89-90. [PMID: 37094241 DOI: 10.24875/gmm.m22000754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Affiliation(s)
- Alberto J Mimenza-Alvarado
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Oscar Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Miguel A Celis
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sergio Islas-Andrade
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alberto Lifshitz
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Armando Mansilla
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Iris Martínez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Mucio Moreno
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Alejandro A Reyes-Sánchez
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Guillermo J Ruiz Argüelles
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Julio Sotelo
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Emma Verástegui
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Diana Vilar-Compte
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
| | - Sonia Toussaint
- Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Academia Nacional de Medicina de México, Mexico City, Mexico
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Moreno M, Arrieta O, Celis MA, Domínguez J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Verástegui E, Rocha-Arrieta LL, Toussaint S, Vilar-Compte D, Sotelo J. Who judges medical practice? GAC MED MEX 2022; 158:332-334. [PMID: 36572021 DOI: 10.24875/gmm.m22000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Lawsuits due to patient perception of inappropriate medical actions are a growing reality in medical practice, which entails widespread concern in the medical community. Lawsuits often entail additional circumstances beyond the primary concern of preventing or sanctioning acts of medical negligence. CETREMI proposes various recommendations aimed at legal and medical professionals to improve this circumstance and avoid harming the doctor-patient relationship.
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Affiliation(s)
- Mucio Moreno
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Oscar Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Miguel A Celis
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Judith Domínguez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Sergio Islas-Andrade
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alberto Lifshitz
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Iris Martínez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Alejandro Reyes-Sánchez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Guillermo J Ruiz-Argüelles
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Antonio Soda-Merhy
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Emma Verástegui
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Sonia Toussaint
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Diana Vilar-Compte
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
| | - Julio Sotelo
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia en la Relación Médico-Industria (CETREMI), Mexico City, Mexico
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Lifshitz A, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez AA, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo-Morales J, Toussaint S, Vilar-Compte D, Verástegui E. Role of individual physicians in pharmacovigilance. GAC MED MEX 2022; 158:257-258. [PMID: 36572037 DOI: 10.24875/gmm.m22000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Alberto Lifshitz
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Oscar Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Miguel A Celis
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Judith Domínguez-Cherit
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Sergio Islas-Andrade
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Armando Mansilla-Olivares
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Iris Martínez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Alejandro A Reyes-Sánchez
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Luisa L Rocha-Arrieta
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Guillermo J Ruiz-Argüelles
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Antonio Soda-Merhy
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Julio Sotelo-Morales
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Sonia Toussaint
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Diana Vilar-Compte
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
| | - Emma Verástegui
- Academia Nacional de Medicina de México, Comité de Ética y Transparencia Médica con la Industria Farmacéutica, Mexico City, Mexico
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Moreno M, Arrieta O, Celis MA, Domínguez J, Islas-Andrade S, Lifshitz A, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Ruiz-Argüelles GJ, Soda-Merhy A, Verástegui E, Rocha-Arrieta LL, Toussaint S, Vilar-Compte D, Sotelo J. ¿Quién juzga la actuación médica? GAC MED MEX 2022. [DOI: 10.24875/gmm.22000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Lifshitz A, Arrieta O, Celis MA, Domínguez-Cherit J, Islas-Andrade S, Mansilla-Olivares A, Martínez I, Mimenza-Alvarado AJ, Reyes-Sánchez A, Rocha-Arrieta LL, Ruiz-Argüelles GJ, Soda-Merhy A, Sotelo J, Toussaint S, Vilar-Compte D, Verástegui E. El papel de los médicos individuales en la farmacovigilancia. GAC MED MEX 2022. [DOI: 10.24875/gmm.22000125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Mimenza-Alvarado AJ, Suing-Ortega MJ, Tusie-Luna T, Juárez-Cedillo T, Ávila-Funes JA, Aguilar-Navarro SG. ASSOCIATION BETWEEN APOE-ε 4 CARRIER STATUS AND QUALITATIVE NEUROIMAGING CHARACTERISTICS IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT. Rev Invest Clin 2022; 74:113-120. [PMID: 35354197 DOI: 10.24875/ric.21000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The pathogenesis of mild cognitive impairment (MCI) is multifactorial and includes the presence of genetic variants such as the ε4 allele of the apolipoprotein E gene (APOE-ε4). Association between the APOE-ε4 carrier status and deleterious structural and functional changes on magnetic resonance imaging (MRI) has been previously described in individuals with Alzheimer's disease. However, the central nervous system changes may possibly develop in earlier stages of cognitive impairment, as reflected in MCI. OBJECTIVE The objective of the study was to determine the association between APOE-ε4 carrier status and qualitative changes on MRI (medial temporal and parietal atrophy), as well as the detection of white matter hyperintensities (WMH) in older adults with MCI, in the memory clinic of a tertiary care hospital in Mexico City. METHODS A cross-sectional study of 72 adults aged 60 years or above who underwent an exhaustive clinical, neuroimaging, and neuropsychological evaluation. Multivariate logistic regression models were constructed to determine the association between APOE-ε4 carrier status and qualitative/quantitative changes on MRI. RESULTS Mean age was 75.2 years (± 7.2) and 64% were female. Twenty-one participants were cognitively normal and 51 had MCI. Almost 56% were APOE-ε4 carriers and were associated with medial-temporal atrophy according to the Scheltens scale (odds ratio [OR]: 20.0, 95% confidence intervals [CI]: 3.03-131.7), parietal atrophy according to the Koedam's score (OR: 6.3; 95% CI 1.03-39.53), and WMH according to the Fazekas scale (OR: 11.7, 95% CI: 1.26-108.2), even after adjusting for age, educational level, and cardiovascular risk factors. CONCLUSION The APOE-ε4 carrier status was associated with medial temporal and parietal atrophy, as well as WMH. Our findings support the hypothesis suggesting the contribution of this genotype to neurodegeneration and cerebral vascular pathology.
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Affiliation(s)
- Alberto J Mimenza-Alvarado
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María J Suing-Ortega
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Teresa Tusie-Luna
- Molecular Biology and Genomic Medicine Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas, UNAM, Mexico City, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiological Studies and Aging Health Services, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - José A Ávila-Funes
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Sara G Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Yeverino-Castro SG, Mejía-Arango S, Mimenza-Alvarado AJ, Cantú-Brito C, Avila-Funes JA, Aguilar-Navarro SG. Prevalence and incidence of possible vascular dementia among Mexican older adults: Analysis of the Mexican Health and Aging Study. PLoS One 2021; 16:e0253856. [PMID: 34237081 PMCID: PMC8266048 DOI: 10.1371/journal.pone.0253856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Vascular dementia is the second most common cause of dementia. Physical disability and cognitive impairment due to stroke are conditions that considerably affect quality of life. We estimated the prevalence and incidence of possible vascular dementia (PVD) in older adults using data from the Mexican Health and Aging Study (MHAS 2012 and 2015 waves). Methods The MHAS is a representative longitudinal cohort study of Mexican adults aged ≥50 years. Data from 14, 893 participants from the 2012 cohort and 14,154 from the 2015 cohort were analyzed to estimate the prevalence and incidence of PVD. Self-respondents with history of stroke were classified as PVD if scores in two or more cognitive domains in the Cross-Cultural Cognitive Examination were ≥ 1.5 standard deviations below the mean on reference norms and if limitations in ≥ 1 instrumental activities of daily living were present. For proxy respondents with history of stroke, we used a score ≥3.4 on the Informant Questionnaire on Cognitive Decline in the Elderly. Crude and standardized rates of prevalent and incident PVD were estimated. Results Prevalence of PVD was 0.6% (95% CI, 0.5–0.8) (0.5 with age and sex- standardization). Rates increased with age reaching 2.0% among those aged 80 and older and decreased with educational attainment. After 3.0 years of follow-up, 87 new cases of PVD represented an overall incident rate of 2.2 (95% CI, 1.7–2.6) per 1,000 person-years (2.0 with age and sex- standardization). Incidence also increased with advancing age reaching an overall rate of 9.4 (95% CI, 6.3–13.6) per 1,000 person-years for participants aged >80 years. Hypertension and depressive symptoms were strong predictors of incident PVD. Conclusion These data provide new estimates of PVD prevalence and incidence in the Mexican population. We found that PVD incidence increased with age. Males aged 80 years or older showed a greater incidence rate when compared to females, which is comparable to previous estimates from other studies.
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Affiliation(s)
- Sara G. Yeverino-Castro
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Silvia Mejía-Arango
- Department of Population Studies, El Colegio de la Frontera Norte, Tijuana, Baja California, México
| | - Alberto J. Mimenza-Alvarado
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A. Avila-Funes
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Inserm, Bordeaux Population Health Research Center, UMR 1219, Univ. Bordeaux, Bordeaux, France
| | - Sara G. Aguilar-Navarro
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- * E-mail:
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Mimenza-Alvarado AJ, Bombón-Albán P, Duarte-Flores JO, Gutiérrez-Gutiérrez L, Ávila-Funes JA, Aguilar-Navarro SG. Five-Word Test, Screening of Mixed Dementia in Older Adults. Validation Study. Rev Colomb Psiquiatr (Engl Ed) 2021; 52:S0034-7450(21)00085-8. [PMID: 34226035 DOI: 10.1016/j.rcp.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/31/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES The prevalence of mixed dementia (MixD), defined as the coexistence of Alzheimer's disease (AD) and vascular dementia (VaD), is likely to increase as the population ages. The five-word test (5WT) is a neuropsychological test that differentiates between major and mild neurocognitive disorder (NCD). The objective of the study is to validate 5WT for the detection of MixD. METHODS 230 participants were evaluated: cognitively healthy (CH) (n=70), mild NCD (n=70), and major NCD (n=90): AD (n=30), VaD (n=30), and MixD (n=30). The Spearman's coefficient, d Sommer and ROC curves were used to determine the construct validity of the 5WT. The linear regression model was performed to determine the association between age and education with 5WT performance. RESULTS The mean age was 79 ±7.7 years (P≤.001), 58% were female (P=.252), and the mean education was 9 ±5.3 years (P≤.001). Construct validity when comparing 5WT and MMSE was: Spearman's correlation ρ=.830 (P<.001) and d Sommer=.41 (P<.001). The area under the curve in the total weighted score (TWS) for MixD was .985, with 98% sensitivity (95%CI, 0.96-1.00) and 99% specificity (95%CI, 0.94-1.00), PPV of 88% (95%CI, 0.82-0.89), NPV of 100% (95%CI, 0.96-1.00), and cut-off point ≤16/20 (P<.001). CONCLUSIONS 5WT is a rapid test with neuropsychological validation for the exploration of cognitive characteristics in major NCD type MixD, regardless of age and education.
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Affiliation(s)
- Alberto J Mimenza-Alvarado
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Paulina Bombón-Albán
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J Octavio Duarte-Flores
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Lidia Gutiérrez-Gutiérrez
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - J Alberto Ávila-Funes
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Bordeaux Population Health Research Center, University of Bordeaux, Inserm, UMR 1219, F-33000 Bordeaux, France
| | - Sara G Aguilar-Navarro
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
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Belaunzarán-Zamudio PF, Ortega-Villa AM, Mimenza-Alvarado AJ, Guerra-De-Blas PDC, Aguilar-Navarro SG, Sepúlveda-Delgado J, Hunsberger S, Salgado RV, Ramos-Castañeda J, Rincón León HA, Rodríguez de La Rosa P, Nájera Cancino JG, Beigel J, Caballero Sosa S, Ruiz Hernández E, Powers JH, Ruiz-Palacios GM, Lane C. Comparison of the Impact of Zika and Dengue Virus Infection, and Other Acute Illnesses of Unidentified Origin on Cognitive Functions in a Prospective Cohort in Chiapas Mexico. Front Neurol 2021; 12:631801. [PMID: 33828518 PMCID: PMC8019918 DOI: 10.3389/fneur.2021.631801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023] Open
Abstract
Zika has been associated with a variety of severe neurologic manifestations including meningitis and encephalitis. We hypothesized that it may also cause mild to subclinical neurocognitive alterations during acute infection or over the long term. In this observational cohort study, we explored whether Zika cause subclinical or mild neurocognitive alterations, estimate its frequency and duration, and compare it to other acute illnesses in a cohort of people with suspected Zika infection, in the region of Tapachula in Chiapas, Mexico during 2016–2018. We enrolled patients who were at least 12 years old with suspected Zika virus infection and followed them up for 6 months. During each visit participants underwent a complete clinical exam, including a screening test for neurocognitive dysfunction (Montreal Cognitive Assessment score). We enrolled 406 patients [37 with Zika, 73 with dengue and 296 with other acute illnesses of unidentified origin (AIUO)]. We observed a mild and transient impact over cognitive functions in patients with Zika, dengue and with other AIUO. The probability of having an abnormal MoCA score (<26 points) was significantly higher in patients with Zika and AIUO than in those with dengue. Patients with Zika and AIUO had lower memory scores than patients with dengue (Zika vs. Dengue: −0.378, 95% CI−0.678 to −0.078; p = 0.014: Zika vs. AIUO 0.264, 95% CI 0.059, 0.469; p = 0.012). The low memory performance in patients with Zika and AIUO accounts for most of the differences in the overall MoCA score when compared with patients with dengue. Our results show a decrease in cognitive function during acute illness and provides no evidence to support the hypothesis that Zika might cause neurocognitive alterations longer than the period of acute infection or different to other infectious diseases. While effects on memory or perhaps other cognitive functions over the long term are possible, larger studies using more refined tools for neurocognitive functioning assessment are needed to identify these. Trial Registration: NCT02831699.
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Affiliation(s)
- Pablo F Belaunzarán-Zamudio
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Ana M Ortega-Villa
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Alberto J Mimenza-Alvarado
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Geriatrics & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Sara G Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jesús Sepúlveda-Delgado
- Directorate of Research, Hospital Regional de Alta Especialidad Ciudad Salud, Tapachula & Medical Science Research, Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Sally Hunsberger
- Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | | | - José Ramos-Castañeda
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Departamento de Inmunidad, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | | | | | - José Gabriel Nájera Cancino
- Directorate of Research, Hospital Regional de Alta Especialidad Ciudad Salud, Tapachula & Medical Science Research, Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - John Beigel
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Sandra Caballero Sosa
- Clínica Hospital Dr. Roberto Nettel Flores, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Tapachula, Mexico
| | | | - John H Powers
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research, Frederick, MD, United States
| | - Guillermo M Ruiz-Palacios
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Clifford Lane
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
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Mimenza-Alvarado AJ, Jiménez-Castillo GA, Yeverino-Castro SG, Barragán-Berlanga AJ, Pérez-Zepeda MU, Ávila-Funes JA, Aguilar-Navarro SG. Effect of poor glycemic control in cognitive performance in the elderly with type 2 diabetes mellitus: The Mexican Health and Aging Study. BMC Geriatr 2020; 20:424. [PMID: 33096995 PMCID: PMC7585218 DOI: 10.1186/s12877-020-01827-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Cognitive impairment is twice more frequent in elderly with type 2 diabetes mellitus (DM). This study was conducted to determine the association between glycemic control and cognitive performance among community-dwelling elderly persons in Mexico. Methods Cross-sectional study conducted in individuals aged 60 years or elderly participating in the 2012 Mexican Health and Aging Study. Type 2 DM participants were classified in 3 groups according to their glycated hemoglobin levels (HbA1c): < 7% (intensive control), 7–7.9% (standard control) or ≥ 8% (poor control), and cognitive performance: low (CCCE ≤44 points), intermediate (44.1–59.52 points), or high (≥59.53 points). Multinomial logistic regression models were constructed to determine this association. Results Two hundred sixteen community-dwelling adults aged 60 and older with type 2 diabetes were selected. Subjects in the low cognitive performance group were older (69.7 ± 6.6 vs 65.86 ± 5.18 years, p < .001) and had a lower educational level (2.5 ± 2.6 vs 7.44 ± 4.15 years, p < .000) when compared to the high cognitive performance participants. HbA1c ≥ 8% was associated with having low (Odds Ratio (OR) 3.17, 95% CI 1.17–8.60, p = .024), and intermediate (OR 3.23, 95% CI 1.27–8.20, p = .014) cognitive performance; this trend was not found for HbA1c 7.0–7.9% group. The multinomial regression analysis showed that the presence of HbA1c ≥ 8% (poor glycemic control) was associated with low (OR 3.17, 95% CI = 1.17–8.60, p = .024), and intermediate (OR 3.23, 95% CI = 1.27–8.20, p = .014) cognitive performance. After adjusting for confounding variables. Conclusions Glycemic control with a HbA1c ≥ 8% was associated with worse cognitive performance.
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Affiliation(s)
- Alberto J Mimenza-Alvarado
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, 14000, Mexico City, Mexico.,Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. Tlalpan, 14000, Mexico City, Mexico
| | - Gilberto A Jiménez-Castillo
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, 14000, Mexico City, Mexico.,Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. Tlalpan, 14000, Mexico City, Mexico.,Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64160, Monterrey, Nuevo León, Mexico
| | - Sara G Yeverino-Castro
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, 14000, Mexico City, Mexico
| | - Abel J Barragán-Berlanga
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, 64160, Monterrey, Nuevo León, Mexico
| | | | - J Alberto Ávila-Funes
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR 1219, F-33000, Bordeaux, France
| | - Sara G Aguilar-Navarro
- Geriatric Medicine & Neurology Fellowship, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, 14000, Mexico City, Mexico. .,Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15. Tlalpan, 14000, Mexico City, Mexico.
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Mimenza-Alvarado AJ, Avila-Funes JA, Aguilar-Navarro SG. OLFACTORY DISORDERS IN SARS-COV-2 INFECTION: CONSIDERATIONS IN AGING. Rev Invest Clin 2020; 72:135-137. [PMID: 32584324 DOI: 10.24875/ric.20000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alberto J Mimenza-Alvarado
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A Avila-Funes
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Sara G Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Jiménez-Castillo GA, Bracho-Vela LA, Yeverino-Castro SG, Ávila-Funes JA. ASSOCIATION OF VITAMIN D WITH MILD COGNITIVE IMPAIRMENT AND ALZHEIMER'S DEMENTIA IN OLDER MEXICAN ADULTS. Rev Invest Clin 2020; 71:381-386. [PMID: 31823966 DOI: 10.24875/ric.19003079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background It has been proposed that Vitamin D helps reduce the accumulation of cerebral β-amyloid-42 by innate immune stimulation and phagocytosis activation. An association between low Vitamin D levels and Alzheimer's dementia (AD) has been established. We determined the association between Vitamin D, mild cognitive impairment (MCI), and AD in older Mexican adults (> 65 years). Methods Cross-sectional study conducted at the memory clinic in a tertiary-level hospital in Mexico City. We evaluated subjects with MCI, AD, and normal cognition (NC) with available serum Vitamin D [25(OH)D] levels (past 6 months). Three categories were assigned according to 25(OH)D levels: sufficiency (> 30 ng/mL), insufficiency (21-29 ng/mL), and deficiency (≤ 20 ng/mL). Descriptive statistics, means and standard deviations were used. Logistic regression analyses adjusted by age, sex, and educational level were performed. Results We evaluated 208 patients. Mean age was 79 ± 1 year, 65% (n = 136) were female; and mean educational level was 6.7 ± 2.3 years. Thirty-one subjects (14%) had NC; 42% (n = 88) had MCI; and 43% (n = 89) had AD. Prevalence of Vitamin D deficiency was 54%, more frequent in the AD group (64%) followed by the MCI (59%) and NC (13%) (p < 0.001) groups. In the multivariate logistic regression analysis, Vitamin D deficiency was associated with MCI (HR 25.02 [confidence interval 95% 4.48-139]; p < 0.001) and AD (HR 41.7 [5.76-301]; p < 0.001) after adjusting for confounders. Conclusions Serum Vitamin D deficiency was associated with MCI and dementia; low levels produced a greater effect over executive functions.
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Affiliation(s)
- Sara G Aguilar-Navarro
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gilberto A Jiménez-Castillo
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Leonardo A Bracho-Vela
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sara G Yeverino-Castro
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A Ávila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Aguilar-Esquivel JE, Yeverino-Castro SG, Juárez-Cedillo T, Mejía-Arango S. Motoric Cognitive Risk Syndrome: Prevalence and Risk of Cognitive Impairment in a Population Studied in the Mexican Health and Aging Study 2012-2015. J Nutr Health Aging 2019; 23:227-231. [PMID: 30820509 PMCID: PMC7038635 DOI: 10.1007/s12603-019-1160-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of Motoric Cognitive Risk (MCR) syndrome, describe associated risk factors and to determine the risk of progression to cognitive impairment after three years of follow-up, in a sample of Mexican older adults. DESIGN A prospective panel study of health and aging in Mexico. SETTING AND PARTICIPANTS Baseline and follow-up information was obtained from the Mexican Health and Aging Study's 2012 and 2015 waves. A total of 726 subjects aged 60 years or older with normal cognition at baseline were classified into 4 groups: 1) with MCR, 2) with memory complaint only, 3) with slow gait speed only and, 4) without MCR. Cox regression analysis controlling for confounder factors was performed to determine the risk of progression to cognitive impairment in the MCR group. MEASURES Data such as gait speed, functional status and cognitive performance (standardized by age and sex in Mexican population) was collected. RESULTS MCR prevalence was 14.3%. When compared with non-MCR subjects, the presence of MCR was associated with older age (p<0.01), lower educational status (p=0.05), having two or more comorbidities (p<0.05) and diabetes mellitus diagnosis (p<0.05). At follow-up and after adjusting for confounders, MCR was associated with a 2.4-fold increased risk (95% CI: 1.28-4.26, p=.000) of cognitive impairment. CONCLUSIONS MCR syndrome increases the risk of cognitive impairment in Mexican older adults. Simple measurements such as gait evaluation in subjects with memory complaints could allow early identification of those at risk of developing cognitive impairment.
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Affiliation(s)
- S G Aguilar-Navarro
- Sara G. Aguilar Navarro. Department of Geriatrics. Instituto Nacional de Ciencias, Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. PC 14080; Tlalpan, Mexico City, Mexico. Phone: +52 (55) 54870900, #5710, E-mail:
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Samudio-Cruz MA, Hernández-Contreras FJ, Gutiérrez-Gutiérrez LA, Ramírez-González F, Avila-Funes JA. Validation of the Clock Drawing Test Scoring Method in older adults with neurocognitive disorder. sm 2018. [DOI: 10.17711/sm.0185-3325.2018.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. The Clock Drawing Test (CDT) is a widely used instrument for identifying neurocognitive disorders (NCDs) in older adults. However, there is insufficient evidence to determine the best scoring method, since current quantitative methods involve the assignment of numerical values, while qualitative ones do not allow for objectivity in the diagnosis. Parsey and Schmitter-Edgecombe (2011) proposed a scoring scheme which, in addition to providing a score of the patient’s performance, permits error analysis, thereby making it possible to identify potential underlying cognitive difficulties. Objective. The purpose of this study was to validate the CDT scoring scheme proposed by Parsey and Schmitter-Edgecombe (2011) for screening for NCDs in Mexican older adults. Method. There were 167 participants: 58 cognitively healthy subjects (CH), 52 with mild neurocognitive disorder (mild-NCD), and 57 with major neurocognitive disorder (major-NCD).The CDT scoring method was compared with the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment in Spanish (MoCA-S). Inter- and intra-observer reliability and construct validity were determined and the sensitivity and specificity of this method were calculated. Results. The age was 75 years (SD ± 8 years) and the educational attainment was 10.7 years (SD ± 5.2 years). Internal reliability was .750, with an intraclass correlation coefficient of .774. The cut-off point for the CDT in mild-NCD was 14 points (sensitivity: 40%, specificity: 70%) and 12 points for major-NCD (sensitivity: 90%, specificity: 95%).The most frequent errors in the CDT were: graphic, conceptual, spatial, and/or planning difficulties. Discussion and conclusion. This method makes it possibly to quickly and easily explore the cognitive status of the patient. It contains ideal psychometric properties for the detection of patients with major-NCD, in addition to offering the possibility of analyzing performance errors and underlying cognitive difficulties.
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Ávila-Funes JA, Juárez-Cedillo T, Bernal-López C, Hernández-Favela CG. Clinical and Demographic Predictors of Conversion to Dementia in Mexican Elderly with Mild Cognitive Impairment. Rev Invest Clin 2017; 69:33-39. [PMID: 28239180 DOI: 10.24875/ric.17002064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mild cognitive impairment (MCI) is considered a clinical stage between normal cognitive aging and dementia. The clinical course of MCI is heterogeneous, with a significant number of cases progressing to dementia or reverting back to normal. OBJECTIVE To determine the predictors of conversion from mild cognitive impairment to dementia among Mexican older adults. MATERIALS AND METHODS A sample of 175 persons underwent clinical and neuropsychological evaluation to establish mild cognitive impairment diagnosis. These patients were followed-up for a mean 3.5 years. RESULTS Mean age was 81.7 (± 6.9) years, 57% were women, and mean education level was 9.5 (± 6.1) years. Sixty-one percent of mild cognitive impairment participants progressed to dementia. Multivariate Cox regression analysis showed that progression to dementia was associated with age (HR: 4.95; 95% CI: 1.96-12.46; p = 0.001), low education level (HR: 5.81; 95% CI: 1.90-7.78; p < 0.002), history of stroke (HR: 3.92; 95% CI: 1.37-11.16; p < 0.012) and cognitive decline (HR: 1.31; 95% CI: 1.18-1.45; p = 0.000). CONCLUSIONS Age, poor education, cognitive decline, and a history of stroke were predictors of conversion to dementia. The identification and control of modifiable risk factors could influence conversion to dementia.
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Affiliation(s)
- Sara G Aguilar-Navarro
- Geriatrics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Geriatrics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Alberto Ávila-Funes
- Geriatrics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiology and Health Services Research Unit, Area of Aging, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social and Faculty of Superior Studies (FES) Zaragoza, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Carolina Bernal-López
- Geriatrics Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Palacios-García AA, Samudio-Cruz A, Gutiérrez-Gutiérrez LA, Ávila-Funes JA. Validity and Reliability of the Spanish Version of the Montreal Cognitive Assessment (MoCA) for the Detection of Cognitive Impairment in Mexico. ACTA ACUST UNITED AC 2017; 47:237-243. [PMID: 30286846 DOI: 10.1016/j.rcp.2017.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To establish the validity and reliability of the Montreal Cognitive Assessment in Spanish (MoCA-S) to identify mild cognitive impairment (MCI) and dementia in the Mexican elderly population. MATERIAL AND METHODS 168 participants from a memory clinic in Mexico City were enrolled and divided into 3 groups: 59 cognitively healthy (CHG), 52 with mild cognitive impairment (MCI) (DSM-5 criteria) and 57 with dementia (NINCDS-ADRDA criteria). The MoCA-S and Mini-Mental State Evaluation (MMSE) were applied at baseline and during the last months to establish intra-observer reliability. ROC curves and a multinomial regression model were constructed to evaluate the effect of age and education on MoCA-S performance. RESULTS The mean age of the participants was 76±8.1 years and the education rate was 10.7±5.2. The MoCA-S scores by group were: CHG, 27.3±1.9; MCI, 22.9±2.9; and dementia, 13.7±4.9 (p<0.001). The reliability of the MoCA-S was 0.89 and the intraclass correlation coefficient was 0.955. Sensitivity was 80% and specificity was 75%, with a cut-off point of 26 points for MCI (area under the curve, 0.886; p<0.001). For the dementia group, the sensitivity was 98% and specificity was 93%, with a cut-off point of 24points (area under the curve, 0.998; p<0.001). The multinomial regression showed no association with education and age for both the MCI and dementia groups. CONCLUSIONS The MoCA-S is a valid and reliable instrument for MCI and dementia screening in the Mexican population, even after adjusting for age and education.
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Affiliation(s)
- Sara G Aguilar-Navarro
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - Alberto J Mimenza-Alvarado
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alberto A Palacios-García
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alejandra Samudio-Cruz
- Facultad de Psicología Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Lidia A Gutiérrez-Gutiérrez
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - José A Ávila-Funes
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Centre de recherche INSERM, Burdeos, Francia
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López-Rodríguez L, Hidalgo-Alquicira FG, Mimenza-Alvarado AJ. [Neurological manifestations in critically ill patients]. Rev Neurol 2006; 43:155-67. [PMID: 16871481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIMS To describe the pathophysiology, diagnosis and clinical manifestations of the neurological complications that critically ill patients often develop in intensive care units, and to discuss their treatment and prognosis, in the light of the most significant contemporary literature. DEVELOPMENT The most frequent complication suffered by critically ill patients is sepsis, with encephalopathy as the main manifestation, and this has a direct effect on their prognosis. Polyneuropathy of the critically ill patient is linked to sepsis, as the main precipitating factor, as well as to the presence of high levels of glucose, which plays an important role in deciding whether mechanical ventilation can be withdrawn or not. Myopathy of the critically ill patient is related to the use of fluorinated steroids and neuromuscular blockers, which are frequently administered to these patients. All these entities represent a significant diagnostic challenge for the physician and are accompanied by important sequelae that continue after the patient's discharge from hospital, as well as myopathies and neuropathies associated to the use of drugs that are commonly administered to critically ill patients. It is therefore necessary to be familiar with the pathophysiology of the damage and with the associated factors, if a suitable diagnostic approach is to be employed. CONCLUSIONS The incidence of these pathologies and their complications makes them important conditions that require a swift, accurate diagnosis so that treatment can be established early on and a prognosis can also be determined.
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Affiliation(s)
- L López-Rodríguez
- Servicio de Medicina Interna, Hospital Regional Lic. Adolfo López Mateos, Instituto de Seguridad Social al Servicio de los Trabajadores del Estado, México DF, Mexico
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Mimenza-Alvarado AJ, Muñiz-Alvarez JC, Estañol-Vidal B, Téllez-Zenteno JF, García-Ramos G. [Painful neuropathies: their pathophysiology and treatment]. Rev Neurol 2004; 39:364-70. [PMID: 15340898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES The purpose of this study is to review the different studies published in the literature concerning the different physiological mechanisms involved in the genesis of painful neuropathy, as well as the diagnostic options and the different pharmacological treatments currently available. DEVELOPMENT Distinct pathologies usually condition painful neuropathy, one of the main ones being diabetes mellitus. The triggering phenomenon is often some kind of damage to the tissues that contain nervous pain receptors, which later gives rise to a release of proinflammatory molecules, and triggers a cascade of phenomena that result in disorders in the central and peripheral nervous system (peripheral and central sensitisation). These disorders usually produce clinical manifestations, such as allodynia, paresthesias, among others, and these are sometimes the sole manifestation of painful neuropathy. Diagnosis of this syndrome is at times complicated due to the involvement of thin fibres, which cannot be identified by the conventional methods used in neurophysiological studies. There is also a broad range of pharmaceuticals used in the treatment of painful neuropathy that range from tricyclic antidepressants, non-steroidal anti-inflammatory drugs, opioid analgesics, antiarrhythmics and even agents for topical use. CONCLUSIONS Diagnosis of thin fibre neuropathy is usually performed by carrying out a Quantitative Sudomotor Axon Reflex Test, quantitative sensory tests and a skin biopsy. As regards the pharmacological treatment, the new generation of anticonvulsive drugs like gabapentin seems to have advantages over the traditional pharmaceuticals, although their widespread use is still largely restricted by their cost.
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Affiliation(s)
- A J Mimenza-Alvarado
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Mexico DF, Mexico.
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Mimenza-Alvarado AJ, Téllez-Zenteno JF, Cantú-Brito C, García-Ramos G. [Systemic lupus erythematosus with affection to brainstem: report of three cases]. Rev Neurol 2002; 35:128-31. [PMID: 12221623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The frequency with which the central nervous system (CNS) is affected by systemic lupus erythematosus (SLE) varies, according to different series, between 13 and 59%, whereas the brain stem is affected in 5%. CASE REPORTS Case 1: a 33 year old male who was submitted to a Nissen funduplicature as a treatment of (hypo)incoercible hiccups. The singultus persisted and some time after a paraplegia appeared. Magnetic resonance (MRI) showed images in the medulla oblongata, and in the cervical and thoracic spine. A biopsy was also performed to examine the cervical lesions and vasculitis was diagnosed. The patient began treatment with prednisone (1 mg/kg) and two months after symptoms had begun to improve he presented an episode of bilateral optic neuritis. Until this last event, the immunological studies had been positive. Case 2: female aged 19 who had had SLE for eight months. The illness began suddenly with bilateral paralysis of the sixth cranial nerve, vertical and horizontal nystagmus, dysdiadochokinesia, truncal ataxia, 4/5 muscular strength in the upper limbs and 3/5 in the lower limbs, and left flexor plantar response, but indifferent on the right hand side. MR showed T2 hyperintensities in the pons, medulla oblongata and the junction of medulla and upper spinal cord. Case 3: female aged 31 with sudden onset of the illness, characterised by diplopy and presence of internuclear ophthalmoplegia. Brain MR showed images of T1 hypointense and T2 hyperintense in the pontobulbar region. CONCLUSION A brain stem disorder in patients suffering from SLE is one of the rarest manifestations of this pathological condition of the CNS and is probably caused by vasculitis
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