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Blümel JE, Arteaga E, Vallejo MS, Ojeda E, Meza P, Martino M, Rodríguez-Vidal D, Ñañez M, Tserotas K, Rojas J, Rodrígues MA, Espinoza MT, Salinas C, Párraga-Párraga J, Chedraui P. Association of bilateral oophorectomy and menopause hormone therapy with mild cognitive impairment: the REDLINC X study. Climacteric 2021; 25:195-202. [PMID: 34323137 DOI: 10.1080/13697137.2021.1951203] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dementia is a major public health problem. Estrogen is a regulator of the central nervous system and its deficit could be involved in cognitive decline in older women. OBJECTIVE This study aimed to evaluate the association of bilateral oophorectomy, menopause hormone therapy (MHT) and other factors on mild cognitive impairment (MCI). METHOD The case-control study included 941 otherwise healthy postmenopausal women aged 60 years and over from six Latin American countries. Personal and family data were recorded and MCI was assessed using the Montreal Cognitive Assessment test (MoCA). RESULTS Average age, years of education and body mass index were 66.1 ± 5.8 years, 12.4 ± 5.0 years and 26.0 ± 4.3 kg/m2, respectively. A total of 30.2% had undergone bilateral oophorectomy and 40.3% had used MHT. A total of 232 women (24.7%) had MCI. The prevalence of MCI was higher in women with intact ovaries and non-MHT users as compared to MHT users (29.3% vs. 11.7% [odds ratio (OR) 0.32; 95% confidence interval (CI) 0.20-0.51]). Among oophorectomized women, MCI prevalence was higher among non-MHT users as compared to MHT users (45.2% vs. 12.8% [OR 0.18; 95% CI 0.10-0.32]). Logistic regression analysis determined that the variables associated with MCI were age >65 years (OR 1.69; 95% CI 1.20-2.38), parity (having >2 children; OR 1.69; 95% CI 1.21-2.37), bilateral oophorectomy (OR 1.56; 95% CI 1.09-2.24), hypertension (OR 1.41; 95% CI 1.01-1.96), being sexually active (OR 0.56; 95% CI 0.40-0.79), education >12 years (OR 0.46; 95% CI 0.32-0.65) and MHT use (OR 0.31; 95% CI 0.21-0.46). CONCLUSION Age, parity, bilateral oophorectomy and hypertension are independent factors associated with MCI; contrary to this, higher educational level, maintaining sexual activity and using MHT are protective factors.
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Affiliation(s)
- J E Blümel
- Departamento de Medicina Interna Sur, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - E Arteaga
- Departamento de Endocrinología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - M S Vallejo
- Clínica Quilín, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | - E Ojeda
- Departamento de Obstetricia y Ginecología, Universidad Andina, Cusco, Perú
| | - P Meza
- Departamento de Medicina Familiar, Universidad San Martin de Porres, Lima, Perú
| | - M Martino
- Departamento de Obstetricia y Ginecología, Universidad Nacional de Rosario, Rosario, Argentina
| | - D Rodríguez-Vidal
- Departamento de Obstetricia y Ginecología, Hospital de Clínicas José de San Martin, Buenos Aires, Argentina
| | - M Ñañez
- Cátedra de Ginecología, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - K Tserotas
- Complejo Hospitalario Dr. Arnulfo Arias Madrid, Caja del Seguro Social, Panamá, Panamá
| | - J Rojas
- Departamento de Ginecología Obstetricia, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - M A Rodrígues
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - M T Espinoza
- Unidad de Climaterio, Clínica Los Ángeles, Cochabamba, Bolivia
| | - C Salinas
- Servicio de Obstetricia y Ginecología, Hospital Ángeles Puebla, Puebla, México
| | - J Párraga-Párraga
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - P Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador.,Facultad de Ciencias de la Salud, Universidad Católica 'Nuestra Señora de la Asunción', Asunción, Paraguay
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Chakraborty A, Hegde S, Praharaj SK, Prabhu K, Patole C, Shetty AK, Mayya SS, Acharya RV, Hande HM, Prabhu MM, Upadhya D. Age Related Prevalence of Mild Cognitive Impairment in Type 2 Diabetes Mellitus Patients in the Indian Population and Association of Serum Lipids With Cognitive Dysfunction. Front Endocrinol (Lausanne) 2021; 12:798652. [PMID: 35035379 PMCID: PMC8758578 DOI: 10.3389/fendo.2021.798652] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
The magnitude of type 2 diabetes mellitus (T2DM) is ever-increasing in India, and at present, ~77 million people live with diabetes. Studies have established that T2DM increases the risk of neurodegenerative disorders. This study aimed to determine the age-related prevalence of mild cognitive impairment (MCI) in T2DM patients in the Indian population and to identify link between cognitive dysfunction in T2DM patients and serum lipid composition through untargeted and targeted lipidomic studies. Using a cross-sectional study, we evaluated 1278 T2DM patients with Montreal cognitive assessment test (MoCA) and digit symbol substitution test (DSST) for cognitive functions. As per MoCA, the prevalences of MCI in T2DM patients in age groups below 40, 41-50, 51-60, 61-70, 71-80 and 81-90 years were 13.7, 20.5, 33.5, 43.7, 57.1 and 75% with DSST scores of 45.8, 41.7, 34.4, 30.5, 24.2 and 18.8% respectively. Binomial logistic regression analysis revealed serum HbA1c ≥ 7.51, duration of T2DM over 20 years, age above 41 years, and females were independent contributors for cognitive dysfunction in T2DM patients. Preliminary studies with untargeted lipidomics of the serum from 20 T2DM patients, including MCI and normal cognition (NC) group, identified a total of 646 lipids. Among the identified lipids, 33 lipids were significantly different between MCI and NC group, which comprised of triglycerides (TGs, 14), sphingolipids (SL, 11), and phosphatidylcholines (PC, 5). Importantly, 10 TGs and 3 PCs containing long-chain polyunsaturated fatty acids (PUFA) were lower, while 8 sphingolipids were increased in the MCI group. Since brain-derived sphingolipids are known to get enriched in the serum, we further quantified sphingolipids from the same 20 serum samples through targeted lipidomic analysis, which identified a total of 173 lipids. Quantitation revealed elevation of 3 species of ceramides, namely Cer (d18:1_24:1), Hex1Cer (d16:0_22:6), and Hex2Cer (d28:1) in the MCI group compared to the NC group of T2DM patients. Overall, this study demonstrated an age-related prevalence of MCI in T2DM patients and highlighted reduced levels of several species of PUFA containing TGs and PCs and increased levels of specific ceramides in T2DM patients exhibiting MCI. Large-scale lipidomic studies in future could help understand the cognitive dysfunction domain in T2DM patients, while studies with preclinical models are required to understand the functional significance of the identified lipids.
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Affiliation(s)
- Arpita Chakraborty
- Centre for Molecular Neurosciences, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
- Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sumukha Hegde
- Centre for Molecular Neurosciences, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samir K. Praharaj
- Department of Psychiatry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Krishnananda Prabhu
- Department of Biochemistry, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Chhaya Patole
- Mass Spectrometry Facility, Institute For Stem Cell Science and Regenerative Medicine, Centre for Cellular and Molecular Platforms Campus, National Centre for Biological Sciences, Bangalore, India
| | - Ashok K. Shetty
- Institute for Regenerative Medicine, Texas Agricultural and Mechanical (A&M) Health Science Center College of Medicine, College Station, TX, United States
- Department of Molecular and Cellular Medicine, Texas Agricultural and Mechanical (A&M) Health Science Center College of Medicine, College Station, TX, United States
| | - Shreemathi S. Mayya
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Raviraj V. Acharya
- Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - H. Manjunath Hande
- Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - M. Mukhyaprana Prabhu
- Department of General Medicine, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
- *Correspondence: Dinesh Upadhya, ; M. Mukhyaprana Prabhu,
| | - Dinesh Upadhya
- Centre for Molecular Neurosciences, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
- *Correspondence: Dinesh Upadhya, ; M. Mukhyaprana Prabhu,
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Parfenov VA, Zhivolupov SA, Poverennova IE, Nesterova MV, Ushakova SE, Zhukova NG, Glazunov AB, Nikulina KV, Alexandrov MV, Lapatukhin VG, Zhestikova MG. Treatment of Cognitive Impairment and the Role of Demographic Factors in Disease Progression: The Final Results of the Russian Observational Program "DIAMANT". Eur Neurol 2020; 83:591-601. [PMID: 33202402 DOI: 10.1159/000508184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/14/2019] [Accepted: 04/24/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic cerebral ischemia (CCI) is a form of cerebrovascular disease manifested as a vascular cognitive impairment (VCI). The management of the patients with CCI is determined by a healthy lifestyle and early therapy aimed at correcting and preventing this disease. Divaza is a drug with endothelial protective and nootropic effects. We present the final efficacy and safety analysis of all-Russian, open-label, prospective, observational, multicenter study of Divaza and emphasize the role of demographic and socioeconomic factors in cognitive disorder (CD) progression. METHODS CCI patients (n = 2,583) with or without CD were enrolled. Patients received Divaza (2 tablets 3 times per day for 12 weeks). Montreal Cognitive Assessment (MoCA) testing was required. The change in the mean MoCA score post-treatment was used as the primary endpoint. As the secondary endpoints, the number of patients with a MoCA <26 and ≤17 (dementia); the percentage of patients with a MoCA score improvement in different age groups; the dynamics of mean MoCA score in age groups; and the relationship between CD and sex or regional social/economic factors were assessed. RESULTS Divaza therapy led to a significant improvement: the mean MoCA score was up to 20% higher post-treatment (Wilcoxon test, p < 0.0001 vs. baseline). The number of participants with MoCA ≥26 increased by 33.6%. The number of patients with dementia was 4.1 times less after therapy (p < 0.00001 vs. baseline). Divaza improved cognitive functions of patients in each age group. Findings demonstrate that regional socioeconomic factors contribute to CD development and severity. The observed divergence between sexes was a result of a larger number of women enrolled. The study confirmed the safety of Divaza. CONCLUSIONS In the study, we observed the efficacy of Divaza for the treatment of CD: a therapy contributed to an increase in the mean MoCA score and the positive dynamics in the number of patients with cognitive improvement.
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Affiliation(s)
- Vladimir Anatolyevich Parfenov
- Neurology and Neurosurgery Department, Medical Faculty, I.M. Sechenov Moscow State University, Moscow, Russian Federation
| | - Sergey Anatolyevich Zhivolupov
- Department of Neurological diseases, Military Medical Academy, Kirov Russian Ministry of Defense, Saint-Petersburg, Russian Federation
| | | | - Marina Valentinovna Nesterova
- Department of Neurological Diseases and Neurosurgery, Ural State Medical, Department of Family Medicine, Ural State Medical, Ekaterinburg, Russian Federation.,Laboratory of Сerebral Circulation, Sverdlovsk Regional War Veterans Hospital, Ekaterinburg, Russian Federation
| | | | - Natalia Grigoryevna Zhukova
- Department of Neurological Diseases and Neurosurgery, Siberian State Medical University, Tomsk, Russian Federation
| | | | | | | | - Vladislav Gennadyevich Lapatukhin
- Department of Neurology, Russian Medical Academy of Professional Medical Education of the Ministry of Health of the Russian Federation (RMANPO of the Ministry of Health of Russia), Penza, Russian Federation
| | - Marina Grigoryevna Zhestikova
- Department of Neurology, Manual Therapy and Reflexology, Novokuznetsk State University of Professional Medical Education (RMANPO of the Ministry of Health of Russia), Novokuznetsk, Russian Federation
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