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Paradela RS, Justo AFO, Paes VR, Leite REP, Pasqualucci CA, Grinberg LT, Naslavsky MS, Zatz M, Nitrini R, Jacob-Filho W, Suemoto CK. Association between APOE-ε4 allele and cognitive function is mediated by Alzheimer's disease pathology: a population-based autopsy study in an admixed sample. Acta Neuropathol Commun 2023; 11:205. [PMID: 38115150 PMCID: PMC10731799 DOI: 10.1186/s40478-023-01681-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Apolipoprotein E ε4 allele (APOE-ε4) is the main genetic risk factor for late-onset Alzheimer's disease (AD) and may impact cognitive function also via other neuropathological lesions. However, there is limited evidence available from diverse populations, as APOE associations with dementia seem to differ by race. Therefore, we aimed to evaluate the pathways linking APOE-ε4 to cognitive abilities through AD and non-AD neuropathology in an autopsy study with an admixed sample. METHODS Neuropathological lesions were evaluated following international criteria using immunohistochemistry. Participants were classified into APOE-ε4 carriers (at least one ε4 allele) and non-carriers. Cognitive abilities were evaluated by the Clinical Dementia Rating Scale sum of boxes. Mediation analyses were conducted to assess the indirect association of APOE-ε4 with cognition through AD-pathology, lacunar infarcts, hyaline arteriosclerosis, cerebral amyloid angiopathy (CAA), Lewy body disease (LBD), and TAR DNA-binding protein 43 (TDP-43). RESULTS We included 648 participants (mean age 75 ± 12 years old, mean education 4.4 ± 3.7 years, 52% women, 69% White, and 28% APOE-ε4 carriers). The association between APOE-ε4 and cognitive abilities was mediated by neurofibrillary tangles (β = 0.88, 95% CI = 0.45; 1.38, p < 0.001) and neuritic plaques (β = 1.36, 95% CI = 0.86; 1.96, p < 0.001). Lacunar infarcts, hyaline arteriosclerosis, CAA, LBD, and TDP-43 were not mediators in the pathway from APOE-ε4 to cognition. CONCLUSION The association between APOE-ε4 and cognitive abilities was partially mediated by AD-pathology. On the other hand, cerebrovascular lesions and other neurodegenerative diseases did not mediate the association between APOE-ε4 and cognition.
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Affiliation(s)
- Regina Silva Paradela
- Division of Geriatrics, University of São Paulo Medical School, 455 Doutor Arnaldo Avenue, room 1355, São Paulo, SP, Brazil.
| | | | - Vítor Ribeiro Paes
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Renata E P Leite
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Carlos A Pasqualucci
- Department of Pathology, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Lea T Grinberg
- Memory and Aging Center, University of California, San Francisco, USA
| | - Michel Satya Naslavsky
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo Medical School, 455 Doutor Arnaldo Avenue, room 1355, São Paulo, SP, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of São Paulo Medical School, 455 Doutor Arnaldo Avenue, room 1355, São Paulo, SP, Brazil
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Paradela RS, Farias-Itao DS, Leite REP, Pasqualucci CA, Grinberg LT, Naslavsky MS, Zatz M, Nitrini R, Jacob-Filho W, Suemoto CK. Apolipoprotein E ε2 allele is associated with lower risk of carotid artery obstruction in a population-based autopsy study. J Stroke Cerebrovasc Dis 2023; 32:107229. [PMID: 37531722 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107229] [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] [Received: 04/20/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION Apolipoprotein E (APOE) ε4 allele has been associated with higher carotid atherosclerosis risk, while the APOE-ε2 seems to decrease this risk. Data from autopsy studies, where carotid arteries can be evaluated in their full extension, is scarce. Therefore, we investigated the association between APOE alleles and direct morphometric measurements of carotid atherosclerosis in an autopsy study with an admixed sample. METHODS We measured the intima-media thickness (IMT) and stenosis of the common (CCA) and internal carotid (ICA) arteries. The APOE polymorphisms were determined by real-time polymerase chain reaction. Participants were classified into three groups according to the APOE alleles (ε2, ε3, and ε4). We evaluated the association between APOE groups and carotid atherosclerosis using adjusted regression models and included interaction terms of APOE alleles with age, sex, and race. RESULTS We evaluated 1,850 carotid artery samples from 185 participants (mean age=75±12 years old, 55% female, and 71% White). The APOE-ε2 group (n=17) had a lower carotid obstruction and a lower number of severe stenoses (≥ 70%). Having at least one ε4 allele (n=51) was not associated with carotid atherosclerosis. APOE alleles were also not associated with carotid IMT. Age, sex, and race did not modify these relationships. CONCLUSION APOE-ε2 carriers had a lower percentage of carotid obstruction and less severe stenosis. APOE-ε4 was not related to a higher risk of carotid atherosclerosis in this cross-sectional population-based autopsy study.
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Affiliation(s)
| | | | - Renata E P Leite
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos A Pasqualucci
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Lea T Grinberg
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil; Memory and Aging Center, University of California San Francisco, USA
| | - Michel Satya Naslavsky
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, Brazil
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Gonçalves NG, Aliberti MJR, Bertola L, Avelino-Silva T, Dias MB, Apolinario D, Busatto G, Forlenza O, Nitrini R, Brucki SMD, Brunoni AR, Vidal KSM, Jacob-Filho W, Suemoto CK. Dissipating the fog: Cognitive trajectories and risk factors 1 year after COVID-19 hospitalization. Alzheimers Dement 2023; 19:3771-3782. [PMID: 36861807 DOI: 10.1002/alz.12993] [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] [Received: 11/07/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Cognitive impairment is common after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, associations between post-hospital discharge risk factors and cognitive trajectories have not been explored. METHODS A total of 1105 adults (mean age ± SD 64.9 ± 9.9 years, 44% women, 63% White) with severe coronavirus disease 2019 (COVID-19) were evaluated for cognitive function 1 year after hospital discharge. Scores from cognitive tests were harmonized, and clusters of cognitive impairment were defined using sequential analysis. RESULTS Three groups of cognitive trajectories were observed during the follow-up: no cognitive impairment, initial short-term cognitive impairment, and long-term cognitive impairment. Predictors of cognitive decline after COVID-19 were older age (β = -0.013, 95% CI = -0.023;-0.003), female sex (β = -0.230, 95% CI = -0.413;-0.047), previous dementia diagnosis or substantial memory complaints (β = -0.606, 95% CI = -0.877;-0.335), frailty before hospitalization (β = -0.191, 95% CI = -0.264;-0.119), higher platelet count (β = -0.101, 95% CI = -0.185;-0.018), and delirium (β = -0.483, 95% CI = -0.724;-0.244). Post-discharge predictors included hospital readmissions and frailty. DISCUSSION Cognitive impairment was common and the patterns of cognitive trajectories depended on sociodemographic, in-hospital, and post-hospitalization predictors. HIGHLIGHTS Cognitive impairment after coronavirus disease 2019 (COVID-19) hospital discharge was associated with higher age, less education, delirium during hospitalization, a higher number of hospitalizations post discharge, and frailty before and after hospitalization. Frequent cognitive evaluations for 12-month post-COVID-19 hospitalization showed three possible cognitive trajectories: no cognitive impairment, initial short-term impairment, and long-term impairment. This study highlights the importance of frequent cognitive testing to determine patterns of COVID-19 cognitive impairment, given the high frequency of incident cognitive impairment 1 year after hospitalization.
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Affiliation(s)
- Natalia Gomes Gonçalves
- Department of Pathology, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | - Laiss Bertola
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Thiago Avelino-Silva
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Murilo Bacchini Dias
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | | | - Geraldo Busatto
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Orestes Forlenza
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Andre Russowsky Brunoni
- Department and Institute of Psychiatry, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, LIM-66, Faculdade de Medicina da Universidade de São Paulo FMUSP, São Paulo, Brazil
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Karnakis T, Kanaji AL, Gattás-Vernaglia IF, Adriazola IO, Ramos PT, Lima MEPLS, Almeida OLS, Jacob-Filho W, Ferriolli E. Ten years of a geriatric oncology service at a public university cancer centre in Brazil. Ecancermedicalscience 2023; 17:1596. [PMID: 37799943 PMCID: PMC10550289 DOI: 10.3332/ecancer.2023.1596] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Indexed: 10/07/2023] Open
Abstract
The implementation of a geriatric oncology service is challenging in both high-income and low-and-middle-income countries. The Octavio Frias de Oliveira Institute of Cancer of Sao Paulo (ICESP) is a tertiary healthcare complex of the Clinics Hospital of the University of Sao Paulo Medical School and is considered a model of excellence in oncology in Latin America. The objective of this manuscript is to describe 10 years of the geriatric oncology service at ICESP and the challenges for its implementation. We performed a narrative description of the ICESP's geriatric oncology service and a general retrospective descriptive analysis of data collected from routine structured medical records of patients referred to the service from 2011 to 2021. This article highlights the different settings in which the service operates (outpatient, pre-operative and hospital follow-up). In this period, 1,700 patients were assessed for preoperative evaluation (median age 83.9, SD 4.95), 468 patients were evaluated for therapeutic decision (median age 79.4, SD 7.38), 968 in general geriatric oncology care outpatient clinics from 2012 to 2021 (median age 78.7, SD 7.91) and 1,391 inpatient evaluations. In the past 10 years, our geriatric oncology team has grown exponentially and changed its characteristics in order to adjust them to the hospital demands, raising awareness among the oncology teams about the benefit of using geriatric assessment and promoting multidisciplinary discussions.
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Affiliation(s)
- Theodora Karnakis
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Ana L Kanaji
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Isabella F Gattás-Vernaglia
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Izabela O Adriazola
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Paola T Ramos
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Maria Eduarda P L S Lima
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Olga L S Almeida
- Clinical Board of the Clinics Hospital of the University of São Paulo Medical School, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
| | - Eduardo Ferriolli
- Department of Internal Medicine, Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
- Department of Internal Medicine, Division of Geriatrics, Sao Paulo Cancer Institute, University of Sao Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Investigation in Aging (LIM 66) of São Paulo Medical School, Sao Paulo, Brazil
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Vendola MCC, Jacob-Filho W. Impact of oral health on frailty syndrome in frail older adults. Einstein (Sao Paulo) 2023; 21:eAO0103. [PMID: 37585884 PMCID: PMC10393215 DOI: 10.31744/einstein_journal/2023ao0103] [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] [Received: 10/04/2022] [Accepted: 12/01/2022] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVE This study aimed to correlate oral and general health in frail and non-frail older adults. METHODS This observational study included 52 older adults, of whom 35 were frail (Frail Group), and 17 were non-frail (Non-Frail Group), according to Fried's self-reported test addressing oral health variables, number of systemic diseases, and medications in use. The geriatric oral health assessment index was used to assess the oral hygiene of the groups. RESULTS The number of preserved teeth in dentulous older adults was significantly higher in the Non-Frail Group (p=0.048). No significant differences were observed between the two groups in the use of dental prostheses or in the detection of soft tissue lesions. Overall, 74.3% of the Frail Group had a "bad" geriatric oral health index score, which significantly differed from that of the Non-Frail Group (p=0.045). The numbers of systemic diseases and medicines used were higher in the Frail Group than in the Non-Frail Group (p<0.001), demonstrating the pathophysiological characteristics of multimorbidity and polypharmacy in frailty syndrome. CONCLUSION The results showed a clear correlation between oral and general health conditions and frailty syndrome.
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Affiliation(s)
- Maria Cecilia Ciaccio Vendola
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Wilson Jacob-Filho
- Hospital das ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrazil Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Magalhães NV, Waitzberg DL, Lopes NC, Vicedomini ACC, Prudêncio APA, Jacob-Filho W, Busse AL, Ferdinando D, Alves TP, Pereira RMR, Torrinhas RS, Belarmino G. High Prevalence of Energy and Nutrients Inadequacy among Brazilian Older Adults. Nutrients 2023; 15:3246. [PMID: 37513664 PMCID: PMC10384757 DOI: 10.3390/nu15143246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Poor nutrition increases the risk of diseases and adverse health outcomes in older adults. We evaluated the potential inadequacy of nutrient intake among older adults in Brazil and its association with body anthropometry and composition outcomes. Dietary intake was obtained from 295 community-living older adults (>60 years old), of both genders, using a seven-day food record. Nutrient inadequacy was further identified based on the Dietary Reference Intakes and European Guidelines. Skeletal muscle mass (SM), strength and performance, and the diagnosis of sarcopenia were assessed using reference methods. Nutritional inadequacy was high, with energy, dietary fiber, and six micronutrients exhibiting the greatest inadequacy levels (>80%). Energy intake was correlated with SM strength (p = 0.000) and performance (p = 0.001). Inadequate energy, fiber, and protein intakes influenced BMI, while inadequate intake of vitamin B6 directly affected the diagnosis of sarcopenia (p ≤ 0.005). Further research is required to investigate whether these inadequacies can be associated with other clinical health outcomes.
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Affiliation(s)
- Natalia Vieira Magalhães
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Dan Linetzky Waitzberg
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Natalia Correia Lopes
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Ana Carolina Costa Vicedomini
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Ana Paula Aguiar Prudêncio
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Wilson Jacob-Filho
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Alexandre Leopold Busse
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Douglas Ferdinando
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Tatiana Pereira Alves
- Laboratório de Investigação Médica em Envelhecimento (LIM-66), Serviço de Geriatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo 01246-903, SP, Brazil
| | - Rosa Maria Rodrigues Pereira
- Research Laboratory in Rheumatology, LIM-17, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Raquel Susana Torrinhas
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Giliane Belarmino
- Laboratory of Nutrition and Metabolic Surgery of the Digestive System, LIM 35, Department of Gastroenterology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
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Castro-Fonseca E, Morais V, da Silva CG, Wollner J, Freitas J, Mello-Neto AF, Oliveira LE, de Oliveira VC, Leite REP, Alho AT, Rodriguez RD, Ferretti-Rebustini REL, Suemoto CK, Jacob-Filho W, Nitrini R, Pasqualucci CA, Grinberg LT, Tovar-Moll F, Lent R. The influence of age and sex on the absolute cell numbers of the human brain cerebral cortex. Cereb Cortex 2023; 33:8654-8666. [PMID: 37106573 PMCID: PMC10321098 DOI: 10.1093/cercor/bhad148] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
The human cerebral cortex is one of the most evolved regions of the brain, responsible for most higher-order neural functions. Since nerve cells (together with synapses) are the processing units underlying cortical physiology and morphology, we studied how the human neocortex is composed regarding the number of cells as a function of sex and age. We used the isotropic fractionator for cell quantification of immunocytochemically labeled nuclei from the cerebral cortex donated by 43 cognitively healthy subjects aged 25-87 years old. In addition to previously reported sexual dimorphism in the medial temporal lobe, we found more neurons in the occipital lobe of men, higher neuronal density in women's frontal lobe, but no sex differences in the number and density of cells in the other lobes and the whole neocortex. On average, the neocortex has ~10.2 billion neurons, 34% in the frontal lobe and the remaining 66% uniformly distributed among the other 3 lobes. Along typical aging, there is a loss of non-neuronal cells in the frontal lobe and the preservation of the number of neurons in the cortex. Our study made possible to determine the different degrees of modulation that sex and age evoke on cortical cellularity.
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Affiliation(s)
- Emily Castro-Fonseca
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Viviane Morais
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila G da Silva
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Wollner
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jaqueline Freitas
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arthur F Mello-Neto
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiz E Oliveira
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vilson C de Oliveira
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Renata E P Leite
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Research in Aging (LIM-66), University of São Paulo Medical School, São Paulo, Brazil
| | - Ana T Alho
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
| | - Roberta D Rodriguez
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | - Renata E L Ferretti-Rebustini
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Department of Medical Surgical Nursing, University of São Paulo School of Nursing, São Paulo, Brazil
| | - Claudia K Suemoto
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Research in Aging (LIM-66), University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Medical Research in Aging (LIM-66), University of São Paulo Medical School, São Paulo, Brazil
| | - Ricardo Nitrini
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Carlos A Pasqualucci
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | - Lea T Grinberg
- Biobank for Aging Studies, LIM 22, University of São Paulo Medical School, São Paulo, Brazil
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States
| | - Fernanda Tovar-Moll
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Roberto Lent
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- National Institute of Translational Neuroscience, Ministry of Science and Technology, São Paulo, Brazil
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Nascimento C, Kyunghee Kim H, Villela Nunes P, Paraiso Leite RE, Katia Cristina DO, Barbosa A, Bernardi Bertonha F, Moreira-Filho CA, Jacob-Filho W, Nitrini R, Pasqualucci CA, Tenenholz Grinberg L, Kimie Suemoto C, Brentani HP, Lafer B. Gene expression alterations in the postmortem hippocampus from older patients with bipolar disorder - A hypothesis generating study. J Psychiatr Res 2023; 164:329-334. [PMID: 37393798 DOI: 10.1016/j.jpsychires.2023.06.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
Bipolar disorder (BD) presents with a progressive course in a subset of patients. However, our knowledge of molecular changes in older BD is limited. In this study, we examined gene expression changes in the hippocampus of BD from the Biobank of Aging Studies to identify genes of interest that warrant further exploration. RNA was extracted from the hippocampus from 11 subjects with BD and 11 age and sex-matched controls. Gene expression data was generated using the SurePrint G3 Human Gene Expression v3 microarray. Rank feature selection was performed to identify a subset of features that can optimally differentiate BD and controls. Genes ranked in the top 0.1% with log2 fold change >1.2 were identified as genes of interest. Average age of the subjects was 64 years old; duration of disease was 21 years and 82% were female. Twenty-five genes were identified, of which all but one was downregulated in BD. Of these, CNTNAP4, MAP4, SLC4A1, COBL, and NEURL4 had been associated with BD and other psychiatric conditions in previous studies. We believe our findings have identified promising targets to inform future studies aiming to understand the pathophysiology of BD in later life.
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Affiliation(s)
- Camila Nascimento
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil; Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil.
| | | | - Paula Villela Nunes
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil; Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil.
| | | | | | - André Barbosa
- Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil.
| | | | | | - Wilson Jacob-Filho
- Division of Geriatrics, University of Sao Paulo Medical School, SP, Brazil.
| | - Ricardo Nitrini
- Department of Neurology, University of Sao Paulo Medical School, SP, Brazil.
| | | | - Lea Tenenholz Grinberg
- Department of Pathology, University of Sao Paulo Medical School, SP, Brazil; Memory and Aging Center University of California, San Francisco, USA.
| | | | | | - Beny Lafer
- Bipolar Disorder Program, Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil; Department of Psychiatry, University of Sao Paulo Medical School, SP, Brazil.
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Nucci RAB, Busse AL, de Souza RR, Maifrino LBM, Pasqualucci CA, Anaruma CA, Leite REP, Rodriguez RD, Suemoto CK, Jacob-Filho W. Smoking Intensity Increases Diaphragm Muscle Injury: A Clinicopathologic Study. J Clin Med 2023; 12:jcm12113823. [PMID: 37298016 DOI: 10.3390/jcm12113823] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Studying the effects of smoking intensity is important to evaluate the risk of tobacco use on a range of illnesses, such as as sarcopenia among the elderly. Thus, this study aimed to analyze the effects of pack-years of cigarette smoking on the diaphragm muscle (DIAm) histopathology of postmortem samples. METHODS Subjects were divided into three groups: never-smoker (n = 46); less than 30 pack-years of smoking (n = 12); and more than 30 pack-years of smoking (n = 30). Diaphragm samples were stained with Picrosirius red and hematoxylin and eosin stain for general structure. RESULTS Participants with more than 30 pack-years of cigarette smoking had a significant increase in adipocytes, blood vessels and collagen deposit, as well as an increase in histopathological alterations. CONCLUSIONS Pack-years of smoking was associated with DIAm injury. However, further clinicopathological studies are needed to confirm our findings.
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Affiliation(s)
- Ricardo Aparecido Baptista Nucci
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Alexandre Leopold Busse
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Romeu Rodrigues de Souza
- Department of Anatomy, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Department of Anatomy, 9 de Julho University-UNINOVE, São Paulo 03155-000, Brazil
| | - Laura Beatriz Mesiano Maifrino
- Laboratory of Clinical Analysis, Faculty of Medicine of the ABC District, Santo André 09060-650, Brazil
- Dante Pazzanese Institute of Cardiology, São Paulo 04012-909, Brazil
| | | | - Carlos Alberto Anaruma
- Laboratory of Morphology and Physical Activity, Department of Physical Education, São Paulo State University "Júlio de Mesquita Filho", Rio Claro 11330-900, Brazil
| | - Renata Elaine Paraizo Leite
- Laboratory of Physiopathology in Aging (LIM-22), Department of Pathology, Faculty of Medicine, University of Sao Paulo, São Paulo 01246-903, Brazil
| | - Roberta Diehl Rodriguez
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Claudia Kimie Suemoto
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
| | - Wilson Jacob-Filho
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine, University of São Paulo, São Paulo 01246-903, Brazil
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10
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Nucci RAB, Filho VAN, Jacob-Filho W, Otoch JP, Pessoa AFM. Role of Nutritional Supplements on Gut-Muscle Axis Across Age: a Mini-Review. Cell Physiol Biochem 2023; 57:161-168. [PMID: 37190847 DOI: 10.33594/000000628] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Sarcopenia is a progressive skeletal muscle disorder associated with aging, resulting in loss of muscle mass and function. It has been linked to inflammation, oxidative stress, insulin resistance, hormonal changes (i.e. alterations in the levels or activity of hormones which can occur due to a variety of factors, including aging, stress, disease, medication, and environmental factors), and impaired muscle satellite cell activation. The gut microbiome is also essential for muscle health, and supplements such as probiotics, prebiotics, protein, creatine, and betaalanine can support muscle growth and function while also promoting gut health. Chronic low-grade inflammation is a leading cause of sarcopenia, which can activate signaling pathways that lead to muscle wasting and reduce muscle protein synthesis. Insulin resistance, hormonal changes, and impaired muscle satellite cell activation contribute to sarcopenia, and high levels of fat mass also play a role in the pathogenesis of sarcopenia. Resistance exercise and dietary supplementation have been shown to be effective treatments for sarcopenia. In addition, a combination of resistance exercise and supplementation has been shown to have a more significant beneficial effect on anthropometric and muscle function parameters, leading to a decrease in sarcopenic state. Thus, understanding the relationship between the gut microbiome and muscle metabolism is crucial for developing new treatments for sarcopenia across age groups.
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Affiliation(s)
- Ricardo Aparecido Baptista Nucci
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo Brazil,
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Victor Abou Nehmi Filho
- Research and Development Efeom Nutrition S/A, São Paulo, Brazil
- Natural Products and Derivatives Laboratory (LIM-26), Department of Surgery, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo Brazil
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - José Pinhata Otoch
- Research and Development Efeom Nutrition S/A, São Paulo, Brazil
- Natural Products and Derivatives Laboratory (LIM-26), Department of Surgery, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Ana Flávia Marçal Pessoa
- Research and Development Efeom Nutrition S/A, São Paulo, Brazil
- Natural Products and Derivatives Laboratory (LIM-26), Department of Surgery, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Brazilian Academic Consortium for Integrative Health (CABSIN), Natural Products Committee, São Paulo, Brazil
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11
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Yahagi-Estevam M, Farias-Itao DS, Leite REP, Rodriguez RD, Pasqualucci CA, Nitrini R, Jacob-Filho W, Power MC, Suemoto CK. The Potential Role of Selection Bias in the Association Between Coronary Atherosclerosis and Cognitive Impairment. J Alzheimers Dis 2023:JAD220820. [PMID: 37182864 DOI: 10.3233/jad-220820] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 05/16/2023]
Abstract
BACKGROUND Coronary atherosclerosis assessed in vivo was associated with cognitive impairment; however, conflicting findings have been reported in autopsy samples. OBJECTIVE Our aims were to assess the association between atherosclerotic stenosis in the coronary arteries and cognitive impairment and to investigate the possibility of selection bias in an autopsy study. METHODS Coronary arteries were collected, and the largest luminal stenosis was measured. Sociodemographic, clinical, and cognitive information were reported by a reliable next-of-kin. The association was tested using logistic and linear regressions adjusted for sociodemographic and clinical variables. We restricted the sample to individuals that were born in 1935 or earlier and stratified the analysis by cause of death to investigate the role of selection bias. RESULTS In 253 participants (mean age = 78.0±8.5 years old, 48% male), stenosis was not associated with cognitive impairment (OR = 0.85, 95% CI = 0.69; 1.06, p = 0.15). In individuals who were born before 1936 in the absence of cardiovascular disease as the cause of death, greater stenosis was associated with cognitive impairment (OR = 4.02, 95% CI = 1.39; 11.6, p = 0.01). On the other hand, this association was not present among those born in 1935 or earlier who died of cardiovascular diseases (OR = 0.83, 95% CI = 0.60; 1.16, p = 0.28). CONCLUSION We found that higher coronary stenosis was associated with cognitive impairment only in individuals born in 1935 or earlier and who had not died from cardiovascular diseases. Selection bias may be an important issue when investigating risk factors for chronic degenerative diseases in older individuals using autopsy samples.
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Affiliation(s)
| | | | - Renata Elaine Paraizo Leite
- Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Discipline of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Carlos Augusto Pasqualucci
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Nitrini
- Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Neurology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Discipline of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Melinda C Power
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Claudia Kimie Suemoto
- Physiopathology in Aging Lab/Brazilian Aging Brain Study Group - LIM22, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Discipline of Geriatrics, University of Sao Paulo Medical School, Sao Paulo, Brazil
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12
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Yonamine CY, Passarelli M, Suemoto CK, Pasqualucci CA, Jacob-Filho W, Alves VAF, Marie SKN, Correa-Giannella ML, Britto LR, Machado UF. Postmortem Brains from Subjects with Diabetes Mellitus Display Reduced GLUT4 Expression and Soma Area in Hippocampal Neurons: Potential Involvement of Inflammation. Cells 2023; 12:cells12091250. [PMID: 37174649 PMCID: PMC10177173 DOI: 10.3390/cells12091250] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/13/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Diabetes mellitus (DM) is an important risk factor for dementia, which is a common neurodegenerative disorder. DM is known to activate inflammation, oxidative stress, and advanced glycation end products (AGEs) generation, all capable of inducing neuronal dysfunctions, thus participating in the neurodegeneration progress. In that process, disturbed neuronal glucose supply plays a key role, which in hippocampal neurons is controlled by the insulin-sensitive glucose transporter type 4 (GLUT4). We investigated the expression of GLUT4, nuclear factor NF-kappa B subunit p65 [NFKB (p65)], carboxymethyllysine and synapsin1 (immunohistochemistry), and soma area in human postmortem hippocampal samples from control, obese, and obese+DM subjects (41 subjects). Moreover, in human SH-SY5Y neurons, tumor necrosis factor (TNF) and glycated albumin (GA) effects were investigated in GLUT4, synapsin-1 (SYN1), tyrosine hydroxylase (TH), synaptophysin (SYP) proteins, and respective genes; NFKB binding activity in the SLC2A4 promoter; effects of increased histone acetylation grade by histone deacetylase 3 (HDAC3) inhibition. Hippocampal neurons (CA4 area) of obese+DM subjects displayed reduced GLUT4 expression and neuronal soma area, associated with increased expression of NFKB (p65). Challenges with TNF and GA decreased the SLC2A4/GLUT4 expression in SH-SY5Y neurons. TNF decreased SYN1, TH, and SYP mRNAs and respective proteins, and increased NFKB binding activity in the SLC2A4 promoter. Inhibition of HDAC3 increased the SLC2A4 expression and the total neuronal content of CRE-binding proteins (CREB/ICER), and also counterbalanced the repressor effect of TNF upon these parameters. This study revealed reduced postmortem human hippocampal GLUT4 content and neuronal soma area accompanied by increased proinflammatory activity in the brains of DM subjects. In isolated human neurons, inflammatory activation by TNF reduced not only the SLC2A4/GLUT4 expression but also the expression of some genes related to neuronal function (SYN1, TH, SYP). These effects may be related to epigenetic regulations (H3Kac and H4Kac status) since they can be counterbalanced by inhibiting HDAC3. These results uncover the improvement in GLUT4 expression and/or the inhibition of HDAC3 as promising therapeutic targets to fight DM-related neurodegeneration.
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Affiliation(s)
- Caio Yogi Yonamine
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Marisa Passarelli
- Laboratório de Lipides (LIM-10) do HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil
- Programa de Pos-Graduação em Medicina, Universidade Nove de Julho (UNINOVE), São Paulo 01525-000, Brazil
| | - Claudia Kimie Suemoto
- Divisao de Geriatria, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01246-000, Brazil
| | | | - Wilson Jacob-Filho
- Divisao de Geriatria, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01246-000, Brazil
| | - Venâncio Avancini Ferreira Alves
- Laboratório de Investigação Médica em Patologia Hepática, (LIM14) do Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-000, Brazil
| | | | - Maria Lucia Correa-Giannella
- Laboratorio de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01246-000, Brazil
| | - Luiz Roberto Britto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
| | - Ubiratan Fabres Machado
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo 05508-000, Brazil
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13
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Avelino-Silva TJ, Garcez FB, Campora F, Curiati JAE, Jacob-Filho W. Finding the Goldilocks zone: Effects of ambient temperature on mortality of hospitalized older adults. J Am Geriatr Soc 2023. [PMID: 37010701 DOI: 10.1111/jgs.18354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/11/2023] [Accepted: 03/07/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, and Trinity College Dublin, Dublin, Ireland
| | - Flavia Barreto Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
- Hospital Universitario, Universidade Federal de Sergipe, Aracaju, Brazil
| | - Flavia Campora
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Jose A E Curiati
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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14
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Gibson LL, Grinberg LT, Ffytche D, Leite REP, Rodriguez RD, Ferretti-Rebustini REL, Pasqualucci CA, Nitrini R, Jacob-Filho W, Aarsland D, Suemoto CK. Neuropathological correlates of neuropsychiatric symptoms in dementia. Alzheimers Dement 2023; 19:1372-1382. [PMID: 36150075 PMCID: PMC10033459 DOI: 10.1002/alz.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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] [Received: 03/23/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are common in Lewy body disease (LBD), but their etiology is poorly understood. METHODS In a population-based post mortem study neuropathological data was collected for Lewy body (LB) neuropathology, neurofibrillary tangles (NFT), amyloid beta burden, TDP-43, lacunar infarcts, cerebral amyloid angiopathy (CAA), and hyaline atherosclerosis. Post mortem interviews collected systematic information regarding NPS and cognitive status. A total of 1038 cases were included: no pathology (NP; n = 761), Alzheimer's disease (AD; n = 189), LBD (n = 60), and AD+LBD (n = 28). RESULTS Hallucinations were associated with higher LB Braak stages, while higher NFT Braak staging was associated with depression, agitation, and greater number of symptoms in the Neuropsychiatric Inventory. Cases with dual AD+LBD pathology had the highest risk of hallucinations, agitation, apathy, and total symptoms but a multiplicative interaction between these pathologies was not significant. DISCUSSION LB and AD pathology contribute differentially to NPS likely with an additive process contributing to the increased burden of NPS.
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Affiliation(s)
- Lucy L Gibson
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology and Pathology, University of California San Francisco, San Francisco, California, USA
- University of São Paulo Medical School, São Paulo, Brazil
| | - Dominic Ffytche
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | | | | | | | - Dag Aarsland
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
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15
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Silva VC, Dias AS, Greve JMD, Davis CL, Soares ALDS, Brech GC, Ayama S, Jacob-Filho W, Busse AL, de Biase MEM, Canonica AC, Alonso AC. Crash Risk Predictors in Older Drivers: A Cross-Sectional Study Based on a Driving Simulator and Machine Learning Algorithms. Int J Environ Res Public Health 2023; 20:4212. [PMID: 36901230 PMCID: PMC10002325 DOI: 10.3390/ijerph20054212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 06/18/2023]
Abstract
The ability to drive depends on the motor, visual, and cognitive functions, which are necessary to integrate information and respond appropriately to different situations that occur in traffic. The study aimed to evaluate older drivers in a driving simulator and identify motor, cognitive and visual variables that interfere with safe driving through a cluster analysis, and identify the main predictors of traffic crashes. We analyzed the data of older drivers (n = 100, mean age of 72.5 ± 5.7 years) recruited in a hospital in São Paulo, Brazil. The assessments were divided into three domains: motor, visual, and cognitive. The K-Means algorithm was used to identify clusters of individuals with similar characteristics that may be associated with the risk of a traffic crash. The Random Forest algorithm was used to predict road crash in older drivers and identify the predictors (main risk factors) related to the outcome (number of crashes). The analysis identified two clusters, one with 59 participants and another with 41 drivers. There were no differences in the mean of crashes (1.7 vs. 1.8) and infractions (2.6 vs. 2.0) by cluster. However, the drivers allocated in Cluster 1, when compared to Cluster 2, had higher age, driving time, and braking time (p < 0.05). The random forest performed well (r = 0.98, R2 = 0.81) in predicting road crash. Advanced age and the functional reach test were the factors representing the highest risk of road crash. There were no differences in the number of crashes and infractions per cluster. However, the Random Forest model performed well in predicting the number of crashes.
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Affiliation(s)
- Vanderlei Carneiro Silva
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Aluane Silva Dias
- Graduate Program in Aging Science, São Judas Tadeu University (USJT), São Paulo 03166-000, Brazil
| | - Julia Maria D’Andréa Greve
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Catherine L. Davis
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30901, USA
| | - André Luiz de Seixas Soares
- Graduate Program in Aging Science, São Judas Tadeu University (USJT), São Paulo 03166-000, Brazil
- Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, GA 30901, USA
| | - Guilherme Carlos Brech
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
- Graduate Program in Aging Science, São Judas Tadeu University (USJT), São Paulo 03166-000, Brazil
| | - Sérgio Ayama
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Wilson Jacob-Filho
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Alexandre Leopold Busse
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Maria Eugênia Mayr de Biase
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Alexandra Carolina Canonica
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
| | - Angelica Castilho Alonso
- Laboratory for the Study of Movement, Department of Orthopedics and Traumatology, School of Medicine, University of São Paulo, São Paulo 05403-010, Brazil
- Graduate Program in Aging Science, São Judas Tadeu University (USJT), São Paulo 03166-000, Brazil
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16
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Dias MB, Medeiros APV, de Melo SS, Fonseca CS, Jacob-Filho W, Avelino-Silva TJ, Aliberti MJR. The long and winding road of COVID-19 in survivors of hospitalisation: Symptoms trajectory and predictors of long COVID. J Intern Med 2023; 293:264-268. [PMID: 36316955 PMCID: PMC9878261 DOI: 10.1111/joim.13583] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Murilo B Dias
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Paula V Medeiros
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sarah S de Melo
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Cecilia S Fonseca
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Márlon J R Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
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de Morais VAC, de Oliveira-Pinto AV, Mello Neto AF, Freitas JS, da Silva MM, Suemoto CK, Leite RP, Grinberg LT, Jacob-Filho W, Pasqualucci C, Nitrini R, Caramelli P, Lent R. Resilience of Neural Cellularity to the Influence of Low Educational Level. Brain Sci 2023; 13:brainsci13010104. [PMID: 36672086 PMCID: PMC9857353 DOI: 10.3390/brainsci13010104] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Education is believed to contribute positively to brain structure and function, as well as to cognitive reserve. One of the brain regions most impacted by education is the medial temporal lobe (MTL), a region that houses the hippocampus, which has an important role in learning processes and in consolidation of memories, and is also known to undergo neurogenesis in adulthood. We aimed to investigate the influence of education on the absolute cell numbers of the MTL (comprised by the hippocampal formation, amygdala, and parahippocampal gyrus) of men without cognitive impairment. METHODS The Isotropic Fractionator technique was used to allow the anisotropic brain tissue to be transformed into an isotropic suspension of nuclei, and therefore assess the absolute cell composition of the MTL. We dissected twenty-six brains from men aged 47 to 64 years, with either low or high education. RESULTS A significant difference between groups was observed in brain mass, but not in MTL mass. No significant difference was found between groups in the number of total cells, number of neurons, and number of non-neuronal cells. Regression analysis showed that the total number of cells, number of neurons, and number of non-neuronal cells in MTL were not affected by education. CONCLUSIONS The results indicate a resilience of the absolute cellular composition of the MTL of typical men to low schooling, suggesting that the cellularity of brain regions is not affected by formal education.
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Affiliation(s)
- Viviane A. Carvalho de Morais
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Ana V. de Oliveira-Pinto
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Arthur F. Mello Neto
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Jaqueline S. Freitas
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
| | - Magnólia M. da Silva
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Claudia Kimie Suemoto
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Renata P. Leite
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Lea T. Grinberg
- Memory and Aging Center, University of California San Francisco, San Francisco, CA 94158, USA
| | - Wilson Jacob-Filho
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Carlos Pasqualucci
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Ricardo Nitrini
- Biobank for Aging Studies, Faculdade de Medicina, Universidade de São Paulo, São Paulo 01246-903, SP, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
| | - Roberto Lent
- Neuroplasticity Laboratory, Instituto de Ciências Biomédicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-902, RJ, Brazil
- D’Or Institute of Research and Education, Rio de Janeiro 22281-100, RJ, Brazil
- Correspondence:
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Taniguchi LU, Aliberti MJR, Dias MB, Jacob-Filho W, Avelino-Silva TJ. Calculating Route: Functional Trajectories and Long-Term Outcomes in Survivors of Severe COVID-19. J Nutr Health Aging 2023; 27:1168-1173. [PMID: 38151867 DOI: 10.1007/s12603-023-2036-4] [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] [Received: 08/28/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVES We investigated functional trajectories after severe COVID-19 and estimated their associations with adverse outcomes (falls, rehospitalizations, institutionalization, or death), cognition and post COVID-19 condition within 1-year of hospital discharge. DESIGN Prospective cohort study. SETTING A large academic medical center in Sao Paulo, Brazil. PARTICIPANTS Survivors of COVID-19 admissions to an intensive care unit. INTERVENTIONS None. MEASUREMENTS We evaluated participants' disability status before hospital admission and three, six, nine, and twelve months after discharge using 15 activities of daily living. During follow-up, cognition and post COVID-19 condition (defined as persistent symptoms with duration ≥2 months) were assessed. A latent class growth analysis was performed to investigate functional trajectories after discharge. RESULTS We included 422 participants (median age 63 years, 13.5% were frail before COVID-19). Four distinct functional trajectories could be identified: "minimal disability trajectory" (37.4% of participants), "mild disability trajectory" (37.9%), "moderate disability trajectory" (16.8%), and "severe disability trajectory" (7.8%). Compared with minimal disability trajectory, the odds ratios (95% confidence interval) for 1-year adverse outcomes were 2.28 (1.38-3.76) for minor disability trajectory; 4.21 (2.10-8.42) for moderate disability trajectory; and 4.16 (1.51-11.46) for severe disability trajectory, even after adjustments. The occurrence of post COVID-19 condition was 67.5% and associated with functional trajectories (p=0.004). Cognition was also associated with functional trajectories. CONCLUSION Severe COVID-19 survivors can experience diverse functional trajectories, with those presenting higher levels of disability at increased risk for long-term adverse outcomes. Further investigations are essential to confirm our findings and assess the effectiveness of rehabilitation interventions, aiming to improve health outcomes in those who survived severe COVID-19 and other causes of sepsis.
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Affiliation(s)
- L U Taniguchi
- Leandro Utino Taniguchi, Emergency Medicine Discipline, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, Av Enéas de Carvalho Aguiar 255 Sala 5023, Postal Code: 05403-000, São Paulo, Brazil, e-mail: , telephone: 55-11-2661-6336, fax: 55-11-2662-6336
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19
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Crenitte MRF, de Melo LR, Jacob-Filho W, Avelino-Silva TJ. Transforming the invisible into the visible: disparities in the access to health in LGBT+ older people. Clinics (Sao Paulo) 2023; 78:100149. [PMID: 36535175 PMCID: PMC9791605 DOI: 10.1016/j.clinsp.2022.100149] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/20/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To compare variables of access to healthcare between the LGBT+ population aged 50 and over and those non-LGBT+. METHODS A cross-sectional study was carried out in Brazil through a confidential online questionnaire. The use of the health system was characterized by the number of preventive tests performed and measured by the PCATool-Brasil scale (a 10-point scale in which higher scores were associated with better assistance in healthcare). The association between being LGBT+ and access to health was analyzed in Poisson regression models. RESULTS 6693 participants (1332 LGBT+ and 5361 non-LGBT+) with a median age of 60 years were included. In the univariate analysis, it was observed not only lower scores on the PCATool scale (5.13 against 5.82, p < 0.001), but a greater proportion of individuals among those classified with the worst quintile of access to healthcare (< 4 points), 31% against 18% (p < 0.001). Being LGBT+ was an independent factor associated with worse access to health (PR = 2.5, 95% CI 2.04‒3.06). The rate of screening cancer, for breast, colon, and cervical cancer was also found to be lower in the LGBT+ population. CONCLUSION Healthcare access and health service experiences were worse in the LGBT+ group than in their non-LGBT peers. Inclusive and effective healthcare public policies are essential to promote healthy aging for all.
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Affiliation(s)
- Milton Roberto Furst Crenitte
- Laboratório de Investigação Médica em Envelhecimento (LIM 66), Serviço de Geriatria, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Caetano do Sul, São Paulo SP, Brazil.
| | - Leonardo Rabelo de Melo
- Laboratório de Investigação Médica em Envelhecimento (LIM 66), Serviço de Geriatria, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Laboratório de Investigação Médica em Envelhecimento (LIM 66), Serviço de Geriatria, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratório de Investigação Médica em Envelhecimento (LIM 66), Serviço de Geriatria, Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil; Faculdade Israelita de Ciências da Saúde "Albert Einstein", Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Paradela RS, Farias-Itao DS, Leite REP, Pasqualucci CA, Grinberg LT, Naslavsky MS, Zatz M, Nitrini R, Jacob-Filho W, Suemoto CK. Apolipoprotein E genotypes were not associated with intracranial atherosclerosis: a population-based autopsy study. Cardiovasc Pathol 2023; 62:107479. [PMID: 36155836 PMCID: PMC9990746 DOI: 10.1016/j.carpath.2022.107479] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Apolipoprotein E gene (APOE) ε4 allele is associated with a higher risk of carotid atherosclerosis, but less is known about the association of APOE with intracranial atherosclerotic disease (IAD). We aimed to investigate the association of APOE alleles with IAD in a cross-sectional autopsy study. METHODS We measured the stenosis in the 12 arteries of the Circle of Willis using postmortem morphometric measurements. The APOE polymorphism was determined by real-time polymerase chain reaction. We assessed the association between APOE polymorphism and IAD using regression models adjusted for sociodemographic and clinical variables. We also verified the modifier effect of age, sex, and race on this association. We stratified the analysis by age group to investigate the possibility of attrition bias. RESULTS In 400 participants (mean age=73.2±12.3 years old, 51% female, and 64% White), IAD was evaluated in 4,504 artery segments. APOE-ε4 was not associated with IAD nor with the number of artery stenosis compared to non-APOE-ε4 carriers. Sociodemographic variables did not modify this relationship. Among participants older than 70 years, there was a trend towards an association between APOE allele ε4 and a lower stenosis index in the middle cerebral artery, suggesting attrition bias related to the APOE-ε4 effect on mortality. CONCLUSIONS APOE alleles were not associated with IAD in this population-based autopsy study. Lower stenosis in older participants suggests the possibility of attrition bias.
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Affiliation(s)
| | | | - Renata E P Leite
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos A Pasqualucci
- Department of Pathology, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Lea T Grinberg
- Memory and Aging Center, University of California San Francisco, USA
| | - Michel Satya Naslavsky
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Center, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, Brazil
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21
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Canonica AC, Alonso AC, Brech GC, Peterson M, Luna NMS, Busse AL, Jacob-Filho W, Rosa JL, Soares-Junior JM, Baracat EC, Greve JMD. Adaptation to the driving simulator and prediction of the braking time performance, with and without distraction, in older adults and middle-aged adults. Clinics (Sao Paulo) 2023; 78:100168. [PMID: 36774731 PMCID: PMC9947223 DOI: 10.1016/j.clinsp.2023.100168] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 12/29/2022] [Indexed: 02/12/2023] Open
Abstract
CONTEXT Many studies show the importance of evaluating the adaptation time of subjects in a virtual driving environment, looking forwards to a response as closest as a possible real vehicle. OBJECTIVES This study aimed to identify and analyze the adaptation to the driving simulator in older adults and middle-aged adults with and without a distraction, and a secondary aim was to identify predictors of safe performance for older adults' drives. DESIGN Male and female middle-aged adults (n = 62, age = 30.3 ± 7.1 years) and older adults (n = 102, age = 70.4 ± 5.8 years) were evaluated for braking time performance in a driving simulator; cognition performance assessment included the Mini-Mental State Examination; motor evaluation included ankle flexor muscle strength with the isokinetic dynamometer and handgrip strength; the postural balance was evaluated with Timed Up and Go test, with and without a cognitive distraction task. RESULTS Older adults (men and women) and middle-aged adult women require more time to adapt to the driving simulator. The distractor increases the adaptation time for all groups. The main predictors of braking time for older women are age, muscle strength, and postural balance associated with distraction, and for older men, muscle strength. CONCLUSIONS Age, sex, and distractor interfere in the adaptation of the virtual task of driving in a simulator. The evaluation model developed with multi-domains demonstrated the ability to predict which skills are related to braking time with and without the presence of the distractor.
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Affiliation(s)
- Alexandra Carolina Canonica
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Angelica Castilho Alonso
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Graduate Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil
| | - Guilherme Carlos Brech
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil; Graduate Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil.
| | - Mark Peterson
- Department of Physical Medicine and Rehabilitation, University of Michigan-Medicine, Michigan, United States
| | - Natália Mariana Silva Luna
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Alexandre Leopold Busse
- Departamento de Geriatria da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Departamento de Geriatria da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Juliana Leme Rosa
- Graduate Program in Aging Sciences, Universidade São Judas Tadeu (USJT), São Paulo, SP, Brazil
| | - Jose Maria Soares-Junior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Júlia Maria D'Andrea Greve
- Laboratory Study of Movement, Instituto de Ortopedia e Traumatologia do Hospital das Clínicas (IOT-HC) da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Suemoto CK, Bertola L, Grinberg LT, Leite REP, Rodriguez RD, Santana PH, Pasqualucci CA, Jacob-Filho W, Nitrini R. Education, but not occupation, is associated with cognitive impairment: The role of cognitive reserve in a sample from a low-to-middle-income country. Alzheimers Dement 2022; 18:2079-2087. [PMID: 34978148 PMCID: PMC9400335 DOI: 10.1002/alz.12542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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] [Received: 06/03/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Education, and less frequently occupation, has been associated with lower dementia risk in studies from high-income countries. We aimed to investigate the association of cognitive impairment with education and occupation in a low-middle-income country sample. METHODS In this cross-sectional study, cognitive function was assessed by the Clinical Dementia Rating sum of boxes (CDR-SOB). We investigated the association of occupation complexity and education with CDR-SOB using adjusted linear regression models for age, sex, and neuropathological lesions. RESULTS In 1023 participants, 77% had < 5 years of education, and 56% unskilled occupations. Compared to the group without education, those with formal education had lower CDR-SOB (1-4 years:β $\beta \;$ = -0.99, 95% confidence interval [CI] = -1.85; -0.14, P = .02; ≥5 years:β $\beta \;$ = -1.42, 95% CI = -2.47; -0.38, P = .008). Occupation complexity and demands were unrelated to cognition. DISCUSSION Education, but not occupation, was related to better cognitive abilities independent of the presence of neuropathological insults.
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Affiliation(s)
- Claudia K Suemoto
- Division of Geriatrics, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Laiss Bertola
- Division of Geriatrics, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Lea T Grinberg
- Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil
- Memory and Aging Center, University of California San Francisco, San Francisco, California, USA
| | - Renata E P Leite
- Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Roberta D Rodriguez
- Department of Neurology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Pedro H Santana
- Division of Geriatrics, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Carlos A Pasqualucci
- Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, Sao Paulo, Brazil
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23
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Naslavsky MS, Suemoto CK, Brito LA, Scliar MO, Ferretti-Rebustini RE, Rodriguez RD, Leite REP, Araujo NM, Borda V, Tarazona-Santos E, Jacob-Filho W, Pasqualucci C, Nitrini R, Yaffe K, Zatz M, Grinberg LT. Global and local ancestry modulate APOE association with Alzheimer's neuropathology and cognitive outcomes in an admixed sample. Mol Psychiatry 2022; 27:4800-4808. [PMID: 36071110 PMCID: PMC9734036 DOI: 10.1038/s41380-022-01729-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 07/10/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023]
Abstract
Dementia is more prevalent in Blacks than in Whites, likely due to a combination of environmental and biological factors. Paradoxically, clinical studies suggest an attenuation of APOE ε4 risk of dementia in African ancestry (AFR), but a dearth of neuropathological data preclude the interpretation of the biological factors underlying these findings, including the association between APOE ε4 risk and Alzheimer's disease (AD) pathology, the most frequent cause of dementia. We investigated the interaction between African ancestry, AD-related neuropathology, APOE genotype, and functional cognition in a postmortem sample of 400 individuals with a range of AD pathology severity and lack of comorbid neuropathology from a cohort of community-dwelling, admixed Brazilians. Increasing proportions of African ancestry (AFR) correlated with a lower burden of neuritic plaques (NP). However, for individuals with a severe burden of NP and neurofibrillary tangles (NFT), AFR proportion was associated with worse Clinical Dementia Rating sum of boxes (CDR-SOB). Among APOE ε4 carriers, the association between AFR proportion and CDR-SOB disappeared. APOE local ancestry inference of a subset of 309 individuals revealed that, in APOE ε4 noncarriers, non-European APOE background correlated with lower NP burden and, also, worse cognitive outcomes than European APOE when adjusting by NP burden. Finally, APOE ε4 was associated with worse AD neuropathological burden only in a European APOE background. APOE genotype and its association with AD neuropathology and clinical pattern are highly influenced by ancestry, with AFR associated with lower NP burden and attenuated APOE ε4 risk compared to European ancestry.
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Affiliation(s)
- Michel Satya Naslavsky
- Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, University of São Paulo, São Paulo, SP, Brazil
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Claudia K Suemoto
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Luciano Abreu Brito
- Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, University of São Paulo, São Paulo, SP, Brazil
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
| | | | - Renata Eloah Ferretti-Rebustini
- Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, University of São Paulo, São Paulo, SP, Brazil
| | | | - Renata E P Leite
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Nathalia Matta Araujo
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Victor Borda
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Eduardo Tarazona-Santos
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Carlos Pasqualucci
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Kristine Yaffe
- Department of Psychiatry, Neurology, and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- VA Medical Center, San Francisco, San Francisco, CA, USA
| | - Mayana Zatz
- Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, University of São Paulo, São Paulo, SP, Brazil
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
| | - Lea T Grinberg
- Department of Pathology, LIM-22, University of São Paulo Medical School, São Paulo, SP, Brazil.
- Memory and Aging Center, Department of Neurology, and Pathology, University of California, San Francisco, San Francisco, CA, USA.
- Global brain Health Institute, University of California, San Francisco, San Francisco, CA, USA.
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Noronha IL, Santa-Catharina GP, Andrade L, Coelho VA, Jacob-Filho W, Elias RM. Glomerular filtration in the aging population. Front Med (Lausanne) 2022; 9:769329. [PMID: 36186775 PMCID: PMC9519889 DOI: 10.3389/fmed.2022.769329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 08/24/2022] [Indexed: 12/11/2022] Open
Abstract
In the last decades, improvements in the average life expectancy in the world population have been associated with a significant increase in the proportion of elderly people, in parallel with a higher prevalence of non-communicable diseases, such as hypertension and diabetes. As the kidney is a common target organ of a variety of diseases, an adequate evaluation of renal function in the approach of this population is of special relevance. It is also known that the kidneys undergo aging-related changes expressed by a decline in the glomerular filtration rate (GFR), reflecting the loss of kidney function, either by a natural senescence process associated with healthy aging or by the length of exposure to diseases with potential kidney damage. Accurate assessment of renal function in the older population is of particular importance to evaluate the degree of kidney function loss, enabling tailored therapeutic interventions. The present review addresses a relevant topic, which is the effects of aging on renal function. In order to do that, we analyze and discuss age-related structural and functional changes. The text also examines the different options for evaluating GFR, from the use of direct methods to the implementation of several estimating equations. Finally, this manuscript supports clinicians in the interpretation of GFR changes associated with age and the management of the older patients with decreased kidney function.
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Affiliation(s)
- Irene L. Noronha
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
- Laboratory of Cellular, Genetic and Molecular Nephrology, University of São Paulo Medical School, São Paulo, Brazil
- *Correspondence: Irene L. Noronha
| | | | - Lucia Andrade
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Venceslau A. Coelho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatric Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Rosilene M. Elias
- Renal Division, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil
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Nunes PV, Suemoto CK, Rodriguez RD, Paraizo Leite RE, Nascimento C, Pasqualucci CA, Nitrini R, Jacob-Filho W, Grinberg LT, Lafer B. Neuropathology of depression in non-demented older adults: A large postmortem study of 741 individuals. Neurobiol Aging 2022; 117:107-116. [PMID: 35709536 PMCID: PMC9970030 DOI: 10.1016/j.neurobiolaging.2022.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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] [Received: 02/12/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/05/2023]
Abstract
Associations between age-related neuropathological lesions and adult-onset lifetime major depressive disorder (a-MDD), late-life MDD (LLD), or depressive symptoms close to death (DS) were examined in a large community sample of non-demented older adults. Seven hundred forty-one individuals (age at death = 72.2 ± 11.7 years) from the Biobank for Aging Studies were analyzed. a-MDD was present in 54 (7.3%) participants, LLD in 80 (10.8%), and DS in 168 (22.7%). After adjustment for covariates and compared to controls, a-MDD, LDD and DS were associated with small vessel disease (p = 0.039, p = 0.003, and p = 0.003 respectively); LLD, and DS were associated with brain infarcts (p = 0.012, p = 0.018, respectively) and Lewy body disease (p = 0.043, p = 0.002, respectively). DS was associated with beta-amyloid plaque burden (p = 0.027) and cerebral amyloid angiopathy (p = 0.035) in cognitively normal individuals (Clinical Dementia Rating scale = 0). Vascular brain pathology was the strongest correlate of clinical depictions of depression in the absence of dementia, corroborating the vascular hypothesis of depression. Lewy body pathology underlay DS. An older adult with DS or LLD should be monitored for possible cognitive decline or neurodegenerative disorders.
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Affiliation(s)
- Paula Villela Nunes
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Claudia Kimie Suemoto
- Department of Geriatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Roberta Diehl Rodriguez
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Camila Nascimento
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Department of Neurology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Department of Geriatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lea T Grinberg
- Department of Pathology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Memory and Aging Center University of California, San Francisco, CA, USA
| | - Beny Lafer
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Siqueira ASS, Biella MM, Borges MK, Mauer S, Apolinario D, Alves TCDTF, Jacob-Filho W, Oude Voshaar RC, Aprahamian I. Decision-making executive function profile and performance in older adults with major depression: a case-control study. Aging Ment Health 2022; 26:1551-1557. [PMID: 34263687 DOI: 10.1080/13607863.2021.1950617] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.
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Affiliation(s)
| | - Marina Maria Biella
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marcus Kiiti Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Sivan Mauer
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Daniel Apolinario
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Richard C Oude Voshaar
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.,Geriatrics Division, Internal Medicine Department, Faculty of Medicine of Jundiaí, Group of Investigation on Multimorbidity and Mental Health in Aging (GIMMA), Jundiaí, Brazil
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Viana SDSC, Souza NPDS, Aliberti MJR, Jacob-Filho W. Use of potentially inappropriate medications and adverse events in older outpatients with acute conditions. einstein (São Paulo) 2022; 20:eAO8024. [PMID: 35792759 PMCID: PMC9239534 DOI: 10.31744/einstein_journal/2022ao8024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022] Open
Abstract
Objective To examine associations between potentially inappropriate medication, use and the risk of falls, unplanned hospitalization and death in older patients receiving initial care in a geriatric day hospital due to acute conditions. Methods Cohort study with older adults referred to a geriatric day hospital from 2014 to 2017 due to acute conditions. Patients were submitted to comprehensive geriatric assessment. Use of medications was analyzed according to Beers Criteria 2019. Outcome assessment was based on monthly follow-up telephone calls made over the course of one year. Results In this sample, 40.6% of patients had been prescribed at least one potentially inappropriate medication, particularly proton pump inhibitors (66.5%). Over the course of follow-up, 44.7% of patients receiving potentially inappropriate medications sustained at least one fall (p=0.0043) and 70% visited the emergency department (p=0.0452). These outcomes were more common among patients using two or more of drugs. Use of potentially inappropriate medication was associated with a 64% increase in the odds of unplanned hospitalization and a two-fold increase in risk of death. Conclusion Associations between potentially inappropriate medication use and unfavorable outcomes such as falls and unplanned hospitalizations within one year of admission to a geriatric day hospital support the application of Beers Criteria and emphasize the importance of periodic prescription review, deprescription and rational use of these drugs whenever possible.
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Taniguchi LU, Avelino-Silva TJ, Dias MB, Jacob-Filho W, Aliberti MJR. Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19. Crit Care Explor 2022; 4:e0712. [PMID: 35765375 PMCID: PMC9225491 DOI: 10.1097/cce.0000000000000712] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Few studies have explored the effect of frailty on the long-term survival of COVID-19 patients after ICU admission. Furthermore, the Clinical Frailty Scale (CFS) validity in critical care patients remains debated. We investigated the association between frailty and 6-month survival in critically ill COVID-19 patients. We also explored whether ICU resource utilization varied according to frailty status and examined the concurrent validity of the CFS in this setting.
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da Costa NR, Mancine L, Salvini R, Teixeira JDM, Rodriguez RD, Leite REP, Nascimento C, Pasqualucci CA, Nitrini R, Jacob-Filho W, Lafer B, Grinberg LT, Suemoto CK, Nunes PV. Microcephaly measurement in adults and its association with clinical variables. Rev Saude Publica 2022; 56:38. [PMID: 35649085 PMCID: PMC9126574 DOI: 10.11606/s1518-8787.2022056004175] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To establish a microcephaly cut-off size in adults using head circumference as an indirect measure of brain size, as well as to explore factors associated with microcephaly via data mining. METHODS In autopsy studies, head circumference was measured with an inelastic tape placed around the skull. Total brain volume was also directly measured. A linear regression was used to determine the association of head circumference with brain volume and clinical variables. Microcephaly was defined as head circumference that were two standard deviations below the mean of significant clinical variables. We further applied an association rule mining to find rules associating microcephaly with several sociodemographic and clinical variables. RESULTS In our sample of 2,508 adults, the mean head circumference was 55.3 ± 2.7cm. Head circumference was related to height, cerebral volume, and sex (p < 0.001 for all). Microcephaly was present in 4.7% of the sample (n = 119). Out of 34,355 association rules, we found significant relationships between microcephaly and a clinical dementia rating (CDR) > 0.5 with an informant questionnaire on cognitive decline in the elderly (IQCODE) ≥ 3.4 (confidence: 100% and lift: 5.6), between microcephaly and a CDR > 0.5 with age over 70 years (confidence: 42% and lift: 2.4), and microcephaly and males (confidence: 68.1% and lift: 1.3). CONCLUSION Head circumference was related to cerebral volume. Due to its low cost and easy use, head circumference can be used as a screening test for microcephaly, adjusting it for gender and height. Microcephaly was associated with dementia at old age.
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Affiliation(s)
- Nicole Rezende da Costa
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Livia Mancine
- Universidade Federal de GoiásInstituto de InformáticaGoiâniaGOBrasilUniversidade Federal de Goiás. Instituto de Informática. Goiânia, GO, Brasil,Instituto Federal GoianoDepartamento de EnsinoIporáGOBrasilInstituto Federal Goiano. Departamento de Ensino. Iporá, GO, Brasil
| | - Rogerio Salvini
- Universidade Federal de GoiásInstituto de InformáticaGoiâniaGOBrasilUniversidade Federal de Goiás. Instituto de Informática. Goiânia, GO, Brasil
| | - Juliana de Melo Teixeira
- Universidade Federal de GoiásInstituto de InformáticaGoiâniaGOBrasilUniversidade Federal de Goiás. Instituto de Informática. Goiânia, GO, Brasil
| | - Roberta Diehl Rodriguez
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Renata Elaine Paraizo Leite
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Camila Nascimento
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Carlos Augusto Pasqualucci
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Ricardo Nitrini
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Wilson Jacob-Filho
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Beny Lafer
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Lea Tenenholz Grinberg
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil,University of CaliforniaMemory and Aging CenterSan FranciscoCaliforniaUnited StatesUniversity of California. Memory and Aging Center. San Francisco, California, United States
| | - Claudia Kimie Suemoto
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Paula Villela Nunes
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
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Neves BA, Nunes PV, Rodriguez RD, Haidar AM, Leite REP, Nascimento C, Pasqualucci CA, Nitrini R, Jacob-Filho W, Lafer B, Grinberg LT, Suemoto CK. Cause of Death Determined by Full-body Autopsy in Neuropathologically Diagnosed Dementias: The Biobank for Aging Studies of the University of Sao Paulo (BAS-USP), Brazil. Alzheimer Dis Assoc Disord 2022; 36:156-161. [PMID: 35001032 PMCID: PMC9149027 DOI: 10.1097/wad.0000000000000489] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/06/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE This study aimed to compare causes of death in the most prevalent neuropathologically diagnosed dementias. METHODS We analyzed causes of death in a community-based cohort of participants aged 50 or older, submitted to full-body autopsy and a comprehensive neuropathologic examination of the brain. Individuals with Alzheimer disease (AD), vascular dementia (VaD), mixed dementia (AD+VaD), or dementia with Lewy bodies (DLBs) were compared with individuals with no dementia. RESULTS In a sample of 920 individuals, 456 had no dementia, 147 had AD, 120 had VaD, 53 had DLB, and 37 had AD+VaD. Pneumonia as the cause of death was more frequent in the AD (P=0.023), AD+VaD (P=0.046), and DLB (P=0.043) groups. In addition, VaD (P=0.041) and AD+VaD (P=0.028) groups had a higher frequency of atherosclerosis as detected by full-body autopsy. CONCLUSION Our findings highlight the importance of preventive measures regarding atherosclerosis and pneumonia in patients with dementia. Moreover, because of cognitive impairment, these patients may not fully account for symptoms to make early detection and diagnosis possible. These results confirm findings from previous studies that were based on clinical data, with added accuracy provided by neuropathologic diagnosis and full-body autopsy reports.
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Affiliation(s)
| | - Paula Villela Nunes
- Faculdade de Medicina de Jundiai, Jundiai, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | | | | | | | - Camila Nascimento
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | | | - Beny Lafer
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
| | - Lea Tenenholz Grinberg
- Faculdade de Medicina, Universidade de São Paulo,
São Paulo, SP, Brazil
- Memory and Aging Center University of California, San
Francisco, USA
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31
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Nucci RAB, Jacob-Filho W. The “Long COVID” Respiratory Symptoms—Concerns with Frailty and Respiratory Diseases. Journal of Health and Allied Sciences NU 2022. [DOI: 10.1055/s-0042-1742467] [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: 10/19/2022]
Affiliation(s)
- Ricardo Aparecido Baptista Nucci
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Clinical Hospital of the Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
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32
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Tavares C, Samesima N, Lazar Neto F, Abrahão Hajjar L, Godoy L, Hirano E, Facin M, Jacob-Filho W, Farkouh M, Pastore C. USEFULNESS OF ECG CRITERIA TO RULE OUT LEFT VENTRICULAR HYPERTROPHY IN OLDER INDIVIDUALS WITH TRUE LEFT BUNDLE BRANCH BLOCK. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.105] [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: 11/16/2022] Open
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Berjeaut EJBK, de Carvalho BM, Aliberti MJR, Avelino-Silva TJ, Campora F, Jacob-Filho W, Garcez FB. "Part of a great team": Perceptions of geriatrics fellows on doing research during a pandemic. J Am Geriatr Soc 2021; 69:3058-3061. [PMID: 34343345 DOI: 10.1111/jgs.17397] [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: 04/23/2021] [Revised: 07/11/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Eugênia Jatene Bou Khazaal Berjeaut
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Bruna Macêdo de Carvalho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saude Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Flavia Campora
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flavia Barreto Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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Tosi FC, Lin SM, Gomes GC, Aprahamian I, Nakagawa NK, Viveiro L, Bacha JMR, Jacob-Filho W, Pompeu JE. A multidimensional program including standing exercises, health education, and telephone support to reduce sedentary behavior in frail older adults: Randomized clinical trial. Exp Gerontol 2021; 153:111472. [PMID: 34271135 DOI: 10.1016/j.exger.2021.111472] [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] [Received: 05/13/2021] [Revised: 06/24/2021] [Accepted: 07/03/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The primary aim of this study was to evaluate the effect of a multidimensional program including home-based standing exercises, health education, and telephone support for the reduction of sedentary behavior in community-dwelling frail older adults. The secondary aim of this study was to evaluate the safety and adherence of the program. STUDY DESIGN A single-blind, randomized controlled trial. METHODS A total of 43 frail older adults were randomly assigned to the intervention and control groups. The intervention consisted of combined strategies including home-based standing exercises, health education, and telephone support for 16 weeks for frail older adults. The control group received orientation regarding the harmful effects of a sedentary lifestyle. Sedentary behavior was evaluated by total sedentary time, accumulated sedentary time in bouts of at least 10 min, and by the break in sedentary time, measured by an accelerometer used for at least 600 min/day for 4 days. Safety was assessed by self-reporting of possible adverse events. Adherence was assessed based on the number of days in which standing exercises were performed by the participants. Repeated measures ANOVA and Tukeys post hoc test were used to analyze the collected data. RESULTS The intervention group reduced the sedentary time by 30 min/day (p= 0.048), but without significant maintenance after 30 days of the program. Of the total number of participants, 82% (n = 14) of the intervention group participants showed more than 70% adherence to the program. The main adverse effects faced by the intervention group participants were tiredness (53%; n = 9) and lower limb pain (47%; n = 8). CONCLUSIONS The multidimensional program reduced sedentary behavior, was safe, and showed satisfactory adherence in frail older adults.
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Affiliation(s)
- Fabiana C Tosi
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil.
| | - Sumika M Lin
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Gisele C Gomes
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Ivan Aprahamian
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil; Group of investigation on Multimorbidity and Mental Health in Aging (GIMMA), Geriatrics Division, Internal Medicine Department, Jundiaí Medical School, Jundiaí, Brazil; University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands
| | - Naomi K Nakagawa
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Larissa Viveiro
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Jessica M R Bacha
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Jose E Pompeu
- Laboratory of Studies in Technology, Functionality and Aging of the Department of Physical Therapy, Speech and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Ciciliati AMM, Adriazola IO, Souza Farias-Itao D, Pasqualucci CA, Leite REP, Nitrini R, Grinberg LT, Jacob-Filho W, Suemoto CK. Severe Dementia Predicts Weight Loss by the Time of Death. Front Neurol 2021; 12:610302. [PMID: 34054683 PMCID: PMC8160379 DOI: 10.3389/fneur.2021.610302] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/30/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Body mass index (BMI) in midlife is associated with dementia. However, the association between BMI and late-life obesity is controversial. Few studies have investigated the association between BMI and cognitive performance near the time of death using data from autopsy examination. We aimed to investigate the association between BMI and dementia in deceased individuals who underwent a full-body autopsy examination. Methods: Weight and height were measured before the autopsy exam. Cognitive function before death was investigated using the Clinical Dementia Rating (CDR) scale. The cross-sectional association between BMI and dementia was investigated using linear regression models adjusted for sociodemographic and clinical variables. Results: We included 1,090 individuals (mean age 69.5 ± 13.5 years old, 46% women). Most participants (56%) had a normal BMI (18.5–24.9 kg/m2), and the prevalence of dementia was 16%. Twenty-four percent of the sample had cancer, including 76 cases diagnosed only by the autopsy examination. Moderate and severe dementia were associated with lower BMI compared with participants with normal cognition in fully adjusted models (moderate: β = −1.92, 95% CI = −3.77 to −0.06, p = 0.042; severe: β = −2.91, 95% CI = −3.97 to −1.86, p < 0.001). Conclusion: BMI was associated with moderate and severe dementia in late life, but we did not find associations of BMI with less advanced dementia stages.
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Affiliation(s)
| | | | | | | | | | - Ricardo Nitrini
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Lea T Grinberg
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.,Department of Neurology and Pathology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Wilson Jacob-Filho
- Discipline of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
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Aliberti MJR, Szlejf C, Avelino-Silva VI, Suemoto CK, Apolinario D, Dias MB, Garcez FB, Trindade CB, Amaral JRDG, de Melo LR, de Aguiar RC, Coelho PHL, Hojaij NHSDL, Saraiva MD, da Silva NOT, Jacob-Filho W, Avelino-Silva TJ. COVID-19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients. J Am Geriatr Soc 2021; 69:1116-1127. [PMID: 33818759 PMCID: PMC8251205 DOI: 10.1111/jgs.17146] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [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: 01/20/2021] [Revised: 03/08/2021] [Accepted: 03/14/2021] [Indexed: 12/29/2022]
Abstract
Background Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID‐19) prognosis remains unclear. Objectives To investigate the association between frailty and mortality over 6 months in middle‐aged and older patients hospitalized with COVID‐19 and the association between acute morbidity severity and mortality across frailty strata. Design Observational cohort study. Setting Large academic medical center in Brazil. Participants A total of 1830 patients aged ≥50 years hospitalized with COVID‐19 (March–July 2020). Measurements We screened baseline frailty using the CFS (1–9) and classified patients as fit to managing well (1–3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7–9). We also computed a frailty index (0–1; frail >0.25), a well‐known frailty measure. We used Cox proportional hazards models to estimate the association between frailty and time to death within 30 days and 6 months of admission. We also examined whether frailty identified different mortality risk levels within strata of similar age and acute morbidity as measured by the Sequential Organ Failure Assessment (SOFA) score. Results Median age was 66 years, 58% were male, and 27% were frail to some degree. Compared with fit‐to‐managing‐well patients, the adjusted hazard ratios (95% confidence interval [CI]) for 30‐day and 6‐month mortality were, respectively, 1.4 (1.1–1.7) and 1.4 (1.1–1.7) for vulnerable patients; 1.5 (1.1–1.9) and 1.5 (1.1–1.8) for mild frailty; 1.8 (1.4–2.3) and 1.9 (1.5–2.4) for moderate frailty; and 2.1 (1.6–2.7) and 2.3 (1.8–2.9) for severe frailty to terminally ill. The CFS achieved outstanding accuracy to identify frailty compared with the Frailty Index (area under the curve = 0.94; 95% CI = 0.93–0.95) and predicted different mortality risks within age and acute morbidity groups. Conclusions Our results encourage the use of frailty, alongside measures of acute morbidity, to guide clinicians in prognostication and resource allocation in hospitalized patients with COVID‐19.
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Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Claudia Szlejf
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Department of Big Data, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Vivian I Avelino-Silva
- Department of Infectious Diseases, University of Sao Paulo Medical School, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Claudia Kimie Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Apolinario
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Hospital do Coracao (HCor), Associacao Beneficente Siria, Sao Paulo, Brazil
| | - Murilo Bacchini Dias
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Flavia Barreto Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Carolina B Trindade
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - José Renato das Graças Amaral
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Leonardo Rabelo de Melo
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Renata Cunha de Aguiar
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paulo Henrique Lazzaris Coelho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Naira Hossepian Salles de Lima Hojaij
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marcos Daniel Saraiva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Natalia Oliveira Trajano da Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Faculdade Israelita de Ciencias da Saúde Albert Einstein, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Nucci RAB, Dolhnikoff M, Saldiva PHDN, Jacob-Filho W. Ultrasound-Guided Minimally Invasive Autopsy of Respiratory Muscles as a Safe and Cost-Effective Technique in COVID-19 Pandemic Era. Acta Cytol 2021; 65:276-278. [PMID: 33690234 PMCID: PMC8018195 DOI: 10.1159/000514222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/06/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Ricardo Aparecido Baptista Nucci
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil,
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil,
| | - Marisa Dolhnikoff
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Brazilian Image Autopsy Study Group (BIAS), Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Paulo Hilário do Nascimento Saldiva
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Brazilian Image Autopsy Study Group (BIAS), Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Department of Pathology, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, Faculty of Medicine of the University of São Paulo, São Paulo, Brazil
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38
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Gattás-Vernaglia IF, Ramos PT, Perini MLL, Higa CS, Apolinario D, Aliberti MJR, Kanaji AL, Adriazola IO, Saraiva MD, Avelino-Silva TJ, de Assis Moura Tavares C, Jacob-Filho W, Karnakis T. Impact of the COVID-19 pandemic on the life-space mobility of older adults with cancer. J Geriatr Oncol 2021; 12:956-959. [PMID: 33640305 PMCID: PMC7883734 DOI: 10.1016/j.jgo.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/26/2020] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Isabella Figaro Gattás-Vernaglia
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Equipe de Oncogeriatria do Hospital Sírio Libanês, São Paulo, Brazil.
| | - Paola Teruya Ramos
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria Laura Lazaretti Perini
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camila Suemi Higa
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Daniel Apolinario
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hospital do Coração- HCor, Brazil
| | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Lumi Kanaji
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Izabela Ono Adriazola
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marcos Daniel Saraiva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio de Assis Moura Tavares
- Unidade de Cardiogeriatria, Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (USP), Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Theodora Karnakis
- Instituto do Cancer do Estado de Sao Paulo (ICESP) - Octavio Frias de Oliveira, Sao Paulo, SP, Brazil; Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Equipe de Oncogeriatria do Hospital Sírio Libanês, São Paulo, Brazil
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39
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Tahira A, Marques F, Lisboa B, Feltrin A, Barbosa A, de Oliveira KC, de Bragança Pereira CA, Leite R, Grinberg L, Suemoto C, de Lucena Ferretti-Rebustini RE, Pasqualucci CA, Jacob-Filho W, Brentani H, Palha JA. Are the 50's, the transition decade, in choroid plexus aging? GeroScience 2021; 43:225-237. [PMID: 33576945 PMCID: PMC8050122 DOI: 10.1007/s11357-021-00329-x] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/25/2021] [Indexed: 12/13/2022] Open
Abstract
The choroid plexus (CP) is an important structure for the brain. Besides its major role in the production of cerebrospinal fluid (CSF), it conveys signals originating from the brain, and from the circulatory system, shaping brain function in health and in pathology. Previous studies in rodents have revealed altered transcriptome both during aging and in various diseases of the central nervous system, including Alzheimer's disease. In the present study, a high-throughput sequencing of the CP transcriptome was performed in postmortem samples of clinically healthy individuals aged 50's through 80's. The data shows an age-related profile, with the main changes occurring in the transition from the 50's to the 60's, stabilizing thereafter. Specifically, neuronal and membrane functions distinguish the transcriptome between the 50's and the 60's, while neuronal and axon development and extracellular structure organization differentiate the 50's from the 70's. These findings suggest that changes in the CP transcriptome occur early in the aging process. Future studies will unravel whether these relate with processes occurring in late- onset brain diseases.
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Affiliation(s)
- Ana Tahira
- LIM23, Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fernanda Marques
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Bianca Lisboa
- LIM23, Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arthur Feltrin
- LIM23, Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Center of Mathematics, Computing and Cognition, Federal University of ABC, Santo André, SP, Brazil
| | - André Barbosa
- LIM23, Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Inter-institutional Grad Program on Bioinformatics, University of São Paulo, São Paulo, SP, Brazil
| | - Kátia Cristina de Oliveira
- LIM23, Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Center of Mathematics, Computing and Cognition, Federal University of ABC, Santo André, SP, Brazil
| | | | - Renata Leite
- Biobank for Aging Studies Group, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Lea Grinberg
- Biobank for Aging Studies Group, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Claudia Suemoto
- Biobank for Aging Studies Group, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Carlos Augusto Pasqualucci
- Biobank for Aging Studies Group, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Biobank for Aging Studies Group, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Helena Brentani
- LIM23, Instituto de Psiquiatria, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Joana Almeida Palha
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
- ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
- Clinical Academic Center, Braga, Portugal.
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40
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Lin SM, Borges MK, de Siqueira ASS, Biella MM, Jacob-Filho W, Cesari M, Voshaar RCO, Aprahamian I. Serotonin receptor inhibitor is associated with falls independent of frailty in older adults. Aging Ment Health 2021; 25:219-224. [PMID: 31603040 DOI: 10.1080/13607863.2019.1675143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. METHODS Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ≥ 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. RESULTS At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. CONCLUSION SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered.
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Affiliation(s)
- Sumika M Lin
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcus K Borges
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alaise S S de Siqueira
- Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Marina M Biella
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedadale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Richard C Oude Voshaar
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ivan Aprahamian
- Medical Investigation Laboratory on Ageing (LIM66), Division of Geriatrics, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil.,Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.,Geriatrics Division, Department of Internal Medicine, Faculty of Medicine of Jundiaí, Jundiaí, Brazil
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41
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Nucci RAB, Maifrino LBM, Busse AL, de Souza RR, Pasqualucci CA, Anaruma CA, Leite REP, Rodriguez RD, Suemoto CK, Jacob-Filho W. Evaluation of the Diaphragm Muscle Remodeling, Inflammation, Oxidative Stress and Vascularization in Smokers: An Autopsy Study. Cell Physiol Biochem 2021; 54:567-576. [PMID: 32496722 DOI: 10.33594/000000240] [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] [Accepted: 05/25/2020] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND/AIMS Cigarette smoking is a key factor in systemic inflammation and oxidative stress, and it has also been associated with the loss of muscle strength and an elevated risk of pulmonary diseases. Thus, this study aimed to analyze the effects of cigarette smoking on the diaphragm muscle structure of postmortem samples. METHODS Immunohistochemical techniques were used for muscle remodeling (metalloproteinases 2 and 9), inflammation (cyclooxygenase-2), oxidative stress (8-hydroxy-2'-deoxyguanosine), and vascularization (vascular endothelial growth factor). Hematoxylin and eosin stain was used for histopathological analysis and Picrosirius stain was used to highlight the collagen fibers. RESULTS Cigarette smokers had an increase of diaphragm muscle remodeling, oxidative stress, inflammation, and vascularization compared to non-smokers. CONCLUSION Diaphragm muscle structure may be negatively affected by cigarette smoking.
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Affiliation(s)
| | | | - Alexandre Leopold Busse
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.,Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Romeu Rodrigues de Souza
- Department of Anatomy, Institute of Biomedical Sciences of the University of São Paulo, São Paulo, Brazil.,Department of Anatomy, 9 de Julho University (UNINOVE), São Paulo, Brazil
| | | | - Carlos Alberto Anaruma
- Laboratory of Morphology and Physical Activity, Department of Physical Education, São Paulo State University "Júlio de Mesquita Filho", Rio Claro, Brazil
| | - Renata Elaine Paraizo Leite
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Roberta Diehl Rodriguez
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.,Laboratory of Medical Research in Aging (LIM-66), Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil
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42
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Aliberti MJR, Covinsky KE, Garcez FB, Smith AK, Curiati PK, Lee SJ, Dias MB, Melo VJD, Rego-Júnior OFD, Richinho VDP, Jacob-Filho W, Avelino-Silva TJ. A fuller picture of COVID-19 prognosis: the added value of vulnerability measures to predict mortality in hospitalised older adults. Age Ageing 2021; 50:32-39. [PMID: 33068099 PMCID: PMC7665299 DOI: 10.1093/ageing/afaa240] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/10/2020] [Revised: 09/28/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Although coronavirus disease 2019 (COVID-19) disproportionally affects older adults, the use of conventional triage tools in acute care settings ignores the key aspects of vulnerability. OBJECTIVE This study aimed to determine the usefulness of adding a rapid vulnerability screening to an illness acuity tool to predict mortality in hospitalised COVID-19 patients. DESIGN Cohort study. SETTING Large university hospital dedicated to providing COVID-19 care. PARTICIPANTS Participants included are 1,428 consecutive inpatients aged ≥50 years. METHODS Vulnerability was assessed using the modified version of PRO-AGE score (0-7; higher = worse), a validated and easy-to-administer tool that rates physical impairment, recent hospitalisation, acute mental change, weight loss and fatigue. The baseline covariates included age, sex, Charlson comorbidity score and the National Early Warning Score (NEWS), a well-known illness acuity tool. Our outcome was time-to-death within 60 days of admission. RESULTS The patients had a median age of 66 years, and 58% were male. The incidence of 60-day mortality ranged from 22% to 69% across the quartiles of modified PRO-AGE. In adjusted analysis, compared with modified PRO-AGE scores 0-1 ('lowest quartile'), the hazard ratios (95% confidence interval) for 60-day mortality for modified PRO-AGE scores 2-3, 4 and 5-7 were 1.4 (1.1-1.9), 2.0 (1.5-2.7) and 2.8 (2.1-3.8), respectively. The modified PRO-AGE predicted different mortality risk levels within each stratum of NEWS and improved the discrimination of mortality prediction models. CONCLUSIONS Adding vulnerability to illness acuity improved accuracy of predicting mortality in hospitalised COVID-19 patients. Combining tools such as PRO-AGE and NEWS may help stratify the risk of mortality from COVID-19.
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Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Kenneth E Covinsky
- Division of Geriatrics, University of California, San Francisco, California, USA
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Flavia Barreto Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Alexander K Smith
- Division of Geriatrics, University of California, San Francisco, California, USA
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Pedro Kallas Curiati
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
- Research Institute, Hospital Sirio-Libanes, Sao Paulo, Brazil
| | - Sei J Lee
- Division of Geriatrics, University of California, San Francisco, California, USA
- Veterans Affairs Medical Center, San Francisco, California, USA
| | - Murilo Bacchini Dias
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Victor José Dornelas Melo
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Otávio Fortes do Rego-Júnior
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Valéria de Paula Richinho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil
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Santos-Bezerra DP, Cavaleiro AM, Santos AS, Suemoto CK, Pasqualucci CA, Jacob-Filho W, Leite REP, Passarelli M, Marie SKN, Machado UF, Correa-Giannella ML. Alcohol Use Disorder is Associated with Upregulation of MicroRNA-34a and MicroRNA-34c in Hippocampal Postmortem Tissue. Alcohol Clin Exp Res 2021; 45:64-68. [PMID: 33190281 DOI: 10.1111/acer.14505] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/09/2020] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND To investigate epigenetic mechanisms potentially involved in the cognitive decline associated with chronic alcohol intake, we evaluated the expressions of three micro-RNAs (miR-34a, -34b, and -34c) highly expressed in the hippocampus and involved in neuronal physiology and pathology. MiR-34a participates in functioning and survival of mature neurons; miR-34b is associated with Alzheimer-like disorders; and miR-34c is implicated in the memory impairment of Alzheimer disease in rodents and humans. METHODS A total of 69 cases were selected from the Biobank for Aging Studies and categorized according to the absence (n = 50) or presence (n = 19) of alcohol use disorder (AUD). Cases presenting with neuropathological diagnoses of dementias were excluded. Total RNA was extracted from hippocampal paraffinized slices, complementary DNA was synthesized from miRs, and RT-qPCR was performed with TaqMan® assays. RESULTS Higher expressions of miR-34a and miR-34c, but not of miR-34b, were found in the group with AUD in comparison with the group without AUD after adjustment for potential confounders (age, sex, body mass index, presence of hypertension, diabetes mellitus, smoking, and physical inactivity). CONCLUSIONS Hippocampal upregulation of miR-34a and miR-34c may be involved in the cognitive decline associated with chronic alcohol consumption.
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Affiliation(s)
- Daniele P Santos-Bezerra
- From the Laboratorio de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, DPS-B, AMC, ASS, MLC-G Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana Mercedes Cavaleiro
- From the Laboratorio de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, DPS-B, AMC, ASS, MLC-G Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Aritania Sousa Santos
- From the Laboratorio de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, DPS-B, AMC, ASS, MLC-G Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics (CKS, WJ-F, REPL), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Wilson Jacob-Filho
- Division of Geriatrics (CKS, WJ-F, REPL), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Renata Elaine Paraizo Leite
- Division of Geriatrics (CKS, WJ-F, REPL), University of Sao Paulo Medical School, Sao Paulo, Brazil.,Department of Pathology (CAP, REPL), University of Sao Paulo, Sao Paulo, Brazil
| | - Marisa Passarelli
- Laboratorio de Lipides (LIM-10) do HCFMUSP (MP), Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.,Programa de Pos-Graduacao em Medicina (MP, MLC-G), Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
| | | | - Ubiratan Fabres Machado
- Departmento de Fisiologia e Biofisica (UFM), Instituto de Ciencias Biomedicas, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Lucia Correa-Giannella
- From the Laboratorio de Carboidratos e Radioimunoensaio (LIM-18) do Hospital das Clinicas HCFMUSP, DPS-B, AMC, ASS, MLC-G Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Programa de Pos-Graduacao em Medicina (MP, MLC-G), Universidade Nove de Julho (UNINOVE), Sao Paulo, Brazil
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Cardoso BR, Apolinário D, da Silva Bandeira V, Busse AL, Magaldi RM, Jacob-Filho W, Cozzolino SMF. Correction to: Effects of Brazil nut consumption on selenium status and cognitive performance in older adults with mild cognitive impairment: a randomized controlled pilot trial. Eur J Nutr 2021; 60:557. [PMID: 33399977 DOI: 10.1007/s00394-020-02443-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Barbara Rita Cardoso
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 580, Bloco 14, Butantã, São Paulo, 05508-000, Brazil.
| | - Daniel Apolinário
- Geriatrics Division, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Verônica da Silva Bandeira
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 580, Bloco 14, Butantã, São Paulo, 05508-000, Brazil
| | - Alexandre Leopold Busse
- Geriatrics Division, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Regina Miksian Magaldi
- Geriatrics Division, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Wilson Jacob-Filho
- Geriatrics Division, Department of Internal Medicine, University of São Paulo Medical School, São Paulo, Brazil
| | - Silvia Maria Franciscato Cozzolino
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 580, Bloco 14, Butantã, São Paulo, 05508-000, Brazil
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Saraiva MD, Apolinario D, Avelino-Silva TJ, de Assis Moura Tavares C, Gattás-Vernaglia IF, Marques Fernandes C, Rabelo LM, Tavares Fernandes Yamaguti S, Karnakis T, Kalil-Filho R, Jacob-Filho W, Romero Aliberti MJ. The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic. J Nutr Health Aging 2021; 25:440-447. [PMID: 33786560 PMCID: PMC7678592 DOI: 10.1007/s12603-020-1532-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/20/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. OBJECTIVE To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. DESIGN Multicenter prospective cohort study based on structured telephone interviews. SETTING Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. PARTICIPANTS 557 community-dwelling adults aged 60 years and older. MEASUREMENTS The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?», to which participants could respond «not at all», «to some extent», or «to a great extent». We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. RESULTS Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). CONCLUSION Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.
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Affiliation(s)
- M D Saraiva
- Márlon Juliano Romero Aliberti, Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo. Av. Dr. Eneas de Carvalho Aguiar 155, 8º andar, Clinica Medica, LIM-66, Cerqueira Cesar, Sao Paulo - SP, 05403-000, Brazil. Tel.: +55-11-26618116. E-mail address:
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Coelho VA, Santos GG, Avesani CM, Bezerra CIL, Silva LCA, Lauar JC, Lindholm B, Stenvinkel P, Jacob-Filho W, Noronha IL, Zatz R, Moysés RMA, Elias RM. Design and methodology of the Aging Nephropathy Study (AGNES): a prospective cohort study of elderly patients with chronic kidney disease. BMC Nephrol 2020; 21:461. [PMID: 33160321 PMCID: PMC7648411 DOI: 10.1186/s12882-020-02116-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 10/20/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Renal replacement therapy (RRT) is usually indicated for patients with chronic kidney disease (CKD) with glomerular filtration rate below 10 ml/ml/min/1.73m2. However, the need for RRT and timing of dialysis initiation are debatable for patients aged 70 years or older. We here describe the study design and methodology of the Aging Nephropathy Study (AGNES) protocol that aims at evaluating to what extent geriatric-related conditions such as frailty, cognitive dysfunction, and presence of comorbidities have an impact on survival and RRT initiation in this group of patients. In this manuscript we provide detailed information about the AGNES study design and methodology. METHODS AGNES is a prospective observational cohort that aim to investigate clinical, biochemical and demographic factors associated with RRT initiation and mortality of patients with CKD stage 4 or 5 who are aged 70 years and older. We plan to include 200 patients over 5 years. Clinically stable outpatients on conservative management for at least 6 months will be recruited from the Nephrogeriatric Clinic at the Hospital das Clinicas da Universidade de Sao Paulo, Brazil. Eligible patients are submitted to a full clinical examination, geriatric assessment, and blood test at baseline. Following the baseline visit the patients are being monitored during an observational follow up period of at least 12 months during which patients will be contacted in the clinic at their regular follow up or by phone until either RRT initiation or death occurs. This cohort includes evaluation of cognition by the education-adjusted 10-point Cognitive Screener (10-CS), frailty by Fried index score, a complete nutritional assessment (by body composition assessment, global subjective assessment and dietary intake), comorbidities by Charlson comorbidity index and biochemical markers including FGF-23 and Klotho. DISCUSSION The AGNES cohort, a real-world study of current clinical practice in elderly patients with advanced CKD prior to dialysis initiation, will shed light into progression of CKD and its complications, indications of RRT and factors determining survival. This investigation will elucidate to what extent geriatric conditions, nutritional status and clinical factors are associated with survival, quality of life and RRT initiation in elderly CKD patients not yet on dialysis. TRIAL REGISTRATION Registered on ClinicalTrials.gov on 18 October 2019 ( NCT04132492 ).
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Affiliation(s)
- Venceslau A Coelho
- LIM 66, Division of Geriatrics, Faculdade de Medicina Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Geriatrics, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - Giovani Gn Santos
- Division of Geriatrics, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - Carla M Avesani
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Julia C Lauar
- Division of Nephrology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Wilson Jacob-Filho
- LIM 66, Division of Geriatrics, Faculdade de Medicina Universidade de Sao Paulo, Sao Paulo, Brazil.,Division of Geriatrics, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil
| | - Irene L Noronha
- Division of Nephrology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil.,LIM 29, Division of Nephrology, Faculdade de Medicina Universidade de Sao Paulo, São Paulo, Brazil
| | - Roberto Zatz
- Division of Nephrology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil.,LIM 16, Division of Nephrology, Faculdade de Medicina Universidade de Sao Paulo, São Paulo, Brazil
| | - Rosa M A Moysés
- Division of Nephrology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil.,LIM 16, Division of Nephrology, Faculdade de Medicina Universidade de Sao Paulo, São Paulo, Brazil
| | - Rosilene M Elias
- Division of Nephrology, Hospital das Clinicas HCFMUSP, Sao Paulo, Brazil.
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Nascimento C, Nunes PV, Suemoto CK, Rodriguez RD, Leite REP, Grinberg LT, Pasqualucci CA, Nitrini R, Jacob-Filho W, Brentani HP, Lafer B. Differential levels of inflammatory and neuroendocrine markers in the hippocampus and anterior cingulate cortex of bipolar disorder subjects: A post-mortem study. Brain Behav Immun 2020; 90:286-293. [PMID: 32949690 PMCID: PMC8549680 DOI: 10.1016/j.bbi.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 01/08/2023] Open
Affiliation(s)
- Camila Nascimento
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, SP, Brazil.
| | - Paula Villela Nunes
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, SP, Brazil
| | - Claudia Kimie Suemoto
- Biobank for Aging Studies, University of São Paulo Medical School, Sao Paulo, SP, Brazil
| | | | | | - Lea Tenenholz Grinberg
- Biobank for Aging Studies, University of São Paulo Medical School, Sao Paulo, SP, Brazil,Memory and Aging Center University of California, Department of Neurology, San Francisco, USA
| | | | - Ricardo Nitrini
- Biobank for Aging Studies, University of São Paulo Medical School, Sao Paulo, SP, Brazil
| | - Wilson Jacob-Filho
- Biobank for Aging Studies, University of São Paulo Medical School, Sao Paulo, SP, Brazil
| | - Helena Paula Brentani
- Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, SP, Brazil
| | - Beny Lafer
- Bipolar Disorder Program (PROMAN), Department of Psychiatry, University of São Paulo Medical School, Sao Paulo, SP, Brazil
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Saraiva MD, Rangel LF, Cunha JLL, Rotta TCA, Douradinho C, Khazaal EJB, Aliberti MJR, Avelino-Silva TJ, Apolinario D, Suemoto CK, Jacob-Filho W. Prospective GERiatric Observational (ProGERO) study: cohort design and preliminary results. BMC Geriatr 2020; 20:427. [PMID: 33109121 PMCID: PMC7590705 DOI: 10.1186/s12877-020-01820-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The demographic changes in Brazil as a result of population aging is one of the fastest in the world. The far-reaching new challenges that come with a large older population are particularly disquieting in low- and middle-income countries (LMICs). Longitudinal studies must be completed in LMICs to investigate the social and biological determinants of aging and the consequences of such demographic changes in their context. Therefore, we designed the Prospective GERiatric Observational (ProGERO) study, a longitudinal study of outpatient older adults in São Paulo, Brazil, to collect data both on aging and chronic diseases, and investigate characteristics associated with adverse outcomes in this population. METHODS The ProGERO study takes place in a geriatric outpatient clinic in the largest academic medical center in Latin America. We performed baseline health examinations in 2017 and will complete subsequent in-person visits every 3 years when new participants will also be recruited. We will use periodic telephone interviews to collect information on the outcomes of interest between in-person visits. The baseline evaluation included data on demographics, medical history, physical examination, and comprehensive geriatric assessment (CGA; including multimorbidity, medications, social support, functional status, cognition, depressive symptoms, nutritional status, pain assessment, frailty, gait speed, handgrip strength, and chair-stands test). We used a previously validated CGA-based model to rank participants according to mortality risk (low, medium, high). Our selected outcomes were falls, disability, health services utilization (emergency room visits and hospital admissions), institutionalization, and death. We will follow participants for at least 10 years. RESULTS We included 1336 participants with a mean age of 82 ± 8 years old. Overall, 70% were women, 31% were frail, and 43% had a Charlson comorbidity index score ≥ 3. According to our CGA-based model, the incidence of death in 1 year varied significantly across categories (low-risk = 0.6%; medium-risk = 7.4%; high-risk = 17.5%; P < 0.001). CONCLUSION The ProGERO study will provide detailed clinical data and explore the late-life trajectories of outpatient older patients during a follow-up period of at least 10 years. Moreover, the study will substantially contribute to new information on the predictors of aging, senescence, and senility, particularly in frail and pre-frail outpatients from an LMIC city.
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Affiliation(s)
- Marcos Daniel Saraiva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil.
| | - Luís Fernando Rangel
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Julia Lusis Lassance Cunha
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Thereza Cristina Ariza Rotta
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Christian Douradinho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Eugênia Jatene Bou Khazaal
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Thiago Junqueira Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Daniel Apolinario
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Claudia Kimie Suemoto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Av. Dr. Eneas de Carvalho Aguiar 155, 8° andar, Setor Azul (Clinica Medica), LIM-66, Cerqueira Cesar, Sao Paulo, SP, 05403-000, Brazil
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Henriques AD, Machado-Silva W, Leite RE, Suemoto CK, Leite KR, Srougi M, Pereira AC, Jacob-Filho W, Nóbrega OT. Genome-wide profiling and predicted significance of post-mortem brain microRNA in Alzheimer’s disease. Mech Ageing Dev 2020; 191:111352. [DOI: 10.1016/j.mad.2020.111352] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 12/12/2022]
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Garcez FB, Aliberti MJR, Poco PCE, Hiratsuka M, Takahashi SDF, Coelho VA, Salotto DB, Moreira MLV, Jacob-Filho W, Avelino-Silva TJ. Delirium and Adverse Outcomes in Hospitalized Patients with COVID-19. J Am Geriatr Soc 2020; 68:2440-2446. [PMID: 32835425 PMCID: PMC7460960 DOI: 10.1111/jgs.16803] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [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: 05/31/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Little is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19. OBJECTIVES To investigate the occurrence of delirium in hospitalized patients with COVID-19 and explore its association with adverse outcomes. DESIGN Longitudinal observational study. SETTING Tertiary university hospital dedicated to the care of severe cases of COVID-19 in São Paulo, Brazil. PARTICIPANTS A total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020. MEASUREMENTS We completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart-Based Delirium Identification Instrument (CHART-DEL). Trained physicians with a background in geriatric medicine completed all CHART-DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C-reactive protein, glomerular filtration rate, D-dimer, and albumin). RESULTS Overall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in-hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in-hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15-2.66); the association held both in middle-aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization. CONCLUSION Delirium was independently associated with in-hospital death in adults aged 50 years and older with COVID-19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID-19 patients.
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Affiliation(s)
- Flavia B Garcez
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Marlon J R Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Paula C E Poco
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Marcel Hiratsuka
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Silvia de F Takahashi
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Venceslau A Coelho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Danute B Salotto
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Marlos L V Moreira
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Wilson Jacob-Filho
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - Thiago J Avelino-Silva
- Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil
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