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OBJECTIVE: To estimate the association between vitamin D and the cognitive decline of older adults and evaluate whether this association is mediated by brain-derived neurotrophic factor (BDNF) serum concentration. METHODS: Cross-sectional study nested in a population-based cohort. Of the 604 participants in the complementary examination of the EpiFloripa Study, 576 older adults (60 years or older) were eligible for the study. The outcome is cognitive decline evaluated by the Mini-Mental State Examination, the exposure is vitamin D, and BDNF is the mediator. The control variables are age, sex, per capita family income, and educational level. The direct effect of vitamin D and BDNF on cognitive decline and the indirect effect mediated by BDNF was evaluated using path analysis, with the estimation of standardized coefficients. RESULTS: Among the participants, we observed a direct and positive effect of vitamin D on cognitive function (Coef: 0.06; 95%CI: 0.02 to 0.11; p < 0.001) and serum BDNF concentration (Coef: 21.55; 95%CI: 9.92 to 33.17; p = 0.002), i.e., the higher the vitamin D, the higher the cognitive function and serum level of BDNF. CONCLUSION: There was an association between vitamin D on serum BDNF and on cognitive decline in older adults. Moreover, BDNF did not have an effect on cognitive decline, so BDNF was not a mediator of the vitamin D effect on cognitive decline.
Assuntos
Transtornos Cognitivos , Vitamina D , Humanos , Idoso , Fator Neurotrófico Derivado do Encéfalo , Brasil , Estudos Transversais , CogniçãoRESUMO
OBJECTIVE: To investigate whether cognitive impairment precedes self-reported poor hearing in adults aged 50 and older over a 14-year period. DESIGN: Biennial longitudinal study. STUDY SAMPLE: The data came from the English Longitudinal Study of Ageing carried out in England between 2002 and 2016, with 11,391 individuals aged 50 years and older. For this study, ELSA participants who had a positive perception of hearing at the beginning of the analysis in 2002 (n = 8,895) were eligible. The dependent variable was self-reported poor hearing, and the exposure measure was cognitive impairment. The analyses were performed using Generalised Estimation Equations and adjusted for gender, age, educational level, household wealth, smoking, alcohol consumption, depressive symptoms, ADL/IADL disability, physical activity level, diabetes, and cardiovascular disease. RESULTS: The results showed 33% increased odds of self-reported poor hearing in individuals with cognitive impairment. In the fully adjusted model, individuals who presented cognitive impairment in the previous wave had, over time, 10% increased odds (95% CI: 1.02; 1.19) of presenting self-reported poor hearing. CONCLUSIONS: The exposure to cognitive impairment was associated with a subsequent self-reported poor hearing. These data represent important tools for improving cognitive and hearing impairment diagnosis and treatment.
Assuntos
Envelhecimento , Disfunção Cognitiva , Humanos , Pessoa de Meia-Idade , Idoso , Estudos Longitudinais , Autorrelato , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , AudiçãoRESUMO
OBJECTIVE: To investigate the association between serum vitamin D (25-hydroxy-cholecalciferol) (25(OH)D) concentrations and cognitive impairment in older adults living in Southern Brazil. DESIGN: Cross-sectional analysis using data from the second follow-up wave of the populational-based EpiFloripa Aging Cohort Study was collected in 2013-2014. SETTING: Cognitive impairment was evaluated using the Mini-Mental State Examination (MMSE). Blood samples were collected to measure serum vitamin D concentrations using a chemiluminescent microparticle immunoassay. Vitamin D concentrations were distributed in quartiles (Q1: 4·0-20·7 ng/ml; Q2: 20·8-26·6 ng/ml; Q3: 26·7-32·0 ng/ml and Q4: 32·1-60·1 ng/ml), and its association with cognitive impairment was tested by crude and adjusted logistic regression (sociodemographic, behavioural and health aspects) using Q4 as a reference group. PARTICIPANTS: 200 men and 371 women aged 60 years or older participated in this study. RESULTS: The prevalence of probable cognitive impairment was 21·7 %. Those without cognitive impairment had a higher mean of vitamin D serum concentrations (26·8 v. 24·6, P = 0·014). In the crude analysis, only individuals in Q2 of vitamin D presented an increased risk for probable cognitive impairment compared with Q4 (highest quartile) (OR 2·65, 95 % CI 1·46, 4·81), remaining significant in the adjusted analysis (OR 6·04, 95 % CI 2·78, 13·13). While Q1 (lowest quartile) was not associated in the crude analysis, but when adjusted, an increased risk of cognitive impairment was observed. CONCLUSION: The lowest quartile of vitamin D was directly associated with probable cognitive impairment in older adults in Southern Brazil. More studies are needed to investigate whether maintaining adequate serum levels may represent a significant factor in preventing age-related neurological disorders as well as to verify the need for new cutoff points for this age group.
Assuntos
Disfunção Cognitiva , Deficiência de Vitamina D , Idoso , Calcifediol , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Vitamina D , Deficiência de Vitamina D/epidemiologia , VitaminasRESUMO
OBJECTIVES: To analyze the effect of a comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction, called "Oficina da Lembrança" (OL), on the cognitive status and concentration of biomarkers of neuroplasticity, neurodegeneration in adults aged 50 years and over attending a Memory Clinic. METHODS: In this pilot randomized controlled study, 64 patients without dementia aged 45 to 79 years, seen at a University Memory Clinic in Southern Brazil, were randomly allocated to the intervention and control groups. The intervention consisted of participation in OL for 12 weeks. Serum biomarkers (brain-derived neurotrophic factor [BDNF], S100ß, and neuron-specific enolase [NSE]) and cognitive status were analyzed as primary and secondary outcomes. The Wilcoxon test and Generalized Estimating Equations (GEE) were applied. RESULTS: Of the 64 patients invited to participate in the study, 33 (intervention: 17, control: 16) completed the study with all data. Improvement of cognitive status was significant in the intervention group (22.6 to 24.5) but not in the control group (20.1 to 21.1). There was a significant reduction of BDNF in OL participants, but no significant change was observed in the neurodegenerative biomarkers S100ß or NSE. The concentration of BDNF decreased significantly post-OL in the intervention group (-288.1, 95%CI -362.1 to -94.1), even after adjusting for sex, age, and educational level. Cognitive status was significantly improved in OL participants. CONCLUSION: The OL program improved cognitive status, reduced serum BDNF levels, and empowered digitally excluded older adults. There was no effect of this intervention on S100ß or NSE. CLINICAL TRIAL REGISTRATION: This study has a Universal Trial Number (UTN) U1111-1195-2642 and was registered in the Brazilian Clinical Trials Registry (ReBEC), number RBR-38X665.
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Fator Neurotrófico Derivado do Encéfalo , Interação Social , Idoso , Biomarcadores , Cognição , Exercício Físico , Humanos , Pessoa de Meia-Idade , Projetos Piloto , Resultado do TratamentoRESUMO
ABSTRACT OBJECTIVE To estimate the association between vitamin D and the cognitive decline of older adults and evaluate whether this association is mediated by brain-derived neurotrophic factor (BDNF) serum concentration. METHODS Cross-sectional study nested in a population-based cohort. Of the 604 participants in the complementary examination of the EpiFloripa Study, 576 older adults (60 years or older) were eligible for the study. The outcome is cognitive decline evaluated by the Mini-Mental State Examination, the exposure is vitamin D, and BDNF is the mediator. The control variables are age, sex, per capita family income, and educational level. The direct effect of vitamin D and BDNF on cognitive decline and the indirect effect mediated by BDNF was evaluated using path analysis, with the estimation of standardized coefficients. RESULTS Among the participants, we observed a direct and positive effect of vitamin D on cognitive function (Coef: 0.06; 95%CI: 0.02 to 0.11; p < 0.001) and serum BDNF concentration (Coef: 21.55; 95%CI: 9.92 to 33.17; p = 0.002), i.e., the higher the vitamin D, the higher the cognitive function and serum level of BDNF. CONCLUSION There was an association between vitamin D on serum BDNF and on cognitive decline in older adults. Moreover, BDNF did not have an effect on cognitive decline, so BDNF was not a mediator of the vitamin D effect on cognitive decline.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Vitamina D , Idoso , Estudos Transversais , Cognição , Fator Neurotrófico Derivado do EncéfaloRESUMO
Purpose The prevalence of dementia has increased in recent years and, along with hearing loss, can negatively impact the health of older adults. The purpose of this retrospective cross-sectional study was to establish self-reported hearing loss and associated factors in older adults at a memory clinic. Method Researchers conducted a retrospective cross-sectional study on factors associated with self-reported hearing loss (i.e., lifestyle, general health, cognition, functional capacity). Data were taken from medical records of older adults (≥ 60 years old) who received care between 2017 and 2018 at a memory clinic located at the Southern Santa Catarina University in Brazil. Analysis included the Pearson chi-squared test and logistic regression, estimation of the crude and adjusted odds ratios (OR), with respective confidence intervals of 95%. Results Researchers analyzed the medical records of 257 older adults and verified a prevalence of 13.2% of these adults with self-reported hearing loss. There was a higher prevalence of the outcome (i.e., self-reported hearing loss) in older adults who reported tinnitus (35.2%), those with mild cognitive impairment (14.7%), and those who were sedentary (19.2%). After adjustment for confusion factors, tinnitus (OR = 4.63; p = .019) and sedentarism (OR = 2.89; p = .029) were still associated with the outcome. Conclusions Tinnitus and sedentarism were associated with hearing loss in older adults receiving care at a memory clinic. As a public health issue, presbycusis needs to be included in the health planning and health promotion agendas, with effective control, prevention, and treatment measures.
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Presbiacusia , Zumbido , Idoso , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Autorrelato , Zumbido/diagnóstico , Zumbido/epidemiologiaRESUMO
To investigate the association between deficient and insufficient serum concentrations of 25(OH)D and cardiometabolic risk factors (CMRF), considering that both conditions are important predictors of cardiovascular disease and diabetes mellitus. A cross-sectional study with a subsample of 526 older adults (63-93 years old) who participated in the second wave of the population-based longitudinal study EpiFloripa Idoso. The CMRF analyzed were abdominal obesity, high fasting glucose, high blood pressure, high triglycerides and high LDL-cholesterol. The exposure variable was 25(OH)D serum concentration (≤20 ng/mL = deficient; 21-29 ng/mL = insufficient, ≥30-<100 ng/mL = sufficient). The prevalences of 25(OH)D deficiency and insufficiency were estimated at 21.9% and 43.7%, respectively. The adjusted OR of prevalence of the abdominal obesity (OR 1.99;1.12-3.54), high blood pressure (OR 2.58;1.35-4.94) and high LDL-cholesterol (OR 2.73;1.63-4.6) were higher among those with deficient serum concentration of 25(OH)D. Participants with insufficient serum concentrations of 25(OH)D also presented higher adjusted OR of prevalence for abdominal obesity (OR 2.14;1.31-3.48). No significant adjusted association was found between 25(OH)D with the outcomes high fasting glucose and high triglycerides. Significant effect modification/interaction by age was also observed in the tested associations for abdominal obesity (P < 0.001), blood pressure (P < 0.001) and LDL-cholesterol (P < 0.001), in which deficient and insufficient 25(OH)D values were associated with higher values of these FRCM. 25(OH)D serum concentrations between 30 and 100 ng/mL can contribute to preventing and controlling CMRF such as abdominal obesity, high blood pressure and high LDL-cholesterol. The understanding this particular interaction may indicate ways to prevent/control cardiometabolic outcomes, health problems common in the older adults.
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We analyzed the factors associated with dementia in the elderly attended at a memory outpatient clinic of the University of Southern Santa Catarina (UNISUL). This is a cross-sectional study with data analysis of medical records from January 2013 to April 2016. The outcome was the clinical diagnosis of dementia. The control variables were: serum vitamin D level at the time of diagnosis, gender, skin color, schooling, age, type 2 diabetes, hypertension, and depression. We performed a crude and adjusted analysis with logistic regression. The sample consisted of 287 elderly, with the predominance of age between 60 and 69 years (48.78%), female (79.09%) and white (92.33%). The mean number of years of study was 6.95 years (SD ± 4.95) and mean vitamin D was 26.09 ng/mL (SD ± 9,20). The prevalence of elderly with dementia was 16.72%. Depression was the most prevalent (42.50%) among the morbidities, followed by hypertension (31.71%). The following were independently associated with dementia: vitamin D (OR = 0.92, 95%CI, 0.88;0.97), depression (OR = 4.09, 95%CI, 1.87;8.94), hypertension (OR = 2.65, 95%CI, 1.15;6.08) and individuals aged 80 years and over (OR = 3.97 95%CI, 1.59;9.91). Dementia prevalence was high and diagnosed dementia was associated with lower levels of vitamin D. Vitamin D is a modifiable factor, opening up essential perspectives for public health policies.
Analisar os fatores associados à demência em idosos atendidos em um ambulatório de memória da Universidade do Sul de Santa Catarina (Unisul). Estudo transversal com análise de dados de prontuário no período de 01/2013 a 04/2016. O desfecho foi o diagnóstico clínico de demência. As variáveis de controle foram: nível sérico de vitamina D na época do diagnóstico, sexo, cor da pele, escolaridade, idade, diabetes tipo 2, hipertensão arterial e depressão. Foi realizada análise bruta e ajustada com regressão logística. Amostra de 287 idosos, com predominância de idade entre 60 e 69 anos (48,78%), sexo feminino (79,09%), cor da pele branca (92,33%). A média de anos de estudo foi de 6,95 anos (DP ± 4,95) e da vitamina D 26,09 ng/mL (DP ± 9,20). A prevalência de idosos com demência foi de 16,72%. Dentre as morbidades a depressão foi a de maior prevalência seguida pela hipertensão arterial. Estiveram independentemente associadas à demência: vitamina D (OR = 0,92 IC 95% 0,88;0,97), depressão (OR = 4,09 IC95% 1,87;8,94), hipertensão arterial (OR = 2,65 IC95% 1,15;6,08) e indivíduos com idade igual e maior que 80 anos. A prevalência de demência foi alta, e houve associação de níveis mais baixos de vitamina D com diagnóstico de demência. Sendo a vitamina D um fator modificável, abrindo importantes perspectivas para políticas de saúde pública.
Assuntos
Demência/diagnóstico , Transtornos da Memória/diagnóstico , Ambulatório Hospitalar , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Demência/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Transtornos da Memória/epidemiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Vitamina D/sangueRESUMO
Resumo Analisar os fatores associados à demência em idosos atendidos em um ambulatório de memória da Universidade do Sul de Santa Catarina (Unisul). Estudo transversal com análise de dados de prontuário no período de 01/2013 a 04/2016. O desfecho foi o diagnóstico clínico de demência. As variáveis de controle foram: nível sérico de vitamina D na época do diagnóstico, sexo, cor da pele, escolaridade, idade, diabetes tipo 2, hipertensão arterial e depressão. Foi realizada análise bruta e ajustada com regressão logística. Amostra de 287 idosos, com predominância de idade entre 60 e 69 anos (48,78%), sexo feminino (79,09%), cor da pele branca (92,33%). A média de anos de estudo foi de 6,95 anos (DP ± 4,95) e da vitamina D 26,09 ng/mL (DP ± 9,20). A prevalência de idosos com demência foi de 16,72%. Dentre as morbidades a depressão foi a de maior prevalência seguida pela hipertensão arterial. Estiveram independentemente associadas à demência: vitamina D (OR = 0,92 IC 95% 0,88;0,97), depressão (OR = 4,09 IC95% 1,87;8,94), hipertensão arterial (OR = 2,65 IC95% 1,15;6,08) e indivíduos com idade igual e maior que 80 anos. A prevalência de demência foi alta, e houve associação de níveis mais baixos de vitamina D com diagnóstico de demência. Sendo a vitamina D um fator modificável, abrindo importantes perspectivas para políticas de saúde pública.
Abstract We analyzed the factors associated with dementia in the elderly attended at a memory outpatient clinic of the University of Southern Santa Catarina (UNISUL). This is a cross-sectional study with data analysis of medical records from January 2013 to April 2016. The outcome was the clinical diagnosis of dementia. The control variables were: serum vitamin D level at the time of diagnosis, gender, skin color, schooling, age, type 2 diabetes, hypertension, and depression. We performed a crude and adjusted analysis with logistic regression. The sample consisted of 287 elderly, with the predominance of age between 60 and 69 years (48.78%), female (79.09%) and white (92.33%). The mean number of years of study was 6.95 years (SD ± 4.95) and mean vitamin D was 26.09 ng/mL (SD ± 9,20). The prevalence of elderly with dementia was 16.72%. Depression was the most prevalent (42.50%) among the morbidities, followed by hypertension (31.71%). The following were independently associated with dementia: vitamin D (OR = 0.92, 95%CI, 0.88;0.97), depression (OR = 4.09, 95%CI, 1.87;8.94), hypertension (OR = 2.65, 95%CI, 1.15;6.08) and individuals aged 80 years and over (OR = 3.97 95%CI, 1.59;9.91). Dementia prevalence was high and diagnosed dementia was associated with lower levels of vitamin D. Vitamin D is a modifiable factor, opening up essential perspectives for public health policies.
Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Ambulatório Hospitalar , Transtornos da Memória/diagnóstico , Vitamina D/sangue , Brasil , Prevalência , Estudos Transversais , Fatores de Risco , Demência/diagnóstico , Demência/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Transtornos da Memória/epidemiologia , Pessoa de Meia-IdadeRESUMO
Objetivo: Avaliar a prevalência da polifarmácia e da prescrição de medicações inapropriadas, bem como suas associações com a capacidade cognitiva e funcional do idoso. Métodos: Estudo observacional transversal, no qual foram analisadas as medicações prescritas em 141 prontuários para pacientes acima de 50 anos, em associação com testes que quantificaram a capacidade funcional e cognitiva deles. Resultados: Observou-se média de 4,41 medicamentos por paciente, sendo que 0,41 deles foram considerados inapropriado, segundo o critério de Beers. Verificou-se também relação estatisticamente significativa quanto ao número de medicações e testes que mediam a capacidade funcional e cognitiva dos idosos. Conclusão: O aumento da polifarmácia e da prescrição de medicações potencialmente inadequadas acarretou significativa piora da capacidade cognitiva e funcional do idoso
Objective: To evaluate the prevalence of polypharmacy and of the prescription of inappropriate medications, as well as their associations with the cognitive and functional capacity of the elderly. Methods: Cross-sectional observational study which analyzed the drugs prescribed in 141 medical records for patients over 50 years of age, associated with tests that quantified their functional and cognitive capacity. Results: An average of 4.41 medications per patient was observed, and 0.41 were considered inappropriate according to the Beers criteria. There was also a statistically significant relation regarding the number of medications and tests that measure the functional and cognitive capacity of the elderly. Conclusion: The increase in polypharmacy and in the prescription of potentially inappropriate medications led to a significant impairment of the cognitive and functional capacity of the elderly