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Del Brutto OH, Rumbea DA, Arias EE, Mera RM. Large (≥3-Millimeter) Parenchymal Brain Calcified Cysticerci Are More Often Associated with Hippocampal Atrophy than Smaller Ones in Seizure-Free Individuals with a Single Lesion. Am J Trop Med Hyg 2024; 111:515-520. [PMID: 39013376 PMCID: PMC11376183 DOI: 10.4269/ajtmh.24-0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/06/2024] [Indexed: 07/18/2024] Open
Abstract
Calcified cysticerci are often associated with hippocampal atrophy (HA). While most studies suggest that repetitive seizures cause HA in these patients, others have demonstrated that HA may also occur in persons without epilepsy. Little is known about mechanisms triggering HA in seizure-free individuals with calcified cysticerci. Here, we aimed to assess whether the size of the calcification is associated with HA. Using a population-based design, we selected apparently seizure-free individuals with a single calcified cysticercus in whom interictal paroxysmal activity and other causes of HA have been discarded. A total of 55 individuals (mean age, 58.3 ± 13 years, 62% women) fulfilled inclusion criteria. Unadjusted and multivariate models were fitted to assess the association between the size of the calcification dichotomized into <3 mm and ≥3 mm (exposure) and the presence of HA (outcome). Sixteen participants (29%) had HA, which was asymmetric in eight (50%) cases. Hippocampal atrophy was noted in 11/20 (55%) participants with large calcifications and in 5/35 (14%) with small calcifications (P = 0.001). A multivariate logistic regression model showed a significant association between the presence of large calcifications and HA, after adjustment for relevant confounders (odds ratio: 7.78; 95% CI: 1.72-35.1). Participants with calcifications ≥3 mm in diameter were 7.8 times more likely to have HA than those with smaller ones. Study results open avenues of research for the use of agents to prevent HA progression.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Emilio E Arias
- School of Medicine and Research Center, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, California
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Goodijk D, Banning LBD, Te Velde-Keyzer CA, van Munster BC, Bakker SJL, van Leeuwen BL, Zeebregts CJ, Pol RA. Preoperative cognitive performance and its association with postoperative complications in vascular surgery patients: A prospective study. Am J Surg 2024:115784. [PMID: 38824053 DOI: 10.1016/j.amjsurg.2024.115784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/14/2024] [Accepted: 05/27/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Cognitive impairment affects nearly half of vascular surgery patients, but its association with postoperative outcomes remains poorly understood. This study explores the link between preoperative cognitive performance and postoperative complications, including postoperative delirium, in vascular surgery patients. METHODS A prospective cohort study was conducted on vascular surgery patients aged ≥65. Preoperative cognitive performance was assessed using the Montreal Cognitive Assessment, and postoperative complications were evaluated using the Comprehensive Complication Index. The association was analyzed through multivariable logistic regression. RESULTS Among 110 patients (18.2 % female, mean age 73.8 ± 5.7 years), cognitive impairment was evident in 48.2 %. Of the participants, 29 (26.3 %) experienced postoperative complications, among which 11 (10 %) experienced postoperative delirium. The adjusted odds ratio for the association between cognitive performance and postoperative complications was 1.19 (95 % CI 1.02-1.38; p = 0.02). CONCLUSION Worse preoperative cognitive performance correlated with increased odds of postoperative complications and postoperative delirium in vascular surgery patients.
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Affiliation(s)
- Dagmar Goodijk
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Louise B D Banning
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Charlotte A Te Velde-Keyzer
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine, Division of Geriatric Medicine, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, Division of Surgical Oncology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Clark J Zeebregts
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
| | - Robert A Pol
- Department of Surgery, Division of Vascular Surgery, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
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Del Brutto OH, Rumbea DA, Costa AF, Patel M, Sedler MJ, Mera RM. Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study. Clin Neurol Neurosurg 2024; 236:108053. [PMID: 37992533 DOI: 10.1016/j.clineuro.2023.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE There is limited information on mortality risk in individuals with cognitive impairment living in rural Latin America. In this study, we assess the association between cognitive impairment and all-cause mortality in adults of Amerindian ancestry living in rural Ecuador. PATIENTS AND METHODS Middle-aged and older adults enrolled in the population-based Three Villages Study cohort were followed prospectively in order to estimate mortality risk according to their baseline cognitive performance as determined by the Montreal Cognitive Assessment (MoCA). Results were adjusted for demographics, level of education, traditional cardiovascular risk factors, symptoms of depression, severe tooth loss, and oily fish intake (factors previously associated with mortality in the study population). RESULTS Analysis included 1022 individuals followed for an average of 7.8 ± 3.4 years. Mean MoCA score was 21.2 ± 5.4 points (median: 22 points), with 334 (32.7%) individuals showing cognitive impairment, as evidenced by a MoCA score ≤ 19 points (the cutoff for poor cognitive performance based on previous studies in the same population). A total of 150 (14.7%) individuals died during the follow-up. Crude mortality rate was 2.87 per 100 person-years (95% C.I.: 2.08 - 3.96). For individuals with normal cognition, the mortality rate was 1.21 (95% C.I.: 0.92 - 1.50) while for those with cognitive impairment the rate increased to 3.48 (95% C.I.: 2.73 - 4.23). A multivariate Cox-proportional hazards model, confirmed that individuals with cognitive impairment had a significantly higher mortality risk than those without cognitive impairment (HR: 1.52; 95% C.I.: 1.05 - 2.18). CONCLUSIONS Cognitive impairment is associated with mortality in the study population.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Maitri Patel
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
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Del Brutto OH, Mera RM, Rumbea DA, Arias EE, Sedler MJ. Does Escalating Violence and Associated Fear of Crime Worsen Psychological Well-Being in Community Dwellers Living in a Rural Setting? Results From the Atahualpa Project Cohort. J Prim Care Community Health 2024; 15:21501319241273167. [PMID: 39143754 PMCID: PMC11327983 DOI: 10.1177/21501319241273167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Escalating street violence and criminal homicides have an adverse impact on psychological well-being. However, these consequences have been difficult to evaluate. Using a recently validated scale, we aimed to assess the impact of fear of crime on the psychological status of middle-aged and older adults living in a rural setting afflicted by endemic violence. METHODS Participants were selected from Atahualpa residents included in previous studies targeting psychological distress in the population. A validated scale was used to objectively quantify fear of crime in participants. Differences in symptoms of depression and anxiety between baseline and follow-up were used as distinct dependent variables and the continuous score of the fear of crime scale was used as the independent variable. Linear regression models were fitted to assess the association between the exposure and the outcomes, after adjusting for relevant confounders. RESULTS A total of 653 participants (mean age = 53.2 ± 11.5 years; 57% women) completed the requested tests. We found a 13% increase in symptoms of depression and anxiety during the peak of violence in the village compared with previous years. Linear regression models showed a significant association between the total score on the fear of crime questionnaire and worsening symptoms of depression (β = .24; 95% CI = 0.14-0.35) and anxiety (β = .31; 95% CI = 0.24-0.37), after adjustment for relevant confounders. CONCLUSIONS This study shows a significant aggravating effect of fear of crime on pre-existing symptoms of depression and anxiety and a deleterious effect of these conditions on overall well-being.
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Affiliation(s)
| | | | | | - Emilio E Arias
- Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
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Butz M, Gerriets T, Sammer G, El-Shazly J, Tschernatsch M, Braun T, Meyer R, Schramm P, Doeppner TR, Böning A, Mengden T, Choi YH, Schönburg M, Juenemann M. Twelve-month follow-up effects of cognitive training after heart valve surgery on cognitive functions and health-related quality of life: a randomised clinical trial. Open Heart 2023; 10:e002411. [PMID: 38011994 PMCID: PMC10685926 DOI: 10.1136/openhrt-2023-002411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/31/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Postoperative cognitive decline (POCD) or decreased health-related quality of life (HQL) have been reported after cardiac surgery. A previous investigation showed beneficial effects of postoperative cognitive training on POCD and HQL 3 months after heart surgery. Here, we present the 12-month follow-up results. METHODS This bicentric, 1:1 randomised and treatment-as-usual controlled trial included elderly patients scheduled for elective heart valve surgery. The training consisted of paper-and-pencil-based exercises practising multiple cognitive functions for 36 min/day 6 days/week over a period of 3 weeks. Neuropsychological tests and questionnaires assessing HQL (36-Item Short Form Health Survey (SF-36)) and cognitive failures in daily living (Cognitive Failures Questionnaire) were performed presurgery and 12 months after training. RESULTS Twelve months post training, the training group (n=30) showed improvements in HQL compared with the control group (n=28), especially in role limitations due to physical health (U=-2.447, p=0.015, η2=0.109), role limitations due to emotional problems (U=-2.245, p=0.025, η2=0.092), pain (U=-1.979, p=0.049, η2=0.068), average of all SF-36 factors (U=-3.237, p<0.001, η2=0.181), health change from the past year to the present time (U=-2.091, p=0.037, η2=0.075), physical component summary (U=-2.803, p=0.005, η2=0.138), and mental component summary (U=-2.350, p=0.018, η2=0.095). Furthermore, the training group (n=19) showed an improvement compared with the control group (n=27) in visual recognition memory (U=-2.137, p=0.034, η2=0.099). POCD frequency was 22% (n=6) in the control group and 11% (n=2) in the training group (χ²(1) =1.06, p=0.440; OR=2.43, 95% CI 0.43 to 13.61). CONCLUSION In conclusion, postoperative cognitive training shows enhancing effects on HQL in cardiac surgery patients after 12 months.
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Affiliation(s)
- Marius Butz
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Tibo Gerriets
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Gebhard Sammer
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Psychology, University of Giessen, Giessen, Germany
| | - Jasmin El-Shazly
- Department of Psychocardiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Marlene Tschernatsch
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Tobias Braun
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Rolf Meyer
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Patrick Schramm
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Thorsten R Doeppner
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Andreas Böning
- Department of Cardiovascular Surgery, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
| | - Thomas Mengden
- Department of Rehabilitation, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Markus Schönburg
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Cardiac Surgery, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Martin Juenemann
- Heart and Brain Research Group, Kerckhoff Clinic, Bad Nauheim, Germany
- Department of Neurology, University Hospitals Giessen and Marburg Campus Giessen, Giessen, Germany
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Aravindhan K, Morgan K, Mat S, Hamid TA, Ibrahim R, Saedon NI, Hasmuk K, Mahadzir H, Tan MP. Cognitive frailty and its association with depression, anxiety and stress during the COVID-19 pandemic among older adults in the transforming cognitive frailty into later-life self-sufficiency (AGELESS) study. Psychogeriatrics 2023; 23:1071-1082. [PMID: 37752079 DOI: 10.1111/psyg.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/04/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Cognitive frailty describes the co-occurrence of cognitive impairment and physical frailty and is classified into reversible and irreversible phenotypes. Data on the impact of COVID-19 pandemic imposed lockdowns, locally known as the Movement Control Order (MCO), on the psychological status of cognitively frail older adults remain scarce. Therefore, this study aimed to determine the relationship between depression, anxiety, stress and cognitive frailty among older adults during the MCO. METHOD Participants aged above 60 years from three ageing cohorts in Malaysia were interviewed virtually. The Fatigue, Resistance, Ambulation, Illness and Loss of Weight scale, blind Montreal Cognitive Assessment, 15-item Geriatric Depression Scale, anxiety subscale of Depression, Anxiety and Stress Scale and four-item Perceived Stress Scale measured frailty, mild cognitive impairment (MCI), depression, anxiety and stress, respectively. RESULTS Cognitive frailty data were available for 870 participants, age (mean ± SD) = 73.44 ± 6.32 years and 55.6% were women. Fifty-seven (6.6%) were robust, 24 (2.8%) had MCI, 451 (51.8%) were pre-frail, 164 (18.9%) were pre-frail+MCI, 119 (13.7%) were frail and 55 (6.3%) were frail+MCI. There were significant differences in depression and anxiety scores between the controlled MCO and recovery MCO. Using multinomial logistic regression, pre-frail (mean difference (95% confidence interval, CI) = 1.16 (0.932, 1.337), frail (1.49 (1.235, 1.803) and frail+MCI (1.49 (1.225, 1.822)) groups had significantly higher depression scores, frail (1.19 (1.030, 1.373)) and frail+MCI (1.24 (1.065, 1.439)) had significantly higher anxiety scores and pre-frail (1.50 (1.285, 1.761)), frail (1.74 (1.469, 2.062)) and frail+MCI (1.81 (1.508, 2.165)) had significantly higher stress scores upon adjustments for the potential confounders. The MCO was a potential confounder in the relationship between depression and prefrail+MCI (1.08 (0.898, 1.340)). CONCLUSION Frail individuals with or without MCI had significantly higher depression, anxiety and stress than those who were robust. Increased depression and stress were also observed in the pre-frail group. Interventions to address psychological issues in older adults during the COVID-19 pandemic could target prefrail and frail individuals and need further evaluation.
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Affiliation(s)
| | - Karen Morgan
- Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus (RCSI & UCD), Penang, Malaysia
| | - Sumaiyah Mat
- Centre for Healthy Ageing and Wellness, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Tengku Aizan Hamid
- Malaysian Research Institute on Ageing (MyAgeingTM), University Putra Malaysia, Selangor, Malaysia
| | - Rahimah Ibrahim
- Malaysian Research Institute on Ageing (MyAgeingTM), University Putra Malaysia, Selangor, Malaysia
| | - Nor Izzati Saedon
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kejal Hasmuk
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Hazlina Mahadzir
- Geriatric Unit, Department of Medicine, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Maw Pin Tan
- Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Jin RR, Cheung CNM, Wong CH, Lo CC, Lee CP, Tsang HW, Virwani PD, Ip P, Lau KK, Lee TM. Sleep quality mediates the relationship between systemic inflammation and neurocognitive performance. Brain Behav Immun Health 2023; 30:100634. [PMID: 37251546 PMCID: PMC10209676 DOI: 10.1016/j.bbih.2023.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Background Systemic inflammation is a significant mechanism underpinning adverse cognitive changes. Sleep quality is a crucial factor associated with systemic inflammation and neurocognitive health. Elevated levels of pro-inflammatory cytokines in the periphery help mark inflammation. With this background, we examined the relationship between systemic inflammation, subjective sleep quality, and neurocognitive performance in adults. Method & Results In 252 healthy adults, we measured the systemic inflammation reflected by serum levels of IL-6, IL-12, IL-18, TNF-α and IFN-γ, subjective sleep quality reflected by the global scores of the Pittsburgh Sleep Quality Index, and their neurocognitive performance measured by the Hong Kong Montreal Cognitive Assessment. We observed that neurocognitive performance was negatively related to IL-18 (p = 0.046) and positively related to sleep quality (p = 0.006). We did not observe significant associations between other cytokines and neurocognitive performance. Furthermore, we found that sleep quality as a mediator explained the relationship between IL-18 and neurocognitive performance depending on the levels of IL-12 (index of moderated mediation: 95% CI = [0.0047, 0.0664]). Better subjective sleep quality buffered the negative effect of IL-18 on neurocognitive performance when IL-12 was low (bootstrapping 95% CI: [- 0.0824, - 0.0018]). On the contrary, poor subjective sleep quality mediated the association between higher IL-18 and poorer neurocognitive performance when IL-12 was elevated (bootstrapping 95% CI: [0.0004, 0.0608]). Conclusion & Implications Our findings indicate that systemic inflammation was negatively associated with neurocognitive performance. Sleep quality regulated by IL-18/IL-12 axis activation could be a potential mechanism underpinning neurocognitive changes. Our results illustrate the intricate relationships between immune functioning, sleep quality and neurocognitive performance. These insights are essential to understand the potential mechanisms underpinning neurocognitive changes, paving the way for the development of preventive interventions for the risk of cognitive impairment.
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Affiliation(s)
- Rachel R. Jin
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China
| | - Carman Nga-Man Cheung
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Clive H.Y. Wong
- Department of Psychology, The Education University of Hong Kong, Hong Kong, China
| | - Chelsea C.W. Lo
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Crystal P.I. Lee
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hing Wai Tsang
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Preeti Dinesh Virwani
- Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kui Kai Lau
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Tatia M.C. Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
- Laboratory of Neuropsychology and Human Neuroscience, The University of Hong Kong, Hong Kong, China
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Nyenhuis DL, Reckow J. Office- and Bedside-based Screening for Cognitive Impairment and the Dementias: Which Tools to Use, Interpreting the Results, and What Are the Next Steps? Clin Geriatr Med 2023; 39:15-25. [PMID: 36404027 DOI: 10.1016/j.cger.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Elderly patients and their families are concerned about the patients' cognitive abilities, and cognitive screening is an efficient diagnostic tool, as long as clinicians administer the screens in a standardized manner and interpret the screen results accurately. The following brief summary reviews commonly used screening instruments and provides information about how to interpret screening test results. It concludes by showing how cognitive screening fits into a four-step process (Education, Screening, Follow-up, and Referral) of how to respond to patients with cognitive concerns.
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Affiliation(s)
- David L Nyenhuis
- Neuropsychology Section, Hauenstein Neuroscience Center, Mercy Health of West Michigan, 220 Cherry Street SE, Grand Rapids, MI 49503, USA.
| | - Jaclyn Reckow
- Department of Psychology, LCC International University, Kretingos g. 36, Klaipeda, Lithuania
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Del Brutto OH, Rumbea DA, Recalde BY, Mera RM. The association between white matter hyperintensities of presumed vascular origin and disability is mediated by age: a population-based study in stroke-free older adults. Aging Clin Exp Res 2023; 35:887-892. [PMID: 36720797 DOI: 10.1007/s40520-023-02355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND Information on the association between disability and severity of white matter hyperintensities (WMH) among stroke-free individuals is limited. We aimed to assess this association in apparently healthy older adults. METHODS Following a population-based cross-sectional design, community-dwelling older adults received a brain MRI to grade WMH severity and the Functional Activities Questionnaire to assess the ability to perform activities of daily living. Demographics, clinical risk factors and other markers of cerebral small vessel disease were taken into consideration for analysis. RESULTS Unadjusted analysis showed a significant association between moderate-to-severe WMH and disability (p = 0.003) that was tempered by the effect of age. Causal mediation analysis showed that age took away 65.9% of the effect of WMH severity on disability. An interaction model showed that disability was higher only among subjects with moderate-to-severe WMH above the median age. CONCLUSIONS Increasing age mediates the probability of WMH-related disability in stroke-free individuals.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, CA, USA
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Liang Y, Yang Y, Yang T, Li M, Ruan Y, Jiang Y, Huang Y, Wang Y. Effects of cognitive impairment and depressive symptoms on health-related quality of life in community-dwelling older adults: The mediating role of disability in the activities of daily living and the instrumental activities of daily living. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5848-e5862. [PMID: 36111820 DOI: 10.1111/hsc.14016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 06/23/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
The objective of this study was to estimate the joint effects of cognitive impairment and depressive symptoms on health-related quality of life (HRQoL) and to explore the mediating role of disability among Chinese community-dwelling older adults. A cross-sectional study was conducted with 2525 community-dwelling older adults aged ≥60 years and living in Shanghai, China in 2019. Participants were divided into four groups: (1) non-depressed without dementia, (2) non-depressed with probable MCI, (3) depressed without dementia and (4) depressed with probable mild cognitive impairment (MCI). HRQoL was assessed using the 36-Item Short-Form Health Survey. Cognitive impairment and depressive symptoms were evaluated with the AD8 and the Geriatric Depression Scale respectively. Activities of daily living (ADL) and instrumental activities of daily living (IADL) disability and other sociodemographic variables were also assessed. The results of this study showed that controlling for sociodemographic characteristics, significant differences in a physical component score (PCS) and a mental component score (MCS) of HRQoL were found across the four groups. Compared to those who were non-depressed without dementia, older adults who were depressed with probable MCI reported the lowest level of PCS and MCS, followed by older adults who were depressed without dementia. Both ADL and IADL disabilities played mediating roles in the relationship between cognitive impairment and depressive symptoms and PCS. Based on this study, we suggest that the early detection and adequate management of depressive symptoms and cognitive status-as well as efforts to improve individuals' ability to manage their ADLs and IADLs-may help to maintain or improve their HRQoL.
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Affiliation(s)
- Yan Liang
- School of Nursing, Fudan University, Shanghai, China
| | - Yinghua Yang
- Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Tingting Yang
- Fudan University School of Public Health, Shanghai, China
| | - Mengying Li
- Fudan University School of Public Health, Shanghai, China
| | - Ye Ruan
- Shanghai Center for Disease Control and Prevention, Shanghai, China
| | - Yihua Jiang
- Shanghai Medicine-Mental Health Center of Minhang District, Shanghai, China
| | - Yanyan Huang
- Department of Geriatrics, Huashan Hospital, Fudan University, Shanghai, China
- TianQiao and Chrissy Chen Institute Clinic Translational Research Center, Shanghai, China
| | - Ying Wang
- Fudan University School of Public Health, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning Commission of the People's Republic of China, Fudan University, Shanghai, China
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11
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Felício LFF, Leão LL, Souza EHEE, Machado FSM, Laks J, Deslandes AC, Paula AMBD, Monteiro-Junior RS. Cognitive abilities of institutionalized older persons with depressive symptoms. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT Objective To determine the level of association between depressive symptoms and cognitive abilities of institutionalized older adults. Methods This is a cross-sectional study that enrolled 69 older adults, living in a long-term care facility. Investigation of depressive symptoms in all individuals was performed using the geriatric depression scale. Cognitive verbal fluency, digit span forward (DSF) and backward (DSB) tests, and two-minute stationary gait, sit-to-stand test, and six-minute walk test were performed to assess their association with depressive symptoms. Results Depressive symptoms were identified in 35 individuals. Worse cognition and physical performances were associated with the presence of depressive symptoms – Mini-Mental State Examination [t (61) = 2.36; p < 0.05] and Stationary gait test of two minutes [t (53) = 3.12; p < 0.05]. Short-term memory and working memory tests presented worse results in individuals with depressive symptoms (DSF: U = 402.00; p < 0.05 e DSB: U = 341,00; p < 0.05). Older adults with scores below normal in DSF were 5 times more likely to exhibit depressive symptoms. Conclusion The importance of physical, cognitive and social intervention strategies in long-term care facilities for the older adults is highlighted, in order to privilege autonomy. Notably, there is an association between deficits in short-term memory and the presence of depressive symptoms in older adults. Therefore, prospective studies are suggested to investigate the cause-effect relationship of this association with the institutionalization of older adults.
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Affiliation(s)
| | | | | | | | - Jerson Laks
- Federal University of Rio de Janeiro, Brazil
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12
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Curtis AF, Schmiedeler A, Musich M, Connell M, Miller MB, McCrae CS. COVID-19-Related Anxiety and Cognition in Middle-Aged and Older Adults: Examining Sex as a Moderator. Psychol Rep 2022; 126:1260-1283. [PMID: 35099322 PMCID: PMC8810388 DOI: 10.1177/00332941211064820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Aging populations experience disproportionate risk for cognitive decline, which may be exacerbated by coronavirus (COVID-19) illness, particularly among women. This study tested sex as a moderator of associations between COVID-19 state anxiety and cognition in middle-aged/older adults. Adults aged 50+ (N = 275; 151 men/124 women) completed the Coronavirus Anxiety Scale and Cognitive Failures Questionnaire online from remote locations in July/August 2020. A subset of participants (n = 62) completed an objective cognitive task (Stroop). Multiple regressions determined whether sex moderated associations between COVID-19 anxiety and cognitive outcomes. Sex was a significant moderator, such that for women (not men), greater COVID-19 anxiety was associated with more memory failures and blunders (subjective measures) and worse processing speed (objective measure). COVID-19 state anxiety is linked to everyday cognition and processing speed in women, but not men. Consistency across subjective and objective measures promotes the need for sex-specific understanding of the pandemic’s behavioral and cognitive effects in mid-to-late life.
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Affiliation(s)
- Ashley F. Curtis
- Department of Psychiatry, University of Missouri, Columbia, MO, USA; Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Anthony Schmiedeler
- Department of Psychiatry, University of Missouri, Columbia, MO, USA; Department of Educational, School, and Counseling Psychology, University of Missouri, Columbia, MO, USA
| | - Madison Musich
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Maggie Connell
- Department of Psychiatry, University of Missouri, Columbia, MO, USA
| | - Mary Beth Miller
- Department of Psychiatry, University of Missouri, Columbia, MO, USA
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Del Brutto OH, Mera RM, Rumbea DA, Recalde BY, Sedler MJ. Social determinants of health and cognitive performance of older adults living in rural communities: The Three Villages Study. Int J Geriatr Psychiatry 2022; 37. [PMID: 35015319 DOI: 10.1002/gps.5671] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES There is limited information on factors associated with poor cognitive performance in rural settings of Low- and Middle-Income Countries. Using the Three Villages Study Cohort, we assessed whether social determinants of health (SDH) play a role in cognitive performance among older adults living in rural Ecuador. METHODS Atahualpa, El Tambo and Prosperidad residents aged ≥60 years received measurement of SDH by means of the Gijon Scale together with a Montreal Cognitive Assessment (MoCA). The association between SDH and cognitive performance (dependent variable) was assessed by generalized linear models, adjusted for demographics, years of education, cardiovascular risk factors, symptoms of depression and biomarkers of structural brain damage. RESULTS We included 513 individuals (mean age: 67.9 ± 7.3 years; 58% women). The mean score on the Gijon scale was 9.9 ± 2.9 points, with 237 subjects classified as having a high social risk (≥10 points). The mean MoCA score was 19.6 ± 5.4 points. Locally weighted scatterplot smoothing showed an inverse linear relationship between SDH and MoCA scores. SDH and MoCA scores were inversely associated in linear models adjusted for clinical covariates (β: -0.17; 95% C.I.: -0.32 to -0.02; p = 0.020), neuroimaging covariates (β: -0.17; 95% C.I.: -0.31 to -0.03; p = 0.018), as well as in the most parsimonious model (β: -0.16; 95% C.I.: -1.30 to -0.02; p = 0.026). CONCLUSIONS Study results provide robust evidence of an inverse association between SDH and cognitive performance. Interventions and programs aimed to reduce disparities in the social risk of older adults living in underserved rural populations may improve cognitive performance in these individuals.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Robertino M Mera
- Biostatistics/Epidemiology, Freenome, Inc., South San Francisco, California, USA
| | - Denisse A Rumbea
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Bettsy Y Recalde
- School of Medicine and Research Center, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador
| | - Mark J Sedler
- Renaissance School of Medicine, Stony Brook University, New York, New York, USA
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Rong J, Wang X, Ge Y, Chen G, Ding H. Association between functional disability and depressive symptoms among older adults in rural China: a cross-sectional study. BMJ Open 2021. [PMCID: PMC8719149 DOI: 10.1136/bmjopen-2020-047939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
ObjectivesThe aim of this study was to explore the relationship between functional disability and depressive symptoms, focusing on whether an interaction exists between functional disability, demographic characteristics and depressive symptoms among older adults in rural China.DesignA cross-sectional study using multistage, stratified random sampling.SettingData from 18 villages in Anhui Province of China between January to July 2018.Participants3491 Chinese participants aged 60 and over.Primary and secondary outcome measuresThe 30-item Geriatric Depression Scale and WHO Disability Assessment Schedule 2.0 were used to evaluate depressive symptoms and functional disability, respectively. Data were analysed using SPSS statistics V.25.0 program with χ2 test, Mann-Whitney U test, binary logistic regression analysis and classification and regression tree (CART) model.ResultsThe prevalence of depressive symptoms in 3336 interviewed older people was 52.94%. After adjustment, subjects who had problems in mobility domain (adjusted OR (AOR) 1.842, 95% CI 1.503 to 2.258), getting along domain (AOR 1.616, 95% CI 1.299 to 2.010), life activities domain (AOR 1.683, 95% CI 1.370 to 2.066) and participation domain (AOR 3.499, 95% CI 2.385 to 4.987) had an increased depressive symptoms risk. However, cognition domain (AOR 0.785, 95% CI 0.647 to 0.953) negatively correlated with depressive symptoms. Additionally, the CART model showed that those who had problems in mobility domain, getting along domain and were unemployed, the possibility of having depressive symptoms was the highest.ConclusionsMore attention should be paid to unemployed older adults, and those with problems in participation, life activities, getting along and mobility and no problems in cognition to maintain a good psychological state.
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Affiliation(s)
- Jian Rong
- Department of Scientific Research, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xueqin Wang
- Department of Medical Engineering, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yanhong Ge
- Department of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Guimei Chen
- Department of Health Service Management, Anhui Medical University, Hefei, Anhui, China
| | - Hong Ding
- Department of Health Service Management, Anhui Medical University, Hefei, Anhui, China
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Cognitive Frailty in Thai Community-Dwelling Elderly: Prevalence and Its Association with Malnutrition. Nutrients 2021; 13:nu13124239. [PMID: 34959791 PMCID: PMC8709040 DOI: 10.3390/nu13124239] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022] Open
Abstract
Cognitive frailty (CF) is defined by the coexistence of physical frailty and mild cognitive impairment. Malnutrition is an underlying factor of age-related conditions including physical frailty. However, the evidence associating malnutrition and cognitive frailty is limited. This cross-sectional study aimed to determine the association between malnutrition and CF in the elderly. A total of 373 participants aged 65-84 years were enrolled after excluding those who were suspected to have dementia and depression. Then, 61 CF and 45 normal participants were randomly selected to measure serum prealbumin level. Cognitive function was assessed using the Montreal Cognitive Assessment-Basic (MoCA-B). Modified Fried's criteria were used to define physical frailty. Nutritional status was evaluated by the Mini Nutritional Assessment-short form (MNA-SF), serum prealbumin, and anthropometric measurements. The prevalence of CF was 28.72%. Malnourished status by MNA-SF category (aOR = 2.81, 95%CI: 1.18-6.67) and MNA-SF score (aOR = 0.84, 95%CI = 0.74-0.94) were independently associated with CF. However, there was no correlation between CF and malnutrition assessed by serum prealbumin level and anthropometric measurements. Other independent risk factors of CF were advanced age (aOR = 1.06, 95%CI: 1.02-1.11) and educational level below high school (aOR = 6.77, 95%CI: 1.99-23.01). Malnutrition was associated with CF among Thai elderly. High-risk groups who are old and poorly educated should receive early screening and nutritional interventions.
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Effects of Sociodemographic Variables and Depressive Symptoms on MoCA Test Performance in Native Germans and Turkish Migrants in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126335. [PMID: 34208085 PMCID: PMC8296159 DOI: 10.3390/ijerph18126335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/28/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022]
Abstract
The validity of the Montreal Cognitive Assessment (MoCA) in migrants is questionable, as sociodemographic factors and the migration process may influence performance. Our aim was to evaluate possible predictors (age, education, sex, depression, and migration) of MoCA results in Turkish migrants and Germans living in Germany. Linear regression models were conducted with a German (n = 419), a Turkish (n = 133), and an overall sample. All predictor analyses reached statistical significance. For the German sample, age, sex, education, and depression were significant predictors, whereas education was the only predictor for Turkish migrants. For the overall sample, having no migration background and higher education were significant predictors. Migration background and education had an impact on MoCA performance in a sample of German and Turkish individuals living in Germany. Thus, culture-specific normative data for the MoCA are needed, and the development of culture-sensitive cognitive screening tools is encouraged.
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Sisa Caiza I, Vega R. Prevalence of depression in older adults living in Ecuador and contributing factors: a population-based study. Rev Salud Publica (Bogota) 2021. [DOI: 10.15446/rsap.v23n2.85965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective To estimate the prevalence of depression in the older population of Ecuador and explore the independent associations of key socio-demographic and health-related factors with moderate/severe depression.Methods A cross-sectional study was conducted using a national database. The outcome variable was estimated using the Short Form of the Geriatric Depression Scale. A cut-value of >9 was used to ascertain the outcome variable. We conducted bivariate and logistic regression analysis.Results The study sample consisted of 5 235 subjects, with a median age of 70 years, 53.5% were female, and 44.9% of the sample was living in rural areas. Our study found a prevalence of any depression of 35.4%. Individuals were classified as having mild depression (1 239, 23.7%), moderate depression (457, 8.7%), and severe depression (156, ~3%). The prevalence of moderate/severe depression was of 11.7%. Among socio-demographic factors, no education (OR=3.69 [95% CI: 1.35-11.94]), Afro-Ecuadorian race (OR= 2.1 [1.03-4.06]), living alone (OR=2.37 [1.67-3.31]), perception of insufficient income (OR= 3.56 [2.14-6.38]), and suffering physical abuse (OR=2.33 [1.59-3.36]) remained statistically significant. Among health-related factors, drinking alcohol (OR=0.27 [0.08-0.66]), exercise (OR=1.68 [1.24-2.31]), incontinence (OR=2.00 [1.54-2.59]), lower perception of hearing (OR=2.19 [1.41-3.32]), cancer (OR=1.90 [1.00-3.51]), and being functionally dependent (OR=1.59 [1.22-2.08]) remained statistically significant.Conclusions Our investigation brings light to an important public health problem in Ecuador. Addressing depression and its contributing factors may help to improve the quality of life and long-term health outcomes in Ecuador’s growing older population.
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Del Brutto OH, Wu S, Mera RM, Costa AF, Recalde BY, Issa NP. Cognitive decline among individuals with history of mild symptomatic SARS-CoV-2 infection: A longitudinal prospective study nested to a population cohort. Eur J Neurol 2021; 28:3245-3253. [PMID: 33576150 PMCID: PMC8014083 DOI: 10.1111/ene.14775] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Neurological complications of SARS-CoV-2 infection are noticed among critically ill patients soon after disease onset. Information on delayed neurological sequelae of SARS-CoV-2 infection is nil. Following a longitudinal study design, the occurrence of cognitive decline among individuals with a history of mild symptomatic SARS-CoV-2 infection was assessed. METHODS Stroke- and seizure-free Atahualpa residents aged ≥40 years, who had pre-pandemic cognitive assessments as well as normal brain magnetic resonance imaging and electroencephalogram recordings, underwent repeated evaluations 6 months after a SARS-CoV-2 outbreak infection in Atahualpa. Patients requiring oxygen therapy, hospitalization, and those who had initial neurological manifestations were excluded. Cognitive decline was defined as a reduction in the Montreal Cognitive Assessment (MoCA) score between the post-pandemic and pre-pandemic assessments that was ≥4 points greater than the reduction observed between two pre-pandemic MoCAs. The relationship between SARS-CoV-2 infection and cognitive decline was assessed by fitting logistic mixed models for longitudinal data as well as exposure-effect models. RESULTS Of 93 included individuals (mean age 62.6 ± 11 years), 52 (56%) had a history of mild symptomatic SARS-CoV-2 infection. Post-pandemic MoCA decay was worse in seropositive individuals. Cognitive decline was recognized in 11/52 (21%) seropositive and 1/41 (2%) seronegative individuals. In multivariate analyses, the odds for developing cognitive decline were 18.1 times higher among SARS-CoV-2 seropositive individuals (95% confidence interval 1.75-188; p = 0.015). Exposure-effect models confirmed this association (β = 0.24; 95% confidence interval 0.07-0.41; p = 0.006). CONCLUSIONS This study provides evidence of cognitive decline among individuals with mild symptomatic SARS-CoV-2 infection. The pathogenesis of this complication remains unknown.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo-Ecuador, Samborondón, Ecuador
| | - Shasha Wu
- Department of Neurology, University of Chicago, Chicago, IL, USA
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc, Foster City, CA, USA
| | - Aldo F Costa
- Department of Neurology, Hospital Universitario Reina Sofía, Cordoba, Spain
| | | | - Naoum P Issa
- Department of Neurology, University of Chicago, Chicago, IL, USA
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Cerebrovascular Correlates of Dementia in Community-Dwelling Older Adults Living in Rural Communities - The Three Villages Study. Rationale and Protocol of a Population-Based Prospective Cohort Study. J Stroke Cerebrovasc Dis 2020; 29:104656. [PMID: 32033904 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104656] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/01/2019] [Accepted: 01/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Despite the assumption that dementia is increasing in rural areas of Latin America, there is no information on the burden and risk factors leading to dementia in these settings. AIMS To assess prevalence and incidence of dementia, and its cerebrovascular correlates in an established cohort of community-dwelling older adults living in rural Ecuador, and to explore the impact of dementia on functional disability and the role of the social determinants of health in the above-mentioned relationships. DESIGN Population-based, cohort study with cross-sectional and longitudinal components. Baseline clinical interviews will focus on the assessment of cognitive performance and dementia by means of the clinical dementia rating scale (CDRS). Functional disability and social determinants of health will be correlated with CDRS scores. In addition, participants will undergo interviews and procedures to assess cardiovascular risk factors and signatures of brain damage, cerebral small vessel disease, and other stroke subtypes. The CDRS and the Functional Activities Questionnaire will be administered every year to assess the rate of incident dementia and the severity of functional disability. Neuroimaging studies will be repeated at the end of the study (5 years) to assess the impact of newly appeared cerebral and vascular lesions on cognitive decline. COMMENT This study will allow determine whether cerebrovascular diseases are in the path of dementia development in these rural settings. This may prove cost-effective for the development of preventive strategies aimed to control modifiable factors and reduce disability in patients with dementia living in underserved populations.
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20
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Del Brutto OH, Mera RM, Recalde BY, Del Brutto VJ. On the Association Between Social Determinants of Health and Disability in Stroke-Free Older Adults Living in Rural Settings. The Three Villages Study. J Prim Care Community Health 2020; 11:2150132720961265. [PMID: 33000667 PMCID: PMC7533924 DOI: 10.1177/2150132720961265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND High social risk, as quantified by the social determinants of health (SDH), may lead to disability. This association has not been well explored in remote settings. Using the three Villages Study cohort, we assessed the association between SDH and disability among stroke-free older adults living in a rural Ecuadorian community. METHODS SDH were measured by the use of the Gijon Scale and disability by the Functional Activities Questionnaire. All participants had a brain MRI to assess subclinical biomarkers of cerebral small vessel disease. Multivariate models were fitted to assess the association between components of SDH and disability, after adjusting for covariates of interest. RESULTS The mean age of 478 enrolled individuals was 70.1 ± 8 years (59% women). High social risk was observed in 220 (46%) individuals and disability in 222 (46%). There was an almost direct linear relationship between SDH and disability, after taking into account the effect of age. A generalized linear model, adjusted for all included covariates, showed an independent association between social risk and disability (P < .001). In addition, multivariate models showed that independent SDH components more strongly associated with disability were worse support networks and social relationships. In contrast, the single SDH component not associated with disability was the economic status. CONCLUSIONS This study showed a robust association between SDH and disability. Economic needs were surpassed by other components of SDH. This knowledge will help to develop strategies for the control of factors that may be in the path for disability among older adults living in rural settings.
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Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Samborondón, Ecuador
| | - Robertino M. Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
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Croghan A, Brunette A, Holm KE, Kozora E, Moser DJ, Wamboldt FS, Meschede K, Make BJ, Crapo JD, Weinberger HD, Moreau KL, Bowler RP, Hoth KF. Reduced Attention in Former Smokers with and without COPD. Int J Behav Med 2019; 26:600-607. [PMID: 31732904 PMCID: PMC7269072 DOI: 10.1007/s12529-019-09826-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Attention difficulties are often reported by patients with chronic obstructive pulmonary disease (COPD); however, limited research exists using objective tests designed specifically to measure attention in this population. This study aimed to (1) identify specific attention deficits in COPD and (2) determine which demographic/clinical characteristics are associated with reduced attention. METHODS Eighty-four former smokers (53 COPD, 31 no COPD) completed questionnaires, pulmonary function testing, and the Conner's Continuous Performance Test II (CPT-II). Participants with and without COPD were compared on CPT-II measures of inattention, impulsivity, and vigilance. CPT-II measures that differed significantly between the two groups were further examined using hierarchical regression modeling. Demographic/clinical characteristics were entered into models with attention as the dependent variable. RESULTS Participants with COPD performed worse than those without COPD on CPT measures of inattention and impulsivity (i.e., detectability [discrimination of target from non-target stimuli], perseverations [reaction time under 100 ms], omissions [target stimuli response failures], and commissions [responses to non-target stimuli]). More severe COPD (measured by greater airflow limitation) was associated with poorer ability to detect targets vs. foils and perseverative responding after adjusting for age and other covariates in the model. CONCLUSION Former smokers with COPD experience problems with attention that go beyond slowed processing speed, including aspects of inattention and impulsivity. Clinicians should be aware that greater airflow limitation and older age are associated with attention difficulties, as this may impact functioning.
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Affiliation(s)
- Anna Croghan
- Department of Psychology, University of North Dakota, Grand Forks, ND, USA
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Amanda Brunette
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Kristen E Holm
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Colorado School of Public Health, Department of Community and Behavioral Health, Aurora, CO, USA
| | - Elizabeth Kozora
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - David J Moser
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA
| | - Frederick S Wamboldt
- National Jewish Health, Department of Medicine, Denver, CO, USA
- Department of Psychiatry, University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | | | - Barry J Make
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - James D Crapo
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Howard D Weinberger
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Kerrie L Moreau
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center Aurora, Denver, CO, USA
| | - Russell P Bowler
- National Jewish Health, Department of Medicine, Denver, CO, USA
- University of Colorado School of Medicine at the Anschutz Medical Campus, Aurora, CO, USA
| | - Karin F Hoth
- Department of Psychiatry, University of Iowa Carver College of Medicine, 200 Hawkins Dr., W278GH, Iowa City, IA, 52242, USA.
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Del Brutto OH, Mera RM, Zambrano M. Cognitive decline is not influenced by the marital status or living arrangements in community-dwelling adults living in a rural setting. A population-based prospective cohort study. J Clin Neurosci 2019; 69:109-113. [PMID: 31466904 DOI: 10.1016/j.jocn.2019.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/04/2019] [Indexed: 01/30/2023]
Abstract
Little is known on factors influencing cognitive decline in rural communities. Using the Atahualpa Project cohort, we aimed to assess whether the marital status or living arrangements influenced cognitive decline in community-dwelling adults living in an Ecuadorian rural village. The study included 629 Atahualpa residents aged ≥40 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least one year after baseline. Multivariate longitudinal linear models were fitted to assess differences between the marital status and living arrangements and cognitive decline (as the outcome). A total of 411 participants were married. The remaining 218 were either single, divorced or widowed (191 of them lived with family members and the others lived alone). Enrolled individuals contributed 2088.4 person-years of follow-up (mean: 3.3 ± 1.1 years). The mean baseline MoCA was 22.1 ± 4.5 points and the follow-up MoCA was 20.6 ± 4.8 points (p = 0.001). Overall, 394 (63%) individuals had lower MoCA scores at follow-up. A fully-adjusted longitudinal linear model showed no differences in MoCA decline across married and non-married individuals (β: -0.15; 95% C.I.: -0.55 - 0.26; p = 0.477). When the subset of non-married individuals was taken into account for analyses, multivariate longitudinal linear models showed no differences in the severity of cognitive decline across individuals living alone versus those living with family members (β: 0.28; 95% C.I.: -0.68 - 1.24; p = 0.572). In this study, the marital status or living arrangements had no influence on cognitive decline in the follow-up.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Samborondón, Ecuador.
| | - Robertino M Mera
- Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA
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Del Brutto OH, Mera RM, Del Brutto VJ, Castillo PR. Enlarged basal ganglia perivascular spaces and sleep parameters. A population-based study. Clin Neurol Neurosurg 2019; 182:53-57. [DOI: 10.1016/j.clineuro.2019.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/20/2019] [Accepted: 05/05/2019] [Indexed: 11/24/2022]
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Age-Dependent Psychological Factors Influencing the Outcome of Cochlear Implantation in Elderly Patients. Otol Neurotol 2019; 40:e441-e453. [DOI: 10.1097/mao.0000000000002179] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Del Brutto OH, Mera RM, Del Brutto VJ, Zambrano M, Wright CB, Rundek T. Clinical and neuroimaging risk factors for cognitive decline in community-dwelling older adults living in rural Ecuador. A population-based prospective cohort study. Int J Geriatr Psychiatry 2019; 34:447-452. [PMID: 30474242 PMCID: PMC6372307 DOI: 10.1002/gps.5037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/14/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE There is limited information on factors influencing cognitive decline in rural settings from low- and middle-income countries. Using the Atahualpa Project cohort, we aimed to assess the burden of cognitive decline in older adults living in a rural Ecuadorian village. METHODS The study included Atahualpa residents aged greater than or equal to 60 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least 1 year after baseline. MoCA decline was assessed by multivariable longitudinal linear models, adjusted for demographics, days between MoCA tests, cardiovascular risk factors, and neuroimaging signatures of structural brain damage. RESULTS We included 252 individuals who contributed 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years). The mean baseline MoCA was 19.5 ± 4.5 points, and the follow-up MoCA was 18.1 ± 4.9 points (P = 0.001). Overall, 154 individuals (61%) had lower MoCA scores at follow-up. The best fitted longitudinal linear model showed a decline of follow-up MoCA from baseline (β: 0.14; 95% CI, 0.0-0.21; P < 0.001). High glucose levels, global cortical atrophy, and white matter hyperintensities were independently and significantly associated with greater MoCA decline. CONCLUSION This study provides evidence of cognitive decline in older adults living in a rural setting. Main targets for prevention should include glucose control and the control of factors that are deleterious for the development of cortical atrophy and white matter hyperintensities.
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Affiliation(s)
- Oscar H. Del Brutto
- School of Medicine, Universidad Espíritu Santo – Ecuador, Guayaquil, Ecuador
| | | | - Victor J. Del Brutto
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA
| | | | - Clinton B. Wright
- National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Tatjana Rundek
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA
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Reasons for Declining Consent in a Population-Based Cohort Study Conducted in a Rural South American Community. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:8267948. [PMID: 30598669 PMCID: PMC6287151 DOI: 10.1155/2018/8267948] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022]
Abstract
There is limited information on participants' adherence and reasons for declining consent in observational cohort studies conducted in remote rural communities. We aimed at sharing lessons learned during the Atahualpa Project, a population-based cohort study conducted in a rural Ecuadorian village. Atahualpa residents aged ≥40 years identified during door-to-door surveys who signed a consent form were enrolled. Annual surveys were conducted to assess the number of participants who moved out of the village, as well as those who died, declined consent, and newly entered the study. Reasons for declining consent were tabulated. Abstracted data included age, sex, education, disability, time between enrollment and declining consent, and reasons for withdrawal. We also counted participants who, despite expressing their willingness to continue in the study, refused specific procedures. After five years of follow-up, 54 (6.3%) of 863 enrolled individuals declined consent. Increasing age and disability had no impact on declining consent. In contrast, refusal was higher among relatives or neighbors of a given participant declining consent. Most people who declined consent did so after one or two years of enrollment. Less than 20% of enrolled individuals refused certain procedures. "Fear of the needle" was the most frequent reason for refusing blood tests, and common reasons for declining complimentary exams were lack of interest and time constraints. Cohort retention in the Atahualpa Project is high. Main reasons for this adherence include adequate selection of the village, detailed planning of procedures, assurance of sponsorship, and field personnel who continuously engage with study participants. This trial is registered with NCT01627600.
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Social exclusion and depression among college students: A moderated mediation model of psychological capital and implicit theories. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-0036-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Stewart-Ibarra AM, Hargrave A, Diaz A, Kenneson A, Madden D, Romero MM, Molina JP, Saltos DM. Psychological Distress and Zika, Dengue and Chikungunya Symptoms Following the 2016 Earthquake in Bahía de Caráquez, Ecuador. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1516. [PMID: 29206195 PMCID: PMC5750934 DOI: 10.3390/ijerph14121516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 12/29/2022]
Abstract
On 16 April 2016, a 7.8 magnitude earthquake struck coastal Ecuador, resulting in significant mortality and morbidity, damages to infrastructure, and psychological trauma. This event coincided with the first outbreak of Zika virus (ZIKV) and co-circulation with dengue virus (DENV) and chikungunya virus (CHIKV). We tested whether the degree of psychological distress was associated with the presence of suspected DENV, CHIKV, ZIKV (DCZ) infections three months after the earthquake. In July 2016, 601 household members from four communities in Bahía de Caráquez, Manabí Province, Ecuador, were surveyed in a post-disaster health evaluation. Information was collected on demographics, physical damages and injuries, chronic diseases, self-reported psychological distress, and DCZ symptoms. We calculated the prevalence of arbovirus and distress symptoms by community. ANOVA was used to compare the mean number of psychological distress symptoms between people with versus without suspected DCZ infections by age, gender, community and the need to sleep outside of the home due to damages. The prevalence of suspected DCZ infections was 9.7% and the prevalence of psychological distress was 58.1%. The average number of psychological distress symptoms was significantly higher among people with suspected DCZ infections in the periurban community of Bella Vista, in women, in adults 40-64 years of age and in individuals not sleeping at home (p < 0.05). The results of this study highlight the need to investigate the interactions between psychological distress and arboviral infections following natural disasters.
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Affiliation(s)
- Anna M Stewart-Ibarra
- Center for Global Health and Translational Science, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA.
| | - Anita Hargrave
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
| | - Avriel Diaz
- Department of Ecology, Evolution and Conservation Biology at Columbia University, New York, NY 10025, USA.
| | - Aileen Kenneson
- Center for Global Health and Translational Science, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA.
| | - David Madden
- Walking Palms Global Initiative, Bahía de Caráquez 131401, Manabí Province, Ecuador.
| | - Moory M Romero
- Center for Global Health and Translational Science, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA.
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Silva HAD, Passos MHPD, Oliveira VMAD, Palmeira AC, Pitangui ACR, Araújo RCD. Short version of the Depression Anxiety Stress Scale-21: is it valid for Brazilian adolescents? EINSTEIN-SAO PAULO 2017; 14:486-493. [PMID: 28076595 PMCID: PMC5221374 DOI: 10.1590/s1679-45082016ao3732] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/23/2016] [Indexed: 01/18/2023] Open
Abstract
Objective To evaluate the interday reproducibility, agreement and validity of the construct of short version of the Depression Anxiety Stress Scale-21 applied to adolescents. Methods The sample consisted of adolescents of both sexes, aged between 10 and 19 years, who were recruited from schools and sports centers. The validity of the construct was performed by exploratory factor analysis, and reliability was calculated for each construct using the intraclass correlation coefficient, standard error of measurement and the minimum detectable change. Results The factor analysis combining the items corresponding to anxiety and stress in a single factor, and depression in a second factor, showed a better match of all 21 items, with higher factor loadings in their respective constructs. The reproducibility values for depression were intraclass correlation coefficient with 0.86, standard error of measurement with 0.80, and minimum detectable change with 2.22; and, for anxiety/stress: intraclass correlation coefficient with 0.82, standard error of measurement with 1.80, and minimum detectable change with 4.99. Conclusion The short version of the Depression Anxiety Stress Scale-21 showed excellent values of reliability, and strong internal consistency. The two-factor model with condensation of the constructs anxiety and stress in a single factor was the most acceptable for the adolescent population. Objetivo Avaliar a reprodutibilidade interdias, a concordância e a validade do construto da versão reduzida da Depression Anxiety Stress Scale-21 aplicada a adolescentes. Método A amostra foi composta por adolescentes de ambos os sexos, com idades entre 10 e 19 anos, recrutados de escolas e centros esportivos. A validade de construto foi realizada por análise fatorial exploratória, e a confiabilidade foi calculada para cada construto, por meio de coeficiente de correlação intraclasse, erro padrão de medida e mudança mínima detectável. Resultados A análise fatorial combinando os itens correspondentes a ansiedade e estresse em um único fator, e depressão em um segundo fator apresentou melhor adequação de todos os 21 itens, com cargas fatoriais mais altas em seus respectivos construtos. Os valores de reprodutibilidade para a depressão foram coeficiente de correlação intraclasse com 0,86, erros padrão de medida com 0,80 e mudança mínima detectável com 2,22 e, para a ansiedade/estresse, foram coeficiente de correlação intraclasse com 0,82, erro padrão de medida com 1,80 e mudança mínima detectável com 4,99. Conclusão A versão reduzida da Depression Anxiety Stress Scale-21 apresentou excelentes valores de confiabilidade e também uma forte consistência interna. O modelo de dois fatores com a condensação dos construtos ansiedade e estresse em um único fator foi o mais aceitável para a população adolescente.
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Lazo-Porras M, Pesantes MA, Miranda JJ, Bernabe-Ortiz A. Evaluation of cognitive impairment in elderly population with hypertension from a low-resource setting: Agreement and bias between screening tools. eNeurologicalSci 2016; 5:35-40. [PMID: 28239668 PMCID: PMC5312667 DOI: 10.1016/j.ensci.2016.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 09/06/2016] [Accepted: 11/28/2016] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION The evaluation of cognitive impairment in adulthood merits attention in societies in transition and especially in people with chronic diseases. Screening tools available for clinical practice and epidemiological studies have been designed in high-income but not in resource-constrained settings. The aim of this study was to assess the agreement and bias of three common tools used for screening of cognitive impairment in people with hypertension: the modified Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Leganés Cognitive Test (LCT). METHODS A cross-sectional study enrolling participants with hypertension from a semi-urban area in Peru was performed. The three screening tools for cognitive impairment were applied on three consecutive days. The prevalence of cognitive impairment was calculated for each test. Pearson's correlation coefficients, Bland-Altman plots, and Kappa statistics were used to assess agreement and bias between screening tools. RESULTS We evaluated 139 participants, mean age 76.5 years (SD ± 6.9), 56.1% females. Cognitive impairment was found in 28.1% of individuals using LCT, 63.3% using MMSE, and 100% using MoCA. Correlation coefficients ranged from 0.501 between LCT and MoCA, to 0.698 between MMSE and MoCA. Bland-Altman plots confirmed bias between screening tests. The agreement between MMSE and LCT was 60.4%, between MMSE and MoCA was 63.3%, and between MoCA and LCT was 28.1%. CONCLUSIONS Three of the most commonly used screening tests to evaluate cognitive impairment showed major discrepancies in a resource-constrained setting, signaling towards a sorely need to develop and validate appropriate tools.
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Affiliation(s)
- María Lazo-Porras
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - María A. Pesantes
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Del Brutto OH, Mera RM, Del Brutto VJ, Sedler MJ. The bicaudate index inversely associates with performance in the Montreal Cognitive Assessment (MoCA) in older adults living in rural Ecuador. The Atahualpa project. Int J Geriatr Psychiatry 2016; 31:944-50. [PMID: 26833914 DOI: 10.1002/gps.4419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 12/03/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Assessment of cognitive impairment in rural areas of developing countries is complicated by illiteracy and cross-cultural factors. A better way to estimate the usefulness of cognitive screening instruments is to evaluate their correlation with imaging biomarkers. The bicaudate index (a marker of central atrophy) correlates with cognitive performance. We assessed the relationship of the bicaudate index with the MoCA to estimate the usefulness of this test to detect individuals with cognitive decline in these regions. METHODS Atahualpa residents aged ≥60 years identified during door-to-door surveys were evaluated with the MoCA and invited to undergo brain MRI. Using generalized linear models, we estimated whether the bicaudate index correlates with MoCA scores, after adjusting for demographics and relevant clinical and neuroimaging confounders. RESULTS Out of 385 eligible persons, 290 (75%) were enrolled. Mean bicaudate index was 0.14 ± 0.03, and mean total MoCA score was 19 ± 5 points. Locally weighted scatterplot smoothing showed a nearly linear inverse relationship between the bicaudate index and the total MoCA score. In the fully adjusted generalized linear model, the bicaudate index was inversely associated with the total MoCA score (p < 0.001), which dropped by 5.3% (95% C.I.: 1.7%-8.8%) for every standard deviation of the bicaudate index. In addition, most domain-specific MoCA scores were inversely associated with the bicaudate index. CONCLUSIONS The inverse relationship between the bicaudate index and the MoCA score provides evidence that the MoCA is reliable to detect structural brain damage and useful to assess cognitive performance in less educated individuals. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Guayaquil, Ecuador
| | | | | | - Mark J Sedler
- School of Medicine, Stony Brook University, New York, NY, USA
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Del Brutto OH, Mera RM, Zambrano M. Metabolic syndrome correlates poorly with cognitive performance in stroke-free community-dwelling older adults: a population-based, cross-sectional study in rural Ecuador. Aging Clin Exp Res 2016; 28:321-5. [PMID: 26142624 DOI: 10.1007/s40520-015-0404-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 06/22/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Studies investigating a possible correlation between metabolic syndrome and cognitive decline have been inconsistent. AIMS To determine whether metabolic syndrome or each of its components correlate with cognitive performance in community-dwelling older adults in rural Ecuador. METHODS Stroke-free Atahualpa residents aged ≥60 years were identified during a door-to-door survey. Metabolic syndrome was defined according to the International Diabetes Federation criteria. Cognition was evaluated by the use of the Montreal Cognitive Assessment (MoCA). Multivariate logistic regression models estimated the association between metabolic syndrome and each of its components with cognitive performance. RESULTS A total of 212 persons (mean age: 69.2 ± 7.2 years, 64 % women) were enrolled. Of these, 120 (57 %) had metabolic syndrome. Mean scores in the MoCA were 18.2 ± 4.6 for persons with and 19 ± 4.7 for those without metabolic syndrome. In fully adjusted logistic models, MoCA scores were not associated with metabolic syndrome (p = 0.101). After testing individual components of metabolic syndrome with the MoCA score, we found that only hypertriglyceridemia was independently associated with the MoCA score (p = 0.009). CONCLUSIONS This population-based study showed a poor correlation of metabolic syndrome with cognitive performance after adjusting for relevant confounders. Of the individual components of metabolic syndrome, only hypertriglyceridemia correlated with worse cognitive performance.
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Depressive Symptoms Negatively Impact Montreal Cognitive Assessment Performance: A Memory Clinic Experience. Can J Neurol Sci 2016; 43:513-7. [DOI: 10.1017/cjn.2015.399] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:The Montreal Cognitive Assessment (MoCA) is a general cognitive screening tool that has shown sensitivity in detecting mild levels of cognitive impairment in various clinical populations. Although mood dysfunction is common in referrals to memory clinics, the influence of mood on the MoCA has to date been largely unexplored.Method:In this study, we examined the impact of mood dysfunction on the MoCA using a memory clinic sample of individuals with depressive symptoms who did not meet criteria for a neurodegenerative disease.Results:Half of the group with depressive symptoms scored below the MoCA-suggested cutoff for cognitive impairment. As a group, they scored below healthy controls, but above individuals with Alzheimer’s disease and frontotemporal dementia. A MoCA subtask analysis revealed a pattern of executive/attentional dysfunction in those with depressive symptoms.Conclusions:This observed negative impact of depressive symptomatology on the MoCA has interpretative implications for its utility as a cognitive screening tool in a memory clinic setting.
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The Effect of Age in the Association between Frailty and Poor Sleep Quality: A Population-Based Study in Community-Dwellers (The Atahualpa Project). J Am Med Dir Assoc 2016; 17:269-71. [PMID: 26832127 DOI: 10.1016/j.jamda.2015.12.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/01/2015] [Accepted: 12/10/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess the effect of age in the association between poor sleep quality and frailty status. DESIGN AND SETTING Population-based, cross-sectional study conducted in Atahualpa, a rural village located in coastal Ecuador. METHODS Out of 351 Atahualpa residents aged ≥ 60 years, 311 (89%) were interviewed with the Pittsburgh Sleep Quality Index (PSQI) and the Edmonton Frail Scale (EFS). The independent association between PSQI and EFS scores was evaluated by the use of a generalized linear model adjusted for relevant confounders. A contour plot with Shepard interpolation was constructed to assess the effect of age in this association. RESULTS Mean score in the PSQI was 5 ± 2 points, with 34% individuals classified as poor sleepers. Mean score in the EFS was 5 ± 3 points, with 46% individuals classified as robust, 23% as prefrail, and 31% as frail. In the fully adjusted model, higher scores in the PSQI were significantly associated with higher scores in the EFS (β 0.23; 95% CI 0.11-0.35; P < .0001). Several clusters depicted the strong effect of age in the association between PSQI and EFS scores. Older individuals were more likely to have high scores in the EFS and the PSQI, and younger individuals had low EFS scores and were good sleepers. Clusters of younger individuals who were poor sleepers and had high EFS scores accounted for the independent association between PSQI and EFS scores. CONCLUSIONS This study shows the strong effect of age in the association between poor sleep quality and frailty status.
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Del Brutto OH, Mera RM, Zambrano M, Castillo PR. Caffeine intake has no effect on sleep quality in community dwellers living in a rural Ecuadorian village (The Atahualpa Project). ACTA ACUST UNITED AC 2016; 9:35-9. [PMID: 27217907 PMCID: PMC4866974 DOI: 10.1016/j.slsci.2015.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 11/25/2022]
Abstract
More information is needed to better understand the effect of caffeine on sleep quality at the community level. In a population-based, cross-sectional study design, we aimed to assess the effect of caffeine intake on sleep quality by the use of a multivariate exposure-effect model, adjusted for relevant confounders. All Atahualpa residents aged ≥40 years were identified during a door-to-door survey and interviewed with the Pittsburgh Sleep Quality Index (PSQI) and a structured instrument designed to estimate the daily amount of caffeine intake. An exposure-effect model was built using augmented inverse probability weighting taking into account variables that were associated with exposure (using a probit model) and variables that were associated with outcome (in a linear model). Out of 779 eligible individuals, 716 (92%) were included. Consumption of <100 mg/day of caffeine was recorded in 320 (45%) participants, from 100 to 200 mg/day in 299 (42%), and >200 mg/day in 97 (13%). Mean score in the PSQI was 4.5±2.2 points, with 203 (28%) individuals classified as poor sleepers (≥6 points). The exposure-effect model, adjusted for variables associated with the exposure (symptoms of depression, total cholesterol blood levels and smoking) and the outcome (age, symptoms of depression, physical activity and fasting glucose levels), revealed no effect of caffeine intake in sleep quality (average exposure effect: 0.027, 95% C.I.: -0.284 to 0.338, p=0.866). This population-based study shows that caffeine intake has no effect on sleep quality in community-dwelling adults living in a rural village of Ecuador.
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Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador
| | - Robertino M Mera
- Vanderbilt University Medical Center, Nashville, TN, United States
| | | | - Pablo R Castillo
- Sleep Disorders Center, Mayo Clinic College of Medicine, Jacksonville, FL, United States
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Subjective Memory Complaint and Depressive Symptoms among Older Adults in Portugal. Curr Gerontol Geriatr Res 2015; 2015:296581. [PMID: 26880907 PMCID: PMC4735984 DOI: 10.1155/2015/296581] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022] Open
Abstract
Background. Older adults report subjective memory complaints (SMCs) but whether these are related to depression remains controversial. In this study we investigated the relationship between the SMCs and depression and their predictors in a sample of old adults. Methods. This cross-sectional study enrolled 620 participants aged 55 to 96 years (74.04 ± 10.41). Outcome measures included a sociodemographic and clinical questionnaire, a SMC scale (QSM), a Geriatric Depression Scale (GDS), a Mini-Mental Status Examination (MMSE), and a Montreal Cognitive Assessment (MoCA). Results. The QSM mean total score for the main results suggests that SMCs are higher in old adults with depressed symptoms, comparatively to nondepressed old adults. The GDS scores were positively associated with QSM but negatively associated with education, MMSE, and MoCA. GDS scores predicted almost 63.4% of variance. Scores on QSM and MoCA are significantly predicted by depression symptomatology. Conclusion. Depression symptoms, lower education level, and older age may be crucial to the comprehension of SMCs. The present study suggested that depression might play a role in the SMCs of the older adults and its treatment should be considered.
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Salazar-Villanea M, Liebmann E, Garnier-Villarreal M, Montenegro-Montenegro E, Johnson DK. Depressive Symptoms Affect Working Memory in Healthy Older Adult Hispanics. JOURNAL OF DEPRESSION & ANXIETY 2015; 4:204. [PMID: 27104091 PMCID: PMC4836854 DOI: 10.4172/2167-1044.1000204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Low and middle income nations will experience an unprecedented growth of the elderly population and subsequent increase in age-related neurological disorders. Worldwide prevalence and incidence of all-types of neurological disorders with serious mental health complications will increase with life expectancy across the globe. One-in- ten individuals over 75 has at least moderate cognitive impairment. Prevalence of cognitive impairment doubles every 5 years thereafter. Latin America's population of older adult's 65 years and older is growing rapidly, yet little is known about cognitive aging among healthy older Latinos. Clinically significant depressive symptomatology is common among community-dwelling older adults and is associated with deficits across multiple cognitive domains, however much of the literature has not modeled the unique effects of depression distinct from negative and low positive affect. Our objective was to understand how mental health affects cognitive health in healthy aging Latinos. METHODS The present study used confirmatory factor analysis (CFA) and structural equation modeling (SEM) to examine the relative effects of Negative Affect, Positive Affect and Geriatric Depression on Verbal Memory, Verbal Reasoning, Processing Speed, and Working Memory in healthy aging Latinos. Data was collected from a sample of healthy community dwelling older adults living in San Jose, Costa Rica. Modeling of latent variables attenuated error and improved measurement reliability of cognition, affect, and depression variables. RESULTS Costa Ricans enjoy a notoriety for being much happier than US citizens and are renowned as one of the happiest nations in the world in global surveys. This was born out in these data. Costa Rican affective profiles differed substantively from US profiles. Levels of negative affect and depression were similar to US samples, but their levels of positive affect were much higher. Cognitive performance of these Costa Rican older adults was similar to US-age and education matched peers. CFA and SEM found that increased depressive symptomatology had deleterious effects on Working Memory made up of subtest scores sampling simple attention and vigilance for numbers. Verbal Memory, Verbal Reasoning, and Processing Speed were not affected by self-reported Positive Affect, Negative Affect or Depressive symptoms. CONCLUSION Costa Rican older adults were happy, as evidenced by the high ratio of positive affect to relatively low negative affect. Thus, we were somewhat surprised to find that depressive symptoms were selectively correlated to decrements in working memory and that negative and positive affect contributed negligible amounts of variance to any of the cognitive factors. Because of the methodological rigor of latent variable analysis, these results are very specific. The Working Memory factor is not contaminated with Speed of Processing or other measured cognitive factors. Likewise, the measured Geriatric Depression represents symptoms that are richly cognitive, not overtly affective.
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Del Brutto OH, Mera RM, Gillman J, Zambrano M, Ha JE. Oily Fish Intake and Cognitive Performance in Community-Dwelling Older Adults: The Atahualpa Project. J Community Health 2015; 41:82-6. [DOI: 10.1007/s10900-015-0070-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Brutto OHD, Mera RM, Zambrano M, Lama J. The Leganés cognitive test correlates poorly with MRI evidence of global cortical atrophy in an underserved community: A population-based and nested case-control study in rural Ecuador (The Atahualpa Project). Dement Neuropsychol 2014; 8:351-355. [PMID: 29213925 PMCID: PMC5619183 DOI: 10.1590/s1980-57642014dn84000008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective We aimed to evaluate whether the Leganés cognitive test (LCT) correlates with global cortical atrophy (GCA) and can be used as a surrogate for structural brain damage. Methods Atahualpa residents aged > 60 years identified during a door-to-door survey underwent MRI for grading GCA. Using multivariate generalized linear models, we evaluated whether continuous LCT scores correlated with GCA, after adjusting for demographics, education, cardiovascular health (CVH) status, depression and edentulism. In a nested case-control study, GCA severity was assessed in subjects with LCT scores below the cutoff level for dementia (< 22 points) and in matched controls without dementia. Results Out of 311 eligible subjects, 241 (78%) were enrolled. Mean age was 69.2±7.5 years, 59% were women, 83% had primary school education, 73% had poor CVH status, 12% had symptoms of depression and 43% had edentulism. Average LCT score was 26.7±3, and 23 (9.5%) subjects scored < 22 points. GCA was mild in 108, moderate in 95, and severe in 26 individuals. On the multivariate model, mean LCT score was not associated with GCA severity (β=0.06, SE=0.34, p=0.853). Severe GCA was noted in 6 / 23 case-patients and in 8 / 23 controls (OR: 0.67, 95% CI: 0.14-2.81, p=0.752, McNemar's test). Conclusion The LCT does not correlate with severity of GCA after adjusting for potential confounding variables, and should not be used as a reliable estimate of structural brain damage.
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Affiliation(s)
- Oscar H Del Brutto
- MD, School of Medicine, Universidad Espíritu Santo - Ecuador, Guayaquil, Ecuador. Department of Neurology, Hospital-Clínica Kennedy, Guayaquil, Ecuador
| | - Robertino M Mera
- MD, PhD, Gastroenterology Department, Vanderbilt University, Nashville, TN
| | | | - Julio Lama
- MD, Department of Imaging, Hospital-Clínica Kennedy, Guayaquil, Ecuador
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