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Kirk B, Cawthon PM, Arai H, Ávila-Funes JA, Barazzoni R, Bhasin S, Binder EF, Bruyere O, Cederholm T, Chen LK, Cooper C, Duque G, Fielding RA, Guralnik J, Kiel DP, Landi F, Reginster JY, Sayer AA, Visser M, von Haehling S, Woo J, Cruz-Jentoft AJ. The Conceptual Definition of Sarcopenia: Delphi Consensus from the Global Leadership Initiative in Sarcopenia (GLIS). Age Ageing 2024; 53:afae052. [PMID: 38520141 PMCID: PMC10960072 DOI: 10.1093/ageing/afae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Indexed: 03/25/2024] Open
Abstract
IMPORTANCE Sarcopenia, the age-related loss of muscle mass and strength/function, is an important clinical condition. However, no international consensus on the definition exists. OBJECTIVE The Global Leadership Initiative in Sarcopenia (GLIS) aimed to address this by establishing the global conceptual definition of sarcopenia. DESIGN The GLIS steering committee was formed in 2019-21 with representatives from all relevant scientific societies worldwide. During this time, the steering committee developed a set of statements on the topic and invited members from these societies to participate in a two-phase International Delphi Study. Between 2022 and 2023, participants ranked their agreement with a set of statements using an online survey tool (SurveyMonkey). Statements were categorised based on predefined thresholds: strong agreement (>80%), moderate agreement (70-80%) and low agreement (<70%). Statements with strong agreement were accepted, statements with low agreement were rejected and those with moderate agreement were reintroduced until consensus was reached. RESULTS 107 participants (mean age: 54 ± 12 years [1 missing age], 64% men) from 29 countries across 7 continents/regions completed the Delphi survey. Twenty statements were found to have a strong agreement. These included; 6 statements on 'general aspects of sarcopenia' (strongest agreement: the prevalence of sarcopenia increases with age (98.3%)), 3 statements on 'components of sarcopenia' (muscle mass (89.4%), muscle strength (93.1%) and muscle-specific strength (80.8%) should all be a part of the conceptual definition of sarcopenia)) and 11 statements on 'outcomes of sarcopenia' (strongest agreement: sarcopenia increases the risk of impaired physical performance (97.9%)). A key finding of the Delphi survey was that muscle mass, muscle strength and muscle-specific strength were all accepted as 'components of sarcopenia', whereas impaired physical performance was accepted as an 'outcome' rather than a 'component' of sarcopenia. CONCLUSION AND RELEVANCE The GLIS has created the first global conceptual definition of sarcopenia, which will now serve to develop an operational definition for clinical and research settings.
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, Melbourne, VIC, Australia
| | - Peggy M Cawthon
- California Pacific Medical Center, Research Institute, 550 16th Street, Second Floor, San Francisco, CA 94143USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CAUSA
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, AichiJapan
| | - José A Ávila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Bordeaux Population Health Research Center, UMR 1219, University of Bordeaux, Inserm, Bordeaux F-33000, France
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Shalender Bhasin
- Boston Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MAUSA
| | - Ellen F Binder
- Division of General Medicine and Geriatrics, School of Medicine, Washington University in St. Louis, St. Louis MO, USA
| | - Olivier Bruyere
- WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
- Department of Sport and Rehabilitation Sciences, University of Liège, Liège, Belgium
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
- Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Epidemiology, University of Oxford, Oxford, OXUK
| | - Gustavo Duque
- Bone, Muscle & Geroscience Group, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Dr Joseph Kaufmann Chair in Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Roger A Fielding
- Nutrition Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, MAUSA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MDUSA
| | - Douglas P Kiel
- Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MAUSA
| | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome 00168, Italy
| | - Jean-Yves Reginster
- WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Avan A Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle Hospitals and Faculty of Medical Sciences Newcastle University, Newcastle, UK
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Jean Woo
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Aguilar-Navarro SG, Carbajal-Silva JC, Palacios-Hernández MGI, Gutiérrez-Gutierrez LA, Ávila-Funes JA, Mimenza-Alvarado AJ. Association between vitamin B 12 levels and cognitive impairment in older adults. GAC MED MEX 2023; 159:32-37. [PMID: 36930548 DOI: 10.24875/gmm.m22000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
INTRODUCTION Whether vitamin B12 deficiency is associated with cognitive impairment remains controversial. OBJECTIVE To determine the association between vitamin B12 serum levels and cognitive performance. METHODS Two-hundred and forty-one adults aged ≥ 60 years who had serum vitamin B12 serum levels measurement were included. Physical and cognitive evaluation was carried out, and three groups were formed: normal cognition (NC), mild cognitive impairment (MCI) and dementia. Vitamin B12 levels were classified as sufficiency (> 400 pg/mL), subclinical deficiency (201-400 pg/mL), and absolute deficiency (≤ 200 pg/mL). Multivariate linear regression analysis was used to evaluate the association between cognitive function and vitamin B12 levels after controlling for confounding variables. RESULTS Mean age was 81.4 ± 8.0 years; 68% were females; 17.8 % and 39.8% had absolute and subclinical vitamin B12 deficiency, respectively; 80 individuals (33%) met the criteria for MCI, and 70 (29%), for dementia. Those with MCI and dementia had lower vitamin B12 levels in comparison with those with NC after adjusting for age, gender and educational level (p = 0.019). CONCLUSIONS A statistically significant association was observed between global cognitive performance and levels of vitamin B12.
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Affiliation(s)
| | | | | | - Lidia A Gutiérrez-Gutierrez
- Department of Neurology and Psychiatry. Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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Cawthon PM, Visser M, Arai H, Ávila-Funes JA, Barazzoni R, Bhasin S, Binder E, Bruyère O, Cederholm T, Chen LK, Cooper C, Duque G, Fielding RA, Guralnik J, Kiel DP, Kirk B, Landi F, Sayer AA, Von Haehling S, Woo J, Cruz-Jentoft AJ. Defining terms commonly used in sarcopenia research: a glossary proposed by the Global Leadership in Sarcopenia (GLIS) Steering Committee. Eur Geriatr Med 2022; 13:1239-1244. [PMID: 36445639 PMCID: PMC9722886 DOI: 10.1007/s41999-022-00706-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 11/30/2022]
Abstract
METHODS The aim of this paper is to define terms commonly related to sarcopenia to enable standardization of these terms in research and clinical settings. The Global Leadership Initiative in Sarcopenia (GLIS) aims to bring together leading investigators in sarcopenia research to develop a single definition that can be utilized worldwide; work on a global definition of sarcopenia is ongoing. The first step of GLIS is to develop the common terminology, or a glossary, that will facilitate agreement on a global definition of sarcopenia as well as interpretation of clinical and research findings. RESULTS Several terms that are commonly used in sarcopenia research are defined, including self-reported measures of function and ability; objective physical performance tests; and measures related to muscle function and size. CONCLUSION As new methods and technologies are developed, these definitions may be expanded or refined over time. Our goal is to promote this common language to describe sarcopenia and its components in clinical and research settings in order to increase clinical awareness and research interest in this important condition. We hope that the use of common terminology in sarcopenia research will increase understanding of the concept and improve communication around this important age-related condition.
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Affiliation(s)
- Peggy M. Cawthon
- California Pacific Medical Center, Research Institute, 550 16th Street, Second Floor, San Francisco, CA 94143 USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA USA
| | - Marjolein Visser
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- The Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Aichi Japan
| | - José A. Ávila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Shalender Bhasin
- Bostin Claude D. Pepper Older Americans Independence Center, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Ellen Binder
- Siteman Cancer Center at Barnes-Jewish Hospital, St. Louis, MO USA
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO USA
| | - Olivier Bruyère
- Division Public Health, Epidemiology and Health Economics, World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
- Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Liang-Kung Chen
- Center for Healthy Longevity and Aging Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans Generfranal Hospital, Taipei, Taiwan
- Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Epidemiology, University of Oxford, Oxford, OX UK
| | - Gustavo Duque
- Research Institute of the McGill University Health Centre, Montreal, QC Canada
- Division of Geriatric Medicine, Department of Medicine, McGill University, Montreal, QC Canada
| | - Roger A. Fielding
- Nutrition Exercise, Physiology, and Sarcopenia Laboratory, Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD USA
| | - Douglas P. Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA USA
| | - Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St. Albans, VIC Australia
- Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC Australia
| | - Francesco Landi
- Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, 00168 Rome, Italy
| | - Avan A. Sayer
- AGE Research Group, NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust and Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Stephan Von Haehling
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Faculty of Medicine, Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong, China
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Mimenza-Alvarado AJ, Suing-Ortega MJ, Tusie-Luna T, Juárez-Cedillo T, Ávila-Funes JA, Aguilar-Navarro SG. ASSOCIATION BETWEEN APOE-ε 4 CARRIER STATUS AND QUALITATIVE NEUROIMAGING CHARACTERISTICS IN OLDER ADULTS WITH MILD COGNITIVE IMPAIRMENT. Rev Invest Clin 2022; 74:113-120. [PMID: 35354197 DOI: 10.24875/ric.21000550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND The pathogenesis of mild cognitive impairment (MCI) is multifactorial and includes the presence of genetic variants such as the ε4 allele of the apolipoprotein E gene (APOE-ε4). Association between the APOE-ε4 carrier status and deleterious structural and functional changes on magnetic resonance imaging (MRI) has been previously described in individuals with Alzheimer's disease. However, the central nervous system changes may possibly develop in earlier stages of cognitive impairment, as reflected in MCI. OBJECTIVE The objective of the study was to determine the association between APOE-ε4 carrier status and qualitative changes on MRI (medial temporal and parietal atrophy), as well as the detection of white matter hyperintensities (WMH) in older adults with MCI, in the memory clinic of a tertiary care hospital in Mexico City. METHODS A cross-sectional study of 72 adults aged 60 years or above who underwent an exhaustive clinical, neuroimaging, and neuropsychological evaluation. Multivariate logistic regression models were constructed to determine the association between APOE-ε4 carrier status and qualitative/quantitative changes on MRI. RESULTS Mean age was 75.2 years (± 7.2) and 64% were female. Twenty-one participants were cognitively normal and 51 had MCI. Almost 56% were APOE-ε4 carriers and were associated with medial-temporal atrophy according to the Scheltens scale (odds ratio [OR]: 20.0, 95% confidence intervals [CI]: 3.03-131.7), parietal atrophy according to the Koedam's score (OR: 6.3; 95% CI 1.03-39.53), and WMH according to the Fazekas scale (OR: 11.7, 95% CI: 1.26-108.2), even after adjusting for age, educational level, and cardiovascular risk factors. CONCLUSION The APOE-ε4 carrier status was associated with medial temporal and parietal atrophy, as well as WMH. Our findings support the hypothesis suggesting the contribution of this genotype to neurodegeneration and cerebral vascular pathology.
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Affiliation(s)
- Alberto J Mimenza-Alvarado
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María J Suing-Ortega
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Teresa Tusie-Luna
- Molecular Biology and Genomic Medicine Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Department of Genomic Medicine and Environmental Toxicology, Instituto de Investigaciones Biomédicas, UNAM, Mexico City, Mexico
| | - Teresa Juárez-Cedillo
- Epidemiological Studies and Aging Health Services, Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Mexico City, Mexico
| | - José A Ávila-Funes
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
| | - Sara G Aguilar-Navarro
- Department of Geriatric Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Jiménez-Castillo GA, Bracho-Vela LA, Yeverino-Castro SG, Ávila-Funes JA. ASSOCIATION OF VITAMIN D WITH MILD COGNITIVE IMPAIRMENT AND ALZHEIMER'S DEMENTIA IN OLDER MEXICAN ADULTS. Rev Invest Clin 2020; 71:381-386. [PMID: 31823966 DOI: 10.24875/ric.19003079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background It has been proposed that Vitamin D helps reduce the accumulation of cerebral β-amyloid-42 by innate immune stimulation and phagocytosis activation. An association between low Vitamin D levels and Alzheimer's dementia (AD) has been established. We determined the association between Vitamin D, mild cognitive impairment (MCI), and AD in older Mexican adults (> 65 years). Methods Cross-sectional study conducted at the memory clinic in a tertiary-level hospital in Mexico City. We evaluated subjects with MCI, AD, and normal cognition (NC) with available serum Vitamin D [25(OH)D] levels (past 6 months). Three categories were assigned according to 25(OH)D levels: sufficiency (> 30 ng/mL), insufficiency (21-29 ng/mL), and deficiency (≤ 20 ng/mL). Descriptive statistics, means and standard deviations were used. Logistic regression analyses adjusted by age, sex, and educational level were performed. Results We evaluated 208 patients. Mean age was 79 ± 1 year, 65% (n = 136) were female; and mean educational level was 6.7 ± 2.3 years. Thirty-one subjects (14%) had NC; 42% (n = 88) had MCI; and 43% (n = 89) had AD. Prevalence of Vitamin D deficiency was 54%, more frequent in the AD group (64%) followed by the MCI (59%) and NC (13%) (p < 0.001) groups. In the multivariate logistic regression analysis, Vitamin D deficiency was associated with MCI (HR 25.02 [confidence interval 95% 4.48-139]; p < 0.001) and AD (HR 41.7 [5.76-301]; p < 0.001) after adjusting for confounders. Conclusions Serum Vitamin D deficiency was associated with MCI and dementia; low levels produced a greater effect over executive functions.
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Affiliation(s)
- Sara G Aguilar-Navarro
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alberto J Mimenza-Alvarado
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gilberto A Jiménez-Castillo
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Leonardo A Bracho-Vela
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sara G Yeverino-Castro
- Geriatric Medicine and Neurology Fellowship Program, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A Ávila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Bordeaux, France
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Cacho-Díaz B, Lorenzana-Mendoza NA, Reyes-Soto G, Ávila-Funes JA, Navarrete-Reyes AP. Neurologic manifestations of elderly patients with cancer. Aging Clin Exp Res 2019; 31:201-207. [PMID: 29704209 DOI: 10.1007/s40520-018-0961-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/21/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The incidence of cancer is an age-related phenomenon; therefore, the interest on clinical manifestations, diagnostic approach and treatment strategies for older patients diagnosed with cancer has increased lately. Neurologic symptoms are one of the main reasons for consultation and a common cause of decreased quality of life among cancer patients. AIMS To identify the neurologic manifestations of patients ≥ 65 years of age diagnosed with cancer and compare them to those presented by a younger population. METHODS Cross-sectional study of cancer patients referred to neuro-oncologic consultation at a Cancer Center. Sociodemographic, health and oncologic characteristics were obtained through clinical interviews. Clinical symptoms and final diagnoses were also recorded. Bivariate logistic regression analyses were carried out. RESULTS More than 17,000 neuro-oncologic consultations in 3015 patients were given, 27% (n = 811) of them were ≥ 65 years of age. Most frequent primary neoplasms in elderly patients were: breast cancer, hematologic neoplasms, gynecological, urologic, skin and head and neck cancers. Elderly patients had an increased risk of having the following diagnoses: abnormal movements, stroke, peripheral vertigo, dementia, degenerative spine disorder, and delirium. DISCUSSION Elderly patients are considered a vulnerable population. The present study found that the main neoplasms associated with neurological manifestations are similar to the reported previously. We described the main symptoms that led to a neuro-oncological assessment. Moreover, we enlisted the final diagnoses made on elderly patients and compared them with others reports. To the best of our knowledge, this study provides valuable information, since there is scarce evidence in the literature about this topic. CONCLUSION Identifying the frequency and correlation of neurologic manifestations in older cancer patients will allow for the implementation of timely multidisciplinary care in an attempt to improve these patients' health-related quality of life.
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Affiliation(s)
- Bernardo Cacho-Díaz
- Neuroscience Unit, Instituto Nacional de Cancerología, Ciudad de México, Av San Fernando 22, Col. Sección XVI, ZC14080, Mexico City, Mexico.
| | - Nydia A Lorenzana-Mendoza
- Neuroscience Unit, Instituto Nacional de Cancerología, Ciudad de México, Av San Fernando 22, Col. Sección XVI, ZC14080, Mexico City, Mexico
| | - Gervith Reyes-Soto
- Neuroscience Unit, Instituto Nacional de Cancerología, Ciudad de México, Av San Fernando 22, Col. Sección XVI, ZC14080, Mexico City, Mexico
| | - José A Ávila-Funes
- Geriatric Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, 14080, Ciudad de México, Mexico
| | - Ana P Navarrete-Reyes
- Geriatric Unit, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Tlalpan, 14080, Ciudad de México, Mexico
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Verduzco-Aguirre HC, Navarrete-Reyes AP, Chavarri-Guerra Y, Ávila-Funes JA, Soto-Perez-de-Celis E. The Effect of a Geriatric Oncology Clinic on Treatment Decisions in Mexican Older Adults With Cancer. J Am Geriatr Soc 2019; 67:992-997. [PMID: 30644088 DOI: 10.1111/jgs.15753] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/06/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Geriatric assessment and interventions improve the care of older adults with cancer, but their effect on treatment decision making in resource-limited settings is unknown. We studied the effect of recommendations made by a consultative geriatric oncology clinic on treatment decision making by oncologists in Mexico. DESIGN, SETTING, AND PARTICIPANTS Retrospective chart review of 173 consecutive patients with solid tumors referred before treatment initiation to the geriatric oncology clinic at a third-level public hospital in Mexico City between March 2015 and October 2017. Patients were evaluated by a multidisciplinary geriatric oncology clinic, and treatment recommendations were issued to treating oncologists. MEASUREMENTS We determined the overall proportion of agreement between geriatric oncology recommendations and oncologists' treatment decisions. We assessed whether agreement increased when geriatric oncology recommendations were acknowledged in the treating oncologist's clinic note. The homogeneity of agreement was tested using the Stuart-Maxwell test. RESULTS Median age was 79 years (range = 64-97 years). "Standard treatment" was recommended in 48% of cases, followed by "less intensive treatment" in 32%, and "best supportive care" in 20%. The overall proportion of agreement for the entire population was 80% (κ = 0.69), although agreement was heterogeneous (X2 = 8.16, P = .02). Geriatric oncology recommendations were acknowledged in the treating oncologists' notes in 62% of cases. Overall agreement was higher when the evaluation was acknowledged (83%, κ = 0.74) than when it was not acknowledged (74%, κ = 0.60). Agreement was homogeneous only when recommendations were acknowledged in the oncologist's note (X2 = 3.0, P = .22). CONCLUSIONS The overall proportion of agreement between geriatric oncology recommendations and final treatment decisions was high, particularly when recommendations were acknowledged in the treating oncologists' note. Including geriatric oncology evaluations in everyday clinical practice and fostering interdisciplinary communication between geriatric oncology and treating oncologists may provide valuable guidance for physicians caring for older patients with cancer in resource-limited settings. J Am Geriatr Soc 67:992-997, 2019.
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Affiliation(s)
- Haydeé C Verduzco-Aguirre
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana P Navarrete-Reyes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José A Ávila-Funes
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Aguilar-Navarro SG, Mimenza-Alvarado AJ, Palacios-García AA, Samudio-Cruz A, Gutiérrez-Gutiérrez LA, Ávila-Funes JA. Validity and Reliability of the Spanish Version of the Montreal Cognitive Assessment (MoCA) for the Detection of Cognitive Impairment in Mexico. ACTA ACUST UNITED AC 2017; 47:237-243. [PMID: 30286846 DOI: 10.1016/j.rcp.2017.05.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/04/2017] [Accepted: 05/08/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To establish the validity and reliability of the Montreal Cognitive Assessment in Spanish (MoCA-S) to identify mild cognitive impairment (MCI) and dementia in the Mexican elderly population. MATERIAL AND METHODS 168 participants from a memory clinic in Mexico City were enrolled and divided into 3 groups: 59 cognitively healthy (CHG), 52 with mild cognitive impairment (MCI) (DSM-5 criteria) and 57 with dementia (NINCDS-ADRDA criteria). The MoCA-S and Mini-Mental State Evaluation (MMSE) were applied at baseline and during the last months to establish intra-observer reliability. ROC curves and a multinomial regression model were constructed to evaluate the effect of age and education on MoCA-S performance. RESULTS The mean age of the participants was 76±8.1 years and the education rate was 10.7±5.2. The MoCA-S scores by group were: CHG, 27.3±1.9; MCI, 22.9±2.9; and dementia, 13.7±4.9 (p<0.001). The reliability of the MoCA-S was 0.89 and the intraclass correlation coefficient was 0.955. Sensitivity was 80% and specificity was 75%, with a cut-off point of 26 points for MCI (area under the curve, 0.886; p<0.001). For the dementia group, the sensitivity was 98% and specificity was 93%, with a cut-off point of 24points (area under the curve, 0.998; p<0.001). The multinomial regression showed no association with education and age for both the MCI and dementia groups. CONCLUSIONS The MoCA-S is a valid and reliable instrument for MCI and dementia screening in the Mexican population, even after adjusting for age and education.
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Affiliation(s)
- Sara G Aguilar-Navarro
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
| | - Alberto J Mimenza-Alvarado
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alberto A Palacios-García
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Alejandra Samudio-Cruz
- Facultad de Psicología Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Lidia A Gutiérrez-Gutiérrez
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - José A Ávila-Funes
- Departamento de Geriatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México; Centre de recherche INSERM, Burdeos, Francia
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Abstract
BACKGROUND The implementation of an aging biomarker into clinical practice is under debate. The Frailty Index is a model of deficit accumulation and has shown to accurately capture frailty in older adults, thus bridging biological with clinical practice. OBJECTIVES To describe the association of socio-demographic characteristics and the Frailty Index in different age groups (from 20 to over one hundred years) in a representative sample of Mexican subjects. DESIGN Cross-sectional analysis. SETTING Nationwide and population-representative survey. PARTICIPANTS Adults 20-years and older interviewed during the last Mexican National Health and Nutrition Survey (2012). MEASUREMENTS A 30-item Frailty Index following standard construction was developed. Multi-level regression models were performed to test the associations of the Frailty Index with multiple socio-demographic characteristics across age groups. RESULTS A total of 29,504 subjects was analyzed. The 30-item Frailty Index showed the highest scores in the older age groups, especially in women. No sociodemographic variable was associated with the Frailty Index in all the studied age groups. However, employment, economic income, and smoking status were more consistently found across age groups. CONCLUSIONS To our knowledge, this is the first report describing the Frailty Index in a representative large sample of a Latin American country. Increasing age and gender were closely associated with a higher score.
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Affiliation(s)
- M U Pérez-Zepeda
- Carmen García-Peña Head of the Research Office of the Instituto Nacional de Geriatría, Periférico Sur 2767, colonia San Jerónimo Lídice, delegación La Magdalena Contreras, ciudad de México, Distrito Federal, México. Phone number: +52 55 55739087 e-mail:
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10
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Ruiz-Arregui L, Ávila-Funes JA, Amieva H, Borges-Yáñez SA, Villa-Romero A, Aguilar-Navarro S, Pérez-Zepeda MU, Gutiérrez-Robledo LM, Castrejón-Pérez RC. The Coyoacán Cohort Study: Design, Methodology, and Participants' Characteristics of a Mexican Study on Nutritional and Psychosocial Markers of Frailty. J Frailty Aging 2016; 2:68-76. [PMID: 27070661 DOI: 10.14283/jfa.2013.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND "Frailty" has emerged as a condition associated with an increased risk of functional decline among the elderly, which may be differentiated from aging, disability, and co-morbidities. OBJECTIVE The Mexican Study of Nutritional and Psychosocial Markers of Frailty among Community-Dwelling Elderly has emerged to help answer many questions about frailty among the older adults. This report presents the design of the study and baseline data of its participants. DESIGN The "Coyoacan cohort" is a longitudinal observational study developed in Mexico City. PARTICIPANTS A representative sample of 1,294 non-institutionalized men and women aged 70 years and older were randomly recruited to undergo a face-to-face interview and a comprehensive geriatric assessment (including clinical evaluations and blood samples) between 2008 and 2009. MEASUREMENTS Data collected included socio-demographic and economic characteristics, medical history, oral health, drug use, cognitive function and mood, nutritional status, physical performance and functional status, physical activity, quality of life, social networks, and biological data. Frailty was defined as the presence of ≥3 of the following components: slowness, poor muscle strength, low physical activity, exhaustion and unintentional weight loss. RESULTS A total of 1,124 participants completed the interview. The mean age was 79.5 ± 7.1 years, and 55.9% were female. Nine hundred and forty-five subjects completed the clinical evaluation and 743 blood samples were collected. The baseline prevalence of frailty was 14.1%. CONCLUSIONS Understanding the medical, biological, and environmental factors that contribute to the phenomenon of frailty is the goal of the current research in the field.
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Affiliation(s)
- L Ruiz-Arregui
- Roberto Carlos Castrejón-Pérez. National Institute of Geriatrics, Periférico Sur No. 2767, Col. San Jerónimo Lídice, Del. Magdalena Contreras, Mexico City, C.P. 10200, Mexico. Tel. (+52) 55 5573 8686.
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11
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Moreno-Aguilar M, García-Lara JMA, Aguilar-Navarro S, Navarrete-Reyes AP, Amieva H, Ávila-Funes JA. The Phenotype of Frailty and Health-Related Quality of Life. J Frailty Aging 2013; 2:2-7. [PMID: 27070451 DOI: 10.14283/jfa.2013.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty is a multidimensional problem in the elderly, but there is little information about its implications on health-related quality of life (HRQoL). OBJECTIVES To determine the association between frailty and HRQoL as well as the association between each component of the phenotype of frailty and the physical (PCS) and mental (MCS) components summaries of QoL. DESIGN, SETTING AND PARTICIPANTS Cross-sectional study of 496 community-dwelling elderly aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. QoL and both of its components were assessed through the SF-36. The association of each component of frailty with the PCS and the MCS of QoL was determined through the construction of multivariate lineal regression models. Final analyses were adjusted by socio-demographic characteristics and by the remaining four components of frailty as covariates. RESULTS Mean age of participants was 78.0 (SD ± 6.2), 49.4% were women, and 12.7% were frail. Multivariate lineal regression analysis showed that frail and prefrail participants had lower scores for the PCS (P < .001) and the MCS (P < .001) of QoL in comparison with non-frail subjects. Weight loss (P < .001) and exhaustion (P < .001) had an independent inverse association with the MCS of QoL while gait speed (P < .001) and grip strength (P < .001) were also inversely associated with the PCS score. CONCLUSION Frailty is independently associated with lower scores in the MCS and the PCS of QoL. The finding that different components of frailty were associated with both dimensions of QoL reflects the need for individualized treatment of frail elderly.
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Affiliation(s)
- M Moreno-Aguilar
- José Alberto Ávila-Funes. Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán. Vasco de Quiroga 15. CP 14000; Tlalpan, Distrito Federal, México. Phone: +52 (55) 54 87 09 00, 5703. E-mail: . Alternate Corresponding Author: Mauricio Moreno-Aguilar. E-mail:
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Ávila-Funes JA, Pina-Escudero SD, Aguilar-Navarro S, Gutierrez-Robledo LM, Ruiz-Arregui L, Amieva H. Cognitive impairment and low physical activity are the components of frailty more strongly associated with disability. J Nutr Health Aging 2011; 15:683-9. [PMID: 21968865 DOI: 10.1007/s12603-011-0111-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the association of the five frailty criteria from the Cardiovascular Health Study, as well as cognitive impairment, with prevalent disability for the instrumental (IADL) and basic activities of daily living (ADL). DESIGN Cross-sectional study of 475 community-dwelling subjects aged 70 and older, participating in the Mexican Study of Nutritional and Psychosocial Markers of Frailty. MEASUREMENTS Six probable frailty criteria were considered: weight loss, poor endurance, low physical activity, slowness, weakness, and cognitive impairment. The association of each component of frailty for IADL and ADL disability as main outcomes was determined constructing multivariate logistic regression analyses. Final models were adjusted by socio-demographic factors and the presence of the other five frailty components as covariates. RESULTS Mean age of participants was 78.1 (SD=6.2). The unadjusted results showed that each of the components of frailty, except weight loss, was associated with both IADL and ADL disability. However, after adjustment, only low physical activity [Odds ratio (OR) =3.27; 95% CI=1.56 to 6.85] and cognitive impairment (OR=2.06; 95% CI=1.04 to 4.06) remain independently associated with IADL disability. Regarding ADL disability, only a lower physical activity (OR=7.72; 95% CI=1.28 to 46.46) was associated with this outcome, whereas cognitive impairment was marginally associated but was not statistically significant (OR=5.45; 95% CI=0.91 to 32.57). CONCLUSIONS Cognitive impairment and low physical activity are the main contributing factors of frailty phenotype to disability. Better understanding the independent contribution of each frailty subdimension to the different adverse-health outcomes may help to provide a more adequate management of frail elderly.
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Affiliation(s)
- J A Ávila-Funes
- Department of Geriatrics. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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