RESUMO
OBJECTIVES: Problematic use of opioids by older adults is associated with adverse effects and has become a public health crisis worldwide. Ageing-related disabilities in activities of daily living (ADL) could promote unnecessary use of opioids in this population. This study evaluates the association between ADL disability and opioid consumption in Brazilian older adults. STUDY DESIGN: Study design- cross-sectional secondary data analysis of the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil). METHODS: Data from the second wave of the Brazil Longitudinal Study of Ageing (ELSI-Brazil) were used. Older adults with chronic pain were included. ADL disability was measured using the Katz Index. The primary outcome was opioid consumption for chronic pain. The primary association was explored using logistic regression models adjusting for predetermined confounders. Sensitivity analyses evaluating model performance were done by calibrating and validating the model using randomly split equal sets. RESULTS: In those who reported presence of chronic pain (n = 2865), the prevalence of opioid use was 29% (95% CI:23.1%-35.6%). In adjusted models, participants with moderate and severe ADL disability had 1.6 (95% CI:1.13-2.32; P = 0.009) and 3.8 (95% CI: 1.80-7.90; P < 0.001) times higher odds of opioid consumption compared to no disability, respectively. Being female, alcohol consumption, higher pain intensity, history of dementia, fractures, and presence of ≥2 comorbidities were significantly associated with increased opioid use (P < 0.05). CONCLUSION: Nearly one-third of the Brazilian elderly population experiencing chronic pain reported using opioids. The functional decline during the process of ageing appears to be a risk factor for pain intolerance and opioid use. Multidisciplinary approaches to detect early ADL disabilities and improve mobility and access to assistive technologies need to be established to prevent opioid overuse and addiction in elderly populations.
Assuntos
Atividades Cotidianas , Analgésicos Opioides , Dor Crônica , Pessoas com Deficiência , Humanos , Brasil/epidemiologia , Feminino , Dor Crônica/tratamento farmacológico , Masculino , Idoso , Analgésicos Opioides/efeitos adversos , Analgésicos Opioides/uso terapêutico , Estudos Transversais , Pessoas com Deficiência/estatística & dados numéricos , Estudos Longitudinais , Pessoa de Meia-Idade , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive, neuromodulatory technique with an emerging role for treating major depression. OBJECTIVE: To investigate the interactions between tDCS and drug therapy in unipolar and bipolar depressed patients who were refractory for at least one pharmacological treatment. METHODS: This was a naturalistic study using data from 54 female and 28 male patients (mean age of 54 years) that consecutively visited our psychiatric unit. They received active tDCS (five consecutive days, 2mA, anodal stimulation over the left and cathodal over the right dorsolateral prefrontal cortex, twice a day, 20minutes). The outcome variable (mood) was evaluated using the Beck Depression Inventory (BDI) and the Hamilton Depression Rating Scale (HDRS). Predictor variables were age, gender, disorder and pharmacological treatment (seven dummy variables). We performed univariate and multivariate analyses as to identify predictors associated to the outcome. RESULTS: After 5 days of treatment, BDI and HDRS scores decreased significantly (29%±36%, 18%±9%, respectively, P<0.01 for both). Benzodiazepine use was independently associated with a worse outcome in both univariate (ß=4.92, P<0.01) and multivariate (ß=5.8, P<0.01) analyses; whereas use of dual-reuptake inhibitors positively changed tDCS effects in the multivariate model (ß=-4.7, P=0.02). A similar trend was observed for tricyclics (ß=-4, P=0.06) but not for antipsychotics, non-benzodiazepine anticonvulsants and other drugs. CONCLUSION: tDCS over the DLPFC acutely improved depressive symptoms. Besides the inherent limitations of our naturalistic design, our results suggest that tDCS effects might vary according to prior pharmacological treatment, notably benzodiazepines and some antidepressant classes. This issue should be further explored in controlled studies.
Assuntos
Afeto/fisiologia , Antidepressivos/uso terapêutico , Depressão/terapia , Transtorno Depressivo Maior/terapia , Terapia por Estimulação Elétrica/métodos , Adulto , Terapia Combinada , Depressão/tratamento farmacológico , Depressão/psicologia , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do TratamentoRESUMO
AIMS: We investigated how different nutritional states resulting from distinct lactation conditions modulate the effects of cortical electrical stimulation (CES) on the excitability-related phenomenon known as cortical spreading depression (CSD). MAIN METHODS: Wistar rats were reared in different litter sizes with 12, 6 or 3 pups, designated as malnourished (M), well-nourished (W) and overnourished (Ov), respectively. CSD was recorded for 4h on 2 cortical points of each cerebral hemisphere at baseline and after CES. CES was applied for 20 min on the left cortex using a bipolar electrode placed between the CSD recording electrodes. Paired Student t test and ANOVA followed by Tukey test were used for statistical analysis (p<0.05). KEY FINDINGS: The lactation conditions significantly influenced body weight (the M and Ov groups presented the lowest and largest average weight, respectively) and modified the CSD velocities of propagation in adulthood (OvAssuntos
Encéfalo/metabolismo
, Depressão Alastrante da Atividade Elétrica Cortical/fisiologia
, Lactação/fisiologia
, Desnutrição/complicações
, Estado Nutricional/fisiologia
, Análise de Variância
, Animais
, Peso Corporal
, Modelos Animais de Doenças
, Estimulação Elétrica
, Feminino
, Masculino
, Ratos
, Ratos Wistar
RESUMO
Several studies have reported that transcranial direct current stimulation (tDCS), a non-invasive method of neuromodulation, enhances some aspects of working memory in healthy and Parkinson disease subjects. The aim of this study was to investigate the impact of anodal tDCS on recognition memory, working memory and selective attention in Alzheimer disease (AD). Ten patients with diagnosis of AD received three sessions of anodal tDCS (left dorsolateral prefrontal cortex, left temporal cortex and sham stimulation) with an intensity of 2 mA for 30 min. Sessions were performed in different days in a randomised order. The following tests were assessed during stimulation: Stroop, Digit Span and a Visual Recognition Memory task (VRM). The results showed a significant effect of stimulation condition on VRM (p = 0.0085), and post hoc analysis showed an improvement after temporal (p = 0.01) and prefrontal (p = 0.01) tDCS as compared with sham stimulation. There were no significant changes in attention as indexed by Stroop task performance. As far as is known, this is the first trial showing that tDCS can enhance a component of recognition memory. The potential mechanisms of action and the implications of these results are discussed.
Assuntos
Doença de Alzheimer/psicologia , Doença de Alzheimer/terapia , Terapia por Estimulação Elétrica , Memória/fisiologia , Reconhecimento Psicológico/fisiologia , Lobo Temporal/fisiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/patologia , Atenção/fisiologia , Feminino , Lateralidade Funcional/fisiologia , Humanos , Masculino , Memória de Curto Prazo/fisiologia , Testes Neuropsicológicos , Desempenho Psicomotor/fisiologia , Lobo Temporal/patologiaRESUMO
OBJECTIVE: To investigate whether the recent repetitive transcranial magnetic stimulation (rTMS) studies on depression using new parameters of stimulation have shown improved clinical results. METHOD: We performed a systematic review and a meta-analysis of the rTMS studies on depression published in the past 12 months comparing these results with an earlier meta-analysis that analyzed the results of the initial rTMS studies on depression. RESULTS: Using our inclusion criteria, we selected the meta-analysis of Martin [Br J Psychiatry (2003) Vol. 182, 480-491] that included 13 studies (324 patients) and five studies for the recent meta-analysis (274 patients). The pooled effect size (standardized mean difference between pretreatment vs. post-treatment) from the random effects model was -0.76 (95% confidence interval, CI, -1.01 to -0.51). This result was significantly larger than that of the earlier meta-analysis (-0.35, 95% CI -0.66 to -0.04). CONCLUSION: Our findings suggest that recent rTMS clinical trials have shown larger antidepressant effects when compared with the earlier studies.
Assuntos
Transtorno Depressivo/terapia , Estimulação Magnética Transcraniana , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/fisiopatologia , Transtorno Depressivo/psicologia , Dominância Cerebral/fisiologia , Humanos , Córtex Pré-Frontal/fisiopatologia , Resultado do TratamentoRESUMO
OBJECTIVE: To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) on vocal function in Parkinson's disease (PD). MATERIAL AND METHODS: Two different sets of rTMS parameters were investigated on 30 patients with PD: active or sham 15 Hz rTMS of the left dorsolateral prefrontal cortex (LDLPFC) (110% of motor threshold (MT), 3000 pulses per session) and active 5 Hz rTMS of the primary motor cortex (M1)-mouth area (90% MT, 2250 pulses per session). A blind rater evaluated speech characteristics (acoustic and perceptual analysis of voice) and voice-related quality of life (V-RQOL). RESULTS: rTMS of LDLPFC resulted in mood amelioration and subjective improvement of the V-RQOL only (71.9% improvement, P < 0.001), but not in objective measures such as fundamental frequency (P = 0.86) and voice intensity (P = 0.99). On the other hand, rTMS of M1-mouth induced a significant improvement of the fundamental frequency (12.9% for men and 7.6% for women, P < 0.0001) and voice intensity (20.6%, P < 0.0001). CONCLUSIONS: Our findings provide initial evidence that rTMS of the primary motor cortex might yield a beneficial effect on vocal function in PD.
Assuntos
Doença de Parkinson/complicações , Estimulação Magnética Transcraniana/métodos , Distúrbios da Voz/terapia , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor , Córtex Pré-Frontal , Acústica da Fala , Resultado do Tratamento , Distúrbios da Voz/etiologia , Qualidade da VozRESUMO
Cervical spondylotic myelopathy is a common disease caused by chronic segmental compression of the spinal cord. Despite the fact that the columns of the nuclei of the phrenic nerve are located between the 3rd and 5th cervical nerve segments, phrenic nerve paresis is not usually clinically significant. We present one case of cervical spondylotic myelopathy with bilateral phrenic paresis in whom magnetic resonance imaging and surgical findings confirmed intrinsic cord disease as being the cause of this syndrome. This case report suggests that one pathophysiology of clinical phrenic nerve paresis may be segmental damage to the anterior horns caused by cervical spondylosis.