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BACKGROUND: Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region. OBJECTIVE: This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US. METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias. RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean. CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.
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Doença de Alzheimer , Estados Unidos/epidemiologia , Humanos , Idoso , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/terapia , Atenção à Saúde , Aceitação pelo Paciente de Cuidados de Saúde , Porto Rico/epidemiologia , EtnicidadeRESUMO
INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.
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Disfunção Cognitiva , Humanos , América Latina , Disfunção Cognitiva/prevenção & controle , Estilo de Vida , Cognição , Projetos de PesquisaRESUMO
OBJECTIVES: U.S. Latino populations are diverse. Research on racial identity, skin tone, and Latino health is imperative for understanding and combating racism and colorism. We examined differences in memory performance: among non-Latinos and Latinos who identified as Black, other, and White in the United States and then among Puerto Ricans in Boston whose skin tones ranged from dark, medium, light to "white." METHODS: We used 2010 Health and Retirement Study and 2004 Boston Puerto Rican Health Survey data, respectively, to examine racial and color differences in memory performance among 50 and older adults in the United States and Puerto Rican older adults in Boston. We applied ordinary least squares regression to immediate and delayed word recall test scores and adjusted for education, health conditions, and health behaviors. RESULTS: In adjusted models, White non-Latinos had better memory performance than White Latinos. Black Latinos, other Latinos, and Black non-Latinos had lower delayed word recall scores than White Latinos. Black Latinos and Black non-Latinos had similar scores. Intra-Latino racial disparities endured despite the inclusion of education and other covariates. Among Puerto Ricans in Boston, medium-toned individuals had higher scores than "white"-toned individuals. DISCUSSION: Findings support the importance of examining self-identified race and skin tone in Latino aging research. Further investigation is needed to understand the stubborn intra-Latino racial disparities in memory performance and surprising adverse cognitive performance among "white"-toned relative to darker-toned Puerto Ricans in Boston.
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Racismo , Pigmentação da Pele , Estados Unidos , Humanos , Idoso , Hispânico ou Latino , Porto Rico , Inquéritos EpidemiológicosRESUMO
Aims: To explore the person, environment, and occupation-related self-management strategies used by older Hispanic men to cope with disabilities in different types of daily activities. Methods: A concurrent transformative mixed method design (with priority given to the qualitative phase) guided by the Environment and Occupational Performance Model was used to collect and analyze data of 12 participants with functional disabilities. Quantitative data was gathered using the PROMIS Physical Function Short Form-20. Qualitative data was obtained from in-depth semi-structured interviews on participants' self-management strategies. Results: The average T-score (35.96) was below the national average. Participants reported higher levels of functional disabilities in instrumental activities of daily living (IADL), and predominantly used practical social support and change in method of performance to manage their difficulties in self-care, IADL, and functional mobility activities. Conclusions: These strategies may be used with similar populations to design interventions aimed at increasing older Puerto Rican's function.
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Envelhecimento , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Psiquiatria Geriátrica , Serviços de Saúde para Idosos , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Idoso , Envelhecimento/fisiologia , Envelhecimento/psicologia , Betacoronavirus , COVID-19 , Região do Caribe/epidemiologia , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Psiquiatria Geriátrica/métodos , Psiquiatria Geriátrica/tendências , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde para Idosos/organização & administração , Serviços de Saúde para Idosos/tendências , Humanos , Saúde Mental/tendências , Serviços de Saúde Mental/organização & administração , Serviços de Saúde Mental/tendências , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , SARS-CoV-2 , Isolamento Social/psicologiaRESUMO
During the last decade, the Caribbean Hispanic islands experienced accelerated demographic aging, representing the fastest aging region within Latin America. Age-related non-communicable diseases, including dementia, are now reported at high prevalence. The Caribbean islands share similar genetic ancestry, culture, migration patterns, and risk profiles, providing a unique setting to understand dementia in the Caribbean-Hispanics. This perspective article aimed to describe the impact of dementia in the Caribbean, at a local and regional level and reflect on research strategies to address dementia. We report on 10/66 project findings, described research projects and regional plans for the region. According to our results, the prevalence of dementia in the Caribbean is the highest in Latin America, with 11.7% in Dominican Republic, 11.6% in Puerto Rico, and 10.8% in Cuba. Preliminary data from new waves of the 10/66 study shows increasing numbers of dementia cases. Furthermore, dementia is expected to be one of the most serious medical and social issues confronted by Caribbean health systems. However, there is a scarcity of knowledge, awareness, and health services to deal with this public health crisis. In light of the new evidence, local and regional strategies are underway to better understand dementia trends for the region and develop policies aimed to decrease the impact of dementia. Implementation of our national plans is critical to deal with an aging population with high dementia rates. Current recommendations include emphasizing public health prevention campaigns to address modifiable risk factors and expand support to caregiver and family interventions.
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Demência , Hispânico ou Latino , Idoso , Cuba/epidemiologia , Demência/epidemiologia , República Dominicana/epidemiologia , Humanos , Ilhas , América Latina/epidemiologia , Porto Rico/epidemiologia , Índias OcidentaisRESUMO
Objective: The objective of this study was to estimate healthy life expectancies in eight low- and middle-income countries (LMICs), using two indicators: disability-free life expectancy (DFLE) and dependence-free life expectancy (DepFLE). Method: Using the Sullivan method, healthy life expectancy was calculated based on the prevalence of dependence and disability from the 10/66 cohort study, which included 16,990 people aged 65 or above in China, Cuba, Dominican Republic, India, Mexico, Peru, Puerto Rico, and Venezuela, and country-specific life tables from the World Population Prospects 2017. Results: DFLE and DepFLE declined with older age across all sites and were higher in women than men. Mexico reported the highest DFLE at age 65 for men (15.4, SE = 0.5) and women (16.5, SE = 0.4), whereas India had the lowest with (11.5, SE = 0.3) in men and women (11.7, SE = 0.4). Discussion: Healthy life expectancy based on disability and dependency can be a critical indicator for aging research and policy planning in LMICs.
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Indicadores Básicos de Saúde , Expectativa de Vida , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Estudos de Coortes , Países em Desenvolvimento , Pessoas com Deficiência/estatística & dados numéricos , República Dominicana/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Peru/epidemiologia , Prevalência , Porto Rico/epidemiologia , Venezuela/epidemiologiaAssuntos
Pesquisa Biomédica/educação , Internato e Residência , Pesquisa Translacional Biomédica/educação , Pesquisa Biomédica/organização & administração , Humanos , Médicos/organização & administração , Pesquisadores/educação , Pesquisadores/organização & administração , Pesquisa Translacional Biomédica/organização & administraçãoRESUMO
BACKGROUND: Little is known of the epidemiology of diabetes among older people in low and middle income countries. We aimed to study and compare prevalence, social patterning, correlates, detection, treatment and control of diabetes among older people in Latin America, India, China and Nigeria. METHODS: Cross-sectional surveys in 13 catchment area sites in nine countries. Diagnosed diabetes was assessed in all sites through self-reported diagnosis. Undiagnosed diabetes was assessed in seven Latin American sites through fasting blood samples (glucose > = 7 mmol/L). RESULTS: Total diabetes prevalence in catchment sites in Cuba (prevalence 24.2%, SMR 116), Puerto Rico (43.4%, 197), and urban (27.0%, 125), and rural Mexico (23.7%, 111) already exceeds that in the USA, while that in Venezuela (20.9%, 100) is similar. Diagnosed diabetes prevalence varied very widely, between low prevalences in sites in rural China (0.9%), rural India (6.6%) and Nigeria (6.0%). and 32.1% in Puerto Rico, explained mainly by access to health services. Treatment coverage varied substantially between sites. Diabetes control (40 to 61% of those diagnosed) was modest in the Latin American sites where this was studied. Diabetes was independently associated with less education, but more assets. Hypertension, central obesity and hypertriglyceridaemia, but not hypercholesterolaemia were consistently associated with total diabetes. CONCLUSIONS: Diabetes prevalence is already high in most sites. Identifying undiagnosed cases is essential to quantify population burden, particularly in least developed settings where diagnosis is uncommon. Metabolic risk factors and associated lifestyles may play an important part in aetiology, but this requires confirmation with longitudinal data. Given the high prevalence among older people, more population research is indicated to quantify the impact of diabetes, and to monitor the effect of prevention and health system strengthening on prevalence, treatment and control.
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Demência , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Renda , Inquéritos e Questionários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Masculino , Modelos Estatísticos , PrevalênciaRESUMO
BACKGROUND: Inbreeding can be associated with a modification of disease risk due to excess homozygosity of recessive alleles affecting a wide range of phenotypes. We estimated the inbreeding coefficient in Caribbean Hispanics and examined its effects on risk of late-onset Alzheimer disease. METHODS: The inbreeding coefficient was calculated in 3,392 subjects (1,451 late-onset Alzheimer disease patients and 1,941 age-matched healthy controls) of Caribbean Hispanic ancestry using 177,997 nearly independent single-nucleotide polymorphisms from genome-wide array. The inbreeding coefficient was estimated using the excess homozygosity method with and without adjusting for admixture. RESULTS: The average inbreeding coefficient in Caribbean Hispanics without accounting for admixture was F = 0.018 (±0.048), suggesting a mating equivalent to that of second cousins or second cousins once removed. Adjusting for admixture from three parent populations, the average inbreeding coefficient was found to be 0.0034 (±0.019) or close to third-cousin mating. Inbreeding coefficient was a significant predictor of Alzheimer disease when age, sex, and APOE genotype were used as adjusting covariates (P = 0.03). CONCLUSION: The average inbreeding coefficient of this population is significantly higher than that of the general Caucasian populations in North America. The high rate of inbreeding resulting in increased frequency of recessive variants is advantageous for the identification of rare variants associated with late-onset Alzheimer disease.Genet Med 17 8, 639-643.
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Doença de Alzheimer/genética , Consanguinidade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Estudos de Casos e Controles , República Dominicana/epidemiologia , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Genótipo , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Fatores de RiscoRESUMO
Anaemia among older people is increasingly recognized as a matter of public health concern. Data from low- and middle-income countries are sparse. We surveyed 10915 people aged 65 years and over (8423 with blood tests) in catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela and Mexico, to assess prevalence and correlates of anaemia and impact on disability. Prevalence varied widely between sites, from 6·4% in rural Mexico to 9·2% in urban Mexico, 9·8% in Venezuela, 19·2% in Cuba, 32·1% in Puerto Rico and 37·3% in Dominican Republic. Prevalence was higher in men and increased with age, but sociodemographic composition did not account for prevalence differences between sites. Standardized morbidity ratios indicated a much higher prevalence in Cuba (173), Puerto Rico (280) and Dominican Republic (332) compared with USA National Health and National Examination Surveys. Anaemia was associated with undernutrition, physical impairments, and serum creatinine. There was an association with greater African admixture in Dominican Republic but not in Cuba. African admixture is therefore unlikely to fully explain the high prevalence in the Caribbean islands, which may also arise from environmental, possibly dietary factors. Given an important independent contribution of anaemia to disability, more research is needed to identify preventable and treatable causes.
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Anemia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Cuba/epidemiologia , Países em Desenvolvimento , República Dominicana/epidemiologia , Feminino , Humanos , Masculino , México/epidemiologia , Prevalência , Porto Rico/epidemiologia , Fatores de Risco , Venezuela/epidemiologiaRESUMO
BACKGROUND: Rapid demographic ageing is a growing public health issue in many low- and middle-income countries (LAMICs). Mild cognitive impairment (MCI) is a construct frequently used to define groups of people who may be at risk of developing dementia, crucial for targeting preventative interventions. However, little is known about the prevalence or impact of MCI in LAMIC settings. METHODS AND FINDINGS: Data were analysed from cross-sectional surveys established by the 10/66 Dementia Research Group and carried out in Cuba, Dominican Republic, Peru, Mexico, Venezuela, Puerto Rico, China, and India on 15,376 individuals aged 65+ without dementia. Standardised assessments of mental and physical health, and cognitive function were carried out including informant interviews. An algorithm was developed to define Mayo Clinic amnestic MCI (aMCI). Disability (12-item World Health Organization disability assessment schedule [WHODAS]) and informant-reported neuropsychiatric symptoms (neuropsychiatric inventory [NPI-Q]) were measured. After adjustment, aMCI was associated with disability, anxiety, apathy, and irritability (but not depression); between-country heterogeneity in these associations was only significant for disability. The crude prevalence of aMCI ranged from 0.8% in China to 4.3% in India. Country differences changed little (range 0.6%-4.6%) after standardization for age, gender, and education level. In pooled estimates, aMCI was modestly associated with male gender and fewer assets but was not associated with age or education. There was no significant between-country variation in these demographic associations. CONCLUSIONS: An algorithm-derived diagnosis of aMCI showed few sociodemographic associations but was consistently associated with higher disability and neuropsychiatric symptoms in addition to showing substantial variation in prevalence across LAMIC populations. Longitudinal data are needed to confirm findings-in particular, to investigate the predictive validity of aMCI in these settings and risk/protective factors for progression to dementia; however, the large number affected has important implications in these rapidly ageing settings.
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Atividades Cotidianas , Transtornos Cognitivos/epidemiologia , Demência/etiologia , Pessoas com Deficiência , Transtornos Mentais/complicações , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Algoritmos , Ansiedade/complicações , China/epidemiologia , Transtornos Cognitivos/complicações , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Índia/epidemiologia , América Latina/epidemiologia , Masculino , Testes Neuropsicológicos , Prevalência , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Classe SocialRESUMO
Dementia is characterized by a progressive deterioration of memory and cognitive function that occurs mostly in the elderly population. In the United States nearly 4.5 million people suffers dementia. Behavioral and psychological symptoms of dementia (BPSD) are defined as agitation, delusions, hallucinations, anxiety, and aggressiveness in patients diagnosed with this condition. One of the most useful therapeutic approaches for behavioral symptoms is antipsychotic medications, though there is no ill-established evidence about their efficacy. This article review possible benefits as well as side effects of these drugs. A detailed orientation about antipsychotic side effects and risks should be given to patients and caregivers, to obtain an appropriate and informed consent decision.
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Antipsicóticos/uso terapêutico , Demência/complicações , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/etiologia , Idoso , HumanosRESUMO
OBJECTIVES: Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans- and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS: Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS: Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p<0.05) for major cancers-lung (SRRs=0.36 in males and 0.29 in females), prostate (SRR=0.71), female breast (SRR=0.73), and colon-rectum (SRRs=0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION: Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.
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Hispânico ou Latino , Neoplasias/epidemiologia , População Branca , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto JovemRESUMO
OBJECTIVES: Examination of cancer rates in a single Hispanic subgroup-Puerto Ricans-and comparison of incidence rates among mainland Puerto Ricans living in the United States, island Puerto Ricans in Puerto Rico, and U.S. non-Hispanic whites to reveal ethnic-specific cancer patterns and disparities in Puerto Ricans. METHODS: Incidence data were obtained from the cancer registries of Puerto Rico and three U.S. northeastern states (New York, New Jersey, and Connecticut) with a high density of mainland Puerto Ricans. Age-adjusted rates were compared by standardized rate ratios (SRRs). RESULTS: Total cancer incidence was the lowest in island Puerto Ricans, intermediate for mainland Puerto Ricans, and highest in U.S. non-Hispanic whites. Compared to mainland Puerto Ricans, islanders had significantly lower rates (p < 0.05) for major cancers-lung (SRRs = 0.36 in males and 0.29 in females), prostate (SRR = 0.71), female breast (SRR = 0.73), and colon-rectum (SRRs = 0.74 in males and 0.65 in females)-as well as several less common cancers (urinary bladder; non-Hodgkin lymphoma; liver; kidney and renal pelvis; pancreas; thyroid; leukemia; and skin melanoma). Overall cancer rates in mainland Puerto Ricans were modestly lower than those in U.S. non-Hispanic whites, but mainland Puerto Ricans had the highest rates for stomach, liver, and cervical cancers among the three populations. CONCLUSION: Despite socioeconomic disadvantages, island Puerto Ricans have relatively low cancer incidence. Identifying contributing factors would be informative for cancer research, and understanding the reasons for increased cancer risk in their mainland counterparts would facilitate the development of ethnic-specific intervention programs.
OBJETIVOS: Se analizaron las tasas de cáncer en un subgrupo de hispanos residentes en los Estados Unidos de América -los puertorriqueños (PRREUA) y se compararon sus tasas de incidencia con las de los puertorriqueños que residen en Puerto Rico (PRRPR) y la población estadounidense blanca sin ascendencia hispana (EUBNH) a fin de encontrar patrones de cáncer y disparidades de orden étnico específicos para los puertorriqueños. MÉTODOS: Se obtuvieron los datos de incidencia de los registros de cáncer de Puerto Rico y tres estados del nordeste de los Estados Unidos (New York, New Jersey y Connecticut) que tienen una elevada densidad de PRREUA. Se compararon las tasas ajustadas por la edad mediante las razones de las tasas estandarizadas (SRR). RESULTADOS: La incidencia total de cáncer fue menor en los PRRPR, intermedia en los PRREUA y mayor en los EUBNH. Los PRRPR presentaron tasas significativamente menores que los PRREUA (P < 0,05) en los principales tipos de cáncer -de pulmón (SRR = 0,36 en hombres; SRR = 0,29 en mujeres), próstata (SRR = 0,71), mama (SRR = 0,73) y colorrectal (SRR = 0,74 en hombres y SRR = 0,65 en mujeres)- así como en algunos tipos de cáncer menos frecuentes (de vejiga, hígado, riñón y pelvis renal, páncreas, tiroides, linfomas no Hodgkin, leucemia y melanoma de piel). En general, las tasas de cáncer en los PRREUA fueron ligeramente menores que las de los EUBNH, aunque de las tres poblaciones los PRREUA tuvieron las mayores tasas de cáncer de estómago, hígado y cervicouterino. CONCLUSIONES: A pesar de las desventajas socioeconómicas, los PRRPR tienen una menor incidencia relativa de cáncer. La identificación de los factores que contribuyen a ello podría ayudar en las investigaciones sobre cáncer, y comprender las razones del mayor riesgo de cáncer en los PRREUA podría facilitar el desarrollo de programas de intervención específicos para esta población.
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Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , População Branca , Hispânico ou Latino , Neoplasias/epidemiologia , Incidência , Porto Rico/epidemiologia , Distribuição por Sexo , Estados Unidos/epidemiologia , Adulto JovemAssuntos
Hispânico ou Latino , Neoplasias , Incidência , Porto Rico , Estados Unidos , Hispânico ou Latino , Neoplasias , Incidência , Estados Unidos , Hispânico ou Latino , Porto Rico , Adulto Jovem , População Branca , Incidência , Distribuição por SexoRESUMO
BACKGROUND: The clinical delineation of dementia with Lewy bodies (DLB) from Alzheimer disease (AD) remains unclear. OBJECTIVES: To compare neuropsychological profiles in DLB and AD among Caribbean Hispanic family members and participants in a population-based epidemiologic sample using extended neuropsychological test batteries and to explore whether these differences were related to heritable factors. DESIGN: Cross-sectional study. SETTING: Clinics in northern Manhattan (New York City), the Dominican Republic, and Puerto Rico. PATIENTS: We compared measures of memory, orientation, language, and executive and visuospatial functioning between patients with DLB vs AD in 2 Caribbean Hispanic cohorts, including a family sample (89 patients with DLB and 118 patients with AD) and an epidemiologic sample (70 patients with DLB and 157 patients with AD). Patients with DLB in the family sample were further categorized as patients having at least 2 family members with DLB or as patients having 1 family member with DLB. MAIN OUTCOME MEASURES: To determine whether observed differences in cognitive profiles were driven by heritable factors, we repeated analyses in the epidemiologic sample after excluding familial cases. We applied general linear models adjusted for age, sex, educational level, disease duration, and apolipoprotein E epsilon4 (OMIM 104310) genotype. RESULTS: Patients with DLB in both samples were more severely impaired in orientation, visuoconstruction, and nonverbal reasoning after controlling for potential confounders. Patients having at least 2 family members with DLB had the most severe impairment in memory, followed by patients having 1 family member with DLB, and then by patients with AD. After excluding familial AD and DLB cases in the epidemiologic sample, the differences between the groups persisted but were attenuated. CONCLUSIONS: Compared with patients having AD, patients having DLB are more severely impaired in various cognitive domains, particularly orientation and visuospatial functioning. The difference seems stronger in familial DLB than in sporadic DLB. Whether this divergence in cognitive functions is caused by gene-gene or gene-environmental interactions remains unclear.
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Doença de Alzheimer/epidemiologia , Doença de Alzheimer/fisiopatologia , Doença por Corpos de Lewy/epidemiologia , Doença por Corpos de Lewy/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/genética , Apolipoproteína E4/genética , Estudos de Coortes , Estudos Transversais , República Dominicana/epidemiologia , Saúde da Família , Feminino , Humanos , Idioma , Doença por Corpos de Lewy/genética , Modelos Lineares , Masculino , Memória/fisiologia , Testes Neuropsicológicos , Orientação/fisiologia , Resolução de Problemas/fisiologia , Porto Rico/epidemiologia , Percepção Visual/fisiologiaRESUMO
BACKGROUND: Approximately 240,000 transient ischemic attacks (TIA's) are diagnosed every year in U.S.A. Recent studies have shown that 4-20% will have a stroke within 90 days after a TIA, half in 2 days. OBJECTIVES: To determine morbidity and assess outcome at 72 hours of patients with TIA's arriving at the Emergency Room (ER) of San Lucas Hospital, Ponce, PR. METHODOLOGY: Medical records of all patients evaluated at ER in 2006 with neurological symptoms for < 24 hours, and outcome for next 72 hrs were reviewed. Anticoagulation given and timeframe between initial symptoms and diagnostic neurologic workup was also recorded. RESULTS: 53/182 records reviewed met inclusion criteria. 45% males, 55% females, median age of 62 years (Range 53-90). All received antithrombotic drugs at ER. Head-CT performed upon arrival in 100%, only 57% of Echocardiograms and Carotid-Doppler done in 24 hrs. CONCLUSION: No patients developed stroke or death related to TIA in 72 hours.
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Ataque Isquêmico Transitório , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Porto Rico , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Urticaria is a common disorder affecting approximately 15-25% of the population at some point in their life. We can assume that with the advancement of medical therapeutics, which have in turn prolonged the duration of life, the incidence of drug induced urticaria will increase in the geriatric population. Other common causes that need to be considered are allergy, autoimmune conditions and stress. Urticaria is characterized by transient pruritic wheals or erythematous patches on the skin. The signs and symptoms usually resolve in less than 24 hrs, leaving no residual scar or discoloration. Generally, the etiology of urticaria remains unknown in 75-90% of patients. In this article we discuss pathogenesis, clinical presentation, and treatment of urticaria in the elderly. A complete medical evaluation and age appropriate screening should be performed in all elderly patients in a primary care setting. We should also weigh risk versus benefits of each prescribed medication to decrease morbidity and improve the quality of life.