-
Heart, Lung & Circulation Jul 2024Clinical guidelines recommend secondary prevention medications following myocardial infarction (MI) regardless of revascularisation strategy. Studies suggest that there...
AIM
Clinical guidelines recommend secondary prevention medications following myocardial infarction (MI) regardless of revascularisation strategy. Studies suggest that there is variation in post-MI medication use following percutaneous coronary intervention (PCI) and coronary artery bypass grafts (CABG). We investigated initial dispensing and 12-month patterns of medication use according to revascularisation strategy following non-ST-elevation MI (NSTEMI).
METHOD
We included all public and private hospital admissions for NSTEMI for patients aged ≥30 years in Victoria, Australia, between July 2012 and June 2017. We investigated initial dispensing of P2Y inhibitors (P2Yi), statins (total and high intensity), angiotensin-converting-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), and beta blockers within 60 days after discharge. Twelve-month post-MI medication use was estimated as the proportion of days covered (PDC) over a 12-month period from the date of hospital discharge. Analyses were performed using adjusted regression models, stratified by revascularisation strategy.
RESULTS
There were 15,399 admissions for NSTEMI: 11,754 with PCI and 3,645 with CABG. Following adjustments, predicted probability of initial dispensing in the PCI and CABG groups, respectively, was 0.94 (95% confidence interval 0.93-0.95) vs 0.17 (0.13-0.21) for P2Yi; 0.69 (0.66-0.71) vs 0.42 (0.37-0.48) for ACEi/ARB; 0.59 (0.57-0.62) vs 0.69 (0.64-0.74) for beta blockers; 0.89 (0.87-0.91) vs 0.89 (0.85-0.92) for statins; and 0.60 (0.57-0.62) vs 0.69 (0.63-0.73) for high intensity statins. The 12-month PDC in the PCI and CABG groups, respectively, was 0.82 (0.80-0.83) vs 0.12 (0.09-0.15) for P2Yi; 0.62 (0.60-0.65) vs 0.43 (0.39-0.48) for ACEi/ARB; 0.53 (0.51-0.55) vs 0.632 (0.58-0.66) for beta blockers; 0.79 (0.78-0.81) vs 0.78 (0.74-0.81) for statins; and 0.49 (0.47-0.51) vs 0.55 (0.50-0.59) for high intensity statins.
CONCLUSIONS
Post-discharge dispensing of secondary prevention medications differed with respect to revascularisation strategy from 2012 to 2017, despite clear evidence of benefit during this period. Interventions may be needed to address possible clinician and patient uncertainty about the benefits of secondary prevention medications, regardless of revascularisation strategy.
PubMed: 38964944
DOI: 10.1016/j.hlc.2024.04.307 -
BMJ Open Quality Jul 2024Improving the quality of life (QoL) is a significant healthcare priority, and it is an important health outcome for elderly individuals with Alzheimer's disease. Quality...
BACKGROUND
Improving the quality of life (QoL) is a significant healthcare priority, and it is an important health outcome for elderly individuals with Alzheimer's disease. Quality of Life in Late-Stage Dementia (QUALID) is a specific scale used to measure the QoL in elderly individuals with Alzheimer's. So far, limited quantitative research has been conducted on the psychometric properties of this scale.
AIMS
This study was conducted to translate the QUALID Scale into Persian and evaluate its psychometric properties among family and professional caregivers of elderly individuals with Alzheimer's disease in Tehran.
METHODS
A cross-sectional methodological study was conducted among family and professional caregivers of elderly individuals with Alzheimer's in Tehran, Iran in 2022. The questionnaire was translated into Persian using the forward-backward method. Face and content validity were assessed. Additionally, construct validity was examined using exploratory factor analysis (EFA) with Equamax rotation (n=210) and confirmatory factor analysis (CFA) (n=155). Cronbach's alpha and interclass correlation coefficient (ICC) were estimated to determine reliability.
RESULTS
A total of 365 caregivers with a mean age of 14.18±42.60 years participated in this study. In the face and content validity phase, all 11 items were retained. To determine the construct validity, two factors were extracted in the EFA phase, including behavioural signs of discomfort and behavioural signs of social interaction. The findings of the CFA also indicated that all goodness of fit indices supported the final model. The Cronbach's alpha was excellent for both factors (0.814), and the ICC was calculated as 0.98.
CONCLUSION
Based on the findings of this study, it can be concluded that the Persian version of the QUALID Scale has sufficient validity and reliability for measuring the QoL in elderly Iranian individuals with Alzheimer's.
Topics: Humans; Quality of Life; Psychometrics; Male; Female; Iran; Alzheimer Disease; Cross-Sectional Studies; Surveys and Questionnaires; Aged; Reproducibility of Results; Caregivers; Middle Aged; Adult; Aged, 80 and over; Dementia
PubMed: 38964884
DOI: 10.1136/bmjoq-2023-002673 -
Environmental Research Jul 2024Long-term exposure to ambient air pollution has been linked with all-cause mortality and cardiovascular and respiratory diseases. Suggestive associations between ambient...
BACKGROUND
Long-term exposure to ambient air pollution has been linked with all-cause mortality and cardiovascular and respiratory diseases. Suggestive associations between ambient air pollutants and neurodegeneration have also been reported, but due to the small effect and relatively rare outcomes evidence is yet inconclusive. Our aim was to investigate the associations between long-term air pollution exposure and mortality from neurodegenerative diseases.
METHODS
A Dutch national cohort of 10.8 million adults aged ≥30 years was followed from 2013 until 2019. Annual average concentrations of air pollutants (ultra-fine particles (UFP), nitrogen dioxide (NO), fine particles (PM and PM) and elemental carbon (EC)) were estimated at the home address at baseline, using land-use regression models. The outcome variables were mortality due to amyotrophic lateral sclerosis (ALS), Parkinson's disease, non-vascular dementia, Alzheimer's disease, and multiple sclerosis (MS). Hazard ratios (HR) were estimated using Cox models, adjusting for individual and area-level socio-economic status covariates.
RESULTS
We had a follow-up of 71 million person-years. The adjusted HRs for non-vascular dementia were significantly increased for NO (1.03; 95% confidence interval (CI) 1.02-1.05) and PM (1.02; 95%CI 1.01-1.03) per interquartile range (IQR; 6.52 and 1.47 μg/m, respectively). The association with PM was also positive for ALS (1.02; 95%CI 0.97-1.07). These associations remained positive in sensitivity analyses and two-pollutant models. UFP was not associated with any outcome. No association with air pollution was found for Parkinson's disease and MS. Inverse associations were found for Alzheimer's disease.
CONCLUSION
Our findings, using a cohort of more than 10 million people, provide further support for associations between long-term exposure to air pollutants (PM and particularly NO) and mortality of non-vascular dementia. No associations were found for Parkinson and MS and an inverse association was observed for Alzheimer's disease.
PubMed: 38964584
DOI: 10.1016/j.envres.2024.119552 -
Journal of Gastrointestinal Surgery :... Jul 2024Both cognitive impairment/dementia (CID) and falls occur more commonly in older adults compared to younger patients. This study aims to analyze the association of a...
INTRODUCTION
Both cognitive impairment/dementia (CID) and falls occur more commonly in older adults compared to younger patients. This study aims to analyze the association of a history of CID or falls with the postoperative outcomes of older adults undergoing major intraabdominal surgeries on a national level.
METHODS
We retrospectively analyzed the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) 2022 Participant Use Data File. Our primary outcome was postoperative mortality. Statistical analysis was performed using Chi-square test, and multivariate regression analysis.
RESULTS
On multivariable regression analyses, both a history of CID (OR: 1.9; CI: 1.5-2.5; p <0.01) and a fall (OR: 1.8, CI: 1.4 -2.3; p <0.01) were independently associated with higher adjusted odds of mortality. History of CID or falls was also a predictor of overall complications, major complications, and discharge to a care facility.
CONCLUSION
A history of CID or falls in older adults prior to major intraabdominal surgeries is associated with a high risk of postoperative mortality and morbidity. Further studies are required to establish the causal relation of these factors and the steps to mitigate the risk of associated adverse outcomes.
PubMed: 38964533
DOI: 10.1016/j.gassur.2024.06.023 -
Biological Psychiatry Jul 2024Emerging theories emphasize the crucial role of allostasis (anticipatory and adaptive regulation of the body's biological processes) and interoception (integration,... (Review)
Review
Emerging theories emphasize the crucial role of allostasis (anticipatory and adaptive regulation of the body's biological processes) and interoception (integration, anticipation, and regulation of internal bodily states) in adjusting physiological responses to environmental and bodily demands. This review explores the disruptions in integrated allostatic interoceptive mechanisms in psychiatric and neurological disorders, including anxiety, depression, Alzheimer's disease, and frontotemporal dementia. We assess the biological mechanisms associated with allostatic interoception, including whole-body cascades, brain structure and function of the allostatic interoceptive network, heart-brain interactions, respiratory-brain interactions, the gut-brain-microbiota axis, peripheral biological processes (inflammatory, immune), and epigenetic pathways. These processes span psychiatric and neurological conditions and call for developing dimensional and trans-nosological frameworks. We synthesize new pathways to understand how allostatic interoceptive processes modulate interactions between environmental demands and biological functions in brain disorders. We discuss current limitations of the framework and future transdisciplinary developments. This review opens a new research agenda for understanding how allostatic interoception involves brain predictive coding in psychiatry and neurology, allowing for better clinical application and the development of new therapeutic interventions.
PubMed: 38964530
DOI: 10.1016/j.biopsych.2024.06.024 -
Journal of Neuroscience Methods Jul 2024Neurological disorders arise primarily from the dysfunction of brain cells, leading to various impairments. Electroencephalography (EEG) stands out as the most popular...
BACKGROUND
Neurological disorders arise primarily from the dysfunction of brain cells, leading to various impairments. Electroencephalography (EEG) stands out as the most popular method in the discovery of neuromarkers indicating neurological disorders. The proposed study investigates the effectiveness of spectral and synchrony neuromarkers derived from resting state EEG in the detection of Mild Cognitive Impairment (MCI) with controls.
NEW METHODS
The dataset is composed of 10 MCI and 10 HC groups. Spectral features and synchrony measures are utilized to detect slowing patterns in MCI. Efficient neuro-markers are classified by 25 classification algorithm. Independent samples t-test and Pearson's Correlation Coefficients are applied to reveal group differences for spectral markers, and repeated measures ANOVA is tested for wPLI-based markers.
RESULTS
Lower peak amplitudes are prominent in MCI participants for high frequencies indicating slower physiological behavior of the demented EEG. The MCI and HC groups are correctly classified with 95% acc. using peak amplitudes of beta band with LGBM classifier. Higher wPLI values are calculated for HC participants in high frequencies. The alpha wPLI values achieve a classification accuracy of 99% using the LGBM algorithm for MCI detection.
COMPARISON WITH EXISTING METODS
The neuro-markers including peak amplitudes, frequencies, and wPLIs with advanced machine learning techniques showcases the innovative nature of this research.
CONCLUSION
The findings suggest that peak amplitudes and wPLI in high frequency bands derived from resting state EEG are effective neuromarkers for detection of MCI. Spectral and synchrony neuro-markers hold great promise for accurate MCI detection.
PubMed: 38964474
DOI: 10.1016/j.jneumeth.2024.110216 -
Revista Espanola de Geriatria Y... Jul 2024The objective is to describe the demographic, clinical, functional characteristics and outcomes of older adult patients hospitalized in the acute unit of the San Ignacio...
BACKGROUND AND OBJECTIVES
The objective is to describe the demographic, clinical, functional characteristics and outcomes of older adult patients hospitalized in the acute unit of the San Ignacio University Hospital (HUSI).
METHODS
Descriptive, cross-sectional observational study, based on the review of the medical records of patients hospitalized in the Geriatrics Unit of the HUSI during the period 2019-2021.
VARIABLES
Demographics, comorbidities, baseline situation, main cause of entry and outcomes. The diagnosis of geriatric syndromes was made through the Barthel index, the Lawton and Brody scale, FRAIL scale, mini nutritional assessment short form and Confusion Assessment Method criteria.
RESULTS
A total of 4601 patients were analyzed, whose average age was 83years (56.2% women). 72.4% had some degree of dependency for basic activities of daily living, 90.8% had some degree of dependency for instrumental activities of daily living, 32.2% had malnutrition, 15. 7% falls, 9.9% oropharyngeal dysphagia, 32.2% frailty, 28.1% delirium, 54.1% previous dementia. The main comorbidities presented were arterial hypertension, chronic obstructive pulmonary disease and diabetes. 2.9% had some complication during their hospitalization, 10.8% died, and the hospital stay was 5days.
CONCLUSION
Older adult patients admitted to the acute unit of the HUSI have a high frequency of dependency, dementia and nutritional disturbances.
PubMed: 38964263
DOI: 10.1016/j.regg.2024.101527 -
Memory (Hove, England) Jul 2024According to Conway's view, Autobiographical memory (AM) construction is accompanied by control processes. These processes range from filtering out relevant memories...
According to Conway's view, Autobiographical memory (AM) construction is accompanied by control processes. These processes range from filtering out relevant memories according to the current context, to generating or elaborating appropriate retrieval cues. These processes can be conceptualised as metacognition, the ability to control and monitor cognitive processes. Experimentally, little has been carried out to support the idea that metacognition is involved in AM. To assess this, we designed a task, the Feeling of Retrieval. Participants had to predict whether cue words would facilitate AM access (i.e., fluent access cues) or not (i.e., limited access cues) in a limited time (either 1 (Exp. 2) or 2 (Exp. 1) s). Later, they retrieved memories in response to both types of cues. Results show that cues judged as fluent access led to better AM generation, as illustrated by AM retrieval latency and a subjective measure of the ease with which the AMs were retrieved. These rapid predictions may rely on epistemic feelings and / or other mnemonic cues such as a partial retrieval of information. This metacognitive access to the earliest stages of AM retrieval illustrates the ability to monitor AM processes as proposed by Conway (2005).
PubMed: 38963905
DOI: 10.1080/09658211.2024.2370532 -
The Journals of Gerontology. Series A,... Jul 2024Statins are a cornerstone in the medical management of cardiovascular disease, yet their efficacy varies greatly between individuals. In this commentary, we outline...
Statins are a cornerstone in the medical management of cardiovascular disease, yet their efficacy varies greatly between individuals. In this commentary, we outline evidence for the role of CD4+CD28null T-cell expansion as a critical moderator of the effects of statins in preventing cardiovascular events via the reduction of pathological inflammation. Given this relationship, we argue that T-cell profiles should be considered as a patient characteristic in clinical and pre-clinical studies examining statin efficacy in other age- and inflammation-related pathologies. We discuss the implications this may have for studies of statin use in numerous disease processes - notably, dementia and neurocognitive dysfunction - and the potential for T-cell profiles to be used as a prognosticator for statin efficacy in rheumatoid arthritis, Alzheimer's disease, and multiple sclerosis.
PubMed: 38963798
DOI: 10.1093/gerona/glae156 -
JMIR Aging Jul 2024Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills,...
Efficacy of COMPAs, an App Designed to Support Communication Between Persons Living With Dementia in Long-Term Care Settings and Their Caregivers: Mixed Methods Implementation Study.
BACKGROUND
Persons living with dementia experience autonomy loss and require caregiver support on a daily basis. Dementia involves a gradual decline in communication skills, leading to fewer interactions and isolation for both people living with dementia and their caregivers, negatively impacting the quality of life for both members of the dyad. The resulting stress and burden on caregivers make them particularly susceptible to burnout.
OBJECTIVE
This study aims to examine the efficacy of Communication Proches Aidants (COMPAs), an app designed following the principles of person-centered and emotional communication, which is intended to improve well-being in persons living with dementia and caregivers and reduce caregiver burden.
METHODS
In this implementation study, volunteer caregivers in 2 long-term care facilities (n=17) were trained in using COMPAs and strategies to improve communication with persons living with dementia. Qualitative and quantitative analyses, semistructured interviews, and questionnaires were completed before and after 8 weeks of intervention with COMPAs.
RESULTS
Semistructured interviews revealed that all caregivers perceived a positive impact following COMPAs interventions, namely, improved quality of communication and quality of life among persons living with dementia and caregivers. Improved quality of life was also supported by a statistically significant reduction in the General Health Questionnaire-12 scores (caregivers who improved: 9/17, 53%; z=2.537; P=.01). COMPAs interventions were also associated with a statistically significant increased feeling of personal accomplishment (caregivers improved: 11/17, 65%; t=2.430; P=.03; d=0.61 [medium effect size]).
CONCLUSIONS
COMPAs intervention improved well-being in persons living with dementia and their caregivers by developing person-centered communication within the dyad, increasing empathy, and reducing burden in caregivers although most caregivers were unfamiliar with technology. The results hold promise for COMPAs interventions in long-term care settings. Larger group-controlled studies with different populations, in different contexts, and at different stages of dementia will provide a clearer picture of the benefits of COMPAs interventions.
Topics: Humans; Dementia; Caregivers; Long-Term Care; Female; Male; Quality of Life; Mobile Applications; Aged; Communication; Middle Aged; Surveys and Questionnaires; Aged, 80 and over
PubMed: 38963691
DOI: 10.2196/47565