BackgroundMultimorbidity is common in advanced age, and is usually associated with negative – yet to some extent preventable – health outcomes. Detecting comorbid conditions is especially difficult in individuals with dementia, as they might not always be able to sufficiently express discomfort. This study compares relevant comorbidity complexes in elderly people with and without dementia, with a particular look at gender- and living environment-specific differences. Moreover, associations between selected comorbid conditions and dementia are reviewed more closely.MethodsUsing 2006 claims data from a large German Statutory Health Insurance fund, 9,139 individuals with dementia and 28,614 age- and gender-matched control subjects aged 65 years and older were identified. A total of 30 comorbidity complexes were defined based on ICD-10 codes. Corresponding prevalence rates were calculated, and the association between a distinct condition and dementia was evaluated via logistic regression in the overall sample as well as in analyses stratified by gender and living environment.ResultsIndividuals with dementia were more likely to be diagnosed with 15 comorbidity complexes, including Parkinson’s, stroke, diabetes, atherosclerosis (supposed dementia risk factors) or fluids and electrolyte disorders, insomnia, incontinence, pneumonia, fractures and injuries (supposed sequelae). In contrast, they were less likely to be diagnosed with 11 other conditions, which included vision and hearing problems, diseases of the musculoskeletal system, lipoprotein disorders and hypertension. In a gender-stratified analysis, the patterns remained largely the same, but a bigger comorbidity gap between cases and control subjects emerged in the male population. Restricting the analysis to community-living individuals did not lead to any substantial changes.ConclusionBesides strengthening the evidence on accepted dementia risk factors and sequelae, the analyses point to particular conditions that are likely to remain untreated or even undiagnosed. This issue seems to affect male and female individuals with dementia to varying degrees. Raising awareness of these conditions is important to possibly preventing comorbidity-associated complications and disease progression in dementia patients. To more comprehensively understand the mutual interactions between dementia and comorbidity, further research on diagnostic and treatment attitudes regarding comorbidity in dementia patients and on their gender-specific health-seeking behaviour seems to be required.
Functional imaging data in adult patients with anorexia nervosa (AN) support a dysfunctional signal in the ventral striatum as neural signature of AN. In the present study, development of this signal was investigated with the prediction that a characteristic pattern of ventral–striatal signalling will be shown in response to cues associated with food restriction that reflects the evolvement of starvation dependence over time. The signal was assessed in adolescent patients with AN, whose duration of illness was about five times shorter relative to the adult sample. During functional magnetic resonance imaging subjects were required to estimate weights of body images (underweight, normal weight, overweight) and to process each stimulus in a self-referring way. Relative to age-matched, young healthy controls, underweight stimuli were already associated with greater activity of the ventral striatum, and processing of normal-weight stimuli elicited already reduced signalling. Subjective preferences showed exactly the same pattern of results. Relative to adult AN, the present data reveal a developing dysfunctional signal that, if untreated, will essentially contribute to the maintenance of AN. We discuss putative mechanisms that may play a crucial role in the development of AN, and also deduce new hypotheses about the involvement of the midbrain dopamine system, of which illness-related alterations may contribute to the development of AN.
In accordance with the stress reduction hypothesis, typical psychopathology of alexithymia, anxiety and depression is prevalent in female adolescent AN patients. It is present detached from physical stability. Pathogenesis of AN is multifactorial and already fully present in adolescence. An additional reinforcement process can be discussed. For clinical practice, those parameters might have a better potential for early prognostic factors related to AN than physical parameters and possible implication for intervention is given.
Although researchers have documented that social anxiety may occur in a wide range of interpersonal and performance situations, little attention has been paid to the potential influence of social anxiety on participation in athletics or physical activity. The performance demands of sport and potential social evaluative nature of exercise make it likely that social anxiety would generalize to these situations. Given the physical and psychological benefits of engaging in regular physical activity, avoidance of such activities by socially anxious individuals may have profound health consequences. One‐hundred and eighty undergraduate university students completed a battery of standardized social anxiety measures, and a series of 5‐point Likert‐type questions examining fear and avoidance of sporting and athletic situations. Results indicated that social anxiety and fear of negative evaluation were generally related to social‐evaluative fears in sporting or athletic situations, particularly for women. Furthermore, social anxiety was positively correlated with avoidance of individual sporting activities, but not with avoidance of team activities. Further analyses revealed social anxiety did not differ by competition level. However, for men, familial pressure to play sports during high school was associated with higher fear of negative evaluation. Implications for the assessment and treatment of social anxiety disorder are discussed. Depression and Anxiety 12:193–202, 2000. © 2000 Wiley‐Liss, Inc.
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