The prevalence of dementia varies substantially worldwide. This is partially attributed to the lack of methodological uniformity among studies, including diagnostic criteria and different mean population ages. However, even after considering these potential sources of bias, differences in age-adjusted dementia prevalence still exist among regions of the world. In Latin America, the prevalence of dementia is higher than expected for its level of population aging. This phenomenon occurs due to the combination of low average educational attainment and high vascular risk profile. Among developed countries, Japan seems to have the lowest prevalence of dementia. Studies that evaluated the immigration effect of the Japanese and blacks to USA evidenced that acculturation increases the relative proportion of AD cases compared to VaD. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidemia, and metabolic syndrome, all of which also raise the risk of VaD and AD. Regulating these factors is critical to generate the commitment to make dementia a public health priority.
Cognitive dysfunction and dementia have recently been proven to be common (and underrecognized) complications of diabetes mellitus (DM). In fact, several studies have evidenced that phenotypes associated with obesity and/or alterations on insulin homeostasis are at increased risk for developing cognitive decline and dementia, including not only vascular dementia, but also Alzheimer's disease (AD). These phenotypes include prediabetes, diabetes, and the metabolic syndrome. Both types 1 and 2 diabetes are also important risk factors for decreased performance in several neuropsychological functions. Chronic hyperglycemia and hyperinsulinemia primarily stimulates the formation of Advanced Glucose Endproducts (AGEs), which leads to an overproduction of Reactive Oxygen Species (ROS). Protein glycation and increased oxidative stress are the two main mechanisms involved in biological aging, both being also probably related to the etiopathogeny of AD. AD patients were found to have lower than normal cerebrospinal fluid levels of insulin. Besides its traditional glucoregulatory importance, insulin has significant neurothrophic properties in the brain. How can clinical hyperinsulinism be a risk factor for AD whereas lab experiments evidence insulin to be an important neurothrophic factor? These two apparent paradoxal findings may be reconciliated by evoking the concept of insulin resistance. Whereas insulin is clearly neurothrophic at moderate concentrations, too much insulin in the brain may be associated with reduced amyloid-beta (Abeta) clearance due to competition for their common and main depurative mechanism - the Insulin-Degrading Enzyme (IDE). Since IDE is much more selective for insulin than for Abeta, brain hyperinsulinism may deprive Abeta of its main clearance mechanism. Hyperglycemia and hyperinsulinemia seems to accelerate brain aging also by inducing tau hyperphosphorylation and amyloid oligomerization, as well as by leading to widespread brain microangiopathy. In fact, diabetes subjects are more prone to develop extense and earlier-than-usual leukoaraiosis (White Matter High-Intensity Lesions - WMHL). WMHL are usually present at different degrees in brain scans of elderly people. People with more advanced WMHL are at increased risk for executive dysfunction, cognitive impairment and dementia. Clinical phenotypes associated with insulin resistance possibly represent true clinical models for brain and systemic aging.
Met.S was significantly associated with functional dependence, depression, cognitive impairment, and low HRQoL, and its effects were independent of clinical stroke, IHD, and its own individual components.
RESUMO RESUMENLa finalidad de este estudio fue identificar características de los cuidadores de ancianos con demencia, tipos de demanda de cuidados y relacionar la demanda con el estadio de la demencia. Este estudio seccional y observacional fue efectuado en 2004 con 104 ancianos y 90 cuidadores en Ribeirão Preto/SP/Brasil, a través del instrumento OARS y un cuestionario para el cuidador. De los 104 ancianos, 66,3% eran mujeres, la edad media fue de 75,5 años y 86,5% del total tenían cuidadores. Entre los cuidadores, 80% eran mujeres, miembros de la familia, con edad media de 52,3 años. Dedicaban 15,10 horas/día para la actividad de cuidar, sin ayuda ninguna. Se encontró una importante relación entre la sobrecarga del cuidador, el esfuerzo físico y emocional y el estadio de la demencia. La sobrecarga emocional resultó mayor en los estadios iniciales y tardíos de la demencia, esta diferencia no fue estadísticamente significativa. Los resultados actuales revelan la necesidad urgente de planear estrategias de soporte formal e informal para cuidadores de ancianos brasileños con demencia.
OBJECTIVE:To identify demographic and socioeconomic differentials associated with the health status of oldest-old individuals living in two cities of different Brazilian regions. METHODS:A comparative and cross-sectional epidemiological study was conducted with the oldest-old (≥ 80 years), living in the cities of Ribeirão Preto (RP, Southeastern Brazil) and Caxias do Sul (CS, Southern). The probabilistic sample included 117 individuals in CS and 155 in RP, and data were collected between 2007 and 2008. The instrument included demographic and socioeconomic data, Mini-Mental State Examination, Functional Independence Measure, number of self-reported comorbidities and Geriatric Depression Scale. RESULTS:Mean age was similar, with predominance of women (~70%) and widowed individuals (~60%) in both cities. Mean level of education did no differ statistically, although mean income was higher in RP than in CS (p = 0.05). RP showed a higher concentration of individuals in the extreme levels of education and income than that of CS. Mean score of the Mini-Mental State Examination was similar in both groups and higher among men, individuals aged between 80 and 84 years, married and with a higher level of education. Better functional performance was observed in elderly individuals aged between 80 and 84 years in both cities, in those with higher level of education in RP; and in males and married individuals in CS. Elderly individuals in CS showed higher number of comorbidities than those in RP (p < 0.001). Male elderly individuals, married and with -higher income level showed fewer depressive symptoms in both groups; and those in RP showed higher Geriatric Depression Scale score than the others in CS (p < 0.001). CONCLUSIONS:Although the oldest old in CS showed lower socioeconomic inequality and fewer depressive symptoms, they also had a higher mean number of comorbidities and lower level of functional independence, when compared to those in RP.DESCRIPTORS: Aged, 80 and over. Depressive Disorder. Comorbidity. Socioeconomic Factors. Cross-Sectional Studies.
Background:The objective of the present study is to compare the findings of comprehensive geriatric assessments of community-dwelling elderly in Maubin township, Myanmar with those in Japan. Methods:A cross-sectional, study was undertaken of community-dwelling people aged 60 years and over who were living in downtown Maubin and two rural villages near Maubin city, and 411 people aged 65 years and over who were living in Sonobe, Kyoto, Japan. They were examined using a common comprehensive geriatric assessment tool, which included interviews regarding activities of daily living (ADL), medical and social history, quality of life (QOL) and the 15-item Geriatric Depression Scale. Anthropometric, neurobehavioral and blood chemical examinations were also conducted. Using ANOVA and Post Hoc Scheffe's F-test, findings from the three groups were compared.Results: Scores of basic ADL, instrumental self-maintenance, intellectual activities, social roles, QOL, Tokyo Metropolitan Institute of Gerontology Index of Competence, body mass index, total cholesterol levels, blood hemoglobin levels and HDL levels were lower in Myanmar's elderly subjects than in Japanese ones. There was no significant difference in prevalence of depression. Mean blood pressure measurements and rates of subjects with systolic pressure > 140 mmHg or diastolic pressure > 90 mmHg and prevalence of stroke were higher in downtown Maubin than in Japan. The atherogenic index was higher in Myanmar's elderly than in Japanese. Conclusion:In Myanmar subjects had lower ADL and QOL scores than Japanese elderly. Of particular note is the higher prevalence of anemia and subjects with history of stroke in Myanmar than in Japan. Further study is needed to detect the cause of high prevalence of stroke in Myanmar.
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