Does HIV infection contribute to increased beta-amyloid synthesis and plaque formation leading to neurodegeneration and Alzheimer’s disease?

Journal of NeuroVirology - HIV infection in the combination antiretroviral therapy (cART) era has become a chronic disease with a life expectancy almost identical to those free from this infection....     

焦虑对老年高血压患者血压变异性、内皮素-1、一氧化氮的影响研究

背景　高血压是心血管系统的高发疾病且病因复杂多样,其中焦虑与高血压互相影响,二者密切相关。焦虑对高血压的影响,可能主要表现在影响血压的波动性,即影响血压变异性（BPV）。内皮素-1（ET-1）与一氧化氮（NO）被认为是影响血管舒缩功能较强的因子,焦虑可以影响ET-1、NO的分泌。目的　分析焦虑对老年高血压患者BPV、ET-1、NO的影响,探讨BPV、ET-1、NO之间的相关性,为老年高血压伴焦虑患者的早期干预及治疗提供理论依据。方法　选择2016年11月—2017年6月于滨州医学院附属医院住院的老年高血压患者120例（男51例,女69例）为研究对象,记录患者一般情况并检测血ET-1、NO,对所有患者进行动态血压监测及Zung焦虑自评量表（SAS）评估,根据SAS评分将患者分为高血压无焦虑组（EH组）、高血压轻度焦虑组（EH＆LA组）及高血压中重度焦虑组（EH＆SA组）。比较3组患者BPV、ET-1及NO水平,并分析高血压伴焦虑患者BPV、ET-1、NO之间的相关性。BPV以血压标准差（SD）表示。结果　EH＆LA组24 h、昼间、夜间收缩压标准差（24 hSBPSD、dSBPSD、nSBPSD）及夜间舒张压标准差（nDBPSD）高于EH组,EH＆SA组高于EH＆LA组;EH＆LA组血清ET-1水平高于EH组,EH＆SA组高于EH＆LA组;EH＆LA组血清NO水平低于EH组,EH＆SA组低于EH＆LA组,差异均有统计学意义（P<0.05）。老年高血压伴焦虑患者血清ET-1水平与BPV指标（24 hSBPSD、dSBPSD、nSBPSD、nDBPSD）呈正相关（r值分别为0.506、0.443、0.666、0.642,P<0.05）;NO与BPV指标无相关性（P>0.05）。结论　焦虑对老年高血压患者BPV、ET-1、NO有影响,且焦虑程度越明显,BPV越大,血清ET-1水平越高,而NO水平越低。焦虑可能通过增加BPV进一步加重高血压患者的血管内皮损害。早期识别老年高血压患者的焦虑状况并根据患者的焦虑程度选择抗焦虑治疗或许可以延缓内皮功能的损害,改善老年高血压患者的病情进展及预后。     

Ethnic Differences in Singapore's Dementia Prevalence: The Stroke,Parkinson's Disease,Epilepsy, and Dementia in Singapore Study

OBJECTIVES: To study the prevalence of dementia in Singapore among Chinese, Malays, and Indians. DESIGN: A two‐phase, cross‐sectional study of randomly selected population from central Singapore with disproportionate race stratification. SETTING: Community‐based study. Subjects screened to have cognitive impairment at phase 1 in their homes were evaluated clinically for dementia at phase 2 in nearby community centers. PARTICIPANTS: Fourteen thousand eight hundred seventeen subjects aged 50 and older (67% participation rate). MEASUREMENTS: The locally validated Abbreviated Mental Test was used to screen for cognitive impairment at phase 1. Dementia was diagnosed at phase 2 as per Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Possible Alzheimer's disease (AD) and possible vascular dementia (VD) were diagnosed along the National Institute of Neurological and Communicative Disorders—Alzheimer's Disease and Related Disorders Association and National Institute of Neurological Disorders and Stroke—Association Internationale pour la Recherche et l'Enseignement en Neuroscienes criteria, respectively. RESULTS: The overall age‐ and race‐standardized dementia prevalence was 1.26% (95% confidence interval (CI)=1.10–1.45). Prevalence (in 5‐year age bands) was 0.08% (50–54), 0.08% (55–59), 0.44% (60–64), 1.16% (65–69), 1.84% (70–74), 3.26% (75–79), 8.35% (80–84), and 16.42% (≥85). From age 50 to 69, 65% of dementia cases were VD; at older ages, 60% were AD. Logistic regression (adjusted for age, sex, education) showed that Malays had twice the risk for AD as Chinese, and Indians had more than twice the risk for AD and VD than Chinese. CONCLUSION: Singapore's dementia prevalence, primarily influenced by its Chinese majority, is lower than seen in the West. The striking interethnic differences suggest a need for a dementia incidence study and further investigation of underlying genetic and cultural differences between the three ethnic groups in relation to dementia risk.     

阿尔茨海默病的康复治疗

目的　探讨康复治疗对阿尔茨海默病 (AD)患者的有效性。方法　将 63例轻、中度AD患者分成 2组进行为期 8周的临床治疗 ,即康复组 (2 9例 )进行康复治疗 ,药物组 (3 4例 )应用盐酸多奈哌齐进行药物治疗。应用简易智能精神状态检查量表 (MMSE)、AD评定量表 (ADAS)及Blessed Roth痴呆量表判定疗效。结果　康复组患者的日常生活自理能力改善 (P <0 .0 5) ;药物组的认知功能 :MMSE较治疗前提高 3 .9分 (P <0 .0 5) ,ADAS认知部分 (ADAS cog)改善 4.8分 (P <0 .0 5) ,日常生活自理能力无明显变化 ,其中 2例(5.88% )出现轻度副作用 ;2组经治疗后的MMSE、ADAS认知部分和Blessed Roth评分进行比较 ,差异均有显著性意义 (P <0 .0 5)。结论　康复治疗能改善AD患者的日常生活自理能力 ;盐酸多奈哌齐可改善AD患者的认知功能 ,减轻痴呆的病情 ;整个治疗过程安全性好 ;康复干预应采取综合措施     

Hospitalization in Community‐Dwelling Persons with Alzheimer's Disease: Frequency and Causes

OBJECTIVES: To examine the rates of and risk factors for acute hospitalization in a prospective cohort of older community‐dwelling patients with Alzheimer's disease (AD). DESIGN: Longitudinal patient registry. SETTING: AD research center. PARTICIPANTS: Eight hundred twenty‐seven older persons with AD. MEASUREMENTS: Acute hospitalization after AD research center visit was determined from a Medicare database. Risk factor variables included demographics, dementia‐related, comorbidity and diagnoses and were measured in interviews and according to Medicare data. RESULTS: Of the 827 eligible patients seen at the ADRC during 1991 to 2006 (median follow‐up 3.0 years), 542 (66%) were hospitalized at least once, and 389 (47%) were hospitalized two or more times, with a median of 3 days spent in the hospital per person‐year. Leading reasons for admission were syncope or falls (26%), ischemic heart disease (17%), gastrointestinal disease (9%), pneumonia (6%), and delirium (5%). Five significant independent risk factors for hospitalization were higher comorbidity (hazard ratio (HR)=1.87, 95% confidence interval (CI)=1.57–2.23), previous acute hospitalization (HR=1.65, 95% CI=1.37–1.99), older age (HR=1.51, 95% CI=1.26–1.81), male sex (HR=1.27, 95% CI=1.04–1.54), and shorter duration of dementia symptoms (HR=1.26, 95% CI=1.02–1.56). Cumulative risk of hospitalization increased with number of risk factors present at baseline: 38% with zero factors, 57% with one factor, 70% with two or three factors, and 85% with four or five factors (P_trend<.001). CONCLUSION: In a community‐dwelling population with generally mild AD, hospitalization is frequent, occurring in two‐thirds of participants over a median follow‐up time of 3 years. With these results, clinicians may be able to identify dementia patients at high risk for hospitalization.     

Brain Volume and Survival from Age 78 to 85: The Contribution of Alzheimer‐Type Magnetic Resonance Imaging Findings

OBJECTIVES: To test the prediction of survival using magnetic resonance imaging (MRI)–derived global and regional brain volumes in subjects aged 78 to 79 without dementia. DESIGN: Observational follow‐up study. SETTING: University teaching hospital. PARTICIPANTS: Participants born in 1921, recruited in 1997/98 to a longitudinal study, who underwent brain MRI in 1999/2000. MEASUREMENTS: Vital status on May 12, 2006, global and regional brain volumes. RESULTS: Thirty‐seven of 98 (34.9%) participants died during follow‐up. After adjustment for cognitive ability at time of MRI examination, childhood intelligence, sex, hypertension, smoking history, obesity, hyperlipidemia, and age at MRI, proportion of intracranial volume occupied by the brain (brain fraction) predicted death before age 85 (P=.04). Participants with brain fraction less than 0.726 had more than twice the relative risk (2.8, 95% confidence interval=1.1–7.3) of death than participants with brain fraction greater 0.726. Lower survival was significantly associated with lower gray matter volumes in bilateral parietal and left frontoparietal areas and with lower white matter volumes in left parietal and right posterior temporal regions. Cox regression analysis showed that parietal white matter volume (P=.003), a subsequent diagnosis of dementia (P<.001), and sex (P=.004) were independent predictors of survival. CONCLUSION: In participants aged 78 to 79, a lower global brain fraction predicted survival to approximately age 85. Smaller regional volumetric brain reductions, seen in Alzheimer's disease (AD), also predicted survival independent of dementia. The presence of prodromal AD probably explain the main findings.     

Prevalence of Neuropsychiatric Symptoms and Their Association with Functional Limitations in Older Adults in the United States: The Aging,Demographics, and Memory Study

OBJECTIVES: To estimate the prevalence of neuropsychiatric symptoms and examine their association with functional limitations. DESIGN: Cross‐sectional analysis. SETTING: The Aging, Demographics, and Memory Study (ADAMS). PARTICIPANTS: A sample of adults aged 71 and older (N=856) drawn from Health and Retirement Study (HRS), a nationally representative cohort of U.S. adults aged 51 and older. MEASUREMENTS: The presence of neuropsychiatric symptoms (delusions, hallucinations, agitation, depression, apathy, elation, anxiety, disinhibition, irritation, and aberrant motor behaviors) was identified using the Neuropsychiatric Inventory. A consensus panel in the ADAMS assigned a cognitive category (normal cognition; cognitive impairment, no dementia (CIND); mild, moderate, or severe dementia). Functional limitations, chronic medical conditions, and sociodemographic information were obtained from the HRS and ADAMS. RESULTS: Forty‐three percent of individuals with CIND and 58% of those with dementia exhibited at least one neuropsychiatric symptom. Depression was the most common individual symptom in those with normal cognition (12%), CIND (30%), and mild dementia (25%), whereas apathy (42%) and agitation (41%) were most common in those with severe dementia. Individuals with three or more symptoms and one or more clinically significant symptoms had significantly higher odds of having functional limitations. Those with clinically significant depression had higher odds of activity of daily living limitations, and those with clinically significant depression, anxiety, or aberrant motor behaviors had significantly higher odds of instrumental activity of daily living limitations. CONCLUSION: Neuropsychiatric symptoms are highly prevalent in older adults with CIND and dementia. Of those with cognitive impairment, a greater number of total neuropsychiatric symptoms and some specific individual symptoms are strongly associated with functional limitations.     

Association Between Fitness and Changes in Body Composition and Muscle Strength

OBJECTIVES: To examine the association between physical fitness, assessed according to ability and time to complete a 400‐m walk, on changes in body composition and muscle strength over a 7‐year period. DESIGN: Prospective observational cohort study. SETTING: Memphis, Tennessee, and Pittsburgh, Pennsylvania. PARTICIPANTS: Two thousand nine hundred forty‐nine black and white men and women aged 70 to 79 participating in the Health, Aging and Body Composition Study. MEASUREMENTS: Body composition (fat and bone‐free lean mass) was assessed using dual‐energy X‐ray absorptiometry in Years 1 to 6 and 8. Knee extension strength was measured using isokinetic dynamometry and grip strength using isometric dynamometry in Years 1, 2, 4, 6, and 8. RESULTS: Less fit people weighed more and had a higher total percentage of fat and a lower total percentage of lean mass than very fit men and women at baseline (P<.001). Additionally, the least fit lost significantly more weight, fat mass, and lean mass over time than the very fit (all P<.01). Very fit people had the highest grip strength and knee extensor strength at baseline and follow‐up; decline in muscle strength was similar in every fitness group. CONCLUSION: Low fitness in old age was associated with greater weight loss and loss of lean mass than with high fitness. Despite having lower muscle strength, the rate of decline in the least fit persons was similar to that in the most fit. In clinical practice, a long‐distance walk test as a measure of fitness might be useful to identify people at risk for these adverse health outcomes.     

Geriatric Impairments and Disability: The Cardiovascular Health Study

OBJECTIVES: To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses. DESIGN: Longitudinal data from the Cardiovascular Health Study were analyzed. Multivariable Cox hazards regression modeling was used to analyze associations between time‐dependent predictors and onset of disability in activities of daily living (ADLs) and mobility. SETTING: Four communities across the United States (Sacramento County, CA; Washington County, MD; Forsyth County, NC; and Allegheny County, PA). PARTICIPANTS: Five thousand eight hundred eighty‐eight elderly persons. MEASUREMENTS: Data were collected annually through in‐person examinations. RESULTS: ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios (HRs) of having one, two, and three or more geriatric impairments (vs none) for the outcome of ADL disability were 2.12 (95% confidence interval (CI)=1.63–2.75), 4.25 (95% CI=3.30–5.48), and 7.87 (95% CI=6.10–10.17), respectively, and for having one, two, and three or more chronic diseases were 1.75 (95% CI=1.41–2.19), 2.45 (95% CI=1.95–3.07), and 3.26 (95% CI=2.53–4.19), respectively. Similarly, the HRs of having one, two, and three or more impairments for the outcome of mobility disability were 1.48 (95% CI=1.27–1.73), 2.08 (95% CI=1.77–2.45), and 3.70 (95% CI=3.09–4.42), respectively, and for having one, two, and three or more diseases were 2.06 (95% CI=1.76–2.40), 2.80 (95% CI=2.36–3.31), and 4.20 (95% CI=3.44–5.14), respectively. CONCLUSION: Number of geriatric impairments was more strongly associated than number of chronic diseases with subsequent ADL disability and nearly as strongly associated with the subsequent mobility disability.