scholarly journals Clinical conditions and memory complaints in outpatient elderly

2008 ◽  
Vol 2 (4) ◽  
pp. 315-320 ◽  
Author(s):  
Regina Miksian Magaldi ◽  
Alexandre Leopold Busse ◽  
Venceslau Antonio Coelho ◽  
Daniel Apolinário ◽  
Leonardo da Costa Lopes ◽  
...  
Keyword(s):  
Comprehensive Evaluation ◽  
Sleep Apnea Syndrome ◽  
Vitamin B12 Deficiency ◽  
Normal Pressure ◽  
Screening Tests ◽  
Cognitive Screening ◽  
Memory Complaints ◽  
Obstructive Sleep ◽  
B12 Deficiency ◽  
Clinical Conditions

Abstract Memory complaints are common in elderly, and may be associated with many clinical problems. Objective: To identify clinical conditions and possible factors related to memory complaints in elderly outpatients presenting at a tertiary unit. Methods: Patients with memory complaints and normal cognitive screening tests were submitted to clinical and laboratorial testing. Radiological evaluation was performed as needed for diagnosis. Results: One hundred and seventy-seven subjects were initially evaluated, 12 were excluded because of poor and inconsistent memory complaints. Of the remainder, seventeen had criteria for dementia diagnosis. Ninety-two (55.4%) had one or more comorbid conditions possibly related to their complaints. Major depression was present in 26.0%. Sixteen patients (9.6%) had vitamin B12 deficiency, 8 were in use of inappropriate medications, and 7 (4.2%) had hypothyroidism. Other conditions diagnosed were: generalized anxiety disorder, obstructive sleep apnea syndrome, hyperparathyroidism, normal pressure hydrocephalus. Three patients had severe hearing loss (in 22 with hearing complaints); one had severe visual impairment (in 22 with visual complaints). Conclusions: Comprehensive evaluation was able to identify treatable conditions possibly related to memory complaints.

scholarly journals Case Report: Liraglutide for Weight Management in Beckwith-Wiedemann Syndromic Obesity

2021 ◽  
Vol 12 ◽  
Author(s):  
Marina Caputo ◽  
Tommaso Daffara ◽  
Simonetta Bellone ◽  
Valentina Mancioppi ◽  
Paolo Marzullo ◽  
...  
Keyword(s):  
Kinase Inhibitor ◽  
Sleep Apnea Syndrome ◽  
Genetic Obesity ◽  
Cyclin Dependent Kinase Inhibitor ◽  
Imprinting Disorder ◽  
Melanocortin 4 Receptor ◽  
First Case ◽  
Syndromic Obesity ◽  
Obstructive Sleep ◽  
Clinical Conditions

Genetic obesity, including syndromic and non-syndromic forms, represents a minority of cases compared to essential obesity but gene dysregulations lead to complex clinical conditions that make their management particularly difficult. Among them, Beckwith-Wiedemann syndrome (BWS) is a multisystem human genomic imprinting disorder characterized by overgrowth. We describe the first case of liraglutide treatment in an 18-year-old boy patient affected by BWS complicated by macroglossia, cryptorchidism, nephroblastoma, organomegaly, microscopic lymphocytic colitis, pharmacologically treated arterial hypertension, obesity, and obstructive sleep apnea syndrome. He presented a normal cognitive development. Body mass index at the time of first transition visit in the adult endocrinology department at the age of 18-years-old was 40.6 kg/m2 without glucose metabolism impairment. Lifestyle interventions failed because of poor compliance. During 20 months of 3.0 mg liraglutide treatment, a weight loss of 19 kg (−13.3%) and BMI reduction of 6.8 points were registered without side effects. To date, liraglutide treatment was effective on obesity in 7 subjects with Prader Willy Syndrome and 14 with melanocortin-4 receptor mutations. The efficacy of liraglutide in BWS could be related to a crosstalk among glucagon-like peptide (GLP)-1 system, mechanisms related to the cyclin-dependent kinase inhibitor 1C (CDKN1C), and dopamine mesolimbic circuit. Clinical trials aiming at a tailored medicine in genetic obesity are needed.

scholarly journals Clinical Conditions and Predictive Markers of Non-Dipper Profile in Hypertensive Patients

2018 ◽  
Vol 64 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Ioan Tilea ◽  
Dorina Petra ◽  
Elena Ardeleanu ◽  
Adina Hutanu ◽  
Andreea Varga
Keyword(s):  
Blood Pressure ◽  
Current Knowledge ◽  
Blood Pressure Monitoring ◽  
Target Organ Damage ◽  
Sleep Apnea Syndrome ◽  
Predictive Markers ◽  
Distribution Width ◽  
Hypertensive Patients ◽  
Obstructive Sleep ◽  
Clinical Conditions

AbstractHypertension remains one of the primary causes of premature cardiovascular mortality representing a major independent risk factor.The importance of ambulatory blood pressure monitoring in clinical evaluation of hypertensive patients, beyond diagnosis, is the identification of circadian dipping/non-dipping profile. The non-dipper pattern in hypertensive and normotensive patients is associated with significant target organ damage and worse outcomes, as an increased cardiovascular risk condition. Non-dipping pattern has been found to be associated with specific clinical conditions. Obesity, diabetes mellitus, metabolic syndrome, obstructive sleep apnea syndrome, chronic kidney disease, autonomic and baroreflex dysfunctions, salt sensitivity, hormonal changes, gender and age were extensively studied. Research efforts are focused on recognizing and exploring predictive markers of abnormal blood pressure circadian pattern. Previous studies acknowledge that red cell distribution width, mean platelet volume, fibrinogen level, C-reactive protein, serum uric acid and gamma-glutamyltransferase, are independently significant and positive associated to non-dipping pattern. Moreover, research on new biomarkers are conducted: Chitinase 3-Like-Protein 1, atrial and B-type natriuretic peptide, brain-derived neurotrophic factor, chemerin, sphingomyelin and the G972R polymorphism of the insulin receptor substrate-1 gene. This review summarizes the current knowledge of different clinical conditions and biomarkers associated with the non-dipper profile in hypertensive patients.

scholarly journals Analysis of a case series of behavioral variant frontotemporal dementia: Emphasis on diagnostic delay

2013 ◽  
Vol 7 (1) ◽  
pp. 55-59
Author(s):  
Henrique Cerqueira Guimarães ◽  
Thiago Cardoso Vale ◽  
Victor Pimentel ◽  
Nayara Carvalho de Sá ◽  
Rogério Gomes Beato ◽  
...  
Keyword(s):  
Frontotemporal Dementia ◽  
Formal Education ◽  
Age At Onset ◽  
Diagnostic Delay ◽  
Case Series ◽  
Screening Tests ◽  
Functional Evaluation ◽  
Cognitive Screening ◽  
International Consensus ◽  
Memory Complaints

ABSTRACT Introduction: Despite many advances in the characterization of the behavioral variant of frontotemporal dementia (bvFTD), the diagnosis of this syndrome poses a significant challenge, while delays or diagnostic mistakes may impact the proper clinical management of these patients. Objective: To describe the clinical profile at first evaluation of a sample of patients with bvFTD from a specialized outpatient neurological unit, with emphasis on the analysis of the delay between the onset of symptoms and diagnosis. Methods: We selected 31 patients that fulfilled international consensus criteria for possible or probable bvFTD. Patients' medical admission sheets were thoroughly reviewed. Results: Patients' mean age was 67.9±8.2 years; 16 (51.6%) were men. Mean number of years of formal education was 7.7±4.0 years. Mean age at onset was 62.2±7.7 years, indicating a mean of 5.8 years of diagnostic delay. Thirteen patients (41.9%) presented with initial behavioral complaints only, eleven patients (35.5%) had mixed behavioral and memory complaints, five patients (16.1%) presented with memory complaints only, and two patient (6.4%) had behavioral and speech problems. Nine patients (29%) were admitted with alternative diagnoses. Mean and standard deviation scores for the mini-mental state examination, animal category fluency and memory test for drawings (five-minute delayed recall) were 19.3±6.3, 8.3±4.1 and 3.7±2.7, respectively. Conclusion: Most patients from this sample were evaluated almost six years after the onset of symptoms and performed poorly on both cognitive screening tests and functional evaluation measures.

scholarly journals Personalized treatment of obesity complicated with obstructive sleep apnea syndrome

2014 ◽  
Vol 11 (1) ◽  
pp. 48-52
Author(s):  
N V Strueva ◽  
L V Saveleva ◽  
G A Melnichenko ◽  
M G Poluektov ◽  
N V Gegel
Keyword(s):  
Obstructive Sleep Apnea ◽  
Body Weight ◽  
Sleep Apnea ◽  
Patient Adherence ◽  
Sleep Apnea Syndrome ◽  
Obstructive Sleep ◽  
Osa Treatment ◽  
Treatment Of Obesity ◽  
Clinical Conditions ◽  
The Impact

Obstructive sleep apnea (OSA) and obesity are mutually burdening clinical conditions. Weight loss is quite effective for the control of breathing disorders during sleep, but the impact of OSA treatment on the dynamics of body weight in obese patients remains poorly studied. Presented clinical case features a significant reduction in body weight in a patient with morbid obesity complicated by severe OSA with contemporary approach and without CPAP therapy due to high patient adherence to therapy and absence of comorbidities.

Approach to the Patient with Hyperhomocysteinemia

2016 ◽  
Author(s):  
Anthony Briddon
Keyword(s):  
Early Adulthood ◽  
False Negative ◽  
Vitamin B12 Deficiency ◽  
Screening Tests ◽  
Caffeine Intake ◽  
Poor Renal Function ◽  
Biochemical Investigation ◽  
Key Enzyme ◽  
Life Threatening ◽  
B12 Deficiency

Hyperhomocysteinaemia (HHC) may occur as a result of a variety of inherited and acquired conditions ranging from mild and benign to severe and life threatening, and there is a higher probability that they will first manifest during early adulthood rather than infancy, with acquired forms commonly presenting into old age. Milder forms of HHC may exist without homocystinuria, and screening tests relying on the presence of homocystine in the urine will give a false negative result. Methylcobalamin is an essential cofactor for methionine synthase, a key enzyme in the homocysteine remethylation pathway: consequently, investigation for inherited abnormalities of intracellular B12 metabolism forms an integral part of the biochemical investigation of HHC. Additionally, there are acquired forms of HHC, notably those involving vitamin B12 deficiency and malabsorption. Mild to moderate HHC has also been associated with alcohol abuse, excessive caffeine intake, hypothyroidism, and poor renal function.

Indigenous indicators of vitamin B12 deficiency

2020 ◽  
Vol 8 (2) ◽  
pp. 38-46
Author(s):  
Deepak Kumar P ◽  
Darshana Makwana ◽  
Pragathi Pragathi
Keyword(s):  
Vitamin B12 ◽  
Complete Blood Count ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Vitamin B12 Deficiency ◽  
Screening Tests ◽  
Mean Corpuscular Hemoglobin ◽  
Cross Sectional ◽  
Predictive Values ◽  
B12 Deficiency

Introduction: Clinical manifestations of vitamin B12 deficiency are mostly non-specific. An entity called subclinical deficiency has become popular where the need has arisen to perform costly investigations which indicate functional deficiency of vitamin B12 even when vitamin B12 levels are normal. These factors pose a challenge in planning management of patients. Aims and objectives : The study was conducted as an attempt to identify affordable and credible laboratory indicators of vitamin B12 deficiency which can be used as screening tests before choosing patients for further evaluation or treatment. Material and Methods : This was a time bound cross-sectional study where 100 adult patients who had undergone the following investigations were randomly chosen: Complete Blood Count with red cell indices, serum bilirubin and serum vitamin B12 levels. The sensitivity, specificity and predictive values (positive-PPV and negative-NPV) of the variables that could hypothetically identify vitamin B12 deficiency, both individually or in combinations were calculated and compared. Results and conclusion : Hemoglobin, MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Hemoglobin), platelets and bilirubin were not equally distributed between vitamin B12 deficient and normal groups(p values for these variables were 0.029, 0.000, 0.000, 0.003 and 0.029 respectively).When these variables were tested individually and in combination, the combination of [MCV=95 fl or MCH=30 pg or Platelets =1.4 lakh/µl or Bilirubin =1 mg/dl] had sensitivity of 68.2%, specificity of 85.7%, PPV of 78.9% and NPV of 77.4%. This proposed combination used as a screening test has potential for wide application considering its simplicity and cost advantage.

scholarly journals CAN EPWORTH SLEEPINESS SCALE BE A PREDICTOR OF COGNITIVE DEFICT IN A COGNITIVE SCREENING TEST IN A COHORT OF ELDERLY FREE OF CLINICALLY MANIFEST VASCULAR BRAIN DISEASE

2021 ◽  
Author(s):  
Marta de Carvalho ◽  
Maria Cecília Trindade ◽  
Wladimir Freitas ◽  
Andrei Sposito
Keyword(s):  
Sleep Apnea Syndrome ◽  
Binary Logistic Regression ◽  
Coronary Calcification ◽  
The Elderly ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Cognitive Screening ◽  
Binary Logistic Regression Model ◽  
Independent Variables ◽  
Obstructive Sleep

Background: The Obstructive Sleep Apnea Syndrome (OSAS) is highly prevalent among the elderly and relevant due to its cognitive impact. Objective: To evaluate an association between cognitive impairment (CI) and the presence of OSAS as assessed by the Mini Mental (MM) scale and the Ephorth Sleepiness Scale (ESS) in a population of octogens free from overt cerebral vascular disease (CVD). Methods: 137 individuals were selected. The study was approved by the ethics committee. Categorical variables were evaluated as percentages, continuous variables with normal distribution as mean ± SD and non-parametric variables as median. The subjects were not categorized into the presence or absence of CI according to the score on the MM scale according to education. In a multivariate binary logistic regression model with dependent variable CI, independent variables were incorporated according to the clinic and whether they were associated with CI in the bivariate models. All independent variables were defined in the model. Results: There was an association between high probability of OSAS by ESS and CI by MM. X2(1) = 5.34 p = 0.021. Conclusions: There was an association between high scores on the ESS and the presence of CI at the MM, even compatible for age, BMI, gender, coronary calcification, blood pressure.

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