scholarly journals Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes

2012 ◽  
Vol 6 (3) ◽  
pp. 137-144 ◽  
Author(s):  
Thiago Cardoso Vale ◽  
Maira Tonidandel Barbosa ◽  
Paulo Caramelli ◽  
Francisco Cardoso
Keyword(s):  
Cognitive Impairment ◽  
Lewy Bodies ◽  
The Elderly ◽  
Pseudobulbar Palsy ◽  
Vascular Parkinsonism ◽  
Community Based ◽  
Diffuse White Matter ◽  
Case Vignettes ◽  
Elderly Cohort ◽  
Brazilian Studies

ABSTRACT Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from cerebrovascular disease. Estimates of the frequency of VP vary greatly worldwide; 3% to 6% of all cases of Parkinsonism are found to have a vascular etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all cases were classified as VP, the third most common form, with a prevalence of 1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3% of VP in the elderly. VP is usually the result of conventional vascular risk factors, particularly hypertension, leading to strategic infarcts of subcortical gray matter nuclei, diffuse white matter ischaemic lesions and less commonly, large vessel infarcts. Patients with VP tend to be older and present with gait difficulties, symmetrical predominant lower-body involvement, poor levodopa responsiveness, postural instability, falls, cognitive impairment and dementia, corticospinal findings, urinary incontinence and pseudobulbar palsy. This article intends to provide physicians with an insight on the practical issues of VP, a disease potentially confounded with vascular dementia, idiopathic Parkinson's disease, dementia with Lewy bodies and other secondary causes of Parkinsonism.

Informant-Reported Discrimination, Dementia, and Cognitive Impairment in Older Brazilians

2021 ◽  
pp. 1-9
Author(s):  
Jose M. Farfel ◽  
Lisa L. Barnes ◽  
Ana Capuano ◽  
Maria Carolina de Moraes Sampaio ◽  
Robert S. Wilson ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Sex Education ◽  
The Elderly ◽  
Structured Interview ◽  
Racially Diverse ◽  
Clinical Dementia Rating ◽  
Community Based ◽  
Poor Cognitive Function ◽  
Diagnosis Of Dementia ◽  
Everyday Discrimination

Background: Self-reported discrimination is a source of psychosocial stress that has been previously associated with poor cognitive function in older African Americans without dementia. Objective: Here, we examine the association of discrimination with dementia and cognitive impairment in racially diverse older Brazilians. Methods: We included 899 participants 65 years or older (34.3% Black) from the Pathology, Alzheimer’s and Related Dementias Study (PARDoS), a community-based study of aging and dementia. A structured interview with informants of the deceased was conducted. The interview included the Clinical Dementia Rating (CDR) Scale for the diagnosis of dementia and cognitive impairment proximate to death and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a second measure of cognitive impairment. Informant-reported discrimination was assessed using modified items from the Major and Everyday Discrimination Scales. Results: Discrimination was reported by informants of 182 (20.2%) decedents and was more likely reported by informants of Blacks than Whites (25.3% versus 17.6%, p = 0.006). Using the CDR, a higher level of informant-reported discrimination was associated with higher odds of dementia (OR: 1.24, 95% CI 1.08 –1.42, p = 0.002) and cognitive impairment (OR: 1.21, 95% CI: 1.06 –1.39, p = 0.004). Similar results were observed using the IQCODE (estimate: 0.07, SE: 0.02, p = 0.003). The effects were independent of race, sex, education, socioeconomic status, major depression, neuroticism, or comorbidities. Conclusion: Higher level of informant-reported discrimination was associated with higher odds of dementia and cognitive impairment in racially diverse older Brazilians.

scholarly journals Progression from normal cognition to mild cognitive impairment in a diverse clinic-based and community-based elderly cohort

2017 ◽  
Vol 13 (4) ◽  
pp. 399-405 ◽  
Author(s):  
Yingjia Chen ◽  
Katherine G. Denny ◽  
Danielle Harvey ◽  
Sarah Tomaszewski Farias ◽  
Dan Mungas ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Community Based ◽  
Elderly Cohort ◽  
Normal Cognition

scholarly journals Features associated with cognitive impairment and dementia in a community-based sample of illiterate elderly aged 75+ years: The Pietà study

2014 ◽  
Vol 8 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Henrique Cerqueira Guimarães ◽  
Jorge Luiz Cascardo ◽  
Rogério Gomes Beato ◽  
Maira Tonidandel Barbosa ◽  
Thais Helena Machado ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Protective Factor ◽  
Brain Aging ◽  
Apoe Genotype ◽  
The Elderly ◽  
Elderly Subjects ◽  
Community Based ◽  
Cross Sectional ◽  
E4 Allele ◽  
Ischemic Attack

ABSTRACT A higher level of educational attainment constitutes a protective factor against cognitive decline in the elderly. Nevertheless, the elements underpinning this association are yet not fully understood. Objective: The primary aim of this study was to compare cognitively impaired illiterate elderly subjects with cognitively preserved counterparts, according to demographics, comorbidities, lifetime habits and APOE genotype. Methods: This is a cross-sectional analysis of the illiterate subset of participants (n=174) from the Pietà study, a community-based survey of successful brain aging conducted in Caeté (MG), Brazil. Subjects were categorized into three diagnostic groups: cognitively normal (CN), cognitive impairment no-dementia (CIND) and dementia. The groups were then compared according to selected variables. Results: Subjects with dementia were older and had an increased prevalence of reported stroke or transient ischemic attack. The three groups did not differ in relation to demographics, prevalence of comorbidities, socioeconomic level, previous occupation profile and APOE-e4 allele frequency. Qualitatively evaluated lifetime habits, such as alcohol consumption, smoking and physical activity engagement were also similar across groups. Conclusion: No associations were found between cognitive impairment/dementia and the variables evaluated in this community-based sample of illiterate elderly.

The validity of brief screening cognitive instruments in the diagnosis of cognitive impairment and dementia after first-ever stroke

2006 ◽  
Vol 18 (2) ◽  
pp. 295-305 ◽  
Author(s):  
Velandai Srikanth ◽  
Amanda G. Thrift ◽  
Jayne L. Fryer ◽  
Michael M. Saling ◽  
Helen M. Dewey ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Operating Characteristic ◽  
The Elderly ◽  
Weighted Sum ◽  
Stroke Patients ◽  
Community Based ◽  
In Series ◽  
Few Data ◽  
State Examination ◽  
Brief Screening

Introduction: Brief cognitive tests such as the Mini-mental State Examination (MMSE) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) have been used to detect cognitive impairment and dementia in studies of stroke patients. However, there are few data on their validity for such use. We have evaluated their validity in detecting cognitive impairment not dementia (CIND) and dementia in a community-based sample of first-ever stroke patients.Methods: The standardized MMSE (S-MMSE) and the 16-item IQCODE were administered to 79 patients 1 year after a first-ever stroke. CIND and dementia were diagnosed independently using a comprehensive cognitive battery. The performances of the two tests were evaluated using receiver operating characteristic (ROC) analyses. Combined performance was evaluated when their scores were used in parallel (the “or rule”), in series (the “and rule”) or as a weighted sum (the “weighted sum rule”).Results: Both tests were extremely poor at detecting CIND individually and in combination. For dementia, at traditional cut-points, the S-MMSE (≤23) was insensitive (0.50, 95% CI 0.16–0.84) and the IQCODE (≥3.30) nonspecific (0.63, 95% CI 0.51–0.75). An acceptable balance between sensitivity and specificity was achieved for dementia using the “or rule” combination, but with only modest positive predictive value.Conclusions: The S-MMSE and the IQCODE were individually poor at detecting CIND and dementia after a nonaphasic first-ever stroke. The combination was useful in detecting dementia but it does not replace the need for detailed neuropsychological tests.

scholarly journals Tooth Loss-associated Cognitive Impairment in the Elderly: A Community-based Study in Japan

2019 ◽  
Vol 58 (10) ◽  
pp. 1411-1416 ◽  
Author(s):  
Hajime Kato ◽  
Yoshimi Takahashi ◽  
Chifumi Iseki ◽  
Ryosuke Igari ◽  
Hidenori Sato ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Tooth Loss ◽  
The Elderly ◽  
Community Based

Mixed Brain Pathology Is the Most Common Cause of Cognitive Impairment in the Elderly

2020 ◽  
Vol 78 (1) ◽  
pp. 453-465
Author(s):  
Irina Alafuzoff ◽  
Sylwia Libard
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Lewy Bodies ◽  
Amyloid Β ◽  
The Elderly ◽  
Systemic Diseases ◽  
Brain Pathology ◽  
Cerebrovascular Lesions ◽  
Peripheral Organs ◽  
Age Related

Background: Systemic diseases, diabetes mellitus (DM), and cardiovascular disease (CaVD) have been suggested being risk factors for cognitive impairment (CI) and/or influence Alzheimer’s disease neuropathologic change (ADNC). Objective: The purpose was to assess the type and the extent of neuropathological alterations in the brain and to assess whether brain pathology was associated with CaVD or DM related alterations in peripheral organs, i.e., vessels, heart, and kidney. Methods: 119 subjects, 15% with DM and 24% with CI, age range 80 to 89 years, were chosen and neuropathological alterations were assessed applying immunohistochemistry. Results: Hyperphosphorylated τ (HPτ) was seen in 99%, amyloid-β (Aβ) in 71%, transactive DNA binding protein 43 (TDP43) in 62%, and α-synuclein (αS) in 21% of the subjects. Primary age related tauopathy was diagnosed in 29% (more common in females), limbic predominant age-related TDP encephalopathy in 4% (14% of subjects with CI), and dementia with Lewy bodies in 3% (14% of subjects with CI) of the subjects. High/intermediate level of ADNC was seen in 47% and the extent of HPτ increased with age. The extent of ADNC was not associated with the extent of pathology observed in peripheral organs, i.e., DM or CaVD. Contrary, brain alterations such as pTDP43 and cerebrovascular lesions (CeVL) were influenced by DM, and CeVL correlated significantly with the extent of vessel pathology. Conclusion: In most (66%) subjects with CI, the cause of impairment was “mixed pathology”, i.e., ADNC combined with TDP43, αS, or vascular brain lesions. Furthermore, our results suggest that systemic diseases, DM and CaVD, are risk factors for CI but not related to ADNC.

scholarly journals First delirium episode in Parkinson’s disease and parkinsonism: incidence, predictors, and outcomes

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Samantha Green ◽  
Sarah L. Perrott ◽  
Andrew McCleary ◽  
Isobel Sleeman ◽  
Jodi Maple-Grødem ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Confidence Interval ◽  
Early Identification ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Atypical Parkinsonism ◽  
Vascular Parkinsonism ◽  
Community Based ◽  
North East

AbstractTo define the incidence, predictors and prognosis of the first hospital delirium episode in Parkinson’s disease (PD) and atypical parkinsonism (AP), we identified the first hospital episode of delirium after diagnosis in the Parkinsonism Incidence in North-East Scotland (PINE) study, a prospective community-based incidence cohort of parkinsonism, using chart-based criteria to define delirium. Of 296 patients (189=PD, 107=AP [dementia with Lewy bodies, progressive supranuclear palsy, multiple system atrophy, vascular parkinsonism]), 152 developed delirium (PD = 98, AP = 54). Incidence of first hospital delirium episode per 100 person years was 8.1 (95% confidence interval [CI] 6.6–9.9) in PD and 18.5 (95% CI 13.9–24.7) in AP. Independent predictors of delirium were atypical parkinsonism (Hazard ratio [HR] vs PD = 2.83 [95% CI 1.60–5.03], age in PD but not in AP (HR for 10-year increase 2.29 [95% CI 1.74–3.02]), baseline MMSE (HR = 0.94 [95% CI 0.89–0.99]), APOE ε4 in PD (HR 2.16 [95% CI 1.15–4.08]), and MAPT H1/H1 in PD (HR 2.08 [95% CI 1.08–4.00]). Hazards of dementia and death after delirium vs before delirium were increased (dementia: HR = 6.93 [95% CI 4.18–11.48] in parkinsonism; death: HR = 3.76 [95% CI 2.65–5.35] in PD, 1.59 [95% CI 1.04–2.42] in AP). Delirium is a common non-motor feature of PD and AP and is associated with increased hazards of dementia and mortality. Whether interventions for early identification and treatment improve outcomes requires investigation.

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