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- Atti, Anna Rita, et al.
(författare)
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Cognitive Impairment after Age 60 : clinical and Social Correlates in the "Faenza Project"
- 2010
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Ingår i: Journal of Alzheimer's Disease. - 1387-2877 .- 1875-8908. ; 21:4, s. 1325-1334
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Tidskriftsartikel (refereegranskat)abstract
- A total of 7,389 dementia-free elderly (60–102 years old) enrolled in the "Faenza Project" (Northern Italy) were clinically evaluated by nurses and physicians with the aim of detecting the independent and combined association of medical and social factors with cognitive status. Cognitive Impairment No Dementia (CIND) was defined for MMSE scores ⩽ 2 standard deviations than the age- and education-corrected mean score obtained by the non-demented persons of the Faenza cohort. Logistic Regression analysis was used to estimate Odds Ratios and 95% Confidence Intervals (OR, 95%CI) for CIND. The diagnostic procedure identified 402 (5.4%) CIND cases. Diabetes (OR, 95%CI=1.6, 1.2–2.2), stroke (OR, 95%CI=1.9, 1.4–2.6), and depressive symptoms (OR, 95%CI=1.9, 1.4–2.7) emerged as the most relevant medical comorbidities of CIND. Low education (OR, 95%CI=1.8, 1.1–2.9), low Socio Economic Status (SES) (OR, 95%CI=1.5, 1.1–2.1), and unmarried status (OR, 95%CI=1.7, 1.2–2.5) were associated with CIND. Medical and social factors were independently related to CIND occurrence. In comparison to subjects without any of the above mentioned conditions, subjects with one medical and one social factor had an OR, 95%CI for CIND equal to 6.0, 2.9–12.4. The strength of the association increased when more of those conditions occurred in combination, suggesting a synergistic effect. Despite some methodological limitations, data from this cross-sectional population-based Italian study show that low education, low SES, unmarried status together with diabetes, stroke, and depressive symptoms are related to cognitive impairment in the general population. The interaction of medical and social factors further increases the probability of CIND.
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| 2. |
- De Ronchi, Diana
(författare)
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Education and dementing disorders : the role of schooling in dementia and cognitive impairment
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This doctoral thesis aimed to investigate the complex relationship between education, dementias, and cognitive impairment. Two different databases were used: the Faenza and the AIDS Projects. The Faenza Project is a longitudinal study on ageing and dementia, targeting 7,930 inhabitants of Faenza (including the village of Granarolo), Italy, aged 61 years and older in 1991. The study population derives from an area which has been one of the wealthiest in Italy since the beginning of the 1950s, but with a high percentage of noneducated subjects. Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised diagnostic criteria were used for the clinical diagnosis of dementia, while a person was classified as affected by cognitive impairment, no dementia if he/she scored two or more standard deviations lower than the mean score of the corrected Mini-Mental State Examination calculated among the nondemented people. The AIDS Project is a longitudinal study on HIV-1-related cognitive impairment. The study sample included 282 consecutive subjects examined at the Division of Infectious Diseases, University of Bologna, Italy. HIV cognitive impairment was defined as poor performance on at least two of the seven neuropsychological tests included in the neuropsychological battery. Poor performance in a test was considered as a score of two or more standard deviations lower than the mean of the seronegative group in the corresponding risk behavior strata (injecting drug users, hemophiliacs, and other risk behaviors). Data were analyzed with logistic regression models. The major findings from the five research papers included in this thesis are summarized below. Study I. In the subpopulation of Granarolo, the relationship between Alzheimer's disease (AD) and other dementias with education was examined. Having no education was associated with dementia independent of all other putative risk factors (OR 4.7; 95% CI=2.3-9.6). This association was stronger among younger old persons, and decreased with increasing age. Similar findings were found for AD and Vascular dementia, separately. Study II. We examined the relationship between HIV-1-related cognitive impairment and education, controlling also for risk behaviors and clinical status. Low education was a strong risk factor for cognitive impairment in HIV-1-seropositive persons: adjusted OR in subjects with less than six years of education was 18.9 (95% Cl=3.7-97.6), and 1.3 (95% Cl=0.5-3.2) in subjects with five to eight years of education, when compared to subjects with nine+ years of schooling. Study III. The effect of education on both cognitive impairment and dementia was investigated in the Faenza cohort. Very low education was a major determinant of both dementia and cognitive impairment. No education was associated with an increased risk of both CIND (OR 16.7; 95% CI=11.2-25.0) and dementia (OR 10.9; 95% G=7.0-16.7) with a dose-response relationship. Study IV. We found that stroke does not completely explain the association between low education and dementia or cognitive impairment. The effect of stroke on dementia was stronger among the higher educated subjects (four+ years of schooling, RR 6.5; 95% CI=4.98.2) as well as among the younger old. These findings support the hypothesis that having a stroke nullifies the beneficial effect of high education and younger age against dementia and cognitive impairment. Study V. Low education and low occupation-based socioeconomic status (SES) were both independent risk factors for dementia and cognitive impairment. Subjects with low education and low SES had the highest risk of dementia (OR 5.1, 95% CI=3.5-7.3) and cognitive impairment (OR 5.2; 95% CI=3.6-7.6). These findings suggest that low occupation-based SES is not a mediator for the association between low education and dementia or cognitive impairment. In summary, mental activity stimulated by education during childhood, could be a possible mechanism explaining how high education protects against cognitive decline and dementia. The cognitive reserve hypothesis could provide the biological plausibility for this theory. The additive dementia risk observed in subjects with both low education and low SES implies that exposure acting at adult life might increase the risk due to education related exposure in childhood. However, the protective effect of high SES during adult life might balance the risk given by a low education.
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| 3. |
- Prusakov, Pavel, et al.
(författare)
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A global point prevalence survey of antimicrobial use in neonatal intensive care units : The no-more-antibiotics and resistance (NO-MAS-R) study
- 2021
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Ingår i: eClinicalMedicine. - : Elsevier. - 2589-5370. ; 32
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Tidskriftsartikel (refereegranskat)abstract
- Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts.Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality.Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02).Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide.
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| 4. |
- von Strauss, Eva, et al.
(författare)
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Aging and the occurrence of dementia : Findings From a Population-Based Cohort With a Large Sample of Nonagenarians
- 1999
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Ingår i: Archives of Neurology. - : American Medical Association. - 0003-9942 .- 1538-3687. ; 56:5, s. 587-592
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Tidskriftsartikel (refereegranskat)abstract
- Context In spite of numerous studies on the occurrence of dementia, many questions remain, such as the relation between age, aging, and dementing disorders. This question is relevant both for understanding the pathogenetic mechanism of the dementias and for the public health prospective because of the increasing number of 85-year-old or older persons in our population.Objective To estimate the occurrence of dementia in the very old, including nonagenarians, in relation to age, gender, and different dementia types.Design An epidemiological survey where all participants were clinically examined by physicians, assessed by psychologists, and interviewed by nurses. The Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria for dementia were followed. A category of "questionable dementia" was added when all criteria were not fulfilled. A double diagnostic procedure was used for all subjects.Setting Community-based population, including all inhabitants of 2 areas in central Stockholm, Sweden (N=1848).Participants Of the 1848 subjects in the study population, 168 (9.1%) had died and 56 (3%) moved before examination. Of the remaining subjects, 1424 (87.7%) were examined, and the refusal rate was 12.3%.Main Outcome Measures Age- and gender-specific prevalence figures, and gender- and education-adjusted odds ratios were used.Results At the end of the diagnostic procedure, 358 clinically definite cases of dementia and 101 questionable cases of dementia were identified. Alzheimer disease (AD) contributed to 76.5%, and vascular dementia (VaD) to 17.9%. The prevalence of dementia increases from 13% in the 77- to 84-year-old subjects to 48% among persons 95 years and older (from 18% to 61% when questionable cases were included). The odds ratio for subjects 90 to 94 years and 95 years and older in comparison with 77- to 84-year-old subjects was 3.7 (95% confidence interval [CI], 2.7-5.1) and 6.5 (95% CI, 3.9-10.8) for dementia, 4.8 (95% CI, 3.3-7.0) and 8.0 (95% CI, 4.6-14.0) for persons with AD, 2.3 (95% CI, 1.3-4.2) and 4.6 (95% CI, 1.9-11.2) for VaD, respectively.Conclusions Dementia prevalence continues to increase even in the most advanced ages. This increase is especially evident among women and is more clear for AD. We believe that our prevalence data reflect the differential distribution of dementia risk.
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