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To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012-2015. The MHAS is a longitudinal study of adults aged ≥ 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in ≥1 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 ±13.2 years, 35.8% were female, and the mean educational level was 5.8 ±5.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63-1.64, p< 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.

The role of ABO gene polymorphisms in acute coronary syndrome (ACS) and lipid metabolism is increasingly recognized. We investigated whether ABO gene polymorphisms are significantly associated with ACS and the plasma lipid profile. Six ABO gene polymorphisms (rs651007 T/C, rs579459 T/C, rs495928 T/C, rs8176746 T/G, rs8176740 A/T, and rs512770 T/C) were determined by 5’exonuclease TaqMan assays in 611 patients with ACS and 676 healthy controls. The results demonstrated that the rs8176746 T allele was associated with a lower risk of ACS under the co-dominant, dominant, recessive, over-dominant, and additive models (P = 0.0004, P = 0.0002, P = 0.039, P = 0.0009, and P = 0.0001, respectively). Furthermore, under co-dominant, dominant, and additive models, the rs8176740 A allele was associated with a lower risk of ACS (P = 0.041, P = 0.022, and P = 0.039, respectively). On the other hand, the rs579459 C allele was associated with a lower risk of ACS under the dominant, over-dominant, and additive models (P = 0.025, P = 0.035, and P = 0.037, respectively). In a subanalysis performed with the control group, rs8176746 T and rs8176740 A alleles were associated with low systolic blood pressure and with both high high-density lipoprotein-cholesterol (HDL-C) and low triglyceride plasma concentrations, respectively. In conclusion, ABO gene polymorphisms were associated with a lower risk of ACS, and lower systolic blood pressure and plasma lipid levels, suggesting a causal relationship between ABO blood groups and the incidence of ACS.

Aims: To develop and validate a new instrument to measure satisfaction with integral care (doctor–nurse) of the patient with type 2 diabetes mellitus, considering expectations-experiences together for the primary level of care. Methods: The instrument was constructed with questions regarding integral care to measure the satisfaction of the diabetes patient and was classified into four domains. The validity of the content was done through a panel of experts, apparent validity through a focus group, the validity of the construct through analysis of the main components and confirmatory factorial analysis, instrument reliability with internal consistency, determined by Cronbach alpha and temporal stability (test-retest). Results: The reliability of the questionnaire was 0.942. The intraclass correlation coefficient was 0.849. Validity of the construct showed acceptable goodness-of-fit and factorial structure with four factors: communication, empathy, technical care, care continuity, and 24 items for each domain, giving a Kayser–Meyer–Olkin index above 0.80 and a total variance above 73%. Conclusions: The instrument is reliable and is also valid in terms of up into construct and content to evaluate satisfaction. Practice Implications: In addition, these results allow to have elements for the design of strategies aimed at improving the relationship of health personnel with the patient.

ObjectiveEvidence supports the important role of neuroinflammation in some types of dementia. This study aimed to evaluate the effect of epistasis of gene cytokines such as interleukin (IL)-α, IL-6, tumor necrosis factor (TNFα), and interferon-gamma (IFN-γ) on the susceptibility to the development of dementia.Materials and methodsIn the study, 221 patients diagnosed with dementia and 710 controls were included. The multifactor-dimensionality reduction (MDR) analysis was performed to identify the epistasis between SNP located in genes of IL-α (rs1800587), IL-6 (rs1800796), TNFα (rs361525 and rs1800629), and IFNγ (rs2069705). The best risk prediction model was identified based on precision and cross-validation consistency.ResultsMultifactor-dimensionality reduction analysis detected a significant model with the genes TNFα, IFNγ, IL1α, and IL6 (prediction success: 72%, p < 0.0001). When risk factors were analyzed with these polymorphisms, the model achieved a similar prediction for dementia as the genes-only model.ConclusionThese data indicate that gene–gene interactions form significant models to identify populations susceptible to dementia.

Background: The pathogenesis of mild cognitive impairment (MCI) is multifactorial and includes the presence of genetic variants such as the ε4 allele of the apolipoprotein E gene (APOE-ε4). Association between the APOE-ε4 carrier status and deleterious structural and functional changes on magnetic resonance imaging (MRI) has been previously described in individuals with Alzheimer’s disease. However, the central nervous system changes may possibly develop in earlier stages of cognitive impairment, as reflected in MCI. Objective: The objective of the study was to determine the association between APOE-ε4 carrier status and qualitative changes on MRI (medial temporal and parietal atrophy), as well as the detection of white matter hyperintensities (WMH) in older adults with MCI, in the memory clinic of a tertiary care hospital in Mexico City. Methods: A cross-sectional study of 72 adults aged 60 years or above who underwent an exhaustive clinical, neuroimaging, and neuropsychological evaluation. Multivariate logistic regression models were constructed to determine the association between APOE-ε4 carrier status and qualitative/quantitative changes on MRI. Results: Mean age was 75.2 years ( 7.2) and 64% were female. Twenty-one participants were cognitively normal and 51 had MCI. Almost 56% were APOE-ε4 carriers and were associated with medial-temporal atrophy according to the Scheltens scale (odds ratio [OR]: 20.0, 95% confidence intervals [CI]: 3.03-131.7), parietal atrophy according to the Koedam’s score (OR: 6.3; 95% CI 1.03-39.53), and WMH according to the Fazekas scale (OR: 11.7, 95% CI: 1.26-108.2), even after adjusting for age, educational level, and cardiovascular risk factors. Conclusion: The APOE-ε4 carrier status was associated with medial temporal and parietal atrophy, as well as WMH. Our findings support the hypothesis suggesting the contribution of this genotype to neurodegeneration and cerebral vascular pathology.

Background/Aim Medication prescription is a fundamental component in the care of the elderly. Several characteristics of aging and geriatric medicine affect prescriptions for these people and make the selection of drug therapy a difficult and complex process. The objective of this study is to develop a geriatric portal for asynchronous online counseling (AGAlink) for use by physicians specializing in family medicine to reduce medication problems among older adult patients in the first level of care. Method A qualitative study was carried out in the first level of care at the Mexican Institute of Social Security (IMSS), 31 family doctors were interviewed to identify attitudes, preferences about the use of the AGAlink geriatric portal, as well as their recommendations for the implementation of this tool in their daily practice. For the analysis of the data obtained, a qualitative thematic content analysis was used. Results 90% of the physicians used the geriatric portal outside office hours without the need for the patient to be present. The perception of the physician towards the use of the AGAlink geriatric portal was favorable, provided relevant information and had several positive effects on the process of care for medical prescription. The barriers identified to accept the change in medication were not having the proposed therapeutic option, lack of any laboratory analysis, continuing to consider their experience for the prescription of the medication. Conclusions The AGAlink geriatric portal was a tool that was well received by physicians who expressed a positive attitude, considered an investment of a short time that allowed them to update and learn about strategies to reduce the prescription problems presented among the elderly population. However, the main barrier was the use of technology, especially in the doctors with more seniority in the service.

Background/aimMedication prescription is a fundamental component in the care of the elderly. Several characteristics of aging and geriatric medicine affect prescriptions for these people and make the selection of drug therapy a difficult and complex process. The objective of this study is to develop a geriatric portal for asynchronous online counseling (AGAlink) for use by physicians specializing in family medicine to reduce medication problems among older adult patients in the first level of care.MethodA qualitative study was carried out in the first level of care at the Mexican Institute of Social Security (IMSS), 31 family doctors were interviewed to identify attitudes, preferences about the use of the AGAlink geriatric portal, as well as their recommendations for the implementation of this tool in their daily practice. For the analysis of the data obtained, a qualitative thematic content analysis was used.Results90% of the physicians used the geriatric portal outside office hours without the need for the patient to be present. The perception of the physician towards the use of the AGAlink geriatric portal was favorable, provided relevant information and had several positive effects on the process of care for medical prescription. The barriers identified to accept the change in medication were not having the proposed therapeutic option, lack of any laboratory analysis, continuing to consider their experience for the prescription of the medication.ConclusionsThe AGAlink geriatric portal was a tool that was well received by physicians who expressed a positive attitude, considered an investment of a short time that allowed them to update and learn about strategies to reduce the prescription problems presented among the elderly population. However, the main barrier was the use of technology, especially in the doctors with more seniority in the service.

Abstract Frailty is a geriatric syndrome, characterized by a loss in functional reserve with an increase in morbidity and mortality. There are no reports that link the genetic polymorphisms between interleukin 10 (IL10) and frailty; for this reason, our objective was used to analyze the role of the polymorphisms of IL10 (rs1800896, rs1800871) in the susceptibility to frailty in a Mexican population. Our study included 984 participants divided into 368 nonfrail, 309 prefrail, and 307 frail. The models for the polymorphisms rs1800896 and rs1800871 were recessive models in association with frailty (OR = 2.3, CI 95% = 1.6–3.2; OR = 1.53, CI 95% = 1.0–2.6), respectively. Two risk haplotypes were identified: ACG and CCG (p

Mild cognitive impairment (MCI) (amnestic or non-amnestic) has different clinical and neuropsychological characteristics, and its evolution is heterogeneous. Cardiovascular risk factors (CVRF), such as hypertension, diabetes, or dyslipidemia, and the presence of the Apolipoprotein E ε4 (ApoE ε4) polymorphism have been associated with an increased risk of developing Alzheimer’s disease (AD) and other dementias but the relationship is inconsistent worldwide. We aimed to establish the association between the ApoE ε4 carrier status and CVRF on MCI subtypes (amnestic and non-amnestic) in Mexican older adults. Cross-sectional study including 137 older adults (n = 63 with normal cognition (NC), n = 24 with amnesic, and n = 50 with non-amnesic MCI). Multinomial logistic regression models were performed in order to determine the association between ApoE ε4 polymorphism carrier and CVRF on amnestic and non-amnestic-MCI. ApoE ε4 carrier status was present in 28.8% participants. The models showed that ApoE ε4 carrier status was not associated neither aMCI nor naMCI condition. The interaction term ApoE ε4 × CVRF was not statistically significant for both types of MCI. However, CVRF were associated with both types of MCI and the association remained statistically significant after adjustment by sex, age, and education level. The carrier status of the ApoE genotype does not contribute to this risk.

OBJECTIVE: To identify the main severe potential drug-drug interactions in older adults with dementia and to examine the factors associated with these interactions. METHOD: This was a cross-sectional study. The enrolled patients were selected from six geriatrics clinics of tertiary care hospitals across Mexico City. The patients had received a clinical diagnosis of dementia based on the current standards and were further divided into the following two groups: those with severe drug-drug interactions (contraindicated/severe) (n=64) and those with non-severe drug-drug interactions (moderate/minor/absent) (n=117). Additional socio-demographic, clinical and caregiver data were included. Potential drug-drug interactions were identified using Micromedex Drug Reax 2.0® database. RESULTS: A total of 181 patients were enrolled, including 57 men (31.5%) and 124 women (68.5%) with a mean age of 80.11±8.28 years. One hundred and seven (59.1%) patients in our population had potential drug-drug interactions, of which 64 (59.81%) were severe/contraindicated. The main severe potential drug-drug interactions were caused by the combinations citalopram/anti-platelet (11.6%), clopidogrel/omeprazole (6.1%), and clopidogrel/aspirin (5.5%). Depression, the use of a higher number of medications, dementia severity and caregiver burden were the most significant factors associated with severe potential drug-drug interactions. CONCLUSIONS: Older people with dementia experience many severe potential drug-drug interactions. Anti-depressants, antiplatelets, anti-psychotics and omeprazole were the drugs most commonly involved in these interactions. Despite their frequent use, anti-dementia drugs were not involved in severe potential drug-drug interactions. The number and type of medications taken, dementia severity and depression in patients in addition to caregiver burden should be considered to avoid possible drug interactions in this population.

Recent studies have shown that P-selectin promotes the early formation of atherosclerotic plaque. The aim of the present study was to evaluate whether the SELP gene single nucleotide polymorphisms (SNPs) are associated with presence of acute coronary syndrome (ACS) and with plasma P-selectin levels in a case-control association study. The sample size was estimated for a statistical power of 80%. We genotyped three SELP (SELP Ser290Asn, SELP Leu599Val, and SELP Thr715Pro) SNPs using 5’ exonuclease TaqMan assays in 625 patients with ACS and 700 healthy controls. The associations were evaluated with logistic regressions under the co-dominant, dominant, recessive, over-dominant and additive inheritance models. The genotype contribution to the plasma P-selectin levels was evaluated by a Student’s t-test. Under different models, the SELP Ser290Asn (OR = 0.59, pCCo-Dominant = 0.047; OR = 0.59, pCDominant = 0.014; OR = 0.58, pCOver-Dominant = 0.061, and OR = 0.62, pCAdditive = 0.015) and SELP Thr715Pro (OR = 0.61, pCDominant = 0.028; OR = 0.63, pCOver-Dominant = 0.044, and OR = 0.62, pCAdditive = 0.023) SNPs were associated with a lower risk of ACS. In addition, these SNPs were associated with low plasma P-selectin levels. In summary, this study established that the SELP Ser290Asn and SELP Thr715Pro SNPs are associated with a lower risk of developing ACS and with decreased P-selectin levels in plasma in a Mexican population.

La depresión es el trastorno mental que se presenta con mayor frecuencia en los adultos mayores en el mundo. Es imperante identificar oportunamente los posibles casos de depresión en los adultos mayores a partir de instrumentos que permitan obtener información relevante de forma rápida (tiempo de aplicación), y eficiente. El presente estudio ha permitido determinar las propiedades psicométricas de la versión reducida de la Escala de Depresión del Centro para Estudios Epidemiológicos (CES-D, 7 items) en adultos mayores y su capacidad de discriminación de síntomas clínicamente significativos de depresión en presencia de otras condiciones (validez de constructo); frente a la versión revisada (CES-DR, 35 items) y el diagnóstico del médico geriatra. Los resultados obtenidos demuestran que la versión reducida del CES-D (7 ítems) presenta aceptables propiedades psicométricas y es una herramienta útil para el cribado de la presencia de signos clínicamente significativos de depresión en adultos mayores mexicanos.

Background: Frailty, a state of increased vulnerability, could play a role in the progression of vascular dementia. We aim to describe the changes in cerebrovascular reactivity of older adults with frailty and vascular-type mild cognitive impairment (MCIv). Methods: This was a cross-sectional study. A comprehensive geriatric assessment, neuropsychological evaluation, and transcranial Doppler ultrasound (TCD) was performed on 180 participants who were allocated into four groups: healthy (n = 74), frail (n = 40), MCIv (n = 35), and mixed (frail + MCIv) (n = 31). ANOVA and Kruskal−Wallis tests were used for the analysis of continuous variables with and without normal distribution. Multinomial logistic regression was constructed to identify associated covariates. Results: Subjects in the mixed group, compared to healthy group, were older (75.0 ± 5.9 vs 70.3 ± 5.9 years; p < 0.001), showed lower education (9.3 ± 6.4 vs 12.2 ± 4.0 years; p = 0.054), greater frequency of diabetes (42% vs 12%; p = 0.005), worse cognitive performance (z = −0.81 ± 0.94), and reduced left medial-cerebral artery cerebrovascular reactivity (0.43 ± 0.42 cm/s). The mixed group was associated with age (odds ratio (OR) 1.16, 95% Confidence Interval (CI) = 1.06−1.27; p < 0.001), diabetes (OR 6.28, 1.81−21.84; p = 0.004), and Geriatric Depression Scale (GDS) score (OR 1.34, 95% CI = 1.09−1.67; p = 0.007). Conclusions: Frailty among older adults was associated with worse cognitive performance, diabetes, and decreased cerebral blood flow.

OBJETIVO: Evaluar el impacto del programa Atención Domiciliaria al Enfermo Crónico (ADEC) comparado con la atención habitual (AH) a ancianos con dependencia funcional, derechohabientes del Instituto Mexicano del Seguro Social (IMSS). MATERIAL Y MÉTODOS: Cohorte prospectiva a tres meses a partir del egreso hospitalario en dos hospitales de la Ciudad de México. Se ingresaron 130 ancianos con dependencia funcional, 70 insertados al programa ADEC y 60 con atención habitual. Se midió impacto en reingresos hospitalarios y calidad de vida a partir de la escala Perfil de Impacto de la Enfermedad (SIP, por sus siglas en inglés). RESULTADOS: La edad promedio de los ancianos fue de 74 años (61/103) y 60% fueron mujeres. El principal diagnóstico fue enfermedad vascular cerebral (EVC) (30.77%). El grupo de ADEC mejoró la calidad de vida en la dimensión psicosocial [46.26 (±13.85) comparado con 29.45 (±16.48) vs. 47.03 (±16.47) a 42.36 (±16.35) p0.05). CONCLUSIONES: El programa mejoró la dimensión psicosocial de calidad de vida.OBJECTIVE: To evaluate the impact of the ADEC program (acronym in Spanish) as compared with the typical care provided to disabled elderly affiliated with the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: Prospective cohort at three months after discharge from two general hospitals in Mexico City. A total of 130 patients with functional dependency were studied, 70 in the ADEC program and 60 with typical care. Impact was measured using hospital readmissions and quality of life based on the Sickness Impact Profile (SIP). RESULTS: Average age was 74 (61/103) years and 60% were women. The main diagnosis was cerebrovascular disease (30.77%). The quality of life in the psychosocial dimension improved for the ADEC group (from 46.26 (±13.85) to 29.45(±16.48) as compared with 47.03 (±16.47) to 42.36 (±16.35) for those receiving typical care (p0.05). CONCLUSIONS: HC program improved the psychosocial dimension of quality of life.

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5% of the total variance and nine factors that explained 57.9% in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82% and a specificity of 49.2%; GDS reported 53.8% sensitivity and 78.9% specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.RESUMEN OBJETIVO: Determinar las propiedades psicométricas de las escalas CES-DR y GDS para depresión en población anciana y compararlas con el diagnóstico clínico psiquiátrico. MATERIAL Y MÉTODOS: La primera fase consistió en entrevistas en casa para determinar las propiedades psicométricas. En la segunda fase, los psiquiatras condujeron entrevistas diagnósticas. La muestra consistió en 534 participantes de 60 años y más asegurados por el Instituto Mexicano del Seguro Social. RESULTADOS: Primera fase: Alfa de Cronbach para el GDS y CES-DR fue de 0.87 y 0.86, respectivamente. El análisis factorial del GDS reportó ocho factores que explicaron 53.5% de la varianza, comparado con nueve del CESDR que explicaron 57.9%. Segunda fase: Comparado con el diagnóstico psiquiátrico, el CES-DR reportó una sensibilidad de 82% y una especificidad de 49.2% comparado con 53.8% y 78.9%, respectivamente del GDS. CONCLUSIONES: Las escalas CES-DR y GDS tienen consistencia y adecuada validez pero el CES-DR reporta más alta sensibilidad.

OBJETIVO: Evaluar el efecto que tiene el estado de la dentición en la capacidad de los ancianos para desempeñar sus actividades habituales en los últimos seis meses. MATERIAL Y MÉTODOS: Estudio transversal en ancianos derechohabientes del Instituto Mexicano del Seguro Social del suroeste de la Ciudad de México. Se realizaron entrevistas domiciliarias para recabar datos sociodemográficos, utilización de los servicios de salud bucodental, problemas para realizar actividades regulares y su relación con el estado de la dentición en los últimos seis meses, mediante el índice OIDP (Oral Impacts on Daily Performances). Con posterioridad, tres profesionales de la salud bucodental, capacitados para determinar el estado de la dentición de acuerdo con los criterios de la Organización Mundial de la Salud, realizaron un examen clínico. RESULTADOS: Se estudió a 540 ancianos. La prevalencia de pacientes geriátricos con problemas para llevar a cabo sus actividades habituales fue de 21.5%. Los principales problemas en las actividades habituales fueron comer (14.4%), hablar (8.7%), incapacidad de no irritarse (5.4%), lavarse los dientes (5%) e imposibilidad de disfrutar el contacto con la gente (4.4 %). Existe una correlación del OIDP positiva entre el número de dientes perdidos y el índice CPO-D (pOBJECTIVE: The aim of this study was to evaluate the effect of dental state on the capacity of elderly individuals to carry out their daily activities during the previous six months. MATERIAL AND METHODS: A transversal study was conducted in the Mexican Institute of Social Security (IMSS) with insured elderly persons residing in southwestern Mexico City. Home interviews were conducted to gather sociodemographic data, data on the use of oral health services, problems in carrying out daily activities, and their relationship with the state of dentition over the past six months, utilizing the Oral Impacts on Daily Performance (OIDP) index. Later, three oral health professionals trained in determining the state of dentition according to World Health Organization (WHO) criteria performed a clinical examination on each elderly subject. RESULTS: A total of 540 elderly individuals were studied. The prevalence of elderly persons with problems in carrying out their daily activities was 21.5%. The main problems in daily activities were eating (14.4%), speaking (8.7%), not becoming irritated (5.4%), brushing their teeth(5%), and inability to enjoy contact with people (4.4%). There is a positive OIDP correlation between number of teeth lost and the decayed, missing, filled teeth(DMFT) index (p