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      Factores de riesgo asociados a deterioro cognitivo en adultos mayores: estudio transversal Translated title: Risk factors associated with cognitive impairment in aged: Cross-sectional study

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          Resumen

          Introducción:

          con el aumento en la esperanza de vida las condiciones relacionadas con mayor edad incrementaron su incidencia; una de estas patologías es el deterioro cognitivo (DC) que presenta una prevalencia de hasta el 28%, hoy en día se conocen condiciones que aumentan la presencia de DC. Sin embargo, existe controversia sobre los factores que aumentan el riesgo para su presencia.

          Objetivo:

          determinar los factores asociados al deterioro cognitivo en adultos mayores.

          Material y métodos:

          se realizó un estudio transversal, analítico, observacional, retroprolectivo que incluyó a adultos ≥ 65 años, sin antecedente de evento vascular cerebral o traumatismo craneoencefálico. Se analizaron factores demográficos, el DC se evaluó con la prueba Mini-Mental. Para el análisis estadístico se usó razón de momios (RM) e intervalo de confianza al 95% (IC95%) para cada factor y como análisis multivariado, regresión logística múltiple.

          Resultados:

          se incluyeron 420 adultos mayores, de los cuales el 61% eran mujeres, el 32.6% tenían edad > 75 años, el 84.5% con escolarización < 9 años. En la regresión logística múltiple los siguientes fueron factores independientes para la presencia de DC leve: la dependencia de actividades básicas de la vida diaria (ABVD), ausencia de estimulación cognitiva, edad > 75 años, polifarmacia y descontrol de tensión arterial.

          Conclusiones:

          la dependencia de ABVD, ausencia de estimulación cognitiva, edad > 75 años, polifarmacia y descontrol de la tensión arterial son factores de riesgo asociados al DC en adultos mayores.

          Abstract

          Background:

          With the increase in life expectancy, conditions related to older age have increased in incidence, one of these pathologies is Cognitive Impairment (CI), which has a prevalence of up to 28%, conditions that increase the presence of CI are known. However, there is controversy about the factors that increase the risk of CI.

          Objective:

          To determine the factors associated with cognitive impairment in older adults.

          Material and methods:

          We conducted a cross-sectional, analytical, observational, retroprolective study that included adults ≥65 years of age, with no history of cerebral vascular event, cranioencephalic trauma. Demographic factors were analyzed, CI was assessed with the Mini Mental State Examination test. For statistical analysis we used Odds Ratio (OR) and 95% confidence interval (95% CI) for each factor and multiple logistic regression as multivariate analysis.

          Results:

          420 older adults were included, 61% were women, 32.6% with age >75 years, 84.5% with schooling <9 years, in the multiple logistic regression the following were independent factors for the presence of mild CI: dependence on basic activities of daily living (ADLs) with OR 5.88, absence of cognitive stimulation RM 4.50, age >75 years OR 2.92, polypharmacy OR 2.16, uncontrolled blood pressure OR 1.92.

          Conclusions:

          ADLs dependence, absence of cognitive stimulation, age >75 years, polypharmacy and uncontrolled blood pressure are risk factors associated with CI in older adults.

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          Most cited references26

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          Functional vascular contributions to cognitive impairment and dementia: mechanisms and consequences of cerebral autoregulatory dysfunction, endothelial impairment, and neurovascular uncoupling in aging

          Increasing evidence from epidemiological, clinical and experimental studies indicate that age-related cerebromicrovascular dysfunction and microcirculatory damage play critical roles in the pathogenesis of many types of dementia in the elderly, including Alzheimer's disease. Understanding and targeting the age-related pathophysiological mechanisms that underlie vascular contributions to cognitive impairment and dementia (VCID) are expected to have a major role in preserving brain health in older individuals. Maintenance of cerebral perfusion, protecting the microcirculation from high pressure-induced damage and moment-to-moment adjustment of regional oxygen and nutrient supply to changes in demand are prerequisites for the prevention of cerebral ischemia and neuronal dysfunction. This overview discusses age-related alterations in three main regulatory paradigms involved in the regulation of cerebral blood flow (CBF): cerebral autoregulation/myogenic constriction, endothelium-dependent vasomotor function, and neurovascular coupling responses responsible for functional hyperemia. The pathophysiological consequences of cerebral microvascular dysregulation in aging are explored, including blood-brain barrier disruption, neuroinflammation, exacerbation of neurodegeneration, development of cerebral microhemorrhages, microvascular rarefaction, and ischemic neuronal dysfunction and damage. Due to the widespread attention that VCID has captured in recent years, the evidence for the causal role of cerebral microvascular dysregulation in cognitive decline is critically examined.
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            Cognitive impairment and risk of cardiovascular events and mortality.

            Cognitive impairment may increase the risk of all cardiovascular (CV) events. We prospectively evaluated the independent association between Mini-Mental State Examination (MMSE) score and myocardial infarction, stroke, hospital admission for heart failure and mortality, and their CV composite (major CV events), in a large high-risk CV population. Mini-Mental State Examination was recorded at baseline in 30 959 individuals enrolled into two large parallel trials of patients with prior cardiovascular disease or high-risk diabetes and followed for a median of 56 months. We used a Cox regression model to determine the association between MMSE score and incident CV events and non-CV mortality, adjusted for age, sex, education, history of vascular events, dietary factors, blood pressure, smoking, glucose, low-density lipoprotein, high-density lipoprotein, CV medications, exercise, alcohol intake pattern, depression, and psychosocial stress. Patients were categorized into four groups based on baseline MMSE; 30 (reference), 29-27, 26-24, and <24. Compared with patients with an MMSE of 30 (n = 9624), those with scores of 29-27 [n = 13 867; hazard ratio (HR) 1.08; 95% confidence intervals (CI) 1.01-1.16], 26-24 (n = 4764; HR: 1.15; 95% CI: 1.05-1.26) and <24 (n = 2704; HR: 1.35; 95% CI: 1.21-1.50) had a graded increase in the risk of major vascular events (P < 0.0001). Mini-Mental State Examination score was significantly associated with each of the individual components of the composite, except myocardial infarction. There was also no association between baseline MMSE and hospitalization for unstable or new angina. Within MMSE domains, impairments in orientation to place (HR: 1.52; 1.25-1.85), attention-calculation (HR: 1.10; 1.02-1.18), recall (HR: 1.10; 1.04-1.16), and design copy (HR: 1.15; 1.06-1.24) were the most predictive of major vascular events and mortality. The magnitude of increased risk of CV events associated with an MMSE <24 was similar to a previous history of stroke. In people at increased CV risk, impairments on baseline cognitive testing are associated with a graded increase in the risk of stroke, congestive heart failure, and CV death, but not coronary events. An MMSE score of <24 increased CV disease risk to the same extent as a previous stroke.
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              Risk Factors for Mild Cognitive Impairment, Dementia and Mortality: The Sydney Memory and Ageing Study.

              The nature and commonality of late-life risk factors for mild cognitive impairment (MCI), dementia, and mortality remain unclear. Our aim was to investigate potential risk factors, simultaneously in a single cohort including many individuals initially with normal cognition and followed for 6 years.
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                Author and article information

                Journal
                Rev Med Inst Mex Seguro Soc
                Rev Med Inst Mex Seguro Soc
                Rev Med Inst Mex Seguro Soc
                Revista Médica del Instituto Mexicano del Seguro Social
                Instituto Mexicano del Seguro Social (Ciudad de México, México )
                0443-5117
                2448-5667
                2023
                2023
                : 61
                : Suppl 3
                : S395-S406
                Affiliations
                [1] originalInstituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 55, Departamento de Enseñanza. Zumpango, Estado de México, México orgnameInstituto Mexicano del Seguro Social México
                [2] originalInstituto Politécnico Nacional, Facultad de Medicina, Unidad de Posgrado. Ciudad de México, México orgnameInstituto Politécnico Nacional México
                [3] originalInstituto Mexicano del Seguro Social, Órgano de Operación Administrativa Desconcentrada Regional Estado de México Oriente, Jefatura de Prestaciones Médicas. Naucalpan, Estado de México, México orgnameInstituto Mexicano del Seguro Social México
                [4] originalInstituto Mexicano del Seguro Social, Unidad de Medicina Familiar No. 52, Consulta Externa. Cuautitlán Izcalli, Estado de México, México orgnameInstituto Mexicano del Seguro Social México
                Author notes
                Author information
                https://orcid.org/0000-0002-8436-7015
                https://orcid.org/0000-0002-4943-4374
                https://orcid.org/0000-0003-3325-1458
                https://orcid.org/0000-0002-4009-6209
                Article
                10.5281/zenodo.8319815
                10732693
                37934797
                28a5503a-1317-44bc-8bf2-91c65cc985c3
                Licencia CC 4.0 (BY-NC-ND) © 2023 Revista Médica del Instituto Mexicano del Seguro Social.

                Esta obra está bajo una Licencia Creative Commons Atribución-NoComercial-SinDerivar 4.0 Internacional.

                History
                : 28 December 2022
                : 15 February 2023
                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 26
                Categories
                Aportación Original

                anciano,factores de riesgo,disfunción cognitiva,estudios transversales,aged,risk factors,cognitive dysfunction,cross-sectional studies

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