Demência, homocisteína, proteína C reativa, HDL-Colesterol, função renal e Vitamina D em idosos longevos - análise de cluster

• Autor(a) principal: Laks, Renato [UNIFESP]
• Data de Publicação: 2016
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4630290; http://repositorio.unifesp.br/handle/11600/46182
• topic: Aged; 80 and over; Homocysteine; C-reactive protein; Cholesterol; HDL; Vitamin D; Dementia; Idoso de 80 anos ou mais; Homocisteína; Proteína c-reativa; HDL-Colesterol; Vitamina D; Demência

Introduction: Identifying the risk factors for dementia is very important in order to avoid the onset of illness. Some risk markers such as homocysteine, 25 (OH) VITD, CRP, HDL-Col and renal function are very prevalent in the elderly, potentially modifiable and can be risk factors for dementia. Objective: To evaluate through cluster analysis the relationship between cognitive function and the risk markers homocysteine, C-reactive protein, renal function, 25-hydroxyvitamin D3 and HDL-cholesterol. Validate formed clusters relating them to the incidence of dementia, stroke and death. Methods: Elderly individuals aged 80 years and older, with no cognitive or functional loss underwent an initial assessment and data applied to cluster analysis by two steps method. The formed clusters were compared with respect to demographic variables, the performance on the clock drawing test, verbal fluency animals, brief cognitive battery, Mini Mental State examination, GDS and serum biochemical markers. To validate the cluster, we evaluated the incidence of dementia, stroke and occurrence of death in the period of 2010 to 2016. Results: At baseline were included 156 elderlies, 69.2% female, mean age 84.8 years. The clustering obtained positive silhouette coefficient (+0.3). The decreasing order of importance of risk markers to the clustering process was BIS_Cr, HDL-Col, homocysteine, CRP, and 25 (OH) VitD. Comparing the initial cognitive tests among the three formed clusters, they differed only on the clock drawing test. During the follow-up to six years 13.5% of all participants developed dementia, 5.1% Stroke and 10.9% died. The incidence of dementia, stroke and deaths in this period was significantly lower in the cluster 2 (p = 0.005), which had intermediate values of homocysteine and creatinine clearance, and the highest CRP, HDL-cholesterol and 25 (OH)VitD. The cluster with lower levels of creatinine clearance, HDL-col and 25 (OH) VITD, higher levels of homocysteine and intermediate levels of CRP, showed higher incidence of dementia, stroke and death. Moreover, the incidence of these outcomes was significantly lower in the cluster 2 (p = 0.005), which had intermediate levels of homocysteine and creatinine clearance, and higher HDL-cholesterol levels, 25-dihydroxyvitamin D3 and CRP. Conclusion: The combination of creatinine clearance greater than 45 mL / min / 1.73m2, HDL-Col greater than 60 mg / dL, 25 (OH)vit D greater than 20 mmol /L