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井蛙内科開業医/診療録(2)

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2008年 07月 28日

内科 あれこれ 2008.7.26

高学歴者ほど認知症による記憶力低下が急速に進行
高学歴者ほど認知症による記憶力低下の発現時期は遅いが,いったん低下が始まるとその進行が速いと,米アルバート・アインシュタイン医科大学のグループがNeurologyの10月23日号に発表した。
 
対象は,Bronx Aging Studyで追跡された高齢者のなかで認知症の発症が確認された117例。
Buschke Selective Reminding Testにより評価した結果,教育期間が 1 年増すごとに記憶力低下の加速が始まる時期が0.21年遅れた。
しかし,記憶力低下の加速が始まった後の低下率は教育期間が 1 年増すごとに年間0.10ポイント上昇した。
Hall CB, et al. Neurology 2007; 69: 1657-1664.
1: Neurology. 2007 Oct 23;69(17):1657-64.
Related Articles, Links

<原著 抄録>
Education delays accelerated decline on a memory test in persons who develop dementia.
Hall CB, Derby C, LeValley A, Katz MJ, Verghese J, Lipton RB.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10462, USA. chall@aecom.yu.edu
OBJECTIVE:
To test the cognitive reserve hypothesis by examining the effect of education on memory decline during the preclinical course of dementia.
BACKGROUND:
Low education is a well known risk factor for Alzheimer disease (AD). Persons destined to develop AD experience an accelerated rate of decline in cognitive ability, particularly in memory. The cognitive reserve hypothesis predicts that persons with greater education begin to experience acceleration in cognitive decline closer to the time of diagnosis than persons with lower reserve, but that their rate of decline is more rapid after the time of acceleration due to increased disease burden.
METHODS:
We studied the influence of education on rates of memory decline as measured by the Buschke Selective Reminding Test in 117 participants with incident dementia in the Bronx Aging Study. Subjects had detailed cognitive assessments at entry and at annual follow-up visits. We estimated the time at which the rate of decline begins to accelerate (the change point), and the pre- and post-acceleration rates of decline, from the longitudinal data using a change point model. RESULTS: Each additional year of formal education delayed the time of accelerated decline on the Buschke Selective Reminding Test by 0.21 years. Post-acceleration, the rate of memory decline was increased by 0.10 points per year for each year of additional formal education.
CONCLUSIONS:
As predicted by the cognitive reserve hypothesis, higher education delays the onset of accelerated cognitive decline; once it begins it is more rapid in persons with more education.

Medical Tribune 2007.11.8
メディカル・トリビューン社


BMIよりウエスト周囲径が心血管疾患,糖尿病と強く関連
Body mass index(BMI)よりウエスト周囲径のほうが心血管疾患(CVD),糖尿病との関連が強いというデータが,International Day for Evaluation of Abdominal Obesity(IDEA)から得られた。
結果はCirculationの10月23日号に発表された。
 
腹部肥満が世界の異なる地域で同じようにCVDや糖尿病と関連しているかは不明で,プライマリケアの場でBMIに加えてウエスト周囲径を測定する有益性はわかっていない。
 
IDEAには世界63か国からランダムに選択されたプライマリケア医が参加。あらかじめ定められた 2 日間(いずれも半日)に受診した18〜80歳の患者のBMIとウエスト周囲径を測定し,CVDと糖尿病の有無を記録した。
対象となった患者は男性 6 万9,409人,女性 9 万8,750人。
 
男性の24%と女性の27%が肥満(BMI 30以上),さらに男性の40%と女性の30%が過体重(BMI 25〜30未満)であった。
男女それぞれウエスト周囲径の増大(男性>102cm,女性>88cm)が29%と48%,CVDが16%と13%,糖尿病が13%と11%に記録された。
 
BMIとウエスト周囲径は,ともにCVDと糖尿病の発症頻度の有意な段階的増加と関係していた。この相関は男女,地域を通じてBMIよりウエスト周囲径で強く,特に糖尿病ではBMI 25未満の患者においてもウエスト周囲径との関連が認められた。
Balkau B, et al. Circulation 2007; 116: 1942-1951.

<英文抄録>
Circulation. 2007 Oct 23;116(17):1942-51.
International Day for the Evaluation of Abdominal Obesity (IDEA): a study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries.
Balkau B, Deanfield JE, Després JP, Bassand JP, Fox KA, Smith SC Jr, Barter P, Tan CE, Van Gaal L, Wittchen HU, Massien C, Haffner SM.
BACKGROUND:
Abdominal adiposity is a growing clinical and public health problem. It is not known whether it is similarly associated with cardiovascular disease (CVD) and diabetes mellitus in different regions around the world, and thus whether measurement of waist circumference (WC) in addition to body mass index (BMI) is useful in primary care practice.
METHODS AND RESULTS:
Randomly chosen primary care physicians in 63 countries recruited consecutive patients aged 18 to 80 years on 2 prespecified half days. WC and BMI were measured and the presence of CVD and diabetes mellitus recorded. Of the patients who consulted the primary care physicians, 97% agreed to participate in the present study. Overall, 24% of 69,409 men and 27% of 98,750 women were obese (BMI > or = 30 kg/m2). A further 40% and 30% of men and women, respectively, were overweight (BMI 25 to 30 kg/m2). Increased WC (> 102 for men and > 88 cm for women) was recorded in 29% and 48%, CVD in 16% and 13%, and diabetes mellitus in 13% and 11% of men and women, respectively. A statistically significant graded increase existed in the frequency of CVD and diabetes mellitus with both BMI and WC, with a stronger relationship for WC than for BMI across regions for both genders. This relationship between WC, CVD, and particularly diabetes mellitus was seen even in lean patients (BMI < 25 kg/m2).
CONCLUSIONS:
Among men and women who consulted primary care physicians, BMI and particularly WC were both strongly linked to CVD and especially to diabetes mellitus. Strategies to address this global problem are required to prevent an epidemic of these major causes of morbidity and mortality.

Medical Tribune 2007.11.8
メディカル・トリビューン社


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「井蛙内科/開業医診療録(2)」

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2008.5.21~
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~2008.5.21 

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by wellfrog2 | 2008-07-28 00:39 | 未分類


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