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Mariz J.,University of Minho | Mariz J.,PT Government Associate Laboratory | Mariz J.,Clinical Academic Center Braga | Santos N.C.,University of Minho | And 9 more authors.
BMC Emergency Medicine

Background: Identification of delirium in emergency departments (ED) is often underestimated; within EDs, studies on delirium assessment and relation with patient outcome in Intermediate Care Units (IMCU) appear missing in European hospital settings. Here we aimed to determine delirium prevalence in an EDIMCU (Hospital de Braga, Braga, Portugal) and assessed routine biochemical parameters that might be delirium indicators.Methods: The study was prospective and observational. Sedation level was assessed via the Richmond Agitation-Sedation Scale and delirium status by the Confusion Assessment Method for the ICU. Information collected included age and gender, admission type, Charlson Comorbidity Index combined condition score (Charlson score), systemic inflammatory response syndrome criteria (SIRS), biochemical parameters (blood concentration of urea nitrogen, creatinine, hemoglobin, sodium and potassium, arterial blood gases, and other parameters as needed depending on clinical diagnosis) and EDIMCU length of stay (LOS). Statistical analyses were performed as appropriate to determine if baseline features differed between the 'Delirium' and 'No Delirium' groups. Multivariate logistic regression was performed to assess the effect of delirium on the 1-month outcome.Results: Inclusion and exclusion criteria were met in 283 patients; 238 were evaluated at 1-month for outcome follow-up after EDIMCU discharge (" good" recovery without complications requiring hospitalization or institutionalization; " poor" institutionalization in permanent care-units/assisted-living or death). Delirium was diagnosed in 20.1% patients and was significantly associated with longer EDIMCU LOS. At admission, Delirium patients were significantly older and had significantly higher blood urea, creatinine and osmolarity levels and significantly lower hemoglobin levels, when compared with No Delirium patients. Delirium was an independent predictor of increased EDIMCU LOS (odds ratio 3.65, 95% CI 1.97-6.75) and poor outcome at 1-month after discharge (odds ratio 3.51, CI 1.84-6.70), adjusted for age, gender, admission type, presence of SIRS criteria, Charlson score and osmolarity at admission.Conclusions: In an EDIMCU setting, delirium was associated with longer LOS and poor outcome at1-month post-discharge. Altogether, findings support the need for delirium screening and management in emergency settings. © 2013 Mariz et al.; licensee BioMed Central Ltd. Source

Soares J.M.,University of Minho | Soares J.M.,PT Government Associate Laboratory | Soares J.M.,Clinical Academic Center Braga | Marques P.,University of Minho | And 11 more authors.
Brain Structure and Function

Aging of brain structure and function is a complex process characterized by high inter- and intra-individual variability. Such variability may arise from the interaction of multiple factors, including exposure to stressful experience and mood variation, across the lifespan. Using a multimodal neuroimaging and neurocognitive approach, we investigated the association of stress, mood and their interaction, in the structure and function of the default mode network (DMN), both during rest and task-induced deactivation, throughout the adult lifespan. Data confirmed a decreased functional connectivity (FC) and task-induced deactivation of the DMN during the aging process and in subjects with lower mood; on the contrary, an increased FC was observed in subjects with higher perceived stress. Surprisingly, the association of aging with DMN was altered by stress and mood in specific regions. An increased difficulty to deactivate the DMN was noted in older participants with lower mood, contrasting with an increased deactivation in individuals presenting high stress, independently of their mood levels, with aging. Interestingly, this constant interaction across aging was globally most significant in the combination of high stress levels with a more depressed mood state, both during resting state and task-induced deactivations. The present results contribute to characterize the spectrum of FC and deactivation patterns of the DMN, highlighting the crucial association of stress and mood levels, during the adult aging process. These combinatorial approaches may help to understand the heterogeneity of the aging process in brain structure and function and several states that may lead to neuropsychiatric disorders. © 2016 The Author(s) Source

Marques P.C.G.,University of Minho | Marques P.C.G.,ICVS 3Bs PT Government Associate Laboratory | Marques P.C.G.,Clinical Academic Center Braga | Soares J.M.M.,University of Minho | And 11 more authors.
Brain Imaging and Behavior

Studies have shown that white matter (WM) volumetric reductions and overall degradation occur with aging. Nonetheless little is known about the WM alterations that may underlie different cognitive status in older individuals. The main goal of the present work was to identify and characterize possible macro and microstructural WM alterations that could distinguish between older healthy individuals with contrasting cognitive profiles (i.e., “poor” vs “good” cognitive performers). Structural and diffusion magnetic resonance imaging was performed in order to quantify local WM volumes, white matter signal abnormalities (WMSA) volume (a measure of lesion burden) and diffusion tensor imaging scalar maps known to probe WM microstructure. A battery of neurocognitive/psychological tests was administered to assess the cognitive performance. Poor performers showed a higher slope for the positive association between WMSA volume and age compared to good performers. Even when controlling for WMSA volume, poor performers also evidenced lower fractional anisotropy, as well as positive associations with age with higher slopes of regression parameters in radial and axial diffusivity. Altogether results suggest that cognitive performance is related to differences in WM, with poor cognitive performers displaying signs of faster aging in WM. © 2015, Springer Science+Business Media New York. Source

Magalhaes R.,University of Minho | Magalhaes R.,ICVS 3Bs PT Government Associate Laboratory | Magalhaes R.,Clinical Academic Center Braga | Marques P.,University of Minho | And 10 more authors.
Advances in Intelligent Systems and Computing

Graph theory and the study of complex networks have, over the last decade, received increasing attention from the neuroscience research community. It allows for the description of the brain as a full network of connections, a connectome, as well as for the quantitative characterization of its topological properties. Still, there is a clear lack of standard procedures for building these networks. In this work we describe a specifically designed full workflow for the pre-processing of resting state functional Magnetic Resonance Imaging (rsfMRI) data and connectome. The proposed workflow focuses on the removal of confound data, the minimization of resampling effects and increasing subject specificity. It is implemented using open source software and libraries through shell and python scripting, allowing its easy integration into other systems such as BrainCAT. With this work we provide the neuroscience research community with a standardized framework for the construction of functional connectomes, simplifying the interpretation and comparison of different studies. © Springer International Publishing Switzerland 2015. Source

Santos N.C.,University of Minho | Santos N.C.,PT Government Associate Laboratory | Santos N.C.,Clinical Academic Center Braga | Costa P.S.,University of Minho | And 23 more authors.
Frontiers in Aging Neuroscience

It is relevant to unravel the factors that may mediate the cognitive decline observed during aging. Previous reports indicate that education has a positive influence on cognitive performance, while age, female gender and, especially, depressed mood were associated with poorer performances across multiple cognitive dimensions (memory and general executive function). Herein, the present study aimed to characterize the cognitive performance of community-dwelling individuals within distinct educational groups categorized by the number of completed formal school years: "less than 4," "4, completed primary education," and "more than 4." Participants (n = 1051) were randomly selected from local health registries and representative of the Portuguese population for age and gender. Neurocognitive and clinical assessments were conducted in local health care centers. Structural equation modeling was used to derive a cognitive score, and hierarchical linear regressions were conducted for each educational group. Education, age and depressed mood were significant variables in directly explaining the obtained cognitive score, while gender was found to be an indirect variable. In all educational groups, mood was the most significant factor with effect on cognitive performance. Specifically, a depressed mood led to lower cognitive performance. The clinical disease indices cardiac and stroke associated with a more negative mood, while moderate increases in BMI, alcohol consumption and physical activity associated positively with improved mood and thus benefitted cognitive performance. Results warrant further research on the cause-effect (longitudinal) relationship between clinical indices of disease and risk factors and mood and cognition throughout aging. © 2014 Santos, Costa, Cunha, Portugal-Nunes, Amorim, Cotter, Cerqueira, Palha and Sousa. Source

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