An examination of the validity of neuropsychological and physical testing batteries in Latin-American adults aged over 55 years.

BACKGROUND: Valid and reliable measurements are necessary to understand and monitor age-related changes. AIMS: To describe the factor structure and provide validity evidence of a neuropsychological and a physical testing batteries using factor analysis. METHODS: We performed a secondary analysis of data from the Epidemiology and Development of Alzheimer's Disease (EDAD) project. Community-dwelling adults aged 55 to 85 years underwent comprehensive physical and neuropsychological assessments. An exploratory factor analysis was performed on both assessment batteries. The models were later confirmed with a random subsample using confirmatory factor analysis. RESULTS: Data from 238 adults (163 females and 75 males) was included. The neuropsychological model revealed a four-factor structure formed by "Executive Functioning", "Verbal Memory", "Logical Memory", and "Labeling And Reading" (Extraction Sums of Squared Loadings [ESSL] = 56.41% explained variance; Standardized Root Mean Square Residual [SRMSR] = 0.06; Comparative Fit Index [CFI] = 0.98). The physical model was formed by a two-factor structure including "Health-related Fitness and "Functional Fitness" (ESSL = 50.54% explained variance; SRMSR = 0.07; CFI = 0.93). DISCUSSION: To our knowledge, this is the first study to analyze the structure of comprehensive testing batteries for the Latin-American older adults. Our analysis contributes to the understanding of theoretical constructs that are evaluated in the EDAD project. CONCLUSION: Our findings provide validity evidence for simplified and reduced testing batteries, which imply shorter testing times and fewer resources.

Exploring Handgrip Strength as a Cross-cultural Correlate of Body Composition and Upper Body Strength in Older Adults from Costa Rica and Kansas.

Sarcopenia and disability in older adults are often characterized by body composition measurements; however, the gold standard of body composition measurement, dual-energy X-ray absorptiometry (DEXA), is expensive to acquire and maintain, making its use in low and middle income countries (LMIC) it out-of-reach in developing nations. Because these LMIC will bear a disproportionate amount of chronic disease burden due to global aging trends, it is important that reliable, low-cost surrogates need to be developed. Handgrip strength (HGS) is a reliable measure of disability in older adults but has not been used widely in diverse populations. This study compared HGS to multiple measurements of body composition in older adults from the US (Kansas) and a middle-income country (Costa Rica) to test if HGS is a cross-culturally appropriate predictive measure that yields reliable estimates across developed and developing nations. Percent body fat (%BF), lean tissue mass index (LTMI), appendicular lean soft tissue index (ALSTI), body fat mass index (BFMI), bone mineral density (BMD), and HGS were measured in older Costa Ricans (n = 78) and Kansans (n = 100). HGS predicted lean arm mass with equal accuracy for both samples (p ≤ 0.05 for all groups), indicating that it is a reliable, low-cost and widely available estimate of upper body lean muscle mass. Older adults from Costa Rica showed different body composition overall and HGS than controls from Kansas. Handgrip operates equivalently in the US and Mesoamerica and is a valid estimate of lean arm muscle mass as derived by the more expensive DEXA.

Measurement invariance of a neuropsychological battery across urban and rural older adults in Costa Rica.

This study evaluated the measurement invariance of a neuropsychological battery across rural and urban older adults from Costa Rica. Rural and urban older adults (N = 295) from the Epidemiology and Development of Alzheimer's Disease (EDAD) study in Costa Rica were assessed. The baseline factor model for the EDAD neuropsychological measures was identified with nine neuropsychological measures and three cognitive constructs: Verbal Memory, Spatial Reasoning, and Cognitive Flexibility. Measurement and structural invariance were established, and, then, group comparisons of the latent cognitive factors were conducted to explore regional disparities. The findings showed that most of the neuropsychological tests in EDAD can be directly compared across the groups, allowing for cognitive constructs comparisons. The rural sample showed a disadvantage in the Spatial Reasoning and Cognitive Flexibility abilities. When age and education were included in the models, differences between the regions disappeared. Having more years of education was associated with higher cognitive abilities, with a larger effect for the rural group. Norms for Costa Rican older adults should consider age and education adjustments. This study contributes to the growing area of measurement invariance in neuropsychological assessment as it highlights the importance of examining the comparability of assessment measures across different cultural groups.

Conciencia transoperatoria en personas operadas mediante craneotomía despierto / Intraoperative awareness in awake craniotomy patients

La craneotomía con paciente despierto (CPD) demanda un manejo multidisciplinario particular debido al componente de conciencia transoperatoria que aporta beneficios en la resección tumoral y preservación neurológica, pero también implica el manejo de los riesgos asociados a la necesidad de cooperación del paciente durante el procedimiento. En este trabajo se describen los beneficios y las complicaciones en pacientes operados bajo la modalidad de CPD. Además, se abordan los retos documentados tanto para el equipo profesional a cargo, como para los pacientes, los cuales tienen un rol activo durante la cirugía. En ese sentido, se exponen los criterios para la selección, preparación psicológica y neuropsicológica tanto previo como durante la cirugía. A su vez, se proponen las consideraciones para lograr un procedimiento exitoso y evitar las posibles secuelas psicológicas a largo plazo, como insumos para la protocolización de este tipo de procedimientos con base en nuestra experiencia.

Awake craniotomy (AC) requires a multidisciplinary management due to trans operative awareness, which benefits the tumor resection and neurologic preservation, but it also implies risks for the patient cooperation during the procedure. This article describes the benefits and complications in patients operated under AC. Besides, it approaches the documented challenges for both the professional team and patients, who have an active role during surgery. In this regard, the criteria for selection and psychological and neuropsychological preparation before and during surgery are set out. It suggests considerations to achieve a successful procedure and to avoid possible long- term psychological sequelae, as a resource for the protocol of this type of procedures based on our experience.

Predicting Exertion from Metabolic, Physiological and Cognitive Variables in Older Adults / Predicción del esfuerzo con variables metabólicas, fisiológicas y cognitivas en adultos mayores / Predição do esforço com variáveis metabólicas, fisiológicas e congênitas em idosos

Abstract Objective. To determine the association between perceived exertion (RPE) and physiological variables and to determine the predictive factors of RPE during submaximal and maximal exertion in older adults. Method. Older adults from Kansas (n = 100) and Costa Rica (n = 79) performed a submaximal and maximal stress test. RPE, education level and a total score of cognitive function (CFTS) were collected. Correlation and multiple regression analyses were computed using RPE as the criterion variable and oxygen consumption (VO2), respiratory exchange ratio (RER), CFTS and education level as predictors. Results. There was a significant correlation between VEP and RER (r = 0.22, p = 0.029) at maximal exertion. The RPE predictors for women were VO2, RER, and CFTS at different stages of the test. For men, VEP was predicted by RER, education level, and VO2 at different stages. Conclusion. Metabolic and physiological variables predicted RPE in older adults. Age, cognition, and heart rate were unrelated to RPE at maximal exertion, and RER predicted RPE scores during submaximal and maximal exertion.

Resumen Objetivo. Determinar la asociación entre el esfuerzo percibido (VEP) y variables fisiológicas y determinar los factores predictivos de VEP durante el esfuerzo submáximo y máximo en adultos mayores. Método. Adultos mayores de Kansas (n = 100) y Costa Rica (n = 79) realizaron una prueba de esfuerzo submáxima y máxima. Se recopiló la VEP, nivel de educación y una puntuación total de la función cognitiva (PTFC). Se usaron análisis de correlación y regresión múltiple utilizando VEP como variable criterio y el consumo de oxígeno (VO2), tasa de intercambio respiratorio (RER), PTFC y nivel de educación como predictores. Resultados. Se encontró una correlación significativa entre la VEP y la RER (r = 0.22, p = 0.029) en el esfuerzo máximo. Los predictores de VEP para las mujeres fueron VO2, RER y PTFC en diferentes etapas de la prueba. Para los hombres, la VEP fue predicha por RER, nivel de educación y VO2 en diferentes etapas. Conclusión. Las variables metabólicas y fisiológicas predijeron los valores de VEP en adultos mayores. La edad, la cognición y la FC no se relacionaron con la VEP en el esfuerzo máximo y la RER predijo las puntuaciones de la VEP durante el esfuerzo submáximo y máximo.

Resumo Escopo. Determinar a associação entre o esforço percebido (VEP) e as variáveis fisiológicas e determinar os fatores preditivos de VEP durante o esforço submáximo e máximo em idosos. Metodologia. Idosos de Kansas (n= 100) e Costa Rica (n= 79) realizaram uma prova de esforço submáxima e máxima. Foi recopilada o VEP, nível de educação e pontuação total da função cognitiva (PTFCO. Foram usadas análises de correlação e regressão múltipla utilizando VEP como variável critério e o consumo de oxigeno (VO2), taxa de intercambio respiratório (RER), PTFC e nível de educação como preditores. Resultados. Foi encontrada uma correlação significativa entre a VEP e a RER (r = 0.22, p = 0.029)) no esforço máximo. Os preditores de VEP para as mulheres foram VO2, RER e PTFC em diferentes etapas da prova. Para os homens, a VEP foi predita por RER, nível de educação e VO2 em diferentes etapas. Conclusão. As variáveis metabólicas e fisiológicas predisseram os valores de VEP em idosos. A idade, a cognição e a FC não estiveram relacionadas com a VEP no esforço máximo e a RER predizia as pontuações da VEP durante o esforço submáximo e máximo.

Health-Related Quality of Life of Older Adults in Costa Rica as Measured by the Short-Form-36 Health Survey.

Objective: To test the validity of a common measure of health-related quality of life (Short-Form-36 [SF-36]) in cognitively healthy older adults living in rural and urban Costa Rica. Method: Confirmatory factor analysis was applied to SF-36 data collected in 250 older adults from San Jose and Guanacaste, Costa Rica. Results: The best fitting model for the SF-36 was an eight first-order factor structure. A high correlation between the Mental Component Summary and Physical Component Summary scores was found. Region differences indicated that rural dwellers perceive a poorer health-related quality of life compared with the urban group. Discussion: Costa Rican older adults perceived health as a unidimensional construct. Age and urbanity of older adult Costa Ricans should be appreciated when trying to measure self-reported physical and mental health. Cultural context of the individuals should be considered when studying health-related quality of life.

Predictores socioemocionales y cognitivos: su papel en la comprensión del envejecimiento con éxito en el contexto costarricense / Socio-Emotional and Cognitive Predictors: Its Roll on the Comprehension of the Successful Aging in Costarica's Context

RESUMEN Tomando en cuenta las teorías del envejecimiento con éxito, este estudio se orientó hacia la identificación y el análisis de las características que presentan personas adultas mayores con altos niveles de actividad y participación social residentes en Costa Rica. El estudio contó con 191 participantes con edades entre 55 y 87 años (M = 68.5, DE = 6.9) que habitan en el área metropolitana y participan en programas dirigidos a personas mayores en cursos de computación, idiomas, actividad física, arte, entre otros. Mediante modelos lineales, se evidenció la importancia de las condiciones sociales, emocionales y cognitivas como las mejores variables predictoras del nivel de actividad en la muestra estudiada: a) variables emocionales como autoeficacia percibida, emociones positivas, satisfacción con la vida, control personal, adecuadas redes de apoyo; b) características cognitivas como funciones ejecutivas preservadas; c) percepción subjetiva de salud y d) características sociodemográficas como nivel educativo e ingresos. El estudio permite funcionar como línea base, a nivel teórico y metodológico, del envejecimiento con éxito en Costa Rica. Describe los estilos de vida activos en la vejez de los participantes costarricenses, caracterizados primordialmente por la participación en relaciones sociales y ocio, más que por actividades de tipo cognitivas y físicas o vinculadas al logro personal.

ABSTRACT The present study was aimed at identifying and analyzing the characteristics of older people with high levels of activity and social participation living in Costa Rica, from perspectives like the Successful Aging approach. It also addresses the classical criteria of successful aging theories and their scope in Costa Rican culture. 191 participants between the ages of 55 and 87 (M = 68.5, SD = 6.9) who live in the metropolitan area and participate in programs of the Costa Rican Gerontological Association and the Program for the older people at the University of Costa Rica (in computer courses, languages courses, physical activity, art, among others). Linear models analysis has shown that social, emotional and cognitive factors are the best predictors of the level of activity in the analyzed sample. The variables combined to better predict social participation in leisure activities, physical activities, cognitive activities, instrumental functionality and productivity in old age are: a.) Variables of emotional stability as self-efficacy, positive emotions, life satisfaction, personal control, adequate support networks b.) executive functions, c.) perceived subjective health and d.) sociodemographic characteristics such as level of education and income. The study can serve as a baseline for theoretical and methodical descriptions of successful aging in Costa Rica, characterized by a strong orientation to give more importance to social participation and leisure activities rather than cognitive and physical activity or personal achievement.

Calidad de vida en pacientes costarricenses con tumores cerebrales: aportes de la neuropsicología

Se describe una experiencia clínico-formativa en el ámbito hospitalario, donde destacan los aportes de la neuropsicología en la atención multidisciplinaria a pacientes con tumores cerebrales. Se ejemplifican cuatro casos atendidos en el Servicio de Neurocirugía del Hospital México en Costa Rica, a quienes se les realizó una valoración neuropsicológica como parte del protocolo de atención en cirugía de resección tumoral. Se documenta una leve pero consistente tendencia a la mejoría en los rendimientos tras la intervención neuroquirúrgica de los casos reportados, evidenciando, también, las secuelas neurocognitivas y emocionales que permanecen e impactan directamente la calidad de vida. Se discute sobre los retos asociados a la expectativa sanitaria de prolongación de la vida pero preservando su calidad y funcionalidad.

The systematization of a clinical and educational experience in a hospital setting shows evidence of the neuropsychological contributions to the multidisciplinary care for patients with brain tumors. Four cases of people diagnosed with brain tumors are exemplified. The patients were treated at the Neurosurgical Unit at the Hospital Mexico, Costa Rica. Each patient underwent neuropsychological evaluations as part of the established protocol for neurosurgical interventions. Results showed a slight yet consistent trend of cognitive performance improvement after each surgery, and identified residual neurocognitive consequences that would have a direct impact on the patients quality of life. This paper discusses the challenges associated with health expectancy of prolonging life while preserving its quality and functionality.

A Systematic Review of the Relationship between Familism and Mental Health Outcomes in Latino Population.

Background:Familismo or familism is a cultural value frequently seen in Hispanic cultures, in which a higher emphasis is placed on the family unit in terms of respect, support, obligation, and reference. Familism has been implicated as a protective factor against mental health problems and may foster the growth and development of children. This study aims at measuring the size of the relationship between familism and mental health outcomes of depression, suicide, substance abuse, internalizing, and externalizing behaviors. Methods: Thirty-nine studies were systematically reviewed to assess the relationship between familism and mental health outcomes. Data from the studies were comprised and organized into five categories: depression, suicide, internalizing symptoms, externalizing symptoms, and substance use. The Cohen's d of each value (dependent variable in comparison to familism) was calculated. Results were weighted based on sample sizes (n) and total effect sizes were then calculated. It was hypothesized that there would be a large effect size in the relationship between familism and depression, suicide, internalizing, and externalizing symptoms and substance use in Hispanics. Results: The meta-analysis showed small effect sizes in the relationship between familism and depression, suicide and internalizing behaviors. And no significant effects for substance abuse and externalizing behaviors. Discussion: The small effects found in this study may be explained by the presence of moderator variables between familism and mental health outcomes (e.g., communication within the family). In addition, variability in the Latino samples and in the measurements used might explain the small and non-significant effects found.

Depressive Symptoms Affect Working Memory in Healthy Older Adult Hispanics.

OBJECTIVES: Low and middle income nations will experience an unprecedented growth of the elderly population and subsequent increase in age-related neurological disorders. Worldwide prevalence and incidence of all-types of neurological disorders with serious mental health complications will increase with life expectancy across the globe. One-in- ten individuals over 75 has at least moderate cognitive impairment. Prevalence of cognitive impairment doubles every 5 years thereafter. Latin America's population of older adult's 65 years and older is growing rapidly, yet little is known about cognitive aging among healthy older Latinos. Clinically significant depressive symptomatology is common among community-dwelling older adults and is associated with deficits across multiple cognitive domains, however much of the literature has not modeled the unique effects of depression distinct from negative and low positive affect. Our objective was to understand how mental health affects cognitive health in healthy aging Latinos. METHODS: The present study used confirmatory factor analysis (CFA) and structural equation modeling (SEM) to examine the relative effects of Negative Affect, Positive Affect and Geriatric Depression on Verbal Memory, Verbal Reasoning, Processing Speed, and Working Memory in healthy aging Latinos. Data was collected from a sample of healthy community dwelling older adults living in San Jose, Costa Rica. Modeling of latent variables attenuated error and improved measurement reliability of cognition, affect, and depression variables. RESULTS: Costa Ricans enjoy a notoriety for being much happier than US citizens and are renowned as one of the happiest nations in the world in global surveys. This was born out in these data. Costa Rican affective profiles differed substantively from US profiles. Levels of negative affect and depression were similar to US samples, but their levels of positive affect were much higher. Cognitive performance of these Costa Rican older adults was similar to US-age and education matched peers. CFA and SEM found that increased depressive symptomatology had deleterious effects on Working Memory made up of subtest scores sampling simple attention and vigilance for numbers. Verbal Memory, Verbal Reasoning, and Processing Speed were not affected by self-reported Positive Affect, Negative Affect or Depressive symptoms. CONCLUSION: Costa Rican older adults were happy, as evidenced by the high ratio of positive affect to relatively low negative affect. Thus, we were somewhat surprised to find that depressive symptoms were selectively correlated to decrements in working memory and that negative and positive affect contributed negligible amounts of variance to any of the cognitive factors. Because of the methodological rigor of latent variable analysis, these results are very specific. The Working Memory factor is not contaminated with Speed of Processing or other measured cognitive factors. Likewise, the measured Geriatric Depression represents symptoms that are richly cognitive, not overtly affective.