Sedentary behavior and physical activity: barriers and facilitators for active behavior during the COVID-19 pandemic / Comportamento sedentário e atividade física: barreiras e facilitadores para o comportamento ativo durante a pandemia de COVID-19

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period.

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social.

Physical activity on anxiety symptoms during the COVID-19 pandemic: a systematic review / Atividade física nos sintomas de ansiedade durante a pandemia de COVID-19: uma revisão sistemática

Abstract This systematic review aimed to investigate the effect of physical activity on anxiety symptoms during the COVID-19 pandemic. Three databases (PubMed; Scopus and Web of Science) were searched in the period from 2020 to 2022 the following base terms were used: "Physical Activity", Exercise, Anxiety and COVID-19. Peer-reviewed, primary studies published in English, Portuguese and Spanish using valid and reliable measures were included. Eighteen studies met the eligibility criteria, of which 17 were cross-sectional, 2 were cohort studies. The number of participants ranged from 43 to 2,301, aged between 18 and 65 years or older. A decrease in PA practice or an increase in sitting time were associated with higher levels of anxiety symptoms. Additionally, participants who did not meet PA recommendations were more likely to experience moderate to severe anxiety symptoms. The results showed that physical activity is associated with the alleviation of anxiety symptoms during confinement in the COVID-19 pandemic.

Resumo Esta revisão sistemática teve como objetivo investigar o efeito da atividade física nos sintomas de ansiedade durante a pandemia de COVID-19. Foram pesquisadas três bases de dados (PubMed; Scopus e Web of Science) no período de 2020 a 2022 foram utilizados os seguintes termos base: "Physical Activity", Exercise, Anxiety e COVID-19. Foram incluídos estudos primários, revisados ​​por pares, publicados em inglês, português e espanhol usando medidas válidas e confiáveis. Dezoito estudos preencheram os critérios de elegibilidade, sendo 17 transversais, 2 estudos de coorte. O número de participantes variou de 43 a 2.301, com idade entre 18 e 65 anos ou mais. Uma diminuição na prática de AF ou um aumento no tempo sentado foram associados a níveis mais elevados de sintomas de ansiedade. Além disso, os participantes que não atendiam às recomendações de AF eram mais propensos a apresentar sintomas de ansiedade moderados a graves. Os resultados mostraram que a atividade física está associada ao alívio dos sintomas de ansiedade durante o confinamento na pandemia de COVID-19.

Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic / Exercício físico online e sintomas neuropsiquiátricos em pacientes com demência: um estudo de corte transversal durante a pandemia de covid-19

ABSTRACT. Social isolation is necessary during the COVID-19 pandemic but can be harmful to mental health, especially in people with neurocognitive disorders. Although physical exercise can alleviate neuropsychiatric symptoms and improve quality of life (QoL), sedentary behavior increased during the pandemic. Online interventions can contribute to improving physical activity and mental health. Objective: The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. Methods: In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. Results: There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Conclusions: Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.

RESUMO. O isolamento social é necessário na pandemia de COVID-19, mas pode impactar a saúde mental, especialmente em idosos com demência, dada a alta prevalência de sintomas neuropsiquiátricos. Apesar da prática de exercícios físicos contribuir para a redução desses sintomas e a melhora da qualidade de vida, houve um aumento de comportamento sedentário durante a pandemia. Objetivo: Comparar os sintomas neuropsiquiátricos e a qualidade de vida de idosos com distúrbios neurocognitivos que participaram de um programa de exercícios físicos online voltado a pacientes sedentários durante a pandemia de COVID-19. Métodos: Neste estudo de corte transversal, 25 idosos diagnosticados com transtorno neurocognitivo (controle=11; exercícios online=14) foram avaliados por meio do inventário neuropsiquiátrico (INP) e da escala de qualidade de vida na doença de Alzheimer (QV-DA). Resultados: Observou-se diferença entre os grupos no INP total (U=36,50, p=0,025), com tamanho de efeito grande (effect size [ES]=-1,03, intervalo de confiança - IC95% -1,83 a -0,16), e no subdomínio sono (U=38,00, p=0,033), com tamanho de efeito grande (ES=-1,06, IC95% -1,86 a -0,19), favoráveis ao grupo fisicamente ativo. Na QV-DA, houve diferença entre os grupos apenas no subitem memória (U=20,00, p=0,005), com tamanho de efeito grande (ES=1,59, IC95% 0,59 a 2,48), não houve diferença na pontuação total (U=45,5, p=0,277). Conclusões: Idosos submetidos a rotina de exercícios físicos com supervisão online na pandemia de COVID-19 apresentam menos sintomas neuropsiquiátricos, melhor qualidade de sono e memória quando comparados aos fisicamente inativos. Estudos randomizados controlados devem ser feitos para a melhor compreensão dos efeitos do exercício físico nos sintomas neuropsiquiátricos de pacientes com demência durante períodos de isolamento social.

Relationship Between Aerobic Capacity, Mobility, and Spatial Navigation in Healthy Individuals and Older Adults With Mild Cognitive Impairment: A Cross-Sectional Study.

This study aimed to investigate the relationship between physical ability and spatial navigation in older adults with mild cognitive impairment and healthy controls, using the floor maze test. Study participants (n = 58) were subjected to the following tests: floor maze test, sit-to-stand, 8-foot up-and-go, and aerobic steps. Factorial analyses showed that performance of the physical tests combined explained approximately 87% of the sample variability. Mobility (R2 = .22, p ≤ .001) and aerobic capacity (R2 = .27, p ≤ .001) were both associated with delayed maze time in the floor maze test. Low levels of aerobic capacity were also associated with an increased odds to perform poorly in the delayed maze time after controlling for age, sex, and mild cognitive impairment diagnosis (odds ratio = 3.1; 95% confidence interval [1.0, 9.5]; p = .04). Aerobic capacity and mobility are associated with spatial navigation in patients with mild cognitive impairment and healthy older adults.

Online physical exercise and the neuropsychiatric symptoms in patients with dementia: a cross-sectional study during the COVID-19 pandemic.

Social isolation is necessary during the COVID-19 pandemic but can be harmful to mental health, especially in people with neurocognitive disorders. Although physical exercise can alleviate neuropsychiatric symptoms and improve quality of life (QoL), sedentary behavior increased during the pandemic. Online interventions can contribute to improving physical activity and mental health. Objective: The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. Methods: In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer's Disease (QoL-AD) scale. Results: There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Conclusions: Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.

O isolamento social é necessário na pandemia de COVID-19, mas pode impactar a saúde mental, especialmente em idosos com demência, dada a alta prevalência de sintomas neuropsiquiátricos. Apesar da prática de exercícios físicos contribuir para a redução desses sintomas e a melhora da qualidade de vida, houve um aumento de comportamento sedentário durante a pandemia. Objetivo: Comparar os sintomas neuropsiquiátricos e a qualidade de vida de idosos com distúrbios neurocognitivos que participaram de um programa de exercícios físicos online voltado a pacientes sedentários durante a pandemia de COVID-19. Métodos: Neste estudo de corte transversal, 25 idosos diagnosticados com transtorno neurocognitivo (controle=11; exercícios online=14) foram avaliados por meio do inventário neuropsiquiátrico (INP) e da escala de qualidade de vida na doença de Alzheimer (QV-DA). Resultados: Observou-se diferença entre os grupos no INP total (U=36,50, p=0,025), com tamanho de efeito grande (effect size [ES]=-1,03, intervalo de confiança - IC95% -1,83 a -0,16), e no subdomínio sono (U=38,00, p=0,033), com tamanho de efeito grande (ES=-1,06, IC95% -1,86 a -0,19), favoráveis ao grupo fisicamente ativo. Na QV-DA, houve diferença entre os grupos apenas no subitem memória (U=20,00, p=0,005), com tamanho de efeito grande (ES=1,59, IC95% 0,59 a 2,48), não houve diferença na pontuação total (U=45,5, p=0,277). Conclusões: Idosos submetidos a rotina de exercícios físicos com supervisão online na pandemia de COVID-19 apresentam menos sintomas neuropsiquiátricos, melhor qualidade de sono e memória quando comparados aos fisicamente inativos. Estudos randomizados controlados devem ser feitos para a melhor compreensão dos efeitos do exercício físico nos sintomas neuropsiquiátricos de pacientes com demência durante períodos de isolamento social.

Beyond the Mini-Mental State Examination: The Use of Physical and Spatial Navigation Tests to Help to Screen for Mild Cognitive Impairment and Alzheimer's Disease.

BACKGROUND: Spatial navigation and dual-task (DT) performance may represent a low-cost approach to the identification of the cognitive decline in older adults and may support the clinical diagnosis of mild cognitive impairment (MCI) and Alzheimer's disease (AD). OBJECTIVE: To assess the accuracy of different types of motor tasks in differentiating older persons with MCI and AD from healthy peers. METHODS: Older adults aged 60 years or over (n = 105; healthy = 39; MCI = 23; AD = 43) were evaluated by the floor maze test (FMT), the senior fitness test, and DT performance. Receiver operating characteristic curve (ROC) analysis was used to evaluate the accuracy of the tests. We also performed principal component analysis (PCA) and logistic regression analysis to explore the variance and possible associations of the variables within the sample. RESULTS: FMT (AUC = 0.84, sensitivity = 75.7%, specificity = 76.1%, p < 0.001) and DT (AUC = 0.87, sensitivity = 80.4%, specificity = 86.9%, p < 0.001) showed the highest performance for distinguishing MCI from AD individuals. Moreover, FMT presented better sensitivity in distinguishing AD patients from their healthy peers (AUC = 0.93, sensitivity = 94%, specificity = 85.6%, p < 0.001) when compared to the Mini-Mental State Examination. PCA revealed that the motor test performance explains a total of 73.9% of the variance of the sample. Additionally, the results of the motor tests were not influenced by age and education. CONCLUSION: Spatial navigation tests showed better accuracy than usual cognitive screening tests in distinguishing patients with neurocognitive disorders.

Domains of Awareness in Young and Late Onset Dementia.

BACKGROUND: There is a lack of research investigating whether there are differences in the domains of awareness according to the age at onset of dementia. OBJECTIVE: This study is designed to investigate differences in awareness of cognitive functioning and health condition, functional activity impairments, emotional state, and social functioning and relationships among people with young onset (YOD) and late onset dementia (LOD); and examine associations between awareness and its domains with cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and quality of life (QoL) in both groups. METHODS: A group of 136 people with dementia and their respective caregivers (YOD = 50 and LOD = 86) were consecutively selected. We assessed awareness of disease, dementia severity, cognition, functionality, neuropsychiatric symptoms, social and emotional functioning, and QoL. RESULTS: People with YOD had more neuropsychiatric symptoms than people with LOD. People with YOD were more aware of disease (total score), of their cognitive functioning and health condition and of their functional activity impairments, even if this group was more severely cognitive impaired and had a worse level of functionality than LOD group. Multivariate linear regressions showed that functionality has a wide relationship to awareness for people with YOD. While neuropsychiatric symptoms and QoL has a greater relation to awareness for people with LOD. CONCLUSION: Different clinical variables are associated to different domains in YOD and LOD groups, reinforcing the heterogeneity of awareness in dementia.

The comorbidity conditions and polypharmacy in elderly patients with mental illness in a middle income country: a cross-sectional study⋆.

BACKGROUND: Mental disorders increase the risk factor for developing physical comorbidity conditions, such as cardiometabolic diseases. There is a high prevalence of multimorbidity and polypharmacy in the elderly population which hampers clinical response. Studies have shown that this positive correlation between the aging process and enhancement of physical comorbidities is especially high among older adults who live in low or middle income countries. OBJECTIVE: To investigate the association between physical disease comorbidities and polypharmacy in older adults with a clinical diagnosis of Alzheimer's disease (AD), mild cognitive impairment (MCI) or major depressive disorder (MDD), living in a middle income country. METHODS: Cross-sectional study of community-dwelling elderly individuals who are cognitively healthy and those with AD, MCI, or MDD. The severity scale of the Charlson Comorbidity Index (CCI) was calculated to classify the severity of comorbidity condition. Logistic regression model (unadjusted and adjusted for age) were used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for cardiometabolic comorbidity (hypertension, diabetes, dyslipidemia and overweight), and polypharmacy. RESULTS: Although there was not an increased risk of hypertension, diabetes, and obesity among the groups, elderly people with mental disorders presented higher odds for polypharmacy condition. Polypharmacy was significantly higher for all groups in comparison with cognitively healthy participants: AD (OR 22.00, 95 % CI 6.11-79.11), MDD (OR 14.73, 95 % CI 3.69-58.75) and MCI (OR 10.31, 95 % CI 2.44-43.59). Elderly patients with AD presented more severe comorbidities and higher risks for dyslipidemia. CONCLUSION: Elderly patients with depression, dementia and mild cognitive impairment have considerably higher odds for polypharmacy. People with dementia also have greater comorbidity severity than those who are cognitively healthy. In middle income countries, there is an urgent need to focus on promoting age-appropriate health approaches for the elderly with mental illness to prevent the development of aggravated cardiometabolic conditions and polypharmacy.

Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop.

In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

Em julho de 2019, um grupo multidisciplinar de pesquisadores em demência do Brasil e do Reino Unido se reuniu em Belo Horizonte para discutir e propor soluções para os desafios no diagnóstico, percepção pública e tratamento dessa condição. Neste artigo, sintetizamos as conclusões do workshop sobre os desafios no diagnóstico de demência. O Brasil enfrenta um grande problema no subdiagnóstico de demência, principalmente entre a população em condições socioeconômicas adversas. Há pouca disponibilidade de recursos e de especialistas e o conhecimento de médicos generalistas e de outros profissionais de saúde é pouco abrangente. Baixa escolaridade é também um obstáculo no diagnóstico de demência, uma vez que os testes de rastreio mais utilizados na prática clínica não são estruturados para avaliar a população com esse perfil. Os pacientes com demência e suas famílias ainda têm que superar o estigma do diagnóstico, que é ainda muito prevalente no Brasil e colabora para a piora da qualidade de vida. O Reino Unido, por outro lado, dispõe de mais recursos financeiros e de pessoal, possui serviços dedicados à avaliação de problemas de memória e um plano estratégico nacional para demência. Contudo, o National Health Service (NHS) tem verbas limitadas, o que faz com que alguns dos desafios no diagnóstico de demência sejam comuns aos dois países. Os autores sugerem possíveis soluções para enfrentá-los, com o objetivo de melhorar a avaliação e o reconhecimento da demência e reduzir os erros de diagnóstico.

Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop / Desafios no diagnóstico de demência: conclusões do Workshop de Demência Reino Unido-Brasil

ABSTRACT. In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

RESUMO. Em julho de 2019, um grupo multidisciplinar de pesquisadores em demência do Brasil e do Reino Unido se reuniu em Belo Horizonte para discutir e propor soluções para os desafios no diagnóstico, percepção pública e tratamento dessa condição. Neste artigo, sintetizamos as conclusões do workshop sobre os desafios no diagnóstico de demência. O Brasil enfrenta um grande problema no subdiagnóstico de demência, principalmente entre a população em condições socioeconômicas adversas. Há pouca disponibilidade de recursos e de especialistas e o conhecimento de médicos generalistas e de outros profissionais de saúde é pouco abrangente. Baixa escolaridade é também um obstáculo no diagnóstico de demência, uma vez que os testes de rastreio mais utilizados na prática clínica não são estruturados para avaliar a população com esse perfil. Os pacientes com demência e suas famílias ainda têm que superar o estigma do diagnóstico, que é ainda muito prevalente no Brasil e colabora para a piora da qualidade de vida. O Reino Unido, por outro lado, dispõe de mais recursos financeiros e de pessoal, possui serviços dedicados à avaliação de problemas de memória e um plano estratégico nacional para demência. Contudo, o National Health Service (NHS) tem verbas limitadas, o que faz com que alguns dos desafios no diagnóstico de demência sejam comuns aos dois países. Os autores sugerem possíveis soluções para enfrentá-los, com o objetivo de melhorar a avaliação e o reconhecimento da demência e reduzir os erros de diagnóstico.

Accuracy of the semantic fluency test to separate healthy old people from patients with Alzheimers disease in a low education population / Acurácia do teste de fluência semântica para separar pessoas saudáveis de pacientes com doença de Alzheimer em uma população de baixa escolaridade

OBJECTIVE: Evaluate the accuracy of two semantic categories of the verbal fluency test (supermarket and animal categories) to separate healthy elderly individuals and lower educated Alzheimer's disease patients. METHODS: We evaluated 69 older adults with less than 5 years of schooling, consisting of 31 healthy elderly, and 38 patients diagnosed with Alzheimer's disease. Semantic verbal fluency was evaluated using the animal and supermarket categories. Mann-Whitney U and Independent t Tests were used to compare the two groups, and the diagnostic accuracy of the tests was analyzed by sensitivity, specificity, likelihood ratio's, and the Area Under the Curve (AUC). RESULTS: We found a significant difference between the healthy older and Alzheimer's disease groups, in both, animal (p = 0.014) and supermarket verbal fluency (p < 0.001). The supermarket category showed better overall diagnostic accuracy (AUC = 0.840, 95% CI = 0.746-0.933; p < 0.001) compared to the animal category (AUC = 0.671, 95% CI = 0.543-0.800; p = 0.014). CONCLUSION: The supermarket category of semantic verbal fluency provides better accuracy than the animal category for the identification of dementia in a Brazilian elderly population with low educational level.

OBJETIVO: Avaliar a acurácia de duas categorias semânticas do teste de fluência verbal (categorias de supermercado e animal) para separar idosos saudáveis e pacientes com doença de Alzheimer com baixa escolaridade. MÉTODOS: Avaliamos 69 idosos com menos de 5 anos de escolaridade, consistindo em 31 idosos saudáveis e 38 pacientes diagnosticados com a doença de Alzheimer. A fluência verbal semântica foi avaliada nas categorias animal e supermercado. O teste de Mann-Whitney U e o teste t independente foram usados para comparar os dois grupos, e a precisão diagnóstica dos testes foi analisada por sensibilidade, especificidade, razão de verossimilhança e área sob a curva (AUC). RESULTADOS: Encontramos uma diferença significativa entre os grupos de idosos saudáveis e com doença de Alzheimer, tanto na fluência verbal de animais (p = 0,014) quanto na de supermercado (p < 0,001). A categoria supermercado apresentou melhor precisão diagnóstica geral (AUC = 0,840; IC 95% = 0,746- 0,933; p < 0,001) em comparação com a categoria animal (AUC = 0,671; IC 95% = 0,543-0,800; p = 0,014). CONCLUSÃO: A categoria supermercado de fluência verbal semântica fornece melhor acurácia do que a categoria animal para a identificação de demência em uma população idosa brasileira com baixo nível educacional.

Floor Maze Test as a predictor of cognitive decline in older adults living in nursing homes / Floor Maze Test como preditor de declínio cognitivo em idosos residentes de instituições de longa permanência

OBJETIVO: Pesquisas em instituições de longa permanência para idosos (ILPI) mostram uma associação entre o aumento de risco de declínio cognitivo e o comprometimento das habilidades de navegação espacial dos idosos. A navegação espacial pode ser definida como uma habilidade complexa, que depende de funções cognitivas e motoras, emergindo como um importante marcador de estadiamento da demência. O presente estudo teve por objetivo comparar a navegação espacial de idosos saudáveis; institucionalizados e com demência MÉTODOS: Foi realizado um estudo de corte transversal com 78 idosos (saudáveis = 37, demência = 22, institucionalizados = 19) avaliados por meio do Miniexame do estado mental (MEEM), Floor Maze Test (FMT) e 8-foot-up-and-go (8UG). Uma ANOVA One-way foi realizada para comparar os grupos. RESULTADOS: Como esperado, o grupo saudável foi mais ágil, tanto no FMT imediato (X2 = 31,23; p < 0,01) quanto no tardio (X2 = 41,21; p < 0,01). Quando comparados os grupos demência e institucionalizados, não houve diferença significativa no MEEM e FMT tardio. Porém, os idosos institucionalizados mostraram piores resultados que o grupo demência no FMT imediato (p < 0,01) e no teste 8UG (p < 0,01). CONCLUSÃO: Os resultados indicam um pior desempenho na navegação espacial, função executiva e habilidades motoras dos idosos em ILPI e com demência. A possibilidade de idosos institucionalizados serem subdiagnosticados deve ser considerada.

OBJECTIVE: Long-term care facilities (LTCF) are associated with an increased risk of cognitive decline and impairment in spatial navigation abilities. Recent studies have demonstrated that spatial navigation as a complex skill, involving cognitive and motor functions, emerging as a new marker for the progression of dementia. The present study aims to compare spatial navigation in healthy, institutionalized, and AD elderly subjects. METHODS: In a cross-sectional study, we evaluated 78 elderly individuals (healthy = 37, AD = 22, institutionalized = 19) using the Mini-Mental State Examination (MMSE), Floor Maze Test (FMT) and 8-foot-up-and-gotest (8UG) to assess global cognitive function, spatial navigation and motor function, respectively. RESULTS: In the FMT, the immediate maze time (IMT) and delay maze time (DMT) were significantly shorter in the healthy group than those of the institutionalized and AD groups (X2 = 31.23; p < 0.01) and (X2 = 41.21; p < 0.01), while there were no significant differences between the AD and institutionalized groups in terms of the DMT and MMSE results. However, the institutionalized group showed worse results in terms of IMT (p < 0.01) and 8UG (p < 0.01) than those in the dementia group. CONCLUSION: Our results indicate that both institutionalized older people and patients with Dementia have a deficit in the spatial navigation ability, cognitive functions and motor skills. We should consider that there might be a possibility of underdiagnosis in institutionalized older people.

Utility of handgrip strength cut-offs for identification of weakness and disability in community-dwelling older people with mild cognitive impairment and Alzheimer's disease / Utilidade de pontos de corte de força de preensão palmar para identificar fraqueza e incapacidade em idosos da comunidade com transtorno cognitivo leve e doença de Alzheimer

ABSTRACT Objectives To evaluate the utility of handgrip strength cut-offs for the identification of weakness and Instrumental Activities of Daily Living (IADL) disability in elderly people with neurocognitive disorders. Methods Cross-sectional study of community-dwelling elderly individuals with Alzheimer's disease (AD, n = 40) and mild cognitive impairment (MCI, n = 22); healthy individuals (n = 36) were recruited as controls. Handgrip cut-offs included European Working Group for Sarcopenic Older People (EWGSOP2), Cardiovascular Healthy Study (CHS) and the Frailty in Brazilian Older People Study from Rio de Janeiro (FIBRA RJ) cut-offs. Handgrip strength indexes were calculated by dividing handgrip strength values by cut-off values and the weakness prevalence for each cut-off value was compared among groups. Correlation analyses were employed to evaluate the relationship between Lawton Scale and handgrip strength (crude value and indexes). Results All handgrip strength indexes were lower in the AD group (p < 0.05), whereas the prevalence of weakness was significantly higher in the AD group only when the CHS cut-off was applied (AD = 47.5%, MCI and control = 18.2%, p < 0.01). Significantly positive correlations were identified between the Lawton ADL scale and handgrip indexes for all cut-offs (p < 0.05), but not between Lawton scale and crude handgrip (p = 0.75). Conclusions Only the CHS cut-off allowed proper differentiation of the weakness prevalence between groups. In addition, adjusting handgrip strength values according to cut-offs was necessary to determine the correlation between strength and disability in cognitively impaired elderly individuals.

RESUMO Objetivos Avaliar a utilidade de pontos de corte (PC) de força de preensão palmar (FPP) para identificar fraqueza e incapacidade em atividades instrumentais de vida diária (AIVDs) em idosos com transtorno neurocognitivo. Métodos Neste estudo de corte transversal, foram recrutados idosos saudáveis (n = 36), com comprometimento cognitivo leve (CCL, n = 22) e doença de Alzheimer (DA, n = 40). Os PCs incluídos foram o European Working Group for Sarcopenic Older People (EWGSOP2), o Cardiovascular Healthy Study (CHS) e o Frailty in Brazilian Older People Study do Rio de Janeiro (FIBRA RJ). Índices de FPP foram calculados dividindo-se o valor da FPP pelos valores de PC, e a prevalência de fraqueza para cada PC foi comparada entre os grupos. Análises de correlação foram empregadas para avaliar a relação entre a escala de Lawton e a FPP (valores brutos e índices). Resultados Todos os índices de FPP foram menores no grupo DA (p < 0,05), enquanto a prevalência de fraqueza foi significativamente maior na DA apenas quando o PC do CHS foi aplicado (DA = 47,5%, CCL e controles = 18,2%, p < 0,01). Foi identificada uma correlação significativa positiva entre a escala de Lawton e índices com todos os PCs (p < 0,05), porém não entre escala de Lawton e valor bruto da FPP (p = 0,75). Conclusões Apenas o PC do CHS permitiu diferenciação apropriada na prevalência de fraqueza entre os grupos. Além disso, o ajuste da FPP de acordo com os PCs foi necessário para determinar a correlação entre força e incapacidade em AIVDs em indivíduos idosos com comprometimento cognitivo.

Posturographic analysis of older adults without dementia and patients with Alzheimer's disease: A cross-sectional study.

Additional clinical tools should be investigated to facilitate and aid the early diagnosis of cognitive decline. Postural control worsens with aging and this may be related to pathological cognitive impairment. OBJECTIVE: to compare the balance of older adults without dementia in a control group (CG) and with Alzheimer's disease (AD), to observe the possible association with the independent variables (diagnosis, age, gender, and global cognition) and to verify the best posturographic analyses to determine the difference between the groups. METHODS: 86 older adults (AD = 48; CG = 38) were evaluated using the Berg Balance Scale (BBS) and postural control was assessed by stabilometry on the Wii Balance Board ® (WBB). Independent T, Mann-Whitney U-tests, Effect Size (ES) and a linear regression were performed. RESULTS: there was a significant difference for Elliptical Area, Total Velocity, Medio-Lateral displacements with closed eyes and open eyes, antero-posterior, with closed eyes and BBS between groups. These variables showed a large effect size for BBS (-1.02), Elliptical Area (0.83) with closed eyes, Medio-Lateral (0.80, 0.96) and Total Velocity (0.92; 1.10) with eyes open and eyes closed, respectively. Regression indicated global cognition accompanied by age, gender, and diagnosis influenced postural control. CONCLUSION: patients with AD showed impaired postural control compared to Control Group subjects. Total Velocity with closed eyes was the most sensitive parameter for differentiating groups and should be better investigated as a possible motor biomarker of dementia in posturographic analysis with WBB.

Ferramentas clínicas adicionais devem ser investigadas para facilitar e auxiliar o diagnóstico prévio do declínio cognitivo. O controle postural piora com o envelhecimento e este fato pode estar relacionado com o comprometimento cognitivo patológico. OBJETIVO: comparar o equilíbrio de adultos idosos sem demência no grupo controle (GC) e com doença de Alzheimer (DA), observar as possíveis associações com as variáveis independentes (diagnóstico, idade, sexo e estado cognitivo global) e verificar as melhores análises posturográficas para determinar a diferença entre os grupos. MÉTODOS: 86 idosos (DA = 48; GC=38) foram avaliados utilizando a escala de equilíbrio Berg (EEB) e o controle postural pela estabilometria no Wii Balance Board ® (WBB). Testes T independente, Mann Whitney U, o tamanho de efeito (TE) e uma regressão linear foram realizados. RESULTADOS: houve diferença significativa para AE, VT, ML com OA e OF, AP com OF e EEB entre os grupos. Estas variáveis mostraram um TE grande para EEB (-1.02), AE (0,83) com OF, ML (0,80; 0,96) e VT (0,92; 1,10) com OA e OF, respectivamente. A regressão indicou que a cognição global acompanhada da idade, gênero e diagnóstico contribuem para as alterações do controle postural. CONCLUSÃO: pacientes com DA apresentam comprometimento do controle postural quando comparados a idosos saudáveis. A VT com OF foi o parâmetro mais sensível para diferenciar os grupos e deve ser melhor investigada como possível biomarcador motor de demência na análise posturográfica com o WBB.

Posturographic analysis of older adults without dementia and patients with Alzheimer's disease: A cross-sectional study / Análise posturográfica de adultos idosos sem demência e com doença de Alzheimer: estudo de corte transversal

ABSTRACT. Additional clinical tools should be investigated to facilitate and aid the early diagnosis of cognitive decline. Postural control worsens with aging and this may be related to pathological cognitive impairment. Objective: to compare the balance of older adults without dementia in a control group (CG) and with Alzheimer's disease (AD), to observe the possible association with the independent variables (diagnosis, age, gender, and global cognition) and to verify the best posturographic analyses to determine the difference between the groups. Methods: 86 older adults (AD = 48; CG = 38) were evaluated using the Berg Balance Scale (BBS) and postural control was assessed by stabilometry on the Wii Balance Board ® (WBB). Independent T, Mann-Whitney U-tests, Effect Size (ES) and a linear regression were performed. Results: there was a significant difference for Elliptical Area, Total Velocity, Medio-Lateral displacements with closed eyes and open eyes, antero-posterior, with closed eyes and BBS between groups. These variables showed a large effect size for BBS (-1.02), Elliptical Area (0.83) with closed eyes, Medio-Lateral (0.80, 0.96) and Total Velocity (0.92; 1.10) with eyes open and eyes closed, respectively. Regression indicated global cognition accompanied by age, gender, and diagnosis influenced postural control. Conclusion: patients with AD showed impaired postural control compared to Control Group subjects. Total Velocity with closed eyes was the most sensitive parameter for differentiating groups and should be better investigated as a possible motor biomarker of dementia in posturographic analysis with WBB.

RESUMO. Ferramentas clínicas adicionais devem ser investigadas para facilitar e auxiliar o diagnóstico prévio do declínio cognitivo. O controle postural piora com o envelhecimento e este fato pode estar relacionado com o comprometimento cognitivo patológico. Objetivo: comparar o equilíbrio de adultos idosos sem demência no grupo controle (GC) e com doença de Alzheimer (DA), observar as possíveis associações com as variáveis independentes (diagnóstico, idade, sexo e estado cognitivo global) e verificar as melhores análises posturográficas para determinar a diferença entre os grupos. Métodos: 86 idosos (DA = 48; GC=38) foram avaliados utilizando a escala de equilíbrio Berg (EEB) e o controle postural pela estabilometria no Wii Balance Board ® (WBB). Testes T independente, Mann Whitney U, o tamanho de efeito (TE) e uma regressão linear foram realizados. Resultados: houve diferença significativa para AE, VT, ML com OA e OF, AP com OF e EEB entre os grupos. Estas variáveis mostraram um TE grande para EEB (-1.02), AE (0,83) com OF, ML (0,80; 0,96) e VT (0,92; 1,10) com OA e OF, respectivamente. A regressão indicou que a cognição global acompanhada da idade, gênero e diagnóstico contribuem para as alterações do controle postural. Conclusão: pacientes com DA apresentam comprometimento do controle postural quando comparados a idosos saudáveis. A VT com OF foi o parâmetro mais sensível para diferenciar os grupos e deve ser melhor investigada como possível biomarcador motor de demência na análise posturográfica com o WBB.