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.

Acute effects of exergames on cognitive function of institutionalized older persons: a single-blinded, randomized and controlled pilot study.

BACKGROUND: Improvements on balance, gait and cognition are some of the benefits of exergames. Few studies have investigated the cognitive effects of exergames in institutionalized older persons. AIMS: To assess the acute effect of a single session of exergames on cognition of institutionalized older persons. METHODS: Nineteen institutionalized older persons were randomly allocated to Wii (WG, n = 10, 86 ± 7 year, two males) or control groups (CG, n = 9, 86 ± 5 year, one male). The WG performed six exercises with virtual reality, whereas CG performed six exercises without virtual reality. Verbal fluency test (VFT), digit span forward and digit span backward were used to evaluate semantic memory/executive function, short-term memory and work memory, respectively, before and after exergames and Δ post- to pre-session (absolute) and Δ % (relative) were calculated. Parametric (t independent test) and nonparametric (Mann-Whitney test) statistics and effect size were applied to tests for efficacy. RESULTS: VFT was statistically significant within WG (-3.07, df = 9, p = 0.013). We found no statistically significant differences between the two groups (p > 0.05). Effect size between groups of Δ % (median = 21 %) showed moderate effect for WG (0.63). DISCUSSION: Our data show moderate improvement of semantic memory/executive function due to exergames session. It is possible that cognitive brain areas are activated during exergames, increasing clinical response. CONCLUSION: A single session of exergames showed no significant improvement in short-term memory, working memory and semantic memory/executive function. The effect size for verbal fluency was promising, and future studies on this issue should be developed. PROTOCOL NUMBER OF BRAZILIAN REGISTRY OF CLINICAL TRIALS: RBR-6rytw2.

Cortisol, DHEA, and depression in the elderly: the influence of physical capacity.

OBJECTIVE: Major depression have been associated with cortisol and dehydroepiandrosterone (DHEA) changes in old depressed patients. We examined the association between depression, cortisol, and DHEA, correcting for confounding variables, including physical capacity. In addition, the association between hormone levels and physical capacity in these two experimental groups was also analyzed. METHOD: Depressed patients (n = 32) and healthy control (n = 31) old adults, both matched for age, were analyzed. Subjects were submitted to a physical capacity evaluation, including physical activity levels, functional fitness test, and balance scale. RESULTS: Depressed patients showed significant lower levels of cortisol than controls, which became non-significant after controlling for physical capacity. A positive correlation was observed between cortisol levels and physical capacity. CONCLUSIONS: The data suggest that physical capacity modulates the relationship between depression and cortisol levels and needs to be taken into consideration in the future investigations.

Cortisol, DHEA, and depression in the elderly: the influence of physical capacity / Cortisol, DHEA e a depressão no idoso: a influência da capacidade física

ABSTRACT Objective Major depression have been associated with cortisol and dehydroepiandrosterone (DHEA) changes in old depressed patients. We examined the association between depression, cortisol, and DHEA, correcting for confounding variables, including physical capacity. In addition, the association between hormone levels and physical capacity in these two experimental groups was also analyzed. Method Depressed patients (n = 32) and healthy control (n = 31) old adults, both matched for age, were analyzed. Subjects were submitted to a physical capacity evaluation, including physical activity levels, functional fitness test, and balance scale. Results Depressed patients showed significant lower levels of cortisol than controls, which became non-significant after controlling for physical capacity. A positive correlation was observed between cortisol levels and physical capacity. Conclusions The data suggest that physical capacity modulates the relationship between depression and cortisol levels and needs to be taken into consideration in the future investigations.

RESUMO Objetivo A depressão maior tem sido associada a alterações nos níveis de cortisol e dehidroepiandrosterona (DHEA) em pacientes idosos depressivos. O presente estudo objetivou investigar a associação entre depressão, cortisol e DHEA, corrigindo por variáveis intervenientes, incluindo a capacidade física. Além disso, a associação entre os níveis hormonais e a capacidade física nos dois grupos experimentais também foi analisada. Método Pacientes idosos depressivos (n = 32) e idosos controles saudáveis (n = 31), pareados pela idade foram analisados. Os sujeitos foram submetidos a uma avaliação da capacidade física, incluindo níveis de atividade física, testes de capacidade funcional e escalas de equilíbrio. Resultados Os pacientes depressivos mostraram níveis significativamente menores de cortisol, os quais tornaram-se não significantes após controlados pela capacidade física. Uma correlação positiva foi observada entre os níveis de cortisol e a capacidade física. Resultados não significativos foram observados para DHEA, possivelmente devido a inclusão de pacientes depressivos e uma única coleta de amostra. Conclusão Os dados sugerem que a capacidade física modula a relação entre depressão e os níveis de cortisol e deve ser considerada em futuras investigações.