[Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic]. / Prevalencia y factores asociados con las quejas cognitivas subjetivas del personal sanitario latinoamericano durante la pandemia de COVID-19.

Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries.Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used.Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel.Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults / Utilidade clínica do phototest via teleneuropsicologia em idosos rurais chilenos

ABSTRACT. The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

RESUMO. A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults.

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Prevalence of Dementia and Associated Factors among Older Adults in Latin America during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has had a great impact on cognitive health in Latin American older adults, increasing the risk of cognitive impairment and dementia. Our objective was to analyze the prevalence of dementia and the associated factors in Latin American older adults during SARS-CoV-2 pandemic. METHODS: A multicentric first phase cross-sectional observational study was conducted during the SARS-CoV-2 pandemic. Five thousand two hundred and forty-five Latin American adults over 60 years of age were studied in 10 countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Mexico, Peru, the Dominican Republic, and Venezuela. We used the telephone version of Montreal Cognitive Assessment, the "Alzheimer Disease 8" scale for functional and cognitive changes, and the abbreviated version of the Yesavage depression scale. We also asked for sociodemographic and lockdown data. All the evaluation was made by telephone. Cross-tabulations and χ2 tests were used to determine the variability of the prevalence of impairment by sociodemographic characteristics and binary logistic regression to assess the association between dementia and sociodemographic factors. RESULTS: We observed that the prevalence of dementia in Latin America is 15.6%, varying depending on the country (Argentine = 7.83 and Bolivia = 28.5%). The variables most associated with dementia were race and age. It does not seem to be associated with the pandemic but with social and socio-health factors. CONCLUSION: The prevalence of dementia shows a significant increase in Latin America, attributable to a constellation of ethnic, demographic, and socioeconomic factors.

Literacy Level and Executive Control in Healthy Older Peruvian Adults.

Introduction: Early-life educational experiences are associated with cognitive performance in aging. Early literacy seems to improve executive control mechanisms, however, it is not clear whether early education would still be an advantage in countries like Peru, where access to and quality of education is highly variable. Aim: Our objective was to analyze the association of literacy level with executive control factors. Method: We evaluated 93 healthy older adults with a clinical protocol that included the Mini-Mental State Examination, the Geriatric Depression Scale and Global Dementia Staging. We also used a neuropsychological executive function battery which included the Trail-Making Test parts A and B, the Stroop Test, phonological and semantic verbal fluency tasks, Forward and Backward Digits, Numbers and Letters of the Wechsler Scale, and the Go/No-Go task. We used a principal component analysis for the dimensional reduction of the variables. To measure the level of literacy we used the word accentuation test (WAT). Results: We observed statistically significant correlations between the principal components (PCs) of working memory, cognitive flexibility and inhibitory control with the WAT scores. Furthermore, we observed that processing speed and WAT predict the scores on PCs factors better than years of education and age. Conclusions: Literacy level correlates more closely with better cognitive performance than years of education and thus, might improve executive control factors that could compensate and protect against brain changes in cognitive decline and dementia.

Neuropsychological profile in the preclinical stages of dementia: principal component analysis approach.

The preclinical stages of dementia include subtle neurocognitive changes that are not easily detected in standard clinical evaluations. Neuropsychological evaluation is important for the classification and prediction of deterioration in all the phases of dementia. OBJECTIVE: Compare the neuropsychological performance in healthy older adults with subjective cognitive decline (SCD) and with mild cognitive impairment (MCI) using principal components analysis. METHODS: We evaluated 94 older adults with a clinical protocol which included general measures of mental, emotional and functional state. The neuropsychological protocol included tasks of memory, executive function, attention, verbal fluency and visuoconstructional abilities. We used principal component analysis (PCA) to reduce variables´ dimensionality on neuropsychological evaluation. RESULTS: 33(35%) participants had a normal cognitive function, 35(37%) had subjective cognitive decline and 26(28%) had a mild cognitive impairment. The PCA showed seven factors: processing speed, memory, visuoconstruction, verbal fluency and executive components of cognitive flexibility, inhibitory control and working memory. ANOVA had shown significant differences between the groups in the memory (F=4.383, p=0.016, η2p=0.087) and visuoconstructional components (F=5.395, p=0.006, η2p=0.105). Post hoc analysis revealed lower memory scores in MCI than SCD participants and in visuospatial abilities between MCI and SCD and MCI and Normal participants. CONCLUSIONS: We observed differentiated cognitive profiles among the participants in memory and visuoconstruction components. The use of PCA in the neuropsychological evaluation could help to make a differentiation of cognitive abilities in preclinical stages of dementia.

Os estágios pré-clínicos da demência incluem mudanças neurocognitivas sutis que não são facilmente detectadas nas avaliações clínicas padrão. A avaliação neuropsicológica é importante para a classificação e predição da deterioração em todas as fases da demência. OBJETIVO: Comparar o desempenho neuropsicológico em idosos saudáveis com declínio cognitivo subjetivo (DCS) e com comprometimento cognitivo leve (CCL) por meio da análise de componentes principais. MÉTODOS: Avaliaram-se 94 idosos com um protocolo clínico que incluía medidas gerais do estado mental, emocional e funcional. O protocolo neuropsicológico incluiu tarefas de memória, função executiva, atenção, fluência verbal e habilidades visuoconstrutivas. Utilizou-se a análise de componentes principais (PCA, na sigla em inglês) para reduzir a dimensionalidade das variáveis na avaliação neuropsicológica. RESULTADOS: Um total de 33 (35%) participantes apresentavam função cognitiva normal, 35 (37%) declínio cognitivo subjetivo e 26 (28%) comprometimento cognitivo leve. A PCA apresentou sete fatores: velocidade de processamento, memória, visuoconstrução, fluência verbal e componentes executivos de flexibilidade cognitiva, controle inibitório e memória de trabalho. ANOVA mostrou diferenças significativas entre os grupos na memória (F=4,383, p=0,016, η2p=0,087) e componentes visuoconstrutivos (F=5,395, p=0,006, η2p=0,105). A análise post hoc revelou escores de memória mais baixos no CCL do que os participantes com DCS e nas habilidades visuoespaciais entre CCL e DCS e CCL e participantes normais. CONCLUSÕES: Observaram-se perfis cognitivos diferenciados entre os participantes nos componentes de memória e visuoconstrução. O uso da PCA na avaliação neuropsicológica poderia auxiliar na diferenciação das habilidades cognitivas em estágios pré-clínicos da demência.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America.

BACKGROUND: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. METHODS: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. FINDINGS: Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, ηp 2  = 0.031); while Blacks reported experiencing discrimination more often (p < .001, ηp 2  = 0.050). Blacks and Latinos reported more positive coping (p < .001, ηp 2  = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination. INTERPRETATION: The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact. FUNDING: Massachusetts General Hospital Department of Psychiatry.

Neuropsychological profile in the preclinical stages of dementia: principal component analysis approach / Perfil neuropsicológico nos estágios pré-clínicos de demência: abordagem por análise de componente principal

ABSTRACT. The preclinical stages of dementia include subtle neurocognitive changes that are not easily detected in standard clinical evaluations. Neuropsychological evaluation is important for the classification and prediction of deterioration in all the phases of dementia. Objective: Compare the neuropsychological performance in healthy older adults with subjective cognitive decline (SCD) and with mild cognitive impairment (MCI) using principal components analysis. Methods: We evaluated 94 older adults with a clinical protocol which included general measures of mental, emotional and functional state. The neuropsychological protocol included tasks of memory, executive function, attention, verbal fluency and visuoconstructional abilities. We used principal component analysis (PCA) to reduce variables´ dimensionality on neuropsychological evaluation. Results: 33(35%) participants had a normal cognitive function, 35(37%) had subjective cognitive decline and 26(28%) had a mild cognitive impairment. The PCA showed seven factors: processing speed, memory, visuoconstruction, verbal fluency and executive components of cognitive flexibility, inhibitory control and working memory. ANOVA had shown significant differences between the groups in the memory (F=4.383, p=0.016, η2p=0.087) and visuoconstructional components (F=5.395, p=0.006, η2p=0.105). Post hoc analysis revealed lower memory scores in MCI than SCD participants and in visuospatial abilities between MCI and SCD and MCI and Normal participants. Conclusions: We observed differentiated cognitive profiles among the participants in memory and visuoconstruction components. The use of PCA in the neuropsychological evaluation could help to make a differentiation of cognitive abilities in preclinical stages of dementia.

RESUMO. Os estágios pré-clínicos da demência incluem mudanças neurocognitivas sutis que não são facilmente detectadas nas avaliações clínicas padrão. A avaliação neuropsicológica é importante para a classificação e predição da deterioração em todas as fases da demência. Objetivo: Comparar o desempenho neuropsicológico em idosos saudáveis com declínio cognitivo subjetivo (DCS) e com comprometimento cognitivo leve (CCL) por meio da análise de componentes principais. Métodos: Avaliaram-se 94 idosos com um protocolo clínico que incluía medidas gerais do estado mental, emocional e funcional. O protocolo neuropsicológico incluiu tarefas de memória, função executiva, atenção, fluência verbal e habilidades visuoconstrutivas. Utilizou-se a análise de componentes principais (PCA, na sigla em inglês) para reduzir a dimensionalidade das variáveis na avaliação neuropsicológica. Resultados: Um total de 33 (35%) participantes apresentavam função cognitiva normal, 35 (37%) declínio cognitivo subjetivo e 26 (28%) comprometimento cognitivo leve. A PCA apresentou sete fatores: velocidade de processamento, memória, visuoconstrução, fluência verbal e componentes executivos de flexibilidade cognitiva, controle inibitório e memória de trabalho. ANOVA mostrou diferenças significativas entre os grupos na memória (F=4,383, p=0,016, η2p=0,087) e componentes visuoconstrutivos (F=5,395, p=0,006, η2p=0,105). A análise post hoc revelou escores de memória mais baixos no CCL do que os participantes com DCS e nas habilidades visuoespaciais entre CCL e DCS e CCL e participantes normais. Conclusões: Observaram-se perfis cognitivos diferenciados entre os participantes nos componentes de memória e visuoconstrução. O uso da PCA na avaliação neuropsicológica poderia auxiliar na diferenciação das habilidades cognitivas em estágios pré-clínicos da demência.