Intervenciones cognitivas a través de realidad virtual en personas con Deterioro Cognitivo Leve: Una Revisión Sistemática

Introducción: La posibilidad de reversión del Deterioro Cognitivo Leve (DCL) ha generado diversas investigaciones en búsqueda de tratamiento, entre ellas la estimulación cognitiva a través de realidad virtual (RV). No obstante su uso, no existe aún evidencia acerca de las modalidades y efectos en personas con DCL. Objetivo: Sistematizar las características de los estudios que han utilizado intervenciones cognitivas con RV en personas con DCL, describir sus efectos y establecer recomendaciones para futuras investigaciones en base a las limitaciones reportadas. Métodos: revisión sistemática de estudios publicados entre 2010 y 2020, en las bases de datos Web of Science, Scopus y Pubmed. Resultados: Se identificaron 14 estudios con programas que emplearon mayoritariamente RV de tipo inmersiva, con el "supermercado" como escenario virtual más frecuente. En siete trabajos se intervino una función cognitiva, siendo la memoria y las funciones ejecutivas las más intervenidas. Los instrumentos de evaluación se concentraron en medidas cognitivas, con escasa evaluación de variables neuropsiquiátricas y de calidad de vida. Trece estudios informaron mejoras a nivel cognitivo general o por dominio específico. Conclusiones: La utilización de RV, inmersiva y no inmersiva, ha tenido resultados positivos en el rendimiento cognitivo general o específico por dominio, de personas con DCL, sin embargo, debido a la incipiente y limitada evidencia de su uso en personas con esta patología, no es posible determinar la sostenibilidad de estos resultados y la generalización de estas intervenciones hacia las actividades de la vida diaria. Se recomienda realizar intervenciones con entornos reales y seguimiento post-intervención.

Introduction: The possibility of Mild Cognitive Impairment (MCI) reversal has generated numerous studies in search of treatment, including cognitive stimulation through virtual reality (VR). Despite its use, there is still no evidence about the modalities and effects in people with MCI. Aim: To systematize the characteristics of the studies that have used cognitive interventions with VR cognitive in people with MCI, describe their effects and to establish recommendations for future research based on the limitations reported. Methods: systematic review of studies published between 2010 and 2020, in the Web of Science, Scopus and Pubmed databases. Results: 14 studies were identified with programs that mostly used immersive VR, with the "supermarket" as the most frequent virtual scenario. In seven studies only one cognitive function was involved, with memory and executive functions being the most intervened. The assessment instruments focused on cognitive measures, with little assessment of neuropsychiatric and quality of life variables. Thirteen studies reported improvements on the general cognitive level or by specific domain. Conclusions: The use of immersive and non-immersive VR has had positive results in the general or domain-specific cognitive performance of people with MCI, however, due to the incipient and limited evidence of its use in people with this pathology, it is not possible to determine the sustainability of these results and the generalization of these interventions regarding daily living activities. Interventions with real environments and post-intervention follow-up are recommended.

Proposta de um guia educativo sobre envelhecimento ativo e estimulação cognitiva para idosos / Proposal for an educational guide on active aging and cognitive stimulation for the elderly / Propuesta de guía educativa sobre envejecimiento activo y estimulación cognitiva para personas mayores

Objetivo: Construir e validar um guia educativo para favorecer a estimulação cognitiva de idosos. Método: As etapas para a elaboração do material educativo consistiram na sistematização do conteúdo, através de análise narrativa da literatura. Após a revisão e a definição do conteúdo, foram propostas as ilustrações, layout e design, com a diagramação do guia educativo. A versão preliminar foi submetida a processo de validação, com utilização de formulário para a análise do conteúdo, linguagem e design. Contou-se com a colaboração de oito juízes com conhecimento em envelhecimento, cognição, educação em saúde, tecnologias educativas e/ou validação de instrumentos. Após essa etapa, foram realizadas as modificações, a diagramação e versão final do guia. Resultados: O guia foi validado através do Índice de Validade de Conteúdo, com pontuação 0,83. Os juízes fizeram considerações acerca da diminuição de conteúdo teórico, disposição e utilização de ilustrações, mudanças no layout e design e alterações de termos. O guia foi corrigido e sua versão final contém sessenta páginas, com dimensão no formato A4 de 21cmx29,7cm, incluindo o aporte técnico-científico sobre envelhecimento, envelhecimento ativo, cognição, estimulação cognitiva e funções cognitivas, incluindo, também, as orientações, a seleção das atividades e as principais funções cognitivas que seriam estimuladas através das atividades propostas. Conclusão: Materiais como esses contribuem no processo de educação em saúde e estimulação do protagonismo do público-alvo no autocuidado e gerenciamento de saúde e seu emprego é recomendado pela Organização Mundial de Saúde, que considera os diversos determinantes e autores envolvidos na saúde da pessoa idosa.

Objective: To build and validate an educational guide to promote cognitive stimulation in the elderly. Method: The steps for the elaboration of the educational material consisted of the systematization of the content, through narrative analysis of the literature. After reviewing and defining the content, the illustrations, layout and design were proposed with the diagramming of the educational guide. The preliminary version underwent a validation process, using a form to analyze the content, language and design. It had the collaboration of eight judges with knowledge in aging, cognition, health education, educational technologies and/or instrument validation. After this step, the modifications were carried out and the layout and final version of the guide were carried out. Results: The guide was validated through the Content Validity Index, with a score of . 0.83. The judges made considerations about the reduction of theoretical content, arrangement and use of illustrations, changes in layout and design, and changes in terms. The guide has been corrected and its final version contains sixty pages, with an A4 size of 21cmx29.7cm, including the technical-scientific contribution on aging, active aging, cognition, cognitive stimulation and cognitive functions, including guidelines, selection activities and the main cognitive functions that Pwaolualdvrabse-cshtiamvuel:atEendsinthorOounglihnet.hTeerparpoiapoOsceudpacitoinvaitli.esA.prCeondniczlaugseimon.:COMVaItDer-i1a9ls. such as these contribute to the process of health education and stimulation of the target audience's role in self- care and health management, and their use is recommended by the World Health Organization, which considers the various determinants and authors involved in the person's health old woman.

Objetivo: Construir y validar una guía educativa para promover la estimulación cognitiva en el adulto mayor. Método: Los pasos para la elaboración del material educativo consistieron en la sistematización del contenido, a través del análisis narrativo de la literatura. Después de revisar y definir el contenido, se propusieron las ilustraciones, maquetación y diseño con la diagramación de la guía didáctica. La versión preliminar pasó por un proceso de validación, utilizando un formulario para analizar el contenido, lenguaje y diseño. Contó con la colaboración de ocho jueces con conocimientos en envejecimiento, cognición, educación para la salud, tecnologías educativas y/o validación de instrumentos. Luego de este paso, se realizaron las modificaciones y se realizó la maquetación y versión final de la guía. Resultados: La guía fue validada a través del Índice de Validez de Contenido, con una puntuación de 0,83. Los jueces hicieron consideraciones sobre la reducción del contenido teórico, disposición y uso de las ilustraciones, cambios en la disposición y diseño, y cambios en los términos. La guía ha sido corregida y su versión final contiene sesenta páginas, con un tamaño A4 de 21cmx29,7cm, que incluye la contribución técnico-científica sobre el envejecimiento, el envejecimiento activo, la cognición, la estimulación cognitiva y las funciones cognitivas, incluyendo pautas, actividades de selección y las principales funciones cognitivas que serían estimuladas a través de las actividades propuestas. Conclusión: Materiales como estos contribuyen al proceso de educación en salud y estimulación del papel del público objetivo en el autocuidado y gestión de la salud, y su uso es recomendado por la Organización Mundial de la Salud, que considera los diversos determinantes y autores involucrados en la vida de la persona anciana de salud.

[Caregiver training in a cognitive stimulation program: Differential effects according to the type of caregiver]. / Formación de cuidadores en un programa de estimulación cognitiva: efectos diferenciales según el tipo de cuidador.

BACKGROUND AND OBJECTIVES: The ageing population and the increasing dependency associated with it, makes the caregiver a highly relevant figure nowadays. The present study analyzes the socio-demographic differences between family and professional caregivers and their satisfaction and implication in a training program for caregivers. METHODS: The sample consisted of 59 caregivers of older people (37 were family caregivers and 22 professional caregivers) which received and implemented a caregivers training program in their daily care functions. These caregivers were trained in communication skills and cognitive stimulation strategies so they could use them in their daily care activities with the older adults under their care during a period of 3 months. All the participants were assessed with a socio-demographic questionnaire, 2 questionnaires to analyze their satisfaction with their work and the training received and one questionnaire to analyze their ability to detect and react to memory and behavior problems in the older adults they attended. RESULTS: The results showed socio-demographic differences, improvements in satisfaction in family caregivers and a greater commitment in their daily work after the treatment in both groups although these effects could be due to different reasons. CONCLUSIONS: The research shows the benefits of carrying out training programs for caregivers as they significantly increase the quality and satisfaction with caregiving. The study also displays the need to adjust such programs taking into account that the socio-demographic characteristics and training needs are different depending on whether de caregiver is a family member or a professional.

Fazer a Diferença 3 - um programa de estimulação cognitiva individual para pessoas idosas: Aceitabilidade e aplicabilidade / Making a Difference 3 - an individual cognitive stimulation program for older people: Appropriateness and feasibility / Fazer a Diferença 3 - un programa de estimulación cognitiva individual para personas mayores: Aceptabilidad y aplicabilidad

Resumo Enquadramento: A estimulação cognitiva individual desenvolvida em contexto domiciliar por um cuidador é uma intervenção inovadora. O programa de estimulação cognitiva Fazer a Diferença 3 (FD3) é um exemplo deste tipo de intervenção. Objetivo: Explorar a aceitabilidade e a aplicabilidade do programa FD3 para a população portuguesa. Metodologia: Estudo desenvolvido em duas fases: na Fase 1 realizaram-se entrevistas exploratórias a académicos, profissionais de saúde e cuidadores, com o intuito de se conhecer a recetividade a este tipo de intervenção; na Fase 2 conduziu-se um painel de peritos e grupos focais, com cuidadores, para explorar a suas perceções sobre o programa FD3, versão portuguesa. Resultados: A Fase 1 foi impulsionadora do estudo. As partes interessadas analisaram este tipo de intervenção como muito útil e versátil. A Fase 2 permitiu perceber as potencialidades em termos de aceitabilidade e de aplicabilidade da intervenção, traduzida e adaptada, para a população portuguesa. Conclusão: O programa FD3 poderá ser uma excelente ferramenta no cuidado à pessoa idosa com deterioração cognitiva a residir em contexto domiciliar.

Abstract Background: The delivery of individual cognitive stimulation by caregivers in a home-based setting is an innovative intervention. An example of this type of intervention is the Making a Difference 3 (MD3) cognitive stimulation program. Objective: To explore the appropriateness and feasibility of the MD3 program for the Portuguese population. Methodology: This study was developed in two phases. In Phase 1, exploratory interviews were conducted with academics, healthcare professionals, and caregivers to identify the receptivity to this type of intervention. In Phase 2, a panel of experts and focus groups with caregivers were conducted to explore their perceptions about the Portuguese version of the MD3 program. Results: Phase 1 was the driving force behind the study. Participants considered this type of intervention very useful and versatile. Phase 2 allowed identifying the level of appropriateness and feasibility of the intervention that was translated and adapted to the Portuguese population. Conclusion: The MD3 program can be an excellent tool in caring for older adults with cognitive impairment living at home.

Resumen Marco contextual: La estimulación cognitiva individual, desarrollada en casa, por un cuidador, es una intervención innovadora. El programa de estimulación cognitiva Marcando la diferencia 3 (MD3) es un ejemplo de este tipo de intervención. Objetivo: explorar la aceptabilidad y aplicabilidad del programa MD3 para la población portuguesa. Metodología: se desarrollaron dos fases. En la Fase 1, se realizaron entrevistas exploratorias con académicos, profesionales y cuidadores, con el fin de conocer la receptividad a este tipo de intervenciones; La Fase 2, se desarrolló un panel de expertos y grupos focales para explorar sus percepciones sobre el programa, versión portuguesa. Resultados: La Fase 1 fue la fuerza impulsora detrás del estudio. Los grupos de interés consideraron este tipo de intervención como muy útil y versátil. La Fase 2 permitió percibir las potencialidades en términos de aceptabilidad y aplicabilidad de la intervención, traducida y adaptada, para la población. Conclusión: El programa MD3 puede ser una excelente herramienta para el cuidado de las personas mayores con deterioro cognitivo que viven en el hogar.

[Long-term effect analysis of a cognitive stimulation program in mild cognitive impairment elderly in Primary Care: A randomized controlled trial]. / Análisis del efecto a largo plazo de un programa de estimulación cognitiva en mayores con deterioro cognitivo leve en Atención Primaria: ensayo controlado aleatorizado.

OBJECTIVE: To provide evidence about the efficacy of a community health intervention through a cognitive stimulation program at long term in older people with mild cognitive impairment. DESIGN: Randomized controlled trial (CONSORT group norms). LOCATION: San José Norte-Centro Primary Care Center and La Caridad Foundation (Zaragoza, Spain). PARTICIPANTS: Twenty-nine people over 65 years old with a 24-27 MEC score that completed 48 months follow up. They were randomized between the intervention group (15) and the control group (14). INTERVENTIONS: The intervention was applied in 10 sessions of 45min for 10 weeks using the red notebook tool for mental activation that works memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention and executive functions. MAIN MEASUREMENTS: The main outcome variables were MEC-35, Set-test, Barthel index, Lawton-Brody scale, Goldberg anxiety scale and Yesavage geriatric depression scale short form. RESULTS: Increases of the main result variable over the baseline level of MEC-35 were analyzed. On average, the intervention group obtained higher scores than control: 3.14 points post intervention, 3.76 points after 6 months and 2.26 points more than control group after 12 months. All the differences were statistically significant. After 48 months the intervention group obtained 2 points more than control group. The intervention did not improve verbal fluency, activity daily living and mood. CONCLUSIONS: Our cognitive stimulation program seems to improve cognitive performance, measured with the variable MEC-35 at post intervention, 6, 12 and 48 months. There is no evidence of improvement in verbal fluency, activity daily livings and mood. Clinicaltrials.gov Identifier: NCT03831061.

Protocolo de intervenção individual baseado na terapia de estimulação cognitiva em idosos com perturbação neurocognitiva ligeira / Individual intervention protocol based on cognitive stimulation therapy for older adults with mild neurocognitive disorder / Protocolo de intervención individual basado en la estimulacíon cognitiva para ancianos con trastorno neurocognitivo leve

Resumo Enquadramento: A estimulação cognitiva (EC) é uma das terapias não-farmacológicas (TNF) recomendadas e com melhores evidências na perturbação neurocognitiva ligeira (PNCL), permitindo estimular a neuroplasticidade e a reserva cognitiva, podendo atenuar a progressão do declínio cognitivo no idoso com PNCL. Objetivo: Apresentar detalhadamente a estrutura e o conteúdo de um protocolo de intervenção em idosos com PNCL, baseada na EC individual. Metodologia: Identificação das fases preliminares ao desenho do protocolo de intervenção. Resultados: Protocolo de intervenção individual baseado na EC, composto por esquema base de 6 sessões, com frequência bissemanal e com duração aproximada de 45 minutos por sessão, administrado por terapeutas treinados. Conclusão: O programa de EC individual pormenorizado facilita a sua implementação e disseminação, podendo ter implicações relevantes na prática clínica e na investigação da PNCL.

Abstract Background: Cognitive stimulation (CS) is one of the recommended non-pharmacological therapies (NPTs) with the best evidence base for mild neurocognitive disorder (mNCD). It stimulates neuroplasticity and cognitive reserve and can reduce the progression of cognitive decline in older adults with mNCD. Objective: To describe the structure and content of an individual CS intervention protocol for older adults with mNCD. Methodology: Identification of the stages preceding the design of the intervention protocol. Results: Individual CS therapy intervention protocol, consisting of a program implemented by trained therapists with six sessions, twice a week, each lasting around 45 minutes. Conclusion: The detailed individual CS protocol facilitates its implementation and dissemination and can have significant implications for clinical practice and research on mNCD.

Resumen Marco contextual: La estimulación cognitiva (EC) es una de las terapias no farmacológicas (TNF) recomendadas y con mejores evidencias en el trastorno neurocognitivo leve (TNL), lo que permite estimular la neuroplasticidad y la reserva cognitiva y puede atenuar la progresión del deterioro cognitivo en los ancianos con PNCL. Objetivo: Presentar detalladamente la estructura y el contenido de un protocolo de intervención en ancianos con TNL, basado en la EC individual. Metodología: Identificación de las fases preliminares al diseñar el protocolo de intervención. Resultados: Protocolo de intervención individual basado en la EC, compuesto por un esquema básico de 6 sesiones, quincenales y con una duración aproximada de 45 minutos por sesión, administrado por terapeutas formados. Conclusión: El programa individual detallado de EC facilita su aplicación y difusión, y puede tener implicaciones relevantes para la práctica clínica y la investigación del TNL.

Reflexiones sobre rehabilitación vestibular a propósito de un caso con uso de paradigma de tareas dobles / Insights on vestibular rehabilitation concerning one case with the use of dual task paradigm

Resumen Se presenta una reflexión producto de la introducción del paradigma de tareas dobles en el abordaje terapéutico en un caso de vestibulopatía unilateral periférica. Se aplicaron pautas de autovaloración de la discapacidad y riesgo de caídas, complementándose con una completa evaluación del equilibrio funcional y la marcha. Se planificó una terapia personalizada, jerarquizándose objetivos con un criterio funcional. Se incorporó el paradigma de tareas dobles, incluyéndose tareas cognitivas simples a la terapia tradicional de rehabilitación vestibular, con el fin de reducir la influencia cortical sobre la ejecución motora, potenciar la ganancia y funcionalidad de los reflejos remanentes, estimular funciones cognitivas superiores y potenciar procesos atencionales subyacentes, necesarios para lograr la compensación. Los resultados de la reevaluación mostraron una evolución favorable, con remisión de la sintomatología, disminución significativa de los puntajes obtenidos en las diferentes pautas empleadas y una mejoría subjetiva en el equilibrio y marcha funcional después de la terapia. Lo anterior se asoció a la recuperación de la autonomía e independencia para la ejecución de actividades diarias, incidiendo favorablemente en la calidad de vida de la paciente. Los hallazgos confirman los beneficios del programa de rehabilitación vestibular diseñado. Se requieren estudios adicionales, orientados a evidenciar y corroborar el impacto específico de la incorporación del paradigma de tareas dobles en la rehabilitación de los trastornos del equilibrio y especialmente, en procesos de estimulación o rehabilitación vestibular en adultos mayores.

Abstract This article presents the analysis and reflections evoked from an experience in vestibular rehabilitation with the introduction of the paradigm of dual task in a unilateral peripheral vestibulopathy case. First, disability self-assessment guidelines, risk of falls scales and assessment tools of functional balance and gait were applied in order to determine the main symptoms and the main difficulties observed. Afterwards, a personalized therapy was planned, in which work objectives were hierarchized based on a functional criterion, introducing "dual-task" strategies as tools for diminish cortical influence on motor performances, allowing the automation of the required task; enhance the gain and functionality of the remaining reflexes, especially vestibulo ocular and vestibulospinal reflex and stimulate superior cognitive functions and underlying attentional processes, necessary to achieve central compensation. The final assessment showed a favorable evolution, with a significant decrease in the after-therapy scores obtained in fear of falling and disability self-perception protocols, before and after therapy and, finally, an improvement in functional balance and gait, through the pre and post therapy performance in the timed up and go and assessment of unipedal stand tests. This allowed the patient to regain her autonomy and independence in daily life activities improving her quality of life, confirming the benefits of the designed vestibular rehabilitation program. However, more studies are needed to corroborate the specific contribution of the dual-task paradigm in vestibular rehabilitation and specially, in vestibular stimulation or rehabilitation processes in older adults.

Envejecimiento saludable basado en el fortalecimiento de las capacidades cognitivas y el reforzamiento de prácticas saludables de un grupo de personas adultas mayores / Healthy aging based on the strengthening of cognitive abilities and the reinforcement of healthy practices of a group of older adults

Resumen Objetivo: fortalecer las capacidades cognitivas orientadas a un envejecimiento saludable desde el enfoque de promoción de la salud en un grupo de personas adultas mayores (PAM) adscritas a la Clínica Integrada de Tibás, 2018. Metodología: enfoque mixto, diseño preexperimental basado en una prueba/posprueba con un solo grupo. La población de estudio fueron las PAM adscritas a la Clínica, la muestra fue de 24 participantes, todos voluntarios. Resultados: en la fase diagnóstica, la aplicación del MoCA mostró que los dominios con menores puntajes son los señalados en otras investigaciones como las capacidades cognitivas más afectadas en las PAM. Por otra parte, el Índice de Kazt evidenció que la mayoría del grupo no tiene incapacidad. Respecto a las percepciones sobre el proceso de envejecimiento, se observó que el 80 % de las PAM poseen conocimientos similares a los contemplados para este trabajo, asimismo, un 90 % identifica los mitos y estereotipos de la vejez, además, se lograron identificar varios cambios respecto al inicio del proceso. Conclusiones: las estrategias y técnicas implementadas en el proceso de aprendizaje permitieron que la población se apropiará de los temas, reforzara capacidades cognitivas y adoptara prácticas saludables, esto se aprecia en los cambios reflejados en las evaluaciones ex post. La investigación evidenció que las prácticas saludables y capacidades cognitivas se pueden promover desde líneas de promoción de la salud como lo son la creación de entornos saludables, el desarrollo de habilidades y actitudes personales.

Abstract Objective: to strengthen the cognitive capacities oriented to a healthy aging from the Health Promotion focus in a group of elderly people ascribed to the Clínica Integrada de Tibás, 2018. Methodology: mixed approach, preexperimental desing based on a test/post test with a single group. The study population were the elderly people ascribed to the Clinica Integrada de Tibás, the target population: 24, all volunteers. Results: in the diagnosis phase, the application of the MoCA shows that the lower scores are those indicated in other studies as the most affected cognitive capacities in the older adults. In addition, the Indice de KATZ showed that the majority of the group does not have any disabilities. Regarding the subject of perceptions about the aging process, it was observed that 80% of the participants possesses knowledge similar to the one contemplated for this study, and 90% identifies the myths and stereotypes of the aging process. Conclusions: The strategies and techniques implemented in the learning process allowed the population to appropriate each of the topics, reinforce certain cognitive capacities and adopt healthy practices, which can be seen in the changes reflected in the ex post evaluations, since they show an increase in the MoCA results and greater amplitude of knowledge. Finally, this study reinforces that the topic of healthy practices and cognitive capacities can be promoted from the lines of health promotion: creation of healthy environments and development of personal skills and attitudes.

Efficacy of a cognitive stimulation programme using technology on older adults self-esteem, self-efficacy, and autonomy / Eficacia de un programa de estimulación cognitiva con tecnología en la autoestima, autoeficacia y autonomía de adultos mayores

Abstract The objective of this study was to verify the effectiveness of a cognitive stimulation programme using technology: PESCO MX in comparison to a traditional programme that used nontechnological recreational activities to improve levels of self-esteem, self-efficacy, and autonomy in older adults. In this quasi-experimental investigation, 63 participants were divided into three groups of older adults attending three different senior day-care centres. One group was treated with technology, another without technology, and the third group received no programme. All three groups were measured pre-test and post-test. The results show a significant difference in the three variables between the technology group and the control group; however, there is no difference in the pre-test results. Another finding shows significant differences between the three groups for the self-efficacy variable; differences were also found between the group that did not use technology and the control group. There was also a difference between the group without technology and the group that used the PESCO MX (the latter being higher). In general, a cognitive stimulation programme using technology benefitted self-esteem, self-efficacy, and autonomy, which indicates that this programme can contribute to improving the quality of life during old age. Finally, the theoretical and practical implications of this study were analysed.

Resumen El objetivo de este estudio fue comprobar la eficacia de un programa de estimulación cognitiva con tecnología: PESCO MX, frente a un programa tradicional con actividades lúdicas sin tecnología, para mejorar los niveles de autoestima, autoeficacia y autonomía en adultos mayores. En esta investigación cuasi-experimental 63 participantes fueron divididos en tres grupos de adultos mayores de tres diferentes estancias, a uno de ellos se le aplicó el programa con tecnología, a otro sin tecnología y el tercer grupo no se le suministró ningún programa; a los tres se les tomaron dos medidas pretest y postest. Los resultados muestran una diferencia significativa en las tres variables entre el grupo con tecnología y el grupo control, en el pretest no existe diferencia alguna. Otro hallazgo muestra diferencias significativas, para la variable de autoeficacia, entre los tres grupos; es decir, también se encontraron diferencias entre el grupo sin tecnología y el grupo control, además de entre el grupo sin tecnología y el grupo que utilizó el PESCO MX, siendo más alto este último. En general, la autoestima, autoeficacia y autonomía se vieron más beneficiadas a través de un programa de estimulación cognitiva con tecnología, lo que indica que este programa puede contribuir a mejorar la calidad de vida durante la vejez. Finalmente se analizaron las implicaciones teóricas y prácticas de este estudio.

Efectos de la estimulación de las funciones cognitivas en adultos mayores / Effects of the stimulation of cognitive functions in the elderly

RESUMEN Introducción: el envejecimiento trae como consecuencia el deterioro de las funciones cognitivas, por lo que resulta necesario diseñar alternativas terapéuticas para prevenir este proceso. Objetivo: determinar el efecto que tiene la estimulación de las funciones cognitivas en adultos mayores. Métodos: se realizó un estudio con un diseño pre-experimental. El universo consistió en 44 adultos mayor, la muestra estuvo compuesta por 18 pacientes a los que se le realizó el estímulo cognoscitivo. La intervención tuvo un total de 20 sesiones, con una frecuencia de dos veces por semana. Las técnicas de evaluación empleadas fueron el análisis de documentos, la entrevista psicológica semiestructurada, la observación participativa, la Batería de Exploración Neuropsicológica (NEUROPSI), la Escala de Depresión Geriátrica, el test no paramétrico de Wilcoxon y la distribución de frecuencia absoluta y porcentaje relativo. Resultados: se obtuvo cambios significativos en las tareas de dígitos en regresión, memoria, comprensión, fluidez verbal semántica y fonológica, lectura, semejanzas, cálculo, cambios en las posiciones de las manos (mano derecha), movimientos alternos y reacciones opuestas. Conclusiones: la estimulación cognitiva demostró un efecto medianamente positivo en las funciones de los adultos mayores de la Casa de Abuelos #1 en Santa Clara.

ABSTRACT Introduction: aging results in the decline of cognitive functions, consequently it is necessary to design therapeutic alternatives to prevent this process. Objective: to determine the effects of the stimulation of cognitive functions in the elderly. Methods: a study with a pre-experimental design was conducted. The target group included 44 of the oldest adults, the sample comprised 18 of them, and it was chosen from whom received the cognitive stimulus. The intervention had 20 sessions with a frequency of two times per week. The assessment techniques applied were documentary analysis, along with the Battery of Neuropsychological Exploration (NEUROPSI), Geriatric Depression Scale (GDS), Wilcoxon non-parametric test, as well as the distribution by absolute frequency and relative percentage. Results: significant changes were observed in the tasks of counting numbers in regression, memory, comprehension, semantic and phonological oral fluency, reading, similarities, calculation, changes in the position of hands (right hand), alternative movements and opposite reactions Conclusions: cognitive stimulation showed an average positive effect on the functions of the elderly.

Intervención integral en el ictus / Comprehensive intervention in stroke

Introducción: se mantiene el debate sobre qué tipos de intervenciones para la recuperación del ictus ofrecen mejores resultados para el paciente. Objetivo: evaluar el efecto de una intervención integral durante seis meses sobre la recuperación funcional en pacientes con ictus. Métodos: la muestra estuvo compuesta por 42 participantes con ictus: un grupo experimental (N = 22) con una media de edad de 52,68 años (DE = 14,39) que recibió una intervención integral, intensiva y multidisciplinar, y un grupo control (N = 20) con una media de edad de 56,20 años (DE = 14,82) que no recibió este tipo de intervención. Se valoraron los siguiente índices de severidad del ictus: Escala de Coma de Glasgow, Escala Canadiense, estancia en Unidad de Cuidados Intensivos, signos de enclavamiento uncal, signos de hipertensión endocraneal, volumen del hematoma/área isquémica, desplazamiento de línea media, necesidad de cirugía y tiempo total de hospitalización. Ambos grupos eran equivalentes en estos índices de gravedad. El grado de funcionalidad fue medido con la aplicación de la escala Functional Independence Measure and Functional Assessment Measure. Esta prueba se aplicó al inicio de la intervención y 6 meses después. Resultados: se observó una evolución positiva en ambos grupos en todas las áreas de la escala. La intervención integral y un menor tiempo total de hospitalización se relacionaron con una mejor recuperación funcional en el ictus. Conclusiones: se sugiere la necesidad de realizar estrategias de rehabilitación integral en los pacientes con ictus(AU)

Introduction: debate is currently underway about what types of stroke recovery interventions are more beneficial for patients. Objective: evaluate the effect of a six-month comprehensive intervention on the functional recovery of stroke patients. Methods: the study sample was 42 stroke patients: an experimental group (N = 22), mean age 52.68 years (SD = 14.39), who received a comprehensive intensive multidisciplinary intervention, and a control group (N = 20), mean age 56.20 years (SD = 14.82), who did not receive this type of intervention. The following stroke severity indices were applied: Glasgow Coma Scale, Canadian Scale, intensive care unit stay, uncal latching signs, endocranial hypertension signs, hematoma volume / ischemic area, midline displacement, need for surgery and total hospital stay time. These severity indices were similar in the two groups. Degree of functionality was gauged with the scales Functional Independence Measure and Functional Assessment Measure. This test was applied at the start of the intervention and 6 months later. Results: both groups had a positive evolution in all the areas of the scale. The comprehensive intervention and a shorter total hospital stay were associated to better functional recovery from stroke. Conclusions: the need is suggested to implement comprehensive rehabilitation strategies in stroke patients(AU)

[Analysis of the effect of a program of cognitive stimulation in elderly people with normal aging in primary care: Randomized clinical trial]. / Análisis del efecto de un programa de estimulación cognitiva en personas con envejecimiento normal en Atención Primaria: ensayo clínico aleatorizado.

OBJECTIVE: To provide evidence of the effectiveness of a community health intervention, that includes a cognitive stimulation program, to prevent the deterioration of cognitive abilities in our population of elderly people with normal cognition that are living in the community. DESIGN: Randomized clinical trial (CONSORT group norms) LOCATION: San José Norte-Centro Health Center and La Caridad Foundation (Zaragoza, Spain). PARTICIPANTS: 201 people aged 65 or older, with a MEC score of at least 28 points, which were randomized between the Intervention group (101) and the Control group (100). INTERVENTION: The intervention was applied in 10 sessions of 45minutes, one per week. It used materials designed by one of the authors, which addressed the following areas: memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention-concentration and programming. MAIN MEASUREMENTS: The main outcome variables were MEC, Set-Test, Barthel and Lawton-Brody. RESULTS: Increases of the main result variables over their baseline level were analized. For MEC variable, the Intervention group obtained, on average, 1.58 points more than the Control group in the evaluation performed immediately after the intervention. After 6months, the improvement was 1.51 points and after a year, it was of 2.04 points. All these differences were statistically significant. For Set-Test, Barthel and Lawton-Brody variables, no statistically significant differences were observed between Intervention group and Control group. CONCLUSIONS: Cognitive stimulation with our program is effective to maintain or improve cognitive performance, measured with the variable MEC, our population of elderly people with normal cognition that are living in the community. There is no evidence that this improvement is transferred to the activities of daily life measured with Barthel and Lawton-Brody variables.

Medición de reserva cognitiva: estudio en una muestra de adultos chilenos / Cognitive reserve assessment: a study in a sample of chilean adults

Mayor reserva se asocia con resistencia al deterioro en sujetos con enfermedades neurodegenerativas. En personas sanas explica las diferencias interindividuales en el rendimiento de tareas. Medir los factores de reserva cognitiva permite contar con un índice numérico de la ganancia cognitiva acumulada por un sujeto. Este índice puede ser correlacionado con otras funciones cuantificables. El presente trabajo tiene como objetivo presentar los índices de reserva obtenidos por una población chilena en la aplicación del Cognitive Reserve Index Questionnaire (CRIq). Para ello 90 adultos (18-85 años) sin evidencias de trastorno cognitivo, de la región de Valparaíso-Chile, fueron entrevistados sobre actividades de estudio, laborales y de tiempo libre ejecutadas desde los 18 años.Los resultados muestran que los índices de reserva de los sujetos varían en función del tiempo de ejecución de actividades promotoras de reserva y no por su edad. Se encontraron diferencias estadísticamente significativas entre los grupos etarios. Estos resultados permiten concluir que la ejecución de actividades de estudio, laborales, sociales, entre otras aumenta los índices de reserva cognitiva, que es una variable diferenciadora entre individuos. La medición de dichos índices puede ser útil en un amplio campo de disciplinas (medicina, neurología, neuropsicología, educación, psicología, fonoaudiología, neurociencias y en las ciencias cognitivas en general).

A higher cognitive reserve is linked to higher resistance to deterioration among subjects suffering from neurodegenerative disorders. In healthy persons the cognitive reserve explains inter-individual differences in task performance. Measuring the cognitive reserve factors involves obtaining a numerical index of the cumulative cognitive gain accumulated by a subject. This index can be correlated with other measurable functions.This study was conceived to determine the reserve indexes accumulated by a Chilean sample, by means of the administration of the Cognitive Reserve Index Questionnaire (CRIq).In order to do so, 90 adults (18-85 years old) without evidence of cognitive disorder, living in Valparaíso region, Chile, were interviewed about their education, their work environment and their and leisure activities carried out since they were 18 years old.Results showed that reserve indexes of the subjects vary as a function of the time of execution of reserve-promoting activities, not age. Statistically significant differences were found among age-groups. These findings allow us to conclude that studying, working and engaging in social activities, among other things, increase the cognitive reserve indexes, which are a differentiating variable among individuals.The measurement of these indexes can be useful in a wide array of disciplines: medicine, neurology, neuropsychology, education, psychology, phonoaudiology, neurosciences and cognitive sciences in general.

Estimulação cognitiva em adultos e idosos de uma Faculdade Aberta à Terceira Idade / Cognitive stimulation in adults and elderly of a Faculty Open to Senior Citizens / Estimulación cognitiva en adultos y ancianos en una Universidad Abierta a Personas Mayores

Este artigo tem como objetivo investigar a efetividade de um treinamento de estimulação cognitiva (EC) em adultos e idosos participantes de uma Faculdade Aberta da Terceira Idade (FATI). Trata-se de um estudo exploratório e intervencionista, em que foram realizadas intervenções de estimulação cognitiva em um grupo de adultos e idosos participantes da FATI, n=19. Esperamos que este artigo contribua com as discussões e intervenções em estimulação cognitiva na área da Gerontologia, contribuindo para uma melhor sistematização das pesquisas aplicadas.

This article aims to investigate the effectiveness of a cognitive stimulation (CE) training in adults and elderly participants of a Faculty Open to Senior Citizens (FATI). This is an exploratory and interventional study in which cognitive stimulation interventions were performed in a group of adults and elderly participants of the FATI, n=19. We hope that this article contributes to the discussions and interventions in cognitive stimulation in the area of Gerontology, contributing to a better systematization of applied research.

Este artículo tiene como objetivo investigar la efectividad del entrenamiento de estimulación cognitiva (CE) en adultos y ancianos participantes de un Open College of the Third Age (FATI). Este es un estudio exploratorio e intervencionista en el que se realizaron intervenciones de estimulación cognitiva en un grupo de adultos y ancianos participantes de FATI, n = 19. Esperamos que este artículo contribuya a las discusiones e intervenciones sobre la estimulación cognitiva en el campo de la gerontología, contribuyendo a una mejor sistematización de la investigación aplicada.

Estimulación cognitiva y apoyo familiar hacia adulto mayor con deterioro cognitivo / Estimulação cognitiva e apoio familiar para idosos com comprometimento cognitivo / Cognitive stimulation and family support towards older adults with cognitive impairment

Se presentó el estudio de una familia del área de salud del Policlínico Comunitario de Palma Soriano con el objetivo de socializar la experiencia de la estimulación cognitiva temprana de un adulto mayor con deterioro cognitivo a través del apoyo familiar. El estudio concluyó en 2015, en Palma Soriano. Se empleó el diseño de investigación no experimental estudio de caso instrumental desde la metodología cualitativa. El estudio incluyó una familia, se sustentó en el trabajo de grupo focal y se auxilió en técnicas estandarizadas. Se concluyó que el apoyo familiar brindado al paciente con deterioro cognitivo impacta positivamente en su condición física, bienestar psicológico y relaciones sociales. Asimismo, se reconoció al apoyo familiar como una vía necesaria, emocionalmente importante y coherente con la situación sociodemográfica cubana, que posibilita la estimulación cognitiva precoz del adulto mayor con deterioro cognitivo(AU)

The study of a family of the health area of the Community Polyclinic of Palma Soriano was presented with the aim of socializing the experience of the early cognitive stimulation of an older adult with cognitive deterioration through family support. The study concluded in 2015, in Palma Soriano. The non-experimental research design was used, instrumental case study from the qualitative methodology. The study included a family, was based on the work of the focus group and assisted in standardized techniques. It was concluded that the family support provided to the patient with cognitive impairment positively impacts their physical condition, psychological well-being and social relationships. Likewise, family support was recognized as a necessary, emotionally important and coherent path with the Cuban sociodemographic situation, which enables early cognitive stimulation of the elderly with cognitive impairment(AU)

O estudo de uma família da área da saúde da Policlínica Comunitária de Palma Soriano foi apresentado com o objetivo de socializar a experiência da estimulação cognitiva precoce de um idoso com deterioração cognitiva através do apoio familiar. O estudo concluiu em 2015, em Palma Soriano. Utilizou-se o delineamento de pesquisa não experimental, estudo de caso instrumental a partir da metodologia qualitativa. O estudo incluiu uma família, foi baseado no trabalho do grupo focal e auxiliou em técnicas padronizadas. Concluiu-se que o apoio familiar fornecido ao paciente com comprometimento cognitivo impacta positivamente sua condição física, bem-estar psicológico e relações sociais. Da mesma forma, o apoio familiar foi reconhecido como um caminho necessário, emocionalmente importante e coerente com a situação sociodemográfica cubana, que possibilita a estimulação cognitiva precoce de idosos com comprometimento cognitivo(AU)

La estimulación cognitiva como estrategia para la atención psicogerontológica a los adultos mayores con demencia / Cognitive stimulation as a strategy for psychogerontological care for the elderly with dementia

La atención integral a los adultos mayores con demencia constituye un reto importante para las dependencias de salud gubernamental encargadas de proponer políticas públicas. En México, se plantea una iniciativa para afrontar la enfermedad y dar un seguimiento a los pacientes que la padecen. Consecuentemente, el propósito de esta comunicación es informar acerca del beneficio de la estimulación cognitiva como una estrategia preventiva, económica y efectiva para el abordaje psicogerontológico de los pacientes con demencia en la atención primaria de salud. Se propone desde una perspectiva integral y centrada en la persona e involucrar las necesidades biopsicosociales del usuario. La estimulación cognitiva mejorará la calidad de vida de los adultos mayores con demencia y propiciara el afrontamiento individual y familiar ante la enfermedad(AU)

Comprehensive care for the elderly with dementia constitutes a major challenge for government health agencies responsible for proposing public policies. In Mexico, an initiative is proposed to confront the disease and to follow up the patients who suffer it. Consequently, the purpose of this communication is to inform about the benefit of cognitive stimulation as a preventive, economic and effective strategy for the psychogerontological approach to patients with dementia in the primary health care. It is proposed from a comprehensive perspective, centered on the person, involving the biopsychosocial needs of the user. It is expected that cognitive stimulation would improve the life quality of the elderly with dementia and will encourage individual and family coping with the disease(AU)

Cognitive interventions to improve memory in healthy older adults: the use of Canadian (MEMO) and Brazilian (Stimullus) approaches / Intervenções cognitivas no aprimoramento da memória em idosos saudáveis: o uso de metodologias canadense (MEMO) e brasileira (Stimullus) / Intervenciones cognitivas para mejorar la memoria en ancianos saludables: el uso de metodologías canadiense (MEMO) y brasileña (Stimullus)

This study aimed to investigate the effects of a memory training (MEMO) and a memory stimulation (Stimullus) procedure in older adults with normal cognitive aging. The study was conducted with 44 participants of both sexes, healthy and over 60 years old, using a randomized control trial design with two groups receiving cognitive interventions and one control group with no intervention, with pre and post-intervention assessments. Results indicated that MEMO interventions produce more cognitive gains than the Stimullus intervention procedure. Visual memory and Face-Name Association tests presented significant differences between groups, but Free Recall and Image Recognition tests were insensitive to the interventions.

Este estudo investigou os efeitos de um treino de memória (MEMO) e de uma estimulação da memória (Stimullus) em idosos com envelhecimento cognitivo normal. O estudo foi realizado com 44 participantes de ambos os sexos, saudáveis e com mais de 60 anos de idade. Aplicou-se um delineamento controlado randomizado com dois grupos que receberam intervenções cognitivas e um grupo controle sem intervenção, com avaliações pré e pós-intervenção. Os resultados demonstraram que a intervenção do tipo MEMO produziu mais ganhos cognitivos do que Stimullus. O teste de memória visual e o teste de associação nome-rosto apresentaram diferenças significativas entre os grupos, mas os testes de recuperação livre de palavras e reconhecimento de imagens não foram sensíveis às intervenções.

Este estudio investigó los efectos de un entrenamiento de la memoria (MEMO) y una estimulación de la memoria (Stimullus) en pacientes de edad avanzada con el envejecimiento cognitivo normal. El estudio se realizó con 44 participantes de ambos sexos, saludables y con más de 60 años. Se aplicó un diseño aleatorizado controlado con dos grupos que recibieron las intervenciones cognitivas y un grupo de control sin intervención, con las evaluaciones previas y posteriores a la intervención. Los resultados mostraron que la intervención del tipo MEMO produjo más beneficios cognitivas que Stimullus. La prueba de memoria y asociación rostro-nombre visual mostró diferencias significativas entre los grupos, pero las pruebas de recuperación de palabras e reconocimiento de imágenes no fueron sensibles a las intervenciones.

Efecto de la implementación de un programa de estimulación cognitiva en una población de adultos mayores institucionalizados en la ciudad de Bogotá / Effect of implementing a program of cognitive stimulation in a population of institutionalized elderly in the city of Bogotá

En el envejecimiento normal, sin generalizar a toda la población adulta mayor, se puede presentar un declive en las funciones cognitivas e intelectuales previamente desarrolladas por el individuo. Desde la neuropsicología se han movilizado estrategias para mejorar este funcionamiento o detener el declive que se pueda presentar. Dentro de las estrategias de intervención, los programas de estimulación cognitiva muestran efectos beneficiosos en la cognición de estos adultos,mejorando o retardando problemas asociados a una demencia. El objetivo de este estudio fue identificar los perfiles pre y post, de un grupo de adultos mayores aquienes se les suministró un programa de estimulación en las funciones mentales superiores. Esta investigación está enmarcada dentro de un tipo de estudio comparativo-descriptivo, cuasi experimental, de diseño con grupo de estudio y grupo de comparación no equivalentes, realizado a 40 adultos mayores de ambosgéneros quienes residen en la Ciudad de Bogotá...

In normal aging, without making a generalization to the entire adult population, there may be a decline in cognitive and intellectual functions previously acquiredby the individual, from neuropsychology have mobilized strategies to improve performance or stop the decline can be put forward. Within intervention strategies, cognitive stimulation programs have shown beneficial effects on cognition of these adults as well, they enhance or retard the problems associated with dementia, these facts are based in the light of the concept of brain plasticity, which refers to human beings in terms of central nervous system, have the ability toweigh compensatory manner constraints specific performance of some cognitive functions, with other areas or circuits that are preserved and allow the execution of cognitive activities, likewise this compensatory phenomenon has been worked today under the concept of cognitive reserve, where it is stated that thevarious activities throughout life, and specifically cognitively stimulating activities in adulthood, allows the delay process in most neurodegenerative adulthood. For this study, our objective was to identify the pre and post of a group of older adults who received cognitive stimulation program of higher mental functions profiles. This research is part of a type of comparative descriptive design, quasi-experimental with a study group and a comparison group not equivalent, thestudy population consisted of 40 elderly residents of both genders, institutionalized in a geriatric center in the city of Bogotá...

A pilot study of a new method of cognitive stimulation using abacus arithmetic in healthy and cognitively impaired elderly subjects. / Estudio piloto de un nuevo método de estimulación aritmética empleando el ábaco en ancianos sanos y con trastorno cognitivo.

BACKGROUND: This study explores the applicability of a cognitive stimulation method based on abacus arithmetic in elderly people with and without cognitive impairment. METHODS: This observational and prospective pilot study was performed in 2 hospitals. The study assessed the applicability of a programme of arithmetic training developed for use in the elderly population. The primary endpoint was an evaluation of the stimulation programme, in terms of usability, satisfaction, and participation, in healthy elderly controls and elderly patients with mild cognitive impairment or Alzheimer disease. Secondary endpoints were family satisfaction, caregiver burden, and the behaviour and cognition of patients. RESULTS: Usability, satisfaction, and degree of participation were high. The Mini-Mental State Examination showed significant changes (23.1±4.8 before the intervention vs 24.9±4.2 afterwards, P=.002); there were no changes on the Trail Making Test parts A and B, Yesavage Geriatric Depression scale, and Zarit caregiver burden scale. CONCLUSIONS: The study suggests that cognitive stimulation with abacus arithmetic may be used in elderly people with and without cognitive impairment. Further studies will be needed to evaluate the efficacy of this kind of programmes.

[Online platforms for neuropsychological rehabilitation: current status and lines of work]. / Plataformas de rehabilitación neuropsicológica: estado actual y líneas de trabajo.

INTRODUCTION: The incidence of neurological and psychiatric diseases and disorders has increased in recent years, and similarly, the number of technological tools facilitating neuropsychological rehabilitation for family members and therapists has also grown. The purpose of this article is to describe some of these tools and indicate the needs they cover. DEVELOPMENT: This article reviews some currently well-known neuropsychological rehabilitation platforms, compares them, and proposes future lines of work to be considered when developing tools that meet real needs. In this review, we list the main advantages and shortcomings of each of the tools and establish benchmarks for evaluating them. In comparing these platforms, we may observe their advantages on the one hand, and areas needing improvement on the other. CONCLUSIONS: This review demonstrates that more of these tools are entering the market, but many aspects of neurorehabilitation remain uncovered. Additional studies evaluating these tools' effectiveness are also needed.