Cortisol reactivity to a psychosocial stressor significantly increases the risk of developing Cognitive Impairment no Dementia five years later.

Alzheimer's disease (AD) patients show high cortisol levels suggesting that biological mediators of stress may play a role in the neurodegenerative process of cognitive disorders. However, there is no consensus as to whether cortisol concentrations represent a risk factor for the development of cognitive impairment. We analyzed the potential association between the incidence of cognitive impairment and cortisol concentrations under basal and acute stress conditions in 129 individuals aged 50 years or older, with preserved cognitive and functional abilities. All participants were recruited in 2011 for assessment of cognitive performance and cortisol levels. Cortisol was analyzed in saliva samples collected during two typical and consecutive days, in the morning, afternoon, and night, and also during exposure to an acute psychosocial stressor (Trier Social Stress Test - TSST). After a five-year follow-up, 69 of these volunteers were reassessed for cognitive performance, functional evaluation, memory complaints, and depression. The incidence of cognitive impairment not dementia (CIND) was 26.1 %, and was positively associated with greater TSST-induced cortisol release (responsiveness) [(95 % CI = 1.001-1.011; B = 0.006), p = 0.023]. Moreover, five years before diagnosis, participants who later developed CIND had greater responsiveness to TSST (p = 0.019) and lower cortisol awakening response (CAR: p = 0.018), as compared to those who did not develop CIND. These findings suggest that higher psychosocial stress responsiveness profiles may represent a preclinical sign of cognitive impairment.

Association between perceived psychological stress and cognitive decline in aging: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this review is to identify, appraise and synthesize the best available evidence on the association between perceived psychological stress and cognitive decline in aging.

Association between heavy metal exposure and poor working memory and possible mediation effect of antioxidant defenses during aging.

BACKGROUND: Inverse associations have been observed between memory performance and blood concentrations of cadmium (Cd) and lead (Pb). Low antioxidant cell activity has also been linked to decline in memory due to aging. However, it has not yet been established whether the heavy metal-memory relationship is mediated by differences in antioxidant activity. METHODS: We examined Cd and Pb levels, as well as oxidative stress parameters, in blood samples from 125 older adults (age range 50-82years). The Counting Span Test (CST) was used to evaluate working memory capacity (WMC). The Monte Carlo Method for Assessing Mediation (MCMAM) was used to analyze the mediation role of antioxidant activity in the heavy metals-memory association. RESULTS: High blood Cd (BCd) concentration alone, and in combination with elevated blood Pb (BPb) concentration, was associated with poor WMC (p≤0.001) and low enzymatic antioxidant defenses (p≥0.006). The variance in WMC accounted for by BCd or by BCd combine with BPb was 20.6% and 18.6%, respectively. The MCMAM revealed that the influence of BCd and BPb concentrations on WMC was mediated by low antioxidant capacity (confidence interval - CI: 0.072 to -0.064 for BCd; CI: -0.062 to -0.045 for BPb). CONCLUSION: These findings showed Pb and Cd blood concentration in older adults, even at levels below the current recommended threshold, was negatively associated with WMC and that this relationship may be partly mediated by low antioxidant defenses. Knowledge on the environmental factors that negatively influence brain and cognition during aging can help inform public policy strategies to prevent and control the adverse effects of environmental contaminant exposure during aging.

Exposição ao chumbo e estresse psicológico como preditores de declínio cognitivo durante o envelhecimento: estudo de coorte / Exposure to lead and psychological stress as predictors of cogniyive decline in aging: cohort study

Evidências recentes têm revelado que a exposição ambiental ao chumbo (Pb), relevante contaminante ambiental, pode comprometer o funcionamento do eixo Hipotálamo-Pituitário-Adrenal (HPA), principal regulador neuroendócrino da resposta de estresse. Tanto o estresse como o Pb agem em estruturas cerebrais relacionadas com habilidades cognitivas como o aprendizado, memória e atenção, podendo comprometer seu desempenho em grupos vulneráveis como os idosos. Entretanto, ainda não está elucidado se a exposição prévia ao Pb e aos hormônios do estresse podem influenciar o desenvolvimento de comprometimento cognitivo durante o envelhecimento. Isso é particularmente importante, dado que tanto a exposição ao Pb como ao estresse podem ser prevenidas por ações de enfermagem e multidisciplinares e, assim, amenizar a ocorrência de transtornos cognitivos em idosos. Nesse sentido, o presente estudo analisou se a incidência de comprometimento cognitivo durante o envelhecimento está associada à exposição prévia ao Pb e ao perfil neuroendócrino de estresse. Trata-se de um estudo de coorte iniciado em 2011, com o trabalho Exposição a contaminantes ambientais e declínio cognitivo em idosos saudáveis: influência sobre o estresse psicológico e estresses oxidativo (Estudo CONTAMINA), que analisou o desempenho cognitivo de 129 adultos e idosos saudáveis entre 50 e 82 anos sem comprometimento cognitivo. A exposição ao Pb foi analisada através de questionário sobre exposição ambiental e a partir de amostras de sangue. O perfil neuroendócrino do estresse foi analisado a partir da concentração de cortisol em amostra de saliva coletadas sob duas condições: ao longo de dias típicos (pela manhã, à tarde e à noite) e sob estresse agudo (estressor psicossocial Trier Social Stress Test). O comprometimento cognitivo foi diagnosticado por médicos neurologistas especialistas em neurologia cognitiva e do comportamento a partir do desempenho em testes neuropsicológicos, de avaliação funcional, de queixa de memória e de depressão. Dos 129 participantes incluídos na coorte em 2011, 69 foram reavaliados em 2016 e compuseram a amostra do presente estudo. Desses, 18 (26,1%) apresentaram comprometimento cognitivo sem demência (CCSD). Mediante o controle de variáveis de confusão foi observado que a incidência de CCSD está associada com maior concentração de cortisol em situação de estresse agudo. Os participantes que apresentaram CCSD apresentaram cinco anos antes do diagnóstico um perfil hiperresponsivo de cortisol a um estressor agudo psicossocial. Não foi observada associação significativa entre a incidência de CCSD e a exposição prévia ao Pb. A baixa concentração de Pb no sangue, bem como a idade da presente amostra podem ser fatores que explicam essa ausência de associação. De modo geral, os achados do presente estudo sugerem que a exposição prévia a perfis neuroendócrinos do estresse alterados pode influenciar o desenvolvimento de transtornos cognitivos durante o envelhecimento.

Recent evidences have revealed that the exposure to Lead (Pb) - a relevant environmental contaminant - mat affect the functioning of the hypothalamuspituitary- adrenal (HPA) axis, the main neuroendocrine regulator of the stress response. Stress and Pb work in the brain structures related to cognitive abilities - such as learning, memory and attention - what compromise the individuals performance, specially in vulnerable groups, like the elderlies. However, it is not well stated whether the previous Pb exposure and the stress hormones may affect the development of cognitive impairment. This is particularly important once nursing and multidisciplinary actions may prevent the Pb exposure and stress and, so, relieve the occurrence of cognitive disorders in elderlies. In this sense, this investigation assessed whether the incidence of cognitive impairment during the aging is associated with previous Pb exposure and stress neuroendocrine profile. This is a cohort study, started in 2011 with the project Exposure to environmental contaminants and cognitive impairment in healthy elderlies: influence on psychological and oxidative stress (CONTAMINA study). It assessed the cognitive performance of 129 healthy adults and elderlies aged between 50 and 82 years without cognitive impairment. The Pb exposure was assessed trough the environmental exposure questionnaire and blood samples. For assessing the stress neuroendocrine profile, the concentrations of cortisol were obtained from saliva samples under two predetermined conditions: across two typical days (by morning, in the evening and at night) and under acute stress (Psychosocial stress measured for Trier Social Stress Test). The mild cognitive impairment was diagnosed for neurologists specialized in behavioral and cognitive neurology from individuals performance in neuropsychological tests, functional evaluation, and its memory and depression complains. Of the 129 participants who met criteria for the cohort in 2012, 69 were reevaluated in 2016 and comprised this study sample. From these individuals, 18 (26.1%) showed Cognitive Impairment no Dementia (CIND). After controlling the confusion variables, we observed that the incidence of CIND is associated with higher cortisol concentrations during acute stress conditions. Those participants who showed CIND had a hyporesponsive profile to cortisol face an acute psychosocial stressor five years earlier. We did not found a significant association between CIND incidence and previous Pb exposure. The low blood Pb levels and the individuals age may explain the absence of association. In a general way, the findings of this study suggest that the previous exposure to stress neuroendocrine profiles may influence the development of cognitive disorders during the aging.

A utilização de terapias complementares associadas ao tratamento convencional para alívio da dor em pacientes oncológicos / The reutilization of comtenplary therapies associated to conventional treatment for oncological patients' pain relief

Este trabalho foi realizado pelo interesse das pesquisadoras em identificar o uso de terapias complemetares por pacientes com patologias neoplásicas no controle da dor. A coleta de dados aconteceu no mês de setembro de 2002 com 30 pacientesdo ambulatório de neurologia do HCF-MUSP. Verificamos que 46,7 por cento dos pacientes utilizam alguma terapia complementar para o controle da dor, e dentre os que atualmente não as utilizam, 50 por cento já as utilizaram em alguma fase, essas práticas do tratamento e as abandonaram por falta de resultados ou de recursos. O enfermeiro ao conhecer essas práticas pode tornar-se um educador e orientar quanto ao uso adequado e correto.

O uso da fitoterapia no cuidado de crianças com até cinco anos em área central e periférica da cidade de São Paulo / The use of phytotherapy in the care of children up to 5 years of age in urban and suburban areas of São Paulo city-Brazil / El uso de la fitoterapia en el cuidado de ninõs menores de cinco años en áreas central y periférica de la ciudad de São Paulo-Brasil

Esta pesquisa verifica a utilização da fitoterapia em crianças que freqüentam um centro de saúde da área central e um centro de saúde da periferia da cidade de São Paulo. É um estudo exploratório descritivo, com 120 mães que freqüentam os dois centros de saúde (sendo 60 na região central e 60 na região periférica) durante o mês de dezembro de 2001. Após aprovação pelo Comitê de Ética, as mães foram questionadas individualmente e verificamos que 79 (66%) delas utilizam com maior freqüência a camomila, a erva-doce e a hortelã para cólicas intestinais, sintomas de gripe e tranqüilizar seus filhos. As informações sobre como e o que utilizar vieram, segundo as mães, principalmente de pais e avós 45 (57%) e, concluindo, não encontramos grandes diferenças entre o uso nas duas regiões de São Paulo.

This research evaluated the use of phytotherapy in children who attend a Health Center in an urban area and a Health Center in the suburbs of São Paulo city. This is an exploratory and descriptive study with 120 mothers who attend two Health Centers (60 mothers in the urban area and another 60 in the suburbs), during December 2001. After receiving approval from the Ethics Committee, the mothers were individually interviewed and it was confirmed that 79 (66%) of them frequently used chamomile, fennel and peppermint for the intestinal cramps, flu symptoms and to calm their children down. Directions on how and what to use was provided mainly by parents and grandparents (57%) and no great differences could be found in the use of herbs in the two areas of São Paulo.

El uso de la fitoterapia en el cuidado de ninõs menores de cinco años en áreas central y periférica de la ciudad de São Paulo.Esta investigación constató la utilización de la fitoterapia en ninõs que acuden a un centro de salud del área central y a un centro de salud de la periferia de São Paulo. Es un estudio exploratorio descriptivo, con 120 madres que acudieron a los dos centros de salud (60 en la región central y 60 en la región periférica) durante el mes de diciembre de 2001. Después de la aprobación por el Comité de Ética, las madres fueron preguntadas individualmente y verificamos que el 79 (66%) de ellas utilizam con mayor frecuencia la manzanilla, el anís y la hierba buena para los cólicos intestinales, síntomas de gripe y tranquilizante para sus hijos. Las informaciones sobre cómo y qué utilizar, vinieron principalmente de padres y abuelos 45 (57%) y no encontramos gran diferencia entre el uso de las hierbas en las regiones de São Paulo.

Ocorrências iatrogênicas em Unidade de Terapia Intensiva: uma revisão da literatura / Iatrogenic ocurrences in critical care units: a literature review

O estudo objetivou identificar as publicações científicas sobre ocorrências iatrogênicas em UTI, no período de dez anos, em dez periódicos nacionais e internacionais...

[Use of phytotherapy in children up to 5 years of age in a central and peripheral area of the city of Sao Paulo]. / O uso da fitoterapia no cuidado de crianças com até cinco anos em área central e periférica da cidade de São Paulo.

This research evaluated the use of phytotherapy in children who attend a Health Center in an urban area and a Health Center in the suburbs of São Paulo city. This is an exploratory and descriptive study with 120 mothers who attend two Health Centers (60 mothers in the urban area and another 60 in the suburbs), during December 2001. After receiving approval from the Ethics Committee, the mothers were individually interviewed and it was confirmed that 79 (66%) of them frequently used chamomile, fennel and peppermint for the intestinal cramps, flu symptoms and to calm their children down. Directions on how and what to use was provided mainly by parents and grandparents (57%) and no great differences could be found in the use of herbs in the two areas of São Paulo.