Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS): Study design and harmonization.

INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.

Diagnostic Accuracy of Usual Cognitive Screening Tests Versus Appropriate Tests for Lower Education to Identify Alzheimer Disease.

INTRODUCTION: The accuracy of commonly used screening tests for Alzheimer's disease (AD) has not been directly compared to those that could be more appropriate for lower schooling. OBJECTIVE: To compare the diagnostic accuracy of usual screening tests for AD with instruments that might be more appropriate for lower schooling among older adults with low or no literacy. METHODS: The study included a clinical sample of 117 elderly outpatients from a Geriatric Clinic classified as literate controls (n = 39), illiterate controls (n = 30), literate AD (n = 30) and illiterate AD (n = 18). The tests were compared as follows: Black and White versus Colored Figure Memory Test; Clock Drawing Test versus Clock Reading Test; Verbal Fluency (VF) animal versus grocery category; CERAD Constructional Praxis versus Stick Design Test. RESULTS: The means of literate and illiterate controls did not differ in the Black and White Figure Memory Test (immediate recall), Colored Figure Memory Test (delayed recall), Clock Reading Test and VF animals and grocery categories. The means of the clinical groups (controls versus AD), in the 2 schooling levels, differed significantly in most of the tests, except for the CERAD Constructive Praxis and the Stick Design Test. Diagnostic accuracy was not significantly different between the compared tests. CONCLUSION: Commonly used screening tests for AD were as accurate as those expected to overcome the education bias in a sample of older adults with lower or no education.

Disease Progression in Frontotemporal Dementia and Alzheimer Disease: The Contribution of Staging Scales.

INTRODUCTION: There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD). OBJECTIVES: To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale-frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR). METHODS: The sample consisted of 70 individuals, aged 40+ years, with at least 2 years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant), and 27 with AD. The FTD-FRS, the CDR, and the 2 additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke Cognitive Examination-Revised was completed by patients. After 12 months, the same protocol was applied. RESULTS: The FTD-FRS, CDR-FTLD, and CDR detected significant decline after 12 months in the 3 clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages. CONCLUSIONS: The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum.

Deficits in short-term memory binding are detectable in individuals with brain amyloid deposition in the absence of overt neurodegeneration in the Alzheimer's disease continuum.

The short-term memory binding (STMB) test involves the ability to hold in memory the integration between surface features, such as shapes and colours. The STMB test has been used to detect Alzheimer's disease (AD) at different stages, from preclinical to dementia, showing promising results. The objective of the present study was to verify whether the STMB test could differentiate patients with distinct biomarker profiles in the AD continuum. The sample comprised 18 cognitively unimpaired (CU) participants, 30 mild cognitive impairment (MCI) and 23 AD patients. All participants underwent positron emission tomography (PET) with Pittsburgh compound-B labelled with carbon-11 ([11C]PIB) assessing amyloid beta (Aß) aggregation (A) and 18fluorine-fluorodeoxyglucose ([18F]FDG)-PET assessing neurodegeneration (N) (A-N- [n = 35]); A+N- [n = 11]; A+ N+ [n = 19]). Participants who were negative and positive for amyloid deposition were compared in the absence (A-N- vs. A+N-) of neurodegeneration. When compared with the RAVLT and SKT memory tests, the STMB was the only cognitive task that differentiated these groups, predicting the group outcome in logistic regression analyses. The STMB test showed to be sensitive to the signs of AD pathology and may represent a cognitive marker within the AD continuum.

Impact of functional capacity on change in self-rated health among older adults in a nine-year longitudinal study.

The aims of the present study were to estimate the frequency of change in self-rated health (SRH) among community-dwelling older adults, between two measures taken at a 9-year interval; and determine factors associated with a decline and an improvement in SRH, in relation to aspects of physical/emotional health and subjective wellbeing. Data were derived from a community-based study on frailty among Brazilian elderly. Associations were investigated using Pearson's chi-square test and relative risk ratios were estimated using multinomial logistic regression analysis. 39.3% of participants did not change their SRH at both assessment times, 21.7% rated it as worse and 39.0% rated it as better. The relative risk ratio of an improvement in SRH for individuals with disability in basic activities of daily living (ADLs) was lower than for individuals with independence in basic ADLs (IRR=0.22; IC95%: 0.08-0.63). Understanding the complex interactions between self-rated health and the dimensions that influence the improvement of health perception may shed light on key determinants of the wellbeing among older adults.

Profiles of cognitive impairment in the continuum from normal cognition to Alzheimer's clinical syndrome: Contributions of the short-term memory binding tests.

BACKGROUND: Short-term memory binding (STMB) tests assess conjunctive binding, in which participants should remember the integration of features, such as shapes (or objects) and colors, forming a unique representation in memory. In this study, we investigated two STMB paradigms: change detection (CD) and free recall (FR). OBJECTIVE: To investigate the cognitive profile in the CD and FR tasks of three diagnostic groups: cognitively unimpaired (CU), mild cognitive impairment (MCI), and Alzheimer's clinical syndrome (ACS). In addition, we aimed to calculate and compare the accuracy of the CD and FR tasks to identify MCI and ACS. METHODS: Participants were 24 CU, 24 MCI, and 37 ACS. The cognitive scores of the clinical groups were compared using analysis of variance (ANOVA) and receiver-operating characteristic (ROC) analyses were carried out to verify the accuracy of the STMB tasks. RESULTS: In the CD task, CU was different from MCI and ACS (CU > MCI = ACS), while in the FR task all groups were different (CU > MCI > ACS). The ROC analyses showed an area under the curve (AUC) of 0.855 comparing CU with MCI for the CD task and 0.975 for the FR. The AUC comparing CU and ACS was 0.924 for the CD and 0.973 for the FR task. The FR task showed better accuracy to identify MCI patients, and the same accuracy to detect ACS. CONCLUSION: The present findings indicate that impairments in CD and FR of bound representations are features of the cognitive profiles of MCI and ACS patients.

Working memory training format in older adults: individual versus group sessions.

Working memory (WM) training has been shown to increase the performance of participants in WM tasks and in other cognitive abilities, but there has been no study comparing directly the impact of training format (individual vs. group) using the same protocol. Therefore, the aim of this study was to compare the efficacy of the Borella et al. three session verbal WM training offered in two different formats on target and transfer tasks. This study was conducted in two waves. In the first wave, participants were randomized into individual training (n = 11) and individual control conditions (n = 15). In the second wave, participants were randomized into group training (n = 16) and group control conditions (n = 17). Training consisted of three sessions of WM exercises and participants in the active control condition responded to questionnaires during the same time. There was significant improvement for both training conditions at post-test and maintenance at follow-up for the target task, other WM tasks, processing speed, and executive functions tasks. The ANOVA results showed that the training gains did not depend on the WM training format. However, the effect size analyses suggested that this intervention can be more effective, at short term and follow-up, when provided individually. To conclude, this study showed that providing this training collectively or individually does not change the training benefits, which increases the possibilities of its use in different contexts.

Categorization Working Memory Span Task: Validation study of two Brazilian alternate versions.

BACKGROUND: The Categorization Working Memory Span Task (CWMS task) is a complex working memory (WM) span test that has been used previously to assess age and individual differences in WM as well as the relationship between WM and complex aspects of cognition such as listening comprehension. Two alternate versions of the task have been developed to be used as outcome variables in WM training protocol, which mirrors the task involved in the CWMS task. OBJECTIVES: (1) To translate and adapt the CWMS task for Brazilian Portuguese; (2) to test the equivalence of its 2 alternate versions; (3) to examine temporal stability; (4) to examine the influence of age and schooling on CWMS task; (5) to establish its relationship with other tests of WM. METHODS: Eighty-one older adults completed version A, and 86 completed version B of the CWMS task. After 6 months, a subsample (n = 85) completed the same version of the task. RESULTS: Versions A and B of the task generated comparable scores. Both versions had adequate temporal stability, which was higher for the CWMS total recall, which is the classical variable in this task to represent WM performance, when compared to the other variables generated by the test. The CWMS task variables were moderately correlated with schooling and other cognitive tests (Mini Mental State Examination, Letter-Number Sequencing, Spatial Span Backward, Digit Span Forward). CONCLUSIONS: The 2 versions of the CWMS task were equivalent and stable temporally. The task was influenced by schooling and global cognition.

Review of Decision-Making in Game Tasks in Elderly Participants with Alzheimer Disease and Mild Cognitive Impairment.

BACKGROUND: Changes in decision-making (DM) have recently been investigated in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI). DM is highly relevant to everyday functioning and autonomy. It relies on several cognitive abilities, such as semantic and episodic memory, as well as aspects of executive functioning. We conducted a systematic review of DM in older adults with MCI and AD. SUMMARY: Only 5 studies whose main objective was to evaluate the DM performance were selected. The results extracted indicated that DM in ambiguity and in at-risk situations are both impaired in probable AD patients. MCI patients have difficulty making advantageous decisions under ambiguity and at risk, similar to patients with probable AD but they are less impaired. Key Messages: DM deficits may be a predictor of cognitive impairment and conversion to dementia and its potential clinical value should be further explored in longitudinal studies involving direct comparison between MCI and AD patients.

A subtest analysis of The Montreal Cognitive Assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer's disease?

The authors would like to apologise for a typographical error in the discussion of the above mentioned article. In the discussion on page 830 of the article, paragraph 'In the present sample, when we tested the accuracy of the MoCA to discriminate between MCI and healthy participants using ROC curves, the best cut-off score was 24 points, with good sensitivity and specificity ( 92% and 82%, respectively).' Should read: In the present sample, when we tested the accuracy of the MoCA to discriminate between MCI and healthy participants using ROC curves, the best cut-off score was 24 points, with good sensitivity and specificity (83% and 89%, respectively).

Boston Naming Test (BNT) original, Brazilian adapted version and short forms: normative data for illiterate and low-educated older adults.

BACKGROUND: The aims of this study were (1) to describe and compare the performance of illiterate and low-educated older adults, without evidence of cognitive impairment, on different versions of the Boston Naming Test (BNT) original, Brazilian adapted, abbreviated 30-item (even and odd) and 15-item from the CERAD (Consortium to Establish a Registry for Alzheimer's Disease) battery; (2) to compare performance on the original versus adapted versions of the BNT. METHODS: A total of 180 healthy older adults (60 years or older) were stratified according to educational level (0, 1-2, and 3-4 years), and age (60-69, 70-79, and ≥ 80 years). The protocol comprised the following instruments: Mini-Mental State Examination (MMSE), Brief Cognitive Screening Battery (BCSB), Functional Activities Questionnaire (FAQ), Geriatric Depression Scale (GDS), and the BNT. RESULTS: The illiterate participants had poorer performance than the educated participants. The performance of the two educated groups was similar on all versions of the BNT. A higher number of correct responses were observed on the adapted BNT than on the original BNT in all three education groups. CONCLUSIONS: The adapted BNT appears to be the most suitable for use in the low-educated Brazilian population. The present study provided normative data for low-educated elderly on several different versions of the BNT, which may be helpful in diagnosing naming deficits among elderly in these strata of the population.

A subtest analysis of the Montreal cognitive assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer's disease?

BACKGROUND: It is necessary to continue to explore the psychometric characteristics of key cognitive screening tests such as the Montreal Cognitive Assessment (MoCA) to diagnose cognitive decline as early as possible and to attend to the growing need of clinical trials involving mild cognitive impairment (MCI) participants. The main aim of this study was to assess which MoCA subtests could best discriminate between healthy controls (HC), participants with MCI, and Alzheimer's disease (AD). METHODS: Cross-sectional analysis of 136 elderly with more than four years of education. All participants were submitted to detailed clinical, laboratory, and neuroimaging evaluation. The MoCA, Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), Geriatric Depression Scale (GDS), and Functional Activities Questionnaire (FAQ) were applied to all participants. The MoCA test was not used in the diagnostic procedure. RESULTS: Median MoCA total scores were 27, 23 and 18 for HC, MCI, and AD, respectively (p < 0.001). Word repetition, inverse digits, serial 7, phrases, verbal fluency, abstraction, and word recall discriminated between MCI and HC participants (p < 0.001). The clock drawing, the rhino naming, delayed recall of five words and orientation discriminated between patients with MCI and AD (p < 0.001). A reduced version of the MoCA with only these items did not improve accuracy between MCI and HC (p = 0.076) or MCI and AD (p = 0.119). CONCLUSIONS: Not all MoCA subtests might be fundamental to clinical diagnosis of MCI. The reduced versions of MoCA did not add diagnostic accuracy.

The applicability of the cognitive abilities screening instrument-short (CASI-S) in primary care in Brazil.

BACKGROUND: The Cognitive Abilities Screening Instrument - Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care. OBJECTIVES: To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy. METHODS: In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients' health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status. RESULTS: The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = -0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%. CONCLUSIONS: The CASI-S can be useful for dementia screening in primary care in Brazil.

Neuropsychiatric Symptoms, Caregiver Burden and Distress in Behavioral-Variant Frontotemporal Dementia and Alzheimer's Disease.

BACKGROUND/AIMS: We aimed to compare caregiver burden and distress in behavioral-variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) and to investigate which factors contribute to caregivers' burden and distress. METHODS: Fifty patients and their caregivers were invited to participate. Among the patients, 20 had a diagnosis of bvFTD and 30 had AD. Caregivers and patients were statistically equivalent for age, sex, education and dementia severity according to Clinical Dementia Rating. The protocol included the Short Zarit Burden Inventory, the Neuropsychiatric Inventory (NPI), Disability Assessment for Dementia (DAD), the Cornell Scale for Depression in Dementia (CSDD), Addenbrooke's Cognitive Examination-Revised, the Executive Interview with 25 Items, Direct Assessment of Functional Status and the Geriatric Anxiety Inventory (GAI). RESULTS: In the NPI, caregivers of bvFTD patients reported a higher presence and severity of neuropsychiatric symptoms and caregiver distress compared to caregivers of AD patients. There was no significant difference in the perceived burden. In bvFTD, DAD and GAI scores were significantly correlated with burden, whereas in AD, burden was correlated with CSDD and NPI scores. Psychiatric symptoms were associated with distress in both groups. CONCLUSIONS: Caregivers of bvFTD patients experienced higher levels of distress than caregivers of AD patients. Patients' functional limitations were associated with burden of caregivers of bvFTD patients, whereas neuropsychiatric symptoms were associated with caregiver strain in both groups.

Direct and indirect assessments of activities of daily living in behavioral variant frontotemporal dementia and Alzheimer disease.

BACKGROUND: There is limited information about the functional profile of behavioral variant frontotemporal dementia (bvFTD). OBJECTIVE: To compare direct and indirect assessments of activities of daily living (ADLs) in bvFTD and Alzheimer disease (AD) and their relationship with cognitive performance. METHODS: In all, 20 patients with bvFTD, 30 patients with AD, and 34 normal controls (NCs), matched for age, education, and severity of dementia, completed the Direct Assessment of Functional Performance (DAFS-BR) and usual cognitive measures. The Disability Assessment for Dementia (DAD) was completed by caregivers. RESULTS: In DAFS-BR, patients with bvFTD and AD had similar performance but lower than NCs. In DAD, there were no significant differences for effective performance, but patients with bvFTD had lower scores for initiation and planning/organization. Patients with bvFTD were less impaired than AD in cognition. CONCLUSION: Functional changes in bvFTD seem to be better documented by indirect measures.

Age, but not education, affects social decision-making in the ultimatum game paradigm.

BACKGROUND: Social decision-making (SDM) is often studied through gaming paradigms, in which participants allocate resources among themselves and others based on predefined rules. In an adapted version of the ultimatum game (UG), SDM behavior was modulated in response to the degree of fairness of monetary offers and the social context of opponents, designed to generate either prosocial or punishing behaviors. OBJECTIVE: To investigate whether SDM evaluated by the UG is affected by age and schooling, as it is relevant to know whether sociodemographic variables may bias UG results. METHODS: A total of 131 healthy adults participated: 35 young university students and 96 participants in Universidade de São Paulo's USP 60+ program (formerly known as Universidade Aberta à Terceira Idade, a program for people aged ≥ 60 years to attend university). The sample was divided into 3 age groups (17-22, 60-69, and 70-79 years) and 3 schooling groups (4-8, 9-11, and ≥ 12 years of schooling). RESULTS: Age and schooling did not affect performance in fair monetary offers. Differences were observed in the unfair conditions. The oldest group (70-79 years) accepted less frequently the baseline unfair offers (without social context), when compared with the 17-22 and the 60-69 years groups (17-22 = 60-69 > 70-79). Regarding the prosocial unfair and punishing unfair conditions, older adults accepted such offers more frequently (17-22 < 60-69 = 70-79). Schooling effects were not observed. CONCLUSION: In the context of SDM, older adults may show prosocial behaviors more frequently than younger adults. The findings suggest performance in the UG is affected by age, but not by schooling.

ANTECEDENTES: A tomada de decisão social (TDS) é frequentemente estudada por meio de paradigmas de jogo, em que os participantes alocam recursos entre si e outros com base em regras predefinidas. Em uma versão adaptada do jogo do ultimato (JU), o comportamento de TDS foi modulado em resposta ao grau de justiça das ofertas monetárias e ao contexto social dos oponentes, projetado para produzir comportamentos pró-sociais ou punitivos. OBJETIVO: Investigar se a TDS avaliada pelo JU é afetada pela idade e escolaridade, pois é relevante saber se variáveis sociodemográficas podem influenciar os resultados do JU. MéTODOS: Participaram 131 adultos saudáveis, sendo 35 jovens universitários e 96 participantes do programa USP 60+ (antigo Universidade Aberta à Terceira Idade). A amostra foi dividida em 3 faixas etárias (17­22, 60­69 e 70­79 anos) e 3 faixas de escolaridade (4­8, 9­11 e ≥ 12 anos). RESULTADOS: Idade e escolaridade não afetaram o desempenho em ofertas monetárias justas. Diferenças foram observadas nas condições injustas. O grupo mais velho (70­79 anos) aceitou menos as ofertas injustas de referência (sem contexto social), quando comparado com o grupo de 17­22 e o de 60­69 anos (17­22 = 60­69 > 70­79). Em relação às condições pró-sociais injustas e punitivas injustas, os idosos aceitaram com maior frequência tais ofertas (17­22 < 60­69 = 70­79). Efeitos da escolaridade não foram observados. CONCLUSãO: No contexto da TDS, os idosos podem apresentar comportamentos pró-sociais com mais frequência do que os adultos mais jovens. Os resultados sugerem que o desempenho no JU é afetado pela idade, mas não pela escolaridade.

Frailty and functional status among older adults with cognitive impairment: data from the second wave of the FIBRA study.

Frailty is defined as a recognizable state of increased vulnerability resulting from age-associated decline of function in various physiological systems, such that the ability to deal with acute or everyday stressors is compromised. Objective: The aim of the study was to characterize the sample of older adults with cognitive impairment, according to the frailty status indirectly assessed by family members, other clinical and sociodemographic variables; and to assess the overlap of clinical conditions evaluated in this sample with cognitive impairment. Methods: Data were extracted from the follow-up database of the Frailty in Brazilian Older Adults (FIBRA) study (2016-2017). The sample consisted of 130 elderly people with cognitive impairment assessed by the Mini Mental State Examination (MMSE). The scores for the Clinical Dementia Scale (CDR), Cornell Scale for Depression in Dementia and Functional Activities Questionnaire were described. Frailty was indirectly measured through questions answered by family members about the five criteria that compose the frailty phenotype. Results: The sample consisted mostly of older women (n=91) with a mean age of 82.4 (SD=5.3) years, mean schooling of 3.3 years (SD=3.07), widowed (47.7%) and who lived with children and/or grandchildren (68%). More than half had multimorbidity (74.90%), 39.5% had depression symptoms suggestive of major depression, 57% had impaired functionality, 49.3% were frail, 37.6% pre-frail, and 13.10% robust. Conclusion: Among older adults with cognitive impairment, frailty and functional limitations are common.

A fragilidade é definida como um estado reconhecível de vulnerabilidade aumentada resultante do declínio da função associado à idade em vários sistemas fisiológicos, de modo que a capacidade de lidar com estressores agudos ou cotidianos fica comprometida. Objetivo: Caracterizar uma amostra de pessoas idosas com comprometimento cognitivo, segundo o estado de fragilidade, avaliado de forma indireta por familiares, assim como outras variáveis clínicas e sociodemográficas; e avaliar a sobreposição das condições clínicas avaliadas nesta amostra com o comprometimento cognitivo. Métodos: Os dados foram extraídos do banco de dados de acompanhamento do estudo Fragilidade em Idosos Brasileiros (FIBRA - 2016-2017). A amostra foi composta por 130 idosos com comprometimento cognitivo avaliado pelo Mini-Exame do Estado Mental (MEEM). Foram descritos os escores da Escala Clínica de Demência (CDR), da Escala Cornell de Depressão em Demência e do Questionário de Atividades Funcionais. A fragilidade foi mensurada indiretamente por meio de questões respondidas junto aos familiares sobre os cinco critérios que compõem o fenótipo de fragilidade. Resultados: A amostra foi composta em sua maioria por mulheres idosas (n=91) com idade média de 82,4 (DP=5,3) anos, escolaridade média de 3,3 anos (DP=3,07), viúvas (47,7%) e que viviam com filhos e/ou netos (68%). Mais da metade apresentava multimorbidade (74,90%), 39,5% apresentavam sintomas depressivos sugestivos de depressão maior, 57% tinham funcionalidade prejudicada, 49,3% eram frágeis, 37,6% pré-frágeis e 13,10% robustos. Conclusão: Entre idosos com alterações cognitivas, é comum a co-ocorrência de fragilidade e de limitações funcionais.

Frailty and brain changes in older adults without cognitive impairment: A scoping review.

Little is known about changes in the brain associated with frailty, in particular, which brain areas could be related to frailty in older people without cognitive impairment. This scoping review mapped evidence on functional and/or structural brain changes in frail older adults without cognitive impairment. The methodology proposed by the JBI® was used in this study. The search in PubMed, PubMed PMC, BVS/BIREME, EBSCOHOST, Scopus, Web of Science, Embase, and PROQUEST was conducted up to January 2023. Studies included following the population, concepts, context and the screening and data extraction were performed by two independent reviewers. A total of 9,912 records were identified, 5,676 were duplicates and were excluded. The remaining articles were screened; 31 were read in full and 17 articles were included. The results showed that lesions in white matter hyperintensities, reduced volume of the hippocampus, cerebellum, middle frontal gyrus, low gray matter volume, cortical atrophy, decreased connectivity of the supplementary motor area, presence of amyloid-beta peptide (aß) in the anterior and posterior putamen and precuneus regions were more frequently observed in frail older adults, compared with non-frail individuals. Studies have suggested that such findings may be of neurodegenerative or cerebrovascular origin. The identification of these brain alterations in frail older adults through neuroimaging studies contributes to our understanding of the underlying mechanisms of frailty. Such findings may have implications for the early detection of frailty and implementation of intervention strategies.

Low grip strength and gait speed as markers of dependence regarding basic activities of daily living: the FIBRA study.

OBJECTIVE: Marincolo et al. showed that older adults without limitations in basic activities of daily living at baseline presented with an 11.7% concomitant presence of functional dependence, slow gait speed, and low muscle strength at follow-up. Slow gait speed remains a predictor of dependence in basic activities of daily living. To determine whether low muscle strength and low gait speed increase the risk of disability related to basic activities of daily living in community-dwelling older adults. METHODS: A longitudinal study (9 years of follow-up) was conducted with 390 older adults who were independent in basic activities of daily living at baseline and answered the Katz Index at follow-up. Associations were determined using Pearson's χ2 test with a 5% significance level and logistic regression analysis. RESULTS: Increases in prevalence between baseline and follow-up were observed for low muscle strength (17.5%-38.2%), slow gait speed (26.0%-81.1%), and functional dependence (10.8%-26.6%). At follow-up, 11.7% of the participants had concomitant functional dependence, slow gait speed, and low muscle strength. Slow gait speed remained a predictor of dependence in basic activities of daily living (odds ratio=1.90; 95% confidence interval=1.06-3.41). CONCLUSION: Slow gait speed is a predictor of functional dependence, constituting an important variable for screening functional decline.

Higher purpose in life and education were associated with better cognition among older adults.

BACKGROUND: With aging, some cognitive abilities change because of neurobiological processes. Cognition may also be influenced by psychosocial aspects. OBJECTIVE: To describe the relationship between a measure of neuroticism, depression symptoms, purpose in life, and cognitive performance in community-dwelling older adults. METHODS: This was a cross-sectional analysis based on the data from the second wave of the Frailty in Brazilian Older Adults (FIBRA) study, carried out between 2016 and 2017. The sample consisted of 419 older people (≥ 72 years old) cognitively unimpaired and mostly with low education. The variables of interest were sociodemographic, Neuroticism domain from the NEO-PI-R, Geriatric Depression Scale (GDS), Purpose in Life (PiL) scale, and a cognitive composite score which included the Mini-Mental State Examination (MMSE), and the scores for the sub-items of the Mini-Addenbrooke's Cognitive Examination (M-ACE), namely, Verbal Fluency (VF) - Animal, Clock Drawing Test (CDT), Episodic Memory (name and address). RESULTS: There was a greater number of women (70%), with older age (median = 80 years, IQR = 77-82), and low education (median = 4 years, IQR = 2-5). In the bivariate correlations, years of education (ρ = 0.415; p < 0.001) and PiL (ρ = 0.220; p < 0.001) were positively associated with cognition. Neuroticism (ρ = -0.175; p < 0.001) and depression symptoms (ρ = -0.185; p < 0.001) were negatively associated with cognition. In the logistic regression, after including confounding variables, the associations between cognition and PiL (OR = 2.04; p = 0.007) and education (OR = 1.32; p < 0.001) remained significant. CONCLUSION: Low PiL and low education levels were associated with worse cognition among older adults. Such results may be of relevance in programs that aim to improve cognition among older adults.

ANTECEDENTES: Com o envelhecimento, algumas habilidades cognitivas mudam devido a processos neurobiológicos. A cognição também pode ser influenciada por aspectos psicossociais. OBJETIVO: Descrever as relações entre uma medida de neuroticismo, sintomas depressivos, propósito de vida e o desempenho cognitivo em pessoas idosas residentes na comunidade. MéTODOS: Trata-se de uma análise transversal com base nos dados da segunda onda do estudo de Fragilidade em Idosos Brasileiros (FIBRA), realizado entre 2016 e 2017. A amostra foi composta por 419 pessoas idosas (≥ 72 anos) cognitivamente saudáveis e em maior parte com baixa escolaridade. As variáveis de interesse foram as sociodemográficas, domínio Neuroticismo do NEO-PI-R, Escala de Depressão Geriátrica (EDG) e Escala de Propósito de Vida (PV) e um escore cognitivo composto que incluiu o Miniexame de Estado Mental (MEEM) e as pontuações dos subitens do Miniexame Cognitivo de Addenbrooke (M-ACE), a saber, Fluência Verbal (FV) Animal, Teste do Desenho do Relógio (TDR) e Memória Episódica (nome e endereço). RESULTADOS: Houve um maior número de mulheres (70%), com idade elevada (mediana = 80 anos, IIQ = 77-82) e baixa escolaridade (mediana = 4 anos, IIQ = 2-5). Nas correlações bivariadas, anos de escolaridade (ρ = 0,415; p < 0,001) e PV (ρ = 0,220; p < 0,001) foram positivamente associadas à cognição. Neuroticismo (ρ = -0,175; p < 0,001) e sintomas depressivos (ρ = -0,185; p < 0,001) foram negativamente associados à cognição. Na regressão logística, após a inclusão de variáveis de confusão, as associações entre cognição e PV (OR = 2,04; p = 0,007) e escolaridade (OR = 1,32; p < 0,001) permaneceram significativas. CONCLUSãO: Baixo PV e baixa escolaridade foram associados à pior cognição em idosos. Tais resultados podem ser relevantes em programas que visam a melhorar a cognição entre pessoas idosas.