[Virtual reality as a tool for the prevention, diagnosis and treatment of cognitive impairment in the elderly: a systematic review]. / Realidad virtual como herramienta de prevención, diagnóstico y tratamiento del deterioro cognitivo en personas mayores: revisión sistemática.

INTRODUCTION: In recent decades, research into the effects of virtual reality on different neurological disorders has increased exponentially. Yet, the literature focused on the beneficial effects of virtual reality on cognitive impairment in elderly people is limited. AIM: To explore the application of virtual reality as a preventive, diagnostic or therapeutic tool for cognitive impairment in elderly people. PATIENTS AND METHODS: A literature search was conducted in the Medline and Web of Science databases, including all the literature published from their inception up until December 2019. RESULTS: Of the 270 publications found, 15 met the inclusion criteria: two examined the effect of virtual reality as a tool for the prevention of cognitive impairment, six looked at its possible applications in diagnosis, and seven explored its effectiveness as a form of treatment. CONCLUSIONS: There is evidence of the potential effect of virtual reality as a preventive strategy against the development of cognitive impairment in elderly people. There is also evidence of its applicability as a diagnostic tool for detecting the development of mild cognitive impairment or dementia, and of its effectiveness as a treatment, since it improves the cognitive functioning of elderly people with cognitive impairment. Further studies are needed that are more methodologically robust and have long follow-up times in order to examine the real impact of virtual reality and to be able to generalise its application in different areas of the management of cognitive impairment.

TITLE: Realidad virtual como herramienta de prevención, diagnóstico y tratamiento del deterioro cognitivo en personas mayores: revisión sistemática.Introducción. En las últimas décadas, se ha incrementado exponencialmente la investigación sobre los efectos de la realidad virtual en diferentes trastornos neurológicos. Sin embargo, la bibliografía centrada en los beneficios de la realidad virtual sobre el deterioro cognitivo en personas mayores es limitada. Objetivo. Explorar la aplicación de la realidad virtual como herramienta preventiva, diagnóstica o de tratamiento del deterioro cognitivo en personas mayores. Pacientes y métodos. Se llevó a cabo una búsqueda bibliográfica en las bases de datos Medline y Web of Science, incluyendo toda la bibliografía publicada desde sus inicios hasta diciembre de 2019. Resultados. De las 270 publicaciones encontradas, 15 cumplieron los criterios de inclusión: dos examinaron el efecto de la realidad virtual como herramienta de prevención del deterioro cognitivo; seis, su aplicabilidad diagnóstica; y siete, su efectividad como tratamiento. Conclusiones. Existe evidencia del potencial efecto de la realidad virtual como estrategia preventiva frente al desarrollo de deterioro cognitivo en personas mayores. Existe también evidencia de su aplicabilidad como herramienta diagnóstica de detección de desarrollo de deterioro cognitivo leve o demencia, y de su efectividad como tratamiento, ya que mejora el funcionamiento cognitivo de personas mayores con deterioro cognitivo. Son necesarios futuros estudios metodológicamente más robustos y con amplios tiempos de seguimiento para examinar el impacto real de la realidad virtual y poder generalizar su aplicación en los diferentes ámbitos de manejo del deterioro cognitivo.

Influence of cognitive impairment on the freezing of gait in non demented people with Parkinson's disease. / Influencia del deterioro cognitivo en la congelacion de la marcha en pacientes con enfermedad de Parkinson sin demencia.

INTRODUCTION: Freezing of gait (FOG) is a motor disturbance usually appearing in advanced Parkinson's disease (PD). Cognitive and executive function seems to play an important role in this phenomenon. AIM: To investigate if cognitive and kinematic parameters correlate with FOG in PD patients without dementia. PATIENTS AND METHODS: We conducted an observational cross-sectional study. Participants were classified in two groups: freezers and non-freezers. Clinical information was obtained by Hoehn and Yahr scale, Unified Parkinson's Disease Rating Scale and balance test of Short Physical Performance Battery. Cognitive function was evaluated using Minimental Examination and the Fuld Object Memory Evaluation; executive function was assessed with the Frontal Assessment Battery test. Battery kinematic parameters were assessed by means of gait speed, cadence, stride length and stride time. RESULTS: Twenty-five participants with PD without dementia completed the evaluation. Statistical significant differences between freezers and non-freezers were found in global cognition (p = 0,02), memory (p = 0,04), executive function (p = 0,04), cadence (p = 0,02), stride length (p = 0,04) and stride time (p = 0,01). CONCLUSION: Cognitive parameters may have an important contribution to the manifestation of freezing of gait in PD. These results may have important clinical implications for developing future non-pharmacological and cognitive interventions strategies targeted to PD patients with FOG.

TITLE: Influencia del deterioro cognitivo en la congelacion de la marcha en pacientes con enfermedad de Parkinson sin demencia.Introduccion. La congelacion de la marcha (CDM) es una alteracion motora que suele aparecer en estadios avanzados de la enfermedad de Parkinson (EP). Las funciones cognitivas y ejecutivas parecen tener un papel importante en la aparicion de este fenomeno. Objetivo. Investigar si los parametros cognitivos y cinematicos se correlacionan con la CDM en pacientes con EP sin demencia. Pacientes y metodos. Estudio observacional y transversal. Los participantes se clasificaron en dos grupos: con y sin CDM. La informacion clinica se obtuvo mediante la escala de Hoehn y Yahr, la Unified Parkinson's Disease Rating Scale y la prueba de equilibrio de la Short Physical Performance Battery. La funcion cognitiva se valoro con el miniexamen cognitivo y la Fuld Object Memory Evaluation, y la funcion ejecutiva, con la Frontal Assessment Battery. Los parametros cinematicos se valoraron mediante la velocidad de la marcha, la cadencia, la longitud del paso y el tiempo del paso. Resultados. Veinticinco participantes con EP sin demencia completaron el programa. Se encontraron diferencias estadisticamente significativas entre individuos con y sin CDM en cognicion global (p = 0,02), memoria (p = 0,04), funcion ejecutiva (p = 0,04), cadencia (p = 0,02), longitud del paso (p = 0,04) y tiempo del paso (p = 0,01). Conclusion. Diversos parametros cognitivos pueden contribuir de forma importante en la aparicion de la CDM en la EP. Estos resultados pueden tener implicaciones clinicas relevantes para el desarrollo de estrategias e intervenciones no farmacologicas y cognitivas dirigidas a pacientes con EP y con CDM.

[Alzheimer's disease and age-related macular degeneration]. / Enfermedad de Alzheimer y degeneración macular asociada a la edad.

OBJECTIVES: We analysed different risk factors involved in the onset of both Alzheimer's disease (AD) and age-related macular degeneration (ARMD). The putative relation between both disorders was studied. METHODS: We studied 57 subjects to determine the correlation between AD and ARMD. Thirty-three of the subjects suffered dementia (cases), whereas 24 of them (controls) did not. Firstly, anamnesis was performed for all individuals. We then examined the macular area of the eye using a non-midriatic TRV-50VT fundus camera. Significant odds ratio (OR) results were used as a statistical tool to survey the putative link between AD and ARMD. RESULTS: The OR test results showed that ARMD was associated with Alzheimer's disease. The occurrence of ARMD was significantly higher for cases (42.4%) than for controls (25%). On this basis, we inferred a cause-effect relation linking both variables. Our dataset suggested that the control group was more protected against ARMD than the case group, as revealed by Fisher's exact test (P = 0.649). However, such a difference between both groups was not strongly supported. CONCLUSIONS: We suggest that AD and ARMD may have common factors concerning etiology and pathogenesis. Our dataset did not allow us to show a significant relation between both disorders, which is likely due to sample size and/or to age differences in the two studied groups. Even so, we feel that the possibility of such an association is justified, and future surveys to test this possibility are warranted.

Correlation between depression and burden observed in informal caregivers of people suffering from dementia with time spent on caregiving and dementia severity.

OBJECTIVE: The aim of the study is to compare data on the examined population of informal caregivers of people suffering from dementia with previous studies, as well as to assess the correlation between (i) depression determined on the basis of the Center for Epidemiologic Studies Depression Scale and (ii) caregiver burden measured by means of the Zarit Caregiver Burden Scale and some chosen parameters, such as total time devoted to caregiving, time of caregiving in hours per week and level of dementia severity measured by Global Deterioration Scale. PATIENTS AND METHODS: 41 informal caregivers of people suffering from dementia from different backgrounds were evaluated using the Zarit Caregiver Burden Scale and the Center for Epidemiologic Studies Depression Scale. Demographic data about the time devoted to caregiving and the number of hours spend on caregiving weekly were gathered. The type of dementia and its stage were registered using the Global Deterioration Scale (GDS). With the aid of the Statistica StatSoft program, mutual correlations between the parameters were measured. The study was conducted within the framework of AAL UnderstAID--a platform that supports and helps to understand and assist caregivers in the care of a relative with dementia. The international project is co-founded by the Joint Programme Ambient Assisted Living (Grant code: ESR-aal 2012 5 107). RESULTS: No significant correlations between the level of depression severity evaluated in caregivers and the total time of taking care of a demented person or time of caregiving in hours per week were observed. Similarly, no significant correlation between depression severity level and dementia severity level measured on the GDS scale were noted. There was also no significant correlation between Zarit Caregiver Burden Scale scores and the above-mentioned parameters. CONCLUSIONS: The level of depression among caregivers do not depend on socio-demographic factors.

Helping the family carers of Alzheimer's patients: from theory...to practice. A preliminary study.

Alzheimer's disease (AD) represents one of the most important health issues in the western world. The ongoing care that the AD patient requires typically causes high stress levels, fatigue, irritation and depression in the caregiver, as well as socio-economical problems. The current study aimed to introduce a support program for carers of AD patients, in order to improve their quality of life. A Questionnaire for Carers and an Anxiety State Feature Questionnaire (STAI) was used to assess the carers. Results showed an overall improvement in the carers' health. Their subjective wellbeing increased, and though their situation had not changed, they nevertheless described feeling less trapped. It can be concluded that possibly the mere fact that the carers feel that they have help available is enough to endorse the value of the program.