Epidemiology of neurocognitive disorders in adults from urban-marginalized areas: a door-to-door population-based study in Puente Piedra, Lima, Peru.

Background: In Latin America (LA), the prevalence of dementia is expected to triple to 150 million people by 2050. The 2020 Lancet Commission report identified several modifiable dementia risk factors, yet few social and environmental factors, most relevant to vulnerable regions of LA, were highlighted in this report. We sought to assess the epidemiology of neurocognitive disorders (NCD) in Puente Piedra, one of the most socially and economically vulnerable districts of Lima, the capital of Peru. Methodology: This was a cross-sectional door-to-door observational study that used two-stage household sampling. One young adult (30-59 years) and one older adult (>60 years) per household were enrolled. We collected demographic, clinical, and neurocognitive data. Addenbrooke's Cognitive Examination (young adults) and the RUDAS-PE (older adults) were used, classifying participants as cognitively normal, possible mild NCD, or possible major NCD. Results: We enrolled 247 participants (median age 46 years; 67% female). One-fourth had not completed secondary school and more than 50% completed only secondary school. Most participants were housewives (46%) and 21% did not have health insurance. The overall prevalence of possible NCD was 30% (25.6 and 41.8% among younger adults and older adults, respectively). Among younger adults, those ages 55-59 years more frequently had NCD (70%) compared to younger age ranges. Among older adults, only 3 subjects (4.5%) had major NCD. Conclusion: We found a high frequency of possible NCDs in a socially and economically vulnerable community in Lima, Peru, with younger adults showing levels of NCD higher than expected. Our findings support the need for health systems to incorporate cognitive screenings programs for NCD in younger ages. Future research on NCD would include younger populations, particularly in vulnerable communities.

High prevalence of HIV-associated neurocognitive disorders (HAND) in São Paulo City, Brazil / Alta prevalência de desordem neurocognitiva associada ao HIV (HAND) na Cidade de São Paulo, Brazil

INTRODUCTION: HIV-associated neurocognitive disorders (HAND) are the subject of many studies, some of them reporting a prevalence of up to 50 percent. OBJECTIVES: To determine the prevalence and factors associated with HIV neurocognitive disorders (HAND) in a cohort of HIV-1-infected patients in São Paulo city, Brazil. METHODOLOGY: Descriptive cross-sectional study including 106 HIV-1-infected patients, employing direct interview and neuropsychological tests, applied by trained neuro-psychologists with expertise in the tests. Other, similar assessment tools we used were Brief Neurocognitive Questionnaire, International HIV Dementia Scale, Lawton Instrumental Activities of Daily Living, Hospital Anxiety and Depression Scale, Social Support Scale for People with HIV/Aids, Assessment of Adherence to Antiretroviral Therapy Questionnaire, and a complex neuropsychological assessment. RESULTS: We included 106 patients from May 2015 to April 2018. We found a high prevalence of HAND in our patients (45%), with 27.5% presenting asymptomatic neurological impairment (ANI) and 17.5% mild neurological dysfunction (MND); only one patient presented HIV-associated dementia (HAD) (0.9%). Women were more likely to have MND (52.9%) and the only case of HAD was also female. The high prevalence of neurocognitive disorders was independent of the immunological status, use of efavirenz, or virological control. CONCLUSIONS: This study may mirror the national and international scenarios, showing a high prevalence of HAND (45%) and the prevalence of some risk factors, in special among women

INTRODUÇÃO: As doenças neurocognitivas associadas ao HIV (HAND), são o assunto de muitos estudos, alguns deles relatando uma prevalência de até 50 por cento. OBJETIVOS: Determinar a prevalência e os fatores associados aos distúrbios neurocognitivos do HIV (HAND) em uma coorte de pacientes infectados pelo HIV-1 na cidade de São Paulo, Brasil. METODOLOGIA: Estudo transversal descritivo incluindo 106 pacientes infectados pelo HIV-1, utilizando entrevista direta e testes neuropsicológicos, aplicados por neuropsicólogos treinados com experiência nos testes. Foram utilizados também: Questionário Neurocognitivo Breve, Escala Internacional de Demência do HIV, Atividades Instrumentais de Vida Diária de Lawton, Escala Hospitalar de Ansiedade e Depressão, Escala de Apoio Social para Pessoas com HIV / Aids, Avaliação da Adesão à Terapia Antiretroviral Questionário e uma bateria de avaliação neuropsicológica complexa. RESULTADOS: Foram avalaidos 106 pacientes de maio de 2015 a abril de 2018. Foi observado uma alta prevalência de HAND em nossos pacientes (45%), com 27,5% apresentando comprometimento neurológico assintomático (ANI) e 17,5% comprometimento cognitive leve (MND); apenas um paciente apresentou demência associada ao HIV (DAH) (0,9%). As mulheres eram mais propensas a ter MND (52,9%) e o único caso de HAD também era do sexo feminino. A alta prevalência de distúrbios neurocognitivos foi independente do estado imunológico, uso de efavirenz ou controle virológico. CONCLUSÕES: Este estudo pode espelhar o cenário nacional e internacional, mostrando uma alta prevalência de HAND (45%) e a prevalência de alguns fatores de risco, em especial entre as mulheres

Exploring the prevalence of substance-induced neurocognitive disorder among polysubstance users, adding subjective and objective evidence of cognitive impairment.

The objective of this study was to explore the prevalence of substance-induced neurocognitive disorder (NCD) in a sample of polysubstance users, adding both objective- and subjective cognitive impairment. METHOD: We collected cross-sectional data from 33 community-based residential facilities in Mexico City. Montreal Cognitive Assessment was used for measurement of objective cognitive impairment, and a DSM-5-based interview for subjective impairment. Years and days of recent use of alcohol, marijuana, cocaine and inhalants were collected for regression analyses. RESULTS: 753 participants were analyzed; from these, 50.5% show objective impairment, 71% and 58.5% self-reported any cognitive deficit and cognitive decline, respectively. Between 21.8%-36.5% would qualify for NCD when integrating both objective- and subjective impairment (deficit or decline). Significant weak associations were found between objective impairment and subjective deficits in all cognitive domains except social cognition. Regression models adding both objective- and subjective measures explained more variation in the years of alcohol, inhalant and cocaine use, and in recent marijuana use, than the objective measure alone, but associations were inconsistent. CONCLUSION: Though significant in proportion, the prevalence of NCD in this population can only be partially related to substance use. Further integrative approaches are needed to refine the epidemiology of this disorder.

Trastornos neurocognitivos asociados al VIH (TNAV): visión general y sus futuros retos / HIV-associated neurocognitive disorders (HAND): a general vision and their future challenges

El Virus de Inmunodeficiencia Humana (VIH) a lo largo de su estudio y comprensión ha creado nuevas líneas de investigación, entre ellas, la correlación entre el virus y un deterioro cognitivo que produce al replicarse en el Sistema Nervioso Central (SNC). En inicio se conoció como Demencia asociada al VIH (DAV) entre otras variaciones. Sin embargo, el nombre del diagnóstico junto con sus criterios diagnósticos fue modificado. En la actualidad, la pérdida de las funciones cognitivos en pacientes con VIH se conoce como Trastornos Neurocognitivos asociadas al VIH (TNAV). No obstante, su presencia recae de otros factores que las guías clínicas y los métodos de investigación más rigurosos no pueden controlar. El objetivo de la presente revisión es, esbozar brevemente el entendimiento y la importancia del estudio de los TNAV y algunas de las dificultades que presentan las investigaciones actuales, principalmente por la variada representatividad de los instrumentos, neuropsicológicos por naturaleza, utilizados para evaluarlos.

The acknowledgment of the Human Immunodeficiency Virus (HIV) through many investigations has to lead to new researchers, like the correlation between the virus and the cognitive impairment due to the replication at the Central Nervous System (CNS). In the beginning, it was known as Dementia associated HIV. The diagnosis and its diagnostic criteria have been modified over the years. Nowadays, it is known as HIV-associated neurocognitive disorders (HAND) and their presence is influence by many factors that cannot contemplate either by the clinical guides nor the most rigorous methodology. The present bibliographic review aims to expose briefly the progress in the studies and the difficulties they present due to multiple variables of their treatment and some methodology aspects within the neuropsychology assessment.

Neurocognitive Disorders in Heart Failure: Novel Pathophysiological Mechanisms Underpinning Memory Loss and Learning Impairment.

Heart failure (HF) is a major public health issue affecting more than 26 million people worldwide. HF is the most common cardiovascular disease in elder population; and it is associated with neurocognitive function decline, which represent underlying brain pathology diminishing learning and memory faculties. Both HF and neurocognitive impairment are associated with recurrent hospitalization episodes and increased mortality rate in older people, but particularly when they occur simultaneously. Overall, the published studies seem to confirm that HF patients display functional impairments relating to attention, memory, concentration, learning, and executive functioning compared with age-matched controls. However, little is known about the molecular mechanisms underpinning neurocognitive decline in HF. The present review round step recent evidence related to the possible molecular mechanism involved in the establishment of neurocognitive disorders during HF. We will make a special focus on cerebral ischemia, neuroinflammation and oxidative stress, Wnt signaling, and mitochondrial DNA alterations as possible mechanisms associated with cognitive decline in HF. Also, we provide an integrative mechanism linking pathophysiological hallmarks of altered cardiorespiratory control and the development of cognitive dysfunction in HF patients. Graphical Abstract Main molecular mechanisms involved in the establishment of cognitive impairment during heart failure. Heart failure is characterized by chronic activation of brain areas responsible for increasing cardiac sympathetic load. In addition, HF patients also show neurocognitive impairment, suggesting that the overall mechanisms that underpin cardiac sympathoexcitation may be related to the development of cognitive disorders in HF. In low cardiac output, HF cerebral infarction due to cardiac mural emboli and cerebral ischemia due to chronic or intermittent cerebral hypoperfusion has been described as a major mechanism related to the development of CI. In addition, while acute norepinephrine (NE) release may be relevant to induce neural plasticity in the hippocampus, chronic or tonic release of NE may exert the opposite effects due to desensitization of the adrenergic signaling pathway due to receptor internalization. Enhanced chemoreflex drive is a major source of sympathoexcitation in HF, and this phenomenon elevates brain ROS levels and induces neuroinflammation through breathing instability. Importantly, both oxidative stress and neuroinflammation can induce mitochondrial dysfunction and vice versa. Then, this ROS inflammatory pathway may propagate within the brain and potentially contribute to the development of cognitive impairment in HF through the activation/inhibition of key molecular pathways involved in neurocognitive decline such as the Wnt signaling pathway.

La crítica y la educación médica: hacia un conocimiento liberador. Parte II / Critique and medical education: towards liberating knowledge. Part II

Resumen La crítica del quehacer médico como espacio educativo implicó caracterizar el entramado de lógicas, ideas y prácticas prevalentes: la disyunción y el reduccionismo; el binomio salud-enfermedad; la historia natural de la enfermedad; la medicalización de la vida social; la tecnologización deshumanizante de la práctica médica, y la medicina supresora reduccionista. La crítica continúa discutiendo la contribución de ese entramado al control social como agente de la dominación de los intereses de lucro sin límites y como expresión del poder de la industria de la salud, justificándose con la argumentación de alternativas tendientes a superar ese entramado: la lógica transdisciplinaria y el concepto de organismo como totalidad jerarquizada e interactuante con su entorno respecto de la disyunción y el reduccionismo; la historia cultural de la enfermedad como alternativa a la historia natural de la enfermedad y al binomio salud-enfermedad; el bien vivir, la búsqueda de la superación espiritual, intelectual, moral y convivencial que confiere sentido profundo a la vida humana, como alternativa a la medicalización y antídoto de la tecnologización deshumanizante y los rasgos degradantes; la medicina estimulante de fuerzas curativas endógenas para afecciones crónicas no trasmisibles, cuyo fundamento de factibilidad y credibilidad radica en la omnipresencia del efecto placebo con respecto a la medicina supresora, basada en fármacos con efectos secundarios indefectibles. Sin una educación basada en la crítica, difícilmente el conocimiento liberador podrá acompañar y orientar a médicos y otros profesionales a organizarse en la búsqueda, desde su ámbito, de un mundo inclusivo, igualitario, justo, solidario y cuidadoso del ecosistema planetario.

Abstract The critique of medicine begins at unveiling and specifying its network of predominant logics, ideas and practices: logics of disjunction and reductionism; the health-disease binomial; the natural history of the disease; the medicalization of social life; the dehumanizing technologization of medical practice and reductionist suppressive medicine. It goes on to argue about its role as agents of domination of limitless profit interests and as an expression of the power of the health industry, justifying itself with the proposal of alternatives tending to overcome that network: transdisciplinarity and the concept of organism as hierarchical totality and interacting with its environment, with respect to disjunction and reductionism; the cultural history of the disease in relation to the health-disease binomial and the dehumanizing technologization; good living, the search for spiritual, intellectual, moral and coexistence growth as meaning of human life, as an alternative to the medicalization and antidote of degrading traits and stimulating medicine of the endogenous healing forces of the organism whose foundation of possibility and credibility is the placebo effect as an alternative to suppressive therapy for non-communicable chronic conditions, based on the pharmacological effect with unfailing side effects. It concludes that without an education based on critique, liberating knowledge would hardly accompany and guide the various social groups in the search for an inclusive, pluralistic, egalitarian, fair, solidary and caring of the planetary ecosystem world.

Fetal Growth Restriction with Brain Sparing: Neurocognitive and Behavioral Outcomes at 12 Years of Age.

OBJECTIVE: To study neurocognitive functions and behavior in children with a history of fetal growth restriction (FGR) with brain sparing. We hypothesized that children with FGR would have poorer outcomes on these domains. STUDY DESIGN: Subjects were 12-year-old children with a history of FGR born to mothers with severe early-onset hypertensive pregnancy disorders (n = 96) compared with a normal functioning full term comparison group with a birth weight ≥2500 g (n = 32). Outcome measures were neurocognitive outcomes (ie, intelligence quotient, executive function, attention) and behavior. RESULTS: For the FGR group, the mean ratio of the pulsatility index for the umbilical artery/middle cerebral artery (UC-ratio = severity of brain sparing) was 1.42 ± 0.69. The mean gestational age was 31-6/7 ± 2-2/7 weeks. The mean birth weight was 1341 ± 454 g, and the mean birth weight ratio 0.68 ± 0.12. Neurocognitive outcomes were comparable between groups. Parents of children with FGR reported more social problems (mean T-score 56.6 ± 7.7; comparison 52.3 ± 4.3, P < .001, effect size = 1, 95% CI 0.52-1.46) and attention problems (mean T-score 57.3 ± 6.9; comparison 53.6 ± 4.2, P = .004, effect size = 0.88, 95% CI 0.42-1.33). UC-ratio was not associated with any of the outcomes, but low parental education and lower birth weight ratio were. CONCLUSIONS: In this prospective follow-up study of 12-year-old children with a history of FGR and confirmed brain sparing, neurocognitive functions were comparable with the comparison group, but parent-reported social and attention problem scores were increased.

Association between Off-Peak Hour Birth and Neonatal Morbidity and Mortality among Very Low Birth Weight Infants.

OBJECTIVE: To assess the independent association between overnight or "off-peak" hour delivery and 3 neonatal morbidities strongly associated with childhood neurocognitive impairment. STUDY DESIGN: Retrospective population based cohort study of all infants with birth weights of 500-1499 g born without severe congenital anomalies in California or Pennsylvania between 2002 and 2009. Off-peak hour delivery was defined as birth between 12:00 a.m. and 6:59 a.m. The study outcomes were death; bronchopulmonary dysplasia, retinopathy of prematurity, and severe (grade 3 or 4) intraventricular hemorrhage among survivors; the composite of each morbidity or mortality; and the composite of death or 1 or more of the evaluated morbidities. RESULTS: Of 47 617 evaluated infants, 9317 (19.6%) were born during off-peak hours. The frequencies of all study outcomes were higher among infants born during off-peak compared with peak hours. After adjusting for maternal, infant, and hospital characteristics, off-peak hour delivery was associated with increased odds of severe intraventricular hemorrhage among survivors (OR 1.39, 95% CI 1.23-1.57) and the composite outcomes of death or severe intraventricular hemorrhage (OR 1.16, 95% CI 1.07-1.25) and death or major morbidity (OR 1.08, 95% CI 1.02-1.15). There was no evidence of subgroup effects based on delivery mode, birth hospital neonatal intensive care level or annual very low birth weight infant delivery volume, or weekday vs weekend off-peak hour delivery for any study outcome. CONCLUSIONS: Very low birth weight infants born between midnight and 7:00 a.m. are at increased risk for severe intraventricular hemorrhage and death or major neonatal morbidity.

Depression and diagnosis of neurocognitive impairment in HIV-positive patients.

Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.

Depression and diagnosis of neurocognitive impairment in HIV-positive patients

Neurocognitive impairment (NCI) is frequently observed in patients infected with human immunodeficiency virus (HIV) and results from the compromise of subcortical brain structures by the virus. The manifestations of NCI range from asymptomatic impairment to dementia. In addition to cognitive impairment resulting from HIV infection, other factors such as depression are associated with the loss of cognitive functions. The aim of this study was to estimate the prevalence of NCI in HIV-positive patients in a city in southern Brazil and to establish possible associations for the prevalence of NCI with HIV-related and other risk factors. This cross-sectional study of HIV-positive outpatients was conducted in a specialized care service in the city of Pelotas in Southern Brazil. Sociodemographic data and HIV-related information were collected, and all patients underwent psychiatric and neurocognitive evaluations. The prevalence of NCI among the 392 patients was 54.1% when tracked using the IHDS (International HIV Dementia Scale) and 36.2% when the IHDS was associated with a battery of complementary tests. A bivariate analysis suggested an association of NCI with gender, age, educational level, depression, current CD4 count and lowest CD4 count. The association of NCI with depression remained in the Poisson regression (PR=1.96, 95%CI=1.12-3.42). The prevalence of cognitive impairment in HIV-positive patients estimated in this study is in accordance with international and Brazilian data. Of the factors analyzed, depression showed the greatest evidence of association with neurocognitive loss. Based on our findings, the inclusion of instruments to evaluate depression in our services for patients with HIV and acquired immunodeficiency syndrome (AIDS) is recommended.

Delirium em pacientes idosos / Delirium in elderly patients

Dada as constataçöes de que a populaçäo idosa mundial tem aumentado consideravelmente com a melhoria da qualidade de vida e que o delirium é um distúrbio frequentemente encontrado nesta populaçäo(três a quatro vezes mais que em adultos jovens), faz-se necessária a compreensäo melhor dessa desordem psiquiátrica. Geralmente, o delirium é encarado como a primeira manifestaçäo de uma doença aguda, exacerbaçäo de uma doença crônica ou intixicaçäo por drogas. A sua presença em pós-operatórios deve ser salientada. Ainda é especulativa a sua fisiopatologia; acredita-se em baixa oferta de oxigênio e de glicise aos tecidos, bem como em alteraçäo em neurotransmissores colinérgicos. Este é uma síndrome mental orgânica transitória que apresenta três variáveis(hipoalerta-hipoativo, hiperalerta-hiperativo e misto) e deve ser sempre diferenciado de demência e psicose funcional. O diagnóstico é basicamente clínico(através de história, exame físico e determinaçäo do fator precipitante)e os testes de avaliaçäo de estado mental ainda näo säo específicos para o delirium. O tratamento se baseia na experiência clínica e é dividida em três etapas: prevenoäo de fatores precipitantes, tratamento da doença subjacente e cuidados de suporte, sendo que as medicaçöes psicotrópicas devem ser guardadas para os casos mais graves. Já o prognóstico é um aspecto pouco estudado e alguns o encaram como prenúncio de morte.(au)

Prevalencia de vida y seis meses de algunos trastornos psiquiátricos en la provincia de Cautín-Chile / Lifetime prevalences and 6 month of some psychiatric disorders in province of Cautín, Chile

Se presentan los resultados de un estudio comunitario de trastornos psiquiátricos realizados en la población de 15 años y más de la provincia de Cautín, con lo que se completa la cuarta y última etapa del ya conocido Programa Nacional de Epidemiologia Psiquiátrica. A 509 adultos se les aplico el CIDI 1,1 además de otros instrumentos. La prevalencia de vida y seis meses según criterios DSM-III-R para los trastornos estudiados se analizan por género, edad, estado civil y escolaridad. Destaca una prevalencia de vida de un 31,4 por ciento y de un 17,9 por ciento cuando se consideran los seis meses previos al estudio. Se concluye sugiriendo que estamos presenciando un deterioro significativo de la salud mental en nuestro país y las medidas adecuadas son impostergables

El nivel socio-económico como factor de riesgo del enfermar psiquiátrico / Socio-economical level as risk factors of the psychiatric disorders

Se intentan mostrar las eventuales asociaciones entre las prevalencias de algunos trastornos psiquiátricos pesquisados por el CIDI y el nivel socio-económico medido por el Graffar. Se utilizan las prevalencias de vida y seis meses de los estudios realizados en Iquique y Cautín. En relación a vida destaca la similitud en las prevalencias de cuadros afectivos y ansiosos en el sector alto de ambas provincias en cambio Iquique tiene una prevalencia 3 veces mayor de abuso y dependencia de sustancias en los mismos sectores. En relación a 6 meses destaca en ambas provincias la alta prevalencia de problemas asociados al consumo de sustancias, especialmente en sectores medios

Distribución urbano-rural de los trastornos psiquiátricos más frecuentes / Urban-rural distribution of the psychiatric disorders

Estudio epidemiológico comunitario de las provincias de Concepción y Cautín, que muestra las prevalencias de vida de seis meses de los trastornos psiquiátricos más frecuentes según criterios DSM-III-R de acuerdo a la distribución urbano-rural. Se discuten las diferencias encontradas en Cautín especialmente en los cuadros afectivos y el síndrome orgánico cerebral severo. En la provincia de Concepción no se encontraron diferencias significativas

Diagnostic rate of comorbid personality disorder in elderly psychiatric inpatients.

Among 547 elderly inpatients grouped by DSM-III-R axis I diagnoses, the diagnostic rate of comorbid personality disorder varied four-fold, from 6% in patients with an organic mental disorder to 24% in those with major depression. The previously reported low prevalence of comorbid personality disorder in geriatric patients may be due to its lower rate of diagnosis among patients with organic mental disorders.

[Prevalence of organic brain syndrome in an elderly population in an metropolitan area of the southeastern region of Brazil]. / Prevalência da síndrome cerebral orgânica em população de idosos de área metropolitana da região sudeste do Brasil.

This paper is a summary of the main findings concerning organic brain syndrome (O.S.S.) in a prevalence study carried out among the elderly population of the city of Rio de Janeiro, Brazil. The project selected three districts of the city-Copacabana, Méier and Santa Cruz-in view of a set of indicators. The study for the validation and reliability of the diagnostic instrument was carried out in the district of Copacabana. Prevalence results for organic brain syndrome were 5.9% in Copacabana, 9.84% in Méier and 29.75% in Santa Cruz. Several hypotheses have been formulated in the attempt to explain such diverse results within a single city. Associations with a variety of socio-economic indicators are presented. Dependence and loss of autonomy in elderly people are closely associated with organic brain syndrome. The results are compared with national and international findings.

Prevalência da síndrome cerebral orgânica em populaçäo de idosos de área metropolitana da regiäo sudeste do Brasil / Prevalence of organic brain syndrome in an elderly population in a metropolitan population of southeastern Brazil

Foram apresentados os principais resultados do estudo de prevalência de síndrome cerebral orgânica, realizado na cidade do Rio de Janeiro, com a populaçäo idosa. A partir de um conjunto de indicadores foram selecionados três distritos: Copacabana, Méier e Santa Cruz. No de Copacabana foi realizado o estudo de validaçäo e confiabilidade do instrumento de diagnóstico. Os resultados de prevalência em Copacabana, Méier e Santa Cruz para síndrome cerebral orgânica foram de 5,9 por cento, 9,8 por cento e 29,7 por cento, respectivamente. Várias hipóteses foram formuladas para resultados täo díspares em uma mesma cidade. Säo apresentadas associaçöes com vários indicadores socioeconômicos. Idosos com perda de autonomia e dependência säo fortemente associados à síndrome cerebral orgânica

Los egresos del Instituto Psiquiátrico de Santiago (1986-1990) / The discharges at Instituto Psiquiátrico of Santiago (1986-1990)

Se revisan los diagnósticos del Instituto Psiquiátrico de Santiago entre los años 1986 a 1990. Sobre el total de 11.766 egresos se realiza una descripción global según edad, sexo, grupos de diagnóstico y variaciones estacionales en le lapso de estos cinco años. El 75,8 por ciento de los diagnósticos correspondió al rango etáreo 15-44 años y sólo el 4,1 por ciento al rango 65 o más. El 52,9 por ciento fueron hombres. Los diagnósticos más frecuentes fueron "esquizofrenia 38,39 por ciento , alcoholismo 11,96 por ciento , daño orgánico cerebral 10,37 por ciento y trastornos del ánimo 9,72 por ciento ". La relación entre esquizofrenia y enfermedad bipolar fue de 9,3:1, a favor de la primera. También hubo aumento del diagnóstico de trastorno de personalidad en los 5 años de estudio. El trastorno esquizo-afectivo experimentó un notable incremento del 0,1 por ciento en 1986 a 1,1 por ciento del total de los egresos en 1990. La esquizofrenia predominó en hombres (55,41 por ciento ) respecto de las mujeres (44,58 por ciento ). En los trastornos del ánimo hombres fueron el 31,8 por ciento y las mujeres 68,2 por ciento . La esquizofrenia fue más frecuente en los egresos de los rangos etáreos más jovenes, lo que es menos acentuado en los trastornos del ánimo. Los cuadros orgánicos aumentaron con la edad