Home Care for the Elderly: An Integrated Approach to Perception, Quality of Life, and Cognition.

This study investigated the impact of home care, health status, and cognition. A qualitative and quantitative approach was employed through a cross-sectional study with a sample of 60 elderly individuals in need of home care in the municipality of Itatiba, São Paulo, Brazil. The analysis utilized the Discourse of the Collective Subject (DCS), EQ-5D, EQ VAS, and Mini-Mental State Examination (MMSE). The sample consisted of 40.0% male and 60.0% female individuals. The majority (61.6%) received weekly visits, mainly from community health agents, who were responsible for the majority of the care (45%). Positive considerations were highlighted, with 36.6% emphasizing the contribution to treatment continuity. The EQ VAS assessment indicated a moderately good perception of health. The EQ-5D analysis revealed significant differences between genders in personal care (p = 0.04). There were significant differences between clinical characteristics and EQ-5D dimensions, such as neoplasia and reduced mobility (p = 0.04), and arthritis/osteoarthritis/rheumatism and a limitation in common activities (p = 0.01). The presence of anxiety/depression was significant in cases of neoplasia (p = 0.006), arthritis/osteoarthritis/rheumatism (p = 0.01), and stroke (p = 0.04). The logistic regression analysis showed associations between usual activities and arthritis, osteoarthritis, rheumatism (p = 0.034), pain/malaise and arthritis, osteoarthritis, rheumatism (p = 0.038), and anxiety/depression and stroke (p= 0.028). The average MMSE scores (17.52) suggested a mild cognitive impairment, with no statistical differences between genders. Based on these results, it can be concluded that home care can provide a comprehensive approach and continuous assistance, emphasizing the importance of personalized care based on perceived and clinical differences.

Pertinencia de la atención de la salud mental de conductores para lograr que sean competitivos

Fundamento: Cuidar la salud mental de los conductores de vehículos, es indispensable para que estos sean competitivos y para prevenir accidentes de tránsito, debido a que una de las causas de los accidentes, es la deficiente salud mental de los conductores. Objetivo: Determinar la pertinencia de la atención en salud mental de conductores de vehículos para evitar accidentes y para que sean competitivos. Métodos: La muestra fue de 219 conductores y cobradores de transporte terrestre en Trujillo, La Libertad, Perú; que contestaron el Test de Bienestar General-5, anteriormente aplicado en el Perú por otros investigadores, conformado por 5 preguntas compuestas. La prueba de Hipótesis nula (Ho) y alterna (Ha); se plantearon con una respecto al puntaje decisorio de 54,75 puntos. Resultados: Para las preguntas 2 y 4 se aprobó la hipótesis alterna con la indicación de que es pertinente la atención de salud mental para conductores para que puedan estar relajados; descansen bien e inicien el día sintiéndose sosegados. Para las preguntas 1, 3 y 5 se aceptó la hipótesis nula. Conclusiones: se percibe que los promedios más bajos se corresponden con las preguntas 2 y 4, entonces es pertinente la atención en salud mental para que los conductores de transporte público, puedan recibir asistencia psicológica para sentirse relajados y descansados. Para las demás preguntas se acepta la hipótesis nula.

Foundation: Taking care of the mental health of vehicle drivers is essential for them to be competitive and to prevent traffic accidents because one of the causes of accidents is the poor mental health of drivers. Objective: Determine the relevance of mental health care for vehicle drivers to avoid accidents and to make them competitive. Methods: The sample was 219 drivers and collectors of land transportation in Trujillo, La Libertad, Peru; who answered the General Well-being Test-5, previously applied in Peru by other researchers, made up of 5 composite questions. The null (Ho) and alternate (Ha) hypothesis test; were raised with a respect to the decisive score of 54.75 points. Results: For questions 2 and 4, the alternative hypothesis was approved with the indication that mental health care for drivers is pertinent so that they can be relaxed; also so that they rest well and start the day feeling well rested. For questions 1, 3 and 5, the null hypothesis was accepted. Conclusions: It is perceived that the lowest averages correspond to questions 2 and 4, then mental health care is pertinent for public transport drivers, so that they can receive psychological assistance to feel relaxed and rested. For the other questions, the null hypothesis is accepted.

Ultra-high risk for psychosis stigma: an updated Systematic Review.

OBJECTIVE: To clarify if stigma associated with schizophrenia has also been directed towards the ultra-high risk for psychosis (UHR) population, the present review aimed at synthetizing the existing literature to update and extend our understanding on the topic. METHODS: A systematic PRISMA-compliant review was performed in PubMed, Embase, Cochrane and Web of Science for articles published until 30/04/2023, using a combination of search terms describing the at-risk mental states for psychosis and stigma and correlated terms. RESULTS: Thirty-eight studies were included. Twenty-nine addressed UHR individuals directly, and 9 conducted interviews with non-patients regarding UHR. A total of 2560 UHR individuals were assessed; mean sample size was of 88.3 participants. Most of the studies were quantitative non-randomized/observational with young adults, 71.4% used SIPS (Structured Interview for Psychosis-risk Syndromes) and 25.0% used CAARMS (Comprehensive Assessment of At-Risk Mental States). Overall, the summarized studies have mainly involved individuals already attending UHR clinics from Western and high income countries. Studies can be grouped into five forms of stigma, among which the most frequently explored was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress and associative stigma. The main study design was quantitative nonrandomized, with only one interventional study. Most of the results confirmed the presence of stigma toward UHR individuals and findings provide additional support to the fact that stigma seems to be present since the very early stages of the disease. CONCLUSION: There is still a paucity of research and knowledge gaps about UHR-related stigma. Nevertheless, results suggest the presence of stigma toward UHR individuals, supporting the fact that stigma is present since the early stages of psychosis.

Stigma of ultra-high risk for psychosis: an updated systematic review

Objective: To determine whether the stigma associated with schizophrenia has also been directed towards people at ultra-high risk of psychosis (UHR), the present review aimed to synthetize the literature to update and extend our understanding of this topic. Methods: A systematic review compliant with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted in the PubMed, EMBASE, Cochrane, and Web of Science databases for articles published until April 30, 2023, using a combination of search terms describing at-risk mental states for psychosis, stigma, and related terms. Results: Thirty-eight studies were included. Twenty-nine addressed individuals with UHR directly, and nine conducted interviews with non-patients regarding UHR. A total of 2,560 individuals with UHR were assessed, with a mean sample size of 88.3 participants. Most were quantitative non-randomized/observational studies with young adults, 71.4% used the Structured Interview for Psychosis-Risk Syndromes, and 25% used the Comprehensive Assessment of At-Risk Mental States. Overall, the studies mainly involved patients of UHR clinics from high-income Western countries. The described stigma can be grouped into five forms, the most frequently explored of which was perceived public stigma, followed by public stigma, self-stigma/internalized stigma, stigma stress, and associative stigma. Quantitative nonrandomized studies predominated: only one was an interventional study. Most of the results confirmed the presence of stigma toward individuals with UHR. Conclusion: Despite the knowledge gaps and scarcity of research on UHR-related stigma, the results suggest that stigma toward people with UHR exists and that it is already present at early stages of psychosis. Registration number: PROSPERO CRD42022332037.

Inequality and barriers in psychosis prevention: A systematic review on clinical high-risk for psychosis studies from developing countries.

Background: The clinical high-risk for psychosis (CHR) paradigm is one of the best studied preventive paradigms in psychiatry. However, most studies have been conducted in high-income countries. It is unclear if knowledge from such countries applies to low and middle-income countries (LAMIC), and if there are specific limitations hindering CHR research there. Our aim is to systematically review studies on CHR from LAMIC. Methods: A multistep PRISMA-compliant literature search was performed in PubMed and Web of Science for articles published until 1/03/2022, conducted in LAMIC, addressing the concept and correlates of CHR. Study characteristics as well as limitations were reported. Corresponding authors of the included studies were invited to answer an online poll. Quality assessment was done with the MMAT. Results: A total of 109 studies were included in the review: none from low-income countries, 8 from lower middle-income countries, and 101 from upper middle-income countries. The most frequent limitations were small sample size (47.9%), cross-sectional design (27.1%), and follow-up issues (20.8%). Mean quality of included studies was of 4.4. Out of the 43 corresponding authors, 12 (27.9%) completed the online poll. They cited further limitations as few financial resources (66.7%), no involvement of population (58.2%) and cultural barriers (41.7%). Seventy five percent researchers reported that CHR research should be conducted differently in LAMIC compared to high-income countries, due to structural and cultural issues. Stigma was mentioned in three out of five sections of the poll. Discussion: Results show the discrepancy of available evidence on CHR in LAMIC, given the shortage of resources in such countries. Future directions should aim to increase the knowledge on individuals at CHR in such settings, and to address stigma and cultural factors that may play a role in the pathways toward care in psychosis. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=316816, CRD42022316816.

Population-Based Mini-Mental State Examination Norms in Adults of Mexican Heritage in the Cameron County Hispanic Cohort.

BACKGROUND: Accurately identifying cognitive changes in Mexican American (MA) adults using the Mini-Mental State Examination (MMSE) requires knowledge of population-based norms for the MMSE, a scale which has widespread use in research settings. OBJECTIVE: To describe the distribution of MMSE scores in a large cohort of MA adults, assess the impact of MMSE requirements on their clinical trial eligibility, and explore which factors are most strongly associated with their MMSE scores. METHODS: Visits between 2004-2021 in the Cameron County Hispanic Cohort were analyzed. Eligible participants were ≥18 years old and of Mexican descent. MMSE distributions before and after stratification by age and years of education (YOE) were assessed, as was the proportion of trial-aged (50-85- year-old) participants with MMSE <24, a minimum MMSE cutoff most frequently used in Alzheimer's disease (AD) clinical trials. As a secondary analysis, random forest models were constructed to estimate the relative association of the MMSE with potentially relevant variables. RESULTS: The mean age of the sample set (n = 3,404) was 44.4 (SD, 16.0) years old and 64.5% female. Median MMSE was 28 (IQR, 28-29). The percentage of trial-aged participants (n = 1,267) with MMSE <24 was 18.6% overall and 54.3% among the subset with 0-4 YOE (n = 230). The five variables most associated with the MMSE in the study sample were education, age, exercise, C-reactive protein, and anxiety. CONCLUSION: The minimum MMSE cutoffs in most phase III prodromal-to-mild AD trials would exclude a significant proportion of trial-aged participants in this MA cohort, including over half of those with 0-4 YOE.

Are the spatiotemporal gait parameters at different walking speeds capable of predicting variations in cognitive status by the mini-mental state examination?

BACKGROUND: Several studies have reported the association between cognition and gait; however, most are limited to investigating gait in just one speed, usually the self-selected one, and commonly, only the general score of cognitive tests is used. AIMS: Investigate the relationship between the spatiotemporal gait parameters at different speeds (self-selected and fast walking speeds) and cognitive status in older adults. METHODS: Cross-sectional study. Two hundred and ninety-five older adults (70.9 ± 7.2 years; 82.3% women) were evaluated according to cognitive status (Mini-Mental State Examination, MMSE) and spatiotemporal gait parameters. RESULTS: Data analysis indicates that the spatiotemporal gait parameters (stride length, step time, and single support time) were able to predict cognitive status, assessed by the MMSE general score and its subdomain (temporal and spatial orientation) at both walking speeds. CONCLUSIONS: The spatiotemporal gait parameters were associated with cognitive status, assessed by the MMSE (general score and temporal and spatial orientation), regardless of the walking conditions. The model's variance was significant and with a large effect size. Stride length and step time were identified as the variables with the best explanatory factors. Therefore, it is concluded that greater cognitive performance is associated with longer stride lengths and faster step times.

Ethical Implications of the Use of Language Analysis Technologies for the Diagnosis and Prediction of Psychiatric Disorders.

Recent developments in artificial intelligence technologies have come to a point where machine learning algorithms can infer mental status based on someone's photos and texts posted on social media. More than that, these algorithms are able to predict, with a reasonable degree of accuracy, future mental illness. They potentially represent an important advance in mental health care for preventive and early diagnosis initiatives, and for aiding professionals in the follow-up and prognosis of their patients. However, important issues call for major caution in the use of such technologies, namely, privacy and the stigma related to mental disorders. In this paper, we discuss the bioethical implications of using such technologies to diagnose and predict future mental illness, given the current scenario of swiftly growing technologies that analyze human language and the online availability of personal information given by social media. We also suggest future directions to be taken to minimize the misuse of such important technologies.

Terapia cognitivo conductual para pacientes con riesgo clínico de psicosis / Cognitive behavior therapy for young patients at clinical risk for psychosis

INTRODUCCIÓN. Los estudios de tratamiento indican que el riesgo de transición a un trastorno psicótico puede al menos retrasarse en la población clínica de alto riesgo de psicosis (CHR), además de mejorar variables relacionadas con la calidad de vida de los pacientes, existiendo evidencia a favor de la terapia cognitivo conductual (TCC). MÉTODOS. Se realizó una síntesis narrativa, basada en la búsqueda de artículos originales, que abordasen la efectividad de la TCC en pacientes CHR, publicados en los últimos cinco años, incluidos en esta síntesis. RESULTADOS. Se incluyeron un total de 10 artículos que evalúan la TCC en CHR, siendo un tratamiento efectivo y ampliamente utilizado, lo que se asocia a una disminución en las consecuencias psicosociales que conlleva el retraso en la presentación del cuadro clínico y/o la disminución de síntomas comórbidos. CONCLUSIÓN. Actualmente, la TCC se ha convertido en el tratamiento de primera elección para CHR, existiendo una gran variedad de estrategias psicoterapéuticas específicas dentro de este grupo de intervención.

INTRODUCTION. Treatment studies indicate that the risk of transition to a psychotic disorder can at least be delayed in the clinical population at high risk for psychosis (CHR), in addition to improving variables related to the quality of life of patients, with evidence in favor of cognitive behavioral therapy (CBT). METHODS. A narrative synthesis was carried out, based on the search for original articles, which addressed the effectiveness of CBT in CHR patients, published in the last five years, included in this synthesis. RESULTS. A total of 10 articles that evaluate CBT in CHR were included, being an effective and widely used treatment, which is associated with a decrease in the psychosocial consequences that the delay in the presentation of the clinical picture and/or the decrease in symptoms entails. comorbid. CONCLUSION. Currently, CBT has become the treatment of first choice for CHR, with a wide variety of specific psychotherapeutic strategies within this intervention group.

Revisión de las pruebas cognitivas breves para pacientes con sospecha de demencia / Review of brief cognitive tests for patients with suspected dementia

RESUMEN NTRODUCCIÓN: Para ser útiles, las pruebas cognitivas breves (PCB) deben ser rápidas, sensibles, fáciles de realizar y no necesitar de un gran entrenamiento para hacerlo. Las pruebas cognitivas breves comúnmente utilizadas incluyen el Mini Examen del Estado Mental (MMSE) y la Evaluación Cognitiva de Montreal (MoCA). OBJETIVO: Brindar una descripción de las PCB disponibles y sus propiedades psicométricas para la detección de la demencia. MÉTODOS: Revisión narrativa RESULTADOS: El MMSE le otorga un gran peso a la orientación, la memoria, la visuo-espacialidad y el lenguaje, y, en consecuencia, puede ser sensible a los déficits cognitivos encontrados en la demencia tipo Alzheimer. MoCA es una prueba breve más compleja que evalúa una gama más amplia de dominios cognitivos, especialmente funciones ejecutivas, proporcionando una mayor sensibilidad para detectar el deterioro cognitivo leve y otros tipos de demencia, no solo la demencia tipo Alzheimer. CONCLUSIONES: Las PCB son parte del arsenal necesario para ayudar a confirmar la sospecha de la demencia. La escolaridad tiene un impacto importante en el desempeño de las PCB y puede sesgar la interpretación de los resultados obtenidos.

ABSTRACT INTRODUCTION: To be useful, Brief Cognitive Tests (BCTs) must be fast, sensitive, easy to perform, and not require extensive training to do so. Commonly used brief cognitive tests include the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). OBJECTIVE: To provide a description of the available BCTs and their psychometric properties for the detection of dementia. METHODS: Narrative review RESULTS: The MMSE places great weight on orientation, memory, visuospatiality, and language, and, consequently, may be sensitive to the cognitive deficits found in Alzheimer's dementia. MoCA is a more complex brief test that assesses a broader range of cognitive domains, especially executive functions, providing greater sensitivity for detecting mild cognitive impairment and other types of dementia, not just Alzheimer's dementia. CONCLUSIONS: BCTs are part of the arsenal needed to help confirm suspected dementia. Schooling has an important impact on the performance of BCTs and can bias the interpretation of the results obtained.

Quality of Life of Elderly People Living in Different Types of Long-term Care Facilities

Abstract Population aging is a worldwide occurrence that has become urgent in developing countries. Quality of life can be measured to identify functional capacity and determine the degree of impact on quality of life exerted on an individual. This study aimed to measure the quality of life of elderly people who have been living in different long-term care facilities for the elderly. Therefore, this research was developed with a qualitative and descriptive approach. Data were obtained from medical records and interviews, and were analyzed in R language interpreter software on the Ubuntu Linux operating system. Seventy-nine elderly people participated in the study. Eleven lived in Home Marista, and 68 lived in Home Jesus Maria José. A socioeconomic questionnaire was used to collect data on the socioeconomic characteristics of the participants. The Mini-Mental State Exam was used to measure degree of cognition. The Short Form-36 Questionnaire was used to measure quality of life. The present study suggests that the results found can clarify the individual vulnerability of the elderly in the age group studied regardless of the type of residence. Despite the discrepancy found regarding the care provided at the long-term care facilities, the scores, obtained with the quality of life assessment, did not show significant differences.

Uma poética do feminino: considerações sobre uma certa hora perigosa / A poetics of the feminine: reflections on a certain dangerous hour / Una poética de lo femenino: consideraciones sobre cierta hora peligrosa / Une poétique du féminin: réflexions sur une certaine heure dangereuse

Entrelaçando fragmentos de uma experiência clínica com a narrativa de um dia na vida de Ana, personagem de um conto da escritora Clarice Lispector, a autora considera o feminino não como um adjetivo, uma qualidade, mas como um estado mental, algo não definitivo, não adquirido e perdido de forma absoluta; um estado mental fugidio que encarna o constitutivo do ser humano, isto é, o enigma da criação, a vida e a morte, o indizível, o mistério, a falta; o feminino como uma metáfora do sujeito na psicanálise, constituindo-se permanentemente na sustentação e no repúdio ao que espanta, fascina, causa horror e assombro.

Interweaving fragments of a clinical experience with the narrative of a day in the life of Ana, a character in a short story written by Clarice Lispector, the author considers the feminine not an adjective or a quality, but rather a mental state, something that is not definitive, not acquired and altogether lost; it is a fleeting mental state that embodies what constitutes the human being, that is to say, the enigma of creation, life and death, the unsayable, the mysterious, the lack; the feminine as a metaphor for the subject in psychoanalysis, which is permanently constituted in the support and repudiation of what frightens, fascinates, causes horror and dread.

Entrelazando fragmentos de una experiencia clínica con la narrativa de un día en la vida de Ana, personaje de un cuento de la escritora Clarice Lispector, la autora considera lo femenino no como un adjetivo, una cualidad, sino como un estado mental, algo no definitivo, no adquirido y perdido absolutamente; un estado mental fugaz que encarna lo que constituye el ser humano, es decir, el enigma de la creación, la vida y la muerte, lo indecible, el misterio, la carencia; lo femenino como metáfora del sujeto en psicoanálisis, constituyéndose permanentemente en el soporte y el rechazo de lo que asombra, fascina, provoca horror y asombro.

Entrelaçant des fragments d'une expérience clinique avec le récit d'une journée dans la vie d'Ana, le personnage d'une nouvelle de l'écrivaine Clarice Lispector, l'auteure considère que le féminin n'est pas un adjectif, une qualité, mais un état mental, quelque chose de non définitif, pas acquis et absolument perdu ; un état mental fugace qui incarne ce qui constitue l'être humain, c'est-à-dire, l'énigme de la création, la vie et la mort, l'indicible, le mystère, le manque ; le féminin comme métaphore du sujet en psychanalyse, se constituant en permanence dans le support et le rejet de ce qui étonne, fascine, fait horreur et stupéfaction.

Mothers' Use of Regulatory Talk with Toddlers in Chile and the US: How Do Cultural Values and Children's Gender Affect Mothers' Regulatory Talk at 12 and 30 Months?

Studies have shown that Chilean and US infants differ in their levels of self-regulation. One of the mechanisms of early socializing is the use of language, particularly mental state language. The current study seeks to deepen our knowledge of the ways in which mental state language is related to socialization processes in early childhood, including the ways both culture and children's gender influence a mothers' use of mental state talk. We used a quantitative and descriptive approach with 109 mothers and their children (64 Chilean and 45 US dyads), measured twice, at 12 and 30 months old. Mental state references related to regulation were coded during a story-sharing task, including positive (calm and patient) and negative (messy and impatient) references to regulating behavior. Chilean mothers generally showed more regulatory references than US mothers, especially if the children were at a younger age (12 month). Frequencies of regulatory references increased in US mothers at 30 months but were still less than in Chilean mothers. At the 12-month measuring point, Chilean mothers showed more negative regulatory attributes than positive regulatory attributes. Finally, US mothers mainly used references to secondary emotions (e.g., pride) and positive regulatory attributes (being obedient, mature and patient) at both ages.

Influence of migration on the thought process of individuals at ultra-high risk for psychosis

Objective: To assess the influence of migration on the psychopathological presentation of individuals at ultra-high risk for psychosis (UHR) in São Paulo, Brazil. Methods: This study is part of the Subclinical Symptoms and Prodromal Psychosis (SSAPP) project, a cohort study in São Paulo, Brazil, designed to follow individuals at UHR. After screening with the Prodromal Questionnaire (PQ) and a clinical interview, the Global Assessment of Functioning (GAF) was administered, a neuropsychological assessment was performed, sociodemographic and migration data were obtained. We then analyzed UHR individuals who had migration data to see if migration had any effect on their cognition and psychopathology. Chi-square tests were used for categorical variables, and Student's t test or analysis of variance (ANOVA) were used for nonparametric and parametric distributions, respectively. Results: The sample was composed of 42 at-risk subjects, of whom 5 had a migration history in the past two generations. Those with migration history showed significantly more formal thought disturbances (p = 0.012) and sleeping problems (p = 0.033) compared to those without. Conclusions: Our data reinforce migration as a risk factor for psychosis in developing countries as well, and highlights the importance of studying the specific effect of this factor in UHR psychopathology.

Análisis descriptivo de los trabajos científicos presentados en la Segunda Conferencia Internacional Chilena de Psicosis 2020 / Descriptive analysis of the posters abstracts submitted to the Chilean International Conference in Psychosis 2020

INTRODUCCIÓN: Dentro de los desafíos de la investigación en Psicosis en Chile y el mundo se encuentra el desarrollo de polos académicos de investigación en estados mentales de riesgo (EMARS). En este artículo se realiza un análisis descriptivo de los resúmenes de los trabajos científicos presentados en la II conferencia internacional: Desafíos Clínicos y terapéuticos en Psicosis realizada en Octubre del 2020. MÉTODOS: Se realizó una selección y premiación del mejor trabajo de acuerdo a un sistema de puntuación realizado por un comité científico ad-hoc. Luego se sistematizó la información en una tabla resumen para su posterior análisis descriptivo cualitativo. RESULTADOS: Se seleccionaron 12 trabajos. El 75% de los trabajos seleccionados abordan el tema de la detección precoz e intervención temprana en psicosis, en particular en la temática EMARS. Asimismo, el 40% de los trabajos presentados provienen de regiones de la zona centro-sur de nuestro país. El 83% de los trabajos realizan un diseño experimental con reclutamiento de pacientes o discusión de casos clínicos complejos. CONCLUSIÓN: Los trabajos seleccionados dan cuenta del interés por el mejoramiento en el diagnóstico y terapéutica en este ámbito. Se debe potenciar el trabajo de investigación y asistencial en Chile en el ámbito de los EMARS.

INTRODUCTION: Within the challenges of research in Psychosis in Chile and the world is the development of academic research poles in mental states of risk (EMARS). This article makes a descriptive analysis of the summaries of the scientific papers presented at the II international conference: Clinical and therapeutic challenges in Psychosis held in October 2020. METHODS: The best work was selected and awarded according to a scoring system carried out by an ad-hoc scientific committee. The information was then systematized in a summary table for subsequent qualitative descriptive analysis. RESULTS: 12 papers were selected. 75% of the selected works address the issue of early detection and early intervention in psychosis, particularly the EMARS theme. Likewise, 40% of the papers presented come from regions of the south-central zone of our country. 83% of the works carry out an experimental design with recruitment of patients or discussion of complex clinical cases. CONCLUSION: The selected works show the interest in the improvement in diagnosis and therapy in this area. Research and assistance work in Chile should be promoted in the field of EMARS.

Evidence for an interrelated cluster of Hallucinatory experiences in the general population: an incidence study.

BACKGROUND: Although hallucinations have been studied in terms of prevalence and its associations with psychopathology and functional impairment, very little is known about sensory modalities other than auditory (i.e. haptic, visual and olfactory), as well the incidence of hallucinations, factors predicting incidence and subsequent course. METHODS: We examined the incidence, course and risk factors of hallucinatory experiences across different modalities in two unique prospective general population cohorts in the same country using similar methodology and with three interview waves, one over the period 1996-1999 (NEMESIS) and one over the period 2007-2015 (NEMESIS-2). RESULTS: In NEMESIS-2, the yearly incidence of self-reported visual hallucinations was highest (0.33%), followed by haptic hallucinations (0.31%), auditory hallucinations (0.26%) and olfactory hallucinations (0.23%). Rates in NEMESIS-1 were similar (respectively: 0.35%, 0.26%, 0.23%, 0.22%). The incidence of clinician-confirmed hallucinations was approximately 60% of the self-reported rate. The persistence rate of incident hallucinations was around 20-30%, increasing to 40-50% for prevalent hallucinations. Incident hallucinations in one modality were very strongly associated with occurrence in another modality (median OR = 59) and all modalities were strongly associated with delusional ideation (median OR = 21). Modalities were approximately equally strongly associated with the presence of any mental disorder (median OR = 4), functioning, indicators of help-seeking and established environmental risk factors for psychotic disorder. CONCLUSIONS: Hallucinations across different modalities are a clinically relevant feature of non-psychotic disorders and need to be studied in relation to each other and in relation to delusional ideation, as all appear to have a common underlying mechanism.

Adherence to medication, physical activity and diet among older people living with diabetes mellitus: Correlation between cognitive function and health literacy.

BACKGROUND: Diabetes mellitus (DM) is a public health problem, which requires enhanced self-care in order to avoid complications. However, cognitive impairment can reduce these abilities and may affect health literacy (HL) of patients in terms to understand and apply information. Therefore, this study evaluated the correlation between cognitive condition and HL related to medication adherence, physical activity and nutritional status among people living with DM. METHODS: A cross-sectional study was carried out among elderly people (≥ 60 years old) with DM. The cognitive condition was evaluated using the Mini-Mental State Examination (MMSE) and the HL using the following questionnaires: Literacy Assessment for Diabetes (LAD-60), Nutritional Literacy among People with Diabetes (NLD), Health Literacy on the Practice of Physical Activities among Diabetics (HLPPA - D), and Health Literacy regarding Drug Adherence among Diabetics (HLDA-D). Sociodemographic and biochemical profile was also evaluated. Spearman correlation was used (p < 0.05). RESULTS: 187 individuals with DM were included. Regarding laboratory analyses, insulin dosage had a mean value of 12.3 microUI/mL (SD: ±15.7), mean blood glucose was 148.1 mg/dl (SD: ±59.7) and mean HbA1c was 7.54 % (SD: ±1.8). In the correlation analysis, higher age and lower income were weakly correlated with lower cognitive level. No correlation was identified for biochemical variables and cognitive condition. A positive and weak correlation between cognition and HL was observed in the studied population. CONCLUSIONS: In older people living with DM the cognitive condition is correlated to specific topics of HL (nutritional status, physical activity and medication adherence).

Montreal Cognitive Assessment as Screening Measure for Mild and Major Neurocognitive Disorder in a Chilean Population.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is a sensitive screening instrument for mild neurocognitive disorder (mild NCD). However, cut-off scores and accuracy indices should be established using representative samples of the population. In this context, the aim of this study was to update the normative values, and diagnostic efficiency statistics of the MoCA to detect mild NCD in the Chilean population. METHODS: This study included 226 participants from the north, center, and south of the country, classified into 3 groups: healthy elderly (HE; n = 113), mild NCD (n = 65), and major neurocognitive disorder (major NCD; n = 48). RESULTS: The optimal cut-off score to discriminate mild NCD from HE participants was 20 points with a sensitivity of 82.8% and a specificity of 84.1%. The observed balance between sensitivity and specificity shows a good test performance either to confirm or discard a diagnosis. The cut-off between mild NCD and major NCD from HE participants was 19 points with 85.6% of sensitivity and 90.3% of specificity. CONCLUSION: Overall diagnostic accuracy can be considered as outstanding (AUC ≥0.904) when discriminating HE from both mild NCD and major NCD. These results showed that the MoCA is a suitable tool to identify mild NCD and major NCD.

Nutritional profile and biochemical alterations in non-institutionalized senior citizens with Alzheimer disease: a case-control study / Perfil nutricional e alterações bioquímicas em idosos com doença de Alzheimer não institucionalizados: um estudo caso-controle

Assess the nutritional and biochemical state of patients with Alzheimer Disease (AD) compared to a control group. This is an observational, case-control and descriptive type study, based on the recruiting of 22 elderly individuals with a clinical diagnosis of AD considered as the case group, and 22 other elderly individuals considered as the control group. Evaluations were made using the results from the following scales Mini Nutritional Assessment (MNA), Mini Mental State Examination (MMSE), anthropometric measurements for obtaining the body mass index (BMI) and biochemical analyses. The analyses were performed on the program SPSS version 20.0, using absolute and relative measures, T test for independent samples for measurement comparisons and the Spearman correlation test. In the cognitive evaluation MMSE, those participants with AD present higher risk of cognitive decline (81.8%), greater risk of malnutrition according to MNA (45.5%) and altered levels of leptin (90.9%). Upon performing the comparison analysis between the group with AD and the control group, there existed noteworthy differences between the means for the variables MNA (4.40; BMI95% 2.75 ­ 6.06), MMSE (10.54; BMI95% 7.09 ­ 13.99) and doses of HDL (High Density Lipoproteins) (14.53; BMI95% 6.18 ­ 22.88). As well as differences in the p-value < 0.09 in the leptin doses (11.54; BMI95% (-24.98 ­ 1.89) and transferrin dose (-72.31; BMI95% -159.48 ­ 14.84). The Spearman correlation demonstrated that the cognitive decline in the group of senior citizens with AD was strongly associated with nutritional conditions MNA (R 0.484) and the leptin dose (R 0.590). Senior citizens with AD present worse nutritional conditions, cognitive decline and biochemical alterations when compared to senior citizens in the control group. As such, the study demonstrated the need for an integrated healthcare assistance concerning senior citizens with AD.

Avaliar o estado nutricional e bioquímico de pacientes com Doença de Alzheimer (DA) comparando com um grupo controle. Materiais e métodos: trata-se de um tipo observacional, caso-controle e descritivo a partir do recrutamento de 22 idosos diagnosticados clinicamente com DA considerados grupo caso e outros 22 idosos considerados controle, foi utilizado a escala Mini Avaliação nutricional (MNA), Mini Exame do Estado Mental (MMSE), medidas antropométricas para obtenção do índice de massa corporal (IMC) e análises bioquímicas. As análises foram realizadas no programa SPSS versão 20.0, utilizou-se de medidas absolutas e relativas, teste T para amostras independentes para comparação de médias e o teste de correlação de Spearman. Na avaliação cognitiva MMSE os participantes com DA apresentaram maior prevalência de declínio cognitivo (81,8%), maior prevalência de risco para desnutrição segundo MNA (45,5%) e níveis alterados de leptina (90,9%). Ao se realizar a análise de comparação o grupo com DA e o controle observou-se diferenças significativas entre as médias das variáveis MNA (4,40; IC95% 2,75 ­ 6,06), MMSE (10,54; IC95% 7,09 ­ 13,99) e dosagens de HDL (14,53; IC95% 6,18 ­ 22,88). E diferenças com o p-valor < 0,09 nas dosagens de leptina (11,54; IC95% (-24,98 ­ 1,89) e dosagem de transferrina (-72,31; IC95% -159,48 ­ 14,84). A correlação de Spearman demonstrou que o declínio cognitivo no grupo de idosos com DA, esteve associado significativamente às condições nutricionais MNA (R 0,484) e dosagem de leptina (R 0,590). Idosos com DA apresentaram piores condições nutricionais, declínio cognitivo e alterações bioquímicas, ao compara-los com idosos controles. Desta forma, o estudo demonstra a necessidade de uma assistência integral a esses idosos.

Cognitive changes in patient living with HIV-AIDS and apolipoprotein-E polymorphism: is there an association?

Patients with HIV-AIDS treated with antiretroviral drugs still have high prevalence of cognitive disorders and many factors are likely to contribute for ongoing neurologic decline such as chronic low-level infection, coinfections with hepatitis B and C and genetic influences, both the virus and the host. Some evidences suggest that the genetic APOE polymorphism may be an associated risk factor. This study aimed to evaluate the association between APOE polymorphisms and cognitive disorders in patients with HIV-AIDS. This was a cross-sectional study comprising 133 patients aged 19-59 years old, with HIV-AIDS and were assisted at the infectious disease outpatient clinics at Hospital Universitário Oswaldo Cruz, in Recife, Brazil. For cognitive evaluation, Mini-Mental State Examination test (MMSE) and Montreal Cognitive Assessment test (MoCA) were used. The determination of APOE gene polymorphism was performed by using the PCR-RFLP technique. Sociodemographic and clinical characteristics were not significantly associated to APOE ε4 polymorphism, except for the high results of CD4 rate (p < 0.015). There was an absence associated between APOE ε4 polymorphism and neurocognitive tests. This study found no association between cognitive alterations and APOE polymorphism in patients with HIV-AIDS in the Northeast of Brazil. The imbalance of APOE allelic frequency distribution, according to Hardy-Weinberg law, there could be an adjustment phase of its equilibrium suffered by the HIV virus, however, the mechanism is still unknown.