Health promotion at home in dementia: an experience of multidisciplinary action with a physical exercise program / Promoção da saúde em domicílio na demência: uma experiência de ação multiprofissional com programa de exercícios físicos

Trata-se de um relato de experiência da "oficina de estimulação cognitiva e reabilitação" para idosos com monitor que ocorreu em formato virtual por meio da plataforma Google Meet, durante a pandemia de COVID19, com o intuito de manter atividades de promoção da saúde e preservação cognitiva com as equipes. equipes multidisciplinares do Serviço de Geriatria/Crasi ­ Hospital Universitário Antônio Pedro - UFF no ano de 2021. A pesquisa visa contribuir para estudos de intervenções futuras do profissional de Educação Física, utilizando diversas ferramentas, incluindo música e efeitos multimídia, no contexto domiciliar cuidar de idosos com capacidade, abrindo novas perspectivas que ajudam a manter a qualidade de vida desses idosos, tornando-os mais ativos fisicamente.

Trata-se de relato de experiência da "oficina de estimulação e reabilitação cognitiva" para smartphones com monitor que ocorreu em formato virtual pela plataforma Google Meet , durante a pandemia da COVID19, intencionando manter as atividades de promoção da saúde e preservação cognitiva com as equipes multidisciplinares do Serviço de Geriatria/Crasi ­ Hospital Universitário Antônio Pedro - UFF no ano de 2021. A pesquisa tem por objetivo contribuir para estudos de intervenções futuras pelo profissional de Educação Física, utilizando ferramentas variadas entre elas a música e os efeitos multimídia, no contexto para idosos com síndrome demencial abrindo novas perspectivas que auxiliam na manutenção da qualidade de vida destes idosos, tornando-os mais ativos fisicamente.

Clinical Utility of a Reaction-Time Attention Task in the Evaluation of Cognitive Impairment in Elderly with High Educational Disparity.

BACKGROUND: The Clinical Dementia Rating (CDR) scale is commonly used to stage cognitive impairment, despite having educational limitations. In elderly with low education, a previous study has shown that intraindividual variability of reaction time (CV) and commission errors (CE), measured using a culture-free Go/No-Go task, can reliably distinguish early Alzheimer's disease (AD) from mild cognitive impairment (MCI) and healthy controls. OBJECTIVE: We aimed to extend the clinical utility of this culture-free Go/No-Go task in a sample with high educational disparity. METHODS: One hundred and ten participants with a wide range of years of formal education (0-14 years) were randomly selected from a geriatric unit and divided based on their CDR scores into cognitively unimpaired (CDR = 0), MCI (CDR = 0.5), and early AD (CDR = 1). All underwent a 90-s reaction-time test that measured the variables previously found to predict CDR in low educated elderly. Here we added years of formal education (educational level) to the model. Multivariate analyses compared differences in group means using educational level as confounding factor. A confirmatory discriminant analyses was performed, to assess if CDR scores could be predicted by the two Go/No-Go variables in a sample with high educational disparity. RESULTS: Over all three groups, differences in both CE and CV reached statistical significance (p < 0.05). The discriminant analysis demonstrated that CV and CE discriminated cognitively impaired from cognitively normal elderly. These results remained similar when discriminating MCI from cognitively unimpaired elderly. CONCLUSION: The Go/No-Go task reliably discriminates elderly with MCI from elderly without cognitive impairment independent of educational disparity.

Detection of Cognitive Dysfunction in Elderly with a Low Educational Level Using a Reaction-Time Attention Task.

BACKGROUND: Scales for cognitive deterioration usually depend on education level. OBJECTIVE: We aimed to study the clinical utility of a culture-free Go/No-Go task in a multi-ethnic cohort with low education level. METHODS: Sixty-four participants with less than 4 years of formal education were included and divided on the basis of their Clinical-Dementia-Rate scores (CDR) into cognitively unimpaired (CDR = 0), mild cognitive impairment (MCI; CDR = 0.5), and early Alzheimer's disease (AD, CDR = 1). All underwent a 90-s Continuous Visual Attention Test. This test consisted of a 90-s Go/No-go task with 72 (80%) targets and 18 (20%) non-targets. For each participant, reaction times and intraindividual variability of reaction times of all correct target responses, as well as the number of omission and commission errors were evaluated. Coefficient of variability was calculated for each participant by dividing the standard deviation of the reaction times by the mean reaction time. A MANCOVA was performed to examine between-group differences using age and sex as covariates. Discriminate analysis was performed to find the most reliable test-variable to discriminate the three groups. RESULTS: Commission error, intraindividual variability of reaction time, and coefficient of variability progressively worsened with increasing CDR level. Discriminant analysis demonstrated that coefficient of variability was the best discriminant factor, followed by intraindividual variability of reaction time and commission error. CONCLUSION: The Go/No-Go task was able to discriminate people with MCI or early AD from controls in the setting of illiteracy.

A dynamic decision model for diagnosis of dementia, Alzheimer's disease and Mild Cognitive Impairment.

CDSS (Clinical Decision Support System) is a domain within digital health that aims at supporting clinicians by suggesting the most probable diagnosis based on knowledge obtained from patient data. Usually, decision models used by current CDSS are static, i.e., they are not updated when new data are included, which could allow them to acquire new knowledge and enhance system accuracy. This paper proposes a dynamic decision model that automatically updates itself from classifier models using supervised machine learning algorithms. Our supervised learning process ranks several decision models using classifier performance measures, considering available patient data, filled by the health center, or local clinical guidelines. The decision model with the best performance is then selected to be used in our CDSS, which is designed for the diagnosis of D (Dementia), AD (Alzheimer's Disease), and MCI (Mild Cognitive Impairment). Patient datasets from CAD (Center for Alzheimer's Disease), at the Institute of Psychiatry of UFRJ (Federal University of Rio de Janeiro), and CRASI (Center of Reference in Attention to Health of the Elderly), at Antonio Pedro Hospital of UFF (Fluminense Federal University), are used. The main conclusion is that the proposed dynamic decision model, which offers the ability to be continuously refined with more recent diagnostic criteria or even personalized according to the local domain or clinical guidelines, provides an efficient alternative for diagnosis of Dementia, AD, and MCI.

Telecuidado no acompanhamento pós-alta de idosos com demência e seus cuidadores: quase-experimental / Tele-care in post-discharge follow-up of elderly people with dementia and their caregivers: quasi-experimental study / Teleasistencia en el seguimiento posterior al alta de personas mayores con demencia y sus cuidadores: casi-experimental

OBJETIVO: Analisar o efeito do telecuidado na redução na sobrecarga no cuidador e na manutenção da capacidade funcional e comportamental do idoso no pós-alta hospitalar. MÉTODO: Pesquisa quantitativa, quase-experimental, com delineamento anterior-posterior, envolvendo como intervenção o Telecuidado. RESULTADO: As avaliações pós teste demonstraram que a intervenção foi efetiva para diminuir a sobrecarga do cuidador Zarit (p-valor < 0,001); no Inventário Neuropsiquiátrico (NPI) houve mudança no item Desgaste (p-valor=0,002) demonstrando a melhora do enfrentamento dos cuidadores mediante as alterações comportamentais; no entanto os testes Prisma 7 (p-valor=0,002) houve diferença no entanto devido a mudança no fator idade dos idosos; e no KATZ 70% dos pacientes não houve alteração, para 25% o escore reduziu e para 5% o escore aumentou. Em análise global, a alteração no KATZ não foi significativa sob o ponto de vista estatístico (p-valor=0,102). CONCLUSÃO: Contudo os dados desse estudo demonstraram que o Telecuidado diminuiu a sobrecarga e o desgaste dos cuidadores, e a manutenção da capacidade para atividades de vida diária dos idosos.

OBJETIVO: analizar el efecto de la teleasistencia en la reducción de la carga sobre el cuidador y en el mantenimiento de la capacidad funcional y conductual de los ancianos después del alta hospitalaria. MÉTODO: investigación cuantitativa, casi-experimental, con diseño anteroposterior, que involucra la teleasistencia como intervención. RESULTADO: las evaluaciones posteriores a la prueba mostraron que la intervención fue efectiva para reducir la carga sobre el cuidador Zarit (p-valor <0.001); En el Inventario Neuropsiquiátrico (NPI) hubo un cambio en el desgaste del ítem (valor p = 0.002) demostrando la mejora en el manejo de los cuidadores a través de cambios de comportamiento; sin embargo, las pruebas de Prisma 7 (p-valor = 0.002) mostraron una diferencia, sin embargo, debido al cambio en el factor de edad de los ancianos; y en KATZ el 70% de los pacientes no cambiaron, en un 25% la puntuación disminuyó y en un 5% la puntuación aumentó. En el análisis global, el cambio en KATZ no fue estadísticamente significativo (p-valor = 0,102). CONCLUSIÓN: Sin embargo, los datos de este estudio demostraron que Teleasistencia redujo la carga y el cansancio de los cuidadores, y el mantenimiento de la capacidad para las actividades de la vida diaria de los ancianos.

OBJECTIVE: To analyze the effect of tele-care in reducing the burden of caregivers and in maintaining the functional and behavioral capacity of the elderly after hospital discharge. METHOD: Quantitative, quasi-experimental research, with anterior-posterior design, involving Telecare as an intervention. RESULT: Post-test evaluations demonstrated that the intervention was effective in reducing the burden of caregivers Zarit (p-value <0.001); in the Neuropsychiatric Inventory (NPI) there was a change in the item Distress (p-value = 0.002) demonstrating the improvement in the coping of caregivers through behavioral changes; however, the Prisma 7 tests (p-value = 0.002) showed a difference, however, due to the change in the age factor of the elderly; and in KATZ 70% of the patients did not change, for 25% the score decreased and for 5% the score increased. In global analysis, the change in KATZ was not statistically significant (p-value = 0.102). CONCLUSION: However, the data from this study demonstrated that the Tele-care reduced the burden and distress of caregivers, and maintaining the capacity to perform the activities of daily living of the elderly.

Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients / Diferenças na cognição e na qualidade de vida entre os pacientes idosos e os muito idosos em hemodiálise

Abstract Introduction: In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. Methods: Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). Results: Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). Conclusion: Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.

Resumo Introdução: Nas últimas décadas, houve um aumento expressivo no número de pacientes idosos com doença renal crônica iniciando hemodiálise. Assim, nosso objetivo foi avaliar o perfil de idosos em hemodiálise crônica e comparar a cognição e a qualidade de vida dos idosos com as de muito idosos. Métodos: Pacientes em hemodiálise havia pelo menos 3 meses, que tinham 65 anos ou mais quando começaram o tratamento dialítico foram convidados a participar, e estratificados de acordo com a idade (menores ou maiores de 80 anos). Os participantes responderam a um questionário clinico-epidemiológico e foram submetidos a testes cognitivos (miniexame do estado mental [MEEM], teste do relógio [TDR] e teste de fluência verbal [TFV]) e a uma avaliação de qualidade de vida 36-Item Short Form Health Survey). Resultados: Dos 125 pacientes elegíveis, 124 concordaram em participar. A idade média foi de 76 ± 6 anos (28% ≥ 80 anos), 56% eram homens e 55% tinham ≥ 8 anos de escolaridade. Depressão foi sugerida em 38%. A prevalência de déficit cognitivo foi 38%, 70% e 30%, pelo MEEM, TDR e TFV, respectivamente. A prevalência de qualquer déficit foi maior entre os muito idosos (94% vs. 72%, p = 0,007). Os escores de qualidade de vida foram semelhantes entre os dois grupos etários, exceto pelo domínio da capacidade funcional, pior no grupo com ≥ 80 anos (p = 0.033). Conclusão: Os pacientes idosos em hemodiálise crônica apresentam elevada prevalência de déficit cognitivo, especialmente os muito idosos, mas esse grupo não possui pior qualidade de vida, exceto pelo aspecto da capacidade funcional.

Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients.

INTRODUCTION: In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. METHODS: Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). RESULTS: Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). CONCLUSION: Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.

Neuropsychiatric assessments in patients with multiple sclerosis in early phases and with low disability.

BACKGROUND: In the early phases of multiple sclerosis (MS), patients exhibit slight neuropsychiatric deficits that can only be detected using reliable tools. AIM: The present investigation aimed to examine neuropsychological performance in 35 patients with incipient MS. PATIENTS AND METHODS: For the MS group, the inclusion criteria included time of disease <3 years and low disability. The neuropsychological battery consisted of Rey Auditory Learning Test, Controlled Oral Word Association Test, Hooper Visual Organization Test, and Symbol Digit Modalities Test (SDMT). RESULTS: After correction for the educational level, no significant effect of MS on performance was found for all the tests except for the number of errors of the SDMT (NE-SDMT). Higher levels of education were associated with better performances in all tests, except for the NE-SDMT. MS patients made more errors than the controls. CONCLUSION: The effect on the NE-SDMT may reflect difficulties in the ability to inhibit inadequate responses. Patients may exhibit impulsive control disorders in incipient MS, independent of their educational level.

Value of combining activated brain FDG-PET and cardiac MIBG for the differential diagnosis of dementia: differentiation of dementia with Lewy bodies and Alzheimer disease when the diagnoses based on clinical and neuroimaging criteria are difficult.

Dementia with Lewy bodies (DLB) is the second most common cause of dementia. The diagnosis of DLB is particularly important because these patients show good response to cholinesterase inhibitors. Clinical and neuroimaging criteria for DLB have not been acceptable for predictive accuracy. We report a case of progressive dementia in which the differentiation of DLB and Alzheimer disease (AD) on the basis of clinical criteria alone was not possible. The patient was admitted to the hospital because he became worse after he had started treatment for severe AD. Both MRI and brain magnetic resonance spectroscopy were normal. The patient underwent myocardial scintigraphy with I-123 MIBG showing marked reduction in cardiac MIBG accumulation. The heart to mediastinum ratio of MIBG uptake was impaired in both early and delayed images. FDG-PET scan before and after activation with a visual attention task showed occipital cortex hypometabolism as compared with AD and a normal control. This case illustrates the value of combining activated brain FDG PET and cardiac MIBG. The association of these 2 techniques could be used as a potential diagnostic tool in a patient with dementia misdiagnosed as AD.