A benchmark study on current GWAS models in admixed populations.

OBJECTIVE: The performances of popular genome-wide association study (GWAS) models have not been examined yet in a consistent manner under the scenario of genetic admixture, which introduces several challenging aspects: heterogeneity of minor allele frequency (MAF), wide spectrum of case-control ratio, varying effect sizes, etc. METHODS: We generated a cohort of synthetic individuals (N = 19 234) that simulates (i) a large sample size; (ii) two-way admixture (Native American and European ancestry) and (iii) a binary phenotype. We then benchmarked three popular GWAS tools [generalized linear mixed model associated test (GMMAT), scalable and accurate implementation of generalized mixed model (SAIGE) and Tractor] by computing inflation factors and power calculations under different MAFs, case-control ratios, sample sizes and varying ancestry proportions. We also employed a cohort of Peruvians (N = 249) to further examine the performances of the testing models on (i) real genetic and phenotype data and (ii) small sample sizes. RESULTS: In the synthetic cohort, SAIGE performed better than GMMAT and Tractor in terms of type-I error rate, especially under severe unbalanced case-control ratio. On the contrary, power analysis identified Tractor as the best method to pinpoint ancestry-specific causal variants but showed decreased power when the effect size displayed limited heterogeneity between ancestries. In the Peruvian cohort, only Tractor identified two suggestive loci (P-value $\le 1\ast{10}^{-5}$) associated with Native American ancestry. DISCUSSION: The current study illustrates best practice and limitations for available GWAS tools under the scenario of genetic admixture. Incorporating local ancestry in GWAS analyses boosts power, although careful consideration of complex scenarios (small sample sizes, imbalance case-control ratio, MAF heterogeneity) is needed.

GAD-7 Generalised Anxiety Disorder scale in Colombian medical professionals during the COVID-19 pandemic: Construct validity and reliability.

INTRODUCTION: The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown. METHODS: E-health study, in which cross-sectional data were collected online (n = 1030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role. RESULTS: A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p < 0.001) showed an "acceptable" unidimensionality and adequate factor loadings in each item of the GAD-7, >0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71). CONCLUSIONS: The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

[Psychological Impact of COVID-19 on Health Workers During the Second Year of the Pandemic in Latin America: Cross-Sectional Survey Study]. / Impacto psicológico del COVID-19 en los trabajadores sanitarios durante el segundo año de pandemia en Latinoamérica: estudio de encuesta transversal.

Introduction: The coronavirus pandemic continues to affect the mental health of healthcare personnel in Latin America (LA). Objective: To estimate the prevalence of psychological disturbances and associated risk factors for mental health in healthcare personnel in LA during the second year of the COVID-19 pandemic. Method: This multicenter cross-sectional study included a total sample of 5437 healthcare professionals from Argentina, Bolivia, Chile, Colombia, Ecuador, and Peru. The PHQ-9, GAD-7, and a brief demographic questionnaire were used. The prevalence of anxiety and depression was estimated based on the cut-off points of the instruments. Two multivariate logistic regressions were performed. Results: A population burden of anxiety (40.1%) and depression (62.2%) was found in healthcare personnel in LA. Among professionals in Argentina (OR = 1.374; P<.001), those working in state hospitals (OR = 1.536; P<.003), frontline healthcare workers for COVID patients (OR = 1.848; P<.001), general practitioners (OR = 1.335; P<.001), and specialists (OR = 1.298; P<.001), a higher risk of experiencing mental disorders was observed. Among women, younger personnel, and administrative staff, a higher probability of experiencing anxiety and depression was identified. Conclusions: The burden of mental disorders on healthcare personnel in Latin America is alarming. Psychological support services are necessary, aimed at providing measures for professionals to develop healthy coping mechanisms that mitigate the impact of the pandemic on their well-being and facilitate post-crisis adjustment.

A benchmark study on current GWAS models in admixed populations.

Objective: The performances of popular Genome-wide association study (GWAS) models haven't been examined yet in a consistent manner under the scenario of genetic admixture, which introduces several challenging aspects such as heterogeneity of minor allele frequency (MAF), a wide spectrum of case-control ratio, and varying effect sizes etc. Methods: We generated a cohort of synthetic individuals (N=19,234) that simulates 1) a large sample size; 2) two-way admixture [Native American-European ancestry] and 3) a binary phenotype. We then examined the inflation factors produced by three popular GWAS tools: GMMAT, SAIGE, and Tractor. We also computed power calculations under different MAFs, case-control ratios, and varying ancestry percentages. Then, we employed a cohort of Peruvians (N=249) to further examine the performances of the testing models on 1) real genetic data and 2) small sample sizes. Finally, we validated these findings using an independent Peruvian cohort (N=109) included in 1000 Genome project (1000G). Results: In the synthetic cohort, SAIGE performed better than GMMAT and Tractor in terms of type-I error rate, especially under severe unbalanced case-control ratio. On the contrary, power analysis identified Tractor as the best method to pinpoint ancestry-specific causal variants, but showed decreased power when no adequate heterogeneity of the true effect sizes was simulated between ancestries. The real Peruvian data showed that Tractor is severely affected by small sample sizes, and produced severely inflated statistics, which we replicated in the 1000G Peruvian cohort. Discussion: The current study illustrates the limitations of available GWAS tools under different scenarios of genetic admixture. We urge caution when interpreting results under complex population scenarios.

Factors associated with cognitive impairment in Latin American older adults: A cross-sectional observational study of COVID-19 confinement.

INTRODUCTION: The effects of COVID-19 confinement have been severe, especially in older adults. Therefore, we analyzed the factors associated with cognitive impairment (CI) in Latin America (LA). METHODS: We conducted a cross-sectional observational study with a total of 5245 older adults from 10 countries in LA. Measurement: We used the Telephone Montreal Cognitive Assessment (T-MoCA) and the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) scale. RESULTS: We found that age, depressive symptomatology, bone fractures, being widowed, having a family member with dementia, and unemployment were associated with an increased risk of CI. In contrast, higher education, hypertension with continuous treatment, quarantine, and keeping stimulating cognitive and physical activities were associated with a lower probability of CI. No significant association was found between suffering from diabetes or being retired and CI. DISCUSSION: It is essential to conduct follow-up studies on these factors, considering their relationship with CI and the duration of confinement.

[Prevalence and factors associated with subjective cognitive complaints in Latin American health workers during the COVID-19 pandemic]. / Prevalencia y factores asociados con las quejas cognitivas subjetivas del personal sanitario latinoamericano durante la pandemia de COVID-19.

Background and objectives: An increase in emotional disturbances and complaints about cognitive performance has been observed in Latin American healthcare workers during the SARS-CoV-2 pandemic, which can affect attention capacity and increase the levels of stress and burnout of these professionals. The objective was to analyse subjective cognitive complaints (SCC) and associated factors in health personnel during the COVID-19 pandemic in five Latin American countries.Methods: Multicentre cross-sectional study, which included 3,738 professionals from Colombia, Chile, Argentina, Ecuador, Bolivia, and Peru. The Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9) was used to assess depression, and the Mini-Z to assess Burnout. For the SCC, an item on cognitive concerns in attention and memory was used.Results: The prevalence of cognitive complaints was 69.2%. The factors associated with a higher risk of SCC were the scores in the GAD-7, PHQ and Mini-Z, in addition to being part of the Ecuadorian health personnel.Conclusions: There is a high prevalence of SCC in health personnel, which is modulated by emotional states and stress.

The cumulative effect of fibromyalgia symptoms on cognitive performance: The mediating role of pain.

Fibromyalgia (FMS) is a chronic condition that encompasses widespread pain associated with cognitive impairment and significant emotional distress related to functional disability. This study aimed to obtain evidence of the role of pain in the effect of time since FMS diagnosis and cognitive performance using a novel online protocol of neuropsychological evaluation since the COVID-19 pandemic has challenged traditional neuropsychology testing leading to the need for novel procedures transitioning to tele-neuropsychology. A sample of 70 adult women was evaluated (50 with FMS and 19 controls) using online questionnaires that evaluated pain and executive functioning (impulsivity, inhibition control, monitoring, and planning). Afterward, participants were evaluated by trained neuropsychologists in a 30 min online session using virtually adapted cognitive tests: the Hopkins Verbal Learning Test (memory), the Symbol-Digit Modalities Test (attention and speed processing), the F-A-S test (verbal fluency), and Digit Span tests (working memory). We found that the time of FMS diagnosis has an effect on cognitive functioning predominantly mediated by pain. Our results point out the role of pain as a mediator on cognitive performance, specifically in executive functions which are directly affected by the cumulative effect of the time of diagnosis. Furthermore, the importance of considering a broader perspective for assessment and treatment including novel procedures via tele-neuropsychology.

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults / Utilidade clínica do phototest via teleneuropsicologia em idosos rurais chilenos

ABSTRACT. The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

RESUMO. A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Validez del cuestionario PHQ-2 para la detección de depresión en personal sanitario colombiano durante Covid-19 / Validity of the PHQ-2 questionnaire for the detection of depression in Colombian health personnel during Covid-19

RESUMEN: Introducción: La sintomatologia depresiva en profesionales de la salud asociado a crisis virales es de alta prevalencia a nivel global, siendo su detección una prioridad por lo cual, el objetivo de esta investigación fue analizar la validez convergente y consistencia interna del cuestionario de salud del paciente-2 (PHQ-2) en profesionales sanitarios. Método: Estudio eSalud donde se recopilaron datos transversales en línea (n=725), de 281 médicos generales, 237 médicos especialistas y 207 enfermeras durante la cuarentena colombiana, entre el 20 de abril y el 10 de agosto de 2020. Edad promedio 41,3 años (± 8,76). El 38,4% eran hombres (278) y el 61.6% mujeres (447). El 66.1% del personal sanitario atendió pacientes contagiados por coronavirus y el 33,9% no prestó estos servicios. Se administró la versión de 9 ítems del PHQ, validada en población colombiana junto a la versión de 2 ítems del PHQ. Resultados: Se encontró una alta correlación entre las escalas (r=.860, P<0.001), demostrando la validez convergente del PHQ-2 para medir la sintomatología depresiva. La consistencia interna del PHQ-2 fue adecuada, con un Alpha de Cronbach de 0.80 (I.C.= 0.76 - 0.83). Conclusiones: El PHQ-2 presenta adecuados estándares psicométricos de confiabilidad y validez, por lo que su rápida administración, fácil calificación e interpretación, lo convierte en un instrumento confiable y valido para la detección rápida, sin sobrecargas laborales, de los síntomas depresivos en médicos y enfermeras que atiendan o no pacientes en condiciones de brotes virales.

ABSTRACT Background: Depressive symptomatology in health professionals associated with viral crises is highly prevalent globally, being its detection a priority. Therefore, the objective of this research was to analyze the convergent validity and internal consistency of the Patient Health Questionnaire (PHQ-2) in healthcare professionals. Method: E-Health study where cross-sectional data was collected online (n = 725), from 281 general practitioners, 237 specialist doctors and 207 nurses during the Colombian quarantine, between April 20 and August 10, 2020. Average age 41.3 years (± 8.76). 38.4% were men (278) and 61.6% women (447). 66.1% of health personnel treated patients infected with coronavirus and 33.9% did not provide these services. The 9-item version of the PHQ was administered, validated in the Colombian population together with the 2-item version of the PHQ. Results: A high correlation was found between the scales (r = .860, P <0.001), demonstrating the convergent validity of the PHQ-2 to measure depressive symptomatology. The internal consistency of the PHQ-2 was adequate, with a Cronbach's Alpha of 0.80 (I.C. = 0.76 - 0.83). Conclusions: The PHQ-2 has adequate psychometric standards of reliability and validity, so its rapid administration, easy qualification and interpretation, makes it a reliable and valid instrument for the rapid detection, without work overload, of depressive symptoms in doctors and nurses whether or not they care for patients with viral outbreaks.

Impact of quarantine due to COVID-19 pandemic on health and lifestyle conditions in older adults from Centro American countries.

BACKGROUND: The impact of quarantine in older adults have been reported in several studies with contradictory results, reporting from negative effects to no significant outcomes or even beneficial consequences. Heterogeneity in aging plays a role in each region, the aim of this study is to analyze the impact of quarantine on health conditions (physical and mental) and lifestyle in older adults in five Centro American countries during COVID-19 pandemic. METHOD: In this cross-sectional study, n = 712 older adults 60 years and older from Mexico, Guatemala, El Salvador, Honduras and Costa Rica were assessed by telephone. Sociodemographic data, physical and mental health, lifestyle and quarantine conditions were asked previous informed consent. RESULTS: In general, mean of days in quarantine at the moment of the study was 142 days (approximately four months and three weeks). In the analysis of the impact of the days in quarantine effects were found on the frequency of falls, functional ability in Activities of Daily Living (ADL), general cognitive function, memory, orientation, language, frequency of drinking alcohol, having a balanced diet, and being active cognitively. Some differences were found between countries. CONCLUSIONS: Effects of quarantine on older adults in Centro America, requires attention of governments and healthcare to prevent long term morbidity and disability, and to promote healthy aging.

Propiedades psicométricas de la escala de salud mental positiva en Arequipa (Perú) / Psychometric properties of the positive mental health scale in Arequipa (Peru)

La salud mental positiva es un constructo complejo que está re-lacionado con el funcionamiento óptimo de la persona. Comprende un conjunto de cualidades orientadas al desarrollo del potencial del individuo. La Escala de Salud Mental Positiva es uno de los instrumentos más utiliza-dos paraevaluarlo, sin embargo, los antecedentes señalan inconsistencias respecto a su estructura interna. El objetivo del presente estudio fue anali-zar las propiedades psicométricas de la Escala de Salud Mental Positiva en Arequipa-Perú. Participaron 3933 personas, 50.3% fueron mujeres y 49.7% fueron varones, incluyendo desde adolescentes hasta adultos mayores. La evaluación mediante AFC de la estructura original evidenció índices de ajuste pobres, por lo que se tuvo que evaluar la dimensionalidad y proponer unanueva estructura. Para lo cual, se dividió a la muestra (n1= 1966 y n2= 1967). En la primera, se aplicó un AFE y en la segunda se valida mediante un AFC. Se hallaron tres factores y se concluye que tiene un buen ajuste (χ2(431) = 2473.378; CFI= .959; TLI= .956, RMSEA= .049; SRMR= .051). La consistencia interna mostró valores mayores a .81. Finalmente, se evaluó la equivalencia de la medición según el sexo, hallando que el instru-mento presenta invarianza de la medición.(AU)

Positive mental health is a complex construct that is related to the optimal functioning of the person. It comprises a set of qualities aimed at the development of the individual's potential. The Positive Mental Health Scale is one of the most used instruments to evaluate it, however, the antecedents indicate inconsistencies regarding its internal structure. The objective of this study was to analyze the psychometric properties of the Positive Mental Health Scale in Arequipa-Peru. 3,933 people partici-pated, 50.3% were women and 49.7% were men, including from adoles-cents to the elderly. The evaluation by CFA ofthe original structure showed poor fit indices, so the dimensionality had to be evaluated and a new structure had to be proposed. For which the sample is divided (n1= 1,966 and n2= 1,967). In the first, an EFA was applied and in the second, it is validated by means of a CFA. Three factors were found and it is con-cluded that it has a good fit (χ2(431) = 2,473.378; CFI= .959; TLI= .956, RMSEA= .049; SRMR= .051). The internal consistency showed values greater than .81. Finally, the equivalence of the measurement according to sex was evaluated, finding that the instrument presents measurement invariance.(AU)

Clinical utility of Phototest via teleneuropsychology in Chilean rural older adults.

The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.

A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.

Prevalence of Dementia and Associated Factors among Older Adults in Latin America during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has had a great impact on cognitive health in Latin American older adults, increasing the risk of cognitive impairment and dementia. Our objective was to analyze the prevalence of dementia and the associated factors in Latin American older adults during SARS-CoV-2 pandemic. METHODS: A multicentric first phase cross-sectional observational study was conducted during the SARS-CoV-2 pandemic. Five thousand two hundred and forty-five Latin American adults over 60 years of age were studied in 10 countries: Argentina, Bolivia, Chile, Colombia, Ecuador, Guatemala, Mexico, Peru, the Dominican Republic, and Venezuela. We used the telephone version of Montreal Cognitive Assessment, the "Alzheimer Disease 8" scale for functional and cognitive changes, and the abbreviated version of the Yesavage depression scale. We also asked for sociodemographic and lockdown data. All the evaluation was made by telephone. Cross-tabulations and χ2 tests were used to determine the variability of the prevalence of impairment by sociodemographic characteristics and binary logistic regression to assess the association between dementia and sociodemographic factors. RESULTS: We observed that the prevalence of dementia in Latin America is 15.6%, varying depending on the country (Argentine = 7.83 and Bolivia = 28.5%). The variables most associated with dementia were race and age. It does not seem to be associated with the pandemic but with social and socio-health factors. CONCLUSION: The prevalence of dementia shows a significant increase in Latin America, attributable to a constellation of ethnic, demographic, and socioeconomic factors.

Literacy Level and Executive Control in Healthy Older Peruvian Adults.

Introduction: Early-life educational experiences are associated with cognitive performance in aging. Early literacy seems to improve executive control mechanisms, however, it is not clear whether early education would still be an advantage in countries like Peru, where access to and quality of education is highly variable. Aim: Our objective was to analyze the association of literacy level with executive control factors. Method: We evaluated 93 healthy older adults with a clinical protocol that included the Mini-Mental State Examination, the Geriatric Depression Scale and Global Dementia Staging. We also used a neuropsychological executive function battery which included the Trail-Making Test parts A and B, the Stroop Test, phonological and semantic verbal fluency tasks, Forward and Backward Digits, Numbers and Letters of the Wechsler Scale, and the Go/No-Go task. We used a principal component analysis for the dimensional reduction of the variables. To measure the level of literacy we used the word accentuation test (WAT). Results: We observed statistically significant correlations between the principal components (PCs) of working memory, cognitive flexibility and inhibitory control with the WAT scores. Furthermore, we observed that processing speed and WAT predict the scores on PCs factors better than years of education and age. Conclusions: Literacy level correlates more closely with better cognitive performance than years of education and thus, might improve executive control factors that could compensate and protect against brain changes in cognitive decline and dementia.

Neuropsychological profile in the preclinical stages of dementia: principal component analysis approach.

The preclinical stages of dementia include subtle neurocognitive changes that are not easily detected in standard clinical evaluations. Neuropsychological evaluation is important for the classification and prediction of deterioration in all the phases of dementia. OBJECTIVE: Compare the neuropsychological performance in healthy older adults with subjective cognitive decline (SCD) and with mild cognitive impairment (MCI) using principal components analysis. METHODS: We evaluated 94 older adults with a clinical protocol which included general measures of mental, emotional and functional state. The neuropsychological protocol included tasks of memory, executive function, attention, verbal fluency and visuoconstructional abilities. We used principal component analysis (PCA) to reduce variables´ dimensionality on neuropsychological evaluation. RESULTS: 33(35%) participants had a normal cognitive function, 35(37%) had subjective cognitive decline and 26(28%) had a mild cognitive impairment. The PCA showed seven factors: processing speed, memory, visuoconstruction, verbal fluency and executive components of cognitive flexibility, inhibitory control and working memory. ANOVA had shown significant differences between the groups in the memory (F=4.383, p=0.016, η2p=0.087) and visuoconstructional components (F=5.395, p=0.006, η2p=0.105). Post hoc analysis revealed lower memory scores in MCI than SCD participants and in visuospatial abilities between MCI and SCD and MCI and Normal participants. CONCLUSIONS: We observed differentiated cognitive profiles among the participants in memory and visuoconstruction components. The use of PCA in the neuropsychological evaluation could help to make a differentiation of cognitive abilities in preclinical stages of dementia.

Os estágios pré-clínicos da demência incluem mudanças neurocognitivas sutis que não são facilmente detectadas nas avaliações clínicas padrão. A avaliação neuropsicológica é importante para a classificação e predição da deterioração em todas as fases da demência. OBJETIVO: Comparar o desempenho neuropsicológico em idosos saudáveis com declínio cognitivo subjetivo (DCS) e com comprometimento cognitivo leve (CCL) por meio da análise de componentes principais. MÉTODOS: Avaliaram-se 94 idosos com um protocolo clínico que incluía medidas gerais do estado mental, emocional e funcional. O protocolo neuropsicológico incluiu tarefas de memória, função executiva, atenção, fluência verbal e habilidades visuoconstrutivas. Utilizou-se a análise de componentes principais (PCA, na sigla em inglês) para reduzir a dimensionalidade das variáveis na avaliação neuropsicológica. RESULTADOS: Um total de 33 (35%) participantes apresentavam função cognitiva normal, 35 (37%) declínio cognitivo subjetivo e 26 (28%) comprometimento cognitivo leve. A PCA apresentou sete fatores: velocidade de processamento, memória, visuoconstrução, fluência verbal e componentes executivos de flexibilidade cognitiva, controle inibitório e memória de trabalho. ANOVA mostrou diferenças significativas entre os grupos na memória (F=4,383, p=0,016, η2p=0,087) e componentes visuoconstrutivos (F=5,395, p=0,006, η2p=0,105). A análise post hoc revelou escores de memória mais baixos no CCL do que os participantes com DCS e nas habilidades visuoespaciais entre CCL e DCS e CCL e participantes normais. CONCLUSÕES: Observaram-se perfis cognitivos diferenciados entre os participantes nos componentes de memória e visuoconstrução. O uso da PCA na avaliação neuropsicológica poderia auxiliar na diferenciação das habilidades cognitivas em estágios pré-clínicos da demência.

Diferencias en tareas de función ejecutiva entre adolescentes y adultos mayores bilingües y monolingües / Differences in Executive Function between Bilingual and Monolingual Teenagers and Older Adults

Resumen Nos propusimos comparar el rendimiento en tareas de función ejecutiva entre adolescentes y adultos mayores bilingües y monolingües. Utilizamos un diseño comparativo transversal. Evaluamos a 48 personas monolingües (24 adolescentes y 24 adultos mayores) y 56 bilingües (31 adolescentes y 25 adultos mayores) con una amplia batería neuropsicológica que comprendían tareas de flexibilidad cognitiva (Wisconsin Card Sorting Test), control inhibitorio (test de Stroop), memoria de trabajo (subescalas de Retención de dígitos, Secuencia de números y letras: test Wechsler de inteligencia) y acceso a la memoria a largo plazo (fluidez semántica y fonológica). Nuestros resultados indican que los adolescentes y adultos mayores monolingües rinden mejor en las pruebas de control ejecutivo que sus pares bilingües, siendo estas diferencias menores en los adultos mayores y no parecen asociarse a la edad y a la frecuencia de uso de L1 (castellano) y L2 (quechua). Estos resultados muestran que durante la adolescencia hay una desventaja a nivel ejecutivo en las personas bilingües, la cual parece disminuir en la adultez. Se discuten los resultados a la luz del peso de los factores socioculturales y a la posibilidad de entender al bilingüismo como un mecanismo ligado a la reserva cognitiva.

Abstract Our purpose was to compare performance in executive function tasks between bilingual and monolingual adolescents and older adults. A cross-sectional design was used. We evaluated 48 monolinguals (24 adolescents and 24 older adults) and 56 bilinguals (31 adolescents and 25 older adults) with a wide neuropsychological battery that included tasks of cognitive flexibility (Wisconsin card sorting test), inhibitory control (Stroop test), working memory (direct and inverse digits) and access to long-term memory (semantic and phonological fluency). Our results indicate that monolingual adolescents and older adults perform better in executive control tests than their bilingual counterparts, and these differences are minor in bilingual older adults, these differences do not seem to be associated with age and the frequency of use of L1 (Spanish) and L2 (Quechua). These results seem to show that during adolescence there is a cognitive disadvantage in executive function, which is reduced when people get older. The results are discussed considering sociocultural factors and the possibility of understanding bilingualism as a mechanism linked to cognitive reserve.

[GAD-7 Generalised Anxiety Disorder scale in Colombian medical professionals during the COVID-19 pandemic: construct validity and reliability]. / Escala de ansiedad generalizada GAD-7 en profesionales médicos colombianos durante pandemia de COVID-19: validez de constructo y confiabilidad.

Introduction: The detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown.Methods: E-health study, in which cross-sectional data were collected online (n=1,030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role.Results: A single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA = 0.080; CFI = 0.995; SRMR = 0.053; p <0.001) showed an "acceptable" unidimensionality and adequate factor loadings in each item of the GAD-7, >0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71).Conclusions: The GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

Cognitive changes in patients with epilepsy identified through the MoCA test during neurology outpatient consultation.

INTRODUCTION: Epilepsy is a chronic neurological disorder that may occur alongside cognitive changes, with effects on multiple cognitive domains. OBJECTIVE: To compare the cognitive performance of patients with epilepsy and healthy controls through Montreal Cognitive Assessment (MoCA) during outpatient consultation at a reference diagnostic center in Colombia and analyze and the influencing factors. MATERIALS AND METHODOLOGY: One-hundred and four patients during neurology outpatient consultation in the city of Cartagena, Colombia, were assessed with the (MoCA) test, i.e., 54 people who consulted for headache and have not been diagnosed with epilepsy (NEP) and 50 with a diagnosis of epilepsy (EPs) according to the diagnostic criteria of the International League Against Epilepsy (ILAE). RESULTS: Significant differences were found in the total mean scores of the (MoCA) between (EPs) and (NPE) groups (t = 4.72; p < 0.01), particularly in attention (t = 3.22; p < 0.02) and memory (t = 5.04; p < 0.01) dimensions. Additionally, a significant association was observed between years of schooling and (MoCA) scores (p = 0,019) but not between socioeconomic level (p = 0,510), age (p = 0,452) and the frequency of seizures (p = 0,471). DISCUSSION: Patients with epilepsy show lower scores in several cognitive domains in respect of the control group. The (MoCA) has proven its appropriateness for cognitive screening in the contexts of clinical neurology outpatient consultation.

The impact of COVID-19 on the well-being and cognition of older adults living in the United States and Latin America.

BACKGROUND: In the COVID-19 pandemic, older adults from vulnerable ethnoracial groups are at high risk of infection, hospitalization, and death. We aimed to explore the pandemic's impact on the well-being and cognition of older adults living in the United States (US), Argentina, Chile, Mexico, and Peru. METHODS: 1,608 (646 White, 852 Latino, 77 Black, 33 Asian; 72% female) individuals from the US and four Latin American countries aged ≥ 55 years completed an online survey regarding well-being and cognition during the pandemic between May and September 2020. Outcome variables (pandemic impact, discrimination, loneliness, purpose of life, subjective cognitive concerns) were compared across four US ethnoracial groups and older adults living in Argentina, Chile, Mexico, and Peru. FINDINGS: Mean age for all participants was 66.7 (SD = 7.7) years and mean education was 15.4 (SD = 2.7) years. Compared to Whites, Latinos living in the US reported greater economic impact (p < .001, ηp 2  = 0.031); while Blacks reported experiencing discrimination more often (p < .001, ηp 2  = 0.050). Blacks and Latinos reported more positive coping (p < .001, ηp 2  = 0.040). Compared to Latinos living in the US, Latinos in Chile, Mexico, and Peru reported greater pandemic impact, Latinos in Mexico and Peru reported more positive coping, Latinos in Argentina, Mexico, and Peru had greater economic impact, and Latinos in Argentina, Chile, and Peru reported less discrimination. INTERPRETATION: The COVID-19 pandemic has differentially impacted the well-being of older ethnically diverse individuals in the US and Latin America. Future studies should examine how mediators like income and coping skills modify the pandemic's impact. FUNDING: Massachusetts General Hospital Department of Psychiatry.