Population-level trends in self-reported healthcare utilization among older adults in Mexico with and without cognitive impairment.

BACKGROUND: Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico. METHODS: Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used. RESULTS: For all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03-1.23) but lower risk of outpatient services (RR = 0.95, 0.93-0.97), cholesterol screening (RR = 0.93, 0.91-0.96), and diabetes screening (RR = 0.95, 0.92-0.97). No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment. CONCLUSIONS: We identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.

Association between cognitive impairment and socioeconomic and sociodemographic factors in Colombian older adults.

INTRODUCTION: Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyse the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults. METHODS: The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables. RESULTS: 19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score <13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (OR = 2.74; 95%CI, 2.43-3.09) as a risk factor and having attended primary school as a protective factor (OR = 0.30; 95%CI, 0.28-0.32), differentially according to gender. CONCLUSIONS: An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.

Risk and protective factors for cognitive decline in Brazilian lower educated older adults: A 15-year follow-up study using group-based trajectory modelling.

BACKGROUND: Patterns of cognitive change and modifiable factors for cognitive decline versus stable cognitive trajectories have rarely been described in lower-educated older adults. OBJECTIVES: We aimed to identify long-term trajectories of cognitive functioning and possible factors associated with cognitive decline. DESIGN AND PARTICIPANTS: We used data from 1,042 adults aged ≥ 60 participating in the Health, Welfare and Aging Study (SABE), São Paulo, Brazil, without cognitive impairment at baseline. Data were collected across four waves (2000-2015). Group-based trajectory modelling was used to identify cognitive trajectories. Associations with socioeconomic variables, childhood background, lifestyle, and cardiovascular risk factors were explored using weighted multinomial logistic regressions. MEASUREMENTS: The abbreviated Mini-Mental State Examination was used to measure cognition. RESULTS: Three cognitive trajectories were identified: stable (n= 754, 68.6%), mild-decline (n= 183, 20.8%), and strong-decline (n= 105, 10.7%). At baseline, respondents in the strong-decline group were more likely to be older than those with stable and mild-decline trajectories. Furthermore, participants in both the mild and strong-decline groups were more likely to have no schooling, be divorced/separated, receive less than 4 monthly wages, and be underweight (BMI < 18.5) compared to the stable group. Finally, the mild-decline group was more likely to have lived in rural areas during childhood than participants located in a stable trajectory. CONCLUSIONS: Our findings suggest that interventions to reduce cognitive decline for low-educated older adults might include strategies addressing inequalities and improving modifiable risk factor burden.

[Association between previous appendectomy and cognitive impairment in adults: a case-control study]. / Vliyanie predshestvuyushchei appendektomii na kognitivnye narusheniya u vzroslykh: issledovanie «sluchai-kontrol'¼.

OBJECTIVE: To determine the relationship between appendectomy and cognitive impairment in adults aged 50-70 years. MATERIAL AND METHODS: A case-control study was carried out with 270 patients between May and July 2023. Ninety cases (with cognitive impairment) and 180 controls (without impairment), diagnosed by the Montreal Cognitive Assessment (MoCA), were assessed. RESULTS: 31.11% of the total cases with cognitive impairment were submitted to an appendectomy, with an average of 25 years since surgery. Regarding other surgeries: 40% with impairment underwent cholecystectomy and 23.33% reported other operations. The analysis revealed significant differences in age, body mass index, hypertension, diabetes and smoking between the groups. However, there was no significant difference by gender. Logistic regression analysis highlighted that age and past appendectomy were strongly associated with cognitive impairment, with an Odds Ratio (OR) of 1.20 and 12.91, respectively. Associations were also found with cholecystectomy (OR 7.33), other surgeries (OR 13.39) and smoking (OR 6.91). CONCLUSION: Appendectomy might be a significant risk factor for cognitive impairment in adults aged 50-70 years.

A Systematic Review and Meta-Analysis on the Prevalence of Mild Cognitive Impairment and Dementia in Mexico.

INTRODUCTION: Age remains one of the major risk factors for the onset of mild cognitive impairment (MCI) and dementia. Studies on the prevalence of these conditions in Mexico used different methods, tools, and populations with different health statuses. All these heterogeneous results may be a problem in identifying the true prevalence of MCI and dementia in Mexico. To our knowledge, there is not a systematic review available that presents essential figures on the prevalence of these conditions in Mexico. Therefore, we intend to access the maximum number of reports published on the topic and determine the prevalence of MCI and dementia in older Mexican adults. METHODS: A systematic review using PubMed, Cochrane, Research Gate, Lilacs, and Scielo databases was performed. Meta-analysis of the prevalence of MCI and dementia was performed using a random-effects model and presented in a forest plot among cross-sectional, epidemiological, and pooled studies. RESULTS: Sixteen articles were included. The overall prevalence of MCI of 18% (95% CI 0.10-0.27) was estimated from pooled information from 12 selected studies, in women 21% (95% CI 0.08-0.38) and in men 18% (95% CI 0.06-0.33). The overall prevalence of dementia of 10% (95% CI 0.06-0.14) was estimated from pooled information from 9 selected studies, in women 14% (95% CI 0.05-0.25) and in men 10% (95% CI 0.04-0.17). CONCLUSION: Mexican older individuals have a similar prevalence of dementia and MCI as reported by international data; nevertheless, the prevalence is higher than in some Latin American countries. Mexico has particular issues that must be resolved, such as a lack of research in the southern regions of the country and the high incidence of comorbidities.

Cognition, physical function, and life purpose in the rural elderly population: A systematic review protocol.

INTRODUCTION: Aging in rural settings worldwide, from the perspective of cognition, physical function, and life purpose essential constructs for a prosperous old age, still needs comprehensive discussion. This systematic review protocol aims to highlight the prevalence of cognitive decline, physical functioning, and life purpose in older adults aging in rural community settings. METHODS AND ANALYSIS: We will include cross-sectional studies published until April 2023 found in 8 databases: Embase, MEDLINE, LILACS, PsycINFO, Scopus, SciELO, and Web of Science. Ryyan software will be used for the first selection, and the Observational Study Quality Evaluation (OSQE) will assess methodological quality and risk of bias. Primary analysis will involve titles and abstracts using MeSH descriptors such as "Physical functioning," "Cognition," "Cognitive function," "Life purpose," "Elderly," "Older," "Rural aging," "Rural population," "Communities, rural," "Distribution, rural spatial," "Medium communities," "Rural settlement," "Small community." If necessary, secondary analysis will include a complete reading of selected articles by two blinded reviewers, confirmed by a third person. Publication bias will be assessed using cross-sectional analytical study quality. Sensitivity analyses will identify manuscripts significantly influencing combined prevalence of endpoints.

Post-COVID-19 cognitive symptoms in patients assisted by a teleassistance service: a retrospective cohort study.

Introduction: Four years after the onset of the COVID-19 pandemic, the frequency of long-term post-COVID-19 cognitive symptoms is a matter of concern given the impact it may have on the work and quality of life of affected people. Objective: To evaluate the incidence of post-acute COVID-19 cognitive symptoms, as well as the associated risk factors. Methods: Retrospective cohort, including outpatients with laboratory-confirmed COVID-19 and who were assisted by a public telehealth service provided by the Telehealth Network of Minas Gerais (TNMG), during the acute phase of the disease, between December/2020 and March/2022. Data were collected through a structured questionnaire, applied via phone calls, regarding the persistence of COVID-19 symptoms after 12 weeks of the disease. Cognitive symptoms were defined as any of the following: memory loss, problems concentrating, word finding difficulties, and difficulty thinking clearly. Results: From 630 patients who responded to the questionnaire, 23.7% presented cognitive symptoms at 12 weeks after infection. These patients had a higher median age (33 [IQR 25-46] vs. 30 [IQR 24-42] years-old, p = 0.042) with a higher prevalence in the female sex (80.5% vs. 62.2%, p < 0.001) when compared to those who did not present cognitive symptoms, as well as a lower prevalence of smoking (8.7% vs. 16.2%, p = 0.024). Furthermore, patients with persistent cognitive symptoms were more likely to have been infected during the second wave of COVID-19 rather than the third (31.0% vs. 21.3%, p = 0.014). Patients who needed to seek in-person care during the acute phase of the disease were more likely to report post-acute cognitive symptoms (21.5% vs. 9.3%, p < 0,001). In multivariate logistic regression analysis, cognitive symptoms were associated with female sex (OR 2.24, CI 95% 1.41-3.57), fatigue (OR 2.33, CI 95% 1.19-4.56), depression (OR 5.37, CI 95% 2.19-13.15) and the need for seek in-person care during acute COVID-19 (OR 2.23, CI 95% 1.30-3.81). Conclusion: In this retrospective cohort of patients with mostly mild COVID-19, cognitive symptoms were present in 23.7% of patients with COVID-19 at 12 weeks after infection. Female sex, fatigue, depression and the need to seek in-person care during acute COVID-19 were the risk factors independently associated with this condition.

The role of clinical and demographic predictors for understanding the cognitive impairment in Spinal Cord Injury (SCI) patients.

STUDY DESIGN: Using a cross-sectional design, we extracted sociodemographic and clinical data from 488 Spinal Cord Injury (SCI) patients during their initial assessment before receiving intensive rehabilitation treatment. OBJECTIVES: The primary objectives of this study were to ascertain the prevalence of cognitive impairment in the study sample and specify the key clinical and demographic predictors of cognitive functioning in SCI patients. SETTING: Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil. METHODS: We utilized independent univariate and multivariate regression models with the Montreal Cognitive Assessment (MoCA) scale, adapted for individuals with visual impairment. Moreover, we consider scores from the execution tasks (visuospatial/executive) as the dependent variable. RESULTS: Our findings demonstrate that approximately 80% of the evaluated study sample exhibited cognitive impairment. Through the multivariate regression models, we show that several factors, including age, education, depression levels, and the use of analgesics and/or opioids, are significant predictors of total cognitive scores. These factors are independent of the clinical features associated with SCI, such as age, sex, education, and time since the injury. CONCLUSIONS: The results indicate a high prevalence of significant cognitive impairment within the sample, with age, education, depression levels, and the use of analgesics and/or opioids emerging as the primary predictors of total cognitive scores, independent of the clinical features correlated to SCI. These findings hold significant implications for both clinical research and practice, offering valuable guidance for comprehensive management throughout hospitalization and rehabilitation.

Dynamic associations between frailty and cognition over 4 years: A population-based study on adults aged ≥50 from 12 European countries.

PURPOSE: This study aimed (1) to investigate autoregressive and cross-lagged associations between frailty and cognition over 4 years in a large sample of European citizens aged ≥50 years, (2) to examine the 4-year temporal associations' differences between sex and between active and inactive physical behaviour, and (3) to explore in the years 2011, 2013, and 2015 associations between cognitive performance and the pre-frailty and frailty conditions. MATERIALS AND METHODS: This longitudinal analysis was conducted with 20,857 individuals (11,540 women) from 12 countries aged ≥50 years who responded to waves 4, 5, and 6 of the SHARE project. The variables analysed were frailty (SHARE-FI) and a general cognition index (Cogindex) calculated for each wave from verbal fluency, immediate recall, and delayed recall. RESULTS: A greater propensity for cognitive impairment was found in women, as well as in pre-frail and frail individuals. There were no significant differences between the sexes for the autoregressive effect of frailty and Cogindex over 4 years. On the other hand, sedentary and active individuals differed in frailty between Time 1-2. Cross-lagged analyses indicated a significant difference for the sexes between frailty and Cogindex Time 1-3 and between Cogindex and frailty of Time 2-3. Sedentary and active differed significantly in the path of frailty on Cogindex between Time 2-3. CONCLUSION: Health policies should increase surveillance of frailty, cognition, and level of physical activity in the older European population, with a special focus on women.

Translation and validation of the audiovisual version of the Montreal cognitive assessment in older adults in Brazil.

BACKGROUND: The use of a reliable remote cognitive screening test for older adults is crucial for the diagnosis of cognitive impairment. This study aimed to translate and validate the audiovisual Montreal Cognitive Assessment (MoCA)for older adults in Brazil. METHODS: One hundred and fourteen older adults were recruited from the community and demographic, functional, mood, and cognitive data were collected. Participants were classified into two groups: cognitively healthy or mild cognitive impairment (MCI). Statistical analyses were performed in order to assess the validity of the test and the cutoff score. RESULTS: The psychometric properties of the audiovisual MoCA showed good convergent validity. The audiovisual MoCA was represented as a unifactorial adjusted model, the composite reliability value was acceptable and a cutoff point of ≥23 reached adequate sensitivity and specificity at 0.77 and 0.92, respectively. CONCLUSIONS: The translated audiovisual MoCA is a valid and reliable cognitive screening test that can be administered remotely in older adults in Brazil. The test demonstrated a great ability to discriminate older adults with MCI from cognitively healthy adults. Future studies should focus on validating the audiovisual MoCA using other target population groups in order to expand the use of this remote screening test.

Optimal cardiovascular health is associated with slower cognitive decline.

BACKGROUND: Life's Simple 7, a lifestyle and cardiovascular index associated with cognition, has been updated to Life's Essential 8 (LE8) to include sleep. LE8 has been related to cardiovascular outcomes but its association with cognition is unclear. METHODS: In this longitudinal analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), LE8 score was based on health behaviors (diet, physical activity, nicotine exposure, and sleep health) as well as health-related factors (body mass index, blood lipids, blood glucose, and blood pressure). Cognition was assessed in three waves, 4 years apart, using the Consortium to Establish a Registry for Alzheimer's Disease - Word List, semantic and phonemic verbal fluency, the Trail-Making Test B (TMT-B), and a global composite score. We used linear mixed-model analysis, inverse probability weighting, and interaction analysis. RESULTS: At baseline, the mean age of the study cohort was 51.4 ± 8.9 years, 56% were women, and 53% were White. Higher baseline LE8 scores were associated with slower decline in global cognition (ß = 0.001, 95% confidence interval [CI] 0.001, 0.002; p < 0.001), memory (ß = 0.001, 95% CI 0.000, 0.002; p = 0.013), verbal fluency (ß = 0.001, 95% CI 0.000, 0.002; p = 0.003), and TMT-B (ß = 0.004, 95% CI 0.003, 0.005; p < 0.001). This association was mainly driven by LE8 health factors, particularly blood glucose and blood pressure. Age, sex, and race were modifiers of the association between LE8 and global cognitive decline (p < 0.001), suggesting it was more pronounced in older, male, and Black participants. CONCLUSIONS: Higher baseline LE8 scores were associated with slower global and domain-specific cognitive decline during 8 years of follow-up, mainly due to health factors such as blood glucose and blood pressure. Sociodemographic factors were modifiers of this association.

Pain and incident cognitive impairment in very old Mexican American adults.

BACKGROUND: Studies have investigated the association between pain and cognitive impairment among older adults, but the findings are mixed. We assessed the relationship of activity-limiting pain (pain interference) with incident cognitive impairment and the mediating effect of depressive symptoms among Mexican American adults aged ≥80. METHODS: Data were taken from the Hispanic Established Population for the Epidemiological Study of the Elderly (2010-2016). Pain interference, or pain that limited daily activities in the last 12 months, was categorized into none, untreated pain interference, and treated pain interference. Cognitive impairment was defined as scoring <21 on the Mini-Mental State Examination and difficulty with at least one instrumental activity of daily living. We used general estimation equations to assess this relationship between pain and incident cognitive impairment over the 6-year period (n = 313). RESULTS: Participants reporting both untreated and treated pain interference had higher odds of incident cognitive impairment than those reporting no pain or pain interference (untreated adjusted odds ratio [aOR]: 2.18; 95% confidence interval [CI]: 1.09-4.36; treated aOR: 1.99; 95% CI: 1.15-3.44). Depressive symptoms explained 15.0% of the total effect of untreated pain and 25.3% of treated pain. CONCLUSIONS: Among very old Mexican American adults, both treated and untreated pain interference was associated with incident cognitive impairment. This association was partially mediated by depressive symptoms, underscoring a need for depression screening in patients with chronic pain. Future work is needed to examine mechanistic/causal pathways between pain and subsequent cognitive impairment and the role of pharmacological and non-pharmacological treatments in these pathways.

A Community-Based Study of Dementia in Mexican American and Non-Hispanic White Individuals.

BACKGROUND: Little information is available on the prevalence of cognitive impairment in Mexican American persons. OBJECTIVE: To determine the prevalence of mild cognitive impairment (MCI) and dementia in those 65 years and older among Mexican American and non-Hispanic white individuals in a community. METHODS: This was a population-based cohort study in Nueces County, Texas, USA. Participants were recruited using a random housing sample. The Harmonized Cognitive Assessment (HCAP) participant and informant protocol was performed after Montreal Cognitive Assessment (MoCA) screening. An algorithm was used to sort participants into diagnostic categories: no cognitive impairment, MCI, or dementia. Logistic regression determined the association of ethnicity with MCI and dementia controlling for age, gender, and education. RESULTS: 1,901 participants completed the MoCA and 547 the HCAP. Mexican Americans were younger and had less educational attainment than non-Hispanic whites. Overall, dementia prevalence was 11.6% (95% CI 9.2-14.0) and MCI prevalence was 21.2% (95% CI 17.5-24.8). After adjusting for age, gender, and education level, there was no significant ethnic difference in the odds of dementia or MCI. Those with ≤11 compared with ≥16 years of education had much higher dementia [OR = 4.9 (95% CI 2.2-11.1)] and MCI risk [OR = 3.5 (95% CI 1.6-7.5)]. CONCLUSIONS: Dementia and MCI prevalence were high in both Mexican American and non-Hispanic white populations. Mexican American persons had double the odds of mild cognitive impairment and this was attenuated when age and educational attainment were considered. Educational attainment was a potent predictor of cognitive impairment.

Association between cardiovascular risk factors and cognitive impairment in adults aged 60 years or older from Chile: a cross-sectional study.

BACKGROUND: Few studies in Latin America have examined the association between cardiovascular risk factors and cognitive impairment (CI) in a nationally representative sample. Therefore, this study aimed to estimate the prevalence of CI in a nationally representative sample of adults aged 60 years or older from Chile and to investigate the association between cardiovascular risk factors and CI. METHODS: Data from the cross-sectional 2016-2017 National Health Survey of Chile, which included 2031 adults (63.7% women) was used. Body mass index, metabolic syndrome (blood pressure, triglycerides, fasting glucose or treatment for diabetics, waist circumference, and HDL cholesterol), risk of cardiovascular disease (history and measured variables, using the Framingham risk score), tobacco use, and physical activity were measured. CI was assessed using the Mini-Mental Status Examination (MMSE). RESULTS: Overall, the prevalence of CI was 12.2% at the national level. Significant differences in CI were observed by age, education level, risk of cardiovascular disease, and smoking. High risk of cardiovascular disease was associated with higher odds of CI (OR: 2.04; 95%CI: 1.20-3.45) compared to low risk. Smoking was significantly associated with a lower likelihood of CI (OR: 0.56; 95%CI: 0.36-0.87) compared to never smoking. Body mass index, metabolic syndrome, and physical activity were not associated with CI. CONCLUSIONS: This study provided additional support for previous findings on the relationship between cognitive decline and an elevated risk of cardiovascular disease. Worse CI was associated with the group with the highest risk of cardiovascular disease, and the presence of lifestyle factors, such as obesity and physical inactivity, exacerbate this relationship, but not being a current smoker.

Impact of type, intensity, frequency, duration and volume of physical activity on dementia and mild cognitive impairment in older adults: protocol for a systematic review and meta-analysis.

INTRODUCTION: Worldwide, the prevalence of degenerative diseases such as dementia and mild cognitive impairment (MCI) is increasing with population ageing and increasing life expectancy. Both conditions share modifiable risk factors. Physical inactivity is one of these modifiable risk factors, and research points to the protective effect of physical activity on the incidence of dementia and MCI. However, this association tends to change according to type, intensity, frequency, duration and volume of physical activity. Furthermore, it remains unclear which of these characteristics offers the greatest protective effect. Therefore, this study aims to evaluate the impacts of different types, intensities, frequencies, duration and volume of physical activity on dementia and cognitive decline in older adults. METHODS AND ANALYSIS: The search will be carried out from October 2023, using the following databases: PubMed, Embase, Scopus, CINAHL and Web of Science. Cohort studies with a follow-up time of 1 year or longer that have investigated the incidence of dementia and/or MCI in older adults exposed to physical activity will be included. There will be no limitations on the date of publication of the studies. Studies published in English, Spanish or Portuguese will be analysed. Two researchers will independently screen the articles and extract the data. Any discrepancies will be resolved by a third reviewer. Association measures will be quantified, including OR, HR, relative risk and incidence ratio, with a 95% CI. If the data allow, a meta-analysis will be performed. To assess the methodological quality of the selected studies, the Grading of Recommendations, Assessment, Development and Evaluations instrument, and the Downs and Black instrument to assess the risk of bias, will be used. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023400411.

[Risk factors associated with cognitive impairment in aged: Cross-sectional study]. / Factores de riesgo asociados a deterioro cognitivo en adultos mayores: estudio transversal.

Background: With the increase in life expectancy, conditions related to older age have increased in incidence, one of these pathologies is Cognitive Impairment (CI), which has a prevalence of up to 28%, conditions that increase the presence of CI are known. However, there is controversy about the factors that increase the risk of CI. Objective: To determine the factors associated with cognitive impairment in older adults. Material and methods: We conducted a cross-sectional, analytical, observational, retroprolective study that included adults ≥65 years of age, with no history of cerebral vascular event, cranioencephalic trauma. Demographic factors were analyzed, CI was assessed with the Mini Mental State Examination test. For statistical analysis we used Odds Ratio (OR) and 95% confidence interval (95% CI) for each factor and multiple logistic regression as multivariate analysis. Results: 420 older adults were included, 61% were women, 32.6% with age >75 years, 84.5% with schooling <9 years, in the multiple logistic regression the following were independent factors for the presence of mild CI: dependence on basic activities of daily living (ADLs) with OR 5.88, absence of cognitive stimulation RM 4.50, age >75 years OR 2.92, polypharmacy OR 2.16, uncontrolled blood pressure OR 1.92. Conclusion: ADLs dependence, absence of cognitive stimulation, age >75 years, polypharmacy and uncontrolled blood pressure are risk factors associated with CI in older adults.

Introducción: con el aumento en la esperanza de vida las condiciones relacionadas con mayor edad incrementaron su incidencia; una de estas patologías es el deterioro cognitivo (DC) que presenta una prevalencia de hasta el 28%, hoy en día se conocen condiciones que aumentan la presencia de DC. Sin embargo, existe controversia sobre los factores que aumentan el riesgo para su presencia. Objetivo: determinar los factores asociados al deterioro cognitivo en adultos mayores. Material y métodos: se realizó un estudio transversal, analítico, observacional, retroprolectivo que incluyó a adultos ≥ 65 años, sin antecedente de evento vascular cerebral o traumatismo craneoencefálico. Se analizaron factores demográficos, el DC se evaluó con la prueba Mini-Mental. Para el análisis estadístico se usó razón de momios (RM) e intervalo de confianza al 95% (IC95%) para cada factor y como análisis multivariado, regresión logística múltiple. Resultados: se incluyeron 420 adultos mayores, de los cuales el 61% eran mujeres, el 32.6% tenían edad > 75 años, el 84.5% con escolarización < 9 años. En la regresión logística múltiple los siguientes fueron factores independientes para la presencia de DC leve: la dependencia de actividades básicas de la vida diaria (ABVD), ausencia de estimulación cognitiva, edad > 75 años, polifarmacia y descontrol de tensión arterial. Conclusión: la dependencia de ABVD, ausencia de estimulación cognitiva, edad > 75 años, polifarmacia y descontrol de la tensión arterial son factores de riesgo asociados al DC en adultos mayores.

[Cognitive alterations in patients recovered from COVID-19 treated in Cardiopulmonary Rehabilitation]. / Alteraciones cognitivas en pacientes recuperados de COVID-19 atendidos en Rehabilitación Cardiopulmonar.

Background: COVID-19 is associated with multiple complications, in addition to those produced at the pulmonary level. Post-COVID-19 cognitive deficits have been detected in the cognitive domain of attention and executive functions, even 4 months after COVID-19. Objective: to determine the frequency of cognitive alterations in patients recovered from COVID-19. Material and methods: A cross-sectional, descriptive and analytical study was carried out. Records of patients in care after infection by SARS-CoV-2 were integrated, the Neuropsi test was applied. Descriptive statistics and association tests were used through the Chi square test, taking p < 0.05 as significant. Results: Data from 44 files were integrated. The median age, I place them in the sixth decade of life. There was a predominance of men (63.6%). The most frequent comorbidities were systemic arterial hypertension (50%) and diabetes mellitus (40.9%). Most of the patients were managed only at home (61.4%) with a moderate-severe COVID-19 picture (68.2%). The most affected dimensions of the Neuropsi test were attention and concentration (47.7%, mild alteration) and short-term memory (77.3%, mild alteration). Conclusions: Cognitive impairment in patients recovered from COVID-19 assessed through the Neuropsi test presented mild alterations in attention and concentration, as well as in short-term memory. These could affect functionality, quality of life and ability to perform work.

Introducción: la COVID-19 está asociada a múltiples complicaciones, además de las producidas a nivel pulmonar. Se han detectado déficits cognitivos post COVID-19 en el dominio cognitivo de atención y funciones ejecutivas, incluso 4 meses después del COVID-19. Objetivo: determinar la frecuencia de alteraciones cognitivas en pacientes recuperados de COVID-19. Material y métodos: se realizó un estudio transversal, descriptivo y analítico. Se integraron expedientes de pacientes en atención posterior a infección por SARS-CoV-2, se aplicó la prueba Neuropsi. Se utilizó estadística descriptiva y pruebas de asociación a través de la prueba Chi cuadrada, tomando como significativo p < 0.05. Resultados: se integraron datos de 44 expedientes. La mediana de la edad los ubicó en la sexta década de la vida. Hubo predominio de pacientes hombres (63.6%). Las comorbilidades más frecuentes fueron: hipertensión arterial sistémica (50%) y diabetes mellitus (40.9%). La mayoría de los pacientes fueron manejados solamente en domicilio (61.4%) con un cuadro de COVID-19 moderado-severo (68.2%). Las dimensiones más afectadas de la prueba de Neuropsi fueron la atención y concentración (47.7%, alteración leve) y memoria a corto plazo (77.3%, alteración leve). Conclusiones: el deterioro cognitivo en pacientes recuperados de COVID-19 valorado a través de la prueba Neuropsi presentó alteraciones leves en la atención y concentración, así como en la memoria a corto plazo. Estas podrian afectar la funcionalidad, calidad de vida y capacidad de desempeño laboral.

Association between hearing loss and cognitive decline in the elderly: A systematic review with meta-analysis study.

OBJECTIVE: Hearing loss has been pointed out as a potential predictor for cognitive decline. This study conducted a systematic review to evaluate the scientific evidence on the association between hearing loss in the elderly and cognitive decline, as well as whether race/color influences this relationship. METHOD: The search for studies was performed in the following electronic databases: MedLine/PubMed Web of Science, Scopus and Virtual Health Library, and MedRkiv up to August 2022. Studies with epidemiological designs that assess the association between hearing loss and cognitive decline in the elderly were eligible for inclusion. Three independent reviewers performed the selection, data extraction and evaluation of the quality of the studies using the Newcastle-Ottawa Scale. A meta-analysis using a random effects model estimated the global association measurements (Beta coefficient: ß) and their 95% confidence intervals (95%CI), and the Higgins and Thompson indicator (I2) was also estimated to assess statistical heterogeneity among the studies. RESULTS: 5,207 records were identified in the database surveys, of which only 18 were eligible studies, totaling 19,551 individuals. Hearing loss was associated with cognitive decline in the elderly, with statistical significance: ß = -0.13; 95%CI = -0.23 to -0.04; I2 = 98.70%). For black individuals, the magnitude of the association increased: ß = -0.64; 95%CI = -3.36 to 2.07; I2 = 95.65%, but it was not statistically significant. CONCLUSION: The findings of this systematic review showed the existence of a significant relationship between hearing loss and cognitive decline in the elderly, as well as signaling that among black individuals the magnitude of the association can be increased.

Análisis de edad, sexo y autopercepción de memoria en el deterioro cognitivo en la adultez mayor / Cognitive Impairment Among Older Adults in Chile: Evidence from the National Health Survey (ENS 2016-2017)

OBJETIVO: Análisis del deterioro cognitivo en personas mayores por edad, sexo y autopercepción de la memoria utilizando la Encuesta Nacional de Salud (ENS 2016-2017). MATERIAL Y MÉTODO: Estudio transversal analítico. Los datos provienen de la Encuesta Nacional de Salud (ENS 2016-2017). Se incluyen un n = 2.030 adultos mayores a 60 años. Se consideraron variables edad, sexo, autopercepción de la memoria y capacidad cognitiva medida con Test "Mini-Mental". Se realizó una correlación de Pearson entre los resultados del Mini-Mental y la edad por sexo y por nivel de autopercepción de la memoria y correlación de Spearman entre edad y nivel de autopercepción. Un análisis de Regresión Logística consideró, variable binaria por sospecha de deterioro cognitivo (DC) y predictoras, edad, nivel de autopercepción de la memoria y sexo. RESULTADOS: La evaluación fue completada por el 63.69% (n = 1.293) mujeres y 36,31% (n = 737) hombres. La edad promedio fue de 71,02 ± 7,9 años. La edad fue significativamente mayor en el grupo que presenta sospecha DC (p = 0,00). Mientras que la Edad y la Autopercepción negativa de manera independiente aumenta el riesgo de DC (OR = 1,1027 CI95%; 1,0392-1,1719 y OR = 1,4974 CI 95%; 0,4091-5,5725) respectivamente. CONCLUSIÓN: Un porcentaje importante de adultos mayores reportaron una memoria regular a mala (autopercibida). La edad fue la variable más significativa con relación a la sospecha de DC. Es decir que a mayor edad mayor deterioro cognitivo sin diferencia significativas por sexo. No obstante, las mujeres presentaron menos deterioro cognitivo.

OBJECTIVE: Analysis of cognitive impairment in the elderly by age, sex and self-perception of memory using the National Health Survey (ENS 2016-2017). MATERIAL AND METHOD: Analytical cross-sectional study. The data comes from the National Health Survey (ENS 2016-2017). A n = 2,030 adults over 60 years of age are included. Variables such as age, sex, self-perception of memory and cognitive ability measured with the "Mini-Mental" Test were considered. A Pearson correlation was made between the results of the Mini-Mental and age by sex and by level of self-perception of memory and Spearman's correlation between age and level of self-perception. A Logistic Regression analysis considered a binary variable due to suspicion of cognitive impairment (CD) and predictors, age, level of self-perception of memory, and sex. RESULTS: The evaluation was completed by 63.69% (n = 1,293) women and 36.31% (n = 737) men. The mean age was 71.02 ± 7.9 years. Age was significantly higher in the group with suspected DC (p=0.00). While Age and negative self-perception independently increase the risk of DC (OR= 1.1027 CI95%; 1.0392-1.1719 and OR = 1.4974 CI95%; 0.4091-5.5725) respectively. CONCLUSION: A significant percentage of older adults reported a fair to poor (self-perceived) memory. Age was the most significant variable in relation to the suspicion of CD. In other words, the older the age, the greater the cognitive deterioration without significant differences by sex. However, women presented less cognitive impairment.