Effects of a dual intervention (motor and virtual reality-based cognitive) on cognition in patients with mild cognitive impairment: a single-blind, randomized controlled trial.

BACKGROUND: The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant. OBJECTIVE: To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI. METHODS: Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions). RESULTS: Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level. CONCLUSIONS: The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements. TRIAL REGISTRATION: ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 .

Effects of cognitive interventions with video games on cognition in healthy elderly people: a systematic review.

BACKGROUND: Currently, studies using video games as an intervention to improve cognitive functions in the elderly are on the rise. OBJECTIVE: To investigate and evaluate the effects of cognitive interventions using video games on cognition in healthy elderly people published in the last ten years. METHODS: A systematic review involving a qualitative analysis carried out between July and September 2021on the SciELO, LILACS and MEDLINE databases.. RESULTS: A total of 262 articles were identified in the initial search. After exclusion of duplicates, analysis of titles/abstracts and of the full text, a final total of 9 studies were included in the review. The objectives of the studies included investigating the effects on cognition of cognitive training (CT) programs using video games compared to programs using entertainment games or to low-intensity CT games. Despite the growing number of studies, many of them were focused on cognitive rehabilitation in elderly people with some degree of cognitive impairment, and few involved training among healthy elderly people. CONCLUSION: According to the studies analyzed, the interventions involving CT with video games promoted significant improvements in processing speed and working memory, but no improvements in executive functions.

ANTECEDENTES: Atualmente, estão em alta estudos que utilizam video games para melhorar as funções cognitivas em idosos. OBJETIVO: Investigar e avaliar os efeitos de intervenções cognitivas com video games na cognição de idosos saudáveis publicadas nos últimos dez anos. MéTODOS: Estudo de revisão sistemática com análise qualitativa realizado entre julho e setembro de 2021, das bases de dados SciELO, LILACS e MEDLINE. RESULTADOS: Foram identificados 262 estudos na busca inicial. Após a exclusão de estudos duplicados, análise dos títulos e resumos, e análise integral dos estudos, nove estudos foram incluídos na revisão. Os objetivos de alguns estudos incluíam investigar os efeitos na cognição de programas de treino cognitivo (TC) com video games comparados aos de programas com jogos de entretenimento ou com jogos com baixa intensidade de TC. Apesar do crescente número de estudos, muitos centravam-se na reabilitação cognitiva em idosos com algum comprometimento cognitivo e poucos realizaram o treino em idosos saudáveis. CONCLUSãO: Pelos estudos analisados, as intervenções de TC com video games apresentaram melhorias significativas na velocidade de processamento (VP) e na memória operacional (MO); por outro lado, não foram observadas melhorias nas funções executivas.

Rehabilitación neuropsicológica en personas con cáncer pediátrico / Neuropsychological rehabilitation in people with paediatric cancer

INTRODUCCIÓN El cáncer es la primera causa de muerte por enfermedad en la infancia y la adolescencia. En España, alrededor de 1 100 niños/as entre 0 y 14 años enferman de cáncer cada año. El porcentaje de supervivencia a los 5 años ha ido en aumento desde 1980, situándose por encima del 80% en la actualidad. El aumento de pacientes que superan la enfermedad hace necesario evaluar los efectos tardíos del tumor y del tratamiento recibido. En comparación con supervivientes de otro tipo de tumores, los diagnosticados en la infancia conllevan mayor riesgo de déficits neuropsicológicos que pueden afectar a la adaptación familiar, el ámbito escolar, su desarrollo psicosocial y su vida profesional. Más de un 40% de supervivientes de tumores cerebrales pediátricos muestran algún déficit neurocognitivo. Las terapias para el tratamiento del cáncer infanto-juvenil incluyen quimioterapia, radioterapia, cirugía, trasplante de progenitores hematopoyéticos o inmunoterapia, entre otras. Estos tratamientos, especialmente los que se utilizan para combatir los tumores del sistema nervioso central, provocan efectos secundarios, entre ellos alteraciones neuropsicológicas que pueden presentarse años después de los tratamientos recibidos. Algunos de los dominios cognitivos que pueden verse afectados son la inteligencia, capacidad de atención, velocidad de procesamiento de la información, memoria, funciones motoras, funciones ejecutivas, lenguaje, habilidades académicas, emociones y/o conducta. Por tanto, es necesario evaluar el estado de la función cognitiva durante el tratamiento y posteriormente, para poder aplicar intervenciones restauradoras o compensatorias que hayan demostrado su eficacia. La rehabilitación neuropsicológica abarca cualquier estrategia de intervención que tenga como objetivo permitir a los niños y a sus familiares reducir los déficits cognitivos, conductuales y emocionales, manejar estas dificultades y reducir su impacto en la vida diaria. Entre estas intervenciones, el entrenamiento neuropsicológico en tareas que rehabiliten los procesos cognitivos tiene como objetivo restaurar el correcto funcionamiento de dichos procesos o minimizar el deterioro producido. OBJETIVOS • Evaluar la efectividad y la seguridad de la rehabilitación neuropsicológica en personas tratadas o en tratamiento por cáncer pediátrico. • Determinar el coste-efectividad de la rehabilitación neuropsicológica en personas tratadas o en tratamiento por cáncer pediátrico. • Determinar el impacto presupuestario de la rehabilitación neuropsicológica en personas tratadas o en tratamiento por cáncer pediátrico. • Describir los aspectos éticos, legales, organizacionales, sociales, ambientales y de la perspectiva de los pacientes relacionados con el uso de la rehabilitación neuropsicológica en personas tratadas o en tratamiento por cáncer pediátrico. • Describir las necesidades de investigación futura sobre la rehabilitación neuropsicológica en personas tratadas o en tratamiento por cáncer pediátrico desde la perspectiva de pacientes, familiares/cuidadores, profesionales y gestores sanitarios. MÉTODO Para los apartados de efectividad/seguridad y coste-efectividad, se realizó una revisión sistemática de ensayos controlados aleatorizados y evaluaciones económicas, respectivamente, en las bases de datos MEDLINE, EMBASE, CINAHL y PsycINFO. Se incluyeron intervenciones no farmacológicas que evaluaran procesos neurocognitivos, función ejecutiva/conducta evaluada por padres y profesores, sintomatolgía psicológica, calidad de vida relacionada con la salud o rendimiento académico. Se realizó un meta-análisis de resultados cuando hubo datos disponibles. Para llevar a cabo la evaluación económica se realizó un estudio de costes desde la perspectiva del sistema sanitario y con el horizonte temporal de 1 año. Además, se analizó el impacto presupuestario que tendría la implementación de la intervención para el sistema sanitario a los 5 años. Para evaluar los aspectos éticos, legales, organizacionales, sociales, ambientales y de la perspectiva de los pacientes, se realizó una revisión sistemática de estudios cualitativos o mixtos en las bases MEDLINE, EMBASE. RESULTADOS Efectividad/seguridad Se incluyeron 11 estudios (n total = 703). El único que aplicó neurofeedback no obtuvo beneficios significativos de la intervención. Los restantes aplicaron exclusivamente un programa de entrenamiento cognitivo salvo en un caso, que también trabajó aspectos psicosociales en una intervención grupal con padres, madres y niños/as. Entre los que aplicaron programas de entrenamiento cognitivo, uno no encontró diferencias significativas en calidad de vida relacionada con la salud. Un estudio con niños hospitalizados obtuvo un efecto significativo de la intervención en independencia funcional y fatiga (en ambos casos muy baja calidad de la evidencia ⨁◯◯◯). La función ejecutiva/conducta reportada por padres/profesores mejoró significativamente tras la intervención (6 estudios; g = -0.34, IC95%: -0.61, -0.06; muy baja calidad ⨁◯◯◯), pero no hubo diferencias significativas en el seguimiento. No hubo diferencias significativas en lectura y matemáticas (3 estudios en cada caso, baja calidad ⨁⨁◯◯). Un estudio con un programa específico de lectura y seguimiento a 5 años no obtuvo diferencias significativas. No hubo diferencias significativas en atención/memoria verbal inmediata (4 estudios, baja calidad ⨁⨁◯◯) y de trabajo (6 estudios, baja calidad ⨁⨁◯◯), pero sí en memoria visoespacial inmediata (2 estudios g = 0.96, IC95%: 0.48, 1.95; baja calidad ⨁⨁◯◯) y de trabajo (3 estudios g = 0.76, IC95%: 0.38, 1.13; baja calidad ⨁⨁◯◯), y en velocidad de procesamiento (3 estudios g = -0.31, IC95%: -0.56, -0.05; baja calidad ⨁⨁◯◯). Estos resultados positivos están influenciados principalmente por un estudio. No se observaron efectos adversos en los artículos que informan de ellos. Coste-efectividad No se identificó evidencia sobre el coste-efectividad de la rehabilitación neuropsicológica en pacientes oncológicos pediátricos. La incertidumbre sobre la validez y consistencia de los resultados de efectividad no permitieron abordar un análisis de coste-efectividad "de novo". Estudio de costes El estudio de costes en el contexto de España, basado en una intervención de rehabilitación cognitiva ofrecida por una asociación de pacientes, estimó el coste por paciente/familia en 687 €. Impacto presupuestario El impacto presupuestario a los 5 años de la implementación de la intervención para los pacientes oncológicos de 0 a 14 años en España sería entre 700 000 y 1 500 000 €, dependiendo del número de sesiones ofrecidas. Aspectos medioambientales, éticos, de pacientes, sociales, legales y organizacionales Se han identificado los siguientes facilitadores de la aceptación y adherencia a los programas de reabilitación neuropsicológica: evaluación en el momento del alta, cuyos resultados sean compartidos con todos los agentes implicados; información personalizada clara y precisa sobre cómo realizar las pruebas de seguimiento, actuación coordinada entre profesionales sanitarios, padres y profesores; e intervenciones psicosociales. Entre las barreras se encuentran: dificultades logísticas y organizativas, falta de comprensión de las necesidades de la población de supervivientes de cáncer, pobre comunicación y coordinación entre los distintos organismos implicados, o barreras culturales o sociales que dificulten el acceso de un superviviente de cáncer a los programas de rehabilitación neuropsicológica. CONCLUSIONES • La calidad de la evidencia sobre rehabilitación neuropsicológica en población pediátrica tratada de cáncer está focalizada en el entrenamiento cognitivo y es de baja calidad, con pocos estudios y un tamaño muestral pequeño para cada variable evaluada, entre otras limitaciones metodológicas. • Solo un estudio evaluó la aplicación de neurofeedback, sin obtener beneficios significativos. • La evidencia disponible no permite afirmar que el entrenamiento cognitivo mejore la competencia en lectura y matemáticas, la sintomatología psicológica o la calidad de vida relacionada con la salud. • El entrenamiento cognitivo podría producir una mejoría de pequeña intensidad en la función ejecutiva/conducta percibida por los padres al final del tratamiento, aunque los resultados disponibles en el seguimiento (3-6 meses) no fueron significativos. • Un programa computerizado de auto-aplicación en el domicilio podría producir beneficios de intensidad moderada-fuerte en atención sostenida, velocidad de procesamiento, y memoria visoespacial (tanto inmediata como de trabajo). • No existe evidencia de que estos programas conlleven un riesgo de efectos adversos de carácter emocional o conductual. • No se identificó evidencia sobre el coste-efectividad de la rehabilitación neuropsicológica en pacientes oncológicos pediátricos. • El coste de la intervención por paciente/familia se estimó en 687 € y depende sobre todo del número de sesiones ofrecidas a cada paciente y/o su familia. • A los 5 años, el impacto presupuestario de la implementación de la intervención para todos los pacientes oncológicos entre 0 y 14 años en España sería entre 700 000 € y 1 525 000 €. RECOMENDACIONES Debido a la baja calidad de la evidencia disponible actualmente no es posible recomendar el entrenamiento cognitivo para la restauración de la función cognitiva y la promoción de la adaptación familiar, social y escolar de pacientes menores de edad tratados de cáncer.

INTRODUCTION Cancer is the leading cause of death by disease in childhood and adolescence. Every year, approximately 1100 children between the ages of 0 and 14 are diagnosed with cancer in Spain. Since 1980, the percentage of children who survive to the age of five has increased, and it now exceeds 80%. The increasing number of patients who survive the disease necessitates assessing the long-term effects of the tumor and the treatment received. When compared to survivors of other types of tumors, those diagnosed in infancy are more likely to experience neuropsychological deficits that could affect family adaptation, academic environment, psychosocial development, and professional life. More than 40% of pediatric brain tumor survivors have some form of neurocognitive deficit. Treatment options for pediatric cancer include chemotherapy, radiation therapy, surgery, hematopoietic stem cell transplantation, and immunotherapy, among others. These treatments, particularly those used to treat central nervous system tumors, have unintended consequences, including neuropsychological changes that can manifest years after the treatments are administered. Some of the cognitive domains that may be affected are intelligence, attention capacity, information processing speed, memory, motor functions, executive functions, language, academic abilities, emotions, and behavior. Therefore, it is necessary to evaluate the state of cognitive function during treatment and afterwards, in order to apply restoring or compensatory interventions that have proven their effectiveness. Neuropsychological rehabilitation encompasses any intervention strategy aimed at allowing children and their families to reduce cognitive, behavioral, and emotional deficits, manage these difficulties, and reduce their impact on daily life. Among these interventions, neuropsychological training in tasks that rehabilitate cognitive processes aims to restore proper functioning of these processes or minimize the deterioration produced. OBJECTIVES • Evaluate the efficacy and safety of neuropsychological rehabilitation in children treated for or undergoing treatment for pediatric cancer. • Determine the cost-effectiveness of neuropsychological rehabilitation in children treated for or undergoing treatment for pediatric cancer. • Determine the pre-budgetary impact of neuropsychological rehabilitation in children treated for or undergoing treatment for pediatric cancer. • Describe the ethical, legal, organizational, social, and environmental aspects, as well as patient perspectives, associated with the use of neuropsychological rehabilitation in children treated for or undergoing treatment for pediatric cancer. • Describe the future research needs for neuropsychological rehabilitation in children treated for or undergoing treatment for pediatric cancer from the viewpoints of patients, family members/caregivers, medical professionals, and facility managers. METHODS For the effectiveness/security and cost-effectiveness sections, a systematic review of randomized controlled trials and economic evaluations, respectively, was conducted in the databases MEDLINE, EMBASE, CINAHL, and PsycINFO. Non-pharmacological interventions that evaluate neurocognitive processes, executive function/conduct as evaluated by parents and teachers, psychiatric symptoms, health-related quality of life, or academic performance were included. When data was available, a meta-analysis of the results was performed. To carry out the economic evaluation, a study of costs was carried out from the perspective of the health system and with a time horizon of 1 year. In addition, the budgetary impact that the implementation of the intervention would have for the health system at 5 years was analyzed.d. To assess the economic, legal, organizational, social, and environmental aspects as well as the patients' perspectives, a systematic review of qualitative or mixed studies in the databases MEDLINE and EMBASE was conducted. RESULTS Effectiveness/safety A total of 11 studies were included (n = 703). The one study that used neurofeedback failed to see any appreciable benefits from the intervention. The rest exclusively applied a cognitive training program except in one case, which also worked on psychosocial aspects in a group intervention with parents and children. Among those who used cognitive training programs, one found no significant differences in life quality related to health. A study involving hospitalized children found a significant impact of intervention on functional independence and fatigue (in both cases, the quality of the evidence was very poor ⨁◯◯◯). Parents' and professors' reports of executive and conductive function improved significantly after intervention (6 studies; g = -0.34, IC95%: - 0.61, -0.06; very poor quality ⨁◯◯◯), but there were no significant differences in follow-up. There were no significant differences in reading comprehension or mathematics (3 low-quality studies in each case ⨁⨁◯ ◯). A study that used a specific program of reading and monitoring for five years did not find significant differences. There were no significant differences in immediate attention/memory verbal (4 studies, poor quality) or work (6 studies, poor quality ⨁⨁◯◯), but there were in immediate visuospatial memory (2 studies, g = 0.96, IC95%: 0.48, 1.95; poor quality ⨁⨁◯◯) and work (3 studies, g = 0.76, IC95%: 0.38, 1.13; poor quality ⨁⨁◯◯). These positive outcomes are primarily influenced by one study. In the articles reporting them, no adverse effects were reported. Cost-effectiveness No evidence on the cost-effectiveness of neuropsychological rehabilitation in pediatric cancer patients was identified. The uncertainty about the validity and consistency of the effectiveness results did not allow us to undertake a "de novo" cost-effectiveness analysis. Cost study The cost study in the Spanish context, based on a cognitive rehabilitation intervention offered by a patient association, estimated the cost per patient/family at €687. Budget impact The budgetary impact after 5 years of the implementation of the intervention for cancer patients from 0 to 14 years of age in Spain would be between €700 000 and €1 500 000, depending on the number of sessions offered. Ethical, legal, organizational, social, environmental factors and patient's perspective The following facilitators of acceptance and adherence to neuropsycholigical rehabilitation were identified: evaluation at the time of discharge, the results of which are shared with all the agents involved; clear and precise personalized information on how to carry out follow-up tests, coordinated action between health professionals, parents and teachers; psychosocial interventions. Among the barriers are: logistical and organizational difficulties, lack of understanding of the needs of the population of cancer survivors, poor communication and coordination between the different organizations involved, or cultural or social barriers that make it difficult for a cancer survivor to access to rehabilitation programs. CONCLUSIONS • The quality of the research on the effectiveness of neuropsychological rehabilitation in pediatric cancer patients is poor-quality and focused on cognitive training, with few studies and a small sample size for each variable evaluated, among other methodological limitations. • Only one study examined neurofeedback, with no significant benefits. • There is no evidence to back up the claim that neurocognitive training improves reading and math skills, psychological symptoms, or health-related quality of life. • Cognitive training may result in a minor improvement in executive/conductive function as perceived by parents at the end of the treatment, but the results available during the follow-up period (between 3-6 months) were not statistically significant. • A computerized self-guided program at home can provide moderate-to-high benefits in terms of attention, processing speed, and visual spatial memory (both immediate and long term). • There is no evidence that these programs may have negative emotional or behavioral consequences. • The cost-effectiveness of these interventions has yet to be determined. Future studies should consider health-related quality of life or academic performance in economic evaluations. • There is no evidence of cost-effectiveness of neuropsychological rehabilitation in pediatric oncology patients. • The cost of the intervention per patient/family was estimated at €687 and depends above all on the number of sessions offered to each patient and/or their family. • At 5 years, the budgetary impact of implementing the intervention for all cancer patients between 0 and 14 years of age in Spain would be between €700 000 and €1 525 000. RECOMMENDATIONS With the available evidence, it is not possible to recommend neuropsychological training for cognitive rehabilitation in pediatric cancer.

Risco de quedas e seus fatores associados na pessoa idosa hospitalizada / Risk of falls and its associated factors in hospitalized older adults

Resumo Objetivo analisar o risco de queda e sua associação com as variáveis demográficas, clínicas, estado cognitivo, risco de sarcopenia e fragilidade da pessoa idosa hospitalizada em uma clínica médica de um hospital universitário. Método Estudo quantitativo, observacional, transversal e analítico realizado com 60 pessoas idosas hospitalizadas na clínica médica de um hospital universitário da cidade de São Paulo - SP, Brasil, com o uso dos seguintes questionários: perfil demográfico, dados clínicos, Mini Exame do Estado Mental, Escala de Morse, Escala SARC-F e Índice de Fragilidade Tilburg. Foram realizadas análises descritivas e teste de normalidade de Kolmogorov-Smirnov. Para as variáveis quantitativas foi utilizado o teste de correlação de Spearman e para categóricas, o teste U Mann-Whitney. Para identificar a associação, foi utilizada a regressão linear múltipla e adotado um nível de significância de 5%. Resultados Predomínio do sexo feminino, entre 60-79 anos e sem companheiro (a). Ademais, 80% apresentavam comprometimento cognitivo, 88,3% foram categorizados como frágeis, 60% apresentavam risco para sarcopenia e 75% possuíam alto risco de queda durante a hospitalização. Verificou-se associação do comprometimento cognitivo, ser frágil e ter risco de sarcopenia com o risco de queda na pessoa idosa hospitalizada. Conclusão o elevado risco de quedas em idosos hospitalizados está diretamente relacionado com a presença de deficit cognitivo, síndrome da fragilidade e o risco para sarcopenia, afirmando que esses fatores merecem atenção dos gestores e profissionais de enfermagem.

Abstract Objective To analyze the risk of falls and its association with demographic and clinical variables, cognitive status, risk of sarcopenia and frailty among older adults hospitalized in a medical clinic of a university hospital. Method A quantitative, observational, cross-sectional analytical study of 60 older adults hospitalized in the medical clinic of a university hospital in São Paulo city, São Paulo state, Brazil, was carried out. Questionnaires collecting demographic profile and clinical data, the Mini-Mental State Examination, Morse Scale, SARC-F Scale and Tilburg Frailty Indicator were applied. Descriptive analyses and the Kolmogorov-Smirnov normality test were performed. Spearman's correlation test was used for quantitative variables and the Mann-Whitney U-test for categorical variables. Multiple linear regression was used to identify the associations and a significance level of 5% was adopted. Results The study sample comprised predominantly individuals that were female, aged 60-79 years and without a partner. Overall, 80% had cognitive impairment, 88.3% were diagnosed as frail, 60% were at risk for sarcopenia, and 75% had a high risk of falls during hospitalization. Cognitive impairment, frailty and sarcopenia risk were associated with risk of falls in the hospitalized older adults. Conclusion High risk of falls in the hospitalized older adults was directly associated with the presence of cognitive impairment, frailty syndrome and sarcopenia risk, confirming that these factors warrant attention from managers and nursing professionals.

Disfunção cognitiva canina: tratamentos disponíveis / Canine cognitive dysfunction: Available treatments

A disfunção cognitiva canina (DCC) é uma enfermidade que causa alterações fisiológicas e comportamentais em cães idosos, e que apresenta uma fisiopatogenia semelhante à doença de Alzheimer (DA), que acomete seres humanos. Os sinais clínicos são representados pela sigla DISHA (desorientação, mudanças na interação com pessoas/animais, alterações no ciclo sono-vigília, falha no aprendizado/memória e nível de atividades alteradas). A principal forma de diagnóstico da doença é baseada em um questionário respondido pelo tutor, relacionado ao comportamento do animal. O tratamento é multimodal, consistindo basicamente em uso de fármacos, mudanças na alimentação, e enriquecimento ambiental e mental. Os fármacos utilizados são de diversas classes farmacológicas e agem diretamente em substâncias relacionadas com a fisiopatogenia da DCC, além de atenuarem alguns sinais clínicos da enfermidade. Essa ação dos fármacos é potencializada com a adição de alimentos específicos, enriquecimento do ambiente que o animal vive e estimulação mental, principalmente por meio de passeios. A união de todas essas modalidades de tratamento auxilia na melhoria do bem-estar do animal acometido. Como a disfunção não tem cura, o tratamento é longo e, muitas vezes, não é possível visualizar melhora evidente no animal. Dessa forma, alguns tutores acabam optando pela eutanásia. Apesar de ser frequente em cães idosos e haver uma ampla base literária acerca da DCC, não há um protocolo terapêutico específico. Sendo assim, há diversos tratamentos disponibilizados de forma isolada na literatura, fazendo com que os clínicos veterinários encontrem dificuldades para achar um compilado de informações em uma única fonte.

Canine cognitive dysfunction (CCD) is a disease that causes physiological and behavioral changes in elderly dogs and presents a physiopathogeny similar to Alzheimer's disease (AD), which affects humans. Clinical signs are represented by the acronym DISHA (disorientation, changes in interaction with people/animals, changes in the sleep-wake cycle, learning/memory failure, and altered activity level). The main form of diagnosis of illness is based on a questionnaire answered by the tutor, related to the animal behavior. The treatment is multimodal, basically consisting of drug use, changes in the diet, and environmental and mental enrichment. The drugs used are of various pharmacological classes and act directly on substances related to the physiopathogeny of CCD, besides attenuating some clinical signs of the disease. This drug action is enhanced with the addition of specific foods, enrichment of the environment where the animal lives and mental stimulation, mainly through tours. The union of all these treatment modalities helps to improve the welfare of the affected animal. As the disease has no cure, the treatment is long and it is often not possible to visualize evident improvement in the animal. In this way, some tutors opt for euthanasia. Despite being frequent in elderly dogs and there is a broad literature on CCD, there is no specific therapeutic protocol. There are several treatments available in isolation in the literature, causing veterinary clinicians find it difficult to locate a compilation of information from a single source.

Estudio piloto sobre el efecto de la telerehabilitación en la calidad de vida de personas mayores con deterioro cognitivo / Pilot study on the effect of telerehabilitation in quality of life among elderly people with cognitive impairment

Introducción: Los procesos de atención a personas mayores han presentado cambios debido al confinamiento sanitario causado por el COVID-19, por esta razón la telerehabilitación se impulsa como una estrategia para continuar los procesos de rehabilitación cognitiva a personas mayores. Objetivo: evaluar la percepción de la calidad de vida de personas mayores con deterioro cognitivo que se encuentran en telerehabilitación, comparado con la calidad de vida de personas mayores con deterioro cognitivo sin telerehabilitación. Método: se realizó un estudio descriptivo para identificar los cambios en la calidad de vida de personas mayores con procesos de telerehabilitación. Se emplearon los instrumentos Quality of Life in Alzheimer's Disease y la escala GENCAT. Resultados: el estudio descriptivo mostró cambios favorables en la calidad de vida de las personas mayores que estuvieron en el proceso de telerehabilitación, mientras que el grupo control presentó cambios negativos. Conclusiones: este estudio permite evidenciar los cambios en la calidad de vida de personas mayores con deterioro cognitivo que participa en un proceso de telerehabilitación durante el confinamiento sanitario. Estos cambios favorables se presentaron en las dimensiones de bienestar emocional, bienestar material, inclusión social y derechos.

Introduction: the processes of care for elderly have presented changes, due to the sanitary confinement caused by COVID-19 pandemic. For this reason, telerehabilitation is promoted as a strategy to continue the processes of cognitive rehabilitation for the elderly. Aim: To evaluate quality of life perceptions among older people with cognitive impairment, who received telerehabilitation, compared with quality of life of older people with cognitive impairment without Telerehabilitation. Method: a descriptive study to identify changes in quality of life of older people receiving tele-rehabilitation processes. Assessment instruments used were: Quality of Life in Alzheimer's Disease and the GENCAT scale. Results: this descriptive study showed favorable changes in quality of life of the elderly who were in the telerehabilitation process, while the control group presented negative changes. Conclusions: this study offers evidence on the changes in the quality of life for elderly people with cognitive impairment who participate in a telerehabilitation process during sanitary confinement. These favorable changes occurred in the dimensions of emotional well-being, material well-being, social inclusion and rights.

Balance rehabilitation with a virtual reality protocol for patients with hereditary spastic paraplegia: Protocol for a clinical trial.

BACKGROUND: Neurodegenerative diseases are sporadic hereditary conditions characterized by progressive dysfunction of the nervous system. Among the symptoms, vestibulopathy is one of the causes of discomfort and a decrease in quality of life. Hereditary spastic paraplegia is a heterogeneous group of hereditary degenerative diseases involving the disorder of a single gene and is characterized by the progressive retrograde degeneration of fibers in the spinal cord. OBJECTIVE: To determine the benefits of vestibular rehabilitation involving virtual reality by comparing pre intervention and post intervention assessments in individuals with hereditary spastic paraplegia. METHODS: In this randomized controlled clinical trial from the Rebec platform RBR-3jmx67 in which allocation concealment was performed and the evaluators be blinded will be included. The participants will include 40 patients diagnosed with hereditary spastic paraplegia. The interventions will include vestibular rehabilitation with virtual reality using the Wii® console, Wii-Remote and Wii Balance Board (Nintendo), and the studies will include pre- and post intervention assessments. Group I will include twenty volunteers who performed balance games. Group II will include twenty volunteers who performed balance games and muscle strength games. The games lasted from 30 minutes to an hour, and the sessions were performed twice a week for 10 weeks (total: 20 sessions). RESULTS: This study provides a definitive assessment of the effectiveness of a virtual reality vestibular rehabilitation program in halting the progression of hereditary spastic paraplegia, and this treatment can be personalized and affordable. CONCLUSION: The study will determine whether a vestibular rehabilitation program with the Nintendo Wii® involving virtual reality can reduce the progressive effect of hereditary spastic paraplegia and serve as an alternative treatment option that is accessible and inexpensive. Rebec platform trial: RBR-3JMX67.

Randomized Controlled Trial of Multi-Component Cognitive Stimulation Therapy (SADEM) in Community-Dwelling Demented Adults.

BACKGROUND: Dementia is a persistent, progressive state of cognitive decline against which pharmacological intervention has a modest efficacy, reducing behavioral but not cognitive symptoms. Therefore, different non-pharmacological therapies have been developed; the most scientifically recognized are cognitive therapies that have improved cognitive function and daily life activities. OBJECTIVE: To evaluate the effectiveness of a multicomponent cognitive stimulation therapy (SADEM) on cognitive and behavioral function and daily life activities in patients with mild stage dementia. METHODS: Controlled clinical trial with pre- and post-intervention (12 months) and follow-up (24 months after) evaluations. Participants (67) diagnosed with mild dementia were randomly assigned to intervention group (n = 39) or control group (n = 28). The intervention took place throughout one year and consisted of two weekly 90-minute sessions and one more a year after a monthly follow-up. Instruments were used to evaluate outcomes in cognitive, behavioral, and affective domains. RESULTS: The results showed statistically significant differences, with improvement in the cognitive outcomes and the Dementia Index post-intervention (p = 0.01). No progression of the disease was observed at the end of the study. CONCLUSION: The multicomponent intervention tested had positive effects on cognitive and behavioral functions and daily life activities in people with mild stage dementia, delaying progression for at least two years.

Rehabilitación neuropsicológica en un caso de trastorno límite de la personalidad / Neuropsychological rehabilitation in a case of borderline personality disorder

La rehabilitación neuropsicológica es una terapia que busca mejorar la independencia y autonomía en pacientes que presentan dificultades cognitivas. El objetivo de la investigación fue determinar la eficacia de un programa de rehabilitación neuropsicológica en una paciente con diagnóstico de trastorno neurocognitivo leve, tipo ejecutivo, asociado a trastorno límite de la personalidad, mediante el fortalecimiento de la atención y de los procesos ejecutivos implicados en la memoria, bajo los principios de sustitución y restitución. Los instrumentos para establecer línea base y para medir el efecto del tratamiento fueron la escala de trastornos de la memoria y la escala de criterios del trastorno límite de la personalidad (TLP) basados en el DSM-V; estos instrumentos se le aplicaron a la paciente y también a su informador para comparar los datos. Los resultados arrojaron una mejoría estadística en las puntuaciones de la escala de trastornos de la memoria y de la escala de criterios para el TLP-DSM-V; pasando de tener una puntuación en memoria de 36 en línea base a 16 después de la intervención, también pasó de tener 3 criterios para impulsividad a 1 criterio después de la intervención. Finalmente se establece la eficacia de la rehabilitación neuropsicológica en los pacientes con TLP, no solo se evidencia mejoría en los síntomas cognitivos asociados a las dificultades en la memoria, sino que también se muestra disminución en los síntomas psiquiátricos asociados con el control de los impulsos.

Neuropsychological rehabilitation is a therapy that seeks to improve independence and autonomy in patients with cognitive difficulties. The objective of the investigation was to determine the efficacy of a neuropsychological rehabilitation program in a patient diagnosed with a mild neurocognitive disorder, executive type, associated with borderline disorder personality, by strengthening attention and executive processes involved in memory, under the principles of substitution and restitution. The instruments to establish a baseline and to measure the effect of treatment were the memory disorders scale and the DSM-V-based borderline personality disorder (BPD) criteria scale; these instruments were applied to the patient and also to her informant to compare the data. The results showed a statistical improvement in the scores of the memory disorders scale and the criteria scale for the BPD-DSM-V; going from having a memory score of 36 at baseline to 16 after the intervention, it also went from having three criteria for impulsivity to one criterion after the intervention. Finally, the efficacy of neuropsychological rehabilitation in patients with BPD is established, not only is there an improvement in the cognitive symptoms associated with memory difficulties, but also a decrease in the psychiatric symptoms associated with impulse control.

[Multidisciplinary rehabilitation for adult patients with stroke]. / Rehabilitación multidisciplinaria para pacientes adultos con accidente cerebrovascular.

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.

Se estima que dos tercios de las personas que han sufrido un accidente cerebrovascular (ACV) tienen secuelas que condicionan su calidad de vida. La rehabilitación del ACV es un proceso complejo, que requiere de un equipo multidisciplinario de profesionales especializados (médicos, kinesiólogos, enfermeros, terapistas ocupacionales, fonoaudiólogos, neuropsicólogos y nutricionistas). Actualmente, las prácticas realizadas en rehabilitación son consecuencia de la combinación de evidencia y consenso, siendo la mayoría aportadas a través de guías internacionales de rehabilitación en ACV. El objetivo de esta revisión es ajustar las recomendaciones internacionales sobre rehabilitación a lo aplicado a la práctica diaria, a fin de unificar criterios en las recomendaciones y reducir la variabilidad de las prácticas empleadas. En este trabajo, se realizó una revisión de la literatura sobre las guías de rehabilitación en ACV realizadas en los últimos 10 años y cada apartado fue supervisado por distintos profesionales especializados en dichas áreas. Se analizaron los tiempos y organización necesaria para desarrollarla, las recomendaciones para la rehabilitación motora, cognitiva y visual, el tratamiento de la disfagia y nutrición, de las comorbilidades (trombosis venosa, úlceras cutáneas, dolor, trastornos psiquiátricos, osteoporosis) y las tareas necesarias para favorecer el retorno a las actividades de la vida diaria.

Rehabilitación multidisciplinaria para pacientes adultos con accidente cerebrovascular / Multidisciplinary rehabilitation for adult patients with stroke

Se estima que dos tercios de las personas que han sufrido un accidente cerebrovascular (ACV) tienen secuelas que condicionan su calidad de vida. La rehabilitación del ACV es un proceso complejo, que requiere de un equipo multidisciplinario de profesionales especializados (médicos, kinesiólogos, enfermeros, terapistas ocupacionales, fonoaudiólogos, neuropsicólogos y nutricionistas). Actualmente, las prácticas realizadas en rehabilitación son consecuencia de la combinación de evidencia y consenso, siendo la mayoría aportadas a través de guías internacionales de rehabilitación en ACV. El objetivo de esta revisión es ajustar las recomendaciones internacionales sobre rehabilitación a lo aplicado a la práctica diaria, a fin de unificar criterios en las recomendaciones y reducir la variabilidad de las prácticas empleadas. En este trabajo, se realizó una revisión de la literatura sobre las guías de rehabilitación en ACV realizadas en los últimos 10 años y cada apartado fue supervisado por distintos profesionales especializados en dichas áreas. Se analizaron los tiempos y organización necesaria para desarrollarla, las recomendaciones para la rehabilitación motora, cognitiva y visual, el tratamiento de la disfagia y nutrición, de las comorbilidades (trombosis venosa, úlceras cutáneas, dolor, trastornos psiquiátricos, osteoporosis) y las tareas necesarias para favorecer el retorno a las actividades de la vida diaria.

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.

Environmental enrichment improves cognitive symptoms and pathological features in a focal model of cortical damage of multiple sclerosis.

Multiple Sclerosis (MS) is a neuroinflammatory disease affecting white and grey matter, it is characterized by demyelination, axonal degeneration along with loss of motor, sensitive and cognitive functions. MS is a heterogeneous disease that displays different clinical courses: relapsing/remitting MS (RRMS), and MS progressive forms: primary progressive (PPMS) and secondary progressive (SPMS). Cortical damage in the progressive MS forms has considerable clinical relevance due to its association with cognitive impairment and disability progression in patients. One treatment is available for the progressive forms of the disease, but none are specific for cognitive deficits. We developed an animal model that reflects most of the characteristics of the cortical damage, such as cortical neuroinflammation, demyelination, neurodegeneration and meningeal inflammation, which was associated with cognitive impairment. Cognitive rehabilitation, exercise and social support have begun to be evaluated in patients and animal models of neurodegenerative diseases. Environmental enrichment (EE) provides exercise as well as cognitive and social stimulation. EE has been demonstrated to exert positive effects on cognitive domains, such as learning and memory, and improving anxiety-like symptoms. We proposed to study the effect of EE on peripherally stimulated cortical lesion induced by the long term expression of interleukin IL-1ß (IL-1ß) in adult rats. Here, we demonstrated that EE: 1) reduces the peripheral inflammatory response to the stimulus, 2) ameliorates cognitive deficits and anxiety-like symptoms, 3) modulates neurodegeneration, demyelination and glial activation, 4) regulates neuroinflammation by reducing the expression of pro-inflammatory cytokines and enhancing the expression of anti-inflammatory ones. Our findings correlate with the fact that EE housing could be considered an effective non- pharmacological therapeutic agent that can synergistically aid in the rehabilitation of the disease.

A Regression Tree for Identifying Risk Factors for Fear of Falling: The International Mobility in Aging Study (IMIAS).

BACKGROUND: We determine the best combination of factors for predicting the risk of developing fear of falling (FOF) in older people via Classification Regression Tree (CaRT) analysis. METHODS: Community-dwelling older adults living in Canada, Albania, Brazil, and Colombia were from International Mobility in Aging Study (IMIAS). In 2014, 1,725 participants (aged 65-74) were assessed. With a retention rate of 81%, in 2016, 1,409 individuals were reassessed. Risk factors for FOF were entered into the CaRT: age, sex, education, self-rated health, comorbidity, medication, visual impairment, frailty, cognitive deficit, depression, fall history, Short Physical Performance Battery (SPPB), walking aid use, and mobility disability measured by the Nagi questionnaire. RESULTS: The classification tree included 12 end groups representing differential risks of FOF with a minimum of two and a maximum of five predictors. The first split in the tree involved impaired physical function (SPPB scores). Respondents with less than 8 in SPPB score and mobility disability had 82% risk of developing FOF at the end of 2-year follow-up. Between 23.2% and 82.3% of the risk of developing FOF in 2 years of follow-up were explained by only five variables: age, sex, self-rated health, functional impairment measured by SPPB, and mobility disability. In those with no functional impairment or mobility disability, levels of education, sex, and self-rated health were important predictors of FOF in the future. CONCLUSION: This classification tree included different groups based on specific combinations of a maximum of five easily measurable predictors with emphasis on impaired physical functioning risk factors for developing FOF.

Cognitive behavioral rehabilitation for bipolar disorder patients: A randomized controlled trial.

OBJECTIVES: Bipolar disorder is frequently associated with cognitive impairment even during euthymia. Previous studies have reported significant impairments in functional and quality of life outcomes and a possible relationship between these variables and cognitive performance. Cognitive rehabilitation interventions have been proposed to address these outcomes but positive results are still scarce. The objective of the present study is to evaluate the efficacy of a new intervention developed to address both cognitive and functional impairment. METHODS: Thirty-nine individuals were included in this randomized controlled trial. All participants were evaluated by the Cambridge Neuropsychological Test Automated Battery (CANTAB) and completed functional and quality of life (QOL) scales. Patients were randomized to either treatment as usual (TAU) or Cognitive Behavior Rehabilitation (CBR), an add-on treatment delivered in 12 weekly group sessions. All individuals were revaluated after 12 weeks. RESULTS: A total of 39 bipolar type I or II patients were included in the analysis, 19 in the TAU group and 20 in the CBR condition. At the entrance of the study, both groups were statistically similar regarding clinical, socio-demographics and cognitive variables. After the end of the intervention, CBR individuals had significantly improved reaction time, visual memory and emotion recognition. In contrast, individuals in the CBR did not present a statistically change in functional and QOL scores after the 12-week intervention. CONCLUSIONS: CBR intervention showed promising results in improving some of the commonly impaired cognitive domains in BD. A longer follow-up period may be necessary to detect changes in functional and QOL domains.

Multicomponent exercise and the hallmarks of frailty: Considerations on cognitive impairment and acute hospitalization.

Frailty syndrome encompasses several physical hallmarks such as loss of muscle strength, power output and mass, which leads to poor gait ability, fatigue, falls and overall difficulty to perform activities of daily living. On the other hand, physical exercise interventions induce marked improvements in frailty physical hallmarks (e.g., gait ability, muscle strength, balance and falls). In addition, because cognitive impairment is closely related to frailty syndrome, exercise is an effective intervention to counteract the physical consequences of mild cognitive impairment and dementia. Moreover, exercise and early rehabilitation programs are among the interventions through which functional decline is prevented in older patients during acute hospitalization. This narrative review provides a summary of the effectiveness of different exercise interventions in the hallmarks of frailty. Furthermore, this review addresses special considerations on exercise in frail older with cognitive impairment. Also, we review the role of exercise interventions in acute hospitalized older patients. There is strong evidence that exercise training is an effective intervention for improving muscle strength, muscle mass, incidence of falls, and gait ability in frail older adults. In addition, it seems that multicomponent exercise intervention programs including resistance, gait and balance training is the best strategy for improving the frailty hallmarks, as well as for reducing the rate of falls in frail individuals, and so maintaining their functional capacity during aging. This training modality also proved to be safe and effective to revert the functional decline and cognitive impairment in acutely hospitalized older adults of advanced age. Based on the association between muscle power output and physical function, explosive resistance training should be included in the exercise intervention in order to optimize the functional outcomes in frail older adults.

The modifying effect of positive emotion on the relationship between cognitive impairment and disability among older Mexican Americans: a cohort study.

OBJECTIVE: To determine if positive emotion modifies the relationship between cognitive impairment and activities of daily living disability status over 10 years in Mexican American adults aged 75 years and older. METHODS: A retrospective cohort design using data from the Hispanic established populations for the epidemiologic studies of the elderly. About 2674 participants aged 75 years and older were included and followed over 10 years. Cognition was measured using the mini-mental state examination, positive emotion was measured using four questions from the Center for Epidemiologic Studies Depression Scale, and disability was measured using seven activities of daily living items. A series of generalized estimating equations models were used, with the initial analysis including those with disability at baseline and subsequent analyses excluding disability at baseline. RESULTS: Positive emotion and cognitive impairment consistently decreased and increased risk for activities of daily living disability, respectively. Positive emotion was a significant modifier in the cross-sectional analysis, and was not a statistically significant modifier in the longitudinal or predictive series analysis. CONCLUSIONS: Positive emotion and cognitive impairment differentially affect the risk of developing activities of daily living disability. Further research is needed to explore the interaction of positive emotion and cognitive impairment, and to identify appropriate interventions that address the specific cognitive and emotional needs of older Mexican Americans. Implications for rehabilitation Promoting emotional well-being may be protective against incident disability for older adults. Cognitive impairment significantly predicts incident disability in activities of daily living and should be considered an early indicator of impending disability for older adults.

The effect of group exercises on balance, mobility, and depressive symptoms in older adults with mild cognitive impairment: a randomized controlled trial.

OBJECTIVE:: To determine the effects of group exercises on balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment. DESIGN:: Single blinded, randomized, matched pairs clinical trial. SETTING:: Four primary healthcare units. SUBJECTS:: Fifty-two sedentary subjects with mild cognitive impairment were paired (age, sex, body mass index, and Addenbrooke's Cognitive Examination Revised score), tested, and then randomized into an intervention group ( n = 26) and a control group ( n = 26). INTERVENTION:: The intervention group performed strength (ankle weights, elastic bands, and dumbbells) and aerobic exercises (walking) in their communities' public spaces, twice a week (60 minutes each), during 24 weeks. The control group maintained its usual routine. MAIN MEASURES:: Balance (Berg Balance Scale (BBS)), mobility (Timed Up and Go Test (TUG)), and depressive symptoms (Geriatric Depression Scale-15) were assessed before and after the intervention. RESULTS:: Before the intervention, the two groups did not differ statistically. After, the intervention group showed significant improvement ( P < 0.05) in balance (before: 53 ± 3; after: 55.1 ± 1.1 points), mobility (before: 10.7 ± 2.9 seconds; after: 8.3 ± 2 seconds), and depressive symptoms (median punctuation (interquartile range) before: 4 (1.8-6); after: 2.5 (1-4)). The control group presented a significant increase in their depressive symptoms (median before: 3.5 (2-7.3); after: 4 (2-5.3)), while their balance and mobility showed no significant modification. Small effect sizes were observed in the intervention group and control group depressive symptoms, as well as in the control group's mobility and balance. Large effect sizes were observed the intervention group's mobility and balance. CONCLUSION:: Group exercises improved balance, mobility, and depressive symptoms in community-dwelling older adults with mild cognitive impairment.

Episodic memory boosting in older adults: exploring the association of encoding strategies and physical activity.

Background: Contextual memory is susceptible to the effects of aging and its impairment compromises episodic memories and quality of life in older adults. Objective: Compare the effects of cognitive support on incidental contextual memory free recall and recognition with a naturalistic experimental paradigm and explore the association of encoding strategies and physical activity on memory improvement. Methods: Subjects (≥60 years, n = 52) were assigned to one of two encoding conditions for the contextual memory task: with or without an incidental associative instruction to encourage association of an item to its spatial context. Immediate free recall and recognition tests were run to assess the encoding instruction efficiency. The association of memory performance and physical activity was analyzed using the scores on the International Physical Activity Questionnaire (IPAQ) to subdivide each experimental group into Low IPAQ (below median) and High IPAQ (above median) subgroups. Results: The associative encoding instruction increased contextual memory free recall and recognition, with greater effects on free recall. The most robust associations between physical activity and contextual memory were also seen on free recall, in which higher levels of physical activity corresponded to increased baseline performance (non-associative encoding condition) and greater improvement of memory by the encoding support (associative encoding condition). Conclusion: Cognitive support at encoding can improve contextual memory free recall and recognition, suggesting they are prone to rehabilitation. Moreover, higher physical activity levels were positively associated with encoding strategies on contextual memory improvement, increasing the availability of latent process-based components of the cognitive reserve.

Rehabilitación cognitiva en déficit cognitivo secundario / Cognitive rehabilitation in deficit secondary cognitive

CONTEXTO CLÍNICO: La cognición se define como el proceso de conocer. Incluye la discriminación y la selección de información relevante, adquisición de información, comprensión, retención, expresión y aplicación del conocimiento en la situación apropiada. La discapacidad cognitiva puede expresarse en la reducción de la eficiencia, el ritmo y la persistencia del funcionamiento, la disminución de la eficacia en el desempeño de las actividades de la vida cotidianas; o falta de adaptación a situaciones nuevas o problemáticas. El déficit cognitivo es una causa importante de discapacidad después de una lesión cerebral traumática (LCT) y accidente cerebrovascular (ACV), también puede estar presente en enfermedades neurológicas, como es el caso de la esclerosis múltiple (EM) y enfermedad de Alzheimer (EA). Se estima de que la LCT y ACV se han convertido en los principales causas de muerte y discapacidad en todo el mundo, y particularmente el ACV constituye la primer causa de invalidez, segunda en demencia y la tercera en muerte dentro del conjunto de las enfermedades neurológicas. Para pacientes con EM la prevalencia problemas cognitivos, que incluyen disfunciones en la memoria, atención, velocidad de procesamiento de la información y funciones ejecutivas, varía de 43% a 72%. TECNOLOGÍA: La rehabilitación cognitiva se define como un servicio orientado de las actividades terapéuticas basadas en la evaluación y comprensión de los déficits conductuales cerebrales destinada a mejorar el desempeño cognitivo de los pacientes. La rehabilitación cognitiva puede dirigirse a muchas áreas de la cognición, que incluyen la atención, concentración, percepción, memoria, comprensión, comunicación, razonamiento, resolución de problemas, juicio, iniciación, planificación, autocontrol y conciencia, etc. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de la rehabilitación cognitiva para pacientes con déficit cognitivo secundario a lesión cerebral traumática, accidente cerebrovascular, esclerosis múltiple, enfermedad de Alzheimer y demencia vascular. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron seis RS, diez GP y 25 informes de políticas de cobertura de la rehabilitación cognitiva para pacientes con déficit cognitivo secundario a lesión cerebral traumática, accidente cerebrovascular, esclerosis múltiple, enfermedad de Alzheimer y demencia vascular. CONCLUSIONES: La evidencia incluida presenta mucha heterogeneidad entre grupos de pacientes, así como abarca intervenciones muy heterogéneas y muchas veces difíciles de agrupar. Evidencia de baja calidad sugiere que la rehabilitación cognitiva podría no mejorar a corto plazo la vuelta al trabajo, la integración comunitaria autorreportada, la calidad de vida y varias escalas cognitivas en pacientes con déficits cognitivos secundarios a lesiones cerebrales traumáticas, enfermedad de Alzheimer leve y demencia vascular. Evidencia de baja calidad sugiere que la rehabilitación cognitiva basada en el entrenamiento de la memoria podría mejorar la valoración subjetiva de la memoria a corto plazo en pacientes con déficit cognitivo secundario a accidente cerebrovascular, aunque este beneficio no se mantiene a largo plazo. En caso de pacientes con déficit cognitivo secundario a esclerosis múltiple, evidencia de baja calidad sugiere que podría mejorar la memoria a corto y largo plazo. También en pacientes con déficit cognitivo secundario a esclerosis múltiple, la rehabilitación cognitiva frente a cualquier control podría mejorar a corto plazo la memoria y el trabajo de memoria. No se identificaron evaluaciones económicas sobre rehabilitación cognitiva en las indicaciones evaluadas. Todas las guías de práctica clínica relevadas proveniente de países de altos ingresos recomiendan la rehabilitación cognitiva en pacientes con déficit cognitivo secundario a lesión cerebral traumática. Para déficit cognitivo secundario a accidente cerebrovascular la mayoría de las guías recomiendan la rehabilitación cognitiva y una no la recomienda. Para déficit cognitivo secundario esclerosis múltiple una guía la recomienda y otra no la menciona. La Sociedad Neurológica Argentina no menciona la rehabilitación cognitiva en su guía de práctica clínica para la enfermedad de Alzheimer. Es de mencionar que las propias guías reconocen que la calidad de la evidencia no es adecuada; y es por ello que las recomendaciones no son fuertes en su favor. En Argentina, la Superintendencia de Servicios de Salud no menciona la rehabilitación cognitiva en el Programa Médico Obligatorio y no es reembolsada por el Sistema Único de Reintegro.