Impact of the Pandemic Time on the Mental Health of People with Dementia and Their Family Caregivers in Brazil and Chile: One-Year Follow-Up.

Background: Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective: To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods: This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61). Results: In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07). Conclusions: In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year.

Acute exercise increases BDNF serum levels in patients with Parkinson's disease regardless of depression or fatigue.

Studies have consistently reported a decreased level of brain-derived neurotrophic factor (BDNF) in individuals with Parkinson's disease (PD). The benefits of exercise on BDNF levels are well-documented in humans, however, the effects of acute exercise are inconclusive in neurological disorders. In addition, there are no studies investigating a precursor molecule - proBDNF - and its comparison to patients with vs. without depression or fatigue. Thirty patients with PD were instructed to walk on a treadmill at light to moderate intensity for 30 min. Generalized Estimating Equation (GEE) showed a significant effect of time (pre- vs. post-exercise) when compared individuals with vs. without depression [Wald Chi Square (4.392), p = 0.036)] and with vs. without fatigue [Wald Chi Square (7.123), p = 0.008)] for mature BDNF (mBDNF) level. There was no effect of group, time, and group x time interaction for proBDNF level when compared individuals with vs. without depression or fatigue. The present study showed that a single bout of light to moderate-intensity exercise increases mBDNF serum levels in patients with PD regardless of depression and fatigue. Our finding is important because it is necessary investigate methods to enhance the gains made by rehabilitation, especially when considering a short period of rehabilitation in different health services. The increase in mBDNF level can lead to an enhancement of neuroplasticity and facilitate the improvement of motor performance. No effect on proBDNF level could be explained, as this precursor molecule is cleaved by intracellular or extracellular enzymes.

Functional mobility in Parkinson's disease: associations with motor and non-motor symptoms / Mobilidade funcional em indivíduos com doença de Parkinson: associações com alterações motoras e não motoras

Functional mobility (FM) is the ability of people to move in different environments, including at home, at work, and in the community, in order to perform functional activities or tasks, independently and safely. Objective: The aim of the present study was to investigate which motor and/or non-motor symptoms (severity of the motor symptoms, depressive symptoms, and fatigue) have the greatest impact on FM assessed by Modified Parkinson Activity Scale (mPAS) in individuals with Parkinson's disease (PD). Method: The outcome of interest was FM assessed by mPAS, which includes 14 activities covering three domains (chair transfers, gait akinesia, and bed mobility). Unified Parkinson's Disease Rating Scale (UPDRS) Part III, Beck Depression Inventory (BDI), and Parkinson's Disease Fatigue Scale-16 (PFS-16) were used. Results: Forty-four individuals (age: 65±11 years) with PD (PD duration: 7±4 years) were eligible to take part in this cross-sectional, exploratory study. The motor symptoms alone explained 36% (F= 17.85, p<0.001) of the variance in the FM scores. When depressive symptoms were included in the model, the explained variance increased to 45% (F= 12.77, p<0.001). This indicated that individuals who had lower motor and depressive symptoms were less likely to have limitations in FM. Conclusion: The findings of the present study demonstrated that motor symptoms were the best potential predictor of FM in individuals with PD, according to mPAS scores. Additionally, the presence of depressive symptoms should not be overlooked.

Mobilidade funcional (MF) é a capacidade das pessoas de se movimentarem em diferentes ambientes, incluindo em casa, no trabalho e na comunidade, a fim de realizar atividades ou tarefas funcionais, de forma independente e segura. Objetivo: Investigar quais variáveis (gravidade das alterações motoras, sintomas depressivos e fadiga) têm maior impacto na MF avaliada por meio da Escala Modificada de Atividade em Parkinson (mPAS) em indivíduos com doença de Parkinson (DP). Método: A MF avaliada por meio da mPAS, que inclui 14 atividades em três domínios (transferências de cadeira, acinesia da marcha, mobilidade na cama). Escala Unificada de Avaliação da Doença de Parkinson (UPDRS) Parte III, Inventário de Depressão de Beck (BDI) e Escala de Fadiga da Doença de Parkinson-16 (PFS-16) foram usados. Resultados: 45 indivíduos (idade: 65 ± 11 anos) com DP (duração do DP: 7 ± 4 anos) participaram deste estudo transversal e exploratório. A gravidade das alterações motoras explicou 36% (F= 17,85, p <0,001) da variância nos escores de MF. Quando os sintomas depressivos foram incluídos no modelo, a variância explicada aumentou para 45% (F= 12,77, p <0,001). Isso indicou que indivíduos com menor gravidade das alterações motoras e sintomas depressivos eram menos propensos a ter limitações na MF. Conclusão: As alterações motoras foram o principal preditor da MF em indivíduos com DP, de acordo com os escores da mPAS. Além disso, a presença de sintomas depressivos não deve ser negligenciada.

Impact of Social Isolation on People with Dementia and Their Family Caregivers.

BACKGROUND: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. OBJECTIVE: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. METHODS: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. RESULTS: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. CONCLUSION: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.