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.

Association of Alcohol Consumption with Cognition and Functionality in Older Adults Aged 75+ Years: The Pietà Study.

The relationship between alcohol consumption and cognition is still controversial. This is a cross-sectional population-based study conducted in Caeté (MG), Brazil, where 602 individuals aged 75+ years, 63.6% female, and with a mean education of 2.68 years, were submitted to thorough clinical assessments and categorized according to the number of alcoholic beverages consumed weekly. The prevalence rates of previous and current alcohol consumption were 34.6% and 12.3%, respectively. No association emerged between cognitive diagnoses and current/previous alcohol consumption categories. Considering current alcohol intake as a dichotomous variable, the absence of alcohol consumption was associated with dementia (OR = 2.34; 95%CI: 1.39-3.90) and worse functionality (p = 0.001). Previous consumption of cachaça (sugar cane liquor) increased the risk of dementia by 2.52 (95%CI: 1.25-5.04). The association between the consumption of cachaça and dementia diagnosis has not been described before.

Diagnostic disclosure of Alzheimer's disease in Brazil: a national survey of specialized physicians.

BACKGROUND: The diagnosis of Alzheimer's disease (AD) can bring financial and emotional consequences to patients and caregivers. Whether or not the diagnosis should be disclosed to patients is a matter of debate amongst physicians and can be influenced by culture and experience. OBJECTIVE: To investigate the current practice of physicians who attend and treat patients with dementia in Brazil regarding the disclosure of dementia diagnosis and compare the practice with what has been performed 15 years ago in the country. METHODS: Data were evaluated using an electronic questionnaire. The questions used to carry out this research were similar to the questions of the study carried out 15 years ago 9. The form was sent to the Brazilian Academy of Neurology, the Brazilian Association of Geriatrics and Gerontology, and the Brazilian Association of Psychiatry, which forwarded it to their members. Analyses were conducted through non-parametric statistical tests, with a post-hoc assessment. RESULTS: 397 physicians responded to the survey, of which 231 are neurologists, 124 geriatricians, 29 psychiatrists and 13 from other specialties. The mean age was 45.2 years. The majority (66.7%) of the physicians reveal the diagnosis of AD always or usually. The youngest group of neurologists were more likely to disclose the diagnosis than the oldest group with a significant difference between them. In comparison to the 2008 Brazilian study, the percentage of physicians who always or usually disclose the diagnosis has risen by 22%. On the other hand, 12.3% of the physicians rarely or never disclose the diagnosis, in comparison to 25,3% in 2008. The main reasons for not disclosing the diagnosis concern the patients' mental health. CONCLUSION: Advances in dementia knowledge and biomarkers availability probably explain the increase in the rate of disclosure. The main challenge is to reconcile the autonomy of affected individuals, mental health issues after the diagnosis and the family member's opinion.

ANTECEDENTES: O diagnóstico da doença de Alzheimer (DA) pode trazer consequências financeiras e emocionais para pacientes e cuidadores. Revelar ou não o diagnóstico aos pacientes é uma questão de debate entre os médicos e pode ser influenciada pela cultura e experiência. OBJETIVO: Investigar a prática atual dos médicos que atendem e tratam pacientes com demência no Brasil quanto à revelação do diagnóstico de demência e comparar a prática com a qual era feita há 15 anos no país. MéTODOS:: Os dados foram avaliados por meio de um questionário eletrônico. As perguntas usadas para realização dessa pesquisa foram similares às perguntas do estudo realizado há 15 anos 9. O formulário foi enviado à Academia Brasileira de Neurologia, à Associação Brasileira de Geriatria e Gerontologia, e à Associação Brasileira de Psiquiatria, as quais o encaminharam aos seus membros. As análises foram realizadas por meio de testes estatísticos não paramétricos, com avaliação post-hoc. RESULTADOS: 397 médicos responderam à pesquisa, sendo 231 neurologistas, 124 geriatras, 29 psiquiatras e 13 de outras especialidades. A média de idade foi de 45,2 anos (standard deviation-SD = 11.6 years). A maioria (66,7%) dos médicos revela o diagnóstico de DA sempre ou habitualmente. O grupo mais jovem de neurologistas foi mais propenso a revelar o diagnóstico do que o mais velho, com diferença significativa entre eles. Em comparação com o estudo brasileiro de 2008, o percentual de médicos que sempre ou usualmente revelam o diagnóstico aumentou em 22%. Em contrapartida, 12,3% dos médicos raramente ou nunca o divulgam, em comparação a 25,3% em 2008. Os principais motivos para não o revelar dizem respeito à saúde mental dos pacientes. CONCLUSãO:: Avanços no conhecimento da demência e disponibilidade de biomarcadores provavelmente explicam o aumento na taxa de divulgação. O principal desafio é conciliar a autonomia dos indivíduos afetados, problemas de saúde mental após o diagnóstico e opinião do familiar.

Clinical and functional correlates of parkinsonism in a population-based sample of individuals aged 75 + : the Pietà study.

BACKGROUND: Parkinsonism is strongly associated with ageing, and many studies have suggested that parkinsonian signs may affect up to half of older adults and is associated with a wide range of adverse health outcomes. We compared clinical and functional characteristics of oldest-old community-dwelling individuals with parkinsonism (parkinsonian group [PG]) to individuals without parkinsonism (non-parkinsonian group [NPG]. METHODS: The Pietà study is a population-based study conducted in Caeté, southeast Brazil, involving 607 individuals aged 75 + years submitted to an extensive clinical evaluation. A subset of 65 PG individuals (61.5% women, median age of 82 years) was compared to 542 NPG individuals (64.8% women, median age of 80 years). RESULTS: PG individuals had significantly more functional impairment, clinical comorbidities (including number of falls, loss of bladder control and dysphagia) and major depression. Multivariate analysis revealed that older age, higher UPDRSm scores, lower category fluency test (animals/minute) and delayed recall memory scores were associated with PG. This group was also more cognitively impaired, with lower performance than NPG individuals in the Mini-Mental State Examination, category fluency test (animals/minute), clock drawing and in delayed recall (p < 0.001 for all tests). UPDRSm scores were the most contributing factor to cognition that independently explained variability in functionality of the entire sample. CONCLUSION: Individuals aged 75 + years with parkinsonism were significantly more clinically and functionally impaired in this population-based sample. Cognitive dysfunction explained most of the loss of functionality in these patients. UPDRS-m scores contributed independently to explain variability in functionality in the whole sample.

Machine Learning-Based Routine Laboratory Tests Predict One-Year Cognitive and Functional Decline in a Population Aged 75+ Years.

BACKGROUND: Cognitive and functional decline are common problems in older adults, especially in those 75+ years old. Currently, there is no specific plasma biomarker able to predict this decline in healthy old-age people. Machine learning (ML) is a subarea of artificial intelligence (AI), which can be used to predict outcomes Aim: This study aimed to evaluate routine laboratory variables able to predict cognitive and functional impairment, using ML algorithms, in a cohort aged 75+ years, in a one-year follow-up study. METHOD: One hundred and thirty-two older adults aged 75+ years were selected through a community-health public program or from long-term-care institutions. Their functional and cognitive performances were evaluated at baseline and one year later using a functional activities questionnaire, Mini-Mental State Examination, and the Brief Cognitive Screening Battery. Routine laboratory tests were performed at baseline. ML algorithms-random forest, support vector machine (SVM), and XGBoost-were applied in order to describe the best model able to predict cognitive and functional decline using routine tests as features. RESULTS: The random forest model showed better accuracy than other algorithms and included triglycerides, glucose, hematocrit, red cell distribution width (RDW), albumin, hemoglobin, globulin, high-density lipoprotein cholesterol (HDL-c), thyroid-stimulating hormone (TSH), creatinine, lymphocyte, erythrocyte, platelet/leucocyte (PLR), and neutrophil/leucocyte (NLR) ratios, and alanine transaminase (ALT), leukocyte, low-density lipoprotein cholesterol (LDL-c), cortisol, gamma-glutamyl transferase (GGT), and eosinophil as features to predict cognitive decline (accuracy = 0.79). For functional decline, the most important features were platelet, PLR and NLR, hemoglobin, globulin, cortisol, RDW, glucose, basophil, B12 vitamin, creatinine, GGT, ALT, aspartate transferase (AST), eosinophil, hematocrit, erythrocyte, triglycerides, HDL-c, and monocyte (accuracy = 0.92). CONCLUSIONS: Routine laboratory variables could be applied to predict cognitive and functional decline in oldest-old populations using ML algorithms.

Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS): Study design and harmonization.

INTRODUCTION: Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS: This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS: Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION: LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.

High performance older adults in a population-based sample with low education: Pietà study.

BACKGROUND: Healthy brain aging can be defined as aging without neurological or psychiatric disorders, sustaining functional independence. In addition to the absence of disease and preserved functionality, there are individuals who stand out for their superior performance to that considered normal for their age in cognitive tests. These individuals are called "high-performance older adults" (HPOA). OBJECTIVES: To investigate the presence of HPOA in an oldest-old population with low education, and if present, to investigate associations with sociodemographic, clinical, and lifestyle variables. METHODS: We evaluated 132 cognitively healthy individuals from the Pietà Study, a population-based investigation with 639 participants. We used the delayed recall from the Rey Auditory-Verbal Learning Test to verify the existence of HPOA and to classify participants based on their performance. Sociodemographic, clinical, and lifestyle variables associated with HPOA were investigated. RESULTS: We identified 18 individuals fulfilling HPOA criteria (age: 77.4 ± 2.6 years old; 14 women; education: 4.6 ± 3.4 years). The other participants, 114 total (age: 79.8 ± 4.5 years old; 69 women; education: 3.0 ± 2.7 years) were classified as "standard performance older adults" (SPOA). In multivariate analysis, younger age (odds ratio [OR] = 0.672; 95% confidence interval [CI]: 0.462-0.979; p = 0.037) and lower scores on the Geriatric Depression Scale (OR = 0.831; 95%CI: 0.688-0.989; p = 0.038) were associated with HPOA. CONCLUSIONS: The present study identifies for the first time HPOA with low educational level, thereby reinforcing the existence of biological substrates related to this condition. Furthermore, the data suggest an association between younger age and less depressive symptoms with HPOA.

ANTECEDENTES: Envelhecimento cerebral saudável pode ser definido como envelhecimento sem transtornos neurológicos ou psiquiátricos e com independência funcional. Além da ausência de doença e funcionalidade preservada, existem indivíduos que se destacam pelo desempenho superior ao normal em testes cognitivos. Estes indivíduos são chamados de "high performance older adults" (HPOA, na sigla em inglês). OBJETIVOS: Investigar a presença de HPOA em uma população de idosos com baixa escolaridade e, se presente, investigar associações com variáveis sociodemográficas, clínicas e de estilo de vida. MéTODOS: Avaliamos 132 indivíduos cognitivamente saudáveis do Estudo Pietà (n = 639). Foi utilizado o Teste de Aprendizagem Auditivo-Verbal de Rey para verificar a existência de HPOA e classificar os participantes em dois grupos com base em seu desempenho. Variáveis sociodemográficas, clínicas e de estilo de vida associadas a HPOA foram investigadas. RESULTADOS: Identificamos 18 indivíduos que preencheram critérios para HPOA (idade: 77,4 ± 2,6 anos; 14 mulheres; escolaridade: 4,6 ± 3,4 anos). Os demais, 114 no total (idade: 79,8 ± 4,5 anos; 69 mulheres; escolaridade: 3,0 ± 2,7 anos), foram classificados como "standard performance older adults" (SPOA, na sigla em inglês). Na análise multivariada, menor idade (odds ratio [OR] = 0,672; intervalo de confiança [IC] 95%: 0,462­0,979; p = 0,037) e menor pontuação na Escala de Depressão Geriátrica (OR = 0,831; IC95%: 0,688­0,989; p = 0,038) foram associados ao grupo HPOA. CONCLUSõES: O presente estudo identifica pela primeira vez HPOA entre indivíduos de baixa escolaridade, reforçando a existência de substratos biológicos relacionados a esta condição. Além disso, os dados sugerem uma associação entre idade mais jovem e menos sintomas depressivos com HPOA.

High performance older adults in a population-based sample with low education: Pietà study / Idosos de alta performance cognitiva em uma amostra de base populacional com baixa escolaridade: estudo Pietà

Abstract Background Healthy brain aging can be defined as aging without neurological or psychiatric disorders, sustaining functional independence. In addition to the absence of disease and preserved functionality, there are individuals who stand out for their superior performance to that considered normal for their age in cognitive tests. These individuals are called "high-performance older adults" (HPOA). Objectives To investigate the presence of HPOA in an oldest-old population with low education, and if present, to investigate associations with sociodemographic, clinical, and lifestyle variables. Methods We evaluated 132 cognitively healthy individuals from the Pietà Study, a population-based investigation with 639 participants. We used the delayed recall from the Rey Auditory-Verbal Learning Test to verify the existence of HPOA and to classify participants based on their performance. Sociodemographic, clinical, and lifestyle variables associated with HPOA were investigated. Results We identified 18 individuals fulfilling HPOA criteria (age: 77.4 ± 2.6 years old; 14 women; education: 4.6 ± 3.4 years). The other participants, 114 total (age: 79.8 ± 4.5 years old; 69 women; education: 3.0 ± 2.7 years) were classified as "standard performance older adults" (SPOA). In multivariate analysis, younger age (odds ratio [OR] =0.672; 95% confidence interval [CI]: 0.462-0.979; p = 0.037) and lower scores on the Geriatric Depression Scale (OR = 0.831; 95%CI: 0.688-0.989; p = 0.038) were associated with HPOA. Conclusions The present study identifies for the first time HPOA with low educational level, thereby reinforcing the existence of biological substrates related to this condition. Furthermore, the data suggest an association between younger age and less depressive symptoms with HPOA.

Resumo Antecedentes Envelhecimento cerebral saudável pode ser definido como envelhecimento sem transtornos neurológicos ou psiquiátricos e com independência funcional. Além da ausência de doença e funcionalidade preservada, existem indivíduos que se destacam pelo desempenho superior ao normal em testes cognitivos. Estes indivíduos são chamados de "high performance older adults" (HPOA, na sigla em inglês). Objetivos Investigar a presença de HPOA em uma população de idosos com baixa escolaridade e, se presente, investigar associações com variáveis sociodemográficas, clínicas e de estilo de vida. Métodos Avaliamos 132 indivíduos cognitivamente saudáveis do Estudo Pietà (n = 639). Foi utilizado o Teste de Aprendizagem Auditivo-Verbal de Rey para verificar a existência de HPOA e classificar os participantes em dois grupos com base em seu desempenho. Variáveis sociodemográficas, clínicas e de estilo de vida associadas a HPOA foram investigadas. Resultados Identificamos 18 indivíduos que preencheram critérios para HPOA (idade: 77,4 ± 2,6 anos; 14 mulheres; escolaridade: 4,6 ± 3,4 anos). Os demais, 114 no total (idade: 79,8 ± 4,5 anos; 69 mulheres; escolaridade: 3,0 ± 2,7 anos), foram classificados como "standard performance older adults" (SPOA, na sigla em inglês). Na análise multivariada, menor idade (odds ratio [OR] =0,672; intervalo de confiança [IC] 95%: 0,462-0,979; p = 0,037) e menor pontuação na Escala de Depressão Geriátrica (OR = 0,831; IC95%: 0,688-0,989; p = 0,038) foram associados ao grupo HPOA. Conclusões O presente estudo identifica pela primeira vez HPOA entre indivíduos de baixa escolaridade, reforçando a existência de substratos biológicos relacionados a esta condição. Além disso, os dados sugerem uma associação entre idade mais jovem e menos sintomas depressivos com HPOA.

Cuidados paliativos: percepção do ensino e avaliação de conceitos entre estudantes de medicina / Palliative care: perception of teaching and evaluation of concepts among medical undergraduates / Cuidados paliativos: percepción de la enseñanza y evaluación de conceptos entre estudiantes de medicina

Resumo O objetivo deste trabalho foi avaliar o conhecimento sobre cuidados paliativos de estudantes do quarto, quinto e sexto anos da graduação em medicina de uma faculdade particular de Belo Horizonte, bem como investigar sua percepções sobre o ensino do tema. Trata-se de estudo transversal observacional com aplicação de questionário on-line para 135 acadêmicos. Dentre os participantes, 40,7% consideram-se preparados para lidar com morte de pacientes e luto dos familiares, 80,7% classificam o próprio nível de conhecimento sobre cuidados paliativos como regular e 77% afirmam não ter recebido informações suficientes sobre o assunto. Ao avaliar conceitos, 20% tiveram desempenho insatisfatório, 48% aceitável e 3% excelente. Acadêmicos de anos mais avançados e que fizeram o internato em saúde do idoso apresentaram melhores respostas. Revelou-se que, apesar de o desempenho dos estudantes ser em geral regular, o internato em saúde do idoso tem impacto positivo na aquisição de conhecimento sobre cuidados paliativos.

Abstract This study evaluates the knowledge of fourth, fifth and sixth-year medical undergraduates about palliative care and their perceptions regarding teaching of this topic. Cross-sectional observational research was conducted with 135 undergraduates from a private medical school in Belo Horizonte by means of an online questionnaire. Of the participants, 40.7% considered themselves prepared to address patient death and the bereavement of family members, 80.7% rated their level of knowledge about palliative care as mediocre and 77% said they received insufficient information on the subject. When evaluating concepts, 20% of the participants had an unsatisfactory performance, 48% acceptable and 3% excellent. Students from more advanced years and who had completed an internship in elderly health had better responses. Despite regular student performance, the internship in elderly health positively impacts the acquisition of palliative care knowledge.

Resumen El objetivo de este trabajo fue evaluar el conocimiento sobre cuidados paliativos de estudiantes de cuarto, quinto y sexto curso de la carrera de medicina de una facultad privada de Belo Horizonte, así como investigar sus percepciones sobre la enseñanza del tema. Se trata de un estudio observacional transversal que utilizó un cuestionario en línea para 135 académicos. Entre los participantes, el 40,7% se considera preparado para afrontar la muerte de los pacientes y el duelo de los familiares, el 80,7% califica como regular su propio nivel de conocimiento sobre cuidados paliativos, y el 77% afirma no haber recibido suficiente información sobre el tema. Al evaluar conceptos, el 20% tuvo un desempeño insatisfactorio, el 48% aceptable y el 3% excelente. Los académicos de años más avanzados y que completaron el internado en salud del anciano presentaron mejores respuestas. Se reveló que, aunque el desempeño de los estudiantes sea generalmente regular, el internado en salud del anciano tiene impacto positivo en la adquisición de conocimiento sobre cuidados paliativos.

Diagnostic disclosure of Alzheimer's disease in Brazil: a national survey of specialized physicians / Revelação do diagnóstico da doença de Alzheimer no Brasil: prática corrente de médicos que atendem pacientes com demência

Abstract Background: The diagnosis of Alzheimer's disease (AD) can bring financial and emotional consequences to patients and caregivers. Whether or not the diagnosis should be disclosed to patients is a matter of debate amongst physicians and can be influenced by culture and experience. Objective: To investigate the current practice of physicians who attend and treat patients with dementia in Brazil regarding the disclosure of dementia diagnosis and compare the practice with what has been performed 15 years ago in the country. Methods: Data were evaluated using an electronic questionnaire. The questions used to carry out this research were similar to the questions of the study carried out 15 years ago 9. The form was sent to the Brazilian Academy of Neurology, the Brazilian Association of Geriatrics and Gerontology, and the Brazilian Association of Psychiatry, which forwarded it to their members. Analyses were conducted through non-parametric statistical tests, with a post-hoc assessment. Results: 397 physicians responded to the survey, of which 231 are neurologists, 124 geriatricians, 29 psychiatrists and 13 from other specialties. The mean age was 45.2 years. The majority (66.7%) of the physicians reveal the diagnosis of AD always or usually. The youngest group of neurologists were more likely to disclose the diagnosis than the oldest group with a significant difference between them. In comparison to the 2008 Brazilian study, the percentage of physicians who always or usually disclose the diagnosis has risen by 22%. On the other hand, 12.3% of the physicians rarely or never disclose the diagnosis, in comparison to 25,3% in 2008. The main reasons for not disclosing the diagnosis concern the patients' mental health. Conclusion: Advances in dementia knowledge and biomarkers availability probably explain the increase in the rate of disclosure. The main challenge is to reconcile the autonomy of affected individuals, mental health issues after the diagnosis and the family member's opinion.

Resumo Antecedentes: O diagnóstico da doença de Alzheimer (DA) pode trazer consequências financeiras e emocionais para pacientes e cuidadores. Revelar ou não o diagnóstico aos pacientes é uma questão de debate entre os médicos e pode ser influenciada pela cultura e experiência. Objetivo: Investigar a prática atual dos médicos que atendem e tratam pacientes com demência no Brasil quanto à revelação do diagnóstico de demência e comparar a prática com a qual era feita há 15 anos no país. Métodos: Os dados foram avaliados por meio de um questionário eletrônico. As perguntas usadas para realização dessa pesquisa foram similares às perguntas do estudo realizado há 15 anos 9. O formulário foi enviado à Academia Brasileira de Neurologia, à Associação Brasileira de Geriatria e Gerontologia, e à Associação Brasileira de Psiquiatria, as quais o encaminharam aos seus membros. As análises foram realizadas por meio de testes estatísticos não paramétricos, com avaliação post-hoc. Resultados: 397 médicos responderam à pesquisa, sendo 231 neurologistas, 124 geriatras, 29 psiquiatras e 13 de outras especialidades. A média de idade foi de 45,2 anos (standard deviation-SD = 11.6 years). A maioria (66,7%) dos médicos revela o diagnóstico de DA sempre ou habitualmente. O grupo mais jovem de neurologistas foi mais propenso a revelar o diagnóstico do que o mais velho, com diferença significativa entre eles. Em comparação com o estudo brasileiro de 2008, o percentual de médicos que sempre ou usualmente revelam o diagnóstico aumentou em 22%. Em contrapartida, 12,3% dos médicos raramente ou nunca o divulgam, em comparação a 25,3% em 2008. Os principais motivos para não o revelar dizem respeito à saúde mental dos pacientes. Conclusão: Avanços no conhecimento da demência e disponibilidade de biomarcadores provavelmente explicam o aumento na taxa de divulgação. O principal desafio é conciliar a autonomia dos indivíduos afetados, problemas de saúde mental após o diagnóstico e opinião do familiar.

Diagnosis and management of Parkinson's disease dementia and dementia with Lewy bodies: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) represent the second most common type of degenerative dementia in patients aged 65 years and older, leading to progressive cognitive dysfunction and impaired quality of life. This study aims to provide a consensus based on a systematic Brazilian literature review and a comprehensive international review concerning PDD and DLB. Moreover, we sought to report on and give recommendations about the best diagnostic approaches focusing on primary and secondary care. Based on the available data, we recommend clinicians to apply at least one brief global cognitive instrument to assess PDD, such as the Mini-Mental State Examination and preferably the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised. Validated instruments to accurately assess functional abilities in Brazilian PD patients are still incipient. Further studies should focus on biomarkers with Brazilian cohorts.

A demência da doença de Parkinson (DDP) e a demência com corpos de Lewy (DCL) representam a segunda causa mais comum de demência neurodegenerativa em pessoas com mais de 65 anos, ocasionando progressivo declínio cognitivo e comprometimento da qualidade de vida. O presente estudo tem como objetivo prover um consenso de especialistas sobre a DDP e DCL, baseado em revisão sistemática da literatura brasileira e revisão não-sistemática de literatura internacional. Ademais, tal estudo visa promover informação e conceder recomendações sobre abordagem diagnóstica, com foco nos níveis de atenção primária e secundária em saúde. Com base nos dados disponíveis, recomendamos que os profissionais realizem pelo menos um breve instrumento cognitivo global, como o Mini-Exame do Estado Mental, contudo de preferência optem pela Avaliação Cognitiva de Montreal e o Exame Cognitivo de Addenbrooke-Revisado. Observa-se uma carência de instrumentos validados para a avaliação precisa das habilidades funcionais em pacientes brasileiros com DDP e DCL. Além disso, mais estudos focando em biomarcadores com coortes brasileiras também são necessários.

Diagnóstico e manejo da demência da doença de Parkinson e demência com corpos de Lewy: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia / Diagnosis and management of Parkinson's disease dementia and dementia with Lewy bodies: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

RESUMO A demência da doença de Parkinson (DDP) e a demência com corpos de Lewy (DCL) representam a segunda causa mais comum de demência neurodegenerativa em pessoas com mais de 65 anos, ocasionando progressivo declínio cognitivo e comprometimento da qualidade de vida. O presente estudo tem como objetivo prover um consenso de especialistas sobre a DDP e DCL, baseado em revisão sistemática da literatura brasileira e revisão não-sistemática de literatura internacional. Ademais, tal estudo visa promover informação e conceder recomendações sobre abordagem diagnóstica, com foco nos níveis de atenção primária e secundária em saúde. Com base nos dados disponíveis, recomendamos que os profissionais realizem pelo menos um breve instrumento cognitivo global, como o Mini-Exame do Estado Mental, contudo de preferência optem pela Avaliação Cognitiva de Montreal e o Exame Cognitivo de Addenbrooke-Revisado. Observa-se uma carência de instrumentos validados para a avaliação precisa das habilidades funcionais em pacientes brasileiros com DDP e DCL. Além disso, mais estudos focando em biomarcadores com coortes brasileiras também são necessários.

ABSTRACT Parkinson's disease dementia (PDD) and dementia with Lewy bodies (DLB) represent the second most common type of degenerative dementia in patients aged 65 years and older, leading to progressive cognitive dysfunction and impaired quality of life. This study aims to provide a consensus based on a systematic Brazilian literature review and a comprehensive international review concerning PDD and DLB. Moreover, we sought to report on and give recommendations about the best diagnostic approaches focusing on primary and secondary care. Based on the available data, we recommend clinicians to apply at least one brief global cognitive instrument to assess PDD, such as the Mini-Mental State Examination and preferably the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised. Validated instruments to accurately assess functional abilities in Brazilian PD patients are still incipient. Further studies should focus on biomarkers with Brazilian cohorts.

When My Child Has Alzheimer's Disease.

The significant increment in life expectancy, associated to the existence of high-performing older adults, and the appropriate diagnosis of early dementias, lead to an uncommon scenario, of healthy parents accompanying their children with Alzheimer's disease or another dementia to medical consultations. Here, we reported three peculiar clinical vignettes of patients diagnosed with a dementia, who were accompanied by healthy parents. This is a modern situation that tends to become more frequent, and must be properly discussed, since multidisciplinary care and specific training are necessary.

Brazilian Version of Addenbrooke's Cognitive Examination-Revised in the Differential Diagnosis of Alzheimer'S Disease and Behavioral Variant Frontotemporal Dementia.

INTRODUCTION: Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) are frequent causes of dementia and, therefore, instruments for differential diagnosis between these two conditions are of great relevance. OBJECTIVE: To investigate the diagnostic accuracy of Addenbrooke's Cognitive Examination-Revised (ACE-R) for differentiating AD from bvFTD in a Brazilian sample. METHODS: The ACE-R was administered to 102 patients who had been diagnosed with mild dementia due to probable AD, 37 with mild bvFTD and 161 cognitively healthy controls, matched according to age and education. Additionally, all subjects were assessed using the Mattis Dementia Rating Scale and the Neuropsychiatric Inventory. The performance of patients and controls was compared by using univariate analysis, and ROC curves were calculated to investigate the accuracy of ACE-R for differentiating AD from bvFTD and for differentiating AD and bvFTD from controls. The verbal fluency plus language to orientation plus name and address delayed recall memory (VLOM) ratio was also calculated. RESULTS: The optimum cutoff scores for ACE-R were <80 for AD, <79 for bvFTD, and <80 for dementia (AD + bvFTD), with area under the receiver operating characteristic curves (ROC) (AUC) >0.85. For the differential diagnosis between AD and bvFTD, a VLOM ratio of 3.05 showed an AUC of 0.816 (Cohen's d = 1.151; p < .001), with 86.5% sensitivity, 71.4% specificity, 72.7% positive predictive value, and 85.7% negative predictive value. CONCLUSIONS: The Brazilian ACE-R achieved a good diagnostic accuracy for differentiating AD from bvFTD patients and for differentiating AD and bvFTD from the controls in the present sample.

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.

Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization.

There are different causes of memory complaints in the elderly, such as subjective cognitive decline (SCD), mild cognitive impairment (MCI) or dementia. OBJECTIVE: 1) To characterize individuals with memory complaints in a mid-sized city in Brazil, through clinical, cognitive and functional assessment; 2) to compare SCD individuals with MCI and dementia patients in terms of clinical and cognitive variables. METHODS: We consecutively included individuals aged ≥50 years, with memory complaints (spontaneous or inquired). Subjects who scored ≥25 on the Memory Complaint Questionnaire or who had spontaneous memory complaints were selected. Participants underwent a semi-structured interview, the Mini-Mental State Examination, Figure Memory Test for visual episodic memory, Clock Drawing Test, Category Fluency (Animals), Neuropsychiatric Inventory, and functional assessment. Individuals were classified as SCD, MCI or dementia. We did not include individuals with previous diagnosis of dementia. RESULTS: The final sample consisted of 91 subjects (73.6% women; mean age 67.6±9.8 years): 14.3% had spontaneous complaints and 85.7% had inquired complaints. The most common comorbidities were hypertension (69.2%), diabetes (36.3%), and dyslipidemia (24.2%). Low levels of vitamin B12 and hypothyroidism were found in 26.4 and 16.5%, respectively. Regarding cognitive diagnosis, 16.5% of the sample were classified as SCD, 49.4% as MCI and 34.1% as dementia. MCI and dementia were identified in five (38.5%) and seven (53.4%) patients with spontaneous complaint, respectively. CONCLUSIONS: MCI and dementia are frequently underdiagnosed. Potential reversible causes of cognitive decline are common. The diagnosis of dementia is highly frequent among individuals with spontaneous memory complaints.

Há diferentes causas de queixas de memória nos idosos, como declínio cognitivo subjetivo (DCS), comprometimento cognitivo leve (CCL) ou demências. OBJETIVO: 1) Caracterizar indivíduos com queixa de memória em uma cidade de médio porte do Brasil, por meio de avaliação clínica, cognitiva e funcional; 2) comparar indivíduos com DCS, com CCL e pacientes com demência em termos de variáveis clínicas e cognitivas. MÉTODOS: Incluiu-se, de modo consecutivo, indivíduos com idade ≥50 anos, com queixas de memória (espontânea ou inquirida). Foram selecionados participantes que pontuaram ≥25 no Questionário de Queixa de Memória ou que apresentaram queixa de memória espontânea. Todos foram submetidos à entrevista semiestruturada, Miniexame do Estado Mental, Teste de Figuras (teste de memória episódica visual), Teste do Desenho do Relógio, Fluência Semântica (Animais), Inventário Neuropsiquiátrico e avaliação funcional. Os indivíduos foram classificados em declínio cognitivo subjetivo (DCS), CCL e demência. RESULTADOS: A amostra final foi composta por 91 indivíduos (73,6% mulheres; média de idade 67,6±9,8 anos); 14,3% apresentaram queixa espontânea e 85,7%, queixa inquirida. As comorbidades mais comuns foram hipertensão (69,2%), diabetes (36,3%) e dislipidemia (24,2%). Baixos níveis de vitamina B12 e hipotireoidismo foram encontrados em 26,4 e 16,5%, respectivamente. Quanto ao diagnóstico cognitivo, 16,5% foram classificados como DCS, 49,4% como CCL e 34,1% como demência. CCL e demência foram respectivamente identificados em cinco (38,5%) e sete (53,4%) pacientes com queixa espontânea de memória. CONCLUSÕES: CCL e demência são frequentemente subdiagnosticados. Causas potencialmente reversíveis de declínio cognitivo foram frequentes na amostra. O diagnóstico de demência foi muito frequente entre indivíduos com queixas espontâneas de memória.

Diabetes and impaired fasting glucose in a population-based sample of individuals aged 75 + years: associations with cognition, major depressive disorder, functionality and quality of life-the Pietà study.

OBJECTIVES: To investigate the rates of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a population-based sample of individuals aged 75 + years old and their associations with cognitive performance, depression, functionality, and quality of life (QoL). STUDY DESIGN: Overall, 350 people participated in the study. Assessments of cognition, mood, functionality and QoL were performed using the mini-mental state examination (MMSE), clock-drawing, category fluency tests, the Mini-International Neuropsychiatric Interview, Pfeffer's Functional Activities Questionnaire, and the WHO Quality of Life-Old (WHOQOL-OLD). RESULTS: IFG (ADA criteria) was identified in 42.1% of the sample, while the DM rate was 24.1%. Lack of knowledge of the DM diagnosis and lack of treatment occurred in 27% and 39% of the sample, respectively. Rates of dementia and depression, MMSE, category fluency scores, and previous cardiovascular events did not differ between the glycaemic groups. Individuals with DM performed worse on the clock-drawing test, functionality, and WHOQOL-OLD than the other participants. Individuals with IFG presented similar QoL and functionality when compared with the group without DM. CONCLUSIONS: IFG and DM were common in this population-based sample aged 75 + years old, as were inadequate diagnoses and treatments of DM. DM individuals presented poor performance in the executive function test, functionality, and QoL. Further studies are recommended to investigate the value of an IFG diagnosis among the most elderly population.

The influence of age, sex and education on the phenomenology of depressive symptoms in a population-based sample aged 75+ years with major depression: the Pietà Study.

OBJECTIVES: Late-life depression (LLD) is the most common mental disorder among the elderly, but its clinical features remain unclear, especially among older adults. We sought to investigate if age, sex and education could influence the severity or frequency of LLD symptoms. METHODS: We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the Mini International Neuropsychiatric Interview to diagnose major depression according to DSM-IV criteria and the GDS-15 to measure depression severity. RESULTS: Excluding 174 individuals diagnosed with dementia, 54 (11.6%) of the remaining 457 individuals were diagnosed with LLD; 77.8% of which were female. On average, these participants were aged 81.0 ± 4.8 years and had 2.7 ± 3.3 years of schooling. Symptom severity was not influenced by sociodemographic variables. Death/suicidal ideation was more frequent among men, while psychomotor disturbance was more present in women (p = 0.04 and p = 0.042). More educated individuals (≥ 4 years) also reported a higher frequency of psychomotor disturbance (p = 0.039). CONCLUSIONS: Severity of depressive episode was not influenced by sociodemographic variables. Sex and educational level had a significant impact on symptom profiles.

Challenges in public perception: highlights from the United Kingdom-Brazil Dementia Workshop.

In July 2019, Belo Horizonte hosted an international workshop for 27 junior researchers, whose participants were from Brazil and the United Kingdom. This three-day meeting organized by the Universidade Federal de Minas Gerais and the University of East Anglia addressed challenges in cognitive impairment and dementia, with particular interest in public perceptions, diagnosis and care management. The purpose of this report is to highlight the outcomes of the above-mentioned workshop regarding the topic of public perceptions (part I). Discussions focused on differences and similarities between countries, as well as on identifying main issues that required collaborative and creative solutions. After these group discussions, four core themes emerged: I) cognitive impairment; II) dementia - beyond Alzheimer's disease; III) prevention; and IV) stigma. National and international initiatives to deal with public misperceptions about cognitive impairment and dementia were discussed.

Em julho de 2019, Belo Horizonte sediou um workshop internacional cujos participantes foram 27 pesquisadores do Brasil e do Reino Unido. Essa reunião de três dias, organizada pela Universidade Federal de Minas Gerais e pela Universidade de East Anglia, abordou os desafios no comprometimento cognitivo e na demência, com interesse particular nas percepções do público, diagnóstico e gerenciamento de cuidados. O objetivo deste relatório foi destacar os resultados do workshop sobre o tópico percepções do público (parte I). O enfoque das discussões foi nas semelhanças e diferenças entre os países, bem como na identificação dos principais problemas que necessitam soluções criativas e colaborativas. Após essas discussões em grupo, quatro temas principais foram elencados: I) comprometimento cognitivo; II) demência - além da doença de Alzheimer; III) prevenção; e IV) estigma. Foram discutidas iniciativas nacionais e internacionais para lidar com as percepções alteradas do público sobre comprometimento cognitivo e demência.

Challenges in public perception: highlights from the United Kingdom-Brazil Dementia Workshop / Desafios na percepção pública: destaques do Workshop Reino Unido-Brasil sobre Demência

ABSTRACT. In July 2019, Belo Horizonte hosted an international workshop for 27 junior researchers, whose participants were from Brazil and the United Kingdom. This three-day meeting organized by the Universidade Federal de Minas Gerais and the University of East Anglia addressed challenges in cognitive impairment and dementia, with particular interest in public perceptions, diagnosis and care management. The purpose of this report is to highlight the outcomes of the above-mentioned workshop regarding the topic of public perceptions (part I). Discussions focused on differences and similarities between countries, as well as on identifying main issues that required collaborative and creative solutions. After these group discussions, four core themes emerged: I) cognitive impairment; II) dementia - beyond Alzheimer's disease; III) prevention; and IV) stigma. National and international initiatives to deal with public misperceptions about cognitive impairment and dementia were discussed.

RESUMO. Em julho de 2019, Belo Horizonte sediou um workshop internacional cujos participantes foram 27 pesquisadores do Brasil e do Reino Unido. Essa reunião de três dias, organizada pela Universidade Federal de Minas Gerais e pela Universidade de East Anglia, abordou os desafios no comprometimento cognitivo e na demência, com interesse particular nas percepções do público, diagnóstico e gerenciamento de cuidados. O objetivo deste relatório foi destacar os resultados do workshop sobre o tópico percepções do público (parte I). O enfoque das discussões foi nas semelhanças e diferenças entre os países, bem como na identificação dos principais problemas que necessitam soluções criativas e colaborativas. Após essas discussões em grupo, quatro temas principais foram elencados: I) comprometimento cognitivo; II) demência - além da doença de Alzheimer; III) prevenção; e IV) estigma. Foram discutidas iniciativas nacionais e internacionais para lidar com as percepções alteradas do público sobre comprometimento cognitivo e demência.