Asociación entre nivel educacional y sospecha de deterioro cognitivo en personas mayores chilenas: resultados de la Encuesta Nacional de Salud 2016-2017 / Association between educational level and suspicion of cognitive imparirment in Chilean older people

BACKGROUND: A low education level has been associated with cognitive impairment in older adults. AIM: To determine the association between educational attainment and suspicion of cognitive imparirment in older Chilean population. MATERIAL AND METHODS: Data from 2,005 adults aged ≥ 60 years assessed during 2016-2017 Chilean National Health Survey were included. Education was self-reported and categorized as primary: ≤ 8 years; secondary: 9 to 12 years and beyond secondary: > 12 years. suspicion of cognitive imparirment was assessed with the Mini-Mental questionnaire. RESULTS: Men and women with low education attainment had a higher prevalence of cognitive impairment (33% [95% confidence intervals (CI): 24; 41] and 27% [95% CI: 21; 33], respectively). Men who reported less schooling (≤ 8 years) were more likely to be at risk of suspicion of cognitive imparirment (Odds ratio (OR): 4.53 [95% CI: 1.10, 18.62]) compared to their peers. Women showed a substantially higher magnitude of association than men. The probability of suspicion of cognitive imparirment increased 9-times (OR: 9.96 [95% CI: 1.24; 79.6]) for 9-12 years and 18-times for ≤ 8 years of education (OR: 18.8 [95% CI: 2.42; 146.1]) compared to women with higher education. CONCLUSIONS: Older adults with low education attainment had an increased likelihood of developing suspicion of cognitive imparirment. However, the risk differs by sex, being higher in women than men.

Cognitive impairment related to arterial stiffness in cardiovascular disease patients with severe periodontitis / Deterioro cognitivo relacionado a la rigidez arterial en pacientes con enfermedad cardiovascular y periodontitis grave

ABSTRACT Severe periodontal disease (SPD) associated with systemic peripheral inflammation, cognitive impairment (CI) and arterial stiffness (AS) has been recognized. The aim of this study was to investigate whether CI and arterial stiffness (AS) occur in cardiovascular disease (CVD) patients with SPD. A crosssectional case-control study included hospitalized patients with CVD. Demographic characteristics, CVD and atherogenic risk factors were recorded. SPD was diagnosed by clinical and radiographic dental examinations. Dental clinical attachment level (CAL) and CAL % were recorded. A Mini-Mental State Examination test (MMSE) assessed cognition, a MMSE score of < 27 was set as the cut-off point of CI; a score > 27 was considered as no CI. Patients were categorized into: MMSE<27 (cases) and MMSE>27 (controls). AS was evaluated by pulse wave velocity (PWV). Serum VCAM-1 levels were determined in a random sample. Results: This study comprised 91 patients (cases, n=26; 29.6%; controls, n=65, 71.4%); aged 73±8 vs. 73±7 years, respectively (p=0.73), of whom 53.8% and 36.9% respectively, were women; SPD was found to be a risk factor for CI; the presence of SPD increased the risk for MMSE <27 by an average 5.39 times (model 1). PWV was associated with MMSE < 27 in the three models. The risk of having MMSE < 27 increased an average of2.404-fold for each 1-unit increase in PWV SPD and AS had significant and independent associations on the risk for development CI. MMSE negatively correlated with CAL% (r=0.69) and PWV (r=0.70). PWV positively correlated with CAL% (r=0.67). Serum VCAM-1 levels were higher in SPD with lower MMSE scores. In conclusion, SPD increases the risk of development of cognitive decline in CVD patients. PWV was directly associated with the risk of cognitive decline. These findings denote a significant opportunity to improve periodontal health in order to avert CI in CVD patients.

RESUMEN La enfermedad periodontal severa (EPS) podría estar asociada a la rigidez arterial (RA) y al deterioro cognitivo (DC). Se realizó un estudio transversal de casos y controles y se investigó la presencia de RA y DC en pacientes con enfermedad cardiovascular (ECV) y EPS. En pacientes hospitalizados con ECVse registraron las características demográficas y factores de riesgo aterogénicos. El DC se diagnosticó a través del Mini-Mental State Examination (MMSE). Punto de corte: MMSE<27 (casos); puntaje >27 ausencia de DC (controles). La EPS fue diagnosticada clínica y radiográficamente. Se registraron el nivel inserción clínica (NIC) y NIC %. La RA fue evaluada a través de la velocidad de onda de pulso (VOP). VCAM-1 sérico se determinó en una muestra aleatoria. Se incluyeron 91 pacientes (casos,n=26; 29.6%; controles,n=65, 71.4%); edad promedio: 73±8 vs. 73±7 años, respectivamente (p=0.73); % de mujeres: 53.8 vs. 36.9, respectivamente y EPS (n=54) y ausencia de EP (noEP) en 37. MMSE< 27 en 26 pacientes; 23 de ellos, con EPS. La presencia de EPS aumentó el riesgo de MMSE< 27 en 5.39 veces (modelo 1). La VOP se asoció a MMSE< 27 (Modelo 1, 2 y 3). El riesgo de MMSE< 27 incrementó en promedio en 2.40 veces por cada aumento de unidad de VOP. EPS y RA mostraron asociaciones significativas e independientes sobre el riesgo de DC. MMSE se correlacionó negativamente con NIC % (r=0.69) y POV (r=0.70); y POV, positivamente con NIC % (r=0.67). Los niveles séricos de VCAM-1 fueron más elevados en presencia de EPS y puntajes bajos de MMSE. Puede concluirse que en pacientes con ECV y EPS, el aumento en RA incrementaría el riesgo de DC. Estos hallazgos enfatizan la necesidad de promover y mantener la salud bucal para evitar el DC en pacientes con ECV.

Efecto de la hipertensión arterial en la función cognitiva de pacientes de 45 a 65 años. Hospital Luis Vernaza, Guayaquil, Ecuador / Impact of arterial hypertension on the cognitive function of patients between 45 and 65 years. Luis Vernaza Hospital, Guayaquil, Ecuador

Resumen Introducción: El deterioro cognitivo leve es una alteración de la función cognitiva que no afecta de manera negativa a las actividades diarias de la persona. Factores de riesgo modificables como la hipertensión arterial podrían intervenir en el aceleramiento de este proceso y afectar a personas menores de 65 años. Una detección temprana del deterioro cognitivo leve por medio del Montreal Cognitive Assesment (MoCA) en personas con hipertensión arterial ayudaría a idear medidas para su control eficaz. Materiales y métodos: Se diseñó un estudio de tipo observacional transversal. La población se integra con pacientes hipertensos de 45 a 65 años de Guayaquil. De una base de datos de 570 pacientes, se realizó un llamado a sujetos que cumplieran los criterios de inclusión y exclusión, para la evaluación de la función cognitiva por medio del MoCA. Resultados: El 93.3% de los participantes sometidos a la prueba MoCA presentó un puntaje menor de 26. El promedio del puntaje total fue de 18.9 y el 51.6% de los participantes reveló deterioro cognitivo leve. Se obtuvo una correlación negativa del 40% (-0.40) con una p = 0.0015 entre años con hipertensión arterial y el resultado total de la prueba MoCA. Conclusiones: Por medio del MoCA se pudo cuantificar la magnitud del deterioro cognitivo en estos pacientes. Se identificó que la mayoría de los participantes examinados presentaba un puntaje promedio menor del intervalo normal. Las cifras obtenidas de los valores de correlación de Pearson muestran una actividad tendencial y relación de la hipertensión arterial con el deterioro de la función cognitiva.

Abstract Introduction: Mild cognitive impairment is an alteration of cognitive function that does not negatively affect the daily activities of the person. Modifiable risk factors such as hypertension could be involved in the acceleration of this process affecting people under 65 years of age. Early detection of mild cognitive impairment through the Montreal Cognitive Assessment (MoCA) in people with high blood pressure, would help to formulate strategies for its effective control. Materials and methods: A cross-sectional observational study was designed. The population is hypertensive patients between 45 and 65 years old in Guayaquil. From a database of 570 patients, a call was made to patients who met the inclusion and exclusion criteria, for the evaluation of cognitive function through MoCA. Results: 93.3% of the participants who underwent the MoCA test had a score lower than 26. The average of the total score was 18.9, with 51.6% of the participants suffering from mild cognitive impairment. A negative correlation of 40% (-0.40) was obtained with a p = 0.0015 between years with arterial hypertension and the total result of the MoCA test. Conclusions: Through MoCA, the magnitude of cognitive deterioration in these patients could be quantified. It was detected that the majority of the examined participants had a lower average score of the normal range. The figures obtained from the Pearson correlation values show trend activity, relating arterial hypertension and deterioration of cognitive function.

Delirium e qualidade de vida em pacientes críticos: um estudo de coorte prospectivo / Delirium and quality of life in critically ill patients: a prospective cohort study

RESUMO Objetivo: Avaliar a associação entre a incidência de delirium na unidade de terapia intensiva e qualidade de vida 1 mês após a alta hospitalar Métodos: Trata-se de estudo de coorte prospectivo desenvolvido em unidades de terapia intensiva de dois hospitais de média complexidade durante o período de dezembro de 2015 a dezembro de 2016. Delirium foi identificado por meio da escala Confusion Assessment Method for the Intensive Care Unit. No momento da alta hospitalar, foram avaliadas capacidade funcional e cognição por meio do índice de Barthel e da escala de Mini Exame do Estado Mental, respectivamente. Após 30 dias da alta hospitalar do paciente, por meio de contato telefônico, aplicou-se o questionário World Health Organization Quality of Life-Bref. Resultados: Foram incluídos 216 pacientes. Delirium foi identificado em 127 (58,8%) deles. Os pacientes com delirium apresentaram maior dependência funcional (mediana do índice de Barthel 50,0 [21,2 - 70,0] versus 80,0 [60,0 - 95,0]; p < 0,001) e menor cognição (escore do Mini Exame do Estado Mental 12,9 ± 7,5 versus 20,7 ± 9,8; p < 0,001) na alta hospitalar. Com relação à qualidade de vida, avaliada 1 mês após alta hospitalar, não houve diferença, em nenhum dos domínios, entre os pacientes com e sem delirium. Conclusão: Nossos achados sugerem que os pacientes com delirium na unidade de terapia intensiva não apresentam piora da qualidade de vida 1 mês após a alta hospitalar, apesar de apresentarem maior prejuízo cognitivo e incapacidade funcional no momento da alta hospitalar.

Abstract Objective: To evaluate the association between the incidence of delirium in the intensive care unit and quality of life 1 month after hospital discharge. Methods: This was a prospective cohort study conducted in the intensive care units of two medium-complexity hospitals from December 2015 to December 2016. Delirium was identified using the Confusion Assessment Method for the Intensive Care Unit scale. At the time of hospital discharge, functional capacity and cognition were assessed with the Barthel index and the Mini Mental State Examination, respectively. Thirty days after patient discharge, the World Health Organization Quality of Life-BREF questionnaire was administered by telephone. Results: A total of 216 patients were included. Delirium was identified in 127 (58.8%) of them. Patients with delirium exhibited greater functional dependence (median Barthel index 50.0 [21.2 - 70.0] versus 80.0 [60.0 - 95.0]; p < 0.001) and lower cognition (Mini Mental State Examination score 12.9 ± 7.5 versus 20.7 ± 9.8; p < 0.001) at hospital discharge. There was no difference in any of the quality-of-life domains evaluated 1 month after hospital discharge between patients with and without delirium. Conclusion: Our findings suggest that patients with delirium in the intensive care unit do not have worse quality of life 1 month after hospital discharge, despite presenting greater cognitive impairment and functional disability at the time of hospital discharge.

Diagnóstico médico de depresión se asocia a sospecha de deterioro cognitivo en adultos mayores / Association between cognitive impairment and depression in Chilean older adults

Background: Depression has been previously associated with cognitive impairment in high income country populations. However, its association in the Chilean population has not been investigated. Aim: To investigate the association between depression and cognitive impairment. Material and Methods: Data from 1384 Chilean adults aged > 60 years, participating in the National Health Survey 2009-2010 was analyzed. Cognitive impairment was assessed using the Mini Mental Examination score. The medical diagnosis of depression was self-reported. The association between depression and cognitive impairment was assessed using a logistic regression. Results: Depression was positively associated with cognitive impairment. However, the magnitude of the association was higher in men (Odds ratio (OR) = 4.02 [95% confidence intervals (CI): 1.44; 6.61], p < 0.01]) than in women (OR = 2.23 [95%CI: 1.03; 3.43], p = 0.04). Older adults who were diagnosed for the first time with depression after 65 years of age, showed a stronger association with cognitive impairment (OR = 6.65 [95% CI: 2.39; 10.9], p < 0.01) than those diagnosed before 55 years. Conclusions: Our study confirms the association between depression and cognitive impairment. Further research is needed to elucidate the nature and potential mechanisms that link depression with cognitive impairment.

Deterioro cognitivo leve en personas mayores de 85 años / Mild cognitive decline in the elderly older than 85 years

Introducción: Las quejas sobre la función cognitiva han aumentado en la población más envejecida del municipio Habana del Este, provincia La Habana, donde se desconoce la frecuencia y causas de este incremento. Objetivo: Determinar la prevalencia y los factores de riesgo de deterioro cognitivo leve en personas mayores de 85 años o más. Métodos: Se realizó un estudio descriptivo y transversal en personas mayores de un área de salud durante el período 2019-2020. El universo estuvo conformado por 51 personas de 85 años o más. Se tomó una muestra de 47, los cuales cumplieron con los criterios de inclusión y exclusión. Se les aplicó un modelo de recogida de información anónimo, pruebas neuropsicológicas y exámenes complementarios con el propósito de elevar la precisión del diagnóstico. Los datos fueron validados estadísticamente mediante el chi cuadrado, la prueba exacta de Fisher, la regresión de Poisson y estadígrafo de Woolf. Resultados: La prevalencia de deterioro cognitivo leve en personas mayores de 80 años o más fue de 74,5 por ciento, encontrándose significativamente influenciada por el género femenino (OR 6,67; IC 95 por ciento1,09-52,01). Un mayor nivel educacional fue asociado con menor riesgo de deterioro cognitivo leve (OR 10,13; IC 95 por ciento 1,83-63,53). Conclusiones: En la población estudiada, el deterioro cognitivo leve constituye un problema de salud. El mayor nivel educacional mostró su efecto protector, se identificó asociación entre el género femenino y el declinar cognitivo(AU)

Introduction: Complaints about cognitive function have increased in the eldest population from Habana del Este municipality, Havana province, where the frequency and causes of such increase are unknown. Objective: To determine the prevalence and risk factors of mild cognitive impairment in elderly older than 85 years. Methods: A descriptive and cross-sectional study was conducted in the elderly from a health area from 2019 to 2020. Fifty one persons aged over 85 made up the universe. Forty seven subjects who met the inclusion and exclusion criteria made the sample. An anonymous information collection model, neuropsychological tests and complementary examinations were applied to them in order to rise the diagnosis precision. Data were statistically validated using chi square, Fisher's exact test, Poisson regression and Woolf statistician. Results: The prevalence of mild cognitive impairment in persons older than 80 years was 74.5 percent. Women accounted the higher number (OR 6.67, 95 percent CI 1.09-52.01). Higher educational level was associated with lower risk of mild cognitive impairment (OR 10.13, 95 percent CI 1.83-63.53). Conclusions: In the studied population, mild cognitive impairment constitutes a health problem. The higher educational level showed protective effect, an association between female gender and cognitive decline was identified(AU)

Cognitive impairment in chronic migraine: a cross-sectional study in a clinic-based sample / Comprometimento cognitivo na enxaqueca crônica: um estudo transversal em uma amostra clínica

Abstract Cognitive impairment has been described in all phases of a migraine attack and interictally. However, the prevalence and phenotype of such impairment in chronic migraine (CM) have not yet been studied. Objectives: The aim of this study was to evaluate both the prevalence of the objective cognitive deficit in patients with CM and the factors underlying its etiology. Methods: 144 patients with CM and 44 age-matched patients with low-frequency episodic migraine (EM) (a maximum of 4 headache days per month) participated in this study. Neuropsychiatric characteristics were measured with the HADS Hospital Anxiety and Depression Scale. Cognitive function was assessed with the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), and the Perceived Deficits Questionnaire (PDQ-20). Results: Compared to EM, CM subjects demonstrated higher subjective and objective cognitive impairment across all tests. CM patients had 4 times higher odds of achieving a RAVLT score in the lower quartile range compared to EM (Odds Ratio [OR] 3.8; 95% confidence interval [95%CI] 1.5‒9.6; р=0.005). In the MoCA, CM patients demonstrated the most striking impairment in memory/delayed recall (65.3%), attention (46.5%), abstraction (30.6%), and language (27.1%). Chronic headache and level of education, but not gender, depression or anxiety, were independent predictors of cognitive impairment. Conclusions: Cognitive impairment is prevalent in the CM population during their mildest possible pain and may be caused by a central sensitization. Timely preventive treatment of EM is warranted.

Resumo O comprometimento cognitivo foi descrito em todas as fases de um ataque de enxaqueca, de maneira intermitente. Entretanto, a prevalência e o fenótipo desse comprometimento na enxaqueca crônica (EC) não foram estudados. Objetivos: O objetivo deste estudo foi avaliar a prevalência do déficit cognitivo objetivo em pacientes com EC e fatores subjacentes à sua etiologia. Métodos: 144 pacientes com CM e 44 pacientes pareados por idade com enxaqueca episódica (EE) de baixa frequência (máximo de 4 dias de dor de cabeça por mês) foram incluídos. As características neuropsiquiátricas foram medidas pela Hospital Anxiety and Depression Scale (HADS). A função cognitiva foi avaliada por meio da Montreal Cognitive Assessment (MoCA), o Digit Symbol Substitution Test (DSST), o Rey Auditory Verbal Learning Test (RAVLT) e o Perceived Deficits Questionnaire (PDQ-20). Resultados: Em comparação com a EE, os indivíduos com EC demonstraram um comprometimento cognitivo subjetivo e objetivo maior em todos os testes. Os pacientes com CM tiveram 4 vezes mais chances de alcançar um escore RAVLT na faixa quartil inferior, em comparação com EE (Odds Ratio [OR] 3,8; intervalo de confiança de 95% [IC95%] 1,5‒9,6; p=0,005). No MoCA, os pacientes com EC demonstraram o maior prejuízo na memória/atraso na recordação (65,3%), atenção (46,5%), abstração (30,6%) e linguagem (27,1%). Dor de cabeça crônica e nível de escolaridade, mas não o sexo, depressão ou ansiedade, foram preditores independentes de comprometimento cognitivo. Conclusões: O comprometimento cognitivo é prevalente na população com enxaqueca crônica mesmo durante uma dor muito leve e pode ser causado pela sensibilização central. O tratamento preventivo oportuno da enxaqueca episódica se faz necessário.

Association between cognitive impairment and criteria for frailty syndrome among older adults / Associação entre o comprometimento cognitivo e os critérios para a síndrome de fragilidade em idosos

Abstract The association between cognitive impairment and physical frailty has been studied in older adults. The criteria degree of frailty may be keys to associated cognitive impairment. Objective: To analyze the association between cognitive impairment and the criteria for frailty. Methods: We cross-sectionally examined data from 667 older adults (≥60 years of age) from a study entitled 'Variables associated to cognition in elderly caregivers' involving patients in an urban and rural primary healthcare center. We defined cognitive impairment based on different groups of scores on the Mini Mental State Examination, and defined frailty and prefrailty using the criteria by the Cardiovascular Health Study. We performed multinomial regression models to analyze the association between levels of frailty and cognitive impairment. Results: Similar proportions of women (54.8%) and men (45.2%) participated in the study (mean age: 71 years old). We found cognitive impairment, prefrailty and frailty in 34, 54, and 24% of the participants, respectively. Concomitant cognitive impairment and frailty was found in 13% of them. The chances of cognitive impairment increased up to 330% (Odds Ratio [OR]: 4.3; 95% confidence interval [95%CI] 2.4‒7.7; p<0.001) among frail individuals, and 70% (OR: 1.7; 95%CI 1.0‒2.8; p=0.033) among prefrail individuals compared to robust/non-frail individuals. After controlling for age, education, place of residence and functional dependence, slowness and fatigue criteria were significantly associated with cognitive impairment. Conclusion: Older adults with frailty have a greater likelihood of concomitant cognitive impairment than prefrail and robust older adults. The prevalence of cognitive impairment and frailty is consistent with data reported in literature. The present findings contribute to the investigation of cognitive frailty.

Resumo A associação entre comprometimento cognitivo e fragilidade tem sida estudada em idosos e os critérios de fragilidade e níveis de fragilidade podem também apresentar influência na função cognitiva. Objetivo: Analisar a associação entre comprometimento cognitivo e os critérios de fragilidade em idosos. Métodos: O estudo analisou transversalmente dados de 667 idosos (≥60 anos) do estudo 'Variables associated to cognition in elderly caregivers' conduzido com usuários da atenção primária a saúde de áreas urbanas e rurais. Comprometimento cognitivo foi definido em função dos escores no Miniexame do Estado Mental baseado na escolaridade e a fragilidade e pré-fragilidade foi operacionalizada segundo os critérios do Cardiovascular Health Study. Foram realizados modelos de regressão multinominal para analisar a associação entre níveis de fragilidade e comprometimento cognitivo. Resultados: Proporções semelhantes de mulheres (54,8%) e homens (45,2%) participaram do estudo (média de idade: 71 anos). Comprometimento cognitivo, pré-fragilidade e fragilidade foram encontrados em 34, 54 e 24% dos participantes, respectivamente. Concomitante comprometimento cognitivo e fragilidade foi evidenciado em 13%. As chances de apresentar comprometimento cognitivo aumentaram em 330% (Odds Ratio [OR]: 4.3; intervalo de confiança de 95% [IC95%] 2.4‒7.7; p<0.001) entre indivíduos frágeis e 70% (OR: 1.7; IC95% 1.0‒2.8; p=0.033) entre indivíduos pré-frágeis em comparação com indivíduos robustos/não-frágeis. Após controle da idade, escolaridade, local de residência e dependência funcional, os critérios de lentidão e fadiga foram significativamente associados ao comprometimento cognitivo. Conclusão: Os idosos mais frágeis têm maior probabilidade de apresentar comprometimento cognitivo comparados a adultos idosos pré-frágeis ou robustos. A prevalência de comprometimento cognitivo e fragilidade é consistente com os dados relatados na literatura e fornece suporte para futuras investigações sobre a fragilidade cognitiva.

Prevalence of dementia in patients seen at a private hospital in the Southern Region of Brazil / Prevalência de demência em pacientes atendidos em um hospital privado no sul do Brasil

ABSTRACT Objective To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic. Methods A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015. Results A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer's disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007). Conclusion Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.

RESUMO Objetivo Avaliar o perfil epidemiológico dos pacientes atendidos em um ambulatório de demência. Métodos Estudo retrospectivo realizado pela revisão de prontuários com busca de dados sobre sexo, raça, idade, escolaridade e diagnóstico de pacientes atendidos de 2008 a 2015. Resultados Foram estudados 760 pacientes, com predomínio do sexo feminino (61,3%; p<0,0001). A média de idade foi 71,2±14,43 anos, para as mulheres, e de 66,1±16,61 anos, para os homens. A faixa etária mais acometida foi de 71 a 80 anos, representando 29,4% dos casos. Em relação à etnia, 96,3% dos pacientes eram brancos. O quadro de demência foi diagnosticado em 68,8% dos pacientes, tendo sido a doença de Alzheimer confirmada em 48,9% dos casos, demência vascular em 11,3% e mista em 7,8%. A prevalência de demência foi de 3% aos 70 anos e de 25% aos 85 anos. O quadro demencial apareceu significativamente mais cedo no sexo masculino (média de idade 68,5±15,63 anos). A distribuição entre os sexos mostrou demência mais frequente em mulheres (59,6%) do que em homens (40,4%; p<0,0001; RC=2,15). Pessoas com maior escolaridade (acima de 9 anos) apresentaram idade de aparecimento da demência significativamente menor que aquelas de menor escolaridade (1 a 4 anos; p=0,0007). Conclusão Os pacientes atendidos no período apresentaram demência na maioria dos casos, sendo Alzheimer a doença mais prevalente. Mulheres foram mais acometidas, entretanto homens apresentaram a doença mais precocemente. Indivíduos com maior escolaridade foram diagnosticados mais cedo que aqueles com menor escolaridade.

Relación entre la función cognitiva y la calidad de vida de personas mayores en una residencia de ancianos / The Relationship Between Cognitive Function and Quality of Life Among Elderly at Nursing Home

Introduction: The decreasing of cognitive function can cause the elderly depends on their daily activities and affect the quality of life among elderly. Objective: This study want to examine the cognitive function status and quality of life among elderly at Nursing Home of Jember, Indonesia. Methods: The study was conducted a cross-sectional design during October December 2018. Among 82 of elderly involved using convenience sampling. Short Portable Mental Status Questionnaire and World Health Organization Quality of Life-BREF were performed to measure congnitive function and quality of life, respectively. Data were analyzed using Chi square test. Results: Among 82 of elderly identified intact intellectual functioning status (43,90 percent) and severe cognitive impairment (2,40 percent). Meanwhile, 70,70 percent and 8,50 percent elderly were moderate and low of quality of life, respectively. Furthermore, cognitive function significantly related to quality of life (X2= 8,685; p-value= 0,003). The elderly who have intact cognitive function was prevent for decreasing quality of life (OR= 0,210; 95 percent CI= 0.071-0.621). Conclusions: Cognitive function is related to quality of life among elderly. Therefore, health promotion program, including physical activity could develop in nursing home to improve the cognitive function and quality of life among elderly(AU)

Introducción: La disminución de la función cognitiva puede causar que los ancianos dependan de sus actividades diarias y afecten su calidad de vida. Objetivo: Examinar el estado de la función cognitiva y la calidad de vida entre los ancianos del Hogar de Ancianos de Jember, Indonesia. Métodos: Estudio de diseño transversal durante octubre y diciembre de 2018. En 82 personas de la tercera edad involucradas, se usó una muestra de conveniencia. Se realizó un breve cuestionario portátil sobre el estado mental y calidad de vida-BREF de la Organización Mundial de la Salud para medir la función cognitiva y la calidad de vida. Los datos se analizaron mediante la prueba de Chi cuadrado. Resultados: De los 82 ancianos se identificó el estado de funcionamiento intelectual intacto en 43,90 por ciento y deterioro cognitivo severo en 2,4 por ciento. Mientras, el 70,7 por ciento y el 8,5 por ciento de los ancianos tenían moderada y baja calidad de vida, respectivamente. Además, la función cognitiva se relacionó significativamente con la calidad de vida (X2 = 8,685; valor p = 0,003). Las personas de edad avanzada que tenían una función cognitiva intacta evitaron la disminución de la calidad de vida (OR = 0,210; IC del 95 por ciento = 0,071-0,621). Conclusiones: La función cognitiva está relacionada con la calidad de vida entre los ancianos. Por lo tanto, el programa de promoción de la salud, incluida la actividad física, podría desarrollarse en un hogar de ancianos para mejorar la función cognitiva y la calidad de vida entre los ancianos(AU)

Perfil cognitivo e associações entre idosos longevos em contexto ambulatorial no Distrito Federal / Cognitive profile and associations among very old adults in an outpatient setting in the Federal Distric

Objetivou investigar associações entre o declínio cognitivo de idosos longevos em contexto ambulatorial e variáveis sociodemográficas, desempenho funcional, doenças crônicas, número de hospitalizações e acesso aos serviços de saúde. Foram entrevistados idosos longevos (80 anos e mais) residentes no Distrito Federal, avaliados em contexto ambulatorial por questionários padronizados e pelo Miniexame do Estado Mental (MEEM). Nas análises bivariadas, o declínio cognitivo esteve associado à faixa etária (85 anos e mais), possuir uma ou mais limitações nas atividades básicas de vida diária (ABVD), residir em arranjos domiciliares bi e trigeracionais e ter maior número de hospitalizações no último ano. No modelo logístico múltiplo, permaneceram associados ao declínio cognitivo em longevos as ABVD e as hospitalizações no último ano. Por tratar-se de uma população com maior demanda assistencial de saúde, torna-se necessário delinear medidas de prevenção e a promoção de cuidados de longa duração.

The aim was to investigate associations between the cognitive decline of very old adults in outpatient settings and sociodemographic variables, functional performance, chronic diseases, number of hospitalizations and access to health services. Very old adults (80 years and over) residing in the Federal District were interviewed, evaluated in an outpatient setting by means of standardized questionnaires and the Mini-Mental State Examination (MMSE). In bivariate analyzes, cognitive decline was associated with the age group (85 years and over), having one or more limitations in basic activities of daily living (BADL), living in bi and tri-generational household arrangements and having a higher number of hospitalizations in the prior year. In the multiple logistic model, BADL and hospitalizations in the prior year remained associated with cognitive decline in very old adults. As it is a population with a greater demand for health care, it is necessary to outline measures of preventive and promotion of long-term care.

Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients / Diferenças na cognição e na qualidade de vida entre os pacientes idosos e os muito idosos em hemodiálise

Abstract Introduction: In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. Methods: Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). Results: Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). Conclusion: Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.

Resumo Introdução: Nas últimas décadas, houve um aumento expressivo no número de pacientes idosos com doença renal crônica iniciando hemodiálise. Assim, nosso objetivo foi avaliar o perfil de idosos em hemodiálise crônica e comparar a cognição e a qualidade de vida dos idosos com as de muito idosos. Métodos: Pacientes em hemodiálise havia pelo menos 3 meses, que tinham 65 anos ou mais quando começaram o tratamento dialítico foram convidados a participar, e estratificados de acordo com a idade (menores ou maiores de 80 anos). Os participantes responderam a um questionário clinico-epidemiológico e foram submetidos a testes cognitivos (miniexame do estado mental [MEEM], teste do relógio [TDR] e teste de fluência verbal [TFV]) e a uma avaliação de qualidade de vida 36-Item Short Form Health Survey). Resultados: Dos 125 pacientes elegíveis, 124 concordaram em participar. A idade média foi de 76 ± 6 anos (28% ≥ 80 anos), 56% eram homens e 55% tinham ≥ 8 anos de escolaridade. Depressão foi sugerida em 38%. A prevalência de déficit cognitivo foi 38%, 70% e 30%, pelo MEEM, TDR e TFV, respectivamente. A prevalência de qualquer déficit foi maior entre os muito idosos (94% vs. 72%, p = 0,007). Os escores de qualidade de vida foram semelhantes entre os dois grupos etários, exceto pelo domínio da capacidade funcional, pior no grupo com ≥ 80 anos (p = 0.033). Conclusão: Os pacientes idosos em hemodiálise crônica apresentam elevada prevalência de déficit cognitivo, especialmente os muito idosos, mas esse grupo não possui pior qualidade de vida, exceto pelo aspecto da capacidade funcional.

Factores asociados al deterioro cognitivo en personas mayores en Chile / Factors associated with cognitive impairment in older adults in Chile

Background: The risk factors for the development of cognitive impairment are not well known. Aim: To identify socio-demographic, lifestyle and health-related factors associated with cognitive impairment in older Chilean adults. Material and Methods: Data analysis of 1,384 participants ≥ 60 years who participated in the National Health Survey of Chile 2009-2010. Sociodemographic, lifestyle and health-related factors were used as exposure variables of interest. Cognitive impairment was assessed using an abbreviated version of the Mini Mental test and defined as a score < 13 points of a maximum of 19. A logistic regression was used to identify factors associated with cognitive impairment. Results: In this sample, the prevalence of cognitive impairment was 11.6 [95% confidence intervals (CI): 8.8; 15.2]. The factors associated with cognitive impairment were age (Odds ratio (OR) for > 76 years: 4.89, p < 0.01), male sex (OR: 2.42, p = 0.02), lower education (OR: 21.6, p < 0.01), physical inactivity (OR: 2.07, p = 0.02), sedentary behavior (OR: 2.23, p = 0.01), sleeping > 9/hours/day (OR: 2.98, p = 0.01), consumption of < 5 portions/day of fruit and vegetables (OR: 2.02, p = 0.05), having an unhealthy lifestyle (OR: 6.10, p = 0.0001), being underweight (OR: 3.67, p < 0.01), obesity (OR: 3.32, p = 0.03), having hearing impairment (OR: 2.26, p = 0.02), having a visual impairment (OR: 3.89, p < 0.01), a history of depression (OR: 3.03, p = 0.01) and having a physical disability (OR: 5.63, p < 0.01). Conclusions: We identified 14 factors associated with cognitive impairment. Although some of these factors were non-modifiable such as age and sex, most of them could be modified by implementing prevention programs aiming to improve lifestyle behaviors in older adults in Chile.

Diagnostic criteria and prevalence of mild cognitive impairment in older adults living in the community: a systematic review and meta-analysis

Abstract Background Mild Cognitive Impairment (MCI) is a disorder in which the patient presents a cognitive decline, but without negative impact on the activities of daily living. Objective To carry out a systematic review of published studies that analyzed the prevalence of Mild Cognitive Impairment (MCI) in older adults living in the community, and the criteria used for the diagnosis of this disorder. Methods A search was carried out in May 2017 using the descriptors: "epidemiology" or "prevalence", "mild cognitive impairment", and "community" in the PubMed, PsycInfo, SciELO, Web of Science, and Scopus databases. Two independent researchers extracted and documented the data. We used a random effect model to calculate pooled prevalence of MCI for overall studies and for each subgroup divided by diagnostic criteria. Results We found initially 1996 articles, and we selected 35 studies. The prevalence of MCI in the selected studies ranged from 0.5% to 41.8%. The overall pooled prevalence of MCI was 17.3% (CI 95%, 13.8-20.8), with significant heterogeneity between estimates (I2 = 99.6%). Discussion The standardization of the diagnostic criteria for MCI, as well as the tests used in the cognitive evaluation, could allow the comparison between the studies and would be an important step in the researches of this area.

Demographic, clinical characteristics and cardiovascular disease burden in a Portuguese cohort of older chronic kidney disease patients / Dados demográficos, características clínicas e peso da doença cardiovascular em uma coorte portuguesa de pacientes idosos com doença renal crônica

ABSTRACT Introduction: Chronic kidney disease (CKD) is an independent risk factor for several unfavorable outcomes including cardiovascular disease (CVD), particularly in the elderly, who represent the most rapidly growing segment of the end-stage kidney disease (ESKD) population. Portugal has the highest European unadjusted incidence and prevalence rates of ESKD. In 2012, we started to follow a cohort of elderly CKD patients, we describe their baseline characteristics, risk profile, and cardiovascular disease burden. Methods: All CKD patients aged 65 years and older referred to our department during 2012 were enrolled. Baseline data included: demographic, CKD stage, medication, comorbid conditions. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI formula. Results: A total of 416 patients, 50% referred by primary care physicians, aged 77 ± 7 years, 52% male, with a median eGFR of 32 mL/min/1.73m2 participated in the study. Fifty percent had diabetes (DM), 85% dyslipidemia, 96% hypertension; 26% were current/former smokers, and 24% had a body mass index > 30 kg/m2. The prevalence of CVD was 62% and higher in stage 4-5 patients; in diabetics, it gradually increased with CKD progression (stage 3a < stage 3b < stage 4-5) (39, 58, 82%; p < 0.001). Conclusions: At baseline, our CKD elderly cohort had a higher burden of CVD. The prevalence of CVD was greater than in other European CKD cohorts. Lower level of eGFR was associated with a greater burden of CVD and was more pronounced in diabetics, highlighting the importance of strategically targeting cardiovascular risk reduction in these patients.

RESUMO Introdução: Doença renal crônica (DRC) é fator de risco independente para vários desfechos desfavoráveis, incluindo doença cardiovascular (DCV), particularmente em idosos, o segmento de crescimento mais rápido da população com doença renal terminal (DRT). Portugal tem a maior incidência europeia não-ajustada e a maior prevalência de DRT. Neste artigo caracterizamos uma coorte de idosos com DRC, referenciados para a nefrologia, com particular ênfase para o risco e carga de doença cardiovascular. Métodos: Foram incluídos todos os pacientes com DRC com 65 anos ou mais encaminhados ao nosso departamento em 2012. Os dados basais incluíram: demografia, estágio da DRC, medicação e comorbidades. A taxa de filtração glomerular (TFGe) foi calculada pela fórmula CKD-EPI. Resultados: Metade dos 416 pacientes incluídos foram encaminhados por médicos da atenção primária; sua idade era 77 ± 7 anos; 52% eram homens; a TFGe mediana era de 32 mL /min/1,73 m2. Metade tinha diabetes (DM), 85% dislipidemia, 96% hipertensão; 26% eram fumantes atuais/ antigos; 24% tinham índice de massa corporal > 30 kg/m2. A prevalência de DCV foi de 62%, sendo maior entre pacientes nos estágios 4-5; em diabéticos, aumentou gradualmente com a progressão da DRC (estágio 3a < estágio 3b < estágio 4-5) (39%, 58%, 82%; p < 0,001). Conclusões: A coorte de idosos com DRC apresentava inicialmente maior carga de DCV. A prevalência de DCV foi maior que em outras coortes europeias com DRC. Níveis menores de TFGe foram associados a carga maior de DCV e foram mais pronunciados entre diabéticos, destacando a importância de objetivar estrategicamente a redução do risco cardiovascular nesses pacientes.

Montreal Cognitive Assessment for cognitive assessment in chronic kidney disease: a systematic review / Montreal Cognitive Assessment para avaliação cognitiva na doença renal crônica: uma revisão sistemática

Abstract Introduction: There is evidence in the literature that cognitive impairment is more prevalent in individuals with chronic kidney disease (CKD) than in the general population. The Montreal Cognitive Assessment (MoCA) is an instrument with a good application profile for cognitive evaluation of patients with CKD-like impairments. The objective of this study is to perform a systematic review of MoCA use in the context of CKD. Method: The keywords "Montreal Cognitive Assessment", "Kidney Disease" and "Chronic Kidney Disease" were used to search the databases. The inclusion criteria were: a) empirical articles; b) approach to cognitive impairment in CKD; c) papers in Portuguese and English. Results: The studies were mostly cross-sectional, published in medical journals, with research carried out mostly in Europe. About 45% of the studies had samples of less than 150 participants and variations in the prevalence of cognitive impairment were found ranging from 28.9% to 74.6%. The cutoff point for the identification of the impairment presented variation between the studies. Discussion: The results' analysis demonstrates the need for more complete studies on MoCA scoring and adaptation in its different versions. We recommend to the health professionals who will use the results in the clinical setting that the interpretation of the results be made in the light of studies more related to the context lived by the patients. Conclusions: The instrument is efficient to be used in several stages and treatment modalities of the disease. We point to the need to adapt a cut-off point for the instrument in the different translations of the instrument.

Resumo Introdução: Há evidências na literatura de que o comprometimento cognitivo se apresenta com maior prevalência em indivíduos com Doença Renal Crônica (DRC) do que na população em geral. O Montreal Cognitive Assessment (MoCA) é um instrumento com bom perfil de aplicação para avaliação cognitiva de pacientes com comprometimentos similares aos da DRC. O objetivo deste estudo é realizar uma revisão sistemática sobre a aplicação do MoCA no contexto da DRC. Método: Foram utilizadas as palavras-chave "Montreal Cognitive Assessment", "Kidney Disease" e "Doença Renal Crônica" nas bases de dados. Os critérios de inclusão foram: a) artigos empíricos; b) abordagem do comprometimento cognitivo na DRC; c) trabalhos em língua portuguesa e inglesa. Resultados: Os estudos foram em sua maioria transversais, publicados em periódicos médicos, com pesquisas realizadas majoritariamente na Europa. Cerca de 45% das pesquisas tiveram amostras inferiores a 150 participantes e foram encontradas variações na prevalência de comprometimento cognitivo variando de 28,9% até 74,6%. O ponto de corte para identificação do comprometimento apresentou variação entre os estudos. Discussão: A análise de resultados demonstra a necessidade de estudos mais completos sobre pontuação e adaptação do MoCA em suas diferentes versões. Recomenda-se aos profissionais de saúde que utilizarão os resultados em âmbito clínico que a interpretação dos resultados seja realizada por estudos mais relacionados ao contexto vivido pelos pacientes. Conclusões: O instrumento demonstra-se eficiente para ser utilizado em diversos estágios e modalidades de tratamento da doença. Aponta-se a necessidade da adaptação de um ponto de corte para o instrumento nas diferentes traduções do instrumento.

Fragilidade em idosos no município de São Paulo: prevalência e fatores associados / Frailty in older adults in the city of São Paulo: Prevalence and associated factors

RESUMO: Introdução: Fragilidade é uma síndrome evitável e reversível caracterizada pelo declínio cumulativo dos sistemas fisiológicos, causando maior vulnerabilidade às condições adversas. Objetivos: Descrever a prevalência de fragilidade entre os idosos, analisar os fatores associados e a evolução da síndrome. Método: Estudo longitudinal que utilizou a base de dados do Estudo Saúde, Bem-Estar e Envelhecimento (SABE), nos anos de 2006 e 2010. A síndrome de fragilidade foi identificada por cinco componentes: perda de peso; fadiga; redução de força, de atividade física e de velocidade de caminhada. Os idosos foram classificados como "pré-frágeis" (1-2 componentes) e "frágeis" (3 ou +). Utilizou-se regressão multinomial múltipla hierárquica para análise dos fatores associados. Resultados: Do total de idosos (n = 1.399), 8,5% eram frágeis tendo como fatores associados idade, comprometimento funcional, declínio cognitivo, hospitalização e multimorbidade. Em quatro anos, tornaram-se frágeis 3,3% dos idosos não frágeis e 14,7% dos pré-frágeis. Conclusão: A identificação da prevalência e dos fatores associados à fragilidade pode ajudar a implementar intervenções adequadas precocemente, de modo a garantir melhorias na qualidade de vida dos idosos.

ABSTRACT: Introduction: Frailty is a preventable and reversible syndrome characterized by a cumulative decline of physiological systems, causing greater vulnerability to adverse conditions. Objective: To describe the prevalence of frailty among older adults and analyze its associated factors and progression. Method: This is a longitudinal study that used the Health, Well-being, and Aging Study (Saúde, Bem-Estar e Envelhecimento - SABE) database of 2006 and 2010. Five components identified the frailty syndrome: weight loss; fatigue; decreased strength, low physical activity, and reduced walking speed. Older adults were classified as "pre-frail" (1-2 components) and "frail" (3 or more). We used a hierarchical multiple multinomial regression to analyze associated factors. Results: Out of the total number of older adults (n = 1,399), 8.5% were frail, and the associated factors were age, functional impairment, cognitive decline, hospitalization, and multimorbidity. In four years, 3.3% of non-frail and 14.7% of pre-frail older adults became frail. Conclusion: Identifying the prevalence of frailty and its associated factors can help to implement adequate interventions early to improve the quality of life of older adults.

Prevalência e fatores associados ao prejuízo cognitivo em idosos de instituições filantrópicas: um estudo descritivo / Prevalence and factors associated with cognitive impairments in the elderly of charity asylums: a descriptive study

Resumo O objetivo deste estudo foi avaliar a prevalência e os fatores associados ao prejuízo cognitivo em uma amostra de idosos residentes em instituições filantrópicas. Trata-se de um estudo transversal e descritivo, com 98 idosos institucionalizados. Os dados sociodemográficos e clínicos foram obtidos nos prontuários. A cognição foi avaliada através do: Mini Exame do Estado Mental, enquanto a manutenção de independência referente às atividades fundamentais (por exemplo: banhar-se, vestir-se, etc.) foi avaliada através do Índice de Katz. Por fim, avaliou-se o desempenho físico através da Short Physical Perfomance Batter. Para a análise estatística, testes não paramétricos foram utilizados. Houve 27,6% de idosos com déficit cognitivo. O prejuízo cognitivo não esteve associado às variáveis sociodemográficas, à independência referente, às atividades fundamentais, bem como ao desempenho físico. Verificou-se maior prevalência de doenças endócrinas, de transtornos mentais e de realização de tratamento psiquiátrico nos idosos com prejuízos cognitivos. A proporção de idosos com alterações cognitivas é semelhante à de outros estudos. Entre as variáveis avaliadas não foram identificados fatores de risco significativos associados à cognição.

Abstract The current transversal and descriptive study evaluates the prevalence and factors associated with cognitive liabilities in a sample of 98 elderly people residents of philanthropic institutions. The sociodemographic and clinical data were retrieved from the patients´ clinical charts. The cognition was assessed by the Mental State Mini-Exam, while the maintenance of independence regarding basic activities (such as bathing, putting on clothes, and others) was evaluated using the Katz Index. The Short Physical Performance Battery exam assessed their physical performance. Non-parametric tests were employed for the statistical analysis. Cognitive impairment was registered in 27.6% of the elderlies and was not associated with sociodemographic variables, independence in basic activities, and physical performance. We verified a high prevalence of endocrine diseases, mental disorders, and psychiatric treatment in the elderlies with cognitive impairments. The percentage of elderly with cognitive alterations is similar to those found in the literature. We identified no significant risk factors associated with cognition among the evaluated variables.

High burden and frailty: association with poor cognitive performance in older caregivers living in rural areas / Sobrecarga elevada e fragilidade: relação com baixo desempenho cognitivo em idosos cuidadores moradores de comunidades rurais

Abstract Introduction: Older caregivers living in rural areas may be exposed to three vulnerable conditions, i.e., those related to care, their own aging, and their residence context. Objective: To analyze the association of burden and frailty with cognition performance in older caregivers in rural communities. Method: In this cross-sectional survey, 85 older caregivers who cared for dependent elders were included in this study. Global cognition (Addenbrooke's Cognitive Examination - Revised; Mini Mental State Examination), burden (Zarit Burden Interview) and frailty (Fried's frailty phenotype) were assessed. All ethical principles were observed. Results: Older caregivers were mostly women (76.7%); mean age was 69 years. Cognitive impairment was present in 15.3%, severe burden in 8.2%, frailty in 9.4%, and pre-frailty in 52.9% of the older caregivers. More severely burdened or frail caregivers had worse cognitive performance than those who were not, respectively (ANOVA test). Caregivers presenting a high burden level and some frailty degree (pre-frail or frail) simultaneously were more likely to have a reduced global cognition performance. Conclusion: A significant number of older caregivers had low cognitive performance. Actions and resources to decrease burden and physical frailty may provide better cognition and well-being, leading to an improved quality of life and quality of the care provided by the caregivers.

Resumo Introdução: Idosos cuidadores que moram em comunidades rurais podem estar expostos a uma tripla condição de vulnerabilidade, por exemplo, condições relacionadas a ser cuidador de outro, condições inerentes ao seu próprio envelhecimento e ao seu contexto de moradia. Objetivo: Analisar a associação entre sobrecarga, fragilidade e desempenho cognitivo em idosos cuidadores que moram em comunidades rurais. Método: Tratou-se de uma pesquisa transversal com 85 idosos cuidadores que cuidavam de idosos dependentes na comunidade. A cognição global (Exame Cognitivo de Addenbrooke - Revisado; Mini Exame do Estado Mental), a sobrecarga (Entrevista de Sobrecarga de Zarit) e a fragilidade (Fenótipo de Fragilidade de Fried) foram mensuradas. Todos os princípios éticos foram respeitados. Resultados: Os idosos cuidadores foram predominantemente mulheres (76.7%) com média de idade de 69 anos. A proporção de indício de alteração cognitiva foi de 15.3%, sobrecarga severa de 8.2%, fragilidade de 9.4% e pré-fragilidade de 52.9% nos idosos cuidadores. Cuidadores severamente sobrecarregados ou frágeis apresentaram pior desempenho cognitivo comparado àqueles levemente sobrecarregados e não frágeis, respectivamente (teste ANOVA). Apresentar simultaneamente sobrecarga elevada e algum grau de fragilidade (pré-frágil ou frágil) esteve associado à redução do desempenho cognitivo global. Conclusão: Um significante número de idosos cuidadores teve indício de alteração cognitiva. Estratégias e recursos para reduzir o sentimento de sobrecarga e a fragilidade física podem melhorar o desempenho mental e o bem estar, levando assim a uma melhora da qualidade de vida do idoso que cuida, bem como a qualidade do cuidado prestado por ele.

High frequency of silent brain infarcts associated with cognitive deficits in an economically disadvantaged population

OBJECTIVE: Using magnetic resonance imaging, we aimed to assess the presence of silent brain vascular lesions in a sample of apparently healthy elderly individuals who were recruited from an economically disadvantaged urban region (São Paulo, Brazil). We also wished to investigate whether the findings were associated with worse cognitive performance. METHODS: A sample of 250 elderly subjects (66-75 years) without dementia or neuropsychiatric disorders were recruited from predefined census sectors of an economically disadvantaged area of Sao Paulo and received structural magnetic resonance imaging scans and cognitive testing. A high proportion of individuals had very low levels of education (4 years or less, n=185; 21 with no formal education). RESULTS: The prevalence of at least one silent vascular-related cortical or subcortical lesion was 22.8% (95% confidence interval, 17.7-28.5), and the basal ganglia was the most frequently affected site (63.14% of cases). The subgroup with brain infarcts presented significantly lower levels of education than the subgroup with no brain lesions as well as significantly worse current performance in cognitive test domains, including memory and attention (p<0.002). CONCLUSIONS: Silent brain infarcts were present at a substantially high frequency in our elderly sample from an economically disadvantaged urban region and were significantly more prevalent in subjects with lower levels of education. Covert cerebrovascular disease significantly contributes to cognitive deficits, and in the absence of magnetic resonance imaging data, this cognitive impairment may be considered simply related to ageing. Emphatic attention should be paid to potentially deleterious effects of vascular brain lesions in poorly educated elderly individuals from economically disadvantaged environments.