Transcutaneous tibial nerve stimulation to treat urgency urinary incontinence in older women: 12-month follow-up of a randomized controlled trial.

INTRODUCTION AND HYPOTHESIS: Urgency urinary incontinence (UUI) is highly prevalent in elderly individuals and has a great impact on quality of life. Transcutaneous tibial nerve stimulation (TTNS) can be an effective treatment option for UUI in older women. METHODS: This is a single-center randomized clinical trial with a 12-month follow-up involving 106 women > 60 years of age. Kegel exercises and bladder retraining were performed alone or in combination with TTNS, which consisted of using a transcutaneous electrical nerve stimulator for 30 min once a week for 12 weeks with the following settings: continuous mode, 10 Hz, 200 ms, and 10 to 50 mA (according to hallux mobilization). Responders to therapy who experienced failure during follow-up were invited for a 3-week protocol with the same parameters as those used for the initial therapy. Patients were evaluated at baseline, 4 weeks after the 12-week protocol, and every 3 months for 12 months, through subjective satisfaction questionnaires, a 3-day bladder diary and the International Consultation on Incontinence Questionnaire-Short Form. King's Health Questionnaire was applied pretreatment and 4 weeks after the last session of the 12-week protocol. RESULTS: A total of 101 women completed the initial 12-week protocol. TTNS patients reported 66.7% subjective global satisfaction vs. 32.0% in the control group (p < 0.001). The TTNS group showed statistically significant improvement in quality of life (QoL) and UUI parameters compared with the control group. Forty-eight patients were satisfied after the 12-week protocol and completed the 12-month follow-up (32 in the TTNS group and 16 in the control group). A total of 80.5% of responders to TTNS were still satisfied at the end of the 12-month follow-up vs. 30.8% in the control group (p = 0.009). CONCLUSION: TTNS is effective at the 12-month follow-up for the treatment of UUI in elderly women.

Relationship between childhood maltreatment and geriatric depression: the mediator effect of personality traits.

BACKGROUND: Childhood maltreatment is an important factor associated with adverse mental health outcomes including geriatric depression and the "big five" personality characteristics. The objective of this study was to evaluate a model where personality characteristics mediate the relationship between childhood maltreatment and geriatric depression. METHOD: In this cross-sectional study, elderly subjects from socioeconomically disadvantaged neighborhoods of Porto Alegre, Brazil (n = 260) completed the Childhood Trauma Questionnaire (CTQ), NEO-Five Factor Inventory (NEO-FFI), and Mini International Neuropsychiatric Interview 5.0 (MINI plus). We used structural equation modeling (SEM) to evaluate the mediation hypothesis. RESULTS: The five personality factors (neuroticism, extraversion, agreeableness, openness, and conscientiousness) were related to childhood maltreatment and depression. Mediation analysis revealed that neuroticism and extraversion are complete mediators, agreeableness and conscientiousness are partial mediators, and openness is not a mediator. CONCLUSIONS: These findings support the hypothesis in which childhood maltreatment is associated with geriatric depression and mediated by personality factors. These results suggest that reducing the maladaptive personality trait in elderly people who suffered childhood maltreatment could prevent geriatric depression.

Exploring Spoken Discourse and Its Neural Correlates in Women With Alzheimer's Disease With Low Levels of Education and Socioeconomic Status.

PURPOSE: Early impairments in spoken discourse abilities have been identified in Alzheimer's disease (AD). However, the impact of AD on spoken discourse and the associated neuroanatomical correlates have mainly been studied in populations with higher levels of education, although preliminary evidence seems to indicate that socioeconomic status (SES) and level of education have an impact on spoken discourse. The purpose of this study was to analyze microstructural variables in spoken discourse in people with AD with low-to-middle SES and low level of education and to study their association with gray matter (GM) density. METHOD: Nine women with AD and 10 matched (age, SES, and education) women without brain injury (WWBI) underwent a neuropsychological assessment, which included two spoken discourse tasks, and structural magnetic resonance imaging. Microstructural variables were extracted from the discourse samples using NILC-Metrix software. Brain density, measured by voxel-based morphometry, was compared between groups and then correlated with the differentiating microstructural variables. RESULTS: The AD group produced a lower diversity of verbal time moods and fewer words and sentences than WWBI but a greater diversity of pronouns, prepositions, and lexical richness. At the neural level, the AD group presented a lower GM density bilaterally in the hippocampus, the inferior temporal gyrus, and the anterior cingulate gyrus. Number of words and sentences produced were associated with GM density in the left parahippocampal gyrus, whereas the diversity of verbal moods was associated with the basal ganglia and the anterior cingulate gyrus bilaterally. CONCLUSIONS: The present findings are mainly consistent with previous studies conducted in groups with higher levels of SES and education, but they suggest that atrophy in the left inferior temporal gyrus could be critical in AD in populations with lower levels of SES and education. This research provides evidence on the importance of pursuing further studies including people with various SES and education levels. WHAT IS ALREADY KNOWN ON THIS SUBJECT: Spoken discourse has been shown to be affected in Alzheimer disease, but most studies have been conducted on individuals with middle-to-high SES and high educational levels. WHAT THIS STUDY ADDS: The study reports on microstructural measures of spoken discourse in groups of women in the early stage of AD and healthy women, with low-to-middle SES and lower levels of education. CLINICAL IMPLICATIONS OF THIS STUDY: This study highlights the importance of taking into consideration the SES and education level in spoken discourse analysis and in investigating the neural correlates of AD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24905046.

Randomized trial of transcutaneous tibial nerve stimulation to treat urge urinary incontinence in older women.

INTRODUCTION: The aim of this study was to examine the efficacy of transcutaneous electrical tibial nerve stimulation (TTNS) to treat urge urinary incontinence (UUI) in older women. MATERIAL AND METHODS: The study design was a randomized clinical trial conducted on 51 elderly women (>60 years) with UUI. All were treated with 12 weeks of bladder retraining and pelvic floor muscle exercises, and 25 were randomly selected to receive TTNS in addition to the standard therapy. The cases were evaluated at the baseline and after the end of therapy by 3-day bladder diary, quality of life questionnaires (QoL), and subjective response. RESULTS: Of the patients, 68.0% in TTNS group reported cure or improvement vs. 34.6% in the control group (P = 0.017). TTNS showed significant improvement in most areas of QoL and in UUI parameters when compared with the control group. CONCLUSION: TTNS is efficacious to treat UUI in older women.

MnSOD Val16Ala gene polymorphism is associated with REDOX biomarkers in the elderly of primary health care in the city of Porto Alegre.

Studies suggest that redox imbalance may be closely associated with pathological aging, contributing effectively to the genesis of several chronic diseases. One of the major defence enzymes against oxidation is Manganese-dependent superoxide dismutase (MnSOD) that acts within the mitochondria. The gene encoding this enzyme is polymorphic and Val16Ala variant is one of its most investigated polymorphisms regarding aging and oxidative stress. This study aimed to verify the occurrence of the MnSOD Val16Ala gene polymorphism association with markers of REDOX metabolism in the elderly of primary health care. A cross-sectional study was performed. The sample consisted of 270 elderly individuals from Family Health Strategy in the city of Porto Alegre, Rio Grande do Sul, Brazil (EMISUS). The following variables were investigated in all subjects: sociodemographic: gender, age, marital status, schooling and income; Anthropometric: weight, height, body mass index (BMI); REDOX markers: advanced oxidation protein products (AOPP), ischemia-modified albumin (IMA), nitric oxide metabolites (NOx), ferric reducing ability of plasma (FRAP) and malondialdehyde (MDA), MnSOD Val16Ala gene polymorphism. Val16Ala gene polymorphism was evaluated by polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP). Statistically significant associations were observed in the elderly with AA genotype compared to those with VV genotype, concerning AOPP (p = 0.023) and FRAP (p = 0.027) quartile frequencies, respectively. No statistically significant differences were observed between MnSOD genotypes with MDA, NOx and IMA oxidative markers. Val16Ala gene polymorphism is associated with AOPP and FRAP quartiles frequencies in the elderly of primary health care.

Translation and Brazilian adaptation of the Relationship Scales Questionnaire (RSQ).

OBJECTIVES: To describe the process of translating and adapting the Relationship Scales Questionnaire (RSQ) from English into Brazilian Portuguese and to present the results of its test-retest reliability using the version developed for interview application. METHODOLOGY: The process was based on the guidelines of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), which propose 10 steps for the translation and cross-cultural adaptation of self-administered instruments. The original authors of the RSQ have agreed to the translation. The interview version was applied to a sample of 43 healthy elders (≥60 years old) enrolled in a primary health care program in the city of Porto Alegre, state of Rio Grande do Sul, southern Brazil, and then reapplied. The scores of the two applications were compared using the paired sample t-test. RESULTS: Only 6 of the 30 items required the adaptation of words or expressions to maintain its conceptual and semantic equivalence. The self-administered form of the RSQ posed difficulties for elders due to visual deficiencies and lower education level, both common in this age group, demonstrating a need for the development of a version of the RSQ in a structured interview format. Only the measure for secure attachment presented significant differences after the application of the retest, indicating reliability of the version being proposed. CONCLUSION: Translation of the RSQ is the first step towards the validation of an attachment evaluation instrument for use in the elderly population in Brazil, allowing for future studies on this topic.

[Consumption of nutrients among the elderly living in Porto Alegre in the State of Rio Grande do Sul, Brazil: a population-based study]. / Consumo de nutrientes em idosos residentes em Porto Alegre (RS), Brasil: um estudo de base populacional.

A cross-sectional, population-based study was conducted on a random sample of 427 elderly individuals living in Porto Alegre, Brazil, to establish the nutrient consumption profile and verify its association with sociodemographic and health variables. Dietary intake was assessed using the 24-hour Food Recall Survey and the Dietetic Research Investigation technique. Seventy percent of the elderly respondents were women: 48.5% were between 60 and 69 years old; 68.8% had less than 8 years of schooling; 39% had a family income of between 2 and 5 minimum wages and 58.4% took no physical exercise. Hypertension was the most prevalent disease among the elderly and 54.9% were underweight. Men consumed more calories, protein, fiber, minerals and vitamins than women. Carbohydrate and calcium intake increases with advancing age, while zinc intake decreases. Physical exercise increased the intake of calories, magnesium, potassium and phosphorus. The higher the schooling the greater the intake of vitamins B6 and B12; the higher the family income, the greater the consumption of vitamin B6 and folic acid. The results show that there are nutritional deficiencies in the daily diet of the Brazilian elderly population, especially among women and individuals over 80 years of age.

Suicide risk in the elderly: data from Brazilian public health care program.

OBJECTIVE: Examine prevalence and level of suicide risk, and its associations with sociodemographic factors and mood disorders. METHODS: A cross-sectional study with a random sample of 530 individuals aged 60 years or more from Family Health Strategy of Porto Alegre, Brazil. Diagnosis was made by psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus). RESULTS: Suicide risk was found in 15.7% of the sample. Female gender, elderly with no income or with no paid activity and those who have lost one or more of his sons presented association with suicide risk. Bipolar disorder shows association with suicide risk for those with or without current episode. For unipolar depression only elderly with a current episode shows association with suicide risk. LIMITATIONS: The cross-sectional design limits the examination of causative relationships. The MINIplus questions are not broad enough to assess other important self-destructive behaviors. CONCLUSIONS: A high rate of suicide risk was found. As expected an increased rate of mood disorders were related to the risk of suicide. The loss of sons may partly explain a subtype of late-life risk of suicide or mood disorders especially in the oldest-old. These findings can be a useful to generate other research hypothesis and for health professionals who care older persons. Detecting characteristics linked to suicide, therefore opening up the possibility of preventing tragic outcomes providing a proper treatment.

Translation and Brazilian adaptation of the Relationship Scales Questionnaire (RSQ) / Tradução e adaptação brasileira do Relationship Scales Questionnaire (RSQ)

Abstract Objectives To describe the process of translating and adapting the Relationship Scales Questionnaire (RSQ) from English into Brazilian Portuguese and to present the results of its test-retest reliability using the version developed for interview application. Methodology The process was based on the guidelines of the International Society for Pharmaeconomics and Outcomes Research (ISPOR), which propose 10 steps for the translation and cross-cultural adaptation of self-administered instruments. The original authors of the RSQ have agreed to the translation. The interview version was applied to a sample of 43 healthy elders (≥60 years old) enrolled in a primary health care program in the city of Porto Alegre, state of Rio Grande do Sul, southern Brazil, and then reapplied. The scores of the two applications were compared using the paired sample t-test. Results Only 6 of the 30 items required the adaptation of words or expressions to maintain its conceptual and semantic equivalence. The self-administered form of the RSQ posed difficulties for elders due to visual deficiencies and lower education level, both common in this age group, demonstrating a need for the development of a version of the RSQ in a structured interview format. Only the measure for secure attachment presented significant differences after the application of the retest, indicating reliability of the version being proposed. Conclusion Translation of the RSQ is the first step towards the validation of an attachment evaluation instrument for use in the elderly population in Brazil, allowing for future studies on this topic.

Resumo Objetivos Descrever o processo de tradução e adaptação cultural do questionário Relationship Scales Questionnaire (RSQ) do inglês para o português do Brasil e apresentar os resultados de confiabilidade teste-reteste utilizando a versão desenvolvida para aplicação em entrevista. Metodologia O método utilizado teve como diretriz a proposta da International Society for Pharmaeconomics and Outcomes Research (ISPOR), de 10 passos para a tradução e adaptação transcultural de instrumentos autoaplicáveis. Os autores originais do RSQ concordaram com a tradução. A versão para entrevista dirigida foi aplicada em uma amostra de 43 idosos saudáveis (≥60 anos) cadastrados em um programa de atenção primária à saúde na cidade de Porto Alegre, RS, sendo então reaplicada. As pontuações das duas aplicações foram comparadas usando o teste t de Student para amostras pareadas. Resultados Apenas 6 dos 30 itens precisaram de adaptação cultural de palavras ou expressões para manter sua equivalência conceitual e semântica. O formato autoaplicável do RSQ mostrou-se pouco adequado entre idosos, devido à presença comum de déficits visuais e baixa escolaridade, demonstrando a necessidade do desenvolvimento de uma versão do RSQ em formato de entrevista dirigida. Apenas a medida de apego seguro apresentou diferença significativa após a aplicação do reteste, indicando a confiabilidade da versão proposta. Conclusão A tradução do RSQ é o primeiro passo para a validação de um instrumento de avaliação de apego para a população idosa no Brasil, permitindo futuros estudos sobre o tema.

Efeitos do treino com jogos de videogame na cognição de idosos: revisão sistemática / Effects of video game training on cognition in the elderly: systematic review

OBJETIVOS: realizar uma revisão sistemática da literatura sobre o efeito do treino com jogos de videogame na cognição de idosos. MÉTODOS: Busca nas bases de dados LILACS, SciELO, PsycINFO e PubMed, idiomas Inglês e Português. Utilizaram-se os descritores treino com jogos de videogame / video game training, adicionando aos seguintes: cognição / cognition, efeito cognitivo / cognitive effects, desempenho cognitivo / cognitive performance, plasticidade cognitiva / cognitive plasticity, testes cognitivos / cognitive tests. Foram incluídos estudos de intervenção cognitiva, artigos originais e disponíveis na íntegra, população alvo idosos (60 anos ou mais), publicados entre 2005 e 2015. A revisão ocorreu entre janeiro e julho de 2015. RESULTADOS: Dos 70 artigos encontrados inicialmente, 21 estudos atenderam aos critérios de seleção. Sete estudos (33%) verificaram melhoras significativas em velocidade de processamento, atenção sustentada, alerta, memória de trabalho visoespacial, flexibilidade cognitiva, memória visual imediata e tardia e coordenação viso-motora-espacial. Em relação à metodologia de treino dos estudos, 11 (52%) foram com treino de curta duração (uma a seis semanas) e tempo total entre menor tempo 4,5 horas e maior tempo 23,5 horas; e 10 (47%) com treino de longa duração (sete a 12 semanas) e tempo total de treino entre 12 e 36 horas. Os treinos de curta duração foram mais eficazes. CONCLUSÕES: A constatação do tempo total necessário de treino foi o achado principal desta revisão sistemática. Intervenção cognitiva com uso de jogos de vídeo game de curta duração, entre uma e seis semanas, e tempo total do programa de treino cognitivo entre 4,5 horas e 23,5 horas foi eficaz para idosos, sendo esta uma dose de tempo de intervenção cognitiva necessária e suficiente para a consolidação de sistemas e aquisição de um aprendizado no envelhecimento. Os efeitos cognitivos encontrados nos estudos sugerem que o cérebro idoso é capaz de adquirir, manter e enriquecer-se com novas aprendizagens.

AIMS: To perform a systematic review of the literature on the effect of video game training on cognition in the elderly. METHODS: The search was conducted using LILACS, SciELO, PsyINFO and PubMed databases in both English and Portuguese. The search term used were video game training, combined with the following: cognition, cognitive effects, cognitive performance, cognitive plasticity, cognitive tests. The inclusion criteria consisted of intervention studies on video game training, original articles in English or Portuguese, fulltext availability, and target population older people. Studies that failed to meet these criteria were excluded. Articles from 2005 to 2015 were collected, and the review was performed between January 2015 and July 2015. RESULTS: Seventy articles were found, but only twenty-one met the selection criteria. Of the 21 articles included in the study, only 7 studies (33%) revealed statistically significant improvement in speed of processing, sustained attention and alert, working visuospatial memory, cognitive flexibility, immediate and delayed visual memory, visual-motor coordination and visuospatial ability between the research groups (p<0.05). Other results were found in relation to the methodology of the studies. Of the 21 studies, 11 studies (52%) were performed with training of short duration (1-6 weeks) and total time of training ranging between 4.5 and 23.5 hours. Ten studies (47%) were performed with training of long duration (7-12 weeks) total time of training between 12 and 36 hours. The short duration training showed better performance. CONCLUSIONS: The total time required for training was the main finding of this systematic review. Cognitive intervention using short duration training (between one and six weeks) with video games in a total time between 4.5 and 23.5 hours is effective in elderly participants. This length time between the minimum and maximum time of cognitive intervention is necessary and sufficient for the consolidation of systems and acquisition of a learning in aging. The cognitive effects observed in the studies suggest that the aging brain is able to acquire, maintain and even enrich new learnings.

Time of delirium onset and prognosis amongst Southern Brazilian hospitalized elderly patients.

The prognostic significance of delirium in hospitalized elderly has not yet been fully clarified. OBJECTIVES: The present study was designed to evaluate the relationship between prevalent delirium (PrD), incident delirium (InD) and final outcome. METHODS: A historical cohort of 261 patients was selected. delirium was diagnosed using the Confusion Assessment Method. RESULTS: The total frequency of delirium detected was 42.5%-31.4% PrD and 16.2% InD. Among patients with InD, the average length of hospital stay was 9.1 days longer than for patients without delirium (p=0.002), and the hospital mortality associated with InD was 48% versus 2.7% for those without delirium (p< 0.001). However, no difference was observed between patients with PrD and those without delirium. CONCLUSIONS: These results suggest that, when investigating delirium and prognosis amongst hospitalized elderly, it is fundamental to differentiate in terms of time of onset. Furthermore, the absence of delirium seems to be an important protective factor.

O significado do prognóstico de delirium em idosos hospitalizados ainda não está completamente elucidado. OBJETIVOS: O presente estudo foi designado para avaliar a relação entre delirium prevalente (DeP), delirium incidente (DeI) e o desfecho final. MÉTODOS: Uma coorte histórica de 261 pacientes foi selecionada. delirium foi diagnosticado pelo Confusion Assessment Method. RESULTADOS: A freqüência total de delirium foi de 42.5%, DeP 31.4%, e DeI 16.2%. Para pacientes com DeI, a média de duração de hospitalização foi 9.1 dias maior do que aqueles sem delirium (p=0.002), e a mortalidade hospitalar associada a DeI foi de 48.3% contra 2.7% dos livres de delirium (p< 0.001). Contudo, não houve diferença entre pacientes com DeP e sem delirium. CONCLUSÕES: Os resultados sugerem que, ao estudar delirium e prognóstico entre idosos hospitalizados, é fundamental diferenciar o problema quanto ao seu momento de início. Além disso, não apresentar delirium parece constituir-se num fator protetor importante.