Factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer

Introducción: La principal causa de demencia degenerativa es la enfermedad de Alzhéimer. En la población cubana, una de cada cuatro personas de 65 años y más fallece por esta enfermedad u otra forma de demencia. Objetivo : Identificar los factores de riesgo asociados al agravamiento clínico de los pacientes ingresados con enfermedad de Alzhéimer en el Hospital Psiquiátrico Universitario Rene Vallejo Ortiz entre enero de 2013 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo y transversal. El universo estuvo integrado por todos los pacientes ingresados en la mencionada institución asistencial y docente. La muestra no probabilística y a criterio de los autores la integraron 77 pacientes adultos con el diagnóstico de la enfermedad en el periodo de estudio señalado. Las historias clínicas fueron la fuente secundaria de información. Se utilizó estadística descriptiva e inferencial. La información se resumió en tablas y gráficos. Resultados: El 90,6 % presentaban más de 60 años y más de la mitad eran del sexo masculino (54,5 %). La mayoría de los pacientes presentaron diversos síntomas asociados. Lo trastornos de personalidad y orientación se constataron en el 75,3 % mientras que los de memoria en el 72,7 %. Conclusiones: El agravamiento clínico luego del ingreso hospitalario se acentuó en aquellos pacientes sin escolaridad, solteros, desocupados, con enfermedades cerebro vasculares y presencia de familias disfuncionales presentaron. Los pacientes anémicos o con signos de irritación cortical focal en región frontoparietal con generalización secundaria presentaron mayoritariamente un empeoramiento clínico.

Introduction: The main cause of degenerative dementia is Alzheimer's disease. In the Cuban population, one in four people aged 65 and over dies from this disease or another form of dementia. Objective: To identify the risk factors associated with the clinical worsening of patients admitted with Alzheimer's disease at the Rene Vallejo Ortiz University Psychiatric Hospital. Methods: An observational, descriptive and cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned healthcare and teaching institution. The non-probabilistic sample and at the discretion of the authors was made up of 77 adult patients with the diagnosis of the disease in the indicated study period between January 2013 and December 2022. Medical records were the secondary source of information. Descriptive and inferential statistics were used. The information was summarized in tables and graphics. Results: 90.6% were over 60 years old and more than half were male (54.5%). Most patients presented various associated symptoms. Personality and orientation disorders were found in 75.3%, while memory disorders were found in 72.7%. Conclusions: The clinical worsening after hospital admission was accentuated in those patients without schooling, single, unemployed, with cerebrovascular diseases and presence of dysfunctional families. Anemic patients or patients with signs of focal cortical irritation in the frontoparietal region with secondary generalization mostly presented clinical worsening.

Análise do conhecimento, das atitudes e das práticas de médicos e enfermeiros sobre as vivências de cuidadores familiares de pessoas idosas com demência: um estudo CAP / Analysis of knowledge, attitudes, and practices of physicians and nurses regarding the experiences of family caregivers of older adults with dementia: a KAP study

Resumo Objetivo analisar o Conhecimento, Atitudes e Práticas (CAP) dos profissionais de saúde, durante a assistência às pessoas idosas vivendo com demência em relação às situações de cuidado vivenciadas pelos cuidadores informais e a associação com fatores sociodemográficos e profissionais. Método estudo transversal e analítico, do tipo CAP, realizado no município de Tangará da Serra, Mato Grosso, Brasil, com 20 enfermeiros e 20 médicos das Unidades de Saúde da Família. Os dados foram coletados por meio de entrevista utilizando-se um instrumento desenvolvido a partir da literatura disponível sobre estudos CAP. Realizou-se análise descritiva e análise bivariada da associação entre as variáveis conhecimento, atitudes e práticas dos profissionais de saúde e as variáveis sociodemográficas e profissionais, utilizando o teste exato de Fisher, com nível de significância de 5%. Resultados os profissionais de saúde apresentaram conhecimento satisfatório e atitude favorável sobre as situações de cuidado vivenciadas pelos cuidadores informais de pessoas idosas vivendo com demência. Dos profissionais, 65% possuem práticas insuficientes direcionadas aos cuidadores, incluindo orientações, grupos de apoio e educação em saúde. Não houve associação significativa entre as variáveis conhecimento, atitudes e práticas e as variáveis sociodemográficas e profissionais. Conclusão embora os profissionais de saúde tenham conhecimento satisfatório sobre a situação de cuidado vivenciada pelos cuidadores e atitudes positivas em relação a eles, suas práticas se mostram insuficientes para atender suas necessidades, de forma a não contribuir para que os cuidadores possam lidar com as várias situações que o decorrer da doença ocasiona para a pessoa idosa e a eles.

Abstract Objective To analyze the Knowledge, Attitudes, and Practices (KAP) of healthcare professionals during the care of older individuals living with dementia, concerning the caregiving situations experienced by informal caregivers, and its association with sociodemographic and professional factors. Method A cross-sectional analytical KAP study was conducted in the municipality of Tangará da Serra, Mato Grosso, with 20 nurses and 20 physicians from Family Health Units. Data were collected through interviews using an instrument developed based on the available literature on KAP studies. Descriptive analysis and bivariate analysis of the association between the knowledge, attitudes, and practices of healthcare professionals and sociodemographic and professional variables were performed using the Fisher's exact test, with a significance level of 5%. Results Healthcare professionals demonstrated satisfactory knowledge and favorable attitudes towards caregiving situations experienced by informal caregivers of older individuals living with dementia. However, 65% of professionals exhibited insufficient practices directed at caregivers, including guidance, support groups, and health education. No significant association was found between knowledge, attitudes, practices, and sociodemographic or professional variables. Conclusion Despite healthcare professionals possessing satisfactory knowledge of caregiving situations and positive attitudes towards informal caregivers, their practices are inadequate in meeting their needs. This deficiency does not contribute to enabling caregivers to cope with the various challenges that arise during the course of the disease for both the older individual and the caregivers themselves.

Dementia prevalence among hospitalized older patients: a multicenter study in Iran / Prevalência de demência entre pacientes idosos hospitalizados: um estudo multicêntrico no Irã

ABSTRACT Dementia poses a significant societal and health challenge in the 21st century, with many hospitalized patients experiencing dementia without a documented diagnosis. Objective: To evaluate the prevalence of dementia and its associated risk factors among older patients admitted to hospitals. Methods: The study included older patients (≥ 60 years) admitted to medical departments of a general hospital in three major Iranian cities. Researchers utilized the Activities of Daily Living-Instrumental Activities of Daily Living (ADL-IADL) scale, the Geriatric Depression Scale (GDS), the Mini-Cog test, the 4 A's test (4AT), and the Abbreviated Mental Test Score (AMTS). Among the 420 recruited older inpatients, 228 (54.3%) were female. Results: The mean age of participants was 71.39 years (standard deviation ±7.95), with 30.7% diagnosed with major neurocognitive disorder (dementia). The likelihood of dementia exhibited statistically significant correlations with gender, age, number of children, and occupation. Conclusions: Screening older individuals for cognitive impairment upon hospital admission holds the potential to prevent adverse outcomes and enhance the quality of treatment for patients concurrently dealing with dementia.

RESUMO A demência representa um grande desafio social e de saúde no século 21, com muitos pacientes hospitalizados sofrendo de demência sem um diagnóstico documentado. Objetivo: Avaliar a prevalência de demência e seus fatores de risco associados entre pacientes idosos hospitalizados. Métodos: O estudo incluiu pacientes idosos (≥ 60 anos) internados em um hospital geral em três grandes cidades iranianas. Os pesquisadores utilizaram a escala de Atividades da Vida Diária-Atividades Instrumentais da Vida Diária (Activities of Daily Living-Instrumental Activities of Daily Living - ADL-IADL), a Escala de Depressão Geriátrica, o teste Mini-Cog, o teste dos 4 As (4AT) e o Pontuação do Teste Mental Abreviado (Abbreviated Mental Test Score - AMTS). Dos 420 idosos selecionados, 228 (54,3%) eram do sexo feminino. Resultados: A média de idade dos participantes foi de 71,39 anos (desvio padrão ±7,95), sendo 30,7% diagnosticados com transtorno neurocognitivo maior (demência). A probabilidade de demência apresentou correlações estatisticamente significativas com sexo, idade, número de filhos e ocupação. Conclusões: A triagem de idosos para comprometimento cognitivo na admissão hospitalar tem o potencial de prevenir resultados adversos e melhorar a qualidade do tratamento para pacientes que lidam simultaneamente com demência.

Effects of training Community Health Agents on dementia: a quasi-experimental study / Efectos de la capacitación de Agentes Comunitarios de Salud en la demencia: un estudio cuasi experimental / Efeitos da capacitação de Agentes Comunitários de Saúde na demência: um estudo quase experimental

ABSTRACT Objectives: to evaluate the knowledge of Community Health Agents about dementia before and after the training workshop for detecting signs of the disease. Methods: a quasi-experimental study with 33 community agents, in which sociodemographic information and knowledge about dementia were collected and assessed using the Alzheimer's Disease Knowledge Scale before and after the workshop. There were 10 weekly, online, synchronous meetings. The Student's t-test for related samples was used, and the effect size was calculated. Results: while the average score on the initial assessment, using the measurement instrument, was 16.3, it was 21.24 in the final assessment. An increase in the scale score was observed after participating in the workshop, with a value of 4.94. Conclusions: it is urgent to invest in the ongoing education of these professionals for greater awareness in the timely detection of dementia cases in primary care and awareness of potentially modifiable factors.

RESUMEN Objetivos: evaluar el conocimiento de los Agentes Comunitarios de Salud sobre la demencia antes y después de un taller de capacitación para la detección de signos de la enfermedad. Métodos: estudio cuasi experimental con 33 agentes comunitarios, en el que se recopilaron datos sociodemográficos y conocimiento sobre la demencia, evaluados mediante la Escala de Conocimiento de la Enfermedad de Alzheimer, antes y después del taller. Hubo 10 sesiones semanales en línea y sincrónicas. Se utilizó la prueba t de Student para muestras relacionadas y se calculó el tamaño del efecto. Resultados: mientras que la puntuación promedio en la evaluación inicial a través del instrumento de medición fue de 16,3, en la evaluación final fue de 21,24. Se observó un aumento en la puntuación de instrumento después de participar en el taller, con un valor de 4,94. Conclusiones: es urgente invertir en la educación continua de estos profesionales para aumentar la conciencia en la detección oportuna de casos de demencia en atención primaria y la concienciación sobre factores potencialmente modificables.

RESUMO Objetivos: avaliar o conhecimento dos Agentes Comunitários de Saúde sobre demência antes e após a oficina de capacitação para detecção de sinais da doença. Métodos: estudo quase-experimental com 33 agentes comunitários, no qual foram coletadas informações sociodemográficas e de conhecimento sobre demência, avaliadas pela Alzheimer's Disease Knowledge Scale, no pré e pós-oficina. Houve 10 encontros semanais, online e síncronos. Utilizou-se o teste t de Student para amostras relacionadas e calculou-se o tamanho do efeito. Resultados: enquanto a média de pontos na avaliação inicial, por meio do instrumento de medida, foi de 16,3, na avaliação final foi de 21,24. Observou-se aumento na pontuação na escala após a participação na oficina, com um valor de 4,94. Conclusões: é urgente investir na educação permanente desses profissionais para maior conscientização na detecção oportuna de casos de demência ainda na atenção básica e conscientização de fatores potencialmente modificáveis.

Translation and cultural adaptation of the Positive Aspects of Caregiving Scale for caregivers of people living with dementia in Brazilian context: a methodological study

ABSTRACT BACKGROUND: The Positive Aspects of Caregiving (PAC) scale is used to assess psychosocial benefits provided to caregivers by the task of caring. The PAC scale consists of nine items, assessed using a five-point Likert scale, with higher values indicating greater positive perceptions and gains from the caregiving experience. OBJECTIVE: To translate and culturally adapt the PAC scale for informal Brazilian caregivers of people with dementia. DESIGN AND SETTING: A methodological study was conducted at the Federal University of São Carlos. METHODS: The following stages were carried out: Translation; Synthesis of the translations; Back-translation; Evaluation by an experts' committee; and Pre-test. RESULTS: Two independent professionals translated the PAC scale. The consensus version was obtained by merging both translations, which were back-translated into English by a third translator. The expert committee comprised three specialists in the area and project researchers. All scale items presented a Content Validity Index of 1 (CVI = 1.0), and thus remained in the pre-final version of the instrument. The instrument was pre-tested with seven caregivers of people with dementia, the majority of whom were women (57.1%), with a degree of kinship corresponding to sons/daughters (57.1%) and an average age of 55.2 (± 4.1) years. The caregivers considered it clear and understandable and made no suggestions for changes. CONCLUSION: The PAC scale was translated and culturally adapted for use by informal caregivers of people with dementia in Brazil. However, a psychometric analysis of the instrument is necessary to provide normative data for this population group.

Safety Evaluation of Tianzhi Granules in Treating Mild-to-moderate Vascular Dementia / 中国实验方剂学杂志

ObjectiveTo systematically evaluate the safety of Tianzhi granules used in the treatment of mild-to-moderate vascular dementia. MethodA randomized， double-blind， double-simulated， positive drug/placebo parallel controlled multi-center phase Ⅳ clinical trial and an open multi-center phase Ⅳ clinical trial of Tianzhi granules in the treatment of mild-to-moderate vascular dementia were conducted. Safety data of 1 492 patients were included and analyzed according to inclusion and exclusion criteria. The main evaluation measures were the incidence rate of adverse events/adverse reactions， laboratory indicators， vital signs， and electrocardiogram （ECG） results. ResultA total of six adverse events possibly related to the test drug occurred in 520 patients of the double-blind trial， and the symptoms were all mild and recovered. The incidence of adverse events was not statistically different among Tianzhi granules， donepezil， and placebo groups. Nine adverse events possibly related to the test drug were observed in 972 patients of the open trial， and the symptoms were mild and recovered. Laboratory tests （blood routine， urine routine， liver function， kidney function， and coagulation） and vital signs were compared before treatment （baseline） and after treatment of 12 and 24 weeks， respectively. There was no statistical significance in the main indicators before and after treatment. In the double-blinded trial， there was no significant difference in safety indicators between different groups before and after treatment. The most frequent adverse reaction was gastrointestinal discomfort， with an incidence rate of 6.64‰. ConclusionAdverse reactions occasionally occur in patients using Tianzhi granules， and it is safe to use Tianzhi granules to treat mild-to-moderate vascular dementia clinically.

Condiciones de salud bucodental en personas adultas mayores con enfermedad de Alzheimer: Scoping Review

Introducción: El aumento de la longevidad de las personas ha generado en la última etapa de vida la aparición de enfermedades de tipo multifactorial y relacionadas con el estilo de vida, aumentando la prevalencia de patologías mentales y enfermedades orales. Objetivo: Identificar las condiciones de salud oral en personas adultas mayores con enfermedad de Alzheimer. Métodos: Se planteó una revisión de la literatura tipo Scoping Review, determinando una estrategia de búsqueda para tres bases de datos (Pubmed, EbscoHost y LILACS). Fueron incluidos artículos con diseño de corte transversal, cohorte y casos y controles en idioma español, inglés y portugués entre 2011 y 2021. Se realizó la extracción y evaluación del riesgo de sesgo teniendo en cuenta los criterios de elegibilidad. Resultados: Se seleccionaron 32 artículos para revisión de texto completo y síntesis cualitativa de la información. Alemania y Estados Unidos presentan mayor cantidad de publicaciones, el sexo femenino predominó como población de estudio. Se observó menor frecuencia de cepillado, mayor cantidad de ausencias dentales en pacientes con demencia por Alzheimer y consecuentemente un mayor uso de prótesis en dicha población. Conclusiones: Es importante fortalecer la relación sistémico-oral de los adultos mayores mediante un manejo interdisciplinario entre el geriatra y el odontólogo.

Introduction. The increase in the longevity of individuals has led to the emergence of multifactorial diseases related to lifestyle during the later stages of life, thereby increasing the prevalence of mental disorders and oral diseases. Objective: To identify oral health conditions in older adults with Alzheimer's disease. Methods: A Scoping Review literature review was conducted, outlining a search strategy for three databases (Pubmed, EbscoHost, and LILACS). Articles with a cross-sectional, cohort, or case-control design published in Spanish, English, or Portuguese between 2011 and 2021 were included. Extraction and bias risk assessments were performed based on eligibility criteria. Results: Thirty-two articles were selected for full-text review and qualitative synthesis of information. Germany and the United States had the highest number of publications, with females predominating as the study population. A lower frequency of brushing, a higher number of missing teeth in Alzheimer's patients, and consequently higher use of prosthetics were observed in this population. Conclusions: It is essential to strengthening the systemic-oral relationship in older adults through interdisciplinary management involving geriatricians and dentists.

Introdução: O aumento da longevidade das pessoas tem gerado na última fase da vida o aparecimento de doenças multifatoriais e relacionadas ao estilo de vida, aumentando a prevalência de patologias mentais e doenças bucais. Objetivo: identificar as condições de saúde bucal em idosos com doença de Alzheimer. Métodos: foi realizada uma revisão de escopo da literatura, determinando uma estratégia de busca em três bancos de dados (Pubmed, EbscoHost e LILACS). Foram incluídos artigos com desenho transversal, de coorte e de caso-controle em espanhol, inglês e português entre 2011 e 2021. A extração e a avaliação do risco de viés foram realizadas levando-se em conta os critérios de elegibilidade. Resultados: Trinta e dois artigos foram selecionados para revisão do texto completo e síntese qualitativa das informações. A Alemanha e os Estados Unidos tiveram o maior número de publicações, e a população do estudo era predominantemente feminina. Observou-se menor frequência de escovação, maior número de ausencias odontológicas em pacientes com demência de Alzheimer e, consequentemente, maior uso de dentaduras nessa população. Conclusões: É importante fortalecer a relação sistêmico-oral dos idosos por meio do gerenciamento interdisciplinar entre o geriatra e o dentista.

Is there interest of Mexican adults in being prepared should they develop Alzheimer's or other dementia? / ¿Existe interés en adultos mexicanos de preparase en caso de llegar a padecer Alzheimer u otra demencia?

Abstract Introduction Alzheimer's disease, as well as other dementias, cause a progressive deterioration of cognitive functions, preventing patients from making decisions and having control over themselves in an advanced stage of the disease. Objective To explore some expectations, wishes and preferences in a sample of mature adults should they develop Alzheimer or other dementia. Method We surveyed 368 mature Mexican adults without dementia using a large survey created by the authors and used in a previous study; data were collected in some public places where mature people were invited to participate. The survey was completed from July 2019 to August 2020. Results Although most participants had considered they might suffer from dementia in the future, less than half had communicated their wishes to their relatives about future medical treatments in case they could no longer decide for themselves; very few had prepared a written advance directive. Most participants agreed that patients should know their initial diagnosis, mainly to be able to prepare themselves. The main reason given by those who would prefer to hide the diagnosis was to avoid suffering. Discussion and conclusion Our results highlight the need for health professionals to promote discussion with people about the possibility of suffering from dementia, as well as the importance of making decisions in advance, and letting their relatives know about them.

Resumen Introducción La enfermedad de Alzheimer, así como las otras demencias, causan un deterioro progresivo de las funciones cognitivas, evitando que en una etapa avanzada de la enfermedad los pacientes puedan tomar decisiones y tener control sobre sí mismos. Objetivo Explorar algunas expectativas, deseos y preferencias en una muestra de adultos maduros en caso de que llegaran a desarrollar Alzheimer u otra demencia. Método Encuestamos a 368 adultos mexicanos maduros sin demencia usando una encuesta creada por los autores y utilizada en un estudio anterior; los datos se recopilaron en algunos lugares públicos donde se invitó a las personas a participar. La encuesta se aplicó de julio de 2019 a agosto de 2020. Resultados Aunque la mayoría de los participantes había considerado que podría sufrir demencia en el futuro, menos de la mitad había comunicado sus deseos a sus familiares sobre futuros tratamientos médicos en caso de que ya no pudieran decidir por sí mismos; muy pocos habían preparado una voluntad anticipada por escrito. La mayoría de los participantes estuvo de acuerdo en que los pacientes deben conocer su diagnóstico inicial, principalmente para poder prepararse. La principal razón aducida por quienes preferirían ocultar el diagnóstico fue el deseo de evitar sufrimiento. Discusión y conclusión Nuestros resultados destacan la necesidad de que el personal de salud promueva la discusión con las personas sobre la posibilidad de padecer demencia, así como la importancia de tomar decisiones por anticipado e informar de ellas a sus familiares.

Tomada de decisão apoiada para pessoas idosas que vivem com demência: contribuições da bioética / Supported decision-making for older people living with dementia: contributions from bioethics

Resumo O aumento significativo da população idosa e a alta incidência de doenças crônicas e degenerativas demandam preocupação com aspectos inerentes à promoção da autonomia, preservação de direitos humanos e qualidade de vida desse grupo populacional. O exercício do direito à tomada de decisão impacta diversos aspectos da vida humana, como é o caso dos cuidados em saúde, administração patrimonial, relacionamentos, escolha de moradia, cuidados familiares, atividades religiosas e até mesmo atividades diárias. A Tomada de Decisão Apoiada (TDA) pode ser importante instrumento para promoção da autonomia de pessoas idosas que vivem com demência, pois consiste em uma abordagem pautada no respeito aos direitos humanos, que visa instituir mecanismos de fornecimento de suportes para que todas as pessoas possam exercer o direito de tomar decisões inerentes às suas vidas. Para implementação mais robusta no Brasil, é fundamental a mudança de cultura, no sentido de valorização da pessoa idosa e da noção de que a proteção perpassa por ofertar mecanismos de promoção da autonomia pessoal, que se dá, em parte, pelo incentivo ao engajamento social e fortalecimento de laços comunitários. Nesse aspecto, a noção de empoderamento, pautada em concepções advindas da Bioética de Intervenção, mostra-se relevante.

Abstract The significant increase in the elderly population and the high incidence of chronic and degenerative diseases are a matter of concern with regard to issues inherent to promotion of autonomy and preservation of human rights and quality of life in this population group. Exercising the right to make a decision impacts various aspects of human life, such as health care, asset management, relationships, choice of housing, family care, religious activities and even daily routine activities. Supported decision-making (SDM) can be an important tool for promoting autonomy among elderly people living with dementia, as it consists of an approach based on respect for human rights, in which the aim is to establish control over the mechanisms for provision of support so that all people can exercise the right to make decisions inherent to their lives. In order to implement this more robustly in Brazil, it is fundamental to change the culture towards valuing elderly people and implementing the notion that protection involves offering mechanisms for promoting personal autonomy, which is partly achieved through encouragement of social engagement and strengthening community ties. In this regard, the notion of empowerment, based on concepts arising from Intervention Bioethics, is relevant.

Panorámica histórica sobre el surgimiento y evolución del síndrome demencial

La demencia es un síndrome usualmente de naturaleza crónica y progresiva, en el cual existe alteración de múltiples funciones corticales superiores. Esta enfermedad genera una gran preocupación bio-psico-social, además de ser la más cotosa que enfrentan los servicios de salud, y de tener un considerable impacto en la familia y en la sociedad a escala mundial. Las primeras descripciones fenomenológicas de la demencia se sitúan en tiempos muy remotos, y hoy su estudio constituye una experiencia enriquecedora para la práctica médica. La presente revisión se realiza con el objetivo de exponer una panorámica histórica sobre el surgimiento y evolución del síndrome demencial, con fundamento en datos respaldados por fuentes documentales autorizadas y avaladas científicamente. Para ello se realizó una búsqueda y análisis bibliográficos acerca del tema, en las bases de datos Scielo, Medline, LILCACS, ClinicalKey e HINARI. Fortalecer la cultura médica con respecto a la demencia puede propiciar un enfoque multidimensional en su diagnóstico, con mejores resultados en la calidad de vida del paciente y familiares.

Dementia is a syndrome usually of a chronic and progressive nature, in which there is an alteration of multiple higher cortical functions. This disease generates great bio-psycho-social concern, as well as being the most costly disease faced by health services, and having a considerable impact on the family and on society worldwide. The first phenomenological descriptions of dementia date back to very remote times, and today its study constitutes an enriching experience for medical practice. The aim of this Review is to set out a historical overview of the emergence and evolution of the dementia syndrome, based on data supported by authorized and scientifically endorsed documentary sources. For this, a bibliographic search and analysis on the subject was carried out in the Scielo, Medline, LILCACS, ClinicalKey and HINARI databases. Strengthening the medical culture regarding dementia can promote a multidimensional approach in its diagnosis, with better results in the patient and family members' quality of life.

Afasia primaria progresiva variante no fluente/agramática

Introducción: Entre las enfermedades neurodegenerativas se encuentra un grupo de patologías que se caracterizan por un compromiso prominente del lenguaje, denominadas usualmente afasias primarias progresivas, las cuales se subdividen en 3 tipos: variante logopénica, variante semántica y variante no fluente o agramática. Presentación del caso: Paciente con cuadro clínico que inicia a los 65 años, con disminución en la interacción social. Un par de meses después, la esposa nota que el lenguaje del paciente se torna poco fluido, habla con palabras o frases cortas, no logra decir oraciones completas, además de presentar cambios en la entonación de las palabras y alteraciones del lenguaje escrito. El paciente manifiesta que su principal limitación en el momento es el no poder expresar lo que quiere decir, y por este motivo consulta. Discusión: En el caso de este paciente, se describe inicialmente un cambio en su personalidad que no compromete su funcionalidad, sin embargo, al poco tiempo se presenta compromiso del lenguaje como síntoma prominente y que genera mayor compromiso en su calidad de vida, con pruebas neuropsicológicas y hallazgos de neuroimagen que apoyan el diagnóstico de afasia primaria progresiva (APP) variante no fluente o agramatical, con síntomas comportamentales y motores asociados. Conclusión: Las APP son un grupo de trastornos neurocognitivos cuya característica primordial es el compromiso en el lenguaje, cada variante de APP tiene unas características clínicas y criterios diagnósticos específicos que se deben conocer para lograr sospechar el diagnóstico y hacer un abordaje apropiado en el paciente.

Introduction: In the group of neurodegenerative diseases, there is a group of pathologies that are characterized by a prominent compromise of language, normally called primary progressive aphasias, these are subdivided into 3 types: logopenic variant, semantic variant and non-fluent or agrammatic variant. Case presentation: Patient with a clinical picture that begins at age 65, with decreased social interaction, a couple of months later his wife notices that his language becomes not fluent, speaks in short words or phrases, cannot say complete sentences, in addition to changes in the intonation of words and alterations in written language, the patient states that his main limitation at the moment is not being able to express what he wants to say and for this reason they consult. Discussion: In the case of this patient, a change in his personality is initially described that does not compromise his functionality, however soon after a language involvement is presented as the main symptom and the one that generates a compromise in his quality of life, with neuropsychological tests and findings on neuroimaging that supports the diagnosis of primary progressive aphasia (PPA) non-fluent or agrammatical variant, with associated behavioral and motor symptoms. Conclusion: APPs are a group of neurocognitive disorders whose primary characteristic is language impairment. Each APP variant has specific clinical characteristics and diagnostic criteria that must be known in order to suspect the diagnosis and make an appropriate approach to the patient.

Diagnóstico de la variante conductual de demencia frontotemporal basado en estadios clínicos adaptado para países con baja educación: el caso de Perú

Demencia frontotemporal (DFT) es una condición neurodegenerativa escasamente reconocida en personas menores a 65 años de edad. El diagnóstico de DFT variante conductual (DFTvc) se basa en una entrevista clínica comprehensiva, complementada por una evaluación multidimensional (neurológica, cognitiva, neuropsiquiátrica, de biomarcadores e imágenes cerebrales) adaptada y validada a la población a estudiar; sin embargo, a pesar del incremento de su prevalencia en Latinoamérica y el Caribe, existe necesidad de herramientas estandarizadas y un consenso para el diagnóstico de DFTvc. El artículo intenta realizar una aproximación del enfoque de diagnóstico de DFTvc en escenario de paises con bajos y medianos ingresos, como el Perú.

Frontotemporal dementia (FTD) is a widely recognized neurodegenerative condition in people under 65 years old. The diagnosis of behavioral variant FTD (bvFTD) is based on a comprehensive clinical assessment, complemented by a multidimensional assessment (neurological, cognitive, neuropsychiatric, biomarker and brain imaging) adapted and validated to the population to be studied; however, despite its increasing prevalence in Latin America and the Caribbean, there is a need for standardized tools and consensus for the bvFTD diagnosis. The manuscript attempts to approximate the approach for the diagnosis of bvFTD in the setting of low and middle-income countries, including Peru.

Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD) / Dor em idosos com demência: validação da versão brasileira do instrumento Pain Intensity Measure for Persons with Dementia (PIMD)

Abstract Background Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. Objective To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. Methods Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. Results A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). Conclusion The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.

Resumo Antecedentes Embora existam várias formas de estimar a dor na demência ainda há necessidade de ferramentas com melhores itens para avaliação da presença e intensidade da dor nesses indivíduos. Objetivo Analisar as propriedades psicométricas de uma ferramenta de avaliação da dor em idosos dementados, a "Pain Intensity Measure for Persons with Dementia Portuguese - PIMD-p". Métodos Idosos expostos a situações potencialmente dolorosas, sendo esses dementados e com prejuízo na comunicação verbal, foram selecionados em uma unidade ambulatorial e uma instituição de longa permanência, em São Paulo. A PIMD-p foi aplicada por 2 pesquisadores (E1 e E2), de forma separada, num mesmo dia, e, com intervalo de no máximo 14 dias, essa foi reaplicada por apenas um deles (E3), e ainda, foi obtida a intensidade álgica inferida pelos cuidadores dos idosos participantes. Na análise estatística foram utilizados o Alfa de Cronbach, o Coeficiente de Spearman e o Índice de Correlação Intraclasses. Resultados Selecionada uma amostra de 50 idosos com média de idade de 86 anos, a maioria portadora de demência moderada e de dor de origem musculoesquelética. Apuradas para a PIMD-p uma boa consistência interna, segundo o alfa Cronbach (0,838); excelentes reprodutibilidades intra e interobservador (0,927 e 0,970, respectivamente; p < 0,001); e uma validade convergente, essa última obtida com as fortes e significativas correlações entre as intensidades dolorosas inferidas e os indicadores de dor do instrumento em estudo (exceto para o indicador "olhar expressivo"; corr = 0,106 e p = 0,462). Conclusão A PIMD-p se mostrou ser uma ferramenta com propriedades de medida adequadas para avaliar a presença e intensidade álgicas em idosos com demência e com prejuízo na comunicação verbal.

What diseases affect elderly Mexican population? Clinical and socialdemographic characteristics of patients of the psychogeriatric clinic of the National Institute of Psychiatry / ¿De qué se enferman nuestros adultos mayores? Características clínicas y sociodemográficas de los pacientes de la clínica de psicogeriatría del Instituto Nacional de Psiquiatría

Abstract Introduction The demographic and epidemiological transition, as well as the aging population has changed how older adults are treated in our healthcare system. Objective To establish the sociodemographic and clinical characteristics of the patients from the Psychogeriatric Clinic (PC) of the Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM) seen between January 1, 2011, and December 31, 2020. Method Descriptive, observational, cross-sectional, retrospective study. A database was created with the information from digital clinical records. No additional scales were used. Statistical analysis performed in SPSS 20.0. Results 2056 records were found, 1247 met the inclusion criteria. The mean age was 74.28 years, women 73.46% (n = 916), primary school 46.62% (n = 427), married 35.70% (n = 327), urban area 93.99% (n = 1172), home-based 78.28% (n = 717), low socioeconomic level 59.99% (n = 522). The most common psychiatric pathology was depressive disorders 62.07% (n = 774) and neurocognitive disorders 37.52% (n = 468) due to Alzheimer's disease 17.08% (n = 213), with Mini-Mental State Examination of 18.88 points (± 6.68). They had comorbidities such as arterial hypertension 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) and had a geriatric syndrome in 64.42% (n = 218). Discussion and conclusion Aging in Mexico affects the female population the most. The analysis report from the prevalence for psychogeriatric pathologies of the PC it's for of its kind. The main goal is promoting research on dementias and highlighting the magnitude of the problem for Latin American governments. The results are not intended to be extrapolated to the general population.

Resumen Introducción La transición demográfica y epidemiológica, el subsecuente envejecimiento poblacional, produjeron cambios en los sistemas de salud y cómo se atiende a los adultos mayores. Objetivo Establecer las características sociodemográficas y clínicas de los pacientes de la Clínica de Psicogeriatría (CP) del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM) que acudieron entre el 1 enero de 2011 y 31 diciembre de 2020. Método Estudio descriptivo, observacional, corte transversal, retrospectivo. Se creó una base de datos con la información de los expedientes clínicos digitales. No se utilizó ninguna escala adicional. Análisis estadístico realizado en SPSS 20.0. Resultados Se encontraron 2056 registros, 1247 cumplieron los criterios de inclusión. Edad media 74.28 años, mujeres 73.46% (n = 916), primaria 46.62% (n = 427), casadas 35.70% (n = 327), área urbana 93.99% (n = 1172), ocupación hogar 78.28% (n = 717), nivel socioeconómico bajo 59.99% (n = 522). La patología psiquiátrica más común fueron los trastornos depresivos 62.07% (n = 774) y trastorno neurocognitivo 37.52% (n = 468), por enfermedad de Alzheimer 17.08% (n = 213), con MMSE de 18.88 puntos (± 6.68). Con comorbilidades como hipertensión arterial 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) y tenían síndromes geriátricos en 64.42% (n = 218). Discusión y conclusión El envejecimiento se observa principalmente en las mujeres mexicanas. Reporte del análisis de las prevalencias puntuales de las patologías psicogeriátricas de la CP. Primero en su tipo. Se intenta fomentar la investigación en las demencias y resaltar la magnitud del problema en los países latinoamericanos para sus gobiernos. Los resultados no pretenden ser extrapolados a la población general.

Current clinical and research practices on frontotemporal dementia in Brazil: a national survey / Práticas clínicas e cenário de pesquisa em demência frontotemporal no Brasil: uma enquete nacional

Abstract Background Frontotemporal dementia (FTD) is a frequent cause of young-onset dementia and represents a major challenge for the diagnosis and clinical management. It is essential to evaluate the difficulties faced by physicians on the diagnostic workup and on patient care. Objective The aim of this study was to investigate the current practices and the local limits on the diagnosis and management of FTD in Brazil. Methods We elaborated an online survey, composed of 29 questions and divided in four parts, comprising questions about existing health facilities, clinical practices related to FTD, and suggestions to increment the national research on FTD. The invitation to participate was sent by email to all neurologists affiliated to the Brazilian Academy of Neurology (n = 3658), and to all physicians who attended the XII Meeting of Researchers on Alzheimer's disease, in 2019 (n = 187). The invitation was also diffused through social media. Results 256 Brazilian physicians answered the questionnaire. The three most relevant disorders for the differential diagnosis of FTD were Alzheimer's disease (AD) (n = 211), bipolar disorder (n = 117) and dementia with Lewy bodies (n = 92). Most respondents (125/256) reported the difficulty in performing genetic testing as the main limit in the diagnostic of FTD. 93% and 63% of participants considered that the assessment of social cognition and AD CSF biomarkers are useful for the diagnosis of FTD, respectively. Conclusions The present study may provide valuable insights for the medical education and clinical training of physicians, and to foster future research on FTD in Brazil.

Resumo Antecedentes A demência frontotemporal (DFT) é causa frequente de demência pré-senil e representa um desafio em termos de diagnóstico e de manejo clínico. É essencial avaliar as dificuldades existentes na propedêutica e nos cuidados médicos. Objetivo Investigar as práticas médicas e as dificuldades para diagnóstico e manejo da DFT no Brasil. Métodos Elaborou-se um questionário online, composto de 29 questões, divididas em quatro partes, com perguntas sobre infraestrutura existente, práticas clínicas relacionadas à DFT e sugestões para desenvolver a pesquisa nacional na área. O convite para participação foi enviado por e-mail a todos neurologistas afiliados à Academia Brasileira de Neurologia (n = 3658), e aos médicos que participaram da XII Reunião de Pesquisadores de Doença de Alzheimer, em 2019 (n = 187). O convite também foi divulgado através de mídias sociais. Resultados 256 médicos brasileiros responderam o questionário. Os três principais diagnósticos diferenciais de DFT foram doença de Alzheimer (n = 211), transtorno bipolar (n = 117) e demência com corpos de Lewy (n = 92). A maior parte dos respondedores (125/256) apontou a dificuldade em realizar testagem genética como o maior limite no diagnóstico de DFT. 93% e 63% dos respondedores indicaram que a avaliação de cognição social e o uso de biomarcadores liquóricos de doença de Alzheimer são úteis no diagnóstico de DFT, respectivamente. Conclusões Estes resultados devem ser considerados na educação e treinamento médicos, e no desenvolvimento da pesquisa brasileira em DFT.

Alzheimer's disease: an epidemiological analysis over the number of hospitalizations and deaths in Brazil / Doença de Alzheimer: análise epidemiológica frente ao número de internações e óbitos no Brasil

Abstract Background Alzheimer's disease (AD) is a neurodegenerative condition characterized by impaired cognitive function. It results in high morbidity, including a large number of hospitalizations, and mortality, generating high costs to health systems. Objective The present epidemiological analysis evaluated the number of hospitalizations and deaths by AD as the main diagnosis in Brazil between 2010 and 2020. This endeavor should contribute to a better understanding of the disease and its implications. Methods The present analytical, observational, longitudinal, and retrospective study used data extracted from the Department of Informatics of the Brazilian Unified Health System (DATASUS, in the Portuguese acronym). The variables include the number of hospitalizations, the total cost spent, the average cost per hospitalization, the average length of hospital stay, the number of deaths during hospitalization, the mortality rate per hospitalization, sex, age group, region, and race. Results From 2010 to 2020, there were 188,811 deaths and 13,882 hospitalizations for AD, with a total expenditure of BRL 25,953,019.40 in hospitalizations. The average length of hospital stay was 25 days. Over the considered period, mortality, the number of hospitalizations, and the total cost increased while the average length of stay decreased. Conclusion From 2010 to 2020, AD represented a large portion of hospital admissions, generating a significant cost to the health system and a large number of deaths. These data are important to undertake joint efforts to prevent hospitalizations of these patients in order to minimize impacts on the health system.

Resumo Antecedentes A doença de Alzheimer (DA) é uma doença neurodegenerativa caracterizada pelo comprometimento da função cognitiva. Resulta em uma alta taxa de morbimortalidade, por meio de um número significativo de óbitos e internações, gerando um alto custo ao sistema de saúde. Objetivo Realizar uma análise epidemiológica, utilizando as variáveis citadas abaixo, por DA como principal diagnóstico, no Brasil, entre 2010 e 2020, a fim de contribuir para um melhor entendimento da doença e suas implicações. Métodos Estudo analítico, observacional, longitudinal e retrospectivo. Os dados foram extraídos do Departamento de Informática do Sistema Único de Saúde (DATASUS). As variáveis utilizadas foram número de internações, custo total gasto, custo médio por internação, tempo médio de internação, número de óbitos nas internações, taxa de mortalidade por internação, número de óbitos absolutos, sexo, faixa etária, região e raça. Resultados De 2010 a 2020, foram registrados 188.811 óbitos e 13.882 internações por DA, com um gasto total de R$ 25.953.019,40 em internações. O tempo médio de permanência no hospital foi de 25 dias. Em 11 anos, houve aumento da mortalidade, internações e custo total; por outro lado, o tempo médio de permanência, no mesmo período, diminuiu. Conclusão A DA, nos anos avaliados, representa uma parcela significativa das internações hospitalares, gerando um custo significativo ao sistema de saúde, além do número de óbitos. Estes dados são importantes para gerar esforços conjuntos para evitar internações desses pacientes, a fim de minimizar o impacto no Sistema de Saúde.

Conocimientos y habilidades del cuidador familiar del adulto mayor con demencia / Knowledge and skills of the family caregiver of the elderly adult with dementia

Introducción: la demencia es la alteración cognitiva con mayor incidencia. Provoca una disminución de las capacidades físicas y mentales. Las habilidades y conocimientos del cuidador familiar tienen un papel importante para entender las necesidades, fortalezas y limitaciones en el cuidado. Objetivo: establecer la relación entre los conocimientos y las habilidades en cuidados del cuidador familiar del adulto mayor con demencia. Metodología: estudio cuantitativo, transversal, prospectivo y con alcance correlacional. Muestra no aleatoria por disponibilidad de 26 cuidadores. Se aplicó la Escala de conocimientos sobre demencia DKAT2-sp con alfa de Cronbach de 0.79 y el Inventario de habilidad de cuidado-CAI con alfa de Cronbach de 0.84. Resultados: el género predominante fue el femenino. Los resultados de la prueba Rho de Spearman (p = 0.149) comprobaron que no existe relación y mostraron un nivel de significación mayor que lo esperado entre el conocimiento y la habilidad. Los familiares de personas con demencia cumplen con otros roles diferentes, además de que no reciben capacitación; tienen conocimientos altos y moderados con habilidades de cuidado medias y altas. Conclusión: los niveles de habilidad y conocimiento no son insuficientes; no existe una relación entre las variables de estudio.

Introduction: Dementia is the cognitive disorder with the higher incidence. It causes a decrease in physical and mental abilities. The skills and knowledge of the family caregiver comprise an important role in understanding the needs, strengths and limitations in care. Objective: To establish the relationship between knowledge and skills of the family caregiver of the elderly with dementia. Methodology: Study with a quantitative, cross-sectional, prospective approach and correlational scope. Non-random sample due to availability of 26 caregivers. The DKAT2-sp Dementia Knowledge Scale (with 0.79 Cronbach's alpha) and the Care Skills Inventory-CAI instrument (0.84 Cronbach's alpha) were applied. Results: The predominant gender was female. The results of the Spearman's Rho test (p = 0.149) confirmed that there is no relationship, showing a higher level of significance than expected between knowledge and ability. Family members of people with dementia fulfill other different roles, in addition to not receiving training; they have high and moderate knowledge with medium and high care skills. Conclusion: The skill and knowledge levels are not insufficient, demonstrating that there is no relationship between the variables.

An epidemiological study on assessment of dementia and general health pattern among geriatric population in the rural field practice area of medical college and hospital, Kolkata

Background: As our age increases, different pathophysiological changes occur, which leads to geriatric syndromes in the elderly. Along with other bodily changes, psychological changes and dementia start emerging that affects day-to-day activities of the elderly people. These symptoms often get undetected due to lack of care or awareness among the geriatric population or their caregivers. Aim and Objectives: This study aims to measure the prevalence of psychiatric disorders and onset of dementia among the geriatric population in a rural area of West Bengal. Materials and Methods: An observational, descriptive, community-based, and cross-sectional study was conducted by interviewing persons aged 60 years and above residing in Banspole village during the months of April–May, 2022, using General Health Questionnaire-12 and dementia assessment by rapid test questionnaire. The data were analyzed with the Statistical Package for the Social Sciences. Results: A total of 104 respondents were interviewed (62.5% male and 37.5% female). Most commonly found comorbidity was hypertension (48.08%), followed by chronic obstructive pulmonary disease (26.92%) and hypothyroidism (25.97%). Significant psychological morbidity was found in 49 (47.11%) persons, whereas, different levels of dementia was found in 72 (69.23%) participants. Significant associations were found between psychiatric morbidity with age and socioeconomic status, and dementia with age and marital status. Significance level was at P < 0.05. Conclusion: As it can be seen that in psychiatric morbidity is present in almost half of the participants, and dementia in almost 70% participants, but most of the times, these get undetected or overlooked. Early detection and management are the need of the hour, as these conditions causes huge economic burden on the caregivers, as well as on the government concerned.

Social cognition across bipolar disorder and behavioral-variant frontotemporal dementia: an exploratory study

Objectives: Bipolar disorder type 1 (BD1) and behavioral-variant frontotemporal dementia (bvFTD) share similar behavioral and cognitive symptoms, rendering the differential diagnosis between them a clinical challenge. We investigated the accuracy of social cognition (SC) measures to differentiate bvFTD from BD. Methods: We included three groups of participants: early-onset BD1 (in remission, n=20), bvFTD (n=18), and cognitively healthy controls (HC) (n=40), matched for age, schooling, and sex. All participants underwent cognitive assessment, including the Facial Emotion Recognition (FER) and Modified Faux-Pas (mFP) tests, which assess mentalizing. Results: Compared to HC, BD1 and bvFTD patients underperformed on both SC measures. BD1 and bvFTD did not differ regarding FER or mFP total scores, although patients with bvFTD had significantly higher difficulties than those in the BD1 group to detect social faux-pas (p < 0.001, d = 1.35). Conclusion: BD1 and bvFTD share deficits in the core SC functions. These findings should be considered in the development of tasks aiming to improve clinical differentiation between the two disorders.

Evaluación de síntomas neuropsiquiátricos para la detección temprana de trastorno neurocognoscitivo / Evaluation of neuropsychiatry symptoms for the early detection of neurocognitive disorder

RESUMEN INTRODUCCIÓN: El diagnóstico oportuno del trastorno neurocognitivo es de los principales retos en la atención de los trastornos neurocognitivos. Por esto, se han generado estrategias para la detección preclínica de la enfermedad, entre ellas las destinadas a evaluar síntomas neuropsiquiátricos (NPS) como la escala Mild Behavior Impairment - Checklist (MBI-C). MÉTODOS: Inicialmente se realizó una búsqueda en BVSalud, Medline y PsycNet, luego se realizó una búsqueda en bola de nieve. Se incluyeron términos referentes a deterioro comportamental leve (abarcando los NPS en etapas tempranas), deterioro cognitivo leve y términos específicos del MBI-C. RESULTADOS: La presencia de NPS se asocia con un aumento en la incidencia anual de demencia. Al evaluarlos con MBI-C, su puntuación se correlaciona con biomarcadores como una mayor atrofia cortical, la presencia de la proteína β-amiloide, así como disminución en funciones ejecutivas como la capacidad de enfocar la atención y la memoria de trabajo. DISCUSIÓN: Los hallazgos en la literatura sugieren la utilidad de MBI-C como marcador de neurodegeneración en estadios previos a la demencia, esto mediante la evaluación de su capacidad predictiva de forma independiente y al compararla con otros biomarcadores. CONCLUSIONES: MBI-C supone ser un instrumento de fácil aplicabilidad e interpretación, sostenible e incluyente. Sin embargo, quedan vacíos sobre la pertinencia de esta escala, por lo que surge la necesidad de investigar este tema.

ABSTRACT INTRODUCTION: Early diagnosis of neurocognitive disorder is the main challenge of dementia health attention. Therefore, strategies for preclinical detection of the disease have been created, like those intended to evaluate neuropsychiatric symptoms (NPS), like the Mild Behavior Impairment - Checklist (MBI-C). METHODS: Research was performed in BVSalud, Medline, and Psynet. Then a snowball sampling was done. The terms included were mild behavioral impairment (included NPS in initial stages), mild cognitive impairment, and specific terms of MBI-C. RESULTS: The presence of NPS increase the incidence of dementia, with an annual conversion rate of 9%. About MBI-C, the score has been related to biomarkers like worse brain atrophy in patients with Parkinson's Disease and a positive relationship with the presence of B-amyloid protein. Also, Creese and cols. show that mild behavioral impairment (measured by MBI-C) is associated with a faster decrease in attention and working memory. DISCUSSION: MBI-C utility as a neurodegenerative marker has been demonstrated to detect cognitive, neuropsychiatry, and functional symptoms that may precede dementia by evaluating its predictive capacity alone and comparing it to other biomarkers. CONCLUSION: MBI-C is easy to apply and interpret, is sustainable and inclusive. However, there are still gaps in the relevance of the scale, so there is the need to continue investigating this topic.