ABSTRACT

Objetivo: Determinar la relación entre el estado cognitivo y la capacidad funcional, en los usuarios pertenecientes al hogar del adulto mayor San Juan de Dios, Ica. Material y métodos: Investigación cuantitativa, transversal, correlacional, no experimental, observacional, con muestra de 60 adultos mayores, aplicándose el test de Barthel y Pfeiffer. Resultados: El estado cognitivo predominó en deterioro leve 40,0%. La capacidad funcional fue de dependencia leve (58,3%), por dimensiones predominó el nivel independiente en la capacidad de comer 46,7%, vestirse 38,3%, arreglarse 55,0%, deposición 63,4%, uso del servicio higiénico 55,0%, trasladarse 40,0%, y subir escalones 51,7%. En la capacidad de deambular predominó el necesitar ayuda 40,0%, y la dependencia predominó en la capacidad de higiene corporal 55% y la micción 80,0%. Se halló relación significativa entre el estado cognitivo y la capacidad funcional (p=0,000), evidenciándose que la dependencia moderada fue mayor en adultos mayores con deterioro cognitivo moderado y severo (16,7% y 6,7% respectivamente). Asimismo, se halló relación del estado cognitivo con capacidad de comer, lavarse, vestirse, arreglarse, uso de servicio higiénico, trasladarse, deambular y en subir escalones. No se halló relación con la capacidad de deposición y micción. Conclusiones: Existe relación significativa entre el estado cognitivo y la capacidad funcional, en los usuarios pertenecientes al hogar del adulto mayor San Juan de Dios, Ica 2024.

Objective: To determine the relationship between the cognitive state and the functional capacity, in the users belonging to the home for the elderly San Juan de Dios, Ica. Material and methods: Quantitative, cross-sectional, correlational, non-experimental, observational research, with a sample of 60 older adults, applying the Barthel and Pfeiffer test. Results: Cognitive status predominated in mild impairment 40.0%. The functional capacity was mild dependence (58.3%), by dimensions the independent level predominated in the ability to eat 46.7%, dress 38.3%, groom 55.0%, defecate 63.4%, use of the toilet 55.0%, move 40.0%, and climb steps 51.7%. In the ability to walk, needing help predominated 40.0%, and dependency predominated in the ability to maintain body hygiene 55% and urination 80.0%. A significant relationship was found between cognitive status and functional capacity (p=0.000), showing that moderate dependence was greater in older adults with moderate and severe cognitive impairment (16.7% and 6.7% respectively). Likewise, a relationship was found between cognitive status and the ability to eat, wash, dress, groom oneself, use toilet facilities, move, walk and climb stairs. No relationship was found with defecation and urination capacity. Conclusions: There is a significant relationship between cognitive status and functional capacity in users belonging to the San Juan de Dios home for the elderly, Ica 2024.

ABSTRACT

La apnea obstructiva del sueño (AOS) es una condición común en adultos en edad laboral. Incluso, en la actualidad, vemos cómo la edad de retiro se ha ido prolongando de tal manera que adultos mayores, quienes tienen mayor prevalencia de AOS, continúan trabajando incluso en situaciones de alto riesgo de siniestralidad. Uno de los principales síntomas de la AOS es la somnolencia diurna que puede contri- buir de manera directa al riesgo de accidentabilidad, compromiso cognitivo y desem- peño laboral. También se ha demostrado cómo la reducción de la materia gris a nivel cerebral y cerebelar provoca alteraciones en coordinación y capacidad de conducción. El tratamiento con dispositivos de presión positiva mejora el desempeño laboral y redu- ce la incidencia de accidentes de tránsito, pero algunos déficits cognitivos pueden per- sistir incluso después de meses de tratamiento. La evaluación del riesgo de accidentabilidad en conductores es un desafío y los cues- tionarios actuales no son adecuados para el cribado. Los simuladores de conducción y las pruebas de alerta son más prometedores. El futuro de la investigación se centra en estandarizar los resultados de los simulado- res, determinar los mejores predictores de eventos reales y utilizar la inteligencia arti- ficial y los automóviles autónomos para reducir los riesgos relacionados con la somno - lencia al volante. Es necesario que la posición de los entes gubernamentales de nuestros países latinoa- mericanos sea proactiva y orientada a la protección de la salud y la seguridad de la po- blación.

Obstructive sleep apnea (OSA) is a common condition among working-age adults. In today's context, we observe that the retirement age has been extended, with older adults, who have a higher prevalence of OSA, continuing to work even in high-risk situations. One of the main symptoms of OSA is daytime sleepiness, which can directly contribu- te to the risk of accidents, cognitive impairment and reduced work performance. It has also been demonstrated that the reduction of gray matter in the brain, especially in the cerebellum, can lead to coordination and driving capacity impairments. Treatment with positive pressure devices improves work performance and reduces the incidence of traffic accidents, but some cognitive deficits may persist even after months of treatment. Assessing the risk of accidents in drivers is a challenge, and current questionnaires are not suitable for screening. Driving simulators and alertness tests show more promise. The future of research is focused on standardizing simulator outcomes, identifying the best predictors of real-world events, and utilizing artificial intelligence and autonomous vehicles to mitigate risks associated with driver drowsiness. It is imperative that the stance of government entities in our Latin American countries is proactive and aimed at safeguarding the health and safety of the population.

ABSTRACT

En 1914 fue descrito un conjunto de manifestaciones neurológicas asociadas a la enfermedad hepática grave (cirrosis), las cuales no fueron francamente dilucidadas hasta su descripción anatomopatológica completa en 1965, lo que permitió diferenciarla de la enfermedad de Wilson, principal diagnóstico diferencial, reconociéndose entonces como degeneración hepatocerebral (DHC) adquirida. Rara vez ha sido reportada y la literatura disponible se queda corta para explicar de forma precisa esta entidad, caracterizada por alteraciones del movimiento y deterioro cognitivo. En este sentido, se presenta el caso de una paciente de 74 años con cirrosis hepática criptogénica desde los 50 años, que acude al servicio de consulta externa de un hospital de alta complejidad de Medellín, Colombia, refiriendo un grupo de manifestaciones motoras y cognitivas, que precisaron de un abordaje multidisciplinario, paraclínico e imagenológico para determinar la correlación del cuadro clínico con la DHC, representando un reto diagnóstico debido al conocimiento limitado que se tiene sobre la entidad.

In 1914, a set of neurological symptoms associated with severe liver disease (cirrhosis) were described, which were not clearly elucidated until its complete anatomopathological description in 1965, allowing its differentiation from Wilson's disease, the main differential diagnosis, and being recognized then as acquired hepatocerebral degeneration (HCD). It has rarely been reported, and the available literature falls short of accurately explaining this entity, characterized by movement disorders and cognitive impairment. In this context, the case of a 74-year-old patient with cryptogenic liver cirrhosis since the age of 50 is presented. She visited the outpatient service of a high-complexity hospital in Medellín, Colombia, reporting a group of motor and cognitive symptoms. This case required a multidisciplinary, paraclinical, and imaging approach to determine the correlation of the clinical picture with HCD, representing a diagnostic challenge due to the limited knowledge about the entity.

ABSTRACT

Objetivos. Con los avances en el cuidado de la salud y el envejecimiento de la población, la cantidad de adultos mayores con epilepsia aumentará sustancialmente en todo el mundo. En los países desarrollados, la mayor incidencia de epilepsia ya se encuentra en personas mayores de 65 años y, a medida que aumenta la esperanza de vida, las personas que desarrollaron epilepsia a una edad temprana también viven más. El objetivo principal de esta revisión consiste en evaluar. Métodos. Revisión de la literatura en los motores de búsqueda en el lapso de 1990-2023 con los términos demencia, epilepsia, deterioro cognitivo, anticomicial, seguimiento. Se seleccionaron un total de 30 artículos considerados los mas relevantes para dicho fin. Resultados. Los hallazgos encontrados muestran que las personas mayores con epilepsia tienen más probabilidades de sufrir disfunción cognitiva y que podría haber una importante relación bidireccional entre la epilepsia y la demencia. Conclusiones. Algunas personas con epilepsia pueden tener un mayor riesgo de desarrollar demencia, mientras que las personas con algunas formas de demencia, en particular la enfermedad de Alzheimer y la demencia vascular, tienen un riesgo significativamente mayor de desarrollar epilepsia, lo cual muestra una relación bidireccional para ambas condiciones. (AU)

Objectives. With advances in health care and the aging of the population, the number of older adults with epilepsy will increase significantly worldwide. In developed countries, the highest incidence of epilepsy is already found in people older than 65 years, and as life expectancy increases, people who developed epilepsy at a younger age are also living longer. The main objective of this review is to evaluate. Methods. Review of literature in search engines in the period of 1990-2023 with the terms dementia, epilepsy, cognitive impairment, anticonvulsant, follow-up. A total of 30 articles were selected as the most relevant for that purpose. Results. The results show that older people with epilepsy are more likely to suffer from cognitive dysfunction and that there may be an important bidirectional relationship between epilepsy and dementia. Conclusions. Some people with epilepsy may have an increased risk of developing dementia, whereas people with some forms of dementia, particularly Alzheimer's disease and vascular dementia, have a significantly increased risk of developing epilepsy, showing a bidirectional relationship for both conditions. (AU)

ABSTRACT

O objetivo da pesquisa foi avaliar a associação entre as variáveis queixas cognitivas e suspeita de demência com alterações visuais e auditivas autorrelatadas na aplicação do Índice de Vulnerabilidade Clínico Funcional (IVCF-20). Trata-se de pesquisa transversal, realizada de julho de 2023 a janeiro de 2024, com 3.128 pessoas idosas, residentes em uma região do Paraná. Os dados foram coletados por meio do Sistema de Informação da Pessoa Idosa no Paraná, no qual constava o registro das informações do IVCF-20. Os dados foram analisados pelo SPSS v.25.0. Dos 3.128 participantes, 905 (28,9%) apresentaram queixas cognitivas e 240 (7,8%) suspeita de demência. Dos que possuíam queixas cognitivas 328 (36,2%) relataram alteração na visão (OR 2,35; p<0,01) e 210 (23,2%) na audição (OR 3,82; p<0,01). Dos com suspeita de demência, 106 (44,2%) apresentaram alteração visual (OR 2,69; p<0,01), e 73 (30,4%) alteração auditiva (OR 3,74; p<0,01). Alterações na visão e audição estão associadas ao aumento de suspeita de demência e queixa cognitiva. É necessário rastrear essas alterações, e intervir precocemente,pois enxergar e ouvir permite que idosos mantenham sua funcionalidade.(AU)

The objective of the research was to evaluate the association between the variablescognitive complaints and suspicion of dementia with self-reported visual and auditory alterations in the application of the Functional Clinical Vulnerability Index (IVCF-20). This is a cross-sectional survey conducted from July 2023 to January 2024, with 3,128 older people living in a region of Paraná. Data were collected through the Information System for Older People in Paraná, which contains the IVCF-20 information record. The analyzed using SPSS v.25.0. Of the 3,128 participants, 905 (28.9%) had cognitive complaints and 240 (7.8%) suspected dementia. Of those who had cognitive complaints, 328 (36.2%) reported changes in vision (OR 2.35; p<0.01) and 210 (23.2%) in hearing (OR 3.82; p<0.01). Of those with suspected dementia, 106 (44.2%) had visual impairment (OR 2.69; p<0.01), and 73 (30.4%) had auditory impairment (OR 3.74; p<0.01). Changes in vision and hearing are associated with increased suspicion of dementia and cognitive complaint. It is necessary to screen for changes, and intervene old, as seeing and hearing properlyallows the older people to maintain their functionality.(AU)

ABSTRACT

The progressive increase in HIV infection among older adults requires constant research and monitoring, given that geriatric syndromes associated with HIV comorbidities have become an important public health problem. We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and it has a central question: Is the incidence of cognitive impairment higher in older patients living with HIV than in their seronegative peers? The following databases were searched for this review: MEDLINE/PubMed, EMBASE, LILACS, Web of Science, and Scopus. The inclusion criteria were studies whose samples were ≥ 50% patients aged ≥ 50 years, with and without HIV, and a main outcome related to the incidence of cognitive impairment. Only cohort studies with follow-up lasting ≥ 24 months were considered. Three reviewers independently screened the documents for eligibility criteria, extracted the data, assessed the risk of bias (Newcastle-Ottawa Scale), and evaluated the quality of evidence. A narrative synthesis was prepared. In total, 10 798 trials were screened, 8884 were excluded, 14 were analyzed, and 5 were included in this review. Only 1 applied cognitive assessment tests; the rest used secondary data from the medical records. Most found that the incidence of cognitive disorders was higher among older people living with HIV, which highlights the need for public policies aimed at primary and secondary prevention strategies. Further research from other countries is still required. PROSPERO register (CRD42022321914). (AU)

ABSTRACT

Abstract People with cognitive disabilities face multiple challenges concerning oral health and frequently show oral tissue decay because of the barriers society imposes upon them, and due to financial issues, professional and family lack of knowledge, limitations regarding access to services, lack of empowering-driven actions, among others. Positive knowledge, attitudes and practices regarding oral health, developed during the course of a lifetime, help in preserving good health. The aim of the current study is to describe oral health knowledge, attitudes and practices in people with cognitive disabilities participating in the Institutional Program for the Inclusion of People with Cognitive Disabilities in Higher Education at the University of Costa Rica (PROIN, in Spanish), during 2021. A descriptive study with mixed focus was performed; a representative sample comprised of 86 students enrolled in PROIN was used for the quantitative approach, while the qualitative approach used a criteria sample along with an opinion sample, limiting size due to information overload. The survey, along with its corresponding questionnaire and the semi-structured interview, were used as data gathering techniques. It was evidenced that certain issues need to be readdressed, such as bleeding gums, the importance of preserving dental pieces, as well, the practice of flossing, which many students expressed difficulties doing. Good attitudes were found, such as dentist visits; however, access barriers for this population must be overthrown. This article showed the importance of training professionals in disabilities as well as developing oral health promotion programs aimed at people with cognitive disabilities.

Resumen La población con discapacidad cognitiva enfrenta múltiples retos en cuanto a la salud oral, presentado comúnmente un deterioro de los tejidos orales; esto como consecuencia a las barreras impuestas por la sociedad, factores económicos, desconocimiento de los profesionales y familiares, limitaciones en el acceso a la atención, falta de acciones para fomentar su autonomía, entre otras. Los conocimientos, actitudes y prácticas favorables en salud oral ayudan a conservar una buena salud, los cuales se desarrollan a lo largo de la vida. El objetivo del presente estudio es describir los conocimientos, actitudes y prácticas de salud oral en las personas con discapacidad cognitiva que participaron en el Programa Institucional de Inclusión de Personas con Discapacidad Cognitiva a la Educación Superior de la Universidad de Costa Rica (PROIN) durante el año 2021. Se realizó un estudio descriptivo con un enfoque mixto, para el enfoque cuantitativo se utilizó una muestra representativa de 86 estudiantes matriculados en PROIN y para la parte cualitativa se utilizó una muestra por criterio con un muestreo opinático, estableciendo el tamaño por saturación de la información. Se utilizaron como técnicas de recolección de datos la encuesta con su respectivo cuestionario y la entrevista semiestructurada. Se evidenció que existen temas que se deben reforzar, como lo es el sangrado de encías, la importancia de conservar las piezas dentales, así como la práctica de uso de hilo dental, donde la mayoría de los estudiantes expresaron tener dificultades para su utilización. Además, se encontró buenas actitudes con respecto a la visita al odontólogo, sin embargo, se debe derribar barreras de acceso que se presentan para esta población. Este estudio demostró la necesidad de capacitar a los profesionales en el tema de discapacidad y desarrollar programas de promoción de la salud oral específicos para personas con discapacidad cognitiva.

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Introducción: La enfermedad de Alzheimer, constituye un problema sanitario y social de gran magnitud; precisa de diagnóstico y terapéutica precoces. Se realizó una búsqueda de artículos sobre factores de riesgo y biomarcadores de la enfermedad en las bases de datos PubMed/Medline, Scopus, Scielo y Lilacs, y mediante el buscador Google académico; desde el año 2017 hasta el 2023, en idioma español, inglés y portugués. Objetivo: Analizar los factores de riesgo y los biomarcadores de la enfermedad de Alzheimer. Desarrollo: Los principales factores de riesgo encontrados son edad avanzada, menor educación, poca actividad física, hábito de fumar, consumo excesivo de alcohol, hipertensión arterial, diabetes, obesidad, depresión, pérdida o disminución de la audición, aislamiento social, los traumas craneales y la contaminación ambiental. Los biomarcadores fundamentales son: los marcadores que se utilizan en los estudios de neuroimágenes como la PET Amiloide, PET tau, PET FDG; y en LCR y plasma: Aß42, Aß42/Aß40, p tau 217, p tau 181, GFAP, y neurofilamentos de cadena ligeras. Conclusiones: Se requieren estudios longitudinales, a partir de la presencia de los factores de riesgo asociados a biomarcador, desde edades pregeriátricas en pacientes sanos, que tengan como salidas el deterioro cognitivo y el desarrollo de la demencia, para construir un modelo de predicción(AU)

Introduction: Alzheimer's disease is a health and social problem of great magnitude; it requires early diagnosis and therapy. A search for articles on risk factors and biomarkers of the disease was conducted; in the databases PubMed/Medline, Scopus, Scielo and Lilacs, and through the Google scholar search engine; from 2017 to 2023, in Spanish, English and Portuguese. Objective: To analyze the risk factors and biomarkers of Alzheimer's disease. Development: The main risk factors found are advanced age, lower education, little physical activity, smoking, excessive alcohol consumption, high blood pressure, diabetes, obesity, depression, hearing loss or decrease, social isolation, head trauma and environmental pollution. The fundamental biomarkers are: markers used in neuroimaging studies such as amyloid PET, tau PET, FDG PET; and in CSF and plasma: Aß42, Aß42/Aß40, p tau 217, p tau 181, GFAP, and light chain neurofilaments. Conclusions: Longitudinal studies are required, based on the presence of risk factors associated with biomarkers, from pregeriatric ages in healthy patients, which have cognitive impairment and the development of dementia as outputs, to build a prediction model(AU)

ABSTRACT

Intermittent theta burst stimulation (iTBS), a time-saving and cost-effective repetitive transcranial magnetic stimulation regime, has been shown to improve cognition in patients with Alzheimer's disease (AD). However, the specific mechanism underlying iTBS-induced cognitive enhancement remains unknown. Previous studies suggested that mitochondrial functions are modulated by magnetic stimulation. Here, we showed that iTBS upregulates the expression of iron-sulfur cluster assembly 1 (ISCA1, an essential regulatory factor for mitochondrial respiration) in the brain of APP/PS1 mice. In vivo and in vitro studies revealed that iTBS modulates mitochondrial iron-sulfur cluster assembly to facilitate mitochondrial respiration and function, which is required for ISCA1. Moreover, iTBS rescues cognitive decline and attenuates AD-type pathologies in APP/PS1 mice. The present study uncovers a novel mechanism by which iTBS modulates mitochondrial respiration and function via ISCA1-mediated iron-sulfur cluster assembly to alleviate cognitive impairments and pathologies in AD. We provide the mechanistic target of iTBS that warrants its therapeutic potential for AD patients.

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Background@#The number of individuals with mild cognitive impairment (MCI), or those people without dementia who are experiencing age-related cognitive decline, has increased in recent years. Conveniently, several interventions to delay cognitive decline exist, where cognitively stimulating activities (CSA) have been receiving too much attention. However, its beneficial effects have not been well established among older people with MCI due to conflicting findings. @*Objectives@#This study aimed to assess and summarize the available evidence on the effects of CSA on the overall cognitive functioning of older people with MCI. Specifically, it sought to answer the PICO question, “In older people with MCI, does engagement in cognitively stimulating activities improve cognitive function?”@*Methods@#A systematic review and meta-analysis of randomized controlled trials examining the effects of CSA on older people with MCI were conducted. Three studies met the inclusion criteria from the 1,328 records from BioMed Central, CINAHL, Cochrane Library, Health Source: Nursing/Academic Edition, MEDLINE, and PubMed databases and 156 articles from WorldCat, DSpace Saint Louis University, and Google Scholar databases and catalogs. Effect size values were inspected using the random-effects model. Data were summarized as standardized mean difference (SMD) with corresponding 95% confidence intervals in the forest plot. @*Results@#This meta-analysis which compared studies that employed similar methodologies, found that CSA has a significant, large effect in improving cognitive functioning among older people with MCI, evidenced by an SMD of 0.798 (95% CI = 0.510-1.085, p = 0.001). While its superiority over other interventions that improve cognitive function was not observed in this study, it was still found that using CSA was helpful in terms of its cost-effectiveness. Also, heterogeneity across studies was non-significant (Cochran’s Q = 0.151, df = 2, p = 0.927, I2 = 0.00%). These results mean that clinical heterogeneity was absent even though a diverse range of CSA was employed. Additionally, methodological diversity was not present since there were no variations in the study design and minimal variability in the risk of bias assessment. @*Conclusion@#Overall, it is acknowledged that CSA are effective and practical, inexpensive, non-pharmacologic cognitive training approaches to delay cognitive decline among older people with MCI. However, interpreting this study’s significant, large effect, and non-significant heterogeneity warrants caution.

ABSTRACT

Background: Given the improvement in life expectancy of people living with HIV (PLWH) in sub-Saharan Africa, the risk of asymptomatic HIV-associated neurocognitive disorder (HAND) has increased. The study objectives were to investigate the prevalence of HAND and associated factors among treatment experienced adults in Ethiopia. Methods: A single-center observational cross-sectional study was conducted between December 2019 and June2020 to investigate HAND. International HIV dementia scale (IHDS) was used to screen for the disorder. Both descriptive and analytical statistics were used to analyze the data. Results: Total of 324 PLWH (63% females) who were on combination antiretroviral therapy for median of 144months (IQR: 108-168) were investigated. The mean age was 42.5 years (1SD=12.2). The prevalence of HAND was 75.3% and the difference was significantly more in those above 40 years of age (65.8% vs. 80.7%, p=0.003). Age is the only risk factor identified with multivariable logistic regression analysis. A linear decrement in the total score of cognitive performance was observed as the patient's age increase; age was responsible for 9.4% variation observed in IHDS score (r= -0.31, R2=0.094, p<0.0001). Although statistically not-significant, the trend for cardio-metabolic and behavioral risk factors (hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol and khat use) was higher in the group diagnosed with HAND. Conclusion: The occurrence of neurocognitive impairment was more pronounced in individuals aged 40 years and above who were HIV positive, compared to those below 40 years. Age was found to be an independent predictor of HAND. Cardiovascular and behavioral risk factors were observed more among patients with HAND compared to no-HAND

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Introduction.Background: Hearing impairment (HI) and cognitive impairment (CI) are common health problems in elderly patients, with far-reaching and diverse consequences. We sought to describe the hearing profile, cognitive profile, and associated factors in elderly patients received at a tertiary level hospital in Cameroon, and determine the relationship between HI and CI.Methodology. We conducted a hospital-based cross-sectional study, at the outpatient department of a tertiary level and referral hospital in Cameroon. We included all consenting elderly patients aged 55years and above from February to April 2024. Critically ill patients and those with known neurological conditions were excluded. Results.A total of 107 patients were included. The average age was 69.1±8.7years. Using the HHIE-S tool, 26 individuals had HI (24.3%). Participants with primary level of education had a significantly higher risk of having HI compared to patients with higher levels (aOR=4.1, 95% CI=1.2-13.8, p=0.02). CI was found in 38 (35.5%) individuals. Twenty-one (19.63%) participants had both HI and CI. Factors associated with CI on multivariate analysis were age ≥60years (aOR=15.1, 95% CI=1.9-117.7, p=0.01), lower level of education (aOR=5.5, 95% CI=1.8-16.9, p=0.003), and HI (aOR=13.3, 95% CI=4-44.8, p<0.001). Married participants had less odds of developing CI (aOR=0.3, 95% CI=0.1-0.9, p=0.03).Conclusion.The significant association between HI and CI justifies intentional screening, holistic assessment, and integrated management.

Introduction. Les déficiences auditives et les déficiences cognitives sont des problèmes de santé courants chez les personnes âgées, dont les conséquences sont vastes et diverses. Nous avons cherché à décrire le profil auditif, le profil cognitif et les facteurs associés chez les patients âgés accueillis dans un hôpital de niveau tertiaire au Cameroun, et à déterminer la relation entre les déficiences auditives et les déficiences cognitives. Méthodologie.Nous avons mené une étude transversale en milieu hospitalier, au service des consultations externes d'un hôpital de niveau tertiaire et de référence au Cameroun. Nous avons inclus tous les patients âgés de 55 ans et plus, consentants, de février à avril 2024. Les patients gravement malades et ceux présentant des troubles neurologiques connus ont été exclus.Résultats. Au total, 107 patients ont été inclus. L'âge moyen était de 69,1±8,7 ans. En utilisant l'outil HHIE-S, 26 personnes étaient atteintes de HI (24,3 %). Les participants ayant un niveau d'éducation primaire avaient un risque significativement plus élevé d'avoir un IH que les patients ayant un niveau d'éducation plus élevé (aOR=4.1, 95% CI=1.2-13.8, p=0.02). L'IC a été trouvé chez 38 personnes (35,5 %). Vingt-et-un (19,63 %) participants présentaient à la fois un HI et un CI. Les facteurs associés à l'IC dans l'analyse multivariée étaient l'âge ≥60 ans (aOR=15,1, 95% CI=1,9-117,7, p=0,01), un niveau d'éducation inférieur (aOR=5,5, 95% CI=1,8-16,9, p=0,003), et le HI (aOR=13,3, 95% CI=4-44,8, p<0,001). Les participants mariés avaient moins de chances de développer une IC (aOR=0,3, 95% CI=0,1-0,9, p=0,03). Conclusion. L'association significative entre l'IH et l'IC justifie un dépistage intentionnel, une évaluation holistique et une prise en charge intégrée

ABSTRACT

Addictive behaviors related to Internet are becoming more common and this tool has been essential once it enables home office, entertainment, homeschooling, and easy access to information. Despite the easiness brought by technology, the exaggerated use has affected users in different ways, including in the development of psychiatric disorders. This study aimed to assess internet addiction, depression, anxiety, attention-deficit/hyperactivity disorder (ADHD), attention, impulsivity, and stress in 48 adolescents (26 young women and 22 young men), aged from 15 to 18 years, with a mean age of 16.74 (0.61), mostly students of public schools, during COVID-19, to investigate correlations between these variables according to sex and sociodemographic aspects. To assess the factors, the Internet Addiction Test (IAT); the Swanson, Nolan, and Pelham Rating Scale (SNAP-IV) Questionnaire ; the Depression, Anxiety, and Stress scale for brazilian adolescents (EDAE-A); the Barratt Impulsiveness Scale (BIS-11); and a sociodemographic questionnaire were applied. The data collection was performed in schools located in southern Brazil. The results indicated that 12 out of 48 adolescents were considered addicted to the Internet. Moreover, Internet addiction was a predictor of depression in regression analysis (p<0.001). In addition, participants classified as more addicted to the Internet scored lower averages in general attention (p<0.035) and higher averages in behavioral symptoms of inattention and ADHD (p<0.050), stress (p<0.003), anxiety (p<0.016), and depression (p<0.015), with effect sizes ranging from moderate to high. Therefore, the intense internet use by adolescents might cause psychological consequences such as depression in adolescents. Family support and professional intervention might help in the reduction of symptoms and consequences of internet addiction as well as in its prevention.(AU)

A dependência de internet é cada vez mais comum, pois essa ferramenta tem se tornado imprescindível, uma vez que possibilita home office, entretenimento, educação domiciliar e fácil acesso às informações. No entanto, o uso exagerado da tecnologia afeta os usuários de diversas formas, inclusive no desenvolvimento de transtornos psiquiátricos. Este estudo visou avaliar a dependência de internet, depressão, ansiedade, hiperatividade, atenção, impulsividade e estresse em 48 adolescentes (26 meninas e 22 meninos) de 15 a 18 anos, com idade média de 16,74 (0,61), estudantes de escolas públicas do Sul do Brasil durante a covid-19, para investigar correlações entre as variáveis anteriores de acordo com gênero e aspectos sociodemográficos. Para avaliar, aplicou-se o Internet Addiction Test (IAT), um teste de atenção, escala SNAP IV, escala de depressão, ansiedade e estresse para adolescentes (EDAE-A), escala de impulsividade de Barratt e um questionário sociodemográfico. Os resultados indicaram que 12 adolescentes foram considerados viciados em internet, e que a dependência desta foi preditora da depressão na análise de regressão (p < 0,001). Ainda, os participantes classificados como adictos tiveram médias mais baixas em atenção geral (p < 0,035) e mais altas em sintomas comportamentais de desatenção e hiperatividade (p < 0,050), estresse (p < 0,003), ansiedade (p < 0,016) e depressão (p < 0,015), com efeitos que variaram de moderado a alto. Portanto, o uso intenso da internet por adolescentes pode ter consequências psicológicas, como a depressão. Bom apoio familiar e intervenção profissional podem ajudar na redução dos sintomas e consequências, bem como na prevenção da dependência.(AU)

La adicción a Internet es cada vez más habitual, puesto que esta herramienta es esencial para el trabajo remoto, el entretenimiento, la educación domiciliar y el fácil acceso a la información. Sin embargo, su uso exagerado afecta a la vida de las personas de diferentes maneras, incluso en el desarrollo de trastornos psiquiátricos. El objetivo de este estudio fue evaluar la adicción a Internet, depresión, ansiedad, hiperactividad, atención, impulsividad y estrés en 48 adolescentes (26 muchachas y 22 muchachos), de entre 15 y 18 años, con una edad promedio de 16,74 (0,61), en su mayoría estudiantes de escuelas públicas del Sur de Brasil, durante la pandemia de la COVID-19, para investigar las correlaciones entre las variables mencionadas según género y aspectos sociodemográficos. Para evaluar los factores, se aplicaron el Test de Adicción a Internet (TAI), un test de atención, la escala SNAP IV, la Escala de Depresión, Ansiedad y Estrés para adolescentes (EDAE-A), la escala de impulsividad de Barratt y un cuestionario sociodemográfico. Los resultados indicaron que 12 adolescentes fueron considerados adictos a Internet, además, la adicción a Internet fue un predictor de la depresión en el análisis de regresión (p<0,001). Igualmente, los participantes clasificados como más adictos a Internet tuvieron promedios más bajos en atención general (p<0,035), y más altos en síntomas conductuales de falta de atención e hiperactividad (p<0,050), estrés (p<0,003), ansiedad (p<0,016) y depresión (p<0,015), con efectos que varían de moderado a alto. Por lo tanto, el uso intenso podría producir consecuencias psicológicas como la depresión en los adolescentes. Tener un buen apoyo familiar e intervención profesional puede ayudar a reducir los síntomas y las consecuencias de la adicción a Internet, así como prevenirla.(AU)

ABSTRACT

Introducción: Seguir instrucciones, inhibir distracciones del entorno, planificar y ejecutar actos motores complejos, así como controlar la impulsividad; son habilidades ejecutivas fundamentales para participar de un programa de rehabilitación de manera satisfactoria. El propósito de esta revisión es concientizar al equipo rehabilitador sobre la importancia de las disfunciones ejecutivas en el proceso de rehabilitación de personas post ACV. Método: se realizó una revisión de literatura a través de las bases de datos PubMed, Embase, Web of Science y Cochrane Library, incluyendo artículos publicados hasta abril 2023. Se emplearon combinaciones de términos de búsqueda para tres categorías: ACV, funciones ejecutivas (FE), y disfunciones ejecutivas. Se seleccionaron diseños de corte transversal, ensayos clínicos y revisiones sistemáticas que incluyeran los términos funciones /disfunciones ejecutivas y ACV. Resultados: Se identificaron 174 artículos que cumplían con los criterios de búsqueda, de los cuales fueron descartados 121 por abordar conceptos distintos al objetivo de estudio y 7 artículos que se encontraban duplicados. Fueron seleccionados 46 artículos considerando su pertinencia, relevancia y actualización en el tema. Conclusión: El deterioro de las EF es un síndrome heterogéneo en el cual la interacción simultánea de múltiples procesos cognitivos, como la capacidad para razonar y resolver problemas a menudo se ve gravemente comprometida. Este deterioro puede resultar perjudicial durante el proceso rehabilitador posterior a un ACV, ya que los componentes de la función ejecutiva son principios necesarios para el funcionamiento en el mundo real.

Introduction: Following instructions, inhibiting distractions from the environment, planning and executing complex motor task, as well as controlling impulsivity are fundamental executive skills to participate in a rehabilitation program in a satisfactory manner. The purpose of this review is to make the rehabilitation team aware of the importance of executive dysfunctions in the rehabilitation process of post-stroke patients. Method: a literature review was carried out using PubMed, Embase, Web of Science and Cochrane Library databases, including articles published up to April 2023. Combinations of search terms were used for three categories: stroke, executive functions (EF) and executive dysfunctions. We selected cross-sectional designs, clinical trials and systematic review that included the terms /dysfunctions and stroke. Results: we identified 174 articles that met the search criteria, of which 121 were discarded because they addressed concepts other than the study objective and 7 articles were found to be duplicates. Forty-six articles were selected considering their pertinence, relevance and up-to-dateness in the subject. Conclusion: impaired EF is a heterogeneous syndrome in which the simultaneous interaction of multiple cognitive processes, such as the ability to reason and solve problems is often severely compromised. This impairment can be detrimental during the post-stroke rehabilitative process, as components of executive function are necessary principles for real-world functioning.

ABSTRACT

Abstract Population aging and the reduction in the availability of family caregivers have driven the demand for care for older adults in long-term care facilities (LTCF). This study aimed to characterize the sociodemographic, functional, cognitive and emotional aspects of residents of philanthropic LTCF in a medium-sized Brazilian city. This study also sought to correlate variables in residents' life and their levels of depression and cognitive performance. Cognitive (MMSE and ACE-R) and mood screening instruments (GDS-15) and a guided interview were applied to 78 residents. Generally, residents were White, single/widowed, independent women showing depressive symptoms (52%) and cognitive impairment (74%). Most participants reported satisfaction with the care offered by the LTCF, but this satisfaction was negatively correlated with the depression score. This profile suggests the need for an institutional arrangement that considers the needs of residents and promotes their quality of life.

Resumo O envelhecimento populacional e a redução de disponibilidade de cuidadores familiares têm impulsionado a procura pelo atendimento de pessoas idosas em instituições de longa permanência (ILPI). Este estudo buscou caracterizar aspectos sociodemográficos, funcionais, cognitivos e emocionais de residentes de ILPI filantrópicas de uma cidade brasileira de médio porte. Também buscou-se correlacionar variáveis do contexto de vida dos residentes e seus níveis de depressão e desempenho cognitivo. Foram aplicados instrumentos de rastreio cognitivo (MEEM e ACE-R) e de humor (EDG-15), além de um roteiro de entrevista em 78 residentes. Em geral, os residentes eram mulheres, brancas, solteiras/viúvas, independentes, apresentando sintomas depressivos (52%) e declínio cognitivo (74%). A maioria referiu satisfação com o atendimento ofertado pelas ILPI, mas essa satisfação se correlacionou negativamente com o escore de depressão. Esse perfil sugere a necessidade de um arranjo institucional que leve em conta as necessidades dos residentes e favoreça sua qualidade de vida.

Resumen El envejecimiento de la población y la reducción de la disponibilidad de cuidadores familiares han impulsado la búsqueda de atención para las personas mayores en instituciones de larga permanencia (ILPI). Este estudio buscó caracterizar los aspectos sociodemográficos, funcionales, cognitivos y emocionales de los residentes en ILPI filantrópicas en una ciudad brasileña de tamaño medio. También se intentó correlacionar variables del contexto de vida de los residentes con sus niveles de depresión y rendimiento cognitivo. Se aplicaron una guía de entrevista y herramientas de evaluación cognitiva (MEEM y ACE-R) y de humor (EDG-15) a 78 residentes. La mayoría de los participantes eran mujeres, blancas, solteras/viudas e independientes, con síntomas depresivos (52%) y declive cognitivo (74%). Aunque la mayoría expresó satisfacción con la atención ofrecida por las ILPI, esta satisfacción se correlacionó negativamente con el puntaje de depresión. Se sugiere la necesidad de un diseño institucional que considere las necesidades de los residentes y favorezca su calidad de vida.

ABSTRACT

Objective to map the characteristics and purposes of Virtual Reality (VR) technologies for the elderly in the community. Method scoping review, according to JBI recommendations and described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Ten databases and four platforms referring to gray literature were included. Studies were selected after duplicates were removed and individual and peer reviews were carried out. Similarity analysis was used to identify competition between words and their results. Results 20 studies on VR for the elderly were mapped, the majority of which used non-immersive devices. The main purpose of using VR with the elderly is to improve and/or rehabilitate functions that decline with aging, either physiologically or as a result of illness or injury. VR devices are a potential tool for the prevention of falls and cognitive decline and favor the performance of instrumental activities of daily living. Similarity analysis resulted in the generation of a maximum tree, which identified the interrelationship between the terms "virtual reality" and "elderly" as the central and intermediate elements, respectively. Conclusion it is recommended that further studies be carried out in other environments, which could allow for a wider use of VR by health professionals, especially nurses, in the care provided to the elderly.

Objetivo: mapear las características y las finalidades de las tecnologías de Realidad Virtual (RV) para adultos mayores en la comunidad. Método: revisión de escopo, según la recomendaciones del JBI ( Joanna Briggs Institute ) y descrito de acuerdo con el Preferred Reporting Items for Systematic Reviewas and Meta-Analyses Extension for Scoping Reviews . Fueron incluidas diez bases de datos y cuatro plataformas referentes a la literatura gris. La selección de los estudios fue realizada después de la remoción de duplicados, evaluación individual y también en pares. El análisis de similitud fue utilizado para identificar las afinidades entre las palabras y sus resultados. Resultados: fueron mapeados 20 estudios de RV para los adultos mayores, siendo la mayoría del uso de dispositivos no inmersivos. Las principales finalidades del uso de la RV con adultos mayores fueron mejorar y/o rehabilitar las funciones que entran en declino con el envejecimiento, de forma fisiológica o provenientes de enfermedades o daños. Los dispositivos de RV constituyen una potencial herramienta para la prevención de caídas y disminución cognitiva, y favorecen la ejecución de actividades instrumentales de la vida diaria. El análisis de similitud resultó en la generación del árbol máximo, que permitió identificar la interrelación con los términos "realidad virtual" y "adulto mayor", como elemento central e intermediario, respectivamente. Conclusión: se recomienda el desarrollo de nuevos estudios, en otros ambientes, para permitir una mayor amplitud en el uso de la RV, por profesionales de la salud, en especial de los enfermeros, en la asistencia prestada a los adultos mayores.

Objetivo: mapear as características e as finalidades das tecnologias de Realidade Virtual (RV) para os idosos na comunidade. Método: revisão de escopo, segundo às recomendações do JBI e descrito de acordo com o Preferred Reporting Items for Systematic Reviewas and Meta-Analyses Extension for Scoping Reviews . Foram incluídas dez bases de dados e quatro plataformas referentes à literatura cinzenta. A seleção dos estudos foi realizada após a remoção de duplicatas e a avaliação individual e em pares. A análise de similitude foi utilizada para identificar as concorrências entre as palavras e seus resultados. Resultados: foram mapeados 20 estudos de RV para os idosos, sendo a maioria de uso de dispositivos não imersivos. As principais finalidades do uso de RV com os idosos foram melhorar e/ou reabilitar as funções que entram em declínio com o envelhecimento, de forma fisiológica ou advindas de doenças ou agravos. Os dispositivos de RV constituem uma potencial ferramenta para a prevenção de quedas e declínio cognitivo, e favorecem a execução de atividades instrumentais de vida diária. A análise de similitude resultou na geração da árvore máxima, que permitiu identificar a inter-relação com os termos "realidade virtual" e "idoso", como elemento central e intermediário, respectivamente. Conclusão: recomenda-se o desenvolvimento de novos estudos, em outros ambientes, o que poderá permitir uma maior amplitude no uso de RV, por profissionais de saúde, em especial dos enfermeiros, na assistência prestada aos idosos.

ABSTRACT

Introducción: La detección temprana del deterioro cognitivo en personas mayores permite disminuir la incertidumbre y mejorar las tareas de intervención. El objetivo de esta investigación fue determinar las características psicométricas de un protocolo de cribado online para detectar tempranamente deterioro leve en personas mayores. Método: el método usado fue de tipo mixta con preguntas de tipo cuantitativas y cualitativas. La muestra fue de 75 personas mayores del gran Concepción, región del Bio-Bio. El protocolo estaba compuesto por: Cuestionario sociodemográfico, Test del Reloj Versión Cacho, Moca, Escala Depresión Yesavage y Test Acentuación de Palabras. El procedimiento consistió en la aplicación del protocolo a través de un Tablet o Laptop, videollamadas. Resultados: Se encontró que el protocolo presenta validez discriminante y convergente. Conclusiones: se concluye que el protocolo de cribado online para detectar tempranamente deterioro leve en personas mayores es válido y fiable. Se discute el uso y la aplicación de un protocolo cribado usando la Teleneuropsicología (TeleNP), en personas mayores

ABTRACT Introduction: Early detection of cognitive impairment in the elderly allows us to reduce uncertainty and improve intervention tasks. The objective of this research was to determine the psychometric characteristics of an online screening protocol for early detection of mild impairment in the elderly. Method: the method used was of a mixed type with quantitative and qualitative questions. The sample consisted of 75 older people from the greater Concepción, Bio-Bio region. The protocol consisted of: Sociodemographic Questionnaire, Cacho Version Clock Test, Mocha, Yesavage Depression Scale and Word Stress Test. The procedure consisted of the application of the protocol through a Tablet or Laptop, video calls. Results: It was found that the protocol presents discriminant and convergent validity. Conclusions: it is concluded that the online screening protocol for early detection of mild deterioration in the elderly is valid and reliable. The use and application of a screening protocol using Teleneuropsychology (TeleNP) in older people is discussed.

ABSTRACT

La Esquizofrenia comprende un conjunto heterogéneo de trastornos, los cuales conforman un espectro con signos y síntomas variables que son diferentes en cada paciente e involucran alteraciones de la percepción, las emociones, la cognición, el pensamiento y el comportamiento. Por su parte, el Trastorno Cognitivo Comunicativo se entiende como un conglomerado de dificultades de la comunicación relacionadas con déficits lingüísticos, sobre todo en sintaxis, semántica y/o habilidades metalingüísticas, así como funciones cognitivas no lingüísticas. El caso clínico expuesto se enfoca en la presentación concomitante de Trastorno Cognitivo Comunicativo y Esquizofrenia. Los tratamientos médicos aplicados a menudo para la esquizofrenia tienden a reducir la desintegración que acompaña a los síntomas positivos, los cuales involucran alteraciones de la percepción, del pensamiento y de la conducta. Sin embargo, los síntomas negativos son atendidos con menor frecuencia, lo que puede impedir la reconexión del paciente con su entorno social. En el caso reportado, el abordaje integral de la sintomatología positiva junto con la negativa reflejan la potencialidad para la reinserción a la rutina social cotidiana.

Schizophrenia comprises a heterogeneous set of disorders, setting up a spectrum with variable signs and symptoms, different in each patient, involving alterations in perception, emotions, cognition, thinking and behavior. The Communicative Cognitive Disorder is understood as a conglomerate of communication impairments related to linguistic deficits, especially in syntax, semantics and/or metalinguistic skills, as well as non-linguistic cognitive functions. We present here a case with Communicative Cognitive Disorder concomitant with Schizophrenia. Medical treatments often applied for schizophrenia tend to reduce the disintegration associated with positive symptoms, thus improving perception, thinking, and behavior. However, negative symptoms are treated less frequently, which may prevent the patient from reconnecting with their social environment. In the case reported, the comprehensive approach to positive symptoms together with the negative ones reflect the potential for reinsertion into the daily social routine.

ABSTRACT

La prevalencia de personas con demencias ha aumentado progresivamente y actualmente constituye un desafío en salud pública. Además de fortalecer las herramientas necesarias para su diagnóstico y tratamiento, es necesario desarrollar estrategias que promuevan el respeto de quienes la padecen y mejorar su participación social. El deterioro cognitivo interfiere progresivamente en la toma de decisiones, especialmente en la etapa final de la enfermedad, generando conflictos en torno al respeto por la autonomía y la atención clínica. Las Voluntades Anticipadas y la Planificación Anticipada de Cuidados ofrece la oportunidad de reflexionar sobre valores, deseos y preferencias de atención a futuro, así como la posibilidad de comunicarlos a familiares y equipos de atención, promoviendo el respeto por la autonomía y disminuyendo los conflictos asociados a la atención, especialmente en la etapa terminal. En Chile se ha avanzado progresivamente, pero aun es un desafío implementar las estrategias para consolidar este proceso, superando las barreras existentes y potenciando sus beneficios.

The prevalence of people with dementia has progressively increased and currently constitutes a public health challenge. In addition, to strengthening the necessary tools for diagnosis and treatment, it is essential to develop strategies that promote respect for those who suffer from it and improve their social participation. Cognitive impairment progressively interferes with decision-making, especially in the final stages of the disease, generating conflicts regarding autonomy and clinical care. Advance Directives and Advance Care Planning offer the opportunity to reflect on values, desires, and future care preferences, as well as the possibility to communicate them to family members and care teams, promoting respect for autonomy and reducing conflicts associated with care, especially in the terminal stage. In Chile, there has been gradual progress, but it is still a challenge to implement the strategies to consolidate this process, overcoming existing barriers and maximizing its benefits.

ABSTRACT

Introducción: el riesgo de caídas y de lesiones relacionadas, así como el de presentar delirio, representan un problema de salud pública en constante aumento, en especial en sociedades con una población que envejece. Objetivo: el propósito de este estudio fue evaluar el nivel de riesgo de caídas, previo a cirugía de cadera o rodilla, y la frecuencia de desarrollar delirio después de las intervenciones quirúrgicas. Materiales y métodos: estudio observacional, analítico de corte transversal en el que se encuestaron pacientes hospitalizados en la Clínica de Cirugía Ortopédica y Traumatología, Novi-Sad, Serbia, entre el inicio de diciembre de 2022 y fin de enero de 2023. Resultados: del número total de pacientes (N = 106), la mayoría (61.3%) tenían más de 70 años, de los cuales la mayor parte eran de sexo femenino (N = 80 (75.5%). El porcentaje más alto de los que respondieron la encuesta fueron categorizados en nivel II de riesgo de caída (73.6%), mientras que se clasificó como nivel I y III a 14 pacientes en cada uno de dichos niveles (13.2%). Los resultados del puntaje 4AT evidenciaron que en la mayoría de los pacientes (N = 50 47.2%) la probabilidad de presentar delirio o deterioro cognitivo fue baja, con posibles deterioro cognitivo en 40 (37.7%) y delirio en 16 (15.1%). Conclusión: los pacientes hospitalizados en el servicio de ortopedia de la Clínica de Cirugía Ortopédica y Traumatología del Centro Clínico Universitario tenían riesgo de caída nivel II, con baja probabilidad de presentar deterioro cognitivo o delirio en el postoperatorio.

Introduction: The fall risk and fall-related injuries, as well as the risk of developing delirium, represent a constantly increasing public health problem, especially in societies with an aging population. Objective: This study aimed to assess the level of risk for falls in patients before hip or knee surgery and the frequency of delirium after hip or knee surgery. Materials & Methods: The study was conducted as an observational, analytical cross-sectional study by surveying hospitalized patients at the Clinic for Orthopedic Surgery and Traumatology, Novi-Sad, Serbia, between the beginning of December 2022 and the end of January 2023. Results: From the total number of patients (N = 106), the majority (61.3%) were over 70 years of age, of which the largest number were female (female = 80 (75.5%)). The highest percentage of respondents had a level II fall risk (73.6%), while level I and level III risks had 14 respondents each (13.2%). The results of the 4AT score showed that the largest number of patients, N = 50 (47.2%), had delirium or cognitive impairment with low probability, with possible cognitive impairment in 40 patients (37.7%), while delirium was possible in 16 patients (15.1%). Conclusion: Orthopedic patients hospitalized at the University Clinical Center of Vojvodina had level II fall risk, and the largest number of these patients had a low probability of cognitive impairment or postoperative delirium.