Oportunidad en la salud digital: una respuesta al control de las demencias / Digital health services as a means to control dementia

The increase of the elderly population with a significant load of non-communicable diseases, accelerates pathological aging and increases the risk of dementia, generating a huge health, social and economic cost for any country. Dementia does not have an effective treatment yet, therefore, the focus must remain on prevention and early diagnosis. The early stages of dementia are known as mild cognitive impairment; at this stage is still possible to mitigate the progression of the disease, however, health systems worldwide face difficulties to provide universal access to health services, due to a lack of specialists and geographical distances, interfering with the access to healthcare centers. In this scenario, WHO urged countries to implement strategies to democratize and to expand the reach of health institutions. In this document, we briefly review the global and local situation of dementias and discuss some attempts to control their progression by using revolutionary digital tools. We believe the focus should be on the population that is just beginning to show cognitive impairment.

Semantic memory, but not education or intelligence, moderates cognitive aging: a cross-sectional study

Objective: Aging studies regularly assume that years of education are a protective factor for baseline cognition. In developing countries with specific sociocultural issues, this relationship may not work as expected, and an unmet need remains for alternative resilience factors. This study aimed to analyze different moderators for the relationship between aging and general cognition that could reflect better protective factors. Methods: One hundred and fourteen Brazilian older adults, deemed healthy by global cognition, absence of psychiatric symptoms, or neurological history, participated in this cross-sectional study. Moderators for the relationship between age and global cognition included education, intelligence, and occupational factors. Semantic memory was added as a protective factor reflecting culturally acquired conceptual knowledge. Results: As expected, age alone is a predictor of global cognitive scores; surprisingly, however, education, intelligence, and occupation were not moderators of the association. Semantic memory was a significant moderator (p = 0.007), indicating that knowledge acquired during life may be a protective factor. Conclusion: In developing countries, the use of resilience factors based only on years of education may be misleading. Sociocultural issues influence the educational system and achievement and, consequently, affect the use of this simple measure. Resilience-factor studies should consider using crystallized abilities when studying populations with sociocultural particularities.

Capacitação de agentes comunitários de saúde para a detecção da demência na fase leve / Capacitating community health workers to detect dementia at the mild stage / Capacitación de agentes comunitarios de salud para detección de las demencias en la fase leve

Objetivo: avaliar o processo de educação permanente na capacitação de agentes comunitários de saúde (ACS) para a detecção de pessoas com demência na fase leve. Método: descritivo, comparando o desempenho dos sujeitos antes e após a oficina de aprendizagem. Após a aprovação pelo Comitê de Ética em Pesquisa, foi realizada oficina de capacitação com oito ACS de uma unidade básica de saúde, da cidade de Santos, em 2018. Antes e após a oficina foram aplicados questionários semiestruturados. Os dados foram tratados a partir da análise temática. Resultados: a falta de conhecimento sobre a demência aponta para a necessidade de investimento em educação permanente dos ACS como uma importante ferramenta a ser utilizada na detecção de casos iniciais. Conclusão: a educação permanente pode contribuir para o maior número de casos identificados nas fases iniciais da demência na atenção básica de forma que os encaminhamentos necessários e tratamentos possíveis sejam iniciados precocemente de forma a beneficiar pessoas e/ou suas famílias.

Objective: to evaluate the continuing professional development (CPD) process in capacitation of community health workers (CHWs) to detect early dementias. Method: this descriptive study compared the performance of eight CHWs from a Basic Health Unit in Santos, by applying semi-structured questionnaires before and after a CPD workshop held in 2018, after approval by the research ethics committee. The data were processed using thematic analysis. Results: the CHWs' lack of knowledge about dementia points to the need to invest in continuing professional development as an important tool to be used to detect early cases. Conclusion: continued professional development can contribute to identification of more cases in the early stages of dementia in primary care, so that necessary referrals and possible treatment are initiated early to benefit individuals and/or their families.

Objetivo: evaluar el proceso de educación permanente en la capacitación de agentes comunitarios de salud (ACS) para detección de personas con demencia en la fase leve. Método: estudio descriptivo, comparado el desempeño de las personas antes y después del taller de aprendizaje. Tras la aprobación del Comité de Ética en Investigación, se realizó un taller de capacitación con ocho ACS de una Unidad Básica de Salud de la ciudad de Santos, en 2018. Antes y después del taller, se aplicaron cuestionarios semiestructurados. Los datos fueron procesados desde el análisis temático. Resultados: la falta de conocimiento sobre la demencia apunta hacia la necesidad de inversión en educación permanente, por parte de los ACS, como una importante herramienta a ser utilizada en la detección de casos iniciales. Conclusión: la educación permanente puede contribuir a la identificación en la atención básica de mayor número de casos en las fases iniciales de la demencia de forma a que las derivaciones aplicables y los posibles tratamientos se inicien precozmente para poder beneficiar a las personas y/o a sus familias.

La terapia hormonal de la menopausia ¿disminuye el riesgo de enfermedades crónicas? / Does menopause hormone therapy reduce the risk of chronic diseases?

The hormonal deficit of post menopause is not only linked to the classic hot flashes, but also to a higher risk of chronic diseases. Menopausal hormone therapy (MHT) adequately treats climacteric symptoms and can prevent some chronic diseases such as osteoporosis. The Women's Health Initiative (WHI) study, which indicated risks of MHT in elderly postmenopausal women, caused a massive withdrawal of this therapy. But, in recent years the results of the WHI have been challenged by methodological problems and by several studies indicating that, if MHT is initiated early and the non-oral route is preferred, the risks could be minimized and it could improve not only the quality of life but also reduce the risk of chronic diseases. However, the US Preventive Services Task Force (USPSTF) recommends against the use of MHT for the prevention of chronic diseases, a position that has been challenged by publications of the North American Menopause Society and the International Menopause Society. This controversy persists so far. We report data that suggest a preventive role of MHT in perimenopausal women.

The convergence of stroke and dementia / A convergência do acidente vascular cerebral e da demência

ABSTRACT Neurological disorders account for the most Disability Adjusted Life Years (DALY's) -of the Global Burden of Disease (10%). More than half of neurological DALY's result from the combination of stroke (42%) and dementia (10%). The two pose risk for each other and share the same predisposing factors. A stroke doubles the risk of dementia. The close interactions call for convergent approaches. Stroke and dementia also converge at the microscopic level. The neurovascular unit has emerged as a key organizational structure of the brain. Involvement of any of its elements affects all the others. Thus, neurodegeneration impairs the microcirculation and disturbances of the microcirculation accelerate neurodegeneration. Evolving technologies allow "in vivo" imaging of the usual mixture of vascular and neurodegenerative pathology of the elderly that makes them prone to stroke and dementia. Since they occur together, they should be prevented together with a multimodal approach of lifestyle changes and mechanistic therapeutic targets. The two fields are also converging at the policy level. The World Stroke Organization has updated its Proclamation to include potentially preventable dementias that has been endorsed by Alzheimer Disease International, The World Federation of Neurology, the American Academy of Neurology and 20 international, regional and national organizations. Those interested in stroke and those dealing with dementia should work together where they can, differ where they must, with the common aim of preventing jointly, both stroke and dementia.

RESUMO As doenças neurológicas são responsáveis pela maior parte dos Anos de Vida Ajustados por Incapacidade (DALY's) segundo o Estudo da Carga Global de Doença (10%). Mais da metade dos DALY's de origem neurológica resultam da combinação de acidente vascular cerebral-AVC (42%) e demência (10%). Estas duas condições representam risco uma para a outra e compartilham dos mesmos fatores predisponentes. Um AVC quase triplica o risco de demência. Esta grande interação demanda abordagens convergentes. AVC e demência também convergem em nível microscópico. A unidade neurovascular emergiu como estrutura de organização chave da saúde do cérebro. O envolvimento de qualquer um dos seus elementos afeta todos os outros. Desse modo, a neurodegeneração compromete a microcirculação, enquanto distúrbios da microcirculação aceleram a neurodegeneração. Novas tecnologias permitem a obtenção de imagens "in vivo" da combinação usual entre patologia vascular e neurodegenerativa de idosos, que os torna vulneráveis ao AVC e à demência. Como estas duas condições ocorrem associadas, devem ser prevenidas em conjunto, com uma abordagem multimodal que conjugue mudanças de hábitos de vida e alvos terapêuticos mecanísticos. Estes dois campos também estão convergindo no campo das políticas de saúde. A Organização Mundial do AVC atualizou sua Proclamação de modo a incluir demências potencialmente passíveis de prevenção, que foi endossada pela Associação Internacional da Doença de Alzheimer, pela Federação Mundial de Neurologia, pela Academia Americana de Neurologia, e por 20 outras organizações internacionais, regionais e nacionais. Os colegas interessados em AVC e aqueles que lidam com demência devem trabalhar juntos onde puderem, diferindo onde devem, com o objetivo comum da prevenção conjunta tanto do AVC quanto da demência.

Dimensiones para la promoción de la salud cognitiva y prevención de demencias / Dimensions for cognitive health´s promotion and prevention of dementias

En la actualidad existe un aumento exponencial en el número de personas que reciben diagnóstico de demencia cada año. Sin embargo el control de determinados factores de riesgo en la población general podría reducir significativamente la tasa global de pacientes que presentan declive cognitivo o algún tipo de demencia (incluida la enfermedad de Alzheimer). Esta realidad convierte a la promoción de salud cognitiva en un campo prioritario desde el cual deben diseñarse acciones encaminadas a potencias el bienestar cognitivo global con énfasis en el envejecimiento. De esta manera el objetivo de este material es discutir un grupo de premisas y dimensiones que deben considerarse para la concepción, diseño e implementación de programas orientados a la promoción de salud cognitiva y la prevención de demencias. Se propone que el diseño de programas orientados a la promoción de salud cognitiva y la prevención de demencias pueden concebirse partiendo de tres dimensiones principales: a) exploración de creencias y conocimiento general, b) educativo-formativo e c) investigación-implementación. La promoción de salud cognitiva está llamada a convertirse en un importante recurso para reducir el declive cognitivo patológico y el riesgo de padecer demencias. Para alcanzar este objetivo la salud cognitiva y prevención de demencias deben constituir una prioridad dentro de los sistemas de salud (y de los profesionales que los integran), concretándose en el diseño de programas dirigidos a reducir los factores de riesgos relacionados con el deterioro cognitivo patológico, y la implementación de intervenciones en función del bien público(AU)

Nowadays, there is an exponential increase in the number of people diagnosed with dementia every year. However, control of certain risk factors in general population could significantly reduce the overall rate of patients with cognitive decline or some form of dementia (including Alzheimer's disease). This reality turns cognitive health´s promotion into a priority field from which actions should be designed to encourage the overall cognitive wellbeing with an emphasis in aging. The objective of this paperwork is to discuss a group of premises and dimensions that must be considered for the conception, design and implementation of programs oriented to cognitive health´s promotions and the prevention of dementias. It is proposed that the design of programs oriented to the promotion of cognitive health and the prevention of dementias can be conceived from three main dimensions: a) exploration of beliefs and general knowledge, b) educational-formative and c) research-implementation. The promotion of cognitive health is called to become an important resource to reduce pathological cognitive decline and the risk of dementias. To achieve this goal, Cognitive Health and Dementia Prevention must be a priority within the health systems (and the professionals that integrate them), focusing on the design of programs aimed to reduce the risk factors related to pathological cognitive impairment , and the implementation of interventions in function of the public good(AU)

The proportion of dementia attributable to common modifiable lifestyle factors in Barbados / Proporción de casos de demencia atribuible a factores comunes y modificables relacionados con el modo de vida en Barbados / Proporção de demência atribuível a fatores comuns modificáveis do estilo de vida em Barbados

ABSTRACT Objective To understand what number and proportion of dementia cases in Barbados are attributable to modifiable lifestyle factors and what effect a reduction in these risk factors would have on future dementia prevalence. Methods This was an observational study using Levin's Attributable Risk formula, which assumes independence of risk factors, to calculate the population attributable risk (PAR) of dementia (all-cause) for six risk factors: midlife obesity, physical inactivity, smoking, low educational attainment, diabetes mellitus, and midlife hypertension in Barbados. A recently-published, modified formula was utilized to account for non-independence of risk factors using secondary data for Barbados. The number and proportion of dementia cases attributable to each risk factor and to all risk factors combined were computed, as was the effect that any reduction in these risk factors might have on future dementia prevalence. Results Accounting for the fact that risk factors do not operate independently, 50.9% (1 526 cases) were attributable to the combined effect of the six risk factors under study. According to the analysis, if each risk factor were reduced by 5% - 20% per decade, dementia prevalence could be 3.3% - 31.8% lower by 2050. Conclusion Using a largely theoretical model, the six modifiable lifestyle factors were estimated to be attributable to 50.9% of dementia cases in Barbados. Since the risk factors have much in common, any intervention that targets one of them could significantly reduce future dementia prevalence.

RESUMEN Objetivo Establecer el número y la proporción de casos de demencia en Barbados que se pueden atribuir a factores modificables relacionados con el modo de vida y el efecto que podría tener una reducción de estos factores de riesgo en la prevalencia de la demencia en el futuro. Métodos Este fue un estudio de observación en el que se usó la fórmula de riesgo atribuible de Levin, que presupone la independencia de los factores de riesgo, para calcular el riesgo de demencia (por cualquier causa) atribuible a la población (RAP) en Barbados en relación con seis factores de riesgo: obesidad en la edad madura, inactividad física, tabaquismo, nivel de escolaridad bajo, diabetes mellitus e hipertensión en la edad madura. Se utilizó una fórmula modificada de publicación reciente para incluir los factores de riesgo no independientes, sobre la base de datos secundarios para Barbados. Se computaron el número y la proporción de casos de demencia atribuibles a cada factor de riesgo y a todos los factores de riesgo combinados, al igual que el efecto de una reducción de estos factores de riesgo sobre la prevalencia de la demencia. Resultados Teniendo en cuenta el hecho de que los factores de riesgo no operan independientemente, 50,9% de los casos (1 526 casos) se podían atribuir al efecto combinado de los seis factores de riesgo en estudio. Según el análisis, si cada factor de riesgo se redujera de 5% a 20% por decenio, la prevalencia de la demencia podría ser de 3,3% a 31,8% más baja para el 2050. Conclusiones Mediante un modelo mayormente teórico, se estimó que 50,9% de los casos de demencia en Barbados eran atribuibles a seis factores modificables relacionados con el modo de vida. Como los factores de riesgo tienen mucho en común, cualquier intervención dirigida específicamente a uno de ellos podría reducir considerablemente la prevalencia de la demencia en el futuro.

RESUMO Objetivo Conhecer o número e a proporção de casos de demência em Barbados que são atribuíveis a fatores modificáveis do estilo de vida e examinar o efeito que teria uma redução desses fatores de risco na prevalência futura de demência. Métodos Estudo observacional realizado com o uso da fórmula do risco atribuível de Levin (pressuposto de independência dos fatores de risco) para calcular o risco atribuível populacional (RAP) da demência (todas as causas) em Barbados para seis fatores de risco: obesidade na meia idade, inatividade física, tabagismo, baixo grau de instrução, diabetes mellitus e hipertensão na meia idade. Uma versão modificada da fórmula recentemente publicada foi usada para representar a não independência dos fatores de risco usando dados secundários do país. O número e a proporção de casos de demência atribuíveis a cada fator de risco e a todos os fatores de risco combinados foram computados, assim como o efeito de uma redução desses fatores de risco na prevalência futura de demência. Resultados Considerando que os fatores do risco não atuam de modo independente, 50,9% (1.526 casos) foram atribuíveis ao efeito combinado dos seis fatores de risco estudados. De acordo com a análise, se cada fator de risco tivesse uma redução de 5%-20% por década, a prevalência da demência poderia cair de 3,3% a 31,8% até 2050. Conclusões De acordo com um modelo eminentemente teórico, estimou-se que os seis fatores modificáveis do estilo de vida eram atribuíveis a 50,9% dos casos de demência em Barbados. Visto que os fatores de risco têm muito em comum, qualquer intervenção que vise um dos fatores poderia reduzir consideravelmente a prevalência futura da demência.

Nuevos términos clínicos, prevención y tratamiento del trastorno cognitivo vascular: revisión de literatura basada en la evidencia / New clinical terms, prevention and treatment of vascular cognitive impairment: a review of evidence-based literature

El trastorno cognitivo vascular agrupa todas las instancias donde el compromiso cognitivo puede ser atribuidoa enfermedad vascular cerebral, es mayor que el esperado para el envejecimiento normal y que, cuando llega aafectar las actividades de la vida diaria, se denomina demencia vascular. En esta revisión, se actualizan los términos relacionados a trastorno cognitivo vascular y se plantean estrategias de prevención y tratamiento basadas en revisiones sistemáticas y meta-análisis. En la primera parte se definen diversos términos relacionados a trastorno cognitivo vascular; en la segunda, se plantea el tratamiento del trastorno cognitivo vascular/demencia vascular, que incluyeun manejo orientado a prevención primaria, controlando los factores de riesgo; un tratamiento secundario paraprevenir la exacerbación o la extensión de las lesiones producidas por la injuria vascular cerebral y, finalmente, untratamiento terciario o sintomático de los problemas cognitivos y/o conductuales. Damos especial énfasis y se fundamenta la conveniencia y beneficios de los tratamientos primario y secundario.

Vascular cognitive impairment is a label ascribed to cases in which the cognitive impairment can be attributed to cerebral vascular disease, is greater than the expected for normal aging and, when affecting the activities of daily life, is called vascular dementia. In this review, the terms related to vascular cognitive impairment, are updated, and strategies for prevention and treatment, based on systematic reviews and meta-analyses are outlined. In the first part, various vascular cognitive impairment-related terms are defined; in the second part, the treatment of vascular cognitive impairment / vascular dementia is described: it includes, management steps oriented towards primary prevention, controlling risk factors; a secondary treatment aimed at the prevention of exacerbation or extension of lesions produced by the vascular brain injuries and, finally, the tertiary or symptomatic treatment of cognitive and / or behavioral manifestations. Special emphasis is placed on, and the convenience and benefits of the primary and secondary treatments are substantiated.

Relación entre probable deterioro cognitivo y depresión en personas adultas mayores / Probable relationship between cognitive impairment and depression in older people

Introducción: con el aumento de la esperanza de vida la vejez es un fenómeno creciente, en ésta etapa de la vida disminuyen las funciones físicas, psicológicas y sociales, favoreciéndose la presencia de enfermedades como el deterioro cognitivo y la depresión. Algunos estudios reportan que estas patologías son factores de riesgo para la demencia; sin embargo, si estos son detectados a tiempo se pueden tomar medidas preventivas para retrasar el posible daño. Objetivo: identificar y correlacionar deterioro cognitivo y depresión en personas adultas mayores de 60 años. Metodología: estudio descriptivo, transversal, con una muestra 399 adultos mayores de 60 años que asistieron a centros de día, asilos, hospitales y centros del adulto mayor, a quienes se les realizó valoración geriátrica de enfermería para identificar probable deterioro cognitivo y depresión, a través de la aplicación de las pruebas de Mini Mental de Folstein y la escala GDS de Yesavage versión corta. Resultados: El 73.7% fueron del sexo femenino, el 46% tienen entre 60 y 70 años de edad, el 23.63 % presenta probable depresión leve y el 24.54% va de probable deterioro cognitivo leve a moderado, cabe destacar que a mayor edad se observan casos de probable depresión y deterioro cognitivo severo. Conclusiones: Existe consistencia entre el probable deterioro cognitivo y depresión en los niveles normal y leve en una quinta parte de la población estudiada conservando una similitud con otros estudios razón por la cual la valoración geriátrica de enfermería en la detección precoz es fundamental para limitar el daño.

Introduction: The increase of the life expectancy in the elderly is a growing phenomenon, in this stage of life the physical, psychological and social functions diminish, favouring the presence of diseases such as cognitive impairment and depression. Some studies report that these conditions are risk factors for dementia. However, if these conditions are detected early, preventive measures can be taken to slow the damage. Objective: To identify and correlate cognitive impairment and depression in adults over 60 years of age. Methodology: descriptive, transversal, study with a sample of 399 adults over 60 years of age who attended day care centres, nursing homes, and hospitals, who underwent geriatric nursing assessment to identify probable cognitive impairment and depression, through the application of Folstein Mini Mental tests and Yesavage GDS short version. Results: 73.7% were female, 46% are between 60 and 70 years of age, 23.63% have probable mild depression and 24.54% is probable mild to moderate cognitive impairment, it is noteworthy that the older are observed probable cases of depression and severe cognitive impairment. Conclusions: There is consistency between the probable cognitive impairment and depression in normal and light levels in a fifth of the population studied retaining a similarity with other studies why geriatric nursing assessment in early detection is critical to limit damage.

Effects of aerobic physical exercise on cognition / Efeitos da atividade física aeróbica na cognição

INTRODUCTION: The increasing prevalence of cognitive impairment in older adults is a major concern nowadays. Interventions able to change the natural history of the most common cause of cognitive impairment in older adults, Alzheimer's disease (AD), are needed. Physical inactivity is considered one of the most important modifiable risk factors for AD. OBJECTIVE: To review recent evidence on the role of physical exercise (PE) in the older adults cognition. METHOD: The authors reviewed recent papers about PE and cognition in older adults. CONCLUSION: Current data indicate that PE is a promising intervention to decrease the risk of cognitive impairment in cognitively normal older subjects and in those with Mild Cognitive Impairment. Controversy still remains about the effect of PE in demented patients, but more recent data is pointing towards a positive effect.

INTRODUÇÃO: A prevalência crescente de comprometimento cognitivo em adultos mais idosos é uma grande preocupação atual. Intervenções capazes de alterar a história natural da causa mais frequente de comprometimento cognitivo em adultos mais idosos, a doença de Alzheimer (DA), são necessárias. A inatividade física é considerada um dos fatores de risco modificáveis mais importantes na DA. OBJETIVO: Rever evidências recentes no papel do exercício físico (EF) na cognição de adultos mais idosos. MÉTODO: Os autores fizeram uma revisão dos artigos recentes sobre EF e cognição em adultos mais idosos. CONCLUSÃO: Dados correntes indicam que o EF é uma intervenção promissora para diminuir o risco de comprometimento cognitivo em indivíduos mais idosos cognitivamente normais e naqueles com Comprometimento Cognitivo Leve. Ainda permanecem controvérsias quanto ao efeito do EF em pacientes demenciados, porém dados mais recentes apontam para um efeito positivo.

La ocupación como factor protector de la demencia por enfermedad de alzheimer / Occupation as a protective factor for alzheimer's disease dementia

La demencia es un síndrome de alteración predominantemente cognitiva que de la mano con el progresivo envejecimiento poblacional ha experimentado un aumento en su frecuencia, con el consecuente impacto en costos en salud y por sobre todo, en las vidas de las personas mayores que la presentan, sus cuidadores y familia. La enfermedad de Alzheimer es la principal causa de demencia en la población de 60 años y más. Actualmente el tratamiento de la demencia por enfermedad de Alzheimer tiene por objetivo retardar o minimizar el impacto en las esferas funcionales, sociales y cognitivas de la persona. No obstante, existe investigación creciente con un enfoque desde la prevención primaria, que busca establecer causalidad a partir de factores protectores o factores de riesgo vinculados por ejemplo, a los estilos de vida, considerables como agentes preventivos de la demencia por enfermedad de Alzheimer. Por medio de este trabajo, se busca realizar un análisis a partir de la evidencia sobre prevención de la demencia por enfermedad de Alzheimer, y desde una perspectiva teórica, reflexionar sobre el rol que tiene la ocupación de los sujetos como factor protector a partir de una intervención preventiva.

Dementia is a syndrome that affects predominantly the individual’s cognitive condition. Related to an aging population dementia has increased in terms of prevalence and incidence, with the consequent impact on health costs and above all, a high impact on the lives of people with dementia, their caregivers and their families. Alzheimer’s disease is the leading cause of dementia in the population aged 60 years and over. Currently the treatment of dementia of the Alzheimer’s type aims to slow or minimize the impact on functional, social and cognitive areas. However there is growing research that focuses in primary prevention that seeks to establish causality from protective or risk factors related for example, to lifestyles, identifying prevention agents for dementia of the Alzheimer’s type. This work seeks to make an analysis considering data from the evidence on the prevention of dementia of the Alzheimer’s type, as well as to reflect on the role that the occupation of the subject as a protective factor from a preventive intervention.

Cuidado do enfermeiro aos portadores de síndromes demenciais: um levantamento bibliográfico / Las enfermeras de atención para las personas con demencia: una revisión bibliográfica / Nurses care for people with dementia: a literature review

Objective: to identify the production literature about nursing care to people with dementia and identify the care performed with the carriers of these syndromes. Method: this study is a bibliographic review. Results: the actions are focused on the caregiver for the elderly and demented; the actions for the caregiver with the highest prevalence were to guiding and supporting. The action focused on the elderly mostly found was to take care of this elderly emotionally. Conclusion: the increasing elderly population in our country shows that actions are needed for specific and structured care.

Objetivo: identificar a produção bibliográfica acerca do cuidado de enfermagem aos portadores de Síndromes Demenciais e identificar os cuidado realizados com os portadores dessas síndromes. Método: este estudo é uma revisão bibliográfica. Resultados: as ações estão voltadas para o cuidador e para o idoso demenciado, as ações voltadas para o cuidador com maior prevalência foram as de orientar e dar suporte. A ação voltada para o idoso mais encontrada foi a de cuidar emocionalmente deste idoso. Conclusão: o aumento da população idosa em nosso país mostra que são necessárias ações de cuidados específicos e estruturados.

Objetivo: identificar la literatura acerca de la producción de los cuidados de enfermería a personas con demencia y determinar los cuidados realizados con los portadores de estos síndromes. Método: se realizó una revisión de la literatura. Resultados: las acciones se centran en el cuidador y para el idoso con demencia, para el cuidador con mayor prevalencia fueron para guiar y apoyar. La acción orientada al anciano más encontrada fue a hacerse cargo de este anciano emocionalmente. Conclusión: el aumento de la población anciana en nuestro país muestra que las acciones se necesitan cuidado especial y estructurado.

Exercise and Physical Activity in Mental Disorders: Clinical and Experimental Evidence / 예방의학회지

Several epidemiological studies have shown that exercise (EX) and physical activity (PA) can prevent or delay the onset of different mental disorders, and have therapeutic benefits when used as sole or adjunct treatment in mental disorders. This review summarizes studies that used EX interventions in patients with anxiety, affective, eating, and substance use disorders, as well as schizophrenia and dementia/mild cognitive impairment. Despite several decades of clinical evidence with EX interventions, controlled studies are sparse in most disorder groups. Preliminary evidence suggests that PA/EX can induce improvements in physical, subjective and disorder-specific clinical outcomes. Potential mechanisms of action are discussed, as well as implications for psychiatric research and practice.

Effects of Dementia Knowledge, Self-Efficacy and Depression on Dementia Preventive Behavior in Elderly Couples: Dyadic Data Analysis

PURPOSE: This study was done to examine actor and partner effect of dementia knowledge, self-efficacy and depression on dementia preventive behavior in elderly couples. METHODS: Participants were 115 couples aged 60 years or over who met eligibility criteria. All measures were self-administered. Data were analyzed using SPSS 18.0 and AMOS 18.0 program. RESULTS: Dementia knowledge in elderly couples showed actor and partner effect on dementia preventive behavior. Self-efficacy in the wife did not have direct effects on dementia preventive behavior, but showed indirect effects through dementia knowledge. Self-efficacy in the husband showed direct effects on dementia preventive behavior and indirect effects through dementia knowledge. Wife's depression had direct actor effect on dementia preventive behavior and indirect effect through self-efficacy and dementia knowledge. Husband's depression did not have direct actor effect on dementia preventive behavior, but indirect effect through self-efficacy and dementia knowledge. Effect size of wives' dementia knowledge, self-efficacy and depression on dementia preventive behavior was larger than that of husbands'. Dementia preventive behavior, dementia knowledge and depression had a mutual effect. CONCLUSION: Results indicate that to promote dementia preventive activity in elderly couples, programs should be conducted for both of the couple, but focused differently for wife and husband.

Prevalencia del síndrome demencial y la enfermedad de Alzheimer en pacientes del policlínico Pedro Fonseca / Prevalence of the dementia syndrome and Alzheimer's disease in patients from Pedro Fonseca polyclinic

Introducción: las demencias y enfermedad de Alzheimer constituyen un importante problema de salud con repercusión humana, social y económica en países con alta expectativa de vida. Objetivo: determinar la prevalencia del síndrome demencial y la enfermedad de Alzheimer en ancianos. Métodos: estudio descriptivo de corte transversal en ancianos pertenecientes al policlínico Pedro Fonseca, municipio La Lisa entre el 3 de enero y el 30 de diciembre de 2011. El universo de estudio estuvo constituido por 1 739 ancianos y se seleccionaron 312 que tenían 65 años o más y pertenecían al consultorio No. 6 del citado policlínico. Se excluyeron aquellos con historia de esquizofrenia, retraso mental, afasia, con terapia electroconvulsivante y otras enfermedades psiquiátricas. El diagnóstico de enfermedad de Alzheimer se realizó fundamentalmente mediante los Criterios de la Sociedad Psiquiátrica Americana. Todos los ancianos que conformaron la muestra o sus cuidadores manifestaron su disposición para participar en la investigación. Resultados: el síndrome demencial estuvo presente en 34 de los 312 ancianos, para una prevalencia de 10,8 porciento. Hubo un incremento de la prevalencia con la edad. Dentro del síndrome demencial, la mayor frecuencia correspondió a la demencia tipo Alzheimer probable, en 22 (64,7 porciento) pacientes. Conclusiones: la prevalencia del síndrome demencial y la enfermedad de Alzheimer es notable en los adultos mayores, lo que demuestra que estas enfermedades constituyen un importante problema de salud

Introduction: dementia and Alzheimer's disease constitute an important health problem with human, social and economic repercussion in countries with high life expectancies. Objectives: to determine the prevalence of the dementia syndrome and Alzheimer's disease in the elderly. Methods: a cross-sectional and descriptive study was conducted in the elderly population belonging to Pedro Fonseca polyclinic in Lisa municipality from January 3rd to December 30th, 2011. The universe of study was 1 739 old people, from whom 312 aged 65 years or more, cared for by the physician's office no. 6 of this polyclinic, were selected. Those old people with history of schizophrenia, mental retardation, other psychiatric diseases and under electroconvulsing therapy were excluded. Alzheimer's disease was diagnosed on the basis of the American Psychiatric Society criteria. All the aged people who made up this sample or their caregivers gave their consent to take part in this study. Results: dementia syndrome was present in 34 out of 312 participants for a prevalence rate of 10.8 percent. Prevalence increased with the age. The highest prevalence rate was observed in probable Alzheimer-type dementia found in 22 (64.7 percent) patients. Conclusions: the prevalence of dementia syndrome and Alzheimer's disease was significant in the older people, which demonstrated that these diseases pose an important health problem in the study area

Involvement of nitric oxide in learning & memory processes.

Nitric oxide (NO), synthesized from the amino acid, L-arginine by nitric oxide synthase (NOS) has received attention as a neurotransmitter in the brain. NO has been found to induce cognitive behaviour in experimental animals. In order to show evidence for the involvement of NO in learning and memory processes, the reports indicating the effects of its precursor, donors, and inhibitors of its synthesis in mammals, birds, fishes and invertebrates have been reviewed. Further, learning and memory impairment occurring in man and animals due to defective NO activity in the brain due to pathological conditions such as epilepsy, stress, diabetes and side effects of therapeutic agents and reversal of this condition by L-arginine and NO donors have been included. In addition, the reports that indicate ageing-induced impairment of cognition that is known to occur in Alzheimer's disease due to deposition of the toxic protein, beta amyloid and the effect of L-arginine and NO donors in preventing dementia in these patients have been reviewed.