Fluidez verbal, inteligencia y velocidad de procesamiento en adultos jóvenes con y sin actividad escolar: el impacto de la reserva cognitiva en adultos jóvenes / Verbal fluency, intelligence and processing speed in young adults with and without school activity: The impact of the cognitive reserve in young adults

Es conocido el impacto positivo de la reserva cognitiva y de mantenerse activo intelectualmente en el funcionamiento cognitivo en el adulto mayor, sin embargo, el impacto de dichas variables en funciones ejecutivas en jóvenes apenas ha sido investigada. Por ello, el objetivo de la presente investigación fue comparar el desempeño de la fluidez verbal (fonológica, semántica y de verbos), inteligencia (fluida y cristalizada) y velocidad de procesamiento entre jóvenes con diferentes grados académicos y personas con el mismo grado, pero que han dejado de estudiar. Participaron 68 adultos, de 20 a 35 años de edad; todos ellos sanos y residentes de la ciudad de Morelia. Los resultados señalan que el grupo sin actividad escolarizada (con nivel de licenciatura) obtuvo peor rendimiento respecto a los grupos activamente escolarizados (de licenciatura y maestría) en las pruebas de fluidez verbal semántica y de verbos, mientras que no se reportan diferencias significativas entre los grupos conformados por estudiantes activos. En fluidez fonológica el grupo con grado de licenciatura inactivo obtuvo menor rendimiento que el grupo de mayor grado escolar activo. Se concluye que la actividad escolar incide favorablemente en el desempeño de fluidez verbal en jóvenes adultos. Ello no sólo puede ser un elemento que a largo plazo puede transferirse en reserva cognitiva, sino que también puede tener una injerencia notable en la propia vida adulta a nivel laboral.

The positive impact of cognitive reserve and of being intellectually active in cognitive functioning in the elderly is known, however, the impact of these variables on executive functions in young people has hardly been investigated. Therefore, the objective of this research was to compare the performance of verbal fluency (phonological, semantic and verbs), intelligence (fluid and crystallized) and processing speed among young people with different academic degrees and people with the same degree, but who have stopped studying. 68 adults participated, from 20 to 35 years of age; all of them healthy and residents of the city of Morelia. The results indicate that the group with no school activity (with a bachelor's degree) performed worse than the groups actively enrolled (undergraduate and master's degree) in verbal semantic fluency and verbs, while no significant differences were reported between the groups made up of active students. In phonological fluency, the group with an inactive bachelor's degree obtained lower performance than the group with the highest active school grade. It is concluded that school activity has a favorable impact on the performance of verbal fluency in young adults. This can not only be an element that can be transferred in cognitive reserve in the long term, but it can also have a notable interference in adult life at work level.

Reserva cognitiva y demencias: Limitaciones del efecto protector en el envejecimiento y el deterioro cognitivo / Limited protective effects of cognitive reserve on the progression of cognitive impairment

Aging constitutes a series of physical, physiological and cognitive changes, affecting independence in the activities of daily living. During this stage, neurodegenerative diseases and cognitive impairment are common. Cognitive Reserve allows to face neuropathological changes and maintain cognitive function in the presence of brain damage. However, there are cases where a high cognitive reserve fails to attenuate and delay the effects of neuropathology, allowing the progression of cognitive damage to advanced stages. The objective of this systematic review is to identify evidence where high cognitive reserve does not limit the effects of cognitive impairment. Results indicate that the protective effect of cognitive reserve occurs only in the presence of minimal cognitive impairment, but not at later stages.

Medición de reserva cognitiva: estudio en una muestra de adultos chilenos / Cognitive reserve assessment: a study in a sample of chilean adults

Mayor reserva se asocia con resistencia al deterioro en sujetos con enfermedades neurodegenerativas. En personas sanas explica las diferencias interindividuales en el rendimiento de tareas. Medir los factores de reserva cognitiva permite contar con un índice numérico de la ganancia cognitiva acumulada por un sujeto. Este índice puede ser correlacionado con otras funciones cuantificables. El presente trabajo tiene como objetivo presentar los índices de reserva obtenidos por una población chilena en la aplicación del Cognitive Reserve Index Questionnaire (CRIq). Para ello 90 adultos (18-85 años) sin evidencias de trastorno cognitivo, de la región de Valparaíso-Chile, fueron entrevistados sobre actividades de estudio, laborales y de tiempo libre ejecutadas desde los 18 años.Los resultados muestran que los índices de reserva de los sujetos varían en función del tiempo de ejecución de actividades promotoras de reserva y no por su edad. Se encontraron diferencias estadísticamente significativas entre los grupos etarios. Estos resultados permiten concluir que la ejecución de actividades de estudio, laborales, sociales, entre otras aumenta los índices de reserva cognitiva, que es una variable diferenciadora entre individuos. La medición de dichos índices puede ser útil en un amplio campo de disciplinas (medicina, neurología, neuropsicología, educación, psicología, fonoaudiología, neurociencias y en las ciencias cognitivas en general).

A higher cognitive reserve is linked to higher resistance to deterioration among subjects suffering from neurodegenerative disorders. In healthy persons the cognitive reserve explains inter-individual differences in task performance. Measuring the cognitive reserve factors involves obtaining a numerical index of the cumulative cognitive gain accumulated by a subject. This index can be correlated with other measurable functions.This study was conceived to determine the reserve indexes accumulated by a Chilean sample, by means of the administration of the Cognitive Reserve Index Questionnaire (CRIq).In order to do so, 90 adults (18-85 years old) without evidence of cognitive disorder, living in Valparaíso region, Chile, were interviewed about their education, their work environment and their and leisure activities carried out since they were 18 years old.Results showed that reserve indexes of the subjects vary as a function of the time of execution of reserve-promoting activities, not age. Statistically significant differences were found among age-groups. These findings allow us to conclude that studying, working and engaging in social activities, among other things, increase the cognitive reserve indexes, which are a differentiating variable among individuals.The measurement of these indexes can be useful in a wide array of disciplines: medicine, neurology, neuropsychology, education, psychology, phonoaudiology, neurosciences and cognitive sciences in general.

Maior risco de delirium no pós-operatório está associado à idade avançada, anemia e baixa reserva cognitiva / Greater risk of postoperative delirium is associated with advanced age, anemia, and low cognitive reserve

INTRODUÇÃO: Delirium é uma mudança aguda na cognição e atenção, comum no período pós-operatório em pessoas idosas, associada ao aumento de custos e à permanência hospitalar. OBJETIVO: Avaliar frequência, fatores de risco e influência no período de permanência hospitalar de delirium pós-operatório em pacientes idosos submetidos a cirurgias não cardíacas eletivas. MÉTODO: Estudo do tipo transversal, observacional, de pessoas idosas (65 anos de idade ou mais), internadas para realização de cirurgia eletiva não cardíaca. Durante o período pré-operatório imediato (24 horas) foram avaliados os fatores de risco: idade, gênero, cognição (MiniCog), funcionalidade (Katz e time up and go), fármacos e aspectos clínicos. O delirium, no pós-operatório imediato (até 72 horas), foi avaliado através do Confusion Assesment Method (CAM). RESULTADOS: Oitenta e três pacientes foram incluídos na pesquisa, sendo 44,6% (n = 37) de cirurgia ortopédica, 42,16% (n = 35) de cirurgia geral e 13,3% (n = 11) de cirurgia urológica. Predominou o sexo masculino (53%), com idade média de 73 anos (65 a 94) anos. Na amostra de pacientes, 9,6% (n = 8) apresentaram delirium pós-operatório: 6% do tipo hiperativo (n = 5), 2,4% do tipo hipoativo (n = 2) e 1,2% do tipo misto (n = 1). Eram mais idosos (p = 0,02), com maior declínio cognitivo (p = 0,01), anemia (p = 0,04) e prolongamento na permanência hospitalar (p = 0,001). CONCLUSÃO: O delirium pós-operatório foi observado com maior frequência nos pacientes mais idosos, portadores de declínio cognitivo e anemia, com influência no período de hospitalização, demonstrando a importância de uma avaliação preventiva mais abrangente no período pré-operatório.

INTRODUCTION: Delirium is an acute change in cognition and attention, common in the postoperative period in older patients, associated with increased costs and longer hospital stay. OBJECTIVE: To evaluate the frequency, risk factors, and influence of postoperative delirium in older patients submitted to elective noncardiac surgery. METHOD: This was a cross-sectional, observational study of older adults (65 years or older) hospitalized for elective noncardiac surgery. During the immediate preoperative period (24 hours), risk factors such as age, sex, cognition (MiniCog), functional status (Katz and Timed Up and Go), medications, and clinical aspects were evaluated. Delirium, in the immediate postoperative period (up to 72 hours), was evaluated using the Confusion Assessment Method (CAM). RESULTS: A total of 83 patients were included in the study. Of these, 44.6% (n = 37) had undergone orthopedic surgery, 42.16% (n = 35), general surgery, and 13.3% (n = 11), urological surgery. Most participants were men (53%), with a mean age of 73 (65­94) years. Overall, 9.6% (n = 8) had postoperative delirium: 6% of the hyperactive subtype (n = 5), 2.4% of the hypoactive subtype (n = 2), and 1.2% of the mixed subtype (n = 1). These patients were older (p = 0.02), had greater cognitive decline (p = 0.01), anemia (p = 0.04), and prolonged hospital stay (p = 0.001). CONCLUSION: Postoperative delirium was more commonly observed in the older old with cognitive decline and anemia, with an impact on hospital length of stay, highlighting the importance of a more comprehensive preventive evaluation in the preoperative period.

Capacidad física y reserva cognitiva como factores protectores de las funciones atencionales en adultos mayores / Physical activity and cognitive reserve as protective factors for attentional functioning in older people

Background: Attention is considered a central control mechanism in cognitive processing systems. Attention deficits contribute to the symptomatic profile of Alzheimer's disease (AD). Physical exercise and cognitive reserve, could delay cognitive impairment and constitute a protective factor against clinical manifestations of AD. Aim: To relate the functionality of the attentional networks with physical activity and cognitive reserve. Material and Methods: Three groups of 20 older adults each (control, physical activity and with osteoarthritis) were studied. The Functional capacity assessment test, Cognitive Reserve Questionnaire and the Attention Networks Test - for Interactions and Vigilance or ANTI-V were applied to participants. Results: Significant differences were observed in the response times of the alert, orientation and executive network, and the percentage of success in the network orientation and executive network. No differences between groups were observed for the different indicators of vigilance. Conclusions: These results confirm the benefits of physical exercise as a protective factor for attentional functioning.

Funcionamiento cognitivo en adultos mayores: rol de la reserva cognitiva, apoyo social y depresión / Cognitive reserve, depression and social support. Analysis of 206 older adults

Background: Cognitive reserve (CR) is a protective factor in aging. Depression and perceived social support are associated with cognitive performance in older adults. However, their role in the relationship between CR and cognitive functioning is less clear. Aim: To determine the relationship between CR and cognitive functioning and whether this relationship is mediated by depression and moderated by social support. Material and Methods: CR, depression, perceived social support, and cognitive functioning scales were applied to a convenience sample of 206 older adults, aged 69 ± 1 years (77% women). Structural equation analysis and moderate mediation analysis were performed. Results: There was a direct effect of CR in cognitive functioning (β = 0.223, p = 0.005), which was not mediated by depression (β = 0.040, p = 0.096). High CR scores were associated with lower depression scores (β = −0.203, p = 0.002). Higher depression scores were associated with worse cognitive functioning (β = −0.168, p = 0.040). The effect of CR on depression was moderated by social support (β = −0.161, p = 0.032) controlling for income and age. Conclusions: The relationship between CR and cognition in older adults allows an early assessment of cognitive dysfunction risk. Depression is an independent risk factor for cognitive functioning. Social support protects individuals with high CR from developing depression.

Stress and Cognitive Reserve as independent factors of neuropsychological performance in healthy elderly / Estresse e Reserva Cognitiva como determinantes independentes para o desempenho neuropsicológico de idosos saudáveis

Abstract Exposure to high levels of cortisol and self-reported stress, as well as cognitive reserve, have been linked to Alzheimer’s disease pathology. However, there are no studies on the interaction of these variables. The present study aims to assess the associations of measures of cortisol, self-reported stress, and cognitive reserve with neuropsychological performance in healthy elderly people; besides, to test the interactions between these variables. Cross-sectional analyzes were conducted using data on stress, cognitive reserve and clinical conditions in 145 healthy elderly adults. A neuropsychological battery was used to assess executive functions, verbal memory and processing speed. Measurement of salivary cortisol at the circadian nadir was taken. A negative association between different stress measures and performance on tasks of memory, executive functions and processing speed was observed. Elderly people with higher cognitive reserve showed superior performance on all neuropsychological measures. No significant interaction between stress and cognitive reserve to neuropsychological performance was observed. These results indicate that older adults with high levels of stress and reduced cognitive reserve may be more susceptible to cognitive impairment.

Resumo A exposição a níveis elevados de cortisol e de estresse psicológico, assim como à reserva cognitiva, têm sido relacionadas a sintomas da Doença de Alzheimer. Contudo, não há estudos sobre a interação dessas variáveis. Objetivamos examinar as associações de medidas de cortisol e estresse psicológico e de reserva cognitiva com o desempenho neuropsicológico de idosos saudáveis, além de analisar a existência de interações entre essas variáveis. Análises transversais foram conduzidas usando dados sobre estresse, reserva cognitiva e condições clínicas em 145 idosos saudáveis. Usamos uma bateria neuropsicológica para medir as funções executivas, memória verbal e velocidade de processamento. Utilizamos uma medida de cortisol salivar para o nadir circadiano. Encontramos uma associação negativa entre diferentes medidas de estresse e o desempenho em tarefas de memória, funções executivas e velocidade de processamento. Idosos com elevada reserva cognitiva apresentaram um desempenho superior em todas as medidas neuropsicológicas. Não houve interação significativa entre estresse e Reserva Cognitiva para o desempenho neuropsicológico. Estes resultados sugerem que idosos com níveis elevados de estresse e reduzida reserva cognitiva podem ser mais suscetíveis ao comprometimento cognitivo.

Cognitive reserve and the severity of Alzheimer’s disease / Reserva cognitiva e a severidade da doença de Alzheimer

Alzheimer´s disease (AD) is a clinical syndrome caused by neurodegeneration and characterized by a progressive deterioration in cognitive ability and capacity for independent living. Cognitive reserve (CR) describes the capacity of the adult brain to cope with the effects of the neurodegenerative process and to minimize the clinical manifestation of pathology of dementia. The aim of this study was to evaluate the association of CR and the severity of AD. Method This study was cross-sectional. Functional and neuropsychological abilities of 75 outpatients with probable AD diagnosis were evaluated. Patients completed two questionnaires, “Participation in leisure activities throughout life” and CR Questionnaire.Result The relationship between Clinical Dementia Rating (CDR) and the level of CR was statistically significant (likelihood ratio (LR), p = 0.015).Conclusion The level of CR influenced the severity of dementia. This study suggests that AD patients with higher CR may benefit against cognitive decline after diagnosis of AD.

Doença de Alzheimer (DA) é uma síndrome neurodegenerativa caracterizada por uma deterioração progressiva das capacidades cognitivas e das competências para uma vida independente. A reserva cognitiva (RC) descreve a capacidade do cérebro adulto em lidar com os efeitos deste processo neurodegenerativo e minimizar a manifestação clínica da patologia de demência. O objetivo deste trabalho foi avaliar a associação entre RC e a severidade da DA. Método Este estudo foi transversal. Foram avaliadas as competências funcionais e neuropsicológicas de 75 pacientes com diagnóstico provável de DA. Os pacientes completaram dois questionários, “Participação em atividades de lazer ao longo da vida” e o Questionário de RC.Resultados A relação entre o nível de Clinical Dementia Rating (CDR) e de RC foi estatisticamente significativa (likelihood ratio (LR), p = 0,015).Conclusão O nível de RC influenciou a severidade da demência. Este estudo sugere que os doentes com DA com um maior nível de RC podem beneficiar de proteção relativamente ao declínio cognitivo após o diagnóstico de DA.

Cambio en el patrón de consumo de sustancias posterior a cirugía bariátrica: presentación de un caso clínico / Changes in the pattern of substance use after bariatric surgery: report of one case

Even though the benefits of bariatric surgery are supported by scientific evidence, its indications and contraindications must be revised to avoid its indiscriminate use. Substance use is more common in patients subjected to bariatric surgery than in the general population. After surgery, an increase in alcohol abuse has been reported. We report a 41 years old male, with morbid obesity, alcohol and cocaine use. After bariatric surgery, his alcohol tolerance significantly decreased, increasing the doses of cocaine and starting to consume it without alcohol. His high anxiety level and paranoid delusions, motivated him to seek help in a rehabilitation center where a Substance Dependence Disorder was diagnosed and received initial treatment. The cause of this adverse effect needs further research. Functional and anatomic changes in the digestive tract lead to a greater alcohol absorption and reduced alcohol dehydrogenase activity. Also neurochemical alterations may produce a displacement from compulsive use of food to compulsive use of addictive substances.