Association of loneliness, social isolation, and daily cognitive function in Mexican older adults living in community during the first wave of COVID-19 pandemic / Asociación del aislamiento social, soledad y la función cognitiva cotidiana en adultos mayores mexicanos de la comunidad durante la primera ola del COVID-19

Abstract Introduction Loneliness and social isolation are known risk factors for cognitive decline; their effect in older adults (OA) after COVID-19 lockdown is emerging. Objective To establish an association between loneliness and social isolation, with daily cognitive function in Mexican OA during the first wave of the COVID-19 pandemic. Method Cross-sectional study, derived from the cohort "The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America", which included 308 OA recruited between March-August 2020 whose daily cognitive function were determined with the Everyday Cognition Scale (E-Cog) as dichotomized score (cut point: 1.31 for normal cognition). Loneliness and social isolation were binomial variables. Results The mean age was 65.4 ± 7.9 years, 75.7% were women. The mean continuous E-Cog score was 57.4 (SD = ± 19.1), 49.1% had a score < 1.31 (normal cognition), while 50.9% had a higher score (cognitive impairment). Eighty four percent of participants reported loneliness, 79.9% reported social isolation. Multivariate regression model showed a negative and statistically significant association between social isolation and loneliness and E-Cog, adjusted by age, sex and education level (β = -.046, 95% CI = [-.8, -.013], p = .007; β = -.16, 95% CI = [-.08, -.018], p = .003), and a positive association with subjective memory complaint (β = .81, 95% CI = [-.16, -.11], p = < .001). Discussion and conclusion These data suggest the need for increased vigilance of those who have loneliness and social isolation due to its potential deleterious effect on cognitive function.

Resumen Introducción La soledad y el aislamiento social son factores de riesgo conocidos para el deterioro cognitivo; su efecto en las personas mayores (PM) después del confinamiento por COVID-19 está emergiendo. Objetivo Establecer una asociación entre la soledad y el aislamiento social, con la función cognitiva diaria en PM mexicanas durante la primera ola de la pandemia por COVID-19. Método Estudio transversal derivado de la cohorte "The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America", incluyó 308 AM reclutados de marzo-agosto 2020, la función cognitiva diaria fue evaluada con Everyday Cognition Scale (E-Cog) con un punto de corte 1.31 (cognición normal); la soledad y el aislamiento social fueron variables binomiales. Resultados La media de edad fue 65.4 ± 7.9 años, 75.7% mujeres. E-Cog promedio fue 57.4 (DE = ± 19.1), 49.1 % tenía una puntuación < 1.31 (cognición normal), 50.9% > 1.31 (deterioro cognitivo). Ochenta y cuatro por ciento de los participantes reportaron soledad, 79.9% aislamiento social. El modelo de regresión multivariado mostró una asociación negativa y estadísticamente significativa entre aislamiento social y soledad con E-Cog (β = -.046, IC 95% = [-.8, -.013], p = .007; β = -.16, IC 95% = [-.08, -.018], p = .003), y una asociación positiva con queja de memoria subjetiva (β = .81, IC 95% = [-.16, -.11], p = < .001) ajustado a edad, sexo y escolaridad. Discusión y conclusión Estos datos sugieren la necesidad de una mayor vigilancia de quienes presentan soledad y aislamiento social debido a su potencial efecto deletéreo sobre la función cognitiva.

Cross-cultural adaptation of the everyday cognition scale (M-ECog) in older Mexican adults with cognitive impairment / Adaptação transcultural da escala de cognição cotidiana (M-ECog) em idosos mexicanos com comprometimento cognitivo

Abstract The Everyday Cognition (ECog) scale was created to evaluate the functional abilities of older adults across a wide range of abilities between normal aging and dementia. ECog screens cognitive alterations such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This early recognition is done by the measurement of the ability to perform the activities of daily living (ADLs). Objective: To establish the cross-cultural adaptation, validity, and reliability of the ECog Mexican version (M-ECog) in participants with: SCD, MCI, and dementia coming from a memory clinic. Methods: There were 200 patients and their respective informants in a memory clinic of a third level hospital in Mexico City. Four groups were studied: 50 cognitively healthy (CH), 50 SCD, 50 MCI, and 50 dementia. The clinical evaluation included: sociodemographic and health characteristics, cognitive status by the Mini-Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA-E), and caregiver information (informants) about the difficulty in ADLs as well as the ECog Spanish version (M-ECog). Results: The M-ECog was significantly correlated with MMSE, MoCA-E, and ADLs. It showed the ability to discriminate the different cognitive declines (Cronbach's alpha 0.881). The intra-class correlation coefficient was 0.877 (95% confidence interval — CI, 0.850-0.902; p<0.001). The patient's group area under curve (AUC) of M-ECog for SCD was 0.70 (95%CI 0.58-0.82, p<0.005), for MCI it was 0.94 (95%CI 0.89-0.99, p<0.001) and for dementia 0.86 (95%CI 0.79-0.92, p<0.001). Conclusion: The M-ECog scale proves to be valid and reliable for measuring everyday abilities mediated by cognition. It is self-applicable without requiring extensive prior formation. It is useful to screen for SCD and MCI in older Mexican adults.

RESUMO A escala Cognição Cotidiana (ECog) foi criada para avaliar as habilidades funcionais de idosos em uma ampla gama de habilidades entre o envelhecimento normal e a demência. O ECog rastreia alterações cognitivas como declínio cognitivo subjetivo (DCS) e comprometimento cognitivo leve (CCL). Esse reconhecimento precoce é feito pela mensuração da capacidade de realizar as atividades de vida diária (AVD). Objetivo: Estabelecer a adaptação transcultural, validade e confiabilidade da versão mexicana do ECog (M-ECog) em participantes com: SCD, MCI e demência provenientes de uma clínica de memória. Métodos: Foram 200 pacientes e seus respectivos informantes em uma clínica de memória de um hospital de terceiro nível na Cidade do México. Quatro grupos foram estudados: 50 cognitivamente saudáveis (CH), 50 SCD, 50 MCI e 50 com demência. A avaliação clínica incluiu: características sociodemográficas e de saúde, estado cognitivo pelo Mini-Mental State Evaluation (MMSE) e Montreal Cognitive Evaluation versão em espanhol (MoCA-E), bem como informações do cuidador (informantes) sobre a dificuldade nas AVD e o ECog versão em espanhol (M-ECog). Resultados: O M-ECog foi significativamente correlacionado com MMSE, MoCA-E e AVD. Mostrou capacidade de discriminar os diferentes declínios cognitivos (alfa de Cronbach 0,881). O coeficiente de correlação intraclasse foi de 0,877 (intervalo de confiança de 95% — IC95%, 0,850-0,902; p<0,001). A AUC do grupo do paciente de M-ECog para SCD foi de 0,70 (IC95% 0,58-0,82, p<0,005), para MCI foi de 0,94 (IC95% 0,89-0,99, p<0,001) e para demência foi de 0,86 (IC95% 0,79-0,92, p<0,001). Conclusão: A escala M-ECog mostra-se válida e confiável para medir habilidades cotidianas mediadas pela cognição. É autoaplicável sem exigir extensa formação prévia. É útil para rastrear MSC e MCI em adultos mexicanos mais velhos.

Prevention, diagnosis, and treatment of delirium in older adults with COVID-19. Literature review / Prevención, diagnóstico y tratamiento del delirium en adultos mayores con COVID-19. Revisión de la literatura

Abstract Background COVID-19 affects several systems in the body, including the central nervous system (CNS), expressed in the form of headaches, hyposmia, cerebrovascular disease, and neuropathy. Older Adults (OA) are vulnerable to this infection, and may also present delirium, which may be the result of the virus directly affecting the CNS or of systemic inflammation during infection. Objective To determine the clinical characteristics, risk factors, pathophysiology, treatment measures, and prevention of delirium associated with COVID-19 from a review of the literature in times of the SARS-CoV-2 pandemic. Method A search was conducted in PubMed, SciELO, UpToDate, and Medscape using keywords in English and Spanish. Results Seventy-two articles were reviewed. We analyzed inclusion and exclusion criteria and 43 articles with relevant information for the narrative description of the review were selected. Twenty to thirty per cent of the COVID-19 patients will present or develop delirium, or changes in mental status during their hospitalization, with rates of 60% to 70% in severe illness. The exact mechanisms are likely to be multifactorial. There is a worrying lack of attention to the implications of identifying and managing delirium in the response to this pandemic. Discussion and conclusion Delirium is a frequent neurological manifestation in OA with COVID-19 and requires early identification, as well as the implementation of non-pharmacological and pharmacological treatment strategies, which may reduce the associated morbidity and mortality in this age group.

Resumen Antecedentes La COVID-19 afecta múltiples sistemas del organismo. Uno de ellos es el sistema nervioso central (SNC), cuya afección se manifiesta con cefalea, hiposmia, enfermedad vascular cerebral y neuropatía. Además de que los adultos mayores (AM) son vulnerables a esta infección, pueden presentar delirium, el cual puede ser resultado de una afección directa del virus al SNC o resultado de la inflamación sistémica durante la infección. Objetivo Conocer las características clínicas, factores de riesgo, fisiopatología, medidas de tratamiento y prevención del delirium asociados a COVID-19 a partir de la revisión de la literatura en tiempos de la pandemia por SARS-CoV-2. Método Se realizó una búsqueda en PubMed, SciELO, UpToDate y Medscape utilizando palabras clave en inglés y español. Resultados Se revisaron 72 artículos, se analizaron criterios de inclusión y exclusión y se seleccionaron 43 artículos con información relevante para la descripción narrativa de la revisión. El 20-30% de los pacientes con COVID-19 presentarán o desarrollarán delirium, o cambios en su estado mental durante el curso de su hospitalización, con tasas del 60-70% en enfermedad grave. Es probable que los mecanismos exactos sean multifactoriales. Existe una preocupante falta de atención a las implicaciones de la identificación y el manejo del delirium en la respuesta a esta pandemia. Discusión y conclusión El delirium es una manifestación neurológica frecuente en los AM con COVID-19 y requiere su identificación temprana, así como la implementación de estrategias de tratamiento no farmacológico y farmacológico, lo que puede disminuir la morbimortalidad asociada en este grupo etario.

Spanish validation and cultural adaptation of the Five-Word Test for the detection of the neurocognitive disorder in older adults / Adaptación cultural y validación al español de la Prueba de Cinco Palabras para detectar el trastorno neurocognitivo en adultos mayores

Abstract Introduction "Episodic" memory problems are common in people with cognitive impairment due to Alzheimer's disease and related disorders. Dubois et al. developed the Five-Word Test (5WT) to evaluate episodic memory, which has proved to be an easy and valid test for identifying cognitive disorders. However, its validation and cultural adaptation from French to Spanish has not been undertaken and its usefulness in Mexican population is unknown. Objective Validation and cultural adaptation of the 5WT for screening minor and major neurocognitive disorder (ND) in Mexican older adults with probable Alzheimer's disease. Method Two hundred and fifteen participants (70 cognitively healthy subjects, 73 with minor ND and 72 with major ND were included). The cognitive status (gold standard) was determined using current clinical criteria and neuropsychological evaluation. The Spearman coefficient, ROC curve, and multinomial logistic regression models were used to determine the concurrent validity of the 5WT. Results The correlation between the 5WT and the Mini-Mental State Exam (MMSE) was .58, whereas for the clock face test it was -.37 (p < .001). The area under the 5WT curve was .97 (95% CI [.94, .99]), with a cut-off point of ≤ 16/20 for the diagnosis of major ND (89% sensitivity, 98% specificity) and .77 (95% CI [.70, .85]) for minor ND with a cut-off point of ≤ 18/20 (66% sensitivity, 77% specificity). Discussion and conclusion Since the 5WT is a simple, valid instrument for the identification of neurocognitive disorders like Alzheimer's disease, it could be a practical screening test.

Resumen Introducción Los problemas de la memoria "episódica" son comunes en las personas con deterioro cognitivo tipo Alzheimer. Dubois et al. desarrollaron la Prueba de Cinco Palabras (P5P) para evaluar la memoria episódica, la cual ha demostrado ser sencilla y válida para identificar trastornos cognitivos. Sin embargo, su validación y adaptación cultural del francés al español no se ha realizado y se desconoce su utilidad en población mexicana. Objetivo Validación y adaptación cultural de la P5P para el tamizaje del trastorno neurocognitivo (TNC) menor y mayor en adultos mayores mexicanos con probable enfermedad de Alzheimer. Método Participaron 215 participantes (70 cognitivamente sanos, 73 con TNC menor y 72 con TNC mayor. El estado cognitivo (estándar de oro) se determinó mediante los criterios clínicos vigentes y de evaluación neuropsicológica. El coeficiente de Spearman, la curva ROC y modelos de regresión logística multinomial se utilizaron para determinar la validez concurrente de la P5P. Resultados La correlación entre la P5P y el MMSE fue de .58, mientras que para la prueba de reloj fue de -.37 (p < .001). El área bajo la curva de la P5P fue .97 (IC 95% [.94, .99]), con un punto de corte ≤ 16/20 para el diagnóstico del TNC mayor (sensibilidad: 89%, especificidad: 98%) y de .77 (IC 95% [.70, .85]) para el TNC menor con un punto de corte ≤ 18/20 (sensibilidad: 66%, especificidad: 77%). Discusión y conclusión La P5P es un instrumento válido y simple para identificar de trastornos neurocognitivos de tipo Alzheimer por lo que podría ser una prueba práctica para uso en el tamizaje.

Validez y confiabilidad del cuestionario del ENASEM para la depresión en adultos mayores / Validity and reliability of the screening questionnaire for geriatric depression used in the Mexican Health and Age Study

OBJETIVO: Estimar la validez y confiabilidad de un instrumento para detectar depresión en adultos mayores. MATERIAL Y MÉTODOS: El estudio se realizó en la consulta externa del Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), entre mayo de 2005 y marzo de 2006. Se utilizaron el diagnóstico clínico de depresión a través de el Manual Diagnóstico y Estadístico de Trastornos Mentales, en su cuarta versión revisada (DSM-IV-TR), y la Escala de depresión geriátrica (EDG) de Yesavage, para establecer las propiedades clinimétricas de un cuestionario dicotómico de nueve reactivos, desprendido del Estudio Nacional sobre Salud y Envejecimiento en México (ENASEM). RESULTADOS: En el proceso de validación participaron 199 individuos de edad media de 79.5 años. El resultado del cuestionario de la ENASEM estuvo significativamente correlacionado con el diagnóstico clínico de depresión (p<0.001) y el puntaje de la EDG (p<0.001). La consistencia interna fue la adecuada (coeficiente alfa de 0.74). El punto de corte e"5/9 puntos tiene una sensibilidad y especificidad de 80.7 por ciento y 68.7 por ciento, respectivamente, para el diagnóstico de depresión. La confiabilidad prueba contra prueba fue excelente (Coeficiente de Correlación Intraclase de 0.933). Finalmente, los límites de acuerdo entre la prueba y contra prueba muestran una diferencia de 0.22 puntos porcentuales. CONCLUSIONES: El cuestionario ENASEM constituye un instrumento válido y confiable para cribar la presencia de depresión en adultos mayores.

OBJECTIVE: To assess the validity and reliability of a geriatric depression questionnaire used in the Mexican Health and Age Study (MHAS). METHODS: The study was conducted at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) clinic from May 2005 to March 2006. This depression screening nine-item questionnaire was validated using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (fourth revised version) and Yesavage's 15-item Geriatric Depression Scale (GDS-15) criteria. The instrument belongs to the MHAS, a prospective panel study of health and aging in Mexico. RESULTS: A total of 199 subjects 65 years of age and older participated in the validation process (median age= 79.5 years). MHAS questionnaire result was significantly correlated to the clinical depression diagnosis (p<0.001) and to the GDS-15 score (p<0.001). Internal consistency was adequate (alpha coefficient: 0.74). The cutoff point e" 5/9 points yielded an 80.7 percent and 68.7 percent sensitivity and specificity respectively. The fidelity for the test retest was excellent (intra-class correlation coefficient= 0.933). Finally, the Bland and Altman agreement points indicated a difference 0.22 percent points between test retest. CONCLUSION: The MHAS questionnaire is valid and trustworthy, and allows screening in the research field for the presence of depression in the elderly.

Alcohol, tabaco y deterioro cognoscitivo en adultos mexicanos mayores de 65 años / Cognitive impairment and alcohol and cigarette consumption in Mexican adults older than 65 years

OBJETIVO: Conocer la prevalencia del consumo de alcohol y tabaco y su asociación con deterioro cognoscitivo en la población mexicana mayor de 65 años. MATERIAL Y MÉTODOS: Se incluyeron 4 872 mayores de 65 años en la muestra del Estudio Nacional sobre Salud y Envejecimiento en México (ENASEM 2001). Se interrogó sobre el consumo de alcohol y tabaco. Para la clasificación de los sujetos con deterioro cognoscitivo, se utilizó la escala total de los diferentes dominios cognoscitivos. Se aplicaron ji cuadrada, Mann Whitney U y regresión logística para encontrar asociaciones. RESULTADOS: La prevalencia de alcoholismo según CAGE fue de 2.8 por ciento y la del consumo de tabaco de 14 por ciento. Factores asociados con el consumo de alcohol: edad 65-69 años (p <0.001), hombres (RR 3.17, p <0.001), nivel alto de educación (p <0.001). Con asociación significativa entre el consumo de alcohol y deterioro cognoscitivo (X²=6.59, p < 0.01). CONCLUSIONES: La prevalencia de consumo de alcohol y tabaco en los adultos mayores mexicanos es similar a lo reportado en otros países; el consumo de alcohol se asoció con el deterioro cognoscitivo.

OBJECTIVE: To determine the prevalence of the consumption of alcohol and cigarette smoking and their association with cognitive impairment among older Mexican adults. MATERIAL AND METHODS: A total of 4 872 people over 65 years of age included in the sample of the National Mexican Health and Aging Study carried out in 2001 were questioned about their consumption of alcohol and cigarette smoking. For the classification of those subjects with cognitive impairment, the total scale of the different cognitive domains was used. The chi-square, Mann-Whitney U test, and logistical regression were used in order to find associations. RESULTS: The prevalence of alcoholism according to CAGE was 2.8 percent and the prevalence of the consumption of cigarette smoking was 14 percent. Factors associated with the consumption of alcohol were:age 65-69 (p <0.001), men (RR 3.17,p <0.001), and high level of education (p <0.001). The association between the consumption of alcohol and cognitive impairment (X2=6.59, p <0.01) was statistically significant. CONCLUSIONS: The prevalence of consumption of alcohol and cigarette smoking in older Mexican adults are similar to that reported in other countries; the consumption of alcohol and its association with cognitive impairment was significant.