Aspectos cognitivos y legales en personas mayores: "Sano Juicio"

In Chile, 7.1% of people aged over 60 years have some type of cognitive disorder. The frequency of the latter increases to 13% in people between 75-79 years and 36.2% in people over 85 years. The concept of mild cognitive impairment (MCI) and dementia have evolved over time. The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) uses the term minor and major neurocognitive disorder, replacing the DCL and dementia respectively. Major cognitive disorder impairs functional performance while minor disorders does not. There is an arbitrary discrimination against the elderly. A form of discrimination is the request made by some notaries of a medical certification of the cognitive function for older people willing to carry out a legal procedure. This request has the sole effect of pre-establishing evidence in favor of the notary and not protecting the testator or the vulnerable person. Assessing the ability of older people to care for themselves and their possessions has important implications for them and their families, since there is a serious risk of prejudice when someone is declared as disabled. Thus, considering the epidemiology of cognitive disorders in our country we propose a series of legal and medical discussion points aimed to protect autonomy and to protect individuals and their possessions when they have difficulties to control their decisions.

Función de los músculos inspiratorios, parámetros hemodinámicos y disnea en pacientes con estenosis mitral / Inspiratory muscle function, hemodynamic parameters and dyspnea in patients with mitral valve stenosis

Background: The mechanism involved in dyspnea in patients with mitral valve stenosis (MS) is not completely understood. Aim: To evaluate in patients with MS, changes in hemodynamic parameters during the assessment of inspiratory muscle endurance (IME) and the relationship between IME, hemodynamics and dyspnea. Subjects and methods: We studied 13 patients (9 in NYHA class II and 4 in class III). Endurance was evaluated using a two minute incremental threshold loading test, to obtain the maximal sustainable inspiratory pressure (SIP), and maximal inspiratory load (MIL). During the test, cardiac output (CO), mean pulmonary and capillary pressures (PAP and PCP, respectively), were evaluated. Results: Compared to six normal subjects, MS patients had reduced SIP and MIL (p <0.01), which correlated with baseline index of dyspnea (r= 0.57 and r=0.52, respectively, p <0.05). At the end of the test period, basal CO, cardiac index (CI), PAP and PCP increased from 3.4 to 4.0 l/min-1; 2.1 to 2.5 l/min-1/m-2; 15 to 25 and 11 to 18 mmHg, respectively (p <0.01). No relationship between IME and hemodynamic parameters was found. Conclusions: IME is reduced and is closely related to dyspnea in these patients with MS. The observed low CI, suggests that muscle underperfusion could contribute to this dysfunction during the inspiratory effort.