Asociación entre la salud oral y el deterioro cognitivo leve en adultos mayores

Introducción: En la medida que se incrementa la población de adultos mayores, aumenta la prevalencia, aumenta la prevalencia del deterioro cognitivo. Recientemente, se ha introducido la mala salud oral entre los factores de riesgo potenciales. Objetivo: Determinar la asociación entre la salud oral y el deterioro cognitivo leve en adultos mayores de una comunidad de la provincia de Santiago de Cuba. Métodos: Se realizó un estudio observacional, analítico y retrospectivo, de tipo casos y controles en el período comprendido entre enero y julio del año 2023. La población de estudio estuvo constituida por 257 adultos mayores que vivían en esta comunidad, de los cuales se escogieron 40 casos con diagnóstico de deterioro cognitivo leve, según los criterios de Petersen. Se seleccionaron tres controles por cada caso, 120 adultos mayores con aproximadamente las mismas características que el caso. Se precisó la fuerza de asociación de cada factor de riesgo. Resultados: Se halló una asociación significativa entre padecer deterioro cognitivo leve y presentar un número de 1 a 9 dientes. El dolor oral se presentó con mayor frecuencia en el 72,5 % de los casos. No recordar la última visita al estomatólogo fue causa de deterioro cognitivo leve en el 42,5 %. Cepillarse irregularmente se asoció 4,1 veces más con el riesgo de desarrollar esta afección. Conclusiones : Existe una asociación entre la salud oral y el deterioro cognitivo leve en los adultos mayores. Tener menos dientes y referir dolor oral fueron factores de riesgo importantes para presentar deterioro cognitivo. La visita al estomatólogo y el cepillado de dientes irregular influyeron negativamente en la enfermedad. Sin embargo, el uso de prótesis dentales fue un factor protector para el deterioro cognitivo leve.

Introduction: Along with the increase in the population of older adults, the prevalence of cognitive impairment is increasing. Recently, poor oral health has been introduced among potential risk factors. Objective: To determine the association between oral health and mild cognitive impairment in older adults in a community in the province of Santiago de Cuba. Methods: An observational, analytical and retrospective case-control study was carried out from January to July 2023. The study population consisted of 257 older adults living in this community, from which 40 cases were selected with a diagnosis of mild cognitive impairment, according to Petersen's criteria. Three controls were selected for each case, 120 older adults with approximately the same characteristics as the case. The strength of association of each risk factor was determined. Results: A significant association was found between having mild cognitive impairment and having 1 to 9 teeth. Oral pain was more frequent in 72.5% of the cases. Not remembering the last visit to the dentist was a cause of mild cognitive impairment in 42.5 %. Irregular brushing was 4.1 times more associated with the risk of developing this condition. Conclusions: There is an association between oral health and mild cognitive impairment in older adults. Having fewer teeth and reporting oral pain were important risk factors for cognitive impairment. Visiting the dentist and irregular tooth brushing had a negative influence on the disease. However, the use of dental prosthetics was a protective factor for mild cognitive impairment.

Alertamientos y movimientos periódicos de las piernas durante las etapas de sueño y deterioro cognitivo leve en adultos mayores. Estudio preliminar / Arousals and periodic leg movements during sleep stages and mild cognitive impairment in older adults: a preliminary study

RESUMEN La fragmentación del sueño puede asociarse con distintas enfermedades, entre ellas, la demencia. En este sentido, la fragmentación de sueño, indicada por el índice de alertamientos y/o movimientos periódicos de las piernas (MPP), podría ser un marcador temprano de deterioro cognitivo leve (DCL), un síndrome precursor de la demencia. El objetivo del presente estudio fue medir el índice de prevalencia de los alertamientos y de los MPP durante el sueño en un grupo control y un grupo con DCL, así como determinar si hay diferencia entre los grupos en ambos índices y establecer si existe una correlación entre los dos fenómenos. En 9 participantes (3 mujeres controles y 3 mujeres con DCL; y 3 hombres con DCL) (edad: 69.1 ± 5; años de educación: 8 ± 2) se registró una noche de polisomnografía. Se obtuvieron los índices por hora de alertamientos y para cada etapa de sueño, así como los MPP globales y por hora; además se realizaron análisis entre y dentro de cada grupo. Se encontró una correlación positiva y un mayor número de MPP que de alertamientos durante toda la noche en los participantes con DCL. Conocer la prevalencia y asociación de ambos fenómenos contribuye en la formulación de una evaluación más cuidadosa y profunda de los adultos mayores en riesgo de desarrollar DCL y/o demencia.

ABSTRACT Sleep fragmentation may be associated with several diseases, including dementia. In this sense, sleep fragmentation, indicated by the rates of arousals and/or periodic leg movements (PLM), could be an early marker of Mild Cognitive Impairment (MCI), a syndromic stage prior to dementia. Therefore, the objective of this study was to compare the index of PLM with that of arousals and correlate both indexes in people with MCI and without MCI during all sleep stages. In 9 participants (3 control women and 3 women with MCI; and 3 men with MCI) (ages: 69.1 ± 5; years of education: 8 ± 2), one night of polysomnography was performed. Hourly rates of arousals and PLM were scored from each sleep stage. Analyses were performed within and between PLM and arousals for each group. Significant differences and a positive correlation were found between the arousal and the PLM rates for the group with MCI during the whole night. Knowledge of the prevalence and the association of both phenomena may contribute to a more careful and thorough evaluation of older adults at risk of developing MCI and/or dementia.

Síndromes geriátricos y abandono

Fundamento: el abandono en la vejez es un condicionante de muchos trastornos de salud y constituye en mayor medida una condición de gran incidencia a nivel mundial. Objetivo: comparar los síndromes geriátricos y el abandono en pacientes adultos mayores. Métodos: se realizó un estudio transversal, descriptivo, analítico y correlacional, en la Unidad de Medicina Familiar No. 33 del Instituto Mexicano del Seguro Social de Tabasco. La muestra se conformó con 203 pacientes de 60 años y más, que acudieron a consulta de Medicina Familiar y Atención Médica Continua. Se aplicaron 3 instrumentos: la escala de Pfeiffer, el International Consultation on Incontinence Questionnaire Short-Form, la Escala de Percepción de Abandono del Adulto Mayor y se interrogó sobre el consumo de medicamentos prescritos y automedicados. Resultados: existió relación entre los síndromes geriátricos y el abandono, como se comprobó en la correlación entre las variables analizadas. El deterioro cognitivo leve, moderado y severo, se encontró en bajas proporciones. El 40,7 % de los pacientes aceptó tener incontinencia urinaria. La presencia de polifarmacia se encontró en altas proporciones. Conclusiones: los síndromes geriátricos presentes en el estudio fueron: deterioro cognitivo, polifarmacia e incontinencia urinaria, más la presencia de ser soltero, viudo o divorciado muestran una relación significativa para sufrir abandono.

Foundation: abandonment in old age is a condition of many health disorders and is, to a greater extent, a condition of high incidence worldwide. Objective: to compare geriatric syndromes and abandonment in older adult patients. Methods: a cross-sectional, descriptive, analytical and correlational study was carried out in the Family Medicine Unit No. 33 of the Mexican Social Security Institute of Tabasco. The sample was made up of 203 patients aged 60 and over, who attended Family Medicine and Continuing Medical Care consultations. Three instruments were applied: the Pfeiffer scale, the International Consultation on Incontinence Questionnaire Short-Form, the Perception of Abandonment Scale for the Elderly, and questions were asked about the consumption of prescribed and self-medicated medications. Results: there is a relationship between geriatric syndromes and abandonment, as verified in the correlation between the variables analyzed. Mild, moderate and severe cognitive impairment was found in low proportions. 40.7 % of the patients accepted having urinary incontinence. The presence of polypharmacy was found in high proportions. Conclusions: the geriatric syndromes present in the study such as: cognitive impairment, polypharmacy and urinary incontinence, plus the presence of being single, widowed or divorced show a significant relationship to suffering abandonment.

Associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros: estudo populacional / Association between self-perceived hearing status and cognitive impairment in the older Brazilian population: a population-based study

Resumo Saúde cognitiva é um fator importante para qualidade de vida e a autonomia dos idosos, sendo influenciada pela capacidade auditiva. O objetivo deste artigo é analisar a associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros. Trata-se de um estudo transversal de base populacional com 4.977 idosos que participaram do ELSI Brasil 2015. Comprometimento cognitivo (desfecho, categorizado como sim e não) e a variável de interesse (autopercepção auditiva, categorizada como boa, regular e ruim), ambos obtidos de forma autorreferida. Para a cognição foram considerados os domínios orientação temporal, memória (curto e longo prazo) e linguagem (recente e tardia). Foi utilizada a regressão de Poisson com estimativa de variância robusta para aferir a associação nas análises bruta e ajustada. Variáveis sociodemográficas, de estilo de vida e de histórico clínico foram utilizadas para ajuste das análises. Dos participantes, 31,8% relataram audição regular ou ruim e 42% apresentaram comprometimento cognitivo. Na análise ajustada, idosos com audição ruim apresentaram maior força de associação com comprometimento cognitivo, em comparação com seus pares com audição boa. Em idosos brasileiros, quanto pior a autopercepção auditiva, maior a associação com o comprometimento cognitivo.

Abstract Cognitive health plays an important role in the quality of life and autonomy of older adults. and it is influenced by hearing ability. This article aims to analyze the association between self-perceived hearing status and cognitive impairment in Brazilian older adults. This cross-sectional population-based study was conducted with 4,977 older adults who participated in ELSI Brazil 2015. The cognitive impairment status (outcome. categorized as "yes" and "no") and variable of interest (self-perceived hearing status. categorized as "good" "fair" and "poor") were obtained using a self-report method. The following domains were considered for cognition: temporal orientation. memory (short and long term). and language (recent and late). Poisson regression with robust variance estimation was used to assess the self-perceived hearing status-cognitive impairment association in the crude and adjusted analyses. Sociodemographic. lifestyle. and medical history variables were used to adjust the analyses. We found that 31.8% of the participants reported fair or poor hearing and 42% had cognitive impairment. In the adjusted analysis. older adults with poor hearing were revealed to have a stronger association with cognitive impairment than their peers with good hearing. Therefore. in older Brazilian adults. lower self-perceived hearing status is associated higher levels of cognitive impairment.

What diseases affect elderly Mexican population? Clinical and socialdemographic characteristics of patients of the psychogeriatric clinic of the National Institute of Psychiatry / ¿De qué se enferman nuestros adultos mayores? Características clínicas y sociodemográficas de los pacientes de la clínica de psicogeriatría del Instituto Nacional de Psiquiatría

Abstract Introduction The demographic and epidemiological transition, as well as the aging population has changed how older adults are treated in our healthcare system. Objective To establish the sociodemographic and clinical characteristics of the patients from the Psychogeriatric Clinic (PC) of the Ramón de la Fuente Muñiz National Institute of Psychiatry (INPRFM) seen between January 1, 2011, and December 31, 2020. Method Descriptive, observational, cross-sectional, retrospective study. A database was created with the information from digital clinical records. No additional scales were used. Statistical analysis performed in SPSS 20.0. Results 2056 records were found, 1247 met the inclusion criteria. The mean age was 74.28 years, women 73.46% (n = 916), primary school 46.62% (n = 427), married 35.70% (n = 327), urban area 93.99% (n = 1172), home-based 78.28% (n = 717), low socioeconomic level 59.99% (n = 522). The most common psychiatric pathology was depressive disorders 62.07% (n = 774) and neurocognitive disorders 37.52% (n = 468) due to Alzheimer's disease 17.08% (n = 213), with Mini-Mental State Examination of 18.88 points (± 6.68). They had comorbidities such as arterial hypertension 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) and had a geriatric syndrome in 64.42% (n = 218). Discussion and conclusion Aging in Mexico affects the female population the most. The analysis report from the prevalence for psychogeriatric pathologies of the PC it's for of its kind. The main goal is promoting research on dementias and highlighting the magnitude of the problem for Latin American governments. The results are not intended to be extrapolated to the general population.

Resumen Introducción La transición demográfica y epidemiológica, el subsecuente envejecimiento poblacional, produjeron cambios en los sistemas de salud y cómo se atiende a los adultos mayores. Objetivo Establecer las características sociodemográficas y clínicas de los pacientes de la Clínica de Psicogeriatría (CP) del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM) que acudieron entre el 1 enero de 2011 y 31 diciembre de 2020. Método Estudio descriptivo, observacional, corte transversal, retrospectivo. Se creó una base de datos con la información de los expedientes clínicos digitales. No se utilizó ninguna escala adicional. Análisis estadístico realizado en SPSS 20.0. Resultados Se encontraron 2056 registros, 1247 cumplieron los criterios de inclusión. Edad media 74.28 años, mujeres 73.46% (n = 916), primaria 46.62% (n = 427), casadas 35.70% (n = 327), área urbana 93.99% (n = 1172), ocupación hogar 78.28% (n = 717), nivel socioeconómico bajo 59.99% (n = 522). La patología psiquiátrica más común fueron los trastornos depresivos 62.07% (n = 774) y trastorno neurocognitivo 37.52% (n = 468), por enfermedad de Alzheimer 17.08% (n = 213), con MMSE de 18.88 puntos (± 6.68). Con comorbilidades como hipertensión arterial 52.85% (n = 659), diabetes mellitus 23.34% (n = 291) y tenían síndromes geriátricos en 64.42% (n = 218). Discusión y conclusión El envejecimiento se observa principalmente en las mujeres mexicanas. Reporte del análisis de las prevalencias puntuales de las patologías psicogeriátricas de la CP. Primero en su tipo. Se intenta fomentar la investigación en las demencias y resaltar la magnitud del problema en los países latinoamericanos para sus gobiernos. Los resultados no pretenden ser extrapolados a la población general.

Pain in older adults with dementia: Brazilian validation of Pain Intensity Measure for Persons with Dementia (PIMD) / Dor em idosos com demência: validação da versão brasileira do instrumento Pain Intensity Measure for Persons with Dementia (PIMD)

Abstract Background Although there are several ways to assess pain in dementia, there is still a need for tools with better items to assess the presence of pain intensity in these individuals. Objective To validate to Brazilian version of the "Pain Intensity Measure for Persons with Dementia - PIMD-p. Methods Older adults, all demented with impaired verbal communication and exposed to potentially painful situations, were selected from an outpatient clinic and long-term care facility (LTCF). The PIMD-p was applied independently by 2 researchers (E1 and E2) on the same day. Within 14 days, the instrument was reapplied by one of the 2 researchers (E3). The pain intensity reported by participants' caregivers and LTCF nurses were recorded on a verbal numeric pain scale. For the statistical analysis, Cronbach's Alpha, Spearman's Coefficient and intraclass correlation Index were calculated. Results A total of 50 older individuals were selected (mean age 86 years), majority with musculoskeletal pain. The PIMD-p demonstrated good internal consistency according to Cronbach's α (0.838), excellent intra and interobserver reproducibility (0.927 and 0.970, respectively; p < 0.001), and convergent validity (strong significant correlations between reported pain intensities and pain indicators on the PIMD-p (except for expressive eyes; corr = 0.106 and p = 0.462). A ROC curve was plotted to determine the best cut-off for the PIMD-P, and a score of 7.5 predicted moderate-to-severe pain, with 77.8% sensitivity and 95.7% specificity (p < 0.001). Conclusion The PIMD-p showed satisfactory psychometric properties for measuring intensity of pain in demented older adults with impaired verbal communication.

Resumo Antecedentes Embora existam várias formas de estimar a dor na demência ainda há necessidade de ferramentas com melhores itens para avaliação da presença e intensidade da dor nesses indivíduos. Objetivo Analisar as propriedades psicométricas de uma ferramenta de avaliação da dor em idosos dementados, a "Pain Intensity Measure for Persons with Dementia Portuguese - PIMD-p". Métodos Idosos expostos a situações potencialmente dolorosas, sendo esses dementados e com prejuízo na comunicação verbal, foram selecionados em uma unidade ambulatorial e uma instituição de longa permanência, em São Paulo. A PIMD-p foi aplicada por 2 pesquisadores (E1 e E2), de forma separada, num mesmo dia, e, com intervalo de no máximo 14 dias, essa foi reaplicada por apenas um deles (E3), e ainda, foi obtida a intensidade álgica inferida pelos cuidadores dos idosos participantes. Na análise estatística foram utilizados o Alfa de Cronbach, o Coeficiente de Spearman e o Índice de Correlação Intraclasses. Resultados Selecionada uma amostra de 50 idosos com média de idade de 86 anos, a maioria portadora de demência moderada e de dor de origem musculoesquelética. Apuradas para a PIMD-p uma boa consistência interna, segundo o alfa Cronbach (0,838); excelentes reprodutibilidades intra e interobservador (0,927 e 0,970, respectivamente; p < 0,001); e uma validade convergente, essa última obtida com as fortes e significativas correlações entre as intensidades dolorosas inferidas e os indicadores de dor do instrumento em estudo (exceto para o indicador "olhar expressivo"; corr = 0,106 e p = 0,462). Conclusão A PIMD-p se mostrou ser uma ferramenta com propriedades de medida adequadas para avaliar a presença e intensidade álgicas em idosos com demência e com prejuízo na comunicação verbal.

Secuelas cognitivas en encefalitis inmunomediadas: cohorte de pacientes en Argentina / Cognitive sequelae in immunomediated encephalitis: cohort of patients in Argentina

Resumen Introducción: Las encefalitis inmunomediadas son un desorden neurológico de origen autoinmune. Actual mente es escasa la descripción de las secuelas cognitivas crónicas. El objetivo del presente trabajo fue caracterizar la secuela cognitiva de diferentes tipos de encefalitis inmunomediadas en una cohorte de un centro único de Argentina. Métodos: Estudio prospectivo, observacional, trans versal, de pacientes en seguimiento en un hospital de la Ciudad de Buenos Aires, con diagnóstico de encefalitis inmunomediada probable y definitiva. Se evaluaron variables epidemiológicas, clínicas, paraclínicas y tra tamiento. Se determinó la secuela cognitiva a través de una evaluación neurocognitiva realizada a partir del año de la presentación clínica. Resultados: Fueron incluidos 15 pacientes, todos con resultado disminuido en al menos un test. La memoria fue el dominio más afectado. Aquellos que se encon traban bajo tratamiento inmunosupresor al momento de evaluarse presentaron menores resultados en el aprendizaje seriado (media -2.94; desvío estándar 1.54) versus los que se encontraban sin tratamiento (media -1.18; desvío estándar 1.40; p = 0.05) y en la prueba de reconocimiento (media -10.34; desvío estándar 8.02) ver sus sin tratamiento (media -1.39; desvío estándar 2.21; p = 0.003). Los pacientes con estatus epiléptico tuvieron resultados deficitarios en la prueba de reconocimiento (media -7.2; desvío estándar 7.91) en comparación a los que no lo tenían (media -1.47; desvío estándar 2.34; p = 0.05). Conclusión: Nuestros resultados demuestran que, a pesar del curso monofásico de la enfermedad, todos los pacientes presentan daño cognitivo persistente más allá del año del inicio del cuadro. Estudios prospectivos de mayor envergadura serían necesarios para confirmar nuestros hallazgos.

Abstract Introduction: Autoimmune encephalitis represents a group of immune-mediated neurological disorders. At present, the description of the chronic cognitive sequela is scarce. The objective of this study was to characterize the cognitive after effects of different types of autoimmune encephalitis in a cohort from a single center in Argentina. Methods: Prospective, observational, cross-sectional study of patients under follow-up at a hospital in Buenos Aires city, with a diagnosis of probable and definitive immune-mediated encephalitis. Epidemiological, clini cal, paraclinical and treatment related variables were evaluated. Cognitive sequela was determined through a neurocognitive evaluation performed at least a year after the clinical presentation. Results: Fifteen patients were included. All had di minished results in at least one test. Memory was the most affected domain. Patients who were under im munosuppressive treatment at the time of evaluation presented lower results in serial learning (mean -2.94; standard deviation 1.54) versus those who weren't under treatment (mean -1.18; standard deviation 1.40; p = 0.05). The same pattern was observed on the recognition test of treatment group (mean -10.34; standard deviation 8.02) versus treatment-free group (mean -1.39; standard deviation 2.21; p =0.003). Patients with status epilepticus had poorer results in the recognition test (mean -7.2; standard deviation 7.91) compared to those without it (mean -1.47; standard deviation 2.34; p = 0.05). Conclusion: Our results show that, despite the mo nophasic course of this disease, all patients had persis tent cognitive damage beyond the year of onset. Larger prospective studies are required to confirm our findings.

HDAC2 Inhibits Hippocampal Neurogenesis and Impairs the Cognitive Function in Prenatally Stressed Adult Offspring / HDAC2 Inhibe la Neurogénesis del Hipocampo y Afecta la Función Cognitiva en la Descendencia Adulta Estresada Prenatalmente

SUMMARY: The objective of this study was to investigate the mechanism of prenatal stress on the cognitive function of offspring, and clarify the change of histone deacetylase 2 (HDAC2) expression in hippocampal neurons of offspring. 16 pregnant SD rats were randomly divided into control group and stress group, with eight rats in each group. The stress group received restrained stress from 15 to 21 days of pregnancy, while the control group did not receive any treatment. Anxiety-like behavior and spatial memory, learning and memory ability were detected in open field, elevated plus maze, novel object recognition test, and Barnes maze. Nissl staining was used to detect the function of hippocampal neurons. Western blot was used to detect the expression of HDAC2 protein in hippocampal neurons of adult offspring. Immunofluorescence staining was used to detect the expression of HDAC2 protein and hippocampal neurogenesis. The learning and memory ability of adult offspring was decreased. The prenatal stress damaged the function of hippocampal neurons , the expression of HDAC2 was down-regulated, and the number of neurons was reduced. Maternal prenatal stress can down- regulate the expression of HDAC2 in the hippocampus of offspring, inhibits hippocampal neurogenesis and impairs the cognitive function.

El objetivo de este estudio fue investigar el mecanismo del estrés prenatal en la función cognitiva de la descendencia y aclarar el cambio de la expresión de la histona desacetilasa 2 (HDAC2) en las neuronas del hipocampo de la descendencia. 16 ratas SD preñadas se dividieron aleatoriamente en un grupo de control y un grupo de estrés, con ocho ratas en cada grupo. El grupo de estrés recibió estrés durante 15 a 21 días de pre, preñez, mientras que el grupo de control no recibió ningún tratamiento. El comportamiento similar a la ansiedad y la memoria espacial, el aprendizaje y la capacidad de memoria se detectaron en campo abierto, laberinto en cruz elevado, prueba de reconocimiento de objetos novedosos y laberinto de Barnes. La tinción de Nissl se utilizó para detectar la función de las neuronas del hipocampo. Se utilizó Western blot para detectar la expresión de la proteína HDAC2 en las neuronas del hipocampo de la descendencia adulta. La tinción de inmunofluorescencia se utilizó para detectar la expresión de la proteína HDAC2 y la neurogénesis del hipocampo. La capacidad de aprendizaje y memoria de la descendencia adulta se redujo. El estrés prenatal dañó la función de las neuronas del hipocampo, se reguló negativamente la expresión de HDAC2 y se redujo el número de neuronas. El estrés prenatal materno puede regular a la baja la expresión de HDAC2 en el hipocampo de la descendencia, inhibe la neurogénesis del hipocampo y deteriora la función cognitiva.

Actividad física y el deterioro cognitivo en adultos mayores

El objetivo del presente estudio fue determinar la relación entre la actividad física con el deterioro cognitivo en adultos mayores; esta investigación tiene un enfoque cuantitativo, de diseño no experimental, transversal, de tipo descriptivo y causal que llegó a evaluar a un total de 203 sujetos mediante el cuestionario de Pfeiffer (SPMSQ) y el cuestionario internacional de actividad física IPAQ. Con respecto a los resultados se encontró que, en la actividad física un 33.99% de los evaluados tienen actividad moderada, un 33% tiene actividad alta y un 21.67% tiene actividad baja; en el deterioro cognitivo un 71.43% no cuenta con deterioro, un 16.26% tiene un deterioro leve y un 12.32% tiene un deterioro moderado; en el análisis de regresión se determinó, a un nivel de confianza del 95%, que la actividad física se relaciona con el deterioro cognitivo (p=0.02, p<0.05). Finalmente, se llegó a la conclusión de que la actividad física si tiene relación con el deterioro cognitivo en los adultos mayores.

The aim of this study was to determine the relationship between physical activity and cognitive impairment in older adults. This research has a quantitative approach, non-experimental design, cross-sectional, descriptive and causal type that evaluated 203 subjects using the Pfeiffer Questionnaire (SPMSQ) and the International Physical Activity Questionnaire (IPAQ). Regarding physical activity, the results obtained show that 33.99% of those evaluated have moderate physical activity, 33% have high activity, and 21.67% have low activity levels. Besides, respecting cognitive impairment, 71.43% have no impairment, 16.26% have a mild impairment, and 12.32% have moderate impairment. In addition, in the regression analysis was determined, at a confidence level of 95%, that physical activity is related to cognitive impairment (p=0.02, p<0.05). Finally, it was concluded that physical activity is related to cognitive impairment in older adults.

O objectivo deste estudo foi determinar a relação entre a actividade física e a deficiência cognitiva em idosos, esta investigação tem uma abordagem quantitativa, desenho não experimental, transversal, descritiva de tipo causal que veio avaliar um total de 203 sujeitos utilizando o questionário Pfeiffer (SPMSQ) e o questionário internacional de actividade física IPAQ. Com respeito aos resultados, verificou-se que 33,99% dos avaliados tinham um Nível de atividade física moderada, 33% tem um nível de atividade física elevada e 21,67% tinham um Nivel de atividade fisica baixa, 71,43% não tinham nenhuma deficiência cognitiva, 16,26% tinham uma deficiência ligeira e 12,32% tinham uma deficiência moderada; na análise de regressão foi determinado, a um nível de confiança de 95%, evidencia que a atividade física esta relacionada com a deficiência cognitiva (p=0,02, p<0,05). Finalmente, concluiu-se que a actividade física está relacionada com uma deficiência cognitiva em idosos.

Social cognition across bipolar disorder and behavioral-variant frontotemporal dementia: an exploratory study

Objectives: Bipolar disorder type 1 (BD1) and behavioral-variant frontotemporal dementia (bvFTD) share similar behavioral and cognitive symptoms, rendering the differential diagnosis between them a clinical challenge. We investigated the accuracy of social cognition (SC) measures to differentiate bvFTD from BD. Methods: We included three groups of participants: early-onset BD1 (in remission, n=20), bvFTD (n=18), and cognitively healthy controls (HC) (n=40), matched for age, schooling, and sex. All participants underwent cognitive assessment, including the Facial Emotion Recognition (FER) and Modified Faux-Pas (mFP) tests, which assess mentalizing. Results: Compared to HC, BD1 and bvFTD patients underperformed on both SC measures. BD1 and bvFTD did not differ regarding FER or mFP total scores, although patients with bvFTD had significantly higher difficulties than those in the BD1 group to detect social faux-pas (p < 0.001, d = 1.35). Conclusion: BD1 and bvFTD share deficits in the core SC functions. These findings should be considered in the development of tasks aiming to improve clinical differentiation between the two disorders.

Asociación entre el bajo nivel de vitamina B12 y deterioro cognitivo en adultos mayores del centro médico naval del Perú

Introducción: Los adultos mayores son suscepctibles a la malnutrición y el déficit de vitaminas. Objetivo: Determinar la asociación entre el bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores del centro médico naval, ubicado en Lima-Perú, en el periodo 2010-2015. Métodos : Se realizó un estudio transversal analítico, a partir de un análisis secundario de la base de datos Texas-Cemena UTMB 2010-2015 del centro de investigación del envejecimiento (CIEN) de la Universidad De San Martín De Porres. Para la cuantificación de la variable de deterioro cognitivo se utilizó el MiniMental test. Para analizar la asociación, se realizó la prueba de chi cuadrado y la regresión de Poisson. Resultados : El 57,6% de los pacientes fueron de sexo masculino y la edad promedio fue de 78 ± 8,4. El 41,2% presentó deterioro cognitivo y el 9,5% de los pacientes presentó déficit de vitamina b12. Los factores independientemente asociados al deterioro cognitivo fueron el antecedente de enfermedad cerebro vascular (RP= 1,38 IC 95% [1,24-1,53]), depresión (RP = 1,88 IC 95% [1,80-1,97]),) y déficit de vitamina B12 (RP = 1,10 ic 95% [1,01-1,20]),). Conclusiones : En el presente estudio se encontró asociación entre un bajo nivel de vitamina B12 y el deterioro cognitivo en adultos mayores.

Introduction: Older adults are susceptible to malnutrition and vitamin deficiency. Objective: To determine the association between the low level of vitamin B12 and cognitive deterioration in older adults from the Naval Medical Center, located in Lima-Peru, in the period 2010-2015. Methods: An analytical cross-sectional study was carried out, based on a secondary analysis of the Texas-Cemena UTMB 2010-2015 database of the center for research on aging (cien) of The University Of San Martín De Porres. To quantify the cognitive impairment variable, the mini mental test was used. To analyze the association, the chi-square test and poisson regression were performed. Results: 57.6% of the patients were male and the mean age was 78 ± 8.4. 41.2% presented cognitive deterioration and 9.5% of the patients presented vitamin B12 deficiency. The factors independently associated with cognitive impairment were a history of cerebrovascular disease (pr= 1.38 95% ci [1.24-1.53]), depression (pr= 1.88 95% ci [1.80-1 .97]) and vitamin B12 deficiency (pr = 1.10 95% ci [1.01-1.20]). Conclusions: In the present study, an association was found between a low level of vitamin B12 and cognitive deterioration in older adults.

A cross-sectional study to determine the cognitive impairment and depression among elderly in a rural area of West Bengal

Background: The increase in worldwide life expectancy among the elderly is contributing to an increase in cognitive impairment (CI). A more complicated etiology makes CI an essential clinical concern for elderly patients with depression. Ageing populations as a result of demographic change have accelerated the development of certain geriatric conditions, including CI and depression. Aims and Objectives: The objective was to identify the prevalence and contributing factors of CI and depression in the elderly rural community. Materials and Methods: A descriptive, cross-sectional, and community-based study was conducted in rural field practice area of Medical College, Kolkata, among 133 geriatric people during time period of March–June, 2022. The prevalence of CI was measured using the Mini-Mental State Examination (MMSE) scale and depression was assessed using the geriatric depression scale. Data were analyzed in SPSS software version 16. Results: Mean age of the participants was 65.68 (±6.03) years. The prevalence of CI was 86.5%, with a mean MMSE score of 19.27 ± 4.34, and the depression was 77.5% and 7.07 ± 3.39. Conclusion: Almost two-third of the geriatric population is suffering from depression and CI. To handle the issue of CI, depression, and its resulting effects, new and modified geriatric health policies are very much needed.

La atrofia cerebral como hallazgo o factor predictor del deterioro cognitivo en el envejecimiento normal / Cerebral Atrophy as a Finding of Predictive Factor for Cognitive Impairment in Normal Aging

Introducción: En el curso del envejecimiento es conocida la existencia de un patrón complejo de cambios estructurales cerebrales, conductuales y cognitivos, en ocasiones relacionados con enfermedades neurológicas y psiquiátricas. Objetivo: Determinar la posible relación de causalidad de la atrofia cerebral en la aparición del deterioro cognitivo en el curso del envejecimiento normal. Métodos: Se desarrolló un estudio retrospectivo, transversal, descriptivo y observacional. El universo estuvo conformado por el total de los pacientes de ambos sexos con edades comprendidas entre 35-74 años de edad, con indicaciones previas de tomografía computarizada de cráneo y cuyos resultados fueron informados con signos de atrofia cerebral, cuya cifra ascendió a 733. Resultados: El grupo de edad que predomino fue el de 45-54 años (35,3 por ciento), así como las pacientes del sexo femenino (66,3 por ciento). El 27,7 por ciento tenía como nivel de escolaridad el técnico medio superior y 36,2 por ciento fueron pacientes amas de casa. El 99,7 por ciento fueron diestros. Un total de 368 voluntarios presentaron deterioro cognitivo y 365 sujetos no evidenciaron declive en las funciones exploradas. Las funciones de atención y cálculo y retención verbal a corto plazo fueron las que se vieron más afectadas, seguidas de orientación espacial y memoria verbal de fijación. Conclusiones: No se logró establecer una relación de causalidad significativa entre el diagnóstico radiológico de atrofia cerebral y la presencia de deterioro cognitivo(AU)

Introduction: In the course of aging, the existence of a complex pattern of behavioral, cognitive and cerebral structural changes is known, sometimes related to neurological and psychiatric diseases. Objective: To determine the possible causal relationship of cerebral atrophy with the onset of cognitive impairment in the course of normal aging. Methods: A retrospective, cross-sectional, descriptive and observational study was carried out. The study universe consisted of all patients of both sexes aged 35-74 years, with previous indications for cranial computed tomography and whose results were reported with signs of cerebral atrophy, which numbered 733. Results: The predominant age group was 45-54 years old (35.3percent), as well as female patients (66.3percent). The educational level of 27.7percent of the patients was technical high school and 36.2percent were housewife patients. A total of 99.7percent were right-handed. A total of 368 volunteers showed cognitive impairment and 365 subjects showed no decline in the tested functions. The functions of attention and calculation, as well as short-term verbal retention, were the most affected, followed by spatial orientation and speech retention memory. Conclusions: No significant causal relationship was established between the radiological diagnosis of cerebral atrophy and the presence of cognitive impairment(AU)

Impaired Cognition – A Menace to Aging

Cognition is defined as mental process of acquiring knowledge and understanding through thought, experi-ence and senses. It is an age-related degenerative condition, as the age advances, individuals experience dete-riorative changes in their cognitive abilities. It is estimated that nearly four fifth of the elderly above 60 years of age will be living in developing countries like Africa, Asia by 2050, thereby placing the developing countries to face threat of cognitive impairment among elderly when compared to developed countries. The result of striking increase in aging population of India, it is expected to have a substantial increase in elderly suffering from cognitive impairment. This review involves discussing the various causes, pathophysiology, modifiable and non-modifiable risk factors associated with this increasing cognitive deterioration in elderly people, di-agnostic criteria, and preventive methods. This review will help in better understanding of the cognitive im-pairment in elderly people. Better understanding of the disease helps in better treatment modalities.

Asociación entre los niveles de vitamina B12 y el deterioro cognitivo en personas mayores / Association between vitamin B12 levels and cognitive impairment in older adults

Resumen Introducción: Aún es controversial si la deficiencia de vitamina B12 se asocia a alteraciones cognitivas. Objetivo: Conocer la asociación entre los niveles séricos de vitamina B12 y el desempeño cognitivo. Métodos: Se incluyeron 241 personas ≥ 60 años con medición de niveles séricos de vitamina B12. Se realizó evaluación física y cognitiva y se formaron tres grupos: cognición normal (CN), deterioro cognitivo leve (DCL) y demencia. Los niveles de vitamina B12 se clasificaron en suficiencia (> 400 pg/mL), deficiencia subclínica (201-400 pg/mL) y deficiencia absoluta (≤ 200 pg/mL). Se realizó análisis de regresión lineal multivariado para evaluar la asociación entre función cognitiva y niveles de vitamina B12 después de controlar las variables confusoras. Resultados: La media de edad fue 81.4 ± 8.0 años; 68 % fue del sexo femenino; 17.8 y 39.8 % presentaron deficiencia absoluta y subclínica de vitamina B12; 80 individuos (33 %) cumplieron los criterios de DCL y 70 (29 %), de demencia. Después de ajustar por edad, sexo y escolaridad, los sujetos con DCL y demencia tuvieron niveles más bajos de vitamina B12 comparados con aquellos con CN (p = 0.019). Conclusiones: Se observó asociación estadísticamente significativa entre el desempeño cognitivo global y los niveles bajos de vitamina B12.

Abstract Introduction: Whether vitamin B12 deficiency is associated with cognitive impairment remains controversial. Objective: To determine the association between vitamin B12 serum levels and cognitive performance. Methods: Two-hundred and forty-one adults aged ≥ 60 years who had serum vitamin B12 serum levels measurement were included. Physical and cognitive evaluation was carried out, and three groups were formed: normal cognition (NC), mild cognitive impairment (MCI) and dementia. Vitamin B12 levels were classified as sufficiency (> 400 pg/mL), subclinical deficiency (201-400 pg/mL), and absolute deficiency (≤ 200 pg/mL). Multivariate linear regression analysis was used to evaluate the association between cognitive function and vitamin B12 levels after controlling for confounding variables. Results: Mean age was 81.4 ± 8.0 years; 68% were females; 17.8 % and 39.8% had absolute and subclinical vitamin B12 deficiency, respectively; 80 individuals (33%) met the criteria for MCI, and 70 (29%), for dementia. Those with MCI and dementia had lower vitamin B12 levels in comparison with those with NC after adjusting for age, gender and educational level (p = 0.019). Conclusions: A statistically significant association was observed between global cognitive performance and levels of vitamin B12.

Cognitive decline among older adults who developed acute coronary syndrome during hospitalization for non-cardiac illness

Background: Atypical presentations of acute coronary syndrome (ACS) delay its recognition and treatment in the elderly patients. Functional decline and delirium which are common to the elderly during hospitalization, leads to cognitive impairment and poor health outcomes. Steps taken for its prevention is usually not considered the top priority by the cardiologist. The present study was conducted to identify cognitive decline among elderly patients who developed ACS during hospitalization for noncardiac illness and their outcome. Materials and Methods: Three hundred and ten elderly patients above 60 years of age with ACS were included from June 26, 2020 to October 13, 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS following admission for noncardiac illness (Group II, n = 216). Co-morbidities, medications, investigations, management, clinical outcome, and Montreal Cognitive Assessment scale were compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of the subjects were admitted due to acute kidney injury (27.1%) in Group II and had a non-ST elevation ACS (90.2%). Optimum management was given to a lesser extent due to the clinical condition of these patients. Poor clinical outcome, cognitive impairment during hospitalization and cognitive decline during follow-up was more in Group II. Conclusion: Clinicians must be vigilant for the development of cognitive impairment and cognitive decline when an elderly patient is admitted to the hospital, as early detection and optimum management provides better clinical and cognitive outcome.

Revisiting global cognitive and functional state 13 years after a clinical trial of lithium for mild cognitive impairment

Objectives: To re-evaluate a sample of older adults enrolled in a randomized controlled trial of lithium for amnestic mild cognitive impairment (MCI) after 11 to 15 years, re-assessing their current (or last available) global cognitive and functional state. Methods: We recalled all former participants of the Lithium-MCI trial conducted by our group between 2009 and 2012 to perform a single-blinded, cross-sectional evaluation of their global clinical state to compare the long-term outcome of those who received lithium vs. those who received placebo. Results: Of the original sample (n=61), we were able to reach 36 participants (59% of retention), of whom 22 had previously received lithium (61% of the recall sample) and 14 (39%) had received placebo. Since 30.5% of the recalled sample was deceased, psychometric data were collected only for 69.5% of the participants. We found statistically significant differences in current mean Mini Mental State Examination score according to previous treatment group (25.5 [SD, 5.3] vs. 18.3 [SD, 10.9], p = 0.04). The lithium group also had better performance in the phonemic Verbal Fluency Test than the control group (34.4 [SD, 14.4] vs. 11.6 [SD, 10.10], p < 0.001). Differences in these measures also had large effect sizes, as shown by Cohen's d values of 0.92 and 1.78, respectively. Conclusion: This data set suggests that older adults with amnestic MCI who had been treated with lithium during a previous randomized controlled trial had a better long-term global cognitive outcome than those from a matched sample who did not receive the intervention.

Conceptual analysis of ICU cognitive impairment: a literature review / 中国实用护理杂志

Objective:To clarify the operational definition of ICU cognitive impairment, so as to provide a reference for accurate assessment of ICU cognitive impairment.Methods:ICU cognitive impairment was conceptually analyzed by the conceptual analysis framework in the Construction Strategy of Nursing Theory (Fifth Edition). The studies about cognitive function of critical illness patients in PubMed, Web of Science, Embase, China National Knowledge Internet, Wanfang, Chinese Biomedical Database, and VIP were searched. The search time limit was from the establishment of the database to August 2021. Literature screening and data extraction were performed independently by two researchers.Results:A total of 5 754 articles were obtained, and 48 articles were finally included. Obtained 20 concepts and 9 commonly used assessment tools related to ICU cognitive impairment. Identifying the defining attributes, conceptual causes, and outcomes of ICU cognitive impairment.Conclusions:The operational definition of ICU cognitive impairment is determined, which is conducive to a comprehensive and intuitive understanding of the concept of cognitive impairment in ICU and accurate evaluation of cognitive impairment in ICU.

A pilot study of gray matter volume and function changes in patients after cardiopulmonary resuscitation / 中华急诊医学杂志

Objective:To explore the structural and functional alterations of related brain regions in patients after cardiopulmonary resuscitation (CPR) by brain magnetic resonance imaging (MRI).Methods:A single-center, observational, cross-sectional study design was used. Patients who had brain MRI scans during hospitalization between July 2020 and July 2021 in Emergency Department of the First Affiliated Hospital of Nanjing Medical University and had good neurologic outcomes were consecutive enrolled in this study. The healthy control (HC) group consisted of age- and sex-matched volunteers. The demographic and clinical data were recorded. The modified Rankin Scale (mRS) was used to check the recovery and degree of continued disabilities when patients performed MRI. Montreal cognitive assessment (MoCA) was used to assess cognitive functions. The analyses of voxel-based morphometry (VBM) and fractional amplitude of low-frequency fluctuation (fALFF) were conducted. After data preprocessing, comparison of gray matter volume (GMV) and fALFF values between the case group and HC group were carried out, and the information of different brain regions was obtained. Partial correlation analyses were performed to evaluate the correlation between the image parameters of different clusters and clinical parameters.Results:Totally 13 patients were enrolled in this study and 13 were in the HC group. All patients achieved good neurologic outcome; mRS was 3 in 1 case, 2 in 3 cases, and 1 in 5 cases during MEI examination. The case group showed significantly lower MoCA score compared with the HC group ( P<0.001). There were significantly decreased GMVs in the right inferior frontal gyrus, superior temporal gyrus, left superior temporal gyrus, and transverse temporal gyrus in the case group. The patients showed significantly decreased fALFF values in the left postcentral gyrus and precentral gyrus, while increased fALFF values in the right putamen than the HC group (voxel-level P<0.001 and cluster-level P<0.05 with GRF correction). In addition, mean fALFF value in the right putamen was negatively correlated with MoCA score in the case group ( r=-0.710, P=0.021). Conclusions:Patients after CPR may have GMVs and neuronal spontaneous activity changes in some brain regions, and VBM and fALFF methods can be used to objectively evaluate the impaired brain functional activity in patients after successful CPR.

Progress of event-related potential P300 in children with neurological diseases and cognitive impairment / 国际儿科学杂志

Children′s neurological diseases can cause problems in structure and function of the brain, which is often accompanied by cognitive impairment.They have a great influence on children′s intellectual development and social life, so assessing cognitive function earlier is particularly significant.Event-related potential(ERP)P300 is an important electrophysiological technique in clinical practice.Compared with other evaluation methods, P300 has the advantages of objective, repeatable and non-invasive.P300 has a good effect in the assessment of children with neurological diseases and cognitive impairment, which provides a reference for clinical diagnosis, treatment and prognosis.This article reviews the research progress of P300 in children with common neurological diseases and cognitive impairment, in order to improve the understanding of clinical workers.