The application scenarios study on the intervention of cognitive decline in elderly population using metaverse technology / 生物医学工程学杂志

China is facing the peak of an ageing population, and there is an increase in demand for intelligent healthcare services for the elderly. The metaverse, as a new internet social communication space, has shown infinite potential for application. This paper focuses on the application of the metaverse in medicine in the intervention of cognitive decline in the elderly population. The problems in assessment and intervention of cognitive decline in the elderly group were analyzed. The basic data required to construct the metaverse in medicine was introduced. Moreover, it is demonstrated that the elderly users can conduct self-monitoring, experience immersive self-healing and health-care through the metaverse in medicine technology. Furthermore, we proposed that it is feasible that the metaverse in medicine has obvious advantages in prediction and diagnosis, prevention and rehabilitation, as well as assisting patients with cognitive decline. Risks for its application were pointed out as well. The metaverse in medicine technology solves the problem of non-face-to-face social communication for elderly users, which may help to reconstruct the social medical system and service mode for the elderly population.

Yigong Powder regulates CXCL12/CXCR4 signaling to reduce glutamate release and prevent cognitive decline in mouse model of aging / 中国中药杂志

This study aims to explore the effect of preventive administration of Yigong Powder on the learning and memory abilities of the mouse model of aging induced by D-galactose and decipher the underlying mechanism, so as to provide a basis for the application of Yigong Powder in the prevention and treatment of cognitive decline. Forty KM mice were randomized into control, model, donepezil(1.5 mg·kg~(-1)), and high-dose(7.5 g·kg~(-1)) and low-dose(3.75 g·kg~(-1)) Yigong Powder groups. The mice in other groups except the control group were injected with D-galactose(200 g·kg~(-1)) at the back of the neck for the modeling of aging. At the same time, the mice were administrated with corresponding drugs by gavage for one month. Morris water maze was used to examine the learning and memory abilities of the mice. Hematoxylin-eosin staining was employed to observe the pathological and morphological changes of the hippocampus. The immunofluorescence assay was employed to detect the expression of ionized calcium-binding adapter molecule 1(IBA1), glial fibrillary acidic protein(GFAP), chemokine C-X-C-motif ligand 12(CXCL12), chemokine C-X-C-motif receptor 4(CXCR4) in the hippocampus and observe the positional relationship between IBA1, GFAP, and CXCR4. Western blot was employed to determine the protein levels of extracellular regulated kinase(ERK), p-ERK, and tumor necrosis factor receptor 1(TNFR1). Enzyme-linked immunosorbent assay was employed to measure the levels of glutamate and tumor necrosis factor(TNF-α) in the brain tissue and the level of TNF-α in the serum and spleen. Yigong Powder significantly shortened the escape latency, increased the times crossing platforms, and prolonged the cumulative time in quadrants of the aging mice. It alleviated the nerve cell disarrangement, increased intercellular space, and cell degeneration or death in the hippocampus and reduced the pathology score of the damaged nerve. Moreover, Yigong Powder reduced the positive area of IBA1 and GFAP, reduced the levels of TNF-α in the brain tissue, serum, and spleen, and decreased spleen index. Furthermore, Yigong Powder decreased the average fluorescence intensity of CXCL12 and CXCR4, reduced CXCR4-positive astrocytes and microglia, down-regulated the protein levels of p-ERK/ERK and TNFR1, and lowered the level of glutamate in the brain tissue. This study showed that the preventive administration of Yigong Powder can ameliorate the learning and memory decline of the D-galactose-induced aging mice by regulating the immune function of the spleen and the CXCL12/CXCR4 signaling in the brain to reduce glutamate release. However, the mechanism of Yigong San in preventing and treating dementia via regulating spleen and stomach function remains to be studied.

Benefits of combined interventions for cognitive enhancement in older adults / Benefícios de intervenções combinadas para aprimoramento cognitivo em idosos

Objective: To investigate the effects of different combined interventions (Stimullus, MEMO, physical activity, and psychoeducation) on the cognitive performance of older adults. Methods: This is a quasi-experimental study with pre- and post-intervention. Thirty-four older adults underwent different combined interventions for a period of 48 weeks and were evaluated at three different points (pre-intervention; post-cognitive intervention; post-physical activity or psychoeducation intervention). Cognitive domains (verbal episodic memory, executive function, general cognitive performance) and depressive symptoms were evaluated. Results: Postintervention gains in global, attentional, and mnemonic cognition were observed, as well as a reduction in depressive symptoms. The MEMO intervention + physical activity or psychoeducation resulted in greater cognitive gains, while Stimullus + psychoeducation showed benefits only in evocation and the free learning index, while Stimullus + physical activity resulted in improvement in the investigated variables. Conclusion: The results of these combined interventions appear promising for healthy older adults and the impact of these interventions should be discussed with individual older patients and evaluated more broadly in the context of public health.

Objetivo: Investigar os efeitos de diferentes intervenções combinadas (Stimullus, MEMO, física e psicoeducacional) no desempenho cognitivo de idosos. Metodologia: Trata-se de um estudo quase experimental com pré e pós-intervenção. Trinta e quatro idosos foram submetidos a diferentes intervenções combinadas pelo período de 48 semanas e avaliados em três tempos diferentes (pré-intervenção; pós-intervenção cognitiva; pós-intervenção física ou psicoeducacional), nos quais foram analisados domínios cognitivos (memória episódica verbal, funções executivas, desempenho cognitivo geral) e sintomas depressivos. Resultados: Após as intervenções, observaram-se ganhos na cognição global, atencional e mnemônica, bem como redução dos sintomas depressivos. A intervenção MEMO (física ou psicoeducacional) resultou em maiores ganhos cognitivos, enquanto Stimullus + psicoeducacional demonstrou benefícios apenas no índice de evocação e aprendizagem livre, e Stimullus + atividades físicas não apresentou melhora em nenhuma das variáveis investigadas. Conclusão: Os achados positivos dessas intervenções combinadas parecem promissores no contexto de idosos saudáveis, e o impacto dessas intervenções deve ser discutido em relação às especificidades de cada indivíduo idoso e avaliado mais amplamente no contexto de saúde pública.

Prevention of dexmedetomidine on postoperative delirium and early postoperative cognitive dysfunction in elderly patients undergoing hepatic lobectomy / 中南大学学报(医学版)

OBJECTIVES@#Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common operative neurocognitive disorders, which places a heavy burden on patients, families and society. Therefore, it is very important to search for preventive drugs. Previous studies have demonstrated that perioperative use of dexmedetomidine resulted in a decrease the incidence of POD and POCD. But the specific effect of dexmedetomidine on elderly patients undergoing hepatic lobectomy and its potential mechanism are not clear. This study aims to evaluate the efficacy of intraoperative use of dexmedetomidine on preventing POD and POCD in elderly patients undergoing hepatic lobectomy and the influence on the balance between proinflammation and anti-inflammation.@*METHODS@#This trial was designed as a single-center, prospective, randomized, controlled study. One hundred and twenty hospitalized patients from January 2019 to December 2020, aged 60-80 years old with American Society of Anesthesiologists (ASA) II-III and scheduled for hepatic lobectomy, were randomly allocated into 3 groups (n=40) using a random number table: A C group, a Dex1 group, and a Dex2 group. After anesthesia induction, saline in the C group, dexmedetomidine [0.3 μg/(kg·h)] in the Dex1 group, and dexmedetomidine [0.6 μg/(kg·h)] in the Dex2 group were infused until the end of operation. The incidences of hypotension and bradycardia were compared among the 3 groups. Confusion Assessment Method (CAM) for assessing POD and Mini Mental State Examination (MMSE) for evaluating POCD were recorded and venous blood samples were obtained for the determination of neuron specific enolase (NSE), TNF-α, IL-1β, and IL-10 at the different time below: the time before anesthesia (T0), and the first day (T1), the third day (T2), the fifth day (T3), and the seventh day (T4) after operation.@*RESULTS@#Compared with the C group, the incidences of bradycardia in the Dex1 group or the Dex2 group increased (both P<0.05) and there was no difference in hypotension in the Dex1 group or the Dex2 group (both P>0.05). The incidences of POD in the C group, the Dex1 group, and the Dex2 group were 22.5%, 5.0%, and 7.5%, respectively. The incidences of POD in the Dex1 group or the Dex2 group declined significantly as compared to the C group (both P<0.05). However, there is no difference in the incidence of POD between the Dex1 group and the Dex2 group (P>0.05). The incidences of POCD in the C group, the Dex1 group, and the Dex2 group were 30.0%, 12.5%, and 10.0%, respectively. The incidences of POCD in the Dex1 group and the Dex2 group declined significantly as compared to the C group (both P<0.05). And no obvious difference was seen in the incidence of POCD in the Dex1 group and the Dex2 group (P>0.05). Compared with the C group, the level of TNF-α and IL-1β decreased and the level of IL-10 increased at each time points (from T1 to T4) in the Dex1 group and the Dex2 group (all P<0.05). Compared with the Dex1 group, the level of IL-1β at T2 and IL-10 from T1 to T3 elevated in the Dex2 group (all P<0.05). Compared with the T0, the concentrations of NSE in C group at each time points (from T1 to T4) and in the Dex1 group and the Dex2 group from T1 to T3 increased (all P<0.05). Compared with the C group, the level of NSE decreased from T1 to T4 in the Dex1 group and the Dex2 group (all P<0.05).@*CONCLUSIONS@#Intraoperative dexmedetomidine infusion can reduce the incidence of POCD and POD in elderly patients undergoing hepatic lobectomy, and the protective mechanism appears to involve the down-regulation of TNF-α and IL-1β and upregulation of IL-10 expression, which lead to rebalance between proinflammation and anti-inflammation.

Postoperative cognitive dysfunction after coronary artery bypass grafting

Abstract Postoperative cognitive dysfunction is a common complication following cardiac surgery. The incidence of cognitive dysfunction is more pronounced in patients receiving a cardiac operation than in those undergoing a non-cardiac operation. Clinical observations demonstrated that pulsatile flow was superior to nonpulsatile flow, and membrane oxygenator was superior to bubble oxygenator in terms of postoperative cognitive status. Nevertheless, cognitive assessments in patients receiving an on-pump and off-pump coronary artery bypass surgery have yielded inconsistent results. The exact mechanisms of postoperative cognitive dysfunction following coronary artery bypass grafting remain uncertain. The dual effects, neuroprotective and neurotoxic, of anesthetics should be thoroughly investigated. The diagnosis should be based on a comprehensive cognitive evaluation with neuropsychiatric tests, cerebral biomarker inspections, and electroencephalographic examination. The management strategies for cognitive dysfunction can be preventive or therapeutic. The preventive strategies of modifying surgical facilities and techniques can be effective for preventing the development of postoperative cognitive dysfunction. Investigational therapies may offer novel strategies of treatments. Anesthetic preconditioning might be helpful for the improvement of this dysfunction.

A newly designed intensive caregiver education program reduces cognitive impairment, anxiety, and depression in patients with acute ischemic stroke

This study aimed to evaluate the effect of a newly designed intensive caregiver education program (ICEP) on reducing cognitive impairment, anxiety, and depression in acute ischemic stroke (AIS) patients. One hundred and ninety-six AIS patients were divided into ICEP group and Control group in a 1:1 ratio using blocked randomization method. In the ICEP group, the caregivers received ICEP, while in the Control group caregivers received usual education and guidance. All patients received conventional rehabilitation treatment. Cognitive impairment (assessed by Mini Mental State Examination (MMSE) score and Montreal Cognitive Assessment (MoCA) score), anxiety (assessed by Hospital Anxiety and Depression Scale (HADS)-A score and Self-rating Anxiety Scale (SAS) score), and depression (assessed by HADS-D score and Self-rating Depression Scale (SDS) score) were assessed at baseline (M0), 3 months (M3), 6 months (M6), and 12 months (M12). Cognitive impairment score at M12 and cognitive impairment score change (M12-M0) were increased, while cognitive impairment rate at M12 was reduced in the ICEP group compared with the Control group. Anxiety score change (M12-M0), anxiety score at M12, and anxiety rate at M12 were decreased in the ICEP group compared with the Control group. Depression score change (M12-M0), depression score at M12, and depression rate at M12 were lower in the ICEP group compared with the Control group. Further subgroup analysis based on baseline features also provided similar results. In conclusion, ICEP effectively reduced cognitive impairment, anxiety, and depression in AIS patients.

Effects of early intervention training on cognitive impairment in critical patients / 中华危重病急救医学

OBJECTIVE@#To investigate the characteristics of cognitive impairment in critical patients, and to explore the role of early cognitive intervention training in improving cognitive impairment in critical patients.@*METHODS@#A prospective cohort study was conducted. 133 patients in conscious and normal intelligence admitted to intensive care unit (ICU) of Hefei Second People's Hospital from January 2015 to June 2018 were enrolled. The patients were divided into control group (n = 66) and cognitive intervention group (n = 67) according to random number table based on chronological number for entry into the study. Cognitive function was assessed by Montreal cognitive assessment scale (MoCA scale) within 24 hours after ICU admission. The patients in the cognitive intervention group received a series of scientifically designed cognitive training sessions (playing electronic musical keyboard, learning simple Spanish, clock-drawing, psychological intervention) for 2 months, and follow-up was completed if the patient was discharged from ICU. While the patients in the control group did not undertake any cognitive training. After 2 months, the cognitive function of patients in both groups were assessed with MoCA scale. Subgroup analysis was conducted according to different age groups (20-40 years old, 41-60 years old, 61-80 years old) to explore the effect of cognitive intervention training in different age groups. According to the subjective evaluation of the patient's ability to live 2 months after cognitive intervention by the patient or his relatives, receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of the total score of MoCA for patients' ability to live after cognitive intervention.@*RESULTS@#133 critical patients were enrolled in the final analysis. There was no significant difference in gender, age, education, complications, ICU hospitalization, sedative or analgesic drug usage between the two groups, indicating that the data of the two groups were balanced and comparable. No significant difference in MoCA scale total score or sub-item cognitive domain score within 24 hours of ICU admission was found between the two groups. After 2 months of intervention, the incidence of cognitive impairment in the cognitive intervention group was significantly lower than that in the control group [38.8% (26/67) vs. 60.6% (40/66), χ2 = 6.321, P = 0.015]. The total score of MoCA scale and four sub-item cognitive domain scores including visual space and execution power, protection of memory, attention execution, and orientation in the cognitive intervention group were significant higher than those in the control group (MoCA scale total score: 26.73±1.92 vs. 24.95±2.26, visual space and executive power score: 4.39±0.70 vs. 3.95±0.88, protection of memory score: 8.91±1.03 vs. 8.24±1.37, attention execution score: 5.21±0.77 vs. 4.79±1.00, orientation score: 5.67±0.53 vs. 5.44±0.68, all P < 0.05), but no significant difference was found in verbal skills score (2.55±0.56 vs. 2.53±0.56, P > 0.05). Subgroup analysis showed that the total MoCA scale score of the younger sample (20-40 years old, n = 20) was recovered by 2.10±1.55 in the cognitive intervention group after 2 months of cognitive intervention, which was significantly higher than that in the control group (n = 21; 0.24±2.76, P < 0.05). In the middle-aged and the older population [aged 41-60 years old (n = 20) and 61-80 years old (n = 27)], the total MoCA scale scores were recovered slightly after cognitive intervention as compared with those in the younger sample (0.43±1.47, -1.91±2.20 vs. 2.10±1.55, both P < 0.05), which were significantly lower than those in the control group [aged 41-60 years old (n = 21) and 61-80 years old (n = 24), -0.78±1.38, -4.41±2.17, both P < 0.01]. It was suggested that cognitive intervention training played an active role in the recovery of cognitive function in young critical patients. It was shown by ROC curve analysis that the area under ROC curve (AUC) of MoCA scale total score for predicting daily life ability after cognitive intervention was 0.732 with 95% confidence interval (95%CI) of 0.646-0.819. When the best cut-off value was 24.5, the sensitivity was 89.3%, the specificity was 60.2%, the positive predictive value was 85.7%, and the negative predictive value was 80.8%.@*CONCLUSIONS@#Early cognitive intervention could efficiently abate the deterioration of cognitive function in critical patients in ICU and had significant effects on the visual space and executive power, protection of memory, attention execution and orientation. Cognitive intervention exerted significantly positive effects on the recovery of cognitive function in the younger sample population (aged 20-40 years old).

Construcción de espacios grupales terapéuticos en el ámbito de la internación: relato de experiencia en una unidad de mediana estancia de la ciudad autónoma de Buenos Aires / Construction of therapeutic group spaces in the field of hospitalization: experience report in a medium-stay unit of the city autonomous of Buenos Aires

Este relato de experiencia describe el desarrollo de un dispositivo grupal de socialización en el abordaje de pacientes complejos en rehabilitación a partir del año 2016 en una Unidad de Mediana Estancia (UME) del Hospital Italiano de Buenos Aires. Se partió de reconocer la posibilidad de trabajar en el marco de la psicología social de Pichon-Rivière adaptando la técnica del grupo operativo para ámbitos hospitalarios que generan alto nivel de estrés, desfuncionalización y disrupción de la vida cotidiana. En este relato describimos la conformación, en esta UME, de grupos operativos terapéuticos de pacientes con deterioro físico, cognitivo o en cuidados paliativos. La metodología para el análisis de esta experiencia se basó en el registro prospectivo narrativo de cada encuentro grupal. Presentamos una reflexión teórica sobre las adaptaciones al encuadre y a la planificación de cada actividad grupal, para lograr continuidad y pertenencia grupal, en los grupos operativos desarrollados en este tipo de contexto hospitalario. (AU)

This experience report describes the development of a socialization group device in the approach of complex patients in rehabilitation from 2016 on a Medium-Stay Unit (MSU) of the Hospital Italiano de Buenos Aires. It started by recognizing the possibility of working within the social psychology framework of Pichon-Rivière by adapting the technique of the operative group for hospital environments with high level of stress, defunctionalization and disruption of daily life. In this report we describe the conformation in this MSU of therapeutic operative groups of patients with physical, cognitive or palliative care impairment. The methodology for the analysis was based on the prospective narrative record of each group meeting. We present a theoretical reflection on the adaptations to the framing and the planning of each group activity. This allowed us to achieve continuity and group belonging in the operative groups developed in this hospital context. (AU)

Efecto de la actividad física sobre el deterioro cognitivo y la demencia / Effects of physical activity on cognitive impairment and dementia

Introducción: La demencia y el deterioro cognitivo son problemas que afectan a la población, no solo al paciente, sino también al adulto mayor, su entorno familiar y social. Objetivo: Valorar la influencia de la actividad física sobre el deterioro cognitivo y la demencia. Fuente de datos: Se revisaron las bases de datos de la Biblioteca Virtual de Salud: Pubmed, Science Direct, Biomed, Ovid, por ecuación de búsqueda con claves de búsqueda según el Medical Subject Headings. Se revisaron 256 artículos y se evaluaron 19 clasificados con categoría 1, nivel de evidencia y recomendación. Síntesis de los datos: La actividad física puede ser un método preventivo para ralentizar el deterioro cognitivo a lo largo de la vida. La población que ha realizado actividad física moderada o vigorosa, son más propensos a mantener los conocimientos, que los inactivos físicamente. Un programa combinado de terapia ocupacional con ejercicio aeróbico, tuvo resultados positivos en personas con Alzheimer, demencia leve o moderada y deterioro cognitivo causados por la edad. La actividad física influyó también en la calidad de vida, proporcionó beneficios en el equilibrio de los sujetos y mejoras significativas en la disminución del riesgo de caídas del adulto mayor. Todos los resultados de funcionamiento físico, mostraron diferencias estadísticamente significativas entre grupos estudiados. Conclusiones: La actividad física contribuye a detener el deterioro cognitivo en adultos mayores y proporciona cambios corporales, emocionales, sociales y del comportamiento, que se relacionan con el mejoramiento del bienestar del paciente y con una mejor calidad de vida(AU)

Introduction: Cognitive impairment and dementia are important problems affecting mostly not only old patients but also their families and social environment. Data sources: To evaluate the influence of physical activity on cognitive impairment and dementia. Data synthesis: Systematic review in the databases Biblioteca Virtual de salud (BVS), Pubmed, Science Direct, Biomed, Ovid, by equation search with search keys (Medical Subject Headings -MESH-), where clinical trials, cohort studies, Case and control where taken into account. 265 articles were reviewed, and 19 articles were classified in category 1, according to the level of evidence and recommendation. Results: Physical activity can be a preventive method to slow down cognitive impairment during life. People who have practiced moderate to strenuous physical activity are very prone to present low levels of cognitive impairment in comparison with those who have been physically inactive. On the other hand, a combined program of occupational therapy with aerobic exercises had positive results in patients with Alzheimer, light to moderate dementia, and cognitive impairment cause by aging. Physical activity had also influence in life quality providing of benefits for patients balance and significant improvements in the decrease of the having a fall's risk in elderly. All the results on physical functioning showed statistically significant differences among the studied groups. Conclusions: Physical activity contributes to stop cognitive impairment in elderly. It provides of physical, emotional, social and behavioral changes which are related with the wellbeing of the patient and also with a better life quality(AU)

Width of sulcus and thickness of gyrus in patients with cerebral atherosclerosis: a new tool for the prevention of vascular cognitive impairment

SUMMARY BACKGROUND AND PURPOSE Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.

RESUMO INTRODUÇÃO E OBJETIVO A aterosclerose cerebral é a principal causa de lesões que contribuem para o comprometimento cognitivo vascular (CCV) e demência vascular, seguida da arteriosclerose de pequenos vasos e da angiopatia amiloide cerebral. Sendo assim, este estudo comparou as alterações radiológicas post mortem de adultos autopsiados com as alterações macroscópicas na região posterior desses encéfalos a fim de estabelecer uma relação entre as duas formas de análise e discutir sobre a relevância da prevenção do CCV em pacientes com aterosclerose encefálica. MATERIAL E MÉTODOS Treze encéfalos foram analisados macroscopicamente para avaliar o grau de aterosclerose das artérias basilar e cerebral posterior. Os pacientes foram autopsiados na disciplina de Patologia Geral no HC-UFTM em Uberaba, Minas Gerais, Brasil. A análise qualitativa da aterosclerose foi realizada com as classificações discreta, moderada ou acentuada. A espessura dos giros e a largura dos sulcos na região posterior dos encéfalos foram analisadas macroscopicamente e por tomografia computadorizada. RESULTADOS E CONCLUSÃO Houve diminuição na largura do sulco calcarino e aumento na espessura do giro occipital temporal medial de acordo com o aumento do grau de aterosclerose macroscopicamente e por tomografia, respectivamente. A baixa oxigenação causada pela aterosclerose provoca a inflamação do parênquima encefálico, provavelmente levando à hipertrofia das células da micróglia e ao consequente aumento dos giros e estreitamento dos sulcos, como observado no presente estudo.

Educación participativa comunitaria para prevenir el deterioro cognitivo en el adulto mayor / Participative community education to prevent cognitive impairment in older adults

Este artículo presenta una intervención educativa realizada por alumnas de enfermería de la Pontificia Universidad Católica de Chile, a un grupo de adultos mayores pertenecientes a la comuna de Puente Alto, Santiago de Chile. OBJETIVO: Prevenir el deterioro cognitivo enfocado en la memoria, empoderando a la comunidad en su autocuidado. METODOLOGÍA: La comunidad se conformó por personas de un rango etario entre 60 y 85 años. En la valoración y análisis se utilizó el modelo "Comunidad como Socio" de Anderson y McFarlane, junto a encuestas elaboradas para este trabajo. Se realizó un diagnóstico participativo con el objetivo de definir la necesidad educativa de la comunidad, donde se decidió trabajar el tema "La memoria y la prevención de su deterioro en adultos mayores" en seis sesiones de una duración de 60 minutos cada una. Las intervenciones y actividades realizadas tomaron como base el modelo Educación Participativa para Adultos de Jane Vella. RESULTADOS: Los participantes adquirieron conocimientos sobre la temática tratada en las sesiones y lograron incrementar su autoeficacia. El programa educativo los impulsó a un autocuidado consciente y la prevención del deterioro cognitivo. CONCLUSIÓN: Las metodologías participativas facilitaron a los integrantes a tomar un rol protagónico en la construcción de su propio conocimiento, posibilitando su integración en la vida diaria.

This article presents an educational intervention carried out by nursing students of Pontificia Universidad Católica de Chile, to a group of older adults belonging to Puente Alto, Santiago, Chile. OBJECTIVE: To prevent cognitive impairment focused on memory, empowering the community in its self-care. METHODOLOGY: The community was formed by people of an age range between 60 and 85 years. In the assessment and analysis the Community as Partner model by Anderson and McFarlane was used, along with surveys developed for this work. A participatory diagnosis was made in order to define the educational needs of the community, six sessions were held for 60 minutes each, where the theme was "Memory and prevention of its deterioration in older adults". The interventions and activities were based on Jane Vella's Participative Adult Education model. RESULTS: Participants acquired knowledge about the topics dealt within the sessions and were able to increase their self-effectiveness. The educational program promoted conscious self-care and prevention of cognitive impairment. CONCLUSION: Participatory methodologies facilitate members to take a leading role in building their own knowledge, enabling their integration into everyday life.

Características sociodemográficas e morbidades entre idosos institucionalizados sem declínio cognitivo / Características sociodemográficas y morbilidad entre los ancianos sindeterioro cognitivo / Sociodemographic characteristics and morbidities among institutionalized elderly without cognitive decline

Objetivo: descrever as características sociodemográficas e clínicas de idosos sem declínio cognitivo de instituições de longa permanência. Métodos: Foi aplicado o Mini-Exame do Estado Mental (MEEM) e um formulário para investigar aspectos sociodemográficos e clínicos nos idosos sem declínio cognitivo. Os dados foram analisados por meio do SPSS 18.0 e do teste qui-quadrado. Resultados: Houve predomínio de idosos sem declínio cognitivo do sexo masculino (55,7%), solteiros (63,29%), com faixa etária ≥ 75 anos (54,43%), com hipertensão arterial sistêmica (64,56%) e com uso de medicamentos que atuam no sistema cardiovascular (64,56%). Conclusão: É necessário que os idosos institucionalizados sem déficit cognitivo sejam avaliados continuamente para diagnóstico precoce do envelhecimento cognitivo patológico para prevenção de estados demenciais.

Objective: to describe the sociodemographic and clinical characteristics of elderly people without cognitive decline in long-stay institutions. Methods: Mini-examination was applied Mental State and a form to investigate sociodemographic and clinical aspects in elderly people without cognitive decline. Data were analyzed using SPSS 18.0 and Chi-square test. Results: There was a predominance of elderly people without cognitive decline in men (55.7%), single (63.29%), aged ≥ 75 years (54.43%) with systemic hypertension (64.56%) and use of drugs that act on the cardiovascular system (64.56%). Conclusion: It is necessary that the institutionalized elderly without cognitive impairment are continuously evaluated for early diagnosis of pathological cognitive aging to prevent dementia states.

Objetivo: describir las características sociodemográficas y clínicas de las personas mayores sin deterioro cognitivo en instituciones de larga estadía. Métodos: Mini-examen se aplicó Estado Mental y una forma de investigar aspectos sociodemográficos y clínicos en personas mayores sin deterioro cognitivo. Los datos fueron analizados con el programa SPSS 18.0 y la prueba de Chi-cuadrado. Resultados: Hubo un predominio de personas mayores sin deterioro cognitivo en los hombres (55,7%), solo (63,29%), con edades ≥ 75 años (54,43%) con hipertensión sistémica (64,56%) y el uso de fármacos que actúan sobre el sistema cardiovascular (64,56%). Conclusión: Es necesario que el anciano institucionalizado y sin deterioro cognitivo son evaluados de forma continua para el diagnóstico precoz de envejecimiento cognitivo patológico para evitar estados de demencia.

The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery / Efeito de dois protocolos de controle glicêmico diferentes sobre a disfunção cognitiva após cirurgia de revascularização do miocárdio

Abstract Introduction: Postoperative cognitive dysfunction (POCD) is an adverse outcome of surgery that is more common after open heart procedures. The aim of this study is to investigate the role of tightly controlled blood glucose levels during coronary artery surgery on early and late cognitive decline. Methods: 40 patients older than 50 years undergoing elective coronary surgery were randomized into two groups. In the "Tight Control" group (GI), the glycemia was maintained between 80 and 120 mg dL-1 while in the "Liberal" group (GII), it ranged between 80-180 mg dL-1. A neuropsychological test battery was performed three times: baseline before surgery and follow-up first and 12th weeks, postoperatively. POCD was defined as a drop of one standard deviation from baseline on two or more tests. Results: At the postoperative first week, neurocognitive tests showed that 10 patients in the GI and 11 patients in GII had POCD. The incidence of early POCD was similar between groups. However the late assessment revealed that cognitive dysfunction persisted in five patients in the GII whereas none was rated as cognitively impaired in GI (p = 0.047). Conclusion: We suggest that tight perioperative glycemic control in coronary surgery may play a role in preventing persistent cognitive impairment.

Resumo Introdução: A disfunção cognitiva pós-operatória (DCPO) é um resultado adverso cirúrgico que é mais comum após cirurgias cardíacas abertas. O objetivo deste estudo foi investigar o papel dos níveis de glicose no sangue rigorosamente controlados durante a cirurgia coronariana no declínio cognitivo precoce e tardio. Métodos: Foram randomizados em dois grupos 40 pacientes acima de 50 anos e submetidos à cirurgia coronariana eletiva. No grupo "controle rigoroso" (GI), a glicemia foi mantida entre 80-120 mg.dL-1; enquanto no grupo "liberal" (GII), variou entre 80-180 mg.dL-1. A bateria de testes neuropsicológicos foi feita três vezes: fase basal, antes da cirurgia e na primeira e 12ª semana de acompanhamento no pós-operatório. DCPO foi definida como uma queda de um desvio padrão da fase basal em dois ou mais testes. Resultados: Na primeira semana de pós-operatório, os testes neurocognitivos mostraram que 10 pacientes no GI e 11 pacientes no GII apresentaram DCPO. A incidência de DCPO precoce foi semelhante entre os grupos. No entanto, a avaliação tardia revelou que a disfunção cognitiva persistiu em cinco pacientes no GII, enquanto nenhum paciente foi classificado como cognitivamente prejudicado no GI (p = 0,047). Conclusão: Sugerimos que o controle glicêmico rigoroso no perioperatório de cirurgia coronariana pode desempenhar um papel na prevenção da deterioração cognitiva persistente.

Análisis descriptivo de la demanda asistencial neurológica ambulatoria en el Hospital Nacional de Clínicas / Análise descritiva da demanda assistencialneurológica ambulatorial no Hospital Nacional deClínicas / Descriptive analysis of demand of outpatient neurological assistance at Hospital Nacional de Clínicas

INTRODUCCIÓN Y OBJETIVOS: En los últimos años haaumentado la demanda de atención neurológica, en relacióna mayor educación, avances en el campo diagnóstico yterapéutico. Según la OMS, el 90 % de las patologíasneurológicas tienen manejo ambulatorio, y representanun problema sanitario importante, el cual promueve laelaboración y actualización de análisis epidemiológicos.Objetivo: Analizar variables demográficas, asistenciales ydiagnósticas de la demanda neurológica ambulatoria deprimera vez en el HNC. MATERIALES Y MÉTODOS: Estudioobservacional prospectivo-descriptivo de 761 pacientes queconcurrieron consecutivamente a consulta ambulatoria deNeurología en el HNC por primera vez, en el período abrilde 2012 - octubre de 2012. RESULTADOS: De los pacientesincluidos 455 fueron mujeres (59,79 %) y 306 hombres(40,21%). La edad media fue de 60,45 años, ligeramentesuperior en hombres (60,90) con respecto a mujeres (60,14).Los mayores de 65 años corresponden al 54,66%. Losdiagnósticos más frecuentes de la consulta neurológica seagruparon en categorías diagnósticas: cefalea y algias faciales20,24%, deterioro cognitivo 18,27%, movimientos anormales 11,56%, neuropatía periférica 10,25%, patología vascular 9,86%. Un 3,94% consultó porpatología no neurológica. CONCLUSIONES: Se observó predominio del sexo femenino ymayor frecuencia de consultas en mayores de 65 años. La cefalea fue el principal diagnóstico.El deterioro cognitivo, condicionado por la edad avanzada de los pacientes, representó elsegundo diagnóstico en frecuencia.

INTRODUCTION AND OBJECTIVES: In the last years, demand for neurological assistancehas increased in connection with more education and progress in the diagnostic andtherapeutic fields. According to WHO, 90% of neurological pathologies are treatedin outpatient basis and represent an important health problem which encourages thedevelopment and updating of epidemiological analysis. Objective: To analyze demographic,care and diagnostic variables in first time outpatient neurological demand at HospitalNacional de Clínicas (HNC). MATERIAL AND METHODS: Prospective-descriptiveobservational study of 761 patients who consecutively attended a first outpatientconsultation in Neurology at HNC, in the period April 2012- October 2012. RESULTS:Within the patients included, 455 were women (59.79%) and 306 were men (40.21%).The mean in age was 60.45 years, slightly higher in men (60.90) in relation to women(60.14) Patients aged over 65 represent 54.66%. The most frequent diagnoses arising fromthe neurological consultations were grouped in diagnostic categories: severe headache andfacial pain 20.24%, cognitive decline 18.27%, abnormal movement 11.56%, peripheralneuropathy 10.25%, vascular pathology 9.86%. Some patients presented non-neurologicpathologies (3.94%). CONCLUSIONS: Female predominance and higher frequency ofconsultation after age 65 were observed. Severe headache was the main diagnosis. Cognitivedecline, related to patients’ old age, represented the second diagnosis as regards frequency.

Caracterización de la familia del anciano con deterioro cognitivo / Characterization of the family of old people with cognitive impairment

Introducción: con la prolongación de la esperanza de vida ha aumentado la incidencia y prevalencia de enfermedades que aparecen en edades avanzadas, entre ellas las demencias. Objetivo: caracterizar a las familias de adultos mayores con deterioro cognitivo según variables de interés. Métodos: estudio descriptivo de corte transversal en familias de adultos mayores con deterioro cognitivo pertenecientes al Consejo Popular Alcides Pino del municipio Holguín en el año 2010. Se trabajó con 139 familias identificadas por el geriatra o por los médicos de consultorios. Para la recogida de la información, se utilizaron la entrevista y el análisis documental y se aplicó un instrumento específico para clasificar a las familias según su funcionamiento. Resultados: se encontró que el 41,6 por ciento eran familias ampliadas y el 38,8 por ciento extensa, el 36,1 por ciento y el 30,6 por ciento estaban en etapa de contracción y disolución, respectivamente. Todas las familias tenían crisis familiares con predominio de las paranormativas en el 86,1 por ciento. El afrontamiento a la enfermedad del anciano fue inadecuado en el 88,9 por ciento de las familias y el 38,9 por ciento eran disfuncionales. Conclusiones: las familias del Consejo Popular Alcides Pino, que conviven con adultos mayores con deterioro cognitivo están muy lejos de ser la red de apoyo que necesitan estas personas en el proceso de su enfermedad

Introduction: the extension of life expectancy has increased the incidence and prevalence of diseases that occur at older ages such as dementias. Objective: to characterize the families of the older adults with cognitive impairment, according to variables of interest. Methods: cross-sectional descriptive study conducted on families of older adults with cognitive impairment in Alcides Ríos people´s council located in Holguín municipality during 2010. The sample was made up of 139 families identified by the geriatricians or by the family physicians. For data collection, the interviews and the documentary review were used together with a customized instrument to classify families on the basis of their functioning. Results: it was found that 41.6 percent of the sample was extended families and 38.8 percent corresponded to big families; 36.1 percent and 30.6 percent of them were getting smaller or were vanishing respectively. All these families faced some family crisis with para-normative crises in 86.1 percent of cases. Inadequate management of the old person´s disease was seen in 88.9 percent of families whereas 38.9 percent of them were dysfunctional. Conclusions: the families of older people with cognitive impairment in Alcides Pino people´s council were far from being the adequate supporting network required by these elders