ABSTRACT
An aging population and a digital society are realities. There is a need to equip older people with knowledge and computer skills so that they can participate in society, without feeling excluded or being marginalized. Third age universities are organizations around the world that specialize in teaching and learning for senior students in a more informal and more integrated way than other educational institutions. The objective of this study was to identify the existing quality publications that deal with the subject of computer education at senior universities. The SCOPUS and Web of Science databases were used, and 18 records were found according to the adopted criteria. It was found that these articles, depending on their focus, can be divided into four groups: educators, organizations/directors, students, and conceptual/review papers. Through these articles, it was possible to draw a picture of what older people's computer learning is like, what barriers exist for students to not be able to attend these classes, as well as tips on how courses should be organized and the pedagogical methodologies that must be adopted. It is intended that this article is used as a good tool for people who work in teaching information technology to the elderly, and especially for course directors who intend to create or reformulate courses of this type for this specific age group.
Subject(s)
Learning , Universities , Aged , Computers , Educational Status , Humans , StudentsABSTRACT
The COVID-19 pandemic has brought dramatic worldwide consequences affecting social, economic and healthcare systems. Considering that the number of infected patients requiring admission to intensive care units far exceeded the available resources, healthcare professionals have had to face challenging decisions concerning who should benefit from the limited resources and who should not. In this context, after a careful ethical reflection, we propose some principles to be adopted when dealing with allocation resource decisions, based on core ethical values. Ideally, these strategies should be established and integrated into institutional policies before a crisis scenario, in order to anticipate a potential new public health emergency and prevent possible tragic consequences.
A pandemia por COVID-19 associa-se a consequências dramáticas a nível social, económico e dos sistemas de saúde. Tendo em conta que o número de pacientes críticos ultrapassa consideravelmente o número de recursos hospitalares disponíveis, os profissionais de saúde depararam-se com decisões difíceis, nomeadamente determinar quais os pacientes que deveriam beneficiar destes recursos escassos. Neste contexto, após uma cuidadosa reflexão ética, propomos alguns princípios a considerar aquando das decisões de alocação de recursos em saúde, baseados em valores éticos fundamentais. Idealmente, estas decisões devem ser estabelecidas e integradas nas políticas institucionais antes de um cenário de crise, de forma a antecipar uma potencial nova emergência de saúde pública e mitigar possíveis consequências trágicas com ela relacionadas.
Subject(s)
COVID-19 , Pandemics , Humans , Intensive Care Units , Resource Allocation , SARS-CoV-2ABSTRACT
Many studies have found that non-pharmacological interventions, such as cognitive stimulation (CS), can benefit people with dementia (PWD) or with mild cognitive impairment (MCI). The use of the computerized cognitive stimulation (CCS) had proven to be an ally to those who want to detect and mitigate this disease. OBJECTIVE: The purpose of this paper was to analyze the scientific production in CCS in PWD or with MCI in journals indexed in Clarivate Analytics' Web of Science and Elsevier's Scopus since 2000. METHODS: Data collected from Web of Science and Scopus during 2000-2019. RESULTS: The data show that dementia research is exponentially developing following the evolution of widespread use of computer science. As such, this article was of enormous importance doing a bibliometric analysis of what has been done in the area since the beginning of this century. The search terms identified 61 papers related to the use of computers applied to CS in PWD or MCI, and the International Journal of Geriatric Psychiatry and Journal of Alzheimer's Disease had the largest number of publications. The most cited article was the Faucounau et colleagues. Major research' countries are United Kingdom, Spain and United States. CONCLUSIONS: The findings in these papers were analysed to find recommendations for future work in this area. The CCS has been increasingly used as an intervention tool for PWD or MCI, and there still seems to be a possibility for evolution in good quality publications.
Muitos estudos têm demonstrado que as intervenções não farmacológicas, como a estimulação cognitiva (EC), podem beneficiar pessoas com demência (PCD) ou com declínio cognitivo ligeiro (DCL). O uso da estimulação cognitiva computadorizada (ECC) tem mostrado ser um meio para detetar e mitigar essa doença. OBJETIVO: O objetivo do presente artigo foi analisar a produção científica em ECC em PCD ou com DCL publicada em revistas indexadas na Web of Science da Clarivate Analytics e na Scopus da Elsevier desde 2000. MÉTODOS: Os dados foram coletados na Web of Science e Scopus relativamente aos anos 20002019. RESULTADOS: Os dados mostram que a pesquisa em demência está se desenvolvendo exponencialmente, acompanhando a evolução do uso generalizado da ciência da computação. Dessa forma, o estudo foi de enorme importância para uma análise bibliométrica do que tem sido feito na área desde o início deste século. Os termos de pesquisa identificaram 61 artigos relacionados ao uso de computadores aplicados à EC em PCD ou DCL, e ambos os periódicos International Journal of Geriatric Psychiatry e Journal of Alzheimer's Disease tiveram o maior número de publicações. O artigo mais citado foi o de Faucounau et al. Os principais países de pesquisa foram Reino Unido, Espanha e Estados Unidos. CONCLUSÕES: Os resultados desses artigos foram analisados de forma a possibilitar encontrar recomendações para trabalhos futuros nessa área. A ECC tem sido cada vez mais utilizada como ferramenta nas intervenções para PCD e DCL, e ainda parece haver possibilidade de evolução em publicações de boa qualidade.
ABSTRACT
ABSTRACT. Many studies have found that non-pharmacological interventions, such as cognitive stimulation (CS), can benefit people with dementia (PWD) or with mild cognitive impairment (MCI). The use of the computerized cognitive stimulation (CCS) had proven to be an ally to those who want to detect and mitigate this disease. Objective: The purpose of this paper was to analyze the scientific production in CCS in PWD or with MCI in journals indexed in Clarivate Analytics' Web of Science and Elsevier's Scopus since 2000. Methods: Data collected from Web of Science and Scopus during 2000-2019. Results: The data show that dementia research is exponentially developing following the evolution of widespread use of computer science. As such, this article was of enormous importance doing a bibliometric analysis of what has been done in the area since the beginning of this century. The search terms identified 61 papers related to the use of computers applied to CS in PWD or MCI, and the International Journal of Geriatric Psychiatry and Journal of Alzheimer's Disease had the largest number of publications. The most cited article was the Faucounau et colleagues. Major research' countries are United Kingdom, Spain and United States. Conclusions: The findings in these papers were analysed to find recommendations for future work in this area. The CCS has been increasingly used as an intervention tool for PWD or MCI, and there still seems to be a possibility for evolution in good quality publications.
RESUMO. Muitos estudos têm demonstrado que as intervenções não farmacológicas, como a estimulação cognitiva (EC), podem beneficiar pessoas com demência (PCD) ou com declínio cognitivo ligeiro (DCL). O uso da estimulação cognitiva computadorizada (ECC) tem mostrado ser um meio para detetar e mitigar essa doença. Objetivo: O objetivo do presente artigo foi analisar a produção científica em ECC em PCD ou com DCL publicada em revistas indexadas na Web of Science da Clarivate Analytics e na Scopus da Elsevier desde 2000. Métodos: Os dados foram coletados na Web of Science e Scopus relativamente aos anos 2000-2019. Resultados: Os dados mostram que a pesquisa em demência está se desenvolvendo exponencialmente, acompanhando a evolução do uso generalizado da ciência da computação. Dessa forma, o estudo foi de enorme importância para uma análise bibliométrica do que tem sido feito na área desde o início deste século. Os termos de pesquisa identificaram 61 artigos relacionados ao uso de computadores aplicados à EC em PCD ou DCL, e ambos os periódicos International Journal of Geriatric Psychiatry e Journal of Alzheimer's Disease tiveram o maior número de publicações. O artigo mais citado foi o de Faucounau et al. Os principais países de pesquisa foram Reino Unido, Espanha e Estados Unidos. Conclusões: Os resultados desses artigos foram analisados de forma a possibilitar encontrar recomendações para trabalhos futuros nessa área. A ECC tem sido cada vez mais utilizada como ferramenta nas intervenções para PCD e DCL, e ainda parece haver possibilidade de evolução em publicações de boa qualidade.
Subject(s)
Humans , Dementia , Computers , Bibliometrics , Deep Brain Stimulation , Data AnalysisABSTRACT
Intermediary metabolism is traditionally viewed as the large, highly integrated network of reactions that provides cells with metabolic energy, reducing power and biosynthetic intermediates. The elucidation of its major pathways and molecular mechanisms of energy transduction occupied some of the brightest scientific minds for almost two centuries. When these goals were achieved, a sense that intermediary metabolism was mostly a solved problem pervaded the broader biochemical community, and the field lost its vitality. However, intermediary metabolism has recently been re-energized by several paradigm-shifting discoveries that challenged its perception as a self-contained system and re-positioned it at the crossroads of all aspects of cell function, from cell growth, proliferation and death to epigenetics and immunity. Emphasis is now increasingly placed on the involvement of metabolic dysfunction in human disease. In this review, we will navigate from the dawn of intermediary metabolism research to present day work on this ever-expanding field.
Subject(s)
Energy Metabolism/physiology , Animals , Apoptosis/physiology , Cell Proliferation , Epigenesis, Genetic , Humans , Immunity/physiology , Models, Animal , Signal TransductionABSTRACT
Worldwide, several million workers are employed in the various chromium (Cr) industries. These workers may suffer from a variety of adverse health effects produced by dusts, mists and fumes containing Cr in the hexavalent oxidation state, Cr(VI). Of major importance, occupational exposure to Cr(VI) compounds has been firmly associated with the development of lung cancer. Counterintuitively, Cr(VI) is mostly unreactive towards most biomolecules, including nucleic acids. However, its intracellular reduction produces several species that react extensively with biomolecules. The diversity and chemical versatility of these species add great complexity to the study of the molecular mechanisms underlying Cr(VI) toxicity and carcinogenicity. As a consequence, these mechanisms are still poorly understood, in spite of intensive research efforts. Here, we discuss the impact of Cr(VI) on the stress response-an intricate cellular system against proteotoxic stress which is increasingly viewed as playing a critical role in carcinogenesis. This discussion is preceded by information regarding applications, chemical properties and adverse health effects of Cr(VI). A summary of our current understanding of cancer initiation, promotion and progression is also provided, followed by a brief description of the stress response and its links to cancer and by an overview of potential molecular mechanisms of Cr(VI) carcinogenicity.
Subject(s)
Carcinogens, Environmental/pharmacology , Chromium/pharmacology , Stress, Physiological/drug effects , Carcinogens, Environmental/toxicity , Cell Transformation, Neoplastic/chemically induced , Cell Transformation, Neoplastic/genetics , Cell Transformation, Neoplastic/metabolism , Chromium/toxicity , DNA Damage , Humans , Neoplasms/etiology , Neoplasms/metabolism , Neoplasms/pathology , Oxidative Stress/drug effects , Oxidative Stress/geneticsABSTRACT
Research into cognitive reserve (CR) and dementia is advancing rapidly. This paper analyses the intellectual structure, emerging trends and relevant shifts in the development of available knowledge. Data collected from the Web-of-Science produced an expanded network of 564 articles and 12,504 citations in the 1998-2017 period. The co-citation network visualized was characterized by a scientometric review using CiteSpace. The results revealed that author Stern Y had the highest number of publications and citations. The network of journals, institutions and countries showed a central-peripheral structure with Neurology, Harvard University and the USA ranked first, respectively. While cognitive reserve remains the most prominent area of research in this field, studies related to functional ability, executive control, mortality data and reserve mechanisms have grown considerably. The identification of critical articles and the development of emerging trends highlights new insights in the area of research, better communicating key findings and facilitating the exploration of data.
A pesquisa em reserva cognitiva e demência avança rapidamente. Este artigo analisa a estrutura intelectual, tendências emergentes e mudanças relevantes no desenvolvimento do conhecimento coletivo. Dados coletados do Web-of-Science, construíram uma rede expandida de 564 artigos e 12.504 citações, entre 1998-2017. A rede de cocitação visualizada foi caracterizada através de uma revisão cientométrica utilizando o CiteSpace. Os resultados revelam Stern Y com o maior número de publicações e citações. A rede de revistas científicas, instituições e países apresenta uma estrutura central-periférica, respetivamente com Neurologia, Universidade de Harvard e EUA em primeiro lugar. Enquanto a reserva cognitiva continua a ser a área de pesquisa mais proeminente neste campo, estudos relacionados à capacidade funcional, controle executivo, dados de mortalidade e mecanismos de reserva têm experimentado um crescimento considerável. A identificação de artigos críticos e o desenvolvimento de novas tendências emergentes destacam novos insights sobre a área de pesquisa, comunicando melhor as principais descobertas e facilitando a exploração de dados.
ABSTRACT
ABSTRACT. Research into cognitive reserve (CR) and dementia is advancing rapidly. This paper analyses the intellectual structure, emerging trends and relevant shifts in the development of available knowledge. Data collected from the Web-of-Science produced an expanded network of 564 articles and 12,504 citations in the 1998-2017 period. The co-citation network visualized was characterized by a scientometric review using CiteSpace. The results revealed that author Stern Y had the highest number of publications and citations. The network of journals, institutions and countries showed a central-peripheral structure with Neurology, Harvard University and the USA ranked first, respectively. While cognitive reserve remains the most prominent area of research in this field, studies related to functional ability, executive control, mortality data and reserve mechanisms have grown considerably. The identification of critical articles and the development of emerging trends highlights new insights in the area of research, better communicating key findings and facilitating the exploration of data.
RESUMO. A pesquisa em reserva cognitiva e demência avança rapidamente. Este artigo analisa a estrutura intelectual, tendências emergentes e mudanças relevantes no desenvolvimento do conhecimento coletivo. Dados coletados do Web-of-Science, construíram uma rede expandida de 564 artigos e 12.504 citações, entre 1998-2017. A rede de cocitação visualizada foi caracterizada através de uma revisão cientométrica utilizando o CiteSpace. Os resultados revelam Stern Y com o maior número de publicações e citações. A rede de revistas científicas, instituições e países apresenta uma estrutura central-periférica, respetivamente com Neurologia, Universidade de Harvard e EUA em primeiro lugar. Enquanto a reserva cognitiva continua a ser a área de pesquisa mais proeminente neste campo, estudos relacionados à capacidade funcional, controle executivo, dados de mortalidade e mecanismos de reserva têm experimentado um crescimento considerável. A identificação de artigos críticos e o desenvolvimento de novas tendências emergentes destacam novos insights sobre a área de pesquisa, comunicando melhor as principais descobertas e facilitando a exploração de dados.
Subject(s)
Scientific Communication and Diffusion , Dementia , Scientific and Technical Publications , Cognitive ReserveABSTRACT
Alzheimer's disease (AD) is a clinical syndrome caused by neurodegeneration and characterized by a progressive deterioration in cognitive ability and capacity for independent living. Cognitive reserve (CR) describes the capacity of the adult brain to cope with the effects of the neurodegenerative process and to minimize the clinical manifestation of pathology of dementia. The aim of this study was to evaluate the association of CR and the severity of AD. Method This study was cross-sectional. Functional and neuropsychological abilities of 75 outpatients with probable AD diagnosis were evaluated. Patients completed two questionnaires, "Participation in leisure activities throughout life" and CR Questionnaire.Result The relationship between Clinical Dementia Rating (CDR) and the level of CR was statistically significant (likelihood ratio (LR), p = 0.015).Conclusion The level of CR influenced the severity of dementia. This study suggests that AD patients with higher CR may benefit against cognitive decline after diagnosis of AD.
Subject(s)
Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Cognitive Reserve/physiology , Severity of Illness Index , Age Factors , Aged , Aged, 80 and over , Disease Progression , Educational Status , Epidemiologic Methods , Female , Humans , Leisure Activities/psychology , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Reference Values , Sex Factors , Time FactorsABSTRACT
Alzheimer´s disease (AD) is a clinical syndrome caused by neurodegeneration and characterized by a progressive deterioration in cognitive ability and capacity for independent living. Cognitive reserve (CR) describes the capacity of the adult brain to cope with the effects of the neurodegenerative process and to minimize the clinical manifestation of pathology of dementia. The aim of this study was to evaluate the association of CR and the severity of AD. Method This study was cross-sectional. Functional and neuropsychological abilities of 75 outpatients with probable AD diagnosis were evaluated. Patients completed two questionnaires, “Participation in leisure activities throughout life” and CR Questionnaire.Result The relationship between Clinical Dementia Rating (CDR) and the level of CR was statistically significant (likelihood ratio (LR), p = 0.015).Conclusion The level of CR influenced the severity of dementia. This study suggests that AD patients with higher CR may benefit against cognitive decline after diagnosis of AD.
Doença de Alzheimer (DA) é uma síndrome neurodegenerativa caracterizada por uma deterioração progressiva das capacidades cognitivas e das competências para uma vida independente. A reserva cognitiva (RC) descreve a capacidade do cérebro adulto em lidar com os efeitos deste processo neurodegenerativo e minimizar a manifestação clínica da patologia de demência. O objetivo deste trabalho foi avaliar a associação entre RC e a severidade da DA. Método Este estudo foi transversal. Foram avaliadas as competências funcionais e neuropsicológicas de 75 pacientes com diagnóstico provável de DA. Os pacientes completaram dois questionários, “Participação em atividades de lazer ao longo da vida” e o Questionário de RC.Resultados A relação entre o nível de Clinical Dementia Rating (CDR) e de RC foi estatisticamente significativa (likelihood ratio (LR), p = 0,015).Conclusão O nível de RC influenciou a severidade da demência. Este estudo sugere que os doentes com DA com um maior nível de RC podem beneficiar de proteção relativamente ao declínio cognitivo após o diagnóstico de DA.
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Alzheimer Disease/physiopathology , Alzheimer Disease/psychology , Cognitive Reserve/physiology , Severity of Illness Index , Age Factors , Disease Progression , Educational Status , Epidemiologic Methods , Leisure Activities/psychology , Neuropsychological Tests , Psychiatric Status Rating Scales , Reference Values , Sex Factors , Time FactorsABSTRACT
INTRODUCTION: Cognitive reserve (CR), a hypothetical construct used to obtain information about cognitive aging, describes the capacity of the adult brain to cope with the effects of neurodegenerative processes. This study evaluated CR using a CR questionnaire (CRQ) and a set of variables (education, leisure activities, lifelong occupation) that inform CR. It also developed a CR index, validated the CRQ, and examined the correlation between the different CR measures. METHODS: Functional and neuropsychological capacities of 75 outpatients (mean age: 80.2 years) with a probable AD diagnosis were evaluated. Socio-demographic data and clinical variables were collected. Patients completed two questionnaires: the Participation in Leisure Activities throughout Life questionnaire, and the CRQ. RESULTS: Participants with a greater CR had higher scores in cognitive tests than the elderly with a lower CR. A CR index was developed. CRQ reliability was 0.795 (Cronbach's alpha). There was a close association between the CR Index and the CRQ. CONCLUSIONS: This study found an association between CR measures and education, occupation and participation in leisure activities. The CRQ seems to be a suitable instrument to measure CR in Portuguese populations (AU)
INTRODUÇÃO: A reserva cognitiva (RC), um construto usado para informar sobre o envelhecimento cognitivo, descreve a capacidade do cérebro adulto em lidar com os efeitos de processos neurodegenerativos. Este estudo teve como objetivos avaliar a RC com o Questionário de RC (QRC) e através de variáveis (escolaridade, actividades de lazer, ocupação ao longo da vida) que informam sobre a RC; desenvolver um índice de RC; validar o QRC; e correlacionar as diferentes medidas de RC. MÉTODOS: Foram avaliadas as capacidades funcionais e neuropsicológicas de 75 doentes (idade média: 80,2 anos) com diagnóstico de provável doença de Alzheimer, seguidos em ambulatório. Os dados recolhidos incluíram variáveis sócio-demográficas e clínicas. Os pacientes completaram dois questionários: Participação em Atividades de Lazer ao Longo da Vida; e QCR. RESULTADOS: Os doentes com os níveis mais elevados de RC obtiveram os valores mais elevados nos testes cognitivos. Neste estudo foi desenvolvido um IRC. O QRC (versão portuguesa) teve uma fidelidade de 0,795 (alpha de Cronbach) e foi demonstrada uma associação alta entre o IRC e o QRC. CONCLUSÕES: Verificou-se a existência de uma associação entre as medidas de RC e a escolaridade, ocupação e participação em atividades de lazer. O CRQ pode ser considerado um instrumento adequado para medir o CR da população portuguesa (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Aging/psychology , Cognitive Reserve , Alzheimer Disease/psychology , Social Class , Aging/pathology , Cross-Sectional Studies , Surveys and Questionnaires/standards , Health Status Indicators , Validation Study , Dementia/diagnosis , Alzheimer Disease/pathology , Leisure Activities/psychology , Life StyleABSTRACT
INTRODUCTION: Cognitive reserve (CR), a hypothetical construct used to obtain information about cognitive aging, describes the capacity of the adult brain to cope with the effects of neurodegenerative processes. This study evaluated CR using a CR questionnaire (CRQ) and a set of variables (education, leisure activities, lifelong occupation) that inform CR. It also developed a CR index, validated the CRQ, and examined the correlation between the different CR measures. METHODS: Functional and neuropsychological capacities of 75 outpatients (mean age: 80.2 years) with a probable AD diagnosis were evaluated. Socio-demographic data and clinical variables were collected. Patients completed two questionnaires: the Participation in Leisure Activities throughout Life questionnaire, and the CRQ. RESULTS: Participants with a greater CR had higher scores in cognitive tests than the elderly with a lower CR. A CR index was developed. CRQ reliability was 0.795 (Cronbach's alpha). There was a close association between the CR Index and the CRQ. CONCLUSIONS: This study found an association between CR measures and education, occupation and participation in leisure activities. The CRQ seems to be a suitable instrument to measure CR in Portuguese populations.
ABSTRACT
Education and participation in leisure activities appear to be highly relevant variables in Alzheimer's disease (AD) and usually form the basis of the Cognitive Reserve construct. OBJECTIVE: [A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD. METHODS: Functional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, "Participation in leisure activities throughout life" while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody's Index. RESULTS: AD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives. CONCLUSION: AD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.
Escolaridade e participação em actividades de lazer parecem ser variáveis muito relevantes na doença de Alzheimer (DA) e normalmente usadas no construto Reserva Cognitiva. OBJETIVO: [A] Conhecer a associação entre escolaridade, capacidades cognitivas e funcionais de doentes com DA; [B] Conhecer a associação entre participação em actividades de lazer e capacidades cogntivas e funcionais de doentes com DA; [C] Avaliar a associação da escolaridade e participação em actividades de lazer no curso da DA. MÉTODOS: Foram avaliadas competências funcionais e neurospsicológicas de 120 doentes com provável DA na baseline, após 36 e 54 meses. Dados recolhidos na baseline incluíram variáveis sociodemográficas, clínicas, escolaridade e frequência da participação em actividades de lazer. Participantes ou/e cuidadores responderam ao questionário, "Participação em actividade de lazer ao longo da vida" e completaram o MMSE, CDR, provas da Bateria de Lisboa para Avaliação das Demências, Índice de Barthel e Índice Lawton e Brody. RESULTADOS: Doentes com DA com níveis mais elevados de escolaridade obtiveram melhores resultados nas provas cognitivas. Participantes com níveis mais elevados de participação em actividades de lazer exibiram melhores resultados nos testes cognitivos e funcionais do que aqueles com níveis mais baixos de participação. A progressão da doença foi linear e progrediu de forma semelhante relativamente ao nível de escolaridade. No entanto, resultados sugerem uma mais lenta progressão da doença relativamente aos doentes com níveis mais elevados de participação em actividades de lazer. CONCLUSÃO: Doentes com DA com elevada escolaridade e alta participação em actividade de lazer podem beneficiar de um mais lento declínio cognitivo e funcional após o diagnóstico da DA.
Subject(s)
Humans , Aging , Educational Status , Alzheimer Disease , Leisure ActivitiesABSTRACT
Education and participation in leisure activities appear to be highly relevant variables in Alzheimer's disease (AD) and usually form the basis of the Cognitive Reserve construct. OBJECTIVE: [A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD. METHODS: Functional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, "Participation in leisure activities throughout life" while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody's Index. RESULTS: AD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives. CONCLUSION: AD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.
Escolaridade e participação em actividades de lazer parecem ser variáveis muito relevantes na doença de Alzheimer (DA) e normalmente usadas no construto Reserva Cognitiva. OBJETIVO: [A] Conhecer a associação entre escolaridade, capacidades cognitivas e funcionais de doentes com DA; [B] Conhecer a associação entre participação em actividades de lazer e capacidades cogntivas e funcionais de doentes com DA; [C] Avaliar a associação da escolaridade e participação em actividades de lazer no curso da DA. MÉTODOS: Foram avaliadas competências funcionais e neurospsicológicas de 120 doentes com provável DA na baseline, após 36 e 54 meses. Dados recolhidos na baseline incluíram variáveis sociodemográficas, clínicas, escolaridade e frequência da participação em actividades de lazer. Participantes ou/e cuidadores responderam ao questionário, "Participação em actividade de lazer ao longo da vida" e completaram o MMSE, CDR, provas da Bateria de Lisboa para Avaliação das Demências, Índice de Barthel e Índice Lawton e Brody. RESULTADOS: Doentes com DA com níveis mais elevados de escolaridade obtiveram melhores resultados nas provas cognitivas. Participantes com níveis mais elevados de participação em actividades de lazer exibiram melhores resultados nos testes cognitivos e funcionais do que aqueles com níveis mais baixos de participação. A progressão da doença foi linear e progrediu de forma semelhante relativamente ao nível de escolaridade. No entanto, resultados sugerem uma mais lenta progressão da doença relativamente aos doentes com níveis mais elevados de participação em actividades de lazer. CONCLUSÃO: Doentes com DA com elevada escolaridade e alta participação em actividade de lazer podem beneficiar de um mais lento declínio cognitivo e funcional após o diagnóstico da DA.
ABSTRACT
BACKGROUND: The Camberwell Assessment of Need for the Elderly (CANE) is widely used for multidimensional evaluation of older people with mental health problems. The aim of this study was to evaluate reliability and validity of a Portuguese version of CANE. METHOD: A cross-sectional multicenter study was designed using a convenience sample of elderly mental health services' users. CANE was compared with EASYCare, GHQ12, MMSE, Barthel Index and GDS15 to assess criterion and construct validity. Inter-rater and test-retest reliability were also assessed. RESULTS: 79 patients (76% female), with mean age of 74 (+/- 6.6) years were included. Most patients lived at home with a family caregiver, generally female. Only 32% had no carer. Dementia was the commonest psychiatric diagnosis (61%) and somatic comorbidity was very prevalent (85%). Kappa values (kappa) for inter-rater item reliability ranged from 0.72 to 1.00 (mean values: 0.96 patient, 0.93 carer, 0.90 staff). The intraclass correlation coefficient (ICC) for total scores ranged from 0.95 to 0.98.For test-retest item reliability, the mean kappa value was: 0.80 patient, 0.77 carer, 0.81 staff. ICC for total scores ranged from 0.82 to 0.92. Given the absence of a gold standard, criterion validity was assessed by comparing CANE with EASYCare (rs 0.460; p < or = 0.01), GDS (rs 0.615; p < or = 0.01), GHQ (rs 0.581; p < or = 0.01) and Barthel Index (rs-0.435; p < or = 0.01). Overall, inter-item and item-total correlations for CANE and item comparison with other measures indicated reasonable construct validity. CONCLUSION: The psychometric proprieties of CANE seem to be consistently good, in accordance with other studies. Robust results on ecological, face, content, criterion and construct validity, as well as good reliability, were achieved. This version is a promising tool for research and practical use in Portuguese old age settings.
