ABSTRACT
BACKGROUND: Subjective memory complaints (SMC) are commonly studied in older adults and have been identified as potentially prodromal to dementia and Alzheimer's disease. Studies among younger adults from South America are lacking. OBJECTIVE: To estimate the prevalence of SMC and the factors associated with it among Maule Cohort (MAUCO) participants. METHODS: We performed a cross-sectional analysis to estimate the prevalence of SMC and investigated its associated factors from MAUCO baseline data (Nâ=â6,687). Within groups defined by age (38-59, 60-74) and global cognition (Mini-Mental State Examination: ≥26, 25-22, ≤21), multinomial logistic regression models evaluated risk factors for SMC (Yes, Sometimes, No). RESULTS: Overall, SMC prevalence was 16.4%; 15.9% (95% CI 14.9-16.9%) among younger and 17.6% (15.8-19.4%) among older participants. Female sex, comorbidities, and bad/fair self-reported health status (SRHS) were generally associated with higher odds of SMC. CONCLUSION: Overall prevalence of SMC was 16%. Different factors were associated with the odds of SMC depending on age and global cognitive status. Future SMC studies should include sex-specific assessments, evaluate SRHS as a moderator of SMC reporting, and the influence of the SARS-CoV-2 pandemic on SMC reporting.
Subject(s)
COVID-19 , Memory Disorders , Male , Humans , Female , Aged , Memory Disorders/etiology , Chile/epidemiology , Prevalence , Rural Population , Cross-Sectional Studies , COVID-19/epidemiology , COVID-19/complications , SARS-CoV-2 , Neuropsychological TestsABSTRACT
BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. RESULTS: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.
Subject(s)
COVID-19 , Catatonia , Delirium , Substance Withdrawal Syndrome , COVID-19/complications , Catatonia/drug therapy , Catatonia/etiology , Delirium/drug therapy , Delirium/etiology , Hospitals, General , Humans , Psychomotor Agitation/drug therapy , Psychomotor Agitation/etiology , SARS-CoV-2 , Substance Withdrawal Syndrome/drug therapyABSTRACT
In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.
Subject(s)
Humans , Psychiatry , Students, Medical , Education, Medical, Undergraduate , Self-Management , COVID-19 , SARS-CoV-2ABSTRACT
Neurological soft signs (NSS) are a common feature of severe psychiatric disorders such as schizophrenia but are also prevalent in organic brain diseases like HIV-associated neurocognitive disorder (HAND) or Alzheimer's disease. While distinct associations between NSS, neurocognition, and cerebral regions were demonstrated in schizophrenia, these associations still have to be elucidated in HIV. Therefore, we investigated 36 persons with HIV of whom 16 were neurocognitively healthy and 20 were diagnosed with HAND. NSS were assessed using the Heidelberg scale. NSS scores were correlated with gray matter (GM) using whole brain voxel-based morphometry. Results showed significantly elevated NSS in the HAND group when compared to the neurocognitively healthy with respect to NSS total score and the subscores "orientation" and "complex motor tasks". While the two groups showed only minor, non-significant GM differences, higher NSS scores (subscales "motor coordination", "orientation") were significantly correlated with GM reduction in the right insula and cerebellum (FWE-corrected). Our results corroborate elevated NSS in HIV+ patients with HAND in contrast to cognitively unimpaired patients. In addition, cerebral correlates of NSS with GM reductions in insula and cerebellum were revealed. Taken together, NSS in this patient group could be considered a marker of cerebral damage and neurocognitive deficits.
Subject(s)
HIV Infections , Schizophrenia , Brain/diagnostic imaging , Gray Matter/diagnostic imaging , HIV Infections/complications , HIV Infections/diagnostic imaging , Humans , Magnetic Resonance ImagingABSTRACT
BACKGROUND: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. AIM: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. MATERIAL AND METHODS: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. CONCLUSIONS: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.
Subject(s)
Humans , Substance Withdrawal Syndrome/drug therapy , Catatonia/etiology , Catatonia/drug therapy , Delirium/etiology , Delirium/drug therapy , COVID-19/complications , Psychomotor Agitation/etiology , Psychomotor Agitation/drug therapy , SARS-CoV-2 , Hospitals, GeneralABSTRACT
We compared neuropsychological functioning and prevalence of mild cognitive impairment (MCI) in two birth cohorts born 20 years apart when participants had reached the same age, i.e., the mid-60s. The study followed up 500 volunteers born 1930-1932 (C30) and 502 born 1950-1952 (C50). Participants underwent medical, neuropsychological, and psychiatric examinations in 1993-1996 (T1), 1997-2000 (T2), 2005-2008 (T3), and 2014-2016 (T4), including assessment of abstract thinking, memory performance, verbal fluency, visuo-spatial thinking, psychomotor speed, and attention. Healthy participants from C30 at T2 (n = 298) and from C50 at T4 (n = 205) were compared using multivariate ANCOVAs. Groups slightly differed with respect to age (C50: 63.86 ± 1.14 vs. C30: 66.80 ± 0.91; p < 0.05) and years of education (13.28 ± 2.89 vs. 14.56 ± 2.45). After correcting for age, C50 significantly outperformed C30 in all domains except concentration and verbal fluency. After additionally adjusting for education, C50 significantly outperformed C30 in declarative memory performances and abstract thinking only. Prevalence rates of MCI were 25.2% in C30 and 9.6% in C50 (p < 0.001). Our findings confirm the association between better educational attainment and enhanced cognitive performance in "younger" old individuals. While this association corresponds to the Flynn effect, various life course influences may have also contributed to better performance, including improvements in healthcare provision, medication, and lifestyle factors. Their overall effects may foster cognitive reserve and thus translate into the decline in MCI prevalence reported here.
ABSTRACT
In the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.
Subject(s)
COVID-19 , Education, Medical, Undergraduate , Psychiatry , Self-Management , Students, Medical , Humans , SARS-CoV-2ABSTRACT
Introduction: The aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. Additionally, we attempt to provide a cognitive profile for T2DM group. Methodology: A cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Student's t-tests and MANOVA. Results: Among all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%, p < 0.001). The risk of CI was 2.8 times higher in older people with T2DM compared to older people without the diagnosis. Multiple regression analysis, adjusted for age and gender, demonstrated that age, education, presence of dyslipidemia, and T2DM duration were the predictor variables significantly associated with CI. T2DM group performed worse on global cognitive performance, attention, language, verbal memory, visual memory, visual constructional ability, and executive function. After adjusting for significant covariates from multiple regression analysis, a relationship between "cognition" and T2DM is still observed. Amnesic multi-domain impairment was the specific cognitive identified pattern for T2DM group. Conclusion: The present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile.
ABSTRACT
Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.
Subject(s)
Patient Rights , Vulnerable Populations , Chile , HumansABSTRACT
Recently, the Chilean Senate approved the main ideas of a constitutional reform and a Neuro-rights bill. This bill aims to protect people from the potential abusive use of "neuro-technologies". Unfortunately, a literal interpretation of this law can produce severe negative effects both in the development of neuroscience research and medical practice in Chile, interfering with current treatments in countless patients suffering from neuropsychiatric diseases. This fear stems from the observation of the negative effects that recent Chilean legislations have produced, which share with the Neuro-Rights Law the attempt to protect vulnerable populations from potential abuse from certain medical interventions. In fact, Law 20,584 promulgated in 2012, instead of protecting the most vulnerable patients "incapacitated to consent", produced enormous, and even possibly irreversible, damage to research in Chile in pathologies that require urgent attention, such as many neuropsychiatric diseases. This article details the effects that Law 20.584 had on research in Chile, how it relates to the Neuro-Rights Law, and the potential negative effects that the latter could have on research and medical practice, if it is not formulated correcting its errors.
Subject(s)
Humans , Patient Rights , Vulnerable Populations , ChileABSTRACT
Resumen Introducción: Aproximadamente 50% de las personas con infección por VIH padecen de alguna patología neuro-psiquiátrica. Características intrínsecas del virus, sus complicaciones, tratamiento y el contexto socio-cultural de los infectados facilitan el desarrollo de estas co-morbilidades, que determinan, en parte, el curso y pronóstico de las personas con infección por VIH. Objetivo: Introducir en la fisiopatología, características clínicas y manejo de la patología neuro-psiquiática en la infección por VIH, centrándose en dos de sus cuadros de mayor prevalencia: el trastorno neuro-cognitivo asociado al VIH (HAND) y el trastorno depresivo mayor (TDM). Desarrollo: En general, la detección y el tratamiento precoz de la patología neuropsiquiátrica en personas con infección por VIH mejora la calidad de vida de los pacientes, el curso clínico de la infección y mejora la adherencia al tratamiento anti-retroviral, lo que constituye una herramienta importante en el control de la propagación del VIH.
Abstract Background: The prevalence of neuropsychiatric disorders in HIV infected individuals is around 50%. Despite this, these diseases are often underdiagnosed and undertreated. Direct effects of the virus, opportunistic infections, adverse effects of antiretroviral therapy and the sociocultural context of the infected persons, contribute to the development of HIV associated neurocognitive disorder (HAND) and major depressive disorder (MDD), both of which have an impact in quality of life and disease progression. Aim: To introduce physicians in the pathophysiology, clinical features and management of psychiatric disease in seropositive patients. Content: Early detection and treatment of neuropsychiatric comorbidity in HIV infected individuals improve clinical outcomes, quality of life and is an important milestone in the control of the pandemic.
Subject(s)
Humans , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Depressive Disorder, Major/etiology , Depressive Disorder, Major/epidemiology , Quality of Life , Comorbidity , PrevalenceABSTRACT
Neurological soft signs (NSS) are frequently found in severe mental disorders, such as Alzheimer's disease, schizophrenia or HIV associated neurocognitive disorder (HAND) which includes asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia. To characterize NSS in patients with HIV we examined them with respect to neuropsychological deficits typically found in the disorder. 67 HIV + patients without a history of head trauma, opportunistic infections, severe psychiatric disorders or acute confounding comorbidities of the Central nervous system (CNS) were recruited. NSS and neuropsychological deficits were examined on the Heidelberg scale and the Cambridge Neuropsychological Test Automated Battery (CANTAB), respectively. Semantic and phonemic verbal fluency were additionally established. According to NIMH and NINDS criteria, 18 patients were diagnosed with ANI and 21 with MND, 28 showed no cognitive deficits. NSS total scores were significantly correlated with several cognitive domains and NSS subscales. These correlations were confirmed when motor performance was entered as a covariate. According to our findings, NSS in HIV positive patients are significantly correlated with deficits in a broad range of neuropsychological domains. Similar findings were reported in schizophrenia, emphasizing the transdiagnostic character of NSS and supporting NSS examination in screening HIV patients for HAND.
Subject(s)
Cognition , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/etiology , HIV Infections/complications , Neurocognitive Disorders/diagnosis , Neurocognitive Disorders/etiology , Adult , Cognitive Dysfunction/psychology , HIV Infections/psychology , Humans , Male , Middle Aged , Neurocognitive Disorders/psychology , Neuropsychological Tests , Schizophrenic PsychologyABSTRACT
Validity of PHQ-2 to screen for depression was assessed in an agricultural population in Chile. The sample included 4767 adults enrolled from 2014 to 2017 in a population-based cohort of chronic disease in Maule, Chile. Receiver operating characteristic (ROC) curve analysis was used to find the optimal PHQ-2 cut-off for depression, defined as the highest Youden index, using PHQ-9 as a reference standard. Sensitivity, specificity, and Youden J index were calculated for every cut-off point of PHQ-2. Prevalence of depression measured by PHQ-9 and PHQ-2 was 18% and 18.4%, respectively. Corresponding rates for women were 24.7% and 23.6%, and 8.3% and 10.9 for men. The optimal PHQ-2 cut-off score was 3, achieved with a sensitivity of 74.6%, specificity 93.9%, and Youden index of 0.68. The area under the curve for the ROC analysis ROC curve was 0.92 (95% CI 0.91-0.93). PHQ-2 has good performance for use as a test for depression screening in a rural population of Chile and can be easily applied in areas with low resources.
Subject(s)
Depression , Patient Health Questionnaire , Adult , Chile/epidemiology , Depression/diagnosis , Depression/epidemiology , Female , Humans , Male , Mass Screening , ROC Curve , Reproducibility of Results , Rural Population , Sensitivity and Specificity , Surveys and QuestionnairesABSTRACT
PURPOSE: Although polypharmacy in younger populations is a growing public health concern, most studies addressing polypharmacy focus on elderly populations. Thus, polypharmacy is not yet well understood in younger populations. METHODS: Baseline data from the Maule Cohort (MAUCO) (adults aged 38-74 years) were used to study the prevalence of polypharmacy and associated participant characteristics using logistic and zero-inflated negative binomial regressions. Factors studied include age, sex, self-rated health, education, smoking, obesity, diabetes, hypertension, and other chronic conditions. RESULTS: Polypharmacy was reported by 10% of participants overall, with higher prevalence among older (≥60 years) vs middle aged (<60 years) participants (overall: 20.9% vs 6.0%, P < .0001; for those reporting any medication use: 30.2% vs 15.9%, P < .0001). Middle-aged adults reported different patterns of medication use by polypharmacy status, while older adults reported similar medication use patterns regardless of polypharmacy. Diabetes, hypertension, dyslipidemia, cardiovascular diseases, hypothyroidism, and osteomuscular diseases were significantly associated with polypharmacy. Analyses also revealed that there are MAUCO participants who are potentially being undertreated for conditions like depression. CONCLUSIONS: Research into medication use among younger and middle-aged adults and development of possible tools to deprescribe medications in this population are warranted. However, it is important that patients who need treatment receive it, and so both potential overtreatment and undertreatment need further study in this population.
Subject(s)
Polypharmacy , Rural Population/statistics & numerical data , Adult , Aged , Aged, 80 and over , Chile/epidemiology , Chronic Disease , Cohort Studies , Female , Humans , Male , Middle Aged , PrevalenceABSTRACT
BACKGROUND: The prevalence of neuropsychiatric disorders in HIV infected individuals is around 50%. Despite this, these diseases are often underdiagnosed and undertreated. Direct effects of the virus, opportunistic infections, adverse effects of antiretroviral therapy and the sociocultural context of the infected persons, contribute to the development of HIV associated neurocognitive disorder (HAND) and major depressive disorder (MDD), both of which have an impact in quality of life and disease progression. AIM: To introduce physicians in the pathophysiology, clinical features and management of psychiatric disease in seropositive patients. CONTENT: Early detection and treatment of neuropsychiatric comorbidity in HIV infected individuals improve clinical outcomes, quality of life and is an important milestone in the control of the pandemic.
Subject(s)
Depressive Disorder, Major , HIV Infections , Comorbidity , Depressive Disorder, Major/epidemiology , Depressive Disorder, Major/etiology , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Prevalence , Quality of LifeABSTRACT
Introducción: La prevalencia de enfermedades crónicas como la diabetes mellitus tipo 2 (DM2) y la demencia aumentan con el envejecimiento. En este contexto, se ha descrito una asociación entre DM2 y trastornos cognitivos. Sin embargo, existen escasos estudios en población hispana. Este trabajo presenta un estudio piloto que evaluará la factibilidad del proyecto DIABDEM el cual determinará la prevalencia de deterioro cognitivo y sus factores de riesgo en personas mayores con diagnóstico de DM2 en España y Chile. Materiales y métodos: Estudio piloto, observacional, no experimental, descriptivo-comparativo, transversal. La muestra se conformará por 72 participantes (39 españoles y 33 chilenos), hombres y mujeres, de 65 años o más, que viven en la comunidad, sin diagnóstico previo de demencia, con y sin diagnóstico de DM2. Los participantes completarán un protocolo de investigación exhaustivo que recogerá datos de variables neuropsicológicas, de estilo de vida, sociodemográficas y clínicas. Resultados esperados: Se espera evaluar la factibilidad del proyecto DIABDEM, lo cual permitirá determinar la prevalencia de deterioro cognitivo y sus factores de riesgo en personas mayores con DM2 posteriormente. Por un lado, se espera identificar factores de riesgo y protectores asociados potencialmente al desarrollo de deterioro cognitivo en DM2. Por otro, se pretende identificar una tendencia en el perfil neuropsicológico específico en personas mayores con DM2, proponiendo posteriormente una batería neuropsicológica corta y útil para discriminar de manera eficaz y precoz los trastornos cognitivos en personas con DM2. Conclusiones: Los hallazgos de este estudio piloto ayudarán a obtener mayor conocimiento acerca de la factibilidad del proyecto DIABDEM, el cual aportará evidencia acerca de las complicaciones cognitivas en las personas con DM2
Introduction: The prevalence of chronic noncommunicable diseases such as type 2 diabetes mellitus (T2DM) and dementia increase with ageing. In this context, an association between T2DM and cognitive impairment has been described in the literature. However, there are few studies in the Hispanic population. This research project presents a pilot study that will evaluate the feasibility of the DIABDEM project that will determine the prevalence of cognitive impairment in old people with diagnosis of T2DM in Spain and Chile. Materials and methods: It is a observation-based pilot study, non-experimental, descriptive-comparative and cross-sectional. The sample will involve 72 participants (39 Spaniards and 33 Chileans), 65 year-old or older, men and women, community dwelling, and who have not been previously diagnosed with dementia, with or without a T2DM diagnosis. Participants will fill in a research protocol form collecting socio-demographic and clinical data, lifestyle details, and neuropsychological variables. Expected results: This study will evaluate the feasibility of the DIABDEM project that will determine the prevalence rate of cognitive impairment in old people with T2DM. On one hand, the aim of this study will establish risk and protectors factors potentially associated with the development of cognitive impairment in T2DM. On the other hand, it is expected to identify a specific neuropsychological profile in people with T2DM, proposing later a brief and useful neuropsychological battery in order to discriminate early cognitive impairment in people with T2DM. Conclusion: Findings in this pilot study will obtain greater knowledge about the feasibility of the DIABDEM project, which will provide evidence about cognitive complications in T2DM
Subject(s)
Humans , Male , Female , Aged , Cognitive Dysfunction/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Chile/epidemiology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Dementia/epidemiology , Dementia/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/psychology , Independent Living , Life Style , Pilot Projects , Prevalence , Socioeconomic FactorsABSTRACT
INTRODUCTION: The prevalence of chronic noncommunicable diseases such as type 2 diabetes mellitus (T2DM) and dementia increase with ageing. In this context, an association between T2DM and cognitive impairment has been described in the literature. However, there are few studies in the Hispanic population. This research project presents a pilot study that will evaluate the feasibility of the DIABDEM project that will determine the prevalence of cognitive impairment in old people with diagnosis of T2DM in Spain and Chile. MATERIALS AND METHODS: It is a observation-based pilot study, non-experimental, descriptive-comparative and cross-sectional. The sample will involve 72 participants (39 Spaniards and 33 Chileans), 65 year-old or older, men and women, community dwelling, and who have not been previously diagnosed with dementia, with or without a T2DM diagnosis. Participants will fill in a research protocol form collecting socio-demographic and clinical data, lifestyle details, and neuropsychological variables. EXPECTED RESULTS: This study will evaluate the feasibility of the DIABDEM project that will determine the prevalence rate of cognitive impairment in old people with T2DM. On one hand, the aim of this study will establish risk and protectors factors potentially associated with the development of cognitive impairment in T2DM. On the other hand, it is expected to identify a specific neuropsychological profile in people with T2DM, proposing later a brief and useful neuropsychological battery in order to discriminate early cognitive impairment in people with T2DM. CONCLUSION: Findings in this pilot study will obtain greater knowledge about the feasibility of the DIABDEM project, which will provide evidence about cognitive complications in T2DM.
Subject(s)
Cognitive Dysfunction/epidemiology , Diabetes Mellitus, Type 2/epidemiology , Aged , Chile/epidemiology , Cognitive Dysfunction/etiology , Cognitive Dysfunction/psychology , Cross-Sectional Studies , Dementia/epidemiology , Dementia/etiology , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/psychology , Female , Humans , Independent Living , Life Style , Male , Pilot Projects , Prevalence , Socioeconomic Factors , Spain/epidemiologyABSTRACT
HIV-associated neurocognitive disorders (HAND) include asymptomatic neurocognitive impairment (ANI), mild neurocognitive disorder (MND) and HIV-associated dementia. Early recognition of HAND is crucial, and usually requires thorough neuropsychological testing. Neurological soft signs (NSS), i.e. minor motor and sensory changes, a common feature in severe psychiatric disorders, may facilitate early diagnosis. NSS were examined using the Heidelberg NSS Scale in 18 patients with ANI, 21 with MND, 28 HIV positive patients without HAND, and 39 healthy controls matched for age, gender, and education. The highest NSS scores were obtained in the MND patients (13.3⯱â¯10.0, pâ¯<â¯0.0001) followed by those with ANI (11.7⯱â¯10.6), the HIV positive subjects without neurocognitive deficits (8.0⯱â¯4.1) and the healthy controls (3.8⯱â¯3.2). This result was confirmed when age and years of school education were entered as covariates. No significant correlations between NSS and CD4 counts or any other clinical variables were found among the HIV positive groups. Our results demonstrate that NSS are frequently found in both ANI and MND but not HIV positive patients without neurocognitive deficits. NSS may facilitate the screening of HIV positive patients for ANI and MND as an easier and less expensive clinical tool.
