Evaluation of genomic factors and early childhood stimulation on intelligence in children from a Brazilian birth cohort: The primary role of independent factors.

BACKGROUND: Childhood cognitive abilities are a predictor of health outcomes and adult income potential. Identifying factors associated with childhood intelligence and their interactions is essential in behavioral research. We assessed the impact of genetic variants and early child stimulation (ECS) on child intelligence and examined their possible interaction as potential modifiers of IQ in a population-based longitudinal study. METHODS: Participants of the 2004 Pelotas Birth Cohort study (N = 4231) underwent intelligent quotient (IQ) by WISC-III assessment at 6 years of age. At 24 and 48-months, mothers answered five ECS marker questions, whose sum was used to create a score. The polygenic score for intelligence (IQ-PGS) was constructed from the GWAS-weighted estimate of cognition. Association was assessed using multiple linear regression models adjusted for maternal, family, and child confounding variables. To explore the possible influence of skin color and ethnoracial classification, the regression models were stratified according to the skin color variable, as a sensitivity analysis. RESULTS: In the adjusted analysis, IQ-PGS (ß = 0.79, 95% confidence interval [95% CI] 0.26;1.31) as well as ECS (ß = 2.34; 95% CI: 1.76;2.92) were associated with IQ in this sample. The association between IQ-PGS and IQ was significant only in the white Brazilian group in the sensitivity analysis. However, there was no interaction between IQ-PGS and ECS on IQ (p(IQ-PGS x ECS) = 0.46). CONCLUSIONS: ECS did not modify the impact of genetic potential on intellectual development during childhood, suggesting that genetic factors and ECS exert independent effects on the IQ levels of children.

Experiences of cognitive stimulation therapy (CST) in Brazil: a qualitative study of people with dementia and their caregivers.

OBJECTIVES: There is a lack of investment in psychosocial treatments for people with dementia in Brazil. Cognitive Stimulation Therapy (CST) is a group-based intervention that has shown to have benefits on activities of daily living and mood for people with dementia in Brazil. This study aims to explore the experiences and perceived changes following CST groups. METHODS: Individual interviews were conducted with the participants of the group (n = 12) and their caregivers (n = 11). Framework analysis was used to inspect the data. RESULTS: Two main themes have emerged: 'Personal benefits of being part of the group', containing two subthemes: 'Benefits for caregivers' and 'Benefits for person with dementia' and 'Day-to-day changes', containing seven subthemes; 'Memory', Sociability', 'Language', 'Mood', 'Orientation', 'Everyday activities' and 'Behavioural and psychological symptoms'. CONCLUSION: Results suggest that CST groups led to perceived personal benefits for the people with dementia and caregivers and that there are perceived changes for the participants of the groups.

Preventing cognitive decline via digital inclusion and virtual game management: an intervention study with older adults in the community.

OBJECTIVE: To evaluate the impact of cognitive stimulation via digital inclusion and the practice of video games on the cognition of the older population. METHOD: This is a randomized controlled intervention study, nested in a population cohort study. Based on the application of the Clinical Dementia Rating (CDR) test, individuals aged 60 years or older with scores 0 and 0.5 were included and randomly allocated in the Intervention Group (IG) or Control Group (CG). Initially, 160 participants met the selection criteria and underwent neuropsychological evaluation via the Montreal Cognitive Assessment (MoCA), applied before and after intervention. The IG (n = 62) participated in computer-based intervention once a week for one-and-a-half hours, for 4 months. The CG (n = 47) participated in the mindfulness workshops held in the same period. RESULTS: The digital literacy intervention group averaged 2.6 points more in the MoCA after 4 months. The change in the final MoCA decreased in 0.46 points at each unit in the basal MoCA. Individuals with average schooling had an increase of 0.93 points in the change of the MoCA in relation to individuals with low or high schooling. CONCLUSION: Digital inclusion combined with the practice of video games has the potential to improve the cognition of the older population.

Pathways from maternal depression to child resilience: Socioeconomic, family, and individual factors in the 2004 Pelotas (Brazil) birth cohort.

Background: The negative impacts of maternal depression on child mental health outcomes are well-documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle-income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience. Methods: Using data from the 2004 Pelotas Birth Cohort (N = 4231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥2 out of 5 assessment waves; n = 1132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent-report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (CS) (at 24 and 48 months) and Intelligence quotient (IQ) (at 6 years), and from CS to resilience via IQ, using counterfactual mediation. Results: A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via CS (odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.02-3.38) and IQ (OR = 1.19, 95% CI 1.01-1.42), such that higher SES was associated with resilience via both higher levels of CS and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01-3.76) and total effect (OR = 1.94, 95% CI 1.05-3.89) of CS on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined. Conclusions: These findings suggest that CS in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.

Cross-cultural effects of reminiscence therapy on life satisfaction and autobiographical memory of older adults: a pilot study across Mexico and Spain.

BACKGROUND: There are increasing reports on the cognitive and emotional benefits of positive reminiscence therapy in older people. The objective of this study is to assess the differential improvement of the quality of life for older people in different vital situations (three different types of aging) and from different countries by implementing a positive reminiscence therapy program (REMPOS). METHODS: The participants were 144 older adults above the age of 65, 77 participants from Spain (45 experimental groups, 32 control groups) and 67 from Mexico (34 experimental groups, 33 control groups). The participants were recruited from nursing and retirement homes. A factorial randomized design with pre-post measurement with three independent variables: country (Mexico, Spain), condition (experimental, control), and types of aging (healthy aging, HA., mild cognitive impairment, MCI., Alzheimer's disease, AD). The experimental groups received REMPOS therapy and control groups received standard cognitive stimulation program. The quality of life was measured with the Life Satisfaction Inventory for adults (LSI-A) and autobiographical memory test (AMT) before and after REMPOS therapy. RESULTS: The REMPOS intervention showed significantly higher positive effects than the control condition on the recall of specific positive memories across countries and types of aging, except for the Spanish MCI group. Life satisfaction in the Alzheimer's and MCI group only improved with REMPOS in the Mexican sample. CONCLUSIONS: The REMPOS effects showed generalizable effects across countries, but the cross-cultural differences shown highlight the necessity of running studies to test those differential effects.

Software-guided (PREVEDEL) cognitive stimulation to prevent delirium in hospitalised older adults: study protocol.

BACKGROUND: Delirium is a clinical condition characterised by acute and fluctuating deterioration of the cognitive state, generally secondary to an acute pathology. Delirium is associated with negative outcomes in older adults, such as longer hospitalisations, higher mortality, and short and medium-term institutionalisation. Randomised clinical trials have shown that delirium is preventable through non-pharmacological prevention measures, decreasing its incidence by 30-50%. These interventions include promoting physical activity, facilitating the use of glasses and hearing aids, cognitive stimulation, and providing frequent reorientation of time and space, among others. These measures are currently seldom applied in hospitals in Chile and around the world for reasons including the heavy workload of clinical staff, the lack of trained personnel, and in general the absence of a systematic implementation processes. We developed a software called PREVEDEL, which includes non-pharmacological strategies such as cognitive stimulation, early mobilisation, orientation, and pain assessment. We propose a randomised clinical trial to evaluate whether cognitive stimulation guided by PREVEDEL software prevents delirium status (full/subsyndromal delirium) in hospitalised older adults. METHOD: A randomised controlled trial, with parallel, multicentre groups. We will recruite patients 65 years or older who have been hospitalised for less than 48 h in the general ward or the intermediate care units of four hospitals in Santiago, Chile. The participants in the intervention group will use a tablet with cognitive stimulation software for delirium prevention for five continuous days versus the control group who will use the tablet without the software. We will evaluate the incidence, duration, density of delirium, subsyndromal delirium with the Confusion Assessment Method, cognitive with the Montreal Cognitive Assessment, and functional status with the Functional Independence Measure at discharge. Moreover, we will evaluate the adherence to prevention measures, as well as demographic variables of interest. DISCUSSION: The use of cognitive PREVEDEL software could increase and improve the implementation of non-pharmacological prevention measures for delirium in hospitalised older adults, thus reducing its incidence and contributing to patients and health professionals. TRIAL REGISTRATION: NCT05108207 ClinicalTrials.gov. Registered 4 November 2021.

Transcultural Pilot Study of the Efficacy of Reminiscence Therapy for Mexican and Spanish Older Adults with Different Levels of Cognitive Decline.

The main objective for this study is to analyze the impact of a positive reminiscence therapy program (REMPOS) in cognitive functioning and depressive symptomatology for older adults in different vital situations (healthy aging, mild cognitive impairment, and Alzheimer's disease).This is a transcultural comparative study (older people from Spain and Mexico). A randomized design with pre-posttest measurement and twelve groups was formulated, during a period of six months of intervention (3 in Mexico and 3 in Spain). The design had: 6 experimental groups with REMPOS intervention (3 in Mexico and 3 in Spain) during a period of six months and 6 control groups that received cognitive stimulation.While a key aspect of this study is the cross-cultural differences, an important part is to determine whether each experimental group had similar results in terms of the change in magnitude between the pre and post analysis. In general, intervention significantly improved cognitive function and decreased depressive symptoms.These findings provide further evidence about the efficacy of the REMPOS therapy between different types of aging and both geographical and cultural contexts (Spain and Mexico).

Effect of Cognitive Training Programs Based on Computer Systems on Executive Functions in Children With ADHD: A Systematic Review.

BACKGROUND: The purpose of this systematic review is to synthesize the existing literature reporting the effects of computerized cognitive trainings on the executive functions of children with ADHD. METHOD: A systematic review was carried out following the PRISMA statement; the primary sources used were five electronic databases (Scopus, Science Direct, Pubmed, Springer, Taylor & Francis). RESULTS: 20 articles met the eligibility criteria, data on the training characteristics and the effects on executive functions were extracted, followed by an analysis of bias and the methodological quality of the studies. The results of the studies were widely heterogeneous, largely associated with the variety of training programs and the measurement instruments used. The most studied executive functions were working memory and inhibitory control. Some of the studies reported that the intervention led to significant effects on working memory and attention (N = 7), and improvements in inhibitory control (N = 5) and planning (N = 4) were also reported. At the same time, others did not report the effects of the intervention on these processes. The assessment of the quality of the evidence showed important risk biases among the reviewed studies. CONCLUSION: Some training based on computer systems showed positive effects on the executive functions of working memory, attention, and inhibitory control in children with ADHD. However, other training sessions did not show significant effects. In general, the evidence shows mixed results, a high diversity of measurement instruments, and high risks of bias between the studies. Therefore, the evidence has not been consistent about the general benefits of computerized training on the executive functions of children with ADHD.

Big Five personality factors predict self-rated cognitive reserve: a two-wave online study in a Mexican sample.

Introduction: One of the main contributors to cognitive reserve (CR) is the involvement in cognitively stimulating activities (CSAs), including education, work, leisure, social and physical activities. Personality traits are plausible determinants of CR, influencing the tendency to engage in CSAs. The goal of this study was to evaluate the association between personality and CR, operationalised as self-rated involvement in CSAs, in a sample of individuals aged 18-50 or more. Method: We collected two-wave non-probabilistic online data throughout Mexico. The instruments were the Big Five Inventory-2 for the baseline, its extra-short form for the follow-up and the Self-Rating of Cognitive Reserve (SRCR). Confirmatory factor analyses (CFAs) were performed to test the unifactorial structure of the SRCR, and multiple regressions were conducted with personality factors as predictors of CR. Results: For the baseline, 2025 participants were recruited, and 610 for the follow-up, most of them female and aged 18-40. CFAs showed excellent goodness-of-fit, and the regression analyses proved Negative Emotionality and Extraversion to be the main predictors of CR. Conclusions: Our study highlights the need to identify personality profiles at high risk of underdevelopment of CR in ages where it is still feasible to promote engagement in CSAs.

Intervenciones cognitivas a través de realidad virtual en personas con Deterioro Cognitivo Leve: Una Revisión Sistemática

Introducción: La posibilidad de reversión del Deterioro Cognitivo Leve (DCL) ha generado diversas investigaciones en búsqueda de tratamiento, entre ellas la estimulación cognitiva a través de realidad virtual (RV). No obstante su uso, no existe aún evidencia acerca de las modalidades y efectos en personas con DCL. Objetivo: Sistematizar las características de los estudios que han utilizado intervenciones cognitivas con RV en personas con DCL, describir sus efectos y establecer recomendaciones para futuras investigaciones en base a las limitaciones reportadas. Métodos: revisión sistemática de estudios publicados entre 2010 y 2020, en las bases de datos Web of Science, Scopus y Pubmed. Resultados: Se identificaron 14 estudios con programas que emplearon mayoritariamente RV de tipo inmersiva, con el "supermercado" como escenario virtual más frecuente. En siete trabajos se intervino una función cognitiva, siendo la memoria y las funciones ejecutivas las más intervenidas. Los instrumentos de evaluación se concentraron en medidas cognitivas, con escasa evaluación de variables neuropsiquiátricas y de calidad de vida. Trece estudios informaron mejoras a nivel cognitivo general o por dominio específico. Conclusiones: La utilización de RV, inmersiva y no inmersiva, ha tenido resultados positivos en el rendimiento cognitivo general o específico por dominio, de personas con DCL, sin embargo, debido a la incipiente y limitada evidencia de su uso en personas con esta patología, no es posible determinar la sostenibilidad de estos resultados y la generalización de estas intervenciones hacia las actividades de la vida diaria. Se recomienda realizar intervenciones con entornos reales y seguimiento post-intervención.

Introduction: The possibility of Mild Cognitive Impairment (MCI) reversal has generated numerous studies in search of treatment, including cognitive stimulation through virtual reality (VR). Despite its use, there is still no evidence about the modalities and effects in people with MCI. Aim: To systematize the characteristics of the studies that have used cognitive interventions with VR cognitive in people with MCI, describe their effects and to establish recommendations for future research based on the limitations reported. Methods: systematic review of studies published between 2010 and 2020, in the Web of Science, Scopus and Pubmed databases. Results: 14 studies were identified with programs that mostly used immersive VR, with the "supermarket" as the most frequent virtual scenario. In seven studies only one cognitive function was involved, with memory and executive functions being the most intervened. The assessment instruments focused on cognitive measures, with little assessment of neuropsychiatric and quality of life variables. Thirteen studies reported improvements on the general cognitive level or by specific domain. Conclusions: The use of immersive and non-immersive VR has had positive results in the general or domain-specific cognitive performance of people with MCI, however, due to the incipient and limited evidence of its use in people with this pathology, it is not possible to determine the sustainability of these results and the generalization of these interventions regarding daily living activities. Interventions with real environments and post-intervention follow-up are recommended.

Proposta de um guia educativo sobre envelhecimento ativo e estimulação cognitiva para idosos / Proposal for an educational guide on active aging and cognitive stimulation for the elderly / Propuesta de guía educativa sobre envejecimiento activo y estimulación cognitiva para personas mayores

Objetivo: Construir e validar um guia educativo para favorecer a estimulação cognitiva de idosos. Método: As etapas para a elaboração do material educativo consistiram na sistematização do conteúdo, através de análise narrativa da literatura. Após a revisão e a definição do conteúdo, foram propostas as ilustrações, layout e design, com a diagramação do guia educativo. A versão preliminar foi submetida a processo de validação, com utilização de formulário para a análise do conteúdo, linguagem e design. Contou-se com a colaboração de oito juízes com conhecimento em envelhecimento, cognição, educação em saúde, tecnologias educativas e/ou validação de instrumentos. Após essa etapa, foram realizadas as modificações, a diagramação e versão final do guia. Resultados: O guia foi validado através do Índice de Validade de Conteúdo, com pontuação 0,83. Os juízes fizeram considerações acerca da diminuição de conteúdo teórico, disposição e utilização de ilustrações, mudanças no layout e design e alterações de termos. O guia foi corrigido e sua versão final contém sessenta páginas, com dimensão no formato A4 de 21cmx29,7cm, incluindo o aporte técnico-científico sobre envelhecimento, envelhecimento ativo, cognição, estimulação cognitiva e funções cognitivas, incluindo, também, as orientações, a seleção das atividades e as principais funções cognitivas que seriam estimuladas através das atividades propostas. Conclusão: Materiais como esses contribuem no processo de educação em saúde e estimulação do protagonismo do público-alvo no autocuidado e gerenciamento de saúde e seu emprego é recomendado pela Organização Mundial de Saúde, que considera os diversos determinantes e autores envolvidos na saúde da pessoa idosa.

Objective: To build and validate an educational guide to promote cognitive stimulation in the elderly. Method: The steps for the elaboration of the educational material consisted of the systematization of the content, through narrative analysis of the literature. After reviewing and defining the content, the illustrations, layout and design were proposed with the diagramming of the educational guide. The preliminary version underwent a validation process, using a form to analyze the content, language and design. It had the collaboration of eight judges with knowledge in aging, cognition, health education, educational technologies and/or instrument validation. After this step, the modifications were carried out and the layout and final version of the guide were carried out. Results: The guide was validated through the Content Validity Index, with a score of . 0.83. The judges made considerations about the reduction of theoretical content, arrangement and use of illustrations, changes in layout and design, and changes in terms. The guide has been corrected and its final version contains sixty pages, with an A4 size of 21cmx29.7cm, including the technical-scientific contribution on aging, active aging, cognition, cognitive stimulation and cognitive functions, including guidelines, selection activities and the main cognitive functions that Pwaolualdvrabse-cshtiamvuel:atEendsinthorOounglihnet.hTeerparpoiapoOsceudpacitoinvaitli.esA.prCeondniczlaugseimon.:COMVaItDer-i1a9ls. such as these contribute to the process of health education and stimulation of the target audience's role in self- care and health management, and their use is recommended by the World Health Organization, which considers the various determinants and authors involved in the person's health old woman.

Objetivo: Construir y validar una guía educativa para promover la estimulación cognitiva en el adulto mayor. Método: Los pasos para la elaboración del material educativo consistieron en la sistematización del contenido, a través del análisis narrativo de la literatura. Después de revisar y definir el contenido, se propusieron las ilustraciones, maquetación y diseño con la diagramación de la guía didáctica. La versión preliminar pasó por un proceso de validación, utilizando un formulario para analizar el contenido, lenguaje y diseño. Contó con la colaboración de ocho jueces con conocimientos en envejecimiento, cognición, educación para la salud, tecnologías educativas y/o validación de instrumentos. Luego de este paso, se realizaron las modificaciones y se realizó la maquetación y versión final de la guía. Resultados: La guía fue validada a través del Índice de Validez de Contenido, con una puntuación de 0,83. Los jueces hicieron consideraciones sobre la reducción del contenido teórico, disposición y uso de las ilustraciones, cambios en la disposición y diseño, y cambios en los términos. La guía ha sido corregida y su versión final contiene sesenta páginas, con un tamaño A4 de 21cmx29,7cm, que incluye la contribución técnico-científica sobre el envejecimiento, el envejecimiento activo, la cognición, la estimulación cognitiva y las funciones cognitivas, incluyendo pautas, actividades de selección y las principales funciones cognitivas que serían estimuladas a través de las actividades propuestas. Conclusión: Materiales como estos contribuyen al proceso de educación en salud y estimulación del papel del público objetivo en el autocuidado y gestión de la salud, y su uso es recomendado por la Organización Mundial de la Salud, que considera los diversos determinantes y autores involucrados en la vida de la persona anciana de salud.

A comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction can modify BDNF levels and improve cognition in adults over 50: a randomized controlled pilot study.

OBJECTIVES: To analyze the effect of a comprehensive program of cognitive stimulation with digital inclusion, physical activity and social interaction, called "Oficina da Lembrança" (OL), on the cognitive status and concentration of biomarkers of neuroplasticity, neurodegeneration in adults aged 50 years and over attending a Memory Clinic. METHODS: In this pilot randomized controlled study, 64 patients without dementia aged 45 to 79 years, seen at a University Memory Clinic in Southern Brazil, were randomly allocated to the intervention and control groups. The intervention consisted of participation in OL for 12 weeks. Serum biomarkers (brain-derived neurotrophic factor [BDNF], S100ß, and neuron-specific enolase [NSE]) and cognitive status were analyzed as primary and secondary outcomes. The Wilcoxon test and Generalized Estimating Equations (GEE) were applied. RESULTS: Of the 64 patients invited to participate in the study, 33 (intervention: 17, control: 16) completed the study with all data. Improvement of cognitive status was significant in the intervention group (22.6 to 24.5) but not in the control group (20.1 to 21.1). There was a significant reduction of BDNF in OL participants, but no significant change was observed in the neurodegenerative biomarkers S100ß or NSE. The concentration of BDNF decreased significantly post-OL in the intervention group (-288.1, 95%CI -362.1 to -94.1), even after adjusting for sex, age, and educational level. Cognitive status was significantly improved in OL participants. CONCLUSION: The OL program improved cognitive status, reduced serum BDNF levels, and empowered digitally excluded older adults. There was no effect of this intervention on S100ß or NSE. CLINICAL TRIAL REGISTRATION: This study has a Universal Trial Number (UTN) U1111-1195-2642 and was registered in the Brazilian Clinical Trials Registry (ReBEC), number RBR-38X665.

Design guidelines and usability for cognitive stimulation through technology in Mexican older adults.

To develop software to stimulate cognitive functions of attention, memory, reasoning, planning, language, and perception in Mexican older adults, and to evaluate the usability of software based on system utility, information quality, and interface quality.For the development of the cognitive stimulation software, an inductive-deductive methodology was used in three stages: Analysis (system requirements), design and coding (cognitive stimulation software), evaluation (usability results).The usability of the software was assessed in 89 older adults between the ages of 60 and 84 years, through a usability questionnaire with evidence of reliability and validity.Eight exercises about attention, seven on memory, three on reasoning, one about planning and language, and two on perception were developed. We evaluated the usability of the developed software using the Computer System Usability Questionnaire, obtaining medium-high usability in 76.2% of the participants regarding the system utility, in 77.7% concerning the information quality and, in 84.2% in the interface quality.The software was developed considering aspects of usability and based on changes and losses associated with aging, as well as on the stimulation of cognitive functions related to instrumental activities of daily living, including exercises based on traditional pencil-paper exercises.

O impacto das atividades cognitivas no desempenho no Mini-Mental de idosos octogenários de São João del Rei/MG: um estudo piloto / The impact of cognitive activities in the Mini-Mental performance of octogenarian elderly in the city of São João del Rei/MG: a pilot study

O aumento da população idosa mundial em torno de 600% nos últimos 50 anos trouxe vários desafios. O principal é a adoção de políticas que possam oferecer um envelhecimento saudável, preservando a autonomia dos sujeitos. Entre essas estratégias, a estimulação cognitiva é uma que possui baixo custo operacional e pode otimizar as funções que ainda se encontram preservadas. O objetivo desse estudo piloto retrospectivo foi avaliar o impacto protetivo das práticas de estimulação cognitiva em octogenários da cidade de São João del Rei. Para tanto foram aplicados dois instrumentos de avaliação: o Mini-Mental e um Questionário de Práticas Cognitivas. Os resultados preliminares indicam uma tendência de as práticas cognitivas impactarem positivamente no desempenho no Mini-Mental dos octogenários (p<0.01). Tais resultados têm implicações diretas, sobretudo nas estratégias de baixo custo a serem implementadas com o objetivo de se construírem reservas cognitivas na população recém adentrada na 3ª idade, visando uma maior autonomia na 4ª idade.

The increase in the world's elderly population of around 600% in the last 50 years has brought many challenges. The main one is adopting policies that can offer healthy aging, preserving the subjects' autonomy. Among these strategies, the cognitive stimulation is one that has a low operational cost and can optimize the functions which are still preserved. This retrospective pilot study aimed at evaluating the impact of cognitive stimulation practices on octogenarian elderly in the city of São João del Rei. Therefore, two evaluation instruments were applied: Mini-Mental and a Cognitive Practice Questionnaire. The preliminary results indicate a tendency that the cognitive practices impact positively on the octogenarians' cognitive performance(p<0.01). Such results have direct implications especially on the low-coststrategies to be implemented aiming at building cognitive reserves in the population of the recent 3rd age viewing a bigger autonomy in the 4th age.

Registros de memória: um estudo acerca de aspectos cognitivos pós internação em UTI / Memory records: a study on cognitive aspects after ICU stay

Existem evidências sobre as consequências de curto e longo prazo, de doenças críticas, a partir da internação do paciente em unidade de terapia intensiva (UTI). Mesmo após a alta, o indivíduo pode manifestar sequelas significativas que prejudicam a manutenção de sua qualidade de vida, no que diz respeito às capacidades físicas, cognitivas e psicológicas, fenômeno atualmente conhecido como Síndrome Pós-Cuidados Intensivos (Post-Intensive Care Syndrome-PICS). O estudo buscou avaliar a prevalência de comprometimento cognitivo relacionado a outros fatores inerentes à internação em pacientes sobreviventes da UTI. Trata-se de uma pesquisa de coorte, de caráter retrospectivo e abordagem quanti-qualitativa. Foram analisados dados de pacientes internados em UTI, que passaram por avaliação especializada e realizaram os testes de rastreio Montreal Cognitive Assessmente Escala Hospitalar de Ansiedade e Depressão. A maior parte dos indivíduos apresentou comprometimento cognitivo após internação e se evidenciou que a memória tem principal impacto dentre os aspectos cognitivos mais afetados. O presente estudo tem potencial de contribuir para o conhecimento a respeito de fatores cognitivos relacionados à PICS e suas repercussões. Ademais, a psicologia da saúde e hospitalar tem papel importante como meio de prevenir e/ou minimizar os efeitos da síndrome.

There are evidences about the short and long-term consequences of critical illnesses from the patient's admission to the intensive care unit (UTI), which may manifest, even after medical discharge, significant sequels that impair the maintenance of the individual's quality of life, with regard to physical, cognitive and psychological capacities, currently known as post-intensive care syndrome (PICS). The study sought to assess the prevalence of cognitive impairment related to other factors inherent to hospitalization in ICU surviving patients. This is a retrospective cohort study with a quantitative and qualitative approach. Data from patients admitted to the ICU, who underwent specialized evaluation and realized the Montreal Cognitive Assessment and Hospital Anxiety and Depression Scale tests, were analysed. Most individuals presented cognitive impairment after hospitalization and it was shown that memory has the main impact among the most affected cognitive aspects. The present study has the potential to contribute to the knowledge about cognitive factors related to PICS and their repercussions. In addition, health and hospital psychology have an important role as means of preventing and/or minimizing the effects of the syndrome.

Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial.

OBJECTIVE: The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit. METHODS: A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured. RESULTS: PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden. CONCLUSIONS: CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.

Programa de Enriquecimento Instrumental (PEI) básico em crianças com TDAH e Dislexia / Feuerstein Instrumental Enrichment (FIE) basic in children with ADHD and Dyslexia

Resumo Há evidências da eficácia do Programa de Enriquecimento Instrumental (PEI), versão básica, sobre inteligência, processamento visoespacial e flexibilidade cognitiva. Como tais habilidades podem estar prejudicadas em transtornos do neurodesenvolvimento, como TDAH e dislexia, investigou-se a eficácia do PEI em 22 crianças com tais quadros. Comparou-se o grupo experimental (GE) ao controle pré e pós-intervenção em testes neuropsicológicos, sendo conduzidas até 26 sessões de intervenção. Foi analisada a interação entre grupo e momento e comparadas as diferenças de desempenho entre os dois momentos. Tal comparação revelou maior ganho do GE em duas tarefas de flexibilidade cognitiva com tamanho de efeito grande; em oito medidas com tamanho de efeito moderado (incluindo medidas de inteligência, processamento visoespacial e funções executivas) e em 13 medidas com tamanho de efeito pequeno. O grupo controle apresentou maior ganho apenas em nomeação. Conclui-se que o PEI-básico apresentou efeitos especialmente em flexibilidade cognitiva com crianças com TDAH e dislexia.

Abstract There is evidence of the effectiveness of Feuerstein's Instrumental Enrichment (FIE), basic version, on intelligence, visuospatial processing, and cognitive flexibility. As such skills may be impaired in neurodevelopmental disorders such as ADHD and dyslexia, their efficacy was investigated in 22 children with such conditions. The experimental group (EG) was compared to pre and post-intervention control in neuropsychological tests, in up to 26 intervention sessions. Interaction between group and moment was analyzed, and performance differences between the two moments were compared. Such a comparison revealed greater gain of the EG in two tasks of cognitive flexibility with large effect size; in eight measures with moderate effect size (including intelligence measures, visuospatial processing and executive functions) and in 13 measures with small effect size. The control group presented greater gain only in appointment. It is concluded that PEI-basic showed effects especially in cognitive flexibility with children with ADHD and dyslexia.

Randomized Controlled Trial of Multi-Component Cognitive Stimulation Therapy (SADEM) in Community-Dwelling Demented Adults.

BACKGROUND: Dementia is a persistent, progressive state of cognitive decline against which pharmacological intervention has a modest efficacy, reducing behavioral but not cognitive symptoms. Therefore, different non-pharmacological therapies have been developed; the most scientifically recognized are cognitive therapies that have improved cognitive function and daily life activities. OBJECTIVE: To evaluate the effectiveness of a multicomponent cognitive stimulation therapy (SADEM) on cognitive and behavioral function and daily life activities in patients with mild stage dementia. METHODS: Controlled clinical trial with pre- and post-intervention (12 months) and follow-up (24 months after) evaluations. Participants (67) diagnosed with mild dementia were randomly assigned to intervention group (n = 39) or control group (n = 28). The intervention took place throughout one year and consisted of two weekly 90-minute sessions and one more a year after a monthly follow-up. Instruments were used to evaluate outcomes in cognitive, behavioral, and affective domains. RESULTS: The results showed statistically significant differences, with improvement in the cognitive outcomes and the Dementia Index post-intervention (p = 0.01). No progression of the disease was observed at the end of the study. CONCLUSION: The multicomponent intervention tested had positive effects on cognitive and behavioral functions and daily life activities in people with mild stage dementia, delaying progression for at least two years.

Reflexiones sobre rehabilitación vestibular a propósito de un caso con uso de paradigma de tareas dobles / Insights on vestibular rehabilitation concerning one case with the use of dual task paradigm

Resumen Se presenta una reflexión producto de la introducción del paradigma de tareas dobles en el abordaje terapéutico en un caso de vestibulopatía unilateral periférica. Se aplicaron pautas de autovaloración de la discapacidad y riesgo de caídas, complementándose con una completa evaluación del equilibrio funcional y la marcha. Se planificó una terapia personalizada, jerarquizándose objetivos con un criterio funcional. Se incorporó el paradigma de tareas dobles, incluyéndose tareas cognitivas simples a la terapia tradicional de rehabilitación vestibular, con el fin de reducir la influencia cortical sobre la ejecución motora, potenciar la ganancia y funcionalidad de los reflejos remanentes, estimular funciones cognitivas superiores y potenciar procesos atencionales subyacentes, necesarios para lograr la compensación. Los resultados de la reevaluación mostraron una evolución favorable, con remisión de la sintomatología, disminución significativa de los puntajes obtenidos en las diferentes pautas empleadas y una mejoría subjetiva en el equilibrio y marcha funcional después de la terapia. Lo anterior se asoció a la recuperación de la autonomía e independencia para la ejecución de actividades diarias, incidiendo favorablemente en la calidad de vida de la paciente. Los hallazgos confirman los beneficios del programa de rehabilitación vestibular diseñado. Se requieren estudios adicionales, orientados a evidenciar y corroborar el impacto específico de la incorporación del paradigma de tareas dobles en la rehabilitación de los trastornos del equilibrio y especialmente, en procesos de estimulación o rehabilitación vestibular en adultos mayores.

Abstract This article presents the analysis and reflections evoked from an experience in vestibular rehabilitation with the introduction of the paradigm of dual task in a unilateral peripheral vestibulopathy case. First, disability self-assessment guidelines, risk of falls scales and assessment tools of functional balance and gait were applied in order to determine the main symptoms and the main difficulties observed. Afterwards, a personalized therapy was planned, in which work objectives were hierarchized based on a functional criterion, introducing "dual-task" strategies as tools for diminish cortical influence on motor performances, allowing the automation of the required task; enhance the gain and functionality of the remaining reflexes, especially vestibulo ocular and vestibulospinal reflex and stimulate superior cognitive functions and underlying attentional processes, necessary to achieve central compensation. The final assessment showed a favorable evolution, with a significant decrease in the after-therapy scores obtained in fear of falling and disability self-perception protocols, before and after therapy and, finally, an improvement in functional balance and gait, through the pre and post therapy performance in the timed up and go and assessment of unipedal stand tests. This allowed the patient to regain her autonomy and independence in daily life activities improving her quality of life, confirming the benefits of the designed vestibular rehabilitation program. However, more studies are needed to corroborate the specific contribution of the dual-task paradigm in vestibular rehabilitation and specially, in vestibular stimulation or rehabilitation processes in older adults.

Envejecimiento saludable basado en el fortalecimiento de las capacidades cognitivas y el reforzamiento de prácticas saludables de un grupo de personas adultas mayores / Healthy aging based on the strengthening of cognitive abilities and the reinforcement of healthy practices of a group of older adults

Resumen Objetivo: fortalecer las capacidades cognitivas orientadas a un envejecimiento saludable desde el enfoque de promoción de la salud en un grupo de personas adultas mayores (PAM) adscritas a la Clínica Integrada de Tibás, 2018. Metodología: enfoque mixto, diseño preexperimental basado en una prueba/posprueba con un solo grupo. La población de estudio fueron las PAM adscritas a la Clínica, la muestra fue de 24 participantes, todos voluntarios. Resultados: en la fase diagnóstica, la aplicación del MoCA mostró que los dominios con menores puntajes son los señalados en otras investigaciones como las capacidades cognitivas más afectadas en las PAM. Por otra parte, el Índice de Kazt evidenció que la mayoría del grupo no tiene incapacidad. Respecto a las percepciones sobre el proceso de envejecimiento, se observó que el 80 % de las PAM poseen conocimientos similares a los contemplados para este trabajo, asimismo, un 90 % identifica los mitos y estereotipos de la vejez, además, se lograron identificar varios cambios respecto al inicio del proceso. Conclusiones: las estrategias y técnicas implementadas en el proceso de aprendizaje permitieron que la población se apropiará de los temas, reforzara capacidades cognitivas y adoptara prácticas saludables, esto se aprecia en los cambios reflejados en las evaluaciones ex post. La investigación evidenció que las prácticas saludables y capacidades cognitivas se pueden promover desde líneas de promoción de la salud como lo son la creación de entornos saludables, el desarrollo de habilidades y actitudes personales.

Abstract Objective: to strengthen the cognitive capacities oriented to a healthy aging from the Health Promotion focus in a group of elderly people ascribed to the Clínica Integrada de Tibás, 2018. Methodology: mixed approach, preexperimental desing based on a test/post test with a single group. The study population were the elderly people ascribed to the Clinica Integrada de Tibás, the target population: 24, all volunteers. Results: in the diagnosis phase, the application of the MoCA shows that the lower scores are those indicated in other studies as the most affected cognitive capacities in the older adults. In addition, the Indice de KATZ showed that the majority of the group does not have any disabilities. Regarding the subject of perceptions about the aging process, it was observed that 80% of the participants possesses knowledge similar to the one contemplated for this study, and 90% identifies the myths and stereotypes of the aging process. Conclusions: The strategies and techniques implemented in the learning process allowed the population to appropriate each of the topics, reinforce certain cognitive capacities and adopt healthy practices, which can be seen in the changes reflected in the ex post evaluations, since they show an increase in the MoCA results and greater amplitude of knowledge. Finally, this study reinforces that the topic of healthy practices and cognitive capacities can be promoted from the lines of health promotion: creation of healthy environments and development of personal skills and attitudes.