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Background: The mechanisms through which acculturation influences the onset of cognitive impairment and dementia are not well understood, especially among older Hispanics. Objective: To investigate whether inflammation and psycho-behavioral factors mediate the relationship between acculturation and incident dementia among older Mexican Americans. Methods: We analyzed the Sacramento Area Latino Study on Aging (1998-2007, SALSA), a longitudinal study (N = 1,194) with 10 years of follow-up, and used g-computation for mediation analysis with pooled logistic regression to evaluate whether acculturation (assessed by the Revised Acculturation Rating Scale for Mexican Americans [ARSMA-II]) affected dementia or cognitive impairment but not dementia (CIND) through inflammation (i.e., interleukin 6 [IL-6], tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein [hs-CRP]), smoking, alcohol consumption, and depressive symptoms. The potential mediators were assessed at baseline. Results: The 10-year average adjusted risk ratio (aRR) for the effect of high U.S. acculturation and dementia/CIND was 0.66, 95% CI (0.36, 1.30). The indirect effects were: IL-6 (aRR = 0.98, 95% CI (0.88, 1.05)); TNF-α (aRR:0.99, 95% CI (0.93, 1.05)); hs-CRP: (aRR = 1.21, 95% CI (0.84, 1.95)); current smoking: aRR = 0.97, 95% CI (0.84, 1.16); daily/weekly alcohol consumption (aRR = 1.00, 95% CI (0.96, 1.05)); and depressive symptom score (aRR = 1.03, 95% CI (0.95, 1.26)). Hs-CRP yielded a proportion mediated of -26%, suggesting that hs-CRP could suppress the potential effect of high U.S. acculturation. The other factors explored resulted in little to no mediation. Conclusions: The effect of acculturation on time to incident dementia/CIND varied over time. Our study suggests that inflammation could suppress the effect between high U.S. acculturation and dementia risk.

Asunto(s)

Aculturación , Demencia , Inflamación , Americanos Mexicanos , Humanos , Demencia/etnología , Demencia/epidemiología , Demencia/psicología , Americanos Mexicanos/psicología , Americanos Mexicanos/estadística & datos numéricos , Masculino , Femenino , Anciano , Inflamación/sangre , Inflamación/etnología , Inflamación/psicología , Estudios Longitudinales , Anciano de 80 o más Años , Incidencia , Factores de Riesgo , Proteína C-Reactiva/metabolismo , Depresión/etnología , Depresión/psicología , Depresión/epidemiología , Interleucina-6/sangre

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Background: The assumption that hearing rehabilitation could improve quality of life and reduce dementia risk in people with hearing loss is a subject that needs further studies, especially clinical trials. It is necessary to determine the effects of hearing aid use, as part of hearing rehabilitation, among people diagnosed with dementia. Objective: To systematically review the literature to evaluate the effects of hearing aid use on cognition and quality of life of people with dementia. Methods: Protocol for this systematic review was registered (CRD42023387187). The Cochrane Central Register of Controlled Trials, Embase, MEDLINE, Scopus, CINAHL, and Web of Science databases, as well as grey literature, including Google Scholar and ResearchGate, were systematically searched for clinical trials using MeSH terms. The PICOS principle was used to develop the inclusion criteria: population (P): adults and older adults, individuals diagnosed with dementia and hearing loss; intervention (I): rehabilitation with hearing aids; control (C): not using a hearing aid; outcome (O): cognitive and/or quality of life assessment using validated tests; study design (S): clinical trial. Results: The initial search yielded 576 studies, five of which met the inclusion criteria for qualitative analyses. Two of the included studies were randomized clinical trials, and three were crossover clinical trials, demonstrating the lack of studies on the subject. Four studies included participants with Alzheimer's disease. Quality of life was found to improve with the use of hearing aids, and hearing rehabilitation was not shown to affect cognitive outcomes. Conclusions: Hearing aid use appears to have a positive impact on quality of life.

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Demencia , Audífonos , Pérdida Auditiva , Calidad de Vida , Humanos , Demencia/psicología , Demencia/rehabilitación , Pérdida Auditiva/rehabilitación , Pérdida Auditiva/psicología , Calidad de Vida/psicología , Cognición

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INTRODUCTION: People caring for patients with dementia are prone to suffering from burden. Behavioral and psychological symptoms of dementia (BPSD) may have an impact on caregiver burden. In Latin American countries, there is a lack of research on caregiver burden. We aimed to determine which BPSD have the greatest impact on caregiver burden among Peruvian patients with dementia and to compare the effects of BPSD on caregiver burden across different types of dementia. METHODS: A cross-sectional study was conducted on 231 patients living with Alzheimer's dementia (AD), behavioral variant frontotemporal dementia (bvFTD), dementia with Lewy bodies (DLB), and vascular dementia (VD) and their caregivers who attended a Peruvian memory clinic. BPSD were assessed with the Neuropsychiatric Inventory (NPI). Caregiver burden was assessed with the Zarit Burden Inventory. We used analysis of variance to compare the AD, bvFTD, DLB, and VD groups. Correlations between Zarit Burden Inventory and NPI subscale scores were assessed with Spearman's correlation. RESULTS: DLB caregivers had significantly higher levels of burden than the other patient groups (p < 0.05) and higher total NPI scores than caregivers for other patient groups (p < 0.05). bvFTD caregivers had significantly higher total NPI scores than AD and VD caregivers (p < 0.05). Hallucinations, aberrant motor behavior, and apathy were the symptoms most significantly correlated with caregiver burden in those caring for DLB, bvFTD, and AD patients, respectively. CONCLUSION: Neuropsychiatric symptoms are higher in DLB caregivers. Hallucinations, aberrant motor behavior, and apathy are the main symptoms correlated with burden.

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Carga del Cuidador , Cuidadores , Demencia , Humanos , Masculino , Femenino , Perú , Estudios Transversales , Anciano , Demencia/psicología , Persona de Mediana Edad , Carga del Cuidador/psicología , Cuidadores/psicología , Pruebas Neuropsicológicas , Enfermedad por Cuerpos de Lewy/psicología , Demencia Vascular/psicología , Enfermedad de Alzheimer/psicología , Demencia Frontotemporal/psicología , Anciano de 80 o más Años , Costo de Enfermedad , Síntomas Conductuales/psicología

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Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.

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Actividades Cotidianas , Demencia , Humanos , Demencia/diagnóstico , Demencia/psicología , Actividades Cotidianas/psicología , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Pruebas Neuropsicológicas , Envejecimiento/psicología , Envejecimiento/fisiología

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Background: Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective: To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods: This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61). Results: In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07). Conclusions: In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year.

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COVID-19 , Demencia , Humanos , Cuidadores/psicología , Pandemias , Salud Mental , Demencia/epidemiología , Demencia/psicología , Estudios de Seguimiento , Chile/epidemiología , Brasil/epidemiología , COVID-19/epidemiología

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OBJECTIVES: We explored views of care home managers when introducing PROCUIDA-Demencia a mixed-methods two-arm cluster randomised controlled pilot and clinical outcomes study aiming to optimise dementia care by introducing psychosocial interventions to reduce antipsychotic medication in care homes. METHOD: We undertook secondary analysis of pre and post in-depth interviews conducted in summer 2018 with not-for-profit care home managers in Mexico who were allocated to the intervention group. Transcribed data were thematically analysed. Themes were mapped out with RE-AIM quality appraisal framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) as preliminary evaluation to identify practice and future intervention development and evaluation. RESULTS: Two pre- and three post-intervention themes were constructed. Participants reported measurable positive impact; one home built a new specialist dementia care unit and others hired a psychologist and psychiatrist to sustain the changes. Antipsychotic medication was reduced for some participating residents which also minimised cost burden on family members. CONCLUSION: Funding, systemic working across families, clinical and social teams and effective systems of governance are urgently required to sustain models like PROCUIDA-Demencia. The RE-AIM preliminary evaluation outlined care home managers' long-term sustainable practice and positive impact on the dementia care system. These findings might inform staff retention strategies and care home systemic care practices. This evaluation is contributing to the Mexican Alzheimer's and other dementias plan.

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Antipsicóticos , Demencia , Humanos , Antipsicóticos/uso terapéutico , Demencia/tratamiento farmacológico , Demencia/psicología , México , Casas de Salud , Evaluación de Programas y Proyectos de Salud , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto

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There are doubts about vehicle driving restriction for patients with Alzheimer's disease. A scoping review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-ScR) methodology. Relevant databases were searched for articles published between 2000 and 2022 in English, Spanish, or Portuguese. Articles were included if they specifically addressed driving, risk of accidents, permission or licence to drive a motor vehicle in a context of important cognitive decline, or if addressed traffic legislation on driving and dementia. Twenty-three articles were selected for full reading, six of which were observational studies and only one with an interventionist method. All articles were carried out in high-income countries such as the UK, the US, and Australia. As a conclusion, there is no psychometric test in the literature sensitive enough to assess vehicle driving competence in older adults with cognitive deficits. Based on selected studies, there is no robust evidence to make recommendation for or against the cessation of vehicular driving for patients with mild cognitive decline or with mild dementia. In some situations, vehicle driving cessation can impact patients and their families. In addition, legal regulations regarding vehicle driving for older adults and people with dementia are scarce worldwide. Despite the scarcity of studies addressing the theme of vehicle driving in the context of dementia, there is some level of consensual reasoning that patients with moderate to severe dementia should halt driving activities, but the same does not apply for patients with mild levels of cognitive impairment, including mild dementia.

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Enfermedad de Alzheimer , Conducción de Automóvil , Anciano , Humanos , Enfermedad de Alzheimer/diagnóstico , Trastornos del Conocimiento , Disfunción Cognitiva/diagnóstico , Demencia/diagnóstico , Demencia/psicología , Estudios Observacionales como Asunto

RESUMEN

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.

Asunto(s)

Cuidadores , Demencia , Humanos , Cuidadores/psicología , Calidad de Vida , Actividades Cotidianas , Brasil , Cognición/fisiología , Demencia/terapia , Demencia/psicología

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INTRODUCTION: Worldwide, the prevalence of degenerative diseases such as dementia and mild cognitive impairment (MCI) is increasing with population ageing and increasing life expectancy. Both conditions share modifiable risk factors. Physical inactivity is one of these modifiable risk factors, and research points to the protective effect of physical activity on the incidence of dementia and MCI. However, this association tends to change according to type, intensity, frequency, duration and volume of physical activity. Furthermore, it remains unclear which of these characteristics offers the greatest protective effect. Therefore, this study aims to evaluate the impacts of different types, intensities, frequencies, duration and volume of physical activity on dementia and cognitive decline in older adults. METHODS AND ANALYSIS: The search will be carried out from October 2023, using the following databases: PubMed, Embase, Scopus, CINAHL and Web of Science. Cohort studies with a follow-up time of 1 year or longer that have investigated the incidence of dementia and/or MCI in older adults exposed to physical activity will be included. There will be no limitations on the date of publication of the studies. Studies published in English, Spanish or Portuguese will be analysed. Two researchers will independently screen the articles and extract the data. Any discrepancies will be resolved by a third reviewer. Association measures will be quantified, including OR, HR, relative risk and incidence ratio, with a 95% CI. If the data allow, a meta-analysis will be performed. To assess the methodological quality of the selected studies, the Grading of Recommendations, Assessment, Development and Evaluations instrument, and the Downs and Black instrument to assess the risk of bias, will be used. ETHICS AND DISSEMINATION: Ethical approval is not required. The results will be submitted for publication in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42023400411.

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Disfunción Cognitiva , Demencia , Humanos , Anciano , Revisiones Sistemáticas como Asunto , Metaanálisis como Asunto , Disfunción Cognitiva/epidemiología , Demencia/epidemiología , Demencia/prevención & control , Demencia/psicología , Ejercicio Físico

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Dementia is currently one of the most common diseases affecting elderly people, ranking seventh among leading causes of death. As it causes memory loss, difficulties in reasoning, and resulting difficulties in making and executing decisions, assistive technologies and cognitive stimulation are valuable resources in the care process. Based on a theoretical inquiry into the bioethics of health care, and drawing on the work of Aline Albuquerque and Victor Montori, this article focuses on three main issues: first, the concept of bioethics in health care, patient-centered care, and the idea of clinical empathy. Second, it looks at the use of assistive technologies in caring for elderly patients with dementia. Lastly, we offer a discussion of whether the care process could be considered a health technology.

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La demencia es actualmente una de las enfermedades más comunes que afecta a las personas mayores, siendo la séptima causa principal de muerte. Provoca pérdida de memoria, dificultad para razonar y, por consiguiente, dificultades para tomar y ejecutar decisiones, por lo que las tecnologías de asistencia y estimulación cognitiva son valiosos recursos en el proceso de cuidado. Desde una investigación teórica basada en la bioética de los cuidados en salud y en las investigaciones de Aline Albuquerque y Victor Montori, este artículo aborda, en primer lugar, el concepto de bioética en el cuidado de la salud, la atención centrada en el paciente y la idea de empatía clínica; en segundo lugar, se centra en el empleo de tecnologías asistivas para el cuidado de adultos mayores con demencia y, por último, plantea la discusión sobre si el proceso de atención podría ser considerado como una tecnología sanitaria.

Asunto(s)

Bioética , Demencia , Dispositivos de Autoayuda , Humanos , Anciano , Demencia/terapia , Demencia/psicología , Instituciones de Salud , Atención a la Salud

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BACKGROUND: Older people are at risk of malnutrition, especially when they suffer from cognitive impairment. Guidelines that orient nursing care in this regard need to be updated. The aim of this review is to address the best available evidence on interventions that can benefit nutritional nursing care for institutionalized older adults with dementia. METHODS: Integrative review using the Dimensions and Eureka search engines, and the PubMed, Embase, Scielo, CINAHL, and ScienceDirect databases. We searched from the year 2015 through to 2021. We employed the MMAT guidelines for mixed, qualitative, and quantitative studies, and the PRISMA, CASP, and JBI guidelines to value the reviews. RESULTS: A total of 55 studies met the inclusion criteria. The best available evidence to support nutritional nursing care for institutionalized older adults with dementia highlights several aspects related to the assessment and caring interventions that are focused on people with dementia, their caregivers, and their context. CONCLUSIONS: Both the assessment and nutritional care interventions for older people with dementia should consider the patient-caregiver dyad as the subject of care and understand the context as a fundamental part of it. The analysis of the context should look further than the immediate environment.

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Disfunción Cognitiva , Demencia , Desnutrición , Humanos , Anciano , Demencia/psicología , Cuidadores/psicología , Desnutrición/terapia , Institucionalización

RESUMEN

Introducción: la demencia es la alteración cognitiva con mayor incidencia. Provoca una disminución de las capacidades físicas y mentales. Las habilidades y conocimientos del cuidador familiar tienen un papel importante para entender las necesidades, fortalezas y limitaciones en el cuidado. Objetivo: establecer la relación entre los conocimientos y las habilidades en cuidados del cuidador familiar del adulto mayor con demencia. Metodología: estudio cuantitativo, transversal, prospectivo y con alcance correlacional. Muestra no aleatoria por disponibilidad de 26 cuidadores. Se aplicó la Escala de conocimientos sobre demencia DKAT2-sp con alfa de Cronbach de 0.79 y el Inventario de habilidad de cuidado-CAI con alfa de Cronbach de 0.84. Resultados: el género predominante fue el femenino. Los resultados de la prueba Rho de Spearman (p = 0.149) comprobaron que no existe relación y mostraron un nivel de significación mayor que lo esperado entre el conocimiento y la habilidad. Los familiares de personas con demencia cumplen con otros roles diferentes, además de que no reciben capacitación; tienen conocimientos altos y moderados con habilidades de cuidado medias y altas. Conclusión: los niveles de habilidad y conocimiento no son insuficientes; no existe una relación entre las variables de estudio.

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Introduction: Dementia is the cognitive disorder with the higher incidence. It causes a decrease in physical and mental abilities. The skills and knowledge of the family caregiver comprise an important role in understanding the needs, strengths and limitations in care. Objective: To establish the relationship between knowledge and skills of the family caregiver of the elderly with dementia. Methodology: Study with a quantitative, cross-sectional, prospective approach and correlational scope. Non-random sample due to availability of 26 caregivers. The DKAT2-sp Dementia Knowledge Scale (with 0.79 Cronbach's alpha) and the Care Skills Inventory-CAI instrument (0.84 Cronbach's alpha) were applied. Results: The predominant gender was female. The results of the Spearman's Rho test (p = 0.149) confirmed that there is no relationship, showing a higher level of significance than expected between knowledge and ability. Family members of people with dementia fulfill other different roles, in addition to not receiving training; they have high and moderate knowledge with medium and high care skills. Conclusion: The skill and knowledge levels are not insufficient, demonstrating that there is no relationship between the variables.

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Humanos , Masculino , Femenino , Cuidadores/educación , Cuidadores/estadística & datos numéricos , Demencia/psicología , Aptitud , Factores Socioeconómicos , Encuestas y Cuestionarios

RESUMEN

BACKGROUND AND OBJECTIVES: Since its first implementation in 1998, evidence has been presented of the positive impact of the TimeSlips storytelling method for people with dementia in long-term care (LTC) settings. This article extends this evidence in important new directions: it is the longest TimeSlips study to date and the first to evaluate the feasibility of online delivery of the method (in response to the coronavirus disease 2019 [COVID-19] quarantine) and the impact of this on the personhood, quality of life, and psychological well-being of Spanish-speaking participants in non-LTC settings in the Global South. RESEARCH DESIGN AND METHODS: Trained facilitators provided weekly, 1-hr TimeSlips sessions via Zoom over 32 consecutive weeks to 8 participants with dementia. Semistructured interviews of participants and care partners were conducted within 1 week of the final intervention. Thematic analysis evaluated the resultant qualitative data. RESULTS: This online implementation of the TimeSlips creative expression (CE) method reinforced key facets of participants' personhood (self-expression and self-perception, which led in turn to increased care partner appreciation), had a positive impact on key domains of quality of life (mood, energy levels, and cognitive function), and stimulated a key aspect of psychological well-being (the formation and maintenance of social ties). DISCUSSION AND IMPLICATIONS: The online delivery of the TimeSlips method to participants who remain in their own homes is feasible and effective. Future research should compare the benefits of online versus face-to-face delivery of this CE method.

Asunto(s)

COVID-19 , Demencia , Humanos , Demencia/psicología , Calidad de Vida , Colombia , Cuarentena

RESUMEN

BACKGROUND: Telehealth can be an alternative action at a distance that can help as a form of motor intervention, alleviating the deleterious effects arising from social distancing on functional capacity, mental health and quality of life among older people with dementia during the COVID-19 pandemic. PURPOSE: We aim to analyze the effects of a telehealth program on functional capacity, mental health and quality of life among older people with dementia and their caregivers. METHODS: seventy-eight individuals with mild and moderate dementia and their caregivers will answer an anamnesis and be evaluated through Clinical Dementia Assessment Score. They will also be evaluated by blinded examiners in terms of functional capacity (Activities of Daily Living Questionnaire and World Health Organization Disability Assessment Schedule 2.0), mental health (Mini-Mental State Examination, Clock Drawing Test, Verbal Fluency test and the Neuropsychiatric Inventor) and quality of life (Quality of Life in Alzheimer's Disease scale). Afterward, the volunteers will be randomized into the telehealth training group and the control group. The TR will perform systematic physical and cognitive exercises in 50-min sessions three times a week with professional monitoring, while the CG will receive non-systematized guidance, both for 12 weeks. Participants will be evaluated at baseline, immediately after the three-month interventions and with a 12-week follow- up. DISCUSSION: Technological approaches such as telehealth can be a viable alternative in home care service during times of pandemic. We expect that older people with dementia and their caregivers have high adherence to the telehealth program and improve their functional capacity, mental health and quality of life of older people with dementia. Telehealth is an alternative that can contribute to public policies and the development of effective intervention strategies that neutralize adverse outcomes. It can also be presented as an alternative to home care services, which could reduce demands for health resources.

Asunto(s)

COVID-19 , Demencia , Telemedicina , Anciano , Humanos , Actividades Cotidianas , Cuidadores , Demencia/psicología , Salud Mental , Pandemias , Calidad de Vida/psicología , Ensayos Clínicos Controlados Aleatorios como Asunto , Telemedicina/métodos

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OBJECTIVES: To investigate the presence of awareness of changes in relationships domain, and additional subdomains (cognitive, emotional and functional status) in a group of participants with dementia. METHOD: Using a qualitative design, 9 participants with mild and moderate dementia attended in a day care center were interviewed. Analyses were implemented throughout the modified version of the Grounded Theory Method. RESULTS: Some participants well-recognized changes in their relationships, albeit a tendency to immediately deny those changes was observed among them. The participants' reports showed that the kind of familiar or social relationship might facilitate the expression of awareness. Less discomfort in social interactions with familiars and friends compared to embarrassment with unfamiliar relationships were described. All participants could partially recognize their cognitive deficits, although attempts to normalize their condition and minimize difficulties were identified. Only two participants partially recognized changes in all investigated domains. The other participants partially described changes in two domains beyond the cognitive domain, such as relationships and emotional status or emotional and functional status. However, answers concerning emotional status reflected that some coping styles were not related to a general condition. CONCLUSION: The relationship domain may provide a valuable perspective of awareness of disease. People with dementia may feel less embarrassed to recognize deficits in the presence of familiars and friends.

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Disfunción Cognitiva , Demencia , Humanos , Demencia/psicología , Relaciones Interpersonales , Emociones , Adaptación Psicológica , Concienciación

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RESUMO. A autonomia privada existencial, como expressão da dignidade da pessoa humana, representa para o indivíduo a possibilidade de agir em conformidade com valores e significados eleitos essenciais na elaboração do seu projeto de vida. Neste estudo, seus autores, dois terapeutas ocupacionais, dois advogados e uma psicóloga, somam saberes e dialogam com intuito de demarcar a relevância da autonomia privada existencial nas condições de demência avançada, nos estados vegetativos permanentes e na iminência de morte. Na tarefa a que se propõem, os autores ponderam sobre suas experimentações e interlocuções enquanto profissionais de formação acadêmica diversificada, inclinados a ofertar espaços para comunicar vida e acolher dores. São apresentadas e discutidas as bases jurídicas da autonomia privada, assim como os pressupostos da Logoterapia de Viktor Frankl em defesa da liberdade de vontade e da dignidade no final da vida.

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RESUMEN La autonomía existencial privada, como expresión de la dignidad de la persona humana, representa para el individuo la posibilidad de actuar de acuerdo con valores y significados elegidos esenciales en la elaboración de su proyecto de vida. En este estudio, sus autores, dos terapeutas ocupacionales, dos abogados y un psicólogo suman conocimiento y diálogo con el fin de demarcar la relevancia de la autonomía privada existencial en condiciones de demencia avanzada, en estados vegetativos permanentes y muerte inminente. En la tarea que proponen, los autores reflexionan sobre sus vivencias e interlocuciones como profesionales con una formación académica diversificada, inclinados a ofrecer espacios para comunicar la vida y acoger el dolor. Se presentan y discuten las bases legales de la autonomía privada, así como los supuestos de la Logoterapia de Viktor Frankl en defensa de la libertad de voluntad y dignidad al final de la vida.

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ABSTRACT. Existential private autonomy, as an expression of the dignity of the human person, represents for the individual the possibility of acting in accordance with essential values and meanings for elaboration of their life project. The authors of this study, two occupational therapists, two lawyers and a psychologist gather their knowledge and dialogue to demarcate the relevance of existential private autonomy in conditions of advanced dementia, in permanent vegetative states and imminent death. In the task proposed, the authors pondered over their experiences and dialogues as professionals with a diversified academic background, inclined to provide spaces to communicate life and welcome pain. The legal bases of private autonomy are presented and discussed, as well as the assumptions of Viktor Frankl's Logotherapy in defense of freedom of will and dignity at the end of life.

Asunto(s)

Derecho a Morir/ética , Estado Vegetativo Persistente/psicología , Demencia/psicología , Logoterapia/educación , Psicología , Volición , Autonomía Personal , Técnicos Medios en Salud/educación , Ética , Libertad , Respeto , Logoterapia/legislación & jurisprudencia , Logoterapia/ética , Derechos Humanos/legislación & jurisprudencia

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BACKGROUND: Modifiable risk factors exert crucial impact on dementia. OBJECTIVE: We sought to answer the question: do two modifiable risk factors, schooling level and physical activity (PA), affect cognitive function similarly in each sex? METHODS: This cross-sectional study was conducted in 2019 and 2021, and the survey was applied to the residents of the metropolitan area of Santos, a seashore of Sao Paulo State. Four hundred and twenty-two participants (women = 254 and men = 168) were eligible. Baecke questionnaire for the elderly was applied for the classification as physically inactive (PI) or active (PA). Cognitive function was assessed by the Mini-Mental State Examination (MMSE) and the Clinical Dementia Rating (CDR). Participants were also stratified by schooling status for both sexes. RESULTS: Higher education had a sex-independent positive influence on MMSE and CDR (p < 0.001). PA influences positively MMSE in older women (PI: 25±5 and PA: 27±3, p < 0.03), but has no effect in older men (26±5 and 25±5, p > 0.05). Concordantly, older women who were PA (1.7 and 0 %) showed a lower prevalence of dementia compared with PI (6.2 and 2.1%), for mild and moderate respectively. Active older women had higher odds of improving the MMSE score (OR: 1.093; 95% CI: 1.008-1.186) than men (OR: 0.97 (95% CI: 0.896-1.051). CONCLUSION: Education affects cognitive function equally in Brazilian elderly whereas older women are more responsive to the beneficial effects of PA for dementia than men.

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Demencia , Masculino , Humanos , Femenino , Anciano , Brasil/epidemiología , Estudios Transversales , Demencia/psicología , Escolaridad , Ejercicio Físico

RESUMEN

BACKGROUND: Dementia is a priority public health issue due to its high prevalence worldwide and its economic, social, and health impact. However, there are few reports in Mexico based on formal tests and with a clinical approach based on the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). OBJECTIVE: This study estimates the prevalence of the main types of dementia among elderly people living in the community in Mexico City. METHODS: A population-based, two-step study was conducted, including 6,204 elderly individuals aged 60 or above with in-home assessment. All participants were screened for cognitive impairment; those who presented some cognitive problem underwent a standardized neurological examination. Each diagnosis was based on the criteria for dementia in the DSM-5, and the final consensus diagnosis of dementia was determined by an expert panel. RESULTS: The global estimated prevalence of dementia in the Mexican population was 7.8% met the criteria for Alzheimer's disease, 4.3% for vascular dementia, and 2.1% for mixed dementia. The prevalence of dementia was higher in women than in men (15.3% versus 12.5%, respectively). CONCLUSION: These results provide evidence to propose strategies for Latin American countries where dementia represents a challenge due to the heterogeneity of the populations and socioeconomic disparities, requiring early diagnosis and at the first levels of care.

Asunto(s)

Enfermedad de Alzheimer , Demencia , Anciano , Envejecimiento , Enfermedad de Alzheimer/diagnóstico , Demencia/diagnóstico , Demencia/epidemiología , Demencia/psicología , Femenino , Humanos , Masculino , México/epidemiología , Prevalencia

RESUMEN

BACKGROUND: Factors associated with sleep quality have not been well examined in hospitalized older persons with dementia, who are at high risk for impaired sleep. The aim was to identify factors associated with sleep quality among hospitalized persons with dementia. METHODS: This secondary analysis used baseline data from a cluster randomized trial. Factors examined included delirium severity, pain, depression, behavioral and psychological symptoms of dementia (BPSD), and daytime physical activity. Multiple stepwise linear regressions evaluated factors related to dimensions of sleep quality (sleep duration, efficiency, latency, and fragmentation; measured by the MotionWatch 8). RESULTS: Increased daytime physical activity was associated with higher sleep duration [ß=0.164; 95% confidence interval (CI), 0.111-0.717; P=0.008; 7.7% variance] and sleep efficiency (ß=0.158; 95% CI, 0.020-0.147; P=0.010; 5.4% variance), and less sleep fragmentation (ß=-0.223; 95% CI, -0.251 to -0.077; P<0.001; 10.4% variance). Higher BPSD was significantly associated with prolonged sleep latency (ß=0.130; 95% CI, 0.098-2.748; P=0.035; 3.7% variance). CONCLUSION: Results suggest the need to encourage daytime physical activity and reduce or manage BPSD to improve sleep quality among hospitalized persons with dementia.

Asunto(s)

Demencia , Calidad del Sueño , Anciano , Anciano de 80 o más Años , Demencia/complicaciones , Demencia/psicología , Hospitalización , Humanos , Agitación Psicomotora , Sueño

RESUMEN

Trata-se de um estudo quantitativo, retrospectivo, correlacional e de corte transversal, com objetivo de fornecer dados normativos do TDR para idosos, levando em consideração diferentes faixas etárias e níveis de escolaridade. Duzentos e trinta e cinco foram entrevistados individualmente, distribuídos em cinco grupos etários e quatro níveis de escolaridade. Os instrumentos foram Ficha de Dados Sociodemográficos, Miniexame do Estado Mental (MEEM), Escala de Depressão Geriátrica, versão reduzida (GDS-15), Tarefa de Fluência Verbal Semântica (TFVS) e o TDR. Utilizou-se estatísticas descritivas, correlação de Pearson e análise univariada (one-way ANOVA) com post hoc Scheffe. Os escores do TDR apresentaram associações significativas com os anos de idade, anos de escolaridade, MEEM, TFVS e GDS-15. Houve diferença de desempenho no TDR ao considerarem os grupos por idade. O estudo fornece valores normativos para o TDR em uma amostra de idosos do sul do Brasil que foram influenciados pela idade, escolaridade, sintomatologia depressiva e fluência verbal. (AU)

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This was a quantitative, retrospective, correlational, cross-sectional study that aimed to provide normative CDT (Clock-Drawing Test) data for older adults, taking into account different age groups and educational levels. The sample included 235 older adults distributed among five age groups and four levels of education. The instruments were Sociodemographic Data Sheet, the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale reduced version (GDS-15), the Semantic Verbal Fluency Task (TFVS), and the CDT. Descriptive statistics, Pearson's correlation, and univariate analysis (one-way ANOVA) with Scheffe post hoc were used. The CDT scores showed significant associations with age, years of schooling, MMSE, TFVS, and GDS-15. There was a difference in performance in CDT when considering age groups. The present study was able to provide normative values ​​for CDT in a sample of older adults in southern Brazil that ​​were influenced by age, education, depressive symptoms, and verbal fluency. (AU)

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Se trata de un estudio cuantitativo, retrospectivo, correlacional y transversal, con el objetivo de aportar datos normativos sobre el TDR para ancianos, teniendo en cuenta diferentes grupos de edad y niveles educativos. La muestra incluyó a 235 ancianos distribuidos en cinco grupos de edad y cuatro niveles de educación. Los instrumentos utilizados fueron Ficha de Datos Sociodemográficos, Mini Examen del Estado Mental (MMSE), Escala de Depresión Geriátrica, versión reducida (GDS-15), Tarea de Fluidez Verbal Semántica (TFVS) y TDR. Se emplearon estadísticas descriptivas, correlación de Pearson y análisis univariante (one-way ANOVA) con post hoc Scheffe. Los puntajes de TDR mostraron asociaciones significativas con la edad, años de escolaridad, MMSE, TFVS y GDS-15. Hubo diferencia en el desempeño en el TDR al considerar los grupos por edad. El presente estudio fue capaz de proporcionar valores normativos para TDR en una muestra de ancianos en el sur de Brasil influenciados por la edad, la escolaridad, los síntomas depresivos y la fluidez verbal. (AU)

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Demencia/psicología , Depresión/psicología , Pruebas Neuropsicológicas , Psicometría , Estudios Transversales/métodos , Entrevistas como Asunto/métodos , Estudios Retrospectivos , Análisis de Varianza , Escala de Fujita-Pearson , Función Ejecutiva , Pruebas de Estado Mental y Demencia , Correlación de Datos , Factores Sociodemográficos