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Introduction: High blood pressure (HBP) is the leading cause of death from cardiovascular disease. Despite the advances, the percentage of undiagnosed and untreated hypertensive patients is 58.4%. The evaluation of cognitive damage in HBP focuses on preventing stroke, while functional damage is ignored. This inadequate management may be multifactorial. The objective was to analyze the opinions that doctors have about the relationship between high blood pressure and cognitive damage. Methodology: Observational, descriptive, cross-sectional study developed in the period between August 2020 and August 2023. Analysis of data obtained from a self-administered, anonymous and voluntary questionnaire. Revealing information on the professional profile, knowledge of HBP, its link with cognitive impairment (CD), diagnosis and treatment. Results: 222 professionals were included, 215 (96.8%) agree with the existence of a link between HBP and other cardiovascular risk factors in CD, and 218 (98.1%) acknowledge assisting patients at risk of suffering from CD. The CD evaluation is carried out in selected cases by 132 (59.4%) participants and 59 (26.7%) always do it. Of those who perform evaluation, 103 (54%) use the Mini Mental State Examination (MMSE), 10 (5.2%) use the Montreal Cognitive Assessment (MoCA) and 9 (4.7%) use the Clock Drawing Test. Regarding the decrease in blood pressure in elderly patients and the link with risk of CD: 54 (24.3%) do not recognize risk and 65 (29.2%) recognize a moderate-high risk. In reference to the implication of the treatment of cardiovascular disease and CD: 217 (97.7%) recognized a beneficial effect. Discussion: Given the recognition of the link between HBP and CD, it would be expected that CD would be investigated in the vast majority, however only 26.7% always evaluate it. There is no consensus on the method, the MMSE being the most used, with a low application of the MoCA test and/or Clock Drawing Test, the latter being the ones that evaluate executive function, mostly altered in CD linked to HBP. Although the treatment of cardiovascular disease is recognized as beneficial with respect to CD, the control of HBP in older adults is considered risky. A diagnosis is made of a situation where a disparity is evident between what one recognizes as knowing and what one claims to do. Conclusions: The role of vascular disease in functional brain damage is recognized, considering it necessary to know the cognitive status of patients, however there is a low application of screening tests that evaluate executive function. In this context, a gap between medical knowledge and practice is shown.
Introdução: A hipertensão arterial (HA) é a principal causa de morte por doenças cardiovasculares. Apesar dos avanços, o percentual de hipertensos não diagnosticados e não tratados é de 58,4%. A avaliação do dano cognitivo na hipertensão concentra-se na prevenção do acidente vascular cerebral, enquanto o dano funcional é ignorado. Esse manejo inadequado pode ser multifatorial. É objetivo fue analisar a opinião dos médicos sobre a relação entre hipertensão arterial e danos cognitivos. Metodologia: Estudo observacional, descritivo, transversal desenvolvido no período entre agosto de 2020 e agosto de 2023. Análise de dados obtidos a partir de questionário autoaplicável, anônimo e voluntário. Revelar informações sobre o perfil profissional, conhecimento sobre a HA, sua ligação com o comprometimento cognitivo (DC), diagnóstico e tratamento. Resultados: Foram incluídos 222 profissionais, 215 (96,8%) concordam com a existência de ligação entre hipertensão e outros fatores de risco cardiovascular na DC e 218 (98,1%) reconhecem ajudar pacientes com risco de sofrer de D.C. A avaliação da DC é realizada em casos selecionados por 132 (59,4%) participantes e 59 (26,7%) a fazem sempre. Dos que realizam avaliação, 103 (54%) utilizam o Mini Exame do Estado Mental (MEEM), 10 (5,2%) utilizam a Avaliação Cognitiva de Montreal (MoCA) e 9 (4,7%) utilizam o Clock Drawing Test. Em relação à diminuição da pressão arterial em pacientes idosos e a ligação com o risco de DC: 54 (24,3%) não reconhecem risco e 65 (29,2%) reconhecem risco moderado-alto. Em referência à implicação do tratamento de doenças cardiovasculares e DC: 217 (97,7%) reconheceram o efeito benéfico. Discussão: Dado o reconhecimento da ligação entre hipertensão e DC, seria de esperar que a DC fosse investigada na grande maioria, no entanto apenas 26,7% sempre a avaliam. Não há consenso sobre o método, sendo o MEEM o mais utilizado, com baixa aplicação do teste MoCA e/ou Clock Drawing Test, sendo estes últimos os que avaliam a função executiva, majoritariamente alterada nos DC vinculados à HA. Embora o tratamento das doenças cardiovasculares seja reconhecido como benéfico em relação à DC, o controle da HA em idosos é considerado arriscado. É feito um diagnóstico de uma situação em que é evidente uma disparidade entre o que se reconhece como saber e o que se afirma fazer. Conclusões: O papel da doença vascular no dano cerebral funcional é reconhecido, considerando-se necessário conhecer o estado cognitivo dos pacientes, porém há baixa aplicação de testes de triagem que avaliam a função executiva. Nesse contexto, evidencia-se uma lacuna entre o conhecimento e a prática médica.
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Abstract Background The treatment for atopic dermatitis (AD) has been the focus of clinical research, and behavioral intervention is considered an indispensable treatment method. To our knowledge, no relevant meta-analysis has evaluated the effects of behavioral interventions on atopic dermatitis. Objectives To evaluate the effects of behavioral interventions on atopic dermatitis. Methods The authors searched PubMed, EMBASE, and Cochrane CENTRAL to retrieve relevant RCTs (up to Feb 2022). The search strategy involved a combination of related keywords. The Cochrane Q and I2 statistics were used to assess heterogeneity. Results Six RCTs involving seven reports with 246 patients were included. The results suggested that behavioral interventions could relieve eczema severity (correlation coefficient [r = −0.39]; p < 0.001) and scratching severity significantly (r = −0.19; p = 0.017), while not affect itching intensity (r = −0.02; p = 0.840). A sensitivity analysis confirmed the robustness of the results. Study limitations An important limitation of this study was the insufficient number of RCTs and the limited sample size. In addition, the study lacked a control group receiving a type of intervention other than the experimental protocol. Another limitation was the short duration of follow-up. Conclusions This study suggests that behavioral interventions could be effective in treating atopic dermatitis by reducing eczema and scratching severity. Additionally, habit-reversal behavioral therapy may be more effective for treating atopic dermatitis.
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La utilidad de la recreación física con carácter lúdico resulta un medio fundamental para mejorar la salud, las funciones cognitivas y la calidad de vida. A partir de un diagnóstico aplicado a una muestra de 19 adultos mayores, estos presentaron insuficiencias en los procesos de la memoria; en tal sentido, se comprobó que las propuestas de actividades físico-recreativas dirigidas a este grupo etario fueron muy generales, no atendieron las características morfofuncionales y estuvieron limitadas en la variedad de ofertas recreativas. La presente investigación tuvo como objetivo mejorar las funciones cognitivas, que se relacionan con la memorización, en los adultos mayores de la comunidad Matahambre, del municipio Songo la Maya, a través de la marcha de orientación. Se emplearon como métodos teóricos el analítico-sintético e inductivo-deductivo; y empíricos, el análisis documental, la observación, la encuesta y la entrevista que permitieron obtener los datos e informaciones necesarias para la correcta realización de la marcha de orientación al tomar en cuenta las características de este grupo poblacional. La propuesta demostró la marcha de orientación como una importante herramienta que estimuló las capacidades memorísticas y los recuerdos, al tomar en cuenta los gustos, preferencias, necesidades e intereses del adulto mayor, resultarles atractiva y permitirles recordar aspectos o emociones vitales de su vida personal.
A utilidade da recreação física de caráter recreativo é um meio fundamental para melhorar a saúde, as funções cognitivas e a qualidade de vida. A partir de diagnóstico aplicado a uma amostra de 19 idosos, estes apresentavam insuficiências nos processos de memória; Neste sentido, constatou-se que as propostas de atividades físico-recreativas dirigidas a esta faixa etária eram muito generalistas, não tinham em conta as características morfofuncionais e limitavam-se na variedade de ofertas recreativas. O objetivo desta pesquisa foi melhorar as funções cognitivas relacionadas à memorização em idosos da comunidade Matahambre, no município de Songo la Maya, por meio da caminhada de orientação. Os métodos analítico-sintético e indutivo-dedutivo foram utilizados como métodos teóricos; e empírica, análise documental, observação, inquérito e entrevista que permitiram obter os dados e informações necessários à correta implementação da marcha de orientação tendo em conta as características deste grupo populacional. A proposta demonstrou a caminhada de orientação como uma importante ferramenta que estimulou habilidades de memória e lembranças, ao levar em conta os gostos, preferências, necessidades e interesses do idoso, tornando-a atrativa para ele e permitindo-lhe relembrar aspectos vitais ou emoções de sua vida. vida pessoal.
The usefulness of physical recreation with a playful character for this group of people is a fundamental means to improve their health, their cognitive functions and their quality of life. From a diagnosis applied to a sample of 19 older adults, it was possible to know the insufficiencies in memoristic events that these subjects had. In this sense, it was also found that the proposal of physical-recreational activities aimed at this age group in the community are very general and do not take into account their morpho-functional characteristics. They are limited in terms of the variety of recreational offers for this population group. The objective of this research is to improve cognitive functions, which are related to memorization, in older adults of the "Matahambre" community of the Songo la Maya municipality through orientation walking. For the solution of the objective, theoretical methods such as: analytical-synthetic and inductive-deductive were used. Among the empirical methods, documentary analysis, observation, survey and interview were used to obtain the necessary data and information for the correct implementation of the orientation walk, taking into account the characteristics of this population group. The proposal showed that the orientation walk is an important tool that stimulates the memory and memory capacities of these people, by taking into account their tastes, preferences, needs and preferences.
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Introdução:O envelhecimento da população está associado ao aumento da prevalência de demências, incluindo a doença de Alzheimer. O diagnóstico precoce é crucial para intervenções terapêuticas eficazes. Estudos recentes investigam o impacto da suplementação de ácidosgraxos ômega-3 na função cognitiva de idosos, devido à falta de tratamentos farmacológicos conhecidos para prevenir ou retardar o início da demência. Objetivo:Analisar os resultados de diversos estudos sobre a suplementação de ácidos graxos ômega-3 na função cognitiva de idosos. Metodologia:Revisão integrativa da literatura a partir das bases de dados BVS, PubMed e Scielo nos últimos dez anos (2013-2023), a partir dos descritores: (Fatty Acids, Omega-3) AND (Cognitive Aging) sem restrição quanto ao idioma e de acesso livre. Foram identificados 107 artigos, dos quais, 32 foram analisados e 14 utilizados nesta revisão. Resultados:O ômega-3, encontrado em peixes e oleaginosas, está associado à saúdecognitiva, especialmente os componentes EPA e DHA. Fatoresgenéticos, como o gene APO E4, podem influenciar sua eficácia na prevenção de doenças como Alzheimer. Estudos variam sobre seus benefícios na cognição em idosos, com resultados mistos. Conclusões:Os estudos revisados apresentam achados divergentes sobre os efeitos da suplementação de ácidos graxos ômega-3 na função cognitiva de idosos. Enquanto alguns sugerem benefícios, outros não identificam diferenças significativas (AU).
Introduction:The aging population is associated with an increased prevalence of dementia, including Alzheimer's disease. Early diagnosis is crucial for effective therapeutic interventions. Recent studies are investigating the impact of omega-3 fatty acid supplementation on the cognitive function of older adults, due to the lack of known pharmacological treatments to prevent or delay dementia onset. Objective:To analyze the results of various studies on omega-3 fatty acid supplementation in the cognitive function of older adults. Methodology:Integrative literature review from the databases BVS, PubMed, and Scielo in the last ten years (2013-2023), using the descriptors: (Fatty Acids, Omega-3) AND (Cognitive Aging) with no language restrictions and open access. A total of 107 articles were identified, of which 32 were analyzed, and 14 were used in this review. Results:Omega-3, found in fish and nuts, is associated with cognitive health, especially the EPA and DHA components. Genetic factors, such as the APO E4 gene, may influence its effectiveness in preventing diseases like Alzheimer's. Studies vary on its benefits in cognition in older adults, with mixed results. Conclusions:The reviewed studies present conflicting findings on the effects of omega-3 fatty acid supplementation on the cognitive function of older adults. While some suggest benefits, others do not identify significant differences (AU).
Introducción: El envejecimiento de la población está asociado con un aumento en la prevalencia de demencia, incluida la enfermedad de Alzheimer. El diagnóstico temprano es crucial para intervenciones terapéuticas efectivas. Estudios recientes investigan el impacto de la suplementación de ácidos grasos omega-3 en la función cognitiva de adultos mayores, debido a la falta de tratamientos farmacológicos conocidos para prevenir o retrasar el inicio de la demencia. Objetivo:Analizar los resultados de diversos estudios sobre lasuplementación de ácidos grasos omega-3 en la función cognitiva de adultos mayores. Metodología: Revisión integrativa de la literatura en las bases de datos BVS, PubMed y Scielo en los últimos diez años (2013-2023), utilizando los descriptores: (Ácidos Grasos Omega-3) Y (Envejecimiento Cognitivo) sin restricciones de idioma y de acceso abierto. Se identificaron un total de 107 artículos, de los cuales se analizaron 32 y se utilizaron 14 en esta revisión. Resultados: El omega-3, presente en pescados y frutos secos, está asociado con la salud cognitiva, especialmente los componentes EPA y DHA. Factores genéticos, como el gen APO E4, pueden influir en su eficacia para prevenir enfermedades como el Alzheimer. Los estudios varían en cuanto a sus beneficios en la cognición en adultos mayores, con resultados mixtos. Conclusiones:Los estudios revisados presentan hallazgos contradictorios sobre los efectos de la suplementación con ácidos grasos omega-3 en la función cognitiva de adultos mayores. Mientras que algunos sugieren beneficios, otros no identifican diferencias significativas (AU).
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Ácidos Graxos Ômega-3/administração & dosagem , Saúde do Idoso , Suplementos Nutricionais , Envelhecimento Cognitivo , Diagnóstico PrecoceRESUMO
BACKGROUND: Handgrip strength (HGS) testing is a highly recommended method for screening for sarcopenia in older adults. However, there is no consensus on the optimal protocol and number of trials for screening sarcopenia in older adults with cognitive impairment. OBJECTIVE: To investigate the use of the first trial (FT), the mean of three trials (MT), and the highest value (HT) from three trials of the HGS test to screen for sarcopenia in older adults with cognitive impairment. Additionally, to analyze the consistency, agreement, and measurement error in the diagnosis of muscle weakness. METHODS: 176 older adults with cognitive impairment were evaluated. The HGS test was repeated three times. Analyses were performed using the Friedman repeated measures test with Wilcoxon post-hoc, intraclass correlation coefficient (ICC), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC95), and Kappa index tests. RESULTS: There was no significant difference between the first trial (FT) and the mean of three trials (MT) (d = 0.17 [95 % CI: -0.08, 0.42]), but both differed significantly from the highest value (HT) (p < 0.001). The ICC indicated a reliability of 0.97 (95 % CI: 0.95, 0.98) across all participants, while the kappa index demonstrated over 80 % agreement. The SEM for the first measure of HGS ranged from 0.59 to 2.12 kgf. The MDC95 ranged from 1.64 to 5.87 kgf. CONCLUSION: For HGS testing, there was excellent consistency between the FM and MT. All three testing methods demonstrated excellent agreement in diagnosing muscle weakness. The measurement errors confirm that FT can be reliably used to monitor changes during rehabilitation.
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Disfunção Cognitiva , Força da Mão , Sarcopenia , Humanos , Sarcopenia/diagnóstico , Sarcopenia/fisiopatologia , Força da Mão/fisiologia , Idoso , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologiaRESUMO
Patients recovering from COVID-19 commonly exhibit cognitive and brain alterations, yet the specific neuropathological mechanisms and risk factors underlying these alterations remain elusive. Given the significant global incidence of COVID-19, identifying factors that can distinguish individuals at risk of developing brain alterations is crucial for prioritizing follow-up care. Here, we report findings from a sample of patients consisting of 73 adults with a mild to moderate SARS-CoV-2 infection without signs of respiratory failure and 27 with infections attributed to other agents and no history of COVID-19. The participants underwent cognitive screening, a decision-making task, and MRI evaluations. We assessed for the presence of anosmia and the requirement for hospitalization. Groups did not differ in age or cognitive performance. Patients who presented with anosmia exhibited more impulsive alternative changes after a shift in probabilities (r = - 0.26, p = 0.001), while patients who required hospitalization showed more perseverative choices (r = 0.25, p = 0.003). Anosmia correlated with brain measures, including decreased functional activity during the decision-making task, thinning of cortical thickness in parietal regions, and loss of white matter integrity. Hence, anosmia could be a factor to be considered when identifying at-risk populations for follow-up.
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Anosmia , Encéfalo , COVID-19 , Imageamento por Ressonância Magnética , SARS-CoV-2 , Humanos , COVID-19/complicações , COVID-19/psicologia , COVID-19/fisiopatologia , COVID-19/diagnóstico por imagem , COVID-19/patologia , Anosmia/etiologia , Anosmia/fisiopatologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Encéfalo/fisiopatologia , SARS-CoV-2/isolamento & purificação , Idoso , Tomada de Decisões , Cognição/fisiologiaRESUMO
BACKGROUND: The increase in cases of mild cognitive impairment (MCI) underlines the urgency of finding effective methods to slow its progression. Given the limited effectiveness of current pharmacological options to prevent or treat the early stages of this deterioration, non-pharmacological alternatives are especially relevant. OBJECTIVE: To assess the effectiveness of a cognitive-motor intervention based on immersive virtual reality (VR) that simulates an activity of daily living (ADL) on cognitive functions and its impact on depression and the ability to perform such activities in patients with MCI. METHODS: Thirty-four older adults (men, women) with MCI were randomized to the experimental group (n = 17; 75.41 ± 5.76) or control (n = 17; 77.35 ± 6.75) group. Both groups received motor training, through aerobic, balance and resistance activities in group. Subsequently, the experimental group received cognitive training based on VR, while the control group received traditional cognitive training. Cognitive functions, depression, and the ability to perform activities of daily living (ADLs) were assessed using the Spanish versions of the Montreal Cognitive Assessment (MoCA-S), the Short Geriatric Depression Scale (SGDS-S), and the of Instrumental Activities of Daily Living (IADL-S) before and after 6-week intervention (a total of twelve 40-minutes sessions). RESULTS: Between groups comparison did not reveal significant differences in either cognitive function or geriatric depression. The intragroup effect of cognitive function and geriatric depression was significant in both groups (p < 0.001), with large effect sizes. There was no statistically significant improvement in any of the groups when evaluating their performance in ADLs (control, p = 0.28; experimental, p = 0.46) as expected. The completion rate in the experimental group was higher (82.35%) compared to the control group (70.59%). Likewise, participants in the experimental group reached a higher level of difficulty in the application and needed less time to complete the task at each level. CONCLUSIONS: The application of a dual intervention, through motor training prior to a cognitive task based on Immersive VR was shown to be a beneficial non-pharmacological strategy to improve cognitive functions and reduce depression in patients with MCI. Similarly, the control group benefited from such dual intervention with statistically significant improvements. TRIAL REGISTRATION: ClinicalTrials.gov NCT06313931; https://clinicaltrials.gov/study/NCT06313931 .
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Atividades Cotidianas , Cognição , Disfunção Cognitiva , Realidade Virtual , Humanos , Disfunção Cognitiva/terapia , Disfunção Cognitiva/reabilitação , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Feminino , Masculino , Idoso , Método Simples-Cego , Cognição/fisiologia , Idoso de 80 Anos ou mais , Depressão/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Older adults with cognitive impairment exhibit different patterns of healthcare utilization compared to their cognitively healthy counterparts. Despite extensive research in high-income countries, similar studies in low- and middle-income countries are lacking. This study aims to investigate the population-level patterns in healthcare utilization among older adults with and without cognitive impairment in Mexico. METHODS: Data came from five waves (2001-2018) of the Mexican Health and Aging Study. We used self-reported measures for one or more over-night hospital stays, doctor visits, visits to homeopathic doctors, and dental visits in the past year; seeing a pharmacist in the past year; and being screened for cholesterol, diabetes, and hypertension in the past two years. Cognitive impairment was defined using a modified version of the Cross Cultural Cognitive Examination that assessed verbal memory, visuospatial and visual scanning. Total sample included 5,673 participants with cognitive impairment and 34,497 without cognitive impairment interviewed between 2001 and 2018. Generalized Estimating Equation models that adjusted for time-varying demographic and health characteristics and included an interaction term between time and cognitive status were used. RESULTS: For all participants, the risk for one or more overnight hospital stays, doctor visits, and dental visits in the past year, and being screened for diabetes, hypertension, and high cholesterol increased from 2001 to 2012 and leveled off or decreased in 2015 and 2018. Conversely, seeing a homeopathic doctor decreased. Cognitive impairment was associated with higher risk of hospitalization (RR = 1.13, 1.03-1.23) but lower risk of outpatient services (RR = 0.95, 0.93-0.97), cholesterol screening (RR = 0.93, 0.91-0.96), and diabetes screening (RR = 0.95, 0.92-0.97). No significant difference was observed in the use of pharmacists, homeopathic doctors, or folk healers based on cognitive status. Interaction effects indicated participants with cognitive impairment had lower risk for dental visits and hypertension screening but that these trajectories differed over time compared to participants without cognitive impairment. CONCLUSIONS: We identified distinct population-level trends in self-reported healthcare utilization and differences according to cognitive status, particularly for elective and screening services. These findings highlight the necessity for policy interventions to ensure older adults with cognitive impairment have their healthcare needs met.
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Disfunção Cognitiva , Aceitação pelo Paciente de Cuidados de Saúde , Autorrelato , Humanos , Masculino , Feminino , Idoso , Disfunção Cognitiva/epidemiologia , México/epidemiologia , Idoso de 80 Anos ou mais , Hospitalização/tendênciasRESUMO
OBJECTIVES: Investigate whether the coexistence of pain and depressive symptoms is a risk factor for cognitive decline in individuals aged 50 or older. METHOD: Longitudinal trajectory study involving 4,718 participants from the English Longitudinal Study of Ageing (ELSA). Joint pain was self-reported, and intensity was classified as mild, moderate/intense. Depressive symptoms were investigated using the Centre for Epidemiologic Studies Depression Scale (CES-D-8 ≥ 4). The sample was divided into six groups: no pain and no depression (NP/NDe), mild pain and no depression (MP/NDe), moderate/intense pain and no depression (M-IP/NDe), no pain and depression (NP/De), mild pain and depression (MP/De), and moderate/intense pain and depression (M-IP/De). The outcome of interest was performance in memory, executive function, and global cognition. Generalised linear mixed models were used to analyse performance in the cognitive domains and global cognition score as a function of pain and depressive symptoms during 12 years of follow-up. RESULTS: Over time, individuals with M-IP/De had a greater memory decline (-0.038 SD/year, 95%CI: -0.068 to -0.007) and the global cognition score (-0.033 SD/year, 95%CI: -0.063 to -0.002) than those with NP/NDe. CONCLUSION: The coexistence of moderate/intense pain and depressive symptoms is a risk factor for the decline of global cognition and memory.
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OBJECTIVE: To determine whether it is the magnitude of early postnatal catch-up growth (CUG) in response to fetal growth restriction (FGR) or the FGR itself that negatively impacts cognitive outcome in a model of monochorionic twins discordant for fetal growth. STUDY DESIGN: This analysis is part of the LEMON study, a cohort study including all monochorionic twins with selective FGR aged 3 through 17 years. Growth measurements as documented by our primary care system were collected retrospectively. An age-appropriate neurodevelopmental test was performed generating a full-scale IQ (FSIQ). CUG at 2 years was calculated as (weight [kg] at 2 years-birth weight [kg]). We used a multivariable regression model investigating the association between FSIQ (outcome) and birth weight zscore, gestational age at birth and CUG at 2 years (predictors). Generalized estimating equations accounted for the fact that observations between cotwins are not independent. RESULTS: Median age at follow-up of the 46 included twin pairs was 11 (IQR 8-13) years. Birth weight z score and gestational age at birth were significantly associated with FSIQ, with ß-coefficients of 5.897 (95% CI 3.382-8.411), and 2.589 (95% CI 1.227-3.951), respectively (P < .0001). Adjusted for birth weight z score and gestational age, CUG in the first 2 years after birth was not significantly associated with FSIQ (ß-coefficient 0.108 [95% CI -1.373 to 1.590], P = .886). CONCLUSIONS: Our results, combining detailed growth measurements and neurodevelopmental follow-up in a discordant identical twin model, demonstrate that FGR itself rather than early postnatal CUG has negative consequences for cognitive development.
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RATIONALE: The accumulation of beta-amyloid peptide (Aß) in the forebrain leads to cognitive dysfunction and neurodegeneration in Alzheimer's disease. Studies have shown that individuals with a consistently cognitively active lifestyle are less vulnerable to Aß toxicity. Recent research has demonstrated that intrahippocampal Aß can impact catecholaminergic release and spatial memory. Interestingly, exposure to novelty stimuli has been found to stimulate the release of catecholamines in the hippocampus. However, it remains uncertain whether repeated enhancing catecholamine activity can effectively alleviate cognitive impairment in individuals with Alzheimer's disease. OBJECTIVES: Our primary aim was to investigate whether repeated exposure to novelty could enable cognitive resilience against Aß. This protection could be achieved by modulating catecholaminergic activity within the hippocampus. METHODS: To investigate this hypothesis, we subjected mice to three different conditions-standard housing (SH), repeated novelty (Nov), or daily social interaction (Soc) for one month. We then infused saline solution (SS) or Aß (Aß1-42) oligomers intrahippocampally and measured spatial memory retrieval in a Morris Water Maze (MWM). Stereological analysis and extracellular baseline dopamine levels using in vivo microdialysis were assessed in independent groups of mice. RESULTS: The mice that received Aß1-42 intrahippocampal infusions and remained in SH or Soc conditions showed impaired spatial memory retrieval. In contrast, animals subjected to the Nov protocol demonstrated remarkable resilience, showing strong spatial memory expression even after Aß1-42 intrahippocampal infusion. The stereological analysis indicated that the Aß1-42 infusion reduced the tyrosine hydroxylase axonal length in SH or Soc mice compared to the Nov group. Accordingly, the hippocampal extracellular dopamine levels increased significantly in the Nov groups. CONCLUSIONS: These compelling results demonstrate the potential for repeated novelty exposure to strengthen the dopaminergic system and mitigate the toxic effects of Aß1-42. They also highlight new and promising therapeutic avenues for treating and preventing AD, especially in its early stages.
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BACKGROUND: Breast cancer is a prevalent form of cancer among women worldwide, often accompanied by physical and psychological side effects due to the disease and the treatment's aggressiveness. Regular physical exercise has emerged as a non-pharmacological approach to improve the quality of life of breast cancer survivors. We herein report the protocol of the WaterMama Study, which aims to evaluate the effects of land- or water-based aerobic exercise programs, compared to a health education program, on cancer-related fatigue and other health-related outcomes in breast cancer survivors. METHODS: The WaterMama trial is a randomized, single-blinded, three-arm, parallel, superiority trial. We aim to recruit 48 women ≥ 18 years of age who have completed primary treatment for stage I-III breast cancer. Participants are randomly allocated in a 1:1:1 ratio to 12-week interventions of aerobic exercise training programs either in the aquatic or land environment (two weekly 45-min sessions) plus health education (a weekly 45-min session), or an active-control group receiving health education alone (a weekly 45-min session). The primary outcome is cancer-related fatigue, and the secondary outcomes include cardiorespiratory fitness, muscular performance, muscle morphology, functional capacity, mental health, cognitive function, pain, and quality of life. Outcomes assessments are conducted before and after the 12-week intervention period. The analysis plan will employ an intention-to-treat approach and per protocol criteria. DISCUSSION: Our conceptual hypothesis is that both aerobic exercise programs will positively impact primary and secondary outcomes compared to the health education group alone. Additionally, due to its multi-component nature, we expect the aquatic exercise program promote more significant effects than the land exercise program on cancer-related fatigue, muscular outcomes, and pain. TRIAL REGISTRATION: The study was prospectively registered at ClinicalTrials.gov NCT05520515. Registered on August 26, 2022. https://clinicaltrials.gov/ct2/show/NCT05520515.
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Neoplasias da Mama , Sobreviventes de Câncer , Terapia por Exercício , Fadiga , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Humanos , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Feminino , Método Simples-Cego , Terapia por Exercício/métodos , Fadiga/etiologia , Resultado do Tratamento , Pessoa de Meia-Idade , Fatores de Tempo , Saúde Mental , Exercício Físico , Aptidão Cardiorrespiratória , Adulto , Educação em Saúde/métodosRESUMO
INTRODUCTION: Worldwide, because of the demographic transition, the proportion of older adults has increased, which has been reflected in an increase in the prevalence of major neurocognitive disorder (MND). This phenomenon is especially important in low- and middle-income countries such as Colombia, given the high economic and social costs it entails. The objective was to analyse the association between socioeconomic variables with the presence of cognitive impairment in Colombian older adults. METHODS: The records of 23,694 adults over 60 years-of-age surveyed for SABE Colombia 2015, that took a stratified sample by conglomerates and were representative of the adult population over 60 years-of-age. This instrument assessed cognitive impairment using the abbreviated version of the Minimental (AMMSE) and collected information on multiple socioeconomic variables. RESULTS: 19.7% of the older adults included in the survey were reviewed with cognitive impairment by presenting a score <13 in the AMMSE. There was a higher prevalence of cognitive impairment in women (21.5%) than in men (17.5%). The socioeconomic variables were shown to impact the prevalence of deterioration, especially being currently working (ORâ¯=â¯2.74; 95%CI, 2.43-3.09) as a risk factor and having attended primary school as a protective factor (ORâ¯=â¯0.30; 95%CI, 0.28-0.32), differentially according to gender. CONCLUSIONS: An association between socioeconomic and sociodemographic factors with cognitive impairment in Colombian older adults was evidenced. Despite the above, a differential impact dependent on sex is suggested.
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Disfunção Cognitiva , Fatores Sociodemográficos , Fatores Socioeconômicos , Humanos , Colômbia/epidemiologia , Masculino , Feminino , Disfunção Cognitiva/epidemiologia , Idoso , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Idoso de 80 Anos ou mais , Fatores Sexuais , Estudos TransversaisRESUMO
Few studies have considered bilingualism's impact on cognitive development within the sociolinguistic and cultural context of the immigrant communities where bilingualism is commonly practiced. In the United States, many Mexican-origin bilingual youth practice their bilingual skills by brokering (i.e., translating/interpreting between languages) for their immigrant parents who have low English proficiency. Meanwhile, these youth may also experience discrimination in their daily life. The present study focuses on Mexican-origin bilingual youth brokers (N=334) in order to examine how discriminatory experiences (i.e., daily and ethnic discrimination) and bilingual brokering experiences captured by profiles are related to cognitive control performance (i.e., attentional control and inhibition). We found no significant direct influence of either bilingual broker profiles or discriminatory experiences on cognitive control. However, the associations between discriminatory experiences and cognitive control performance depended upon brokering experiences. Specifically, greater discrimination was associated with lower cognitive control performance among moderate brokers (with moderate bilingual experiences), but the association was attenuated among efficacious brokers (with positive bilingual experiences). Findings highlight the need to consider the sociolinguistic heterogeneity of both discriminatory experiences and language use when investigating cognitive control performance in bilinguals.
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OBJECTIVE: Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, this method has some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia. In recent years, there has been an increasing interest in its use in patients with psychotic disorders. This meta-analysis aims to evaluate the effectiveness of CBT-I on sleep problems in patients with psychotic disorders. METHODS: A systematic search was conducted using PubMed, Scopus, and EBSCO (MEDLINE) databases to identify relevant studies. The study included RCTs and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had sleep problems for at least one month, and who were receiving treatment. The initial search yielded 246 studies, and eight studies were selected for the meta-analysis after screening and applying inclusion and exclusion criteria.The statistical analysis was conducted using the R software. RESULTS: CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders during short and long-term periods. In addition to this, CBT-I leads to a significant improvement in psychotic symptoms in the short-term period and contributes significantly to the improvement in mental well-being in both short and long-term periods. CONCLUSIONS: CBT-I is an effective and valuable method for sleep problems in patients with psychotic disorders and its use is recommended to be widespread.
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The objective of this study is to gain an understanding of the development of consciousness and its relationship with education based on different theoretical models-namely those by Piaget, Vygotsky and Steiner. All three of them focus on different subcomponents of the educational process and there is hence a need for integrative discussion. Piaget and Vygotsky are fundamental references in the understanding of developmental and learning processes. Steiner was a pioneer in proposing a pedagogy that progresses by integrating feeling and wanting alongside thinking in the educational process. Their theories have important similarities but also differences and these will be essential for broadening the understanding of the construction of consciousness and its relationships with education.
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The majority of people with dementia live in low or middle-income countries (LMICs) where resources that play a crucial role in brain health, such as quality education, are still not widely available. In Brazil, illiteracy remains a prevalent issue, especially in communities with lower socioeconomic status (SES). The PROAME study set out to explore basic education in illiterate adults as a means to improve cognitive reserve. Objective: This manuscript aims to explore the relationship between SES and learning, as well as cognitive outcomes, in an older illiterate population. Methods: This six-month clinical trial (NCT04473235) involved 108 participants, of which 77 concluded all assessments, enrolled in late-life basic education. SES assessments included Quality of Urban Living Index, Municipal Human Development Index and Household SES calculated for each participant. Cognitive assessments encompassed the Free and Cued Selective Reminding Test (FCSRT), a word list to assess reading, and the Beta III matrix. Results: The sample consisted primarily of women, with a mean age of 58.5. Participants improved their reading (p=0.01) and their FCSRT (p=0.003). Regarding episodic memory, women outperformed men (p=0.007) and younger participants improved more than their older counterparts (p=0.001). There was no association observed between SES and cognitive outcomes. Conclusion: Irrespective of SES, participants demonstrated positive outcomes after attending basic education. These findings highlight that late life education could be an important non-pharmacologic preventative measure, especially in LMICs.
A maioria das pessoas com demência vive em países de baixa/média renda, onde recursos essenciais para a saúde cerebral, como educação de qualidade, ainda não são amplamente acessíveis. No Brasil, o analfabetismo ainda é frequente, especialmente em comunidades de baixo nível socioeconômico. O estudo PROAME teve como objetivo explorar a educação básica tardia em pessoas analfabetas como ferramenta para o aumento da reserva cognitiva. Objetivo: Investigar a relação entre nível socioeconômico com aprendizado e com desempenho em testes cognitivos, em adultos analfabetos. Métodos: Este estudo clínico de seis meses (NCT04473235) contou com 108 participantes inscritos no projeto Educação para Jovens e Adultos (EJA), dos quais 77 completaram os testes. O nível socioeconômico de cada participante foi medido usando-se: o Índice de Qualidade de Vida Urbana, o Índice de Desenvolvimento Humano Municipal e o nível socioeconômico doméstico. Avaliações cognitivas incluíram: o Teste de Recordação Seletiva Livre e Guiada (TRSLG), uma lista de palavras para avaliar leitura e a matriz Beta III. Resultados: A amostra era predominantemente feminina, com idade média de 58,5. Os participantes melhoraram a leitura (p=0,01) e o TRSLG (p=0,003). Com relação à memoria episódica, as mulheres tiveram resultados superiores aos dos homens (p=0,007) e participantes mais jovens melhoraram mais que seus colegas mais velhos (p=0,001). Não foi observada nenhuma relação entre o nível socioeconômico e o desempenho cognitivo. Conclusão: Independentemente do nível socioeconômico, participantes obtiveram resultados positivos após frequentar a educação básica. Isso sugere que a educação tardia pode ser uma medida preventiva não farmacológica importante, especialmente em países de baixa/média renda.
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BACKGROUND: Patterns of cognitive change and modifiable factors for cognitive decline versus stable cognitive trajectories have rarely been described in lower-educated older adults. OBJECTIVES: We aimed to identify long-term trajectories of cognitive functioning and possible factors associated with cognitive decline. DESIGN AND PARTICIPANTS: We used data from 1,042 adults aged ≥ 60 participating in the Health, Welfare and Aging Study (SABE), São Paulo, Brazil, without cognitive impairment at baseline. Data were collected across four waves (2000-2015). Group-based trajectory modelling was used to identify cognitive trajectories. Associations with socioeconomic variables, childhood background, lifestyle, and cardiovascular risk factors were explored using weighted multinomial logistic regressions. MEASUREMENTS: The abbreviated Mini-Mental State Examination was used to measure cognition. RESULTS: Three cognitive trajectories were identified: stable (n= 754, 68.6%), mild-decline (n= 183, 20.8%), and strong-decline (n= 105, 10.7%). At baseline, respondents in the strong-decline group were more likely to be older than those with stable and mild-decline trajectories. Furthermore, participants in both the mild and strong-decline groups were more likely to have no schooling, be divorced/separated, receive less than 4 monthly wages, and be underweight (BMI < 18.5) compared to the stable group. Finally, the mild-decline group was more likely to have lived in rural areas during childhood than participants located in a stable trajectory. CONCLUSIONS: Our findings suggest that interventions to reduce cognitive decline for low-educated older adults might include strategies addressing inequalities and improving modifiable risk factor burden.
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Disfunção Cognitiva , Escolaridade , Fatores de Proteção , Humanos , Masculino , Disfunção Cognitiva/epidemiologia , Feminino , Brasil/epidemiologia , Idoso , Fatores de Risco , Seguimentos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Idoso de 80 Anos ou mais , Testes de Estado Mental e DemênciaRESUMO
INTRODUCTION: Impairments in bottom-up perceptual processing have been associated to the age-related cognitive decline. Digital cognitive training focusing on bottom-up and/or top-down processes have been studied as a tool to remediate age-related cognitive decline. However, the most effective training type and order of application remain unclear. METHODS: One hundred and fifteen older adults were randomly assigned to 40 h of bottom-up then top-down or top-down then bottom-up digital cognitive training or an active control group. We evaluated cognition at baseline, after 20 h and 40 h of training and at follow-up using a mixed-model analysis. RESULTS: Global cognition improved, for the top-down group, after 20 h of training (p = 0.04; d = 0.7) and for all three groups after 40 h. The improvement in global cognition remained five months after the bottom-up/ top-down training (p = 0.009; d = 4.0). There were also improvements in the recall cognitive domain, after 20 h of training, for the bottom-up group and, after 40 h, for all three groups. Gains were observed in verbal fluency after 40 h of training for both therapeutic groups. Processing speed was significantly slower, after 20 h of training, for the control and bottom-up groups and, after 40 h, only for the control group. Emotion recognition improved, after 20 h, for the control group as compared to the therapeutic groups. CONCLUSIONS: These results indicate that the bottom-up/top-down training has the most endurable effects, which reveals the importance of the order of application of the exercises for gains in cognition in older adults.
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Cognição , Disfunção Cognitiva , Humanos , Masculino , Feminino , Idoso , Disfunção Cognitiva/terapia , Cognição/fisiologia , Terapia Cognitivo-Comportamental/métodos , Testes Neuropsicológicos , Idoso de 80 Anos ou mais , Treino CognitivoRESUMO
Aging is characterized by the decline in many of the individual's capabilities. It has been recognized that the brain undergoes structural and functional changes during aging that are occasionally associated with the development of neurodegenerative diseases. In this sense, altered glutamatergic neurotransmission, which involves the release, binding, reuptake, and degradation of glutamate (Glu) in the brain, has been widely studied in physiological and pathophysiological aging. In particular, changes in glutamatergic neurotransmission are exacerbated during neurodegenerative diseases and are associated with cognitive impairment, characterized by difficulties in memory, learning, concentration, and decision-making. Thus, in the present manuscript, we aim to highlight the relevance of glutamatergic neurotransmission during cognitive impairment to develop novel strategies to prevent, ameliorate, or delay cognitive decline. To achieve this goal, we provide a comprehensive review of the changes reported in glutamatergic neurotransmission components, such as Glu transporters and receptors during physiological aging and in the most studied neurodegenerative diseases. Finally, we describe the current therapeutic strategies developed to target glutamatergic neurotransmission.