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de Paula França Resende E, Lara VP, Santiago ALC, Friedlaender CV, Rosen HJ, Brown JA, Cobigo Y, Silva LLG, Cruz de Souza L, Rincon L, Grinberg LT, Maciel FIP, Caramelli P. Health literacy, but not memory, is associated with hippocampal connectivity in adults with low levels of formal education. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2024; 16:e12634. [PMID: 39263246 PMCID: PMC11388057 DOI: 10.1002/dad2.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 06/18/2024] [Accepted: 07/16/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION The influence of hippocampal connectivity on memory performance is well established in individuals with high educational attainment. However, the role of hippocampal connectivity in illiterate populations remains poorly understood. METHODS Thirty-five illiterate adults were administered a literacy assessment (Test of Functional Health Literacy in Adults [TOFHLA]), structural and resting state functional magnetic resonance imaging, and an episodic memory test (Free and Cued Selective Reminding Test). Illiteracy was defined as a TOFHLA score < 53. We evaluated the correlation between hippocampal connectivity at rest and both free recall and literacy scores. RESULTS Participants were mostly female (57.1%) and self-declared as being Black individuals (84.8%), with a median age of 50 years. The median TOFHLA literacy score was 28.0 [21.0; 42.5] out of 100 points and the median free recall score was 30.0 [26.2; 35] out of 48 points. The median gray matter volume of both the left and right hippocampi was 2.3 [2.1; 2.4] cm3. We observed a significant connectivity between both hippocampi and the precuneus and the ventral medial prefrontal cortex. The right hippocampal connectivity positively correlated with the literacy scores (β = 0.58, P = 0.008). There was no significant association between episodic memory and hippocampal connectivity. Neither memory nor literacy scores correlated with hippocampal gray matter volume. DISCUSSION Low literacy levels correlated with hippocampal connectivity in illiterate adults. The lack of association with memory scores might be associated with low brain reserve in this sample. Highlights A significant link was found between health literacy and hippocampal connectivity.Enhanced hippocampus- ventromedial prefrontal cortex connectivity suggests potential cognitive reserve improvement.Higher cognitive reserve may protect against hippocampal atrophy and neurodegeneration.Health literacy improvements could help prevent cognitive impairment in illiterate populations.Study highlights importance of considering structural racism in brain connectivity research.
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Affiliation(s)
- Elisa de Paula França Resende
- Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
- Global Brain Health InstituteSan FranciscoCaliforniaUSA
- Faculdade de Medicina de Ciências Médicas de Minas Gerais, CentroBelo HorizonteBrazil
| | - Vivian P. Lara
- Faculdade de Medicina de Ciências Médicas de Minas Gerais, CentroBelo HorizonteBrazil
| | - Ana Luisa C. Santiago
- Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | | | - Howard J. Rosen
- Global Brain Health InstituteSan FranciscoCaliforniaUSA
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Jesse A. Brown
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Yann Cobigo
- University of California San FranciscoSan FranciscoCaliforniaUSA
| | | | | | - Luciana Rincon
- Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Lea T. Grinberg
- Global Brain Health InstituteSan FranciscoCaliforniaUSA
- University of California San FranciscoSan FranciscoCaliforniaUSA
- Faculdade de Medicina da Universidade de São PauloPacaembuSão PauloBrazil
| | | | - Paulo Caramelli
- Departamento de Clínica MédicaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
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Beltrão TW, Maranhão EBDA, Correia VAG, de Albuquerque PM, Pinheiro MGM, Santos RAL, Nunes LEDB, Brandão SCS, Barbosa BJAP. Phenotypic and Positron Emission Tomography with [18F]fluordeoxyglucose (FDG PET) differences in corticobasal syndrome: comparison of two cases. Dement Neuropsychol 2024; 18:e20230085. [PMID: 38933079 PMCID: PMC11206225 DOI: 10.1590/1980-5764-dn-2023-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 06/28/2024] Open
Abstract
Corticobasal syndrome (CBS) is a rare cause of dementia and comprises varied combinations of subcortical signs (akinetic-rigid parkinsonism, dystonia, or myoclonus) with cortical signs (apraxia, alien hand or cortical sensory deficit), usually asymmetric. We aimed to report and compare the clinical and neuroimaging presentation of two patients diagnosed with CBS. While case 1 had severe non-fluent aphasia associated with mild apraxia and limb rigidity, case 2 had a more posterior cognitive impairment, with a different language pattern associated with marked visuospatial errors and hemineglect. FDG PET played a significant role in diagnosis, suggesting, in the first case, corticobasal degeneration and, in the second, Alzheimer's disease pattern. CBS has been widely studied with the advent of new in vivo methods such as brain FDG PET. Studies that deepen the phenotypic and biomarker heterogeneity of CBS will be of great importance for better classification, prognosis, and treatment of the condition.
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Affiliation(s)
- Thais Winkeler Beltrão
- Geriatrics Service, Hospital das Clínicas de Pernambuco, Empresa Brasileira de Serviços Hospitalares, Universidade Federal de Pernambuco, Recife PE, Brazil
| | - Eduardo Barbosa de Albuquerque Maranhão
- Academic Area of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife PE, Brazil
- Afya Faculdade de Ciências Médicas de Jaboatão, Jaboatão dos Guararapes PE, Brazil
| | - Victor Adill Gomes Correia
- Academic Area of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife PE, Brazil
| | - Pedro Mota de Albuquerque
- Academic Area of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife PE, Brazil
| | | | | | | | - Simone Cristina Soares Brandão
- Nuclear Medicine Service, Hospital das Clínicas de Pernambuco, Empresa Brasileira de Serviços Hospitalares, Universidade Federal de Pernambuco, Recife PE, Brazil
- Academic Area of Clinical Medicine, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife PE, Brazil
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Fisher E, Venkatesan S, Benevides P, Bertrand E, Brum PS, El Baou C, Ferri CP, Fossey J, Jelen M, Laks J, Liu L, Mograbi DC, Natarajan N, Naylor R, Pantouli D, Ramanujam V, Rangaswamy T, Santos de Carvalho RL, Stoner C, Vaitheswaran S, Spector A. Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation. JMIR Aging 2024; 7:e55557. [PMID: 38861708 PMCID: PMC11200045 DOI: 10.2196/55557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. OBJECTIVE In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. METHODS A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. RESULTS A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. CONCLUSIONS vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges.
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Affiliation(s)
- Emily Fisher
- University College London, London, United Kingdom
| | | | - Pedro Benevides
- Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | - Jane Fossey
- University of Exeter, Exeter, United Kingdom
| | - Maria Jelen
- University College London, London, United Kingdom
| | - Jerson Laks
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lisa Liu
- University College London, London, United Kingdom
| | - Daniel C Mograbi
- Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Renata Naylor
- Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Thara Rangaswamy
- Dementia Care in Schizophrenia Research Foundation, Chennai, India
| | - Raquel L Santos de Carvalho
- Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade do Grande Rio, Rio de Janeiro, Brazil
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Affinito G, Salerno V, Di Gennaro M, Scafa L, Russo A, Fumo MG, Giordana R, Falco F, Della Pia F, Di Cecca A, Migliaccio M, Ilardi CR, Criscuolo C, Spisto M, Triassi M, Brescia Morra V, Palladino R, Salvatore E, Moccia M. Incidence and Prevalence of Dementia: A 2015-2020 Population-Based Study in the Campania Region of Italy. Neuroepidemiology 2024:1-12. [PMID: 38657587 DOI: 10.1159/000539031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/14/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE The aims of this study were to provide population-based estimates of prevalence and incidence of any dementia and Alzheimer's dementia (AD) in the Campania region (South Italy) and to validate towards a clinical registry. METHODS This was a population-based study, using routinely collected healthcare data of individuals living in the Campania region (South Italy) from 2015 to 2020. We included individuals aged ≥65 years alive at the prevalence day (January 1, 2021) who had at least one administrative record for dementia and/or AD from 2015 to 2020. Age-and sex-standardised prevalence rates were calculated using direct standardisation method (European population in 2020 as the reference population). To estimate the incidence, we tested three possible algorithms, which differed for the duration of the time interval between study baseline (January 1, 2015) and index date (first record for dementia and/or AD in administrative databases). We employed a clinical database for the validation of our algorithms towards neuropsychological test results. RESULTS Among individuals aged over 65 years, 80,392 had dementia, of which 35,748 had AD. The age- and sex-standardised prevalence rates per 1,000 individuals for any dementia and AD were 77.64 (95% confidence interval [CI] = 77.57; 77.68) and 34.05 (95% CI = 34.01; 34.09), respectively. There were 82.10 incident cases of any dementia per 100,000 per year (0.79 sensitivity and 0.62 specificity) and 59.89 incident cases of AD per 100,000 per year (0.80 sensitivity and 0.59 specificity). The capture-recapture method showed a very low number of undetected cases (1.7% for any dementia and 3.0% for AD). Our algorithms showed acceptable performance with the area under the curve ranging from 0.59 to 0.72 and a double likelihood ratio of correctly identifying individuals above and below mini-mental status examination (MMSE) standard cut-offs (24 and 26). CONCLUSIONS Prevalence and incidence of any dementia and AD in the Campania region (South Italy) from 2015 to 2020 are in line with previous estimates from other countries. Our algorithm, integrating administrative and clinical data, holds potential for assessing dementia's epidemiological burden, identifying risk factors, planning healthcare access, and developing prevention strategies.
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Affiliation(s)
- Giuseppina Affinito
- Department of Public Health, University of Naples Federico II, Naples, Italy,
| | - Vito Salerno
- Regional Healthcare Society (So.Re.Sa), Naples, Italy
| | - Massimo Di Gennaro
- Innovation and Data Analytics, Regional Healthcare Society (So.Re.Sa), Naples, Italy
| | - Luca Scafa
- Regional Healthcare Society (So.Re.Sa), Naples, Italy
| | | | | | | | - Fabrizia Falco
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Flavio Della Pia
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
| | | | | | | | - Chiara Criscuolo
- Neurology Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Myriam Spisto
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Vincenzo Brescia Morra
- Department of Neuroscience, Reproductive Science and Odontostomatology, University of Naples Federico II, Naples, Italy
- Multiple Sclerosis Unit, Policlinico Federico II University Hospital, Naples, Italy
| | - Raffaele Palladino
- Department of Public Health, University of Naples Federico II, Naples, Italy
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Elena Salvatore
- Cognitive Impairment and Neurorehabilitation Unit, Policlinico Federico II University Hospital, Naples, Italy
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Marcello Moccia
- Neurology Unit, Policlinico Federico II University Hospital, Naples, Italy
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, Naples, Italy
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Roeser J, Bayliss N, Blom M, Croney R, Lanman L, Laks J, Lyons M, Proulx L, Tsatali M, Westerlund K, Georges J. Insights and recommendations for working collaboratively and improving care in Alzheimer's disease: Learnings from the Finding Alzheimer's Solutions Together (F.A.S.T.) Council. Health Expect 2024; 27:e14040. [PMID: 38629481 PMCID: PMC11022292 DOI: 10.1111/hex.14040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Collaborations between patient organisations (POs) and the pharmaceutical industry can help identify and address the unmet needs of people living with a disease. In Alzheimer's disease (AD), the scale and complexity of the current unmet needs call for a broad and cross-sectoral collaboration, including people living with Alzheimer's (PLWA), their care partners and the wider research community. OBJECTIVE This study aimed to describe learnings from the Finding Alzheimer's Solutions Together (F.A.S.T.) Council, a collaboration between POs and Roche, convened to better understand the unmet needs of PLWA and their care partners. RESULTS 1. Learnings from the collaboration, including clarifying objectives and members' expectations upfront, and establishing a set of guiding values and engagement principles. 2. Insights and recommendations for improving care in AD, including a wide range of unmet needs and potential solutions, systematically captured throughout the PLWA journey. These have resulted in several published reports and other outcomes, including (1) 'Portraits of care', highlighting the role of care partners, and the impact of coronavirus disease 2019 on care; (2) Clinical trial guidebook, recommending how PLWA and care partner experience can be incorporated into trial design; (3) 'Commitments Catalogue', highlighting progress by governmental organisations in achieving their commitments; and (4) a report to guide policy on improving diversity, equity and inclusion in clinical trials. CONCLUSIONS Close collaboration between POs and the pharmaceutical industry in AD can enable effective research, in which PLWA and care partners are engaged as 'experts through experience' to help identify key unmet needs and co-create solutions with the wider AD research community. This paper and the work undertaken by the F.A.S.T. Council may act as a blueprint for meaningful collaboration between POs and the pharmaceutical industry. PATIENT OR PUBLIC CONTRIBUTION The paper reports the collaboration between POs, the F.A.S.T. Council and Roche to progress towards a future in which PLWA can live fulfilling lives with their disease managed well. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | | | - Marco Blom
- Alzheimer NetherlandsAmersfoortThe Netherlands
| | | | | | - Jerson Laks
- Federação Brasileira das Associações de AlzheimerRio de JaneiroBrazil
| | | | - Lea Proulx
- Roche Innovation CenterF. Hoffmann‐La Roche LtdBaselSwitzerland
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Xiong Y, Tvedt J, Åkerstedt T, Cadar D, Wang HX. Impact of sleep duration and sleep disturbances on the incidence of dementia and Alzheimer's disease: A 10-year follow-up study. Psychiatry Res 2024; 333:115760. [PMID: 38301285 DOI: 10.1016/j.psychres.2024.115760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/03/2024]
Abstract
The nature of the relationship between sleep problems and dementia remains unclear. This study investigated the relationship between sleep measures and dementia in older adults (≥ 65) using data from the English Longitudinal Study of Ageing (ELSA) and further investigated the causal association in Mendelian randomization (MR) analysis. In total of 7,223 individuals, 5.7 % developed dementia (1.7 % Alzheimer's disease (AD)) within an average of 8 (± 2.9) years. Cox regression models and MR were employed. Long sleep duration (>8 h) was associated with 64 % increased risk of incident dementia and 2-fold high risk of AD compared to ideal sleep duration (7-8 h). This association was particularly evident in older-older adults (≥70 years) and those who consumed alcohol. Short sleep duration (<7 h) was associated with lower risk of incident dementia among older-older but higher risk among younger-older adults. Sleep disturbances and perceived sleep quality were not associated with dementia or AD. The MR study did not reveal causal associations between sleep duration and dementia. These findings suggest that self-reported short sleep in younger-older and long sleep in older-older adults and those with frequent alcohol consumption are associated with dementia. Early detection of these sleep patterns may help identify individuals at higher dementia risk.
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Affiliation(s)
- Ying Xiong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Tvedt
- Division of Psychobiology and Epidemiology, Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Torbjörn Åkerstedt
- Division of Psychobiology and Epidemiology, Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Dorina Cadar
- Centre for Dementia Studies, Department of Neuroscience, Brighton and Sussex Medical School, Brighton, United Kingdom; Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Hui-Xin Wang
- Division of Psychobiology and Epidemiology, Department of Psychology, Stockholm University, Stockholm, Sweden.
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Sepúlveda-Ibarra C, Chaparro FH, Marcotti A, Soto G, Slachevsky A. Normalization of Rowland Universal Dementia Assessment Scale (RUDAS) in Chilean older people. Dement Neuropsychol 2023; 17:e20230033. [PMID: 38089173 PMCID: PMC10715235 DOI: 10.1590/1980-5764-dn-2023-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/12/2023] [Indexed: 02/01/2024] Open
Abstract
Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening that evaluates older people with low educational levels. In Chile, there are no normative data to assess this population. Objective To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person's performance on RUDAS and on the items that constitute it. Methods A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items. Results Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147). Conclusion This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.
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Affiliation(s)
- Consuelo Sepúlveda-Ibarra
- Universidad Bernardo O’Higgins, Facultad de Ciencias de la Salud, Escuela de Fonoaudiología, Santiago, Chile
- Universidad de Chile, Facultad de Filosofía y Humanidades, Santiago, Chile
| | - Fernando Henríquez Chaparro
- Geroscience Center for Brain Health and Metabolism, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Program Institute of Biomedical Sciences, Neuroscience and East Neuroscience Departments, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Hospital del Salvador Neurology Department, Memory and Neuropsychiatric Center, Santiago, Chile
- Pontificia Universidad Católica de Chile, Facultad de Medicina, Laboratorio de Neurociencia Cognitiva y Evolutiva, Santiago, Chile
| | - Anthony Marcotti
- Universidad San Sebastián, Facultad de Odontología y Ciencias de la Rehabilitación, Escuela de Fonoaudiología, Santiago, Chile
- Pontificia Universidad Católica de Chile, Facultad de Ciencias Sociales, Escuela de Psicología, Programa de Doctorado en Psicología, Santiago, Chile
| | - Guillermo Soto
- Universidad de Chile, Facultad de Filosofía y Humanidades, Santiago, Chile
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Program Institute of Biomedical Sciences, Neuroscience and East Neuroscience Departments, Santiago, Chile
- Universidad de Chile, Faculty of Medicine, Hospital del Salvador Neurology Department, Memory and Neuropsychiatric Center, Santiago, Chile
- Clínica Alemana-Universidad del Desarrollo, Departamento de Medicina, Servicio de Neurología, Santiago, Chile
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How Telemedicine Can Improve the Quality of Care for Patients with Alzheimer's Disease and Related Dementias? A Narrative Review. Medicina (B Aires) 2022; 58:medicina58121705. [PMID: 36556907 PMCID: PMC9783876 DOI: 10.3390/medicina58121705] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/13/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer's disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population.
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Barbosa BJAP, Siqueira Neto JI, Alves GS, Sudo FK, Suemoto CK, Tovar-Moll F, Smid J, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Brucki SMD, Nitrini R, Engelhardt E, Chaves MLF. Diagnosis of vascular cognitive impairment: recommendations of the scientific department of cognitive neurology and aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s104en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
ABSTRACT Since the publication of the latest recommendations for the diagnosis and treatment of Vascular Dementia by the Brazilian Academy of Neurology in 2011, significant advances on the terminology and diagnostic criteria have been made. This manuscript is the result of a consensus among experts appointed by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2020-2022). We aimed to update practical recommendations for the identification, classification, and diagnosis of Vascular Cognitive Impairment (VCI). Searches were performed in the MEDLINE, Scopus, Scielo, and LILACS databases. This guideline provides a comprehensive review and then synthesizes the main practical guidelines for the diagnosis of VCI not only for neurologists but also for other professionals involved in the assessment and care of patients with VCI, considering the different levels of health care (primary, secondary and tertiary) in Brazil.
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Affiliation(s)
- Breno José Alencar Pires Barbosa
- Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Universidade de São Paulo, Brasil
| | | | | | | | | | | | | | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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Barbosa BJAP, Siqueira Neto JI, Alves GS, Sudo FK, Suemoto CK, Tovar-Moll F, Smid J, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Brucki SMD, Nitrini R, Engelhardt E, Chaves MLF. Diagnóstico do comprometimento cognitivo vascular: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:53-72. [DOI: 10.1590/1980-5764-dn-2022-s104pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/08/2021] [Accepted: 04/27/2022] [Indexed: 12/14/2022] Open
Abstract
RESUMO Desde a publicação das últimas recomendações para o diagnóstico e tratamento da Demência Vascular pela Academia Brasileira de Neurologia em 2011, avanços significativos ocorreram na terminologia e critérios diagnósticos. O presente manuscrito é resultado do consenso entre especialistas indicados pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia (2020-2022). O objetivo foi atualizar as recomendações práticas para a identificação, classificação e diagnóstico do Comprometimento Cognitivo Vascular (CCV). As buscas foram realizadas nas plataformas MEDLINE, Scopus, Scielo e LILACS. As recomendações buscam fornecer uma ampla revisão sobre o tema, então sintetizar as evidências para o diagnóstico do CCV não apenas para neurologistas, mas também para outros profissionais de saúde envolvidos na avaliação e nos cuidados ao paciente com CCV, considerando as diferentes realidades dos níveis de atenção à saúde (primário, secundário e terciário) no Brasil.
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Affiliation(s)
- Breno José Alencar Pires Barbosa
- Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil; Universidade de São Paulo, Brasil
| | | | | | | | | | | | | | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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11
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Abdelnour C, Agosta F, Bozzali M, Fougère B, Iwata A, Nilforooshan R, Takada LT, Viñuela F, Traber M. Perspectives and challenges in patient stratification in Alzheimer’s disease. Alzheimers Res Ther 2022; 14:112. [PMID: 35964143 PMCID: PMC9375274 DOI: 10.1186/s13195-022-01055-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 07/27/2022] [Indexed: 12/14/2022]
Abstract
Background Patient stratification is the division of a patient population into distinct subgroups based on the presence or absence of particular disease characteristics. As patient stratification can be used to account for the underlying pathology of a disease, it can help physicians to tailor therapeutic interventions to individuals and optimize their care management and treatment regime. Alzheimer’s disease, the most common form of dementia, is a heterogeneous disease and its management benefits from patient stratification in clinical trials, and the development of personalized care and treatment strategies for people living with the disease. Main body In this review, we discuss the importance of the stratification of people living with Alzheimer’s disease, the challenges associated with early diagnosis and patient stratification, and the evolution of patient stratification once disease-modifying therapies become widely available. Conclusion Patient stratification plays an important role in drug development in clinical trials and may play an even larger role in clinical practice. A timely diagnosis and stratification of people living with Alzheimer’s disease is paramount in determining people who are at risk of progressing from mild cognitive impairment to Alzheimer’s dementia. There are key issues associated with stratifying patients which include the heterogeneity and complex neurobiology behind Alzheimer’s disease, our inadequately prepared healthcare systems, and the cultural perceptions of Alzheimer’s disease. Stratifying people living with Alzheimer’s disease may be the key in establishing precision and personalized medicine in the field, optimizing disease prevention and pharmaceutical treatment to slow or stop cognitive decline, while minimizing adverse effects.
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12
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Lima DP, Queiroz IB, Carneiro AHS, Pereira DAA, Castro CS, Viana-Júnior AB, Nogueira CB, Coelho Filho JM, Lôbo RR, Roriz-Filho JDS, Braga-Neto P. Feasibility indicators of telemedicine for patients with dementia in a public hospital in Northeast Brazil during the COVID-19 pandemic. PLoS One 2022; 17:e0268647. [PMID: 35604914 PMCID: PMC9126396 DOI: 10.1371/journal.pone.0268647] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 04/14/2022] [Indexed: 01/02/2023] Open
Abstract
Background The use of telemedicine has become a fundamental tool in healthcare in recent years, especially at times of Covid-19 pandemic. Currently, there are several telemedicine tools that are simple, inexpensive, and effective means of communication. This article aims to describe indicators of feasibility including patient recruitment, attendance, discomfort (internet connection issues and/or noncompliant patient behavior), satisfaction, and travel time and cost savings of virtual telemedicine consultations for patients with dementia. Methods The study was conducted at the Geriatrics Department of Hospital Universitário Walter Cantídio (HUWC) in Fortaleza, Brazil, between May 1st and December 31, 2020. The eligibility criteria included previous diagnosis of dementia syndrome and receiving care at the hospital’s dementia outpatient clinic in face-to-face consultations in the preceding 12 months. Patients were excluded if they did not feel comfortable with virtual consultations, did not have the required communication technology available or their caregiver was not available to attend the remote consultation. The patients were recruited from the outpatient dementia clinic’s medical appointment scheduling list. The intervention was designed as a one-time consultation and it included treatment approaches and health promotion recommendations. Results Patient recruitment, attendance and discomfort rates were 85.5%, 97.7% and 9.4%, respectively. To attend face-to-face visits, they reported an average travel time (including the consultation) of 233.21 minutes and average total cost of 60.61 reais (around USD 11). The study intervention was well accepted among the patients and their caregivers with 97.6% being satisfied. Many were happy to avoid long waits in crowded medical waiting rooms and the risk of covid-19 contagion. Conclusions We found good recruitment, attendance, and acceptance rates of remote care for the follow-up of dementia patients as well as low discomfort rates. Trial registration Brazilian Trial Registry (REBEC) RBR-9xs978.
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Affiliation(s)
- Danielle Pessoa Lima
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Medical School of Universidade de Fortaleza, Fortaleza, Brazil
- * E-mail:
| | - Ingrid Barros Queiroz
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | | | - Camila Silva Castro
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | | | - Charlys Barbosa Nogueira
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - João Macedo Coelho Filho
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Rômulo Rebouças Lôbo
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Clinical Research Unit of Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Jarbas de Sá Roriz-Filho
- Division of Geriatrics, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Universidade Federal do Ceará, Fortaleza, Brazil
- Center of Health Sciences, Universidade Estadual do Ceará, Fortaleza, Brazil
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Borelli WV, de Senna PN, Brum WS, Schumacher-Schuh AF, Zimmer ER, Fagundes Chaves ML, Castilhos RM. Functional Cognitive Disorder Presents High Frequency and Distinct Clinical Profile in Patients With Low Education. Front Aging Neurosci 2022; 14:789190. [PMID: 35431909 PMCID: PMC9011344 DOI: 10.3389/fnagi.2022.789190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Functional Cognitive Disorder (FCD) is a non-degenerative, common cause of memory complaint in patients with high educational levels. FCD has been insufficiently described in individuals with low education. Here, we investigated the frequency of FCD among individuals with low education. Methods We analyzed retrospectively all new referrals from primary care to a tertiary memory clinic from 2014 to 2021. Final diagnosis, diagnostic work-up, clinical and cognitive testing data were compared between FCD and other diagnoses, grouped as Neurodegenerative Disorders (NDD). A regression model was used to assess the effect of education on the diagnosis. Data is shown in Mean [SD]. Results A total of 516 individuals (70.76 [10.3] years) with low educational attainment (4.5 [3.94] years) were divided into FCD (146, 28.3%) and NDD. Compared with NDD, FCD patients showed lower age at presentation (66.2 [9.4] vs. 72.6 [10.2], p < 0.001), higher Mini-Mental State Examination (MMSE) scores (22.4 [6.2] vs. 14.7 [7.8], p < 0.001) and Geriatric Depression Scale (GDS) scores (7.4 [5.4] vs. 5.3 [3.7], p = 0.0001). Discussion Surprisingly, FCD was the most frequent diagnosis in a low educational setting. However, education was not associated with FCD. Individuals presenting FCD showed a distinct clinical profile, including younger age and higher depressive scores. Strategies to identify FCD in primary care settings may benefit both patients and healthcare systems.
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Affiliation(s)
- Wyllians Vendramini Borelli
- Cognitive and Behavioral Neurology Center, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- *Correspondence: Wyllians Vendramini Borelli,
| | - Priscylla Nunes de Senna
- Cognitive and Behavioral Neurology Center, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Wagner Scheeren Brum
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Artur Francisco Schumacher-Schuh
- Cognitive and Behavioral Neurology Center, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Eduardo R. Zimmer
- Graduate Program in Biological Sciences: Pharmacology and Therapeutics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Graduate Program in Biological Sciences: Biochemistry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Márcia Lorena Fagundes Chaves
- Cognitive and Behavioral Neurology Center, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Raphael Machado Castilhos
- Cognitive and Behavioral Neurology Center, Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Henríquez F, Cabello V, Baez S, de Souza LC, Lillo P, Martínez-Pernía D, Olavarría L, Torralva T, Slachevsky A. Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges. Front Neurol 2022; 12:768591. [PMID: 35250791 PMCID: PMC8890568 DOI: 10.3389/fneur.2021.768591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.
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Affiliation(s)
- Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Cabello
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Departamento de Psicología, Bogotá, Colombia
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - David Martínez-Pernía
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Borelli WV, Augustin MC, de Oliveira PBF, Reggiani LC, Bandeira-de-Mello RG, Schumacher-Schuh AF, Chaves MLF, Castilhos RM. Neuropsychiatric Symptoms in Patients with Dementia Associated with Increased Psychological Distress in Caregivers During the COVID-19 Pandemic. J Alzheimers Dis 2021; 80:1705-1712. [PMID: 33646168 DOI: 10.3233/jad-201513] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The social isolation imposed by COVID-19 pandemic can have a major impact on the mental health of dementia patients and their caregivers. OBJECTIVE We aim to evaluate the neurological decline of patients with dementia and the caregivers' burden during the pandemic. METHODS We performed a cross-sectional study. Caregivers of dementia patients following in the outpatient clinic were included. A structured telephone interview composed of the Neuropsychiatric Inventory Questionnaire (NPI-Q), Zarit Burden Interview (ZBI), Beck Depression (BDI) and Anxiety (BAI) Inventories to address cognitive, behavioral, and functional changes associated with social distancing during the Sars-Cov-2 outbreak. Patients were divided in two groups according to caregivers' report: with perceived Altered Cognition (AC) and Stable Cognition (SC). RESULTS A total of 58 patients (median age: 57 years [21-87], 58.6%females) and caregivers (median age: 76.5 years [55-89], 79.3%females) were included. Cognitive decline was shown by most patients (53.4%), as well as behavioral symptoms (48.3%), especially apathy/depression (24.1%), and functional decline (34.5%). The AC group (n = 31) presented increased behavioral (67.7%versus 25.9%, p = 0.002) and functional (61.3%versus 3.7%, p < 0.001) changes when compared to the SC group. In the AC group, ZBI, BDI, NPI-Q caregiver distress, and NPI-Q patient's severity of symptoms scores were worse than the SC group (p < 0.005 for all). CONCLUSION Patients' neuropsychiatric worsening and caregiver burden were frequent during the pandemic. Worsening of cognition was associated with increased caregivers' psychological distress.
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Affiliation(s)
| | | | | | | | | | - Artur Francisco Schumacher-Schuh
- Serviço de Neurologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Farmacologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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16
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Hartle L, Charchat-Fichman H. Mild cognitive impairment history and current procedures in low- and middle-income countries: a brief review. Dement Neuropsychol 2021; 15:155-163. [PMID: 34345356 PMCID: PMC8283875 DOI: 10.1590/1980-57642021dn15-020001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/07/2021] [Indexed: 12/21/2022] Open
Abstract
Mild cognitive impairment (MCI) is a widely studied concept that has changed over time. Epidemiology, diagnosis, costs, prognostics, screening procedures, and categorization have been extensively discussed. However, unified guidelines are still not available, especially considering differences between low- and middle-income countries (LMIC) and high-income countries (HIC).
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Affiliation(s)
- Larissa Hartle
- Department of Psychology, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.,Department of Philosophy, Social, Human and Education Sciences, Università degli Studi di Perugia, Perugia, Italy
| | - Helenice Charchat-Fichman
- Department of Psychology, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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