Cognitive and functional evolution in older adults with and without intellectual disability using a multicomponent intervention: A prospective longitudinal study

BACKGROUND

The global population is experiencing accelerated biopsychosocial aging. Cognitive impairment is frequently associated with functional impairment in basic and instrumental daily living activities. To maintain optimal cognitive and functional functioning, health professionals recommend that older adults participate in cognitive training.

AIMS

This study examines the cognitive and functional evolution of older adults with and without Intellectual Disability and the factors associated with favourable evolution following the intervention of a multicomponent programme based on the human occupational model and the person-centred care model.

METHODS AND PROCEDURES

247 people participated. Descriptive and univariate analyses were performed to examine baseline data. The Wilcoxon paired samples test was used to compare cognitive and functional evolution one year after the intervention. Linear regression was used to detect factors predicting favourable evolution.

OUTCOMES AND RESULTS

Both populations improved cognitively. There was no change in basic activities of daily living. There was an improvement in instrumental activities of daily living in the group with Intellectual Disability. None of the variables collected was a predictor of greater improvement.

CONCLUSIONS AND IMPLICATIONS

This study demonstrated that older people with Intellectual Disability who have supports to cope with this life stage can improve their cognitive and functional abilities.

Predictive variables of depressive symptoms and anxiety in older adults from primary care: a cross-sectional observational study

BACKGROUND

By 2050, the number of people aged 60 years and older will have doubled worldwide and the most common mental disorders in this age group are currently depressive symptoms and anxiety. This study aimed to analyze the Basic and Instrumental Activities of Daily Living (BADLs and IADLs, respectively) in older adults; socio-demographic, clinical, lifestyle, and environmental variables; and cognitive impairment related to the appearance of depressive symptoms and anxiety.

MATERIAL AND METHODS

A cross-sectional observational study was conducted with 327 participants aged ≥65 years in primary care. The variables were Yesavage's Geriatric Depression Scale, the Goldberg Anxiety Subscale, socio-demographic, clinical, lifestyle, environmental variables, BADLs, IADLs, and the Spanish version of the Mini-Mental State Examination.

RESULTS

An analysis of variance was carried out for the predictive multiple linear regression models. '≥ 1 chronic pathology' and 'low dependency' in BADL are negatively associated with anxiety, while 'physical activity' and 'low dependency' in BADL are associated with positive factors for depressive symptoms.

CONCLUSIONS

Predictor variables could improve the early detection of anxiety and depressive symptoms by general practitioners and serve as a basis for future studies and personalised-adapted cognitive stimulation programs.

Cognitive stimulation and psychosocial results in older adults: A systematic review and meta-analysis

INTRODUCTION

Cognitive stimulation (CS) is a popular and cost-effective intervention, which applies different types of techniques focused on cognitive skills and can be administered by different professionals. CS can be defined as activities that involve cognitive processing usually conducted in a social context and often in a group. Therefore, CS can improve psychosocial functioning and quality of life (QoL), depression, anxiety and activities of daily living (ADLs) independent of the pharmacological treatment such as acetylcholinesterase inhibitors. The objective of this systematic review and meta-analysis was to evaluate the effects of CS on psychosocial outcomes in older adults (aged 65 years or over), with healthy cognitive ageing, mild cognitive impairment (MCI), and dementia.

METHODS

PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were initially identified in these databases. After discarding studies that did not meet the inclusion criteria, 30 studies were finally included in the systematic review and the meta-analysis performed with robust variance estimator (RVE) due the inclusion of studies with repeated measurements. The quality assessment tools from the National Institutes of Health were used to evaluate the quality of the studies.

RESULTS

CS was significantly associated with a higher QoL in participants who received personalized/adapted CS (RVE = 0.11±0.19 [-0.76, 0.99], t(1.86) = 0.6, p = 0.61). .

CONCLUSION

Personalized/adapted CS seems to improve QoL in older adults.

Linking sedentary behavior and mental distress in higher education: a cross-sectional study

Background

Sedentary behavior among university students could negatively affect their mental health.

Objective

The aim of this study was to examine the relationship of mental health (anxiety and depression) and sedentary behavior between gender in Health Degrees at the University of Zaragoza.

Design

Cross-sectional descriptive study.

Participants

Sample of 257 University students who completed an online questionnaire.

Methods

Sedentary behavior was assessed with the SBQ questionnaire. Anxiety and depression were assessed with the GADS questionnaire. The Mann-Whitney U test and multiple linear regression models were used.

Results

In comparison to men, female students with symptoms of anxiety spend more time in total engaged in sedentary behaviors (10.56 ± 4.83) vs. (7.8 ± 3.28; p < 0.001) and mentally-passive sedentary activities [2.24 (1.57) vs. 1.15 (0.90; p < 0.005)]. Female students at risk of depression also spend more hours engaged in mentally-passive sedentary behaviors in comparison to men (8.28 ± 50.70 vs. 1.27 ± 1.02; p = 0.009).

Conclusion

Female students at risk of anxiety and/or depression spend more time engaged in sedentary activities in comparison to male students. The risk of anxiety and depression is associated with the total number of hours a day spent engaged in sedentary behaviors and with mentally passive behaviors, but not mentally active behaviors.

Effects of cognitive stimulation program on cognition and mood in older adults, stratified by cognitive levels: A randomized controlled trial

PURPOSE OF THE RESEARCH

Cognitive stimulation (CS) is defined as activities that involve cognitive processing, usually conducted in a social context and often in a group. This study aims to evaluate the effects of a personalized-adapted CS program in older adults on global cognition, neuropsychological constructs, activities of daily living (ADLs), and mood.

MATERIALS AND METHODS

The randomized controlled single-blind trial involving 337 participants (235 women and 102 men) ≥ 65 years of age in a Primary Care centre classified participants into 4 groups: 101 for the no deterioration (ND) group; 100 for the subjective cognitive impairment (SCI) group; 108 for the level deterioration (LD) group and 28 for the moderate deterioration group. The intervention consisted of a personalized CS adapted program for 10 weeks. Follow-up assessments were conducted post-intervention, and at 6 and 12 months. The primary outcome was global cognition measured by the Spanish version of the Mini-Mental State Examination. The secondary outcomes were measured by the Barthel Index, the Lawton and Brody Scale, the Goldberg Questionnaire (anxiety sub-scale) and the abbreviated Yesavage Geriatric Depression Scale.

RESULTS

The intervention showed a tendency of improvement on global cognition and different cognitive functions for groups with no deterioration or level deterioration. The group with moderate deterioration improved in anxiety.

CONCLUSIONS

The findings demonstrated benefits in global cognition, different cognitive functions, semantic fluency, IADLs and anxiety. The most benefits are given in the intermediate groups, SCI, and LD. Moreover, the intervention works by increasing the benefits in the different phases.

Cognitive Effects of a Cognitive Stimulation Programme on Trained Domains in Older Adults with Subjective Memory Complaints: Randomised Controlled Trial

Age-related subjective memory complaints (SMC) are a common concern among older adults. However, little is known about the effects of cognitive stimulation (CS) interventions on subjective memory complaints. The aim of this study was to analyse the effectiveness of a CS programme on global cognition and cognitive functions of older adults with SMC. A randomised clinical trial was conducted on older adults with SMC, including 308 participants ≥65 years of age assessed 6 and 12 months after the intervention. The assessment instrument was the Spanish version of the Mini-Mental State Examination (MEC-35), and all domains of the instrument were assessed. For statistical analysis, the data were analysed using robust ANOVA with means truncated at 20% utilising a two-way repeated measures model, with between (groups) and within (measurements) factors. In post hoc tests, a Wilcoxon signed-rank test of exact permutations between groups and Bonferroni correction were applied. In post hoc between-group tests, significant differences were found: (1) post-treatment in MEC-35, temporal orientation, short-term memory (STM), global language and praxis, and language and praxis (p ≤ 0.005); (2) at 6 months in MEC-35, global orientation, temporal orientation, and STM (p = 0.005); (3) at 12 months in MEC-35, global orientation, temporal orientation, STM, global language and praxis, and language (p = 0.005). This study shows benefits in global cognition and orientation, temporal orientation, STM, and language in older adults with SMC.

Sex-Moderated Socio-Labor Aspects as Mediators of a Cognitive Stimulation Program in Older Adults: Randomized Clinical Trial

Cognitive stimulation is essential for successful aging. The influence of sex and socio-occupational elements on this area remains unknown. This study aimed to analyze the possible mediation of those elements in the effectiveness of a cognitive stimulation program in primary care. A randomized clinical trial was conducted with 232 adults aged 65 years or older without cognitive impairment. The intervention produced significant cognitive improvements. Women improved independently of social and occupational factors, while men's improvement occurred at a low role level (zero to one), a medium level of interests (two to three), with a medium level of mental occupation (neither high nor low), and with marked personal values. The mediating variables were the intervention group in both sexes and, also in men, a low and medium role level. Therefore, the intervention and roles appear as mediating variables moderated by sex. In conclusion, cognitive stimulation programs should be adapted.

Cognitive stimulation and cognitive results in older adults: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

The lack of cognitive activity accelerates age cognitive decline. Cognitive stimulation (CS) tries to enhance cognitive functioning. The purpose of this systematic review and meta-analysis was to evaluate the effects of CS on cognitive outcomes (general cognitive functioning and specific cognitive domains) in older adults (aged 65 years or older, cognitively healthy participants, or with mild cognitive impairment, or dementia).

METHODS

PubMed, Scopus and Web of Science databases were examined from inception to October 2021. A total of 1,997 studies were identified in these databases, and. 33 studies were finally included in the systematic review and the meta-analysis. Raw means and standard deviations were used for continuous outcomes. Publication bias was examined by Egger's Regression Test for Funnel Plot Asymmetry and the quality assessment tools from the National Institutes of Health.

RESULTS

CS significantly improves general cognitive functioning (mean difference=MD = 1.536, 95%CI, 0.832 to 2.240), memory (MD = 0.365, 95%CI, 0.300 to 0.430), orientation (MD = 0.428, 95%CI, 0.306 to 0.550), praxis (MD = 0.278, 95%CI, 0.094 to 0.462) and calculation (MD = 0.228, 95%CI, 0.112 to 0.343).

CONCLUSION

CS seems to increase general cognitive functioning, memory, orientation, praxis, and calculation in older adults.

Development and Validation of a Mobile Application as an Adjuvant Treatment for People Diagnosed with Long COVID-19: Protocol for a Co-Creation Study of a Health Asset and an Analysis of Its Effectiveness and Cost-Effectiveness

OBJECTIVE

To analyse the overall effectiveness and cost-efficiency of a mobile application (APP) as a community health asset (HA) with recommendations and recovery exercises created bearing in mind the main symptoms presented by patients in order to improve their quality of life, as well as other secondary variables, such as the number and severity of ongoing symptoms, physical and cognitive functions, affective state, and sleep quality.

METHODS

The first step was to design and develop the technologic community resource, the APP, following the steps involved in the process of recommending health assets (RHA). After this, a protocol of a randomised clinical trial for analysing its effectiveness and cost-efficiency as a HA was developed. The participants will be assigned to: (1st) usual treatment by the primary care practitioner (TAU), as a control group; and (2nd) TAU + use of the APP as a HA and adjuvant treatment in their recovery + three motivational interviews (MI), as an interventional group. An evaluation will be carried out at baseline with further assessments three and six months following the end of the intervention.

DISCUSSION

Although research and care for these patients are still in their initial stages, it is necessary to equip patients and health care practitioners with tools to assist in their recovery. Furthermore, enhanced motivation can be achieved through telerehabilitation (TR).

Effects of multi-component non-pharmacological interventions on cognition in participants with mild cognitive impairment: A systematic review and meta-analysis

BACKGROUND AND PURPOSE

Mild cognitive impairment (MCI) describes a stage of intermediate cognitive dysfunction where the risk of conversion to dementia is elevated. Given the absence of effective pharmacological treatments for MCI, increasing numbers of studies are attempting to understand how multicomponent non-pharmacological interventions (MNPI) could benefit MCI. The purpose of this systematic review and meta-analysis were to assess the effects of two-component MNPI (simultaneous cognitive intervention based on cognitive stimulation, cognitive training and/or cognitive rehabilitation or combined cognitive and physical interventions) on global cognition and cognitive functions in older adults with MCI and to compare the degree of efficacy between the two interventions.

METHODS

After searching electronic databases (PubMed, Web of Science, Scopus and Cochrane Central) for randomized controlled trials and clinical trials published from 2010 to 18 January 2021, 562 studies were found. 8 studies were included in this review, with a fair to good quality according to the PEDro scale.

RESULTS

From a random-effects model meta-analysis, the pooled standardized MMSE mean difference between the intervention and control groups showed a significant small-to-medium effect in global cognition in MMSE score (0.249; 95% CI = [0.067, 0.431]), which seemed to be greater for combined physical and cognitive interventions. However, the meta-analyses did not show any effects regarding specific cognitive functions.

CONCLUSION

Our analyses support that MNPI could improve the global cognition in older adults with MCI. However, more studies are needed to analyze the potential benefits of MNPI on older adults with MCI.

Job demands may determine cognitive and physical aging after retirement

During adulthood, we spend most of our time and efforts at work. However, the impact of employment in aging is poorly explored. Our study addressed how job demands can affect aging after retirement. We have developed a descriptive observational study carried out in 367 older adults with a mean age of 73.9 years (66.5% women and 33.5% men), measuring cognition and functional status. Our results demonstrate that older adults who had high mental demands in their jobs, show better scores in cognition. However, they show poor functional development of basic and instrumental activities of daily life (p< .05). In contrast, former workers who had high physical demands, display lower scores in cognition and lower functional performance in instrumental activities (p< .05). Work life activities contribute to cognitive and physical decline after retirement. Therefore, healthy aging should include interventions that consider the job influence on the age impairment.

Effectiveness of Personalized Cognitive Stimulation in Older Adults with Mild Possible Cognitive Impairment: A 12-month Follow-up Cognitive Stimulation in Mild Cognitive Impairment

OBJECTIVE

The objective of this study was to analyze the long-term effects of a personalized cognitive stimulation (PCS) program on the global cognition, cognitive aspects, activities of daily living (ADLs), anxiety, and depression in older adults with possible mild cognitive impairment (MCI).

METHODS

A 12-month follow-up analysis was carried out in a single-blind, randomized clinical trial to research the long-term effects of a 10-week PCS program evaluating the cognitive level, depression, and anxiety of older adults with possible MCI.

RESULTS

Fifty older adults were assessed 12 months after the CS program, 23 in the intervention group and 27 in the control group. There were significant differences between the groups at 12 months in the global cognition (p = .002), in global orientation (p < .001), and in spatial orientation (p = .004) in favor of the intervention group, measured with the Spanish version of the Mini-Mental Status Examination (MEC-35).

CONCLUSIONS

A PCS program could be effective in improving global cognition and global and spatial orientation.

CLINICAL IMPLICATIONS

A PCS program based on cognitive levels in older adults with possible MCI achieves improvements in global cognition and global and spatial orientation. PCS programs can be applied successfully by trained occupational therapists.

Short-term memory, attention, and temporal orientation as predictors of the cognitive impairment in older adults: A cross-sectional observational study

Late-life cognitive decline ranges from the mildest cases of normal, age-related change to mild cognitive impairment to severe cases of dementia. Dementia is the largest global burden for the 21st century welfare and healthcare systems. The aim of this study was to analyze the neuropsychological constructs (temporal orientation (TO), spatial orientation (SO), fixation memory (FM), attention (A), calculation (C), short-term memory (STM), language (L), and praxis (P)), semantic fluency, level of functionality, and mood that reveal the greatest deficit in the different stages ranging from normal cognition (NC) to cognitive impairment in older adults in a primary healthcare setting. The study included 337 participants (102 men, 235 women), having a mean age of 74 ± 6 years. According to their scores on the Spanish version of the Mini-Mental State Examination (MEC-35), subjects were divided into 4 groups: no deterioration (ND) (score 32-35), subtle cognitive impairment (SCI) (score 28-31), level deterioration (LD) (score 24-27) and moderate deterioration (MD) (score 20-23). The ND group revealed significant differences in TO, STM, C, A, L, P, and S-T as compared to the other groups. The MD group (in all the neuropsychological constructs) and the ND and SCI groups showed significant differences on the Yesavage geriatric depression scale (GDS-15). All except the FM neuropsychological construct were part of the MEC-35 prediction model and all of the regression coefficients were significant for these variables in the model. Furthermore, the highest average percentage of relative deterioration occurs between LD and MD and the greatest deterioration is observed in the STM for all groups, including A and TO for the LD and MD groups. Based on our findings, community programs have been implemented that use cognitive stimulation to prevent cognitive decline and to maintain the neuropsychological constructs.

Gender Self-Perception and Psychological Distress in Healthcare Students during the COVID-19 Pandemic

The aim of this study was to analyze university Health Sciences students’ self-perception regarding gender stereotypes, and to explore whether there was any association between gender stereotypes and clinical/socio-demographic variables. Methods: This cross-sectional study was conducted with a sample of 252 university students who completed a self-administrated online questionnaire (18.3% males, 81.7% females). We evaluated the self-perception of gender stereotypes as determined using the BSRI-12 questionnaire and explored the association of this measure with the impact of perceived stress measured using a modified scale (PSS-10-C) as well as anxiety and depression according to scores on the Goldberg scale (GADS). Results: According to the students’ self-perception of gender stereotypes, 24.9% self-perceived themselves as feminine, 20.1% as masculine, 24.9% as androgynous, and 30% as undifferentiated. The degree determines self-identification with gender stereotypes. Nursing and Occupational Therapy are studied mostly by women, 28.4% and 45%, respectively, while Physiotherapy is studied mainly by men (71.2%). Females indicated more anxiety (75.7%) and depression (81.7%) than males (52.9% and 67.3%, respectively). In contrast, males developed more stress (88.5%) than females (74.1%). Conclusions: University degree, anxiety, depression, and stress determined self-identification with gender stereotypes. The results of this study indicate that gender roles influence the possibility of developing mental disorders and should be taken into account in future studies.

[Analysis of the effect of cognitive stimulation program in older adults with normal cognition: randomized clinical trial]

BACKGROUND

Cognitive stimulation programs in older adults seek cognitive and emotional improvements. The literature makes no reference to programs adapted according to cognitive and occupational levels in older adults with no cognitive impairment. The objective of this study was to analyze the effectiveness of level-adapted cognitive stimulation interven-tion in older adults in terms of cognition and mood.

METHODS

Randomized clinical trial (CONSORT) at a health center, which included 201 participants =?65 years (101 inter-vention and 100 control) evaluated immediately after the intervention, then at six months and finally at one year. The assessment instruments were the cognitive mini-exam (CME), the abbreviated Goldberg anxiety scale and the Yesavage geriatric depression scale (GDS-15). The intervention was carried out through a cognitive stimulation program with two cognitive levels according to CME (high: 32-35; low: 28-31) with ten sessions of 45 minutes. Statistical analysis was per-formed by Student's t-test.

RESULTS

The difference observed in the averages between control and intervention groups was statistically significant in the three assessments; these differences were observed regardless of gender, age, cognitive level, and mood. One year after the intervention, CME score reached an increase of 1.48 points in the in the high level group and 2.03 points in the low level. However, no significant differences in CME score were observed in any of the assessments for anxiety or depression.

CONCLUSION

A cognitive stimulation program, cognitive level-adapted, has shown cognitive benefits in older adults without cognitive impairment living in the community, regardless of sex, age and educational level.

[Analysis of the effect of a program of cognitive stimulation in elderly people with normal aging in primary care: Randomized clinical trial]

OBJECTIVE

To provide evidence of the effectiveness of a community health intervention, that includes a cognitive stimulation program, to prevent the deterioration of cognitive abilities in our population of elderly people with normal cognition that are living in the community.

DESIGN

Randomized clinical trial (CONSORT group norms) LOCATION: San José Norte-Centro Health Center and La Caridad Foundation (Zaragoza, Spain).

PARTICIPANTS

201 people aged 65 or older, with a MEC score of at least 28 points, which were randomized between the Intervention group (101) and the Control group (100).

INTERVENTION

The intervention was applied in 10 sessions of 45minutes, one per week. It used materials designed by one of the authors, which addressed the following areas: memory, orientation, language, praxis, gnosis, calculation, perception, logical reasoning, attention-concentration and programming.

MAIN MEASUREMENTS

The main outcome variables were MEC, Set-Test, Barthel and Lawton-Brody.

RESULTS

Increases of the main result variables over their baseline level were analized. For MEC variable, the Intervention group obtained, on average, 1.58 points more than the Control group in the evaluation performed immediately after the intervention. After 6months, the improvement was 1.51 points and after a year, it was of 2.04 points. All these differences were statistically significant. For Set-Test, Barthel and Lawton-Brody variables, no statistically significant differences were observed between Intervention group and Control group.

CONCLUSIONS

Cognitive stimulation with our program is effective to maintain or improve cognitive performance, measured with the variable MEC, our population of elderly people with normal cognition that are living in the community. There is no evidence that this improvement is transferred to the activities of daily life measured with Barthel and Lawton-Brody variables.

Multiple sclerosis in Spain: an epidemiological study of the Alcoy health region, Valencia

Alcoy is a defined health region in eastern Spain, at 3 degrees E-38 degrees N, with a single neurology department and includes 33 towns with a total population of 133,915 inhabitants. We have evaluated the prevalence and incidence of multiple sclerosis (MS) by analysing this region. Six new cases have been detected (2.24/100,000/year) and the prevalence rate was 17.17/100,000, the highest in Spain at the moment. However, we found an irregular distribution in the different towns in so far that 15 of our 23 patients lived in a particular subregion, which means a prevalence of 44.59/100,000. Our study shows that the area of Alcoy is a medium MS risk region according to the thesis of Kurzke, although high MS areas may be found, thus confirming that MS distribution in southern Europe is not uniform.