Alexandre Leopold Busse

Short Assessment of Health Literacy for Portuguese-speaking Adults

OBJECTIVE To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individuals ability to correctly pronounce and understand common medical terms. We evaluated the instruments psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tools accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS Moderate to high correlations were found in the assessment of construct validity (Spearmans coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbachs alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.OBJETIVO: Desenvolver e validar um instrumento breve para avaliacao de alfabetismo em saude na lingua portuguesa. METODOS: O instrumento desenvolvido consiste de 50 itens que avaliam a capacidade do individuo de pronunciar e compreender termos medicos comuns. As propriedades psicometricas foram avaliadas em uma amostra de 226 idosos brasileiros. A validade de construto foi estabelecida pela correlacao com o numero de anos de escolaridade, relato de alfabetismo funcional e desempenho cognitivo global. A validade discriminativa foi estabelecida pela acuracia do instrumento na deteccao de alfabetismo em saude inadequado, definido como a incapacidade de compreender corretamente prescricoes medicas padronizadas. RESULTADOS: As correlacoes com os criterios de construto apresentaram magnitude moderada a alta (coeficientes de Spearman = 0,63 a 0,76). O instrumento apresentou ainda consistencia interna satisfatoria (Cronbach = 0,93) e boa confiabilidade teste-reteste (coeficiente de correlacao intraclasse = 0,95). A area sob a curva caracteristica de operacao do receptor para deteccao de alfabetismo inadequado foi 0,82. Uma versao com 18 itens foi derivada e apresentou propriedades psicometricas similares. CONCLUSOES: O instrumento desenvolvido apresentou boa validade e consistencia em uma amostra de idosos brasileiros e pode ser utilizado em ambientes clinicos ou de pesquisa com a finalidade de detectar alfabetismo em saude inadequado.

Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study

Objectives To investigate the relationship between functional health literacy and glycaemic control in a sample of older patients with type 2 diabetes. Design Cross-sectional study. Setting A government-financed outpatient geriatric clinic in São Paulo, Brazil. Participants 129 older patients with type 2 diabetes, a mean (SD) age of 75.9 (6.2) years, a mean glycosylated haemoglobin (HbA1c) of 7.2% (1.4), of which 14.7% had no formal education and 82.9% had less than a high-school diploma. Measures HbA1c was used as a measure of glycaemic control. Functional health literacy was assessed with the 18-item Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18), a validated instrument to evaluate pronunciation and comprehension of commonly used medical terms. Regression models were controlled for demographic data, depressive symptoms, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications. Results Functional health literacy below adequate was encountered in 56.6% of the sample. After controlling for potential confounding factors, patients with inadequate functional health literacy were more likely than patients with adequate functional health literacy to present poor glycaemic control (OR=4.76; 95% CI 1.36 to 16.63). In a fully adjusted linear regression model, lower functional health literacy (β=−0.42; p<0.001), longer diabetes duration (β=0.24; p=0.012) and lack of assistance for taking medications (β=0.23; p=0.014) were associated with higher levels of HbA1c. Contrary to our expectations, illiterate patients did not have poorer outcomes when compared with patients with adequate functional health literacy, raising the hypothesis that illiterate individuals are more likely to have their difficulties recognised and compensated. However, the small subsample of illiterate patients provided limited power to reject differences with small magnitude. Conclusions Patients with inadequate functional health literacy presented with higher odds of poor glycaemic control. These findings reinforce the importance of addressing limited functional health literacy in clinical practice.

Physical activity and cognition in the elderly: A review

Physical activity has been indicated as a strategy to promote health in the elderly, as well as to encourage the maintenance of functional capacity, and acts in the prevention and control of various diseases. In recent years, there has been great interest in studying the benefits of physical activity in the preservation or even improvement of cognitive performance in both the elderly without cognitive impairment and in elderly patients with some degree of cognitive impairment or dementia. The majority of epidemiological studies and clinical trials have evaluated aerobic exercises while few have assessed resistance exercise programs. The objective of this review was to examine the effects of different types of physical activity on cognitive function of elderly individuals with or without prior impairment.

Efeitos das atividades físicas resistida e aeróbia em idosos em relação à aptidão física e à funcionalidade: ensaio clínico prospectivo

ABSTRACT Objective: To compare the effects of physical fitness and function on older adults in two programs of supervised exercise activity: resistance training and aerobic exercise. Methods: This study is a randomized, prospective clinical trial composed of sedentary elderly people who did not have contraindications to exercise. Participants were divided into two groups: group one performed 6 exercises of resistance training twice a week, and group two participated in walking activity for 30 minutes twice a week. Functional assessment (time 0,6 and 12 months) was measured by the Short Physical Performance Battery (time to sit or stand, gait speed, and balance), flexibility test, and the six-minute walking test. We randomly selected 96 patients: 46 in the Resistance Training Group and 50 in the Aerobic Exercise Group. In the Resistance Training Group, 46 attended the first assessment and 20 attended until the third section. In the Aerobic Exercise Group, 50 attended the first assessment and 12 attended until the third assessment. Results: Mean age was 68.8 years in the Resistance Training Group and 69.1 years in the Aerobic Exercise Group. The Resistance Training Group showed improvement in the sit/ stand (p=0.022), balance with feet in a row (p=0.039) and queued (p=0.001). The second showed a statistical difference in speed and balance with the feet lined up and the feet together (p=0.008; p=0.02; and p=0.043, respectively). Concerning flexibility, the Resistance Training Group had improvement (p=0.001), whereas in the Aerobic Exercise Group, no significant difference was seen (p=0.359). Both groups had improvement in the six-minute walking test, but no significant improvement was seen in the Aerobic Exercise Group (p=0.033). Conclusion: Both groups showed improvement in physical fitness. No statistical difference was seen when groups was compared in the short physical performance battery, flexibility, and six-minute walking test. Clinical trial register: UTN: U1111-1141-3066

Effects of Tai Chi Chuan on cognition of elderly women with mild cognitive impairment

OBJECTIVE To detect the effects of Tai Chi Chuan practice on the cognition of elderly subjects with Mild Cognitive Impairment. METHODS This is a pilot study with 26 elderly patients (mean age of 74 years) with Mild Cognitive Impairment. The evaluation instruments were Subjective Memory Complaint Scale (SMC), Rivermead Behavioral Memory Test (RBMT) and Digit Span Forward and Backward (DSF and DSB) from the Wechsler Adult Intelligence Scale (WAIS). One group of 13 patients received two weekly 60-minute classes of Tai Chi Chuan (Yang style) for 6 consecutive months, and the rest formed the Control Group. The Tai Chi Chuan Group was also evaluated as to learning of the Tai Chi Chuan practical exercises by means of a Specific Learning Test applied after three months of intervention. RESULTS After six months of intervention, the TCC Group showed significant improvement on the RBMT and the SMC (p = 0.007 and p = 0.023, respectively). The Control Group showed no significant differences in the cognitive tests during the study. There was a significant correlation between the Tai Chi Chuan Learning Test and RBMT (p = 0.008), showing that patients with a better performance in exercising TCC also showed a better performance in memory. CONCLUSIONS In this study, a six-month program of Tai Chi Chuan afforded a significant improvement of the performance of memory complaints in the elderly with Mild Cognitive Impairment. Additional randomized studies with larger samples and more prolonged follow-up are needed to confirm these benefits.

Estimating Premorbid Cognitive Abilities in Low-Educated Populations

Objective To develop an informant-based instrument that would provide a valid estimate of premorbid cognitive abilities in low-educated populations. Methods A questionnaire was drafted by focusing on the premorbid period with a 10-year time frame. The initial pool of items was submitted to classical test theory and a factorial analysis. The resulting instrument, named the Premorbid Cognitive Abilities Scale (PCAS), is composed of questions addressing educational attainment, major lifetime occupation, reading abilities, reading habits, writing abilities, calculation abilities, use of widely available technology, and the ability to search for specific information. The validation sample was composed of 132 older Brazilian adults from the following three demographically matched groups: normal cognitive aging (n = 72), mild cognitive impairment (n = 33), and mild dementia (n = 27). The scores of a reading test and a neuropsychological battery were adopted as construct criteria. Post-mortem inter-informant reliability was tested in a sub-study with two relatives from each deceased individual. Results All items presented good discriminative power, with corrected item-total correlation varying from 0.35 to 0.74. The summed score of the instrument presented high correlation coefficients with global cognitive function (r = 0.73) and reading skills (r = 0.82). Cronbachs alpha was 0.90, showing optimal internal consistency without redundancy. The scores did not decrease across the progressive levels of cognitive impairment, suggesting that the goal of evaluating the premorbid state was achieved. The intraclass correlation coefficient was 0.96, indicating excellent inter-informant reliability. Conclusion The instrument developed in this study has shown good properties and can be used as a valid estimate of premorbid cognitive abilities in low-educated populations. The applicability of the PCAS, both as an estimate of premorbid intelligence and cognitive reserve, is discussed.

Learning effect of computerized cognitive tests in older adults

ABSTRACT Objective: To evaluate the learning effect of computerized cognitive testing in the elderly. Methods: Cross-sectional study with 20 elderly, 10 women and 10 men, with average age of 77.5 (±4.28) years. The volunteers performed two series of computerized cognitive tests in sequence and their results were compared. The applied tests were: Trail Making A and B, Spatial Recognition, Go/No Go, Memory Span, Pattern Recognition Memory and Reverse Span. Results: Based on the comparison of the results, learning effects were observed only in the Trail Making A test (p=0.019). Other tests performed presented no significant performance improvements. There was no correlation between learning effect and age (p=0.337) and education (p=0.362), as well as differences between genders (p=0.465). Conclusion: The computerized cognitive tests repeated immediately afterwards, for elderly, revealed no change in their performance, with the exception of the Trail Making test, demonstrating high clinical applicability, even in short intervals.

Efeitos da prática de Tai Chi Chuan na cognição de idosas com comprometimento cognitivo leve

Objetivo: Detectar os efeitos da pratica de Tai Chi Chuan na cognicao de idosas com comprometimento cognitivo leve. Metodos: Estudo piloto com 26 idosas (media de idade de 74 anos) com comprometimento cognitivo leve. Os instrumentos de avaliacao foram: Escala Subjetiva de Queixas de Memoria (EQM), Teste Comportamental de Memoria de Rivermead (RBMT) e Amplitude de Digitos Verbal Direta e Indireta (DD e DI, respectivamente) derivadas do Weschler Adult Intelligence Scale (WAIS). Um grupo de 13 pacientes recebeu duas aulas semanais de 60 minutos de Tai Chi Chuan (estilo Yang) por 6 meses consecutivos, e o restante formou o Grupo Controle. O grupo Tai Chi Chuan tambem foi avaliado quanto ao aprendizado da pratica dos exercicios de Tai Chi Chuan atraves de um Teste de Aprendizado Especifico aplicado apos tres meses de intervencao. Resultados: Apos seis meses de intervencao, o grupo Tai Chi Chuan apresentou melhora significativa no RBMT e na EQM (p = 0,007 e p = 0,023, respectivamente). O Grupo Controle nao apresentou diferencas significativas nos testes cognitivos no decorrer do estudo. Houve correlacao significativa entre o Teste de Aprendizado de Tai Chi Chuan e o RBMT (p = 0,008), apontando que os pacientes com melhor performance na pratica de Tai Chi Chuan apresentaram melhor desempenho da memoria. Conclusoes: Neste estudo, um programa de seis meses de Tai Chi Chuan propiciou uma melhora significativa do desempenho e das queixas de memoria de idosas com comprometimento cognitivo leve. Estudos adicionais randomizados com casuistica maior e seguimento mais prolongado sao necessarios para confirmar estes beneficios.

Cognitive impairment and driving. A review of the literature

Although some drivers with mild dementia may continue to drive after the condition has been diagnosed, the ability to drive a motor vehicle safely is eventually lost as the disease progresses. Clinicians involved in dementia care are often asked to make an assessment on whether a patient is fit to drive, even though they often lack basic knowledge and formal training in this area. The purpose of this review was to identify the factors that may differentiate safe from unsafe drivers with cognitive impairment and to discuss management strategies. Isolated information about staging measures or particular cognitive tests was found to be insufficient for decision making. Driving fitness counseling for patients with cognitive impairment requires a solid knowledge base, comprehensive assessment and thoughtful communication.

Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS).

A screening strategy composed of three‐item temporal orientation and three‐word recall has been increasingly used for detecting cognitive impairment. However, the intervening task administered between presentation and recall has varied. We evaluated six brief tasks that could be useful as intervening distractors and possibly provide incremental accuracy: serial subtraction, clock drawing, category fluency, letter fluency, timed visual detection, and digits backwards.