Anita Liberalesso Neri

Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly

OBJECTIVE: To obtain internal construct and criteria validity for the Center of Epidemiological Studies - Depression scale in elderly people. METHODS: The instrument was applied to 903 elderly living in a city in southeastern Brazil, between 2002 and 2003. Results were compared with the Brazilian version of the CES-D applied to a sub-sample of 446 participants. Internal consistency of the two scales was assessed using Cronbachs alpha measured for the items in their total and for the items of each factor obtained for the assessed instrument. To assess the construct validity, the 20 items underwent exploratory factorial analysis to discover their variation pattern and the variance explained according to each factor. RESULTS: The scale presented satisfactory index for internal validity (a=0.860), sensibility (74.6%), specificity (73.6%), and for cutoff point >11. However, it presented a relatively high frequency of false positives compared to the GDS 33.8% vs. 15%. Exploratory factorial analysis of the instrument created factorial structure with three factors: negative affects, problems initiating behaviors, and positive affects. CONCLUSIONS: The instrument seemed to be psychometrically suitable when applied to older people. However, further cross-sectional and longitudinal studies, carried out in different contexts, may explain the effects of somatic and situational variables on the results of the instrument in older people.

Metodologia e perfil sociodemográfico, cognitivo e de fragilidade de idosos comunitários de sete cidades brasileiras: Estudo FIBRA

Um estudo foi planejado para identificar condicoes de fragilidade em relacao a variaveis sociodemograficas, de saude, cognicao, funcionalidade e psicossociais em idosos comunitarios. Metodologia e dados preliminares sao apresentados. Foram selecionados 3.478 idosos (65 anos e mais), integrantes de amostras probabilisticas de sete cidades brasileiras escolhidas por conveniencia, participaram de sessao de coleta de dados, em ambiente comunitario. Predominaram as seguintes caracteristicas: mulheres (67,7%), casados (48%) ou viuvos (36,4%), vivendo com a familia de filho/a (52,6%), chefes de familia (64,5%) e 1-4 anos de escolaridade (49%); 28,8% eram analfabetos e 24,8% tinham deficit cognitivo; 9,1% eram frageis, 51,8% pre-frageis e 39,1% nao-frageis. Houve mais frageis entre as mulheres, os de 80 anos e mais, os viuvos, os analfabetos, os que nunca foram a escola e os com deficit cognitivo. Em geral, os dados sociodemograficos replicam os de estudos epidemiologicos brasileiros, e os de fragilidade, estado cognitivo e escolaridade, os da literatura internacional.

The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds

BACKGROUND Although the Clock Drawing Test (CDT) is the second most used test in the world for the screening of dementia, there is still debate over its sensitivity, specificity, application and interpretation in dementia diagnosis. This study has three main aims: to evaluate the sensitivity and specificity of the CDT in a sample composed of older adults with Alzheimers disease (AD) and normal controls; to compare CDT accuracy to the that of the Mini-mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG); and to test whether the association of the MMSE with the CDT leads to higher or comparable accuracy as that reported for the CAMCOG. METHODS Cross-sectional assessment was carried out for 121 AD and 99 elderly controls with heterogeneous educational levels from a geriatric outpatient clinic who completed the Cambridge Examination for Mental Disorder of the Elderly (CAMDEX). The CDT was evaluated according to the Shulman, Mendez and Sunderland scales. RESULTS The CDT showed high sensitivity and specificity. There were significant correlations between the CDT and the MMSE (0.700-0.730; p < 0.001) and between the CDT and the CAMCOG (0.753-0.779; p < 0.001). The combination of the CDT with the MMSE improved sensitivity and specificity (SE = 89.2-90%; SP = 71.7-79.8%). Subgroup analysis indicated that for elderly people with lower education, sensitivity and specificity were both adequate and high. CONCLUSIONS The CDT is a robust screening test when compared with the MMSE or the CAMCOG, independent of the scale used for its interpretation. The combination with the MMSE improves its performance significantly, becoming equivalent to the CAMCOG.

Frailty criteria and cognitive performance are related: Data from the Fibra study in Ermelino Matarazzo, Sao Paulo, Brazil

ObjectivesTo assess the relationship between the CHS frailty criteria (Fried et al., 2001) and cognitive performance.DesignCross sectional and population-based. Setting: Ermelino Matarazzo, a poor sub district of the city of São Paulo, Brazil.Participants384 community dwelling older adults, 65 and older.MeasurementsAssessment of the CHS frailty criteria, the Brief Cognitive Screening Battery (memorization of 10 black and white pictures, verbal fluency animal category, and the Clock Drawing Test) and the Mini-Mental State Examination (MMSE).ResultsFrail older adults performed significantly lower than non-frail and pre frail elderly in most cognitive variables. Grip strength and age were associated to MMSE performance, age was associated to delayed memory recall, gait speed was associated to verbal fluency and CDT performance, and education was associated to CDT performance.ConclusionBeing frail may be associated with cognitive decline, thus, gerontological assessments and interventions should consider that these forms of vulnerability may occur simultaneously.

Autoavaliação da saúde em idosos: pesquisa de base populacional no Município de Campinas, São Paulo, Brasil

Nesta pesquisa, analisou-se a autoavaliacao da saude em idosos segundo variaveis demograficas, socioeconomicas e de comportamentos relacionados a saude. Trata-se de estudo transversal de base populacional, com amostra por conglomerados, que utilizou dados de inquerito realizado em Campinas, Sao Paulo, Brasil (ISACamp 2008/2009). Foram estimadas razoes de prevalencias ajustadas por meio de regressao multipla de Poisson. Participaram do estudo 1.432 idosos. A prevalencia de saude excelente/muito boa foi 24,6% e significativamente mais elevada nos idosos com maior escolaridade, maior renda, sem religiao, que moravam sozinhos, tinham computador em casa, consumiam bebida alcoolica de uma a quatro vezes por mes, praticavam atividade fisica no lazer, nao eram obesos e consumiam frutas e verduras quatro vezes ou mais por semana. Alguns dos achados sao pouco encontrados na literatura e sinalizam temas relevantes para novas investigacoes. Os resultados apontam para a necessidade de maior atencao aos segmentos socialmente mais vulneraveis e do desenvolvimento de estrategias de promocao de habitos saudaveis entre os idosos.

Treino de memória no idoso saudável: benefícios e mecanismos

INTRODUCTION: Studies document a change in memory during the process of aging. However, studies report the possibility of improvement after training. OBJECTIVE: To replicate international findings regarding the effects of memory training with a sample of Brazilian elders and to investigate mechanisms, such as the use of strategies, that can explain its benefits. METHODS: 69 healthy Brazilian elders were randomly divided into an experimental group (EG) and a control group (CG), and received four sessions of training (CG received training after pos-test). Training included information on memory and the process of aging, instruction and practice in organizing grocery lists and the underlining of main ideas in short texts. RESULTS: There was superior improvement for prose recall and greater use of strategies (organizing lists and underlining texts) for the EG at post-test. Both groups reported fewer memory complaints (assessed with the MAC-Q) and faster information processing (WAIS-R Digit Symbols sub-test). CONCLUSIONS: After training, elders intensify the use of strategies, however, this fact does not guarantee a better performance (there was no significant improvement in list recalls). List recall results suggest the presence of the utilization deficiency: elders used the strategy but failed to benefit from it.

Mini-Mental State Examination performance in frail, pre-frail, and non-frail community dwelling older adults in Ermelino Matarazzo, São Paulo, Brazil.

BACKGROUND Frailty in older adults is a multifactorial syndrome defined by low metabolic reserve, less resistance to stressors, and difficulty in maintaining organic homeostasis due to cumulative decline of multiple physiological systems. The relationship between frailty and cognition remains unclear and studies about Mini-Mental State Examination (MMSE) performance and frailty are scarce. The objective was to examine the association between frailty and cognitive functioning as assessed by the MMSE and its subdomains. METHODS A cross-sectional population-based study (FIBRA) was carried out in Ermelino Matarazzo, a poor subdistrict of the city of São Paulo, Brazil. Participants were 384 community dwelling older adults, 65 years and older who completed the MMSE and a protocol to assess frailty criteria as described in the Cardiovascular Health Study (CHS). RESULTS Frail older adults had significantly worse performance on the MMSE (p < 0.001 for total score). Linear regression analyses showed that the MMSE total score was influenced by age (p < 0.001), education (p < 0.001), family income (p < 0.001), and frailty status (p < 0.036). Being frail was associated more significantly with worse scores in Time Orientation (p < 0.004) and Immediate Memory (p < 0.001). CONCLUSIONS Our data suggest that being frail is associated with worse cognitive performance, as assessed by the MMSE. It is recommended that the assessment of frail older adults should include the investigation of their cognitive status.

Envelhecimento bem-sucedido: uma meta no curso da vida

Nao ha definicao consensual de envelhecimento bem-sucedido. Os termos envelhecimento ativo, robusto e bem-sucedido sao usados de maneira indiscriminada para explicar o processo de envelhecer bem. O objetivo deste artigo e discutir o significado de envelhecimento bem-sucedido, enfatizando que a subjetividade do conceito esta relacionada a individualidade e as diferencas socioculturais. A longevidade nao deve ser o unico componente para avaliar o envelhecimento bem-sucedido. Envelhecer bem envolve multiplos fatores, incluindo individuais, psicologicos, biologicos e sociais. A conclusao e que o bem-estar subjetivo e o componente mais importante para avaliar o “sucesso”. O envelhecimento bem-sucedido assemelha-se a um principio organizacional que pode ser alcancado estabelecendo-se metas pessoais realistas no curso de vida.

Bem-estar Psicológico e Inteligência Emocional entre Homens e Mulheres na Meia-idade e na Velhice

There was carryed out a descriptive study aimed at investigate relations between psychological well-being and emotional intelligence. There was a convenience sample with 60 middle aged (45-55) and 60 old (60-69) males and females. Measures: Self-development Scale and Scale of Emotional Intelligence. Results: Male subjects scored higher than female on self motivation and self conscientiouness (MIE). There occurred significant relations between self motivation and self acceptation (MIE), and between self motivation and purpose, personal growing, mastery and generativity (maintenance and offering) (EDEP). Factorial analysis performed on EDEP resulted in five factors. Self development dimentions splited from others related to interpersonal relationships. Psychological well-being and emotional intelligence did not behave as independent constructs neither were consistently affected by gender and age.There was carryed out a descriptive study aimed at investigate relations between psychological well-being and emotional intelligence. There was a convenience sample with 60 middle aged (45-55) and 60 old (60-69) males and females. Measures: Self-development Scale and Scale of Emotional Intelligence. Results: Male subjects scored higher than female on self motivation and self conscientiouness (MIE). There occurred significant relations between self motivation and self acceptation (MIE), and between self motivation and purpose, personal growing, mastery and generativity (maintenance and offering) (EDEP). Factorial analysis performed on EDEP resulted in five factors. Self development dimentions splited from others related to interpersonal relationships. Psychological well-being and emotional intelligence did not behave as independent constructs neither were consistently affected by gender and age.

Meta-memória e auto-eficácia: um estudo de validação de instrumentos de pesquisa sobre memória e envelhecimento

The cognitive aging literature documents in numerous studies the existence of significant age differences between younger and older adults in tests of episodic memory. Researchers have been investigating possible explanations for such differences. One hypothesis being tested is whether older adults hold different perceptions, attitudes and feelings towards memory that could affect performance negatively. Metamemory and self-efficacy are concepts that have been used in the test of this hypothesis. In the present research, a metamemory questionnaire (MIA), a self-efficacy questionnaire (MSEQ) and 4 versions of 2 episodic memory tasks (4 grocery lists and 4 short stories) were translated into Portuguese, adapted to Brazilian culture and submitted to validity testing with 33 younger and 27 older healthy Brazilian adults. The results from the analyses suggest that the Portuguese versions of these instruments have good psychometric characteristics and seem promising for research in this field in Brazil.