Deusivania Vieira da Silva Falcão

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.

Depressive symptoms in old age: relations among sociodemographic and self-reported health variables

BACKGROUND Depression in old age is a complex multifactorial phenomenon that is influenced by several biopsychosocial variables. Depressive symptoms are associated with the presence of chronic diseases, with being female, with low education and low income levels, and with poor perceived health assessment. In impoverished areas, older adults may have more physical disability, as they may have less access to health services. Therefore, they may be more likely to report depressive symptoms. METHODS Population-based cross-sectional research was undertaken using data from the FIBRA study conducted in Ermelino Matarazzo, a poor subdistrict of the city of São Paulo, Brazil. The participants comprised 303 elderly people, aged 65 years and over, who attended a single-session data collection effort carried out at community centers. The protocol comprised sociodemographic and self-reported health variables, and the Geriatric Depression Scale. RESULTS The majority of the subjects reported five or fewer symptoms of depression (79.21%), reported one or two self-reported chronic diseases (56.86%), declared themselves to have one or two self-reported health problems (46.15%), and had good perceived health assessment (40.27%). The presence of depressive symptoms was associated with a higher number of self-reported health problems, poor perceived health assessment, and lower schooling levels, in the total sample and in analyses including men only. For women, depressive symptoms were associated with the number of self-reported health problems and family income. CONCLUSION The presence of health problems, such as falls and memory problems, lower perceived health, and low education (and low family income for women) were associated with a higher presence of depressive symptoms among elderly people in this poor area of São Paulo.

Cuidar de familiares idosos com a doença de alzheimer: uma reflexão sobre aspectos psicossociais

This article searchs to discuss the role of the family caregivers of elders suffering from Alzheimers disease (AD) and its implications in the social-familiar context bringing to emerge a reflexion based on the psychogerentologic literature. An analytical referential was developed based on the following aspects: the principal characteristics of the family caregivers of elders suffering from mental ilness; the mainly motivations that favor the activity of taking care and its multiple faced dimensions; the overcharged roles of the family caregivers and its consequences in the marital and intergenerationals relationships. At last, contents belonging to familiar context of elderly suffering from Alzheimers disease (AD) and support and psychosocial interventions programs were appointed. It was concluded that the diagnosis of AD should be done in the most possible precocious way proportionating a better opportunity to develop the treatment, relief the patient’s and his/her familys suffering.

Relations between memory complaints, depressive symptoms and cognitive performance among community dwelling elderly

Contexto A queixa de memoria e comum entre pessoas idosas, entretanto sua relevância clinica para o diagnostico de alteracoes cognitivas e questionavel, visto que diversos fatores podem se associar as queixas. Objetivo: O presente estudo avaliou a relacao entre queixas de memoria, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Objetivo O presente estudo avaliou a relacao entre queixas de memoria, sintomas depressivos e desempenho cognitivo em 301 idosos residentes em Ermelino Matarazzo que participaram da pesquisa de base populacional Perfis de Fragilidade em Idosos Brasileiros da Rede FIBRA. Metodos O desempenho cognitivo foi avaliado por meio dos testes de memorizacao de 10 figuras comuns, Miniexame do Estado Mental (MEEM), Fluencia Verbal (FV) e Teste do Desenho do Relogio, que compoem a Bateria Breve de Rastreio Cognitivo (BBRC). As queixas de memoria foram avaliadas pelo Questionario de Queixas de Memoria (MAC-Q) e os sintomas depressivos, pela Escala de Depressao Geriatrica (EDG). Resultados Participantes do sexo feminino apresentaram maior indice de queixas de memoria, comparado ao dos homens (p = 0,013). Idosos menos escolarizados apresentaram queixas de memoria mais intensas e pior desempenho cognitivo, comparados aos de maior escolaridade (p < 0,003). A presenca de sintomas depressivos associou-se a pior avaliacao da memoria (r = 0,39, p < 0,001). Conclusao: As queixas de memoria se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Nao houve associacao entre queixas e desempenho cognitivo. Conclusao As queixas de memoria se associaram a sexo, escolaridade e sintomas depressivos, entre idosos residentes na comunidade. Nao houve associacao entre queixas e desempenho cognitivo.

Terapia familiar sistêmica e idosos: contribuições e desafios

This study aims to describe some systemic clinical interventions focused on the treatment of elderly individuals. Four different therapeutics modes are explored: individual therapy, couples therapy, family therapy with elder family members, and accessing elder members to help in the family therapy process. Some prototype situations in therapy with elderly individuals are discussed, taking into account some concepts developed in family therapy. The elderly can be perceived by the family, or even by themselves, as a weight or as a resource. On the other hand, successful aging reflects a personal position that is influenced by family relations.

Determinants of cognitive performance among community dwelling older adults in an impoverished sub-district of São Paulo in Brazil.

Determinants of cognitive performance in old age have received limited attention in Latin America. We investigated the association of socio-demographic and health-related variables with cognitive performance in a sample of older adults with limited educational experience living in a poor sub-district of the city of São Paulo. This was a cross-sectional population-based study which included a sample of 384 seniors 65 years and older. Cognition was assessed by the Mini-Mental State Examination (MMSE) and the Brief Cognitive Screening Battery (BCSB) (episodic memory test with 10 pictures, verbal fluency (VF), Clock Drawing Test (CDT)). Results indicated that age, sex, schooling, depressive symptoms, and systolic blood pressure (SBP) level had a significant impact on the cognitive performance of the sample. Therefore, pharmacological and psychosocial interventions with a focus on improving mood and controlling hypertension may have beneficial effects on cognition among seniors with similar socio-demographic characteristics.

O impacto da doença de Alzheimer nas relações intergeracionais

RESUMO Este estudo investigou, na perspectiva de 24 filhas cuidadoras de seus pais/maes com provavel/possivel diagnostico da doenca de Alzheimer (DA), o relacionamento entre eles e seus filhos (netos dos portadores). Foram utilizadas uma entrevista com roteiro semiestruturado e o FAST (Family System Test), que analisou a coesao e a hierarquia nas relacoes. Verificou-se que nas representacoes atuais das relacoes intergeracionais a coesao das filhas cuidadoras com seus filhos foi significativamente maior do que a coesao destes com as avos portadoras da DA. Tambem os netos apresentavam uma maior hierarquia em relacao as portadoras da doenca nas situacoes atual e ideal. Concluiu-se que, com a DA, os papeis de avos, de maes e de netos sofreram mudancas que precisaram ser reavaliadas. Palavras-chave: Alzheimer; cuidadores; avos; relacoes intergeracionais.

Atividades Avançadas de Vida Diária (AAVD) e desempenho cognitivo entre idosos

O estudo objetivou investigar a associacao entre Atividades avancadas de vida diaria (AAVD) e o desempenho cognitivo entre idosos participantes do estudo FIBRA em Ermelino Matarazzo, Sao Paulo. Foram investigados 302 idosos sem declinio cognitivo, classificados em muito ativos e pouco ativos nas AAVDs, e avaliados pelo Mini exame do estado mental (MEEM), bateria breve de rastreio cognitivo (BBRC), fluencia verbal (FV), teste do desenho do relogio (TDR) e escala de depressao geriatrica (EDG). As AAVDs associaram-se ao desempenho no MEEM e no TDR, nas analises univariadas, mas esta associacao perdeu significância no modelo multivariado. O desempenho, no MEEM, esteve associado a idade, escolaridade, sexo e numero de sintomas depressivos. O escore, no TDR, associou-se a escolaridade. Conclui-se que a relacao entre as AAVDs e o desempenho cognitivo parece ser modulada por variaveis sociodemograficas e por sintomas depressivos.

Normative data for the Brief Cognitive Screening Battery stratified by age and education

Introduction Diagnosing neurocognitive disorders is challenging in low-educated individuals. Objective To report normative data for the Brief Cognitive Screening Battery (BCSB) and to assess the association of age and education with performance on the BCSB in 240 community-dwelling elderly from Ermelino Matarazzo, São Paulo city. Methods The inclusion criteria were scoring above the education-adjusted cut-off points on the Mini-Mental State Examination (MMSE) and below six points on the Geriatric Depression Scale (GDS). Results Age was associated with performance on the Naming, Incidental Memory, Verbal Fluency, Clock Drawing Test, Delayed Recall and Recognition subtests. Education was associated with performance on Naming, Recognition, Verbal Fluency and the Clock Drawing Test. Conclusion The normative values reported are relevant for diagnosing neurocognitive disorders in low-educated elderly.

Advanced Activities of Daily Living (AADL) and cognitive performance among older adults

O estudo objetivou investigar a associacao entre Atividades avancadas de vida diaria (AAVD) e o desempenho cognitivo entre idosos participantes do estudo FIBRA em Ermelino Matarazzo, Sao Paulo. Foram investigados 302 idosos sem declinio cognitivo, classificados em muito ativos e pouco ativos nas AAVDs, e avaliados pelo Mini exame do estado mental (MEEM), bateria breve de rastreio cognitivo (BBRC), fluencia verbal (FV), teste do desenho do relogio (TDR) e escala de depressao geriatrica (EDG). As AAVDs associaram-se ao desempenho no MEEM e no TDR, nas analises univariadas, mas esta associacao perdeu significância no modelo multivariado. O desempenho, no MEEM, esteve associado a idade, escolaridade, sexo e numero de sintomas depressivos. O escore, no TDR, associou-se a escolaridade. Conclui-se que a relacao entre as AAVDs e o desempenho cognitivo parece ser modulada por variaveis sociodemograficas e por sintomas depressivos.