Sara Mora-Simón

Prevalence of cognitive impairment in individuals aged over 65 in an urban area: DERIVA study

BackgroundFew data are available on the prevalence of cognitive impairment (CI) in Spain, and the existing information shows important variations depending on the geographical setting and the methodology employed. The aim of this study was to determine the prevalence of CI in individuals aged over 65 in an urban area, and to analyze its associated risk factors.MethodsDesign: A descriptive, cross-sectional, home questionnaire-based study; Setting: Populational, urban setting. Participants: The reference population comprised over-65s living in the city of Salamanca (Spain) in 2009. Randomized sampling stratified according to health district was carried out, and a total of 480 people were selected. In all, 327 patients were interviewed (68.10%), with a mean age of 76.35 years (SD: 7.33). Women accounted for 64.5% of the total. Measurements: A home health questionnaire was used to obtain the following data: age, sex, educational level, family structure, morbidity and functionality. All participants completed a neuropsychological test battery. The prevalence data were compared with those of the European population, with direct adjustment for age and sex. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment - no dementia (CIND), and dementia.ResultsThe prevalence of CI among these over-65s was 19% (14.7% CIND and 4.3% dementia). The age-and sex-adjusted global prevalence of CI was 14.9%. CI increased with age (p < 0.001) and decreased with increasing educational level (p < 0.001). Significant risk factors were found with the multivariate analyses: age (OR = 1.08, 95%CI: 1.03-1.12), anxiety-depression (OR = 3.47, 95%CI: 1.61-7.51) and diabetes (OR = 2.07, 95%CI: 1.02-4.18). In turn, years of education was found to be a protective factor (OR = 0.79, 95%CI: 0.70-0.90). Although CI was more frequent among women and in people living without a partner, these characteristics were not significantly associated with CI risk.ConclusionsThe observed raw prevalence of CI was 19% (14.9% after adjusting for age and sex). Older age and the presence of diabetes and anxiety-depression increased the risk of CI, while higher educational level reduced the risk.

Effects of a Psychological Intervention in a Primary Health Care Center for Caregivers of Dependent Relatives: A Randomized Trial

PURPOSE To assess, in the context of Primary Health Care (PHC), the effect of a psychological intervention in mental health among caregivers (CGs) of dependent relatives. DESIGN AND METHODS Randomized multicenter, controlled clinical trial. The 125 CGs included in the trial were receiving health care in PHC. INCLUSION CRITERIA Identifying oneself as principal CG of a dependent relative with dementia or any other disability, and having performed this task for at least 6 months. CGs were randomized to an intervention group (cognitive-behavioral treatment for managing dysfunctional thoughts about caregiving and training in self-help techniques) or to a control group (care as usual). CG mental health (General Health Questionnaire [GHQ-12]), dysfunctional thoughts about caregiving, quality of life, and burden were measured. RESULTS The intervention group showed improvement in mental health: A mean reduction in GHQ-12 score of -3.33 points was recorded in the intervention group vs. the control group (95% CI: -5.95 to -0.70; p = .01; Cohen d = 0.55). Improvement was also recorded in dysfunctional thoughts about caregiving: (-5.84; 95% CI: -10.60 to -1.09; p = .01; Cohen d = 0.62). Among the CGs that completed the initial and final assessments, a mean of 4.77 (SD 2.68) attended a maximum of 8 sessions. Men attended more often (5.00 sessions with SD 2.68) than women (4.70 sessions with SD 2.45; p < .001). IMPLICATIONS Psychological group intervention in the context of PHC, aimed at the CGs of dependent persons with dementia and other disabilities, has improved mental health condition in CGs.

Prevalencia de enfermedades cardiovasculares y de factores de riesgo cardiovascular en mayores de 65 años de un área urbana: estudio DERIVA

Resumen Objetivo Estimar la prevalencia de enfermedades cardiovasculares, los factores de riesgo cardiovascular y las características psicosociales asociadas en mayores de 65 años de una población urbana. Diseño Estudio descriptivo transversal, poblacional. Emplazamiento Ciudad de Salamanca (España). Participantes Mediante un muestreo aleatorio estratificado por zona de salud, seleccionamos 480 sujetos mayores de 65 años. Se efectuó una encuesta de salud en el domicilio de los sujetos mediante un cuestionario. Medidas principales Peso, talla, circunferencia de cintura, presión arterial, glucemia y colesterol. Se estimó la prevalencia estandarizada a la población europea. Resultados Se entrevistaron 327 sujetos (68,10% de los seleccionados), edad media de 76 años (DE: 7,33). El 64,5% eran mujeres. El 20,2% (15,8-24,5) presentaban enfermedad cardiovascular. La cardiopatía isquémica (12,1% [6,1-18]) fue la más prevalente en varones y la insuficiencia cardiaca (10,4% [6,3-14,6]) en mujeres. La hipertensión era el factor de riesgo más frecuente tanto en varones (63,8% [53,2-70,9]) como en mujeres (69,7% [63,5-75,9]), seguido de diabetes en varones (36,2% [27,5-45]) y sedentarismo en mujeres (36,0% [29,5-42,5]). Los que presentaban enfermedades cardiovasculares eran más dependientes y mostraron peor pronóstico (Índice de Comorbilidad de Charlson). Conclusiones La cardiopatía isquémica fue la enfermedad más prevalente en varones y la insuficiencia cardiaca en mujeres. Casi el 80% de los mayores de 65 años no presentaban ninguna de las 3 enfermedades cardiovasculares que suponen las principales causas de muerte en este grupo de edad. Los participantes que presentaban alguna enfermedades cardiovasculares fueron más dependientes para las actividades de la vida diaria.

Postprandial Effects of Breakfast Glycemic Index on Vascular Function among Young Healthy Adults: A Crossover Clinical Trial

This study aimed to evaluate the postprandial effects of high and low glycemic index (GI) breakfasts on vascular function. It was a crossover trial that included 40 young healthy adults (50% women), aged 20–40 years, who were recruited at primary care settings. They consumed three experimental breakfasts in randomized order, each one separated by a 1-week washout period: (1) control conditions (only water); (2) low GI (LGI) breakfast (29.4 GI and 1489 KJ energy); and (3) high GI (HGI) breakfast (64.0 GI and 1318 KJ energy). Blood samples were collected at 60 and 120 min after each breakfast to determine glucose and insulin levels. Vascular parameters were measured at 15 min intervals. Augmentation index (AIx) was studied as a primary outcome. Secondary outcomes comprised glucose, insulin, heart rate (HR) and pulse pressures (PPs). We found a trend toward increased AIx, HR and PPs for the HGI versus the LGI breakfast. A significant interaction between the type of breakfast consumed and all measured parameters was identified (p < 0.05) except for central PP. Stratifying data by sex, this interaction remained significant for AIx and augmentation pressure only in males (p < 0.05). In conclusion, breakfast GI could affect postprandial vascular responses in young healthy adults.

OriginalPrevalencia de enfermedades cardiovasculares y de factores de riesgo cardiovascular en mayores de 65 años de un área urbana: estudio DERIVAPrevalence of cardiovascular diseases and cardiovascular risk factors in older than 65 years persons in an urban area: DERIVA study

Resumen Objetivo Estimar la prevalencia de enfermedades cardiovasculares, los factores de riesgo cardiovascular y las características psicosociales asociadas en mayores de 65 años de una población urbana. Diseño Estudio descriptivo transversal, poblacional. Emplazamiento Ciudad de Salamanca (España). Participantes Mediante un muestreo aleatorio estratificado por zona de salud, seleccionamos 480 sujetos mayores de 65 años. Se efectuó una encuesta de salud en el domicilio de los sujetos mediante un cuestionario. Medidas principales Peso, talla, circunferencia de cintura, presión arterial, glucemia y colesterol. Se estimó la prevalencia estandarizada a la población europea. Resultados Se entrevistaron 327 sujetos (68,10% de los seleccionados), edad media de 76 años (DE: 7,33). El 64,5% eran mujeres. El 20,2% (15,8-24,5) presentaban enfermedad cardiovascular. La cardiopatía isquémica (12,1% [6,1-18]) fue la más prevalente en varones y la insuficiencia cardiaca (10,4% [6,3-14,6]) en mujeres. La hipertensión era el factor de riesgo más frecuente tanto en varones (63,8% [53,2-70,9]) como en mujeres (69,7% [63,5-75,9]), seguido de diabetes en varones (36,2% [27,5-45]) y sedentarismo en mujeres (36,0% [29,5-42,5]). Los que presentaban enfermedades cardiovasculares eran más dependientes y mostraron peor pronóstico (Índice de Comorbilidad de Charlson). Conclusiones La cardiopatía isquémica fue la enfermedad más prevalente en varones y la insuficiencia cardiaca en mujeres. Casi el 80% de los mayores de 65 años no presentaban ninguna de las 3 enfermedades cardiovasculares que suponen las principales causas de muerte en este grupo de edad. Los participantes que presentaban alguna enfermedades cardiovasculares fueron más dependientes para las actividades de la vida diaria.

Structure of Enhanced Cued Recall Task in the 7 Minute Screen Test

ABSTRACT Episodic memory in the 7 Minute Screen is assessed by the Enhanced Cued Recall (ECR) test. The ECR test is composed of three phases, Identification, Immediate Recall, and Free and Cued Recall. However, just the last phase is considered for the total score. We believe that collecting the performance data of the Identification and Immediate Recall phases could provide information regarding possible difficulties or impairments in the different aspects involved in the temporal mnesic process of acquisition of new information, such as in working memory or visual identification. The objective was to assess the goodness of fit for the three phases of the ECR test using a Confirmatory Factor Analysis (CFA) to show if each phase is separated from each other as a different aspect that participates in the mnesic process. A total of 311 participants greater than 65 years were included in this study. Confirmatory factor analyses were conducted for each individual phase. The analyses show that the ECR test consists of three separate phases that identify different steps of the mnesic process. Individual scores for each phase could allow for investigation of patient performance in different aspects of the memory process and could help in further neuropsychological assessment.

Alteraciones en el procesamiento visual de formas: clasificación clínica integradora

INTRODUCTION Patients who have difficulties recognising visual form stimuli are usually labelled as having visual agnosia. However, recent studies let us identify different clinical manifestations corresponding to discrete diagnostic entities which reflect a variety of deficits along the continuum of cortical visual processing. DEVELOPMENT We reviewed different clinical cases published in medical literature as well as proposals for classifying deficits in order to provide a global perspective of the subject. Here, we present the main findings on the neuroanatomical basis of visual form processing and discuss the criteria for evaluating processing which may be abnormal. We also include an inclusive diagram of visual form processing deficits which represents the different clinical cases described in the literature. Lastly, we propose a boosted decision tree to serve as a guide in the process of diagnosing such cases. CONCLUSIONS Although the medical community largely agrees on which cortical areas and neuronal circuits are involved in visual processing, future studies making use of new functional neuroimaging techniques will provide more in-depth information. A well-structured and exhaustive assessment of the different stages of visual processing, designed with a global view of the deficit in mind, will give a better idea of the prognosis and serve as a basis for planning personalised psychostimulation and rehabilitation strategies.

Detection of mild cognitive impairment in people older than 65 years of age and its relationship to cardiovascular risk factors (DECRIVAM)

BackgroundStudies centered on the detection of cognitive impairment and its relationship to cardiovascular risk factors in elderly people have gained special relevance in recent years. Knowledge of the cardiovascular risk factors that may be associated to cognitive impairment could be very useful for introducing treatments in early stages - thereby possibly contributing to improve patient quality of life.The present study explores cognitive performance in people over 65 years of age in Salamanca (Spain), with special emphasis on the identification of early symptoms of cognitive impairment, with the purpose of detecting mild cognitive impairment and of studying the relationships between this clinical situation and cardiovascular risk factors.Methods/DesignA longitudinal study is contemplated. The reference population will consist of 420 people over 65 years of age enrolled through randomized sampling stratified by healthcare area, and who previously participated in another study. Measurement: a) Sociodemographic variables; b) Cardiovascular risk factors; c) Comorbidity; d) Functional level for daily life activities; and e) Study of higher cognitive functions based on a neuropsychological battery especially adapted to the evaluation of elderly people.DiscussionWe hope that this study will afford objective information on the representative prevalence of cognitive impairment in the population over 65 years of age in Salamanca. We also hope to obtain data on the relationship between cognitive impairment and cardiovascular risk factors in this specific population group. Based on the results obtained, we also will be able to establish the usefulness of some of the screening tests applied during the study, such as the Mini-Mental State Examination and the 7 Minute Screen test.Trial registrationClinicalTrials.gov: NCT01327196

Postprandial effects of breakfast glycaemic index on cognitive performance among young, healthy adults: A crossover clinical trial

Objective: To evaluate the postprandial effects of high and low glycaemic index (GI) breakfasts on cognitive performance in young, healthy adults. Methods: A crossover clinical trial including 40 young, healthy adults (aged 20–40 years, 50% females) recruited from primary healthcare centres in Salamanca, Spain. Verbal memory, phonological fluency, attention, and executive functions were examined 0, 60, and 120 minutes after consuming a low GI (LGI), high GI (HGI), or water breakfast. Every subject tried each breakfast variant, in a randomized order, separated by a washout period of 7 days, for a total of 3 weeks. Results: A significant interaction between the type of breakfast consumed and immediate verbal memory was identified (P<.05). We observed a trend towards better performance in verbal memory (delayed and immediate), attention, and phonological fluency following an LGI breakfast. Discussion: Cognitive performance during the postprandial phase in young, healthy adults was minimally affected by the GI of breakfast. The potential for breakfast’s GI modulation to improve short- and long-term cognitive functioning requires further research. GRAPHICAL ABSTRACT

Effectiveness of an intensive intervention to improve lifestyles in subjects with intermediate cardiovascular risk (DATE study): study protocol for a randomized controlled trial

AIM The aim of this study was to evaluate the effectiveness of an intensive intervention led by primary care nurses for lifestyle modification among people with intermediate cardiovascular risk. BACKGROUND Cardiovascular diseases may be prevented by adopting healthy lifestyles. Interventions focused on populations at risk are more efficient than those aimed at the general population. More than 50 per cent of cardiovascular events occur in people with intermediate cardiovascular risk, but only a few studies have targeted this population. DESIGN A randomized controlled trial approved in January 2017. METHODS We will recruit 208 participants aged 35-74 years who have intermediate cardiovascular risk. They will be selected by consecutive sampling and will be randomized into a control group or intervention group. Individual standardized brief counselling on healthy lifestyles will be provided to both groups. Additionally, individuals from the intervention group will receive four weekly group sessions focusing on cardiovascular risk, healthy diet, moderation in alcohol consumption, daily physical activity, stress management and smoking cessation and two motivational follow-up calls. The primary outcome will be the lifestyle modification measured by total steps recorded by a pedometer, total score on the Mediterranean Diet Adherence Screener and percentage of current smokers. DISCUSSION This study will allow us to investigate whether an intensive intervention based on a multifactorial group approach is more effective in lifestyle modification than individual standardized brief counseling among adults with intermediate cardiovascular risk. Our results could lead to the establishment of new strategies for cardiovascular risk management.