Síndrome de fragilidade em idosos: prevalência e correlação com características clínicas, cognitivas e funcionais / Frailty syndrome in older adults: prevalence and clinical, cognitive and functional correlations

Introdução: O envelhecimento está relacionado à redução da capacidade de órgãos e sistemas, à desregulação neuroendócrina, à disfunção imunológica e a alterações osteoneuromusculares. A síndrome de fragilidade pode ser definida como uma diminuição da resistência e das reservas fisiológicas, na qual um ciclo de exacerbação de declínio em múltiplos sistemas resulta em déficit de energia, sarcopenia, diminuição da força muscular e de tolerância aos esforços. Sua presença está associada a declínio cognitivo, pior qualidade de vida, incidência aumentada de quedas, maior morbidade e mortalidade. Objetivos: investigar a prevalência da síndrome de fragilidade e correlacioná-la a características clínicas, cognitivas e funcionais de idosos. Metodologia: estudo transversal de idosos consecutivamente atendidos em ambulatório de Geriatria. Foram utilizados testes de avaliações cognitiva, funcional, de humor e aplicados os critérios do fenótipo de fragilidade de Fried. Resultados: foram avaliados 94 idosos, idade média 80,8 anos. Entre os participantes, 37,2% foram classificados como frágeis, 36,2% como pré-frágeis e 26,6% como robustos. Incluímos pacientes com síndromes demenciais, parkinsonianas e com sequelas de acidente vascular cerebral. A síndrome de fragilidade foi associada a menor escolaridade, maiores comprometimentos cognitivo e funcional, importante redução de velocidade de marcha e maior incidência de depressão. Conclusão: foi encontrada elevada prevalência da fragilidade, e nossos resultados corroboram os poucos dados disponíveis na literatura quando são incluídos pacientes com multimorbidades e doenças neuropsiquiátricas atendidos em ambulatórios de Geriatria

Challenges in public perception: Highlights from the United Kingdom-Brazil dementia workshop

In July 2019, Belo Horizonte hosted an international workshop for 27 junior researchers, whose participants were from Brazil and the United Kingdom. This 3-day meeting organized by the Federal University of Minas Gerais and the University of East Anglia addressed challenges in cognitive impairment and dementia, with particular interest in public perceptions, diagnosis and care management. The purpose of this report is to highlight the outcomes of the above-mentioned workshop regarding the topic of public perceptions (part I). Discussions focused on differences and similarities between countries, as well as identifying main issues to that required collaborative and creative solutions for them. After these group discussions, four core themes emerged: I) Cognitive impairment; II) Dementia – Beyond Alzheimer’s Disease; III) Prevention; and IV) Stigma. National and international initiatives to deal with public misperceptions about cognitive impairment and dementia are discussed

Primary School Education May Be Sufficient to Moderate a Memory-Hippocampal Relationship

According to the cognitive reserve theory, intellectual stimuli acquired during life can prevent against developing cognitive impairment. The underlying cognitive reserve mechanisms were underexplored in low-educated individuals. Because episodic memory impairment due to hippocampal dysfunction is a key feature of Alzheimer’s dementia (AD), we sought to look at a possible cognitive reserve mechanism by determining whether few years of education moderated the relationship between the hippocampal volumes and the episodic-memory scores. The sample was composed by 183 older adults, 40.1% male, with the median age of 78[76,82] years and the median years of education of 4[2,10] who had undergone an episodic-memory test and a 3-Tesla MRI scan to access the hippocampal volumes. Overall, 112 were cognitively healthy, 26 had cognitive impairment-no dementia (CIND) and 45 had dementia. We used multiple linear regression to assess whether the interaction between years of education and each hippocampal volume significantly predicted the episodic-memory scores’ variance, controlling for cognitive diagnosis and nuisance variables. The interaction term with the left hippocampus (ß = 0.2, p = 0.043, CI = 1.0, 1.4), but not with the right (ß = 0.1, p = 0.218, CI = 0.9, 1.2) significantly predicted the variation on memory scores. The mechanism by which the left hippocampus seems to play a more important role on memory processing in more educated individuals needs to be further investigated and might be associated with a better use of mnemonic strategies or higher hippocampal connectivity. Because the sample’s median years of education was four, which corresponds to primary school, we may infer that this level might be sufficient to contribute for building cognitive reserve

Dementia in Latin America : paving the way towards a regional action plan

Regional challenges faced by Latin American and Caribbean countries (LACs) to fight dementia, such as heterogeneity, diversity, political instabilities, and socioeconomic disparities, can be addressed more effectively grounded in a collaborative setting based on the open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking and translational research) and align them to current global strategies to translate regional knowledge into actions with transformative power. Then, by characterizing genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions and mapping these to the above challenges, we provide the basic mosaics of knowledge that will pave the way towards a KtAF. We describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF