32 research outputs found

    Short Assessment of Health Literacy for Portuguese-speaking Adults

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    OBJETIVO: Desarrollar y validar un instrumento breve para evaluación de alfabetismo en salud en el idioma portugués. MÉTODOS: El instrumento desarrollado consiste de 50 itens que evalúan la capacidad del individuo de pronunciar y comprender términos médicos comunes. Las propiedades psicométricas se evaluaron en una muestra de 226 ancianos brasileños. La validez del constructo se estableció por la correlación con el número de años de escolaridad, relato de alfabetismo funcional y desempeño cognitivo global. La validez discriminatoria fue establecida por la exactitud del instrumento en la detección de alfabetismo en salud inadecuado, definido como la incapacidad de comprender correctamente prescripciones médicas estandarizadas. RESULTADOS: Las correlaciones con los criterios de constructo presentaron magnitud moderada a alta (coeficientes de Spearman = 0,63 a 0,76). El instrumento presentó también consistencia interna satisfactoria (Cronbach = 0,93) y buena confiabilidad examen-reexamen (coeficiente de correlación intra-clase = 0,95). El área bajo la curva característica de operación del receptor para detección de alfabetismo inadecuado fue 0,82. Una versión con 18 itens fue derivada y presentó propiedades psicométricas similares. CONCLUSIONES: El instrumento desarrollado presentó buena validez y consistencia en una muestra de ancianos brasileños y puede ser utilizado en ambientes clínicos o de investigación con la finalidad de detectar alfabetismo en salud inadecuado.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 individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's 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 tool's 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 (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's 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 avaliação de alfabetismo em saúde na língua portuguesa. MÉTODOS: O instrumento desenvolvido consiste de 50 itens que avaliam a capacidade do indivíduo de pronunciar e compreender termos médicos comuns. As propriedades psicométricas foram avaliadas em uma amostra de 226 idosos brasileiros. A validade de construto foi estabelecida pela correlação com o número de anos de escolaridade, relato de alfabetismo funcional e desempenho cognitivo global. A validade discriminativa foi estabelecida pela acurácia do instrumento na detecção de alfabetismo em saúde inadequado, definido como a incapacidade de compreender corretamente prescrições médicas padronizadas. RESULTADOS: As correlações com os critérios de construto apresentaram magnitude moderada a alta (coeficientes de Spearman = 0,63 a 0,76). O instrumento apresentou ainda consistência interna satisfatória (Cronbach = 0,93) e boa confiabilidade teste-reteste (coeficiente de correlação intraclasse = 0,95). A área sob a curva característica de operação do receptor para detecção de alfabetismo inadequado foi 0,82. Uma versão com 18 itens foi derivada e apresentou propriedades psicométricas similares. CONCLUSÕES: O instrumento desenvolvido apresentou boa validade e consistência em uma amostra de idosos brasileiros e pode ser utilizado em ambientes clínicos ou de pesquisa com a finalidade de detectar alfabetismo em saúde inadequado

    Thalamic alexia with agraphia

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    Alexia with agraphia is defined as an acquired impairment affecting reading and writing ability. It can be associated with aphasia, but can also occur as an isolated entity. This impairment has classically been associated with a left angular gyrus lesion In the present study, we describe a case involving a patient who developed alexia with agraphia and other cognitive deficits after a thalamic hemorrhage. In addition, we discuss potential mechanisms of this cortical dysfunction syndrome caused by subcortical injury. We examined a patient who presented with alexia with agraphia and other cognitive deficits due to a hemorrhage in the left thalamus. Neuropsychological evaluation showed attention, executive function, arithmetic and memory impairments. In addition, language tests revealed severe alexia with agraphia in the absence of aphasia. Imaging studies disclosed an old thalamic hemorrhage involving the anterior, dorsomedial and pulvinar nuclei. Tractography revealed asymmetric thalamocortical radiations in the parietal region (left <right), and single photon emission computed tomography demonstrated hypoperfusion in the left thalamus that extended to the frontal and parietal cortices. Cortical cognitive deficits, including alexia with agraphia, may occur as the result of thalamic lesions. The probable mechanism is a diaschisis phenomenon involving thalamic tract disconnections

    Impact of depressive symptoms on outcome of Alzheimer's disease

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    Abstract There is no consensus in the medical literature about the impact of depressive symptoms on the evolution of Alzheimer's disease (AD). Objective: To compare the evolution of AD patients, with and without depressive symptoms, in terms of cognition, functionality and caregiver stress. Methods: The study entailed 2 stages: an initial retrospective stage involving review of medical charts of patients with mild and moderate AD. Patients were divided according to the presence or absence of depressive symptoms, defined by medical interview and questions on depressed mood from the CAMDEX (Cambridge Examination for Mental Disorders of the Elderly) and Neuropsychiatric Inventory (NPI). Twenty-nine patients were evaluated, 37.9% with depression (Group D+) and 62.1% without depression (Group D-). The groups were compared regarding demographic and medical characteristics, cognitive and functional performance, presence of apathy as a separate symptom, and caregiver stress, using standardized tests and questionnaires. In the second transversal step, the same tools were reapplied after 2 to 4 years of follow-up, and evolution for the two groups was compared. Results: The two groups were highly homogeneous in demographic and clinic characteristics, as well as in length of follow-up, and presented no significant difference in cognitive or functional evaluation at the time of diagnoses or after follow-up. Only caregiver stress was greater in Group D+ at the two time points (p<0.001). Conclusions: No differences in the evolution of AD patients with or without depressive symptoms were evident. Nevertheless, these symptoms were associated to emotional burden of caregivers

    Prevalence of hearing impairment in patients with mild cognitive impairment

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    Abstract -The correlation between hearing and cognition is well established in dementia, but not in mild cognitive impairment (MCI). Objective: The aim of the present study was to defi ne the prevalence of hearing impairment in elderly patients with MCI and in controls. Methods: Twenty-nine patients with MCI and 24 control subjects were analyzed. We evaluated memory and hearing impairments through clinical tests, including the Mini Mental Status Examination, Clinical Dementia Rating (CDR) and Hearing Handicap Inventory for the Elderly Screening (HHIE-S). Audiometries were performed in 22 patients with MCI and 19 subjects in a control group. Results: MCI patients showed more hearing complaints (68.9%) compared to the control group (25%) (p=0.001). No differences in the intensity of hearing complaints, measured by the HHIE-S, were detected. Nonetheless, differences between mean hearing threshold (MCI group=23.4±11.3 dB and control group=16.0±10.1dB) (p=0.03) were identifi ed. Conclusions: There is a signifi cant association between MCI and hearing impairment. Hearing impairment in MCI patients may be a contributory factor to cognitive decline. This may however be related to the same neuropathological process, due to lesions of cortical areas related to hearing. The early diagnosis of hearing impairment in MCI patients may offer a more appropriate approach to this disease. Key words: dementia, memory, hearing, audiometry, elderly, aged. Prevalência de defi cit auditivo em pacientes com comprometimento cognitivo leve Resumo -A relação entre audição e cognição está bem estabelecida em demências, porém não no comprometimento cognitivo leve (CCL). Objetivo: Propomos um estudo para determinar a prevalência de defi cit auditivo em idosos portadores de CCL e controles. Métodos: Foram avaliados 29 pacientes com CCL e 24 controles. Analisamos as perdas de memória e de audição através de testes, como o Mini Exame do Estado Mental, o Escore Clínico de Demência e o HHIE-S (Hearing Handicap Inventory for the Elderly Screening). Vinte e dois pacientes com CCL e 19 controles foram submetidos a audiometrias. Resultados: O grupo CCL apresentou mais queixas auditivas (68,9%) se comparado com o controle (25%) (p=0.001). Não foram encontradas diferenças na intensidade da queixa auditiva, medida pelo HHIE-S. Foram detectadas diferenças entre a média dos limiares auditivos de pacientes com CCL (23,4±11,3 dB) e de controles (16,0±10,1 dB) (p=0,03). Conclusões: Existe signifi cativa associação entre CCL e perdas auditivas. O defi cit auditivo em pacientes com CCL pode ser um fator contribuinte para o declínio cognitivo ou estar relacionado a um mesmo processo neuropatológico, devido à lesão de áreas corticais relacionadas à audição. O diagnóstico precoce de perdas auditivas em pacientes com CCL pode permitir uma abordagem mais adequada desta doença. Palavras-chave: demência, memória, audição, audiometria, idosos

    Comprehensive geriatric assessment in elderly outpatients with dementia

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    Abstract Dementia is a common disabling disease in the elderly. In such patients, general health conditions may worsen the functional decline and loss of autonomy. The Comprehensive Geriatric Assessment (CGA) is a validated and recommended instrument for multidimensional evaluation of the aged. Nonetheless, it has yet to be assessed in demented patients. Objectives: To analyze the functional, emotional and clinical status in elderly with dementia measured by the CGA. We also compared the results obtained in the same patients stratified for severity of dementia. Methods: Transversal study with demented elderly outpatients. Subjects were evaluated by the CGA consisting of clinical data, Clinical Dementia Rating, performance-oriented mobility assessment of gait and balance (POMA), Cornell scale for depression, activities of daily living, Mini Mental Status Examination (MMSE), Mini Nutritional Assessment, Whispered and Snellen Test. Results: Fifty-two patients with mean age of 77 years were evaluated. Majority of patients had Alzheimer disease (77%). Depression was the most prevalent comorbidity. The POMA score was related to the number of falls in the previous year. Also, there was correlation between complaints of visual and hearing impairment and the results on the Snellen and Whispered Tests. Regarding severity, 56% presented mild, 33% moderate and 11% severe condition. Patients with moderate/severe dementia had less leisure activities, greater risk of falls, along with worse performance on the MMSE, POMA and activities of daily living. Conclusions: The CGA was applied in demented elderly with the help of their caregivers, and was able to better characterize patient state of health. Subjects with moderate/severe dementia obtained poor results in several assessed criteria

    Testosterone profile in older men with Alzheimer's disease

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    Abstract Evidence suggests low testosterone levels in Alzheimer's disease. Objectives: To compare testosterone levels between older men with and without Alzheimer's disease. Methods: Fourteen men with Alzheimer's disease were compared with twenty eight men without dementia. Demographic variables and clinical profiles were analyzed. Within fifteen days before or after the described evaluation, measures of total testosterone and Sex Hormone Binding Globulin (SHBG) were performed. Free testosterone level was calculated based on total testosterone and SHBG. Quantitative variables were analyzed using Student's t test or Kruskal-Wallis test, while qualitative variables were analyzed using chi-square or Fisher test. Results: Mean age in the Control and Alzheimer's disease groups were 72.0 (SD±4.8) years and 79.3(SD±5.9) years, respectively (p=0.001). Mean schooling between these two groups were 8.78 and (±5.86) years, respectively (p=0.022). There were no statistically significant differences between the two groups for testosterone levels, although a trend was observed for the Alzheimer's disease group to present lower levels than the control group (p=0.066). There was no direct correlation between free testosterone and age, although a trend was evident (p=0.068). Conclusions: There was no significant difference in testosterone between men with AD and those without dementia
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