Dementia e Neuropsychologia最新文献

The COVID-19 pandemic has exacerbated loneliness and social isolation among older adults, raising concerns about their mental and physical well-being. While loneliness's adverse effects on health are well-documented, its specific impact on cognitive health during the pandemic remains under investigation.

Objective: The aim of this study was to examine the association between loneliness during the COVID-19 pandemic and cognitive decline in cognitively unimpaired older adults by synthesizing evidence from primary studies.

Methods: A comprehensive search strategy was employed across multiple databases, including MEDLINE (PubMed), CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE, Scopus, AgeLine, and ProQuest, following PRISMA guidelines. Studies were selected to examine the association between loneliness and cognitive function in cognitively unimpaired older adults (aged ≥50 years) during the COVID-19 pandemic.

Results: A total of eight studies were included from 1,384 search results, reviewing data from 10,449 cognitively unimpaired older adults. A total of six studies found significant associations between loneliness or social isolation and subjective cognitive decline (SCD). Only one study linked loneliness to lower objective cognitive performance. Notably, half of the studies considered key covariates, such as depression, which could mediate the relationship between loneliness and cognitive decline.

Conclusion: Loneliness during the COVID-19 pandemic is linked to SCD in older adults, though objective evidence is limited. The pandemic underscored the long-term impact of social isolation on cognition and mental health, highlighting the need for standardized neuropsychological tools and key covariates in studies to identify those at risk.

Neuropsychiatric symptoms of dementia, also known as behavioral and psychological symptoms of dementia, are extremely common. These symptoms represent one of the main causes of burden and distress among caregivers and can lead to decline in their physical and mental health.

Objective: This study aimed to identify predominant characteristics in a sample of Brazilian outpatient dementia patients and explore which symptoms exert the greatest influence on caregiver burden.

Methods: This was a cross-sectional study involving 119 caregivers. Stepwise regression analysis was used, with caregiver burden as the dependent variable and depressive symptoms, caregiver distress due to neuropsychiatric symptoms, and quality of life as independent variables in the final model.

Results: Regression analysis identified three different models as predictors of caregiver burden. The first model, composed of depressive symptoms, predicted 34% of caregiver burden (p≤0.000). The second model, composed of depressive symptoms and caregiver distress due to neuropsychiatric symptoms, predicted 49% (p≤0.000). The third model, composed of depressive symptoms, caregiver distress due to neuropsychiatric symptoms, and quality of life, predicted 52% (p≤0.008).

Conclusion: Our findings indicate that problematic behaviors in dementia patients, depressive symptoms, and quality of life are associated with the level of caregiver burden and distress. Further research is needed to differentiate these findings among different types of dementia and to better understand how caregivers' individual characteristics influence their own burden.

Dementia is a significant public health challenge, particularly in low- and middle-income countries such as Indonesia, where underdiagnosis is common.

Objective: To investigate the psychometric properties of the Brief Cognitive Screening Battery - Indonesian Version (BCSB-INA), a culturally-adapted tool aimed at improving the early detection of dementia.

Methods: The tool was tested on a sample of 140 older adults, covering various cognitive domains through multiple subscales. Data were analyzed using bootstrap resampling, Kaiser-Meyer-Olkin (KMO) test, Confirmatory Factor Analysis (CFA), and reliability assessments such as Cronbach's Alpha.

Results: The overall reliability, measured by Cronbach's Alpha, was high (α=0.968). The KMO test yielded a value of 0.889, indicating sample adequacy for factor analysis. The CFA indicated that most dimensions achieved satisfactory validity, with the majority of items demonstrating acceptable factor loadings.

Conclusions: BCSB-INA has demonstrated good reliability and validity throughout its dimensions, suggesting its applicability for use in cognitive assessments in the Indonesian context.

Dementia with Lewy Bodies and depression are two common conditions in older adults that can share clinical similarities or coexist. We aim to highlight the diagnostic and therapeutic challenges of these two pathologies through the case of Mrs. S., a 67-year-old patient admitted to the psychiatric department for agitation and insomnia. Her symptoms initially presented as depression, followed by severe agitation. In the admission interview, we observed an anxious patient with bradyphemia, primarily focused on well-detailed visual hallucinations related to death. Upon neurological examination, we identified Parkinsonian syndrome. The patient was treated with quetiapine 200 mg/day and sertraline 50 mg/day, leading to a marked improvement in both depressive and Parkinsonian symptoms. Ultimately, the diagnosis was a major depressive episode with psychotic and melancholic features as part of a bipolar II disorder. In neuropsychiatric presentations of dementia with Lewy Bodies, cognitive and neurological evaluations should always be considered. In some cases, clinical evolution remains the only means of distinguishing between depression and dementia with Lewy Bodies.

Transient global amnesia (TGA) is a syndrome characterized by the sudden onset of anterograde amnesia, typically lasting for a few to less than 24 h. This condition is considered benign, as it is usually self-limited and unrelated to brain lesions; however, TGA may less frequently occur due to vascular brain changes. We report a rare case of a 66-year-old male with a diagnosis of recurrent TGA associated with a brain dural arteriovenous fistula (DAVF), alongside the absence of clear triggering and risk factors. He was submitted to embolization and remained event-free until his last attempt, 18 months after the surgical procedure. The case presentation follows a brief literature review on TGA and the pathophysiological mechanisms probably underpinning its occasional correlation with brain DAVF.

Recruitment for dementia research remains a persistent challenge, particularly when trying to reach underrepresented groups such as Latin Americans with traditional enrollment strategies.

Objective: In this retrospective case study, we investigate two communication approaches used on social media to recruit participants for a dementia research study in Lima, Peru.

Methods: Initially, recruitment materials featured medical terminology, which was later replaced by colloquial language to make the content more accessible.

Results: According to the results, using simpler and more relatable language led to an increase in participants' contacts and enrollments. This suggests that culturally tailored communication strategies may be more effective in reaching diverse populations.

Conclusion: The findings highlight the importance of adapting research recruitment efforts to the target community's cultural and linguistic context to improve engagement in dementia studies.

Psychometric tests as the gold-standard for diagnosing Alzheimer's disease (AD) tend to be inefficient, nonreproducible, and are affected by many factors. Research on pupillary response in AD is not novel; however, there has not been a single study providing the diagnostic value of pupillary response parameters as a recommendation for their potential use for early AD diagnosis.

Objective: To investigate pupillary response parameters as clinical biomarkers of AD that are dynamic, affordable, efficient, and objective (non-operator dependent).

Methods: A cross-sectional study on pupillary response parameters was conducted, with comparative and correlation-analytical tests between pupillary response and the Mini-Mental State Examination cognitive score. The diagnostic value of pupillary response parameters was obtained by determining the cutoff point of each parameter by calculating the sensitivity, specificity, Youden's maximum index, Area Under the Curve (AUC) value from the Receiver Operating Characteristic (ROC) curve, positive predictive value, and negative predictive value. Pupillary response parameters were classified into four types: size, response time, velocity, and acceleration.

Results: There were 128 respondents in total, consisting of cognitively-unimpaired young adults, cognitively-unimpaired older adults, and cognitively-impaired older adults. The pupillary response values without involving acceleration parameters were reliable. The diagnostic value of change in pupil size, the maximum and the average constriction velocity parameters have normal cognitive cutoff scores of 1.77 mm (sensitivity: 61.3%; specificity: 80%; positive predictive value [PPV]: 47.76%; negative predictive value [NPV]: 86.88%), ≥4.43 mm/s (sensitivity: 70.4%; specificity: 58.5%; PPV: 46.93%; NPV: 78.48%), and 3.12 mm/s (sensitivity: 70.4%; specificity: 55.0%; PPV: 45.83%; NPV: 77.5%), respectively.

Conclusions: Pupillary response, in particular changes in constriction and velocity, can be potentially used as an early diagnostic biomarker for AD.

Dementia encompasses a range of cognitive disorders marked by declining abilities in attention, memory, and social cognition. Considering this theme, motoric cognitive risk syndrome arises as a promising response to long-term care and early dementia detection although it is a pre-dementia stage.

Objective: Considering that the early identification of individuals at higher risk of developing dementia could be key for the development of preventive actions, we conducted a scoping review to investigate the instruments used for the diagnosis of motoric cognitive risk syndrome.

Methods: we searched ten electronic databases for studies presenting the assessment of motoric cognitive risk syndrome published between 2019 and 2023. Two independent reviewers screened studies according to including criteria using Mendeley Desktop software to collect, eliminate duplicates and facilitate full-text readings.

Results: From an initial 225 publications related to motoric cognitive risk syndrome, 67 studies were considered eligible for full-text review. Some of those studies presented information for more than one sample, totalizing 82 studies in this scoping review.

Conclusion: Although the diagnostic criteria to identify motoric cognitive risk syndrome are well defined in the literature, there is no description of a structured protocol or list of instruments recommended to evaluate this condition.

The Montreal Cognitive Assessment (MoCA) has proven to be an effective tool for detecting early dementia in older adults. However, in the Latin American region, there are few available norms of the Spanish version. The Peruvian population faces major healthcare barriers to early screening, so it is important to validate this instrument within this population.

Objective: To standardise the Spanish version of the MoCA for the older population in Lima, addressing the critical need for culturally and demographically adapted cognitive evaluation tools in Peru.

Methods: The test was administered to 338 ambulatory and homebound adults aged 60 to 80 (216 women) from three institutions: San Miguel District Municipality, San José Obrero Polyclinic in Barranco, and EDMECON in Surco. we computed regression-based norms adjusted for age and education.

Results: Sex was not a predictor of the total scores of MoCA. Moreover, age (R2=0.12) and education (R2=0.24) significantly influenced cognitive performance, with education being the strongest predictor. A raw score above 18 indicates normal cognitive performance for the total sample.

Conclusions: We provided normative data and cutoff scores for older Peruvians, supporting the clinical use of the MoCA in Peru and setting a benchmark for future test standardizations in the region.