Publicación Oficial de la Sociedad Ecuatoriana de Neurología, de la Liga Ecuatoriana Contra la Epilepsia y de la Sociedad Iberoamericana de Enfermedad Cerebrovascular

cognitive impairment

 

Depression in adult day care centers in Ecuador: Prevalence and associated variables. Depresión en adultos que asisten a los centros de día en Ecuador: Prevalencia y variables asociadas.

Objectives: The present study aims to identify the prevalence and factors associated with depression in older adults attending day care centers in Quito, Ecuador.

Methods: This study is a correlational study with a non-experimental cross-sectional design. The study was applied in the 8 “Centros de Experiencia del Adulto Mayor” in the city of Quito, Ecuador. A total of 463 older adults with a mean age of 70.15 years were evaluated. All participants were administered a sociodemographic and health questionnaire, cognitive functioning, levels of depression, autonomy, and physical activity were measured.

Results: Using linear regressions, direct relationships were identified between depression scores with marital status (B=0.276, p=0.04) and renal impairment (B=1.257, p=0.007); and inverse relationships with educational level (B=-0. 537, p=0.002), sleep hours (B=-0.342, p<0.001), fish consumption (B=-0.318, p=0.021), physical activity (B=-0.454, p=0.002) and cognitive impairment (B=-0.091, p<0.001).

Conclusions: The results reflect the importance of considering a holistic approach in addressing depression in the older adult, including health, functional status and cognitive status together to prevent and or address depression in older adults. This study contributes to the implementation of public health policies related to the variables associated with depression in adults.

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Palabras clave: adulto mayor, autonomía funcional, centro de cuidado diurno, depresión, deterioro cognitivo,

Keywords: cognitive impairment, day care center, depression, elderly, functional autonomy,

Evaluación de la función cognitiva diaria del adulto y adulto mayor mediante el uso del ECog (everyday cognition). Evaluation of the daily cognitive function of adults and elderly adults through the use of ECog (everyday cognition).

Introduction: Older adulthood is the stage of life where significant biological changes occur, such as a decrease in cognitive function. The ECog is a valuable tool for detecting early changes in declining cognitive function and subjective cognitive impairment. It can be answered by an informant (relative) without needing the patient to be present. It can be applied to patients with a low educational level or some disability without this limitation.

Objective: To know the changes in the daily cognitive function of adults and older adults for decades. (50-59, 60-69, >70 years) using the ECog.

Methods: Descriptive, cross-sectional, randomized, survey-type study. Patients over 50 who attended a Family Medicine consultation for any reason other than dementia were included, patients who did not wish to participate were excluded, and incomplete surveys were eliminated. The n was 180 patients, 60 for each age group (group 1=50-59 years, group 2=60-69 years, and group 3=>70 years). The ECog was applied to the patients (answered by an informant). The means were calculated by age group, the variation between each group was calculated using a means comparison formula, the prevalence of Subjective Cognitive Impairment (cut-off point in ECog>1.36) was calculated by age group, and the most affected domains.

Results: The decrease in cognitive function measured by the ECog increased significantly with age in each group (Anova p value less than 0.001) and the prevalence of cases with Subjective Cognitive Impairment. The most affected functions were memory, attention and organization. The least affected domain was language.

Conclusion: A significant decline in cognitive function was observed with advancing age. The ECog is an excellent tool, easy
and straightforward to use for the Primary Care physician.

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Palabras clave: adulto mayor, deterioro cognitivo, ECog,

Keywords: cognitive impairment, ECog, older adult,

Prevalencia de deterioro cognitivo leve en peruanos adultos mayores y de mediana edad. Cognitive impairment prevalence in peruvian middle-age and elderly adults

Appraisals of dementias worldwide envisage an unfavorable scenario, especially in developing countries. Since factors such as education, socioeconomic status and healthiness play an important role in the development of Alzheimer’s disease and other dementias. It is known that pathophysiological features begin up to 20 years before an Alzheimer’s diagnosis and that the disease transits through three stages that include normal aging, mild cognitive impairment, and Alzheimer’s disease. The objective of this study was to determine the prevalence of cognitive impairment in a sample of middle-aged and older adults in southern Peru. A discriminant cognitive evaluation is performed for the absence or presence of cognitive alteration, focused especially on memory, language, visuoperception/visuoconstruction and other cognitive domains. Mini-Mental State Examination, Clock´s Test, and Verbal Fluency test were used, obtaining prevalence data for cognitive impairment with adjusted cut-off points according to age ranges (50-98 years) sex and education. Parametric and non-parametric statistics, logistic regression, Pearson correlation and ANCOVA were performed. The most suitable cut points for our population were selected through the ROC curves and the Youden index. The percentage of global mild cognitive deterioration was 58.80%. It is necessary to generate more effective mental health policies, especially referring to the middle-aged and elderly population, that address the early detection of MCI and Alzheimer’s disease.

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Palabras clave: Adultos de mediana edad, Adultos Mayores, deterioro cognitivo, epidemiología, fluidez verbal, MMSE, Test del reloj,

Keywords: Clock's test, cognitive impairment, elderly adults, epidemiology, Middle-age adults, MMSE, verbal fluency,

El chico con medio cerebro. Boy with nearly half-of-brain

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Palabras clave: deterioro cognitivo, Quistes aracnoideos intracraneales,

Keywords: cognitive impairment, Intracranial intra-arachnoid cyst,

Asociación Entre Enfermedad Renal Crónica No Terminal y Deterioro Cognitivo en Adultos Entre 55 a 65 años de Edad. Association Between Chronic Non-Terminal Renal Disease And Cognitive Impairment In Adults Between 55 And 65 Years Old

Introduction: According to the Latin American Nephrology and Hypertension Society it is estimated that in Latin America exists around 300 patients with chronic renal failure per million inhabitants, while the American Academy of Neurology reports that patients with cognitive risk are investigated from 60 years old.

Objective: To demonstrate the existence of a relationship between levels of decreased glomerular filtration rate and the presence of cognitive impairment in patients with chronic kidney disease.

Methodology: A cross-sectional, observational, descriptive and analytical study was performed to relate glomerular filtration rate levels to the score obtained in the MoCA Test.

Results: The degree of association between the GFR and MoCA Test variables was evaluated. It was found that when the GFR decreases, the value of punctuation of the MoCA test also does, both variables are directly proportional with a p value of statistical significance of 0.000 (very significant) and a 76.55% strong force of association.

Conclusion: We propose that in medical consultations chronic renal ifailure patients must be evaluated integrally, especially their levels of cognition for avoiding the worsening of their quality of life and functional capacity. Our public health system should make more research about this topic

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Palabras clave: deterioro cognitivo, Enfermedad renal crónica, Nefrología, Tasa de Filtrado Glomerular,

Keywords: cognitive impairment, Glomerular Filtration Rate, Nephrology, Renal chronic disease,

El Perfil Epidemiológico y Clínico de la Esclerosis Múltiple en el Ecuador. The Clinical And Epidemiological Profile Of Multiple Sclerosis In Ecuador.

In recent years, the number of publications on Multiple Sclerosis (MS) from Ecuador has seen a significant increase. As a result, the research on the clinical and epidemiological behaviour of the disease has allowed us to make comparisons with other cohorts of patients with MS that come from regions where the prevalence of the disease is high. Nevertheless, Ecuador is still a country in which the prevalence of MS is low with a prevalence that fluctuates between 3 to 5 cases per 100,000 inhabitants. The epidemiological behaviour of MS is very similar to that of european cohorts, for example female patients are the most affected. However, the clinical behaviour of multiple sclerosis differs in terms of cognitive impairment and fatigue being less frequent. The impact of vitamin D on patients with MS is still unknown as only one study has been carried out. This study show that there is a high prevalence of vitamin D deficiency and insufficiency in ecuadorian patients, but this does not translate into an increase in prevalence or disability as it does in european populations. Although we have a better understanding of the disease in the country, more studies are necessary, and it is imperative that all ecuadorian patients with MS be included in future studies in order to improve our knowledge about the behaviour of this disease in our region.

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Palabras clave: deterioro cognitivo, Ecuador, esclerosis múltiple, Fatiga, Prevalencia, vitamina D,

Keywords: cognitive impairment, Ecuador, Fatigue, multiple sclerosis, Prevalence, vitamin D,

Demencia por Cuerpos de Lewy, un Reto Diagnóstico. Dementia With Lewy Bodies, A Diagnostic Challenge.

Dementia with Lewy bodies is a neurodegenerative disease of unknown etiology, it is the second cause of dementia of the sixth decade of life; Its diagnosis is a challenge, because certain signs and symptoms that it presents are typical of Parkinson’s Disease and Alzheimer’s Disease. The following case report is one of the few documented patients with Dementia with Lewy bodies in Ecuador. We report this in order to state the diagnostic difficulty that this pathology generates and describe the main characteristics that differentiate it from other dementia syndromes, highlighted in the recently updated criteria by the Consortium of Dementia with Lewy bodies. A meticulous neurological examination and neuropsychological assessment were essential in the study and prognosis of the patient. Dementia with Lewy bodies requires a thorough diagnosis, due to the challenge that originates its early recognition; the criteria described accelerated their recognition due the update of the recommendations on the clinical diagnosis of Dementia with Lewy bodies.

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Palabras clave: Demencia por cuerpos de Lewy, deterioro cognitivo, Hiponatremia, parkinsonismo,

Keywords: cognitive impairment, Dementia with Lewy bodies, Hyponatremia, parkinsonism,

Deterioro Cognitivo en Pacientes Diabéticos De 55 a 65 Años de Edad. Reporte Final de Estudio Observacional, Transversal en la Ciudad de Guayaquil. Cognitive Impairment In Diabetic Patients Between 55 And 65 Years Old. Final Report Of A Cross-Sectional, Observational Study In Guayaquil City.

Introduction: Diabetes mellitus is a frequent and systemic illness. Deleterious effects on cognition are one of its lesser known consequences. Diabetic individuals are at an increased risk for development of dementia in the future. Objective: To compare cognitive function in middle aged diabetic population with non-diabetic control group, in order to determine high risk population for developing cognitive decline or dementia in the future. Methodology: This is a cross-sectional, observational study conducted in Guayaquil. We studied 309 individuals between the ages of 55 and 65 years, of which 142 were diabetics and 167 were non-diabetic controls. A neuropsychological evaluation was performed to assess memory, attention, executive functioning and processing speed. Results: Group comparisons revealed significant differences between diabetics and non-diabetics in systolic blood pressure (p<.001), hyperlipidemia (p<.001) and cardiovascular risk (p < .001). Cognitive performance, after considering differences in scholarship, was lower in diabetic people (memory p values between .000 and .002; attention p values between .000 and .019; executive function p values between .000 and .001). Correlation between years of disease and cognitive decline was not significant (memory -.055; attention -.040; executive function .0169). Correlation between glycated hemoglobin and cognitive performance was significant for all evaluated functions (memory -.219; attention -.186; executive function -.269). Conclusion: Middle aged diabetic population has lower cognitive performance compared with non diabetics. The identification of individuals at risk for cognitive decline will contribute to the development and implementation of intervention strategies that will allow the slowing of cognitive decline in vulnerable individuals.

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Palabras clave: Alzheimer, Cognición, demencia, deterioro cognitivo, Diabetes mellitus, pruebas neuropsicológicas, salud cerebral,

Keywords: Alzheimer, brain health, Cognition, cognitive impairment, dementia, Diabetes Mellitus, neuropsychological tests,

La Musicoterapia Neurológica Como Modelo de Neurorrehabilitación. Neurologic Music Therapy As A Neurorehabilitation Model.

Neurologic music therapy (NMT) is being implemented in hospitals and neurorehabilitation facilities around the world, thanks to the abundant neuroscience research and to the growing interest in the effects of music on the brain. Recognized and endorsed by the World Federation for Neurorehabilitation, neurologic music therapy is utilized as a non-pharmacological, non-invasive intervention to treat patients with neurologic disease that present cognitive, motor, and/or language impairments. This article aspires to introduce this discipline as an effective, evidence-based method of treatment for neurologic disease.

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Palabras clave: musicoterapia neurológica, neurociencia, Neurorrehabilitación, trastornos cognitivos, trastornos del lenguaje, trastornos motores, trastornos neurológicos,

Keywords: cognitive impairment, language impairment, motor impairment, neurologic disorders, neurologic music therapy, Neurorehabilitation, neuroscience,

Prevalencia de Enfermedades Neurológicas no Transmisibles en una Población Rural del Estado de Chiapas, México: Protocolo y Resultados Basales. Estudio Pro-Mas (Proyecto Comunitario La Soledad)

Objective: We aimed to assess cardiovascular health and neurological status of community-dwelling adults living in “La Soledad,” Chiapas, México, to calculate prevalence and incidence of cerebrovascular diseases, epilepsy and cognitive decline. Among others, these conditions are currently considered as the new epidemics in rural.
Design: Following a protocol similar to that used for the Atahualpa Project, we conducted a two-phase epidemiological study. During phase I, La Soledad residents were interviewed with validated field instruments to assess cardiovascular health status and well as to detect suspected stroke, epilepsy and cognitive impairment patients. During phase II, trained physicians examined suspected individuals as well as a random sample of non-suspected individuals to assess prevalence of diseases of interest.
Comment: Public health strategies must be based on the study of region-specific risk factors. Studies such the Atahualpa Project were proven to be effective for the assessment of public health problems in a rural Ecuadorian village. PROMAS will likely be cost effective to increase current knowledge on these conditions in Mexican rural villages and to promote a better cardiovascular health status among their inhabitants.

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Palabras clave: deterioro cognitivo, enfermedad cerebrovascular, Epilepsia, estudio poblacional, PROMAS, salud cardiovascular,

Keywords: cardiovascular health, Cerebrovascular disease, cognitive impairment, Epilepsy, population-based study, PROMAS,

Concepto de la Demencia como Enfermedad en un Grupo Poblacional de la Ciudad de Guayaquil

Background: Dementia is a clinical condition that causes progressive cognitive impairment, and early diagnosis may have a significant impact on the quality of life. So far, no studies have been conducted to evaluate the conception of the general population about this disease.
Methods: Cross-sectional, descriptive and analytical study, which surveyed individuals between 55 and 65 years old without neurocognitive pathology about the concept of the term “dementia”. The educational level of each respondent was also collected. The responses were assigned to one of 6 possible response groups for analysis, depending on which group better matched each individual response. The percentage of each type of response was calculated, and chi-square was used to observe the relationship between level of education and the type of answers given.
Results: a total of 274 individuals were surveyed, 35.8% were male and 64.2% female. Most patients (36.5%) had only elementary education. 11.7% did not know what dementia means. 45.5% defined it as memory loss and 23% incorrectly identified it as a psychiatric illness. A very small percentage of individuals correctly defined it as a type of cognitive impairment. We found a statistically significant relationship between the level of education and the type of answers obtained (p <0.001).
Discussion: more than half of respondents gave an acceptably correct answer about the concept of dementia, but there is still a significant percentage of people who do not know its meaning, or confuse it with psychiatric illness. It is imperative to carry out health campaigns to alert people about this disease and how to delay it’s onset by lowering risk factors, and to train as well primary care physicians to provide better information to their patients in order to improve the prevention of dementia and lessen its impact on quality of life.

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Palabras clave: demencia, deterioro cognitivo, Ecuador, epidemiología, escolaridad,

Keywords: cognitive impairment, dementia, Ecuador, education, epidemiology,

Fractura de cadera y deterioro cognitivo: un estudio seccional-cruzado.

Cognitive impairment is a non modifiable risk factor for hip fracture.

Objective: To determine if patients older than 60 years old with hip fracture presented association with cognitive impairment.

Method: Cross-sectional study.

Patients. All patients older than 60 years admitted in the traumatology service of Enrique Garcés Hospital in Quito-Ecuador.

Data recollection. It was made by: clinical history, interview with the patient that included valoration of cognitive state by minimental test and the photograph test, interview with the relatives of the patients if they where during his or her hospital stay. The variables were analyzed in percentages and the data was utilized to evaluate if there was a mayor association between cognitive impairment and hip fracture.

Results. Of the 56 patients included 83,92% presented cognitive impairment, of this patients 85,10% presented dementia and 42,55% presented severe dementia. The association between the following variables was significant: patients older than 80 years old with severe dementia OR 8 (IC 1,75 – 41,18), analphabets with severe dementia OR 5,33 (IC 1,13 – 27,97), hip fracture with severe dementia OR 6,28 (IC 1,54 – 30,24), hip fracture with falling OR 19,09 (IC 3,36 – 187,38).

Conclusions: Severe dementia presented an association with age older or equal to 80 years and analphabetism, and hip fracture presented an association with severe dementia and falling.

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Palabras clave: demencia, Demencia severa, deterioro cognitivo, Fractura de cadera,

Keywords: cognitive impairment, dementia, Hip fracture, Severe dementia,

Patrones de Perfusión Cerebral en la Epilepsia Rolándica: Formas Típicas y Atípicas.

Introduction: Cerebral perfusion patterns in typical rolandic Epilepsy and its variants remain unknown.

Objective: To describe interictal cerebral perfusion patterns in this Epilepsy and in one of its variants.

Patients and methods: Twenty four children were followed-up for 6 years after their first seizure. Magnetic Resonance Imaging and Single Photon Emission Tomography were performed during follow-up. We investigated for perfusion asymmetries in different cerebral structures using statistical parametric map. The perfusion images were registered whether atypical evolution was diagnosed or if we found some cognitive deficits suggestive of focal cortical lesion.

Results: Seven patients with atypical Benign Partial Epilepsy and seventeen with typical Rolandic Epilepsy were recruited. The vast majorly of the patients showed a cortical hyperperfusion pattern associated with asymmetric hypoperfusion pattern in basal ganglia and thalamus. Patients with atypical Benign Partial Epilepsy showed a well defined different cerebral perfusion pattern characterized by symmetrical hypoperfusion at the level of basal ganglia including thalamus.

Conclusions: Different cerebral perfusion patterns were documented in different variants of Rolandic epilepsy.

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Palabras clave: deterioro cognitivo, Epilepsia Parcial benigna de la Infancia, Epilepsia Rolándica, perfusión cerebral, puntas centro-temporales, SPECT,

Keywords: atypical Benign Partial Epilepsy, centro-temporal spikes, cerebral perfusion, cognitive impairment, rolandic epilepsy, SPECT,
 
 
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