Search

Background Aim Methods & Procedures Outcomes & Results Conclusions & Implications WHAT THIS PAPER ADDS What is already known on the subject What this paper adds to existing knowledge What are the potential or actual clinical implications of this work? Speech and language therapists (SLTs) play an important role in assessing and rehabilitating communication disorders in people with dementia, but there is evidence to suggest that they do not receive appropriate training to provide management and support during their training.To investigate the level of awareness and knowledge that practising SLTs from Brazil have about dementia and their role in the care of dementia through an online survey.An online survey tool was developed to collect information from practising Brazilian SLTs regarding their knowledge about dementia, awareness about their role in the care of people with dementia, and opinions on how SLTs may be better prepared to work in the dementia field. The survey was disseminated via social media, websites, and e‐mail lists of researchers and stakeholders.A total of 227 SLTs completed the survey. Participants showed good knowledge of dementia in general, while their answers were less accurate on primary progressive aphasia. Regarding the awareness by SLTs of their role in the care of people with dementia, most agreed or strongly agreed that SLTs could help people in the diagnosis, treatment and prevention of dementia (> 80%). However, fewer participants agreed or strongly agreed that they felt confident in contributing to the treatment and diagnosis process of dementia (about 50%). To improve the training of SLTs in Brazil, most participants believed that it would be necessary to improve the teaching of dementia at the undergraduate speech and language therapy curriculum level and to develop recommendations or guidelines about speech and language therapy practice in dementia.The results of this survey point to a need for improvement in the knowledge and confidence of Brazilian SLTs about dementia. To reach this goal, targeted training courses and applied practice opportunities should be embedded within university curricula and training programmes. Many studies confirm the importance of speech and language therapy in the non‐pharmacological treatment of people with dementia. However, other evidence suggests to a possible lack of training for Brazilian SLTs, especially in the curriculum of undergraduate courses. This study reveals that Brazilian SLTs have substantial knowledge of dementia and recognize the significance of their role in treating people with dementia. However, a minority expressed confidence in their ability to assess and treat people with dementia. The findings of this research demonstrate that Brazilian SLTs have good knowledge of dementia and endorse their professional role in dementia care; however, they lack confidence in their own skills and expertise in diagnostic assessment and treatment of dementia. Interventions aimed at boosting the SLT's confidence level could lead to improved patients outcomes and overall quality of care within clinical settings. [ABSTRACT FROM AUTHOR]

STRiDE was an ambitious four-year project in seven countries aiming to build capacity around generating and using research to support the development of policies to improve quality of life of people with dementia and their carers. The project's innovative approach combined rigorous academic research and hands-on civil society advocacy. This paper explores the project's unique strategy for policy change and compiles case-studies from several of the STRiDE countries. Finally, we share lessons learned and next steps to keep momentum for policy change going in each of these countries – and beyond. [ABSTRACT FROM AUTHOR]

Background: Social Frailty is a significant public health concern affecting the elderly, particularly with the global population aging rapidly. Older adults with social frailty are at significantly higher risk of adverse outcomes such as disability, cognitive impairment, depression, and even death. In recent years, there have been more and more studies on social frailty, but no bibliometrics has been used to analyze and understand the general situation in this field. Therefore, by using CiteSpace, VOSviewer, and Bilioshiny software programs, this study aims to analyze the general situation of the research on social frailties of the older adults and determine the research trends and hot spots. Methods: A bibliometric analysis was conducted by searching relevant literature on the social frailty of the older adults from 2003 to 2022 in the Web of Science core database, using visualization software to map publication volume, country and author cooperation networks, keyword co-occurrences, and word emergence. Results: We analyzed 415 articles from 2003 to 2022. Brazil has the highest number of articles in the field of social frailty of the older adults, and the United States has the highest number of cooperative publications. Andrew MK, from Canada, is the most published and co-cited author, with primary research interests in geriatric assessment, epidemiology, and public health. "Social Vulnerability," "Health," "Frailty," "Mortality," and "Older Adult" are among the research hotspots in this field. "Dementia," "Alzheimer's disease," "Population," and "Covid-19" are emerging research trends in social frailty among the older adults. Conclusion: This scientometric study maps the research hotspots and trends for the past 20 years in social frailty among the older adults. Our findings will enable researchers to better understand trends in this field and find suitable directions and partners for future research. [ABSTRACT FROM AUTHOR]

The last years have evinced a remarkable growth in neuroimaging studies around the world. All these studies have contributed to a better understanding of the cerebral outcomes of dementia, even in the earliest phases. In low- and middle-income countries, studies involving structural and functional neuroimaging are challenging due to low investments and heterogeneous populations. Outstanding the importance of diagnosing mild cognitive impairment and dementia, the purpose of this paper is to offer an overview of neuroimaging dementia research in Brazil. The review includes a brief scientometric analysis of quantitative information about the development of this field over the past 10 years. Besides, discusses some peculiarities and challenges that have limited neuroimaging dementia research in this big and heterogeneous country of Latin America. We systematically reviewed existing neuroimaging literature with Brazilian authors that presented outcomes related to a dementia syndrome, published from 2010 to 2020. Briefly, the main neuroimaging methods used were morphometrics, followed by fMRI, and DTI. The major diseases analyzed were Alzheimer's disease, mild cognitive impairment, and vascular dementia, respectively. Moreover, research activity in Brazil has been restricted almost entirely to a few centers in the Southeast region, and funding could be the main driver for publications. There was relative stability concerning the number of publications per year, the citation impact has historically been below the world average, and the author's gender inequalities are not relevant in this specific field. Neuroimaging research in Brazil is far from being developed and widespread across the country. Fortunately, increasingly collaborations with foreign partnerships contribute to the impact of Brazil's domestic research. Although the challenges, neuroimaging researches performed in the native population regarding regional peculiarities and adversities are of pivotal importance. [ABSTRACT FROM AUTHOR]

Introduction Approximately 10 million people in Brazil have some hearing impairment. Because of the natural progression of hearing impairment to presbycusis, coupled with the increasing number of young people exposed to the risk factors for early hearing loss, the social impact of hearing impairment is high. Objective A team of otolaryngologists and speech therapists conducted an unprecedented worldwide campaign in the primary health sector, aiming to reduce the global burden of hearing impairment with preventive measures. Methods A cultural information campaign called “Ear Parade”was developed. It lasted 3 months, during which São Paulo received information on the prevention of deafness and the importance of hearing rehabilitation to reduce prejudice against the use of hearing aids. Results The information was relayed through an art exhibition of public paintings, including 62 sculptures of ears, 2.40 meters high, which colored the city, elucidating the beauty of hearing. The media coverage impacted 170 million people, and at the end of the campaign, a nongovernmental organization was established to raise resources for hearing rehabilitation. In addition, an auction of the ear sculptures raised money toward hearing aid batteries and stem-cell research for hearing. Conclusion The present paper presents the effects of this campaign. Information dissemination is a powerful preventive measure for the primary healthcare system to reduce future treatment expenditures [ABSTRACT FROM AUTHOR]

This paper provides estimates of mortality rates from Alzheimer's disease dementia (AD) in the elderly Brazilian population. Data were obtained from the 2010 Population Census by Brazilian Institute of Geography and Statistics (IBGE) and microdata on mortality in Brazil's 27 state capitals recorded in the Brazilian Mortality Information System (SIM) for the population 65 years or older by place of residence for the years 2009 to 2013. Corrections were obtained for underreporting of mortality, and final adjustments were made to the specific mortality rates based on Bayesian methods with prior probability distributions built on the basis of information obtained from a meta-analysis. The mortality rates from all dementias and from AD in Brazil were higher than in developed countries. The mortality rates from Alzheimer's disease in 2013 were 140.03 (95%CI: 117.05; 166.4) and 127.07 (95%CI: 103.74; 149.62) per 100,000 inhabitants, respectively, in men and women. The contribution of AD to mortality in elderly Brazilians was 4.4% (95%CI: 3.25; 5.72) in the group with 0 to 3 years of schooling, independently of age and sex. The study aimed to increase knowledge on corrected estimates of mortality rates from Alzheimer's disease based on vital statistics, providing more precise and pertinent evidence-based estimates.

An increase in the number of older people with dementia is currently a trend around the world. In low and middle countries, effective public health services are not yet well‐developed, and family care‐givers may be overwhelmed by the requirements of care. This paper has two purposes: to share findings from an ethnographic study about family dementia care practices in Brazil and to draw attention to the significance of the materiality of care practices in the family context. The study was conducted in Belo Horizonte, Brazil. We describe the care trajectory of one family and, analysing data using the insights of Actor Network Theory, show the significance of objects in a networked relation of care. In particular, we show how incontinence products such as adult diapers assume different positions in the network, acting as either mediator or intermediary of care in relation to other elements of the network composed of family members and their living situation, the person with dementia herself, the doctor, and Brazilian health policies. Although the diaper is often seen as an ordinary object for care providers, its participation in a care network shapes relations, activating conflict, financial constraint, and disciplining the body of the person with dementia. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Initial dementia prevalence estimates have revealed a significant burden of the disease in Indigenous communities in Amazonas, Brazil. However, the need for culturally adapted cognitive tools poses a critical challenge when assessing cognitive performance in these communities. This study addressed this issue by culturally adapting and providing validity indicators for the Brazilian Indigenous Cognitive Assessment (BRICA) tool in Manaus, Brazil's urban multiethnic Indigenous community. METHODS: Using a three‐stage process and a stakeholder‐engaged approach, the BRICA tool was culturally adapted in an urban multiethnic Indigenous community from Manaus, Brazil. The content validity index (CVI) examined inter‐rater concordance between experts, while criterion and concurrent validity were performed using diagnostic consensus criteria in 141 Indigenous participants aged ≥ 50 years. RESULTS: Findings showed evidence of content validity in terms of equivalence aspects (scale CVI [S‐CVI] 0.93) and relevance ratings (S‐CVI 0.85) between expert panels. The identified cut‐off score of ≤ 33/39 on the BRICA demonstrated a sensitivity of 94.4%, specificity of 99.2%, positive predictive value of 94.4%, and negative predictive value of 99.2% for dementia diagnosis. DISCUSSION: Using a stakeholder‐engaged approach, we culturally adapted the BRICA tool for a Brazilian urban multiethnic Indigenous community. This comprehensive adaptation process resulted in favorable indicators of content, construct, and criteria validity for the BRICA tool. By addressing the existing bias in cognitive assessment within Indigenous communities, the BRICA tool represents a noteworthy breakthrough. Its implementation exhibits potential for improving the early detection and management of dementia among Indigenous groups. Highlights: Culturally sensitive tools are essential to assess cognition in Indigenous populations.An expert panel and stakeholders' perspectives were incorporated to design the Brazilian Indigenous Cognitive Assessment (BRICA) tool.A cognitive screening tool was adapted and validated using a stakeholder approach.BRICA is the first culturally sensitive cognitive tool for urban Brazilian Indigenous individuals. [ABSTRACT FROM AUTHOR]

Background: Indigenous populations may be at increased risk, compared with majority populations, for the development of dementia due to lower education levels and socio-economic status, higher rates of diabetes, hypertension, cardiovascular disease and alcohol abuse, an aging population structure, and poorer overall health. This is the first systematic review investigating the prevalence and incidence of dementia in indigenous populations worldwide., Methods: This systematic review was conducted in accordance with PRISMA guidelines. We searched MEDLINE, Embase, and PsycInfo for relevant papers published up to April 2015. Studies were included if they reported prevalence or incidence, the disease typically occurred after the age of 45, the study population included indigenous people, and the study was conducted in the general population., Results: Fifteen studies representing five countries (Canada, Australia, the USA, Guam, Brazil) met the inclusion criteria. Dementia prevalence ranged from 0.5% to 20%. Retrospective studies relying on medical records for diagnoses had much lower prevalence rates and a higher risk of bias than population-based prospective studies performing their own diagnoses with culturally appropriate cognitive assessment methods., Conclusions: The prevalence of dementia among indigenous populations appears to be higher than it is for non-indigenous populations. Despite a building body of evidence supporting the need for dementia research among indigenous populations, there is a paucity of epidemiological research, none of which is of high quality.

Background: Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective: To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods: This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61). Results: In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07). Conclusions: In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year. [ABSTRACT FROM AUTHOR]

It is only to be expected that the elderly population manifests a high prevalence of chronic diseases that jeopardize their autonomy. One example is syndromes of dementia. The scope of this paper is to make projections of the number of elderly individuals with dementia. An estimate of the current number is made by applying age-related prevalence data to the population of 65 and over, by age-group, with the figures from the Brazilian Demographic Census of 2010. The data were obtained from assessments found in the literature. For a national measure, a weighted average of the estimated prevalence was used. Prevalence rates by age and gender were calculated for the elderly Brazilian population. Current investigations show a steep increase of dementia with age. Women and illiterate individuals have a higher prevalence. The mean prevalence in Brazil is higher than that found in the rest of the world. Projections for the Brazilian population point to a small increase in the prevalence of dementia in the 65+ age-group, from 7.6% to 7.9% between 2010 and 2020, which means 55,000 new cases a year. Dementia is a public health issue, and elicits a strong bioethical concern with aging, due to the loss of autonomy of the affected individuals and the responsibility of the health system to provide adequate care.

Objective: To systematically review the literature on the psychometric properties of the Clinical Dementia Rating (CDR) scale among Hispanic-Latinx communities. Data Selection: We searched multiple cross-disciplinary databases from January 1970 until April 2023 for relevant papers written in English and Spanish. We used the following terms: (1) Clinical Dementia Rating, (2) validity, (3) reliability, (4) psychometric, (5) Hispanic, (6) Latinos or Latinx, (7) outcome measures, (8) Spanish language, and (9) Alzheimer's disease. Data Synthesis: We found 609 studies with 56 eligible studies. Only 5 studies examined psychometric properties of the CDR in Hispanic-Latinx communities. Each study implemented divergent study designs. Of the 5 selected studies, one study evaluated the validity of the CDR Sum of Boxes among 1073 Mexican Americans. A second study evaluated the CDR's test–retest reliability and internal consistency among 94 Spanish speaking participants from the United States. The third study examined the validity of the CDR Sum of Boxes among 343 Brazilians living in Brazil. A fourth study assessed the CDR Sum of Boxes sensitivity and specificity among 407 Brazilians living in Brazil, whereas a fifth study evaluated the validity of a Portuguese CDR version on 424 Brazilians living in Brazil. Conclusions: Our systematic review revealed limited studies examining the validation of the CDR in the Hispanic-Latinx communities. The limited number of studies raises concerns about versions of the CDR scale implemented in ad clinical trials, and its implications to study results, interpretation, and generalizability of findings. [ABSTRACT FROM AUTHOR]

Objectives: Hearing loss, depression, and cognitive decline are common among older people. We investigated the association of hearing loss with depressive symptoms and cognitive function in a nationally representative sample of people aged 50+ in Brazil. Methods: Data from the Brazilian Longitudinal Study of Aging (ELSI‐Brazil) included information on self‐reported hearing loss, hearing aid use (effective or not effective), depressive symptoms (CES‐D‐8), and a global cognitive score (composed of immediate and late recall, verbal fluency, orientation and prospective memory) in a sample of 9412 individuals. Multiple linear regression was used to estimate the association of hearing loss and hearing aid use with both depressive symptoms and cognitive performance. The analyses were conducted with 7837 participants with complete data, and then repeated with data from the whole sample after multiple imputation. Results: Compared to those without hearing loss, those with hearing loss were more likely to have a higher number of depressive symptoms (β: 0.53 (0.40–0.67) p < 0.001) but not worse cognitive performance (β: −0.01 (−0.03 to 0.19) p = 0.631). Among those with hearing loss, the use of hearing aid was neither associated with cognitive performance (β: −0.08 (−0.19 to 0.03) p = 0.169) or depressive symptoms (β: −0.42 (−0.98 to 0.14) p = 0.143); its effective use was associated with less depressive symptoms (β: −0.62 (−1.23 to −0.01) p = 0.045) but not worse cognitive performance (β: −0.15 (−0.030 to 0.03) p = 0.057). Sensitivity analyses revealed that hearing loss is associated with a worse performance in two non‐amnestic cognitive domains. Conclusions: Hearing loss may negatively affect specific cognitive domains and depressive symptoms among older people, and the use of a hearing aid may mitigate the association with depressive symptoms. Key points: Hearing loss is highly prevalent among older people and may contribute to an increased risk of depression, cognitive impairment, and dementia.In our nationally representative sample of Brazilians aged 50 and older, those with hearing loss had more depressive symptoms compared to those without hearing loss, and individuals with hearing loss with an effective use of a hearing aid had fewer depressive symptoms than those without hearing aid.Individuals with hearing loss had more depressive symptoms compared to those without hearing loss, but did not have a poorer cognitive performance. An effective use of hearing aids was associated with fewer depressive symptoms but was not associated with cognitive performance.Hearing rehabilitation in the older people might be a feasible public health intervention to reduce the burden of depression among older adults. [ABSTRACT FROM AUTHOR]

Objective: Examine the process of culturally adapting the content of the World Health Organization iSupport program for family caregivers of people living with dementia in Brazil. Method: This is a multicenter and methodological study to cross-culturally adapt the iSupport program. Initially, the content of the iSupport program was translated into Brazilian Portuguese by professional translator trained in Psychology, with mastery of the original language of the content (English). Focus groups were then held with caregivers/former caregivers of people who have dementia (n = 24) and health professionals specialized in aging (n = 24). The participants had access to part of the iSupport material for analysis purposes. Semi-structured interviews were conducted between June and September 2019. All the interviews were recorded and transcribed in full for subsequent analysis. All the ethical aspects were respected. Results: The translator implemented some cross-cultural adaptations, such as substituting 69 proper names used in the original version by names of different Brazilian regions. In relation to the analysis of the material and comments from the focus groups, in general, all the participants had positive opinions about the material included in iSupport. Some changes were suggested in relation to the terminology and examples given in the modules to better fit the Brazilian culture and health systems, and links to relevant pages of the local Alzheimer's association were included. All the linguistic and cultural adaptations proposed were systematically documented and duly justified in structured forms provided by the World Health Organization, which approved all of them after verification of fidelity. Conclusion: The product of this research is the first version of the iSupport-Brasil program and the inclusion of its content in a digital platform. For the most part, the content offered in iSupport proved to be an important online tool to provide support and diverse information to the caregivers of people who have dementia. [ABSTRACT FROM AUTHOR]

This study aimed to understand stigma in relation to people living with dementia in São Paulo, Brazil. A critical narrative inquiry methodology was used. Home-based semi-structured interviews were conducted between January and March 2020 with six people living with dementia and 15 family carers. Data analysis was conducted using inductive and deductive techniques. The latter was informed by Link and Phelan's sociological theory of stigma. We found that dementia was commonly viewed by people living with dementia as part of ageing and carers reported low levels of knowledge and awareness about the condition. To avoid negative reactions from people, people living with dementia managed the negative views of dementia by minimising and normalising the condition, by expressing their ability to live an active life, and by emphasising the positive impacts of dementia in their lives. Fear of negative reactions appeared to lead to a selective disclosure of their diagnosis. Among carers, stigmatising attitudes coincided with a strong willingness to provide good care, to protect the person cared for, as well as to understand and validate their own caring experiences, rather than to cause any harm. In doing so, however, carers ended up depersonalising and infantilising people living with dementia, underestimating their capacities, demanding 'obedience' and restricting the person's freedom. There is a need to increase awareness about dementia and to provide support and training on person-centred and ethical care for carers in Brazil. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Dementia has become a major public health issue due to its high prevalence and serious consequences. In this context, the use of Information and Communication Technologies (ICT) could provide support for communication between people living with dementia and their formal and informal caregivers, both locally and remotely. More specifically, multimedia communication in the form of digital story narratives might improve communication in such care networks through richer forms of expression of life experiences and care activities. Objective: To explore caregiver perspectives on the communication issues and requirements involved in caring for people with dementia at home, and their reactions to digital storytelling technology as a possible intervention. Method: Semi-structured interviews were carried out with ten community caregivers in a countryside town of Sao Paulo state, Brazil. Each involved discussion of communication issues, and feedback on a mobile digital storytelling app and associated stories. Results: Formal and informal caregivers were both concerned about how to understand and to be understood by the people they were caring for, and saw value in digital storytelling as a new kind of assistive communication tool for more visual communication. Caregivers also wanted better ways of capturing or stimulating memories and conversation in people with dementia and saw digital stories as an extension of current social media systems for sharing life experiences. Conclusion: One of the greatest challenges in caring for people with dementia is communication, especially to understand their feelings, frustrations, and language. Another major challenge is finding time to go beyond caring for their basic activities of daily living (ADL) to enhance their quality of life through more meaningful conversations and experiences. Requirements for new digital storytelling technology were suggested for each of these challenges. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Perceptions of dementia are important determinants of support, treatment and care received in the dementia community. Understanding these perceptions are vital for regions such as Latin America, where there is a rapid increase in people living with dementia. The aim of this study is to review and synthesise the general public's perceptions of dementia in Latin America, what factors are associated with these perceptions, and how they differ between countries in the region. Methods: Searches were completed across five databases (Medline, SCOPUS, PsychINFO, SciELO, and WoS). Studies were required to capture attitudes or knowledge of dementia in the general public residing within Latin America. English, Spanish and Portuguese search terms were used. Results were synthesised narratively. Results: About 1574 unique records were identified. Following lateral searches, de-duplication and screening, six articles (four studies) met the inclusion criteria for this review. All the studies were quantitative research from Brazil (median, n = 722). There was evidence of a limited to moderate knowledge of dementia, though a significant minority had negative or stigmatising attitudes. Only higher levels of education were consistently associated with better attitudes and knowledge of dementia in the region. Conclusion: There is a need for more in-depth research about attitudes of the general public across Latin America, particularly outside of São Paulo state, Brazil. There appears to be a greater need to raise awareness of dementia amongst less educated Latin American groups. [ABSTRACT FROM AUTHOR]

With the increase in our older adult population, there is a need for dementia training for informal and formal dementia caregivers. The objective of this scoping study is to assess dementia knowledge instruments utilized in educational programs and interventions intended for formal and informal dementia caregivers. Scoping review methodology was used to search PubMed, PsycInfo, CINAHL and Web of Science with tailored database search terms. The search yielded 8101 results, with 35 studies meeting inclusion. Studies were conducted in eight countries, had varying study designs (randomized controlled trials [RCTs] = 9, non‐RCTs = 6, one‐group study design = 20) and utilized previously published (19) and author developed (16) instruments. Furthermore, the studies were internationally diverse, conducted in the United States (n = 18), Australia (n = 7), UK (n = 3), China (n = 2), Canada (n = 2), Taiwan (n = 1), Brazil (n = 1) and multi‐country (n = 1). Only two studies focused on minority populations. While author‐developed instruments may be more relevant and timesaving, studies should strive to validate instruments or use previously published instruments to help standardize findings across studies and understand better the effects of educational programs on caregiver knowledge. Geriatr Gerontol Int 2020; 20: 397–413. [ABSTRACT FROM AUTHOR]

Background: Dementia training for Brazilian general practitioners (GPs) is underdeveloped. We investigated knowledge and attitudes to dementia management among Brazilian GPs and compared these with previous UK findings to inform future decisions about how training is structured. Methods: A total of 115 Brazilian GPs were asked to complete a Portuguese translation of a questionnaire previously used in the UK. This comprised a 14-item multiple-choice knowledge quiz, and a 5-point Likert-scale questionnaire assessing attitudes across 10 dementia management domains. Exploratory factorial analysis was conducted for attitudes. Results: Attitudes toward dementia demonstrated the same underlying factor structure, "heartsink" and "heartfelt" factors, in Brazil as in previous UK studies, explaining 61.6% of variance in responses. Knowledge scores were negatively correlated with heartfelt and heartsink factors. Conclusions: Greater knowledge about dementia was associated with some pessimism about dementia care. The similarity in the structure of attitudes toward dementia management between Brazilian and UK GPs provides a starting point for shared educational approaches targeting attitudes. [ABSTRACT FROM AUTHOR]

Recently, a major turning point in the field of dementia research has occurred: serious and independent studies have shown that there are risk factors that can be modified in ways that reduce dementia risk. However, the reality behind this hopeful message is much more complex than simply translating it into concrete public health prescriptions regarding medications and lifestyle changes. The objective of this article is twofold: 1. In line with observations from other authors in the field of critical public health, the recent turn in dementia epistemologies will be described as a fallacy when conceived as individualized behavioral recommendations; 2. The profound change in the notion of risk for Alzheimer's disease (AD) – now defined using nearly identical risk factors as Vascular dementia ("vascularization of AD") – has also had an important impact on whether people are classified as "good citizens." After a short description of recent studies about Alzheimer's disease and the new risk factors associated with it, three interrelated historical changes are described as being constitutive of the "new dementia." Based on fieldwork in geriatrics in Brazil, one example will be given that illustrates how recent changes in understanding dementia result in value-laden models which, as a consequence, are sorting out people. [ABSTRACT FROM AUTHOR]

Objective: Neuropsychological tests are important instruments to determine a cognitive profile, giving insight into the etiology of dementia; however, these tests cannot readily be used in culturally diverse, low-educated populations, due to their dependence upon (Western) culture, education, and literacy. In this review we aim to give an overview of studies investigating domain-specific cognitive tests used to assess dementia in non-Western, low-educated populations. The second aim was to examine the quality of these studies and of the adaptations for culturally, linguistically, and educationally diverse populations. Method: A systematic review was performed using six databases, without restrictions on the year or language of publication. Results: Forty-four studies were included, stemming mainly from Brazil, Hong Kong, Korea, and considering Hispanics/Latinos residing in the USA. Most studies focused on Alzheimer's disease (n = 17) or unspecified dementia (n = 16). Memory (n = 18) was studied most often, using 14 different tests. The traditional Western tests in the domains of attention (n = 8) and construction (n = 15), were unsuitable for low-educated patients. There was little variety in instruments measuring executive functioning (two tests, n = 13), and language (n = 12, of which 10 were naming tests). Many studies did not report a thorough adaptation procedure (n = 39) or blinding procedures (n = 29). Conclusions: Various formats of memory tests seem suitable for low-educated, non-Western populations. Promising tasks in other cognitive domains are the Stick Design Test, Five Digit Test, and verbal fluency test. Further research is needed regarding cross-cultural instruments measuring executive functioning and language in low-educated people. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Enfermagem Referência is the property of Escola Superior de Enfermagem de Coimbra and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Brazilian Journal of Occupational Therapy / Cadernos Brasileiros de Terapia Ocupacional is the property of Cadernos de Terapia Ocupacional da UFSCar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims: To provide normative data for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) and to measure the effect of sociodemographic variables on the cognitive performance of cognitively healthy elderly people. Methods: A sample of 110 cognitively healthy individuals, aged over 65 years, with at least 4 years of schooling were recruited from 3 health care centers for the elderly in Recife, Brazil. The cognitive performance was assessed using MoCA-BR. Results: The average score of these elderly people in the MoCA-BR was 23.2 ± 2.7. Their schooling correlated positively with the cognitive performance, with a Spearman’s coefficient of 0.33 (p < 0.001). There was a statistically significant negative correlation between age and the cognitive performance (Spearman’s rho = –0.19). The multiple linear regression model with the highest adjusted coefficient of determination was the one that included schooling and age (adjusted R2 = 0.127). Conclusions: The cognitive performance of healthy elderly was evaluated and was strongly influenced by schooling and, to a lower degree, by age. [ABSTRACT FROM AUTHOR]

Aims Few studies have been published on the use of the Cambridge Cognitive Examination Test - Revised ( CAMCOG- R) for cognitive assessment of low educational level older adults. The aim of the present study was to determine the accuracy of the Brazilian version of the CAMCOG- R ( Br- CAMCOG- R) within a sample of low educational level and illiterate older adults. Methods The Br- CAMCOG- R was administered to outpatients in a public geriatric clinic. The diagnosis of dementia was based on the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria. The receiving operator characteristic curves were plotted, and the best trade-offs between sensitivities and specificities were calculated. Results A total of 189 participants were evaluated. The mean age was 77 ± 6.9 years. The mean educational level was 3.1 ± 2.2 years. The mean test score was 66.5 ± 13.1 points; there were 56 (29.6%) participants with dementia. The best cut-off score for illiterate participants was 50/51; sensitivity, specificity and area under the curve ( AUC) were 69%, 69% and 0.75, respectively; for participants with a low educational level, the best cut-off point was 60/61; the sensitivity, specificity and AUC were 83%, 85%, and 0.93, respectively; for participants with a middle educational level, the best cut-off point was 69/70; the sensitivity, specificity and AUC were 90%, 76% and 0.91, respectively. Conclusions The Br- CAMCOG- R was useful for identifying cases of dementia among older adults with middle and low levels of literacy, but inadequate for the illiterate individuals. Geriatr Gerontol Int 2014; 14: 763-768. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the survival rate, pneumonia incidence, and hospital admissions among elderly patients with advanced dementia and to compare these outcomes between patients receiving enteral and oral nutrition. Design: An observational, prospective, non-randomized, and unblinded study, with a minimum follow up of 6 months. Setting: Inpatient wards as well as ambulatory and emergency units run by a Brazilian university. Participants: Dysphagic elderly patients aged ≥60 years with advanced dementia (classified as at least 7A according to the Functional Assessment Staging [FAST]). Both patients with gastrostomies and nasogastric feeding tubes were included in the alternative feeding group. Measurements: Following informed consent, a complete clinical examination was performed upon recruitment, and the primary caregiver was interviewed. Data concerning the major outcomes described above, as well as other demographic and clinical information, were recorded at admission and during follow-up phone calls. Survival analysis was performed using a Kaplan-Meier curve and a stepwise Cox regression analysis. Results: Sixty-seven elderly patients were recruited: 36 (53,7%) for oral feeding and 31 for alternative feeding (n=28 nasogastric tube). Of these, 57 (85.1%) were classified as at least FAST 7C. They were, on average, 84.79 years old, mostly women (85.1%), and with a low level of education (2.9 years). Mortality at 3 months was 11.1% among the oral feeding group and 41.9% among the alternative feeding group (p=0.004). At 6 months, the mortality rate increased to 27.8% and 58.1%, respectively (p=0.012). The following variables persisted in the regression model at the end of the analysis: feeding route (p =.018; RR = 2.33; CI: 1.158-4.667), duration of dementia (p =.014; RR =.88; CI:.786-.974) and number of pressure ulcers (p =.007; RR = 1.250; CI: 1.063-1.470). A higher incidence of aspiration pneumonia was observed in the alternative feeding group (p=0.006), but no difference in the number of hospital admissions was detected between the groups (p=0.365). Conclusion: The use of alternative feeding, along with the number of pressure ulcers were associated with an increased risk of death in elderly patients with advanced dementia. A higher incidence of aspiration pneumonia was also observed in the alternative feeding group. The number of hospital admissions was not different between the feeding routes. [ABSTRACT FROM AUTHOR]

SUMMARY Aims Depression is a highly prevalent disorder in the elderly and one of the risk factors for developing dementia. The present study involves patients with Alzheimer's disease (AD), geriatric major depressive disorder (MDD) and cognitively healthy controls aiming to compare baseline cerebrospinal fluid (CSF) biomarkers. Methods The study included 52 patients with more than 60 years of age with a diagnosis of MDD, AD, and healthy controls. All individuals underwent a medical history, physical, and neurologic examination, laboratory tests and neuropsychological assessment to rule out any clinical diseases or disorders. Measurement of CSF P-tau181, T-tau, and Aβ42 was performed using commercial assays (ELISA). Results CSF Aβ42 levels of depressed patients and normal controls were significantly higher than in AD. There was not any significant difference in measures of P-tau among the groups. T-tau, however, showed to be significantly different among the groups, with higher measures in AD group. Higher levels of P-tau were observed in four MDD patients compared with controls. Conclusion CSF Aβ42, T-tau, and P-tau levels may differentiate between AD and depression in a Brazilian sample. [ABSTRACT FROM AUTHOR]

Background: Several epidemiologic studies have shown a possible association between thyroid function and cognitive decline. Our aim was to evaluate the association of subclinical hyperthyroidism and dementia in a population sample of older people Methods: A cross-sectional study - São Paulo Ageing & Health Study (SPAH) -in a population sample of low-income elderly people &#x2A7E; 65 years-old to evaluate presence of subclinical thyroid disease as a risk factor for dementia. Thyroid function was assessed using thyrotropic hormone and free-thyroxine as well as routine use of thyroid hormones or antithyroid medications. Cases of dementia were assessed using a harmonized one-phase dementia diagnostic procedure by the "10/66 Dementia Research Group" including Alzheimer's disease and vascular dementia. Logistic regression models were used to test a possible association between subclinical hyperthyroidism and dementia. Results and discussion: Prevalence of dementia and of subclinical hyperthyroidism were respectively of 4.4% and 3.0%. After age adjustment, we found an association of subclinical hyperthyroidism and any type of dementia and vascular dementia (Odds Ratio, 4.1, 95% Confidence Interval [95% CI] 1.3-13.1, and 5.3 95% CI, 1.1-26.4; respectively). Analyzing data by gender, we found an association of subclinical hyperthyroidism with dementia and Alzheimer's disease only for men (OR, 8.0; 95% CI, 1.5-43.4; OR, 12.4; 95% CI, 1.2-128.4; respectively). No women with subclinical hypothyroidism presented Alzheimer's disease in the sample. Conclusion: The results suggest a consistent association among people with subclinical hyperthyroidism and dementia. [ABSTRACT FROM AUTHOR]

The Mini-Mental State Examination (MMSE) is the most widely used instrument for the screening of cognitive impairment worldwide, but its ability to produce valid estimates of dementia in populations of low socioeconomic status and minimal literacy skills has not been adequately established. The authors investigated the psychometric properties of the MMSE in a community-based sample of older Brazilians. Cross-sectional one-phase population-based study of all residents of pre-defined areas of the city of Sao Paulo, aged 65 years or over. The Brazilian version of the MMSE was compared with DSM-IV diagnosis of dementia assessed with a harmonized one-phase procedure developed by the 10/66 Dementia Research Group. Analyses were performed with 1,933 participants of the SPAH study. Receiver operating characteristic analysis showed that the MMSE cut-point of 14/15 was associated with 78.7% sensitivity and 77.8% specificity for the diagnosis of dementia amongst participants with no formal education, and the cut-point 17/18 with 91.9% sensitivity and 89.5% specificity for those with at least 1 year of formal education (areas under the curves 0.87 and 0.94, respectively; P = 0.03). Even with these best fitting cut-points, the MMSE estimate of the prevalence of dementia was four times higher than determined by the DSM-IV criteria. Education, age, sex and income influenced MMSE scores, independently of dementia caseness. The MMSE is an adequate tool for screening dementia in older adults with minimum literacy skills, but misclassification is unacceptably high for older adults who are illiterate, which has serious consequences for research and clinical practice in low and middle income countries, where the proportion of illiteracy among older adults is high. [ABSTRACT FROM AUTHOR]

Objectives: To describe the application in Brazil of a simple, low-cost procedure, developed in India by the 10/66 Dementia Research Group, for the identification of dementia cases in the community. Design: Community-based dementia case-finding method. Setting: Piraju, São Paulo, Brazil. Participants: Twenty-five community health workers were trained to identify dementia cases in 2,222 people aged 65 and older in Piraju, a Brazilian town with 27,871 inhabitants. Measurements: After the training, the health workers prepared a list of possible cases that afterward an experienced psychiatrist clinically evaluated, according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), criteria and the Clinical Dementia Rating. Results: Of the 72 cases that were clinically assessed, 45 met the DSM-IV diagnostic criteria for dementia. Therefore, the positive predictive value of this case finding method was 62.5%; the estimated frequency of dementia was 2%. Most of the confirmed cases met clinical criteria for Alzheimer's disease and vascular dementia. Conclusion: This simple method was appropriate to identify cases of dementia in the general population and can possibly be extended to other developing countries with limited resources to be applied in health programs. [ABSTRACT FROM AUTHOR]

The main findings are presented of a prevalence study of mental health problems (organic brain syndrome and depression) in the elderly population of Rio de Janeiro, Brazil. Three districts in the city were surveyed—Copacabana, Meier and Santa Cruz—chosen using a set of socioeconomic indicators to identify rich, middle income and poor areas. Validity and reliability studies of the survey instrument were carried out in Copacabana. Prevalence results for organic brain syndrome (OBS) were 5.95% in Copacabana, 9.84% in Meier and 29.75% in Santa Cruz, while results for depression were 22.62%, 19.67% and 35.12% respectively. The methodological problems of the survey which influence confidence in the results are discussed. Dependence and loss of autonomy in elderly people were strongly associated with organic brain syndrome and depression. The results are compared with those in the other Brazilian and international studies. [ABSTRACT FROM AUTHOR]

The article discusses research conducted to investigate the sex differential effect of parental longevity on the risk of dementia. Researchers evaluated 345 healthy subjects. They found that those with dementia were significantly older than those without dementia, that mother’s age of death was greater in the group without dementia and that the groups with and without dementia were similar in terms of sex distribution.

This section offers news briefs related to health care as of July 11, 2015. Topics covered include the Care Quality Commission's release of the results of its inspection of general practice clinics in England, a plan by universities in the Netherlands to boycott publishing company Elsevier after it fails to agree an open access deal, and World Medical Association President Xavier Deau's call on the Australian government to let doctors to disclose information about the health of asylum seekers.