Introduction: There is a growing awareness about the noxious effects of the 2019 Coronavirus Disease (COVID-19) pandemic on the mental health of the elderly. However, there is limited information from clinically driven research. The objectives of the present study were to examine the magnitude of psychiatric symptoms and to determine their association with caregiver distress, in a cross-section of community-dwelling older adults and a subsample of aging adults with Down syndrome (DS) attending a psychogeriatric service in São Paulo, Brazil. Method: Telephone-based interviews and electronically filled self-assessment questionnaires were used to collect information from patients and caregivers, addressing their impressions and concerns about the pandemic and related effects on the patient's emotional state and behavior. Clinical information was obtained from hospital charts, medical records, and psychometric tests administered through telephone interviews [Hospital Anxiety and Depression Scale (HADS) and Neuropsychiatric Inventory Questionnaire (NPI-Q)]. Results: We included 100 consecutive participants, comprising 71 older adults with psychogeriatric/neurocognitive disorders and 29 aging adults with DS. Higher HADS and NPI-Q scores were significantly associated with caregiver distress ( p < 0.05) in both groups. Correlation analyses indicated strong, positive associations between caregiver burden and scores in HADS anxiety (HADS-A) and HADS depression (HADS-D) scales in the subsamples of euploid and DS subjects. Higher NPI-Q scores in the former group were also correlated with caregiver distress, with stronger associations for neuropsychiatric symptoms. Similar findings were observed among DS subjects. ANOVA tests indicated significant associations between NPI-Q scores and caregiver distress among dementia patients, as well as with HADS scores. Similar results were found after multiple linear regressions; as such, among the elderly subsample, higher scores in HADS-A ( p = 0.002) and HADS-D ( p = 0.001) predict a significant impact on caregiver burden ( p < 0.00001, R 2 0.46); taking into consideration caregiver burden as a dependent variable and NPI-Q total score as an independent variable, we obtained significant strong prediction values for either DS ( p < 0.00001, R 2 0.95) or elderly adults ( p < 0.00001, R 2 0.88). Conclusion: During the COVID-19 pandemic, patients with neurocognitive disorders present with clinically relevant neuropsychiatric symptoms, with significant impact on caregiver distress. Apathy, aberrant motor behavior, sleep disorders, and psychoses were the main psychopathological domains, which had determined caregiver burden worsening.
Background The longevity of people with DS has increased substantially in recent decades. This population shows signs of premature aging in many organs and systems. The neuropathology of Alzheimer's disease (AD) is overexpressed in DS. Cognitive and functional losses, such as decline in executive function and apraxia, interfere with the sequencing of movements and the integrity of gait. There is evidence that a decrease in gait may precede other clinical symptoms of dementia in AD in the general population, but we found no studies investigating gait performance and decline in DS. The aim of this study is to characterize gait and speed performance in a sample of adults with DS divided into three groups by diagnosis: stable cognition, prodromal dementia and AD. Methods We used the Performance Oriented Mobility Assessment (POMA) to address balance, gait and the risk of falls and the Timed “Up and Go” test (TUG) to assess gait speed in a sample of 35 individuals with DS over 35 years of age. Dementia diagnosis was based on the Cambridge Examination for Mental Disorders of Older People with Down’s Syndrome and Others with Intellectual Disabilities (CAMDEX‐DS). The 1‐factor, 3‐level ANOVA model was used in the 3 groups. Results 9 participants (25.7%) had AD (mean POMA 12.0 ± 7.1; mean TUG 18.0 ±5.8), 8 (22.9%) were classified as prodromal dementia (mean POMA 19.0 ± 5.6; mean TUG 21.0± 6.1) and 18 (51.4%) were in the stable cognition group (mean POMA score 20 ± 4.5; mean TUG 17.0 ±5.5). Mean POMA scores were significant different among the groups (p<0.05) with higher impairment in the group with AD relative to those with prodromal dementia and stable cognition. We did not find difference for the TUG scores among the groups. Conclusions POMA results indicates that those with AD have worse balance, gait performance and higher risk of falls relative to those with prodromal dementia and stable cognition, suggesting that gait performance may be more affected in later stages of neurodegeneration. Gait speed does not seem to be useful differentiating the groups. Further longitudinal studies with bigger samples are needed to confirm our results.
The ABCD battery is a useful tool in the evaluation of adults and elderly with DS and the performance of individuals in this battery correlates with indices of functionality. This is a pioneer study in Brazil, and it points to the need for a better characterization of the linguistic abilities of individuals with DS, in order to allow the elaboration of strategies that stimulate their communicative abilities as to promote greater social insertion for this population.
Background: Down syndrome (DS) is associated with a high prevalence of cognitive impairment and dementia in middle age and older adults. Given the presence of common neuropathological findings and similar pathogenic mechanisms, dementia in DS is regarded as a form of genetically determined, early-onset AD. The clinical characterization of cognitive decline in persons with DS is a difficult task, due to the presence intellectual disability and pre-existing cognitive impairment. Subtle changes that occur at early stages of the dementing process may not be perceived clinically, given that most cognitive screening tests are not sensitive enough to detect them. Therefore, biological markers will provide support to the diagnosis of DS-related cognitive impairment and dementia, particularly at early stages of this process. Objective: To perform a systematic review of the literature on AD-related biomarkers in DS. Method: We searched PubMed, Web of Science and Cochrane Library for scientific papers published between 2008 and 2018 using as primary mesh terms ‘Down’, ‘Alzheimer’, ‘biomarker’. Results: 79 studies were retrieved, and 39 were considered eligible for inclusion in the systematic review: 14 post-mortem studies, 10 neuroimaging, 4 addressing cerebrospinal fluid biomarkers, and 11 on peripheral markers. Conclusion: There is consistent growth in the number of publication in this field over the past years. Studies in DS-related dementia tend to incorporate many of the diagnostic technologies that have been more extensively studied and validated in AD. In many instances, the study of CNS and peripheral biomarkers reinforces the presence of AD pathology in DS.
The increasing life expectancy for people with intellectual disability is a intriguing theme that deserves attention of professionals related to this area. Although it is well known that the benefits brought by modern interventions and advances in biomedicine have increased life's longevity, it also means that during the later years of life these people often have comorbidities and a pathological aging processes. Enhancing the quality of life for this population is a unique challenge in the field of Gerontology and Intellectual Disabilities. The present work is the result of a pilot study carried out by a Service for intellectual disability and aging. The intervention focused on the participants who undergo some form of senile process through a proposal of management and temporary service adaptation which was developed based on patients´ demands. The need for social and service's adjustments for the new demands of this population is evident, and it is of special significance professional qualification and expertise in this area, as well as, the rise of information for the families and the community.
O aumento da expectativa de vida da pessoa com Síndrome de Down (SD) está atrelado a um conjunto de ações realizadas através da intervenção de uma equipe multiprofissional. A fonoaudiologia pode ser inserida neste contexto contribuindo com medidas de saúde que favoreçam a promoção da qualidade de vida dessa população. Este artigo apresenta uma descrição dos principais aspectos fonoaudiológicos existentes no envelhecimento da pessoa com Síndrome de Down, baseada na revisão bibliográfica, realizada através da consulta a artigos científicos selecionados nos principais bancos de dados: Scielo e Bireme. Com base nessa revisão foi possível verificar que a população longeva com SD necessita de atendimento fonoaudiológico envolvendo questões como os aspectos comunicativos e linguagem, audição, deglutição, demência do tipo Alzheimer e cuidados paliativos, que preconizem a reabilitação, a manutenção e favoreçam o uso funcional da comunicação em todas as fases da vida. Palavras-chaves: Deficiência Intelectual. Envelhecimento. Fonoaudiologia.
Background Currently, it is estimated that 1 in 800 live births worldwide has Down syndrome (DS). In addition to the relationship with intellectual disability, DS is directly associated with a group of clinical manifestations resulting from premature aging, and may present patterns of comorbidities similar to those found in the elderly. Therefore, together with the greater number of years lived, there is an increased risk of developing Alzheimer's disease (AD) in DS, especially with regard to the interaction between pathogenic mechanisms related to cerebral amyloidogenesis and factors inherent to premature aging. Thus, this study aimed to investigate biological markers of AD in peripheral blood samples from adults and elderly individuals with DS and to compare them with individuals with normal karyotype, stratifying the groups according to the presence or absence of cognitive impairment. Method A total sample of 123 individuals was recruited. The experimental group consisted of 31 adults and elderly individuals with DS. Two comparative groups were categorized according to euploid individuals (EU), being 23 elderly with AD (EUAD) and 69 adults with normal cognition (EUNC). The DS group was subclassified according to the occurrence of cognitive decline, DS without evidence of cognitive decline (DSNC) and DS with cognitive decline (DSAD). AD biomarkers were determined in platelets, including the Amyloid Precursor Protein ratio (APPr), established by the ratio between the 130‐ and 110kDA secreted peptides (sAPP), as well as the protein expression of APP‐secretases α (ADAM‐10), β (BACE‐1) and γ (PSEN1). Result The comparison between DSNC vs. EUNC, showed lower protein expression of APP secretases among individuals with DS. When observed groups with cognitive decline (i.e., DSAD vs. EUAD), the DSAD group showed lower expression of APP130 and 110kDa and BACE1 fragments, as well as increased levels of APPr compared to EUAD. It was also observed a 2.5‐fold decrease expression of APP130 in SDAD, compared to SDNC. Conclusion These results demonstrate that people with DS may show different expression patterns of proteins involved in the amyloid cascade, detectable even in the absence of cognitive decline. However, more analysis is needed for these data to be confirmed.
Background The WHO estimates by 2050 the proportion of people over 60 will be 22% of the world’s population. This scenario does not differ in Brazil. The elderly represent the fastest growing population segment, with estimates of average increase over the next ten years of more than 1 million elderly per year, which is worrying because epidemiological data show that one third of elderly Brazilians are affected by neuropsychiatric disorders. It is important to consider some conditions can represent risk factors for the development of cognitive decline. Therefore, attention to these disorders is necessary as they bring important social and economic impacts. Thus, the development of projects in this area may provide not only a reduction in public spending, but also more years of life with autonomy and independence. Based on all of these data and on our knowledge about gerontology and dementia, we decided to bring the Memory Cafe philosophy to Sao Paulo, Brazil. Methods We initiated the Memory Café Brasil (MCBr) in December 2019 and realized three face‐to‐face meetings (FFM) until February and four online meetings (OM) until 23rd May 2020, due to COVID‐19. All of them were guided according Memory Cafe Directory guidelines. Cognitive stimulation was performed during all meetings. Results 30 people have participated in the meetings so far, 14 of whom answered the online questionnaire with open‐ended questions to evaluate the MCBr. Of the 14 participants (mean 56 years old; 19SD), 78.6% were women. Ten of them participated more than once in the meetings and five participated in both types of meetings. The FFM were attended by 6 people (70yo; SD9), while the OM were attended by 13 people (57yo; 19,6DS). Most of them reported that OM helped in a positive way to alleviate loneliness during social isolation as well as making it possible to improve cognitive functions. Subjective complaints of cognitive decline was reported by 4 participants. Conclusions MCBr is recent in Brazil and is looking for ways to increasingly include people with congenital and/or acquired cognitive decline in society, as well as their caregivers, by promoting well‐being and cognitive stimulation.
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