Estimulação cognitiva em idosos: uma proposta de intervenção online em tempos de pandemia

BackgroundCurrently, pharmacological interventions to delay cognitive decline in older adults have proven to be insufficient. Non‐pharmacological approaches, however, are gaining attention for improving cognition, enhancing well‐being, and alleviating caregiver burden. This study evaluates the effects of a non‐pharmacological program combining physical and cognitive interventions on cognition, well‐being, and physical health in older adults in Panama.MethodsThis three‐arm randomized controlled trial included 43 participants aged 60‐80. Pre‐tests involved sociodemographic interviews, clinical scales, cognitive tests, and physical assessments. Participants were randomized into three groups: 1) experimental group 1 (n = 15) received cognitive and physical interventions, including CogniFit training, group cognitive training, and walks 3 to 5 times weekly; 2) experimental group 2 (n = 15) participated exclusively in walks; and 3) active control group (n = 13) attended monthly health information sessions. Both experimental groups joined monthly group walks. After the intervention, a post‐test was carried out applying the same initial measures.ResultsImprovements in performance on neuropsychological tests were observed when comparing pre‐ and post‐test scores for the three groups. The combined group showed significant improvements in global cognition and the executive function of abstraction. Improvements were observed also for the combined group in depression and quality of life measures. The physical intervention group presented improvements in learning, visuospatial skills, and long‐term memory. In the control group, increases in learning and the executive function of inhibition were observed. No significant differences were found between pre‐ and post‐tests in physical assessments for any group.ConclusionThe results obtained suggest that a multidomain intervention program can positively impact cognition, depressive symptoms, and quality of life in older adults. Likewise, physical activity may benefit cognition. This study could serve as a basis for the implementation of multimodal interventions at the community level aimed at the prevention of cognitive decline.

Background/Objectives: The progressive increase in the aging population highlights the need for interventions aimed at preserving cognitive health and overall well-being in older adults. This study aimed to assess the impact of a structured cognitive training program on psychological well-being, executive function performance, and Brain-Derived Neurotrophic Factor levels (BDNF) in older adults from a Mexican geriatric center. Methods: A quasi-experimental pretest-posttest design with a nonequivalent control group was conducted. Thirty-two older adults were assigned either to a cognitive stimulation intervention group or a control group. The intervention consisted of 120 individually structured sessions, each lasting approximately 60 min, delivered five times per week over 24 weeks. Independent neuropsychologists, blinded to group allocation, assessed executive function (BANFE-3), depressive symptoms (Yesavage Geriatric Depression Scale), autonomy in daily living (Barthel Index), and quality of life (WHOQOL-OLD) before and after the intervention. Serum BDNF levels were also measured. Results: The intervention group showed significant improvements in executive function, depressive symptoms, independence in daily activities, and quality of life, while the control group showed no changes. Additionally, the intervention group showed an increase in BDNF expression post-intervention. Conclusions: The cognitive stimulation program effectively improved cognitive performance, emotional well-being, autonomy, and quality of life in older adults. These findings highlight the importance of integrating structured cognitive stimulation into geriatric care. For nursing practice, this underscores the key role nurses can play in delivering cognitive interventions to promote cognitive health, independence, and emotional stability among institutionalized and non-institutionalized older adults.

BackgroundComputer-based cognitive stimulation applications can help the elderly maintain and improve their cognitive skills. In this research paper, our objectives are to verify the usability of PESCO (an open-software application for cognitive evaluation and stimulation) and to determine the concurrent validity of cognitive assessment tests and the effectiveness of PESCO’s cognitive stimulation exercises.MethodsTwo studies were conducted in various community computer centers in the province of Granada. The first study tested tool usability by observing 43 elderly people and considering their responses to a questionnaire. In the second study, 36 elderly people completed pen-and-paper and PESCO tests followed by nine cognitive stimulation sessions. Meanwhile, a control group with 34 participants used computers for nine non-structured sessions.ResultsAnalysis of the first study revealed that although PESCO had been developed by taking usability guidelines into account, there was room for improvement. Results from the second study indicated moderate concurrent validity between PESCO and standardized tests (Pearson’s r from .501 to .702) and highlighted the effectiveness of training exercises for improving attention (F = -4.111, p < .001) and planning (F = 5.791, p < .001) functions.ConclusionsPESCO can be used by the elderly. The PESCO cognitive test module demonstrated its concurrent validity with traditional cognitive evaluation tests. The stimulation module is effective for improving attention and planning skills.

Physical and cognitive interventions are deemed the primary methods of improving cognitive functioning in healthy older adults. However, the effectiveness of these interventions is still debated. This systematic review, synthesised findings from the literature on four different types of interventions: physical activities, cognitive training, cognitive stimulation and a combined intervention. We searched six databases for each intervention category. Findings demonstrated that 65% of the studies across all intervention groups reported improvement in the experimental group following the intervention. Furthermore, memory, executive and global cognitive functions were the most reported improvements post-intervention. Additionally, participants with higher education benefited more from cognitive training (an intervention that targets a specific cognitive domain), while those with lower education gained more following cognitive stimulation (an intervention that targets general domains). Lastly, in sub-types of physical activity, cognitive stimulation and combined category, longer durations (more than 20 sessions) were associated with significant cognitive improvements. Conversely, in cognitive training, having less than 20 sessions led to significant results. Findings indicated an interaction of education and intervention duration with significant outcomes post-intervention. In conclusion, this review demonstrated the importance of intervention type, duration and education in understanding cognitive improvement post-intervention.

Improvement in Depression is Associated with Improvement in Cognition in Late-Life Psychotic Depression

The ability to recognize facial emotional expression is essential for social interactions and adapting to the environment. Emotion recognition is impaired in people with Alzheimer's disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. To assess the efficacy of a combined treatment of rehabilitation of emotion recognition (RER) and cognitive stimulation (CS) for people with AD, due to its potential implications for more effective psychosocial interventions. 36 patients were assigned to one of three experimental conditions: an experimental group (EG) that received 20 sessions of RER and 20 sessions of CS; a control group (CG) that received 40 sessions of CS, and a treatment as usual group (TAU). 32 patients completed the treatment (77.53 ± 5.43 years). Significant differences were found in MMSE30 (F = 5.10; p = 0.013), MMSE35 (F = 4.16; p = 0.026), affect recognition (Z = -2.81; p = 0.005) and basic activities of daily living (Z = -2.27; p = 0.018) favouring the efficacy of the combined treatment. The TAU group showed a decline in depression (Z = -1.99; p = 0.048), apathy (Z = -2.30; p = 0.022) and anosognosia (Z = -2.19; p = 0.028). The combined treatment of RER + CS was more effective than TAU and CS alone for the treatment of patients with AD. This is the first study about the rehabilitation of affect recognition in AD.

BackgroundPopulation aging poses challenges in terms of cognitive health, requiring effective interventions. Cognitive stimulation has shown promising results in healthy older adults. This study investigated the effects of a structured cognitive stimulation program on older adults without cognitive impairment.Method189 older adults randomized into three groups: Training Group (TG); Active Control Group (ACG); and Passive Control Group (PCG). The primary outcome of the study was cognitive performance assessed by the following tests: Addenbrooke's Cognitive Examination‐Revised (ACE‐R); Short Cognitive Performance Test (SKT); Forward and Backward Digit Span Test; Trail Making Test A and B; Phonemic Verbal Fluency Test for the letters FAS; Abacus Calculation Test. Secondary outcomes were psychosocial variables, which included the Geriatric Depression Scale (GDS); the Depression Anxiety and Stress Scale (DASS); the Control, Autonomy, Self‐Realization and Pleasure (CASP‐19); and the Minimum Map of Relationships of Older Individuals (MRRI). The intervention consisted of cognitive stimulation 72 sessions conducted weekly for an 18‐month period, with assessments performed over 24 months.ResultTraditional analyses showed significant statistical differences on delta analyses on the verbal fluency variables letter F and calculus test, indicating improvement in the TG during the 24‐month assessment compared to the other experimental groups. Z‐scores revealed improvements in cognitive functions, such as working memory and logical reasoning. Benefits were maintained after 12 and 18 months. Also, the TG showed improvements over 24 months in the form of reduced depressive symptoms and better self‐perceived memory performance compared to the ACG and PCG. Cognitive stimulation demonstrated potential cognitive benefits, with positive implications for healthy aging. Continuous multimodal strategies may enhance long‐term effects, making this intervention a promising tool for cognitive preservation in older individuals.ConclusionThe profile of older adults assessed may have contributed to the efficacy of the training, given that many were active, socially engaged, high‐educated individuals compared with the general Brazilian older population. The low drop‐out rate demonstrates the high level of adherence to the intervention. The cognitive training was likely more attractive to participants because it sought to improve both cognitive performance and psychosocial variables concomitantly.

Background: Alzheimer’s disease (AD) is a neurodegenerative condition that challenges the physical and mental health of individuals but also affects their Quality of Life (QoL). The concept of QoL transcends mere absence of disease, encompassing multidimensional aspects reflecting physical, psychological, social, and emotional well-being. Addressing the various dimensions of AD, in which the insidious progression of the disease often deprives patients of their autonomy and identity, preservation and promotion of quality of life emerge as essential objectives in caring for these individuals. Objective: To conduct a systematic review of the impacts of non-pharmacological therapies on the Quality of Life of patients with Alzheimer’s Disease described in the literature in the last 10 years. Methods: A systematic literature review was conducted in PubMed and BVS databases on March 18, 2024. The descriptors "Alzheimer’s disease", "non-pharmacological treatment", and "quality of life" were used, combined with the boolean operator AND. Systematic reviews and meta-analyses published in the last 10 years in English, Portuguese, and Spanish were included. 48 articles were found, of which 22 were selected after initial reading of the abstracts. After full-text reading, 9 were excluded and 13 were included in this research. Results: Among non-pharmacological therapies, music therapy, whether singing or listening to music, appears as one of the main alternative therapies for AD, with improvements in some cognitive domains such as attention and language, and in the patient’s QoL. Additionally, dance can be a useful tool in the promotion of wellbeing in patients with AD and Mild Cognitive Impairment well-being, assisting in balance and, primarily, in promoting mental health, which is helpful in depression management. Reminiscence therapy presented positive results in the global cognitive and neuropsychiatric aspects of AD patients, with improvement in depressive symptoms. It is a low-cost technique that improved the QoL of patients after its application. Structured physical activity is also a tool that promotes QoL, assisting in cognitive improvement and sleep. Cognitive stimulation was another approach that proved relevant improvement in QoL and overall cognition, providing benefits even in ADLs. These activities, especially if applied in a multimodal form, can help promote the comfort of these patients. Conclusion: It is observed that there is a definitive responsiveness of patients with Alzheimer’s Disease (AD) to non-pharmacological treatments. In this sense, despite their apparent simplicity, these activities directly contribute to the positive QoL of individuals with AD and indirectly affect neurocognitive aspects that sometimes reflect consequences of disease progression. Therefore, such non-pharmacological therapies are treatment modalities capable of addressing not only AD but also the associated negative impacts.

Introduction:Sleep disturbances are common among older adults and can have detrimental effects on their overall well-being. Tai Chi exercise has shown promise in improving sleep quality, quality of life (QoL), and psychological well-being in various populations.Objective:To investigate the effect of a home-based simplified Tai Chi exercise program on sleep quality, daytime sleepiness, QoL, and psychological well-being in Egyptian older adults.Methods:A quasi-experimental design was employed, with 152 participants aged 60 years and above assigned to either an experimental group (n= 87) or a control group (n= 65). Thecontrol group received a health education program to improve their sleeping quality and life-style, while the experimental group received a similar health education program and Tai Chi exercise training program. The participants in the experimental group were instructed to perform 3 months Tai Chi exercise. Data on sleep quality, daytime sleepiness, QoL, generalized anxiety disorder (GAD), and depression symptoms were collected at baseline, and one month, and 3 months post-intervention using validated questionnaires. Repeated measures ANOVA was done to investigate the effectiveness of the intervention programsover 3 time periods.Results:The results showed significant improvements in sleep quality (p< .001), QoL (p< .005), GAD (p< .005), and depression symptoms (p< .005) post-interventions. Also, there were significant difference in the effectiveness of the intervention programs between both the experimental and control groups. The experimental group exhibited greater improvements compared to the control group.Conclusion:The findings support the beneficial effects of a home-based simplified Tai Chi exercise program on sleep quality, QoL, and psychological well-being in Egyptian older adults. These results have important implications for promoting healthy aging and improving overall well-being in this population. Further research is recommended to validate these findings and explore the underlying mechanisms of Tai Chi exercise on the outcomes of interest.

The global ageing of the population has made the increase in age-related diseases more obvious, some of which are accompanied by a patient's cognitive decline (CD). That is a hard problem for Mexico, as a large number of older adults belong to marginalized sectors. These older adults are characterized by their illiteracy and limited financial resources, which make them more vulnerable to conditions such as the Alzheimer's disease. According to the literature, a person who participates often in cognitive stimulation (CS) activities reduces the risk of suffering a CD-related condition. This has provided the motivation to carry out case studies to understand older adults' interactions in CS sessions, and their relation with technologies and with members of their social family networks (SFN). To address these technological, social and illiteracy gaps, a pervasive CS collaborative system has been designed and evaluated which eases interaction through natural interfaces and enables SFN members to interact with older adults during their CS activities regardless of their physical location. The evaluation results provide evidence that participants perceived the system as useful, easy to use and providing a pleasurable user experience. Furthermore, these results show the feasibility of augmenting traditional board games (e.g. chess, checkers) to create pervasive CS collaborative applications and the importance and benefits of integrating SFN members as informal caregivers.

Effects of traditional Thai folk dance combined with cognitive stimulation program on behavior and cognition among older adults with cognitive decline: A randomized controlled trial

Objective: To determine if a 9-week group cognitive-behavioral therapy (CBT) intervention delivered by women who have recovered from postpartum depression (peers) can effectively reduce symptoms of postpartum depression (PPD) and anxiety and improve social support and the mother-infant relationship.Methods: A sample of 73 mothers living in Ontario, Canada, were randomized into experimental and waitlist control groups between March 2018 and February 2020. Participants were ≥ 18 years of age, had an infant < 12 months old, were fluent in English, and scored ≥ 10 on the Edinburgh Postnatal Depression Scale. The experimental group completed the 9-week group CBT intervention immediately after study enrollment, while the control group did so after a 9-week waiting period. All outcomes were assessed at enrollment (n = 54) and 9 weeks later (n = 38). Outcomes were assessed in the experimental group at 6 months to assess treatment stability.Results: Peer-delivered group CBT for PPD led to clinically and statistically significant improvements in symptoms of depression (F1,47 = 22.52, P < .01) and anxiety (F1,45 = 20.56, P < .05) in the experimental group, and these improvements were stable at the 6-month follow-up. Perceptions of impaired mother-infant bonding (t15 = 3.72, P < .01) and rejection and pathological anger (t15 = 3.01, P < .01) also decreased at the 6-month follow-up in the experimental group.Conclusions: Peer-delivered group CBT for PPD effectively treats symptoms of PPD and anxiety and may lead to improvements in the mother-infant relationship. This intervention is an effective and potentially scalable means by which access to a treatment that meets the needs and wants of mothers with PPD can be increased.Trial Registration: ClinicalTrials.gov Identifier: NCT03285139.

Buddhist Group Therapy for Diabetes Patients With Depressive Symptoms

Older adults may experience a wish to die in the context of deteriorating health, a loss of autonomy, loneliness, or depression. Home care workers may likewise experience burden or symptoms of depression as a result of prolonged contact with this physical and emotional suffering. Training initiatives that can support the well-being of home care workers are therefore important. To describe the typical profile of older adults who express a wish to die to their home care worker, and to examine whether a psycho-educational intervention for care workers exploring the end-of-life process and self-care strategies had an impact on the older adult's wish to die and on the care worker's perceived burden and depressive symptoms. Quasi-experimental, longitudinal study involving non-randomized experimental and control groups and follow-up at 3-6 months post-intervention. At the start of the study, all care workers (n = 126) provided sociodemographic information (age, gender) for themselves and the care recipient, and completed the Karnofsky Performance Status scale and the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) interview to provide a baseline measure of the care recipient's functional status and wish to die. They also completed the Beck Depression Inventory (BDI) and Zarit Burden Interview (ZBI) as a measure of their own perceived burden and depressive symptoms. The AFEDD, BDI, and ZBI were completed again by care workers at 3 and 6 months post-intervention. The typical profile of care recipients was a woman aged 85.5 years who required considerable support and assistance and who had at least occasionally experienced a wish to die, although these thoughts were not always verbalized. Scores on the AFEDD remained relatively stable over the follow-up period in both the control and experimental groups. There was no significant association between the older adult's wish to die and depressive symptoms in the care worker across the study period. However, a positive and significant correlation between a wish to die in the older adult and perceived burden in the care worker was observed at 6 months post-intervention in both the total sample (p = 0.032) and among controls (p = 0.028). By contrast, this significant association was not found for care workers in the experimental group (p = 0.376), suggesting that the psycho-educational intervention may have had a protective effect. Although further studies are needed to corroborate and extend these findings, the results suggest that psycho-educational interventions aimed at increasing home care workers' understanding of the end-of-life process and which introduce them to self-care strategies may help to reduce their perceived burden when the older person for whom they are caring expresses a wish to die. Home care workers may find it challenging to care for an older adult who expresses a wish to die. Psycho-educational interventions that enhance care workers' understanding of the end-of-life process and teach them self-care strategies could help to support their well-being and their ability to provide adequate care.

485 – Cognitive interventions in mild alzheimer’s disease