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Background Several studies have sought to investigate the trajectory of scholarly publications on dementia. Yet, there has been limited attention to contributions from Latin America.

Introdução A doença de Alzheimer (DA) é uma doença neurodegenerativa progressiva associada à idade avançada e outros fatores. É caracterizada por déficits de memória, confusão mental, dificuldades na comunicação e na execução de tarefas diárias, além de possíveis alterações de humor e comportamento. Portanto, o tratamento preconizado compreende opções medicamentosas e não medicamentosas para controle de sintomas psicológicos e comportamentais. A terapia de estimulação cognitiva (CST, cognitive stimulation therapy) é indicada para promover cognição, independência e bem-estar em pessoas com demência. A CST envolve exercícios cognitivos estruturados e repetitivos (por exemplo, sons, infância, comida, categorização de objetos, orientação, uso do dinheiro), oferecidos em grupo e conduzida por facilitadores treinados (profissionais de saúde como psicólogos, terapeutas ocupacionais, enfermeiros ou mesmo por cuidadores). As sessões de CST consistem em 14 encontros, 45 minutos cada sessão, sendo realizada em até duas vezes por semana. Assim, o objetivo desta revisão sistemática com meta-análise foi avaliar a eficácia da CST para pessoas com DA leve a moderada para a cognição, qualidade de vida, depressão, atividade de vida diária e em sintomas neuropsiquiátricos (comportamento e ansiedade). Métodos Foi conduzida uma revisão sistemática com meta-análise direta, considerando elegíveis ensaios clínicos randomizados (ECR) que compararam CST combinada ao tratamento padrão com o tratamento padrão isolado. Buscas foram realizadas em PubMed, Embase e Cochrane Library. Risco de viés e qualidade da evidência foram avaliados pela ROB-2 e GRADE, respectivamente. Resultados Foram incluídos 11 ECR com 1162 participantes com demência leve a moderada, incluindo dois estudos com pessoas com DA. Tratamento padrão foi descrito, na maioria das vezes, como visitas ao psiquiatra geriátrico e inibidores de acetilcolinesterase. Foi identificado que a CST promoveu melhora clinicamente significativa na cognição de acordo com a escala Mini-Exame do Estado Mental (MMSE) (DM: 1,71, IC 95%: 1,19 a 2,22), mas sem diferença estatística ao considerar a Escala de Avaliação da DA – subescala cognitiva (ADAS-Cog) (DM: 1,52, IC 95%: -0,50 a 3,54) (risco de viés predominantemente com algumas preocupações, certeza moderada). Foi identificada melhora na qualidade de vida de acordo com a Escala de Qualidade de vida para DA (DM: 2,75, IC 95%: 0,25 a 5,25) e na depressão de acordo com a escala Escala Cornell para Depressão na Demência (SMD: 0,21, IC 95%: 0,06 a 0,36). Porém, não houve melhora na atividade de vida diária e em sintomas neuropsiquiátricos (comportamento e ansiedade). Discussão e conclusões Considerando estudos realizados por 7 a 14 semanas, predominantemente com idosos com demência, é provável que a CST combinada ao tratamento padrão promova ligeiro aumento da cognição em comparação com o tratamento padrão isolado. Além disso, benefícios em qualidade de vida e depressão também foram identificados. No entanto, novos estudos podem ser necessários para melhor caracterizar o impacto das características da CST, facilitadores e população-alvo na eficácia da técnica, bem como na manutenção dos benefícios para médio e longo prazo.

Introdução Integrado ao projeto Desenvolvimento da Avaliação de Tecnologias em Saúde (DATS) do Hospital Alemão Oswaldo Cruz (HAOC) no âmbito do PROADI-SUS desde o triênio 2012-2014, o curso de MBA em Economia e ATS apresenta uma proposta inovadora na capacitação de profissionais para interpretação e condução de estudos de ATS, com ênfase em atividades práticas relacionadas às etapas de revisões sistemáticas e avaliações econômicas. Métodos Foi desenvolvido um questionário de monitoramento para os ex-alunos do MBA em Economia e Avaliação de Tecnologias em Saúde pela equipe do projeto DATS. O questionário, também revisado pelo Núcleo de Monitoramento e Avaliação da Diretoria de Sustentabilidade e Responsabilidade Social do HAOC, abordou quatro eixos temáticos: 1) utilização e disseminação do conhecimento do curso; 2) engajamento profissional em contextos relacionados à ATS; 3) execução das atividades atuais ligadas à ATS; e 4) contribuição para avanços na carreira e envolvimento na docência. Como a avaliação se concentrou em informações administrativas em vez de envolver diretamente as pessoas, não precisou passar pela revisão de um comitê de ética em pesquisa com seres humanos. Resultados Dos 173 egressos do curso, 171 foram contatados para responder o questionário, dos quais 74 (43%) participaram. A maioria dos respondentes (68%) pertencia às últimas três turmas. Os resultados destacam que o curso atraiu profissionais de variadas formações (15 graduações diferentes) e níveis acadêmicos (mestrado, doutorado, especialização e pós-doutorado) de todas as regiões do país. Os ex-alunos demonstraram ampla aplicação dos conhecimentos adquiridos em suas práticas profissionais, influenciando na elaboração de estudos de síntese de evidências e avaliações econômicas. Além disso, esses conhecimentos impulsionaram redes de trabalho em ATS, crescimento profissional e oportunidades de disseminação de conteúdo. É importante observar que a pesquisa baseada em questionários pode apresentar viés de seleção, considerando que os egressos mais ativos na área podem ter maior interesse em participar. Discussões e conclusões O curso de MBA em Economia e Avaliação de Tecnologias em Saúde tem atingido satisfatoriamente os objetivos do projeto DATS, contribuindo significativamente para o fortalecimento da ATS no Brasil. A capacitação de profissionais aptos a liderar e disseminar conteúdo de alta qualidade em ATS demonstra seu impacto positivo na área da saúde.

Abstract OBJECTIVE The rise in dementia prevalence, particularly in lower‐ and middle‐income countries (LMIC), places a significant burden on healthcare systems. However, comprehensive data on dementia hospital admissions are scarce. METHODS We analyzed admission rates for dementia, cost of hospital admissions, lengths of hospital stay, and in‐hospital deaths in 2010 and 2019 in Brazil. RESULTS Admission rates declined from 19.7/100,000 inhabitants in 2010 to 14.6/100,000 in 2019. In‐hospital mortality increased from 3.9% in 2010 to 8.8% in 2019, particularly for short‐term stays. Although 9.6% of hospital admissions occurred in regions with lower economic power in 2010 and 10.4% in 2019, these regions had higher mortality, reaching 4.3% of in‐hospital deaths in 2010 and 9.3% in 2019. CONCLUSION The observed trends, alongside sex and regional disparities, underscore the need for targeted investment in healthcare infrastructure and training to improve dementia care in LMIC. Highlights The rate of hospital admissions for dementia was similar in 2010 and 2019 in Brazil. The cost per hospital admission in 2010 decreased by 38.5% compared with 2019. There was an increase in short‐term hospital stays for dementia in 2019 compared to 2010, accompanied by an increase in mortality rates for these short‐term stays. While hospital admissions for dementia decreased in men and increased in women, the in‐hospital mortality due to dementia increased for both sexes.

This is the first of two documents prepared by experts for the Brazilian S20 mental health report. These reports outline strategies aimed at addressing the exacerbated mental health challenges arising from a post-pandemic world. Ongoing psychiatric epidemiology research has yielded evidence linking mental health with intricate social determinants, including gender, race/ethnicity, racism, socioeconomic status, social deprivation, and employment. More recently, the focus has expanded to also encompass violence and social oppression. By prioritizing prevention and early intervention, harnessing technology, and fostering community support, we can mitigate the long-term impact of emerging mental disorders throughout the life course. By utilizing evidence-based practices and forging partnerships between the health and education sectors, S20 countries can promote the health and safety of their student population, paving the way for a more promising future for the next generations. The first document focuses on addressing the mental health concerns of vulnerable populations, catering to the needs of children, youth, and aging populations, assessing the current state of alcohol and drug addictions, scaling up psychosocial interventions in primary care, exploring the potential integration of health and educational systems, and emphasizing the imperative adoption of human rights in mental health policies.

Objectives: Rural residents are exposed to many risk factors for poor diet quality, such as low socioeconomic status and food insecurity. However, the differences between urban and rural residents regarding the association of fruit and vegetable consumption with cognitive performance have not been explored. The aim of this study was to investigate the association of fruit and vegetable consumption with cognitive performance in urban and rural areas in a nationally representative sample of Brazilian older adults. Methods: The sample included 9,412 adults aged 50 years or older from the Brazilian Longitudinal Study of Aging (Estudo Longitudinal da Saúde dos Idosos Brasileiros [ELSI]). The association between consumption of fruits and vegetables and cognitive performance was evaluated using linear regression. Results: In 8,158 participants (mean age 61.6 ± 9.3 years, 54% women, 44% White, and 15% from rural areas), the mean frequency of fruit and vegetable consumption was 2.0 ± 1.3 times a day. Higher intake of fruits and vegetables was associated with better memory (β = 0.031, 95%CI 0.014-0.049), verbal fluency (β = 0.030, 95%CI 0.004-0.056), and global cognition (β = 0.035, 95%CI 0.015-0.055) performance in urban, but not rural residents (p for interaction = 0.036). Conclusion: Higher frequency of fruit and vegetable intake was associated with better cognitive performance in urban, but not in rural areas in Brazil.

Abstract Education is protective against cognitive impairment. We used nationally representative data from Mexico and Brazil to assess the association between education and cognitive function. The sample included adults ≥ 50 years from the Brazilian Longitudinal Study of Aging (ELSI) and the Mexican Health and Aging Study (MHAS). Participants were classified as cognitively impaired or not impaired. We used logistic regression models to estimate the association between education and cognitive function. Education level was higher in MHAS than in ELSI. Participants with at least 1 year of education were less likely to have cognitive impairment than those with no formal education in both cohorts. Men in ELSI had higher odds for cognitive impairment compared to men in MHAS. In both cohorts, higher educational level was associated with lower odds of cognitive impairment compared to no formal education. Sex was an effect modifier in MHAS but not in ELSI. HIGHLIGHTS Cognitive test batteries were harmonized using a regression‐based approach. Even very low levels of education were associated with reduced odds of cognitive impairment compared to no formal education. Brazilians were more likely to have cognitive impairment than Mexicans given the same education level. The differences in the association of education with cognition between Brazil and Mexico were only observed among men.

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

Introduction Evidence suggests that brief interventions are effective in reducing alcohol consumption among older adults. However, the effectiveness of these interventions when delivered by community health workers (non-specialists) in a primary healthcare setting is unknown. To our knowledge, this will be the first randomised trial to examine this.Methods and analysis Two hundred and forty-two individuals considered at-risk drinkers (Alcohol Use Disorders Identification Test-Consumption, AUDIT-C score ≥4) will be recruited and randomly allocated to usual care (waiting-list) or usual care plus an intervention delivered by trained community health workers (non-specialists). Seven primary care units (PCUs) in Sao José dos Campos, Brazil. PCUs are part of the Brazilian public healthcare system (Sistema Único de Saúde). Follow-up 6 months. Outcomes The primary outcome will be the proportion of participants considered at-risk drinkers (AUDIT-C score ≥4). Secondary outcomes will include alcohol consumption in a typical week in the last 30 days (in units per week) assessed by the AUDIT, service use questionnaire, cognitive performance—assessed by The Health and Retirement Study Harmonised Cognitive Assessment, physical activity—assessed by the International Physical Activity Questionnaire, depression—assessed by the Geriatric Depression Scale and quality of life—assessed by the Control, Autonomy, Self-realisation and Pleasure-16 instrument. The analysis will be based on intention-to-treat principle.Ethics and dissemination This study has been approved by the Ethics Committee of the Universidade Federal de São Paulo, CEP/UNIFESP Project n: 0690/2018; CAAE: 91648618.0.0000.5505. All eligible participants will provide informed consent prior to randomisation. The results of this study will be published in relevant peer-reviewed journals and in conference presentations.Trial registration number RBR-8rcxkk.

BackgroundWith no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups.Methods and findingsWe harmonized longitudinal data from 20 population-based cohorts from 15 countries over 5 continents, including 48,522 individuals (58.4% women) aged 54-105 (mean = 72.7) years and without dementia at baseline. Studies had 2-15 years of follow-up. The risk factors investigated were age, sex, education, alcohol consumption, anxiety, apolipoprotein E ε4 allele (APOE*4) status, atrial fibrillation, blood pressure and pulse pressure, body mass index, cardiovascular disease, depression, diabetes, self-rated health, high cholesterol, hypertension, peripheral vascular disease, physical activity, smoking, and history of stroke. Associations with risk factors were determined for a global cognitive composite outcome (memory, language, processing speed, and executive functioning tests) and Mini-Mental State Examination score. Individual participant data meta-analyses of multivariable linear mixed model results pooled across cohorts revealed that for at least 1 cognitive outcome, age (B = -0.1, SE = 0.01), APOE*4 carriage (B = -0.31, SE = 0.11), depression (B = -0.11, SE = 0.06), diabetes (B = -0.23, SE = 0.10), current smoking (B = -0.20, SE = 0.08), and history of stroke (B = -0.22, SE = 0.09) were independently associated with poorer cognitive performance (p < 0.05 for all), and higher levels of education (B = 0.12, SE = 0.02) and vigorous physical activity (B = 0.17, SE = 0.06) were associated with better performance (p < 0.01 for both). Age (B = -0.07, SE = 0.01), APOE*4 carriage (B = -0.41, SE = 0.18), and diabetes (B = -0.18, SE = 0.10) were independently associated with faster cognitive decline (p < 0.05 for all). Different effects between Asian people and white people included stronger associations for Asian people between ever smoking and poorer cognition (group by risk factor interaction: B = -0.24, SE = 0.12), and between diabetes and cognitive decline (B = -0.66, SE = 0.27; p < 0.05 for both). Limitations of our study include a loss or distortion of risk factor data with harmonization, and not investigating factors at midlife.ConclusionsThese results suggest that education, smoking, physical activity, diabetes, and stroke are all modifiable factors associated with cognitive decline. If these factors are determined to be causal, controlling them could minimize worldwide levels of cognitive decline. However, any global prevention strategy may need to consider ethno-regional differences.

ABSTRACT OBJECTIVE To investigate macroregional variations in cognitive function in a national sample representative of the Brazilian population aged 50 years and older. METHODS Data from the baseline of the Longitudinal Study of Brazilian Elderly (ELSI-Brazil), collected between 2015 and 2016, were used. Memory was measured by means of a 10-word list and executive function, by semantic verbal fluency, based on the naming of animals. Gender, age, education, and rural or urban residence were potentially confounding RESULTS Among the 9,412 ELSI-Brazil participants, 9,085 were included in the analysis; 53.9% were women and the average age was 63.0 (0.42) years. After adjusting for potential confounding variables, average scores for memory and verbal fluency were lower in the Northeast region and higher in the Midwest and Southeast, respectively. In the South region, higher scores were found for immediate and combined memory. In all regions, older participants and those with lower schooling had worse scores for memory and verbal fluency. CONCLUSIONS There are differences in cognitive function among older adults in the different macroregions, independent of age, gender, schooling, and rural or urban residence.

In a Perspective, Cleusa Ferri and K. S. Jacob discuss the assessment, recognition, and care of people living with dementia in low- and middle-income countries.