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Background Generalized anxiety disorder (GAD) has negative implications for people’s lives, but is often underdiagnosed in the elderly. There is a shortage of instruments to assess geriatric anxiety. Objectives To analyze the applicability and psychometric properties of the Portuguese version of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) within primary care. Methods Fifty-five seniors were classified as non-demented by a multidisciplinary panel. The protocol included the GAI, the Self-Reporting Questionnaire (SRQ-20), the Depression Scale D-10, Mini-Mental State Examination (MMSE), Bayer Scale for Activities of Daily Living (B-ADL) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A sub-sample also completed the Beck Anxiety Inventory (BAI). Results The GAI and GAI-SF showed good internal consistency (0.89; 0.62, respectively) and test-retest stability (0.58, 0.97). The GAI and GAI-SF correlated significantly with the SRQ-20 (0.74, 0.55) and BAI (0.75, 0.58). Discussion The psychometric characteristics of the Brazilian versions of the GAI and GAI-SF suggest these instruments are suitable for application in the Brazilian elderly population within the primary care setting.

INTRODUÇÃO: Em pouco mais de três décadas, a previsão é que os países em desenvolvimento concentrem 70% dos casos de demência no mundo O Brasil ainda não possui um plano nacional de demência, mesmo com o envelhecimento populacional. A detecção precoce das demências pode contribuir para a implementação de intervenções precoces, promover a atenção às famílias e reduzir custos com a doença. OBJETIVO: Validar o Cognitive Abilities Screening Instrument - Short (CASI-S) e a versão brasileira do General Practitioner Assessment of Cognition (GPCOG-Br) para uso em atenção primária no Brasil, analisando suas propriedades psicométricas. MÉTODO: Noventa e três idosos usuários de duas Unidades Básicas de Saúde da cidade de São Paulo foram avaliados com escalas de sintomas psiquiátricos e testagem cognitiva com CASI-S, GPCOG-Br, bateria Cambridge CAMCOG e Mini-Exame do Estado Mental (MEEM). Informantes foram entrevistados a fim de obter dados sobre a funcionalidade através da Informant Questionnaire of Decline in the Elderly e a Bayer Activities of Daily Living. Critérios de exclusão envolviam diagnóstico atual de depressão ou delirium, história de uso abusivo de álcool e déficits sensoriais moderados ou graves. Os sujeitos eram distribuídos em grupo caso e controle a partir de diagnóstico clínico baseado nos critérios do DSM-IV. RESULTADOS: Os casos foram significativamente mais velhos (p < 0,006) e mostraram desempenho significativamente pior em todos os instrumentos cognitivos (p < 0,001). O CASI-S e a etapa do paciente do GPCOG-Br mostraram alta consistência interna (alfa de Cronbach = 0,810 e 0,835 , respectivamente). As taxas de sensibilidade e especificidade foram semelhantes entre si, sendo que o CASI-S apresentou sensibilidade mais alta (Se=91,8%) e o GPCOGBr escore total, a especificidade mais alta (Es=90,9%). Em comparação com o MEEM, ambos mostraram semelhantes propriedades psicométricas, porém sem viés de nível sócio-econômico. Todos mostraram interferência da idade e da escolaridade. CONCLUSÃO: A versão brasileira do GPCOG-Br e do CASI-S mostraram ser instrumentos eficazes para uso em nossa população no contexto de atenção primária. Estudos futuros deveriam envolver amostras maiores, de preferência oriundas de diferentes contextos sócio-econômicos e com controle da gravidade do comprometimento cognitivo. Apesar da cautela recomendada sobre a prática do rastreio cognitivo em atenção primária, as taxas de erro diagnóstico e/ou de subdiagnóstico de demência nesse contexto são altas em diversos países e parecem justificar a prática BACKGROUND: In a few more than three decades, it is estimated that developing countries comprise approximately 70% of dementia cases in the world. Brazil still does not have a national plan for dementia, although facing the populational ageing. The early detection of dementia may contribute to the implementation of early intervention, promote Family care and reduce costs with the disease treatment. OBJECTIVE: To validate the Cognitive Abilities Screening Instrument - Short (CASI-S) and the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) in a primary care setting. METHODS: Ninety-three elderly users of two Primary Care Units in the city of Sao Paulo have been assessed using scales for psychiatric symptoms and cognitive testing (GPCOG-Br, CASI-S, Cambridge cognitive battery CAMCOG and Mini-Mental Status Examination (MMSE). Informants have been interviewed in order to collect functionality data by using the Informant Questionnaire of Decline in the Elderly and the Bayer Activities of Daily Living. Exclusion criteria consisted in: current depression or delirium diagnosis, previous or current abusive use of alcohol and moderate or severe sensory impairment. RESULTS: Cases were significantly older (p < 0.006) and showed significantly more impaired performance in all the cognitive and functional instruments (p < 0.001). CASI-S and the patient part of the GPCOG-Br showed high internal consistency (Cronbach\'s alpha = 0.810 and 0.835, respectively). Sensitivity and specificity rates were similar, despite CASI-S presented the highest sensitivity (Se=91,8%) and the GPCOG-Br total score, the highest specificity (Sp=90,9%). Correlation between both instruments and the other cognitive and functional tests were significant in virtually all the comparisons. Comparatively to the MMSE, both instruments showed similar psychometric properties, however they did not share the socio-economic bias as presented by the MMSE. Educational bias was found in all the cognitive instruments. CONCLUSION: GPCOG-Br and CASI-S have shown to be efficient for use in our population in primary care setting. Future studies should address higher samples from different backgrounds and controlling for the severity of the cognitive impairment. Despite the recommended caution of the screening practice in primary care, the diagnosis error and underdiagnosis rates for dementia are high in several countries and seem to justify its implementation

Background: There is a proven link between Down syndrome and the early development of the neuropathological features of Alzheimer's disease (AD). Changes in the personality and behavior of adults with Down syndrome might indicate the early stages of dementia or of frontotemporal lobar degeneration. The objective of this study was to investigate the executive functions and changes in behavior associated with frontal lobe degeneration in individuals with Down syndrome who develop AD. We conducted a systematic review selecting studies employing cognitive assessments. Summary: We identified few studies using objective measurements to determine whether cognitive aspects associated with the frontal lobe correlate with dementia in this population. We observed a tendency toward such correlations. Key Messages: There is a need for further studies in which objective measures of cognitive and behavioral factors are evaluated together with data related to brain function and morphology.

Background:The Cognitive Abilities Screening Instrument – Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care.Objectives:To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy.Methods:In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients’ health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status.Results:The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = −0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%.Conclusions:The CASI-S can be useful for dementia screening in primary care in Brazil.

Background: Changes in decision-making (DM) have recently been investigated in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI). DM is highly relevant to everyday functioning and autonomy. It relies on several cognitive abilities, such as semantic and episodic memory, as well as aspects of executive functioning. We conducted a systematic review of DM in older adults with MCI and AD. Summary: Only 5 studies whose main objective was to evaluate the DM performance were selected. The results extracted indicated that DM in ambiguity and in at-risk situations are both impaired in probable AD patients. MCI patients have difficulty making advantageous decisions under ambiguity and at risk, similar to patients with probable AD but they are less impaired. Key Messages: DM deficits may be a predictor of cognitive impairment and conversion to dementia and its potential clinical value should be further explored in longitudinal studies involving direct comparison between MCI and AD patients.

Mild Cognitive Impairment (MCI) represents a transitional state between normal aging and early dementia and is commonly associated with memory impairment (amnestic or A-MCI). Several studies have investigated therapeutic approaches to A-MCI, including cholinestherase inhibitors (I-ChEs), although this practice is still controversial. Thus, there is a current need to determine the effects of cognitive interventions either in combination with I-ChEs or alone. To assess the efficacy of such treatments, neuropsychological instruments and self-evaluated scoring of memory, mood, daily life activities and quality of life are employed. Recently, some studies have used functional magnetic resonance imaging (fMRI) in order to understand the neurobiological effects of these interventions. The aim of this systematic review is to investigate the effectiveness of cognitive interventions on the enhancement of learning abilities as well as their impacts on cognitive measurements of mood, everyday functioning and functional neuroimaging. This review also focused on the methodological aspects of such studies and attempted to introduce new perspectives on cognitive interventions in this population. The authors concluded that a-MCI patients are capable to learn new information and memory strategies. Although findings in standardized neuropsychological tests are limited, non-standardized cognitive measures and subjective measures show significant changes. Furthermore, fMRI reveals changes in the patterns of brain activation and increase of connectivity.

OBJECTIVE: To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS: Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS: Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS: The GPCOG-Br is clinically well-suited for use in primary care.

The present study evaluated 4-grade children and university professors considered good readers in a computerized test of textreading. Trajectories of eye movements obtained during reading made possible to compare the two groups regarding the number of regressivesaccades; type of regressive saccade - that could be intra-word or inter-word; and grammatical classification of words that suffered regression.Results show that children presented a higher number of regressive saccades than university professors. Both groups carried out more inter-wordregressions to the word immediately antecedent to the last fixation than intra-word regressions. The two groups carried out more intra-wordsregressive saccades in the following word types: nouns, adjectives and verbs. Regressions to the previous word took place principally in wordcouples conjunction-verb, adjective-noun, and preposition-noun. On the whole, good readers carry out fewer regressive saccades than childrenin the process of literacy, but the standard of regressive saccades and the type of words that suffer regression are similar in the two groups.Also a higher number of regressive saccades was observed in the beginning of each line of the text, which can be explained by paraphovealprocessing in reading. Regressions to the previous word may be related to the fact that, depending on the grammatical class of the word, thereis a higher possibility of its not fixed.

Background:Identifying dementia in primary care could minimize the impact of a late intervention; however, it shows high rates of misdiagnosis. One of the reasons seems to be the lack of knowledge of adequate cognitive screening instruments. This is a systematic review of the available instruments for the primary care context.Method:For this systematic review, articles were collected according to the following combined key terms: “cognitive screening” and “dementia” and “primary care” and “review”. Studies should be reviews focusing on cognitive screening instruments best used in primary care setting.Results:Thirteen reviews were selected. In total, it was considered 34 cognitive screening instruments. Half of the instruments can be applied in an adequate time-limit for primary care context. Memory is the most commonly assessed cognitive function (91%). Almost half of the tests are mentioned to have influence of education or cultural factors (44%).Conclusion:Tests such as 6CIT, AMT, GPCOG, Mini-Cog, MIS, MoCA, and STMS seem to be good alternatives to the use of the Mini-Mental State Examination when considering factors such as application time, sensitivity, specificity, and number of studies. However, there is a wide range of tests with different characteristics, therefore it is recommended that the professional gets some expertise in a few number of instruments in order to be able to choose which to use, or use in combination, depending on the setting and the profile of the patient.

the SUVR threshold defined by spares k-means clustering in any one of six ROIs or by exceeding the SUVR threshold in the global cortical region. Results: Separate ANCOVAs were conducted to compare mental age-adjusted means on each neuropsychological measure for the PiB+ versus PiBsubjects. The PiB+ subjects evidenced significantly lower mean scores on several neuropsychological measures, including executive/working memory, delayed recall, and attention/processing speed. These differences are hypothesized to become more pronounced at follow-up time points. Conclusions: This study provides a unique opportunity to study the preclinical manifestations of AD. Findings may not only provide information that could affect early detection, prevention, and treatment of AD for individuals with DS, but also may offer information that will prove extremely useful for the general population.

A análise do padrão do movimento ocular auxilia discriminar leitores competentes daqueles com dificuldades de leitura. O padrão de leitura dos movimentos oculares é afetado por propriedades psicolingüísticas da palavra, tais como: comprimento, regularidade, freqüência e lexicalidade O objetivo do presente estudo foi analisar o padrão de movimentos oculares durante a leitura em português do Brasil e compará-lo com resultados de estudos de outras línguas. Os movimentos oculares durante a leitura de palavras e pseudopalavras foram analisados em 20 universitários com idade média de 20,5 anos (DP=2,9). Os resultados indicam que o número de fixações, tempo da primeira fixação e tempo total das fixações foram influenciados pelas variáveis, comprimento, lexicalidade e freqüência dos itens. Foi observado efeito de regularidade para todas as variáveis, exceto naquela do número de fixações. Os resultados obtidos foram semelhantes àqueles encontrados em outras línguas com predomínio de palavras regulares, mas não de palavras irregulares, como o inglês. Analyses of eye movement's pattern contribute significantly to the discrimination between good and poor readers. The pattern of eye movements during reading is affected by psycholinguistic properties of words such as: length, regularity, and frequency. The objective of the present study was to analyze eye movements during words and non-words reading in Brazilian Portuguese and compare the results with the data from other languages. Eye movements during the words and non-words reading were recorded from 20 university students with the mean age of 20.5 years (SD=2.9). Results showed significant effect of word length, regularity and frequency on number of fixations, first fixation duration and gaze duration. Regularity showed effect on all of the variables except on number of fixations. The results are similar to those found in languages with predominantly regular orthographies, but not with the irregular ones such as English. El análisis del padrón del movimiento ocular ayuda a discriminar lectores competentes de aquellos con dificultades de lectura. El padrón de lectura de los movimientos oculares es afectado por propiedades psico-lingüísticas de la palabra, como por ejemplo: extensión, regularidad, frecuencia y lexicalidad. El objetivo de este estudio fue analizar el padrón de movimientos oculares durante la lectura en portugués del Brasil y compararlo con resultados de estudios de otros idiomas. Durante la lectura, los movimientos oculares de palabras y pseudo-palabras fueron analizados en 20 universitarios con un promedio de edad de 20,5 años (DP=2,9). Los resultados indican que el número de fijaciones, tiempo de la primera fijación y tiempo total de las fijaciones fueron influenciados por las variables extensión, lexicalidad y frecuencia de los ítems. Fue observado efecto de regularidad para todas las variables, excepto en aquella del número de fijaciones. Los resultados obtenidos fueron semejantes a los encontrados en otros idiomas con predominancia de palabras regulares pero no de palabras irregulares, como el inglés.

Os transtornos mentais como quadros psicóticos e transtorno afetivo bipolar, de uma maneira geral, cursam com alterações e prejuízos na cognição e nas habilidades sociais, além do estigma que resulta em exclusão social. Em quadros psicóticos, por exemplo, evidencia-se uma série de graves limitações sociais e pessoais, repercutindo em dificuldades para desempenhar papéis sociais e ocupacionais esperados, que podem levar ao retraimento social, deterioração da aparência e dificuldades para fazer novos laços. Além disso, as evidências disponíveis indicam que o isolamento social representa um fator de risco para doenças cardiovasculares e uma das principais causas de mortalidade destes pacientes. Já no Transtorno Bipolar, os principais achados se concentram em prejuízos de funções cognitivas como atenção, memória, funções executivas e velocidade de processamento, com poucos dados sobre prejuízos em cognição social. Neste escopo, destaca-se a questão de se pensar o diagnóstico não só nosológico, mas principalmente, funcional. Com base neste aporte, a presente pesquisa avaliou habilidades sociais e aspectos cognitivos de pacientes com diagnósticos de transtornos psicóticos e transtorno do afetivo bipolar. Trata-se de um estudo exploratório que foi composto por uma amostra de conveniência com 42 participantes, a partir dos 18 (dezoito) anos de idade. Os participantes foram distribuídos em dois grupos de acordo com o diagnóstico. A amostra foi dividida em: Grupo 1 com 20 participantes com transtornos psicóticos e Grupo 2 22 participantes com transtorno do humor bipolar (TAB). A pesquisa revelou pouca alteração nas avaliações de processos atencionais e funções executivas entre os grupos, e elevada diferença nos resultados de habilidades sociais, velocidade de processamento e funções executivas em relação à população geral, com prejuízo maior para os pacientes com Transtornos Psicóticos. Frente ao exposto, enfatiza-se a necessidade da aplicação de protocolos de avaliação cognitiva, emocional e de habilidades sociais como forma de medir a efetividade de programas de intervenções em equipamentos de atenção à saúde mental. Dessa forma entende-se que uma compreensão mais ampla do impacto de um determinado transtorno mental na vida de uma pessoa, resulta em informações imprescindíveis para a confecção de programas de intervenções, por exemplo, pensando na melhora da habilidade social Mental disorders, such as psychoses and bipolar mood disorder, are generally associated with altered and impaired cognition and social skills, not to mention the stigma that leads to social exclusion. Considering of psychotic disorders, a series of severe social and personal limitations can be observed, resulting in difficulty to engage in social and occupational roles, possibly leading to social withdrawal, deterioration in appearance and hardship building new social bonds. Furthermore, available evidence suggests that social isolation is a risk factor for cardiovascular diseases and a major cause of mortality in these patients. For bipolar disorder, the main findings are focused on cognitive disfunctions in attention, memory, executive functions and processing speed, with small evidence of impaired social cognition. In this sense, it becomes evident that the diagnosis should not be restricted to nosological aspects and be mostly functional. In view of these contributions, the present work has assessed social skills and cognitive aspects in patients diagnosed with psychotic disorders and bipolar disorder. This is an exploratory study composed by a convenience sample of 42 participants, from the age of 18. Participants were divided in two groups according to their diagnostic. Therefore, the sample is divided in: Group 1 with 20 participants with psychotic disorders and Group 2 has 22 participants with bipolar disorder. The research has found little distinction in the assessment of attentional processes and executive functions between groups, and major differences regarding social skills, processing speed and executive functions, compared to general population, with bigger impairment in patients with psychotic disorders. This data suggests that cognitive, emotional and social skills evaluation protocols should be implemented as a way of measuring the effect of intervention programs in mental health facilities. A wider comprehension of the impact of specific mental disorders in peoples lives results in indispensable information concerning intervention programs, e.g., aiming social skills improvement

A autorregulação emocional é um mecanismo pelo qual ocorre a modulação e ajuste dos estados emocionais, em função do alcance de alguns objetivos específicos. Falhas nesse mecanismo, denominadas de desregulação emocional, configuram-se como aspectos centrais na etiologia de diferentes quadros psicopatológicos. Assim, a possibilidade de compreensão de como se expressa e se configura pode ser de grande valia como parte integrante no tratamento de diferentes quadros psiquiátricos, possibilitando um direcionamento de intervenções mais abrangentes e com maior alcance para diferentes patologias. Este estudo se propôs a avaliar a capacidade de autorregulação emocional em pacientes adultos com e sem diagnósticos psiquiátricos na perspectiva das funções executivas quentes. Avaliamos 62 participantes, entre 19 e 70 anos, com múltiplos diagnósticos, predominando o fenótipo ansioso. A regulação e desregulação emocional foram mensuradas através da escala QRAR e DERS, funções executivas através da escala BIS-11 e BDEFS, fatores de personalidade com NEO-FFI e respostas comportamentais associadas a funcionamento executivo com CPTIII e FDT. Os participantes também foram submetidos a uma avaliação de desempenho intelectual através do WASI reduzido. As associações entre as variáveis foram testadas através de testes paramétricos e não paramétricos, com análises de correlação e de predição. A população estudada configurou-se em 77,42% (n=48) de gênero feminino, sem diferença significativa entre grupo clínico e controle. Os principais resultados evidenciaram que o grupo clínico apresentou maior dificuldade em relação a capacidade de regular suas emoções (p=0,02), bem como maiores prejuízos em funções executivas do que o grupo controle (p=0,02). O Grupo clínico também apresentou um número maior de falhas por comissão, indicador de impulsividade, do que o grupo controle. Foram identificadas ainda, forte associação entre dificuldade de regulação emocional e falhas em funções executivas, bem como uma associação entre fatores específicos da personalidade (neuroticismo, conscienciosidade, extroversão) e dificuldades de regulação emocional. Emotional self-regulation is a mechanism by which the modulation and adjustment of emotional states occurs, depending on the achievement of some specific goals. Failures in this mechanism, called emotional dysregulation, are central aspects in the etiology of different psychopathological conditions. Thus, the possibility of understanding how it is expressed and configured can be of great value as an integral part in the treatment of different psychiatric conditions, allowing for more comprehensive interventions and with greater reach for different pathologies. This study aimed to assess the capacity for emotional self-regulation in adult patients with and without psychiatric diagnoses from the perspective of hot executive functions. We evaluated 62 participants, between 19 and 70 years old, with multiple diagnoses, with an anxious phenotype predominating. Emotion regulation and dysregulation were measured using the QRAR and DERS scale, executive functions using the BIS-11 and BDEFS scale, personality factors with NEO-FFI and behavioral responses associated with executive functioning with CPT-III and FDT. Participants also underwent an intellectual performance assessment using the reduced WASI. The associations between the variables were tested using parametric and nonparametric tests, with correlation and prediction analyses. The population studied was 77.42% (n=48) female, with no significant difference between clinical and control groups. The main results showed that the clinical group had greater difficulty in terms of the ability to regulate their emotions (p=0.02), as well as greater impairments in executive functions than the control group (p=0.02). The clinical group also presented a higher number of failures per commission, an indicator of impulsiveness, than the control group. A strong association was also identified between emotional regulation difficulties and failures in executive functions, as well as an association between specific personality factors (neuroticism, conscientiousness, extroversion) and emotional regulation difficulties.

INTRODUÇÃO: A identificação do risco de desnutrição/desnutrição e da depressão é fundamental para realizar o diagnóstico precoce e o tratamento adequado, propiciando um melhor prognóstico e maior qualidade de vida aos idosos. A partir de instrumentos previamente validados como: Mini Avaliação Nutricional (MAN), Simplified Nutritional Appetite Questionnaire (SNAQ), Escala de Depressão Geriátrica de 15 itens (GDS-15), Patient Health Questionnaire 9 (PHQ-9) e critérios de depressão do DSM5, é possível avaliar os riscos para reduzir as condições desfavoráveis e impedir o agravamento de prognóstico. OBJETIVO: Avaliar a prevalência do risco de desnutrição/desnutrição entre idosos ambulatoriais com e sem depressão atual (TDM ou DSS) e avaliar a associação entre variáveis sociodemográficas e clínicas com o risco de desnutrição/desnutrição. MÉTODOS: amostra do tipo convencional composta por 317 idosos com idade 60 anos atendidos em ambulatório de especialidades. Os dados foram obtidos por meio de entrevista estruturada no ambulatório de especialidades da FMJ. Para identificar os riscos nutricionais foram utilizados os instrumentos: MAN e SNAQ. A investigação da depressão atual (TDM ou DSS) foi realizada com a utilização da escala GDS-15 e o instrumento PHQ-9. O diagnóstico de depressão atual (TDM ou DSS) seguiu o fluxo de acordo com a categorização DSM-5. Foram construidos modelos de regressão linear e logistica simples e ajustada considerando os cofatores: idade, sexo, escolaridade, velocidade de marcha, polifarmácia, limitação de AIVD e pontuação no 10-Cognitive Screener. RESULTADO: Dos 317 idosos avaliados, 177 estavam com Estado Nutricional Normal; 118 em Risco de Desnutrição; 22 como Desnutridos; 83 com PHQ-9 que 9; 127 com GDS-15 que 5; 64 identificados com TDM; e 41 com DSS. Nos modelos de regressão logística ajustados, a associação entre risco de desnutrição/desnutrição e a depressão atual (TDM ou DSS), avaliada pelo DSMTDM, resultou em OR 6,05 (IC 95% = 3,05-12,0) e quando avaliada pelo DSMDSS, em OR 2,28 (IC 95% = 1,09-4,75). No modelo de regressão linear, a associação entre o risco de desnutrição/desnutrido e o PHQ-9 resultou em 0,381 (p-valor < 0,001). CONCLUSÃO: Nossos resultados mostraram a associação do risco de desnutrição/desnutrição com a depressão atual (TDM ou DSS) destacando a importância da participação de equipe multiprofissional na avaliação geriátrica INTRODUCTION: The early identification of the risk of malnutrition/malnutrition and depression in the elderly is fundamental for health maintenance. Using previously validated instruments such as Mini-Nutritional Assessment (MNA), Simplified Nutritional Appetite Questionnaire (SNAQ), 15-item Geriatric Depression Scale (GDS-15), Patient Health Questionnaire 9 (PHQ-9), and DSM5 depression criteria, it is possible to assess risk to reduce unfavorable conditions and prevent worsening of prognosis. OBJECTIVE: To assess the prevalence of malnutrition/malnutrition risk among elderly outpatients with and without current depression (MDD or SD) and to evaluate the association between socio-demographic and clinical variables with malnutrition/malnutrition risk. METHODS: Conventional type sample composed of 317 elderly aged 60 years attending a specialty outpatient clinic. Data were obtained in a structured interview at the MUJ (Medicine University of Jundiaí) specialties outpatient clinic. MNA and the SNAQ were used to identify nutritional risks. The investigation of current depression (MDD or SD) was performed by GDS-15 and PHQ-9. The diagnosis of current depression (MDD or SD) followed the flow according to the DSM-5 categorization. Simple and adjusted linear and logistic regression models were built considering the cofactors: age, sex, education, gait speed, poly pharmacy, limitation of IADL and score in the 10-Cognitive Screener. RESULT: 317 of the elderly assessed, 177 elderly were in Normal Nutritional Status, 118 at Risk of Malnutrition, 22 Malnourished, 83 had PHQ-9 greater than 9, 127 GDS-15 greater than 5, and 64 were identified with DSMMDD and 41 with DSMSD. In the adjusted logistic Regression models the association between risk of malnutrition/malnutrition and current depression (MDD or SD) assessed by DSMMDD was OR 6.05 (95% CI = 3.05-12.0) and DSMSD was OR 2.28 (95% CI = 1.09-4.75). In the Linear Regression model, the association between risk of malnutrition/ malnourished and PHQ-9 was - 0.381 (p-value < 0.001). CONCLUSION: Our results showed the association of risk of malnutrition /malnutrition with current depression (MDD or SD) highlighting the importance of multiprofessional team participation in geriatric assessment

Introdução: Apesar dos esforços contínuos para esclarecer os mecanismos neurobiológicos que contribuem para a progressão da disfunção cognitiva no Transtorno Depressivo Maior (TDM), várias questões permanecem sem resposta. Objetivos: Investigar o desempenho e o perfil de tomada de decisão (TD) em idosos com TDM. Metodologia: Trata-se de estudo transversal analítico avaliando a TD em idosos com TDM versus controles. Foram avaliados 73 idosos com TDM (43 com depressão remitida e 30 com depressão atual) e 60 controles saudáveis. O desempenho de TD foi avaliado através do Iowa Gambling Task (IGT) e o perfil de TD através do Melbourne Decision Making Questionnaire (MDMQ). Resultados: O grupo com depressão atual apresentou uma tendência de maior pontuação média na pilha desvantajosa B. Em outras pilhas e blocos, os escores médios resultaram em diferenças mais discretas entre os grupos. O grupo com depressão atual também apresentou um netscore com valores negativos mais elevados do que o grupo com depressão remitida e o grupo controle. No que diz respeito à evolução da aprendizagem na tarefa, o grupo controle passou a apresentar resultados positivos a partir do bloco 4 enquanto o grupo depressão remitida iniciou resultados positivos apenas no bloco 5 e o grupo com depressão atual manteve resultados negativos em todos os blocos. Todas as medidas não mostraram resultados significativos. Correlações múltiplas foram testadas entre os itens do IGT (pilhas, blocos e netscore) e características sociodemográficas e clínicas, produzindo dois achados significativos em relação à sintomatologia da ansiedade. A pilha A no grupo atual de TDM foi correlacionada com o escore Escala de Ansiedade de Hamilton (HAMA) (r = 0,31; p = 0,049) e a pilha D no TDM remitido foi negativamente correlacionado com o escore HAM-A (r = -0,43; p = 0,005). Na análise dos perfis de TD observamos que, em comparação com o grupo controle, os pacientes com depressão atual apresentaram maiores escores nos perfis evitação (p = 0,002) e procrastinação (p = 0,001). No perfil de hipervigilância, houve uma diferença significativa entre os grupos depressão atual e depressão remitida (p < 0,001). A depressão atual foi mais associada a perfis de TD desadaptativos (p = 0,017). Os resultados também indicaram que valores mais elevados na Escala de Depressão de Hamilton- 21 (HAM-D) e valores mais baixos no Mini-Exame do Estado Mental (MEEM) aumentaram a probabilidade de perfis de TD desvantajosos. Conclusão: Nossos achados demonstram que idosos com depressão atual ou remitida apresentam uma tendência a TD prejudicada quando comparados aos idosos sem depressão. E que idosos com depressão atual apresentam perfis de TD considerados desadaptados em comparação com idosos com depressão remitida e com controles saudáveis Introduction: Despite ongoing efforts to clarify the neurobiological mechanisms that contribute to the progression of cognitive dysfunction in Major Depressive Disorder (MDD), several questions remain unanswered. Objectives: To investigate the performance and profile of Decision Making (DM) in older adults with MDD. Methodology: This is a analytical cross-sectional study of 73 older adults with MDD (43 with remitted depression and 30 with current depression) and 60 healthy controls were evaluated. DM performance was assessed using the Iowa Gambling Task (IGT) and DM profile using the Melbourne Decision Making Questionnaire (MDMQ). Results: The group with current depression tended to have a higher mean score in the disadvantageous pile B. In other piles and blocks, the mean scores resulted in more discrete differences between the groups. The group with current depression also had a netscore with negative values higher than the group with remitted depression and the control group. With regard to the evolution of learning during the task, the control group started to show positive results from block 4 while the remitted depression group started positive results only in block 5, and the group with current depression maintained negative results in all blocks. All measures did not show significant results. Multiple correlations were tested between the IGT items (piles, blocks and netscore) and sociodemographic and clinical characteristics, producing two significant findings in relation to anxiety symptomatology. Pile A in the current MDD group was correlated with the HAM-A score (r = 0.31; p = 0.049) and pile D in the remitted MDD was negatively correlated with the HAM-A score (r = -0.43; p = 0.005). In the analysis of the DM profiles, we observed that patients with current depression had higher scores in the avoidance (p = 0.002) and procrastination (p = 0.001) profiles compared to the control group. In the hypervigilance profile, there was a significant difference between the current depression and remitted depression groups (p < 0.001). Current depression was more associated with maladaptive DM profiles (p = 0.017). The results also indicated that higher values on the HAM-D scale and lower values on the MMSE increased the probability of disadvantageous DM profiles. Conclusion: Our findings demonstrate that older people with current or remitted MDD had a tendency to impaired DM when compared to those without depression. Older adults with current depression had DM profiles considered to be maladaptive compared to those with remitted depression or healthy controls

Um conceito pertinente na avalição do curso dos transtornos do humor, e muitas vezes ignorado pela psiquiatria, é o conceito de temperamentos afetivos. Emil Kraepelin descreveu os quatro elementos básicos (depressivo, maníaco, ciclotímico e irritável), os quais ele considerava formas subclínicas e possíveis precursores dos transtornos afetivos, e que tinham raízes na adolescência. O conceito de temperamento afetivo foi perdido no século XX com o crescimento das teorias psicanalíticas, onde o conceito de personalidade era visto sob a lente psicológica ao invés de biológica. Baseado neste contexto, os objetivos principais deste estudo foram identificar e comparar a frequência dos três principais tipos de temperamento (distimia, hipertimia, ciclotimia), além da associação dos diagnósticos e os três tipos de temperamento. O estudo foi realizado com pacientes idosos diagnosticados com transtorno afetivo bipolar (TAB) e depressão maior, e em pacientes Controles. Para isto foram avaliados 22 casos de transtorno afetivo bipolar, 50 casos de depressão maior e 100 pacientes controles. Para este estudo foram usados os seguintes instrumentos de avaliação clínica: Mini Exame do Estado Mental, HAMD17, Hamilton para ansiedade, YMRS e TEMPS-A. Os pacientes do grupo com TAB apresentaram a maior incidência de hipertimia (59,1%), os pacientes com depressão maior apresentaram uma incidência maior também de hipertimia (48%). Em relação a análise de associação entre TAB e depressão maior e os três principais temperamentos, a medida usada foi o risco relativo (RR). Pacientes distímicos tiveram uma chance aumentada para o diagnóstico de TAB (RR=3,6, 95% IC 1,1-12,4), os pacientes hipertímicos apresentaram um RR estatisticamente significante, mas protetivo. Já os pacientes com depressão maior apresentaram uma chance maior de diagnóstico entre os pacientes ciclotímicos (RR=3,2, 95% IC 1,7-6,0) e uma chance menor entre os pacientes hipertímicos (RR=0,6, 95% IC 0,4-0,8). Foram analisadas as relações de alguns desfechos secundários (tentativa de suicídio, abuso na infância, abuso sexual e automutilação). Pode-se concluir neste estudo que sujeitos com temperamento ciclotímico tem um risco maior de serem diagnosticados tanto com TAB quanto com depressão maior, quando comparados aos Controles. Entretanto, pacientes com temperamento hipertímico possuem um risco diminuído de apresentarem diagnóstico de depressão maior A relevant concept in assessing the course of mood disorders, and often ignored by psychiatry, is the concept of affective temperaments. Emil Kraepelin described the four basic elements (depressive, manic, cyclothymic and irritable), which he considered subclinical forms and possible precursors of affective disorders, and which had their roots in adolescence. The concept of affective temperament was lost in the twentieth century with the growth of psychoanalytic theories, where the concept of personality was seen through a psychological rather than a biological concept. Based on this context, the main aims of this study were to identify and compare the frequency of the three main types of temperament (dysthymia, hyperthymia, cyclothymia), in addition to the association of diagnoses and the three types of temperament The study was conducted with older adults diagnosed with bipolar disorder (BD) and major depression, and in Control patients. For this, 22 cases of bipolar disorder, 50 cases of major depression and 100 control patients were evaluated. For this study, the following rating scales were used: Mini Mental State Examination, HAMD17, Hamilton Scale for anxiety, YMRS and TEMPS-A. Patients in the group with BD had the highest incidence of hyperthymia (59.1%), patients with major depression also had a higher incidence of hyperthymia (48%). Regarding the analysis of the association between BD and major depression and the three main temperaments, the measure used was the relative risk (RR). Dysthymic patients had an increased chance of diagnosing BD (RR = 3.6, 95% CI 1.1-12.4), hyperthymic patients had a statistically significant but protective RR. Patients with major depression had a greater chance of diagnosis among cyclothymic patients (RR = 3.2, 95% CI 1.7-6.0) and a lower chance among hyperthymic patients (RR = 0.6, 95% CI 0.4-0.8). The relationships of some secondary outcomes (suicide attempt, childhood abuse, sexual abuse and self-harm) were analyzed. It can be concluded in this study that subjects with cyclothymic temperament have a higher risk of being diagnosed with both BD and major depression, when compared to Controls. However, patients with hyperthymic temperament have a reduced risk of having a diagnosis of major depression