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Background Healthy brain aging can be defined as aging without neurological or psychiatric disorders, sustaining functional independence. In addition to the absence of disease and preserved functionality, there are individuals who stand out for their superior performance to that considered normal for their age in cognitive tests. These individuals are called “high-performance older adults” (HPOA). Objectives To investigate the presence of HPOA in an oldest-old population with low education, and if present, to investigate associations with sociodemographic, clinical, and lifestyle variables. Methods We evaluated 132 cognitively healthy individuals from the Pietà Study, a population-based investigation with 639 participants. We used the delayed recall from the Rey Auditory-Verbal Learning Test to verify the existence of HPOA and to classify participants based on their performance. Sociodemographic, clinical, and lifestyle variables associated with HPOA were investigated. Results We identified 18 individuals fulfilling HPOA criteria (age: 77.4 ± 2.6 years old; 14 women; education: 4.6 ± 3.4 years). The other participants, 114 total (age: 79.8 ± 4.5 years old; 69 women; education: 3.0 ± 2.7 years) were classified as “standard performance older adults” (SPOA). In multivariate analysis, younger age (odds ratio [OR] =0.672; 95% confidence interval [CI]: 0.462-0.979; p = 0.037) and lower scores on the Geriatric Depression Scale (OR = 0.831; 95%CI: 0.688-0.989; p = 0.038) were associated with HPOA. Conclusions The present study identifies for the first time HPOA with low educational level, thereby reinforcing the existence of biological substrates related to this condition. Furthermore, the data suggest an association between younger age and less depressive symptoms with HPOA. Resumo Antecedentes Envelhecimento cerebral saudável pode ser definido como envelhecimento sem transtornos neurológicos ou psiquiátricos e com independência funcional. Além da ausência de doença e funcionalidade preservada, existem indivíduos que se destacam pelo desempenho superior ao normal em testes cognitivos. Estes indivíduos são chamados de “high performance older adults” (HPOA, na sigla em inglês). Objetivos Investigar a presença de HPOA em uma população de idosos com baixa escolaridade e, se presente, investigar associações com variáveis sociodemográficas, clínicas e de estilo de vida. Métodos Avaliamos 132 indivíduos cognitivamente saudáveis do Estudo Pietà (n = 639). Foi utilizado o Teste de Aprendizagem Auditivo-Verbal de Rey para verificar a existência de HPOA e classificar os participantes em dois grupos com base em seu desempenho. Variáveis sociodemográficas, clínicas e de estilo de vida associadas a HPOA foram investigadas. Resultados Identificamos 18 indivíduos que preencheram critérios para HPOA (idade: 77,4 ± 2,6 anos; 14 mulheres; escolaridade: 4,6 ± 3,4 anos). Os demais, 114 no total (idade: 79,8 ± 4,5 anos; 69 mulheres; escolaridade: 3,0 ± 2,7 anos), foram classificados como “standard performance older adults” (SPOA, na sigla em inglês). Na análise multivariada, menor idade (odds ratio [OR] =0,672; intervalo de confiança [IC] 95%: 0,462-0,979; p = 0,037) e menor pontuação na Escala de Depressão Geriátrica (OR = 0,831; IC95%: 0,688-0,989; p = 0,038) foram associados ao grupo HPOA. Conclusões O presente estudo identifica pela primeira vez HPOA entre indivíduos de baixa escolaridade, reforçando a existência de substratos biológicos relacionados a esta condição. Além disso, os dados sugerem uma associação entre idade mais jovem e menos sintomas depressivos com HPOA.

Background: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. Objective: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. Methods: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. Results: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. Conclusion: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.

Objective To investigate differences in white matter microstructure between illiterate and low-literate elderly Brazilians. Background High literacy levels are believed to partially counteract the negative effects of neurodegenerative diseases. Investigating the impact of low literacy versus illiteracy on brain structure can contribute knowledge about cognitive reserve in elderly populations with low educational attainment. Fractional anisotropy is a measure derived from diffusion tensor imaging sequences that positively correlate with the integrity of the brain's white matter microstructure. Methods Older adults who participated in an epidemiological study to investigate brain aging in Brazil and had magnetic resonance scans with the diffusion tensor imaging acquisition were selected (n=31). Participants were divided into two groups: (a) low-literate (n=21), with 3.4 (1.4) years of education, 79.8 (3.8) years of age, 17 cognitively healthy and four with cognitive impairment-no dementia; and (b) illiterate (n=10) with no formal schooling, 80.7 (4.1) years of age, six cognitively healthy and four with cognitive impairment-no dementia. We contrasted the two groups' white matter microstructure measures using whole-brain and region of interest approaches. Results The low-literate participants had significantly higher fractional anisotropy values in the right superior longitudinal fasciculus than did the illiterate ones. Conclusions Although our results are preliminary because of the sample size, they suggest that low literacy, versus illiteracy, is associated with higher fractional anisotropy values, which are indirect measurements of white matter microstructure. This finding provides insight into a possible mechanism by which literacy, even at low levels, may contribute to cognitive reserve.

Cognitive impairment, including mild cognitive impairment (MCI) and dementia, compromises the patients’ cognitive abilities and, to different extents, to carry out daily activities, accompanied by personality and behavioral changes. Studies suggest that leptin, an adipokine, has a neuroprotective role against Alzheimer’s disease (AD) and that cytokines are associated with inflammatory processes and dementia. This study aimed to evaluate serum leptin, hsCRP, IL-6 and TNF-α levels in a cognitive continuum group from normal to demential status, and to assess whether they correlates to Mini-Mental State Examination (MMSE) and Functional Assessment Staging (FAST) scores. Forty-three participants were included, of whom 12 with probable AD, 18 with MCI and 13 with no objective cognitive decline. Serum leptin and hsCRP levels were evaluated by immunoturbidimetric method, and IL-6 and TNF-α by ELISA. Higher TNF-α levels were found in individuals with FAST stages 1/2 and normal scores evaluated by MMSE. hsCRP levels were inversely correlated with FAST stages. No association with function or global cognition was observed for leptin and IL-6 levels. However, women presented higher leptin serum levels than men while lower leptin and IL-6 levels were observed in individuals aged ≥59 years. Our results suggest that TNF-α is associated with cognitive and functional decline and that inflammation could be a substrate of cognitive impairment at early clinical stages of dementia.

Background:Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education.Methods:We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ).Results:Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = −0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD.Conclusion:Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.

According to the cognitive reserve theory, intellectual stimuli acquired during life can prevent against developing cognitive impairment. The underlying cognitive reserve mechanisms were underexplored in low-educated individuals. Because episodic memory impairment due to hippocampal dysfunction is a key feature of Alzheimer’s dementia (AD), we sought to look at a possible cognitive reserve mechanism by determining whether few years of education moderated the relationship between the hippocampal volumes and the episodic-memory scores. The sample was composed by 183 older adults, 40.1% male, with the median age of 78[76,82] years and the median years of education of 4[2,10] who had undergone an episodic-memory test and a 3-Tesla MRI scan to access the hippocampal volumes. Overall, 112 were cognitively healthy, 26 had cognitive impairment-no dementia (CIND) and 45 had dementia. We used multiple linear regression to assess whether the interaction between years of education and each hippocampal volume significantly predicted the episodic-memory scores’ variance, controlling for cognitive diagnosis and nuisance variables. The interaction term with the left hippocampus (ß = 0.2, p = 0.043, CI = 1.0, 1.4), but not with the right (ß = 0.1, p = 0.218, CI = 0.9, 1.2) significantly predicted the variation on memory scores. The mechanism by which the left hippocampus seems to play a more important role on memory processing in more educated individuals needs to be further investigated and might be associated with a better use of mnemonic strategies or higher hippocampal connectivity. Because the sample’s median years of education was four, which corresponds to primary school, we may infer that this level might be sufficient to contribute for building cognitive reserve.

Introdução: O envelhecimento cerebral bem-sucedido é definido como condição em que há mínimo ou nenhum declínio cognitivo em comparação a adultos mais jovens. Dessa forma, além da ausência de doenças e funcionalidade preservada, existem indivíduos que se destacam pelo desempenho superior ao normal para a idade em testes de avaliação cognitiva. Ainda não são totalmente conhecidas as variáveis sociodemográficas e biológicas que favorecem tais idosos.Objetivos: Investigar aspectos sociodemográficos, clínicos e de hábitos de vida de indivíduos com 75 anos ou mais e desempenho cognitivo similar ao de idosos mais jovens (60-69 anos) saudáveis. Métodos: Em estudo de base populacional realizado em Caeté (MG), foram avaliados 639 idosos com idade 75 anos. Através de rastreio cognitivo pelo Mini-Exame do Estado Mental, Bateria Cognitiva Breve e questionário de Pfeffer, identificamos 132 idosos (idade: 79,5 ± 4,4 anos; escolaridade: 3,2 ± 2,8 anos; gênero: 84F/48M) cognitivamente saudáveis, que foram submetidos a questionários sociodemográficos, de hábitos de vida e à avaliação clínica e neuropsicológica, incluindo o Rey Auditory-Verbal Learning Test (RAVLT). Indivíduos sem comprometimento cognitivo ou funcional e com pontuação 9 pontos na fase de evocação tardia do RAVLT foram considerados como pertencentes ao grupo de envelhecimento cerebral bem-sucedido (ECB), enquanto indivíduos cognitivamente saudáveis, independentes e com pontuação < 9 pontos, foram classificados como envelhecimento cerebral habitual (ECH). Foram investigadas possíveis associações entre dados demográficos, clínicos e de hábitos de vida com ECB.Resultados: Dos 132 indivíduos com envelhecimento cerebral saudável, 18 foram incluídos no grupo ECB (idade: 77,4 ± 2,6 anos; escolaridade: 4,6 ± 3,4 anos; gênero 14F / 4M) e 114 no grupo ECH (idade: 79,8 ± 4,5 anos; escolaridade: 3,0 ± 2,7 anos; gênero 70F / 44M). Na análise multivariada, houve associação significativa de menor idade (OR: 0,672 - IC95% 0,462-0,979; p = 0,037) e menor pontuação na escala de depressão geriátrica (GDS) (OR: 0,831 - IC95% 0,698-0,989; p = 0,038) com o ECB. Conclusões: Os dados obtidos sugerem a associação entre menor idade e menor quantidade de sintomas depressivos com melhor desempenho cognitivo nesta amostra de idosos muito idosos, de baixa escolaridade, vivendo na comunidade. A presença de indivíduos, com tão baixa escolaridade, classificados como ECB sugere uma possível participação de determinantes biológicos do ECB. Background: Successful brain aging is a condition in which there is little, or no cognitive decline compared to younger adults. Thus, beyond the mere absence of disease and preserved functionality, there are individuals who stand out for outperforming what is considered normal for age on cognitive tests. We still do not have sufficient studies investigating the sociodemographic and biological variables that favor such elderly. Objectives: To investigate sociodemographic and lifestyle aspects of individuals aged 75+ years and cognitive performance similar to younger healthy elderly (60-69 years). Methods: In the Pietà study, a population-based investigation conducted in Caeté (MG), we evaluated 639 elderly individuals aged 75 years. After cognitive screening using the Mini-Mental State Examination, Brief Cognitive Battery and the Pfeffer Questionnaire, 132 healthy elderly subjects were identified (age: 79.8 ± 4.5 years; education: 3.0 ± 2.6 years; gender: 84F / 48M), who also underwent demographic and lifestyle questionnaires and extensive clinical and neuropsychological assessment, including the Rey Auditory-Verbal Learning Test (RAVLT). We considered successful brain aging individuals without cognitive or functional impairment who scored 9 points in subsection A7 (delayed recall) from the RAVLT, and usual brain aging, cognitively healthy and independent individuals who scored

Background Population aging is a global phenomenon whose main consequence is the increase of chronic degenerative diseases, including dementia. The aim of this case–control study was to evaluate the laboratorial parameters lipid profile, cortisol, and apolipoprotein E (APOE) gene genotype, comparing cognitively healthy controls and subjects with cognitive impairment no dementia (CIND) and dementia in a group of elderly people. Methods Three hundred and nine individuals enrolled in the Pieta Study (Brazil) were divided into three groups: control (n = 158), CIND (n = 92), and dementia (n = 59). Participants were interviewed, went through examination, and had blood samples taken. Results Age and APOE showed significant differences among the groups, while sex and lipid profile did not. According to multivariate regression logistic analyses, higher cortisol levels, lower high-density lipoprotein (HDL-c) and very low-density lipoprotein (VLDL-c), presence of e4 allele of APOE, and aging were associated with CIND and dementia. Conclusion These laboratorial parameters are risk factors associated to CIND and dementia in the elderly people and should be investigated in order to develop strategies to prevent or delay the onset of dementia in the oldest-old populations.

The low-educated elderly are a vulnerable population in whom studying the role of white matter integrity on memory may provide insights for understanding how memory declines with aging and disease. Methods: Thirty-one participants (22 women), 23 cognitively healthy and eight with cognitive impairment-no dementia, aged 80.4 ± 3.8 years, with 2.2 ± 1.9 years of education, underwent an MRI scan with diffusion tensor imaging (DTI) acquisition. We verified if there were correlations between the performance on the Brief Cognitive Screening Battery (BCSB) and the Rey Auditory Verbal Learning Test (RAVLT) with DTI parameters. Results: The BCSB delayed recall task correlated with frontotemporoparietal connection bundles, with the hippocampal part of the cingulum bilaterally and with the right superior longitudinal fasciculus. The RAVLT learning and delayed recall scores also correlated with the hippocampal part of the cingulum bilaterally. Conclusions: Although preliminary, our study suggests that the integrity of white matter frontotemporoparietal fasciculi seems to play a role in episodic memory performance in the low-educated elderly. This finding opens opportunities to study potential targets for memory decline prevention in vulnerable populations. RESUMO Idosos de baixo nível educacional representam uma população vulnerável em que o estudo do papel da integridade da substância branca na memória pode revelar como essa declina no envelhecimento. Métodos: Trinta e um indivíduos (22 mulheres), sendo 23 cognitivamente saudáveis, oito com comprometimento cognitivo não demência, 80,4 ± 3,8 anos de idade e 2,2 ± 1,9 anos de escolaridade, foram submetidos à RM com imagem de tensor de difusão, cujos parâmetros foram correlacionados com a Bateria Cognitiva Breve (BCSB) e o Teste Auditivo Verbal de Rey (RAVLT). Resultados: A evocação tardia da BCSB correlacionou-se com fascículos de conexão frontotemporoparietal, fascículo longitudinal superior direito e cíngulo parte hipocampal bilateral, sendo que esse último também correlacionou com o RAVLT (aprendizado e evocação tardia). Conclusão: Apesar de preliminar, nosso estudo sugere que a integridade da substância branca parece ser importante para a memória em idosos de baixa escolaridade, achado que revela alvo potencial na prevenção do seu declínio em populações vulneráveis.

Recently, there has been an increasing number of studies on exceptional cognitive aging. Herein, we aim to objectively provide the operationalized characterization of older adults with unusually high memory ability. Some authors have defined them as "SuperAgers", individuals aged 80 years or older with memory ability similar or superior to middle-aged subjects. On the other hand, the terminology "high-performing older adults" (HPOA) seems to appropriately conceptualize these individuals without exaggeration. A threshold for age is not a reliable criterion, but may be defined as 75 and 80 years of age for developing and developed countries, respectively. We propose that HPOA may exhibit episodic memory test scores equal to or greater than those of individuals aged 50-60 years, according to the validated tables for the respective country. This group must also have global cognition scores within expected average values for age and education. Executive functioning may play a central role in the exceptional memory performance of this group. Further studies are essential to confirm existing findings and may provide important evidence for cognitive aging theory and the neurobiology of dementia.O número de estudos sobre envelhecimento cognitivo acima da média vem crescendo recentemente. Neste trabalho, nosso objetivo é fornecer a caracterização operacionalizada de idosos com capacidade de memória excepcionalmente alta. Certos autores definem-nos “Superidosos”, indivíduos com 80 anos ou mais com habilidade de memória similar a adultos de meia-idade. No entanto, a terminologia “idosos de alto desempenho” parece definir de maneira apropriada esses indivíduos, sem restrição excessiva. Apesar de um limite de idade ser imperfeito, ele pode ser definido como 75 ou 80 anos, em países em desenvolvimento ou desenvolvidos, respectivamente. Nós propomos que os idosos de alto desempenho devam ter escores em testes de memória episódica de indivíduos entre 50 a 60 anos, de acordo com tabelas validadas para o país. Esse grupo também deve ter escores de cognição global dentro da média para idade e educação. O funcionamento executivo pode ter um papel central no desempenho excepcional de memória desse grupo. Mais estudos são essenciais para confirmar a existência desses achados e podem fornecer evidência importante para teoria de envelhecimento cognitivo e a neurobiologia das demências.

Background This study aimed to compare serum cortisol concentrations in cognitively healthy elderly and in subjects with cognitive impairment no dementia (CIND) and dementia, besides to evaluate these concentrations according to apolipoprotein E genotype (APOE). Methods Three-hundred and nine elderly enrolled in the Pieta Study (Brazil) were divided in 3 groups: control (n = 158), CIND (n = 92) and dementia (n = 59) and had concentrations of morning serum cortisol measured. Hormone concentrations were measured by chemiluminescence and APOE genotypes were determined by PCR followed by restriction fragment length polymorphism (RFLP). Results Medians of cortisol concentrations (μg/dl) for the groups were 12.14 (interquartile range — IQR 6.34) for control, 13.65 (IQR 5.88) for CIND and 14.47 (IQR 7.35) for dementia. Significant differences were observed for control vs. CIND (P = 0.003), control vs. dementia (P = 0.001), but not for CIND vs. dementia (P = 0.269). No association was observed between cortisol concentrations and APOE genotype among the groups (P = 0.348). Conclusions The elevation in cortisol concentrations is associated with dementia, independently of APOE genotypes. Further studies are required to understand if elevation of cortisol is an initial event and how hippocampal damage and the loss of hypothalamus–pituitary–adrenal (HPA) axis inhibition may affect its concentrations.