Programa de entrenamiento de memoria para mayores con alteraciones de memoria: resultados y predictores

IntroductionDeficits in memory performance in later life are frequent and well documented. There are several terms that refer to this phenomenon and the most commonly used is age associated memory impairment (AAMI). Currently, cognitive or memory training programmes are increasingly being used to treat this deficit. The Department of Health of the City of Madrid has developed a multifactorial memory training programme for older people which is carried out in 13 City Health Centres.ObjectivesTo study the effects of this programme in a sample of users aged more than 65 years with memory impairment, to determine the persistence of the results after 6 months, and to investigate predictors of results.Patients and methodThe sample was composed of 1,083 subjects who underwent memory training. The subjects were assessed before and after training and after 6 months. Among other tests, the Mini Examen Cognoscitivo (MEC), the Rivermead Behavioural Memory Test (RBMT), the Geriatric Depression Scale (GDS), and Memory Failures of Everyday (MFE) were used. The training method used (UMAM method) was developed by the Memory Unit of the City of Madrid.ResultsObjective memory improvement for the entire group was 40% (Cohen’s «d», 0.95) and 77% of the subjects improved. Seventy- five percent of the subjects improved in subjective memory functioning (Cohen’s «d», 0.64). Improvement in mood was also observed. These changes were maintained after 6 months. The predictive variables were age, MEC, GHQ and GDS scores before training, but the percentage of explained variance was very low.ConclusionsThe multifactorial memory training programme, UMAM, improves objective and subjective memory functioning in older people with memory impairment and the benefits persist after 6 months. The predictive value of the variables studied is low.     

Efecto de 8 semanas de entrenamiento con vibraciones en la tercera edad

Introduction

Physical activity has been shown to maintain or improve autonomy in the elderly. It has also been demonstrated that vibration exercise in adults achieves rapid benefits. This study analyses the effects of an 8-week program of reduced volume vibration training on autonomy and strength in a group of elderly subjects.

Material and methods

The 23 participants (18 women and 5 men, aged between 70 and 92 years, mean age 81.2 years) underwent a training program of five 30-second series of mechanical vibrations at 25 Hz and 2 mm wavelength three times a week for eight weeks. The isometric strength of the extensor muscles of the knee was assessed with a MuscleLab^® gauge, and autonomy was tested with the “Expanded-Timed-Get-Up-and-Go” (ETGUG) test, both before and immediately after the eight weeks of the program and then eight weeks afterwards.

Results

Significant differences were detected between the three time points in strength, and also in total time taken to complete the ETGUG and the various sections of the test, with the exception of the time taken to stand up and to turn.The vibration training program significantly improved the time taken to complete the ETGUG and strength after eight weeks of training. However, these benefits only endured for walking speed, not for strength.

Discussion

The results of the ETGUG test revealed significant changes overall. However, in two sections (standing up and turning) the differences were not significant, probably because the results do not depend exclusively on participants’ physical capacity but are also related to their coordination skills.

Conclusions

Eight weeks of reduced volume vibration training in the elderly improved autonomy, but not isometric strength.     

Experiencia con el uso del registrador implantable de eventos en una serie de personas mayores con caídas y sospecha de síncopes de origen arrítmico

Objective

To review our experience on using an implantable loop recorder (ILR) in patients with recurrent falls, when an arrhythmogenic cause is suspected.

Material and methods

This is a retrospective, observational study of patients with repetitive unexplained falls, suspected syncope, or electrocardiographic abnormalities. All of them had been evaluated by a cardiologist, who decided to implant a loop recorder (ILR) for an accurate diagnosis.

Results

A total of 13 patients received an ILR. The average falls rate for the sample was 3.3. The mean age was 78 years, and 46% were female, with a mean follow-up period of 24 months. During this time, three patients did not suffer from a new fall. An arrhythmogenic diagnosis was obtained in 5 patients: bradycardia was identified in 4 cases, and tachycardia in one of them. The symptoms did not coincide with a documented arrhythmia in the rest of the patients.

Conclusion

ILR is a helpful tool to establish an arrhythmogenic cause of unexplained and recurrent falls, in this selected sample of older adults.     

La evaluación de la calidad de vida en personas con demencia

Quality of life (QoL) is one of the most important outcome variables in the study of the efficacy of interventions with people with dementia. However, its assessment is difficult 1) because it is a complex construct for which there is no unified theoretical or conceptual approach, and 2) because of the inherent difficulties in the cognitive impairments of the people under study. In this work different methods and instruments to this end are reviewed, and related findings are discussed. It is important to take into account the subjective view of the assessed person, as assessments done by proxies tend to underestimate QoL. In spite of the need for further development in this field, it is concluded that the instrument of choice is the QOL-AD, as it is change-sensitive, it correlates with health measurements, it is translated into several languages and it can be administered to people with low MMSE scores.     

Hipertiroidismo y captaciones de yodo bajas en una paciente con enfermedad de Graves

Thyrotoxicosis factitia is defined as thyrotoxicosis resulting from exogenous ingestion of thyroid hormone, usually in patients with a psychiatric disorder. Diagnosis can be difficult and this entity should be suspected in patients with high free tiroxine (T4) concentrations, low or suppressed thyroglobulin concentrations, normal urinary iodide excretion and low or suppressed ¹³¹I uptake. To establish the differential diagnosis, thyrotoxicosis factitia must be distinguished from several diseases with low ¹³¹I uptake, such as Graves’ disease, subacute thyroiditis, hyperthyroidism due to excessive iodine intake, struma ovarii and metastasis from thyroid cancer. Treatment is based on b-blockers to reduce symptoms and avoid iatrogeny. We present a case of thyrotoxicosis factitia treated in our outpatient clinic.     

Calidad de vida y sobrecarga de los cuidadores de pacientes con daño cerebral adquirido

Introduction

The health impact of acquired brain injury (ABI) is not only apparent in the patient, but also in the loss of health related quality of life (HRQol) of their carers. The objectives of this study were to measure the loss of HRQol as well as the burden of the carers of patients with ABI.

Material and methods

A retrospective study was conducted with 76 carers of patients with ABI. A questionnaire was used to collect information on the sociodemographic aspects, carer burden (Zarit Scale) and the HRQol (EuroQol Questionnaire) of the carers. A multiple linear regression model was constructed to analyse the effect of the different variables.

Results

The carers were predominantly women over 50 years, retired or dedicated to domestic tasks and who cared for their husband or one of their parents. One third showed a high risk of claudication. The mean HRQol obtained with the EuroQol went from a similar score to that of the general population (0.9) in the group without burden, to 0.67 in the group with risk of claudication. The regression models explained the burden better than the loss in quality of life.

Conclusions

Carers of patients with brain injury suffer a significant loss in HRQol compared to the general population. The deterioration arises from the mental dimensions and depends on the level of burden.     

La calidad de vida en ancianos polimedicados con multimorbilidad

Objectives

To estimate the values of the quality of life dimensions using the SF-12 questionnaire in the elderly on polymedication and with multiple morbidities, and identify the variables associated with it.

Material and methods

A cross-sectional study on a sample of 393 patients selected from the elderly population over 67 years and who took more than 5 drugs. The SF-12 was complemented by a personal interview in the clinic or in the home of the patient. Central tendency, dispersion, and the percentiles of the 8 dimensions were calculated, as well as the SF-36 physical and mental component summary measures (PCS and MCS). All patients below the 25th percentile of the PCS and MCS were classified as patients with a deterioration. Logistic regression was used to determine the variables that were associated with the deterioration in the quality of life.

Results

It is a population with high morbidity. The subjects showed very low scores on the general health scales −mean (SD): 25.7 (17.4)−; physical function −32.6 (32.1)−; and PCS: [(37.8 (25.1)]. Women had a worse quality of life than men in all the scales. Female sex, being over 80 years, frequent falls, chronic pain, cancerous disease, and depression, are variables that determine the health-related quality of life (HR-QoL).

Conclusion

This population has a poor HR-QoL, particularly in the physical dimensions. Chronic pain and depression, together with age and being female are variables that determine the deterioration in the HR-QoL.