Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde ABSTRACT OBJECTIVE:To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS:The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS:The mean age of the sample was 47.3 years (SD=16.8) and the mean education was 9.7 years (SD=5; range: 1 -17). A total of 32.4% of the sample showed literacy/numeracy defi cits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not signifi cant when the effects of education were held constant (rp=-0.031, p=0.584). A signifi cant association (B=3.877, Beta=0.733; p<0.001) was found between schooling and scores. Age was not a signifi cant predictor in this model p=0.584). CONCLUSIONS:The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classifi ed as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Oxidative stress has been associated with normal aging and Alzheimer's disease (AD). However, little is known about oxidative stress in mild cognitive impairment (MCI) patients who present a high risk for developing AD. The aim of this study was to investigate plasma production of the lipid peroxidation marker, malonaldehyde (MDA) and to determine, in erythrocytes, the enzymatic antioxidant activity of catalase, glutathione peroxidase (GPx), glutathione reductase (GR), and glutathione S-transferase (GST) in 33 individuals with MCI, 29 with mild probable AD and 26 healthy aged subjects. GR/GPx activity ratio was calculated to better assess antioxidant defenses. The relationship between oxidative stress and cognitive performance was also evaluated by the Mini Mental State Examination (MMSE). AD patients showed higher MDA levels than both MCI and healthy elderly subjects. MCI subjects also exhibited higher MDA levels compared to controls. Catalase and GPx activity were similar in MCI and healthy individuals but higher in AD. GR activity was lower in MCI and AD patients than in healthy aged subjects. Additionally, GR/GPx ratio was higher in healthy aged subjects, intermediate in MCI and lower in AD patients. No differences in GST activity were detected among the groups. MMSE was negatively associated with MDA levels (r = -0.31, p = 0.028) and positively correlated with GR/GPx ratio in AD patients (r = 0.68, p < 0.001). MDA levels were also negatively correlated to GR/GPx ratio (r = -0.31, p = 0.029) in the AD group. These results suggest that high lipid peroxidation and decreased antioxidant defenses may be present early in cognitive disorders.

Population aging has been accompanied by worldwide growth in dementia. However, little is known about the prevalence of dementia and cognitive impairment not dementia in ethnically diverse populations, such as indigenous populations conceptualized as groups of persons who self-identify as indigenous and who are recognized as distinctive communities reproducing ancestral, historical, and territorial culture. This is particularly relevant in view of increasing life expectancy in indigenous populations and, consequently, in the number of elderly people, as well as the changes in their multimorbidity profile. In this study, a systematic review of the literature on the subject "cognitive impairment in indigenous elderly population" in the databases MEDLINE via PubMed, Lilacs, and Scopus showed that the prevalence of dementia in indigenous populations between 45 and 94 years old, originally from different countries, varied between 0.5% and 26.8% for age 60 and older, whereas the prevalence of cognitive impairment not dementia varied between 4.4% and 17.7%. Early onset of the disease, older age, low education level, and several poor health conditions were associated with prevalence rates and conversion from normal to any cognitive impairment. Cultural inadequacy of neuropsychological tests was the main factor reported in the selected studies, which makes the investigation of dementia a challenge in indigenous populations. These data reveal that the prevalence rates of dementia ranged from low to very high for those aged 60 years and older, with early onset of the disease and elevated mortality rate after initial diagnosis compared with the current global prevalence studies, suggesting that these individuals may be more vulnerable to cognitive disorders. Cognitive reserve and exposure to poor health status throughout life span may be considered in the interpretation of results.

An inverted U-shape function between cortisol levels and memory performance has been reported in studies on both young animals and humans. Yet little is known about this relationship in normal aging or in older subjects with cognitive impairment. This issue is particularly significant since increased levels of cortisol have been reported in Alzheimer's disease (AD). The present study examined the association between cortisol levels and visual memory performance in healthy subjects as well as in individuals presenting mild cognitive impairment (MCI) or AD. Salivary cortisol was measured in 40 healthy elderly subjects, 31 individuals with amnestic MCI, and 40 subjects with mild probable AD. Memory performance was evaluated using the Brief Cognitive Screening Battery. Higher cortisol levels were associated with better memory performance in healthy elderly (p=0.005), while higher cortisol levels were correlated with poorer memory performance in MCI subjects (p=0.011). No correlation between cortisol and memory was found in the AD group (p > 0.05). These results suggest that the relationship between cortisol levels and memory performance in the aging process could vary according to the presence or absence of cognitive impairment.

Several studies have demonstrated a wide cognitive variability among aged individuals. One factor thought to be associated with this heterogeneity is exposure to chronic stress throughout life. Animal and human evidence demonstrates that glucocorticoids (GCs), the main class of stress hormones, are strongly linked to memory performance whereby elevated GC levels are associated with memory performance decline in both normal and pathological cognitive aging. Accordingly, it is believed that GCs may increase the brain’s vulnerability to the effects of internal and external insults, and thus may play a role in the development of age-related cognitive disorders such as Alzheimer’s disease (AD). The aim of this review article was to investigate the effects of GCs on normal and pathological cognitive aging by showing how these hormones interact with different brain structures involved in cognitive abilities, subsequently worsen memory performance, and increase the risk for developing dementia.