Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization

Pereira, Marcos Leandro; Vasconcelos, Thiago Henrique Ferreira de; Oliveira, Amanda Aparecida Rocha de; Campagnolo, Sarah Bárbara; Figueiredo, Sarah de Oliveira; Guimarães, Ana Flávia Bereta Coelho; Barbosa, Maira Tonidandel; Miranda, Luís Felipe José Ravic de; Caramelli, Paulo; Souza, Leonardo Cruz de

doi:10.1590/1980-57642021dn15-010009

Cited by 7 publications

(10 citation statements)

References 44 publications

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“…24 The only Brazilian study we found that compared the prevalence of spontaneous and directed complaints had a population sample of 91 individuals above the age of 50, of which only 14% had spontaneous complaints, while 76% had complaints when directed. 25 In addition, as in findings from other population-based studies, we found a higher prevalence of SMCs in women. 10,26 Women with SMCs have shown greater neurodegeneration when compared to men with SMCs, 10,27 and also a trend toward evolving with more cognitive impairment.…”

Section: Discussionsupporting

confidence: 89%

“…Another point that may be related to this slightly higher prevalence is the fact that our study considered directed complaints rather than spontaneous ones, which tend to have a higher prevalence 24 . The only Brazilian study we found that compared the prevalence of spontaneous and directed complaints had a population sample of 91 individuals above the age of 50, of which only 14% had spontaneous complaints, while 76% had complaints when directed 25 …”

Section: Discussionmentioning

confidence: 83%

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Subjective memory complaints: Prevalence, associated factors and sex differences in the ELSI‐Brazil study

Pinho,

Bertola,

Ramos

et al. 2023

Int J Geriat Psychiatry

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BackgroundSubjective memory complaints (SMCs) are a possible prodrome of cognitive decline but are understudied in low‐ and middle‐income countries (LMIC). We aimed to estimate the prevalence of SMCs in a large, nationally representative sample of older adults from Brazil and to identify sociodemographic and health‐related factors that are associated with SMCs independently of objective memory.MethodsBaseline data (n = 7831) from the ELSI‐Brazil study, a national representative sample of adults aged 50 and over. They were asked to rate their memory and then divided into two groups ‐ having or not having SMCs. Logistic regression models were used to estimate the association of demographic characteristics, health related factors, objective memory performance and disability in basic (b‐ADL), instrumental (i‐ADL), and advanced (a‐ADL) activities of daily living associated with SMCs. Whether sex was an effect modifier of the association between age and objective memory performance and SMCs was also tested.ResultsOf the sample, 42% (95% CI; 39.9–43.9) had SMCs, and it was higher among women (46.9%) than men (35.9%). SMC prevalence decreased with age among women and increased among men, and for both it decreased with better cognitive performance. Fully adjusted logistic regression model showed that older age, higher education, higher b‐ADL scores, and better cognitive performance were associated with decreased SMCs, while being female, with higher number of chronic conditions, higher i‐ADL scores, worst self‐rated health, and an increased number of depressive symptoms were associated with increased SMCs. However, the interaction test (p < 0.001) confirmed that increased age was associated with decreased SMCs only among women, and that better objective memory performance was associated with decreased SMCs only among men.ConclusionsSMCs are common in the Brazilian older population and are associated with health and sociodemographic factors, with different patterns between men and women. There is a need for future studies looking at the cognitive trajectory and dementia risk in older adults with subjective cognitive complaints.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 83%

Subjective memory complaints: Prevalence, associated factors and sex differences in the ELSI‐Brazil study

Pinho,

Bertola,

Ramos

et al. 2023

Int J Geriat Psychiatry

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“…It is considered that the emphasis of the intervention on comprehensive aspects such as promoting a healthy lifestyle, providing information on cognitive functioning in aging, managing emotions, demystifying cultural stereotypes related to the elderly, among other aspects may have favored the positive results found in this study. In accordance, Metternich et al found that expectancy change training (interventions that focus on cognitive restructuring and/or psychoeducation) positively influenced subjective memory complaints 31 .…”

Section: Discussionmentioning

confidence: 67%

Promoting cognitive health: a virtual group intervention for community-living older adults

Vasques

Almeida

Toldrá

et al. 2023

Dement. neuropsychol.

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Group cognitive interventions can promote a sense of self-efficacy to older adults. Due to restrictive social distancing measures in the COVID-19 pandemic, face-to-face interventions that aimed to promote cognitive health needed to be adapted to a virtual offering. Objectives: This study aimed to analyze the effects of promoting cognitive health in a virtual group intervention for community-living older adults. Methods: This is a mixed, prospective, and analytical study. Before and after the intervention, the tests were applied: Brief Cognitive Screening Battery (BCSB) and the Subjective Memory Complaints Questionnaire (MAC-Q). Data were collected at semi-structured interviews related to the adoption of memory strategies. Statistical tests were conducted for initial and final intragroup comparison. The qualitative data were assessed using thematic analysis. Results: A total of 14 participants concluded the intervention. With respect to mnemonic strategies, the most relevant for the qualifier “Did not use it before and started to do so after the group” were association (n=10; 71.4%) and dual-task inhibition (n=9; 64.3%). According to the tests, the intervention improved incidental, immediate, and delayed recall, as well as the perception of memory for “Remembering the name of the person they just met,” “Remembering the telephone number you use at least once a week,” “Remembering where they put an object,” “Remembering news from a magazine article or television program,” and “In general, how would you describe your memory now compared to when you were 40 years old.” Conclusions: The synchronous virtual group intervention was shown to be feasible for the elderly in the community who participated in the study.

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“…In the absence of a systematic screening program in Brazil, cognitive impairment is typically detected during a visit to the health team, either because of a subjective memory complaint or as part of a geriatric exam that commonly includes a brief, standardized cognitive test, such as the Mini‐Mental State Examination (MMSE). However, most cases of cognitive impairment are detected late in primary care, 19 or not at all because of limited training in and experience with memory care, 20 which has also been reported in other countries 21 . One study estimated a median delay of 1.5 years between onset of dementia symptoms and diagnosis, mostly because impairment was considered normal aging 22 .…”

Section: Resultsmentioning

confidence: 99%

Preparedness of the Brazilian health‐care system to provide access to a disease‐modifying Alzheimer's disease treatment

Mattke

Filho

Hanson

et al. 2022

Alzheimer's & Dementia

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Background: While the majority of patients with Alzheimer's disease resides in low and middle-income countries, little is known of their preparedness for emerging disease-modifying treatments. We analyze the preparedness of Brazil, one of the most populous middle-income countries, from a capacity and institutional preparedness perspective.Methods: Desk research and 12 interviews for background and capacity data. Markov model to estimate wait times for access to treatment.Findings: Brazil has no national dementia strategy or established pathway for evaluation of cognitive concerns, and dementia is typically diagnosed late if at all. While members of private health plans have ready access to elective specialty care, wait times in the public sector are long. Assuming potentially treatment-eligible patients are referred from primary to specialty care based on a brief cognitive exam and a blood test for the Alzheimer's pathology, available capacity will not be sufficient to match the projected demand. The biggest obstacle is availability of dementia specialist visits, and the effect of population growth and ageing means that the wait list for specialist appointment will continue to grow from around 400,000 in 2022 to over 2.2 million in 2040. We do not project substantial wait times for confirmatory biomarker testing and treatment delivery but note that this is a consequence of patients waiting for their specialist appointments. These queues will result in estimated persistent wait times for treatment of around two years on average with substantial differences between the public and private sectors, as capacity growth is insufficient to keep up with increasing demand.Discussion: Our findings suggest that Brazil is ill-prepared to provide timely access to an Alzheimer's treatment with predicted wait times of about two years, largely because of a limited number of dementia specialists.

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Memory complaints at primary care in a middle-income country: clinical and neuropsychological characterization

Cited by 7 publications

References 44 publications

Subjective memory complaints: Prevalence, associated factors and sex differences in the ELSI‐Brazil study

Subjective memory complaints: Prevalence, associated factors and sex differences in the ELSI‐Brazil study

Promoting cognitive health: a virtual group intervention for community-living older adults

Preparedness of the Brazilian health‐care system to provide access to a disease‐modifying Alzheimer's disease treatment

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