ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions. racecolor race color (IC domains middleaged middle aged cohort objective regions crosssectional cross sectional 20152016 2015 2016 2015–201 ELSIBrazil. ELSIBrazil ELSI Brazil . (ELSI-Brazil) verbal fluency, fluency , fluency) gait velocity/handgrip, velocityhandgrip velocity/handgrip velocity handgrip velocity/handgrip) Center Depression Moreover selfreported self reported vision andor or impairment criteria 9070 9 070 9,07 5 years. years years) 80 41 controls 180 1 1.80 95%CI 95CI CI 95 142228 42 2 28 1.42–2.28 0001 0 001 0.00 141 1.41 121165 21 65 1.21–1.65 0.001. 291 91 2.91 189447 89 4 47 1.89–4.47 251 51 2.51 209 09 2.0 302 3 02 3.02 62 162 1.62 1.02–2.57 102257 57 32 132 1.32 1.10–1.57 110157 10 South aging 2015201 201 2015–20 (ELSI-Brazil 907 07 9,0 8 18 1.8 14222 1.42–2.2 000 00 0.0 14 1.4 12116 6 1.21–1.6 29 2.9 18944 1.89–4.4 25 2.5 20 2. 30 3.0 16 1.6 1.02–2.5 10225 13 1.3 1.10–1.5 11015 201520 2015–2 90 9, 1. 1422 1.42–2. 0. 1211 1.21–1. 1894 1.89–4. 3. 1.02–2. 1022 1.10–1. 1101 20152 2015– 142 1.42–2 121 1.21–1 189 1.89–4 1.02–2 102 1.10–1 110 1.42– 12 1.21– 1.89– 1.02– 1.10– 11 1.42 1.21 1.89 1.02 1.10 1.2 1.0 1.1

ABSTRACT OBJECTIVE This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction. Additionally (IADL macroregion crosssectional cross sectional ELSIBrazil. ELSIBrazil ELSI . (ELSI-Brazil) populationbased population noninstitutionalized non institutionalized communitydwelling community dwelling 5 7 country stratification addition group gender level North, (North Southeast Midwest, Midwest , Midwest) selfreported self reported health multimorbidity falls 8849 8 849 8,84 94% 94 (94% 28.5% 285 28 (28.5 351 35 1 35.1% respectively. respectively respectively) fluency 4.8% 48 4 (4.8 55 5.5% respectively, 2.3%. 23 2.3% 2 3 (2.3%) 5.8% 58 (5.8% (ELSI-Brazil 884 84 8,8 9 (94 28.5 (28. 35.1 4.8 (4. 5.5 2.3 (2.3% 5.8 (5.8 88 8, (9 28. (28 35. 4. (4 5. 2. (2.3 (5. ( (2 (2. (5

RESUMO Objetivos: Os objetivos do presente estudo foram avaliar o comportamento sedentário e os níveis de atividade física antes e durante da pandemia de COVID-19 em indivíduos saudáveis e com diagnóstico autorreportado de ansiedade e/ou depressão e identificar os facilitadores e barreiras para a prática de atividade física nessas populações. Métodos: Trata-se de uma pesquisa de corte transversal baseada em um questionário de autorrelato aplicado durante o período de pandemia da COVID-19. Resultados: Na amostra total (N = 1.285), a prevalência de comportamento sedentário (>8 horas/dia) aumentou em 25% durante o isolamento social. O isolamento social aumentou o tempo sedentário e diminuiu os níveis de atividade física em indivíduos saudáveis, com ansiedade e/ou depressão autorreportada. Nos dois grupos, os facilitadores mais prevalentes foram a atividade física supervisionada (antes da pandemia) e as atividades e equipamentos para a prática em casa (durante a pandemia). As barreiras mais prevalentes foram a falta de tempo para realizar atividades físicas (antes da pandemia) e os locais inacessíveis ou distantes para a prática (durante a pandemia). Conclusão: A pandemia de COVID-19 está relacionada a aumento do comportamento sedentário e redução dos níveis de atividade física. Mudanças significativas nas barreiras percebidas e facilitadores ao exercício foram observadas durante o período de isolamento social. Objetivos COVID19 COVID 19 COVID-1 eou populações Métodos Tratase Trata se COVID19. 19. Resultados N 1.285, 1285 1.285 , 1 285 1.285) >8 8 (> horas/dia horasdia horas dia 25 autorreportada grupos pandemia. . Conclusão COVID1 COVID- 128 1.28 28 > ( 2 12 1.2 1.

ABSTRACT Objectives: The objectives of the present study were to assess sedentary behavior and physical activity levels before and during the COVID-19 pandemic in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression, and also identify facilitators and barriers to physical activity in these populations. Methods: This is a cross-sectional survey based on a self-report questionnaire applied during the COVID-19 pandemic period. Results: In the total sample (N = 1,285) the prevalence of sedentary behavior (>8 hours/day) increased by 25% during social isolation. Social isolation increased sedentary time and decreased physical activity levels in healthy individuals and in those with self-reported diagnosis of anxiety and/or depression. In both groups, the most prevalent facilitators were supervised physical activity (before the pandemic) and activities and equipment to practice at home (during the pandemic). The most prevalent barriers were the lack of time to perform physical activities (before the pandemic) and inaccessible or distance places to practice (during the pandemic). Conclusion: The COVID-19 pandemic is related to an increased sedentary behavior and reduced physical activity levels. Significant changes in perceived barriers and facilitators to exercise were observed during the social isolation period. Objectives COVID19 COVID 19 COVID-1 selfreported self reported andor depression populations Methods crosssectional cross sectional selfreport report period Results N 1,285 1285 1 285 >8 8 (> hours/day hoursday hours day 25 groups pandemic. . Conclusion COVID1 COVID- 1,28 128 28 > ( 2 1,2 12 1,

ABSTRACT OBJECTIVE To investigate associations among race/color, gender, and intrinsic capacity (IC) (total and by domains) in middle-aged and older adults from a Brazilian cohort. As a secondary objective, we investigate these associations across Brazilian regions. METHODS This is a cross-sectional study conducted with baseline data from the 2015–2016 Brazilian Longitudinal Study of Aging (ELSI-Brazil). IC was investigated via cognitive (verbal fluency), physical (gait velocity/handgrip), and psychosocial (Center for Epidemiological Studies Depression) domains. Moreover, IC sensory domain was evaluated via self-reported sensory disease diagnoses (vision and/or hearing impairment) and race/color was identified via self-reported criteria. RESULTS We evaluated a total of 9,070 participants (aged ≥ 50 years). Black and Brown participants were 80% and 41% more likely to show a worse IC cognitive domain than white controls, respectively (OR = 1.80, 95%CI: 1.42–2.28, p < 0.001 and OR = 1.41, 95%CI: 1.21–1.65, p < 0.001). Moreover, Black and Brown women had almost a threefold greater chance of showing a worse IC than white men (OR = 2.91, 95%CI: 1.89–4.47, p < 0.001 and OR = 2.51, 95%CI: 2.09 - 3.02, p < 0.001) and a 62% (OR = 1.62, 95%CI: 1.02–2.57) and 32% (OR = 1.32, 95%CI: 1.10–1.57) greater risk of falling below our IC score cutoff point than white women. We found the greatest differences in the Brazilian South, whereas its North showed the lowest associations among race/color, gender, and IC. CONCLUSION IC racial and gender disparities reinforce the need for public health policies to guarantee equality during aging. Promoting greater access to good health care requires understanding how racism and sexism can contribute to health inequities and their consequences in different Brazilian regions.

ABSTRACT OBJECTIVE This study aims to investigate handgrip strength and dynapenia prevalence among older adults stratified by Brazilian macroregions. Additionally, we aim to evaluate the overlap between dynapenia and Instrumental Activities of Daily Living (IADL) disability, depression, and executive dysfunction on a national basis and by each Brazilian macroregion. METHODS This cross-sectional analysis was based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). A multistage cluster sample design was used, with a representative population-based study of non-institutionalized community-dwelling Brazilians aged ≥ 50 years from 70 municipalities across all five macroregions of the country. The outcome variable was dynapenia. Covariables were IADL disability, depression, and executive dysfunction. The Brazilian macroregions were used for stratification. In addition, the following additional variables were included: age group, gender, education level, macroregions (North, Northeast, Southeast, South, and Midwest), self-reported health, multimorbidity, and falls. RESULTS A total of 8,849 (94%) of the sample provided complete information for the handgrip strength assessment and were included in this analysis. Dynapenia prevalence was higher in North and Northeast regions (28.5% and 35.1%, respectively). We identified statistically significant differences between different macroregions for dynapenia, IADL disability, and verbal fluency, with worse values in the North and Northeast regions. In the North and Northeast macroregions, nearly half of the subjects that presented executive dysfunction and IADL disability also had dynapenia. There was a more significant overlap in the prevalence of all four conditions in the North and Northeast regions (4.8% and 5.5%, respectively), whereas the overlap was smaller in the South (2.3%). There was also a smaller overlap in the prevalence of dynapenia and depression in the South (5.8%) compared with other macroregions. CONCLUSIONS Macroregions in Brazil exhibit marked differences in the prevalence of dynapenia and in its overlap with IADL disability, depression, and executive dysfunction.

RESUMO. O isolamento social é necessário na pandemia de COVID-19, mas pode impactar a saúde mental, especialmente em idosos com demência, dada a alta prevalência de sintomas neuropsiquiátricos. Apesar da prática de exercícios físicos contribuir para a redução desses sintomas e a melhora da qualidade de vida, houve um aumento de comportamento sedentário durante a pandemia. Objetivo: Comparar os sintomas neuropsiquiátricos e a qualidade de vida de idosos com distúrbios neurocognitivos que participaram de um programa de exercícios físicos online voltado a pacientes sedentários durante a pandemia de COVID-19. Métodos: Neste estudo de corte transversal, 25 idosos diagnosticados com transtorno neurocognitivo (controle=11; exercícios online=14) foram avaliados por meio do inventário neuropsiquiátrico (INP) e da escala de qualidade de vida na doença de Alzheimer (QV-DA). Resultados: Observou-se diferença entre os grupos no INP total (U=36,50, p=0,025), com tamanho de efeito grande (effect size [ES]=-1,03, intervalo de confiança - IC95% -1,83 a -0,16), e no subdomínio sono (U=38,00, p=0,033), com tamanho de efeito grande (ES=-1,06, IC95% -1,86 a -0,19), favoráveis ao grupo fisicamente ativo. Na QV-DA, houve diferença entre os grupos apenas no subitem memória (U=20,00, p=0,005), com tamanho de efeito grande (ES=1,59, IC95% 0,59 a 2,48), não houve diferença na pontuação total (U=45,5, p=0,277). Conclusões: Idosos submetidos a rotina de exercícios físicos com supervisão online na pandemia de COVID-19 apresentam menos sintomas neuropsiquiátricos, melhor qualidade de sono e memória quando comparados aos fisicamente inativos. Estudos randomizados controlados devem ser feitos para a melhor compreensão dos efeitos do exercício físico nos sintomas neuropsiquiátricos de pacientes com demência durante períodos de isolamento social.

ABSTRACT. Social isolation is necessary during the COVID-19 pandemic but can be harmful to mental health, especially in people with neurocognitive disorders. Although physical exercise can alleviate neuropsychiatric symptoms and improve quality of life (QoL), sedentary behavior increased during the pandemic. Online interventions can contribute to improving physical activity and mental health. Objective: The objective of this study was to compare the neuropsychiatric symptoms and QoL of older adults with neurocognitive disorders who participated in an online physical exercise program with sedentary patients during the COVID-19 pandemic. Methods: In this cross-sectional study, 25 older patients with neurocognitive disorders (control group=11; online exercise group=14) were evaluated based on Neuropsychiatric Inventory (NPI) and the Quality of Life in Alzheimer’s Disease (QoL-AD) scale. Results: There were differences between the two groups in the total NPI (U=36.50, p=0.025) and the nighttime behavior disturbances item (U=38.00, p=0.033), both with large effect sizes (ES=-1.03, 95% confidence interval [CI]:-1.83 to -0.16 and ES=-1.06, 95%CI -1.86 to -0.19, respectively). In terms of QoL-AD, a difference was identified only in the memory subitem (U=20.00, p=0.005), with a large ES (1.59, 95%CI 0.59-2.48). Conclusions: Older adults with neurocognitive disorders who participated in an online physical exercise program, during the COVID-19 pandemic, showed fewer neuropsychiatric total symptoms, fewer nighttime disturbances episodes, and better subjective memory, compared to their physically inactive counterparts. Randomized controlled trials should be performed to better understand the effect of physical exercise in neuropsychiatric symptoms in dementia patients during periods of social isolation.

RESUMO Objetivo Determinar o nível de associação entre sintomas depressivos e habilidades cognitivas de idosos institucionalizados. Métodos Trata-se de um estudo transversal que envolveu 69 idosos residentes em uma instituição de longa permanência. A investigação dos sintomas depressivos em todos os indivíduos foi realizada por meio da escala de depressão geriátrica. Os testes cognitivos de fluência verbal, digit span forward (DSF) e backward (DSB)e os testes físicos de marcha estacionária de dois minutos, de sentar e levantar e o teste de caminhada de seis minutos foram realizados para avaliar sua associação com sintomas depressivos. Resultados Sintomas depressivos foram identificados em 35 indivíduos. Baixos desempenhos cognitivo e físico foram associados à presença de sintomas depressivos – Miniexame do Estado Mental [t (61) = 2,36; p < 0,05] e Teste de marcha estacionária de dois minutos [t (53) = 3,12; p < 0,05]. A memória de curto prazo e os testes de memória operacional mostraram piores resultados em indivíduos com sintomas depressivos (DSF: U = 402,00; p < 0,05 e DSB: U = 341,00; p < 0,05). Idosos com escores abaixo do normal no DSF tiveram 5 vezes mais chance de apresentar sintomas depressivos. Conclusão Destaca-se a importância de estratégias de intervenção físicas, cognitivas e sociais em instituições de longa permanência para idosos, a fim de privilegiar a autonomia. Notavelmente, apresenta-se uma associação entre déficit na capacidade de memória de curto prazo e a presença de sintomas depressivos em adultos mais velhos. Sugerem-se, então, estudos prospectivos que investiguem a relação de causa-efeito dessa associação com a institucionalização de idosos.

ABSTRACT Objective To determine the level of association between depressive symptoms and cognitive abilities of institutionalized older adults. Methods This is a cross-sectional study that enrolled 69 older adults, living in a long-term care facility. Investigation of depressive symptoms in all individuals was performed using the geriatric depression scale. Cognitive verbal fluency, digit span forward (DSF) and backward (DSB) tests, and two-minute stationary gait, sit-to-stand test, and six-minute walk test were performed to assess their association with depressive symptoms. Results Depressive symptoms were identified in 35 individuals. Worse cognition and physical performances were associated with the presence of depressive symptoms – Mini-Mental State Examination [t (61) = 2.36; p < 0.05] and Stationary gait test of two minutes [t (53) = 3.12; p < 0.05]. Short-term memory and working memory tests presented worse results in individuals with depressive symptoms (DSF: U = 402.00; p < 0.05 e DSB: U = 341,00; p < 0.05). Older adults with scores below normal in DSF were 5 times more likely to exhibit depressive symptoms. Conclusion The importance of physical, cognitive and social intervention strategies in long-term care facilities for the older adults is highlighted, in order to privilege autonomy. Notably, there is an association between deficits in short-term memory and the presence of depressive symptoms in older adults. Therefore, prospective studies are suggested to investigate the cause-effect relationship of this association with the institutionalization of older adults.

Abstract Introduction Individuals with major depressive disorder (MDD) face more barriers to engagement in sports and exercise interventions. Evaluating clinical and demographic factors associated with adherence to sports and exercise among MDD outpatients could support development of new options and strategies to increase their participation. Methods In a cross-sectional study, 268 depressed outpatients were evaluated (83.51% females; mean age = 50.74 [standard deviation {SD} = 10.39]). Sports and exercise participation were assessed using a question about participation frequency during the previous month. Clinical and demographic factors were evaluated. Linear regression was used to identify predictors of participation in sports and exercise. Results MDD patients with mild symptoms of depression (odds ratio [OR] = 2.42; 95% confidence interval [95%CI] 1.00, 5.88; p = 0.04) and patients with mild to moderate symptoms (OR = 3.96; 95%CI 1.41, 11.15; p = 0.009) were more likely to engage regularly in sports and exercise than patients with more severe depression. Moreover, smoking (OR = 0.23; 95%CI 0.67, 0.80; p = 0.007) and being divorced (OR = 0.22; 95%CI 0.57, 0.86; p = 0.03) were associated with lower rates of engagement in sports and exercise. Conclusion Our findings indicate a significant association between clinical and demographic factors and participation in sports and exercise among MDD outpatients.

RESUMO Objetivo Avaliar a acurácia de duas categorias semânticas do teste de fluência verbal (categorias de supermercado e animal) para separar idosos saudáveis e pacientes com doença de Alzheimer com baixa escolaridade. Métodos Avaliamos 69 idosos com menos de 5 anos de escolaridade, consistindo em 31 idosos saudáveis e 38 pacientes diagnosticados com a doença de Alzheimer. A fluência verbal semântica foi avaliada nas categorias animal e supermercado. O teste de Mann-Whitney U e o teste t independente foram usados para comparar os dois grupos, e a precisão diagnóstica dos testes foi analisada por sensibilidade, especificidade, razão de verossimilhança e área sob a curva (AUC). Resultados Encontramos uma diferença significativa entre os grupos de idosos saudáveis e com doença de Alzheimer, tanto na fluência verbal de animais (p = 0,014) quanto na de supermercado (p < 0,001). A categoria supermercado apresentou melhor precisão diagnóstica geral (AUC = 0,840; IC 95% = 0,746-0,933; p < 0,001) em comparação com a categoria animal (AUC = 0,671; IC 95% = 0,543-0,800; p = 0,014). Conclusão A categoria supermercado de fluência verbal semântica fornece melhor acurácia do que a categoria animal para a identificação de demência em uma população idosa brasileira com baixo nível educacional.

ABSTRACT Objective Evaluate the accuracy of two semantic categories of the verbal fluency test (supermarket and animal categories) to separate healthy elderly individuals and lower educated Alzheimer’s disease patients. Methods We evaluated 69 older adults with less than 5 years of schooling, consisting of 31 healthy elderly, and 38 patients diagnosed with Alzheimer’s disease. Semantic verbal fluency was evaluated using the animal and supermarket categories. Mann-Whitney U and Independent t Tests were used to compare the two groups, and the diagnostic accuracy of the tests was analyzed by sensitivity, specificity, likelihood ratio’s, and the Area Under the Curve (AUC). Results We found a significant difference between the healthy older and Alzheimer’s disease groups, in both, animal (p = 0.014) and supermarket verbal fluency (p < 0.001). The supermarket category showed better overall diagnostic accuracy (AUC = 0.840, 95% CI = 0.746-0.933; p < 0.001) compared to the animal category (AUC = 0.671, 95% CI = 0.543-0.800; p = 0.014). Conclusion The supermarket category of semantic verbal fluency provides better accuracy than the animal category for the identification of dementia in a Brazilian elderly population with low educational level.

RESUMO Objetivo Pesquisas em instituições de longa permanência para idosos (ILPI) mostram uma associação entre o aumento de risco de declínio cognitivo e o comprometimento das habilidades de navegação espacial dos idosos. A navegação espacial pode ser definida como uma habilidade complexa, que depende de funções cognitivas e motoras, emergindo como um importante marcador de estadiamento da demência. O presente estudo teve por objetivo comparar a navegação espacial de idosos saudáveis; institucionalizados e com demência Métodos Foi realizado um estudo de corte transversal com 78 idosos (saudáveis = 37, demência = 22, institucionalizados = 19) avaliados por meio do Miniexame do estado mental (MEEM), Floor Maze Test (FMT) e 8-foot-up-and-go (8UG). Uma ANOVA One-way foi realizada para comparar os grupos. Resultados Como esperado, o grupo saudável foi mais ágil, tanto no FMT imediato ( X 2 = 31,23; p < 0,01) quanto no tardio ( X 2 = 41,21; p < 0,01). Quando comparados os grupos demência e institucionalizados, não houve diferença significativa no MEEM e FMT tardio. Porém, os idosos institucionalizados mostraram piores resultados que o grupo demência no FMT imediato (p < 0,01) e no teste 8UG (p < 0,01). Conclusão Os resultados indicam um pior desempenho na navegação espacial, função executiva e habilidades motoras dos idosos em ILPI e com demência. A possibilidade de idosos institucionalizados serem subdiagnosticados deve ser considerada.

ABSTRACT Objective Long-term care facilities (LTCF) are associated with an increased risk of cognitive decline and impairment in spatial navigation abilities. Recent studies have demonstrated that spatial navigation as a complex skill, involving cognitive and motor functions, emerging as a new marker for the progression of dementia. The present study aims to compare spatial navigation in healthy, institutionalized, and AD elderly subjects. Methods In a cross-sectional study, we evaluated 78 elderly individuals (healthy = 37, AD = 22, institutionalized = 19) using the Mini-Mental State Examination (MMSE), Floor Maze Test (FMT) and 8-foot-up-and-gotest (8UG) to assess global cognitive function, spatial navigation and motor function, respectively. Results In the FMT, the immediate maze time (IMT) and delay maze time (DMT) were significantly shorter in the healthy group than those of the institutionalized and AD groups ( X 2 = 31.23; p < 0.01) and ( X 2 = 41.21; p < 0.01), while there were no significant differences between the AD and institutionalized groups in terms of the DMT and MMSE results. However, the institutionalized group showed worse results in terms of IMT (p < 0.01) and 8UG (p < 0.01) than those in the dementia group. Conclusion Our results indicate that both institutionalized older people and patients with Dementia have a deficit in the spatial navigation ability, cognitive functions and motor skills. We should consider that there might be a possibility of underdiagnosis in institutionalized older people.

RESUMO Objetivos Avaliar a utilidade de pontos de corte (PC) de força de preensão palmar (FPP) para identificar fraqueza e incapacidade em atividades instrumentais de vida diária (AIVDs) em idosos com transtorno neurocognitivo. Métodos Neste estudo de corte transversal, foram recrutados idosos saudáveis (n = 36), com comprometimento cognitivo leve (CCL, n = 22) e doença de Alzheimer (DA, n = 40). Os PCs incluídos foram o European Working Group for Sarcopenic Older People (EWGSOP2), o Cardiovascular Healthy Study (CHS) e o Frailty in Brazilian Older People Study do Rio de Janeiro (FIBRA RJ). Índices de FPP foram calculados dividindo-se o valor da FPP pelos valores de PC, e a prevalência de fraqueza para cada PC foi comparada entre os grupos. Análises de correlação foram empregadas para avaliar a relação entre a escala de Lawton e a FPP (valores brutos e índices). Resultados Todos os índices de FPP foram menores no grupo DA (p < 0,05), enquanto a prevalência de fraqueza foi significativamente maior na DA apenas quando o PC do CHS foi aplicado (DA = 47,5%, CCL e controles = 18,2%, p < 0,01). Foi identificada uma correlação significativa positiva entre a escala de Lawton e índices com todos os PCs (p < 0,05), porém não entre escala de Lawton e valor bruto da FPP (p = 0,75). Conclusões Apenas o PC do CHS permitiu diferenciação apropriada na prevalência de fraqueza entre os grupos. Além disso, o ajuste da FPP de acordo com os PCs foi necessário para determinar a correlação entre força e incapacidade em AIVDs em indivíduos idosos com comprometimento cognitivo.

ABSTRACT Objectives To evaluate the utility of handgrip strength cut-offs for the identification of weakness and Instrumental Activities of Daily Living (IADL) disability in elderly people with neurocognitive disorders. Methods Cross-sectional study of community-dwelling elderly individuals with Alzheimer’s disease (AD, n = 40) and mild cognitive impairment (MCI, n = 22); healthy individuals (n = 36) were recruited as controls. Handgrip cut-offs included European Working Group for Sarcopenic Older People (EWGSOP2), Cardiovascular Healthy Study (CHS) and the Frailty in Brazilian Older People Study from Rio de Janeiro (FIBRA RJ) cut-offs. Handgrip strength indexes were calculated by dividing handgrip strength values by cut-off values and the weakness prevalence for each cut-off value was compared among groups. Correlation analyses were employed to evaluate the relationship between Lawton Scale and handgrip strength (crude value and indexes). Results All handgrip strength indexes were lower in the AD group (p < 0.05), whereas the prevalence of weakness was significantly higher in the AD group only when the CHS cut-off was applied (AD = 47.5%, MCI and control = 18.2%, p < 0.01). Significantly positive correlations were identified between the Lawton ADL scale and handgrip indexes for all cut-offs (p < 0.05), but not between Lawton scale and crude handgrip (p = 0.75). Conclusions Only the CHS cut-off allowed proper differentiation of the weakness prevalence between groups. In addition, adjusting handgrip strength values according to cut-offs was necessary to determine the correlation between strength and disability in cognitively impaired elderly individuals.

RESUMO. Ferramentas clínicas adicionais devem ser investigadas para facilitar e auxiliar o diagnóstico prévio do declínio cognitivo. O controle postural piora com o envelhecimento e este fato pode estar relacionado com o comprometimento cognitivo patológico. Objetivo: comparar o equilíbrio de adultos idosos sem demência no grupo controle (GC) e com doença de Alzheimer (DA), observar as possíveis associações com as variáveis independentes (diagnóstico, idade, sexo e estado cognitivo global) e verificar as melhores análises posturográficas para determinar a diferença entre os grupos. Métodos: 86 idosos (DA = 48; GC=38) foram avaliados utilizando a escala de equilíbrio Berg (EEB) e o controle postural pela estabilometria no Wii Balance Board ® (WBB). Testes T independente, Mann Whitney U, o tamanho de efeito (TE) e uma regressão linear foram realizados. Resultados: houve diferença significativa para AE, VT, ML com OA e OF, AP com OF e EEB entre os grupos. Estas variáveis mostraram um TE grande para EEB (-1.02), AE (0,83) com OF, ML (0,80; 0,96) e VT (0,92; 1,10) com OA e OF, respectivamente. A regressão indicou que a cognição global acompanhada da idade, gênero e diagnóstico contribuem para as alterações do controle postural. Conclusão: pacientes com DA apresentam comprometimento do controle postural quando comparados a idosos saudáveis. A VT com OF foi o parâmetro mais sensível para diferenciar os grupos e deve ser melhor investigada como possível biomarcador motor de demência na análise posturográfica com o WBB.

ABSTRACT. Additional clinical tools should be investigated to facilitate and aid the early diagnosis of cognitive decline. Postural control worsens with aging and this may be related to pathological cognitive impairment. Objective: to compare the balance of older adults without dementia in a control group (CG) and with Alzheimer’s disease (AD), to observe the possible association with the independent variables (diagnosis, age, gender, and global cognition) and to verify the best posturographic analyses to determine the difference between the groups. Methods: 86 older adults (AD = 48; CG = 38) were evaluated using the Berg Balance Scale (BBS) and postural control was assessed by stabilometry on the Wii Balance Board ® (WBB). Independent T, Mann-Whitney U-tests, Effect Size (ES) and a linear regression were performed. Results: there was a significant difference for Elliptical Area, Total Velocity, Medio-Lateral displacements with closed eyes and open eyes, antero-posterior, with closed eyes and BBS between groups. These variables showed a large effect size for BBS (-1.02), Elliptical Area (0.83) with closed eyes, Medio-Lateral (0.80, 0.96) and Total Velocity (0.92; 1.10) with eyes open and eyes closed, respectively. Regression indicated global cognition accompanied by age, gender, and diagnosis influenced postural control. Conclusion: patients with AD showed impaired postural control compared to Control Group subjects. Total Velocity with closed eyes was the most sensitive parameter for differentiating groups and should be better investigated as a possible motor biomarker of dementia in posturographic analysis with WBB.

Resumo Introdução: A depressão maior (DM) é uma doença associada ao estresse crônico que pode apresentar um desequilíbrio nos níveis de cortisol, podendo ser recuperado com a remissão dos sintomas. O exercício tem sido utilizado como uma ferramenta para promover mudanças nos níveis de cortisol em indivíduos saudáveis. No entanto, não se sabe se o exercício produz os mesmos resultados em indivíduos com DM. Objetivo: Revisar evidências de alterações dos níveis de cortisol após o exercício em indivíduos com DM. Métodos: Foi realizada busca nas bases de dados PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus e PsycInfo. Procedeu-se a metanálise com o cálculo do tamanho do efeito da diferença de média padronizada. Foi utilizado o software Stata v.11.0. Resultados: Foram obtidos na busca 463 estudos. Após o procedimento de seleção, cinco artigos com sete análises foram incluídos. O tipo de exercício, frequência de treinamento, tipo de medida do cortisol e tipo de grupo controle foram analisados como subgrupos. Houve uma redução dos níveis de cortisol no grupo de exercício. Além disso, a análise de sensibilidade e análises de subgrupos revelaram um efeito do tipo (exercício aeróbico) e da frequência (cinco vezes por semana) de exercício na redução dos níveis de cortisol. No entanto, esses resultados devem ser interpretados com cautela, devido ao pequeno número de estudos e uma heterogeneidade substancial entre eles. Conclusão: O exercício promove redução dos níveis de cortisol em indivíduos com DM. No entanto, esse achado pode ser influenciado pelo tipo de exercício, medida do cortisol e frequência semanal.

Abstract Introduction: Major depressive disorder (MDD) is a prevalent medical illness that is associated with chronic stress. Patients with MDD can show an imbalance in cortisol levels, which can be restored with the remission of symptoms. Physical exercise training has been used as a tool to promote changes in cortisol levels in healthy individuals. However, it is unknown if exercise can produce the same results in individuals with MDD. Objective: To review evidence of cortisol changes after exercise training in individuals with MDD. Methods: We conducted a search on PubMed, SciELO, LILACS, ISI Web of Knowledge, Scopus, and PsycInfo databases. Random effects meta-analysis was performed and standardized mean difference (SMD) effect size was calculated. Analyses of forest and funnel plots was conducted using Stata v.11.0 software. Results: At first, 463 studies were obtained in the search. After completion of the selection procedure, five articles with seven analyses were included. Type of exercise, frequency of training, cortisol measurement, and type of control group were analyzed. There was a reduction of cortisol levels in the exercise group (SMD = −0.65, 95%CI 1.30-0.01). Moreover, sensitivity analysis and subgroup analyses revealed an effect of type (aerobic exercise) and frequency (five times per week) of exercise on reduction of cortisol levels. However, these results should be interpreted cautiously due to the small number of studies and a substantial heterogeneity among them. Conclusion: Physical exercise promotes a reduction in cortisol levels in individuals with MDD. However, this finding can be influenced by type of exercise, weekly frequency, and type of cortisol measurement.

RESUMO Objetivo Avaliar a capacidade cardiorrespiratória em idosos com depressão maior (DM), doença de Alzheimer (DA) e saudáveis, subjetiva (nomograma VSAQ) e objetivamente (2-minute STEP). Métodos Cinquenta e sete idosos (72 ± 7,9 anos) foram divididos em três grupos: DM (n = 20), DA (n = 17) e saudáveis (n = 20). Os sujeitos responderam a escala de Hamilton (HAM-D), Miniexame do Estado Mental (MEEM), VSAQ (Veterans Specific Activity Questionnaire) e o teste 2-minute Step. Resultados DM e DA apresentaram menores escores comparados aos saudáveis no nomograma VSAQ (p < 0,001) e no teste Step (p = 0,009 e p = 0,008). Controlado por idade e escolaridade, não houve diferenças entre os grupos no Step (DM, p = 0,097; DA, p = 0,102). DA também não mostrou diferenças no STEP em comparação aos saudáveis, quando controlado pelo MEEM (p = 0,261). Conclusões Apesar de a menor aptidão cardiorrespiratória de idosos com DM e DA ter sido encontrada nas duas avaliações, os resultados devem ser observados com cautela, uma vez que os testes apresentaram baixa correlação e classificações de risco de perda funcional divergentes. Além disso, a idade, o nível educacional e a capacidade cognitiva são variáveis que podem influenciar o desempenho na avaliação objetiva.

ABSTRACT Objective To assess cardiorespiratory capacity through subjective and objective tests in older adults diagnosed with major depression (MDD), Alzheimer disease (AD) and healthy older adults. Methods Fifty seven subjects (72 ± 7.9 years) were divided into three groups: MDD (n = 20), AD (n = 17) and Healthy (n = 20). The subjects answered Hamilton Scale (HAM-D), Mini-Mental State Examination (MMSE), Veterans Specific Activity Questionnaire (VSAQ) and 2-minute Step test. Results MDD and AD showed lower scores than healthy group for Nomogram VSAQ (p < 0.001) and 2-minute Step (p = 0.009; p = 0.008, respectively). Adjusted for age and educational level, no differences among groups were observed for Step (MDD, p = 0.097; AD, p = 0.102). AD group did not present differences to healthy group for Step, when adjusting for MMSE (p = 0.261). Conclusions Despite the lower cardiorespiratory fitness of elderly patients with DM and DA have been found in both evaluations, the results should be viewed with caution, since the tests showed low correlation and different risk classifications of functional loss. In addition, age, level educational and cognitive performance are variables that can influence the performance objective evaluation.

INTRODUÇÃO: O exercício físico parece estar relacionado à melhora na qualidade de vida (QdV), mas seus efeitos em populações de indivíduos idosos com depressão ou Doença de Alzheimer (DA) ainda não foram estabelecidos. Esta revisão sistemática avaliou estudos controlados randomizados sobre os efeitos do exercício físico sobre a QdV em idosos com diagnóstico clínico de depressão e DA.MÉTODOS: Foi feita uma busca nas bases de dados PubMed, ISI, SciELO e Scopus de dezembro de 2011 a junho de 2013 usando os seguintes descritores: exercício físico, qualidade de vida, idosos, depressão, doença de Alzheimer. Apenas seis estudos satisfizeram os critérios de inclusão: Dois com pacientes com DA e quatro com pacientes com depressão.RESULTADOS: Os estudos adotaram metodologias diferentes de prescrição de exercícios e avaliação de QdV, mas todos preencheram os requisitos de alta qualidade metodológica. Os resultados da maioria dos estudos com idosos com depressão sugerem que a QdV melhora com o treinamento físico, mas os estudos com pacientes com DA tiveram resultados divergentes.CONCLUSÕES: Apesar de os estudos usarem metodologias diferentes, seus resultados sugerem que os exercícios físicos são uma intervenção não-farmacológica efetiva para melhorar a QdV entre idosos com depressão e DA. Estudos futuros devem investigar os efeitos de outros fatores, tais como o uso de questionários específicos para idosos, a prescrição controlada de exercícios, e o tipo de grupo controle.

INTRODUCTION: Physical exercise has been associated with improvement of quality of live (QoL), but its effect among the elderly with depression and Alzheimer's disease (AD) is still unclear. This systematic review evaluated randomized and controlled studies about the effect of physical exercise on QoL of older individuals with a clinical diagnosis of depression and AD.METHODS:We searched PubMed, ISI, SciELO and Scopus from December 2011 to June 2013 using the following keywords: physical exercise, quality of life, elderly, depression, Alzheimer's disease. Only six studies met inclusion criteria: two examined patients with AD and four, patients with depression.RESULTS: The studies used different methods to prescribe exercise and evaluate QoL, but all had high quality methods. Findings of most studies with individuals with depression suggested that exercise training improved QoL, but studies with patients with AD had divergent results.CONCLUSIONS: Although different methods were used, results suggested that physical exercise is an effective non-pharmacological intervention to improve the QoL of elderly individuals with depression and AD. Future studies should investigate the effect of other factors, such as the use of specific scales for the elderly, controlled exercise prescriptions and type of control groups.