Abstract Introduction Loneliness and social isolation are known risk factors for cognitive decline; their effect in older adults (OA) after COVID-19 lockdown is emerging. Objective To establish an association between loneliness and social isolation, with daily cognitive function in Mexican OA during the first wave of the COVID-19 pandemic. Method Cross-sectional study, derived from the cohort “The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America”, which included 308 OA recruited between March-August 2020 whose daily cognitive function were determined with the Everyday Cognition Scale (E-Cog) as dichotomized score (cut point: 1.31 for normal cognition). Loneliness and social isolation were binomial variables. Results The mean age was 65.4 ± 7.9 years, 75.7% were women. The mean continuous E-Cog score was 57.4 (SD = ± 19.1), 49.1% had a score < 1.31 (normal cognition), while 50.9% had a higher score (cognitive impairment). Eighty four percent of participants reported loneliness, 79.9% reported social isolation. Multivariate regression model showed a negative and statistically significant association between social isolation and loneliness and E-Cog, adjusted by age, sex and education level (β = -.046, 95% CI = [-.8, -.013], p = .007; β = -.16, 95% CI = [-.08, -.018], p = .003), and a positive association with subjective memory complaint (β = .81, 95% CI = [-.16, -.11], p = < .001). Discussion and conclusion These data suggest the need for increased vigilance of those who have loneliness and social isolation due to its potential deleterious effect on cognitive function.

Resumen Introducción La soledad y el aislamiento social son factores de riesgo conocidos para el deterioro cognitivo; su efecto en las personas mayores (PM) después del confinamiento por COVID-19 está emergiendo. Objetivo Establecer una asociación entre la soledad y el aislamiento social, con la función cognitiva diaria en PM mexicanas durante la primera ola de la pandemia por COVID-19. Método Estudio transversal derivado de la cohorte “The impact of COVID 19 on well-being, cognition, and discrimination among older adults in the United States and Latin America”, incluyó 308 AM reclutados de marzo-agosto 2020, la función cognitiva diaria fue evaluada con Everyday Cognition Scale (E-Cog) con un punto de corte 1.31 (cognición normal); la soledad y el aislamiento social fueron variables binomiales. Resultados La media de edad fue 65.4 ± 7.9 años, 75.7% mujeres. E-Cog promedio fue 57.4 (DE = ± 19.1), 49.1 % tenía una puntuación < 1.31 (cognición normal), 50.9% > 1.31 (deterioro cognitivo). Ochenta y cuatro por ciento de los participantes reportaron soledad, 79.9% aislamiento social. El modelo de regresión multivariado mostró una asociación negativa y estadísticamente significativa entre aislamiento social y soledad con E-Cog (β = -.046, IC 95% = [-.8, -.013], p = .007; β = -.16, IC 95% = [-.08, -.018], p = .003), y una asociación positiva con queja de memoria subjetiva (β = .81, IC 95% = [-.16, -.11], p = < .001) ajustado a edad, sexo y escolaridad. Discusión y conclusión Estos datos sugieren la necesidad de una mayor vigilancia de quienes presentan soledad y aislamiento social debido a su potencial efecto deletéreo sobre la función cognitiva.

Abstract The Everyday Cognition (ECog) scale was created to evaluate the functional abilities of older adults across a wide range of abilities between normal aging and dementia. ECog screens cognitive alterations such as subjective cognitive decline (SCD) and mild cognitive impairment (MCI). This early recognition is done by the measurement of the ability to perform the activities of daily living (ADLs). Objective: To establish the cross-cultural adaptation, validity, and reliability of the ECog Mexican version (M-ECog) in participants with: SCD, MCI, and dementia coming from a memory clinic. Methods: There were 200 patients and their respective informants in a memory clinic of a third level hospital in Mexico City. Four groups were studied: 50 cognitively healthy (CH), 50 SCD, 50 MCI, and 50 dementia. The clinical evaluation included: sociodemographic and health characteristics, cognitive status by the Mini-Mental State Evaluation (MMSE) and Montreal Cognitive Evaluation Spanish version (MoCA-E), and caregiver information (informants) about the difficulty in ADLs as well as the ECog Spanish version (M-ECog). Results: The M-ECog was significantly correlated with MMSE, MoCA-E, and ADLs. It showed the ability to discriminate the different cognitive declines (Cronbach’s alpha 0.881). The intra-class correlation coefficient was 0.877 (95% confidence interval — CI, 0.850–0.902; p<0.001). The patient’s group area under curve (AUC) of M-ECog for SCD was 0.70 (95%CI 0.58–0.82, p<0.005), for MCI it was 0.94 (95%CI 0.89–0.99, p<0.001) and for dementia 0.86 (95%CI 0.79–0.92, p<0.001). Conclusion: The M-ECog scale proves to be valid and reliable for measuring everyday abilities mediated by cognition. It is self-applicable without requiring extensive prior formation. It is useful to screen for SCD and MCI in older Mexican adults.

RESUMO A escala Cognição Cotidiana (ECog) foi criada para avaliar as habilidades funcionais de idosos em uma ampla gama de habilidades entre o envelhecimento normal e a demência. O ECog rastreia alterações cognitivas como declínio cognitivo subjetivo (DCS) e comprometimento cognitivo leve (CCL). Esse reconhecimento precoce é feito pela mensuração da capacidade de realizar as atividades de vida diária (AVD). Objetivo: Estabelecer a adaptação transcultural, validade e confiabilidade da versão mexicana do ECog (M-ECog) em participantes com: SCD, MCI e demência provenientes de uma clínica de memória. Métodos: Foram 200 pacientes e seus respectivos informantes em uma clínica de memória de um hospital de terceiro nível na Cidade do México. Quatro grupos foram estudados: 50 cognitivamente saudáveis (CH), 50 SCD, 50 MCI e 50 com demência. A avaliação clínica incluiu: características sociodemográficas e de saúde, estado cognitivo pelo Mini-Mental State Evaluation (MMSE) e Montreal Cognitive Evaluation versão em espanhol (MoCA-E), bem como informações do cuidador (informantes) sobre a dificuldade nas AVD e o ECog versão em espanhol (M-ECog). Resultados: O M-ECog foi significativamente correlacionado com MMSE, MoCA-E e AVD. Mostrou capacidade de discriminar os diferentes declínios cognitivos (alfa de Cronbach 0,881). O coeficiente de correlação intraclasse foi de 0,877 (intervalo de confiança de 95% — IC95%, 0,850–0,902; p<0,001). A AUC do grupo do paciente de M-ECog para SCD foi de 0,70 (IC95% 0,58–0,82, p<0,005), para MCI foi de 0,94 (IC95% 0,89–0,99, p<0,001) e para demência foi de 0,86 (IC95% 0,79–0,92, p<0,001). Conclusão: A escala M-ECog mostra-se válida e confiável para medir habilidades cotidianas mediadas pela cognição. É autoaplicável sem exigir extensa formação prévia. É útil para rastrear MSC e MCI em adultos mexicanos mais velhos.

Resumen La Arteriopatía Cerebral Autosómica Dominante con Infartos Subcorticales y Leucoencefalopatía (CADASIL), es producida por mutaciones en el gen NOTCH3, es la causa hereditaria más común de accidentes cerebrovasculares isquémicos repetidos. Objetivo: establecer el desempeño cognitivo en portadores asintomáticos con las mutaciones R1031C Y R141C. Método: estudio observacional, analítico transversal. Se dividieron en tres grupos: portadores asintomáticos con mutación R1031C (𝑛 = 39), asintomáticos con mutación R141C (𝑛 = 8) y no portadores (𝑛 = 50). Resultados: se encontraron diferencias estadísticamente significativas (𝑝 < 0.05) entre el grupo de portadores asintomáticos de la mutación R1031C y los no portadores en praxias construccionales, función ejecutiva y razonamiento abstracto. En la mutación R141C, se observaron puntuaciones bajas en función ejecutiva y cálculo mental. Conclusiones: los portadores asintomáticos de las dos mutaciones evidenciaron bajo rendimiento en memoria de trabajo, abstracción mental y velocidad de procesamiento, pudiendo estar asociados como biomarcadores cognitivos preclínicos, antes del primer evento vascular o los primeros síntomas.

Abstract CADASIL is the most common hereditary cause of repeated ischemic strokes, and has also been identified as a model of pure vascular dementia. The objective of this study was to establish the cognitive performance of asymptomatic carriers with the mutations R1031C and R141C. This observational crosssectional analytical study divided subjects into three groups: asymptomatic carriers of the R1031C mutation (𝑛 = 39), asymptomatic carries of the R141C mutation (𝑛 = 8) and noncarriers (𝑛 = 50). Statistically significant differences were found (𝑝 < 0.05) between the group of the R1031C mutation and the noncarriers in constructional praxis, executive function and abstract reasoning. For the R141C mutation, scores below expected values in executive function and mental calculation were observed. It is concluded that asymptomatic carriers of the two mutations showed low performance in working memory, mental abstraction and processing speed, which could be associated with preclinical cognitive biomarkers preceding the presentation of the first vascular event.