Academic literature on the topic 'Fragilità cognitiva'

Steven Stich's The Fragmentation of Reason will get the adrenalin pumping. At least it will for-reactionaries (like me) who cling to truth, reason and knowledge as cognitive values.Steve Stich sets himself to undermine the entire analytic tradition in epistemology. His book is infused with the spirit of the “radical epistemic reformer.” I do not think he succeeds. Reformations are hard to launch in philosophy. Nonetheless, he raises some deep and troubling issues.

Context: the fragility of the elderly served in a community health area and to characterize elderlies according to fragility criteria. Objective: to characterize the functional state in fragile bigger adults from the medical practice. Material and Methods: a descriptive, cross-sectional investigation with a quantitative approach was carried out between April 2017 and April 2018. Results: prevailed the alterations of mobility and balance in 54,8 %, only 16,1 % was alterations of the emotional state and 29,0 % was alterations functional cognitive. Conclusion: the presence of several fragility criteria such as elderlies older female sex with associated pathologies as hypertension.

Relacionar a fragilidade com variáveis clínicas de pacientes com Insuficiência Renal Crônica. Pesquisa transversal de caráter analítico, de abordagem quantitativa, com pacientes portadores de Insuficiência Renal Crônica em tratamento hemodialítico. Como instrumento de avaliação utilizou-se o prontuário físico funcional, e questionários para avaliação de fragilidade, função cognitiva, atividades de vida diária, depressão e atividade física no lazer, sendo os mesmos analisados por estatística descritiva e teste de correlação linear de Spearman, considerou-se p≤0,05. O aumento da fragilidade relacionou-se com o avanço da idade, com a redução da força de membros inferiores e da flexibilidade, além da redução da função cognitiva, dependência para a realização das atividades básicas de vida diária, bem como de sintomas depressivos. A fragilidade é uma síndrome frequente em paciente em HD, dessa forma, a avaliação e monitoramento das condições de saúde é essencial a fim de proporcionar uma melhor qualidade de vida a esta população.Descritores: Insuficiência Renal Crônica, Fragilidade, Hemodiálise. Relationship of fragility with clinical variables of patients with chronic kidney insufficiencyAbstract: To relate frailty with clinical variables of patients with Chronic Renal Failure. Cross-sectional research of an analytical character, with a quantitative approach, with patients with chronic renal failure undergoing hemodialysis. As an assessment instrument, the functional physical record and questionnaires were used to assess frailty, cognitive function, activities of daily living, depression and leisure-time physical activity, which were analyzed using descriptive statistics and Spearman's linear correlation test, considered up p≤0.05. The increase in frailty was related to advancing age, with the reduction of strength of the lower limbs and flexibility, in addition to the reduction of cognitive function, dependence for performing basic activities of daily living, as well as depressive symptoms. Frailty is a frequent syndrome in HD patients, so the evaluation and monitoring of health conditions is essential in order to provide a better quality of life for this population.Descriptors: Chronic Kidney Failure, Fragility, Hemodialysis. Relación de fragilidad con variables clínicas de pacientes con insuficiencia crónica de riñónResumen: Relacionar la fragilidad con las variables clínicas de pacientes con insuficiencia renal crónica. Investigación analítica transversal, con un enfoque cuantitativo, con pacientes con insuficiencia renal crónica sometidos a hemodiálisis. Como herramienta de evaluación, el registro físico funcional y los cuestionarios se utilizaron para evaluar la fragilidad, la función cognitiva, las actividades de la vida diaria, la depresión y la actividad física en el tiempo libre, que se analizaron mediante estadística descriptiva y la prueba de correlación lineal de Spearman arriba p≤0.05. El aumento de la fragilidad se relacionó con el avance de la edad, con la reducción de la fuerza de las extremidades inferiores y la flexibilidad, además de la reducción de la función cognitiva, la dependencia para realizar actividades básicas de la vida diaria, así como los síntomas depresivos. La fragilidad es un síndrome frecuente en pacientes con EH, por lo que la evaluación y el monitoreo de las condiciones de salud son esenciales para proporcionar una mejor calidad de vida a esta población.Descriptores: Insuficiencia Renal Crónica, Fragilidad, Hemodiálisis.

RÉSUMÉLa fragilité met les individus à un risque accru de mauvaise santé. Les personnes âgées consomment une quantité disproportionnée des ressources du service des urgence [SU]. Afin d’étudier la relation entre les marqueurs de fragilité et l’effet sur l’utilisation des services des urgence par les personnes âgées vivant dans les communautés, nous avons mené une analyse secondaire d’un essai prospectif randomisé contrôlé de 22 mois à Montreal, au Canada, en utilisant la base de données du Système de services intégrés pour personnes âgées en perte d’autonomie (SIPA). Nous avons evalué un échantillon de 565 individus, avec cinq marqueurs de fragilité : l’activité physique, la force, la cognition, l’énérgie et la mobilité. Une régression logistique univariée et multivariée a été réalisée afin d’évaluer la relation potentielle entre les marqueurs de fragilité et les visites aux urgences. Les résultats ont révelé que 70 pour cent des participants avaient au moins trois marqueurs de fragilité. Cependant, aucune relation n’a été trouvée entre les marqueurs de fragilité et les visites aux urgences. Ces résultats suggèrent, donc, que parmi les personnes âgées fonctionellement sévèrement handicapés au sein des communautés, la présence de marqueurs de fragilité ne semble pas prévoir les visites aux urgences.

Any global structure comprises of ideational and material elements. To put the idea into practice, members of the global community formulate rules and regulations and marshal resources to build capacities and institutions that can affect states and societies. Although the effects of the global structures on the state fragility are increasingly being recognized, the pathways through which they can affect the states contributing to its fragility or strengthening its resilience have been rarely examined. This paper aims at filling the void in the literature by offering a structural explanation of state fragility. The post 9/11 structure of the Global War on Terrorism (GWoT) has been taken as a proxy to theorize the pathways. It argues that the ideational and material factors of the GWoT operate through: (i) the cognitive pathway shaping the states’ thinking, interpreting and reasoning process (ii) the regulatory pathway creating demand for policy coordination, cooperation and compatible legal and procedural instruments for counter terrorism (CT) and their compliance (iii) the capability pathway shaping the states’ coercive capability, institutions and CT alliance building. The theorized pathways are illustrated through schematic diagrams showing how they can impact the states’ legitimacy and capacity dimensions contributing to the increase or decrease of the state fragility to facilitate their tracing in individual case studies. Finally, the paper makes comparative analysis of the cognitive, regulatory and capability pathways highlighting their relationship and relative significance.

Nutrition is an important factor for health, physical and cognitive function, vitality, quality of life and longevity. Elderly people oft en have low food intake, induced by multifactorial causes, as a result, malnutrition is an independent risk factor for increased morbidity and mortality, regardless of the underlying pathologies (chronic organ failure, cognitive impairment, cancer, cardiovascular disease, type 2 diabetes etc.) including overweight or obese subjects.The prevalence of malnutrition varies from 4% to 10% in the elderly population from the community, from 15% to 38% for institutionalized elderly people and from 30% to 70% for hospitalized ones. The purpose of this study was to assess the nutritional status of institutionalized elderly people and establish correlations between the determinants of malnutrition and fragility syndrome.Th e epidemiological study is part of the project 20.80009.8007.25 “Fragility: diagnosis and prophylaxis in relation to medicopsychosocial problems of the vulnerable elderly”, included 50 patients institutionalized in the Republican Asylum for the Disabled and Retired in Chisinau.All persons were examined by the complex geriatric evaluation, approved by the order of the Ministry of Health no. 619 of 07.09.2010. According to the results, both malnutrition and the risk of malnutrition were high in institutionalized elderly people.Among the determinants of malnutrition, the highest association had the number of concomitant diseases, decreased functionality of the elderly, the presence of depression syndrome and cognitive disorders. At the same time, the malnutrition syndrome correlated with the fragility criteria but also with the degree of severity of frailty of the institutionalized elderly people.

RÉSUMÉCette étude visait à déterminer (1) si des mesures de position sociale sont associées à la fragilité, (2) si une association observée entre la position sociale et la fragilité est un effet de seuil ou de gradient, et (3) si une relation observée est indépendante des facteurs de confusion possibles. Les données ont été tirées d’un échantillon de 1 751 adultes, habitants des communautés, âgés de 65 ans et plus, habitant la province canadienne de Manitoba en 1991. On a utilisé, comme mesures de la position sociale l’éducation, et la suffisance et la satisfaction du revenu selon auto-évaluation personnelle. La précarité a été classée selon la perte fontionnelle, la cognition et l’incontinence urinaire. Des analyses de régressions multiples ont révelés, après ajustement pour les facteurs possibles de confusion, que toutes les mesures de la position sociale étaient fortement associées à la fragilité par gradient d’effet, plutôt que d’effet de seuil. Nous concluons que les gradients sociaux de la fragilité sont présents chez les adultes âgés, même si un mécanisme causatif n’est pas encore clair.

Introduction: Cognitive impairment can hinder a fracture patient’s capacity to consent to surgery and negatively impact their postoperative recovery and rehabilitation. National guidelines recommend screening for cognitive impairment upon admission, and the Abbreviated Mental Test Score (AMTS) is a commonly used tool for this. This project aimed to assess current practice regarding documentation of AMTS among frail fracture patients upon admission and to improve AMTS documentation following a simple intervention. Methods: Baseline data were obtained by inpatient chart review throughout November to December 2018 in a district general hospital with emergency fracture services. All patients admitted with a fragility hip fracture and patients over 65 years with any fracture were included. National guidelines and baseline results were then distributed among junior doctors. Following an intervention, further data were collected throughout January to February 2019. Results: Preintervention, 40 suitable patients (mean age: 82 years) were identified; 9 (22.0%) of whom had an AMTS recorded upon admission. Among the hip fracture subgroup (n = 25), 7 (26.9%) had an AMTS recorded. Postintervention, 39 patients (mean age: 80 years) were identified; 15 (38.5%) of whom had an AMTS recorded. Among the hip fracture subgroup (n = 30), 11 (36.7%) had an AMTS recorded. Statistical analysis demonstrated a significant improvement in AMTS documentation both among the overall cohort ( P = .001) and hip fracture patients ( P = .019). No significant association was found between AMTS documentation and patient age ( P = .566), grade of admitting doctor ( P = .058), or prior cognitive/mental health disorder ( P = .256). Discussion: A small yet significant improvement in AMTS documentation among elderly/hip fracture patients was observed following distribution of educational material. Further work should explore the effect of cognitive impairment on outcomes related to orthopedic injuries beyond hip fractures.

La précarité est associée à une morbi-mortalité accrue. Ce phénomène est moins étudié auprès des sujets âgés qu’il ne l’est auprès des adultes jeunes. Pourtant, le vieillissement démographique et la précarisation de la population font que la France connait chaque jour davantage de personnes présentant cette double caractéristique d’être âgées et précaires. L’objectif de cette thèse est de mieux caractériser les liens existant entre la précarité – définie en son sens initial psycho-socio-économique – et deux problématiques du vieillissement que sont la cognition et la fragilité. Nous avons tout d’abord étudié le vieillissement cognitif au cours de 25 années de suivi de la cohorte Paquid. Cette étude a rapporté un déclin cognitif et un risque de démence majorés pour les personnes âgées précaires. Par la suite, nous avons complété cette première étude en y intégrant une mesure de précarité géographique et en appliquant une méthodologie statistique prenant en compte le risque compétitif de décès. Les résultats ont confirmé l’association entre la précarité psycho-socio-économique et le risque de démence, mais n’ont montré aucun effet de la précarité géographique. Mis en perspective avec les différents travaux scientifiques, ces études ont servi de base à une revue de la littérature sur l’impact de la précarité sur le vieillissement cognitif soumise pour publication. Enfin, un dernier travail a examiné les relations entre la précarité psycho-socio-économique, la fragilité et le décès. Sur la base de 14 années de suivi de la cohorte des 3 Cités, les résultats ont montré qu’aussi bien la précarité que la fragilité augmentent le risque de mortalité mais de manière indépendante. Ces travaux permettent de mieux comprendre ce qu’implique vieillir en situation de précarité et soulignent en particulier l’influence des déterminants psycho-sociaux de la précarité sur la santé, aussi bien en termes de survie que de santé cognitive
Precariousness is associated with higher morbi-mortality. This phenomenon is less studied among the elderly than it is among adults. Yet, the aging of the population, as well as the increasing precariousness of the population, implies that a growing number of people in France are experiencing both conditions of aging and precariousness. The objective of this thesis is to better characterize the links between precariousness - defined with a psychosocioeconomic approach - and two issues related to aging: cognition and frailty. We first studied cognitive aging over 25 years within the Paquid cohort study. This study reported an accelerated cognitive decline and an increased risk of dementia for the precarious elderly. Then, this study was completed by including a measure of geographical deprivation and by applying a statistical methodology taking into account the competing risk of death. The results confirmed the association between psychosocioeconomic precariousness and the risk of dementia, but did not show any effects of geographical deprivation. In link with previous scientific literature, these two works have been the basis of a literature review on the impact of precariousness on cognitive aging submitted for publication. A final study examined the relationship between psychosocioeconomic precariousness, frailty and death. Based on the 14 years of follow-up of the 3 Cities cohort study, the results showed that both precariousness and frailty increased the risk of death but independently. This thesis contributes to a better understanding of the impact of precariousness on aging and in particular, it emphasizes the influence of the psychosocial determinants of precariousness on health in terms of survival and better cognition

Introducció: La fragilitat és un estat de vulnerabilitat que predisposa a tenir esdeveniments adversos de salut com ara pèrdua d’autonomia, institucionalització i mort, malgrat tot no hi ha una definició operativa que es prengui com a referència i s’utilitzen diferents instruments per a la seva avaluació. La sarcopènia definida com una alteració de la massa i funció muscular també s’ha associat a esdeveniments adversos de la salut. L’objectiu d’aquesta tesi és determinar la prevalença de fragilitat i sarcopènia amb diferents instruments, i avaluar l’impacte dels problemes cognitius sobre la detecció i prevalença de la fragilitat. Mètodes: La població objecte d’estudi són les persones de 65 anys o més no institucionalitzades que no estiguin en les etapes finals de la vida. Es van seleccionar mitjançant mostreig aleatori d’un registre d’usuaris de l’Atenció Primària, estratificant en funció de la presència de problemes cognitius. S’han seleccionat instruments per detectar la fragilitat que poguessin ser utilitzats a l’atenció primària. L’avaluació de la sarcopènia s’ha realitzat seguint els criteris de l’European Working Group of Sarcopenia in Older People (EWGSOP) Resultats: La prevalença de fragilitat amb els criteris de Sheerbrooke és del 64%. Amb la resta de criteris oscil·la entre el 4% i el 34%. Les prevalences amb els instruments basats en el fenotip físic son més baixes i estables fins els 80 anys, mentre que amb els instruments multidimensionals són més elevades i s’incrementen més precoçment. Els problemes cognitius són el factor de risc més importants per la fragilitat i afecten negativament la concordança dels instruments utilitzats. Els criteris de Sheerbrooke no concorden amb la resta d’ instruments. En persones sense problemes cognitius les concordances dels altres instruments en general és bona, sent més alta entre instruments de la mateixa classe. La prevalença de sarcopènia és del 19% (3% en homes i 30% en dones) i s’incrementa amb l’edat sense que la presència de problemes cognitius afecti la prevalença. Conclusions: La prevalença de fragilitat varia ostensiblement en funció de l’instrument utilitzat i de la presència de problemes cognitius. La prevalença de la sarcopènia es veu afectada principalment pel sexe. En persones sense problemes cognitius l’ús d’instruments de detecció de fragilitat de la mateixa classe en general afecta poc els resultats.
Introducción: La fragilidad es un estado de vulnerabilidad que predispone a tenir aconteciomientos adversos de salud como pérdida de autonomia, institucionalización y muerte, aunque no hay una definición operativa que se tome como referencia y se utilizan diferentes instrumentos para su evaluación. La sarcopénia definida como una disminución de la masa y función muscular también se ha asociado a acontecimientos adversos de salud. El objetivo de esta tesis es determinar la prevalencia de fragilidad y sarcopènia con diferentes instrumentos y evaluar el impacto de los problemas cognitivos sobre la prevalencia y detección de la fragilidad. Métodos: La población objeto de estudio está constituida por personas no institucionalizadas de 65 años o más que no estén en la etapa de final de vida. La muestra se ha seleccionado a partir del registru de usuarios de un centro de atención primaria mediante muestreo aleatorio estratificado en función de la presencia de problemas cognitivos. Se han seleccionado instrumentos para avaluar la fragilidad que pudieran ser utilizados en atención primaria. La evaluación de la sarcopenia se ha realitzado siguiendo los criterios del European Working Group of Sarcopenia in Older People (EWGSOP). Resultados: La prevalencia de fragilidad con los criterios de Sheerbrooke es del 64%. Con el resto de criterios oscila entre el 4% y el 34%. La prevalencias con los instrumentos basado en el fenotipo físico son más bajas y estables hasta los 80 años, mientras que con los instrumentos multidimensionales son más elevadas y se incrementan más precozmente. Los problemas cognitivos son el factor de riesgo más importante de fragilidad, y afectan negativamente la concordancia de los instrumentos utilizados. Los criterios de Sheerbrooke no concuerdan con el resto de instrumentos. En personas sin problemas congitivos las concordancias del resto de instrumentos es buena en general, especialmente entre isntrumentos del mismo tipo. La prevalencia de sarcopènia es de l 19% (3% en hombres, 30% en mujeres) y se incrementa con la edad, sin que la presencia de problemas cognitivos afecte su prevalencia. Conclusiones: La prevalencia de fragilidad varia ampliamente en función del instrumento utilizado y de la presencia de problemes cognitives. La valenciàcia de sarcopènia se ve afectada principalmente por el sexo. En personas sin problemas cognitivos el uso de instrumentos de detección de fragilidad de la misma clase en general afecta poco los resultados.
Introduction: Frailty is a state of vulnerability that predisposes to adverse health outcomes as loss of autonomy, institutionalization and death. Nevertheless currently there is no operative definition that could be considered a gold standard, and several tools are used to their assessment. Sarcopenia defined as a reduction in both, muscle mass and muscle function also has been linked to adverse health outcomes. The aim of this thesis is to assess the prevalence of frailty and sarcopenia with different tools and to assess the impact of cognitive issues over frailty prevalence and its detection. Methods: The study population is made by community-dwelling elderly persons over 65, not it the end-of-life stage. Sample has been drawn from the registry of users of a primary care center using a randomized stratified sampling according to the presence of cognitive issues. We have selected tools to detect frailty that could be used in primary care. Sarcopenia assessment has been done according to the European Working Group of Sarcopenia in Older People (EWGSOP) criteria. Results: Frailty prevalence according to Sheerbrooke criteria is 64%, fluctuating between 4% and 34% with the other tools. Prevalence with tools relaying in the physical phenotype is lower and stable until 80’s, whereas with multidimensional tools is higher and rises early. Cognitive issues are the most important risk factor for frailty and worsen agreement between tools. Shreerbrooke criteria has no agreement with the other tools. In persons without cognitive problems agreement between tools is good, being higher between tools of the same class. Prevalence of sarcopènia is 19% (3% in men, 30% in women) and increases with age, but cognitive issues does not affect its prevalence. Conclusions: Frailty prevalence changes widely according to the tool used and the presence of cognitive problems. Sex is the main factor affecting sarcopenia prevalence. In persons without cognitive problems the use of frailty instruments of the same kind has little impact over the results.

La « fragilité » fait référence à un état de forte vulnérabilité qui résulte d’une réduction des réserves adaptatives de multiples systèmes biologiques et physiologiques sous l’action conjuguée de l’âge, de maladies et du contexte de la vie. Ce syndrome accroit la vulnérabilité de l’individu ainsi que son risque de dépendance, de chutes, d’hospitalisations, d’entrée en institution et de mortalité. La définition la plus utilisée, celle de Fried et collaborateurs, est basée sur la prise en compte d’éléments exclusivement physiques mais la possibilité d’inclure à cette définition d’autres composantes non-physiques, parmi lesquelles la cognition, est actuellement débattue. Cette thèse aborde donc la question d’un point de vue épidémiologique du possible lien entre l’altération des performances cognitives et la fragilité grâce aux données de deux études en population, une cohorte française et une cohorte mexicaine. Les résultats présentés dans cette thèse nous permettent d’affirmer l’existence d’une association entre la fragilité et un déficit cognitif. Qu’il s’agisse de la cohorte de Coyoacan ou des 3 Cités, les deux premières études de cette thèse ont montré une force d’association majorée sur l’incidence d’incapacité, d’hospitalisation ou de décès lorsqu’on considère la fragilité et le déficit cognitif de manière combinée, un résultat plaidant en faveur de l’intégration de la mesure de la cognition dans la définition de la fragilité. Concernant le risque de survenue de démence en revanche, la troisième étude ne montre pas d’effet majoré lorsque ces deux conditions étaient présentes puisque seuls les participants ayant un déficit cognitif étaient à risque de démence, indépendamment de leur statut de fragilité. Enfin, si la fragilité ne constituait pas un risque en soi de démence tous types confondus, la dernière étude de cette thèse a montré une forte association entre l’état de fragilité et le risque de démence vasculaire. Les résultats de cette thèse, ajoutés aux données de la littérature décrivant la présence d’atteintes vasculaires et cérébro-vasculaires dans le syndrome de fragilité, nous ont conduits à formuler l’hypothèse selon laquelle la fragilité pourrait être un état prodromique de démence vasculaire
“Frailty” is a clinical syndrome characterized by physiological loss of reserves and resilience and represents the summatory action of age, disease and living environment. This geriatric syndrome increases the vulnerability of elderly persons and their risk of disability, falls, hospitalization, institutionalization, and mortality. The definition most widely used, the one proposed by Fried and collaborators, only includes physical elements. Nonetheless, the inclusion of other non-physical components, in particular cognitive function is currently debated. Therefore, the aim of this thesis was the study, from an epidemiological point of view, of the association between cognitive function and frailty using the data of two population-based studies, a French cohort and a Mexican one. The results are in favor of the existence of an association between frailty and cognitive impairment. In the first two studies presented in this thesis, an increased risk of incident disability, hospitalization, and death was found. Therefore, including cognitive function in the phenotype of frailty may be relevant since both processes seem to contribute to the development of negative health-related outcomes. However, regarding the risk of dementia, the results of the third study show that only elderly subjects with cognitive impairment have an increased risk of developing dementia irrespective of their frailty status. Nevertheless, if frailty per se may not be a risk factor of dementia, all types confounded, the last study evidences a strong association between frailty and the incidence of vascular dementia. Such results along with previous studies reporting the existence of vascular and cerebrovascular damage in frail elderly lead us to postulate that frailty could be a prodromal state of vascular dementia

Questa sintesi conclusiva del percorso di dottorato ruota attorno al costrutto di fragilità, attualmente definita come una condizione disfunzionale dinamica di natura multi-sistemica, associata a un aumentato rischio di conseguenze negative quali istituzionalizzazione, ospedalizzazione e morte. Come illustrato tramite gli studi inclusi nella presente tesi, le osservazioni empiriche e l’esperienza in ambito clinico hanno sistematicamente evidenziato l’assenza di strumenti di screening cognitivo nella fragilità che presentino sistematicamente valore clinico e validità trasversalmente a diverse tipologie di pazienti o utenti fragili, affetti da disturbi neurologici e cognitivi o che presentino profili di rischio psicosociale. Nei capitoli empirici sono stati riportati tre studi che hanno riguardato, il primo, la valutazione del potenziale clinico di un nuovo test di screening cognitivo, il CASP, somministrabile anche a persone affette da afasia. Questo è stato comparato con strumenti classici come il MMSE e il MoCA. Nel secondo studio è stato sviluppato e testato un protocollo di valutazione della fragilità cognitiva e psicosociale nella malattia cronica, ideato per essere inclusivo anche nel suo utilizzo con pazienti migranti. Infine, il terzo studio, oltre a mirare – come i precedenti – all’arricchimento della cassetta di attrezzi del neurospicologo, si è focalizzato sull’integrazione del testing neuropsicologico classico con le potenzialità della neuroinformatica, avendo come obiettivo lo sviluppo di un approccio di screening multi-componenziale e di un sistema di machine learning per finalità diagnostiche nell’ambito dell’invecchiamento fisiologico e patologico, che non fosse una mera digitalizzazione di test neuropsicologici tradizionali.
This final synthesis of the PhD program revolves around the construct of fragility, currently defined as a dynamic dysfunctional condition of a multi-systemic nature, associated with an increased risk of negative consequences such as institutionalization, hospitalization and death. As illustrated through the studies included in this thesis, empirical observations and experience in the clinical setting have systematically highlighted the absence of cognitive screening tools in frailty that systematically present clinical value and validity across different types of patients or frail users, suffering from neurological and cognitive disorders or with psychosocial risk profiles. Three studies have been reported in the empirical chapters which concerned, the first, the evaluation of the clinical potential of a new cognitive screening test, CASP, which can also be administered to people with aphasia. This has been compared with classical instruments such as the MMSE and the MoCA. In the second study, a protocol for assessing cognitive and psychosocial frailty in chronic disease was developed and tested, designed to be inclusive also in its use with migrant patients. Finally, the third study, in addition to aiming - like the previous ones - at the enrichment of the neurospychologist's toolbox, focused on the integration of classical neuropsychological testing with the potential of neuroinformatics, aiming at the development of a screening approach. multi-component and a machine learning system for diagnostic purposes in the field of physiological and pathological aging, which was not a mere digitization of traditional neuropsychological tests.

Questa sintesi conclusiva del percorso di dottorato ruota attorno al costrutto di fragilità, attualmente definita come una condizione disfunzionale dinamica di natura multi-sistemica, associata a un aumentato rischio di conseguenze negative quali istituzionalizzazione, ospedalizzazione e morte. Come illustrato tramite gli studi inclusi nella presente tesi, le osservazioni empiriche e l’esperienza in ambito clinico hanno sistematicamente evidenziato l’assenza di strumenti di screening cognitivo nella fragilità che presentino sistematicamente valore clinico e validità trasversalmente a diverse tipologie di pazienti o utenti fragili, affetti da disturbi neurologici e cognitivi o che presentino profili di rischio psicosociale. Nei capitoli empirici sono stati riportati tre studi che hanno riguardato, il primo, la valutazione del potenziale clinico di un nuovo test di screening cognitivo, il CASP, somministrabile anche a persone affette da afasia. Questo è stato comparato con strumenti classici come il MMSE e il MoCA. Nel secondo studio è stato sviluppato e testato un protocollo di valutazione della fragilità cognitiva e psicosociale nella malattia cronica, ideato per essere inclusivo anche nel suo utilizzo con pazienti migranti. Infine, il terzo studio, oltre a mirare – come i precedenti – all’arricchimento della cassetta di attrezzi del neurospicologo, si è focalizzato sull’integrazione del testing neuropsicologico classico con le potenzialità della neuroinformatica, avendo come obiettivo lo sviluppo di un approccio di screening multi-componenziale e di un sistema di machine learning per finalità diagnostiche nell’ambito dell’invecchiamento fisiologico e patologico, che non fosse una mera digitalizzazione di test neuropsicologici tradizionali.
This final synthesis of the PhD program revolves around the construct of fragility, currently defined as a dynamic dysfunctional condition of a multi-systemic nature, associated with an increased risk of negative consequences such as institutionalization, hospitalization and death. As illustrated through the studies included in this thesis, empirical observations and experience in the clinical setting have systematically highlighted the absence of cognitive screening tools in frailty that systematically present clinical value and validity across different types of patients or frail users, suffering from neurological and cognitive disorders or with psychosocial risk profiles. Three studies have been reported in the empirical chapters which concerned, the first, the evaluation of the clinical potential of a new cognitive screening test, CASP, which can also be administered to people with aphasia. This has been compared with classical instruments such as the MMSE and the MoCA. In the second study, a protocol for assessing cognitive and psychosocial frailty in chronic disease was developed and tested, designed to be inclusive also in its use with migrant patients. Finally, the third study, in addition to aiming - like the previous ones - at the enrichment of the neurospychologist's toolbox, focused on the integration of classical neuropsychological testing with the potential of neuroinformatics, aiming at the development of a screening approach. multi-component and a machine learning system for diagnostic purposes in the field of physiological and pathological aging, which was not a mere digitization of traditional neuropsychological tests.

En la presente tesis doctoral se ha evaluado el efecto a corto y largo plazo de una intervención multifactorial para modificar parámetros relacionados con la fragilidad física y cognitiva en personas de 65 años o más, convivientes de la comunidad; secundariamente se analizó la mortalidad, fracturas, hospitalizaciones e inclusión en programa de atención domiciliaria (Atdom) en los pacientes reclutados. Se realizó un estudio multicéntrico, aleatorizado, ciego simple, de grupos paralelos en ancianos prefrágiles y frágiles que viven en la comunidad en Barcelona ciudad. Un total de 352 pacientes, de ≥65 años con predetección de fragilidad positiva fueron asignados al azar en dos grupos para recibir 12 semanas de intervención multidisciplinar o su atención habitual, con asignación oculta. La intervención consistió en: fisioterapia con ejercicios multicomponente, ingesta de batidos nutricionales hiperproteicos en las semanas de ejercicio físico, talleres de estimulación cognitiva y revisión de medicación, en especial fármacos psicotrópicos, durante la intervención. Las medidas realizadas tanto en intervención (GI) como en control (GC), en el momento basal, a los 3 meses y a los 18 meses se detallan en la sección de resultados. Tales resultados se evaluaron con análisis multivariante por intención de tratar, con imputación de valores perdidos, en ambos cortes. Los resultados revelan que el 98.6% de participantes completaron la primera fase, con un 24% de pérdidas de la muestra a los 18 meses. La edad media fue de 77.3 años, 89 sujetos prefrágiles (25.3%) y 75.3% mujeres (n = 265). A los 3 y 18 meses del inicio de la intervención, la diferencia de medias ajustadas entre los grupos mostró mejoras significativas para el GI en todas las comparaciones físicas: la media del Short Physical Performance Battery mejoró 1.58 y 1.36 (p<0.001) puntos, la fuerza prensora de la mano 2.86 y 2.49 kilogramos (p<0.001), el Funtional Reach Test 4.34 y 4.52 centímetros (p<0.001), y en la Estación Unipodal 3.58 y 2.98 segundos (p<0.001), respectivamente. En las puntuaciones neurocognitivas, en el GI respecto al GC a los 3 y 18 meses, la diferencia de medias ajustadas de puntuación mejoró: en memoria verbal a corto y medio plazo 1.19 (p<0.001) y 0.68 (p=0.015) puntos y 1.11 (p<0.001) y 0.69 (p=0.016), respectivamente; en el test nominal de animales en 1 minuto incrementó la media de nominación en 2.01 (p<0.001) y 1.05 (p=0.026) animales; en la evocación de palabras iniciadas por una letra, la media se elevó en 3.64 (p<0.001) y 2.10 (p=0.010) palabras; en la designación de personajes famosos, fue de 1.92 (p<0.001) y 0.71 (p=0.212) personajes, sin significación estadística; en la designación verbal de imágenes en menos de 3 segundos resultó un incremento en 0.71 (p<0.001) y 0.53 (p=0.002); y en la abstracción verbal de parejas de palabras, aumentó la media en 0.40 (p<0.001) y 0.46 (p=0.032) pares de palabras, respectivamente. El número de prescripciones en el GI disminuyó de media en 1.39 (p<0.001) a los 3 meses, efecto que se perdió a los 18 meses. El tamaño del efecto fue de >0.8 y >0.7 para la mayoría de los dominios de parámetros de fragilidad estudiados en el corte de los 3 meses, aunque tales efectos se atenúan levemente en todos los casos a los 18 meses, con predominio de los mentales. Al finalizar el estudio, hubo más fallecimientos (6.8% vs 3.4%, p-valor no significativa), fracturas (12.4% vs 6.5%, p=0.062), hospitalizaciones (17.2% vs 5.9%, p=0,001) y progresión a programa Atdom (15.9% vs 6.2%, p=0,004) en el GC respecto al GI. Conclusión: una intervención múltiple física, nutricional, neurocognitiva y farmacológica desde Atención Primaria es eficaz en revertir medidas de fragilidad tanto a corto plazo como a los 18 meses.
In the current thesis, the effectiveness of a multifactorial intervention to modify physical and cognitive frailty parameters has been evaluated at short and long-term in individuals aged ≥ 65 years old; secondly, mortality, fractures, hospital admissions and inclusion in home-care programs (Atdom program) were analyzed in recruited patients. In order to assess these aims, a multicenter, randomized, single-blind, parallel-group clinical trial with control group in community-living prefrail/frail elderly people in urban districts in Barcelona was developed. A total of 352 patients, aged ≥65 years old with positive frailty pre-screening were equally randomized into two groups to receive a 12-week multidisciplinary intervention or usual care, with concealed allocation. The intervention consisted of: multicomponent exercise training, plus protein shakes during exercise training, neurocognitive stimulation workshops and medication review, above all psychotropic drugs, for the intervention period. Changes from baseline frailty measurements (as detailed below) were compared between the Intervention Group (IG) and the Control Group (CG) at the end of the intervention, and 18 months later. Main outcome assessments with multivariate intention-to-treat analysis, using the multiple imputations for missing data, were conducted at 3 and 18 months. A total of 347 participants (98.6%) completed the study at the first stage, and 24% of the sample could not be reassessed at 18-month cut-off point (mainly from the CG). Participants mean age was 77.3 years old, 89 prefrail subjects (25.3%), and 75.3% female (n=265). At the 3-months and 18 –months cut-off points from the intervention start, adjusted mean difference between groups showed significant improvements for the intervention group in all physical comparisons: mean in Short Physical Performance Battery score increased 1.58 and 1.36 (p<0.001) points, handgrip 2.86 and 2.49 kilograms (p<0.001), lower limbs power 50.25 watts (p<0.001) (by pragmatic reasons, just 3-months cut-off point was measured), Functional Reach test 4.34 and 4.52 centimeters (p<0.001), and Unipodal Station 3.58 and 2.98 seconds (p<0.001), respectively. About neurocognitive score, in the intervention group compared to control group at 3-months and 18 –months, adjusted mean difference between groups improved: in Short and Medium-term Memory 1.19 (p<0.001) and 0.68 (p=0.015) points at short-term and 1.11 (p<0.001) and 0.69 (p=0.016) at medium-term, respectively. In Animal Naming Test, mean of nomination increased in 2.01 (p<0.001) and 1.05 (p=0.026) animals referred; in evocation in words, mean increased in 3.64 (p<0.001) and 2.10 (p=0.010) words; in Designation of Famous People´s names 1.92 (p<0.001) and 0.71 (p=0.212) celebrities; in Verbal Designation of images in ≤ 3 seconds increased 0.71 (p<0.001) and 0.53 (p=0.002) images; and about Verbal abstraction of word pairs, main raised 0.40 (p<0.001) and 0.46 (p=0.032) pairs of words, respectively. Number of prescriptions mean in the intervention group decreased 1.39 (p <0.001) at the 3-months cut-off point, although this effect was lost at 18-months´ analysis. Standardized effect sizes were >0.8 and >0.7 for most of the physical and neurocognitive parameters assessed, respectively, at the 3-months cut-off point, although these effects slightly diminished at 18-months, especially in cognitive items. At the end of the study, more percentage of mortality (6.8% vs 3.4%, no significant p-value), fractures (12.4% vs 6.5%, p=0.062), hospital admissions (17.2% vs 5.9%, p=0,001) and inclusion at Atdom program (15.9% vs 6.2%, p=0,004) were detected in the CG compared to the intervention one. Based on all these results, our conclusion is that a physical, nutritional, neurocognitive, and pharmacological multifaceted Primary Care intervention was effective in reversing frailty measures both at short-term and 18 months. Decreasing mortality, fractures, hospitalization and inclusion in home-care dispositive and lasting benefits of a multi-intervention program among frail elderly individuals encourage its prioritization in our daily clinical practice to promote healthy aging in the community.

El continu envelliment de la població suposa un repte per a les polítiques de salut, ja que es pretén que aquest augment de la longevitat no impliqui una menor qualitat de vida en els darrers anys. Per aquest motiu, sorgeix la necessitat d’estudiar els indicadors d’estat de salut, per poder recomanar hàbits saludables a la població i així prevenir els efectes negatius en l’envelliment. En estudis recents, s’ha observat que l’adherència d’un patró d’alimentació mediterrània s’associa amb diverses millores de l’estat de salut de la població. Aquest patró es caracteritza per un elevat consum d’aliments com fruites, verdures i els seus derivats, els quals són rics en polifenols. Darrerament, la quantitat d’estudis experimentals sobre el paper protector dels polifenols en l’envelliment s’ha incrementat exponencialment, tot i que l’evidència aportada per estudis epidemiològics encara és molt limitada. Habitualment, en epidemiologia nutricional s’estima la ingesta de polifenols mitjançant enquestes alimentàries. L’ús de biomarcadors cada cop és més freqüent i permet que l’estimació de l’exposició sigui més precisa, robusta i sobretot més objectiva. Aquesta Tesi Doctoral té com a objectiu estudiar l’efecte del consum de dietes riques en polifenols en la prevenció del deteriorament físic i cognitiu, la fragilitat i la mortalitat total entre la població italiana major de 65 anys de l’estudi InCHIANTI, un estudi de cohort amb 12 anys de seguiment. En aquest, s’han estimat la ingesta dietètica de polifenols totals i resveratrol mitjançant un qüestionari de freqüència de consum d’aliments prèviament validat i la creació d’una base de dades pròpia de composició d’aliments, a partir de les bases de dades de composició en polifenols actualment disponibles com són la del USDA i Phenol-Explorer. La ingesta de polifenols totals i resveratrol fou de 555.2 mg/d i 0.5 mg/d, respectivament. El cafè, les pomes, el vi negre, el té i les taronges foren les fonts alimentàries més importants de polifenols totals. A més, el vi negre fou la font principal de resveratrol. També, s’ha estudiat la presència d’aquests compostos bioactius en orina, com a reflexa de la seva biodisponibilitat en humans. En concret, la concentració en orina de polifenols totals utilitzant el mètode colorimètric Folin-Ciocalteu, i resveratrol usant un mètode basat en la detecció per espectrometria de masses, com a biomarcadors de la ingesta de polifenols totals i resveratrol, respectivament. Els resultats obtinguts han mostrat que la quantificació urinària dels polifenols totals considerant el volum total d’orina 24h és preferible a la orina puntual normalitzada per creatinina, donat què està influïda per la funció renal, on la seva prevalença es alta en la població estudiada. Comparant els tercils extrems d’excreció de polifenols totals urinaris, es van evidenciar associacions inverses amb el risc de deteriorament cognitiu i físic, fragilitat i mortalitat total. No obstant, no es va observar cap associació amb els polifenols totals dietètics. Donats aquests resultats, observem necessari considerar el biomarcador urinari per a la valoració del consum de polifenols totals en la salut. En el cas del resveratrol, s’ha proposat per primera vegada la combinació del qüestionari dietètic i biomarcador urinari mitjançant un score, el qual ha permès estimar de forma més exacta i precisa l’exposició dietètica habitual d’aquest. Els participants del tercil de consum més alt van presentar un menor risc de desenvolupar fragilitat durant els primers tres anys de seguiment, en comparació amb el tercil més baix. A més, s’ha demostrat que els paràmetres inflamatoris no actuen com a mediadors. En conclusió, aquests resultats basats en l’estudi InCHIANTI aporten evidència sobre l’efecte d’una dieta rica en polifenols en la protecció enfront el deteriorament físic i cognitiu, la fragilitat i la mortalitat total en les persones grans.
The aim of this PhD thesis is to investigate if the intake of rich diets in polyphenols may have a protective effect in the prevention of physical and cognitive decline, frailty and total mortality among the participants aged 65 years or more within the InCHIANTI study, an Italian cohort study with 12 years of follow-up. To achieve this goal, the dietary intake of total polyphenols and resveratrol was estimated using a validated food frequency questionnaire and an ad hoc database of food composition on polyphenols, created from the two only databases available in the literature: USDA and Phenol-Explorer databases. The intake of total polyphenols and resveratrol was 555.2 mg/d and 0.5 mg/d, respectively. Coffee, apples, red wine and oranges were the most important food sources of total polyphenols. In addition, red wine was the main dietary source of resveratrol. Also, we studied the presence of these bioactive compounds in urine as a reflection of their bioavailability in humans. In particular, the urinary concentration of total polyphenols and resveratrol was determined by Folin-Ciocalteu colorimetric and mass spectrometry methods, as biomarkers of the dietary of total polyphenols and resveratrol, respectively. Results showed that the total urinary polyphenols expressed by 24-h volume is a better biomarker of total dietary polyphenol than by urinary creatinine normalization. The highest tertile of total urinary polyphenols was inversely associated with the risk of cognitive and physical decline, frailty and total mortality, in comparison with the lowest tertile. However, no association with total dietary polyphenols was observed. Additionally, habitual dietary exposure of resveratrol was associated with a lower risk of developing frailty over a follow-up of three years by a combination of both measures (diet and biomarker), as well as, individually. In conclusion, the results of this PhD thesis suggest a protective effect of polyphenol-rich diet, using a biomarker of total dietary polyphenols (the total urinary polyphenols expressed by 24-h urine), against cognitive and physical decline, frailty and all-cause mortality in older persons. In addition, it demonstrates the importance of assessing dietary polyphenol exposure, whenever is possible using nutritional biomarkers and not only using self-reported questionnaires.

La tesi di dottorato mira a valutare il ruolo dell'infermiere nello screening della fragilità dell'anziano, secondo il modello bio-psico-sociale. Mira altresì a valutare le possibili associazioni tra la Health Literacy del Caregiver con esiti di salute su questa specifica popolazione.

This chapter lays out AMBIT’s core integrating theory of mentalizing, and the developmental and experimental research evidence supporting it. Mentalizing is a specific (prefrontal cortical) activity of mind, directed at explaining an agent’s (one’s own or another’s) behavior on the grounds of presumed or imagined intentional mental states. The chapter covers evidence from developmental and attachment studies supporting this. The multidimensional nature (automatic–controlled, self–other, internal–external, cognitive–affective) and complexity of this activity is described, as well as the implications when it fails—as it frequently does, given its fragility in the face of anxiety or arousal. Finally, the role of mentalizing in allowing access to learning from another person is explored. It is a powerful ostensive cue, triggering epistemic trust (trust in the social value of information that a helping individual may have to offer). AMBIT is reframed as a systemic application of this theory of communication.

This chapter discusses the contrast between fragility of shared policies and robustness of social rules; the need in our model of social rules for weaker forms of interlocking and interdependence; the cognitive dependence of shared policies on actual patterns; the need for a kernel-penumbra structure to allow for “alienated” participants in a social rule; a Lockean model of the diachronic ties characteristic of social rules; and puzzles about the withering away of kernels and pretense. This supports a model of social rules as involving a pattern of action that is explained by a robust Lockean diachronic network of shared-policy-shaped synchronic networks. And this supports an account of the content of social rules. This account is compared with ideas from Scott Shapiro about “massively shared agency,” from Geoffrey Brennan and colleagues about clusters of normative attitudes, and from Cristina Bicchieri about the role of beliefs about the normative expectations of others.

This chapter delves deeper into the ubiquity of race in migration policing, its camouflage, and disavowal, and its legitimation and power for making sense of a complex and fluid social geography. It explores how racial knowledge and taxonomies are deployed and redefined through migration policing. As the ‘fine-grained cognitive maps’ with which the police operate are rendered insufficient and inefficient, immigration enforcement has been increasingly brought on board. Immigration enforcement works with and through race as a sorting technique in insidious, oblique, and paradoxical ways, giving meaning to and redefining the contours of police suspicion. Its presence is ubiquitous and legally sanctioned, yet selective, continuously disavowed, and often left unarticulated and nebulous. In immigration enforcement, the chapter argues, race makes state power operate in particularly mysterious, hazy, and magic-like ways, hinging on some bodies and not others, building on irretrievable vocabulary, associations, visual registers, smells and other sensory clues, and lingering colonial imageries and knowledge. In this context, racial sorting and profiling is not a deviation or aberration, but a constitutive part without which its exercise is futile. As a racial technology, immigration control practices illustrate the power and resilience of race, as well as its fragility. Ultimately, the chapter concludes, race is a shaky and fragile basis for policing which lays bare its contradictions, paradoxes, and limits.

The work is devoted to the study of forms, models and principles of the organization of intercultural communication, as well as the peculiarities of their functioning in dialogical statements. The relevance of the topic is due to the need to develop problems of typologization of the principles of intercultural communication (IC) and the conditions for their speech implementation interest in which is dictated by changes in society, the expansion of interaction between cultures and peoples. The problems of cultural identity, cultural differences and mutual understanding are especially relevant. The subject of the research is intercultural communication in Ukrainian and English linguistic cultures. The object of the research is the typology of models, forms and principles of the organization of intercultural communication, their speech realization in the analyzed linguocultures. The aim of the study is to analyze scientific data on the problems of typologizing models, forms and principles of intercultural communication, to generalize its semantics and pragmatics in each of the studied linguocultures, to determine the typology of models, forms and principles of organizing intercultural communication. The definition of intercultural communication is obvious from the term itself: it is the communication of people representing different cultures. We adhere to the following definition: "Intercultural communication is an adequate understanding of two participants in a communicative act belonging to different national cultures." Intercultural communication as a social phenomenon was brought to life by the practical needs of the post-war world, which were supported by changes in public consciousness, in recognition of absolute value of the diversity of world cultures in the rejection of the colonial cultural policy, in the awareness of the fragility of existence and the threat of destruction of most traditional cultures and languages. Currently, there are various approaches to describing the intercultural and intracultural interaction of people in society, but the study of linguistic and semiotic models of communication is not given due attention either in domestic or foreign linguistic knowledge. The Western communication models described in the work do not meet contemporary requirements. Acquaintance with the works of Western scientists allows us to assert: used methods and approaches do not cover and do not describe all aspects of intercultural communication. IC can be explored either at the group level or at the individual level. Most of the research carried out at the group level was of an anthropological and sociological nature. They were based on two methodological approaches: 1) "understanding of cultures as cognitive systems", which is described by V. Gudenaf; 2) understanding of culture as a "symbolic system" the opposite approach of K. Geertz. The state of contemporary society, in which one of the main problems is the problem of intercultural interaction, has led to a heightened interest in the research of cultural anthropologists who have developed a new understanding of the foundations of the existence of culture. Historically, contemporary communicative linguistics, continuing the traditions of F. Schleiermacher and his "general" hermeneutics, which studied the process of understanding and its regularities, focused on the conditions for only successful communication. At the heart of any process of understanding is precisely the principle of interaction between parts and the whole, which is a prerequisite for the application of the systemic method in each specific area of research. In this way, an understanding of both the behavior of people and the products of their cultural and historical activities occurs.

Background: Elderly patients with and without dementia are especially vulnerable to COVID-19 infection due to their disease status, age and comorbidities, needing to face measures of social restrictions. However, it is known that social isolation is a risk factor for decline of cognitive functions. Objectives: Gather information about consequences of isolation in elderly patients with and without dementia during the COVID-19 pandemic. Methods: Narrative literature review through active search for publications on the topic on the PubMed platform, resulting in 17 articles for evaluation. Results: Apathy has shown to be the most common neuropsychiatric symptom of social isolation in the elderly, followed by irritability, agitation, aggression and depression. In institutionalized patients with dementia, there was an increased burden of neuropsychiatric symptoms by 60%, the main symptoms being anxiety, depression, sleep disorder, behavior aberrant motor and changes in appetite. In addition, limitation of outdoor activity and absence of direct social contact required an increased dosage of antipsychotic drugs and mood stabilizers. In a sample of individuals with mild cognitive decline, had decreased physical activity, reduced adherence to Mediterranean diet, and more than 35% had weight gain. Conclusions: Isolation has mental, physical and social consequences for the elderly with and without dementia, enhancing their fragility and vulnerability. Hence, it is necessary a follow up by the health system and family members, as well as the development of strategies to minimize such losses.