Efeitos de oficinas de estimulação cognitiva na capacidade cognitiva de idosos residentes em São Paulo: estudo clínico controlado
Data
2018-12-03
Autores
Vicentin, Ana Paula Martins 
Orientadores
Ramos, Luiz Roberto
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Considerando o envelhecimento populacional em curso, a manutenção
da capacidade funcional torna-se aspecto fundamental para a saúde pública. É sabido
que o declínio cognitivo é um fator de risco para dependência funcional e mortalidade.
A combinação de estimulação cognitiva via computador e atividade física tem se
mostrado um potencial meio para intervenções não farmacológicas na busca da
preservação das funções cognitivas. Objetivo: analisar os efeitos de estimulação
cognitiva – composta por atividade física, atividade no computador e social - nas
funções cognitivas e funcionalidade de idosos pertencentes a coorte EPIDOSO,
residentes na Vila Clementino, São Paulo. Métodos: estudo prospectivo de
intervenção controlado com dois grupos: grupo intervenção (GI; n=53; 75,5%
mulheres; 76,3 ±6,8 anos) e grupo controle (GC; n=54; 85,2% mulheres; 75,3 ±7,2
anos), formados após triagem com Clinical Demential Rating (CDR; 0 ou 0,5 pontos)
e Escala de Depressão Geriátrica (GDS 15; máximo de 5 pontos). Os idosos do GI
participaram de estimulação cognitiva com atividade física, atividade no comutador e
social, com sessões de 80 minutos, duas vezes por semana durante 17 semanas (total
de 34 sessões), enquanto o GC seguiu a rotina habitual. Aplicaram-se testes
neuropsicológicos e de funcionalidade: Montreal Cognitive Assessment (MoCA), Mini
Exame do Estado Mental (MEEM), lista de palavras, evocação, fluência verbal e
limitações nas atividades da vida diária (AVD - BOMFAQ) antes e ao final do período
de intervenção. O efeito da intervenção em relação ao GC nas variáveis dependentes
foi avaliado por meio de modelos de análise de covariância considerando a Intenção
de Tratar (ITT) e, de forma secundária, fez-se a avaliação do efeito do número de
presenças nas sessões (0 a 34). Resultados: Foram registradas 5 perdas no
seguimento (3 no GI; 2 no GC). Na análise por ITT o GI mostrou um aumento
significativo para a pontuação média do MoCA de 1,23 pontos (B=1,23, 95%CI [0,28;
2,19], p=0,012) em relação ao GC. Na análise que considerou a participação nas
sessões, a pontuação final do MoCA aumentou em média 0,07 pontos (B=0,07,
95%CI[0,04;0,11], p<0,001) para cada aumento de uma unidade no número de
participação, e a pontuação final do MEEM aumentou em média 0,03 pontos (B=0,03,
95%CI[0,01;0,05], p=0,022) para cada aumento de uma unidade no número de
participação. Não foram observadas diferenças estatísticas nas demais variáveis
dependentes. Conclusão: A intervenção realizada mostrou efeito positivo na melhora
da cognição global de idosos cognitivamente normais ou com provável déficit cognitivo
leve (CDR=0 ou 0,5), indicando que pode ser aplicada para prevenção de perdas
cognitivas em contexto comunitário. Não foram evidenciadas, no entanto, melhorias
nos domínios cognitivos específicos e na limitação das AVD. Espera-se que a
presente pesquisa possa contribuir para o avanço na discussão de possíveis
intervenções para prevenção de declínio cognitivo no contexto de políticas para a
promoção da saúde no processo de envelhecimento.
Introduction: Considering the aging of the population, maintenance of functional capacity has become a fundamental aspect for public health. It is already known that cognitive decline is a risk factor for functional dependence and mortality. In the search for nonpharmacological interventions that enable preservation of cognitive functions, the combination of computer cognitive stimulation and physical activity have shown potential. Objectives: Analyze the effects of cognitive stimulation – composed of physical activity, computer activity and social activity - on the cognitive functions and functionality of elderly individuals belonging to the EPIDOSO cohort, living in Vila Clementino, São Paulo. Methods: A prospective controlled intervention study with two groups: intervention group (GI, n = 53, 75.5% women, 76.3 ± 6.8 years) and control group (CG, n = 54, 85.2% women, 75.3% ± 7.2 years), formed after screening using the Clinical Dementia Rating (CDR; 0 or 0.5 points) and Geriatric Depression Scale (GDS 15; maximum of 5 points). The elderly in the GI participated in cognitive stimulation composed of physical activity, computer activity and social activity, with 80- minute sessions, twice a week for 17 weeks (total of 34 sessions), while the CG followed their usual routine. The following neuropsychological and functional tests were applied: Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), word list, evocation, verbal fluency and limitations in activities of daily living (ADL - BOMFAQ) before and after the end of the intervention period. The effect of the intervention on the dependent variables in relation to the GC was evaluated by means of covariance analysis models considering Intention to Treat (ITT) and, as a secondary analysis, the effect of the number of intervention sessions attended was evaluated (0 to 34). Results: There were 5 losses in the follow-up (3 in the GI, 2 in the GC). In the ITT analysis the GI presented a significant increase in the average MoCA score of 1.23 points (B=1.23, 95% CI [0.28, 2.19], p=0.012) in relation to the GC. In the secondary analysis, the final score in the MoCA increased by an average of 0.07 points (B=0.07, 95% CI [0.04; 0.11], p<0.001) for each increase of one unit in the number of sessions attended and the final score of the MMSE increased by an average of 0.03 points (B=0.03, 95% CI [0.01; 0.05], p=0.022) for each increase of one unit in the number of sessions attended. No statistical differences were observed in the other dependent variables. Conclusion: The intervention facilitated a positive effect on the improvement in the global cognition of elderly individuals with normal cognitive function or with a probable mild cognitive impairment (CDR=0 or 0.5), indicating that it can be applied to prevent cognitive losses in a community context. However, no improvements were observed in specific cognitive domains or limitations of ADL. It is hoped that the present research may contribute to advancement in the discussion of possible interventions to prevent cognitive decline in the context of policies to promote health during the aging process. Key words: Aging; Clinical trial; Cognitive sti
Introduction: Considering the aging of the population, maintenance of functional capacity has become a fundamental aspect for public health. It is already known that cognitive decline is a risk factor for functional dependence and mortality. In the search for nonpharmacological interventions that enable preservation of cognitive functions, the combination of computer cognitive stimulation and physical activity have shown potential. Objectives: Analyze the effects of cognitive stimulation – composed of physical activity, computer activity and social activity - on the cognitive functions and functionality of elderly individuals belonging to the EPIDOSO cohort, living in Vila Clementino, São Paulo. Methods: A prospective controlled intervention study with two groups: intervention group (GI, n = 53, 75.5% women, 76.3 ± 6.8 years) and control group (CG, n = 54, 85.2% women, 75.3% ± 7.2 years), formed after screening using the Clinical Dementia Rating (CDR; 0 or 0.5 points) and Geriatric Depression Scale (GDS 15; maximum of 5 points). The elderly in the GI participated in cognitive stimulation composed of physical activity, computer activity and social activity, with 80- minute sessions, twice a week for 17 weeks (total of 34 sessions), while the CG followed their usual routine. The following neuropsychological and functional tests were applied: Montreal Cognitive Assessment (MoCA), Mini Mental State Examination (MMSE), word list, evocation, verbal fluency and limitations in activities of daily living (ADL - BOMFAQ) before and after the end of the intervention period. The effect of the intervention on the dependent variables in relation to the GC was evaluated by means of covariance analysis models considering Intention to Treat (ITT) and, as a secondary analysis, the effect of the number of intervention sessions attended was evaluated (0 to 34). Results: There were 5 losses in the follow-up (3 in the GI, 2 in the GC). In the ITT analysis the GI presented a significant increase in the average MoCA score of 1.23 points (B=1.23, 95% CI [0.28, 2.19], p=0.012) in relation to the GC. In the secondary analysis, the final score in the MoCA increased by an average of 0.07 points (B=0.07, 95% CI [0.04; 0.11], p<0.001) for each increase of one unit in the number of sessions attended and the final score of the MMSE increased by an average of 0.03 points (B=0.03, 95% CI [0.01; 0.05], p=0.022) for each increase of one unit in the number of sessions attended. No statistical differences were observed in the other dependent variables. Conclusion: The intervention facilitated a positive effect on the improvement in the global cognition of elderly individuals with normal cognitive function or with a probable mild cognitive impairment (CDR=0 or 0.5), indicating that it can be applied to prevent cognitive losses in a community context. However, no improvements were observed in specific cognitive domains or limitations of ADL. It is hoped that the present research may contribute to advancement in the discussion of possible interventions to prevent cognitive decline in the context of policies to promote health during the aging process. Key words: Aging; Clinical trial; Cognitive sti
Descrição
Citação
VICENTIN, A.P.M. Efeitos de oficinas de estimulação cognitiva na capacidade cognitiva de idosos residentes em São Paulo: estudo clínico controlado. São Paulo, 2018. 121 p. Tese (Doutorado em Saúde Coletiva) - Universidade Federal de São Paulo, 2018.