REGINA MIKSIAN MAGALDI
Índice h a partir de 2011
8
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Effects of Brazil nut consumption on selenium status and cognitive performance in older adults with mild cognitive impairment: a randomized controlled pilot trial (vol 55, pg 107, 2016)(2021) CARDOSO, Barbara Rita; APOLINARIO, Daniel; BANDEIRA, Veronica da Silva; BUSSE, Alexandre Leopold; MAGALDI, Regina Miksian; JACOB-FILHO, Wilson; COZZOLINO, Silvia Maria Franciscato
- Applicability of the Spoken Knowledge in Low Literacy Patients with Diabetes in Brazilian elderly(2016) SOUZA, Jonas Gordilho; APOLINARIO, Daniel; FARFEL, José Marcelo; JALUUL, Omar; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; CAMPORA, Flávia; JACOB-FILHO, WilsonABSTRACT Objective To translate, adapt and evaluate the properties of a Brazilian Portuguese version of the Spoken Knowledge in Low Literacy Patients with Diabetes, which is a questionnaire that evaluate diabetes knowledge. Methods A cross-sectional study with type 2 diabetes patients aged ≥60 years, seen at a public healthcare organization in the city of Sao Paulo (SP). After the development of the Portuguese version, we evaluated the psychometrics properties and the association with sociodemographic and clinical variables. The regression models were adjusted for sociodemographic data, functional health literacy, duration of disease, use of insulin, and glycemic control. Results We evaluated 129 type 2 diabetic patients, with mean age of 75.9 (±6.2) years, mean scholling of 5.2 (±4.4) years, mean glycosylated hemoglobin of 7.2% (±1.4), and mean score on Spoken Knowledge in Low Literacy Patients with Diabetes of 42.1% (±25.8). In the regression model, the variables independently associated to Spoken Knowledge in Low Literacy Patients with Diabetes were schooling (B=0.193; p=0.003), use of insulin (B=1.326; p=0.004), duration of diabetes (B=0.053; p=0.022) and health literacy (B=0.108; p=0.021). The determination coefficient was 0.273. The Cronbach a was 0.75, demonstrating appropriate internal consistency. Conclusion This translated version of the Spoken Knowledge in Low Literacy Patients with Diabetes showed to be adequate to evaluate diabetes knowledge in elderly patients with low schooling levels. It presented normal distribution, adequate internal consistency, with no ceiling or floor effect. The tool is easy to be used, can be quickly applied and does not depend on reading skills.
- Effects of Brazil nut consumption on selenium status and cognitive performance in older adults with mild cognitive impairment: a randomized controlled pilot trial(2016) CARDOSO, Barbara Rita; APOLINARIO, Daniel; BANDEIRA, Veronica da Silva; BUSSE, Alexandre Leopold; MAGALDI, Regina Miksian; JACOB-FILHO, Wilson; COZZOLINO, Silvia Maria FranciscatoOxidative stress is closely related to cognitive impairment, and the antioxidant system may be a potential therapeutic target to preserve cognitive function in older adults. Selenium plays an important antioxidant role through selenoproteins. This controlled trial aimed to investigate the antioxidant and cognitive effects of the consumption of Brazil nuts, the best selenium food source. We enrolled 31 older adults with mild cognitive impairment (MCI) who were randomly assigned to ingestion of Brazil nuts or to the control group. Participants of the treatment group consumed one Brazil nut daily (estimated 288.75 A mu g/day) for 6 months. Blood selenium concentrations, erythrocyte glutathione peroxidase (GPx) activity, oxygen radical absorbance capacity, and malondialdehyde were evaluated. Cognitive functions were assessed with the CERAD neuropsychological battery. Eleven participants of the treated group and nine of the control group completed the trial. The mean age of the participants was 77.7 (+/- 5.3) years, 70 % of whom were female. We observed increased selenium levels after the intervention, whereas the control group presented no change. Among the parameters related to the antioxidant system, only erythrocyte GPx activity change was significantly different between the groups (p = 0.006). After 6 months, improvements in verbal fluency (p = 0.007) and constructional praxis (p = 0.031) were significantly greater on the supplemented group when compared with the control group. Our results suggest that the intake of Brazil nut restores selenium deficiency and provides preliminary evidence that Brazil nut consumption can have positive effects on some cognitive functions of older adults with MCI.
- Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study(2014) SOUZA, Jonas Gordilho; APOLINARIO, Daniel; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; CAMPORA, Flavia; JACOB-FILHO, WilsonObjectives To investigate the relationship between functional health literacy and glycaemic control in a sample of older patients with type 2 diabetes. Design Cross-sectional study. Setting A government-financed outpatient geriatric clinic in SAo Paulo, Brazil. Participants 129 older patients with type 2 diabetes, a mean (SD) age of 75.9 (6.2) years, a mean glycosylated haemoglobin (HbA1c) of 7.2% (1.4), of which 14.7% had no formal education and 82.9% had less than a high-school diploma. Measures HbA1c was used as a measure of glycaemic control. Functional health literacy was assessed with the 18-item Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18), a validated instrument to evaluate pronunciation and comprehension of commonly used medical terms. Regression models were controlled for demographic data, depressive symptoms, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications. Results Functional health literacy below adequate was encountered in 56.6% of the sample. After controlling for potential confounding factors, patients with inadequate functional health literacy were more likely than patients with adequate functional health literacy to present poor glycaemic control (OR=4.76; 95% CI 1.36 to 16.63). In a fully adjusted linear regression model, lower functional health literacy (=-0.42; p<0.001), longer diabetes duration (=0.24; p=0.012) and lack of assistance for taking medications (=0.23; p=0.014) were associated with higher levels of HbA1c. Contrary to our expectations, illiterate patients did not have poorer outcomes when compared with patients with adequate functional health literacy, raising the hypothesis that illiterate individuals are more likely to have their difficulties recognised and compensated. However, the small subsample of illiterate patients provided limited power to reject differences with small magnitude. Conclusions Patients with inadequate functional health literacy presented with higher odds of poor glycaemic control. These findings reinforce the importance of addressing limited functional health literacy in clinical practice.
- Using temporal orientation, category fluency, and word recall for detecting cognitive impairment: the 10-point cognitive screener (10-CS)(2016) APOLINARIO, Daniel; LICHTENTHALER, Daniel Gomes; MAGALDI, Regina Miksian; SOARES, Aline Thomaz; BUSSE, Alexandre Leopold; AMARAL, Jose Renato das Gracas; JACOB-FILHO, Wilson; BRUCKI, Sonia Maria DozziObjectives: A screening strategy composed of three-item temporal orientation and three-word recall has been increasingly used for detecting cognitive impairment. However, the intervening task administered between presentation and recall has varied. We evaluated six brief tasks that could be useful as intervening distractors and possibly provide incremental accuracy: serial subtraction, clock drawing, category fluency, letter fluency, timed visual detection, and digits backwards. Methods: Older adults (n = 230) consecutively referred for suspected cognitive impairment underwent a comprehensive assessment for gold-standard diagnosis, of whom 56 (24%) presented cognitive impairment not dementia and 68 (30%) presented dementia. Among those with dementia, 87% presented very mild or mild stages (Clinical Dementia Rating 0.5 or 1). The incremental value of each candidate intervening task in a model already containing orientation and word recall was assessed. Results: Category fluency (animal naming) presented the highest incremental value among the six candidate intervening tasks. Reclassification analyses revealed a net gain of 12% among cognitively impaired and 17% among normal participants. A four-point scaled score of the animal naming task was added to three-item temporal orientation and three-word recall to compose the 10-point Cognitive Screener. The education-adjusted 10-point Cognitive Screener outperformed the longer Mini-Mental State Examination for detecting both cognitive impairment (area under the curve 0.85 vs 0.77; p = 0.027) and dementia (area under the curve 0.90 vs 0.83; p= 0.015). Conclusions: Based on empirical data, we have developed a brief and easy-to-use screening strategy with higher accuracy and some practical advantages compared with commonly used tools.
- Estimating Premorbid Cognitive Abilities in Low-Educated Populations(2013) APOLINARIO, Daniel; BRUCKI, Sonia Maria Dozzi; FERRETTI, Renata Eloah de Lucena; FARFEL, Jose Marcelo; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; JACOB-FILHO, WilsonObjective: To develop an informant-based instrument that would provide a valid estimate of premorbid cognitive abilities in low-educated populations. Methods: A questionnaire was drafted by focusing on the premorbid period with a 10-year time frame. The initial pool of items was submitted to classical test theory and a factorial analysis. The resulting instrument, named the Premorbid Cognitive Abilities Scale (PCAS), is composed of questions addressing educational attainment, major lifetime occupation, reading abilities, reading habits, writing abilities, calculation abilities, use of widely available technology, and the ability to search for specific information. The validation sample was composed of 132 older Brazilian adults from the following three demographically matched groups: normal cognitive aging (n = 72), mild cognitive impairment (n = 33), and mild dementia (n = 27). The scores of a reading test and a neuropsychological battery were adopted as construct criteria. Post-mortem inter-informant reliability was tested in a sub-study with two relatives from each deceased individual. Results: All items presented good discriminative power, with corrected item-total correlation varying from 0.35 to 0.74. The summed score of the instrument presented high correlation coefficients with global cognitive function (r = 0.73) and reading skills (r = 0.82). Cronbach's alpha was 0.90, showing optimal internal consistency without redundancy. The scores did not decrease across the progressive levels of cognitive impairment, suggesting that the goal of evaluating the premorbid state was achieved. The intraclass correlation coefficient was 0.96, indicating excellent inter-informant reliability. Conclusion: The instrument developed in this study has shown good properties and can be used as a valid estimate of premorbid cognitive abilities in low-educated populations. The applicability of the PCAS, both as an estimate of premorbid intelligence and cognitive reserve, is discussed.
- CAN WE EXCLUDE DEMENTIA IN OLDER ADULTS WITH SUSPECTED COGNITIVE IMPAIRMENT WHO ATTEND THE CLINICAL ENCOUNTER ALONE?(2014) APOLINARIO, Daniel; SOARES, Aline Thomaz; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; BARRETTO-FILHO, Antonio Carlos Pereira; JACOB-FILHO, Wilson
- Pro198Leu polymorphism affects the selenium status and GPx activity in response to Brazil nut intake(2016) CARDOSO, Barbara R.; BUSSE, Alexandre L.; HARE, Dominic J.; COMINETTI, Cristiane; HORST, Maria A.; MCCOLL, Gawain; MAGALDI, Regina M.; JACOB-FILHO, Wilson; COZZOLINO, Silvia M. F.Selenoproteins play important roles in antioxidant mechanisms, and are thus hypothesised to have some involvement in the pathology of certain types of dementia. Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are both thought to involve impaired biological activity of certain selenoproteins. Previously, supplementation with a selenium-rich Brazil nut (Bertholletia excelsa) has shown potential in reducing cognitive decline in MCI patients, and could prove to be a safe and effective nutritional approach early in the disease process to slow decline. Here, we have conducted a pilot study that examined the effects of a range of single nucleotide polymorphisms (SNPs) in genes encoding the selenoproteins glutathione peroxidase (GPX1) and selenoprotein P (SEPP) in response to selenium supplementation via dietary Brazil nuts, including selenium status, oxidative stress parameters and GPX1 and SEPP gene expression. Our data suggest that GPX1 Pro198Leu rs1050450 genotypes may differentially affect the selenium status and GPx activity. Moreover, rs7579 and rs3877899 SNPs in SEPP gene, as well as GPX1 rs1050450 genotypes can influence the expression of GPX1 and SEPP mRNA in response to Brazil nuts intake. This small study gives cause for larger investigations into the role of these SNPs in both the selenium status and response to selenium dietary intake, especially in chronic degenerative conditions like MCI and AD.
- Development of a word accentuation test for predicting cognitive performance in Portuguese-speaking populations(2019) GIL, Gislaine; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; RIBEIRO, Elyse Soares; BRUCKI, Sonia Maria Dozzi; YASSUDA, Monica Sanches; JACOB-FILHO, Wilson; APOLINARIO, DanielThe Word Accentuation Test (WAT) has been used to predict premorbid intelligence and cognitive performance in Spanish-speaking populations. It requires participants to read a list of words without the accent marks that indicate the stressed syllable. Objective: As Portuguese pronunciation is also strongly based on accent marks, our aim was to develop a Brazilian version of the WAT. Methods: An initial pool of 60 items was constructed and a final version of 40 items (named WAT-Br) was derived by item response theory. A sample of 206 older adults underwent the WAT-Br and a standardized neuropsychological battery. Independent ratings were performed by two observers in 58 random participants. Results: The items showed moderate to high discrimination (alpha between 0.93 and 25.04) and spanned a wide range of difficulty (beta between -2.07 and 1.40). The WAT-Br was shown to have an excellent internal consistency (Kuder-Richardson Formula 20 = 0.95) and inter-rater reliability (intraclass correlation coefficient = 0.92). It accounted for 61% of the variance in global cognitive performance. Conclusion: Aversion of the WAT for Portuguese-speaking populations was developed and proved to be a valuable tool for estimating cognitive performance.
- Characterizing spontaneously reported cognitive complaints: the development and reliability of a classification instrument(2013) APOLINARIO, Daniel; MIRANDA, Rafaela Branco; SUEMOTO, Claudia Kimie; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; SOARES, Aline Thomaz; LOPES, Leonardo da Costa; KASAI, Juliana Yumi Tizon; SATOMI, Erika; KIKUCHI, Elina Lika; JACOB-FILHO, WilsonBackground: The characteristics and associated risks of spontaneously reported cognitive complaints have not been investigated due to the lack of a classification instrument. Methods: In phase 1, a classification system with descriptive categories and cognitive domains was developed by experts through a modified Delphi technique. In phase 2, 180 elderly patients seeking medical attention for cognitive complaints provided free reports of their cognitive difficulties and each complaint was recorded verbatim. Three observers were asked to classify each complaint into a descriptive category. Perceived cognitive function was further characterized using the Memory Complaint Questionnaire (MAC-Q). Results: The patients reported 493 spontaneous complaints, with a range of 1-6 complaints per patient and a mean of 2.7 (+/- 1.3). The proportion of complaints that could be classified into a category by each of the three observers varied from 91.9% to 95.7%. Inter-observer agreement assessed using the kappa statistic varied from 0.79 to 1 for descriptive categories and 0.83 to 0.97 for domains. Compared with the MAC-Q, spontaneously reported complaints provided complementary information by avoiding the cueing effect provoked by the questionnaire. The total number of complaints and their occurrences in specific domains were associated with important sociodemographic and clinical factors, indicating that their meaning and associated risks need to be further investigated. Conclusion: The instrument developed in this study proved to be a practical tool for classifying the majority of spontaneously reported cognitive complaints with high reliability. Further studies are needed to investigate clinical usefulness of this approach.