Browsing by Author "Toro, Pablo"
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- ItemCognitive impairment with Type 2 Diabetes Mellitus among community-dwelling older adults in Chile: Prevalence, risk factors and cognitive characteristics(2023) Bozanic, Agnieszka; Toro, Pablo; Bello-Lepe, Sebastian; Hurtado-Oliva, Javier; Beyle, Christian; Valdes, Catalina; Formiga, FrancescIntroductionThe aim of this study is to determine prevalence and risk factors of Cognitive Impairment (CI) and its association with Type 2 Diabetes Mellitus (T2DM) in subjects aged 65 years and above. Additionally, we attempt to provide a cognitive profile for T2DM group. MethodologyA cross-sectional analytical study to assess CI was carried out. We evaluated a sample of community-dwelling residents from Chile. All participants underwent a general interview, lifestyle questionnaires and a comprehensive neuropsychological battery. Regression analyses were performed to evaluate risk of CI with T2DM and influencing factors. Results between groups in the different domains of the neuropsychological assessment were compared by Student's t-tests and MANOVA. ResultsAmong all 358 subjects, overall T2DM prevalence were 17.3%. The prevalence of CI was higher in T2DM group compared to the healthy participants (30.7%, p < 0.001). The risk of CI was 2.8 times higher in older people with T2DM compared to older people without the diagnosis. Multiple regression analysis, adjusted for age and gender, demonstrated that age, education, presence of dyslipidemia, and T2DM duration were the predictor variables significantly associated with CI. T2DM group performed worse on global cognitive performance, attention, language, verbal memory, visual memory, visual constructional ability, and executive function. After adjusting for significant covariates from multiple regression analysis, a relationship between "cognition" and T2DM is still observed. Amnesic multi-domain impairment was the specific cognitive identified pattern for T2DM group. ConclusionThe present study confirms the high prevalence of CI with T2DM among Chilean older adults in a community-based population. T2DM is significantly associated with a higher risk of CI, and age, education, presence of dyslipidemia, and duration of T2DM are risk factors. T2DM patients with CI are impaired in multiple cognitive domains, even after adjusting covariables, resulting in an amnesic multi-domain cognitive profile.
- ItemDifferences in Cognitive Functioning in Two Birth Cohorts Born 20 Years Apart: Data from the Interdisciplinary Longitudinal Study of Ageing(2022) Degen, Christina; Frankenberg, Claudia; Toro, Pablo; Schroeder, JohannesWe compared neuropsychological functioning and prevalence of mild cognitive impairment (MCI) in two birth cohorts born 20 years apart when participants had reached the same age, i.e., the mid-60s. The study followed up 500 volunteers born 1930-1932 (C30) and 502 born 1950-1952 (C50). Participants underwent medical, neuropsychological, and psychiatric examinations in 1993-1996 (T1), 1997-2000 (T2), 2005-2008 (T3), and 2014-2016 (T4), including assessment of abstract thinking, memory performance, verbal fluency, visuo-spatial thinking, psychomotor speed, and attention. Healthy participants from C30 at T2 (n = 298) and from C50 at T4 (n = 205) were compared using multivariate ANCOVAs. Groups slightly differed with respect to age (C50: 63.86 +/- 1.14 vs. C30: 66.80 +/- 0.91; p < 0.05) and years of education (13.28 +/- 2.89 vs. 14.56 +/- 2.45). After correcting for age, C50 significantly outperformed C30 in all domains except concentration and verbal fluency. After additionally adjusting for education, C50 significantly outperformed C30 in declarative memory performances and abstract thinking only. Prevalence rates of MCI were 25.2% in C30 and 9.6% in C50 (p < 0.001). Our findings confirm the association between better educational attainment and enhanced cognitive performance in "younger" old individuals. While this association corresponds to the Flynn effect, various life course influences may have also contributed to better performance, including improvements in healthcare provision, medication, and lifestyle factors. Their overall effects may foster cognitive reserve and thus translate into the decline in MCI prevalence reported here.
- ItemHigh contextual sensitivity of metaphorical expressions and gesture blending: A video event-related potential design(ELSEVIER IRELAND LTD, 2011) Ibanez, Agustin; Toro, Pablo; Cornejo, Carlos; Hurquina, Hugo; Manes, Facundo; Weisbrod, Matthias; Schroeder, JohannesHuman communication in a natural context implies the dynamic coordination of contextual clues, paralinguistic information and literal as well as figurative language use. In the present study we constructed a paradigm with four types of video clips: literal and metaphorical expressions accompanied by congruent and incongruent gesture actions. Participants were instructed to classify the gesture accompanying the expression as congruent or incongruent by pressing two different keys while electrophysiological activity was being recorded. We compared behavioral measures and event related potential (ERP) differences triggered by the gesture stroke onset. Accuracy data showed that incongruent metaphorical expressions were more difficult to classify. Reaction times were modulated by incongruent gestures, by metaphorical expressions and by a gesture-expression interaction. No behavioral differences were found between the literal and metaphorical expressions when the gesture was congruent. N400-like and LPC-like (late positive complex) components from metaphorical expressions produced greater negativity. The N400-like modulation of metaphorical expressions showed a greater difference between congruent and incongruent categories over the left anterior region, compared with the literal expressions. More importantly, the literal congruent as well as the metaphorical congruent categories did not show any difference. Accuracy, reaction times and ERPs provide convergent support for a greater contextual sensitivity of the metaphorical expressions. (C) 2010 Elsevier Ireland Ltd. All rights reserved.
- ItemNeurological soft signs and brain morphology in people living with HIV(2022) Herold, Christina J.; Kong, Li; Ceballos, Maria Elena; Schroeder, Johannes; Toro, PabloNeurological soft signs (NSS) are a common feature of severe psychiatric disorders such as schizophrenia but are also prevalent in organic brain diseases like HIV-associated neurocognitive disorder (HAND) or Alzheimer's disease. While distinct associations between NSS, neurocognition, and cerebral regions were demonstrated in schizophrenia, these associations still have to be elucidated in HIV. Therefore, we investigated 36 persons with HIV of whom 16 were neurocognitively healthy and 20 were diagnosed with HAND. NSS were assessed using the Heidelberg scale. NSS scores were correlated with gray matter (GM) using whole brain voxel-based morphometry. Results showed significantly elevated NSS in the HAND group when compared to the neurocognitively healthy with respect to NSS total score and the subscores "orientation" and "complex motor tasks". While the two groups showed only minor, non-significant GM differences, higher NSS scores (subscales "motor coordination", "orientation") were significantly correlated with GM reduction in the right insula and cerebellum (FWE-corrected). Our results corroborate elevated NSS in HIV+ patients with HAND in contrast to cognitively unimpaired patients. In addition, cerebral correlates of NSS with GM reductions in insula and cerebellum were revealed. Taken together, NSS in this patient group could be considered a marker of cerebral damage and neurocognitive deficits.
- ItemPhysical Fitness as a Protective Factor for Cognitive Impairment in a Prospective Population-Based Study in Germany(IOS PRESS, 2011) Sattler, Christine; Erickson, Kirk I.; Toro, Pablo; Schroeder, JohannesTo evaluate the predictive effects of subjective measures of physical activity (PA) and objective measures of physical fitness (PF) on dementia risk, participants of the prospective population-based ILSE-study (*1930-1932; 12-year follow-up) were examined at three examination waves (t1 : 1993/94; t2 : 1997/98; t3 : 2005/07). 381 subjects of the original cohort (n = 500) were re-examined at t3. 29% of the subjects who were cognitively healthy at baseline received the diagnosis of mild cognitive impairment (MCI) and 7% of Alzheimer's disease (AD). Subjects were screened for physical and mental health using medical interviews, physical, and neuropsychological examinations. Participants completed a questionnaire on their current and past PA at t1. Subjects were classified as physically active if they reported a regular sport activity for at least 2 hours per week in the past year. Muscular strength (handgrip) and motor coordination (balance) served as objective indicators of PF. Subjects who passed the balance-test at t1 had a reduced risk of developing MCI/AD at t3 (OR = 0.35, 95%CI 0.19-0.66, p < 0.01) and performed significantly better on various neuropsychological measures. Muscular strength or subjective reports of PA did not predict MCI/AD development. Our results confirm the hypothesis that PF acts as a protective factor for the development of cognitive disorders. In our study context, motor coordination served as a better predictor than muscular strength or self-rated PA. Since subjects with cognitive disorders due to cerebral and/or systemic disorders were excluded from the analyses, our findings suggest that the effect of skill-related PF extends beyond the reduction of cardiovascular risk factors.
- ItemPoor periodontal health is linked to impaired cognitive performance in older people: A cross-sectional study(2023) Arenas Márquez, María Jesús; Toro, Pablo; Aguayo, SebastiánBackground At present, there is no cure for dementia, and most available treatments have shown marginal or no effect. This fact makes it crucial to identify factors that increase the risk of cognitive decline in the population. Evidence suggests that poor periodontal health may be one of those factors; nonetheless, to ascertain this possibility, it is necessary to account for the influence of education, as it is frequently the determining factor that explains the association between a risk factor and cognitive impairment. Therefore, this study aimed to determine whether poor periodontal health is associated with impaired cognitive performance in older people from an agricultural community in Chile, independent of education. Methods A cross-sectional study was conducted with the entire universe of participants older than 60 years from the MAUCO cohort in 2015. The exposure of interest was periodontal health status assessed through a proxy measure based on gum appearance (color) and bleeding, and individuals were categorized into three groups: healthy periodontium, signs of possible disease, and unhealthy periodontium. The dependent variable was cognitive performance evaluated using the ACE-R test. The confounding effect generated by sociodemographic factors was controlled through regression models: linear regression with the score obtained in the ACE-R test and multinomial regression for normal cognition, cognitive impairment, and dementia as outcomes. Results The study included 2,716 participants with a mean age of 65.7 ± 4 years, of whom 52% were women and 63% had a low educational level. Unhealthy periodontium was observed in 10.8% of the individuals, while 17.6% had cognitive impairment or dementia. People with an unhealthy periodontium scored two points lower on the ACE-R test and were almost twice as likely to have dementia (OR 1.86 95% CI 1.07–3.25) than those with periodontal health, regardless of age, sex, and educational level. Conclusion Older people with unhealthy periodontium seem to have worse cognitive performance and a higher possibility of suffering from dementia than those with healthy periodontium, regardless of sociodemographic factors. Education does not explain this outcome. © 2023, CC BY.
- ItemPrevalence and Factors Associated with Subjective Memory Complaint in a Semi-Rural Community in Chile(2023) Oyarzun-Gonzalez, Ximena; Abner, Erin L.; Toro, Pablo; Ferreccio, CatterinaBackground: Subjective memory complaints (SMC) are commonly studied in older adults and have been identified as potentially prodromal to dementia and Alzheimer's disease. Studies among younger adults from South America are lacking.
- ItemSelf-managed psychiatry seminars as a model of active student participation in undergraduate education(2022) Araya, Pablo; Martinez, Camila; Revello, Alejandro; Caneo, Constanza; Figueroa, Rodrigo Andres; Toro, PabloIn the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 +/- 33 SD; online mean = 336 +/- 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory.
- ItemSeminarios autogestionados de psiquiatría como modelo de participación estudiantil activa en pregrado: experiencia 2014-2021 en la Pontificia Universidad Católica de Chile(2022) Figueroa Cabello, Rodrigo Andres; Araya, Pablo; Martínez, Camila; Caneo, Constanza; Toro, PabloIn the last decade, medical students stood out as active agents in their training, which implies their involvement in the design, implementation, evaluation, and curricular co-governance. This article describes a model of active undergraduate student participation from 2014 to 2021 and compares the face-to-face and synchronous online modalities, later brought forward by the SARS-COV-2 pandemic. Annually, a call was made to UC School of Medicine undergraduate students to establish the topics and areas to be addressed during self-managed seminars. Then, medical students located in Chile were invited to attend the activity. Psychiatry was established as a priority topic in six out of eight years. Five seminars were conducted, the last two in synchronous online mode. The number of people enrolled in the online modality increased by 251% compared to the face-to-face modality (face-to-face mean = 133 ± 33 SD; online mean = 336 ± 24SD), with no significant differences in rates of attendance between modalities (Odds ratio (OR) = 1,12; 95% CI= 0,82 - 1,55; p = 0,45). The online modality was associated with a higher proportion of enrollees belonging to an institution outside the Metropolitan Region (OR 12,63; 95% CI = 8,64 - 18,46; p < 0,01). The self-managed psychiatry seminars correspond to a model of active undergraduate student participation, with the synchronous online modality representing an opportunity to massify it throughout the national territory. (Rev Med Chile 2022; 150: 1087-1094)
- ItemVerbal fl uency in normal aging and cognitive decline: Results of a longitudinal study(2021) Frankenberg, Claudia; Weiner, Jochen; Knebel, Maren; Abulimiti, Ayimunishagu; Toro, Pablo; Herold, Christina J.; Schultz, Tanja; Schroeder, JohannesVerbal fluency -i.e. the ability to name as many words of a given category as possible in a defined time interval -is an integral part of neuropsychological test batteries for the diagnosis of dementia. Verbal fluency can be easily administered and thus may also be implemented in computerized dementia screening tests.