Associação de maus-tratos na infância e declínio cognitivo no idoso

Abstract

Population aging occurs especially in developing countries. This fact changes the health and disease profile in the population, prevailing chronicdegenerative diseases over acute and infectious ones. Among the alterations of chronic characteristics, we highlight the cognitive decline, highly prevalent in the world, which is present in dementia syndromes, representing a public health problem. This change affects the functional capacity of the individual in their daily lives, implying loss of independence and autonomy. The World Health Organization (WHO) points out that the impact is most intense in low- and middleincome countries, which is related to underdiagnosis and undertreatment in the context of primary care (PH). In addition, other factors contribute to the complexity of cognitive decline in the elderly, including comorbidity with depressive disorders, contributing to the severity of the psychiatric condition. In recent decades, violence has become a major cause of morbidity and mortality, especially in the population of adolescents and young adults in large cities. However, there are few studies on child maltreatment focusing on the consequences in the elderly. This is a prospective cross-sectional study that aimed to examine the possible associations between childhood maltreatment and cognitive decline in a stratified random sample of older adults enrolled by the Family Health Strategy (FHS) program in the city of Porto Alegre. For the development of the study, the data used come from two stages of collection: 1) screening stage: with sociodemographic data collection, multidimensional health and Clinically Significant Depressive Symptoms (SDCS) with: the Geriatric Depression Scale of 15 (EDG-15) at home visit by Community Health Agents (ACS), the Vellore (screening tool for cognitive impairment), the Informant Questionnaire on the Cognitive Decline in the Elderly (IQCODE) for those with alterations in the Vellore, the Activities of Daily Living Questionnaire - Activities of Daily Living Questionnaire (ADLQ); and 2) specialized interview with: diagnostic evaluation of psychiatric disorders, using the validated Brazilian version of the Mini International Neuropsychiatric Interview 5.0.0 plus (MINI 5.0.0 plus BR) - admitting the criteria of the 5th revised edition of the Diagnostic Manual. and 12 Statistical of Mental Disorders (DSM-5) as gold standard; cognitive assessment through the Addenbrook Revised Cognitive Examination - Addenbrooke's Cognitive Examination-Revised (ACE-R) and the Mine Mental State Examination (MMSE), which is contained in the ACE-R; assessment of neuropsychiatric symptoms by the Neuropsychiatric Inventory Questionnaire (NPI-Q); and assessment of the presence and type of child maltreatment using the Childhood Trauma Questionnaire (CTQ). The present work aimed to: 1) study the prevalence of childhood maltreatment of elderly patients enrolled in the FHS of Porto Alegre-RS, Brazil; 2) analyze the most frequent types of abuse in this population; 3) estimate the presence of behavioral and psychological signs and symptoms in patients with cognitive decline; 4) study the prevalence of cognitive disorders and their relationship to the presence and type (s) of childhood maltreatment. As a product of this work, an integrative review scientific article and a bioethical reflection article have been produced and already published and two others are in the process of preparation, each investigating one of the objectives described above. In the integrative review work, a total of 10 articles were part of the sample. Based on the results obtained, it was possible to conclude that childhood maltreatment is associated with the decline of cognitive function in the elderly. The article on bioethical reflection, of which 09 articles were part, may allow the conclusion that the abuse in childhood and old have similarities, especially in relation to the aggressor agent. In the other two studies, data were collected from 274 elderly, with 59.8% of patients with dementia according to MMSE, 37.5% according to ACE-R and 69% cognitive decline according to ACE-R. There is a decrease in ACE-R attention and orientation subdomains score as the burden of maltreatment - CTQ increases (rs = -0.14; P = 0.024). From 70 to 79 years old, with 8 to 11 years of schooling, there were statistically significant, inverse and moderate to strong correlations between CTQ and attention and orientation, spatial vision and MMSE domains (rs = -0.56, P = 0.011; rs = -0.57, P = 0.008; rs = -0.48, P = 0.032, respectively). In the age group of over 80, in the 4-7 years of schooling, there was a statistically significant, inverse and strong correlation between CTQ and ACER (rs = -0.66, P = 0.014) and between CTQ and spatial view (rs = -0.63, P = 0.022). 13 There was a difference in the distribution of CTQ to income, and subjects with income from 2 to 4 minimum wages had a higher score on CTQ (higher burden of abuse) compared to subjects with 4 minimum wages or more. Individuals with a partner had lower CTQ scores (lower burden of abuse) when compared to individuals without a partner, and this difference was statistically significant (P = 0.019). When comparing patients with and without dementia for MMSE and ACER, patients with dementia have higher NPI scores (neuropsychiatric symptoms) than patients without dementia (P <0.001), as well as patients with cognitive decline. had higher NPI scores than non-declining patients (P <0.001). There was a direct and statistically significant correlation between total CTQ and NPI (rs = 0.13, P = 0.032). As CTQ increases, the NPI increases. Among patients without ACE-R dementia, there was a statistically significant and direct correlation between total CTQ and NPI (rs = 0.20, P = 0.012). As the burden of maltreatment increases, the presence of neuropsychiatric symptoms increases. In addition, childhood maltreatment was clearly related to the onset and perpetuation of psychiatric and anxiety disorders throughout the life cycle. When analyzing the relationship between CTQ and the presence or absence of psychiatric disorders, it was possible to detect that patients with depression, at risk of suicide, with anxiety disorders, with generalized anxiety disorders, and with the presence of any disorder had significantly higher scores. than patients without each of these disorders. Patients with anxiety disorders have a higher burden of maltreatment in childhood than patients without current or life anxiety disorders. The disorders most associated with the highest burden of abuse were agoraphobia and social phobia. And there was an increase in the number of anxiety disorders in old age for subjects who had a higher burden of child maltreatment. With population aging and increasing cognitive decline in the world, it is becoming increasingly important to increase knowledge about this pathology and its associations with the presence of child maltreatment. The results evidenced in this study are worrying and shed light on important public health problems. However, the operationalization of local health teams brings hope for a model of strategic implementation of mental health actions of the elderly, as they point out 14 that “lay professionals” can play a fundamental role in the early detection of cognitive changes in the community and in the community. AB. Studies have examined important health problems, providing data on the high prevalence of cognitive decline and dementia, as well as childhood maltreatment in this population. Thus, it is necessary to implement a strategic and active model of action for preventive approach in the mental health of the elderly, because using low cost tools (screening scales), it is possible to identify cases of cognitive impairment in the early stages. , severe cases, as well as assist in identifying those elderly who may have suffered some kind of maltreatment in childhood.