Predictive factors of cognitive impairment in people over 60 | Enfermería Clínica (English Edition)

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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tb0005"></elsevierMultimedia></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0020" class="elsevierStylePara elsevierViewall">The proportion of people aged 60 or more years in the world is currently increasing in comparison with the rest of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">1</span></a> This phenomenon is giving rise to changes not only in the age structure of the world population&#44; but also in the emergence of new and greater demands made on health systems&#44; due to the social and economic impact this involves&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The state of health of those individuals who are over the age of 60 years affects the degree to which they are independent&#44; which is already affected by a series of problems&#46; These include cognitive problems that directly affect quality of life&#46; Cognitive deterioration is characterised by a decline in brain function that affects the ability to concentrate&#44; memory&#44; language&#44; speed of reaction and decision-making&#44; executive functions&#44; language and visual-spatial skills&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">3&#8211;6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Several risk factors are underlined in the literature&#44; and these may be associated with the development of cognitive deterioration in the elderly population&#44; especially in terms of depressive symptoms&#44; sleep quality&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">7</span></a> malnutrition<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">8</span></a> and walking speed&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">9</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It has therefore been observed that individuals over the age of 60 years with depressive symptoms are also affected in terms of attentional tasks and immediate memory&#46; This is reflected in poorer performance in explicit memory tests for free recall&#44; recall using keys and recognition&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">10</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">On the other hand&#44; it is observed that excessive daytime somnolence is a marker of degenerative disease&#44; due to the role of trunk cholinergic cells in the waking system&#44; and these are susceptible to cognitive alteration&#46; Equally&#44; prolonged periods of sleep have been associated with an early symptoms of cognitive decline&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Respecting the risk factor of malnutrition&#44; the literature shows that insufficient levels of essential nutrients in the diet may alter nervous system activity&#44; giving rise to a neurological disorder&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">12</span></a> Likewise&#44; excessive malnutrition may lead to the development of brain lesions due to ischaemia caused by a high consumption of fats and sugars&#44; and it may also increase the probability of brain inflammation&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Slow walking speed has also been found to cause a cognitive disorder&#44; because motion governing centres have limited capacity of attention functioning&#44; executive control and memory which are necessary to walk at normal speed&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">13</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">In spite of the inputs from several authors&#44; no studies were found that combine and observe the effect of risk factors such as symptoms of depression&#44; sleep quality&#44; nutrition and walking speed on cognition&#46; Due to this&#44; the aim of this study is to discover the effect of symptoms of depression&#44; sleep quality&#44; nutrition and walking speed on cognitive deterioration in individuals over the age of 60 years&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Method</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study design</span><p id="par0060" class="elsevierStylePara elsevierViewall">A transversal correlational study was undertaken&#46; The independent variables in this study are depressive symptoms&#44; sleep quality&#44; nutrition and walking speed&#46; Cognitive deterioration is considered to be a dependent variable&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Population&#44; sampling and sample</span><p id="par0065" class="elsevierStylePara elsevierViewall">The study population was composed of individuals of both sexes over the age of 60 years who attended day centres for seniors from May to July 2017 in Nuevo Laredo&#44; Tamaulipas&#44; Mexico&#46; Sampling was not probabilistic for reasons of convenience&#44; as an open invitation was issued to take part in the study&#46; The final sample &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>108&#41; was calculated using version 4&#46;2 of the Programme for epidemiological data analysis &#40;EPIDAT&#174;&#41;&#44; with a level of significance of 95&#37;&#44; an estimation error limit of 0&#46;05 and a design effect of 1&#46;0&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Inclusion and exclusion criteria</span><p id="par0070" class="elsevierStylePara elsevierViewall">The following individuals were included&#58; &#40;1&#41; individuals aged over 60 years&#59; &#40;2&#41; aware in space&#44; time and person &#40;verified by questions about their name&#44; age&#44; the date and location&#41;&#59; and &#40;3&#41; who voluntarily wished to take part&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Exclusion criteria&#58; &#40;1&#41; those with difficulty in walking&#59; &#40;2&#41; those with a motor neurone disease that prevented them from standing&#59; &#40;3&#41; those with severe eyesight problems that hindered their reading&#44; and those who could not read&#44; as one of the instruments used required reading to be administered&#59; &#40;4&#41; those who were under pharmacological treatment which may affect their judgement&#44; as cognitive tests could have been altered &#40;for example&#44; neuroleptic and antidepressant drugs&#41;&#59; &#40;5&#41; individuals over the age of 60 years who had trembling that visibly affected their mobility and balance&#59; &#40;6&#41; participants who had been hospitalised in the previous 6 months due to severe disease or surgery that affected their mobility &#40;such as hip or knee prosthesis&#41;&#59; and &#40;7&#41; those who had the medical diagnosis of senile dementia and&#47;or Alzheimer-type disease&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Instruments and measurements</span><p id="par0080" class="elsevierStylePara elsevierViewall">A sociodemographic data card was used to record personal and clinical data&#46; 3 open questions were asked &#40;age&#44; years of education and occupation&#41; together with 5 multiple choice questions&#58; marital status&#44; sex and 3 questions to evaluate the awareness of the participants in time &#40;&#8220;Do you know what day of the week it is&#63;&#8221;&#41;&#44; space &#40;&#8220;Do you know where we are&#63;&#8221;&#41; and person &#40;&#8220;What is your complete name&#63;&#8221;&#41;&#44; so that if they answered correctly they were included in the study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Result variables</span><p id="par0085" class="elsevierStylePara elsevierViewall">Cognitive attention and memory were tested using a battery of cognitive measurements composed of 3 neuropsychological tests&#58; the STROOP test&#44; the traces test and the digit interval test&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The STROOP test is composed of 3 parts &#40;P&#44; C and PC&#41;&#46; In the first part&#44; known as Stroop-P&#44; the participant had to read the words in black ink in columns&#46; The time limit is 45<span class="elsevierStyleHsp" style=""></span>s&#44; and they are told when to start and finish&#46; This sheet contains 5 columns&#44; each with 20 words&#46; The respondent is asked to start again at the first column if they reach the end and have not been asked to stop there&#46; The number of words read correctly is counted&#46; The second part&#44; Stroop-C&#44; involves the naming of colours&#46; It is composed of rows of colour names printed in different colours&#46; The respondent is asked to say the name of the colour that is written regardless of the colour it is printed in&#44; and the number of correct choices in 45<span class="elsevierStyleHsp" style=""></span>s is recorded&#46; The third test&#44; Stroop-PC&#44; of colour-words&#44; contains the colours red&#44; green and blue&#44; but printed in a colour other than the corresponding one&#46; During 45<span class="elsevierStyleHsp" style=""></span>s the respondent has to name the colour of the ink the word is printed in&#44; ignoring its meaning&#46; The number of correct choices is recorded&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The traces test &#40;A and B&#41; evaluates the speed of concentration&#44; sequencing and also mental flexibility&#44; visual searching and motor function&#46; It consists of 2 parts&#44; Tracing Test A&#44; which comprises joining a series of numbered circles in ascending order from 1 to 25&#44; starting with the circle marked 1 and drawing a straight line from this number to the next&#44; in ascending order until the circle marked 25 is reached&#46; The participant is asked to draw the lines as quickly as they can&#44; to try not to raise the pencil from the paper and wait to be told when to start&#46; Part B shows all of the numbers from 1 to 25 twice and printed in different colours &#40;yellow and pink&#41;&#44; so that the participant makes a perceptive choice in all of the numbers&#46; In this section they are asked to connect the numbers from 1 to 25 in alternating colours while remembering to maintain the sequence of them&#46; If the participant commits an error they are informed of this and asked to continue from the last circle&#44; completing the sequence correctly&#46; This measurement is made based on the errors committed and the time in seconds the respondent takes to complete the test&#44; as each error adds one second to the final time score of the test&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">15</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The &#40;progressive and inverse&#41; digit interval test is in 2 parts&#44; one in advancing order and the other in inverse order&#46; It measures how much information a person is able to handle at the same time&#46; The digit test in advancing order comprises 2 tests that run from a 3 digit series to a 9 digit series&#44; and it consists of orally presenting sequences of random numbers at approximately one per second&#44; so that later the participant is able to repeat the digits in exactly the same sequence they were given in&#46; The examiner continues added digits every time the respondents completes the task correctly&#46; The examiner normally starts by asked the subject to only repeat 2 or 3 digits&#44; before increasing the number of digits until the subject is unable to repeat the sequence correctly&#46; A score of 6 or more is within normal limits&#44; while 5 is marginal&#44; 4 is borderline and 3 is deficient&#46; On the other hand&#44; the inverse order digit tests comprises 2 tests which run from a 2 digit series to an 8 digit series&#46; As was the case in the previous test&#44; the series of digits is read aloud but the participant has to say them in reverse order&#44; the last first and so on&#46; The number of digits repeated correctly in reverse order is recorded&#46; A score from 4 to 5 is within normal limits&#44; 3 is borderline deficient and 2 is deficient&#46; A higher score corresponds to greater retentive power or memory&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Risk factors</span><p id="par0105" class="elsevierStylePara elsevierViewall">The following scales are also applied&#58; the geriatric depression scale &#40;GDS-15&#41;&#44; which measures the presence of depressive symptoms in individuals over the age of 60 years&#44; the Pittsburgh sleep quality index &#40;PSQI&#41;&#44; which covers sleep characteristics &#40;quantity and quality&#41; in the previous month&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The Mini Nutritional Assessment &#40;MNA&#41; is an evaluation that makes it possible to discover the risk of malnutrition according to dietary and anthropometric parameters&#46; The questionnaire consists of 18 items and it is divided into 2 sections&#58; a screening section &#40;6 questions&#41; and an evaluation section &#40;12 questions&#41;&#44; the same as those used as a whole for this study to prevent measurement errors during statistical analysis&#46; This test classifies elderly individuals into 3 groups&#44; with a maximum of 30 points&#58; satisfactory nutritional state &#40;&#62;24 points&#41;&#44; risk of malnutrition &#40;17&#8211;23&#46;5&#41; and malnutrition &#40;&#60;17 points&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Finally&#44; a short battery of tests of physical performance is applied &#40;SPPB&#41;&#59; this battery includes 3 timed tests on balance&#44; walking and lower limb strength &#40;standing up and sitting down on a chair&#41;&#44; and anthropometric measurements are also taken of weight&#44; height&#44; arm and calf diameters&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Data gathering procedure</span><p id="par0120" class="elsevierStylePara elsevierViewall">After obtaining the relevant permits the specific area of the institution to be used for data gathering was checked&#46; The area was also inspected to ensure that it was safe and suitable for the measurement of walking speed&#58; a spacious area 4<span class="elsevierStyleHsp" style=""></span>m long was required that did not have a slippery floor surface or major differences in level&#44; and with sufficient light to prevent accidents occurring&#46; Respondents were given appointments at successive times&#44; and they were told that it would take approximately 45<span class="elsevierStyleHsp" style=""></span>min for them to answer the tests and perform the corresponding anthropometric measurements&#44; so that they were aware of the time they would be away from their other activities&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The participants were told that they were not obliged to take part in the study&#44; and that those who did not wish to do so were completely free to refuse and leave&#44; without this affecting their membership of the said geriatric institution&#46; They were also informed that the data supplied were confidential&#44; repeating their right not to take part&#44; or to cease doing the tests whenever they wished&#46; After this each one of the older adults who decided to take part was given an informed consent form for their written authorisation&#44; and the sociodemographic data card was filled in&#46; The test instruments were then administered to each participant individually&#44; in the following order&#58; &#40;1&#41; Stroop test&#59; &#40;2&#41; Colour traces test&#59; &#40;3&#41; Digit interval test&#59; &#40;4&#41; GDS&#59; &#40;5&#41; PSQI&#59; &#40;6&#41; MNA&#59; and &#40;7&#41; short physical performance test battery&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Approval was sought from the Research and Ethics Commission of the Nursing Faculty of the <span class="elsevierStyleItalic">Universidad Aut&#243;noma</span>&#44; Tamaulipas&#44; as well as the authorisation of the corresponding geriatric institute for the implementation of the study&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data analysis</span><p id="par0135" class="elsevierStylePara elsevierViewall">Version 20&#46;0 of the Statistical Package for the Social Sciences &#40;SPSS&#41;&#174; was used to process the data of this study&#44; with descriptive and inferential statistics&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Descriptive statistics were used to describe the study population by means of frequency analysis&#44; proportions&#44; core tendency measurements and variability&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">The normalcy of continuous and numerical variable distributions were determined by using the Kolmogorov&#8211;Smirnov test&#44; with Lilliefors&#39;s correction for parametrical or non-parametrical statistical use&#44; and the latter was reported as such&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Spearman&#39;s correlation coefficient was used to study the research variables&#46; Additionally&#44; multiple lineal regression was used to discover the effect of the independent variables &#40;depressive symptoms&#44; sleep quality&#44; nutritional status and walking speed&#41; on the dependent variable &#40;cognition&#41;&#46;</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Results</span><p id="par0155" class="elsevierStylePara elsevierViewall">The final sample was composed of 108 individuals over the age of 60 years&#46; According to the personal characteristics of the participants in the study there were more women &#40;87&#37;&#41; than there were men &#40;14&#37;&#41;&#46; 73&#46;1&#37; of the participants stated that they were not in work&#46; Likewise&#44; the majority of the participants had been widowed &#40;39&#46;8&#37;&#41;&#44; followed by those who were married &#40;30&#46;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">The average age of the participants was 71&#46;77 years &#40;SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>7&#46;016&#41;&#44; varying from 60 to 89 years&#46; The average number of years of education of the participants was found to be 4 years &#40;x&#175;&#61;0&#46;9&#59; SD<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>6&#46;8&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">According to <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> in the Stroop test&#44; the Stroop PC test showed higher correlation coefficients with the variables that resulted from the Stroop P test&#44; and significant correlations were detected between the said test and depressive symptoms &#40;rs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#8211;0&#46;192&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;04&#41; and walking speed &#40;rs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;283&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41;&#46; On the other hand&#44; according to the advancing and inverse digit interval test&#44; the inverse digit test showed a higher number of significant correlations&#44; and correlations were identified with sleep quality &#40;<span class="elsevierStyleItalic">r</span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;203&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;035&#41;&#44; and walking speed &#40;<span class="elsevierStyleItalic">r</span>2<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;249&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;009&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0170" class="elsevierStylePara elsevierViewall">However&#44; the B traces test was the one that was associated the most closely with risk factors&#44; showing correlations with depressive symptoms &#40;rs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;243&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;011&#41;&#44; nutritional status &#40;rs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;284&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;003&#41; and walking speed &#40;rs<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;416&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Due to the above finding it was decided to use the B traces test to represent cognitive deterioration in the analysis of the multiple lineal regression model&#44; using the &#8220;Enter&#8221; method&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the results obtained by the multiple lineal regression model&#44; where it can be seen that the model as a whole was significant &#40;<span class="elsevierStyleItalic">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#46;914&#59; gl<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; showing an explained variance of 33&#46;4&#37;&#44; where depressive symptoms &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;205&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;048&#41;&#44; sleep &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;322&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; nutritional status &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;336&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and walking speed &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;244&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41; predict significant effects on cognitive deterioration&#44; thereby giving a model that fits all of the variables it contains&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">According to the study objective&#44; cognitive deterioration in individuals older than 60 years was analysed using 4 specific risk factors&#58; depressive symptoms&#44; sleep quality&#44; nutritional status and walking speed&#46; Results were found that support this inference&#44; and these are discussed together with each risk factor&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">A positive correlation was found respecting depressive symptoms&#59; i&#46;e&#46;&#44; a greater number of depressive symptoms is a predictive factor for cognitive deterioration&#44; and this agrees with the finding by Dur&#225;n-Badillo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">17</span></a> This effect may be due to the fact that depressive symptoms promote the distortion of reality and the development of emotional collapse which increases fixation on the negative aspects of life&#44; interiorising a persistent sadness that leads to a general loss of interest in life&#44; altering the level of attention&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">18</span></a> This may often be reflected by states of apathy and the presence of little effort in performing any task they are asked to perform&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">19</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">When an individual over the age of 60 years loses interest in their environment and seeks isolation and rejects social contact in situations of mild depression&#44; this leads them to reduce all forms of activity in general that involve cognitive process for their execution&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">20</span></a> This may cause the areas of the brain involved in such functions to reduce their activity because of the lack of stimulation&#44; and this in turn leads to cognitive deterioration&#44; as it has been proven that brain stimulation has beneficial effects&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">21</span></a> Additionally&#44; the development of an established depression with severe emotional alterations is characterised by episodes of impulsiveness and suicidal thoughts&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">22</span></a> denoting alterations in the inhibitory executive system to self-regulate these behavioural responses&#44; which in turn may arise due to the progress of the disease&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">In reference to sleep quality and according to our results&#44; a good amount of sleep is a predictor for cognitive deterioration&#59; this is possible because the instrument has the purpose of evaluating the number of hours of sleep&#44; indicating higher quality sleep in those individuals who sleep the most&#46; The existence of an association between sleep quality and cognitive deterioration has already been the subject of other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">23</span></a> Niu et al&#46; found in their results that individuals over the age of 60 years with deficient sleep quality suffered cognitive decline in comparison with those who had a good quality of sleep&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">24</span></a> However&#44; in this study the relationship found was negative&#44; indicating that good sleep quality is associated with cognitive decline&#46; Similarly&#44; Westwood et al&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">25</span></a> undertook a study with a 10-year follow-up which found that prolonged duration of sleep is associated with a higher risk of cognitive deterioration and dementia&#44; with a low level in the executive functions&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The results of this study may therefore be associated more with the number of hours of sleep than they are with the quality of the hours in question&#46; This is probably due to the fact that sleeping for too long leads the body to relax excessively&#44; so that biorhythms fall as does the metabolic rate&#46; This causes the organism to slow down and the sensation of tiredness increases&#46; It is known as a feeling of lethargy&#44; as actions too slow down because of the prolongation of the time in which the organism is hardly active at all&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a></p><p id="par0210" class="elsevierStylePara elsevierViewall">Sleeping too many hours minimises the capacity to respond during the day&#44; as sleeping slows down the heart rate&#46; Prolonging the hours of sleep also prolongs the effect of this inactivity&#44; leading to lower response capacity as the blood circulates more slowly and less blood is received&#46; This may lead to a feeling of always being run-down and tired because the body hardly recovers from so much time spent sleeping&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">26</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">A negative association was found with nutritional status&#44; i&#46;e&#46;&#44; a lower nutritional status is associated with increased cognitive deterioration&#46; These results agree with those found by EI Zoghbi et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">27</span></a> as they identified that a state of malnutrition and a low educational level represent a higher probability of suffering cognitive function deterioration&#46; In the same way&#44; Sanders et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">28</span></a> found that a deficient nutritional state was associated with greater cognitive and functional deterioration in cases of dementia&#44; which supports the study hypothesis&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Malnutrition may be expressed in 2 ways&#58; malnutrition due to deficit and malnutrition due to excess&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">29</span></a> This may not only cause nutritional problems&#44; as both types of malnutrition may case cognitive problems&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">When malnutrition is caused by excess&#44; cognitive deterioration probably arises due to the deficient in essential nutrients needed for nervous system activity&#44; as this requires a large number of ingredients in the diet for it to work effectively&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">30</span></a> These necessary nutrients can be said to include B complex vitamins&#44; which take part in nervous system reactions as cofactors in myelin synthesis and obtaining energy&#46; Thiamine deficiency may play a fundamental role in the development of acute delirium&#44; niacin deficiency may be involved in the development of dementia&#44; while folate deficiency has been associated with depression and B<span class="elsevierStyleInf">12</span> deficiency has been associated with reversible dementia&#59; moreover&#44; low concentrations of vitamins C&#44; B<span class="elsevierStyleInf">2</span> and folic acid may be associated with memory and abstract thinking problems&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">A positive correlation was found with participants&#8217; walking speed&#44; indicating that slow walking is a predictive factor for cognitive deterioration&#46; This finding agrees with Maclean et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">31</span></a> who found an association between walking and attention during complex and simple tasks&#44; indicating that a slower walking speed is a sign of a greater degree of interference with attention&#46;</p><p id="par0235" class="elsevierStylePara elsevierViewall">This is probably because walking is not a simple motor activity&#44; as normal walking also requires cognitive function&#44; involving several neuropsychological factors and mobility control&#46; These factors include awareness of direction&#44; skill in lower limb control and the skill required to move within complex environments&#46; As well as the capacity of awareness&#44; executive control and memory directly influence balance and walking speed&#44; and they are important aspects for healthy walking in individuals over the age of 60 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0315"><span class="elsevierStyleSup">31&#44;32</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">Respecting its limitations&#44; given the transversal nature of this study&#44; the results should be interpreted with caution&#44; without drawing causality inferences&#59; every hypothesis that is generated must be confirmed by experimental studies&#46; Likewise&#44; the inherent defect in self-reporting instruments lies in the fact that participants may not be completely sincere in their answers&#46; On the other hand&#44; cultural differences may restrict extrapolation of the findings&#44; as well as the lack of randomisation and sampling based on convenience&#46; Additionally&#44; as completing the questionnaires took an average of 45<span class="elsevierStyleHsp" style=""></span>min&#44; this means that adjustments were made in how to commence the cognitive tests&#44; to prevent any type of distortion arising in them&#46; Even so&#44; it is recommended to conduct interviews over 2 days to prevent inconveniencing participants and allowing them to carry on with their usual activities without any problem&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">It is recommended that this study be repeated in an open population&#44; as given that it was restricted to users of a recreational facility the information collected cannot be extrapolated&#46; It would be important to include the falls variable&#44; as during data gathering it was observed that the number of falls suffered by the participants in the previous months was often mentioned&#46; It is therefore also important to explore the variables over time&#44; to discover whether the effects of deterioration in connection with the predictive factors remain constant over time&#46;</p><p id="par0250" class="elsevierStylePara elsevierViewall">To conclude&#44; it may be said that elderly adults are members of society who are exposed to a range of disorders caused by the changes that arise with ageing and other factors with a direct influence on their state of health&#46; Nevertheless&#44; this study explains some of the factors that intervene in the development of one of the most widespread health problems for elderly adults&#44; cognitive deterioration&#46; Thanks to this it was found that a higher level of depressive symptoms&#44; poorer nutritional status&#44; higher quality of sleep and slower walking speed are predictive factors for cognitive deterioration in the elderly&#44; supplying knowledge so that interventions can take place to prevent the risk factors that predict cognitive deterioration&#44; thereby delaying its onset&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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              "titulo" => "Population&#44; sampling and sample"
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              "titulo" => "Inclusion and exclusion criteria"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-09-20"
    "fechaAceptado" => "2020-10-14"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1349322"
          "palabras" => array:5 [
            0 => "Cognition"
            1 => "Gait"
            2 => "Depression"
            3 => "Sleep"
            4 => "Nutritional status"
          ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1349323"
          "palabras" => array:5 [
            0 => "Cognici&#243;n"
            1 => "Marcha"
            2 => "Depresi&#243;n"
            3 => "Sue&#241;o"
            4 => "Estado nutricional"
          ]
        ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To determine the relationship of depressive symptoms&#44; sleep hygiene&#44; nutritional status and gait speed with cognitive impairment in people over 60 years&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional&#44; correlational design with a non-probability convenience sampling&#46; The population was made up of people over 60 years of age belonging to recreational stays in an urban area of Tamaulipas&#44; Mexico&#46; Criterion measures included three neuropsychological tests &#40;Stroop Test&#44; Trail Making Test and Digit Span Subtest&#41; the Geriatric Depression Scale&#44; Pittsburgh Sleep Quality Index&#44; Mini Nutritional Assessment and the Short Physical Performance Battery&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The final sample was of 108 participants&#46; Regarding the influence of risk factors to predict cognitive impairment a significant model was observed &#40;<span class="elsevierStyleItalic">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#46;914&#44; <span class="elsevierStyleItalic">gl</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; showing a variance explained of 33&#46;4&#37;&#44; where depressive symptoms &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;205&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;048&#41;&#44; sleep &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;322&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#44; nutritional status &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;&#46;336&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and gait speed &#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;244&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;004&#41; were associated with cognitive impairment&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">High levels of depressive symptoms&#44; prolonged sleep duration&#44; a malnutrition status and a slow gait speed predict cognitive impairment of the people over 60 years&#44; this provides knowledge for the implementation of interventions aimed at preventing the risk factors that predict cognitive decline in order to delay its appearance&#46;</p></span>"
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            "identificador" => "abst0005"
            "titulo" => "Objective"
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            "identificador" => "abst0010"
            "titulo" => "Method"
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            "identificador" => "abst0015"
            "titulo" => "Results"
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            "identificador" => "abst0020"
            "titulo" => "Conclusions"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Determinar la asociaci&#243;n de s&#237;ntomas depresivos&#44; la calidad del sue&#241;o&#44; el estado nutricional y la velocidad de la marcha con el deterioro cognitivo de las personas de m&#225;s de 60 a&#241;os&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio de corte transversal con dise&#241;o correlacional con un muestreo no probabil&#237;stico por conveniencia&#46; La poblaci&#243;n estuvo conformada por personas mayores de 60 o m&#225;s a&#241;os de edad pertenecientes a centros de d&#237;a para adultos mayores de un &#225;rea urbana de Tamaulipas&#44; M&#233;xico&#46; Se utilizaron 3 test neuropsicol&#243;gicos &#40;Stroop&#44; Trazos de colores e Intervalo de d&#237;gitos&#41; la Escala de depresi&#243;n geri&#225;trica&#44; el &#205;ndice de calidad del sue&#241;o de Pittsburgh&#44; el <span class="elsevierStyleItalic">Mini Nutritional Assessment</span> y la Bater&#237;a corta de desempe&#241;o&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La muestra final fue de 108 adultos mayores&#46; En cuanto a la influencia de los factores de riesgo para predecir el deterioro cognitivo se observ&#243; un modelo significativo &#40;F<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>12&#44;914&#44; gl<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44; p<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; mostrando una varianza explicada de 33&#44;4&#37;&#44; donde los s&#237;ntomas depresivos &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;205&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;048&#41;&#44; el sue&#241;o &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;0&#44;322&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; el estado nutricional &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;0&#44;336&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y la velocidad de la marcha &#40;&#946;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;244&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;004&#41; se asociaron con el deterioro cognitivo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Niveles altos de s&#237;ntomas depresivos&#44; horas de sue&#241;o prolongadas&#44; un estado de malnutrici&#243;n y una velocidad de marcha lenta se asociaron con el deterioro cognitivo de las personas de m&#225;s de 60 a&#241;os&#44; lo cual aporta conocimientos para la implementaci&#243;n de intervenciones dirigidas a prevenir los factores de riesgo que predicen el deterioro cognitivo para as&#237; retardar su aparici&#243;n&#46;</p></span>"
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            "identificador" => "abst0035"
            "titulo" => "Resultados"
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            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Rend&#243;n-Torres L&#44; Sierra-Rojas I&#44; Benavides-Guerrero C&#44; Botello-Moreno Y&#44; Guajardo-Balderas V&#44; Garc&#237;a-Perales L&#46; Factores predictores del deterioro cognitivo en personas mayores de 60 a&#241;os&#46; Enferm Clin&#46; 2021&#59;31&#58;91&#8211;98&#46;</p>"
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t" scope="col">Model 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;Constant&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">188&#46;348&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#46;270&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Depressive symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">16&#46;308&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&#46;160&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;999&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#46;048<a class="elsevierStyleCrossRef" href="#tblfn0015">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Nutritional status&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;3&#46;380&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Multiple lineal regression model for depressive symptoms&#44; sleep quality&#44; nutritional status and walking speed over cognitive deterioration &#40;Enter Method&#41;&#46;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">What is known&#63;</span><p id="par0010" class="elsevierStylePara elsevierViewall">Cognitive function is the set of mental operations that involve the perception of stimuli before responding or performing a specific form of behaviour&#46; This function may undergo modifications during the stage of ageing&#44; developing cognitive deterioration&#46; This may be influenced by factors such as walking speed&#44; depressive emotions&#44; sleep or nutritional state&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">What does this paper contribute&#63;</span><p id="par0015" class="elsevierStylePara elsevierViewall">This condition is found in individuals over the age of 60 years who attend day centres for senior citizens&#46; Cognitive deterioration is associated with stronger depressive symptoms&#44; poorer nutrition&#44; longer hours of sleep and slower walking speed&#46; It is therefore necessary to evaluate these dimensions in the said population&#44; as well as to implement interventions designed to prevent these factors&#46;</p></span></span>"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La situaci&#243;n demogr&#225;fica en el mundo 2014 &#91;Internet&#93;"
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                        0 => array:2 [
                          "colaboracion" => "Departamento de Asuntos Econ&#243;micos y Sociales de las Naciones Unidas &#91;DESA&#93;"
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                  "referenciaCompleta" => "Crecimiento acelerado de la poblaci&#243;n adulta de 60 a&#241;os y m&#225;s de edad&#58; Reto para la salud p&#250;blica&#46; &#91;Internet&#93;&#46; Pan American Health Organization&#47;World Health Organization&#46; Available at&#58; <a target="_blank" href="https://www.paho.org/hq/index.php?option=com_content%26view=article%26id=2796%3A2010-crecimiento-acelerado-poblacion-adulta-60-anos-mas-edad-reto-salud-publica%26Itemid=1914%26lang=es">https&#58;&#47;&#47;www&#46;paho&#46;org&#47;hq&#47;index&#46;php&#63;option&#61;com&#95;content&#38;view&#61;article&#38;id&#61;2796&#37;3A2010-crecimiento-acelerado-poblacion-adulta-60-anos-mas-edad-reto-salud-publica&#38;Itemid&#61;1914&#10216;&#61;es</a> &#91;accessed 24&#46;01&#46;20&#93;&#46;"
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                      "titulo" => "Probable deterioro cognitivo asociado a factores de riesgo en poblaci&#243;n mayor de 40 a&#241;os"
                      "autores" => array:1 [
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                            0 => "A&#46; Jim&#233;nez Mendoza"
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                            2 => "M&#46; Tapia Arriaga"
                            3 => "E&#46; Cadena Torres"
                            4 => "D&#46; Ib&#225;&#241;ez L&#243;pez"
                            5 => "A&#46; G&#243;mez Cruz"
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                      "Revista" => array:5 [
                        "tituloSerie" => "Enf Neurol"
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