Early detection of possible cognitive decline (PwCD) is crucial for preserving function and independence in aging. Objective:To examine whether dual-task and functional assessment tools can help detect cognitive impairment in older adults without prior diagnosis of neurocognitive disorders. Methods:A cross-sectional study was conducted with healthy older adults (≥60 years). The following exclusion criteria were adopted: neurological diseases with motor deficits, severe functional limitations, mobility aid use, and inability to walk six meters unaided. Assessments included the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Clock Drawing Test (CDT), Verbal Fluency (VF), Pfeffer Functional Activities Questionnaire, Timed Up and Go (TUG), Sit-to-Stand Test (STS), Berg Balance Scale (BBS), Step Test, and dual-task TUG (TUGdt) using animal naming (TUGdt-NA) and serial subtraction (TUGdt-S7). Statistical analyses included t-tests, Mann-Whitney U, ꭓ2 tests, and logistic regression (p≤0.05). Results:Among 144 participants, 89 were classified as healthy and 55 as PwCD. Most were female (90.9%), black (57.7%), with an average of 11.04 years of education. Groups did not differ in age, gender, or comorbidities. The PwCD group had lower education (p=0.01), more black individuals (p=0.03), and scored significantly worse on all cognitive tests (p<0.0001) and TUGdt (NA: p=0.040; S7: time p=0.027; accuracy p<0.001). No differences were found in STS, Step Test, BBS, or total Pfeffer scores; however, the PwCD group showed greater instrumental activities of daily living (IADL) impairment. Conclusion:The ability to perform dual tasks appears to be associated with functional capacity.
ABSTRACT Functional decline in activities of daily living (ADL) is considered a marker of ageing and Alzheimer’s disease. However, there is a lack of performance-based instruments specifically designed to assess ADL in adults and older adults with Down syndrome. Objective: To describe the adaptation process of the Direct Assessment of Functional Status (DAFS) to assess the functional capacity of adults with Down syndrome. Methods: The Direct Assessment of Functional Status-Brazilian Version (DAFS-BR) was administered to 15 adults with Down syndrome (nine men and six women) who were divided into two diagnostic groups: stable cognition and suspected dementia or cognitive impairment. The process was conducted in two phases: phase one was characterized by an adaptation in the tasks. In phase two, (cultural and semantic) equivalences were verified, as well as structural aspects, including layout and instructions. This phase was essential for verifying the applicability and comprehensibility of newly adapted tasks Results: The DAFS-BR was adapted for the time orientation, communication (telephone use), moneyhandling skills, and shopping skills domains, considering the target population. Conclusion: The adaptation process of the DAFS-BR for people with Down syndrome was made considering linguistic, psychological, and cultural idiosyncrasies in the target population, with the input of experts with relevant experience in each domain. After psychometric studies, the Direct Assessment of Functional Status-Down Syndrome (DAFS-DS) could be considered the first ecological instrument for evaluating functional status in adults with Down syndrome in Brazil to enhance both clinical practice and research.
Advances in healthcare have led to increased life expectancy among individuals with Down syndrome, resulting in a growing population of older adults within this group. As a result, the prevalence of cognitive decline and dementia has increased, largely due to the genetic predisposition of Down syndrome to early and significant accumulation of brain amyloid and intensified formation of neurofibrillary tangles. Early detection of functional alterations, particularly those related to gait and balance, may serve as a valuable clinical marker of emerging neurocognitive impairment. Objective:To synthesize the current evidence on the relationship between gait, cognitive decline, and dementia in adults and older adults with Down syndrome. Methods:A systematic search was conducted in the PubMed database in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Original observational studies evaluating gait, balance, or fall risk in relation to cognitive decline or dementia in adults with Down syndrome were included. Methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Results:Thirty-seven records were identified, of which five original studies met the inclusion criteria. Overall, the findings suggest an association between gait alterations, balance, and cognitive decline in individuals with Down syndrome. Commonly reported abnormalities included reduced gait speed, increased gait variability, inconsistency in gait parameters, and impaired balance. However, heterogeneity in study design, different measurement protocols, and small sample sizes limited the comparability and generalizability of the results. Conclusion:Gait assessment holds promise as a non-invasive, accessible approach for early identification of cognitive decline in individuals with Down syndrome. Future research should prioritize longitudinal designs, standardized assessment protocols, and larger representative samples to inform targeted and evidence-based clinical interventions.
Aphasia is a neurological condition characterized by partial or total loss of verbal communication, most commonly caused by stroke. In hospital settings, brief and reliable tools are essential to identify and quantify aphasia early, enabling prompt diagnosis and appropriate rehabilitation planning. However, Brazil lacks language assessment instruments adapted for bedside use. Objective:To perform the cross-cultural adaptation and validation of the Bedside Language test for Brazilian Portuguese. Methods:The BL underwent translation, back-translation, expert review, and cultural adaptation. The final version was administered to 70 participants. Two evaluators applied the instrument on the same day to assess inter-rater reliability, and the same examiner reapplied it within two days to assess test-retest reliability. The Bedside Evaluation Screening Test (BEST-2) language test was also used for concurrent validity. Results:The Brazilian version of the BL demonstrated high internal consistency (Cronbach's alpha: spontaneous reading - LE=0.80; comprehension - CO=0.86; repetition - RE=0.95; writing - ES=0.73; overall=0.87), as well as satisfactory intra-rater (p=0.22) and inter-rater (p=0.77) reliability. It showed a strong correlation with the BEST-2 across all linguistic domains except writing. Conclusion:The Brazilian Portuguese version of the BL is a brief, valid, and reliable bedside screening tool for identifying aphasia in patients with ischemic stroke, supporting high-quality care in specialized stroke centers.
