Alyne Gonçalves de Jesus

Neuropsychiatric symptoms as the main determinant of caregiver burden in Alzheimer's disease

Caregiver burden is common in Alzheimer’s disease (AD), decreasing the quality of life among caregivers and patients. Projections of aging and aging-related diseases such as AD in developing countries justify additional data about this issue because people living in these countries have shown similarly high levels of caregiver strain as in the developed world. Objective The aim of this study was to analyze the association of AD caregivers’ burden with patients’ neuropsychiatric symptoms (NPS), cognitive status, severity of dementia, functional capacity, caregiver sociodemographic characteristics, and the characteristics of care provided by caregivers. Methods A cross-sectional study was conducted in a sample of 39 consecutive AD patients and their primary caregivers. NPS were evaluated using the Neuropsychiatric Inventory (NPI). Severity of dementia was assessed with the Clinical Dementia Rating (CDR) scale. Functional capacity was assessed using the Katz and Lawton scales. The burden level was rated using the Burden Interview (BI). Sociodemographic characteristics of caregivers and the characteristics of care provided by them were evaluated. The Mann-Whitney U-test, Kruskal-Wallis test and Spearman’s rho coefficient were performed. Results The BI had a moderate correlation with NPI intensity (rho=0.563), p<001. Female caregivers reported a greater level of burden (p=0.031) than male caregivers. The other variables were not significantly associated to caregiver burden. Conclusion NPS were the main determinant of burden in primary caregivers of AD patients. This result underscores the need for prevention and treatment of these symptoms. Sex also had an effect on caregiver burden, but the small male sample in this study precludes the generalization of this finding.

Correlation between serum brain-derived neurotrophic factor and verbal fluency

ering “probable AD” alone as well as “probable” plus “ possible” AD. The neuropathological diagnosis of AD was defined using multiple combinations of CERAD neuritic plaque density scores and Braak neurofibrillary tangle stages.Results:The sensitivity of the clinical diagnosis of AD ranged from 65% to 87% while specificity ranged from 64% to 78%. Sensitivity was increased with more permissive clinical criteria and specificity was increased with more restrictive criteria while the opposite was true for neuropathological criteria. The highest combined diagnostic performance (sensitivity of 79% and specificity of 71%) was achieved when the clinical diagnosis was defined as including both probable and possible AD and the neuropathological diagnosis was defined as being inclusive of the following two situations: 1) frequent neuritic plaque density with Braak stage III-VI 2) moderate neuritic plaque density with Braak stage V or VI. Conclusions: Agreement between the clinical and neuropathological definitions of AD, based on data from NIA ADC’s, varies depending on the levels of clinical and neuropathological confidence, with sensitivities and specificities ranging between 64% and 87%. The rate of misdiagnosis is critical for many types of research, including the calculation of sample size for clinical trials.

Did patient's cognitive status correlate with functional impairment assessment?

daytime sleepiness were measured using the SCOPA-SLEEP scale during the 6-week treatment period (Baseline and Days 8, 15, 29 and 42). Results: Mean baseline (pretreatment) SCOPA Part B (nighttime sleep) scores were 10.5 for the placebo and 40 mg dose groups (N 1⁄4 97 and 92, respectively). Statistically significant improvement in nighttime sleep scores were observed in the 40 mg pimavanserin group vs. placebo as early as Day 8 (-1.0 vs. no change, p 1⁄4 0.003) and continued through Day 29. At the end of treatment (Day 42), a trend toward significance remained (-1.7 40-mg vs. -1.2 placebo; p 1⁄4 0.066). The 10 mg pimavanserin group was not significantly different from placebo at any timepoint. Daytime sleepiness scores were unaffected by pimavanserin treatment indicating no sedative effects of the drug. Conclusions: Pimavanserin appears to improve nighttime sleep without negative effects on daytime sleepiness in patients with PDP. Studies of pimavanserin in Alzheimer’s psychosis, where sleep impairment is also a common comorbidity, are planned. Evaluation of sleep in these studies may be of interest.

The education adjusted cut-off point of word span test to screening dementia in a South Brazilian sample

Considering several serious limitations of the MMSE like insensitivity to visuospatial deficits or frontal executive dysfunctions other cognitive assessment test tools were developed to overcome the limitations of MMSE. Methods: Active search for the patients with memory complaints General Practioners and Department of Neurology of Slovak Medical University Neuropsychological screening of investigated patients with neuropsychological tests for determinging global cognitive functions MMSE (Folstein et al., 1975) and ACE-R (Mioshi et al., 2006) Results: In the time period of 1.5 year over 400 patients with memory complaints were screened with neuropsychological screening tests MMSE and ACE-R. The patients with MMSE< 24 and ACE< 88 were further clinically examined by psychiatric, and neurological examination for differential diagnosis of dementia. Conclusions: The assessment of patients with memory complaints by neuropsychological screening tests MMSE and ACE-R to determine the cognitive mental state of the patients clearly demonstrated superior sensitivity of ACE-R over MMSE.