Amanda Lucas da Costa

Validation of a telephone screening test for Alzheimer's disease

ABSTRACT Financial constraints, mobility issues, medical conditions, crime in local areas can make cognitive assessment difficult for elders and telephone interviews can be a good alternative. This study was carried out to evaluate the reliability, validity and clinical utility of a Brazilian telephone version of the Mini Mental State Examination (Braztel-MMSE) in a community sample of healthy elderly participants and AD patients. The MMSE and the Braztel-MMSE were applied to 66 AD patients and 67 healthy elderly participants. The test–retest reliability was strong and significant (r = .92, p = .01), and the correlation between the Braztel-MMSE and the MMSE were significant (p = .01) and strong (r = .92). The general screening ability of the Braztel-MMSE was high (AUC = 0.982; CI95% = 0.964–1.001). This telephone version can therefore be used as a screening measure for dementia in older adults that need neuropsychological screening and cannot present for an evaluation.

Comparison of the Mini Mental State Examination and depressive symptoms between high cardiovascular risk and healthy community elderly groups

The aging of the population is a universal phenomenon with direct consequences upon the public health system. One of the main repercussions of the growth in this sector of the population is the increased prevalence of disorders such as dementia and depression which are very frequent among the elderly. The relationship between cardiovascular risk factors, dementia and depression have been addressed in many recent investigations. Objectives To evaluate the relationship of cognitive performance and depressive symptoms with cardiovascular risk in the elderly. Methods 94 high cardiovascular risk elderly patients and 160 healthy community elderly were evaluated cross-sectionally. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used as the main measures. The cutoff for presence of depression was 6 on the GDS. Results The high cardiovascular risk elderly group showed significantly lower scores on the MMSE (p<0.001) and was significantly associated to depression (p<0.001), independently of education. The logistic regression analysis for depression as the dependent variable, age and group (healthy community or high cardiovascular risk elderly) were kept in the final equation. Higher age (Odds Ratio=0.92; 95% CI 0.86–0.98) and high cardiovascular risk elderly (OR=2.99; 95% CI 1.36–6.59) were associated to depression. Conclusions The present findings corroborate the different cognitive performance of elderly with high cardiovascular risk factors and the association of depressive symptoms with this group.

Maxillary Hypoplasia: Differential Diagnosis of Nasal Obstruction in Infants

Abstract Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants’ nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy.

Body mass index, cognitive deficit and depressive symptoms in high cardiovascular risk patients

To evaluate the relationship of obesity, cognitive impairment and depressive symptoms in patients with high cardiovascular risk. Methods A sample of 93 patients aged 50 years or older was selected from the Center of Dyslipidemia and High Cardiovascular Risk from Hospital de Clínicas de Porto Alegre (HCPA). Patients with stroke were excluded. For cognitive evaluation, the MMSE (Mini Mental State Examination) was used. A score of 24 or less was considered as cognitive impairment, and for those who had 4 years or less of education, the cutoff point was 17. The GDS-15 (Geriatric Depression Scale) was also used, with the cutoff of 6 for presence of depressive symptoms. Results Obese patients showed lower mean MMSE scores compared to non-obese patients (p=0.0012). Additionally, for every one point increase in BMI above 30 there was a 27% increase in the chances of the patient having cognitive impairment. The obese patients presented 31% chance of having cognitive impairment compared with overweight subjects. Conclusions Our findings corroborated the association between obesity and cognitive impairment in high cardiovascular risk patients. This association however, was not observed for depressive symptoms.

Dementia and hearing impairment: Diferential diagnosis

was associated with support service need, worse psychologial well-being, and patient’s neuropsychiatric symptoms. Time spent caring was related to patient’s functional status. There was no relationship between the patient’s cognitive functioning/depression and burden. Conclusions: Caregivers of individuals with MCI report greater burden in caring for their loved ones and this level of burden appears to be related to the patient’s neurobehavioral and functional status. Early identification of MCI patients with psychiatric issues may be particularly important for predicting caregiver burden.

Cardiovascular risk and its consequences in the cognition of patients of an university hospital

independently associated with CIND. An interaction was found between education and job physical demand; persons with a high level of education but a high job physical demand showed an association with CIND, both if they were employed as manual or non-manual workers (OR 1⁄4 4.4;95%CI 1⁄4 1.03-18.9, and OR 1⁄4 4.3;95%CI 1⁄4 1.6-11.7, respectively). Conclusions: Different lifetime’s socioeconomic factors are associated with CIND in late life. Early-life education seems to play the most important role. However, being in a job that is highly physically demanding might modify the effect of education, independently of occupation.

Obesity and dementia: Protection or risk?

Background: Late-life depression has been associated with increased dementia risk, but it is unclear whether this association is consistent across all types of dementia. To address this question, we examined associations between depression symptoms and development of clinical Alzheimer’s disease (AD), vascular, mixed (due to multiple etiologies), and other (non-AD, non-vascular) dementias in participants of the Adult Changes in Thought study, a community-based prospective study. Methods: A combined cohort of 3, 410 cognitively normal participants aged 65 years (60% female, mean age-at-entry 74.9 years [range 65 101]) underwent biennial assessments for dementia using DSM-IV criteria for dementia of the Alzheimer’s, vascular, mixed, and other types. Depression was assessed using the 11-item version of the Center for Epidemiologic Studies Depression Scale (CESD11, total score: 0 33). The primary exposure of interest for this study was depression at baseline, with significant depression symptoms designated as CESD-11 score > 10. Self-reported history and age at onset of depression episodes were also collected at baseline interview. Cox proportional hazards regression with delayed entry and age as the time axis was used to assess the association between baseline CESD-11 > 10 and hazard of each dementia subtype. Results: Mean follow-up was 7.1 years. During follow-up, 386 participants were diagnosed with AD, 89 vascular, 109 mixed, and 73 with other dementia. CESD-11 score > 10 at baseline was present in 14% of participants who developed dementia. Compared with participants with a baseline CESD-11 score of 0-10, the hazard ratio of depression symptoms at baseline for AD was 1.43 (95% CI 1.05, 1.94), vascular dementia 1.78 (95% CI 0.98, 3.22), mixed dementia 2.30 (95% CI 1.39, 3.79), and other dementia 2.42 (1.32, 4.43) after adjusting for ageat-entry categories, gender, education, and cohort. Self reported past history of depression at baseline was only associated with the ‘‘other dementia’’ subtype (adjusted hazard ratio 1.95 [1.17, 3.26]) but not with AD, vascular, or mixed dementia. Conclusions: These data suggest that depression symptoms in late life may be associated with increased dementia risk across all dementia subtypes, but possibly particularly with subtypes other than AD and vascular dementia.

Prevalence of cognitive impairment and depressive symptoms in patients with ischemic heart disease of an university hospital

Background: Dementia is a large and growing problem but is often not diagnosed in its earlier stages. Screening and earlier treatment could reduce the burden of suffering of this syndrome. Recently, the relation between cardiovascular risk factors, dementia and depression have been approached in many investigations. Cardiovascular risk factors such as hypertension may be associated with an increased risk for Alzheimer disease. This study aims to evaluate the relation of cognitive performance and depressive symptoms in patients with ischemic heart disease. Methods: 57 high cardiovascular risk elderly patients were evaluated using cognitive screening tests. Subjects were patients that maintained a regular follow-up in the Coronary Artery Disease Clinics of Hospital de Clinicas de Porto Alegre for 6,07 years (mean time of follow-up). The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used for the main measures. The cutoff for presence of depression was 6 on GDS. A score of 24 or less in the MMSE was considered as cognitive impairment, and in case the patient had 4 years or less of education, the cutoff point was 17. Results: The sample mean age was 67,54 years and 59,6% were male patients. The mean MMSE score was 25.88 (SD: 3,47). The mean GDS score was 3,93; 63,2% of the patients showed no depressive symptoms (GDS<6), 33,3% showed mild symptoms (GDS 6-10) and 1,8% showed severe symptoms (GDS>10). Conclusions: The present findings describe preliminary results of the cognitive performance of elderly with high cardiovascular risk factors, showing a possible association of depressive symptoms in this group. Vascular risk factors are a promising pathway of research for this condition, since they could represent preventable factors associated with depression, a common mental disorder of the elderly.