Andréa Heisler

Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil

The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out. Objectives The goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil. Methods A sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA), Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL) and application of the Neuropsychiatry Inventory (NPI) for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia. Results Of the whole sample, 71% were female. Age was 79±8 years (mean±SD). Educational level was 4±3 years (mean±SD). Sixty-four patients (60%) presented the diagnosis of Alzheimer’s disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE) and functional status scores was observed among the CDR categories (severity). No significant association was found between severity and impairment on memory tests and behavioral symptoms. Conclusions Alzheimer’s disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause.

Cognitive impairment screening in a southern Brazilian elderly outpatient sample

Background: The elderly Brazilian population in 2008 was 20 million people. Considering the evidence of benefit of the therapeutic interventions for the initial phases of dementia, it is relevant to emphasize the early diagnosis and information of the medical class in relation to the disease and the diagnosis. Methods: The physicians were invited to refer to Neurogeriatric Outpatient Clinic those individual waiting for a consultation who presented positive screening for cognitive impairment. The MMSE and a questionnaire with demographic data were applied in elderly outpatients that were waiting for a consultation at the hospital waiting room. The results from screening were sent to assistant physician who will decide the referral to Neurogeriatric Outpatient Clinic in order to perform full diagnostic evaluation. Results: Nine hundred sixty-seven outpatients that were at the hospital waiting room were interviewed in a 4 month period. From these patients, 413 were less than 65 years-old, 82 refused to participate in the study and 472 were included. From the included patient, 326(69.1%) were women; the mean age was 73.866.4 years (range 65-94 years) and mean education years was 4.463.5 years (0-20 years). From these patients, 109(23.1%) had MMSE scores under cutoff. From the 109 positive screening, 26 patients with impairment in the MMSE were sent to a more detailed ambulatory evaluation. From these, 7.6% fulfilled criteria for dementia, 26% for depression, 26% did not showed impairment in the evaluation and 38.5% fulfilled criteria for cognitive impairment, but did not complete the etiological evaluation until now. Conclusions: The dementia frequency rate in our study realized into a tertiary university hospital was similar to that found in other study conducted in Brazil in the community population. The screening test was adequate, even with some false-positive results, since it made it possible to detect patients with cognitive impairment that would not receive adequate treatment. The referral rate of suspect cases of cognitive impairment was low and deserves further investigation.

Were elderly patients, who were escorted by family members for medical appointments, more likely to present cognitive dysfunction?

the strongest associations. The estimated relative risks with 95% confidence intervals were 0.94 (0.89 to 0.99) per 10 year increase in age, 0.33 (0.23 to 0.49) comparing blacks to non-blacks, and 1.61 (1.37 to 1.89) for individuals with a college education or more compared to those with less than college education. These estimates are all adjusted for family and clinical characteristics. Conclusions: Performance of autopsy does not occur randomly, in fact, many factors appear to play a role. This study was among the first attempts to approach the problem using multivariate statistical methods. Our results suggest that autopsy was much more likely to be performed on younger subjects, Caucasians, and subjects with higher education. These results show that neuropathological data are available on a rather select sample, which influences generalizability. We also illustrate how such results can be used to help correct for selective sampling in neuropathology studies.

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.

Burden interview versus neuropsychiatric inventory: Evaluation of burden in caregivers of Alzheimer's disease patients

This study aims to evaluate patient and caregiver’s characteristics related with neuropsychiatric symptoms. Methods: A cross-sectional study was conducted in a sample of 58 probable Alzheimer’s disease (AD) patients (NINCDS-ADRDA criteria). The neuropsychiatric symptoms were evaluated by the Brazilian version of the Neuropsychiatric Inventory (NPI). The dementia severity was assessed with the Clinical Dementia Rating (CDR), Brazilian version. The analyzed patient’s variables were sex, age, age of onset of AD symptoms and education. The analyzed caregiver’s variables were sex, type of relationship, age, education, time as caregiver, weekly time of care, residing with patient and type of job. Student’s t test and one-way Anova were performed for parametric variables. Spearman’s rho was used for correlations. Results: NPI intensity and distress were similar in both patient’s sex (p 1⁄4 0.742 and p 1⁄4 0.902, respectively) and in the three stages of severity of dementia (F1⁄4 1.951, p1⁄4 0.152; F1⁄4 0.763, p1⁄4 0.471, respectively). Patient’s education was inversely correlated with NPI frequency, intensity and distress (rho1⁄4 -0.283, rho1⁄4 -0.276, rho1⁄4 -0.262, p1⁄4 0.05). NPI intensity and distress were similar in both caregiver’s sex (p1⁄4 0.809 and p1⁄4 0.743, respectively), relationship type (p> 0.5) and caregiver’s type of job (p > 0.5). However, a tendency for statistical difference was observed between caregivers who resided and those who not resided with patients (p 1⁄4 0.05), caregivers who resided with patients showed higher NPI intensity and NPI distress. Caregiver’s education was inversely correlated with NPI frequency, intensity and distress (rho1⁄4 -0.302, rho1⁄4 -0. 272, rho1⁄4 -0. 300, p1⁄4 0.05). Caregiver’s age was inversely correlated with NPI severity (rho 1⁄4 -0.270, p 1⁄4 0.05). Weekly time of care was correlated with NPI frequency (rho 1⁄4 0. 291, p1⁄4 0.05). Conclusions: Some variables may interfere on neuropsychiatric symptoms evaluation by caregivers of AD patients, as age, education, weekly time of care and residing with patients. Some of them can be modified through different approaches improving quality of care.