Antonio Eduardo Damin

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

Post-Mortem diagnosis of dementia by informant interview

The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. Objectives To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. Methods A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists’ panel consensus, in each group, determined the final diagnosis of the case, blind to other center’s diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. Results Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. Conclusions The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.

Influence of age, gender and educational level on performance in the Brief Cognitive Battery-Edu

The Brief Cognitive Battery-Edu (BCB-Edu) contains nine tests, seven of which are related to the memory of drawings, and has good accuracy in the diagnosis of cognitive impairment. Objectives To evaluate the influence of age, gender and educational level on the performance in tests related to memory of drawings of the BCB-Edu in healthy subjects. Methods Participants were adult volunteers; exclusion criteria were illiteracy, neurologic or psychiatric disorders, visual or hearing impairment, untreated chronic clinical conditions, alcoholism, use of drugs, and for those aged 65 or over, an informant report of cognitive or functional impairment. We evaluated 325 individuals (207 women), with a mean age of 47.1 (±16.8) years, ranging from 19 to 81, and a mean of 9.8 (±5.0) schooling-years. Univariate analyses, correlations and logistic regression were employed (α=0.05). Results There were significant negative correlations between age and the scores in four of the seven tests. However, schooling-years were positively correlated to the scores, where schooling-years decreased with age in this sample (rho= -0.323; p<0.001). Logistic regression confirmed that gender influenced the learning of drawings, where women performed better, while age influenced incidental memory, immediate memory, learning and delayed recall of the drawings, and schooling-years influenced visual identification, immediate memory, learning, delayed recall and recognition of the drawings. Conclusion Gender, age and education influence the performance on the memory of drawings of the BCB-Edu, although the extent of these influences differs according to the nature of the test.

Short IQCODE as a screening tool for MCI and dementia Preliminary results

Reaching a diagnosis may be difficult in the initial stages of dementia, especially in low educated individuals, when informant reports may be useful. Objectives To compare the sensitivity and specificity of the IQCODE against cognitive tests applied in clinical practice and to evaluate the possible cut-off points in Brazil. Methods Individuals without dementia (CDR=0; N=5), with Mild Cognitive Impairment (MCI) (CDR=0.5; N=15) and demented (CDR≥1; N=29) were evaluated using the Short IQCODE, a 16-item questionnaire applied to an informant, and on standard cognitive and functional scales. Diagnosis was reached by a consensus team with expertise in dementia, according to DSM-IV criteria, which was blind to the IQCODE results. Results IQCODE scores were positively correlated to the CDR (r=0.65, p<0.001) and negatively correlated with years of schooling (r= –0.33, p=0.021). IQCODE scores were positively correlated with CDR controlled by age and education (r=0.61, p<0.001). Linear regression showed that age was associated with the IQCODE (p=0.016) whereas education was not associated (p=0.078). IQCODE means according to the CDR classification were: CDR 0–3.37; CDR 0.5–3.75; CDR 1–4.32; CDR 2–4.61; CDR 3–5.00. The area under the ROC curve for dementia vs. controls was 0.869 (p<0.001), MCI vs. controls, 0.821 (p<0.001); and according to the groups classified by the CDR was: CDR 0.5 vs. CDR 1=0.649 (p=0.089), CDR 1 vs. CDR 2=0.779 (p=0.009), and CDR 2 vs. CDR 3=0.979 (p=0.023). Conclusions These preliminary findings suggest that the short IQCODE can be used for the screening of MCI and dementia in Brazil.

Behavioral and activities of daily living inventories in the diagnosis of frontotemporal lobar degeneration and Alzheimer's disease

The differential diagnosis between frontotemporal lobar degeneration (FTLD) and Alzheimer’s disease (AD) is often challenging. Objectives To verify the usefulness of behavioral and activities of daily living inventories in the differential diagnosis between FTLD and AD. Methods Caregivers of 12 patients with FTLD (nine with frontotemporal dementia, two with semantic dementia and one with progressive non-fluent aphasia) and of 12 patients with probable AD were interviewed. The Brazilian version of the Frontal Behavioral Inventory (FBI) and Disability Assessment for Dementia (DAD ) were used. Results The mean of the MMSE score was 12.4±10.7for patients with FTLD and 11.9±6.2for patients with AD (p=0.93). Mean scores on the DAD were 33.7±27.7in patients with FTLD and 55.6±29.7in patients with AD (p=0.06), while for the FBI they were 42.6±10.0for FTLD and 16.7±11.7for AD (p<0.01). Conclusions In this study, FBI was found to be a helpful tool for the differential diagnosis between FTLD and AD. Although the DAD was not useful in differential diagnosis in our sample we believe it to be important for measuring the severity of the disease through quantitative and qualitative assessment of functional deficits of the patients.

Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

The abbreviated form of the Brief Cognitive Battery in the diagnosis of dementia in Alzheimer's disease

The Brief Cognitive Battery (BCB) developed by our group for cognitive assessment of low educated individuals has also shown to be highly accurate in diagnosing dementia of individuals with medium or high levels of education, making it a useful tool for populations with heterogeneous educational background. The application of BCB takes around eight minutes, a rather long period for a screening test. Objectives Our aim was to evaluate whether the exclusion of items of the BCB could reduce its application time without losing accuracy. Methods Patients with Alzheimer’s disease with mild or moderate dementia (N=20), and 30 control subjects were submitted to an abbreviated version of the BCB in which the clock drawing test was not included as an interference test for the delayed recall test. Data from another 22 control individuals who were submitted to the original BCB in another study were also included for comparison. A mathematical formula was employed to compare the two versions of the BCB. Descriptive statistics and ROC (receiver operator characteristic) curves were used (alpha=0.05). Results Using the abbreviated version, the delayed recall test also had high accuracy in diagnosing dementia and the mathematical formula results did not differ to those obtained using the original version, while mean time was reduced by 2 minutes and 37 seconds. Conclusions This abbreviated form of the BCB is a potentially valuable tool for screening dementia in population studies as well as in busy clinical practices in countries with heterogeneous educational backgrounds.

Dementia post-radiotherapy: improvement with acetylcholinesterase inhibitor A case report

Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment.

Desempeño de una población brasilera en la prueba de alfabetización funcional para adultos en el área de salud

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.