Claudia S. Porto

Testes neuropsicológicos de aplicação simples para o diagnóstico de demência

Thirty patients with dementia defined by DSM-III-R criteria (Alzheimers disease (22), vascular dementia (3), Parkinsons disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blesseds information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.Thirty patients with dementia defined by DSM-III-R criteria (Alzheimers disease (22), vascular dementia (3), Parkinsons disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensitivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blesseds information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease

OBJECTIVES To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimers disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. METHOD The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. RESULTS The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. CONCLUSION The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.

Evaluation of 100 patients with dementia in São Paulo, Brazil : correlation with socioeconomic status and education

One hundred consecutive outpatients with dementia were prospectively studied to investigate the diagnoses of dementing diseases and to correlate these diagnoses with socioeconomic status and with education. Alzheimer disease was the most common cause of dementia (54%), followed by vascular dementia (20%). Eight patients presented with potentially reversible causes of dementia. These frequencies are similar to those reported by case register studies from Western Europe and the United States. We did not find differences in the frequencies of the dementing diseases according to socioeconomic status or education. Alzheimer disease was the most common cause of dementia in all socioeconomic classes. Potentially reversible dementias, vascular dementias, and other secondary dementias were not more frequent in the lower socioeconomic strata. There was a trend to a higher frequency of vascular dementia among patients with less education, but this was not statistically significant.

Primary progressive aphasia: Classification of variants in 100 consecutive Brazilian cases

Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterized primarily by progressive language impairment. Recently, consensus diagnostic criteria were published for the diagnosis and classification of variants of PPA. The currently recognized variants are nonfluent/agrammatic (PPA-G), logopenic (PPA-L) and semantic (PPA-S). OBJECTIVE To analyze the demographic data and the clinical classification of 100 PPA cases. METHODS Data from 100 PPA patients who were consecutively evaluated between 1999 and 2012 were analyzed. The patients underwent neurological, cognitive and language evaluation. The cases were classified according to the proposed variants, using predominantly the guidelines proposed in the consensus diagnostic criteria from 2011. RESULTS The sample consisted of 57 women and 43 men, aged at onset 67.2±8.1 years (range of between 53 and 83 years). Thirty-five patients presented PPA-S, 29 PPA-G and 16 PPA-L. It was not possible to classify 20% of the cases into any one of the proposed variants. CONCLUSION It was possible to classify 80% of the sample into one of the three PPA variants proposed. Perhaps the consensus classification requires some adjustments to accommodate cases that do not fit into any of the variants and to avoid overlap where cases fit more than one variant. Nonetheless, the established current guidelines are a useful tool to address the classification and diagnosis of PPA and are also of great value in standardizing terminologies to improve consistency across studies from different research centers.

Prevalence of Cognitive Impairment Without Dementia and Dementia in Tremembé, Brazil.

Background:The prevalence of cognitive impairment is insufficiently determined in developing countries. The aim of this study was to ascertain the prevalence of cognitive impairment without dementia and dementia in community-dwelling elderly in Brazil. Methods:This was a single-phase cross-sectional survey of the elderly (aged 60 years and above) living in the municipality of Tremembé, Brazil. Twenty percent of the households with elderly persons were randomly selected from urban and rural areas, to obtain a homogenous representation of all socioeconomic and cultural levels. Results:We assessed 630 individuals [mean age, 71.3 y (±7.99); mean years of education, 4.9 (±4.54)] and found prevalence rates of 17.5% (95% confidence interval, 14.6-20.6) for dementia and 19.5% (95% confidence interval, 16.6-22.8) for cognitive impairment without dementia. These prevalence rates were influenced by age (P<0.001) and by educational level (P<0.001). There was no significant sex difference among diagnostic groups (P=0.166). The prevalence of dementia was higher in relatively younger individuals (below 70 y) when compared with other studies. Besides, dementia was associated with low socioeconomic status, stroke, previous psychiatric disorder, alcoholism, and epilepsy. Conclusions:The prevalence of dementia in this study was higher than in other studies, particularly among younger elderly.

Detection of cognitive impairment in the elderly by general practitioners in Brazil

Background: There is a need for novel assessment methods in the determination of clinically meaningful change in Alzheimer Disease (AD). The Clinical Meaningfulness in Alzheimer Disease Treatment (CLIMAT) scale is a newly developed instrument that targets two constructs: severity, defined as the magnitude of AD symptoms, and social impact, defined as the importance patients and caregivers attribute to AD symptoms. If social impact can be established as a construct distinct from disease severity, it could aid in weighting treatment benefit in AD. This cross-sectional study investigated the relationship between CLIMAT severity and social impact ratings. Methods: The CLIMAT covers social, functional, cognitive and behavioral items in separate patient and informant interviews. In the patient interview, items were rated for severity and impact on self (I-Pat-self). In the informant interview items were rated for severity, impact on patient reported by informant (I-Inf-Pat) and impact on self reported by informant (IInf-self). Domain and total scores were computed for all ratings. Pearson correlation coefficients were used to assess the relation between severity and impact ratings. Collinearity was defined as r>.70. Results: Participants were n1⁄423 community-dwelling ‘probable’ AD subjects (MMSE M1⁄419.9, SD1⁄47.3, range 11-28), with spousal informants. For patient ratings, the correlation between total severity and total I-Pat-self ratings was r1⁄4.54. Correlations between domain severity and domain I-Pat-self ratings were r<.50 for the social, functional and cognitive, r1⁄4.74 for the behavioral domain. For informant ratings, the correlation between total severity and total I-Inf-Pat was r1⁄4.50, and correlations between domain ratings r<.50 for social, functional and cognitive, r1⁄4.72 for the behavioral domain. The correlation between total severity and I-Inf-self was r1⁄4.78, with all correlations between domain ratings r>.70. Conclusions: Disease severity and social impact were hypothesized as two distinct constructs in AD symptom assessment. CLIMAT data largely support this hypothesis. The determination of the social impact on patients appears to add a valid dimension in the assessment of social, functional and cognitive symptoms, and in turn hold promise in the measurement of clinically meaningful response to treatment. The overlap between severity and social impact in the behavioral domain warrants further study.

Prevalence study of cognitive impairment no dementia (CIND) and dementia in tremembé, brazil

am in at io n : M o C A 6 M o n tr ea l C o g n it iv e A ss es sm en t Karolina G. Cesar, Sonia M.D. Brucki, Leonel T. Takada, Luiz Fernando C. Nascimento, Camila M.S. Gomes, Milena C.S. Almeida, Maira O. Oliveira, Fabio H.G. Porto, Mirna L.H. Senaha, Valeria S. Bahia, Thais Bento Lima Silva, Jessica N. Ianof, Mario A. Cecchini, Luciana Cassimiro, Marcia R. Gonçalves, Jerusa Smid, Claudia S. Porto, Maria Teresa Carthery-Goulart, Mônica Sanches Yassuda, Leticia L. Mansur, Ricardo Nitrini, Sr,, University of S~ao Paulo, S~ao Paulo, Brazil; University of Taubat e, Taubat e, Brazil; Universidade Federal do ABC, S~ao Bernardo do Campo, Brazil. Contact e-mail: karolgcesar@gmail.com

Performance of the Visual Analogue Scale of Happiness and of the Cornell Scale for Depression in Dementia in the Tremembé Epidemiological Study, Brazil

Depression is a major growing public health problem. Many population studies have found a significant relationship between depression and the presence of cognitive disorders. Objective To establish the correlation between the Visual Analogue Scale of Happiness and the Cornell Scale for Depression in Dementia in the population aged 60 years or over in the city of Tremembé, state of São Paulo, Brazil. Methods An epidemiological survey involving home visits was carried out in the city of Tremembé. The sample was randomly selected by drawing 20% of the population aged 60 years or older from each of the citys census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, and application of both the Cornell Scale and the Analogue Scale of Happiness for psychiatric symptoms. The presence of depressive symptoms was defined as scores greater than or equal to 8 points on the Cornell Scale. Results A total of 623 subjects were evaluated and of these 251 (40.3%) had clinically significant depressive symptoms on the Cornell Scale, with a significant association with female gender (p<0.001) and with lower education (p=0.012). One hundred and thirty-six participants (21.8%) chose the unhappiness faces, with a significant association with age (p<0.001), female gender (p=0.020) and low socioeconomic status (p=0.012). Although there was a statistically significant association on the correlation test, the correlation was not high (rho=0.47). Conclusion The prevalence of depressive symptoms was high in this sample and the Visual Analogue Scale of Happiness and Cornell Scale for Depression in Dementia should not be used as similar alternatives for evaluating the presence of depressive symptoms, at least in populations with low educational level.

Study on the performance of behavioural assessment of the dysexecutive syndrome (BADS) in healthy individuals, mild cognitive impairment and Alzheimer's disease

Background: Neurosychological tests or scales such as MMSE (Mini-Mental State Examination) and CDR (Clinical Dementia Rating) are employed to classify the population into normal subjects, subjects with mild cognitive impairment (MCI) and patients with Alzheimer’s disease (AD). For example, in an international project, the Alzheimer’s Disease Neuroimage Initiative (ADNI), the three groups were classified by the neuropsychologocal tests as follows. 1. Subjects with MMSE scores between 24 and 30 are classified as Normal or MCI subjects. In contrast, subjects with MMSE scores between 20 and 26 are classified as mild AD. (Note that subjects with scores between 24 and 26 are not exactly diagnosed). 2. Subjects with a CDR global score of 0 are classified as Normal subjects. In contrast, subjects with a CDR global score of 0.5 are as MCI subjects or mild AD, and those with a CDR global score greater than 0.5 are as mild AD. Methods: This study aims to clarify whether a short form of MMSE or that of CDR can classify subjects into the three groups in the same way as the full form of MMSE (10 categories) or that of CDR (6 categories). The screening and baseline data of the 804 ADNI subjects were analyzed to examine accuracies of the various short forms. Results: It was shown that a short form of MMSE excluding the 3 categories such as Naming, Reading and Writing from the full form can discriminate the three groups with accuracy of 99.1%. It was revealed that a short form of CDR (Memory category only) can discriminate Normal from the others with accuracy of 100%. Conclusions: Hence, the combination of the short form of MMSE and that of CDR enables us to classify subjects precisely into the three groups more quickly than the full forms.

P3-179: Language-based dementia: A cross-sectional study of 55 patients

elements of the ARCS and compare its psychometric properties with those of the Mini Mental State Examination (MMSE) in a mixed sample. Methods: Outpatients referred to us in the Neuropsychiatry Service underwent comprehensive clinical and detailed neuropsychological assessments on the basis of which, at consensus conference, they were diagnosed as normal, cognitively impaired, or demented. In addition all patients, and a sample of controls from a volunteer register, were tested with the ARCS and the MMSE. We undertook Receiver Operating Curve (ROC) analyses comparing results with the ARCS and the MMSE in the same sample. We recorded the time needed to score a random sample of 10 ARCS response booklets. Results: Subjects comprised 107 normal controls (mean MMSE 29.0, SD 1.1), 34 with cognitive impairment (mean MMSE 27.4, SD 3.9), and 23 with dementia including 12 with Alzheimer’s disease (mean MMSE 25.0, SD 2.9). Patients with dementia were older and had fewer years of education than controls. In ROC analyses on the entire sample, sensitivity, specificity, and AUC for the detection of dementia was 96%, 89%, 0.952 for a global score derived from the ARCS and 78%, 85% and 0.90 for the MMSE. The mean time to score an ARCS response booklet was one minute 47 seconds. Conclusions: The ARCS is highly efficient for the clinician, performs very well relative to the MMSE, and warrants ongoing evaluation. Potentially it could provide a more sophisticated cognitive assessment than is currently feasible in a range of clinical and research settings.