Eliasz Engelhardt

Mini-Mental State Examination norms in a community-dwelling sample of elderly with low schooling in Brazil

The objective of this study was to assess Mini-Mental State Examination norms of a functionally normal sample of community-dwelling elderly. Illiterate and low-educated subjects who scored less than 5 on the Pfeffer Functional Activities Questionnaire (PFAQ) [n = 397; female = 269; mean age = 72.15 (SD = 7.24) years] had the 5th, 25th, 50th, and 75th percentiles calculated according to age (65-74; 75-84 years). Overall MMSE score was 21.97 (SD = 4.48). Mean MMSE for illiterate younger individuals was 19.46 (SD = 3.47), and the quartile distribution was 14, 17, 19, and 21. MMSE of subjects with 1-8 years of schooling was 23.90 (3.87), and the distribution was 15, 22, 24, and 27. MMSE of older illiterate subjects was 18.11 (SD = 3.63), and the distribution of scores was 13, 16, 18, and 20, whereas subjects with 1-8 years of schooling scored 23.81 (SD = 4.01) and the distribution was 15, 22, 24, and 27. These MMSE normative data may help improve the detection of cognitive impairment in Brazil, mainly in the primary clinical setting.Avaliar normas do Mini-Exame do Estado Mental (MEEM) de acordo com a idade e escolaridade de idosos vivendo na comunidade. Calcularam-se os quartis do MEEM para idosos com 65 a 74 e 75 a 84 anos, analfabetos e com 1-8 anos de escolaridade, com pontuacao menor que cinco no Questionario de Atividades Funcional de Pfeffer (QAF) [n = 397; feminino = 269; idade = 72,15 (dp = 7,24) anos].O MEEM total foi 21,97 (dp = 4,48). Nos individuos mais jovens, o MEEM entre analfabetos foi 19 (3,47) com quartis de 14, 17, 19, 21. O MEEM dos com 1-8 anos de escolaridade foi 23,90 (dp = 3,87), e a distribuicao foi 15, 22, 24, 27. O MEEM dos analfabetos mais idosos foi 18,11 (dp = 3,63) com quartis de 13, 16, 18, 20, enquanto a pontuacao dos sujeitos com 1-8 anos foi 23,81 (dp = 4,01), quartis de 15, 22, 24, 27. Os dados de normatizacao do MEEM podem ajudar o reconhecimento de disturbios cognitivos no Brasil, principalmente no atendimento primario.

Different Patterns of White Matter Degeneration Using Multiple Diffusion Indices and Volumetric Data in Mild Cognitive Impairment and Alzheimer Patients

Alzheimeŕs disease (AD) represents the most prevalent neurodegenerative disorder that causes cognitive decline in old age. In its early stages, AD is associated with microstructural abnormalities in white matter (WM). In the current study, multiple indices of diffusion tensor imaging (DTI) and brain volumetric measurements were employed to comprehensively investigate the landscape of AD pathology. The sample comprised 58 individuals including cognitively normal subjects (controls), amnestic mild cognitive impairment (MCI) and AD patients. Relative to controls, both MCI and AD subjects showed widespread changes of anisotropic fraction (FA) in the corpus callosum, cingulate and uncinate fasciculus. Mean diffusivity and radial changes were also observed in AD patients in comparison with controls. After controlling for the gray matter atrophy the number of regions of significantly lower FA in AD patients relative to controls was decreased; nonetheless, unique areas of microstructural damage remained, e.g., the corpus callosum and uncinate fasciculus. Despite sample size limitations, the current results suggest that a combination of secondary and primary degeneration occurrs in MCI and AD, although the secondary degeneration appears to have a more critical role during the stages of disease involving dementia.

[Mini-mental state examination in community-dwelling elderly: preliminary data from Santo Antônio de Pádua, Rio de Janeiro, Brazil].

OBJECTIVE To define mini-mental state examination (MMSE) global scores, by age and education in elderly in Santo Antônio de Pádua, Rio de Janeiro, Brazil. METHOD Elderly > 65 years-old (n=341; m=109, f=232) responded to MMSE. Sample was divided by age and education: young old (65-84 years)/oldest old (>85 years), illiterates, low/medium schooling. MMSE scores were compared using t test of Student, Mann-Whitney and Tukey (p<0.05). RESULTS Young and oldest olds mean age were 73.13 5.27; 88.00 4.90, respectively. Young old MMSE score was 19.91 5.35 and oldest old was 16.90 4.96. There was a significant difference between the groups (p=0.01). Illiterate and educated elderly scored 17.08 4.42 and 22.34 4.94, respectively (p<0.0001). Illiterate and educated young old (age=73.61 +/- 5.26; 72.67 +/- 5.26) scored 17.29 +/- 4.40 and 22.42 +/- 4.98, respectively. MMSE shows significant difference between groups of young old (p<0.0001). MMSE of illiterate and educated oldest old (age=86.50 +/- 1.09; 90.25 +/- 7.34) were 14.33 +/- 3.89 and 20.75 +/- 3.85, respectively. CONCLUSION Schooling and age influence on MMSE. These results do not compare with those of developed countries taking education as a variable.

Prevalence of cognitive and functional impairment in community-dwelling elderly: importance of evaluating activities of daily living

The study aims to evaluate the prevalence of cognitive/functional impairment in community-dwelling elderly above 60 years of age (n = 870; m = 297, f = 573) and the relationship of age, gender, and functional impairment with cognitive impairment using Mini-Mental State Examination (MMSE) and Pfeffer Functional Activities Questionnaire (PFAQ). Chi-square and Students tests were used to compare cognitive and functional deficits. Linear regression assessed MMSE/PFAQ relationship. Stratified analysis assessed confounding factors. Logistic regression assessed the relationship among age/gender/functional status with cognitive impairment (p < 0.05). Prevalence of cognitive/functional impairment was 19.2%. Functional and cognitive impairment are negatively correlated (Pearson = 0.737), despite educational level (illiterate/literate: OR = 15.60; p = 0/OR = 16.40; p = 0). Age and gender (female) were associated with cognitive/functional impairment. Functional impairment is highly correlated to cognitive impairment. Family/health professionals may recognize functional impairment more easily than cognitive impairment. Thus, the use in combination of cognitive and functional scales is important when screening for dementia.

Role of physical activity on the maintenance of cognition and activities of daily living in elderly with Alzheimer's disease

BACKGROUND The practice of physical activities has proved to be an efficient strategy in the improvement of independency and cognitive functions in the elderly with Alzheimers disease (AD). OBJECTIVE To evaluate the relation between the practice of physical activity, cognition and activities of daily living (ADL) of patients with AD. METHOD The cognitive and physical aspects and ADL were evaluated of 37 elders (19 normal controls, 11 sedentary with AD and 7 active with AD). RESULTS The variable that best predicts the cognitive state (MMSE) is the duration of disease for the AD sedentary group and Lawtons Scale for the AD active group. We observed a correlation between MMSE score and duration of disease in the sedentary group and between MMSE and ADL in the active group. CONCLUSION Our study showed that physical and cognitive stimulation in patients with AD can contribute to decrease cognitive and functional decline.FUNDAMENTO: A pratica de atividade fisica tem se mostrado uma estrategia eficaz na melhora da independencia e das funcoes cognitivas em idosos com doenca de Alzheimer (DA). OBJETIVO: Avaliar a relacao entre a pratica de atividade fisica, a cognicao e as atividades de vida diaria (AVD) em pacientes com DA. METODO: Foram avaliados os aspectos cognitivos, fisicos e as AVD de 37 idosos (19 controles normais, 11 com DA sedentarios e 7 com DA ativos). RESULTADOS: A variavel que melhor prediz o estado cognitivo (MEEM) foi o tempo de doenca para o grupo DA sedentarios e a Escala de Lawton para o grupo DA ativo. Observou-se correlacao entre MEEM e tempo de doenca no grupo sedentario e MEEM e AVD no grupo ativo. CONCLUSAO: O nosso estudo mostrou que a estimulacao fisica e cognitiva em pacientes com DA pode contribuir na diminuicao do declinio cognitivo e funcional.

Neuropsychological tests and driving in dementia: a review of the recent literature

INTRODUCTION Neuropsychological tests measure several aspects of cognition and are useful to evaluate elderly drivers with cognitive impairment. However, there is no consensus on a standard battery of tests that could accurately predict safe driving. OBJECTIVE The aim of this study is to review specific neuropsychological measures that may be useful to predict driving competence of demented individuals. METHOD To address neuropsychological tests used for dementia and the ability to drive, the authors searched for the keywords dementia, Alzheimers, drive, driver, drivers, driving, tests, neuropsychological, and assessment, in Medline, PubMed, ISI and SciELO databases seeking articles from 2000 to 2008. RESULTS From 131 articles, 27 met the inclusion criteria. Porteus Maze, Clock drawing, Trail B, UFOV and NAB Tests were found to be the most relevant neuropsychological measures for the evaluation of fitness to drive. CONCLUSION Porteus Maze, Clock Drawing, Trail B, UFOV and NAB tests highlight visuospatial attention demands and/ or executive function. Those and other visuospatial and executive measures may be useful to predict driving competence of demented individuals.

Aspectos neuropsicológicos da depressão

This study aims at reviewing the main neuropsychological findings in depression and the differences between the unipolar and bipolar forms, with or without psychosis, during the acute and intercritical phases. Moreover, the study intends to correlate the neuropsychological findings described in the literature with neuroanatomic and neurofunctional aspects, emphasizing frontal areas and their main circuits. Considering neuropsychological studies carried out in the field of affective disorders, some alterations have shown to be more consistent, with important dysfunctions in critical phases but also in asymptomatic patients. Of these, attentive and mnemic aspects, in addition to executive functioning, are of special interest. Studies of this nature have important therapeutical implications, suggesting the need for the development of other supporting therapeutical techniques, such as cognitive rehabilitation and psychosocial interventions, making the treatment broader and more incisive.Este artigo objetiva rever os principais achados neuropsicologicos na depressao, procurando diferenciar o tipo unipolar do bipolar, com ou sem psicose, tanto nos periodos de fase aguda quanto nos periodos intercriticos. Procurou-se, ainda, correlacionar os achados neuropsicologicos descritos na literatura consultada com os seus correlatos neuroanatomicos e neurofuncionais, ressaltando-se as areas frontais e seus principais circuitos. Considerando-se estudos neuropsicologicos dos transtornos afetivos, algumas alteracoes tem se mostrado mais consistentes, sendo descritas disfuncoes importantes nas fases criticas, mas tambem no paciente assintomatico. Nestas, interessam principalmente os aspectos atentivos e mnemicos e o funcionamento executivo. Estudos desta natureza tem profundas implicacoes terapeuticas, apontando para a necessidade de desenvolver outras tecnicas coadjuvantes, tais como reabilitacao cognitiva e intervencoes psicossociais, tornando o tratamento mais abrangente e incisivo nestes casos.

Peculiarities of geriatric psychiatry: a focus on aging and depression.

There is a debate on whether Geriatric Psychiatry stands for itself as a discrete specialty or whether it is an extension of clinical Geriatrics, Neurology, and Psychiatry. This review aims to outline some recent data and possible approaches to define peculiarities of Geriatric Psychiatry, focusing on certain characteristics that define the aging brain. Geriatric depression is discussed taking into consideration some data from translational research. The brain aging process is not uniform. Frontal areas show marked impairment in inhibiting irrelevant information in working memory as they age, and the recruitment of these areas occur differently than in young subjects. Executive functions also change in normal elderly. Geriatric depression is a general definition of a multidimensional disorder with multiple risk factors. Dysexecutive syndrome is considered as a key to the neuropsychology of geriatric depression, correlated with functional impairment in late life. Late‐onset depression has a higher load of comordibity, of cerebrovascular disease, and of some genetic factors that may be different from early onset depression. Also, there are at least four clusters of treatment outcomes that are common in geriatric depression, which mirror the neuropsychological and clinical profiles. Research and practice in Geriatric Psychiatry should focus on the interaction of various dimensions and risk factors rather than on attempting to find a single cause to the disorders. Some answers may be found in comorbidity issues, in white matter lesions, which are more common in the elderly, and in genetic factors that impact on the aging process.

Topiramate may modulate alcohol abuse but not other compulsive behaviors in frontotemporal dementia: case report.

Frontotemporal dementia (FTD) is an insidious presenile neurodegenerative disorder presenting with personality changes, compulsive behaviors, psychosis, apathetic, aberrant, and elated mood and behavior. No psychopharmacologic strategy has proven to be efficacious in the treatment of FTD yet. This is a case report of FTD in a 53-year-old male engineer whose alcohol abuse, but not other compulsive behaviors, responded to topiramate. Alcohol exerts reinforcing effects on cortico-mesolimbic dopamine pathways through the disinhibition of the inhibitory effects of gamma-amino-butyric acid-A neurons in the ventral tegmental area. Topiramate is a sulfamate-substituted fructopyranose derivative that may antagonize the reinforcing effects associated with the abuse liability of alcohol by modulation of cortico-mesolimbic dopamine function. On the basis of the mechanism of action of topiramate, we discuss the possible specificity of action of topiramate to control abusive drinking, but not to treat other clinical symptoms of FTD.

Consciência da doença na demência: resultados preliminares em pacientes com doença de Alzheimer leve e moderada

OBJECTIVE: To evaluate the presence and the level of awareness of disease in mild and moderate Alzheimers disease (AD). METHOD: Cross-sectional evaluation of patients with mild/moderate AD (n=42) assessed by Assessment of Psychosocial Impact of the Dementia Diagnosis (APSID), Mini-mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). RESULTS: Awareness of disease and its consequences were present in 66.7% patients with mild AD (n=18). In moderate AD (n=24), 20.8% presented total awareness, 45.8% presented only awareness of cognitive symptoms. Unawareness of disease was observed in 33.3%. CONCLUSIONS: The present data show association between awareness and level of severity of disease. CDR 1 patients show a better recognition of cognitive and daily life activity symptoms, whereas CDR 2 patients recognized their cognitive symptoms but failed to appraise their severity and consequences in daily life activities.