Francisco de Assis Carvalho do Vale

Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic

We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9% of the total attendance). Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimers disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics.

Influência da escolaridade na avaliação neuropsicológica de idosos: aplicação e análise dos resultados da Escala de Mattis para Avaliação de Demência (Mattis Dementia Rating Scale - MDRS)

OBJECTIVE: To assess the influence of low education and illiteracy on the evaluation of dementia by the Mattis Dementia Rating Scale (MDRS). METHOD: We applied the MDRS to 62 normal elderly subjects (64- 77 years), divided into five groups according to schooling, i.e., 15-16 years, 11-12 years, 8-9 years, 4 years, and illiterate. The MDRS covers the study of five subscales and the sum of their scores may represent the degree of cognitive impairment. RESULTS: A significant difference (p 4 and 8 years of schooling, p<0.001) and the total MDRS score (illiterates< all others and 4 and 8 years < 15-16 years, p <0.001). No significant correlations where found for age and, regarding gender, the differences were significant in only one item CONCLUSION: Education interfered with individual performance on the MDRS. Illiteracy is a determinant factor of lower MDRS scores that could generate diagnostic errors.

The demands of family caregivers of elderly individuals with dementia

As finalidades deste estudo foram identificar as caracteristicas dos cuidadores de idosos demenciados, os tipos de demandas de cuidados e relacionar a demanda com o estagio da demencia. O estudo seccional e observacional foi conduzido em 2004, com 104 idosos e 90 cuidadores, em Ribeirao Preto/SP, por meio do instrumento OARS e de um questionario para o cuidador. Dos 104 idosos, 66.3% eram mulheres, a idade media de 75.5 anos, sendo que 86.5% deles tinham cuidadores. Entre os cuidadores, 80% eram mulheres, membros da familia, com idade media de 52.3 anos. Dedicavam 15.10 horas/dia para a atividade de cuidar, sem nenhuma ajuda. Encontrou-se importante relacao entre a sobrecarga do cuidador, o esforco fisico e emocional, e o estagio da demencia. A sobrecarga emocional foi maior nos estagios iniciais e tardios da demencia, mas a diferenca foi estatisticamente nao-significante. Os resultados atuais revelam a urgente necessidade de planejar estrategias de suporte formal e informal para cuidadores de idosos brasileiros com demencia.The purpose of this cross-sectional observational study was to identify characteristics of caregivers of elderly people with dementia, types of care demands and to relate demands to the stage of dementia. The study was carried out in 2004 with 104 older adults and 90 caregivers in Ribeirão Preto, state of São Paulo. The OARS instrument was utilized and a questionnaire answered by caregivers. Among older adults, 66.3% were female, aged 75.5 years in average and 86.5% had caregivers. Eighty percent of the caregivers were women family members, aged 52.3 years in average. They spent 15.10 hours/day with care, without help. An important relationship was observed between caregivers burden, physical and emotional effort and stage of dementia. Emotional overburden was higher at dementia early and late stages, this difference was statistically non-significant. Results reveal the urgent need to plan formal and informal support strategies to caregivers of Brazilian elderly people with dementia.

Effects of galantamine on attention and memory in Alzheimer's disease measured by computerized neuropsychological tests: results of the Brazilian Multi-Center Galantamine Study (GAL-BRA-01)

OBJECTIVE To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimers disease (AD) in a computerized neuropsychological test battery (CNTB). METHOD Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. RESULTS Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1). The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. CONCLUSION Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.

Memory complaint scale (MCS): Proposed tool for active systematic search

Subjective Memory Complaints (SMC) are frequent among adults and elderly and are associated with poor quality of life. The etiology and clinical significance of SMCs are unclear, but these complaints are associated with objective cognitive decline or with depression, anxiety and psychosocial stressors. Biological and physiological brain alterations resembling those in Alzheimers Disease have been found in SMC. SMC can evolve with different outcomes and represent the initial symptom or a risk factor of dementia. Active systematic search can be useful for early screening of candidates for preventive or therapeutic interventions. Objective To propose a Memory Complaints Scale (MCS) as an instrument for actively searching for memory complaints and to investigate its utility for discriminating demented from cognitively normal elderly. Methods A total of 161 patients from a teaching behavioral neurology outpatient unit of a tertiary hospital were studied. The MCS was used in two ways, by direct application to the patient and by application to the patients companion. Cognitive tests assessing depression and daily living activities were also applied. Results High Cronbachs alpha coefficients were found for the two application methods. Correlations between the two versions and the other instruments administered for patients grouped by type and severity of dementia were also found. Conclusion The MCS is a useful scale for identifying memory complaints and discriminating demented from cognitively normal elderly. Further studies confirming these findings are warranted.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer’s disease. Methods Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI). Results 96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05. Conclusions All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Executive cognitive tests for the evaluation of patients with Parkinson's disease

Parkinson’s disease (PD) is characterized by changes in movement, which are later followed by cognitive, behavioral and psychological changes. The objective of the present study was to correlate different tests used to examine executive functions in PD patients followed at a specialized outpatient clinic. Methods Thirty-five patients with idiopathic PD aged 63.0 years on average and with mean schooling of 5.5±4.2 years, were examined using the following tests: Mattis Dementia Rating Scale (MDRS), Scales for Outcomes of Parkinson’s Disease-Cognition (SCOPA-COG), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Digit Span – Inverse Order (IO) (a subtest of the WAIS III) and Verbal Fluency Test (category animals). Results Significant correlations were detected between FAB and MDRS Conceptualization (0.814), MDRS Initiation/Perseveration (I/P) and SCOPA-COG Executive Function (0.643), FAB and MDRS I/P (0.601), FAB and Verbal Fluency (0.602), MDRS I/P and MDRS Conceptualization (0.558), Verbal Fluency and MDRS I/P (0.529), MDRS Attention and SCOPA-COG Executive Function (0.495), MDRS Conceptualization and SCOPA-COG Executive Function (0.520), FAB and Digit Span (OI) (0.503), Verbal Fluency and MDRS Conceptualization (0.501), and WCST perseverative errors and FAB (–0.379), WCST perseverative errors and MDRS Conceptualization (0.445), WCST perseverative errors and MDRS I/P (–0.407) and WCST categories completed and MDRS Conceptualization (0.382). Discussion The results demonstrated strong correlations between most of the tests applied, but no associations were detected between the WCST and the other tests, a fact that may be explained by the heterogeneity of scores obtained in the tests by the patients evaluated. A difficulty of the present study was the lack of a control groups for the establishment of adequate standards for this population.

Sintomas obsessivo-compulsivos nas demências

CONTEXTO: Demencias sao cada vez mais prevalentes na populacao. Sintomas cognitivos costumam ser acompanhados de sintomas comportamentais e psicologicos das demencias (SCPD), causando aumento do custo dos cuidados e da carga do cuidador. OBJETIVOS: Identificar na literatura indexada ate junho de 2008 artigos relacionados a estudos sobre a ocorrencia de sintomas obsessivo-compulsivos (SOC) nas diversas sindromes demenciais para identificar prevalencia, caracteristicas e impacto nos cuidadores em termos de carga, qualidade de vida ou custo socioeconomico. METODOS: Procedeu-se a busca sistematica nos indexadores PubMed e LILACS, utilizando as palavras-chave obsessive, compulsive, obsession, compulsion e dementia, identificando-se 10 artigos. RESULTADOS: Desses, cinco enfocavam primariamente os SOC, enquanto, nos outros cinco, SOC eram objetivos secundarios; oito estudos relatavam exames de neuroimagem; oito relataram sintomas compulsivos; dois relataram sintomas obsessivos e compulsivos, enquanto nenhum trouxe sintoma simplesmente obsessivo. A maioria dos estudos aborda pacientes com demencia frontotemporal. CONCLUSAO: A analise dos 10 artigos evidenciou a escassez de investigacao de SOC nas demencias, a importância da neuroimagem para esse tipo de estudo e grande diversidade de instrumentos para avaliar os SOC. Nenhum artigo avaliou impacto dos SOC nos cuidadores, o que pode direcionar estudos futuros.

Demanda do cuidados familiar com idoso demenciado

As finalidades deste estudo foram identificar as caracteristicas dos cuidadores de idosos demenciados, os tipos de demandas de cuidados e relacionar a demanda com o estagio da demencia. O estudo seccional e observacional foi conduzido em 2004, com 104 idosos e 90 cuidadores, em Ribeirao Preto/SP, por meio do instrumento OARS e de um questionario para o cuidador. Dos 104 idosos, 66.3% eram mulheres, a idade media de 75.5 anos, sendo que 86.5% deles tinham cuidadores. Entre os cuidadores, 80% eram mulheres, membros da familia, com idade media de 52.3 anos. Dedicavam 15.10 horas/dia para a atividade de cuidar, sem nenhuma ajuda. Encontrou-se importante relacao entre a sobrecarga do cuidador, o esforco fisico e emocional, e o estagio da demencia. A sobrecarga emocional foi maior nos estagios iniciais e tardios da demencia, mas a diferenca foi estatisticamente nao-significante. Os resultados atuais revelam a urgente necessidade de planejar estrategias de suporte formal e informal para cuidadores de idosos brasileiros com demencia.The purpose of this cross-sectional observational study was to identify characteristics of caregivers of elderly people with dementia, types of care demands and to relate demands to the stage of dementia. The study was carried out in 2004 with 104 older adults and 90 caregivers in Ribeirão Preto, state of São Paulo. The OARS instrument was utilized and a questionnaire answered by caregivers. Among older adults, 66.3% were female, aged 75.5 years in average and 86.5% had caregivers. Eighty percent of the caregivers were women family members, aged 52.3 years in average. They spent 15.10 hours/day with care, without help. An important relationship was observed between caregivers burden, physical and emotional effort and stage of dementia. Emotional overburden was higher at dementia early and late stages, this difference was statistically non-significant. Results reveal the urgent need to plan formal and informal support strategies to caregivers of Brazilian elderly people with dementia.

Transtornos cognitivos e demências na clínica privada do especialista: estudo piloto de um inquérito de auto-avaliação

OBJECTIVES To know about the features of cognitive disorders and dementias in the private practice of specialists and these doctors skills on that area. METHOD In this pilot study, self-assessment questionnaires were delivered to neurologists of Sao Paulo State and 196 (22.8%) were respondents. RESULTS Many neurologists are involved, besides the private practice, with teaching (61.5%) and/or research (59.5%) activities. Most of them assessed as not good the training on cognitive disorders and dementias they had had during both the graduate (77.3%) and residence (63.1%) courses; nevertheless 60.8% self rated their knowledge on that subject as satisfactory and 83.0% declared their interest on it as at least equal to other areas. The most frequent cognitive complaints occurring as primary reason for appointment are memory loss (73.0%) and attention/concentration deficits (48.0%). Dementia of Alzheimer type (54.9%) and vascular dementia (23.0%) are the most frequent ones in the neurologist private practice. CONCLUSION Cognitive disorders and dementias represent a significant proportion in the neurological private practice. Although they had not had a good training on the area of cognitive disorders and dementias, the respondent neurologists demonstrated great interest on it.OBJECTIVES: To know about the features of cognitive disorders and dementias in the private practice of specialists and these doctors skills on that area. METHOD: In this pilot study, self-assessment questionnaries were delivered to neurologists of Sao Paulo State and 196 (22,8%) were respondents. RESULTS: Many neurologists are involved, besides the private practice, with teaching (61.5%) and/or research (59.5%) activities. Most of them assessed as not good the training on cognitive disorders and dementias they had had during both the graduate (77.3%) and residence (63.1%) courses; nevertheless 60.8% self rated their knowledge on that subject as satisfactory and 83.0% declared their interest on it as at least equal to other areas. The most frequent cognitive complaints occurring as primary reason for appointment are memory loss (73.0%) and attention/concentration deficits (48.0%). Dementia of Alzheimer type (54.9%) and vascular dementia (23.0%) are the most frequent ones in the neurologist private practice. CONCLUSION: Cognitive disorders and dementias represent a significant proportion in the neurological private practice. Although they had not had a good training on the area of cognitive disorders and dementias, the respondent neurologists demonstrated great interest on it.