José Humberto da Silva-Filho

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.

Teste Wisconsin de Classificação de Cartas: uma revisão sistemática de 1952 a 2009

The WCST is a problem-solving, neuropsychological test, with solving criteria initially unknown and mutant. Such task requires the respondent to understand the logical principles of the proposed problem. Considering the relevance of such test for neuropsychological assessment, this present study describes a bibliographic review of articles mentioning the WSCT. Such articles were searched for in three international databases (Medline, Science Direct and PsycINFO), with WSCT used as the descriptor. From 1952 to 2009, 1076 scientific articles were indentified, with a significant increase of publications from 1993 on. The countries with most studies on the WSCT were the Netherlands, USA, and UK. The main descriptors of journals that published these studies were Psychiatry, Neuropsychology, Psychology and Brain. This present study also demonstrates that the journals that published 10 or more articles on WSCT show an elevated impact factor (JCR).

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.

Typical performance of elderly patients with Alzheimer disease on the Wisconsin Card Sorting Test (WCST)

The Wisconsin Card Sorting Test (WCST) is a neuropsychological assessment tool designed to assess executive functions, frequently used in cases of cognitive disorders. However, Brazilian neuroscientific settings lack standardization studies of psychological assessment instruments, especially in the neuropsychological area. Thus, the assessment of clinical groups including dementias and particularly Alzheimers disease (AD) patients, may be compromised by the lack of analytical references. Objective To characterize the performance of elderly patients with Alzheimers disease on the WCST, aiming at establishing preliminary evaluative norms. Method Thirty-six elderly patients (mean age of 75.8 years) with mild AD from a teaching hospital were assessed using the printed form of the WCST. Results The elderly patients with AD had impaired performance on the various WCST technical indicators, highlighting cognitive deficit with traces of stereotyped behavior and failures in working memory, conceptualization and learning. The results allowed preliminary norms to be defined for elderly AD patients on the various WCST indicators, grading their performance in eight diagnostic areas and yielding the identification of different levels of impairment of executive functions in these elderly patients. Conclusions The results demonstrated specific aspects of performance on the WCST by elderly people with AD, highlighting the effect of the disease on cognitive performance and executive functioning. Those normative references, although preliminary make a significant contribution to the neuropsychological assessment of AD patients in the Brazilian context, within the informative scope of the WCST.

Reports by caregivers of behavioral and psychological symptoms of dementia

Behavioral and Psychological Symptoms of Dementia (BPSD) are relevant since they are frequent and cause distress to caregivers. However, they may not be reported by physicians due to the priority usually attributed to cognitive symptoms. Objectives To verify whether BPSD is being systematically investigated by physicians even in specialized settings and whether their records on medical files are accurate. Methods Assessment of records on medical files of BPSD reported by caregivers to 182 patients (57.1% men, mean age 67.6±13.5 years) assisted in a tertiary-care behavioral neurology outpatient clinic (BNOC) who also had appointments in other clinics of the same hospital. Alzheimer’s disease (37.9%) and vascular disease (19.2%) were the most frequent causes of dementia. Results Report/appointment ratios were 0.58 in BNOC, 0.43 in other neurological, 0.93 in psychiatric and 0.20 in non-neurological, non-psychiatric clinics. BPSD most frequently recorded in BNOC were insomnia, aggressiveness, agitation/hyperactivity, visual hallucinations, apathy, inadequate behavior and ease of crying. Sorted by psychiatrists, categories associated to more BPSD were affect/mood, thought and personality/behavior. affect/mood and sensoperception symptoms were the most frequently reported. Sorted according to Neuropsychiatric Inventory (NPI), categories associated to more BPSD were depression/dysphoria, delusion and apathy/indifference. depression/dysphoria and agitation/ aggression symptoms were the most frequently reported. Conclusions BPSD reported by caregivers were very diverse and were not systematically investigated by physicians. Notes in medical files often contained non-technical terms.

Normas de associação semântica para 20 categorias em adultos e idosos

Es necesario el desarrollo de normas para categorias semanticas para poder comprender como las personas organizan el conocimiento en la memoria y para la construccion de instrumentos de evaluacion cognitiva. El objetivo de este estudio es proporcionar normas asociativas de 20 categorias semanticas para muestras de brasilenos adultos y ancianos. Participaron 236 personas entre 40 y 88 anos, de cinco regiones de Brasil. Los participantes completaron un cuestionario de datos sociodemografico y un cuestionario de items para categorias semanticas y se les solicito la produccion de los cinco primeros ejemplares de cada categoria presentada. Los resultados fueron agrupados y son presentadas las normas de las categorias (ejemplares, tamano de categoria, respuestas correctas, en blanco y errores), asi como las respuestas de cada categoria, comunes a todas las regiones de Brasil.The development of semantic category norms is necessary to assist in the understanding of how individuals organize knowledge in memory, and to the creation of cognitive assessment instruments. The aim of this study is to provide associative norms of 20 semantic categories for Brazilian adults and elderly. The study included 236 participants from 40 to 88 years of age from the five Brazilian regions. They answered a socio-demographic questionnaire and a semantic category questionnaire, in which they were asked to produce the first five items of each category. Results are presented in category norms (items, category set size, correct responses, no responses and errors), as well as the responses that were common to all Brazilian regions belonging to each category.

Normas de asociación semántica para 20 categorías en adultos y ancianos

Es necesario el desarrollo de normas para categorias semanticas para poder comprender como las personas organizan el conocimiento en la memoria y para la construccion de instrumentos de evaluacion cognitiva. El objetivo de este estudio es proporcionar normas asociativas de 20 categorias semanticas para muestras de brasilenos adultos y ancianos. Participaron 236 personas entre 40 y 88 anos, de cinco regiones de Brasil. Los participantes completaron un cuestionario de datos sociodemografico y un cuestionario de items para categorias semanticas y se les solicito la produccion de los cinco primeros ejemplares de cada categoria presentada. Los resultados fueron agrupados y son presentadas las normas de las categorias (ejemplares, tamano de categoria, respuestas correctas, en blanco y errores), asi como las respuestas de cada categoria, comunes a todas las regiones de Brasil.The development of semantic category norms is necessary to assist in the understanding of how individuals organize knowledge in memory, and to the creation of cognitive assessment instruments. The aim of this study is to provide associative norms of 20 semantic categories for Brazilian adults and elderly. The study included 236 participants from 40 to 88 years of age from the five Brazilian regions. They answered a socio-demographic questionnaire and a semantic category questionnaire, in which they were asked to produce the first five items of each category. Results are presented in category norms (items, category set size, correct responses, no responses and errors), as well as the responses that were common to all Brazilian regions belonging to each category.

Semantic association norms for 20 categories in adults and elderly

Es necesario el desarrollo de normas para categorias semanticas para poder comprender como las personas organizan el conocimiento en la memoria y para la construccion de instrumentos de evaluacion cognitiva. El objetivo de este estudio es proporcionar normas asociativas de 20 categorias semanticas para muestras de brasilenos adultos y ancianos. Participaron 236 personas entre 40 y 88 anos, de cinco regiones de Brasil. Los participantes completaron un cuestionario de datos sociodemografico y un cuestionario de items para categorias semanticas y se les solicito la produccion de los cinco primeros ejemplares de cada categoria presentada. Los resultados fueron agrupados y son presentadas las normas de las categorias (ejemplares, tamano de categoria, respuestas correctas, en blanco y errores), asi como las respuestas de cada categoria, comunes a todas las regiones de Brasil.The development of semantic category norms is necessary to assist in the understanding of how individuals organize knowledge in memory, and to the creation of cognitive assessment instruments. The aim of this study is to provide associative norms of 20 semantic categories for Brazilian adults and elderly. The study included 236 participants from 40 to 88 years of age from the five Brazilian regions. They answered a socio-demographic questionnaire and a semantic category questionnaire, in which they were asked to produce the first five items of each category. Results are presented in category norms (items, category set size, correct responses, no responses and errors), as well as the responses that were common to all Brazilian regions belonging to each category.