Lilian Schafirovits Morillo

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.

Swallowing in moderate and severe phases of Alzheimer's disease

OBJECTIVE To characterize the problems of feeding and swallowing in individuals with moderate and severe Alzheimer´s disease (AD) and to correlate these with functional aspects. METHOD Fifty patients with AD and their caregivers participated in this study. The instruments used were: Clinical Dementia Rating (CDR), Mini-Mental State Examination, Index of Activities of Daily Living, Assessment of Feeding and Swallowing Difficulties in Dementia, Functional Outcome Questionnaire for Aphasia, and Swallowing Rating Scale. RESULTS Problems with passivity, distraction and refusal to eat were encountered in the CDR2 group. Distraction, passivity and inappropriate feeding velocity were predominant in the CDR3 group. The problems were correlated with communication, swallowing severity of AD individuals and caregiver schooling. CONCLUSION Given the inexorable functional alterations during the course of the disease, it is vital to observe these in patients with a compromised feeding and swallowing mechanism. The present study supplies the instruments to orient caregivers and professionals.

Progressive posterior cortical dysfunction

Progressive posterior cortical dysfunction (PPCD) is an insidious syndrome characterized by prominent disorders of higher visual processing. It affects both dorsal (occipito-parietal) and ventral (occipito-temporal) pathways, disturbing visuospatial processing and visual recognition, respectively. We report a case of a 67-year-old woman presenting with progressive impairment of visual functions. Neurologic examination showed agraphia, alexia, hemispatial neglect (left side visual extinction), complete Balint’s syndrome and visual agnosia. Magnetic resonance imaging showed circumscribed atrophy involving the bilateral parieto-occipital regions, slightly more predominant to the right. Our aim was to describe a case of this syndrome, to present a video showing the main abnormalities, and to discuss this unusual presentation of dementia. We believe this article can contribute by improving the recognition of PPCD.

A Useful and Brief Cognitive Assessment for Advanced Dementia in a Population with Low Levels of Education

Background/Aims: Almost half of community-dwelling patients and 59.6% of institutionalized residents with dementia are in moderate or severe stages of this disease. The Mini-Mental State Examination (MMSE) has limited applicability to these patients due to floor effects. We aimed to determine the correlation between the MMSE and the Severe Mini-Mental State Examination (SMMSE), as well as SMMSE association with functional scales in patients having moderate to severe dementia and low levels of education. Methods: A cross-sectional study of patients 60 years or older attending an outpatient clinic was conducted. The MMSE, SMMSE and functional scales were applied. Clinical and demographic data from medical records were reviewed. Results: Seventy-five patients with a mean of 4.1 ± 3.6 years of education were analyzed. The mean scores on the MMSE and SMMSE were 7.8 ± 7.0 and 17.8 ± 9.4, respectively. The results indicated that the MMSE and SMMSE correlated only in patients who had an MMSE score of less than 10 (r = 0.87; p < 0.001). In addition, significant correlations were found between the SMMSE and functional scales (p < 0.001). It was observed that educational level did not interact with SMMSE performance. Conclusion: The SMMSE is a useful and reliable tool for a brief cognitive assessment of advanced dementia patients with low educational levels.

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.

Nutritional profile and its relationship with cognitive and functional status of severe dementia patients

with FAST 5 to 7G, 75% in use of anticholinesterase, 16.7% died in the household and 77% in hospital. Caregivers had on average age 61.4 6 13.9 years, 79.5% women and 65.9% child (a). The prevalence of prolonged grief in caregivers occurred in 11.4%. Decreased risk of Mourning Extended when the son was who provided care (OR: 0.032; 95% CI: 0.001 to 0.905; p 1⁄4 0.044). There was an increased risk of Mourning Extended caregivers interested in counseling (OR: 17.838; 95% CI: 1.302 to 244.39, p 1⁄4 0.031). Conclusion: It is important that caregivers have a targeted assessment and psychological support before and after death of patients with advanced dementia to prevent Prolonged grief. Further research may help to identify and direct them to specialized professional help.

Profile of elderly patients with advanced dementia from an outpatient geriatric clinic at São Paulo, Brazil

the accumulation ofWMH.Methods: Plasma omega 3 pufas were available in 104 non-demented participants of the Oregon Brain Aging Study (mean age 87 6 10 and MMSE 27 6 3). Linear mixed effects modeling assessed the within-person change in executive function and processing speed by baseline plasma pufas as a predictor after controlling for age, gender, education, ApoE genotype, and hypertension. Mediation by baselineWMHvolume was also examined for both cognitive outcomes. Results: Higher plasma pufas associated with a reduced rate of decline in trail making test B (P1⁄4 0.004) and digit symbol making test (P1⁄4 0.013) over a mean follow up period of 3.4 years. Adding baseline WMH volume to the model significantly attenuated both of these longitudinal relationships. Conclusions: High plasma pufa content (EPA and DHA together) is associated with more stable executive function and processing speed over time in non-demented elders. This association appears to be mediated through vascular mechanisms.

Associations of apathy with depression and NPS measured by standard scales in patients with moderate-to-advanced dementia

Methods: From April 2007 to June 2011, in the neurology department of Seoul National University Bundang Hospital, patients diagnosed as probable Alzheimer’s disease according to NINDS-ADRDA were included. And those with extreme cognitive impairment (CDR 2, 3) were excluded. The Geriatric depression scale was used as a symptom checklist to diagnose depression. And Korean Neuropsychiatric Inventory (NPI) and Seoul-Instrumental Activities of Daily Living (SIADL) score were assessed. Results: Among 229 patients with probable Alzheimer’s disease, 127 patients (54.46%) were female. There were no differences in CDR, CDRSOB, underlying disease such as hypertension, stroke between two groups. Education years, age, total MMSE score, and diabetes were higher in the male group. The Chi-square test and independent t-test were used to check the significance of association. Geriatric depression scale was higher in female patients, but it was not significant (13.67 vs 12.54, P1⁄4.291). But depression in NPI was higher in female patients (64% vs. 36%, P1⁄4.015). The current and possible SIADL total scores were lower in female patients (13.14 vs. 16.40, P1⁄4.013), (11.79 vs 15.10, P1⁄4.009).Conclusions: There is a higher tendency of depression among patients of Alzheimer’s disease, particularly female patients. And daily performance was relatively better in female patients. We suggested that social-living status and previous daily activity were related to these results.

Impact of dementia caregiving in caregiver's life

Background: Laminaria japonica , an edible brown seaweed, has long been utilized since ancient times as an important food resource to promote maternal health in Pacific and Asian countries. Due to its high contents of dietary fiber, minerals, carbohydrates, and protein, L. japonica has recently attracted much attention for its bioactive materials and nutraceutical qualities. Methods: The present study examined the effects of desalted Laminaria japonica (D LJ) on learning and memory function and cholinergic neuron activity in trimethyltin (TMT) induced memory deficits rats.After TMT injection (8mg/kg, i.p.), rats were administered with saline or D LJ (10 and 50mg/kg, p.o.) daily for 21 days. The cognitive improving effects of D LJ on TMT-induced amnesic rats were investigated by assessing the Morris water maze test and by performing choline acetyltransferase (ChAT) immunohistochemistry.Results: In theMorris water maze, TMT treated group produced impairment in escape latency to find the platform. However, DLJ treated groups were significantly recovered the impairment of memory compared to the control group (on the 2nd and 4th day (P <0.05)). Consistent with behavioral data, DLJ group was significantly increased ChAT-ir neurons in the midial striatum compared to the control group (P <0.01). Conclusions: In conclusion, administration of D LJ improved spatial learning and memory. These results suggest that D LJ may be useful for the cognitive improvement via regulation of cholinergic marker enzyme activity.

Testosterone profile in older men with Alzheimer’s disease

Evidence suggests low testosterone levels in Alzheimer’s disease. Objectives To compare testosterone levels between older men with and without Alzheimer’s disease. Methods Fourteen men with Alzheimer’s disease were compared with twenty eight men without dementia. Demographic variables and clinical profiles were analyzed. Within fifteen days before or after the described evaluation, measures of total testosterone and Sex Hormone Binding Globulin (SHBG) were performed. Free testosterone level was calculated based on total testosterone and SHBG. Quantitative variables were analyzed using Student’s t test or Kruskal-Wallis test, while qualitative variables were analyzed using chi-square or Fisher test. Results Mean age in the Control and Alzheimer’s disease groups were 72.0 (SD±4.8) years and 79.3(SD±5.9) years, respectively (p=0.001). Mean schooling between these two groups were 8.78 and (±5.86) years, respectively (p=0.022). There were no statistically significant differences between the two groups for testosterone levels, although a trend was observed for the Alzheimer’s disease group to present lower levels than the control group (p=0.066). There was no direct correlation between free testosterone and age, although a trend was evident (p=0.068). Conclusions There was no significant difference in testosterone between men with AD and those without dementia.