Marco A. Moscoso

Estimate of Dementia Prevalence in a Community Sample from São Paulo, Brazil

Aims: To estimate dementia prevalence and describe the etiology of dementia in a community sample from the city of São Paulo, Brazil. Methods: A sample of subjects older than 60 years was screened for dementia in the first phase. During the second phase, the diagnostic workup included a structured interview, physical and neurological examination, laboratory exams, a brain scan, and DSM-IV criteria diagnosis. Results: Mean age was 71.5 years (n = 1,563) and 58.3% had up to 4 years of schooling (68.7% female). Dementia was diagnosed in 107 subjects with an observed prevalence of 6.8%. The estimate of dementia prevalence was 12.9%, considering design effect, nonresponse during the community phase, and positive and negative predictive values. Alzheimer’s disease was the most frequent cause of dementia (59.8%), followed by vascular dementia (15.9%). Older age and illiteracy were significantly associated with dementia. Conclusions: The estimate of dementia prevalence was higher than previously reported in Brazil, with Alzheimer’s disease and vascular dementia being the most frequent causes of dementia. Dementia prevalence in Brazil and in other Latin American countries should be addressed by additional studies to confirm these higher dementia rates which might have a sizable impact on countries’ health services.

Influence of education and depressive symptoms on cognitive function in the elderly

OBJECTIVE The purpose of the present study was to investigate the influence that education and depression have on the performance of elderly people in neuropsychological tests. METHODS The study was conducted at the Institute of Psychiatry, University of São Paulo School of Medicine, Hospital das Clínicas. All of the individuals evaluated were aged 60 or older. The study sample consisted of 59 outpatients with depressive disorders and 51 healthy controls. We stratified the sample by level of education: low = 1-4 years of schooling; high = 5 or more years of schooling. Evaluations consisted of psychiatric assessment, cognitive assessment, laboratory tests and cerebral magnetic resonance imaging. RESULTS We found that level of education influenced all the measures of cognitive domains investigated (intellectual efficiency, processing speed, attention, executive function and memory) except the Digit Span Forward and Fuld Object Memory Evaluation (immediate and delayed recall), whereas depressive symptoms influenced some measures of memory, attention, executive function and processing speed. Although the combination of a low level of education and depression had a significant negative influence on Stroop Test part B, Trail Making Test part B and Logical Memory (immediate recall), we found no other significant effects of the interaction between level of education and depression. CONCLUSION The results of this study underscore the importance of considering the level of education in the analysis of cognitive performance in depressed elderly patients, as well as the relevance of developing new cognitive function tests in which level of education has a reduced impact on the results.

Effect of temporal lobe structure volume on memory in elderly depressed patients.

OBJECTIVE To compare the volume of the hippocampus and parahippocampal gyrus in elderly individuals with and without depressive disorders, and to determine whether the volumes of these regions correlate with scores on memory tests. METHOD Clinical and demographic differences, as well as differences in regional gray matter volumes, were assessed in 48 elderly patients with depressive disorders and 31 control subjects. Brain (structural MRI) scans were processed using statistical parametric mapping and voxel-based morphometry. Cognitive tests were administered to subjects in both groups. RESULTS There were no between-group gray matter volume differences in the hippocampus or parahippocampal gyrus. In the elderly depressed group only, the volume of the left parahippocampal gyrus correlated with scores on the delayed naming portion of the visual-verbal learning test. There were also significant direct correlations in depressed subjects between the volumes of the left hippocampus, right and left parahippocampal gyrus and immediate recall scores on verbal episodic memory tests and visual learning tests. In the control group, there were direct correlations only between overall cognitive performance (as assessed with the MMSE) and the volume of right hippocampus, and between the total score on the visual-verbal learning test and the volume of the right and left parahippocampal gyrus. CONCLUSIONS These findings highlight different patterns of relationship between cognitive performance and volumes of medial temporal structures in depressed individuals and healthy elderly subjects. The direct correlation between delayed visual-verbal memory recall scores with left parahippocampal volumes specifically in elderly depressed individuals provides support to the view that depression in elderly populations may be a risk factor for dementia.

DTI voxelwise analysis did not differentiate older depressed patients from older subjects without depression.

INTRODUCTION Neuroimaging has been widely used in studies to investigate depression in the elderly because it is a noninvasive technique, and it allows the detection of structural and functional brain alterations. Fractional anisotropy (FA) and mean diffusivity (MD) are neuroimaging indexes of the microstructural integrity of white matter, which are measured using diffusion tensor imaging (DTI). The aim of this study was to investigate differences in FA or MD in the entire brain without a previously determined region of interest (ROI) between depressed and non-depressed elderly patients. METHOD Brain magnetic resonance imaging scans were obtained from 47 depressed elderly patients, diagnosed according to DSM-IV criteria, and 36 healthy elderly patients as controls. Voxelwise statistical analysis of FA data was performed using tract-based spatial statistics (TBSS). RESULTS After controlling for age, no significant differences among FA and MD parameters were observed in the depressed elderly patients. No significant correlations were found between cognitive performance and FA or MD parameters. CONCLUSION There were no significant differences among FA or MD values between mildly or moderately depressed and non-depressed elderly patients when the brain was analyzed without a previously determined ROI.

Profile of caregivers of Alzheimer’s disease patients attended at a reference center for cognitive disorders

This is a study on burden of caregivers of patients with Alzheimer’s disease attended at a Reference Center for Cognitive Disorders. Objective To evaluate the profile and burden on caregivers of patients with Alzheimer’s disease attended at a Reference Center for Cognitive Disorders. Methods We collected demographic information and data on the relationship with the patient from caregivers, and measured burden with the Zarit scale. The patients were evaluated with the following scales: the Cambridge Cognitive Test (CAMCOG); Mini Mental State Examination, the Neuropsychiatric Inventory for neuropsychiatry symptoms, and Functional Activities Questionnaire - FAQ for functional impairment. Results Of the 31 caregivers, 77.4% were female, predominantly, and daughters, having a mean age of 58.6 years, educational level of 8.1 years, 70% of caregivers co-resided with the patient and 71% did not work. The mean time as a caregiver was 3 years. Twenty-seven percent of the caregivers presented mild to severe burden. The variables presenting significant association with caregiver burden were scores on the NPI and CAMCOG. Conclusion The social demographic characteristics of the sample were similar to those of studies performed in other countries. The average time as a caregiver and the frequency of caregivers with mild to intense burden were lower than those reported in international studies. Neuropsychiatric symptoms and severity of cognitive decline were the main factors associated to burden in this sample of mostly mild to moderate demented AD patients. Further studies are necessary to verify whether the burden is indeed less intense in our milieu.

Validation of a treatment algorithm for major depression in an older Brazilian sample.

The aim of this study was to investigate the effectiveness of a modified version of the Duke Somatic Algorithm Treatment for Geriatric Depression (STAGED) in a Brazilian sample of older patients with major depression. Besides, we aimed to investigate possible baseline predictive factors for remission in this sample.

P4-010: Estimate of dementia prevalence and associated factors in São Paulo, Brazil

Conclusions: Our results suggest that FHx of AD has a stronger association with microstructural brain differences, than 4. Presence of 4 alone was not associated with measurable difference, though presence of FHx and 4 resulted in the greatest difference in FA. These results support the conclusion that a greater emphasis be placed on elucidating the contribution of FHx to early brain changes in people at risk for AD. Additionally, our results provide evidence that DTI may be useful for detecting or tracking AD related brain changes, prior to disease onset.

P1-385: Correlation between memory and volume of brain structures in depressed elderly: A study using voxel-based morphometry

Background: Cognitive deficits and structural brain alterations are usually found in depressed elderly. The objective of this study was to compare the volume of the hippocampus and parahippocampal gyrus of elderly with and without depressive disorders, investigating whether there is a correlation between the volume of these regions and the scores on these cognitive tests. Methods: In this study, the clinical and demographic differences, as well as the difference in the volume of the total brain matter were assessed using structural magnetic resonance imaging in 48 elderly people with depressive disorders and 31 controls. The comparison of the scores on the cognitive tests of both groups was carried out using the Analysis of Covariance, since the groups were different in terms of level of education. The correlation between the volume of each structure and the scores on the cognitive tests for each group studied was made using the Statistical Parametric Mapping program and Pearson’s Correlation Coefficient. Results: Patients and controls were similar regarding the total brain volume and also with respect to the regions of interest; however, the patients presented lower performance on the tests that assessed memory, executive functions and processing speed. In the group of elderly subjects with depressive disorder, there was a correlation between the verbal episodic memory test and the volume of the left hippocampus (p 0.023); right (p 0.044) and left (p 0.007) parahippocampal gyrus. In this group, there was also a correlation between the left parahippocampal gyrus, the visual episodic memory (p 0.039) and the delayed naming in the visual-verbal learning test (p 0.040). In the control group, there was a correlation between the performance on the Mini Mental State Examination and the right hippocampus (p 0.010), and the total naming on the visual-verbal learning test and the right (p 0.10) and left (p 0.015) parahippocampal gyrus. Conclusions: The results demonstrate that the elderly with depressive disorders have memory deficits and that these deficits are correlated to structural brain alterations. Such finding might help to understand the pathophysiology of depression in the elderly.

P1-150: The ‘Bayer-Activities of Daily Living Scale’ (B-ADL) in the differentiation between Alzheimer’s disease, CIND and normal aging

Jefferson C. Folquitto, Sérgio B. Barros, Mariana F. Tatsch, Dionisio Azevedo Jr, Sérgio R. Hototian, Marco A. Moscoso, Andreia Z. Scalco, Júlio Litvoc, Cássio MC Bottino. Old Age Research Group University of Sao Paulo Brazil, São Paulo, Brazil; Medical School University of Sao Paulo, São Paulo, Brazil; Preventive Medicine University of Sao Paulo, São Paulo, Brazil. Contact e-mail: jcfolquitto@gmail.com

P1-238 : Prevalence of dementia in a community-based sample from São Paulo, Brazil

Cassio M C Bottino, Marcos A. Lopes, Sergio R. Hototian, Dionisio Azevedo, Mariana Tatsch, Mario C. Bazzarella, Jeferson Folquitto, Marco A. Moscoso, Homero Valada Filho, Julio Litvoc, Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil; Dept. of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil. Contact e-mail: cbottino@usp.br