Marcos A. Lopes

Prevalência de demência em diversas regiões do mundo: Análise dos estudos epidemiológicos de 1994 a 2000

OBJECTIVE To analyse the prevalence studies of dementia from 1994 to 2000. METHODS The papers were searched on Medline and Lilacs and the inclusion criteria were: to be an original study, that estimated dementia prevalence and investigated community samples. RESULTS thirty-eight studies were evaluated from all continents. The mean age-specific prevalence rates of dementia were 1,17% for the 65-69 years group, and 54,83% over 95 years. The results were strongly influenced by age. Dementia prevalence rates were higher on women on 75% of the papers reviewed. The Alzheimers disease/vascular dementia ratio was higher in South America and lower in Asia. DISCUSSION Methodological advances were found, specially regarding the homogeneity of diagnostic criteria. The effect of age on the rates of dementia prevalence was pronounced, up to 90 years of age.OBJECTIVE: To analyse the prevalence studies of dementia from 1994 to 2000. METHODS: The papers were searched on Medline and Lilacs and the inclusion criteria were: to be an original study, that estimated dementia prevalence and investigated community samples. RESULTS: thirty-eight studies were evaluated from all continents. The mean age-specific prevalence rates of dementia were 1,17% for the 65-69 years group, and 54,83% over 95 years. The results were strongly influenced by age. Dementia prevalence rates were higher on women on 75% of the papers reviewed. The Alzheimers disease/vascular dementia ratio was higher in South America and lower in Asia. DISCUSSION: Methodological advances were found, specially regarding the homogeneity of diagnostic criteria. The effect of age on the rates of dementia prevalence was pronounced, up to 90 years of age.

Instrumentos combinados na avaliação de demência em idosos: resultados preliminares

ABSTRACT - Objective : To determine if a functional scale combined with a cognitive test would improve thediagnostic accuracy of dementia. Method : Thirty patients with mild to moderate dementia, diagnosed accordingto ICD-10 and DSM-III-R criteria, and 46 elderly controls, divided into three groups according to theirsocioeconomic status and educational level (high, medium and low) were investigated. The subjects wereassessed with the MMSE, and their informants were assessed with the scales IQCODE and B-ADL. Results : Onthe logistic regression, the MMSE isolated classified correctly 86.8% of patients and controls (80% sensitivityand 91.3% specificity). The combination MMSE + IQCODE classified correctly 92.1% of the subjects (83.3%sensitivity and 97.8% specificity), and the combination MMSE + B-ADL classified correctly 92.1% of subjects(86.7% sensitivity and 95.7% specificity). Conclusion : The results suggest that the combination of a cognitivetest with a functional scale can improve the detection of mild to moderate cases of dementia even on samplesof a very heterogeneous population regarding its socioeconomic status and educational level, as the Brazilian.KEY WORDS: dementia, diagnosis, cognitive test, functional scales.

The Bayer: Activities of Daily Living Scale (B-ADL) in the differentiation between mild to moderate dementia and normal aging

OBJECTIVES To investigate the applicability of the Bayer - Activities of Daily Living scale and its efficiency in differentiating individuals with mild to moderate dementia from normal elderly controls. METHOD We selected 33 patients with diagnosis of mild to severe dementia, according to ICD-10 criteria, and 59 controls. All the subjects were evaluated with the Mini-Mental State Examination and the Clinical Dementia Rating Scale and the Bayer - Activities of Daily Living scale was applied to informants. RESULTS The internal consistency of the Bayer - Activities of Daily Living was high (Cronbachs alpha = 0.981). Mean Mini-Mental State Examination and Bayer - Activities of Daily Living scores of demented patients and controls were significantly different (p < 0.001). Mean Mini-Mental State Examination and Bayer - Activities of Daily Living scores were significantly different between Clinical Dementia Rating Scale 0 (controls; n = 59) versus Clinical Dementia Rating Scale 1 (mild dementia; n = 15), Clinical Dementia Rating Scale 0 versus Clinical Dementia Rating Scale 2 (moderate dementia; n = 13), and for Clinical Dementia Rating Scale 1 versus Clinical Dementia Rating Scale 2 (p < 0.003). DISCUSSION The Bayer - Activities of Daily Living scale and Mini-Mental State Examination differentiated elderly controls from patients with mild or moderate dementia, and patients with mild dementia from those with moderate dementia. CONCLUSIONS The results suggest that the Bayer - Activities of Daily Living scale applied to an informant can help in the diagnosis and follow-up of Brazilian patients with mild to moderate dementia.

Prevalence of Cognitive and Functional Impairment in a Community Sample from São Paulo, Brazil

Aims: To present the prevalence of cognitive and functional impairment (CFI) in community-dwelling elderly subjects from the city of São Paulo. Methods: The population was aged 60 years and older (n = 1,563; 68.7% women and 31.3% men) and lived in different socioeconomic areas. The following instruments were administered to the elderly: the Mini Mental State Examination and the Fuld Object Memory Evaluation. The Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living scale were administered to an informant. Results: The prevalence of CFI (n = 250) was 16% (95% confidence interval, CI: 14.2–17.8%) or 15.8% (95% CI: 13.8–17.8%). In regression models, the increase in the odds ratio (OR) of CFI was associated with age, for elderly individuals aged 75 years or older, illiterates or with 1–4 years of schooling, and with a history of stroke and diabetes mellitus. On the other hand, for subjects with a tumor history, the OR of CFI was significantly reduced. Conclusion: CFI was high and increased at older ages and in subjects with low education. Potentially changeable factors were identified (stroke and diabetes), and the possible ‘protective effect’ of tumor/cancer against CFI should be further investigated by longitudinal studies.

Performance of Brazilian long and short IQCODE on the screening of dementia in elderly people with low education.

BACKGROUND Dementia screening in elderly people with low education can be difficult to implement. For these subjects, informant reports using the long (L) (26 items) and short (C) (16 items) versions of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) can be useful. The objective of the present study was to investigate the performance of Brazilian versions of the IQCODE L, S and a new short version (SBr) (15 items) in comparison with the Mini-mental State Examination (MMSE) for dementia screening in elderly people with low education. METHODS Thirty-four patients with mild to moderate dementia, diagnosed according to ICD-10 criteria, and 57 controls were evaluated and divided into three groups based on their socioeconomic status and level of education. Patients were evaluated using the MMSE and the informants were interviewed using the IQCODE by interviewers blind to the clinical diagnosis. RESULTS Education was correlated with MMSE results (r = 0.280, p = 0.031), but not with the versions of the IQCODE. The performance of the instruments, evaluated by the ROC curves, was very similar, with good internal consistency (Cronbachs alpha = 0.97). MMSE correctly classified 85.7% of the subjects while the three IQCODE versions (L, S and SBr) correctly classified 91.2% of the subjects. CONCLUSIONS The long, short and the new short Brazilian IQCODE versions can be useful as a screening tool for mild and moderate patients with dementia in Brazil. The IQCODE is not biased by schooling, and it seems to be an adequate instrument for samples with low levels of education.

Combined instruments for the screening of dementia in older people with low Education

OBJECTIVE To determine which combination of cognitive tests and informant reports can improve the diagnostic accuracy of dementia screening in low educated older people. METHOD Patients with mild to moderate dementia (n=34) according to ICD-10 and DSM-III-R criteria and 59 older controls were assessed with the Mini-Mental State Examination (MMSE) and the Fuld Object Memory Evaluation (FOME). Informants were assessed using the Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living Scale. RESULTS The 4 instruments combined with the mixed rule correctly classified 100% and the logistic regression (weighted sum) classified 95.7% of subjects. The weighted sum had a significantly larger ROC area compared to MMSE (p=0.008) and FOME (p=0.023). The specificity of the tested combinations was superior to the MMSE alone (p=0.002). CONCLUSIONS Cognitive tests combined with informant reports can improve the screening of mild to moderate dementia in low educated older people.

Systematic review of dementia prevalence 1994 to 2000

Ageing has occurred in all regions of the world, with impact on neuropsychiatric disorders, particularly dementia. However, previous meta-analysis and reviews have shown high variability in world dementia prevalence rates. Objective The aim of this study was to perform a wide-ranging review of the dementia prevalence studies published in recent years. Methods The search was made on Medline, Lilacs and Embase databases for research conducted between 1994 and 2000. The main inclusion criteria were: use of standard diagnostic criteria and investigation of community samples. Results The final selection included 42 papers, from all continents. The mean prevalence rate of dementia in subjects aged 65 years and older, for continents, ranged from 2.2% in Africa to 8.9% in Europe, and among countries, from 1.3% in India to 14.9% in Spain. However, there was a trend of clustering of the world prevalence rates with the majority of studies reporting rates between 4.2% and 7.2% (≥65 years). Age directly influenced the rates, with a mean prevalence rate of 1.2% (95% CI: 0.8.1.5) for the 65-69 years group and 39.9% (95% CI: 34.4.45.3) for the 90-94 year group, but showing less pronounced influence in the very elderly age group. The urban samples had higher rates, where no significant gender difference was evidenced. Conclusion The age influence over dementia rates apparently leveled off in the very elderly group while a trend toward similar dementia prevalence rates around the world was probably influenced by greater homogeneity in diagnostic criteria.

Depressive Symptoms Associated to Cognitive Decline and Sociodemographic Factors in Community-dwelling Elderly Non-Demented Subjects

type). In this study, we sought to determine the utility and informativeness of different classes of biomarkers and cognitive markers at various stages of disease progression, including a preclinical phase, and their ability to predict an important change in diagnostic status from Mild Cognitive Impairment (MCI) to Alzheimer’s disease (AD). Methods: We chose to interrogate the ADNI public database and therefore studied three groups: Healthy Controls (HC) (N 1⁄4 197), MCI patients who converted to AD (N 1⁄4 116), and MCI patients who did not covert (N 1⁄4 204). We determined the predictive utility of 25 variables from all classes of markers and biomarkers in predicting MCI to AD conversion over a two year period in a series of multiple regression models. Results: In an unbiased stepwise logistic regression that thus included variables from all classes of markers, the following predicted anytime conversion within a two year period: everyday functional activities questionnaire (FAQ), delayed verbal memory, and left middle temporal lobe volume. Cox regression survival analyses were consistent with these results. Next, in an effect size analysis, we observed that change scores for biomarkers were relatively modest over a one year period, but a change in FAQ was considerably larger (ES1⁄4.44 at 12 months, .84 at 24 months). FAQ decline and trailmaking b decline accounted for nearly 50% of the predictive variance in conversion from MCI to AD. Conclusions: Predictors of conversion have obvious utility for clinical decision making, understanding the nature of neurobiological changes at a critical phase in the illness, and assessment of response to treatment. In logistic stepwise regressions, cognitive, functional, and volumetric markers were significant predictors of conversion from MCI to AD. Strikingly and unexpectedly, this was driven less by changes in neurobiological variables over two years than by a sharp decline in functional ability. This set of findings has implications for interpreting neurodegeneration in the MCI-AD transitional phase.

P3-039: Performance of the long and short Brazilian versions of the IQCODE as screening for dementia in low-educated elderly

this study to determine the clinimetrical properties (construct validity and reliability) of the NPI Q and NPI D in a group of Mexican demented patients. Methods: We conducted a transversal, analytical and validation essay. We selected 100 dyads, with dementia diagnosis (of any type). The dyads were interviewed with neuropsychological tools (Mini Mental State Examination, Geriatric Depression Scale, Screening Caregiver Burden, Sleep Disorders Inventory NPI Q, NPI D), sociodemographic questionnaire (age, sex, caregiver relationship, work status, scholarship, etc), a thorough record of comorbidities, medications, and an exploration to complete the Mini Nutritional Assessment. NPI Q s total score was correlated with MMSE, GDS, NPI D and SCB; and individual domains were also evaluated (depression, psychotic symptoms, nutrition and sleep). The NPI D s total score was correlated with SCB and NPI Q. Six patients were selected for a test-retest, to evaluate reliability. Spearman s one tailed correlation, intraclass correlation coefficient (ICC) and Cronbach s alpha, were performed for statistical analysis. Results: Eighty-seven dyads were interviewed, general characteristics are shown in Table 1. The NPI-Q had a significant correlation with MMSE of 0,190 (p 0.001), NPI-D of r 0,887 (p 0,001), with GDS of r 0,385 (p 0.0001). The NPI-Q with a testretest of r 0,829 (p 0.021), ICC 0.824 and internal consistency of 0.778, the individual domain results are shown in Table 2. The NPI D had a significant correlation of r 0.555 with the SCB; test-retest r 0.986, ICC 0.857 and 0.779. Conclusions: Our NPI-Q and NPI-D versions are valid in the evaluation of Mexican patients with dementia. Our results are similar to those reported previously, but add the significant evaluation in the individual domains of sleep and oral intake.

P4-088: Community-based prevalence of structural brain changes in dementia and cognitively impaired nondemented elderly from Brazil

epitopes: LPS, major OMP, and purified elementary bodies. Results: Chlamydia-specific labeling was noted, in the brains of AR-39 infected mice, and was most prominent at 1 month p.i., which was prior to substantial amyloid deposition. Amyloid-specific labeling was prominent at and after 2 months p.i., but did not consistently co-localize with Chlamydia antigen. Conclusions: Our initial data suggest that Chlamydia infection, although initially established in the brains of BALB/c mice is limited with regards to co-localizing with resultant pathology, however, the infection may continue to serve as a chronic stimulus for inflammation in the brain that ultimately results in amyloid deposition.