Maria Paula Foss

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.

Cross-cultural Adaptation, Reliability, and Validity of the BICAMS in Brazil

Objective: To investigate the reliability and validity of a Brazilian-Portuguese adaptation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS). Method: A Brazilian sample of 58 multiple sclerosis (MS) patients and 58 healthy controls (HC) were administered the Brazilian-Portuguese BICAMS test battery, comprising the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test Second Edition (CVLT2), and the Brief Visuospatial Memory Test Revised (BVMTR). Mean differences between groups on BICAMS tests were assessed using analysis of covariance (ANCOVA), controlling for age, gender, education, anxiety, and depression. Test–retest data were obtained from 49 of the MS patients, two weeks after the initial assessment. Results: The MS patient group scored significantly lower on all BICAMS tests (CVLT2 F1,110 = 28.99, p < .001; BVMTR F1,110 = 7.77, p < .01; SDMT F1,110 = 21.09, p < .001). Mixed-factor ANCOVAs tested differences in learning curves across trials for CVLT2 and BVMTR. HCs had significantly steeper learning curves on both CVLT2 (F1,111 = 10.82, p < .01) and BVMTR (F1,110 = 7.816, p < .01). These findings support diagnostic validity of the Brazilian-Portuguese adaptation. Test–retest reliability was satisfactory for SDMT, CVLT2, and BVMTR (.86, .84, and .77, respectively). Conclusion: The results suggest that this Brazilian version of the BICAMS will be a valid and reliable measure once complete normative data become available.

Heterogeneity of cognitive aging in Brazilian normal elderls

With aging, several cognitive skills inevitably decline. However, cognitive losses do not occur homogenously in all elderly people, differing in number and severity of affected cognitive functions. These differences could be exacerbated by socioeconomic differences in a developing country like Brazil. Objectives to characterize the cognitive functioning of healthy elderly subjects whose socioeconomic conditions differ to those of other studies. Methods 60 elderly subjects with a mean age of 68 years, 43 women and 17 men, and mean schooling of 7.1 years, were studied. The cognitive function of this group was assessed using the following neuropsychological tests: Mattis Dementia Rating Scale (MDRS), Stroop Test, Verbal Fluency, Wisconsin Card Sorting Test (WCST), Rey Complex Figure, Vocabulary – Wais – III, Logical Memory (WMS-R), Visual Reproduction (WMS-R), and Rey Auditory-Verbal Learning Test (RAVLT). The neuropsychological data were submitted to Multivariate cluster analysis using SAS - Proc Cluster software and the complete binding hierarchical method. Results Variability was found allowing classification of the studied group into 4 clusters of individuals who had above-average (C1), average (C3 and C4) and below average (C2) performance. Schooling determined the results obtained, with less educated subjects showing poorer performance than higher-educated subjects. Conclusions Significant differences in the process of cognitive aging were detected on neuropsychological tests in this group of healthy elderly from the developing country of Brazil, where socioeconomic differences may exacerbate cognitive differences among older adults.

Mattis Dementia Rating Scale (DRS): Normative data for the Brazilian middle-age and elderly populations

OBJECTIVE To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations. METHODS The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over). RESULTS Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores. CONCLUSION As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

An analysis of the cognitive items of the movement disorders society checklist for the diagnosis of dementia in patients with Parkinson's disease.

OBJECTIVE Some studies about the Movement Disorders Society checklist for the diagnosis of Parkinsons disease (PD) dementia (PDD) suggested that its accuracy was not totally satisfactory. Our study focused to evaluate the two items of the checklist related to the cognitive assessment. METHODS We assessed 95 consecutive patients with a diagnosis of PD using the UPDRS, Hoehn and Yahr, Schwab and England scales, Pfeffer Functional Activities Questionnaire, MMSE, Clinical Dementia Rating, clock drawing test, verbal fluency test (animals), digit span, word list battery of CERAD, Frontal Assessment Battery and the 15-item Geriatric Depression Scale The cognitive diagnosis was based on the MDS diagnostic criteria for PDD. The checklist was completed later by a blinded investigator. The data were evaluated using descriptive analysis and calculation of sensitivity, and specificity of the checklist for the diagnosis of PDD. RESULTS 33 patients (35%) were diagnosed with PDD. The ROC curve showed that the MMSE cut-off score < 26 had the highest accuracy (sensitivity: 94%, specificity: 55%) for the diagnosis of PDD. Using the checklist with original cut-off scores we found sensitivity of 97% and specificity of 58%. Using an alternative way to interpret the cognitive assessment of the checklist we found sensitivity of 94% and specificity of 89% for the diagnosis of PDD. CONCLUSIONS Our findings suggest that to improve the accuracy of the checklist, it would be necessary to adjust the way we use and interpret the cut-off scores of the MMSE and of the subtests, without the need to eliminate their use.

Screening of cognitive impairment in patients with Parkinson's disease: diagnostic validity of the Brazilian versions of the Montreal Cognitive Assessment and the Addenbrooke's Cognitive Examination-Revised.

OBJECTIVE The aim of the present study is to examine the accuracy of the Brazilian versions of the Montreal Cognitive Assessment (MoCA) and the Addenbrookes Cognitive Examination-Revised (ACE-R) to screen for mild cognitive impairment (PDMCI) and dementia (PDD) in patients with Parkinsons disease (PD). METHOD Both scales were administered to a final convenience sample of 79 patients with PD. Patients were evaluated by a neurologist, a psychiatrist and a neuropsychologist using UPDRS, Hoehn and Yahr and Schwab and England scales, global deterioration scale, a psychiatric structured interview, Mattis Dementia Rating Scale and other cognitive tests. RESULTS There were 32 patients with PDMCI and 17 patients with PDD. The MoCA and the ACE-R were able to discriminate patients with PDD from the others. CONCLUSION Both scales showed to be useful to screen for dementia but not for mild cognitive impairment in patients with PD.

Normal aging and decision-making: a systematic review of the literature of the last 10 years

Objective Conduct a systematic review to investigate whether healthy elderly have deficits in the decision-making process when compared to the young. Methods We performed a systematic search on SciELO, Lilacs, PsycINFO, Scopus and PubMed database with keywords decision making and aging (according to the description of Mesh terms) at least 10 years. Results We found nine studies from different countries, who investigated 441 young and 377 elderly. All studies used the IOWA Gambling Task as a way of benchmarking the process of decision making. The analysis showed that 78% of the articles did not have significant differences between groups. However, 100% of the studies that assessed learning did find relevant differences. Furthermore, studies that observed the behavior of individuals in the face of losses and gains, 60% of articles showed that the elderly has more disadvantageous choices throughout the task. Conclusion: The consulted literature showed no consensus on the existence of differences in performance of the decision-making process between old and young, but it is observed that the elderly has deficits in learning and a tendency to fewer advantageous choices.

Support groups for caregivers of patients with Dementia A comparative study

Since the dementias lead to the need for caregivers, a Group for Dementia Caregivers (GC) was set up where the present study compared the psychosocial characteristics, quality of life and caregiver overload in a Group For Dementia Caregivers (GC) with caregivers not involved in this scheme (non–GC). Methods 19 primary caregivers counseled by this group (GC group) was studied and compared to a group of 13 caregivers not receiving such counseling (non-GC group). The instruments used were the World Health Organization Quality of Life (WHOQOL-bref), the State-Trait Anxiety Inventory (STAI) and Caregiver Load Scale (CLS). Results The two groups did not differ in mean age or gender (P<0.05). GC caregivers had a higher educational level, were service workers where majority were the children of patients. In the Non-CG group, the most frequent occupation was housewife, with most subjects being spouses. The WHOQOL revealed a significant difference (p<0.05) between groups in the physical, social relations and environment domains (GC>Non-GC). The STAI revealed a significant difference (p<0.05) in the Trait subscale (GC>Non-GC), but not in the State subscale. There was no significant difference in CLS. Conclusion The GC appeared to be of benefit to its participants, with probable positive repercussions on the patients, particularly regarding their quality of life.

Correlation between Alzheimer's disease, pre-diabetes and diabetes mellitus evaluated by quantitative magnetic resonance imaging

regions. The diagnostic accuracy of conventional EEG in AD is around 80%. Statistical Pattern Recognition (SPR) is a statistical analysis that uses a database of information, in this case features from EEG registration, to identify individuals with aberrant pattern of brain waves. By using this method, the intention is to increase the diagnostic accuracy of EEG in AD. Methods: The participants were 300 patients diagnosed with AD at a Memory Clinic and 400 normal individuals evenly distributed in the age range of 50 90 years. SPR was used to identify the patients using more than 600 features of the EEG registration. A numeric index from 0-100 was established to describe the likelihood of AD in each case. Results: This method correctly identified AD patients when compared to the normal group with >90% accuracy. Furthermore, the AD-index correlated with the severity of the disease as evaluated by the MMSE. The method also correctly identified AD patients when compared to EEG in patients with vascular dementia (VD) with some overlap in patients with mixed VD and AD. Conclusions: By using SPR on features of EEG registration, this method is more sensitive in identifying patients with AD from normal individuals and from patients with VD than conventional EEG. The method is easy to use and is therefore more widely applicable than more specialized methods like MRI or SPECT/PET.

Recalling feature bindings differentiates Alzheimer’s disease from Frontotemporal Dementia

It has been challenging to identify clinical cognitive markers that can differentiate patients with Alzheimer’s disease (AD) from those with behavioral variant frontotemporal dementia (bvFTD). The short-term memory binding (STMB) test assesses the ability to integrate colors and shapes into unified representations and to hold them temporarily during online performance. The objective of this study is to investigate whether free recall deficits during short-term memory binding (STMB) test can differentiate patients with AD from those with bvFTD and controls. Participants were 32 cognitively intact adults, 35 individuals with AD and 18 with bvFTD. All patients were in the mild dementia stage. Receiver-operating characteristic (ROC) analyses were used to examine the diagnostic accuracy of the STMB. The results showed that AD patients performed significantly worse than controls and bvFTD patients in the STMB test, while the latter groups showed equivalent performance. The bound condition of the STMB test showed an AUC of 0.853, with 84.4% of sensitivity and 80% of specificity to discriminate AD from controls and an AUC of 0.794, with 72.2% of sensitivity and 80% of specificity to differentiate AD from bvFTD. Binding deficits seem specific to AD. The free recall version of the STMB test can be used for clinical purposes and may aid in the differential diagnosis of AD. Findings support the view that the STMB may be a suitable cognitive marker for AD.