Mariana Tatsch

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.

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.

Proton spectroscopy in Alzheimer's disease and cognitive impairment no dementia: a community-based study.

Objective: To describe the findings of proton magnetic resonance spectroscopy (1H-MRS) in Alzheimer’s disease (AD) and cognitive impairment, no dementia (CIND) elderly from a community-based sample. Methods: Thirteen patients with AD, 12 with CIND and 15 normal individuals were evaluated. The 1H-MRS was performed in the right temporal, left parietal and medial occipital regions studying the metabolites N-acetylaspartate (NAA), creatine (Cr), choline (Cho) and myoinositol (mI). The clinical diagnosis was based on standardized cognitive tests – MMSE and CAMDEX – and the results correlated with the 1H-MRS. Results: Parietal Cho was higher in control individuals and lower in CIND subjects. AD and control groups were better identified by temporal and parietal mI combined with the temporal NAA/Cr ratio. CIND was better identified by parietal Cho. Conclusion: The 1H-MRS findings confirmed the hypothesis that metabolic alterations are present since the first symptoms of cognitively impaired elderly subjects. These results suggest that combining MRS from different cerebral regions can help in the diagnosis and follow-up of community elderly individuals with memory complaints and AD.

Espectroscopia de prótons na doença de Alzheimer e no comprometimento cognitivo sem demência: estudo de uma amostra comunitária

OBJECTIVE: To describe the proton magnetic resonance spectroscopy (1H-ERM) data in Alzheimers disease (AD) and Cognitive Impairment Not Dementia (CIND) in a community sample. METHOD: We investigated subjects with AD (n=6), CIND (n=7) and normal control (n=7). 1H-ERM was performed with single voxel (8 cm3) placed in temporal, parietal e occipital regions and studied metabolites were: N-acetylaspartate (NAA), creatine (Cr), choline (Cho) and myo-inositol (mI). RESULTS: NAA concentration was higher in control subjects than AD and intermediated in CIND patients. Cho parietal plus occipital and Cr parietal plus Cho occipital classified correctly 92.3% of subjects Control vs AD. Temporal mI classified 78.6% of subjects between Control vs CIND. CONCLUSION: Spectroscopy can be used in the diagnosis and follow-up of individuals with cognitive impairment; evaluation of community subjects may show different patterns of brain metabolites distribution.

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.

P1-150: 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