Mario Amore Cecchini

Prevalence of Cognitive Impairment Without Dementia and Dementia in Tremembé, Brazil.

Background:The prevalence of cognitive impairment is insufficiently determined in developing countries. The aim of this study was to ascertain the prevalence of cognitive impairment without dementia and dementia in community-dwelling elderly in Brazil. Methods:This was a single-phase cross-sectional survey of the elderly (aged 60 years and above) living in the municipality of Tremembé, Brazil. Twenty percent of the households with elderly persons were randomly selected from urban and rural areas, to obtain a homogenous representation of all socioeconomic and cultural levels. Results:We assessed 630 individuals [mean age, 71.3 y (±7.99); mean years of education, 4.9 (±4.54)] and found prevalence rates of 17.5% (95% confidence interval, 14.6-20.6) for dementia and 19.5% (95% confidence interval, 16.6-22.8) for cognitive impairment without dementia. These prevalence rates were influenced by age (P<0.001) and by educational level (P<0.001). There was no significant sex difference among diagnostic groups (P=0.166). The prevalence of dementia was higher in relatively younger individuals (below 70 y) when compared with other studies. Besides, dementia was associated with low socioeconomic status, stroke, previous psychiatric disorder, alcoholism, and epilepsy. Conclusions:The prevalence of dementia in this study was higher than in other studies, particularly among younger elderly.

Prevalence of depressive symptoms among elderly in the city of Tremembé, Brazil: Preliminary findings of an epidemiological study

Depression is a heterogeneous mental disease classified as a set of disorders, which manifest with a certain duration, frequency and intensity. The prevalence of depression in the elderly ranges from 0.5 to 16%. OBJECTIVE To establish, in an epidemiological study, the prevalence of significant depressive symptoms in the population aged 60 years or older. METHODS Results of a cross-sectional epidemiological study, involving home visits, being carried out in the city of Tremembé, Brazil, were reported. The sample was randomly selected by drawing 20% of the population over 60 years from each of the citys census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, the Cornell scale and the Patient Health Questionnaire for psychiatric symptoms. Scores greater than or equal to 8 on the Cornell scale were taken to indicate the presence of depressive symptoms. RESULTS A total of 455 elders were assessed, and of these 169 (37.1%) had clinically significant depressive symptoms (CSDS). Depression prevalence was higher among women (p<0.001) and individuals with lower education (p=0.033). The Chi-square test for trends showed a significant relationship where lower socioeconomic status was associated with greater likelihood of depressive symptoms (p=0.005). CONCLUSION The prevalence of depressive symptoms was high in this sample of the population-based study and was associated with female gender, low educational level and socioeconomic status. The assessment of the entire population sample must be completed.

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.

THE SHORT-TERM MEMORY BINDING TEST DIFFERENTIATES ELDERLY WITH SUBJECTIVE COGNITIVE DECLINE FROM HEALTHY CONTROLS IN A BRAZILIAN COHORT

Swing Time (s) 0.022524 0.008446 0.013697 Stance Time (s) 0.02011 0.003952 0.01898 Double Support Time (s) 0.137795 0.012415 0.074738 Stride Time (s) 0.011896 0.003264 0.009942 Step Time (s) 0.013079 0.003247 0.010186 Cadence (steps/min) 0.01376 0.003583 0.010019 Swing Period (%) 0.299833 0.103909 0.128888 Stance Period (%) 0.299833 0.103909 0.128888 Double Support Period (%) 0.248642 0.073979 0.190587 0 Gait Speed (m/s) 0.016868 0.002813 0.002633 1 CVof Swing Time (%) 0.213179 0.222785 0.011888 2 CVof Stance Time (%) 0.515457 0.072578 0.092257 3 CVof Double Support Time (%) 0.763278 0.100174 0.949687 Adalberto Studart Neto, Natalia Cristina Moraes, Mario Amore Cecchini, Sr., Jacy Bezerra Parmera, Raphael Ribeiro Spera, Omar Jaluul, Monica Sanches Yassuda, Mario Alfredo Parra, Sonia Maria Dozzi Brucki, Ricardo Nitrini, Medical School of University of S~ao Paulo, S~ao Paulo, Brazil; University of Sao Paulo, School of Medicine, Sao Paulo, Brazil; University of S~ao Paulo, S~ao Paulo, Brazil; University Heriot-Watt, Edinburgh, United Kingdom. Contact e-mail: adalbertostudartneto@gmail.com

TESTS OF EXECUTIVE FUNCTION MAY NOT DIFFERENTIATE ALZHEIMER’S DISEASE FROM BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA

twenty-six patients with MCI, 97 patients with AD, and 91 healthy older adults were recruited. All participants consented to examination with the MMSE-2, the MMSE, and other detailed neuropsychological assessments. Discriminant analysis of each test was used to evaluate and compare their correct classifications and sensitivity and specificity of each test was compared using receiver operating characteristic (ROC) analysis. Results: The result of discriminant validity of MMSE-2 showed that 71.1% of cases correctly identified in a discriminant analysis of patients with MCI (68.6%), patients with AD (78.4%), and healthy older adults (72.5%). The result of discriminant validity of K-MMSE showed that 67.9% of cases correctly identified in a discriminant analysis of patients with MCI (83.6%), patients with AD (68.0%), and healthy older adults (28.6%). Moreover, the AUC of the MMSE2:BV (0.708), the MMSE-2:SV (0.720), and the MMSE-2:EV (0.728) were larger than the AUC of the K-MMSE (0.703) when comparing with healthy older adults and patients with MCI. However, the AUC of the K-MMSE (0.936) was lager than the MMSE2:BV (0.930), the MMSE-2:SV (0.925), and the MMSE-2:EV (0.921) when comparing with patients with MCI and AD. Conclusions:TheMMSE-2 is more useful cognitive screening instrument for assessing cognitive impairment in a Korean population than the K-MMSE. Especially, theMMSE-2:SVand theMMSE-2:EVare more sensitive to discriminate cognitive dysfunction between healthy normal aging and patients with MCI, but when comparing between patients with MCI and AD, the MMSE-2:BV and the KMMSE are more sensitive to discriminate cognitive dysfunction.

THE STICK DESIGN TEST (SDT): CAN A VISUOCONSTRUCTION TEST HELP DISCRIMINATE HEALTHY CONTROLS (HC), MILD COGNITIVE IMPAIRMENT (MCI) AND ALZHEIMER’S DISEASE (AD)?

Background:Previous studies have characterized pathways linking frontal control systems with temporal regions involved in semantic memory storage that are critically involved in retrieval under effortful conditions. Recent findings also suggest that disruption within frontotemporal pathways are present in preclinical AD and may predict conversion to prodromal/clinical AD. Cognitive tasks placing high demands on controlled semantic retrieval may therefore be particularly sensitive markers of AD pathology in presymptomatic individuals. Methods: Cognitively normal older adults (mean age: 64.3 years) with a family history of AD and subjective memory complaints performed a semantic control task in which participants were asked to determine which word from a set of possible targets was most related to a cue word. Retrieval demands were manipulated by varying the associative strength (Strong or Weak) between cue and correct target, and semantic load was manipulated by varying the number (2 or 4) of potential targets. Two summary scores were derived from participants’ response times across conditions: 1) Controlled Retrieval (Weak 2 vs. Strong 2) and 2) Semantic Load (Strong 4 vs. Strong 2). All participants underwent Florbetapir PET beta-amyloid (Ab) imaging at time of cognitive testing and 27 months prior to testing. Results:Using an SUVr threshold of 1.1 in the anterior cingulate cortex, participants were classified as either Ab+ (n1⁄415) or Ab(n1⁄423), and the two groups did not differ for age or education. The Ab+ group performed significantly worse on Controlled Retrieval despite comparable performance on Semantic Load across groups. Twenty participants had increased SUVr levels (D+) from their scan 27 months earlier, whereas 18 did not. A two-way ANOVA revealed a significant interaction between change status and summary score, with the D+ group performing worse on Controlled Retrieval despite comparable performance on Semantic Load across groups. Conclusions: Results suggest that tests of controlled semantic retrieval dependent on the integrity of frontotemporal pathways are sensitive both to current Ab status and to changes in Ab load in preclinical AD. Impaired controlled retrieval may reflect subtle disruptions of frontotemporal pathways in preclinical AD, and may serve as a potential cognitive stress test for the detection of subtle change in presymptomatic AD.

DISEASE STAGING IN FRONTOTEMPORAL DEMENTIA AND ALZHEIMER'S DISEASE: THE CONTRIBUTION OF THE FRONTOTEMPORAL DEMENTIA RATING SCALE (FTD-FRS) IN A 12-MONTH FOLLOW-UP STUDY

811⁄49.407, p1⁄40.0002, R1⁄4.188, b1⁄47.897) but not the lPRC, ERC, or PHC (all p-values <.05). Conclusions:Verbal semantic memory tests are commonly used tools in AD diagnosis. We found that the fluency performance for living, but not nonliving, things differentiated NCs from very early AD patients. Further, we showed that only mean cortical thickness of the mPRC predicted living thing fluency performance. These results are in line with the findings of Kivisaari et al. (2012) showing that only mPRC thickness significantly predicted picture naming performance for living relative to nonliving things. Fluency tasks with living thing categories may provide an early marker of incipient AD. Severe Baseline 48,39 46,43 33,33 Follow up 45,16 50,00 33,33 Very Severe Baseline 16,13 3,57 8,33 Follow up 12,90 3,57 16,67 P2-301 DISEASE STAGING IN

Prevalence study of cognitive impairment no dementia (CIND) and dementia in tremembé, brazil

am in at io n : M o C A 6 M o n tr ea l C o g n it iv e A ss es sm en t Karolina G. Cesar, Sonia M.D. Brucki, Leonel T. Takada, Luiz Fernando C. Nascimento, Camila M.S. Gomes, Milena C.S. Almeida, Maira O. Oliveira, Fabio H.G. Porto, Mirna L.H. Senaha, Valeria S. Bahia, Thais Bento Lima Silva, Jessica N. Ianof, Mario A. Cecchini, Luciana Cassimiro, Marcia R. Gonçalves, Jerusa Smid, Claudia S. Porto, Maria Teresa Carthery-Goulart, Mônica Sanches Yassuda, Leticia L. Mansur, Ricardo Nitrini, Sr,, University of S~ao Paulo, S~ao Paulo, Brazil; University of Taubat e, Taubat e, Brazil; Universidade Federal do ABC, S~ao Bernardo do Campo, Brazil. Contact e-mail: karolgcesar@gmail.com

Performance of the Visual Analogue Scale of Happiness and of the Cornell Scale for Depression in Dementia in the Tremembé Epidemiological Study, Brazil

Depression is a major growing public health problem. Many population studies have found a significant relationship between depression and the presence of cognitive disorders. Objective To establish the correlation between the Visual Analogue Scale of Happiness and the Cornell Scale for Depression in Dementia in the population aged 60 years or over in the city of Tremembé, state of São Paulo, Brazil. Methods An epidemiological survey involving home visits was carried out in the city of Tremembé. The sample was randomly selected by drawing 20% of the population aged 60 years or older from each of the citys census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, and application of both the Cornell Scale and the Analogue Scale of Happiness for psychiatric symptoms. The presence of depressive symptoms was defined as scores greater than or equal to 8 points on the Cornell Scale. Results A total of 623 subjects were evaluated and of these 251 (40.3%) had clinically significant depressive symptoms on the Cornell Scale, with a significant association with female gender (p<0.001) and with lower education (p=0.012). One hundred and thirty-six participants (21.8%) chose the unhappiness faces, with a significant association with age (p<0.001), female gender (p=0.020) and low socioeconomic status (p=0.012). Although there was a statistically significant association on the correlation test, the correlation was not high (rho=0.47). Conclusion The prevalence of depressive symptoms was high in this sample and the Visual Analogue Scale of Happiness and Cornell Scale for Depression in Dementia should not be used as similar alternatives for evaluating the presence of depressive symptoms, at least in populations with low educational level.