Paulo Roberto de Brito-Marques

The role of education in mini-mental state examination: a study in Northeast Brazil

BACKGROUND There is evidence that schooling can influence performance in cognitive assessment tests. In developing countries, formal education is limited for most people. The use of tests such as Mini-Mental State Examination (MMSE), could have an adverse effect on the evaluation of illiterate and low education individuals. OBJECTIVE To propose a new version of MMSE as a screening test to assess Illiterate and low education people. METHOD A study was carried out enrolling 232 individuals, aged 60 or more of low and middle socio-economic classes. Three groups were studied: Illiterate;1-4 schooling years; 5-8 schooling years. The new version (MMSEmo) consisted of modifications in copy and calculation items of the adapted MMSE (MMSEad) to Portuguese language. The maximum possible score was the same in the two versions: total, 30; copy, 1 and calculation, 5. RESULTS In the total test score ANOVA detected main effects for education and test, as well as an interaction between these factors: higher schooling individuals performed better than lower schooling ones in both test versions; scores in MMSE-mo were higher than in MMSE-ad in every schooling group. CONCLUSION Higher schooling levels improve the performance in both test versions, the copy and calculation items contributing to this improvement. This might depend on cultural factors. The use of MMSE-mo in illiterate and low school individuals could prevent false positive and false negative cognitive evaluations.

Influence of age and scholing on the performance in a modified Mini-Mental State Examination version: a study in Brazil Northeast

UNLABELLED Performance in cognitive tests can be influenced by age and education level. In developing countries, formal education is limited for most people. Application of the Mini-Mental State Examination (MMSE) test, in its original version could have an adverse effect on the evaluation of low educated and elderly individuals. OBJECTIVE To assess the cognitive performance of low and middle educated old people in a modified version of the adapted to portuguese language MMSE. METHOD A study was carried out enrolling 253 individuals, aged 60 to 90 years included in different schooling levels. Four educational groups were studied: illiterate; 1-4 schooling years; 5-8 schooling years and over 8 schooling years. Besides, the sample was also studied according to six classes: 60-65, 66-70, 71-75, 76-80, 81-85 and 86-90 years. The modified version (mo-MMSE) included modifications in copy and calculation items from the adapted MMSE (ad-MMSE) to Portuguese language. The maximum possible score was the same in the two versions: total, 30; copy, 1 and calculation, 5. RESULTS mo-MMSE scores were significantly higher than ad-MMSE for every age classes. A negative correlation was observed between age and scores in individuals of 1-4 and in individuals over eight schooling years, both in ad-MMSE and mo-MMSE. However, there was not a significant correlation between age and scores in illiterate group and in individuals of 5-8 schooling years. CONCLUSION The modification of copy and calculation items of ad-MMSE, are responsible by the best performance in mo-MMSE. Cultural background could have influenced this result. Individuals with more than eight years of formal instruction are protected against a reduction of their capacity to solve cognitive tests. However, low instructed individuals have not this capacity and so they present signals of intellectual aging before they become elderly people.

Classic Pick's disease type with ubiquitin-positive and tau-negative inclusions: case report.

We report on a patient presenting Picks disease similar to the one reported by Pick in 1892, with ubiquitin-positive and tau-negative inclusions. His diagnosis was made on the basis of clinical (language disturbance and behavioural disorders), neuropsychological (progressive aphasia of the expression type and late mutism), neuroimaging with magnetic resonance (bilateral frontal and temporal lobes atrophy) and brain single photon emission computed tomography (frontal and temporal lobes hypoperfusion) studies. Macroscopic examination showed atrophy on the frontal and temporal lobes. The left hippocampus displayed a major circumscribed atrophy. The diagnostic confirmation was made by the neuropathological findings of the autopsy that showed neuronal loss with gliosis of the adjacent white matter and apearance of status spongiosus in the middle frontal and especially in the upper temporal lobes. There were also neuronal swelling (ballooned cell) and argyrophilic inclusions (Picks bodies) in the left and right hippocampi. Anti-ubiquitin reaction tested positive and anti-tau tested negative.

Amyotrophic lateral sclerosis with dementia: case report

A patient is described in whom a profound and rapidly progressive dementia occurred in association with clinical features of amyotrophic lateral sclerosis. A magnetic resonance imaging showed signs of frontal and especially left temporal atrophy. The pattern of dementia indicated impaired frontotemporal lobe functions, evidenced by reduced tracer uptake in the frontotemporal lobes on brain single photon emission computed tomography. Neuropathological examination in this patient revealed mild frontotemporal atrophy with spongiform changes and neuronal loss affecting mainly layers II and III of the frontotemporal cortices. There was atrophy of the hypoglossal nuclei. The spinal cord changes were consistent with motor neuron disease. The patient showed an irreversible and progressive course. A review of the relevant literature was made.

Frontoparietal cortical atrophy with gliosis in the gray matter of cerebral cortex: case report

The case of a patient who suffered from progressive amnesia, depressive humor, language and visuospatial disturbances, and hallucination episodies with interference at the daily living activities is reported. She had moderate neuropsychological diffuse deficits at the first examination, especially at the executive and visuo-constructive functions. Her cerebrospinal fluid test presented high total protein. Magnetic resonance image showed slight white matter increase in periventricular, semi-oval center bilateral and left external capsule regions, besides light frontal and parietal lobe atrophy, bilaterally. Brain single photon emission computerized tomography revealed both a bilateral moderate frontal and a severe parietal lobe hypoperfusion, especially on the left side. Macroscopic examination showed cortical atrophy, severe on the frontal, moderate on the parietal and mild on the posterior third temporal lobes, bilaterally. There was a slight atrophy on the neostriatum in the basal ganglia. The histopathological findings of the autopsy showed severe neuronal loss with intensive gemioscytic gliosis and variable degrees of status spongiosus in cortical layer. Hematoxylin-eosin and Bielschowsky staining did not show neuronal swelling (balooned cell), argyrophilic inclusion (Picks bodies), neurofibrillary tangles nor senile plaques. Immunohistochemical staining for anti-ubiquitin, anti-tau, anti-beta-amyloide, and anti-prion protein were tested negative.

Doença de Binswanger: estudo anátomo-clínico de um caso

The authors describe a case of Binswangers disease in a female patient with arterial hypertension followed during 10 years, before and after the demential syndrome. The clinical diagnosis was established through history, clinical and neurological examination, and neuropsychologic evaluation. Computed tomography and particularly magnetic resonance imaging suggested the diagnosis, that was confirmed by the anatomo-pathological study. They discuss behavioral and clinical data, and radiological and histopathologic aspects, comparing them with data found in the literature.The authors describe a case of Binswangers disease in a female patient with arterial hypertension followed during 10 years, before and after the demential syndrome. The clinical diagnosis was established through history, clinical and neurological examination, and neuropsychologic evaluation. Computed tomography and particularly magnetic resonance imaging suggested the diagnosis, that was confirmed by the anatomo-pathological study. They discuss behavioral and clinical data, and radiological and histopathologic aspects, comparing them with data found in the literature.

Clinicopathologic analysis of progressive non-fluent aphasia and corticobasal degeneration. Case report and review

Objective To investigate progressive non-fluent aphasia and histopathologically-proven corticobasal degeneration. Methods We evaluated symptoms, signs, neuropsychological deficits, and radiology data longitudinally, in a patient with autopsy-proven corticobasal degeneration and correlated these observations directly to the neuroanatomic distribution of the disease. Results At presentation, a specific pattern of cognitive impairment was evident with an extreme extrapyramidal motor abnormality. Follow-up examination revealed persistent impairment of praxis and executive functioning, progressive worsening of language performance, and moderately preserved memory. The motor disorder manifested and worsened as the condition progressed. Many of the residual nerve cells were ballooned and achromatic with eccentric nuclei. Tau-immunoreactive pathology was significantly more prominent in neurons in the frontal and parietal cortices and dentate nuclei than in temporal neocortex, hippocampi and brainstem. Conclusion The clinical diagnosis of progressive non-fluent aphasia secondary to corticobasal degeneration hinged on a specific pattern of impaired cognition as well as an extrapyramidal motor disorder, reflecting the neuroanatomic distribution of the disease in frontal and anterior temporal cortices and the dentate nuclei.

Adrenoleucodistrofia estudo clinico e histopatológico de um caso associado ao uso de abortivos no segundo mês de gestação

The authors report a case of adrenoleukodystrophy in a 8 years old male patient whose mother has taken several abortive drugs during the first three months of pregnancy. The disease was progressive starting with auditory, visual and mental disturbances, followed by neurovegetatives and motor changes with convulsion and fetal position. At the final stage the patient became blind, deaf, quadriplegic and dementiated. Death resulted from lung infection. The diagnosis was confirmed by the CSF, electrophysiological, radidlogical and necropsy findings. Necropsy changes in the brain and adrenal cortex are detailed.Os autores descrevem um caso de adrenoleucodistrofia (ALD) em um paciente do sexo masculino, com 8 anos de idade, cuja genitora no primeiro trimestre da gravidez tomou miscelânea de drogas com fins abortivos. O curso da doenca foi progressivo inician-do-se por disturbios auditivos, visuais e mentais, seguindo-se alteracoes neurovegetativas, motoras, convulsivas e postura fetal. No estagio final o paciente tornou-se amaurotico, surdo, quadriplegieo e demente. O obito ocorreu por infeccao respiratoria. O diagnostico foi confirmado pelo estudos do LCR, eletrofisiologicos, radiologicos e pelos achados de necropsia (cerebro e glândulas adrenais).

Heterogeneidade cognitiva na doença de Alzheimer

The authors describe and discuss neuropsichological aspects related to the functional organization of the brain connected to cognition in 81 Alzheimers disease patients in the Laboratoire Theophile-Alajouanine du Centre de Recherche du Centre hospitalier Cote-des-Neiges in the University of Montreal. They confront the clinical of homogeneity against the heterogeneity within functional organization of the brain. The criteria used for diagnosis were those of the NINCDS-ADRDA. All of the patients were in the begining of the evolution, in stages 3 and 4 of Reiberg (Functional Assessement Staging, FAST). The conclusion shows that there are two cognitive profiles: a non-recurrent profile, made up by the majority of the patients, and the heterogeneity depends on the genetic background of each individual; a recurrent profile, made up by a small group of patients that show changes in the heterogeneity of clinical, nosological, pathological and normal aging forms.

Hérnias discais dorso-lumbares e síndrome da cauda equina como complicações da doença de Scheuermann: relato de caso

The author reports the case of a patient with spinal cord compression by a thoracic herniated disc without paraplegia as well as a cauda equina syndrome due to spondylotic and discai lesions, with small protrusions of the L4-L5 and L5-S1 discs associated with Scheuermann disease. There was complete recovery in six months with clinical treatment. The radiological evaluation using standard radiography, myelography, computed tomography, magnetic resonance imaging of the vertebral column, and electromyographic evaluation indicate a precise correlation between clinical picture and the distribution and course of lumbar spinal cord degenerations. Furthermore, a strong correlation was also found with hernias, roots and the bony sequalae of spinal cord dystrophy found in Scheuermann disease.