Rodrigo Rizek Schultz

Versão brasileira da Escala Cornell de depressão em demência (Cornell depression scale in dementia)

ABsTRACT - Objective: Translating and adapting the Cornell scale for depression in dementia to the Por-tuguese language and verifying the interrater and test-retest reliability of the translated and adapted version. Method: The Cornell scale was translated into Portuguese and back translated into english. Di-vergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers. Results: The Cornell scale presented good interrater (Kappa=0,77; p<0,001) and test-retest reliability (Kappa=0,76; p<0,001). The final version was easy to administer and well understood by the caregivers. Conclusion: The Brazilian version of the Cornell scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evalua-tion and follow-up of depressed patients with dementia in our population and may also be used in multi-centric studies with Brazilian population.Key woRDs: depression, scales, adaptation, reproducibility of results.OBJECTIVE Translating and adapting the Cornell scale for depression in dementia to the Portuguese language and verifying the interrater and test-retest reliability of the translated and adapted version. METHOD The Cornell scale was translated into Portuguese and back translated into English. Divergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers. RESULTS The Cornell Scale presented good interrater (Kappa=0,77; p<0,001) and test-retest reliability (Kappa=0,76; p<0,001). The final version was easy to administer and well understood by the caregivers. CONCLUSION The Brazilian version of the Cornell Scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evaluation and follow-up of depressed patients with dementia in our population and may also be used in multicentric studies with Brazilian population.

Adaptação transcultural da escala de avaliação de incapacidade em demência (Disability Assessment For Dementia - DAD)

The original version of the Disability Assessment for Dementia (DAD) was translated into Portuguese and back translated to English. The divergences of translation were identified and discussed, resulting in a version that was used in a preliminary investigation for cross-cultural adaptation. The final version was administered to 29 patients with mild to moderate probable Alzheimers disease. The correlation coefficients of DAD were 0.929 and 0.932 for the inter-examiner and test-retest evaluations respectively. The reliability indexes were also high (Kappa 0.72 p<0.001 inter-examiners and 0.85 p<0.001 test-retest). The Brazilian version of DAD was easy to administer and had good reliability to assess the functional status of demented patients. It will contribute to the follow-up of these patients in our population. Moreover, it can be used in transcultural studies on functional abilities in dementia.

Nutrition in severe dementia.

An increasing proportion of older adults with Alzheimers disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination

UNLABELLED Cognitive assessment in advanced stages of Alzheimers disease (AD) is limited by the imprecision of most instruments. OBJECTIVE To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. METHOD Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. RESULTS Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001). CONCLUSION The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.

Prevalence of treatable and reversible dementias: A study in a dementia outpatient clinic

Dementia is a syndrome characterized by the development of multiple cognitive deficits and behavioral changes that leads to impairment of functional activities. There are primary degenerative, progressive and irreversible dementias, and other dementias resulting from a progressive but potentially reversible dementia of secondary origin. Objective To assess the prevalence of cases with a diagnosis of potentially reversible dementia at a Behavioral Neurology Outpatient Unit. Methods A retrospective study based on a review of 340 medical records of patients seen from 1999 to 2009 was conducted. All patients received a thorough diagnostic assessment to verify the etiological hypothesis proposed. Results Of the 340 patients seen in the study period, 172 (50.5%) were females and 168 (49.5%) males, 90 patients (26.4%) were under 60 years of age, and 250 (73.6%) were over 60 years of age. Alzheimer’s disease, with 89 cases (26%), followed by vascular dementia with 39 cases (11.47%), were the leading etiological diagnoses. A total of 193 patients had dementia and 37 of these (19.17%) were found to have potentially reversible dementias, distributed as follows: head injury: 15 patients; alcohol-related dementias: 11 patients; meningoencephalitis: 2 patients; hypothyroidism: 2 patients; neurosyphilis: 2 patients; normal pressure hydrocephalus: 2 patients; AIDS: 1 patient; Korsakoff’s syndrome: 1 patient, and Post-anoxic dementia: 1 patient. Conclusions A significant number of patients were found to have potentially reversible dementias (19.17%). These data show an urgent need for more extensive diagnostic investigation, and indicate the possibility of reversing some dementias, especially cases detected early.

Is there correlation between cognition and functionality in severe dementia? The value of a performance-based ecological assessment for Alzheimer’s disease

OBJECTIVE Besides significant cognitive decline, patients in later stages of Alzheimers disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale. METHOD A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL). RESULTS Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (ρ<0.001), according to FAST subdivisions. CONCLUSION Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.

Correlation and adaptation among functional and cognitive instruments for staging and monitoring Alzheimer?s disease in advanced stages

Contexto : Apesar de a doenca de Alzheimer (DA) ser a forma de demencia mais prevalente, pouco se sabe sobre aspectos cognitivos e funcionais em suas fases avancadas. Objetivo: Foi objetivo deste trabalho a adaptacao e correlacao entre instrumentos especificos para a DA em fases avancadas no que diz respeito a sua cognicao objetivamente ponderada, alem da comparacao entre aspectos da capacidade funcional estatica e ecologica. Metodos : Noventa e cinco pacientes (33 homens e 62 mulheres) com DA moderada, moderadamente grave e grave foram submetidos as escalas CDR (Clinical for Dementia Rating), FAST (Functional Assessment Scale), MEEM (Mini-Mental State Examination), MMSEsev (Severe Mini-Mental State Examination), SIB-8 (Severe Impairment Battery) e TSI (Test for Severe Impairment) para comparacao com uma escala ecologica padrao-ouro, a PADL (Performance Activities of Daily Living). Resultados : As evidencias encontradas sugerem uma correlacao linear crescente e estatisticamente significativa entre a escala funcional ecologica e os testes cognitivos conforme a estratificacao das fases da DA uma vez ponderadas pela escala funcional estatica. Conclusao : Os resultados indicam que, para pacientes em fases avancadas da DA, testes cognitivos apropriados e escalas funcionais baseadas no desempenho sao uteis na avaliacao mais acurada do estadiamento da doenca e acompanhamento de sua progressao.

Treatment of vascular dementia Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Scientific Department of Cognitive Neurology and Aging of ABN had a consensus meeting to write recommendations on treatment of vascular dementia, there was no previous issue. This disease has numerous particularities and can be considered a preventable dementia. Prevention treatment is primary care of vascular risk factors or a secondary prevention of factors that could cause recurrence of ischemic or hemorrhagic brain modifications. In these guidelines we suggested only symptomatic treatment, pharmacologic or non-pharmacologic. We have reviewed current publications on MEDLINE (PubMed), LILACS e Cochrane Library databases. Recommendations are concern to the following factors and their prevention evidences, association, or treatment of vascular dementia: physical activity, tobacco use, diet and food supplements, arterial hypertension, diabetes mellitus, obesity, statins, cardiac failure, atrial fibrillation, antithrombotics, sleep apnea, carotid revascularization, symptomatic pharmacological treatment.

Balance impairment does not necessarily coexist with gait apraxia in mild and moderate Alzheimer’s disease

OBJECTIVES To assess correlations among gait apraxia, balance impairment and cognitive performance in mild (AD1, n = 30) and moderate (AD2, n = 30) AD. METHOD The following evaluations were undertaken: gait apraxia (Assessment Walking Skills); balance performance (Berg Balance Scale); Clinical Dementia Rating and Mini-mental State Examination (MMSE). RESULTS While disregarding AD subgroups, Berg Balance Scale and the MMSE correlated significantly with Assessment Walking Skills and 23% of all subjects scored below its cut-off. After stratification, Berg Balance Scale correlated significantly with Assessment Walking Skills in both AD subgroups, and with the MMSE only in AD1. CONCLUSIONS Balance impairment does not necessarily coexist with gait apraxia. Gait apraxia is more prevalent in moderate AD when compared with mild AD.

Comprometimento do equilíbrio e apraxia da marcha não necessariamente coexistem na doença de Alzheimer leve e moderada

Apraxia da marcha e desequilibrio sao condicoes subinvestigadas na doenca de Alzheimer (DA) leve e moderada. Objetivo Verificar a correlacao da apraxia da marcha com desequilibrio e cognicao em 30 idosos com DA leve (DA1) e 30 idosos com DA moderada (DA2). Metodo Foram feitas as seguintes avaliacoes: apraxia da marcha (Assessment Walking Skills); equilibrio (Berg Balance Scale); Clinical Dementia Rating e Mini-exame do estado mental – MEEM. Resultados Desconsiderando-se os grupos, Berg Balance Scale e MEEM correlacionaram-se significativamente com a Assessment Walking Skills, enquanto 23% dos participantes pontuaram abaixo da note de corte da mesma. Considerando-se os grupos, Berg Balance Scale correlacionou-se significativamente com a Assessment Walking Skills em ambos os grupos, embora o MEEM o tenha feito apenas em DA1. Conclusoes Desequilibrio e apraxia da marcha nao necessariamente coexistem com apraxia da marcha. Prevalencia de apraxia da marcha foi maior na DA moderada do que na DA leve.