Rogério Gomes Beato

Brazilian version of the Frontal Assessment Battery (FAB): Preliminary data on administration to healthy elderly

The Frontal Assessment Battery (FAB) has been proposed as a diagnostic tool for patients with frontal lobe syndrome. Objectives To present the Brazilian version of the FAB and to show preliminary data on the performance of healthy elderly in the battery, correlating with age, education and scores in the Mini- Mental State Examination (MMSE). Methods Forty-eight healthy elderly individuals (34 female/14 male) were evaluated, aged 69.3±6.1 years and with educational level=8.0±5.6 years. The subjects were submitted to the MMSE, the Cornell depression scale and the FAB, in which scores were determined for each item and for the total scale. All individuals had to attain above education adjusted cut-off scores in the MMSE and =7 points on the Cornell depression scale. Correlations were calculated between FAB total scores and age, educational level and MMSE scores, as well as between FAB items and education. Results The mean score ±SD in the FAB was 13.0±2.3(7 to 18). Total FAB scores correlated significantly with education (r=0.37; p=0.01) and MMSE scores (r=0.46; p=0.001). No correlation emerged between FAB scores and age. The mean score ±SD of the MMSE was 27.4 ± 1.8. Considering the six FAB items separately, two of them (similarities and conflicting instructions) correlated significantly with educational. Conclusions In this group of healthy elderly, the Brazilian version of the FAB proved to be influenced by education, but not age.

Neurobiology of apathy in Alzheimer's disease

Apathy is considered the most frequent neuropsychiatric disturbance in dementia and its outcome is generally deleterious. Apathy can be related to a dysfunction of the anatomical-system that supports the generation of voluntary actions, namely the prefrontal cortex and/or the prefrontal-subcortical circuits. In Alzheimers disease, pathological and neuroimaging data indicate that apathy is likely due to a dysfunction of the medial prefrontal cortex. Accordingly, in this review article, we propose a pathophysiological model to explain apathetic behavior in Alzheimers disease, combining data from neuroimaging, neuropathology and experimental research on the role of orbito-frontal cortex, anterior cingulate cortex, basal ganglia and dopamine in decision-making neurobiology.

The Pietà study: epidemiological investigation on successful brain aging in Caeté (MG), Brazil. Methods and baseline cohort characteristics

OBJECTIVES To present the methods and baseline characteristics of the Pietà study, a population-based survey investigating successful brain aging in the oldest-old. METHOD The study was conducted in Caeté (MG), Brazil. In 2007, 1,251 individuals aged 75+ years were living in the city and were invited to participate. Participants responded to a general health questionnaire and were submitted to clinical, neurological, cognitive, psychiatric and functional evaluations. A subgroup was submitted to neuropsychological testing, blood tests and magnetic resonance of the skull. Individuals were classified as having cognitive impairment-no dementia, dementia, parkinsonism, psychiatric disorders or successful brain aging. RESULTS We evaluated 639 individuals (51.1% of the target population; 64% women), aged 81.4±5.2 years and with 2.7±2.6 years of schooling. Almost 30% of the elderly were illiterates and 82.1% belonged to middle/middle-low socioeconomic levels. Almost 50% were widows, but only 14.3% were living alone. CONCLUSION The Pietà cohort is representative of the oldest-old Brazilian population. We believe the results of the study may contribute to increase our knowledge about healthy and pathological brain aging in the oldest-old.

Frontal assessment battery in a Brazilian sample of healthy controls: normative data

OBJECTIVE To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE). METHODS Two hundred and seventy-five healthy individuals with mean age of 66.4 ± 10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level. RESULTS Mean total FAB scores according to the educational level were 10.9 ± 2.3, for one to three years; 12.8 ± 2.7, for four to seven years; 13.8 ± 2.2, for eight to 11 years; and 15.3 ± 2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p<0.0001) and MMSE scores (r=0.39; p<0.0001). No correlation emerged between FAB scores, age, and gender. CONCLUSION In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.

Dementia caregiver burden in a Brazilian sample: Association to neuropsychiatric symptoms

Taking care of elderly demented individuals, especially when they present behavioral changes, can be very exhaustive for both family and caregivers. Generally, this leads to changes in the family lifestyle, and the caregiver must deal with a range of problems. Information on this topic in Latin America, including Brazil, remains scarce. Objective To investigate the relationship between the presence of neuropsychiatric symptoms and the level of caregiver burden in a group of Brazilian elderly with dementia. Methods The Brazilian versions of the Zarit Caregiver Burden Interview (ZBI) and of the Neuropsychiatric Inventory (NPI) were administered to a total of 83 family-caregivers of patients with dementia followed at a university-affiliated outpatient clinic. Pearson’s correlations were calculated to measure the level of association between the scores on both instruments. Results Among the caregivers, 83.1% were women, and had a mean age of 55.6±12.8 years. The ZBI scores ranged from 3 to 79 (mean=31.4). Patients’ NPI scores ranged from 0 to 102 (mean=26.9), consistent with a significant degree of behavioral manifestations in most patients. A significant positive correlation was found between ZBI and NPI scores (r=0.402; p=0.000). Conclusion The presence and severity of behavioral manifestations assessed by the NPI were associated with a high level of caregiver burden in this sample of Brazilian elderly with dementia.

Executive functioning in adult patients with Sydenham's chorea.

Sydenhams chorea (SC) is characterized by a combination of motor and behavioral findings. Cognitive function has been scarcely studied in this condition. The aim of this study is to investigate executive functions in adult patients with SC. We performed neuropsychological tests to evaluate executive functions in controls and adult patients with persistent and in remission SC. Patients with SC have impairment in Tower of London task, reduced verbal fluency, and lower scores in the Stroop test. A subset of adult patients with SC present with executive dysfunction, even when chorea is in remission.

Subjective memory complaints and cognitive performance in a sample of healthy elderly

Memory loss is a major complaint among the elderly population. However, the clinical significance of this symptom is variable and also controversial in the scientific literature. Objective To compare the cognitive performance of two groups of healthy elderly, one group with and the other without, subjective memory complaints (SMC). Methods Sixty cognitively intact elderly individuals (39 females and 21 males), aged 69.9±6.3 years and with educational level of 8.5±5.5 years, were included in the study. Participants were submitted to the Mini-Mental State Examination and to the Cornell depression scale in order to rule out global cognitive impairment and depression, respectively. Moreover, they answered the MAC-Q, a questionnaire devised to evaluate subjective impression of memory function. Subsequently, they were submitted to the digit span forward and backward, the Brief Cognitive Screening Battery, and to the Frontal Assessment Battery. Results Twenty-seven individuals had MAC-Q scores <25 and thus were classified as not having SMC, while 33 had MAC-Q scores ≥25 and were considered to have SMC. No differences for age, gender, education and MMSE scores were found between the two groups. The comparison between the performance of the groups of complainers and non-complainers on the different cognitive tests yielded no significant difference, although there was a trend toward non-complainers performing better on incidental memory. Conclusions The presence of SMC was not associated to objective memory impairment or to other cognitive deficits in this group of elderly individuals.

Cognitive, functional and behavioral assessment. Alzheimer’s disease

A review of the evidence on cognitive, functional and behavioral assessment for the diagnosis of dementia due to Alzheimer’s disease (AD) is presented with revision and broadening of the recommendations on the use of tests and batteries in Brazil for the diagnosis of dementia due to AD. A systematic review of the literature (MEDLINE, LILACS and SCIELO database) was carried out by a panel of experts. Studies on the validation and/or adaptation of tests, scales and batteries for the Brazilian population were analyzed and classified according to level of evidence. There were sufficient data to recommend the IQCODE, DAFS-R, DAD, ADL-Q and Bayer scale for the evaluation of instrumental activities of daily living, and the Katz scale for the assessment of basic activities of daily living. For the evaluation of neuropsychiatric symptoms, the Neuropsychiatric Inventory (NPI) and the CAMDEX were found to be useful, as was the Cornell scale for depression in dementia. The Mini-Mental State Examination has clinical utility as a screening test, as do the multifunctional batteries (CAMCOG-R, ADAS-COG, CERAD and MDRS) for brief evaluations of several cognitive domains. There was sufficient evidence to recommend the CDR scale for clinical and severity assessment of dementia. Tests for Brazilian Portuguese are recommended by cognitive domain based on available data.

Brain SPECT in Sydenham's chorea in remission

Sydenhams chorea, a major manifestation of rheumatic fever, is characterized by chorea, behavioral changes, and cognitive dysfunction. Perfusion changes in the basal ganglia are the most frequent imaging findings observed in patients with Sydenhams chorea.

Takayasu's Arteritis in a Patient with Sydenham's Chorea: is There an Association?

Background Takayasu’s arteritis (TA) has been associated with many conditions. Herein described is a case of TA in a patient with rheumatic fever complicated with Sydenham’s chorea. Case Report A 17-year-old female presented at age 6 with rheumatic fever followed by chorea a month later. At the age of 16, she developed a blood pressure discrepancy between the arms and faint pulses. Computed tomography angiography revealed diffuse aortic involvement and narrowing of the arteries. Discussion The presence of rheumatic fever and Sydenham’s chorea in TA raises the possibility of an immunological basis for the pathogenesis of the disease.