Tíbor Rilho Perroco

Post-Mortem diagnosis of dementia by informant interview

The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. Objectives To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. Methods A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists’ panel consensus, in each group, determined the final diagnosis of the case, blind to other center’s diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. Results Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. Conclusions The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.

Performance of Brazilian long and short IQCODE on the screening of dementia in elderly people with low education.

BACKGROUND Dementia screening in elderly people with low education can be difficult to implement. For these subjects, informant reports using the long (L) (26 items) and short (C) (16 items) versions of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) can be useful. The objective of the present study was to investigate the performance of Brazilian versions of the IQCODE L, S and a new short version (SBr) (15 items) in comparison with the Mini-mental State Examination (MMSE) for dementia screening in elderly people with low education. METHODS Thirty-four patients with mild to moderate dementia, diagnosed according to ICD-10 criteria, and 57 controls were evaluated and divided into three groups based on their socioeconomic status and level of education. Patients were evaluated using the MMSE and the informants were interviewed using the IQCODE by interviewers blind to the clinical diagnosis. RESULTS Education was correlated with MMSE results (r = 0.280, p = 0.031), but not with the versions of the IQCODE. The performance of the instruments, evaluated by the ROC curves, was very similar, with good internal consistency (Cronbachs alpha = 0.97). MMSE correctly classified 85.7% of the subjects while the three IQCODE versions (L, S and SBr) correctly classified 91.2% of the subjects. CONCLUSIONS The long, short and the new short Brazilian IQCODE versions can be useful as a screening tool for mild and moderate patients with dementia in Brazil. The IQCODE is not biased by schooling, and it seems to be an adequate instrument for samples with low levels of education.

Short IQCODE as a screening tool for MCI and dementia Preliminary results

Reaching a diagnosis may be difficult in the initial stages of dementia, especially in low educated individuals, when informant reports may be useful. Objectives To compare the sensitivity and specificity of the IQCODE against cognitive tests applied in clinical practice and to evaluate the possible cut-off points in Brazil. Methods Individuals without dementia (CDR=0; N=5), with Mild Cognitive Impairment (MCI) (CDR=0.5; N=15) and demented (CDR≥1; N=29) were evaluated using the Short IQCODE, a 16-item questionnaire applied to an informant, and on standard cognitive and functional scales. Diagnosis was reached by a consensus team with expertise in dementia, according to DSM-IV criteria, which was blind to the IQCODE results. Results IQCODE scores were positively correlated to the CDR (r=0.65, p<0.001) and negatively correlated with years of schooling (r= –0.33, p=0.021). IQCODE scores were positively correlated with CDR controlled by age and education (r=0.61, p<0.001). Linear regression showed that age was associated with the IQCODE (p=0.016) whereas education was not associated (p=0.078). IQCODE means according to the CDR classification were: CDR 0–3.37; CDR 0.5–3.75; CDR 1–4.32; CDR 2–4.61; CDR 3–5.00. The area under the ROC curve for dementia vs. controls was 0.869 (p<0.001), MCI vs. controls, 0.821 (p<0.001); and according to the groups classified by the CDR was: CDR 0.5 vs. CDR 1=0.649 (p=0.089), CDR 1 vs. CDR 2=0.779 (p=0.009), and CDR 2 vs. CDR 3=0.979 (p=0.023). Conclusions These preliminary findings suggest that the short IQCODE can be used for the screening of MCI and dementia in Brazil.

Dementia post-radiotherapy: improvement with acetylcholinesterase inhibitor A case report

Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment.

Analysis of the posterior cingulate cortex with [ 18 F]FDG-PET and Naa/mI in mild cognitive impairment and Alzheimer's disease: Correlations and differences between the two methods

Reduction of regional brain glucose metabolism (rBGM) measured by [18F]FDG-PET in the posterior cingulate cortex (PCC) has been associated with a higher conversion rate from mild cognitive impairment (MCI) to Alzheimers disease (AD). Magnetic Resonance Spectroscopy (MRS) is a potential biomarker that has disclosed Naa/mI reductions within the PCC in both MCI and AD. Studies investigating the relationships between the two modalities are scarce. Objective To evaluate differences and possible correlations between the findings of rBGM and NAA/mI in the PCC of individuals with AD, MCI and of cognitively normal volunteers. Methods Patients diagnosed with AD (N=32) or MCI (N=27) and cognitively normal older adults (CG, N=28), were submitted to [18F]FDG-PET and MRS to analyze the PCC. The two methods were compared and possible correlations between the modalities were investigated. Results The AD group exhibited rBGM reduction in the PCC when compared to the CG but not in the MCI group. MRS revealed lower NAA/mI values in the AD group compared to the CG but not in the MCI group. A positive correlation between rBGM and NAA/mI in the PCC was found. NAA/mI reduction in the PCC differentiated AD patients from control subjects with an area under the ROC curve of 0.70, while [18F]FDG-PET yielded a value of 0.93. Conclusion rBGM and Naa/mI in the PCC were positively correlated in patients with MCI and AD. [18F]FDG-PET had greater accuracy than MRS for discriminating AD patients from controls.

Correlation of brain structural and functional changes in amnestic mild cognitive impairment and mild Alzheimer's disease: A voxel-by-voxel analysis in a single cohort of patients in Brazil

Background: Although cognitive abilities in human are universal basic brain function, it is well known that Asians and Westerners have some differences in cognitive processing; that the Asian process in a more holistic and integrativeway, whileWesterners domore analytically focused on a central theme. This study tried to compare the cortical thicknesses of Western and Asian MCI subjects, and to correlate those changes in the context of neuropsychological functions. Methods: Subjects: Western MCI subjects were participants of the Alzheimer’s Disease Neuroimaging Initiative (ADNI) study. Korean MCI subjects were a subset of the Clinical Research for Dementia of South Korea (CREDOS) study. Age and education matched set of 40 subjects per each group were selected (CREDOSNormal 40, CREDOS MCI 40, ADNI Normal 40, ADNI MCI 40). Measurements: Imaging process: Using FreeSurfer package, cortical reconstruction and volumetric segmentation were performed. Results: ADNI MCI subjects showed decreased volume and cortical thickness in various areas. 1) Volume: entorhinal, lateral orbitofrontal, temporal cortices including pole, caudal and rostral anterior cingulate, posterior cingulate. 2) Cortical thinning: entorhinal, inferior and superior temporal, posterior cingulate, bank of superior temporal sulcus, precuneus, superior and middle frontal, paracentral, insula, fusiform, and medial orbitofrontal. CREDOS MCI subjects showed reduced volume and thickness in; 1) Volume: superior parietal, pericalcarine, entorhinal, para-hippocampal, and precentral. 2) Cortical thickness: parahippocampal and temporal pole. Normal ADNI and CREDOS elderly showed variable differences in cortical thickness. 1) Thicker in CREDOS: superior parietal, bank of superior temporal sulcus and inferior parietal

P3-039: Performance of the long and short Brazilian versions of the IQCODE as screening for dementia in low-educated elderly

this study to determine the clinimetrical properties (construct validity and reliability) of the NPI Q and NPI D in a group of Mexican demented patients. Methods: We conducted a transversal, analytical and validation essay. We selected 100 dyads, with dementia diagnosis (of any type). The dyads were interviewed with neuropsychological tools (Mini Mental State Examination, Geriatric Depression Scale, Screening Caregiver Burden, Sleep Disorders Inventory NPI Q, NPI D), sociodemographic questionnaire (age, sex, caregiver relationship, work status, scholarship, etc), a thorough record of comorbidities, medications, and an exploration to complete the Mini Nutritional Assessment. NPI Q s total score was correlated with MMSE, GDS, NPI D and SCB; and individual domains were also evaluated (depression, psychotic symptoms, nutrition and sleep). The NPI D s total score was correlated with SCB and NPI Q. Six patients were selected for a test-retest, to evaluate reliability. Spearman s one tailed correlation, intraclass correlation coefficient (ICC) and Cronbach s alpha, were performed for statistical analysis. Results: Eighty-seven dyads were interviewed, general characteristics are shown in Table 1. The NPI-Q had a significant correlation with MMSE of 0,190 (p 0.001), NPI-D of r 0,887 (p 0,001), with GDS of r 0,385 (p 0.0001). The NPI-Q with a testretest of r 0,829 (p 0.021), ICC 0.824 and internal consistency of 0.778, the individual domain results are shown in Table 2. The NPI D had a significant correlation of r 0.555 with the SCB; test-retest r 0.986, ICC 0.857 and 0.779. Conclusions: Our NPI-Q and NPI-D versions are valid in the evaluation of Mexican patients with dementia. Our results are similar to those reported previously, but add the significant evaluation in the individual domains of sleep and oral intake.