Valéria Santoro Bahia

Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease

OBJECTIVES To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimers disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. METHOD The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. RESULTS The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. CONCLUSION The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.

Oxidative state in platelets and erythrocytes in aging and Alzheimer's disease

Several studies have shown involvement of peroxynitrite anion, a potent oxidative agent, in Alzheimers disease (AD) neuropathology. Herein, we assessed in platelets and erythrocytes of AD patients, age-matched and young adults controls: thiobarbituric acid-reactive substances (TBARS) production; superoxide dismutase (SOD), nitric oxide synthase (NOS) and Na,K-ATPase activities; cyclic GMP (cGMP) content, both basal and after sodium nitroprusside (SNP) stimulation. Aging was associated with an increase in TBARS production and NOS activity, a decrease in basal cGMP content and no change in SOD and Na,K-ATPase activities. AD patients, compared to aged controls, have: increase in TBARS production and in NOS, SOD and Na,K-ATPase activities but no alteration in basal cGMP content. SNP increased cGMP platelets production in all groups. In conclusion, we demonstrated in platelets and erythrocytes a disruption in systemic modulation of oxidative stress in aging and with more intensity in AD.

Performance of a Brazilian population on the test of functional health literacy in adults

OBJECTIVE To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS The mean age of the sample was 47.3 years(sd=16.8) and the mean education was 9.7 years(sd=5; range: 1 - 17). A total of 32.4% of the sample showed literacy/numeracy deficits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not significant when the effects of education were held constant (rp=-0.031, p=0.584). A significant association (B=3.877, Beta =0.733; p<0.001) was found between schooling and scores. Age was not a significant predictor in this model (B=-0.035, Beta=-0.22; p=0.584). CONCLUSIONS The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classified as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.OBJETIVO: Analisar os escores de instrumento que avalia habilidade de leitura e compreensao de materiais da area da saude segundo escolaridade e idade. METODOS: Foram avaliados 312 participantes saudaveis de diferentes idades por meio da versao reduzida do instrumento Test of Functional Health Literacy in Adults. O estudo foi realizado entre 2006 e 2007 na cidade de Sao Paulo (SP). O instrumento envolve materiais como frascos de medicamentos e cartoes de agendamento de consultas, avaliando a compreensao de leitura e de conceitos numericos. Os testes de correlacao parcial e de Pearson e um modelo de regressao multipla foram usados para verificar a associacao entre os escores no instrumento, escolaridade e idade. RESULTADOS: As medias de idade e de escolaridade da amostra foram respectivamente 47,3 (dp=16,8 ) e 9,7 (dp=5; de um a 17 anos de estudo). O total de 32,4% da amostra mostraram deficits de alfabetizacao funcional/ uso de conceitos numericos na area de saude, com desempenho inadequado ou limitrofe no instrumento. Entre idosos (65 anos ou mais) esta taxa atingiu 51,6%. Encontrou-se correlacao positiva entre anos de estudo e escores no instrumento (r=0,740; p<0,01) e correlacao negativa entre idade e escores no instrumento (r=-0,259; p<0,01). A correlacao entre escores no instrumento e idade nao foi significante quando os efeitos da escolaridade foram controlados (r=-0,031, p=0,584). Uma associacao significante (B=3,877, Beta=0,733; p<0,001) foi encontrada entre anos de estudo e escores no instrumento. A idade nao foi uma variavel preditiva no modelo (B=-0,035, Beta=-0,22; p=0,584). CONCLUSOES: O instrumento e adequado para avaliar a alfabetizacao funcional em saude na populacao brasileira. O elevado numero de individuos classificados como analfabetos funcionais indica a importância de adocao de medidas especiais para ajudar estes individuos a compreenderem corretamente as orientacoes para cuidados de saude.

Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil

The importance of investigating the etiology for dementia lies in the possibility of treating potentially reversible dementias. The aims of this retrospective study are to determine the prevalence of potentially reversible dementias among 454 outpatients seen at the Cognitive and Behavioral Neurology Unit, Hospital das Clínicas, São Paulo University School of Medicine-Brazil, between the years of 1991 and 2001, and observe their evolution in follow-up. Among the initial 454 patients, 275 fulfilled the DSM-IV criteria for dementia. Alzheimers disease was the most frequent diagnosis (164 cases; 59.6%). Twenty-two cases (8.0%) of potentially reversible dementia were observed, the most frequent diagnoses being neurosyphilis (nine cases) and hydrocephalus (six cases). Full recovery was observed in two patients and partial recovery in 10 patients. Two cases were not treated and eight cases were lost on follow-up. The prevalence found in the present study falls within the range reported in previous studies (0-30%).

Comparison between two tests of delayed recall for the diagnosis of dementia

UNLABELLED Diagnosis of dementia is a challenge in populations with heterogeneous educational background. OBJECTIVE To compare the accuracies of two delayed recall tests for the diagnosis of dementia in a community with high proportion of illiterates. METHOD The delayed recall of a word list from the CERAD battery (DR-CERAD) was compared with the delayed recall of objects presented as line drawings from the Brief Cognitive Screening Battery (DR-BCSB) using ROC curves. Illiterate (23 controls and 17 patients with dementia) and literate individuals (28 controls and 17 patients with dementia) were evaluated in a community-dwelling Brazilian population. RESULTS The DR-BCSB showed higher accuracy than the DR-CERAD in the illiterate (p=0.029), similar accuracy in the literate individuals (p=0.527), and a trend for higher accuracy in the entire population (p=0.084). CONCLUSION the DR-BCSB could be an alternative for the diagnosis of dementia in populations with high proportion of illiterates.

Dementia Pugilistica with clinical features of Alzheimer's disease

A 61-year-old ex-boxer presented with a three-year history of progressive memory decline. During a seven-year follow-up period, there was a continuous cognitive decline, very similar to that usually observed in Alzheimers disease. Parkinsonian, pyramidal or cerebellar signs were conspicuously absent. Neuropathological examination revealed the typical features of dementia pugilistica: cavum septi pellucidi with multiple fenestrations, numerous neurofibrillary tangles in the cerebral isocortex and hippocampus (and rare senile plaques). Immunohistochemistry disclosed a high number of tau protein deposits and scarce beta-amyloid staining. This case shows that dementia pugilistica may present with clinical features practically undistinguishable from Alzheimers disease.

Lack of Association Between the Brain-Derived Neurotrophin Factor (C-270T) Polymorphism and Late-Onset Alzheimer's Disease (LOAD) in Brazilian Patients

After the identification of the apolipoprotein E gene isoform (APOE-ε4) as a risk factor for late-onset Alzheimer’s disease (LOAD), the search for other polymorphisms associated with AD has been undertaken by many groups of investigators around the world. These studies have shown controversial results in many populations. More recently, a single nucleotide polymorphism in the promoter region of the brain-derived neurotrophin factor (BDNF) was found to be a risk factor for AD in two independent population studies. Here we report the analysis of this polymorphism in a group of 188 LOAD Brazilian patients compared to matched normal controls. A strong association between the APOE-ε4 polymorphism and LOAD was observed, but there was no significant association between this BNDF polymorphism and affected patients. The possibility that other polymorphisms or mutations in this gene play a role in the development of AD cannot be ruled out. However, the results of the present study suggest that in opposition to the two reported studies, this polymorphism does not seem to be implicated in LOAD Brazilian patients. It also shows the importance of replication studies in different populations, as susceptibility loci might differ in different ethnic groups; this will have important implications in future treatments with pharmacological agents.

Functional Disability in Alzheimer Disease A Validation Study of the Brazilian Version of the Disability Assessment for Dementia (DAD-Br)

BackgroundThe assessment of activities of daily living (ADL) is important both for the diagnosis and staging of dementia. The objective of this study was to verify the applicability and validity of the Brazilian version of the Disability Assessment for Dementia (DAD-Br). MethodsThe DAD was applied to caregivers of 89 patients with probable Alzheimer disease (AD) and to 40 elderly individuals without cognitive impairment (controls). We assessed the construct validity of the scale and its diagnostic accuracy (sensitivity, specificity, and predictive value). In addition, intergroup and intragroup analyses were conducted to characterize patient performance on basic and instrumental ADL and to determine underlying deficits (initiation, planning, or effective execution). ResultsAD patients and controls had mean ages of 76.4±6.9 years and 74.5±7.3 years (P=0.08), respectively. Mean Mini-Mental State Examination scores were 17.4±5.0 and 26.1±5.1 (P<0.001) and scores on the DAD were 68.4±19.0 and 99.8±0.9 (P<0.001), for patients and controls, respectively. The DAD scale showed good internal consistency (Cronbach α=0.77) and correlation with the Mini-Mental State Examination (r=0.44; P<0.001). The AD group did better on basic ADL than on instrumental ADL (P<0.001). As expected, controls did not exhibit significant deficits on the items evaluated. ConclusionThe Brazilian version of the DAD is an adequate and reliable tool for assessing functional ability in AD patients.

Polymorphisms of apoe and lrp Genes in Brazilian Individuals With Alzheimer Disease

Alzheimer disease (AD) is the most frequent cause of dementia in Western countries. Putative genetic risk factors for AD are polymorphisms in the apolipoprotein E (APOE) gene and in the low-density lipoprotein receptor-related protein (LRP) gene. Our objective was to investigate the role of the APOE coding region polymorphisms ϵ2, ϵ3, and ϵ4 and APOE promoter variants A/T at position -491 and G/T at -219, as well as LRP polymorphism C/T, as risk factors for AD in Brazilian individuals. One hundred and twenty patients with probable AD, along with 120 controls were analyzed. A significant difference between patients and controls for ϵ4 alleles was observed: frequency of this allele in AD was 0.31, and 0.10 in controls. Individuals with 2 ϵ4 alleles had a higher risk for AD than subjects with only 1 such allele; presence of 1 ϵ2 allele proved protective. The presence of the T allele of the -219 polymorphism was also associated with an increased risk of AD, but this polymorphism is in linkage disequilibrium with APOE ϵ polymorphisms. No significant differences between patients and controls were observed for -491 APOE or LRP polymorphisms. In this Brazilian population, both the ϵ4 allele and T -219 polymorphism were associated with an increased risk for AD.

Monoamine Oxidase A Polymorphism in Brazilian Patients Risk Factor for Late-Onset Alzheimer's Disease?

Different studies have attempted to find polymorphisms involved in the serotonergic pathway that could be involved in mood disorders and late-onset Alzheimer’s disease (LOAD) symptoms. Here, we compared the frequency of two polymorphisms: monoamine oxidase A (MAOA) and serotonin transporter in LOAD patients versus controls. No evidence of association was observed when these polymorphisms were compared separately; however, the combination of the MAOA allele 1 + the short allele of 5-HTTLPR + ApoE-ɛ4 was significantly more frequent in patients than in controls. It reinforces the hypothesis that different genes acting together might play a role in AD susceptibility. Based on these data, we suggest replicating these studies in larger samples of LOAD patients belonging to different ethnic groups.