Viviane Amaral Carvalho

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.

Brazilian caregiver version of the Apathy Scale

No Brazilian version of a specific scale for evaluating apathy in dementia is available. Objectives To introduce a translated version of the Apathy Scale (AS) for use with caregivers. Methods The instrument was formally translated and then administered to the caregivers of a small sample of dementia patients, in order to assess scale comprehensibility and make final adjustments. The scale was subsequently administered to the caregivers of a second, independent sample of Alzheimers disease (AD) patients. The content validity of the scale was tested by correlating the AS scores with the Neuropsychiatric Inventory (NPI) - apathy sub-score and Disability Assessment in Dementia (DAD) total scores. Results The first sample consisted of eleven subjects with dementia, most of whom had AD. The second sample comprised twenty patients with probable or possible AD (10 with mild dementia), a mean age of 84.1±5.8 years, and 2.2±1.6 years of schooling. The AS scores correlated with both NPI-apathy sub-score (r=0.756, p=0.001) and DAD total scores (r=-0.793, p=0.0005). Conclusions The final version had good comprehensibility and correlated strongly with standardized apathy and functional activities of daily living measures.

Direct and Indirect Assessments of Activities of Daily Living in Behavioral Variant Frontotemporal Dementia and Alzheimer Disease

Background: There is limited information about the functional profile of behavioral variant frontotemporal dementia (bvFTD). Objective: To compare direct and indirect assessments of activities of daily living (ADLs) in bvFTD and Alzheimer disease (AD) and their relationship with cognitive performance. Methods: In all, 20 patients with bvFTD, 30 patients with AD, and 34 normal controls (NCs), matched for age, education, and severity of dementia, completed the Direct Assessment of Functional Performance (DAFS-BR) and usual cognitive measures. The Disability Assessment for Dementia (DAD) was completed by caregivers. Results: In DAFS-BR, patients with bvFTD and AD had similar performance but lower than NCs. In DAD, there were no significant differences for effective performance, but patients with bvFTD had lower scores for initiation and planning/organization. Patients with bvFTD were less impaired than AD in cognition. Conclusion: Functional changes in bvFTD seem to be better documented by indirect measures.

Mattis Dementia Rating Scale (DRS): Normative data for the Brazilian middle-age and elderly populations

OBJECTIVE To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations. METHODS The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over). RESULTS Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores. CONCLUSION As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

Translation, cross-cultural adaptation and applicability of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS)

BACKGROUND Staging scales for dementia have been devised for grading Alzheimers disease (AD) but do not include the specific symptoms of frontotemporal lobar degeneration (FTLD). OBJECTIVE To translate and adapt the Frontotemporal Dementia Rating Scale (FTD-FRS) to Brazilian Portuguese. METHODS The cross-cultural adaptation process consisted of the following steps: translation, back-translation (prepared by independent translators), discussion with specialists, and development of a final version after minor adjustments. A pilot application was carried out with 12 patients diagnosed with bvFTD and 11 with AD, matched for disease severity (CDR=1.0). The evaluation protocol included: Addenbrookes Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Executive Interview (EXIT-25), Neuropsychiatric Inventory (NPI), Frontotemporal Dementia Rating Scale (FTD-FRS) and Clinical Dementia Rating scale (CDR). RESULTS The Brazilian version of the FTD-FRS seemed appropriate for use in this country. Preliminary results revealed greater levels of disability in bvFTD than in AD patients (bvFTD: 25% mild, 50% moderate and 25% severe; AD: 36.36% mild, 63.64% moderate). It appears that the CDR underrates disease severity in bvFTD since a relevant proportion of patients rated as having mild dementia (CDR=1.0) in fact had moderate or severe levels of disability according to the FTD-FRS. CONCLUSION The Brazilian version of the FTD-FRS seems suitable to aid staging and determining disease progression.

Functional profile of patients with behavioral variant frontotemporal dementia (bvFTD) compared to patients with Alzheimer's disease and normal controls

There are few studies describing the functional changes in behavioral variant frontotemporal dementia (bvFTD) and it is not clear which aspects of functionality are affected by the disease. OBJECTIVE The aim of the present investigation was to characterize the functional profile of patients previously diagnosed with bvFTD. METHODS The sample consisted of 31 patients diagnosed with bvFTD, who were compared to patients with Alzheimers disease (AD) (n=31) and to healthy control subjects (NC) (n=34), matched for schooling and age. bvFTD and AD patients were matched by severity of dementia. The protocol included the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Direct Assessment of Functional Status (DAFS-BR), Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD) and the Clinical Dementia Rating scale (CDR). RESULTS The group with bvFTD showed worse performance on Initiation and Planning/Organization in the DAD and on ability to feed oneself in the DAFS-BR, as well as higher scores on the PFAQ, suggesting greater dependence in the bvFTD group. CONCLUSION The results suggest that individuals with bvFTD display greater functional impairment compared to AD patients with a similar degree of dementia severity and to healthy controls. Direct assessment of functionality proved unable to clearly differentiate between the dementia subtypes.

Prevalence of major psychiatric disorders in a cohort of oldest old in Brazil: The Pietà study

consensus discussion. Results: 639 individuals (55.3% of the total oldestold population) were fully evaluated, being 408 women (63.8%) and 231 men(36.2%),aged81.1 65.2years,withmeanschoolingof2.6 62.8years. Dementia was diagnosed in 176 subjects, (prevalence¼27.5%), while CIND was identified in 166 (prevalence¼26.0%). Among dementia patients, only 39 cases (6.1%) had a previous diagnosis of this condition. Patients with dementia were significantly older (p<0.0001) and less educated (p¼0.001). Prevalence of dementia was also higher in women, although the difference was not statistically significant (p¼0.06). CIND prevalence was similar in both genders. When compared with the cognitively healthy individuals (n¼227),CINDsubjectsweresignificantlyolder(p¼0.004),buthadasimilar schooling. A previous history of depression was more frequent among dementia (p¼0.002) and CIND (p¼0.007) patients. Conclusions: Prevalence of CIND and dementia was high in this oldest-old population, although dementia was highly under-diagnosed. Age and previous history of depression were associated with both diagnoses, while low education dementia was associated only with dementia.

The structural basis of performance in an episodic memory test in an elderly population with heterogeneous educational level: The pietà study

patients with confirmed diagnosis of AD (11.8% increase V1⁄449, p<.05; Figure 2) and those with confirmed diagnosis of non-AD (13.6% increase; V1⁄40, p<.05; Figure 3). 243 PET scans were evaluated by two nuclear medicine physicians, who disagreed on 32 cases (rate of concordance: 86.8%). Conclusions:Data are in line with previous reports. Based on preliminary results, amyloid PET with 18F-Florbetapir has a significant impact on diagnosis and diagnostic confidence of dementia experts.

THE CAREGIVER BURDEN AND WEAR IN BEHAVIORAL VARIANT FRONTOTEMPORAL DEMENTIA AND ALZHEIMER DISEASE

not available. P2-336 STUDY ON THE NEEDS FOR EDUCATIONAL SUPPORT PROGRAMS FOR FAMILY CAREGIVERS OF PERSONS WITH DEMENTIA— FOR EFFECTIVE IMPLEMENTATIONS OF INTER-DISCIPLINARY PROGRAMS Aya Seike, Takashi Sakurai, Chieko Sumigaki, Akinori Takeda, Kenji Toba, Kyoto University, Kyoto-City, Japan; National Center for

Functionality and cognitive performance of patients with behavioral variant frontotemporal dementia

temporo-parietal areas. MIBG myocardial scintigraphy showed mild abnormalities. Patient 3: A 75-year old right-handed man became confused with multiple tasks for six months and then had difficulty in word finding and comprehension. Impairment in naming, comprehension and repetition of sentences, phonological paraphasia and cognitive decline was detected. Brain atrophy and hypoperfusion were noted at the left temporo-parietal areas. Uptake on MIBG myocardial scintigraphy was slightly decreased. P-tau and A b 42 in CSF suggested AD pathology. Patient 4: A 67-year old right-handed woman became forgetful and poorer in consecutive calculation, and the family noticed that the patient often misidentified her two sons interchangeably. At presentation, she scored 24/30 on a short cognitive test; mental manipulation of numbers was more impaired than memory. Although the patient did not show physical signs, abnormal MIBGmyocardial scintigraphy and normal brain MRI suggested DLB. SPECT showed bilateral frontoparietal uptake decreases. Two years after the onset, the patient developed difficulty in producing the first sound of sentences. Language evaluations revealed characteristics of apraxia of speech but no aphasia. Conclusions: Clinical DLB may present logopenic aphasia and rarely apraxia of speech. Concomitant AD pathology may possibly contribute to logopenic aphasia in DLB.