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Melo LM, Barbosa ER, Caramelli P. Declínio cognitivo e demência associados à doença de Parkinson: características clínicas e tratamento. ACTA ACUST UNITED AC 2007. [DOI: 10.1590/s0101-60832007000400003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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327
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Abstract
PURPOSE OF REVIEW The aim of this article is to discuss new data on presently approved drugs for dementia, such as cholinesterase inhibitors and memantine, and concerns regarding the use of antipsychotics for treating neuropsychiatric symptoms, as well as to summarize some relevant studies recently published on emerging therapies with potential disease-modifying effects. RECENT FINDINGS The main focuses of recent studies of cholinesterase inhibitors and memantine have been on efficacy and safety aspects in extended clinical trials, combined treatments or comparative analysis between agents, and also on potential neuroprotective effects and new indications. Other publications have assessed the evidence of efficacy and the increased risk of cerebrovascular events, rapid cognitive decline, and mortality with the use of antipsychotics in dementia, providing important information in relation to the controversy surrounding its use. Although more studies are warranted, a sizable literature on novel treatment options under investigation is currently available as a result of a better understanding of pathogenesis of dementia. SUMMARY So far, there is no established method to predict better responders or long-term benefits with currently approved drugs for treatment of dementia. Recent systematic reviews and new research on current treatment, however, provide valuable information for clinicians, and novel drugs under investigation reveal promising new therapeutic strategies.
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328
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Teixeira-Jr AL, Caramelli P. Apatia na doença de Alzheimer. BRAZILIAN JOURNAL OF PSYCHIATRY 2006. [DOI: 10.1590/s1516-44462006005000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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329
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Teixeira AL, Caramelli P. [Apathy in Alzheimer's disease]. BRAZILIAN JOURNAL OF PSYCHIATRY 2006; 28:238-41. [PMID: 16816880 DOI: 10.1590/s1516-44462006000300017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2005] [Accepted: 11/16/2005] [Indexed: 11/21/2022]
Abstract
Apathy is the most common neuropsychiatry syndrome in Alzheimer's disease affecting 30-60% of patients. It can be defined as a loss of motivation and manifests in affect, cognition and behavioral changes, determining blunted emotional response, lack of insight and social retraction, respectively. In this paper, the clinical features and the therapeutic perspectives of apathy are presented. There is considerable overlap between apathy and depression in Alzheimer's disease, but both are considered discrete syndromes. Pharmacological interventions for apathy include psychostimulants, such as methylphenidate, dopaminergic agents and cholinesterase inhibitors, but the results are controversial and there is no established treatment.
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330
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Porto CS, Caramelli P, Nitrini R. P3–062: The Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of Alzheimer's disease and mild cognitive impairment. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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331
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Raicher I, Shimizu MM, Takahashi DY, Nitrini R, Caramelli P. P1–136: Alzheimer's disease diagnostic disclosure in Brazil: A pilot study of specialized physicians current practice and attitudes. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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332
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Carthery-Goulart MT, Nitrini R, Macedo EC, Caramelli P. P3–019: Working memory dysfunction in normal aging and in Alzheimer's disease. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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333
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Corrêa-Neto Y, Charchat-Fichman H, Caramelli P. P1–450: Dopaminergic medication and fluctuation of attention in Parkinson's disease. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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334
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Shimizu MM, Raicher I, Takahashi DY, Caramelli P, Nitrini R. P4–227: Disclosure of the diagnosis of Alzheimer's disease: Influence of education and socioeconomic factors. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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335
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Nitrini R, Caramelli P, Porto CS, Charchat-Fichman H, Formigoni AP, Otero C, Prandini JC. P3–069: Brief cognitive evaluation in the diagnosis of mild dementia in Alzheimer's disease. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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336
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Caramelli P, Lee HW, Leite CC, Otaduy MG, Nitrini R. IC–P–036: Evaluation of Alzheimer's disease using magnetic resonance spectroscopy: Comparation between findings in the posterior cingulate and hippocampi. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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337
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Marcourakis T, Bahia VS, Kawamoto EM, Munhoz CD, Scavone C, Gorjão R, Curi R, Caramelli P, Nitrini R. P3–370: APOE genotype has no influence in platelet and erythrocyte oxidative state. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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338
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Abstract
BACKGROUND There are several ethical aspects related to the medical assistance of patients with Alzheimer's disease (AD) including diagnostic disclosure to the patient, performance of autopsy for diagnostic confirmation, and also topics pertaining to the caregivers constantly subjected by these patients to physical and mental stress. This work investigates some of these issues, by comparing family caregivers of patients with AD followed-up at both public and private health services. METHODS Twenty family caregivers of AD patients followed up at a public university hospital and 20 family caregivers of AD patients followed up at a private clinic were interviewed using a specific questionnaire comprised of 36 questions about diagnosis, treatment and prognosis of the disease. RESULTS The two groups presented similar age and gender distributions while the socioeconomic level was higher for the private clinic group. No differences were found between opinions of both groups regarding diagnostic disclosure to the patients, with 42.5% of the total in favor of disclosing the information only to the family. The number of caregivers who agreed with performance of autopsy was significantly higher in the public service (35% against 30% in the private clinic). Twenty caregivers (50% of the total sample) spontaneously manifested the wish to allow an autopsy for research purposes. CONCLUSION Disclosure of AD diagnosis to patients was approved by more than half of all family caregivers and these rates were not correlated to the socioeconomic level. This variable, however, influenced the concordance rate related to the post-mortem neuropathological examination.
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339
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Correa-Neto Y, Charchat-Fichman H, Caramelli P. II.P3 Dopamine and fluctuation of attention in Parkinson's Disease. Parkinsonism Relat Disord 2006. [DOI: 10.1016/s1353-8020(07)70082-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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340
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Takada LT, Caramelli P, Fichman HC, Porto CS, Bahia VS, Anghinah R, Carthery-Goulart MT, Radanovic M, Smid J, Herrera E, Nitrini R. Comparison between two tests of delayed recall for the diagnosis of dementia. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:35-40. [PMID: 16622550 DOI: 10.1590/s0004-282x2006000100008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
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.
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341
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Barbosa MT, Caramelli P, Maia DP, Cunningham MCQ, Guerra HL, Lima-Costa MF, Cardoso F. Parkinsonism and Parkinson's disease in the elderly: A community-based survey in Brazil (the Bambuí study). Mov Disord 2006; 21:800-8. [PMID: 16482566 DOI: 10.1002/mds.20806] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Several community-based surveys on the prevalence of Parkinsonism and Parkinson's disease have been conducted worldwide, with variations on their methodology and results. The objective of this study is to assess the prevalence of Parkinsonism and its causes in a cohort of individuals age 64 years or older in Bambuí, a Brazilian town. In phase I, 1,186 people older than 64 years responded to a 9-question screening questionnaire for Parkinsonism. In phase II, all subjects who scored > or = 2 points on the test were examined independently by at least 2 movement disorder-trained physicians. A movement disorder senior specialist excluded or confirmed the diagnosis in all suspected cases. The response rate was high for both phases (96% for phase I and 94% for phase II). The prevalence rate per 100 population over 64 years of age in this group was 7.2% for Parkinsonism of all types (n = 86). The most frequent causes were idiopathic Parkinson's disease and drug-induced Parkinsonism, with prevalence rates of 3.3% (n = 39) and 2.7% (n = 32), respectively. The prevalence of vascular Parkinsonism was 1.1% (n = 13). We found 1 case of posttraumatic Parkinsonism and another with multiple system atrophy. In this first population-based study of Parkinsonism conducted in Brazil, the prevalence in a cohort of elderly subjects was higher than the observed in other populations worldwide, especially because of the high rates of drug-induced and vascular Parkinsonism. The prevalence of Parkinson's disease was similar to that observed in elderly people in door-to-door surveys in other American, European, and Eastern countries.
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Abstract
In this review, we explore the relationship between epilepsy and cognition and between epilepsy and dementia. Chronic epilepsy, particularly mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis, may be associated with impaired cognition, which can be secondary to uncontrolled seizures, to adverse effects of antiepileptic drugs (AEDs) or to the underlying biological abnormality. The choice of an adequate AED with an appropriate dose regimen may lead to a favorable outcome. This feature is especially relevant in elderly patients with dementia and associated epilepsy, a vulnerable population in which the diagnosis of seizures can be difficult and for whom treatment guidelines are not yet available. Based on available information and on data derived from studies with other populations, recommendations for the management of these patients are presented.
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343
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Mansur LL, Carthery MT, Caramelli P, Nitrini R. Linguagem e cognição na doença de Alzheimer. PSICOLOGIA-REFLEXAO E CRITICA 2005. [DOI: 10.1590/s0102-79722005000300002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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344
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Nitrini R, Caramelli P, Herrera E, Charchat-Fichman H, Porto CS. Performance in Luria's Fist-Edge-Palm Test According to Educational Level. Cogn Behav Neurol 2005; 18:211-4. [PMID: 16340394 DOI: 10.1097/01.wnn.0000195292.48422.d5] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the performance of a large population with heterogeneous educational background in a test apparently uninfluenced by formal education. METHODS We administered the Luria's fist-edge-palm test to 966 elderly individuals (299 illiterates) while screening for dementia in a Brazilian population. Individuals with scores in the Mini-Mental State Examination below the 25th percentile (adjusted for each of 4 educational levels) were considered suspect for dementia and excluded. The influence of educational level, age, and gender on the occurrence of failures and on the number of demonstrations for a successful reproduction was investigated. RESULTS The final population comprised 745 individuals (238 illiterates). Forty-eight individuals (25 illiterates) were unable to reproduce the sequence. Logistic regression showed that illiteracy was associated with failure, whereas gender and age were not. The proportion of individuals failing to reproduce the sequence was inversely related to the years of schooling. For those individuals who were able to reproduce the sequence, the number of demonstrations for successful reproduction was also inversely related to the years of schooling. CONCLUSION Illiteracy and low educational level are associated with impaired performance in the fist-edge-palm test, which may be the result of the use of different strategies according to educational level.
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Senaha MLH, Martin MGM, Amaro E, Campi C, Caramelli P. Patterns of cerebral activation during lexical and phonological reading in Portuguese. Braz J Med Biol Res 2005; 38:1847-56. [PMID: 16302099 DOI: 10.1590/s0100-879x2005001200013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
According to the concepts of cognitive neuropsychology, there are two principal routes of reading processing: a lexical route, in which global reading of words occurs and a phonological route, responsible for the conversion of the graphemes into their respective phonemes. In the present study, functional magnetic resonance imaging (fMRI) was used to investigate the patterns of cerebral activation in lexical and phonological reading by 13 healthy women with a formal educational level greater than 11 years. Participants were submitted to a silent reading task containing three types of stimuli: real words (irregular and foreign words), nonwords and illegitimate graphic stimuli. An increased number of activated voxels were identified by fMRI in the word reading (lexical processing) than in the nonword reading (phonological processing) task. In word reading, activation was greater than for nonwords in the following areas: superior, middle and inferior frontal gyri, and bilateral superior temporal gyrus, right cerebellum and the left precentral gyrus, as indicated by fMRI. In the reading of nonwords, the activation was predominant in the right cerebellum and in the left superior temporal gyrus. The results of the present study suggest the existence of differences in the patterns of cerebral activation during lexical and phonological reading, with greater involvement of the right hemisphere in reading words than nonwords.
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Carthery MT, de Mattos Pimenta Parente MA, Nitrini R, Bahia VS, Caramelli P. Spelling tasks and Alzheimer's disease staging. Eur J Neurol 2005; 12:907-11. [PMID: 16241982 DOI: 10.1111/j.1468-1331.2005.01094.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reading, writing and oral spelling were evaluated in 30 normal elderly individuals and 28 patients with probable Alzheimer's disease (AD). Significant differences between control and AD groups were found in all tasks. Oral spelling was the most impaired function in AD and the only one which differentiated mild and moderate dementia cases. This task is very sensitive to the disease's effects on working memory and may be included in batteries aimed at staging AD.
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Nitrini R, Caramelli P, Bottino CMDC, Damasceno BP, Brucki SMD, Anghinah R. [Diagnosis of Alzheimer's disease in Brazil: cognitive and functional evaluation. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:720-7. [PMID: 16172733 DOI: 10.1590/s0004-282x2005000400034] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The educational and cultural heterogeneity of the Brazilian population leads to peculiar characteristics regarding the diagnosis of Alzheimer's disease (AD). This consensus had the objective of recommending evidence-based guidelines for the clinical diagnosis of AD in Brazil. Studies on the diagnosis of AD published in Brazil were systematically evaluated in a thorough research of PUBMED and LILACS databases. For global cognitive evaluation, the Mini-Mental State Examination was recommended; for memory evaluation: delayed recall subtest of CERAD or of objects presented as drawings; attention: trail-making or digit-span; language: Boston naming, naming test from ADAS-Cog or NEUROPSI; executive functions: verbal fluency or clock-drawing; conceptualization and abstraction: similarities from CAMDEX or NEUROPSI; construction: drawings from CERAD. For functional evaluation, IQCODE, or Pfeffer Questionnaire or Bayer Scale for Activities of Daily Living was recommended. The panel concluded that the combined use of cognitive and functional evaluation based on interview with informant is recommended.
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Nitrini R, Caramelli P, Bottino CMDC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: critérios diagnósticos e exames complementares. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:713-9. [PMID: 16172732 DOI: 10.1590/s0004-282x2005000400033] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este consenso teve o objetivo de recomendar condutas baseadas em evidências para o diagnóstico clínico de doença de Alzheimer (DA) em nosso meio. Foram avaliados sistematicamente consensos elaborados em outros países e artigos sobre o diagnóstico de DA no Brasil disponíveis no PUBMED ou LILACS. Concluiu-se que o diagnóstico de demência deve basear-se nos critérios do Manual de Diagnóstico e Estatística da Associação Psiquiátrica Americana (DSM) e o de DA, nos de McKhann et al. (NINCDS-ADRDA). Os exames complementares recomendados são: hemograma completo, concentrações séricas de uréia, creatinina, tiroxina livre, hormônio tíreo-estimulante, albumina, enzimas hepáticas, vitamina B12 e cálcio, reações sorológicas para sífilis e, em pacientes com idade inferior a 60 anos, sorologia para HIV. Exame do líquido cefalorraqueano está indicado em situações particulares. Tomografia computadorizada (ou preferentemente ressonância magnética, quando disponível) é exame obrigatório e tem a finalidade principal de excluir outras doenças. Cintilografia de perfusão (SPECT) e EEG são métodos opcionais.
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349
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Novelli MMPC, Dal Rovere HH, Nitrini R, Caramelli P. Cross-cultural adaptation of the quality of life assessment scale on Alzheimer disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2005; 63:201-6. [PMID: 16100962 DOI: 10.1590/s0004-282x2005000200002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To present the internal validation of the quality of life (QOL) evaluation scale for patients with Alzheimer's disease (AD) and their caregivers/family members, proposed by Logsdon et al. METHOD: The scale was adapted through translation, back translation and equivalence evaluation. The Portuguese version was administered to a sample of 40 patients with mild to moderate AD according to NINCDS ADRDA and DSM-III-R criteria, and also to their respective caregivers/family members. RESULTS: The reliability of the instrument was excellent, both in the intra and the inter-examiner test-retest. The correlation coefficients for the intra-examiner assessment were 0.87/0.95/0.95 (p<0.001)) for the patient, family and caregiver versions, respectively. The correlation coefficients for the inter-examiner assessment were 0.76/0.96/0.93 (p<0.001) for the patients, family and caregiver versions, respectively. The reliability was excellent for both the patient and the relatives' versions in relation to the patient's QOL (alpha=0.81 and 0.85, respectively), and also in relation to the caregiver's QOL (alpha=0.84). CONCLUSION: The adapted version of the instrument proved to be straightforward and brief, presenting excellent stability and reliability. The Portuguese version can be obtained by contacting the first author.
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Kawamoto EM, Munhoz CD, Glezer I, Bahia VS, Caramelli P, Nitrini R, Gorjão R, Curi R, Scavone C, Marcourakis T. Oxidative state in platelets and erythrocytes in aging and Alzheimer's disease. Neurobiol Aging 2005; 26:857-64. [PMID: 15718044 DOI: 10.1016/j.neurobiolaging.2004.08.011] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Revised: 07/19/2004] [Accepted: 08/12/2004] [Indexed: 11/29/2022]
Abstract
Several studies have shown involvement of peroxynitrite anion, a potent oxidative agent, in Alzheimer's 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.
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