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Schilling LP, Balthazar MLF, Radanovic M, Forlenza OV, Silagi ML, Smid J, Barbosa BJAP, Frota NAF, Souza LCD, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Brucki SMD, Damasceno BP, Nitrini R. Diagnosis of Alzheimer’s disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s102en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
ABSTRACT This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer’s disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.
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Affiliation(s)
- Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
| | | | | | | | - Marcela Lima Silagi
- Universidade Federal de São Paulo, Brasil; Universidade de São Paulo, Brasil
| | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
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Schilling LP, Balthazar MLF, Radanovic M, Forlenza OV, Silagi ML, Smid J, Barbosa BJAP, Frota NAF, de Souza LC, Vale FAC, Caramelli P, Bertolucci PHF, Chaves MLF, Brucki SMD, Damasceno BP, Nitrini R. Diagnosis of Alzheimer's disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022; 16:25-39. [PMID: 36533157 PMCID: PMC9745995 DOI: 10.1590/1980-5764-dn-2022-s102pt] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/22/2021] [Accepted: 04/27/2022] [Indexed: 01/25/2023] Open
Abstract
This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer's disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.
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Affiliation(s)
- Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Escola de Medicina, Serviço de Neurologia, Porto Alegre RS, Brasil
- Pontifícia Universidade do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brasil
- Pontifícia Universidade do Rio Grande do Sul, Programa de Pós-Graduação em Gerontologia Biomédica, Porto Alegre RS, Brasil
| | | | - Márcia Radanovic
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Laboratório de Neurociências, São Paulo SP, Brasil
| | - Orestes Vicente Forlenza
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Psiquiatria, Laboratório de Neurociências, São Paulo SP, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - Marcela Lima Silagi
- Universidade Federal de São Paulo, Departamento de Fonoaudiologia, São Paulo SP, Brasil
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Jerusa Smid
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
- Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área Acadêmica de Neuropsiquiatria, Recife PE, Brasil
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brasil
| | | | - Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | - Francisco Assis Carvalho Vale
- Universidade Federal de São Carlos, Centro de Ciências Biológicas e da Saúde, Departamento de Medicina, São Carlos SP, Brasil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brasil
| | | | - Márcia Lorena Fagundes Chaves
- Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brasil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Departamento de Medicina Interna, Porto Alegre RS, Brasil
| | - Sonia Maria Dozzi Brucki
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
| | - Benito Pereira Damasceno
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brasil
| | - Ricardo Nitrini
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brasil
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Henríquez F, Cabello V, Baez S, de Souza LC, Lillo P, Martínez-Pernía D, Olavarría L, Torralva T, Slachevsky A. Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges. Front Neurol 2022; 12:768591. [PMID: 35250791 PMCID: PMC8890568 DOI: 10.3389/fneur.2021.768591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.
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Affiliation(s)
- Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Cabello
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Departamento de Psicología, Bogotá, Colombia
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - David Martínez-Pernía
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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Gobbi LTB, Pelicioni PHS, Lahr J, Lirani-Silva E, Teixeira-Arroyo C, Santos PCRD. Effect of different types of exercises on psychological and cognitive features in people with Parkinson's disease: A randomized controlled trial. Ann Phys Rehabil Med 2020; 64:101407. [PMID: 32561505 DOI: 10.1016/j.rehab.2020.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parkinson's disease (PD) is a neurodegenerative and progressive disease marked by the presence of motor and non-motor symptoms, as psychological and cognitive impairment. Physical exercises have been prescribed as complementary therapy for PD, and the type of intervention and duration of the intervention should be taken into account. OBJECTIVE We aimed to compare the effect of different exercise modalities (functional mobility, multimodal and cognitive) and length (4 and 8 months) on psychological and cognition in people with PD. This study followed the CONSORT extension for non-pharmacological trials. METHODS In this randomized controlled trial, we assessed 107 participants between 2011 and 2013. At the end of 3 years, participants with PD (mild to moderate stages) who achieved the criteria were assessed considering 3 different groups of exercise: Multimodal (n=38), Functional Mobility (n=33) and Mental/Leisure (n=36). All 3 interventions were performed for 32 weeks, twice a week, with 60min for each session (64 sessions in total). Psychological and cognitive function were assessed at baseline and after 4 and 8 months. RESULTS The Functional Mobility and Mental/Leisure training had a potential effect on maintaining cognitive function (executive function, attention and work memory). The Multimodal training did not show a benefit for cognitive features and was not even able to delay the progressive decline in cognitive functions; however, this modality had a positive effect on physical stress after 8 months of exercise. CONCLUSIONS An intervention that requires high complexity and specific activities, such as locomotor and cognitive exercise, provides a maintenance effect against the degeneration in cognition associated with the progression of PD and thus can delay the progressive decline in cognitive function in PD.
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Affiliation(s)
- Lilian Teresa Bucken Gobbi
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil.
| | - Paulo Henrique Silva Pelicioni
- Neuroscience Research Australia, University of New South Wales, Sydney, Australia; School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Juliana Lahr
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | - Ellen Lirani-Silva
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil
| | | | - Paulo Cezar Rocha Dos Santos
- São Paulo State University (UNESP), Post-graduation Program in Movement Sciences, Institute of Biosciences, Posture and Gait Studies Laboratory (LEPLO), Rio Claro, Brazil; University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands
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de Mendonça FJP, Teixeira IA, Marinho V. Ekbom Syndrome associated with Lewy Body Dementia: A case report. Dement Neuropsychol 2020; 14:83-87. [PMID: 32206204 PMCID: PMC7077860 DOI: 10.1590/1980-57642020dn14-010014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Ekbom Syndrome, also known as parasitosis delusion or psychogenic parasitosis, is
a rare condition in which patients present with a fixed belief of being infested
by parasites, vermin or small insects, along with tactile hallucinations (such
as pruritus or sensations of the parasites crawling over or under the skin). The
syndrome may occur idiopathically or be associated with other medical conditions
and drug use. This case report describes the occurrence of Ekbom syndrome in a
patient diagnosed with Lewy Body Dementia (LBD), a neurodegenerative disease
that commonly presents with sensory perception and thought disorders and other
neuropsychiatric symptoms. Although visual hallucination is considered a core
diagnostic criterion, other modalities of psychiatric symptoms can also occur
posing a further challenge for correct diagnosis. Proper recognition allows
early diagnosis and adequate treatment, preventing hazardous antipsychotic use
in these patients.
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Affiliation(s)
- Felippe José Pontes de Mendonça
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry - Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Ivan Abdalla Teixeira
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry - Universidade Federal do Rio de Janeiro, RJ, Brazil
| | - Valeska Marinho
- Center for Alzheimer's Disease and Related Disorders, Institute of Psychiatry - Universidade Federal do Rio de Janeiro, RJ, Brazil
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Viana FS, Boechat YEM, Lugon JR, de Matos JPS. Differences in quality of life and cognition between the elderly and the very elderly hemodialysis patients. J Bras Nefrol 2019; 41:375-383. [PMID: 30897190 PMCID: PMC6788852 DOI: 10.1590/2175-8239-jbn-2018-0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/29/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION In the last decades, there was an expressive increase in the number of elderly patients with chronic kidney disease starting hemodialysis. Thus, our goal was to evaluate the profile of the elderly in chronic hemodialysis and to compare the cognition and quality of life of the younger elderly with those of the very elderly. METHODS Patients on hemodialysis for at least 3 months, who were 65 years of age or older when they started dialysis were invited to participate, and stratified according to age (under or over 80 years). The participants answered a clinical-epidemiological questionnaire and underwent cognitive tests (Mini Mental State Exam [MMSE], clock drawing test [CDT] and verbal fluency test [VFT]) and a quality of life assessment 36- Item Short Form Health Survey). RESULTS Of the 125 eligible patients, 124 agreed to participate. The mean age was 76 ± 6 years (28% ≥ 80 years), 56% were men and 55% had ≥ 8 years of schooling. Depression was suggested in 38%. The prevalence of cognitive deficit was 38%, 70% and 30%, by MEEM, CDT and VFT, respectively. The prevalence of any deficit was higher among the very elderly (94% vs. 72%, p = 0.007). Quality of life scores were similar between the two age groups, except for the functional capacity domain, worse in the group with ≥ 80 years (p = 0.033). CONCLUSION Elderly patients on chronic hemodialysis have a high prevalence of cognitive deficits, especially the very elderly, but this group does not have a worse quality of life, except for functional capacity.
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Affiliation(s)
- Fernanda Siqueira Viana
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Niterói, RJ, Brasil.,Correspondence to: Fernanda Siqueira Viana. E-mail:
| | - Yolanda Eliza M. Boechat
- Universidade Federal FluminenseFaculdade de MedicinaDepartamento de Medicina ClínicaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Departamento de Medicina Clínica, Niterói, RJ, Brasil.
| | - Jocemir Ronaldo Lugon
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Niterói, RJ, Brasil.,Universidade Federal FluminenseFaculdade de MedicinaDepartamento de Medicina ClínicaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Departamento de Medicina Clínica, Niterói, RJ, Brasil.
| | - Jorge Paulo Strogoff de Matos
- Universidade Federal FluminenseFaculdade de MedicinaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Niterói, RJ, Brasil.,Universidade Federal FluminenseFaculdade de MedicinaDepartamento de Medicina ClínicaNiteróiRJBrasilUniversidade Federal Fluminense, Faculdade de
Medicina, Departamento de Medicina Clínica, Niterói, RJ, Brasil.
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de Moraes FM, Bertolucci PF. The Contribution of Supplementary Tests in the Differential Diagnosis of Dementia. Am J Alzheimers Dis Other Demen 2018; 33:131-137. [PMID: 29210283 PMCID: PMC10852472 DOI: 10.1177/1533317517744060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Supplementary tests are part of the clinical approach to diagnose cognitive impairment. We aimed to determine the role of supplementary examinations, except for biomarkers, on diagnostic stability of dementia over time and to identify reversible dementias. METHODS We identified 432 patients with dementia who performed 2 clinical evaluations and the supplementary examinations recommended by the American Academy of Neurology in a follow-up period of 1 year. RESULTS In this sample, 110 (24.5%) patients changed their diagnosis at 1-year follow-up for the appearance of vascular cognitive impairment than the initial diagnosis, due to the neuroimaging. Concerning the reversible dementias, depression was the major differential diagnosis, detected in 13 (81%) of the 16 patients with cognitive improvement. CONCLUSION Therefore, regarding the supplementary examinations only neuroimaging and the depression triage were relevant for clinical practice regarding the differential diagnosis of dementia.
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Affiliation(s)
- Fabiano Moulin de Moraes
- Service of Cognitive and Behavioral Neurology, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
| | - Paulo Ferreira Bertolucci
- Service of Cognitive and Behavioral Neurology, Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo, Brazil
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Abstract
BACKGROUND Assigning a diagnosis to a patient with dementia is important for the present treatment of the patient and caregivers, and scientific research. Nowadays, the dementia diagnostic criteria are based on clinical information regarding medical, history, physical examination, neuropsychological tests, and supplementary exams and, therefore, subject to variability through time. METHODS A retrospective observational study to evaluate variables related to clinical diagnostic stability in dementia syndromes in at least one year follow up. From a sample of 432 patients, from a single university center, data were collected regarding sociodemographic aspects, Clinical Dementia Rating, physical examination, neuropsychological tests, and supplementary exams including a depression triage scale. RESULTS From this sample, 113 (26.6%) patients have their diagnosis changed, most of them adding a vascular component to initial diagnosis or depression as comorbidity or main disease. Our findings show that many factors influence the diagnostic stability including the presence of symmetric Parkinsonism, initial diagnosis of vascular dementia, presence of diabetes and hypertension, the presence of long term memory deficit in the neuropsychological evaluation, and normal neuroimaging. We discuss our findings with previous findings in the literature. CONCLUSION Every step of the clinical diagnosis including history, vascular comorbidities and depression, physical examination, neuropsychological battery, and neuroimaging were relevant to diagnosis accuracy.
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Spenciere B, Alves H, Charchat-Fichman H. Scoring systems for the Clock Drawing Test: A historical review. Dement Neuropsychol 2017; 11:6-14. [PMID: 29213488 PMCID: PMC5619209 DOI: 10.1590/1980-57642016dn11-010003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is a simple neuropsychological screening instrument
that is well accepted by patients and has solid psychometric properties. Several
different CDT scoring methods have been developed, but no consensus has been
reached regarding which scoring method is the most accurate. This article
reviews the literature on these scoring systems and the changes they have
undergone over the years. Historically, different types of scoring systems
emerged. Initially, the focus was on screening for dementia, and the methods
were both quantitative and semi-quantitative. Later, the need for an early
diagnosis called for a scoring system that can detect subtle errors, especially
those related to executive function. Therefore, qualitative analyses began to be
used for both differential and early diagnoses of dementia. A widely used
qualitative method was proposed by Rouleau et al. (1992). Tracing the historical
path of these scoring methods is important for developing additional scoring
systems and furthering dementia prevention research.
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Affiliation(s)
- Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
| | - Heloisa Alves
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ - Brazil
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Mazancova AF, Nikolai T, Stepankova H, Kopecek M, Bezdicek O. The Reliability of Clock Drawing Test Scoring Systems Modeled on the Normative Data in Healthy Aging and Nonamnestic Mild Cognitive Impairment. Assessment 2016; 24:945-957. [DOI: 10.1177/1073191116632586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Clock Drawing Test (CDT) is a commonly used tool in clinical practice and research for cognitive screening among older adults. The main goal of the present study was to analyze the interrater reliability of three different CDT scoring systems (by Shulman et al., Babins et al., and Cohen et al.). We used a clock with a predrawn circle. The CDT was evaluated by three independent raters based on the normative data set of healthy older and very old adults and patients with nonamnestic mild cognitive impairment (naMCI; N = 438; aged 61-94). We confirmed a high interrater reliability measured by the intraclass correlation coefficients (ICCs): Shulman ICC = .809, Babins ICC = .894, and Cohen ICC = .862, all p < .001. We found that age and education levels have a significant effect on CDT performance, yet there was no influence of gender. Finally, the scoring systems differentiated between naMCI and age- and education-matched controls: Shulman’s area under the receiver operating characteristic curve (AUC) = .84, Cohen AUC = .71, all p < .001; and a slightly lower discriminative ability was shown by Babins: AUC = .65, p = .012.
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Affiliation(s)
- Adela Fendrych Mazancova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Tomas Nikolai
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- International Clinical Research Center, St. Anne’s University Hospital Brno, Brno, Czech Republic
| | - Hana Stepankova
- National Institute of Mental Health, Klecany, Czech Republic
| | | | - Ondrej Bezdicek
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine and General University Hospital in Prague, Charles University in Prague, Prague, Czech Republic
- National Institute of Mental Health, Klecany, Czech Republic
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Mendes-Santos LC, Mograbi D, Spenciere B, Charchat-Fichman H. Specific algorithm method of scoring the Clock Drawing Test applied in cognitively normal elderly. Dement Neuropsychol 2015; 9:128-135. [PMID: 29213954 PMCID: PMC5619351 DOI: 10.1590/1980-57642015dn92000007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is an inexpensive, fast and easily administered measure of cognitive function, especially in the elderly. This instrument is a popular clinical tool widely used in screening for cognitive disorders and dementia. The CDT can be applied in different ways and scoring procedures also vary. Objective The aims of this study were to analyze the performance of elderly on the CDT and evaluate inter-rater reliability of the CDT scored by using a specific algorithm method adapted from Sunderland et al. (1989). Methods We analyzed the CDT of 100 cognitively normal elderly aged 60 years or older. The CDT ("free-drawn") and Mini-Mental State Examination (MMSE) were administered to all participants. Six independent examiners scored the CDT of 30 participants to evaluate inter-rater reliability. Results and Conclusion A score of 5 on the proposed algorithm ("Numbers in reverse order or concentrated"), equivalent to 5 points on the original Sunderland scale, was the most frequent (53.5%). The CDT specific algorithm method used had high inter-rater reliability (p<0.01), and mean score ranged from 5.06 to 5.96. The high frequency of an overall score of 5 points may suggest the need to create more nuanced evaluation criteria, which are sensitive to differences in levels of impairment in visuoconstructive and executive abilities during aging.
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Affiliation(s)
| | - Daniel Mograbi
- PhD, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil.,Department of Psychology, Institute of Psychiatry, King's College London, UK
| | - Bárbara Spenciere
- BsC, Department of Psychology, Pontifical Catholic University of Rio de Janeiro RJ, Brazil
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Teixeira Fabricio A, Aprahamian I, Sanches Yassuda M. Qualitative analysis of the Clock Drawing Test by educational level and cognitive profile. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:289-95. [PMID: 24760093 DOI: 10.1590/0004-282x20140004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/17/2013] [Indexed: 11/21/2022]
Abstract
UNLABELLED The use of a qualitative scale for the Clock Drawing Test (CDT) may add information about the pattern of errors committed. OBJECTIVE To translate and adapt the Modified Qualitative Error Analysis of Rouleau into Brazilian Portuguese and to examine the pattern of errors according to educational level and cognitive profile. METHOD 180 adults (47-82 years) completed the CDT. Participants were stratified into age and educational levels and separated between those with and without changes in cognitive screening tests (Mini-Mental State Examination, Verbal Fluency). RESULTS No significant differences were found in CDT scores among age groups. Among participants without cognitive impairment, those with lower education often presented graphic difficulties, conceptual deficits and spatial deficits. Participants with cognitive deficits, demonstrated more frequently conceptual and spatial errors. CONCLUSION The qualitative analysis of the CDT may contribute to the identification of cognitive changes. Education level has to be taken into consideration during the analysis.
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Affiliation(s)
| | - Ivan Aprahamian
- Laboratório de Neurociências LIM-27, Departamento e Instituto de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
| | - Mônica Sanches Yassuda
- Escola de Artes, Ciências e Humanidades, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Dias FLDC, Silva RMFLD, Moraes END, Caramelli P. Clinical and autonomic profile of patients with Alzheimer's disease and mixed dementia patients. Rev Assoc Med Bras (1992) 2013; 59:435-41. [PMID: 24119378 DOI: 10.1016/j.ramb.2013.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 04/10/2013] [Accepted: 04/14/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To analyze the clinical and autonomical profile of patients with Alzheimer's disease or mixed dementia (MD). METHODS Fifty-four patients with indication for cholinesterase inhibitors use were evaluated through clinical examination, rest electrocardiogram, and spectral analysis of heart rate (HR) variability through digital Holter system recordings. RESULTS Overall, 61.1% of patients were female and were, on average, 77.1 years of age, 3.3 years of schooling and scored 16.4 points on the Mini Mental State Examination. The gap between symptom onset and diagnosis was 26.2 months. Almost all patients (90.7%) presented at least one clinical comorbidity, and each patient took, on average, 3.7 drugs to control them. Thirty-one patients had some alteration on the electrocardiogram and nine (16.6%) had orthostatic hypotension (OH). The latter was associated with the diagnosis of MD (p=0.001), with lower values of low (LF) and high (HF) frequency components of the spectral analysis in the supine position (p=0.000 and p=0.017, respectively) and with lower values of LF in the orthostatic position (p=0.006). Diagnosis of MD was associated with lower values of LF in both positions (p=0.003 and p=0.007). CONCLUSION This sample of patients had frequent comorbidities, which resulted in the prescription of multiple drugs. Signs of autonomic dysfunction resulting in OH were found mainly in those with MD.
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Affiliation(s)
- Filipi Leles da Costa Dias
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil.
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Chaves ML, Godinho CC, Porto CS, Mansur L, Carthery-Goulart MT, Yassuda MS, Beato R. Cognitive, functional and behavioral assessment: Alzheimer's disease. Dement Neuropsychol 2011; 5:153-166. [PMID: 29213740 PMCID: PMC5619475 DOI: 10.1590/s1980-57642011dn05030003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Márcia L.F. Chaves
- Neurology Service of the Hospital de Clínicas of
Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Claudia C. Godinho
- Neurology Service of the Hospital de Clínicas of
Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre RS, Brazil
| | - Claudia S. Porto
- Cognitive and Behavioral Neurology Group of the
Department of Neurology of the University of São Paulo School of Medicine,
Hospital das Clínicas of the University of São Paulo School of
Medicine, and Center for Mathematics, Computing and Cognition, Federal University of
ABC, São Paulo SP, Brazil
| | - Leticia Mansur
- Cognitive and Behavioral Neurology Group of the
Department of Neurology of the University of São Paulo School of Medicine,
Hospital das Clínicas of the University of São Paulo School of
Medicine, and Center for Mathematics, Computing and Cognition, Federal University of
ABC, São Paulo SP, Brazil
- Department of Physiotherapy, Speech Therapy and
Occupational Therapy of the University of São Paulo School of Medicine,
São Paulo SP, Brazil
| | - Maria Teresa Carthery-Goulart
- Cognitive and Behavioral Neurology Group of the
Department of Neurology of the University of São Paulo School of Medicine,
Hospital das Clínicas of the University of São Paulo School of
Medicine, and Center for Mathematics, Computing and Cognition, Federal University of
ABC, São Paulo SP, Brazil
| | - Mônica S. Yassuda
- Cognitive and Behavioral Neurology Group of the
Department of Neurology of the University of São Paulo School of Medicine,
Hospital das Clínicas of the University of São Paulo School of
Medicine, and Center for Mathematics, Computing and Cognition, Federal University of
ABC, São Paulo SP, Brazil
- Department of Gerontology, School of Arts, Sciences and
Humanities of the University of São Paulo (EACH-USP East), São Paulo
SP, Brazil
| | - Rogério Beato
- Research Group in Cognitive and Behavioral Neurology,
Department of Internal Medicine, School of Medicine, Federal University of Minas
Gerais (UFMG), Belo Horizonte MG, Brazil
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Paradela EMP, Lopes CDS, Lourenço RA. [Portuguese adaptation of the Cambridge Cognitive Examination-Revised in a public geriatric outpatient clinic]. CAD SAUDE PUBLICA 2010; 25:2562-70. [PMID: 20191148 DOI: 10.1590/s0102-311x2009001200004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 09/08/2009] [Indexed: 11/22/2022] Open
Abstract
This paper presents the results of the first four steps (conceptual, item, semantic, and operational equivalences) of cross-cultural adaptation to Portuguese of the Cambridge Cognitive Examination-Revised (CAMCOG-R). The process was based on the theoretical model proposed by Herdman et al., which includes not only the four steps described above, but also measurement and functional equivalences, not evaluated in the current study. A panel of experts evaluated whether all dimensions that comprise the CAMCOG-R were present in Brazilian reality. Two translations and back-translations were performed, in addition to the 'focus group' technique. The Brazilian Portuguese version of the CAMCOG-R (Br-CAMCOG-R) was developed, maintaining the 69 items from the original instrument, with different levels of difficulty. It was then applied to 196 elders, with the test lasting an average of 43 +/- 9.4 minutes, and an average total score of 67 +/- 14.8 points. The Br-CAMCOG-R can be a useful tool for the cognitive evaluation of elders that tested positive during initial screening.
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Eggins W, Gustafsson L, Cooke D. Interrater Reliability of the Clock Drawing Task in the Occupational Therapy Adult Perceptual Screening Test. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12658062793889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The clock drawing item in the Occupational Therapy Adult Perceptual Screening Test (OT-APST) screens for unilateral neglect and impairments in constructional skills. The purpose of this study was to re-evaluate the interrater reliability of the clock drawing item in the OT-APST following the addition of example clock drawings to the manual. This study also compared the interrater reliability for occupational therapy clinicians with that for final year occupational therapy students and examined clocks with poor interrater reliability for the individual scoring criteria. Sixteen occupational therapy students and 15 practising occupational therapists scored 50 clocks drawn by people with stroke, using the OT-APST clock drawing criteria. Interrater reliability was determined for each rater in comparison to the gold standard, using intraclass correlation (ICC) and kappa statistics. Student and clinician interrater reliability were compared using t-tests. The scoring of clocks with poor agreement was examined further in order to identify disparities. The student and clinician groups demonstrated excellent reliability for ICC (0.83 and 0.84 respectively) and moderate reliability for kappa statistics (0.58 and 0.59). The differences between the groups were not significant (p > 0.05). Scoring disparities were seen in the formation of the circle or in the placement of the numbers. The results support reliable scoring for the clock drawing item in the OT-APST.
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Affiliation(s)
- Wendy Eggins
- Formerly an honours student at The University of Queensland, Brisbane, Queensland, Australia
| | | | - Deirdre Cooke
- Mater Private Hospital, Rehabilitation Unit, Brisbane, Queensland, Australia
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Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The Clock Drawing Test: A review of its accuracy in screening for dementia. Dement Neuropsychol 2009; 3:74-81. [PMID: 29213615 PMCID: PMC5619222 DOI: 10.1590/s1980-57642009dn30200002] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The Clock Drawing Test (CDT) is a simple neuropsychometric instrument that can be easily applied to assess several cognitive functions. Over the past 20 years, the CDT has aroused considerable interest in its role for the early screening of cognitive impairment, especially in dementia. Although the CDT is considered an accurate test for dementia screening, recent studies including comparisons with structured batteries such as the CAMCOG have shown mixed results. Objectives To investigate the importance of the CDT compared to other commonly used tests, in the diagnosis of dementia in the elderly; (2) to evaluate the reliability and correlation between available CDT scoring scales from recent studies. Methods A systematic search in the literature was conducted in September 2008 for studies comparing CDT scoring systems and comparing the CDT with neuropsychiatric batteries. Results Twelve studies were selected for analyses. Seven of these studies compared CDT scoring scales while five compared the CDT against the CAMCOG and the MMSE. Eight studies found good correlation and reliability between the scales and the other tests. Conclusion Despite the mixed results in these studies, the CDT appears to be a good screening test for dementia.
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Affiliation(s)
- Ivan Aprahamian
- MD, MSc, Psychogeriatric Unit, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, SP, Brazil. Gerontology Division, University of Campinas
| | - José Eduardo Martinelli
- MD, MSc, PhD, Assistant Professor, Geriatrics Division, Jundiaí Medical School, Jundiaí, SP, Brazil
| | | | - Mônica Sanches Yassuda
- PhD, Assistant Professor of Gerontology, School of Arts, Sciences and Humanities (EACH), University of São Paulo. Psychogeriatric Unit, Laboratory of Neuroscience (LIM 27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Brum PS, Forlenza OV, Yassuda MS. Cognitive training in older adults with Mild Cognitive Impairment: Impact on cognitive and functional performance. Dement Neuropsychol 2009; 3:124-131. [PMID: 29213623 PMCID: PMC5619230 DOI: 10.1590/s1980-57642009dn30200010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 04/30/2009] [Indexed: 11/22/2022] Open
Abstract
Aging is associated with cognitive decline, yet this does not prevent older adults from finding ways to compensate for age-related deficits. Earlier studies have shown that cognitively unimpaired older adults can benefit from training programs. The efficacy of cognitive interventions among older adults without dementia but with cognitive decline (mild cognitive impairment, MCI) has not yet been widely tested. OBJECTIVES To evaluate the impact of 8-session cognitive training on the cognitive and functional performance of older adults with MCI. METHODS 16 older adults diagnosed with MCI received cognitive training (18 participated as controls). All participants were assessed pre and post intervention using the Short Cognitive Test (SKT), Direct Assessment of Functional Scale Revised (DAFS-R), Geriatric Depression Scale (GDS), and Clock Drawing Test (CDT). RESULTS A significant improvement was observed in the study group between pre and post-test in attention (SKT), time orientation, shopping skills and dealing with finances (DAFS-R) along with reduced depressive symptoms (GDS). CONCLUSION These results indicate the importance of non-pharmacological interventions for older adults with MCI to help compensate for cognitive decline.
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Affiliation(s)
| | - Orestes Vicente Forlenza
- MD, Psychiatrist. Collaborating Professor and PhD in
Medicine from the Department of Psychiatry of the Faculty of Medicine of the
University of São Paulo, São Paulo, SP, Brazil
| | - Mônica Sanches Yassuda
- PhD, Assistant Professor of the Gerontology EACH-USP.
Researcher at the Psychogeriatric Outpatient Unit, LIM-27, IPq FMUSP, São
Paulo, SP, Brazil
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Lourenço RA, Ribeiro-Filho ST, Moreira IDFH, Paradela EMP, Miranda ASD. The Clock Drawing Test: performance among elderly with low educational level. BRAZILIAN JOURNAL OF PSYCHIATRY 2008; 30:309-15. [DOI: 10.1590/s1516-44462008000400002] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 08/11/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To compare the accuracy of four scales, and to determine the inter-rater reliability and the influence of schooling on Clock Drawing Test performance in screening for dementia in elderly with low educational level. METHOD: Design: Criterion validation, concurrent type. Setting: Outpatient unit of Universidade do Estado do Rio de Janeiro Hospital, Brazil. Participants: A total of 306 individuals (> 65 years) were assessed by a geriatrician and a neuropsychologist using functional and cognitive instruments. The diagnosis of dementia was established by consensus in a meeting between these professionals. Four different researchers blinded as to the cognitive status of the patients scored the Clock Drawing Test using Shulman's, Sunderland's, Manos', and Wolf-Klein's methods; and a fifth researcher assessed Manos' method for an inter-rater reliability study. RESULTS: The data of 211 individuals (≤ 4 years of schooling) were analyzed. The sensitivity and specificity of the four methods were similar (about 65%). The inter-rater reliability of Manos' method was excellent (ICC = 0.944). The areas under the ROC curves were small (0.657 to 0.681), and the differences between them were not statistically significant. CONCLUSIONS: The Clock Drawing Test is a reliable but not valid test to screen for dementia in older outpatients with 4 or less years of formal schooling.
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Affiliation(s)
- Roberto Alves Lourenço
- Universidade do Estado do Rio de Janeiro, Brazil; Universidade do Estado do Rio de Janeiro, Brazil
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Atalaia-Silva KC, Lourenço RA. Tradução, adaptação e validação de construto do Teste do Relógio aplicado entre idosos no Brasil. Rev Saude Publica 2008; 42:930-7. [DOI: 10.1590/s0034-89102008000500020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 04/14/2008] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Poucos estudos no Brasil investigaram a validação de testes cognitivos em amostras populacionais de idosos e nenhum deles analisou as propriedades psicométricas do Teste do Relógio de Tuokko. O objetivo do estudo foi traduzir e adaptar o modelo desse teste ao contexto brasileiro e avaliar sua validade de construto. MÉTODOS: Estudo transversal com uma amostra populacional constituída por 353 sujeitos de Juiz de Fora (MG), 2004-2005. Para avaliar as validades convergente e discriminante, utilizou-se a correlação de Pearson. Os subtestes do Teste do Relógio foram correlacionados com os instrumentos de referência: cubos e dígitos, e mini-exame do estado mental para avaliar a validade convergente. A validade discriminante foi investigada por meio da correlação dos subtestes com a Center for Epidemiologic Studies Depression Scale. RESULTADOS: Da amostra, 74,1% eram do sexo feminino, com idade entre 63 e 107 anos (73,8+8,5) e média de escolaridade foi 7,4 anos (DP=4,7). Obteve-se validade convergente, com correlações estatisticamente significativas entre todos os subtestes (p<0,01). Quanto à validade discriminante, o único subteste que teve correlação significativa com a escala de referência foi o "indicação das horas" (p<0,05). CONCLUSÕES: O Teste de Relógio traduzido e adaptado em uma amostra comunitária de idosos mostrou ser um instrumento de rastreio cognitivo breve, com boa validade de construto quando analisado com outros dados da literatura. Futuros trabalhos devem investigar outras propriedades psicométricas, como as validades de critério e de conteúdo.
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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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Affiliation(s)
- Ricardo Nitrini
- Departamento Científico de Neurologia Cognitiva e do Envelhecimento, Academia Brasileira de Neurologia, Brazil.
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