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de Almeida MA, Barbosa MT, Resende EDPF, Carvalho VA, Santos APB, Machado JCB, Lara VP, Gomes KB, Machado TH, Caramelli P. Association of Alcohol Consumption with Cognition and Functionality in Older Adults Aged 75+ Years: The Pietà Study. Can J Aging 2024:1-11. [PMID: 38467581 DOI: 10.1017/s0714980824000126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024] Open
Abstract
The relationship between alcohol consumption and cognition is still controversial. This is a cross-sectional population-based study conducted in Caeté (MG), Brazil, where 602 individuals aged 75+ years, 63.6% female, and with a mean education of 2.68 years, were submitted to thorough clinical assessments and categorized according to the number of alcoholic beverages consumed weekly. The prevalence rates of previous and current alcohol consumption were 34.6% and 12.3%, respectively. No association emerged between cognitive diagnoses and current/previous alcohol consumption categories. Considering current alcohol intake as a dichotomous variable, the absence of alcohol consumption was associated with dementia (OR = 2.34; 95%CI: 1.39-3.90) and worse functionality (p = 0.001). Previous consumption of cachaça (sugar cane liquor) increased the risk of dementia by 2.52 (95%CI: 1.25-5.04). The association between the consumption of cachaça and dementia diagnosis has not been described before.
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Affiliation(s)
- Mariana Alves de Almeida
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Elisa de Paula França Resende
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, MG, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil
| | - Viviane Amaral Carvalho
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Ana Paula Borges Santos
- Hospital das Clínicas da Universidade Federal de Minas Gerais/EBSERH, Belo Horizonte, MG, Brazil
| | | | - Vivian Proença Lara
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Karina Braga Gomes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Thais Helena Machado
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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2
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Agnollitto MISS, Leoni RF, Foss MP, Palaretti J, Cayres M, Pansarim V, Nather JC, Zotin MCZ, Ferrioli E, Lima NK, dos Santos AC, Moriguti JC. Influence of cerebral blood flow on volumetric loss related to Alzheimer's disease. Dement Neuropsychol 2023; 17:e20230004. [PMID: 37810430 PMCID: PMC10552620 DOI: 10.1590/1980-5764-dn-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/04/2023] [Accepted: 05/24/2023] [Indexed: 10/10/2023] Open
Abstract
CBF measured with Arterial Spin Labeling (ASL) obtained by Magnetic Resonance Imaging (MRI) may become an important biomarker by showing changes in early stages of AD, such as in the prodromal stage of Mild Cognitive Impairment (MCI). Objective Verify the correlation between atrophy and CBF in patients with MCI and mild phase ADD, to demonstrate whether changes in CBF can be considered as vascular biomarkers in the diagnosis of the DA continuum. Methods 11 healthy volunteers, 16 MCI and 15 mild ADD were evaluated. Images of the brain were acquired, including CBF measured with Arterial Spin Labeling (ASL). Results When comparing MCI with control, a reduction in normalized CBF was observed in left posterior cingulate (estimated difference -0.38; p=0.02), right posterior cingulate (estimated difference -0.45; p=0.02) and right precuneus (estimated difference -0.28; p <0.01); also increase in normalized CBF in right upper temporal pole (estimated difference 0.22; p=0.03). It was also observed that in MCI, the smaller the gray matter volume, the smaller the CBF in the left posterior cingulate; as well as the greater the cerebrospinal fluid volume, consequent to the encephalic volumetric reduction associated with atrophy, the greater the CBF in the right superior temporal pole. When comparing controls, MCI and mild AD, in relation to the other variables, no other correlations were observed between CBF and atrophy. Conclusion In patients with MCI, the reduction of CBF in the left posterior cingulate correlated with gray matter atrophy, as well as the increase of CBF in the right upper temporal pole correlated with an increase in cerebrospinal fluid consequent to the encephalic volumetric reduction associated with atrophy, demonstrating the influence of CBF in AD related brain atrophy. These findings position CBF as a possible vascular biomarker for early-stage AD diagnoses.
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Affiliation(s)
| | - Renata Ferranti Leoni
- Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Maria Paula Foss
- Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Julia Palaretti
- Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Marcela Cayres
- Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Vitor Pansarim
- Universidade de São Paulo, Faculdade de Filosofia Ciências e Letras de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Julio Cesar Nather
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Maria Clara Zanon Zotin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Eduardo Ferrioli
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | - Nereida Kilza Lima
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
| | | | - Julio Cesar Moriguti
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil
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Carmona KC, Resende EDPF, Guimarães HC, Machado TH, Amaral-Carvalho V, Santos ELD, Barbosa MT, Caramelli P. High performance older adults in a population-based sample with low education: Pietà study. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:112-118. [PMID: 36948197 PMCID: PMC10033194 DOI: 10.1055/s-0042-1759760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Healthy brain aging can be defined as aging without neurological or psychiatric disorders, sustaining functional independence. In addition to the absence of disease and preserved functionality, there are individuals who stand out for their superior performance to that considered normal for their age in cognitive tests. These individuals are called "high-performance older adults" (HPOA). OBJECTIVES To investigate the presence of HPOA in an oldest-old population with low education, and if present, to investigate associations with sociodemographic, clinical, and lifestyle variables. METHODS We evaluated 132 cognitively healthy individuals from the Pietà Study, a population-based investigation with 639 participants. We used the delayed recall from the Rey Auditory-Verbal Learning Test to verify the existence of HPOA and to classify participants based on their performance. Sociodemographic, clinical, and lifestyle variables associated with HPOA were investigated. RESULTS We identified 18 individuals fulfilling HPOA criteria (age: 77.4 ± 2.6 years old; 14 women; education: 4.6 ± 3.4 years). The other participants, 114 total (age: 79.8 ± 4.5 years old; 69 women; education: 3.0 ± 2.7 years) were classified as "standard performance older adults" (SPOA). In multivariate analysis, younger age (odds ratio [OR] = 0.672; 95% confidence interval [CI]: 0.462-0.979; p = 0.037) and lower scores on the Geriatric Depression Scale (OR = 0.831; 95%CI: 0.688-0.989; p = 0.038) were associated with HPOA. CONCLUSIONS The present study identifies for the first time HPOA with low educational level, thereby reinforcing the existence of biological substrates related to this condition. Furthermore, the data suggest an association between younger age and less depressive symptoms with HPOA.
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Affiliation(s)
- Karoline Carvalho Carmona
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Elisa de Paula França Resende
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Henrique Cerqueira Guimarães
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Thais Helena Machado
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
| | - Viviane Amaral-Carvalho
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
| | - Etelvina Lucas Dos Santos
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
| | - Maira Tonidandel Barbosa
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
- Faculdade de Ciências Médicas de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Faculdade de Medicina, Grupo de Pesquisa em Neurologia Comportamental e Cognitiva, Belo Horizonte MG, Brazil
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Núñez-Fernández S, Rivera D, Arroyo-Anlló EM, Ortiz Jiménez XA, Camino-Pontes B, Salinas Martínez R, Arango-Lasprilla JC. Validation of the Norma Latina Neuropsychological Assessment Battery in Patients with Alzheimer's Disease in Mexico. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11322. [PMID: 36141594 PMCID: PMC9517570 DOI: 10.3390/ijerph191811322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
To our knowledge, this is the first study reported in the literature that has validated the Norma Latina Battery in a population of people with Alzheimer's disease (AD) in Mexico. The objective of the study was to determine the discriminant validity of the Norma Latina Battery in a group of Mexican individuals with AD and a group of heathy controls (HC). The Norma Latina Battery was administered to 234 Mexican participants (117 HC and 117 individuals with AD). Results show that: (1) the Norma Latina Battery has high discriminative capacity between groups in all domains; (2) participants with AD presented worse scores in each of the cognitive domains compared to the HC and a greater number of low scores in each of the established thresholds or cut-off points; and finally, (3) the Norma Latina Battery had optimal sensitivity and specificity, especially when a set was observed ≥5 scores below the 10th percentile or ≥4 scores below the 5th percentile. In conclusion, it is recommended that both clinicians and researchers use this battery in the evaluation of Mexican people with AD to better understand the prognosis of the disease and its subsequent treatment.
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Affiliation(s)
- Silvia Núñez-Fernández
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
- Neuroscience Institute of Castilla-León, University of Salamanca, 37007 Salamanca, Spain
| | - Diego Rivera
- Department of Health Sciences, Public University of Navarre, 31006 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
| | - Eva María Arroyo-Anlló
- Department of Psychobiology, Neuroscience Institute of Castilla-León, University of Salamanca, 37007 Salamanca, Spain
| | | | - Borja Camino-Pontes
- Biocruces Bizkaia Health Research Institute, 48903 Barakaldo, Spain
- Biomedical Research Doctorate Program, University of the Basque Country (UPV/EHU), 48940 Leioa, Spain
| | - Ricardo Salinas Martínez
- Department of Geriatrics, “José Eleuterio González” University Hospital, Autonomous University of Nuevo León, Monterrey 64460, Mexico
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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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6
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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] [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
| | - Norberto Anízio Ferreira Frota
- Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brasil.,Universidade de Fortaleza, Fortaleza CE, 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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de Paula JJ, Romanelli LC, de Faria RCV, Proietti AB, Malloy-Diniz LF, Romano-Silva MA, de Miranda DM, Nicolato R. Cognitive impairment in the HTLV-1 infection: a comparative study associated with functional performance. J Neurovirol 2021; 27:849-856. [PMID: 32955704 DOI: 10.1007/s13365-020-00905-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 06/30/2020] [Accepted: 08/28/2020] [Indexed: 12/01/2022]
Abstract
Human T cell leukemia virus type-I (HTLV-1) infection courses with a myelopathy, the tropical spastic paraparesis (HAM/TSP). In a case-control study, we compared the neuropsychological profile and functional characteristics in two case HTLV-1-infected groups (asymptomatic and with HAM/TSP) with a control group negative for HTLV-1. Subjects were paired for age, sex, and educational features. The case group differed from control group in neuropsychological measures such as in episodic memory recall, executive functions, and fine motor dexterity measure. Individuals with HAM/TSP have more depressive symptoms and worst performance in activities of daily living (ADL) presenting a less functionality. In multivariate models, the fine motor performance, the executive functioning, the recognition memory, and the depressive symptoms explained part of the variance in functionality. Those findings may contribute to understand of everyday life impairments and limitations of HTLV-1-infected population and to organize the rehabilitation. Once more, based in neuropsychological and functional data, we can reaffirm that HTLV-1 is never a benign condition, but sometimes it is only in a stage coursing with less symptoms.
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Affiliation(s)
- Jonas Jardim de Paula
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | | | - Renata Caetano Vieira de Faria
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Leandro Fernandes Malloy-Diniz
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Marco Aurélio Romano-Silva
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Debora Marques de Miranda
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Pediatria Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Rodrigo Nicolato
- Centro de Tecnologia em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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8
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Machado TH, Carthery-Goulart MT, Campanha AC, Caramelli P. Cognitive Intervention Strategies Directed to Speech and Language Deficits in Primary Progressive Aphasia: Practice-Based Evidence from 18 Cases. Brain Sci 2021; 11:brainsci11101268. [PMID: 34679333 PMCID: PMC8533834 DOI: 10.3390/brainsci11101268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Practice-based evidence can inform and support clinical decision making. Case-report series about the implementation of programs in real-world clinical settings may contribute to verifying the effectiveness of interventions for treating PPA in specific contexts, as well as illustrating challenges that need to be overcome. OBJECTIVE To describe and provide practice-based evidence on the effectiveness of four cognitive rehabilitation programs designed for individuals with PPA and directed to speech and language impairments, which were implemented in a specialized outpatient clinic. METHODS Multiple single-case study. Eighteen individuals with different subtypes of PPA were each assigned to one out of four training programs based on comprehensive speech and language assessments. The treatments targeted naming deficits, sentence production, speech apraxia, and phonological deficits. Pre- and post-treatment assessments were undertaken to compare trained and untrained items. Gains were generalized to a different task in the first two types of intervention (naming and sentence production). A follow-up assessment was conducted 1-8 months after treatment among 7 participants. RESULTS All individuals presented better performance in the trained items at the post-test for each rehabilitation program accomplished, demonstrating that learning of the trained strategies was achieved during the active phase of treatment. For 13 individuals, statistical significance was reached; while for five, the results were maintained. Results about untrained items, generalization to other tasks, and follow-up assessments are presented. CONCLUSIONS The positive results found in our sample bring some practice-based evidence for the benefits of speech and language treatment strategies for clinical management of individuals with PPA.
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Affiliation(s)
- Thais Helena Machado
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Av Prudente de Morais, 290-Sala 1106, Belo Horizonte 30380-002, MG, Brazil
- Correspondence:
| | - Maria Teresa Carthery-Goulart
- Grupo de Estudos em Neurociência da Linguagem e Cognição, Núcleo Interdisciplinar de Neurociência Aplicada, Centro de Matemática, Computação e Cognição da Universidade Federal do ABC, São Bernardo do Campo 09210-580, SP, Brazil;
- Grupo de Neurologia Cognitiva e do Comportamento, Divisão de Clínica Neurológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil
- INCT-ECCE (Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino), Rodovia Washington Luís, Km 235, São Carlos 13565-905, SP, Brazil
| | - Aline Carvalho Campanha
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
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9
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Diabetes and impaired fasting glucose in a population-based sample of individuals aged 75 + years: associations with cognition, major depressive disorder, functionality and quality of life-the Pietà study. Neurol Sci 2021; 42:3663-3671. [PMID: 33439392 DOI: 10.1007/s10072-020-05008-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate the rates of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a population-based sample of individuals aged 75 + years old and their associations with cognitive performance, depression, functionality, and quality of life (QoL). STUDY DESIGN Overall, 350 people participated in the study. Assessments of cognition, mood, functionality and QoL were performed using the mini-mental state examination (MMSE), clock-drawing, category fluency tests, the Mini-International Neuropsychiatric Interview, Pfeffer's Functional Activities Questionnaire, and the WHO Quality of Life-Old (WHOQOL-OLD). RESULTS IFG (ADA criteria) was identified in 42.1% of the sample, while the DM rate was 24.1%. Lack of knowledge of the DM diagnosis and lack of treatment occurred in 27% and 39% of the sample, respectively. Rates of dementia and depression, MMSE, category fluency scores, and previous cardiovascular events did not differ between the glycaemic groups. Individuals with DM performed worse on the clock-drawing test, functionality, and WHOQOL-OLD than the other participants. Individuals with IFG presented similar QoL and functionality when compared with the group without DM. CONCLUSIONS IFG and DM were common in this population-based sample aged 75 + years old, as were inadequate diagnoses and treatments of DM. DM individuals presented poor performance in the executive function test, functionality, and QoL. Further studies are recommended to investigate the value of an IFG diagnosis among the most elderly population.
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10
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Vieira EL, Mendes-Silva AP, Ferreira JD, Bertola L, Barroso L, Vieira M, Teixeira AL, Diniz BS. Oxidative DNA damage is increased in older adults with a major depressive episode: A preliminary study. J Affect Disord 2021; 279:106-110. [PMID: 33045551 DOI: 10.1016/j.jad.2020.09.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/02/2020] [Accepted: 09/17/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND DNA oxidative damage is a marker of increased oxidative stress activity. Elevated DNA oxidative damage has been associated with major depressive disorder in young adults, but there is no information about DNA oxidative damage in late-life depression. This study aims to evaluate whether older adults with late-life depression (LLD) has increased DNA oxidative damage compared to healthy older adults. METHODS We included 92 participants (57 with LLD [73.2 ± 7.7 years-old] and 35 non-depressed subjects (Controls) [70.5 ± 7.4 years-old]). We analyzed the plasma 8‑hydroxy-2'-deoxyguanosine (8-oxo-dG), a marker of DNA oxidation, using a commercially-available ELISA assay. RESULTS LLD participants had significantly higher 8-oxo-DG levels compared to controls (P<0.001). 8-oxo-dG levels were significantly correlated with depressive symptoms as assessed by the Hamilton Depression Rating Scale (rho=0.34, p<0.001). The plasma levels of 8-OHdG were not significantly correlated with other clinical, neurocognitive, and demographic variables. LIMITATIONS Our current results are limited by the relatively small sample size, cross-sectional design, and the recruitment of participants in tertiary center for assessment and treatment of LLD. CONCLUSIONS Older adults with LLD have increased DNA oxidative damage. Our findings provide additional evidence for elevated oxidative stress activity in LLD and the possible activation of age-related biological pathways and enhanced biological aging changes in LLD.
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Affiliation(s)
- Erica L Vieira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Ana Paula Mendes-Silva
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jessica D Ferreira
- Geriatric Psychiatry Service, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Laiss Bertola
- Geriatric Psychiatry Service, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Lucelia Barroso
- Molecular Medicine Graduate Program, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Monica Vieira
- Molecular Medicine Graduate Program, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Antonio L Teixeira
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Breno S Diniz
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Adult Neurodevelopment and Geriatric Psychiatry Division, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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11
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Carvalho GA, Caramelli P. Normative data for middle-aged Brazilians in the Mattis Dementia Rating Scale. Dement Neuropsychol 2020; 14:350-357. [PMID: 33354287 PMCID: PMC7735059 DOI: 10.1590/1980-57642020dn14-040004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Despite the advances in the diagnosis of dementia, neuropsychological assessment remains an important tool. The Mattis Dementia Rating Scale (DRS) was designed to evaluate people with suspected dementia and allows for the analysis of different cognitive domains. Considering the numerous cases of early-onset dementia, specific reference standards aimed at the middle-aged population are necessary.
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Affiliation(s)
- Guilherme Almeida Carvalho
- Rede Sarah de Hospitais de Reabilitação - Belo Horizonte, MG, Brazil.,Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil.,Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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12
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Cecchini MA, Foss MP, Tumas V, Patrocinio FAP, Chiari-Correia RD, Novaretti N, Brozinga TR, Bahia VS, de Souza LC, Cerqueira Guimarães H, Caramelli P, Lima-Silva TB, Cassimiro L, Brucki SMD, Nitrini R, Della Sala S, Parra MA, Yassuda MS. Profiles of cognitive impairment in the continuum from normal cognition to Alzheimer's clinical syndrome: Contributions of the short-term memory binding tests. Int J Geriatr Psychiatry 2020; 35:1331-1340. [PMID: 32584463 DOI: 10.1002/gps.5370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/21/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Short-term memory binding (STMB) tests assess conjunctive binding, in which participants should remember the integration of features, such as shapes (or objects) and colors, forming a unique representation in memory. In this study, we investigated two STMB paradigms: change detection (CD) and free recall (FR). OBJECTIVE To investigate the cognitive profile in the CD and FR tasks of three diagnostic groups: cognitively unimpaired (CU), mild cognitive impairment (MCI), and Alzheimer's clinical syndrome (ACS). In addition, we aimed to calculate and compare the accuracy of the CD and FR tasks to identify MCI and ACS. METHODS Participants were 24 CU, 24 MCI, and 37 ACS. The cognitive scores of the clinical groups were compared using analysis of variance (ANOVA) and receiver-operating characteristic (ROC) analyses were carried out to verify the accuracy of the STMB tasks. RESULTS In the CD task, CU was different from MCI and ACS (CU > MCI = ACS), while in the FR task all groups were different (CU > MCI > ACS). The ROC analyses showed an area under the curve (AUC) of 0.855 comparing CU with MCI for the CD task and 0.975 for the FR. The AUC comparing CU and ACS was 0.924 for the CD and 0.973 for the FR task. The FR task showed better accuracy to identify MCI patients, and the same accuracy to detect ACS. CONCLUSION The present findings indicate that impairments in CD and FR of bound representations are features of the cognitive profiles of MCI and ACS patients.
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Affiliation(s)
- Mario Amore Cecchini
- Neurology, School of Medicine, University of São Paulo, Sao Paulo, Brazil.,Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK
| | - Maria Paula Foss
- Neurology, School of Medicine, University of São Paulo Ribeirão Preto, Sao Paulo, Brazil
| | - Vitor Tumas
- Neurology, School of Medicine, University of São Paulo Ribeirão Preto, Sao Paulo, Brazil
| | - Flávia A P Patrocinio
- Neurology, School of Medicine, University of São Paulo Ribeirão Preto, Sao Paulo, Brazil
| | - Rodolfo D Chiari-Correia
- Center of Image Sciences and Medical Physics, University of Sao Paulo Ribeirão Preto, Sao Paulo, Brazil
| | - Nathalia Novaretti
- Neurology, School of Medicine, University of São Paulo Ribeirão Preto, Sao Paulo, Brazil
| | - Tamara R Brozinga
- Neurology, School of Medicine, University of São Paulo Ribeirão Preto, Sao Paulo, Brazil
| | | | - Leonardo Cruz de Souza
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Cerqueira Guimarães
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paulo Caramelli
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Luciana Cassimiro
- Neurology, School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | | | - Ricardo Nitrini
- Neurology, School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Sergio Della Sala
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK
| | - Mario A Parra
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK.,Department of Psychology, Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Mônica Sanches Yassuda
- Neurology, School of Medicine, University of São Paulo, Sao Paulo, Brazil.,Gerontology, School of Arts, Sciences and Humanities, University of São Paulo, Sao Paulo, Brazil
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13
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Ortega LDFV, Aprahamian I, Borges MK, Cação JDC, Yassuda MS. Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 77:279-288. [PMID: 31090809 DOI: 10.1590/0004-282x20190024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/18/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). OBJECTIVE To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. METHODS Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. RESULTS We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. CONCLUSION For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.
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Affiliation(s)
- Luciane de Fátima Viola Ortega
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil
| | - Ivan Aprahamian
- Faculdade de Medicina de Jundiaí, Grupo de Investigação em Multimorbidades e Saúde Mental em Idosos, Disciplina de Geriatria e Gerontologia, Jundiaí SP, Brasil.,Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - Marcus Kiiti Borges
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Psiquiatria, São Paulo SP, Brasil
| | - João de Castilho Cação
- Faculdade de Medicina de São José do Rio Preto, Unidade de Geriatria, São José do Rio Preto SP, Brasil
| | - Mônica Sanches Yassuda
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Programa de Pós-Graduação em Gerontologia, Campinas SP, Brasil.,Universidade de São Paulo, Escola de Artes, Ciências e Humanidades, São Paulo SP, Brasil
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14
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Foss MP, Diniz PRB, da Roza DL, Gefen T, Maher AC, Formigheri P, Spedo CT, Salmon CEG, Tumas V, Speciali JG, Santos AC. Anatomic and neuropsychological findings in low-educated cognitively intact elderly from a Brazilian cohort. Dement Neuropsychol 2019; 13:378-385. [PMID: 31844490 PMCID: PMC6907709 DOI: 10.1590/1980-57642018dn13-040003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In elderly individuals, low educational level may represent a risk factor for the
development of dementia and a proxy of cognitive reserve. Objective: This study
examined the cognitive and neuroanatomic correlates of high versus low
educational levels in cognitively healthy community-dwelling older adults in
Brazil. Methods: Fifty-three older adults (mean age: 68±5.3 years) were divided
into a “low education” group [LE; 1-4 years of education (N=33)] and “high
education” group [HE; >11 years of education (N=20)]. Both groups completed a
comprehensive neuropsychological battery and underwent in vivo
structural MRI close to the time of testing. Results: Higher educational level
increased the chance of having better scores on neuropsychological tests,
including verbal and visual delayed recall of information, verbal learning,
category fluency, global cognition, and vocabulary. Better scores on these tests
were observed in the HE group relative to the LE group. Despite this, there were
no group differences between MRI measures. Conclusion: Older adults with higher
educational levels showed better scores on neuropsychological measures of
cognition, highlighting the need for education-adjusted norms in developing
countries. Given the absence of differences in structural anatomy between the
groups, these findings appear to be best explained by theories of cognitive
reserve.
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Affiliation(s)
- Maria Paula Foss
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Neurosciences Program, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto, SP, Brazil
| | - Paula Rejane Beserra Diniz
- Universidade Federal de Pernambuco (UFPE), Center of Telehealth (NUTES), Department of Clinical Medicine, Recife, PE, Brazil
| | - Daiane Leite da Roza
- University of São Paulo, Ribeirão Preto Medical School, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto, SP, Brazil
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Center, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Amanda Cook Maher
- Department of Psychiatry, Neuropsychology Division, University of Michigan, Ann Arbor, MI, 48105, USA
| | - Paulo Formigheri
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Program of Internal Medicine, Ribeirão Preto/SP, Brazil
| | - Carina T Spedo
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Neurosciences Program, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto, SP, Brazil
| | - Carlos Ernesto Garrido Salmon
- Universidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto (FFCLRP), Department of Physics. Ribeirão Preto, SP, Brazil
| | - Vitor Tumas
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Neurosciences Program, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto, SP, Brazil
| | - José Geraldo Speciali
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Neurosciences Program, Department of Neurosciences and Behavioral Sciences, Ribeirão Preto, SP, Brazil
| | - Antônio Carlos Santos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Department Internal Medicine, Radiology Division, Ribeirão Preto, SP, Brazil
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15
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de Souza LC, Mariano LI, de Moraes RF, Caramelli P. Behavioral variant of frontotemporal dementia or frontal variant of Alzheimer's disease? A case study. Dement Neuropsychol 2019; 13:356-360. [PMID: 31555411 PMCID: PMC6753911 DOI: 10.1590/1980-57642018dn13-030015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Alzheimer's disease (AD) has heterogeneous clinical presentations. Amnestic progressive disorder leading to dementia is the most typical, but non-amnestic presentations are also recognized. Here we report a case of frontal variant of AD. A right-handed woman, aged 68 years, was referred for progressive behavioral disorders and personality changes. She had a corroborated history of dietary changes, hyperorality, impulsivity, affective indifference and apathy, with functional impairment. Cognitive assessment yielded severe executive deficits. Positron emission tomography with fluorodeoxyglucose showed marked hypometabolism in frontotemporal regions, with relative preservation of parietal regions. CSF AD biomarkers showed low Aβ42, high Tau and high P-Tau. The patient fulfilled criteria for probable behavioral variant frontotemporal dementia. However, considering the AD pathophysiological signature on CSF biomarkers, a diagnosis of frontal variant of AD was established. In the perspective of disease-modifying therapies, it is important to identify atypical Alzheimer presentations, as these patients may be candidates for specific treatments.
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Affiliation(s)
- Leonardo Cruz de Souza
- Universidade Federal de Minas Gerais Programa de Pós-Graduação em Neurociências Belo HorizonteMG Brazil Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,UFMG Faculdade de Medicina Departamento de Clínica Médica Belo HorizonteMG Brazil Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Luciano Inácio Mariano
- Universidade Federal de Minas Gerais Programa de Pós-Graduação em Neurociências Belo HorizonteMG Brazil Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Paulo Caramelli
- Universidade Federal de Minas Gerais Programa de Pós-Graduação em Neurociências Belo HorizonteMG Brazil Programa de Pós-Graduação em Neurociências, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,UFMG Faculdade de Medicina Departamento de Clínica Médica Belo HorizonteMG Brazil Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
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16
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Champs APS, de Azeredo Passos VM, Carvalho G, Barreto SM, Meirelles C, Caramelli P. Cognitive impairment in HTLV-1-associated myelopathy, proviral load and inflammatory markers. Int J Infect Dis 2019; 84:121-126. [PMID: 31085316 DOI: 10.1016/j.ijid.2019.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/02/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Myelopathy is a well-established long-term clinical manifestation of HTLV-1 infection. Besides motor dysfunction, cognitive impairment may be another consequence of HTLV-1 infection. Moreover, inflammatory markers may be associated with cognitive impairment in these patients. The present study compared the cognitive performance of HAM/TSP patients with healthy controls and investigated the associations between cognitive performance, proviral load and blood inflammatory markers. METHODS Eighty-three patients fulfilling diagnostic criteria for HAM/TSP were submitted to a comprehensive clinical, cognitive and functional evaluation, brain magnetic resonance imaging and determination of levels of IL-1β, IL-6, TNF-α, immunoglobulins and HTLV-1 proviral load in blood and cerebrospinal fluid. The control group was composed of 88 cognitively healthy subjects, matched for age, sex and educational level. RESULTS Compared to healthy subjects, HAM/TSP patients displayed significant global cognitive impairment and executive function deficits. HAM/TSP cognitive impairment was significantly associated with altered levels of IgM, IgG, IL-6 and TNF-α in blood. There was no association between HAM/TSP cognitive impairment and HTLV-1 proviral load. CONCLUSIONS This study suggests cognitive impairment may be a long-term clinical manifestation of HTLV-1 infection, which seems to be linked to the persistent inflammatory activity that is found in the disease.
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Affiliation(s)
- Ana Paula Silva Champs
- Hospital Sarah Belo Horizonte, Belo Horizonte, MG, Brazil; Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - Valéria Maria de Azeredo Passos
- Faculdade de Ciências Médicas de Minas Gerias, Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Guilherme Carvalho
- Hospital Sarah Belo Horizonte, Belo Horizonte, MG, Brazil; Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Sandhi Maria Barreto
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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17
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Cintra MTG, Ávila RT, Soares TO, Cunha LCM, Silveira KD, de Moraes EN, Simas KR, Fernandes RB, Gonçalves DU, de Rezende NA, Bicalho MAC. Increased N200 and P300 latencies in cognitively impaired elderly carrying ApoE ε-4 allele. Int J Geriatr Psychiatry 2018; 33:e221-e227. [PMID: 28833437 DOI: 10.1002/gps.4773] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 07/12/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the results of neuropsychological tests, evoked potentials N200 and P300 and polymorphisms of ApoE and BDNF rs6265 between patients with normal cognition and those with mild cognitive impairment (MCI) and Alzheimer's dementia (AD). METHODS This is a cross-sectional study of elderly individuals with normal cognition and those with MCI and AD, who were submitted to evoked potential tests (N200 and P300) by means of hearing stimuli based on the auditory oddball paradigm. Genotyping was obtained by using the real-time PCR technique. RESULTS Sixty-five patients were evaluated as follows: 14 controls, 34 with MCI and 17 with AD. N200 latency and P300 latency and amplitude were not associated with MCI and AD diagnosis. Patients with cognitive impairment (MCI or AD) showed increase in the latencies of P300 and N200. BNDF gene was not associated with cognitive impairment. CONCLUSION Latencies of N200 and P300 increased in cognitively impaired patients with the presence of ApoE ε-4 allele.
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Affiliation(s)
| | - Rafaela Teixeira Ávila
- Neuropsychologist of Clinical Hospital of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Thayana Oliveira Soares
- Molecular Medicine Postgraduate Program of Universidade Federal de Mina Gerais, Belo Horizonte, Brazil
| | | | - Katia Daniela Silveira
- Department of Biochemistry and Immunology of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Edgar Nunes de Moraes
- Department of Medical Clinic of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kaique Roger Simas
- Medicine Student of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Denise Utsch Gonçalves
- Department of Ophthalmology and Otorhinolaryngology of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Nilton Alves de Rezende
- Department of Medical Clinic of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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18
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Barcelos LB, Saad F, Giacominelli C, Saba RA, de Carvalho Aguiar PM, Silva SMA, Borges V, Bertolucci PHF, Ferraz HB. Neuropsychological and clinical heterogeneity of cognitive impairment in patients with multiple system atrophy. Clin Neurol Neurosurg 2018; 164:121-126. [DOI: 10.1016/j.clineuro.2017.10.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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19
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Faria CDA, Alves HVD, Barbosa ENBE, Charchat-Fichman H. Cognitive deficits in older adults with mild cognitive impairment in a two-year follow-up study. Dement Neuropsychol 2018; 12:19-27. [PMID: 29682229 PMCID: PMC5901245 DOI: 10.1590/1980-57642018dn12-010003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 11/16/2017] [Indexed: 01/24/2023] Open
Abstract
Characterizing cognitive decline in older adults with MCI over time is important to identify the cognitive profile of those who convert to dementia. OBJECTIVE This study examined the two-year cognitive trajectory of elderly adults diagnosed with MCI, from geriatrics and neurology outpatient clinics of a public hospital in Rio de Janeiro. METHODS 62 older adults with MCI were submitted to a neuropsychological battery and re-evaluated after two years. The Mann-Whitney U test was employed to assess differences between groups with respect to education, functioning, the Geriatric Depression Scale and diagnosis. RESULTS 24.2% converted to dementia after two years. The group with declines in two or more cognitive functions had a higher conversion rate to dementia than the group with decline in executive functions (EF) only (Z = -2.11, p = .04). The EF decline group had higher scores on the depression scale than both the memory decline group (Z = -1.99, p = .05) and multiple decline group (Z = -2.23, p = .03). CONCLUSION The present study found different cognitive decline profiles in elderly adults with MCI and differences between them regarding depressive symptoms and rate of conversion to dementia.
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20
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de Paula JJ, Oliveira TD, Querino EHG, Malloy-Diniz LF. The Five Digits Test in the assessment of older adults with low formal education: construct validity and reliability in a Brazilian clinical sample. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 39:173-179. [DOI: 10.1590/2237-6089-2016-0060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 04/16/2017] [Indexed: 11/22/2022]
Abstract
Abstract Introduction In the assessment of older adults with very low formal education, typical tests of selective attention and inhibitory control are biased by reading abilities. In this sense, we aim to assess the psychometric characteristics of the Five Digits Test (FDT), a numerical Stroop paradigm, in older adults without cognitive disorders, with mild cognitive impairment, and with dementia. Methods We assessed 211 Brazilian older adults with low formal education using the FDT and other cognitive measures. Construct validity and reliability were assessed by correlations and internal consistency. Results The FDT test had weak correlations with crystalized intelligence tests and moderate-high correlations with fluid intelligence measures and tests of global cognitive status and executive functions. The split-half coefficient of reliability showed high internal consistency (>0.900). Conclusion Together, the results suggest that the FDT is a valid and reliable measure for the assessment of processing speed and executive functions in older adults with low formal education.
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Affiliation(s)
- Jonas Jardim de Paula
- Faculdade de Ciências Médicas de Minas Gerais, Brazil; Universidade Federal de Minas Gerais, Brazil
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21
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Cintra FCMDC, Cintra MTG, Nicolato R, Bertola L, Ávila RT, Malloy-Diniz LF, Moraes EN, Bicalho MAC. Functional decline in the elderly with MCI: Cultural adaptation of the ADCS-ADL scale. Rev Assoc Med Bras (1992) 2017; 63:590-599. [DOI: 10.1590/1806-9282.63.07.590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 01/02/2017] [Indexed: 01/12/2023] Open
Abstract
Summary Objective: Translate, transcultural adaptation and application to Brazilian Portuguese of the Alzheimer’s Disease Cooperative Study - Activities of Daily Living (ADCS-ADL) scale as a cognitive screening instrument. Method: We applied the back translation added with pretest and bilingual methods. The sample was composed by 95 elderly individuals and their caregivers. Thirty-two (32) participants were diagnosed as mild cognitive impairment (MCI) patients, 33 as Alzheimer’s disease (AD) patients and 30 were considered as cognitively normal individuals. Results: There were only little changes on the scale. The Cronbach alpha coefficient was 0.89. The scores were 72.9 for control group, followed by MCI (65.1) and by AD (55.9), with a p-value < 0.001. The ROC curve value was 0.89. We considered a cut point of 72 and we observed a sensibility of 86.2%, specificity of 70%, positive predictive value of 86.2%, negative predictive value of 70%, positive likelihood ratio of 2.9 and negative likelihood ratio of 0.2. Conclusion: ADCS-ADL scale presents satisfactory psychometric properties to discriminate between MCI, AD and normal cognition.
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Affiliation(s)
| | | | - Rodrigo Nicolato
- UFMG, Brazil; Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Brazil
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22
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Bellaj T, Ben Jemaa S, Khelifa M, Ben Djebara M, Gouider R, Le Gall D. The Development of the Dementia Screening Battery-100: Instrument Presentation, Reliability, and Construct Validity. Dement Geriatr Cogn Dis Extra 2017; 7:215-229. [PMID: 28690635 PMCID: PMC5498961 DOI: 10.1159/000477437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background/Aim The screening of dementia in non-Westerners has so far relied on translations and adaptations of reputed instruments. Other efforts focused on developing culturally appropriate tests or tests in touch with new developments in the field. This study presents the rationale behind the construction of a new dementia screening test: the Dementia Screening Battery-100 (DSB-100). Methods The DSB-100 was administered to 46 demented individuals and 159 healthy matched controls. All demented participants met the DSM-IV criteria for dementia. The healthy controls showed no cognitive impairment and were independent in activities of daily living. The DSB-100 was administered as part of a larger neuropsychological assessment to collect additional indices on the severity of patients' dementia, depression, and frontal dysfunctions. The same information was used for comparisons with DSB-100 scores. Results Multiple regression analysis suggested that age and education, but not the variable sex, are essential in predicting cognitive performance. Construct validation yielded 4 factors, namely attention-visuospatial factors, memory, language, and executive functions. The results showed that the DSB-100 has a high interrater reliability and an acceptable overall internal homogeneity. Conclusion These results validate the DSB-100 and suggest its appropriateness for dementia screening in Tunisian elderly and possibly elderly people from other cultures with modifications to some subscales.
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Affiliation(s)
- Tarek Bellaj
- Psychology Program, Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | - Sonia Ben Jemaa
- Faculty of Human and Social Sciences of Tunis, Tunis University, Tunis, Tunisia
| | - Maher Khelifa
- Psychology Program, Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, Qatar
| | | | | | - Didier Le Gall
- Laboratoire de Psychologie des Pays de la Loire, University of Angers, Bretagne-Loire University, Angers, France
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23
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Schelp AO, Mendes-Chiloff CL, Paduan VC, Corrente JE, Vieira A, Marchette JCN, de Souza JT, Luvizuto GJ, Nogueira CR, Bazan R. Amnestic dementia impairment in Parkinson's disease: The role of body composition, ageing and insulin resistance. Clin Nutr ESPEN 2017; 20:47-51. [PMID: 29072169 DOI: 10.1016/j.clnesp.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 03/08/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The risk of cognitive impairment associated with Parkinson's disease (PD) is related to ageing. The role of body compartmentalization and associated metabolic dysfunctions, as a risk factor for dementia in PD is still not clear. OBJECTIVE To investigate body mass distribution, insulin resistance, and other parameters in patients without dementia, and those with dementia classified as compromised delayed memory. SUBJECTS AND METHODS We recorded body composition, basal levels of insulin resistance, and other data from 135 patients, who were followed for at least two years. The patients completed a Brief Cognitive Battery test. Patients with delayed recall memory impairment were assessed using the Mattis dementia rating scale. RESULTS There was a correlation between age and the patient's scores. Age was negatively correlated with scores on all of the screening battery subtests (p ≤ 0.001), while formal education was positively correlated with the test scores. Insulin resistance was higher in non-demented patients compared to patients with impaired memory (p = 0.0027). There was no association between body composition and cognitive dysfunction in patients with PD. CONCLUSIONS The results of this study indicate an apparent decrease in insulin resistance associated with cognitive impairment in PD. We found no correlations between body composition and memory dysfunction associated with PD.
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Affiliation(s)
- Arthur Oscar Schelp
- Department of Neurology, Psychology and Psychiatry - Univ Estadual Paulista (UNESP), Brazil; Neurology Fellowship, Dept. of Neurology, Psychology, and Psychiatry - Univ Estadual Paulista (UNESP), Brazil.
| | | | | | - José Eduardo Corrente
- Bioscience Institute, Statistical Department - Univ Estadual Paulista (UNESP), Brazil; Neurology Fellowship, Dept. of Neurology, Psychology, and Psychiatry - Univ Estadual Paulista (UNESP), Brazil.
| | - Aline Vieira
- Department of Internal Medicine - Univ Estadual Paulista (UNESP), Brazil.
| | | | | | - Gustavo José Luvizuto
- Rehabilitation Service, Clinical Hospital of Botucatu Medical School, Brazil; Neurology Fellowship, Dept. of Neurology, Psychology, and Psychiatry - Univ Estadual Paulista (UNESP), Brazil.
| | - Célia Regina Nogueira
- Department of Internal Medicine - Univ Estadual Paulista (UNESP), Brazil; Neurology Fellowship, Dept. of Neurology, Psychology, and Psychiatry - Univ Estadual Paulista (UNESP), Brazil.
| | - Rodrigo Bazan
- Department of Neurology, Psychology and Psychiatry - Univ Estadual Paulista (UNESP), Brazil.
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Frota NAF, Barbosa ER, Porto CS, Lucato LT, Ono CR, Buchpiguel CA, Machado AAC, Caramelli P. Which factors are associated with global cognitive impairment in Wilson's disease? Dement Neuropsychol 2016; 10:320-326. [PMID: 29213476 PMCID: PMC5619272 DOI: 10.1590/s1980-5764-2016dn1004011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Patients with Wilson's disease (WD) present cognitive impairment, especially
in executive functions. Which other factors might be associated with global
cognitive decline in these patients remains unclear. Objective To assess which factors are associated with worse performance on a global
cognitive test in patients with WD. Methods Twenty patients with WD underwent cognitive assessment with the following
tests: the Mini-Mental State Examination (MMSE), Dementia Rating Scale
(DRS), verbal fluency test, brief cognitive battery, clock drawing test,
Frontal Assessment Battery, Stroop test, Wisconsin card sorting test, Hopper
test, cubes (WAIS) and the Pfeffer questionnaire. MRI changes were
quantified. Patients with poor performance on the DRS were compared to
patients with normal performance. Results Nine patients had a poor performance on the DRS. This group had lower
educational level (9.11±3.58× 12.82±3.06) and a greater
number of changes on MRI (9.44±2.74× 6.27±2.45). The
presence of hyperintensity in the globus pallidus on MRI was more frequent
in this group (66.6% vs 9.0%), with OR=5.38 (95% CI 0.85-33.86). Conclusion Global cognitive impairment was prevalent in this sample of patients with WD
and was associated with low educational level, number of changes on MRI and
MRI hyperintensity in the globus pallidus.
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Affiliation(s)
| | - Egberto Reis Barbosa
- Department of Neurology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Claudia Sellitto Porto
- PhD. Department of Neurology, University of São Paulo School of Medicine, São Paulo, SP Brazil
| | - Leandro Tavares Lucato
- MD, PhD. Department of Radiology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | - Carla Rachel Ono
- MD, PhD. Department of Radiology, University of São Paulo School of Medicine, São Paulo, SP, Brazil
| | | | | | - Paulo Caramelli
- MD, PhD. Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, MG, Brazil
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25
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Schelp AO, Mendes-Chiloff CL, Paduan VC, Corrente JE, de Lima FD, Marchette JCN, Luvizuto GJ, Bazan R. Delayed recall memory impairment in patients with Parkinson's disease. Dement Neuropsychol 2016; 10:204-209. [PMID: 29213456 PMCID: PMC5642416 DOI: 10.1590/s1980-5764-2016dn1003006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/11/2016] [Indexed: 11/22/2022] Open
Abstract
Age is one of the risk factors for dementia in patients with Parkinson's disease (PDD). Distinct cognitive syndromes of Parkinson's disease (PD) have been identified in previous studies. Questions about the role of such cognitive disorders in PD outcomes, especially memory dysfunction, in patients with PD remain unanswered. OBJECTIVE To establish possible correlations between delayed recall memory (episodic memory), age, and other demographic variables in patients with PD. METHODS A two-stage protocol was applied. Patients with delayed recall memory compromise, selected based on a brief battery of tests (BBRC-Edu), were classified as dementia cases and submitted to the Mattis Dementia Rating Scale (MDRS). Data from patients with memory disturbances were compared against individuals without episodic memory impairment, and correlated with age and demographic variables. RESULTS Except for identification and naming, all subtests in the screening battery showed a significant difference (p≤0.0001) between the memory-compromised group (case) and the group without memory impairment (no case). The results also correlated negatively with age (p≤0.0001) and positively with level of education (p=0.0874) in patients with PD. CONCLUSION The analysis showed a significant relationship between age and dementia characterized by impaired episodic memory. The findings support reports of a wide spectrum of neuropsychological performance impairment in PD with age, particularly dementia associated with memory deterioration. No correlations between disease duration and cognitive dysfunction were evident.
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Affiliation(s)
- Arthur Oscar Schelp
- Universidade Estadual Paulista, Faculdade de Medicina Botucatu,
Departamento de Neurologia, Psicologia and Psiquiatria, Botucatu SP, Brazil
| | | | - Vanessa Cristina Paduan
- Serviço de Psicologia, Hospital das Clínicas da Faculdade de Medicina de
Botucatu, PS, Brazil
| | - José Eduardo Corrente
- Universidade Estadual Paulista, Instituto de Biociências, Departamento
de Estatística, Botucatu SP, Brazil
| | | | | | - Gustavo José Luvizuto
- Serviço de Reabilitação, Hospital das Clinicas da Faculdade de Medicina
de Botucatu, SP, Brazil
| | - Rodrigo Bazan
- Universidade Estadual Paulista, Faculdade de Medicina Botucatu,
Departamento de Neurologia, Psicologia and Psiquiatria, Botucatu SP, Brazil
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de Paula JJ, Albuquerque MR, Lage GM, Bicalho MA, Romano-Silva MA, Malloy-Diniz LF. Impairment of fine motor dexterity in mild cognitive impairment and Alzheimer's disease dementia: association with activities of daily living. ACTA ACUST UNITED AC 2016; 38:235-8. [PMID: 27508398 PMCID: PMC7194270 DOI: 10.1590/1516-4446-2015-1874] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/23/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Cognitive impairment is a hallmark of mild cognitive impairment (MCI) and Alzheimer's disease dementia (AD). Although the cognitive profile of these patients and its association with activities of daily living (ADLs) is well documented, few studies have assessed deficits in fine motor dexterity and their association with ADL performance. The objective of this research paper is to evaluate fine motor dexterity performance among MCI and AD patients and to investigate its association with different aspects of ADLs. METHODS We assessed normal aging controls, patients with multiple- and single-domain amnestic MCI (aMCI), and patients with mild AD. Fine motor dexterity was measured with the Nine-Hole Peg Test and cognitive functioning by the Mattis Dementia Rating Scale. We analyzed the data using general linear models. RESULTS Patients with AD or multiple-domain aMCI had slower motor responses when compared to controls. AD patients were slower than those with single-domain aMCI. We found associations between cognition and instrumental ADLs, and between fine motor dexterity and self-care ADLs. CONCLUSION We observed progressive slowing of fine motor dexterity along the normal aging-MCI-AD spectrum, which was associated with autonomy in self-care ADLs.
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Affiliation(s)
- Jonas J de Paula
- Instituto Nacional de Ciências e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Psicologia, Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil
| | - Maicon R Albuquerque
- Instituto Nacional de Ciências e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Educação Física, Universidade Federal de Viçosa (UFV), Viçosa, MG, Brazil
| | - Guilherme M Lage
- Instituto Nacional de Ciências e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Educação Física, UFMG, Belo Horizonte, MG, Brazil
| | - Maria A Bicalho
- Instituto Nacional de Ciências e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Clínica Médica, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Marco A Romano-Silva
- Instituto Nacional de Ciências e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
| | - Leandro F Malloy-Diniz
- Instituto Nacional de Ciências e Tecnologia em Medicina Molecular (INCT-MM), Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Departamento de Saúde Mental, Faculdade de Medicina, UFMG, Belo Horizonte, MG, Brazil
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27
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de Paula JJ, Bicalho MA, Ávila RT, Cintra MTG, Diniz BS, Romano-Silva MA, Malloy-Diniz LF. A Reanalysis of Cognitive-Functional Performance in Older Adults: Investigating the Interaction Between Normal Aging, Mild Cognitive Impairment, Mild Alzheimer's Disease Dementia, and Depression. Front Psychol 2016; 6:2061. [PMID: 26858666 PMCID: PMC4727063 DOI: 10.3389/fpsyg.2015.02061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 12/31/2015] [Indexed: 12/12/2022] Open
Abstract
Depressive symptoms are associated with cognitive-functional impairment in normal aging older adults (NA). However, less is known about this effect on people with mild Cognitive Impairment (MCI) and mild Alzheimer's disease dementia (AD). We investigated this relationship along with the NA-MCI-AD continuum by reanalyzing a previously published dataset. Participants (N = 274) underwent comprehensive neuropsychological assessment including measures of Executive Function, Language/Semantic Memory, Episodic Memory, Visuospatial Abilities, Activities of Daily Living (ADL), and the Geriatric Depression Scale. MANOVA, logistic regression and chi-square tests were performed to assess the association between depression and cognitive-functional performance in each group. In the NA group, depressed participants had a lower performance compared to non-depressed participants in all cognitive and functional domains. However, the same pattern was not observed in the MCI group or in AD. The results suggest a progressive loss of association between depression and worse cognitive-functional performance along the NA-MCI-AD continuum.
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Affiliation(s)
- Jonas J de Paula
- Faculdade de Medicina, Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Department of Psychology, Faculdade de Ciências Médicas de Minas GeraisBelo Horizonte, Brazil
| | - Maria A Bicalho
- Faculdade de Medicina, Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Reference Center for Geriatrics Instituto Jenny de Andrade Faria, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Rafaela T Ávila
- Faculdade de Medicina, Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Reference Center for Geriatrics Instituto Jenny de Andrade Faria, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Marco T G Cintra
- Reference Center for Geriatrics Instituto Jenny de Andrade Faria, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Breno S Diniz
- Faculdade de Medicina, Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Marco A Romano-Silva
- Faculdade de Medicina, Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
| | - Leandro F Malloy-Diniz
- Faculdade de Medicina, Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas GeraisBelo Horizonte, Brazil; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas GeraisBelo Horizonte, Brazil
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Coutinho AM, Porto FH, Zampieri PF, Otaduy MC, Perroco TR, Oliveira MO, Nunes RF, Pinheiro TL, Bottino CM, Leite CC, Buchpiguel CA. Analysis of the posterior cingulate cortex with [18F]FDG-PET and Naa/mI in mild cognitive impairment and Alzheimer's disease: Correlations and differences between the two methods. Dement Neuropsychol 2015; 9:385-393. [PMID: 29213988 PMCID: PMC5619321 DOI: 10.1590/1980-57642015dn94000385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/03/2015] [Indexed: 11/22/2022] Open
Abstract
Reduction of regional brain glucose metabolism (rBGM) measured by [18F]FDG-PET in the posterior cingulate cortex (PCC) has been associated with a higher conversion rate from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Magnetic Resonance Spectroscopy (MRS) is a potential biomarker that has disclosed Naa/mI reductions within the PCC in both MCI and AD. Studies investigating the relationships between the two modalities are scarce. OBJECTIVE To evaluate differences and possible correlations between the findings of rBGM and NAA/mI in the PCC of individuals with AD, MCI and of cognitively normal volunteers. METHODS Patients diagnosed with AD (N=32) or MCI (N=27) and cognitively normal older adults (CG, N=28), were submitted to [18F]FDG-PET and MRS to analyze the PCC. The two methods were compared and possible correlations between the modalities were investigated. RESULTS The AD group exhibited rBGM reduction in the PCC when compared to the CG but not in the MCI group. MRS revealed lower NAA/mI values in the AD group compared to the CG but not in the MCI group. A positive correlation between rBGM and NAA/mI in the PCC was found. NAA/mI reduction in the PCC differentiated AD patients from control subjects with an area under the ROC curve of 0.70, while [18F]FDG-PET yielded a value of 0.93. CONCLUSION rBGM and Naa/mI in the PCC were positively correlated in patients with MCI and AD. [18F]FDG-PET had greater accuracy than MRS for discriminating AD patients from controls.
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Affiliation(s)
- Artur M.N. Coutinho
- Centro de Medicina Nuclear, Instituto e Departamento de
Radiologia, HC/FMUSP, LIM 43
| | - Fábio H.G. Porto
- Centro de Referência em Distúrbios
Cognitivos (CEREDIC) do HC/FMUSP
| | - Poliana F. Zampieri
- Centro de Medicina Nuclear, Instituto e Departamento de
Radiologia, HC/FMUSP, LIM 43
| | - Maria C. Otaduy
- Serviço de Ressonância Magnética,
Instituto e Departamento de Radiologia, HC/FMUSP, LIM 44
| | - Tíbor R. Perroco
- Centro de Referência em Distúrbios
Cognitivos (CEREDIC) do HC/FMUSP
| | | | - Rafael F. Nunes
- Centro de Medicina Nuclear, Instituto e Departamento de
Radiologia, HC/FMUSP, LIM 43
| | | | | | - Claudia C. Leite
- Serviço de Ressonância Magnética,
Instituto e Departamento de Radiologia, HC/FMUSP, LIM 44
| | - Carlos A. Buchpiguel
- Centro de Medicina Nuclear, Instituto e Departamento de
Radiologia, HC/FMUSP, LIM 43
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de Paula JJ, Diniz BS, Bicalho MA, Albuquerque MR, Nicolato R, de Moraes EN, Romano-Silva MA, Malloy-Diniz LF. Specific cognitive functions and depressive symptoms as predictors of activities of daily living in older adults with heterogeneous cognitive backgrounds. Front Aging Neurosci 2015; 7:139. [PMID: 26257644 PMCID: PMC4507055 DOI: 10.3389/fnagi.2015.00139] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/06/2015] [Indexed: 12/28/2022] Open
Abstract
Cognitive functioning influences activities of daily living (ADL). However, studies reporting the association between ADL and neuropsychological performance show inconsistent results regarding what specific cognitive domains are related to each specific functional domains. Additionally, whether depressive symptoms are associated with a worse functional performance in older adults is still under explored. We investigated if specific cognitive domains and depressive symptoms would affect different aspects of ADL. Participants were 274 older adults (96 normal aging participants, 85 patients with mild cognitive impairment, and 93 patients probable with mild Alzheimer's disease dementia) with low formal education (∼4 years). Measures of ADL included three complexity levels: Self-care, Instrumental-Domestic, and Instrumental-Complex. The specific cognitive functions were evaluated through a factorial strategy resulting in four cognitive domains: Executive Functions, Language/Semantic Memory, Episodic Memory, and Visuospatial Abilities. The Geriatric Depression Scale measured depressive symptoms. Multiple linear regression analysis showed executive functions and episodic memory as significant predictors of Instrumental-Domestic ADL, and executive functions, episodic memory and language/semantic memory as predictors of Instrumental-Complex ADL (22 and 28% of explained variance, respectively). Ordinal regression analysis showed the influence of specific cognitive functions and depressive symptoms on each one of the instrumental ADL. We observed a heterogeneous pattern of association with explained variance ranging from 22 to 38%. Different instrumental ADL had specific cognitive predictors and depressive symptoms were predictive of ADL involving social contact. Our results suggest a specific pattern of influence depending on the specific instrumental daily living activity.
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Affiliation(s)
- Jonas J de Paula
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Psychology, Faculdade de Ciências Médicas de Minas Gerais Belo Horizonte, Brazil
| | - Breno S Diniz
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Maria A Bicalho
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Maicon Rodrigues Albuquerque
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Physical Education, Universidade Federal de Viçosa Viçosa, Brazil
| | - Rodrigo Nicolato
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Edgar N de Moraes
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Marco A Romano-Silva
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Leandro F Malloy-Diniz
- Faculdade de Medicina, Instituto Nacional de Ciências e Tecnologia e em Medicina Molecular, Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculdade de Medicina, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
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A hybrid intelligent diagnosis approach for quick screening of Alzheimer's disease based on multiple neuropsychological rating scales. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:258761. [PMID: 25815043 PMCID: PMC4359840 DOI: 10.1155/2015/258761] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 01/23/2023]
Abstract
Neuropsychological testing is an effective means for the screening of Alzheimer's disease. Multiple neuropsychological rating scales should be used together to get subjects' comprehensive cognitive state due to the limitation of a single scale, but it is difficult to operate in primary clinical settings because of the inadequacy of time and qualified clinicians. Aiming at identifying AD's stages more accurately and conveniently in screening, we proposed a computer-aided diagnosis approach based on critical items extracted from multiple neuropsychological scales. The proposed hybrid intelligent approach combines the strengths of rough sets, genetic algorithm, and Bayesian network. There are two stages: one is attributes reduction technique based on rough sets and genetic algorithm, which can find out the most discriminative items for AD diagnosis in scales; the other is uncertain reasoning technique based on Bayesian network, which can forecast the probability of suffering from AD. The experimental data set consists of 500 cases collected by a top hospital in China and each case is determined by the expert panel. The results showed that the proposed approach could not only reduce items drastically with the same classification precision, but also perform better on identifying different stages of AD comparing with other existing scales.
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Assis LDO, de Paula JJ, Assis MG, de Moraes EN, Malloy-Diniz LF. Psychometric properties of the Brazilian version of Pfeffer's Functional Activities Questionnaire. Front Aging Neurosci 2014; 6:255. [PMID: 25309432 PMCID: PMC4174881 DOI: 10.3389/fnagi.2014.00255] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/08/2014] [Indexed: 11/25/2022] Open
Abstract
Pfeffer's Functional Activities Questionnaire (FAQ) is one of the most commonly employed tools in studies on pathological cognitive aging. Despite the different versions of the questionnaire translated for use in clinical practice, few studies have analyzed the psychometric properties of the Brazilian version of the FAQ (P-FAQ). Thus, the aim of the present study was to analyze the P-FAQ with regard to internal consistency, factorial structure and associations with demographic factors (age, sex, and schooling), depressive symptoms, cognitive measures and other measures of functionality. One hundred sixty-one older adults were divided into four groups (91 with dementia, 46 with mild cognitive impairment, 11 with psychiatric disorders and 13 healthy controls). All participants were evaluated by cognitive, behavioral and functional tests and scales. Their caregivers answered the P-FAQ. The questionnaire showed high internal consistency (α = 0.91). Factor analysis revealed a two-factor structure, which, accounted for 66% of the total variance. The P-FAQ was not correlated with demographic factors, was weakly correlated with depressive symptoms (ϱ = 0.271, p < 0.01, R2 = 7%) and strongly correlated with cognitive measures (Matttis Dementia Rating Scale total score: ϱ = −0.574, p < 0.01, R2 = 33%) as well as complex instrumental activities of daily living (ϱ = −0.845, p < 0.01, R2 = 71%). Cognitive performance and depression status were independent predictors of P-FAQ scores in regression models. The present findings indicate that the P-FAQ has satisfactory reliability, internal consistency, construct validity and ecological validity. Therefore, this questionnaire can be used in clinical practice and research involving the Brazilian population of older adults.
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Affiliation(s)
- Luciana de Oliveira Assis
- Post Graduation Program in Neuroscience, Federal University of Minas Gerais Belo Horizonte, Brazil ; Faculty of Humanities, Social Sciences and Health, FUMEC University Belo Horizonte, Brazil
| | - Jonas J de Paula
- Department of Psychology, Faculty of Medical Sciences of Minas Gerais Belo Horizonte, MG, Brazil ; Faculty of Medicine, National Institute of Science and Technology - Molecular Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Marcella G Assis
- Department of Occupational Therapy, Faculty of Physical Education, Physiotherapy and Occupational Therapy, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Edgar N de Moraes
- Department of Clinics, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
| | - Leandro F Malloy-Diniz
- Faculty of Medicine, National Institute of Science and Technology - Molecular Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil ; Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais Belo Horizonte, Brazil ; Department of Mental Health, Faculty of Medicine, Federal University of Minas Gerais Belo Horizonte, Brazil
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de Souza LC, Guimarães HC, Teixeira AL, Caramelli P, Levy R, Dubois B, Volle E. Frontal lobe neurology and the creative mind. Front Psychol 2014; 5:761. [PMID: 25101029 PMCID: PMC4107958 DOI: 10.3389/fpsyg.2014.00761] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/28/2014] [Indexed: 11/25/2022] Open
Abstract
Concepts from cognitive neuroscience strongly suggest that the prefrontal cortex (PFC) plays a crucial role in the cognitive functions necessary for creative thinking. Functional imaging studies have repeatedly demonstrated the involvement of PFC in creativity tasks. Patient studies have demonstrated that frontal damage due to focal lesions or neurodegenerative diseases are associated with impairments in various creativity tasks. However, against all odds, a series of clinical observations has reported the facilitation of artistic production in patients with neurodegenerative diseases affecting PFC, such as frontotemporal dementia (FTD). An exacerbation of creativity in frontal diseases would challenge neuroimaging findings in controls and patients, as well as the theoretical role of prefrontal functions in creativity processes. To explore this paradox, we reported the history of a FTD patient who exhibited the emergence of visual artistic productions during the course of the disease. The patient produced a large amount of drawings, which have been evaluated by a group of professional artists who were blind to the diagnosis. We also reviewed the published clinical cases reporting a change in the artistic abilities in patients with neurological diseases. We attempted to reconcile these clinical observations to previous experimental findings by addressing several questions raised by our review. For instance, to what extent can the cognitive, conative, and affective changes following frontal damage explain changes in artistic abilities? Does artistic exacerbation truly reflect increased creative capacities? These considerations could help to clarify the place of creativity—as it has been defined and explored by cognitive neuroscience—in artistic creation and may provide leads for future lesion studies.
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Affiliation(s)
- Leonardo C de Souza
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Henrique C Guimarães
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Antônio L Teixeira
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Paulo Caramelli
- Neuropsychiatric Branch, Neurology Division, University Hospital, Universidade Federal de Minas Gerais Belo Horizonte, Brazil
| | - Richard Levy
- Inserm, U 1127, ICM Frontlab Paris, France ; CNRS, UMR 7225, ICM Frontlab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127 Paris, France ; Institut du Cerveau et de la Moelle épinière, ICM Frontlab Paris, France ; AP-HP, Hôpital Saint-Antoine, Service de Neurologie Paris, France
| | - Bruno Dubois
- Inserm, U 1127, ICM Frontlab Paris, France ; CNRS, UMR 7225, ICM Frontlab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127 Paris, France ; Institut du Cerveau et de la Moelle épinière, ICM Frontlab Paris, France ; AP-HP, Hôpital de la Salpétrière, Neurology Department, Institut de la Mémoire et de la Maladie d'Alzheimer Paris, France
| | - Emmanuelle Volle
- Inserm, U 1127, ICM Frontlab Paris, France ; CNRS, UMR 7225, ICM Frontlab Paris, France ; Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127 Paris, France ; Institut du Cerveau et de la Moelle épinière, ICM Frontlab Paris, France
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Suggested instruments for General Practitioners in countries with low schooling to screen for cognitive impairment in the elderly. Int Psychogeriatr 2014; 26:1121-5. [PMID: 24655588 DOI: 10.1017/s1041610214000325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND General Practitioners (GPs) from underdeveloped countries apply cognitive impairment (CI) assessment tools translated and adapted to cultural setting from other idioms, mainly English. As schooling in elderly from underdeveloped countries tends to be relatively heterogeneous, it is necessary to establish normative and cut-off scores for these CI instruments that are based on studies conducted locally. Some CI screening instruments frequently used by Brazilian specialists in dementia were analyzed to determine which could be most useful to GPs in their working sets. METHOD Two hundred forty-eight patients aged 65 years or older that had been assisted by GPs in a tertiary hospital in Brazil were evaluated. Based on the MMSE and/or Short-IQCODE scores, 52 probable cases were identified on the basis of clinical data, performances on the neuropsychological tests and questionnaires (Functional Assessment Questionnaire/FAQ, Category Verbal Fluency/CVF, Clock Drawing Test/CDT) and blood tests and brain CT. RESULTS The combination of a functional questionnaire with a cognitive instrument had higher sensitivity and specificity than using the instruments alone. A FAQ cut-off of 3 in conjunction with a CDT cut-off of 6 proved optimal (93% sensitivity and 92.5% specificity). A higher specificity (93.5%) was attained using a combination of the FAQ (cut-off of 3) with the CVF (cut-off of 10). CONCLUSIONS For low schooling elderly, the combination of the FAQ and CVF represented a very simple method of increasing the chances of correct screening. For those with higher schooling, the combination of the FAQ and CDT was more suitable.
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Mograbi DC, Faria CDA, Fichman HC, Paradela EMP, Lourenço RA. Relationship between activities of daily living and cognitive ability in a sample of older adults with heterogeneous educational level. Ann Indian Acad Neurol 2014; 17:71-6. [PMID: 24753664 PMCID: PMC3992775 DOI: 10.4103/0972-2327.128558] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 10/25/2013] [Accepted: 12/04/2013] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level. OBJECTIVES The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults - with and without dementia - from a middle-income country. SAMPLE The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro. RESULTS Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors. CONCLUSIONS These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.
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Affiliation(s)
- Daniel C Mograbi
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil ; Psychology, Institute of Psychiatry, King's College London, London, UK
| | - Camila de Assis Faria
- Department of Psychology, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Emylucy Martins Paiva Paradela
- Internal Medicine, Research Laboratory on Human Aging - GeronLab, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Roberto Alves Lourenço
- Internal Medicine, Research Laboratory on Human Aging - GeronLab, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Vocabulary is an appropriate measure of premorbid intelligence in a sample with heterogeneous educational level in Brazil. Behav Neurol 2014; 2014:875960. [PMID: 24803737 PMCID: PMC4006600 DOI: 10.1155/2014/875960] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 02/13/2014] [Accepted: 03/03/2014] [Indexed: 11/18/2022] Open
Abstract
Crystallized intelligence refers to one's knowledge base and can be measured by vocabulary tests. Fluid intelligence is related to nonverbal aspects of intelligence, depends very little on previously acquired knowledge, and can be measured by tests such as Block Design (BD) and Raven Colored Matrices (RCM). Premorbid intelligence quotient (IQ) refers to one's intellectual ability level previous to the onset of disorders like mild cognitive impairment (MCI) and Alzheimer's disease (AD) and it is important to estimate disease severity. The objective was to compare performance in tests that measure crystallized and fluid intelligence in healthy subjects and patients with amnestic MCI (aMCI) and AD. One hundred forty-four participants (aMCI (n = 38), AD (n = 45), and healthy controls (n = 61)) were submitted to neuropsychological tests (WAIS-III vocabulary, BD, and RCM). There were significant among groups, except for vocabulary, indicating a relative stability of crystallized intelligence in the continuum from normal to pathological cognitive decline. Vocabulary seems to be stable during the progression of the disease and useful as a measure of premorbid intelligence, that is, to estimate previous function in relation to the level of education and, as a collateral measure of cognition in people with low education.
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Jacinto AF, Brucki SMD, Porto CS, Arruda Martins MD, Nitrini R. Subjective memory complaints in the elderly: a sign of cognitive impairment? Clinics (Sao Paulo) 2014; 69:194-7. [PMID: 24626946 PMCID: PMC3935127 DOI: 10.6061/clinics/2014(03)09] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 07/28/2013] [Accepted: 08/16/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Cognitive impairment in the elderly is frequently overlooked by general practitioners. The use of subjective memory complaints as a sign of cognitive impairment by the general practice is controversial. METHODS Elderly individuals (N = 248) were asked whether they had memory complaints and underwent a cognitive impairment screening. Subjects classified as exhibiting "probable cognitive impairment" underwent a complete cognitive evaluation, and the final diagnoses were established by expert consensus. RESULTS A total of 147 patients presented with subjective memory complaints, and 43 were further classified as demented or "cognitively impaired not demented". Subjective memory complaints presented a sensitivity of 100% and a negative predictive value of 100%. CONCLUSION Subjective memory complaints are an indicator for cognitive impairment screening.
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Affiliation(s)
- Alessandro Ferrari Jacinto
- Faculdade de Medicina, Universidade de São Paulo, Department of Neurology, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo/SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Faculdade de Medicina, Universidade de São Paulo, Department of Neurology, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo/SP, Brazil
| | - Claudia Sellitto Porto
- Faculdade de Medicina, Universidade de São Paulo, Department of Neurology, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Department of Neurology, São Paulo/SP, Brazil
| | - Milton de Arruda Martins
- Faculdade de Medicina, Universidade de São Paulo, Internal Medicine, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Internal Medicine, São Paulo/SP, Brazil
| | - Ricardo Nitrini
- Faculdade de Medicina, Universidade de São Paulo, Internal Medicine, São PauloSP, Brazil, Faculdade de Medicina da Universidade de São Paulo, Internal Medicine, São Paulo/SP, Brazil
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de Oliveira MO, Nitrini R, Brucki SMD. The S-TOFHLA as a measure of functional literacy in patients with mild Alzheimer's disease or mild cognitive impairment. Arch Clin Neuropsychol 2014; 29:269-77. [PMID: 24503948 DOI: 10.1093/arclin/act120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In developing countries, education levels vary dramatically, and the number of years of schooling does not always correlate with the true level of educational competency. This study was designed to verify the accuracy of the Short-Test of Functional Health Literacy in Adults (S-TOFHLA) in individuals with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), when compared with healthy controls (HCs), in order to assess its utility as a measure of functional literacy. One hundred forty-eight subjects were divided into three groups: HC (n = 61), MCI patients (n = 42), and AD patients (n = 45). The S-TOFHLA does not seem to be suitable as an instrument to measure functional literacy for patients with advanced cognitive impairment, but proved to be appropriate in both the HC group and MCI patients in numeracy and prove to be useful as an adjuvant to estimate IQ, reading ability, and premorbid IQ, as an indicator of cognitive reserve.
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Affiliation(s)
- Maira Okada de Oliveira
- Behavioral and Cognitive Neurology Unit, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brazil
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The Stick Design Test on the assessment of older adults with low formal education: evidences of construct, criterion-related and ecological validity. Int Psychogeriatr 2013; 25:2057-65. [PMID: 23905545 DOI: 10.1017/s1041610213001282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The assessment of visuospatial abilities is usually performed by drawing tasks. In patients with very low formal education, the use of these tasks might be biased by their cultural background. The Stick Design Test was developed for the assessment of this population. We aim to expand the test psychometric properties by assessing its construct, criterion-related and ecological validity in older adults with low formal education. METHOD Healthy older adults (n = 63) and Alzheimer's disease patients (n = 92) performed the Stick Design Test, Mini-Mental State Examination, Digit Span Forward and the Clock Drawing Test. Their caregivers answered Personal Care and Instrumental Activities of Daily Living). Construct validity was assessed by factor analysis, convergent correlations (with the Clock Drawing Test), and divergent correlations (with Digit Span Forward); criterion-related validity by receiver operating characteristic curve analysis and binary logistic regression; and Ecological validity by correlations with ADL. RESULTS The test factor structure was composed by one component (R 2 = 64%). Significant correlations with the Clock Drawing Test and Digit Span Forward were found, and the relationship was stronger with the first measure. The test was less associated with formal education than the Clock Drawing Test. It classified about 76% of the participants correctly and had and additive effect with the Mini-Mental State Examination (84% of correct classification). The test also correlated significantly with measures of ADL, suggesting ecological validity. CONCLUSIONS The Stick Design Test shows evidence of construct, criterion-related and ecological validity. It is an interesting alternative to drawing tasks for the assessment of visuospatial abilities.
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Champs APS, Passos VMDA, Barreto SM, Caramelli P, de Melo CM, Carvalho G, Menezes MM, Ribas JGR. Encephalomyelopathy associated with HTLV-I a primary disease or coexisting with multiple sclerosis? Dement Neuropsychol 2013; 7:439-443. [PMID: 29213871 PMCID: PMC5619508 DOI: 10.1590/s1980-57642013dn74000014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
HTLV-I-associated myelopathy (HAM/TSP) is the most common neurological manifestation of HTLV-I, causing progressive weakness, sensory disturbance, and sphincter dysfunction. Although motor disorders have been well described, few studies have associated cognitive disorders and HTLV-I infection. In areas endemic for HTLV-I infection, the differential diagnosis between HAM/TSP and other myelopathy etiologies can be difficult, particularly if the patient has signs and symptoms of brain involvement, since seropositive HTLV-I patients can present other neurological diseases. Here, we report one case initially diagnosed as Multiple Sclerosis (MS) which, upon further investigation, was found to be HTLV-I seropositive.
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Affiliation(s)
- Ana Paula Silva Champs
- Hospital Sarah Belo Horizonte, Belo Horizonte MG, Brazil.,Post-Graduate Program in Adult Health Sciences, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Valéria Maria de Azeredo Passos
- Department of Clinical Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.,Post-Graduate Program in Adult Health Sciences, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Sandhi Maria Barreto
- Post-Graduate Program in Adult Health Sciences, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.,Department of Preventive and Social Medicine, Medical School, UFMG, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Department of Clinical Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil.,Post-Graduate Program in Adult Health Sciences, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
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Foss MP, de Carvalho VA, Machado TH, Dos Reis GC, Tumas V, Caramelli P, Nitrini R, Porto CS. Mattis dementia rating scale (DRS) normative data for the brazilian middle-age and elderly populations. Dement Neuropsychol 2013; 7:374-379. [PMID: 29213861 PMCID: PMC5619498 DOI: 10.1590/s1980-57642013dn74000004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Maria Paula Foss
- Psicóloga do Setor de Distúrbios do Movimento e Neurologia Comportamental do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da USP, Doutora em Ciências Médicas (Neurociências) da FMRP-USP, Ribeirão Preto SP, Brazil
| | - Viviane Amaral de Carvalho
- Psicóloga, Neurologia Cognitiva e do Comportamento da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Thais Helena Machado
- Fonoaudióloga, Doutora em Linguística pela UFMG, Pesquisadora no Ambulatório de Neurologia Cognitiva e do Comportamento do Hospital das Clínicas da UFMG, Belo Horizonte MG, Brazil
| | - Geraldo Cássio Dos Reis
- Estatístico do Departamento de Neurociências e Ciências do Comportamento da FMRP-USP, Ribeirão Preto SP, Brazil
| | - Vitor Tumas
- Médico, Faculdade de Medicina de Ribeirão Preto - FMRP-USP, Ribeirão Preto SP, Brazil
| | - Paulo Caramelli
- Professor do Departamento de Clínica Médica da Faculdade de Medicina da UFMG; Coordenador do Ambulatório de Neurologia Cognitiva e do Comportamento do Hospital das Clínicas da UFMG, Belo Horizonte MG, Brazil
| | - Ricardo Nitrini
- Diretor da Disciplina de Neurologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Cláudia Sellitto Porto
- Psicóloga do Grupo de Neurologia Cognitiva do Comportamento da Clínica Neurológica do Hospital das Clínicas da FMUSP, Doutora em Ciências pela FMUSP, São Paulo SP, Brazil
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de Paula JJ, Bertola L, Ávila RT, Moreira L, Coutinho G, de Moraes EN, Bicalho MAC, Nicolato R, Diniz BS, Malloy-Diniz LF. Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education. PLoS One 2013; 8:e73167. [PMID: 24066031 PMCID: PMC3774762 DOI: 10.1371/journal.pone.0073167] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 07/17/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. METHODS AND RESULTS A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. CONCLUSION The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.
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Affiliation(s)
- Jonas Jardim de Paula
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Laiss Bertola
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Rafaela Teixeira Ávila
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lafaiete Moreira
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Gabriel Coutinho
- Clinical Staff, D'Or Institute for Research and Education (ID'Or), Rio de Janeiro, Rio de Janeiro, Brazil
- Programa de Pós-graduação em Ciências Morfológicas, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Edgar Nunes de Moraes
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Rodrigo Nicolato
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Breno Satler Diniz
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leandro Fernandes Malloy-Diniz
- Laboratory of Neuropsychological Investigations (LIN), Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Foss MP, Diniz PRB, Formigheri P, Salmon CEG, Speciali JG, Santos AC. Magnetic resonance imaging and neuropsychological testing in the spectrum of normal aging. Clinics (Sao Paulo) 2013; 68:1197-205. [PMID: 24141834 PMCID: PMC3782730 DOI: 10.6061/clinics/2013(09)04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 01/15/2013] [Accepted: 04/16/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To understand the relationships between brain structures and function (behavior and cognition) in healthy aging. METHOD The study group was composed of 56 healthy elderly subjects who underwent neuropsychological assessment and quantitative magnetic resonance imaging. Cluster analysis classified the cohort into two groups, one (cluster 1) in which the magnetic resonance imaging metrics were more preserved (mean age: 66.4 years) and another (cluster 2) with less preserved markers of healthy brain tissue (mean age: 75.4 years). RESULTS The subjects in cluster 2 (older group) had worse indices of interference in the Stroop test compared with the subjects in cluster 1 (younger group). Therefore, a simple test such as the Stroop test could differentiate groups of younger and older subjects based on magnetic resonance imaging metrics. CONCLUSION These results are in agreement with the inhibitory control hypotheses regarding cognitive aging and may also be important in the interpretation of studies with other clinical groups, such as patients with dementia and mild cognitive impairment.
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Affiliation(s)
- Maria Paula Foss
- Neurosciences Program, Department of Neurosciences and Behavioral Sciences, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo, Ribeirão PretoSP, Brazil
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Correa Ribeiro PC, de Souza Lopes C, Lourenço RA. Prevalence of dementia in elderly clients of a private health care plan: a study of the FIBRA-RJ, Brazil. Dement Geriatr Cogn Disord 2013; 35:77-86. [PMID: 23364129 DOI: 10.1159/000345984] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2011] [Indexed: 11/19/2022] Open
Abstract
AIMS To describe the overall prevalence of dementia syndrome and its major subtypes among elderly clients of a private health care plan and to ascertain the association between this syndrome and socioeconomic characteristics. METHODS A survey was organized in two stages: screening for cognitive impairment and diagnostic evaluation. The study population comprised 683 elderly subjects (aged >67 years), an expanded sample of 7,486 individuals, of the database of the FIBRA-RJ, which evaluated clients of a private health care plan residing in northern districts of the municipality of Rio de Janeiro, Brazil. The diagnosis of dementia was obtained according to DSM-IV criteria. RESULTS A total of 115 individuals were diagnosed with dementia, resulting in a prevalence of 16.9% (95% CI = 14.4-19.8). The association was strongest among older age groups, i.e. 85-89 years old (prevalence ratio = 8.85; 95% CI = 2.11-37.11) and 90 or more years old (prevalence ratio = 8.85; 95% CI = 2.11-37.11), and among illiterate people (prevalence ratio = 2.77; 95% CI = 1.07-7.19). Sex, personal income and marital status displayed no association with dementia. CONCLUSION The prevalence of dementia was higher than found by population-based studies. These findings point to a possibility of a high demand for specialized services among older adults served by the private health care sector.
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de Miranda LFJR, Barbosa MDA, Peles PRH, Pôças PH, Tito PAL, Matoso RDO, de Lima TOL, de Moraes EN, Caramelli P. Good rate of clinical response to cholinesterase inhibitors in mild and moderate Alzheimer's disease after three months of treatment: An open-label study. Dement Neuropsychol 2013; 7:190-196. [PMID: 29213839 PMCID: PMC5619517 DOI: 10.1590/s1980-57642013dn70200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Life expectancy in Brazil has increased markedly over the last 30 years. Hence, age-related disorders, such as Alzheimer's disease (AD), warrant special attention due to their high prevalence in the elderly. Pharmacologic treatment of AD is based on cholinesterase inhibitors (ChEI) and memantine, leading to modest clinical benefits both in the short and long-term. However, clinical response is heterogeneous and needs further investigation. OBJECTIVE To investigate the rate of response to ChEI in AD after three months of treatment. METHODS Patients with mild or moderate dementia due to probable AD or to AD associated with cerebrovascular disease were included in the study. The subjects were assessed at baseline and again after three months of ChEI treatment. Subjects were submitted to the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale, Katz Basic Activities of Daily Living, Pfeffer Functional Activities Questionnaire, Neuropsychiatric Inventory and Cornell Scale for Depression in Dementia. Good response was defined by a gain of ≥2 points on the MMSE after three months of treatment in relation to baseline. RESULTS Seventy-one patients, 66 (93%) with probable AD and five (7%) with AD associated with cerebrovascular disease, were evaluated. The good response rate at three months was 31.0%, being 37.2% and 21.4% in mild and moderate dementia, respectively. There were no significant differences on most tests, except for improvement in hallucinations, agitation and dysphoria in moderate dementia patients. CONCLUSION The rate of good clinical response to ChEI was higher than usually reported. Specific behavioral features significantly improved in the subgroup of moderate dementia.
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Affiliation(s)
- Luis Felipe José Ravic de Miranda
- Post-Graduate Program in Adult Health Applied Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | | | | | | | | | | | | | - Edgar Nunes de Moraes
- Post-Graduate Program in Adult Health Applied Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil.,Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
| | - Paulo Caramelli
- Post-Graduate Program in Adult Health Applied Sciences, Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil.,Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte MG, Brazil
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Frota NAF, Barbosa ER, Porto CS, Lucato LT, Ono CR, Buchpiguel CA, Caramelli P. Cognitive impairment and magnetic resonance imaging correlations in Wilson's disease. Acta Neurol Scand 2013; 127:391-8. [PMID: 23215772 DOI: 10.1111/ane.12037] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2012] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the cognitive performance of a group of patients with Wilson's disease (WD) and to correlate the cognitive findings with changes in magnetic resonance imaging (MRI). METHODS All patients with WD consecutively attended in a Movement Disorders Clinic between September 2006 and October 2007 were invited to participate in the study, together with a group of matched healthy controls. Patients and controls were submitted to comprehensive neuropsychological assessment. MRI was performed in all patients, and abnormalities (high-intensity signal, low-intensity signal and atrophy) were semi-quantitatively rated. Performance of patients and controls in each cognitive test was compared, and correlations between cognitive scores and MRI changes were investigated within the patients' group. RESULTS Twenty patients with WD (11 men) and 20 controls (nine men) were evaluated. Mean age in the WD and control groups was 30.05 ± 7.25 and 32.15 ± 5.37 years, respectively. Mean schooling years were 11.15 ± 3.73 among WD cases and 10.08 ± 2.62 among controls. Patients with WD performed significantly worse than controls in the Mini-Mental State Examination, Dementia Rating Scale, phonemic verbal fluency (FAS), verb generation, digit span forward, Stroop test, Frontal Assessment Battery and in the Brief Cognitive Screening Battery. A significant correlation emerged between global cognitive impairment and MRI scale (r = 0.535), being higher for high-intensity signal plus atrophy (r = 0.718). CONCLUSION Patients with WD presented cognitive impairment, especially in executive functions, with good correlation between cognitive abnormalities and MRI changes.
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Affiliation(s)
| | - E. R. Barbosa
- Department of Neurology; University of São Paulo School of Medicine; São Paulo; São Paulo; Brazil
| | - C. S. Porto
- Department of Neurology; University of São Paulo School of Medicine; São Paulo; São Paulo; Brazil
| | - L. T. Lucato
- Department of Radiology; University of São Paulo School of Medicine; São Paulo,; Brazil
| | - C. R. Ono
- Department of Radiology; University of São Paulo School of Medicine; São Paulo,; Brazil
| | - C. A. Buchpiguel
- Department of Radiology; University of São Paulo School of Medicine; São Paulo,; Brazil
| | - P. Caramelli
- Department of Internal Medicine; Faculty of Medicine; Federal University of Minas Gerais; Belo Horizonte; Minas Gerais; Brazil
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Satler C, Tomaz C. Cognitive anosognosia and behavioral changes in probable Alzheimer's disease patients. Dement Neuropsychol 2013; 7:197-205. [PMID: 29213840 PMCID: PMC5619518 DOI: 10.1590/s1980-57642013dn70200010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Anosognosia, impairment insight and unawareness of deficits are used as
equivalent terms in this study.
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Affiliation(s)
- Corina Satler
- PhD, Adjunct Professor, Faculty of Ceilandia, UnB, Brasilia DF, Brazil
| | - Carlos Tomaz
- PhD, Full Professor, Laboratory of Neurosciences and Behavior, Institute of Biology, UnB, Brasília DF, Brazil
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de Paula JJ, Cintra MTG, Miranda DM, Bicalho MAC, Moares EN, Malloy-Diniz LF. Remission of cognitive deficits in Parkinson's disease: recovery from a nonamnestic mild cognitive impairment or psychiatric symptoms remission? Case Rep Psychiatry 2012; 2012:427698. [PMID: 23193494 PMCID: PMC3501808 DOI: 10.1155/2012/427698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 10/01/2012] [Indexed: 12/02/2022] Open
Abstract
Mild cognitive impairment is a clinical condition more frequent in patients with Parkinson's disease than in general population. The nonamnestic presentations, usually characterized by executive dysfunction, are most prevalent. We present a case report of a Parkinson's disease patient diagnosed with nonamnestic mild cognitive impairment that showed complete remission of cognitive symptoms after one year. We discuss the possible causes for the remission, focusing on the treatment of medical conditions such as a major depressive episode and vitamin B12 deficiency, in addition to the change of pharmacological treatment. In a third assessment, cognitive performance remained normal. The case report highlights the importance of controlling clinical comorbidities on the assessment and followup of mild cognitive impairment, especially on Parkinson's disease.
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Affiliation(s)
- Jonas Jardim de Paula
- Laboratório de Investigações Neuropsicológicas (LIN), Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil
- Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso, Hospital das Clínicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Marco Túlio Gualberto Cintra
- Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso, Hospital das Clínicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Débora Marques Miranda
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil
| | - Maria Aparecida Camargos Bicalho
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Edgar Nunes Moares
- Instituto Jenny de Andrade Faria de Atenção à Saúde do Idoso, Hospital das Clínicas, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
| | - Leandro Fernandes Malloy-Diniz
- Laboratório de Investigações Neuropsicológicas (LIN), Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
- INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 190, 30130-100 Belo Horizonte, MG, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, 31270-901 Belo Horizonte, MG, Brazil
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Normative data for healthy middle-aged and elderly performance on the Addenbrooke Cognitive Examination-Revised. Cogn Behav Neurol 2012; 25:72-6. [PMID: 22596112 DOI: 10.1097/wnn.0b013e318259594b] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To provide normative data for healthy middle-aged and elderly Brazilians' performance on the Addenbrooke Cognitive Examination-Revised (ACE-R) and to investigate the effects of age, sex, and schooling on test performance. BACKGROUND The ACE-R is a brief cognitive battery that assesses various aspects of cognition. Its 5 subdomains (Attention and Orientation, Memory, Verbal Fluency, Language, and Visuospatial Abilities) are commonly impaired in Alzheimer disease or frontotemporal dementia. METHODS We evaluated 144 cognitively healthy volunteers (50% men, 50% women) aged 50 to 93 years, with 4 to 24 years of schooling. We divided the participants into 4 age groups, each of which was then stratified into 3 groups according to years of education. We assessed all participants with the ACE-R, the Mattis Dementia Rating Scale, and the Cornell Scale for Depression in Dementia. RESULTS Years of education affected all ACE-R subscores. Age influenced the Verbal Fluency subscore (P<0.001) and the ACE-R total score (P<0.05). Sex affected the Attention and Orientation (P=0.037) and Mini-Mental State Examination subscores (P=0.048), but not the ACE-R total score (P>0.05). CONCLUSIONS The performance of healthy middle-aged and elderly individuals on the ACE-R battery is strongly influenced by education and, to a lesser extent, by age. These findings are of special relevance in countries with populations that have marked heterogeneity in educational levels.
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Jacinto AF, Aguiar ACPDO, Franco FGDM, Ribeiro MI, Citero VDA. Estudo psicométrico da Escala de Avaliação de Demência e sua aplicabilidade em instituições de longa permanência no Brasil. EINSTEIN-SAO PAULO 2012; 10:318-22. [DOI: 10.1590/s1679-45082012000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 08/25/2012] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Avaliar a sensibilidade e a especificidade diagnósticas, e a concordância da Escala de Avaliação de Demência, com diagnóstico clínico de comprometimento cognitivo, e compará-las com as do Miniexame do Estado Mental. MÉTODOS: Oitenta e seis idosos de uma instituição de longa permanência foram convidados a participar do estudo e, destes, 58 concordaram em fazê-lo. A avaliação continha Miniexame do Estado Mental e Escala de Avaliação de Demência. O diagnóstico clínico de comprometimento cognitivo foi realizado por especialistas que utilizaram os critérios do DSM-IV. Escores da Escala de Avaliação de Demência e do Miniexame do Estado Mental foram correlacionados e suas sensibilidade e especificidade, obtidas. RESULTADOS: Vinte e dois (37,9%) idosos tinham comprometimento cognitivo (8,6% apresentaram comprometimento cognitivo leve e 29,3% demência). O Miniexame do Estado Mental e a Escala de Avaliação de Demência classificaram 31% e 55,2% como apresentando comprometimento cognitivo. Os escores da Escala de Avaliação de Demência e do Miniexame do Estado Mental tiveram uma forte correlação. A Escala de Avaliação de Demência teve uma sensibilidade maior do que o Miniexame do Estado Mental (86,4% versus 61,9%) e a especificidade foi menor (63,9% versus 86,5%). A concordância diagnóstica da Escala de Avaliação de Demência e do Miniexame do Estado Mental com a o diagnóstico clínico foi similar. CONCLUSÃO: A Escala de Avaliação de Demência mostrou uma sensibilidade maior na detecção de comprometimento cognitivo na população estudada e poderia ser um instrumento útil para aplicação em instituições de longa permanência.
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Oliveira AAVD, Satler C, Tomaz C. Neuropsychological performance differences between two groups of probable-AD patients from different areas of Brazil. Dement Neuropsychol 2012; 6:97-103. [PMID: 29213781 PMCID: PMC5619248 DOI: 10.1590/s1980-57642012dn06020006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
During normal aging there are some cognitive and behavioral changes similar to
those observed in a transitional state or mild cognitive impairment (MCI) and
early onset dementia, making it challenging for health care professionals to
reach an accurate and reliable diagnosis.
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