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International journal of geriatric psychiatry, Jan 25, 2015
Individuals with dementia due to Alzheimer's disease often receive care from family members w... more Individuals with dementia due to Alzheimer's disease often receive care from family members who experience associated burden. This study provides the first broad, population-based account of caregiving-related health outcome burden in Brazil. Data were analyzed from the 2012 National Health and Wellness Survey in Brazil (n = 12 000), an Internet-based survey of adults (aged 18+ years), using stratified sampling by sex and age to ensure demographic representation of Brazil's adult population. Caregivers of individuals with Alzheimer's disease or dementia were compared with non-caregivers on comorbidities, productivity impairment, health-related quality of life, resource utilization, sociodemographic/health characteristics and behaviors, and Charlson comorbidity index scores. Regression models assessed outcomes associated with caregiving, adjusting for potential confounds. Among 10 853 respondents, caregivers' (n = 209) average age was 42.1 years, 53% were female, and ...
Dementia and geriatric cognitive disorders extra, 2012
This study explores factors associated with depression in Alzheimer's disease (AD) compared w... more This study explores factors associated with depression in Alzheimer's disease (AD) compared with mild cognitive impairment (MCI) and other dementia disorders. In a prospective study we included 195 patients: 31 with MCI, 112 with AD and 52 with other dementias. According to the ICD-10 and the DSM-IV criteria, 88 (44.1%) and 59 (30.3%), respectively, had a depressive disorder. An adjusted multiple regression analysis showed that previous depression (p < 0.05) was significantly associated with depression in AD patients. Severity of dementia (p < 0.05) was significantly associated with a depressive disorder in a group of patients with frontotemporal dementia, vascular dementia, or dementia due to Lewy Body disease or Parkinson's disease. We found different factors associated with a depressive disorder in AD compared to those found for other dementia disorders.
Contexto: A doença de Alzheimer (DA) é a demência de maior prevalência e está associada a alteraç... more Contexto: A doença de Alzheimer (DA) é a demência de maior prevalência e está associada a alterações cognitivas, comportamentais e funcionais. Entretanto, faz-se necessário esclarecer a in uência do agravamento da doença no declínio dessas funções. Objetivo: Comparar funções cognitivas especí cas, funções motoras e atividades de vida diária (AVD) de pacientes com DA em diferentes estágios da doença. Métodos: Foram avaliadas as funções cognitivas, as funções motoras e as AVD de 74 pacientes com doença de Alzheimer (35 pacientes CDR1; 20 pacientes CDR2; 19 pacientes CDR3). Resultados: A função motora e a independência das AVD apresentam declínio não linear. Enquanto a função motora apresenta maior declínio na fase leve para moderada, as AVD básicas sofrem maior declínio na fase grave da doença. Conclusão: O declínio motor é mais importante nas fases moderada e grave, associado a valores de perda de capacidade física e risco de quedas. Veri ca-se que a perda de independência para realização das AVD instrumentais dos pacientes é muito maior do que o declínio físico e cognitivo avaliado objetivamente nas três fases da doença. Zidan M, et al. / Rev Psiq Clín. 2012;39(5):161-5 Palavras-chave: Capacidade funcional, demência, mobilidade, cognição.
We describe a three-year experience with patients with dementia. clinical, cognitive and function... more We describe a three-year experience with patients with dementia. clinical, cognitive and functional evaluation was performed by a multidisciplinary team for persons above 60 years. Mortality was assessed after three years. Mini-Mental State Examination (MMSE) (n=2,074) was 15.7 (8.4). Male patients MMSE (n=758) was 15.6 (8.3) and female's (n=1315) was 15.8 (8.3). Instrumental Activities of Daily Living Scale (n=2023) was 16.5 (7.6); females (n=1277) was 16.9 (7.2) and males (n=745) was 15.7(8.2). From these patients, 12.6% (n=209) died within three years. Baseline cognition of patients still alive was higher (p<0.001) than MMSE of those who died [MMSE=16.3 (8.1) vs. 10.6 (7.6)]. Mortality rate decreased 6% (IR=0.94) for each additional point on MMSE. Higher functional status decreases the mortality rate approximately 11% (IR=0.89) independently of age, gender, and education. Three-year mortality rates are dependent on baseline functional and cognitive status.
295 l/ Fig. l. High signal in anterior frontal lobes due to susceptibility artefact from air in f... more 295 l/ Fig. l. High signal in anterior frontal lobes due to susceptibility artefact from air in frontal sinuses: (a) subtracted average CBF-map (5 controls -2pts.); (b) averaged 3D-Tl-image (2 pts.); (c) Fig. la superimposed on Fig. lb. Cross points to area with lowest flow in white matter of left temporal lobe (brightest colour = lowest flow).
Strokes in privileged sites of the cognitive and behavioral circuits constitute strategic infarct... more Strokes in privileged sites of the cognitive and behavioral circuits constitute strategic infarct vascular dementia (VaD) subtypes (SIVaD) 1-3 . Among such eloquent regions the thalamic nuclei are important targets 3-4 . Such lesions are not common, and those involving thalamus and basal ganglia represent 4.6% of VaD cases 5-6 . These strategic thalamic nuclei play an important integrative role and interconnects with several cortical areas (hippocampal, prefrontal). Amnesia, executive dysfunction and dysphasia are common clinical presentations, besides behavioral and psychological symptoms 6-8 . The thalamic nuclei may be classified in five functional classes and include associative and limbic ones. Branches from the posterior cerebral circulation supply different nuclear groups and intrathalamic tract fibers. The syndromes may be classified considering functional characteristics of the damaged nuclei and the affected vascular territories 9 . Such reports are rare in Brazil, and only two papers were published focusing subcortical structures lesions, including the thalamus.
The objective of this study was to assess Mini-Mental State Examination norms of a functionally n... more The objective of this study was to assess Mini-Mental State Examination norms of a functionally normal sample of community-dwelling elderly. Illiterate and low-educated subjects who scored less than 5 on the Pfeffer Functional Activities Questionnaire (PFAQ) [n = 397; female = 269; mean age = 72.15 (SD = 7.24) years] had the 5th, 25th, 50th, and 75th percentiles calculated according to age (65-74; 75-84 years). Overall MMSE score was 21.97 (SD = 4.48). Mean MMSE for illiterate younger individuals was 19.46 (SD = 3.47), and the quartile distribution was 14, 17, 19, and 21. MMSE of subjects with 1-8 years of schooling was 23.90 (3.87), and the distribution was 15, 22, 24, and 27. MMSE of older illiterate subjects was 18.11 (SD = 3.63), and the distribution of scores was 13, 16, 18, and 20, whereas subjects with 1-8 years of schooling scored 23.81 (SD = 4.01) and the distribution was 15, 22, 24, and 27. These MMSE normative data may help improve the detection of cognitive impairment in Brazil, mainly in the primary clinical setting.
Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of... more Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of life in mixed dementia: a 24week, randomized, placebo-controlled exploratory trial (the REMIX study)
Microstructural abnormalities in white matter (WM) are often reported in Alzheimer's disease (AD)... more Microstructural abnormalities in white matter (WM) are often reported in Alzheimer's disease (AD) and may reflect primary or secondary circuitry degeneration (i.e., due to cortical atrophy). The interpretation of diffusion tensor imaging (DTI) eigenvectors, known as multiple indices, may provide new insights into the main pathological models supporting primary or secondary patterns of WM disruption in AD, the retrogenesis, and Wallerian degeneration models, respectively. The aim of this review is to analyze the current literature on the contribution of DTI multiple indices to the understanding of AD neuropathology, taking the retrogenesis model as a reference for discussion. A systematic review using MEDLINE, EMBASE, and PUBMED was performed. Evidence suggests that AD evolves through distinct patterns of WM disruption, in which retrogenesis or, alternatively, the Wallerian degeneration may prevail. Distinct patterns of WM atrophy may be influenced by complex interactions which comprise disease status and progression, fiber localization, concurrent risk factors (i.e., vascular disease, gender), and cognitive reserve. The use of DTI multiple indices in addition to other standard multimodal methods in dementia research may help to determine the contribution of retrogenesis hypothesis to the understanding of neuropathological hallmarks that lead to AD.
: Definir o mini-exame do estado mental (MEEM) global, por idade e educação em idosos de Santo An... more : Definir o mini-exame do estado mental (MEEM) global, por idade e educação em idosos de Santo Antônio de Pádua, RJ. Método: Avaliaram-se idosos residentes na comunidade (n=341; m=109, f=232) com MEEM. Dividiu-se a amostra em idosos jovens (65-84 anos) / idosos velhos (>85 anos) e escolaridade (analfabetos, alfabetizados). Comparou-se o MEEM dos grupos utilizando-se testes t de Student, Mann-Whitney e Tukey (p< 0,05). Resultados: A idade dos idosos jovens foi 73,13 ± 5,27 anos e o MEEM=19,91 ± 5,35. A idade dos idosos velhos foi 88,00 ± 4,90 anos e o MEEM=16,90 ± 4,96. Os grupos diferiram no MEEM significativamente (p=0,01). O MEEM dos analfabetos foi 17,08 ± 4,42 e dos alfabetizados 22,34 ± 4,94 (p<0,0001). O MEEM de idosos jovens analfabetos (73,61 ± 5,26 anos) e alfabetizados (72,67 ± 5,26 anos) foi 17,29 ± 4,40 e 22,42 ± 4,98, respectivamente. O MEEM diferiu significativamente nos grupos de idosos jovens (p<0,0001). O MEEM dos idosos velhos analfabetos e alfabetizados (86,50 ± 1,09 e 90,25 ± 7,34 anos) foi 14,33 ± 3,89 e 20,75 ± 3,85, respectivamente. Conclusão: Escolaridade e idade influenciam o MEEM. Estes resultados não se comparam aos de países desenvolvidos pela variável educação.
The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpat... more The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment. Objective: The course of two illustrative cases of GD is discussed, highlighting its clinical picture after antidepressant treatment and underlining variables related to disease prognosis, treatment effectiveness and conversion to major cognitive disorders such as vascular dementia (VD). Methods: The cognitive performance, depressive symptoms, autonomy and brain structural measurements as white matter hyperintensities (WMH) and hippocampal size, and microstructural integrity of WM with diffusion tensor imaging were followed during four years. Results: Case 1, with a severe degree of WMH, was associated with worsening cognition and increasing functional disability. Case 2, with mild WMH, an improvement of cognitive functioning could be seen. Conclusions: The existence of different subtypes of GD, as presented in this report, points a pathophysiological heterogeneity of GD, and suggests a possible continuum vascular depression (VaDp) and vascular cognitive impairment (VCI).
Despite the growing understanding of the conceptual complexity of awareness, there currently exis... more Despite the growing understanding of the conceptual complexity of awareness, there currently exists no instrument for assessing different domains of awareness in dementia. In the current study, the psychometric properties of a multidimensional awareness scale, the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), are explored in a sample of 201 people with dementia and their family caregivers. Cronbach's alpha was high (␣ = 0.87), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. ASPIDD presented a four-factor solution with a well-defined structure: awareness of activities of daily living, cognitive functioning and health condition, emotional state, and social functioning and relationships. Functional disability was positively correlated with total ASPIDD, unawareness of activities of daily living, cognitive functioning, and with emotional state. Caregiver burden was correlated with total ASPIDD scores and unawareness of cognitive functioning. The results suggest that ASPIDD is indeed a multidimensional scale, providing a reliable measure of awareness of disease in dementia. Further studies should explore the risk factors associated with different dimensions of awareness in dementia.
Journal of Alzheimer's Disease xx (20xx) x-xx Abstract. Awareness of disease can be compromised t... more Journal of Alzheimer's Disease xx (20xx) x-xx Abstract. Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.
Objective: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression ... more Objective: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. Method: Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. Results: We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. Conclusion: A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.
Journal of geriatric psychiatry and neurology, Jan 9, 2014
This study investigated in a community sample associations of 2 different measures of unawareness... more This study investigated in a community sample associations of 2 different measures of unawareness of memory impairment in dementia with cognitive variables and behavioral and psychological symptoms of dementia. Design-cross-sectional, population-based survey. Settings-community samples (n = 15 022) from 3 world regions (Latin America, China, and India). Participants-829 people with dementia identified from standardized interviews and diagnostic algorithms. Measurements-unawareness of memory deficits was measured in 2 ways: comparison of participant subjective report with either objective performance on memory tests or informant report (IR). Associations were investigated using prevalence ratios and Poisson regressions. Differences in frequency of unawareness were explored with McNemar tests for each region and agreement between variables calculated with Cohen κ. The unawareness variable based on comparison with performance was associated with cognitive variables, such as fluency (in...
This study aimed to estimate the quartile distribution on the cognitive assessment of normal elde... more This study aimed to estimate the quartile distribution on the cognitive assessment of normal elderly with low education as measured by the Cambridge Cognitive Examination (CAMCOG). A sample of 292 elderly (> 65 years of age), screened for dementia and depression, were assessed using the CAMCOG. The CAMCOG scores of normal subjects (n = 206) were stratified according to age (65-69, 70-74, 75-79, ≥ 80) and schooling (illiterate, 1-4, and ≥ 5 years of formal education). Mean age was 72.8 (± 3.5) and mean schooling was 3.5 years (± 3). The mean score on the CAMCOG was 71 (± 12.7). The scores at the first quartile for illiterate/1-4 years of schooling were 58/62 (65-69 years), 52/63 (70-74 years), 48/67 (75-79 years) and 46/64 (> 80 years), respectively. There was a significant difference in the CAMCOG quartiles according to education and age. This study provides normative data on the CAMCOG of elderly people with low educational levels which may be clinically useful.
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
International journal of geriatric psychiatry, Jan 25, 2015
Individuals with dementia due to Alzheimer's disease often receive care from family members w... more Individuals with dementia due to Alzheimer's disease often receive care from family members who experience associated burden. This study provides the first broad, population-based account of caregiving-related health outcome burden in Brazil. Data were analyzed from the 2012 National Health and Wellness Survey in Brazil (n = 12 000), an Internet-based survey of adults (aged 18+ years), using stratified sampling by sex and age to ensure demographic representation of Brazil's adult population. Caregivers of individuals with Alzheimer's disease or dementia were compared with non-caregivers on comorbidities, productivity impairment, health-related quality of life, resource utilization, sociodemographic/health characteristics and behaviors, and Charlson comorbidity index scores. Regression models assessed outcomes associated with caregiving, adjusting for potential confounds. Among 10 853 respondents, caregivers' (n = 209) average age was 42.1 years, 53% were female, and ...
Dementia and geriatric cognitive disorders extra, 2012
This study explores factors associated with depression in Alzheimer's disease (AD) compared w... more This study explores factors associated with depression in Alzheimer's disease (AD) compared with mild cognitive impairment (MCI) and other dementia disorders. In a prospective study we included 195 patients: 31 with MCI, 112 with AD and 52 with other dementias. According to the ICD-10 and the DSM-IV criteria, 88 (44.1%) and 59 (30.3%), respectively, had a depressive disorder. An adjusted multiple regression analysis showed that previous depression (p < 0.05) was significantly associated with depression in AD patients. Severity of dementia (p < 0.05) was significantly associated with a depressive disorder in a group of patients with frontotemporal dementia, vascular dementia, or dementia due to Lewy Body disease or Parkinson's disease. We found different factors associated with a depressive disorder in AD compared to those found for other dementia disorders.
Contexto: A doença de Alzheimer (DA) é a demência de maior prevalência e está associada a alteraç... more Contexto: A doença de Alzheimer (DA) é a demência de maior prevalência e está associada a alterações cognitivas, comportamentais e funcionais. Entretanto, faz-se necessário esclarecer a in uência do agravamento da doença no declínio dessas funções. Objetivo: Comparar funções cognitivas especí cas, funções motoras e atividades de vida diária (AVD) de pacientes com DA em diferentes estágios da doença. Métodos: Foram avaliadas as funções cognitivas, as funções motoras e as AVD de 74 pacientes com doença de Alzheimer (35 pacientes CDR1; 20 pacientes CDR2; 19 pacientes CDR3). Resultados: A função motora e a independência das AVD apresentam declínio não linear. Enquanto a função motora apresenta maior declínio na fase leve para moderada, as AVD básicas sofrem maior declínio na fase grave da doença. Conclusão: O declínio motor é mais importante nas fases moderada e grave, associado a valores de perda de capacidade física e risco de quedas. Veri ca-se que a perda de independência para realização das AVD instrumentais dos pacientes é muito maior do que o declínio físico e cognitivo avaliado objetivamente nas três fases da doença. Zidan M, et al. / Rev Psiq Clín. 2012;39(5):161-5 Palavras-chave: Capacidade funcional, demência, mobilidade, cognição.
We describe a three-year experience with patients with dementia. clinical, cognitive and function... more We describe a three-year experience with patients with dementia. clinical, cognitive and functional evaluation was performed by a multidisciplinary team for persons above 60 years. Mortality was assessed after three years. Mini-Mental State Examination (MMSE) (n=2,074) was 15.7 (8.4). Male patients MMSE (n=758) was 15.6 (8.3) and female's (n=1315) was 15.8 (8.3). Instrumental Activities of Daily Living Scale (n=2023) was 16.5 (7.6); females (n=1277) was 16.9 (7.2) and males (n=745) was 15.7(8.2). From these patients, 12.6% (n=209) died within three years. Baseline cognition of patients still alive was higher (p<0.001) than MMSE of those who died [MMSE=16.3 (8.1) vs. 10.6 (7.6)]. Mortality rate decreased 6% (IR=0.94) for each additional point on MMSE. Higher functional status decreases the mortality rate approximately 11% (IR=0.89) independently of age, gender, and education. Three-year mortality rates are dependent on baseline functional and cognitive status.
295 l/ Fig. l. High signal in anterior frontal lobes due to susceptibility artefact from air in f... more 295 l/ Fig. l. High signal in anterior frontal lobes due to susceptibility artefact from air in frontal sinuses: (a) subtracted average CBF-map (5 controls -2pts.); (b) averaged 3D-Tl-image (2 pts.); (c) Fig. la superimposed on Fig. lb. Cross points to area with lowest flow in white matter of left temporal lobe (brightest colour = lowest flow).
Strokes in privileged sites of the cognitive and behavioral circuits constitute strategic infarct... more Strokes in privileged sites of the cognitive and behavioral circuits constitute strategic infarct vascular dementia (VaD) subtypes (SIVaD) 1-3 . Among such eloquent regions the thalamic nuclei are important targets 3-4 . Such lesions are not common, and those involving thalamus and basal ganglia represent 4.6% of VaD cases 5-6 . These strategic thalamic nuclei play an important integrative role and interconnects with several cortical areas (hippocampal, prefrontal). Amnesia, executive dysfunction and dysphasia are common clinical presentations, besides behavioral and psychological symptoms 6-8 . The thalamic nuclei may be classified in five functional classes and include associative and limbic ones. Branches from the posterior cerebral circulation supply different nuclear groups and intrathalamic tract fibers. The syndromes may be classified considering functional characteristics of the damaged nuclei and the affected vascular territories 9 . Such reports are rare in Brazil, and only two papers were published focusing subcortical structures lesions, including the thalamus.
The objective of this study was to assess Mini-Mental State Examination norms of a functionally n... more The objective of this study was to assess Mini-Mental State Examination norms of a functionally normal sample of community-dwelling elderly. Illiterate and low-educated subjects who scored less than 5 on the Pfeffer Functional Activities Questionnaire (PFAQ) [n = 397; female = 269; mean age = 72.15 (SD = 7.24) years] had the 5th, 25th, 50th, and 75th percentiles calculated according to age (65-74; 75-84 years). Overall MMSE score was 21.97 (SD = 4.48). Mean MMSE for illiterate younger individuals was 19.46 (SD = 3.47), and the quartile distribution was 14, 17, 19, and 21. MMSE of subjects with 1-8 years of schooling was 23.90 (3.87), and the distribution was 15, 22, 24, and 27. MMSE of older illiterate subjects was 18.11 (SD = 3.63), and the distribution of scores was 13, 16, 18, and 20, whereas subjects with 1-8 years of schooling scored 23.81 (SD = 4.01) and the distribution was 15, 22, 24, and 27. These MMSE normative data may help improve the detection of cognitive impairment in Brazil, mainly in the primary clinical setting.
Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of... more Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of life in mixed dementia: a 24week, randomized, placebo-controlled exploratory trial (the REMIX study)
Microstructural abnormalities in white matter (WM) are often reported in Alzheimer's disease (AD)... more Microstructural abnormalities in white matter (WM) are often reported in Alzheimer's disease (AD) and may reflect primary or secondary circuitry degeneration (i.e., due to cortical atrophy). The interpretation of diffusion tensor imaging (DTI) eigenvectors, known as multiple indices, may provide new insights into the main pathological models supporting primary or secondary patterns of WM disruption in AD, the retrogenesis, and Wallerian degeneration models, respectively. The aim of this review is to analyze the current literature on the contribution of DTI multiple indices to the understanding of AD neuropathology, taking the retrogenesis model as a reference for discussion. A systematic review using MEDLINE, EMBASE, and PUBMED was performed. Evidence suggests that AD evolves through distinct patterns of WM disruption, in which retrogenesis or, alternatively, the Wallerian degeneration may prevail. Distinct patterns of WM atrophy may be influenced by complex interactions which comprise disease status and progression, fiber localization, concurrent risk factors (i.e., vascular disease, gender), and cognitive reserve. The use of DTI multiple indices in addition to other standard multimodal methods in dementia research may help to determine the contribution of retrogenesis hypothesis to the understanding of neuropathological hallmarks that lead to AD.
: Definir o mini-exame do estado mental (MEEM) global, por idade e educação em idosos de Santo An... more : Definir o mini-exame do estado mental (MEEM) global, por idade e educação em idosos de Santo Antônio de Pádua, RJ. Método: Avaliaram-se idosos residentes na comunidade (n=341; m=109, f=232) com MEEM. Dividiu-se a amostra em idosos jovens (65-84 anos) / idosos velhos (>85 anos) e escolaridade (analfabetos, alfabetizados). Comparou-se o MEEM dos grupos utilizando-se testes t de Student, Mann-Whitney e Tukey (p< 0,05). Resultados: A idade dos idosos jovens foi 73,13 ± 5,27 anos e o MEEM=19,91 ± 5,35. A idade dos idosos velhos foi 88,00 ± 4,90 anos e o MEEM=16,90 ± 4,96. Os grupos diferiram no MEEM significativamente (p=0,01). O MEEM dos analfabetos foi 17,08 ± 4,42 e dos alfabetizados 22,34 ± 4,94 (p<0,0001). O MEEM de idosos jovens analfabetos (73,61 ± 5,26 anos) e alfabetizados (72,67 ± 5,26 anos) foi 17,29 ± 4,40 e 22,42 ± 4,98, respectivamente. O MEEM diferiu significativamente nos grupos de idosos jovens (p<0,0001). O MEEM dos idosos velhos analfabetos e alfabetizados (86,50 ± 1,09 e 90,25 ± 7,34 anos) foi 14,33 ± 3,89 e 20,75 ± 3,85, respectivamente. Conclusão: Escolaridade e idade influenciam o MEEM. Estes resultados não se comparam aos de países desenvolvidos pela variável educação.
The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpat... more The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment. Objective: The course of two illustrative cases of GD is discussed, highlighting its clinical picture after antidepressant treatment and underlining variables related to disease prognosis, treatment effectiveness and conversion to major cognitive disorders such as vascular dementia (VD). Methods: The cognitive performance, depressive symptoms, autonomy and brain structural measurements as white matter hyperintensities (WMH) and hippocampal size, and microstructural integrity of WM with diffusion tensor imaging were followed during four years. Results: Case 1, with a severe degree of WMH, was associated with worsening cognition and increasing functional disability. Case 2, with mild WMH, an improvement of cognitive functioning could be seen. Conclusions: The existence of different subtypes of GD, as presented in this report, points a pathophysiological heterogeneity of GD, and suggests a possible continuum vascular depression (VaDp) and vascular cognitive impairment (VCI).
Despite the growing understanding of the conceptual complexity of awareness, there currently exis... more Despite the growing understanding of the conceptual complexity of awareness, there currently exists no instrument for assessing different domains of awareness in dementia. In the current study, the psychometric properties of a multidimensional awareness scale, the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), are explored in a sample of 201 people with dementia and their family caregivers. Cronbach's alpha was high (␣ = 0.87), indicating excellent internal consistency. The mean of corrected item-total correlation coefficients was moderate. ASPIDD presented a four-factor solution with a well-defined structure: awareness of activities of daily living, cognitive functioning and health condition, emotional state, and social functioning and relationships. Functional disability was positively correlated with total ASPIDD, unawareness of activities of daily living, cognitive functioning, and with emotional state. Caregiver burden was correlated with total ASPIDD scores and unawareness of cognitive functioning. The results suggest that ASPIDD is indeed a multidimensional scale, providing a reliable measure of awareness of disease in dementia. Further studies should explore the risk factors associated with different dimensions of awareness in dementia.
Journal of Alzheimer's Disease xx (20xx) x-xx Abstract. Awareness of disease can be compromised t... more Journal of Alzheimer's Disease xx (20xx) x-xx Abstract. Awareness of disease can be compromised to some degree in a proportion of people with dementia, with evident differences across domains. We designed this study to determine the factors associated with the impairment of awareness over a period of time. Using a longitudinal design, 69 people with mild Alzheimer's disease and their family caregivers completed the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia, the Quality of Life in Alzheimer's Disease Scale, the Mini-Mental State Examination, the Clinical Dementia Rating scale, the Cornell Scale for Depression in Dementia, the Pfeffer Functional Activities Questionnaire, the Neuropsychiatric Inventory, and the Zarit Burden Interview. Univariate and logistic regression analyses were conducted to examine the contribution of the various factors. The level of awareness of disease was significantly lower (p ≤ 0.001) between baseline and at follow up. At follow up, there was no change in the level of awareness of disease in 61.8%, whereas 25.4% worsened. However, the level of awareness improved in 12.3%. Logistic regression demonstrated that functional deficits (OR = 1.12, 95% CI: (1.03-1.22), p ≤ 0.01), and caregivers' quality of life (OR = 0.83, 95% CI: (0.70-0.98), p ≤ 0.05) were a significant predictor of impaired awareness of disease. The results confirmed that awareness and cognition are relatively independent, and showed that in people with mild dementia, unawareness is mainly manifested by poor recognition of changes in the activities of daily living, and decrease in quality of life.
Objective: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression ... more Objective: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. Method: Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. Results: We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. Conclusion: A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.
Journal of geriatric psychiatry and neurology, Jan 9, 2014
This study investigated in a community sample associations of 2 different measures of unawareness... more This study investigated in a community sample associations of 2 different measures of unawareness of memory impairment in dementia with cognitive variables and behavioral and psychological symptoms of dementia. Design-cross-sectional, population-based survey. Settings-community samples (n = 15 022) from 3 world regions (Latin America, China, and India). Participants-829 people with dementia identified from standardized interviews and diagnostic algorithms. Measurements-unawareness of memory deficits was measured in 2 ways: comparison of participant subjective report with either objective performance on memory tests or informant report (IR). Associations were investigated using prevalence ratios and Poisson regressions. Differences in frequency of unawareness were explored with McNemar tests for each region and agreement between variables calculated with Cohen κ. The unawareness variable based on comparison with performance was associated with cognitive variables, such as fluency (in...
This study aimed to estimate the quartile distribution on the cognitive assessment of normal elde... more This study aimed to estimate the quartile distribution on the cognitive assessment of normal elderly with low education as measured by the Cambridge Cognitive Examination (CAMCOG). A sample of 292 elderly (> 65 years of age), screened for dementia and depression, were assessed using the CAMCOG. The CAMCOG scores of normal subjects (n = 206) were stratified according to age (65-69, 70-74, 75-79, ≥ 80) and schooling (illiterate, 1-4, and ≥ 5 years of formal education). Mean age was 72.8 (± 3.5) and mean schooling was 3.5 years (± 3). The mean score on the CAMCOG was 71 (± 12.7). The scores at the first quartile for illiterate/1-4 years of schooling were 58/62 (65-69 years), 52/63 (70-74 years), 48/67 (75-79 years) and 46/64 (> 80 years), respectively. There was a significant difference in the CAMCOG quartiles according to education and age. This study provides normative data on the CAMCOG of elderly people with low educational levels which may be clinically useful.
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Papers by Jerson Laks