02 maio

Análise comparativa entre CAMCOG, Fluência Verbal e o CASI-Short em idosos sem escolaridade

Existem vários testes para ajudar no diagnóstico da Doença de Alzheimer (DA) e é importante que o mesmo seja feito o quanto antes. A escolha dos testes neuropsicológicos pode variar de acordo com o tempo de escolaridade, pois a mesma pode influenciar o desempenho cognitivo. Instrumento breve de rastreio de habilidades cognitivas é o CASI (Cognitive Abilities Screening Instrument). Há uma versão resumida deste instrumento, CASI-S, que inclui registro, orientação temporal, fluência verbal, e evocação de palavras. O objetivo do estudo foi o desempenho cognitivo de idosos analfabetos entre os testes Cambridge Cognitive Examination, Fluência Verbal e o Cognitive Abilities Screening Instrument em sua versão reduzida. Método: foram avaliados 38 idosos analfabetos atendidos no Ambulatório de Geriatria de Jundiaí. Os instrumentos utilizados foram o Casi-S, CAMCOG, Fluência Verbal (FV), EDG e Questionário de Atividades Funcionais de Pfeffer. As análises do teste de correlação evidenciaram que o Casi-S correlacionou-se significativamente com o CAMCOG (r = 0,82; p < 0,0001). Pode-se observar um coeficiente moderado e significativo entre o teste de FV versão animais (r = 0,59; p < 0,0001) e a versão frutas (r = 0,69; p < 0,0001). Pode-se concluir que o Casi-S apresenta vantagens na aplicação em idosos analfabetos, por ser de simples execução e não exigir aspectos de escrita e leitura.

Palavras-chave: idoso, escolaridade, testes neuropsicológicos.

02 maio

A subtest analysis of the Montreal cognitive assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer’s disease?

Background: It is necessary to continue to explore the psychometric characteristics of key cognitive screening tests such as the Montreal Cognitive Assessment (MoCA) to diagnose cognitive decline as early as possible and to attend to the growing need of clinical trials involving mild cognitive impairment (MCI) participants. The main aim of this study was to assess which MoCA subtests could best discriminate between healthy controls (HC), participants with MCI, and Alzheimer’s disease (AD).

Methods: Cross-sectional analysis of 136 elderly with more than four years of education. All participants were submitted to detailed clinical, laboratory, and neuroimaging evaluation. The MoCA,Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), Geriatric Depression Scale (GDS), and Functional Activities Questionnaire (FAQ) were applied to all participants. The MoCA test was not used in the diagnostic procedure.

Results: Median MoCA total scores were 27, 23 and 18 for HC, MCI, and AD, respectively (p < 0.001). Word repetition, inverse digits, serial 7, phrases, verbal fluency, abstraction, and word recall discriminated between MCI and HC participants (p < 0.001). The clock drawing, the rhino naming, delayed recall of five words and orientation discriminated between patients with MCI and AD (p < 0.001). A reduced version of the MoCA with only these items did not improve accuracy between MCI and HC (p = 0.076) or MCI and AD (p = 0.119).

Conclusions: Not all MoCA subtests might be fundamental to clinical diagnosis ofMCI. The reduced versions of MoCA did not add diagnostic accuracy.

Key words: mild cognitive impairment diagnosis, Alzheimer’s disease, cognitive assessment, cognitive testing.

02 maio

Evaluation of Montreal cognitive assessment for the differential diagnosis of mild cognitive impairment and Alzheimer’s disease in elderly patients with more than 5 years of schooling: Data from a Brazilian sample

 

Background: Diagnostic investigation of dementia is based on a series of tests which lie the neuropsychological evaluations. The Montreal Cognitive Assessment (MoCA) was developed as an instrument to recognize Mild Cognitive Impairment (MCI) and initial cases of Alzheimer’s disease. The present study aims to evaluate the predictive value of Brazilian MoCA test version in a sample of elderly above 5 years of education. Methods: Cross-sectional study with 136 elderly, above 60 years old at least 5 years of education. Diagnostic criteria is based on clinical and neuropsychological data classified Alzheimer’s disease n = 52, MCI n = 45 e normal controls n = 39. MoCA test was compared with Cambridge Cognitive Examination, Mini-Mental

State Exam, Verbal Fluency, Clock Drawing Test, Geriatric Depression Scale and Pfeffer Functional Activities Questionnaire. Accuracy was evaluated by receiver operating characteristic (ROC) curve analyses. Pearson correlation coefficient was used to compare the MoCA with the other tests. It was also used logistic regression analysis to identify the main risk factors for the diagnostic groups. Results: MoCA was the best test to differentiate Alzheimer’s disease cases from MCI with 86.5% sensitivity and 75.6% specificity. Furthermore, analyzes of correlation test showed that MoCA correlates robust way of already validated with other tests and wide application in Brazil. Conclusions: It can be concluded that MoCA is a good screening tool for investigation of MCI among the elderly in Brazil with over 5 years of schooling. Studies with larger numbers of participants are needed to further validate the test also for elderly people with low education.

Keywords: Elderly, MoCA; Mild Cognitive Impairment; Alzheimer’s Disease; Neuropsychological Tests.

02 maio

Assessment of Cognitive Functions in Nonagenarians with Different Educational Levels Comparing Controls and Alzheimer’s Patients

Background: It is necessary to continue to explore the psychometric characteristics of key cognitive screening tests such as the Montreal Cognitive Assessment (MoCA) to diagnose cognitive decline as early as possible and to attend to the growing need of clinical trials involving mild cognitive impairment (MCI) participants. The main aim of this study was to assess which MoCA subtests could best discriminate between healthy controls (HC), participants with MCI, and Alzheimer’s disease (AD).

Methods: Cross-sectional analysis of 136 elderly with more than four years of education. All participants were submitted to detailed clinical, laboratory, and neuroimaging evaluation. The MoCA,Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), Geriatric Depression Scale (GDS), and Functional Activities Questionnaire (FAQ) were applied to all participants. The MoCA test was not used in the diagnostic procedure.

Results: Median MoCA total scores were 27, 23 and 18 for HC, MCI, and AD, respectively (p < 0.001). Word repetition, inverse digits, serial 7, phrases, verbal fluency, abstraction, and word recall discriminated between MCI and HC participants (p < 0.001). The clock drawing, the rhino naming, delayed recall of five words and orientation discriminated between patients with MCI and AD (p < 0.001). A reduced version of the MoCA with only these items did not improve accuracy between MCI and HC (p = 0.076) or MCI and AD (p = 0.119).

Conclusions: Not all MoCA subtests might be fundamental to clinical diagnosis ofMCI. The reduced versions of MoCA did not add diagnostic accuracy.

Key words: mild cognitive impairment diagnosis, Alzheimer’s disease, cognitive assessment, cognitive testing.

02 maio

O videogame como ferramenta na melhora de marcha e equilíbrio em pacientes com doença de parkinson

A Doença de Parkinson (DP) é a segunda doença neurodegenerativa mais comum que acomete o Sistema Nervoso Central. Apresenta alterações das funções motoras e cognitivas como incapacidade de tomar decisões e de controle da atenção, particularmente para execução entre duas tarefas muito comum nas situações reais do cotidiano. Objetivo: Testar a capacidade de melhora da marcha e equilíbrio em pacientes com Doença de Parkinson, por meio de treinamento com os jogos do vídeo game Nintendo Wii®. Metodologia: Foram avaliados 4 pacientes com diagnóstico clínico de Doença de Parkinson, com idade variando entre 50 e 85 anos, de ambos os sexos. Resultados: Observa-se que os jogos Table Tilt Plus, Balance Bubble Plus e Big Top Juggling mostraram resultados mais promissores a respeito da capacidade de aprendizagem, e os jogos Ski Slalom e Snowball Fight apresentaram uma aprendizagem mais lenta. Conclusão: Os pacientes com DP foram capazes de aprender a maioria dos jogos propostos e mesmo que haja habilidades prejudicadas pela doença a maioria teve seu desempenho melhorado por meio do treino com o auxílio da realidade virtual e suas demandas cognitivas e motoras.

 Palavras-chave: Doença de Parkinson; Cognição; Marcha; Aprendizagem.

02 maio

Avaliação Da Apraxia No Comprometimento Cognitivo Leve E Doença De Alzheimer

Objetivo: Avaliar apraxia em idosos saudáveis, com diagnóstico de doença de Alzheimer (DA) e Comprometimento Cognitivo Leve (CCL).

Métodos: Foram avaliados 136 indivíduos com uma idade média de 75,74 anos (mínimo de 60 anos de idade, máximo 92 anos) e escolaridade média de 9 anos (mínimo de 7 e máximo de 12 anos), por meio do Mini-exame do Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) e o teste do relógio. Para analisar a presença de apraxia, foram selecionados oito subitens do CAMCOG: os desenhos do Pentágono, da espiral, da casa, do relógio, e também a tarefa de colocar um pedaço de papel em um envelope e os movimentos corretos com uma mão para dar “adeus”, cortar papel com uma tesoura e escovar os dentes.

Resultados: Idosos saudáveis sem alterações cognitivas apresentaram média de 11,51, em comparação com CCL (11,13), e DA o qual apresentou pior média no teste de apraxia (10.23). O subteste de apraxia diferenciou os três grupos diagnósticos (p=0,001). Observou-se uma correlação negativa entre os escores de apraxia e os do MEEM.

Conclusão: Conclui-se que a investigação da presença de apraxia é importante na avaliação cognitiva de pacientes com comprometimento cognitivo e pode ser útil em diferenciar controles idosos, indivíduos com CCL e com DA.

02 maio

Comportamento verbal em pacientes com doença de Alzheimer: análise da repetição de frases

As dificuldades com a linguagem em idosos com Alzheimer (DA) se devem ao fato de que a deterioração não está relacionada apenas à memória semântica, mas um conjunto de fatores cognitivos, os quais demonstram a deficiência nas estratégias de busca de informações lingüísticas. Objetivos: Avaliar a repetição de frases em dois testes cognitivos (MEEM e MoCA), em um grupo de participantes normais e outro com o diagnóstico de DA. Métodos: Estudo transversal com 20 pacientes que procuraram o serviço de saúdo no instituto de geriatria em Jundiaí, São Paulo. Os participantes passaram por anamnese clínica detalhada e avaliação neuropsicométrica. O grupo de participantes com diagnóstico de DA foi feito pelos critérios do DSM-IV e NINCDS-ADRDA. Dez pacientes receberam o diagnóstico de DA e 10 como participantes normais, formando o grupo controle (GC). Resultados: Todos os participantes responderam corretamente a frase do MEEM. As frases do MoCA (frase 2 e 3) foram corretas em 80% e 90% respectivamente no GC. O grupo com DA respondeu corretamente 40% e 50% respectivamente. Conclusões: O teste MoCA mostrou ser mais eficiente em avaliar o comportamento verbal ecóico em pacientes com DA quando comparados ao MEEM. A simples repetição de frase no MEEM mostrou ser menos sensível para detectar declínio leve de linguagem em pacientes com DA.

Palavras-chave: comportamento verbal, idosos, doença de Alzheimer, linguagem, testes cognitivos.

02 maio

Cognitive Abilities Screening

Dementia prevalence is increasing in developing countries due to population aging. Brief tests for assessing cognition and activities of daily living are very useful for the diagnosis of dementia by the clinician. Low education, particularly illiteracy, is a hindrance to the diagnosis of dementia in several regions of the world. Objectives: To compare the Brazilian version of the Cognitive Abilities Screening Instrument-Short Form (CASI-S) with the Mini-Mental State Examination (MMSE) and Pfeffer Functional Activities Questionnaire (PFAQ) for the diagnosis of dementia in illiterate elderly. Methods: A cross-sectional study with illiterate elderly of both genders seen at the outpatient clinics of the Institute of Gerontology and Geriatrics Jundiaí, São Paulo state was performed. Spearman’s correlation coefficient was used to correlate CASI-S, MMSE and PFAQ scores. Results: The sample comprised 29 elderly over 57 years old whose mean scores on the CASI-S (scores ranging from 3 to 23) and the MMSE (scores ranging from 2 to 23) were 11.69 and 12.83, respectively. There was a strong significant correlation between the CASI-S and MMSE (r=0.75, p<0.001) and a moderate correlation coefficient that was significant and negative between the PFAQ and CASI-S (r= –0.53 p=0.003),similar to that between the MMSE and PFAQ (r= –0.41 p=0.025). Conclusion: The Brazilian version of the CASI-S demonstrates ease of application and correction in the illiterate elderly, and warrants further studies regarding its applicability for the diagnosis of dementia in populations with a heterogeneous educational background.

Key words: CASI-S, MMSE, PFAQ, aging, cognition.

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02 maio

Cognitive Impairment in Alzheimer’s Disease: Longitudinal Data from Brazilian Elderly

Research on cognitive aging is becoming increasingly common because aging is a global phenomenon and brings with it many challenges, for example, the increased incidence of dementias such as Alzheimer’s Disease (AD). Even if the cognitive decline in AD is apparently linear, impairment of autonomy in activities of daily living does not follow the same pattern. Objectives: To monitor and evaluate the cognitive aspects of elderly diagnosed with Alzheimer’s disease. Methodological procedures: This research was conducted from January 2006 to July 2013 at the Clinic of Geriatrics and Gerontology. Longitudinal study of 51 elderly patients aged 60 years, of both sexes who received a diagnosis of Alzheimer’s disease by DSM-IV (APA, 1994) and NINDS-ADRDA (McKhann et al., 2011). Results: From the results obtained in the present study, we observed that the participants had a decline in cognitive function from the first to the second assessment, even with drug treatment.

Keywords: Alzheimer Disease, Neuropsychiatric Evaluation, Cognition, Learning

02 maio

Comparison in cognitive function in alzheimer’s disease and vascular dementia: Contributions to the differential diagnosis

Dementia syndromes are characterized by the presence of deficit progressive cognitive function. Vascular dementia (VD) is the most prevalent between secondary dementias, ranking second among all dementia after Alzheimer’s disease (AD). The aim of this study was to evaluate the cognitive aspects of elderly patients with diagnoses of AD and VD. Participants were 256 elderly patients with mean age of 78 years and both sexes who received a diagnosis of Alzheimer’s disease by the Diagnostic Statistic Manual (DSM-IV) and National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA). The diagnosis of vascular dementia was done according to National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINCDS-AIREN). The results showed that the prevalence of AD was superior to VD, mean age increases the ratio DA / VD, with women and people with lower education levels most affected. VD and AD patients have had similar cognitive abilities and VD patients exhibit more temporal orientation impairments than AD.

 Key Words: Neuropsychological assessment, vascular dementia, alzheimer disease, cognition.