Navegando por Palavras-chave "Alzheimer disease"

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    Adaptação e correlação entre instrumentos neuropsicológicos para avaliação e acompanhamento da doença de Alzheimer em fases avançadas
    (Universidade Federal de São Paulo (UNIFESP), 2012) Wajman, José Roberto [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]
    Objetivo: foi objetivo principal deste projeto o estudo da correlacao entre instrumentos especificos para avaliacao de pacientes com demencia da doenca de Alzheimer em fases avancadas no que diz respeito a sua cognicao objetivamente ponderada e aspectos da capacidade funcional. Metodos: foram utilizadas nesta pesquisa as escalas CDR (Clinical for Dementia Rating), FAST (Functional Assessment Scale), BANS (Bedford Alzheimer Nursing Severity Scale), MMSE (Mini-Mental State Exame), MMSE-G (Mini-Mental State Exame-Grave), SIB-8 (Severe Impairment Battery) e TSI (Test for Severe impairment) para comparacao com uma escala ecologica que serviu como padraoouro, a PADL (Performance Activities of Daily Living). Como proposta estatistica foram aplicadas analises descritivas, analise de Variancia (ANOVA), o Teste de Kruskal-Wallis para efeito de comparacao, alem de ter sido adotado nivel de significancia de 5% para as analises inferenciais. Resultados: foram incluidos 95 individuos acompanhados junto ao Setor de Neurologia do Comportamento do Hospital São Paulo - UNIFESP, sendo 33 (34,7%) do genero masculino e 62 (65,3%) do feminino. A idade media dos 95 individuos foi de 74,7 anos, variando de 60 a 89 anos, com desvio padrao de 6,2 anos. Em media, o tempo de escolaridade foi de 4,2 anos, variando de 3 a 8 anos, com desvio padrao de 1,5 anos. O tempo medio de doenca dos individuos foi de 7,3 anos, variando de 5 a 12 anos, com desvio padrao de 1,7 anos. Conclusoes: as evidencias encontradas sugerem uma correlacao linear crescente e estatisticamente significante entre a PADL e os instrumentos MEEM-G, SIB-8 e TSI. Houve, ainda, relacao estatisticamente significante entre os resultados alcancados na escala PADL uma vez comparada com o MEEM-G, a SIB-8 e a TSI e a fase da doenca em que os pacientes se encontravam, na medida em que quanto mais prejudicados foram seus desempenhos nesses tres testes, maior o indice de progressao da doenca na escala funcional FAST e em suas subdivisoes. Estes resultados indicam que para populacoes com estas caracteristicas escalas especificas para demencia grave sao uteis na avaliacao mais acurada do estagio da doenca e sua progressao
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    Análise do padrão articulatório da tarefa de fluência verbal frutas no comprometimento cognitivo leve, na demência de Alzheimer leve e moderado
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-17) Giacominelli, Carla [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; http://lattes.cnpq.br/0536597854124056; http://lattes.cnpq.br/3138949086178926; Universidade Federal de São Paulo (UNIFESP)
    The semantic verbal fluency task as a neuropsychological assessment, is widely used in the clinical practice of Alzheimer's Disease (AD) and involves the subject generate during 60s to generate the highest number of words belonging to a specific semantic category. Verbal fluency animals and verbal fluency fruits (VFf) have previously been described to be similarly effective in discriminating normal participants from subjects with AD. Both tasks were less accurate in discriminating AD-stages for unknown reasons. Based on semantic clustering scores in verbal fluency animals, a literacy depending pattern has been revealed across cultures; however, no previous analysis has been performed for VFf. The aim of this study is to investigate whether the task of verbal fluency fruit is useful for discriminating controls, Mild Cognitive Impairment (MCI), Mild Alzheimer Disease (MAD) and Moderate Alzheimer Disease(ModAD) and to determine task’s specificities and sensibilities at various stages of the AD. Methods: Three-hundred-fourteen native Brazilian Portuguese speakers were divided in four groups: Control Group (CG) and Mild Cognitive Impairment (MCI), Mild Alzheimer’s Disease (MAD) and Moderate Alzheimer’s Disease (ModAD) groups. A quantitative total score and a qualitative, clusters analysis, were conducted for VFf and were compared to other cognitive tasks. As no semantic setting was found, a non-arbitrary classification of fruits based on sub categorical items, according to the articulatory point of International Phonetic Alphabetic (2015) was performed. The words were grouped as follows: 1) bilabial, 2) velars, 3) open vowels, 4) closed vowels, 5) lateral dental/ alveolar, 6) dental /alveolar, and 7) labio- dentals. Results: Clustering strategies in the AD groups differed from those of the CG. Clustering revealed differences beyond groups depending on which articulatory point was emitted. MCI had a 73% lower chance of attaining an NV than did the CG and with AD groups presented odds ratios of using the /k/, /g/ velars feature 85% lower than those of the CG. Participants who used bilabials had 2.04 times higher total scores than those who did not. Younger subjects had a higher probability to perform better on the task. Participants with ≥ 9 years of education had a higher probability of higher performance with respect to the total score. Conclusion: Articulatory deterioration occurred in AD since the early stages. VFf seems to be a suitable task since MCI evaluation.
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    Apathy Is not Associated with Performance in Brief Executive Tests in Patients with Mild Cognitive Impairment and Mild Alzheimer's Disease
    (Bentham Science Publ Ltd, 2014-01-01) Guimaraes, Henrique Cerqueira [UNIFESP]; Fialho, Patricia Paes; Carvalho, Viviane Amaral; Machado, Thais Helena; Santos, Etelvina Lucas; Caramelli, Paulo; Universidade Federal de Minas Gerais (UFMG); Universidade Federal de São Paulo (UNIFESP)
    Neuropsychological correlates of apathy in Alzheimer's disease (AD) may shed some light on the neurobiology of this behavioral disorder. Whereas previous research has suggested an association between apathy and executive functions in AD, amnestic mild cognitive impairment (aMCI) cohorts point to an association with memory tests. We aimed to further investigate this issue in a sample of low educated, hitherto unexposed to cholinesterase inhibitors, aMCI (n=26) and mild AD (n=28) patients using brief executive tests, namely the Executive Interview (EXIT-25) and the Frontal Assessment Battery (FAB). Patients and controls (n=33) were included from a community-based survey of successful brain aging in Brazilian elderly (75+ years), The Pieta Study. The participants were submitted to a comprehensively neuropsychological assessment and apathy evaluation through the Apathy Scale (AS). We found a strong correlation in AD group between AS scores and functional performance measured by the Disability Assessment in Dementia (rho =-0.7; p<0,001). No association was found between any executive test performance and apathy symptoms. Apathy symptoms were also associated with the performance in memory tests and in the attention subscale of the Mattis Dementia Rating Scale. These findings reinforce the functional effect of apathy even in the mildest stages along the AD cognitive impairment spectrum, and challenges previous assumptions regarding the association between apathy and classical executive functions.
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    Applicability of the abbreviated neuropsychologic battery (NEUROPSI) in Alzheimer disease patients
    (Lippincott Williams & Wilkins, 2008-01-01) Abrisqueta-Gomez, Jacqueline [UNIFESP]; Ostrosky-Solis, Feggy; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Bueno, Orlando Francisco Amodeo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Nacl Autonoma Mexico
    NEUROPSI is a brief neuropsychologic battery developed to briefly assess a wide spectrum of cognitive functions. The aim of this study was to examine the applicability of a Portuguese version of this battery and verify the efficacy in detecting cognitive impairment in Alzheimer disease (AD) patients. NEUROPSI was applied to 75 elderly people, 25 patients with probable AD in mild stage (AD1), 25 patients in moderate stage (AD2), and 25 healthy elderly persons (control group), matched with the AD patients for age and schooling. Before testing all participants were applied the Mini-Mental State Examination. Results showed significant differences in total scores of the tests; NEUROPSI (P<0.001) and Mini-Mental State Examination (P < 0.001), and the control group scored highest in both of the tests followed by groups AD1 and AD2. Differences were also found between the initial phase and the moderate phase. Results indicate that NEUROPSI is an efficient instrument for detecting AD patients in the initial stage of the disease.
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    Applicability of the CERAD neuropsychological battery to Brazilian elderly
    (Academia Brasileira de Neurologia - ABNEURO, 2001-09-01) Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Okamoto, Ivan Hideyo [UNIFESP]; Brucki, Sonia Maria Dozzi [UNIFESP]; Siviero, Marilena Occhini [UNIFESP]; Toniolo Neto, João [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.
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    Apraxia de fala e apraxia não-verbal na doença de Alzheimer
    (Universidade Federal de São Paulo (UNIFESP), 2010-01-27) Cera, Maysa Luchesi [UNIFESP]; Minett, Thaís Soares Cianciarullo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: to assess the speech and orofacial apraxia in Alzheimer’s disease (AD) and identify praxic speech errors at different stages of the disease and to verify the similarity among their occurrences. Methods: thirty subjects in each stage of AD (mild, moderate and severe) were submitted to the following assessment: Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE) and Lawton Instrumental Activities of Daily Living, and praxis tasks, using the oral agility subtest of the Boston diagnostic aphasia examination and the protocol assessment speech and orofacial apraxias. Results: there were 66 women, the mean age was 80,2±7,2 years and means educational was 4,2 ±3,5 years. The means in the oral agility task of AD patients were significantly lower than of the normal population. Difficulties in verbal and nonverbal praxis increased with the progression of the disease. Regarding the types of errors, omission and substitution were more common, followed by trial-and-error, repetition, self-correction and addition. The error type addition determined different patterns of errors between stages of the disease. Conclusions: the speech and orofacial praxias of patients with AD were impaired and deteriorated according to the stage of the disease.
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    Assessment of risk factors for earlier onset of sporadic Alzheimer's disease dementia
    (Medknow Publications & Media Pvt Ltd, 2014-11-01) Oliveira, Fabricio Ferreira de [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Chen, Elizabeth Suchi [UNIFESP]; Smith, Marilia de Arruda Cardoso [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: Pharmacological treatment has mild effects for patients with Alzheimer's disease dementia (AD); therefore, the search for modifiable risk factors is an important challenge. Though risk factors for AD are widely recognized, elements that influence the time of dementia onset have not been comprehensively reported. We aimed to investigate which risk factors might be related to the age of onset of AD in a sample of patients with highly variable educational levels, taking into account the Framingham risk scoring as the sole measure of vascular risk. Subjects and Methods: We included 209 consecutive late-onset AD patients to find out which factors among educational levels, coronary heart disease risk estimated by way of Framingham risk scores, history of head trauma or depression, surgical procedures under general anesthesia, family history of neurodegenerative diseases, gender, marital status and APOE haplotypes might be related to the age of dementia onset in this sample of patients with low mean schooling. Results: Mean age of AD onset was 73.38 +/- 6.5 years old, unaffected by schooling or family history of neurodegenerative diseases. Patients who were APOE-epsilon 4 carriers, married, or with history of depression, had earlier onset of AD, particularly when they were women. Coronary heart disease risk was marginally significant for later onset of AD. Conclusions: APOE haplotypes, marital status and history of depression were the most important factors to influence the age of AD onset in this sample. While midlife cerebrovascular risk factors may increase incidence of AD, they may lead to later dementia onset when present in late life.
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    Associations of cerebrovascular metabolism genotypes with neuropsychiatric symptoms and age at onset of Alzheimer's disease dementia
    (Assoc Brasileira Psiquiatria, 2017) de Oliveira, Fabricio F. [UNIFESP]; Chen, Elizabeth S. [UNIFESP]; Smith, Marilia C. [UNIFESP]; Bertolucci, Paulo H. [UNIFESP]
    Objective: To study associations of cerebrovascular metabolism genotypes and haplotypes with age at Alzheimer's disease dementia (AD) onset and with neuropsychiatric symptoms according to each dementia stage. Methods: Consecutive outpatients with late-onset AD were assessed for age at dementia onset and Neuropsychiatric Inventory scores according to Clinical Dementia Rating scores, apolipoprotein E gene (APOE) haplotypes, angiotensin-converting enzyme gene (ACE) variants rs1800764 and rs4291, low-density lipoprotein cholesterol receptor gene (LDLR) variants rs1 1669576 and rs5930, cholesteryl ester transfer protein gene (CETP) variants I422V and TaqIB, and liver X receptor beta gene (NR1H2) polymorphism rs2695121. Results: Considering 201 patients, only APOE-epsilon 4 carriers had earlier dementia onset in multiple correlations, as well as less apathy, more delusions, and more aberrant motor behavior. Both ACE polymorphisms were associated with less intense frontally mediated behaviors. Regarding LDLR variants, carriers of the A allele of rs1 1669576 had less anxiety and more aberrant motor behavior, whereas carriers of the A allele of rs5930 had less delusions, less anxiety, more apathy, and more irritability. CETP variants that included G alleles of I422V and TaqIB were mostly associated with less intense frontally mediated behaviors, while severely impaired carriers of the T allele of rs2695121 had more anxiety and more aberrant motor behavior. Conclusion: Though only APOE haplotypes affected AD onset, cerebrovascular metabolism genotypes were associated with differences in several neuropsychiatric manifestations of AD.
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    Caregiver awareness of cerebrovascular risk of patients with dementia due to Alzheimer's disease in São Paulo, Brazil
    (Faculdade de Medicina da Universidade de São Paulo, 2014-07-01) Oliveira, Fabricio Ferreira de [UNIFESP]; Wajman, Jose Roberto; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BackgroundProper control of cerebrovascular risk is essential to prevent cognitive change in dementia due to Alzheimer’s disease (AD). ObjectiveTo investigate whether caregiver awareness to control cerebrovascular risk impacts the lifestyles of patients with AD. MethodConsecutive outpatients with AD were assessed for demographic features, Clinical Dementia Rating scores, cerebrovascular risk, pharmacotherapy, dietary therapy and practice of physical activities. Patients and caregivers were inquired on awareness of the importance of measures to control cerebrovascular risk. Chi-square test was employed for statistics, significance at ρ < 0.05. ResultA total of 217 patients were included; whereas 149 caregivers (68.7%) were aware of the need to control cerebrovascular risk, only 11 patients (5.1%) simultaneously practiced physical activities and received pharmacological treatment and dietary therapy. Patients with hypertension and diabetes mellitus were more likely to receive dietary therapy (ρ = 0.007). Male patients were more engaged in physical activities (ρ = 0.018). Patients in earlier AD stages exercised (ρ = 0.0003) and received pharmacological treatment more often (ρ = 0.0072). Caregiver awareness of the need to control cerebrovascular risk was higher when patients had hypertension (ρ = 0.024) and/or hypercholesterolemia (ρ = 0.006), and influenced adherence to dietary therapy (ρ = 0.002) and to pharmacological treatment (ρ = 0.001). DiscussionCaregiver awareness of the need to control cerebrovascular risk has positive impacts for patients with AD.
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    Cerebellar volume in patients with dementia
    (Associação Brasileira de Psiquiatria - ABP, 2011-06-01) Baldaçara, Leonardo [UNIFESP]; Borgio, João Guilherme Fiorani [UNIFESP]; Moraes, Walter André dos Santos [UNIFESP]; Lacerda, Acioly Luiz Tavares de [UNIFESP]; Montaño, Maria Beatriz Marcondes Macedo [UNIFESP]; Tufik, Sergio [UNIFESP]; Bressan, Rodrigo Affonseca [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Jackowski, Andrea Parolin [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Tocantins; Instituto Sinapse de Neurociências Clínicas
    OBJECTIVE: The aim of this study was to examine the cerebellar volume of subjects at different stages of Alzheimer's disease and to investigate whether volume reductions in this structure are related to cognitive decline. METHOD: Ninety-six subjects from an epidemiological study were submitted to a magnetic resonance imaging scan and evaluated using the Mini-Mental State Examination and the Functional Activities Questionnaire. Subjects were divided into five groups according to the Clinical Dementia Rating scale. Twenty-six subjects from the original group who had no dementia diagnosis at baseline were re-evaluated for the onset of dementia after two years. RESULTS: The volumes of the cerebellar hemispheres, posterior cerebellar lobe, vermis and temporal lobe were found to be reduced as a function of the severity of the disease. There were significant positive correlations between the volume of the temporal lobe and cerebellum and the language, attention, and total scores in the Mini-Mental State Examination and the Functional Activities Questionnaire. A logistic regression analysis demonstrated that reduced temporal lobe, posterior cerebellar lobe and vermal volume at baseline is a risk factor for the onset of dementia. CONCLUSION: This is the first study demonstrating that reduced cerebellar volume is already apparent at the predementia stage. The results of this study support the involvement of the cerebellum in the progression of dementia. Whereas the cerebellum might not be directly associated with the origin of Alzheimer's disease, it may provide useful information related to its prognosis.
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    Comparação entre dois instrumentos de avaliação neuropsicológica para demencia grave
    (Universidade Federal de São Paulo (UNIFESP), 2005) Wajman, José Roberto [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objetivo: Este trabalho tem como objetivos avaliar a correlação entre dois instrumentos de avaliação cognitiva. o Mini-exame do estado Mental-grave (MEEM-g) e a Bateria para Comprometimento Grave (SIB), e comparar a Escala Funcional de Atividades Diárias Bristol e sua correlação com o Mini-exame do Estado Mental (MEEM). Nossa hipótese é que o MEEM-g e o SIB apresentam uma melhor correlação com desempenho funcional que o MEEM, em pacientes com demência moderadamente grave a grave. Para isto foi feita uma estratificação entre os desempenhos alcançados através do instrumento MEEM-g, a bateria SIB, o MEEM e a Escala Funcional de Atividades Diárias Bristol. Métodos: Foram avaliados 50 pacientes provenientes do Setor de Neurologia do Comportamento - UNIFESP-EPM - com idade entre 57 e 95 anos (média de 76,84 anos, desvio-padrão de 7.94 anos e mediana de 77,00 anos). Dezesseis (32,0 por cento) eram do sexo masculino e 34 (68,0 por cento) do sexo feminino. O tempo de doença destes pacientes variou de 2 a 10 anos (média de 3,98 anos, desvio-padrão de 1,53 anos e mediana de 4,00 anos) e o tempo de escolaridade de 4 a 15 anos (média de 5,08 anos, desvio-padrão de 2,31 anos e mediana de 4,00 anos). Nestes pacientes foram aplicados os testes MEEM, o MEEM-g, a bateria SIB e para o cuidador, a escala Bristol. Resultados: Embora os achados sejam preliminares e coletados de uma pequena parcela da população em destaque, foi possível observar aspectos de sensibilidade entre o MEEM tradicional e os outros dois instrumentos de avaliação para fases avançadas, sendo que o MEEM-g parece ser ligeiramente mais adequado quando estratificados seus valores e correlacionados com a escala funcional. Conclusões: Os dados deste projeto, precursor em nosso meio, corroboram registros de diversos centros de referência de que é possível seguir acompanhando o paciente demenciado, mesmo em fases avançadas da doença, em relação às avaliações cognitiva e funcional.
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    Discurso narrativo oral e escrito na fase inicial da doença de Alzheimer
    (Universidade Federal de São Paulo (UNIFESP), 2010-06-29) Miranda, Claudia Shizue [UNIFESP]; Minett, Thaís Soares Cianciarullo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Purpose: To identify whether there is a difference in narraíive discourse of patients with mild Alzheimers disease and elderly contrais regarding the number of words, number of units of information, type of units of information and conciseness, and to confirm if there is coherence between the oral and written narratives and which are the units of information that most differentiate the íwo groups both in the oral and the written characteristics. Methods: A cross-sectional observational conírol-case síudy evaluating 60 individuais, over 65 years of age, divided into 30 contrais and 30 patients with initial stage Alzheimers disease, of both genders and with over four years of schooling. The subjects were submiíted to Mini Mental State Examination and Alzheimers Disease Assessment Scale - Cognitive subscale and to Clinicai Dementia Rating and were asked to produce an oral and a written story based on a picture. The informative content was analyzed taking into account the total number of words and the number of units of information. Resulte: A major number of words and information units were observed in the oral story compared to the written one in the Alzheimers disease patients this was not observed in the narratives of the contrai group. There were also more information units in the oral narrative for the key-category action than in the written story of the Alzheimers disease patients, while this difference was not observed in that of the contrai group. This suggests a reduction in the number of words and the information units of the written narrative compared to the oral one by the Alzheimers disease patients. It also indicates a reduction in the units of information for the key-category action for the written narrative of the Alzheimers disease patients regarding the oral narrative. In general, the results of this study suggest that the reduction in the number of words and the information contained in the production of narratives occurred in the initial stage of Alzheimers disease. Conclusions: A reduction occurred in the number of words and the number of units of information, the units of information for key-category action and of conciseness of the written narrative in patients sufferíng from mild Alzheimers disease compared to the elderly individuais in the control group. They demonstrated consistency, that is, similariíy between the oral and written narratives of Alzheimers disease patients and controls. Some information was identified that will enable differentiation between the two groups.
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    Doença de Alzheimer
    (Associação Brasileira de Psiquiatria - ABP, 1999-10-01) Smith, Marilia de Arruda Cardoso [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    This paper concisely reviews the genetics of Alzheimer Disease (AD). So far, three different genes have been implicated in AD. Specifically, the gene that codes for APP - the amyloid beta precursor protein, which is associated to dementia through intense brain deposition - the presenilin 1 gene (PS1) and the presenilin 2 gene (PS2). Both presenilin genes code for cellular membrane proteins and PS1 are responsible for approximately 40% of the early-onset familial cases. Genes that code for ApoE4, alpha-2 macroglobulin and cathepsin D, which are all involved in APP metabolism, have been considered as risk factors for AD. The ApoE4 gene is a risk factor in about 50% of the AD sporadic and late-onset cases. Several other genes that have been associated to AD are briefly discussed. Different strategies for genetic counseling of relatives are considered, and finally, ribosomal gene alterations are discussed as possible mechanisms underlying genetic progeroid syndromes such as AD.
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    Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination
    (Academia Brasileira de Neurologia - ABNEURO, 2014-04-01) Wajman, José Roberto; Oliveira, Fabricio Ferreira de [UNIFESP]; Schultz, Rodrigo Rizek; Marin, Sheilla de Medeiros Correia [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Cognitive assessment in advanced stages of Alzheimer’s disease (AD) is limited by the imprecision of most instruments.Objective:To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method:Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results:Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001). Conclusion:The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.
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    Effects of APOE haplotypes and measures of cardiovascular risk over gender-dependent cognitive and functional changes in one year in Alzheimer's disease
    (Taylor & Francis Ltd, 2018) de Oliveira, Fabricio Ferreira [UNIFESP]; Pereira, Fernando Vieira [UNIFESP]; Kamikado Pivi, Glaucia Akiko [UNIFESP]; Smith, Marilia Cardoso [UNIFESP]; Ferreira Bertolucci, Paulo Henrique [UNIFESP]
    Background: Illiteracy, high cerebrovascular risk and copies of APOE-E4 are risk factors for Alzheimer's disease dementia (AD). We aimed to investigate the impacts of gender, education, coronary heart disease (CHD) risk and creatinine clearance variations, body mass index (BMI) and APOE haplotypes over the rates of cognitive and functional decline of AD in one year.Methods: Consecutive outpatients with late-onset AD were assessed for gender, schooling, BMI and APOE haplotypes, variations in one year of creatinine clearance and Framingham projections of the 10-year absolute CHD risk, and prospective scores of the Mini-Mental State Examination (MMSE), the Clinical Dementia Rating Sum-of-Boxes (CDR-SOB), the Index of Independence in Activities of Daily Living (ADL) and Lawton's Scale for Instrumental Activities of Daily Living (IADL).Results: For 191 patients, mean age at AD onset was 73.266.4 years-old, earlier for APOE-E4/E4 carriers (p = 0.0039). For women, higher BMI led to improvements in CDR-SOB ( = -0.091
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    Estudo comparativo dos níveis de neurotransmissores no líquor de pacientes com demência com corpúsculos de Lewy, demência da doença de Alzheimer e indivíduos controles
    (Universidade Federal de São Paulo (UNIFESP), 2017-11-30) Miraldo, Marjorie Câmara [UNIFESP]; Mazzacoratti, Maria da Graça Naffah [UNIFESP]; Oliveira, Fabricio Ferreira de [UNIFESP]; http://lattes.cnpq.br/3204275967717703; http://lattes.cnpq.br/0945751507151552; http://lattes.cnpq.br/2144732134557538; Universidade Federal de São Paulo (UNIFESP)
    The early and accurate diagnosis of dementia with Lewy bodies and Alzheimer’s disease dementia needs objective and quantifiable available parameters. These syndromes have many neurodegenerative characteristics in common, which can eventually difficult their differentiation based on the neuropsychological profile. It is known that changes in the metabolism of neurotransmitters are somehow involved in these dementia syndromes. Thus, this study has as main objective the comparative study of neurotransmitter levels in CSF of patients with dementia with Lewy bodies, patients with Alzheimer's disease dementia, and controls without dementia. The levels of the main monoamines were quantified analyzing the content of their metabolites (VMA, MHPG, L-DOPA, DOPAC, 5-HIAA and HVA) as well as neurotransmitter amino acids (Asp, Glu, Gln, Gly, Tau and GABA). The identification of these neurotransmitters as possible cerebrospinal fluid biomarkers, aims at a better diagnostic differentiation among patients with such dementia syndromes. Participants with dementia with Lewy bodies (n = 20) were paired with participants with Alzheimer's disease dementia (n = 20) by gender and cognitive scores (Mini- Mental State Examination and CDR), and paired with controls without dementia (n = 20) by gender and age (± 1 year). Cerebrospinal fluid monoamine metabolites and amino acids were analyzed by high performance liquid chromatography. The concentrations of VMA, 5-HIAA and HVA were lower in both type of patients (dementia with Lewy bodies and in patients with Alzheimer’s disease dementia), when compared with controls without dementia. These data suggest a reduction in the release of norepinephrine, dopamine and serotonin by the brain of patients suffering dementia. Reduced Glu levels in CSF were also found in patients with dementia with Lewy bodies, compared with control subjects, suggesting increased release and metabolization of these neurotransmitters by the brain tissue of these patients. However, despite the alterations found, none of them had difference among the three groups. Thus, this study concluded that none of these neurotransmitters could serve as a specific marker for the dementia syndromes studied.
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    A Influência do bilinguismo na doença de Alzheimer
    (Universidade Federal de São Paulo (UNIFESP), 2018-11-28) Paulavicius, Andrea Muner [UNIFESP]; Trevisani, Virginia Fernandes Moca [UNIFESP]; Mizzaci, Carolina Christianini; http://lattes.cnpq.br/2567303884901444; São Paulo; http://lattes.cnpq.br/9054730236021091; http://lattes.cnpq.br/5869827837451986; Universidade Federal de São Paulo (UNIFESP)
    Background: Alzheimer's disease is a neurodegenerative disease characterized by the loss of cognitive functions. Bilingualism maybe one factor contributing to cognitive reserve and delay in symptom to onset. Objectives: To assess effect of bilingualism compared with monolingualism in Alzheimer's disease. Methods: Systematic review of the literature of observational studies comparing bilingualism versus monolinguals in patients with Alzheimer’s disease. We searched the databases: The Cochrane Central Register of Controlled Trials, MEDLINE, Embase and LILACS. The quality of each included study was assessed using the NewcastleOttawa Scale. Two reviewers independently extracted data and bias risk assessment. The quality of the evidence was evaluated by the Grading of Recommendations Assessment, Development and Evaluation. Results: Eight studies were included in the systematic review. The metaanalysis showed there was no difference between monolinguals and bilinguals group in the outcomes: Cognitive impairment level measured through MiniMental State Examination at the time of assessment (MD = 0. 20; 95%CI: 0.99,1.40) ; at the age of diagnosis (MD = 0.46; 95%CI: 0.21, 1.14), age of diagnosis of Alzheimer's disease (MD = 2.61; 95%CI: 5.77, 0.55); cognitive and functional performance measured through Clinical Dementia Rating ( MD = 0. 11; 95%CI: 0.06, 0.27), and Behavioral Neurology Assessment (MD=6.35; 95%CI:0.17,12.88). The analysis showed that bilingual patients exhibited symptoms of dementia later than a comparable group of monolingual patients (MD 5. 57; 95%CI: 3.43, 7. 70). The evidence found was low and very low quality. Conclusion: Although this systematic review did not show difference between bilingual and monolingual group in most outcomes analyzed, the available data s how that the onset of symptoms in Alzheimer's disease was later in the bilingual group compared with the monolingual.
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    Is there correlation between cognition and functionality in severe dementia? The value of a performance-based ecological assessment for Alzheimer’s disease
    (Academia Brasileira de Neurologia - ABNEURO, 2014-11-01) Wajman, José Roberto [UNIFESP]; Oliveira, Fabricio Ferreira de [UNIFESP]; Marin, Sheilla de Medeiros Correia [UNIFESP]; Schultz, Rodrigo Rizek [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective Besides significant cognitive decline, patients in later stages of Alzheimer's disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale. Method A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL). Results Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (ρ<0.001), according to FAST subdivisions. Conclusion Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.
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    Manifestações da apraxia de fala na doença de Alzheimer
    (Sociedade Brasileira de Fonoaudiologia, 2011-09-01) Cera, Maysa Luchesi [UNIFESP]; Ortiz, Karin Zazo [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Minett, Thaís Soares Cianciarullo [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    PURPOSE: To identify praxic speech manifestations in patients diagnosed with different stages of Alzheimer's disease, and to verify similarities among their occurrences. METHODS: Participants were 90 patients with Alzheimer's, 30 in each stage of the disease (mild, moderate and severe), who were assessed using the following instruments: Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Lawton Instrumental Activities of Daily Living, and the Assessment Protocol of Verbal and Orofacial Apraxia. Sixty six female subjects and 24 male subjects were assessed; mean age was 80.2±7.2 years, and mean level of education was 4.2±3.5 years. RESULTS: In the mild stage, the proportions of trial-and-error, repetition and addition were similar, as well as omission, substitution and self-correction. In the moderate stage, the following items were similar: trial-and-error and repetition, substitution, omission and addition, and self-correction. In the severe stage, all manifestations were similar, except addition. The error type addition differentiated the patients regarding the stages of the disease. CONCLUSION: Patients in the three stages of Alzheimer's disease showed distinct patterns of verbal praxic manifestations.
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    O papel dos exames complementares na confirmação diagnóstica e no diagnóstico diferencial das síndromes demenciais
    (Universidade Federal de São Paulo (UNIFESP), 2016-11-29) Moraes, Fabiano Moulin de [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; http://lattes.cnpq.br/0536597854124056; http://lattes.cnpq.br/4973782522392836; Universidade Federal de São Paulo (UNIFESP)
    Objectives: To evaluate the role of supplementary exams (TSH, B12, VDRL, HIV, Brain CT or MRI, depression scale and when appropriate SPECT, Polysomnography, cerebrospinal fluid and electroencephalogram) on the final diagnostic confirmation and on the differential diagnosis in dementia syndromes after at least one year follow up. Methods: A retrospective observational study to estimate the contribution of the supplementary exams on the final diagnosis of the dementia syndromes established after the initial diagnosis. The collected data were sociodemographic, types of the patient and family complaints, family history, comorbidities, disability scale measured by the Clinical Dementia Rating (CDR), neurological physical examination, neuropsychological tests divided in cognitive domains and finally the results of the supplementary exams including a depression scale (geriatric depression scale ?GDS). Once an initial diagnosis was made, it was compared with the final diagnosis to asses which exams had any relevant impact in the stability or change whether degenerative or reversible syndromes. Besides the exams, the other clinical variables were evaluated to check for any relevant influence on the final diagnosis. Results: There were selected 432 patients from 1485 patients from a single university center. From this sample, 110 (25,4 %) patients have their diagnosis changed, most of them adding the vascular component to initial diagnosis as a significant contribution to the dementia syndrome. The clinical variables related to the diagnostic stability was the presence symmetric parkinsonism in neurological examination, initial diagnosis of vascular dementia, the presence of diabetes and systemic arterial hypertension, the presence of long term memory deficit in the neuropsychological evaluation and normal neuroimaging (brain CT or MRI). Regarding the reversibility of dementia, depression was the most important mimicker, responsible for 13 from the 16 patients (3,7% of the total sample) who had their severity reduced. The other three patients had normal pressure hydrocephalus (NPH) treated surgically. The clinical variables related to reversibility were follow up time, absence of the family complaint, sedentary, initial diagnosis of NPH, initial diagnosis of depression and normal brain image(CT or MRI). Conclusion: Regarding the supplementary exams, only the depression screening scale and the brain image were statistically relevant for the differential diagnosis of the dementia syndromes. Furthermore, every step of the clinical diagnosis including history, comorbidities, physical examination and neuropsychological battery were relevant as well.