Subjective memory complaint and its relationship with cognitive changes and physical vulnerability of community-dwelling older adults

Memory complaint (MC) is common in older adults and can be confirmed by people close to them, such as family members and caregivers. Studies show an association between MC and cognitive impairment and, hence, physical vulnerability may exacerbate MC. However, the relationship between MC and physical vulnerability is not yet clear in the literature.\.

Objective

to investigate the association between MC, cognitive impairment, and physical vulnerability.

Methods

this is a cross-sectional study. We evaluated 100 older adults with a mean age of 65 years or over. The Memory Complaint Scale (MCS), Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Vulnerable Elderly Research-13 (VES-13), Geriatric Depression Scale and a sociodemographic questionnaire were applied.

Results

participants were divided into two groups according to results on the MCS-A (elderly) and MCS-B (informant). Correlations were found between the MCS-A and the MMSE (p=.045/ρ=.201), ACE-R/Visual-Spatial (p=.048/ρ=.199), and ACE-R/Attention-Orientation (p=.026/ρ=.223). For the MCS-B, correlations were found with total score on the ACE-R (p=.044/ρ=-.202) and the ACE-R/Visual-Spatial (p=0.003/ρ=-.291).

Conclusion

MC reported by the informant indicate the need to assess, in more depth, the cognition of the older adult. Thus, for clinical practice, screening of MC through an informant is advised.

Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of life in mixed dementia: a 24-week, randomized, placebo-controlled exploratory trial (the REMIX study)

The effects of galantamine (GAL) on quality of life (QoL) and cognitive speed, as well its effects combined with nimodipine (NIM) in Alzheimer disease (AD) with cerebrovascular disease (mixed dementia), have not been explored.

METHOD

Double-blind, placebo-controlled, multicenter Brazilian trial, studying the effects of GAL/NIM vs. GAL/placebo (PLA) in mild to moderate mixed dementia. Patients were randomized to receive GAL/NIM or GAL/PLA for 24 weeks. Primary efficacy measures were changes on a computerized neuropsychological battery (CNTB) and QoL Scale in Alzheimer's Disease (QoL-AD) from baseline to week 24.

RESULTS

Twenty-one patients received at least one drug dose (9 GAL/NIM and 12 GAL/PLA). Groups were matched for age, sex, education, cognitive and QoL scores at baseline. No significant differences were observed between groups on primary or secondary measures. QoL and cognitive performance showed significant improvement (p<0.05) from baseline when all GAL-treated patients were analyzed. Adverse events were predominantly mild to moderate.

CONCLUSION

GAL treatment improved QoL in mixed dementia, in addition to its previously known cognitive benefits. The combination GAL/NIM was not advantageous. However, the small sample size precludes any definitive conclusions. Trial registered at ClinicalTrials.gov: NCT00814658.

Correlation between mini-mental state examination and platelet ADAM10 expression in Alzheimer's disease

BACKGROUND

Previous studies have demonstrated a decrease in platelet ADAM10 expression among patients with Alzheimer's disease (AD) and healthy matched subjects. The association between cognitive tests and molecular biomarkers, such as platelet ADAM10, may contribute to an accurate AD diagnosis.

OBJECTIVE

The aim of this research was to investigate whether cognitive deficits in AD, assessed by Mini-Mental State Exam (MMSE), correlate with ADAM10 platelet levels and if that contributes to a more effective AD diagnosis.

METHODS

Elderly patients with probable AD (n = 30) and a non-AD control group (n = 25), matched by age, gender, and education level were evaluated. Platelet proteins were analyzed on SDS-PAGE (10%) and ADAM10 expression was identified by western blotting. β-actin was used as the endogenous control. The Spearman correlation coefficient between ADAM10 and MMSE ratio was obtained for each group.

RESULTS

The MMSE ratio of AD subjects (0.45 ± 0.32) was significantly different (p < 0.001) compared to the non-AD group (1.14 ± 0.07). The relationship between MMSE ratio and ADAM10 expression was significant (r = 0.62, p = 0.0003) for the AD group. The combination of ADAM10 and MMSE at a cutoff ≤ 0.87 presented a sensitivity of 85%, and a specificity of 97% (AUC 0.99, 95% CI 0.92 -1.00), which was significantly better for AD diagnosis than the AUCs of MMSE (p = 0.05) and ADAM10 expression (p = 0.18) separately.

CONCLUSIONS

The association of MMSE and ADAM10 expression was significantly better compared with MMSE and ADAM10 expression separately, thus providing and additional diagnostic tool for AD.

ADAM10 as a biomarker for Alzheimer's disease: a study with Brazilian elderly

Alzheimer's disease (AD) is the most common cause of dementia in people above age 65. Platelet studies with ADAM10 have shown that its expression is reduced in AD patients. The aim of this research was to compare the platelet levels of ADAM10 protein in two Brazilian elderly groups, considering the stages of the disease. The SDS-PAGE technique followed by Western blotting was used. Data were analyzed using comparison, correlation and association statistical methods. The results showed reduced platelet ADAM10 levels in AD elderly compared to non-AD subjects. The disease progression intensified this reduction. ADAM10 was the only statistically significant variable (p = 0.01) to increase the AD occurrence probability. The cutoff value of 0.4212 in the receiver operating characteristic curve captured sensitivity and specificity of 70 and 80.77%, respectively. Together with other clinical criteria, ADAM10 seems to be a relevant biomarker tool for early and accurate AD diagnosis.

Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil

Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries.

OBJECTIVE

We aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic.

METHODS

We reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation.

RESULTS

Two hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors.

CONCLUSION

We found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.

Doença de Alzheimer: declínio funcional e estágio da demência

OBJETIVOS: Verificar como o estágio da doença de Alzheimer se correlaciona com a capacidade funcional do idoso segundo a Medida de Independência Funcional. MÉTODOS: Trata-se de estudo observacional e transversal envolvendo idosos com diagnóstico de doença de Alzheimer e seus cuidadores. Para coleta de dados utilizou-se a Medida de Independência Funcional e a escala de Avaliação Clínica de Demência. RESULTADOS: A amostra foi composta por 67 idosos com média de idade de 79 anos. Demência grave foi encontrada em 46,3%, demência moderada em 22,4% e demência leve em 31,3%. As médias da Medida de Independência Funcional encontradas foram 107,9, 84,5 e 39,7 em idosos com demência leve, moderada e grave, respectivamente. Encontrou-se correlação entre o nível de independência funcional e o estágio de demência (p<0,001). CONCLUSÃO: O estágio de demência é um fator preditivo importante do comprometimento funcional de idosos com doença de Alzheimer.

Treatment of Alzheimer's disease in Brazil: II. Behavioral and psychological symptoms of dementia

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer’s disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition.

Treatment of Alzheimer's disease in Brazil: I. Cognitive disorders

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer’s disease (AD) in Brazil, with special focus on cognitive disorders. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of cognitive disorders in AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of cognitive disorders encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine and other drugs and substances) and non-pharmacological (including cognitive rehabilitation, physical activity, occupational therapy, and music therapy) approaches. Recommendations for the treatment of behavioral and psychological symptoms of dementia due to Alzheimer’s disease are included in a separate article of this edition.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer’s disease.

Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease

Parkinson's disease (PD) is a neurological disorder characterized by motor disturbances, neuropsychological symptoms and cognitive changes, including cases of dementia. The most frequently described cognitive changes in these patients involve executive and visuospatial functions, which are very important for the execution of daily life activities.

Objective

To compare different tests used to examine visuospatial functions in patients with PD.

Methods

Thirty-five patients (21 women) with PD symptoms (medicated and "on") and mean schooling of 5.5±4.2 years were examined using the following tests: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Scales of Outcomes of Parkinson's Disease (SCOPA-COG), Hooper Visual Organization Test (HVOT), Judgment of Line Orientation, Form V (JLO), and Clock drawing task - CLOX (1 and 2).

Results

The mean MMSE score was 24.8±3.03and 54.8% of the patients performed correctly in the copy of a pentagon drawing, with a medium-level performance in most tests. Good correlations were detected between JLO versus SCOPA Assembling patterns (0.67), JLO versus HVOT (0.56), JLO versus CLOX2 (0.64), SCOPA Figure Composition versus HVOT (0.54), CLOX1 versus CLOX2 (0.43), and DRS Construction versus CLOX2 (0.42).

Discussion

Although correlations were detected, not all were strong, probably because the tests employed do not measure solely visuospatial functions, but also other skills such as attention, motor ability and executive functions. A limitation of the present study was the lack of a control group for the establishment of adequate standards for this population.

Executive cognitive tests for the evaluation of patients with Parkinson's disease

Parkinson's disease (PD) is characterized by changes in movement, which are later followed by cognitive, behavioral and psychological changes. The objective of the present study was to correlate different tests used to examine executive functions in PD patients followed at a specialized outpatient clinic.

METHODS

Thirty-five patients with idiopathic PD aged 63.0 years on average and with mean schooling of 5.5±4.2 years, were examined using the following tests: Mattis Dementia Rating Scale (MDRS), Scales for Outcomes of Parkinson's Disease-Cognition (SCOPA-COG), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Digit Span - Inverse Order (IO) (a subtest of the WAIS III) and Verbal Fluency Test (category animals).

RESULTS

Significant correlations were detected between FAB and MDRS Conceptualization (0.814), MDRS Initiation/Perseveration (I/P) and SCOPA-COG Executive Function (0.643), FAB and MDRS I/P (0.601), FAB and Verbal Fluency (0.602), MDRS I/P and MDRS Conceptualization (0.558), Verbal Fluency and MDRS I/P (0.529), MDRS Attention and SCOPA-COG Executive Function (0.495), MDRS Conceptualization and SCOPA-COG Executive Function (0.520), FAB and Digit Span (OI) (0.503), Verbal Fluency and MDRS Conceptualization (0.501), and WCST perseverative errors and FAB (-0.379), WCST perseverative errors and MDRS Conceptualization (0.445), WCST perseverative errors and MDRS I/P (-0.407) and WCST categories completed and MDRS Conceptualization (0.382).

DISCUSSION

The results demonstrated strong correlations between most of the tests applied, but no associations were detected between the WCST and the other tests, a fact that may be explained by the heterogeneity of scores obtained in the tests by the patients evaluated. A difficulty of the present study was the lack of a control groups for the establishment of adequate standards for this population.

Typical performance of elderlypatients with Alzheimer disease on the Wisconsin Card Sorting Test (WCST)

The Wisconsin Card Sorting Test (WCST) is a neuropsychological assessment tool designed to assess executive functions, frequently used in cases of cognitive disorders. However, Brazilian neuroscientific settings lack standardization studies of psychological assessment instruments, especially in the neuropsychological area. Thus, the assessment of clinical groups including dementias and particularly Alzheimer's disease (AD) patients, may be compromised by the lack of analytical references.

Reports by caregivers of behavioral and psychological symptoms of dementia

Behavioral and Psychological Symptoms of Dementia (BPSD) are relevant since they are frequent and cause distress to caregivers. However, they may not be reported by physicians due to the priority usually attributed to cognitive symptoms.

[Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS)]

OBJECTIVE

To assess the influence of low education and illiteracy on the evaluation of dementia by the Mattis Dementia Rating Scale (MDRS).

METHOD

We applied the MDRS to 62 normal elderly subjects (64-77 years), divided into five groups according to schooling, i.e., 15-16 years, 11-12 years, 8-9 years, 4 years, and illiterate. The MDRS covers the study of five subscales and the sum of their scores may represent the degree of cognitive impairment.

RESULTS

A significant difference (p < 0.05) in performance on this scale was observed among the subgroups in relation to education on 12 items, 5 subscales (illiterates < all other groups and 15-16 years > 4 and 8 years of schooling, p < or = 0.001) and the total MDRS score (illiterates < all others and 4 and 8 years < 15-16 years, p < 0.001). No significant correlations where found for age and, regarding gender, the differences were significant in only one item.

CONCLUSION

Education interfered with individual performance on the MDRS. Illiteracy is a determinant factor of lower MDRS scores that could generate diagnostic errors.

[Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS)]

OBJECTIVE

To assess the influence of low education and illiteracy on the evaluation of dementia by the Mattis Dementia Rating Scale (MDRS).

METHOD

We applied the MDRS to 62 normal elderly subjects (64-77 years), divided into five groups according to schooling, i.e., 15-16 years, 11-12 years, 8-9 years, 4 years, and illiterate. The MDRS covers the study of five subscales and the sum of their scores may represent the degree of cognitive impairment.

RESULTS

A significant difference (p < 0.05) in performance on this scale was observed among the subgroups in relation to education on 12 items, 5 subscales (illiterates < all other groups and 15-16 years > 4 and 8 years of schooling, p < or = 0.001) and the total MDRS score (illiterates < all others and 4 and 8 years < 15-16 years, p < 0.001). No significant correlations where found for age and, regarding gender, the differences were significant in only one item.

CONCLUSION

Education interfered with individual performance on the MDRS. Illiteracy is a determinant factor of lower MDRS scores that could generate diagnostic errors.

[Cognitive disorders and dementias in the private practice of specialists: pilot study of a self-assessment survey]

OBJECTIVES

To know about the features of cognitive disorders and dementias in the private practice of specialists and these doctor's skills on that area.

METHOD

In this pilot study, self-assessment questionnaires were delivered to neurologists of São Paulo State and 196 (22.8%) were respondents.

RESULTS

Many neurologists are involved, besides the private practice, with teaching (61.5%) and/or research (59.5%) activities. Most of them assessed as not good the training on cognitive disorders and dementias they had had during both the graduate (77.3%) and residence (63.1%) courses; nevertheless 60.8% self rated their knowledge on that subject as satisfactory and 83.0% declared their interest on it as at least equal to other areas. The most frequent cognitive complaints occurring as primary reason for appointment are memory loss (73.0%) and attention/concentration deficits (48.0%). Dementia of Alzheimer type (54.9%) and vascular dementia (23.0%) are the most frequent ones in the neurologist private practice.

CONCLUSION

Cognitive disorders and dementias represent a significant proportion in the neurological private practice. Although they had not had a good training on the area of cognitive disorders and dementias, the respondent neurologists demonstrated great interest on it.