Interpretation of proverbs by subjects with Alzheimer's disease at an early stage

Orientador: Edwiges Maria MoratoTese (doutorado) - Universidade Estadual de Campinas, Instituto de Estudos da LinguagemResumo: Esta pesquisa teve como objetivo estudar os processos de significação na interpretação de provérbios por sujeitos com provável doença de Alzheimer (DA) leve. Participaram da pesquisa qualitativa 10 sujeitos com idade igual ou superior a 60 anos com DA de ambos os sexos, que foram selecionados no Ambulatório de Psiquiatria Geriátrica do HC da UNICAMP. Esses sujeitos receberam diagnóstico de provável DA, a partir da avaliação clínica do médico e da avaliação neuropsicológica. Também foram considerados dados de um grupo controle composto por 10 sujeitos não-Alzheimer de perfil sociolinguístico semelhante ao da população com DA. O corpus desta pesquisa constituiu-se de dados obtidos da aplicação do Protocolo de Estudo de Provérbios elaborado por CAZELATO (2003) constituído de 10 provérbios considerados mais metafóricos e de 10 provérbios menos metafóricos. O procedimento metodológico consistiu em primeiro apresentar a cada sujeito os provérbios do Protocolo de forma oral e escrita, perguntando a ele "o que quer dizer tal provérbio". Num segundo momento, foi solicitado ao sujeito que "elaborasse ou imaginasse uma situação em que caberia o uso de tal provérbio". Os dados dos dois grupos foram gravados em vídeo e transcritos com base na notação de transcrição linguístico-interacional. A análise dos dados considerou o cotejamento dos dois grupos em relação ao trabalho linguístico-cognitivo requerido na manipulação enunciativa dos provérbios. Podemos apontar importantes questões em torno do funcionamento linguístico e cognitivo dos dois grupos de sujeitos estudados. Pudemos observar que ambas as populações procederam mais às interpretações centralmente relevantes e marginalmente relevantes frente aos provérbios mais e menos metafóricos, nos dois procedimentos do estudo. Entretanto, a população DA produziu maior número de interpretações literais. Quanto a isso, esta população não procedeu a interpretações irrelevantes do ponto de vista semântico-lexical, ainda que tais interpretações não tenham sido relevantes do ponto de vista pragmático. Foi possível verificar que ambos os grupos procederam à contextualização dos provérbios, imaginando uma situação de uso. Houve diferenças significativas no percurso enunciativo-discursivo realizado pelos sujeitos não-Alzheimer e pelos Alzheimer. Os sujeitos não-Alzheimer recorreram mais às exemplificações de situações cotidianas de uso dos provérbios e recorreram mais a expedientes linguísticos e textuais para proceder à interpretação, tais como modalizações epistêmicas e marcadores de relações espaço-temporais, fazendo ainda comparações temporais do uso do provérbio, utilizando indicadores de relações lógico-semânticas (condicionalidade, finalidade, causalidade), articuladores argumentativos (evidenciados nas ações reflexivas e metaenunciativas). As interpretações consideradas irrelevantes ocorreram com menor frequência. Quanto às estratégias linguístico-discursivas empregadas pelos sujeitos, verificou-se uma maior ocorrência entre os sujeitos com DA de autorrepetição, de reflexão em voz alta, de hesitação, de pausas não preenchidas, de repetição hesitante, de reformulação, de indagação, de falsos inícios de turno e de retomadas. Todos esses fenômenos, típicos do processamento online da língua falada, indicam movimentos do papel organizador e estruturador da linguagem. Esta pesquisa torna-se relevante para qualificar o processo linguístico-cognitivo implicado na significação, notadamente na construção de sentidos indiretos e da referenciação no contexto neurolinguístico. Isso é particularmente importante para melhor compreendermos a natureza sócio-cognitiva da linguagem no contexto das neurodegenerescênciasAbstract: The aim of this research was to study the signification processes in the interpretation of proverbs by subjects with probable mild Alzheimer's disease (AD). 10 subjects 60 years or older of both genders with AD participated of the qualitative research. They were selected in the Clinic of Geriatric Psychiatry, of Faculty of Medicine - HC - UNICAMP. These subjects were diagnosed with probable AD from the doctor's clinical examination and neuropsychological examination. Data from a control group of 10 non-Alzheimer subjects of sociolinguistic profile similar to that of people with AD were also considered. The corpus of this research was composed of data obtained from the application of the Protocol for the Proverbs Study written by CAZELATO (2003) which consisted of 10 proverbs considered more metaphorical and 10 considered less metaphorical. The methodological procedure consisted in first presenting the Protocol proverbs in verbal and writing forms to each subject, asking him "what means such proverb". Secondly, the subject was asked to "prepare or imagine a situation in which the use of such proverb would fit". The data from both groups were video-recorded and transcribed based on the linguistic-interactional transcript notation. The data analysis considered the comparison of both groups in relation to the cognitive-linguistic work required in proverbs enunciative manipulation. We can indicate important issues concerning to language and cognitive functioning of both groups of subjects studied. We could also note that both populations made more to the centrally relevant and marginally relevant interpretations concerning the more and less metaphorical proverbs in both study procedures. However, the AD population produced more literal interpretations. In regard to that, this population has not made irrelevant interpretations in terms of lexicon and semantics, even though such interpretations have not been relevant from the pragmatic point of view. It was possible to verify that both groups contextualized the proverbs, imagining a situation of use. There were meaningful differences in enunciative-discursive course performed by non-Alzheimer's and Alzheimer's subjects. The non-Alzheimer's subjects evoked more exemplifying everyday situations of use of proverbs and remembered more linguistic and textual expedients to make the interpretation, such as epistemic modalities and markers of space-time relations. They also made temporal comparisons in the use of the proverb using indicators of logical-semantic relations (conditionality, purpose, causality), argumentative articulators (evident in the reflexive and meta-enunciative actions). Interpretations considered irrelevant occurred less frequently. As for the linguistic-discursive strategies applied by the subjects, it was noticed among individuals with AD a most frequent occurrence of auto-repetition, of thinking aloud, of hesitation, of unfilled pauses, of hesitant repetition, of reformulation, of quest, of false beginning of shifts and of retaking. All these phenomena, typical of the online processing of spoken language, indicate movements of the leading and structuring role of the language. This research becomes relevant to qualify the cognitive-linguistic process involved in the significance, especially in the construction of indirect meanings and of referenciation in the neurolinguistic context. This is particularly important to better understand the socio-cognitive nature of language, specifically in the context of neurodegenerationDoutoradoLinguisticaDoutor em Linguístic

Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

CONTEXTO E OBJETIVO: Embora os psicotrópicos sejam uma das classes de medicações mais prescritas em abrigos para idosos, os estudos avaliando o seu padrão de prescrição são limitados em número e escopo. Este estudo visou investigar os fatores associados ao uso de psicofármacos em um abrigo para idosos no Brasil. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo observacional realizado no Abrigo da Velhice de Rio Claro, Instituto de Biociências, Universidade Estadual Paulista. MÉTODOS: Dados sobre prescrições foram extraídos dos prontuários médicos dos 108 idosos moradores do abrigo. Sessenta e cinco sujeitos (idade média ± desvio padrão = 74,5 ± 9,4 anos), em uso regular de medicação, constituíram a amostra. Foram examinados os efeitos das variáveis sociodemográficas e clínicas sobre o padrão de prescrição de psicofármacos. RESULTADOS: As mulheres recebiam mais psicofármacos (p = 0.038); indivíduos em uso de medicações para doenças cardiovasculares recebiam menos psicofármacos (p = 0.001). Houve correlação negativa entre número de psicofármacos prescritos e, ambos, idade (p = 0.009) e número de medicações clínicas (p = 0.009). CONCLUSÃO: Embora preliminares, os resultados indicam as doenças cardiovasculares como a variável clínica que mais influenciou a prescrição de psicofármacos. Uma excessiva precaução por parte dos clínicos pode explicar parcialmente este resultado. Novas investigações, com amostras maiores e de diferentes regiões são desejáveis para confirmação destes dados.CONTEXT and OBJECTIVE: Although psychotropics are one of the classes of medications most prescribed in nursing homes for the elderly, studies examining prescribing patterns are limited in both number and scope. The present study was undertaken to investigate factors associated with general psychotropic use in a nursing home in Brazil. DESIGN and SETTING: Retrospective observational study at the Nursing Home for the Elderly, Institute of Biosciences, Universidade Estadual Paulista. METHODS: Information on prescriptions was retrieved from the medical records of 108 elderly residents in a nursing home. Sixty-five of these patients, with mean age 74.5 years (± standard deviation 9.4 years), who were taking medications on a regular basis, comprised the sample. The effects of demographic and clinical variables on the psychotropic prescription pattern were examined. RESULTS: Females were more likely to receive psychotropics (p = 0.038). Individuals on medicines for cardiovascular diseases received psychotropics less frequently (p = 0.001). The number of prescribed psychotropics correlated negatively with both age (p = 0.009) and number of non-psychotropic drugs (p = 0.009). CONCLUSIONS: Although preliminary, the present results indicated that cardiovascular disease was the clinical variable that most influenced psychotropic prescription. Physicians' overconcern regarding drug interactions might at least partially explain this result. Further investigations involving larger sample sizes from different regions are warranted to confirm these findings

Factors influencing psychotropic prescription by non-psychiatrist physicians in a nursing home for the elderly in Brazil

CONTEXT AND OBJECTIVE: Although psychotropics are one of the classes of medications most prescribed in nursing homes for the elderly, studies examining prescribing patterns are limited in both number and scope. The present study was undertaken to investigate factors associated with general psychotropic use in a nursing home in Brazil. DESIGN AND SETTING: Retrospective observational study at the Nursing Home for the Elderly, Institute of Biosciences, Universidade Estadual Paulista. METHODS: Information on prescriptions was retrieved from the medical records of 108 elderly residents in a nursing home. Sixty-five of these patients, with mean age 74.5 years (± standard deviation 9.4 years), who were taking medications on a regular basis, comprised the sample. The effects of demographic and clinical variables on the psychotropic prescription pattern were examined. RESULTS: Females were more likely to receive psychotropics (p = 0.038). Individuals on medicines for cardiovascular diseases received psychotropics less frequently (p = 0.001). The number of prescribed psychotropics correlated negatively with both age (p = 0.009) and number of non-psychotropic drugs (p = 0.009). CONCLUSIONS: Although preliminary, the present results indicated that cardiovascular disease was the clinical variable that most influenced psychotropic prescription. Physicians' overconcern regarding drug interactions might at least partially explain this result. Further investigations involving larger sample sizes from different regions are warranted to confirm these findings

Risk factors for vascular dementia in elderly psychiatric outpatients with preserved cognitive functions

The aim of the study was to assess risk factors for vascular dementia (VaD) in elderly psychiatric outpatients without dementia, and to determine to what extent clinical interventions targeted such risk factors. Out of 250 clinical charts, 78 were selected of patients over 60 years old, who showed no signs of dementia. Information was obtained regarding demographics, clinical conditions (diagnosis according to ICD-10), complementary investigation, cognitive functions (via CAMCOG), neuroimaging, and the presence of risk factors for VaD. Depression was the most prevalent psychiatric disorder (74%). A great majority of the patients (86%) had at least one risk factor for VaD. One-third of the sample showed three or more risk factors for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), tryglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (19.2%), alcohol abuse (16.7%), and sedentarism (14.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD. © 2007 Elsevier B.V. All rights reserved

Risk Factors For Vascular Dementia In Elderly Psychiatric Outpatients With Preserved Cognitive Functions.

The aim of the study was to assess risk factors for vascular dementia (VaD) in elderly psychiatric outpatients without dementia, and to determine to what extent clinical interventions targeted such risk factors. Out of 250 clinical charts, 78 were selected of patients over 60 years old, who showed no signs of dementia. Information was obtained regarding demographics, clinical conditions (diagnosis according to ICD-10), complementary investigation, cognitive functions (via CAMCOG), neuroimaging, and the presence of risk factors for VaD. Depression was the most prevalent psychiatric disorder (74%). A great majority of the patients (86%) had at least one risk factor for VaD. One-third of the sample showed three or more risk factors for VaD. The clinical conditions related to risk factors for VaD were hypertension (48.7%), heart disease (30.8%), hypercholesterolemia (25.6%), diabetes mellitus (23.1%), stroke (12.8%), tryglyceride (12.8%), and obesity (5.1%). In terms of lifestyle, smoking (19.2%), alcohol abuse (16.7%), and sedentarism (14.1%) were other risk factors found. Definite risk factors for VaD were found in 83.3% of the patients. Previous interventions targeting risk factors were found in only 20% of the cases. The high rates of risk factors for VaD identified in this sample suggest that psychiatrists should be more attentive to these factors for the prevention of VaD.257247-

The Brazilian version of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity in dementia

ABSTRACT Background: Patients with dementia may be unable to describe their symptoms, and caregivers frequently suffer emotional burden that can interfere with judgment of the patient's behavior. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C) was therefore developed as a comprehensive and versatile instrument to assess and accurately measure neuropsychiatric symptoms (NPS) in dementia, thereby using information from caregiver and patient interviews, and any other relevant available data. The present study is a follow-up to the original, cross-national NPI-C validation, evaluating the reliability and concurrent validity of the NPI-C in quantifying psychopathological symptoms in dementia in a large Brazilian cohort. Methods: Two blinded raters evaluated 312 participants (156 patient-knowledgeable informant dyads) using the NPI-C for a total of 624 observations in five Brazilian centers. Inter-rater reliability was determined through intraclass correlation coefficients for the NPI-C domains and the traditional NPI. Convergent validity included correlations of specific domains of the NPI-C with the Brief Psychiatric Rating Scale (BPRS), the Cohen-Mansfield Agitation Index (CMAI), the Cornell Scale for Depression in Dementia (CSDD), and the Apathy Inventory (AI). Results: Inter-rater reliability was strong for all NPI-C domains. There were high correlations between NPI-C/delusions and BPRS, NPI-C/apathy-indifference with the AI, NPI-C/depression-dysphoria with the CSDD, NPI-C/agitation with the CMAI, and NPI-C/aggression with the CMAI. There was moderate correlation between the NPI-C/aberrant vocalizations and CMAI and the NPI-C/hallucinations with the BPRS. Conclusion: The NPI-C is a comprehensive tool that provides accurate measurement of NPS in dementia with high concurrent validity and inter-rater reliability in the Brazilian setting. In addition to universal assessment, the NPI-C can be completed by individual domains. © International Psychogeriatric Association 2013

Validation of the brazilian version of the apathy inventory

Background Apathy is a frequent neuropsychiatric condition in neurodegenerative disorders, depression, and often in mild cognitive impairment. The Apathy Inventory (AI) is a reliable instrument for improving the accuracy of the apathy diagnosis. The aim was to establish the validity of the Apathy Inventory for the Brazilian community. Methods We established the concurrent validity, internal consistency, inter-rater reliability, and the sensitivity and specificity of AI for the Brazilian community in a cohort of 175 individuals with Alzheimer's disease, Parkinson's disease, depression, mild cognitive impairment, and healthy controls. The three dimensions of the AI (emotional blunting, lack of initiative, and lack of interest) were compared with the Apathy domain of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C) in an independent scheme. Results The analyses demonstrated high correlation coefficients in AI's individual dimensions and in AI-total score (F = 0.965). Concerning the NPI-C/Apathy domain, intra-class correlation coefficients were also high (F = 0.977). Concurrent validity was high according to both raters on AI dimensions × NPI-C/Apathy domain and regarding total score (rater 1: rho = 0.956 vs. rater 2: rho = 0.970). The internal consistency of the AI was also high concerning the AI's individual dimensions and total score (rater 1: 0.945 vs. rater 2: 0.958). Conclusion We observed high internal consistency, high concurrent validity, and inter-rater reliability of the Apathy Inventory. In addition, we found that its sensitivity and specificity were high. We suggest that the Brazilian version of the Apathy Inventory would be an appropriate instrument to identify the apathy syndrome in Brazilian patients. © 2012 John Wiley & Sons, Ltd