Reliability study of the Behavioral Assessment of the Dysexecutive Syndrome adapted for a Brazilian sample of older-adult controls and probable early Alzheimer's disease patients Um estudo de confiabilidade da Bateria de Avaliação da Síndrome Disexecutiva adaptada para uma amostra brasileira de idosos controles e pacientes com doença de Alzheimer provável em fase inicial

OBJECTIVE: Ecological tests are useful in assessing executive function deficits and may be of value in appraising response to treatment in Alzheimer's disease patients. Our aims were to examine executive function using the Behavioral Assessment of the Dysexecutive Syndrome for a Brazilian sample of older-adult controls and probable early Alzheimer's disease patients, and verify the applicability of this test battery. METHOD: Forty-one older-adult controls were matched with mild Alzheimer's disease patients by age, education, and gender. RESULTS: There significant inter-group differences in overall profile and almost all subtests except temporal judgment, time spent on planning the first and second Zoo Map visit, number of errors when copying drawings, naming pictures and Six Modified Elements arithmetic, and dysexecutive questionnaire self-rating. The Behavioral Assessment of the Dysexecutive Syndrome item that best discriminated controls from patients was the Modified Six Elements - adapted (general index), with a sensitivity of 80% and specificity of 90%, (AUC = 0.91, p OBJETIVO: Testes ecológicos são os mais indicados para a avaliação dos déficits nas funções executivas, sendo importante também na avaliação da resposta ao tratamento de pacientes com doença de Alzheimer. O objetivo deste estudo é verificar o desempenho nas funções executivas usando a Behavioural Assessment of the Dysexecutive Syndrome em uma amostra brasileira de idosos controles e pacientes com doença de Alzheimer provável em fase inicial e a aplicabilidade desta bateria ecológica em nosso meio. MÉTODO: Avaliamos com a Behavioural Assessment of the Dysexecutive Syndrome 41 idosos controles e 41 pacientes com doença de Alzheimer provável em fase inicial, sem diferença estatisticamente significativa em relação à idade, escolaridade e sexo. RESULTADOS: Houve diferença estatisticamente significativa entre os grupos no escore total e em quase todos os subtestes da Behavioural Assessment of the Dysexecutive Syndrome, não ocorrendo o mesmo no subteste de Julgamento Temporal, no tempo gasto no planejamento da primeira e segunda visita no Mapa do Zoológico, no número de erros ao copiar os desenhos, na nomeação de figuras e na aritmética do Seis Elementos Modificado e no questionário disexecutivo autoavaliação. CONCLUSÃO: A Behavioural Assessment of the Dysexecutive Syndrome mostrou-se eficaz na detecção dos déficits em funções executivas em pacientes com doença de Alzheimer provável em fase inicial, particularmente em tarefas de alternância, monitoramento de tempo e subtestes de mudanças de regras

Neuropsychological rehabilitation program and behavioral disturbances in early-stage Alzheimer patients

Abstract Alzheimer's disease (AD) is the most frequent cause of dementia and cholinesterase inhibitors are the available treatment in the mild stage. However cognitive rehabilitation has shown satisfactory results when combined with pharmacological treatment. Behavioral alteration is common in AD patients, which burdens caregivers and raises the risk of institutionalization. Providing caregivers guidance may enable them to assure better quality of life for patient and caregiver and lower institutionalization rates. Objective: To evaluate the effects of a neuropsychological rehabilitation program (NRP) combined with pharmacological treatment in early stage AD patients. Methods: We studied 12 AD patients (6 women), average age 75.42 (6.22) with 9.58 (5.6) years education in use of stable doses of cholinesterase inhibitors. Cognitive performance was evaluated using Mini-Mental State Examination (MMSE) and Alzheimer´s Disease Assessment Scale-cognitive (ADAS-Cog). Caregivers responded to Neuropsychiatric Inventory (NPI) and Functional Activities Questionnaire (FAQ) at initial evaluation (T1), and after 8 months of rehabilitation program (T2). The program comprised two sessions every week and family guidance every fortnight. Results: MMSE (T1:23.25 (1.82)/T2:23.42 (2.81); ADAS-Cog (T1:17.11 (6.73)/T2:21.2 (8.59); NPI (T1:23.42 (23.38)/T2:19.83 (17.73); FAQ (T1:10.67 (7.24)/T2: 13.92 (6.92). Conclusions: These results show the importance of providing guidance and support for caretakers. Study limitations were the small number of patients and absence of a control group with only drug treatment to compare with combined pharmacological and rehabilitation treatments