Sporadic early onset Alzheimer´s disease

A doença de Alzheimer (DA) é a principal causa de demência. Um subgrupo de pacientes apresenta sua forma familiar ou precoce (< 65 anos), caracterizada por uma evolução rápida e geralmente relacionada a um padrão genético dominante transmitido por sucessivas gerações. Relata-se o caso de um paciente sem história familiar de DA, que apresentou precocemente alterações de memória e progressivo declínio funcional e cognitivo (linguagem, praxia, funções executivas e habilidades visuoespaciais). Sintomas psicológicos (depressão) e comportamentais (insônia, agitação psicomotora e hipersexualidade) da DA também foram observados em diferentes estágios da doença. Exames de neuroimagem estrutural e funcional revelaram acometimento das regiões corticais posteriores. A precocidade do início da DA pode ser confundida com quadros psiquiátricos, especialmente quando não há história familiar da doença. O impacto do início pré-senil na vida do paciente e da família é intenso e o tratamento nos estágios iniciais é de suma importância para reduzir a sobrecarga de cuidadores e pacientes.Alzheimer's disease (AD) is the main cause of dementia. A subgroup of patients has the familial or early-onset

Factors Associated with a Depressive Disorder in Alzheimer's Disease Are Different from Those Found for Other Dementia Disorders

Background: This study explores factors associated with depression in Alzheimer’s disease (AD) compared with mild cognitive impairment (MCI) and other dementia disorders. Method: In a prospective study we included 195 patients: 31 with MCI, 112 with AD and 52 with other dementias. Results: According to the ICD-10 and the DSM-IV criteria, 88 (44.1%) and 59 (30.3%), respectively, had a depressive disorder. An adjusted multiple regression analysis showed that previous depression (p Conclusion: We found different factors associated with a depressive disorder in AD compared to those found for other dementia disorders

Long term follow-up can differenciate two subtypes of late-life psychosis

There are few studies about late-onset schizophrenia (LOS). LOS is thought to be a heterogeneous pathology with a similar cognitive profile compared to adult schizophrenia and two types of evolution: one group with steady neuropsychological deficits and another group with progressive deficits. We report on two clinical cases evaluated with neuropsychological tests CAMCOG and MMSE, Hachinski's Ischemic Score, Pfeffer Functional Activities Questionnaire, PANSS and the Neuropsychiatric Inventory. The course of cognitive deficits and daily life activities were different, showing the need of prospective studies with neuropsychological approach to understand the clinical course and etiology of LOS.A esquizofrenia de início tardio ainda é pouco estudada. Os trabalhos atuais apontam para uma patologia heterogênea, com perfil cognitivo semelhante ao encontrado na esquizofrenia com início no adulto jovem e dois tipos de evolução: um grupo com estabilização dos déficits neuropsicológicos e outro grupo com piora destes déficits ao longo do tempo. Apresentam-se dois casos clínicos avaliados por testes neuropsicológicos CAMCOG e Miniexame do Estado Mental (MEEM), Escore Isquêmico de Hachinski, Questionário de Atividades Funcionais de Pfeffer, PANSS e Inventário Neuropsiquiátrico. O desempenho cognitivo e das atividades de vida diária destes casos foram distintos, o que aponta para a necessidade de estudos prospectivos com enfoque neuropsicológico, para entendimento dos diferentes tipos de evolução das psicoses de início tardio

Uso de tabaco entre idosos: revisão sistemática e meta-análise

The aim of this study was to combine the results of identified surveys on the prevalence of tobacco use in old age to estimate world prevalence of tobacco use and possible factors related to such behavior among the elderly. The literature search included electronic databases such as MEDLINE, LILACS, and Biological Abstracts, hand-searching of specialist journals and cited reference searches. The combined global prevalence was estimated using the random effects model. The total number of elderly subjects included in all surveys was 140,058, with data available from all the continents. Overall prevalence of tobacco use was 13% in both genders (22% male and 8% female). The prevalence rates were heterogeneous among surveys and were associated with smoking definition, questionnaire application, and country economic status. Few epidemiological studies assessed tobacco use among the elderly. A higher prevalence rate of tobacco use in males who live in higher income countries could be found, although additional evidence regarding elderly samples is still required.O objetivo deste estudo foi combinar os resultados de pesquisas identificadas sobre a prevalência do tabagismo em idosos, para estimar sua prevalência mundial e possíveis fatores relacionados a este tipo de comportamento entre eles. A revisão da literatura incluiu busca nas bases de dados eletrônicas como MEDLINE, LILACS e Biological Abstracts, busca manual em jornais especializados e nas referências citadas. A prevalência global combinada foi estimada usando-se o modelo de efeitos randômicos. O número total de idosos incluídos em todos os levantamentos foi 140.058, com dados disponíveis em todos os continentes. A prevalência de tabagismo foi de 13% em ambos os sexos (22% homens e 8% mulheres). As taxas de prevalência foram heterogêneas e estiveram associadas com a definição de tabagismo, aplicação do questionário e com a economia de cada país. A maior taxa de prevalência foi encontrada entre idosos do sexo masculino que vivem em países de renda mais alta.Universidade Federal do Rio de Janeiro Instituto de PsiquiatriaGlaxoSmithKline do BrasilUniversidade do Estado do Rio de Janeiro Faculdade de Ciências MédicasFundação Oswaldo Cruz Escola Nacional de Saúde Pública Sergio AroucaUniversidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Consciência da doença na demência

BACKGROUND: Awareness of disease is a concept related to the recognition of deficits, lack of knowledge of cognitive deficits or, also, to the awareness of deficits in activities of daily living in Alzheimer's disease. OBJECTIVE: This review aimed at comparing definitions and etiological hypotheses for awareness of disease in Alzheimer's disease. METHOD: Search of prospective, retrospective, longitudinal, and cross-sectional articles at ISI, Medline, Lilacs and Scielo databases from 1984 to 2004 using the key-words awareness of deficit, awareness of disease, insight and Alzheimer's disease. Articles were examined to evaluate the definition of awareness of disease and divided by areas according to the objective. RESULTS: The concepts of awareness of disease, awareness of deficit, awareness of cognitive deficit, insight, self-awareness and anosognosia were used as synonymous in the 43 articles, regardless of the organic, psychosocial explanations and of the differences of perception between patients and family. CONCLUSION: Awareness of disease may be defined as the ability to notice changes in the self-consciousness and in the daily activities due to the disease. This definition may be operationalized and can help the examination of awareness of disease in dementia.CONTEXTO: A consciência da doença é um conceito relacionado ao conhecimento da presença de comprometimento generalizado, à falta de reconhecimento dos déficits cognitivos ou, também, da percepção dos prejuízos nas atividades de vida diária causados pela doença de Alzheimer. OBJETIVO: Esta revisão comparou as definições e as hipóteses etiológicas para a consciência da doença na doença de Alzheimer. MÉTODO: Busca nas bases de dados ISI, Medline, Lilacs e Scielo de artigos clínicos seccionais, longitudinais, prospectivos, retrospectivos e de caso-controle entre 1984 e 2004 utilizando as palavras-chave "consciência do déficit", "consciência da doença", insight e "doença de Alzheimer". Os artigos foram examinados para avaliar a definição expressa do conceito de "consciência da doença" e divididos por áreas, segundo seus objetivos. RESULTADOS: Os conceitos "consciência da doença", "consciência do déficit", "consciência do déficit cognitivo", insight, "consciência de si" e "anosognosia" foram usados como sinônimos nos 43 artigos selecionados, independentemente de apresentarem explicações orgânicas, psicossociais ou diferença de percepções entre pacientes e familiares. CONCLUSÃO: A consciência da doença pode ser definida como a capacidade de perceber em si e na vida diária alterações causadas por déficits relacionados ao adoecimento. Essa definição é passível de operacionalização e pode auxiliar no exame da consciência da doença na demência

A Bayesian network decision model for supporting the diagnosis of dementia, Alzheimer׳s disease and mild cognitive impairment

AbstractPopulation aging has been occurring as a global phenomenon with heterogeneous consequences in both developed and developing countries. Neurodegenerative diseases, such as Alzheimer׳s Disease (AD), have high prevalence in the elderly population. Early diagnosis of this type of disease allows early treatment and improves patient quality of life. This paper proposes a Bayesian network decision model for supporting diagnosis of dementia, AD and Mild Cognitive Impairment (MCI). Bayesian networks are well-suited for representing uncertainty and causality, which are both present in clinical domains. The proposed Bayesian network was modeled using a combination of expert knowledge and data-oriented modeling. The network structure was built based on current diagnostic criteria and input from physicians who are experts in this domain. The network parameters were estimated using a supervised learning algorithm from a dataset of real clinical cases. The dataset contains data from patients and normal controls from the Duke University Medical Center (Washington, USA) and the Center for Alzheimer׳s Disease and Related Disorders (at the Institute of Psychiatry of the Federal University of Rio de Janeiro, Brazil). The dataset attributes consist of predisposal factors, neuropsychological test results, patient demographic data, symptoms and signs. The decision model was evaluated using quantitative methods and a sensitivity analysis. In conclusion, the proposed Bayesian network showed better results for diagnosis of dementia, AD and MCI when compared to most of the other well-known classifiers. Moreover, it provides additional useful information to physicians, such as the contribution of certain factors to diagnosis

Metacognitive Improvements Following Cognitive Stimulation Therapy for People with Dementia: Evidence from a Pilot Randomized Controlled Trial

OBJECTIVES: Impaired self-awareness is a common feature of dementia, with considerable clinical impact. Some therapeutic strategies such as cognitive stimulation and psychotherapy have been suggested to mitigate loss of awareness. Nevertheless, evidence of intervention improving awareness of deficits is scarce. The present study aims to explore the impact of a Brazilian adapted version of Cognitive Stimulation Therapy (CST-Brasil), an evidence-based psychosocial intervention for people with dementia (PwD), on the level of awareness, reporting here a secondary outcome of a pilot randomized controlled trial. METHODS: 47 people with mild to moderate dementia attending an out-patient unit were randomly allocated to CST (n = 23) or treatment as usual (TAU) (n = 24) across 7 weeks, in a pilot randomized controlled trial. Awareness was measured before and after the intervention. RESULTS: Results indicated that people in both groups increased in overall awareness of the disease, but only those receiving CST exhibited improvements of awareness of cognitive ability. CONCLUSIONS: These findings suggest that CST may also improve metacognitive abilities in PwD, which could potentially be applied to other settings with beneficial effects. CLINICAL IMPLICATIONS: Considering the negative impacts of anosognosia, CST-led improvements in awareness have the potential to benefit PwD and their caregivers

Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression

OBJECTIVE: To compare verbal fluency among Alzheimer's disease, Parkinson's disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity. METHODS: Patients from an outpatient university center with a clinical diagnosis of Alzheimer's disease, Parkinson's disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinson's disease, major depression, and Alzheimer's disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals). We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model. RESULTS: The mean digit span and verbal fluency scores were lower in patients with Alzheimer's disease (n = 34) than in patients with major depression (n = 52) or Parkinson's disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimer's disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinson's disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinson's disease groups listed 44% (ROM = 1.44) and 48% (ROM = 1.48) more words, respectively, compared to those patients with Alzheimer's disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26% (ROM = 0.74) reduction in the number of words listed when compared to mild cases. CONCLUSIONS: Verbal fluency provides a better characterization of Alzheimer's disease, major depression, and Parkinson's disease, even at later stages