Early-Onset Alzheimer Disease (EOAD) With Aphasia: A Case Report

Background: Alzheimer's disease (AD) is traditionally subdivided into early onset (EOAD) and late onset (LOAD). EOAD has an onset before age 65 years and accounts for 1–5% of all cases. Two main presentation types of AD are familial and sporadic.Case presentation: The authors present the case of a 68-year-old retired white man, with a college level educational background. At 55 years of age, the patient presented cognitive decline with short-term memory impairment and slowed, hesitant speech. At 57 years, he was unable to remember the way to work, exhibiting spatial disorientation. PET-CT: revealed hypometabolism and atrophy in the left temporal lobe and posterior region of the parietal lobes.Disease course: Evolving with difficulties in comprehension and sentence repetition over past 3 years and with global aphasia in past 6 months, beyond progressive memory impairment.Discussion: Possibly due to the young age and atypical presentation, and the diagnosis of EOAD is often delayed. To the best of our knowledge, this case can be classified as a sporadic EOAD with aphasia. Clinical variant and neuroimaging findings were crucial to the diagnosis and treatment of this atypical presentation of AD

DEVELOPMENT OF INTERACTIVE LEARNING MEDIA BASED ON COMPUTER USING LECTORA INSPIRE SOFTWARE ON BASIC ACCOUNTING SUBJECT TO IMPROVE STUDENT LEARNING MOTIVATION OF CLASS X AK 1 IN SMK MUHAMMADIYAH 1 YOGYAKARTA

This research is aimed at developing interactive learning media for class X student of Accounting Major at SMK Muhammadiyah 1 Yogyakarta with basic competency materials Making Adjustment Journal Entries. This research also examines the feasibility of interactive learning media as well as investigate the improvement of student learning motivation after using the media. This research used Research and Development (R & D) models and adapted ADDIE development model, which include 5 phases namely: Analysis, Design, Development, Implementation, and Evaluation. The interactive learning media created using Lectora Inspire software. In the development stage, the feasibility of interactive learning media was validated by material expert, media expert, accounting teacher, and 30 students of class XI AK 1 as the student of field trials. Measurement of students learning motivation used questionnaire filled by 33 students of class X AK 1 as treatment group and 33 students of class X AK 2 as control group. The treatment group used interactive learning media, and control group used whiteboard and textbooks. Data obtained from the questionnaires were analyzed by descriptive qualitative and quantitative. The research results show that interactive learning media in Basic Accounting Subject declared as Strongly Feasible category with average scores of 4.5 by material expert, 4.47 by media expert, 4.35 by accounting teacher, and 4.29 by students. Based on student learning motivation analysis, the treatment group obtain an increase of 6% from 73% to 79% and control group obtain an increase of 2% from 74% to 76%. In the paired sample t-test, X AK 1 obtain empirical t -8.889 with sig. 0.000 and X AK 2 obtain empirical t -3.456 with sig. 0.000. It shows that the learning media used in each class can improve student learning motivation. However in the independent sample t-test, X AK 1 obtain an average 6,00 and X AK 2 obtain 1.90 with sig 0.000 which shows that there is a significant difference improvement of student learning motivation between treatment group and control group

Serotonin receptor inhibitor is associated with falls independent of frailty in older adults

Objectives: To evaluate whether fall risk in older adults is associated with the use of selective serotonin receptor inhibitor (SSRI) monotherapy among geriatric outpatients, and whether this association is moderated by the presence of depressive disorder and/or frailty. Methods: Prospective cohort study with a 12-month follow-up and including 811 community-dwelling adults aged 60 or older from a university-based Geriatric Outpatient Unit. Major depressive disorder (MDD) was diagnosed according to DSM-5 criteria; subsyndromal depression as not meeting MDD criteria, but a Geriatric Depression Scale 15-item score ? 6 points. Frailty was evaluated with the FRAIL questionnaire. The association between SSRI use, depression, or both as well as the association between SSRI use, frailty, or both with falls were estimated through a generalized estimating equation (GEE) adjusted for relevant confounders. Results: At baseline, 297 patients (36.6%) used a SSRI (82 without remitted depression) and 306 (37.7%) were classified as physically frail. Frailty was more prevalent among SSRI users (44.8% versus 33.7%, p =.004). After 12 months, 179 participants had at least one fall (22.1%). SSRI use, depression as well as frailty were all independently associated with falls during follow-up. Nonetheless, patients with concurrent of SSRI usage and non-remitted depression had no higher risk compared to either remitted SSRI users or depressed patients without SSRIs. In contrast, concurrence of SSRI use and frailty increases the risk of falling substantially above those by SSRI usage or frailty alone. Conclusion: SSRI usage was independently associated with falls. Especially in frail-depressed patients, treatment strategies for depression other than SSRIs should be considered

Decision-making executive function profile and performance in older adults with major depression:a case-control study

OBJECTIVES: Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD: The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS: In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value ​in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION: Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups

Depression as predictor for frailty in older adults: outpatient cohort study

Introdução: As evidências atuais da literatura relatam uma relação bidirecional entre a depressão geriátrica e a fragilidade. Revisões sistemáticas mostram potencial sobreposição de fatores clínicos e epidemiológicos de ambas condições prevalentes. O objetivo deste estudo foi investigar se a depressão geriátrica está associada à fragilidade incidente ao longo do tempo. Métodos: O presente estudo incluiu dados de uma coorte prospectiva de 315 idosos ( >= 60 anos) atendidos em um ambulatório de geriatria. Análises transversal (no baseline) e longitudinal (após o seguimento de 1 ano) foram realizadas. Os participantes foram avaliados com uma avaliação geriátrica ampla e, responderam a questionários de autorrelato incluindo dados sociodemográficos e clínicos. GDS-15 e PHQ-9 foram aplicados como escalas de rastreamento e gravidade da depressão. A depressão (maior e subsindrômica) foi diagnosticada através dos critérios do DSM-5 e seguindo a entrevista clínica SCID-5-CV. O índice de fragilidade de 36 itens (IF-36) foi utilizado como o principal instrumento para definição da fragilidade. A associação entre as variáveis de interesse foi estimada através de diferentes métodos de regressão logística e linear. Os participantes que eram frágeis no início do estudo foram excluídos das análises de acordo com as medidas de fragilidade (o questionário FRAIL e o IF-36). Estimamos as medidas de razão de chances (RC), razão de riscos ou risco relativo (RR) e diferença de riscos ou risco atribuível (RA) para a fragilidade incidente. Os modelos foram ajustados para covariáveis, tais como: idade, sexo, escolaridade, índice de massa corpórea (IMC), desempenho cognitivo, polifarmácia e multimorbidade. Resultados: Os participantes foram caracterizados por uma média de idade de 72,1 anos, 68,3% de mulheres, 20% com depressão maior, 27% com depressão subsindrômica e 33,3% de frágeis. A prevalência de fragilidade foi diferente entre os idosos deprimidos e os não deprimidos (p 60 years) assisted in a geriatric outpatient clinic. Cross-sectional (at baseline) and longitudinal (over a 1-year follow-up) analyses were performed. Participants were assessed with a comprehensive geriatric assessment (CGA) and answered self-report questionnaires including sociodemographic and clinical data. GDS-15 and PHQ-9 were applied as depression screening measure and to quantify the severity of depressive symptoms. Depression (major and subthreshold) was diagnosed according to DSM-5 criteria and following the SCID-5-CV clinical interview. 36-item Frailty Index (FI-36) was used as the main tool related to definition of frailty. The association between the variables of interest was estimated using different methods of logistic and linear regression. Participants who were frail at baseline were excluded from the analyses according to measures of frailty (the FRAIL questionnaire and the FI-36). We estimated the odds ratio (OR), the risk ratio or relative risk (RR) and the risk difference (RD) for incident frailty. The models were adjusted for covariates, such as, age, sex, education, body mass index (BMI), cognitive performance, multimorbidity and polypharmacy. Results: Participants were characterized by mean age of 72.1 years, 68.3% of women, 20% of major depressive disorder, 27% of subthreshold depression and 33.3% of frail. Frailty prevalence was different between depressed older adults and non-depressed ones (p < 0.001). Depressed older adults presented OR of 2.77 for frailty at baseline (p = 0.01). OR for frailty was higher (3.17) when considered the diagnosis of major depression (p = 0.006) but it was not significant for subthreshold depression at baseline (p = 0.777). The severity of depressive symptoms was associated to a greater risk of frailty (p < 0.001). We observed a 2 to 4-fold increased risk for incident frailty among participants with depression over time. The presence of a depressive disorder was significantly associated with the onset of frailty (adjusted OR for FRAIL and FI-36: 3.07 [95% CI = 1.03 - 9.17] and 3.76 [95% CI = 1.09 - 12.97]), respectively. The risk for frailty due to LLD was significantly higher with the FI-36 compared to the FRAIL (RR: 3.03 versus 2.23). RD was of 17.3% and 12.7% with the FRAIL and the FI-36, respectively. Conclusion: The relationship between LLD and frailty is based on few longitudinal studies. Our data support the association between depression and incident frailty among older adults over a one-year follow-up, reinforcing longitudinal evidence from population-based studie

Validity and reliability of the Brazilian Portuguese version of the Australian National University - Alzheimer’s Disease Risk Index (ANU-ADRI)

Abstract The ANU-ADRI is a self-report tool that assesses risk for Alzheimer’s Disease (AD). Objective: To validate an adapted Portuguese version of this instrument and to carry out the reliability Test-Retest of the ANU-ADRI in Brazil. Methods: In this longitudinal study, the sample was formed (n=100) by two groups (A and B): each comprising 50 patients assisted by GPs (general practitioners) or specialists in dementia. All participants were cognitively healthy upon screening using the MMSE. The ANU-ADRI was applied at baseline (Test) and again within 1 week of the test (Retest). Results: There was a correlation between the mean scores of the ANU-ADRI Test and Retest (r=0.918, P<0.001). Group A had higher ANU-ADRI scores than those of group B (P<0.05). There was a moderate negative linear relation between the ANU-ADRI and MMSE scores (r= -0.353, P<0.001). Conclusion: The ANU-ADRI is a valid and reliable instrument to assess whether community-dwelling Brazilians are at greater risk for AD. Low levels of education were associated with higher risk scores on the ANU-ADRI

Cross-cultural adaptation of the "Australian National University Alzheimer's Disease Risk Index" for the Brazilian population

ABSTRACT Alzheimer's disease (AD) represents a major public health problem and it is therefore crucial that modifiable risk factors be known prior to onset of dementia in late-life. The "Australian National University - Alzheimer's Disease Risk Index" (ANU-ADRI) is one of the potential tools for primary prevention of the disease. Objective: The aim of this study was to devise an adapted version of the ANU-ADRI for use in Brazil. Methods: The instrument was translated from its original language of English into Portuguese and then back-translated into English by bilingual translators. It was subsequently reviewed and evaluated as to the degree of translation issues and equivalence. In this study, the ANU-ADRI was applied using individual (face-to-face) interviews in a public hospital, unlike the original version which is applied online by self-report. The final version (pretest) was evaluated in a sample of 10 participants with a mean age of 60 years (±11.46) and mean education of 11 years (±6.32). Results: The intraclass correlation coefficient (ICC) (inter-rater) was 0.954 (P<0.001 for a confidence interval (CI) of 95%=[0.932; 0.969]). Cultural equivalence was performed without the need for a second instrument application step. Conclusion: After cross-cultural adaptation, the language of the resultant questionnaire was deemed easily understandable by the Brazilian population

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review

ABSTRACT Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country