Combining Cognitive Screening Tests for the Evaluation of Mild Cognitive Impairment in the Elderly

OBJECTIVE: To determine the accuracy of the Mini-Mental State Examination combined with the Verbal Fluency Test and Clock Drawing Test for the identification of patients with mild cognitive impairment and Alzheimer's disease (AD). METHOD: These tests were used to evaluate cognitive function in 247 older adults. Subjects were divided into three groups according to their cognitive state: mild cognitive impairment (n=83), AD (n=81), cognitively unimpaired controls (n=83), based on clinical and neuropsychological data. The diagnostic accuracy of each test for discriminating between these diagnostic groups (mild cognitive impairment or AD vs. controls) was examined with the aid of Receiver Operating Characteristic (ROC) curves. Additionally, we evaluated the benefit of the combination of tests on diagnostic accuracy. RESULTS: Although they were accurate enough for the identification of Alzheimer's disease, neither test alone proved adequate for the correct separation of patients with mild cognitive impairment from healthy subjects. Combining these tests did not improve diagnostic accuracy, as compared to the Mini-Mental State Examination alone, in the identification of patients with mild cognitive impairment or Alzheimer's disease. CONCLUSIONS: The present data do not warrant the combined use of the Mini-Mental State Examination, the Verbal Fluency Test and the Clock Drawing Test as a sufficient diagnostic schedule in screening for mild cognitive impairment. The present data do not support the notion that the combination of test scores is better that the use of Mini-Mental State Examination scores alone in the screening for Alzheimer's disease

Delirium e demência no idoso: existem fatores de risco comuns?

Delirium is a neurobehavioral syndrome caused by the transient disruption of cerebral homeostasis, which is invariably subsequent to systemic or central nervous system insults. In general medical settings, the occurrence of delirium is also associated with a higher incidence of post-operative complications, longer hospital stays, and poor functional recovery. Ageing and cognitive decline are known risk factors for the occurrence of delirium. In elderly patients, delirium has been shown to be associated with pre-existing dementia. Conversely, non-demented elderly subjects who develop a new delirium episode display an increased incidence of dementia in the long-term outcome. Prospective case-control studies have demonstrated a significant association between the previous diagnosis of delirium and the development of dementia. The association between delirium and dementia may be even higher among the eldest elderly. After reviewing the relevant literature on the association between delirium and dementia, we hypothesize that the occurrence of delirium in non-demented elderly individuals is predictive of a worse cognitive outcome, and increased risk of dementia, in the long-term follow-up. We further discuss the biological nature of this association in the light of the cholinergic deficit observed in the pathophysiology of both delirium and Alzheimer's disease.Delirium é uma síndrome neurocomportamental decorrente da quebra transitória da homeostase cerebral. Deve-se, invariavelmente, a perturbações sistêmicas ou do sistema nervoso central. No contexto médico geral, a ocorrência de delirium está associada à maior incidência de complicações clínico-cirúrgicas, maior tempo de permanência hospitalar e pior recuperação funcional. O envelhecimento e o comprometimento cognitivo são fatores de risco conhecidos para o delirium. Em pacientes idosos, a ocorrência aumenta o reconhecimento de quadros demenciais preexistentes. Em contrapartida, indivíduos idosos não-demenciados que desenvolvem um episódio de delirium durante uma dada internação hospitalar têm incidência aumentada de demência na evolução em longo prazo. Estudos prospectivos e controlados demonstraram uma associação significativa entre o diagnóstico prévio de delirium e o ulterior desenvolvimento de síndromes demenciais. Essa associação parece ser ainda maior em indivíduos muito idosos. O presente estudo de revisão aborda criticamente a natureza da associação entre delirium e demência. Hipotetiza-se que a sua ocorrência em indivíduos idosos cognitivamente preservados é fator preditivo de deterioração cognitiva, e de risco aumentado para o desenvolvimento de demência, no seguimento de longo termo. As bases neurobiológicas da associação entre delirium e demência são discutidas à luz da hipótese colinérgica da doença de Alzheimer, uma vez que o comprometimento da neurotransmissão colinérgica é denominador comum a essas duas perturbações neuropsíquicas

Delirium: uma perspectiva histórica

Delirium remained a stable psychiatric category until the early 19th century when it underwent etiological and phenomenological redefinition, precipitating the transformation of the functional insanities into psychoses. Confusion, introduced by French workers during the second half of the century, referred to a syndrome wider than (but including) delirium. It emphasized chaotic thinking and cognitive failure. The notion of clouding of consciousness (and temporo-spatial disorientation) established a common denominator for the two concepts, while Chaslin and Bonhoeffer redefined confusion and delirium as the stereotyped manifestations of acute brain failure.O delirium corresponde a uma das primeiras doenças mentais descritas na literatura médica, há mais de 2.500 anos. Nas classificações psiquiátricas, permaneceu como categoria nosológica independente até o final do século XIX, quando foi redefinida com base nos seus aspectos fenomenológicos e etiológicos, precipitando a reclassificação das insanidades funcionais em psicoses. os estados confusionais passaram a se referir a uma síndrome mais ampla que incluía o delirium, enfatizando a desorganização dos processos cognitivos e do pensamento, e tendo no turvamento da consciência e na desorientação temporoespacial a condição de base. Com o objetivo de descrever a evolução histórica do conceito de delirium, foram realizados levantamentos da literatura médica através do sistema Medline, além da pesquisa em publicações literárias específicas sobre os temas história da medicina e história da psiquiatria. Partiu-se de algumas observações dogmáticas praticadas na Antigüidade e Idade Média, para atingir as definições e práticas atuais, oferecendo uma análise crítica dos critérios diagnósticos vigentes (DSM-III, DSM-IIIR, DSM-IV e CID-10). Não obstante a evolução conceitual, o delirium continua sendo mal compreendido, do ponto de vista fisiopatológico e são poucas as opções terapêuticas. o diagnóstico de delirium é ato eminentemente clínico: baseia-se na observação cautelosa das manifestações psíquicas e comportamentais dos pacientes acometidos, além da análise dos fatores predisponentes e precipitantes. É freqüente o seu subdiagnóstico em contextos clínicos e cirúrgicos. o diagnóstico do delirium é estabelecido em apenas 30% a 50% dos pacientes, sendo a omissão diagnóstica menos freqüente em serviços que contam com a interconsulta psiquiátrica. o delirium é uma das complicações mais comuns entre pacientes idosos hospitalizados e está associado a maior morbimortalidade. Isso sustenta a importância do seu pronto reconhecimento e manejo

Marital adjustment in the context of female breast cancer: A systematic review

Objective: Breast cancer (BC) diagnosis and subsequent treatments present significant challenges and distress for both patients and their partners. This can lead to difficulties in marital relationships and, consequently, decreases in marital adjustment and psychosocial adaptation to BC for both partners. Our objective was to systematically review studies assessing marital adjustment in the context of female BC to understand which factors are associated with marital adjustment in both patients and partners, and characterize the measures employed to assess marital adjustment within these studies. Methods: This systematic review was conducted in accordance with PRISMA guidelines. English, peer-reviewed articles exploring factors associated with marital adjustment in the context of female BC were considered for inclusion. Results: Fourteen studies were included. Results evidenced that psychosocial variables play an important role on marital adjustment. Specifically, open and constructive communication, more social support, and supportive dyadic coping were found to be associated with higher levels of marital adjustment. Other variables such as self-efficacy, sexual functioning, and psychological adjustment were also positively associated with marital adjustment. Conclusions: Most studies evidenced an association between psychosocial variables and marital adjustment for both women and their partners. Some important dimensions such as communication patterns, coping strategies, and social support dynamics were identified as potential targets for psychological interventions. Some variables, however, were explored only in a few studies which limit our conclusions. Future studies should explore the role these variables and other relational and emotional variables play in promoting marital adjustment after BC

Intra-hospital mortality for community-acquired pneumonia in mainland Portugal between 2000 and 2009

Introduction: Community-acquired pneumonia (CAP) remains a common and serious infection with wide variability in intra-hospital mortality. Methods: We performed a retrospective analysis of adult patients admitted with CAP in mainland Portugal between the years 2000 and 2009. Results: The intra-hospital mortality rate was 20.4% with deaths in all age groups. The average age of deceased patients was 79.8 years, significantly higher than surviving patients with 71.3 years. Patients aged 50 or more presented a relative risk of death 4.4 times the risk of patients under this age group. Likewise, in patients aged 65 or more the risk of death was 3.2 times the risk of patients <65 years. Men died more at a younger age than women, the men who died were, on average, 4 years younger than women, 78.1 vs 82.1 years old. Relative risk of death in men was 17% higher than women after adjustment for year of admission and age. Conclusion: CAP remains an important cause of hospital mortality in all age groups.info:eu-repo/semantics/publishedVersio

Effects of a multidisciplinar cognitive rehabilitation program for patients with mild Alzheimer's disease

OBJECTIVE: To evaluate the effects of a multidisciplinary rehabilitation program on cognition, quality of life, and neuropsychiatry symptoms in patients with mild Alzheimer's disease. METHOD: The present study was a single-blind, controlled study that was conducted at a university-based day-hospital memory facility. The study included 25 Alzheimer's patients and their caregivers and involved a 12-week stimulation and psychoeducational program. The comparison group consisted of 16 Alzheimer's patients in waiting lists for future intervention. INTERVENTION: Group sessions were provided by a multiprofessional team and included memory training, computer-assisted cognitive stimulation, expressive activities (painting, verbal expression, writing), physiotherapy, and physical training. Treatment was administered twice a week during 6.5-h gatherings. MEASUREMENTS: The assessment battery comprised the following tests: Mini-Mental State Examination, Short Cognitive Test, Quality of Life in Alzheimer's disease, Neuropsychiatric Inventory, and Geriatric Depression Scale. Test scores were evaluated at baseline and the end of the study by raters who were blinded to the group assignments. RESULTS: Measurements of global cognitive function and performance on attention tasks indicated that patients in the experimental group remained stable, whereas controls displayed mild but significant worsening. The intervention was associated with reduced depression symptoms for patients and caregivers and decreased neuropsychiatric symptoms in Alzheimer's subjects. The treatment was also beneficial for the patients' quality of life. CONCLUSION: This multimodal rehabilitation program was associated with cognitive stability and significant improvements in the quality of life for Alzheimer's patients. We also observed a significant decrease in depressive symptoms and caregiver burden. These results support the notion that structured nonpharmacological interventions can yield adjunct and clinically relevant benefits in dementia treatment

Noctuóides (Lepidoptera: Noctuoidea) associados a soja Bt e não-Bt no Cerrado brasileiro

O uso de OGM que expressam toxina Bt na produção de soja tem aumentado significativamente nos últimos anos no Brasil e são utilizados para conter os danos causados ​​pelos lepidópteros pragas. Neste estudo comparamos a riqueza e a abundância de Noctuoides (Noctuoidea) associados à soja Bt e não-Bt. Determinamos as variações temporais em função da fenologia e correlacionamos às variações populacionais das espécies mais comuns com variáveis ​​meteorológicas. A pesquisa foi conduzida na área experimental da Embrapa Cerrados. O método de coleta utilizado foi diferenciado sendo supressivo e absoluto. Um total de 13 espécies foram coletadas, das quais oito ocorreram em soja Bt. Os taxa mais representativos foram Chrysodeixis includens, Anticarsia gemmatalis e Spodoptera spp. O número de larvas pertencentes às espécies alvo da tecnologia Bt foram 10 vezes menores na soja Bt do que em soja não-Bt . Utetheisa ornatrix e Elaphria deltoides foram registradas na soja pela primeira vez, observando-se larvas de ambas espécies na soja não-Bt e as de U. ornatrix também na soja Bt. Somente as larvas de A. gemmatalis se correlacionaram (p <0,05) negativamente com a precipitação. Este estudo forneceu informações em campo sobre a abundância e riqueza de espécies na soja não- Bt, associada aos efeitos da soja Bt. A importância do monitoramento das lagartas é substancial, a fim de tomar a melhor decisão de controle, considerando-se os diferentes níveis de infestação entre cultivares como critério.The use of GMO expressing Bt toxin in soybean production has increased significantly in the last years in Brazil in order to manage the damage caused by lepidopteran pests. In this study, we compared the richness and abundance of owlet moths (Noctuoidea) associated with Bt and non-Bt soybean. We determined the temporal variations as a function of phenology, and correlated the population variations of the most common species with meteorological variables. The research was conducted at the experimental area of Embrapa Cerrados. The collection method used was differentiated being suppressive and absolute. A total of 13 species were collected, of which eight occurred on Bt soybeans. The most representative taxa were Chrysodeixis includens (72.87%), Anticarsia gemmatalis (18.17%) and Spodoptera spp (5.22%). The number of larvae belonging to species targeted by the Bt technology was 10 times lower on Bt than on non-Bt soybeans. Utetheisa ornatrix and Elaphria deltoides were recorded on soybean for the first time, observing larvae of both species in non-Bt soybean and those of U. ornatrix also in Bt soybean. Only A. gemmatalis larvae correlated (p <0.05) negatively with precipitation. This study provided field information on the abundance and species richness of owlet moths on non-Bt soybeans, associated with the effects of Bt soybean. When considering the different levels of infestation between cultivars as a criterion, larvae monitoring is of substantial importance in order to develop the lost control program

Variabilidade de genótipos de mandioca indústria e mesa quanto a resistência de percevejo-de-renda.

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