Language impairment in the early stages of Alzheimer's disease

Alzheimer disease (AD) is usually associated with cognitive, language and behavioral impairments, which can get more and more serious as the disease progresses. The aim of this study is to verify language disorders in the early stages of this disease. Twelve patients meeting criteria for problable AD were evaluated by the Boston test, and all of them scored more than 23 points on the Mini-Mental State Examination. Data acquired on this language evaluation were compared with the average of normal population data. All patients showed language disorders. Statistical differences were found in visual confrontating naming and auditory comphrension tasks. The patients performed well in writing and reading tasks. We believe that there might have had an interference in the patient's linguistic task performance due to their memory impairment. We could find language impairments in the early stages of AD.A doença de Alzheimer (DA) está associada a alterações cognitivas, de linguagem e de comportamento que se agravam durante seu curso. O objetivo deste estudo foi verificar a presença de alterações de linguagem, em pacientes com DA em fase inicial. Foram avaliados 12 pacientes com diagnóstico de provável (DA). Todos tinham pontuação no Mini Exame do Estado Mental acima de 23 pontos. Os pacientes foram submetidos à aplicação do Teste de Boston e os resultados comparados aos da população normal. Todos os pacientes apresentaram alterações de linguagem. Foram encontradas diferenças estatisticamente significantes nas tarefas de Compreensão auditiva e na tarefa de denominação. Nas demais tarefas de expressão e compreensão oral, bem como nas de leitura e escrita, os pacientes tiveram desempenho similar aos normais. Embora com um grupo pequeno,esta investigação identificou alterações bem definidas de linguagem em uma fase bastante inicial da DA.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de Neurologia e NeurocirurgiaUNIFESP, EPM, Depto. de Neurologia e NeurocirurgiaSciEL

Periodic lateralized epileptiform discharges: II. Evolutive patterns

A investigation was done on EEG evolution of 9 patients with PLEDs. In all patients PLEDs eventualy disappeared, in general in a short period, less than 4 daysin 5 cases. In 4 cases evolution was to slow background activity, and to posterior normalization in 2. In 3 cases evolution was to delta activity and suppression bursts, and all the 3 patients died. In the last 2 patients PLEDs were replaced by localized paroxysmal activity, which was anteriorly registered in 1. PLEDs was found in acute dysfunction of CNS, and in epileptic patients in periods of increased seizure activity. These data suggest that a critical point of alteration of the normal neuronal activity is needed for appearance and maintenance of PLEDs. No correlation could be done between the evolution of PLEDs, always to disappearance, and clinical outcome, that was variable.Foi feita a investigação da evolução das PLEDs em 9 pacientes, com idade variando entre 7 meses e 73 anos. As PLEDs evoluiram uniformemente para o desaparecimento, em um período curto, menor que 4 dias em 5 casos. Em 4 casos a evolução foi para atividade de base lenta, com posterior normalização em dois. Três casos evoluíram para período de supressão e para o óbito. Dois para atividade irritativa localizada, a qual já havia sido registrada anteriormente em um deles. Estes dados sugerem que as PLEDs dependem de um ponto crítico na alteração da atividade neuronal para seu aparecimento e manutenção. Não foi observada correlação entre a evolução das PLEDs, sempre para o desaparecimento, e evolução clínica, que foi variável.Escola Paulista de Medicina Setor de EletrencefalografiaUNIFESP, EPM, Setor de EletrencefalografiaSciEL

Dementia in Adults: Initial Approach and Main Causes

A short review of dementia in adults was done, stressing the initial approach and neuropsychological scales currently used, and possible errors in the interpretation of performance scores. Causes are grouped according to the more common etiologies of dementia in young adults as dementia associated with drug abuse, infections (with emphasis in AIDS), environmental contamination and drugs side effects, and neurological disorders. Suggestions of clues to the differential diagnosis are given

Naming ability in patients with mild to moderate Alzheimer’s disease: what changes occur with the evolution of the disease?

OBJECTIVES: Naming deficit is a linguistic symptom that appears in the initial phase of Alzheimer’s disease, but the types of naming errors and the ways in which this deficit changes over the course of the disease are unclear. We analyzed the performance of patients with Alzheimer’s disease on naming tasks during the mild and moderate phases and verified how this linguistic skill deteriorates over the course of the disease. METHODS: A reduced version of the Boston Naming Test was administered to 30 patients with mild Alzheimer’s disease, 30 patients with moderate Alzheimer’s disease and 30 healthy controls. Errors were classified as verbal semantic paraphasia, verbal phonemic paraphasia, no response (pure anomia), circumlocution, unrelated verbal paraphasia, visual errors or intrusion errors. RESULTS: The patients with moderate Alzheimer’s disease had significantly fewer correct answers than did both the control group and the group with mild Alzheimer’s disease. With regard to the pattern of errors, verbal semantic paraphasia errors were the most frequent errors in all three groups. Additionally, as the disease severity increased, there was an increase in the number of no-response errors (pure anomia). The group with moderate Alzheimer’s disease demonstrated a greater incidence of visual errors and unrelated verbal paraphasias compared with the other two groups and presented a more variable pattern of errors. CONCLUSIONS: Performance on nominative tasks worsened as the disease progressed in terms of both the quantity and the type of errors encountered. This result reflects impairment at different levels of linguistic processing

Uma paciente com afasia progressiva primária devido à doença de Alzheimer

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Neurology and NeurosurgeryUNIFESP, EPM, Department of Neurology and NeurosurgerySciEL

Conhecimento dos cuidadores acerca do risco cerebrovascular de pacientes com síndrome demencial da doença de Alzheimer em São Paulo, Brasil

Background Proper control of cerebrovascular risk is essential to prevent cognitive change in dementia due to Alzheimer’s disease (AD). Objective To investigate whether caregiver awareness to control cerebrovascular risk impacts the lifestyles of patients with AD. Methods Consecutive outpatients with AD were assessed for demographic features, Clinical Dementia Rating scores, cerebrovascular risk, pharmacotherapy, dietary therapy and practice of physical activities. Patients and caregivers were inquired on awareness of the importance of measures to control cerebrovascular risk. Chi-square test was employed for statistics, significance at ρ < 0.05. Results A total of 217 patients were included; whereas 149 caregivers (68.7%) were aware of the need to control cerebrovascular risk, only 11 patients (5.1%) simultaneously practiced physical activities and received pharmacological treatment and dietary therapy. Patients with hypertension and diabetes mellitus were more likely to receive dietary therapy (ρ = 0.007). Male patients were more engaged in physical activities (ρ = 0.018). Patients in earlier AD stages exercised (ρ = 0.0003) and received pharmacological treatment more often (ρ = 0.0072). Caregiver awareness of the need to control cerebrovascular risk was higher when patients had hypertension (ρ = 0.024) and/or hypercholesterolemia (ρ = 0.006), and influenced adherence to dietary therapy (ρ = 0.002) and to pharmacological treatment (ρ = 0.001). Discussion Caregiver awareness of the need to control cerebrovascular risk has positive impacts for patients with AD.Contexto O risco cerebrovascular é fundamental na etiologia da demência da doença de Alzheimer (DA), sendo importante seu controle adequado. Objetivo Investigar se o conhecimento dos cuidadores sobre o controle do risco cerebrovascular tem impacto sobre a saúde de pacientes com DA. Métodos Pacientes consecutivos com DA foram avaliados quanto a dados demográficos, Clinical Dementia Rating, risco cerebrovascular, tratamento farmacológico, dietoterapia e prática de atividades físicas. Pacientes e cuidadores foram questionados quanto à importância de medidas para controle do risco cerebrovascular. Chi-quadrado foi empregado na análise estatística, significância com ρ < 0,05. Resultados No total, 217 pacientes foram incluídos; enquanto 149 cuidadores (68,7%) conheciam a necessidade de controle do risco cerebrovascular, somente 11 pacientes (5,1%) simultaneamente praticavam exercícios e recebiam tratamento farmacológico e dietoterápico. Pacientes com hipertensão arterial e diabetes mellitus tinham maiores chances de receber dietotetapia (ρ = 0,007). Homens estavam mais engajados em atividades físicas (ρ = 0,018). Pacientes em estágios precoces da DA praticavam exercícios (ρ = 0,0003) e recebiam farmacoterapia mais frequentemente (ρ = 0,0072). O conhecimento dos cuidadores acerca do controle do risco cerebrovascular era maior quando os pacientes tinham hipertensão arterial (ρ = 0,024) e/ou dislipidemia (ρ = 0,006), e influenciou a adesão à dietoterapia (ρ = 0,002) e à farmacoterapia (ρ = 0,001). Conclusão O conhecimento dos cuidadores acerca do risco cerebrovascular tem impactos positivos para pacientes com DA

Prejuízo da atenção em pacientes com esclerose múltipla na forma remitente-recorrente com incapacidade leve

Neuropsychological studies have consistently reported cognitive dysfunctions associated with multiple sclerosis. One-hundred fifteen subjects with relapsing-remitting multiple sclerosis (RRMS) were compared with forty health controls according to a neuropsychological test battery, which included digit span, trail making, cancellation and stroop test. Both groups were matched for age, sex and educational level. Subjects with RRMS had a worse performance the speed of response. Subjects with RRMS spent more time to complete the test in either sections A (p=0.001) or B (p=0.001), although there was no significant difference in terms of number of errors. The total time required to finish the Stroop test was higher for subjects with RRMS (p<0.001), being the time difference between groups significant at trial 4 (p<0.001). Attention impairment in subjects with RRMS is related to slowed central processing, which may be affected in all stages, including impairment of automatic and controlled processing of information and in the motor program.Estudos neuropsicológicos demonstram alterações cognitivas associadas à esclerose múltipla. Foram avaliados, através de uma bateria neuropsicológica, 115 pacientes com esclerose múltipla remitente-recorrente (EMRR), comparada a um grupo controle com 40 indivíduos saudáveis. A bateria inclui os testes, span de dígitos, trilhas, teste de cancelamento e stroop. Os grupos foram pareados por sexo, idade e escolaridade.Os pacientes com EMRR tiveram um pior desempenho na rapidez de resposta (p=0,001), os pacientes gastaram um tempo maior para realizar o trilhas A (p=0,001) e o trilhas B (p=0,0001), não havendo diferenças significativas no número de erros. O tempo total no teste stroop foi maior dos sujeitos EMRR (p<0,001), apresentando diferença significativa na tentativa 4 (p<0,001). Os pacientes EMRR apresentaram lentificação do processamento central, podendo estar prejudicado em todos os estágios da doença, incluindo prejuízo do processamento de informações automático e controlado.Santa Casa School of Medical Sciences Department of NeurologyFederal University of São Paulo Department of Neurology and NeurosurgeryUNIFESP, Department of Neurology and NeurosurgerySciEL

Nutrition in Severe Dementia

An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy

Behavior disorders and subjective burden among caregivers of demented patients.

UNLABELLED: Many patients with dementia live within the community supported by their family and friends. Majority of patient caregivers suffer from high levels of stress. METHODS: A quasi-experimental study, which compared the effects of nursing interventions on behavior disorders in both patients with moderate to severe dementia and their caregivers, followed over 18 months. The assessments were performed at the outpatient clinic of the Federal University of São Paulo and again at patients' homes with their primary caregiver, after informed consent form. Measurements were performed at baseline and after 18 months (pre and post-test). The instruments used were: The CDR, NPI and NPI-D; Katz Index and FAQ. Simultaneously, caregivers were enrolled onto the Dementia Education Program. RESULTS: The final sample was composed of 31 subjects, having a mean age of 77.4 y.o. (±8 SD). Nursing interventions were effective in reducing some of the behavioral disturbances (Z= -3.1; p=0.002), such as Aggression (Z= -3.7; p<0.001) and anxiety (Z= -2.3; p=0.023). Caregiver distress also reduced upon interventions (Z= -2.2; p=0.030). CONCLUSION: Our results indicate nursing interventions may be effective in reducing the frequency and severity of behavioral disorders and subjective burden among caregivers. Education Programs can improve caregiver burden through conveying information on difficulties related to the disease and how to deal with them