Navegando por Palavras-chave "doença de Alzheimer"
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- ItemAcesso aberto (Open Access)Adaptação transcultural da escala de avaliação de incapacidade em demência (Disability Assessment For Dementia - DAD)(Academia Brasileira de Neurologia - ABNEURO, 2007-09-01) Carthery-goulart, Maria Tereza; Areza-fegyveres, Renata; Schultz, Rodrigo R. [UNIFESP]; Okamoto, Ivan [UNIFESP]; Caramelli, Paulo; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Nitrini, Ricardo; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)The original version of the Disability Assessment for Dementia (DAD) was translated into Portuguese and back translated to English. The divergences of translation were identified and discussed, resulting in a version that was used in a preliminary investigation for cross-cultural adaptation. The final version was administered to 29 patients with mild to moderate probable Alzheimer's disease. The correlation coefficients of DAD were 0.929 and 0.932 for the inter-examiner and test-retest evaluations respectively. The reliability indexes were also high (Kappa 0.72 p<0.001 inter-examiners and 0.85 p<0.001 test-retest). The Brazilian version of DAD was easy to administer and had good reliability to assess the functional status of demented patients. It will contribute to the follow-up of these patients in our population. Moreover, it can be used in transcultural studies on functional abilities in dementia.
- ItemAcesso aberto (Open Access)Alterações de linguagem nas fases iniciais da doença de Alzheimer(Academia Brasileira de Neurologia - ABNEURO, 2005-06-01) Ortiz, Karin Zazo [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)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.
- ItemAcesso aberto (Open Access)Alzheimer's disease in Brazilian elderly has a relation with homocysteine but not with MTHFR polymorphisms(Academia Brasileira de Neurologia - ABNEURO, 2006-12-01) Silva, Vanessa Cavalcante da; Ramos, Flávio José da Costa; Freitas, Elizabete Malaquias; Brito-marques, Paulo Roberto de; Cavalcanti, Márcia Nery de Holanda; D'Almeida, Vânia [UNIFESP]; Cabral-filho, José Eulálio; Muniz, Maria Tereza Cartaxo; Universidade de Pernambuco Instituto de Ciências Biológicas; Universidade de Pernambuco Faculdade de Ciências Médicas Departamento de Neurologia; Universidade Federal de São Paulo (UNIFESP); Instituto Materno-Infantil de PernambucoOBJECTIVE: To investigate the association between total plasma homocysteine concentration, C677T and A1298C polymorphisms in MTHFR gene and Alzheimer's disease (AD) development. METHOD: Forty-three patients with probable (63%) and possible (37%) AD and 50 non-demented controls were evaluated. Groups did not differ as to gender, age, scholar years, diabetes, alcohol and coffee intake and physical activity. Total plasma homocysteine (Hcy) levels were determined by HPLC and genotyping for MTHFR by PCR/RFLP. Mann-Whitney U test was used to compare quantitative variable, Fisher-Freeman-Halton test to compare genotypes and allele proportions and Chi-square test to other qualitative variables. RESULTS: AD patients presented higher total plasma Hcy levels than controls and the difference was statistically significant. No differences in the C677T and A1298C MTHFR polymorphisms distributions were found between patients and controls. Plasma homocysteine concentration did not change with MTHFR genotypes. CONCLUSION: Our data confirms the association between increased plasma Hcy concentration and AD and suggests that neither C677T nor A1298C MTHFR polymorphisms contributed to genetic susceptibility for AD in elderly individuals in the Northeast of Brazil.
- ItemAcesso aberto (Open Access)Applicability of the CERAD neuropsychological battery to Brazilian elderly(Academia Brasileira de Neurologia - ABNEURO, 2001-09-01) Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Okamoto, Ivan Hideyo [UNIFESP]; Brucki, Sonia Maria Dozzi [UNIFESP]; Siviero, Marilena Occhini [UNIFESP]; Toniolo Neto, João [UNIFESP]; Ramos, Luiz Roberto [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.
- ItemAcesso aberto (Open Access)Depressão vascular no idoso: resposta ao tratamento antidepressivo associado a inibidor das colinesterases(Faculdade de Medicina da Universidade de São Paulo, 2007-01-01) Barcelos, Ricardo; Faria, Juliano [UNIFESP]; Grossi, Paulo; Aparício, Marco Antonio Moscoso; Bottino, Cássio M. C.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Hospital Geral Santa Lúcia Centro de Terapia IntensivaCONTEXT: Among neuropsychiatric disorders caused by cerebrovascular factors, vascular depression is diagnosed in a small degree by general practitioners, causing morbid-mortality increase in elderly. CASE REPORT: That is a case of a 67 year-old-man with partial response after treatment with a Selective Serotonin Receptors Inhibitor, and severe autonomic adverse effects with other antidepressants. The addition of rivastigmine to citalopram resulted in a therapeutic success, with a reduction of 23 to 7 points on the Hamilton Depressive Scale (HAM-D). DISCUSSION: The result obtained brings new perspectives to the treatment of vascular depression, providing that randomized controlled trials with larger sample sizes confirm the positive effect of the addition of a cholinesterase inhibitor to antidepressants in the treatment of these patients.
- ItemAcesso aberto (Open Access)Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination(Academia Brasileira de Neurologia - ABNEURO, 2014-04-01) Wajman, José Roberto; Oliveira, Fabricio Ferreira de [UNIFESP]; Schultz, Rodrigo Rizek; Marin, Sheilla de Medeiros Correia [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Cognitive assessment in advanced stages of Alzheimer’s disease (AD) is limited by the imprecision of most instruments.Objective:To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method:Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results:Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001). Conclusion:The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.
- ItemAcesso aberto (Open Access)Effects of semantic relations, repetition of words, and list length in word list recall of Alzheimer's patients(Academia Brasileira de Neurologia - ABNEURO, 2008-06-01) Bueno, Orlando Francisco Amodeo [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Oliveira, Maria Gabriela Menezes de [UNIFESP]; Abrisqueta-Gomez, Jacqueline [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)INTRODUCTION: Semantic relations among words and repetition enhance free recall, but it is unknown if these facilitating factors are effective in dementia. METHOD: Alzheimer's patients (MILD-Alz, MOD-Alz) were compared to healthy elderly. Fifteen-word lists were read out to the subjects. In four sets of lists the words in intermediary input positions were semantically related or not, or the midlist words were repeated, or they were repeated and semantically related. RESULTS: The usual third peak of recall of semantically related words was not observed in MOD-Alz, repetition of words did not increase recall of the patients, and the combination of relatedness and repetition benefited only MID-Alz. In a second experiment, with related or unrelated midlist words, and list length shortened from 15 to 9 words, semantic facilitation was observed in mild and moderate Alzheimer´s patients, although diminished compared to controls. CONCLUSION: Progression of dementia turns facilitating factors of recall less effective.
- ItemAcesso aberto (Open Access)Is there correlation between cognition and functionality in severe dementia? The value of a performance-based ecological assessment for Alzheimer’s disease(Academia Brasileira de Neurologia - ABNEURO, 2014-11-01) Wajman, José Roberto [UNIFESP]; Oliveira, Fabricio Ferreira de [UNIFESP]; Marin, Sheilla de Medeiros Correia [UNIFESP]; Schultz, Rodrigo Rizek [UNIFESP]; Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective Besides significant cognitive decline, patients in later stages of Alzheimer's disease (AD) also present global functional impairment, usually reported by their caregivers. This study searched for preserved activities of daily living by investigating correlations among specific instruments for severe dementia with a performance-based functional scale. Method A sample of 95 moderate to severe AD patients and their caregivers underwent a neuropsychological battery consisting of screening tools, the Functional Assessment Staging Test (FAST), the Severe Mini-Mental State Examination (MMSEsev) and a performance-based ecological scale, the Performance Test of Activities of Daily Living (PADL). Results Consistent findings emerged from the comparisons among tests. PADL showed significant statistical correlation with MMSEsev (ρ<0.001), according to FAST subdivisions. Conclusion Upon suspicion of unreliable caregiver reports, ecological scales may be useful for disease staging. Variable degrees of functionality and cognition may be present even in later stages of AD, requiring proper assessment.
- ItemAcesso aberto (Open Access)Proposta de uma versão brasileira para a escala ADCS-CGIC(Academia Brasileira de Neurologia - ABNEURO, 2003-09-01) Bertolucci, Paulo Henrique Ferreira [UNIFESP]; Nitrini, Ricardo; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Given increasing research into new therapies for dementia, especially for Alzheimer disease, it has become clear that traditional methods of evaluation, centered on cognition, have proved insufficient. Thus, scales for behavioral disturbances and activities of daily living have been added. Nevertheless, some observations of clinical significant changes, as reported by caregivers, could be overlooked. Clinician's impression of global change scales (CIGIC) are based on broader information and may detect more subtle changes. Typically they take into consideration caregiver information, that which is seen by the health professional during the interview, and may also include brief cognitive tests. We present a Brazilian Portuguese version of a widely used scale of this type, specifically designed for Alzheimer disease (ADCS-CGIC), being the result of the recommended method of translation, back-translation and version by panel consensus.