Disease Progression in Frontotemporal Dementia and Alzheimer Disease: The Contribution of Staging Scales.

INTRODUCTION: There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD). OBJECTIVES: To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale-frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR). METHODS: The sample consisted of 70 individuals, aged 40+ years, with at least 2 years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant), and 27 with AD. The FTD-FRS, the CDR, and the 2 additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke Cognitive Examination-Revised was completed by patients. After 12 months, the same protocol was applied. RESULTS: The FTD-FRS, CDR-FTLD, and CDR detected significant decline after 12 months in the 3 clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages. CONCLUSIONS: The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum.

Diagnosis of frontotemporal dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

"Frontotemporal dementia" (FTD) is a clinical syndrome characterized by the focal involvement of the frontal and/or temporal lobes. FTD has three clinical phenotypes: the behavioral variant and two linguistic subtypes, namely, non-fluent/agrammatic primary progressive aphasia (PPA-NF/A) and semantic PPA (PPA-S). FTD is the second most common cause of dementia in individuals under the age of 65 years. This article presents recommendations for the diagnosis of FTD in the Brazilian scenario, considering the three levels of complexity of the health system: primary health care, secondary and tertiary levels. Diagnostic guidelines are proposed, including cognitive testing, behavioral and language assessments, laboratory tests, and neuroimaging.

A "demência frontotemporal" (DFT) é uma síndrome clínica, cujo denominador comum é o acometimento focal dos lobos frontais e/ou temporais. A DFT tem três fenótipos clínicos distintos: a variante comportamental e dois subtipos linguísticos, a saber, a afasia progressiva primária não-fluente/agramática (APP-NF/A) e a afasia progressiva primária semântica (APP-S). A DFT é a segunda causa mais comum de demência em indivíduos com idade inferior a 65 anos, após a doença de Alzheimer. O presente artigo apresenta recomendações para diagnóstico da DFT no cenário brasileiro, considerando os três níveis de complexidade do sistema de saúde: atenção primária à saúde e níveis secundários. São propostos protocolos de investigação diagnóstica abrangendo testagem cognitiva, avaliação comportamental, avaliação fonoaudiológica, exames laboratoriais e de neuroimagem.

Effects of multisensory and motor stimulation on the behavior of people with dementia.

A quasi-experimental study using a pre-posttest design was conducted in four aged care facilities to assess the effects of a person-centred care (PCC) multisensory stimulation (MSS) and motor stimulation (MS) program, implemented by direct care workers, on the behaviors of residents with dementia. Data were collected at baseline and after the intervention through video recordings of morning care routines. Forty-five residents with moderate and severe dementia participated in the study. A total of 266 morning care routines were recorded. The frequency and duration of a list of behaviors were analyzed. The frequency of engagement in task decreased significantly ( p = .002) however, its duration increased ( p = .039). The duration of gaze directed at direct care workers improved significantly ( p = .014) and the frequency of closed eyes decreased ( p = .046). There was a significant decrease in the frequency of the expression of sadness. These results support the implementation of PCC-MSS and MS programs as they may stimulate residents' behaviors.

Diagnóstico da demência frontotemporal: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia / Diagnosis of frontotemporal dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

RESUMO A "demência frontotemporal" (DFT) é uma síndrome clínica, cujo denominador comum é o acometimento focal dos lobos frontais e/ou temporais. A DFT tem três fenótipos clínicos distintos: a variante comportamental e dois subtipos linguísticos, a saber, a afasia progressiva primária não-fluente/agramática (APP-NF/A) e a afasia progressiva primária semântica (APP-S). A DFT é a segunda causa mais comum de demência em indivíduos com idade inferior a 65 anos, após a doença de Alzheimer. O presente artigo apresenta recomendações para diagnóstico da DFT no cenário brasileiro, considerando os três níveis de complexidade do sistema de saúde: atenção primária à saúde e níveis secundários. São propostos protocolos de investigação diagnóstica abrangendo testagem cognitiva, avaliação comportamental, avaliação fonoaudiológica, exames laboratoriais e de neuroimagem.

ABSTRACT "Frontotemporal dementia" (FTD) is a clinical syndrome characterized by the focal involvement of the frontal and/or temporal lobes. FTD has three clinical phenotypes: the behavioral variant and two linguistic subtypes, namely, non-fluent/agrammatic primary progressive aphasia (PPA-NF/A) and semantic PPA (PPA-S). FTD is the second most common cause of dementia in individuals under the age of 65 years. This article presents recommendations for the diagnosis of FTD in the Brazilian scenario, considering the three levels of complexity of the health system: primary health care, secondary and tertiary levels. Diagnostic guidelines are proposed, including cognitive testing, behavioral and language assessments, laboratory tests, and neuroimaging.

Advanced Activities of Daily Living (AADLs) and cognitive performance in community-dwelling elderly persons: Data from the FIBRA Study - UNICAMP / Atividades avançadas de vida diária (AAVDs) e o desempenho cognitivo em idosos residentes na comunidade: Dados do Estudo FIBRA Polo UNICAMP

Objective The aim of this study was to investigate the relationship between participation in advanced activities of daily living (AADLs) and cognitive performance in community-dwelling elderly persons. Method The data presented is drawn from the population-based study entitled Frailty Profile of Elderly Brazilians (FIBRA-Unicamp). The sample comprised 2,549 older adults without cognitive impairments suggestive of dementia. Data was collected relating to socio-demographic characteristics (sex, age, years of education and family income), health status (number of diseases and depressive symptoms), cognitive performance (Mini-Mental State Examination - MMSE) and self-reported social, physical and intellectual AADLs. Results Mean MMSE scores were significantly higher among men, younger individuals and those with more years of education, higher income, fewer diseases and fewer depressive symptoms. Multivariate linear regression analysis and hierarchical regression analysis showed that years of education, family income and participation in intellectual AADLs were positively associated with cognitive performance. Conclusion The findings suggest that these factors may have a protective role in cognitive aging and that participation in intellectual AADLs can represent a feasible strategy for the promotion of mental health among older adults.

Objetivo Investigar a relação entre o envolvimento em atividades avançadas de vida diária (AAVDs) e desempenho cognitivo em idosos residentes na comunidade. Método Os dados foram extraídos do estudo de base populacional intitulado Fragilidade em Idosos Brasileiros (FIBRA-UNICAMP). A amostra foi composta por 2.549 idosos sem comprometimento cognitivo sugestivo de demência. Foram coletadas informações sobre características sociodemográficas (gênero, idade, escolaridade e renda familiar), condições de saúde (número de doenças relatadas e sintomas depressivos), desempenho cognitivo (Miniexame do Estado Mental - MEEM) e AAVDs sociais, físicas e intelectuais autorrelatadas. Resultados Os escores médios do MEEM foram significativamente maiores entre os homens, os indivíduos mais jovens e aqueles que tinham maior escolaridade, maior renda, menos doenças e menos sintomas depressivos. As análises de regressão linear multivariada e análise de regressão hierárquica mostraram que mais anos de escolaridade, maior renda familiar e engajamento em AAVDs intelectuais foram associados positivamente com o desempenho cognitivo. Conclusão Os resultados sugerem que esses fatores podem ter um papel protetor no envelhecimento cognitivo e que o engajamento em AAVDs intelectuais pode representar uma estratégia viável para a promoção da saúde mental entre os idosos.

The Geriatric Anxiety Inventory in primary care: applicability and psychometric characteristics of the original and short form

Abstract Background Generalized anxiety disorder (GAD) has negative implications for people’s lives, but is often underdiagnosed in the elderly. There is a shortage of instruments to assess geriatric anxiety. Objectives To analyze the applicability and psychometric properties of the Portuguese version of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) within primary care. Methods Fifty-five seniors were classified as non-demented by a multidisciplinary panel. The protocol included the GAI, the Self-Reporting Questionnaire (SRQ-20), the Depression Scale D-10, Mini-Mental State Examination (MMSE), Bayer Scale for Activities of Daily Living (B-ADL) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A sub-sample also completed the Beck Anxiety Inventory (BAI). Results The GAI and GAI-SF showed good internal consistency (0.89; 0.62, respectively) and test-retest stability (0.58, 0.97). The GAI and GAI-SF correlated significantly with the SRQ-20 (0.74, 0.55) and BAI (0.75, 0.58). Discussion The psychometric characteristics of the Brazilian versions of the GAI and GAI-SF suggest these instruments are suitable for application in the Brazilian elderly population within the primary care setting.

Treino cognitivo e intervenção psicoeducativa para indivíduos hipertensos: efeitos na cognição / Cognitive training and educational intervention for individuals with hypertension: effects on cognition

OBJETIVOS: Avaliar a possibilidade de aliar o treino cognitivo à intervenção psicoeducativa de oito sessões sobre hipertensão visando melhor manejo desta condição crônica em idosos. MÉTODOS: Participaram 64 idosos que se declararam como hipertensos, divididos em grupo experimental (GE, n=35) e grupo controle (GC, n=29). O grupo controle recebeu treino após o pós teste. O protocolo incluiu dados sócio-demográficos e clínicos, o Mini-Exame do Estado Mental (MEEM), Escala de Depressão Geriátrica (EDG), Teste Comportamental de Memória de Rivermead (RBMT), Fluência Verbal categoria animais (FV) e Short Cognitive Test (SKT). RESULTADOS: Pôde-se observar que o GE apresentou melhor desempenho cognitivo, quando comparado ao GC, após a intervenção. CONCLUSÕES: Podem ocorrer ganhos cognitivos associados a uma intervenção psicoeducativa para idosos hipertensos.

OBJECTIVES: To evaluate the possibility of combining cognitive training to an educational intervention composed by eight sessions about hypertension for a better management of the disease among the elderly. METHODS: 64 older adults who reported having hypertension, divided into experimental group (EG, n=35) and control group (CG, n=29) participated in the study. Control participants received training after the post-test. The protocol contained socio-demographic and clinical data, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Rivermead Behavioral Memory Test (RBMT), Verbal Fluency Animal Category (VF) and Short Cognitive Test (SKT). RESULTS: The EG showed better cognitive performance when compared with the CG, at post-test. CONCLUSION: Cognitive gains may occur after psychoeducational interventions for older adults with hypertension.

Rede de suporte social de idosos do programa universidade aberta à terceira idade da escola de artes,ciências e humanidades da universidade de São Paulo / Social support network for senior open university program for senior college of arts, sciences and humanities, university of São Paulo, Brazil

O objetivo do estudo é descrever a rede de suporte social dos participantes da Universidade Aberta à Terceira Idade, da Escola de Artes Ciências e Humanidades da Universidade de São Paulo. Como material e método: o estudo foi de corte transversal, com uma população de 117 idosos. Os dados foram coletados utilizando-se um questionário sociodemográfico e o instrumento gráfico foi o Mapa Mínimo de Relações do Idoso (MMRI), que identifica o tamanho da rede de suporte social, estabelecendo índices de suporte social, a partir da frequência dos contatos recebidos, para as funções avaliadas: visita, companhia, auxílio para atividades domésticas, cuidados pessoais e auxílio financeiro. Participaram do estudo idosos que com este concordaram, assinando Termo de Consentimento Livre e Esclarecido. Os dados foram digitados no Programa Epidata e analisados estatisticamente no programa SPSS, versão 17.0. Como resultados: a maioria do sexo feminino (78%) casada (53%); aposentada (82%), com média de idade de 65,32 (DP=7,02). A predominância da rede de suporte social foi de tamanho médio, caracterizada por 16,80 (DP=4,48). Estratificados por faixa etária, os mais velhos possuíam menor tamanho de rede social e menor número de contatos sociais. Os idosos com união estável, em comparação aos solteiros, possuíam rede de suporte social maior. Correlacionando-se dados de idade, renda com suporte social, observou-se que, quanto maior a renda familiar, maior a rede de suporte social. Os achados mostraram que a rede de suporte social reduz-se com o processo de envelhecimento. Variáveis como renda e estado civil agem como fatores moduladores, colaborando para a manutenção ou o declínio da rede de relações.

The aim of the study is to describe the social support network of participants from the Third Age Open University, School of Arts, Sciences and Humanities of the University of Sao Paulo. Methods: The study was cross sectional, with a population of 117 elderly. Data were collected using a sociodemographic questionnaire and the instrument graphics Minimum Map of Elderly Affairs (MMRI), which identifies the size of the social support network, establishing levels of social support from the frequency of contacts received, for the functions assessed: visits, companionship, help in household chores, personal care and financial assistance. Seniors who participated in the study agreed with that by signing an informed consent and informed consent. Data were entered in the program Epidata and statistically analyzed using SPSS, version 17.0 Results: Most women (78%), married (53%), retired (82%) with mean age of 65.32 (SD = 7.02). Predominance of social support was of medium size, characterized by 16.80 (SD = 4.48). Stratified by age, older people had smaller social network and fewer social contacts. Elderly patients with stable compared to the unmarried, had larger social support network. Correlating data on age, income, social supports, it was observed that the higher family income, greater social support network. The results show that the social support decreases with the aging process. The variables of income and marital status factors act as modulators, contributing to the maintenance or decline of the network of relationships.

Ausência de relação entre hipertensão arterial sistêmica e desempenho cognitivo em idosos de uma comunidade / Lack of relationship between hypertension and cognitive performance in community dwelling older adults

CONTEXTO: Pesquisas documentam que a hipertensão arterial pode estar envolvida no declínio cognitivo em pacientes idosos. Estima-se que até 60 por cento dos idosos apresentem hipertensão arterial, tornando-os mais suscetíveis ao declínio cognitivo. OBJETIVO: Investigar a relação entre hipertensão arterial e desempenho cognitivo em idosos não portadores de demências ou depressão. MÉTODO: A amostra foi constituída por idosos participantes de pesquisa populacional em andamento sobre envelhecimento no município de Amparo (SP). Seguindo critérios de inclusão e exclusão, foram selecionados 80 homens e mulheres (40 hipertensos e 40 normotensos) com idade igual ou superior a 60 anos, equivalentes quanto às variáveis sociodemográficas e de saúde. Para avaliar sintomas depressivos, foi utilizada a Geriatric Depression Scale (GDS). Os testes cognitivos utilizados foram a bateria neuropsicológica Consortium to Establish a Registry for Alzheimer's Disease (CERAD) e o Teste do Desenho do Relógio e Dígitos ordem direta e inversa. A análise estatística foi realizada por meio de análise de regressão logística com modelo univariado e multivariado e análise de conglomerados (cluster analysis). RESULTADOS: Não foram encontradas diferenças estatisticamente significativas para as variáveis cognitivas entre os dois grupos. A diferença para fluência verbal aproximou-se da significância estatística (p = 0,075). CONCLUSÕES: Os resultados encontrados podem ser explicados pela adesão desta população pertencente à estratégia de saúde da família ao tratamento medicamentoso. Estudos longitudinais serão necessários para investigar a relação entre a hipertensão arterial e o declínio cognitivo na pessoa idosa.

BACKGROUND: Studies suggest that hypertension might be involved in cognitive decline among older adults. It is estimated that up to 60 percent of older adults have hypertension, what makes them more vulnerable to cognitive decline. OBJECTIVE: The objective of this study was to investigate the relationship between hypertension and cognitive performance in non-demented non-depressed older adults. METHOD: The sample was constituted by community dwelling older adults from an on-going epidemiological study which includes all senior citizens residing in Amparo (SP). Following inclusion and exclusion criteria, 80 seniors (40 diagnosed as having hypertension), including men and women over 60, were recruited. Both groups were equivalent as to socio-demographic and other health variables. In order to evaluate depressive symptoms the Geriatric Depression Scale (GDS) was used. The cognitive tests included the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery, the Clock Drawing Test, and Digit Span Forward and Backward. Logistic regression analyses with univariate and multivariate models and cluster analyses were carried out. RESULTS: No significant differences were found between the two groups. The difference for verbal fluency approached statistical significance (p = 0.075). DISCUSSION: Present results may be explained by the high compliance of the studied sample to the antihypertensive drug regimen. Longitudinal studies will be needed to continue to investigate the relationship between hypertension and cognition in aging.