Depression as a determinant of frailty in late life.

OBJECTIVES: Accumulating evidence shows depression as a risk factor for frailty, but studies are mainly population-based and widely differ in their assessment of either depression or frailty. We investigated the association between depression and frailty among geriatric outpatients using different assessment instruments for both conditions. METHOD: Among 315 geriatric outpatients (mean age 72.1 years, 68.3% female sex) participating the MiMiCS-FRAIL cohort study, major and subthreshold depression were measured with psychiatric diagnostic interview according to DSM-5 criteria (SCID-5) as well as with instruments to screen and measure severity of depressive symptoms (GDS-15 and PHQ-9). Frailty was assessed according to a screening instrument (FRAIL-BR) and a multidimensional Frailty Index (FI-36 items). Multiple logistic and linear regression were performed to assess the association between depression (independent variable) and frailty (dependent variable) adjusted for confounders. RESULTS: Frailty prevalence in patients with no, subthreshold or major depressive disorder increases from either 14.5%, 46.5% to 65.1% when using the FRAIL-BR questionnaire, and from 10.2%, 20.9%, to 30.2% when using the FI-36 index. These association remain nearly the same when adjusted for covariates. Both the FRAIL-BR and the FI-36 were strongly associated with major depressive disorder, subthreshold depression, and depressive symptoms by PHQ-9 and GDS-15. CONCLUSION: Late life depression and frailty are associated in a dose-dependent manner, irrespective of the used definitions. Nonetheless, to avoid residual confounding, future research on underlying biological mechanisms should preferably be based on formal psychiatric diagnoses and objectively assessment frailty status.

The "SuperAgers" construct in clinical practice: neuropsychological assessment of illiterate and educated elderly.

INTRODUCTION: The demographic transition is a global event intensified during the last decades that represents population aging. Thus, the studies directed to the elderly 80 years of age or more with preserved cognitive functions (named SuperAgers) emerges as a possible path to full comprehension of the health of those aging with acceptable levels of functionality and independency. OBJECTIVE: To evaluate the cognitive performance of the elderly over 80 years old, associating the results to their educational level. METHOD: We evaluated 144 healthy elders with 80 years or more through the following cognitive tests Mini-Mental State Examination (MMSE), Cambridge Cognitive Examination (CAMCOG), Clock Drawing Test (CDT), and Verbal Fluency Test (VF) and compared the tests' scores with their educational level segmented in years of formal education, being the groups ILLITR (<1 year of schooling), 1TO4 (from 1 to 4 years of schooling), and 5MORE (>5 years of schooling). RESULTS: There was positive influence of educational level on the cognitive tests' score, which indicates higher cognitive reserve of the elderly with higher educational levels. CONCLUSION: The functionality and independence of the so-called SuperAgers is determined by the cognitive reserve acquired throughout life, mainly developed by the years of formal education.

A subtest analysis of The Montreal Cognitive Assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer's disease?

The authors would like to apologise for a typographical error in the discussion of the above mentioned article. In the discussion on page 830 of the article, paragraph 'In the present sample, when we tested the accuracy of the MoCA to discriminate between MCI and healthy participants using ROC curves, the best cut-off score was 24 points, with good sensitivity and specificity ( 92% and 82%, respectively).' Should read: In the present sample, when we tested the accuracy of the MoCA to discriminate between MCI and healthy participants using ROC curves, the best cut-off score was 24 points, with good sensitivity and specificity (83% and 89%, respectively).

A subtest analysis of the Montreal cognitive assessment (MoCA): which subtests can best discriminate between healthy controls, mild cognitive impairment and Alzheimer's disease?

BACKGROUND: It is necessary to continue to explore the psychometric characteristics of key cognitive screening tests such as the Montreal Cognitive Assessment (MoCA) to diagnose cognitive decline as early as possible and to attend to the growing need of clinical trials involving mild cognitive impairment (MCI) participants. The main aim of this study was to assess which MoCA subtests could best discriminate between healthy controls (HC), participants with MCI, and Alzheimer's disease (AD). METHODS: Cross-sectional analysis of 136 elderly with more than four years of education. All participants were submitted to detailed clinical, laboratory, and neuroimaging evaluation. The MoCA, Mini-Mental State Examination (MMSE), the Cambridge Cognitive Examination (CAMCOG), Geriatric Depression Scale (GDS), and Functional Activities Questionnaire (FAQ) were applied to all participants. The MoCA test was not used in the diagnostic procedure. RESULTS: Median MoCA total scores were 27, 23 and 18 for HC, MCI, and AD, respectively (p < 0.001). Word repetition, inverse digits, serial 7, phrases, verbal fluency, abstraction, and word recall discriminated between MCI and HC participants (p < 0.001). The clock drawing, the rhino naming, delayed recall of five words and orientation discriminated between patients with MCI and AD (p < 0.001). A reduced version of the MoCA with only these items did not improve accuracy between MCI and HC (p = 0.076) or MCI and AD (p = 0.119). CONCLUSIONS: Not all MoCA subtests might be fundamental to clinical diagnosis of MCI. The reduced versions of MoCA did not add diagnostic accuracy.

Five Digit Test in neuropsychological assessment of working memory in aged individuals:normative data.

Five Digit Test (FDT) is an executive function assessment tool designed to be used across the lifespan, from children to the aged. Objective: To provide validity evidence for FDT in the neuropsychological assessment of working memory in the aged. Methods: A total of 100 subjects, aged between 56 and 86 years, representing both genders with varying levels of education, underwent a comprehensive clinical history and neuropsychological evaluation using FDT. The mean age of participants was 71.04 years, with 67.3% having intermediate education. Participants were categorized into two groups: Control Group and Cognitive Decline Group. To establish validity evidence, FDT scores (both time and errors) were correlated with the WAIS-III Digits scale. Spearman's correlation coefficient and ROC curve methodology were employed to determine psychometric properties. Results: A significant and moderate negative correlation was evident between FDT Shifting (number of errors) and Digits score (rho=-0.51; p<0.0001), Direct Order (rho=-0.39; p<0.0001), and Indirect Order (rho=-0.46; p<0.0001). The area under the curve was higher for FDT Shifting (errors) (AUC=0.935) for a cutoff point greater than or equal to 5 points, compared to Digits (AUC=0.748). Conclusion: The assessment of the number of errors in FDT Shifting appears to be a statistically significant tool for evaluating working memory impairment in the aged.

O Teste dos Cinco Dígitos (Five Digit Test ­ FDT) é um instrumento de função executiva para avaliação ao longo da vida, desde crianças até idosos. Objetivo: Apresentar evidências de validade para o FDT na avaliação neuropsicológica da memória operacional em idosos. Métodos: O total de 100 participantes, com idades entre 56 a 86 anos, de ambos os sexos, diferentes níveis de escolaridade, foi submetido a anamnese clínica detalhada e avaliação neuropsicológica por meio do FDT. A média de idade foi igual a 71,04 anos, 67,3% com escolaridade média. Os participantes foram divididos em dois grupos: Grupo Controle e com Declínio Cognitivo. Para verificar evidências de validade, os escores do FDT (tempo e erros) foram correlacionados ao subteste Dígitos da WAIS-III. O coeficiente de correlação de Spearman e a metodologia da Curva Receiver Operating Characteristic (ROC) foram utilizados para determinar as propriedades psicométricas. Resultados: Verificaram-se coeficientes de correlação negativa significativos e moderados entre o FDT Alternância (número de erros) e o escore do Dígitos (rho=-0,51; p<0,0001), Ordem Direta (rho=-0,39; p<0,0001) e Ordem Indireta (rho=-0,46; p<0,0001). A área sob a curva (AUC) apresentou-se no item FDT Alternância (número de erros) com maior valor (AUC=0,935) para um ponto de corte maior e igual a 5 pontos em comparação ao Dígitos (AUC=0,748). Conclusão: A avaliação do número de erros no item Alternância do FDT parece ser uma ferramenta estatisticamente significativa para avaliar o comprometimento da memória operacional em idosos.

Can the CAMCOG be a good cognitive test for patients with Alzheimer's disease with low levels of education?

BACKGROUND: The Cambridge Cognitive Examination (CAMCOG) is a useful test in screening for Alzheimer's disease (AD). However, the interpretation of CAMCOG cut-off scores is problematic and reference values are needed for different educational strata. Given the importance of earlier diagnoses of mild dementia, new cut-off values are required which take into account patients with low levels of education. This study aims to evaluate whether the CAMCOG can be used as an accurate screening test among AD patients and normal controls with different educational levels. METHODS: Cross-sectional assessment was undertaken of 113 AD and 208 elderly controls with heterogeneous educational levels (group 1: 1-4 years; group 2: 5-8 years; and group 3: ≥ 9 years) from a geriatric clinic. submitted to a thorough diagnostic evaluation for AD including the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). Controls had no cognitive or mood complaints. Sensitivity (SE) and specificity (SP) for the CAMCOG in each educational group was assessed with receiver-operator-characteristic (ROC) curves. RESULTS: CAMCOG mean values were lower when education was reduced in both diagnostic groups (controls - group 1: 87; group 2: 91; group 3: 96; AD - group 1: 63; group 2: 62; group 3: 77). Cut-off scores for the three education groups were 79, 80 and 90, respectively. SE and SP varied among the groups (group 1: 88.1% and 83.5%; group 2: 84.6% and 96%; group 3: 70.8% and 90%). CONCLUSION: The CAMCOG can be used as a cognitive test for patients with low educational level with good accuracy. Patients with higher education showed lower scores than previously reported.

Brief version of the CAMCOG for illiterate older adults with Alzheimer's dementia.

BACKGROUND: The Cambridge Cognition Examination (CAMCOG) is one of the most used cognitive assessment batteries for older adults. OBJECTIVE: To evaluate a brief version of the CAMCOG for illiterate older adults (CAMCOG-BILL) with Alzheimer's dementia (AD) and healthy controls (CG). METHODS: Cross-sectional case-control study with 246 illiterate older adults (AD [n=159] and CG [n=87], composed by healthy seniors without cognitive complaints) who never attended school or took reading or writing lessons. Diagnosis of AD was established based on the NIA-AA and DSM-5 criteria. All participants were assessed with the CAMCOG by a researcher blinded for diagnosis. To assess the consistency of the chosen CAMCOG-BILL sub-items, we performed a binary logistic regression analysis. RESULTS: Both the CAMCOG and the CAMCOG-BILL had satisfactory psychometric properties. The area under the curve (AUC) was 0.932 (p<0.001) for the original version of CAMCOG and 0.936 for the CAMCOG-BILL. Using a cut-off score of ≥60 (CAMCOG) and ≥44 (CAMCOG-BILL), both instruments had the same sensitivity and specificity (89 and 96%, respectively). CONCLUSION: The CAMCOG-BILL may be a preferred tool because of the reduced test burden for this vulnerable subgroup of illiterate patients with dementia.

Psychometric properties of Cognitive Instruments in Vascular Dementia and Alzheimer's disease: a neuropsychological study.

OBJECTIVES: To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer's disease (AD) patients, and vascular dementia (VD) patients. METHODS: We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis. RESULTS: Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT's scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT's scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility. CONCLUSION: A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.

Accuracy of praxis test from Cambridge Cognitive Examination (CAMCOG) for Alzheimer's disease: a cross-sectional study.

BACKGROUND: Praxis impairment may be one of the first symptoms manifested in dementia, primarily in cortical dementia. The Cambridge Cognitive Examination (CAMCOG) evaluates praxis, but little is known about the accuracy of CAMCOG for diagnosing dementia. The aims here were to investigate the accuracy of praxis and its subitems in CAMCOG (constructive, ideomotor and ideational subitems) for diagnosing Alzheimer's disease (AD) among elderly patients. DESIGN AND SETTING: Cross-sectional study on community-dwelling elderly people. METHODS: 158 elderly patients were evaluated. CAMCOG, Mini-Mental State Examination and Pfeffer Functional Activities Questionnaire were used. ROC curve analysis was used to establish cutoff points. RESULTS: The total scores for praxis and the constructive subitem presented significant differences (P < 0.0001) between healthy elderly people and AD patients. Stage of dementia (clinical dementia rating, CDR = 0, 1 and 2) showed that total and constructive praxis can be used to classify the stages of dementia (mild and moderate cases), i.e. constructive praxis classified 88% of the patients with mild dementia (P < 0.0001) while total praxis classified 56% with moderate dementia. Comparison of normal controls (NC) and mild dementia cases showed specificity of 71% and sensitivity of 88% (AUC = 0.88; P < 0.0001). CONCLUSION: Some praxis subtests can have higher predictive diagnostic value for detecting Alzheimer's disease in mild stages (total praxis AUC = 0.858; P < 0.0001; constructive AUC = 0.972; P < 0.0001). Constructive praxis as measured using CAMCOG may contribute towards diagnosing dementia, because occurrence of impairment of praxis may help in recognizing an evolving dementia syndrome.

Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia.

The Pentagon Drawing Test (PDT) is a common cognitive screening test. OBJECTIVE: The aim of this study was to evaluate performance properties of a specific PDT scoring scale in older adults with Alzheimer's disease (AD) and healthy controls. METHODS: A cross-sectional study of 390 elderly patients, aged 60 years or older with at least two years of education was conducted. All participants completed clinical and neuropsychological evaluations, including the Cambridge Cognitive Examination, the Mini-Mental State Examination (MMSE), and the Clock Drawing Test. All PDT were blindly scored with the scale of Bourke et al. RESULTS: PDT analyses of the binary score on the MMSE (0 or 1 point) did not discriminate AD from controls (p = 0.839). However, when PDT was analyzed using the Bourke et al. scale, the two groups could be distinguished (p <0.001). PDT was not affected by education, showed sensitivity of 85.5% and specificity of 66.9%, discriminated different clinical stages of dementia, and correlated with the other cognitive tests (p <0.001). A 1-point difference on the Bourke et al. scale was associated with an odds ratio of 3.46 for AD. CONCLUSION: PDT can be used as a cognitive screen for suspected cases of dementia, especially AD, irrespective of educational level.

O teste do desenho do pentágono (PDT) é um teste de rastreio cognitivo simples. OBJETIVO: O objetivo deste estudo foi avaliar o desempenho de uma escala específica de pontuação da PDT em idosos com doença de Alzheimer (DA) e controles saudáveis. MÉTODOS: Estudo transversal, com 390 idosos, com mais de 60 anos de idade, com pelo menos dois anos de escolaridade. Todos os participantes passaram por anamnese clínica e neuropsicológica, incluindo o Cambridge Cognitive Examination (CAMCOG), o Mini-Exame do Estado Mental (MEEM) e o Teste do Desenho do Relógio (TDR). A avaliação do PDT com a escala Bourke et al. foi feita de forma cega. RESULTADOS: As análises PDT do escore binário do MEEM (0 e 1 ponto) não discriminaram DA dos controles (p = 0,839). Contudo, quando PDT foi avaliada pela escala Bourke et al., verificou-se diferenças estatisticamente significativa (p <0,001). A PDT não sofreu interferência da escolaridade, apresentando sensibilidade de 85,5% e especificidade de 66,9% para discriminar os diferentes estágios clínicos da demência. A escala também mostrou correlação com os testes cognitivos aplicados (p <0,001). Uma diferença de um ponto na escala Bourke et al. foi associada com OR (odds ratio) de 3,46 para DA. CONCLUSÃO: PDT pode ser utilizada como rastreio cognitivo para casos suspeitos de demência, especialmente DA, independentemente.

Brazilian National Anthem presenting as musical hallucination: A case report with 9-year follow-up.

Musical hallucination is a type of complex auditory hallucination. Possible etiologies are deafness, psychiatric disorders such as schizophrenia, major depression, use of medication and stress, besides neurologic diseases including epilepsy, stroke and cancer. Uncommon etiologies encompass infectious diseases, metabolic disorders, and sensory deprivation. Although musical hallucinations have a major impact on patients' lives, they have been undervalued and understudied in the literature. We report a case of a 79-year-old woman with musical hallucination (hearing a sung National anthem) without cognitive impairment or hearing loss. The patient had preserved insight of her complaint and responded well to neuroleptics.

A alucinação musical é o um tipo de alucinação auditiva complexa. As etiologias possíveis são a perda auditiva, transtornos psiquiátricos tais como a esquizofrenia, depressão maior, uso de medicações e estresse, condições neurológicas como a epilepsia, acidente vascular encefálico e neoplasias. Etiologias menos frequentes englobam doenças infecciosas, metabólicas e endócrinas e privação sensorial. Apesar das alucinações musicais causarem grandes repercussões na vida dos pacientes sempre foram pouco valorizadas e estudadas na literatura. Relatamos o caso de uma senhora de 79 anos com alucinação musical (ouvia o hino nacional cantado), sem déficit cognitivo ou perda auditiva. A paciente tinha insight de seu problema e respondeu bem ao tratamento com neurolépticos.

Brief version of the CAMCOG for illiterate older adults with Alzheimer's dementia / Versão breve do CAMCOG para idosos analfabetos com doença de Alzheimer

Abstract Background: The Cambridge Cognition Examination (CAMCOG) is one of the most used cognitive assessment batteries for older adults. Objective: To evaluate a brief version of the CAMCOG for illiterate older adults (CAMCOG-BILL) with Alzheimer's dementia (AD) and healthy controls (CG). Methods: Cross-sectional case-control study with 246 illiterate older adults (AD [n=159] and CG [n=87], composed by healthy seniors without cognitive complaints) who never attended school or took reading or writing lessons. Diagnosis of AD was established based on the NIA-AA and DSM-5 criteria. All participants were assessed with the CAMCOG by a researcher blinded for diagnosis. To assess the consistency of the chosen CAMCOG-BILL sub-items, we performed a binary logistic regression analysis. Results: Both the CAMCOG and the CAMCOG-BILL had satisfactory psychometric properties. The area under the curve (AUC) was 0.932 (p<0.001) for the original version of CAMCOG and 0.936 for the CAMCOG-BILL. Using a cut-off score of ≥60 (CAMCOG) and ≥44 (CAMCOG-BILL), both instruments had the same sensitivity and specificity (89 and 96%, respectively). Conclusion: The CAMCOG-BILL may be a preferred tool because of the reduced test burden for this vulnerable subgroup of illiterate patients with dementia.

RESUMO Antecedentes: O Cambridge Cognition Examination (CAMCOG) é uma das baterias de avaliação cognitiva mais usadas para idosos. Objetivos: Avaliar uma versão breve do CAMCOG para idosos analfabetos (CAMCOG-BILL) com demência de Alzheimer (DA) em comparação com controles saudáveis não demenciados (GC). Métodos: Estudo caso-controle transversal com 246 idosos analfabetos (AD [n=159] e GC [n=87], composto por idosos saudáveis sem queixas cognitivas) que nunca frequentaram a escola ou fizeram aulas de leitura ou redação. O diagnóstico de DA foi estabelecido pelos critérios NIA-AA e DSM-5. Todos os participantes foram avaliados por meio do CAMCOG por avaliador cego, para o diagnóstico dos grupos. Para avaliar a consistência dos subitens escolhidos do CAMCOG-BILL, realizou-se uma análise de regressão logística binária. Resultados: Tanto o CAMCOG quanto o CAMCOG-BILL apresentaram propriedades psicométricas satisfatórias. A área sob a curva (AUC) foi de 0,932 (p<0,001) para a versão original do CAMCOG e de 0,936 para o CAMCOG-BILL. Usando-se uma pontuação de corte de ≥60 (CAMCOG) e ≥44 (CAMCOG-BILL), ambos os instrumentos tiveram a mesma sensibilidade e especificidade (89 e 96%, respectivamente). Conclusão: O CAMCOG-BILL pode ser preferido para reduzir a sobrecarga do teste para esse subgrupo vulnerável de pacientes analfabetos com demência.

Assessment for apraxia in mild cognitive impairment and Alzheimer's dise.

OBJECTIVE: To evaluate apraxia in healthy elderly and in patients diagnosed with Alzheimer's disease (AD) and Mild cognitive impairment (MCI). METHODS: We evaluated 136 subjects with an average age of 75.74 years (minimum 60 years old, maximum 92 years old) and average schooling of 9 years (minimum of 7 and a maximum of 12 years), using the Mini-Mental State examination (MMSE), Cambridge Cognitive Examination (CAMCOG) and the Clock Drawing Test. For the analysis of the presence of apraxia, eight subitems from the CAMCOG were selected: the drawings of the pentagon, spiral, house, clock; and the tasks of putting a piece of paper in an envelope; the correct one hand waiving "Goodbye" movements; paper cutting using scissors; and brushing teeth. RESULTS: Elder controls had an average score of 11.51, compared to MCI (11.13), and AD patients, whose average apraxia test scores were the lowest (10.23). Apraxia scores proved able to differentiate the three groups studied (p=0.001). In addition, a negative correlation was observed between apraxia and MMSE scores. CONCLUSION: We conclude that testing for the presence of apraxia is important in the evaluation of patients with cognitive impairments and may help to differentiate elderly controls, MCI and AD.

OBJETIVO: Avaliar apraxia em idosos saudáveis, com diagnóstico de doença de Alzheimer (DA) e Comprometimento Cognitivo Leve (CCL). MÉTODOS: Foram avaliados 136 indivíduos com uma idade média de 75,74 anos (mínimo de 60 anos de idade, máximo 92 anos) e escolaridade média de 9 anos (mínimo de 7 e máximo de 12 anos), por meio do Mini-exame do Estado Mental (MEEM), Cambridge Cognitive Examination (CAMCOG) e o teste do relógio. Para analisar a presença de apraxia, foram selecionados oito subitens do CAMCOG: os desenhos do Pentágono, da espiral, da casa, do relógio, e também a tarefa de colocar um pedaço de papel em um envelope e os movimentos corretos com uma mão para dar "adeus", cortar papel com uma tesoura e escovar os dentes. RESULTADOS: Idosos saudáveis sem alterações cognitivas apresentaram média de 11,51, em comparação com CCL (11,13), e DA o qual apresentou pior média no teste de apraxia (10.23). O subteste de apraxia diferenciou os três grupos diagnósticos (p=0,001). Observou-se uma correlação negativa entre os escores de apraxia e os do MEEM. CONCLUSÃO: Conclui-se que a investigação da presença de apraxia é importante na avaliação cognitiva de pacientes com comprometimento cognitivo e pode ser útil em diferenciar controles idosos, indivíduos com CCL e com DA.

Psychometric properties of Cognitive Instruments in Vascular Dementia and Alzheimer's disease: a neuropsychological study

OBJECTIVES: To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer's disease (AD) patients, and vascular dementia (VD) patients. METHODS: We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis. RESULTS: Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT's scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT's scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility. CONCLUSION: A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.

Comparison of the diagnostic accuracy of neuropsychological tests in differentiating Alzheimer's disease from mild cognitive impairment: can the montreal cognitive assessment be better than the cambridge cognitive examination?

OBJECTIVE: Considering the lack of studies on measures that increase the diagnostic distinction between Alzheimer's disease (AD) and mild cognitive impairment (MCI) and on the role of the Cambridge Cognitive Examination (CAMCOG) in this, our study aims to compare the utility of the CAMCOG, Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in helping to differentiate AD from MCI in elderly people with >4 years of schooling. METHOD: A total of 136 elderly subjects - 39 normal controls as well as 52 AD patients and 45 MCI patients treated at the Institute of Geriatrics and Gerontology, Porto Alegre, Brazil - were assessed using the MMSE, CAMCOG, clock drawing test (CDT), verbal fluency test (VF), Geriatric Depression Scale and Pfeffer Functional Activities Questionnaire. RESULTS: The results obtained by means of a receiver operating characteristic curve showed that the MoCA is a better screening test for differentiating elderly subjects with AD from those with MCI than the CAMCOG and MMSE as well as other tests such as the CDT and VF. CONCLUSION: The MoCA, more than the CAMCOG and the other tests, was shown to be able to differentiate AD from MCI, although, as Roalf et al. [Alzheimers Dement 2013;9:529-537] pointed out, further studies might lead to measures that will improve this differentiation.

Cognitive abilities screening instrument-short form, mini-mental state examination and functional activities questionnaire in the illiterate elderly.

Dementia prevalence is increasing in developing countries due to population aging. Brief tests for assessing cognition and activities of daily living are very useful for the diagnosis of dementia by the clinician. Low education, particularly illiteracy, is a hindrance to the diagnosis of dementia in several regions of the world. OBJECTIVES: To compare the Brazilian version of the Cognitive Abilities Screening Instrument-Short Form (CASI-S) with the Mini-Mental State Examination (MMSE) and Pfeffer Functional Activities Questionnaire (PFAQ) for the diagnosis of dementia in illiterate elderly. METHODS: A cross-sectional study with illiterate elderly of both genders seen at the outpatient clinics of the Institute of Gerontology and Geriatrics Jundiaí, São Paulo state was performed. Spearman's correlation coefficient was used to correlate CASI-S, MMSE and PFAQ scores. RESULTS: The sample comprised 29 elderly over 57 years old whose mean scores on the CASI-S (scores ranging from 3 to 23) and the MMSE (scores ranging from 2 to 23) were 11.69 and 12.83, respectively. There was a strong significant correlation between the CASI-S and MMSE (r=0.75, p<0.001) and a moderate correlation coefficient that was significant and negative between the PFAQ and CASI-S (r= -0.53 p=0.003),similar to that between the MMSE and PFAQ (r= -0.41 p=0.025). CONCLUSION: The Brazilian version of the CASI-S demonstrates ease of application and correction in the illiterate elderly, and warrants further studies regarding its applicability for the diagnosis of dementia in populations with a heterogeneous educational background.

A prevalência de demência está aumentando nos países em desenvolvimento, devido ao envelhecimento da população. Testes breves para a avaliação da cognição e atividades de vida diária são muito úteis para o diagnóstico de demência pelo médico. Baixa escolaridade, especialmente analfabetismo, é um obstáculo para o diagnóstico de demência em diversas regiões do mundo. OBJETIVOS: Comparar a versão brasileira do teste Casi-S com o Mini Exame do Estado Mental (MMSE) e Questionário de Atividades Funcionais de Pfeffer (QAFP) para o diagnóstico de demência de analfabetos idosos. MÉTODOS: Estudo de corte transversal, com idosos de ambos os sexos, analfabetos, atendidos no Instituto de Geriatria e Gerontologia do município de Jundiaí, São Paulo. Foi utilizado o coeficiente de correlação de Spearman. RESULTADOS: A amostra foi composta por 29 idosos analfabetos, com médias de escore no Casi-S e no MEEM de 11,69 (variando de 3 a 23 pontos) e 12,83 (variando entre 2 a 23 pontos), respectivamente. Observou-se uma correlação forte e significativa entre o Casi-S e o MEEM (r=0,75; p<0,001) e um coeficiente de correlação moderado, significativo e negativo entre o Casi-S e o QAFP (r= ­0,53; p=0,003), o que foi semelhante ao observado entre o MEEM e o QAFP (r= ­0.41 p=0.025). Nota-se, portanto, uma correlação importante entre o MEEM e o Casi-S e valores moderados e significativos entre o desempenho cognitivo e o comprometimento nas atividades de vida diária. CONCLUSÃO: Observa-se que o Casi-S é um teste de fácil aplicação e correção, e que merece mais estudos sobre sua aplicabilidade no diagnóstico de demência em populações com heterogeneidade educacional.

Working Memory and Executive Functions in Parkinson's disease after intervention with non-immersive virtual reality / Memória Operacional e Funções Executivas na doença de Parkinson: desempenho após intervenção com realidade virtual / Memoria Operativa y Funciones Ejecutivas en la enfermedad de Parkinson: desempeño tras intervención con realidad virtual

To analyze Working Memory (WM) and Executive Function (EF) scores after and before intervention with non-immersive virtual reality in patients with Parkinson's disease (PD). Longitudinal study, with 13 subjects, of both sexes. Fourteen sessions of interventions based on Nintendo games. Cognitive functions were assessed using the Cambridge Cognitive Examination (CAMCOG). Statistical analysis of Wilcoxon was used to compare the performance of WM and EF scores before and after intervention. Results: Improvement in EF and VF scores after intervention was observed with statistically significant differences p= 0.004 and p=0.037, respectively. There were no differences between the interventions for WM scores (p= 0.609). Conclusion: Training with virtual games is suggested as a therapeutic approach that offers cognitive stimulation that improve EF.

Analisar os escores da Memória Operacional (MO) e Funções Executivas (FE), antes e depois da intervenção com realidade virtual, em pacientes com doença de Parkinson (DP). Estudo longitudinal com 13 participantes, de ambos os sexos. Quatorze sessões de intervenção através de jogos do Nintendo. As funções cognitivas foram avaliadas por meio do Cambridge Cognitive Examination (CAMCOG). As análises estatísticas foram realizadas por meio da prova de Wilcoxon, para comparar o desempenho da MO e FE, antes e depois das intervenções. Os resultados mostraram uma melhora nos escores de FE e FV, após a intervenção com diferenças estatisticamente significativas de p= 0,004 e p=0.037, respectivamente. Não foram encontradas diferenças estatisticamente significativas entre os escores de MO (p=0,609). Treinamentos por meio de realidade virtual podem contribuir com uma abordagem terapêutica que ofereça estimulação cognitiva que melhora funções executivas.

Analizar los escores de la Memoria Operativa (MO) y las Funciones Ejecutivas (FE), antes y después de la intervención con realidad virtual, en pacientes con enfermedad de Parkinson (DP). Estudio longitudinal con 13 participantes, de ambos sexos. Catorce sesiones de intervención a través de juegos de Nintendo. Las funciones cognitivas se evaluaron a través del Cambridge Cognitive Examination (CAMCOG). Los análisis estadísticos se realizaron a través de la prueba de Wilcoxon, para comparar el desempeño de la MO y FE, antes y después de las intervenciones. Los resultados mostraron una mejora en los escores de FE y FV, después de la intervención con diferencias estadísticamente significativas de p = 0,004 y p = 0.037, respectivamente. No se encontraron diferencias estadísticamente significativas entre los escores de MO (p = 0,609). Los entrenamientos a través de la realidad virtual pueden contribuir con un enfoque terapéutico que ofrezca estimulación cognitiva que mejora las funciones ejecutivas.

Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia / Desempenho do teste do desenho do pentágono para rastreio de idosos com demência de alzheimer

ABSTRACT. The Pentagon Drawing Test (PDT) is a common cognitive screening test. Objective: The aim of this study was to evaluate performance properties of a specific PDT scoring scale in older adults with Alzheimer's disease (AD) and healthy controls. Methods: A cross-sectional study of 390 elderly patients, aged 60 years or older with at least two years of education was conducted. All participants completed clinical and neuropsychological evaluations, including the Cambridge Cognitive Examination, the Mini-Mental State Examination (MMSE), and the Clock Drawing Test. All PDT were blindly scored with the scale of Bourke et al. Results: PDT analyses of the binary score on the MMSE (0 or 1 point) did not discriminate AD from controls (p = 0.839). However, when PDT was analyzed using the Bourke et al. scale, the two groups could be distinguished (p <0.001). PDT was not affected by education, showed sensitivity of 85.5% and specificity of 66.9%, discriminated different clinical stages of dementia, and correlated with the other cognitive tests (p <0.001). A 1-point difference on the Bourke et al. scale was associated with an odds ratio of 3.46 for AD. Conclusion: PDT can be used as a cognitive screen for suspected cases of dementia, especially AD, irrespective of educational level.

RESUMO. O teste do desenho do pentágono (PDT) é um teste de rastreio cognitivo simples. Objetivo: O objetivo deste estudo foi avaliar o desempenho de uma escala específica de pontuação da PDT em idosos com doença de Alzheimer (DA) e controles saudáveis. Métodos: Estudo transversal, com 390 idosos, com mais de 60 anos de idade, com pelo menos dois anos de escolaridade. Todos os participantes passaram por anamnese clínica e neuropsicológica, incluindo o Cambridge Cognitive Examination (CAMCOG), o Mini-Exame do Estado Mental (MEEM) e o Teste do Desenho do Relógio (TDR). A avaliação do PDT com a escala Bourke et al. foi feita de forma cega. Resultados: As análises PDT do escore binário do MEEM (0 e 1 ponto) não discriminaram DA dos controles (p = 0,839). Contudo, quando PDT foi avaliada pela escala Bourke et al., verificou-se diferenças estatisticamente significativa (p <0,001). A PDT não sofreu interferência da escolaridade, apresentando sensibilidade de 85,5% e especificidade de 66,9% para discriminar os diferentes estágios clínicos da demência. A escala também mostrou correlação com os testes cognitivos aplicados (p <0,001). Uma diferença de um ponto na escala Bourke et al. foi associada com OR (odds ratio) de 3,46 para DA. Conclusão: PDT pode ser utilizada como rastreio cognitivo para casos suspeitos de demência, especialmente DA, independentemente.

Clock drawing test in elderly individuals with different education levels: correlation with clinical dementia rating.

OBJECTIVE: The aim of this study was to describe the performance in Clock Drawing Test (CDT) of the elderly individuals assessed in a geriatric clinic, with at least 1 year of schooling, comparing with other groups with higher education and with Clinical Dementia Rating (CDR) levels. The study also aims to correlate the results of CDT and other used diagnostic tests for dementia by CDR levels, providing additional validity evidence to the CDT. METHODS: Cross-sectional study with 426 elderly individuals, >60 years old and at least 1 year of education. All participants searched for medical assistance at Geriatric and Gerontology Ambulatory of Jundiaí city, in Brazil. The community-dwelling outpatients previously undergone a detailed clinical examination and neuropsychological evaluation: Cambrigde Cognitive Examination (CAMCOG), Mini-Mental State Examination (MMSE), andCDT. To differentiate data from diagnostic groups based on CDR, it Kruskal-Wallis test was used. Pearson statistics were calculated to compare data from CDT and CDR. The statistical analyses were 2-tailed and were considered significant when P < .05. RESULTS: Regarding CDT, groups with more years of schooling showed similar means in CDR = 0 and CDR = 0.5 and in CDR = 1 and CDR = 2. Shulman and Sunderland scale were high score in groups with more years of education and above of cutoff points in all CDT score. On the contrary, in Mendez scale we did not observed similar means. Otherwise, in the group with less years of schooling greater means differences in the CDT were observed. CONCLUSION: The CDT did not show a strong correlation with MMSE and CAMCOG, both important instruments in Brazilian population to investigate dementia. For elderly individuals with high education levels, the CDT did not seem to be a good test to detect cognitive impairment.

Tumor primário de pulmão simulando doença de Alzheimer: relato de caso / Primary lung tumor simulating Alzheimer's disease: case report

RESUMO Retratamos o relato de um homem de 61 anos que apresentava um glioblastoma multiforme em região do giro têmporo-occipital lateral esquerdo que rechaça cranialmente o hipocampo e o corno temporal do ventrículo lateral correspondente. Não havia sinais e sintomas neurológicos e o quadro clínico lembrava a demência de Alzheimer. Havia comprometimento de memória e alterações comportamentais com duração de três meses. Foram afastadas inicialmente outras causas de demência rapidamente progressivas e a ressonância magnética revelou a etiologia tumoral dos sintomas neuropsiquiátricos. Foi submetido à bateria de testes neuropsicométricos com pontuação compatível com doença de Alzheimer (DA). Em razão de extensa área de edema, foi introduzida dexametasona com reversão completa dos sintomas neuropsiquiátricos iniciais e a repetição da bateria neuropsicológica mostrou melhora acentuada em todos os testes. Optou-se por tratamento conservador, após biópsia por agulha, com evolução para óbito em cinco meses.

ABSTRACT We report a 61-year-old man case who presented a multiform glioblastoma located at the left side of the temporal-occiptal gyrus that reached the hippocampus cranially and the temporal horn of the left lateral ventriculus. There were no neurological signs and symptoms and the clinical picture reminded the Alzheimer’s dementia. Memory impairment and behavioral alterations were observed during three months. Other causes of rapid progressive dementia were initially discarded and the magnetic resonance revealed a tumoral etiology for the neuropsychiatric symptoms. A battery of neuropsychometric tests were applied, with a score similar to AD. Due to the extensive edema’s area, dexamethasone was introduced with complete reversal of the neuropsychiatric initial symptoms and the repetition of the neuropsychological battery showed a noticeable improvement in all the tests. A conervative treatment was chosen, after needle biopsy, evolving to death in five months.