Accuracy of the semantic fluency test to separate healthy old people from patients with Alzheimers disease in a low education population / Acurácia do teste de fluência semântica para separar pessoas saudáveis de pacientes com doença de Alzheimer em uma população de baixa escolaridade

OBJECTIVE: Evaluate the accuracy of two semantic categories of the verbal fluency test (supermarket and animal categories) to separate healthy elderly individuals and lower educated Alzheimer's disease patients. METHODS: We evaluated 69 older adults with less than 5 years of schooling, consisting of 31 healthy elderly, and 38 patients diagnosed with Alzheimer's disease. Semantic verbal fluency was evaluated using the animal and supermarket categories. Mann-Whitney U and Independent t Tests were used to compare the two groups, and the diagnostic accuracy of the tests was analyzed by sensitivity, specificity, likelihood ratio's, and the Area Under the Curve (AUC). RESULTS: We found a significant difference between the healthy older and Alzheimer's disease groups, in both, animal (p = 0.014) and supermarket verbal fluency (p < 0.001). The supermarket category showed better overall diagnostic accuracy (AUC = 0.840, 95% CI = 0.746-0.933; p < 0.001) compared to the animal category (AUC = 0.671, 95% CI = 0.543-0.800; p = 0.014). CONCLUSION: The supermarket category of semantic verbal fluency provides better accuracy than the animal category for the identification of dementia in a Brazilian elderly population with low educational level.

OBJETIVO: Avaliar a acurácia de duas categorias semânticas do teste de fluência verbal (categorias de supermercado e animal) para separar idosos saudáveis e pacientes com doença de Alzheimer com baixa escolaridade. MÉTODOS: Avaliamos 69 idosos com menos de 5 anos de escolaridade, consistindo em 31 idosos saudáveis e 38 pacientes diagnosticados com a doença de Alzheimer. A fluência verbal semântica foi avaliada nas categorias animal e supermercado. O teste de Mann-Whitney U e o teste t independente foram usados para comparar os dois grupos, e a precisão diagnóstica dos testes foi analisada por sensibilidade, especificidade, razão de verossimilhança e área sob a curva (AUC). RESULTADOS: Encontramos uma diferença significativa entre os grupos de idosos saudáveis e com doença de Alzheimer, tanto na fluência verbal de animais (p = 0,014) quanto na de supermercado (p < 0,001). A categoria supermercado apresentou melhor precisão diagnóstica geral (AUC = 0,840; IC 95% = 0,746- 0,933; p < 0,001) em comparação com a categoria animal (AUC = 0,671; IC 95% = 0,543-0,800; p = 0,014). CONCLUSÃO: A categoria supermercado de fluência verbal semântica fornece melhor acurácia do que a categoria animal para a identificação de demência em uma população idosa brasileira com baixo nível educacional.

Dual task in healthy elderly, depressive and Alzheimer's disease patients / Dupla tarefa em idosos saudáveis, depressivos e pacientes com doença de Alzheimer

ABSTRACT Objective To investigate whether the DT performance can be affected by the diagnosis of major depressive disorder (MDD) and Alzheimer's disease (AD). Methods Cross-sectional data with 108 individuals [Healthy (HE) = 56, MDD =19, AD = 33] aged 60 and older of both sexes diagnosis with AD, MDD, and HE without a clinical diagnosis of mental disorders, residents of the city of Rio de Janeiro. DT performance, was measured by mean velocity (m/s), DT cost and the number of evoked words (DTanimals). One-way ANOVA was used to compare groups. In addition, a logistic regression was used to verify the association between the performance in the DT variables and the risk of MD and AD, controlled by age and scholarity. Results There was a significant difference between the HE and AD groups in the DT variables. The worst performance in the DTC and DTanimals variables increased risk of AD, regardless of age and scholarity (DTC, OR = 5.6, 95% CI = 1.4-22.2, p = 0.01 and DTanimals, OR = 3.6, 95% CI = 0.97-14.0, p = 0.05). Conclusion The ability to perform two tasks simultaneously appears to be impaired in patients with Alzheimer's disease, and unaffected by the major depressive disorder.

RESUMO Objetivo Avaliar o quanto o desempenho em dupla tarefa pode ser afetado pelo diagnóstico do transtorno depressivo maior (TDM) e pela doença de Alzheimer (DA). Métodos Estudo de corte transversal com 108 indivíduos [Saudáveis (IS) = 56, TDM = 19, DA = 33] com 60 anos ou mais, de ambos os sexos, diagnosticados com doença de Alzheimer, transtorno depressivo maior e sem diagnóstico de doenças mentais, residentes na cidade do Rio de Janeiro. O desempenho em DT foi avaliado pela velocidade média (m/s), custo da dupla tarefa (CDT) e número de animais evocados por segundo (DTanimais). ANOVA one-way foi feita para a comparação dos grupos. Além disso, foi utilizada uma regressão logística para verificar a associação entre o desempenho nas variáveis em DT e o risco de TDM e DA, controlado pela idade e escolaridade. Resultados Houve diferença significativa entre os grupos IS e DA nas variáveis em DT. O pior desempenho no CDT e no número de animais evocados em DT aumentou o risco de DA, independentemente da idade e escolaridade (CDT, OR = 5,6, IC de 95% = 1,4-22,2, p = 0,01 e DTanimals, OR = 3,6, IC de 95% = 0,97-14,0, p = 0,05). Conclusão A capacidade de realizar duas tarefas de forma simultânea parece ser prejudicada em pacientes com doença de Alzheimer e não afetada em pacientes com TDM.

Atendimento odontológico domiciliar ao idoso e a necessidade de tratamento endodôntico / The home dental care to elderly and the need for endodontic treatment

O objetivo deste trabalho foi realizar um estudo transversal dos pacientes atendidos pelo Serviço Integrado de Atendimento Domiciliar do Hospital Naval Marcílio Dias e relatar a necessidade que eles apresentam de tratamento endodôntico. Duzentos e setenta e cinco pacientes foram avaliados através de exame clínico (visual-tátil), sendo avaliada a presença ou ausência de dentes e a necessidade de intervenção. Assim, os pacientes foram divididos em três grupos: grupo indicado para extração, outro para Endodontia e restauração e um terceiro para extração e Endodontia em elementos dentários diferentes. Os dados da avaliação odontológica foram levantados e os percentuais avaliados.

The aim of this study was a cross-sectional study of patients seen by the Integrated Home Care Service, linked to the Hospital Naval Marcílio Dias and the need they have of endodontic treatment. Were evaluated by clinical examination (visual-tactile) 275 patients. These patients were divided into three groups, extraction was indicated, designated endodontics and subsequent restoration and indicated extraction and endodontics in different dental elements. The dental evaluation data were collected and evaluated percentage.

Impaired cognition in depression and Alzheimer (AD): a gradient from depression to depression in AD.

OBJECTIVE: To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. METHOD: Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. RESULTS: We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. CONCLUSION: A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position.

Impaired cognition in depression and Alzheimer (AD): a gradient from depression to depression in AD / Alterações cognitivas na depressão e na doença de Alzheimer: um gradiente da depressão até a doença de Alzheimer

Objective To assess cognition in major depressed (MD), Alzheimer's disease (AD), and depression in AD elderly. Method Subjects were evaluated by Mini Mental, Rey Auditory Verbal Learning Test, Rey Complex Figure, Digit Span, Similarities, Trail Making A/B, Verbal Fluency and Stroop. One-way ANOVA and multivariate models were used to compare the performance of each group on neuropsychological tests. Results We evaluated 212 subjects. Compared to MD, attention, working memory, processing speed and recall showed significantly better in controls. Controls showed significantly higher performance in all cognitive measures, except in attention compared to AD. Verbal fluency, memory, processing speed and abstract reasoning in MD was significantly higher compared to AD. AD was significantly better in general cognitive state than depression in AD. All other cognitive domains were similar. Conclusion A decreasing gradient in cognition appeared from the control to depression in AD, with MD and AD in an intermediate position. .

Objetivo Avaliar a cognição em idosos com depressão Maior (DM), doença de Alzheimer (DA) e Depressão na DA. Método Utilizou-se o Mini Mental, Rey Auditory Verbal Learning Test, Figura de Rey, Dígitos, Semelhanças, Trail Making A/B, Fluência Verbal e Stroop. ANOVA one-way e modelos multivariados foram utilizados para comparar o desempenho dos grupos. Resultados Foram avaliados 212 sujeitos. Comparado com DM, controles apresentaram desempenho significativamente melhor na atenção, memória de trabalho, velocidade de processamento e evocação. Os controles apresentaram desempenho significativamente superior em todas as avaliações, exceto na atenção comparado com DA. Fluência verbal, memória, velocidade de processamento e raciocínio abstrato na DM foi significativamente maior comparado com DA. DA foi significativamente melhor no estado cognitivo geral comparado a depressão na DA, os outros domínios foram semelhantes. Conclusão Observou-se um gradiente decrescente na cognição dos controles até a Depressão na DA, com os grupos DM e DA com desempenhos intermediários. .

Treadmill training as an augmentation treatment for Alzheimer's disease: a pilot randomized controlled study.

OBJECTIVE: To assess the effect of aerobic exercise on the cognition and functional capacity in Alzheimer's disease (AD) patients. METHOD: Elderly (n=20) with mild dementia (NINCDS-ADRDA/CDR1) were randomly assigned to an exercise group (EG) on a treadmill (30 minutes, twice a week and moderate intensity of 60% VO2max) and control group (GC) 10 patients. The primary outcome measure was the cognitive function using Cambridge Cognitive Examination (CAMCOG). Specifics instruments were also applied to evaluate executive function, memory, attention and concentration, cognitive flexibility, inhibitory control and functional capacity. RESULTS: After 16 weeks, the EG showed improvement in cognition CAMCOG whereas the CG declined. Compared to the CG, the EG presented significant improvement on the functional capacity. The analysis of the effect size has shown a favorable response to the physical exercise in all dependent variables. CONCLUSION: Walking on treadmill may be recommended as an augmentation treatment for patients with AD.

Treadmill training as an augmentation treatment for Alzheimers disease: a pilot randomized controlled study / Treinamento na esteira como um tratamento adicional para a doenca de Alzheimer: estudo piloto controlado randomizado

Objective To assess the effect of aerobic exercise on the cognition and functional capacity in Alzheimer’s disease (AD) patients. Method Elderly (n=20) with mild dementia (NINCDS-ADRDA/CDR1) were randomly assigned to an exercise group (EG) on a treadmill (30 minutes, twice a week and moderate intensity of 60% VO2max) and control group (GC) 10 patients. The primary outcome measure was the cognitive function using Cambridge Cognitive Examination (CAMCOG). Specifics instruments were also applied to evaluate executive function, memory, attention and concentration, cognitive flexibility, inhibitory control and functional capacity. Results After 16 weeks, the EG showed improvement in cognition CAMCOG whereas the CG declined. Compared to the CG, the EG presented significant improvement on the functional capacity. The analysis of the effect size has shown a favorable response to the physical exercise in all dependent variables. Conclusion Walking on treadmill may be recommended as an augmentation treatment for patients with AD. .

Objetivo Avaliar o efeito do exercício aeróbio na cognição e na capacidade funcional em pacientes com Doença de Alzheimer (DA). Método Idosos (n=20) com demência leve ((NINCDS-ADRDA/CDR1) foram randomizados em grupo exercício (GE) na esteira (30 minutos, 2 vezes por semana e intensidade moderada de 60% VO2max)e grupo controle (GC) 10 pacientes. A medida principal foi a função cognitiva através do Cambridge Cognitive Examination (CAMCOG). Instrumentos específicos também foram aplicados para avaliar a função executiva, atenção e concentração, flexibilidade cognitiva, controle inibitório e capacidade funcional. Resultados Após 16 semanas, o GE mostrou melhora na cognição CAMCOG enquanto o CG declinou. Comparado ao GC, o GE apresentou melhora significativa na capacidade funcional. A análise do tamanho de efeito mostrou resposta favorável do exercício físico em todas as variáveis dependentes. Conclusão Caminhar na esteira pode ser recomendado como um tratamento adicional para pacientes com doença de Alzheimer. .

Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease.

OBJECTIVE: To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III). METHOD: Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r² =0.30; p=0.005) and executive function (r² =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r² =0.27; p=0.010) and global cognitive status (r² =0.24; p=0.024). CONCLUSION: The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD.

Muscle strength and executive function as complementary parameters for the assessment of impairment in Parkinson's disease / Forca muscular e funcao executiva como parametros complementares para a avaliacao do comprometimento da doenca de Parkinson

Objective To evaluate the relationship between the quantitative results of functional and cognitive performance of patients with Parkinson's disease (PD) and disease severity; and to study the relationship between patients' functional and cognitive capacity and motor impairment (Unified Parkinson's Disease Rating Scale - UPDRS III). Method Twenty-nine subjects clinically diagnosed with PD were classified into three groups according to disease severity using the modified Hoehn and Yahr Scale (H&Y). They were submitted to functional (Senior Fitness Test) and neuropsychological tests. Stepwise regression analysis showed a significant association between H&Y and upper limb strength (r 2 =0.30; p=0.005) and executive function (r 2 =0.37; p=0.004). In relation to UPDRS III, there was a significant association between lower limb strength (r 2 =0.27; p=0.010) and global cognitive status (r 2 =0.24; p=0.024). Conclusion The implementation of simple tests of functional capacity associated with neuropsychological testing can help to assess disease severity and motor impairment, and can be used to monitor the response to treatment in PD. .

Objetivo Avaliar a relação entre resultados quantitativos do desempenho funcional e cognitivo de pacientes com doença de Parkinson (DP) e a gravidade da doença; estudar a relação entre a capacidade funcional e cognitiva dos pacientes e o comprometimento motor (Unified Parkinson's Disease Rating Scale - UPDRS III). Método Vinte e nove sujeitos diagnosticados clinicamente com DP foram classificados em três grupos de acordo com a gravidade da doença através da Escala de Hoehn & Yahr (H&Y) modificada, e submetidos a testes funcionais (Senior Fitness Test) e neuropsicológicos. As análises de regressão Stepwise mostraram associação significativa entre a gravidade da doença e a força de membros superiores (r 2 =0,30; p=0,005) e a função executiva (r 2 =0,37; p=0,004). Em relação ao comprometimento motor, houve associação significativa com a força de membros inferiores (r 2 =0,27; p=0,010) e com o estado cognitivo global (r 2 =0,24; p=0,024). Conclusão Testes simples de capacidade funcional associados a testes neuropsicológicos podem contribuir para a avaliação da gravidade e do comprometimento motor e podem ser utilizados para o acompanhamento da resposta ao tratamento da DP. .

Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression.

OBJECTIVE: To compare verbal fluency among Alzheimer's disease, Parkinson's disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity. METHODS: Patients from an outpatient university center with a clinical diagnosis of Alzheimer's disease, Parkinson's disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinson's disease, major depression, and Alzheimer's disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals). We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model. RESULTS: The mean digit span and verbal fluency scores were lower in patients with Alzheimer's disease (n = 34) than in patients with major depression (n = 52) or Parkinson's disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimer's disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinson's disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinson's disease groups listed 44% (ROM = 1.44) and 48% (ROM = 1.48) more words, respectively, compared to those patients with Alzheimer's disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26% (ROM = 0.74) reduction in the number of words listed when compared to mild cases. CONCLUSIONS: Verbal fluency provides a better characterization of Alzheimer's disease, major depression, and Parkinson's disease, even at later stages.

Verbal fluency in Alzheimer's disease, Parkinson's disease, and major depression

OBJECTIVE: To compare verbal fluency among Alzheimer's disease, Parkinson's disease, and major depression and to assess the sociodemographic and clinical factors associated with the disease severity. METHODS: Patients from an outpatient university center with a clinical diagnosis of Alzheimer's disease, Parkinson's disease or major depression were studied. Severity was staged using the Hoehn & Yahr scale, the Hamilton Depression scale and the Clinical Dementia Rating for Parkinson's disease, major depression, and Alzheimer's disease, respectively. All subjects were tested with the Mini-Mental State Examination, the digit span test, and the verbal fluency test (animals). We fit four types of regression models for the count variable: Poisson model, negative binomial model, zero-inflated Poisson model, and zero-inflated negative binomial model. RESULTS: The mean digit span and verbal fluency scores were lower in patients with Alzheimer's disease (n = 34) than in patients with major depression (n = 52) or Parkinson's disease (n = 17) (p<0.001). The average number of words listed was much lower for Alzheimer's disease patients (7.2 words) compared to the patients presenting with major depression (14.6 words) or Parkinson's disease (15.7 words) (KW test = 32.4; p<0.01). Major depression and Parkinson's disease groups listed 44 percent (ROM = 1.44) and 48 percent (ROM = 1.48) more words, respectively, compared to those patients with Alzheimer's disease; these results were independent of age, education, disease severity and attention. Independently of diagnosis, age, and education, severe disease showed a 26 percent (ROM = 0.74) reduction in the number of words listed when compared to mild cases. CONCLUSIONS: Verbal fluency provides a better characterization of Alzheimer's disease, major depression, and Parkinson's disease, even at later stages.