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ABSTRACT: Although several surveys have been conducted around the world, few surveys have investigated the prevalence of dementia in Latin America. The aim of this study was to estimate dementia prevalence in a community sample in Ribeirão Preto, Brazil, and to evaluate its distribution across several socio-demographic and clinical characteristics and habits. The population was aged 60 years and older and a representative sample from three different social regions. The screening instruments used in the first phase were the Mini-Mental State Examination, the Fuld Object-Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, and the Bayer Activities of Daily Living Scale. In the second phase, the Cambridge Examination was employed to diagnose dementia according to the DSM-IV criteria. The estimate of dementia prevalence was adjusted for screening instrument performance, using the positive and negative predictive values. The data were weighted to compare frequencies, considering the sampling and the non-response effect, and subjected to multivariate analysis. In all, 1.145 elderly subjects were evaluated (mean age: 70.9 years), of whom 63.4% were female and 52.8% had up to 4 years of schooling (participation rates at the first and the second phases were 62.6 and 60%, respectively). The observed and estimated prevalences of dementia were 5.9% and 12.5%, respectively (n = 68). Alzheimer's disease was the main cause (60.3%). Dementia was associated with old age, low education, stroke, absence of arthritis, and not reading books. The estimated prevalence of dementia was higher than the prevalence previously found. Associated factors confirmed the importance of intellectual activities in prevention.
Journal of Alzheimer's disease: JAD 07/2012; 32(2):307-16. · 3.74 Impact Factor
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ABSTRACT: Studies on functional capacity in community-dwelling older people have shown associations between declines in instrumental activities of daily living (IADL) and several factors. Among these, age has been the most consistently related to functional capacity independent of other variables. We aimed at evaluating the performance of a sample of healthy and cognitively intact Brazilian older people on activities of daily living and to analyze its relation to social-demographic variables.
We conducted a secondary analysis of data collected for previous epidemiological studies with community-dwelling subjects aged 60 years or more. We selected subjects who did not have dementia or depression, and with no history of neurological diseases, heart attack, HIV, hepatitis or arthritis (n = 1,111). Functional capacity was assessed using the Brazilian version of the Older American Resources and Services Questionnaire (BOMFAQ). ADL performance was analyzed according to age, gender, education, and marital status (Pearson's χ2, logistic regression).
IADL difficulties were present in our sample, especially in subjects aged 80 years or more, with lower levels of education, or widowed. The logistic regression analysis results indicated that "higher age" and "lower education" (p ≤ 0.001) remained significantly associated with IADL difficulty.
Functional decline was present in older subjects even in the absence of medical conditions and cognitive impairment. Clinicians and researchers could benefit from knowing what to expect from older people regarding IADL performance in the absence of medical conditions.
International Psychogeriatrics 01/2012; 24(5):784-93. · 2.24 Impact Factor
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ABSTRACT: Studies investigating the association between alcohol use and cognitive disorders in the elderly population have produced divergent results. Moreover, the role of alcohol in cognitive dysfunction is not clear. The aims of this study were to estimate the prevalence of alcohol-related problems in an elderly population from Brazil and to investigate their association with cognitive and functional impairment (CFI) and dementia.
A community-based cross-sectional study was performed. A sample of 1,145 elderly people was examined in 2 phases. Several instruments were utilized in the first phase: the CAGE questionnaire was used to identify potential cases of alcohol-related problems, and a screening test for dementia was used to estimate CFI. The CAMDEX interview (Cambridge Examination) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) criteria were used for the clinical diagnosis of dementia in the second phase.
"Heavy alcohol use" (CAGE > or = 2) was found in 92 subjects (prevalence: 8.2%). It was associated with gender (males, p < 0.001), low education (only in females, p = 0.002), and low socioeconomic level (p = 0.001, in females; p = 0.002, in males). The Mini Mental State Examination exhibited a nonlinear relationship with alcohol-related problems in females; "mild-moderate alcohol use" (CAGE < 2) presented the highest score. A significant association between alcohol-related problems and cognitive dysfunction was found only in females. "Heavy alcohol use" was associated with higher CFI and dementia rates compared to "mild-moderate alcohol use" (p = 0.003 and p < 0.001, respectively). "Mild-moderate alcohol use" had a tendency of association with lower CFI and dementia rates when compared to "no alcohol use" (p = 0.063 and 0.050, respectively).
Our findings suggest that alcohol use does not have a linear relationship with cognitive decline.
Alcoholism Clinical and Experimental Research 04/2010; 34(4):726-33. · 3.34 Impact Factor
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ABSTRACT: To assess the prevalence of alcoholism in elderly living in the city of São Paulo (Brazil) and investigate associated risk factors.
A total of 1,563 individuals aged 60 years or older, of both genders of three districts of different socioeconomic classes (high, medium and low) in the city of São Paulo (Brazil) were interviewed. The CAGE screening test for alcoholism was applied and a structured interview was used to assess associated sociodemographic and clinical factors. The tests Mini Mental State Examination, Fuld Object Memory Evaluation, The Informant Questionnaire on Cognitive Decline in the Elderly and Bayer-Activities of Daily Living Scale were used for cognitive and functional assessment.
Prevalence of alcoholism was 9.1%. Multivariate regression analysis showed that alcoholism was associated with male gender, 'mulatto' ethnicity, smoking, and cognitive and functional impairment. In addition, the younger the individual and the lower the schooling level, the higher the risk for alcoholism.
The results obtained in this study show that alcoholism is highly frequent in the community-dwelling elderly living in São Paulo, and that it is associated with socio-demographic and clinical risk factors similar to those reported in the literature. This suggests that alcoholism in the elderly of a developing country shares the same basic characteristics seen in developed countries. These findings suggest that it is essential for health services and professional to be prepared to meet this demand that will significantly grow in the next years, especially in developing countries, where the rates of population aging are higher than those of developed countries.
International Journal of Geriatric Psychiatry 10/2009; 24(10):1045-53. · 2.42 Impact Factor
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ABSTRACT: To determine the frequency of clinically significant depressive symptoms (CSDS) in a community sample of Brazilian elderly and to assess their relationship with sociodemographic factors, cognitive and functional impairment (CFI), and clinical diseases.
Cross-sectional study of a community-based sample of elderly subjects.
City of Sao Paulo, State of Sao Paulo, Brazil.
A total of 1,563 elderly subjects aged 60 years or older.
A 10-item scale for screening of depressive symptoms in elderly people (D-10), the Mini Mental State Examination, the Fuld Object Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, the Bayer Activities of Daily Living Scale, and a sociodemographic and clinical questionnaire.
The frequency of CSDS was 13.0%. Univariate analysis identified independent factors associated with these symptoms in our sample. Logistic regression analysis indicated that being female, brown skinned, previously depressed, having CFI, using psychotropics, and not practicing physical exercise were related to CSDS. On the other hand, being older, clinically sick, employed, or married were not associated with CSDS.
: Consistent with previous reports, female gender, lack of physical activity, and CFI were significantly associated with higher frequencies of CSDS. Further investigations are necessary to clarify the occurrence of depression and possible modifiable factors in developing countries such as Brazil.
The American journal of geriatric psychiatry: official journal of the American Association for Geriatric Psychiatry 08/2009; 17(7):582-90. · 3.35 Impact Factor
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ABSTRACT: Dementia screening in elderly people with low education can be difficult to implement. For these subjects, informant reports using the long (L) (26 items) and short (C) (16 items) versions of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) can be useful. The objective of the present study was to investigate the performance of Brazilian versions of the IQCODE L, S and a new short version (SBr) (15 items) in comparison with the Mini-mental State Examination (MMSE) for dementia screening in elderly people with low education.
Thirty-four patients with mild to moderate dementia, diagnosed according to ICD-10 criteria, and 57 controls were evaluated and divided into three groups based on their socioeconomic status and level of education. Patients were evaluated using the MMSE and the informants were interviewed using the IQCODE by interviewers blind to the clinical diagnosis.
Education was correlated with MMSE results (r = 0.280, p = 0.031), but not with the versions of the IQCODE. The performance of the instruments, evaluated by the ROC curves, was very similar, with good internal consistency (Cronbach's alpha = 0.97). MMSE correctly classified 85.7% of the subjects while the three IQCODE versions (L, S and SBr) correctly classified 91.2% of the subjects.
The long, short and the new short Brazilian IQCODE versions can be useful as a screening tool for mild and moderate patients with dementia in Brazil. The IQCODE is not biased by schooling, and it seems to be an adequate instrument for samples with low levels of education.
International Psychogeriatrics 04/2009; 21(3):531-8. · 2.24 Impact Factor
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ABSTRACT: BACKGROUND
Longitudinal studies have found that some lifestyle and sociodemographic factors could increase the risk of dementia including Alzheimer Disease. The evaluation of these conditions associated to the risk of cognitive and functional impairment could help physicians to better understand and prevent the development of dementia in elderly population.
OBJECTIVES
The present study aims to estimate the prevalence of CFI and investigate the association with lifestyles and sociodemographic factors in a sample of community-dwelling Brazilian elderly subjects.
METHODS
A cross-sectional study of a randomized community-based sample of 1,563 elderly subjects aged 60 years or older was performed. Instruments applied: Fuld Object Memory Evaluation (FOME), Mini Mental Status Examination (MMSE), the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Bayer Activities of Daily Living Scale (B-ADL), Cambridge Mental Disorders of the Elderly Examination (CAMDEX), and a socio-economic questionnaire. Based on a pilot study, these instruments were combined to classify subjects with CFI.
RESULTS
The overall prevalence of CFI was 16% (95% CI; 14%-17.6%). The initial multivariate analysis indicated sociodemographic factors associated to CFI (Table-1). After adjusting for all the variables (Tabela-2), the multivariate analysis showed an association with the age group 80-84 (OR=4.0; p<0.001); Diabetes (OR=1.5; p=0.046); Stroke (OR=3.6; p<0.001); drinking alcohol (OR=1.4; p=0.052); Tumor (OR=0.5; p=0.020); physical activity (OR=0.7; p=0.044); going to museum (OR=0.3; p<0.001), watching TV (OR=0.5; p=0.022); reading journals (OR=0.6; p=0.003), and reading books (OR=0.6; p=0.008). There was no association with gender, socioeconomic class, marital status and educational level.
CONCLUSIONS
In our sample, physical activity and leisure activities such as “going to museum”, “watching TV”, “reading journals” and “reading books” seem to be protective against CFI. On the other hand, having clinical comorbidities and “drinking alcohol” are harmful for cognitive function. Regarding the lack of association between educational level and CFI, in our sample, education could be a proxy for leisure activities that stimulate cognitive performance. Our findings reinforce the idea that relatively simple lifestyle changes such as increasing physical activity and providing cognitively stimulating activities could enhance the cognition and general health in elderly people.
Alzheimer s and Dementia 07/2008; · 6.37 Impact Factor
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ABSTRACT: To describe item reduction and its distribution into dimensions in the construction process of a quality of life evaluation instrument for the elderly.
The sampling method was chosen by convenience through quotas, with selection of elderly subjects from four programs to achieve heterogeneity in the "health status", "functional capacity", "gender", and "age" variables. The Clinical Impact Method was used, consisting of the spontaneous and elicited selection by the respondents of relevant items to the construct Quality of Life in Old Age from a previously elaborated item pool. The respondents rated each items importance using a 5-point Likert scale. The product of the proportion of elderly selecting the item as relevant (frequency) and the mean importance score they attributed to it (importance) represented the overall impact of that item in their quality of life (impact). The items were ordered according to their impact scores and the top 46 scoring items were grouped in dimensions by three experts. A review of the negative items was performed.
One hundred and ninety three people (122 women and 71 men) were interviewed. Experts distributed the 46 items into eight dimensions. Closely related items were grouped and dimensions not reaching the minimum expected number of items received additional items resulting in eight dimensions and 43 items.
The sample was heterogeneous and similar to what was expected. The dimensions and items demonstrated the multidimensionality of the construct. The Clinical Impact Method was appropriate to construct the instrument, which was named Elderly Quality of Life Index--EQoLI. An accuracy process will be examined in the future.
Clinics 05/2008; 63(2):179-88. · 2.06 Impact Factor
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ABSTRACT: To investigate the applicability of the Bayer - Activities of Daily Living scale and its efficiency in differentiating individuals with mild to moderate dementia from normal elderly controls.
We selected 33 patients with diagnosis of mild to severe dementia, according to ICD-10 criteria, and 59 controls. All the subjects were evaluated with the Mini-Mental State Examination and the Clinical Dementia Rating Scale and the Bayer - Activities of Daily Living scale was applied to informants.
The internal consistency of the Bayer - Activities of Daily Living was high (Cronbach's alpha = 0.981). Mean Mini-Mental State Examination and Bayer - Activities of Daily Living scores of demented patients and controls were significantly different (p < 0.001). Mean Mini-Mental State Examination and Bayer - Activities of Daily Living scores were significantly different between Clinical Dementia Rating Scale 0 (controls; n = 59) versus Clinical Dementia Rating Scale 1 (mild dementia; n = 15), Clinical Dementia Rating Scale 0 versus Clinical Dementia Rating Scale 2 (moderate dementia; n = 13), and for Clinical Dementia Rating Scale 1 versus Clinical Dementia Rating Scale 2 (p < 0.003).
The Bayer - Activities of Daily Living scale and Mini-Mental State Examination differentiated elderly controls from patients with mild or moderate dementia, and patients with mild dementia from those with moderate dementia.
The results suggest that the Bayer - Activities of Daily Living scale applied to an informant can help in the diagnosis and follow-up of Brazilian patients with mild to moderate dementia.
Revista Brasileira de Psiquiatria 01/2008; 29(4):350-3. · 1.20 Impact Factor
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ABSTRACT: This study aimed at estimating the prevalence of cognitive and functional impairment (CFI) in a community sample in Ribeirão Preto, Brazil, evaluating its distribution in relation to various socio-demographic and clinical factors.
The population was a representative sample aged 60 and older, from three different socio-economic classes. Cluster sampling was applied. Instruments used to select CFI (a syndromic category that does not exclude dementia): 'Mini Mental State Examination' (MMSE), 'Fuld Object Memory Evaluation' (FOME), 'Informant Questionnaire on Cognitive Decline in the Elderly' (IQCODE), 'Bayer Activities of Daily Living Scale' (B-ADL) and clinical interviews. The data obtained were submitted to bivariate and logistic regression analysis.
A sample of 1.145 elderly persons was evaluated, with a mean age of 70.9 years (60-100; DP: 7.7); 63.4% were female, and 52.8% had up to 4 years of schooling. CFI prevalence was 18.9% (n = 217). Following logistic regression analysis, higher age, low education, stroke, epilepsy and depression were associated with CFI. Female sex, widowhood, low social class and head trauma were associated with CFI only on bivariate analysis.
CFI prevalence results were similar to those found by studies in Brazil, Puerto Rico and Malaysia. Cognitive and functional impairment is a rather heterogeneous condition which may be associated with various clinical conditions found in the elderly population. Due to its high prevalence and association with higher mortality and disability rates, this clinical syndrome should receive more attention on public health intervention planning.
International Journal of Geriatric Psychiatry 09/2007; 22(8):770-6. · 2.42 Impact Factor
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ABSTRACT: To study the influence of functional electric stimulation (FES) on grip acquisition and on the change of grip processing speed, 38 hemiplegic patients took part in the rehabilitation program of the Division of Rehabilitation Medicine of the Hospital das Clinicas, School of Medicine, University of Sao Paulo. Half of the patients received FES on their wrist and finger extensor muscles. The patients in this study were evaluated initially, then after 3 months and after 6 months using the Minnesota manual dexterity test. We concluded that the time necessary for use of FES to generate a significant improvement in the grip speed in hemiplegic patients is 6 months, using twice-weekly administration of stimulation.
International Journal of Rehabilitation Research 04/2005; 28(1):25-31. · 1.08 Impact Factor
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ABSTRACT: To determine if a functional scale combined with a cognitive test would improve the diagnostic accuracy of dementia.
Thirty patients with mild to moderate dementia, diagnosed according to ICD-10 and DSM-III-R criteria, and 46 elderly controls, divided into three groups according to their socioeconomic status and educational level (high, medium and low) were investigated. The subjects were assessed with the MMSE, and their informants were assessed with the scales IQCODE and B-ADL.
On the logistic regression, the MMSE isolated classified correctly 86.8% of patients and controls (80% sensitivity and 91.3% specificity). The combination MMSE + IQCODE classified correctly 92.1% of the subjects (83.3% sensitivity and 97.8% specificity), and the combination MMSE + B-ADL classified correctly 92.1% of subjects (86.7% sensitivity and 95.7% specificity).
The results suggest that the combination of a cognitive test with a functional scale can improve the detection of mild to moderate cases of dementia even on samples of a very heterogeneous population regarding its socioeconomic status and educational level, as the Brazilian.
Arquivos de Neuro-Psiquiatria 10/2003; 61(3A):601-6. · 0.72 Impact Factor
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ABSTRACT: OBJETIVO: Investigar se a combinação de uma escala de avaliação funcional com um teste cognitivo poderia melhorar a precisão do diagnóstico de demência. MÉTODO: Foram avaliados 30 pacientes com diagnóstico de demência leve a moderada, segundo critérios da CID-10 e DSM-III-R e 46 controles idosos, divididos em grupos segundo seu nível socioeconômico e educacional (alto, médio e baixo). Nos sujeitos foi aplicado o MMSE, e em seus informantes as escalas IQCODE e B-ADL. RESULTADOS: Pela regressão logística, o MMSE isolado classificou corretamente 86,8% dos pacientes e controles (sensibilidade 80% e especificidade 91,3%). A combinação MMSE + IQCODE classificou corretamente 92,1% dos sujeitos (sensibilidade 83,3% e especificidade de 97,8%), e a combinação MMSE + B-ADL classificou corretamente 92,1% dos sujeitos (sensibilidade 86,7% e especificidade 95,7%). CONCLUSÃO: Os resultados sugerem que a combinação de um teste cognitivo a escalas funcionais pode melhorar a detecção de casos leves ou moderados de demência, mesmo em amostras de população heterogênea com relação ao nível sócio-econômico e educacional como a brasileira.
Arquivos de Neuro-Psiquiatria. 01/2003;
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ABSTRACT: The study aimed to compare cost-effectiveness of analgesic schemes administered to 89 patients submitted to hemorrhoidectomy, on the 1st postoperative day. The descriptive and retrospective study was carried out in a General Hospital, Sao Paulo, Brazil. In order to carry out the cost-effectiveness analysis, the five most frequently used analgesic schemes were identified in practice. The main outcome was the absence of breakthrough pain episodes. While calculating the costs, analgesics and all devices related to the schemes were taken into consideration. Codeine 120 mg+acetaminophen 2000 mg was the most effective therapy with the lowest cost per patient with no breakthrough pain episodes ($65.23). Incremental analysis indicated that codeine 120 mg+acetaminophen 2000 mg+ketoprofen 200 mg involved the additional cost of $238.31 in case an extra effectiveness benefit was needed. The analysis showed that the most suitable choice of analgesic therapy should consider the resources available at the institution along with economic and clinical aspects.
Revista Latino-Americana de Enfermagem 16(1):42-6. · 0.63 Impact Factor
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ABSTRACT: In this article, we evaluate electrocardiographic (ECG) alterations among urban workers from a mechanical-metallurgical industry in Sao Paulo, Brazil. In a cross-sectional survey carried out in 1980, we found 2.2% positive serological testing for Trypanosoma cruzi infection among 27,081 workers. A comparison between seropositive workers and a random sample of seronegative workers frequency-matched by age and occupation revealed that seropositive workers had a much lower educational level, and that a higher proportion of seropositive workers had ECG abnormalities (42.7%) when compared to those negative for T. cruzi infection (19.8%). The high frequency of ECG abnormalities suggests the need to provide medical assistance to these workers, without any kind of discrimination and to bring in a form of management that would decrease this dangerous risk to the workers and people around them.
Revista do Instituto de Medicina Tropical de São Paulo 46(6):299-302. · 1.00 Impact Factor
