[Show abstract][Hide abstract] ABSTRACT: Cognitive functioning influences activities of daily living (ADL). However, studies reporting the association between ADL and neuropsychological performance show inconsistent results regarding what specific cognitive domains are related to each specific functional domains. Additionally, whether depressive symptoms are associated with a worse functional performance in older adults is still under explored. We investigated if specific cognitive domains and depressive symptoms would affect different aspects of ADL. Participants were 274 older adults (96 normal aging participants, 85 patients with mild cognitive impairment, and 93 patients probable with mild Alzheimer's disease dementia) with low formal education (∼4 years). Measures of ADL included three complexity levels: Self-care, Instrumental-Domestic, and Instrumental-Complex. The specific cognitive functions were evaluated through a factorial strategy resulting in four cognitive domains: Executive Functions, Language/Semantic Memory, Episodic Memory, and Visuospatial Abilities. The Geriatric Depression Scale measured depressive symptoms. Multiple linear regression analysis showed executive functions and episodic memory as significant predictors of Instrumental-Domestic ADL, and executive functions, episodic memory and language/semantic memory as predictors of Instrumental-Complex ADL (22 and 28% of explained variance, respectively). Ordinal regression analysis showed the influence of specific cognitive functions and depressive symptoms on each one of the instrumental ADL. We observed a heterogeneous pattern of association with explained variance ranging from 22 to 38%. Different instrumental ADL had specific cognitive predictors and depressive symptoms were predictive of ADL involving social contact. Our results suggest a specific pattern of influence depending on the specific instrumental daily living activity.
[Show abstract][Hide abstract] ABSTRACT: Suicide is one of the major causes of preventable death. We evaluated suicidality among pregnant women who participated in prenatal care in Brazil. A total of 255 patients were assessed using semi-structured interviews as well as the Edinburgh Postnatal Depression Scale (EPDS), Beck Depression Inventory (BDI), and Mini-International Neuropsychiatric Interview (MINI) Plus. Thereafter, Stata 12 was used to identify the significant predictors of current suicide risk (CSR) among participants using univariate and multivariate analyses (p < 0.05). According to MINI Plus module C, the lifetime suicide attempt rate was 12.55 %. The overall CSR was 23.53 %, distributed across risk levels of low (12.55 %), moderate (1.18 %), and high (9.80 %). Our rates approximate those found in another Brazilian study (18.4 %). Antenatal depression (AD), lifetime bipolar disorder, and any current anxiety disorder (as measured using the MINI) as well as BDI scores ≥15 and EPDS scores ≥11 were identified as positive risk factors in a univariate analysis (p < 0.001). These factors changed after a multivariate analysis was employed, and only years of education [odds ratio (OR) = 0.45; 95 % confidence intervals (CIs) = 0.21-0.99], AD (OR = 3.42; 95 % CIs = 1.37-8.53), and EPDS scores ≥11 (OR = 4.44; 95 % CIs = 1.97-9.97) remained independent risk factors. AD and other psychiatric disorders were the primary risk factors for suicidality, although only the former remained an independent factor after a multivariate analysis. More than 10 years of education and EPDS scores ≥11 were also independent factors; the latter can be used as a screening tool for suicide risk.
Archives of Women s Mental Health 07/2015; DOI:10.1007/s00737-015-0552-x · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Previous studies suggest that executive functions influence the performance on visuoconstructional tasks. This study aims to investigate whether the relationship between planning ability and the copy of complex figures is mediated by distinct components of executive functions (i.e., working memory, inhibitory control and cognitive flexibility). We included a 129 older adults with Alzheimer’s disease (
=36, AD), mild cognitive impairment (MCI,
=67), and with no evidence of cognitive impairment (controls,
=26). We evaluated the mediation effect of planning abilities, working memory, cognitive flexibility and inhibitory control on visuoconstructional tasks using a multiple mediation models. We found a significant direct effect of planning on visuoconstructional abilities and a partial mediation effect of working memory and cognitive flexibility on visuoconstructional abilities. The present results indicate that the performance on visuoconstructional task is mediated by multiple interrelated executive functions components, in particular working memory and cognitive flexibility. (
Journal of the International Neuropsychological Society 06/2015; 21(05):1-7. DOI:10.1017/S135561771500034X · 2.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bipolar disorder (BD) is common in clinical psychiatric practice, and several studies have estimated its prevalence to range from 0.5 to 5% in community-based samples. However, no systematic review and meta-analysis of the prevalence of BD type 1 and type 2 has been published in the literature. We carried out a systematic review and meta-analysis of the lifetime and 1-year prevalence of BD type 1 and type 2 and assessed whether the prevalence of BD changed according to the diagnostic criteria adopted (DSM-III, DSM-III-R vs. DSM-IV).
We searched MEDLINE, Scopus, Web of Science, PsycINFO, and the reference lists of identified studies. The analyses included 25 population- or community-based studies and 276,221 participants.
The pooled lifetime prevalence of BD type 1 was 1.06% (95% confidence interval [95%CI] 0.81-1.31) and that of BD type 2 was 1.57% (95%CI 1.15-1.99). The pooled 1-year prevalence was 0.71% (95%CI 0.56-0.86) for BD type 1 and 0.50% (95%CI 0.35-0.64) for BD type 2. Subgroup analysis showed a significantly higher lifetime prevalence of BD type 1 according to the DSM-IV criteria compared to the DSM-III and DSM-IIIR criteria (p < 0.001).
This meta-analysis confirms that estimates of BD type 1 and type 2 prevalence are low in the general population. The increase in prevalence from DSM-III and DSM-III-R to DSM-IV may reflect different factors, such as minor changes in diagnostic operationalization, use of different assessment instruments, or even a genuine increase in the prevalence of BD.
Revista Brasileira de Psiquiatria 05/2015; 37(ahead). DOI:10.1590/1516-4446-2012-1693 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms "postpartum depression" and "genetics". Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.
[Show abstract][Hide abstract] ABSTRACT: Background:
Sensorimotor deficits are an important phenomenological facet observed in patients with bipolar disorder (BD). However, there is little research on this topic. We hypothesize that the MPraxis test can be used to screen for motor impairments in BD aiming movements.
The MPraxis, which is a quick and easy-to-apply computerized test, measures sensorimotor control. During the test, the participant must move the computer mouse cursor over an ever-shrinking green box and click on it once. We predict that the MPraxis test is capable of detecting differences in sensorimotor performance between patients with BD and controls. We assessed 21 euthymic type I BD patients, without DSM-IV-TR Axis I comorbidity, and 21 healthy controls.
Results and conclusions:
Compared to the controls, the patients with BD presented a lower response time in their movements in all conditions. Our results showed sensorimotor deficits in BD and suggested that the MPraxis test can be used to screen for motor impairments in patients with euthymic BD.
Revista Brasileira de Psiquiatria 03/2014; DOI:10.1590/1516-4446-2013-1243 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
To propose and evaluate the psychometric properties of a multidimensional measure of activities of daily living (ADLs) based on the Katz and Lawton indices for Alzheimer's disease (AD) and mild cognitive impairment (MCI).
In this study, 85 patients with MCI and 93 with AD, stratified by age (≤ 74 years, > 74 years), completed the Mini Mental State Examination (MMSE) and the Geriatric Depression Scale, and their caregivers completed scales for ADLs. Construct validity (factor analysis), reliability (internal consistency), and criterion-related validity (receiver operating characteristic analysis and logistic regression) were assessed.
Three factors of ADL (self-care, domestic activities, and complex activities) were identified and used for item reorganization and for the creation of a new inventory, called the General Activities of Daily Living Scale (GADL). The components showed good internal consistency (> 0.800) and moderate (younger participants) or high (older participants) accuracy for the distinction between MCI and AD. An additive effect was found between the GADL complex ADLs and global ADLs with the MMSE for the correct classification of younger patients.
The GADL showed evidence of validity and reliability for the Brazilian elderly population. It may also play an important role in the differential diagnosis of MCI and AD.
Revista Brasileira de Psiquiatria 01/2014; DOI:10.1590/1516-4446-2012-1003 · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use.
A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living.
The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.
PLoS ONE 10/2013; 8(9):e73167. DOI:10.1371/journal.pone.0073167 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
Depressive pseudodementia (DPD) is a clinical condition characterized by depressive symptoms followed by cognitive and functional impairment characteristics of dementia. Memory complaints are one of the most related cognitive symptoms in DPD. The present study aims to assess the verbal learning profile of elderly patients with DPD.
Ninety-six older adults (34 DPD and 62 controls) were assessed by neuropsychological tests including the Rey auditory-verbal learning test (RAVLT). A multivariate general linear model was used to assess group differences and controlled for demographic factors.
Moderate or large effects were found on all RAVLT components, except for short-term and recognition memory.
DPD impairs verbal memory, with large effect size on free recall and moderate effect size on the learning. Short-term storage and recognition memory are useful in clinical contexts when the differential diagnosis is required.
Arquivos de neuro-psiquiatria 09/2013; 71(9A):596-9. DOI:10.1590/0004-282X20130102 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Planning is a component of executive functions and refers to the ability to establish the best way to achieve a specific goal, considering the hierarchy of steps necessary to achieve it. There are two types of planning. The preplanning or look-ahead occurs before the initiation of the behavior to achieve the goal, involving elaboration of a sequence of steps and their consequences. While online planning occurs when planning and execution are commingled. The Tower of London (TOL) is a classic measure of planning. Complex Figure tests, like the Taylor Complex Figure (TCF), measures spatial abilities, visioconstruction and planning skills. The objective of the present study is to investigate the influence of planning measured by TOL in the quality of the copy of a simplified version of the TCF (sTCF).
A heterogeneous group composed of 101 elderly with Clinical Dementia Rating ranging between 0 and 1, with a mean age of 72.67 (SD = 9.59 years) and mean education of 4.46 (SD = 3.951 years), performed the TOL , the copy of sTCF and the Mini-Mental State Examination (MMSE). Bivariate correlations were used to assess which variables are related to the sTCF being significant values used in a linear regression model to evaluate the interference of these on the visioconstruction task. The total sample was divided into three groups related to the effectiveness of planning, paired by age, education and MMSE, using percentiles accumulated total score of TOL (G1 = <16, 16-85 = G2, G3 => 85) and were compared by ANOVA using the Tukey HSD correction.
No correlation was found between sex and sTCF (p = 0.432). Age, education, MMSE and TOL were used in a stepwise regression with sTCF as a dependent variable, where TOL represented 25% of the explained variance while the addition of the other variables only 8%. There were significant differences in the performance of the three groups in the copy of sTCF (G1-G2: p <0.001; G1-G3: p <0.001; G2-G3: p = 0.032).
The results indicates that the planning ability influences the quality of the copy of sTCF independent of general cognition, age and education.
The Alzheimer’s Association International Conference, Boston; 07/2013
[Show abstract][Hide abstract] ABSTRACT: The aim of the present study was to examinethe association between polymorphism in thecatechol-O-methyltransferase(COMT) gene and Alzheimer's disease (AD) in a Brazilianpopulation. The case-control method was used to study the association between AD and geneticvariants of COMT. Six tag single-nucleotide polymorphisms(SNPs) in the COMT gene were genotyped by RT-PCR. Ourfindings showed that the 6 tag SNPs analyzed in this study were not associated with AD at the alleleand genotype levels in comparison with the control group. No statistical difference was foundbetween groups with and without behavioral and psychological symptoms of dementia (BPSD). Ourresults do not support the hypothesis that the polymorphisms of theCOMT gene may be associated with susceptibility to AD withand without BPSD.
[Show abstract][Hide abstract] ABSTRACT: To analyze the psychometric properties of the Token test (TT), a verbal comprehension test, and its applicability to the diagnosis of mild Alzheimer's disease (AD).
One hundred and sixty participants (80 AD and 80 controls) performed the TT and a short battery of neuropsychological tests designed to evaluate general cognitive status, working memory and executive functions. Internal consistency, factor structure, correlation with other measures and group comparisons were evaluated.
The test evinced good internal consistency and a bi-factorial structure (related to comprehension and attention). Differences between AD and controls were significant, however the TT presented only moderate sensitivity and specificity for the AD diagnosis.
The TT showed evidence of good psychometric properties and adequacy for characterizing comprehension deficits in AD, but it was not an appropriate test for the AD detection and diagnosis.
Arquivos de neuro-psiquiatria 06/2012; 70(6):435-40. DOI:10.1590/S0004-282X2012000600010 · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Schizophrenia is characterized by a slow deteriorating mental illness. Although the pathophysiology mechanisms are not fully understood, different studies have suggested a role for the immune system in the pathogenesis of schizophrenia. To date, an altered expression or signaling of neurotransmitters receptors is observed in immune cells during psychiatric disorders. In the present study, we investigated the expression of different serotonin and dopamine receptors in T-cells of schizophrenic and control patients. We used flow cytometry to determine the pattern of expression of dopamine (D2 and D4) and serotonine receptors (SR1A, SR1C, SR2A, SR2B), as well as serotonin transporter (ST), in T-cell subsets (CD4 and CD8). Expression of serotonin receptors and ST in T-cells of schizophrenic patients were not different from controls. However, the percentages of CD4+D4+ and CD8+D4+ were increased in schizophrenic patients as compared to controls. In addition, increased percentages of CD8+D2+ cells were also observed in schizophrenic patients, albeit this population revealed lower CD4+D2+ cells in comparison to controls. Interestingly, a relationship between clinical symptoms and immunological parameters was also observed. We showed that the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS) and the Abnormal Involuntary Movement Scale (AIMS) were positively related to CD8+D2+ cells, though AIMS was inversely related to CD4+D4+ cells. In conclusion, the alteration in the pattern of cell population and molecules expressed by them might serve as a promising biomarker for diagnosis of schizophrenia.
Journal of Psychiatric Research 04/2012; 46(6):738-42. DOI:10.1016/j.jpsychires.2012.03.004 · 3.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Tower of London (TOL) is used for evaluating planning skills, which is a component of the executive functions. Different versions and scoring criteria were developed for this task, and some of them present with different psychometrical properties. This study aimed to evaluate two specific scoring methods of the TOL in diagnosing Mild Cognitive Impairment and probable Alzheimer's disease. The TOL total scores from 60 patients of each diagnosis were compared with the performance of 60 healthy-aged controls using receiver operating characteristics analysis and multinomial logistic regression. Krikorian method better diagnosed Alzheimer's disease, while Portellas's was better at discriminating healthy controls from Mild Cognitive Impairment, but were not efficient at comparing this last group with Alzheimer's patients. Regression analysis indicates that in addition to screening tests, TOL improves the classification of the three groups. The results suggest the two scoring methods used for this task may be useful for different diagnostic purposes.
[Show abstract][Hide abstract] ABSTRACT: The Tower of London (TOL) is a task used for assessing planning skills, a component of the executive functions. The present study aimed to investigate the contribution of TOL for the assessment of planning skills of Mild Cognitive Impairment (MCI) patients. We also aimed to evaluate two specific scoring methods of the TOL’s correction (Krikorian’s x Portela’s score method). Ninety six participants were included in this study (53 females; mean age 75.18 + / -7.31 years) - 35 healthy controls, 30 amnestic MCI and 35 multiple domain amnestic MCI. Our results show that only multiple domains amnestic MCI performed worse than the control group. Furthermore, adding the TOL (considering both Krikorian
and Portela’s method) to the Mini-Mental State Exam the correct classification of subjects according to its diagnostics improves significantly. Our finding suggests that both Krikorian’s and Portella’s score method for TOL have good psychometric properties considering the assessment of executive impairment in elderly subjects.