[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). Methods: 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. Results: 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. Conclusion: 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; · 1.86 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. Methods 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. Results Moderate or large effects were found on all RAVLT components, except for short-term and recognition memory. Conclusion 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. · 0.55 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 01/2013; 8(9):e73167. · 3.73 Impact Factor
[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. · 0.55 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. · 3.72 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.
Revista Neuropsiscología Latinoamericana. 01/2012; 4(2-2075-9479):16-21.
[show abstract][hide abstract] ABSTRACT: Background: The Rey Auditory-Verbal Learning Test (RAVLT) is widely used for the assessment of episodic memory. However, there are few studies in Brazil assessing its psychometric properties. Objectives: To search for evidence of reliability and construct validity of the RAVLT, and to assess the influence of age,
schooling, gender, and depressive symptoms on test performance. Methods: One hundred twenty-six healthy older adults (aged 60 and over) performed the RAVLT, Mini-Mental State Exam (MMSE), Clock Drawing Test (CDT) and the Geriatric Depression Scale. Reliability was assessed by analysis of internal
consistency, and construct validity by factor analysis and correlations with the MMSE and CDT. The influence of age, schooling and depressive symptoms was estimated by conducting linear regression analysis, and the role of gender by comparing the performance of males and females. Results: The RAVLT showed a high internal consistency, weak correlations with the MMSE and CDT, and a bifactorial structure, which is related to the processes of learning and episodic memory retrieval. Only age and gender affected test performance. Discussion: Our results provide evidence of reliability and construct validity in the tested
RAVLT version, attesting its potential for clinical and research purposes for the Brazilian elderly population.
Revista de Psiquiatria Clínica 01/2012; 39(1-0101-6083):19-23. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: Recent finding suggests that in Amnestic Mild Cognitive Impairment (MCI) executive functions deficits may be a frequent clinical finding. Automatic and Controlled attentional processes are related to the allo-cation of cognitive resources in different stimuli, being important to executive functioning. The present study aims at assessing the hypothesis of executive dysfunction deficits in MCI patients. Method: forty five MCI patients and forty five normal aging controls (NC) were assessed with the Five Digits Test (5D), a Mini-Verbal test version of the Stroop Test. Group comparisons were performed by t tests and the non-parametric Mann-Whitney test. Results: comparisons indicates significant differences between NC and MCI in efficiency measures of controlled attentional processes, with moderate effect sizes, but not in automatic attentional processes or processing speed. Conclusion: the present work shows a selective pat-tern of impairment in MCI, indicating specific deficits in executive functioning with spared processing speed.
[show abstract][hide abstract] ABSTRACT: Abstract. This paper aims at reviewing the literature on the use of Rey’s Verbal Auditory Learning Test (RAVLT) with respect to its potential contribution to the differential diagnosis between normal aging and Alzheimer’s disease. We researched articles published in the last ten years, indexed in the databases of PubMed and Lilacs, which were designed to evaluate the use of the RAVLT
in the diagnosis of dementia, particularly Alzheimer’s disease. Thirty-seven studies were selected according to the methodology outlined. Seventeen items assessed the utility of the RAVLT test in neuropsychological assessment of de-mentia is usefulness to differentiate AD and normal development and twenty studies investigated the performance of normal elderly on RAVLT or how the factors age, education and gender may influence the performance in the test. Weconclude that the RAVLT is an effective tool to assist in the differential diagnosis between normal and pathological aging. It is necessary, however, further stud-ies on regulation of it to evaluate the different dementia syndromes.
[show abstract][hide abstract] ABSTRACT: OObjective: Executive functions and processing speed assessment in subjects diagnosed with Alzheimer’s disease (AD), Mild Cognitive Impairment (MCI), and Major Depressive Disorder (MDD) are often made by use of classical neuropsychological tasks (e.g.: Stroop Color Word Test). Drawbacks in instruments like the chromatic and linguistic properties of the SCWT have limited its application in elderly. An alternative are the Mini-Verbal Tests (MVT) where language content is kept on a minimum. We evaluate the use of a MVT version of the Stroop paradigm in the assessment of a mixed clinical group of older adults and its relation with global cognitive impairment. Method: In a case-control study, we examined 114 subjects divided in four groups: 30 AD, 30 MCI, 24 MDD, and 30 community-dwelling normal aged controls (NAC) with the Five Digit Test (5D) a MVT adaptation of the SCWT, in low educated older adults. The four groups were compared by one-way ANOVA in the processing speed, inhibition and cognitive shifting components of 5D. Results: Our results suggest that the processing speed impairments may be a more consistent finding in diffuse neurological damage cases as dementia, or chronic mood disorders, although the inhibition deficits may be a more specific feature of the dementia. The shifting component of the 5D have also shown good clinical validity in the characterization of MDD patients (which shown a slower performance when compared to NAC) and AD (where an expressive amount of patients were unable to perform the task and error were more frequently). Conclusion: The 5D seems a valuable tool for the assessment of processing speed and executive functions in the clinical population of Brazilians low educated older adults, being an alternative to the classic SCWT.
[show abstract][hide abstract] ABSTRACT: A large body of evidence suggests that several aspects of face processing are impaired in autism and that this impairment might be hereditary. This study was aimed at assessing facial emotion recognition in parents of children with autism and its associations with a functional polymorphism of the serotonin transporter (5HTTLPR).
We evaluated 40 parents of children with autism and 41 healthy controls. All participants were administered the Penn Emotion Recognition Test (ER40) and were genotyped for 5HTTLPR.
Our study showed that parents of children with autism performed worse in the facial emotion recognition test than controls. Analyses of error patterns showed that parents of children with autism over-attributed neutral to emotional faces. We found evidence that 5HTTLPR polymorphism did not influence the performance in the Penn Emotion Recognition Test, but that it may determine different error patterns.
Facial emotion recognition deficits are more common in first-degree relatives of autistic patients than in the general population, suggesting that facial emotion recognition is a candidate endophenotype for autism.
Revista Brasileira de Psiquiatria 09/2011; 33(3):261-7. · 1.86 Impact Factor
[show abstract][hide abstract] ABSTRACT: Male patient, 81 years, referred by Geriatry to Geriatric Psychiatry by presenting agitation,
aggression and delusions . Initial evaluation raises doubts about the characteristics of delusions
of grandeur and its differentiation from pseudologia fantastica or vain mythomania. He
presents narcissist ic personality traits . It is also discussed the possibility of confabulations.
Expansive hyperthymia in the past and present, but the changes of the imagination does not
always depend on the expansion of humor. The patient claims to be the owner of "REFER", a
term related to Rede Ferroviária (n etwork rail) , where he worked, to have had several careers,
and to own several buildings of great value. He exalts himself with relatives when challenged.
He reported to be an aircraft commander and to have helped pilots on a trip, as well as to have
received a commenda tion from the Order of Lawyers. In a psychodynamic point of view , he
remains trough his beliefs as self - sufficient and authoritative provider of the family. There are
reports of forgetfulness since 2008 and worsening of spatial orientation. Informants d eny
progressive deterioration in memory deficit ( confirmed by follow - up with Mini- Mental), but the
functional loss appeared to be progressive : he can’t turn on the television or use the phone .
Today he is t otal dependent on i nstrumental activities of daily living - ADL ( employed Lawton -
Brody S cale) and partially dependent for basic ADL ( employed Katz Index). He presents
apraxia , as some difficulty buttoning his shirt. Neuropsychological tests indicate dement ia, as
well as the imaging studies ( mixed dementia). Remaining laboratory findings do not justify the
neuro psychiatric condition. The diagnostic hypotheses are of mixed dementia, late paraphrenia
or delusional disorder - content of grandeur ( delusions were not bizarre and there were no
changes in sensory perception , hence it was excluded schizophrenia), also late bipolar
disorder, and narcissistic personality disorder. There remains the question whether changes of
the imagination, at least in the initial st age , would correspond to pseudologia fantastica, and to
what extent this would be associated with delusions of grandeur in this case. From the
standpoint of general practice, there are also diagnostic impressions of hypertension , benign
prostatic hyperplas ia , kidney stones, pangastritis , CKD class 2 ( mild), hypovitaminosis B12
(with regular replacement) and hypertensive hypertrophic cardiopathy with preserved systolic
function. S everal prescriptions are mentioned, and the introduction of galantamine . It fol lows
discussion, which includes the possibility that hypomanic patients act as opposed to what
happens in depressive pseudodementia, namely with a deceptive performance or hyp omanic
pseudohealthiness, which c an in initial dementias undesirably delay specif ic treatment and the
use of anticholinesterasic agent.
[show abstract][hide abstract] ABSTRACT: Objective: This transversal study aims to evaluate the discriminant validity of the Rey Auditory Verbal Learning Test (RAVLT) by comparing a sample of normal elderly with a patient at the initial stage of Alzheimer’s disease. Methods: Age and educational attainment matched patients at the initial stages of Alzheimer’s disease (n = 35) and normal elderly (n = 35) were submitted to the Rey Auditory Verbal Learning Test, Mini Mental State Examination and the Geriatric Depression Scale. The performance of the two groups was compared using the Mann-Whitney test at each stage of the RAVLT and by ROC analysis the discriminant validity of the test in both populations was evaluated. r esults: The group at the initial stages of Alzheimer’s disease had significantly worse performance in all steps of the RAVLT compared to the control group, and the steps showed good diagnostic power, with areas under the curve ranging between 0.806 and 0.989 (A1 = 0,806; A2 = 0,869; A3 = 0,958; A4 = 0,947; A5 = 0,989; A6 = 0,962; A7 = 0,985; TOTAL = 0,975; LOT = 0,895; REC = 0 ,915). Conclusion: The results suggest that the Rey Auditory Verbal Learning Test is effective for discriminating normal elderly seniors from the ones in early stages of Alzheimer’s disease.
Jornal brasileiro de psiquiatria 01/2011; 60(4-004720-85):253-258.
[show abstract][hide abstract] ABSTRACT: Reducing the use of fresh water can lead to energy savings when this is properly planned and executed. Chemical process simulation has proven to be an effective tool for performing a global analysis of water systems to identify routes for maximizing the process efficiency concerning to wa-ter recovery. System closure has been introduces in pulp mills resulting in simultaneous buildup of non-process elements (NPEs). This buildup generates operational problems in the bleach plant, the biggest consuming stage of water. This paper describes how to use computer simulation tools to carry out a global analysis of a bleach mill plant in Brazil, using WinGEMS and CADSIM simulators, and the NICA-Donnan Model to predict NPE (Mn 2+ , Fe 3+ , Mg 2+ , Ca 2+) distribution. Results obtained from simulation in this paper show which changes in the Kraft pulp process in order to implement water savings should be associated to new advanced technologies. The simulated value results for the NICA–Donnan model have been satisfactorily compared with the meas-urement value. The model made a good description of NPE behavior, and might assist the pulp mill in operating problems caused by the buildup of those elements.
Latin American Applied Research. 01/2010; 40:81-90.