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Successful aging (SA) is a current positive aging-related perspective and it is important to determine the variables associated with this concept. Most longitudinal population-based studies on predictors of SA were carried out in developed countries. OBJECTIVE: This investigation evaluated which baseline characteristics predicted successful aging in 16 years of follow-up in a southern Brazilian cohort - the Porto Alegre Longitudinal Aging study. METHODS: At baseline, 345 community-dwelling healthy independent individuals aged 60 or older were assessed for medical and psychiatric conditions, memory, orientation, judgment and problem solving, functioning in the community and at home, and hobbies. SA, according to Rowe and Kahn's definition, was the outcome assessed in the last evaluation at a maximum 16-year follow-up. All baseline variables were evaluated as potential predictors for the outcome SA. RESULTS: Of the 345 individuals evaluated at baseline, 32 (9.3%) participants were classified as successful agers in the follow-up. Younger age (OR=0.926, 95%CI=0.863-0.994), female gender (OR=0.226, 95%CI=0.072-0.711) and higher MMSE (OR=1.220, 95%CI=1.031-1.444) were predictors of SA for the 16-year follow-up in a logistic regression model. CONCLUSION: In contrast with our previous hypothesis, the impact of the socioeconomic and socio-environmental characteristics was small, as was the baseline classification into successful and normal aging.
Envelhecimento bem sucedido (EBS) é uma perspectiva positiva sobre o envelhecimento, sendo importante determinar as variáveis associadas a esse conceito. A maioria dos estudos longitudinais de base populacional sobre preditores do EBS foi realizada em países desenvolvidos. OBJETIVO: Este estudo avaliou quais características da linha de base predisseram o envelhecimento bem sucedido em 16 anos de seguimento de uma coorte do sul-brasileira - o Estudo Longitudinal de envelhecimento de Porto Alegre (Porto Alegre Longitudinal Aging - PALA - study). MÉTODOS: No início do estudo, 345 indivíduos da comunidade, saudáveis e independentes, com 60 anos ou mais foram avaliados para condições médicas e psiquiátricas, memória, orientação, julgamento e solução de problemas, funcionamento na comunidade, em casa e passatempos. EBS, segundo Rowe e Kahn, foi o desfecho obtido na última visita em um máximo de 16 anos de seguimento. Todas as variáveis da linha de base foram avaliadas como potenciais preditoras para o desfecho EBS. RESULTADOS: Dos 345 indivíduos avaliados na linha de base, 32 participantes (9,3%) foram classificados como idosos com envelhecimento bem sucedidos em 16 anos de seguimento. No modelo de regressão logística, menor idade (OR=0,926; 95%CI=0,863-0,994), gênero feminino (OR=0,226; 95%CI=0,072-0,711) e MEEM mais elevado (OR=1,220; 95%CI=1,031-1,444) foram preditores de EBS para o seguimento de 16 anos. CONCLUSÃO: Em contraste com nossa hipótese prévia, o impacto das características socioeconômicas e socio-ambientais foi pequeno, bem como o da classificação inicial de envelhecimento normal e bem sucedido.
ABSTRACT
ABSTRACT Successful aging (SA) is a current positive aging-related perspective and it is important to determine the variables associated with this concept. Most longitudinal population-based studies on predictors of SA were carried out in developed countries. Objective: This investigation evaluated which baseline characteristics predicted successful aging in 16 years of follow-up in a southern Brazilian cohort - the Porto Alegre Longitudinal Aging study. Methods: At baseline, 345 community-dwelling healthy independent individuals aged 60 or older were assessed for medical and psychiatric conditions, memory, orientation, judgment and problem solving, functioning in the community and at home, and hobbies. SA, according to Rowe and Kahn's definition, was the outcome assessed in the last evaluation at a maximum 16-year follow-up. All baseline variables were evaluated as potential predictors for the outcome SA. Results: Of the 345 individuals evaluated at baseline, 32 (9.3%) participants were classified as successful agers in the follow-up. Younger age (OR=0.926, 95%CI=0.863-0.994), female gender (OR=0.226, 95%CI=0.072-0.711) and higher MMSE (OR=1.220, 95%CI=1.031-1.444) were predictors of SA for the 16-year follow-up in a logistic regression model. Conclusion: In contrast with our previous hypothesis, the impact of the socioeconomic and socio-environmental characteristics was small, as was the baseline classification into successful and normal aging.
RESUMO Envelhecimento bem sucedido (EBS) é uma perspectiva positiva sobre o envelhecimento, sendo importante determinar as variáveis associadas a esse conceito. A maioria dos estudos longitudinais de base populacional sobre preditores do EBS foi realizada em países desenvolvidos. Objetivo: Este estudo avaliou quais características da linha de base predisseram o envelhecimento bem sucedido em 16 anos de seguimento de uma coorte do sul-brasileira - o Estudo Longitudinal de envelhecimento de Porto Alegre (Porto Alegre Longitudinal Aging - PALA - study). Métodos: No início do estudo, 345 indivíduos da comunidade, saudáveis e independentes, com 60 anos ou mais foram avaliados para condições médicas e psiquiátricas, memória, orientação, julgamento e solução de problemas, funcionamento na comunidade, em casa e passatempos. EBS, segundo Rowe e Kahn, foi o desfecho obtido na última visita em um máximo de 16 anos de seguimento. Todas as variáveis da linha de base foram avaliadas como potenciais preditoras para o desfecho EBS. Resultados: Dos 345 indivíduos avaliados na linha de base, 32 participantes (9,3%) foram classificados como idosos com envelhecimento bem sucedidos em 16 anos de seguimento. No modelo de regressão logística, menor idade (OR=0,926; 95%CI=0,863-0,994), gênero feminino (OR=0,226; 95%CI=0,072-0,711) e MEEM mais elevado (OR=1,220; 95%CI=1,031-1,444) foram preditores de EBS para o seguimento de 16 anos. Conclusão: Em contraste com nossa hipótese prévia, o impacto das características socioeconômicas e socio-ambientais foi pequeno, bem como o da classificação inicial de envelhecimento normal e bem sucedido.
Subject(s)
Humans , Aged , Aged, 80 and over , Healthy Aging/ethnology , Quality of Life , Longitudinal Studies , Executive FunctionABSTRACT
Parkinson's disease (PD) is a common and complex neurodegenerative disorder, the second most prevalent, only behind Alzheimer's disease. Recent studies suggest that environmental factors may contribute for neurodegeneration through induction of epigenetic modifications, such as DNA methylation, that is carried out by enzymes, such as DNMT1 and DNMT3B. This present study targeted to investigate the association among DNMT1 and DNMT3B polymorphisms with PD. Five hundred and twenty-two participants (214 PD patients following UK Brain Bank criteria and 308 healthy individuals) were evaluated. DNA was obtained from whole blood and genotypes were detected by an allelic discrimination assay using TaqMan® MGB probes on a real-time PCR system. The polymorphisms studied were rs2162560 and rs759920 (DNMT1) and rs2424913, rs998382 and rs2424932 (DNMT3B). Was found association between DNMT3B rs2424913 in T allele carriers with PD. The presence of the T allele was associated with PD (OR=1.80, 95% CI 1.16-2.81, p=0.009). No significant difference was observed for others DNMT3B SNPs. Also, no association between PD and the control group were observed for DNMT1 polymorphisms. This is the first study addressing an association between DNMT3B polymorphism and PD. The polymorphism may play a role in the pathogenesis of PD.
Subject(s)
DNA (Cytosine-5-)-Methyltransferases/genetics , DNA Methylation/genetics , Epigenesis, Genetic/genetics , Genetic Predisposition to Disease , Parkinson Disease/genetics , Polymorphism, Genetic/genetics , Aged , Alleles , Female , Gene Frequency/genetics , Genetic Testing/methods , Genotype , Humans , Male , Middle Aged , Risk Factors , DNA Methyltransferase 3BABSTRACT
BACKGROUND/AIMS: Hippocampal atrophy is a recognized biomarker of Alzheimer disease (AD) pathology. Serum brain-derived neurotrophic factor (BDNF) reduction has been associated with neurodegeneration. We aimed to evaluate BDNF serum levels and hippocampal volume in clinical AD (dementia and mild cognitive impairment [MCI]). METHODS: Participants were 10 patients with MCI and 13 with dementia due to AD as well as 10 healthy controls. BDNF serum levels were determined by ELISA and volumetric measures with NeuroQuant®. RESULTS: MCI and dementia patients presented lower BDNF serum levels than healthy participants; dementia patients presented a smaller hippocampal volume than MCI patients and healthy participants. DISCUSSION: The findings support that the decrease in BDNF might start before the establishment of neuronal injury expressed by the hippocampal reduction.
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UNLABELLED: The NPI-Q (Neuropsychiatry Inventory-Questionnaire) was developed to facilitate the evaluation of neuropsychiatric symptoms. This study evaluated the internal consistency, the test-retest reliability of the Brazilian NPI-Q version and its convergent validity with the original NPI. METHOD: The NPI-Q and the NPI were administered to 64 caregivers of dementia patients. Thirteen informants were asked to complete a second NPI-Q form. RESULTS: The internal consistency of the Brazilian NPI-Q version was 0.67 for the severity scale and 0.81 for the distress scale. The test-retest reliability of the total NPI-Q severity and the distress scales were 0.97 and 0.92, respectively (p < 0.001). There were significant correlations between the total NPI-Q severity score and the NPI (r = 0.75) and between the total NPI-Q distress score and the total NPI standard distress (r = 0.74). CONCLUSION: The Brazilian NPI-Q version showed evidence of good psychometric properties and can be used in general clinical practice.
Subject(s)
Dementia/diagnosis , Surveys and Questionnaires , Brazil , Cross-Sectional Studies , Cultural Characteristics , Diagnostic and Statistical Manual of Mental Disorders , Educational Status , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Reproducibility of Results , TranslatingABSTRACT
The NPI-Q (Neuropsychiatry Inventory-Questionnaire) was developed to facilitate the evaluation of neuropsychiatric symptoms. This study evaluated the internal consistency, the test-retest reliability of the Brazilian NPI-Q version and its convergent validity with the original NPI. Method The NPI-Q and the NPI were administered to 64 caregivers of dementia patients. Thirteen informants were asked to complete a second NPI-Q form. Results The internal consistency of the Brazilian NPI-Q version was 0.67 for the severity scale and 0.81 for the distress scale. The test-retest reliability of the total NPI-Q severity and the distress scales were 0.97 and 0.92, respectively (p < 0.001). There were significant correlations between the total NPI-Q severity score and the NPI (r = 0.75) and between the total NPI-Q distress score and the total NPI standard distress (r = 0.74). Conclusion The Brazilian NPI-Q version showed evidence of good psychometric properties and can be used in general clinical practice. .
O Q-INP (Questionário do Inventário Neuropsiquiátrico) foi desenvolvido para facilitar a avaliação dos sintomas neuropsiquiátricos. Este estudo avaliou a consistência interna, confiabilidade teste-reteste e validade convergente da versão brasileira do Q-INP com o INP (Inventário Neuropsiquiátrico). Método Sessenta e quatro cuidadores de pacientes com demência responderam ambas as escalas. O NPI-Q foi reaplicado em 13 informantes. Resultados A consistência interna da versão brasileira do Q-INP foi 0,67 para a escala de gravidade e 0,81 para escala de desgaste. A confiabilidade teste-reteste da escala de gravidade foi 0,97 e 0,92 para a escala de desgaste (p < 0,001). Houve correlação significativa entre o escore de gravidade do Q-INP e INP (r = 0,75) e entre os escores de desgaste destas escalas (r = 0,74). Conclusão A versão brasileira do Q-INP mostrou evidências de boas propriedades psicométricas e pode ser usado na prática clínica geral. .
Subject(s)
Female , Humans , Male , Middle Aged , Dementia/diagnosis , Surveys and Questionnaires , Brazil , Cross-Sectional Studies , Cultural Characteristics , Diagnostic and Statistical Manual of Mental Disorders , Educational Status , Neuropsychological Tests , Reproducibility of Results , TranslatingABSTRACT
Epigenetic mechanisms have been implicated in syndromes associated with neuropsychiatric disorders, but little is known about the role of epigenetics in Alzheimer's disease (AD). DNA methylation, one of the main epigenetic mechanisms, is a complex process carried out by specific enzymes, such as DNMT1 and DNMT3B. This study aimed to investigate the association between DNMT1 and DNMT3B polymorphisms and AD. Two hundred and ten elderly subjects (108 healthy controls and 102 with AD-NINCDS/ARDA, DSM-IV-TR criteria) were assessed. DNA was obtained from whole blood, and genotypes were detected by an allelic discrimination assay using TaqMan(®) MGB probes on a real-time PCR system. The polymorphisms studied were rs2162560, rs759920 (DNMT1) and rs998382, rs2424913, rs2424932 (DNMT3B). For both genes, the polymorphisms were in strong linkage disequilibrium. Carriers of the DNMT3B TGG haplotype were associated with AD (OR=3.03, 95% CI 1.63 to 5.63, P<0.001). No significant difference between AD and the control group were observed for DNMT1 polymorphisms. This study is one of the first describing a significant association between DNMT3B polymorphisms and AD. This enzyme, which is responsible for methylation in a general way, may be involved in AD.
Subject(s)
Alzheimer Disease/genetics , DNA (Cytosine-5-)-Methyltransferases/genetics , DNA Modification Methylases/genetics , Haplotypes/genetics , Aged , Case-Control Studies , DNA (Cytosine-5-)-Methyltransferase 1 , Epigenesis, Genetic , Female , Gene Frequency , Genotype , Humans , Isoenzymes/genetics , Male , Neuropsychological Tests , Phenotype , Polymorphism, Genetic/genetics , DNA Methyltransferase 3BABSTRACT
The definition of successful aging and identification of predictors have been extensively reviewed, less attention however, has been given to the role of this condition on mortality. OBJECTIVE: To evaluate the effect of aging status (normal or successful) on mortality in a South Brazilian population-based cohort, adjusted for sociodemographic and clinical variables, and to report the mortality rate and causes of death in this population. METHODS: The baseline sample comprised 345 community-dwelling, independent and healthy Southern Brazilian older individuals who were followed for 12 years. Clinical, socio-demographic, functional and cognitive variables were assessed at baseline and during the follow-up. At baseline, 214 participants fulfilled criteria for successful aging, and 131 for normal aging. The main outcome was death. RESULTS: The Cox regression model showed an increased risk for mortality in subjects with normal aging (HR=1.9; p=0.003) adjusted by age (HR=1.1; p<0.001) and by sex (HR=1.9; p=0.002). The overall mortality rate was 41% and the rate was significantly lower among successful than normal agers (p=0.001). The main causes of death were cardiovascular disease and cancer. CONCLUSION: Our main finding was an increased risk of mortality among normal in comparison with successful aging subjects, emphasizing the impact of the heterogeneity of the healthy aging process on mortality.
A definição de envelhecimento bem sucedido e a identificação dos seus preditores têm sido extensamente revisadas, entretanto o papel desta condição na mortalidade tem sido menos estudado. OBJETIVO: Avaliar o efeito do status de envelhecimento (normal ou bem sucedido) sobre a mortalidade em uma coorte de base populacional do Sul do Brasil, ajustado para variáveis sociodemográficas e clínicas. Descrever a taxa de mortalidade e as causas de morte nessa população. MÉTODOS: A amostra inicial foi composta de 345 idosos residentes na comunidade, independentes e saudáveis, que foram acompanhados por 12 anos. Variáveis sociodemográficas, funcionais, cognitivas e clínicas foram avaliadas no início e durante o seguimento. No início do estudo, 214 participantes preencheram os critérios para envelhecimento bem-sucedido, e 131 para envelhecimento normal. O desfecho foi mortalidade. RESULTADOS: O modelo de regressão de Cox mostrou um aumento do risco de mortalidade para indivíduos com envelhecimento normal (RC=1,9; p=0,003), ajustado para idade (RC=1,1; p<0,001) e sexo (RC=1,9; p=0,002). A taxa de mortalidade foi significativamente menor entre os idosos com envelhecimento bem sucedido em comparação aos idosos com envelhecimento normal (p=0,001). A taxa de mortalidade geral foi de 41%. As principais causas de morte foram doenças cardiovasculares e câncer. CONCLUSÃO: O principal resultado deste estudo foi o risco de mortalidade aumentado nos indivíduos com envelhecimento normal em comparação com os indivíduos com envelhecimento bem sucedido, enfatizando o impacto da heterogeneidade do processo de envelhecimento saudável sobre a mortalidade.
Subject(s)
Humans , Mortality , Cause of Death , Healthy AgingABSTRACT
The definition of successful aging and identification of predictors have been extensively reviewed, less attention however, has been given to the role of this condition on mortality. OBJECTIVE: To evaluate the effect of aging status (normal or successful) on mortality in a South Brazilian population-based cohort, adjusted for sociodemographic and clinical variables, and to report the mortality rate and causes of death in this population. METHODS: The baseline sample comprised 345 community-dwelling, independent and healthy Southern Brazilian older individuals who were followed for 12 years. Clinical, socio-demographic, functional and cognitive variables were assessed at baseline and during the follow-up. At baseline, 214 participants fulfilled criteria for successful aging, and 131 for normal aging. The main outcome was death. RESULTS: The Cox regression model showed an increased risk for mortality in subjects with normal aging (HR=1.9; p=0.003) adjusted by age (HR=1.1; p<0.001) and by sex (HR=1.9; p=0.002). The overall mortality rate was 41% and the rate was significantly lower among successful than normal agers (p=0.001). The main causes of death were cardiovascular disease and cancer. CONCLUSION: Our main finding was an increased risk of mortality among normal in comparison with successful aging subjects, emphasizing the impact of the heterogeneity of the healthy aging process on mortality.
A definição de envelhecimento bem sucedido e a identificação dos seus preditores têm sido extensamente revisadas, entretanto o papel desta condição na mortalidade tem sido menos estudado. OBJETIVO: Avaliar o efeito do status de envelhecimento (normal ou bem sucedido) sobre a mortalidade em uma coorte de base populacional do Sul do Brasil, ajustado para variáveis sociodemográficas e clínicas. Descrever a taxa de mortalidade e as causas de morte nessa população. MÉTODOS: A amostra inicial foi composta de 345 idosos residentes na comunidade, independentes e saudáveis, que foram acompanhados por 12 anos. Variáveis sociodemográficas, funcionais, cognitivas e clínicas foram avaliadas no início e durante o seguimento. No início do estudo, 214 participantes preencheram os critérios para envelhecimento bem-sucedido, e 131 para envelhecimento normal. O desfecho foi mortalidade. RESULTADOS: O modelo de regressão de Cox mostrou um aumento do risco de mortalidade para indivíduos com envelhecimento normal (RC=1,9; p=0,003), ajustado para idade (RC=1,1; p<0,001) e sexo (RC=1,9; p=0,002). A taxa de mortalidade foi significativamente menor entre os idosos com envelhecimento bem sucedido em comparação aos idosos com envelhecimento normal (p=0,001). A taxa de mortalidade geral foi de 41%. As principais causas de morte foram doenças cardiovasculares e câncer. CONCLUSÃO: O principal resultado deste estudo foi o risco de mortalidade aumentado nos indivíduos com envelhecimento normal em comparação com os indivíduos com envelhecimento bem sucedido, enfatizando o impacto da heterogeneidade do processo de envelhecimento saudável sobre a mortalidade.
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BACKGROUND: Higher mild cognitive impairment (MCI) prognostic variability has been related to sample characteristics (community-based or specialized clinic) and to diverse operationalization criteria. The aim of the study was to evaluate the trajectory of MCI of Alzheimer type in a population-based elderly cohort in Southern Brazil. We also estimated the risk for the development of probable Alzheimer's disease (AD) in comparison with healthy subjects. METHODS: Data were derived from a population-based cohort (the PALA study). MCI outcomes were sub-classified into three categories: conversion, stabilization, and reconversion. The risk of progression to dementia was compared between MCI and normal participants. The analysis was based on 21 MCI subjects and 220 cognitively intact participants (N = 241). RESULTS: Of the 21 MCI subjects, 38% developed dementia, 24% remained stable and 38% improved. The MCI annual conversion rate to AD was 8.5%. MCI was associated with significantly higher risk of conversion to AD (HR = 49.83, p = 0.004), after adjustment for age, education, sex and Mini-Mental State Examination score. CONCLUSIONS: Independent of the heterogeneity of the outcomes, MCI of the Alzheimer type participants showed significantly higher risk of developing probable AD, demonstrating the impact of the use of these MCI criteria that emphasize long-term episodic memory impairment.
Subject(s)
Alzheimer Disease/epidemiology , Cognitive Dysfunction/epidemiology , Age Factors , Aged , Aged, 80 and over , Brazil/epidemiology , Case-Control Studies , Disease Progression , Educational Status , Female , Humans , Male , Proportional Hazards Models , Risk Factors , Sex FactorsABSTRACT
Abstract. Caregiver burden is common in Alzheimer's disease (AD), decreasing the quality of life among caregivers and patients. Projections of aging and aging-related diseases such as AD in developing countries justify additional data about this issue because people living in these countries have shown similarly high levels of caregiver strain as in the developed world. Objective: The aim of this study was to analyze the association of AD caregivers' burden with patients' neuropsychiatric symptoms (NPS), cognitive status, severity of dementia, functional capacity, caregiver sociodemographic characteristics, and the characteristics of care provided by caregivers. Methods: A cross-sectional study was conducted in a sample of 39 consecutive AD patients and their primary caregivers. NPS were evaluated using the Neuropsychiatric Inventory (NPI). Severity of dementia was assessed with the Clinical Dementia Rating (CDR) scale. Functional capacity was assessed using the Katz and Lawton scales. The burden level was rated using the Burden Interview (BI). Sociodemographic characteristics of caregivers and the characteristics of care provided by them were evaluated. The Mann-Whitney U-test, Kruskal-Wallis test and Spearman's rho coefficient were performed. Results: The BI had a moderate correlation with NPI intensity (rho=0.563), p<001. Female caregivers reported a greater level of burden (p=0.031) than male caregivers. The other variables were not significantly associated to caregiver burden. Conclusion: NPS were the main determinant of burden in primary caregivers of AD patients. This result underscores the need for prevention and treatment of these symptoms. Sex also had an effect on caregiver burden, but the small male sample in this study precludes the generalization of this finding.
Resumo. Sobrecarga no cuidador é comum na doença de Alzheimer (DA), diminuindo a qualidade de vida dos cuidadores e pacientes. As projeções de envelhecimento e doenças relacionadas ao envelhecimento como a DA nos países em desenvolvimento justificam dados adicionais sobre esta questão, porque as pessoas que vivem nestes países têm apresentado níveis semelhantes de sobrecarga no cuidador tão alto quanto no mundo desenvolvido. Objetivo: O estudo teve como objetivo analisar a associação da sobrecarga em cuidadores de pacientes com DA com sintomas neuropsiquiátricos (NPS) dos pacientes, estatus cognitivo, gravidade da demência, capacidade funcional, características sociodemográficas do cuidador e as características dos cuidados prestados pelos cuidadores. Métodos: Um estudo transversal foi realizado em uma amostra de 39 pacientes consecutivos de DA e seus cuidadores primários. NPS foram avaliados através do Inventário Neuropsiquiátrico (NPI). A gravidade da demência foi avaliada com a escala Clinical Dementia Rating (CDR). A capacidade funcional foi avaliada com as escalas de Katz e Lawton. O nível de sobrecarga foi avaliada utilizando a escala Burden Interview (BI). Características sociodemográficas dos cuidadores e as características de atendimento prestado por eles foram avaliadas. Mann-Whitney, Kruskal-Wallis e coeficiente rho de Spearman foram calculados. Resultados: BI apresentou correlação moderada com a intensidade do NPI (rho=0,563), p<001. Cuidadoras mulheres relataram maior nível de sobrecarga (p=0,031) do que cuidadores do sexo masculino. As demais variáveis não foram significativamente associados à sobrecarga do cuidador. Conclusão: NPS foram o principal determinante da sobrecarga do cuidador de pacientes com DA. Esse resultado reforça a necessidade de prevenção e tratamento desses sintomas. Sexo também teve um efeito sobre a sobrecarga do cuidador, mas a pequena amostra do sexo masculino neste estudo evita a generalização dessa constatação.
Subject(s)
Humans , Caregivers , Alzheimer Disease , Neurologic ManifestationsABSTRACT
Financial constraints, mobility issues, medical conditions, crime in local areas can make cognitive assessment difficult for elders and telephone interviews can be a good alternative. This study was carried out to evaluate the reliability, validity and clinical utility of a Brazilian telephone version of the Mini Mental State Examination (Braztel-MMSE) in a community sample of healthy elderly participants and AD patients. The MMSE and the Braztel-MMSE were applied to 66 AD patients and 67 healthy elderly participants. The test-retest reliability was strong and significant (r = .92, p = .01), and the correlation between the Braztel-MMSE and the MMSE were significant (p = .01) and strong (r = .92). The general screening ability of the Braztel-MMSE was high (AUC = 0.982; CI95% = 0.964-1.001). This telephone version can therefore be used as a screening measure for dementia in older adults that need neuropsychological screening and cannot present for an evaluation.
Subject(s)
Alzheimer Disease/diagnosis , Interviews as Topic/methods , Mass Screening , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Brazil , Female , Humans , Male , Mental Status Schedule , Neuropsychological Tests , ROC Curve , Reproducibility of Results , Statistics, Nonparametric , Validation Studies as TopicABSTRACT
Caregiver burden is common in Alzheimer's disease (AD), decreasing the quality of life among caregivers and patients. Projections of aging and aging-related diseases such as AD in developing countries justify additional data about this issue because people living in these countries have shown similarly high levels of caregiver strain as in the developed world. OBJECTIVE: The aim of this study was to analyze the association of AD caregivers' burden with patients' neuropsychiatric symptoms (NPS), cognitive status, severity of dementia, functional capacity, caregiver sociodemographic characteristics, and the characteristics of care provided by caregivers. METHODS: A cross-sectional study was conducted in a sample of 39 consecutive AD patients and their primary caregivers. NPS were evaluated using the Neuropsychiatric Inventory (NPI). Severity of dementia was assessed with the Clinical Dementia Rating (CDR) scale. Functional capacity was assessed using the Katz and Lawton scales. The burden level was rated using the Burden Interview (BI). Sociodemographic characteristics of caregivers and the characteristics of care provided by them were evaluated. The Mann-Whitney U-test, Kruskal-Wallis test and Spearman's rho coefficient were performed. RESULTS: The BI had a moderate correlation with NPI intensity (rho=0.563), p<001. Female caregivers reported a greater level of burden (p=0.031) than male caregivers. The other variables were not significantly associated to caregiver burden. CONCLUSION: NPS were the main determinant of burden in primary caregivers of AD patients. This result underscores the need for prevention and treatment of these symptoms. Sex also had an effect on caregiver burden, but the small male sample in this study precludes the generalization of this finding.
Sobrecarga no cuidador é comum na doença de Alzheimer (DA), diminuindo a qualidade de vida dos cuidadores e pacientes. As projeções de envelhecimento e doenças relacionadas ao envelhecimento como a DA nos países em desenvolvimento justificam dados adicionais sobre esta questão, porque as pessoas que vivem nestes países têm apresentado níveis semelhantes de sobrecarga no cuidador tão alto quanto no mundo desenvolvido. OBJETIVO: O estudo teve como objetivo analisar a associação da sobrecarga em cuidadores de pacientes com DA com sintomas neuropsiquiátricos (NPS) dos pacientes, estatus cognitivo, gravidade da demência, capacidade funcional, características sociodemográficas do cuidador e as características dos cuidados prestados pelos cuidadores. MÉTODOS: Um estudo transversal foi realizado em uma amostra de 39 pacientes consecutivos de DA e seus cuidadores primários. NPS foram avaliados através do Inventário Neuropsiquiátrico (NPI). A gravidade da demência foi avaliada com a escala Clinical Dementia Rating (CDR). A capacidade funcional foi avaliada com as escalas de Katz e Lawton. O nível de sobrecarga foi avaliada utilizando a escala Burden Interview (BI). Características sociodemográficas dos cuidadores e as características de atendimento prestado por eles foram avaliadas. Mann-Whitney, Kruskal-Wallis e coeficiente rho de Spearman foram calculados. RESULTADOS: BI apresentou correlação moderada com a intensidade do NPI (rho=0,563), p<001. Cuidadoras mulheres relataram maior nível de sobrecarga (p=0,031) do que cuidadores do sexo masculino. As demais variáveis não foram significativamente associados à sobrecarga do cuidador. CONCLUSÃO: NPS foram o principal determinante da sobrecarga do cuidador de pacientes com DA. Esse resultado reforça a necessidade de prevenção e tratamento desses sintomas. Sexo também teve um efeito sobre a sobrecarga do cuidador, mas a pequena amostra do sexo masculino neste estudo evita a generalização dessa constatação.
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OBJECTIVES: Since 2002, the treatment with cholinesterase inhibitors (CHEIs) for Alzheimer's disease (AD) has been paid for by the public health system of the Brazilian Ministry of Health for any patient that fulfills clinical criteria established by an evidence-based guideline developed and published by the Ministry. The aim of this study was to evaluate compliance of prescription patterns to the national guideline for use of CHEIs' in the southern Brazilian state of Rio Grande do Sul. METHODS: We created a regional expert-committee reference center to review all prescriptions of CHEIs and to send feedback to physicians whenever prescriptions without compliance to the guideline were noted. One thousand three hundred ninety-nine (1,399) CHEI prescriptions presented to the public health system from 2005 to 2007 were evaluated by an expert team of neurologists and psychiatrists. Clinical history, performance on mental status screening by Mini Mental State Examination (MMSE), Clinical Dementia Rating scale (CDR), laboratory results, and neuroimaging findings were evaluated in relation to the adherence to the national guideline's recommendations. If the prescription was rejected because of lack of adherence to the criteria of the guideline, a written response was sent by the expert committee to physicians concerning the request. RESULTS: The majority of the requests (n = 1,044; 75 percent) did not meet the AD guideline's criteria, either for diagnosis or for treatment, and were not granted. A diagnostic mistake was evident in 64.3 percent of cases. Findings of vascular or Parkinson's dementia or severe AD were the main reasons for rejection. Rivastigmine was the most prescribed cholinesterase inhibitor, used in 86 percent of cases. Of note was the reduction in the number of CHEIs prescriptions in the years following this intervention. CONCLUSIONS: The public health strategy of using expert-review of prescriptions and their compliance to national guideline revealed a low rate of rational use of CHEIs for dementia. Such a strategy is relevant for protecting patients from unproven medical interventions and for reducing waste of resources.
Subject(s)
Alzheimer Disease/drug therapy , Cholinesterase Inhibitors/therapeutic use , Guidelines as Topic , Peer Review , Public Health , Brazil , Evidence-Based Medicine , HumansABSTRACT
The association of successful aging with demographic, socioeconomic, and medical characteristics in healthy community-dwelling Brazilian individuals aged 60 years and older (N = 345) was investigated. Participants were classified as successful (n = 214, 62%) or normal (n = 131, 38%) agers. Successful agers participated in significantly more leisure activities (34%) than did normal agers (21%). Multivariate logistic regression analysis revealed that the number of living children was a risk factor, whereas confidants and family income were protective factors for successful aging.
Subject(s)
Adaptation, Psychological , Aging/psychology , Developing Countries , Urban Population , Activities of Daily Living/psychology , Aged , Brazil , Cohort Studies , Cross-Cultural Comparison , Family Characteristics , Female , Friends/psychology , Geriatric Assessment , Health Status , Humans , Interpersonal Relations , Leisure Activities , Longitudinal Studies , Male , Middle Aged , Social Support , Socioeconomic FactorsABSTRACT
AIM: The endogenous circadian clock generates daily variations of physiological and behavior functions such as the endogenous interindividual component (morningness/eveningness preferences). Also, mood disorders are associated with a breakdown in the organization of ultradian rhythm. Therefore, the purpose of the present study was to assessed the association between chronotype and the level of depressive symptoms in a healthy sample population. Furthermore, the components of the depression scale that best discriminate the chronotypes were determined. METHODS: This cross-sectional study involved 200 volunteers, aged 18-99 years, 118 women and 82 men. The instruments were the Montgomery-Asberg Depression Rating Scale (MADRS), the Morningness/Eveningness Questionnaire, the Self-Reporting Questionnaire-20, and the future self-perception questionnaire. RESULTS: Logistic regression showed that subjects with the eveningness chronotype had a higher chance of reporting more severe depressive symptoms compared to morning- and intermediate-chronotypes, with an odds ratio (OR) of 2.83 and 5.01, respectively. Other independent cofactors associated with a higher level of depressive symptoms were female gender (OR, 3.36), minor psychiatric disorders (OR, 3.70) and low future self-perception (OR, 3.11). Younger age, however, was associated with a lower level of depressive symptoms (OR, 0.97). The questions in the MADRS that presented higher discriminate coefficients among chronotypes were those related to sadness, inner tension, sleep reduction and pessimism. CONCLUSION: Identification of an association between evening typology and depressive symptoms in healthy samples may be useful in further investigation of circadian typology and the course of depressive disease.
Subject(s)
Circadian Rhythm , Depression/psychology , Personality , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Photoperiod , Psychiatric Status Rating Scales , SleepABSTRACT
The objective of the study was to evaluate incident cases of Alzheimer disease (AD) and mild cognitive impairment (MCI) in an elderly community cohort in a major city of southern Brazil and to determine the variables associated with the development of cognitive dysfunction. Data were drawn from a cohort to investigate healthy aging among community elderly (N = 345) and were derived from the follow-up for a maximum of 8 years. Sociodemographic, psychiatric and medical information, the Mini-Mental State Examination (MMSE), and the Clinical Dementia Rating scale were obtained in each assessment. The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition; DSM-IV), NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and related Disorders Association), and the Mayo Clinic criteria were applied to ascertain diagnoses of AD and MCI. The incidence rate per 1000 persons-year for MCI was 13.2 (95% confidence interval [CI] 7.79-20.91) and for AD was 14.8 (95% CI 9.04-22.94). Cognitive dysfunction was associated with education (odds ratio [OR] = 0.86; confidence limit [CL] 0.76-0.97 95%) and baseline MMSE (OR = 0.81; CL 0.70-0.94 95%). The AD incidence in this sample was higher than those reported in a previous Brazilian study. The study filled the epidemiological gap in the evaluation of MCI in Brazil.
Subject(s)
Alzheimer Disease/epidemiology , Cognition Disorders/epidemiology , Aged , Analysis of Variance , Brazil/epidemiology , Educational Status , Female , Follow-Up Studies , Humans , Incidence , Logistic Models , Male , Neuropsychological Tests , Odds Ratio , Psychiatric Status Rating Scales , Socioeconomic FactorsABSTRACT
BACKGROUND: Behavioral symptoms and caregivers' responses may differ among various ethnic and cultural groups. Therefore it is important to have a reliable instrument to assess behavioral disturbances of dementia in various cultures. The Neuropsychiatric Inventory (NPI) has been widely used in many countries. To date there has been no reliability study of this instrument in Brazil. METHODS: The psychometric properties of the Brazilian Portuguese version of the NPI were studied in a sample of 36 Alzheimer's disease (AD) outpatients from southern Brazil. Test-retest, inter-rater reliability and internal consistency were estimated. The profile of neuropsychiatric symptoms and caregiver distress were also evaluated. The NPI was translated into Portuguese and then back translated to English. RESULTS: The Brazilian Portuguese version of the NPI showed good inter-rater and test-retest reliability with the coefficients of all scales > 0.85. Internal consistency was also good (Cronbach's alpha 0.70 for total severity and distress). Apathy provided higher NPI scores of total severity and distress. CONCLUSIONS: This NPI version was found to be a reliable instrument for the evaluation of neuropsychiatric symptoms and caregiver distress due to dementia in AD. The profile of behavioral disturbances was similar to that observed in other countries. Severity of dementia may have biased some caregivers' answers.
Subject(s)
Alzheimer Disease , Caregivers , Language , Aged , Alzheimer Disease/diagnosis , Alzheimer Disease/epidemiology , Alzheimer Disease/psychology , Brazil , Caregivers/psychology , Caregivers/statistics & numerical data , Cross-Sectional Studies , Female , Humans , Male , PsychometricsABSTRACT
Memory and other cognitive complaints are common in the elderly population. However, the clinical meaning of these complaints remains controversial. OBJECTIVES: The goal of this study was to investigate the association between cognitive complaints and performance on a mental state screening test in elderly patients attended for the first time at the Neurogeriatric and Dementia (NGA) Outpatient Clinic within a major University hospital. METHODS: Two hundred patients referred to the NGA Clinic during 2005, 2006 and 2007 first semesters participated in the study. The variables of interest were:(a) source of and reason for referral;(b) whether or not they had previously been evaluated with the screening test (Mini Mental State Exam - MMSE) by their physicians before referral to our specialized clinic;(c) cognitive complaints; and(d) performance on the screening test (MMSE) at the NGA Clinic. RESULTS: The main reason for referral to the NGA clinic was cognitive complaints 63% (N=126), where only 5% (N=10) of the referred patients had been previously evaluated by the cognitive screening test (MMSE or equivalent). Of the 135 patients who presented cognitive complaints during the first appointment, 52 (38%) presented MMSE scores below the education-adjusted cut-off. No association between cognitive complaint and performance on the MMSE during the first evaluation at the NGA Clinic was observed (χ2=3.04, p=0.1). CONCLUSIONS: Although cognitive complaints among elders should not be disregarded, the mental state screening evaluation is crucial for the detection of clinically significant cognitive impairment.
Memória e outras queixas cognitivas são comuns na população idosa. No entanto, o significado clínico destas queixas permanece controverso. OBJETIVO: O objetivo deste estudo foi investigar a associação entre queixa cognitiva e desempenho em um teste de rastreio do estado mental em pacientes idosos que consultavam pela primeira vez no Ambulatório de Neurogeriatria e Demência (NGA) de um grande hospital universitário. MÉTODOS: Duzentos pacientes que foram encaminhados ao Ambulatório de Neurogeriatria durante os primeiros semestres de 2005, 2006 e 2007 participaram do estudo. As variáveis de interesse foram:(a) fonte e razão do encaminhamento;(b) existência de avaliação, com um teste de rastreio (Mini Exame do Estado Mental - MEEM), pelos seus médicos assistentes prévia ao encaminhamento ao NGA;(c) queixa cognitiva na consulta do NGA, e(d) desempenho no teste de rastreio (MEEM) no Ambulatório NGA. RESULTADOS: O principal motivo de encaminhamento ao ambulatório de NGA foi queixa cognitiva 63% (N=126), somente 5% (N=10) dos pacientes encaminhados foram submetidos a algum teste de rastreio cognitivo prévio (MEEM ou equivalente). Dos 135 pacientes com queixa cognitiva durante a primeira avaliação, 52 (38%) apresentavam escores do MEEM abaixo do ponto de corte, ajustados para escolaridade. Nenhuma associação entre queixa cognitiva e desempenho no MEEM durante a primeira avaliação no ambulatório de NGA foi observada (χ2=3.04, p=0.1). CONCLUSÕES: Embora, queixas cognitivas entre idosos não devem ser ignoradas, avaliação, através de rastreio do estado mental, é crucial para detecção de comprometimento cognitivo clinicamente significativo.
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General psychiatric symptoms may interfere with the ability of individuals to take care of their health, to get involved with activities and develop social abilities, thereby increasing risk of death. OBJECTIVE: To evaluate general psychiatric symptoms as predictive factors for mortality in a community elderly cohort in Southern Brazil. METHODS: 345 healthy elderly, aged .60 years, from the catchment area of Hospital de Clinicas de Porto Alegre were followed from 1996. Data for the present study were drawn from the period 1996-2004. General psychiatric symptoms (Self-Reporting Questionnaire . SRQ), depressive symptoms (Montgomery-Asberg depressive rating scale), and Mini Mental State Examination scores at baseline were included in the study. Socio-demographic, medical conditions, and functional capacity were also analyzed. The outcome was vital status at follow-up obtained from family members, hospital records and checked against official death registers. RESULTS: Of the 345 baseline individuals, 246 were followed-up. The global mortality rate over the study period was 36.9% (N=90). Those who deceased during the period were older (73.5±7.5), more dependent overall, and more cognitively impaired than the living elderly (univariate analyses). In the logistic regression, only age (OR=0.93; p=0.003) and functional capacity (OR=0.22; p=0.007) remained significant in the final equation. CONCLUSION: Psychiatric symptoms presented no association with mortality in the present sample. Older age and functional incapacity were risk factors for mortality.
Sintomas psiquiátricos gerais podem interferir com a capacidade do indivíduo cuidar de sua saúde, de envolver-se com outras atividades e desenvolver habilidades sociais, aumentando o risco de morte. OBJETIVO: Avaliar se os sintomas psiquiátricos são preditores de mortalidade em uma coorte de idosos de uma comunidade do sul do Brasil. MÉTODOS: 345 idosos saudáveis, com idade igual ou superior a 60 anos, da área de abrangência de um hospital universitário de uma cidade do sul do Brasil foram acompanhados desde 1996. Os dados desse estudo representam o período de avaliação de 1996 a 2004. Os sintomas psiquiátricos na avaliação inicial foram medidos através do Self-Reporting Questionnaire (SRQ) e da Escala Montgomery-Asberg para sintomas depressivos (MADRS) e as variáveis independentes foram desempenho cognitivo no Mini Exame do Estado Mental (MEEM). Dados sócio-demográficos, questionário sobre condições sociais e de saúde, e capacidade funcional também foram analizados. O desfecho principal foi mortalidade durante o seguimento, obtida através de familiares e registros de óbito. RESULTADOS: Dos 345 idosos "baseline", dados foram obtidos de 246 no seguimento. Taxa de mortalidade global no seguimento foi de 36.9% (N=90). Aqueles que faleceram durante o período de avaliação eram mais idosos (73,5±7,5), mais globalmente dependentes e comprometidos do ponto de vista cognitivo do que os idosos que permaneceram vivos (análises univariadas). Na regressão logística, apenas idade (RC=0,93; p=0,003) e capacidade funcional (RC=0,22; p=0,007) mantiveram significância na equação final. CONCLUSÕES: Sintomas psiquiátricos não mostraram efeito preditor para mortalidade na presente amostra. Maior idade e incapacitação foram fatores de risco para mortalidade.
