ABSTRACT
BACKGROUND/AIMS: Almost half of community-dwelling patients and 59.6% of institutionalized residents with dementia are in moderate or severe stages of this disease. The Mini-Mental State Examination (MMSE) has limited applicability to these patients due to floor effects. We aimed to determine the correlation between the MMSE and the Severe Mini-Mental State Examination (SMMSE), as well as SMMSE association with functional scales in patients having moderate to severe dementia and low levels of education. METHODS: A cross-sectional study of patients 60 years or older attending an outpatient clinic was conducted. The MMSE, SMMSE and functional scales were applied. Clinical and demographic data from medical records were reviewed. RESULTS: Seventy-five patients with a mean of 4.1±3.6 years of education were analyzed. The mean scores on the MMSE and SMMSE were 7.8±7.0 and 17.8±9.4, respectively. The results indicated that the MMSE and SMMSE correlated only in patients who had an MMSE score of less than 10 (r=0.87; p<0.001). In addition, significant correlations were found between the SMMSE and functional scales (p<0.001). It was observed that educational level did not interact with SMMSE performance. CONCLUSION: The SMMSE is a useful and reliable tool for a brief cognitive assessment of advanced dementia patients with low educational levels.
Subject(s)
Alzheimer Disease/diagnosis , Dementia, Vascular/diagnosis , Dementia/diagnosis , Educational Status , Mental Status Schedule/statistics & numerical data , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Cross-Sectional Studies , Dementia/etiology , Dementia/psychology , Dementia, Vascular/psychology , Disability Evaluation , Disease Progression , Female , Humans , Male , Middle Aged , Psychometrics/statistics & numerical data , Reproducibility of Results , Statistics as TopicABSTRACT
Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment.
A demência associada à radioterapia é uma complicação grave e tardia que acomete muitos pacientes submetidos à RT. A falta de um tratamento efetivo faz com que novas opções de tratamento sejam pesquisadas, no intuito de melhorar a qualidade de vida dos pacientes que apresentam esta complicação. Apresentamos o caso de um homem de 64 anos que anos depois de radioterapia utilizada para tratamento de um tumor de hipófise evoluiu com uma síndrome demencial frontal grave com lesões subcorticais frontais. Depois de muitas tentativas farmacológicas para melhorar seus transtornos cognitivos e comportamentais houve importante melhora cognitiva, funcional e comportamental com o uso de inibidor da acetilcolinesterase. Hipóteses para explicar este efeito positivo do tratamento são discutidas.
ABSTRACT
Os autores descrevem um caso de depressao que nao recebeu inicialmente tal diagnostico, devido a achados clinico-laboratoriais sugestivos de disfuncao frontal. Discutem o impacto desse erro de diagnostico no curso e na evolucao do caso. Discutem tambem a provavel fisiopatologia desse achado e o uso de metodos auxiliares do diagnostico em psiquiatria geriatrica
