RESUMO
BACKGROUND: The characteristics and associated risks of spontaneously reported cognitive complaints have not been investigated due to the lack of a classification instrument. METHODS: In phase 1, a classification system with descriptive categories and cognitive domains was developed by experts through a modified Delphi technique. In phase 2, 180 elderly patients seeking medical attention for cognitive complaints provided free reports of their cognitive difficulties and each complaint was recorded verbatim. Three observers were asked to classify each complaint into a descriptive category. Perceived cognitive function was further characterized using the Memory Complaint Questionnaire (MAC-Q). RESULTS: The patients reported 493 spontaneous complaints, with a range of 1-6 complaints per patient and a mean of 2.7 (±1.3). The proportion of complaints that could be classified into a category by each of the three observers varied from 91.9% to 95.7%. Inter-observer agreement assessed using the κ statistic varied from 0.79 to 1 for descriptive categories and 0.83 to 0.97 for domains. Compared with the MAC-Q, spontaneously reported complaints provided complementary information by avoiding the cueing effect provoked by the questionnaire. The total number of complaints and their occurrences in specific domains were associated with important sociodemographic and clinical factors, indicating that their meaning and associated risks need to be further investigated. CONCLUSION: The instrument developed in this study proved to be a practical tool for classifying the majority of spontaneously reported cognitive complaints with high reliability. Further studies are needed to investigate clinical usefulness of this approach.
Assuntos
Transtornos Cognitivos/classificação , Fatores Etários , Idoso , Cognição , Transtornos Cognitivos/psicologia , Técnica Delphi , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Fatores Sexuais , Inquéritos e QuestionáriosRESUMO
Dementia is a common disabling disease in the elderly. In such patients, general health conditions may worsen the functional decline and loss of autonomy. The Comprehensive Geriatric Assessment (CGA) is a validated and recommended instrument for multidimensional evaluation of the aged. Nonetheless, it has yet to be assessed in demented patients. OBJECTIVES: To analyze the functional, emotional and clinical status in elderly with dementia measured by the CGA. We also compared the results obtained in the same patients stratified for severity of dementia. METHODS: Transversal study with demented elderly outpatients. Subjects were evaluated by the CGA consisting of clinical data, Clinical Dementia Rating, performance-oriented mobility assessment of gait and balance (POMA), Cornell scale for depression, activities of daily living, Mini Mental Status Examination (MMSE), Mini Nutritional Assessment, Whispered and Snellen Test. RESULTS: Fifty-two patients with mean age of 77 years were evaluated. Majority of patients had Alzheimer disease (77%). Depression was the most prevalent comorbidity. The POMA score was related to the number of falls in the previous year. Also, there was correlation between complaints of visual and hearing impairment and the results on the Snellen and Whispered Tests. Regarding severity, 56% presented mild, 33% moderate and 11% severe condition. Patients with moderate/severe dementia had less leisure activities, greater risk of falls, along with worse performance on the MMSE, POMA and activities of daily living. CONCLUSIONS: The CGA was applied in demented elderly with the help of their caregivers, and was able to better characterize patient state of health. Subjects with moderate/severe dementia obtained poor results in several assessed criteria.
Demência é uma doença comum e incapacitante entre os idosos. Nesses pacientes, condições gerais de saúde podem agravar ainda mais o declínio funcional e a perda da autonomia. A Avaliação Geriátrica Global (AGG) é um instrumento validado e recomendado para uma abordagem multidimensional do idoso, porém, ainda pouco estudada em pacientes com demência. OBJETIVO: Analisar o estado funcional, emocional e clínico dos idosos portadores de demência através da aplicação da AGG. Nós também comparamos os resultados obtidos nos mesmos pacientes classificados de acordo com a gravidade da demência. MÉTODOS: Estudo transversal com idosos ambulatoriais portadores de demência. Eles, acompanhados de seus cuidadores, foram submetidos à AGG que constava de dados clínicos, escore clínico de demência, escala do equilíbrio e marcha de Tinetti (EEMT), escala de Cornell para depressão, atividades de vida diária, mini exame do estado mental (MEEM), mini avaliação nutricional e Testes do Sussurro e Snellen. RESULTADOS: Cinqüenta e dois idosos com idade média de 77 anos. A maioria possuía doença de Alzheimer (77%). A comorbidade mais prevalente foi depressão. A pontuação na EEMT relacionou-se com o número de quedas no último ano. Houve também correlação entre a queixa de déficit auditivo e visual com os resultados dos Testes do Sussurro e Snellen. Em relação à gravidade obteve-se: 56% leve, 33% moderada e 11% grave. Os pacientes com demência moderada/grave apresentaram menos atividades de lazer, maior risco para quedas, pior desempenho no MEEM, na EEMT e nas atividades de vida diária. CONCLUSÕES: A AGG foi realizada nos idosos portadores de distúrbios cognitivos com o auxílio do cuidador, e foi capaz de caracterizar melhor o estado geral de saúde desses pacientes. Indivíduos com demência moderada/grave obtiveram piores resultados em diversos critérios avaliados.
