Francisco Vale | Universidade Federal De Sao Carlos (original) (raw)
Papers by Francisco Vale
![Research paper thumbnail of [Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS)]](https://attachments.academia-assets.com/44875819/thumbnails/1.jpg)
](Arquivos de neuro-psiquiatria, 2005
To assess the influence of low education and illiteracy on the evaluation of dementia by the Matt... more To assess the influence of low education and illiteracy on the evaluation of dementia by the Mattis Dementia Rating Scale (MDRS). We applied the MDRS to 62 normal elderly subjects (64-77 years), divided into five groups according to schooling, i.e., 15-16 years, 11-12 years, 8-9 years, 4 years, and illiterate. The MDRS covers the study of five subscales and the sum of their scores may represent the degree of cognitive impairment. A significant difference (p < 0.05) in performance on this scale was observed among the subgroups in relation to education on 12 items, 5 subscales (illiterates < all other groups and 15-16 years > 4 and 8 years of schooling, p < or = 0.001) and the total MDRS score (illiterates < all others and 4 and 8 years < 15-16 years, p < 0.001). No significant correlations where found for age and, regarding gender, the differences were significant in only one item. Education interfered with individual performance on the MDRS. Illiteracy is a dete...
Alzheimers & Dementia, 2008
The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. P... more The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. Previously, sleepiness was negatively correlated with memory in an exploratory cross-sectional study of cognitively normal APOE-⑀4 homozygotes. If the induction of acute somnolence by lorazepam were to expose neuropsychological deficits in at-risk individuals, then it could be applied to a pharmacologic challenge for prediction of subsequent cognitive decline. Methods: Eighteen ⑀3/4 heterozygotes (HTZ) and 18 ⑀4 noncarriers (NC), 50 to 65 years of age, all healthy and cognitively normal, participated in the study. In a double blind, crossover design, we performed neuropsychological testing before, 2.5 hours, and 5 hours after participants received a single 2 mg dose of lorazepam or placebo. Main outcome measures were the Groton Maze Learning Test (GMLT), Rey Auditory Verbal Learning Test (AVLT), and 1-Back test. NC were matched to HTZ by age and years of education. Results: At 2.5 hours after the dose of lorazepam, the GMLT total errors score (Pϭ.04) and the AVLT long-term memory (Pϭ.01) and percent recall (Pϭ.005) measures of verbal memory were more impaired in HTZ than NC. A MANOVA comparing the vector of all six GMLT and AVLT measures for HTZ versus the vector of all six measures for NC yielded Pϭ.003 for 2.5 hours and Pϭ.58 for 5 hours. No differences between HTZ and NC were observed for measures of somnolence, speed, attention, or performance on the 1-Back test at any of the time points. At 5 hours, HTZ continued to make substantially more errors than NC (Pϭ.17) only on the GMLT. Conclusions: Our study suggests that somnolence induced by lorazepam impairs verbal and visuospatial memory more in healthy middle-aged APOE ⑀4 carriers than noncarriers. The results warrant further research with a larger sample to determine if lorazepam induces an even greater effect in ⑀4 homozygotes, whether substantial lorazepam-induced memory impairment predicts subsequent onset of cognitive decline and conversion to mild cognitive impairment or AD, and whether adverse effects of clinical lorazepam administration are greater in ⑀4 carriers.
Revista da Escola de Enfermagem da USP, 2014
Objetivo: Traducir y adaptar culturalmente para Brasil la escala Pain Assessment in Advanced Deme... more Objetivo: Traducir y adaptar culturalmente para Brasil la escala Pain Assessment in Advanced Dementia (PAINAD). Método: El proceso de adaptación cultural del instrumento utilizó la metodología de un referencial teórico, realizada en cinco etapas: traducción para el portugués -brasileño, versión consensual de las traducciones, retro-traducción para el idioma original, revisión por un comité de expertos en el área del instrumento y prueba piloto de equivalencia. En la última etapa, el instrumento fue evaluado y aplicado por 27 profesionales de la salud. Resultados: La Escala de Evaluación del Dolor en Demencia Avanzada fue adaptada culturalmente para Brasil y mostró equivalencia semántica con la original, así como claridad, aplicabilidad y fácil comprensión de los elementos del instrumento. Conclusión: Este proceso garantizó las propiedades psicométricas tales como confiabilidad y la validez de contenido de esa escala.
Journal of the Neurological Sciences, 2009
Arquivos de Neuro-Psiquiatria, 2005
RESUMO: O b j e t i v o: Estimar a influência da baixa escolaridade e do analfabetismo na avaliaç... more RESUMO: O b j e t i v o: Estimar a influência da baixa escolaridade e do analfabetismo na avaliação das demências através da aplicação da Escala de Mattis para Avaliação de Demência (MDRS). Método: Aplicouse a MDRS em 62 idosos normais (64-77 anos), divididos em cinco grupos, segundo a escolaridade: 15-16 anos, 11-12 anos, 8-9 anos, 4 anos, analfabetos. A MDRS abrange o estudo de 36 itens distribuídos em cinco subescalas, sendo que a soma pode representar o grau de comprometimento cognitivo. R e s u l t a d o s: Observou-se diferença significativa (p<0,05) na escala, no desempenho entre os grupos quanto a escolaridade, em 12 dos itens, nas cinco subescalas ( analfabetos< os demais grupos e os de 15-16 anos> que os de 4 e/ou 8 anos de escolaridade, p≤0,001)e no total de pontos da MDRS (analfabetos<todos os demais e 4 e 8 anos< 15-16 anos, p<0,001). Não houve correlações significativas para a idade e, quanto ao gênero, as diferenças foram significativas em apenas um item. C o n c l u s ã o: A escolaridade interferiu no desempenho dos indivíduos no MDRS. O analfabetismo é um fator determinante no rebaixamento nos escores da MDRS, podendo gerar erros diagnósticos. PA L AV R A S -C H AVE: Mattis Dementia Rating Scale (MDRS), escolaridade, demência, avaliação neuropsicológica, analfabetos.
Arquivos de Neuro-Psiquiatria, 2004
Objective: To investigate the effects of galantamine on the performance of patients with mild to ... more Objective: To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimer's disease (AD) in a computerized neuropsychological test battery (CNTB). Method:Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. Results: Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1).The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. Conclusion: Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.
Arquivos de Neuro-Psiquiatria, 2005
This article reports the recommendations of the Scientific Department of Cognitive Neurology and ... more This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition. Key words: Alzheimer's disease, dementia, behavioral and psychological symptoms of dementia, treatment. Tratamento da doença de Alzheimer no Brasil: II. Dos sintomas comportamentais e psicológicos da demência Resumo -Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os sintomas comportamentais e psicológicos da demência (SCPD). Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos sintomas comportamentais e psicológicos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos SCPD, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina, neurolépticos, antidepressivos, benzodiazepínicos, anticonvulsivantes e outros 190 Treatment of AD in Brazil: BPSD Vale FAC, et al.
Arquivos de Neuro-Psiquiatria, 2002
We describe clinical and socio-demographic features of patients with dementia attended in a terti... more We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9% of the total attendance). Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics.
Alzheimer's & Dementia, 2008
Patients and controls were matched for age (66.3Ϯ4.3 and 67.2Ϯ6.8 years, pϭ0.57), education (7.1Ϯ... more Patients and controls were matched for age (66.3Ϯ4.3 and 67.2Ϯ6.8 years, pϭ0.57), education (7.1Ϯ4.9 and 8.7Ϯ4.1 years of schooling; pϭ0.24), and cognitive state (all non-demented). Subjects were yearly assessed with the CAMCOG, a brief but comprehensive cognitive battery comprising orientation, language, memory, attention, praxis, gnosis, calculation and abstraction sub-scores. Patients were euthymic at the time of cognitive evaluation (HAMD-21 Յ 7 and YMRS Յ 4). Results: Baseline CAMCOG
Alzheimer's & Dementia, 2008
future clinical trials. Methods: From a large 24 week, double-blind, parallel group study of done... more future clinical trials. Methods: From a large 24 week, double-blind, parallel group study of donepezil vs. placebo, data will be presented on goals set at baseline by up to 1600 caregivers and patients with moderate to severe DAT . The study is global, with over 200 sites across North America, South America, Europe, Asia, Oceania and South Africa. At study initiation the caregiver and patient are separately asked to specify up to four goals. First, dementia-related symptoms in which improvement is desired are defined. These are then defined in plain language, and plausibly better and worse states are established and recorded. The resulting scale, scored from 0 at baseline, ranges from ϩ 2 ("much better" [than baseline])" to -2 ("much worse"). Results: The analyses from this large, unique, global dataset will include: proportions of patients per MMSE grouping who are able to define and set goals at baseline; concordance between caregiver and patient-set goals; influence on caregiver goal of caregiver gender and MMSE of the patient. Conclusions: The results may have the potential for better understanding of the expectations of patients and their caregivers from pharmacological intervention in moderate to severe DAT.
Alzheimer's & Dementia, 2008
The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. P... more The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. Previously, sleepiness was negatively correlated with memory in an exploratory cross-sectional study of cognitively normal APOE-⑀4 homozygotes. If the induction of acute somnolence by lorazepam were to expose neuropsychological deficits in at-risk individuals, then it could be applied to a pharmacologic challenge for prediction of subsequent cognitive decline. Methods: Eighteen ⑀3/4 heterozygotes (HTZ) and 18 ⑀4 noncarriers (NC), 50 to 65 years of age, all healthy and cognitively normal, participated in the study. In a double blind, crossover design, we performed neuropsychological testing before, 2.5 hours, and 5 hours after participants received a single 2 mg dose of lorazepam or placebo. Main outcome measures were the Groton Maze Learning Test (GMLT), Rey Auditory Verbal Learning Test (AVLT), and 1-Back test. NC were matched to HTZ by age and years of education. Results: At 2.5 hours after the dose of lorazepam, the GMLT total errors score (Pϭ.04) and the AVLT long-term memory (Pϭ.01) and percent recall (Pϭ.005) measures of verbal memory were more impaired in HTZ than NC. A MANOVA comparing the vector of all six GMLT and AVLT measures for HTZ versus the vector of all six measures for NC yielded Pϭ.003 for 2.5 hours and Pϭ.58 for 5 hours. No differences between HTZ and NC were observed for measures of somnolence, speed, attention, or performance on the 1-Back test at any of the time points. At 5 hours, HTZ continued to make substantially more errors than NC (Pϭ.17) only on the GMLT. Conclusions: Our study suggests that somnolence induced by lorazepam impairs verbal and visuospatial memory more in healthy middle-aged APOE ⑀4 carriers than noncarriers. The results warrant further research with a larger sample to determine if lorazepam induces an even greater effect in ⑀4 homozygotes, whether substantial lorazepam-induced memory impairment predicts subsequent onset of cognitive decline and conversion to mild cognitive impairment or AD, and whether adverse effects of clinical lorazepam administration are greater in ⑀4 carriers.
Arquivos de Neuro-Psiquiatria, 2014
Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of... more Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of life in mixed dementia: a 24week, randomized, placebo-controlled exploratory trial (the REMIX study)
Arquivos de neuro-psiquiatria, 2005
To assess the influence of low education and illiteracy on the evaluation of dementia by the Matt... more To assess the influence of low education and illiteracy on the evaluation of dementia by the Mattis Dementia Rating Scale (MDRS). We applied the MDRS to 62 normal elderly subjects (64-77 years), divided into five groups according to schooling, i.e., 15-16 years, 11-12 years, 8-9 years, 4 years, and illiterate. The MDRS covers the study of five subscales and the sum of their scores may represent the degree of cognitive impairment. A significant difference (p < 0.05) in performance on this scale was observed among the subgroups in relation to education on 12 items, 5 subscales (illiterates < all other groups and 15-16 years > 4 and 8 years of schooling, p < or = 0.001) and the total MDRS score (illiterates < all others and 4 and 8 years < 15-16 years, p < 0.001). No significant correlations where found for age and, regarding gender, the differences were significant in only one item. Education interfered with individual performance on the MDRS. Illiteracy is a dete...
Alzheimers & Dementia, 2008
The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. P... more The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. Previously, sleepiness was negatively correlated with memory in an exploratory cross-sectional study of cognitively normal APOE-⑀4 homozygotes. If the induction of acute somnolence by lorazepam were to expose neuropsychological deficits in at-risk individuals, then it could be applied to a pharmacologic challenge for prediction of subsequent cognitive decline. Methods: Eighteen ⑀3/4 heterozygotes (HTZ) and 18 ⑀4 noncarriers (NC), 50 to 65 years of age, all healthy and cognitively normal, participated in the study. In a double blind, crossover design, we performed neuropsychological testing before, 2.5 hours, and 5 hours after participants received a single 2 mg dose of lorazepam or placebo. Main outcome measures were the Groton Maze Learning Test (GMLT), Rey Auditory Verbal Learning Test (AVLT), and 1-Back test. NC were matched to HTZ by age and years of education. Results: At 2.5 hours after the dose of lorazepam, the GMLT total errors score (Pϭ.04) and the AVLT long-term memory (Pϭ.01) and percent recall (Pϭ.005) measures of verbal memory were more impaired in HTZ than NC. A MANOVA comparing the vector of all six GMLT and AVLT measures for HTZ versus the vector of all six measures for NC yielded Pϭ.003 for 2.5 hours and Pϭ.58 for 5 hours. No differences between HTZ and NC were observed for measures of somnolence, speed, attention, or performance on the 1-Back test at any of the time points. At 5 hours, HTZ continued to make substantially more errors than NC (Pϭ.17) only on the GMLT. Conclusions: Our study suggests that somnolence induced by lorazepam impairs verbal and visuospatial memory more in healthy middle-aged APOE ⑀4 carriers than noncarriers. The results warrant further research with a larger sample to determine if lorazepam induces an even greater effect in ⑀4 homozygotes, whether substantial lorazepam-induced memory impairment predicts subsequent onset of cognitive decline and conversion to mild cognitive impairment or AD, and whether adverse effects of clinical lorazepam administration are greater in ⑀4 carriers.
Revista da Escola de Enfermagem da USP, 2014
Objetivo: Traducir y adaptar culturalmente para Brasil la escala Pain Assessment in Advanced Deme... more Objetivo: Traducir y adaptar culturalmente para Brasil la escala Pain Assessment in Advanced Dementia (PAINAD). Método: El proceso de adaptación cultural del instrumento utilizó la metodología de un referencial teórico, realizada en cinco etapas: traducción para el portugués -brasileño, versión consensual de las traducciones, retro-traducción para el idioma original, revisión por un comité de expertos en el área del instrumento y prueba piloto de equivalencia. En la última etapa, el instrumento fue evaluado y aplicado por 27 profesionales de la salud. Resultados: La Escala de Evaluación del Dolor en Demencia Avanzada fue adaptada culturalmente para Brasil y mostró equivalencia semántica con la original, así como claridad, aplicabilidad y fácil comprensión de los elementos del instrumento. Conclusión: Este proceso garantizó las propiedades psicométricas tales como confiabilidad y la validez de contenido de esa escala.
Journal of the Neurological Sciences, 2009
Arquivos de Neuro-Psiquiatria, 2005
RESUMO: O b j e t i v o: Estimar a influência da baixa escolaridade e do analfabetismo na avaliaç... more RESUMO: O b j e t i v o: Estimar a influência da baixa escolaridade e do analfabetismo na avaliação das demências através da aplicação da Escala de Mattis para Avaliação de Demência (MDRS). Método: Aplicouse a MDRS em 62 idosos normais (64-77 anos), divididos em cinco grupos, segundo a escolaridade: 15-16 anos, 11-12 anos, 8-9 anos, 4 anos, analfabetos. A MDRS abrange o estudo de 36 itens distribuídos em cinco subescalas, sendo que a soma pode representar o grau de comprometimento cognitivo. R e s u l t a d o s: Observou-se diferença significativa (p<0,05) na escala, no desempenho entre os grupos quanto a escolaridade, em 12 dos itens, nas cinco subescalas ( analfabetos< os demais grupos e os de 15-16 anos> que os de 4 e/ou 8 anos de escolaridade, p≤0,001)e no total de pontos da MDRS (analfabetos<todos os demais e 4 e 8 anos< 15-16 anos, p<0,001). Não houve correlações significativas para a idade e, quanto ao gênero, as diferenças foram significativas em apenas um item. C o n c l u s ã o: A escolaridade interferiu no desempenho dos indivíduos no MDRS. O analfabetismo é um fator determinante no rebaixamento nos escores da MDRS, podendo gerar erros diagnósticos. PA L AV R A S -C H AVE: Mattis Dementia Rating Scale (MDRS), escolaridade, demência, avaliação neuropsicológica, analfabetos.
Arquivos de Neuro-Psiquiatria, 2004
Objective: To investigate the effects of galantamine on the performance of patients with mild to ... more Objective: To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimer's disease (AD) in a computerized neuropsychological test battery (CNTB). Method:Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. Results: Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1).The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. Conclusion: Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.
Arquivos de Neuro-Psiquiatria, 2005
This article reports the recommendations of the Scientific Department of Cognitive Neurology and ... more This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition. Key words: Alzheimer's disease, dementia, behavioral and psychological symptoms of dementia, treatment. Tratamento da doença de Alzheimer no Brasil: II. Dos sintomas comportamentais e psicológicos da demência Resumo -Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os sintomas comportamentais e psicológicos da demência (SCPD). Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos sintomas comportamentais e psicológicos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos SCPD, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina, neurolépticos, antidepressivos, benzodiazepínicos, anticonvulsivantes e outros 190 Treatment of AD in Brazil: BPSD Vale FAC, et al.
Arquivos de Neuro-Psiquiatria, 2002
We describe clinical and socio-demographic features of patients with dementia attended in a terti... more We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9% of the total attendance). Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics.
Alzheimer's & Dementia, 2008
Patients and controls were matched for age (66.3Ϯ4.3 and 67.2Ϯ6.8 years, pϭ0.57), education (7.1Ϯ... more Patients and controls were matched for age (66.3Ϯ4.3 and 67.2Ϯ6.8 years, pϭ0.57), education (7.1Ϯ4.9 and 8.7Ϯ4.1 years of schooling; pϭ0.24), and cognitive state (all non-demented). Subjects were yearly assessed with the CAMCOG, a brief but comprehensive cognitive battery comprising orientation, language, memory, attention, praxis, gnosis, calculation and abstraction sub-scores. Patients were euthymic at the time of cognitive evaluation (HAMD-21 Յ 7 and YMRS Յ 4). Results: Baseline CAMCOG
Alzheimer's & Dementia, 2008
future clinical trials. Methods: From a large 24 week, double-blind, parallel group study of done... more future clinical trials. Methods: From a large 24 week, double-blind, parallel group study of donepezil vs. placebo, data will be presented on goals set at baseline by up to 1600 caregivers and patients with moderate to severe DAT . The study is global, with over 200 sites across North America, South America, Europe, Asia, Oceania and South Africa. At study initiation the caregiver and patient are separately asked to specify up to four goals. First, dementia-related symptoms in which improvement is desired are defined. These are then defined in plain language, and plausibly better and worse states are established and recorded. The resulting scale, scored from 0 at baseline, ranges from ϩ 2 ("much better" [than baseline])" to -2 ("much worse"). Results: The analyses from this large, unique, global dataset will include: proportions of patients per MMSE grouping who are able to define and set goals at baseline; concordance between caregiver and patient-set goals; influence on caregiver goal of caregiver gender and MMSE of the patient. Conclusions: The results may have the potential for better understanding of the expectations of patients and their caregivers from pharmacological intervention in moderate to severe DAT.
Alzheimer's & Dementia, 2008
The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. P... more The apolipoprotein E (APOE) ⑀4 allele is a common Alzheimer's disease (AD) susceptibility gene. Previously, sleepiness was negatively correlated with memory in an exploratory cross-sectional study of cognitively normal APOE-⑀4 homozygotes. If the induction of acute somnolence by lorazepam were to expose neuropsychological deficits in at-risk individuals, then it could be applied to a pharmacologic challenge for prediction of subsequent cognitive decline. Methods: Eighteen ⑀3/4 heterozygotes (HTZ) and 18 ⑀4 noncarriers (NC), 50 to 65 years of age, all healthy and cognitively normal, participated in the study. In a double blind, crossover design, we performed neuropsychological testing before, 2.5 hours, and 5 hours after participants received a single 2 mg dose of lorazepam or placebo. Main outcome measures were the Groton Maze Learning Test (GMLT), Rey Auditory Verbal Learning Test (AVLT), and 1-Back test. NC were matched to HTZ by age and years of education. Results: At 2.5 hours after the dose of lorazepam, the GMLT total errors score (Pϭ.04) and the AVLT long-term memory (Pϭ.01) and percent recall (Pϭ.005) measures of verbal memory were more impaired in HTZ than NC. A MANOVA comparing the vector of all six GMLT and AVLT measures for HTZ versus the vector of all six measures for NC yielded Pϭ.003 for 2.5 hours and Pϭ.58 for 5 hours. No differences between HTZ and NC were observed for measures of somnolence, speed, attention, or performance on the 1-Back test at any of the time points. At 5 hours, HTZ continued to make substantially more errors than NC (Pϭ.17) only on the GMLT. Conclusions: Our study suggests that somnolence induced by lorazepam impairs verbal and visuospatial memory more in healthy middle-aged APOE ⑀4 carriers than noncarriers. The results warrant further research with a larger sample to determine if lorazepam induces an even greater effect in ⑀4 homozygotes, whether substantial lorazepam-induced memory impairment predicts subsequent onset of cognitive decline and conversion to mild cognitive impairment or AD, and whether adverse effects of clinical lorazepam administration are greater in ⑀4 carriers.
Arquivos de Neuro-Psiquiatria, 2014
Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of... more Effects of galantamine and galantamine combined with nimodipine on cognitive speed and quality of life in mixed dementia: a 24week, randomized, placebo-controlled exploratory trial (the REMIX study)