Criteria for the diagnosis of Alzheimer’s disease (original) (raw)
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Dementia & Neuropsychologia, 2011
This consensus prepared by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology is aimed at recommending new criteria for the diagnosis of dementia and Alzheimer's disease (AD) in Brazil. A revision was performed of the proposals of clinical and of research criteria suggested by other institutions and international consensuses. The new proposal for the diagnosis of dementia does not necessarily require memory impairment if the cognitive or behavioral compromise affects at least two of the following domains: memory, executive function, speech, visual-spatial ability and change in personality. For the purpose of diagnosis, AD is divided into three phases: dementia, mild cognitive impairment and pre-clinical phase, where the latter only applies to clinical research. In the dementia picture, other initial forms were accepted which do not involve amnesia and require a neuroimaging examination. Cerebrospinal fluid biomarkers are recommended for study, but can be utilized as optional instruments, when deemed appropriate by the clinician.
Arquivos de Neuro-Psiquiatria, 2005
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.
Dementia & Neuropsychologia
This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer’s disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.
2011
A review of the evidence on cognitive, functional and behavioral assessment for the diagnosis of dementia due to Alzheimer's disease (AD) is presented with revision and broadening of the recommendations on the use of tests and batteries in Brazil for the diagnosis of dementia due to AD. A systematic review of the literature (MEDLINE, LILACS and SCIELO database) was carried out by a panel of experts. Studies on the validation and/or adaptation of tests, scales and batteries for the Brazilian population were analyzed and classified according to level of evidence. There were sufficient data to recommend the IQCODE, DAFS-R, DAD, ADL-Q and Bayer scale for the evaluation of instrumental activities of daily living, and the Katz scale for the assessment of basic activities of daily living. For the evaluation of neuropsychiatric symptoms, the Neuropsychiatric Inventory (NPI) and the CAMDEX were found to be useful, as was the Cornell scale for depression in dementia. The Mini-Mental State Examination has clinical utility as a screening test, as do the multifunctional batteries (CAMCOG-R, ADAS-COG, CERAD and MDRS) for brief evaluations of several cognitive domains. There was sufficient evidence to recommend the CDR scale for clinical and severity assessment of dementia. Tests for Brazilian Portuguese are recommended by cognitive domain based on available data.
Clinicopathological correlates of Alzheimer's disease in a general autopsy series from Brazil
The current neuropathological staging models of Alzheimer's disease (AD) have been developed within the last 20 years. Nevertheless, they were mostly tested on Caucasians of Northern European ancestry or on Asians. Objective: To verify which of the accepted neuropathologic criteria best discriminates AD from normal aging in a well characterized Brazilian clinicopathological series. Methods: A random sample consisting of 89 subjects belonging to the Brazilian Brain Bank of the Aging Brain Study were clinically and neuropathologically fully assessed using immunohistochemistry. Clinical and functional statuses were assessed by interviewing a reliable informant. The Clinical dementia rating scale (CDR) was compared to Braak and Braak stage, the consortium to establish a registry for Alzheimer's disease (CERAD) score and NIA-Reagan (National Institute of Aging - Reagan Institute) score. Subjects with a neuropathologic diagnosis other then AD were excluded (n=27). Results: The CDR score distribution for the 62 selected subjects was as follows: CDR0=39, CDR0.5=9, CDR≥1=14. There were no differences regarding age, gender and education among the groups. CDR score correlated best with the CERAD score (r=0.5303; p<0.001) . Braak and Braak stage was significantly higher in subjects with higher CDR. Correlation of the NIA-Reagan criteria was partially disrupted because a large proportion of subjects did not fit any of its categories. Conclusions: In this series, CERAD criteria better correlated with the CDR groups. Consistent with earlier studies, some cognitively normal subjects have AD neuropathological diagnosis.
Arquivos de Neuro-Psiquiatria, 2003
Objectives: To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimer's disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. Method: The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. Results: The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. Conclusion: The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.
2020
Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly s...
During normal aging there are some cognitive and behavioral changes similar to those observed in a transitional state or mild cognitive impairment (MCI) and early onset dementia, making it challenging for health care professionals to reach an accurate and reliable diagnosis. Objective: The current study examined the performance of two different groups of patients diagnosed with probable Alzheimer's disease (AD) on a neuropsychological test battery. Methods: Twenty-two AD patients from Brasília-DF (AD1) and thirty-four AD patients from Palmas-TO, northern Brazil (AD2), were selected and a short neuropsychological battery administered. To verify the reliability of these previous diagnoses of AD, both groups of patients were compared with a group of healthy controls. Results: AD patients showed cognitive deficit but scores were lower for the AD2 group compared with the AD1 group considering the cutoff point. Notably, patients from the AD1 group were older (p=0.004) and had less formal education (p<0.001) than those from the AD2 group. Comparing different cognitive domains between AD groups, post hoc analysis showed that the AD1 group was characterized by deficits in episodic memory retrieval (p<0.001), semantic memory (p<0.001) and verbal fluency (p<0.001). In contrast, the AD2 group showed lower scores in attention (p=0.007), executive functioning (p<0.001) and working memory (p<0.001). Conclusion: This pattern suggests that the Palma group of patients had a neuropsychological profile that was inconsistent with AD. Although the results of this study have important clinical implications, the effects of age, education, and gender on cognitive performance should be explored further. DESEMPENHO NEUROPSICOLÓGICO DIFERENTE ENTRE DOIS GRUPOS DE PACIENTES DE DUAS REGIÕES DO BRASIL COM PROVÁVEL DIAGNÓSTICO DE DOENÇA DE ALZHEIMER RESUMO. Durante o envelhecimento normal existem algumas mudanças cognitivas e comportamentais similares àquelas observadas no estágio transicional ou declínio cognitivo leve e demência precoce, desafiando os profissionais da saúde a fazer um diagnóstico preciso e confiável. Objetivo: O presente estudo investigou o desempenho cognitivo de dois diferentes grupos de pacientes com provável diagnóstico de doença de Alzheimer (DA). Métodos: Vinte e dois pacientes de Brasília-DF (DA1) e trinta e quatro pacientes de Palmas-TO, norte do Brasil (DA2), foram submetidos a uma bateria neuropsicológica reduzida para verificar a confiabilidade do diagnóstico prévio de DA, comparando-se ambos os grupos a um grupo de idosos sadios. Resultados: Pacientes com DA mostraram déficit cognitivo; no entanto, os escores foram mais baixos para o grupo DA2, considerando-se o ponto de corte. É importante destacar que os pacientes do grupo DA1 foram mais velhos (p=0,004) e com menor nível de educação formal (p<0,001) que o grupo DA2. Quando comparados os diferentes domínios cognitivos entre os grupos com DA, a análise post hoc indicou que o grupo DA1 caracterizou-se por déficits em recuperação de informação episódica (p<0,001), memória semântica (p<0,001) e fluência verbal (p<0,001). Em contraste, o grupo DA2 mostrou escores menores em atenção (p=0,007), funcionamento executivo (p<0,001) e memória operacional (p<0,001). Conclusão: Estes resultados sugerem que o grupo de pacientes de Palmas apresentou um perfil neuropsicológico não compatível com DA. Embora os resultados deste estudo tenham importantes implicações clínicas, o efeito da idade, educação e gênero no desempenho cognitivo devem ser mais explorados. Palavras-chave: demência, declínio cognitivo, doença de Alzheimer, avaliação neuropsicológica, diagnóstico.
Diagnosis of Alzheimer's disease in Brazil: Supplementary exams
Dementia & Neuropsychologia, 2011
This article presents a review of the recommendations on supplementary exams employed for the clinical diagnosis of Alzheimer's disease (AD) in Brazil published in 2005. A systematic assessment of the consensus reached in other countries, and of articles on AD diagnosis in Brazil available on the PUBMED and LILACS medical databases, was carried out. Recommended laboratory exams included complete blood count, serum creatinine, thyroid stimulating hormone (TSH), albumin, hepatic enzymes, Vitamin B12, folic acid, calcium, serological reactions for syphilis and serology for HIV in patients aged younger than 60 years with atypical clinical signs or suggestive symptoms. Structural neuroimaging, computed tomography or - preferably - magnetic resonance exams, are indicated for diagnostic investigation of dementia syndrome to rule out secondary etiologies. Functional neuroimaging exams (SPECT and PET), when available, increase diagnostic reliability and assist in the differential diagnos...