Differential diagnosis between dementia and psychiatric disorders: Diagnostic criteria and supplementary exams Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Bottino, Cássio M.C.; Pádua, Analuiza Camozzato de; Smid, Jerusa; Areza-Fegyveres, Renata; Novaretti, Tânia; Bahia, Valeria S.

doi:10.1590/S1980-57642011DN05040006

Abstract

In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1) to present the evidence found on Brazilian (LILACS, SCIELO) and International (MEDLINE) databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and 2) to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption.

Key words:
dementia; Alzheimer's disease; depression; alcohol; psychoactive drug; guidelines; consensus; Brazil.

Resumo

Em 2005, o Departamento Científico de Neurologia Cognitiva e do Envelhecimento da ABN publicou as recomendações para o diagnóstico da Doença de Alzheimer. Essas recomendações foram revisadas através de buscas em bases de dados PUBMED, SCIELO e LILACS, buscando evidências nacionais e internacionais sobre esses temas. Este artigo de revisão tem como objetivos: 1) apresentar as evidências encontradas em bases de dados brasileiras (LILACS, SCIELO) e internacionais (MEDLINE), até maio de 2011, sobre o diagnóstico diferencial desses transtornos psiquiátricos com demência, tendo como foco especial a demência de Alzheimer e a demência vascular, incluindo os exames complementares que podem auxiliar neste processo diagnóstico; e 2) propor recomendações que podem ser úteis a clínicos e pesquisadores envolvidos com o diagnóstico de pacientes com demência. O diagnóstico diferencial entre demência e outros transtornos neuropsiquiátricos deve sempre incluir a avaliação de depressão, delirium, e o uso de substâncias psicoativas, tais como benzodiazepínicos, antiepilépticos e o padrão de consumo de bebidas alcoólicas.

Palavras-chave:
demência; doença de Alzheimer; depressão; álcool; substâncias psicoativas; diretrizes; consenso; Brasil.

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Full text available only in PDF format.

References

Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R; Academia Brasileira de Neurologia.Diagnóstico de doença de Alzheimer no Brasil: critérios diagnósticos e exames complementares. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:713-719.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, D.C: American Psychiatric Association; 1994.
World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Genova: World Health Organization; 1993.
Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 2006;63:530-538.
Kawas CH. Clinical practice: early Alzheimer's disease. N Engl J Med 2003;349:1056-1063.
Steffens DC, Otey E, Alexopoulos GS, Butters MA, et al. Perspectives on depression, mild cognitive impairment, and cognitive decline. Arch Gen Psychiatry 2006;63:130-138.
Potter GG, Steffens DC. Contribution of depression to cognitive impairment and dementia in older adults. Neurologist 2007;13:105-117.
Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. 'Vascular depression' hypothesis. Arch Gen Psychiatry 1997;54:915-922.
Alexopoulos GS. Depression in the elderly. Lancet 2005;365: 1961-1970.
Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-1983;17:37-49.
Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999;14:858-865.
Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 1977; 106:203-214.
Batistoni SS, Neri AL, Cupertino AP. Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly. Rev Saude Publica 2007;41:598-605.
Dratcu L, da Costa Ribeiro L, Calil HM. Depression assessment in Brazil. The first application of the Montgomery-Asberg Depression Rating Scale. Br J Psychiatry 1987;150: 797-800.
Moreno RA, Moreno DH. Escalas de Depressão de Montgomery & Asberg (MADRS) e de Hamilton (HAM-D)/Hamilton and Montgomery & Asberg depression rating scales. Rev Psiquiatr Clin 1998;25:262-272.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh G. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.
Gorestein C, Andrade L. Inventário de Depressão de Beck: propriedades psicométricas da versão em português. Rev Psiquiatr Clin 1998;25:245-250.
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.
Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Brazilian version of the Cornell depression scale in dementia. Arq Neuropsiquiatr 2007;65:912-915.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
Camozzato AL, Kochhann R, Simeoni C, et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393.
Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Res 1991;38: 143-162.
Guimarães HC, Fialho PPA, Carvalho VA, Santos EL, Caramelli P. Brazilian caregiver version of the Apathy Scale. Dement Neuropsychol 2009;3:321-326.
Paradela EMP, Lourenço RA, Veras RP. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saude Publica 2005;39:918-923.
Tavares M. Entrevista Clínico-Estruturada para o DSM IV - Transtorno do Eixo I, Edição de Pesquisa, SCID-I/P. Instituto de Psicologia, Universidade de Brasília, DF; 1996.
Diniz BS, Teixeira AL, Talib LL, Mendonça VA, Gattaz WF, Forlenza OV. Increased soluble TNF receptor 2 in antidepressant-free patients with late-life depression. J Psychiatr Res 2010;44:917-920.
Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-1. J Clin Psychiatry 1998;59 Suppl 20:22-33.
Lecrubier Y, Weiller E, Hergueta T, Amorim P, Bonora LI, Lépine JP, et al. Mini International Neuropsychiatric Interview. Brazilian Version 5.0.0 DSM-IV; 2002. http://www.medical-outcomes.com.www.medical-outcomes.com
» http://www.medical-outcomes.com.www.medical-outcomes.com
de Azevedo Marques JM, Zuardi AW. Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil. Gen Hosp Psychiatry 2008;30:303-310.
Roth M, Tym E, Mountjoy CQ, et al. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.
Bottino CMC, Almeida OP, Tamai S, Forlenza OV, Scalco MZ, Carvalho IAM. Entrevista estruturada para diagnóstico de transtornos mentais em idosos - CAMDEX - The Cambridge examination for mental disorders of the elderly. Brazilian version (translated and adapted on behalf of the editors, Cambridge University Press); 1999.
Bottino CMC, Zucollo P, Moreno MDPQ, et al. Assessment of memory complainers in São Paulo, Brazil: three-year results of a memory clinic. Dement Neuropsychol 2008; 2:52-56.
Feil D, Razani J, Boone K, Lesser I. Apathy and cognitive performance in older adults with depression. Int J Geriatr Psychiatry 2003;18:479-485.
Butters MA, Whyte EM, Nebes RD, Begley AE, Dew MA, Mulsant BH, Zmuda MD, Bhalla R, et al. The nature and determinants of neuropsychological functioning in late-life depression. Arch Gen Psychiatry 2004;61:587-595.
Henry JD, Crawford JR. A meta-analytic review of verbal fluency deficits in depression. J Clin Exp Neuropsychol 2005;27:78-101.
Thomas AJ, O'Brien JT. Depression and cogntion in older adults. Curr Opin Psychiatry 2008;21:8-13.
O'Brien JT. Role of imaging techniques in the diagnosis of dementia. Br J Radiol 2007;80 Spec No 2:S71-7.
Lorenzetti V, Allen NB, Fornito A, Yücel M. Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. J Affect Disord 2009;117:1-17.
McKinnon MC, Yucel K, Nazarov A, MacQueen GM. A meta-analysis examining clinical predictors of hippocampal volume in patients with major depressive disorder. J Psychiatry Neurosci 2009;34:41-54.
Inouye SK. Delirium in older persons. N Engl J Med 2006; 354:1157-1165.
Lima DP, Ochiai ME, Lima AB, Curiati JA, Farfel JM, Filho WJ. Delirium in hospitalized elderly patients and post-discharge mortality. Clinics (Sao Paulo) 2010;65:251-255.
Adamis D, Sharma N, Whelan PJ, Macdonald AJ. Delirium scales: a review of current evidence. Aging Ment Health 2010;14: 543-555.
Fabbri RM, Moreira MA, Garrido R, Almeida OP. Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Arq Neuropsiquiatr 2001;59:175-179.
American Psychiatric Association. Practice guidelines for the treatment of patients with Alzheimer´s disease and other dementias of late life. APA: Washington, DC; 1997:8-10.
Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs 2004;18:37-48.
Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol 2004;19:437-454.
Kockelmann E, Elger CE, Helmstaedter. Significant improvement in frontal lobe associated neupsychological functions after withdrawal of topiramate in epilepsy patients. Epilepsy Res 2003;54:171-178.
Park SPP, Kwon SH. Cognitive effects of antiepileptic drugs. J Clin Neurol 2008;4:99-106.
Loring DW, Williamson DJ, Meador KJ, Wiegand F, Hulihan J. Topiramate dose effects on cognition: a randomized double-blind study. Neurology 2011;76:131-137.
Stella F, Caetano D, Cendes F, Gurreiro CAM. Acute psychotic disorders induced by topiramate: report of two cases. Arq Neuropsiquiatr 2002;60:285-287.
Dias BCS, Capitanio LV, Ferreira BCG, Senna RC, Silva WO, Albuquerque M. Efeitos adversos psiquiátricos desencadeados por topiramato: relato de dois casos. J Epilepsy Clin Neurophysiol 2007;13:79-82.
Brust JCM. Ethanol and cognition: indirect effects, neurotoxicity and neuroprotection. A review. Int J Environ Res Public Health 2010;7:1540-1557.
Harper C. The neuropathology of alcohol-related brain damage. Alcohol Alcohol 2009;44:136-140.
Oslin D, Atkinson RM, Smith DM, Hendrie H. Alcohol related dementia: proposed clinical criteria. Int J Geriatr Psychiatry 1998;13:203-212.
Kopelman MD, Thomson AD, Guerrini I, Marshall EJ. The Korsakoff Syndrome: Clinical aspects, psychology and treatment. Alcohol Alcohol 2009;44:148-154.
Maciel C, Kerr-Correa F. Psychiatry complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders. Rev Bras Psiquiatr 2004;26 Suppl 1:S47-S50.
Colchester A, Kingsley D, Lasserson D, et al. Structural MRI volumetric analysis in patients with organic amnesia: 1. Methods and comparative findings across diagnostic groups. J Neurol Neurosurg Psychiatry 2001;71:13-22.
Guerrini I, Thomson AD, Gurling HM. Molecular genetics of alcohol-related brain damage. Alcohol Alcohol 2009; 44:166-70.
Kohler CG, Ances BM, Coleman AR, Ragland JD, Lazarev M, Gur RC. Marchiafava-Bignami disease: literature review and case report. Neuropsychiatry Neuropsychol Behav Neurol 2000;13:67-76.
Bello, VME, Schultz RR. Prevalence of treatable and reversible dementias. A study in a dementia outpatient clinic. Dement Neuropsychol 2011;5:44-47.
Bottino CM, Azevedo D Jr, Tatsch M, et al. Estimate of dementia prevalence in a community sample from São Paulo, Brazil. Dement Geriatr Cogn Disord 2008;26:291-299.
Hirata ES, Nakano EY, Junior JA, Litvoc J, Bottino CM. Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil. Int J Geriatr Psychiatry 2009;24:1045-1053.
Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA 1984;252:1905-1957.
Lopes MA, Furtado EF, Ferrioli E, Litvoc J, Bottino CM. Prevalence of alcohol-related problems in an elderly population and their association with cognitive impairment and dementia. Alcohol Clin Exp Res 2010;34:726-733.
Hulse GK, Lautenschlager NT, Tait RJ, Almeida OP. Dementia associated with alcohol and other drug use. Int Psychogeriatr 2005;17 Suppl 1:S109-S127.
Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol 1995;56:423-432.
Lima CT, Freire AC, Silva AP, Teixeira RM, Farrell M, Prince M. Concurrent and construct validity of the audit in an urban brazilian sample. Alcohol Alcohol 2005;40:584-589.
Oliveira JB, Santos JL, Kerr-Corrêa F, Simão MO, Lima MC. Alcohol screening instruments in elderly male: a population-based survey in metropolitan São Paulo, Brazil. Rev Bras Psiquiatr 2011;33:1-6
Selzer ML. Michigan Alcoholism Screening Test (MAST): preliminary report. Univ Mich Med Cent J 1968;34:143-145.
Willenbring ML, Christensen KJ, Spring WD Jr, Rasmussen R. Alcoholism screening in the elderly. J Am Geriatr Soc 1987;35:864-869.
Hirata ES, Almeida OP, Funari RR, Klein EL. Validity of the Michigan Alcoholism Screening Test (MAST) for the detection of alcohol-related problems among male geriatric outpatients. Am J Geriatr Psychiatry 2001;9:30-34.

Publication Dates

Publication in this collection
Oct-Dec 2011

History

Received
10 Sept 2011
Accepted
12 Nov 2011

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R; Academia Brasileira de Neurologia.Diagnóstico de doença de Alzheimer no Brasil: critérios diagnósticos e exames complementares. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:713-719.

[2] American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, D.C: American Psychiatric Association; 1994.

[3] World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Genova: World Health Organization; 1993.

[4] Ownby RL, Crocco E, Acevedo A, John V, Loewenstein D. Depression and risk for Alzheimer disease: systematic review, meta-analysis, and metaregression analysis. Arch Gen Psychiatry 2006;63:530-538.

[5] Kawas CH. Clinical practice: early Alzheimer's disease. N Engl J Med 2003;349:1056-1063.

[6] Steffens DC, Otey E, Alexopoulos GS, Butters MA, et al. Perspectives on depression, mild cognitive impairment, and cognitive decline. Arch Gen Psychiatry 2006;63:130-138.

[7] Potter GG, Steffens DC. Contribution of depression to cognitive impairment and dementia in older adults. Neurologist 2007;13:105-117.

[8] Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. 'Vascular depression' hypothesis. Arch Gen Psychiatry 1997;54:915-922.

[9] Alexopoulos GS. Depression in the elderly. Lancet 2005;365: 1961-1970.

[10] Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-1983;17:37-49.

[11] Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry 1999;14:858-865.

[12] Weissman MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol 1977; 106:203-214.

[13] Batistoni SS, Neri AL, Cupertino AP. Validity of the Center for Epidemiological Studies Depression Scale among Brazilian elderly. Rev Saude Publica 2007;41:598-605.

[14] Dratcu L, da Costa Ribeiro L, Calil HM. Depression assessment in Brazil. The first application of the Montgomery-Asberg Depression Rating Scale. Br J Psychiatry 1987;150: 797-800.

[15] Moreno RA, Moreno DH. Escalas de Depressão de Montgomery & Asberg (MADRS) e de Hamilton (HAM-D)/Hamilton and Montgomery & Asberg depression rating scales. Rev Psiquiatr Clin 1998;25:262-272.

[16] Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh G. An inventory for measuring depression. Arch Gen Psychiatry 1961;4:561-71.

[17] Gorestein C, Andrade L. Inventário de Depressão de Beck: propriedades psicométricas da versão em português. Rev Psiquiatr Clin 1998;25:245-250.

[18] Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.

[19] Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Brazilian version of the Cornell depression scale in dementia. Arq Neuropsiquiatr 2007;65:912-915.

[20] Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[21] Camozzato AL, Kochhann R, Simeoni C, et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychogeriatr 2008;20:383-393.

[22] Marin RS, Biedrzycki RC, Firinciogullari S. Reliability and validity of the apathy evaluation scale. Psychiatry Res 1991;38: 143-162.

[23] Guimarães HC, Fialho PPA, Carvalho VA, Santos EL, Caramelli P. Brazilian caregiver version of the Apathy Scale. Dement Neuropsychol 2009;3:321-326.

[24] Paradela EMP, Lourenço RA, Veras RP. Validação da escala de depressão geriátrica em um ambulatório geral. Rev Saude Publica 2005;39:918-923.

[25] Tavares M. Entrevista Clínico-Estruturada para o DSM IV - Transtorno do Eixo I, Edição de Pesquisa, SCID-I/P. Instituto de Psicologia, Universidade de Brasília, DF; 1996.

[26] Diniz BS, Teixeira AL, Talib LL, Mendonça VA, Gattaz WF, Forlenza OV. Increased soluble TNF receptor 2 in antidepressant-free patients with late-life depression. J Psychiatr Res 2010;44:917-920.

[27] Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-1. J Clin Psychiatry 1998;59 Suppl 20:22-33.

[28] Lecrubier Y, Weiller E, Hergueta T, Amorim P, Bonora LI, Lépine JP, et al. Mini International Neuropsychiatric Interview. Brazilian Version 5.0.0 DSM-IV; 2002. http://www.medical-outcomes.com.www.medical-outcomes.com
» http://www.medical-outcomes.com.www.medical-outcomes.com

[29] de Azevedo Marques JM, Zuardi AW. Validity and applicability of the Mini International Neuropsychiatric Interview administered by family medicine residents in primary health care in Brazil. Gen Hosp Psychiatry 2008;30:303-310.

[30] Roth M, Tym E, Mountjoy CQ, et al. CAMDEX: a standardised instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. Br J Psychiatry 1986;149:698-709.

[31] Bottino CMC, Almeida OP, Tamai S, Forlenza OV, Scalco MZ, Carvalho IAM. Entrevista estruturada para diagnóstico de transtornos mentais em idosos - CAMDEX - The Cambridge examination for mental disorders of the elderly. Brazilian version (translated and adapted on behalf of the editors, Cambridge University Press); 1999.

[32] Bottino CMC, Zucollo P, Moreno MDPQ, et al. Assessment of memory complainers in São Paulo, Brazil: three-year results of a memory clinic. Dement Neuropsychol 2008; 2:52-56.

[33] Feil D, Razani J, Boone K, Lesser I. Apathy and cognitive performance in older adults with depression. Int J Geriatr Psychiatry 2003;18:479-485.

[34] Butters MA, Whyte EM, Nebes RD, Begley AE, Dew MA, Mulsant BH, Zmuda MD, Bhalla R, et al. The nature and determinants of neuropsychological functioning in late-life depression. Arch Gen Psychiatry 2004;61:587-595.

[35] Henry JD, Crawford JR. A meta-analytic review of verbal fluency deficits in depression. J Clin Exp Neuropsychol 2005;27:78-101.

[36] Thomas AJ, O'Brien JT. Depression and cogntion in older adults. Curr Opin Psychiatry 2008;21:8-13.

[37] O'Brien JT. Role of imaging techniques in the diagnosis of dementia. Br J Radiol 2007;80 Spec No 2:S71-7.

[38] Lorenzetti V, Allen NB, Fornito A, Yücel M. Structural brain abnormalities in major depressive disorder: a selective review of recent MRI studies. J Affect Disord 2009;117:1-17.

[39] McKinnon MC, Yucel K, Nazarov A, MacQueen GM. A meta-analysis examining clinical predictors of hippocampal volume in patients with major depressive disorder. J Psychiatry Neurosci 2009;34:41-54.

[40] Inouye SK. Delirium in older persons. N Engl J Med 2006; 354:1157-1165.

[41] Lima DP, Ochiai ME, Lima AB, Curiati JA, Farfel JM, Filho WJ. Delirium in hospitalized elderly patients and post-discharge mortality. Clinics (Sao Paulo) 2010;65:251-255.

[42] Adamis D, Sharma N, Whelan PJ, Macdonald AJ. Delirium scales: a review of current evidence. Aging Ment Health 2010;14: 543-555.

[43] Fabbri RM, Moreira MA, Garrido R, Almeida OP. Validity and reliability of the Portuguese version of the Confusion Assessment Method (CAM) for the detection of delirium in the elderly. Arq Neuropsiquiatr 2001;59:175-179.

[44] American Psychiatric Association. Practice guidelines for the treatment of patients with Alzheimer´s disease and other dementias of late life. APA: Washington, DC; 1997:8-10.

[45] Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs 2004;18:37-48.

[46] Barker MJ, Greenwood KM, Jackson M, Crowe SF. Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Arch Clin Neuropsychol 2004;19:437-454.

[47] Kockelmann E, Elger CE, Helmstaedter. Significant improvement in frontal lobe associated neupsychological functions after withdrawal of topiramate in epilepsy patients. Epilepsy Res 2003;54:171-178.

[48] Park SPP, Kwon SH. Cognitive effects of antiepileptic drugs. J Clin Neurol 2008;4:99-106.

[49] Loring DW, Williamson DJ, Meador KJ, Wiegand F, Hulihan J. Topiramate dose effects on cognition: a randomized double-blind study. Neurology 2011;76:131-137.

[50] Stella F, Caetano D, Cendes F, Gurreiro CAM. Acute psychotic disorders induced by topiramate: report of two cases. Arq Neuropsiquiatr 2002;60:285-287.

[51] Dias BCS, Capitanio LV, Ferreira BCG, Senna RC, Silva WO, Albuquerque M. Efeitos adversos psiquiátricos desencadeados por topiramato: relato de dois casos. J Epilepsy Clin Neurophysiol 2007;13:79-82.

[52] Brust JCM. Ethanol and cognition: indirect effects, neurotoxicity and neuroprotection. A review. Int J Environ Res Public Health 2010;7:1540-1557.

[53] Harper C. The neuropathology of alcohol-related brain damage. Alcohol Alcohol 2009;44:136-140.

[54] Oslin D, Atkinson RM, Smith DM, Hendrie H. Alcohol related dementia: proposed clinical criteria. Int J Geriatr Psychiatry 1998;13:203-212.

[55] Kopelman MD, Thomson AD, Guerrini I, Marshall EJ. The Korsakoff Syndrome: Clinical aspects, psychology and treatment. Alcohol Alcohol 2009;44:148-154.

[56] Maciel C, Kerr-Correa F. Psychiatry complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders. Rev Bras Psiquiatr 2004;26 Suppl 1:S47-S50.

[57] Colchester A, Kingsley D, Lasserson D, et al. Structural MRI volumetric analysis in patients with organic amnesia: 1. Methods and comparative findings across diagnostic groups. J Neurol Neurosurg Psychiatry 2001;71:13-22.

[58] Guerrini I, Thomson AD, Gurling HM. Molecular genetics of alcohol-related brain damage. Alcohol Alcohol 2009; 44:166-70.

[59] Kohler CG, Ances BM, Coleman AR, Ragland JD, Lazarev M, Gur RC. Marchiafava-Bignami disease: literature review and case report. Neuropsychiatry Neuropsychol Behav Neurol 2000;13:67-76.

[60] Bello, VME, Schultz RR. Prevalence of treatable and reversible dementias. A study in a dementia outpatient clinic. Dement Neuropsychol 2011;5:44-47.

[61] Bottino CM, Azevedo D Jr, Tatsch M, et al. Estimate of dementia prevalence in a community sample from São Paulo, Brazil. Dement Geriatr Cogn Disord 2008;26:291-299.

[62] Hirata ES, Nakano EY, Junior JA, Litvoc J, Bottino CM. Prevalence and correlates of alcoholism in community-dwelling elderly living in São Paulo, Brazil. Int J Geriatr Psychiatry 2009;24:1045-1053.

[63] Ewing JA. Detecting alcoholism: the CAGE questionnaire. JAMA 1984;252:1905-1957.

[64] Lopes MA, Furtado EF, Ferrioli E, Litvoc J, Bottino CM. Prevalence of alcohol-related problems in an elderly population and their association with cognitive impairment and dementia. Alcohol Clin Exp Res 2010;34:726-733.

[65] Hulse GK, Lautenschlager NT, Tait RJ, Almeida OP. Dementia associated with alcohol and other drug use. Int Psychogeriatr 2005;17 Suppl 1:S109-S127.

[66] Bohn MJ, Babor TF, Kranzler HR. The Alcohol Use Disorders Identification Test (AUDIT): validation of a screening instrument for use in medical settings. J Stud Alcohol 1995;56:423-432.

[67] Lima CT, Freire AC, Silva AP, Teixeira RM, Farrell M, Prince M. Concurrent and construct validity of the audit in an urban brazilian sample. Alcohol Alcohol 2005;40:584-589.

[68] Oliveira JB, Santos JL, Kerr-Corrêa F, Simão MO, Lima MC. Alcohol screening instruments in elderly male: a population-based survey in metropolitan São Paulo, Brazil. Rev Bras Psiquiatr 2011;33:1-6

[69] Selzer ML. Michigan Alcoholism Screening Test (MAST): preliminary report. Univ Mich Med Cent J 1968;34:143-145.

[70] Willenbring ML, Christensen KJ, Spring WD Jr, Rasmussen R. Alcoholism screening in the elderly. J Am Geriatr Soc 1987;35:864-869.

[71] Hirata ES, Almeida OP, Funari RR, Klein EL. Validity of the Michigan Alcoholism Screening Test (MAST) for the detection of alcohol-related problems among male geriatric outpatients. Am J Geriatr Psychiatry 2001;9:30-34.

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