Assessment of memory complainers in São Paulo, Brazil: Three-year results of a memory clinic

Bottino, Cássio Machado de Campos; Zucollo, Pedro; Moreno, Maria Del Pilar Quintero; Gil, Gislaine; Cid, Carla Garcia; Campanha, Eduardo Vilodres; Rumi, Demétrio Ortega; Camargo, Cândida Helena Pires de

doi:10.1590/S1980-57642009DN20100011

Abstract

Memory clinics were established in the USA and European countries as services to attend patients who complain of cognitive deficits, referred by primary care doctors, specialists and other hospitals. Objective: We aimed to describe the clinical and cognitive profile of consecutively evaluated subjects during the initial three years of service of a memory clinic from a university hospital. Methods: Subjects were submitted to a clinical work-up for dementia, which included laboratory exams, cranial computerized tomography, cognitive tests, and a comprehensive neuropsychological battery. Diagnosis was made according to ICD-10 criteria. Results: We evaluated 104 subjects (67.3% females and 32.7% males), with mean age of 59.1 years, 88.8% aged 50 years or above. Mean schooling was 9.9 years. Patients were classified into 10 different primary diagnostic categories, namely Depression (26.9%), Alzheimer's disease (17.3%), Memory complaints without objective impairment (17.3%), Mild Cognitive Disorder - MCD (14.4%), and Anxiety (12.5%) the most frequent diagnosis. Comparing patients with dementia, MCD, Depression or Anxiety and Memory complainers, by age (below and above 60 years), dementia was more commonly diagnosed in older subjects, while a higher frequency of memory complainers was found in the younger group. Conclusions: This preliminary report from an outpatient group of referred patients with cognitive complaints showed a higher frequency of psychiatric disorders in this sample. The memory clinic approach should be considered as a model of service which can evaluate subjects with cognitive complaints effectively and improve the quality of care delivered to this patient group.

Key words:
memory clinic; Alzheimer's disease; cognitive disorders; depression

Resumo

Clínicas de memória foram estabelecidas nos EUA e em países europeus como serviços para atender pacientes que se queixam de déficits cognitivos, encaminhados por médicos em cuidados primários, especialistas e outros hospitais. Objetivo: Nós pretendemos descrever o perfil clínico e cognitivo de sujeitos consecutivamente avaliados nos primeiros três anos de funcionamento de uma clínica de memória de um hospital universitário. Metódos: Os sujeitos foram submetidos a avaliação clínica para demência, incluindo exames laboratoriais, tomografia computadorizada de crânio, testes cognitivos e uma bateria neuropsicológica completa. Diagnóstico foi feito segundo critérios da CID-10. Resultados: Nós avaliamos 104 sujeitos (67,3% mulheres e 32,7% homens), com idade média de 59,1 anos, 88,8% com mais de 50 anos de idade. A escolaridade média era de 9,9 anos. Pacientes foram classificados em 10 categorias diagnósticas primárias diferentes, sendo Depressão (26,9%), doença de Alzheimer (17,3%), Queixas de memória sem comprometimento objetivo (17,3%), Transtorno cognitivo leve - TCL (14,4%), e Ansiedade (12,5%) as mais freqüentes. Comparando pacientes com demência, TCL, Depressão ou Ansiedade e aqueles com Queixa de memória, por idade (abaixo e acima de 60 anos), demência foi mais comumente diagnosticada nos idosos, enquanto maior freqüência daqueles com queixa de memória foi encontrada nos mais jovens. Conclusões: Este relato preliminar de pacientes ambulatoriais encaminhados com queixas cognitivas mostrou uma freqüência elevada de transtornos psiquiátricos nesta amostra. A abordagem da clínica de memória deveria ser considerada como um modelo de serviço para avaliar efetivamente sujeitos com queixas cognitivas, podendo melhorar a qualidade do cuidado prestado a estas pessoas.

Palavras-chave:
clínica de memória; doença de Alzheimer; transtornos cognitivos; depressão

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References

¹
Almeida OP, Hill K, Howard R, O'Brien J, Levy R. Demographic and clinical features of patients attending a memory clinic. Int J Geriatr Psychiatry 1993;8:487-501.
²
Philpot MP, Levy R . A Memory Clinic of the early diagnosis of dementia. Int J Geriatr Psychiatry 1987;2:195-200.
³
Roth M, Tym E, Mountjoy C, et al. CAMDEX: A standardised instrument of de diagnosis of mental disorder in the elderly with special reference for de early detection of dementia. Br J Psychiatry 1986;149:698-673.
⁴
Bottino CMC, Almeida OP, Tamai S, OV Forlenza, MZ Scalco, IAM Carvalho. 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.
⁵
Folstein MF, Folstein SE, Mchugh PR: Mini Mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
⁶
Lezak MD. Neuropsychological Assessment - 3rd ed. New York: Oxford University Press; 1995.
⁷
Spreen O, Strauss E. A Compendium of Neuropsychological Tests, Administration Norms and Commentary. New York: Oxford University Press; 1991.
⁸
Organização Mundial de Saúde. Classificação de Transtornos Mentais de Comportamento da CID-10: Descrições Clínicas e Diretrizes Diagnósticas. Porto Alegre: Editora Artes Médicas; 1993.
⁹
Petersen RC, Smith GE, Warring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
¹⁰
Hejl AM, Hørding M, Hasselbalch E, Dam H, Hemmingsen R, Waldemar G. Psychiatric morbidity in a neurology-based memory clinic: the effect of systematic psychiatric evaluation. J Am Geriatr Soc 2003;51:1773-1778.
¹¹
Edwards ER, Lindquist K, Yaffe K. Clinical profile and course of cognitively normal patients evaluated in memory disorders clinics. Neurology 2004;62:1639-1642.
¹²
Rockwood K, Chertkow H, Feldman HH. Is mild cognitive impairment a valid target of therapy? Can J Neurol Sci 2007;34(Suppl 1):S90-S96.
¹³
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.
¹⁴
Vraamark Elberling T, Stokholm J, Høgh P, Waldemar G. Diagnostic profile of young and middle-aged memory clinic patients. Neurology 2002;59:1259-1262.
¹⁵
Jonker C, Geerlings MI, Schmand B. Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 2000;15:983-991.

Publication Dates

Publication in this collection
Jan-Mar 2008

History

Received
14 Feb 2008
Reviewed
20 Feb 2008
Accepted
28 Feb 2008

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

[1] ¹
Almeida OP, Hill K, Howard R, O'Brien J, Levy R. Demographic and clinical features of patients attending a memory clinic. Int J Geriatr Psychiatry 1993;8:487-501.

[2] ²
Philpot MP, Levy R . A Memory Clinic of the early diagnosis of dementia. Int J Geriatr Psychiatry 1987;2:195-200.

[3] ³
Roth M, Tym E, Mountjoy C, et al. CAMDEX: A standardised instrument of de diagnosis of mental disorder in the elderly with special reference for de early detection of dementia. Br J Psychiatry 1986;149:698-673.

[4] ⁴
Bottino CMC, Almeida OP, Tamai S, OV Forlenza, MZ Scalco, IAM Carvalho. 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.

[5] ⁵
Folstein MF, Folstein SE, Mchugh PR: Mini Mental state. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[6] ⁶
Lezak MD. Neuropsychological Assessment - 3rd ed. New York: Oxford University Press; 1995.

[7] ⁷
Spreen O, Strauss E. A Compendium of Neuropsychological Tests, Administration Norms and Commentary. New York: Oxford University Press; 1991.

[8] ⁸
Organização Mundial de Saúde. Classificação de Transtornos Mentais de Comportamento da CID-10: Descrições Clínicas e Diretrizes Diagnósticas. Porto Alegre: Editora Artes Médicas; 1993.

[9] ⁹
Petersen RC, Smith GE, Warring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[10] ¹⁰
Hejl AM, Hørding M, Hasselbalch E, Dam H, Hemmingsen R, Waldemar G. Psychiatric morbidity in a neurology-based memory clinic: the effect of systematic psychiatric evaluation. J Am Geriatr Soc 2003;51:1773-1778.

[11] ¹¹
Edwards ER, Lindquist K, Yaffe K. Clinical profile and course of cognitively normal patients evaluated in memory disorders clinics. Neurology 2004;62:1639-1642.

[12] ¹²
Rockwood K, Chertkow H, Feldman HH. Is mild cognitive impairment a valid target of therapy? Can J Neurol Sci 2007;34(Suppl 1):S90-S96.

[13] ¹³
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment--beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.

[14] ¹⁴
Vraamark Elberling T, Stokholm J, Høgh P, Waldemar G. Diagnostic profile of young and middle-aged memory clinic patients. Neurology 2002;59:1259-1262.

[15] ¹⁵
Jonker C, Geerlings MI, Schmand B. Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 2000;15:983-991.

Brasil