Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia

Pimentel, Érica Maria Lima

doi:10.1590/S1980-57642009DN30300007

Abstract

The prevalence of dementia increases significantly from the age of 65 years, doubling every five years thereafter. Alzheimer's disease (AD) and vascular dementia (VaD) constitute the two main dementia types. Differentiating them encompasses anamnesis, neurological examination, laboratory and neuroimaging exams and neuropsychological assessment. Neuropsychological assessment produces different findings for each dementia type, and reveals those areas most impaired as well as those most preserved. The aim of the present article was to describe the role of neuropsychology in diagnosing dementia and achieving a differential diagnosis between AD and VaD. A general overview follows of the most widely known instruments used to assess cognitive function in dementia, and the cognitive changes seen in AD and VaD. The conclusion drawn was that there is significant overlap in cognitive changes between both these dementia types, while each type has its own specific characteristics which are identifiable and quantifiable on neuropsychological assessments and provide the basis for reaching a differential diagnosis.

Key words:
Alzheimer's disease; vascular dementia; neuropsychology; diagnosis.

Resumo

A prevalência de demência aumenta de maneira expressiva a partir dos 65 anos, dobrando a cada cinco anos. Doença de Alzheimer (DA) e demência vascular (DVa) são os seus dois principais tipos. O diagnóstico diferencial entre DA e DVa engloba anamnese adequada, exame neurológico, exames laboratoriais e de neuroimagem e avaliação neuropsicológica. Dentro da avaliação neuropsicológica, é possível observar as diferenças nos achados para cada demência, as áreas mais comprometidas e aquelas que ainda estão preservadas. O presente artigo tem como objetivo descrever a contribuição da neuropsicologia para o diagnóstico das demências e para o diagnóstico diferencial entre DA e DVa. É apresentada uma visão geral dos instrumentos mais conhecidos e utilizados para avaliar a função cognitiva na demência e as alterações cognitivas encontradas na DA e na DVa. Conclui-se que existe importante sobreposição das alterações cognitivas em ambas, contudo cada uma possui características particulares que podem ser identificadas e quantificadas pela avaliação neuropsicológica e que contribui para o diagnóstico diferencial.

Palavras-chave:
doença de Alzheimer; demência vascular; neuropsicologia; diagnóstico.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Abrisqueta-Gómez JA. Avaliação neuropsicológica nas fases inicial e moderada da demência do tipo Alzheimer (tese). Escola Paulista de Medicina - Universidade Federal de São Paulo. São Paulo, 1999.
²
Agüero-Torres H, Winblad B, Fratiglioni L. Epidemiology of vascular dementia: some results despite research limitations. Alzheimer Dis Assoc Disord 1999;13(Suppl 3):S15-S20.
³
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988; 23:271-284.
⁴
Allegri RF, Harris P, Serrano C, Delavald N. Perfis diferenciais de perda de memória entre a demência frontotemporal e a do tipo Alzheimer. Psicol Reflex Crit 2001;14:317-324.
⁵
André C. Demência vascular: dificuldades diagnósticas e tratamento. Arq Neuropsiquiatr 1998;56:498-510.
⁶
Azambuja L. Avaliação neuropsicológica do idoso. Rev Bras Ciênc Envelh Hum 2007;4:40-45.
⁷
Bertolucci PHF, Okamoto IH, Brucki SMD, et al. Aplicability of the CERAD neuropsychological battery to brasilian elderly. Arq Neuropsiquiatr 2001;59:532-536.
⁸
Bertollucci PHF, Brucci SMD, Campacci SR. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
⁹
Bottino CMC, Stoppe A Jr, Scalco AZ, Ferreira RCR, Hototian SR, Scalco MZ. Validade e confiabilidade da versão brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl ):S20
¹⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
¹¹
Canadian study of health and aging: study methods and prevalence of dementia. [No authors listed]. CMAJ 1994;150:899-913.
¹²
Caramelli P, Barbosa M. Como diagnosticar as quatro causas mais freqüentes de demência? Rev Bras Psiquiatr 2002;24 (Supl I):S7-S10.
¹³
Charchat H, Nitrini R, Caramelli P, Sameshima K. Investigação de marcadores clínicos dos estágios iniciais da doença de Alzheimer com testes neuropsicológicos computadorizados. Psicol Reflex Crit 2001;14:305-316.
¹⁴
Teste Wisconsin de Classificação de Cartas. (2005). WCST: Manual (JA Cunha, CM Trentini, IL Argimon, MS Oliveira, BSG Werlang, RG Prieb, Adaptação e padronização brasileira). São Paulo, SP: Casa do Psicólogo.
¹⁵
De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the token test. Cortex 1978;14:41-49.
¹⁶
Diniz LFM, Cruz MF, Torres VM, Cosenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.
¹⁷
Cassio Engel, Marcello LM, Alexandre D, Humberto E, Marcio RL, editors. Neurologia. Rio de Janeiro: Frattari; 2003.
¹⁸
Fabbri RMA, 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.
¹⁹
Fama R, Sullivan EV, Shear PK, et al. Selective cortical and hipocampal volume correlates of Mattis Dementia Rating Scale in Alzheimer disease. Arch Neurol 1997;54:719-728.
²⁰
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.
²¹
Daniel Fuentes, Leandro F. Malloy-Diniz, Candida H. Pires CA, editores. Neuropsicologia: teoria e prática. Porto Alegre: Artmed; 2008.
²²
Fuld P, Masur DM, Blau A, Howard C, Aronson M. Object memory evaluation for prospective detection of dementia in normal functioning elderly: predictive and normative data. J Clin Exp Neuropsychol 1990;12:520-528.
²³
Gallucci Neto J, Tamelini MG, Forlenza OV. Diagnostico diferencial das demências. Rev Psiq Clin (São Paulo) 2005;32:119-130.
²⁴
Gil R, Toullat G, Pluchon C, et al. Une méthode d'évaluation rapide des functions cognitives (ERFC). Son application à la démence senile de tupe Alzheimer: Cognitive function evaluation, a quick test used in Alzheimer's disease. La Semaine des hôpitaux de Paris 1986;62:2127-2133.
²⁵
Goodglass H, Kaplan E. Boston Diagnostic Aphasia Examination (BDAE). Philadelphia: Lea and Febiger; 1983.
²⁶
Graeff F, Brandão M. Neurobiologia das doenças mentais. São Paulo: Lemos editorial; 1999.
²⁷
Groves WC, Brandt J, Steinberg M, et al. Vascular dementia and Alzheimer's Disease: is there a difference? A comparation of symptoms by disease duration. J Neuropsychiatry Clin Neurosci 2000;12:305-315.
²⁸
Hachinski VC, Iliff LD, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.
²⁹
Hachinski V. Preventable senility: a call for action against the vascular dementias. Lancet 1992;340(8820):645-648.
³⁰
Herrera Jr. E, Caramelli P, Silveira ASB, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
³¹
Goodglass H, Kaplan E. Boston Naming Test. Philadelphia: Lea & Febiger; 1983.
³²
Kertesz A. Western Aphasia Battery. San Antonio TX: The Psychological Corporation; 1982.
³³
Kingsley RE. Manual de Neurociência. Rio de Janeiro: Guanabara Koogan; 2001.
³⁴
Lefèvre BH, Nitrini R. Semiologia neuropsicológica. Arq Neuropsiquiatr 1985;43:119-132.
³⁵
Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th. Oxford: Oxford University; 2004.
³⁶
Lukatela K, Cohen RA, Howard K. Dementia Rating Scale performance: a comparison of vascular and Alzheimer's dementia. J Clin Exp Neuropsychol 2000;22:445-454.
³⁷
Mattis S. Dementia Rating Scale. Professional Manual. Florida: Psychological Assessment Resources; 1988.
³⁸
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
³⁹
Monsch AU, Bondi MW, Salmon DP, et al. Clinical validity of the Mattis Dementia Rating Scale in detecting dementia of the Alzheimer type. Arch Neurol 1995;52:899-904.
⁴⁰
Morris JC, Mohs RC, Rogers H, Fillenbaum G, Heyman A. Consortium to establish a registry for Alzheimer's disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacol Bull 1988;24:641-652.
⁴¹
Nascimento E. WAIS III Manual para administraçao e avaliaçao. Sao Paulo: Casa do Psicologo; 2005.
⁴²
Nitrini R. Diagnóstico de demência: avaliação clínica neuropsicológica e através da tomografia computadorizada por emissão de fóton único. Livre-Docência. Faculdade de Medicina da Universidade de São Paulo 1993.
⁴³
Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R. Academia Brasileira de Neurologia. [Diagnosis of Alzheimer's disease in Brazil: cognitive and functional evaluation. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. Arq Neuropsiquiatr. 2005;63:720-727.
⁴⁴
Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R. Academia Brasileira de Neurologia. [Diagnosis of Alzheimer's disease in Brazil: diagnostic criteria and auxiliary tests. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. Arq Neuropsiquiatr 2005;63: 713-719.
⁴⁵
Ott A, Breteler MM, van Harskamp F, Stijnen T, Hofman A. Incidence and risk of dementia. The Rotterdam Study. Am J Epidemiol 1998;147:574-580.
⁴⁶
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
⁴⁷
Porto CS, Charchat-Fichman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
⁴⁸
Rey A. L'exam clinique en psychologie. Paris: Presses Universitaire de France ; 1964.
⁴⁹
Román GC. Defining dementia: clinical criteria for the dignosis of vascular dementia. Acta Neurol Scand 2002;106(Suppl. 178):6-9.
⁵⁰
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43: 250-260.
⁵¹
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 Br J Psychiatry 1986;149:698-709.
⁵²
Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparision of 3 standardized mental status examinations. Neurology 1990;40:1225-1230.
⁵³
Simon RP, Aminoff MJ, Greenberg DA, editors. Neurologia Clínica e Terapêutica. Porto Alegre, RS: Ed. Artes Médicas; 1991.
⁵⁴
Smid J, Nitrini R, Bahia VS, Caramelli P. Clinical characterization of vascular dementia: retrospective evaluation of an outpatient sample. Arq Neuropsiquiatr 2001;59:390-393.
⁵⁵
Schultz RR, Siviero MO, Bertolucci PH. The cognitive subscale of the "Alzheimer's Disease Assessment Scale" in a Brazilian sample. Braz J Med Biol Res. 2001;34:1295-1302.
⁵⁶
Ueda K, Hasuo Y, Fujishima M. Prevalence and etiology of dementia in a Japanese community. Stroke 1992;23:798-803.
⁵⁷
Vitiello APP, Ciríaco JGM, Takahashi DY, Nitrini R, Caramelli P. Avaliação cognitiva breve de pacientes atendidos em ambulatórios de neurologia geral. Arq Neuropsiquiatr 2007; 65: 299-303.
⁵⁸
Welsh K, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol 1991;48:278-81.
⁵⁹
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-1983;17:37-49.
⁶⁰
Jamus D, Mader M. A figura complexa de Rey e seu papel na avaliação neuropsicológica. J Epilepsy Clin Neurophysiol 2005;11:193-198.
⁶¹
Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology 1992;42(3 Pt 1):473-80.
⁶²
Engelhardt E. Demência Vascular. In: Bottino CM, Laks J, Blay SL. Demência e transtornos cognitivos em idosos. Rio de Janeiro: Guanabara-Koogan; 2006:177-195.
⁶³
DSM-IV-TR (2002). Manual Diagnóstico e Estatístico de Transtornos Mentais. (tradução) Claudia Dornelles. 4.ed. Texto revisado em 2008. São Paulo, Artmed.

Publication Dates

Publication in this collection
Jul-Sep 2009

History

Received
31 Mar 2009
Accepted
02 Aug 2009

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

[1] ¹
Abrisqueta-Gómez JA. Avaliação neuropsicológica nas fases inicial e moderada da demência do tipo Alzheimer (tese). Escola Paulista de Medicina - Universidade Federal de São Paulo. São Paulo, 1999.

[2] ²
Agüero-Torres H, Winblad B, Fratiglioni L. Epidemiology of vascular dementia: some results despite research limitations. Alzheimer Dis Assoc Disord 1999;13(Suppl 3):S15-S20.

[3] ³
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988; 23:271-284.

[4] ⁴
Allegri RF, Harris P, Serrano C, Delavald N. Perfis diferenciais de perda de memória entre a demência frontotemporal e a do tipo Alzheimer. Psicol Reflex Crit 2001;14:317-324.

[5] ⁵
André C. Demência vascular: dificuldades diagnósticas e tratamento. Arq Neuropsiquiatr 1998;56:498-510.

[6] ⁶
Azambuja L. Avaliação neuropsicológica do idoso. Rev Bras Ciênc Envelh Hum 2007;4:40-45.

[7] ⁷
Bertolucci PHF, Okamoto IH, Brucki SMD, et al. Aplicability of the CERAD neuropsychological battery to brasilian elderly. Arq Neuropsiquiatr 2001;59:532-536.

[8] ⁸
Bertollucci PHF, Brucci SMD, Campacci SR. O Mini-Exame do Estado Mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

[9] ⁹
Bottino CMC, Stoppe A Jr, Scalco AZ, Ferreira RCR, Hototian SR, Scalco MZ. Validade e confiabilidade da versão brasileira do CAMDEX. Arq Neuropsiquiatr 2001;59(Suppl ):S20

[10] ¹⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[11] ¹¹
Canadian study of health and aging: study methods and prevalence of dementia. [No authors listed]. CMAJ 1994;150:899-913.

[12] ¹²
Caramelli P, Barbosa M. Como diagnosticar as quatro causas mais freqüentes de demência? Rev Bras Psiquiatr 2002;24 (Supl I):S7-S10.

[13] ¹³
Charchat H, Nitrini R, Caramelli P, Sameshima K. Investigação de marcadores clínicos dos estágios iniciais da doença de Alzheimer com testes neuropsicológicos computadorizados. Psicol Reflex Crit 2001;14:305-316.

[14] ¹⁴
Teste Wisconsin de Classificação de Cartas. (2005). WCST: Manual (JA Cunha, CM Trentini, IL Argimon, MS Oliveira, BSG Werlang, RG Prieb, Adaptação e padronização brasileira). São Paulo, SP: Casa do Psicólogo.

[15] ¹⁵
De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the token test. Cortex 1978;14:41-49.

[16] ¹⁶
Diniz LFM, Cruz MF, Torres VM, Cosenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.

[17] ¹⁷
Cassio Engel, Marcello LM, Alexandre D, Humberto E, Marcio RL, editors. Neurologia. Rio de Janeiro: Frattari; 2003.

[18] ¹⁸
Fabbri RMA, 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.

[19] ¹⁹
Fama R, Sullivan EV, Shear PK, et al. Selective cortical and hipocampal volume correlates of Mattis Dementia Rating Scale in Alzheimer disease. Arch Neurol 1997;54:719-728.

[20] ²⁰
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.

[21] ²¹
Daniel Fuentes, Leandro F. Malloy-Diniz, Candida H. Pires CA, editores. Neuropsicologia: teoria e prática. Porto Alegre: Artmed; 2008.

[22] ²²
Fuld P, Masur DM, Blau A, Howard C, Aronson M. Object memory evaluation for prospective detection of dementia in normal functioning elderly: predictive and normative data. J Clin Exp Neuropsychol 1990;12:520-528.

[23] ²³
Gallucci Neto J, Tamelini MG, Forlenza OV. Diagnostico diferencial das demências. Rev Psiq Clin (São Paulo) 2005;32:119-130.

[24] ²⁴
Gil R, Toullat G, Pluchon C, et al. Une méthode d'évaluation rapide des functions cognitives (ERFC). Son application à la démence senile de tupe Alzheimer: Cognitive function evaluation, a quick test used in Alzheimer's disease. La Semaine des hôpitaux de Paris 1986;62:2127-2133.

[25] ²⁵
Goodglass H, Kaplan E. Boston Diagnostic Aphasia Examination (BDAE). Philadelphia: Lea and Febiger; 1983.

[26] ²⁶
Graeff F, Brandão M. Neurobiologia das doenças mentais. São Paulo: Lemos editorial; 1999.

[27] ²⁷
Groves WC, Brandt J, Steinberg M, et al. Vascular dementia and Alzheimer's Disease: is there a difference? A comparation of symptoms by disease duration. J Neuropsychiatry Clin Neurosci 2000;12:305-315.

[28] ²⁸
Hachinski VC, Iliff LD, Zilhka E, et al. Cerebral blood flow in dementia. Arch Neurol 1975;32:632-637.

[29] ²⁹
Hachinski V. Preventable senility: a call for action against the vascular dementias. Lancet 1992;340(8820):645-648.

[30] ³⁰
Herrera Jr. E, Caramelli P, Silveira ASB, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[31] ³¹
Goodglass H, Kaplan E. Boston Naming Test. Philadelphia: Lea & Febiger; 1983.

[32] ³²
Kertesz A. Western Aphasia Battery. San Antonio TX: The Psychological Corporation; 1982.

[33] ³³
Kingsley RE. Manual de Neurociência. Rio de Janeiro: Guanabara Koogan; 2001.

[34] ³⁴
Lefèvre BH, Nitrini R. Semiologia neuropsicológica. Arq Neuropsiquiatr 1985;43:119-132.

[35] ³⁵
Lezak MD, Howieson DB, Loring DW. Neuropsychological assessment. 4th. Oxford: Oxford University; 2004.

[36] ³⁶
Lukatela K, Cohen RA, Howard K. Dementia Rating Scale performance: a comparison of vascular and Alzheimer's dementia. J Clin Exp Neuropsychol 2000;22:445-454.

[37] ³⁷
Mattis S. Dementia Rating Scale. Professional Manual. Florida: Psychological Assessment Resources; 1988.

[38] ³⁸
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[39] ³⁹
Monsch AU, Bondi MW, Salmon DP, et al. Clinical validity of the Mattis Dementia Rating Scale in detecting dementia of the Alzheimer type. Arch Neurol 1995;52:899-904.

[40] ⁴⁰
Morris JC, Mohs RC, Rogers H, Fillenbaum G, Heyman A. Consortium to establish a registry for Alzheimer's disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease. Psychopharmacol Bull 1988;24:641-652.

[41] ⁴¹
Nascimento E. WAIS III Manual para administraçao e avaliaçao. Sao Paulo: Casa do Psicologo; 2005.

[42] ⁴²
Nitrini R. Diagnóstico de demência: avaliação clínica neuropsicológica e através da tomografia computadorizada por emissão de fóton único. Livre-Docência. Faculdade de Medicina da Universidade de São Paulo 1993.

[43] ⁴³
Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R. Academia Brasileira de Neurologia. [Diagnosis of Alzheimer's disease in Brazil: cognitive and functional evaluation. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. Arq Neuropsiquiatr. 2005;63:720-727.

[44] ⁴⁴
Nitrini R, Caramelli P, Bottino CM, Damasceno BP, Brucki SM, Anghinah R. Academia Brasileira de Neurologia. [Diagnosis of Alzheimer's disease in Brazil: diagnostic criteria and auxiliary tests. Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology]. Arq Neuropsiquiatr 2005;63: 713-719.

[45] ⁴⁵
Ott A, Breteler MM, van Harskamp F, Stijnen T, Hofman A. Incidence and risk of dementia. The Rotterdam Study. Am J Epidemiol 1998;147:574-580.

[46] ⁴⁶
Pfeffer RI, Kurosaki TT, Harrah CH Jr, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[47] ⁴⁷
Porto CS, Charchat-Fichman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[48] ⁴⁸
Rey A. L'exam clinique en psychologie. Paris: Presses Universitaire de France ; 1964.

[49] ⁴⁹
Román GC. Defining dementia: clinical criteria for the dignosis of vascular dementia. Acta Neurol Scand 2002;106(Suppl. 178):6-9.

[50] ⁵⁰
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43: 250-260.

[51] ⁵¹
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 Br J Psychiatry 1986;149:698-709.

[52] ⁵²
Salmon DP, Thal LJ, Butters N, Heindel WC. Longitudinal evaluation of dementia of the Alzheimer type: a comparision of 3 standardized mental status examinations. Neurology 1990;40:1225-1230.

[53] ⁵³
Simon RP, Aminoff MJ, Greenberg DA, editors. Neurologia Clínica e Terapêutica. Porto Alegre, RS: Ed. Artes Médicas; 1991.

[54] ⁵⁴
Smid J, Nitrini R, Bahia VS, Caramelli P. Clinical characterization of vascular dementia: retrospective evaluation of an outpatient sample. Arq Neuropsiquiatr 2001;59:390-393.

[55] ⁵⁵
Schultz RR, Siviero MO, Bertolucci PH. The cognitive subscale of the "Alzheimer's Disease Assessment Scale" in a Brazilian sample. Braz J Med Biol Res. 2001;34:1295-1302.

[56] ⁵⁶
Ueda K, Hasuo Y, Fujishima M. Prevalence and etiology of dementia in a Japanese community. Stroke 1992;23:798-803.

[57] ⁵⁷
Vitiello APP, Ciríaco JGM, Takahashi DY, Nitrini R, Caramelli P. Avaliação cognitiva breve de pacientes atendidos em ambulatórios de neurologia geral. Arq Neuropsiquiatr 2007; 65: 299-303.

[58] ⁵⁸
Welsh K, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol 1991;48:278-81.

[59] ⁵⁹
Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1982-1983;17:37-49.

[60] ⁶⁰
Jamus D, Mader M. A figura complexa de Rey e seu papel na avaliação neuropsicológica. J Epilepsy Clin Neurophysiol 2005;11:193-198.

[61] ⁶¹
Chui HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R. Criteria for the diagnosis of ischemic vascular dementia proposed by the State of California Alzheimer's Disease Diagnostic and Treatment Centers. Neurology 1992;42(3 Pt 1):473-80.

[62] ⁶²
Engelhardt E. Demência Vascular. In: Bottino CM, Laks J, Blay SL. Demência e transtornos cognitivos em idosos. Rio de Janeiro: Guanabara-Koogan; 2006:177-195.

[63] ⁶³
DSM-IV-TR (2002). Manual Diagnóstico e Estatístico de Transtornos Mentais. (tradução) Claudia Dornelles. 4.ed. Texto revisado em 2008. São Paulo, Artmed.

Brasil