Clinical and demographic characteristics of elderly patients with dementia assisted at an outpatient clinic in Southern Brazil

Godinho, Cláudia; Gorczevski, Iulek; Heisler, Andréa; Cerveira, Maria Otília; Chaves, Márcia Lorena

doi:10.1590/S1980-57642010DN40100007

Abstract

The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out. Objectives: The goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil. Methods: A sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA), Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL) and application of the Neuropsychiatry Inventory (NPI) for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia. Results: Of the whole sample, 71% were female. Age was 79±8 years (mean±SD). Educational level was 4±3 years (mean±SD). Sixty-four patients (60%) presented the diagnosis of Alzheimer's disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE) and functional status scores was observed among the CDR categories (severity). No significant association was found between severity and impairment on memory tests and behavioral symptoms. Conclusions: Alzheimer's disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause.

Key words:
tertiary outpatient clinic; dementia; Alzheimer's disease; vascular dementia; Brazil

Resumo

O envelhecimento da população é um fenômeno mundial, 60% destas pessoas moram em áreas em desenvolvimento do mundo, como no Brasil, onde poucos estudos têm sido conduzidos. Objetivos: O objetivo deste estudo é avaliar o perfil clínico e demográfico de pacientes com demência vistos em uma clínica especializada em demência do Hospital de Clínicas de Porto Alegre (HCPA), Brasil, durante o período de junho de 2004 a junho de 2008. A avaliação dos pacientes consistiu de história médica, testes cognitivos, avaliação do estado funcional (Atividades de vida diária - AVD; atividades instrumentais de vida diária - AIVD) e Inventário Neuropsiquiátrico (INP) para avaliação comportamental. A gravidade da demência foi avaliada com a escala CDR. Todos os pacientes realizaram testes laboratoriais de rastreio e exames de imagem para definir a etiologia da demência. Resultados: Da amostra 71% eram mulheres; idade de 79±8 anos (média±DP) e escolaridade de 4±3 anos. Sessenta e quatro pacientes (60%) apresentavam diagnóstico de doença de Alzheimer; dentro da amostra 26.7% foram classificados como CDR=1; 44% como CDR=2 e 3% como CDR=3. Uma diferença significativa nos escores do MMSE e nos escores funcionais foi observada entre as categorias de CDR (gravidade). Não houve associação significativa entre gravidade e comprometimento nos testes de memória e sintomas comportamentais. Conclusões: Doença de Alzheimer foi a etiologia mais comum, e a seguir demência vascular. No diagnóstico, a maioria dos pacientes apresentou gravidade da demência de grau leve a moderado, independente da causa.

Palavras-chave:
clínica terciária; demência; doença de Alzheimer; demência vascular; Brasil

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References

¹
Brazilian Institute of Geography and Statistics. Demographic Census (IBGE - Instituto Brasileiro de Geografia e Estatística. Censo demográfico). Rio de Janeiro: IBGE, 2000.
²
Prince M, Acosta D, Chiu H, Scazufca M, Varghese M. Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet 2003;361(9361):909-917.
³
Herrera E, Caramelli P, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
⁴
Ferri CP, Prince M, Carol C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117
⁵
Vale FAC, Miranda SC. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.
⁶
Tascone L, Marques RC, Pereira EC, Bottino CMC. Characteristics of patients assisted at an ambulatory of dementia from a University Hospital. Arq Neuropsiquiatr 2008;66:631-635.
⁷
Nitrini R, Lefèvre BH, Mathias SC, et al. Evaluation of 100 patients with dementia in São Paulo, Brazil: correlation with socioeconomic status and education. Alzheimer Dis Assoc Disord 1995;9:146-151.
⁸
Silva DW, Damasceno BP. Demência na população de pacientes do Hospital das Clínicas da Unicamp. Arq Neuropsiquiatr 2002;60:996-999
⁹
Chodosh J, Petitti DB, Eliott M, et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc 2004;52:1051-1059.
¹⁰
Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med 2000;160:2964-2968.
¹¹
Löppönen M, Räihä I, Isoaho R, et al. Diagnosing cognitive impairment and dementia in primary health care: a more active approach is needed. Age Ageing 2003;32:606-612.
¹²
Diagnostic and Statistical Manual of Psychiatric Disorders 4.Ed. (DSMIV) Washington DC: APA, 1994.
¹³
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease. Neurology 1984;34:939-944.
¹⁴
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Neurology 1993;43:250-260.
¹⁵
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration a consensus on clinical diagnostic criteria.Neurology 1998;51:1546-1554.
¹⁶
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.
¹⁷
Chaves ML, Camozzato AL. How many items from a word list can Alzheimer's disease patients and normal controls recall? Do they recall in a similar way? Dement Neuropsychol 2007;1:52-58.
¹⁸
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.
¹⁹
Katz A, Ford AB, Moskowitz RW et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 1963;185:914-919.
²⁰
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.
²¹
Chaves ML, Camozzato AL, G Godinho C, et al. Validity of the clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007;21:210-217.
²²
Jorm AF. The epidemiology of Alzheimer's disease and related disorders. London: Chapman and Hill; 1990.
²³
Rocca WA, Bonaiuto S, Luciani P, et al. Prevalence of clinically diagnosed Alzheimer disease and other dementing disorders: a door-to-door survey in Appignano, Macerata province, Italy. Neurology. 1990;40:626-631.
²⁴
Zhang M, Katzman R, Salmon D, et al. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol 1990;27:428-437.
²⁵
Ott A, Breteler MMB, Harskamp F, et al. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995;310:970-973.
²⁶
Tatsch MF, Bottino CMC, Azevedo D, et al. Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, non-demented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. Am J Geriatric Psychiatry 2006;14:438-445.

Publication Dates

Publication in this collection
Jan-Mar 2010

History

Received
06 Nov 2009
Accepted
15 Jan 2010

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

[1] ¹
Brazilian Institute of Geography and Statistics. Demographic Census (IBGE - Instituto Brasileiro de Geografia e Estatística. Censo demográfico). Rio de Janeiro: IBGE, 2000.

[2] ²
Prince M, Acosta D, Chiu H, Scazufca M, Varghese M. Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet 2003;361(9361):909-917.

[3] ³
Herrera E, Caramelli P, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[4] ⁴
Ferri CP, Prince M, Carol C, et al. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112-2117

[5] ⁵
Vale FAC, Miranda SC. Clinical and demographic features of patients with dementia attended in a tertiary outpatient clinic. Arq Neuropsiquiatr 2002;60:548-552.

[6] ⁶
Tascone L, Marques RC, Pereira EC, Bottino CMC. Characteristics of patients assisted at an ambulatory of dementia from a University Hospital. Arq Neuropsiquiatr 2008;66:631-635.

[7] ⁷
Nitrini R, Lefèvre BH, Mathias SC, et al. Evaluation of 100 patients with dementia in São Paulo, Brazil: correlation with socioeconomic status and education. Alzheimer Dis Assoc Disord 1995;9:146-151.

[8] ⁸
Silva DW, Damasceno BP. Demência na população de pacientes do Hospital das Clínicas da Unicamp. Arq Neuropsiquiatr 2002;60:996-999

[9] ⁹
Chodosh J, Petitti DB, Eliott M, et al. Physician recognition of cognitive impairment: evaluating the need for improvement. J Am Geriatr Soc 2004;52:1051-1059.

[10] ¹⁰
Valcour VG, Masaki KH, Curb JD, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med 2000;160:2964-2968.

[11] ¹¹
Löppönen M, Räihä I, Isoaho R, et al. Diagnosing cognitive impairment and dementia in primary health care: a more active approach is needed. Age Ageing 2003;32:606-612.

[12] ¹²
Diagnostic and Statistical Manual of Psychiatric Disorders 4.Ed. (DSMIV) Washington DC: APA, 1994.

[13] ¹³
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease. Neurology 1984;34:939-944.

[14] ¹⁴
Roman GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Neurology 1993;43:250-260.

[15] ¹⁵
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration a consensus on clinical diagnostic criteria.Neurology 1998;51:1546-1554.

[16] ¹⁶
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.

[17] ¹⁷
Chaves ML, Camozzato AL. How many items from a word list can Alzheimer's disease patients and normal controls recall? Do they recall in a similar way? Dement Neuropsychol 2007;1:52-58.

[18] ¹⁸
Chaves ML, Izquierdo I. Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurol Scand 1992;85:378-382.

[19] ¹⁹
Katz A, Ford AB, Moskowitz RW et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 1963;185:914-919.

[20] ²⁰
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.

[21] ²¹
Chaves ML, Camozzato AL, G Godinho C, et al. Validity of the clinical dementia rating scale for the detection and staging of dementia in Brazilian patients. Alzheimer Dis Assoc Disord 2007;21:210-217.

[22] ²²
Jorm AF. The epidemiology of Alzheimer's disease and related disorders. London: Chapman and Hill; 1990.

[23] ²³
Rocca WA, Bonaiuto S, Luciani P, et al. Prevalence of clinically diagnosed Alzheimer disease and other dementing disorders: a door-to-door survey in Appignano, Macerata province, Italy. Neurology. 1990;40:626-631.

[24] ²⁴
Zhang M, Katzman R, Salmon D, et al. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol 1990;27:428-437.

[25] ²⁵
Ott A, Breteler MMB, Harskamp F, et al. Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995;310:970-973.

[26] ²⁶
Tatsch MF, Bottino CMC, Azevedo D, et al. Neuropsychiatric symptoms in Alzheimer disease and cognitively impaired, non-demented elderly from a community-based sample in Brazil: prevalence and relationship with dementia severity. Am J Geriatric Psychiatry 2006;14:438-445.

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