Neuropsychological performance differences between two groups of probable-AD patients from different areas of Brazil

Oliveira, Analucy Aury Vieira de; Satler, Corina; Tomaz, Carlos

doi:10.1590/S1980-57642012DN06020006

ABSTRACT

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 cut-off 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.

Key words:
dementia; cognitive impairment; Alzheimer's disease; neuropsychological assessment; diagnosis.

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.

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REFERENCES

Brazilian Institute of Geography and Statistics. Demographic Census (IBGE - Instituto Brasileiro de Geografia e Estatística. Censo demográfico). Rio de Janeiro: IBGE, 2000.
Herrera E, Caramelli P, Silveira A, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
Nitrini, R. Diagnóstico de demência: avaliação clínica neuropsicológica e através da tomografia computadorizada por emissão de fóton único. Livre-Docência. Faculdade de Medicina da USP, 1993.
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.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4 ed. Washington DC: APA, 1994.
Nitrini R, Caramelli P, Herrera E, et al. Incidence of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2004; 18:241-246.
Salmon D, Bondi M. NeuropsychologicaI assessment of dementia. Ann Rev Assess Dementia 2009;60:257-282.
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol 1991;82:239-259.
Almeida O, Crocco E. Percepção dos déficits cognitivos e alterações do comportamento em pacientes com doença de Alzheimer. Arq Neuropsiquiatr 2000;58:292-299.
Dickerson B, Sperling R, Hyman B, Albert M, Blacker D. Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. Arch Gen Psychiatry 2007;64:1443-1450.
Kelley B, Petersen R. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007;25:577-609.
Petersen RC, Negash S. Mild cognitive impairment: an overview. CNS Spectr 2008;13:45-53.
Petersen RC, Parisi JE, Dickson DW. Neuropathologic features of amnestic mild cognitive impairment. Arch Neurol 2006;63:665-672.
Kidd PM. Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention. Altern Med Rev 2008;13:85-115.
Kramer JH, Nelson A, Johnson JK. Multiple cognitive deficits in amnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2006;22: 306-311.
Petersen RC, Smith GE, Ivnik RJ, et al. Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals. JAMA 1995;273:1274-1278.
Caramelli P, Barbosa M. Como diagnosticar as quatro causas mais freqüentes de demência? Rev Bras Psiquiatr 2002;24(Supl I):S7-S10.
Pimentel, E. Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia. Dement Neuropsychol 2009;3:214-221.
Folstein M, Folstein S, McHugh P. Minimental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975;12:189-198.
Bertolucci P, Brucki S, Campacci R, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
Brucki S, Nitrini R, Caramelli P, Bertolucci P, Okamoto I. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
Mattis S. Dementia Rating Scale. Professional Manual. Psychological Assessment Resources. Florida; 1988.
Porto C, Charchat-Fichman H, Caramelli P, Bahia V, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale. Arq Neuropsiquiatr 2003;61:339-345.
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.
Nunes PV, Diniz BS, Radanovic M, et al. CAMcog as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. Int J Geriatr Psychiatry 2008;23:1127-1133.
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;34:1295-302.
Hughes CP, Berg L, Danzingen WL, Cohen LA. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
Jorm A. A short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.
Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(5Suppl 6):S10-S16.
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.
Morris J, Heyman A, Mohs R, Hughes J, van Belle G, Fillenbaum G, Mellits E, Clark C: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.
Fichman HC, Fernandes CS, Nitrini R, Lourenço RA, Paradela MPP, Carthey-Goulart MT, Caramelli P. Age and educational effects on the performance of normal elderly on category fluency tasks. Dement Neuropsychol 2009; 3:49-54.
Machado TH, Fichman HC, Santos EL, et al. Normative data for healthy elderly on the Phonemic Verbal Fluency Task - FAS. Dement Neuropsychol 2009;3:55-60.
Aprahamian I, Martinelli J, Neri A, Yassuda M. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. Int Psychogeriatr 2010;22: 64-71.

Publication Dates

Publication in this collection
Apr-Jun 2012

History

Received
01 Dec 2011
Accepted
21 Mar 2012

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

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

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

[3] Nitrini, R. Diagnóstico de demência: avaliação clínica neuropsicológica e através da tomografia computadorizada por emissão de fóton único. Livre-Docência. Faculdade de Medicina da USP, 1993.

[4] 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.

[5] American Psychiatric Association. Diagnostic and statistical manual of mental disorders 4 ed. Washington DC: APA, 1994.

[6] Nitrini R, Caramelli P, Herrera E, et al. Incidence of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2004; 18:241-246.

[7] Salmon D, Bondi M. NeuropsychologicaI assessment of dementia. Ann Rev Assess Dementia 2009;60:257-282.

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

[9] Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. Acta Neuropathol 1991;82:239-259.

[10] Almeida O, Crocco E. Percepção dos déficits cognitivos e alterações do comportamento em pacientes com doença de Alzheimer. Arq Neuropsiquiatr 2000;58:292-299.

[11] Dickerson B, Sperling R, Hyman B, Albert M, Blacker D. Clinical prediction of Alzheimer disease dementia across the spectrum of mild cognitive impairment. Arch Gen Psychiatry 2007;64:1443-1450.

[12] Kelley B, Petersen R. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007;25:577-609.

[13] Petersen RC, Negash S. Mild cognitive impairment: an overview. CNS Spectr 2008;13:45-53.

[14] Petersen RC, Parisi JE, Dickson DW. Neuropathologic features of amnestic mild cognitive impairment. Arch Neurol 2006;63:665-672.

[15] Kidd PM. Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention. Altern Med Rev 2008;13:85-115.

[16] Kramer JH, Nelson A, Johnson JK. Multiple cognitive deficits in amnestic mild cognitive impairment. Dement Geriatr Cogn Disord 2006;22: 306-311.

[17] Petersen RC, Smith GE, Ivnik RJ, et al. Apolipoprotein E status as a predictor of the development of Alzheimer's disease in memory-impaired individuals. JAMA 1995;273:1274-1278.

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

[19] Pimentel, E. Role of neuropsychological assessment in the differential diagnosis of Alzheimer's disease and vascular dementia. Dement Neuropsychol 2009;3:214-221.

[20] Folstein M, Folstein S, McHugh P. Minimental state: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res 1975;12:189-198.

[21] Bertolucci P, Brucki S, Campacci R, Juliano Y. O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

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

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

[24] Porto C, Charchat-Fichman H, Caramelli P, Bahia V, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale. Arq Neuropsiquiatr 2003;61:339-345.

[25] Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001;59:532-536.

[26] Nunes PV, Diniz BS, Radanovic M, et al. CAMcog as a screening tool for diagnosis of mild cognitive impairment and dementia in a Brazilian clinical sample of moderate to high education. Int J Geriatr Psychiatry 2008;23:1127-1133.

[27] 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;34:1295-302.

[28] Hughes CP, Berg L, Danzingen WL, Cohen LA. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[29] Jorm A. A short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychol Med 1994;24:145-153.

[30] Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997;48(5Suppl 6):S10-S16.

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

[32] Morris J, Heyman A, Mohs R, Hughes J, van Belle G, Fillenbaum G, Mellits E, Clark C: The Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Part I. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.

[33] Fichman HC, Fernandes CS, Nitrini R, Lourenço RA, Paradela MPP, Carthey-Goulart MT, Caramelli P. Age and educational effects on the performance of normal elderly on category fluency tasks. Dement Neuropsychol 2009; 3:49-54.

[34] Machado TH, Fichman HC, Santos EL, et al. Normative data for healthy elderly on the Phonemic Verbal Fluency Task - FAS. Dement Neuropsychol 2009;3:55-60.

[35] Aprahamian I, Martinelli J, Neri A, Yassuda M. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. Int Psychogeriatr 2010;22: 64-71.

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