Visuospatial function in early Alzheimer's disease: Preliminary study

Quental, Natália Bezerra Mota; Brucki, Sonia Maria Dozzi; Bueno, Orlando Francisco Amodeo

doi:10.1590/S1980-57642009DN30300010

Abstract

Alzheimer's disease (AD) is the most frequent cause of dementia, accounting for 55% of all cases. AD patients gradually lose functional capacity, manifesting deficits in attention, language, temporal and direction orientation, mood, socialization and visuospatial function. The visuospatial function entails identification of a stimulus and its location. AD patients can present deficits in visuo-spatial skills during initial stages of the disease, but in the course of clinical evolution this function can become severely impaired. One of the neuropsychological tests indicated to evaluate the visuospatial function is the VOSP (The Visual Object and Space Perception Battery).

Objectives:

The aim of this preliminary study was to detect visuospatial dysfunction in early AD patients using the VOSP, and assess its sensitivity in a Brazilian sample.

Results:

Controls outperformed AD patients on all neuropsychological evaluations, except the Corsi block tapping task and cancellation task-errors. The AD patients performed significantly worse on all object perception and two space perception (Number Location and Cube Analyses) subtests of the VOSP.

Conclusion:

The AD patients demonstrated impaired visuospatial function in several aspects. The subtests of the VOSP were found to be sensitive for detecting this impairment in mild cases.

Key words:
dementia; early Alzheimer disease; visuospatial function.

Resumo

A doença de Alzheimer (DA) é a causa mais frequente de demencia, atingindo 55% dos casos. Os pacientes com DA gradativamente perdem a capacidade funcional, apresentando comprometimento na atenção, na linguagem, na orientação temporal e espacial, uso de objetos, no humor, na socialização, na função visuoespacial. A função visuoespacial diz respeito a identificação de um estímulo e a sua localização. O paciente com DA pode apresentar perdas da habilidade visuo-espacial no início da doença, contudo no curso do quadro clínico esta função deve apresentar-se bastante comprometida. Um dos instrumentos utilizados para avaliar a função visuo-espacial é o VOSP ( Visual Object and Space Perception Battery).

Objetivos:

A proposta deste estudo é avaliar as alterações na função visuoespacial em pacientes com DA de intensidade leve com a VOSP, e verificar a sensibilidade desta bateria em uma amostra brasileira.

Resultados:

Os controles obtiveram melhores resultados em todos os testes neuropsicológicos, com excessão do Blocos de Corsi e no teste de cancelamento - erros. Nos subtestes da VOSP os pacientes com DA mostraram uma significativa diferença em todos os subtestes de percepção de objeto e em dois de percepção de lugar (Localização de Número e Análise de Cubo).

Conclusão:

Os pacientes com DA leve mostraram ter a função visuoespacial comprometida em alguns aspectos. Os subtestes da VOSP mostraram-se sensiveis a esses déficits na fase leve da doença.

Palavras-chave:
demência; doença de Alzheimer de intensidade leve; função visoespacial.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Bottino, CMC, Laks J, Blay SL. Demência e transtornos cognitivos em idosos. Rio de Janeiro:Guanabara Koogan; 2006.
²
Herrera 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.
³
Lopes MA, Hotoiam SR, Reis GC, Elkis H, Bottino CMC. Systematic Review of Dementia Prevalence 1994 to 2000. Dement Neuropsychol 2007;1:230-240.
⁴
Lindeboom J, Weinstein H. Neuropsychology of cognitive ageing, minimal cognitive impairment, Alzheimer's disease, and vascular cognitive impairment. Eur J Pharmacol 2004;490: 83-86.
⁵
Lezak MD. Neuropsychological Assessment. 4th ed. New York: Oxford University Press; 2004.
⁶
Strauss E, Sherman EMS, Spreen O. A Compendium of Neuropsychological Tests:administration, norms and commentary. 3th ed. New York: Oxford University Press; 2006.
⁷
Katz, B, & Rimmer S. Ophthalmologic manifestations of Alzheimer's disease. Surv Ophthalmol 1989;34:31-43.
⁸
Thiyagesh S, Farrow T, Parks R, et al. The neural basis of visuospatial perception in Alzheimer's disease and healthy elderly comparison subjects: An fMRI study. Psychiatry Research: Neuroimaging 2009;172:109-116.
⁹
Nguyen AS, Chubb C, Huff FJ. Visual Identification and spatial location in Alzheimer's disease. Brain Cogn 2003;52: 155-166.
¹⁰
Piccini C, Pecori D, Campani D, et al. Alzheimer's disease: patterns of cognitive impairment at different levels of disease severity. J Neurol Sci 1998;156:59-64.
¹¹
Cronin-Colomb A, Corkin S, Rizzo JF, Cohen J, Growdon JH, Banks KB. Visual dysfunction in Alzheimer's disease: relation to normal aging. Ann Neurol 1991;29:41-52.
¹²
Schmidtke K, Olbrich S. The Clock Reading Test: validation of an instrument for the diagnosis of dementia and disorders of visuo-spatial cognition. Int Psychogeriat 2007;19:307-321.
¹³
Nitrini R, Caramelli P, Bottino C, et al. 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.
¹⁴
Binetti G, Cappa S, Magni E, et al. Visual and spatial perception in the early phase of Alzheimer's disease. Neuropsychology 1998;12:29-33.
¹⁵
Warrington EK, James M. The Visual Object and Space Perception Battery. Thames Valley Test Company. Bury St Edmunds; 1991.
¹⁶
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.
¹⁷
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.
¹⁸
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-81.
¹⁹
Almeida OP, Almeida SA. Confiabilidade da versão brasileira da Escala de Depressão em Geriatria (GDS) versão reduzida. Arq Neuropsiquiatr 1999;57:421-426.
²⁰
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.
²¹
Rey A. Reativo delle figure complesse A e B. Florence, Italy: Organizzazioni Speciali; 1983.
²²
Milner B. Interhemispheric differences in the location of psychological processes in man. Brit Med Bull 1971;27:272-277.
²³
Rey A. L'Examen Clinique en Psychologie. Paris: Press Universitaire de France;1964.
²⁴
Brucki SMD. Malheiros SMF, Okamoto I, Bertolucci P. Dados Normativos para o uso do teste de fluência verbal (categoria animais) em nosso meio. Arq Bras Neuropsiquiatria 1997; 55:56-61.
²⁵
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo J Neto, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001; 59:532-536.
²⁶
Mesulam MM. Principles of Behavioural Neurology. Philadelphia: F. A. Davis Company;1985.
²⁷
Brucki SMD, Nitrini R. Cancellation Task in very low educated people. Arq Neuropsiquiatr 2008;23:139-147.
²⁸
Raven JC. Colored Progressives Matrices Sets A, Ab, B. Oxford: Oxford Psychologists Press Ltd;1947.
²⁹
Sunderlan T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's Disease: a novel measure of dementia severity. Journal of the American Geriatric Association 1989;37: 725-729.
³⁰
Stopford CL, Snowden JS, Thompson JC, Neary D. Variability in cognitive presentation of Alzheimer's disease. Cortex 2008; 44:185-95.
³¹
Balthazar MLF, Cendes F, Damasceno BP. Semantic Error Patterns on the Boston Naming Test in Normal Aging, Amnestic Mild Cognitive Impairment, and Mild Alzheimer's Disease: Is There Semantic Disruption? Neuropsychology 2008;22: 703-709.
³²
Paxton JL, Peavy GM, Jenkins C, Rice VA, Heindel WC, Salmon DP. Deterioration of visual-perceptual organization ability in Alzheimer's disease. Cortex 2007;43:967-75.
³³
Hajilou BB, Done DJ Evidence for a dissociation of structural and semantic knowledge in dementia of the Alzheimer type (DAT). Neuropsychologia 2007;45:810-816.
³⁴
Merigan WH, Maunsell JH. How parallel are the primate visual pathways? Annu Rev Neurosci 1993;16:369-402.

Publication Dates

Publication in this collection
Jul-Sep 2009

History

Received
03 July 2009
Accepted
13 Aug 2009

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

[1] ¹
Bottino, CMC, Laks J, Blay SL. Demência e transtornos cognitivos em idosos. Rio de Janeiro:Guanabara Koogan; 2006.

[2] ²
Herrera 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.

[3] ³
Lopes MA, Hotoiam SR, Reis GC, Elkis H, Bottino CMC. Systematic Review of Dementia Prevalence 1994 to 2000. Dement Neuropsychol 2007;1:230-240.

[4] ⁴
Lindeboom J, Weinstein H. Neuropsychology of cognitive ageing, minimal cognitive impairment, Alzheimer's disease, and vascular cognitive impairment. Eur J Pharmacol 2004;490: 83-86.

[5] ⁵
Lezak MD. Neuropsychological Assessment. 4th ed. New York: Oxford University Press; 2004.

[6] ⁶
Strauss E, Sherman EMS, Spreen O. A Compendium of Neuropsychological Tests:administration, norms and commentary. 3th ed. New York: Oxford University Press; 2006.

[7] ⁷
Katz, B, & Rimmer S. Ophthalmologic manifestations of Alzheimer's disease. Surv Ophthalmol 1989;34:31-43.

[8] ⁸
Thiyagesh S, Farrow T, Parks R, et al. The neural basis of visuospatial perception in Alzheimer's disease and healthy elderly comparison subjects: An fMRI study. Psychiatry Research: Neuroimaging 2009;172:109-116.

[9] ⁹
Nguyen AS, Chubb C, Huff FJ. Visual Identification and spatial location in Alzheimer's disease. Brain Cogn 2003;52: 155-166.

[10] ¹⁰
Piccini C, Pecori D, Campani D, et al. Alzheimer's disease: patterns of cognitive impairment at different levels of disease severity. J Neurol Sci 1998;156:59-64.

[11] ¹¹
Cronin-Colomb A, Corkin S, Rizzo JF, Cohen J, Growdon JH, Banks KB. Visual dysfunction in Alzheimer's disease: relation to normal aging. Ann Neurol 1991;29:41-52.

[12] ¹²
Schmidtke K, Olbrich S. The Clock Reading Test: validation of an instrument for the diagnosis of dementia and disorders of visuo-spatial cognition. Int Psychogeriat 2007;19:307-321.

[13] ¹³
Nitrini R, Caramelli P, Bottino C, et al. 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.

[14] ¹⁴
Binetti G, Cappa S, Magni E, et al. Visual and spatial perception in the early phase of Alzheimer's disease. Neuropsychology 1998;12:29-33.

[15] ¹⁵
Warrington EK, James M. The Visual Object and Space Perception Battery. Thames Valley Test Company. Bury St Edmunds; 1991.

[16] ¹⁶
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.

[17] ¹⁷
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.

[18] ¹⁸
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-81.

[19] ¹⁹
Almeida OP, Almeida SA. Confiabilidade da versão brasileira da Escala de Depressão em Geriatria (GDS) versão reduzida. Arq Neuropsiquiatr 1999;57:421-426.

[20] ²⁰
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.

[21] ²¹
Rey A. Reativo delle figure complesse A e B. Florence, Italy: Organizzazioni Speciali; 1983.

[22] ²²
Milner B. Interhemispheric differences in the location of psychological processes in man. Brit Med Bull 1971;27:272-277.

[23] ²³
Rey A. L'Examen Clinique en Psychologie. Paris: Press Universitaire de France;1964.

[24] ²⁴
Brucki SMD. Malheiros SMF, Okamoto I, Bertolucci P. Dados Normativos para o uso do teste de fluência verbal (categoria animais) em nosso meio. Arq Bras Neuropsiquiatria 1997; 55:56-61.

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

[26] ²⁶
Mesulam MM. Principles of Behavioural Neurology. Philadelphia: F. A. Davis Company;1985.

[27] ²⁷
Brucki SMD, Nitrini R. Cancellation Task in very low educated people. Arq Neuropsiquiatr 2008;23:139-147.

[28] ²⁸
Raven JC. Colored Progressives Matrices Sets A, Ab, B. Oxford: Oxford Psychologists Press Ltd;1947.

[29] ²⁹
Sunderlan T, Hill JL, Mellow AM, et al. Clock drawing in Alzheimer's Disease: a novel measure of dementia severity. Journal of the American Geriatric Association 1989;37: 725-729.

[30] ³⁰
Stopford CL, Snowden JS, Thompson JC, Neary D. Variability in cognitive presentation of Alzheimer's disease. Cortex 2008; 44:185-95.

[31] ³¹
Balthazar MLF, Cendes F, Damasceno BP. Semantic Error Patterns on the Boston Naming Test in Normal Aging, Amnestic Mild Cognitive Impairment, and Mild Alzheimer's Disease: Is There Semantic Disruption? Neuropsychology 2008;22: 703-709.

[32] ³²
Paxton JL, Peavy GM, Jenkins C, Rice VA, Heindel WC, Salmon DP. Deterioration of visual-perceptual organization ability in Alzheimer's disease. Cortex 2007;43:967-75.

[33] ³³
Hajilou BB, Done DJ Evidence for a dissociation of structural and semantic knowledge in dementia of the Alzheimer type (DAT). Neuropsychologia 2007;45:810-816.

[34] ³⁴
Merigan WH, Maunsell JH. How parallel are the primate visual pathways? Annu Rev Neurosci 1993;16:369-402.

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