Longitudinal cognitive screening study in community-dwelling individuals

Pereira, Carolina P.M.; Stella, Florindo; Hernandez, Salma S.S.; Andrade, Larissa P.; Texeira, Camila V.L.; Gobbi, Sebastião

doi:10.1590/S1980-57642010DN40300010

Abstract

Cognitive changes in normal aging can be similar to the alterations that take place in the initial stages of a dementia process. Longitudinal studies can provide a better understanding of this progression.

Objectives:

To evaluate the cognitive and functional evolution of community-dwelling individuals without dementia through a three-year longitudinal study.

Methods:

168 individuals were evaluated in 2006. Three years later in 2009, 73 of these subjects were reevaluated as regards cognition and functionality using the Mini Mental State Examination (MMSE), Brief Cognitive Battery (BCB) and the Pfeffer Functional Activities Questionnaire. The statistical analysis included descriptive measurements, the Wilcoxon's test for intra-group comparison, and the Spearman's correlation coefficient test for comparing cognitive and functionality scores.

Results:

After three years, the Wilcoxon's test showed a discreet yet significant cognitive decline (MMSE: -0.7 points; p=0.02; Z= -2.29; and global score on the BCB: +3.6 points; p=0.02; Z= -2.29), in addition to functional decline (Pfeffer: +0.7 points; p= 0.001; Z= -3.38).

Conclusions:

After three years of follow-up we observed a discreet yet significant functional and cognitive decline in the subjects. Longitudinal cognitive screening represents an important strategy in the early identification of changes from normal conditions to a dementia process.

Key words:
longitudinal study; cognitive screening; dementia

Resumo

Mudanças cognitivas no envelhecimento normal podem se assemelhar às alterações nos períodos iniciais de um processo demencial. Estudos longitudinais possibilitam um entendimento melhor desta progressão.

Objetivos:

Avaliar, em um estudo longitudinal de três anos, a evolução cognitiva e funcional de sujeitos sem demência da comunidade.

Métodos:

Após três anos de uma primeira avaliação de 168 sujeitos, em 2006, 73 sujeitos foram reavaliados em 2009 quanto à cognição e funcionalidade, através do Mini-Exame do Estado Mental (Mini-Mental), Bateria Breve de Rastreio Cognitivo (BBRC) e Questionário de Atividades Instrumentais (Pfeffer). A análise estatística constou de medidas descritivas, teste de Wilcoxon para comparação intragrupo e coeficiente de correlação de Spearman para comparação entre escores cognitivos e de funcionalidade.

Resultados:

Após três anos, o teste de Wilcoxon evidenciou declínio cognitivo discreto, porém significativo (Mini Mental: -0.7 pontos; p=0.02; Z= -2.29; e escore global da BBRC: +3.6 pontos; p=0.02; Z= -2.29), além de declínio funcional (Peffer: +0.7 pontos; p= 0.001; Z= -3,38).

Conclusões:

Após três anos de seguimento, observou-se discreto, porém significativo, declínio cognitivo e funcional dos sujeitos. A BBRC e o Mini-Mental mostraram-se eficazes para o screening cognitivo. O seguimento cognitivo longitudinal representa uma estratégia importante para a identificação precoce de possível evolução de uma condição de normalidade para um processo demencial.

Palavras-chave:
estudo longitudinal; avaliação cognitiva; demência

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Full text available only in PDF format.

References

Damasceno BP. Envelhecimento cerebral: o problema dos limites entre o normal e o patológico. Arq Neuropsiquiatr 1999;57:78-83.
Bennett DA, Wilson RS, Schneider JA, et al. Natural history of mild cognitive impairment in older persons. Neurology 2002;59:198-205.
Bischkopf J, Busse A, Angermeyer MC. Mild cognitive impairment: a review of prevalence, incidence and outcome according to current approaches. Arch Psychiatr Scand 2002;106: 403-414.
Risacher SL, Saykin AJ, West JD, Shen L, Firpi HA, McDonald BC. Baseline MRI of conversion from MCI to probable Alzheimer's disease in ADNI cohort. Current Alzheimer Res 2009;6:347-361.
Rosenberg PB, Lyketsos CG. Mild cognitive impairment: searching for the prodrome of Alzheimer's disease. World Psychiatry 2008;7:72-78.
Gauthier SG. Realizing early treatment benefits in dementia. Eur J Neurol 2005;12(Suppl 3):1-2.
Ritchie K, Touchon J. Mild cognitive impairment: conceptual basis and current nosological status. Lancet 2000;355:225-228.
Prichep LS, John ER, Ferris SH, et al. Prediction of longitudinal cognitive decline in normal elderly with subjective complaints using electrophysiological imaging. Neurobiol Aging 2006;27:471-481.
Galvin JE, Powlishta KK, Wilkins K, et al. Predictors of preclinical Alzheimer disease and dementia: a clinicopathologic study. Arch Neurol 2005;62:758-765.
Vale PHF, Spíndola L, Oliveira MO, Armentano CGC, Porto CS, Brucki SMD. Comparison of performance on neuropsychological tests in amnestic mild cognitive impairment and Alzheimer's disease patients. Dement Neuropsychol 2009; 3:41-48.
Yassuda MS, Diniz BS, Flaks MK, et al. Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Arch Clin Neuropsychol 2009;24:71-79.
Pimentel EML. Role of neuropsychological assessment in differential diagnosis of Alzheimer's disease and vascular dementia. Dement Neuropsychol 2009;3:214-221.
APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)4th Edition, Text Revision. Washington DC: American Psychiatric Association, 2000.
Williams JG, Huppert FA, Matthews FE, Nickson J. Performance and normative values of a concise neuropsychological test (CAMCOG) in an elderly population sample. Int J Geriatr Psychiatry 2003;18:631-634.
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demências. Arq Neuropsiquiatr 1994;52:457-465.
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36.
Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Research 1975;12:198.
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.
Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford University Press, 1995:1030.
Sunderland T, Hill JI, Melow AM, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.
Nitrini R, Caramelli P, Porto CS, et al. Uma bateria cognitiva breve com alta acurácia no diagnóstico de doença de Alzheimer em população com grande heterogeneidade educacional. Arq Neuropsiquiatr 2006;64(supl.1):200.
Pfeffer RI, Kurosaki TT, Harrah CH, Chance J.M, Filis S. Measurement of functional activities in older adults in the community. J Gerontol 1982,37:323-329.
Baudic S, Dalla Barba G, Thibaudet MC, Smagghe A, Remy P, Traykov L. Executive function deficits in early Alzheimer's disease and their relations with episodic memory. Arch Clin Neuropsychol 2006;21:15-21.
Gomez R, White DA. Using verbal fluency to detect very mild dementia of the Alzheimer type. Arch Clin Neuropsychol 2006;21:771-775.
Jefferson AL, Byerly LK, Vanderhill S, et al. Characterization of activities of daily living in individuals with mild cognitive impairment. Am J Geriatr Psychiatry 2008;16:375-383.
Cahn-Weiner DA, Boyle PA, Malloy PF. Tests of executive function predict instrumental activities of daily living in community-dwelling older individuals. Appl Neuropsychol 2002;9:187-191.
Christofoletti G, Oliani MM, Stella F, Gobbi S, Gobbi LTB. Influence of scholarity on cognitive screening test in elderly people. Dement Neuropsychol 2007;1:46-51.
Gauthier S, Vellas B, Farlow M, Burn D. Aggressive course of disease in dementia. Alzheimer Dement 2006,2:210-217.
Cahn-Weiner DA, Williams K, Grace J, Tremont G, Westervelt H, Stern RA. Discrimination of dementia with Lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test. Cognit Behav Neurol 2003;16:85-92.
Schwartz S, Baldo J, Graves RE, Brugger P. Pervasive influence of semantics in letter and category fluency: a multidimensional approach. Brain Language 2003;87:400-411.
Baldivia B, Andrade VM, Bueno OFA. Contribution of education, occupational and cognitively stimulating activities to the formation of cognitive reserve. Dement Neuropsychol 2008;2:173-182.
Nithianantharajah J, Hannan AJ. The neurobiology of brain and cognitive reserve: Mental and physical activity as modulators of brain disorders. Progress Neurobiol 2009;89:369-382.
Stern Y. Cognitive reserve and Alzheimer disease. Alzheimer Dis Assoc Disord 2006;20:S69-S74.
Foss MP, Formigheri P, Speciali JG. Heterogeneity of cognitive aging in Brazilian normal elderly individuals. Dement Neuropsychol 2009;3:344-351.
Lyketsos CG, Szekely CA, Mielke MM, Rosenberg PB, Zandi PP. Developing new treatments for Alzheimer's disease: the who, what, when, and how of biomarker-guided therapies. Int J Psychogeriatr 2008;20:871-889.
Salloway S, Mintzer J, Weiner MF, Cummings JL. Disease-modifying therapies in Alzheimer's disease. Alzheimer Dement 2008;4:65-79.
Forlenza OV, Diniz BS, Nunes PV, Memória CM, Yassuda MS, Gattaz WF. Diagnostic transitions in mild cognitive impairment subtypes. Int Psychogeriatr 2009;21:1088-1095.
Brum PS, Forlenza OV, Yassuda MS. Cognitive training in older adults with mild cognitive impairment. Dement Neuropsychol 2009;3:124-131.
Manzine PR, Pavarini SCI. Cognitive rehabilitation. Dement Neuropsychol 2009;3:248-255.
Bottino CMC, Carvalho I, Alvarez AM, et al. Reabilitação cognitiva em pacientes com doença de Alzheimer: relato de trabalho em equipe multidisciplinar. Arq Neuropsiquiatr 2002;60:70-79.
Ávila R. Resultados da reabilitação neuropsicológica em pacientes com doença de Alzheimer leve. Rev Psiquiatr Clín 2003;30:139-146.
Lautenschlager NT, Kox KL, Flicker L, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer's disease: a randomized trial. JAMA 2008;300(9): 1027-1037.
Ruscheweyh R, Willemer C, Kruger K, et al. Physical activity and memory functions: an interventional study. Neurobiol Aging 2010, in press.
Floel A, Ruscheweyh R, Kruger K, et al. Physical activity and memory functions: are neurotrophins and cerebral gray matter volume the missing link? NeuroImage 2010;49:2756-2763.
Bugg JM, Head D. Exercise moderates age-related atrophy of the medial temporal lobe. Neurobiol Aging 2010, in press
Mirochcnic S, Wolf S, Staufenbiel M, Kempermann G. Age effects on the regulation of adult hippocampal neurogenesis by physical and environmental enrichment in the APP23 mouse model Alzheimer disease. Hippocampus 2009;19:1008-1018.
Kramer AF, Erickson KI. Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function. Trends Cogn Sci 2007;11:342-348.
Draganski B, May A. Training-Induced structural changes in the adult human brain. Behav Brain Res 2008;192:137-142.
Pereira AC, Huddleston DE, Brickman AM, et al. An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proc Natl Acad Sci USA 2007;104:5638-5643.
Cotman CW, Berchtold NC, Christie LA. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci 2007;30:464-472.

Publication Dates

Publication in this collection
Jul-Sep 2010

History

Received
24 May 2010
Accepted
02 Aug 2010

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

[1] Damasceno BP. Envelhecimento cerebral: o problema dos limites entre o normal e o patológico. Arq Neuropsiquiatr 1999;57:78-83.

[2] Bennett DA, Wilson RS, Schneider JA, et al. Natural history of mild cognitive impairment in older persons. Neurology 2002;59:198-205.

[3] Bischkopf J, Busse A, Angermeyer MC. Mild cognitive impairment: a review of prevalence, incidence and outcome according to current approaches. Arch Psychiatr Scand 2002;106: 403-414.

[4] Risacher SL, Saykin AJ, West JD, Shen L, Firpi HA, McDonald BC. Baseline MRI of conversion from MCI to probable Alzheimer's disease in ADNI cohort. Current Alzheimer Res 2009;6:347-361.

[5] Rosenberg PB, Lyketsos CG. Mild cognitive impairment: searching for the prodrome of Alzheimer's disease. World Psychiatry 2008;7:72-78.

[6] Gauthier SG. Realizing early treatment benefits in dementia. Eur J Neurol 2005;12(Suppl 3):1-2.

[7] Ritchie K, Touchon J. Mild cognitive impairment: conceptual basis and current nosological status. Lancet 2000;355:225-228.

[8] Prichep LS, John ER, Ferris SH, et al. Prediction of longitudinal cognitive decline in normal elderly with subjective complaints using electrophysiological imaging. Neurobiol Aging 2006;27:471-481.

[9] Galvin JE, Powlishta KK, Wilkins K, et al. Predictors of preclinical Alzheimer disease and dementia: a clinicopathologic study. Arch Neurol 2005;62:758-765.

[10] Vale PHF, Spíndola L, Oliveira MO, Armentano CGC, Porto CS, Brucki SMD. Comparison of performance on neuropsychological tests in amnestic mild cognitive impairment and Alzheimer's disease patients. Dement Neuropsychol 2009; 3:41-48.

[11] Yassuda MS, Diniz BS, Flaks MK, et al. Neuropsychological profile of Brazilian older adults with heterogeneous educational backgrounds. Arch Clin Neuropsychol 2009;24:71-79.

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

[13] APA (American Psychiatric Association). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)4th Edition, Text Revision. Washington DC: American Psychiatric Association, 2000.

[14] Williams JG, Huppert FA, Matthews FE, Nickson J. Performance and normative values of a concise neuropsychological test (CAMCOG) in an elderly population sample. Int J Geriatr Psychiatry 2003;18:631-634.

[15] Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demências. Arq Neuropsiquiatr 1994;52:457-465.

[16] Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36.

[17] Folstein MF, Folstein SE, McHugh PR. Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatric Research 1975;12:198.

[18] 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.

[19] Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford University Press, 1995:1030.

[20] Sunderland T, Hill JI, Melow AM, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989;37:725-729.

[21] Nitrini R, Caramelli P, Porto CS, et al. Uma bateria cognitiva breve com alta acurácia no diagnóstico de doença de Alzheimer em população com grande heterogeneidade educacional. Arq Neuropsiquiatr 2006;64(supl.1):200.

[22] Pfeffer RI, Kurosaki TT, Harrah CH, Chance J.M, Filis S. Measurement of functional activities in older adults in the community. J Gerontol 1982,37:323-329.

[23] Baudic S, Dalla Barba G, Thibaudet MC, Smagghe A, Remy P, Traykov L. Executive function deficits in early Alzheimer's disease and their relations with episodic memory. Arch Clin Neuropsychol 2006;21:15-21.

[24] Gomez R, White DA. Using verbal fluency to detect very mild dementia of the Alzheimer type. Arch Clin Neuropsychol 2006;21:771-775.

[25] Jefferson AL, Byerly LK, Vanderhill S, et al. Characterization of activities of daily living in individuals with mild cognitive impairment. Am J Geriatr Psychiatry 2008;16:375-383.

[26] Cahn-Weiner DA, Boyle PA, Malloy PF. Tests of executive function predict instrumental activities of daily living in community-dwelling older individuals. Appl Neuropsychol 2002;9:187-191.

[27] Christofoletti G, Oliani MM, Stella F, Gobbi S, Gobbi LTB. Influence of scholarity on cognitive screening test in elderly people. Dement Neuropsychol 2007;1:46-51.

[28] Gauthier S, Vellas B, Farlow M, Burn D. Aggressive course of disease in dementia. Alzheimer Dement 2006,2:210-217.

[29] Cahn-Weiner DA, Williams K, Grace J, Tremont G, Westervelt H, Stern RA. Discrimination of dementia with Lewy bodies from Alzheimer disease and Parkinson disease using the clock drawing test. Cognit Behav Neurol 2003;16:85-92.

[30] Schwartz S, Baldo J, Graves RE, Brugger P. Pervasive influence of semantics in letter and category fluency: a multidimensional approach. Brain Language 2003;87:400-411.

[31] Baldivia B, Andrade VM, Bueno OFA. Contribution of education, occupational and cognitively stimulating activities to the formation of cognitive reserve. Dement Neuropsychol 2008;2:173-182.

[32] Nithianantharajah J, Hannan AJ. The neurobiology of brain and cognitive reserve: Mental and physical activity as modulators of brain disorders. Progress Neurobiol 2009;89:369-382.

[33] Stern Y. Cognitive reserve and Alzheimer disease. Alzheimer Dis Assoc Disord 2006;20:S69-S74.

[34] Foss MP, Formigheri P, Speciali JG. Heterogeneity of cognitive aging in Brazilian normal elderly individuals. Dement Neuropsychol 2009;3:344-351.

[35] Lyketsos CG, Szekely CA, Mielke MM, Rosenberg PB, Zandi PP. Developing new treatments for Alzheimer's disease: the who, what, when, and how of biomarker-guided therapies. Int J Psychogeriatr 2008;20:871-889.

[36] Salloway S, Mintzer J, Weiner MF, Cummings JL. Disease-modifying therapies in Alzheimer's disease. Alzheimer Dement 2008;4:65-79.

[37] Forlenza OV, Diniz BS, Nunes PV, Memória CM, Yassuda MS, Gattaz WF. Diagnostic transitions in mild cognitive impairment subtypes. Int Psychogeriatr 2009;21:1088-1095.

[38] Brum PS, Forlenza OV, Yassuda MS. Cognitive training in older adults with mild cognitive impairment. Dement Neuropsychol 2009;3:124-131.

[39] Manzine PR, Pavarini SCI. Cognitive rehabilitation. Dement Neuropsychol 2009;3:248-255.

[40] Bottino CMC, Carvalho I, Alvarez AM, et al. Reabilitação cognitiva em pacientes com doença de Alzheimer: relato de trabalho em equipe multidisciplinar. Arq Neuropsiquiatr 2002;60:70-79.

[41] Ávila R. Resultados da reabilitação neuropsicológica em pacientes com doença de Alzheimer leve. Rev Psiquiatr Clín 2003;30:139-146.

[42] Lautenschlager NT, Kox KL, Flicker L, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer's disease: a randomized trial. JAMA 2008;300(9): 1027-1037.

[43] Ruscheweyh R, Willemer C, Kruger K, et al. Physical activity and memory functions: an interventional study. Neurobiol Aging 2010, in press.

[44] Floel A, Ruscheweyh R, Kruger K, et al. Physical activity and memory functions: are neurotrophins and cerebral gray matter volume the missing link? NeuroImage 2010;49:2756-2763.

[45] Bugg JM, Head D. Exercise moderates age-related atrophy of the medial temporal lobe. Neurobiol Aging 2010, in press

[46] Mirochcnic S, Wolf S, Staufenbiel M, Kempermann G. Age effects on the regulation of adult hippocampal neurogenesis by physical and environmental enrichment in the APP23 mouse model Alzheimer disease. Hippocampus 2009;19:1008-1018.

[47] Kramer AF, Erickson KI. Capitalizing on cortical plasticity: influence of physical activity on cognition and brain function. Trends Cogn Sci 2007;11:342-348.

[48] Draganski B, May A. Training-Induced structural changes in the adult human brain. Behav Brain Res 2008;192:137-142.

[49] Pereira AC, Huddleston DE, Brickman AM, et al. An in vivo correlate of exercise-induced neurogenesis in the adult dentate gyrus. Proc Natl Acad Sci USA 2007;104:5638-5643.

[50] Cotman CW, Berchtold NC, Christie LA. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci 2007;30:464-472.

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