RESUMO -Objetivo: Avaliar a concordância da escala CDR com critérios diagnósticos e mini exame do estado mental (MEEM), e correlação com escala de Blessed, numa amostra de pacientes do sul do Brasil. M é t o d o :A escala foi avaliada em 269 pacientes com doença de Alzheimer (DA), demência vascular e demência questionável num desenho transversal. Os critérios do NINCDS-ADRDA para provável DA e NINDS-AIREN para p rovável demência vascular foram os padrões-ouro. O MEEM, a escala Blessed para gravidade da demência, o escore isquêmico de Hachinski, e uma bateria de testes cognitivos também foram aplicados. R e s u l t a d o s :A concordância com o padrão-ouro foi boa (kappa=0,73), e com o MEEM em categorias foi moderada (kappa= 0,53). Observou-se correlação significativa da escala CDR com Blessed (r=0,96; p=0,001). Não se observ o u d i f e rença de escolaridade ou de idade entre as categorias da escala CDR. Conclusão: A concordância da CDR foi boa para os critérios diagnósticos e moderada para o MEEM. A escala mostrou validade de constru t o para gravidade de demência. Não se observou impacto da escolaridade sobre este instru m e n t o . PALAVRAS-CHAVE: demência, escala CDR, validação, Mini Exame do Estado Mental, Brasil. Application of the Brazilian version of the CDR scale in samples of dementia patients ABSTRACT -O b j e c t i v e :The objective of the study was the analysis of agreement between the CDR scale with diagnostic criteria and mini mental state examination (MMSE), as well as correlation with Blessed scale, in a sample of Southern Brazilian patients. Method: The CDR scale was cross-sectionaly evaluated in 269 dementia patients Alzheimer's disease (AD) vascular dementia, and questionable. The NINCDS-ADRDA criteria for probable AD and the NINDS-AIREN for probable vascular dementia were the gold s t a n d a rd. The MMSE, the Blessed scale, the Hachinski ischemic score, and a battery of cognitive tests were also applied. Results: The agreement to gold standard was good (kappa=0.73), while to MMSE categorized was moderate (kappa=0.53). A significant correlation with the Blessed scale (r=0.96; p=0.001) was observ e d . Education and age were similar among CDR categories. Conclusion: The global score agreement of the CDR scale with the gold standard was good, and with the MMSE was moderate. We also observed face validity for dementia severity. No impact of education was observed upon CDR global scores.
The main objective of the present study was to evaluate the diagnostic value (clinical application) of brain measures and cognitive function. Alzheimer and multiinfarct patients (N = 30) and normal subjects over the age of 50 (N = 40) were submitted to a medical, neurological and cognitive investigation. The cognitive tests applied were Mini-Mental, word span, digit span, logical memory, spatial recognition span, Boston naming test, praxis, and calculation tests. The brain ratios calculated were the ventricle-brain, bifrontal, bicaudate, third ventricle, and suprasellar cistern measures. These data were obtained from a brain computer tomography scan, and the cutoff values from receiver operating characteristic curves. We analyzed the diagnostic parameters provided by these ratios and compared them to those obtained by cognitive evaluation. The sensitivity and specificity of cognitive tests were higher than brain measures, although dementia patients presented higher ratios, showing poorer cognitive performances than normal individuals. Normal controls over the age of 70 presented higher measures than younger groups, but similar cognitive performance. We found diffuse losses of tissue from the central nervous system related to distribution of cerebrospinal fluid in dementia patients. The likelihood of case identification by functional impairment was higher than when changes of the structure of the central nervous system were used. Cognitive evaluation still seems to be the best method to screen individuals from the community, especially for developing countries, where the cost of brain imaging precludes its use for screening and initial assessment of dementia.
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