RESUMO -Objetivo: Avaliar a presença e o grau de consciência da doença na doença de Alzheimer (DA) em estágio leve e moderado. M é t o d o: Pacientes com DA leve/moderada (n=42) avaliados em corte transversal através da Escala de Avaliação do Impacto Psicossocial do Diagnóstico de Demência (APSID), MiniExame do Estado Mental (MEEM) e Estadiamento Clínico das Demências (CDR). Resultados: No estágio leve (n=18), 66,7% dos pacientes perceberam os sintomas cognitivos e os prejuízos causados na vida cotidiana. No estágio moderado (n=24), 20,8% tinham consciência da doença preservada; em 45,8% observouse somente a noção sobre a presença de sintomas cognitivos; ausência total de consciência da doença foi encontrada em 33,3%. C o n c l u s ã o : Os dados encontrados indicam a associação entre consciência e evolução clínica da doença. Pacientes com CDR 1 reconhecem melhor os sintomas cognitivos e dificuldades de atividade de vida diária. A maioria dos pacientes com CDR 2 reconhece seus sintomas, mas não percebe a gravidade e as conseqüências nas atividades de vida diária.PALAVRAS-CHAVE: doença de Alzheimer, consciência de doença, estágio clínico, "insight".Awareness of disease in dementia: preliminary results in patients with mild and moderate Alzheimer's disease ABSTRACT -O b j e c t i v e:To evaluate the presence and the level of awareness of disease in mild and moderate Alzheimer's disease (AD). M e t h o d: Cross-sectional evaluation of patients with mild/moderate AD (n=42) assessed by Assessment of Psychosocial Impact of the Dementia Diagnosis (APSID), Mini-mental State Examination (MMSE) and Clinical Dementia Rating Scale (CDR). Results: Awareness of disease and its consequences were present in 66.7% patients with mild AD (n=18). In moderate AD (n=24), 20.8% presented total awareness, 45.8% presented only awareness of cognitive symptoms. Unawareness of disease was observed in 33.3%. Conclusions: The present data show association between awareness and level of severity of disease. CDR 1 patients show a better recognition of cognitive and daily life activity symptoms, whereas CDR 2 patients recognized their cognitive symptoms but failed to appraise their severity and consequences in daily life activities. KEY WORDS: Alzheimer disease, awareness of disease, severity of disease, insight.O reconhecimento dos sintomas de demência por parte de pacientes e cuidadores é crucial para o diagnóstico mais precoce da doença de Alzheimer (DA). Esse reconhecimento inicial auxilia o desenvolvimento e manejo de abordagens e intervenções f a rmacológicas e não-medicamentosas que propiciem a melhora da qualidade de vida dos pacientes [1][2][3][4][5] . Não há uma definição precisa do que seria consciên-cia da doença (ou insight) e, portanto, este termo é usado para se referir à falta de conhecimento ou ao reconhecimento dos déficits causados pela demência. A consciência da doença envolve três aspectos: a capacidade de identificar certos eventos mentais como patológicos, o reconhecimento pelo indivíduo de que tem uma doença e o grau de ...
This study aimed to estimate the quartile distribution on the cognitive assessment of normal elderly with low education as measured by the Cambridge Cognitive Examination (CAMCOG). A sample of 292 elderly (> 65 years of age), screened for dementia and depression, were assessed using the CAMCOG. The CAMCOG scores of normal subjects (n = 206) were stratified according to age (65-69, 70-74, 75-79, > 80) and schooling (illiterate, 1-4, and > 5 years of formal education). Mean age was 72.8 (+/- 3.5) and mean schooling was 3.5 years (+/- 3). The mean score on the CAMCOG was 71 (+/- 12.7). The scores at the first quartile for illiterate/1-4 years of schooling were 58/62 (65-69 years), 52/63 (70-74 years), 48/67 (75-79 years) and 46/64 (> 80 years), respectively. There was a significant difference in the CAMCOG quartiles according to education and age. This study provides normative data on the CAMCOG of elderly people with low educational levels which may be clinically useful.
ObjectiveTo describe the development of the Assessment Scale of Psychosocial Impact of the Diagnosis of Dementia (ASPIDD), a multidimensional scale to evaluate awareness of disease in dementia.MethodThe development of this scale was conducted in four steps. In step one, questions were drawn up after a review of the literature. The second step involved the suggestions offered by a neurologist regarding the skills considered important for the scale. The third step involved the re-writing and review of the domains and questions in the scale followed by a semantic evaluation performed by two independent psychiatrists. Step four consisted of the preliminary study aimed at evaluating the applicability of the ASPIDD.ResultsIn the semantic evaluation only minor changes were proposed. The preliminary sample had 52 patients, comprising 23 CDR 1 (male=9; female=14) and 29 CDR2 (male=13; female=16).Mean age of patients was 69.7±5.51(CDR1) and 73.6±9.4 (CDR2), and age at onset was 66.4±5.7 years (CDR1) and 68.3±9.3 year (CDR2).Mean schooling was 9.0±4.3 years (CDR1) and 8.8±4.4 years (CDR2). Mean MMSE was 21.0±3.3(CDR1) and 17.6±3.5(CDR2).Mean Cornell was 4.8±2.3(CDR1) and 4.2±1.9 (CDR2). The patient and caregiver dyads were aware of problems, mainly of those related to social, family and affective relations. The higher rates of discrepant responses were found on the awareness of cognitive deficits and changes in ADL.ConclusionThe ASPIDD is a multidimensional instrument to assess awareness of disease among AD patients.
Mild AD patients could associate the disease process with the presence of cognitive deficits, and also the changes in the emotional response with difficulties in social, family, and affective relations. Moderate AD patients were less aware of the symptoms and did not attribute them to the disease.
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