The authors report the prevalence of dementia in a community-dwelling Brazilian elderly population and correlate prevalence data with educational and socioeconomic levels. The study was conducted in Catanduva, Brazil. A total of 1,656 randomly selected subjects aged 65 years or more were submitted to a health questionnaire, the Mini-Mental State Examination (MMSE), and the Pfeffer Functional Activities Questionnaire (PFAQ). According to the PFAQ and MMSE scores, selected subjects were submitted to clinical, neurologic, and cognitive evaluations. The subjects diagnosed with dementia underwent laboratory tests and brain computed tomography (CT). Dementia was diagnosed in 118 subjects, corresponding to a prevalence of 7.1%. The main clinical diagnoses were Alzheimer disease (AD; 55.1%), vascular dementia (9.3%), and AD with cerebrovascular disease (14.4%). The prevalence increased with age and was higher in women. There was an inverse association with education (3.5% among persons with 8 or more years of schooling to 12.2% among those who were illiterate). Multivariate analysis disclosed significant association between these three variables and dementia. The prevalence of dementia in this Brazilian population was 7.1%, and AD was the most frequent diagnosis. Age, female gender, and low educational level were significantly associated with a higher prevalence of dementia.

Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.

This consensus prepared by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology is aimed at recommending new criteria for the diagnosis of dementia and Alzheimer’s disease (AD) in Brazil. A revision was performed of the proposals of clinical and of research criteria suggested by other institutions and international consensuses. The new proposal for the diagnosis of dementia does not necessarily require memory impairment if the cognitive or behavioral compromise affects at least two of the following domains: memory, executive function, speech, visual-spatial ability and change in personality. For the purpose of diagnosis, AD is divided into three phases: dementia, mild cognitive impairment and pre-clinical phase, where the latter only applies to clinical research. In the dementia picture, other initial forms were accepted which do not involve amnesia and require a neuroimaging examination. Cerebrospinal fluid biomarkers are recommended for study, but can be utilized as optional instruments, when deemed appropriate by the clinician.

-Diagnosis of dementia is a challenge in populations with heterogeneous educational background. Objective: To compare the accuracies of two delayed recall tests for the diagnosis of dementia in a community with high pro p o rtion of illiterates. Method: The delayed recall of a word list from the CERAD battery (DR-CERAD) was compared with the delayed recall of objects presented as line drawings f rom the Brief Cognitive Screening Battery (DR-BCSB) using ROC curves. Illiterate (23 controls and 17 patients with dementia) and literate individuals (28 controls and 17 patients with dementia) were evaluated in a community-dwelling Brazilian population. Results: The DR-BCSB showed higher accuracy than the DR-CERAD in the illiterate (p=0.029), similar accuracy in the literate individuals (p=0.527), and a trend for higher accuracy in the entire population (p=0.084). Conclusion: the DR-BCSB could be an alternative for the diagnosis of dementia in populations with high proportion of illiterates.KEY WORDS: dementia, Alzheimer's disease, memory, neuropsychological tests, educational status, illiteracy. Comparação entre dois testes de recordação tardia para o diagnóstico de demência RESUMO -O diagnóstico de demência é um desafio em populações com heterogeneidade educacional.Objetivo: Comparar as acurácias de dois testes de re c o rdação tardia no diagnóstico de demência em comunidade com alta prevalência de analfabetos. Método: O teste de re c o rdação tardia de lista de palavras da bateria CERAD (RT-CERAD) foi comparado com o de re c o rdação tardia de figuras simples da bateria de testes neuropsicológicos breves (RT-BTNB), utilizando-se curvas ROC. Indivíduos analfabetos (23 controles e 17 pacientes com demência) e alfabetizados (28 controles e 17 pacientes com demência) foram avaliados em uma comunidade brasileira. Resultados: O RT-BTNB demonstrou maior acurácia que a RT-C E R A D e n t re os analfabetos (p=0,029), acurácia similar nos indivíduos alfabetizados (p=0,527), e tendência a maior acurácia na população inteira (p=0,084). Conclusão: A RT-BTNB pode ser uma alternativa para o diagnós-tico de demência em populações com alta prevalência de analfabetos.PA L AV R A S -C H AVE: demência, doença de Alzheimer, testes neuropsicológicos, analfabetismo, escolaridade.

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Lexical access difficulties are frequent in normal aging and initial stages of dementia.Verbal fluency tests are valuable to detect cognitive decline, evidencing lexico-semantic and executive dysfunction.ObjectivesTo establish which language tests can contribute in detecting dementia and to verify schooling influence on subject performance.Method74 subjects: 33 controls, 17 Clinical Dementia Rating (CDR) 0.5 and 24 (Brief Cognitive Battery - BCB e Boston Naming Test - BNT) 1 were compared in tests of semantic verbal fluency (animal and fruit), picture naming (BCB and BNT) and the language items of Mini Mental State Examination (MMSE).ResultsThere were significant differences between the control group and both CDR 0.5 and CDR 1 in all tests. Cut-off scores were: 11 and 10 for animal fluency, 8 for fruit fluency (in both), 8 and 9 for BCB naming. The CDR 0.5 group performed better than the CDR 1 group only in animal fluency. Stepwise multiple regression revealed fruit fluency, animal fluency and BCB naming as the best discriminators between patients and controls (specificity: 93.8%; sensitivity: 91.3%). In controls, comparison between illiterates and literates evidenced schooling influence in all tests, except for fruit fluency and BCB naming. In patients with dementia, only fruit fluency was uninfluenced by schooling.ConclusionThe combination of verbal fluency tests in two semantic categories along with a simple picture naming test is highly sensitive in detecting cognitive decline. Comparison between literate and illiterate subjects shows a lesser degree of influence of schooling on the selected tests, thus improving discrimination between low performance and incipient cognitive decline.

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The movie Ben-Hur highlights the dynamics of contagion associated with leprosy, a pattern of forced aggregation driven by the emergence of symptoms and the fear of contagion. The 2014 Ebola outbreaks reaffirmed the dynamics of redistribution among symptomatic and asymptomatic or non-infected individuals as a way to avoid contagion. In this manuscript, we explore the establishment of clusters of infection via density-dependence avoidance (diffusive instability). We illustrate this possibility in two ways: using a phenomenological driven model where disease incidence is assumed to be a decreasing function of the size of the symptomatic population and with a model that accounts for the deliberate movement of individuals in response to a gradient of symptomatic infectious individuals. The results in this manuscript are preliminary but indicative of the role that behavior, here modeled in crude simplistic ways, may have on disease dynamics, particularly on the spatial redistribution of epidemiological classes.