The GDS-30, GDS-15, GDS-10 and GDS-4 proved to be good screening instruments for depression in primary care clinics in Brazil, whereas the GDS-1 failed to perform adequately.
Introduction: Cognitive assessment of older adults who are either illiterate or with low levels of education is particularly challenging because several battery tasks require a certain educational background. Early detection of mild cognitive impairment (MCI) in the elderly using validated screening tools is of great importance since this population group could benefit from new drugs that are being investigated for the treatment of dementias. Cutoff scores for psychometric properties of cognitive tests are not well established among adults with low levels of education. The present study aimed to critically review the literature on cognitive assessment tools for screening cognitive syndromes including MCI and Alzheimer's disease (AD) in older adults with low levels of education. Methods: We conducted a systematic search of MEDLINE, LILACS, Cochrane, and SCOPUS electronic databases of cross-sectional and prospective studies with adults over 55 years of age. Results: We found a significant number of assessment tools available (n = 44), but only a few of them showed diagnostic accuracy for the diagnosis of MCI and AD in older adults with low levels of education: the Mini-Mental State Exam; the Montreal Cognitive Assessment; the Persian Test of Elderly for Assessment of Cognition and Executive Function; the Six-Item Screener; and the Memory Alteration Test. Few studies evaluated individuals with low levels of education, with a wide range of cutoff scores and cognitive test batteries. Conclusion: We found that a small number of studies evaluated adults with 4 years of formal education or less. Our findings further support the importance of developing specific tools for the assessment of older adults with low levels of education.
The sum of evidence highlights the importance of BPSD-related imaging findings for the understanding of the non-cognitive symptom spectrum in AD. Results suggest that structural and functional changes in fronto-limbic areas may lead to emotional deregulation and symptom unawareness. As these findings may be present early on the AD clinical course, they may have a relevance for the development of imaging markers that could be used in diagnosis, disease monitoring and prediction of therapeutic response.
Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly
common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these
patients at presentation is still poorly characterized in developing
countries.OBJECTIVEWe aimed to characterize the prevalence of neuropsychiatric symptoms, as well
as the clinical and cognitive profile of patients with VaD and VCI in our
tertiary University outpatient cognitive clinic.METHODSWe reviewed data on 253 patients diagnosed with VaD or VCI at our center
between January 1996 and December 2005, located in an industrial region of
the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did
not complete the medical investigation or who did not meet the clinical or
neuroimaging criteria for vascular dementia. We collected socio-demographic
data, educational level, vascular risk factors, behavioral and
neuropsychological symptoms and cognitive complaints at presentation.RESULTSTwo hundred and thirty-four cases were included in this analysis. The mean
age was 67.77±10.35 years; 72% were males and 82% had less than four
years of education (average 2.84±2.96 years). The initial Clinical
Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had
neuropsychiatric symptoms distributed in main categories as follows:
psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%),
depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were
the most prevalent risk factors.CONCLUSIONWe found a high prevalence of neuropsychiatric symptoms. The
clinical-neuropsychiatric profile of patients presenting to cognitive
clinics in developing countries may differ greatly to that of more developed
nations. These characteristics may have implications for public health
strategies.
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