Aims: To estimate dementia prevalence and describe the etiology of dementia in a community sample from the city of São Paulo, Brazil. Methods: A sample of subjects older than 60 years was screened for dementia in the first phase. During the second phase, the diagnostic workup included a structured interview, physical and neurological examination, laboratory exams, a brain scan, and DSM-IV criteria diagnosis. Results: Mean age was 71.5 years (n = 1,563) and 58.3% had up to 4 years of schooling (68.7% female). Dementia was diagnosed in 107 subjects with an observed prevalence of 6.8%. The estimate of dementia prevalence was 12.9%, considering design effect, nonresponse during the community phase, and positive and negative predictive values. Alzheimer’s disease was the most frequent cause of dementia (59.8%), followed by vascular dementia (15.9%). Older age and illiteracy were significantly associated with dementia. Conclusions: The estimate of dementia prevalence was higher than previously reported in Brazil, with Alzheimer’s disease and vascular dementia being the most frequent causes of dementia. Dementia prevalence in Brazil and in other Latin American countries should be addressed by additional studies to confirm these higher dementia rates which might have a sizable impact on countries’ health services.

RESUMO -Objetivo:Investigar se a combinação de uma escala de avaliação funcional com um teste cognitivo poderia melhorar a precisão do diagnóstico de demência. Método: Foram avaliados 30 pacientes com diagnóstico de demência leve a moderada, segundo critérios da CID-10 e DSM-III-R e 46 controles idosos, divididos em grupos segundo seu nível socioeconômico e educacional (alto, médio e baixo). Nos sujeitos foi aplicado o MMSE, e em seus informantes as escalas IQCODE e B-ADL. Resultados: Pela regressão logística, o MMSE isolado classificou corretamente 86,8% dos pacientes e controles (sensibilidade 80% e especificidade 91,3%). A combinação MMSE + IQCODE classificou corretamente 92,1% dos sujeitos (sensibilidade 83,3% e especificidade de 97,8%), e a combinação MMSE + B-ADL classificou corretamente 92,1% dos sujeitos (sensibilidade 86,7% e especificidade 95,7%). Conclusão: Os resultados sugerem que a combinação de um teste cognitivo a escalas funcionais pode melhorar a detecção de casos leves ou moderados de demência, mesmo em amostras de população heterogênea com relação ao nível sócio-econômico e educacional como a brasileira.PALAVRAS-CHAVE: Demência, diagnóstico, teste cognitivo, escalas funcionais. Combined instruments on the evaluation of dementia in the elderly: preliminary results ABSTRACT -Objective:To determine if a functional scale combined with a cognitive test would improve the diagnostic accuracy of dementia. Method: Thirty patients with mild to moderate dementia, diagnosed according to ICD-10 and DSM-III-R criteria, and 46 elderly controls, divided into three groups according to their socioeconomic status and educational level (high, medium and low) were investigated. The subjects were assessed with the MMSE, and their informants were assessed with the scales IQCODE and B-ADL. Results: On the logistic regression, the MMSE isolated classified correctly 86.8% of patients and controls (80% sensitivity and 91.3% specificity). The combination MMSE + IQCODE classified correctly 92.1% of the subjects (83.3% sensitivity and 97.8% specificity), and the combination MMSE + B-ADL classified correctly 92.1% of subjects (86.7% sensitivity and 95.7% specificity). Conclusion: The results suggest that the combination of a cognitive test with a functional scale can improve the detection of mild to moderate cases of dementia even on samples of a very heterogeneous population regarding its socioeconomic status and educational level, as the Brazilian. Novas estratégias terapêuticas têm surgido no tratamento da síndrome demencial e em especial da doença de Alzheimer, retardando a progressão dessa doença e possibilitando melhora na qualidade de vida dos pacientes e seus familiares. Essas novas abordagens terapêuticas e a pesquisa de fatores de risco para demência, em estudos epidemiológicos, têm estimulado a busca de instrumentos de rastreio, que permitam identificar na prática clínica e na comunidade os casos leves dessa doença. Infelizmente, muitos dos testes neuropsicológicos usados são extensos, muito complicados, ou nece...

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The mini-mental state examination (MMSE) has been widely used as a screening instrument for cognitive disorders. Age, schooling and many other sociodemographic and health variables may be associated with a worse performance on the MMSE. The objectives of this study were to investigate the distribution of MMSE percentiles in a large Brazilian community-based elderly sample, divided according to age and schooling, and to evaluate the impact of sociodemographic and health variables on groups of elderly people with lower cognitive performance. The MMSE was applied to a sample of 2,708 adults, aged 60 years and older. Of this population, 1,563 individuals were living in the city of São Paulo, while 1,145 were living in the city of Ribeirão Preto. The subjects were divided into six groups according to the amount of schooling that they had received (no formal education, 1-4 and ≥5 years) and age (<75 and ≥75 years old). To each one of the subgroups a stepwise logistic regression was applied, considering the following dependent variable: subjects who scored under or above the 15th percentile on MMSE. High scores on a depression scale, high scores on a memory complaints scale and low socio-economic levels were associated with poorer performance on the MMSE. Being currently employed and being married were related to higher scores on the test. Many sociodemographic and health variables can influence MMSE performance, with impacts depending on age and schooling. Clinicians and primary care physicians should pay attention to variables that may be associated with worse cognitive performance.

CFI prevalence results were similar to those found by studies in Brazil, Puerto Rico and Malaysia. Cognitive and functional impairment is a rather heterogeneous condition which may be associated with various clinical conditions found in the elderly population. Due to its high prevalence and association with higher mortality and disability rates, this clinical syndrome should receive more attention on public health intervention planning.

Although several surveys have been conducted around the world, few surveys have investigated the prevalence of dementia in Latin America. The aim of this study was to estimate dementia prevalence in a community sample in Ribeirão Preto, Brazil, and to evaluate its distribution across several socio-demographic and clinical characteristics and habits. The population was aged 60 years and older and a representative sample from three different social regions. The screening instruments used in the first phase were the Mini-Mental State Examination, the Fuld Object-Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, and the Bayer Activities of Daily Living Scale. In the second phase, the Cambridge Examination was employed to diagnose dementia according to the DSM-IV criteria. The estimate of dementia prevalence was adjusted for screening instrument performance, using the positive and negative predictive values. The data were weighted to compare frequencies, considering the sampling and the non-response effect, and subjected to multivariate analysis. In all, 1.145 elderly subjects were evaluated (mean age: 70.9 years), of whom 63.4% were female and 52.8% had up to 4 years of schooling (participation rates at the first and the second phases were 62.6 and 60%, respectively). The observed and estimated prevalences of dementia were 5.9% and 12.5%, respectively (n = 68). Alzheimer's disease was the main cause (60.3%). Dementia was associated with old age, low education, stroke, absence of arthritis, and not reading books. The estimated prevalence of dementia was higher than the prevalence previously found. Associated factors confirmed the importance of intellectual activities in prevention.

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The Bayer -Activities of Daily Living Scale (B-ADL) in the differentiation between mild to moderate dementia and normal aging A escala da Bayer -Atividades da Vida Diária (B-AVD) na diferenciação entre demência leve e moderada e o envelhecimento normal