Phonemic verbal fluency tests assess the production of words beginning with specific letters. Of these letters, the most frequently used are F, A and S. It is a sensitive test for assessing frontal lobe functions.ObjectiveTo provide normative data for the elderly Brazilian population on the FAS test and to investigate the effects of age and schooling on test performance.MethodsThe individuals were divided into three age groups (60–69, 70–79 and =80 years), and into four groups according to education (1–3, 4–7, 8–11 and 12 years). All subjects were assessed by the Mini Mental State Examination and the FAS. Data were analyzed with Student’s t test, ANOVA, simple linear regression and Spearman’s correlation.ResultsWe evaluated 345 cognitively healthy volunteers, 66.66% being female, aged 60 to 93 years, with an educational level ranging from one to 24 years. The average (number of items) ±SD for the whole sample was 28.28±11.53. No significant effect of gender was observed (p=0.5). Performance on the MMSE and education exerted a direct influence on FAS scores (p<0.001), with education being the most significant factor. A positive correlation was found between FAS and the MMSE (r=0.404; p<0.001).ConclusionThe performance of Brazilian elderly on the phonemic verbal fluency tests-FAS is significantly influenced by education, where individuals with higher educational level present better performance than those with fewer years of schooling. Age and gender did not prove significant with the FAS.

No Brazilian version of a specific scale for evaluating apathy in dementia is available.ObjectivesTo introduce a translated version of the Apathy Scale (AS) for use with caregivers.MethodsThe instrument was formally translated and then administered to the caregivers of a small sample of dementia patients, in order to assess scale comprehensibility and make final adjustments. The scale was subsequently administered to the caregivers of a second, independent sample of Alzheimer’s disease (AD) patients. The content validity of the scale was tested by correlating the AS scores with the Neuropsychiatric Inventory (NPI) - apathy sub-score and Disability Assessment in Dementia (DAD) total scores.ResultsThe first sample consisted of eleven subjects with dementia, most of whom had AD. The second sample comprised twenty patients with probable or possible AD (10 with mild dementia), a mean age of 84.1±5.8 years, and 2.2±1.6 years of schooling. The AS scores correlated with both NPI-apathy sub-score (r=0.756, p=0.001) and DAD total scores (r=–0.793, p=0.0005).ConclusionsThe final version had good comprehensibility and correlated strongly with standardized apathy and functional activities of daily living measures.

Taking care of elderly demented individuals, especially when they present behavioral changes, can be very exhaustive for both family and caregivers. Generally, this leads to changes in the family lifestyle, and the caregiver must deal with a range of problems. Information on this topic in Latin America, including Brazil, remains scarce.ObjectiveTo investigate the relationship between the presence of neuropsychiatric symptoms and the level of caregiver burden in a group of Brazilian elderly with dementia.MethodsThe Brazilian versions of the Zarit Caregiver Burden Interview (ZBI) and of the Neuropsychiatric Inventory (NPI) were administered to a total of 83 family-caregivers of patients with dementia followed at a university-affiliated outpatient clinic. Pearson’s correlations were calculated to measure the level of association between the scores on both instruments.ResultsAmong the caregivers, 83.1% were women, and had a mean age of 55.6±12.8 years. The ZBI scores ranged from 3 to 79 (mean=31.4). Patients’ NPI scores ranged from 0 to 102 (mean=26.9), consistent with a significant degree of behavioral manifestations in most patients. A significant positive correlation was found between ZBI and NPI scores (r=0.402; p=0.000).ConclusionThe presence and severity of behavioral manifestations assessed by the NPI were associated with a high level of caregiver burden in this sample of Brazilian elderly with dementia.

OBJECTIVE: It was to examine the effects of a Cognitive-Behavioral Therapy (CBT) program administered to family caregivers of dementia patients. METHODS: Forty family caregivers were enrolled in a CBT intervention across eight weekly sessions. Cognitive, functional and behavioral status of patients were evaluated, as well as their own and their family caregivers' perceptions of quality of life. Specific instruments were also applied to evaluate caregiver stress level, coping, anxiety and depression. RESULTS: At the end of the program, family caregivers reported fewer neuropsychiatric symptoms among patients and an improvement in patients' quality of life. In addition, caregivers changed their coping strategies, whereas a significant decrease was observed in their anxiety levels. CONCLUSION: The CBT program employed appears to be a promising and useful tool for clinical practice, displaying positive effects on quality of life and neuropsychiatric symptoms of dementia, as well as proving beneficial for alleviating anxiety and stress in family caregivers.

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BackgroundNegative effects of stress have pose one of the major threats to the health and economic well being of individuals independently of age and cultural background. Nevertheless, the term “stress” has been globally used unlinked from scientificevidence-based meaning. The discrepancies between scientific and public stress knowledge are focus of concern and little is know about it. This is relevant since misconceptions about stress may influence the effects of stress-management psychoeducational programs and the development of best practices for interventions. The study aimed to analyze stress knowledge among the Canadian and Brazilian general public and to determine the extent to which scientific and popular views of stress differ between those countries.MethodsWe evaluated 1156 healthy participants between 18 and 88 years of age recruited from Canada (n = 502) and Brazil (n = 654). To assess stress knowledge, a questionnaire composed of questions regarding stress concepts (“stress is bad” versus “stress-free life is good”) and factors capable of triggering the stress response (“novelty, unpredictability, low sense of control and social evaluative threat versus “time pressure,work overload, conflict, unbalance and children”) was used.ResultsBoth Canadian and Brazilian participants showed misconceptions about stress and the factors capable of triggering a stress response. However, the rate of misconceptions was higher in Brazil than in Canada (p < 0.05).ConclusionThese findings suggest a lack of public understanding of stress science and its variance according to a country’s society. Psychoeducational programs and vulnerability of stress-related disorder are discussed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0886-6) contains supplementary material, which is available to authorized users.

Neuropsychological correlates of apathy in Alzheimer's disease (AD) may shed some light on the neurobiology of this behavioral disorder. Whereas previous research has suggested an association between apathy and executive functions in AD, amnestic mild cognitive impairment (aMCI) cohorts point to an association with memory tests. We aimed to further investigate this issue in a sample of low educated, hitherto unexposed to cholinesterase inhibitors, aMCI (n=26) and mild AD (n=28) patients using brief executive tests, namely the Executive Interview (EXIT-25) and the Frontal Assessment Battery (FAB). Patients and controls (n=33) were included from a community-based survey of successful brain aging in Brazilian elderly (75+ years), The Pietà Study. The participants were submitted to a comprehensively neuropsychological assessment and apathy evaluation through the Apathy Scale (AS).We found a strong correlation in AD group between AS scores and functional performance measured by the Disability Assessment in Dementia (rho =-0.7 ; p<0,001). No association was found between any executive test performance and apathy symptoms. Apathy symptoms were also associated with the performance in memory tests and in the attention subscale of the Mattis Dementia Rating Scale. These findings reinforce the functional effect of apathy even in the mildest stages along the AD cognitive impairment spectrum, and challenges previous assumptions regarding the association between apathy and classical executive functions.

Apathy is intimately associated with dementia. Unfortunately, its pathophysiology remains poorly understood. The motivational impairment that characterizes this disorder might share the same inflammatory mechanisms, as suggested by the sickness behavior theory.OBJECTIVEThe primary aim of this study was to investigate the association between apathy symptoms and serum levels of tumor necrosis factor alpha (TNF-α) and its soluble receptors. Brain-derived neurotrophic factor (BDNF) levels were also analyzed since these have been associated with depression, a condition which shares abulic features with apathy.METHODSThe sample consisted of 27 subjects with mild Alzheimer's disease or amnestic mild cognitive impairment, who were submitted to specific apathy evaluation using the Apathy Scale (AS) and provided blood samples for biomarker analysis. Participants were categorized into two groups according to median AS scores (17 points).RESULTSSubjects with higher apathy symptoms (n=13) displayed higher levels of TNF-α soluble receptors (type 1: p=0.03; type 2: p=0.04). No other difference was found between groups.CONCLUSIONThese findings point to the involvement of inflammatory mediators in the genesis of apathy symptoms, as suggested by the sickness behavior theory.