Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde ABSTRACT OBJECTIVE:To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS:The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS:The mean age of the sample was 47.3 years (SD=16.8) and the mean education was 9.7 years (SD=5; range: 1 -17). A total of 32.4% of the sample showed literacy/numeracy defi cits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not signifi cant when the effects of education were held constant (rp=-0.031, p=0.584). A signifi cant association (B=3.877, Beta=0.733; p<0.001) was found between schooling and scores. Age was not a signifi cant predictor in this model p=0.584). CONCLUSIONS:The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classifi ed as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Resumo -Objetivo: Tradução e adaptação da escala Cornell de depressão em demência e verificação da confiabilidade entre e intra-examinadores da versão na língua portuguesa. Método: A versão original da escala Cornell foi traduzida para o português por firma especializada em tradução de textos médicos e retrotraduzida para o inglês por outros dois tradutores independentes. As divergências de tradução foram identificadas e discutidas, chegando-se à versão que foi submetida à pré-teste para adaptação sócio-cultural. Após esta adaptação, obteve-se a versão final que foi administrada a amostra de 29 pacientes com doença de Alzheimer provável e aos seus cuidadores. Resultados: A versão final da escala mostrou-se de fá-cil aplicação e obteve boa confiabilidade intra-examinador (Kappa=0,77; p<0,001) e entre-examinadores (Kappa=0,76; p<0,001). Conclusão: A versão brasileira da escala Cornell é um instrumento que pode ser utilizado para avaliação e acompanhamento de depressão em pacientes com demência.PAlAvRAs-ChAve: depressão, escalas, adaptação, reprodutibilidade dos testes. Brazilian version of the cornell depression scale in dementiaABsTRACT -Objective: Translating and adapting the Cornell scale for depression in dementia to the Portuguese language and verifying the interrater and test-retest reliability of the translated and adapted version. Method: The Cornell scale was translated into Portuguese and back translated into english. Divergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers. Results: The Cornell scale presented good interrater (Kappa=0,77; p<0,001) and test-retest reliability (Kappa=0,76; p<0,001). The final version was easy to administer and well understood by the caregivers. Conclusion: The Brazilian version of the Cornell scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evaluation and follow-up of depressed patients with dementia in our population and may also be used in multicentric studies with Brazilian population.Key woRDs: depression, scales, adaptation, reproducibility of results. Depressão e demência são síndromes clínicas muito freqüentes na população idosa e podem, muitas vezes, coexistir. A prevalência de sintomas depressivos em pacientes com doença de Alzheimer (DA) varia entre 10 e 86%, dependendo dos critérios diagnósticos, das avaliações utilizadas e das populações estudadas [1][2][3][4][5] . estudos longitudinais sugerem que a depressão pode preceder o desenvolvimento de demên-cia ou mesmo constituir um fator de risco para o aparecimento da DA [6][7][8] . esses fatores apontam para a necessidade de se utilizar instrumentos específicos para avaliar sintomas depressivos em pacientes com demência. A escala Cornell de depressão em demência (eCDD) é um instrumento para auxiliar em pesquisa farmacológica e em estudos sobre a e...

Lung disease with chronic hypoxia has been associated with cognitive impairment of the subcortical type.ObjectivesTo review the cognitive effects of chronic hypoxia in patients with lung disease and its pathophysiology in brain metabolism.MethodsA literature search of Pubmed data was performed. The words and expressions from the text subitems including “pathophysiology of brain hypoxia”, “neuropsychology and hypoxia”, “white matter injury and chronic hypoxia”, for instance, were key words in a search of reports spanning from 1957 to 2009. Original articles were included.ResultsAccording to national and international literature, patients with chronic obstructive pulmonary disease and sleep obstructive apnea syndrome perform worse on tests of attention, executive functions and mental speed. The severity of pulmonary disease correlates with degree of cognitive impairment. These findings support the diagnosis of subcortical type encephalopathy.ConclusionCognitive effects of clinical diseases are given limited importance in congresses and symposia about cognitive impairment and its etiology. Professionals that deal with patients presenting cognitive loss should be aware of the etiologies outlined above as a major cause or potential contributory factors, and of their implications for treatment adherence and quality of life.

-A 61-year-old ex-boxer presented with a three-year history of progressive memory decline. During a seven-year follow-up period, there was a continuous cognitive decline, very similar to that usually observed in Alzheimer's disease. Parkinsonian, pyramidal or cerebellar signs were conspicuously absent. Neuropathological examination revealed the typical features of dementia pugilistica: cavum septi pellucidi with multiple fenestrations, numerous neurofibrillary tangles in the cerebral isocortex and hippocampus (and rare senile plaques). Immunohistochemistry disclosed a high number of tau protein deposits and scarce beta-amyloid staining. this case shows that dementia pugilistica may present with clinical features practically undistinguishable from Alzheimer's disease.Key worDs: dementia, dementia pugilistica, punch drunk, Alzheimer's disease, chronic traumatic encephalopathy, parkinsonian/motor signs, neuropathology.Dementia pugilistica com características clínicas de doença de alzheimer resumo -um ex-boxeador de 61 anos apresentou-se com história de três anos de perda progressiva de memória e evoluiu com declínio cognitivo lentamente progressivo, sugestivo de doença de Alzheimer, durante seguimento de sete anos. sinais parkinsonianos, piramidais ou cerebelares estiveram ausentes durante toda a evolução. exame neuropatológico evidenciou características típicas de dementia pugilistica: cavum do septo pelúcido com múltiplas fenestrações, numerosos emaranhados neurofibrilares no isocór-tex cerebral e hipocampo (e raras placas senis). Imuno-histoquímica confirmou número elevado de depó-sitos de proteína tau e raros de beta-amilóide. este caso demonstra que dementia pugilistica pode apresentar quadro clínico indistinguível daquele da doença de Alzheimer.PAlAvrAs-chAve: demência, dementia pugilistica, síndrome punch-drunk, doença de Alzheimer, encefalopatia traumática crônica, sinais motores/parkinsonianos, neuropatologia. 1 , first brought the expression "punch drunk syndrome" to medical literature, hitherto used by the lay public and boxing fans to name the condition that some boxers develop during or after their fighting career. the syndrome consisted of extrapyramidal and cerebellar signs and symptoms, associated or not, with cognitive and behavioral abnormalities. In 1937, the designation "dementia pugilistica" was proposed 2 . critchley, in 1957 3 , named it "chronic progressive encephalopathy of the boxer", being more descriptive in that it represents the long term cumulative effect of repetitive head trauma 1,3-5 . however, the label dementia pugilistica has been more frequently used. we report the clinical and neuropathological findings of a case of dementia pugilistica presenting a cognitive profile similar to Alzheimer's disease (AD). Informed consent to publish these data was given by the patient's wife and son.Case the patient was a 61 year-old former boxer with six years of education, who presented with a three-year history of memory decline in which he kept forgetting recent events, names of kno...

Resumo -A versão original da escala de Avaliação de Incapacidade em Demência (Disability Assessment for Dementia, DAD) foi traduzida para a língua portuguesa e retrotraduzida para o inglês. Divergências de tradução foram identificadas e discutidas, chegando-se a uma versão que foi submetida a pré-teste para adaptação sócio-cultural. A versão final foi administrada a amostra de 29 pacientes com doença de Alzheimer provável de leve a moderada. os coeficientes de correlação da DAD foram 0,929 e 0,932 nas avaliações inter e intra-examinadores respectivamente. os índices de confiabilidade também foram elevados (Kappa=0,72; p<0,001 inter-examinadores e Kappa=0,85; p<0,001 intra-examinadores). A versão brasileira da escala DAD mostrou-se um instrumento de fácil aplicação e boa confiabilidade para avaliação funcional de pacientes com demência e poderá contribuir para o acompanhamento desses pacientes em nosso meio. esta versão também poderá ser utilizada em estudos transculturais sobre habilidades funcionais de pacientes com demência.PAlAvRAs-chAve: demência, doença de Alzheimer, incapacidade, atividades de vida diária, diagnóstico. Cross-cultural adaptation of the disability assessment for dementia (DAD)ABstRAct -the original version of the Disability Assessment for Dementia (DAD) was translated into Portuguese and back translated to english. the divergences of translation were identified and discussed, resulting in a version that was used in a preliminary investigation for cross-cultural adaptation. the final version was administered to 29 patients with mild to moderate probable Alzheimer's disease. the correlation coefficients of DAD were 0.929 and 0.932 for the inter-examiner and test-retest evaluations respectively. the reliability indexes were also high (Kappa 0.72 p<0.001 inter-examiners and 0.85 p<0.001 test-retest). the Brazilian version of DAD was easy to administer and had good reliability to assess the functional status of demented patients. It will contribute to the follow-up of these patients in our population. moreover, it can be used in transcultural studies on functional abilities in dementia.Key woRDs: dementia, Alzheimer's disease, disability, activities of daily living, diagnosis. Além do comprometimento das funções cognitivas, a doença de Alzheimer (DA) também se caracteriza pelo declínio no desempenho funcional, condição necessária para o diagnóstico de acordo com os critérios do National Institute of Neurologic, Communicative Disorders and Stroke-Alzheimer´s Disease and Related Disorders Association (NINcDs-ADRDA) 1 e do manual de Diagnóstico estatístico dos transtornos mentais-quarta edição (Dsm-Iv) 2 . muitas escalas têm sido usadas para medir o desempenho nas atividades da vida diária (AvD) na população idosa e com DA, entre elas a Avaliação de Incapacidade para Demência (DAD-Disability Assessment for Dementia), desenvolvida por Gauthier e Gélinas em 1994 3 . No estudo inicial, a escala demonstrou alto grau de concordância interna (0,96), inter-examinadores (0,95) e teste-reteste (0,96) 4 .A DA...

The Brief Cognitive Battery-Edu (BCB-Edu) contains nine tests, seven of which are related to the memory of drawings, and has good accuracy in the diagnosis of cognitive impairment.ObjectivesTo evaluate the influence of age, gender and educational level on the performance in tests related to memory of drawings of the BCB-Edu in healthy subjects.MethodsParticipants were adult volunteers; exclusion criteria were illiteracy, neurologic or psychiatric disorders, visual or hearing impairment, untreated chronic clinical conditions, alcoholism, use of drugs, and for those aged 65 or over, an informant report of cognitive or functional impairment. We evaluated 325 individuals (207 women), with a mean age of 47.1 (±16.8) years, ranging from 19 to 81, and a mean of 9.8 (±5.0) schooling-years. Univariate analyses, correlations and logistic regression were employed (α=0.05).ResultsThere were significant negative correlations between age and the scores in four of the seven tests. However, schooling-years were positively correlated to the scores, where schooling-years decreased with age in this sample (rho= -0.323; p<0.001). Logistic regression confirmed that gender influenced the learning of drawings, where women performed better, while age influenced incidental memory, immediate memory, learning and delayed recall of the drawings, and schooling-years influenced visual identification, immediate memory, learning, delayed recall and recognition of the drawings.ConclusionGender, age and education influence the performance on the memory of drawings of the BCB-Edu, although the extent of these influences differs according to the nature of the test.

The Brazilian version of the DAD is an adequate and reliable tool for assessing functional ability in AD patients.

Dementia presenting with prominent higher order visual symptoms may be observed in a range of neurodegenerative conditions and is often challenging to diagnose.ObjectivesTo describe cases of progressive dementia presenting with prominent visual cortical symptoms.MethodsWe conducted a retrospective search of cases of progressive dementia with predominant visual symptoms, seen at our dementia unit from 1996 to 2006.ResultsTwelve patients (5 men, 7 women) were identified, with ages ranging from 49 to 67 years. At the first examination, the duration of the symptoms ranged from one to ten years and the Mini-Mental State Examination scores from 7 to 27. Eleven patients presented with predominant visuospatial symptoms (partial or complete Balint syndrome) and one with visuoperceptive impairment. Other reported manifestations were: constructional apraxia in 11 patients, partial or complete Gerstmann syndrome in ten, ideomotor apraxia in nine, hemineglect or extinction in four patients, alien hand phenomenon in three, and prosopagnosia in one patient. Memory loss was reported by ten patients, but was not the main complaint in any of these cases. Insight was relatively preserved in five patients even after a long period following the onset of symptoms. Six patients developed parkinsonism during evolution. Clinical diagnoses were possible or probable AD in seven patients, cortico-basal degeneration in four, and dementia with Lewy body in one.ConclusionsClinicians should consider this condition especially in presenile patients with slowly progressive higher-order visual symptoms. Although described in association with different conditions, it may also occur in Alzheimer disease.