The cognitive subscale of the Alzheimers Disease Assessment Scale (ADAS-Cog) is widely used for the evaluation of dementia and is very popular in dementia drug trials because of the characteristics of the scale. The objective of the present study was to adapt the ADASCog for use for the Brazilian population. A major problem is that education is variable, a fact that may influence performance in cognitive evaluation. This study was conducted on a control group (CG) of 96 subjects (25 males and 71 females aged 68 ± 8.6 years) and on 44 Alzheimers disease (AD) patients (19 males and 25 females aged 72 ± 6.4 years) with mild dementia (Clinical Dementia Rating score 1). For statistical analysis groups were divided into three educational levels: I, 0-4 years of schooling (65 CG/20 AD); II, 5-11 years of schooling (19 CG/7 AD), and III, 12 or more years of schooling (12 CG/17 AD). The battery was applied according to original instructions. Total mean score for CG and AD was 10.9 and 22.9 for level I, 7.8 and 22.4 for level II, and 6.2 and 15.4 for level III, respectively. These results indicate that our version of the ADAS-Cog is useful to identify mild dementia, though there may be an overlapping when comparing high education demented with low education non-demented subjects.

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...

Objectives –  A highly adaptive aspect of human memory is the enhancement of explicit, consciously accessible memory by emotional stimuli. We studied the performance of Alzheimer’s disease (AD) patients and elderly controls using a memory battery with emotional content, and we correlated these results with the amygdala and hippocampus volume. Methods –  Twenty controls and 20 early AD patients were subjected to the International Affective Picture System (IAPS) and to magnetic resonance imaging‐based volumetric measurements of the medial temporal lobe structures. Results –  The results show that excluding control group subjects with 5 or more years of schooling, both groups showed improvement with pleasant or unpleasant figures for the IAPS in an immediate free recall test. Likewise, in a delayed free recall test, both the controls and the AD group showed improvement for pleasant pictures, when education factor was not controlled. The AD group showed improvement in the immediate and delayed free recall test proportional to the medial temporal lobe structures, with no significant clinical correlation between affective valence and amygdala volume. Conclusion –  AD patients can correctly identify emotions, at least at this early stage, but this does not improve their memory performance.

An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

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Cognitive assessment in advanced stages of Alzheimer's disease (AD) is limited by the imprecision of most instruments. Objective: To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method: Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results: Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p,0.0001). Conclusion: The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.

-Objective: To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimer's disease (AD) in a computerized neuropsychological test battery (CNTB). Method:Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. Results: Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1).The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. Conclusion: Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.KEY WORDS: Alzheimer's disease, clinical trial, galantamine, computerized neuropsychological tests, attention, memory. Efeitos da galantamina sobre a memória e a atenção na doença de Alzheimer medidos por testes neuropsicológicos computadorizados: resultados do Estudo Multicêntrico com Galantamina (GAL-BRA-01)RESUMO -Objetivo: Investigar os efeitos da galantamina no desempenho de pacientes portadores de doença de Alzheimer (DA) leve a moderada em uma bateria de testes neuropsicológicos computadorizados (BTNC). Método: Trinta e três pacientes com DA provável receberam tratamento com galantamina por três meses em ensaio clínico multicêntrico aberto e prospectivo. A escala BTNC e a ADAS-Cog foram administradas no início e ao final de 12 semanas. A BTNC incluiu testes de tempo de reação avaliando atenção, memória implícita e memória episódica para palavras e faces. Comparações estatísticas foram realizadas entre os resultados na 12ª semana versus a linha de base. Pacientes que não atingiram dose terapêutica foram excluídos da análise. Resultados: Quatro pacientes (12,1%) foram excluídos por interrupção do tratamento (n=3) ou por não atingir dose terapêutica (n=1). Os 29 pacientes remanescentes foram tratados com doses de 24 mg/dia (n=22) e 16 mg/dia (n=7). Ao final de 12 semanas, reduções nos tempos de reação foram observadas nos testes de memória episódica para faces (p=0,023) e no teste de tempo de reação de dupla

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...