Palavras-chave Doença de Alzheimer, demência mista, sintomas neuropsiquiátricos. rEsumoAlguns estudos sugerem que infartos cerebrais possam agravar a demência em pacientes com doença de Alzheimer (DA) e que sintomas neuropsiquiátricos sejam comuns tanto na DA quanto na demência vascular (DV). Doença cerebrovascular concomitante à DA incorre na chamada demência mista (DM). objetivos: Comparar a freqüência e o perfil dos sintomas neuropsiquiátricos em uma amostra de pacientes com DA e DM. métodos: Análise retrospectiva dos prontuários de 70 pacientes com diagnóstico de DA provável e 14 com DM. Informações sobre sintomatologia neuropsiquiátrica foram obtidas por meio dos relatos de familiares e cuidadores. resultados: A média etária foi de 74,5 anos na DA e 75,1 na DM. O sintoma mais comum na DA foi agitação (61,4%), enquanto na DM foi apatia (71,7%). Na DM, nove (64,3%) pacientes apresentavam ≥ 5 sintomas, enquanto na DA, 40 (57,1%) apresentavam ≤ 4. Quarenta e cinco (64,3%) pacientes com DA tinham ≥ 4 anos de doença; na DM, 10 (71,4%) tinham ≤ 3 anos. Pacientes com DM mostraram menor duração de sintomas (p < 0,05), sugerindo que tenham procurado atendimento médico mais precocemente. Conclusões: Os pacientes com DM exibiram maior gravidade de sintomas neuropsiquiátricos, fato que pode ter sido responsável pela busca mais precoce de assistência especializada. aBstraCT Some studies suggest that concomitant cerebral infarction may worsen the severity of dementia in patients with Alzheimer disease (AD) and that neuropsychiatric symptoms are common either in patients with AD and vascular dementia. AD lesions together with cerebrovascular disease is commonly called mixed dementia (MD).
evaluation (delayed recall task, category fluency and clock drawing), the Geriatric Depression Scale, the Mini International Neuropsychiatric Interview and to physical and neurological examination. Individuals with suspected cognitive impairment and a subset of cognitively healthy individuals were also submitted to a comprehensive neuropsychological and functional evaluation. Dementia and CIND were diagnosed according to standard criteria, accounting for the educational level, after an extensive two-phase clinical consensus discussion. Results: 639 individuals (55.3% of the total oldestold population) were fully evaluated, being 408 women (63.8%) and 231 men (36.2%), aged 81.1 6 5.2 years, with mean schooling of 2.6 6 2.8 years. Dementia was diagnosed in 176 subjects, (prevalence¼27.5%), while CIND was identified in 166 (prevalence¼26.0%). Among dementia patients, only 39 cases (6.1%) had a previous diagnosis of this condition. Patients with dementia were significantly older (p<0.0001) and less educated (p¼0.001). Prevalence of dementia was also higher in women, although the difference was not statistically significant (p¼0.06). CIND prevalence was similar in both genders. When compared with the cognitively healthy individuals (n¼227), CIND subjects were significantly older (p¼0.004), but had a similar schooling. A previous history of depression was more frequent among dementia (p¼0.002) and CIND (p¼0.007) patients. Conclusions: Prevalence of CIND and dementia was high in this oldest-old population, although dementia was highly under-diagnosed. Age and previous history of depression were associated with both diagnoses, while low education dementia was associated only with dementia. Background: Successful brain aging (SBA) can be defined as the absence of any neurological or psychiatric disorder in the elderly. Understanding SBA and its correlates, especially within the oldest-old population, may help in the prevention of some neuropsychiatric diseases. This study aimed to determine the rate of SBA in a cohort of oldest-old individuals and to investigate sociodemographic and clinical correlates of this condition. Methods: The study was conducted in the rural and urban areas of the city of Caeté, Minas Gerais state, Brazil. The city has 1,155 subjects aged 75 years or more (oldest-old) according to the 2007 Brazilian census. We aimed to evaluate at least 50% of these individuals. The selected random sample was submitted to a general personal and health questionnaire, the Mini-Mental State Examination, the Pfeffer Functional Activities Questionnaire, a brief cognitive evaluation, the Geriatric Depression Scale, the Mini International Neuropsychiatric Interview and to physical and neurological examination (including UPDRS-motor subscale). Individuals with suspected cognitive impairment and a subset of cognitively healthy individuals were also submitted to a comprehensive neuropsychological and functional evaluation. SBA was defined by intact cognitive performance, no current psychiatric diagnoses, no parkinsonism or...
RESumo objetivo: Determinar a freqüência de epilepsia em uma amostra ambulatorial de pacientes idosos com demência e analisar possível associação da epilepsia a uma causa específica de demência. metodologia: Estudo retrospectivo com dados de 135 pacientes com demência acompanhados em ambulatório de Neurologia Cognitiva, no período de setembro de 2006 a novembro de 2007. Foi realizado levantamento de dados clínicos, laboratoriais, de neuroimagem e de eletroencefalograma. As etiologias das demências foram definidas de acordo com critérios diagnósticos específicos, a partir do quadro clínico, exame neurológico, avaliação neuropsicológica, exames laboratoriais e de neuroimagem. Resultados: A freqüência de epilepsia foi 12%, sendo maior na demência mista (21,4%), seguida pela demência frontotemporal (18,6%), demência vascular (15,4%) e doença de Alzheimer (10,8%). No entanto, nenhuma diferença estatística foi observada entre essas freqüências (p = 0,817). Observou-se que 87,5% dos pacientes iniciaram o quadro de epilepsia na vida adulta, sendo que em 84,6% destes pacientes, o desenvolvimento de epilepsia foi posterior ao início do declínio cognitivo. Os tipos de crise mais comuns foram a tônico-clônico generalizada (43%) e a parcial complexa (38%). Conclusão: Apesar da freqüência de epilepsia ser variável entre os diversos tipos de demência, essa variabilidade não foi suficiente para demonstrar diferença estatística. unitermos: Epilepsia, demência, idosos. AbSTRACTEpilepsy and dementia in a sample of elderly patients followed at a tertiary outpatient clinic objectives: To determine the frequency of epilepsy in a sample of elderly outpatients with dementia and to evaluate whether epilepsy was more associated with a specific dementia etiology. methodology: Data from 135 patients with dementia were retrospectively analyzed in a Cognitive Neurology Outpatient Unit. We analyzed data from clinical evaluation, neurological examination, neuropsychological testing, laboratory and neuroimaging findings, and electroencephalogram, whenever available. Etiologies of dementia were defined according to specific diagnostic criteria. Results: Epilepsy was present in 12% of the cases, being more frequent in mixed dementia (21.4%), followed by frontotemporal dementia (18.6%), vascular dementia (15.4%) and Alzheimer's disease (10.8%). However, the rates of epilepsy across the different dementia etiologies were not significantly different (p = 0.817). Overall, 87.5% of patients started the epilepsy during adulthood, and in 84.6% of these individuals, epilepsy started after the emergence of cognitive decline. The most common types of seizures were generalized tonic-clonic (43%) and complex partial (38%). Conclusion: Although epilepsy occurred rather commonly in this sample of patients with dementia, no significant difference was found among the distinct etiologies.
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