The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant.ObjectivesTo ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic.MethodsA prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists’ panel consensus, in each group, determined the final diagnosis of the case, blind to other center’s diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed.ResultsNinety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition.ConclusionsThe informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.

The long, short and the new short Brazilian IQCODE versions can be useful as a screening tool for mild and moderate patients with dementia in Brazil. The IQCODE is not biased by schooling, and it seems to be an adequate instrument for samples with low levels of education.

Reaching a diagnosis may be difficult in the initial stages of dementia, especially in low educated individuals, when informant reports may be useful.ObjectivesTo compare the sensitivity and specificity of the IQCODE against cognitive tests applied in clinical practice and to evaluate the possible cut-off points in Brazil.MethodsIndividuals without dementia (CDR=0; N=5), with Mild Cognitive Impairment (MCI) (CDR=0.5; N=15) and demented (CDR≥1; N=29) were evaluated using the Short IQCODE, a 16-item questionnaire applied to an informant, and on standard cognitive and functional scales. Diagnosis was reached by a consensus team with expertise in dementia, according to DSM-IV criteria, which was blind to the IQCODE results.ResultsIQCODE scores were positively correlated to the CDR (r=0.65, p<0.001) and negatively correlated with years of schooling (r= –0.33, p=0.021). IQCODE scores were positively correlated with CDR controlled by age and education (r=0.61, p<0.001). Linear regression showed that age was associated with the IQCODE (p=0.016) whereas education was not associated (p=0.078). IQCODE means according to the CDR classification were: CDR 0–3.37; CDR 0.5–3.75; CDR 1–4.32; CDR 2–4.61; CDR 3–5.00. The area under the ROC curve for dementia vs. controls was 0.869 (p<0.001), MCI vs. controls, 0.821 (p<0.001); and according to the groups classified by the CDR was: CDR 0.5 vs. CDR 1=0.649 (p=0.089), CDR 1 vs. CDR 2=0.779 (p=0.009), and CDR 2 vs. CDR 3=0.979 (p=0.023).ConclusionsThese preliminary findings suggest that the short IQCODE can be used for the screening of MCI and dementia in Brazil.

Reduction of regional brain glucose metabolism (rBGM) measured by [18F]FDG-PET in the posterior cingulate cortex (PCC) has been associated with a higher conversion rate from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Magnetic Resonance Spectroscopy (MRS) is a potential biomarker that has disclosed Naa/mI reductions within the PCC in both MCI and AD. Studies investigating the relationships between the two modalities are scarce.ObjectiveTo evaluate differences and possible correlations between the findings of rBGM and NAA/mI in the PCC of individuals with AD, MCI and of cognitively normal volunteers.MethodsPatients diagnosed with AD (N=32) or MCI (N=27) and cognitively normal older adults (CG, N=28), were submitted to [18F]FDG-PET and MRS to analyze the PCC. The two methods were compared and possible correlations between the modalities were investigated.ResultsThe AD group exhibited rBGM reduction in the PCC when compared to the CG but not in the MCI group. MRS revealed lower NAA/mI values in the AD group compared to the CG but not in the MCI group. A positive correlation between rBGM and NAA/mI in the PCC was found. NAA/mI reduction in the PCC differentiated AD patients from control subjects with an area under the ROC curve of 0.70, while [18F]FDG-PET yielded a value of 0.93.ConclusionrBGM and Naa/mI in the PCC were positively correlated in patients with MCI and AD. [18F]FDG-PET had greater accuracy than MRS for discriminating AD patients from controls.

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Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment.

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