Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil

Abstract

-The importance of investigating the etiology for dementia lies in the possibility of treating potentially reversible dementias. The aims of this retrospective study are to determine the prevalence of potentially reversible dementias among 454 outpatients seen at the Cognitive and Behavioral Neurology Unit, Hospital das Clínicas, São Paulo University School of Medicine -Brazil, between the years of 1991 and 2001, and observe their evolution in follow-up. Among the initial 454 patients, 275 fulfilled the DSM-IV criteria for dementia. Alzheimer´s disease was the most frequent diagnosis (164 cases; 59.6%). Twenty-two cases (8.0%) of potentially reversible dementia were observed, the most frequent diagnoses being neurosyphilis (nine cases) and hydrocephalus (six cases). Full recovery was observed in two patients and partial recovery in 10 patients. Two cases were not treated and eight cases were lost on follow-up. The prevalence found in the present study falls within the range reported in previous studies (0-30%).KEY WORDS: dementia, prevalence, Alzheimer´s disease, neurosyphilis, hydrocephalus. Prevalência de demências potencialmente reversíveis em ambulatório especializado de hospital universitário terciário no BrasilRESUMO -A importância de se investigar a etiologia da demência encontra-se na possibilidade de se tratar demências potencialmente reversíveis. Os objetivos deste estudo retrospectivo são determinar a prevalência de demências potencialmente reversíveis em 454 pacientes atendidos no Grupo de Neurologia Cognitiva e do Comportamento do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre 1991 e 2001 e observar a sua evolução em seguimento. Entre os casos iniciais, 275 preencheram os critérios de demência do DMS-IV. Doença de Alzheimer foi o diagnóstico mais freqüente (164 casos; 59,6%). Vinte e dois casos (8,0%) de demência potencialmente reversível foram encontrados, sendo os diagnósticos mais freqüentes neurossífilis (nove casos) e hidrocefalia (seis casos). Recuperação completa após tratamento foi observada em dois pacientes e parcial, em dez. Dois pacientes não receberam tratamento e oito não aderiram ao seguimento. A prevalência encontrada neste estudo situa-se entre as relatadas em estudos anteriores (0-30%).

Clinical diagnosis of 80 cases of dementia in a university hospital

“…None of the patients were diagnosed with neurosyphilis. The prevalence in our study is higher than three Brazilian studies 6,21,22 . Takada et al 21 showed a prevalence of potentially reversible dementia was 8% of total sample in a university hospital.…”

Prevalence of presenile dementia in a tertiary outpatient clinic

“…It is necessary more studies in different regions of our country about early onset dementia, and the ones with senile dementia clearly has showed AD as principal cause of dementia [9][10][11][12][13] . Collaborative researches can clarify this picture.…”

“…There are no studies analyzing the prevalence of presenile dementia in our country in a search in MEDLINE. Other authors have reported diagnostic prevalence in senile dementia or overall rates of dementia in their outpatient clinics [9][10][11][12] or institutionalized patients 13 . One report was presented as abstract and has reviewed a considerable number of patients (n= 619) and found a prevalence of 28.6% of presenile dementia 14 .…”

Lower mortality rate in people with dementia is associated with better cognitive and functional performance in an outpatient cohort

“…All over the country, few outpatient units mostly from the university [7][8][9][10] , have trained specialists and have given assistance to older persons with dementia and other related disorders, whereas primary and tertiary care are still difficult to find.…”