Dementia In Brazil Research Articles

Dementias in Brazil: increasing burden in the 2000-2016 period. Estimates from the Global Burden of Disease Study 2016.

Dementia is a globally relevant health problem, which places a great burden on patients and their families. This study aimed to estimate the burden associated with Alzheimer's disease (AD) and other dementias in Brazil. In this descriptive study, we investigated the estimates obtained by the Global Burden of Disease study. We described the prevalence of AD and other dementias, years lived with disability (YLDs), age-standardized mortality, years of life lost (YLLs), and disability-adjusted life years (DALYs) among individuals aged 60 years or older between 2000 and 2016, with their respective 95% uncertainty intervals (95%UI). During this period, the age-standardized prevalence of AD and other dementias per 100,000 people increased by 7.8%, from 961.7 (95%UI 828.3-1,117.5) to 1,036.9 (95%UI 882.0-1,219.5), with approximately 1.5 million people living with dementia in Brazil. The incidence increased by 4.5%. Similarly, all age-standardized rates had an upward trend (mortality: 3.1%; YLLs: 5.8%; YLDs: 7.9%; and DALYs: 6.3%). Mortality profiles increased with age in both years. Dementias were ranked fourth among the leading causes of death in people aged ≥70 years in 2000, rising to second place in 2016. In 2016, it also represented the second and third leading causes of disability among older women and men, respectively. Population growth and aging have resulted in an increased burden of AD and other dementias in Brazil. Preventive and early diagnostic measures are essential to mitigate the burden associated with these diseases.

Translation and cultural adaptation of iSupport in Brazil

AbstractBackgroundMost people with dementia are living in low‐ and middle‐income countries and are being cared for at home by their families. This task can negatively affect the mental and physical health of carers. However, public health initiatives to support family carers are still scarce. This study aimed to translate and culturally adapt the iSupport programme from World Health Organization for use by carers of people with dementia in Brazil.MethodsThe translation of the programme from English to Brazilian Portuguese was conducted by a professional translator. The translated content was discussed and checked for relevance, clarity and accuracy by a multidisciplinary team of researchers in Brazil. Next, 16 focus groups (n=48) were conducted with family carers of people with dementia and health and social care professionals in Sao Carlos‐SP, Brasilia‐DF and Sao Lourenco‐MG. Discussions were aimed at exploring whether the content of the translated version of iSupport was both clear and relevant to the needs of carers of people with dementia in Brazil. Representatives of the Brazilian Ministry of Health and Alzheimer’s Associations also contributed to this assessment.ResultsOverall, all participants had positive views of the iSupport material. In addition to researchers and translators, carers and professionals helped refine the text to make it clearer and more tuned to the Brazilian context. In general, participants found the material clearly written and culturally relevant. A few changes were suggested with regards to terminology and examples given in the modules to better fit the Brazilian culture and health systems, and links to relevant web pages of the Brazilian Alzheimer Association were included. Although further information could be added, the existing material was seen as sufficient.ConclusionThe translation and cultural adaptation of iSupport included inputs from four categories of participants and showed that the programme was considered easy to understand and culturally relevant for carers of people with dementia in Brazil. The next step will be to pilot the translated and culturally adapted programme with carers in Brazil to establish its efficacy and usability.

Who are the patients diagnosed with dementia in Brazil? A nation‐wide descriptive study

AbstractBackgroundBrazil has the second highest age‐standardized prevalence of dementia in the world. However, there are no studies that used national‐wide data to describe how this disease is distributed among Brazilian population. We aimed to describe demographic, clinical, and behavioral characteristics from people with dementia (PWD) in Brazil.MethodsWe extracted data from adults who had diagnosed dementia during the latest National Health Survey (2013), which is the most comprehensive survey with data about health status, lifestyle, and healthcare utilization among Brazilian adult population. We reported data about demographic (i.e. education, ethnicity, marital status, occupation), clinical (i.e. functional capacity, number of morbidities, hospital admission), and behavioral (i.e. physical inactivity, social interaction) aspects of PWD in Brazil.ResultsUsing data from 60,202 individuals (response rate: 74.2%), we reported higher prevalence of dementia in subjects aged 60 years or older (76.1%), female (67.2%), white people (50.8%), widowed (38.3%), unemployed (60.4%), and among those with low educational level (67.1%). PWD reported higher prevalence of hearing (19.5%) and visual (34.4%) impairment, functional disability (66%), physical inactivity (90.2%), social isolation (89.3%) and diagnostic of chronic diseases (73.2%). About 75% from sample self‐rated their health as regular or worse. Although habitual activities were severally limited by dementia in about 70% of sample, only 21% frequented any type of rehabilitation service. Besides a higher incidence on hospitalizations during the last 12 months before interview (27.3%), PWD had longer hospital admissions (p<0.001), with public health system being the major provider (65.7%). In addition to 61% of PWD did not have access to any public place near their houses to perform physical activity, 97.6% did not know any public program for physical activity promotion.ConclusionDementia is more prevalent in certain sociodemographic groups in Brazil. PWD have higher prevalence of morbidities, social isolation, physical inactivity, and general health rated regular or worse. Low frequency in rehabilitation services and access to physical activity practice may be associated to higher incidence and duration of hospitalizations among PWD. Strategies to reduce social inequality in dementia in Brazil should be encourage in order to reduce its burden of this disease on Brazilian healthcare system.

Cognitive stimulation therapy for people with dementia in Brazil (CST-Brasil): Results from a single blind randomized controlled trial.

The prevalence of dementia has been increasing particularly in developing countries but care provision is still limited in these regions. Psychosocial interventions are recognized as useful tools to improve cognitive and behavioral difficulties, as well as quality of life of people with dementia (PwD) and their caregivers. Cognitive stimulation therapy (CST) is an evidence-based psychosocial intervention, recommended and implemented in many countries. In Brazil, there is no validated psychosocial intervention for dementia care. The present study aims to explore feasibility and obtain preliminary data on the efficacy of CST-Brasil in a sample of 47 people with mild to moderate dementia attending an outpatient unit. A single-blind design was used, with participants being randomly allocated to either 14 sessions of CST + treatment as usual (TAU; n = 23) or TAU (n = 24) during 7 weeks. Changes in cognition, quality of life, depressive symptoms, caregiver burden and functionality were measured. PwD receiving CST and their family caregivers expressed good acceptance of the intervention, with low attrition and high attendance. Participants receiving CST exhibited significant improvements in mood and in activities of daily living compared to TAU. There were no significant effects in cognition, quality of life and caregiver burden. CST-Brasil proved to be a feasible and useful intervention to improve mood in PwD, with high acceptance between study participators. CST-Brasil is a promising psychosocial intervention for dementia and should be explored in other clinical settings to allow generalization to a wider Brazilian context.

Qualidade de vida de idosos com Alzheimer: um estudo de correlação

Objetiva-se correlacionar a percepção da qualidade de vida do idoso com Doença de Alzheimer com a percepção de seus cuidadores e identificar o perfil sociodemográfico dos idosos. Estudo correlacional com abordagem quantitativa, com 34 idosos com Doença de Alzheimer leve e/ou moderado e seus cuidadores, durante as consultas de enfermagem, utilizando-se um questionário sociodemográfico e escala de Avaliação da Qualidade de Vida na Doença de Alzheimer. Os idosos apontaram como negativas (ruim e regular) memória (55,9%), em ambos com maior percentual; positivas (bom e excelente), moradia (91,2%), respectivamente e seus cuidadores como negativas (ruim e regular) memória (61,8%) e disposição (64,7%), e positivas (bom e excelente) moradia (61,8%) e família (29,4%), respectivamente. Conclui-se que os idosos com comprometimento cognitivo apresentam uma boa percepção de sua qualidade de vida, evidenciando um dos principais itens negativos, a memória.

An assessment of direct and indirect costs of dementia in Brazil.

BackgroundTo analyze costs associated with dementia based on a cross-sectional study in the Brazilian health system.MethodsDirect and indirect costs were estimated by conducting comprehensive interviews on the use of resources in a sample of 156 patients with dementia treated at an outpatient memory clinic of a tertiary hospital. A regression model was used to determine the main determinants of costs associated with dementia.ResultsGlobal costs of dementia were US$1,012.35; US$1,683.18 and US$1,372.30 per patient/month for mild, moderate and severe stages, respectively. Indirect costs ranged from US$536.62 to US$545.17 according to severity. Dementia costs were influenced by medication, FAST score, and educational level of caregiver.DiscussionThe study represents an original contribution toward establishing direct and indirect costs of dementia in Brazil. Results indicate significant economic impacts, including projection of annual costs of US$16,548.24 per patient.

Revisão sistemática sobre prevalência de demência entre a população brasileira

<p>À medida que a população idosa aumenta no mundo, as doenças relacionadas ao envelhecimento, particularmente a demência, tornam-se mais frequentes. Tendo em vista que o Brasil segue essa tendência global do envelhecimento populacional, deve apresentar, também, aumento da prevalência de demência em sua população. Objetivos: os objetivos desse estudo são revisar artigos sobre prevalência de demência no Brasil nos últimos anos, estabelecer comparações entre os estudos e identificar associações entre a prevalência de demência e características populacionais. Bases de dados: SciELO, Lilacs e Medline. Métodos: pesquisa por artigos originais sobre estudos epidemiológicos de prevalência de demência em amostras populacionais brasileiras, usando especificas palavras-chaves nas bases de dados com três fases de seleção final dos artigos e caracterização daqueles selecionados. Resultados: dos 357 artigos encontrados, apenas 8 foram selecionados após a avaliação. A prevalência encontrada nos artigos variou de 5,1% a 17,5%. Discussão: apesar da boa qualidade dos artigos, o pequeno número deles é insuficiente para caracterizar a população brasileira. A doença de Alzheimer é a causa de demência que lidera em número de casos e a associação entre demência e idade é demonstrada, assim como escolaridade. Conclusão: são necessários mais estudos de outras regiões do Brasil para avaliar e comparar a população brasileira com outras populações.</p>

Indirect cost with dementia: A Brazilian study.

Costs with dementia have been the focus of research around the world and indirect costs to the caregiver appear in the literature as responsible for the greatest impact. In Latin American (LA) studies, indirect costs with dementia range from 60% to 75% of family income.ObjectiveTo present preliminary results of the study "Description of the methods and cost analysis with dementia" currently being conducted at the Behavioral and Cognitive Neurology Unit of Hospital de Clínicas of University of São Paulo - HC-FMUSP.MethodsA cross-sectional study which, to date, includes interviews of 93 primary caregivers. The research protocol includes a sociodemographic questionnaire, the Functional Assessment Staging (FAST) scale, the Burden Interview (Zarit), an economic classification scale, and the Resource Utilization in Dementia (RUD) scale.ResultsMonthly indirect costs were US$ 1,122.40, US$ 1,508.90 and US$ 1,644.70 stratified into mild, moderate and severe dementia, respectively. The projected annual indirect costs were US$ 13,468.80, US$ 18,106.80 and US$ 19,736.40, representing 69 to 169% of family income.ConclusionThis small sample showed that the impact of indirect costs with dementia in Brazil may be higher than that reported in other Latin American (LA) studies. These initial results may represent an important contribution for further research on costs with dementia in LA.

Impact of Caregiving for Patients with Alzheimer's Disease and Dementia on Psychiatric and Clinical Comorbidities in Brazil.

PND67 ImPact of caregIvINg for PatIeNts wIth alzheImer’s DIsease aND DemeNtIa oN PsychIatrIc aND clINIcal comorbIDItIes IN brazIl Goren A.1, Novick D.2, Barros B.R.3, Laks J.4, Duenas H.5, Kahle-Wrobleski K.6 1Kantar Health, New York, NY, USA, 2Eli Lilly and Company, Windlesham, UK, 3Eli Lilly do Brasil Ltda, Sao Paulo, Brazil, 4Federal University of Rio de Janeiro, Rio de Janeiro, Brazil, 5Eli Lilly de Mexico, Mexico City, Mexico, 6Eli Lilly and Company, Indianapolis, IN, USA Objectives: Patients with dementia due to Alzheimer’s disease (AD) are often cared for by family members who experience physical, psychological, social, and financial burdens associated with provision of care. This study quantifies the impact of caregiving in Brazil and helps identify characteristics associated with caregiving. MethOds: Data were analyzed from the 2012 National Health and Wellness Survey (NHWS) in Brazil (n = 12,000), an Internet-based survey of adults (aged 18+), using stratified random sampling (by sex and age) to ensure demographic representation of the Brazil adult population. Caregivers were compared with non-caregivers on select comorbidities considered potential outcomes of caregiving, plus sociodemographic characteristics, health characteristics and behaviors, and Charlson comorbidity index (CCI) scores. Binary logistic regression models assessed comorbidities associated with caregiving, adjusting for potential confounds (CCI, age, gender, education, income, insurance, and marital status). Results: Among 10,853 respondents (caregivers [n= 209]; non-caregivers [n= 10,644]), caregivers were on average 42.1 years old, and 53% were female, 52% married/living with a partner, 87% insured, and 42% living with 1+ children in the household. Caregivers vs. non-caregivers were more frequently obese, smokers, insured, employed, and with college education or above, and they had higher CCI scores and higher income, all p < .05. Adjusting for covariates, caregiving was associated with significantly increased risk of depressive symptoms (odds ratio [OR] = 2.008), major depressive disorder (OR= 1.483), anxiety (OR= 1.714), insomnia (OR= 1.644), hypertension (OR= 1.584), pain (OR= 1.704), and diabetes (OR= 2.103), all p< .015. cOnclusiOns: This is the first study on caregivers for persons with dementia in Brazil using a large dataset (NHWS). Being a caregiver (compared with noncaregiver) is a predictor of overall psychiatric and clinical disorders in this sample. The online survey format provides certain sampling advantages but may under-represent caregivers without access/comfort with online technology. Direct treatment and policies to help caregivers are needed in Brazil.

Exercise is effective in preventing high-fat-diet–induced beta-amyloid deposition and memory deficit but continuation is necessary to keep the effect of exercise in APP transgenic mice

rehabilitation, cognitive stimulation, cognitive training), 5 to caregivers intervention (two for managing behavioral symptoms and reducing caregiver burden), 2 to functional training (ADL) and 2 to physical exercise. The main population studied, was of elderly individuals with Alzheimer’s disease and mild cognitive impairment. Conclusions: This first review gives us a preliminary sight of the ongoing national production on NPIs directed to patients with dementia in Brazil. Most studies it was Multicomponent Interventions. None of the studies retrieved investigated the cost effectiveness of the intervention strategies. More extensive studies are needed for analyzing the methodologies and variables used, as well as classifying the evidence level of the published studies. This will contribute to future consensus and recommendations for the clinical practice in Brazil.

Prion protein gene in Alzheimer's disease

Alzheimer’s disease (AD) is a complex disorder, including sporadic (representing the majority of cases) and familial forms, the latter being usually linked to a genetic etiology. Three major genes have been already described as the cause of AD: amyloid precursor protein (APP) gene, presenilin 1 gene (PSEN1), and presenilin 2 gene (PSEN2), typically presenting with an early onset (before 60 years). However, these genetic forms are responsible for less than 5% of all AD cases1. Conversely, more common gene polymorphisms, such as the presence of the e4 allele of the apolipoprotein E (APOE) gene, are associated with an increased risk of developing late-onset AD2,3. Numerous other candidate genes have been identified, especially through genome-wide association studies, and are currently the topic of intensive research1,2. Among the polymorphisms that have been explored in relation to AD, homozygosis for methionine at codon 129 of the prion protein gene (PRNP) has been associated with a 1.3-fold increased risk of developing the disease in populations of Caucasian origin, in comparison with heterozygosis (i.e., methionine/valine), according to a meta-analysis4. However, these findings have not been confirmed by other investigators, particularly in a study including patients with definite AD5. Human prion diseases, although very rare, share some neuropathological features with AD, especially the accumulation of misfolded proteins [prion protein (PrPC) and β-amyloid] in the brain tissue. Moreover, PrPC seems to function as a receptor for the β-amyloid oligomers, and this interaction could mediate the characteristic neurotoxicity of AD pathology, leading to synaptic failure and cognitive decline6,7. Within this context, the paper published in this issue of Arquivos de Neuro-Psiquiatria by Smid et al.8 adds another piece of information to this intriguing and interesting puzzle. The authors conducted a case-control study comparing PRNP polymorphisms in AD patients and matched controls, and they also explored associations between the genotypes and cognitive performance. No genotype differences were found between AD and controls in relation to PRNP, even when APOE genotype was taken into account in the analysis. Moreover, cognitive performance was not influenced by PRNP polymorphisms. Hence, the overall results of the study are essentially negative. This could be explained by sample size limitations or by the ethnic background of the population, possibilities that were already acknowledged by the authors. On the other hand, the findings are in agreement with those of previous reports, particularly with the sole neuropathological investigation published on this topic5. No similar data from other Brazilian populations are available for comparison, as this is the first study to have explored PRNP polymorphisms in AD in the country. This latter feature brings special relevance to the present study. We need more and better information about the genetics of dementia in Brazil and in other developing countries, either to confirm or to refute current candidate genes, as well as to identify new ones, which may ultimately contribute to improve our understanding about the pathogenesis of these devastating conditions. MD, PhD; Professor; Department of Internal Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte (MG), Brazil.

Non- pharmacologic intervention in people with dementia in Brazil: An overview

Non- pharmacologic intervention in people with dementia in Brazil: An overview

Prevalence of dementia among elderly Brazilians: a systematic review.

The rapid growth of the elderly population in Brazil has implied a significant rise in the number of individuals with dementia. The real prevalence of this disease needs to be ascertained in order to establish appropriate measures for improving the quality of life of those affected. The aim of this study was to estimate the prevalence of dementia among elderly Brazilians (≥ 60 years) through a systematic review of high-quality, population-based, double-blind studies published between 1990 and 2010. Systematic review of prevalence studies. The manuscript was produced in the School of Medicine, Universidade de Brasília. Database searches for articles were conducted in Medline (Medical Literature Analysis and Retrieval System Online), Embase (Excerpta Medica database), Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde), SciELO (Scientific Electronic Library Online) and theses and dissertations, using specific keywords. Quality was assessed according to eight criteria for sampling and measurement of findings. Out of 112 articles identified, eleven were included in the qualitative synthesis. In five higher-quality studies from São Paulo, the prevalence rates ranged from 5.1 to 19.0%. No meta-analysis was presented because of heterogeneity among the studies. Poor, illiterate, female and very elderly individuals were the groups most affected. The findings from this review did not reflect the reality of the whole country. Although the results brought some information on the prevalence and distribution of dementia in Brazil, cross-sectional studies with consistent methodology are needed.

Performance of Brazilian long and short IQCODE on the screening of dementia in elderly people with low education

Dementia screening in elderly people with low education can be difficult to implement. For these subjects, informant reports using the long (L) (26 items) and short (C) (16 items) versions of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) can be useful. The objective of the present study was to investigate the performance of Brazilian versions of the IQCODE L, S and a new short version (SBr) (15 items) in comparison with the Mini-mental State Examination (MMSE) for dementia screening in elderly people with low education. Thirty-four patients with mild to moderate dementia, diagnosed according to ICD-10 criteria, and 57 controls were evaluated and divided into three groups based on their socioeconomic status and level of education. Patients were evaluated using the MMSE and the informants were interviewed using the IQCODE by interviewers blind to the clinical diagnosis. Education was correlated with MMSE results (r = 0.280, p = 0.031), but not with the versions of the IQCODE. The performance of the instruments, evaluated by the ROC curves, was very similar, with good internal consistency (Cronbach's alpha = 0.97). MMSE correctly classified 85.7% of the subjects while the three IQCODE versions (L, S and SBr) correctly classified 91.2% of the subjects. 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.

Short IQCODE as a screening tool for MCI and dementia: Preliminary results.

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.

P2-214: CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in Brazil

P2-214: CAMCOG as a screening tool for diagnosis of mild cognitive impairment and dementia in Brazil

Prevalence of presenile dementia in a tertiary outpatient clinic.

There are very few reports about prevalence of presenile dementia in Brazil. We reviewed files of patients evaluated with early onset of cognitive impairment in our institution. Among 141 patients (61% males) there was no difference between gender by age at onset or at first evaluation. We have observed an increasing number of patients after 50 years. The most frequent causes were: vascular dementia (36.9%), Alzheimer's disease (20.3%) and traumatic brain injury (9.2%). There was difference among dementia type by age of onset and first evaluation, educational level and length of dementia. These results may be compared with those from other neurologic services in order to replicate or confirm these results.

Elderly Japanese emigrants to Brazil before World War II: II. Prevalence of senile dementia.

We previously showed the prevalence of dementia in the town of Tajiri (Miyagi Prefecture, Japan), and found it to be 8.0%. The first population-based study on dementia in Brazil (Catanduva) disclosed the prevalence as being 7.1%. To evaluate the effects of environment on development of dementia, elderly Japanese immigrants living in Brazil were examined. Brazil is the country with the largest number of Japanese immigrants. All immigrants aged 65 years and over from Miyagi Prefecture, living in the four cities of the São Paulo Metropolitan area were targeted (n = 192). We were able to examine 166 subjects (86.5%). The diagnosis of dementia was based on the DSM-IV with the severity assessed by the CDR (clinical dementia rating) scales. The cognitive ability screening instrument (CASI) was used for neuropsychological assessment. Thirteen subjects were diagnosed with dementia, CDR 1-3, the prevalence being 7.8%. Older subjects suffered more from dementia, and, paradoxically, the more highly educated subjects also suffered more. All the CASI items, except for long-term memory and visual construction, significantly deteriorated in the CDR 0.5 group compared with the CDR 0 group. The prevalence of dementia was not thought to be affected by environmental factors. A paradoxically higher rate of dementia in the more educated subjects was probably due to the historical problems of the immigrants. Intact CASI item long-term memory in the CDR 0.5 group indicated that suspected dementia patients could maintain this function. This is the first epidemiological study on dementia in elderly Japanese immigrants in Brazil.

Reliability study of the Brazilian version of a structured interview for the diagnosis of dementia

to evaluate the reliability of the Structured Interwiew for the Diagnosis of Alzheimer's Type Dementia, Multi-Infarct Dementia and Dementia of other Aetiology (SIDAM) Portuguese version; validated as a reliable instrument to be applied to patients with a presumed diagnosis of dementia or mild cognitive impairment. twenty elderly patients of our Service with a clinical diagnosis of dementia were interviewed simultaneously by the authors, utilizing the SIDAM's Portuguese version. The answers were noted down concomitantly, and then compared. The reliable evaluation of the diagnosis of the SIDAM's Portuguese version was based on Kappa's statistics (K). of the patients studied, ten were women; with an average age of 75.5 years. Nine were maried, two were not and nine widowers. They had attended school for about 5.3 years. The average score on the Mini Mental State was 16.8. As to their professional activities, 12 (60%) were manual workers, eight were not. Everyone had the diagnosis of dementia, being most of them, Alzheimer's Type. The concordance rate between ICD-10, DSM III-R and the SIDAM's questions showed a K > 0.87; and between the interviewers, rarely K < 0.87. K >/= 0.87 suggests that the Brazilian version of SIDAM can be considered a reliable instrument to be applied to outpatients with presumed diagnosis of dementia in Brazil.

Mini mental state examination and the diagnosis of dementia in Brazil

The diagnosis of dementia is based on the presence of memory deficits and decline of other cognitive functions. Many scales have been designed to aid the clinician in the assessment of at risk subjects, such as the elderly. The Mini-Mental State Examination (MMSE) is the most widely used of such scales, although its use as an aid to the diagnosis of dementia has not as yet been studied in a Brazilian sample of patients. The current study was designed with 2 main aims: (1) to determine the best cut-off point of the MMSE for the diagnosis of dementia in a sample of elderly subjects assessed in a mental health outpatient unit and; (2) evaluate the impact of age and schooling on MMSE scores. Two hundred and eleven subjects aged 60 or over assessed at the Mental Health Outpatient Unit for the elderly at "Santa Casa de São Paulo" between February 1997 and February 1998 were included in the study. They were assessed with the SRQ-20, MMSE, and a clinical interview for the diagnosis of dementia according to the ICD-10. Seventy patients received the diagnosis of dementia. The MMSE cut-off point of 23/24 (cases/non-cases) was associated with a sensitivity of 84.3% and specificity of 60.3%. MMSE scores were associated with age (r = -0.41, p < 0.001) and schooling (F = 12.69, p < 0.001). Analysis of covariance taking age into account showed that MMSE scores were significantly lower among those with no formal education (F = 10.51, p < 0.001). A cut-off point of 19/20 on the MMSE was associated with sensitivity of 80.0% and specificity of 70.9% for the diagnosis of dementia in this particular group. Subjects with previous school history were better classified to the diagnosis of dementia with the cut-off point of 23/24: sensitivity of 77.8% and specificity of 75.4%. The evaluation of elderly subjects with the MMSE should take education into account, and different cut-off points should be used accordingly as a guideline to the diagnosis of dementia.