Pfeffer Functional Activities Questionnaire Research Articles

Association between depression, functional capacity, cognitive status and the consumption of fruits and vegetables in elderly in Joinville/SC-Brazil

The consumption of fruits and vegetables seems to contribute to the prevention and/or delay of depression, cognitive decline and, indirectly, to functional dependence, at the same time that it can be influenced by these clinical conditions. The objective of this study was to verify the association between depression, functional capacity, cognitive status and consumption of fruits and vegetables in elderly people in Joinville-SC. A study with secondary data collection carried out in 2021 that assessed depressive symptoms using the Geriatric Depression Scale, functional capacity using the PFEFFER Functional Activities Questionnaire, and cognitive status using the Mini-Mental State Examination. Consumption of fruits and vegetables (FV) was quantified using a food frequency questionnaire and was classified according to regularity. A total of 61 elderly were evaluated, of which 23% had depressive symptoms, 18% functional dependence in instrumental activities of daily living, 14.8% cognitive decline. A low frequency of elderly people with regular consumption of vegetables (36.1%), as well as associated fruits and vegetables (29.5%) was identified. On the other hand, the frequency of regular fruit consumption was high (73.8%) and was associated with a lower frequency of depressive symptoms and functional dependence. It was observed that elderly people with depressive symptoms, functional dependence and cognitive decline consumed FV irregularly.

Functionality and socio‐demographic factors in chilean’s community‐dwelling elderly with subjective cognitive complaints . The GERO Cohort

AbstractBackgroundSubjective cognitive complaints (SCCs), defined as cognitive concerns of people who may or may not have deficits in objective, is considered a predictor for cognitive and functional decline and incident to dementia risk of progression to dementia. SCC is a heterogeneous condition associated. Most of the studies have been carried out in populations other than those of Latin America. The objective of this study was to analyze the socio‐demographic and functional profile in SCC elderly with and without cognitive impairment.MethodThe GERO cohort is a prospective cohort study of community‐dwelling elderly with SCC, without dementia, aged 70 or older living in Santiago, Chile. Participants were identified by a household census and information on demographics, biomedical, psychosocial, neuropsychological, neuropsychiatric, and motor function were collected by means of questionnaires and evaluations. Montreal Cognitive Assessment (MOCA) was used to compare individuals with and without cognitive impairment (MOCA score ≤ 21 and > 21 respectively). Functionality was measured with the Pfeffer Functional Activities Questionnaire (FAQ) and Technology Activities of Daily Living Questionnaire (T‐ADLQ) that yield a global score and score by domain of activities of daily living (ADL), i.e basic (BADL), instrumental (IADL), and advanced ADL (a‐ADL).ResultFrom May 2017 to December 2020, a total of 17,759 households were successfully approached, identifying 2,533 eligible subjects, of which 299 individuals were included. After evaluation, 7 individuals were excluded for different reasons and 291 individuals were analyzed, female 80% (n = 243). The age of the individuals was 76.8 ± 5 years old, 60% of the participants were older than 75 years old. Participants with cognitive impairment compared to those without it were older (p = 0.003), with lower education years (p = <0.001), lower income (p = 0.036), lower MMSE score (p = <0.001), decline in a‐ADL (p = 0.006) and with more hypertension prevalence (p = 0.009)ConclusionFew other studies addressed cognitive complaint and functionality decline in recruited elderly at home. Older adults with cognitive impairments are characterized by less years of education, income, poor functionality and more comorbidities. Future multidimensional and prospective analysis of this cohort could bring more information about this association.

Admixed ancestral composition with Amerindian predominance at the Peruvian Alzheimer Disease Initiative (PeADI)

AbstractBackgroundCurrent genetic studies for AD and other dementias are making efforts to incorporate underrepresented populations including admixed Latinos. Peruvian population is characterized by admixed ancestry with a significant Amerindian component, which varies according to specific regions across Peru. The Peruvian Alzheimer Disease initiative (PeADI) was developed to ascertain a cohort for AD and other related dementias for genetic studies in Peru. We aim to determine the patterns of continental ancestry by regions across Peru.MethodsOver the last 3 years, The PeADI study has recruited 212 unrelated cognitive participants through collaborative health centers and community outreach ascertainment strategies. Cases were assessed by neurologists following NINDS‐ADRDA criteria. Controls were screened using MMSE, Clock drawing test and Pfeffer functional activities questionnaire. Genome‐wide genotyping was performed by Illumina screening array. PC‐AiR and model‐based. The cohort was divided into five regions (Northern, Southern, Lima, Central Highlands, and Amazonian) based on place of birth of the participant or the ancient known ancestor.ResultsThe global Admixture analysis showed that Peruvians have a substantial Amerindian component (63.6%), followed by European (35.9%), African (2.5%) and East Asian (2.1%) components. When analyzed by regions, we found that the Central region concentrates the highest Amerindian ancestry (72.7%), followed by the Northern region (58.2%), Lima and Callao (57%), the Amazonian region (55.6%), and the Southern region (55.1%). The highest European ancestry is located in the Amazonian region (42.1%), while the Central region has the lowest (26.6%). African and East Asian ancestry has little influence in Peru, being the Northern with the higher African component (4.1%), and Lima and Callao the region with the higher East Asian component (3.5%). There is no significant for Amerindian component across five regions (p=0.054); however, Central highlands region has higher Amerindian component compared to Lima (p=0.005), the Northern (p=0.005) and Southern(p=0.017) regions.ConclusionOur results confirmed the ancestry admixture of the Peruvian population with predominance of the Amerindian component. The Central region concentrates the highest Amerindian ancestry compared with other regions across Peru.

Association of mild cognitive impairment and physical activity level in older persons in Chile

BackgroundUnderstanding the association between cognitive impairment and low physical activity is a useful way to proactively prevent MCI or delay the onset of dementia. This study aims to explore the association between MCI and physical activity (PA) levels in Chilean persons aged 60 and over. MethodsData came from the 2016–17 Chilean National Health Survey data. MCI was evaluated with Mini-Mental State Examination and Pfeffer Functional Activities Questionnaire, excluding individuals with suspected dementia. The Global Physical Activity Questionnaire was used to assess PA levels. The association between MCI and PA levels was examined using logistic regression analysis, including overall and sex stratified models. ResultsA total of 1981 participants were analysed. The mean age was 70.7 years (SD: 7.77), and 63% were women. The MCI prevalence was 10%, increasing with age. The overall MCI model for low PA level showed an Odds Ratio (OR): 1.95 (95% Confidence Interval (95% CI): 1.18; 3.20, p = 0.009), meaning that a low PA level has a significant association with the risk of having MCI. The MCI model for PA levels in women was not statistically significant; however, the model for men showed an OR of 2.44 (95% CI: 1.17; 5.11, p = 0.018). ConclusionsA low PA level significantly increases the likelihood of developing MCI, and the risk was significantly higher among men. Therefore, promoting PA for older persons should be considered as a valuable prevention strategy among healthy older adults or those with initial symptoms of MCI.

The Relationship between Functional Status and Social, Emotional and Family Loneliness among Older Adults in Pontian

Life at mature age is perceived to be very challenging and mostly influenced by the ageing process and negative changes that increase the risk of functional abilities. The most enormous thing to achieve is to live independently with less help from others to achieve an optimum quality of life. Methods: This is a community-based cross-sectional survey conducted among 414 community-dwelling older adults in Pontian District aiming to identify the functional status and examine the relationship between functional status and three types of loneliness. The Pfeffer Functional Activities Questionnaire was used to measure the level of functional status. Loneliness was measured with the short form of the Social and Emotional Loneliness Scale for Adults. The Statistical Package for Social Science Ver.26 for Windows was used to analyse all of the data.The results of this study show that the mean (+SD) age is 71.4 (+2.0). The majority of respondents perceived good health status and no deterioration in functional status. 8.2% of respondents experienced deterioration in functional status. Of these, 32.6% of respondents experienced social loneliness, 39.9% experienced emotional loneliness, and 9.2% experienced family loneliness. The results also revealed a significant relationship between functional status and social loneliness (p = 0.02). In conclusion, the majority of respondents are independent enough to perform functional activities, and less than half of them have experienced social, emotional, or family loneliness. Social loneliness was linked to a decline in functional ability in older adults. This research could aid in the care of older adults who live independently and freely in the community.

Clinical profile of an Alzheimer´s disease cohort in the Peruvian population

AbstractBackgroundAmong older Peruvians (over 65‐years) the prevalence of dementia is 7%, with 56% meeting clinical criteria for Alzheimer Disease (AD). Peruvians, are an admixed population with approximately 80% Amerindian ancestral background. We have ascertained a cohort of Alzheimer Disease (AD) cases and cognitively intact controls for genetic studies.MethodAll participants have been recruited since 2019 using community outreach ascertainment strategies and hospital‐based recruitment from Lima, Peru. Cases were assessed by neurologist following NINDS/ADRDA criteria; and completed a comprehensive neurocognitive, neuropsychiatric and functional assessments. Controls were screened using MMSE, Clock drawing test and Pfeffer functional activities questionnaire. IRBs approvals from the participating Peruvian institutions and University of Miami were obtained for this study.ResultA total of 102 AD cases (4 familial cases) and 152 controls were recruited since 2019 to December 2020. For AD cases: age at examination were 76.5±9.09, age at onset were 72.15±8.82, and 63.7% were female, average of 9.9±4.9 year of education. For controls: age at examination were 73.13±6.54, 62.5% were female, average of 11.62±4.41 year of education. Among cases diagnosis was classified as: 62.8% possible AD (two cases screened for Cerebrospinal fluid Abeta42 and tau protein levels) and 37.2% probable AD. Clinical and cognitive assessment profile for cases: MMSE average score was 17.2± 4.9 and Addenbrook’s Cognitive Examination average score was 38.5± 21.7 with memory loss predominance. Based on NPI the most frequent neuropsychiatric symptoms were irritability (51%), delusions (46%) and apathy (45%). Severity of dementia were assessed by CDR (CDR=3 for 33.9%, CDR=2 for 32.3%, CDR=1 for 24.2% and CDR=0.5 for 9.7%). Depressive symptoms were assessed with Geriatric Depression Scale with an average of 4.4±3.5 .ConclusionThe clinical features of the AD cohort in the Peruvian population are consistent with previous reports. There is a tendency of a higher level of education in the control . Among the Peruvian AD cohort, the main neuropsychiatric symptoms are irritability, delusions and apathy consistent with the predominance of moderate to severe dementia. Reference: Marca V. et al. Dissecting the role of Amerindian genetic ancestry and ApoE ε4 allele on Alzheimer disease in an admixed Peruvian population, Neurobiology of Aging, 2020.

Screening for cognitive impairment among individuals aged 60 years or over: scoping review.

Growth in aging of the population has led to increasing numbers of elderly people presenting cognitive impairment and evolution to dementia. There is still no consensus within primary care on the best strategy for screening for cognitive impairment among elderly people. Standardization of a simple but reasonably accurate instrument for a brief cognitive test, in primary care environments, would enable healthcare professionals to identify individuals who require a more in-depth assessment of cognition. To investigate the instruments used by healthcare professionals in studies conducted worldwide and ascertain the most suitable instruments for screening for cognitive impairment among individuals aged 60 years or over, in the Brazilian population. Scoping review developed at Pontifícia Universidade Católica de São Paulo, Brazil. A systematic search of the literature was conducted for primary studies using instruments to screen for cognitive impairment among individuals aged 60 years or over, in the MEDLINE, EMBASE, Cochrane Central and LILACS databases. A total of 983 articles were identified by two independent reviewers, from which 49 were selected for full-text reading, based on the criteria defined for this review. From this, 16 articles adhering to the theme of screening for cognitive impairment among the elderly were selected for in-depth analysis. The Mini-Mental State Examination was the instrument most cited in these studies. The Pfeffer Functional Activities Questionnaire and the Verbal Fluency Test (semantic category) present characteristics favoring further studies, for testing as screening instruments for cognitive impairment among elderly people in Brazil.

Diabetes and impaired fasting glucose in a population-based sample of individuals aged 75 + years: associations with cognition, major depressive disorder, functionality and quality of life-the Pietà study.

To investigate the rates of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a population-based sample of individuals aged 75 + years old and their associations with cognitive performance, depression, functionality, and quality of life (QoL). Overall, 350 people participated in the study. Assessments of cognition, mood, functionality and QoL were performed using the mini-mental state examination (MMSE), clock-drawing, category fluency tests, the Mini-International Neuropsychiatric Interview, Pfeffer's Functional Activities Questionnaire, and the WHO Quality of Life-Old (WHOQOL-OLD). IFG (ADA criteria) was identified in 42.1% of the sample, while the DM rate was 24.1%. Lack of knowledge of the DM diagnosis and lack of treatment occurred in 27% and 39% of the sample, respectively. Rates of dementia and depression, MMSE, category fluency scores, and previous cardiovascular events did not differ between the glycaemic groups. Individuals with DM performed worse on the clock-drawing test, functionality, and WHOQOL-OLD than the other participants. Individuals with IFG presented similar QoL and functionality when compared with the group without DM. IFG and DM were common in this population-based sample aged 75 + years old, as were inadequate diagnoses and treatments of DM. DM individuals presented poor performance in the executive function test, functionality, and QoL. Further studies are recommended to investigate the value of an IFG diagnosis among the most elderly population.

Lifestyle Risk Factors and Cognitive Outcomes from the Multidomain Dementia Risk Reduction Randomized Controlled Trial, Body Brain Life for Cognitive Decline (BBL-CD).

To evaluate the efficacy of a multidomain intervention to reduce lifestyle risk factors for Alzheimer's disease (AD) and improve cognition in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI). The study was an 8-week two-arm single-blind proof-of-concept randomized controlled trial. Community-dwelling individuals living in Canberra, Australia, and surrounding areas. Participants were 119 individuals (intervention n = 57; control n = 62) experiencing SCD or MCI. The control condition involved four educational modules covering dementia and lifestyle risk factors, Mediterranean diet, physical activity, and cognitive engagement. Participants were instructed to implement this information into their own lifestyle. The intervention condition included the same educational modules and additional active components to assist with the implementation of this information into participants' lifestyles: dietitian sessions, an exercise physiologist session, and online brain training. Lifestyle risk factors for AD were assessed using the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI), and cognition was assessed using Alzheimer's Disease Assessment Scale-Cognitive subscale, Pfeffer Functional Activities Questionnaire, Symbol Digit Modalities Test (SDMT), Trail Making Test-B, and Category Fluency. The primary analysis showed that the intervention group had a significantly lower ANU-ADRI score (χ2 = 10.84; df = 3; P = .013) and a significantly higher cognition score (χ2 = 7.28; df = 2; P = .026) than the control group. A secondary analysis demonstrated that the changes in lifestyle were driven by increases in protective lifestyle factors (χ2 = 12.02; df = 3; P = .007), rather than a reduction in risk factors (χ2 = 2.93; df = 3; P = .403), and cognitive changes were only apparent for the SDMT (χ2 = 6.46; df = 2; P = .040). Results were robust to intention-to-treat analysis controlling for missing data. Results support the hypothesis that improvements in lifestyle risk factors for dementia can lead to improvements in cognition over a short time frame with a population experiencing cognitive decline. Outcomes from this trial support the conduct of a larger and longer trial with this participant group.

Validation of the RUDAS for the Identification of Dementia in Illiterate and Low-Educated Older Adults in Lima, Peru.

Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education.Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores.Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cut-off <19 (sensitivity 95%, specificity 97%); whereas, to differentiate MCI and controls was 98.0% with an optimal cut-off <23 (sensitivity 89%, specificity 93%).Conclusions: Based on its excellent psychometric properties, we find the RUDAS-PE suitable to aid in the opportune detection of dementia in a geriatric illiterate population with low-levels of education.

Psychometric properties of Cognitive Instruments in Vascular Dementia and Alzheimer's disease: a neuropsychological study

OBJECTIVES:To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer’s disease (AD) patients, and vascular dementia (VD) patients.METHODS:We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis.RESULTS:Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT’s scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT’s scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility.CONCLUSION:A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.

Life expectancy with and without cognitive impairment among Chilean older adults: results of the National Survey of Health (2003, 2009 and 2016)

BackgroundChile has one of the highest life expectancies within Latin American. This is the first study to determine health expectancies in older populations in Chile, considering cognitive status as a health indicator.MethodsWe estimated prevalence of cognitive decline among people aged 60 years and over based on the Mini-mental State Examination and the Pfeffer Functional Activities Questionnaire, with data from the National Survey of Health (2003, 2009, 2016). Life expectancy free of cognitive impairment was calculated using the Sullivan method.ResultsAt age 60, life expectancy free of cognitive impairment was more than 3 years longer for women, compared to men of the same age. Life expectancy free from cognitive impairment was higher for both men and women aged 60 in 2016 when compared to 2003 (2.1 and 2 years higher, respectively).ConclusionsLonger life expectancy in women was accompanied by more years free of cognitive impairment. Men expected to live a similar proportion of years free of cognitive impairment, compared to women. Common and standardised assessments of health status of older people should be adopted in Latin American studies, to allow for time-trend analyses and international comparisons.

Modelling the impact of functionality, cognition, and mood state on awareness in people with Alzheimer's disease.

To investigate the nature of the relationship between cognitive function, mood state, and functionality in predicting awareness in a non-clinically depressed sample of participants with mild to moderate Alzheimer's disease (AD) in Brazil. People with AD (PwAD) aged 60 years or older were recruited from an outpatient unit at the Center of AD of the Federal University of Rio de Janeiro, Brazil. Measures of awareness of condition (Assessment Scale of the Psychosocial Impact of the Diagnosis of Dementia), cognitive function (Mini-Mental State Examination), mood state (Cornell Scale for Depression in Dementia), and functionality (Pfeffer Functional Activities Questionnaire) were applied to 264 people with mild to moderate AD and their caregivers. Hypotheses were tested statistically using SEM approach. Three competing models were compared. The first model, in which the influence of mood state and cognitive function on awareness was mediated by functionality, showed a very good fit to the data and a medium effect size. The competing models, in which the mediating variables were mood state and cognitive function, respectively, only showed poor model fit. Our model supports the notion that the relationship between different factors and awareness in AD is mediated by functionality and not by depressive mood state or cognitive level. The proposed direct and indirect effects on awareness are discussed, as well as the missing direct influence of mood state on awareness. The understanding of awareness in dementia is crucial and our model gives one possible explanation of its underlying structure in AD.

Accuracy and Psychometric Properties of the Brazilian Version of the Montreal Cognitive Assessment as a Brief Screening Tool for Mild Cognitive Impairment and Alzheimer’s Disease in the Initial Stages in the Elderly

Objective: To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). Method: A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. Results: There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. Conclusions: The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.

Association between diabetes, hypertension, activities of daily living and physical activity among elderly users of primary healthcare facilities

Abstract The aim of this cross-sectional study was to estimate the prevalence of self-reportedhypertension and diabetes among elderly users of primary healthcare facilities in Ribeirão Preto, Brazil, and to investigate the association between these chronic conditions and physical activity and the degree of independence on the performance of activities of daily living. The study included 357 subjects aged 60 years or older. The classification of physical activity was based on the International Physical Activity Questionnaire (IPAQ) and the Pfeffer FunctionalActivities Questionnaire (PFAQ) was applied to assess activities of daily living. Prevalence of diabetes was associated with the level of physical activity, the self-perception of health and the degree of independence on the performance of activities of daily living. No significant associations were found between the prevalence of hypertension and these variables. These findings reinforce the relevance of continuous strategies of management of diabetes in the primary healthcare facilities based on the promotion of physical and occupational activities.

Disability subtypes and mortality rates in older adults: A longitudinal population-based study (NEDICES)

ObjectiveWe investigated the mortality rates of three subtypes of disability and their specific explanatory factors in older adults. MethodsOur data come from NEDICES, a population-based longitudinal cohort study of Spanish older adults. We examined 3816 participants without dementia who completed the Pfeffer's Functional Activities Questionnaire (FAQ) and an assessment of self-perceived functional limitations (SFL) associated with health conditions. Subjects were classified into mutually exclusive subtypes of disability: subtype 1 (SFL), subtype 2 (impaired FAQ), and subtype 3 (impaired FAQ plus SFL). Factors related to all disability subtypes were analyzed using a multinomial logistic regression (MLR), whereas Cox regression (CR) models adjusted by covariates were applied to compare survival rates between groups at the 5-year follow up. ResultsThe CR models indicated that SFL and FAQ scores were associated with higher risk of mortality at 5-years. After stratifying by subtypes of disability, mortality was significantly higher in subtype 3 than in subtypes 1 and 2. All models were consistent after adjusting by different covariates. The MLR showed that subtype 1 was specifically associated with the number of comorbidities, whereas subtype 2 was associated with lower MMSE scores depression and living in nursing homes. ConclusionsOur results show that the combination of impaired FAQ plus SFL have an increased differential predictive utility for mortality than approaches based on unique measures. They also indicate that both measures of disability are associated with different explanatory factors.

Accuracy of praxis test from Cambridge Cognitive Examination (CAMCOG) for Alzheimer's disease: a cross-sectional study.

Praxis impairment may be one of the first symptoms manifested in dementia, primarily in cortical dementia. The Cambridge Cognitive Examination (CAMCOG) evaluates praxis, but little is known about the accuracy of CAMCOG for diagnosing dementia. The aims here were to investigate the accuracy of praxis and its subitems in CAMCOG (constructive, ideomotor and ideational subitems) for diagnosing Alzheimer's disease (AD) among elderly patients. Cross-sectional study on community-dwelling elderly people. 158 elderly patients were evaluated. CAMCOG, Mini-Mental State Examination and Pfeffer Functional Activities Questionnaire were used. ROC curve analysis was used to establish cutoff points. The total scores for praxis and the constructive subitem presented significant differences (P < 0.0001) between healthy elderly people and AD patients. Stage of dementia (clinical dementia rating, CDR = 0, 1 and 2) showed that total and constructive praxis can be used to classify the stages of dementia (mild and moderate cases), i.e. constructive praxis classified 88% of the patients with mild dementia (P < 0.0001) while total praxis classified 56% with moderate dementia. Comparison of normal controls (NC) and mild dementia cases showed specificity of 71% and sensitivity of 88% (AUC = 0.88; P < 0.0001). Some praxis subtests can have higher predictive diagnostic value for detecting Alzheimer's disease in mild stages (total praxis AUC = 0.858; P < 0.0001; constructive AUC = 0.972; P < 0.0001). Constructive praxis as measured using CAMCOG may contribute towards diagnosing dementia, because occurrence of impairment of praxis may help in recognizing an evolving dementia syndrome.

RELATIONSHIP BETWEEN FUNCTIONAL STATUS AND TWO MEASURES OF COGNITIVE FUNCTION IN PATIENTS WITH MCI AND AD

Functional abilities have been related to cognition, specifically to detriment of instrumental activities of daily living (IADL) which are more associated with cognitive decline. The IADL dysfunction is easier to recognize by the family and sometimes easier to evaluate by a non-specialized clinician. We analyzed the relationship between functional impairment in IADL and cognitive decline in a sample of AD and MCI, in order to explore how functionality could be an estimator of patient's cognitive function. IADL were measured by FAQ (Pfeffer Functional Activities Questionnaire), and cognitive decline was assessed by MMSE and IQCODE (16- item). Our sample consisted of 107 patients with AD and 60 with MCI, without significant differences on age or years of education between groups (Table 1). A correlation (-0.72) was found between FAQ and MMSE scores. This result indicates that there is a moderate association with these two measures, where higher scores in the FAQ means more impairment of functional abilities and it is associated with lower scores of MMSE, which is related to a low overall cognitive performance. FAQ and IQCODE showed a more significant correlation (0.8), higher scores in both instruments (FAQ and IQCODE) indicate more impairment on each domain. This significance was not observed in bivariate group (MCI and AD) analyses, where correlation values fluctuated around -0.26 and 0.64, indicating a weak and partial correlation between the measures.

CONVERSION FROM MILD COGNITIVE IMPAIRMENT TO DEMENTIA: A BRAZILIAN STUDY

Dementia is one of the major health issues due to the rapidly growing elderly population. Studies on the evolution of mild cognitive impairment (MCI) or cognitive impairment no dementia (CIND) are scarce in developing countries. The aim of this study was to evaluate the rate of conversion from CIND and MCI to dementia and the predictors of this conversion. This was an ongoing epidemiological study with the elderly (aged ≥60 years) living in the municipality of Tremembe, Brazil, where CIND was diagnosed in 135 among 630 individuals assessed [19.5% (95% CI: 16.6 - 22.8)]. Patients with CIND were invited to be reexamined in their homes, approximately 3.5 years after the first assessment. The diagnosis was done through consensus meeting with data of history, educational level, neurological evaluations, scores of neuropsychological tests (Brief Cognitive Screening Battery (BCSB), Mini-Mental State Examination (MMSE), verbal fluency test (semantic and phonemic) and clock drawing test), score of Pfeffer Functional Activities Questionnaire (FAQ) and of Cornell scale for depression, in comparison with the first phase scores. Reevaluation was performed in 75 individuals (20 patients had died, 18 did not accepted a new evaluation, 10 were not reached and 12 only answered to the FAQ by phone). Nineteen individuals converted to dementia (rate of conversion= 7.2/year). Complaints of cognitive decline by the individual and/or informant were reported at the prevalence study by 66 individuals (MCI group), whereas in 9 there was no cognitive complaint (CIND group). Among the 66 individuals of the MCI group, 18 converted to dementia (conversion rate = 7.8%/year) whereas 9 (3.9%/year) were normal at reevaluation (p=0.4). The predictors for conversion to dementia in the MCI group in univariate analysis were higher age (p=0.015), lower scores in the MMSE (p=0.036), in delayed recall of BCSB (p=0.048) and higher scores in the FAQ (p=0.014). Low education was not predictive of conversion to dementia (p=0.367). The conversion rate of CIND and MCI to dementia were in lower range when compared to international studies mostly performed in developed countries. Educational level was not a predictor of conversion to dementia.

Cognitive performance of community-dwelling oldest-old individuals with major depression: the Pietà study.

Individuals with late-life depression (LLD) may present cognitive symptoms. We sought to determine whether a brief cognitive battery (BCB) could identify cognitive and functional deficits in oldest-old individuals with LLD and a low level of education. We evaluated 639 community-dwelling individuals aged 75+ years in Caeté (MG), Brazil. We used the MINI and GDS-15 to diagnose major depression and evaluate its severity, respectively. The cognitive evaluation comprised the Mini-Mental State Examination (MMSE), BCB, clock-drawing test, category fluency test (animals) and Pfeffer's Functional Activities Questionnaire (FAQ). Fifty-four (11.6%) of the included individuals were diagnosed with LLD; on average, these participants were aged 81.0 ± 4.8 years and had 3.9 ± 3.4 years of schooling, and 77.8% of the subjects with LLD were female. Depressed individuals scored lower than subjects without dementia/depression on the MMSE overall (p < 0.001) and on several of the MMSE subscales, namely, time (p < 0.001) and spatial orientation (p = 0.021), attention/calculation (p = 0.019), and language (p = 0.004). Individuals with LLD performed worse on the incidental and (p = 0.011) immediate memory (p = 0.046) and learning tasks (p = 0.039) of the BCB. Individuals with LLD also performed worse on the category fluency test (p = 0.006), clock-drawing test (p = 0.011) and FAQ (p < 0.001). Depression severity was negatively correlated with incidental memory (ρ = -0.412; p = 0.003) and positively correlated with FAQ score (ρ = 0.308; p = 0.035). In the multiple regression analysis, only temporal orientation and FAQ score remained independently associated with LLD. Individuals with depression and a low level of education presented several cognitive and functional deficits. Depression severity was negatively correlated with incidental memory and functionality. Our findings serve as a description of the presence of cognitive dysfunction in individuals with LLD and suggest that these deficits may be identified based on the results of a BCB.