RESUMO
Alzheimer's disease (AD) and frontotemporal dementia (FTD) are the most common neurodegenerative early-onset dementias. Despite the fact that both conditions have a very distinctive clinical pattern, they present with an overlap in their cognitive and behavioral features that may lead to misdiagnosis or delay in diagnosis. The current review intends to summarize briefly the main differences at the clinical, neuropsychological, and behavioral levels, in an attempt to suggest which aspects would facilitate an adequate diagnosis in a clinical setting, especially in Latin American and low- and middle-income countries, where the resources needed for a differential diagnosis (such as MRI or biomarkers) are not always available. A timely diagnosis of AD and FTD have significant implications for the medical management and quality of life of patients and careers.
Assuntos
Doença de Alzheimer/diagnóstico , Demência Frontotemporal/diagnóstico , Doença de Alzheimer/psicologia , Diagnóstico Diferencial , Função Executiva/fisiologia , Demência Frontotemporal/psicologia , Humanos , Memória/fisiologia , Testes Neuropsicológicos , Cognição SocialRESUMO
BACKGROUND: Impairments in activities of daily living (ADL) are a criterion for Alzheimer's disease (AD) dementia. However, ADL gradually decline in AD, impacting on advanced (a-ADL, complex interpersonal or social functioning), instrumental (IADL, maintaining life in community), and finally basic functions (BADL, activities related to physiological and self-maintenance needs). Information and communication technologies (ICT) have become an increasingly important aspect of daily functioning. Yet, the links of ADL, ICT, and neuropathology of AD dementia are poorly understood. Such knowledge is critical as it can provide biomarker evidence of functional decline in AD. METHODS: ADL were evaluated with the Technology-Activities of Daily Living Questionnaire (T-ADLQ) in 33 patients with AD and 30 controls. ADL were divided in BADL, IADL, and a-ADL. The three domain subscores were covaried against gray matter atrophy via voxel-based morphometry. RESULTS: Our results showed that three domain subscores of ADL correlate with several brain structures, with a varying degree of overlap between them. BADL score correlated mostly with frontal atrophy, IADL with more widespread frontal, temporal and occipital atrophy and a-ADL with occipital and temporal atrophy. Finally, ICT subscale was associated with atrophy in the precuneus. CONCLUSIONS: The association between ADL domains and neurodegeneration in AD follows a traceable neuropathological pathway which involves different neural networks. This the first evidence of ADL phenotypes in AD characterised by specific patterns of functional decline and well-defined neuropathological changes. The identification of such phenotypes can yield functional biomarkers for dementias such as AD.
Assuntos
Atividades Cotidianas , Doença de Alzheimer/patologia , Doença de Alzheimer/fisiopatologia , Córtex Cerebral/patologia , Progressão da Doença , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico por imagem , Atrofia/patologia , Córtex Cerebral/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
Episodic memory tests with cued recall, such as the Free and Cued Selective Reminding Test (FCSRT), allow for the delineation of hippocampal and prefrontal atrophy contributions to memory performance in Alzheimer's disease (AD). Both Word and Picture versions of the test exist but show different profiles, with the Picture version usually scoring higher across different cohorts. One possible explanation for this divergent performance between the different modality versions of the test might be that they rely on different sets of neural correlates. The current study explores this by contrasting the neural correlates of the Word and Picture versions of the FCSRT with voxel-based morphometry (VBM) in AD and healthy subjects. We predicted that the Picture version would be associated with different cortical regions than the Word version, which might be more hippocampal-centric. When comparing 35 AD patients and 34 controls, AD patients exhibited impairments on both versions of the FCSRT and both groups performed higher in the Picture version. A region of interest analysis based on prior work revealed significant correlations between free recall of either version with atrophy of the temporal pole and hippocampal regions. Thus, contrary to expectations, performance on both the Word and the Picture version of the FCSRT is associated with largely overlapping networks. Free recall is associated with hippocampal volume and might be properly considered as an indicator of hippocampal structural integrity.
Assuntos
Doença de Alzheimer/psicologia , Hipocampo/patologia , Memória Episódica , Rememoração Mental , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/patologia , Biomarcadores , Estudos de Casos e Controles , Sinais (Psicologia) , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estimulação LuminosaRESUMO
The Neuropsychiatric Inventory Questionnaire (NPI-Q) is an informant-based instrument that measures the presence and severity of 12 Neuropsychiatric Symptoms (NPS) in patients with dementia, as well as informant distress. OBJECTIVE: To measure the psychometric properties of the NPI-Q and the prevalence of NPS in patients with Alzheimer's disease (AD) in Chile. METHODS: 53 patients with AD were assessed. Subjects were divided into two different groups: mild AD (n=26) and moderate AD (n=27). Convergent validity was estimated by correlating the outcomes of the NPI-Q with Neuropsychiatric Inventory (NPI) scores and with a global cognitive efficiency test (Addenbrooke's Cognitive Examination - Revised - ACE-R). Reliability of the NPI-Q was analysed by calculating its internal consistency. Prevalence of NPS was estimated with both the NPI and NPI-Q. RESULTS: Positive and significant correlations were observed between the NPI-Q, the NPI, and the ACE-R (r=0.730; p<0.01 and 0.315; p<0.05 respectively). The instrument displayed an adequate level of reliability (Cronbach's alpha=0.783). The most prevalent NPS were apathy/indifference (62.3%) and dysphoria/depression (58.5%). CONCLUSION: The NPI-Q exhibited acceptable validity and reliability indicators for patients with AD in Chile, indicating that it is a suitable instrument for the routine assessment of NPS in clinical practice.
O Questionário de Inventário Neuropsiquiátrico (NPI-Q) é um instrumento baseado em informantes que mede a presença e a gravidade de 12 Sintomas Neuropsiquiátricos (NPS) em pacientes com demência, bem como o sofrimento do informante. OBJETIVO: Avaliar as propriedades psicométricas do NPI-Q e a prevalência de NPS em pacientes com doença de Alzheimer (DA). MÉTODOS: Foram avaliados 53 pacientes com DA. Eles foram divididos em dois grupos diferentes: AD leve (n=26) e AD moderado (n=27). A validade convergente foi estimada correlacionando os resultados do NPI-Q com os escores do Inventário Neuropsiquiátrico (NPI) e um teste de eficiência cognitiva global (Addenbrooke's Cognitive Examination - Revised - ACE-R). A confiabilidade do NPI-Q foi analisada pelo cálculo da sua consistência interna. A prevalência de NPS foi estimada com NPI e NPI-Q. RESULTADOS: Foram observadas correlações positivas e significativas entre NPI-Q, NPI e ACE-R (r=0,730; p<0,01 e 0>315; p<0>05). O instrumento apresentou um nível adequado de confiabilidade (alfa de Cronbach=0J83). Os NPS mais prevalentes foram apatia/indiferença (62,3%) e disforia/depressão (58,5%). CONCLUSÃO: O NPI-Q apresenta indicadores de validade e confiabilidade aceitáveis em pacientes com DA, o que indica que é um instrumento adequado para a avaliação rotineira de NPS na prática clínica.
RESUMO
ABSTRACT. The Neuropsychiatric Inventory Questionnaire (NPI-Q) is an informant-based instrument that measures the presence and severity of 12 Neuropsychiatric Symptoms (NPS) in patients with dementia, as well as informant distress. Objective: To measure the psychometric properties of the NPI-Q and the prevalence of NPS in patients with Alzheimer's disease (AD) in Chile. Methods: 53 patients with AD were assessed. Subjects were divided into two different groups: mild AD (n=26) and moderate AD (n=27). Convergent validity was estimated by correlating the outcomes of the NPI-Q with Neuropsychiatric Inventory (NPI) scores and with a global cognitive efficiency test (Addenbrooke's Cognitive Examination - Revised - ACE-R). Reliability of the NPI-Q was analysed by calculating its internal consistency. Prevalence of NPS was estimated with both the NPI and NPI-Q. Results: Positive and significant correlations were observed between the NPI-Q, the NPI, and the ACE-R (r=0.730; p<0.01 and 0.315; p<0.05 respectively). The instrument displayed an adequate level of reliability (Cronbach's alpha=0.783). The most prevalent NPS were apathy/indifference (62.3%) and dysphoria/depression (58.5%). Conclusion: The NPI-Q exhibited acceptable validity and reliability indicators for patients with AD in Chile, indicating that it is a suitable instrument for the routine assessment of NPS in clinical practice.
RESUMO. O Questionário de Inventário Neuropsiquiátrico (NPI-Q) é um instrumento baseado em informantes que mede a presença e a gravidade de 12 Sintomas Neuropsiquiátricos (NPS) em pacientes com demência, bem como o sofrimento do informante. Objetivo: Avaliar as propriedades psicométricas do NPI-Q e a prevalência de NPS em pacientes com doença de Alzheimer (DA). Métodos: Foram avaliados 53 pacientes com DA. Eles foram divididos em dois grupos diferentes: AD leve (n=26) e AD moderado (n=27). A validade convergente foi estimada correlacionando os resultados do NPI-Q com os escores do Inventário Neuropsiquiátrico (NPI) e um teste de eficiência cognitiva global (Addenbrooke's Cognitive Examination - Revised - ACE-R). A confiabilidade do NPI-Q foi analisada pelo cálculo da sua consistência interna. A prevalência de NPS foi estimada com NPI e NPI-Q. Resultados: Foram observadas correlações positivas e significativas entre NPI-Q, NPI e ACE-R (r=0,730; p<0,01 e 0>315; p<0>05). O instrumento apresentou um nível adequado de confiabilidade (alfa de Cronbach=0J83). Os NPS mais prevalentes foram apatia/indiferença (62,3%) e disforia/depressão (58,5%). Conclusão: O NPI-Q apresenta indicadores de validade e confiabilidade aceitáveis em pacientes com DA, o que indica que é um instrumento adequado para a avaliação rotineira de NPS na prática clínica.
Assuntos
Humanos , Prevalência , Manifestações Neurocomportamentais , Demência , Doença de Alzheimer , Testes de Estado Mental e DemênciaRESUMO
BACKGROUND: Intracellular neurofibrillary tangles are part of the core pathology of Alzheimer's disease (AD), which are mainly composed of hyperphosphorylated tau protein. OBJECTIVES: The purpose of this study is to determine whether high molecular weight (HMW) or low molecular weight (LMW) tau protein levels, as well as the ratio HMW/LMW, present in platelets correlates with brain magnetic resonance imaging (MRI) structural changes in normal and cognitively impaired subjects. METHODS: We examined 53 AD patients and 37 cognitively normal subjects recruited from two Memory Clinics at the Universidad de Chile. Tau levels in platelets were determined by immunoreactivity and the MRI scans were analyzed using voxel-based morphometry in 41 AD patients. RESULTS: The HMW/LMW tau ratio was statistically different between controls and AD patients, and no associations were noted between HMW or LMW tau and MRI structures. In a multivariate analysis controlled for age and education level, the HMW/LMW tau ratio was associated with reduced volume in the left medial and right anterior cingulate gyri, right cerebellum, right thalamus (pulvinar), left frontal cortex, and right parahippocampal region. CONCLUSIONS: This exploratory study showed that HMW/LMW tau ratio is significantly higher in AD patients than control subjects, and that it is associated with specific brain regions atrophy. Determination of peripheral markers of AD pathology can help understanding the pathophysiology of neurodegeneration in AD.
Assuntos
Doença de Alzheimer/sangue , Doença de Alzheimer/complicações , Plaquetas/metabolismo , Encéfalo/patologia , Proteínas tau/sangue , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico por imagem , Atrofia/diagnóstico por imagem , Atrofia/etiologia , Encéfalo/diagnóstico por imagem , Chile , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-IdadeRESUMO
The aim of this study was to compare the psychometric properties of the "Word" and "Picture" versions of the Spanish FCSRT across the same sample of mild Alzheimer disease (AD) patients and controls. Mild AD patients (N = 50, 27 CDR = 0.5; 23 CDR = 1) and controls (N = 42, CDR = 0) were assessed with an extensive clinical and neuropsychological evaluation. Psychometric characteristics for both versions of the FCSRT were compared. Free recall (FR) and total recall (TR) across both versions of the FCSRT showed areas under the curve >0.9 and did not significantly differ between them. The scores of both versions were well correlated, although the scores for the Picture version were greater than those for the Word version, particularly for the TR scores of the mild AD group. Both versions of the FCSRT showed an appropriate accuracy to distinguish mild AD patients and controls. Visual cues were easier to recall than verbal cues, especially in the memory impaired patients.
Assuntos
Doença de Alzheimer/psicologia , Hispânico ou Latino/psicologia , Testes Neuropsicológicos , Estimulação Acústica , Idoso , Estudos de Casos e Controles , Sinais (Psicologia) , Feminino , Humanos , Idioma , Masculino , Rememoração Mental , Estimulação Luminosa , PsicometriaRESUMO
OBJECTIVES: To develop the Test Your Memory (TYM)-Spanish version (TYM-S), a self-administered cognitive screening test, in a Chilean older sample and to estimate its psychometric properties and diagnostic accuracy. METHODS: The TYM was translated into Spanish and adapted for a Chilean population to develop the TYM-S. Measures of global cognitive impairment and executive dysfunction were administered to 30 controls, 30 dementia patients, and 14 subjects with mild cognitive impairment (MCI). All participants' proxies were interviewed with assessments of dementia severity, functionality in daily living activities, and cognitive change. Convergent validity and internal consistency reliability of the TYM-S were estimated. Cut-off points, sensitivity, and specificity were determined to test its diagnostic capacity for dementia or MCI. RESULTS: Regarding convergent validity, the TYM-S was significantly correlated (p < 0.001) with global cognitive impairment (Mini-Mental State Examination: r = 0.902; Addenbrooke's Cognitive Examination-Revised-Chilean version: r = 0.922; Montreal Cognitive Assessment: r = 0.923), executive dysfunction (Frontal Assessment Battery: r = 0.862), dementia severity (Clinical Dementia Rating: r = -0.757), functional capacity (Technology-Activities of Daily Living Questionnaire: r = -0.864; Pfeffer Functional Activities Questionnaire: r = -0.748; Instrumental Activities of Daily Living: r = 0.769), and cognitive change (Alzheimer's Disease 8-Chilean version: r = -0.700) measures. Regarding reliability, Cronbach's α was 0.776. Optimum cut-off scores of 39 and 44 distinguished dementia cases from controls (93.1% sensitivity, 82.2% specificity) and MCI cases from controls (85.7% sensitivity, 69% specificity), respectively. The extent of assistance required in the TYM-S and cognitive impairment was correlated. CONCLUSIONS: The TYM-S is a valid and reliable instrument to assess cognitive impairment, showing good psychometric properties and diagnostic capacity to identify cases of dementia in a Spanish-speaking older cohort. Although its need for assistance may be limiting, its ability to quickly assess several cognitive domains supports widespread clinical use.
Assuntos
Transtornos Cognitivos/diagnóstico , Demência/diagnóstico , Testes Neuropsicológicos/normas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Demência/fisiopatologia , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de DoençaRESUMO
Matricide, the killing of a mother by her biological child, is a rare event. We report a case of matricide associated with a woman who sustained a right ventromedial prefrontal lesion during surgery for nasal polyposis that was performed when she was 40 years old. After her surgery, she developed psychotic symptoms associated with the emergence of antisocial behavior. She committed matricide 22 years later. Neuropsychological evaluation showed decreased frontal-executive deficits, and magnetic resonance imaging revealed a lesion in the right gyrus rectus area of the ventromedial prefrontal region. This case suggests that a secondary psychotic syndrome associated with a lesion in the frontal neural network, which is disturbed in psychopathy, could facilitate homicidal behavior. Furthermore, this case has legal implications for the prosecution of murder associated with a brain lesion.
Assuntos
Transtorno da Personalidade Antissocial/diagnóstico , Transtorno da Personalidade Antissocial/fisiopatologia , Homicídio/psicologia , Doença Iatrogênica , Mães , Pólipos Nasais/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Córtex Pré-Frontal/lesões , Córtex Pré-Frontal/fisiopatologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/fisiopatologia , Agressão/fisiologia , Transtorno da Personalidade Antissocial/psicologia , Chile , Dominância Cerebral/fisiologia , Função Executiva/fisiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Rede Nervosa/lesões , Rede Nervosa/fisiopatologia , Testes Neuropsicológicos , Complicações Pós-Operatórias/psicologia , Córtex Pré-Frontal/patologia , Transtornos Psicóticos/psicologiaRESUMO
OBJECTIVE: This study sought to analyze the psychometric properties and diagnostic accuracy of the Chilean version of the INECO Frontal Screening (IFS-Ch) in a sample of dementia patients and control subjects.METHODS: After adapting the instrument to the Chilean context and obtaining content validity evidence through expert consultation, the IFS-Ch was administered to 31 dementia patients and 30 control subjects together with other executive assessments (Frontal Assessment Battery [FAB], Modified version of the Wisconsin Card Sorting Test [MCST], phonemic verbal fluencies [letters A and P] and semantic verbal fluency [animals]) and global cognitive efficiency tests (Mini mental State Examination [MMSE] and Addenbrooke's Cognitive Examination-Revised [ACE-R]). Caregivers of dementia patients and proxies of control subjects were interviewed with instruments measuring dysexecutive symptoms (Dysexecutive Questionnaire [DEX]), dementia severity (Clinical Dementia Rating Scale [CDR]) and functional status in activities of daily living (Activities of Daily Living Scale [IADL] and Technology-Activities of Daily Living Questionnaire [T-ADLQ]). Convergent and discriminant validity, internal consistency reliability, cut-off points, sensitivity and specificity for the IFS-Ch were estimated. RESULTS: Evidence of content validity was obtained. Evidence of convergent validity was also found showing significant correlations (p<0.05) between the IFS-Ch and the other instruments measuring: executive functions (FAB, r=0.935; categories achieved in the MCST, r=0.791; perseverative errors in the MCST, r= -0.617; animal verbal fluency, r=0.728; "A" verbal fluency, r=0.681; and "P" verbal fluency, r=0.783), dysexecutive symptoms in daily living (DEX, r= -0.494), dementia severity (CDR, r= -0.75) and functional status in activities of daily living (T-ADLQ, r= -0.745; IADL, r=0.717). Regarding reliability, a Cronbach's alpha coefficient of 0.905 was obtained. For diagnostic accuracy, a cut-off point of 18 points (sensitivity=0.903; specificity=0.867) and an area under curve of 0.951 were estimated to distinguish between patients with dementia and control subjects. DISCUSSION: The IFS-Ch showed acceptable psychometric properties, supported by evidence of validity and reliability for its use in the measurement of executive functions in patients with dementia. The diagnostic accuracy of the IFS-Ch for detecting dementia patients was also considered acceptable.
OBJETIVO: Analisar as propriedades psicométricas e utilitário de diagnóstico da versão chilena do rastreio frontal INECO (IFS-Ch) em uma amostra de pacientes com demência e controles. MÉTODOS: Após a adaptação do instrumento para o contexto chileno e obtenção de evidências de validade de conteúdo, o IFS-Ch foi administrado a 31 pacientes com demência e 30 indivíduos do grupo controle, além de outros testes de eficiência cognitiva global e executiva. Cuidadores de pacientes com demência e informantes de indivíduos controles foram entrevistados com instrumentos de medidas de sintomas disexecutivos, gravidade da demência e estado funcional nas atividades da vida diária. Validade convergente e discriminante, consistência interna, pontos de corte, sensibilidade e especificidade para o IFS-Ch foram estimados.RESULTADOS: A evidência de validade de conteúdo foi obtida através de consulta a um especialista. Evidências de validade convergente foram encontrados, bem como, descritas correlações significativas entre o IFS-Ch e outros instrumentos de medidas: de funções executivas (FAB, r=0,935; categorias alcançadas no MCST, r=0,791; erros perseverativos na MCST, r= -0,617; fluência verbal animais, r=0,728; "A" de fluência verbal, r=0,681; gravidade de demência e fluência verbal de "P", r=0,783), sintomas disexecutivos na vida diária (DEX, r= -0,494), (CDR, r= -0,75) e estado funcional nas atividades da vida diária (T-ADLQ, r= -0,745; AIVD, r=0,717). Quanto à confiabilidade, coeficiente alfa de Cronbach de 0,905 foi obtido. Quanto a utilidade de diagnóstico, um ponto de corte de 18 pontos (sensibilidade=0,903, especificidade=0,867) e uma área sob a curva de 0,951 foi estimada para distinguir entre pacientes com demência e sujeitos controles. DISCUSSÃO: O IFS-Ch mostra propriedades psicométricas aceitáveis, apoiadas por evidências de validade e confiabilidade para sua utilização como medida de funções executivas em pacientes com demência. Sua utilidade diagnóstica para detectar pacientes com demência também é considerada aceitável.