OBJETIVO: Avaliar as caracteristicas de medida do Mini-Exame do Estado Mental em idosos atendidos em um ambulatorio geral. METODOS: O total de 303 individuos (>65 anos) foi submetido a avaliacao geriatrica com varios instrumentos, inclusive o Mini-Exame do Estado Mental. Foram calculadas a sensibilidade, a especificidade, os valores preditivos positivo e negativo e a curva ROC. RESULTADOS: A sensibilidade, a especificidade, os valores preditivos positivo e negativo e a area sob a curva ROC foram 80,8%, 65,3%, 44,7%, 90,7% e 0,807, respectivamente (ponto de corte 23/24). O melhor ponto de corte para individuos analfabetos foi 18/19 (sensibilidade =73,5%; especificidade =73,9%), e para aqueles com instrucao escolar foi 24/25 (sensibilidade =75%; especificidade =69,7%). CONCLUSOES: Para o rastreamento cognitivo de idosos atendidos em ambulatorios gerais pelo Mini-Exame do Estado Mental, a escolaridade devera ser considerada para a adocao do ponto de corte mais adequado.

/pdf/mini-exame-do-estado-mental-caracteristicas-psicometricas-em-36qq5b57r6.pdf

Mini-Exame do Estado Mental: características psicométricas em idosos ambulatoriais

The Consortium to Establish a Registry for Alzheimer's Disease (CERAD) was funded by the National Institute on Aging in 1986 to develop standardized, validated measures for the assessment of Alzheimer's disease (AD) The present report describes the measures that CERAD developed during its first decade and their continued use in their original and translated forms These measures include clinical, neuropsychological, neuropathologic, and behavioral assessments of AD and also assessment of family history and parkinsonism in AD An approach to evaluating neuroimages did not meet the standards desired Further evaluations that could not be completed because of lack of funding (but where some materials are available) include evaluation of very severe AD and of service use and need by patient and caregiver The information that was developed in the US and abroad permits standardized assessment of AD in clinical practice, facilitates epidemiologic studies, and provides information valuable for individual and public health planning CERAD materials and data remain available for those wishing to use them

Consortium to Establish a Registry for Alzheimer's Disease (CERAD): the first twenty years.

https://www.smgg.es/images/articulos/guia-espen.pdf

ESPEN guidelines on nutrition in dementia

There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.

https://www.scielo.br/pdf/anp/v59n3A/5915.pdf

Applicability of the CERAD neuropsychological battery to Brazilian elderly

Cognitive evaluation in developing countries is a difficult undertaking due to low levels of schooling and particularly the illiteracy still frequent in the elderly. This study was part of the epidemiologic evaluation of dementia in Catanduva, Brazil, and had the objective of comparing the performance of illiterate and literate nondemented elderly individuals in 2 tests of long-term memory-the delayed recall of a word list from the CERAD and the delayed recall of common objects presented as simple drawings from the Brief Cognitive Screening Battery (BCSB). Fifty-one elderly subjects (23 illiterates) were evaluated, and the performance of the illiterates and literates differed in the CERAD memory test, but not in the BCSB memory test. This test may be more suitable for the assessment of long-term memory in populations with a high frequency of illiterates, and therefore might prove to be a useful screening tool for the diagnosis of dementia.

Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory

Modificacoes no mini-exame do estado mental (MEM) foram sugeridas anteriormente em nosso meio. Neste artigo relatamos sugestoes para aplicacao uniforme deste instrumento. METODO: Avaliamos 433 individuos saudaveis sem queixas de memoria atraves do MEM tendo seu desempenho sido avaliado quanto as variaveis demograficas. As modificacoes propostas foram detalhadamente descritas. RESULTADOS: A escolaridade foi o principal fator que influenciou o desempenho dos individuos. Na analise de variância entre os grupos de escolaridade obtivemos F(4,425)=100,45, p<0,0001. Os escores medianos por escolaridade foram: para analfabetos, 20; para idade de 1 a 4 anos, 25; de 5 a 8 anos, 26,5; de 9 a 11 anos, 28; para individuos com escolaridade superior a 11 anos, 29. CONCLUSAO: Sugerimos o uso desta versao para uniformizacao dos resultados em nosso meio. Sua aplicabilidade revelou-se boa para ambientes hospitalar, ambulatorial e para estudo populacionais.

https://www.arquivosdeneuropsiquiatria.org/wp-content/uploads/articles_xml/1678-4227-anp-S0004-282X2003000500014/1678-4227-anp-S0004-282X2003000500014.pdf

Sugestões para o uso do mini-exame do estado mental no Brasil

OBJECTIVE: Evaluate the performance on verbal fluency (VF) in our population in a Brazilian sample checking the influence of age and literacy. METHODS: 336 people without neurological or psychiatric complaints evaluated through Mini-Mental State Examination and VF (animals). For comparison, and to determine cut-off points, 65 people with cognitive loss followed at our clinic were also evaluated. RESULTS: We found a mean of 13.8 animals in 1 minute, with the following distribution: illiterates, 11.9; up 4 years of education, 12.8; 4 to 7 years, 13.4; 8 years or more, 15.8 (p= 0.0001). In relation to age the means were: up to 64 years, 13.7; 65 years or more, 13.9. There was no difference between the two groups. The cut-off points were 9 for people under 8 years of education with a sensitivity of 75% for illiterates, 100% for low educational level (up 4 years),and 87% for middle level (4 to 7 years). The specificity was respectively 79%, 84%, and 88%. For the high educational level the mean was 13 with a sensitivity of 86% and specificity of 67%. CONCLUSIONS: In the VF (animals) there is a significant influence of schooling and different cut-off points should be used.

/pdf/dados-normativos-para-o-teste-de-fluencia-verbal-categoria-34k5q58x3a.pdf

Dados normativos para o teste de fluencia verbal categoria animais em nosso meio

Objective Evaluate the performance on verbal fluency (VF) in our population in a Brazilian sample checking the influence of age and literacy. Methods 336 people without neurological or psychiatric complaints evaluated through Mini-Mental State Examination and VF (animals). For comparison, and to determine cut-off points, 65 people with cognitive loss followed at our clinic were also evaluated. Results We found a mean of 13.8 animals in 1 minute, with the following distribution: illiterates, 11.9; up 4 years of education, 12.8; 4 to 7 years, 13.4; 8 years or more, 15.8 (p = 0.0001). In relation to age the means were: up to 64 years, 13.7; 65 years or more, 13.9. There was no difference between the two groups. The cut-off points were 9 for people under 8 years of education with a sensitivity of 75% for illiterates, 100% for low educational level (up 4 years), and 87% for middle level (4 to 7 years). The specificity was respectively 79%, 84%, and 88%. For the high educational level the mean was 13 with a sensitivity of 86% and specificity of 67%. Conclusions In the VF (animals) there is a significant influence of schooling and different cut-off points should be used.

/pdf/normative-data-on-the-verbal-fluency-test-in-the-animal-pgocnrdplv.pdf

Normative data on the verbal fluency test in the animal category in our milieu

- Objective: Translating and adapting the Cornell scale for depression in dementia to the Por-tuguese language and verifying the interrater and test-retest reliability of the translated and adapted version. Method: The Cornell scale was translated into Portuguese and back translated into english. Di-vergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers. Results: The Cornell scale presented good interrater (Kappa=0,77; p<0,001) and test-retest reliability (Kappa=0,76; p<0,001). The final version was easy to administer and well understood by the caregivers. Conclusion: The Brazilian version of the Cornell scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evalua-tion and follow-up of depressed patients with dementia in our population and may also be used in multi-centric studies with Brazilian population.Key woRDs: depression, scales, adaptation, reproducibility of results.

/pdf/versao-brasileira-da-escala-cornell-de-depressao-em-demencia-1lwp2bjg3k.pdf

Ivan Hideyo Okamoto

Papers

Sugestões para o uso do mini-exame do estado mental no Brasil

Applicability of the CERAD neuropsychological battery to Brazilian elderly

Dados normativos para o teste de fluencia verbal categoria animais em nosso meio

Normative data on the verbal fluency test in the animal category in our milieu

Versão brasileira da Escala Cornell de depressão em demência (Cornell depression scale in dementia)