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      Cognitive deficits in older adults with mild cognitive impairment in a two-year follow-up study Translated title: DÉFICITS COGNITIVOS EM IDOSOS COM COMPROMETIMENTO COGNITIVE LEVE EM DOIS ANOS DE ACOMPANHAMENTO

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          ABSTRACT

          Characterizing cognitive decline in older adults with MCI over time is important to identify the cognitive profile of those who convert to dementia.

          Objective:

          This study examined the two-year cognitive trajectory of elderly adults diagnosed with MCI, from geriatrics and neurology outpatient clinics of a public hospital in Rio de Janeiro.

          Methods:

          62 older adults with MCI were submitted to a neuropsychological battery and re-evaluated after two years. The Mann-Whitney U test was employed to assess differences between groups with respect to education, functioning, the Geriatric Depression Scale and diagnosis.

          Results:

          24.2% converted to dementia after two years. The group with declines in two or more cognitive functions had a higher conversion rate to dementia than the group with decline in executive functions (EF) only (Z = -2.11, p = .04). The EF decline group had higher scores on the depression scale than both the memory decline group (Z = -1.99, p = .05) and multiple decline group (Z = -2.23, p = .03).

          Conclusion:

          The present study found different cognitive decline profiles in elderly adults with MCI and differences between them regarding depressive symptoms and rate of conversion to dementia.

          RESUMO

          Caracterizar o declínio cognitivo em idosos com Comprometimento Cognitivo Leve (CCL) ao longo do tempo é importante para identificar o perfil cognitivo de quem converte para demência.

          Objetivo:

          Estudar as trajetórias evolutivas de dois anos de acompanhamento de idosos com CCL assistidos em clinicas de geriatria e neurologia de um Hospital Federal na cidade do Rio de Janeiro.

          Métodos:

          62 idosos com CCL foram submetidos a uma bateria neuropsicológica e reavaliados após dois anos. O teste U de Mann-Whitney foi utilizado para avaliar as diferenças entre os grupos quanto a escolaridade, funcionalidade, escala de depressão geriátrica e diagnóstico.

          Resultados:

          24,2% converteram-se em demência após dois anos. O grupo com declínio em duas ou mais funções cognitivas apresentou maior porcentagem de conversão para demência do que o grupo com declínio apenas nas funções executivas (Z = -2,11, p = 0,04). O grupo de declínio das FEs, apresentou escores maiores na escala de depressão do que o grupo de declínio na memória (Z = -1.99, p = .05) e múltiplos declínios (Z = -2.23, p = .03).

          Conclusão:

          O presente estudo mostrou que existem perfis diferentes de declínio cognitivo em idosos com CCL e que existem diferenças entre eles em relação a sintomas depressivos e a taxa de conversão para demência.

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          Most cited references19

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          Clock drawing in Alzheimer's disease. A novel measure of dementia severity.

          We have tested a simple and reliable measure of visuospatial ability in Alzheimer patients--the Clock Drawing Test. To determine the usefulness of this measure, we asked 67 Alzheimer patients and 83 normal controls to draw the face of a clock reading the time of 2:45. Six independent observers blindly evaluated the results with ratings from 10 (best) to 1 (worst). The mean performance score of Alzheimer subjects was 4.9 +/- 2.7 compared to 8.7 +/- 1.1 for normal controls (P less than .001). Inter-rater reliability for the clocks drawn by Alzheimer patients was highly significant (r = 0.86; P less than .001), and there was relatively little overlap between ratings for Alzheimer patients and normal controls. Furthermore, correlations were highly significant (P less than .001) between the mean score of clock drawings and three independent global measures of dementia severity. Although the Clock Drawing Test is certainly not a definitive indicator of Alzheimer's disease, the test is easy to administer and provides a useful measure of dementia severity for both research and office settings where sophisticated neuropsychological testing is not available.
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            Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease.

            To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimer's disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.
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              Longitudinal change in cognitive performance among individuals with mild cognitive impairment.

              The authors used mixed-effects growth models to examine longitudinal change in neuropsychological performance over a 4-year period among 197 individuals who were either normal or had mild cognitive impairment (MCI) at baseline. At follow-up, the participants were divided into 4 groups: (a) controls: participants who were normal at both baseline and follow-up (n = 33), (b) stables: participants with MCI whose Clinical Dementia Rating-Sum of Boxes (CDR-SB) score did not differ between the first and last evaluations (n = 22), (c) decliners: participants with MCI whose CDR-SB score declined between the first and last evaluations (n = 95), and (d) converters: participants who received a clinical diagnosis of Alzheimer's disease during the follow-up period (n = 47). Only the Episodic Memory factor showed a significantly greater rate of decline over the follow-up period among the converters. Two other factors were significantly lower in converters at baseline in comparison with other groups (the executive function factor and the general knowledge factor), but the rate of decline over time did not differ. Individuals with an APOE epsilon4 allele scored lower on the episodic memory and executive function factors at baseline.
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                Author and article information

                Journal
                Dement Neuropsychol
                Dement Neuropsychol
                dn
                Dementia & Neuropsychologia
                Associação de Neurologia Cognitiva e do Comportamento
                1980-5764
                Jan-Mar 2018
                Jan-Mar 2018
                : 12
                : 1
                : 19-27
                Affiliations
                [1 ]MD. Pontifícia Universidade Católica do Rio de Janeiro, RJ, Brazil
                [2 ]PhD. Pontifícia Universidade Católica do Rio de Janeiro, RJ, Brazil
                Author notes
                Camila de Assis Faria. Rua Marquês de São Vicente 225 - 22451-900 Rio de Janeiro RJ - Brazil. E-mail: camila_psic@ 123456yahoo.com.br

                Author contribution. Camila de Assis Faria: data collection, statistical analysis, discussion of results and text production. Eduarda Naidel Barboza e Barbosa: data collection, revision of English and post-submission changes. Heloísa Veiga Alves: revision of English and text. Helenice Charchat Fichman: elaboration of the research, participation of the discussion of the results, orientation and revision of the production of the text.

                Disclosure: The authors report no conflicts of interest.

                Article
                10.1590/1980-57642018dn12-010003
                5901245
                d700d0ad-7d91-42e9-9a07-598ddb4af594

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 11 April 2017
                : 16 November 2017
                Categories
                Original Article

                mild cognitive impairment,dementia,cognitive decline,conversion,cognitive trajectory,comprometimento cognitivo leve,demência,declínio cognitivo,conversão,trajetória cognitiva

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