1 Aprahamian, et al, 2010(3)3. Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. International psychogeriatrics / IPA. 2010;22(1):64-71. https://doi.org/10.1017/S1041610209991141
https://doi.org/10.1017/S104161020999114...
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To evaluate the sensitivity and specificity of the CDT to identify AD. |
121 patients AD, education 1-4 years 64.5%;
5-8 years 11.6% and>8 years 24%.
90 elderly controls, education 1-4 years 40.4%,
5-8 years 26.3% and < 8 years 33.3%. |
The CDT is used for visuospatial, visuoconstructive, executive function evaluation and it consists of drawing a circle, distributing the numbers inside and allocating the hands of the clock at 11:10 am. |
1-4 a years of education
Mendez: Cut-off = 17.5/20; sens. 80.5%;
spec. 87.5% and AUC = 0.886.
Shulman: Cut-off = 3.5/5; sens. 81.8%;
spec. 92.5% and AUC = 0.895.
Sunderland: Cut-off = 9.5/10; sens. 87%;
spec. 82.5% and AUC = 0.889
5-8 years of education
Mendez: Cut-off = 19.5/20; sens. 74.4%;
spec. 61% and AUC = 0.752.
Shulman: Cut-off = 4.5/5; sens. 72.1%;
spec. 74.6% and AUC = 0.783.
Sunderland: Cut-off = 9.5/10; sens. 51.2%;
spec. 94.9% and AUC = 0.738. |
2 Aprahamian, et al, 2011(20)20. Aprahamian I, Martinelli JE, Cecato J, Izbicki R, Yassuda MS. Can the CAMCOG be a good cognitive test for patients with Alzheimer's disease with low levels of education? Int Psychogeriatr. 2011 Feb;23(1):96-101. https://doi.org/10.1017/S104161021000116X
https://doi.org/10.1017/S104161021000116...
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To examine whether the CAMCOG can be used as a screening test for AD in a sample including different levels of education. |
113 older adults with AD and 208 controls divided into three groups by education: 1-4 years; 5-8 years, and ≥9 years. |
CAMCOG: orientation, language, memory, attention, praxis, perception, calculation, and abstract thinking. |
In two groups, mean values were inferior for lower levels of education.
Group1 (1-4 years of education):
Cut-off score = 79/107; sens. 88.1%;
spec. 83.5% and AUC = 0.915
Group 2 (5-8 years of education):
Cut-off score: 80/107; sens. 84.6%;
spec. 96% and AUC = 0.922
Group 3 (≥ 9 years of education):
Cut-off score: 90/107; sens. 70.8%;
spec. 90% and AUC = 0.813. |
3 Aprahamian, et al, 2011(21)21. Aprahamian I, Martinelli JE, Cecato J, Yassuda MS. Screening for Alzheimer's disease among illiterate elderly: accuracy analysis for multiple instruments. J Alzheimers Dis. 2011;26(2):221-9. https://doi.org/10.3233/JAD-2011-110125
https://doi.org/10.3233/JAD-2011-110125...
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Evaluated the accuracy of Single screening tests as well as combined protocols including the MMSE, VF, CDT, and PFAQ to discriminate illiterate elderly with and without AD. |
66 illiterate with mild and moderate AD; 40 illiterate normal controls. |
MMSE: evaluates temporal and spatial orientation (5 points each), three-word registration (3 points), attention and calculation (5 points), remembering the three words (3 points), language (8 points), constructive praxis (1 point). Total: 30 points.
VF: evaluates the language and capacity of abstraction. Score is the numbers of animals evoked in 60 seconds.
CDT: It evaluates the visoconstructive and visuospatial abilities and abstraction capacity. Total: 5 points.
PFAQ: evaluates function status with 10 questions filled out by the family member or caregiver. Total: 0-30. |
The best screening instruments for this sample of illiterate elderly were the MMSE and the PFAQ.
MMSE: Cut-off = 17.5/30; sens. 95%;
spec. 72.7% and AUC = 0.913.
VF: Cut-off = 7.5; sens.85%;
spec. 60.6% and AUC = 0.790.
CDT: Cut-off = 2.5/5; sens. 66.7%;
spec. 82.8% and AUC = 0.829.
PFAQ: Cut-off: 11.5/33; sens. 85.3%;
spec. 76.5% and AUC = 0.864.
The most sensitive combination came from the MMSE and PFAQ (sens 94.1%, spec. 76.5%, AUC 0.921),and the best specificity was observed with the combination of the MMSE and CDT (sens. 89%,spec. 82%, AUC 0.780). |
4 Araújo, et al, 2018(22)22. Araujo NB, Nielsen TR, Engedal K, Barca ML, Coutinho ES, Laks J. Diagnosing dementia in lower educated older persons: validation of a Brazilian Portuguese version of the Rowland Universal Dementia Assessment Scale (RUDAS). Rev Bras Psiquiatr. 2018 Jul-Sep;40(3):264-9. https://doi.org/10.1590/1516-4446-2017-2284
https://doi.org/10.1590/1516-4446-2017-2...
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To validate the Rowland Universal Dementia Assessment Scale for use in Brazil (RUDAS-BR). |
65 cognitively healthy, education mean = 9.42 (SD = 7.69) and 25.8% illiterate.70 with AD, education mean = 7.62 (SD = 5.13) and 10% illiterate. |
The RUDAS-BR includes six items which test memory (registration and recall), body orientation, praxis, drawing, judgment, and language. |
Low educational level (≤ 4 years):
Cut-off score: <23/30; sens. 67.74%;
spec. 78.95% and AUC= 0.82.
High educational level (≥ 8 years):
Cut-off score: <24/30; sens. 91.18%;
spec. 81.82% and AUC= 0.92. |
5 Caramelli, et al, 2007(5)5. Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord. 2007 Jan-Mar;21(1):65-7. https://doi.org/10.1097/WAD.0b013e31802f244f
https://doi.org/10.1097/WAD.0b013e31802f...
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To determine education-adjusted cut-off scores and correspondent sens. and spec. values of the VF as a screening tool for AD. |
88 patients with mild AD and 117 normal controls. Both were divided into 4 groups according to educational level (illiterates, 1 to 3, 4 to 7, and > 8 years) |
VF evaluates the language and capacity of abstraction. Score is the numbers of animals evoked in 60 seconds. |
Illiterate: Cut-off = <9; sens. 90.5%;
spec. 80.6% and AUC = 0.922.
1-3 years education: Cut-off = <12; sens. 95.2%;
spec. 80% and AUC = 0.914
4-8 years education: Cut-off = < 12; sens. 91.3%;
spec. 91.9% and AUC = 0.963.
≥ 8 years education: Cut-off = < 13;
sens. 82.6%; spec. 100% and AUC = 0.954. |
6 Damasceno et al, 2005(23)23. Damasceno A, Delicio AM, Mazo DF, Zullo JF, Scherer P, Ng RT, et al. [Validation of the Brazilian version of mini-test CASI-S]. Arq Neuropsiquiatr. 2005 Jun;63(2b 2B):416-21. Portuguese. https://doi.org/10.1590/S0004-282X2005000300010
https://doi.org/10.1590/S0004-282X200500...
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To determine CASI-S accuracy in the diagnosis of AD. |
43 AD patients, education mean =7 (SD=5), illiterate n= 2;
74 normal controls, educational mean = 5 (SD= 4), illiterate n=6. |
CASI-S includes: Registration of 3 words, temporal orientation, verbal fluency (4-legged animals in 30s), and recall (3 words). |
Diagnosis of AD:
Cut-off score: < 23/33; sens. 76.7%; spec. 86.5% and AUC = 0.87. |
7 Fichman-Charchat, et al, 2016(24)24. Fichman-Charchat H, Miranda CV, Fernandes CS, Mograbi D, Oliveira RM, Novaes R, et al. Brief Cognitive Screening Battery (BCSB) is a very useful tool for diagnosis of probable mild Alzheimer´s disease in a geriatric clinic. Arq Neuropsiquiatr. 2016 Feb;74(2):149-54. https://doi.org/10.1590/0004-282X20150202
https://doi.org/10.1590/0004-282X2015020...
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To investigate the use of BCSB for the diagnosis of mild AD. |
51 AD patients, education mean = 3.7 (SD = 2.8).
123 non-AD, education mean = 4.7 (SD 3.5). |
BCSB includes the MMSE, VF, CDT and the Figure Memory Test (naming, incidental, immediate memory, learning, delayed recall and recognition). |
Incidental Memory: Cut-off= <3; sens. 71.9%;
spec. 66.7% and AUC = 0.737.
Immediate Memory: Cut-off = <5; sens. 75%;
spec. 81% and AUC = 0.825.
Learning: Cut-off = <5; sens. 78.1%;
spec. 69% and AUC = 0.820.
Delayed recall test: Cut-off = <5; sens. 71.9%;
spec. 88.1% and AUC = 0.867
Recognition: Cut-off = <8; sens. 81%;
spec. 69% and AUC = 0.766
VF: Cut-off = <9; sens. 67.2%;
spec. 73.8% and AUC = 0.749
CDT: Cut-off = <3; sens. 62.5%;
spec. 57.1% and AUC = 0,608. |
8 Martinelli, et al, 2018(25)25. Martinelli JE, Cecato JF, Martinelli MO, de Melo BA, Aprahamian I. Performance of the Pentagon Drawing test for the screening of older adults with Alzheimer's dementia. Dement Neuropsychol. 2018 Jan-Mar;12(1):54-60. https://doi.org/10.1590/1980-57642018dn12-010008
https://doi.org/10.1590/1980-57642018dn1...
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To evaluate performance properties of a specific PDT scoring scale in older adults with Alzheimer's disease (AD) and healthy controls. |
266 patients with AD and 124 normal controls. They were stratified by education 2-4 years, 5-8 and> 8 years. |
PDT= drawing of two intersecting pentagons, in which the interconnected area should be shaped like a rhombus, scored binarily (0, 1) and with the Bourke et al. scale (0-6). |
Analyses of the PDT binary score on the MMSE did not discriminate AD
from controls (p = 0.839).
Using the Bourke et al. scale, the two groups could be distinguished (p <0.001):
PDT: Cut-off = ≥ 5; sens. 95.2%;
spec. 45.9% and AUC = 0.784. |
9 Porto, et al, 2003(26)26. Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr. 2003 Jun;61 2B:339-45. https://doi.org/10.1590/S0004-282X2003000300004
https://doi.org/10.1590/S0004-282X200300...
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To verify the diagnostic accuracy of the Brazilian version of the DRS to identify AD |
41 patients mild AD, educational mean = 9.07 (SD=5.31) and 60 controls, education mean = 8,05 (SD = 4.62) |
36 tasks grouped into 5 subscales, in the different cognitive areas: Attention, Initiation/ Perseveration (I/P), Construction, Conceptualization and Memory |
DRS Total: Cut-off = <123/144, sens. 91.7%,
spec. 87.8% and AUC = 0.943.
Attention: Cut-off = < 36/37; sens. 60%;
spec. 73.2% and AUC = 0.694.
I/P: Cut-off = <33/37; sens. 73.3%,
spec. 78% and AUC = 0.829.
Construction: Cut-off = <6/6; sens. 88.3%;
spec. 29.3% and AUC = 0.590.
Conceptualization: Cut-off = <34/39; sens. 71.7%;
spec. 65.9% and AUC = 0.786.
Memory: Cut-off = <19/25; sens. 99.3%;
spec. 92.7% and AUC = 0.980. |
