Rastreio para doença de Alzheimer em idosos brasileiros de baixa escolaridade ou analfabetos: revisão sistemática

Ortega, Luciane de Fátima Viola; Aprahamian, Ivan; Borges, Marcus Kiiti; Cação, João de Castilho; Yassuda, Mônica Sanches

doi:10.1590/0004-282X20190024

Brasil

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

View and Review • Arq. Neuro-Psiquiatr. 77 (4) • Abr 2019 • https://doi.org/10.1590/0004-282X20190024 linkcopiar

Rastreio para doença de Alzheimer em idosos brasileiros de baixa escolaridade ou analfabetos: revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Os instrumentos de rastreio cognitivo sofrem influência educacional e/ou cultural. No Brasil, como as taxas de analfabetismo e baixa escolaridade são altas, é necessário identificar os instrumentos com maior acurácia diagnóstica para a doença de Alzheimer (DA).

Objetivo: identificar os instrumentos de rastreio cognitivo aplicados na população brasileira com maior acurácia para detectar DA em indivíduos com baixo nível de escolaridade ou que são analfabetos.

Métodos: Busca sistemática de estudos que utilizaram testes de rastreio cognitivo para detectar DA em idosos brasileiros de baixa escolaridade ou analfabetos, nas bases de dados: SCIELO, PUBMED E LILACS.

Resultados: Foram encontrados 328 artigos e 9 preencheram os critérios de inclusão. Os instrumentos identificados apresentaram acurácia diagnóstica adequada ou elevada.

Conclusão: Para um rastreio cognitivo válido é importante considerar os fatores socioculturais e educacionais na interpretação dos resultados. A construção de instrumentos epecíficos para idosos de baixa escolaridade ou analfabetos deve ser incentivada para melhor refletir as dificuldades dos idosos brasileiros de diferentes regiões.

Palavras-chave: Cognição; educação; doença de Alzheimer; alfabetização; demência

Author, Years	Objectives	Sample	Instruments	Results
1 Aprahamian, et al, 2010⁽³⁾	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⁾	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⁾	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⁾	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⁾	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⁾	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⁾	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⁾	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⁾	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.

vertical_align_top file_download show_chart

more_horizclose
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Academia Brasileira de Neurologia - ABNEURO R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices Torre Norte, 04101-000 São Paulo SP Brazil, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revista.arquivos@abneuro.org

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

Acessibilidade / Reportar erro

[TFN1] AD: Alzheimer's disease; CAMCOG: Cambridge Cognition Examination; AD: Alzheimer's disease; Sens.: Sensitivity; Spec.: Specificity; AUC: area under the ROC curve; RUDAS-BR: Rowland Universal Dementia Assessment Scale – Brazilian version; SD: standard deviation; CASI-S: Cognitive Abilities Screening Instrument – Short Form; BCSB: Brief Cognitive Screening Battery; MMSE: Mini-Mental State Examination; VF: Animal Category Verbal Fluency Test; CDT: Clock Drawing Test; DRS: Mattis Dementia Rating Scale; PFAQ: Pfeffer Functional Activities Questionnaire; PDT: Pentagon Drawing Test.