RESUMEN
We retrospectively assessed the data from 24 patients with dementia of the Alzheimer type (DAT) who underwent comprehensive neuropsychological evaluations in order to determine whether there is a relationship between neuropsychological heterogeneity and educational level. Postmortem neuropathological examination results were made available for seven cases, confirming the diagnosis of DAT. Thirteen patients had < or = 8 years of schooling (less educated subgroup), and the other 11 had > or = 8 years (higher educated subgroup). There were no significant differences between the two subgroups regarding age and duration of symptoms. Performance within each subgroup was compared with that of a specific set of education-matched elderly controls. In the less educated subgroup, 10 patients evidenced a homogeneous pattern of cognitive impairment, with all cognitive areas being similarly affected. Conversely, 10 higher educated patients had at least one cognitive area relatively preserved in comparison with the others, characterizing a heterogeneous pattern of impairment. These data suggest that a high level of education may lead to a greater capacity to compensate for neuronal damage and determines specific patterns of cognitive impairment in DAT.
Asunto(s)
Enfermedad de Alzheimer/psicología , Anciano , Anciano de 80 o más Años , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estudios RetrospectivosRESUMEN
The authors describe and discuss neuropsychological aspects related to the functional organization of the brain connected to cognition in 81 Alzheimer's disease patients in the Laboratoire Théophile-Alajouanine du Centre de Recherche du Centre hospitalier Côte-des-Neiges in the University of Montreal. They confront the clinical of homogeneity against the heterogeneity within functional organization of the brain. The criteria used for diagnosis were those of the NINCDS-ADRDA. All of the patients were in the beginning of the evolution, in stages 3 and 4 of Reiberg (Functional Assessment Staging, FAST). The conclusion shows that there are two cognitive profiles: a non-recurrent profile, made up by the majority of the patients, and the heterogeneity depends on the genetic background of each individual; a recurrent profile, made up by a small group of patients that show changes in the heterogeneity of clinical, nosological, pathological and normal aging forms.
Asunto(s)
Enfermedad de Alzheimer/fisiopatología , Cognición , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/psicología , Encéfalo/fisiopatología , Humanos , Pruebas NeuropsicológicasRESUMEN
The authors discuss the protocol of the Optimal Neuropsychological Evaluation of Dementias of Montreal and its possible application in Brazil. This protocol is important for evaluation in neuropsychological evolution of dementia of the Alzheimer type and for bringing to the fore distinct affected cognitive profiles as much on a transversal base as longitudinal. The authors believe that its application would contribute to the progress of research in neurology, as in the clear distinction between normal aging and pathological aging.
Asunto(s)
Demencia/diagnóstico , Pruebas Neuropsicológicas , Enfermedad de Alzheimer/diagnóstico , HumanosRESUMEN
Ninety-five normal controls divided into three subgroups (55-64 yrs, 65-74 yrs, and 75-84 yrs) and 11 subjects with early dementia of Alzheimer's type (DAT) were given a line orientation judgment task (Benton, Varney, & Hamsher, 1978). No difference appeared between the three control subgroups in global score but the difference between controls and DAT subjects was significant. However, some DAT subjects had a global score overlapping the scores of controls. Error types were also analyzed. Results of this analysis showed that some errors appeared in all subjects, normal and DAT, while others were specific to DAT subjects. It was speculated that these error types were a manifestation of a deeper visuospatial deficit, revealing a major problem of the DAT in spatial organization. Thus, this study suggests that an analysis of the error types observed in the line orientation judgment task may be helpful in differentiating normal elderly from early DAT.
Asunto(s)
Enfermedad de Alzheimer/diagnóstico , Atención , Aprendizaje Discriminativo , Pruebas Neuropsicológicas , Orientación , Reconocimiento Visual de Modelos , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , PsicometríaRESUMEN
An increasing number of studies point to the fact that distinct cognitive subgroups may be identified among subjects with dementia of the Alzheimer type (DAT). Although such heterogeneity could be the expression of neuropsychological, genetic, or epidemiological factors, the identification of neuropsychological subtypes in DAT could also reflect the existence of cognitive subgroups in a normal aged population. In the present study, the existence of neuropsychological subgroups was sought from among 81 volunteers aged between 55 and 84 years. Subjects were given a neuropsychological battery addressing various aspects of cognitive functioning. Results show that six subgroups could be identified among this population. Subgroups differ primarily in their overall degree of performance. Qualitative differences in cognitive performance are also present, mostly when subgroups which exhibit poor overall performance are considered. Consequently, the presence of such heterogeneity in normal elderly should be taken into account in any attempt to identify neuropsychologically based subgroups in early dementia of the Alzheimer type.