Acessibilidade / Reportar erro

Testes neuropsicológicos de aplicação simples para o diagnóstico de demência

Brief and easy-to-administer neuropsychological tests in the diagnosis of dementia

Resumos

Os desempenhos em testes neuropsicológicos de trinta pacientes, com diagnóstico de demência leve ou moderada baseado nos critérios do DSM-III-R, com escore no Mini-exame do Estado Mental inferior a 24 pontos e escolaridade mínima de 4 anos, foram comparados aos de trinta voluntários normais equiparados quanto a idade, escolaridade e sexo. Foram calculadas as sensibilidades e especificidades dos testes na distinção entre doentes e controles normais Dentre os testes empregados, o que demonstrou maior acurácia nesta distinção, calculada através de curva ROC, foi o de informação-memória-concentração de Blessed, seguido em ordem decrescente de acurácia, pelos de construção (cópias de figuras simples), memória verbal tardia (após 5 minutos), reconhecimento de 10 figuras e fluencia verbal (animais). Seis testes de aplicação e interpretação simples (fluencia verbal, percepção visual, memória visual incidental, cálculo, desenho de um relógio e memória tardia após 5 minutos) permitiram definir função linear discriminante que revelou elevada capacidade de discriminação entre pacientes e controles, na amostra. Esta função deve ser submetida à comprovação em outra casuística. Em virtude da simplicidade e rapidez de aplicação, poderá ser associada ao MEM para identificar indivíduos com demência e indivíduos sadios em estudos epidemiológicos.

demência; avaliação; testes neuropsicológicos


Thirty patients with dementia defined by DSM-III-R criteria (Alzheimer's disease (22), vascular dementia (3), Parkinson's disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blessed's information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

dementia; evaluation; neuropsychological tests


Testes neuropsicológicos de aplicação simples para o diagnóstico de demência

Brief and easy-to-administer neuropsychological tests in the diagnosis of dementia

Ricardo NitriniI; Beatriz Helena LefèvreI; Sandra Cristina MathiasI; Paulo CaramelliI; Paulo Eduardo M. CarrilhoI; Naim SauaiaII; Eduardo MassadII; Clóvis TakigutiIII; Ivaldo Olímpio Da SilvaII; Cláudia Sellito PortoI; Maria Cristina MagilaI; Milberto ScaffI

IFaculdade de Medicina da Universidade de São Paulo: Departamentos de Neurologia

IIFaculdade de Medicina da Universidade de São Paulo: Informática Médica

IIIFaculdade de Medicina da Universidade de São Paulo: Medicina Preventiva

RESUMO

Os desempenhos em testes neuropsicológicos de trinta pacientes, com diagnóstico de demência leve ou moderada baseado nos critérios do DSM-III-R, com escore no Mini-exame do Estado Mental inferior a 24 pontos e escolaridade mínima de 4 anos, foram comparados aos de trinta voluntários normais equiparados quanto a idade, escolaridade e sexo. Foram calculadas as sensibilidades e especificidades dos testes na distinção entre doentes e controles normais Dentre os testes empregados, o que demonstrou maior acurácia nesta distinção, calculada através de curva ROC, foi o de informação-memória-concentração de Blessed, seguido em ordem decrescente de acurácia, pelos de construção (cópias de figuras simples), memória verbal tardia (após 5 minutos), reconhecimento de 10 figuras e fluencia verbal (animais). Seis testes de aplicação e interpretação simples (fluencia verbal, percepção visual, memória visual incidental, cálculo, desenho de um relógio e memória tardia após 5 minutos) permitiram definir função linear discriminante que revelou elevada capacidade de discriminação entre pacientes e controles, na amostra. Esta função deve ser submetida à comprovação em outra casuística. Em virtude da simplicidade e rapidez de aplicação, poderá ser associada ao MEM para identificar indivíduos com demência e indivíduos sadios em estudos epidemiológicos.

Palavras-chave: demência, avaliação, testes neuropsicológicos.

SUMMARY

Thirty patients with dementia defined by DSM-III-R criteria (Alzheimer's disease (22), vascular dementia (3), Parkinson's disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blessed's information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

Key words: dementia, evaluation, neuropsychological tests.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 14-abril-1994.

Dr. Ricardo Nitrini - Rua Bartolomeu Feio 560 - 04580-001 São Paulo SP - Brasil.

  • 1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Ed 3 rev. Washington, DC: American Psychiatric Association, 1987.
  • 2. Anthony JC, LeResche L, Niaz U, Von Körff MR, Folstein M. Limits of the "Mini-mental state" as a screening test for dementia and delirium among hospital patients. Psychol Med 1982, 12: 397-408.
  • 3. Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry 1968,114: 797-811.
  • 4. Conn HO. Trailmaking and number-connection tests in the assessment of mental state in portal systemic encephalopathy. Dig Dis 1977, 22: 541-550.
  • 5. Crystal HA, Dickson DW, Lizardi JE, Davies P, Wolfson LL. Antemorten diagnosis of diffuse Lewy body disease. Neurology 1990, 40: 1523-1528.
  • 6. Dean AG, Dean JA, Burton AH, Dicker RC. Epi Info, version 5: a word processing, database, and statistics program for epidemiology on micro-computers. Atlanta: Centers for Disease Control, 1990.
  • 7. Eslinger PJ, Damásio AR, Benton AL, Van Allen M. Neuropsychologic detection of abnormal mental decline in older persons. JAMA 1985, 253: 670-674.
  • 8. Fillenbaun GG, Heyman A, Wilkinson WE, Haynes CS. Comparison and reliability of the mini-mental state examination and the modified Blessed test. Arch Neurol 1987, 44: 924-927.
  • 9. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the coignitive state of patients for the clinician. J Psychiatr Res 1975, 12: 189-198.
  • 10. Galasko D, Klauber MR, Hofstetter R, Salmon DP, Lasker B, Thal LJ. The mini-mental state examination in the early diagnosis of Alzheimer's disease. Arch Neurol 1990, 47: 49-52.
  • 11. Lefèvre BH, Nitrini R. Semiologia neuropsicológica. Arq Neuropsiquiatr 1985, 43: 119-132.
  • 12. McKeith LG, Perry RH, Fairbairn AF, Jabeen S, Perry EK. Operacional criteria for senile dementia of Lewy body type (SDLT). Psychol Med 1992, 22: 911-922.
  • 13. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease. Neurology 1984, 34: 939-944
  • 14. Monsch AU, Bondi MW, Butters N, Salmon DP, Katzman R, Thai LJ. Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer type. Arch Neurol 1992, 49: 1253-1258.
  • 15. Morris JC, McKeel DW, Storandt M, Rubin EH, Price JL, Grant EA, Ball MJ, Berg L. Very mild Alzheimer's disease: informant-based clinical, psychometric, and pathologic distinction from normal aging. Neurology 1991, 41: 469-478.
  • 16. Mossman D, Somoza E. ROC curves, test accuracy, and the description of diagnostic tests. J Neuropsychiatry 1991, 3: 330-333.
  • 17. Nie NH, Hull CH, Jenkins JG, Steinbrenner K, Bent D. Statistical package or the social sciences. Ed 2, New York: McGraw-Hill, 1975.
  • 18. Nitrini R. Diagnóstico de demência; avaliação clínica, neuropsicológica e através da tomografia computadorizada por emissão de fóton único. Tese de Livre-Docência. Faculdade de Medicina da Universidade de São Paulo, São Paulo, 1993.
  • 19. Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, Moody DM, O'Brien MD, Yamaguchi T, Grafman J, Drayer BP, Bennett DA, Fischer M, Ogata J, Kokmen E, Bermejo F, Wolf PA, Gorelick PB, Bick KL, Pajeau AK, Bell MA, DeCarli C, Culebras A, Korczyn ADS, Bougousslavsky J, Hartmann A, Cheinberg P. Vascular dementia: diagnostic criteria for research studies. Neurology 1993, 43: 250-260.
  • 20. Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984, 141: 1356-1364.
  • 21. Storandt M, Botwinick J, Danziger WL, Berg L, Hughes CP. Psychometric differentiation of mild senile dementia of the Alzheimer type. Arch Neurol 1984, 41: 497-499.
  • 22. Storandt M, Hill RD. Very mild senile dementia of the Alzheimer type: psychometric test performance. Arch Neurol 1989, 46: 383-386.
  • 23. Sunderland T, Hill JL, Mellow AM, Lawlor BA, Gundersheimer J, Newhouse PA, Grafman JH. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Geriatr Soc 1989, 37: 725-729.
  • 24. Swets JA. Measuring the accuracy of diagnostic systems. Science 1988, 240: 1285-1293.
  • 25. Tierney MC, Snow G, Reid DW, Zorzitto ML, Fisher RH. Psychometric differentiation of dementia: replication and extension of the findings of Storandt and coworkers. Arch Neurol 1987; 44: 720-722.
  • 26. Uhlmann RF, Larson EB. Effect of education on the mini-mental state examination as a screening test for dementia. J Am Geriatr Soc 1991, 39: 876- 880.
  • 27. Wechsler D. A standardized memory scale for clinical use. J Psychology 1945, 19: 87-95.
  • 28. Weintraub S, Mesulam MM. Mental state assessment of young and elderly adults in behavioral neurology. In Mesulam MM. Principles of behavioral neurology. Philadelphia: Davis, 1985: 71-123.
  • 29. Welsh K, Butters N, Hughes J, Mohs R, Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol 1991, 48: 278-281.

Datas de Publicação

  • Publicação nesta coleção
    19 Jan 2011
  • Data do Fascículo
    Dez 1994
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