When a sub sample was paired by age and education with controls, it was possible to verify that the delayed recall of the FMT (DR-FMT) showed excellent sensitivity (93.3%) and specificity (96.6%) in differentiating between patients with mild to moderate dementia from controls, with a cut-off score of ≤5.
The study continued with the inclusion of 100 patients with dementia and the conclusion was that the socioeconomic level had no influence on the relative frequency of neurodegenerative, vascular, and other dementia subtypes. Scoring on these subtests ranges from 0 to 10 points (except for the Verbal Fluency test). Finally, a sheet of paper with the 10 target figures, mixed with 10 new distracting figures, is presented and the subjects are asked to recognize those figures displayed originally (Recognition score). Then, after the Verbal Fluency test (animals in 1 minute) and the Clock Drawing Test (CDT), which are interference tests, subjects are asked to recall the figures shown previously (Delayed Recall score). The same procedure is then repeated to obtain the Learning score (or encoding). Subsequently, the figures are displayed again and the subjects are asked to memorize them for 30 seconds, after which they should be recalled (Immediate Memory score). The figures are named by the subjects (Naming score), who are then asked to recall each drawing immediately, without having been told that the figures should be memorized (Incidental Memory score). This test consists of presenting a sheet of paper with 10 simple black and white drawings. Although it would be an interesting set of tests to be used, the memory test (word list) would still require reading, thus preventing its use among illiterates.įaced with this difficulty and not knowing any method that could be used for adequate cognitive assessment of illiterates and individuals with low schooling, especially memory, we developed the Brief Cognitive Screening Battery (BCSB), which includes the Figure Memory Test (FMT). Published the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) battery for the clinical and neuropathological diagnosis of Alzheimer disease (AD). Would not be adequate to screen for dementia among patients with no or low education.Ī few months before the study started, Morris et al. It was clear that the use of the MMSE, particularly if considering the cut-off score originally proposed by the authors (24 points), In another study carried out in Brazil, it was found that the most suitable MMSE cut-off score for dementia diagnosis among illiterates was 13 (5 th percentile value), posteriorly published. Scores ranged from 17 to 27 among illiterates, and from 18 to 30 among those with schooling from 1 to 3 years.
One of the authors of the present study (RN) had already carried out a study at Hospital das Clínicas, of the School of Medicine of Universidade de São Paulo, using a version of the MMSE in a sample of 362 individuals without cognitive impairment, including 23 illiterate and 69 with 1 to 3 years of schooling. The Mini-Mental State Examination (MMSE) had proved to be very inadequate in previous studies carried out in low- and middle-income countries, such as in China, many years before, when Katzman tried to use the MMSE for the diagnosis of dementia. Tests used in other countries would probably be insufficient or could lead to misdiagnosis. In the designing phase of the project, it was clear that it would be difficult to establish the diagnosis of dementia in individuals with low education, especially illiterates. Cases seen at a private clinic were also included in order to improve the sample regarding higher socioeconomic levels. To carry out the research, a specialized outpatient clinic was created at the Hospital das Clínicas of the School of Medicine of Universidade de São Paulo, in São Paulo, Brazil, a large public university hospital. In 1990, we started a project whose objective was to investigate whether dementia caused by neurodegenerative diseases, in particular Alzheimer disease, was more frequent among people with higher socioeconomic level, while vascular dementia and dementia of other non-degenerative etiologies were more frequent in individuals of lower socioeconomic status.
0 kommentar(er)
