RAMB - JULHO 2017

teiner

ABQ

654

ssoc

ras

2017; 63(7):651-655

Neuroimaging exams must be requested, including

CT or MRI scans, not only to verify the limbic structures

but also to rule out other diseases, particularly vascular

cognitive impairment.

Screening tests such as the mini-exam of the mental

state,

clock-drawing test, verbal fluency and a question-

naire on instrumental and basic daily life activities, as

well as the geriatric depression scale (GDS) questionnaire,

must be applied.

36,37

europsychological

testing

Longitudinal studies investigating the usefulness of neu-

ropsychological tests to identify subjects at high risk of

developing dementia reported that, by measuring recall,

delayed recall, verbal fluency and visual-motor skill, they

were able to identify 85% of the individuals that developed

dementia and 95% of those that remained stable, in four

years of accompaniment.

The results suggest that indi-

viduals with increased risk of developing dementia, or in

a preclinical state of AD, can be identified by neuropsy-

chological tests, which evaluate mainly memory (measures

of late evocation) and other cognitive functions, such as

attention, language and thought.

The standardized

application of tests to elderly individuals with cognitive

complaints is a manner of rendering the concept of cog-

nitive impairment both valid and reliable.

euroimaging

In the initial stages of the disease, cranial MRI might not

present abnormalities. In some cases, a SPECT or PET

scan can be considered.

In SPECT a decline in blood

flow is noted whereas in PET a reduction of glucose uti-

lization is observed. PIB and FDG PET are employed in

some research studies to compare controls with patients

suffering from AD and MCI.

reatment

Currently, there is no evidence for the utilization of drugs

for the treatment of individuals with MCI.

Nonetheless,

several clinical trials have been conducted in an attempt

to slow down the appearance of dementia.

There was a

large clinical trial involving 70 medical centers in North

America.

The study was randomized, double-blind and

placebo-controlled and aimed to verify the safety and

efficacy of vitamin E (2,000 IU per day) and donepezil (10

mg per day). A decrease, although not significant, was

noted in the conversion rate of MCI to AD from 45 to

30% in a three-year period. Among 769 randomized indi-

viduals, the annual conversion rate of MCI to AD was

approximately 16%. Donepezil reduced the risk of AD in

the first 12 months of the trial, but there was no drop in

the progression to AD in 36 months. Vitamin E had no

therapeutic effect.

onclusion

Aging of the population is making the cases of chronic de-

generative diseases more frequent, including AD. InMCI, a

loss of memory for recent facts with relative preservation of

functionality is observed. A general practitioner must know

that individuals with MCI constitute a group of great risk

for AD. Early identification of individuals in the beginning

of clinical dementia provides a possibility of intervening in

the progression of the disease and providing support to

patients and their family members. Upon encountering el-

derly patients withmemory complaints, the physicianmust

perform a detailed anamnesis and complete physical exam,

ruling out reversible causes of cognitive alterations. Mood

symptoms such as depression and anxiety, if identified, need

to be treated. Laboratory exams must include a complete

blood count, fasting blood glucose, electrolytes, renal, liver

and thyroidal function, lipidogram, folic acid and vitamin

B12. An imaging exam such as cranial CT or MR should also

be performed. Cognitive testing must include a mini-exam

of the mental state (mini-mental), clock-drawing test and

verbal fluency for fruits and animals. The Brazilian Public

Health System (SUS, in the Portuguese acronym) is respon-

sible for a great portion of patient healthcare in the country.

The Family Health Team of Basic Health Units must serve

as both the first contact and the longitudinal contact with

SUS users, enabling the recognition of the patients’ cognitive

impairment and potential progression to AD.

esumo

Comprometimento cognitivo leve e progressão para a

demência da doença de Alzheimer

O aumento da expectativa de vida da população brasileira

faz surgir questões sobre o preparo do sistema de saúde

pública na identificação de pacientes idosos com sinais de

alteração cognitiva. Atualmente, como consequência da

longa duração da fase pré-clínica da doença de Alzheimer

(DA), existe maior ênfase sobre a detecção precoce. A de-

mência apresenta um importante impacto sobre a família,

os cuidadores, a sociedade e a economia. Identificar indi-

víduos que já apresentam algum comprometimento cog-

nitivo, embora eles mantenham a funcionalidade, bem

como analisar as comorbidades associadas constituem

oportunidades para direcionar futuras intervenções. De-

mências são doenças que impõem sobrecarga ao sistema