Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil.

Cognitive evaluation in developing countries is a difficult undertaking due to low levels of schooling and particularly the illiteracy still frequent in the elderly. This study was part of the epidemiologic evaluation of dementia in Catanduva, Brazil, and had the objective of comparing the performance of illiterate and literate nondemented elderly individuals in 2 tests of long-term memory-the delayed recall of a word list from the CERAD and the delayed recall of common objects presented as simple drawings from the Brief Cognitive Screening Battery (BCSB). Fifty-one elderly subjects (23 illiterates) were evaluated, and the performance of the illiterates and literates differed in the CERAD memory test, but not in the BCSB memory test. This test may be more suitable for the assessment of long-term memory in populations with a high frequency of illiterates, and therefore might prove to be a useful screening tool for the diagnosis of dementia.

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

-Objectives: To verify the diagnostic accuracy of the Brazilian version of the Mattis Dementia Rating Scale (DRS) in the diagnosis of patients with mild dementia in Alzheimer's disease (AD); to verify the interference of the variables age and schooling on the performance of the DRS. Method: The DRS was administered to 41 patients with mild AD and to 60 controls. In order to analyze the effects of age and schooling on the performance of the tests, patients and controls were separated into three age groups and three levels of schooling. Results: The cutoff score of 122 showed a sensitivity of 91.7 % and specificity of 87.8 %. Age and schooling interfered in the DRS total score and in the scores of its subscales. Conclusion: The DRS showed good diagnostic accuracy in the discrimination of patients with mild AD from the control individuals. In the sample examined, the effects of schooling were more marked than age.KEY WORDS: Alzheimer's disease, dementia, neuropsychological assessment, education.

Brief cognitive tests are widely used for dementia screening, but are usually influenced by education. The present work aimed to determine education-adjusted cut-off scores and correspondent sensitivity (S) and specificity (Sp) values of the category fluency (CF) test (animals/min) as a screening tool for Alzheimer disease (AD). Eighty-eight patients with mild AD and 117 normal matched controls were evaluated. Patients and controls were divided into 4 groups according to educational level (illiterates, 1 to 3, 4 to 7, and > or =8 y) and were administered the CF test. In each group, cut-off values were determined using Receiver Operator Characteristic analysis. The areas under Receiver Operator Characteristic curves were 0.922/0.914/0.963/0.954, for the identification of AD among the groups of illiterates, 1 to 3, 4 to 7, and > or =8 years of education, respectively. The cut-off points for each group were 9 (S=90.5% and Sp=80.6%) for illiterates; 12 (S=95.2%% and Sp=80.0%) for 1 to 3 years; 12 (S=91.3% and Sp=91.9%) for 4 to 7 years, and 13 for those with > or =8 years (S=82.6% and Sp=100.0%). These results suggest that the CF may be a useful screening test for mild AD in different educational levels, with the need of using specific cut-off scores adjusted for each range of schooling.