A brief neuropsychological screening test battery for cognitive dysfunction in Brazilian multiple sclerosis patients

Negreiros, Marco Aurélio; Mattos, Paulo; Landeira-Fernández, J.; Paes, Renata Alves; Alvarenga, Regina Maria Papais

doi:10.1080/02699050801998243

Cited by 18 publications

(25 citation statements)

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“…Yet, most investigations have focused on clinical description of hospital-based or MS Centers cohorts in different parts of the country [9][10][11][12][13][14][15][16] . Other studies have concentrated on the association with HLA 17, 18 , the influence of ethnic factors on the phenomenological presentation of the disease 19 ; the neuropsychological aspects of the disease 20,21 and the impact of the disease on patients' quality of life 22 .…”

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The prevalence of multiple sclerosis in Belo Horizonte, Brazil

Lana-Peixoto

Frota

Campos

et al. 2012

Arq. Neuro-Psiquiatr.

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Multiple sclerosis (MS) is a demyelinating inflammatory and degenerative disease of the central nervous system (CNS) whose etiology is still unknown. Epidemiological studies have suggested that the interaction between genetic susceptibility and a variety of environmental factors may play a key role accounting for the differences in its prevalence in distinct populations 1 .In the last few decades, a large number of studies have demonstrated the frequency of MS in all continents 2 . Unfortunately, however, many of these epidemiological studies lack consistent methodological features, such as strict diagnostic criteria, well defined study populations or geographical areas, and complete case ascertainment 3 . Such faults have rendered their results unreliable for comparisons with established data from other geographical areas 2,3 . In Latin America, surveys on the epidemiology of MS are still scanty and most of them exhibit these methodological limitations [4][5][6][7][8] .Interest in the study of MS in Brazil has markedly increased in the last few years. Yet, most investigations have focused on clinical description of hospital-based or MS Centers cohorts in different parts of the country [9][10][11][12][13][14][15][16] . Other studies have concentrated on the association with HLA 17,18 , the influence of ethnic factors on the phenomenological presentation of the disease 19 ; the neuropsychological aspects of the disease 20,21 and the impact of the disease on patients' quality of life 22 .Three papers on the prevalence of MS in well-defined geographical areas in Brazil have been so far published. The first study, in São Paulo city, considered 1990 as the prevalence year and showed a prevalence rate of 4.3 per 100,000 inhabitants 23 . A re-evaluation of this prevalence rate by the same senior author 24 took 1997 as the prevalence year and, through the use of aBstract Investigations on the prevalence rates of multiple sclerosis (MS) around the world have yielded important clues on the interplay between genetic susceptibility and environmental factors. As Brazil is a huge country laid on many latitudes and inhabited by population with distinct ethnic backgrounds, it might be assumed that the frequency of MS varies in its different regions. Objective: To determine the prevalence rate of MS in Belo Horizonte, the capital of the State of Minas Gerais, Southeastern Brazil. Methods: We used six sources to draw up a provisional list of identified cases of MS. Only patients with diagnosis of clinically definite MS according to Poser Committee criteria were included. Results: The calculated crude MS prevalence was 18.1/100,000 inhabitants. Conclusions: The MS prevalence in Belo Horizonte is similar to that found in São Paulo and Botucatu, two other cities in southeastern Brazil with similar ethnic background.Key words: multiple sclerosis, prevalence, Belo Horizonte, Southeastern Brazil.resumo Estudos sobre as taxas de prevalência da esclerose múltipla (EM) no mundo têm fornecido importantes evidências do papel da inter-relaçã...

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The prevalence of multiple sclerosis in Belo Horizonte, Brazil

Lana-Peixoto

Frota

Campos

et al. 2012

Arq. Neuro-Psiquiatr.

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“…Noronha, Sisto, Bartholomeu, Lamounier e Rueda (2006) propuseram o emprego dos testes AC (atenção concentrada) e AS (atenção sustentada); Negreiros et al (2008) sugeriram uma bateria composta por nove testes. Essas tentativas vêm comprovar que ainda não há consenso quanto aos testes mais adequados para tal avaliação.…”

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“…Inglese et al (2008), também empregando esse instrumento, informaram que 50% dos pacientes tinham perda de memória de curto prazo. O percentual de pacientes da presente pesquisa com prejuízo dessa memória, avaliada pelo RAVLT, foi menor que os 33,3% relatados por Negreiros et al (2008), testando 54 pacientes na forma clínica surto-remissão, mas teve em comum a identificação de uma curva de aprendizagem que não se associou à gravidade de esclerose múltipla, avaliada pelo EDSS. No estudo de Jønsson et al (2006), os resultados do teste de dígitos em ordem direta e inversa indicaram que 28,8% dos pacientes com EM tinham redução de memória operacional, percentual muito menor que os 57,1% da presente pesquisa.…”

Section: Discussionunclassified

“…Amato et al (2006), acompanhando a história natural da disfunção cognitiva em 45 pacientes, com segmento de dez anos, identificaram que, no estágio inicial da doença, a disfunção cognitiva estava ausente em 74% dos pacientes, era discreta em 8% e moderada em 18%, percentuais que se alteraram para 44%, 34% e 22%, após dez anos de doença. Dentre as funções cognitivas, a mnemônica é o domínio mais freqüentemente acometido, identificado em 40% a 60% dos portadores de esclerose múltipla, com variação em função do teste empregado para sua aferição (Moriarty et al, 1999;Negreiros, Mattos, Paes, Landeira-Fernandez, & Alvarenga, 2008). Quanto à atenção nos quadros de EM, tem-se demonstrado repetidamente uma capacidade reduzida de manter e manipular informações na mente, processos comumente conceituados como funções de memória de trabalho ou de atenção concentrada.…”

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Avaliação das funções cognitivas de atenção, memória e percepção em pacientes com esclerose múltipla

Freitas¹,

Aguiar²

2012

Psicol. Reflex. Crit.

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ResumoEsclerose múltipla é uma doença desmielinizante, que leva à destruição de importantes estruturas do Sistema Nervoso Central. Essas lesões podem resultar em déficits cognitivos. Com o objetivo de investigar a relação entre esclerose múltipla e alterações cognitivas de atenção, memória e percepção, foram avaliados 28 pacientes em um Centro Estadual de Referência, que satisfaziam os critérios de inclusão: idade entre 20 e 55 anos, nível escolar mínimo de 2 o grau completo e classificação na Escala Expandida de Incapacidade menor que 7,0. Foram empregados quatro testes neuropsicológicos, validados pelo Conselho Federal de Psicologia: teste da cópia e reprodução de memória da figura complexa A de Rey-Osterrieth, teste de aprendizagem áudio-verbal de Rey, teste d2 e teste de dígitos. Para investigar o impacto da fadiga sobre as atividades cognitivas foi utilizada a escala MFIS-21Br. A análise estatística consistiu dos testes ANOVA, t para amostras pareadas ou de Mann-Whitney e de Kolmogorov-Smirnoff, unicaudais à direita, para rejeição da hipótese nula com nível de significância de 0,05. Os resultados apontaram perdas cognitivas com significância estatística nos pacientes com idade entre 40 e 55 anos e nos que apresentaram comprometimento por fadiga nos subdomínios cognitivo e psicossocial. Os pacientes com tempo de doença entre 5,0 e 19,9 anos apresentaram redução da pontuação nos testes, mas sem significância estatística. Concluiu-se que, dentre as funções cognitivas avaliadas, memória foi a mais freqüentemente comprometida, seguindo-se de atenção, sendo a percepção, comparativamente, a mais preservada. Palavras-chave: Esclerose múltipla, déficits cognitivos, atenção, memória, percepção. AbstractMultiple sclerosis is a demyelinating disease that leads to the destruction of important structures of the Central Nervous System. These lesions may result in cognitive deficits. Aiming to investigate the relation between multiple sclerosis and cognitive alterations of attention, memory and perception 28 patients have been evaluated in a State Reference Center. They satisfied the following inclusion criteria: age between 20 and 55 years old, minimum scholarship level of High School and classification in the Expanded Disability Status Scale minor than 7.0. Four neuropsychological tests, validated by Federal Council of Psychology, were used: copy and memory reproduction of Rey-Osterrieth Complex Figure Test, Rey Audio-Verbal Learning Test, d2 Test and Digit-Span Test. To investigate the impact of fatigue on cognitive activities, MFIS-21Br scale was used. Statistical analysis consisted of ANOVA, pared samples t test or Mann-Whitney test, and Kolmogorov-Smirnoff test, right sided, for rejection of null hypothesis with significance level of .05. The results pointed out statistically significant cognitive losses for patients between 40 and 55 years old as well as for those who presented detriment due to fatigue in cognitive and psychosocial subdomains. Patients with disease duration between 5.0 and 19.9 years presented reduc...

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“…Patients with predominantly spinal forms of the disease may present only mild cognitive impairment (Pelosi, Geesken, Holly, Hayward, & Blumhardt, 1997). More recent studies indicate, however, that many patients with primary progressive forms of MS may present cognitive impairment from the inception of the disease (Negreiros, Mattos, Landeira-Fernandez, Paes, & Alvarenga, 2008;Paes, Alvarenga, Vasconcelos, Negreiros, & Landeira-Fernandez, 2009). However, the studies showing cognitive impairment in primary progressive MS analyzed central tendency statistics and did not examine individual heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

A "Conceptual Nervous System" for multiple sclerosis.

Haase¹,

Medeiros²,

Pinheiro‐Chagas³

et al. 2010

Psychology & Neuroscience

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Neuropsychological diagnosis requires a structure-function correlation model or a "Conceptual Nervous System." The unpredictably variable, widespread, and multifocal nature of pathological changes in multiple sclerosis (MS) challenges the neuropsychological localizationist assumption. To be adapted to MS pathological and clinical heterogeneity, a Conceptual Nervous System should explain impairments associated with multifocal, subcortical, and white matter lesions that cause information processing slowing and working memory/executive function impairment. Our main goal in this theoretical study was to develop a Conceptual Nervous System for MS by integrating current neuropsychological conceptions of structural-functional correlations in MS with a model of conscious mental activity developed by Ernst Pöppel , based on periodic reentrant activity between cortical and subcortical structures. Neuropsychological profiles in MS can be explained by both threshold and multiple disconnection mechanisms. The Conceptual Nervous System encompasses a functional and structural model of the human brain-mind. The functional model classifies mental function into material and formal. Material/semantic functions are modularly organized, and their impairment causes classical focal neuropsychological symptoms. Multiple sclerosis preferentially impairs formal/syntactic function related to widespread patterns of activation and temporal organization. The structural model specifies the system anatomically functions. The neuropsychological adequacy of the proposed Conceptual Nervous System to MS is analyzed by comparing its predictions to results of extant metaanalytic studies.

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A brief neuropsychological screening test battery for cognitive dysfunction in Brazilian multiple sclerosis patients

Abstract: These three tests constitute a Brief Battery that represents a first Brazilian MS cognitive screening instrument. However, further validation study is necessary to achieve better normative scores in a larger sample and to establish feasibility of this battery.

Cited by 18 publications

References 45 publications

The prevalence of multiple sclerosis in Belo Horizonte, Brazil

The prevalence of multiple sclerosis in Belo Horizonte, Brazil

Avaliação das funções cognitivas de atenção, memória e percepção em pacientes com esclerose múltipla

A "Conceptual Nervous System" for multiple sclerosis.

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