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O presente artigo tem como objetivo analisar como as narrativas autobiográficas de sujeitos privados de liberdade podem protagonizar formas de resistência à colonialidade de poder, de saber e de ser. A narrativa trabalhada foi Diário de um Detento (2016), escrita por Jocenir Prado durante sua privação de liberdade no sistema prisional paulista nos anos 1990. Para refletir sobre as suas potencialidades de reescrita das histórias subalternizadas, o estudo baseia-se no pensamento decolonial, admitindo as histórias e saberes deslegitimados socialmente como essenciais à resistência à colonialidade e à constituição de saberes decoloniais. Para a análise, foi necessário contextualizar o sistema penitenciário brasileiro, as práticas de aprisionamento e os sujeitos que são mais afetados pelas lógicas coloniais de subalternização, marginalização e criminalização. Os resultados indicaram que as narrativas autobiográficas possibilitam a superação das visões assistencialistas e estigmatizantes, bem como promovem o reconhecimento e a humanização dos sujeitos em privação de liberdade.

Background: Social interaction is a lifestyle factor associated with a decreased risk of dementia in several studies. However, specific aspects of these social factors influencing dementia are unknown. This study aimed at evaluating the role of the distinct aspects of social support on the incidence of dementia in a community-based cohort of older people in Brazil. Methods: A total of 345 healthy and independent elderly subjects living in the community were followed by 12 years. Incident cases of dementia and probable Alzheimer's disease were defined by DSM-IV criteria and NINCDS-ADRDA criteria, respectively. Social variables evaluated were marital status, living arrangement, living children, living sibling, confidant and attending recreational groups. Sex, age, education, Mini-Mental State Examination (MMSE) score, depressive symptoms and family income were entered as co-variates in a Cox proportional hazard model. Results: The absence of confidant was the only social variable associated to higher risk of developing dementia (HR = 5.31; p < 0.001), even after adjustment for age (HR = 1.08; p = 0.048) and baseline MMSE score (HR = 0.79; p = 0.002). Conclusions: Our data suggest that to have a confidant could be an important lifestyle factor associated with dementia.

The aging of the population is a worldwide phenomenon, where 60% of elders live in developing areas of the world such as Brazil, regions in which few studies have been carried out. Objectives: The goal of this study was to evaluate the clinical and demographic profile of patients with dementing disorders seen at a specialized outpatient clinic in South Brazil. Methods: A sample of 105 demented patients seen at the Dementia Outpatient Clinic from Hospital de Clínicas de Porto Alegre (HCPA), Brazil between June 2004 and June 2008. Evaluation of patients consisted of medical history, cognitive testing, assessment of functional status (Activities of Daily Living Scale - ADL; Instrumental Activities Daily Living - IADL) and application of the Neuropsychiatry Inventory (NPI) for behavioral symptoms. Severity of dementia was evaluated based on the CDR scale. All patients underwent laboratory screening tests and brain imaging exams to define etiology of dementia. Results: Of the whole sample, 71% were female. Age was 79±8 years (mean±SD). Educational level was 4±3 years (mean±SD). Sixty-four patients (60%) presented the diagnosis of Alzheimer's disease. Of the whole sample, 26.7% were classified as CDR=1, 44% as CDR=2 and 29. 3% as CDR=3. A significant difference on the Mini Mental State Examination (MMSE) and functional status scores was observed among the CDR categories (severity). No significant association was found between severity and impairment on memory tests and behavioral symptoms. Conclusions: Alzheimer's disease was the most common etiology, followed by vascular dementia. At diagnosis, most patients presented mild to moderate severity of dementia, independent of cause. Resumo O envelhecimento da população é um fenômeno mundial, 60% destas pessoas moram em áreas em desenvolvimento do mundo, como no Brasil, onde poucos estudos têm sido conduzidos. Objetivos: O objetivo deste estudo é avaliar o perfil clínico e demográfico de pacientes com demência vistos em uma clínica especializada em demência do Hospital de Clínicas de Porto Alegre (HCPA), Brasil, durante o período de junho de 2004 a junho de 2008. A avaliação dos pacientes consistiu de história médica, testes cognitivos, avaliação do estado funcional (Atividades de vida diária - AVD; atividades instrumentais de vida diária - AIVD) e Inventário Neuropsiquiátrico (INP) para avaliação comportamental. A gravidade da demência foi avaliada com a escala CDR. Todos os pacientes realizaram testes laboratoriais de rastreio e exames de imagem para definir a etiologia da demência. Resultados: Da amostra 71% eram mulheres; idade de 79±8 anos (média±DP) e escolaridade de 4±3 anos. Sessenta e quatro pacientes (60%) apresentavam diagnóstico de doença de Alzheimer; dentro da amostra 26.7% foram classificados como CDR=1; 44% como CDR=2 e 3% como CDR=3. Uma diferença significativa nos escores do MMSE e nos escores funcionais foi observada entre as categorias de CDR (gravidade). Não houve associação significativa entre gravidade e comprometimento nos testes de memória e sintomas comportamentais. Conclusões: Doença de Alzheimer foi a etiologia mais comum, e a seguir demência vascular. No diagnóstico, a maioria dos pacientes apresentou gravidade da demência de grau leve a moderado, independente da causa.

Caregiver burden is common in Alzheimer's disease (AD), decreasing the quality of life among caregivers and patients. Projections of aging and aging-related diseases such as AD in developing countries justify additional data about this issue because people living in these countries have shown similarly high levels of caregiver strain as in the developed world. Objective: The aim of this study was to analyze the association of AD caregivers' burden with patients' neuropsychiatric symptoms (NPS), cognitive status, severity of dementia, functional capacity, caregiver sociodemographic characteristics, and the characteristics of care provided by caregivers. Methods: A cross-sectional study was conducted in a sample of 39 consecutive AD patients and their primary caregivers. NPS were evaluated using the Neuropsychiatric Inventory (NPI). Severity of dementia was assessed with the Clinical Dementia Rating (CDR) scale. Functional capacity was assessed using the Katz and Lawton scales. The burden level was rated using the Burden Interview (BI). Sociodemographic characteristics of caregivers and the characteristics of care provided by them were evaluated. The Mann-Whitney U-test, Kruskal-Wallis test and Spearman's rho coefficient were performed. Results: The BI had a moderate correlation with NPI intensity (rho=0.563), p

The definition of successful aging and identification of predictors have been extensively reviewed, less attention however, has been given to the role of this condition on mortality. Objective: To evaluate the effect of aging status (normal or successful) on mortality in a South Brazilian population-based cohort, adjusted for sociodemographic and clinical variables, and to report the mortality rate and causes of death in this population. Methods: The baseline sample comprised 345 community-dwelling, independent and healthy Southern Brazilian older individuals who were followed for 12 years. Clinical, socio-demographic, functional and cognitive variables were assessed at baseline and during the follow-up. At baseline, 214 participants fulfilled criteria for successful aging, and 131 for normal aging. The main outcome was death. Results: The Cox regression model showed an increased risk for mortality in subjects with normal aging (HR=1.9; p=0.003) adjusted by age (HR=1.1; p

The aging of the population is a universal phenomenon with direct consequences upon the public health system. One of the main repercussions of the growth in this sector of the population is the increased prevalence of disorders such as dementia and depression which are very frequent among the elderly. The relationship between cardiovascular risk factors, dementia and depression have been addressed in many recent investigations. Objectives: To evaluate the relationship of cognitive performance and depressive symptoms with cardiovascular risk in the elderly. Methods: 94 high cardiovascular risk elderly patients and 160 healthy community elderly were evaluated cross-sectionally. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used as the main measures. The cutoff for presence of depression was 6 on the GDS. Results: The high cardiovascular risk elderly group showed significantly lower scores on the MMSE (p

The NPI-Q (Neuropsychiatry Inventory-Questionnaire) was developed to facilitate the evaluation of neuropsychiatric symptoms. This study evaluated the internal consistency, the test-retest reliability of the Brazilian NPI-Q version and its convergent validity with the original NPI. Method The NPI-Q and the NPI were administered to 64 caregivers of dementia patients. Thirteen informants were asked to complete a second NPI-Q form. Results The internal consistency of the Brazilian NPI-Q version was 0.67 for the severity scale and 0.81 for the distress scale. The test-retest reliability of the total NPI-Q severity and the distress scales were 0.97 and 0.92, respectively (p < 0.001). There were significant correlations between the total NPI-Q severity score and the NPI (r = 0.75) and between the total NPI-Q distress score and the total NPI standard distress (r = 0.74). Conclusion The Brazilian NPI-Q version showed evidence of good psychometric properties and can be used in general clinical practice.

A review of the evidence on cognitive, functional and behavioral assessment for the diagnosis of dementia due to Alzheimer's disease (AD) is presented with revision and broadening of the recommendations on the use of tests and batteries in Brazil for the diagnosis of dementia due to AD. A systematic review of the literature (MEDLINE, LILACS and SCIELO database) was carried out by a panel of experts. Studies on the validation and/or adaptation of tests, scales and batteries for the Brazilian population were analyzed and classified according to level of evidence. There were sufficient data to recommend the IQCODE, DAFS-R, DAD, ADL-Q and Bayer scale for the evaluation of instrumental activities of daily living, and the Katz scale for the assessment of basic activities of daily living. For the evaluation of neuropsychiatric symptoms, the Neuropsychiatric Inventory (NPI) and the CAMDEX were found to be useful, as was the Cornell scale for depression in dementia. The Mini-Mental State Examination has clinical utility as a screening test, as do the multifunctional batteries (CAMCOG-R, ADAS-COG, CERAD and MDRS) for brief evaluations of several cognitive domains. There was sufficient evidence to recommend the CDR scale for clinical and severity assessment of dementia. Tests for Brazilian Portuguese are recommended by cognitive domain based on available data. Resumo Este artigo apresenta revisão e ampliação das recomendações sobre os testes e baterias empregados no Brasil para o diagnóstico e avaliação cognitiva, funcional e comportamental da demência na doença de Alzheimer (DA). De modo sistemático foi revista a literatura disponível (nas bases MEDLINE, LILACS e SCIELO) e os artigos foram avaliados e classificados por níveis de evidência, para se estabelecerem as recomendações. Para a avaliação funcional a recomendação é o uso das escalas IQCODE, DAFS-R, DAD, ADL-Q e Bayer para avaliação das atividades instrumentais da vida diária e escala Katz para avaliação das atividades básicas. Para avaliação dos sintomas neuropsiquiátricos foram recomendadas as escalas NPI e CAMDEX e a Cornell para depressão em demência. Como instrumento de rastreio deve-se utilizar o Mini-Exame do Estado Mental; quanto às baterias multifuncionais, pode-se aplicar CAMCOG-R, ADAS-COG, CERAD e MDRS, que avaliam brevemente várias funções cognitivas. Para avaliação clínica da demência e classificação de acordo com a gravidade é recomendada a escala CDR. São recomendados os testes por domínio cognitivo baseados nas evidências disponíveis para uso na nossa língua.

Financial constraints, mobility issues, medical conditions, crime in local areas can make cognitive assessment difficult for elders and telephone interviews can be a good alternative. This study was carried out to evaluate the reliability, validity and clinical utility of a Brazilian telephone version of the Mini Mental State Examination (Braztel-MMSE) in a community sample of healthy elderly participants and AD patients. The MMSE and the Braztel-MMSE were applied to 66 AD patients and 67 healthy elderly participants. The test-retest reliability was strong and significant (r = .92, p = .01), and the correlation between the Braztel-MMSE and the MMSE were significant (p = .01) and strong (r = .92). The general screening ability of the Braztel-MMSE was high (AUC = 0.982; CI95% = 0.964-1.001). This telephone version can therefore be used as a screening measure for dementia in older adults that need neuropsychological screening and cannot present for an evaluation.

and to assess the influence of other variables such as gender, age, education, manual activities and reading habits in this sample. Methods: The sample consisted of 520 individuals of both sexes from three different health care institutions (School Hospital, Center for Living and Unit-Family Health). All participants received a questionnaire and the standard Mini Mental State Examination (MMSE), which is an auxiliary method of treatment of possible cognitive deficits in individuals at risk, such as the elderly. The cutoff used was 13 points for illiterates, 18 for primary and secondary education and 26 for high school graduates (Bertolucci, 1994). Results: The mean age was 66.3 years. The mean score of MMSE in the total sample was 24.8 points.19.6% of the total sample had scores suggestive of dementia, with similar distribution between the sexes. Frequency of manual activity and reading are inversely related to the frequency of cognitive impairment. Conclusions: It was observed that the prevalence rates suggesting dementia were lower in the Center for Living, which may be correlated with the frequent practice of physical and social activities, and possibly greater interpersonal contact. Individuals from the primary unit and tertiary care displayed similar prevalence.

The objective of the study was to evaluate incident cases of Alzheimer disease (AD) and mild cognitive impairment (MCI) in an elderly community cohort in a major city of southern Brazil and to determine the variables associated with the development of cognitive dysfunction. Data were drawn from a cohort to investigate healthy aging among community elderly (N = 345) and were derived from the follow-up for a maximum of 8 years. Sociodemographic, psychiatric and medical information, the Mini-Mental State Examination (MMSE), and the Clinical Dementia Rating scale were obtained in each assessment. The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition; DSM-IV), NINCDS-ADRDA (National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and related Disorders Association), and the Mayo Clinic criteria were applied to ascertain diagnoses of AD and MCI. The incidence rate per 1000 persons-year for MCI was 13.2 (95% confidence interval [CI] 7.79-20.91) and for AD was 14.8 (95% CI 9.04-22.94). Cognitive dysfunction was associated with education (odds ratio [OR] = 0.86; confidence limit [CL] 0.76-0.97 95%) and baseline MMSE (OR = 0.81; CL 0.70-0.94 95%). The AD incidence in this sample was higher than those reported in a previous Brazilian study. The study filled the epidemiological gap in the evaluation of MCI in Brazil.

The aim of this study was to determine the diagnostic value and agreement analyses between Clinical Dementia Rating (CDR) and dementia diagnostic criteria (gold standard), Blessed Dementia Rating scale (BDRS), and Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM III-R) criteria for severity. In a sample of 343 Southern Brazilian participants, CDR was consecutively assessed in 295 dementia patients (Alzheimer disease, vascular dementia, and questionable) and 48 healthy elderly. The National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable Alzheimer disease and the National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS-AIREN) for probable vascular dementia were the gold standard. A battery of cognitive tests and the Mini Mental State Examination (as a screening test at study entry) were also applied. Sensitivity and specificity were obtained through contingency tables. Validity and reliability were measured through kappa coefficient, Kendall b, and percent agreement. CDR agreement among raters was demonstrated by percent agreement. Agreement to gold standard was good (kappa=0.75), as well as to the Blessed scale (kappa=0.73), and excellent to the DSM III-R (kappa=0.78). CDR detection of dementia among healthy elderly or questionable dementia was 86% and 80% sensitive, respectively, and 100% specific for both settings. In conclusion, agreement of CDR global score with the gold standard was good, and diagnostic values were high.

Objetivo: Avaliar a concordância da escala CDR com critérios diagnósticos e mini exame do estado mental (MEEM), e correlação com escala de Blessed, numa amostra de pacientes do sul do Brasil. Método: A escala foi avaliada em 269 pacientes com doença de Alzheimer (DA), demência vascular e demência questionável num desenho transversal. Os critérios do NINCDS-ADRDA para provável DA e NINDS-AIREN para p rovável demência vascular foram os padrões-ouro. O MEEM, a escala Blessed para gravidade da demência, o escore isquêmico de Hachinski, e uma bateria de testes cognitivos também foram aplicados. Resultados: A concordância com o padrão-ouro foi boa (kappa=0,73), e com o MEEM em categorias foi moderada (kappa= 0,53). Observou-se correlação significativa da escala CDR com Blessed (r=0,96; p=0,001). Não se observ o u d i f e rença de escolaridade ou de idade entre as categorias da escala CDR. Conclusão: A concordância da CDR foi boa para os critérios diagnósticos e moderada para o MEEM. A escala mostrou validade de construto para gravidade de demência. Não se observou impacto da escolaridade sobre este instrumento. Objective: The objective of the study was the analysis of agreement between the CDR scale with diagnostic criteria and mini mental state examination (MMSE), as well as correlation with Blessed scale, in a sample of Southern Brazilian patients. Method: The CDR scale was cross-sectionaly evaluated in 269 dementia patients Alzheimer’s disease (AD) vascular dementia, and questionable. The NINCDSADRDA criteria for probable AD and the NINDS-AIREN for probable vascular dementia were the gold standard. The MMSE, the Blessed scale, the Hachinski ischemic score, and a battery of cognitive tests were also applied. Results: The agreement to gold standard was good (kappa=0.73), while to MMSE categorized was moderate (kappa=0.53). A significant correlation with the Blessed scale (r=0.96; p=0.001) was observed. Education and age were similar among CDR categories. Conclusion: The global score agreement of the CDR scale with the gold standard was good, and with the MMSE was moderate. We also observed face validity for dementia severity. No impact of education was observed upon CDR global scores.

Memory and other cognitive complaints are common in the elderly population. However, the clinical meaning of these complaints remains controversial. Objectives: The goal of this study was to investigate the association between cognitive complaints and performance on a mental state screening test in elderly patients attended for the first time at the Neurogeriatric and Dementia (NGA) Outpatient Clinic within a major University hospital. Methods: Two hundred patients referred to the NGA Clinic during 2005, 2006 and 2007 first semesters participated in the study. The variables of interest were: (a) source of and reason for referral; (b) whether or not they had previously been evaluated with the screening test (Mini Mental State Exam - MMSE) by their physicians before referral to our specialized clinic; (c) cognitive complaints; and (d) performance on the screening test (MMSE) at the NGA Clinic. Results: The main reason for referral to the NGA clinic was cognitive complaints 63% (N=126), where only 5% (N=10) of the referred patients had been previously evaluated by the cognitive screening test (MMSE or equivalent). Of the 135 patients who presented cognitive complaints during the first appointment, 52 (38%) presented MMSE scores below the education-adjusted cut-off. No association between cognitive complaint and performance on the MMSE during the first evaluation at the NGA Clinic was observed (c²=3.04, p=0.1). Conclusions: Although cognitive complaints among elders should not be disregarded, the mental state screening evaluation is crucial for the detection of clinically significant cognitive impairment. Resumo Memória e outras queixas cognitivas são comuns na população idosa. No entanto, o significado clínico destas queixas permanece controverso. Objetivo: O objetivo deste estudo foi investigar a associação entre queixa cognitiva e desempenho em um teste de rastreio do estado mental em pacientes idosos que consultavam pela primeira vez no Ambulatório de Neurogeriatria e Demência (NGA) de um grande hospital universitário. Métodos: Duzentos pacientes que foram encaminhados ao Ambulatório de Neurogeriatria durante os primeiros semestres de 2005, 2006 e 2007 participaram do estudo. As variáveis de interesse foram: (a) fonte e razão do encaminhamento; (b) existência de avaliação, com um teste de rastreio (Mini Exame do Estado Mental - MEEM), pelos seus médicos assistentes prévia ao encaminhamento ao NGA; (c) queixa cognitiva na consulta do NGA, e (d) desempenho no teste de rastreio (MEEM) no Ambulatório NGA. Resultados: O principal motivo de encaminhamento ao ambulatório de NGA foi queixa cognitiva 63% (N=126), somente 5% (N=10) dos pacientes encaminhados foram submetidos a algum teste de rastreio cognitivo prévio (MEEM ou equivalente). Dos 135 pacientes com queixa cognitiva durante a primeira avaliação, 52 (38%) apresentavam escores do MEEM abaixo do ponto de corte, ajustados para escolaridade. Nenhuma associação entre queixa cognitiva e desempenho no MEEM durante a primeira avaliação no ambulatório de NGA foi observada (c²=3.04, p=0.1). Conclusões: Embora, queixas cognitivas entre idosos não devem ser ignoradas, avaliação, através de rastreio do estado mental, é crucial para detecção de comprometimento cognitivo clinicamente significativo.

Until better measures have been accepted for wider use, the Mini-Mental State Examination (MMSE) will continue to be utilized. In this context, knowledge on characteristics and determinants of its distribution for the Brazilian population are particularly valuable. The present study aimed to evaluate, based on multivariate analysis, the independent effect of age, educational level and sex, and their interactions, on MMSE scores in a healthy sample. Methods: Demographic data and scores on the MMSE of 1,553 healthy individuals were analyzed. The sample was grouped according to age and education. Results: The sample was composed of 963 females (62%), mean age ±SD was 49.6±20.7 yrs (range 20 to 92 yrs). The mean years of education ±SD was 8.9±5.5 yrs (range 0 to 28 yrs). The mean score ±SD on the MMSE was 27.3±2.7 (range 15 to 30). A significant effect of the interaction between education and sex (p=0.011), and also between education and age was observed (p=0.003). An independent effect of education (p