Browsing by Author "Alves, Luísa"
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- Amyloid-negative, neurodegeneration-negative amnestic mild cognitive impairmentPublication . Cardoso, Sandra; Guerreiro, Manuela; Montalvo, Alexandre; Silva, Dina; Alves, Luísa; Mendonça, Alexandre deBackground:The concept of amnestic mild cognitive impairment (aMCI) was developed to identify patients at an initial stage of Alzheimer's disease (AD). However, some patients with aMCI do not present biomarkers of amyloid pathology or neuronal injury.Objective:To know the natural history of amyloid-negative and neurodegeneration-negative patients with aMCI, namely to ascertain: 1) whether these patients remain cognitively stable or they present a slow decline in neuropsychological tests; 2) whether the memory complaints subside with the apparently benign clinical course of the disorder or if they persist along the time.Methods:Patients who fulfilled criteria for aMCI with no biomarkers of amyloid pathology or neuronal injury were selected from a large cohort of non-demented patients with cognitive complaints, and were followed with clinical and neuropsychological assessments.Results:Twenty-one amyloid-negative and neurodegeneration-negative aMCI patients were followed for 7.1 +/- 3.7 years. At the baseline they had more pronounced deficits in verbal learning (California Verbal Learning Test) and were also impaired in Word Recall and Logical Memory. However, they did not decline in any cognitive test during follow-up. The patients maintained a high level of subjective memory complaints from baseline (9.7 +/- 4.1) to the follow-up visit (9.2 +/- 4.1, a non-significant difference), in spite of a statistically significant decrease in the depressive symptoms, with Geriatric Depression Scale (15 items) score 4.9 +/- 2.8 at baseline and 3.2 +/- 1.8 at the follow-up visit. Conclusions: Amyloid-negative, neurodegeneration-negative aMCI is a chronic clinical condition characterized by the long-term persistence of cognitive deficits and distressing memory complaints. Adequate strategies to treat this condition are needed.
- Long-term predictive accuracy of the ‘mild cognitive impairment due to Alzheimer's disease’ criteriaPublication . Cardoso, Sandra; Montalvo, Alexandre; Maroco, João; Silva, Dina; Alves, Luísa; Guerreiro, Manuela; Mendonça, Alexandre deBackground: The development and clinical use of biomarkers has dramatically changed the framework of Alzheimer’s disease (AD) management, allowing the diagnosis at the mild cognitive impairment (MCI) stage. In 2015 we compared the prevalence and prognosis of AD at the MCI stage according to different criteria available at that time, and we found that the National Institute of Aging-Alzheimer Association (NIA-AA) criteria provided higher predictive accuracy for AD dementia after 3 years. Since then, we adopted these criteria in clinical practice. Objective: To evaluate the long-term predictive accuracy of the ‘MCI due to AD - high likelihood’ criteria by taking advantage from an extended follow-up in a memory clinic setting. Methods: Patients were diagnosed according to the ‘MCI due to AD - high likelihood’ criteria and followed up until conversion to dementia. Results: One hundred and fourteen patients with ‘MCI due to AD - high likelihood’ were enrolled in the study and followed-up for 3.0±1.8 [0.4–8.3] years. During the follow-up 106 (93.0%) patients progressed to dementia, 2 (1.8%) had stroke, 6 (5.3%) died, and none remained in MCI or reverted to normal cognitive status. The average survival time remaining in MCI, analyzed with Kaplan-Meier curve, was 3.2 (95% CI 2.9–3.6) years. Using a multivariate Cox proportional hazards regression model, patients with higher Mini-Mental State Examination kept the MCI status longer. Conclusions: The diagnostic criteria of NIA-AA ‘MCI due to AD - high likelihood’ have an excellent long-term predictive accuracy in a memory clinic setting.
- Memory awareness in patients with Major Depressive DisorderPublication . Mendes, Tiago; Cardoso, Sandra; Guerreiro, Manuela; Maroco, João; Silva, Dina; Alves, Luísa; Schmand, Ben; Simões do Couto, Frederico; Figueira, Maria Luísa; de Mendonça, AlexandreBackground: Subjective Memory Complaints (SMC) along with cognitive deficits are frequently observed in patients with Major Depressive Disorder (MDD). The relationship between SMC and objective memory performance in patients with MDD was evaluated, in comparison with patients with Mild Cognitive Impairment due to Alzheimer’s Disease (MCI-AD) and healthy controls (HC). Methods: Patients with MDD (n = 47), MCI-AD (n = 43) and HC (n = 45) were assessed with a self-report memory complaints scale (SMCS) and underwent a comprehensive clinical and neuropsychological assessment. A discrepancy score between the Logical Memory delayed recall and the SMCS total score was calculated as a measure of memory awareness. Results: Patients with MDD (12.5 ± 4.4) and patients with MCI-AD (10.9 ± 4.1) had not significantly different SMCS total scores, whereas HC showed significantly lower scores (4.0 ± 3.0). As much as 74.5% of patients with MDD patients and 65.1% of patients with MCI-AD reported prominent memory complaints, whereas only 4.4% of HC did. Patients with MDD had relatively preserved memory tests, resulting in a higher discrepancy score than both patients with MCI-AD and HC. The SMCS total score correlated positively with depressive symptoms in the 3 groups of participants. Conclusions: Patients with MDD showed inaccurate memory self-awareness as they under-estimated their memory functioning, a pattern distinct from both patients with MCI-AD and HC.