ORESTES VICENTE FORLENZA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment(2013) MEMORIA, Claudia M.; YASSUDA, Monica S.; NAKANO, Eduardo Y.; FORLENZA, Orestes V.Background The Montreal Cognitive Assessment (MoCA) is a brief cognitive schedule that has been developed for the screening of patients with Mild Cognitive Impairment (MCI). MCI is recognized as a high-risk state for Alzheimer's disease. The aim of the present study is to examine the reliability and validity of the Brazilian version of the MoCA test (MoCA-BR) in a sample of older individuals with at least 4?years of education. Methods The MoCA-BR was administered to 112 older adults who were classified into three diagnostic groups according to their cognitive state (Alzheimer's disease, n?=?28; MCI, n?=?43; normal controls, n?=?41). This procedure was based on clinical and neuropsychological data. The performance in the MoCA-BR was compared with the Mini-mental state examination (MMSE) and the Cambridge Cognitive Examination. Diagnostic accuracy was examined with the receiver operating characteristic (ROC) curve analyses. Results Cronbach's alpha for the MoCA-BR was 0.75. Temporal stability (retesting after 3?months) using intraclass correlation coefficient was 0.75 (p?
- An intervention to reduce neuropsychiatric symptoms and caregiver burden in dementia: Preliminary results from a randomized trial of the tailored activity program-outpatient version(2019) OLIVEIRA, Alexandra Martini de; RADANOVIC, Marcia; MELLO, Patricia Cotting Homem de; BUCHAIN, Patricia Cardoso; VIZZOTTO, Adriana Dias; HARDER, Janaina; STELLA, Florindo; PIERSOL, Catherine Verrier; GITLIN, Laura N.; FORLENZA, Orestes VicenteObjective To evaluate the efficacy of the tailored activity program-outpatient version (TAP-O) and to reduce neuropsychiatric symptoms (NPS) in patients with dementia and caregiver burden compared with a control group (psychoeducation intervention). Methods Twenty-one persons with dementia and their caregivers were recruited and randomized. The intervention group received TAP-O, designed for outpatients with dementia and their caregivers. TAP-O consisted of eight sessions in which an occupational therapist assessed the patient's abilities and interests; prescribed tailored activities; and educated caregivers about dementia, NPS, and how to implement meaningful activities in the daily routine. The control group received eight sessions of a psychoeducation intervention about dementia and NPS. Results Compared with controls, patients receiving TAP-O had a significant decrease in hallucination (P = 0.04), agitation (P = 0.03), anxiety (P = 0.02), aggression (P = 0.01), sleep disorder (P = 0.02), aberrant motor behavior (P = 0.02), and in caregiver burden (P = 0.003). Conclusions Findings suggest that TAP-O may be an effective nonpharmacological strategy to reduce NPS of outpatients with dementia and to minimize caregiver burden.
- Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project(2024) SAJATOVIC, Martha; REJ, Soham; ALMEIDA, Osvaldo P.; ALTINBAS, Kursat; BALANZA-MARTINEZ, Vicent; BARBOSA, Izabela G.; BEUNDERS, Alexandra J. M.; BLUMBERG, Hilary P.; BRIGGS, Farren B. S.; DOLS, Annemiek; FORESTER, Brent P.; FORLENZA, Orestes V.; GILDENGERS, Ariel G.; JIMENEZ, Esther; KLAUS, Federica; LAFER, Beny; MULSANT, Benoit; MWANGI, Benson; NUNES, Paula Villela; OLAGUNJU, Andrew T.; OLUWANIYI, Stephen; ORHAN, Melis; PATRICK, Regan E.; RADUA, Joaquim; RAJJI, Tarek; SARNA, Kaylee; SCHOUWS, Sigfried; SIMHANDL, Christian; SEKHON, Harmehr; SOARES, Jair C.; SUTHERLAND, Ashley N.; TEIXEIRA, Antonio L.; TSAI, Shangying; VIDAL-RUBIO, Sonia; VIETA, Eduard; YALA, Joy; EYLER, Lisa T.Objectives: The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean +/- standard deviation age 47.2 +/- 13.5, 65% women, 49% aged over 50) dataset. Design/Methods: Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). Results: Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p <= 0.001, depression p <= 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. Conclusions: In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.
- Sociodemographic and clinical characteristics of people with oldest older age bipolar disorder in a global sample: Results from the global aging and geriatric experiments in bipolar disorder project(2024) CHEN, Peijun; SAJATOVIC, Martha; BRIGGS, Farren B. S.; MULSANT, Benoit; DOLS, Annemiek A.; GILDENGERS, Ariel; YALA, Joy; BEUNDERS, Alexandra J. M.; BLUMBERG, Hilary P.; REJ, Soham; FORLENZA, Orestes V.; JIMENEZ, Esther; SCHOUWS, Sigfried; ORHAN, Melis; SUTHERLAND, Ashley N.; VIETA, Eduard; TSAI, Shangying; SARNA, Kaylee; EYLER, Lisa T.Objects: Studies of older age bipolar disorder (OABD) have mostly focused on ""younger old"" individuals. Little is known about the oldest OABD (OOABD) individuals aged >= 70 years old. The Global Aging and Geriatric Experiments in Bipolar Disorder (GAGE-BD) project provides an opportunity to evaluate the OOABD group to understand their characteristics compared to younger groups. Methods: We conducted cross-sectional analyses of the GAGE-BD database, an integrated, harmonized dataset from 19 international studies. We compared the sociodemographic and clinical characteristics of those aged <50 (YABD, n = 184), 50-69 (OABD, n = 881), and >= 70 (OOABD, n = 304). To standardize the comparisons between age categories and all characteristics, we used multinomial logistic regression models with age category as the dependent variable, with each characteristic as the independent variable, and clustering of standard errors to account for the correlation between observations from each of the studies. Results: OOABD and OABD had lower severity of manic symptoms (Mean YMRS = 3.3, 3.8 respectively) than YABD (YMRS = 7.6), and lower depressive symptoms (% of absent = 65.4%, and 59.5% respectively) than YABD (18.3%). OOABD and OABD had higher physical burden than YABD, especially in the cardiovascular domain (prevalence = 65% in OOABD, 41% in OABD and 17% in YABD); OOABD had the highest prevalence (56%) in the musculoskeletal domain (significantly differed from 39% in OABD and 31% in YABD which didn't differ from each other). Overall, OOABD had significant cumulative physical burden in numbers of domains (mean = 4) compared to both OABD (mean = 2) and YABD (mean = 1). OOABD had the lowest rates of suicidal thoughts (10%), which significantly differed from YABD (26%) though didn't differ from OABD (21%). Functional status was higher in both OOABD (GAF = 63) and OABD (GAF = 64), though only OABD had significantly higher function than YABD (GAF = 59). Conclusions: OOABD have unique features, suggesting that (1) OOABD individuals may be easier to manage psychiatrically, but require more attention to comorbid physical conditions; (2) OOABD is a survivor cohort associated with resilience despite high medical burden, warranting both qualitative and quantitative methods to better understand how to advance clinical care and ways to age successfully with BD.
- Sensitivity and specificity of a briefer version of the Cambridge Cognitive Examination (CAMCog-Short) in the detection of cognitive decline in the elderly: An exploratory study(2018) RADANOVIC, Marcia; FACCO, Giuliana; FORLENZA, Orestes V.ObjectiveTo create a reduced and briefer version of the widely used Cambridge Cognitive Examination (CAMCog) battery as a concise cognitive test to be used in primary and secondary levels of health care to detect cognitive decline. Our aim was to reduce the administration time of the original test while maintaining its diagnostic accuracy. MethodsOn the basis of the analysis of 835 CAMCog tests performed by 429 subjects (107 controls, 192 mild cognitive impairment [MCI], and 130 dementia patients), we extracted items that most contributed to intergroup differentiation, according to 2 educational levels (8 and >8y of formal schooling). ResultsThe final 33-item low education and 24-itemhigh education CAMCog-Short correspond to 48.5% and 35% of the original version and yielded similar rates of accuracy: area under ROC curves (AUC)>0.9 in the differentiation between controlsxdementia and MCIxdementia (sensitivities>75%; specificities>90%); AUC>0.7 for the differentiation between controls and MCI (sensitivities>65%; specificities>75%). ConclusionsThe CAMCog-Short emerges as a promising tool for a brief, yet sufficiently accurate, screening tool for use in clinical settings. Further prospective studies designed to validate its diagnostic accuracy are needed.
- Caregiver report versus clinician impression: disagreements in rating neuropsychiatric symptoms in Alzheimer's disease patients(2015) STELLA, Florindo; FORLENZA, Orestes Vicente; LAKS, Jerson; ANDRADE, Larissa Pires de; CACAO, Joao de Castilho; GOVONE, Jose Silvio; MEDEIROS, Kate de; LYKETSOS, Constantine G.BackgroundThe measurement of neuropsychiatric symptoms (NPS) in dementia is often based on caregiver report. Challenges associated with providing care may bias the caregiver's recognition and reporting of symptoms. Given potential problems associated with caregiver report, clinicians may improve measurement by drawing from a wider array of available data and by applying clinical judgment. ObjectiveThe objective of this study is to evaluate potential disagreements between caregiver report and clinician impression when rating psychopathological manifestations from the same patient with dementia. MethodsThree hundred twelve participants (156 patients with Alzheimer's disease [AD] and 156 caregivers) were studied using the Neuropsychiatric Inventory-Clinician Rating Scale. We considered disagreement to be present when caregiver ratings were significantly higher or lower (p<0.05) than NPS ratings by clinicians of the same patient. To evaluate whether disagreements were related to dementia severity, we repeated comparisons across levels defined by the clinical dementia rating. ResultsThe most common disagreements involved ratings of agitation, depression, anxiety, apathy, irritability, and aberrant motor behavior especially in patients with mild dementia. There were fewer discrepancies in moderate or severe dementia. The most consistent disagreements involved global ratings of depression where caregiver scores ranged from +22.5 higher to -4.5 lower than clinician rating. ConclusionsCaregivers may have incomplete perception of patient NPS mainly in mild dementia. NPS ratings might be confounded by cultural beliefs, sometimes leading caregiver to interpret symptoms as part of normal aging.
- Noninvasive brain stimulation for behavioural and psychological symptoms of dementia: A systematic review and meta-analysis(2019) VACAS, Sara M.; STELLA, Florindo; LOUREIRO, Julia C.; COUTO, Frederico Simoes do; OLIVEIRA-MAIA, Albino J.; FORLENZA, Orestes V.Background Pharmacological and conventional nonpharmacological treatments for behavioural and psychological symptoms of dementia (BPSD) have only modest efficacy. Furthermore, pharmacotherapy carries the risk of important side effects. Noninvasive brain stimulation (repetitive transcranial magnetic stimulation (TMS) or transcranial direct current stimulation (tDCS)) are valuable and safe for cognitive function in Alzheimer disease (AD). However, there have been few studies, and there is no consensus, regarding the use of these techniques to treat BPSD. Methods We performed a systematic review of the literature and meta-analysis of studies reporting the effect of rTMS or tDCS on BPSD. Results Seven articles were included: five randomized, controlled clinical trials and two open-label clinical trials. Five studies investigated the effects of rTMS and two the effects of tDCS. Both studies using tDCS reported no evidence of efficacy on BPSD, while two of the three RCTs using rTMS found statistically significant benefits. In an exploratory meta-analysis with four of the RCT studies, we did not find evidence of efficacy of noninvasive brain stimulation techniques, with an overall effect of -0.02 (95% CI = -0.90, 0.94; I-2 = 85%). However, when we used only the data from the studies that applied rTMS, we found a positive effect on BPSD, with an overall effect of -0.58 (95% CI = -1.02, -0.14; I-2 = 0%). With regards to the adverse effects reported, these were mild and not clinically relevant. Conclusions Our results establish a tendency for efficacy of rTMS protocols on BPSD, while corroborating their safety and tolerability, suggesting the need for further research.
- Clinical correlates of late-onset versus early-onset bipolar disorder in a global sample of older adults(2022) LAVIN, Paola; BUCK, Gabriella; ALMEIDA, Osvaldo P.; SU, Chien-Lin; EYLER, Lisa T.; DOLS, Annemieke; BLUMBERG, Hilary P.; FORESTER, Brent P.; V, Orestes Forlenza; GILDENGERS, Ariel; MULSANT, Benoit H.; TSAI, Shang-Ying; VIETA, Eduard; SCHOUWS, Sigfried; BRIGGS, Farren B. S.; SUTHERLAND, Ashley; SARNA, Kaylee; YALA, Joy; ORHAN, Melis; KORTEN, Nicole; SAJATOVIC, Martha; REJ, SohamObjectives: Late-onset bipolar disorder (LOBD) represents a significant subgroup of bipolar disorder (BD). However, knowledge for this group is mostly extrapolated from small studies in subjects with early/mixed age of illness onset. In this global sample of older adults with BD (OABD: >= 50 years old) we aim to characterize the sociodemographic and clinical presentation of LOBD (>= 40 years at BD onset) compared to early-onset BD (EOBD: <40 years at BD onset). Methods: The Global Aging and Geriatric Experiments in Bipolar Disorder consortium provided international data on 437 older age bipolar disorder participants. We compared LOBD versus EOBD on depression, mania, functionality, and physical comorbidities. Exploratory analyses were performed on participants with BD onset >= 50 years old. Results: LOBD (n = 105) did not differ from EOBD (n = 332) on depression, mania, global functioning, nor employment status (p > 0.05). Late-onset bipolar disorder was associated with higher endocrine comorbidities (odds ratio = 1.48, [95%CI = 1.0,12.1], p = 0.03). This difference did not remain significant when subjects with BD onset >= 50 years old were analyzed. Limitations: This study is limited by the retrospective nature of the variable age of onset and the differences in evaluation methods across studies (partially overcame by harmonization processes). Conclusion: The present analysis is in favor of the hypothesis that LOBD might represent a similar clinical phenotype as classic EOBD with respect to core BD symptomatology, functionality, and comorbid physical conditions. Large-scale global collaboration to improve our understanding of BD across the lifespan is needed.
- Optimizing the CAMCOG test in the screening for mild cognitive impairment and incipient dementia: saving time with relevant domains(2011) APRAHAMIAN, Ivan; DINIZ, Breno Satler; IZBICKI, Rafael; RADANOVIC, Marcia; NUNES, Paula Villela; FORLENZA, Orestes VicenteObjective: To identify the CAMCOG sub-items that best contribute for the identification of patients with mild cognitive impairment (MCI) and incipient Alzheimer's disease (AD) in clinical practice. Methods: Cross-sectional assessment of 272 older adults (98 MCI, 82 AD, and 92 controls) with a standardized neuropsychological battery and the CAMCOG schedule. Backward logistic regression analysis with diagnosis (MCI and controls) as dependent variable and the sub-items of the CAMCOG as independent variable was carried out to determine the CAMCOG sub-items that predicted the diagnosis of MCI. Results: Lower scores on Language, Memory, Praxis, and Calculation CAMCOG sub-items were significantly associated with the diagnosis of MCI. A composite score obtained by the sum of these scores significantly discriminated MCI patients from comparison groups. This reduced version of the CAMCOG showed similar diagnostic accuracy than the original schedule for the identification of patients with MCI as compared to controls (AUC = 0.80 +/- 0.03 for the reduced CAMCOG; AUC = 0.79 +/- 0.03 for the original CAMCOG). Conclusion: This reduced version of the CAMCOG had similar diagnostic properties as the original CAMCOG and was faster and easier to administer, rendering it more suitable for the screening of subtle cognitive deficits in general clinical practice.