DANIEL APOLINARIO
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- Effects of a Non-focal Plasticity Protocol on Apathy in Moderate Alzheimer's Disease: A Randomized, Double-blind, Sham-controlled Trial(2014) SUEMOTO, Claudia Kimie; APOLINARIO, Daniel; NAKAMURA-PALACIOS, Ester Miyuki; LOPES, Leonardo; LEITE, Renata Elaine Paraizo; SALES, Manuela Castro; NITRINI, Ricardo; BRUCKI, Sonia Maria; MORILLO, Lilian Shafirovitz; MAGALDI, Regina Miksian; FREGNI, FelipeBackground: Apathy is the most common neuropsychiatric symptom in Alzheimer's disease (AD) and it is associated with changes in prefrontal neural circuits involved with generation of voluntary actions. To date no effective treatment for apathy has been demonstrated. Objective: We aimed to investigate the effects and safety of repetitive transcranial direct current stimulation (tDCS) on apathy in moderate AD patients. Methods: Forty patients were randomized to receive either active or sham-tDCS over the left dorsolateral prefrontal cortex (DLPFC). Patients received six sessions of intervention during 2 weeks and were evaluated at baseline, at week 1 and 2, and after 1 week without intervention. Clinical raters, patients, and caregivers were blinded. The primary outcome was apathy. Global cognition and neuropsychiatric symptoms were examined as secondary outcomes. Results: The mean MMSE score at baseline was 15.2 +/- 2.9 and the mean Apathy Scale score was 27.7 +/- 6.7. Changes on apathy scores over time were not different between active and sham tDCS (P = 0.552 for repeated measures). Further analyses confirm that changes from baseline did not differ between groups after the sixth session (active tDCS -1.95 (95%CI -3.49, -0.41); sham-tDCS -2.05 (95% Cl -3.68, 0.42); P = 0.9891. Similarly, tDCS had no effect on secondary outcomes (P > 0.40). tDCS was well tolerated and not associated with significant adverse effects. Conclusion: In this adequately powered study for minimal clinically significant difference, our findings show that using the parameters we chose for this study, repeated anodal tDCS over the left DLPFC had no effect on apathy in elderly patients with moderate AD.
- LEARNING TO READ IN OLDER AGE IMPROVES COGNITIVE PERFORMANCE: FINDINGS FROM A PROSPECTIVE OBSERVATIONAL STUDY(2014) SILVA, Eduardo Marques da; APOLINARIO, Daniel; MAGALDI, Regina Miksian; BENNETT, David A.; NITRINI, Ricardo; JACOB FILHO, Wilson; FARFEL, Jose Marcelo
- Functional health literacy and glycaemic control in older adults with type 2 diabetes: a cross-sectional study(2014) SOUZA, Jonas Gordilho; APOLINARIO, Daniel; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; CAMPORA, Flavia; JACOB-FILHO, WilsonObjectives To investigate the relationship between functional health literacy and glycaemic control in a sample of older patients with type 2 diabetes. Design Cross-sectional study. Setting A government-financed outpatient geriatric clinic in SAo Paulo, Brazil. Participants 129 older patients with type 2 diabetes, a mean (SD) age of 75.9 (6.2) years, a mean glycosylated haemoglobin (HbA1c) of 7.2% (1.4), of which 14.7% had no formal education and 82.9% had less than a high-school diploma. Measures HbA1c was used as a measure of glycaemic control. Functional health literacy was assessed with the 18-item Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18), a validated instrument to evaluate pronunciation and comprehension of commonly used medical terms. Regression models were controlled for demographic data, depressive symptoms, diabetes duration, treatment regimen, diabetes knowledge and assistance for taking medications. Results Functional health literacy below adequate was encountered in 56.6% of the sample. After controlling for potential confounding factors, patients with inadequate functional health literacy were more likely than patients with adequate functional health literacy to present poor glycaemic control (OR=4.76; 95% CI 1.36 to 16.63). In a fully adjusted linear regression model, lower functional health literacy (=-0.42; p<0.001), longer diabetes duration (=0.24; p=0.012) and lack of assistance for taking medications (=0.23; p=0.014) were associated with higher levels of HbA1c. Contrary to our expectations, illiterate patients did not have poorer outcomes when compared with patients with adequate functional health literacy, raising the hypothesis that illiterate individuals are more likely to have their difficulties recognised and compensated. However, the small subsample of illiterate patients provided limited power to reject differences with small magnitude. Conclusions Patients with inadequate functional health literacy presented with higher odds of poor glycaemic control. These findings reinforce the importance of addressing limited functional health literacy in clinical practice.
- Detecting limited health literacy in Brazil: development of a multidimensional screening tool(2014) APOLINARIO, Daniel; MANSUR, Leticia Lessa; CARTHERY-GOULART, Maria Teresa; BRUCKI, Sonia Maria Dozzi; NITRINI, RicardoScreening questions have been proposed as practical tools for detecting limited functional health literacy, but have achieved only moderate accuracy in previous studies. We hypothesized that a combination of screening questions and demographic characteristics could better predict a patients functional health literacy. Three hundred and twenty-two hospital users from So Paulo, Brazil, were interviewed for demographic information and answered questions about literacy habits and perceived difficulties. The Short Test of Functional Health Literacy in Adults was used to classify individuals as having adequate or limited functional health literacy. Of the 322 participants, 102 (31.7) presented limited functional health literacy. The final logistic model included six predictors. The three demographic variables were educational attainment, mothers educational attainment and major lifetime occupation (manual or non-manual). The three questions concerned frequency of use of computers, difficulty with writing that have precluded the individual from getting a better job and difficulty reading the subtitles while watching a foreign movie. A simple score was derived to constitute a practical tool we named the Multidimensional Screener of Functional Health Literacy (MSFHL). The sensitivity of the MSFHL in detecting limited functional health literacy was 81.4 and the specificity was 87.7, with an area under receiver operating characteristic (ROC) curve of 0.93 (95 CI 0.890.95). The MSFHL was better than educational attainment in accurately classifying functional health literacy status (p 0.0018). We have developed a screening tool based on three demographic characteristics and three simple questions which provides an accurate prediction of a patients functional health literacy level.
- CAN WE EXCLUDE DEMENTIA IN OLDER ADULTS WITH SUSPECTED COGNITIVE IMPAIRMENT WHO ATTEND THE CLINICAL ENCOUNTER ALONE?(2014) APOLINARIO, Daniel; SOARES, Aline Thomaz; MAGALDI, Regina Miksian; BUSSE, Alexandre Leopold; BARRETTO-FILHO, Antonio Carlos Pereira; JACOB-FILHO, Wilson