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Biography

He graduated in Medicine at the State University of Campinas, degree in Psychology from the Catholic University of Campinas, Masters in Health Psychology from the State University of Campinas, doctorate in psychiatry at the State University of Campinas and doctorate in Neurology at the University of Campinas. Stages in the aera of Geriatric Neuropsychiatry at McGill University of Montreal, Canada. He is currently a Full Professor at the Universidade Estadual Paulista, Biosciences Institute, Campus of Rio Claro, with research area focused on geriatric neuropsychiatry and human movement. It Geriatric Psychiatry Clinic coordinator of the State University of Campinas School of Medical Sciences, in partnership with the Cruesp. It is a researcher at the Neuroscience Laboratory - LIM 27, Institute of Psychiatry, Faculty of Medicine, University of Sao Paulo. Has been active in the field of neuroscience, neuropsychiatry and neuropsychology applied to topics such as: Alzheimer's disease, dementia in Parkinson's disease, dementia with Lewy bodies, frontotemporal dementia, apathy and depression in the elderly, in association with motor intervention programs.

Abstract

Introduction A crucial point regarding neuropsychiatric symptoms in Alzheimer’s disease (AD) concerns the reliability of information about the patient’s behavior that the caregiver provides to the clinician. Caregivers frequently suffer emotional distress, depression, anxiety, sleep disorders, and eventually, cognitive decline when his is older, causing important biases which interfere with his interpretation of patient’s behavior. Aims We aimed to compare the caregiver report with the clinician impression of neuropsychiatric symptoms in the same patients with mild, moderate or severe AD. Methods We investigated 156 patients with AD and their 156 respective caregivers in order to detect disagreements between caregiver report and clinician impression regarding neuropsychiatric symptoms in the same patient. We used the Neuropsychiatric Inventory-Clinician Rating Scale to investigate psychopathological manifestations as this instrument allows a confrontation of informant report and clinician judgement. We divided patients into dementia severity levels: CRD 1=60, CDR 2=53, and CDR 3=43 (N=156) in order to identify disagreements between caregiver and clinician according to severity dementia in the same patient. Statistical analyses were based mainly on the likelihood ratio test. Results Disagreements between caregiver report and clinician impression were very common and high. More higher percentages of discordances were detected in specific domains: Apathy/Indifference (78.8%), Agitation (74.4%), Anxiety (72.4%), and Depression (68.6%) among patients with severe dementia. Lower percentages were observed in: Hallucinations (17.9%), Delusions (30.8%), and Aberrant Motor Vocalizations (33.3%) among patients with mild dementia. In the majority of domains, disagreements between caregiver report and clinician impression were increased according to dementia severity. In general, disagreement percentages were classified as higher among patients with CDR 3. Conclusion The accuracy of symptoms basically depends on clinician impression for behavioural disturbances of AD patients, and his impression frequently is in disagreement with caregiver report. Emotional distress and daily burden of the caregiver seem to be relevant conditions associated to misidentification of patient’s symptoms. Support: FAPESP