Perfil clínico-epidemiológico de pacientes com transtorno cognitivo maior no Amazonas: um estudo transversal

Abstract

Clinical-epidemiological profile of patients with major cognitive impairment in the Amazon: a cross-sectional study. Introduction and Objectives: Dementia consists of a decline in two or more domains of cog-nitive functions leading to loss of functionality. It is included in the spectrum of neurodegen-erative diseases, which increase with population aging – a global reality. Studies on cognitive profile of elderly patients in developing countries are rare and difficult to perform. In Brazil, the analysis of the clinical and epidemiological profile of the population with cognitive disor-ders in the northern region is deficient and, consequently is the characterization of this popula-tion in the country. The aim of this study is to investigate the clinical and epidemiological pro-file of patients with cognitive disorders when they begin a follow-up at a tertiary reference outpatient clinic in Amazonas. And, specific aims are: to identify time elapse from the onset of cognitive disease symptoms to the first appointment at this outpatient clinic; to verify the main factors associated with the degree of cognitive impairment; and to identify the main fac-tors associated with deficits in cognitive functionality and basic life activities. Methods: This is a cross-sectional data analysis study. The study was approved by the local Research Ethics Committee and carried out at the Araújo Lima outpatient clinic (AAL), the only one with spe-cific outpatient clinic for dementia care in Amazonas. Data from the medical records of these patients seen between 2016 and 2021 were used. All patients aged 40 years or older were in-cluded. The medical records of patients whose first symptoms and signs on entering this out-patient clinic were impossible to retrieve were excluded. Results: 124 patients were evaluated and there was a predominance of females (55.7%); the average age was 73.4 +-10.4 years for first attendance. The average age of the first symptom was 70.7 years and the average school-ing was low (1 to 4 years). 65% of the sample had systemic arterial hypertension (SAH) diag-nosed. The first most frequent symptom was forgetting recent facts, followed by change in behavior. The average time from the first symptom to the first appointment was 3.36 years. Alzheimer's disease was the predominant diagnosis (30.3%). Temporo-spatial disorientation and previous surgeries were associated with lower MMSE values; temporal-spatial disorienta-tion and forgetfulness of recent events were related to higher dependency values on the Pfef-fer scale; and the statistically significant variables associated with the Katz values were: pa-tients with an initial manifestation of acute confusional episode and difficulty in understand-ing. Conclusion: The clinical and epidemiological profile of patients with cognitive disorders when starting follow-up at the AAL (tertiary service) is predominantly female, with a mean age of 73.4 years. Average schooling is low - 1 to 4 years. Age of onset 71 years, considered high for the average in developing countries. 65% of these have SAH. 50% of these patients had a change in behavior as an initial symptom and 48.8% entered the service already using specific medication for dementia – perhaps reflecting the action of the primary service. The average time of arrival at the service after the first symptom was 3 years, considered short taking into account the size of the state and the particularities in transportation. This epidemi-ological study inserts the northern region in the context of analyzes and characterizations of the profile of dementias in Brazil and the need for studies of the primary access network for this population is exposed.