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INTRODUCTION: An increasing body of research suggests that stress and allostatic load are related to cognitive dysfunction and neurodegeneration. OBJECTIVES: to determine the relationship between allostatic load (AL) and cognitive status in older adults classified with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). METHODOLOGY: Using the Brazilian Memory and Aging Study (BRAMS) database, we analyzed data from 57 older adults with SCD and MCI. Blood neuroendocrine (cortisol, DHEA-s), inflammatory (C-reactive protein, fibrinogen), metabolic (HbA1c, HDL-cholesterol, total cholesterol, creatinine), and cardiovascular (blood pressure, waist/hip ratio) were transformed into an AL index. RESULTS: Despite a significant difference in the univariate analysis between waist/hip ratio (0.94 in the MCI group vs. 0, 88 in the SCD group, p = 0.03), total cholesterol levels (194 vs. 160, p = 0.02), and AL index (36.9â¯% in the MCI group vs. 27.2â¯% in the SCD group, p = 0.04), AL was not associated with SCD or MCI in the multivariate analysis. CONCLUSION: Our data suggest that different profiles of AL in MCI compared to individuals with SCD could be due to cofounding factors. These findings need to be confirmed in longitudinal studies investigating profiles of AL changes at preclinical and prodromal stages of Alzheimer's disease.
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Alostase , Disfunção Cognitiva , Humanos , Disfunção Cognitiva/fisiopatologia , Disfunção Cognitiva/sangue , Masculino , Idoso , Feminino , Alostase/fisiologia , Brasil , Estudos Transversais , Idoso de 80 Anos ou mais , Envelhecimento/fisiologia , Pessoa de Meia-IdadeRESUMO
Background: Global brain health initiatives call for improving methods for the diagnosis of Alzheimer's disease (AD) and frontotemporal dementia (FTD) in underrepresented populations. However, diagnostic procedures in upper-middle-income countries (UMICs) and lower-middle income countries (LMICs), such as Latin American countries (LAC), face multiple challenges. These include the heterogeneity in diagnostic methods, lack of clinical harmonisation, and limited access to biomarkers. Methods: This cross-sectional observational study aimed to identify the best combination of predictors to discriminate between AD and FTD using demographic, clinical and cognitive data among 1794 participants [904 diagnosed with AD, 282 diagnosed with FTD, and 606 healthy controls (HCs)] collected in 11 clinical centres across five LAC (ReDLat cohort). Findings: A fully automated computational approach included classical statistical methods, support vector machine procedures, and machine learning techniques (random forest and sequential feature selection procedures). Results demonstrated an accurate classification of patients with AD and FTD and HCs. A machine learning model produced the best values to differentiate AD from FTD patients with an accuracy = 0.91. The top features included social cognition, neuropsychiatric symptoms, executive functioning performance, and cognitive screening; with secondary contributions from age, educational attainment, and sex. Interpretation: Results demonstrate that data-driven techniques applied in archival clinical datasets could enhance diagnostic procedures in regions with limited resources. These results also suggest specific fine-grained cognitive and behavioural measures may aid in the diagnosis of AD and FTD in LAC. Moreover, our results highlight an opportunity for harmonisation of clinical tools for dementia diagnosis in the region. Funding: This work was supported by the Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat), funded by NIA/NIH (R01AG057234), Alzheimer's Association (SG-20-725707-ReDLat), Rainwater Foundation, Takeda (CW2680521), Global Brain Health Institute; as well as CONICET; FONCYT-PICT (2017-1818, 2017-1820); PIIECC, Facultad de Humanidades, Usach; Sistema General de Regalías de Colombia (BPIN2018000100059), Universidad del Valle (CI 5316); ANID/FONDECYT Regular (1210195, 1210176, 1210176); ANID/FONDAP (15150012); ANID/PIA/ANILLOS ACT210096; and Alzheimer's Association GBHI ALZ UK-22-865742.
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BACKGROUND: Gait and balance disturbance are challenging symptoms in advanced Parkinson's disease (PD). Anatomic and clinical data suggest that the fields of Forel may be a potential surgical target to treat these symptoms. OBJECTIVE: To test whether bilateral stimulation centered at the fields of Forel improves levodopa unresponsive freezing of gait (FOG), balance problems, postural instability, and falls in PD. METHODS: A total of 13 patients with levodopa-unresponsive gait disturbance (Hoehn and Yahr stage ≥3) were included. Patients were evaluated before (on-medication condition) and 1 yr after surgery (on-medication-on-stimulation condition). Motor symptoms and quality of life were assessed with the Unified Parkinson's Disease Rating scale (UPDRS III) and Quality of Life scale (PDQ-39). Clinical and instrumented analyses assessed gait, balance, postural instability, and falls. RESULTS: Surgery improved balance by 43% (95% confidence interval [CI]: 21.2-36.4 to 35.2-47.1; P = .0012), reduced FOG by 35% (95% CI: 15.1-20.3 to 8.1-15.3; P = .0021), and the monthly number of falls by 82.2% (95% CI: 2.2-6.9 to -0.2-1.7; P = .0039). Anticipatory postural adjustments, velocity to turn, and postural sway measurements also improved 1 yr after deep brain stimulation (DBS). UPDRS III motor scores were reduced by 27.2% postoperatively (95% CI: 42.6-54.3 to 30.2-40.5; P < .0001). Quality of life improved 27.5% (95% CI: 34.6-48.8 to 22.4-37.9; P = .0100). CONCLUSION: Our results suggest that DBS of the fields of Forel improved motor symptoms in PD, as well as the FOG, falls, balance, postural instability, and quality of life.
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Estimulação Encefálica Profunda , Transtornos Neurológicos da Marcha , Doença de Parkinson , Encéfalo , Marcha , Transtornos Neurológicos da Marcha/tratamento farmacológico , Transtornos Neurológicos da Marcha/etiologia , Humanos , Levodopa/uso terapêutico , Doença de Parkinson/complicações , Doença de Parkinson/tratamento farmacológico , Equilíbrio Postural , Qualidade de VidaRESUMO
Inference comprehension is a complex ability that recruits distinct cognitive domains, such as language, memory, attention, and executive functions. Therefore, it might be sensitive to identify early deficits in subjects with MCI. To compare the performance of subjects with mild cognitive impairment (MCI) in an inference reading comprehension task, and to analyze the correlations between inferential comprehension and other cognitive functions. We studied 100 individuals aged 60 and over, divided into MCI (50) [aMCI (35), naMCI (15)], and cognitively healthy individuals [controls (50)]. The Implicit Management Test (IMT) was used to assess inference in reading comprehension in five categories: explicit, logical, distractor, pragmatic, and "others". MCI group performed worse than controls in logical, pragmatic, distractor, and "others" questions (p < 0.01). The aMCI and naMCI subgroups presented a similar performance in all types of questions (p > 0.05). We observed significant correlations between the total IMT score and the TMT-A in the naMCI group (r = - 0.562, p = 0.036), and the Rey-Osterrieth Complex Figure and RAVLT tasks in the aMCI group (r = 0.474, p = 0.010 and r = 0.593, p = 0.0001, respectively). The MCI group as a whole performed worse than controls on the logical, pragmatic, other and distractor questions, and consequently on the total score. There were no differences in explicit questions, which impose lower inferential demands. The aMCI group suffered a significant impact from memory on inference comprehension, and difficulties in executive functions impacted naMCI performance. The IMT was useful to differentiate MCI patients from cognitively healthy individuals, but not MCI subgroups among themselves.
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Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Compreensão/fisiologia , Testes Neuropsicológicos , Leitura , Idoso , Idoso de 80 Anos ou mais , Atenção/fisiologia , Cognição/fisiologia , Estudos Transversais , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In the last paragraph of the subsession "Recruitment of the study population and clinical Evaluation" (Material and methods session).
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PURPOSE: [18F]FDG-PET and [11C]PIB-PET are validated as neurodegeneration and amyloid biomarkers of Alzheimer's disease (AD). We used a PET staging system based on the 2018 NIA-AA research framework to compare the proportion of amyloid positivity (A+) and hypometabolism ((N)+) in cases of mild probable AD, amnestic mild cognitive impairment (aMCI), and healthy controls, incorporating an additional classification of abnormal [18F]FDG-PET patterns and investigating the co-occurrence of such with A+, exploring [18F]FDG-PET to generate hypotheses in cases presenting with clinical-biomarker "mismatches." METHODS: Elderly individuals (N = 108) clinically classified as controls (N = 27), aMCI (N = 43) or mild probable AD (N = 38) were included. Authors assessed their A(N) profiles and classified [18F]FDG-PET neurodegenerative patterns as typical or non-typical of AD, performing re-assessments of images whenever clinical classification was in disagreement with the PET staging (clinical-biomarker "mismatches"). We also investigated associations between "mismatches" and sociodemographic and educational characteristics. RESULTS: AD presented with higher rates of A+ and (N)+. There was also a higher proportion of A+ and (N)+ individuals in the aMCI group in comparison to controls, however without statistical significance regarding the A staging. There was a significant association between amyloid positivity and AD (N)+ hypometabolic patterns typical of AD. Non-AD (N)+ hypometabolism was seen in all A- (N)+ cases in the mild probable AD and control groups and [18F]FDG-PET patterns classified such individuals as "SNAP" and one as probable frontotemporal lobar degeneration. All A- (N)- cases in the probable AD group had less than 4 years of formal education and lower socioeconomic status (SES). CONCLUSION: The PET-based staging system unveiled significant A(N) differences between AD and the other groups, whereas aMCI and controls had different (N) staging, explaining the cognitive impairment in aMCI. [18F]FDG-PET could be used beyond simple (N) staging, since it provided alternative hypotheses to cases with clinical-biomarker "mismatches." An AD hypometabolic pattern correlated with amyloid positivity. Low education and SES were related to dementia in the absence of biomarker changes.
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Doença de Alzheimer , Disfunção Cognitiva , Idoso , Doença de Alzheimer/diagnóstico por imagem , Peptídeos beta-Amiloides/metabolismo , Biomarcadores , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Disfunção Cognitiva/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Stereotactic lesion in the Forel's field H (campotomy) was proposed in 1963 to treat Parkinson disease (PD) symptoms. Despite its rationale, very few data on this approach have emerged. Additionally, no study has assessed its effects on nonmotor symptoms, neuropsychological functions and quality of life. OBJECTIVE: To provide a prospective 2-yr assessment of motor, nonmotor, neuropsychological and quality of life variables after unilateral campotomy. METHODS: Twelve PD patients were prospectively evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), the Dyskinesia Rating Scale and the Parkinson's disease quality of life questionnaire (PDQ39) before campotomy, and after 6 and 24 mo. Nonmotor, neuropsychiatric, neuropsychological and quality of life variables were assessed. The impact of PD on global health was also rated. RESULTS: A significant reduction in contralateral rest tremor (65.7%, P < .001), rigidity (87.8%, P < .001), bradykinesia (68%, P < .001) and axial symptoms (24.2%, P < .05) in offmedication condition led to a 43.9% reduction in UPSDRS III scores 2 yr after campotomy (P < .001). Gait improved by 31.9% (P < .05) and walking time to cover 7 m was reduced by 43.2% (P < .05). Pain decreased by 33.4% (P < .01), while neuropsychiatric and neuropsychological functions did not change. Quality of life improved by 37.8% (P < .05), in line with a 46.7% reduction of disease impact on global health (P < .001). CONCLUSION: A significant 2-yr improvement of motor symptoms, gait performance and pain was obtained after unilateral campotomy without significant changes to cognition. Quality of life markedly improved in parallel with a significant reduction of PD burden on global health.
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Testes Neuropsicológicos , Doença de Parkinson/psicologia , Doença de Parkinson/cirurgia , Qualidade de Vida/psicologia , Técnicas Estereotáxicas/psicologia , Subtálamo/cirurgia , Idoso , Cognição/fisiologia , Feminino , Marcha/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Estudos Prospectivos , Técnicas Estereotáxicas/tendências , Subtálamo/fisiologia , Inquéritos e Questionários , Fatores de Tempo , Tremor/diagnóstico , Tremor/psicologia , Tremor/cirurgiaRESUMO
INTRODUCTION: The depiction of features in discourse production promotes accurate diagnosis and helps to establish the therapeutic intervention in cognitive impairment and dementia. We aimed to identify alterations in the macrolinguistic aspects of discourse using a new computational tool. METHODS: Sixty individuals, aged 60 years and older, were distributed in three different groups: mild Alzheimer's disease (mAD), amnestic mild cognitive impairment, and healthy controls. A narrative created by individuals was analyzed through the Coh-Metrix-Dementia program, extracting the features of interest automatically. RESULTS: mAD showed worse overall performance compared to the other groups: less informative discourse, greater impairment in global coherence, greater modalization, and inferior narrative structure. It was not possible to discriminate between amnestic mild cognitive impairment and healthy controls. DISCUSSION: Our results are in line with the literature, verifying a pathological change in the macrostructure of discourse in mAD.
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It has been hypothesized that dietary creatine could influence cognitive performance by increasing brain creatine in developing individuals. This double-blind, randomized, placebo-controlled, proof-of-principle study aimed to investigate the effects of creatine supplementation on cognitive function and brain creatine content in healthy youth. The sample comprised 67 healthy participants aged 10 to 12 years. The participants were given creatine or placebo supplementation for 7 days. At baseline and after the intervention, participants undertook a battery of cognitive tests. In a random subsample of participants, brain creatine content was also assessed in the regions of left dorsolateral prefrontal cortex, left hippocampus, and occipital lobe by proton magnetic resonance spectroscopy (1H-MRS) technique. The scores obtained from verbal learning and executive functions tests did not significantly differ between groups at baseline or after the intervention (all p > 0.05). Creatine content was not significantly different between groups in left dorsolateral prefrontal cortex, left hippocampus, and occipital lobe (all p > 0.05). In conclusion, a 7-day creatine supplementation protocol did not elicit improvements in brain creatine content or cognitive performance in healthy youth, suggesting that this population mainly relies on brain creatine synthesis rather than exogenous creatine intake to maintain brain creatine homeostasis.
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Encéfalo/metabolismo , Fenômenos Fisiológicos da Nutrição Infantil , Cognição , Creatina/administração & dosagem , Suplementos Nutricionais , Modelos Neurológicos , Neurônios/metabolismo , Encéfalo/diagnóstico por imagem , Brasil , Criança , Creatina/metabolismo , Método Duplo-Cego , Função Executiva , Feminino , Neuroimagem Funcional , Hipocampo/diagnóstico por imagem , Hipocampo/metabolismo , Humanos , Masculino , Lobo Occipital/diagnóstico por imagem , Lobo Occipital/metabolismo , Substâncias para Melhoria do Desempenho/administração & dosagem , Córtex Pré-Frontal/diagnóstico por imagem , Córtex Pré-Frontal/metabolismo , Espectroscopia de Prótons por Ressonância MagnéticaRESUMO
The effect of psychotic symptoms in Parkinson's disease (PD) is variable among patients, and different methods to assess psychosis may yield conflicting results. A sample of 102 patients with a diagnosis of idiopathic PD underwent neurological, psychiatric, and neuropsychological assessment. Participants were divided into three groups: those who met DSM criteria for psychotic disorder, those who had psychotic symptoms but did not meet DSM criteria, and those without any psychotic symptoms. The first group had significantly worse sleep and worse cognitive and psychopathological symptoms compared with the other two groups. Results suggested that patients meeting DSM criteria for psychotic disorder comprise a separate clinical category.
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National Institute of Neurological Disorders and Stroke (USA) , Doença de Parkinson/diagnóstico , Doença de Parkinson/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/psicologia , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Doença de Parkinson/epidemiologia , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/epidemiologia , Estados UnidosRESUMO
BACKGROUND: Aerobic training (AT) is a promising intervention for mild cognitive impairment (MCI). OBJECTIVE: To evaluate the effects of AT on cognition and regional brain glucose metabolism (rBGM) in MCI patients. METHODS: Subjects performed a twice-a-week, moderate intensity, AT program for 24 weeks. Assessment with ADAS-cog, a comprehensive neuropsychological battery, and evaluation of rBGM with positron emission tomography with 18F-fluorodeoxyglucose ([18F]FDG-PET) were performed before and after the intervention. Aerobic capacity was compared using the maximal oxygen consumption VO2max (mL/Kg/min). [18F]FDG-PET data were analyzed on a voxel-by-voxel basis with SPM8 software. RESULTS: Forty subjects were included, with a mean (M) age of 70.3 (5.4) years and an initial Mini-Mental State Exam score of 27.4 (1.7). Comparisons using paired t-tests revealed improvements in the ADAS-cog (M difference: -2.7 (3.7), pâ< â0.001) and VO2max scores (M difference: 1.8 (2.0) mL/kg/min, pâ< â0.001). Brain metabolic analysis revealed a bilateral decrease in the rBGM of the dorsal anterior cingulate cortex, pFWEâ=â0.04. This rBGM decrease was negatively correlated with improvement in a visuospatial function/attentional test (rhoâ=-0.31, pâ=â0.04). Several other brain areas also showed increases or decreases in rBGM. Of note, there was an increase in the retrosplenial cortex, an important node of the default mode network, that was negatively correlated with the metabolic decrease in the dorsal anterior cingulate cortex (râ=-0.51, pâ=â0.001). CONCLUSION: AT improved cognition and changed rBGM in areas related to cognition in subjects with MCI.
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Encéfalo/metabolismo , Disfunção Cognitiva/patologia , Disfunção Cognitiva/reabilitação , Terapia por Exercício/métodos , Exercício Físico , Glucose/metabolismo , Idoso , Encéfalo/diagnóstico por imagem , Disfunção Cognitiva/líquido cefalorraquidiano , Feminino , Fluordesoxiglucose F18 , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Testes Neuropsicológicos , Consumo de Oxigênio , Tomografia por Emissão de PósitronsRESUMO
Crystallized intelligence refers to one's knowledge base and can be measured by vocabulary tests. Fluid intelligence is related to nonverbal aspects of intelligence, depends very little on previously acquired knowledge, and can be measured by tests such as Block Design (BD) and Raven Colored Matrices (RCM). Premorbid intelligence quotient (IQ) refers to one's intellectual ability level previous to the onset of disorders like mild cognitive impairment (MCI) and Alzheimer's disease (AD) and it is important to estimate disease severity. The objective was to compare performance in tests that measure crystallized and fluid intelligence in healthy subjects and patients with amnestic MCI (aMCI) and AD. One hundred forty-four participants (aMCI (n = 38), AD (n = 45), and healthy controls (n = 61)) were submitted to neuropsychological tests (WAIS-III vocabulary, BD, and RCM). There were significant among groups, except for vocabulary, indicating a relative stability of crystallized intelligence in the continuum from normal to pathological cognitive decline. Vocabulary seems to be stable during the progression of the disease and useful as a measure of premorbid intelligence, that is, to estimate previous function in relation to the level of education and, as a collateral measure of cognition in people with low education.
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Doença de Alzheimer/psicologia , Amnésia/psicologia , Disfunção Cognitiva/psicologia , Testes de Inteligência , Inteligência , Vocabulário , Idoso , Idoso de 80 Anos ou mais , Brasil , Cognição , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
ABSTRACT: Diagnosis of Parkinson's disease dementia is a challenge in clinical settings. A comprehensive neuropsychological evaluation is time-consuming and expensive; brief instruments for cognitive evaluation must be easier to administer and provide a reliable classification. OBJECTIVE: To study the validity of the Brazilian version of Addenbrooke's Cognitive Examination-Revised (ACE-R) for the cognitive assessment of Parkinson's disease (PD) patients with heterogeneous educational level. METHODS: Patients were evaluated according to the diagnostic procedures recommended by the Movement Disorder Society (MDS) as the gold standard for the diagnosis of dementia in PD. RESULTS: We studied 70 idiopathic PD patients, with a mean (SD) age of 64.1 (9.3) years and mean disease duration of 7.7 (5.3) years and educational level of 5.9 years, matched for education and age to controls. Twenty-seven patients fulfilled MDS clinical criteria for PD dementia. Mean scores on the ACE-R were 54.7 (12.8) points for patients with PD dementia, 76 (9.9) for PD patients without dementia and 79.7 (1.8) points for healthy controls. The area under the receiver operating curve, taking the MDS diagnostic procedures as a reference, was 0.93 [95% CI, 0.87-0.98; p<0.001] for ACE-R. The optimal cut-off value for ACE-R was <72 points [sensitivity 90%; specificity 85%; Kappa concordance (K) 0.79]. CONCLUSION: ACE-R appears to be a valid tool for dementia evaluation in PD patients with heterogeneous educational level, displaying good correlation with clinical criteria and diagnostic procedures of the MDS.
RESUMO: O diagnóstico da demência na doença de Pakinson é desafiador na prática clínica. A avaliação neuropsicológica ampla é cara e demorada; instrumentos breves para avaliação cognitiva devem ser fáceis de realizar e fornecer uma classificação confiável. OBJETIVO: Estudar a validade da versão Brasileira do Addenbrooke's Cognitive Examination-Revised (ACE-R) para a avaliação em pacientes com doença de Parkinson (DP) com nível de escolaridade heterogêneo. MÉTODOS: Os pacientes foram avaliados segundo os procedimentos diagnósticos recomendados pela Movement Disorder Society (MDS) como padrão ouro para diagnóstico de demência da DP (DDP). RESULTADOS: Nós estudamos 70 pacientes com DP idiopática, pareados por idade e escolaridade a controles, com média de idade de 64,1 (9,3) anos, tempo médio de doença de 7,7 (5,3) anos e nível educacional de 5,9 anos. Vinte e sete pacientes preencheram critério da MDS para DDP. Os escores médios na ACE-R foram de 54,7 (12,8) pontos para DDP, 76 (9,9) para DP sem demência e 79,7 (1,8) pontos para os controles saudáveis. A área sob a curva tomando-se os procedimentos diagnósticos da MDS como referência foi 0,93 [95% CI, 0,87-0,98; p<0,001] para ACE-R. O melhor escore de corte foi de <72 pontos (sensibilidade de 90% e especificidade de 85%; Kappa concordance (K) 0.79). CONCLUSÃO: A ACE-R parece ser um instrumento válido para avaliação de demência em pacientes com DP de níveis educacionais heterogêneos, mostrando boa correlação com o critério clínico e procedimentos diagnósticos da MDS.
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Humanos , Doença de Parkinson , Demência , Testes de Estado Mental e Demência , NeuropsicologiaRESUMO
Currently, computerized batteries are of great value in detecting cognitive impairment. This aim of this review was to compare the computerized neurocognitive batteries used in most studies with cognitive decline over the last 10 years. Using the search words computerized cognitive assessment with: dementia, mild cognitive impairment, and Alzheimer's disease, the CogState, CNS Vital Sings, COGDRAS and Mindstreams batteries were retrieved.
Atualmente, baterias de testes computadorizados têm sido de grande valor na detecção de comprometimento cognitivo. Esta revisão teve como objetivo comparar as baterias cognitivas computadorizadas que foram utilizadas nos últimos 10 anos, na maioria dos estudos com declínio cognitivo. Usando as palavras avaliação cognitiva computadorizada com: demência, comprometimento cognitivo leve e doença de Alzheimer nós encontramos as baterias CogState, CNS Vital Signs, COGDRAS e Mindstreams.
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Humanos , Idoso , Cognição , Doença de Alzheimer , Disfunção Cognitiva , Testes de Estado Mental e Demência , Testes NeuropsicológicosRESUMO
In developing countries, education levels vary dramatically, and the number of years of schooling does not always correlate with the true level of educational competency. This study was designed to verify the accuracy of the Short-Test of Functional Health Literacy in Adults (S-TOFHLA) in individuals with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), when compared with healthy controls (HCs), in order to assess its utility as a measure of functional literacy. One hundred forty-eight subjects were divided into three groups: HC (n = 61), MCI patients (n = 42), and AD patients (n = 45). The S-TOFHLA does not seem to be suitable as an instrument to measure functional literacy for patients with advanced cognitive impairment, but proved to be appropriate in both the HC group and MCI patients in numeracy and prove to be useful as an adjuvant to estimate IQ, reading ability, and premorbid IQ, as an indicator of cognitive reserve.
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Doença de Alzheimer/psicologia , Disfunção Cognitiva/psicologia , Letramento em Saúde , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: To establish whether alterations of brain structures in Alzheimer's disease are associated with executive dysfunction. METHODS: Nineteen patients with Alzheimer's disease and 22 older control subjects underwent a comprehensive evaluation. The clock drawing test, digit span test, executive motor function test, Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test), and Stroop test were used to evaluate executive dysfunction. A multiparametric approach using the FreeSurfer image analysis suite provided a description of volumetric and geometric features of the gray matter structures. RESULTS: The cortical thickness maps showed a negative correlation between the Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test) and the right middle frontal gyrus; a positive correlation between the executive motor function test and the left superior parietal gyrus, left middle temporal gyrus, bilateral supramarginal gyri, right middle frontal gyrus, and right precuneus; a negative correlation between the Stroop test (part III) and the right superior parietal gyrus; and a negative correlation between the Stroop test (part III) and the right middle temporal gyrus. CONCLUSION: Executive dysfunction in Alzheimer's disease is correlated with alterations not only in the frontal areas but also within many temporal and parietal regions.
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Doença de Alzheimer/fisiopatologia , Encéfalo/anatomia & histologia , Encéfalo/fisiopatologia , Função Executiva/fisiologia , Idoso , Idoso de 80 Anos ou mais , Mapeamento Encefálico , Estudos de Casos e Controles , Cognição/fisiologia , Transtornos Cognitivos/fisiopatologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tamanho do Órgão , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To establish whether alterations of brain structures in Alzheimer's disease are associated with executive dysfunction. METHODS: Nineteen patients with Alzheimer's disease and 22 older control subjects underwent a comprehensive evaluation. The clock drawing test, digit span test, executive motor function test, Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test), and Stroop test were used to evaluate executive dysfunction. A multiparametric approach using the FreeSurfer image analysis suite provided a description of volumetric and geometric features of the gray matter structures. RESULTS: The cortical thickness maps showed a negative correlation between the Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test) and the right middle frontal gyrus; a positive correlation between the executive motor function test and the left superior parietal gyrus, left middle temporal gyrus, bilateral supramarginal gyri, right middle frontal gyrus, and right precuneus; a negative correlation between the Stroop test (part III) and the right superior parietal gyrus; and a negative correlation between the Stroop test (part III) and the right middle temporal gyrus. CONCLUSION: Executive dysfunction in Alzheimer's disease is correlated with alterations not only in the frontal areas but also within many temporal and parietal regions. .
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Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Alzheimer/fisiopatologia , Encéfalo/anatomia & histologia , Encéfalo/fisiopatologia , Função Executiva/fisiologia , Mapeamento Encefálico , Estudos de Casos e Controles , Transtornos Cognitivos/fisiopatologia , Cognição/fisiologia , Imageamento por Ressonância Magnética , Testes Neuropsicológicos , Tamanho do Órgão , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
Diagnosis of Parkinson's disease dementia is a challenge in clinical settings. A comprehensive neuropsychological evaluation is time-consuming and expensive; brief instruments for cognitive evaluation must be easier to administer and provide a reliable classification. OBJECTIVE: To study the validity of the Brazilian version of Addenbrooke's Cognitive Examination-Revised (ACE-R) for the cognitive assessment of Parkinson's disease (PD) patients with heterogeneous educational level. METHODS: Patients were evaluated according to the diagnostic procedures recommended by the Movement Disorder Society (MDS) as the gold standard for the diagnosis of dementia in PD. RESULTS: We studied 70 idiopathic PD patients, with a mean (SD) age of 64.1 (9.3) years and mean disease duration of 7.7 (5.3) years and educational level of 5.9 years, matched for education and age to controls. Twenty-seven patients fulfilled MDS clinical criteria for PD dementia. Mean scores on the ACE-R were 54.7 (12.8) points for patients with PD dementia, 76 (9.9) for PD patients without dementia and 79.7 (1.8) points for healthy controls. The area under the receiver operating curve, taking the MDS diagnostic procedures as a reference, was 0.93 [95% CI, 0.87-0.98; p<0.001] for ACE-R. The optimal cut-off value for ACE-R was ≤72 points [sensitivity 90%; specificity 85%; Kappa concordance (K) 0.79]. CONCLUSION: ACE-R appears to be a valid tool for dementia evaluation in PD patients with heterogeneous educational level, displaying good correlation with clinical criteria and diagnostic procedures of the MDS.
O diagnóstico da demência na doença de Pakinson é desafiador na prática clínica. A avaliação neuropsicológica ampla é cara e demorada; instrumentos breves para avaliação cognitiva devem ser fáceis de realizar e fornecer uma classificação confiável. OBJETIVO: Estudar a validade da versão Brasileira do Addenbrooke's Cognitive Examination-Revised (ACE-R) para a avaliação em pacientes com doença de Parkinson (DP) com nível de escolaridade heterogêneo. MÉTODOS: Os pacientes foram avaliados segundo os procedimentos diagnósticos recomendados pela Movement Disorder Society (MDS) como padrão ouro para diagnóstico de demência da DP (DDP). RESULTADOS: Nós estudamos 70 pacientes com DP idiopática, pareados por idade e escolaridade a controles, com média de idade de 64,1 (9,3) anos, tempo médio de doença de 7,7 (5,3) anos e nível educacional de 5,9 anos. Vinte e sete pacientes preencheram critério da MDS para DDP. Os escores médios na ACE-R foram de 54,7 (12,8) pontos para DDP, 76 (9,9) para DP sem demência e 79,7 (1,8) pontos para os controles saudáveis. A área sob a curva tomando-se os procedimentos diagnósticos da MDS como referência foi 0,93 [95% CI, 0,87-0,98; p<0,001] para ACE-R. O melhor escore de corte foi de ≤72 pontos (sensibilidade de 90% e especificidade de 85%; Kappa concordance (K) 0.79). CONCLUSÃO: A ACE-R parece ser um instrumento válido para avaliação de demência em pacientes com DP de níveis educacionais heterogêneos, mostrando boa correlação com o critério clínico e procedimentos diagnósticos da MDS.
RESUMO
Currently, computerized batteries are of great value in detecting cognitive impairment. This aim of this review was to compare the computerized neurocognitive batteries used in most studies with cognitive decline over the last 10 years. Using the search words computerized cognitive assessment with: dementia, mild cognitive impairment, and Alzheimer's disease, the CogState, CNS Vital Sings, COGDRAS and Mindstreams batteries were retrieved.
Atualmente, baterias de testes computadorizados têm sido de grande valor na detecção de comprometimento cognitivo. Esta revisão teve como objetivo comparar as baterias cognitivas computadorizadas que foram utilizadas nos últimos 10 anos, na maioria dos estudos com declínio cognitivo. Usando as palavras avaliação cognitiva computadorizada com: demência, comprometimento cognitivo leve e doença de Alzheimer nós encontramos as baterias CogState, CNS Vital Signs, COGDRAS e Mindstreams.
RESUMO
Acquired hepatocerebral degeneration is an underdiagnosed neurologic syndrome characterized by parkinsonism,ataxia or other movement disorders and by neuropsychiatric and cognitive symptoms. It occurs in patients with chronic liverdisease, especially those who develop portosystemic shunting and is often unrecognized as a cause of cognitive decline.Recently, its pathogenesis has been associated with manganese accumulation in basal ganglia and some treatmentsproposed. The aim of this article was to report a case and discuss some discoveries in connection with the disease.
Degeneração hepatocerebral adquirida é uma síndrome neurológica subdiagnosticado caracterizada porparkinsonismo, ataxia ou outros distúrbios do movimento e por sintomas neuropsiquiátricos e cognitivos. Ocorre empacientes com doença hepática crônica, especialmente aqueles que desenvolvem shunts porto-sistêmicos e frequentementenão é reconhecido como uma causa de declínio cognitivo. Recentemente, sua patogênese tem sido associada ao acúmulode manganês nos gânglios da base e alguns tratamentos foram propostos. O objetivo do artigo foi relatar um caso e discutiralgumas descobertas nesta doença.