RESUMO
BACKGROUND: Psoriatic arthritis (PsA) is an inflammatory rheumatic disorder associated with cutaneous psoriasis. Neurological manifestations are not uncommon in rheumatic diseases and recent studies point to a possible underestimation of cognitive impairment in this group of diseases. Our aim was to assess the cognitive impairment in patients with PsA. METHODS: We carried out a cross-sectional case-control study with consecutive patients with PsA. Trained interviewers conducted structured and standardized in-person assessments. At baseline, functional limitations were characterized using the Health Assessment Questionnaire (HAQ). Cognitive function was evaluated with the Montreal Cognitive Assessment (MoCA) and neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale (HADS). Using a proper statistical analysis, we compared the differences in the neurological outcomes between cases and controls. RESULTS: A total of 37 patients with PsA and 36 healthy controls were included in our study. Patients with PsA had a worse MoCA score when compared to controls (p = 0.01). The proportion of patients with cognitive impairment according to MoCA between cases and controls was also statistically significant (91.9% vs 58.3%, p = 0.002). Executive skills, naming, language, and abstraction were the most affected domains. There was no statistical difference between the prevalence of neuropsychiatric symptoms between the two groups. Patients with increased functional limitations are associated with poor cognitive performance (p < 0.05). CONCLUSION: Cognitive impairment might be a neurological manifestation of PsA.
Assuntos
Artrite Psoriásica/psicologia , Disfunção Cognitiva/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Índice de Gravidade de DoençaRESUMO
BACKGROUND: The role that cholesterol levels play in stroke is still uncertain, especially in secondary prevention. The aim was to determine how a comprehensive analysis of the lipid profile can be associated with post-stroke outcomes.Consecutive patients diagnosed with ischemic stroke were included in our cohort and followed up for 24months. Baseline clinical and demographic data were collected as well as a complete lipid profile 6-months after the index stroke. Lipid variables were analyzed quantitatively and qualitatively. Clinical outcomes included stroke recurrence, major cardiovascular events, and functional performance (assessed with the modified Rankin scale). RESULTS: The study included 588 patients with an average age of 58.3 years. There were 148 (25.2%) patients with high total cholesterol, 260 (44.2%) with low HDL, 180 (30.6%) with high LDL, and 204 (34.7%) with high triglycerides. There were 164 (27.9%) patients with no abnormalities in the lipid profile. After the follow-up, 108 (18.3%) had another stroke, 32 (5.4%) had major cardiovascular events, and 360 (61.2%) presented good functional outcomes. A higher LDL-C/HDL-C ratio and a low HDL-C level were significantly associated with worse cardiovascular outcomes. The detection of LDL-C > 70 mg/dL was an independent predictor of a higher risk of stroke recurrence and worse functional performance. The greater the number of altered lipid variables, the greater the chance of developing an unfavorable composite outcome and presenting cardiovascular events after the stroke. CONCLUSIONS: The complete analysis of the lipid panel allows the determination of the prognosis of patients who suffered a stroke.
Assuntos
HDL-Colesterol/sangue , LDL-Colesterol/sangue , AVC Isquêmico/sangue , AVC Isquêmico/diagnóstico , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , PrognósticoRESUMO
OBJECTIVES: Patients who are victims of a mild stroke are vulnerable to several invisible and neglected neurological sequelae. In parallel, it is known that fatigue and neuropsychiatric symptoms are common complications after a stroke in general. Our aim was to describe the prevalence and the factors associated with these two outcomes after a minor stroke. MATERIALS AND METHODS: We conducted a prospective observational cohort study that included consecutive patients diagnosed with minor ischemic stroke between 2015 and 2019. Minor stroke was defined as NIHSS < 4 and modified Rankin Scale (mRS) < 2. Patients were followed for 12 months after the index stroke. The primary endpoints included fatigue and neuropsychiatric impairment, which were evaluated with the Fatigue Severity Scale (FSS) and the Hospital Anxiety Depression Scale (HADS), respectively. RESULTS: A total of sixty patients were followed in our cohort. The mean age was 53.0 (SD 15.0) and 51.7% were male. There were 32 (53.3%) and 25 (41.7%) patients who developed PSF and post-stroke neuropsychiatric symptoms, respectively. The use of antidepressants and statins were associated with post-stroke fatigue, while women and younger patients were more likely to develop neuropsychiatric symptoms after the stroke (p < 0.05). Eighteen (30.0%) patients were diagnosed with both post-stroke fatigue and psychiatric disorders. CONCLUSIONS: Post-stroke fatigue and neuropsychiatric symptoms are prevalent in minor stroke and should be independently addressed as a part of the recovery goal.
Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Fadiga/epidemiologia , AVC Isquêmico/epidemiologia , Adulto , Idoso , Ansiedade/diagnóstico , Ansiedade/psicologia , Brasil/epidemiologia , Depressão/diagnóstico , Depressão/psicologia , Fadiga/diagnóstico , Fadiga/fisiopatologia , Feminino , Humanos , AVC Isquêmico/diagnóstico , AVC Isquêmico/fisiopatologia , AVC Isquêmico/psicologia , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de TempoRESUMO
Aphasia is a frequent and devastating stroke complication that does not spare even great writers. In these cases, not only one of the highest cognitive functions is suddenly lost but also the act of bringing beauty into the world. Herein, we discuss the case of three writers who had to abandon their art compulsorily due to a cerebrovascular disease: Charles Baudelaire, Ralph Waldo Emerson, and Stendhal. They were magnificent writers, united by excellence in literature and an inevitable destiny that restricted their art to just a few words. They are also examples of the proximity of Neurology to Art, History, and Literature.
Assuntos
Afasia , Neurologia , Acidente Vascular Cerebral , Afasia/etiologia , Cognição , Humanos , Acidente Vascular Cerebral/complicaçõesRESUMO
ABSTRACT Aphasia is a frequent and devastating stroke complication that does not spare even great writers. In these cases, not only one of the highest cognitive functions is suddenly lost but also the act of bringing beauty into the world. Herein, we discuss the case of three writers who had to abandon their art compulsorily due to a cerebrovascular disease: Charles Baudelaire, Ralph Waldo Emerson, and Stendhal. They were magnificent writers, united by excellence in literature and an inevitable destiny that restricted their art to just a few words. They are also examples of the proximity of Neurology to Art, History, and Literature.
RESUMO A afasia é uma complicação frequente e devastadora do acidente vascular cerebral (AVC), que não poupa nem mesmo os grandes escritores. Nesses casos, de repente, perde-se não apenas uma das funções cognitivas mais importantes, mas o ato de colocar a beleza no mundo. Discutimos o caso de três escritores que precisaram abandonar sua arte compulsoriamente devido a uma doença cerebrovascular: Charles Baudelaire, Ralph Waldo Emerson e Stendhal. Todos eles foram escritores magníficos, unidos pela excelência em literatura e por um destino inevitável que restringia sua arte a apenas algumas palavras. Eles também são exemplos da proximidade da Neurologia com a Arte, a História e a Literatura.
Assuntos
Humanos , Afasia/etiologia , Neurologia , Cognição , Acidente Vascular Cerebral/complicaçõesRESUMO
INTRODUCTION: With multiple proven benefits, statin therapy has become the most critical advance in stroke prevention. We aimed to evaluate the risk factors and the effect of poor adherence or statin interruption on the clinical outcomes of ischemic stroke. METHODS: This prospective cohort study included patients admitted with acute ischemic stroke between 2014 and 2018. Consecutive patients were distinguished into subgroups according to the adherence and withdrawal of statin. All participants were followed for 24 months. The outcomes included stroke recurrence, major cardiovascular events, all-cause mortality, and functional performance. Functional outcome was assessed using the modified Rankin Scale at 7 days, 30 days, 6 months, and 2 years after hospital admission for ischemic stroke. In a secondary analysis, outcome variables were compared with statin-naïve patients. RESULTS: We included 479 patients with acute ischemic stroke. The mean age was 58.3, and 55.0% were male. There were 96 (21.8%) patients who received no statin, 150 (34.9%) patients with poor adherence, 40 (9.1%) patients with intermediate adherence, and 154 (35.0%) patients with good adherence. There were 54 (15.7%) cases of withdrawal of treatment. Patients with hypertension, previous stroke, and large-artery atherosclerosis were associated with poor adherence (p < 0.05). Those with poor adherence were significantly associated with worse functional outcomes and a higher incidence of stroke recurrence (p < 0.05). Significant functional recovery was just seen in patients with satisfactory adherence. CONCLUSION: The suboptimal use of statins is associated with significantly worse clinical outcomes in stroke patients.
Assuntos
Isquemia Encefálica , Inibidores de Hidroximetilglutaril-CoA Redutases , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/epidemiologia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Recidiva Local de Neoplasia , Estudos Prospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologiaAssuntos
Encéfalo/diagnóstico por imagem , Cocaína/efeitos adversos , Inibidores da Captação de Dopamina/efeitos adversos , Leucoencefalopatia Multifocal Progressiva/induzido quimicamente , Adulto , Humanos , Leucoencefalopatia Multifocal Progressiva/diagnóstico por imagem , Imageamento por Ressonância Magnética , MasculinoRESUMO
BACKGROUND: Recent medical advances have enabled the control of neurological symptoms and increased survival of patients with myasthenia gravis (MG). However, MG has many veiled consequences that may be underestimated by neurologists. Our aim was to clarify the social, professional, and neuropsychiatric issues of MG patients. METHODS: We carried out a cross-sectional cohort study with MG patients from a university-affiliated referral hospital. We registered clinical and sociodemographic data, and patients were classified according the MGFA classification. Clinical severity was assessed with Myasthenia Gravis Composite (MGC) scale. Trained and blind investigators analyzed social and professional outcomes. Neuropsychiatric symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS) and the social support with the Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: We enrolled 49 patients with MG. The mean age was 45.3 ± 18.1 years and 39 (79.6%) were women. There were 19 (38.8%) patients who become unemployed, 23 (46.9%) who had to retire prematurely, 31 (63.3%) that reported a significant reduction in work performance, and 23 (46.9%) who had a reduction in monthly income after the diagnosis of MG. Only 16 (32.6%) received any financial support and 24 (48.9%) patients had the perception of receiving a satisfactory social support. The practice of physical activity is a habit in only 10 patients (20.4%). Neuropsychiatric symptoms were present in 26 (53.1%) patients. CONCLUSION: Patients with MG are vulnerable to social, professional, and mental disadvantages. Therapeutic success in MG goes beyond symptom relief and inevitably depends on a personalized approach to the patient.
Assuntos
Miastenia Gravis , Qualidade de Vida , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/epidemiologia , Miastenia Gravis/terapia , Apoio SocialRESUMO
BACKGROUND: Statin therapy has become one of the most important advances in stroke secondary prevention. OBJECTIVE: To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. METHODS: We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS: Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. CONCLUSIONS: Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.
Assuntos
Isquemia Encefálica , Inibidores de Hidroximetilglutaril-CoA Redutases , AVC Isquêmico , Acidente Vascular Cerebral , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/prevenção & controle , Brasil , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Estudos Prospectivos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controleRESUMO
Abstract A unique association joins Guillaume Apollinaire, Blaise Cendrars and Louis Ferdinand Céline. Besides being great exponents of French literature, they were all neurologically wounded during the First World War. Apollinaire had a traumatic brain injury, Cendrars developed phantom limb neuropathic pain and Céline presented radial nerve paralysis. There is quite an evidence that supports that their artistic output was also influenced by acquired neurological conditions during the war. The examples of these three French authors reveal the surprising intimacy Neurology can share with art and history.
Resumo Uma associação única une Guillaume Apollinaire, Blaise Cendrars e Louis Ferdinand Céline. Além de serem grandes expoentes da literatura francesa, todos eles foram feridos neurologicamente durante a Primeira Guerra Mundial. Apollinaire sofreu traumatismo cranioencefálico, Cendrars desenvolveu dor neuropática do membro fantasma e Céline apresentou paralisia do nervo radial. Há bastantes evidências que sustentam que a sua produção artística também foi influenciada pelas condições neurológicas adquiridas durante a guerra. Os exemplos desses três autores franceses revelam a surpreendente intimidade que a neurologia pode compartilhar com a arte e a história.
Assuntos
História do Século XIX , História do Século XX , Arte , Doenças do Sistema Nervoso , Neurologia , I Guerra MundialRESUMO
BACKGROUND: Currently, statins are widely used for secondary prevention of stroke due to their pleiotropic neuroprotective effects. Epilepsy is a common complication of cerebrovascular diseases. The purpose of this study was to evaluate the effect of statin therapy on the occurrence of post-stroke epilepsy (PSE). METHODS: In this prospective cohort study, patients who suffered an ischemic stroke and without history of epilepsy before stroke were enrolled. At baseline, patients were classified according to the particularities of statin therapy. Statin use onset and adherence to treatment were registered as well. After a follow-up period of 1 year, we assessed the occurrence of seizures and PSE. RESULTS: Among the 477 patients included in our cohort, there were 91 (19.1%) patients without statins, 160 (33.5%) with simvastatin 20 mg, 180 (37.7%) with simvastatin 40 mg, and 46 (9.6%) with high-potency statins. Overall, PSE emerged in 53 (11.1%) patients. PSE was significantly more prevalent among those who did not receive statins and those with lower doses of simvastatin. Acute onset of statin use was associated with reduced odds of having PSE. CONCLUSION: Adequate treatment with statins after stroke may lower the risk of PSE.
Assuntos
Epilepsia , Inibidores de Hidroximetilglutaril-CoA Redutases , Acidente Vascular Cerebral , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Estudos Prospectivos , Convulsões , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/epidemiologiaRESUMO
A unique association joins Guillaume Apollinaire, Blaise Cendrars and Louis Ferdinand Céline. Besides being great exponents of French literature, they were all neurologically wounded during the First World War. Apollinaire had a traumatic brain injury, Cendrars developed phantom limb neuropathic pain and Céline presented radial nerve paralysis. There is quite an evidence that supports that their artistic output was also influenced by acquired neurological conditions during the war. The examples of these three French authors reveal the surprising intimacy Neurology can share with art and history.
Assuntos
Arte , Doenças do Sistema Nervoso , Neurologia , História do Século XIX , História do Século XX , Humanos , I Guerra MundialRESUMO
BACKGROUND: Little is known about the potential systemic effects of ankylosing spondylitis (AS) on the nervous system. We designed a study aiming to assess the frequency and clinical predictors of cognitive impairment in AS patients. METHODS: We carried out a cross-sectional case-control study composed of consecutive patients with AS. Trained and blinded interviewers registered clinical-epidemiological data and applied a standardized neurological assessment for each subject of the study. At baseline, functional limitations were characterized using the Health Assessment Questionnaire. Cognitive impairment was evaluated with the Brief Cognitive Screening Battery, the Montreal Cognitive Assessment, and the Clinical Dementia Rating, while neuropsychiatric symptoms were investigated with the Hospital Anxiety and Depression Scale. Healthy controls were matched for age, educational attainment, sex, and comorbidities. We compared the neurological outcomes between case and controls, and we determined the clinical predictors of cognitive decline. RESULTS: We included 40 patients (mean: 49.3 years) with AS and 40 healthy controls (mean: 48.8 years) in our study. In Brief Cognitive Screening Battery, patients with AS presented a statistically significant poor performance in the clock drawing test and in the verbal fluency. The mean Montreal Cognitive Assessment (MoCA) scores were significantly lower in AS subjects compared to the control group. Also, the prevalence of subjects classified as cognitively impaired according to MoCA was significantly higher in the AS group (90.0% vs. 57.5%, p = 0.02). Moreover, neuropsychiatric symptoms were more prevalent in AS patients. Worse functional limitations were associated with poor cognitive performance as well. CONCLUSIONS: Patients with AS might be more vulnerable to cognitive decline.
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Disfunção Cognitiva/epidemiologia , Espondilite Anquilosante/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes NeuropsicológicosRESUMO
Advances in the treatment of MG have allowed most patients to effectively treat their disorder with oral medications. In parallel, non-adherence to medication treatment regimens is a worldwide health problem. Other chronic neurological disorders have already been associated with low adherence to treatment. However, the literature regarding adherence among patients with MG is definitely poor. The purpose of this study was to capture the prevalence and the associated factors of non-adherence to pharmacological treatment in patients with MG. We carried out a cross-sectional cohort study with 58 consecutive patients with MG from a university-affiliated referral hospital in São Paulo, Brazil. We registered clinical and sociodemographic data and patients were classified according to the MGFA classification. Clinical severity was assessed with myasthenia gravis composite (MGC) scale. Neuropsychiatric symptoms were evaluated with the Hospital Anxiety and Depression Scale (HADS) and quality of life with the 15-Item Quality Of Life Instrument for myasthenia gravis scale (MG-QOL15). Adherence to pharmacological treatment was evaluated using the 8-item Morisky Medication Adherence Scale (MMAS-8). There were 26 (44.8%) patients adherent to treatment. Low adherence was associated with poor educational attainment, longer time of disease and greater daily number of pills (p < 0.05). Patients with poor compliance to treatment presented worse quality of life and increased neuropsychiatric symptoms (p < 0.05). Adherence can be relatively challenging in patients with MG. Medical approach should recognize that therapeutic success in the treatment of MG goes through adherence to treatment.
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Adesão à Medicação/estatística & dados numéricos , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Cardiac rhabdomyoma is a benign tumor which constitutes the most common cardiovascular feature of the tuberous sclerosis complex, a multisystem genetically determined neurocutaneous disorder. Cardiac rhabdomyomas can be detected in the prenatal ultrasound, are usually asymptomatic and spontaneously regress within the first three years of life. Less often, the tumors' size, number, and location can produce a mass effect that may lead to blood flow abnormalities or organ dysfunction (heart failure and arrhythmia). In this setting, severe morbidity, and eventually, a lethal outcome despite clinical and surgical treatment may ensue. We describe a fatal case of multiple cardiac rhabdomyomas in a newborn girl. One of the rhabdomyomas was large and unfavorably located, causing significant obstruction of the left ventricular outflow tract. The autopsy identified, in addition to cardiac rhabdomyomas, brain glioneuronal hamartomas (cortical tubers), subependymal nodules and subependymal giant cell tumors, characteristic of the tuberous sclerosis complex. The newborn's family was investigated for the presence of typical clinical symptoms of the complex and image findings showed significant phenotypical variations and a broad symptom spectrum among the family members. This interesting case underscores the variability of tuberous sclerosis complex and the importance of performing a comprehensive postmortem examination in the identification of the cause of death, especially in the setting of familial disease.
Assuntos
Humanos , Feminino , Recém-Nascido , Rabdomioma/patologia , Esclerose Tuberosa/patologia , Neoplasias Cardíacas , Autopsia , Evolução Fatal , Síndromes NeurocutâneasRESUMO
Cardiac rhabdomyoma is a benign tumor which constitutes the most common cardiovascular feature of the tuberous sclerosis complex, a multisystem genetically determined neurocutaneous disorder. Cardiac rhabdomyomas can be detected in the prenatal ultrasound, are usually asymptomatic and spontaneously regress within the first three years of life. Less often, the tumors' size, number, and location can produce a mass effect that may lead to blood flow abnormalities or organ dysfunction (heart failure and arrhythmia). In this setting, severe morbidity, and eventually, a lethal outcome despite clinical and surgical treatment may ensue. We describe a fatal case of multiple cardiac rhabdomyomas in a newborn girl. One of the rhabdomyomas was large and unfavorably located, causing significant obstruction of the left ventricular outflow tract. The autopsy identified, in addition to cardiac rhabdomyomas, brain glioneuronal hamartomas (cortical tubers), subependymal nodules and subependymal giant cell tumors, characteristic of the tuberous sclerosis complex. The newborn's family was investigated for the presence of typical clinical symptoms of the complex and image findings showed significant phenotypical variations and a broad symptom spectrum among the family members. This interesting case underscores the variability of tuberous sclerosis complex and the importance of performing a comprehensive postmortem examination in the identification of the cause of death, especially in the setting of familial disease.
RESUMO
Maurice Ravel is one of the most important French musicians. In the last years of his life, Ravel was victim of a dementia of uncertain etiology that caused aphasia, apraxia, agraphia and amusia. The artistic brain of the author of eternal musical compositions was progressively silenced due to his neurodegenerative disease. On the 90th anniversary of Boléro, this historical note revisits Ravel's case and discusses the relationship of his dementia to his artistic production. It illustrates the intimacy that can exist between art, music, creativity, and neurology.
Assuntos
Demência/história , Música/história , Arte/história , França , História do Século XIX , História do Século XX , Humanos , Neurologia/históriaRESUMO
ABSTRACT Maurice Ravel is one of the most important French musicians. In the last years of his life, Ravel was victim of a dementia of uncertain etiology that caused aphasia, apraxia, agraphia and amusia. The artistic brain of the author of eternal musical compositions was progressively silenced due to his neurodegenerative disease. On the 90th anniversary of Boléro, this historical note revisits Ravel's case and discusses the relationship of his dementia to his artistic production. It illustrates the intimacy that can exist between art, music, creativity, and neurology.
RESUMO Maurice Ravel é um dos músicos franceses mais importantes. Nos últimos anos de vida, Ravel foi vítima de uma demência de etiologia incerta que causou afasia, apraxia, agrafia e amusia. O cérebro artístico do autor de eternas composições musicais foi progressivamente silenciado devido à sua doença neurodegenerativa. No 90° aniversário de Bolero, esta nota histórica revive o caso de Ravel e discute a relação de sua demência em sua produção artística. Ele ilustra a intimidade que pode existir entre arte, música e criatividade com a neurologia.