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Introduction: Frailty is a geriatric syndrome frequently associated with executive dysfunction and white matter hyperintensities (WMH). But the relation between executive dysfunction and brain changes is poorly understood in frail subjects. Our hypothesis is that frontal-WMH mediates the association between frailty and executive dysfunction. Methods: A convenience sample of 113 subjects older than 65 years without dementia was studied with neuropsychological test, a structured clinical interview, physical examination and brain MRI. They were classified as robust or pre-frail and frail using the frailty phenotype score (0-5). The frontal WMH (F-WMH) were manually graduated (0-6) using the "Age-Related White Matter Changes score" from FLAIR sequences at a 3 Tesla brain MRI. A mediation analysis was done for testing whether F-WMH could act as a link factor between frailty phenotype score and executive dysfunction. Results: The group's mean age was 74 ± 6 years, subjects with higher frailty score had more depressive symptoms and worse performance in executive function tests. A regression analysis that explained 52% of the variability in executive functions, revealed a significant direct effect of frailty score (Standardized ßcoeff [95% CI] -0.201, [-0.319, -0.049], and F-WMH (-0.152[-0.269, -0.009]) on executive functions, while the F-WMH showed a small partial mediation effect between frailty and executive functions (-0.0395, [-0.09, -0.004]). Discussion: Frontal matter hyperintensities had a small mediation effect on the association between frailty and executive dysfunction, suggesting that other neuropathological and neurofunctional changes might also be associated with executive dysfunction in frail subjects.

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The spectrum of neurodegenerative diseases that primarily affect cognition and behaviorspreads from asymptomatic preclinical disease to very mild cognitive impairment to frank dementia. Alzheimer's disease (AD) is the most common cause of a decline in cognitive ability. Also, it is a devastating condition that affects patients and their entirefamilies of caregivers, exacting tremendous financial hardships. Diagnosis may be complicated by other forms of dementia that have symptoms and pathologies similar to AD. Knowing the key features and pathology of each type of dementia can help in the accurate diagnosis of patients, so they will receive the treatment and support services appropriate for their condition and maintain the highest possible functioning in daily life and quality of life. Differentiate, based on clinical criteria, neuropathology, and biomarkers, AD and its atypical variants from other common dementias including Dementia with Lewy Bodies, Vascular Cognitive Impairment, Frontotemporal Degeneration, and less frequent cognitive disorders. The importance of getting an accurate and early diagnosis of dementiais now increasingly significant to make important decisions about treatment, support, and care. Nonpharmacological as well as pharmacological interventions should be initiated once the diagnosis is obtained. Biochemical markers to identify Alzheimer's disease play a central role in the new diagnostic criteria for the disease and in the recent biological definition of AD. This review article presents up-to-date data regarding the recent diagnostic criteria of Alzheimer´s disease and related disorders, emphasizing its usefulness in routine clinical practice.

El espectro de enfermedades neurodegenerativas que afectan principalmente a la cognición y el comportamiento abarca desde la enfermedad preclínica asintomática hasta el deterioro cognitivo muy leve y la demencia franca. La enfermedad de Alzheimer (EA) es la causa más común de deterioro de la capacidad cognitiva. Es una enfermedad devastadora que afecta a los pacientes y a toda su familia de cuidadores, lo que supone enormes dificultades socioeconómicas y psicoemocionales. El diagnóstico puede complicarse debido a otras formas de demencia que presentan síntomas y patologías similares a la EA. Los marcadores bioquímicos para identificar la enfermedad de Alzheimer desempeñan un papel central en los nuevos criterios diagnósticos de la enfermedad y en la reciente definición biológica de la EA. Conocer las características claves y la patología de cada tipo de demencia puede ayudar en el diagnóstico preciso de los pacientes, a fin de que reciban el tratamiento y los servicios de apoyo adecuados a su condición y mantengan el mayor funcionamiento posible en la vida diaria y la calidad de vida. Por lo tanto es prioritario diferenciar, basándose en criterios clínicos, neuropatología y biomarcadores, la EA y sus variantes atípicas de otras demencias comunes como el Deterioro Cognitivo Vascular, la Degeneración Fronto- temporal entre otras, y los trastornos cognitivos menos frecuentes. Este artículo de revisión presenta datos actualizados relativos a los recientes criterios diagnósticos de algunas formas de demencia haciendo hincapié en su utilidad en la práctica clínica habitual. Se exponen los criterios de EA, de Demencia Vascular (DV), de la demencia Fronto-temporal (DFT) y de una forma rara de demencia, descripta en los últimos años, que se evidencia en pacientes muy añosos con un perfil similar a la EA. Se trata de la encefalopatía predominantemente límbica por tdp- 43 relacionada a la edad (LATE).

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BACKGROUND: Electroacupuncture (EA) is a complementary and alternative therapy which has shown protective effects on vascular cognitive impairment (VCI). However, the underlying mechanisms are not entirely understood. METHODS: Rat models of VCI were established with cerebral ischemia using occlusion of the middle cerebral artery or bilateral common carotid artery. The brain structure and function imaging were measured through animal MRI. miRNA expression was detected by chip and qPCR. Synaptic functional plasticity was detected using electrophysiological techniques. RESULTS: This study demonstrated the enhancement of Regional Homogeneity (ReHo) activity of blood oxygen level-dependent (BOLD) signal in the entorhinal cortical (EC) and hippocampus (HIP) in response to EA treatment. miR-219a was selected and confirmed to be elevated in HIP and EC in VCI but decreased after EA. N-methyl-D-aspartic acid receptor1 (NMDAR1) was identified as the target gene of miR-219a. miR-219a regulated NMDAR-mediated autaptic currents, spontaneous excitatory postsynaptic currents (sEPSC), and long-term potentiation (LTP) of the EC-HIP CA1 circuit influencing synaptic plasticity. EA was able to inhibit miR-219a, enhancing synaptic plasticity of the EC-HIP CA1 circuit and increasing expression of NMDAR1 while promoting the phosphorylation of downstream calcium/calmodulin-dependent protein kinase II (CaMKII), improving overall learning and memory in VCI rat models. CONCLUSION: Inhibition of miR-219a ameliorates VCI by regulating NMDAR-mediated synaptic plasticity in animal models of cerebral ischemia.

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This study presents evidence of validity and reliability of the results obtained with the Cognitive Screening (TRIACOG) to evaluate post-stroke adults. The TRIACOG assesses orientation memory, language, arithmetic, praxis, information processing speed, and executive functions. A total of 126 post-stroke adults (M = 63.50; SD = 13.28 years old) and 126 neurologically healthy adults (M = 61.97; SD = 11.48 years old) participated in the study. Performance on the TRIACOG was positively correlated with scores on the Montreal Cognitive Assessment-Basic (MoCA-B), schooling, and reading and writing habits, and negatively correlated with the NIHSS and Rankin scales. Post-stroke adults scored lower and took longer to complete the instrument than neurologically healthy adults. Inter-rater agreement was achieved in scoring the TRIACOG. The TRIACOG presents evidence of validity based on its relationships to other variables (criterion and convergent) and on response processes, in addition to presenting reliability evidence established by inter-rater agreement. We expect that the TRIACOG will be employed by health workers in hospital settings, health units, and medical offices.

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OBJECTIVES: Our previous study indicated that aerobic exercise relieves cognitive impairment in patients with vascular cognitive impairment (VCI) via regulating brain-derived neurotrophic factor (BDNF), but the mechanism is not yet clear. This study aimed to explore whether lncRNA taurine upregulated gene 1 (TUG1) participates in the process of VCI by regulating BDNF. METHODS: The expressions of TUG1 and BDNF in the serum of VCI patients were detected. The potential molecular mechanisms of TUG1 in regulating hippocampal neuronal apoptosis were explored in oxygen and glucose deprivation-induced (OGD-induced) hippocampal cell line HT22. The VCI mouse model was established, and TUG1 and BDNF were overexpressed via lentivirus injection. The cognitive impairment of mice was detected by the Morris water maze experiment after the aerobic exercise. RESULTS: The level of TUG1 was elevated in the serum of VCI patients compared with the control group. The knockdown of TUG1 in OGD-induced HT22 cells increased BDNF level and decreased cell apoptosis, and the downregulation of BDNF restored the decreased cell apoptosis. RNA immunoprecipitation and RNA pull-down assays showed that TUG1 could bind to BDNF protein. The aerobic exercise alleviated cognitive impairment and inhibited hippocampal apoptosis in VCI mice. Meanwhile, the overexpression of TUG1 reversed the therapeutic effects of aerobic exercise on cognitive impairment. CONCLUSIONS: The knockdown of TUG1 reduced hippocampal neuronal apoptosis and participates in the aerobic exercise-alleviated VCI, which was partly through regulating BDNF.

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OBJECTIVES: Our previous study indicated that aerobic exercise relieves cognitive impairment in patients with vascular cognitive impairment (VCI) via regulating brain-derived neurotrophic factor (BDNF), but the mechanism is not yet clear. This study aimed to explore whether lncRNA taurine upregulated gene 1 (TUG1) participates in the process of VCI by regulating BDNF. METHODS: The expressions of TUG1 and BDNF in the serum of VCI patients were detected. The potential molecular mechanisms of TUG1 in regulating hippocampal neuronal apoptosis were explored in oxygen and glucose deprivation-induced (OGD-induced) hippocampal cell line HT22. The VCI mouse model was established, and TUG1 and BDNF were overexpressed via lentivirus injection. The cognitive impairment of mice was detected by the Morris water maze experiment after the aerobic exercise. RESULTS: The level of TUG1 was elevated in the serum of VCI patients compared with the control group. The knockdown of TUG1 in OGD-induced HT22 cells increased BDNF level and decreased cell apoptosis, and the downregulation of BDNF restored the decreased cell apoptosis. RNA immunoprecipitation and RNA pull-down assays showed that TUG1 could bind to BDNF protein. The aerobic exercise alleviated cognitive impairment and inhibited hippocampal apoptosis in VCI mice. Meanwhile, the overexpression of TUG1 reversed the therapeutic effects of aerobic exercise on cognitive impairment. CONCLUSIONS: The knockdown of TUG1 reduced hippocampal neuronal apoptosis and participates in the aerobic exercise-alleviated VCI, which was partly through regulating BDNF.

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BACKGROUND: Endothelial dysfunction and subsequent inflammation contribute to the development of vascular cognitive impairment (VCI). Soluble intercellular adhesion molecule-1 (sICAM-1) is upregulated in endothelial dysfunction and promotes an inflammatory response; however, the relationship between sICAM-1 and VCI remains equivocal. OBJECTIVE: To determine whether sICAM-1 contributes to the prediction of VCI. METHODS: Community-dwelling older adults (n = 172) from the "Cohort of Obesity, Sarcopenia and Frailty of Older Mexican Adults" (COSFOMA) study were identified as VCI or controls using standard neuropsychological evaluations and neuroimaging. sICAM-1 was quantified using ELISA, and multivariate logistic regression determined the association between sICAM-1 and VCI. RESULTS: A total of 31 VCI cases were identified. sICAM-1 was higher in VCI (VCI: 450.7 [241.6] ng/mL vs. controls: 296.9 [140.9] ng/mL). sICAM-1 concentrations above the 90th percentile (464.1 ng/mL) were associated with VCI group membership in all models (OR: 6.9, 95% CI: 1.1-42.2). The final saturated model explained 64% of the variance in VCI group membership. CONCLUSION: High concentrations of sICAM-1 are independently associated with VCI group membership. Efforts to further characterize the relationship between indices of endothelial dysfunction and pathological changes to the aging brain should be further pursued.

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Background: Frailty, a state of increased vulnerability, could play a role in the progression of vascular dementia. We aim to describe the changes in cerebrovascular reactivity of older adults with frailty and vascular-type mild cognitive impairment (MCIv). Methods: This was a cross-sectional study. A comprehensive geriatric assessment, neuropsychological evaluation, and transcranial Doppler ultrasound (TCD) was performed on 180 participants who were allocated into four groups: healthy (n = 74), frail (n = 40), MCIv (n = 35), and mixed (frail + MCIv) (n = 31). ANOVA and Kruskal-Wallis tests were used for the analysis of continuous variables with and without normal distribution. Multinomial logistic regression was constructed to identify associated covariates. Results: Subjects in the mixed group, compared to healthy group, were older (75.0 ± 5.9 vs 70.3 ± 5.9 years; p < 0.001), showed lower education (9.3 ± 6.4 vs 12.2 ± 4.0 years; p = 0.054), greater frequency of diabetes (42% vs 12%; p = 0.005), worse cognitive performance (z = -0.81 ± 0.94), and reduced left medial-cerebral artery cerebrovascular reactivity (0.43 ± 0.42 cm/s). The mixed group was associated with age (odds ratio (OR) 1.16, 95% Confidence Interval (CI) = 1.06-1.27; p < 0.001), diabetes (OR 6.28, 1.81-21.84; p = 0.004), and Geriatric Depression Scale (GDS) score (OR 1.34, 95% CI = 1.09-1.67; p = 0.007). Conclusions: Frailty among older adults was associated with worse cognitive performance, diabetes, and decreased cerebral blood flow.

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Screening instruments are ideal for acute clinical settings because they are easy to apply, fast, inexpensive and sensitive for specific samples. However, there is a need to verify the psychometric properties of screening in stroke patients. OBJECTIVE: This study investigated the psychometric properties (methodological procedures) of cognitive screening for patients with cerebrovascular diseases. METHODS: A systematic review of papers published on PsycINFO, Web of Knowledge, PubMed and Science Direct (2005 to 2016) was performed. RESULTS: A total of 55 articles remained after applying exclusion criteria. The samples ranged from 20 to 657 patients. Most articles evaluated elderly individuals with four to 13 years of education who had experienced ischemic or hemorrhagic stroke. There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments. Although the studies frequently used the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to seek evidence of validity and reliability, the use of these instruments among stroke patients has been criticized due to their psychometric properties and the neuropsychological functions evaluated. CONCLUSION: Although there is no gold standard screen for assessing adults post-stroke, instruments devised specifically for this population have shown promise. This review helps both researchers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke.

Instrumentos de triagem são ideias no contexto clínico hospitalar, uma vez que são fáceis de administrar, rápidos, tem baixo custo e são sensíveis para amostras específicas. Portanto, há a necessidade de se verificar as propriedades psicométricas de instrumentos de triagem para pacientes pós acidente vascular cerebral. OBJETIVO: Este estudo investigou as propriedades psicométricas (procedimentos metodológicos) de triagens cognitivas para pacientes com doenças cerebrovasculares. MÉTODOS: Foi realizada uma revisão sistemática de artigos publicados em PsycINFO, Web of Knowledge, PubMed e Science Direct (2005 a 2016). Apenas 55 artigos permaneceram após a aplicação dos critérios de exclusão. RESULTADOS: As amostras variaram de 20 a 657 pacientes; a maioria dos artigos avaliou indivíduos idosos, com quatro a 13 anos de educação, que sofreram AVC isquêmico e hemorrágico. Houve uma tendência para encontrar evidências de validade relacionadas ao critério e analisar a sensibilidade/especificidade dos instrumentos. Embora os estudos frequentemente apliquem o Mini Exame do Estado Mental (MMSE) e o Montreal Cognitive Assessment (MoCA) para buscar evidências de validade e de fidedignidade, o uso desses instrumentos em pacientes com AVC é criticado por razões relacionadas às suas propriedades psicométricas e funções neuropsicológicas avaliadas. CONCLUSÃO: Embora não exista uma triagem padrão-ouro para avaliação de adultos pós-AVC, os instrumentos construídos especificamente para esta população mostraram-se promissores. Este estudo de revisão contribui tanto aos pesquisadores quanto aos clínicos que desejam selecionar o rastreio mais apropriado para identificar comprometimento cognitivo em adultos pós-AVC.

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ABSTRACT. Screening instruments are ideal for acute clinical settings because they are easy to apply, fast, inexpensive and sensitive for specific samples. However, there is a need to verify the psychometric properties of screening in stroke patients. Objective: This study investigated the psychometric properties (methodological procedures) of cognitive screening for patients with cerebrovascular diseases. Methods: A systematic review of papers published on PsycINFO, Web of Knowledge, PubMed and Science Direct (2005 to 2016) was performed. Results: A total of 55 articles remained after applying exclusion criteria. The samples ranged from 20 to 657 patients. Most articles evaluated elderly individuals with four to 13 years of education who had experienced ischemic or hemorrhagic stroke. There was a tendency to find evidence of validity for criteria and to analyze the sensitivity/specificity of the instruments. Although the studies frequently used the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) to seek evidence of validity and reliability, the use of these instruments among stroke patients has been criticized due to their psychometric properties and the neuropsychological functions evaluated. Conclusion: Although there is no gold standard screen for assessing adults post-stroke, instruments devised specifically for this population have shown promise. This review helps both researchers and clinicians to select the most appropriate screen for identifying cognitive impairment in adults post-stroke.

RESUMO. Instrumentos de triagem são ideias no contexto clínico hospitalar, uma vez que são fáceis de administrar, rápidos, tem baixo custo e são sensíveis para amostras específicas. Portanto, há a necessidade de se verificar as propriedades psicométricas de instrumentos de triagem para pacientes pós acidente vascular cerebral. Objetivo: Este estudo investigou as propriedades psicométricas (procedimentos metodológicos) de triagens cognitivas para pacientes com doenças cerebrovasculares. Métodos: Foi realizada uma revisão sistemática de artigos publicados em PsycINFO, Web of Knowledge, PubMed e Science Direct (2005 a 2016). Apenas 55 artigos permaneceram após a aplicação dos critérios de exclusão. Resultados: As amostras variaram de 20 a 657 pacientes; a maioria dos artigos avaliou indivíduos idosos, com quatro a 13 anos de educação, que sofreram AVC isquêmico e hemorrágico. Houve uma tendência para encontrar evidências de validade relacionadas ao critério e analisar a sensibilidade/especificidade dos instrumentos. Embora os estudos frequentemente apliquem o Mini Exame do Estado Mental (MMSE) e o Montreal Cognitive Assessment (MoCA) para buscar evidências de validade e de fidedignidade, o uso desses instrumentos em pacientes com AVC é criticado por razões relacionadas às suas propriedades psicométricas e funções neuropsicológicas avaliadas. Conclusão: Embora não exista uma triagem padrão-ouro para avaliação de adultos pós-AVC, os instrumentos construídos especificamente para esta população mostraram-se promissores. Este estudo de revisão contribui tanto aos pesquisadores quanto aos clínicos que desejam selecionar o rastreio mais apropriado para identificar comprometimento cognitivo em adultos pós-AVC.

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This study aimed to develop a short version of an instrument to detect cognitive impairment in stroke patients, investigate which cognitive dimensions best discriminate between stroke patients and healthy adults and to graphically analyze the relationships among the neuropsychological variables and groups. This pilot study included 94 adults (49 post-stroke and 45 neurologically healthy) who answered the Brief Neuropsychological Assessment Battery NEUPSILIN for patients with expressive aphasia (NEUPSILIN-Af) to assess orientation, perception, memory, praxis, executive functions, oral language, and academic achievement (written language and arithmetic). The IRT Rasch model for dichotomous data indicated the exclusion of items that could not be used to discriminate performances. ROC curves indicated that only the orientation, oral language, academic achievement, and executive function dimensions could be used to differentiate between the clinical and healthy groups. Graphical analysis indicated that independently of the relation among variables, orientation and executive functions tasks are essentials in the neuropsychological assessments. This study contributes to the development of specific and sensitive neuropsychological instruments to assess stroke patients and to better understand the common deficits present in this clinical population.

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We assessed the linguistic abilities of multi-infarct (cortical) dementia and subcortical ischemic vascular dementia (VaD) patients and compared the linguistic performance of VaD and Alzheimer's Disease (AD) patients. A total of 23 VaD patients, 20 mild AD patients, and 31 controls participated in the study. All were evaluated using the Arizona Battery for Communication Disorders of Dementia (ABCD). Neuropsychological testing was performed to ascertain that VaD and AD patients had comparable cognitive performance. Both dementia groups performed more poorly than controls in the ABCD measures, except for the comparative question subtest. Comparison between VaD and AD patients showed statistically significant differences only in the confrontation naming subtest (p < 0.05), where paraphasias and visual errors were the most prevalent. AD patients showed a trend towards more circumlocution errors than VaD patients (p = 0.0483). When compared to controls, linguistic abilities of VaD patients were impaired in all measures of linguistic expression and linguistic comprehension, except for the comparative question subtest. Linguistic differences between VaD and AD patients were observed only in the confrontation naming subtest.

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INTRODUCTION: Supplementary tests are part of the clinical approach to diagnose cognitive impairment. We aimed to determine the role of supplementary examinations, except for biomarkers, on diagnostic stability of dementia over time and to identify reversible dementias. METHODS: We identified 432 patients with dementia who performed 2 clinical evaluations and the supplementary examinations recommended by the American Academy of Neurology in a follow-up period of 1 year. RESULTS: In this sample, 110 (24.5%) patients changed their diagnosis at 1-year follow-up for the appearance of vascular cognitive impairment than the initial diagnosis, due to the neuroimaging. Concerning the reversible dementias, depression was the major differential diagnosis, detected in 13 (81%) of the 16 patients with cognitive improvement. CONCLUSION: Therefore, regarding the supplementary examinations only neuroimaging and the depression triage were relevant for clinical practice regarding the differential diagnosis of dementia.

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ABSTRACT. Cognitive impairment includes mild cognitive decline and dementia, such as Alzheimer's disease (AD) and cerebrovascular-related pathologies. Objective: To investigate the profile of AD-related CSF biomarkers in a sample of cognitively impaired and unimpaired older adults with concomitant subcortical cerebrovascular burden. Methods: Seventy-eight older adults attending an outpatient psychogeriatric clinic were enrolled. Diagnoses were based on clinical, neuropsychological, laboratory, and neuroimaging data. Participants were classified into: cognitively normal (controls, n = 30), mild cognitive impairment (MCI, n = 34), and dementia (AD, n = 14). All subjects were submitted to CSF analyses for determination of amyloid-beta (Aß1-42), total tau (t-tau), phosphorylated tau (p-tau) and Aß1-42/p-tau ratio according to the Luminex method. MRI was performed in all individuals, and was scored independently by two experts according to Fazekas scale. Statistical analyses were conducted with the aid of general linear model procedures, and the Chi-squared test. Results: T-tau levels were significantly associated with subcortical lesion pattern when Fazekas was considered as a group factor. CSF biomarkers were not associated with MCI, AD, or controls when considered separately. There was a tendency for reduction in CSF Aß1-42 together with increasing Fazekas scores, but without statistical significance. Comparisons of Aß1-42 and t-tau with each clinical group or with each neuroimaging pattern did not reach statistical differences. Likewise, Fazekas scores had no impact on CAMCOG scores. Conclusion: We found a significant association between t-tau levels and subcortical lesions when all Fazekas classifications were considered as a single group; comparisons of Fazekas subgroups and CSF biomarkers did not reach significance.

RESUMO. O comprometimento cognitivo inclui alterações leves da cognição e demência, como doença de Alzheimer (DA) e patologias vasculares associadas. Objetivo: Investigar o perfil de biomarcadores da DA no líquor e doença cerebrovascular concomitante em idosos com e sem alterações cognitivas. Métodos: Foram incluídos 78 sujeitos de um ambulatório de psicogeriatria. Efetuaram-se os diagnósticos com base em dados clínicos, neuropsicológicos, laboratoriais e neuroimagem. Os participantes foram classificados em: cognitivamente normais (controles, n = 30), comprometimento cognitivo leve (CCL, n = 34) e demência (DA, n = 14). Todos foram submetidos ao exame liquórico para determinação de ß-amiloide (Aß1-42), tau total (t-tau), tau fosforilada (p-tau) e razão Aß1-42/p-tau, segundo o método de Luminex. RM foi efetuada em todos os indivíduos. Dois especialistas independentes avaliaram as imagens segundo a escala de Fazekas. As análises estatísticas basearam-se em modelo linear geral e teste qui-quadrado. Resultados: T-tau foi significantemente associada ao padrão de lesão subcortical quando o grau de Fazekas foi considerado como fator grupal. Não houve associação entre biomarcadores e diagnóstico clínico de CCL, DA e grupo controle, considerados individualmente. Observou-se uma tendência de redução de Aß1-42 concomitante com elevação dos escores de Fazekas, sem correlação significante. Comparações entre Aß1-42 e tau e diagnóstico clínico ou neuroimagem não foram significantes. Os resultados de Fazekas não influenciaram os escores do CAMCOG. Conclusão: Como principal resultado, observou-se associação significante entre os níveis de t-tau e lesões subcorticais quando as classificações de Fazekas foram incluídas em um único grupo. As comparações dos subgrupos de Fazekas e biomarcadores liquóricos não foram significantes.

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ABSTRACT. There is limited evidence about the progression of cognitive performance during the post-stroke stage. Objective: To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD). Methods: A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). Results: 152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening. Conclusion: According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

RESUMO. Há evidências limitadas sobre a progressão do desempenho cognitivo durante o estágio pós- acidente vascular cerebral (AVC). Objetivo: Avaliar a evolução do desempenho cognitivo em pacientes com AVC sem comprometimento cognitivo vascular (SCCV), pacientes com comprometimento cognitivo leve vascular (CCL-V) e pacientes com demência vascular (DV). Métodos: Coorte prospectivo de pacientes ambulatoriais com AVC de dois centros médicos secundários de Lima, Peru. Realizamos avaliações padronizadas no diagnóstico definitivo (avaliação inicial) e controles aos 6 e 12 meses depois, incluindo um conjunto de testes cognitivos breves: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). Resultados: Completaram o estudo 152 pacientes ambulatoriais, mostrando que as médias de pontuação da CDR apresentaram aumento progressivo (0,34 a 0,46), contrariamente ao observado com ACE e IFS (78,18 a 76,48 e 23,63 a 22,24). A soma das caixas do teste CDR mostrou que os pacientes com comprometimento cognitivo vascular (CCL-V e DV) apresentaram piora progressiva (0,79 a 0,16). Por outro lado, em indivíduos SCCV, essa tendência não foi observada. O gráfico box-plot para ACE e IFS mostrou que, para a maioria dos tipos de AVC observados, tanto os pacientes SCCV como aqueles com CCV apresentaram piora progressiva. Conclusão: De acordo com os resultados de ACE e IFS durante o acompanhamento de 1 ano, o desempenho cognitivo em pacientes com AVC piora, o que é particularmente consistente em pacientes com AVC tipo infarto.

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There is limited evidence about the progression of cognitive performance during the post-stroke stage. OBJECTIVE: To assess the evolution of cognitive performance in stroke patients without vascular cognitive impairment (VCI), patients with vascular mild cognitive impairment (MCI), and patients with vascular dementia (VD). METHODS: A prospective cohort of stroke outpatients from two secondary medical centers in Lima, Peru was studied. We performed standardized evaluations at definitive diagnosis (baseline evaluation), and control follow-ups at 6 and 12 months, including a battery of short cognitive tests: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). RESULTS: 152 outpatients completed the follow-up, showing progressive increase in mean score on the CDR(0.34 to 0.46), contrary to the pattern observed on the ACE and IFS (78.18 to 76.48 and 23.63 to 22.24). The box plot for the CDR test showed that VCI patients had progressive worsening (0.79 to 0.16). Conversely, this trend was not observed in subjects without VCI. The box plot for the ACE and IFS showed that, for the majority of the differentiated stroke types, both non-VCI and VCI patients had progressive worsening. CONCLUSION: According to both ACE and IFS results during a 1-year follow-up, the cognitive performance of stroke patients worsened, a trend which was particularly consistent in infarction-type stroke patients.

Há evidências limitadas sobre a progressão do desempenho cognitivo durante o estágio pós- acidente vascular cerebral (AVC). OBJETIVO: Avaliar a evolução do desempenho cognitivo em pacientes com AVC sem comprometimento cognitivo vascular (SCCV), pacientes com comprometimento cognitivo leve vascular (CCL-V) e pacientes com demência vascular (DV). MÉTODOS: Coorte prospectivo de pacientes ambulatoriais com AVC de dois centros médicos secundários de Lima, Peru. Realizamos avaliações padronizadas no diagnóstico definitivo (avaliação inicial) e controles aos 6 e 12 meses depois, incluindo um conjunto de testes cognitivos breves: Clinical Dementia Rating (CDR), Addenbrooke's Cognitive Examination (ACE), and INECO Frontal Screening (IFS). RESULTADOS: Completaram o estudo 152 pacientes ambulatoriais, mostrando que as médias de pontuação da CDR apresentaram aumento progressivo (0,34 a 0,46), contrariamente ao observado com ACE e IFS (78,18 a 76,48 e 23,63 a 22,24). A soma das caixas do teste CDR mostrou que os pacientes com comprometimento cognitivo vascular (CCL-V e DV) apresentaram piora progressiva (0,79 a 0,16). Por outro lado, em indivíduos SCCV, essa tendência não foi observada. O gráfico box-plot para ACE e IFS mostrou que, para a maioria dos tipos de AVC observados, tanto os pacientes SCCV como aqueles com CCV apresentaram piora progressiva. CONCLUSÃO: De acordo com os resultados de ACE e IFS durante o acompanhamento de 1 ano, o desempenho cognitivo em pacientes com AVC piora, o que é particularmente consistente em pacientes com AVC tipo infarto.

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Cognitive impairment includes mild cognitive decline and dementia, such as Alzheimer's disease (AD) and cerebrovascular-related pathologies. OBJECTIVE: To investigate the profile of AD-related CSF biomarkers in a sample of cognitively impaired and unimpaired older adults with concomitant subcortical cerebrovascular burden. METHODS: Seventy-eight older adults attending an outpatient psychogeriatric clinic were enrolled. Diagnoses were based on clinical, neuropsychological, laboratory, and neuroimaging data. Participants were classified into: cognitively normal (controls, n = 30), mild cognitive impairment (MCI, n = 34), and dementia (AD, n = 14). All subjects were submitted to CSF analyses for determination of amyloid-beta (Aß1-42), total tau (t-tau), phosphorylated tau (p-tau) and Aß1-42/p-tau ratio according to the Luminex method. MRI was performed in all individuals, and was scored independently by two experts according to Fazekas scale. Statistical analyses were conducted with the aid of general linear model procedures, and the Chi-squared test. RESULTS: T-tau levels were significantly associated with subcortical lesion pattern when Fazekas was considered as a group factor. CSF biomarkers were not associated with MCI, AD, or controls when considered separately. There was a tendency for reduction in CSF Aß1-42 together with increasing Fazekas scores, but without statistical significance. Comparisons of Aß1-42 and t-tau with each clinical group or with each neuroimaging pattern did not reach statistical differences. Likewise, Fazekas scores had no impact on CAMCOG scores. CONCLUSION: We found a significant association between t-tau levels and subcortical lesions when all Fazekas classifications were considered as a single group; comparisons of Fazekas subgroups and CSF biomarkers did not reach significance.

O comprometimento cognitivo inclui alterações leves da cognição e demência, como doença de Alzheimer (DA) e patologias vasculares associadas. OBJETIVO: Investigar o perfil de biomarcadores da DA no líquor e doença cerebrovascular concomitante em idosos com e sem alterações cognitivas. MÉTODOS: Foram incluídos 78 sujeitos de um ambulatório de psicogeriatria. Efetuaram-se os diagnósticos com base em dados clínicos, neuropsicológicos, laboratoriais e neuroimagem. Os participantes foram classificados em: cognitivamente normais (controles, n = 30), comprometimento cognitivo leve (CCL, n = 34) e demência (DA, n = 14). Todos foram submetidos ao exame liquórico para determinação de ß-amiloide (Aß1-42), tau total (t-tau), tau fosforilada (p-tau) e razão Aß1-42/p-tau, segundo o método de Luminex. RM foi efetuada em todos os indivíduos. Dois especialistas independentes avaliaram as imagens segundo a escala de Fazekas. As análises estatísticas basearam-se em modelo linear geral e teste qui-quadrado. RESULTADOS: T-tau foi significantemente associada ao padrão de lesão subcortical quando o grau de Fazekas foi considerado como fator grupal. Não houve associação entre biomarcadores e diagnóstico clínico de CCL, DA e grupo controle, considerados individualmente. Observou-se uma tendência de redução de Aß1-42 concomitante com elevação dos escores de Fazekas, sem correlação significante. Comparações entre Aß1-42 e tau e diagnóstico clínico ou neuroimagem não foram significantes. Os resultados de Fazekas não influenciaram os escores do CAMCOG. CONCLUSÃO: Como principal resultado, observou-se associação significante entre os níveis de t-tau e lesões subcorticais quando as classificações de Fazekas foram incluídas em um único grupo. As comparações dos subgrupos de Fazekas e biomarcadores liquóricos não foram significantes.

RESUMO

BACKGROUND: Staging vascular cognitive impairment (VCI) might be useful for sample selection in clinical trials and for guiding clinical decision-making. Clinical dementia rating (CDR) has been applied for staging cognitive impairments of different etiologies, but it may underestimate severity of non-Alzheimer's disease cognitive deficits. METHODS: Out of a total of 147 elderly subjects, 23 (mean age: 72.95 ± 7.51 years; 56% female; mean schooling: 9.52 ± 5.11 years) fulfilled clinical and neuroimaging criteria for VCI. Correlations among cognitive and functional status and scores in CDR and its subsums (CDR Sum of Boxes - CDR-SoB - and CDR Functional Subsum - CDR-FUNC) were performed. RESULTS: Both CDR-SoB and CDR-FUNC correlated with global cognitive performance, functional status, CLOX 2, working memory and abstraction tests. CDR global score only correlated with functional status. DISCUSSION: CDR-FUNC, as well as CDR-SoB, appear to be better indexes of severity in VCI than CDR global score.

RESUMO

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]).Objective:To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI).Methods:Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI).Results:A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD.Conclusion:The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]).Objetivo:Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP).Métodos:Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP.Resultados:Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV.Conclusão:O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.

Assuntos

RESUMO

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]). OBJECTIVE: To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI). METHODS: Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI). RESULTS: A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD. CONCLUSION: The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]). OBJETIVO: Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP). MÉTODOS: Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP. RESULTADOS: Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV. CONCLUSÃO: O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.