Dementia e Neuropsychologia最新文献

Novel therapies for Alzheimer's disease, particularly anti-amyloid drugs like lecanemab and donanemab, have shown modest clinical benefits but also significant risks. The present paper highlights the challenges of access to diagnosis, cost-effectiveness, safety, and the need for more representation of diverse populations in clinical trials. Recommendations include careful patient selection, risk-benefit analysis, and the importance of proven amyloid pathology for treatment. Future work involves further research on anti-amyloid therapies in Brazil and the development of more effective treatments for Alzheimer's disease.

Population aging brings about numerous challenges, particularly concerning cognitive health. In this context, socioeconomic factors such as education have received special attention due to their role in brain health.

Objective: The aim of this study was to describe the performance of executive functions, mental health variables, and quality of life among healthy older adults in relation to their level of education.

Methods: A descriptive, cross-sectional study was conducted with participants aged 60 or older. The assessment protocol included Addenbrooke's cognitive examination and FAS, trail-making tests A and B, Control, Autonomy, Self-Realization, and Pleasure Scale (CASP-19), as well as the depression, anxiety, and stress scale.

Results: Significant differences were found in the performance of executive functions among older adults with higher levels of education. However, mental health and quality of life variables were only related to participants' age.

Conclusion: The study showed that mental health and quality of life are not influenced by participants' level of education but are instead strongly correlated with age.

Transient global amnesia (TGA) is a rare, temporary, sudden-onset disturbance in anterograde episodic memory with unclear pathophysiology. Previous brain volumetric analysis in TGA patients showed varied results.

Objective: To explore brain morphometry, hypothesizing that patients with TGA exhibit structural alterations.

Methods: A case-control study was performed involving TGA subjects (n=50) and matched healthy controls (n=50). Both groups underwent a 3D-T1 weighted structural MRI on a 3T scanner, and voxel-based morphometry (VBM), region-based morphometry (RBM), and surface-based morphometry (SBM) were analyzed.

Results: After performing the VBM, RBM, and SBM analyses, no consistent and statistically significant differences were found after applying multiple corrections.

Conclusion: Despite previous studies showing volumetric changes in TGA patients, our results differ from this. The discrepancy could be due to sample size and timing of MRI scans. While our findings do not explain TGA pathophysiology, they support a network dysfunction as a possible mechanism and discards a structural alteration as a predisposing factor for TGA.

In recent years, the diagnostic accuracy of Alzheimer's disease has been enhanced by the development of different types of biomarkers that indicate the presence of neuropathological processes. In addition to improving patient selection for clinical trials, biomarkers can assess the effects of new treatments on pathological processes. However, there is concern about the indiscriminate and poorly supported use of biomarkers, especially in asymptomatic individuals or those with subjective cognitive decline. Difficulties interpreting these tests, high costs, and unequal access make this scenario even more challenging in healthcare. This article presents the recommendations from the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (Departamento Científico de Neurologia Cognitiva e Envelhecimento da Academia Brasileira de Neurologia) regarding the rational use and interpretation of Alzheimer's disease biomarkers in clinical practice. The clinical diagnosis of cognitive-behavioral syndrome is recommended as the initial step to guide the request for biomarkers.

Human history has been linked to numerous risks to survival, with pandemics being a constant in human life. People suffering from dementia experienced greater difficulties accessing healthcare and treatment during the COVID-19 pandemic.

Objective: To identify how the COVID-19 pandemic influenced care for people with dementia or cognitive impairment.

Methods: This research work is a systematic review conducted with a literature search in four databases such as Web of Science, Scopus, EBSCOHost, Cochrane Library, and ProQuest, following the methodological proposals of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guide.

Results: The bibliographic research in the different databases offered a total of 561 records, of which 23 were chosen to elaborate the results. The main results were the increasing cognitive impairment and psychosocial consequences of social distancing during the pandemic, including sadness, helplessness, and abandonment in patients or feelings of burnout and overload in caregivers and health professionals.

Conclusion: The COVID-19 placed patients with dementia in the background. During the pandemic, attention was focused primarily on emergencies and not so much on the monitoring of chronic diseases, which also caused psycho-emotional and social worsening.

To date, little is known about psychological and personality variables related to protective factors against the development of dementia. The Five-Factor Model of personality is worldwide recognized and consolidated for understanding the structure and operation of personality, organized into five main factors that delineate and elucidate personality traits/characteristics.

Objective: We aimed to analyze the association of the Five-Factor Model with the epidemiological classification of dementia.

Methods: Cross-sectional design with data collected from the first wave of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil) cohort study, the largest longitudinal study on aging in Brazil. Data gathered from the ELSI-Brazil provided the foundation for demographic and health-related variables (gender, age, education, lifestyle, etc.), mental health indicators, and items associated with personality traits. Logistic regression models were conducted with personality traits as predictors of dementia.

Results: The psychoindicator optimism was the only protective factor associated with dementia (p=0.006). The other variables were not significant predictors in this sample.

Conclusion: Optimism, as a dispositional variable related to personality factors (conscientiousness and neuroticism), emerges as a target variable possible to be developed in preventive longitudinal psychosocial interventions, based on theoretical and empirical evidence of learned optimism, to improve health promotion and self-care throughout life. The data from this study contribute to the advancement of research and to efforts of strengthening services and professional qualification for health and care practices, focused on protective factors, crucial to the global agenda for dementia care and research.

The quality of life of breast cancer patients is strongly affected by physical pain, psychological distress, and uncertainty about vital prognosis.

Objective: To assess breast cancer patients' mental well-being and level of psychological distress at the Mohammed VI University Hospital in Marrakech.

Methods: Cross-sectional study carried out from April to December 2023 at the Mohammed VI University Hospital of Marrakech. The data were collected via a questionnaire comprising a sociodemographic section and a section reserved for the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and the Kessler Psychological Distress Scale (K10). Data analysis was performed using SPSS software, version 25.

Results: A total of 38.3% of patients experienced severe psychological distress. However, their mental well-being was high with a mean of 54.59 (±11.29). Older patients (>50 years) exhibited better mental well-being (56.46±10.39 vs. 52.99±11.81; p=0.020) and lower psychological distress (26.27±7.21 vs. 28.44±8.19; p=0.034) compared to their younger counterparts (≤50 years). As for the stage of cancer, patients with localized cancer presented a higher mental well-being score than patients with metastatic cancer (55.53±10.93 vs. 50.40±12.03; p=0.008). However, no statistically significant difference was recorded between mastectomy and lumpectomy patients regarding mental well-being or psychological distress.

Conclusion: Breast cancer has not only a physical but also a psychological and emotional impact on patients. Thus, early diagnosis and referral to appropriate psychosocial services can improve patients' mental well-being.

Dementia is a global public health issue, with 57.5 million people living with at least one type of dementia in 2019 worldwide, and projected to rise to 152 million by 2050.

Objective: We assessed the cognitive function in diabetic patients aged 60 or older in Bukavu city, in the eastern Republic of the Congo (DRC).

Methods: This case-control study involved 123 patients with established diabetes mellitus (DM) and 123 controls over 60-year-olds also with high rates of illiteracy. Cognitive function was assessed using the Swahili version of the Community Screening Instrument for Dementia (CSI-D).

Results: Foremost, our study revealed language-related differences between Swahili spoken in other eastern African countries such as Tanzania and Kenya, where the Swahili CSI-D is readily applied, compared to the Swahili spoken in Bukavu (DRC). Our results also showed that cognitive impairment was present in 18.7% of the total 246 participants. Remarkably, the prevalence rate of cognitive impairment was higher in the non-diabetic group (12.2 versus 25.2%; p=0.009). Participants aged 80 or older were more likely to present with cognitive impairment compared to those aged less than 80 (adjusted odds ratio - aOR=70.27; 95% confidence interval - 95%CI 3.94-125.15; p=0.004). We also found that patients living with DM for more than 20 years were three times more likely to be impaired compared to those who were recently diagnosed with DM (aOR=3.63; 95%CI 1.70-18.81; p=0.026).

Conclusion: This study revealed that cognitive impairment was relatively high in Bukavu city. It emphasizes the lack of effective tools to assess cognitive function. This requires, therefore, that research be adapted to the intellect and cultural experiences of the patients.

Vascular cognitive impairment (VCI) is the second most common cause of cognitive impairment after Alzheimer's disease. The VCI spectrum involves a decline in cognition attributable to vascular pathologies (e.g., large infarcts or hemorrhages, microinfarcts, microbleeds, lacunar infarcts, white matter hyperintensities, and perivascular space dilation). Pathophysiological mechanisms include direct tissue injury, small vessel disease, inflammaging (inflammation + aging), atrophy, and altered neurotransmission. VCI is diagnosed using distinct clinical and radiological criteria. It may lead to long-term disability and reduced quality of life. An essential factor for reducing cognitive impairment incidence is preventing stroke by managing traditional and non-traditional cerebrovascular risk factors. This article reviews the spectrum of VCI, epidemiology, risk factors, pathophysiology, diagnosis, available treatment, and preventive strategies.

There is presently no disease-modifying therapy for Alzheimer's Disease (AD), which is the most prevalent cause of dementia.

Objective: This study aspires to estimate the efficacy and safety of cell-based treatments in AD.

Methods: Observing the Joanna Briggs Institute (JBI) methods and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a systematic search was accomplished in PubMed, Medical Literature Analysis and Retrieval System Online (Medline, via Ovid), Embase; Cochrane, and Cumulative Index of Nursing and Allied Health Literature - CINAHL (via EBSCO) databases up to June 2023. The relevant clinical studies in which cell-based therapies were utilized to manage AD were included. The risk of bias was evaluated using the JBI checklists, based on the study designs.

Results: Out of 1,014 screened records, a total of five studies with 70 individuals (including 59 patients receiving stem cells and 11 placebo controls) were included. In all these studies, despite the discrepancy in the origin of stem cells, cell density, and transplant site, safety goals were obtained. The intracerebroventricular injection of adipose-derived stromal vascular fraction (ADSVF) and umbilical cord-derived mesenchymal stem cells (UC-MSCs), the intravenous injection of Lomecel-B, and the bilateral hippocampi and right precuneus injection of UC-MSCs are not linked to any significant safety concerns, according to the five included studies. Studies also revealed improvements in biomarkers and clinical outcomes as a secondary outcome. Three studies had no control groups and there are concerns regarding the similarity of the groups in others. Also, there is considerable risk of bias regarding the outcome assessment scales.

Conclusion: Cell-based therapies are well tolerated by AD patients, which emphasizes the need for further, carefully planned randomized studies to reach evidence-based clinical recommendations in this respect.