Dementia e Neuropsychologia最新文献

Spatial orientation is defined as the ability to find one's way around an environment, follow familiar routes, recognize places, and learn new routes. Spatial disorientation is one of the early symptoms of Alzheimer's disease (AD), and traditional cognitive evaluation lacks ecological validity. Therefore, new assessment methods are needed for the early identification of this cognitive impairment.

Objective: This study aimed to compare the applicability and stability of an immersive virtual reality (VR) system developed to assess route learning between older adults with and without mild cognitive impairment (MCI).

Methods: The study sample included 43 older adults: 22 without MCI and 23 with MCI. Applicability was assessed based on the recording of adverse events and the sense of presence reported through questionnaires. The Mann-Whitney U test was applied to compare the applicability of the Spatial Orientation in Immersive Virtual Environment Test (SOIVET)-Route task between older adults with and without MCI. Both short- and long-term stabilities of the task were evaluated using the intraclass correlation coefficient (ICC).

Results: The mean age of participants was 71.4 years (SD=5.5). A minimum number of adverse events (mean=1.46; SD=2.11) and high levels of presence (mean=138.04; SD=14.80) were reported, and there was no difference between groups with and without MCI. A good to excellent correlation was found for short-term stability (CCI 0.78) and a reasonable correlation was found for long-term stability (CCI 0.58).

Conclusions: The VR system was applicable for older adults and showed a good to excellent correlation for short-term stability.

Motor fluctuations in Parkinson's disease (PD) are a frequent long-term complication. Knowledge is limited on the prevalence and incidence of non-motor symptoms (NMS) fluctuations, especially in Brazil.

Objective: The objective of this study was to verify the frequency of NMS fluctuations and its relationship with other aspects of PD in patients followed at an outpatient movement disorders clinic.

Methods: This is a cross-sectional study in which patients were evaluated for the presence of both types of fluctuations using the Wearing Off Questionnaire (WOQ-19).

Results: A total of 37 patients (11 women and 26 men) were participated in this study, and the frequency of NMS fluctuations was 54.1% (90.9% in women and 38.5% in men). Anxiety was the most frequent non-motor fluctuation (35.1%). The highest percentage of NMS fluctuations (70%) was found in the group in which disease duration was more than 6 years. Most patients with motor fluctuations also had NMS fluctuations (66.7%). No patient presented with isolated NMS fluctuations.

Conclusions: This study showed that, in the study population, approximately half of the patients had NMS fluctuations, with a higher frequency among women. A higher frequency was present in patients with earlier age of diagnosis, longer duration, and greater severity of disease. These findings point to the importance of recognizing the fluctuations of NMS in the study population, since these may not be spontaneously mentioned by the patient, who is remaining unnoticed, undiagnosed, and not treated by the neurologist, representing a significant aggravating factor in the patient's quality of life.

Fatigue is a non-motor symptom of high prevalence in Parkinson's disease (PD); however, it is still unknown and neglected by health professionals.

Objective: This study aimed to demonstrate the prevalence of fatigue in patients with PD after excluding confounding factors, as well as its correlation with clinical and demographic data, and to find its negative impact on the quality of life of these patients.

Methods: A cross-sectional study was carried out with 237 randomly selected patients. According to inclusion and exclusion criteria, we selected 53 patients, who were then submitted to the Fatigue Severity Scale. Clinical and demographic data were also analyzed, comparing them between patients with and without fatigue.

Results: We identified fatigue in 21 (39.62%) patients. Patients with and without fatigue had similar mean scores on the UPDRS-III (p=0.36), equivalent daily dose of levodopa (p=0.94), mean disease duration (p=0.43), and mean age (p<0.99). Fatigued patients had worse quality of life scores (PDQ-39) (p=0.00). We did not observe a correlation between fatigue, duration of illness (r=0.11; p=0.43), age (r=0.00; p=0.99), and UPDRS-III (r=0.20; p=0.16).

Conclusions: Fatigue is a highly prevalent and independent symptom of PD. There is no correlation between age, mean duration of disease, motor impairment, and its presence. It has a negative impact on quality of life.

The prevalence of Parkinson's disease (PD) tends to increase worldwide in the coming decades. Thus, the incidence of falls is likely to increase, with a relevant burden on the health care system.

Objective: The objective of this study was to evaluate clinical factors and drug use associated with falls in PD patients.

Methods: We conducted a cross-sectional study at the Movement Disorders outpatient clinic of a tertiary hospital in Northeast Brazil. We performed structured interviews to collect sociodemographic and clinical data. Functional capacity was assessed using the Schwab and England Activities of Daily Living Scale and the modified Hoehn and Yahr Staging Scale. We divided the study sample into non-fallers (no falls) and fallers (≥1 fall), and non-recurrent (≤1 fall) and recurrent fallers (>1 fall).

Results: The study population comprised 327 PD patients (48% women), with a mean age of 70 years. The mean disease duration was 9.9±6.9 years. The most prevalent comorbidities were depression (47.2%), hypertension (44.0%), and type 2 diabetes mellitus (21.5%). The logistic regression analysis revealed that hallucinations, amantadine, and catechol-O-methyltransferase inhibitors (entacapone) were independently associated with falls in PD patients. Also, hallucinations, dyskinesia, and the use of amantadine were independently associated with recurrent falls.

Conclusions: Health care providers play an essential role in fall prevention in PD patients, particularly by identifying older adults experiencing dyskinesia and visual hallucinations. Prospective studies should investigate the use of amantadine as a risk factor for falls in PD patients.

Studies show that aging is accompanied by losses in cognitive functions and that interventions can increase performance and/or support the maintenance of cognitive skills in the elderly.

Objective: The objective of this study was to carry out a systematic review of long-term studies involving cognitive training (CT) in older adults without dementia and/or with mild cognitive impairment (MCI).

Methods: A systematic review of controlled studies was published in scientific journals from 2000 onward, with duration ≥6 months, CT intervention, cognitively normal (CN) or MCI participants aged ≥60 years, and assessments using cognitive and/or neuropsychological tests.

Results: A total of 32 studies were reviewed, comprising 10 on study protocols, 14 in CN older adults (no MCI and/or dementia), and 8 in older adults with MCI or at risk for dementia.

Conclusions: The studies reported improvements in cognitive performance for some motor abilities, among older participants of CT with or without booster sessions, including multimodal interventions or otherwise.

Repeated cognitive assessment in longitudinal studies favors the occurrence of retest effects, usually increasing the scores obtained at the follow-up assessments when compared to baseline. Therefore, retest effects can compromise the evaluation of cognitive decline in older adults.

Objectives: We aimed to verify the occurrence of the retest effect and the impact of sociodemographic characteristics on the follow-up scores in a sample of 5,592 participants with a diverse sociodemographic profile, who were assessed twice during 4 years of follow-up.

Methods: We tested two possible approaches to correct the retest effect and calculated the Reliable Change Index.

Results: We observed increased scores at the follow-up assessment after 4 years, but the results indicate a modest occurrence of retest effects. The regression difference correction successfully generated follow-up corrected scores, while the mean difference did not provide effective corrections. Sociodemographic characteristics had a minor impact on the retest.

Conclusions: We recommend the regression difference correction for retest effects. The absence of this methodological approach might lead to biased results using longitudinal cognitive scores.

Science and science reporting are under threat. Knowingly or not, researchers and clinicians are part of this debacle. This is not due so much to the notorious replication crisis, as to our acceptance of lowering common morality for personal gains, including the widespread, deprecable phenomenon of predatory publishing. Rather than fiercefully countering this loathsome practice, academics are accepting, often supporting a masquerade solution: paying several thousand dollars to publish for all their own papers. This new policy will create a disparity across richer and poorer disciplines; will result in concentrating even more in the hands of large, rich, Western institutions, also penalising younger researchers; will kill observational studies and exploratory research; and will make disseminating science depending more on finances than on quality. This article calls for the full awareness of the academic community on the risks of the current situation in scientific publishing.

Rapidly progressive dementia (RPD) is a rare neurological disorder. Drug toxicity is among the differential diagnoses, including the use of lithium, in which an overdosage might cause cognitive dysfunction. Clinical suspicion, laboratory confirmation, and drug interruption are key points in the management of lithium intoxication. We described a 66-year-old female patient under treatment with lithium who developed an RPD associated with parkinsonian symptoms. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) showed an "Alzheimer-like" pattern, while cerebrospinal fluid biomarkers for the disease were negative. There was a significant clinical and radiological improvement after lithium interruption. Lithium intoxication is a potentially reversible cause of RPD, as demonstrated in this case report. Drug discontinuation should be considered even in patients with normal levels of this metal, if cognitive impairment is detected. ¹⁸F-FDG PET/CT images may show an "Alzheimer-like" image pattern in acute intoxication and are useful for monitoring these patients.

Autism spectrum disorder (ASD) is characterized by difficulties in social interaction and inflexible behaviors/interests. To quantify ASD traits in adults with preserved intelligence, the Autism Spectrum Quotient (AQ) was developed, which is a self-report instrument and one of the most used and recommended tools.

Objectives: We aimed to present a descriptive analysis of the AQ in a sample of Brazilian adults with neurotypical development (n=385) and investigate how the scale performs in a clinical subsample (n=33).

Methods: We recruited 1,024 participants. They answered the Self-Reporting Questionnaire-20 (SRQ-20), AQ, and about their psychiatric record. Then, we selected 385 participants without any psychiatric diagnosis to describe the distribution of the ASD traits. To investigate the AQ performance, we evaluated 33 adults with ASD and 19 adults with neurotypical development from the total sample (n=1,024).

Results: ASD traits were normally distributed in the population, with high internal consistency. Of a total of 91 men, volunteers with 32 points (clinical cutoff point) or more scored higher than 93% of the control sample. Of a total of 294 women, those who got a clinical score on the scale scored higher than 97%. In the clinical subsample (n=33), the positive predictive value (PPV) of the AQ was 0.84, and the negative predictive value (NPV) was 0.7.

Conclusions: The study population has a different profile compared to the original study regarding the AQ scale. ASD traits were normally distributed in the neurotypical sample, and the scale seems to have a satisfactory performance to predict ASD. Future studies are required to adequate the use of the scale in the Brazilian population.

The 12-item version of the Boston Naming Test (BNT) was adapted to Argentina for the detection of dementia due to Alzheimer's disease (AD), with scores similar to the original 60-item version (sensitivity and specificity of 85 and 94%, respectively) without demographic influence (age and educational level). To date, no publications on the use of abbreviated BNT in other degenerative pathologies with language impairment have been reported.

Objective: The objective of this study was to evaluate the usefulness of 12-item BNT in primary progressive aphasia (PPA), the behavioral variant of frontotemporal dementia (FTDbv), and AD.

Methods: Notably, 47 patients with probable AD (NIA-AA 2011) - clinical dementia rating (CDR) 0.5-1, 55 with FTDbv, 17 with PPA, and 46 controls were evaluated and matched for age and education. Exclusion criteria were as follows: alcoholism, other previous neurological or psychiatric illnesses, and education <4 years. All were assessed with a full neuropsychological battery and a 12-item version of BNT.

Results: Median scores of 12-item BNT were as follows: PPA: 3.87 (SD=2.99), AD: 6.13 (SD=3.03); FTDbv: 8.41 (SD=2.53); and controls: 10.22 (SD=1.82). Receiver Operating Characteristic (ROC) curves were plotted.

Conclusions: The 12-item version of BNT can be useful, simple, and fast to identify and differentiate PPA, FTDbv, and AD from controls while retaining the discriminative ability of the original version.