Dementia e Neuropsychologia最新文献

Reading anxiety (RA) significantly influences children's emotional and cognitive development, affecting their reading performance. Effective identification of RA requires reliable and valid assessment tools tailored for specific populations, such as Brazilian children.

Objective: To evaluate the psychometric properties, including validity and reliability, of the Brazilian version of the Reading Anxiety Scale (RAS) in elementary school children.

Methods: A sample of 225 Brazilian elementary students was assessed using the RAS-20. Confirmatory factor analysis (CFA) was employed to evaluate content-based validity. Internal consistency was measured using Cronbach's alpha, and Pearson's correlations assessed associations with external constructs such as reading performance and executive functions. Group comparisons were conducted using ANCOVA between children with and without reading difficulties.

Results: After CFA adjustments, a single-factor model with 18 items showed robust internal consistency. The correlation between RAS-20 scores and variables related to reading and cognitive functions supported moderate validity. Children with reading difficulties scored significantly higher on the RA scale than those without.

Conclusion: The adapted 18-item RAS version is a reliable and valid tool for assessing reading anxiety in Brazilian children, contributing to more effective identification and intervention in educational contexts.

There are a limited number of reports on dementia in Brazil. Due to data heterogeneity, dementia figures in Brazil do not uniformly reflect all regions. Therefore, data from the North and Northeast regions, historically most affected by social inequalities, are required.

Objective: To describe the sample of patients followed at a dementia outpatient clinic in a tertiary center in Northeastern Brazil.

Methods: This was a single-center, descriptive analysis of patients evaluated in the dementia outpatient clinic at the Federal University of Pernambuco between 2018 and 2023.

Results: A total of 145 patients with complete data were included in the descriptive analysis. The mean age was 71 years, and 57% were women. The most prevalent comorbidity was hypertension (54%), followed by diabetes (31%). Most patients were assessed in either the moderate (30%) or severe (33%) stage of dementia. Alzheimer disease was the most frequent diagnosis (31%), followed by frontotemporal dementia (14%) and vascular cognitive impairment (9%). Approximately 36% of the sample was classified as having mixed-pathology dementia. Neuroimaging assessments varied; 60% of patients underwent cranial magnetic resonance imaging, and molecular neuroimaging exams were performed in 42% of cases.

Conclusion: Patients referred for evaluation were mostly in moderate to advanced stages of dementia, with a significant prevalence of mixed-type and non-Alzheimer's pathologies. The present study may set the foundation for further collaborations and prospective studies.

In low- and middle-income countries, dementia awareness remains limited; behavioral and psychological symptoms of dementia (BPSD) are often misunderstood and underutilized in early screening.

Objective: To examine the correlation between cognitive and behavioral symptoms using the Mini-Mental State Examination (MMSE) and the Neuropsychiatric Inventory Questionnaire (NPI-Q) in a Vietnamese clinical sample.

Methods: A total of 98 participants aged 40 and above with memory complaints were recruited from the outpatient dementia clinic at University Medical Center, Ho Chi Minh City. All participants underwent neurological and physical examinations, cognitive screening using the Vietnamese version of the MMSE, and behavioral assessment using the Vietnamese NPI-Q completed by caregivers. Brain imaging via computed tomography (CT) or magnetic resonance imaging (MRI) was also performed. Participants were categorized based on MMSE scores, and correlations between MMSE and NPI-Q scores were analyzed.

Results: BPSD was present in 95.9% of participants. Anxiety was most frequent in individuals with subjective memory complaints, while psychotic symptoms and apathy were more common in those with severe cognitive impairment. A moderate negative correlation was found between MMSE and NPI-Q scores.

Conclusion: The combined use of MMSE and NPI-Q, supported by brain imaging, may provide a practical approach for the initial screening of individuals with memory complaints, particularly in low- and middle-income countries (LMICs) where access to specialist resources is limited.

Subjective cognitive decline and mild cognitive impairment are often associated with gait disturbances, increasing dementia risk. Cerebral small vessel disease (CSVD) may underlie these associations.

Objective: To examine the association between CSVD lesion types and locations with slow gait speed in older adults with subjective cognitive decline and mild cognitive impairment.

Methods: In this cross-sectional study, 124 older adults met the inclusion criteria. Participants underwent clinical evaluation, gait speed assessment, and brain magnetic resonance imaging. CSVD burden was assessed using the STRIVE-2 criteria and quantified using Fazekas and modified Scheltens scales. Logistic regression analyses were conducted to calculate odds ratios (OR) with 95% confidence intervals.

Results: Individuals with slow gait were older, had lower education levels, and a higher prevalence of hypertension. Neuroimaging analysis revealed a significant association between slow gait and global white matter hyperintensities (WMH) burden (Fazekas score ≥2: 34.5 vs. 12.1%, p<0.003; Scheltens score ≥5: 65.8 vs. 42.4%, p<0.010). Regional WMH analysis showed increased burden in frontal and occipital regions in the slow gait group. Lacunar infarcts were more prevalent in the slow gait group (15.2 vs. 3.4%, p=0.028). Multivariate analysis revealed that lacunar infarcts and WMH in specific brain regions remained significant predictors of slow gait, even after adjusting for confounders.

Conclusion: CSVD, particularly lacunar infarcts and specific WMH patterns, is associated with slow gait in this population. Early identification and management of CSVD may help mitigate its impact on gait and functional status.

Alzheimer's disease (AD) is one of the leading causes of dementia in older adults and is associated with a significant increase in the number of deaths globally.

Objective: This study analyzed mortality from AD in the state of Espírito Santo, Brazil, between 2013 and 2022.

Methods: This ecological time series study used data from the Mortality Information System and the Brazilian Institute of Geography and Statistics, identifying deaths per the International Classification of Diseases 10^th Revision (ICD-10) codes for AD (G30, G30.0, G30.1, G30.8, G30.9). Time trend analyses were estimated using Prais-Winsten linear regression to assess annual variations, and the Joinpoint regression model was applied to calculate the annual percentage change (APC).

Results: A total of 6,083 deaths from AD were identified during the study period. We observed a progressive increase in the absolute number of deaths, up from 375 in 2013 to 802 in 2022, as well as in the mortality rate, which rose from 9.77 to 21.02 per 100 thousand inhabitants. We identified a statistically significant upward trend (p<0.001), with a mean annual increase of 49.68 deaths (β₁=49.68) and an APC of 8.84%. Most deaths were recorded among women, with a mean age of 85.13 years, predominantly among white individuals and widows. Deaths occurred mainly in hospitals, followed by homes.

Conclusion: The study showed a significant increase in mortality from AD in Espírito Santo over the years, reinforcing the importance of preventive strategies aimed at health care and healthy aging.

Diagnosis of behavioral variant frontotemporal dementia (bvFTD) in its initial stages can be supported by brain [18F] fluorodeoxyglucose-positron emission tomography (FDG-PET). The routine use of semi-quantitative analyses in FDG-PET is formally recommended. However, the longitudinal changes observed in sequential FDG-PETs scans throughout neurodegenerative diseases remain insufficiently understood. In this case, a bvFTD phenocopy remained clinically stable for nine years before exhibiting functional decline consistent with bvFTD. Hypometabolism compatible with bvFTD was observed only on the third FDG-PET, performed six years after the first. Retrospective analysis revealed that the second FDG-PET had already shown a decline in metabolism in areas typically affected by bvFTD compared to the first scan. During the period of clinical stability, individual exams were insufficient to confirm the diagnosis. However, the metabolic decrease between the first and second scans may have indicated subclinical progression. The decline in semi-quantitative FDG-PET scores could represent a useful diagnostic tool in bvFTD.

Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) are progressive neurodegenerative diseases with unclear etiology. Mutations in the TBK1 gene are associated with an increased risk of both FTD and ALS, presenting a diverse phenotype that includes the behavioral variant of FTD, primary progressive aphasia, and pure ALS. This mutation is rare, and to date, only one case report on TBK1-related clinical manifestations has been published in Brazil.

Objective: To investigate the association between TBK1 gene mutations and the clinical manifestations of FTD and ALS in a Brazilian family, documenting the clinical history and disease progression of three first-degree relatives. Additionally, to conduct a literature review to better understand the impact of this mutation and its implications for neurological practice.

Methods: Clinical data were collected from three patients in the same family who were receiving care at Dom Pedro II Geriatric Hospital and Central Hospital of the Irmandade da Santa Casa de Misericordia de São Paulo, including information on clinical symptoms, disease progression, and complementary exams - particularly genetic testing to detect and confirm the diagnosis. A detailed analysis of the existing literature on the disease was also conducted to better understand the implications of this mutation.

Results: Three siblings affected by the TBK1 gene mutation were documented, with a unique family history suggesting that this genetic alteration has affected the lineage for several generations.

Conclusion: Although rare, frontotemporal dementia with accompanying motor deficits is of significant relevance to neurologists due to its poor prognosis and the potential familial impact on descendants.

Dementia has emerged as a growing global health concern, particularly in aging populations across the Americas. Despite increasing recognition of its burden, substantial gaps remain in understanding its mortality patterns, especially regarding sex differences and regional disparities.

Objective: To evaluate the temporal trends of sex disparities in dementia mortality across the American Continent.

Methods: This ecological study used Pan American Health Organization mortality data (2000-2019) validated against national and World Health Organization sources. Age-adjusted dementia mortality rates by sex and country were analyzed using joinpoint regression to estimate trends and detect significant temporal changes. Results were interpreted using annual percentage changes and their confidence intervals to classify trends as increasing, decreasing, or stationary.

Results: Across the Americas, dementia mortality trends were highly variable by country and sex. Some nations saw parallel trends between men and women, while others exhibited sex-based divergence in direction or intensity. Despite this variability, rising mortality was a common pattern in many locations, especially in North America and parts of South America.

Conclusion: Dementia mortality trends across the Americas reveal marked sex differences and regional heterogeneity, reflecting a complex interaction of demographic, social, and health system factors. These findings emphasize the need for gender-sensitive public health strategies, improved surveillance, and cross-national research to inform equitable and effective dementia care policies.

There has been limited attention given to awareness and subjective experience in people with dementia living in longterm care facilities (LTCFs), particularly those who are likely to have moderate to severe levels of cognitive impairment.

Objective: To understand the awareness of people with dementia living in LTCFs of their own condition and its relationship with sociodemographics, cognitive status, depression, neuropsychiatric symptoms and aspects related to care.

Methods: Medical Literature Analysis and Retrieval System Online (Medline), Scopus, Web of Science Core Collection and Cochrane Central Register of Controlled Trials were searched with a predefined search strategy (International Prospective Register of Systematic Reviews - PROSPERO: CRD42023472820), generating 2,694 articles. The studies included comprised an awareness evaluation in older residents with dementia. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist for analytical cross-sectional was applied to calculate the quality of the observational studies, and the results were synthesized narratively.

Results: Nine cross-sectional observational studies were eligible for this review. One developed a tool to evaluate awareness in residents with severe dementia. Four studies considered depression as an important mediator of awareness. Two studies explored the phenomenological perspective of awareness: the "what" (i.e. objects) and the "how" (i.e. mechanisms and modes of expression) in Alzheimer's residents. Two studies found a high prevalence of neuropsychiatric symptoms (mainly agitation and apathy) and an association with the severity of the dementia. All evidence concluded that the level of awareness decreases as cognitive deficit progresses.

Conclusion: Awareness in the context of LTCFs is influenced by complex factors and requires personalized care strategies that value their potential and reduce caregiver burden.

Bell's test, a cancellation task, permits a quantitative and qualitative evaluation of inattention and visual neglect. It was included in a neuropsychological assessment by Gauthier, Dehaut, and Joanette in 1989. It is a quick test that can detect visuospatial changes.

Objective: To demonstrate the importance of Bell's test in elderly individuals without visuospatial complaints. To evaluate Bell's test in different levels of schooling, age groups, Mini-Mental State Examination (MMSE), and the Modified Mini-Mental State (MMMS) tests.

Methods: A cross-sectional, randomized study was carried out on 278 elderly people, aged between 60 and 89 years old, with a mean age of 69.4 (±6.8 years standard deviation - SD). Among the participants, 73.9% of the females lived in Olinda City, Brazil. Age was stratified every five years between 60 and 89 years old, and schooling levels were categorized into four subgroups, ranging from illiterate to more than eight years old. Each participant underwent an analysis of age, sex, education, risk factors, MMSE, the modified MMMS, and Bell's test.

Results: The correlation between the A and B errors and age was statistically significant; as age increases, the number of errors also increases. A near significant and strong correlation was observed in individuals aged above 84 and between 60 and 64. Correlation between MMSE, MMSM, and Bell's test showed a significant, moderate negative correlation.

Conclusion: Increasing age worsens the results of the Bell test. The MMSE and the MMMS tests showed a direct relationship with the results of the Bell test.