Dementia e Neuropsychologia最新文献

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.

Dysarthria is prevalent in Parkinson's disease (PD) and has negative effects on communication and social interaction. A gap exists in understanding whether patient-reported outcome measures can effectively identify speech disorders prematurely.

Objective: Compare the relationship between patients' reported outcome measures and the speech objective outcome measure between early-onset (EOPD) and late-onset Parkinson's disease (LOPD).

Methods: Thirty-nine participants diagnosed before age 50 (EOPD) and 32 diagnosed older than 50 (LOPD) were included. Self-perception was collected through the Radboud Oral Motor Inventory for Parkinson's Disease questionnaire. The speech samples collected involved diadochokinesia (/pataka/) and monologue. Auditory perceptive analysis was performed through the degree of dysarthria and acoustic analysis of speech.

Results: Regarding speech characterization, there were also no significant differences in ROMP (p=0.462), degree of dysarthria (p=0.423), and acoustic variables. In EOPD, the ROMP self-perception scale was consistent with the degree of dysarthria assigned by professionals through perceptual auditory analysis. However, in LOPD, there were discrepancies when patients had a severe degree of dysarthria. Additionally, both groups had a positive and significant correlation between disease duration and the degree of dysarthria concerning ROMP.

Conclusion: The results between clinical diagnosis of dysarthria and self-perception in the early and late onset groups showed no significant differences, indicating that self-perception may be a useful tool in identifying dysarthria.

Schizophrenia is a complex psychiatric disorder characterized by positive and negative symptoms, as well as cognitive deficits, with an impact on functioning.

Objective: To investigate the relationship between symptomatic remission, cognition, and functioning patients with schizophrenia, based on the criteria of the Remission in Schizophrenia Working Group, and to examine whether achieving remission reflects functional recovery.

Methods: The search was conducted in the United States National Library of Medicine (PubMed) and Biblioteca Virtual em Saúde (BVS) databases, covering observational studies published between 2014 and 2023, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results: After screening, 23 studies were included. The results indicated that remission is associated with better cognitive performance - such as memory, attention, processing speed, and flexibility - and functional outcomes.

Conclusion: These findings reinforce the importance of consistent criteria for comparisons across studies and clinical practice. Remission is a desired outcome for many patients. However, given the current treatment resources, it remains an objective that only a limited number truly achieve. Investigating its influence is essential for developing more effective interventions.

Parkinson's disease (PD) severely affects motor and non-motor functions, leading to dependency and reduced quality of life. Conventional rehabilitation methods often fail to meet patients' diverse needs. Virtual reality (VR) offers an innovative approach by creating immersive, customizable therapeutic environments.

Objective: This systematic review and meta-analysis evaluated the efficacy of VR interventions in PD rehabilitation compared to conventional therapies.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted across five databases for randomized controlled trials (RCTs) published until November 2023. Inclusion criteria encompassed RCTs comparing VR with other interventions in PD patients. Data on motor and balance outcomes were extracted. Risk of bias was assessed using the RoB 2 tool.

Results: Five RCTs, including 199 participants, were analyzed. VR interventions demonstrated significant improvements in the Time Up-to-Go (TUG) test (mean difference: -2.42; 95% confidence interval - 95%CI -3.95 to -0.89; p=0.002), indicating enhanced dynamic balance. However, the Berg Balance Scale (BBS) results favored the control group (mean difference: 3.28; 95%CI 1.92 to 4.65; p<0.00001).

Conclusion: VR interventions significantly improve dynamic balance and mobility in PD patients, as evidenced by TUG results. The limited impact on static balance tasks highlights the need for tailored interventions. While VR shows promise as a complementary therapy, challenges such as cost, accessibility, and standardization must be addressed to enhance its clinical utility.

Dementia significantly impairs cognitive function and severely affects daily living activities. To support independent mobility in older adults and individuals with dementia, home modification strategies, such as safety adaptations, have been identified as critical interventions.

Objective: To explore caregivers' perspectives on the potentials of digital interventions in enhancing independent mobility for PwD in mild to moderate stages of the condition. The aim is to determine if digital intervention could help PwD to effectively use existing home safety interventions and to safely move around their environment.

Methods: A cross-sectional survey was used to gather insights from 121 professional caregivers and family members providing care for PwD. Participants aged 18 years and above were eligible for inclusion. Responses were analysed using R software, employing descriptive statistics, contingency tables, and graphical charts. χ² tests (p<0.05) assessed the relationships between categorical variables, with Cramér's V measuring association strength (weak relationship if ≤0.30). Cronbach's alpha demonstrated reliability for mobility factors (0.87, 95%CI 0.810-0.908).

Results: The study revealed that PwD made limited use of existing home safety interventions, with statistically significant findings (p<0.05) across the four mobility factors evaluated. This indicates that the effectiveness of these interventions could be undermined particularly for individuals living alone.

Conclusion: The study found that digital interventions can support PwD in using existing home safety interventions and navigating their environments more independently. It could help the target population know when and how to these interventions thereby increasing the overall goal of their implementations.

Gene dysregulation in trisomy 21 can cause disorders of genes that are members of the heat-shock proteins (HSPs) family and contribute to the early onset of Alzheimer's disease (AD) in Down syndrome (DS).

Objective: Investigate in silico differently expressed genes (DEGs) of HSPs and the interaction with microRNAs (miRNAs) located in human chromosome 21 (Hsa21).

Methods: Two transcriptome libraries of human brain samples, datasets GSE5390 (DS) and GSE33000 (DA), were extracted from the Gene Expression Omnibus (GEO) and analyzed via GEO2R. DEGs with p-values (Adj p-values) <0.05 were analyzed via STRING. MiRNAs were identified in the miRbase database and analysis of their potential regulation on DEGs was performed using the DIANA tools.

Results: HSPE1, HSP90B1, HSPB8 and HSPA13 genes showed a different expression pattern in the transcriptomes of DS. The HSPA13 and HSPA2 genes showed an altered expression profile in the DS and AD datasets. In the predicted protein-protein interactions (PPI), we identified the interaction of HSPE1, HSP90B1, HSPB8 and HSPA13 with other HSP proteins. The miRNA encoded by Hsa21 (hsa-miR-155-5p) interacted with the HSPA13 gene.

Conclusion: The results suggest that certain genes encoding members of the HSP family, and in particular the interaction between miR-155-5p and HSPA13, may be associated with AD in DS.

The ability to walk independently is essential for the quality of life of individuals with Parkinson's disease (PD), and aspects such as mobility, balance, and cognition are important for walking. However, the association between these factors has not yet been fully established.

Objective: To verify the correlations between cognitive and motor clinical scales, and gait intervals in individuals with PD.

Methods: Twenty-two individuals with a clinical diagnosis of idiopathic PD were evaluated using balance and cognitive tests to classify the severity of the disease and gait analysis in the laboratory.

Results: The Unified Parkinson's Disease Rating Scale, motor part (UPDRS-III) was directly related to step width in the OFF state of medication (p=0.029); the Mini-Test of Balance Assessment System (Mini-BESTest) was inversely proportional to step width in medication ON (p=0.001) and OFF (p=0.005) states; Stroop-III was directly proportional to the stride time (p=0.039) and the stance (p=0.003) and double stance (p=0.011) phases and inversely proportional to the cadence (p=0.033) and swing phase (p=0.003), both in the ON state of medication; the Trail Making Test Part A (TMTB-A) was inversely proportional to step size (p=0.035), stride size (p=0.037), cadence (p=0.036) and speed (p=0.003) in the ON state.

Conclusion: Cognitive dysfunctions are directly related to gait instability in PD, reinforcing the importance of interventions that integrate motor and cognitive rehabilitation. These strategies can improve gait safety and efficacy in individuals with PD.

Parkinson's disease (PD) is associated with cognitive and personality changes that extend beyond its characteristic motor symptoms.

Objective: To analyze the effects of subthalamic nucleus deep brain stimulation (STN-DBS) on executive function (EF) and personality (The Five-Factor Model - FFM) in PD patients, comparing outcomes between those treated solely with medication and those receiving both medication and STN-DBS.

Methods: A total of 69 participants were divided into three groups: DBS, medication, and control. Evaluations included inventories, tests, and scales, with results summarized in tables highlighting sociodemographic variables and screening outcomes.

Results: Cognitive assessments indicated that the DBS group exhibited slightly lower cognitive scores compared to the medication group. Personality differences were minimal, with only extraversion demonstrating significance.

Conclusion: STN-DBS did not have a significant impact on executive functions or personality traits in patients with PD. These results highlight the importance of considering broader cognitive and neuropsychiatric factors when evaluating patient outcomes following DBS.