Dementia e Neuropsychologia最新文献

Anticholinergic burden (ACB) and polypharmacy are poorly studied in the context of primary care in Brazil.

Objective: To evaluate the ACB and polypharmacy of individuals with suspected dementia referred from primary care to tertiary dementia outpatient clinics in Brazil.

Methods: We performed a cross-sectional study in two tertiary dementia clinics. We included individuals with suspected dementia referred from primary care. Sociodemographic variables, number of drugs, ACB score, disease duration, Mini Mental State Examination (MMSE) were collected in the first evaluation. Final diagnosis received was also collected.

Results: A total of 921 individuals were included, with a median (IQR) age of 72 [64-78] years, 57.8% (532) women, 4 [2-7] years of formal education and 15 [10-20] points in MMSE. Most patients had a final diagnosis of dementia (66%, 616) and Alzheimer's disease (21.4%, 197), psychiatric disorders (16%, 147) and multifactorial dementia (14.8%, 136) were the most common diagnoses. Most individuals (68.1%, 627) were using at least one medication with anticholinergic effect, and in 44.6% (411) there was polypharmacy. ACB total score correlated with MMSE (rho=-0.13) and with total number of medications (rho=0.52). In multivariate regression, ACB score ≥1 was associated with MMSE and polypharmacy.

Conclusion: Most individuals referred from primary care in Brazil were using at least one medication with anticholinergic effect and this was correlated with cognitive severity. Educational measures for primary care physicians, focusing on the management of pharmacological treatment, are essential to reduce the anticholinergic load in this context.

Cerebral Amyloid Angiopathy (CAA) is a small vessel disease associated with β-amyloid (Aβ) deposition in cortical and leptomeningeal vessels. Traditionally diagnosed through invasive methods, it can now be identified via advanced imaging modalities, enhancing non-invasive diagnostic accuracy. A subset of patients exhibits an inflammatory presentation, termed Inflammatory Cerebral Amyloid Angiopathy (CAA-RI), characterized by cognitive decline, behavioral changes, and neurological deficits. This study highlighted two cases of CAA-RI with subacute onset, detailed clinical progression, and distinct MRI findings consistent with revised diagnostic criteria, enabling early suspicion. Both cases showed significant improvement with immunosuppressive therapy, reinforcing the potentially reversible nature of CAA-RI and the importance of early recognition. This article underscores the relevance of advanced imaging in the differential diagnosis of CAA and the potential for improved patient outcomes with timely treatment.

One year after the German-American neurologist and psychiatrist Kurt Goldstein had died, the Soviet-Russian neurologist Alexander R. Luria published a brief obituary-like article in which he praised Goldstein's 1925 lecture Das Symptom (The symptom) as the founding text of neuropsychology. Some reasons given by Luria for praising Goldstein's paper, however, seem unclear. The present contribution presents the core ideas of Goldstein's paper, and analyses in which way Luria may not have fully grasped its scope. In fact, Das Symptom looks rather like a founding lecture on how to convincingly understand neuropathological symptoms for the benefit, among other things, of neuropsychology, with implications even for present-day neuroscience.

Dementia is one of the biggest global health crises of the 21st century. It is known that Alzheimer's disease (AD) is the most common cause of dementia. Therefore, developing drugs with the potential to alter disease progression has been a priority.

Objective: This study aims to review the efficacy and safety of drugs for AD.

Methods: Based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) document, a systematic review was carried out in different databases. The Alzheimer's Disease Assessment Scale (ADAS-Cog) was used as the primary outcome. The risk of bias was checked using the Risk of Bias in Randomized Trials (RoB 2).

Results: A systematic review resulted in 64 articles which were included in the analysis. The main medications discussed were: donepezil, which demonstrated a significant improvement in cognitive function, with good tolerability, although it has limitations in patients with swallowing difficulties. Transdermal patches showed similar effectiveness and were recently approved. Galantamine showed benefits on cognitive function, with good tolerability. Rivastigmine was effective and presented in transdermal form with similar efficacy to capsules, but had mainly gastrointestinal adverse effects. Pioglitazone showed no significant results initially, but some studies suggest benefits in patients with AD associated with type II diabetes mellitus.

Conclusion: The studies reviewed indicate that, although some current medications such as donepezil, galantamine, and rivastigmine have modest, well-established benefits in clinical practice, many new agents have not yet demonstrated significant efficacy in modifying AD progression.

Studies have shown that visual impairment is associated with an increased risk of cognitive decline. Individuals with co-existing cognitive and visual impairments are also at a higher risk of having disability, which can further impact on one's independence in everyday activities. Computerized Cognitive Training (CCT) is one of the non-pharmacological interventions in managing cognitive decline.

Objective: This study investigated the effects of an auditory CTT program in a group of participants with both cognitive and visual impairment.

Methods: Sixteen participants were recruited. Participants had cognitive complaints and visual impairment. They received eight sessions of auditory-based CCT once or twice a week for 45 minutes within a 6-week period for each participant. Pre- and post-assessments were conducted before and after the training. Neuropsychological assessments included the Cantonese version of the Mini-Mental State Examination (CMMSE), the digit span forward test, the Chinese version of the Verbal Learning Test (CVVLT), and memory subtest of Neurobehavioral Cognitive Status Examination (NCSE). Pre- and post- mean assessment scores were compared.

Results: Mean CMMSE score for this group of participants was 18.1. Significant differences were found in four assessments (digit span forward, CVVLT-Total: CVVLT-first trial, and NCSE-memory). No significant differences were found in the other tests. Additional repeated measures analysis showed age might play a role in CVVLT first trial and CVVLT total scores.

Conclusion: The study is limited by its one-group design. The results provide preliminary evidence that auditory-based CCT may be beneficial to attention and memory in people with both cognitive and visual impairment.

In the developing countries, there is a long delay between parents' first concerns and the diagnosis of neurodevelopmental disorders such as autism spectrum disorder (ASD) and intellectual disability (ID).

Objective: To verify the time interval between the first concerns reported by parents and the diagnosis of ASD and ID in a pediatric neurology outpatient clinic in the public health network in Brazil, and to verify any association between indicators of cognitive functioning and behavioral and emotional problems.

Methods: One hundred and six children diagnosed with ID (n=69) and ASD (n=37), with a mean age of 10.03 years; standard deviation (SD)=2.2. The inclusion criteria were diagnoses of ID and ASD, and the exclusion criteria were comorbid conditions such as attention-deficit/hyperactivity disorder and specific learning disorder.

Results: The mean age of reported first symptoms was 29.9 months (SD=19.5) for ASD and 37.9 months (SD=19.5) for ID; and the mean time from first concerns to diagnosis of ID was 6.8 years (SD=2.2) and 6.6 years (SD=2.7) for ASD. Children with ID scored significantly lower than those with ASD cognitive functioning (t [97]=-16.22, p<0.001). Children with ID had higher mean scores for externalizing problems (M=62.20; SD=11) and those with ASD had higher mean scores for internalizing problems (M=66.71; SD=10.01).

Conclusion: The results indicated a late diagnosis in the sample and, given the mental health care received, the data highlight the need for training primary care professionals to identify and diagnose ASD and ID at an early stage.

Individuals with Down syndrome (DS) are at a higher risk of developing dementia at an earlier age. Identifying and summarizing studies that provide strong evidence in drug therapy is crucial for aiding healthcare professionals in clinical decision-making.

Objective: To identify systematic reviews (SRs) published in various databases and evaluate the effectiveness of pharmacological interventions for treating dementia specifically in individuals with DS.

Methods: SRs published in the United States National Library of Medicine (PubMed), Scopus, Web of Science, Biblioteca Virtual em Saúde (BVS), and Cochrane Library over the past ten years were included. The methodological quality of the SRs was assessed using the AMSTAR-2 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools.

Results: Five SRs were included, analyzing the effects of simvastatin, antioxidants, acetyl-L-carnitine, anticonvulsants, acetylcholinesterase inhibitors (donepezil), NMDA receptor antagonists (memantine), and fast-acting intranasal insulin on dementia symptoms in DS patients.

Conclusion: All SRs indicated low - or less - certainty of evidence, suggesting that various pharmacological approaches should be interpreted with caution.

P300 is a long-latency evoked potential that takes place around 300 milliseconds after the onset of a relevant stimulus. It can be assessed by measuring the latency and amplitude of the P3 wave, which are associated with information processing time and attention level, respectively.

Objective: To investigate the association between sleep quality and latency and amplitude of the P300 wave in aged individuals.

Methods: A quantitative and observational cross-sectional study was conducted with 28 older adults, excluding those with cognitive impairments or hearing loss. Sociodemographic data, P300 test latency and amplitude and the Mini Sleep Questionnaire were used, which defined two study groups: good sleep and altered sleep.

Results: The results indicated that the group with altered sleep quality presented lower P3 wave amplitudes in the Cz, Fz and Pz channels (p=0.07; p=0.00; p=0.01, respectively). No significant differences were observed in the P300 wave latency between the groups. In the correlation test, it was noticed that the more sleep altered, the lower the P3 wave amplitude in the Fz channel (rho=-0.46, p=0.02).

Conclusion: P300 amplitude was sensitive to changes in sleep quality, suggesting a decline in attention without a corresponding effect on the information processing speed. There is a relationship between amplitude of the P300 wave and sleep quality in aged people, suggesting that poor sleep quality exerts negative impacts on cognitive performance.

Down syndrome (DS) is a genetic condition associated with cognitive and linguistic impairments, presenting specific challenges in aging and an increased risk of cognitive decline.

Objective: To evaluate naming alterations in adults and older individuals with DS using the Object and Action Naming Battery (OANB) and to identify the influence of age, educational attainment, and degree of intellectual disability (ID) on linguistic performance.

Methods: This study included 26 individuals diagnosed with DS aged ≥20 years, assessed with the Cambridge Examination for Mental Disorders of Older Persons with Down Syndrome and Other People with Intellectual Disabilities (CAMDEX-DS) for cognitive evaluation and the OANB, a visual confrontation naming test including 162 objects and one hundred actions.

Results: No significant differences were found between groups based on ID level in object and action naming. Literate individuals performed better than non-literates in object naming (p=0.033), while verb naming was not influenced by educational level. Age did not correlate with naming performance, suggesting that typical aging is not an isolated determinant of naming impairment.

Conclusion: Our results indicate that contextual factors, such as educational level, have a greater impact on linguistic performance than intrinsic factors, such as ID degree or age. The OANB proved to be an effective tool for identifying performance patterns and supporting interventions for DS persons.