Dementia e Neuropsychologia最新文献

Underlying the neuropsychological manifestations of Alzheimer's disease (AD), hypothalamic-pituitary-adrenal (HPA) axis dysregulation and subsequent hypercortisolemia have been proposed as major mechanisms driving AD progression from mild cognitive impairment (MCI) to the onset of dementia. Nonetheless, changes in cerebrospinal fluid (CSF) levels of HPA axis hormones remain controversial despite their potential in AD diagnosis and prognosis testing.

Objective: This study aimed to review the evidence of the variation in CSF levels of CRH, ACTH, and cortisol in subjects with mild cognitive impairment (MCI) and AD compared with subjects without cognitive disorders.

Methods: A systematic review was conducted in MEDLINE, EMBASE, and Web of Science databases on July 5, 2022.

Results: Seventeen observational studies were included. The results from the compiled investigations showed that individuals with AD exhibit a significant elevation of CSF cortisol levels which appear to correlate with the presence of the ApoE-ε4 allele, being higher in those homozygous for this allele. The variation of CSF CRH and ACTH levels in AD, on the other hand, is still inconclusive. Moreover, most studies found no significant difference in CSF cortisol levels in individuals with MCI compared to healthy subjects and patients with AD.

Conclusion: The findings gathered in this review disclose a significant elevation of CSF cortisol levels in AD. Future investigations are warranted to elucidate the potential use of CSF cortisol as a biomarker in AD-associated dementia.

Primary progressive aphasia is a clinical syndrome caused by neurodegeneration of areas and neural networks involved in language, usually in the left hemisphere. The term "crossed aphasia" denotes an acquired language dysfunction caused by a lesion in the ipsilateral hemisphere to the dominant hand.

Objective: To describe a case of crossed aphasia in a 60-year-old left-handed patient with a non-fluent variant of primary progressive aphasia diagnosis (age of onset=52), evidenced by a left asymmetry on brain SPECT scan.

Methods: Clinical and family history, the Edinburgh Handedness Inventory, Measurement of Functional Activities in Older Adults in the Community, the "Mini-Mental State Examination", the Trail Making Test, the Tower of London, and the Neuropsychological assessment for dementia, and neuroimaging studies were carried out.

Results: Neuropsychological assessment showed severe cognitive impairment, especially regarding language. The magnetic resonance imaging showed important signs of cortico-subcortical atrophy, with predominance in the frontal and temporal lobes. The single-photon emission computed tomography scan showed moderate to severe hypoperfusion in the left cerebral hemisphere, including the hippocampus.

Conclusion: We described a clinical case of crossed aphasia in a left-handed woman with a non-fluent variant of primary progressive aphasia with asymmetry on brain SPECT, mainly on the left, followed up for seven years.

Social cognition is an umbrella term used to address the set of neurocognitive processes involved in effective social interaction, such as Theory of Mind and empathy, and is important for understanding of others' intentions and actions and decision making. Narratives can serve as tools for learning social norms and understanding other people, as they involve mental simulations of social interactions. This review aimed to gather the results of current studies on the effects of reading and watching fiction movies on the development of social cognition. We included 16 publications, all of which were empirical studies. The results showed that, depending on individual factors, as well as on the specifics of the intervention, both reading and watching movies seem to influence the processes of development of social cognition, especially if associated with concomitant or subsequent activities, such as discussions. More research is needed to understand the specific details of this relationship.

Primary Progressive Aphasia (PPA) is a progressive language disorder associated with frontotemporal impairment and mainly affects the left hemisphere of the brain. In general, this condition compromises abilities related to comprehension and expression of language. The diagnosis of PPA depends on in-depth knowledge regarding functions of language, neurology, and neuropsychology. Speech and language therapists (SLTs) have a pivotal role in the diagnosis and rehabilitation of PPA. The absence of these professionals involved in the diagnosis and rehabilitation may reflect on the quality of care of people with PPA.

Objective: To identify the sociodemographic, educational, and professional practice characteristics of SLTs who work with people with PPA in Brazil.

Methods: An online questionnaire was disseminated to reach SLTs across Brazil. The questionnaire collected information regarding sociodemographics, training and education, practice (time, setting, service provision), and sources of referral.

Results: The study included 71 participants (95.8% women). Specialization was the most frequent educational level followed by master's degree, and participants where mainly from the Southeast and South regions of Brazil. Neurologists were the professionals who most referred patients with PPA to SLTs. Finally, SLTs worked primarily in homecare settings and provided mainly individual therapy services.

Conclusion: SLTs who work with PPA in Brazil can be characterized mainly as professionals with postgraduate degrees, relatively young, and from the South and Southeast regions of Brazil.

Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening that evaluates older people with low educational levels. In Chile, there are no normative data to assess this population.

Objective: To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person's performance on RUDAS and on the items that constitute it.

Methods: A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items.

Results: Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147).

Conclusion: This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.

Dementias secondary to cardiovascular diseases are the second cause of neurogenerative diseases. These conditions can be prevented by controlling risk factors, and it is necessary to observe the relationship between chronic diseases.

Objective: to know the influence of chronic non-communicable diseases on cognition and depressive symptoms in the elderly, amid the COVID-19 pandemic.

Methods: 578 older adults were evaluated using a sociodemographic questionnaire, the Brazilian Telephone version of the Mini Mental State Examination (Braztel-MMSE), the Geriatric Depression Scale (GDS-15) and an open questionnaire related to NCDs.

Results: the association of Non-Communicable Diseases (NCD) with age, depressive symptoms and schooling was confirmed.

Conclusion: no association with cognitive decline was evident due to the relationship of high schooling of participants and control of NCDs.

Effective communication skills are crucial for caregivers to provide quality care and meet the unique needs of patients of all ages. However, older patients have specific communication requirements, and their satisfaction depends on several factors.

Objective: This study aimed to evaluate the level of satisfaction among older adults in Marrakech, Morocco, regarding the communication skills of their caregivers, and to identify the factors influencing this satisfaction.

Methods: This is a cross-sectional study conducted between March and July 2022 among 204 people aged 60 years and older who presented to the Mouhamed VI University Hospital of Marrakech, Morocco, for various care services. The older adults' satisfaction with caregivers' communication was assessed by the American Board of Internal Medicine (ABIM) patient satisfaction questionnaire. Sociodemographic and clinical characteristics of the participants were collected through interview and consultation of medical records. Multiple linear regression was used to determine potential factors influencing the total satisfaction score.

Results: The total satisfaction score of older adults with caregiver' communication was 2.55±0.95 and the mean scores of the lowest subscales were answering questions, greeting and listening. Analysis revealed that having visual disorders (B=-0.276±0.12; p=0.029) and receiving affective touch from caregivers (B=0.745±0.12; p=0.001) were the main factors associated with older adults' satisfaction with caregiver' communication.

Conclusion: Older people are not sufficiently satisfied with caregivers' communication skills, especially those with vision problems and those who have not received affective touch from caregivers. Caregivers need to be aware of the specific needs of older patients and use appropriate communication techniques.

Parkinson's disease (PD) is a common neurodegenerative disease associated with cognitive impairment. The Montreal Cognitive Assessment (MoCA) has been used as a recommended global cognition scale for patients with PD, but there are some concerns about its application, partially due to the floor and ceiling effects.

Objective: To explore the floor and ceiling effects on the MoCA in patients with PD in Brazil.

Methods: Cross-sectional study with data from patients with PD from five Brazilian Movement Disorders Clinics, excluding individuals with a possible diagnosis of dementia. We analyzed the total score of the MoCA, as well as its seven cognitive domains. The floor and ceiling effects were evaluated for the total MoCA score and domains. Multivariate analyses were performed to detect factors associated with floor and ceiling effects.

Results: We evaluated data from 366 patients with PD and approximately 19% of individuals had less than five years of education. For the total MoCA score, there was no floor or ceiling effect. There was a floor effect in the abstraction and delayed memory recall domains in 20% of our sample. The ceiling effect was demonstrated in all domains (80.8% more common in naming and 89% orientation), except delayed recall. Education was the main factor associated with the floor and ceiling effects, independent of region, sex, age at evaluation, and disease duration.

Conclusion: The floor and ceiling effects are present in specific domains of the MoCA in Brazil, with a strong impact on education. Further adaptations of the MoCA structure for underrepresented populations may reduce these negative effects.

The aging population poses a serious challenge concerning an increased prevalence of Alzheimer's disease (AD) and its impact on global burden, morbidity, and mortality. Oxidative stress, as a molecular hallmark that causes susceptibility in AD, interplays to other AD-related neuropathology cascades and decreases the expression of central and circulation brain-derived neurotrophic factor (BDNF), an essential neurotrophin that serves as nerve development and survival, and synaptic plasticity in AD. By its significant correlation with the molecular and clinical progression of AD, BDNF can potentially be used as an objectively accurate biomarker for AD diagnosis and progressivity follow-up in future clinical practice. This comprehensive review highlights the oxidative stress interplay with BDNF in AD neuropathology and its potential use as an AD biomarker.

With the technological advancement and democratization of electronic devices, computerized cognitive tests have been increasingly used in the clinical context to evaluate cognitive performance in individuals.

Objective: This study aimed to propose a brief digital cognitive test based on the paradigm of stimulus equivalence and assess its convergent validity by comparing it with traditionally applied tests.

Methods: The study was carried out with a non-probabilistic sample of 50 older adults selected from a public call through the communication media, health units, and day centers of a city in the countryside of São Paulo. Participants were assessed by the brief digital cognitive test, Mini-Mental State Examination, Brief Cognitive Screening Battery, and the Five Digit Test.

Results: Participants had a mean age of 71.23 years (standard deviation [SD]: ±9.36) and a mean of 7.15 years of schooling (SD: ±5.34). The mean time to answer the test was 5.33 minutes (SD: ±1.92). There were statistically significant correlations between traditional and digital tests in most domains evaluated. In addition, considering the total score of the digital test, the test could discriminate participants with and without cognitive impairment: area under the ROC curve=0.765; 95%CI 0.630-0.901.

Conclusion: The brief digital cognitive test, using the stimulus equivalence paradigm, is an easy-to-apply and valid instrument for the investigation of cognitive impairment in older adults.