Dementia e Neuropsychologia最新文献

Alzheimer disease (AD) is a neurodegenerative disorder. Evidence suggests that AD shares pathophysiological similarities with type 2 diabetes. Intranasal insulin (INI) has emerged as a potential therapeutic approach for AD by directly targeting the brain and modulating insulin signaling pathways.

Objective: To evaluate the efficacy and safety of INI therapy for AD through a systematic review and meta-analysis of randomized controlled trials.

Methods: A search of electronic databases, including PubMed, Web of Science, Scopus, and Embase, was conducted to identify relevant studies published up to June 2024. Inclusion criteria encompassed peer-reviewed original research articles focused on humans, investigating the therapeutic effects of INI administration on cognitive impairment associated with AD, and reporting quantitative data on cognitive outcomes, biomarkers, or pathological markers relevant to AD. A meta-analysis was conducted to quantitatively synthesize the effects of INI on cognitive outcomes.

Results: A total of 647 articles were identified, and eight studies met the inclusion criteria. The overall odds ratio was 3.75 (95%CI 1.49-9.40). The test for overall effect showed a statistically significant difference (p<0.05). However, the I² value indicated a high level of heterogeneity (85.5%), suggesting significant variability among the studies.

Conclusion: While the current data is not yet conclusive enough to definitively establish INI as a standard treatment for AD, the evidence supporting its safety, efficacy, and reduced risk of systemic side effects suggests potential cognitive benefits for improving global cognition in patients with AD.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, memory loss, and behavioral changes. Despite being the most common cause of dementia, effective treatments have been elusive. However, recent years have witnessed significant advancements in understanding and treating Alzheimer's. Key to these advancements is the shift toward targeted therapies tailored to individual genetic and biomarker profiles, promising more effective outcomes while minimizing side effects. The integration of advanced neuroimaging techniques has revolutionized early diagnosis and disease monitoring, enabling proactive intervention strategies that may alter disease trajectories. This review provides an overview of these advancements, focusing on disease-modifying therapies, symptomatic treatments, combination therapies, lifestyle interventions, biomarker development, innovative drug delivery systems, immunotherapy, gene therapy, and neuroprotective agents.

In cases of dementia or major neurocognitive disorder, restless legs syndrome has not been extensively studied because the diagnosis relies on clinical assessments and self-reports from patients.

Objective: The aim of this study was to investigate the association between Willis-Ekbom disease/restless legs syndrome and iron-deficiency anemia in older adults with dementia.

Methods: A cross-sectional study was conducted with 70 older adults diagnosed with dementia and restless legs syndrome at a psychogeriatric clinic in the state of São Paulo, Brazil. The participants answered data collection instruments addressing sociodemographic characteristics, restless legs syndrome, neuropsychiatric symptoms, sleep quality, daytime sleepiness, and cognitive function. Creatinine, ferritin, red blood cells, hemoglobin, and hematocrit were determined by blood exams (the latter of which was collected from the patient records).

Results: The sample was composed predominantly of individuals with mixed dementia (i.e., Alzheimer's disease+vascular dementia). Women accounted for 55.7% of the sample, with a mean age of 77.80±9.36 years. The prevalence of restless legs syndrome among the participants was found to be 15.7%. Individuals with this syndrome had greater frequencies of neuropsychiatric symptoms, poor sleep quality, higher BMI, and lower ferritin levels (p<0.05).

Conclusion: The prevalence of restless legs syndrome among older adults with dementia was 15.7%, and individuals with this syndrome had ferritin deficiency.

The assessment of living and health conditions of the institutionalized older adults contributes to the development of health promotion measures. The high prevalence of cognitive decline in this population leads to unfavorable health outcomes, which can be prevented and managed.

Objective: To investigate the health conditions of institutionalized older adults according to global cognitive performance.

Methods: Cross-sectional study of institutionalized older adults in Brasília, Distrito Federal (DF) and Salvador, Bahia (BA) using questionnaires on multidimensional health assessment and the Mini-Mental State Examination (MMSE).

Results: Of the 185 residents, 86 were evaluated, with the majority of the sample composed of women and people aged 80 years old or older. Cognitive decline in the MMSE was associated with greater difficulties in Activities of Daily Living (ADL) (62.5%). Lower performance on the MMSE was correlated with longer length of institutionalization (p=0.043), older age (p=0.004), poorer Geriatric Oral Health Assessment Index (GOHAI) (p=0.087), greater difficulty in ADL (p<0.001), and higher scores on the Bristol scale (p<0.001). Conversely, higher education (p<0.001), better scores on the Mini Nutritional Assessment (p=0.003), larger Calf Circumference (CC) (p=0.036), and Hand Grip Strength (HGS) (p=0.0467) were associated with better performance in the MMSE.

Conclusion: The cognitive performance of institutionalized older people is correlated with sociodemographic and health variables. These results are oriented toward the formulation of public health policies and care management.

Psychiatric disorders have been recognized as important risk factors for neurodegenerative diseases, especially dementia. The strength of association varies among different psychiatric conditions, being more pronounced in severe mental illnesses, i.e., schizophrenia and bipolar disorder. Multiple mechanisms seem to underlie this association, such as high prevalence of cardiovascular and other physical morbidities, poor lifestyle choices, and accelerated aging, including 'inflammaging'. They all represent opportunities for intervention, but it is still unclear whether current therapeutic approaches for psychiatric disorders can prevent the development of dementia. Other knowledge gaps include whether the risk of dementia applies to all patients with a certain condition, or if subgroups of patients are more vulnerable than others, whether different types of dementia are linked to specific psychiatric disorders.

The Clock Drawing Test (CDT) is a widely used tool for dementia screening, assessing executive functions by drawing an analog clock. With the rise of smartphones, many individuals have transitioned from their traditional watches to checking hours digitally. This raises questions about whether difficulties in CDT performance are linked to cognitive decline or lack of familiarity with analog clocks. A potential decline in the number of studies using the CDT may reflect concerns regarding this issue.

Objective: To investigate whether the number of studies using CDT has been affected over the years by the predominance of smartphones over analog clocks.

Methods: This bibliometric study analyzed 1,298 articles published in PubMed over the past 30 years (1994-2023). Data included year of publication region and methodological design. The chi-square test was used for statistical analysis. Significance was set at 5%.

Results: The number of studies using CDT has increased over the past 30 years, from 118 (1994-2003) to 405 (2004-2013) and 775 (2014-2023). Most studies were conducted in Europe (37.6%), Asia (27.7%), and North America (21.0%). The primary focus of the studies was diagnosis (82.2%), followed by treatment (11.5%).

Conclusion: The prevalence of smartphones over analog clocks has not affected the number of studies that have used CDT. Although analog clocks are no longer a part of daily life for many people, this trend does not currently pose an obstacle to the use of the CDT.

Bipolar disorder (BD) is a psychiatric disorder associated with functioning and cognitive impairments, as well as a higher prevalence of physical disease comorbidities.

Objective: To determine the main predictors of functioning in patients with BD.

Methods: Thirty-five patients with BD type I in remission participated in this study. To better characterize the degree of impairment, 20 matched controls were also studied. Functioning was assessed through the Functioning Assessment Short Test (FAST) and the UCSD Performance-based Skills Assessment (UPSA), while cognition was assessed through the BAC-A. Current physical conditions were assessed and categorized according to the Cumulative Illness Rating Scale (CIRS). Regression analyses were performed to examine the relationship between functioning and clinical variables, global cognitive performance, and physical comorbidities in BD.

Results: UPSA correlated positively with the BAC-A total score (r=0.488; p=0.025), years of education (rho=0.41; p<0.01), and CIRS total score (rho=0.394; p<0.001). CIRS was the only predictor that remained negatively and significantly correlated with the UPSA total score (R²=0.446, F (1, 33)=8.198, p=0.007).

Conclusion: Patients with BD had poor functioning, with the primary determinant of poor functioning being the burden of physical illnesses. In addition, the low agreement between the FAST and UPSA scales suggests these tolls assess distinct constructs.

Like a coin, the impacts of screens on children's development have two sides, as reflected in current scientific knowledge. This narrative review aimed to explore the dual-faceted state of the art regarding screen use, highlighting both positive and negative aspects on neurodevelopment, intervention proposals, and future perspectives for appropriate screen use. Recent scientific findings emphasize two central points: on the one hand, the benefits of appropriate use, such as co-viewing and the use of educational content; on the other hand, the negative impacts of excessive screen use, passive, and non-educational use on the development of neural networks. In this sense, with the advent of the digital age and in light of current scientific results, it is clear that eliminating screens from daily life is unrealistic. Therefore, implementing strategies to ensure a healthy balance between screen time and other activities important for child development is essential.

Children with autism spectrum disorder (ASD) may experience impairments across all domains of the International Classification of Functioning, Disability, and Health. However, there is a scarcity of programs that integrate interventions encompassing all these domains.

Objective: To investigate parents' perception of performance and satisfaction with functional goals for children with ASD after intervention with the Global Integration.

Methods: This single-group quasi-experimental study involved a total of 98 participants aged 1.8 to 18.2 years who underwent a 3-month intervention, five times a week, for 3-4 h per day. The intervention involved functional task training in an environment inspired by the natural environment associated with the use of a flexible therapeutic suit. The primary outcome measure was the Canadian Occupational Performance Measure, administered before and after the intervention.

Results: Ninety-five participants completed the study. Approximately 60% of participants showed improvements in performance and satisfaction that ranged from 1 to 9 points on the Canadian Occupational Performance Measure. The Global Integration Method program resulted in significant improvements in goal performance (p<0.001, d=0.80) and satisfaction (p<0.001, d=0.67). Most parents (81%) believed that the Global Integration Method incorporated aspects of family-professional collaboration and were satisfied (93%) with the intervention.

Conclusion: In the perception of parents, the Global Integration Method demonstrated effectiveness in achieving functional goals for children with ASD and their families. Parents expressed satisfaction with the intervention and indicated that it incorporated elements of family-professional collaboration.