Arquivos de neuro-psiquiatria最新文献

Studies on the association between pineal gland calcification (PGC) and non-breathing sleep-related symptoms are inconclusive.The present study aims to evaluate this association in middle-aged and older adults living in rural villages located in coastal Ecuador.Community-dwellers aged ≥ 40 years enrolled in the Three Villages Study cohort were interviewed with the Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality and received head computed tomography for automated measurement of PGC volumes. Generalized linear and logistic regression models were used to assess the association between PGC volumes (exposure) and the PSQI score and sleep quality (as separate dependent variables), after adjusting for age and sex.The study included 1,009 participants (mean age: 56.5 ± 12.6 years; 57% women). The mean volume of PGC was 51 ± 53.5 µL. The mean score of the PSQI was 5.3 ± 2.8 points, with 399 (40%) participants having poor sleep quality. Locally-Weighted Scatterplot Smoothing showed a linear relationship between continuous PGC volumes and PSQI scores. An unadjusted generalized linear regression model showed a significant association between PGC volumes stratified in tertiles and the continuous PSQI score. However, this association lost statistical significance after adjustment for age and sex. The association between tertiles of PGC and poor sleep quality was non-significant in both unadjusted and multivariate logistic regression models.Study results did not find an association between increased PGC and sleep quality after adjusting for demographics, suggesting that PGC may not necessarily indicate pineal dysfunction but could reflect adaptive physiological mechanisms.

The Activity Limitation Measure (ACTIVLIM) is a self-reported instrument consisting of 22 daily activity items graded on 3 levels (easy, difficult, or impossible).To translate, culturally adapt, and validate the Brazilian Portuguese version of the ACTIVLIM for individuals with neuromuscular disorders.The present was a cross-sectional observational study. The translation process followed standardized guidelines, including steps such as forward translation, synthesis, back-translation, expert committee review, and pretesting (psychometric analysis). A total of 268 individuals with neuromuscular disorders filled out the Brazilian ACTIVLIM. Test-retest reliability was assessed in a subgroup of 60 participants, who were evaluated twice by the same physiotherapist with an interval of one month.The intraclass correlation coefficient (ICC) for intrarater reliability was of 0.95. Internal consistency was high (Cronbach's alpha = 0.940). External validity showed strong correlations involving ACTIVLIM scores and the scores on the Vignos scale (r = -0.907), the Brooke scale (r = -0.908), and the Functional Independence Measure (r = 0.864), all with p < 0.001. Proximal muscle strength in the upper (r = 0.748) and lower limbs (r = 0.793), measured through the Medical Research Council scale, also correlated significantly with ACTIVLIM scores. Linear regression identified that the scores on the Vignos (R² = 0.8236), and Brooke scales (R² = 0.8132), as well as proximal muscle strength in the lower (R² = 0.6480) and upper limbs (R² = 0.5805), were the main predictors of ACTIVLIM variance.The Brazilian Portuguese version of the ACTIVLIM demonstrated strong reliability and validity. Its scores were significantly associated with disability level, functional independence, and muscle strength in individuals with neuromuscular disorders.

Aging is accompanied by an increasing incidence of dementia. Alzheimer's disease (AD) is the leading cause of dementia, and it impairs autonomic function. Heart rate variability (HRV) is a marker of autonomic function, but findings in AD are conflicting, and there is scant information on the association of HRV with falls in dementia patients.To assess autonomic activity in older adults with AD, comparing these patients to older adults without dementia (the control group, CG), and to investigate the relationship between HRV and falls.The HRV was analyzed in older adults without dementia and in those with AD using a heart rate monitor. The measurements were made on a single day in the supine and orthostatic positions for 10 minutes each. The HRV components in the time and frequency domains were assessed, along with the history of falls in the past 3 years.The groups were homogenous, with a predominance of female individuals, and mean ages of 81 (AD) and 79 (CG) years. A reduction in the R-R interval upon changing from the supine to the orthostatic positions was evident in both groups, but the AD group showed reduced parasympathetic components in the orthostatic position. For the frequency domain, a reduction in high frequency (HF) and increases in low frequency (LF) and in the LF/HF ratio were observed, suggesting increased sympathetic and reduced parasympathetic activities. The AD group presented more falls, whose incidence was associated with HRV components.Alzheimer's disease was associated with worse autonomic dysfunction, increased sympathetic activity and greater parasympathetic impairment, a high incidence of falls and interaction with HRV components.

Tarsila do Amaral's painting "Abaporu" is a seminal work in Brazilian modernist art, yet its interpretation continues to intrigue scholars due to its complex symbolism.To examine "Abaporu" through the perspective of neuroesthetics, exploring potential parallels between its visual elements and sensory disturbances characteristics of migraine aura.A structured review of primary and secondary art-historical sources and a systematic literature search in PubMed and Google Scholar were conducted. The analysis focused on Amaral's recurrent use of disproportion and gigantism in the 1920s and on evaluating the plausibility of a neuroesthetic hypothesis in this art-historical context.Our analysis indicated that the gigantism and deliberate deformation in "Abaporu" belong to a consistent program already evident in Amaral's 1920s painting. From this perspective, the painting's oversized feet and hands contrasting with a diminutive head evoke perceptual alterations reminiscent of macropsia and micropsia, phenomena linked to Alice in Wonderland Syndrome and migraine aura. Its vibrant palette and melancholic undertones, likewise, resound the sensory disturbances and affective dimensions associated with migraine, suggesting that Amaral's programmatic distortions also invite a neuroesthetic reading.While no evidence supports a medical diagnosis of migraine in Amaral, the visual motifs and techniques in "Abaporu" can be read both as deliberate esthetic strategies of her Pau-Brasil and Anthropophagic phases and as intuitively resonant with neurological models of altered perception. This dual lens enriches our understanding of art's capacity to embody complex perceptual experiences and encourages further interdisciplinary dialogue between art history and neuroscience.

Dengue encephalitis is an uncommon neurological complication of dengue virus infection. In immunocompromised patients, such as solid organ transplant recipients, the clinical presentation may be atypical and nonspecific, posing significant diagnostic and therapeutic challenges. We report a clinical case and use it as a framework to discuss key considerations for suspicion of dengue encephalitis. Topics include optimal timing for clinical suspicion, essential differential diagnoses, and the most appropriate diagnostic strategies. Emphasis is placed on the correct interpretation of cerebrospinal fluid findings and recognition of subtle brain magnetic resonance imaging changes that may support the diagnosis. The discussion also reviews current evidence on dengue encephalitis in immunocompromised populations, highlighting implications for timely diagnosis and management in this vulnerable group.

SuperAgers (SA) are adults aged ≥ 80 years with memory equivalent to individuals 20 to 30 years younger. Few studies have evaluated multimodal neuroimaging approach in the same SA cohort.To investigate neurobiological mechanisms underlying exceptional cognitive aging by evaluating cortical amyloid deposition, regional cerebral glucose metabolism (rBGM), and gray matter volume (GMV), and their associations with neuropsychological performance and subjective cognitive decline (SCD).The participants were classified as SA (n = 11), age-matched healthy controls (HC80; n = 23), and healthy controls aged 60 to 69 years (HC60; n = 23). Positron-emission tomography (PET) using ¹¹C-PIB and ¹⁸F-FDG were analyzed using semiquantitative three-dimensional stereotactic surface projection (3D-SSP), with group comparisons using Statistical Parametric Mapping 8 (SPM8).The median ages were 81 years (interquartile range [IQR] = 5.0) for SA, 83 years (IQR = 5.0) for HC80, and 66 years (IQR = 3.0) for HC60. All groups had a median of 16 years of schooling (IQR for SA = 7, for HC80 and HC60 = 5). There were 4 PIB-PET positive individuals (36.4%) in the SA group, which is similar to the HC80 group (40.9%). Also, 6 SA had SCD, with 3 being PIB-positive. In SA, composite SUVr predicted RAVLT delayed recall (β = -0.666, p = 0.011, adjusted R² = 0.748), controlling for age, sex, and schooling. Compared to HC80, the SA group showed increased metabolism in the anterior cingulate gyrus and caudate, as well as increased GMV in the putamen.The SA group exhibited similar amyloid burden to HC80, yet amyloid deposition specifically impaired their memory. Increased rBGM and GMV in the salience network and striatum suggest these regions support successful cognitive aging.

Parkinson's disease (PD) is a progressive neurodegenerative disorder associated with substantial disability, morbidity, and mortality. Timely diagnosis and treatment are essential to mitigate its impact. Despite its burden, real-world data on PD in Brazil remain limited.To describe the demographic and clinical profile of individuals with PD treated in the Brazilian public healthcare system and to evaluate patterns of treatment and healthcare resource utilization (HCRU).The present observational, retrospective, longitudinal study analyzed data from the Brazilian public healthcare system (Sistema Único de Saúde, SUS, in Portuguese) between January 2013 and December 2022. Patients aged ≥ 20 years with at least 2 core procedures coded for PD (ICD-10 G20) were included. Inpatient and outpatient datasets were analyzed separately.A total of 53,674 PD patients were identified. The mean age at diagnosis was 65.4 years, with a slight male predominance (53.0%). Most patients (47.0%) had more than 6 outpatient visits, and 44.4% had 1 or 2 hospitalizations. The most frequent procedures were PD treatment (inpatient) and physical therapy (outpatient). The most used medications were pramipexole (45.6%), amantadine (26.0%), and entacapone (17.1%).The present study provides valuable insights into the demographic and clinical profile of PD patients in Brazil, highlighting frequent procedures and treatment patterns. A key limitation is the non-capture of basic PD medications, such as levodopa, which are often dispensed outside the analyzed datasets. These findings underscore the need for improved data integration and access to comprehensive PD care within the public health system.

Fear of falling can be present in the daily lives of patients with Parkinson's disease (PD) due to their predisposition to falls.The main objective of this study was to translate the Fear of Falls Scale (FFS) into Brazilian Portuguese, adapt it cross-culturally, and validate it.A multicenter, cross-sectional study was conducted with PD patients fluent in Brazilian Portuguese, recruited from five research centers in Brazil. Descriptive analysis characterized the sample and compared the data. Cronbach's α and McDonald's ω coefficients were used to assess the internal consistency of the scale.No significant differences were observed between the translated versions T1 and T2. The B1 and B2 versions did not present significant divergences in the back-translation from the original scale. The Movement Disorder Society - Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III significantly correlated with motor skills (rho = 0.56, 0.43-0.67; p ≤ 0.001) and fear of falling (rho = 0.48, 0.34-0.60; p ≤ 0.001). Higher stages on the modified Hoehn & Yahr scale were associated with a greater decline in motor skills and a greater fear of falling (p < 0.001). The total internal consistency of balance-related motor skills and fear of falling was considered sufficiently reliable. Cronbach's α values were 0.96, 0.91, and 0.90; while McDonald's ω values were 0.96, 0.92, and 0.91, respectively.The Brazilian version of the FFS proved to be valid and reliable for assessing fear of falling in people with PD.

Fatigue is a frequent and under-recognized symptom in adults with spinal muscular atrophy (SMA). Although motor scales can detect disease progression, they may be insufficiently sensitive over short observation periods, particularly in patients with slower progression.To assess the prevalence and longitudinal course of fatigue in adult SMA patients using validated instruments. General perceived fatigue was assessed using the Fatigue Severity Scale (FSS), while the Modified Fatigue Impact Scale (MFIS) was used to evaluate multidimensional fatigue-comprising the physical, cognitive, and psychosocial domains. Additionally, we explored associations with motor function, neurophysiological parameters, and treatment status.Twenty-five adults with genetically confirmed SMA were evaluated at baseline and after one year using the FSS and MFIS. Motor function was measured by the Hammersmith Functional Motor Scale - Expanded, Revised Upper Limb Module (RULM), and Motor Function Measurement (MFM); neurophysiological assessment included Compound Muscle Action Potential (CMAP), Motor Unit Number Index (MUNIX) and repetitive nerve stimulation. Patients were stratified by fatigue status and use of disease-modifying therapies.Significant fatigue (FSS > 4) was observed in 60% of patients at baseline and 56% at follow-up. After 1 year, the prevalence of fatigue was significantly lower in treated patients (33.3%) compared to untreated ones (75%; p = 0.04). The MFIS scores remained stable across the physical, cognitive, and psychosocial domains. No associations were found between fatigue severity and age, disease duration, motor scale scores, or neurophysiological parameters.Fatigue is highly prevalent in adults with SMA and does not correlate with disease severity or motor/neurophysiological measures. Patients receiving disease-modifying therapies showed lower fatigue frequency, reinforcing the relevance of fatigue as a meaningful patient-reported outcome in this population.