Arquivos de neuro-psiquiatria最新文献

The diagnosis of predementia stages indicates an increased risk of progression to dementia. The Amyloid, Tau, and Neurodegeneration AT(N) classification considers measurements of altered proteins and the presence of neurodegeneration to classify the risk groups regarding the pathophysiology of Alzheimer's disease (AD). The cognitive and anatomical characteristics of the patients in the predementia stage according to the AT(N) classification are not fully understood.To investigate whether there are differences in the clinical and anatomical profiles among older adults in the predementia stage according to the ATN classification, and to investigate the associations involving cognition and cortical thickness and subcortical volume in the AT(N) groups.In total, 72 older adults with subjective cognitive decline and mild cognitive impairment were allocated to groups according to the AT(N) classification (AD continuum: n = 37; suspected non-AD pathophysiology: n = 8; normal biomarkers: n = 27). The participants were investigated through cognitive tests, magnetic resonance imaging scans, and cerebrospinal fluid analyses. We used multivariate and univariate analyses with post-hoc testing to verify differences among groups. In addition, linear regressions were performed to verify the interactions involving cognition and gray matter metrics.The suspected non-AD pathophysiology group showed worse performance in attention/executive function than the AD continuum and normal biomarkers groups (p = 0.04). However, the ATN classification groups did not differ in terms of cortical thickness (p > 0.05). In addition, in the AD continuum group, memory was associated with left fusiform gyrus thickness (p = 0.000 uncorrected; r = 0.238).Cognition, but not gray matter metrics, differs among AT(N) classification groups. Memory is associated with cortical thickness in patients with positive amyloid Beta (AD continuum).

Chronic migraine is a prevalent and debilitating condition, frequently associated with sleep disorders, particularly insomnia.To evaluate the impact of sleep psychoeducation measures on clinical aspects of chronic migraine patients with sleep quality complaints, under the hypothesis that such interventions would benefit both migraine symptoms and insomnia difficulties.A total of 100 patients from our neurology service's headache outpatient clinic were screened using an author-developed questionnaire addressing sleep quality complaints. The intervention group included 68 patients with sleep disturbance complaints, who completed the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Insomnia Severity Index (ISI), and subsequently received psychoeducation guidelines and individualized recommendations. The control group consisted of 32 patients without sleep disorder complaints, from whom clinical data on migraine were collected. After 2 to 3 months, the questionnaires were reapplied to the intervention group, and medical records from both groups were reviewed for comparison.In the control group, there was no statistically significant change in headache frequency or intensity. In the intervention group, a significant reduction was observed in both parameters. Regarding sleep disturbance, the intervention group showed a significant reduction in PSQI (from 13.7 to 11.7) and ISI (from 18.5 to 13.4), but no significant variation in ESS.Sleep psychoeducation, supported by an informative booklet, produced positive outcomes not only in sleep parameters but also in reducing the frequency and intensity of headaches in chronic migraine sufferers.

Palliative care has been shown to yield benefits in terms of quality of life and therapeutic planning in oncological and non-oncological diseases, but its integration in neurology remains limited.To evaluate the predictive factors of mortality in neurological patients to improve prognosis.In this 1-year cohort study, we followed patients aged > 18 years hospitalized in a neurological Semi-Intensive Care Unit in Brazil. The patients were categorized into two groups based on palliative care indication: those with and those without indication. The palliative care criteria included a "no" response to the Surprise Question, a Palliative Performance Scale (PPS) score below 70%, or significant weight loss (> 5%) with associated body changes.We included 166 patients, 87 with indication and 79 without it. The group with indication had a 29.8% mortality rate (26 deaths) and a 27.7-fold higher risk of death. The factors associated with increased mortality risk within 1 year included PPS score < 40%, answering "no" to the Surprise Question, and weight loss. Notably, 62% (n = 54) of the group with indication were admitted to the Intensive Care Unit (ICU), compared to 12% (n = 12) in the group without indication. Advanced directives were only documented in 31% (n = 27) of the group with indication and in 59% (n = 16) of the patients who died. Prognostic assessment in neurological diseases is challenging due to limited data.In the present study, we found that the PPS score, the Surprise Question, and weight loss were significant predictors of mortality within 1 year. These findings highlight the need for further research to provide better end-of-life markers and ensure greater autonomy in neurological disease management.

Hereditary transthyretin amyloidosis (ATTRv) is a rare, autosomal dominant, inherited disease caused by variants in the gene encoding the transthyretin (TTR) protein. These variants lead to TTR tetramer destabilization, resulting in the formation and progressive deposition of insoluble amyloid fibrils in various tissues, including those of the central nervous system (CNS). Although previously neglected, the recognition of CNS involvement in ATTRv has become progressively relevant due to prolonged patient survival and the ineffectiveness of the current therapies in addressing CNS synthesis of TTR. The first descriptions of the pathological involvement of the CNS in ATTRv date from the 1960s; however, this topic has not been fully explored. In the present article, the main CNS clinical manifestations of ATTRv, such as transient focal neurological episodes, bleeding complications, leptomeningeal amyloidosis, and cognitive impairment, are reviewed, and the phenotypic variability of this condition is highlighted. A literature review of the PubMed/Medline database was conducted using the following keywords: hereditary amyloidosis, transthyretin amyloidosis, familial amyloidosis, central nervous system, neurological manifestations, leptomeningeal amyloidosis, cognition, and cognitive impairment. Studies published in the last 15 years, including review articles, prospective observational studies, experimental studies and clinical trials, were evaluated. Improving our understanding of CNS involvement in ATTRv will enable the early identification of neurological symptoms in this condition, which will enhance the understanding of the pathophysiological mechanisms and boost the advancement of research, expanding potential treatments and improving the quality of life of these individuals.

Acquired apraxia of speech is often a comorbidity that accompanies aphasia. In some cases, it may be difficult to distinguish whether speech errors are phonological (resulting from aphasia) or phonetic (resulting from apraxia of speech).To verify the capacity of the Costa, Brescancini, and Ortiz (CBO) protocol to identify acquired apraxia of speech in persons with aphasia (PWA) among Brazilian Portuguese speakers.This is a cross-sectional and prospective study that included the participation of 7 PWA and suspected apraxia of speech (PWAG) poststroke and 25 neurotypical individuals who formed the control group (CG). All participants were followed the tasks of the CBO protocol, such as spontaneous conversation, description of a thematic card, word repetition, and diadochokinesias (DKK).The protocol differentiated the groups in the spontaneous speech tasks (percentage of errors per word); word repetition list (time, punctuation, quantity, and type of manifestations); and DKK /ka/ and /pataka/. The results showed that the PWAG presented less fluent, slower speech, with more errors than the CG. Additionally, the protocol mapped the nature of the errors.The protocol enabled the identification of acquired apraxia of speech in PWA. It was also possible to analyze the tasks and linguistic variables that most interfered with the motor production of speech in Brazilian PWA.

Parkinson's disease (PD) presents with both motor and non-motor symptoms. Postural and gait aspects, as well as the risk of falls, are important causes of morbidity and mortality in PD. The neural correlates of PD are alterations in the substantia nigra of the midbrain and, among other sites mentioned, the pontine peduncle nucleus stands out. Noninvasive neuromodulation, such as galvanic vestibular stimulation (GVS), can be used in the neural centers involved in motor control alterations in PD. Projections from the vestibular system are involved in motor control and can stimulate the basal nuclei and the pontine peduncle nucleus, as well as strengthen neural networks.To analyze the effects of GVS associated with physical-functional exercise on the motor control of PD patients.A randomized, placebo-controlled clinical trial. Participants with PD, diagnosed through the Hoehn & Yahr scale (HY) 2 or 3, will be allocated to groups. Pre- and postintervention and follow-up assessments will follow a structured protocol of physical-functional instruments, as recommended in the European Guidelines for managing people with PD. The intervention for both groups will follow the American Neurofunctional Physical Therapy Guideline for managing people with PD.It is expected that, in the experimental group, the exercises will be associated with active GVS. Finally, a descriptive and statistical analysis must be conducted to verify the effects of GVS.The study of new devices focusing on motor control in PD is a novel approach and warrants further investigation in the context of vestibular function.

Neurocritical care (NCC) education involves integrating knowledge and skills into various complex areas. While the USA, Canada, and Europe regulate didactic core training for medical residencies and fellowships, the quantity and quality of these training programs in Brazil remain unclear.To assess how NCC training is currently integrated into neurology and intensive care residency programs in Brazil.A cross-sectional survey composed of 27 multiple-choice and short-answer questions was distributed by email to professionals registered in national congresses and medical organizations. Data regarding exposure to NCC training, duration, supervision, infrastructure, and self-perceived competencies were analyzed.A total of 208 responses from 82 centers across 14 Brazilian states were included. Respondents were primarily neurologists (58.2%) and intensivists (28.2%). Only 50.5% reported receiving NCC training during residency, typically lasting more than 4 weeks. Training predominantly occurred in intensive care units with 5 to 20 beds, supervised by intensivists. However, exposure to specialized skills was limited: 23% to transcranial Doppler, 21% to electroencephalogram (EEG) interpretation, and 24% to multimodal neuromonitoring. Confidence in managing complex cases was suboptimal, with 56% reporting confidence in postcardiac arrest care, 47% in refractory intracranial hypertension, and 40% in spinal cord trauma.Neurocritical care education in Brazil is heterogeneous and remains at an early stage of development. Most residents receive limited exposure to advanced neurocritical skills, resulting in low confidence to independently manage highly complex conditions. Standardized, competency-based training programs are urgently needed to enhance professional preparedness and potentially improve patient outcomes in NCC.

Parkinson's disease (PD) presents motor and non-motor symptoms that impair function and quality of life. Identifying clinical factors linked to physical performance is key for patient care and management.To examine associations between sarcopenia-related measures and physical performance in mild-to-moderate PD (Hoehn & Yahr [HY] I-III).This was a cross-sectional study including patients with idiopathic Parkinson's disease at mild to moderate stages (Hoehn & Yahr I-III), evaluated in the ON medication state. Physical performance was assessed using the Short Physical Performance Battery (SPPB). Sarcopenia was evaluated according to the revised European Working Group on Sarcopenia in Older People (EWGSOP2) consensus, including screening with the SARC-F questionnaire and the Ishii score, assessment of muscle strength by handgrip dynamometry, and evaluation of body composition and appendicular lean mass by whole-body dual-energy X-ray absorptiometry (DXA). Analyses included bivariate comparisons, correlation analyses, and logistic regression models (Enter and Best Subsets).A total of 127 patients were evaluated (mean age 66 years; 41.7% females). Low physical performance was observed in 39% (n = 50) of patients and was strongly associated with positive screening of sarcopenia (SARC-F score ≥ 4; odds ratio [OR]: 1.67; 95%CI: 1.30-2.15; p < 0.001). Ishii score (p = 0.009), reduced mean handgrip strength (26 ± 10 kgf versus 30 ± 10 kgf; p = 0.02), and postural instability and gait difficulty (PIGD) (p < 0.001) were also significantly associated with low SPPB performance in bivariate analyses. In the multivariable models, SARC-F and PIGD emerged as independent predictors of poor physical performance. The best subset model, combining SARC-F and PIGD, showed good discriminative accuracy (area under the curve [AUC] = 0.82).Higher PIGD scores and SARC-F ≥ 4 correlated with poor physical performance in PD. Low performance was linked to both SARC-F and Ishii scores, which help identify risk of functional decline. Longitudinal studies are needed to clarify causality and treatment implications.

Cognitive impairment is increasingly recognized as a long-term consequence of coronavirus disease 2019 (COVID-19), but most evidence comes from high-income settings. Little is known about its impact in socioeconomically-vulnerable populations.The current study investigated long-term cognitive effects in 133 individuals older than 50 years of age with low level of schooling and low socioeconomic status who were hospitalized for COVID-19.The participants were assessed 12 to 18 months after hospitalization using the Modified Telephone Interview for Cognitive Status (TICS-M). A subset of 65 participants underwent further cognitive and neuropsychiatric evaluations. Cognitive impairment was defined as scores ≤ -1.5 standard deviations from age- and education-adjusted Brazilian norms. During the acute phase of the disease, sociodemographic, clinical, and laboratory data were evaluated to identify potential risk factors.The mean age of the subjects (n = 65) was of 65.3 years, and the sample was composed of 69.2% of women, 57.1% of pardo individuals, 47.7% of subjects with ≤ 4 years of schooling, and 83.6% of participants with monthly family income ≤ 3 minimum wages. Hospitalization averaged 16.1 days, and 55.4% required intensive care. Cognitive impairment affected 70.8% of the participants. Higher age, female sex, and hyposmia were associated with cognitive impairment.Cognitive impairment was frequent in this socioeconomically-vulnerable sample, a group still underrepresented in existing research.

Methylphenidate (MPH) is a psychostimulant widely used to enhance attention and executive functions through increased dopaminergic and noradrenergic transmission. Although its effects on cognitive performance are well documented, its acute influence on cortical oscillatory activity, particularly α power, during tasks requiring simultaneous motor and cognitive processing remains poorly understood in healthy adults.To investigate the acute effects of 10 mg MPH on absolute α power (8-12 Hz) in frontal regions during a visuomotor task in healthy subjects.A total of 13 right-handed healthy adults (7 men; age 25.6 ± 4.5 years) participated in a randomized, double-blind, placebo-controlled, crossover study. A 20-channel electroencephalography (EEG) was recorded before and after execution of the MIRA visuomotor task (joystick response when a moving target crosses a previously memorized position) under placebo and MPH (10 mg) conditions, with sessions 1 week apart. Absolute α power was compared using two-way ANOVA (condition vs. moment: pre- vs. post-joystick press), followed by paired t-tests when appropriate.Significant condition versus moment interactions were observed at F3 (p = 0.006), F4 (p = 0.003), and F8 (p = 0.023). The main effects of condition and/or moment occurred at Fp1, Fp2, and Fz (all p < 0.05). The use of MPH attenuated or reversed the typical task-related α desynchronization seen under placebo, especially in right frontal regions.A single 10 mg dose of MPH homogeneously modulates frontal α power during a visuomotor task, promoting sustained cortical activation. This paradigm emerges as a sensitive tool for studying motor-cognitive coupling and may contribute to understanding MPH mechanisms in both healthy and clinical populations.