Diagnóstico de la variante conductual de demencia frontotemporal basado en estadios clínicos adaptado para países con baja educación: el caso de Perú

Demencia frontotemporal (DFT) es una condición neurodegenerativa escasamente reconocida en personas menores a 65 años de edad. El diagnóstico de DFT variante conductual (DFTvc) se basa en una entrevista clínica comprehensiva, complementada por una evaluación multidimensional (neurológica, cognitiva, neuropsiquiátrica, de biomarcadores e imágenes cerebrales) adaptada y validada a la población a estudiar; sin embargo, a pesar del incremento de su prevalencia en Latinoamérica y el Caribe, existe necesidad de herramientas estandarizadas y un consenso para el diagnóstico de DFTvc. El artículo intenta realizar una aproximación del enfoque de diagnóstico de DFTvc en escenario de paises con bajos y medianos ingresos, como el Perú.

Frontotemporal dementia (FTD) is a widely recognized neurodegenerative condition in people under 65 years old. The diagnosis of behavioral variant FTD (bvFTD) is based on a comprehensive clinical assessment, complemented by a multidimensional assessment (neurological, cognitive, neuropsychiatric, biomarker and brain imaging) adapted and validated to the population to be studied; however, despite its increasing prevalence in Latin America and the Caribbean, there is a need for standardized tools and consensus for the bvFTD diagnosis. The manuscript attempts to approximate the approach for the diagnosis of bvFTD in the setting of low and middle-income countries, including Peru.

Evaluación de síntomas neuropsiquiátricos para la detección temprana de trastorno neurocognoscitivo / Evaluation of neuropsychiatry symptoms for the early detection of neurocognitive disorder

RESUMEN INTRODUCCIÓN: El diagnóstico oportuno del trastorno neurocognitivo es de los principales retos en la atención de los trastornos neurocognitivos. Por esto, se han generado estrategias para la detección preclínica de la enfermedad, entre ellas las destinadas a evaluar síntomas neuropsiquiátricos (NPS) como la escala Mild Behavior Impairment - Checklist (MBI-C). MÉTODOS: Inicialmente se realizó una búsqueda en BVSalud, Medline y PsycNet, luego se realizó una búsqueda en bola de nieve. Se incluyeron términos referentes a deterioro comportamental leve (abarcando los NPS en etapas tempranas), deterioro cognitivo leve y términos específicos del MBI-C. RESULTADOS: La presencia de NPS se asocia con un aumento en la incidencia anual de demencia. Al evaluarlos con MBI-C, su puntuación se correlaciona con biomarcadores como una mayor atrofia cortical, la presencia de la proteína β-amiloide, así como disminución en funciones ejecutivas como la capacidad de enfocar la atención y la memoria de trabajo. DISCUSIÓN: Los hallazgos en la literatura sugieren la utilidad de MBI-C como marcador de neurodegeneración en estadios previos a la demencia, esto mediante la evaluación de su capacidad predictiva de forma independiente y al compararla con otros biomarcadores. CONCLUSIONES: MBI-C supone ser un instrumento de fácil aplicabilidad e interpretación, sostenible e incluyente. Sin embargo, quedan vacíos sobre la pertinencia de esta escala, por lo que surge la necesidad de investigar este tema.

ABSTRACT INTRODUCTION: Early diagnosis of neurocognitive disorder is the main challenge of dementia health attention. Therefore, strategies for preclinical detection of the disease have been created, like those intended to evaluate neuropsychiatric symptoms (NPS), like the Mild Behavior Impairment - Checklist (MBI-C). METHODS: Research was performed in BVSalud, Medline, and Psynet. Then a snowball sampling was done. The terms included were mild behavioral impairment (included NPS in initial stages), mild cognitive impairment, and specific terms of MBI-C. RESULTS: The presence of NPS increase the incidence of dementia, with an annual conversion rate of 9%. About MBI-C, the score has been related to biomarkers like worse brain atrophy in patients with Parkinson's Disease and a positive relationship with the presence of B-amyloid protein. Also, Creese and cols. show that mild behavioral impairment (measured by MBI-C) is associated with a faster decrease in attention and working memory. DISCUSSION: MBI-C utility as a neurodegenerative marker has been demonstrated to detect cognitive, neuropsychiatry, and functional symptoms that may precede dementia by evaluating its predictive capacity alone and comparing it to other biomarkers. CONCLUSION: MBI-C is easy to apply and interpret, is sustainable and inclusive. However, there are still gaps in the relevance of the scale, so there is the need to continue investigating this topic.

Serum Occludin and Zonulin Levels in Children With Attention-Deficit/Hyperactivity Disorder and Healthy Controls

Objective: To evaluate zonulin and occludin levels, potentially associated with immunological pathways in the gut-brain axis, in children with attention-deficit/hyperactivity disorder (ADHD). Method: We examined the association between serum levels of zonulin and occluding, and behavioral/emotional problems in children with ADHD. 40 medicationnaïve children meeting Diagnostic and statistical (DSM-5) criteria for ADHD (11 females; mean (SD) age 9.4 (1.6) years) and 39 healthy comparisons (12 females; mean (SD) age 9.3 (1.9) years) were studied. Serum zonulin and occludin levels were measured by (ELISA). Result: We found higher mean (SD) serum zonulin levels [37.1 (28.2) vs 8.1 (4.5) ng/mL; P<0.001) and occludin levels [2.4 (1.6) vs 0.6 (0.4) ng/mL; P<0.001] in the ADHD group compared to control group. Serum zonulin levels had a positive correlation with weight (r=0.452; P=0.003) and BMI (r=0.401; P=0.01) among children with ADHD. Serum zonulin and occludin levels also had a positive correlation with Conners parent rating scale scores (r=0.58; P<0.001), and Strengths and difficulties questionnaire scores (r=0.49; P<0.001). Multiple linear regression analysis revealed that age, sex, weight, conduct problems and oppositional sub-scores were significant predictors of increased serum zonulin levels. Conclusion: These data confirm an association between ADHD, and serum zonulin and occludin levels. Pathophysiological and clinical significance of these findings needs to be elucidated.

Aggressive behavior and prognosis in patients with mild cognitive impairment / Comportamento agressivo e prognóstico em pacientes com comprometimento cognitivo

ABSTRACT The diagnosis of mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. When evaluating the further prognosis of MCI, the occurrence of neuropsychiatric symptoms, particularly aggressive and impulsive behavior, may play an important role. Objective: The aim of this study was to evaluate the relationship between aggressive behavior and cognitive dysfunction in patients diagnosed with MCI. Methods: The results are based on a 7-year prospective study. At the time of inclusion in the study, participants, recruited from an outpatient clinic, were assessed with Mini-Mental State Examination (MMSE) and the Cohen-Mansfield Agitation Inventory (CMAI). A reassessment was performed after 1 year using the MMSE scale in all patients. The time of next MMSE administration was depended on the clinical condition of patients took place at the end of follow-up, that is, at the time of diagnosis of the dementia or after 7 years from inclusion when the criteria for dementia were not met. Results: Of the 193 patients enrolled in the study, 75 were included in the final analysis. Patients who converted to dementia during the observation period exhibited a greater severity of symptoms in each of the assessed CMAI categories. Moreover, there was a significant correlation between the global result of CMAI and the results of the physical nonaggressive and verbal aggressive subscales with cognitive decline during the first year of observation. Conclusions: Despite several limitations to the study, aggressive and impulsive behaviors seem to be an unfavorable prognostic factor in the course of MCI.

RESUMO O diagnóstico de comprometimento cognitivo leve (CCL) está associado a um risco aumentado de desenvolver demência. Ao avaliar o prognóstico adicional do CCL, a ocorrência de sintomas neuropsiquiátricos, particularmente o comportamento agressivo e impulsivo, pode desempenhar um papel importante. Objetivo: Avaliar a relação entre comportamento agressivo e disfunção cognitiva em indivíduos com diagnóstico de CCL. Métodos: Nossos resultados são baseados em um estudo prospectivo de sete anos. No momento da inclusão no estudo, os participantes, recrutados em um ambulatório, foram avaliados com o Mini-Exame do Estado Mental (MEEM) e o Inventário de Agitação de Cohen-Mansfield (CMAI). A reavaliação foi realizada após um ano com a escala MEEM em todos os pacientes. O momento da próxima administração do MEEM dependeu da condição clínica dos indivíduos e ocorreu no final do acompanhamento, ou seja, no momento do diagnóstico da demência ou após sete anos da inclusão, quando os critérios para demência não foram atendidos. Resultados: Dos 193 pacientes incluídos no estudo, 75 foram incluídos na análise final. Os indivíduos que converteram para demência durante o período de observação exibiram uma maior gravidade dos sintomas em cada uma das categorias avaliadas pelo CMAI. Além disso, houve uma correlação significativa entre o resultado global do CMAI e os resultados das subescalas de agressão física e verbal com declínio cognitivo durante o primeiro ano de observação. Conclusões: Apesar das várias limitações do estudo, os comportamentos agressivos e impulsivos parecem ser um fator prognóstico desfavorável no curso do CCL.

Female and Worst Academic Performance are Associated with Anxiety and Stress among Dental Students / Mulheres e Pior Desempenho Acadêmico Estão Associados com Ansiedade e Estresse em Estudantes de Odontologia

This study aimed to assess the levels and associated factors of stress and anxiety in dental students during the Covid-19 pandemic. This cross-sectional study involved both undergraduate and graduate dental students regularly enrolled in the first semester of 2020 of one University. An online structured questionnaire was applied, and demographical, behavioral, academic performance, fear and anxiety related to the Covid-19 pandemic were collected. The 21-item Depression Anxiety Stress Scale (DASS-21) was applied, but only the subscales of anxiety and stress were considered. Adjusted analyses were performed using Poisson regression with robust variance. To both anxiety and stress, independent analyses were performed considering the different levels of study (undergraduate and graduate dental students). At least moderate anxiety was detected in 42.9% and 24.7% of undergraduate and graduate students, respectively. Meanwhile, at least moderate stress was observed in 41.7% and 29.9% of undergraduate and graduate students, respectively. In the multivariate analyses, female undergraduate dental students presented significantly more anxiety (prevalence ratio [PR]: 1.57; 95% confidence interval [95%CI]: 1.11 ­ 2.22) and stress (PR: 1.54; 95%CI: 1.06 ­ 2.24) when compared to males. Conversely, undergraduate dental students with better academic performance demonstrated lower rates of anxiety (PR: 0.86; 95%CI: 0.75 ­ 0.98). Females undergraduate dental students demonstrate higher rates of anxiety and stress, and the academic performance may influence the levels of anxiety in these individuals. (AU)

O estudo objetivou avaliar os níveis e fatores associados de estresse e ansiedade em estudantes de Odontologia durante a pandemia de Covid-19. Esse estudo transversal envolveu alunos de graduação e pós-graduação em Odontologia regularmente matriculados no primeiro semestre de 2020 de uma Universidade. Um questionário estruturado online foi aplicado, e variáveis demográficas, comportamentais, performance acadêmica, medo e ansiedade relacionados à pandemia de Covid-19 foram coletadas. A "Depression Anxiety Stress Scale" (DASS-21) de 21 itens foi aplicada, mas somente os domínios de ansiedade estresse foram considerados. Análises ajustadas foram realizadas utilizando regressão de Poisson com variância robusta. Para ambos ansiedade e estresse, análises independentes foram realizadas considerando os diferentes níveis de estudo (estudantes de odontologia de graduação e pós-graduação). Pelo menos ansiedade moderada foi detectada em 42,9% e 24,7% dos alunos de graduação e pós-graduação, respectivamente. Já o estresse pelo menos moderado foi observado em 41,7% e 29,9% dos alunos de graduação e pós-graduação, respectivamente. Nas análises multivariadas, mulheres estudantes de graduação apresentaram significativamente mais ansiedade (razão de prevalência [RP]: 1,57; intervalo de confiança de 95% [IC95%]: 1,11 ­ 2,22) e maior estresse (RP: 1,54; IC95%: 1,06 ­ 2,24) quando comparados com homens. Contudo, estudantes de graduação com melhor performance acadêmica demonstraram menores taxas de ansiedade (RP: 0,86; IC95%: 0,75 ­ 0,98). Estudantes de graduação do sexo feminino demonstraram maiores taxas de ansiedade e estresse, e a performance acadêmica pode influenciar os níveis de ansiedade desses indivíduos. (AU)

Efeito de uma intervenção educativa no desgaste emocional ou psicológico e na qualidade de vida dos cuidadores familiares de idosos com sintomas neuropsiquiátricos / Effect of an educational intervention on emotional or psychological distress and on the quality of life of family caregivers of elderly people with neuropsychiatric symptoms

Objetivos: Avaliar o efeito de uma intervenção educativa no desgaste emocional ou psicológico e na qualidade de vida dos cuidadores familiares de idosos com doença de Alzheimer ou demência mista com sintomas neuropsiquiátricos e avaliar a efetividade da intervenção educativa sobre o manejo dos sintomas neuropsiquiátricos, na perspectiva dos cuidadores. Método: Delineamento misto com estratégia incorporada das fases quantitativa e qualitativa, com seguimento de cinco semanas. Amostra de 17 cuidadores familiares principais de idosos seguidos em Ambulatório de Geriatria e Demências em Hospital Terciário. Uma intervenção educativa sobre manejo dos sintomas neuropsiquiátricos dos idosos, por meio de vídeo e folheto educativos para cuidadores, foi elaborada, implementada e avaliada no seguimento. O procedimento de coleta de dados e a implementação da intervenção se deu sequencialmente, em cinco etapas: 1) recrutamento e seleção dos cuidadores no ambulatório; 2) pré-intervenção no domicílio com entrevista de caracterização dos cuidadores, dos idosos e cuidado prestado, avaliação do desgaste e qualidade de vida, além da implementação da intervenção; 3 e 4) realização das duas etapas para reforço telefônico da intervenção; 5) pós-intervenção no domicílio com repetição de entrevista aos cuidadores. As etapas um, dois e cinco compuseram a fase quantitativa, e as etapas três e quatro, a fase qualitativa do estudo. Para avaliação do desgaste, foi aplicado o Neuropsychiatric Inventory Distress e para qualidade de vida, o World Health Organization Quality of Life-bref. Na análise dos dados quantitativos, utilizaram-se estatística descritiva e teste de Wilcoxon. O nível de significância foi de 5%. Para os dados qualitativos, utilizou-se análise temática indutiva. O estudo foi aprovado pelo Comitê de Ética da instituição proponente. Resultados: A idade média dos idosos foi 83,06 anos, 52,94% eram mulheres, 58,82% apresentavam demência mista, assim como demência moderada; predominou a apatia (94,12%), antes e após (82,35%) a intervenção. A idade média dos cuidadores foi 65,88 anos; 64,71% eram mulheres; 76,48%, casados; média de 11 anos de estudo; 53,33% deixaram de trabalhar para cuidar do idoso; 52,94% cuidavam do pai ou mãe, 76,47% cuidavam por mais de 12 horas diárias e todos, sete dias na semana. Houve redução do escore médio do desgaste de 17,88 pré, para 17,00 pós-intervenção (p=0,555). Houve aumento dos escores médios de qualidade de vida, pré e pós-intervenção: para o domínio Físico 61,76 e 63,45 (p=0,753); Psicológico 59,80 e 62,26 (p=0,295); Relações sociais 61,76 e 65,19 (p=0,516) e Meio ambiente 59,56 e 60,48 (p=0,684). Na fase qualitativa, categorizaram-se os resultados em: "Cotidiano dos cuidadores familiares dos idosos com doença de Alzheimer ou demência mista" e "Avaliação da efetividade da intervenção educativa sobre o manejo dos sintomas neuropsiquiátricos pelos cuidadores". Ao final, realizou-se a análise integrada sobre a qualidade de vida, o desgaste dos cuidadores e o cuidado dos idosos com demência. Conclusão: Com a intervenção, houve redução do desgaste e melhora da qualidade de vida dos cuidadores, ainda que sem significância estatística. Os resultados qualitativos indicaram a complexidade de situações que repercutiram na qualidade de vida e no desgaste desses cuidadores, assim como enfatizou a relevância dessa intervenção

Objectives: To evaluate the effect of an educational intervention on the emotional or psychological distress and quality of life of family caregivers of elderly people with Alzheimer's disease or mixed dementia with neuropsychiatric symptoms and evaluate the effectiveness of the educational intervention on the management of neuropsychiatric symptoms from the caregivers' perspective. Method: Mixed design with quantitative and qualitative phases, with a five-week follow-up. Sample of 17 main family caregivers of elderly patients followed in the Geriatrics and Dementia Outpatient Clinic in a Tertiary Hospital. An educational intervention on the management of neuropsychiatric symptoms in the elderly through an educational video and leaflet for caregivers was designed, implemented and assessed in the follow-up. Data collection and the intervention took place sequentially, in five stages: 1) recruitment and selection of caregivers at the outpatient clinic; 2) pre-intervention at home with an interview to characterize the caregivers, the elderly and the care provided, assessment of distress and quality of life, and implementation of the intervention; 3 and 4) completion of the two stages for telephone reinforcement of the intervention; 5) post-intervention at home with repeated interviews with caregivers. Stages one, two and five comprised the quantitative phase, and stages three and four comprised the qualitative phase. The Neuropsychiatric Inventory Distress was applied to assess distress and the World Health Organization Quality of Life-bref for quality of life. Descriptive statistics and the Wilcoxon test were used in the quantitative analysis. The significance level was 5%. For qualitative data, inductive thematic analysis was used. The study was approved by the Ethics Committee of the proposing institution. Results: The mean age of the elderly was 83.06 years, 52.94% were women, 58.82% had mixed dementia, and moderate dementia; apathy predominated (94.12%) before and after (82.35%) the intervention. The mean age of the caregivers was 65.88 years; 64.71% were women; 76.48% were married; with 11 years of schooling on average; 53.33% stopped working to take care of the elderly; 52.94% took care of the father or mother; 76.47% provided care for more than 12 hours a day, seven days a week. There was a reduction in the mean distress score from 17.88 to 17.00 after the intervention (p=0.555). Quality of life scores improved in the domains as follows: Physical, from 61.76 to 63.45 (p=0.753); Psychological, from 59.80 to 62.26 (p=0.295); Social relationships, from 61.76 to 65.19 (p=0.516); Environment, from 59.56 to 60.48 (p=0.684). In the qualitative phase, the results were categorized into: "Daily life of family caregivers of elderly people with Alzheimer's disease or mixed dementia" and "Assessment of the effectiveness of the educational intervention on the management of neuropsychiatric symptoms by caregivers". At the end, an integrated analysis was made of the quality of life and distress and the care provided to the elderly individuals with dementia. Conclusion: The intervention resulted in reduced distress and improved quality of life among caregivers, although without statistical significance. The qualitative results indicated the complexity of the situations that had an impact on the quality of life and distress of the caregivers and highlight the relevance of this intervention

Physical exercise is effective for neuropsychiatric symptoms in Alzheimer's disease: a systematic review / Exercício físico é efetivo para sintomas neuropsiquiátricos na doença de Alzheimer: uma revisão sistemática

ABSTRACT Background: Neuropsychiatric symptoms are disorders frequently seen in Alzheimer's disease. These symptoms contribute to reduction of brain reserve capacity and, in addition, they present unfavorable implications, such as: poor prognosis for the disease, increased functional decline, increased burden on the caregiver and institutionalization. This scenario makes neuropsychiatric symptoms one of the biggest problems in Alzheimer's disease, and gives rise to a need for treatments focused on improving these symptoms. Sow progress in drug trials has led to interest in exploring non-pharmacological measures for improving the neuropsychiatric symptoms of Alzheimer's disease, such as physical exercise. Objective: To ascertain the effect of exercise on the neuropsychiatric symptoms of Alzheimer's disease and its implications. Methods: This was a systematic review of effective longitudinal research, conducted by searching for articles in the PubMed, Web of Science, CINAHL and Scopus electronic databases, from 2009 to 2019. Studies in which the sample consisted of elderly people aged 65 years old or over with a diagnosis of Alzheimer's disease were included. Initially 334 articles were identified. After exclusions, 21 articles remained to be read in full. From these, five articles fitted the eligibility criteria, and a further two articles were added through manual searches in the references of the articles found. Results: Out of the seven articles analyzed in this review, five studies revealed that physical exercise had a positive effect on the neuropsychiatric symptoms of Alzheimer's disease. Conclusion: This systematic review indicated that physical exercise is a favorable non-pharmacological means for attenuating the neuropsychiatric symptoms of elderly people with Alzheimer's disease, with special attention to aerobic exercises.

RESUMO Introdução: Sintomas neuropsiquiátricos são desordens frequentemente observadas na Doença de Alzheimer, os quais contribuem para a diminuição da capacidade de reserva cerebral e ocasiona implicações ruins, como mau prognóstico da doença, aumento do declínio funcional, aumento da sobrecarga do cuidador e institucionalização. Esse cenário faz com que os sintomas neuropsiquiátricos se tornem um dos maiores problemas da Doença de Alzheimer, incitando, assim, o interesse em explorar medidas não-farmacológicas nos sintomas neuropsiquiátricos na Doença de Alzheimer, como o exercício físico. Objetivo: Verificar o efeito do exercício físico em sintomas neuropsiquiátricos da Doença de Alzheimer e suas implicações. Métodos: Trata-se de uma revisão sistemática com pesquisas longitudinais efetivadas por meio da busca de artigos nas bases de dados eletrônicas: PubMed, Web of Science, CINAHL e Scopus, de 2009 a 2019. Foram incluídos estudos cuja amostra foi constituída por idosos com diagnóstico de Doença de Alzheimer com idade igual ou acima de 65 anos. Inicialmente, foram identificados 334 artigos; após as exclusões, restaram 21 artigos para leitura na íntegra. Destes, cinco artigos se enquadraram nos critérios de elegibilidade, assim como dois artigos adicionados por meio de busca manual nas referências dos artigos encontrados. Resultados: Dos sete artigos analisados na presente revisão, cinco estudos revelaram um efeito positivo do exercício físico em sintomas neuropsiquiátricos na Doença de Alzheimer. Conclusão: Esta revisão sistemática indica que o exercício físico é um meio não-farmacológico favorável à atenuação dos sintomas neuropsiquiátricos de idosos com Doença de Alzheimer, com especial atenção na modalidade aeróbia.

Neuropsychiatric symptoms associated with family caregiver burden and depression / Sintomas neuropsiquiátricos associados à sobrecarga e depressão do cuidador familiar

ABSTRACT Alzheimer's disease (AD) is a progressive and degenerative condition affecting several cognitive areas, with a decline in functional abilities and behavioral changes. Objective: To investigate the association between neuropsychiatric symptoms in older adults with AD and caregiver burden and depression. Methods: A total of 134 family caregivers of older people diagnosed with AD answered a questionnaire with sociodemographic data and questions concerning the care context, neuropsychiatric symptoms, caregiver burden, and depressive symptoms. Results: Results revealed that 95% of older adults had at least one neuropsychiatric symptom, with the most common being: apathy, anxiety, and depression. Among the 12 neuropsychiatric symptoms investigated, 10 were significantly associated with caregiver burden, while 8 showed significant correlations with depressive symptoms. Conclusions: Neuropsychiatric symptoms were related to caregiver burden and depressive symptoms. In addition to the older adult with AD, the caregiver should receive care and guidance from the health team to continue performing quality work.

RESUMO. A doença de Alzheimer (DA) é progressiva e degenerativa, afetando diversas áreas cognitivas com declínio nas habilidades funcionais e alterações comportamentais. Objetivo: Investigar a associação entre presença de sintomas neuropsiquiátricos apresentados por idosos com doença de Alzheimer e sobrecarga, e depressão dos cuidadores. Métodos: Um total de 134 cuidadores familiares de idosos com diagnóstico da doença de Alzheimer responderam a um questionário com dados sociodemográficos e questões referentes ao contexto de cuidado, sintomas neuropsiquiátricos, sobrecarga e depressão do cuidador. Resultados: Os resultados revelaram que 95% dos idosos apresentaram pelo menos um sintoma neuropsiquiátrico. A apatia, a ansiedade e a depressão foram os sintomas neuropsiquiátricos mais frequentes nos idosos. Dos 12 sintomas neuropsiquiátricos investigados, 10 associaram-se significativamente à sobrecarga do cuidador (exceto ansiedade e alteração alimentar), e oito sintomas neuropsiquiátricos apresentaram correlações significativas com os sintomas de depressão. Conclusão: A presença de determinados sintomas neuropsiquiátricos está relacionada com a sobrecarga e com sintomas de depressão apresentados pelos cuidadores. Além do idoso com doença de Alzheimer, o cuidador deve receber cuidados e orientação da equipe de saúde para que possa continuar desempenhando sua função com qualidade.

Sociodemographic Profile of Elderly People with Temporomandibular Disorder and Depression in Combination with Parkinson's Disease

ABSTRACT Objective: To describe the sociodemographic profile of elderly people with temporomandibular disorder and depression in Parkinson's disease cases. Material and Methods: It is a cross-sectional cohort cut study, which used secondary data from 124 elderly people with Parkinson's disease (PD). To diagnose temporomandibular disorder (TMD), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire was used, and the variables studied were: age, sex, race, education, marital status, family income, stage of the disease, and depression. The statistical analysis performed was descriptive and used absolute numbers and a frequency count. Results: After the application of the eligibility criteria, the patient records of 81 elderly people with Parkinson's disease were selected; 15 presented associated TMD and depression. The average age was 69 years old; 66.67% were male; 46.67% had more than 9 years of schooling; 60% were married or had a partner; 53.33% received between 1 and 2 minimum wages; 33.33% stated they were brown; 80% were in the moderate stage of the disease; 46.66% were in group II according to the RDC/TMD, presenting disk displacement; and 53.33% presented severe depression. Conclusion: It was verified that the elderly people with Parkinson's and associated TMD and depression were male, married or with a partner, on a low income, with nine or more years of schooling, and were in the moderate stage of the disease.

COVID-19: challenges for dementia care and research / Covid-19: desafios para os cuidados e a pesquisa na demência

ABSTRACT. The COVID-19 pandemic has raised significant concerns about the management and care for people with dementia and their caregivers. In this context, this work will discuss how social isolation or social distancing caused by the pandemic may impact the clinical management of people with dementia, caregivers' health, and dementia research. The pandemic disrupts all forms of social interaction and may increase the behavioral impairment of people with dementia. Regarding pharmacological treatment, telemedicine is an option, but the context of social isolation raises questions about how to manage people with dementia with lack of cognitive stimulation and non-pharmacological treatment. In addition, the impact of the pandemic on caregivers should be considered. There is some evidence that telephone counseling can reduce depressive symptoms of caregivers of people with dementia. In dementia research, social isolation imposes researchers to modify their study protocols in order to continue collecting data by developing remote tools to assess the participants such as electronic informed consent and online questionnaires and tests. Thus, there is an urgent need for the evaluation and refinement of interventions to address several cognitive, behavioral, and clinical aspects of the long-term impact of the pandemic in dementia.

RESUMO. A pandemia causada pelo COVID-19 desencadeia grandes preocupações sobre o manejo e cuidados com as pessoas com demência e seus cuidadores. Neste contexto, discutiremos como o isolamento social causado pela pandemia pode impactar o manejo clínico de pessoas com demência, a saúde do cuidador e a pesquisa sobre demência. A pandemia interrompe todas as formas de interação social e pode causar aumento do comprometimento dos sintomas neuropsiquiátricos nas pessoas com demência. Em relação ao tratamento farmacológico, a telemedicina é uma opção, mas o contexto de isolamento social levanta questões sobre como manejar as pessoas com demência com falta de estimulação cognitiva ou intervenções nãofarmacológicas. Além disso, o impacto da pandemia sobre os cuidadores deve ser considerado. Existem evidências de que o aconselhamento telefônico pode reduzir os sintomas depressivos dos cuidadores. Além disso, o isolamento social impõe que pesquisadores modifiquem seus protocolos de pesquisa com o objetivo de continuar coletando dados, através do desenvolvimento de ferramentas remotas para avaliar os participantes, como o consentimento livre e esclarecido eletrônico e questionários e testes online. Assim, há uma necessidade urgente de avaliação e refinamento das intervenções para abordar aspectos cognitivos, comportamentais e clínicos do impacto de longo prazo da pandemia na demência.

Phineas Gage's great legacy / O grande legado de Phineas Gage

ABSTRACT. The case of Phineas Gage is an integral part of medical folklore. His accident still causes astonishment and curiosity and can be considered as the case that most influenced and contributed to the nineteenth century's neuropsychiatric discussion on the mind-brain relationship and brain topography. It was perhaps the first case to suggest the role of brain areas in determining personality and which specific parts of the brain, when affected, can induce specific mental changes. In addition, his case contributed to the emergence of the scientific approaches that would later culminate in psychosurgery. Gage is a fixed element in the studies of neurology, psychology, and neuroscience, having been solidified as one of the greatest medical curiosities of all time, deserving its prominence.

RESUMO. O caso de Phineas Gage é parte integrante do folclore médico. Seu acidente ainda causa espanto e curiosidade, e pode ser considerado como o caso que mais influenciou e contribuiu para a discussão neuropsiquiátrica do século XIX sobre a relação mente-cérebro e topografia cerebral. Foi talvez o primeiro caso a sugerir o papel de áreas cerebrais na determinação da personalidade e que partes específicas do cérebro, quando afetadas, podem induzir mudanças mentais específicas. Além disso, seu caso contribuiu para o surgimento de abordagens cientificas que culminariam posteriormente na psicocirurgia. Gage é um elemento fixo nos estudos de neurologia, psicologia e neurociências, tendo sido solidificado como uma das grandes curiosidades médicas de todos os tempos que merece seu destaque.

Neuropsychiatric symptoms in brain diseases - historical foundations / Sintomas neuropsiquiátricos em doenças cerebrais - fundamentos históricos

ABSTRACT. Neuropsychiatric symptoms, which may appear alone or combined with cognitive and neurological manifestations, are frequent in many brain dysfunctions or lesions due to vascular, traumatic, neurodegenerative, or systemic conditions. Throughout history, many of the most prominent names have contributed to the clinical definition of the currently recognized mental symptoms and syndromes. The present paper aims at providing a comprehensive overview of the development, from ancient to modern times, of some widely known concepts and constructs about such neuropsychiatric disorders.

RESUMO. Os sintomas neuropsiquiátricos que podem ocorrer de modo isolado ou acompanhando manifestações cognitivas e neurológicas são ocorrências frequentes em variadas disfunções ou lesões cerebrais devidas a condições vasculares, traumáticas, neurodegenerativas ou sistêmicas. Através da história, muitos dos nomes mais proeminentes contribuíram para a definição clínica dos sintomas e síndromes mentais reconhecidos atualmente. O presente artigo visa prover uma visão abrangente sobre o desenvolvimento, desde os tempos antigos até os presentes, de alguns dos conceitos e constructos amplamente reconhecidos sobre tais transtornos neuropsiquiátricos.

Trastornos neuroconductuales en la demencia tipo Alzheimer / Neurobehavioral disorders in Alzheimers dementia type

Resumen Los trastornos neuroconductuales (TNC) son síntomas de la percepción alterada, del contenido del pensamiento, estado de ánimo o del comportamiento, aunque se desconocen qué tipos de TNC específicos están afectados en la Demencia tipo Alzheimer (DTA). El objetivo del estudio fue investigar los TNC en pacientes con DTA en comparación con sujetos sin deterioro cognitivo (SSDC). Se estudiaron 50 pacientes con DTA y 60 SSDC en un estudio no experimental-transversal con un muestreo no probabilístico en base a una serie de criterios de inclusión. Tras la aplicación del inventario neuropsiquiátrico, los resultados demostraron que los pacientes con DTA tienen mayor afectación de TNC como la ansiedad, depresión, apatía, irritabilidad, agitación en comparación con SSDC. Los SSDC presentan alteraciones en los TNC de depresión, ansiedad, apatía y alteraciones del sueño. En conclusión, los resultados confirman la hipótesis de que en la DTA se produce una mayor afectación de los TNC en comparación que los SSDC.

Abstract Neurobehavioral disorders (NBD) are symptoms of altered perception, content of thought, mood or behavior, although what specific types of NBD are affected in Alzheimer-type dementia (ATD) are unknown. The aim of the study is to investigate NBD in patients with ATD compared to Subjects without cognitive impairment (SWCI). Fifty patients with ATD and 60 SWCI were studied in a non-experimental-cross-sectional study with a non-probability sampling based on a series of inclusion criteria. After applying the neuropsychiatric inventory, the results showed that patients with ATD have greater involvement of NBD such as anxiety, depression, apathy, irritability, agitation compared to SWCI. The SWCI present alterations in the NBD of depression, anxiety, apathy and sleep disorders. In conclusion, the results confirm the hypothesis that a greater affectation of NBD occurs in ATD compared to SWCI.

Characteristics of Delirium in the Pediatric Intensive Care Unit Using the Dynamic Symptoms Model / Características del delirium en la unidad de cuidado intensivo pediátrico utilizando el modelo de síntomas dinámicos

ABSTRACT Background: Delirium is considered a symptom of acute brain dysfunction occurring in the adult and pediatric population, which can be approached from the Dynamic Symptoms Model to have a complete view of its characteristics. Objective: To describe the prevalence and characteristics of delirium in preschool-aged patients in the pediatric intensive care unit using the Dynamic Symptoms Model. Methodology: Cohort study conducted in a pediatric intensive care unit in the city of Bogotá, Colombia. Patients between 6 months and 5 years were included. The sample size was 31 patients, and a literature review was conducted for understanding patient factors that are correlated with a higher rate of delirium. Delirium was diagnosed with the scale of evaluation of Preschool Confusion in Intensive Care (PsCAM-ICU) in Spanish version, which has a high specificity (94.8%), sensitivity (93.3%) and a reliability kappa statistic of 0.95. Results: Delirium occurred in 25.8% of patients. The characteristics of these patients with delirium were: 62.5% had a primary diagnosis of acute respiratory infection and 37.5% had respiratory failure; 62.5% presented hypoactive and 37.5% hyperactive; bronchopulmonary dysplasia and bronchiolitis were the most common pathological antecedents, 50% received benzodiazepines, 33.3% narcotics, and 16.6% analgesics. Delirious patients had longer PICU (10 vs. 7 days), and hospital length of stay (7.5 vs. 2.2 days). Conclusion: Presence of delirium in critically ill children is evidenced, whose characteristics are contained in the Dynamic Symptoms Model, therefore, from this perspective it is possible to identify it opportunely.

RESUMEN Resumen: El delirium es considerado un síntoma de disfunción cerebral aguda, presente en población adulta y pediátrica, la utilización de un modelo de enfermería permitió entender desde la investigación en enfermería las características del síntoma. Objetivo: Describir la prevalencia de delirium en pacientes prescolares en unidad de cuidado intensivo pediátrico desde el modelo de los síntomas dinámicos. Metodología: Estudio de cohorte realizado en una unidad de cuidados intensivos pediátricos de la ciudad de Bogotá, Colombia. Se incluyeron pacientes entre 6 meses y 5 años. El tamaño de la muestra fue de 31 pacientes, y se realizó una revisión de la literatura para comprender los factores del paciente que se correlacionan con una mayor tasa de delirio. El delirio fue diagnosticado con la escala de evaluación de Confusión Preescolar en Cuidados Intensivos (PsCAM-UCl) en versión española, que tiene una especificidad (94,8%), sensibilidad (93,3%) y una fiabilidad estadística de kappa de 0,95. Resultados: El delirium se presentó en un 25.8% de los pacientes, el diagnostico primario de los pacientes positivos para delirium fue del 62.5% (5 pacientes) asociado a infección respiratoria aguda y un 37.5% (3 pacientes) asociado específicamente a falla respiratoria. El 62.5% presento delirium hipoactivo y el 37.5% fue clasificado como delirium hiperactivo; la displasia broncopulmonar y la bronquiolitis fueron las patología más comunes como antecedentes, el 50% de los pacientes recibieron benzodiacepinas, 33,3 % narcóticos y el 16,6% analgésicos. Los pacientes delirantes hospitalizados en la UCIP tenían una estancia prolongada (10 frente a 7 días) y estancia hospitalaria (7,5 frente a 2,2 días). Conclusión: La presencia del Delirium en los niños críticamente enfermos es frecuente y, cuyas características están contenidos en el Modelo de Síntomas Dinámicos, por lo tanto, desde esta perspectiva es posible identificarlo oportunamente.

Las diferentes facetas de la encefalitis autoinmune / The different facets of autoinmune encephalitis

RESUMEN INTRODUCCIÓN: La encefalitis autoinmune es causada por mecanismos inmunes antineuronales, su presentación clínica es heterogénea, los criterios clínicos y paraclínicos disponibles orientan el abordaje, sin embargo, el reto ocurre cuando no hay autoanticuerpos detectables en suero o líquido cefalorraquídeo (LCR). METODOLOGÍA: Reportamos cuatro casos destacando la variabilidad de las manifestaciones clínicas, que ante la ausencia de anticuerpos (negativos finalmente en tres de los casos) fueron tratados con inmunoterapia con buena respuesta. CONCLUSIÓN: En sitios donde no se dispone de medición de anticuerpos de manera expedita, o a pesar de ser estos negativos, ante la sospecha clínica, apoyado de estudios de LCR, resonancia magnética nuclear y registro electroencefalográfico, se sugiere iniciar inmunoterapia temprana, usualmente dando lugar a reversibilidad del trastorno neurológico.

SUMMARY INTRODUCTION: Autoimmune encephalitis is caused by antineuronal immune mechanisms, its clinical presentation is heterogeneous, clinical and paraclinical criteria guide the approach, however, the challenge occurs when there are no detectable autoantibodies in serum or cerebrospinal fluid. METHODOLOGY: We report four cases that highlight the variability of clinical manifestations, which in the absence of antibodies (finally negative in three of the cases) were treated with immunotherapy with good response. CONCLUSION: In places where antibody measurement is not available expeditiously, or despite it being negative, given clinical suspicion, supported by CSF studies, magnetic resonance imaging and electroencephalographic recording, it is suggested to start early immunotherapy, usually resulting in the reversibility of the neurological disorder.

Association between family adversity exposed to different period and psychopathological symptoms among adolescents in rural areas / 中国学校卫生

Objective@#To investigate the cumulative and sensitive period effects of family adversity on the outcome of psychopathological symptoms,so as to provide evidence for the prevention and intervention of adverse events.@*Methods@#A total of 710 adolescents were recruited from local schools in rural area of Fuyang,Anhui Province in Dec. 2017 by using the convenience sampling method. The Adverse Childhood Experiences Questionnaire was used to assess family adversity. The MacArthur Health & Behavior Questionnaire was used to assess internalizing and externalizing symptoms. Multiple linear regression model was used to analyze the association between number and time of family adversity and psychopathological symptoms.@*Results@#Persistent family adversity was associated with increased internalizing symptoms [(β(95%CI)=0.35(0.15-0.54)] and increased externalizing symptoms [β(95%CI)=0.16(0.01-0.32)]. 2 and ≥3 family adversities were associated with increased internalizing symptoms[β(95%CI)=0.20(0.04-0.36),0.42(0.24-0.60)]and increased externalizing symptoms[β(95%CI)=0.14(0.01-0.26),0.23(0.09-0.37)]. In childhood family adversity group,2 and ≥3 family adversities were associated with increased internalizing symptoms [β(95%CI)=0.23(0.06-0.41),0.34(0.11-0.58)] and increased externalizing symptoms [β(95%CI)=0.17(0.02-0.31),0.21(0.02-0.39)]. In persistent family adversity group,≥3 family adversities were associated with increased internalizing symptoms[β(95%CI)=0.56(0.31-0.82)] and increased externalizing symptoms [β(95%CI)=0.24(0.02-0.45)]. Adolescence family adversity was not associated with psychopathological symptoms.@*Conclusion@#The cumulative family adversity may increase the risk of psychopathological symptoms,and that childhood may be the sensitive period for family adversity to cause psychopathological symptoms.

El síntoma / The symptom

El síntoma entendido por alteraciones subjetivas percibidas por las per-sonas ha sido desarrollado desde los años 50 por los psiquiatras y en los años 70 por psicólogos clínicos. Una sinopsis completa de esta alteración se resume en el libro de Süllwold y Huber, desde 1974. Los síntomas son alteraciones subclínicas sutiles y subjetivamente experimentadas en el im-pulso, el afecto, el pensamiento, el habla, la percepción (corporal), la acción motora, las funciones vegetativas centrales y la tolerancia al estrés. Por definición, los síntomas son diferentes de lo que se considera el ser mental "normal" de uno. Al ser subjetivos, siguen siendo predominantemente pri-vados y aparentes solo para la persona afectada, y raramente son obser-vables. Los síntomas básicos difieren de los síntomas negativos tal como se los entiende actualmente, es decir, como déficit funcionales observables por otros. La percepción de que algo está mal con el pensamiento de uno está presente; sin embargo, algunas experiencias pueden ser tan nuevas y extrañas que siguen siendo casi inexplicables. En el campo de la medicina, las enfermeras ayudan a los pacientes a hacer frente a la angustia de los síntomas, mientras que los médicos se preocupan principalmente por la aparición de síntomas en el diagnóstico o tratamiento de la enfermedad.(AU)

The symptom understood by subjective alterations perceived by people has been developed since the 50s by psychiatrists and in the 70s by clinical psychologists. A complete synopsis of this alteration is summarized in the book written by Süllwold and Huber, since 1974. The symptoms are subtle and subjectively subclinical experienced alterations in impulse, affection, thought, speech, (body) perception, motor action, central vegetative functions and stress tolerance. By definition, the symptoms are different from what is considered to be the "normal" mental being of one. Being subjective, they remain predominantly private and apparent only for the affected person, and they are rarely observable. The basic symptoms differ from the negative symptoms as they are currently understood, that is, as functional deficits observable by others. The perception that something is wrong with one's thinking is present; however, some experiences may be so new and strange that they remain almost inexplicable. In the medical field, nurses help patients to cope to the symptoms, while doctors are primarily concerned with the appearance of symptoms in the diagnosis or treatment of the disease.(AU)

Risk Factors of Behavioral and Psychological Symptoms in Patients with Alzheimer Disease: The Clinical Research of Dementia of South Korea Study / 가정의학회지

BACKGROUND: Few studies have evaluated risk factors for behavioral and psychological symptoms of dementia at the initial assessment for Alzheimer disease in large patient samples. In this study, the factors influencing Alzheimer disease were examined using the Clinical Research of Dementia of South Korea data. METHODS: This cross-sectional study was conducted using data of 1,128 patients with Alzheimer disease. The behavioral and psychological symptoms of dementia were examined using the Korean version of the Neuropsychiatric Inventory. Demographic characteristics, health-related behavior, neuropsychological tests, comorbidities, blood test results, and caregiver characteristics were assessed. Median logistic regression analysis with adjustment for covariates was conducted. RESULTS: The behavioral and psychological symptoms of dementia were negatively associated with memory (P=0.022) and frontal/executive (P < 0.001) function in the Seoul Neuropsychological Screening Battery-dementia, Barthel Index for Activities of Daily Living (P < 0.001), Korean version of the Mini-Mental State Examination score (P=0.003), and caregiver age (P=0.005) after adjustment for confounding factors, and positively associated with the Seoul-Instrumental Activities of Daily Living score (P < 0.001), Clinical Dementia Rating Sum of Box (P < 0.001), Global Deterioration Scale score (P < 0.001), abnormality of free T4 level (P < 0.001), anemia (P < 0.001), and family history of stroke (P=0.001). Patients with female caregivers exhibited more severe behavioral and psychological symptoms of dementia than those with male caregivers. CONCLUSION: Behavioral and psychological symptoms of dementia in Alzheimer disease patients were associated with various risk factors including the inability to live independently and Alzheimer disease severity. These findings suggest that prevention and treatment strategies for the behavioral and psychological symptoms of dementia should be comprehensive.

Care complexity in hospitalized elderly according to cognitive performance / Complejidad asistencial en ancianos hospitalizados según desempeño cognitivo / Complexidade assistencial em idosos hospitalizados conforme desempenho cognitivo

ABSTRACT Objective: to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline. Method: quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP. Results: cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain. Conclusion: the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.

RESUMEN Objetivo: investigar posibles diferencias en la complejidad asistencial, desempeño funcional, y en los aspectos biopsicosociales y del sistema de salud entre ancianos hospitalizados con o sin declinación cognitiva. Método: estudio cuantitativo, transversal y analítico que utilizó el método INTERMED y escalas de rastreo cognitivo y funcional. Se investigaron 384 ancianos internados en clínica médica y quirúrgica de un Hospital Universitario ubicado en São Paulo/SP. Resultados: se obtuvo que el 40,1% de la muestra presentó declinación cognitiva, la mayoría compuesta por ancianos más longevos, del sexo femenino, con menor escolaridad e ingresos, más dependientes para las actividades de vida diaria y con mayor vulnerabilidad en diferentes dominios del INTERMED. Después de ajustes, los ancianos con declinación cognitiva presentaron mayor vulnerabilidad en el dominio psicológico. Conclusión: la relación entre declinación cognitiva y vulnerabilidad psicológica destaca la necesidad de adoptar cuidados de larga duración basados en la participación de la familia, del equipo de salud y de los diferentes servicios, maximizando la calidad de la atención.

RESUMO Objetivo: investigar possíveis diferenças na complexidade assistencial, desempenho funcional e aspectos biopsicossociais e de sistema de saúde entre idosos hospitalizados com ou sem declínio cognitivo. Método: estudo quantitativo, transversal e analítico que utilizou o método INTERMED e escalas de rastreio cognitivo e funcional. Foram investigados 384 idosos internados em clínica médica e cirúrgica de um Hospital Universitário em São Paulo/SP. Resultados: Houve declínio cognitivo em 40,1% da amostra, cuja maior parte era de idosos mais longevos e do sexo feminino, com menor escolaridade e renda, mais dependentes para as atividades de vida diária e com maior vulnerabilidade em diferentes domínios do INTERMED. Após ajustes, os idosos com declínio cognitivo apresentaram maior vulnerabilidade no domínio psicológico. Conclusão: A relação entre declínio cognitivo e vulnerabilidade psicológica destaca a necessidade de adotar cuidados de longa duração pautados no envolvimento da família, da equipe de saúde e dos diferentes serviços para qualidade da assistência.

Behavioral problems of HIV infected children / 中国学校卫生

Objective@#To understand the behavioral problems of children infected with HIV, and to provide reference for further psychological intervention.@*Methods@#The survey was conducted from January to December 2017. A total of 256 HIV-infected 10-16 years old school-aged children who were receiving highly active antiretroviral therapy (HAART) in Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention were invited to participate. Another 256 children without HIV infection who were matched with sex and age were selected as the control group. Achenbach Children’s Behavior Scale was used to conduct psychological questionnaires in the two groups of children.@*Results@#Activity, social competence, and learning ability in the study group scored lower than control group (P<0.05). In children with HIV infection group, score of social competence in boys and girls aged 10-11 years were (14.35±3.96) (15.26±5.00), respectively, and was (14.21±4.64) and (14.57±5.50) in boys and girls aged 12-16 years was significantly lower than age and sex-matched control group (19.38±6.77 and 18.09±5.16 in boys and girls aged 10-11 years, 17.26±6.88 and 17.84±6.76 in boys and girls aged 12-16 years) (P<0.05). The total detection rate of behavioral problems in the study group (13% and 10% in boys and girls aged 10-11 years, 17% and 13% in boys and girls aged 12-16 years) was significantly higher than that in the control group (5% and 3% in boys and girls aged 10-11 years, both 4% in boys and girls aged 12-16 years) (P<0.05).@*Conclusion@#Behavioral problems in HIV-infected children are prevalent, which worth more attention to carry out psychological intervention among this vulnerable population.