Prévalence et facteurs associés des déficits neurocognitifs chez les patients diabétiques admis au centre neuro-psychopathologique de Kinshasa / NA

Objectif de l'étude.Préciser, chez les diabétiques, la fréquence et les facteurs associés des troubles neurocognitifs. Patients et Méthode. Une étude cas-témoin menée de janvier à décembre 2020 au Centre Neuro-Psychopathologique de l'Université de Kinshasa. Le diabète sucré (DS) a été diagnostiqué selon les critères biologiques de l'OMS et les fonctions neurocognitives évaluées à l'aide du test de Grober et Buschke après un dépistage avec le community screening interview for dementia (CSI-D). Résultats. Cinquante cas et 50 témoins ont été inclus. La fréquence globale des troubles neurocognitifs était de 58%. L'âge moyen des patients diabétiques atteints de troubles neurocognitifs était de 60,48 ± 6,90 ans avec un sex ratio (H/F) de 0,81. Les troubles neurocognitifs étaient en proportion élevés chez les diabétiques qui avaient un DS évoluant entre 6 et 10 ans. Les troubles mnésiques étaient associées au DS ; OR: 3,58, IC 95% [1,29-5,87], p = 0,003 ; avec prédominance d'amnésie d'évocation (65%). Les troubles neurocognitifs chez les diabétiques étaient influencés par l'âge ≥ 60 ans, l'HTA, le manque de ressource sure de revenue financière, les AVC et la durée du diabète supérieure à 5 ans. Le DS demeurait, après ajustement sur différents facteurs, un facteur de risque des troubles neurocognitifs avec un OR ajusté = 3,63, IC 95% [1,86-6,70] et un p = 0, 0001.Conclusion. Les diabétiques sont plus enclins aux troubles neurocognitifs que les non diabétiques. Des facteurs de risque pouvant influencer la survenue de ces troubles ont été identifiés.

Objective. To specify, in diabetics, the frequency and associated factors of neurocognitive disorders.Patients and Method. A case-control study conducted from January to December 2020 at the Neuro-Psychopathological Center of the University of Kinshasa. Diabetes mellitus (DM) was diagnosed according to WHO biological criteria and neurocognitive functions assessed using the Grober and Buschke test after screening by the community screening interview for dementia (CSI-D).Results. Fifty cases and 50 controls were included. The overall frequency of neurocognitive disorders was 58%. The mean age of diabetic patients with neurocognitive disorders was 60.48 ± 6.90 years with a sex ratio (M/F) of 0.81. Neurocognitive disorders were in high proportion in diabetics who had DM evolving between 6 and 10 years. Memory disorders were associated with DM; OR: 3.58, 95% CI [1.29-5.87], p = 0.003; with predominance of evocation amnesia (65%). Neurocognitive disorders in diabetics were influenced by age ≥ 60 years, hypertension, lack of secure financial income, stroke and duration of diabetes more than 5 years. DM remained, after adjustment for various factors, a risk factor for neurocognitive disorders with an adjusted OR = 3.63, 95% CI [1.86-6.70] and a p = 0.0001.Conclusion. Diabetics are more prone to neurocognitive disorders than non-diabetics. Risk factors that may influence the occurrenceof these disorders have been identified

Afasia primaria progresiva variante no fluente/agramática / Non-fluent/agrammatic variant of primary progressive aphasia

Introducción: Entre las enfermedades neurodegenerativas se encuentra un grupo de patologías que se caracterizan por un compromiso prominente del lenguaje, denominadas usualmente afasias primarias progresivas, las cuales se subdividen en 3 tipos: variante logopénica, variante semántica y variante no fluente o agramática. Presentación del caso: Paciente con cuadro clínico que inicia a los 65 años, con disminución en la interacción social. Un par de meses después, la esposa nota que el lenguaje del paciente se torna poco fluido, habla con palabras o frases cortas, no logra decir oraciones completas, además de presentar cambios en la entonación de las palabras y alteraciones del lenguaje escrito. El paciente manifiesta que su principal limitación en el momento es el no poder expresar lo que quiere decir, y por este motivo consulta. Discusión: En el caso de este paciente, se describe inicialmente un cambio en su personalidad que no compromete su funcionalidad, sin embargo, al poco tiempo se presenta compromiso del lenguaje como síntoma prominente y que genera mayor compromiso en su calidad de vida, con pruebas neuropsicológicas y hallazgos de neuroimagen que apoyan el diagnóstico de afasia primaria progresiva (APP) variante no fluente o agramatical, con síntomas comportamentales y motores asociados. Conclusión: Las APP son un grupo de trastornos neurocognitivos cuya característica primordial es el compromiso en el lenguaje, cada variante de APP tiene unas características clínicas y criterios diagnósticos específicos que se deben conocer para lograr sospechar el diagnóstico y hacer un abordaje apropiado en el paciente.

Introduction: In the group of neurodegenerative diseases, there is a group of pathologies that are characterized by a prominent compromise of language, normally called primary progressive aphasias, these are subdivided into 3 types: logopenic variant, semantic variant and non-fluent or agrammatic variant. Case presentation: Patient with a clinical picture that begins at age 65, with decreased social interaction, a couple of months later his wife notices that his language becomes not fluent, speaks in short words or phrases, cannot say complete sentences, in addition to changes in the intonation of words and alterations in written language, the patient states that his main limitation at the moment is not being able to express what he wants to say and for this reason they consult. Discussion: In the case of this patient, a change in his personality is initially described that does not compromise his functionality, however soon after a language involvement is presented as the main symptom and the one that generates a compromise in his quality of life, with neuropsychological tests and findings on neuroimaging that supports the diagnosis of primary progressive aphasia (PPA) non-fluent or agrammatical variant, with associated behavioral and motor symptoms. Conclusion: APPs are a group of neurocognitive disorders whose primary characteristic is language impairment. Each APP variant has specific clinical characteristics and diagnostic criteria that must be known in order to suspect the diagnosis and make an appropriate approach to the patient.

Role of gut microbiota in perioperative neurocognitive disorders after cardiopulmonary bypass surgery in rats with humanized gut flora / 南方医科大学学报

OBJECTIVE@#To investigate whether gut microbiota disturbance after cardiopulmonary bypass (CPB) contributes to the development of perioperative neurocognitive disorders (PND).@*METHODS@#Fecal samples were collected from healthy individuals and patients with PND after CPB to prepare suspensions of fecal bacteria, which were transplanted into the colorectum of two groups of pseudo-germ-free adult male SD rats (group NP and group P, respectively), with the rats without transplantation as the control group (n=10). The feces of the rats were collected for macrogenomic sequencing analysis, and serum levels of IL-1β, IL-6 and TNF-α were measured with ELISA. The expression levels of GFAP and p-Tau protein in the hippocampus of the rats were detected using Western blotting, and the cognitive function changes of the rats were assessed with Morris water maze test.@*RESULTS@#In all the 3 groups, macrogenomic sequencing analysis showed clustering and clear partitions of the gut microbiota after the transplantation. The relative abundances of Klebsiella in the control group (P < 0.005), Akkermansia in group P (P < 0.005) and Bacteroides in group NP (P < 0.005) were significantly increased after the transplantation. Compared with those in the control group, the rats in group NP and group P showed significantly decreased serum levels of IL-1β, IL-6 and TNF-α and lowered expression levels of GFAP and p-Tau proteins (all P < 0.05). Escape platform crossings and swimming duration in the interest quadrant increased significantly in group NP (P < 0.05), but the increase was not statistically significant in group N. Compared with those in group P, the rats in group NP had significantly lower serum levels of IL-1β, IL-6 and TNF-α and protein expressions of GFAP and p-Tau (all P < 0.05) with better performance in water maze test (P < 0.05).@*CONCLUSION@#In patients receiving CPB, disturbances in gut mirobiota contributes to the development of PND possibly in relation with inflammatory response.

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.

Doença de Alzheimer: um estudo de caso sobre o transtorno neurocognitivo que mais afeta idosos / Alzheimer's disease: a case study involving the most prevalent neurocognitive disorder in older people

Resumo Objetivo Analisar a evolução clínica de um paciente acometido pela Doença de Alzheimer (DA) e discutir as repercussões de um diagnóstico precoce. Método Estudo de caso instrumental do tipo qualitativo e de caráter descritivo que se desenvolveu em três etapas: 1) seleção e delimitação do caso; 2) coleta dos dados em campo; e 3) organização e redação do relatório. Este estudo baseia-se na análise da evolução clínica descrita em prontuário de um paciente com diagnóstico de DA, atendido e acompanhado pelo Centro de Atenção Psicossocial (CAPS), por um período de 10 anos, na região do Alto Vale do Rio do Peixe. Resultados Estudo realizado com a paciente M.R., sexo feminino, 71 anos, casada e do lar, com ensino fundamental incompleto, portadora de DA e hipotireoidismo, a qual iniciou seu acompanhamento no CAPS II em 10 de setembro de 2012. Paciente submetida ao Miniexame do Estado Mental (MEEM), tendo como resultado no primeiro teste 14 pontos, abaixo do ponto de corte para o nível de escolaridade da paciente. Posteriormente, em 2018, registraram-se 10 pontos no MEEM, e em 2020 possuiu pontuação igual a 11, já em tratamento medicamentoso para DA: Memantina 10mg 2x/dia e Donepezila 5mg 1x/dia. Conclusão O diagnóstico precoce da DA é de extrema importância para tratamento adequado a fim de retardar a progressão da doença. No entanto, afecções mentais, tal como a depressão, constituem-se como barreiras na análise clínica inicial dos pacientes e ainda em certos casos apresenta-se como pródromo para a DA.

Abstract Objective To analyze the clinical evolution of a patient affected by Alzheimer's disease and discuss the repercussions of an early diagnosis. Method Instrumental case study of qualitative and descriptive type that was developed in three stages: 1) selection and delimitation of the case; 2) collection of data in the field; and 3) organization and writing of the report. This study is based on the analysis of the clinical evolution described in the medical records of a patient diagnosed with Alzheimer's disease, treated and followed-up by the Center for Psychosocial Care (CAPS), for a period of 10 years, in the Alto Vale do Rio do Peixe region. Results This study was conducted with the patient M.R., female, 71 years old, married, housewife, with incomplete elementary education, carrier of AD and hypothyroidism, who started her follow-up at CAPS II on September 10, 2012. Patient submitted to the Mini Mental State Examination (MMSE), with a result of 14 points in the first test, below the cut-off point for the patient's level of education. Later, in 2018, she scored 10 points on the MMSE, and in 2020 she scored 11, already under medication treatment for AD: memantine 10mg 2x/day and donepezilla 5mg 1x/day. Conclusion Early diagnosis of AD is extremely important for appropriate treatment to slow the progression of the disease. However, mental disorders such as depression are barriers in the initial clinical analysis of patients and in some cases presents itself as a prodrome for AD.

Déficits neuropsicológicos en mujeres con trastornos de la conducta alimentaria / Neuropsychological impairment in women with eating disorders

RESUMEN Introducción Antecedentes: La anorexia nerviosa (AN) y la bulimia nerviosa (BN) son enfermedades mentales graves y crónicas que afectan a un alto porcentaje de la población. Un número creciente de estudios han informado de alteraciones neuropsicológicas en esta población, que aparentemente contribuyen a la aparición y progresión del trastorno, y que repercuten en la eficacia del tratamiento y la recuperación. Metodología: El objetivo de esta Revisión Narrativa es resumir los hallazgos relativos al perfil neuropsicológico de las mujeres con AN y BN en diferentes fases de tratamiento. Resultados: La evidencia disponible sugiere que las mujeres con AN y BN presentan un perfil de déficits de cognición ejecutiva y social. Estos resultados son consistentes con la evidencia de los hallazgos de neuroimagen de alteraciones cerebrales estructurales en las áreas frontales y en los circuitos frontales-subcorticales. Conclusiones: El conocimiento de los perfiles neuropsicológicos de las mujeres con AN y BN ofrece información clave para entender la presentación clínica de esta población y los retos en la adherencia y beneficio del tratamiento. Los estudios futuros deberían explorar la eficacia de las intervenciones dirigidas a las deficiencias neuropsicológicas y cómo contribuyen al tratamiento habitual.

Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are severe and chronic mental health illnesses that affect a high percentage of the population. A growing number of studies have reported neuropsychological impairments in this population, apparently contributing to the onset and progression of the disorder, and impacting on treatment efficacy and recovery. Methodology: This Narrative Review aimed to summarize findings regarding the neuropsychological profile of women with AN and BN at different treatment phases. Results: Available evidence suggests that women with AN and BN present a profile of executive and social cognition deficits. These results are consistent with evidence from neuroimaging findings of structural brain alterations in frontal areas and frontal-subcortical circuits. Conclusions: Knowledge about the neuropsychological profiles of AN and BN women offers key information to understand the clinical presentation of this population and challenges in adhering and benefiting from treatment. Future studies should explore the efficacy of interventions targeting neuropsychological impairments and how they contribute to treatment as usual.

Fundamentos teórico-técnicos para la comprensión y detección de la simulación de déficits neurocognitivos / Theoretical-technical foundations for the understanding and detection of the simulation of neurocognitive deficits

La neuropsicología está desarrollándose y migrando a otras áreas tales como la judicial, en donde el neuropsicólogo forense ayuda al juez a tomar decisiones ecuánimes e imparciales, sin embargo, nace como problemática el fenómeno de la simulación de déficits neurocognitivos con el propósito de obtener ganancias secundarias. Este artículo tiene como objetivo abordar dicho fenómeno mediante una sistematización bibliográfica, estableciendo un marco teórico-comprensivo del fenómeno, así como también identificando las principales herramientas para su detección. Se esquematizan apartados que forman un hilo conductor que arrojan como resultado que la detección de la simulación de déficits neurocognitivos es una tarea compleja, multidimensional y que debería tener un enfoque holístico, por lo tanto, es necesario seguir investigando al respecto para perfeccionar sus métodos de identificación.

Neuropsychology is developing and migrating to other areas such as the judicial, where the forensic neuropsychologist helps the judge to make fair and impartial decisions, however, the phenomenon of the simulation of neurocognitive deficits with the purpose of obtaining secondary gains is born as a problem. This article aims to address this phenomenon through a bibliographic systematization, establishing a theoretical-comprehensive framework of the phenomenon, as well as identifying the main tools for its detection. Thus, sections are outlined that form a common thread that show as a result that the detection of the simulation of neurocognitive deficits is a complex, multidimensional task and that it should have a holistic approach, therefore, it is necessary to continue researching in this regard. to perfect its results identification methods.

Curso clínico y perfil neuropsicológico de un caso de trastorno neurocognitivo frontotemporal mayor variante lingüística / Clinical course and neuropsychological profile of Frontotemporal Neurocognitive Disorder Linguistic Language Variant

Resumen El trastorno neurocognitivo frontotemporal es una enfermedad neurodegenerativa que incluye manifestaciones clínicas de subtipo comportamental y lingüística. La afasia progresiva primaria (APP) es un síndrome en el que aparecen alteraciones del lenguaje que comprende tres tipos de variantes: no fluente, semántica y logopénica. Este estudio describe la evolución clínica y las características neuropsicológicas de una mujer de 63 años que presenta un deterioro progresivo del lenguaje. Se evalúan las funciones de atención, memoria, lenguaje y funciones ejecutivas. La paciente obtuvo un bajo rendimiento en memoria, velocidad de procesamiento y funciones ejecutivas. Su lenguaje se caracteriza por presentar baja fluidez, agramatismo, parafasias verbales y dificultades en denominación. Se concluye que la paciente presenta características de la APP no fluente, que varía a través del tiempo y afecta su funcionamiento; características de un curso clínico de un trastorno neurocognitivo mayor posible debido a una degeneración del lóbulo frontotemporal.

Abstract Mild cognitive impairment, frontotemporal dementia (FTD) is a neurodegenerative disease characterized by clinical manifestations of behavior and linguistic subtypes. Primary Progressive Aphasia (APP) is a syndrome in which language alterations appear that include three types of variations: Non - fluent, Semantic and Logopenic. This study describes the clinical evolution and the neurophysiological characteristics of a 63 years old woman that started with a progressive language impairment. The functions which are evaluated are attention, memory, language and executive functions. The patient obtained a low performance in memory, processing speed and executive functions. The language is characterized by low fluency, agramatism, paraphasias and denomination difficulties. It is concluded, that the patient has characteristics of APP non-fluent which varies throughout the time and it affects her performance; characteristics of a clinical course of a greater neurocognitive disorder might be due to a lobe frontotemporal degeneration.

The mnemic system of the ego: from war to splitting / O sistema mnêmico do eu: da guerra à clivagem

RESUMO: O sistema mnêmico do eu (Icherinnerungssystem) consiste em uma das contribuições teóricas mais originais de Sándor Ferenczi. Propomos, no presente artigo, colocar essa concepção em evidência, rastreando seus antecedentes, expondo detalhadamente sua formulação e, finalmente, seguindo seus desdobramentos. Consideramos que o antecedente da concepção de sistema mnêmico do eu localiza-se na experiência de Ferenczi com a neurose de guerra. Quanto aos seus desdobramentos, indicamos que ele participa, de maneira decisiva, na construção de um dos múltiplos modelos de clivagem desenvolvidos por Ferenczi na sua clínica do trauma.

Abstract: The mnemic system of the ego (Icherinnerungssystem) consists of one of the most original theoretical contributions by Sándor Ferenczi. We propose, in this article, to put this conception in evidence, tracing its antecedents, exposing its formulation in detail and, finally, following its unfolding. We consider that the antecedent of the conception of the mnemic system of the ego lies in Ferenczi's experience with war neurosis. As for his developments, we indicate that it participates, decisively, in the construction of one of the multiple splitting models developed by Ferenczi in his clinic of trauma.

Cannabinoids for major neurocognitive disorder: case report and literature review / Uso de cannabinoides en trastorno neurocognitivo mayor: reporte de un caso y revisión de la literatura

ABSTRACT Introduction: Major neurocognitive disorder (MNCD) affects millions of people worldwide. However, the pharmacological options for its management are limited, ineffective and frequently associated with severe adverse reactions. Case report: An 85-year-old man with history of multiple chronic brain injuries (alcohol-use disorder, haemorrhagic stroke, brain trauma, chronic use of benzodiazepines) developed an MNCD, reaching 7 points on the Reisberg Global Deterioration Scale. He had minimal response to antidepressants, antipsychotics and anticholinergic medications. After the use of mother tincture of Indian hemp (cannabis), a significant improvement was found in his cognitive function, ability to carry out activities of daily living and independence. Discussion: The endocannabinoid system seems to be implicated in age-related cognitive decline. In addition, the evidence derived from in-vitro and animal models suggest that this system could play an important role in the management of MNCD of different causes. Conclusions: Cannabinoid treatment for MNCD emerges as a promising therapeutic approach that may benefit a growing number of patients who do not have other treatment options. It is therefore necessary to encourage more research efforts that will help to remove political and scientific barriers to its clinical use.

RESUMEN Introducción: El trastorno neurocognitivo mayor (TNM) afecta a millones de personas a nivel mundial. Sin embargo, las opciones farmacológicas para su manejo son limitadas, poco efectivas y se asocian a importantes reacciones adversas. Caso clínico: Se presenta el caso clínico de un hombre de 85 años, con antecedente de múltiples lesiones cerebrales crónicas (abuso de alcohol, enfermedad cerebrovascular, traumatismo cerebral, uso crónico de benzodiacepinas), quien desarrolló un TNM clasificado con 7 puntos en la Reisberg Global Deterioration Scale. Tuvo poca respuesta al manejo con antidepresivos, antipsicóticos y anticolinérgicos. Tras el uso de tintura madre de cáüamo índico (cannabis), se evidenció una mejoría en la función cognitiva, la capacidad de cuidado para las actividades de la vida diaria y la independencia. Discusión: El sistema endocanabinoide parece estar relacionado con los procesos de deterioro cognitivo asociados con la edad. Además, la evidencia derivada de modelos in vitro y animales sugiere que podría tener un papel importante en el manejo del TNM de diferentes etiologías. Conclusiones: El uso de cannabinoides en el TNM se presenta como una pista terapéutica prometedora. Por lo tanto, es necesario promover procesos de investigación que contribuyan a eliminar las barreras políticas y científicas para su uso clínico, beneficiando a un número creciente de pacientes que no poseen opciones terapéuticas eficaces.

High prevalence of HIV-associated neurocognitive disorders (HAND) in São Paulo City, Brazil / Alta prevalência de desordem neurocognitiva associada ao HIV (HAND) na Cidade de São Paulo, Brazil

INTRODUCTION: HIV-associated neurocognitive disorders (HAND) are the subject of many studies, some of them reporting a prevalence of up to 50 percent. OBJECTIVES: To determine the prevalence and factors associated with HIV neurocognitive disorders (HAND) in a cohort of HIV-1-infected patients in São Paulo city, Brazil. METHODOLOGY: Descriptive cross-sectional study including 106 HIV-1-infected patients, employing direct interview and neuropsychological tests, applied by trained neuro-psychologists with expertise in the tests. Other, similar assessment tools we used were Brief Neurocognitive Questionnaire, International HIV Dementia Scale, Lawton Instrumental Activities of Daily Living, Hospital Anxiety and Depression Scale, Social Support Scale for People with HIV/Aids, Assessment of Adherence to Antiretroviral Therapy Questionnaire, and a complex neuropsychological assessment. RESULTS: We included 106 patients from May 2015 to April 2018. We found a high prevalence of HAND in our patients (45%), with 27.5% presenting asymptomatic neurological impairment (ANI) and 17.5% mild neurological dysfunction (MND); only one patient presented HIV-associated dementia (HAD) (0.9%). Women were more likely to have MND (52.9%) and the only case of HAD was also female. The high prevalence of neurocognitive disorders was independent of the immunological status, use of efavirenz, or virological control. CONCLUSIONS: This study may mirror the national and international scenarios, showing a high prevalence of HAND (45%) and the prevalence of some risk factors, in special among women

INTRODUÇÃO: As doenças neurocognitivas associadas ao HIV (HAND), são o assunto de muitos estudos, alguns deles relatando uma prevalência de até 50 por cento. OBJETIVOS: Determinar a prevalência e os fatores associados aos distúrbios neurocognitivos do HIV (HAND) em uma coorte de pacientes infectados pelo HIV-1 na cidade de São Paulo, Brasil. METODOLOGIA: Estudo transversal descritivo incluindo 106 pacientes infectados pelo HIV-1, utilizando entrevista direta e testes neuropsicológicos, aplicados por neuropsicólogos treinados com experiência nos testes. Foram utilizados também: Questionário Neurocognitivo Breve, Escala Internacional de Demência do HIV, Atividades Instrumentais de Vida Diária de Lawton, Escala Hospitalar de Ansiedade e Depressão, Escala de Apoio Social para Pessoas com HIV / Aids, Avaliação da Adesão à Terapia Antiretroviral Questionário e uma bateria de avaliação neuropsicológica complexa. RESULTADOS: Foram avalaidos 106 pacientes de maio de 2015 a abril de 2018. Foi observado uma alta prevalência de HAND em nossos pacientes (45%), com 27,5% apresentando comprometimento neurológico assintomático (ANI) e 17,5% comprometimento cognitive leve (MND); apenas um paciente apresentou demência associada ao HIV (DAH) (0,9%). As mulheres eram mais propensas a ter MND (52,9%) e o único caso de HAD também era do sexo feminino. A alta prevalência de distúrbios neurocognitivos foi independente do estado imunológico, uso de efavirenz ou controle virológico. CONCLUSÕES: Este estudo pode espelhar o cenário nacional e internacional, mostrando uma alta prevalência de HAND (45%) e a prevalência de alguns fatores de risco, em especial entre as mulheres

Language in corticobasal syndrome: a systematic review / Linguagem na síndrome corticobasal: uma revisão sistemática

ABSTRACT. Language is commonly impacted in corticobasal syndrome (CBS). However, the profile and type of language assessment in CBS are poorly studied. Objective: To identify language impairments in CBS. Methods: A search was performed in the Medline/PubMed database, according to the PRISMA criteria, using the keywords "corticobasal syndrome" OR "corticobasal degeneration" AND "language". Articles on CBS covering language assessment that were written in English were included, with no constraints on the publication date. Results: A total of 259 articles were found and 35 were analyzed, consisting of 531 participants. Twenty-eight studies showed heterogeneous language deficits and seven mentioned nonfluent primary progressive aphasia. The most used tests were the Western Aphasia Battery (8 studies) and the Boston Naming Test (8 studies). Conclusion: It was not possible to identify a unique linguistic profile in CBS.

RESUMO. A linguagem encontra-se comumente alterada na síndrome corticobasal (SCB). No entanto, o perfil e a forma de avaliação da linguagem na SCB são pouco estudados. Objetivo: identificar as alterações de linguagem na SCB. Método: Realizou-se uma busca na base de dados Medline/PubMed, com as palavras-chave "síndrome corticobasal" OU "degeneração corticobasal" E "linguagem". Artigos sobre SCB envolvendo avaliação de linguagem, escritos em inglês, foram incluídos, sem restrição de data de publicação. Resultados: Foram encontrados 259 artigos, e 35 estudos foram analisados, abrangendo 531 sujeitos. Um total de 28 estudos mostraram déficits heterogêneos de linguagem, e sete mencionaram afasia progressiva primária não-fluente. Os testes mais utilizados foram Western Aphasia Battery (8 estudos) e o Teste de Nomeação de Boston (8 estudos). Conclusão: Não foi possível identificar um perfil linguístico único em pacientes com SCB.

Calidad de vida en cuidadores informales de pacientes con Alzheimer tras implementación de programa multicomponente / Quality of life in informal caregivers of Alzheimer's patients after implementation of a multi-component program

INTRODUCCIÓN: el cuidado de un paciente dependiente tiene mayores implicaciones si el diagnóstico es la enfermedad de Alzheimer, su calidad de vida se ve afectada de manera considerable en los aspectos relacionados con la salud. OBJETIVO: evaluar el efecto de una intervención multicomponente y transdisciplinar en la calidad de vida relacionada con la salud en cuidadores informales de pacientes con Trastorno Neurocognitivo Mayor (TNC) tipo Alzheimer. MÉTODOS: participaron 50 cuidadores informales de pacientes con Alzheimer, empleando el cuestionario SF-36, mediante un ensayo aleatorizado con tres grupos de comparación y con evaluación de la calidad al inicio, y a los 5 y 10 meses. Para encontrar el tamaño del efecto de las intervenciones en la calidad de vida, según los grupos estudiados, se usó un modelo de efectos mixtos con covarianza no estructurada. RESULTADOS: se encontró que quienes recibieron la intervención multicomponente más respiro obtuvieron un mejoramiento de la calidad de vida en todas las dimensiones y componentes excepto en la función física, con efectos sostenidos en seguimiento. CONCLUSIÓN: las intervenciones no farmacológicas multicomponente acompañadas de un relevo del cuidado tienen un efecto positivo en la percepción de calidad de vida en cuidadores.

INTRODUCTION: The care of a dependent patient has greater implication if the diagnostic is the disease of Alzheimer's, their quality of life is affected considerably in the aspects related to health. OBJECTIVE: to evaluate the effect of a multicomponent and transdisciplinary intervention on health-related quality of life in informal caregivers of patients with Alzheimer-type Major Neurocognitive Disorder (TNC). METHODS: 50 informal caregivers of Alzheimer's patients participated, using the SF-36 questionnaire, through a randomized trial with three comparison groups and quality assessment at baseline, and at 5 and 10 months. To find the effect size of the quality of life interventions, according to the groups studied, a mixed effects model with unstructured covariance was used. RESULTS: it was found that those who received the multicomponent intervention plus respite obtained an improvement in the quality of life in all dimensions and components except physical function, with sustained effects in follow-up. CONCLUSION: multicomponent non-pharmacological interventions accompanied by a change of care have a positive effect on the perception of quality of life in caregivers.

Characterization of Behavioral Symptoms of Older Adults with Neurocognitive Disorder by the Report of Informal Caregivers / Caracterização de Sintomas Comportamentais de Adultos Mais Velhos com Transtorno Neurocognitivo pelo Relato de Cuidadores Informais / Caracterización de Síntomas Conductuales de Adultos Mayores con Trastorno Neurocognitivo Según el Informe de Cuidadores Informales

Abstract: Behavioral symptoms of people with dementia can negatively affect the mental health of informal caregivers. The aims of this study were to describe the behavioral symptoms of adults diagnosed with dementia based on the report of their caregivers and to characterize the caregivers regarding the level of hope, burden and stress related to care. Twenty informal caregivers participated in the study, with an average age of 54 years, predominantly daughters and wives of the patients, who granted an interview and responded to instruments regarding burden and stress, hope, patient's characteristics and behavioral problems. Despite a high level of hope, the participants had a burden level compatible with that of caregivers of chronic patients. The most mentioned challenging behaviors were difficulties in carrying out activities of daily living and aggressiveness, predominantly characterized as behavioral excesses. We emphasize the importance of interventions with caregivers of people with neurocognitive disorder, oriented to the management of challenging behaviors.

Resumo Sintomas comportamentais de pessoas com demência podem impactar negativamente a saúde mental de cuidadores informais. Os objetivos do presente estudo foram descrever os sintomas comportamentais de adultos com diagnóstico de demência pelo relato de seus cuidadores e caracterizar os cuidadores informais entrevistados em relação ao nível de esperança, sobrecarga e estresse relacionados ao cuidado. Participaram 20 cuidadoras informais, com idade média de 54 anos, predominantemente filhas e esposas dos pacientes, que responderam a uma entrevista e a instrumentos sobre sobrecarga e estresse, esperança, características dos pacientes e problemas de comportamento. Apesar de um alto nível de esperança, as participantes tinham nível de sobrecarga compatível com o de cuidadores de pacientes crônicos. Os comportamentos mais citados foram dificuldades de realização de atividades de vida diária e agressividade, caracterizados predominantemente como excessos comportamentais. Ressalta-se a importância de intervenções com cuidadores de pessoas com transtorno neurocognitivo, orientadas para o manejo de comportamentos desafiadores.

Resumen Los síntomas comportamentales de personas con demencia pueden impactar negativamente a la salud mental de sus cuidadores informales. En este estudio se pretende describir los síntomas comportamentales de adultos con diagnóstico de demencia mediante el relato de sus cuidadores y caracterizar a los cuidadores informales entrevistados en términos de nivel de esperanza, sobrecarga y estrés relacionados con el cuidado. Participaron 20 cuidadoras informales, edad promedio: 54 años, predominantemente hijas y esposas de los pacientes, que respondieron a una entrevista y a instrumentos sobre sobrecarga y estrés, esperanza, características de los pacientes y problemas de comportamiento. A pesar del alto nivel de esperanza, las participantes presentaron un nivel de sobrecarga compatible con el de cuidadores de pacientes crónicos. Los comporta4mientos más citados fueron dificultades en la ejecución de actividades cotidianas y agresividad, caracterizados predominantemente como excesos comportamentales. Se resalta la importancia de intervenciones con los cuidadores de personas con trastorno neurocognitivo orientadas al manejo de comportamientos desafiadores.

Cerebral toxoplasmosis and alcohol abuse in AIDS: dementia with multiple etiologies / Neurotoxoplasmose e abuso de álcool em aids: demência com múltiplas etiologias

ABSTRACT Major neurocognitive disorder due to multiple etiologies, or dementia due to multiple etiologies (DME), is a term coined by the Diagnostic and Statistical Manual of Mental Disorders to refer to complex cases when multiple pathologies, such as Alzheimer's disease, Lewy Bodies, human immunodeficiency virus (HIV), vascular-related brain damage or frontotemporal lobar degeneration, are identified as contributing to neurocognitive impairment and/or behavioral alterations, based on patient's neuroimaging tests, laboratorial exams, associated symptomatology and medical history. In this study, we report the case of a 63-year-old male patient who presented with parkinsonism symptoms, aphasia and cognitive impairment on multiple domains after cerebral toxoplasmosis related to acquired immunodeficiency syndrome, vascular damage and a history of alcohol abuse. We discuss the neurocognitive and neurobehavioral variables that characterized this diagnosis, as well as the importance of the differential diagnosis of DME on the field of neuropsychology of aging and, especially, for individuals living with HIV infection.

RESUMO Transtorno neurocognitivo maior devido a múltiplas etiologias, ou demência por múltiplas etiologias (DME), é um termo estabelecido pelo Manual Diagnóstico e Estatístico de Transtornos Mentais para se referir a casos complexos em que múltiplas patologias, como a Doença de Alzheimer, Corpos de Lewy, o vírus da imunodeficiência humana (HIV), danos de origem vascular ou a degeneração lobar frontotemporal, são identificados como contribuintes para o comprometimento neurocognitivo e/ou para alterações comportamentais, com base em testes de neuroimagem do paciente, exames laboratoriais, sintomatologia associada e histórico médico. Neste artigo, relatamos o caso de um paciente do sexo masculino de 63 anos que apresentou sintomas de parkinsonismo, afasia e comprometimento cognitivo em múltiplos domínios após neurotoxoplasmose relacionada à síndrome da imunodeficiência adquirida, dano vascular e histórico de abuso de álcool. Foram discutidas as variáveis neurocognitivas e neurocomportamentais que caracterizaram esse diagnóstico, assim como a importância do diagnóstico diferencial de DME para a neuropsicologia do envelhecimento e, especialmente, para indivíduos portadores do HIV.

Alteraciones del comportamiento de pacientes con diagnóstico de trastorno neurocognoscitivo en Bogotá (Colombia) / Behavioural Disturbances in Patients with Diagnosis of Neurocognitive Disorder in Bogotá (Colombia)

RESUMEN Introducción: El objetivo de este estudio es determinar la frecuencia de alteraciones conductuales (AC) en un grupo de pacientes con diagnóstico de trastorno neurocognoscitivo (TN) valorado por clínica de memoria en un centro de evaluación en Bogotá, Colombia, durante el ano 2015. Material y métodos: Estudio observacional descriptivo y de corte retrospectivo de 507 pacientes con diagnóstico de trastorno neurocognoscitivo (según criterios del DSM-5), valorados en un centro de referencia en Bogotá en 2015. Resultados: La media de edad de los sujetos con trastorno neurocognoscitivo leve en el momento del diagnóstico era 71,04 arios y la de aquellos con trastorno neurocognoscitivo mayor, 75,32 años (p < 0,001). El 62,72% de la muestra son mujeres. La etiología más frecuente del trastorno neurocognoscitivo fue la enfermedad de Alzheimer probable, seguida por la degeneración lobar frontotemporal, variante conductual, y el trastorno neurocognoscitivo debido a múltiples etiologías. Las AC se presentan con mayor frecuencia en TN debido a degeneración frontotemporal variante conductual (100%), enfermedad de Alzheimer (77,29%) y vascular (76,19%). Las AC más prevalentes en el grupo evaluado fueron la apatía (50,75%), la irritabilidad (48,45%), la agresividad (16,6%) y la labilidad emocional (14,76%). Conclusiones: Las AC son prevalentes en pacientes con diagnóstico de trastorno neurocognoscitivo mayor. Según la etiología del trastorno neurocognoscitivo mayor, las AC son más prevalentes en la degeneración frontotemporal variante conductual. Apatía, irritabilidad, labilidad emocional y agresividad son las AC más comunes en toda la muestra.

ABSTRACT Introduction: The main aim of this study is to determine the prevalence of behavioural disturbances (BD) in a group of patients with diagnosis of neurocognitive disorders assessed by a memory clinic in a referral assessment centre in Bogotá, Colombia, in 2015. Material and methods: This is an observational, retrospective descriptive study of 507 patients with a diagnosis of neurocognitive disorder (according to DSM-5 criteria) evaluated in a referral centre in Bogotá, Colombia, in 2015. Results: Among the group of patients assessed, analyses reveal mean age for minor neurocognitive disorders of 71.04 years, and 75.32 years for major neurocognitive disorder (P < 0.001). A total of 62.72% of the sample were female. The most prevalent aetiology of the neurocognitive disorders was Alzheimer's disease, followed by behavioural variant fronto-temporal dementia and neurocognitive disorders due to multiple aetiologies. BD occur more frequently in neurocognitive disorder due to behavioural variant frontotemporal dementia (100%), Alzheimer's disease (77.29%) and vascular disease (76.19%). The most prevalent BD in the group assessed were apathy (50.75%), irritability (48.45%), aggression (16.6%), and emotional lability (14.76%). Conclusions: BD are highly prevalent in patients with diagnosis of major neurocognitive disorder. BD are more prevalent in behavioural variant frontotemporal dementia than any other group. Apathy, irritability, emotional lability and aggression are the BD that occur with greater prevalence in our sample. We discuss the importance of BD in the clinical progression of neurocognitive disorders.

Estructura factorial del Síndrome de Cotard: revisión sistemática de reportes de caso / Factor Structure of Cotard's Syndrome: Systematic Review of Case Reports

RESUMEN Introducción: El síndrome de Cotard es de rara aparición en la clínica psiquiátrica. Debido a esto, la información actual se basa principalmente en reportes y series de casos. Objetivo: Analizar las características psicopatológicas y la agrupación de los síntomas de los casos de síndrome de Cotard reportados en la literatura médica. Métodos: Se realizó en la base de datos MEDLINE/PubMed una búsqueda sistemática de la literatura de todos los casos de síndrome de Cotard reportados desde 2005 hasta enero de 2018. Se recolectaron variables demográficas y las características clínicas de cada caso. Se realizó un análisis factorial exploratorio de los síntomas. Resultados: La búsqueda identificó 86 artículos, de los cuales 69 eran potencialmente relevantes. Luego de la revisión de los textos completos, se seleccionaron 55 artículos para la revisión sistemática, entre los cuales se hallaron 69 casos. En el grupo de más edad con síndrome de Cotard fueron más frecuentes los diagnósticos de depresión mayor (p < 0,001) y trastorno mental orgánico (p = 0,004). El análisis factorial exploratorio arrojó 3 factores: depresión psicótica, en la que se incluye a los pacientes con delirios de culpa (0,721), ideas suicidas (0,685), delirios de condena (0,662), delirio nihilista del cuerpo (0,642), depresión (0,522) y delirios hipocondriacos (0,535); delirante-alucinatorio, con pacientes que sufrían delirio de inmortalidad (0,566), alucinaciones visuales (0,545) y delirio nihilista de la existencia (0,451), y mixto, con pacientes que sufrían delirio nihilista de los conceptos (0,702), ansiedad (0,573) y alucinaciones auditivas (0,560). Conclusiones: La psicopatología del síndrome de Cotard es más compleja que la simple asociación con el delirio de estar muerto, ya que abarca una estructura factorial organizada en 3 factores.

ABSTRACT Introduction: Cotard's syndrome is a rare psychiatric condition. As a result, current information is mainly based on reports and case series. Objective: To analyse the psychopathological characteristics and the grouping of the symptoms of the Cotard's syndrome cases reported in the medical literature. Methods: A systematic review of the literature of all reported cases of Cotard's syndrome from 2005 to January 2018 was performed in the MEDLINE/PubMed database. Demographic variables and clinical characteristics of each case were collected. An exploratory factor analysis of the symptoms was performed. Results: The search identified 86 articles, of which 69 were potentially relevant. After reviewing the full texts, 55 articles were selected for the systematic review, in which we found 69 cases. We found that the diagnosis of major depression (P < 0.001) and organic mental disorder (P =0.004) were more frequent in the older group with Cotard's syndrome. An exploratory factor analysis extracted 3 factors: psychotic depression, in which it includes patients with delusions of guilt (0.721), suicidal ideas (0.685), delusions of damnation (0.662), nihilistic delusions of the body (0.642), depression (0.522), and hypochondriacal delusions (0.535); delusive-hallucinatory, with patients who presented delusions of immortality (0.566), visual hallucinations (0.545) and nihilistic delusions of existence (0.451), and mixed, with patients who presented nihilistic delusions of concepts (0.702), anxiety (0.573), and auditory hallucinations (0.560). Conclusions: The psychopathology of Cotard's syndrome is more complex than the simple association with the delusion of being dead, since it encompasses a factorial structure organised into 3 factors.

Trastorno neurocognitivo debido a neurosífilis: informe de un caso / Neurocognitive disorder due to neurosyphilis: a case report

RESUMEN Introducción: La neurosífilis es una enfermedad infecciosa crónica ocasionada por Treponema pallidum y puede producir una gran variedad de signos y síntomas neuropsiquiátricos, lo que complica su diagnóstico. Descripción del caso: Se presenta el caso de un paciente de 40 años que consultó al servicio de urgencias por una convulsión de novo, junto con un cuadro crónico de deterioro cognitivo y psicosis. Se le realizaron los estudios pertinentes para el diagnóstico de neurosífilis y se inició el tratamiento recomendado. El paciente presentó mejoría clínica y fue dado de alta. Discusión: Con resultados de serología VDRL positivos y hallazgos imagenológicos de atrofia cortical marcada, se consideró una neurosífilis parenquimatosa de tipo tardío, junto con franco deterioro cognoscitivo y psicosis. Se le dejó tratamiento con penicilina cristalina, que disminuyó la intensidad de los síntomas del paciente; sin embargo, el poco interés de este en asistir a sus controles disminuye sus probabilidades de una recuperación adecuada. Conclusiones: La neurosífilis se debe sospechar en pacientes con síntomas neurológicos o psiquiátricos clínicamente evidentes. El análisis de la serología de VDRL y los estudios de neuroimagen son importantes como evaluación inicial del paciente, que debe complementarse con pruebas cognitivas o examen mental para determinar el estado de deterioro cognitivo.

ABSTRACT Introduction: Neurosyphilis is a chronic infectious disease caused by Treponema pallidum that can cause a great variety of neuropsychiatric signs and symptoms, which complicates its diagnosis. Case description: This case occurred in a 40-year-old man who consulted the Emergency Department because of a convulsion (de novo) which was related to a chronic condition of cognitive impairment and psychosis. The appropriate studies were performed for the diagnosis of neurosyphilis and the recommended treatment was initiated. The patient presented clinical improvement and was discharged. Discussion: Positive VDRL serology results and imaging findings of marked cortical atrophy conducted to consider a late-stage parenchymatous neurosyphilis with serious cognitive impairment and associated psychosis. Treatment with crystalline penicillin was formulated, which reduced the intensity of the patient's symptoms; however, the patient's lack of interest to attend the check-ups significantly reduces his chances of an adequate recovery. Conclusions: Neurosyphilis must be suspected in patients with clinically evident neurological or psychiatric symptoms. Analysis of VDRL serology and neuroimaging studies are important as an initial evaluation of the patient and must be complemented with cognitive tests or mental examination to determine the state of cognitive impairment.