La atrofia cerebral como hallazgo o factor predictor del deterioro cognitivo en el envejecimiento normal / Cerebral Atrophy as a Finding of Predictive Factor for Cognitive Impairment in Normal Aging

Introducción: En el curso del envejecimiento es conocida la existencia de un patrón complejo de cambios estructurales cerebrales, conductuales y cognitivos, en ocasiones relacionados con enfermedades neurológicas y psiquiátricas. Objetivo: Determinar la posible relación de causalidad de la atrofia cerebral en la aparición del deterioro cognitivo en el curso del envejecimiento normal. Métodos: Se desarrolló un estudio retrospectivo, transversal, descriptivo y observacional. El universo estuvo conformado por el total de los pacientes de ambos sexos con edades comprendidas entre 35-74 años de edad, con indicaciones previas de tomografía computarizada de cráneo y cuyos resultados fueron informados con signos de atrofia cerebral, cuya cifra ascendió a 733. Resultados: El grupo de edad que predomino fue el de 45-54 años (35,3 por ciento), así como las pacientes del sexo femenino (66,3 por ciento). El 27,7 por ciento tenía como nivel de escolaridad el técnico medio superior y 36,2 por ciento fueron pacientes amas de casa. El 99,7 por ciento fueron diestros. Un total de 368 voluntarios presentaron deterioro cognitivo y 365 sujetos no evidenciaron declive en las funciones exploradas. Las funciones de atención y cálculo y retención verbal a corto plazo fueron las que se vieron más afectadas, seguidas de orientación espacial y memoria verbal de fijación. Conclusiones: No se logró establecer una relación de causalidad significativa entre el diagnóstico radiológico de atrofia cerebral y la presencia de deterioro cognitivo(AU)

Introduction: In the course of aging, the existence of a complex pattern of behavioral, cognitive and cerebral structural changes is known, sometimes related to neurological and psychiatric diseases. Objective: To determine the possible causal relationship of cerebral atrophy with the onset of cognitive impairment in the course of normal aging. Methods: A retrospective, cross-sectional, descriptive and observational study was carried out. The study universe consisted of all patients of both sexes aged 35-74 years, with previous indications for cranial computed tomography and whose results were reported with signs of cerebral atrophy, which numbered 733. Results: The predominant age group was 45-54 years old (35.3percent), as well as female patients (66.3percent). The educational level of 27.7percent of the patients was technical high school and 36.2percent were housewife patients. A total of 99.7percent were right-handed. A total of 368 volunteers showed cognitive impairment and 365 subjects showed no decline in the tested functions. The functions of attention and calculation, as well as short-term verbal retention, were the most affected, followed by spatial orientation and speech retention memory. Conclusions: No significant causal relationship was established between the radiological diagnosis of cerebral atrophy and the presence of cognitive impairment(AU)

Newborn screening for congenital hypothyroidism in a public sector hospital

Congenital hypothyroidism if left untreated results in growth failure, irreversible mental retardation, and cretinism. National neonatal screening programs are therefore, launched to diagnose congenital hypothyroidism and manage it timely. To screen newborns for congenital hypothyroidism in two public sector hospitals of Lahore. Cross sectional descriptive study conducted at departments of Gynae/Obs and Pediatric Shaikh Zayed Hospital and Jinnah Hospital, Lahore from February 2010 to November 2011. Awareness brochures for congenital hypothyroidism were developed and attached with the antenatal card of each pregnant case attending antenatal clinic at Gynae/Obs OPD. Newborns who had stayed in hospital for more than 24 hour, and whose parents consented for heal prick were tested for blood spot thyroid-stimulating hormone. Results were reported within four days and thyroid-stimulating hormone >/= 20mIU/L was taken as high value. Parents of those neonates who had high value were contacted to give a fresh sample for confirmation. Confirmed results were provided within next 4-5 days to the parents and treating pediatrician for appropriate treatment. A total of 1357 samples were screened using blood spot thyroid-stimulating hormone and out of these 1330 were normal [< 20mIU/L] while 27 had high levels [>/= 20mIU/L]. These 27 neonates were further tested using confirmatory tests for serum thyroid-stimulating hormone, T3 and T4. After confirmatory tests only one case had congenital hypothyroidism who was referred for treatment. Three cases were suspected to have subclinical hypothyroidism and these were retested after six months which, picked another case of confirmed subclinical hypothyroidism who was referred for treatment. The incidence of congenital hypothyroidism was 2 out of 1357 cases. The screening could pick 2 cases of hypothyroidism from a total of 1357 cases which is high when compared to global rates. Routine screening of neonates for thyroid disease can pick the disease early and thus prevent later complications

Enfermedad de Pick: un análisis clínico acerca de su etiología / Pick's disease: a clinical analysis regarding its etiology

Antecedentes: El curso clínico de la enfermedad de Pick (EP) es similar a la enfermedad de Alzheimer (EA). Casos clínicos: Presentamos el curso clínico y los hallazgos tomográficos en 3 pacientes (dos casos esporádicos y un caso familiar) con diagnóstico de EP. Resultados: El curso de esta enfermedad estuvo caracterizado por: 1) cambios de conducta y personalidad, 2) deterioro progresivo de la memoria reciente, 3) disturbios sexuales y/o aumento del apetito, 4) disfunción cortical superior, 5) empeoramiento motor, sensitivo y esfinteriano, y 6) deterioro de la postura, marcha y postración. Los estudios tomográficos demostraron aterosclerosis en las carótidas supraclínoideas y sus ramas, así como atrofia moderada o severa en los lóbulos prefrontales y temporales anteriores. Conclusiones: Estos hallazgos sugieren que la EP es también causada por isquemia progresiva en el territorio intraparenquimal de las arterias perforantes anteriores, coroideas anteriores y lentículo-estriadas, debido a placas ateroscleróticas localizadas en las bocas de estas ramas arteriales.

Background: The clinical course of Pick´s disease (PD) is similar to that of Alzheimer´s disease (AD). Clinical cases: We present the clinical course and CT-scan findings in 3 patients (two sporadic cases and one familial case) diagnosed with PD. Results: The course of this disease was characterized by the following: 1) behavioral and personality changes; 2) progressive impairment of recent memory; 3) sex disturbances and/or appetite incr ease; 4) upper cortex dysfunction; 5) motor, sensorial and sphincter control worsening, and 6) posture and gait impairment, as well as prostration. Brain tomography studies demonstrated atherosclerosis at the supraclinoid segment of carotid arteries and its branches, and also moderate or severe atrophy in both prefrontal and anterior temporal lobes. Conclusions: These findings suggest that PD is also caused by progressive ischemia in the intra-par enchymal territory of the anterior perforating, anterior choroidal, and lenticulostriate arteries; due to atherosclerotic plaques located at the origin of these arterial branches.

Clinical Features and Therapeutic Approaches of Frontotemporal Dementia

Frontotemporal dementia (FTD), formerly called Pick's disease, is a progressive dementia that is associated with focal atrophy of the frontal and/or temporal lobes. FTD has three major clinical subtypes ; 1) a frontal variant of frontotemporal dementia (fvFTD), 2) semantic dementia (SD), and 3) progressive nonfluent aphasia (PNFA). These different variants differ in their clinical symptoms, cognitive deficits, and affected brain regions. The insidious onset of personality changes and behavioral abnormalities is the most prominent feature of fvFTD. Poor insight, loss of personal and social awareness, and blunting of affect are common behavioral changes in fvFTD. The most common presenting complaint in SD involves language, and is often described as a loss of memory for words or a loss of word meaning. Patients with PNFA present with changes in fluency, pronunciation, or word finding difficulty. An accumulating body of evidence suggests that FTD overlaps with three other neurodegenerative diseases: motor neuron disease (MND), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP). Treatment for FTD consists of behavioral and pharmacological approaches. Medications such as selective serotonin reuptake inhibitors, antipsychotics have used in FTD. Cholinesterase inhibitors do not consistently improve cognitive and behavioral symptoms of FTD. Further research should be directed at developing new therapeutic methods to improve the patients' symptoms.

Pharmacological treatment of frontotemporal lobar degeneration: systematic review / Tratamento farmacológico da degeneração lobar frontotemporal: revisão sistemática

OBJECTIVE: To identify the therapeutic options available for treatment of cognitive and behavioral symptoms in frontotemporal lobar degeneration. METHOD: Systematic review using the descriptors "frontotemporal lobar degeneration" OR "frontotemporal dementia" OR "fronto-temporal dementia" OR "fronto-temporal degeneration" OR "Pick's disease" OR "Pick's atrophy" OR "semantic dementia" OR "progressive aphasia" AND "pharmacotherapy" OR "treatment" OR "efficacy" OR "effects" OR "management" was performed in the Medline and Lilacs databases. Selection criteria: Quality A - randomized clinical trials. Quality B - open studies or reports of six or more cases. Quality C - reports of five or fewer cases. Two reviewers independently assessed the clinical studies. Information collected included diagnostic criteria used, sample size, duration, efficacy and tolerability measures used and results obtained. RESULTS: From the 532 studies found, 29 complied with the inclusion criteria. All studies worked with a small sample, had short duration of treatment and used non-uniform measures in evaluating efficacy and tolerability. Studies showed disparate results with respect to behavior and cognition. CONCLUSION: There is still little, and poor, evidence available for treatment of frontotemporal lobar degeneration and studies with better methodological background are needed.

OBJETIVO: Identificar as opções terapêuticas disponíveis para tratamento dos sintomas cognitivos e comportamentais da degeneração lobar frontotemporal. MÉTODO: Revisão sistemática utilizando os descritores "frontotemporal lobar degeneration OR frontotemporal dementia OR fronto-temporal dementia OR fronto-temporal degeneration OR Pick's disease OR Pick's atrophy OR semantic dementia OR progressive aphasia AND pharmacotherapy OR treatment OR efficacy OR effects OR management" nas bases Medline e Lilacs. Critérios de seleção: Qualidade A - Estudos clínicos randomizados. Qualidade B - Estudos abertos ou relatos de seis ou mais casos. Qualidade C - Relatos de cinco ou menos casos. Dois revisores avaliaram independentemente os estudos clínicos. As informações coletadas incluíram critérios de diagnóstico utilizados, número da amostra, duração, medidas de eficácia e tolerabilidade utilizadas e os resultados obtidos. RESULTADOS: Encontraram-se 532 estudos e 29 preenchiam os critérios. Todos os estudos incluíam uma amostra pequena, com curta duração de tratamento, com utilização de medidas não uniformes na avaliação da eficácia e da tolerabilidade. O comportamento e a cognição apresentaram resultados díspares entre os estudos. CONCLUSÃO: São poucas as evidências disponíveis para tratamento da degeneração lobar frontotemporal e de qualidade insatisfatória, sendo necessários estudos com maior rigor metodológico.

Tau and tauopathies.

Tau protein is a neuronal microtubule-associated protein (MAP), which localizes primarily in the axon. It is one of the major and most widely distributed MAPs in the central nervous system. Its biochemistry and molecular pathology is being increasingly studied. Tau is a key component of neurofbrillary tangles in Alzheimer's disease (AD). Disorders with neuronal, oligodendroglial or astrocytic filamentous tau inclusions are now grouped under the common rubric of tauopathies. The discovery of mutations in the tau gene, located on Chromosome 17 and its relationship to frontotemporal dementia with Parkinsonism (FTDP-17) has enhanced the importance of tau protein in cognitive neurology. Aberrant aggregates of tau have been documented in most of the neurodegenerative diseases with filamentous inclusions. The role of cerebrospinal fluid tau in the diagnosis of dementias is being investigated quite extensively. Recently, it has been shown that Abeta immunotherapy leads to the clearance of early tau pathology. It is becoming clearer that understanding tau better will lead to better understanding of many neurodegenerative diseases that may help develop interventional strategies.

Study of infantile spasms in developmentally delayed infants with seizures

This study was conducted at Zagazig University Hospital, Pediatric Department, during a period of 8 months. To discuss the relationship between developmental delay associated with seizures and the presence of infantile spasms. 40 infants selected on the bisis of developmental delay in association with the presence of seizures. They were divided into two groups: Group I included developmentally delayed infants with infantile spasms and group II included developmentally delayed infants with other types of seizures. The two groups were compared regarding age, gender, family history, cutaneous manifestations of neuro-cutaneous syndromes notably tuberous sclerosis, dysmorphic features, EEG findings, CT brain findings, chromosomal analysis, TORCH screen and reducing substances in urine. Infantile spasms were present in 22.5% of cases, 44.4% of them developed other types of seizures; and it was the commonest type of seizures in developmentally delayed infants. No significant statistical difference was found between both groups regarding age, sex, family history, microcephaly, muscle tone, dysmorphic features; and cutaneous manifestations of neurocutaneous syndromes apart from association of group I with tuberous sclerosis which was statistically significant. Also, there was no significant statistical difference between both groups as regard CT brain findings, chromosomal analysis, TORCH screen; and reducing substances in urine. Although hypsarrhythmia was not found in all cases of group I, its presence was statistically significant, but other types of EEG abnormalities were statistically insignificant. Regarding findings related to all cases of both groups, microcephaly occurred in 37.5% of cases, brain atrophy in 50% of cases; and dysmorphic feature were present in 25% of cases, half of them had chromosomal anomalies

Algorithm for automatic quantification of brain atrophy with computed tomography / 中国医疗器械杂志

In this paper, a new, fully-automatic method for the quantification of brain atrophy based on CT volume data is put forward by taking advantage of the characteristics of cerebral CT images in combination with the prior medical knowledge. This algorithm has been verified through the calculation of 2388 cases of normal and brain atrophy subjects.

Avaliação da doença de Parkinson pela ressonância magnética / Evaluation of Parkinsonïs disease using magnetic resonance imaging

OBJETIVO: Avaliar a doença de Parkinson pela ressonância magnética. MATERIAIS E MÉTODOS: De outubro de 1999 a outubro de 2002, foram estudados 42 pacientes com parkinsonismo, por meio de um aparelho de ressonância magnética de 1,5 T. Os pacientes foram divididos em dois grupos: grupo com doença de Parkinson (n = 26) e grupo com síndrome parkinsoniana atípica (n = 16), sendo os resultados comparados com um grupo controle (n = 18). Foram avaliadas as seguintes variáveis: espessura da pars compacta do mesencéfalo, grau de hipointensidade de sinal no putâmen, grau de atrofia cerebral, lesões no mesencéfalo, lesões na substância branca e a presença de lesão na borda póstero-lateral do putâmen. A análise estatística dos dados foi realizada, com a utilização do programa SPSS. RESULTADOS: A média de idade foi de 58,2 anos nos grupos com doença de Parkinson e controle, e 60,5 anos no grupo com síndrome parkinsoniana atípica. Os pacientes com doença de Parkinson e síndrome parkinsoniana atípica apresentaram redução da espessura da pars compacta e maior grau de hipointensidade de sinal no putâmen. O grau de atrofia cerebral foi maior nos pacientes com síndrome parkinsoniana atípica. As lesões no mesencéfalo e na substância branca foram semelhantes entre os grupos. O sinal hiperintenso na borda póstero-lateral do putâmen foi um achado pouco freqüente na população estudada, mas sugestivo de atrofia de múltiplos sistemas. CONCLUSÃO: Desta forma, a ressonância magnética detectou alterações morfológicas cerebrais que podem auxiliar no diagnóstico por imagem das síndromes parkinsonianas.

OBJECTIVE: The objective of this study was to evaluate the magnetic resonance imaging findings in patients with Parkinson's disease. MATERIALS AND METHODS: In the period from October 1999 to October 2002, 42 patients with parkinsonism were investigated using a 1.5 T MR equipment. Patients were divided into two groups: patients with Parkinson's disease (n = 26) and patients with atypical Parkinsonian syndrome (n = 16). The results were compared with a control group (n = 18). The following variables were evaluated: thickness of the mesencephalon compact pars, hypointense signal in the putamen, degree of brain atrophy, lesions in the mesencephalon, lesions in the white matter, and the presence of lesions in the posterior-lateral edge of the putamen. Statistical data analysis was carried out using the SPSS program. RESULTS: The mean age was 58.2 years for the Parkinson's disease and control groups, and 60.5 years for the atypical Parkinsonian syndrome group. Patients with Parkinson's disease and atypical Parkinsonian syndromes presented decreased thickness of the compact pars and a higher degree of signal hypointensity in the putamen. Cerebral atrophy was more prominent in the patients with atypical Parkinsonian syndrome. Lesions in mesencephalon and white matter were similar in both groups. The frequency of hyperintense signal in the posterior-lateral edge of the putamen was low within the studied population, although that could suggest multiple-system atrophy. CONCLUSION: Magnetic resonance imaging allows the detection of brain morphological changes that may help in the diagnosis of Parkinsonian syndromes.

Pathologic diagnosis of non-Alzheimer type dementia / 中华病理学杂志

<p><b>OBJECTIVE</b>To characterize histopathologic features of non-Alzheimer type dementia.</p><p><b>METHODS</b>Bodian, Gallyas-Braak silver staining, tau and ubiquitin immunohistochemistry were applied in an analysis of 22 cases of autopsy-proven neurodegenerative dementia. Appearance, distribution and immunoreactivity of neuronal and glial inclusions in the brain were observed. The final histological diagnoses were made according to the pathological criteria for several types of common non-Alzheimer type dementia.</p><p><b>RESULTS</b>Among the 22 cases of neurodegenerative dementia, 12 cases were identified as non-Alzheimer type dementia, including Pick's disease (2 cases), progressive supranuclear palsy (3 cases) and corticobasal degeneration (3 cases), dementia with Lewy bodies (1 case), and Parkinson's disease (3 cases). Another 10 cases consisted of pure Alzheimer's disease (AD, 9 cases) and AD combined with argyrophilic grain disease (1 case). Characteristic neuronal and glial inclusions, such as classical and cortical Lewy body, Pick body, Globous NFTs, astrocytic plaque and tufted astrocyte, argyrophilic grain were found in the brains of non-Alzheimer type dementia. Classical and cortical Lewy bodies were not argyrophilic but were immunoreactive to ubiquitin. Pick bodies, Globous NFTs, astrocytic plaques, tufted astrocytes and argyrophilic grains were all argyrophilic. Pick bodies showed tau and ubiquitin immunoreactivity. However, Globous NFTs, astrocytic plaques, tufted astrocytes, and argyrophilic grains were reactive only to tau immunohistochemistry.</p><p><b>CONCLUSIONS</b>Findings of characteristic neuronal and glial inclusions may help to differentiate non-Alzheimer type dementia from AD, and in conjunction with Gallyas-Braak staining and immunohistochemistry for tau and ubiquitin, to further define histopathologic subcategories of non-Alzheimer type dementia.</p>

Clinical and Pathological Characteristics of Frontotemporal Lobar Degeneration(FTLD) and Molecular Genetics of Tau Protein

Criticisms about amyloid cascade hypothesis of Alzheimer's disease(AD) are based on the findings, first, that the degree of dementia does not correlate with the number of plaques, and second, that the neurofibrillary tangle formation seems to predate plaque formation. In addition, neurofibrillary tangle counts correlate well with the degree of cognitive impairment. These findings suggest the independent importance of tau abnormality in AD research which is involved in the neurofibrillary tangle formation. Recently, tau pathology without amyloid deposits and mutations in tau protein gene were reported to be the major pathogenic mechanism in Pick's disease, progressive supranuclear palsy, corticobasal degeneration and FTDP-17(frontotemporal dementia and parkinsonism linked with chromosome 17). These data suggest that understanding the causes and consequences of tau dysfunction might give new clinical and therapeutic solutions to many known tauopathies.

Episal dio depressivo grave ou demênncia de Pick? / Severe depressive episode or Pick's dementia?

Os autores descrevem o caso de uma mulher de 72 anos que matou seu marido na vig¥nncia de quadro psiquiemtrico caracterizado por sintomas tanto depressivos como demenciais.

A Case of Frontotemporal Lobe Dementia

Frontotemporal lobe dementia have been underevaluated because of various clinical features, changing diagnostic criteria, and indifference of clinicians. It is important that frontotemporal lobe dementia patient showing behavioral and lingual problems should be early diagnosed and treated. Because frontotemporal lobe dementia patients often confused with Alzheimer's disease, senile depression, schizophrenia, drug abuse. We have presented a case of frontotemporal lobe dementia. He had typical clinical history and symptoms which deserve to be considered frontotemporal lobe dementia. He showed appropriate findings of frontotemporal lobe dementia in the neuropsychological tests and brain magnetic resonance imaging and single photon emission computed tomography. This case is thought to be helpful for clinicians to give attention to early diagnosis and appropriate treatment of frontotemporal lobe dementia.

Classic Pick's disease type with ubiquitin-positive and tau-negative inclusions: case report

We report on a patient presenting Pick's disease similar to the one reported by Pick in 1892, with ubiquitin-positive and tau-negative inclusions. His diagnosis was made on the basis of clinical (language disturbance and behavioural disorders), neuropsychological (progressive aphasia of the expression type and late mutism), neuroimaging with magnetic resonance (bilateral frontal and temporal lobes atrophy) and brain single photon emission computed tomography (frontal and temporal lobes hypoperfusion) studies. Macroscopic examination showed atrophy on the frontal and temporal lobes. The left hippocampus displayed a major circumscribed atrophy. The diagnostic confirmation was made by the neuropathological findings of the autopsy that showed neuronal loss with gliosis of the adjacent white matter and apearence of status spongiosus in the middle frontal and especially in the upper temporal lobes. There were also neuronal swelling (ballooned cell) and argyrophilic inclusions (Pick's bodies) in the left and right hippocampi. Anti-ubiquitin reaction tested positive and anti-tau tested negative

An Autopsy Case of Pick's Disease

Pick's disease is a rare neurodegenerative disorder presenting cortical type of dementia. Pick's disease shows unique clinical and pathological features, that are due to a degeneration of fronto-temporal lobes of the cerebrum. The authors experienced a case of Pick's disease in a 58-year-old male patient who had dementia symptoms for five years. The patient showed compulsive behavior since five years ago. Memory decline started from four years ago and progressed. Brain CT disclosed lobar atrophy of the cerebral gyri in frontal and temporal lobes. He died of septicemia associated with aspiration pneumonia. At autopsy, both cerebral hemispheres showed marked encephalomalacia. The gyral atrophy was moderately severe in prefrontal and anterior temporal lobes. Coronal section disclosed moderate dilatation of the lateral ventricles. Microscopically, there were marked neuronal loss in prefrontal and anterior temporal cortices. Also noted were Pick's cells and Pick's body in occasional pyramidal cells preserved.

Clinical Features of Other Dementias

Dementias can be calssified into cortical, subcortical, cortical-subcortical and multifocal ones based on the major pathological distribution within the brain. The literatures of recent knowledge about clinical features of other dementias than Alzheimer's and vascular ones, which were most frequently experienced by many clinicians were reviewed. That is, cortical dementias such as Pick's disease, frontal lobe type dementia and non-Alzheimer's type lobar atrophy including fronto-temporal dementia, progressive dysphasia, fronto-temporal dementia with motor neuron disease, and alcohol-related dementia were reviewed. Subcortical dementias such as dementias accompanying Parkinson's disease, Huntington's disease and progressive supranuclear palsy, and cortical-subcortical dementias such as Lewy body dementiaq and cortical-basal degeneration were also reviewed. As multifocal dementias, prion dementias including KUru, Creutzfeldt-Jakob disease, fatal familial insomnia and Gerstmann-Strussler-Sheinker syndrone, and AIDS dementia were also reviewed.

Alcoolismo cronico e Atrofia cortical: um estudo de seis casos / Chronic alcoholism and cortical atrophy: a study of six cases

Os autores estudaram seis casos de alcoolismo cronico com atrofia cortical decorrente, diagnosticada por meio de tomografia computadorizada. Esses pacientes estavam voluntariamente internados no Instituto Bairral de Psiquiatria de Itapira,SP,Brasil, que trabalha nos moldes de comunidade terapeutica. Apos quatro semanas de tratamento, com boa evoluçäo de cinco casos, foram aplicados o Teste de Inteligencia Näo Verbal, o G 36, de Boccalandro e o Teste de Memoria Retentiva de Paternostro. Os resultados demonstraram que 66,6 por cento ou quatro casos obtiveram escores abaixo da media em comparaçäo com a populaçäo normativa de cada teste. Os dados obtidos forma discutidos relacionando os resultados das tomografias computadorizadas, o desempenho nos testes e as características psiquiatricas e sócio-demográficas dos casos

Aplicação dos florais de bach em uma paciente com doença de pick para uma melhor qualidade de vida / How to manage Bach's florals improve the quality of life in a patient with Dick's disease

Objetiva-se demonstrar a eficácia dos florais de Bach em uma idosa, com doença de Pick, através de consulta de enfermagem na promoção da qualidade vida. Como referencial teórico, utilizaram-se os conceitos de qualidade de vida e os florais de Bach, empregados como intervenção de enfermagem. Metodologicamente, utilizou-se o estudo de caso. Foram estabelecidas metas a serem alcançadas, através das essências florais. Foram identificados os seguintes diagnósticos de enfermagem: constipação colônica, ansiedade, distúrbio no padrão do sono, e isolamento social. Durante a fase do acompanhamento, percebeu-se uma melhora substancial no quando clínico do cliente, evidenciando por melhora no inter-relacionamento pessoal, diminuição da ansiedade, e melhora no padrão do sono. Evidenciou-se a relevância da operacionalização dos diagnósticos de enfermagem, bem como a aplicação das essências florais...

With an eye on the purpose to show the efficiency of Bach's Flowers in an old, with Pick disease, it's shown by nursery's consultation in a promotion of lifeÆs quality. Based in a theory, was a used concept of life's quality and Bach's Flowers, utilized like nursery's intervention. By methodology, was used in case for study. Were aims established to reach over flowers essence. The following nursery's diagnostic were identified: Colonic constipation, anxiety, sleeping disturbers and social isolation. During the phase of accompaniment, it was obviously noticed a clinic improvement on the patient, based in a better relationships, with least anxiety and better sleeping. Became evident the prominence of nurseryÆs diagnostic function together with the flowers essence...

Objetivase demostrar la eficacia de los florales de Bach en una avanzada edad, con la enfermedad de pick, por medio de consulta de enfermería en la promoción de calidad de vida. En base teórico, fueron utilizados los conceptos de calidad de vida de los florales de Bach, aplicados como intervención de enfermería. Con una metodología fue utilizado el estudio de caso. Fueron identificados los siguientes diagnósticos de enfermería: constipación colônica, ansiedad, disturbio en el padrón del sueño y asolamiento social. Mientras la fase del acompañamiento, fue posible se da cuenta de una mejora sustancial en el cuadro clínico del cliente, evidenciando una mejora en ele reracionamiento interpersonal, disminución de la ansiedad y mejora en el padrón del sueño. Fue evidenciado la relevancia de la operacionalización de los diagnósticos de enfermaría, como también en la aplicación de la esencia florales...

A case of Primary Progressive Aphasia (PPA)

BACKGROUND AND SIGNIFICANCE: PPA is the clinical syndrome that reveals a marked, progressive loss of language functions over time with relative preservation of non-linguistic cognitive functions. Patients with this syndrome eventually develop a general dementia, but the natural history, neuropathology, and etiology are poorly understood. We report a patient who suffered from progressive aphasia unaccompanied with prominent cognitive deficits for 5 years. CASE: A 64-year-old man presented with an at least a 5-year history of a progressive language disorder. The initial symptoms were a disability to speak in complete sentences, word-finding difficulty, verbal hesitancy, and resultant social withdrawal. Over the next 5-years, his symptoms slowly worsened, but non-verbal cognitive functions such as memory, visuospatial skill, and daily living activities were preserved. Eventually, the patient was mutistic, incommunicable, and impaired in general intelligence parallel with personality and mood changes like emotional lability, impersistence, or agitation. The imaging of brain revealed generalized atrophy with more prominent changes in the left temporal lobe and the degree of atrophy progressed on the follow-up study 4 years later. The brain SPECT showed hypoperfusion in the left frontotemporal area. Initially, the patient scored 25 points with Mini-Mental State Examination but worsened to 3 points 4 years later. Language examination at the onset showed mildly decreased fluency, naming, and reading. Recently, our patient has become mutistic and alexic, but has preserved some comprehension. COMMENT: Non-dementic patients with progressive language disturbances as a result of the left focal temporal atrophy from 2-year of onset, have the possibility of being diagnosed with PPA, frontotemporal degeneration, Pick disease, or Alzheimer disease. But we suggest that characteristic isolated linguistic dysfunction with preserved cognitive function in PPA may be a distinct from other degenerative diseases of dementia.