ABSTRACT
BACKGROUND: Compare changes in performance on subtasks of the Timed Up and Go test over 32 months in older adults with and without mild cognitive impairment; analyze the correlation between frontal cognitive functions at baseline and changes in Timed Up and Go subtasks over time. METHODS: A longitudinal study was conducted involving 31 older adults (15 with and 16 without cognitive impairment). Functional mobility was assessed at both evaluations using an adapted version of the Timed Up and Go test and the Qualisys motion system. The test was divided into five subtasks: sit-to-stand, walking forward, turn-to-walk, walking back and turn-to-sit. Cognition was assessed at baseline using the Frontal Assessment Battery and the Clock Drawing Test. FINDINGS: Significant differences in changes in the sit-to-stand subtask over time were found between groups. The difference in the time required to conclude this subtask was greater in the older adults with cognitive impairment. However, the difference in kinematic variables (peak trunk speed and range of motion) was greater in the group without cognitive impairment. Strong and moderate correlations were found between frontal cognitive functions and changes in Timed Up and Go subtasks, especially those involving transitions (sit-to-stand, turn-to-walk and turn-to-sit) in both groups. INTERPRETATION: Motor intervention protocols should incorporate the sit-to-stand subtask in older adults with mild cognitive impairment. Moreover, changes in more complex subtasks seem to be related to frontal cognitive performance at baseline. Therefore, treatments that combine motor and cognitive functions should be administered to older adults regardless of cognitive impairment.
Subject(s)
Cognitive Dysfunction , Postural Balance , Aged , Cognition , Humans , Longitudinal Studies , Time and Motion StudiesABSTRACT
Dementia is a public health issue making the screening and diagnosing of dementia and its prodromal phases in all health settings imperative. OBJECTIVE: using PRISMA, this systematic review aimed to identify how low-, middle-, and high-income countries establish dementia and cognitive dysfunction diagnoses in primary health care. METHODS: studies from the past five years in English, Spanish, and Portuguese were retrieved from Scopus, PubMed, Embase, Lilacs, Scielo, and Web of Science. Of 1987 articles, 33 were selected for analysis. RESULTS: only three articles were from middle-income countries and there were no studies from low-income countries. The most used instrument was the Mini-Mental State Examination (MMSE). Mild Cognitive Impairment (MCI) and dementia criteria were based on experts' recommendation as well as on the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD-10), respectively. CONCLUSION: differences between these criteria among high- and middle-income countries were observed.
Demência é uma questão de saúde pública logo, rastrear e diagnosticar demência e suas fases prodrômicas em todos os níveis de atenção à saúde é imperativo. OBJETIVO: uilizando o PRISMA, esta revisão sistemática verificou como os países de baixa, média e alta renda realizam o diagnóstico de demência e disfunção cognitiva na atenção primária. MÉTODOS: estudos dos últimos cinco anos, em inglês, português e espanhol foram obtidos no Scopus, PubMed, Embase, Lilacs, Scielo, e Web of Science. De 1987 artigos, 33 foram selecionados para a análise. RESULTADOS: três artigos eram de países de média renda e nenhum de baixa renda. O Mini-Exame do Estado Mental (MEEM) foi o instrumento mais utilizado. Os diagnósticos de Comprometimento Cognitivo Leve (CCL) e demência foram baseados em recomendações de especialistas e no Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM)/Classificação Internacional de Doenças (CID-10), respectivamente. CONCLUSÃO: houve diferenças para estes critérios entre países de alta e média renda.
ABSTRACT
ADAM10 is the α-secretase that cleaves amyloid-ß protein precursor in the non-amyloidogenic pathway in Alzheimer's disease (AD) and is known to be regulated by different microRNAs (miRNAs), which are post-transcriptional regulators related to several biological and pathological processes, including AD. Here we proposed to explore and validate miRNAs that have direct or indirect relations to the AD pathophysiology and ADAM10 gene. Approximately 700 miRNAs were analyzed and 21 differentially expressed miRNAs were validated in a sample of 21 AD subjects and 17 cognitively healthy matched controls. SH-SY5Y cells were transfected with miR-144-5p, miR-221, and miR-374 mimics and inhibitors, and ADAM10 protein levels were evaluated. miR-144-5p, miR-221, and miR-374 were downregulated in AD. The overexpression of miR-221 in SH-SY5Y cells resulted in ADAM10 reduction and its inhibition in ADAM10 increased. These findings show that miR-221 can be a new potential therapeutic target for increasing ADAM10 levels in AD. In addition, these results can contribute to the better understanding of ADAM10 post-transcriptional regulation.
Subject(s)
ADAM10 Protein/genetics , Alzheimer Disease/genetics , Down-Regulation/genetics , MicroRNAs/metabolism , RNA, Messenger/metabolism , ADAM10 Protein/metabolism , Aged , Aged, 80 and over , Alzheimer Disease/metabolism , Cell Line, Tumor , Cohort Studies , Female , Humans , Male , MicroRNAs/genetics , Middle Aged , Neuroblastoma/pathology , Psychiatric Status Rating Scales , ROC Curve , TransfectionABSTRACT
BACKGROUND: Studies with functional and applicable methods and new cognitive demands involving executive function are needed to improve screening, prevention and rehabilitation of cognitive impairment and falls. OBJECTIVE: to identify differences in gait, dual task performances, and history of falls between elderly people with preserved cognition, mild cognitive impairment and mild Alzheimer's disease. METHOD: A cross-sectional study was conducted. The sample consisted of 40 community-dwelling older adults with preserved cognition, 40 older adults with mild cognitive impairment, and 38 older adults with mild Alzheimer's disease. The assessment consisted of anamneses, gait (measured by the 10-meter walk test), dual task (measured by the Timed Up and Go Test associated with the motor-cognitive task of calling a phone number), and history of falls in the past year. RESULTS: There were no differences among all groups for all variables. However, the Alzheimer's disease Group performed significantly worse in the dual task than the other groups. No item of dual task could distinguish people with preserved cognition from those with mild cognitive impairment. The groups with cognitive impairment included more fallers, and specific characteristics in history of falls between groups were identified. CONCLUSION: Dual task could distinguish Alzheimer's disease patients specifically from other cognitive profiles.
Subject(s)
Alzheimer Disease/physiopathology , Cognition/physiology , Cognitive Dysfunction , Gait/physiology , Accidental Falls , Aged , Cross-Sectional Studies , Humans , Task Performance and AnalysisABSTRACT
Subjective Memory Complaints (SMC) are frequent among adults and elderly and are associated with poor qualityof life. The etiology and clinical significance of SMCs are unclear, but these complaints are associated with objective cognitivedecline or with depression, anxiety and psychosocial stressors. Biological and physiological brain alterations resembling thosein Alzheimer?s Disease have been found in SMC. SMC can evolve with different outcomes and represent the initial symptomor a risk factor of dementia. Active systematic search can be useful for early screening of candidates for preventive ortherapeutic interventions. Objective: To propose a Memory Complaints Scale (MCS) as an instrument for actively searchingfor memory complaints and to investigate its utility for discriminating demented from cognitively normal elderly. Methods: Atotal of 161 patients from a teaching behavioral neurology outpatient unit of a tertiary hospital were studied. The MCS wasused in two ways, by direct application to the patient and by application to the patient?s companion. Cognitive tests assessingdepression and daily living activities were also applied. Results: High Cronbach?s alpha coefficients were found for the twoapplication methods. Correlations between the two versions and the other instruments administered for patients grouped bytype and severity of dementia were also found. Conclusion: The MCS is a useful scale for identifying memory complaintsand discriminating demented from cognitively normal elderly. Further studies confirming these findings are warranted.
Queixa Subjetiva de Memória (QSM) é frequente entre adultos e idosos e está associada a pior qualidade de vida.Etiologia e significado clínico são incertos, sendo associada a perdas cognitivas objetivas ou a depressão, ansiedade eestressores psicossociais. Foram demonstradas alterações biológicas e fisiológicas encefálicas semelhantes às da doençade Alzheimer. Pode ter diferentes desfechos e representar sintoma inicial ou fator de risco para demência. A busca ativae sistematizada pode ser útil na identificação precoce de pessoas que poderão receber intervenções preventivas outerapêuticas. Objetivo: Propor a Escala de Queixa de Memória (EQM) como um instrumento para a busca de queixa dememória e investigar se é útil para discriminar idosos demenciados de normais. Métodos: Foram estudados 161 pacientesde um ambulatório didático de neurologia comportamental de um hospital terciário. A EQM foi utilizada nas duas formas,uma diretamente aplicada ao paciente e a outra aplicada ao acompanhante sobre o paciente. Também foram aplicadostestes cognitivos, para depressão e para atividades diárias. Resultados: Foram encontrados altos coeficientes alfa deCronbach para as duas formas. Também foram encontradas correlações entre as duas formas e os outros instrumentos,para os pacientes agrupados conforme tipo e gravidade da demência. Conclusão: A EQM é uma escala útil para identificarqueixa de memória e pode ser útil para discriminar idosos demenciados de normais. Estudos subsequentes deverão serrealizados para verificar essas informações.
Subject(s)
Psychological Tests , Dementia , MemoryABSTRACT
Subjective Memory Complaints (SMC) are frequent among adults and elderly and are associated with poor quality of life. The etiology and clinical significance of SMCs are unclear, but these complaints are associated with objective cognitive decline or with depression, anxiety and psychosocial stressors. Biological and physiological brain alterations resembling those in Alzheimer's Disease have been found in SMC. SMC can evolve with different outcomes and represent the initial symptom or a risk factor of dementia. Active systematic search can be useful for early screening of candidates for preventive or therapeutic interventions. Objective: To propose a Memory Complaints Scale (MCS) as an instrument for actively searching for memory complaints and to investigate its utility for discriminating demented from cognitively normal elderly. Methods: A total of 161 patients from a teaching behavioral neurology outpatient unit of a tertiary hospital were studied. The MCS was used in two ways, by direct application to the patient and by application to the patient's companion. Cognitive tests assessing depression and daily living activities were also applied. Results: High Cronbach's alpha coefficients were found for the two application methods. Correlations between the two versions and the other instruments administered for patients grouped by type and severity of dementia were also found. Conclusion: The MCS is a useful scale for identifying memory complaints and discriminating demented from cognitively normal elderly. Further studies confirming these findings are warranted.
Queixa Subjetiva de Memória (QSM) é frequente entre adultos e idosos e está associada a pior qualidade de vida. Etiologia e significado clínico são incertos, sendo associada a perdas cognitivas objetivas ou a depressão, ansiedade e estressores psicossociais. Foram demonstradas alterações biológicas e fisiológicas encefálicas semelhantes às da doença de Alzheimer. Pode ter diferentes desfechos e representar sintoma inicial ou fator de risco para demência. A busca ativa e sistematizada pode ser útil na identificação precoce de pessoas que poderão receber intervenções preventivas ou terapêuticas. Objetivo: Propor a Escala de Queixa de Memória (EQM) como um instrumento para a busca de queixa de memória e investigar se é útil para discriminar idosos demenciados de normais. Métodos: Foram estudados 161 pacientes de um ambulatório didático de neurologia comportamental de um hospital terciário. A EQM foi utilizada nas duas formas, uma diretamente aplicada ao paciente e a outra aplicada ao acompanhante sobre o paciente. Também foram aplicados testes cognitivos, para depressão e para atividades diárias. Resultados: Foram encontrados altos coeficientes alfa de Cronbach para as duas formas. Também foram encontradas correlações entre as duas formas e os outros instrumentos, para os pacientes agrupados conforme tipo e gravidade da demência. Conclusão: A EQM é uma escala útil para identificar queixa de memória e pode ser útil para discriminar idosos demenciados de normais. Estudos subsequentes deverão ser realizados para verificar essas informações.
ABSTRACT
As presentes recomendações e sugestões para o "Tratamento da Doença de Alzheimer" foram elaboradas por grupo de trabalho constituído por participantes da IV Reunião de Pesquisadores em Doença de Alzheimer e Desordens Relacionadas, patrocinada pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Compreendem tópicos sobre o tratamento farmacológico e não farmacológico do comprometimento cognitivo e declínio funcional, assim como dos sintomas de comportamento e psicológicos dessa doença demenciante. São utilizados diversos níveis de evidências e de recomendações e sugestões para os diversos fármacos propostos, assim como para o tratamento não farmacológico, baseado em ampla revisão bibliográfica, nacional e internacional.
Subject(s)
Humans , Alzheimer Disease/therapy , Cognition Disorders/therapy , Academic Medical Centers , Alzheimer Disease/psychology , Brazil , Evidence-Based MedicineABSTRACT
The present recommendations and suggestions on "Treatment of Alzheimer's Disease" were elaborated by a work group constituted by participants of the IV Meeting of Researchers on Alzheimer's Disease and Related Disorders, sponsored by the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. They comprise topics on pharmacological and non-pharmacological treatment of cognitive impairment and functional decline, as well as of behavioral and psychological symptoms of this dementing disease. Several levels of evidence and of recommendations and suggestions are used for the various proposed drugs, as well as for non-pharmacological treatment, underpinned by a wide national and international bibliographical review.
Subject(s)
Alzheimer Disease/therapy , Cognition Disorders/therapy , Academic Medical Centers , Alzheimer Disease/psychology , Brazil , Evidence-Based Medicine , HumansABSTRACT
OBJECTIVE: To investigate the effects of galantamine on the performance of patients with mild to moderate Alzheimer's disease (AD) in a computerized neuropsychological test battery (CNTB). METHOD: Thirty-three patients with probable AD were treated with galantamine for three months and evaluated in a prospective, open-label, multi-center study. The CNTB and the ADAS-Cog were administered at baseline and after 12 weeks. The CNTB includes reaction time tests to evaluate attention, implicit and episodic memory for faces and words. Statistical comparisons were performed between the results in week 12 versus baseline. Patients who did not reach the therapeutic doses were excluded from the efficacy analysis. RESULTS: Four patients (12.1%) were excluded from the analysis either because of treatment discontinuation (n=3) or because a therapeutic dose was not reached (n=1). The remaining 29 patients were treated with doses of 24 mg/day (n=22) and 16 mg/day (n=7). After 12 weeks, significant reductions in reaction time were seen in the test of episodic memory for faces (p=0.023) and in the test of two-choice reaction time (p=0.039) of the CNTB. CONCLUSION: Treatment with galantamine produced improvement in computerized tests of attention and episodic memory after 12 weeks, leading to statistically significant reduction in the reaction times.
Subject(s)
Alzheimer Disease/drug therapy , Attention/drug effects , Cholinesterase Inhibitors/pharmacology , Galantamine/pharmacology , Memory/drug effects , Neuropsychological Tests , Aged , Aged, 80 and over , Alzheimer Disease/psychology , Brazil , Diagnosis, Computer-Assisted , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJETIVO: Investigar os efeitos da galantamina no desempenho de pacientes portadores de doença de Alzheimer (DA) leve a moderada em uma bateria de testes neuropsicológicos computadorizados (BTNC). MÉTODO: Trinta e três pacientes com DA provável receberam tratamento com galantamina por três meses em ensaio clínico multicêntrico aberto e prospectivo. A escala BTNC e a ADAS-Cog foram administradas no início e ao final de 12 semanas. A BTNC incluiu testes de tempo de reação avaliando atenção, memória implícita e memória episódica para palavras e faces. Comparações estatísticas foram realizadas entre os resultados na 12ª semana versus a linha de base. Pacientes que não atingiram dose terapêutica foram excluídos da análise. RESULTADOS: Quatro pacientes (12,1%) foram excluídos por interrupção do tratamento (n=3) ou por não atingir dose terapêutica (n=1). Os 29 pacientes remanescentes foram tratados com doses de 24 mg/dia (n=22) e 16 mg/dia (n=7). Ao final de 12 semanas, reduções nos tempos de reação foram observadas nos testes de memória episódica para faces (p=0,023) e no teste de tempo de reação de dupla escoí lha (p=0,039) da BTNC. CONCLUSAO: O tratamento com galantamina melhorou o desempenho em testes de atenção e memória episódica, com redução estatisticamente significativa dos tempos de reação.
Subject(s)
Humans , Male , Female , Middle Aged , Alzheimer Disease/drug therapy , Attention/drug effects , Cholinesterase Inhibitors/pharmacology , Galantamine/pharmacology , Memory/drug effects , Neuropsychological Tests , Brazil , Diagnosis, Computer-Assisted , Prospective StudiesABSTRACT
We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9% of the total attendance). Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimer's disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics.
Subject(s)
Dementia/epidemiology , Adult , Aged , Aged, 80 and over , Ambulatory Care Facilities , Brazil/epidemiology , Dementia/etiology , Female , Humans , Male , Middle Aged , Socioeconomic FactorsABSTRACT
We describe clinical and socio-demographic features of patients with dementia attended in a tertiary outpatient clinic during a three years period (56.9 percent of the total attendance). Most of them were men, white, from the local community, urban district. Nobody had a job at the moment, two thirds of them got social welfare benefit. They lived with their family, the caregiver being the spouse or a daughter. The education level was very low, a quarter of them being illiterate. They were referred mostly from the public health care service, by neurologists or psychiatrists due to cognitive disorders. Family history as well as individual history of previous neurological/psychiatric disorders were frequent, especially alcoholism, stroke, head trauma and dementia. The neurological exam showed abnormalities in two thirds of cases, chiefly extra-pyramidal and pyramidal signs. Alzheimer's disease was the most frequent cause, followed by cerebrovascular disorder; alcoholism and normal pressure hydrocephalus were also frequent causes. Most patients presented concomitant non-etiological neurological/psychiatric disorders, mainly alcoholism and depression, and non-neurological/psychiatric diseases, predominantly hypertension, cardiopathy and diabetes. Most patients had been referred under medication, frequently politherapy, including psychotropics
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Dementia , Aged, 80 and over , Ambulatory Care Facilities , Brazil , Dementia , Socioeconomic FactorsABSTRACT
Os autores relatam um caso de sindrome catatonica que evoluiu com afasia apos um provavel episodio infeccioso do sistema nervoso central (encefalite viral?), que nao foi confirmado por exames complementares...
