Detecção de flavivirus e alphavirus em mosquitos (diptera: culicidae) capturados em região próxima à Três Lagoas ­ Ms / Detection of flavivirus and alphavirus in mosquitoes (diptera: culicidae) captured in a region close to Tres Lagoas ­ Ms / Detección de flavivirus y alphavirus en mosquitos (diptera: culicidae) capturados en una región cercana a Tres Lagoas ­ Ms

Introdução: Arbovírus são causadores de doenças humanas, sendo que mudança ecológicas e aumento do contato humano-vetor aumenta a possibilidade de surtos. Objetivo: Detectar, identificar e caracterizar arbovírus presentes em mosquitos vetores capturados em regiões de mata próximas a Três Lagoas, MS. Metodologia: Mosquitos foram capturados utilizando armadilhas de luz em regiões de mata circunvizinha a Três Lagoas. Os mosquitos capturados foram classificados por gênero (chave morfológica) e agrupados em pools com até 20 espécimes, e utilizados através da reação de RT-PCR com posterior sequenciamento e análise filogenética. Resultados: Foram capturados 851 dos gêneros: Culex spp. (11 pools); Aedes spp. (13 pools); Haemagogus spp. (7 pools) e outros gêneros não identificados. Sequencias de vírus Dengue (DENV) foram amplificadas de 2/13 (15,38%) pools de Aedes spp. e uma sequência de vírus Mayaro (MAYV) 1/7 (7,7%) foi amplificada de pools de Haemagogus spp. As análises filogenéticas mostraram que as sequências de DENV agrupava-se no clado de DENV1 e DENV2. A sequência de MAYV agrupou-se junto a sequências de amostras de infecções humana por MAYV do grupo L. Conclusão: Estes resultados reforçam a circulação de DENV, que é causador de surtos anuais de doenças febris agudas no município, e detecção, por primeira vez na região, a circulação de MAYV, reforçando a necessidade de monitoramento viral constante nessa região.

Introduction: Arboviruses cause human diseases, and ecological changes and increased human-vector contact increase the possibility of outbreaks. Objective: To detect, identify and characterize arboviruses present in mosquito vectors captured in forest regions close to Tres Lagoas, MS. Methodology: Mosquitoes were captured using light traps in forest regions surrounding Tres Lagoas. The captured mosquitoes were classified by gender (morphological key) and grouped into pools with up to 20 specimens and used through the RT-PCR reaction with subsequent sequencing and phylogenetic analysis. Results: 851 of the genera were captured: Culex spp. (11 pools); Aedes spp. (13 pools); Haemagogus spp. (7 pools) and other unidentified genera. Dengue virus (DENV) sequences were amplified from 2/13 (15.38%) pools of Aedes spp. and a Mayaro virus (MAYV) sequence 1/7 (7.7%) were amplified from pools of Haemagogus spp. Phylogenetic analyzes showed that one of the DENV sequences clustered in the DENV1 and DENV2 clade. The MAYV sequence was grouped together with sequences from samples of human MAYV infections of the L group. Conclusion: These results reinforce the circulation of DENV, which causes annual outbreaks of acute febrile illnesses in the municipality, and detection, for the first time in the region, the circulation of MAYV, reinforcing the need for constant viral monitoring in this region.

Introducción: Los arbovirus causan enfermedades humanas, y los cambios ecológicos y el mayor contacto humano-vector aumentan la posibilidad de brotes. Objetivo: Detectar, identificar y caracterizar arbovirus presentes en mosquitos vectores capturados en regiones de selva próximas a Tres Lagoas, MS. Metodología: Los mosquitos fueron capturados utilizando trampas de luz en las regiones forestales que rodean Tres Lagoas. Los mosquitos capturados fueron clasificados por género (clave morfológica) y agrupados en pools de hasta 20 ejemplares, y utilizados mediante la reacción RT-PCR con posterior secuenciación y análisis filogenético. Resultados: Se capturaron 851 de los géneros: Culex spp. (11 pools); Aedes spp. (13 pools); Haemagogus spp. (7 pools) y otros géneros no identificados. Las secuencias del virus del dengue (DENV) se amplificaron a partir de 2/13 (15,38 %) grupos de Aedes spp. y una secuencia de virus Mayaro (MAYV) 1/7 (7,7%) de pools de Haemagogus spp. Los análisis filogenéticos mostraron que una de las secuencias de DENV se agrupaba en el clado DENV1 y DENV2. La secuencia de MAYV se agrupó con secuencias de muestras de infecciones humanas de MAYV del grupo L. Conclusión: Estos resultados refuerzan la circulación de DENV, causante de brotes anuales de enfermedades febriles agudas en el municipio, y la detección, por primera vez en la región, la circulación de MAYV, reforzando la necesidad de un monitoreo viral constante en esta región.

Resin infiltration in white spot lesions caused by orthodontic hypomineralisation: a minimally invasive therapy.

Objective White spot lesions are characterised by the presence of clinically detectable opaque lesions due to enamel demineralisation. These frequently present in patients following fixed orthodontic treatment, mostly due to the prolonged accumulation of bacterial plaque on the dental surface. When remineralisation is not achieved through good oral hygiene and prophylaxis with fluoride products, the infiltration of lesions with low-viscosity photopolymerised resin has proved to be a valid micro-invasive alternative compared to traditional conservative therapy.Clinical considerations A case series will be presented, where the chosen approach was resin infiltration, a micro-invasive and aesthetic technique.Clinical significance Infiltrative resin therapies are single-session procedures that reduce the need for more invasive therapies such as the use of rotary instruments for greater patient comfort. The need for periodic fluoride applications is also avoided. This approach increases the durability of the infiltrated lesion without compromising its mechanical properties and impedes the development of recurrent or secondary caries.Conclusions Resin infiltration might be considered as a routine procedure in the treatment of post-eruptive hypomineralised lesions. This follows the line of thought of minimally invasive dentistry, is an excellent treatment option and prevents the lesion's progression.

Emotional disorders evidenced by family caregivers of older people with Alzheimer's disease.

The task of caring for a family member with dementia is associated with caregiver physical and emotional problems. The patient's decline in health and specific needs contribute directly to this situation. OBJECTIVE: To evaluate burden, stress, depression and anxiety symptoms in family caregivers of elderly with Alzheimer's disease. METHODS: A cross-sectional, descriptive, correlational and quantitative study was carried out. The sample consisted of 66 family caregivers of elderly with Alzheimer's disease, whom attended the Cognitive and Behavioral Neurology Outpatient Clinic of the Federal University of São Carlos, in the city of São Carlos, SP, Brazil. RESULTS: Of the caregivers evaluated in the severe AD subgroup, 47.3% had intense burden; 86, 4% exhibited significant stress levels; 57% presented severe anxiety levels and 36.9% presented mild depression symptoms. CONCLUSION: Caring for a family member with Alzheimer's disease generates burden, stress, anxiety and depression. Support groups comprising a multiprofessional team can be set up to assist caregivers. These actions can help caregivers cope with the daily demands and challenges and ensure better care quality in an increasingly aging population.

A tarefa de cuidar de um familiar com demência está relacionada a problemas físicos e emocionais no cuidador. O declínio do paciente e suas demandas específicas contribuem diretamente para essa situação. OBJETIVO: Avaliar sintomas de sobrecarga, estresse, depressão e ansiedade em cuidadores familiares de idosos com doença de Alzheimer. MÉTODOS: Estudo transversal, descritivo, correlacional e de caráter quantitativo. A amostra foi composta por 66 cuidadores familiares de idosos com doença de Alzheimer, atendidos no Ambulatório de Neurologia da Universidade Federal de São Carlos, na cidade de São Carlos, SP, Brasil. RESULTADOS: Dos cuidadores alocados no subgrupo DA avançada, 47,3% foram avaliados com sobrecarga intensa; 86,4% apresentaram níveis de estresse significativo; 57% apresentaram níveis graves de ansiedade e 36,9% apresentaram sintomas de depressão leve. CONCLUSÃO: Cuidar de um familiar com doença crônica e degenerativa como a doença de Alzheimer gera sobrecarga, assim como estresse, ansiedade e depressão. Grupos de apoio compostos por uma equipe multiprofissional podem ser implantados no sentido de garantir o acompanhamento desses cuidadores. Tais ações podem auxiliar a lidar com as demandas e os enfrentamentos diários e ainda garantir uma melhor qualidade no cuidado prestado, considerando o avanço do envelhecimento populacional.

Subjective memory complaint and its relationship with cognitive changes and physical vulnerability of community-dwelling older adults.

Memory complaint (MC) is common in older adults and can be confirmed by people close to them, such as family members and caregivers. Studies show an association between MC and cognitive impairment and, hence, physical vulnerability may exacerbate MC. However, the relationship between MC and physical vulnerability is not yet clear in the literature.\. OBJECTIVE: to investigate the association between MC, cognitive impairment, and physical vulnerability. METHODS: this is a cross-sectional study. We evaluated 100 older adults with a mean age of 65 years or over. The Memory Complaint Scale (MCS), Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Vulnerable Elderly Research-13 (VES-13), Geriatric Depression Scale and a sociodemographic questionnaire were applied. RESULTS: participants were divided into two groups according to results on the MCS-A (elderly) and MCS-B (informant). Correlations were found between the MCS-A and the MMSE (p=.045/ρ=.201), ACE-R/Visual-Spatial (p=.048/ρ=.199), and ACE-R/Attention-Orientation (p=.026/ρ=.223). For the MCS-B, correlations were found with total score on the ACE-R (p=.044/ρ=-.202) and the ACE-R/Visual-Spatial (p=0.003/ρ=-.291). CONCLUSION: MC reported by the informant indicate the need to assess, in more depth, the cognition of the older adult. Thus, for clinical practice, screening of MC through an informant is advised.

A queixa de memória (QM) é comum em idosos e pode ser confirmada por pessoas próximas a ele, como familiares e cuidadores. Estudos apontam associação entre QM e alterações cognitivas e, nesse sentido, a vulnerabilidade física poderia exacerbá-la. Porém, a relação entre QM e vulnerabilidade física ainda não está clara na literatura. OBJETIVO: investigar a relação entre QM, alterações cognitivas e vulnerabilidade física. MÉTODOS: trata-se de um estudo transversal. Foram avaliados 100 idosos com idade igual ou superior a 65 anos. Utilizou-se a Escala de Queixa de Memória (EQM), Exame Cognitivo de Addenbrooke - Revisado (ACE-R), Mini Exame do Estado Mental (MEEM), Vulnerable Elders Survey-13 (VES-13), Escala de Depressão Geriátrica e questionário sociodemográfico. RESULTADOS: os participantes foram divididos em dois grupos de acordo com os resultados da EQM formas A (idoso) e B (informante). Encontrou-se correlação entre a EQM-A e MEEM (p=.045/ρ=.201), ACE-R Atenção e Orientação (p=.026/ρ=.223) e ACE-R/Visual-Espacial (p=.048/ρ=.199). Na EQM-B encontrou-se correlação entre pontuação total do ACE-R (p=.044/ρ=-.202) e ACE-R/Visual-Espacial. (p=.003/ρ=-.291). CONCLUSÃO: o relato de QM a partir do informante aponta a necessidade de avaliação mais aprofundada da cognição dos idosos. Assim, para a prática clínica, o rastreio de QM do informante é aconselhado.

Short-term pharyngeal airway space changes after mandibular advancement surgery in Class II patients-a two-dimensional retrospective study.

INTRODUCTION: Planning successful treatment for the correction of anatomic abnormalities of the upper airways, by surgical advancement of the mandible, depends on extensive knowledge of the pharyngeal airway space (PAS). However, there is limited scientific evidence about changes in PAS after mandibular advancement surgery. AIM: To evaluate the immediate changes in superior posterior airway space (SPAS) in Class II patients, after mandibular advancement surgery. MATERIALS AND METHODS: A cephalometric evaluation of 37 patients with skeletal Class II deformity was performed at 2 distinct time intervals: Pre-operative (T0) and immediate post-operative (T1), using Dolphin Image & Management Solutions, version 11.9, according to the method of Arnett/Gunson FAB Surgery. The differences due to the surgical intervention were assessed with Student's t test, and a Principal Component Analysis was used to evaluate the relationship between mandibular advancement and SPAS variables. Anticlockwise and clockwise rotation groups were also evaluated with Mann-Whitney tests. The statistical analysis was conducted in SPSS and R assuming a 0.05 level of significance. RESULTS: As an effect of mandibular advancement, an anteroposterior statistically significant increase in SPAS (P < 0.001) was perceived at all points measured. CONCLUSION: Our findings indicate that mandibular advancement surgery is a viable option to achieve widening of the SPAS in patients with Class II skeletal morphology.

Comparative analysis of impacted upper canines: Panoramic radiograph Vs Cone Beam Computed Tomography.

BACKGROUND: The use of CBCT exam in the study of IMC is not new. However, it's still not known in what specific aspects CBCT exam shows a better result than then conventional exams. The aim of this study was to compare and conclude in what way the opinion regarding upper canine impaction differed when observing a panoramic image compared to the observation of a set of CBCT reconstructions. MATERIAL AND METHODS: Twenty patients (10 males and 10 females) with a total of 28 impacted maxillary canines were identified from the database of the Department of Dentistry, Faculty of Medicine, University of Coimbra. For each canine, two different images were available: a panoramic image and a set of CBCT reconstructions. After a random distribution of both groups images, nine orthodontists completed a questionnaire where they were asked to evaluate ten different questions regarding canine impaction. Statistic analysis was performed using Cronbach's alpha statistics, Kappa statistics and McNemar test, considering p<0,05 statistically significant. RESULTS: This study showed differences between the two images regarding tooth position. A statistical significant poor agreement was found between the two methods for the mesio-distal position of the apex (k=0,388, p<0,001) and for the labio-palatal tip cusp position (k=0,035, p=0,114). The adjacent root resorption showed a poor and very poor agreement between the two methods. Every other items were scored with an agreement between modalities ranging from moderate to strong. CONCLUSIONS: The analyses of panoramic images versus CBCT images reconstructions provided different information regarding tooth position (especially concerning the mesio-distal apex position and the labio-palatal cusp position) but also in the assessment of root resorption. Further investigation should be done to determine in what cases CBCT exam has a clear advantage over conventional 2D exams, justifying its use. Key words:Cone-Beam Computed Tomography, Orthodontics, Impacted Tooth, Root resorption.

Therapies for White Spot Lesions-A Systematic Review.

INTRODUCTION: The first sign of dental caries is denoted by white spot lesions (WSLs) which can be defined as a demineralization of the enamel surface and subsurface, although these lesions can be reversed and do not form cavities. The aim of this systematic review was investigate which remineralization agents are effective for the treatment of WSLs. MATERIALS AND METHODS: For this systematic review a literature search was conducted on Pubmed, Cochrane Library and ScienceDirect. RESULTS: The initial search resulted in 273 references. After elimination of duplicate articles, 236 references remained. After reading titles and abstracts, all non-relevant results were excluded, resulting in 45 potentially relevant studies. After reading the full text, 13 references were included. CONCLUSION: More studies are required for scientific evidence in order to reach a conclusion of the most suitable therapeutic method for the treatment of surface and subsurface demineralization of the enamel.

A computed tomographic, mixed dentition, space analysis comparison.

INTRODUCTION: A considered space analysis aims to predict the combined mesiodistal widths of unerupted permanent canine and premolars. A miscalculation can lead to the application of inadequate and irreversible treatments. OBJECTIVE: To assess the level of agreement between predictions generated by three methods (Moyers' predictive tables at the 50th and 75th percentiles and Tanaka-Johnston's equations) on the sum of unerupted teeth compared with measurements derived from cone beam computed tomography, considered in the present study as a 'gold standard'. MATERIALS AND METHODS: The study sample was comprised of children (N = 26) aged 8-13 who visited the Department of Dentistry. Moyers' predictive tables and the Tanaka-Johnston equation were applied to ascertain the space requirements. Cone beam computed tomography was performed on each patient and the volumetric data analysed. A concordance correlation coefficient between each method's predictions was applied. RESULTS: The three methods tended to overestimate the cone beam computed tomography readings and were not able to entirely capture the variability of the sum of the unerupted teeth. Moyers' 50th percentile estimate revealed a more balanced distribution between over- and underestimation. CONCLUSION: The present study suggested that Moyers' 50th percentile is the predictive method with the lowest absolute error and is preferred for clinical use.

Alterations in Gas Exchange and Oxidative Metabolism in Rice Leaves Infected by Pyricularia oryzae are Attenuated by Silicon.

Rice blast, caused by Pyricularia oryzae, is the most important disease in rice worldwide. This study investigated the effects of silicon (Si) on the photosynthetic gas exchange parameters (net CO2 assimilation rate [A], stomatal conductance to water vapor [gs], internal-to-ambient CO2 concentration ratio [Ci/Ca], and transpiration rate [E]); chlorophyll fluorescence a (Chla) parameters (maximum photochemical efficiency of photosystem II [Fv/Fm], photochemical [qP] and nonphotochemical [NPQ] quenching coefficients, and electron transport rate [ETR]); concentrations of pigments, malondialdehyde (MDA), and hydrogen peroxide (H2O2); and activities of superoxide dismutase (SOD), catalase (CAT), ascorbate peroxidase (APX), glutathione reductase (GR), and lypoxigenase (LOX) in rice leaves. Rice plants were grown in a nutrient solution containing 0 or 2 mM Si (-Si or +Si, respectively) with and without P. oryzae inoculation. Blast severity decreased with higher foliar Si concentration. The values of A, gs and E were generally higher for the +Si plants in comparison with the -Si plants upon P. oryzae infection. The Fv/Fm, qp, NPQ, and ETR were greater for the +Si plants relative to the -Si plants at 108 and 132 h after inoculation (hai). The values for qp and ETR were significantly higher for the -Si plants in comparison with the +Si plants at 36 hai, and the NPQ was significantly higher for the -Si plants in comparison with the +Si plants at 0 and 36 hai. The concentrations of Chla, Chlb, Chla+b, and carotenoids were significantly greater in the +Si plants relative to the -Si plants. For the -Si plants, the MDA and H2O2 concentrations were significantly higher than those in the +Si plants. The LOX activity was significantly higher in the +Si plants than in the -Si plants. The SOD and GR activities were significantly higher for the -Si plants than in the +Si plants. The CAT and APX activities were significantly higher in the +Si plants than in the -Si plants. The supply of Si contributed to a decrease in blast severity, improved the gas exchange performance, and caused less dysfunction at the photochemical level.

ADAM10 as a biomarker for Alzheimer's disease: a study with Brazilian elderly.

Alzheimer's disease (AD) is the most common cause of dementia in people above age 65. Platelet studies with ADAM10 have shown that its expression is reduced in AD patients. The aim of this research was to compare the platelet levels of ADAM10 protein in two Brazilian elderly groups, considering the stages of the disease. The SDS-PAGE technique followed by Western blotting was used. Data were analyzed using comparison, correlation and association statistical methods. The results showed reduced platelet ADAM10 levels in AD elderly compared to non-AD subjects. The disease progression intensified this reduction. ADAM10 was the only statistically significant variable (p = 0.01) to increase the AD occurrence probability. The cutoff value of 0.4212 in the receiver operating characteristic curve captured sensitivity and specificity of 70 and 80.77%, respectively. Together with other clinical criteria, ADAM10 seems to be a relevant biomarker tool for early and accurate AD diagnosis.

Neuropsychiatric Symptoms (NPS) in patients with pure Vascular Dementia (VaD) and Mixed Dementia (MD) from a memory outpatient clinic in southeast Brazil.

Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI) are increasingly common worldwide. Nevertheless, the clinical-neuropsychiatric profile of these patients at presentation is still poorly characterized in developing countries. OBJECTIVE: We aimed to characterize the prevalence of neuropsychiatric symptoms, as well as the clinical and cognitive profile of patients with VaD and VCI in our tertiary University outpatient cognitive clinic. METHODS: We reviewed data on 253 patients diagnosed with VaD or VCI at our center between January 1996 and December 2005, located in an industrial region of the state of Sao Paulo, southeast Brazil. We excluded 19 patients who did not complete the medical investigation or who did not meet the clinical or neuroimaging criteria for vascular dementia. We collected socio-demographic data, educational level, vascular risk factors, behavioral and neuropsychological symptoms and cognitive complaints at presentation. RESULTS: Two hundred and thirty-four cases were included in this analysis. The mean age was 67.77±10.35 years; 72% were males and 82% had less than four years of education (average 2.84±2.96 years). The initial Clinical Dementia Rating score was 2 & 3 in 68%. A total of 185 patients had neuropsychiatric symptoms distributed in main categories as follows: psychosis (52.6%), hallucinations (23.5%), psychomotor agitation (22.5%), depression (17.5%) and apathy (17.5%). Hypertension and previous stroke were the most prevalent risk factors. CONCLUSION: We found a high prevalence of neuropsychiatric symptoms. The clinical-neuropsychiatric profile of patients presenting to cognitive clinics in developing countries may differ greatly to that of more developed nations. These characteristics may have implications for public health strategies.

Demência Vascular (DV) e comprometimento cognitivo vascular (CCV) são diagnósticos cada vez mais relatados em todos os continentes. Entretanto, o perfil dos sintomas comportamentais e psicológicos das demências (SCPD) nos pacientes com DV é ainda pouco descrito e caracterizado, nos países em desenvolvimento. OBJETIVO: Determinar a prevalência dos SCPD, o perfil de manifestações neuropsiquiátricas e cognitivas, nos pacientes com DV no ambulatório de Neurologia Cognitiva e Comportamental (ANCC), do Hospital das Clínicas da Universidade de São Paulo em Ribeirão Preto (HCRP-FMUSP). MÉTODOS: Revisamos os prontuários de 253 pacientes diagnosticados com DV ou CCV atendidos entre janeiro de 1996 e dezembro de 2005. Excluímos 19 pacientes que não completaram a investigação diagnóstica, não preencheram os critérios clínicos do DSM-IV, e neuroimagem não disponível para análise. Coletamos dados sócio-demográficos, nível de escolaridade, fatores de risco vascular, e SCPD da consulta de admissão. RESULTADOS: 234 pacientes foram incluídos nesta análise. A idade média global foi de 67,77±10,35; com 38% de mulheres; escolaridade de 2,84±2,96 anos; MEEM inicial 13,22±7,00, e 68% de CDR 2 & 3. 79% de pacientes com SCPD foram divididos nas seguintes categorias: psicose (52,6%), alucinações (23,5%), agitação (22,2%), depressão (17,5%) e apatia (17,5%) foram às manifestações mais prevalentes. Hipertensão Arterial e AVC prévio foram os fatores de risco de maior prevalência. CONCLUSÃO: Verificou-se elevada prevalência de SCPD em DV. O perfil destas alterações neuropsiquiátricas na DV mostrou uma tendência na direção de sintomatologia psicótica, devendo ser objeto de mais pesquisas, pois os padrões em nações desenvolvidas podem ser substancialmente diferentes.

Treatment of Alzheimers disease in Brazil: II. Behavioral and psychological symptoms of dementia / Tratamento da doença de Alzheimer no Brasil: II. Dos sintomas comportamentais e psicológicos da demência

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimers disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the . The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition.

Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os sintomas comportamentais e psicológicos da demência (SCPD). Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos sintomas comportamentais e psicológicos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos SCPD, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina, neurolépticos, antidepressivos, benzodiazepínicos, anticonvulsivantes e outros fármacos e substâncias), como não farmacológico (incluindo intervenções educacionais, fisioterapia, terapia ocupacional, musicoterapia, terapia com luz, massagem e arterapia). As recomendações para o tratamento dos transtornos cognitivos da DA são apresentadas em outro artigo desse fascículo.

Treatment of Alzheimers disease in Brazil: I. Cognitive disorders / Tratamento da doença de Alzheimer no Brasil: I. dos transtornos cognitivos

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimers disease (AD) in Brazil, with special focus on cognitive disorders. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the . The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of cognitive disorders in AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of cognitive disorders encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine and other drugs and substances) and non-pharmacological (including cognitive rehabilitation, physical activity, occupational therapy, and music therapy) approaches. Recommendations for the treatment of behavioral and psychological symptoms of dementia due to Alzheimers disease are included in a separate article of this edition.

Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os transtornos cognitivos. Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos transtornos cognitivos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos transtornos cognitivos, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina e outros fármacos e substâncias), como não farmacológico (incluindo reabilitação cognitiva, atividade física, terapia ocupacional e musicoterapia). As recomendações para o tratamento dos sintomas comportamentais e psicológicos da demência da DA são apresentadas em outro artigo desse fascículo.

Treatment of Alzheimer's disease in Brazil: I. Cognitive disorders.

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD) in Brazil, with special focus on cognitive disorders. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of cognitive disorders in AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of cognitive disorders encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine and other drugs and substances) and non-pharmacological (including cognitive rehabilitation, physical activity, occupational therapy, and music therapy) approaches. Recommendations for the treatment of behavioral and psychological symptoms of dementia due to Alzheimer's disease are included in a separate article of this edition.

Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os transtornos cognitivos. Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos transtornos cognitivos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos transtornos cognitivos, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina e outros fármacos e substâncias), como não farmacológico (incluindo reabilitação cognitiva, atividade física, terapia ocupacional e musicoterapia). As recomendações para o tratamento dos sintomas comportamentais e psicológicos da demência da DA são apresentadas em outro artigo desse fascículo.

Treatment of Alzheimer's disease in Brazil: II. Behavioral and psychological symptoms of dementia.

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition.

Esse texto apresenta as recomendações da Academia Brasileira de Neurologia, por intermédio do seu Departamento Científico de Neurologia Cognitiva e do Envelhecimento, para o tratamento da doença de Alzheimer (DA) no Brasil, enfocando os sintomas comportamentais e psicológicos da demência (SCPD). Trata-se de uma revisão ampliada das diretrizes publicadas em 2005, resultada de um consenso envolvendo pesquisadores da área, médicos e não médicos. Os autores realizaram uma busca de artigos publicados a partir de 2005 nas bases MEDLINE, LILACS e Cochrane Library. A busca foi direcionada para tratamento farmacológico e não farmacológico dos sintomas comportamentais e psicológicos da DA. Os estudos foram categorizados em quatro classes e as evidências em quatro níveis, com base nas recomendações da Academia Americana de Neurologia publicadas em 2008. As recomendações terapêuticas referem-se à fase demencial da DA. Apresentam-se recomendações para o tratamento dos SCPD, tanto farmacológico (incluindo inibidores da acetilcolinesterase, memantina, neurolépticos, antidepressivos, benzodiazepínicos, anticonvulsivantes e outros fármacos e substâncias), como não farmacológico (incluindo intervenções educacionais, fisioterapia, terapia ocupacional, musicoterapia, terapia com luz, massagem e arterapia). As recomendações para o tratamento dos transtornos cognitivos da DA são apresentadas em outro artigo desse fascículo.

The demands of family caregivers of elderly individuals with dementia.

The purpose of this cross-sectional observational study was to identify characteristics of caregivers of elderly people with dementia, types of care demands and to relate demands to the stage of dementia. The study was carried out in 2004 with 104 older adults and 90 caregivers in Ribeirão Preto, state of São Paulo. The OARS instrument was utilized and a questionnaire answered by caregivers. Among older adults, 66.3% were female, aged 75.5 years in average and 86.5% had caregivers. Eighty percent of the caregivers were women family members, aged 52.3 years in average. They spent 15.10 hours/day with care, without help. An important relationship was observed between caregiver's burden, physical and emotional effort and stage of dementia. Emotional overburden was higher at dementia early and late stages, this difference was statistically non-significant. Results reveal the urgent need to plan formal and informal support strategies to caregivers of Brazilian elderly people with dementia.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease.

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer's disease. METHODS: Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI). RESULTS: 96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05. CONCLUSIONS: All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Analisar as relações entre desgaste do cuidador e Sintomas Comportamentais e Psicológicos nas Demências (SCPD) na doença de Alzheimer leve. MÉTODOS: Cinquenta pacientes e cuidadores foram entrevistados com o Inventário Neuro-Psiquiátrico (INP). RESULTADOS: 96,0% dos pacientes tinham pelo menos um SCPD. A média do escore total do INP foi 19,6 (dp=18,05; amplitude=0-78). A média do índice de desgaste do cuidador (IDC) foi 11,5 (dp=10,41; amplitude=0-40). Para os sintomas individuais, a média ponderada do IDC foi 2,8 (dp=1,58) (escala 0-5). Exceto para euforia/elação (m=1,8; dp=1,49), as médias dos IDC foram maiores do que 2,0. Foram encontradas correlações entre o IDC e medidas derivadas para todos os sintomas, exceto Desinibição e Sono. As correlações variaram entre 0,443 e 0,894 (p<0,05). CONCLUSÕES: Todas as medidas derivadas foram úteis em algum caso. Os dados sugerem que o IDC não pode ser inferido pela presença ou perfil dos sintomas. Antes, deve ser investigado sistematicamente.

Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease.

Parkinson's disease (PD) is a neurological disorder characterized by motor disturbances, neuropsychological symptoms and cognitive changes, including cases of dementia. The most frequently described cognitive changes in these patients involve executive and visuospatial functions, which are very important for the execution of daily life activities. OBJECTIVE: To compare different tests used to examine visuospatial functions in patients with PD. METHODS: Thirty-five patients (21 women) with PD symptoms (medicated and "on") and mean schooling of 5.5±4.2 years were examined using the following tests: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Scales of Outcomes of Parkinson's Disease (SCOPA-COG), Hooper Visual Organization Test (HVOT), Judgment of Line Orientation, Form V (JLO), and Clock drawing task - CLOX (1 and 2). RESULTS: The mean MMSE score was 24.8±3.03and 54.8% of the patients performed correctly in the copy of a pentagon drawing, with a medium-level performance in most tests. Good correlations were detected between JLO versus SCOPA Assembling patterns (0.67), JLO versus HVOT (0.56), JLO versus CLOX2 (0.64), SCOPA Figure Composition versus HVOT (0.54), CLOX1 versus CLOX2 (0.43), and DRS Construction versus CLOX2 (0.42). DISCUSSION: Although correlations were detected, not all were strong, probably because the tests employed do not measure solely visuospatial functions, but also other skills such as attention, motor ability and executive functions. A limitation of the present study was the lack of a control group for the establishment of adequate standards for this population.

A doença de Parkinson (PD) é um transtorno neurológico caracterizado por distúrbios motores, sintomas neuropsicológicos e por alterações cognitivas, inclusive casos de demência. As alterações cognitivas mais descritas nesses pacientes são as funções executivas e as visuais-espaciais, funções importantíssimas para a realização de atividades da vida diária. OBJETIVO: Comparar diferentes testes que examinam funções visuais-espaciais em pacientes com DP. MÉTODOS: Foram avaliados 35 pacientes (21 mulheres) sintomáticos para DP (medicados e em "on") e escolaridade média de 5,5±4,2 com os seguintes testes: Mini-Exame do Estado Mental (MEEM), Escala de Avaliação de Demência de Mattis (EADM), Escala de Conseqüências da Doença de Parkinson (SCOPA-COG), Teste de Organização Visual de Hooper (TOVH), Julgamento de Orientação de Linhas ­ Forma V (JOL), e Teste do Desenho do Relógio ­ CLOX (1 e 2). RESULTADOS: Os pacientes obtiveram média 24,8±3,03 no MMSE e 54,8% acertou o de cópia do desenho do pentágono e desempenho mediano na maioria dos testes. Foram encontradas boas correlações entre JOL versus SCOPA Composição de Figuras (0.67), JLO versus TOVH (0.56), JOL versus CLOX2 (0.64), SCOPA Composição de Figuras versus TOVH (0.54), CLOX1 versus CLOX2 (0.43) e EADM Construção versus CLOX2 (0.42). DISCUSSÃO: Mesmo tendo sido verificadas correlações, nem todas foram "fortes", o que pode ser explicado pelo fato de que os testes não medem somente funções visuais-espaciais, mas outras habilidades como atenção, habilidade motora e funções executivas. Uma dificuldade do presente estudo diz respeito à falta de grupo controle para estabelecer padrões adequados à essa população.

Executive cognitive tests for the evaluation of patients with Parkinson's disease.

Parkinson's disease (PD) is characterized by changes in movement, which are later followed by cognitive, behavioral and psychological changes. The objective of the present study was to correlate different tests used to examine executive functions in PD patients followed at a specialized outpatient clinic. METHODS: Thirty-five patients with idiopathic PD aged 63.0 years on average and with mean schooling of 5.5±4.2 years, were examined using the following tests: Mattis Dementia Rating Scale (MDRS), Scales for Outcomes of Parkinson's Disease-Cognition (SCOPA-COG), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Digit Span - Inverse Order (IO) (a subtest of the WAIS III) and Verbal Fluency Test (category animals). RESULTS: Significant correlations were detected between FAB and MDRS Conceptualization (0.814), MDRS Initiation/Perseveration (I/P) and SCOPA-COG Executive Function (0.643), FAB and MDRS I/P (0.601), FAB and Verbal Fluency (0.602), MDRS I/P and MDRS Conceptualization (0.558), Verbal Fluency and MDRS I/P (0.529), MDRS Attention and SCOPA-COG Executive Function (0.495), MDRS Conceptualization and SCOPA-COG Executive Function (0.520), FAB and Digit Span (OI) (0.503), Verbal Fluency and MDRS Conceptualization (0.501), and WCST perseverative errors and FAB (-0.379), WCST perseverative errors and MDRS Conceptualization (0.445), WCST perseverative errors and MDRS I/P (-0.407) and WCST categories completed and MDRS Conceptualization (0.382). DISCUSSION: The results demonstrated strong correlations between most of the tests applied, but no associations were detected between the WCST and the other tests, a fact that may be explained by the heterogeneity of scores obtained in the tests by the patients evaluated. A difficulty of the present study was the lack of a control groups for the establishment of adequate standards for this population.

A doença de Parkinson (DP) caracteriza-se por alterações do movimento, cognitivas, comportamentais e psicológicas. O objetivo do presente estudo foi correlacionar diferentes testes que examinam funções executivas em pacientes com DP acompanhados em um ambulatório especializado. MÉTODOS: Foram avaliados 35 pacientes com DP idiopática com idade média de 63,0 anos e escolaridade média de 5,5±4,2 utilizando os seguintes testes: Escala de Avaliação de demência de Mattis (EADM), Escala de Desfechos da Doença de Parkinson (SCOPA-COG), Teste Wisconsin de Classificação de Cartas (WCST), Bateria de Avaliação Frontal (BAF), Amplitude de Dígitos-Ordem Inversa (OI) (subteste do WAIS III) e Teste de Fluência Verbal (categoria animais). RESULTADOS: Foram encontradas correlações significativas entre BAF e EADM Conceituação (0,814), EADM Iniciativa/Perseveração (I/P) e SCOPA-COG Funções Executivas (0,643), BAF e EADM I/P (0,601), BAF e Fluência Verbal (0,602) e EADM I/P e EADM Conceituação (0,558), Fluência Verbal e EADM I/P (0,529), EADM Atenção e SCOPA-COG Funções Executivas (0,49), EADM Conceituação e SCOPA-COG Funções Executivas (0,495), BAF e Amplitude de dígitos (OI) (0,503), Fluência Verbal e EADM Conceituação (0,501), WCST Erros Perseverativos e BAF (­0,379), WCST erros perseverativos e MDRS Conceptualization (­0,445), WCST erros perseverativos e EADM I/P (­0,407) e WCST categorias completas e EADM Conceituação (0,382). DISCUSSÃO: Os resultados evidenciaram fortes correlações entre a maioria dos testes aplicados. Uma dificuldade do estudo presente diz respeito à falta de grupo controle para estabelecer padrões adequados a essa população.

Reports by caregivers of behavioral and psychological symptoms of dementia.

Behavioral and Psychological Symptoms of Dementia (BPSD) are relevant since they are frequent and cause distress to caregivers. However, they may not be reported by physicians due to the priority usually attributed to cognitive symptoms. OBJECTIVES: To verify whether BPSD is being systematically investigated by physicians even in specialized settings and whether their records on medical files are accurate. METHODS: Assessment of records on medical files of BPSD reported by caregivers to 182 patients (57.1% men, mean age 67.6±13.5 years) assisted in a tertiary-care behavioral neurology outpatient clinic (BNOC) who also had appointments in other clinics of the same hospital. Alzheimer's disease (37.9%) and vascular disease (19.2%) were the most frequent causes of dementia. RESULTS: Report/appointment ratios were 0.58 in BNOC, 0.43 in other neurological, 0.93 in psychiatric and 0.20 in non-neurological, non-psychiatric clinics. BPSD most frequently recorded in BNOC were insomnia, aggressiveness, agitation/hyperactivity, visual hallucinations, apathy, inadequate behavior and ease of crying. Sorted by psychiatrists, categories associated to more BPSD were affect/mood, thought and personality/behavior. affect/mood and sensoperception symptoms were the most frequently reported. Sorted according to Neuropsychiatric Inventory (NPI), categories associated to more BPSD were depression/dysphoria, delusion and apathy/indifference. depression/dysphoria and agitation/ aggression symptoms were the most frequently reported. CONCLUSIONS: BPSD reported by caregivers were very diverse and were not systematically investigated by physicians. Notes in medical files often contained non-technical terms.

Sintomas Comportamentais e Psicológicos de Demência (SCPD) são relevantes, pois são freqüentes e causam estresse aos cuidadores. Contudo, podem não ser relatados pelos médicos devido à prioridade usualmente atribuída aos sintomas cognitivos. OBJETIVOS: Verificar que SCPD podem não ser sistematicamente investigados pelos médicos mesmo em ambientes especializados e que seus registros nos prontuários podem ser imprecisos. MÉTODOS: Avaliação dos registros nos prontuários médicos dos SCPD de relatos de cuidadores de 182 pacientes (57,1% homens, idade média 67,6±13,5 anos) assistidos em um ambulatório de neurologia comportamental (ANCP), que também tiveram consultas em outras clínicas neurológicas, psiquiátricas, não-neurológicas e não-psiquiátricas do mesmo hospital. Doença de Alzheimer (37,9%) e doença vascular (19,2%) foram as causas mais freqüentes de demência. RESULTADOS: As razões relato/consulta foram 0,58 no ANCP, 0,43 em outros ambulatórios neurológicos, 0,93 em ambulatórios psiquiátricos e 0,20 em outros ambulatórios não-neurológicos e não-psiquiátricos. SCPD mais freqüentemente anotados no ANCP foram insônia, agressividade, agitação/ hiperatividade, alucinações visuais, apatia, comportamento inadequado e choro fácil. Classificados por psiquiatras, as categorias reunindo mais SCPD foram afeto/humor, pensamento e personalidade/comportamento. sintomas de afeto/humor e sensopercepção foram os mais freqüentemente relatados. Classificados de acordo com o Inventário Neuropsiquiátrico (INP), as categorias reunindo mais SCPD foram depressão/disforia, delírio e apatia/indiferença. sintomas de depressão/disforia e agitação/agressão foram os mais freqüentemente relatados. CONCLUSÕES: SCPD relatados pelos cuidadores eram muito diversos e não eram sistematicamente investigados pelos médicos. Anotações nos prontuários eram freqüentemente feitas com termos não técnicos.