Alzheimer's disease diagnosis based on detection of autoantibodies against Aß using Aß40 peptide in liposomes.

BACKGROUND: Alzheimer's disease (AD) is the most common form of dementia and affect more than 50 million people worldwide. Thus, there is a high demand by non-invasive methods for an early diagnosis. This work explores the AD diagnostic using the amyloid beta 1-40 (Aß40) peptide encapsulated into dipalmitoyl phosphatidyl glycerol (DPPG) liposomes and immobilized on polyethylene imine previously deposited on screen-printed carbon electrodes to detect autoantibodies against Aß40, a potential biomarker found in plasma samples. METHODS: The immunosensor assembly was accompanied by atomic force microscopy (AFM) images that showed globular aggregates from 20 to 200 nm corresponding liposomes and by cyclic voltammetry (CV) through increase of the voltammogram area each material deposited. After building the immunosensor, when it was exposed to antibody anti-Aß40, there was an increase in film roughness of approximately 9 nm, indicating the formation of the immunocomplex. RESULTS: In the detection by CV, the presence of specific antibody, in the range of 0.1 to 10 µg/ml, resulted in an increase in the voltammograms area and current in 0.45 V reaching 3.2 µA.V and 5.7 µA, respectively, in comparison with the control system, which remained almost unchanged from 0.1 µg/ml. In patient samples, both cerebrospinal fluid (CSF) and plasma, was possible separated among positive and negative samples for AD using CV profile and area, with a difference of 0.1 µA.V from the upper error bar of healthy samples for CSF sample and 0.6 µA.V for plasma sample. CONCLUSIONS: These results showed the feasibility of the method employed for the non-invasive diagnostic of Alzheimer's disease detecting natural autoantibodies that circulate in plasma through a simple and easy-to-interpret method.

Aging-related episodic-like memory decline in dogs.

Episodic memory, in humans, is the memory most affected by age-related deterioration or the constitution of neurodegenerative pathologies, such as Alzheimer's disease. However, it is unknown whether this relationship is also present in nonhuman animals. Since studies in birds, rats, primates, and dogs have been shown to have episodic-like memory, more studies aiming to improve the present understanding of this relationship in nonhuman animals are important to aid the development of new translational models for neurodegenerative disorders. Knowing that dogs (Canis familiaris) represent a promising experimental model for neurodegenerative disorders, a memory retrieval test was conducted with 90 clinically healthy domestic dogs of different ages, both sexes, and distinct breeds, for the purpose of evaluating episodic-like memory. The present study adapted a test that corroborates episodic memory requirements through incidental codification of experienced events. We performed a test with two exposure phases, with different characteristics between them, so that in the third phase it was necessary to integrate previous experiences in order to achieve success in the test. In our study, it was possible to verify the decline of episodic memory in elderly dogs, even clinically healthy, regardless of the dogs' sex and size. This episodic-like memory decline observed in elderly dogs may be related to the physiological process of aging or preclinical pathological manifestation of cognitive impairment, similar as reported in humans. More studies should be carried out evaluating episodic-like memory in dogs with suspected of canine cognitive dysfunction syndrome in order to better understand the physiological and pathological behavior of this type of memory in canine species.

Source Analysis of Triphasic Waves Using Quantitative Neuroimaging.

PURPOSE: Triphasic waves (TWs), a common EEG pattern, are considered a subtype of generalized periodic discharges. Most patients with TWs present with an altered level of consciousness, and the TW pattern is believed to represent thalamocortical dysfunction. However, the exact meaning and mechanism of TWs remain unclear. The objective of the current study was to evaluate the source of TWs using EEG source imaging and computerized tomography. METHODS: Twenty-eight patients with TWs were investigated. Source analysis was performed on the averaged TWs for each individual, and source maps were extracted. Normalization and automatic segmentation of gray matter were performed on computerized tomography scans before analysis. Finally, voxelwise correlation analyses were conducted between EEG source maps and gray matter volumes. RESULTS: Source analyses showed that the anterior cingulate cortex was mainly involved in TWs (16/28 patients, 57%). Correlation analyses showed moderate positive and negative correlations between source location and gray matter volumes for the posterior cingulate ( T = 2.85; volume = 6,533 mm 3 ; r = 0.53; P = 0.002) and the superior frontal gyrus ( T = 2.54; volume = 18,167 mm 3 ; r = -0.48; P < 0.0001), respectively. CONCLUSIONS: The results suggest that the anterior cingulate is involved in the origin of TWs. Furthermore, the volumes of posterior brain regions were positively correlated with TWs, indicating a possible preservation of these structures. Conversely, the volumes of anterior regions were negatively correlated with TWs. These findings may indicate a structural pattern necessary for the generation of the abnormal network responsible for TWs.

Applicability of tactile memory examination as an option to visual- and verbal-based batteries.

The validity and applicability of tactile battery tests for the diagnosis and medical follow-up of patients with Alzheimer's disease and other dementia syndromes do not have their usefulness well understood in clinical practice. While haptic abilities in older individuals receive less attention, in earlier stages of human life they are well focused on. There are even fewer studies on tactile memory, including episodic memory of demented individuals with or without sensorial limitations. The applicability of a new haptic memory battery was evaluated in patients with Alzheimer's disease with mild or moderate commitment. OBJECTIVE: The aim of this study is to apply a battery based on tactile perception, recognition, and recollection of everyday objects in patients with Alzheimer's disease, testing tactile delayed recall memory discrimination and late recognition to compare validated visual and verbal tests. METHODS: Tactile-, visual-, and verbal-based memory performance was registered in 21 patients diagnosed with Alzheimer's disease. RESULTS: Except for tactile identification, it showed that there was a close relationship between the three sensory modalities of memory, with an apparent better performance of tactile incidental memory and recognition compared with the test with pictures. CONCLUSIONS: The haptic evaluation of memory demonstrated applicability in the evaluation of memory dysfunction in patients with Alzheimer's disease. Further studies are needed to establish the sensibility and specificity of the proposed test that had a small sample size and many limitations.

A aplicação de baterias baseadas em informações táteis para diagnóstico e acompanhamento de pacientes com doença de Alzheimer e outras demências não é muito difundida na prática clínica. Ao passo que a capacidade de reconhecimento tátil de objetos em crianças recebe bastante atenção dos pesquisadores, o mesmo não ocorre com indivíduos mais idosos. Existem ainda menos estudos abordando avaliação de memória episódica em pacientes idosos, com ou sem limitações sensoriais, como cegueira e surdez. O presente estudo propõe avaliar aplicabilidade de teste para avaliação de memória tátil em paciente com doença de Alzheimer. OBJETIVO: Aplicar em pacientes com doença de Alzheimer uma bateria baseada na percepção e reconhecimento táctil de objetos de uso cotidiano, avaliando a memória e reconhecimento tardio, comparado com testes visuais e verbais validados. MÉTODOS: Foi avaliado o desempenho de baterias baseadas em informação táteis, visuais e verbais em 21 pacientes diagnosticados com a doença de Alzheimer. RESULTADOS: Com a exceção da percepção tátil, foi demonstrada uma boa correlação entre as três modalidades de apresentação das informações a serem resgatadas tardiamente. Houve um desempenho aparentemente melhor do reconhecimento tátil quando comparado com apresentação de figuras impressas. CONCLUSÕES: A determinação da memória tátil em pacientes com doença de Alzheimer demonstrou ser aplicável como instrumento de avaliação dos distúrbios de memória presentes em portadores de doença de Alzheimer com comprometimento leve a moderado. As limitações do estudo, com reduzido tamanho da amostra, aponta para a necessidade de novos estudos com a devida validação, incluindo determinação de sensibilidade e especificidade, assim como pareamento, de acordo com sexo e idade com grupo controle.

Applicability of tactile memory examination as an option to visual- and verbal-based batteries / A aplicabilidade da avalição da memória tátil como uma opção para as baterias visuais a verbais

ABSTRACT The validity and applicability of tactile battery tests for the diagnosis and medical follow-up of patients with Alzheimer's disease and other dementia syndromes do not have their usefulness well understood in clinical practice. While haptic abilities in older individuals receive less attention, in earlier stages of human life they are well focused on. There are even fewer studies on tactile memory, including episodic memory of demented individuals with or without sensorial limitations. The applicability of a new haptic memory battery was evaluated in patients with Alzheimer's disease with mild or moderate commitment. Objective: The aim of this study is to apply a battery based on tactile perception, recognition, and recollection of everyday objects in patients with Alzheimer's disease, testing tactile delayed recall memory discrimination and late recognition to compare validated visual and verbal tests. Methods: Tactile-, visual-, and verbal-based memory performance was registered in 21 patients diagnosed with Alzheimer's disease. Results: Except for tactile identification, it showed that there was a close relationship between the three sensory modalities of memory, with an apparent better performance of tactile incidental memory and recognition compared with the test with pictures. Conclusions: The haptic evaluation of memory demonstrated applicability in the evaluation of memory dysfunction in patients with Alzheimer's disease. Further studies are needed to establish the sensibility and specificity of the proposed test that had a small sample size and many limitations.

RESUMO A aplicação de baterias baseadas em informações táteis para diagnóstico e acompanhamento de pacientes com doença de Alzheimer e outras demências não é muito difundida na prática clínica. Ao passo que a capacidade de reconhecimento tátil de objetos em crianças recebe bastante atenção dos pesquisadores, o mesmo não ocorre com indivíduos mais idosos. Existem ainda menos estudos abordando avaliação de memória episódica em pacientes idosos, com ou sem limitações sensoriais, como cegueira e surdez. O presente estudo propõe avaliar aplicabilidade de teste para avaliação de memória tátil em paciente com doença de Alzheimer. Objetivo: Aplicar em pacientes com doença de Alzheimer uma bateria baseada na percepção e reconhecimento táctil de objetos de uso cotidiano, avaliando a memória e reconhecimento tardio, comparado com testes visuais e verbais validados. Métodos: Foi avaliado o desempenho de baterias baseadas em informação táteis, visuais e verbais em 21 pacientes diagnosticados com a doença de Alzheimer. Resultados: Com a exceção da percepção tátil, foi demonstrada uma boa correlação entre as três modalidades de apresentação das informações a serem resgatadas tardiamente. Houve um desempenho aparentemente melhor do reconhecimento tátil quando comparado com apresentação de figuras impressas. Conclusões: A determinação da memória tátil em pacientes com doença de Alzheimer demonstrou ser aplicável como instrumento de avaliação dos distúrbios de memória presentes em portadores de doença de Alzheimer com comprometimento leve a moderado. As limitações do estudo, com reduzido tamanho da amostra, aponta para a necessidade de novos estudos com a devida validação, incluindo determinação de sensibilidade e especificidade, assim como pareamento, de acordo com sexo e idade com grupo controle.

Amnestic dementia impairment in Parkinson's disease: The role of body composition, ageing and insulin resistance.

BACKGROUND: The risk of cognitive impairment associated with Parkinson's disease (PD) is related to ageing. The role of body compartmentalization and associated metabolic dysfunctions, as a risk factor for dementia in PD is still not clear. OBJECTIVE: To investigate body mass distribution, insulin resistance, and other parameters in patients without dementia, and those with dementia classified as compromised delayed memory. SUBJECTS AND METHODS: We recorded body composition, basal levels of insulin resistance, and other data from 135 patients, who were followed for at least two years. The patients completed a Brief Cognitive Battery test. Patients with delayed recall memory impairment were assessed using the Mattis dementia rating scale. RESULTS: There was a correlation between age and the patient's scores. Age was negatively correlated with scores on all of the screening battery subtests (p ≤ 0.001), while formal education was positively correlated with the test scores. Insulin resistance was higher in non-demented patients compared to patients with impaired memory (p = 0.0027). There was no association between body composition and cognitive dysfunction in patients with PD. CONCLUSIONS: The results of this study indicate an apparent decrease in insulin resistance associated with cognitive impairment in PD. We found no correlations between body composition and memory dysfunction associated with PD.

Abnormal Spontaneous Eye Movements as Initial Presentation of Organophosphate Poisoning.

BACKGROUND: Atypical ocular bobbing may result from an intentional poisoning from an organophosphate compound. PHENOMENOLOGY SHOWN: The patient exhibited conjugated, slow, arrhythmic, unpredictable eye movements in all directions, diagnosed as atypical ocular bobbing. EDUCATIONAL VALUE: This is a rare, well-documented, clinically relevant case for medical students for correct diagnosis and appropriate treatment of organophosphate intoxication.

Stroke Chameleons Manifesting as Distinct Radial Neuropathies: Expertise Can Hasten the Diagnosis.

OBJECTIVE: Stroke chameleons encompass an atypical group of syndromes that do not initially appear to be cerebrovascular accidents. The objective of this study was to report patients with different lesions of central origin clinically presenting as wrist drop and with a semiology similar to that produced by peripheral lesions of the radial nerve at different topographical levels. METHODS: This is a case series study of patients presenting with wrist drop during the acute phase of stroke who were assessed by clinical examination and CT and MRI brain scans. RESULTS: Three cases presenting as monoparesis were evaluated. In all patients, the MRI revealed restricted diffusion in the pre- and post-central gyrus. Electromyography showed that the functionality of the radial, median, and ulnar nerves were intact in all three cases. The monoparesis resolved completely within 1 month of rehabilitation therapy, and no evidence of recurrent or new events was reported during the 6-month follow-up after stenting. CONCLUSION: The central message of this study is that when acute onset symptoms are present in a relatively old patient with vascular risk factors, stroke should be considered as the possible aetiology until proven otherwise, and the appropriate steps should be taken to avoid a delay in the treatment and to improve outcomes.

Delayed recall memory impairment in patients with Parkinson's disease / Comprometimento da memória de evocação tardia na doença de Parkinson

ABSTRACT. Age is one of the risk factors for dementia in patients with Parkinson's disease (PDD). Distinct cognitive syndromes of Parkinson's disease (PD) have been identified in previous studies. Questions about the role of such cognitive disorders in PD outcomes, especially memory dysfunction, in patients with PD remain unanswered. Objective: To establish possible correlations between delayed recall memory (episodic memory), age, and other demographic variables in patients with PD. Methods: A two-stage protocol was applied. Patients with delayed recall memory compromise, selected based on a brief battery of tests (BBRC-Edu), were classified as dementia cases and submitted to the Mattis Dementia Rating Scale (MDRS). Data from patients with memory disturbances were compared against individuals without episodic memory impairment, and correlated with age and demographic variables. Results: Except for identification and naming, all subtests in the screening battery showed a significant difference (p≤0.0001) between the memory-compromised group (case) and the group without memory impairment (no case). The results also correlated negatively with age (p≤0.0001) and positively with level of education (p=0.0874) in patients with PD. Conclusion: The analysis showed a significant relationship between age and dementia characterized by impaired episodic memory. The findings support reports of a wide spectrum of neuropsychological performance impairment in PD with age, particularly dementia associated with memory deterioration. No correlations between disease duration and cognitive dysfunction were evident.

RESUMO. Idade é um fator de risco bem determinado para surgimento de demência em pacientes com doença de Parkinson (PDD). Estudo prévio tem demonstrado diferentes distúrbios cognitivos em portadores da doença de Parkinson (PD). O significado do comprometimento da memória é pouco compreendido. Objetivo: Estabelecer possíveis correlações entre comprometimento de memória de evocação tardia (memória episódica), idade e outras variáveis demográficas em pacientes com DP. Métodos: Os pacientes foram submetidos a um protocolo dividido em duas etapas. Os pacientes com alterações na memória de evocação tardia (memória episódica), selecionados a partir de bateria breve de rastreio cognitivo (BBRC-Edu) foram classificados como portadores de demência e submetidos ao exame de rastreio para demência de Mattis (MDRS). Os dados relacionados a comprometimento da memória, foram comparados ao grupo que não apresentava alterações e correlacionados a idade e outras variáveis demográficas. Resultados: Com exceção de identificação e nominação, todos os sub-testes mostraram diferenças significativas (p≤0,0001) entre o grupo que apresentava disfunções na memória episódica e o grupo que não apresentava alterações. Foi demonstrada correlação negativa com idade (p≤0,0001) e positiva com nível educacional (p=0.0874). Conclusão: O estudo registrou correlação significativa entre idade e demência caracterizada por comprometimento da memória episódica. Os resultados dão suporte para existência de amplo espectro de disfunções associadas ao envelhecimento, em pacientes com PD. Não foram demonstradas correlações significativas com tempo de doença.

Delayed recall memory impairment in patients with Parkinson's disease.

Age is one of the risk factors for dementia in patients with Parkinson's disease (PDD). Distinct cognitive syndromes of Parkinson's disease (PD) have been identified in previous studies. Questions about the role of such cognitive disorders in PD outcomes, especially memory dysfunction, in patients with PD remain unanswered. OBJECTIVE: To establish possible correlations between delayed recall memory (episodic memory), age, and other demographic variables in patients with PD. METHODS: A two-stage protocol was applied. Patients with delayed recall memory compromise, selected based on a brief battery of tests (BBRC-Edu), were classified as dementia cases and submitted to the Mattis Dementia Rating Scale (MDRS). Data from patients with memory disturbances were compared against individuals without episodic memory impairment, and correlated with age and demographic variables. RESULTS: Except for identification and naming, all subtests in the screening battery showed a significant difference (p≤0.0001) between the memory-compromised group (case) and the group without memory impairment (no case). The results also correlated negatively with age (p≤0.0001) and positively with level of education (p=0.0874) in patients with PD. CONCLUSION: The analysis showed a significant relationship between age and dementia characterized by impaired episodic memory. The findings support reports of a wide spectrum of neuropsychological performance impairment in PD with age, particularly dementia associated with memory deterioration. No correlations between disease duration and cognitive dysfunction were evident.

Idade é um fator de risco bem determinado para surgimento de demência em pacientes com doença de Parkinson (PDD). Estudo prévio tem demonstrado diferentes distúrbios cognitivos em portadores da doença de Parkinson (PD). O significado do comprometimento da memória é pouco compreendido. OBJETIVO: Estabelecer possíveis correlações entre comprometimento de memória de evocação tardia (memória episódica), idade e outras variáveis demográficas em pacientes com DP. MÉTODOS: Os pacientes foram submetidos a um protocolo dividido em duas etapas. Os pacientes com alterações na memória de evocação tardia (memória episódica), selecionados a partir de bateria breve de rastreio cognitivo (BBRC-Edu) foram classificados como portadores de demência e submetidos ao exame de rastreio para demência de Mattis (MDRS). Os dados relacionados a comprometimento da memória, foram comparados ao grupo que não apresentava alterações e correlacionados a idade e outras variáveis demográficas. RESULTADOS: Com exceção de identificação e nominação, todos os sub-testes mostraram diferenças significativas (p≤0,0001) entre o grupo que apresentava disfunções na memória episódica e o grupo que não apresentava alterações. Foi demonstrada correlação negativa com idade (p≤0,0001) e positiva com nível educacional (p=0.0874). CONCLUSÃO: O estudo registrou correlação significativa entre idade e demência caracterizada por comprometimento da memória episódica. Os resultados dão suporte para existência de amplo espectro de disfunções associadas ao envelhecimento, em pacientes com PD. Não foram demonstradas correlações significativas com tempo de doença.

Characterization of patients treated by rehabilitation service after establishing of an acute stroke unit in a Brazilian hospital.

[Purpose] The study aimed to characterize patients treated by rehabilitation section after establishment of an acute stroke unit. [Subjects and Methods] Medical consultation records of individuals with ischemic stroke were studied retrospectively, excluding individuals with hemorrhagic stroke, thrombolysis, previous Modified Rankin Scale ≥ 1, prior stroke, structural bone deformities, associated neurological disease, and prior cognitive deficit. The data evaluated were age, gender, etiology, localization, treatment received, ictus onset, hospitalization time, discharge date, and date of first evaluation at the rehabilitation center. The Modified Rankin Scale in 90 days after ictus was utilized to measure functional incapacity with the individuals divided into two groups, before and after acute stroke unit implementation (2010). Functional incapacity was compared between before and after acute stroke unit implementation by the Mann-Whitney test, χ(2) test and Fisher's exact test. [Results] The medical records of 170 patients were evaluated. In the group evaluated after 2010, the patients were significantly older and presented a shorter time between hospitalization and discharge, shorter time until the first evaluation in rehabilitation, and increased percentage of mild incapacity (Modified Rankin Scale = 0 to 2). [Conclusion] After acute stroke unit implementation, the patients treated in the rehabilitation section presented a shorter hospitalization time and rehabilitation delay and less functional incapacity.

Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke.

BACKGROUND: The present study aimed to evaluate the relation between the National Institutes of Health Stroke Scale (NIHSS) score and the presence of laryngeal penetration and/or laryngotracheal aspiration in ischemic stroke patients and to verify what factors are predictors of the occurrence of pneumonia in the evaluated patients. METHODS: This was an observational study of ischemic stroke in the acute or subacute phases. Neurologic examination included anamnesis, Bamford classification, and application of the NIHSS. Speech therapy evaluation was carried out after clinical stabilization of the patient, and all individuals who were considered dysphagic were sent for examination by means of videofluoroscopic recordings. The parameters observed in the objective examination were the presence of laryngeal penetration and/or laryngotracheal aspiration. The pneumonia data were obtained in accordance with local protocols, which were based on international guidelines. The relation of laryngeal penetration and laryngotracheal aspiration with the NIHSS score was assessed by the Mann-Whitney U test, and predictors for the occurrence of pneumonia were analyzed by multiple logistic regression using semiautomatic backward selection. Significance was set at P less than .05. RESULTS: The relations between laryngeal penetration and the NIHSS score and between laryngotracheal aspiration and the NIHSS score were not statistically significant. The predictors for pneumonia occurrence in the ischemic stroke patients with a clinical diagnosis of dysphagia were age (P = .002; odds ratio [OR], 1.12) and NIHSS score (P = .04; OR, 1.17), whereas laryngeal penetration of liquid (P = .065; OR, 3.70) tended to correlate with pneumonia but not significantly. CONCLUSIONS: There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.

The incidence of dysphagia in patients receiving cerebral reperfusion therapy poststroke.

BACKGROUND: The high prevalence of dysphagia after stroke leads to increased mortality, and cerebral reperfusion therapy has been effective in reducing neurologic deficits. The aim of this study was to investigate the severity and evolution of dysphagia and the occurrence of pneumonia in patients submitted to cerebral reperfusion therapy. METHODS: Seventy ischemic stroke patients were evaluated. Of these, 35 patients (group 1) were submitted to cerebral reperfusion therapy and 35 (group 2) did not receive thrombolytic treatment. The following were evaluated: severity of dysphagia by means of videofluoroscopy, evolution of oral intake rate by means of the Functional Oral Intake Scale, and the occurrence of pneumonia by international protocol. The relation between the severity of dysphagia and the occurrence of pneumonia with the treatment was evaluated through the chi-square test; the daily oral intake rate and its relation to the treatment were assessed by the Mann-Whitney test and considered significant if P is less than .05. RESULTS: The moderate and severe degrees of dysphagia were more frequent (P=.013) among the patients who were not submitted to cerebral reperfusion therapy. The daily oral intake evolved independently of the treatment type, without statistical significance when compared between the groups, whereas pneumonia occurred more frequently in group 2 (28%) in relation to group 1 (11%) and was associated with the worst degrees of dysphagia (P=.045). CONCLUSIONS: We can conclude that there is improvement in the oral intake rate in both groups, with lower severity of dysphagia and occurrence of pneumonia in ischemic stroke patients submitted to cerebral reperfusion therapy.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke.

PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients.

Sour taste and cold temperature in the oral phase of swallowing in patients after stroke / Sabor azedo e temperatura fria na fase oral da deglutição no acidente vascular encefálico

PURPOSE: To determine the effect of sour flavor and cold temperature on oral transit time during swallowing. METHODS: Participants were 52 subjects (28 male and 24 female) with ages between 50 and 80 years (median=66 years), after ischemic stroke involving right or left side damage and mild to moderate oropharyngeal dysphagia. Videofluoroscopy was performed to analyze the swallowing times. Each subject was assessed during swallowing of a paste consistency bolus offered in 5 ml spoons, with a total of four different stimuli (natural, cold, sour and sour-cold). After the exam, the oral transit time was measured using specific software. The oral transit time (starting at the beginning of the bolus movement in the mouth) and the total oral transit time (starting at the moment that the bolus is placed in the mouth) were measured. RESULTS: The association between sour and cold stimuli caused a significant decrease of oral transit time and total oral transit time. CONCLUSION: Sour flavor and cold temperature reduced oral transit time in stroke patients.

OBJETIVO: Verificar o efeito do sabor azedo e da temperatura fria no tempo de trânsito oral da deglutição. MÉTODOS: Participaram deste estudo 52 indivíduos (28 do gênero masculino e 24 do gênero feminino) após acidente vascular encefálico isquêmico, com lesão à direita ou à esquerda e disfagia orofaríngea de grau leve a moderado, com idades variando de 50 a 80 anos (mediana=66 anos). Foi realizada a videofluoroscopia da deglutição para a análise dos tempos de deglutição. Cada indivíduo foi avaliado durante a deglutição de bolo na consistência pastosa, oferecido em colher com 5 ml, com quatro estímulos diferentes (natural, frio, azedo e azedo-frio). Após o exame foram realizadas as medidas de tempo de trânsito oral utilizando software específico. Foram mensurados o tempo de trânsito oral (a partir do início do movimento do bolo alimentar na boca) e o tempo de trânsito oral total (a partir do momento em que o bolo é colocado na boca). RESULTADOS: A associação entre o estímulo azedo e a temperatura fria provocou mudanças significavas no tempo de trânsito oral total e no tempo de trânsito oral, com redução nestes tempos. CONCLUSÃO: O sabor azedo e a temperatura fria associados apresentaram redução do tempo de trânsito oral em pacientes pós acidente vascular encefálico.

Taste and temperature in swallowing transit time after stroke.

BACKGROUND: Oropharyngeal dysphagia is common in individuals after stroke. Taste and temperature are used in dysphagia rehabilitation. The influence of stimuli, such as taste and temperature, on swallowing biomechanics has been investigated in both healthy individuals and in individuals with neurological disease. However, some questions still remain unanswered, such as how the sequence of offered stimuli influences the pharyngeal response. The goal of the present study was to determine the influence of the sequence of stimuli, sour taste and cold temperature, on pharyngeal transit time during deglutition in individuals after stroke. METHODS: The study included 60 individuals with unilateral ischemic stroke, 29 males and 31 females, aged 41-88 years (mean age: 66.2 years) examined 0-50 days after ictus (median: 6 days), with mild to moderate oropharyngeal dysphagia. Exclusion criteria were hemorrhagic stroke patients, patients with decreased level of consciousness, and clinically unstable patients, as confirmed by medical evaluation. The individuals were divided into two groups of 30 individuals each. Group 1 received a nonrandomized sequence of stimuli (i.e. natural, cold, sour, and sour-cold) and group 2 received a randomized sequence of stimuli. A videofluoroscopic swallowing study was performed to analyze the pharyngeal transit time. Four different stimuli (natural, cold, sour, and sour-cold) were offered. The images were digitalized and specific software was used to measure the pharyngeal transit time. Since the values did not present regular distribution and uniform variances, nonparametric tests were performed. RESULTS: Individuals in group 1 presented a significantly shorter pharyngeal transit time with the sour-cold stimulus than with the other stimuli. Individuals in group 2 did not show a significant difference in pharyngeal transit time between stimuli. CONCLUSIONS: The results showed that the sequence of offered stimuli influences the pharyngeal transit time in a different way in individuals after stroke and suggest that, when the sour-cold stimulus is offered in a randomized sequence, it can influence the response to the other stimuli in stroke patients. Hence, the sour-cold stimulus could be used as a therapeutic aid in dysphagic stroke patients.

Components of the acoustic swallowing signal: preliminary study.

PURPOSE: To analyze the components of the acoustic signal of swallowing using a specific software. METHODS: Fourteen healthy subjects ranging in age from 20 to 50 years (mean age 31 ± 10 years), were evaluated. Data collection consisted on the simultaneous capture of the swallowing audio with a microphone and of the swallowing videofluoroscopic image. The bursts of the swallowing acoustic signal were identified and their duration and the interval between them were later analyzed using a specific software, which allowed the simultaneous analyses between the acoustic wave and the videofluoroscopic image. RESULTS: Three burst components were identified in most of the swallows evaluated. The first burst presented mean time of 87.3 milliseconds (ms) for water and 78.2 for the substance. The second burst presented mean time of 112.9 ms for water and 85.5 for the pasty substance. The mean interval between first and second burst was 82.1 ms for water and 95.3 ms for the pasty consistency, and between second and third burst was 339.8 ms for water and 322.0 ms for the pasty consistency. CONCLUSION: The software allowed the visualization of three bursts during the swallowing of healthy individuals, and showed that the swallowing signal in normal subjects is highly variable.

Estudo multicêntrico sobre escalas para grau de comprometimento em disfagia orofaríngea neurogênica / Multicenter study about severity scales of neurogenic oropharyngeal dysphagia

OBJETIVO: Analisar a concordância entre distintas escalas para grau de comprometimento em disfagia orofaríngea neurogênica. MÉTODOS: Foi realizado estudo clínico transversal. Participaram 200 indivíduos com disfagia orofaríngea neurogênica, 108 do gênero masculino e 92 do gênero feminino, com idades de 3 meses a 91 anos. Foram aplicadas quatro escalas para classificar o grau de comprometimento da disfagia orofaríngea, sendo duas escalas clínicas e duas videofluoroscópicas. Análises estatísticas foram realizadas para verificar a concordância entre as escalas clínicas e objetivas. RESULTADOS: Os resultados mostraram concordância muito boa entre as escalas clínicas estudadas (Kappa=0,92) e concordância moderada entre as escalas objetivas (Kappa=0,52). CONCLUSÃO: Embora a concordância entre as escalas clínicas tenha sido muito boa e entre as escalas objetivas tenha sido moderada, ainda é necessária ampla discussão e possível revisão dos parâmetros que definem o grau de comprometimento da disfagia orofaríngea em pacientes neurológicos.

PURPOSE: To analyze the agreement among different severity scales for neurogenic oropharyngeal dysphagia. METHODS: A clinical cross-sectional study was conducted. Participants were 200 individuals (108 male, 92 female) with neurogenic oropharyngeal dysphagia, aged between three months and 91 years. Four severity scales were applied to classify the oropharyngeal dysphagia: two clinical scales and two videofluoroscopic scales. Statistical analysis were conducted to verify the agreement between clinical and objective scales. RESULTS: Results showed very good agreement between the clinical scales (kappa=0.92) and moderate agreement between the objective scales (kappa=0.52). CONCLUSION: Although the agreement between the clinical scales was very good and between the objective scales was moderate, further discussion and possible revision of the parameters that define the severity of oropharyngeal dysphagia in neurological patients are required.