Post-COVID-19 cognitive symptoms in patients assisted by a teleassistance service: a retrospective cohort study.

Introduction: Four years after the onset of the COVID-19 pandemic, the frequency of long-term post-COVID-19 cognitive symptoms is a matter of concern given the impact it may have on the work and quality of life of affected people. Objective: To evaluate the incidence of post-acute COVID-19 cognitive symptoms, as well as the associated risk factors. Methods: Retrospective cohort, including outpatients with laboratory-confirmed COVID-19 and who were assisted by a public telehealth service provided by the Telehealth Network of Minas Gerais (TNMG), during the acute phase of the disease, between December/2020 and March/2022. Data were collected through a structured questionnaire, applied via phone calls, regarding the persistence of COVID-19 symptoms after 12 weeks of the disease. Cognitive symptoms were defined as any of the following: memory loss, problems concentrating, word finding difficulties, and difficulty thinking clearly. Results: From 630 patients who responded to the questionnaire, 23.7% presented cognitive symptoms at 12 weeks after infection. These patients had a higher median age (33 [IQR 25-46] vs. 30 [IQR 24-42] years-old, p = 0.042) with a higher prevalence in the female sex (80.5% vs. 62.2%, p < 0.001) when compared to those who did not present cognitive symptoms, as well as a lower prevalence of smoking (8.7% vs. 16.2%, p = 0.024). Furthermore, patients with persistent cognitive symptoms were more likely to have been infected during the second wave of COVID-19 rather than the third (31.0% vs. 21.3%, p = 0.014). Patients who needed to seek in-person care during the acute phase of the disease were more likely to report post-acute cognitive symptoms (21.5% vs. 9.3%, p < 0,001). In multivariate logistic regression analysis, cognitive symptoms were associated with female sex (OR 2.24, CI 95% 1.41-3.57), fatigue (OR 2.33, CI 95% 1.19-4.56), depression (OR 5.37, CI 95% 2.19-13.15) and the need for seek in-person care during acute COVID-19 (OR 2.23, CI 95% 1.30-3.81). Conclusion: In this retrospective cohort of patients with mostly mild COVID-19, cognitive symptoms were present in 23.7% of patients with COVID-19 at 12 weeks after infection. Female sex, fatigue, depression and the need to seek in-person care during acute COVID-19 were the risk factors independently associated with this condition.

Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education / Queixa de memória na comunidade em um país de renda média: um estudo longitudinal de quatro anos em uma coorte de baixa escolaridade

Abstract Background Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. Objective To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. Methods Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. Results The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. Conclusion Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.

Resumo Antecedentes Queixas de memória são frequentes em idosos e estão associadas ao maior risco de declínio cognitivo. Objetivo Investigar o desfecho funcional de indivíduos com queixas de memória acompanhados em centros atenção primária. Métodos Os dados foram coletados entre 2016 e 2020 em centros de atenção primária à saúde no Brasil. Os pacientes foram submetidos à Bateria Cognitiva Breve e ao Questionário de Atividades Funcionais. Resultados A amostra inicial (2016) foi composta por 91 indivíduos, classificados como tendo declínio cognitivo subjetivo (DCS, n = 15), comprometimento cognitivo leve (CCL, n = 45), ou demência (n = 31). Durante o seguimento, 8 indivíduos (8,8% da amostra inicial) faleceram e 26 (28,5% da amostra inicial) não foram encontrados. Cinquenta e sete participantes foram submetidos à reavaliação clínica. Dos 15 indivíduos com DCS, 7 não foram encontrados (46,7%), 4 (26,7%) declinaram para CCL e 4 (26,7%) permaneceram estáveis. Dos 45 indivíduos com CCL, 11 não foram encontrados (24,4%), 2 (4,4%) morreram, 6 (13,4%) declinaram para demência, 12 (26,7%) evoluíram para DCS e 14 (31,1%) permaneceram estáveis. Dos 31 indivíduos com demência, 8 não foram encontrados, (25,8%), 6 (19,4%) morreram, 2 (6,5%) evoluíram para DCS e 7 (22,6%) para CCL; e 8 permaneceram estáveis (25,8%). A melhora clínica deveu-se ao tratamento de causas reversíveis, como hipovitaminose B12 e transtornos de humor. A idade avançada, a baixa pontuação no Mini-Exame do Estado Mental e os escores de queixa de memória mais altos, mas não o uso de benzodiazepínicos e inibidores da bomba de prótons, foram preditores de declínio funcional. Conclusão Apesar de suas limitações (amostra pequena, dados ausentes), esses resultados corroboram que a triagem adequada, o acompanhamento e o tratamento de causas reversíveis de demência na atenção primária são essenciais.

Bacopa monnieri in Patients with Parkinson's Disease: A Pilot Study.

Bacopa monnieri (L.) Wettst. could be of interest in the control of symptoms of Parkinson's disease, but clinical evidence of its efficacy is lacking. This clinical trial assessed the effects of an extract of B. monnieri on parameters that are related to Parkinson's diseases. Twenty volunteers with Parkinson's disease were recruited for a primary, interventional, controlled, parallel, double-blind clinical study. The volunteers were assigned to treatment with either a commercial B. monnieri extract (225 or 450 mg/day) or placebo. The Parkinson's Disease Quality-of-Life (PDQL) questionnaire was applied, and motor activity was assessed before treatment and 30, 60, and 90 days after treatment with the B. monnieri extract or placebo. Characteristics such as age, body weight, and height were also collected. No differences in parkinsonian and systemic symptoms, emotional function, or social function were observed between. The delta percent (Δ%) showed time-dependent improvements in emotional function with B. monnieri treatment at the daily dose of 450 mg. A strong correlation was found between quality of life and motor outcomes at baseline and 30 days of treatment with B. monnieri, and a moderate correlation for 60 and 90 days of treatment with B. monnieri when compared with baseline time. A moderate correlation was found between motor outcomes and Hoehn and Yahr stages at baseline. Our results suggest that B. monnieri extract can improve emotional function in Parkinson's disease patients, but further clinical trials are needed to confirm this possibility.

Long-lasting brain fog is related with severity clusters of symptoms in COVID-19 patients

BACKGROUND: COVID-19 patients may experience Long-lasting symptoms from weeks to even months. AIM: To evaluate long-term cognitive impairment based on the severity of symptoms of COVID-19 infection in a primary health system setting. Material and Methods: From a database of 363 patients, 83 cases aged 47 ± 15 years, (58% females) were selected from June to August 2020. In patients who survived the virus, 24 infection-related symptoms were collected to create three severity clusters (mild, moderate, and severe). The follow-up time was at least seven months. Comparing the first two clusters with the severe cluster, the existence of brain fog and risk factors (obesity, hypertension, diabetes, chronic lung disease, and hypothyroidism) were analyzed. RESULTS: Thirty-one patients (37%) had persistent symptoms lasting up to 240 days. Fifty-one patients (61%) experienced brain fog. Concentration was affected by symptom severity (odds ratio [OR] 3.63, 95% confidence interval [CI] 1.26-10.46, p = 0.02). Short- or long-term memory loss was not affected. Moreover, symptom severity was related to brain fog (OR 3.16, 95% CI 1.05-9.51, p = 0.04). Patients with persistent symptoms had a concentration impairment associated with severity patterns (OR 24.3, 95% CI 1.73-340.11, p = 0.03). Conclusions: Brain fog is associated with symptom severity in COVID-19 survivors and lasts for more than eight months.

ANTECEDENTES: Los pacientes que han tenido COVID-19 pueden experimentar síntomas persistentes que duran semanas a meses. OBJETIVO: Evaluar el deterioro cognitivo a largo plazo en función de la severidad de los síntomas de la infección por COVID-19, en un escenario de sistema primario de salud. Material y Métodos: De una base de datos de 363 pacientes se seleccionaron 83 casos de 47 ± 15 años (58% mujeres), de junio-agosto de 2020. Se recopilaron 24 síntomas relacionados con la infección, creando tres grupos (leve, moderado y severo), en pacientes que padecieron y sobreviven al virus. El tiempo de seguimiento fue de al menos siete meses. La existencia de niebla cerebral y de factores de riesgo (obesidad, hipertensión, diabetes, enfermedad pulmonar crónica e hipotiroidismo) se comparó los dos grupos de severidad más bajos con el nivel superior. RESULTADOS: Treinta y un pacientes (37%) tuvieron síntomas prolongados con una duración de hasta 240 días. Cincuenta y un pacientes (61%) mostraron niebla cerebral. El deterioro de la concentración fue afectado por la severidad (Razón de riesgo (RR) = 3,63, Intervalos de confianza (IC) 95%: 1,26-10,46, p = 0,02). La pérdida de memoria a corto o largo plazo no fue afectada. El grupo con mayor severidad se asoció a niebla cerebral (RR = 3,16, IC95%: 1,05-9,51, p = 0,04). Los portadores de síntomas prolongados tuvieron una alteración de la concentración asociado a severidad (RR: 3,16, IC95%: 1,05-9,51, p= 0,04). Conclusiones: La niebla cerebral está relacionada con la severidad de los síntomas en supervivientes de COVID-19 permaneciendo por más de ocho meses.

Unusual complication of Herpes simplex encephalitis: complete Klüver-Bucy syndrome.

Klüver-Bucy syndrome is a rare neurobehavioral disorder caused by a bilateral temporal lobe lesion affecting the hippocampus and amygdala; clinically characterised by hyperorality, hypermetamorphosis, placidity, altered sexual behaviour, eating, disorders and visual impairment, agnosia and amnesia. However, the complete syndrome is rarely seen, and diagnosis does not require all the symptoms to be manifested simultaneously.We describe a patient who developed a complete Klüver-Bucy syndrome secondary to bilateral temporal involvement due to herpetic encephalitis.

Subjective Cognitive Decline and its Relation to Verbal Memory and Sex in Cognitively Unimpaired Individuals from a Colombian Cohort with Autosomal-Dominant Alzheimer's Disease.

OBJECTIVE: Subjective Cognitive Decline (SCD) may be an early indicator of risk for Alzheimer's disease (AD). Findings regarding sex differences in SCD are inconsistent. Studying sex differences in SCD within cognitively unimpaired individuals with autosomal-dominant AD (ADAD), who will develop dementia, may inform sex-related SCD variations in preclinical AD. We examined sex differences in SCD within cognitively unimpaired mutation carriers from the world's largest ADAD kindred and sex differences in the relationship between SCD and memory performance. METHODS: We included 310 cognitively unimpaired Presenilin-1 (PSEN-1) E280A mutation carriers (51% females) and 1998 noncarrier family members (56% females) in the study. Subjects and their study partners completed SCD questionnaires and the CERAD word list delayed recall test. ANCOVAs were conducted to examine group differences in SCD, sex, and memory performance. In carriers, partial correlations were used to examine associations between SCD and memory performance covarying for education. RESULTS: Females in both groups had greater self-reported and study partner-reported SCD than males (all p < 0.001). In female mutation carriers, greater self-reported (p = 0.02) and study partner-reported SCD (p < 0.001) were associated with worse verbal memory. In male mutation carriers, greater self-reported (p = 0.03), but not study partner-reported SCD (p = 0.11) was associated with worse verbal memory. CONCLUSIONS: Study partner-reported SCD may be a stronger indicator of memory decline in females versus males in individuals at risk for developing dementia. Future studies with independent samples and preclinical trials should consider sex differences when recruiting based on SCD criteria.

Depressive symptoms may be associated with semantic memory decline in elderly adults.

Depressive symptoms are associated with a decline of episodic memory, but the relationship with semantic memory remains unclear. OBJECTIVE: The aim of the study was to analyze the relationship of depressive symptoms with the semantic memory in a community-based sample of elderly adults. The sample comprised two groups, namely, clinical (with depressive symptoms) and control. METHODS: The following instruments were used General Evaluation Questionnaire, Montreal Cognitive Assessment-Basic, Wechsler Abbreviate Scale of Intelligence, Geriatric Depression Scale-30 (GDS-30), Beck Depression Inventory-II, Boston Nomination Test (BNT), vocabulary, verbal fluency test (fruits and animals), and Brief Cognitive Screening Battery. RESULTS: The results showed a significant difference between groups only in BNT. A significant correlation was observed between the BNT and GDS-30. Participants with symptoms of severe depression performed poorly on BNT when compared with individuals with mild symptoms. CONCLUSION: These results support the hypothesis that depressive symptoms in elderly adults can affect semantic memory and may worsen with the severity of symptoms.

Sintomas depressivos estão associados ao declínio da memória episódica, mas sua relação com a memória semântica permanece obscura. OBJETIVO: O objetivo deste estudo foi analisar a relação dos sintomas depressivos à memória semântica em idosos que vivem na comunidade. A amostra foi composta de dois grupos: clínico (com sintomas depressivos) e controle. MÉTODO: Foram utilizados os seguintes instrumentos: Questionário de Avaliação Geral, Montreal Cognitive Assessment-Basic (MoCA-B), Wechsler Abbreviate Scale of Intelligence (WASI), Geriatric Depression Scale-30 (GDS-30), Beck Depression Inventory-II (BDI-II), Teste de Nomeação de Boston (TNB), Vocabulário, Fluência Verbal (Frutas e Animais) e Bateria Breve de Rastreio Cognitivo. RESULTADOS: Os resultados evidenciaram diferença significativa entre os grupos apenas no BNT. Foi observada uma correlação significativa entre TNB e GDS-30. Os participantes com sintomas de depressão grave tiveram um desempenho pior no BNT, quando comparados aos indivíduos com sintomas leves. CONCLUSÃO: Esses resultados apoiam a hipótese de que os sintomas depressivos em idosos podem afetar a memória semântica e aumentam com a gravidade dos sintomas.

Depressive symptoms may be associated with semantic memory decline in elderly adults / Sintomas depressivos podem estar associados a declínio na memória semântica em idosos

ABSTRACT Depressive symptoms are associated with a decline of episodic memory, but the relationship with semantic memory remains unclear. Objective: The aim of the study was to analyze the relationship of depressive symptoms with the semantic memory in a community-based sample of elderly adults. The sample comprised two groups, namely, clinical (with depressive symptoms) and control. Methods: The following instruments were used General Evaluation Questionnaire, Montreal Cognitive Assessment-Basic, Wechsler Abbreviate Scale of Intelligence, Geriatric Depression Scale-30 (GDS-30), Beck Depression Inventory-II, Boston Nomination Test (BNT), vocabulary, verbal fluency test (fruits and animals), and Brief Cognitive Screening Battery. Results: The results showed a significant difference between groups only in BNT. A significant correlation was observed between the BNT and GDS-30. Participants with symptoms of severe depression performed poorly on BNT when compared with individuals with mild symptoms. Conclusion: These results support the hypothesis that depressive symptoms in elderly adults can affect semantic memory and may worsen with the severity of symptoms.

RESUMO Sintomas depressivos estão associados ao declínio da memória episódica, mas sua relação com a memória semântica permanece obscura. Objetivo: O objetivo deste estudo foi analisar a relação dos sintomas depressivos à memória semântica em idosos que vivem na comunidade. A amostra foi composta de dois grupos: clínico (com sintomas depressivos) e controle. Método: Foram utilizados os seguintes instrumentos: Questionário de Avaliação Geral, Montreal Cognitive Assessment-Basic (MoCA-B), Wechsler Abbreviate Scale of Intelligence (WASI), Geriatric Depression Scale-30 (GDS-30), Beck Depression Inventory-II (BDI-II), Teste de Nomeação de Boston (TNB), Vocabulário, Fluência Verbal (Frutas e Animais) e Bateria Breve de Rastreio Cognitivo. Resultados: Os resultados evidenciaram diferença significativa entre os grupos apenas no BNT. Foi observada uma correlação significativa entre TNB e GDS-30. Os participantes com sintomas de depressão grave tiveram um desempenho pior no BNT, quando comparados aos indivíduos com sintomas leves. Conclusão: Esses resultados apoiam a hipótese de que os sintomas depressivos em idosos podem afetar a memória semântica e aumentam com a gravidade dos sintomas.

Common symptoms of Alzheimer's dementia that are easily recognizable by families.

The increase in dementia incidence among the elderly is directly related to aging, which is associated with changes in bodily functions and other health-related risk factors. Alzheimer's dementia is the most prevalent form of dementia, and individuals in the late stages are predominantly dependent on other family members. Therefore, it is important for families, as the closest support group, to recognize common symptoms early. OBJECTIVE: To provide a family-friendly guide to the ten common symptoms of Alzheimer's dementia. METHODS: This is a descriptive survey-based research that included 354 families comprising elderly people (≥60 years) residing in Jakarta. The instrument aimed at identifying ten common Alzheimer's dementia symptoms in Indonesia. Descriptive statistical analysis based on frequency tables was used. RESULTS: The participant's major characteristics were age ≥66 years (52.3%), female sex (70.3%) and primary school education (87.3%). The predominant symptoms experienced by 42.4% of the elderly included forgetting recent events and asking questions and narrating a particular detail repeatedly. The remaining 35.6% demonstrated signs of forgetting where an item was placed and frequently suspecting others of theft and concealment of personal items. CONCLUSION: The symptoms of frequently forgetting new events and the location of personal belongings are of particular concern for families, as they have a propensity to progress and interfere with daily activities. Therefore, the families of affected individuals are expected to identify this symptom early on and present the affected individual for screening or examination at a health care facility.

O aumento da incidência de demência entre os idosos está diretamente relacionado ao envelhecimento, que está associado a alterações nas funções corporais e outros fatores de risco relacionados à saúde. A demência de Alzheimer é a forma mais prevalente de demência e os indivíduos nos estágios avançados são predominantemente dependentes de outros membros da família. Portanto, é importante que as famílias, como grupo de apoio mais próximo, reconheçam os sintomas comuns precocemente. OBJETIVO: fornecer um guia familiar para os dez sintomas comuns da demência de Alzheimer. Métodos: Trata-se de uma pesquisa descritiva de base survey que incluiu 354 famílias compostas por idosos (≥60 anos) residentes em Jacarta. O instrumento teve como objetivo identificar dez sintomas comuns de demência de Alzheimer na Indonésia. Foi utilizada análise estatística descritiva baseada em tabelas de frequência. RESULTADOS: As principais características do participante foram idade ≥ 66 anos (52,3%), sexo feminino (70,3%) e escolaridade primária (87,3%). Os sintomas predominantes vivenciados por 42,4% dos idosos incluem o esquecimento de acontecimentos recentes, fazer perguntas e narrar um determinado detalhe repetidamente. Os 35,6% restantes demonstraram sinais de esquecimento de onde um item foi colocado e frequentemente suspeitam de furto e ocultação de itens pessoais. CONCLUSÃO: Os sintomas de esquecimento frequente de novos eventos e da localização de objetos pessoais são de particular preocupação para as famílias, visto que apresentam tendência para progredir e interferir nas atividades diárias. Portanto, espera-se que as famílias dos indivíduos afetados identifiquem esse sintoma logo no início e apresentem o indivíduo afetado para triagem ou exame em uma unidade de saúde.

Comparison of screening tests in the evaluation of cognitive status of patients with epilepsy.

Epilepsy, a chronic neurological condition which is associated with neurobiological and psychosocial changes, affects 0.5 to 1% of the world's population, presenting in most cases a deficit in reasoning, memory and attention. OBJECTIVE: To contribute to the implementation of screening strategies for cognitive decline and memory deficits in patients with epilepsy. METHODS: Two questionnaires, MMSE and MoCA, were used in this cross-sectional and observational study. Fifty-four patients diagnosed with different types of epilepsy (55% refractory) were assessed; they were all over 18 years old, of both genders, with autonomy to answer the questionnaire. They were followed exclusively at an outpatient clinic of the Neurology Service Department, specialized in epilepsy, which is part of the tertiary healthcare level of the Brazilian Unified Health System (SUS). RESULTS: The final sample consisted of 54 patients. There was a significant correlation (p<0.001) between the scores of both tests, indicating that low values in the MMSE score also corresponded to low values in the MoCA score. Sensitivity was 90% (ROC curve adjusted) and 87.5% of the patients with a normal score in the MMSE test obtained alterations in the MoCA scores. None of them showed a low MMSE score with a normal MOCA score. The Spearman correlation coefficient was 0.80. Also, there was a significant relationship between both immediate memory and delayed recall memory and the type of seizure (p<0.03) and level of schooling (p<0.001), respectively. CONCLUSION: The MoCA is a well-suited test to be performed in epilepsy patients to evaluate their cognition as it seems more extensive and complete compared to MMSE.

A epilepsia, condição neurológica crônica associada a alterações neurobiológicas e psicossociais, afeta de 0,5 a 1% da população mundial. Na maior parte dos casos, há redução de raciocínio, memória e atenção. OBJETIVOS: Contribuir para a implementação de estratégias de rastreio de declínio cognitivo e distúrbios na memória nos pacientes com epilepsia. MÉTODOS: Estudo transversal observacional de 54 pacientes diagnosticados com epilepsia de diversos tipos (55% refratários) e com idade superior a 18 anos, de ambos os sexos, com autonomia para responder o questionário e em acompanhamento exclusivamente pelo Sistema Único de Saúde (SUS) em um ambulatório especializado em epilepsia, do serviço de neurologia, que faz parte do nível terciário de atenção à saúde. Foram aplicados dois questionários: o MEEM e o MoCA. RESULTADOS: Amostra final de 54 pacientes. Encontrou-se uma correlação significativa (p<0,001) entre os escores dos dois testes, o que significa que valores baixos do escore MEEM correspondem a valores baixos do escore MoCA. Sensibilidade de 90% (curva ROC ajustada). Verificou-se que dentre os pacientes considerados normais no MEEM, 87,5% deles obtiveram escore com alterações por meio do teste de rastreio MoCA. Não se obteve nenhum caso de escore no MEEM baixo com pontuação no MoCA normal. O coeficiente de correlação Spearman foi 0,80. Há relação significativa da memória imediata e evocação tardia com o tipo de crise (p<0,03) e escolaridade (p<0,001), respectivamente. CONCLUSÃO: Torna-se pertinente a adição do teste MoCA para rastreio cognitivo em pacientes com epilepsia por ser um instrumento mais extenso e preciso, minimizando as chances de "falsos-negativos" quando comparado ao MEEM.

Common symptoms of Alzheimer's dementia that are easily recognizable by families / Sintomas comuns da demência de Alzheimer facilmente reconhecíveis pelas famílias

ABSTRACT. The increase in dementia incidence among the elderly is directly related to aging, which is associated with changes in bodily functions and other health-related risk factors. Alzheimer's dementia is the most prevalent form of dementia, and individuals in the late stages are predominantly dependent on other family members. Therefore, it is important for families, as the closest support group, to recognize common symptoms early. Objective: To provide a family-friendly guide to the ten common symptoms of Alzheimer's dementia. Methods: This is a descriptive survey-based research that included 354 families comprising elderly people (≥60 years) residing in Jakarta. The instrument aimed at identifying ten common Alzheimer's dementia symptoms in Indonesia. Descriptive statistical analysis based on frequency tables was used. Results: The participant's major characteristics were age ≥66 years (52.3%), female sex (70.3%) and primary school education (87.3%). The predominant symptoms experienced by 42.4% of the elderly included forgetting recent events and asking questions and narrating a particular detail repeatedly. The remaining 35.6% demonstrated signs of forgetting where an item was placed and frequently suspecting others of theft and concealment of personal items. Conclusion: The symptoms of frequently forgetting new events and the location of personal belongings are of particular concern for families, as they have a propensity to progress and interfere with daily activities. Therefore, the families of affected individuals are expected to identify this symptom early on and present the affected individual for screening or examination at a health care facility.

RESUMO. O aumento da incidência de demência entre os idosos está diretamente relacionado ao envelhecimento, que está associado a alterações nas funções corporais e outros fatores de risco relacionados à saúde. A demência de Alzheimer é a forma mais prevalente de demência e os indivíduos nos estágios avançados são predominantemente dependentes de outros membros da família. Portanto, é importante que as famílias, como grupo de apoio mais próximo, reconheçam os sintomas comuns precocemente. Objetivo: fornecer um guia familiar para os dez sintomas comuns da demência de Alzheimer. Métodos: Trata-se de uma pesquisa descritiva de base survey que incluiu 354 famílias compostas por idosos (≥60 anos) residentes em Jacarta. O instrumento teve como objetivo identificar dez sintomas comuns de demência de Alzheimer na Indonésia. Foi utilizada análise estatística descritiva baseada em tabelas de frequência. Resultados: As principais características do participante foram idade ≥ 66 anos (52,3%), sexo feminino (70,3%) e escolaridade primária (87,3%). Os sintomas predominantes vivenciados por 42,4% dos idosos incluem o esquecimento de acontecimentos recentes, fazer perguntas e narrar um determinado detalhe repetidamente. Os 35,6% restantes demonstraram sinais de esquecimento de onde um item foi colocado e frequentemente suspeitam de furto e ocultação de itens pessoais. Conclusão: Os sintomas de esquecimento frequente de novos eventos e da localização de objetos pessoais são de particular preocupação para as famílias, visto que apresentam tendência para progredir e interferir nas atividades diárias. Portanto, espera-se que as famílias dos indivíduos afetados identifiquem esse sintoma logo no início e apresentem o indivíduo afetado para triagem ou exame em uma unidade de saúde.

Comparison of screening tests in the evaluation of cognitive status of patients with epilepsy / Comparação de testes rastreio na avaliação do estado cognitivo em pacientes com epilepsia

ABSTRACT. Epilepsy, a chronic neurological condition which is associated with neurobiological and psychosocial changes, affects 0.5 to 1% of the world's population, presenting in most cases a deficit in reasoning, memory and attention. Objective: To contribute to the implementation of screening strategies for cognitive decline and memory deficits in patients with epilepsy. Methods: Two questionnaires, MMSE and MoCA, were used in this cross-sectional and observational study. Fifty-four patients diagnosed with different types of epilepsy (55% refractory) were assessed; they were all over 18 years old, of both genders, with autonomy to answer the questionnaire. They were followed exclusively at an outpatient clinic of the Neurology Service Department, specialized in epilepsy, which is part of the tertiary healthcare level of the Brazilian Unified Health System (SUS). Results: The final sample consisted of 54 patients. There was a significant correlation (p<0.001) between the scores of both tests, indicating that low values in the MMSE score also corresponded to low values in the MoCA score. Sensitivity was 90% (ROC curve adjusted) and 87.5% of the patients with a normal score in the MMSE test obtained alterations in the MoCA scores. None of them showed a low MMSE score with a normal MOCA score. The Spearman correlation coefficient was 0.80. Also, there was a significant relationship between both immediate memory and delayed recall memory and the type of seizure (p<0.03) and level of schooling (p<0.001), respectively. Conclusion: The MoCA is a well-suited test to be performed in epilepsy patients to evaluate their cognition as it seems more extensive and complete compared to MMSE.

RESUMO. A epilepsia, condição neurológica crônica associada a alterações neurobiológicas e psicossociais, afeta de 0,5 a 1% da população mundial. Na maior parte dos casos, há redução de raciocínio, memória e atenção. Objetivos: Contribuir para a implementação de estratégias de rastreio de declínio cognitivo e distúrbios na memória nos pacientes com epilepsia. Métodos: Estudo transversal observacional de 54 pacientes diagnosticados com epilepsia de diversos tipos (55% refratários) e com idade superior a 18 anos, de ambos os sexos, com autonomia para responder o questionário e em acompanhamento exclusivamente pelo Sistema Único de Saúde (SUS) em um ambulatório especializado em epilepsia, do serviço de neurologia, que faz parte do nível terciário de atenção à saúde. Foram aplicados dois questionários: o MEEM e o MoCA. Resultados: Amostra final de 54 pacientes. Encontrou-se uma correlação significativa (p<0,001) entre os escores dos dois testes, o que significa que valores baixos do escore MEEM correspondem a valores baixos do escore MoCA. Sensibilidade de 90% (curva ROC ajustada). Verificou-se que dentre os pacientes considerados normais no MEEM, 87,5% deles obtiveram escore com alterações por meio do teste de rastreio MoCA. Não se obteve nenhum caso de escore no MEEM baixo com pontuação no MoCA normal. O coeficiente de correlação Spearman foi 0,80. Há relação significativa da memória imediata e evocação tardia com o tipo de crise (p<0,03) e escolaridade (p<0,001), respectivamente. Conclusão: Torna-se pertinente a adição do teste MoCA para rastreio cognitivo em pacientes com epilepsia por ser um instrumento mais extenso e preciso, minimizando as chances de "falsos-negativos" quando comparado ao MEEM.

Nursing diagnoses of impaired memory and chronic confusion for older adults: diagnostic content validation / Diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos: validação de conteúdo diagnóstico / Diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores: validación del contenido diagnóstico

ABSTRACT Objective: To validate the defining characteristics of the nursing diagnoses, impaired memory and chronic confusion for older adults, by testing diagnostic concept definitions among expert nurses. Methods: We used a Diagnostic content validation using an online survey of expert clinical nurses. Results: 195 expert nurses performed the diagnostic validations. Findings provided validity of impaired memory with 11 major defining characteristics and chronic confusion, with 11 major and one minor defining characteristics. In both diagnoses, content validity index was 0.85. Factor analysis provided four and five supported factors for impaired memory and chronic confusion, respectively. Conclusion: The study provided evidence of validity of the two diagnoses and made them clearer. Using these updated nursing diagnoses, nurses have the potential to improve accuracy and quality of care for elderly patients, contributing to more accurate nursing gerontological care.

RESUMO Objetivo: Validar as características definidoras dos diagnósticos de enfermagem memória prejudicada e confusão crônica para idosos, testando as definições dos diagnósticos entre enfermeiros especialistas. Método: Validação de conteúdo diagnóstico utilizando um questionário online para enfermeiros clínicos especialistas. Resultados: 195 enfermeiras especialistas realizaram as validações diagnósticas. Os resultados demonstraram a validade de memória prejudicada com 11 características definidoras principais, e confusão crônica com 11 características definidoras principais e uma secundária. Em ambos os diagnósticos, o índice de validade de conteúdo foi de 0,85. A análise fatorial forneceu quatro para memória prejudicada e cinco fatores para confusão crônica. Conclusão: O estudo forneceu evidências de validade dos dois diagnósticos, tornando-os mais claros. Por meio do uso desses diagnósticos de enfermagem atualizados, os enfermeiros podem melhorar a precisão e a qualidade do atendimento a pacientes idosos, contribuindo para um cuidado gerontológico de enfermagem mais preciso.

RESUMEN Objetivo: Validar las características que definen los diagnósticos de enfermería memoria deteriorada y confusión crónica en adultos mayores, testeando las definiciones de los diagnósticos entre enfermeros especialistas. Método: Se trata de una validación del contenido diagnóstico realizado mediante un cuestionario en línea para enfermeros clínicos especialistas. Resultados: Las validaciones de diagnóstico las llevaron a cabo 195 enfermeras especialistas. Los resultados demostraron la validez del deterioro de la memoria con 11 características principales definidoras y la confusión crónica, con 11 principales definidoras y una secundaria. En ambos diagnósticos, la tasa de validez del contenido fue de 0,85. El análisis factorial proporcionó cuatro factores para el deterioro de la memoria y cinco para la confusión crónica. Conclusión: El estudio trajo evidencias de la validez de los dos diagnósticos y los dejó más claros. Al valerse de estos diagnósticos actualizados, los enfermeros pueden mejorar la precisión y la calidad de la atención de los pacientes adultos mayores y contribuir aún más con el cuidado gerontológico de enfermería.

Memory impairments and increased GFAP expression in hippocampal astrocytes following hypercaloric diet in rats / Prejuízos de memória e expressão aumentada de GFAP em astrócitos hipocampais após dieta hipercalórica em ratos

ABSTRACT Objective: Hypothalamic inflammation and glial fibrillary acidic protein (GFAP) overexpression in astrocytes are well described in obese animals, as are some cognitive and memory deficits. As the hippocampus plays important roles in the consolidation of information, this investigation aimed to observe the memory function and the astrocyte expression of GFAP in the hippocampus of rats that received either a hypercaloric or a normocaloric diet. Methods: Adult male Wistar rats received a high-fat (cafeteria) or a standard diet for 60 days. On the 61st day, the rats were submitted to the novel object recognition (NOR) test at three and 24 hours after the first contact with objects, to assess short-term and long-term memory, respectively. Thereafter, the rats were euthanized and their brains were collected for GFAP immunohistochemical investigation in the hippocampus (CA1, CA2, CA3 areas) and hypothalamus (periventricular and arcuate nuclei). Astrocytic reactivity was assessed by morphometry. Different white adipose tissue depots and brown adipose tissue were weighed to calculate the adiposity index. Results: The hypercaloric diet increased body weight gain, adiposity index, white adipose tissue weight (epididymal, subcutaneous and retroperitoneal) and brown adipose tissue weight. Rats fed with the hypercaloric diet showed short-term and long-term memory impairments in the NOR test, as well as increased GFAP expression in astrocytes from all analyzed hypothalamic and hippocampal areas. Conclusion: This astrogliosis suggests that the neuroinflammatory response also occurs in the hippocampus and may be involved in the memory losses observed in obese/overweight animals.

RESUMO Objetivo: A inflamação hipotalâmica e a superexpressão da proteína glial fibrilar ácida (GFAP) em astrócitos são bem descritas em animais obesos, assim como déficits cognitivos e de memória. Como o hipocampo desempenha importante papel na consolidação de informações, esta investigação teve como objetivo observar a função da memória e a expressão astrocitária da GFAP no hipocampo de ratos que receberam dieta hipercalórica ou normocalórica. Métodos: Ratos Wistar machos adultos receberam dieta rica em gordura (cafeteria) ou dieta padrão por 60 dias. No 61º dia, os ratos foram submetidos ao teste de reconhecimento de objetos (NOR) 3 e 24 horas após o primeiro contato com os objetos, para avaliação da memória de curto e de longo prazo, respectivamente. Após, os ratos foram eutanasiados e os encéfalos coletados para pesquisa imuno-histoquímica da expressão astrocitária de GFAP no hipocampo (áreas CA1, CA2 e CA3) e no hipotálamo (núcleos periventricular e arqueado). A reatividade astrocitária foi avaliada por morfometria. Diferentes depósitos de tecido adiposo branco e marrom foram pesados para calcular o índice de adiposidade. Resultados: A dieta hipercalórica aumentou o ganho de peso corporal, o índice de adiposidade, o peso do tecido adiposo branco (epididimal, subcutâneo e retroperitoneal) e marrom. Ratos alimentados com dieta hipercalórica apresentaram prejuízos na memória de curto e longo prazo no teste NOR e aumento da expressão de GFAP em astrócitos de todas as áreas hipotalâmicas e hipocampais analisadas. Conclusão: Esta astrogliose sugere que a resposta neuroinflamatória também ocorre no hipocampo, podendo estar envolvida nas perdas de memória observadas em animais obesos/com sobrepeso.

Avaliação da satisfação e das preferências do doente com o diário em cuidados intensivos / Assessment of patient satisfaction and preferences with an intensive care diary

RESUMO Objetivos: Avaliar a satisfação dos doentes internados em uma unidade de cuidado intensivo com o diário e analisar possíveis pontos de melhoria deste instrumento. Métodos: Estudo retrospectivo observacional, decorrido entre março de 2014 e julho de 2017, em uma unidade de cuidado intensivo polivalente de um hospital distrital. Foi iniciado o diário em doentes sedados por 3 ou mais dias. Depois de 3 meses da alta, foi avaliada a satisfação deles por meio de um questionário. O doente que concordou com as cinco afirmações que visavam avaliar esclarecimento, preenchimento de lacunas de memória, ajuda na recuperação, tranquilização e recomendação da intervenção foi definido como satisfeito. Resultados: Foram incluídos 110 doentes, dos quais 55 responderam o questionário. Destes, 36 (65,5%) foram classificados como satisfeitos. Cada item teve uma resposta positiva em mais de 74% dos casos. Sugeriram o aumento do número de fotografias 60% dos participantes. Não foram encontradas diferenças estatisticamente significativas na análise de subgrupos (idade, sexo, tempo de sedação e ventilação, tempo de diário, gravidade à admissão, delirium, depressão ou ansiedade na unidade de cuidado intensivo). Conclusões: A maioria dos doentes mostrou-se satisfeita com o diário, sugerindo, no entanto, o aumento do número de fotografias.

ABSTRACT Objectives: To evaluate the satisfaction of patients admitted to the intensive care unit using a diary and analyze possible points for improving this instrument. Methods: This was an observational, retrospective study, conducted between March 2014 and July 2017, in a multidisciplinary intensive care unit of a district hospital. The diary was implemented in patients sedated for 3 or more days. Three months after discharge, their satisfaction was assessed using a questionnaire. A patient who agreed with the 5 statements assessing the diary's help in clarifying the intensive care unit stay, in filling memory gaps, in recovery, in reassurance, and in the recommendation of this intervention was defined as satisfied. Results: A total of 110 patients were included, of whom 55 answered the questionnaire. Of these, 36 (65.5%) were classified as satisfied. Each item had a positive response in more than 74% of cases. A total of 60% of the participants suggested increasing the number of photographs. No significant differences were found in the subgroup analysis (age, sex, duration of sedation and ventilation, length of diary keeping, severity on admission, or delirium, depression, or anxiety in the intensive care unit). Conclusions: Most patients were satisfied with the diary but suggested an increase in the number of photographs.

The Von Restorff effect in the Brazilian version of the Rey Auditory Verbal Learning Test in an elderly population.

The Von Restorff (isolation) effect refers to a stimulus that is more likely to be remembered amongst other stimuli in memory tasks. It has been demonstrated with different age ranges and methodologies. OBJECTIVE: To investigate: a) the presence of the isolation effect in elders tested with the new Brazilian Portuguese version of the Rey Auditory Verbal Learning Task (RAVLT) in which a word with potential emotional weight (mother) was introduced; b) whether isolation effects persist in memory disorders of different degrees of severity (Mild Cognitive Impairment [MCI]; Alzheimer's Dementia [AD]). METHODS: The RAVLT was administered to 287 consecutive volunteers. Individuals underwent medical and neuropsychological evaluation and were further sub-grouped into normal controls (n=114), MCI (n=87) and AD (n=86) patients. One-way analysis of variance (ANOVA) and Chi-squared tests were performed. Post-hoc Tukey analysis was conducted to assess significance of group differences. RESULTS: There were significant group effects on the learning curve. A W-shape - instead of the classical U-shape - was found for the serial position curve in all groups. CONCLUSION: The new Brazilian version of the RAVLT exhibited the Von Restorff effect, where this phenomenon was evident not only in older adults but also patients with MCI and AD, providing further psychometric measures for inter-group analyses.

Efeito de von Restorff (efeito de isolamento) refere-se ao estímulo que é mais facilmente lembrado em relação a outros em tarefas de memória. Tal efeito foi demonstrado em diferentes faixas etárias com diferentes metodologias. OBJETIVO: Investigar: a) presença do efeito de isolamento numa população idosa avaliada com a nova versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT), em que uma palavra com potencial carga emocional ('mãe') foi introduzida; b) se o efeito de isolamento persiste em distúrbios de memória de diferentes gravidades (Comprometimento Cognitivo Leve [MCI]; Demência de Alzheimer [AD]). MÉTODOS: RAVLT foi aplicado em 287 voluntários. Indivíduos participaram de avaliações médica e neuropsicológica e foram posteriormente agrupados em controles normais (n=114), MCI (n=87) e DA (n=86). Análises de variância e testes de Chi-quadrado foram realizados. Análises post-hoc foram conduzidas para avaliar diferenças de características entre os grupos. RESULTADOS: Observaram-se efeitos significativos de grupo na curva de aprendizagem. Todos os grupos apresentaram curva de posição serial em formato W - invés do clássico formato em U. CONCLUSÃO: A nova versão brasileira do RAVLT evidenciou um efeito de von Restorff. Tal fenômeno foi visto não apenas em idosos, mas também em pacientes com MCI e AD, fornecendo medidas psicométricas adicionais para análises de diferenças intergrupais.

The Von Restorff effect in the Brazilian version of the Rey Auditory Verbal Learning Test in an elderly population / Efeito de Von Restorff na versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey em idosos

ABSTRACT. The Von Restorff (isolation) effect refers to a stimulus that is more likely to be remembered amongst other stimuli in memory tasks. It has been demonstrated with different age ranges and methodologies. Objective: To investigate: a) the presence of the isolation effect in elders tested with the new Brazilian Portuguese version of the Rey Auditory Verbal Learning Task (RAVLT) in which a word with potential emotional weight (mother) was introduced; b) whether isolation effects persist in memory disorders of different degrees of severity (Mild Cognitive Impairment [MCI]; Alzheimer's Dementia [AD]). Methods: The RAVLT was administered to 287 consecutive volunteers. Individuals underwent medical and neuropsychological evaluation and were further sub-grouped into normal controls (n=114), MCI (n=87) and AD (n=86) patients. One-way analysis of variance (ANOVA) and Chi-squared tests were performed. Post-hoc Tukey analysis was conducted to assess significance of group differences. Results: There were significant group effects on the learning curve. A W-shape - instead of the classical U-shape - was found for the serial position curve in all groups. Conclusion: The new Brazilian version of the RAVLT exhibited the Von Restorff effect, where this phenomenon was evident not only in older adults but also patients with MCI and AD, providing further psychometric measures for inter-group analyses.

RESUMO. Efeito de von Restorff (efeito de isolamento) refere-se ao estímulo que é mais facilmente lembrado em relação a outros em tarefas de memória. Tal efeito foi demonstrado em diferentes faixas etárias com diferentes metodologias. Objetivo: Investigar: a) presença do efeito de isolamento numa população idosa avaliada com a nova versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT), em que uma palavra com potencial carga emocional ('mãe') foi introduzida; b) se o efeito de isolamento persiste em distúrbios de memória de diferentes gravidades (Comprometimento Cognitivo Leve [MCI]; Demência de Alzheimer [AD]). Métodos: RAVLT foi aplicado em 287 voluntários. Indivíduos participaram de avaliações médica e neuropsicológica e foram posteriormente agrupados em controles normais (n=114), MCI (n=87) e DA (n=86). Análises de variância e testes de Chi-quadrado foram realizados. Análises post-hoc foram conduzidas para avaliar diferenças de características entre os grupos. Resultados: Observaram-se efeitos significativos de grupo na curva de aprendizagem. Todos os grupos apresentaram curva de posição serial em formato W - invés do clássico formato em U. Conclusão: A nova versão brasileira do RAVLT evidenciou um efeito de von Restorff. Tal fenômeno foi visto não apenas em idosos, mas também em pacientes com MCI e AD, fornecendo medidas psicométricas adicionais para análises de diferenças intergrupais.

Hypothalamic relapse of a cardiac large B-cell lymphoma presenting with memory loss, confabulation, alexia-agraphia, apathy, hypersomnia, appetite disturbances and diabetes insipidus.

A 37-year-old Hispanic man with a right atrial intracardiac mass diagnosed as diffuse large B-cell lymphoma (DLBCL) was successfully treated with surgery and chemotherapy. During 4 years, several total-body positron emission tomography and MRI scans showed no extracardiac lymphoma. On year 5 after the cardiac surgery, patient presented with sleepiness, hyperphagia, memory loss, confabulation, dementia and diabetes insipidus. Brain MRI showed a single hypothalamic recurrence of the original lymphoma that responded to high-dose methotrexate treatment. Correction of diabetes insipidus improved alertness but amnesia and cognitive deficits persisted, including incapacity to read and write. This case illustrates two unusual locations of DLBCL: primary cardiac lymphoma and hypothalamus. We emphasise the importance of third ventricle tumours as causing amnesia, confabulation, behavioural changes, alexia-agraphia, endocrine disorders and alterations of the circadian rhythm of wakefulness-sleep secondary to lesions of specific hypothalamic nuclei and disruption of hypothalamic-thalamic circuits.

Paramnesia reduplicativa: a propósito de un caso asociado a esquizofrenia / Reduplicative paramnesia: a propos of a case associated with schizophrenia

Los síndromes de falsa identificación delusional (SFID) constituyen un cuadro clínico relativamente frecuente en la casuística psiquiátrica aunque la paramnesia reduplicativa (PR) se ha atribuido con más frecuencia a causas de tipo orgánico cerebral. Presentamos el caso de un paciente con diagnóstico de esquizofrenia paranoide, que desarrolló paramnesia reduplicativa afirmando que poseía dos domicilios iguales, uno verdadero y otro falso -copia del primero-, pero en este último no podía respirar porque no disponía de aire. Dentro de una breve revisión de la literatura respectiva, hallamos progresos en la explicación neurobiológica de la PR, sobre todo a partir del fenómeno hallado en pacientes con organicidad cerebral, sin embargo subsisten preguntas que pueden requerir una concepción más abarcativa de este síntoma en cuanto manifestación psicótica de la esquizofrenia.

Delusional misidentification syndromes (DMS) are a relatively common group of disorders in clinical psychiatry, although the symptom known as Reduplicative Paramnesia (RP) has been, in most cases, attributed to organic (brain- related) causes. The case of a patient with diagnosis of paranoid schizophrenia who developed RP is presented: he reported having two identical homes, one real and one false, the latter a copy of the former, but in which he could not breathe because of lack of air. A brief review of the literature revealed progress in the neurobiological explanation of RP, particularly related to evidences of organic cerebral pathology; nevertheless, a number of questions remain, requiring a more comprehensive conception of this symptom as a psychotic manifestation of schizophrenia.

¿Un camino sin señal? Alzheimer la enfermedad del siglo, hallazgos por imagen en PET-CT / A dark path? Alzheimer, Disease of the Century, PET-CT findings

Introducción: Revisión de la literatura acerca de la demencia tipo Alzheimer, estableciendo definición, signos, síntomas y clasificación. Objetivo: Determinar la importancia del PET-CT con 18 FDG en el algoritmo de abordaje diagnóstico, teniendo en cuenta que es un método que proporciona una información detallada de las áreas anatómicas de hipometabolismo cerebral, con un protocolo de rápida adquisición sin complicaciones y de fácil acceso. Materiales y métodos: Se realizó revisión exhaustiva de la literatura actual, y de la base de datos de los estudios realizados en el PET-CT del CT Scanner del Sur, en pacientes con deterioro cognitivo utilizando 18 F-FDG.

Introduction: Revision of literature regarding Alzheimer type dementia, establishing a definition, signs, symptoms, and classification. Objective: To determine the importance of PET-CT with 18 FDG in the algorithm of diagnostic approach, taking into account that it is a method that enables detailed information of the anatomical areas of cerebral hyper-metabolism without complications and with an easy access. Materials and methods: A thorough revision of current literature was performed, and of the database of the studies performed in the PET-CT of the CT Scanner del Sur, in patients with cognitive deterioration using 18 F-FDG.