Dementia & Neuropsychologiahttps://www.scielo.br/feed/dn/2016.v10n3/2024-03-26T19:15:28.491000ZVol. 10 No. 3 - 2016WerkzeugIn the September 2016 issue10.1590/S1980-5764-2016DN10030012024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZNitrini, Ricardo
<em>Nitrini, Ricardo</em>;
<br/><br/>
Subjective cognitive decline: The first clinical manifestation of Alzheimer's disease?10.1590/S1980-5764-2016DN10030022024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZStudart Neto, AdalbertoNitrini, Ricardo
<em>Studart Neto, Adalberto</em>;
<em>Nitrini, Ricardo</em>;
<br/><br/>
ABSTRACT Background: Mild cognitive impairment is considered as the first clinical manifestation of Alzheimer's disease (AD), when the individual exhibits below performance on standardized neuropsychological tests. However, some subjects before having a lower performance on cognitive assessments already have a subjective memory complaint. Objective: A review about subjective cognitive decline, the association with AD biomarkers and risk of conversion to dementia. Methods: We performed a comprehensive non-systematic review on PubMed. The keywords used in the search were terms related to subjective cognitive decline. Results: Subjective cognitive decline is characterized by self-experience of deterioration in cognitive performance not detected objectively through formal neuropsychological testing. However, various terms and definitions have been used in the literature and the lack of a widely accepted concept hampers comparison of studies. Epidemiological data have shown that individuals with subjective cognitive decline are at increased risk of progression to AD dementia. In addition, there is evidence that this group has a higher prevalence of positive biomarkers for amyloidosis and neurodegeneration. However, Alzheimer's disease is not the only cause of subjective cognitive decline and various other conditions can be associated with subjective memory complaints, such as psychiatric disorders or normal aging. The features suggestive of a neurodegenerative disorder are: onset of decline within the last five years, age at onset above 60 years, associated concerns about decline and confirmation by an informant. Conclusion: These findings support the idea that subjective cognitive complaints may be an early clinical marker that precedes mild cognitive impairment due to Alzheimer's disease.Effects of cognitive stimulation on neuropsychiatric symptoms in elderly with Alzheimer's disease: A systematic review10.1590/S1980-5764-2016DN10030032024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZFukushima, Raiana Lídice MórCarmo, Elisangela Gisele doPedroso, Renata do ValleMicali, Pollyanna NataliaDonadelli, Paula SecomandiFuzaro Junior, GilsonVenancio, Reisa Cristiane de PaulaViola, JulianaCosta, José Luiz Riani
<em>Fukushima, Raiana Lídice Mór</em>;
<em>Carmo, Elisangela Gisele Do</em>;
<em>Pedroso, Renata Do Valle</em>;
<em>Micali, Pollyanna Natalia</em>;
<em>Donadelli, Paula Secomandi</em>;
<em>Fuzaro Junior, Gilson</em>;
<em>Venancio, Reisa Cristiane De Paula</em>;
<em>Viola, Juliana</em>;
<em>Costa, José Luiz Riani</em>;
<br/><br/>
ABSTRACT Introduction: Neuropsychiatric symptoms are frequent in Alzheimer's disease and negatively affect patient quality of life. Objective: To assess the effectiveness of cognitive stimulation on neuropsychiatric symptoms in elderly patients with Alzheimer's disease. Methods: The included articles were reviewed between December 2015 and June 2016, and the inclusion criteria were: (1) studies involving older adults diagnosed with Alzheimer's disease; (2) studies published in English, Spanish or Portuguese; (3) studies that determined the effect of cognitive stimulation on neuropsychiatric symptoms in elderly patients with Alzheimer's disease; (4) controlled trials. Results: Out of the total 722, 9 articles matched the inclusion criteria. Depression, apathy and anxiety were the most frequent symptoms. Conclusion: Studies reported significant results post-treatment, suggesting cognitive stimulation can be effective for these neuropsychiatric symptoms, thus improving the quality of life of Alzheimer's disease patients and their caregivers.Sleep and executive functions in older adults: A systematic review10.1590/S1980-5764-2016DN10030042024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZHolanda Júnior, Francisco Wilson NogueiraAlmondes, Katie Moraes de
<em>Holanda Júnior, Francisco Wilson Nogueira</em>;
<em>Almondes, Katie Moraes De</em>;
<br/><br/>
ABSTRACT Introduction: A recent increase in studies suggests a role of age-related sleep changes in executive functions (EF). However, this relationship remains unclear and mixed results have emerged. Objective: To investigate how age-related sleep changes may play an important role in the extent to which healthy older adults exhibit decline in EF. Methods: A systematic strategy was employed to identify the available literature on age-related sleep changes and EF. Results: Of the 465 studies identified, 26 were included. Results suggest that multiple sleep parameters differ in the way they benefit or impair EF. Parameters such as greater wake after sleep onset and lower sleep efficiency, in addition to circadian fragmentation of sleep, showed more consistent results and are potentially correlated with worsening in EF measures. However, other results seem inconclusive. Conclusion: These findings were discussed based on the prefrontal circuitry vulnerability model, in which sleep has been identified as a beneficial factor for prefrontal cortex functioning and hence for EF, which relies mostly on this brain area and its related networks.Association of education with occurrence of delirium in patients from an emergency department10.1590/S1980-5764-2016DN10030052024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZMota, Simone Sieben daDelgado, Vera BeatrizSchumacher-Schuh, Artur FranciscoChaves, Marcia Lorena Fagundes
<em>Mota, Simone Sieben Da</em>;
<em>Delgado, Vera Beatriz</em>;
<em>Schumacher-Schuh, Artur Francisco</em>;
<em>Chaves, Marcia Lorena Fagundes</em>;
<br/><br/>
ABSTRACT Background: Delirium is a neuropsychiatric syndrome with multiple etiological factors. Evaluation of delirium in different settings, especially the Emergency Department (ED) pertaining to different regions of the world with patients from different cultural and educational backgrounds is needed. Objective: To determine the prevalence of delirium and its association with education in an ED in Brazil during a 6-month period. Methods: Patients aged >18 years were randomly selected from ED admissions. The instruments Confusion Assessment Method (CAM) scale, Mini-Mental State Examination (MMSE), Wechsler Logical Memory (WLM) and Charlson comorbidity score were applied to evaluate delirium, cognitive status, and comorbidities. Results: The prevalence of delirium was10.7%. Delirium patients had significantly lower education, MMSE and WLM (immediate and delayed) scores, with 97.4% presenting episodic memory impairment. Patients with delirium had more history of neurological disorders. Three logistic regression models evaluating the association of variables with delirium were developed. Age and MMSE were retained in the first model, WLM scores in the second, and education in the third. Conclusion: To the best of our knowledge, this is the first study estimating the prevalence of delirium in a Brazilian ED. Lower education was associated with the occurrence of delirium.Delayed recall memory impairment in patients with Parkinson's disease10.1590/S1980-5764-2016DN10030062024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZSchelp, Arthur OscarMendes-Chiloff, Cristiane LaraPaduan, Vanessa CristinaCorrente, José EduardoLima, Fabrício Diniz deMarchette, Juliana Cristine NunesLuvizuto, Gustavo JoséBazan, Rodrigo
<em>Schelp, Arthur Oscar</em>;
<em>Mendes-Chiloff, Cristiane Lara</em>;
<em>Paduan, Vanessa Cristina</em>;
<em>Corrente, José Eduardo</em>;
<em>Lima, Fabrício Diniz De</em>;
<em>Marchette, Juliana Cristine Nunes</em>;
<em>Luvizuto, Gustavo José</em>;
<em>Bazan, Rodrigo</em>;
<br/><br/>
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.Sensorimotor speech disorders in Parkinson's disease: Programming and execution deficits10.1590/S1980-5764-2016DN10030072024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZOrtiz, Karin ZazoBrabo, Natalia CasagrandeMinett, Thais Soares C.
<em>Ortiz, Karin Zazo</em>;
<em>Brabo, Natalia Casagrande</em>;
<em>Minett, Thais Soares C.</em>;
<br/><br/>
ABSTRACT Introduction: Dysfunction in the basal ganglia circuits is a determining factor in the physiopathology of the classic signs of Parkinson's disease (PD) and hypokinetic dysarthria is commonly related to PD. Regarding speech disorders associated with PD, the latest four-level framework of speech complicates the traditional view of dysarthria as a motor execution disorder. Based on findings that dysfunctions in basal ganglia can cause speech disorders, and on the premise that the speech deficits seen in PD are not related to an execution motor disorder alone but also to a disorder at the motor programming level, the main objective of this study was to investigate the presence of sensorimotor disorders of programming (besides the execution disorders previously described) in PD patients. Methods: A cross-sectional study was conducted in a sample of 60 adults matched for gender, age and education: 30 adult patients diagnosed with idiopathic PD (PDG) and 30 healthy adults (CG). All types of articulation errors were reanalyzed to investigate the nature of these errors. Interjections, hesitations and repetitions of words or sentences (during discourse) were considered typical disfluencies; blocking, episodes of palilalia (words or syllables) were analyzed as atypical disfluencies. We analysed features including successive self-initiated trial, phoneme distortions, self-correction, repetition of sounds and syllables, prolonged movement transitions, additions or omissions of sounds and syllables, in order to identify programming and/or execution failures. Orofacial agility was also investigated. Results: The PDG had worse performance on all sensorimotor speech tasks. All PD patients had hypokinetic dysarthria. Conclusion: The clinical characteristics found suggest both execution and programming sensorimotor speech disorders in PD patients.Validation of the Argentine version of the Memory Binding Test (MBT) for Early Detection of Mild Cognitive Impairment10.1590/S1980-5764-2016DN10030082024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZRoman, FabianIturry, MónicaRojas, GalenoBarceló, ErnestoBuschke, HermanAllegri, Ricardo F.
<em>Roman, Fabian</em>;
<em>Iturry, Mónica</em>;
<em>Rojas, Galeno</em>;
<em>Barceló, Ernesto</em>;
<em>Buschke, Herman</em>;
<em>Allegri, Ricardo F.</em>;
<br/><br/>
ABSTRACT Background: "Forgetfulness" is frequent in normal aging and characteristic of the early stages of dementia syndromes. The episodic memory test is central for detecting amnestic mild cognitive impairment (MCI). The Memory Binding Test (MBT) is a simple, easy and brief memory test to detect the early stage of episodic memory impairment. Objective: To validate the Argentine version of the MBT in a Latin American population and to estimate the diagnostic accuracy as a tool for early detection of MCI. Methods: 88 subjects (46 healthy controls and 42 patients with amnestic MCI) matched for age and educational level were evaluated by an extensive neuropsychological battery and the memory binding test. Results: A significantly better performance was detected in the control group; all MBT scales were predictive of MCI diagnosis (p<.01). The MBT showed high sensitivity (69%) and high specificity (88%), with a PPV of 93% and a NPV of 55% for associative paired recall. A statistically significant difference (c2=14,164, p<.001) was obtained when comparing the area under the curve (AUC) of the MBT (0.88) and the MMSE (0.70). Conclusion: The Argentine version of the MBT correlated significantly with the MMSE and the memory battery and is a useful tool in the detection of MCI. The operating characteristics of the MBT are well suited, surpassing other tests commonly used for detecting MCI.The Clock Drawing Test: Performance differences between the free-drawn and incomplete-copy versions in patients with MCI and dementia10.1590/S1980-5764-2016DN10030092024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZBeber, Bárbara CostaKochhann, RenataMatias, BrunaChaves, Márcia Lorena Fagundes
<em>Beber, Bárbara Costa</em>;
<em>Kochhann, Renata</em>;
<em>Matias, Bruna</em>;
<em>Chaves, Márcia Lorena Fagundes</em>;
<br/><br/>
ABSTRACT Background: The Clock Drawing Test (CDT) is a brief cognitive screening tool for dementia. Several different presentation formats and scoring methods for the CDT are available in the literature. Objective: In this study we aimed to compare performance on the free-drawn and "incomplete-copy" versions of the CDT using the same short scoring method in Mild Cognitive Impairment (MCI) and dementia patients, and healthy elderly participants. Methods: 90 participants (controlled for age, sex and education) subdivided into control group (n=20), MCI group (n=30) and dementia group (n=40) (Alzheimer's disease - AD=20; Vascular Dementia - VD=20) were recruited for this study. The participants performed the two CDT versions at different times and a blinded neuropsychologist scored the CDTs using the same scoring system. Results: The scores on the free-drawn version were significantly lower than the incomplete-copy version for all groups. The dementia group had significantly lower scores on the incomplete-copy version of the CDT than the control group. MCI patients did not differ significantly from the dementia or control groups. Performance on the free-drawn copy differed significantly among all groups. Conclusion: The free-drawn CDT version is more cognitively demanding and sensitive for detecting mild/early cognitive impairment. Further evaluation of the diagnostic value (accuracy) of the free-drawn CDT in Brazilian MCI patients is needed.The influence of age, gender and education on the performance of healthy individuals on a battery for assessing limb apraxia10.1590/S1980-5764-2016DN10030102024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZMantovani-Nagaoka, JoanaOrtiz, Karin Zazo
<em>Mantovani-Nagaoka, Joana</em>;
<em>Ortiz, Karin Zazo</em>;
<br/><br/>
ABSTRACT Introduction: Apraxia is defined as a disorder of learned skilled movements, in the absence of elementary motor or sensory deficits and general cognitive impairment, such as inattention to commands, object-recognition deficits or poor oral comprehension. Limb apraxia has long been a challenge for clinical assessment and understanding and covers a wide spectrum of disorders, all involving motor cognition and the inability to perform previously learned actions. Demographic variables such as gender, age, and education can influence the performance of individuals on different neuropsychological tests. Objective: The present study aimed to evaluate the performance of healthy subjects on a limb apraxia battery and to determine the influence of gender, age, and education on the praxis skills assessed. Methods: Forty-four subjects underwent a limb apraxia battery, which was composed of numerous subtests for assessing both the semantic aspects of gestural production as well as motor performance itself. The tasks encompassed lexical-semantic aspects related to gestural production and motor activity in response to verbal commands and imitation. Results: We observed no gender effects on any of the subtests. Only the subtest involving visual recognition of transitive gestures showed a correlation between performance and age. However, we observed that education level influenced subject performance for all sub tests involving motor actions, and for most of these, moderate correlations were observed between education level and performance of the praxis tasks. Conclusion: We conclude that the education level of participants can have an important influence on the outcome of limb apraxia tests.Mother and daughter with adolescent-onset severe frontal lobe dysfunction and epilepsy10.1590/S1980-5764-2016DN10030112024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZPassos, Giordani Rodrigues dosFernández, Alonso CuadradoVasques, Adriana MachadoMartins, William AlvesPalmini, André
<em>Passos, Giordani Rodrigues Dos</em>;
<em>Fernández, Alonso Cuadrado</em>;
<em>Vasques, Adriana Machado</em>;
<em>Martins, William Alves</em>;
<em>Palmini, André</em>;
<br/><br/>
ABSTRACT Familial cases of early-onset prominent frontal lobe dysfunction associated with epilepsy have not been reported to date. We report a mother and her only daughter with incapacitating behavioral manifestations of frontal lobe dysfunction and epilepsy of variable severity. The possibility of a hitherto undescribed genetic condition is discussed.Arteriovenous malformation and dementia: A case report10.1590/S1980-5764-2016DN10030122024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZBrucki, Sonia Maria DozziGomes, Samila Marissa Pinheiro
<em>Brucki, Sonia Maria Dozzi</em>;
<em>Gomes, Samila Marissa Pinheiro</em>;
<br/><br/>
ABSTRACT Arteriovenous malformation (AVM) is a congenital lesion commonly associated with intracranial hemorrhage. We describe a woman with an AVM (Spetzler-Martin grade V) and presenile progressive dementia. The association between AVM and cognition is discussed.Brazilian National Anthem presenting as musical hallucination: A case report with 9-year follow-up10.1590/S1980-5764-2016DN10030132024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZMartinelli, José EduardoCecato, Juliana FranciscaAprahamian, Ivan
<em>Martinelli, José Eduardo</em>;
<em>Cecato, Juliana Francisca</em>;
<em>Aprahamian, Ivan</em>;
<br/><br/>
ABSTRACT Musical hallucination is a type of complex auditory hallucination. Possible etiologies are deafness, psychiatric disorders such as schizophrenia, major depression, use of medication and stress, besides neurologic diseases including epilepsy, stroke and cancer. Uncommon etiologies encompass infectious diseases, metabolic disorders, and sensory deprivation. Although musical hallucinations have a major impact on patients' lives, they have been undervalued and understudied in the literature. We report a case of a 79-year-old woman with musical hallucination (hearing a sung National anthem) without cognitive impairment or hearing loss. The patient had preserved insight of her complaint and responded well to neuroleptics.All that glitters is not gold: When motor and vocal tics in a child do not match Tourette syndrome: A case report10.1590/S1980-5764-2016DN10030142024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZCosta, Raquel Quimas Molina daMarrocos, Rogério PaysanoLeite, Marco Antonio AraujoPorto, Fabio Henrique Gobbi
<em>Costa, Raquel Quimas Molina Da</em>;
<em>Marrocos, Rogério Paysano</em>;
<em>Leite, Marco Antonio Araujo</em>;
<em>Porto, Fabio Henrique Gobbi</em>;
<br/><br/>
ABSTRACT The atypical form of Pantothenate Kinase-Associated Neurodegeneration (PKAN) tends to present at around the age of 14 years, has a heterogeneous presentation with extrapyramidal symptoms, and approximately one third of patients exhibit psychiatric problems. This paper reports the case of a patient with apparent typical symptoms of Tourette syndrome. However, the severity and poor response to treatment led to further investigation and the diagnosis of PKAN as a secondary cause of Tourettism was reached.Magendie and Luschka: Holes in the 4<sup>th</sup> ventricle10.1590/S1980-5764-2016DN10030152024-03-26T19:15:28.491000Z2020-08-09T06:48:27.683000ZEngelhardt, Eliasz
<em>Engelhardt, Eliasz</em>;
<br/><br/>
ABSTRACT Cerebrospinal fluid (CSF) is a complex liquid formed mainly by the choroid plexuses. After filling the ventricular system where it circulates, CSF flows out to the subarachnoid spaces through openings in the 4th ventricle. Following numerous studies on CSF pathways, these openings were first discovered in the 19th century by two notable researchers, François Magendie and Hubert von Luschka, who described the median and lateral openings subsequently named after them. Even after the studies of Axel Key and Gustav Magnus Retzius confirming these openings, their existence was questioned by many anatomists, yet acknowledged by others. Finally gaining the acceptance of all, recognition of the holes endures to the present day. Interest in these openings may be attributed to the several congenital or acquired pathological conditions that may affect them, usually associated with hydrocephalus. We report some historical aspects of these apertures and their discoverers.