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.

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.

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.

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.

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.

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.

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.

Residual signal auto-correlation to evaluate speech in Parkinson's disease patients.

OBJECTIVE: To evaluate the maximum residual signal auto-correlation also known as pitch amplitude (PA) values in patients with Parkinson's disease (PD) patients. METHOD: The signals of 21 Parkinson's patients were compared with 15 healthy individuals, divided according age and gender. RESULTS: Statistical difference was seen between groups for PA, 0.39 for controls and 0.25 for PD. Normal value threshold was set as 0.3; (p<0.001). In the Parkinson's group 80.77%, and in the control group only 12.28%, had a PA<0.3 demonstrating an association between these variables. The dispersion diagram for age and PA for PD individuals showed p=0.01 and r=0.54. There was no significant difference in relation to gender and PA between groups. CONCLUSION: The significant differences in pitchs amplitude between PD patients and healthy individuals demonstrate the methods specificity. The results showed the need of prospective controlled studies to improve the use and indications of residual signal auto-correlation to evaluate speech in PD patients.

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.

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.

[Incidence of oropharyngeal dysphagia associated with stroke in a regional hospital in São Paulo State - Brazil]. / Incidência de disfagia orofaríngea após acidente vascular encefálico em hospital público de referência.

Cerebrovascular disease is recognized as to be associated with the highest mortality rate in Brazil. Dysphagia, speech and language disturbances are common consequences of the high incidence of stroke. Dysphagia is known to occur in at least 50% of the patients with acute stroke. The study is designed to establish the incidence of stroke in a reference hospital. One hundred and two consecutive patients admitted between January 2001 and January 2002 underwent a neurological examination with dysphagia specific analysis, performed by speech/dysphagia professionals as soon as they have clinical conditions. The localization of the lesions are determined by computer tomography or magnetic resonance image of the brain. Sixty one patients underwent videofluorscopic evaluation of swallowing. There was detected oropharyngeal dysphagia in 78 patients (76.5%) if the examination was limited to the clinical evaluation. Nevertheless, if complemented by videofluorscopic evaluation, the incidence grows to 90%. The explanation for the high incidence observed in this study could be pointed to the fact that dysphagia was registered on different times of the convalescence period. The data reinforces the importance of repeated evaluations made by different professionals of the staff involved in acute stroke attendance.

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.

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.

Metabolic syndrome and dementia associated with Parkinson's disease: impact of age and hypertension.

OBJECTIVE: To determine correlations between age and metabolic disorders in Parkinson's disease (PD) patients. METHODS: This observational cross-sectional study included brief tests for dementia and the Mattis test. Signals of metabolic syndrome were evaluated. RESULTS: There was no significant effect from the presence of hypertension (OR=2.36 for patients under 65 years old and OR=0.64 for patients over 65), diabetes or hypercholesterolemia regarding occurrences of dementia associated with PD (24% of the patients). The study demonstrated that each year of age increased the estimated risk of dementia in PD patients by 9% (OR=1.09; 95%CI: 1.01-1.17). CONCLUSION: There was no evidence to correlate the presence of metabolic syndrome with the risk of dementia that was associated with PD. The study confirmed that dementia in PD is age dependent and not related to disease duration.

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.

Distinct attitudes of professionals from different medical specialties toward autonomy and legal instruments in the assessment of patients with Alzheimer's disease.

The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue. OBJECTIVES: The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer's disease and practitioners' competence to interfere with decision-making autonomy. METHODS: Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely:[1] Critical judgment and capacity of the patient to take decisions related to daily activities;[2] The role of family physicians in nominating trustees and caregivers. RESULTS: Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer's disease. CONCLUSIONS: Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia.

A avaliação da competência de pacientes com doença de Alzheimer (DA) para assumir responsabilidades pessoais ou coletivas e as implicações legais resultantes constituem um tema relevante. OBJETIVOS: O objetivo do estudo foi analisar as diferentes atitudes de profissionais de diferentes áreas de formação frente à incapacidade de pacientes com doença de Alzheimer e sua competência para interferir com autonomia para tomada de decisões. MÉTODOS: Profissionais das diferentes áreas de atuação (Neurologia, Psiquiatria e Geriatria e Medicina geral) foram entrevistados por um dos autores, depois de serem apresentados a um caso clínico fictício, no qual alguns tópicos foram levantados:[1] Juízo crítico e capacidade do paciente para tomar decisões relacionadas ao seu cotidiano;[2] Papel do médico na escolha e nomeação de cuidadores e tutores. RESULTADOS: A resposta a primeira questão não evidenciou grandes divergências quando ao grau de incapacidade, mas 25% dos entrevistados chamaram atenção para o fato de que os pacientes devem ser ouvidos e avaliados, independentemente da opinião externada pelos cuidadores e representantes legais. Na resposta ao segundo quesito ficou evidente a falta de informações sobre aspectos legais e éticos relacionados aos tutores e cuidadores. CONCLUSÕES: Aspectos legais constituem um tópico que deve ser incorporado ao treinamento profissional para aprimorar condutas no tratamento de longo prazo de pacientes com demência.

The influence of sour taste and cold temperature in pharyngeal transit duration in patients with stroke.

CONTEXT: The effect of sour taste and food temperature variations in dysphagic patients has not been entirely clarified. OBJECTIVE: To determine the effect of sour and cold food in the pharyngeal transit times of patients with stroke. METHODS: Patients participating in this study were 30 right-handed adults, 16 of which were male and 14 were female, aged 41 to 88 (average age 62.3 years) with ictus varying from 1 to 30 days (median of 6 days). To analyze the pharyngeal transit time a videofluoroscopy swallow test was performed. Each patient was observed during swallow of a 5 mL paste bolus given by spoon, totaling four different stimuli (natural, cold, sour and cold sour), one at a time, room temperature (22 degrees C) and cold (8 degrees C) were used. Later, the tests were analyzed using specific software to measure bolus transit time during the pharyngeal phase. RESULTS: The results showed that the pharyngeal transit time was significantly shorter during swallow of cold sour bolus when compared with other stimuli. CONCLUSION: Sour taste stimuli associated to cold temperature cause significant change in swallowing patterns, by shortening the pharyngeal transit time, which may lead to positive effects in patients with oropharyngeal dysphagia.

Public awareness of dementia: A study in Botucatu, a medium-sized city in the State of São Paulo, Brazil.

Dementia is a progressive and debilitating disease affecting an increasing number of people worldwide. Despite its importance, only a few studies have examined public awareness of dementia. We present a study of the public awareness of dementia in Botucatu, São Paulo, Brazil. METHODS: A sample of 73 individuals answered a questionnaire approved by the Medical Ethics Research Committee inquiring about the characteristics of healthy old-aged and demented individuals. RESULTS: Those interviewed believed that dementia is characterized by prevalent memory impairment (41%) and behavioral changes (32.9%) with onset in the 60's or older (42.5%) and upon suspecting dementia, only a few would seek specialized medical help. DISCUSSION: Better understanding of public awareness of dementia provides the clue to more effective health and social policies in order to achieve a higher rate of early diagnosis and thereby possibly decreasing patient, family and caregiver distress.

Demência é uma síndrome progressiva e inabilitante que afeta um número crescente de pessoas ao redor do mundo. A despeito de sua importância, poucos estudos tem examinado a conhecimento público sobre demência. OBJETIVO: Apresentar um estudo sobre o conhecimento sobre demência em Botucatu, São Paulo, Brasil. MÉTODOS: Uma amostra de 73 indivíduos responderam a um questionário, aprovado pelo Comitê de Ética em Pesquisa Médica, a respeito das características de indivíduos idosos sadios e pessoas com demência. Resultados: Os sujeitos entrevistados acreditavam que a demência se caracteriza por uma prevalente perda de memória (41%) e alterações comportamentais (32.9%) com início aos 60 anos ou mais (42.5%) e, e no caso de suspeita de demência, somente poucos procurariam ajuda médica especializada. DISCUSSÃO: Melhor compreensão do conhecimento público sobre demência fornece pistas para políticas sociais e de saúde mais efetivas a fim de atingir um índice mais alto de diagnóstico precoce e possivelmente diminuir o desgaste do paciente, da família e dos cuidadores.

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.