Prevalence of and Factors Associated with Hypersexuality in Patients with Dementia: A Retrospective Cross-Sectional Study.

INTRODUCTION: The psychological and behavioral symptoms of dementia are frequently observed in clinical practice, and those related to sexuality are particularly challenging. However, few studies have evaluated the prevalence or factors associated with hypersexuality in patients with dementia. OBJECTIVES: This study aims to determine the prevalence of hypersexuality in patients with dementia, describe associated factors, and qualitatively report the most common presentations and treatments. METHODS: This retrospective cross-sectional study collected data from semi-structured charts of dementia patients who were followed up at a secondary care reference center between 2015 and 2019. Results: Of 552 total patients, 52 (9.3%) were hypersexual, which was associated with male sex (P < .000; OR 2.95, 95% CI 1.73-5.01), frontotemporal dementia (P < .007), alcohol use (P < .015; OR 2.35, 95% CI 1.16-4.73) and tobacco use (P < .000; OR 2.88, 95% CI 1.61-5.13). CONCLUSIONS: Although our findings were similar to the literature, their significant variability reflects the limited and low quality of the available evidence and a lack of standardization regarding terminology, definitions, and diagnostic criteria for hypersexuality.

Diagnosis of Alzheimer's dementia and vehicle driving restriction: a scoping review.

There are doubts about vehicle driving restriction for patients with Alzheimer's disease. A scoping review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-ScR) methodology. Relevant databases were searched for articles published between 2000 and 2022 in English, Spanish, or Portuguese. Articles were included if they specifically addressed driving, risk of accidents, permission or licence to drive a motor vehicle in a context of important cognitive decline, or if addressed traffic legislation on driving and dementia. Twenty-three articles were selected for full reading, six of which were observational studies and only one with an interventionist method. All articles were carried out in high-income countries such as the UK, the US, and Australia. As a conclusion, there is no psychometric test in the literature sensitive enough to assess vehicle driving competence in older adults with cognitive deficits. Based on selected studies, there is no robust evidence to make recommendation for or against the cessation of vehicular driving for patients with mild cognitive decline or with mild dementia. In some situations, vehicle driving cessation can impact patients and their families. In addition, legal regulations regarding vehicle driving for older adults and people with dementia are scarce worldwide. Despite the scarcity of studies addressing the theme of vehicle driving in the context of dementia, there is some level of consensual reasoning that patients with moderate to severe dementia should halt driving activities, but the same does not apply for patients with mild levels of cognitive impairment, including mild dementia.

Lack of association between apolipoprotein E genotypes and cognitive performance in the non-demented elderly.

AIM: The ε4 alelle of the apolipoprotein E gene is known to be a key genetic risk factor for Alzheimer's disease and possibly for other neurological disorders. Some evidence in the literature indicates that the ε4 allele interferes with human cognition independently of chronological age and diagnosis of Alzheimer's disease. The present study investigated the correlation of allelic variants of apolipoprotein E with the cognitive performance of elderly individuals without apparent cognitive impairment. METHODS: This was a cross-sectional analysis that included 213 non-demented elderly individuals (age ≥60 years) from the Brazilian Federal District. The analysis assessed the subjects for cognitive domains including short- and long-term episodic memory, processing speed, and attention and executive functions. Sociodemographic and other clinical characteristics were gathered and analyzed as covariates. RESULTS: Being sufficiently powered, the present study did not identify differential performance across apolipoprotein E genotypes. There was no influence of age, gender, marital status, schooling, depressive symptoms or use of central nervous system depressants when the analyses were controlled for such factors. CONCLUSIONS: Our findings suggest that the ε4 allele does not contribute to detectable cognitive decline within the context of non-dementia.

The newly discovered glymphatic system: the missing link between physical exercise and brain health?

Dementias are responsible for the most frequent neurodegenerative diseases and the seventh leading cause of death worldwide. As a result, there is a growing effort by the neuroscientific community to understand the physiopathology of neurodegenerative diseases, including how to alleviate the effects of the cognitive decline by means of non-pharmacological therapies (e.g., physical exercise). Studies have shown that exercise can improve aspects of brain health related to cognition. However, there still needs to be more knowledge regarding the mechanisms controlling these relationships, and a newly discovered cleansing system in the brain, named the glymphatic system, can be the missing link in this mechanism. The objective of this paper is to review recent findings regarding the potential impacts of physical exercise on the glymphatic system and its implications for the onset of neurodegenerative diseases. Additionally, considering the close interplay between exercise and sleep quality, we aim to explore how sleep patterns may intersect with exercise-induced effects on glymphatic function, further elucidating the complex relationship between lifestyle factors and brain health.

Neuropsychological domains and fitness to drive in mild cognitive impairment or Alzheimer's disease.

Cognitive deficits associated with mild cognitive impairment (MCI) or Alzheimer's disease (AD) can impact driving. This integrative review investigated which cognitive domains were associated with poor driving performance or unfitness to drive in studies with outcomes measured in simulator or on-road driving in patients with MCI or AD. The review was conducted by searching for articles published between 2001 and 2020 in the MEDLINE (via PubMed), EMBASE, and SCOPUS databases. Studies addressing patients with other dementias (e.g., vascular or mixed dementia, Lewy body dementia, Parkinson's disease) were excluded. Of 404 articles initially selected, 17 met the eligibility criteria for this review. Based on the findings of this integrative review, attentional capacity, processing speed, executive functions and visuospatial skills were the functions whose declines were most frequently reported in a context of unsafe driving by older adults with MCI or AD. Reports were remarkably heterogeneous in methodological aspects whereas quite limited in cross-cultural coverage and in sample recruited, what prompts for further trials in the field.

Treatment of dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

There is currently no cure for neurodegenerative or vascular dementias, but some pharmacological and non-pharmacological interventions may contribute to alleviate symptoms, slow disease progression and improve quality of life. Current treatment approaches are based on etiology, symptom profile and stage of dementia. This manuscript presents recommendations on pharmacological and non-pharmacological treatments of dementia due to Alzheimer's disease, vascular cognitive impairment, frontotemporal dementia, Parkinson's disease dementia, and dementia with Lewy bodies.

Atualmente não há tratamento curativo para as demências neurodegenerativas ou para a demência vascular, mas algumas intervenções farmacológicas e não farmacológicas podem contribuir para aliviar os sintomas, retardar a progressão da doença e melhorar a qualidade de vida. As abordagens terapêuticas atuais são baseadas na etiologia, no perfil dos sintomas e no estágio da demência. Neste artigo apresentamos recomendações sobre os tratamentos farmacológicos e não farmacológicos da demência devida à doença de Alzheimer, comprometimento cognitivo vascular, demência frontotemporal, demência da doença de Parkinson e demência com corpos de Lewy.

Use of psychotropic agents to treat agitation and aggression in Brazilian patients with Alzheimer's disease: A naturalistic and multicenter study.

We assessed psychotropic prescribing patterns in the clinical treatment of agitation and aggressive behavior in patients with Alzheimer's disease (AD) treated at specialist outpatient clinics in the Federal District of Brazil. This was a naturalistic, observational, multicenter study of a convenience sample of patients with AD (according to DSM-5) who had behavioral symptoms of aggression and/or agitation at outpatient visits, as assessed by the Neuropsychiatric Inventory (NPI), and required pharmacologic intervention. Participants were recruited in 2018-2019 from 11 AD treatment centers. Sociodemographic and clinical data were collected during routine visits. The sample consisted of 369 older adults with a mean age of 82.3 (SD, 7.7) years. The medications most commonly used in patients with behavioral disorders were antidepressants (79.1%), antipsychotics (70.2%), benzodiazepines (10.6%), and mood stabilizers (9.5%). Quetiapine was the most frequently prescribed antipsychotic medication (48.5%), at a mean dose of 57.4 (SD, 40.7) mg. Citalopram was the most widely used antidepressant medication (32.0%), at a mean daily dose of 24.1 (SD, 8.1) mg. In this sample, two or more pharmacologic agents were frequently used together to control aggression and agitation. Benzodiazepine was not frequently used.

Older drivers are at increased risk of fatal crash involvement: Results of a systematic review and meta-analysis.

Older adults have become a larger part of the driving population, but whether they are at increased risk of being involved in fatal crashes remains unclear. METHODS: We performed a systematic review of studies investigating fatal crash involvement of older vs non-older drivers by searching the following databases: PubMed, Cochrane Library, Embase, LILACS, SciELO, Web of Science, and ProQuest. Studies that used fatal crash involvement rates per distance driven as a measure of frequency were selected for meta-analysis. RESULTS: We analyzed 14 studies published between 2001 and 2018. Of these, 12 reported a higher rate of fatal crashes involving older drivers than non-older drivers; 9 of them used involvement rates per distance driven, which is considered the most appropriate metric. The meta-analysis revealed high heterogeneity between studies. The meta-regression attributed 40% of the heterogeneity to age (older vs non-older drivers) (p<0.005). CONCLUSION: Age appears to be associated with higher driver involvement rates for fatal crashes among older persons.

Whole-Blood Levels of MicroRNA-9 Are Decreased in Patients With Late-Onset Alzheimer Disease.

Recent evidence suggests changes in circulating microRNA levels may be promising biomarkers for the clinical diagnosis of Alzheimer disease (AD). We hypothesized that whole-blood microRNAs may be useful to identify individuals with established AD. For this purpose, a sample of community-dwelling women (≥55 years old) carrying the ApoE ∊4 allele were clinically evaluated using the American Psychiatric Association/Diagnostic and Statistical Manual of Mental Disorders, Fourth edition and the Alzheimer Disease Assessment Scale-Cognitive Subscale criteria to diagnose probable AD, and the Clinical Dementia Rating scale to stage the dementia. A set of 25 mature microRNAs was rationally selected for evaluation based on experimental evidence of interaction with genes linked to the late-onset AD neuropathology. Whole-blood concentrations were determined by quantitative real-time polymerase chain reaction. Compared to patients without dementia, a median 3-fold decrease in miR-9 levels was found among patients with AD (P = .001). Our findings support blood-borne miR-9 as a candidate biomarker for probable AD, embodied by evidence from the literature of its implication in amyloidogenesis.

Attitudes Toward Lesbians and Gay Men Scale: validation in Brazilian physicians.

OBJECTIVE: To perform the cross-cultural adaptation of the original North American version of the Attitudes Toward Lesbians and Gay Men Scale (ATLG) for use in Brazil, and to evaluate the psychometric properties of the adapted instrument in a sample of Brazilian heterosexual physicians. METHODS: Stages of cross-cultural adaptation were as follows: translation by two independent evaluators, translation synthesis, evaluation by the target population for semantic equivalence, pilot study with 42 physicians, and final instrument preparation involving 224 heterosexual physicians practicing medicine in the Federal District. Invitations containing a link to the study were sent to physicians via e-mail, social media and medical associations. Inclusion criteria were as follows: being a physician authorized to practice medicine in Brazil, practicing medicine in the Brazilian Federal District, and self-declared heterosexual, as stipulated in the original version of the ATLG scale. Exclusion criteria were not disclosed to potential participants to avoid inhibition and unwillingness to participate; respondents meeting exclusion criteria were removed from the sample during data analysis. RESULTS: Exploratory and confirmatory factor analyses suggested a one-factor solution to be the most representative of the data, including all 20 items with high reliability (composite reliability coefficients =0.948). CONCLUSION: The ATLG scale is a suitable instrument to assess physicians' attitudes toward homosexuals, with good validity and reliability evidence based on the sample studied.

Study of the clinical profile of older patients with bipolar disorder in a tertiary care center in the Midwest of Brazil / Estudo do perfil clínico de pacientes idosos com transtorno bipolar em um centro terciário do Centro-Oeste do Brasil

Objective: This study aimed to describe the clinical and psychiatric characteristics of older outpatients with bipolar disorder (BD), including psychiatric history (age of onset of symptoms, length of time with the illness, and number of psychiatric hospitalizations), mood state, and cognitive function. Methods: This was a cross-sectional study where clinical and demographic data were obtained by a psychiatric interview with each patient and family members as well as by a review of medical records. The sample consisted of 20 individuals aged 60 years or older with a diagnosis of BD type I according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Descriptive data analysis was performed, with categorical variables expressed as absolute and relative frequencies. Results: No patient had manic or depressive symptoms at the time of the evaluation; 15 (75.0%) had an early onset while 5 (25.0%) had a late onset of the disease. Nine patients (45.0%) showed no cognitive decline whereas 11 (55.0%) showed mild cognitive impairment. Conclusions: This study presents an understudied group of patients with BD. Considering the personal impact and burden on the health system related to this psychiatric condition, it is recommended that further studies be conducted in this area to better evaluate this growing population. (AU)

Effects of physical exercise on cognition and glymphatic system of patients with mild cognitive impairment or Alzheimer's disease ­ study protocol

Objective: To evaluate the impact of a multicomponent physical exercise program on clinical variables associated with the glymphatic clearance system, sleep-awake patterns, and cognitive function in individuals with mild cognitive impairment or mild Alzheimer's disease. Methods: This is a single-center parallel randomized controlled trial involving pre- and post-intervention assessments. The intervention consists of a 12 (±3)-week multicomponent aerobic and resistance physical exercise program of moderate intensity divided into 2 groups: an experimental group (undergoing multicomponent training) and a control group (no intervention). Eligible participants are those diagnosed with probable mild cognitive impairment or mild Alzheimer's disease. Expected results: Anticipated outcomes suggest that the multicomponent training protocol, incorporating both aerobic and resistance physical exercises at a moderate intensity, will yield improvements in glymphatic clearance dynamics, sleep-awake parameters, and performance on cognitive, functional, and behavioral tasks among eligible patients. Relevance: The need to move beyond cognitive clinical testing justifies our trial, which proposes an assessment employing neuroimaging techniques and the analysis of biomarkers present in cerebrospinal fluid in conjunction with clinical tests for physical and cognitive assessment. (AU)

What do physicians know about homosexuality? Translation and adaptation of Knowledge about Homosexuality Questionnaire.

OBJECTIVE: To adapt the Knowledge about Homosexuality Questionnaire to Brazilian Portuguese, and to assess knowledge of heterosexual physicians on homosexuality. METHODS: The following steps for cultural adaptation were made: translation by two independent evaluators, translation synthesis, and evaluation of semantic properties by the target population, followed by the development of a pilot study and administration of the instrument to 224 heterosexual physicians working in the Brazilian Federal District. RESULTS: The mean number of correct answers in the questionnaire was 11.8 (SD=2.81) out of 18 items, i.e., 65.5%. Catholic and evangelical physicians gave a significant lower number of correct answers compared with those who believed in other religions or who did not believe in any religion (p=0.009), and 40% of sample did not know that homosexuality is not considered a disease. CONCLUSION: This study adapted the American instrument entitled Knowledge about Homosexuality Questionnaire and provided evidence for its validation in Brazil, revealing physicians' lack of knowledge about several aspects related to homosexuality. The findings of this study may help in guiding improvements in medical training and practice.

Monoclonal antibodies for Alzheimer disease: statistical significance vs clinical efficacy / Anticorpos monoclonais para doença de Alzheimer: significância estatística versus eficácia clínica

Nas últimas décadas, os anticorpos monoclonais (AcM) promoveram uma transformação dramática no tratamento de diversas doenças, especialmente nos linfomas, leucemias, câncer de mama e câncer colorretal. Estima-se que atualmente as indústrias de biotecnologia ligadas ao desenvolvimento de AcM são responsáveis por importante fatia do produto interno bruto de muitos países onde essas indústrias estão sediadas. Já as pesquisas com AcM para doença de Alzheimer (DA) alicerçadas na hipótese da cascata amiloide parecem não apresentar os mesmos resultados. Alguns ensaios clínicos realizados com crenezumabe e solanezumabe não conseguiram demonstrar uma desaceleração da progressão clínica da doença, fazendo com que seus respectivos laboratórios encerrassem novos ensaios clínicos com essas drogas. Não obstante a falha de eficácia de alguns fármacos, outros recentes resultados de ensaios clínicos facilitaram a aprovação do aducanumabe pelo Food and Drug Administration (FDA) dos Estados Unidos (EUA) em junho de 2021, um anticorpo monoclonal IgG1 humano anti-beta amiloide (Aß) seletivo, como o primeiro tratamento modificador da doença na DA, especificamente para as fases de comprometimento cognitivo leve (CCL) e de demência leve. Dois anos após, o FDA também concedeu aprovação acelerada a outro AcM, o lecanemabe, e muito provavelmente o mesmo ocorrerá com o donanemabe após recente publicação do ensaio clínico TRAILBLAZER-ALZ 2.

In recent decades, monoclonal antibodies (MAbs) have dramatically shifted the treatment landscape for multiple malignant diseases, especially lymphomas and leukemias, breast cancer, and colorectal cancer. This change has been so momentous that many biotechnology companies involved in MAb discovery and development are currently estimated to account for a major share of the gross domestic product of their host countries. Research on MAb therapies for Alzheimer's disease (AD), however, all of which has been based on the amyloid cascade hypothesis, does not seem to have achieved similar results. Some clinical trials carried out with crenezumab and solanezumab failed to demonstrate slowing of clinical progression of AD, causing their respective manufacturers to discontinue further development. The lack of efficacy of these drugs notwithstanding, the recent results of clinical trials with another drug, aducanumab ­ a human IgG1 MAb which selectively targets aggregated amyloid-beta (Aß) ­ led to its FDA approval in June 2021 as the first ever disease-modifying treatment for AD, specifically at the mild cognitive impairment (MCI) and mild dementia stages. Two years later, the FDA granted accelerated approval to another MAb, lecanemab; a third, donanemab, is likely to follow, with the recent publication of the TRAILBLAZER-ALZ 2 trial.

Fluid and imaging biomarkers for Alzheimer's disease: Where we stand and where to head to.

There is increasing evidence that a number of potentially informative biomarkers for Alzheimer disease (AD) can improve the accuracy of diagnosing this form of dementia, especially when used as a panel of diagnostic assays and interpreted in the context of neuroimaging and clinical data. Moreover, by combining the power of CSF biomarkers with neuroimaging techniques to visualize Aß deposits (or neurodegenerative lesions), it might be possible to better identify individuals at greatest risk for developing MCI and converting to AD. The objective of this article was to review recent progress in selected imaging and chemical biomarkers for prediction, early diagnosis and progression of AD. We present our view point of a scenario that places CSF and imaging markers on the verge of general utility based on accuracy levels that already match (or even surpass) current clinical precision.

Lower risk of car crashes among older drivers compared with younger drivers: analysis of 10 years of data / Menor risco de acidentes de automóvel entre motoristas idosos comparado a jovens: resultado de um estudo de 10 anos

Objective: Traffic crashes are a significant cause of health expenditure, mainly considering disability and death. Driving skills are key when it comes to traffic crashes, and older drivers may be unfit to drive. The statistics of traffic crashes involving older drivers can contribute to planning actions that reduce accidents. This study aimed to present statistical data on traffic crashes among older adults in a Brazilian state. Methods: This is an epidemiological study performed with data from the Traffic Accident Information System of the Federal District Traffic Department, Brazil, ranging from 2008 to 2017 and comparing the incidence of injury crashes between older drivers and adult drivers. Results: Although the system recorded 60 705 drivers involved in injury crashes, a 24% reduction was seen in the overall crash incidence during the studied period (2008 ­ 2017); within the older drivers group, this reduction was two times smaller (12%). Despite the smaller drop in incidence, older car drivers presented around three times less risk of crashes when compared to adult drivers, along with a lower risk of accidents on urban, low-speed streets, and were mostly involved in collisions during the day. Conclusion: We found that the risk of older drivers being involved in injury crashes was three times smaller than that of adult drivers. The behavior of older drivers can influence the occurrence of accidents.

Objetivo: Os acidentes de trânsito são causa significativa de gasto em saúde com incapacidades e mortes. Habilidades de condução veicular são elementos-chave para a ocorrência de acidentes de trânsito, e o motorista idoso pode ser incapaz para dirigir. As estatísticas de acidentes de trânsito com motoristas idosos podem contribuir para o planejamento de ações que reduzam os acidentes. Este estudo teve como objetivo apresentar dados estatísticos sobre acidentes de trânsito entre idosos em um estado brasileiro. Metodologia: Estudo epidemiológico com dados do Sistema de Informações de Acidentes de Trânsito do Departamento de Trânsito do Distrito Federal, Brasil, no período de 2008 a 2017, comparando a incidência de acidentes com vitima entre motoristas de automóveis idosos e não idosos. Resultados: De 2008 a 2017, apesar de o sistema contabilizar 60 705 motoristas envolvidos em acidentes de automóveis com vítimas, houve uma redução de 24% na incidência geral nos anos avaliados, sendo essa redução duas vezes menor no grupo de motoristas idosos (12%). A despeito da menor queda na incidência, os motoristas idosos condutores de automóveis tiveram cerca de três vezes menos risco de acidentes comparados a motoristas não idosos; menor risco para acidentes em vias urbanas, as de velocidade mais baixa; e maior predominância de acidentes tipo colisão no período diurno. Conclusões: Encontrou-se risco três vezes menor de motoristas idosos se envolverem em acidentes de automóveis com vitima quando comparados a não idosos. O comportamento dos motoristas idosos pode influenciar na ocorrência de acidentes.

Cerebellar cognitive affective syndrome due to cerebellar atrophy: case report / Síndrome cerebelar cognitivo-afetiva secundária à atrofia cerebelar: relato de caso

Cerebellar atrophy is a rare and challenging disease with few descriptions in the medical literature. Motor impairment is mild, but behavioral and linguistic alterations stand out, in what is known as the cerebellar cognitive affective syndrome secondary to cerebellar atrophy. We report the case of an older woman with early-onset (age 45) signs and symptoms of this syndrome, including impairment of executive functions and visuospatial cognition, personality changes, and language deficits, who was followed at a geriatric medical center for 14 years. Neuropsychological, imaging, and behavioral aspects during this period are discussed in light of scientific evidence. This case report contributes to the scientific literature by describing the progression of the signs and symptoms of cerebellar atrophy over the years, which can help guide medical management and support advice for patients and their families.

A atrofia cerebelar é uma doença rara, desafiadora e com poucas descrições na literatura médica. O prejuízo motor é discreto, mas as alterações comportamentais e de linguagem se destacam, caracterizando a síndrome cognitivo-afetiva cerebelar secundária à atrofia cerebelar. Apresentamos o relato de caso de uma paciente idosa, que apresentou sinais e sintomas dessa síndrome precocemente (aos 45 anos de idade) ­ tais como déficits na função executiva, prejuízo visuoespacial, alterações de personalidade e déficits de linguagem ­ e foi acompanhada em um centro médico geriátrico por um período de 14 anos. Aspectos neuropsicológicos, de imagem e comportamentais durante esse período são comentados à luz das evidências científicas. O caso relatado contribui com a literatura científica ao descrever a evolução dos sinais e sintomas da atrofia cerebelar ao longo dos anos, balizando as condutas médicas e amparando as orientações ao paciente e seus familiares.