Allostatic load measures in older adults with subjective cognitive decline and mild cognitive impairment: A cross-sectional analysis from the Brazilian Memory and Aging Study.

INTRODUCTION: An increasing body of research suggests that stress and allostatic load are related to cognitive dysfunction and neurodegeneration. OBJECTIVES: to determine the relationship between allostatic load (AL) and cognitive status in older adults classified with subjective cognitive decline (SCD) and mild cognitive impairment (MCI). METHODOLOGY: Using the Brazilian Memory and Aging Study (BRAMS) database, we analyzed data from 57 older adults with SCD and MCI. Blood neuroendocrine (cortisol, DHEA-s), inflammatory (C-reactive protein, fibrinogen), metabolic (HbA1c, HDL-cholesterol, total cholesterol, creatinine), and cardiovascular (blood pressure, waist/hip ratio) were transformed into an AL index. RESULTS: Despite a significant difference in the univariate analysis between waist/hip ratio (0.94 in the MCI group vs. 0, 88 in the SCD group, p = 0.03), total cholesterol levels (194 vs. 160, p = 0.02), and AL index (36.9 % in the MCI group vs. 27.2 % in the SCD group, p = 0.04), AL was not associated with SCD or MCI in the multivariate analysis. CONCLUSION: Our data suggest that different profiles of AL in MCI compared to individuals with SCD could be due to cofounding factors. These findings need to be confirmed in longitudinal studies investigating profiles of AL changes at preclinical and prodromal stages of Alzheimer's disease.

Computerized Neurocognitive Test (CNT) in mild cognitive impairment and Alzheimers disease / Testes neurocognitivos computadorizados no comprometimento cognitivo leve e doença de Alzheimer

Currently, computerized batteries are of great value in detecting cognitive impairment. This aim of this review was to compare the computerized neurocognitive batteries used in most studies with cognitive decline over the last 10 years. Using the search words computerized cognitive assessment with: dementia, mild cognitive impairment, and Alzheimer's disease, the CogState, CNS Vital Sings, COGDRAS and Mindstreams batteries were retrieved.

Atualmente, baterias de testes computadorizados têm sido de grande valor na detecção de comprometimento cognitivo. Esta revisão teve como objetivo comparar as baterias cognitivas computadorizadas que foram utilizadas nos últimos 10 anos, na maioria dos estudos com declínio cognitivo. Usando as palavras avaliação cognitiva computadorizada com: demência, comprometimento cognitivo leve e doença de Alzheimer nós encontramos as baterias CogState, CNS Vital Signs, COGDRAS e Mindstreams.

The thickness of posterior cortical areas is related to executive dysfunction in Alzheimer's disease.

OBJECTIVE: To establish whether alterations of brain structures in Alzheimer's disease are associated with executive dysfunction. METHODS: Nineteen patients with Alzheimer's disease and 22 older control subjects underwent a comprehensive evaluation. The clock drawing test, digit span test, executive motor function test, Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test), and Stroop test were used to evaluate executive dysfunction. A multiparametric approach using the FreeSurfer image analysis suite provided a description of volumetric and geometric features of the gray matter structures. RESULTS: The cortical thickness maps showed a negative correlation between the Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test) and the right middle frontal gyrus; a positive correlation between the executive motor function test and the left superior parietal gyrus, left middle temporal gyrus, bilateral supramarginal gyri, right middle frontal gyrus, and right precuneus; a negative correlation between the Stroop test (part III) and the right superior parietal gyrus; and a negative correlation between the Stroop test (part III) and the right middle temporal gyrus. CONCLUSION: Executive dysfunction in Alzheimer's disease is correlated with alterations not only in the frontal areas but also within many temporal and parietal regions.

The thickness of posterior cortical areas is related to executive dysfunction in Alzheimer's disease

OBJECTIVE: To establish whether alterations of brain structures in Alzheimer's disease are associated with executive dysfunction. METHODS: Nineteen patients with Alzheimer's disease and 22 older control subjects underwent a comprehensive evaluation. The clock drawing test, digit span test, executive motor function test, Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test), and Stroop test were used to evaluate executive dysfunction. A multiparametric approach using the FreeSurfer image analysis suite provided a description of volumetric and geometric features of the gray matter structures. RESULTS: The cortical thickness maps showed a negative correlation between the Behavioral Assessment of the Dysexecutive Syndrome battery (Rule Shift Cards test) and the right middle frontal gyrus; a positive correlation between the executive motor function test and the left superior parietal gyrus, left middle temporal gyrus, bilateral supramarginal gyri, right middle frontal gyrus, and right precuneus; a negative correlation between the Stroop test (part III) and the right superior parietal gyrus; and a negative correlation between the Stroop test (part III) and the right middle temporal gyrus. CONCLUSION: Executive dysfunction in Alzheimer's disease is correlated with alterations not only in the frontal areas but also within many temporal and parietal regions. .

Acquired hepatocerebral degeneration: a case report / Degeneração hepatocerebral adquirida: relato de caso

Acquired hepatocerebral degeneration is an underdiagnosed neurologic syndrome characterized by parkinsonism,ataxia or other movement disorders and by neuropsychiatric and cognitive symptoms. It occurs in patients with chronic liverdisease, especially those who develop portosystemic shunting and is often unrecognized as a cause of cognitive decline.Recently, its pathogenesis has been associated with manganese accumulation in basal ganglia and some treatmentsproposed. The aim of this article was to report a case and discuss some discoveries in connection with the disease.

Degeneração hepatocerebral adquirida é uma síndrome neurológica subdiagnosticado caracterizada porparkinsonismo, ataxia ou outros distúrbios do movimento e por sintomas neuropsiquiátricos e cognitivos. Ocorre empacientes com doença hepática crônica, especialmente aqueles que desenvolvem shunts porto-sistêmicos e frequentementenão é reconhecido como uma causa de declínio cognitivo. Recentemente, sua patogênese tem sido associada ao acúmulode manganês nos gânglios da base e alguns tratamentos foram propostos. O objetivo do artigo foi relatar um caso e discutiralgumas descobertas nesta doença.

Voxel-based morphometry findings in Alzheimer's disease: neuropsychiatric symptoms and disability correlations - preliminary results.

INTRODUCTION: The role of structural brain changes and their correlations with neuropsychiatric symptoms and disability in Alzheimer's disease are still poorly understood. OBJECTIVE: To establish whether structural changes in grey matter volume in patients with mild Alzheimer's disease are associated with neuropsychiatric symptoms and disability METHODS: Nineteen Alzheimer's disease patients (9 females; total mean age =75.2 y old +4.7; total mean education level =8.5 y +4.9) underwent a magnetic resonance imaging (MRI) examination and voxel-based morphometry analysis. T1-weighted images were spatially normalized and segmented. Grey matter images were smoothed and analyzed using a multiple regression design. The results were corrected for multiple comparisons. The Neuropsychiatric Inventory was used to evaluate the neuropsychiatric symptoms, and the Functional Activities Questionnaire and Disability Assessment for Dementia were used for functional evaluation RESULTS: A significant negative correlation was found between the bilateral middle frontal gyri, left inferior temporal gyrus, right orbitofrontal gyrus, and Neuropsychiatric Inventory scores. A negative correlation was found between bilateral middle temporal gyri, left hippocampus, bilateral fusiform gyri, and the Functional Activities Questionnaire. There was a positive correlation between the right amygdala, bilateral fusiform gyri, right anterior insula, left inferior and middle temporal gyri, right superior temporal gyrus, and Disability Assessment for Dementia scores CONCLUSIONS: The results suggest that the neuropsychiatric symptoms observed in Alzheimer's disease patients could be mainly due to frontal structural abnormalities, whereas disability could be associated with reductions in temporal structures.

Voxel-based morphometry findings in Alzheimer's disease: neuropsychiatric symptoms and disability correlations - preliminary results

INTRODUCTION: The role of structural brain changes and their correlations with neuropsychiatric symptoms and disability in Alzheimer's disease are still poorly understood. OBJECTIVE: To establish whether structural changes in grey matter volume in patients with mild Alzheimer's disease are associated with neuropsychiatric symptoms and disability METHODS: Nineteen Alzheimer's disease patients (9 females; total mean age =75.2 y old +4.7; total mean education level =8.5 y +4.9) underwent a magnetic resonance imaging (MRI) examination and voxel-based morphometry analysis. T1-weighted images were spatially normalized and segmented. Grey matter images were smoothed and analyzed using a multiple regression design. The results were corrected for multiple comparisons. The Neuropsychiatric Inventory was used to evaluate the neuropsychiatric symptoms, and the Functional Activities Questionnaire and Disability Assessment for Dementia were used for functional evaluation RESULTS: A significant negative correlation was found between the bilateral middle frontal gyri, left inferior temporal gyrus, right orbitofrontal gyrus, and Neuropsychiatric Inventory scores. A negative correlation was found between bilateral middle temporal gyri, left hippocampus, bilateral fusiform gyri, and the Functional Activities Questionnaire. There was a positive correlation between the right amygdala, bilateral fusiform gyri, right anterior insula, left inferior and middle temporal gyri, right superior temporal gyrus, and Disability Assessment for Dementia scores CONCLUSIONS: The results suggest that the neuropsychiatric symptoms observed in Alzheimer's disease patients could be mainly due to frontal structural abnormalities, whereas disability could be associated with reductions in temporal structures.

S-TOFHLA in mild Alzheimer's disease andMild Cognitive Impairment patientsas a measure of functional literacy: preliminary study / S-TOFHLA em pacientes com doença de Alzheimer Leve e Comprometimento Cognitivo Leve como medida de alfabetismo funcional: estudo preliminar

Abstract: The greatest difficulty in diagnosing cognitive loss in our population is the diversity of its education which has a broad spectrum ranging from illiteracy, functional illiteracy and different degrees of literacy, even in those with the same level of schooling. Objectives: To verify whether there is impairment on the S-TOFHLA among individuals with AD and MCI compared with healthy controls, and to compare performance on the S-TOFHLA performance with neuropsychological tests and the scores achieved on the Raven's Colored Matrices and Vocabulary and Block Design (WAIS-III) as a measure of estimated intellectual level. Methods: 59 subjects: controls (n=23; age 70.96±8.31y; schooling 10.2±5.87y; 6 men), MCI patients (n=11; age 74.18±8.12y; schooling 7.55±4.32y; 5 men) and AD patients (n=25; age 76.16±4.96y; schooling 7.32±4.78y; 10 men) were submitted to neuropsychological assessment, S-TOFHLA and functional evaluation. Results: Differences on BD, Raven and Estimated IQ were found between controls and MCI patients as well as controls and AD patients. On the S-TOFHLA, differences were found between MCI and AD patients, controls and AD patients, but not between control and MCI groups. S-TOFHLA performance correlated strongly with schooling and all neuropsychological tests, except Clock Drawing. Conclusions: The S-TOFHLA seems to be a useful measure for determining the level of literacy in MCI patients, but not in AD patients. S-TOFHLA performance was more closely associated with neuropsychological test scores than were years of education and seems to be a good predictor of level of literacy. The Vocabulary subtest proved to be uninfluenced by the disease process in early stages and preserved in both MCI and AD patients, showing that semantic memory and crystallized intelligence are preserved.

Resumo: A maior dificuldade no diagnóstico de perda cognitiva na nossa população é sua heterogeneidade educacional, com um espectro que vai do analfabetismo, analfabetismo funcional até os escolarizados com diferentes graus de alfabetização mesmo com o mesmo grau de escolarização. Objetivos: Verificar se existe comprometimento no S-TOFHLA em indivíduos com DA Leve e CCL comparados a controle saudáveis, correlacionando o desempenho do S-TOFHLA à avaliação neuropsicológica e aos escores alcançados no teste Matrizes Progressivas Coloridas de Raven e nos subtestes vocabulário e cubos (WAIS-III) como medida de nível intelectual estimado. Métodos: 59 sujeitos controles (n=23; idade 70.96±8.31 anos; escolaridade 10.2±5.87 anos; 6 homens), pacientes com CCL (n=11; idade 74.18±8.12 anos; escolaridade 7.55±4.32 anos; 5 homens) e pacientes com DA (n=25; idade 76.16±4.96; escolaridade 7.32±4.78;10 homens) foram submetidos a avaliação neuropsicológica, S-TOFHLA e avaliação funcional. Resultados: Em Cubos, Raven e QI Estimado foram encontradas diferenças estatísticas entre controle e pacientes com CCL; controles e pacientes com DA, mas não entre os grupos controle e CCL. O S-TOFHLA correlacionou fortemente com escolaridade e todos os testes neuropsicológicos, exceto Desenho do Relógio. Conclusões: O S-TOFHLA demonstrou ser uma medida útil em determinar o nível de alfabetismo em paciente com CCL, mas não em pacientes com DA. O S-TOFHLA apresentou maior foi mais relacionado com testes neuropsicológicos do que anos de escolaridade e parece ser um bom preditor do nível de alfabetismo. O subteste Vocabulário demonstrou ser um teste que não sofre com o processo da doença nos estágios iniciais não sofrendo alterações em pacientes com CCL e DA mostrando que memória semântica e inteligência cristalizada são preservadas.

[Analysis of the eye movement patterns in visual search tasks: effect of familiarity and stimulus features]. / Análise dos padrões dos movimentos oculares em tarefas de busca visual: efeito da familiaridade e das características físicas do estímulo.

PURPOSE: To analyze eye movements in asymmetric visual search using the task of normal and mirrored position letters. To evaluate the effect of familiarity and stimulus features. METHODS: Eighty-three university students with normal or corrected-to-normal vision were asked to search for a letter in inverted position to the letters in a group of either normal or mirrored letters. Four types of letters were used (Z, N, E and G) and the eye movements were tracked by a specialized computer-based system (eyetracking). The analyzed measurements were: reaction time, fixation number and duration, saccade distance and duration. RESULTS: All measures varied with the type of letter. Reaction time, fixation number, and saccade distance were higher when the task was to find the normal letter in a group of mirrored letters. In this condition, fixation duration was smaller. Interaction was found between familiarity and the type of letter for the reaction time, fixation number and duration. The reaction time and fixation number increased together with the stimulus complexity, with a greater increase for the normal letter target. Fixation duration, however, decreased with the complexity of the stimuli and the search condition. CONCLUSIONS: Finding a mirrored letter among normal letters proved to be easier than the contrary. The letter type also affected the performance. When the context is formed of unfamiliar complex stimuli, the fixation duration is shorter, indicating a narrower span for visual processing. Therefore, a greater number of fixations with shorter duration are needed for the unfamiliar context while less fixations with greater duration are needed for the familiar context.

Análise dos padrões dos movimentos oculares em tarefas de busca visual: efeito da familiaridade e das características físicas do estímulo / Analysis of the eye movement patterns in visual search tasks: effect of familiarity and stimulus features

OBJETIVOS: Analisar os movimentos oculares numa tarefa de busca visual assimétrica com letras normais e espelhadas. Explorar o efeito da familiaridade e características do estímulo. MÉTODOS: Oitenta e três universitários emétropes ou com correção óptica foram solicitados a procurar por uma letra normal ou espelhada, num contexto de letras espelhadas ou normais, respectivamente. Foram utilizados quatro tipos de letras (Z, N, E e G) e os movimentos dos olhos foram rastreados por meio de um sistema computacional especializado (eyetracking). As medidas utilizadas para análise foram: tempo de reação, duração e número de fixações, duração e distância dos movimentos sacádicos. RESULTADOS: A análise em função do tipo de letra mostrou diferenças para todas as medidas. O tempo de reação, o número de fixações e a distância média dos movimentos sacádicos foram maiores para encontrar uma letra normal em um conjunto de letras espelhadas. A duração média das fixações, entretanto, foi menor nessa situação. Houve interação dupla entre espelhamento e tipo de letra para o tempo de reação, duração média e número de fixações. O tempo de reação e o número de fixações apresentam função crescente de acordo com o grau de complexidade do estímulo, com aumento acentuado na situação em que o alvo é a letra normal. A duração das fixações, por sua vez, diminui em função da complexidade do estímulo e da situação. CONCLUSÕES: Foi mais fácil encontrar uma letra espelhada entre as normais, que o oposto, sendo que o desempenho também sofreu influência do tipo de letra. Quando o contexto é formado por estímulos não familiares e complexos, a duração média das fixações é menor, indicando um processamento visual com amplitude reduzida. Desta forma, são necessárias mais fixações com menor duração para um contexto não familiar e menos fixações com maior duração, para o familiar.

PURPOSE: To analyze eye movements in asymmetric visual search using the task of normal and mirrored position letters. To evaluate the effect of familiarity and stimulus features. METHODS: Eighty-three university students with normal or corrected-to-normal vision were asked to search for a letter in inverted position to the letters in a group of either normal or mirrored letters. Four types of letters were used (Z, N, E and G) and the eye movements were tracked by a specialized computer-based system (eyetracking). The analyzed measurements were: reaction time, fixation number and duration, saccade distance and duration. RESULTS: All measures varied with the type of letter. Reaction time, fixation number, and saccade distance were higher when the task was to find the normal letter in a group of mirrored letters. In this condition, fixation duration was smaller. Interaction was found between familiarity and the type of letter for the reaction time, fixation number and duration. The reaction time and fixation number increased together with the stimulus complexity, with a greater increase for the normal letter target. Fixation duration, however, decreased with the complexity of the stimuli and the search condition. CONCLUSIONS: Finding a mirrored letter among normal letters proved to be easier than the contrary. The letter type also affected the performance. When the context is formed of unfamiliar complex stimuli, the fixation duration is shorter, indicating a narrower span for visual processing. Therefore, a greater number of fixations with shorter duration are needed for the unfamiliar context while less fixations with greater duration are needed for the familiar context.