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.

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.

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.

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.

Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia / Treatment of dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

RESUMO 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.

ABSTRACT 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.

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.

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.

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.

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.

Evaluation of depression and anxiety symptoms, alcohol consumption, and binge eating in older adults undergoing bariatric surgery: a 6-year follow-up / Avaliação dos sintomas de depressão e ansiedade, consumo de álcool e compulsão alimentar em idosos submetidos à cirurgia bariátrica: seguimento de 6 anos

INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson's χ2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.

INTRODUÇÃO: A literatura ainda é escassa sobre os efeitos tardios na saúde geral de pacientes idosos submetidos à cirurgia bariátrica. O presente estudo teve como objetivo avaliar os sintomas de depressão e ansiedade, consumo de álcool de risco e compulsão alimentar em idosos submetidos à cirurgia bariátrica. METODOLOGIA: Este estudo utilizou dados atuais (de prontuários e exames) para realizar um estudo transversal. Um total de 74 indivíduos com 60 anos ou mais que se submeteram à cirurgia bariátrica após os 55 anos em um centro especializado em tratamento da obesidade localizado no Brasil foram incluídos e avaliados pelo Inventário de Depressão e Ansiedade de Beck, Alcohol Use Disorders Identification e Escala de compulsão alimentar. Dados demográficos e clínicos relacionados ao procedimento cirúrgico (perda de peso) também foram coletados. O teste de tendência Cochran-Armitage, o teste do χ2 de Pearson e um modelo de regressão linear múltipla foram usados conforme necessidade. Um p < 0,05 foi considerado significativo. RESULTADOS: Os indivíduos em sua maioria eram brancos (65,70%) e mulheres (78,30%), com média de idade de 65,8 (DP 3,90) anos. O tempo médio decorrido desde a cirurgia até a avaliação foi de 75,70 (DP 43,70) meses; 10,80% dos participantes tinham depressão moderada a grave, 8,10% ansiedade moderada a grave e 5,40% consumo de álcool de risco ou alto risco. Nenhum dos participantes teve problemas de compulsão alimentar. O ganho de peso não foi associado à gravidade dos sintomas depressivos ou consumo de álcool de risco, mas foi significativamente associado (p = 0,034) com poucos ou nenhum sintoma de ansiedade. A perda de excesso de peso não se associou a nenhuma variável do estudo. CONCLUSÕES: Os resultados mostram baixa prevalência de sintomas mentais em idosos submetidos à cirurgia bariátrica em comparação com dados da literatura em adultos jovens submetidos ao mesmo procedimento.

Inappropriate requests for tumor markers in patients aged 50 years and older: lessons not learned / Solicitação inapropriada de marcadores tumorais em pacientes com 50 anos ou mais: lições não aprendidas

OBJECTIVE: To investigate, within a private health insurance, the ordering frequency and the costs related to inappropriate tumor markers test orders. METHODS: This study analyzed data regarding tumor markers requests within a private health insurance between 2010 and 2017. Patients included in this analysis were ≥ 50 years old, had available medical records, and had at least 1 tumor markers tested within the study period. Tests were considered inappropriate when tumor markers were used in screening for neoplasms, ie, when there was no previous diagnosis. We evaluated data regarding age, sex, the ordering physician's medical specialty, and test costs. RESULTS: Between 2010 and 2017, 1112 tumor markers tests were performed and increased from 52 to 262 per year. Our sample consisted mostly of women (69.50%) with a mean age of 59.40 (SD 8.20) years. Most orders were inappropriate (87.80%) and represented 79.40% of all expenses with tumor markers tests. Cardiology professionals were the medical specialty that requested the most tumor markers tests (23.90%), followed by internal medicine specialists (22.70%) and gynecologists (19.20%). CONCLUSIONS: We observed a high percentage of inappropriate test orders in the study period, resulting in elevated costs. Studies of this nature deserve the attention of health care managers, and interventions should be performed in order to reduce the inappropriate use of tumor markers tests in clinical practice.

OBJETIVO: investigar no âmbito de um plano de saúde privado a frequência de solicitação e os custos relacionados à solicitação inapropriada de marcadores tumorais. METODOLOGIA: Utilizou-se a base de dados de um plano de saúde privado entre os anos de 2010 a 2017. Foram incluídos na pesquisa, sujeitos com idade ≥ 50 anos, que apresentavam prontuários médicos acessíveis e que havia realizado a dosagem de algum marcadores tumorais no período. Considerou-se como "exame inapropriado" quando o marcador tumoral foi utilizado como rastreio de neoplasia, ou seja, quando não havia o diagnóstico prévio. Foram avaliados os dados referentes à idade, sexo, especialidade do médico solicitante e informações sobre os custos desses exames. RESULTADOS: Foram realizados um total 1.112 testes no período, representando um aumento de 52 para 262 exames/ano. A amostra foi composta na maioria pelo sexo feminino (69,50%), com média de idade de 59,40 ± 8,20 anos. A maioria das solicitações foram inapropriadas (87,80%). Notou-se que a solicitação desses exames, impactaram cerca de 79,40% dos gastos totais do plano de saúde com marcadores tumorais. Os cardiologistas foram a especialidade que mais solicitaram marcadores tumorais em 23,90% das ocasiões, seguidos pelos especialistas em clínica médica (22,70%) e ginecologistas (19,20%). CONCLUSÕES: Observamos um alto percentual de pedidos de exames inadequados no período do estudo, resultando em custos elevados. Estudos dessa natureza merecem a atenção dos gestores de saúde e intervenções devem ser realizadas a fim de reduzir o uso inadequado de testes de marcador tumoral na prática clínica.

A cirurgia bariátrica como intervenção segura e eficaz para o controle de comorbidades em idosos / Bariatric surgery as a safe and effective intervention for the control of comorbidities in older adults

INTRODUÇÃO: A obesidade no idoso, além de estar associada à piora de doenças relacionadas à síndrome metabólica e a distúrbios osteoarticulares, aumenta o risco de quedas, síndrome de fragilidade, depressão e demência, com consequente perda de funcionalidade. Entre todos os tratamentos disponíveis, a cirurgia bariátrica é uma alternativa em pacientes elegíveis. OBJETIVOS: Discutir aspectos relacionados à segurança e aos benefícios da cirurgia bariátrica para o controle ou a remissão de comorbidades no idoso. METODOLOGIA: Foi realizada revisão de literatura em bases de dados utilizando os seguintes descritores: bariatric surgery and elderly or aged or older adult and comorbidities or safety. Foram incluídos ensaios clínicos, estudos observacionais, estudos comparativos e revisões que avaliaram o efeito da cirurgia bariátrica no controle ou na remissão de comorbidades em idosos. RESULTADOS: Nos últimos anos, vários estudos têm demonstrado não apenas controle ou remissão de comorbidades como diabetes, hipertensão e síndrome da apneia do sono, mas também reduzida taxa de complicações, semelhante à observada em jovens. CONCLUSÕES: Com base nos resultados desses estudos, há espaço para que procedimentos de cirurgia bariátrica sejam indicados a idosos elegíveis, sem limite de idade, considerando também aspectos funcionais e de expectativa de vida.

INTRODUCTION: In addition to being associated with worsening of diseases related to metabolic syndrome and musculoskeletal disorders, obesity in older adults increases the risk of falls, frailty syndrome, depression, and dementia, with consequent functional loss. Among all treatments available, bariatric surgery is an option for eligible patients. OBJECTIVES: To discuss aspects related to the safety and benefits of bariatric surgery for the control or remission of comorbidities in older adults. METHODS: This literature review was carried out in databases, using the following keywords: bariatric surgery and elderly or aged or older adult and comorbidities or safety. We included clinical trials, observational studies, comparative studies, and reviews that evaluated the effect of bariatric surgery on the control or remission of comorbidities in older adults. RESULTS: In recent years, several studies have evidenced not only control or remission of comorbidities, such as diabetes, hypertension, and sleep apnea syndrome, but also a low rate of complications, similar to those observed in young people. CONCLUSIONS: Based on the results of these studies, bariatric surgical procedures can be indicated for eligible older adults, without age restriction, taking into account functional and life expectancy aspects.