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1.
Int J Obes (Lond) ; 47(3): 165-174, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36585494

RESUMO

BACKGROUND: Obesity is a disease that may involve disrupted connectivity of brain networks. Bariatric surgery is an effective treatment for obesity, and the positive effects on obesity-related conditions may be enhanced by exercise. Herein, we aimed to investigate the possible synergistic effects of Roux-en-Y Gastric Bypass (RYGB) and exercise training on brain functional networks. METHODS: Thirty women eligible for bariatric surgery were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n = 15, age = 41.0 ± 7.3 years) or RYGB plus Exercise Training (RYGB + ET: n = 15, age = 41.9 ± 7.2 years). Clinical, laboratory, and brain functional connectivity parameters were assessed at baseline, and 3 (POST3) and 9 months (POST9) after surgery. The 6-month, three-times-a-week, exercise intervention (resistance plus aerobic exercise) was initiated 3 months post-surgery (for RYGB + ET). RESULTS: Exercise superimposed on bariatric surgery (RYGB + ET) increased connectivity between hypothalamus and sensorial regions (seed-to-voxel analyses of hypothalamic connectivity), and decreased default mode network (DMN) and posterior salience (pSAL) network connectivity (ROI-to-ROI analyses of brain networks connectivity) when compared to RYGB alone (all p-FDR < 0.05). Increases in basal ganglia (BG) network connectivity were only observed in the exercised training group (within-group analyses). CONCLUSION: Exercise training is an important component in the management of post-bariatric patients and may improve the hypothalamic connectivity and brain functional networks that are involved in controlling food intake. TRIAL REGISTRATION: Clinicaltrial.gov: NCT02441361.


Assuntos
Cirurgia Bariátrica , Derivação Gástrica , Obesidade Mórbida , Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Obesidade Mórbida/cirurgia , Exercício Físico , Obesidade/cirurgia , Encéfalo , Hipotálamo
2.
Alzheimers Dement ; 19(5): 1849-1857, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-36326095

RESUMO

INTRODUCTION: Twelve risk factors (RFs) account for 40% of dementia cases worldwide. However, most data for population attributable fractions (PAFs) are from high-income countries (HIC). We estimated how much these RFs account for dementia cases in Brazil, stratifying estimates by race and socioeconomic level. METHODS: We calculated the prevalence and communalities of 12 RFs using 9412 Brazilian Longitudinal Study of Aging participants, then stratified according to self-reported race and country macro-regions. RESULTS: The overall weighted PAF was 48.2%. Less education had the largest PAF (7.7%), followed by hypertension (7.6%), and hearing loss (6.8%). PAF was 49.0% and 54.0% in the richest and poorest regions, respectively. PAFs were similar among White and Black individuals (47.8% and 47.2%, respectively) but the importance of the main RF varied by race. DISCUSSION: Brazil's potential for dementia prevention is higher than in HIC. Education, hypertension, and hearing loss should be priority targets.


Assuntos
Demência , Perda Auditiva , Hipertensão , Humanos , Brasil/epidemiologia , Estudos Longitudinais , Fatores de Risco , Demência/epidemiologia , Perda Auditiva/epidemiologia
3.
Alzheimers Dement ; 19(2): 721-735, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36098676

RESUMO

Limited knowledge on dementia biomarkers in Latin American and Caribbean (LAC) countries remains a serious barrier. Here, we reported a survey to explore the ongoing work, needs, interests, potential barriers, and opportunities for future studies related to biomarkers. The results show that neuroimaging is the most used biomarker (73%), followed by genetic studies (40%), peripheral fluids biomarkers (31%), and cerebrospinal fluid biomarkers (29%). Regarding barriers in LAC, lack of funding appears to undermine the implementation of biomarkers in clinical or research settings, followed by insufficient infrastructure and training. The survey revealed that despite the above barriers, the region holds a great potential to advance dementia biomarkers research. Considering the unique contributions that LAC could make to this growing field, we highlight the urgent need to expand biomarker research. These insights allowed us to propose an action plan that addresses the recommendations for a biomarker framework recently proposed by regional experts.


Assuntos
Demência , Humanos , América Latina , Demência/diagnóstico
4.
BMC Med ; 20(1): 374, 2022 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-36284318

RESUMO

BACKGROUND: Observational studies support a role for oral anticoagulation to reduce the risk of dementia in atrial fibrillation patients, but conclusive data are lacking. Since dabigatran offers a more stable anticoagulation, we hypothesized it would reduce cognitive decline when compared to warfarin in old patients with atrial fibrillation. METHODS: The GIRAF trial was a 24-month, randomized, parallel-group, controlled, open-label, hypothesis generating trial. The trial was done in six centers including a geriatric care unit, secondary and tertiary care cardiology hospitals in São Paulo, Brazil. We included patients aged ≥ 70 years and CHA2DS2-VASc score > 1. The primary endpoint was the absolute difference in cognitive performance at 2 years. Patients were assigned 1:1 to take dabigatran (110 or 150 mg twice daily) or warfarin, controlled by INR and followed for 24 months. Patients were evaluated at baseline and at 2 years with a comprehensive and thorough cognitive evaluation protocol of tests for different cognitive domains including the Montreal Cognitive Assessment (MoCA), Mini-Mental State Exam (MMSE), a composite neuropsychological test battery (NTB), and computer-generated tests (CGNT). RESULTS: Between 2014 and 2019, 5523 participants were screened and 200 were assigned to dabigatran (N = 99) or warfarin (N = 101) treatment. After adjustment for age, log of years of education, and raw baseline score, the difference between the mean change from baseline in the dabigatran group minus warfarin group was - 0.12 for MMSE (95% confidence interval [CI] - 0.88 to 0.63; P = 0.75), 0.05 (95% CI - 0.07 to 0.18; P = 0.40) for NTB, - 0.15 (95% CI - 0.30 to 0.01; P = 0.06) for CGNT, and - 0.96 (95% CI - 1.80 to 0.13; P = 0.02) for MoCA, with higher values suggesting less cognitive decline in the warfarin group. CONCLUSIONS: For elderly patients with atrial fibrillation, and without cognitive compromise at baseline that did not have stroke and were adequately treated with warfarin (TTR of 70%) or dabigatran for 2 years, there was no statistical difference at 5% significance level in any of the cognitive outcomes after adjusting for multiple comparisons. TRIAL REGISTRATION: Cognitive Impairment Related to Atrial Fibrillation Prevention Trial (GIRAF), NCT01994265 .


Assuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Idoso , Humanos , Varfarina/efeitos adversos , Dabigatrana/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/complicações , Anticoagulantes/efeitos adversos , Brasil/epidemiologia , Acidente Vascular Cerebral/complicações , Cognição
5.
Alzheimers Dement ; 18(4): 581-590, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34338427

RESUMO

INTRODUCTION: Few dementia incidence studies have been performed in Latin America. We aimed to provide the incidence of dementia in a Brazilian community-dwelling elderly population. METHODS: This study was conducted in urban and rural areas of Tremembé. The 520 participants without dementia at baseline were invited to participate in the follow-up. RESULTS: After a median follow-up of 5 years, the incidence rate of dementia was 26.1 per 1000 person-years (PY) (95% confidence interval  = 18.7-36.6/1000PY). This rate increased exponentially with age (8.3/1000PY for 60- to 64-year-olds to 110.2/1000PY for ≥80-year-olds) and lower education (10.5/1000PY for > 8 years of education to 59.2/1000PY for illiterates). Higher dementia risk was found among individuals with cognitive impairment no dementia at baseline. DISCUSSION: The dementia incidence rate found was higher than in other countries in people under 65 years. Higher incidence in younger individuals is expected in developing countries probably due to low education and a high burden of cardiovascular diseases.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Brasil/epidemiologia , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Demência/epidemiologia , Demência/psicologia , Humanos , Incidência , Pessoa de Meia-Idade , Fatores de Risco
6.
J Geriatr Psychiatry Neurol ; 34(5): 397-404, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-32762416

RESUMO

INTRODUCTION: There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD). OBJECTIVES: To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale-frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR). METHODS: The sample consisted of 70 individuals, aged 40+ years, with at least 2 years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant), and 27 with AD. The FTD-FRS, the CDR, and the 2 additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke Cognitive Examination-Revised was completed by patients. After 12 months, the same protocol was applied. RESULTS: The FTD-FRS, CDR-FTLD, and CDR detected significant decline after 12 months in the 3 clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages. CONCLUSIONS: The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum.


Assuntos
Doença de Alzheimer , Afasia Primária Progressiva , Demência Frontotemporal , Doença de Alzheimer/diagnóstico , Afasia Primária Progressiva/diagnóstico , Progressão da Doença , Demência Frontotemporal/diagnóstico , Humanos , Testes de Estado Mental e Demência
7.
Alzheimer Dis Assoc Disord ; 32(4): 314-319, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29734264

RESUMO

INTRODUCTION: Executive dysfunction is a common symptom in neurodegenerative disorders and is in need of easy-to-apply screening tools that might identify it. The aims of the present study were to examine some of the psychometric characteristics of the Brazilian version of the INECO frontal screening (IFS), and to investigate its accuracy to diagnose executive dysfunction in dementia and its accuracy to differentiate Alzheimer disease (AD) from the behavioral variant of frontotemporal dementia (bvFTD). METHODS: Patients diagnosed with bvFTD (n=18) and AD (n=20), and 15 healthy controls completed a neuropsychological battery, the Neuropsychiatric Inventory, the Cornell Scale for Depression in Dementia, the Clinical Dementia Rating, and the IFS. RESULTS: The IFS had acceptable internal consistency (α=0.714) and was significantly correlated with general cognitive measures and with neuropsychological tests. The IFS had adequate accuracy to differentiate patients with dementia from healthy controls (AUC=0.768, cutoff=19.75, sensitivity=0.80, specificity=0.63), but low accuracy to differentiate bvFTD from AD (AUC=0.594, cutoff=16.75, sensitivity=0.667, specificity=0.600). CONCLUSION: The present study suggested that the IFS may be used to screen for executive dysfunction in dementia. Nonetheless, it should be used with caution in the differential diagnosis between AD and bvFTD.


Assuntos
Doença de Alzheimer/diagnóstico , Diagnóstico Diferencial , Demência Frontotemporal/diagnóstico , Programas de Rastreamento , Idoso , Brasil , Função Executiva , Feminino , Humanos , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Psicometria/normas , Sensibilidade e Especificidade
8.
Alzheimer Dis Assoc Disord ; 32(3): 220-225, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29438114

RESUMO

INTRODUCTION: Few studies on instruments for staging frontotemporal dementia (FTD) have been conducted. OBJECTIVE: The objective of this study was to analyze the factor structure, internal consistency, reliability, and convergent validity of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS). METHODS: A total of 97 individuals aged 40 years and above with >2 years' education took part in the study, 31 patients diagnosed with behavioral variant FTD (bvFTD), 8 patients with primary progressive aphasia, 28 with Alzheimer disease, 8 with mild cognitive impairment, and a control group of 22 healthy subjects. The FTD-FRS was completed by family members or caregivers, and Neurologists completed the 8-item Clinical Dementia Rating for Frontotemporal Lobar Degeneration (CDR-FTLD) scale (6 original domains plus Language and Behavior). The Alzheimer disease and FTD patients had equivalent disease severity level. RESULTS: The internal consistency of the FTD-FRS, estimated by Cronbach α, was 0.975 whereas test-retest reliability was 0.977. Scree plot and exploratory factor (Varimax rotation) analyses revealed the existence of 4 factors, with eigenvalues >1, which together explained 77.13% of the total variance with values of 1.28 to 17.52. The domains of the Brazilian version of the FTD-FRS scale correlated with the domains of the CDR-FTLD. CONCLUSIONS: The present study is the first to document the factorial structure of the FTD-FRS and its convergent validity with the CDR-FTLD. These tools are key to determine dementia severity in FTD. The Brazilian FTD-FRS demonstrated adequate psychometric properties for use in Brazil. This instrument may contribute to disease staging in FTD and may help to document intervention-related changes.


Assuntos
Progressão da Doença , Demência Frontotemporal/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/normas , Idoso , Doença de Alzheimer/diagnóstico , Afasia Primária Progressiva/diagnóstico , Brasil , Disfunção Cognitiva/diagnóstico , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
9.
PLoS Med ; 14(3): e1002267, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28350821

RESUMO

BACKGROUND: Clinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative and vascular-related neuropathological lesions in 1,092 Brazilian admixed older adults, their correlation with cognitive and neuropsychiatric symptoms, and the accuracy of dementia subtype diagnosis. METHODS AND FINDINGS: In this cross-sectional study, we describe clinical and neuropathological variables related to cognitive impairment in 1,092 participants (mean age = 74 y, 49% male, 69% white, and mean education = 4 y). Cognitive function was investigated using the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory (NPI). Associations between neuropathological lesions and cognitive impairment were investigated using ordinal logistic regression. We developed a neuropathological comorbidity (NPC) score and compared it to CDR, IQCODE, and NPI scores. We also described and compared the frequency of neuropathological diagnosis to clinical diagnosis of dementia subtype. Forty-four percent of the sample met criteria for neuropathological diagnosis. Among these participants, 50% had neuropathological diagnoses of Alzheimer disease (AD), and 35% of vascular dementia (VaD). Neurofibrillary tangles (NFTs), hippocampal sclerosis, lacunar infarcts, hyaline atherosclerosis, siderocalcinosis, and Lewy body disease were independently associated with cognitive impairment. Higher NPC scores were associated with worse scores in the CDR sum of boxes (ß = 1.33, 95% CI 1.20-1.46), IQCODE (ß = 0.14, 95% CI 0.13-0.16), and NPI (ß = 1.74, 95% CI = 1.33-2.16). Compared to neuropathological diagnoses, clinical diagnosis had high sensitivity to AD and high specificity to dementia with Lewy body/Parkinson dementia. The major limitation of our study is the lack of clinical follow-up of participants during life. CONCLUSIONS: NFT deposition, vascular lesions, and high NPC scorewere associated with cognitive impairment in a unique Brazilian sample with low education. Our results confirm the high prevalence of neuropathological diagnosis in older adults and the mismatch between clinical and neuropathological diagnoses.


Assuntos
Demência/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/patologia , Brasil/epidemiologia , Cognição , Estudos Transversais , Demência/patologia , Demência Vascular/epidemiologia , Demência Vascular/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Int Psychogeriatr ; 29(8): 1345-1353, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28511735

RESUMO

BACKGROUND: Several cognitive tools have been developed aiming to diagnose dementia. The cognitive battery Addenbrooke's Cognitive Examination - Revised (ACE-R) has been used to detect cognitive impairment; however, there are few studies including samples with low education. The aim of the study was to provide ACE-R norms for seniors within a lower education, including illiterates. An additional aim was to examine the accuracy of the ACE-R to detect dementia and cognitive impairment no dementia (CIND). METHODS: Data originated from an epidemiological study conducted in the municipality of Tremembé, Brazil. The Brazilian version of ACE-R was applied as part of the cognitive assessment in all participants. Of the 630 participants, 385 were classified as cognitively normal (CN) and were included in the normative data set, 110 individuals were diagnosed with dementia, and 135 were classified as having CIND. RESULTS: ACE-R norms were provided with the sample stratified into age and education bands. ACE-R total scores varied significantly according to age, education, and sex. To distinguish CN from dementia, a cut-off of 64 points was established (sensitivity 91%, specificity 76%) and to differentiate CN from CIND the best cut-off was 69 points (sensitivity 73%, specificity 65%). Cut-off scores varied according to the educational level. CONCLUSIONS: This study offers normative and accuracy parameters for seniors with lower education and it should expand the use of the ACE-R for this population segment.


Assuntos
Cognição , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Programas de Rastreamento , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Brasil , Disfunção Cognitiva/psicologia , Estudos Transversais , Demência/psicologia , Feminino , Humanos , Idioma , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes
12.
Alzheimer Dis Assoc Disord ; 30(3): 281-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26840546

RESUMO

Population aging has been accompanied by worldwide growth in dementia. However, little is known about the prevalence of dementia and cognitive impairment not dementia in ethnically diverse populations, such as indigenous populations conceptualized as groups of persons who self-identify as indigenous and who are recognized as distinctive communities reproducing ancestral, historical, and territorial culture. This is particularly relevant in view of increasing life expectancy in indigenous populations and, consequently, in the number of elderly people, as well as the changes in their multimorbidity profile. In this study, a systematic review of the literature on the subject "cognitive impairment in indigenous elderly population" in the databases MEDLINE via PubMed, Lilacs, and Scopus showed that the prevalence of dementia in indigenous populations between 45 and 94 years old, originally from different countries, varied between 0.5% and 26.8% for age 60 and older, whereas the prevalence of cognitive impairment not dementia varied between 4.4% and 17.7%. Early onset of the disease, older age, low education level, and several poor health conditions were associated with prevalence rates and conversion from normal to any cognitive impairment. Cultural inadequacy of neuropsychological tests was the main factor reported in the selected studies, which makes the investigation of dementia a challenge in indigenous populations. These data reveal that the prevalence rates of dementia ranged from low to very high for those aged 60 years and older, with early onset of the disease and elevated mortality rate after initial diagnosis compared with the current global prevalence studies, suggesting that these individuals may be more vulnerable to cognitive disorders. Cognitive reserve and exposure to poor health status throughout life span may be considered in the interpretation of results.


Assuntos
Envelhecimento , Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Grupos Populacionais/etnologia , Fatores Etários , Humanos , Testes Neuropsicológicos , Prevalência
13.
Alzheimer Dis Assoc Disord ; 30(4): 310-317, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27082848

RESUMO

BACKGROUND: Mutations in GRN (progranulin) and MAPT (microtubule-associated protein tau) are among the most frequent causes of monogenic frontotemporal dementia (FTD), but data on the frequency of these mutations in regions such as Latin America are still lacking. OBJECTIVE: We aimed to investigate the frequencies of GRN and MAPT mutations in FTD cohorts from 2 Brazilian dementia research centers, the University of Sao Paulo and the Federal University of Minas Gerais medical schools. METHODS: We included 76 probands diagnosed with behavioral-variant FTD (n=55), semantic-variant Primary Progressive Aphasia (PPA) (n=11), or nonfluent-variant PPA (n=10). Twenty-five percent of the cohort had at least 1 relative affected with FTD. RESULTS: Mutations in GRN were identified in 7 probands, and in MAPT, in 2 probands. We identified 3 novel GRN mutations (p.Q130X, p.317Afs*12, and p.K259Afs*23) in patients diagnosed with nonfluent-variant PPA or behavioral-variant FTD. Plasma progranulin levels were measured and a cutoff value of 70 ng/mL was found, with 100% sensitivity and specificity to detect null GRN mutations. CONCLUSIONS: The frequency of GRN mutations was 9.6% and that of MAPT mutations was 7.1%. Among familial cases of FTD, the frequency of GRN mutations was 31.5% and that of MAPT mutations was 10.5%.


Assuntos
Demência Frontotemporal/genética , Peptídeos e Proteínas de Sinalização Intercelular/genética , Proteínas tau/genética , Idade de Início , Encéfalo/patologia , Brasil , Feminino , Demência Frontotemporal/diagnóstico por imagem , Estudos de Associação Genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação , Afasia Primária Progressiva não Fluente/diagnóstico por imagem , Afasia Primária Progressiva não Fluente/genética , Progranulinas
14.
Alzheimer Dis Assoc Disord ; 30(3): 264-71, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26629676

RESUMO

BACKGROUND: The prevalence of cognitive impairment is insufficiently determined in developing countries. The aim of this study was to ascertain the prevalence of cognitive impairment without dementia and dementia in community-dwelling elderly in Brazil. METHODS: This was a single-phase cross-sectional survey of the elderly (aged 60 years and above) living in the municipality of Tremembé, Brazil. Twenty percent of the households with elderly persons were randomly selected from urban and rural areas, to obtain a homogenous representation of all socioeconomic and cultural levels. RESULTS: We assessed 630 individuals [mean age, 71.3 y (±7.99); mean years of education, 4.9 (±4.54)] and found prevalence rates of 17.5% (95% confidence interval, 14.6-20.6) for dementia and 19.5% (95% confidence interval, 16.6-22.8) for cognitive impairment without dementia. These prevalence rates were influenced by age (P<0.001) and by educational level (P<0.001). There was no significant sex difference among diagnostic groups (P=0.166). The prevalence of dementia was higher in relatively younger individuals (below 70 y) when compared with other studies. Besides, dementia was associated with low socioeconomic status, stroke, previous psychiatric disorder, alcoholism, and epilepsy. CONCLUSIONS: The prevalence of dementia in this study was higher than in other studies, particularly among younger elderly.


Assuntos
Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Testes Neuropsicológicos , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Demência/epidemiologia , Feminino , Humanos , Masculino , Prevalência
15.
Sleep Med ; 121: 359-364, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39079370

RESUMO

BACKGROUND: Few studies have assessed whether neuropathological markers of AD in the preclinical and prodromal stages are associated with polysomnographic changes and obstructive sleep apnea (OSA). METHODS: This was a cross-sectional, case-control study of older adults (≥60 years) without relevant clinical and psychiatric comorbidities selected randomly from a cohort of individuals without dementia in a tertiary university hospital in São Paulo, Brazil. They underwent neuropsychological evaluation for clinical diagnosis and were allocated into two samples: cognitively unimpaired (CU) and mild cognitive impairment (MCI). Also, they underwent PET-PiB to determine the amyloid profile and all-night in-lab polysomnography. For each sample, we compared polysomnographic parameters according to the amyloid profile (A+ vs A-). RESULTS: We allocated 67 participants (mean age 73 years, SD 10,1), 70 % females, 14 ± 5 years of education, into two samples: CU (n = 28, 42.4 %) and MCI (n = 39, 57.6 %). In the CU sample, the group A+ (n = 9) showed worse sleep parameters than A- (n = 19) (lower total sleep time (p = 0.007), and sleep efficiency (p = 0.005); higher sleep onset latency (p = 0.025), wake time after sleep onset (p = 0.011), and arousal index (AI) (p = 0.007)), and changes in sleep structure: higher %N1 (p = 0.005), and lower %REM (p = 0.006). In the MCI sample, MCI A-had higher AI (p = 0.013), respiratory disturbance index (p = 0.025, controlled for age), and higher rates of severe OSA than A+. DISCUSSION: The amyloid profile was associated with polysomnographic markers of worse sleep quality in individuals with preclinical AD but not with prodromal AD, probably due to the higher frequencies of severe OSA.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Polissonografia , Sintomas Prodrômicos , Qualidade do Sono , Humanos , Feminino , Masculino , Idoso , Estudos Transversais , Estudos de Casos e Controles , Apneia Obstrutiva do Sono , Brasil , Testes Neuropsicológicos/estatística & dados numéricos , Tomografia por Emissão de Pósitrons , Pessoa de Meia-Idade , Amiloide/metabolismo
16.
Arch Clin Neuropsychol ; 37(3): 553-567, 2022 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-34673890

RESUMO

OBJECTIVE: Teleneuropsychology (teleNP) could potentially expand access to services for patients who are confined, have limited personal access to healthcare, or live in remote areas. The emergence of the COVID-19 pandemic has significantly increased the use of teleNP for cognitive assessments. The main objective of these recommendations is to identify which procedures can be potentially best adapted to the practice of teleNP in Latin America, and thereby facilitate professional decision-making in the region. METHOD: Steps taken to develop these recommendations included (1) formation of an international working group with representatives from 12 Latin American countries; (2) assessment of rationale, scope, and objectives; (3) formulation of clinical questions; (4) evidence search and selection; (5) evaluation of existing evidence and summary; and (6) formulation of recommendations. Levels of evidence were graded following the Oxford Centre for Evidence-Based Medicine system. Databases examined included PubMed, WHO-IRIS, WHO and PAHO-IRIS, Índice Bibliográfico Español en Ciencias de la Salud (IBCS), and LILACS. RESULTS: Working group members reviewed 18,400 titles and 422 abstracts and identified 19 articles meeting the criteria for level of evidence, categorization, and elaboration of recommendations. The vast majority of the literature included teleNP tests in the English language. The working group proposed a series of recommendations that can be potentially best adapted to the practice of teleNP in Latin America. CONCLUSIONS: There is currently sufficient evidence to support the use of videoconferencing technology for remote neuropsychological assessments. These recommendations will likely contribute to the advancement of teleNP research and practice in the region.


Assuntos
COVID-19 , Pandemias , Humanos , América Latina , Testes Neuropsicológicos , Neuropsicologia/métodos
17.
Front Neurol ; 12: 662253, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484092

RESUMO

Background: In the last 10 months, due to the Covid-19 pandemic, several studies have shown that health education and virtual support strategies for caregivers of patients with dementia, in the management of home care, can be viable. Low and middle income countries, in particular, have sought to use these means to reduce the daily burden of caregivers, through virtual meetings of education and support. Objectives: To present the feasibility of a pilot study on the use of a support action contemplated by the Caad Project-indirect costs of dementia-from HC-FMUSP. Methods: Observational study in which 93 caregivers were invited to participate in virtual meetings on a frequency of three times/week, lasting 1 h each. Results: Of the 93 invited family members, and after 3 months, 42 answered eight questions about the effectiveness of the action. High percentages of positive responses regarding program satisfaction ranged from 86 to 100%. Conclusion: This study showed results of a very simple intervention that suggests that it is possible to offer caregivers of patients with dementia a program that can be used in primary care, in order to understand the difficulty of caregivers in their daily care of patients with dementia, with daily management guidelines on a case-by-case basis, in addition to promoting the implementation of an education strategy about the importance of knowing, and recognizing anatomophysiological changes in the aging process and its implications for the rupture of the imaginary line that involves senescence and senility. This allows the caregiver to feel able to protect his patient and himself by preventing the emergence of common diseases in this age group. Further studies are needed to explore this type of non-pharmacological support.

18.
Lancet Healthy Longev ; 2(4): e222-e231, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-34790905

RESUMO

The prevalence of dementia in Latin America and the Caribbean is growing rapidly, increasing the burden placed on caregivers. Exacerbated by fragile health-care systems, unstable economies, and extensive inequalities, caregiver burden in this region is among the highest in the world. We reviewed the major challenges to caregiving in Latin America and the Caribbean, and we propose regional and coordinated actions to drive future change. Current challenges include the scarcity of formal long-term care, socioeconomic and social determinants of health disparities, gender-biased burdens, growing dementia prevalence, and the effect of the current COVID-19 pandemic on families affected by dementia. Firstly, we propose local and regional short-term strategic recommendations, including systematic identification of specific caregiver needs, testing of evidence-based local interventions, contextual adaptation of strategies to different settings and cultures, countering gender bias, strengthening community support, provision of basic technology, and better use of available information and communications technology. Additionally, we propose brain health diplomacy (ie, global actions aimed to overcome the systemic challenges to brain health by bridging disciplines and sectors) and convergence science as frameworks for long-term coordinated responses, integrating tools, knowledge, and strategies to expand access to digital technology and develop collaborative models of care. Addressing the vast inequalities in dementia caregiving across Latin America and the Caribbean requires innovative, evidence-based solutions coordinated with the strengthening of public policies.


Assuntos
COVID-19 , Demência , Diplomacia , Encéfalo , Região do Caribe , Feminino , Humanos , América Latina , Masculino , Pandemias , Sexismo
19.
Front Neurol ; 12: 631722, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33776890

RESUMO

Dementia is becoming increasingly prevalent in Latin America, contrasting with stable or declining rates in North America and Europe. This scenario places unprecedented clinical, social, and economic burden upon patients, families, and health systems. The challenges prove particularly pressing for conditions with highly specific diagnostic and management demands, such as frontotemporal dementia. Here we introduce a research and networking initiative designed to tackle these ensuing hurdles, the Multi-partner consortium to expand dementia research in Latin America (ReDLat). First, we present ReDLat's regional research framework, aimed at identifying the unique genetic, social, and economic factors driving the presentation of frontotemporal dementia and Alzheimer's disease in Latin America relative to the US. We describe ongoing ReDLat studies in various fields and ongoing research extensions. Then, we introduce actions coordinated by ReDLat and the Latin America and Caribbean Consortium on Dementia (LAC-CD) to develop culturally appropriate diagnostic tools, regional visibility and capacity building, diplomatic coordination in local priority areas, and a knowledge-to-action framework toward a regional action plan. Together, these research and networking initiatives will help to establish strong cross-national bonds, support the implementation of regional dementia plans, enhance health systems' infrastructure, and increase translational research collaborations across the continent.

20.
Artigo em Inglês | MEDLINE | ID: mdl-32850757

RESUMO

The recent development of IQ-CSF, the second generation of real-time quaking-induced conversion (RT-QuIC) using cerebrospinal fluid (CSF), for the diagnosis of Creutzfeldt-Jakob Disease (CJD) represents a major diagnostic advance in the field. Highly accurate results have been reported with encouraging reproducibility among different centers. However, availability is still insufficient, and only a few research centers have access to the method in developing countries. In Brazil, we have had 603 suspected cases of CJD since 2005, when surveillance started. Of these, 404 were undiagnosed. This lack of diagnosis is due, among other factors, to the lack of a reference center for the diagnosis of these diseases in Brazil, resulting in some of these samples being sent abroad for analysis. The aim of this research study is to report the pilot use of IQ-CSF in a small cohort of Brazilian patients with possible or probable CJD, implementing a reference center in the country. We stored CSF samples from patients with possible, probable or genetic CJD (one case) during the time frame of December 2016 through June 2018. All CSF samples were processed according to standardized protocols without access to the clinical data. Eight patients presented to our team with rapidly progressive dementia and typical neurological signs of CJD. We used CSF samples from seven patients with other neurological conditions as negative controls. Five out of seven suspected cases had positive tests; two cases showed inconclusive results. Among controls, there was one false-positive (a CSF sample from a 5-year-old child with leukemia under treatment). The occurrence of a false positive in one of the negative control samples raises the possibility of the presence of interfering components in the CSF sample from patients with non-neurodegenerative pathologies. Our pilot results illustrate the feasibility of having CJD CSF samples tested in Brazilian centers and highlight the importance of interinstitutional collaboration to pursue a higher diagnostic accuracy in CJD in Brazil and Latin America.

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