Motor and cognitive outcomes of neonates with low birth weight in Brazil: a systematic review and meta-analysis.

BACKGROUND: Data on the outcomes of preterm newborns in South American countries are scarce. Given the great effect of low birth weight (LBW) and/or prematurity on children's neurodevelopment, it is extremely necessary to conduct studies on these phenomena in greater depth in more heterogeneous populations such as those ones from countries with limited resources. METHODS: We conducted a comprehensive literature search on databases including PubMed, the Cochrane Library, and Web of Science for articles published in Portuguese and English up to March 2021 involving children born and evaluated in Brazil. The analysis of the risk of bias was adapted from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to evaluate the methodology of the included studies. RESULTS: From the eligible trials, 25 articles were selected for qualitative synthesis, and 5 of those, for quantitative synthesis (meta-analysis). The meta-analyses showed that children born with LBW presented lower scores on motor development when compared with controls (standardized mean difference: -1.15; 95% confidence interval [95%CI]: -1.56--0.73]; I2: 80%) and also scored lower in terms of cognitive development (standardized mean difference: -0.71; 95% CI: -0.99--0.44; I2: 67%). CONCLUSION: The results of the present study reinforce that impaired motor and cognitive functions can be a significant long-term outcome of LBW. The lower the gestational age at delivery, the higher the risk of impairment in those domains. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database under number CRD42019112403.

ANTECEDENTES: Dados sobre desfechos de recém-nascidos prematuros em países da América do Sul são escassos. Dado o grande efeito do baixo peso ao nascer (BPN) e/ou da prematuridade no neurodesenvolvimento das crianças, é extremamente necessária a realização de estudos que investiguem esses fenômenos com maior profundidade em populações mais heterogêneas. MéTODOS: Realizou-se uma busca da literatura em bases de dados, incluindo PubMed, Cochrane Library e Web of Science, por artigos publicados em português e inglês até março de 2021 envolvendo crianças nascidas e avaliadas no Brasil. A análise de risco de viés foi adaptada da declaração de Fortalecimento do Relato de Estudos Observacionais em Epidemiologia (Strengthening the Reporting of Observational Studies in Epidemiology, STROBE), que foi utilizada para avaliar a metodologia dos estudos. RESULTADOS: Dos estudos elegíveis, 25 artigos foram selecionados para síntese qualitativa, e 5 desses 25, para síntese quantitativa (metanálise). As metanálises mostraram que crianças nascidas com BPN apresentaram pontuação menor em desenvolvimento motor quando comparadas aos controles (diferença média padronizada, −1,15; intervalo de confiança de 95% [IC95%]: −1,56­−0,73]; I2: 80%) e pontuação também menor em termos de desenvolvimento cognitivo (diferença média padronizada, −0,71; IC95%: −0,992−0,44; I2: 67%). CONCLUSãO: Os resultados deste estudo reforçam que o comprometimento das funções motoras e cognitivas pode ser um desfecho significativo de longo prazo do BPN. Quanto menor a idade gestacional no momento do parto, maior o risco de prejuízo nesses domínios. O protocolo do estudo foi registrado no banco de dados International Prospective Register of Systematic Reviews (PROSPERO) sob o número CRD42019112403.

Motor and cognitive outcomes of neonates with low birth weight in Brazil: a systematic review and meta-analysis / Desfechos motores e cognitivos de recém-nascidos com baixo peso ao nascer no Brasil: uma revisão sistemática e metanálise

Abstract Background Data on the outcomes of preterm newborns in South American countries are scarce. Given the great effect of low birth weight (LBW) and/or prematurity on children's neurodevelopment, it is extremely necessary to conduct studies on these phenomena in greater depth in more heterogeneous populations such as those ones from countries with limited resources. Methods We conducted a comprehensive literature search on databases including PubMed, the Cochrane Library, and Web of Science for articles published in Portuguese and English up to March 2021 involving children born and evaluated in Brazil. The analysis of the risk of bias was adapted from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and used to evaluate the methodology of the included studies. Results From the eligible trials, 25 articles were selected for qualitative synthesis, and 5 of those, for quantitative synthesis (meta-analysis). The meta-analyses showed that children born with LBW presented lower scores on motor development when compared with controls (standardized mean difference: -1.15; 95% confidence interval [95%CI]: -1.56--0.73]; I2: 80%) and also scored lower in terms of cognitive development (standardized mean difference: -0.71; 95% CI: -0.99--0.44; I2: 67%). Conclusion The results of the present study reinforce that impaired motor and cognitive functions can be a significant long-term outcome of LBW. The lower the gestational age at delivery, the higher the risk of impairment in those domains. The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database under number CRD42019112403.

Resumo Antecedentes Dados sobre desfechos de recém-nascidos prematuros em países da América do Sul são escassos. Dado o grande efeito do baixo peso ao nascer (BPN) e/ou da prematuridade no neurodesenvolvimento das crianças, é extremamente necessária a realização de estudos que investiguem esses fenômenos com maior profundidade em populações mais heterogêneas. Métodos Realizou-se uma busca da literatura em bases de dados, incluindo PubMed, Cochrane Library e Web of Science, por artigos publicados em português e inglês até março de 2021 envolvendo crianças nascidas e avaliadas no Brasil. A análise de risco de viés foi adaptada da declaração de Fortalecimento do Relato de Estudos Observacionais em Epidemiologia (Strengthening the Reporting of Observational Studies in Epidemiology, STROBE), que foi utilizada para avaliar a metodologia dos estudos. Resultados Dos estudos elegíveis, 25 artigos foram selecionados para síntese qualitativa, e 5 desses 25, para síntese quantitativa (metanálise). As metanálises mostraram que crianças nascidas com BPN apresentaram pontuação menor em desenvolvimento motor quando comparadas aos controles (diferença média padronizada, -1,15; intervalo de confiança de 95% [IC95%]: -1,56--0,73]; I2: 80%) e pontuação também menor em termos de desenvolvimento cognitivo (diferença média padronizada, -0,71; IC95%: -0,992-0,44; I2: 67%). Conclusão Os resultados deste estudo reforçam que o comprometimento das funções motoras e cognitivas pode ser um desfecho significativo de longo prazo do BPN. Quanto menor a idade gestacional no momento do parto, maior o risco de prejuízo nesses domínios. O protocolo do estudo foi registrado no banco de dados International Prospective Register of Systematic Reviews (PROSPERO) sob o número CRD42019112403.

Increased Glucose Activity in Subgenual Anterior Cingulate and Hippocampus of High Performing Older Adults, Despite Amyloid Burden.

BACKGROUND: Individuals at 80 years of age or above with exceptional memory are considered SuperAgers (SA), an operationalized definition of successful cognitive aging. SA showed increased thickness and altered functional connectivity in the anterior cingulate cortex as a neurobiological signature. However, their metabolic alterations are yet to be uncovered. OBJECTIVE: Herein, a metabolic (FDG-PET), amyloid (PIB-PET), and functional (fMRI) analysis of SA were conducted. METHODS: Ten SA, ten age-matched older adults (C80), and ten cognitively normal middle-aged (C50) adults underwent cognitive testing and multimodal neuroimaging examinations. Anterior and posterior regions of the cingulate cortex and hippocampal areas were primarily examined, then subregions of anterior cingulate were segregated. RESULTS: The SA group showed increased metabolic activity in the left and right subgenual anterior cingulate cortex (sACC, p < 0.005 corrected, bilateral) and bilateral hippocampi (right: p < 0.0005 and left: p < 0.005, both corrected) as compared to that in the C80 group. Amyloid deposition was above threshold in 30% of SA and C80 (p > 0.05). The SA group also presented decreased connectivity between right sACC and posterior cingulate (p < 0.005, corrected) as compared to that of the C80 group. CONCLUSION: These results support the key role of sACC and hippocampus in SA, even in the presence of amyloid deposition. It also suggests that sACC may be used as a potential biomarker in older adults for exceptional memory ability. Further longitudinal studies measuring metabolic biomarkers may help elucidate the interaction between these areas in the cognitive aging process.

Evaluating subjective cognitive decline: a systematic review of tools available for evaluating cognitive complaints in Portuguese.

BACKGROUND: Subjective cognitive decline (SCD) is a perception that is not objectively measured in screening tests. Although many tools are available for evaluating SCD, no single gold standard is available for classifying individuals as presenting SCD, in the Portuguese-speaking population. The aim of this study was to systematically review the literature for tools used to evaluate SCD in the Portuguese-speaking population. METHODS: Four databases (Web of Science, SciELO, LILACS and MEDLINE) were primarily utilized in this study (Phase 1). Subsequently, we conducted a manual search of the literature (Phase 2). We then retrieved tools for critical evaluation (Phase 3). Studies that matched the inclusion criteria were analyzed. We summarized the features of each tool in terms of the number of questions, scoring system, benefits and deficiencies, translation and validity. RESULTS: A total of 30 studies utilizing four questionnaires and seven different single questions were found. The tools retrieved were the Memory Assessment Questionnaire (MAC-Q; 12/30 studies), single-question methods (7/30 studies), Subjective Memory Complaint Scale (SMC scale; 5/30 studies), Prospective and Retrospective Memory Questionnaire (PRMQ; 3/30 studies) and Memory Complaint Scale (MCS; 3/30 studies). Only two were formally translated and validated for the Portuguese speaking population (PRMQ and MCS). CONCLUSIONS: In summary, SCD is still underinvestigated in Portuguese-speaking countries. The MAC-Q was the most commonly used tool in Portuguese, despite its lack of formal translation and validation for the Portuguese-speaking population. Further studies are required in order to develop and validate a screening tool that includes questions for detecting SCD-plus features and affective symptoms, so as to improve its predictive value.

Left Hemisphere Lateralization of Epileptic Focus Can Be More Frequent in Temporal Lobe Epilepsy Surgical Patients with No Consensus Associated with Depression Lateralization.

Temporal lobe epilepsy (TLE) is considered to be the most common form of epilepsy, and it has been seen that most patients are refractory to antiepileptic drugs. A strong association of this ailment has been established with psychiatric comorbidities, primarily mood and anxiety disorders. The side of epileptogenic may contribute to depressive and anxiety symptoms; thus, in this study, we performed a systematic review to evaluate the prevalence of depression in TLE in surgical patients. The literature search was performed using PubMed/Medline, Web of Science, and PsycNet to gather data from inception until January 2019. The search strategy was related to TLE, depressive disorder, and anxiety. After reading full texts, 14 articles meeting the inclusion criteria were screened. The main method utilized for psychiatric diagnosis was Diagnostic and Statistical Manual of Mental Disorders/Structured Clinical Interview for DSM. However, most studies failed to perform the neuropsychological evaluation. For those with lateralization of epilepsy, focus mostly occurred in the left hemisphere. For individual depressive diagnosis, 9 studies were evaluated, and 5 for anxiety. Therefore, from the data analyzed in both situations, no diagnosis was representative in preoperative and postoperative cases. In order to estimate the efficacy of surgery in the psychiatry episodes and its relation to seizure control, the risk of depression and anxiety symptoms in epileptic patients need to be determined before surgical procedures. Rigorous preoperative and postoperative evaluation is essential for psychiatry conditions in patients with refractory epilepsy candidates for surgery.

Evaluating subjective cognitive decline: a systematic review of tools available for evaluating cognitive complaints in Portuguese / Avaliação de declínio cognitivo subjetivo: uma revisão sistemática de instrumentos disponíveis para avaliar queixa cognitiva em português

ABSTRACT Background: Subjective cognitive decline (SCD) is a perception that is not objectively measured in screening tests. Although many tools are available for evaluating SCD, no single gold standard is available for classifying individuals as presenting SCD, in the Portuguese-speaking population. The aim of this study was to systematically review the literature for tools used to evaluate SCD in the Portuguese-speaking population. Methods: Four databases (Web of Science, SciELO, LILACS and MEDLINE) were primarily utilized in this study (Phase 1). Subsequently, we conducted a manual search of the literature (Phase 2). We then retrieved tools for critical evaluation (Phase 3). Studies that matched the inclusion criteria were analyzed. We summarized the features of each tool in terms of the number of questions, scoring system, benefits and deficiencies, translation and validity. Results: A total of 30 studies utilizing four questionnaires and seven different single questions were found. The tools retrieved were the Memory Assessment Questionnaire (MAC-Q; 12/30 studies), single-question methods (7/30 studies), Subjective Memory Complaint Scale (SMC scale; 5/30 studies), Prospective and Retrospective Memory Questionnaire (PRMQ; 3/30 studies) and Memory Complaint Scale (MCS; 3/30 studies). Only two were formally translated and validated for the Portuguese speaking population (PRMQ and MCS). Conclusions: In summary, SCD is still underinvestigated in Portuguese-speaking countries. The MAC-Q was the most commonly used tool in Portuguese, despite its lack of formal translation and validation for the Portuguese-speaking population. Further studies are required in order to develop and validate a screening tool that includes questions for detecting SCD-plus features and affective symptoms, so as to improve its predictive value.

RESUMO Introdução: Declínio cognitivo subjetivo (DCS) é uma percepção não objetivamente mensurada em testes de rastreio. Apesar de muitos instrumentos estarem disponíveis para avaliação de DCS, nenhum padrão-ouro único é capaz de classificar um indivíduo com DCS em população falante de português. Este estudo objetivou revisar sistematicamente a literatura para instrumentos usados, para avaliar DCS em falantes de português. Métodos: Quatro bases de dados (Web of Science, SciELO, LILACS e MEDLINE) foram inicialmente usadas neste estudo (Fase 1). Em seguida, conduzimos uma busca manual (Fase 2) e os instrumentos coletados foram criticamente avaliados (Fase 3). Estudos que correspondiam aos critérios de inclusão foram analisados. Nós resumimos as características de cada instrumento em termos de números de questões, sistema de pontuação, vantagens e desvantagens, tradução e validação. Resultados: O total de 30 estudos utilizou 4, questionários e 7 diferentes questões para avaliar DCS. Os instrumentos avaliados foram Memory Assessment Questionnaire (MAC-Q, 12/30 estudos), método de questão única (7/30 estudos), Subjective Memory Complaint Scale (SMC-scale, 5/30 estudos), Prospective and Retrospective Memory Questionnaire (PRMQ, 3/30 estudos) e Memory Complaint Scale (MCS, 3/30 estudos). Apenas dois instrumentos foram formalmente traduzidos e validados para falantes de português (PRMQ e MCS). Conclusões: Em suma, DCS é ainda sub-representado em países lusofônicos. O MAC-Q foi o instrumento mais utilizado em português, apesar de sua falta de tradução e validação formal para a população falante de português. Mais estudos são necessários para desenvolver e validar um instrumento de rastreio que inclua questões sobre DCS-plus e sintomas afetivos, para aumentar seu poder preditivo.

Review of neuroimaging findings in congenital Zika virus syndrome and its relation to the time of infection.

BACKGROUND: Many original articles and case series have been published emphasizing the neuroimaging findings of congenital Zika virus (ZIKV) infection. The majority of these studies do not follow a neuroradiological methodology to describe malformations and brain abnormalities resulting from ZIKV infection. The cause-and-effect correlation between the gestational period of maternal infection and the severity of encephalic changes at birth has rarely been reported. A systematic literature review was conducted on the neuroimaging findings in children affected with microcephaly due to ZIKV. METHODS: PubMed, Cochrane Library and Web of Science were searched for full-text articles published up to July 2019. Duplicate entries were removed. Two independent reviewers performed a quality assessment of all the studies included. RESULTS: A total of 2214 publications were identified. Of these 2170 were excluded by analysis of titles and abstracts, resulting in the inclusion of only eight articles. Chi-square and Fisher's exact tests were performed with a 95% confidence interval to verify the statistically significant differences in the neuroradiological findings between the cases of ZIKV infection in the first or second trimester of gestation. The studies published so far have described image abnormalities at random, without utilizing any pre-established neuroradiological criteria, and imaging modalities with different sensitivity and accuracy have been used, which jeopardizes a reliable and adequate statistical analysis. CONCLUSIONS: Neuroimaging abnormalities are much more prevalent and severe when the infection by ZIKV is contracted in the first or second trimester of pregnancy.

Validação do instrumento "teste seu cérebro" para idosos: versão para iPad / Validation of the instrument "test your brain" for the elderly: iPad version

OBJETIVOS: Validar o aplicativo para iPad (Apple, Califórnia, EUA) "Teste seu Cérebro", bem como estabelecer ponto de corte entre idosos normais e com transtorno neurocognitivo leve. MÉTODOS: Em um estudo transversal prospectivo, idosos que frequentaram o ambulatório de neuropsicologia de um hospital terciário de saúde da região sul do Brasil e da comunidade em geral, foram submetidos a avaliação cognitiva por meio de dois instrumentos: Montreal Cognitive Assessment (teste padrão ouro) e "Teste seu Cérebro". Esses resultados serviram como parâmetro para validar o referido aplicativo a partir de um teste diagnóstico e estabelecer o ponto de corte entre idosos normais e com transtorno neuropsicológico leve; para tanto foram determinadas as seguintes medidas estatísticas: sensibilidade e especificidade; consistência interna e confiabilidade alcançadas pelo coeficiente Ômega de McDonald e coeficiente de correlação de Pearson, respectivamente. A classificação média do ponto de corte do "Teste seu Cérebro" para detectar os casos classificados como transtorno neurocognitivo leve pelo teste Montreal Cognitive Assessment, foi obtida através da curva ROC. As avaliações contemplam funções como: memória, atenção/orientação, fluência, linguagem e habilidades viso-espaciais... RESULTADOS: A amostra foi constituída por 104 participantes com média de idade de 70,3±6,6 anos, sendo a idade mínima de 60 e máxima de 87 anos. Foi alcançada uma confiabilidade aceitável para o aplicativo "Teste seu Cérebro" através da análise da consistência interna. Na comparação entre as pontuações gerais dos dois instrumentos (Teste seu Cérebro e Montreal Cognitive Assessment), o resultado apontou uma correlação estatisticamente significativa positiva e classificada como moderada. O ponto de corte das pontuações do "Teste seu Cérebro" que melhor discriminou os pacientes com transtorno neurocognitivo leve diagnosticados pelo Montreal Cognitive Assessment foi de 89,5%, ou seja, pontuações inferiores ou iguais a esse percentual alcançaram maiores sensibilidade e especificidade para o instrumento. Não foi identificada influência das variáveis sociodemográficas como sexo, idade e escolaridade sobre a relação de linearidade entre os instrumentos "Teste seu Cérebro" e Montreal Cognitive Assessment. CONCLUSÕES: Os resultados obtidos sugerem que o instrumento "Teste seu Cérebro" pode ser utilizado com segurança para identificar precocemente e com acurácia a presença de transtorno neurocognitivo leve na população idosa. Novos estudos serão direcionados à validação do instrumento "Teste seu Cérebro" na identificação de outros tipos de distúrbios cognitivos, além de Transtorno Neurocognitivo Leve.

AIMS: Validate the application for iPad (Apple, California, USA) "Teste seu Cérebro" as well as establish cutoff point between normal seniors and Mild Neurocognitive Impairment. METHODS: In a prospective cross-sectional study, elderly subjects who attended the neuropsychology clinic of a tertiary health hospital in the southern region of Brazil and the community in general underwent cognitive assessment using two instruments: the Montreal Cognitive Assessment (Gold Standard Test) and the "Teste seu Cérebro". These results served as a parameter to validate the said application from a diagnostic test and to establish the cutoff point between normal elderly and mild cognitive impairment; the following statistical measures were determined: sensitivity and specificity, internal consistency and reliability reached by the McDonald's Omega coefficient and Pearson's correlation coefficient, respectively. The average "Teste seu Cérebro" cutoff point to detect cases classified as mild neurocognitive impairment by the Montreal Cognitive Assessment was obtained through the ROC curve. Evaluations include functions such as memory, attention / orientation, fluency, language, and visuospatial skills. RESULTS: The sample consisted of 104 participants with mean age of 70.3 (standard deviation=6.6), with a minimum age of 60 and a maximum of 87 years. An acceptable reliability was achieved for the "Teste seu Cérebro" application by analyzing the internal consistency. In the comparison between the general scores of the two instruments (Teste seu Cérebro and Montreal Cognitive Assessment), where the result showed a statistically significant correlation, positive and classified as moderate. The cutoff point of the "Teste seu Cérebro" scores that best discriminated patients with mild neurocognitive impairment diagnosed by the Montreal Cognitive Assessment was 89.5%, that is, scores below or equal to that percentage reached higher sensitivity and specificity for the instrument. No influence of sociodemographic variables such as sex, age and schooling were identified on the linearity relationship between the "Teste seu Cérebro" and Montreal Cognitive Assessment instruments. CONCLUSIONS: The results suggest that the "Teste seu Cérebro" instrument can be safely used to identify early and accurately the presence of Mild Neurocognitive Impairment in the elderly population. New studies will be directed to the validation of the instrument "Teste seu Cérebro" in the identification of other types of cognitive disorders, in addition to Mild Neurocognitive Impairment.