Fernando Machado Vilhena Dias

Depression impairs executive functioning in Parkinson disease patients with low educational level.

ObjectiveTo assess overall cognitive performance and executive functioning of nondemented Parkinson disease (PD) patients, and the influence of variables such as depression and education on cognition. BackgroundCognitive dysfunction in PD is common even in early stages. Different variables have been identified as potential risk factors for cognitive decline in PD. Some of these variables, such as depression and educational level, are complexly interrelated. MethodsEighty-two (male:female 52:30) subjects underwent clinical assessment which included the Unified Parkinsons Disease Rating Scale, Schwab-England Scale, Hoehn-Yahr Scale, Beck Depression Inventory, the Frontal Assessment Battery (FAB), and the Mini-Mental State Examination (MMSE). ResultsPatients with higher education, younger age, and who had a younger age at disease onset performed better on both the FAB and MMSE. Severity of disease correlated with worse cognitive performance. Performance on the FAB, but not the MMSE, worsened with increased severity of depressive symptoms. When patients were divided into groups with lower (≤4 y of schooling) and higher (≥5 y of schooling) education, the FAB and Beck Depression Inventory correlated negatively only in the group with lower educational level. ConclusionsPatients with PD present with cognitive impairment even when nondemented. Depression may exacerbate executive dysfunction, especially in subjects with lower educational level.

Executive functioning in patients with blepharospasm in comparison with patients with hemifacial spasm

BACKGROUND Non-motor symptoms have been described in primary dystonia, but the results on cognitive impairment in this condition are discordant. Blepharospasm (BM) is a type of primary focal dystonia characterized by recurrent and involuntary eye blinking. Hemifacial spasm (HS), a condition with different pathophysiology, constitutes an adequate control group when investigating non-motor disturbances in BM. OBJECTIVE To compare the performance of patients with BM and HS in the Frontal Assessment Battery (FAB). METHOD Twenty-two patients with BM and 29 patients with HS were submitted to the FAB and the Mini-Mental State Examination (MMSE). FAB scores were compared between the two groups. Correlations between FAB and sociodemographic and clinical variables were calculated. RESULTS BM group was not different from HS in relation to gender, age, length of symptoms, educational level and performance in the MMSE. FAB scores were also similar in both groups. FAB scores correlated negatively with age and positively with educational level and MMSE scores. CONCLUSION Executive functioning as assessed by FAB is not altered in BM in comparison with HS.

Infusion of Sydenham's chorea antibodies in striatum with up-regulated dopaminergic receptors: A pilot study to investigate the potential of SC antibodies to increase dopaminergic activity

BACKGROUND Sydenhams chorea (SC) is a neurological manifestation of rheumatic fever. Autoimmune mechanism of SC is supported by clinical improvement with immunomodulatory therapy; presence of circulating serum anti-basal ganglia antibodies; increase in Th2 group of cytokines in serum and CSF of patients. However, a role of the antibodies in the pathogenesis can only be established by their passive transfer. Chorea is a manifestation clearly related to increased dopaminergic (DA) activity. The purpose of this study was to investigate the potential of antibodies from patients with Sydenhams chorea to cause behavior alterations on rats with unilateral post-synaptic dopamine receptor up-regulation. METHODS Rats previously submitted to 6-hydroxidopamine (6-OH-DA) unilateral lesion of substantia nigra pars compacta (SNc) and tested with apomorphine to ensure DA receptors up regulation, received intrastriatal infusion of antibodies from SC patients (n=4) or healthy controls (n=3) during 48 h. 24h post infusion initiation (24PI) and 48 h post infusion initiation (48PI), we registered the occurrence of spontaneous contra lateral rotations (CLR). FINDINGS SC group exhibited significantly higher number of CLR than control group at 24PI (p=0.049) and 48PI (p=0.048). CONCLUSION The limited sample of the present study restricts us to affirm that SC is really an immune-mediated condition. However the significant result of this pilot study points to preliminary evidence that SC antibodies may affect DA activity in rats with up-regulated striatal DA receptors.

Frequency of psychiatric disorders in blepharospasm does not differ from hemifacial spasm

Dias FM, Doyle F, Kummer A, Cardoso F, Fontenelle LF, Teixeira AL. Frequency of psychiatric disorders in blepharospasm does not differ from hemifacial spasm. Objective: To compare the frequency of psychiatric disorders and the severity of psychiatric symptoms between patients with blepharospasm (BS) and hemifacial spasm (HS). Methods: BS is a type of primary focal dystonia characterised by recurrent and involuntary eye blinking. HS is a condition with different pathophysiology but similar clinical phenotype. Twenty-two patients with BS and 29 patients with HS participated in this study. They underwent a comprehensive psychiatric evaluation that included a structured clinical interview for current psychiatric diagnosis according to Diagnostic Statistical Manual, fourth edition (DSM-IV) (MINI-Plus) and psychometric scales, including the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression (HRSD), the Hamilton Anxiety Scale (HAS) and the Liebowitz Social Anxiety Scale (LSAS). Results: BS and HS groups did not differ in most demographic and clinical parameters, such as gender, age and length of symptoms. The frequency of psychiatric disorders and the severity of psychiatric symptoms were similar in both groups. Conclusion: BS does not seem to have more psychiatric disorders than HS.

The connection between maternal thiamine shortcoming and offspring cognitive damage and poverty perpetuation in underprivileged communities across the world.

The acquisition of cognitive, sensory-motor and social emotional functions depend on a proper development of the Central Nervous System (CNS). This set of functions, known as intelligence, allows a better adaptation to the environment. In the last decades, an increase in the average of intelligence has been reported. However, such an increase cannot be observed in an equivalent way in economically and social underprivileged regions. Children from those regions are in great risk of being affected by mental retardation or impaired cognitive development. In later life they will, probably, be unable to transform and improve themselves and their communities, perpetuating the poverty of the region. Therefore, knowledge of factors involved in CNS development is a matter of health closely related to social improvement. Malnutrition throughout pregnancy and breastfeeding is clearly identifiable as a cause of damage in CNS development. Vitamin B1 (Thiamine) is a micronutrient important to the growth and maturity of the CNS. Thiamine shortcoming may affect 50% of pregnant women. Thiamine function in cerebral development is still not well known. There is a gap in the literature regarding systematical research about the blood thiamine concentration throughout the periods of gestation and breastfeeding. These studies are relevant in populations with a high level of nutritional vulnerability, because in a follow up offspring cognitive exam they could reveal if the maternal thiamine deficiency is related to child CNS impairment. This paper introduce the hypothesis that thiamine shortcoming during pregnancy and breastfeeding is directly related to cognitive impairment of child. Data about the neurophysiological role of thiamine, consequences of its shortcoming in experimental models, populations under the risk of thiamine shortcoming are presented. The hypothesis that maternal thiamine shortcoming causes damage related to child cognitive development needs to be considered. Thus, thiamine shortcoming during gestation and breastfeeding and its effects on children must be studied in many populations in order to know the magnitude of the problem and to indicate actions to overcome it.

Distonia primária e transtorno obsessivo-compulsivo

OBJECTIVE: Patients with primary dystonia have been reported to have a major incidence of obsessive-compulsive disorder (OCD). The objective of the present work is to review the studies that investigated the association between OCD and primary dystonia. METHODS: Articles that correlated both conditions, including case-control and descriptive studies as well as case-reports and series, were selected. Articles were searched on Medline and Lilacs. RESULTS: Twelve articles were found, and eight were case-control studies. In half of case-control studies, obsessive-compulsive symptoms were more common in patients with dystonia than controls, while in the other half there was no such a difference. CONCLUSION: As the results are controversial, definite conclusion regarding the association between dystonia and OCD cannot be established.

Psychiatric disorders in a patient with persistent developmental stuttering.

Persistent developmental stuttering (PDS) is a common disorder of speech with no identifiable cause. Psychiatric disorders appear to be related and influence clinical manifestation of PDS. In this case report, we present the clinical evolution of 1 PDS patient submitted to pharmacological treatment with fluoxetine and speech therapy intervention. At the end of 12 weeks of treatment, she evolved from 28 at Beck Depression Inventory; 32 in the Hamilton Scale for Anxiety; 43 and 47, respectively, in the anxiety and avoidance components of the Liebowitz Social Anxiety Scale; and severe speech impairment according Iowa Scale, to 12 at Beck Depression Inventory; 8 at Hamilton Scale for Anxiety; 25 and 21 at Liebowitz Social Anxiety Scale anxiety and avoidance components, respectively; and moderate speech impairment. Diagnosing and treating psychiatric symptoms in addition to speech therapy appears to be the best therapeutic approach.