Jéssica Natuline Ianof

Index of Alpha/Theta Ratio of the Electroencephalogram: A New Marker for Alzheimer’s Disease

Objective: We evaluated quantitative EEG measures to determine a screening index to discriminate Alzheimer’s disease (AD) patients from normal individuals. Methods: Two groups of individuals older than 50 years, comprising a control group of 57 normal volunteers and a study group of 50 patients with probable AD, were compared. EEG recordings were obtained from subjects in a wake state with eyes closed at rest for 30 min. Logistic regression analysis was conducted. Results: Spectral potentials of the alpha and theta bands were computed for all electrodes and the alpha/theta ratio calculated. Logistic regression of alpha/theta of the mean potential of the C3 and O1 electrodes was carried out. A formula was calculated to aid the diagnosis of AD yielding 76.4% sensitivity and 84.6% specificity for AD with an area under the ROC curve of 0.92. Conclusion: Logistic regression of alpha/theta of the spectrum of the mean potential of EEG represents a good marker discriminating AD patients from normal controls.

Prevalence of Cognitive Impairment Without Dementia and Dementia in Tremembé, Brazil.

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.

Analysis of Electroencephalogram Resting State in Diffuse Axonal Injury â APilot Study

Traumatic brain injury (TBI) is caused by an external mechanical force. The most common causes of TBI are car crash, falls, assaults and thefts and accidents during recreational activity. The acceleration-deceleration mechanism responsible for DAI, often damage the lateral and ventral regions of the frontal and temporal lobes. Deficits in attention and memory, difficulty in learning new information, solving problems and planning are common sequelae. Impulsivity and lack of self-control are also common after a TBI. Our goal was to correlate functional changes obtained in the electroencephalogram (EEG) with the cognitive decline in diffuse axonal injury (DAI) and understand the pathophysiology of this injury. Ten patients with diffuse axonal lesion and 5 control subjects were recruited by the Group of Cognitive Rehabilitation after TBI in the Division of Neurology, Clinics Hospital, Faculty of Medicine, University of Sao Paulo. A high-resolution EEG with 128 channels were performed at the Psychiatry Institute (LIM-23), University of Sao Paulo. The cortical sources of EEG rhythms were estimated by analysis of low resolution brain electromagnetic tomography (LORETA), which revealed that patients with DAI had reduced alpha activity and increased theta activity, indicating a slowing of brain activity. In contrast, control subjects showed a predominance of alpha activity and hippocampal activation during the exam, which was not observed in the group with DAI. The DAI patients showed reduced brain activity and little or no hippocampal activation, which is consistent with memory complaints presented by these patients.

Sport-related concussions

Traumatic brain injury (TBI) is a major cause of lifelong disability and death worldwide. Sport-related traumatic brain injury is an important public health concern. The purpose of this review was to highlight the importance of sport-related concussions. Concussion refers to a transient alteration in consciousness induced by external biomechanical forces transmitted directly or indirectly to the brain. It is a common, although most likely underreported, condition. Contact sports such as American football, rugby, soccer, boxing, basketball and hockey are associated with a relatively high prevalence of concussion. Various factors may be associated with a greater risk of sport-related concussion, such as age, sex, sport played, level of sport played and equipment used. Physical complaints (headache, fatigue, dizziness), behavioral changes (depression, anxiety, irritability) and cognitive impairment are very common after a concussion. The risk of premature return to activities includes the prolongation of post-concussive symptoms and increased risk of concussion recurrence.

Comparative analysis of the electroencephalogram in patients with Alzheimer's disease, diffuse axonal injury patients and healthy controls using LORETA analysis

Alzheimers disease (AD) is a dementia that affects a large contingent of the elderly population characterized by the presence of neurofibrillary tangles and senile plaques. Traumatic brain injury (TBI) is a non-degenerative injury caused by an external mechanical force. One of the main causes of TBI is diffuse axonal injury (DAI), promoted by acceleration-deceleration mechanisms. Objective To understand the electroencephalographic differences in functional mechanisms between AD and DAI groups. Methods The study included 20 subjects with AD, 19 with DAI and 17 healthy adults submitted to high resolution EEG with 128 channels. Cortical sources of EEG rhythms were estimated by exact low-resolution electromagnetic tomography (eLORETA) analysis. Results The eLORETA analysis showed that, in comparison to the control (CTL) group, the AD group had increased theta activity in the parietal and frontal lobes and decreased alpha 2 activity in the parietal, frontal, limbic and occipital lobes. In comparison to the CTL group, the DAI group had increased theta activity in the limbic, occipital sublobar and temporal areas. Conclusion The results suggest that individuals with AD and DAI have impairment of electrical activity in areas important for memory and learning.

Prevalence study of cognitive impairment no dementia (CIND) and dementia in tremembé, brazil

am in at io n : M o C A 6 M o n tr ea l C o g n it iv e A ss es sm en t Karolina G. Cesar, Sonia M.D. Brucki, Leonel T. Takada, Luiz Fernando C. Nascimento, Camila M.S. Gomes, Milena C.S. Almeida, Maira O. Oliveira, Fabio H.G. Porto, Mirna L.H. Senaha, Valeria S. Bahia, Thais Bento Lima Silva, Jessica N. Ianof, Mario A. Cecchini, Luciana Cassimiro, Marcia R. Gonçalves, Jerusa Smid, Claudia S. Porto, Maria Teresa Carthery-Goulart, Mônica Sanches Yassuda, Leticia L. Mansur, Ricardo Nitrini, Sr,, University of S~ao Paulo, S~ao Paulo, Brazil; University of Taubat e, Taubat e, Brazil; Universidade Federal do ABC, S~ao Bernardo do Campo, Brazil. Contact e-mail: karolgcesar@gmail.com

Performance of the Visual Analogue Scale of Happiness and of the Cornell Scale for Depression in Dementia in the Tremembé Epidemiological Study, Brazil

Depression is a major growing public health problem. Many population studies have found a significant relationship between depression and the presence of cognitive disorders. Objective To establish the correlation between the Visual Analogue Scale of Happiness and the Cornell Scale for Depression in Dementia in the population aged 60 years or over in the city of Tremembé, state of São Paulo, Brazil. Methods An epidemiological survey involving home visits was carried out in the city of Tremembé. The sample was randomly selected by drawing 20% of the population aged 60 years or older from each of the citys census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, and application of both the Cornell Scale and the Analogue Scale of Happiness for psychiatric symptoms. The presence of depressive symptoms was defined as scores greater than or equal to 8 points on the Cornell Scale. Results A total of 623 subjects were evaluated and of these 251 (40.3%) had clinically significant depressive symptoms on the Cornell Scale, with a significant association with female gender (p<0.001) and with lower education (p=0.012). One hundred and thirty-six participants (21.8%) chose the unhappiness faces, with a significant association with age (p<0.001), female gender (p=0.020) and low socioeconomic status (p=0.012). Although there was a statistically significant association on the correlation test, the correlation was not high (rho=0.47). Conclusion The prevalence of depressive symptoms was high in this sample and the Visual Analogue Scale of Happiness and Cornell Scale for Depression in Dementia should not be used as similar alternatives for evaluating the presence of depressive symptoms, at least in populations with low educational level.

BPSD following traumatic brain injury

Annually, 700,000 people are hospitalized with brain injury acquired after traumatic brain injury (TBI) in Brazil. OBJECTIVE We aim to review the basic concepts related to TBI, and the most common Behavioral and Psychological Symptoms of Dementia (BPSD) findings in moderate and severe TBI survivors. We also discussed our strategies used to manage such patients in the post-acute period. METHODS Fifteen TBI outpatients followed at the Center for Cognitive Rehabilitation Post-TBI of the Clinicas Hospital of the University of São Paulo were submitted to a neurological, neuropsychological, speech and occupational therapy evaluation, including the Mini-Mental State Examination. Rehabilitation strategies will then be developed, together with the interdisciplinary team, for each patient individually. Where necessary, the pharmacological approach will be adopted. RESULTS Our study will discuss options of pharmacologic treatment choices for cognitive, behavioral, or affective disorders following TBI, providing relevant information related to a structured cognitive rehabilitation service and certainly will offer an alternative for patients and families afflicted by TBI. CONCLUSION Traumatic brain injury can cause a variety of potentially disabling psychiatric symptoms and syndromes. Combined behavioral and pharmacological strategies, in the treatment of a set of highly challenging behavioral problems, appears to be essential for good patient recovery.