Mário Silva Jorge

Estudo da coerência do eletrencefalograma para a banda de frequência alfa em indivíduos adultos normais e com provável demência do tipo Alzheimer

We studied the occiptal inter-hemispheric coherence (IHCoh) of EEG (electrodes O1-O2) for alpha band (alpha1 - 8,0 to 10,0 Hz and alpha2 - 10,1 to 12,5 Hz) in healthy adults and Alzheimers type dementia (ATD) subjects, to observe if there is any significant difference between these two groups that could help in the early diagnosis of ATD. We found a decrease of occipital IHCoh in ATD group for both alpha sub-bands. We believe that Coh analysis of EEG is a powerful auxiliary method in ATD diagnosis.

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.

Recomendaçöes para o registro/interpretaçäo do mapeamento topográfico do eletrencefalograma e potenciais evocados: parte II: correlaçöes clínicas

Digital EEG (DEEG) and quantitative EEG (QEEG) are recently developed tools present in many clinical situations. Besides showing didactic and research utility, they may also have a clinical role. Although a considerable amount of scientific literature has been published related to QEEG, many controversies still subsist regarding its clinical utilization. Clinical applications are: 1. DEEG is already an established substitute for conventional EEG, representing a clear technical advance. 2. Certain QEEG techniques are an established addition to DEEG for: 2a) screening for epileptic spikes or seizures in long-term recordings; 2b) Operation room and intensive care unit EEG monitoring. 3. Certain QEEG techniques are considered possible useful additions to DEEG: 3a) topographic voltage and dipole analysis in epilepsy evaluations; 3b) frequency analysis in cerebrovascular disease and dementia, mostly when other tests have been inconclusive. 4. QEEG remains investigational for clinical use in postconcussion syndrome, learning disability, attention disorders, schizophrenia, depression, alcoholism and drug abuse. EEG brain mapping and other QEEG techniques should be clinically used only by physicians highly skilled in clinical EEG interpretation and as an adjunct to traditional EEG work.

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.

Prevalence of depressive symptoms among elderly in the city of Tremembé, Brazil: Preliminary findings of an epidemiological study

Depression is a heterogeneous mental disease classified as a set of disorders, which manifest with a certain duration, frequency and intensity. The prevalence of depression in the elderly ranges from 0.5 to 16%. OBJECTIVE To establish, in an epidemiological study, the prevalence of significant depressive symptoms in the population aged 60 years or older. METHODS Results of a cross-sectional epidemiological study, involving home visits, being carried out in the city of Tremembé, Brazil, were reported. The sample was randomly selected by drawing 20% of the population over 60 years from each of the citys census sectors. In this single-phase study, the assessment included clinical history, physical and neurological examination, cognitive evaluation, the Cornell scale and the Patient Health Questionnaire for psychiatric symptoms. Scores greater than or equal to 8 on the Cornell scale were taken to indicate the presence of depressive symptoms. RESULTS A total of 455 elders were assessed, and of these 169 (37.1%) had clinically significant depressive symptoms (CSDS). Depression prevalence was higher among women (p<0.001) and individuals with lower education (p=0.033). The Chi-square test for trends showed a significant relationship where lower socioeconomic status was associated with greater likelihood of depressive symptoms (p=0.005). CONCLUSION The prevalence of depressive symptoms was high in this sample of the population-based study and was associated with female gender, low educational level and socioeconomic status. The assessment of the entire population sample must be completed.

Eletrencefalograma quantitativo e topográfico (mapeamento cerebral): estudo do padrão normal para uma população adulta

: We studied the electric brain activity during wakefulness in 20 Brazilian people through digital EEG and spectral analysis in order to propose a standardization for Brazilian adult population. All this group is healthy with laboratory examinations and mini-mental state (scores higher than 27) evaluation normal. After Fourier fast transformation (FFT) calculation, we found a histogram display with monomodal distribution, with higher values in alpha band. Analyzing the average of these results, different standards from the analogical traditional EEG were found, as the distribution of alpha band and delta activity behavior. The beta 2 and beta 3 behavior showed a diffuse distribution, that is not the usual. By the other hand, other findings are congruent to the analogical EEG as the alpha posterior predominance and the bigger presence of theta activity at the central regions.We studied the electric brain activity during wakefulness in 20 Brazilian people through digital EEG and spectral analysis in order to propose a standardization for Brazilian adult population. All this group is healthy with laboratory examinations and mini-mental state (scores higher than 27) evaluation normal. After Fourier fast transformation (FFT) calculation, we found a histogram display with monomodal distribution, with higher values in alpha band. Analyzing the average of these results, different standards from the analogical traditional EEG were found, as the distribution of alpha band and delta activity behavior. The beta 2 and beta 3 behavior showed a diffuse distribution, that is not the usual. By the other hand, other findings are congruent to the analogical EEG as the alpha posterior predominance and the bigger presence of theta activity at the central regions.

Study of interhemispheric coherence on healthy adults

The interhemispheric coherence of electroencephalogram was studied in a group of healthy individuals in the age range of 20-50 years. The results showed higher coherence for all bands in parietal regions (P3-P4). It was observed that individuals with high values of coherence for a certain frequency band in a pair of electrodes also showed high values of coherence for other bands across other pairs of electrodes. No significant influence on interhemispheric coherence was found for age, gender or hand dominance.

Index of alpha/theta ratio of the electroencephalogram: A new marker for Alzheimer's disease

Background: The inclusion of electroencephalography in diagnostic research protocols for AD is fully justified given EEG’s wide availability, low cost and high sensitivity, allowing serial exams and neurological evolution follow-ups. Objective: To determine a screening index for use in routine clinical practice to aid the diagnosis of Alzheimer’s disease (AD).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. All were recruited from Outpatient Clinic of the Cognitive and Behavioral Neurology Group (GNCC) of the Division of Clinical Neurology of the HCFMUSP(Clinics Hospital of Medicine School of University of S~ao Paulo) and/or from the CEREDIC (Referral Center for CognitiveDisorders) of the HCFMUSP, who were submitted to routine outpatient assessment for diagnosing Alzheimer disease. EEG recordings were performed of subjects in a wake state with eyes closed at rest for 30 mins. Spectral potentials of the alpha and theta bands were computed separately for all electrodes and all electroencephalograms. Subsequently, the alpha/theta ratio between these spectral potentials was calculated. Thus, a total of 20 electrodes common to the whole sample were analyzed. Correlation analysis and crossing of the alpha/theta ratio of the Mean Potential with the Alzheimer disease variable was carried out, followed by logistic regression analysis and obtention of the ROC curve. Results: Spectral potentials of the alpha and theta bands were computed and the alpha/theta ratio calculated. Logistic regression of the variables 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. Multiply alpha/theta of mean potential of C3 electrode by 18 Multiply alpha/theta of mean potential of O1 electrode by 12 Sum the two values A result of less than 33 indicates dementia else no dementia.Conclusions: Logistic regression of the alpha/theta of the Spectrum of the mean potential of EEG represents a good marker for discriminating between AD patients and normal controls.

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.

Epilepsias com focos projetados na linha media. Estudo com EEG quantitativo e topografico (mapeamento cerebral)

We report a topographic and quantitative EEG (EEGQT) study of four patients with analogic EEG diagnostics of midline foci. The new study with EEGQT offered an increased definition of the electrical source with advantages in foci localization. These findings should be confirmed with studies including a greater number of patients.We report a topographic and quantitative EEG (EEGQT) study of four patients with analogic EEG diagnostics of midline foci. The new study with EEGQT offered an increased definition of the electrical source with advantages in foci localization. These findings should be confirmed with studies including a greater number of patients.