Thais Helena Machado

Nonpharmacological interventions for cognitive impairments following primary progressive aphasia: A systematic review of the literature

This study provided a systematic review on nonpharmacological interventions applied to patients diagnosed with Primary Progressive Aphasia (PPA) and its variants: Semantic (SPPA), Nonfluent (NFPPA) and Logopenic (LPPA) to establish evidence-based recommendations for the clinical practice of cognitive rehabilitation for these patients. METHODS A PubMed and LILACS literature search with no time restriction was conducted with the keywords PPA (and its variants) AND rehabilitation OR training OR intervention OR therapy OR treatment OR effectiveness. To develop its evidence-based recommendations, a research committee identified questions to be addressed and determined the level of evidence for each study according to published criteria (Cicerone et al., 2000). Overall evidence for treatments was summarized and recommendations were derived. RESULTS Our search retrieved articles published from 1995 to 2013: 21 for SPPA, 8 for NFPPA, 3 for LPPA and 8 for PPA with no specification. Thirty-five studies were rated as Class III, consisting of studies with results obtained from one or more single-cases and that used appropriate single-subject methods with adequate quantification and analysis of results. The level of evidence of three functional interventions could not be established. One study was rated as Class II and consisted of a nonrandomized case-control investigation. CONCLUSION Positive results were reported in all reviewed studies. However, in order to be recommended, some investigation regarding the intervention efficacy was required. Results of the present review allows for recommendation of some nonpharmacological interventions for cognitive deficits following PPA as Practice Options. Suggestions for further studies on PPA interventions and future research are discussed.

Dementia caregiver burden in a Brazilian sample: Association to neuropsychiatric symptoms

Taking care of elderly demented individuals, especially when they present behavioral changes, can be very exhaustive for both family and caregivers. Generally, this leads to changes in the family lifestyle, and the caregiver must deal with a range of problems. Information on this topic in Latin America, including Brazil, remains scarce. Objective To investigate the relationship between the presence of neuropsychiatric symptoms and the level of caregiver burden in a group of Brazilian elderly with dementia. Methods The Brazilian versions of the Zarit Caregiver Burden Interview (ZBI) and of the Neuropsychiatric Inventory (NPI) were administered to a total of 83 family-caregivers of patients with dementia followed at a university-affiliated outpatient clinic. Pearson’s correlations were calculated to measure the level of association between the scores on both instruments. Results Among the caregivers, 83.1% were women, and had a mean age of 55.6±12.8 years. The ZBI scores ranged from 3 to 79 (mean=31.4). Patients’ NPI scores ranged from 0 to 102 (mean=26.9), consistent with a significant degree of behavioral manifestations in most patients. A significant positive correlation was found between ZBI and NPI scores (r=0.402; p=0.000). Conclusion The presence and severity of behavioral manifestations assessed by the NPI were associated with a high level of caregiver burden in this sample of Brazilian elderly with dementia.

Mattis Dementia Rating Scale (DRS): Normative data for the Brazilian middle-age and elderly populations

OBJECTIVE To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations. METHODS The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over). RESULTS Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores. CONCLUSION As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

Brief intervention for agrammatism in Primary Progressive Nonfluent Aphasia: A case report

The non-fluent and agrammatic variant of Primary Progressive Aphasia (NFPPA) is characterized by reduced verbal production with deficits in building grammatically correct sentences, involving dysfunctions in syntactic and morphological levels of language. There are a growing number of studies about non-pharmacological alternatives focusing on the rehabilitation of functional aspects or specific cognitive impairments of each variant of PPA. This study reports a short-term treatment administered to a patient with NFPPA focusing on the production of sentences. The patient had significant reduction in verbal fluency, use of keywords, phrasal and grammatical simplifying as well as anomia. Using the method of errorless learning, six sessions were structured to stimulate the formation of sentences in the present and past with the cloze technique. The patient had improvement restricted to the strategy, with 100% accuracy on the trained phrases and generalization to untrained similar syntactic structure after training. These results persisted one month after the treatment.

Prevalence of major psychiatric disorders in a cohort of oldest old in Brazil: The Pietà study

consensus discussion. Results: 639 individuals (55.3% of the total oldestold population) were fully evaluated, being 408 women (63.8%) and 231 men(36.2%),aged81.1 65.2years,withmeanschoolingof2.6 62.8years. Dementia was diagnosed in 176 subjects, (prevalence¼27.5%), while CIND was identified in 166 (prevalence¼26.0%). Among dementia patients, only 39 cases (6.1%) had a previous diagnosis of this condition. Patients with dementia were significantly older (p<0.0001) and less educated (p¼0.001). Prevalence of dementia was also higher in women, although the difference was not statistically significant (p¼0.06). CIND prevalence was similar in both genders. When compared with the cognitively healthy individuals (n¼227),CINDsubjectsweresignificantlyolder(p¼0.004),buthadasimilar schooling. A previous history of depression was more frequent among dementia (p¼0.002) and CIND (p¼0.007) patients. Conclusions: Prevalence of CIND and dementia was high in this oldest-old population, although dementia was highly under-diagnosed. Age and previous history of depression were associated with both diagnoses, while low education dementia was associated only with dementia.

Features associated with cognitive impairment and dementia in a community-based sample of illiterate elderly aged 75+ years: The Pietà study

A higher level of educational attainment constitutes a protective factor against cognitive decline in the elderly. Nevertheless, the elements underpinning this association are yet not fully understood. Objective The primary aim of this study was to compare cognitively impaired illiterate elderly subjects with cognitively preserved counterparts, according to demographics, comorbidities, lifetime habits and APOE genotype. Methods This is a cross-sectional analysis of the illiterate subset of participants (n=174) from the Pietà study, a community-based survey of successful brain aging conducted in Caeté (MG), Brazil. Subjects were categorized into three diagnostic groups: cognitively normal (CN), cognitive impairment no-dementia (CIND) and dementia. The groups were then compared according to selected variables. Results Subjects with dementia were older and had an increased prevalence of reported stroke or transient ischemic attack. The three groups did not differ in relation to demographics, prevalence of comorbidities, socioeconomic level, previous occupation profile and APOE-ε4 allele frequency. Qualitatively evaluated lifetime habits, such as alcohol consumption, smoking and physical activity engagement were also similar across groups. Conclusion No associations were found between cognitive impairment/dementia and the variables evaluated in this community-based sample of illiterate elderly.

Apathy Is not Associated with Performance in Brief Executive Tests in Patients with Mild Cognitive Impairment and Mild Alzheimers Disease

Neuropsychological correlates of apathy in Alzheimers disease (AD) may shed some light on the neurobiology of this behavioral disorder. Whereas previous research has suggested an association between apathy and executive functions in AD, amnestic mild cognitive impairment (aMCI) cohorts point to an association with memory tests. We aimed to further investigate this issue in a sample of low educated, hitherto unexposed to cholinesterase inhibitors, aMCI (n=26) and mild AD (n=28) patients using brief executive tests, namely the Executive Interview (EXIT-25) and the Frontal Assessment Battery (FAB). Patients and controls (n=33) were included from a community-based survey of successful brain aging in Brazilian elderly (75+ years), The Pietà Study. The participants were submitted to a comprehensively neuropsychological assessment and apathy evaluation through the Apathy Scale (AS).We found a strong correlation in AD group between AS scores and functional performance measured by the Disability Assessment in Dementia (rho =-0.7 ; p<0,001). No association was found between any executive test performance and apathy symptoms. Apathy symptoms were also associated with the performance in memory tests and in the attention subscale of the Mattis Dementia Rating Scale. These findings reinforce the functional effect of apathy even in the mildest stages along the AD cognitive impairment spectrum, and challenges previous assumptions regarding the association between apathy and classical executive functions.

EDUCATION CAN STRENGTHEN THE ROLE OF THE LEFT HIPPOCAMPUS IN EPISODIC MEMORY PERFORMANCE

disease (AD). Methods:13 controls, 18 MCI and 11 AD subjects underwent T1-MPRAGE and PET imaging with the tau ligand [F]-AV-1451. Atrophy was measured from MRI and the simplified reference tissue model (SRTM) was applied to the [F]-AV-1451 PET data to quantify both tau deposition (binding; BPND) and perfusion (relative to the cerebellum; R1). T1 data were processed with Freesurfer 6 beta to derive cortical thickness maps. PET data were co-registered to the T1 and sampled onto the cortical surface (Greve et al., 2014) (Figure 1). Zscore maps of tau, hypoperfusion and atrophy were derived for each subject with reference against the healthy controls. Surface-based comparisons of tau, perfusion, and atrophy were compared between the groups. Paired T-Tests were used to compare the global Z score of each marker, and correlations across the brain regions were performed to assess the interrelationship among tau, hypoperfusion and cortical thickness. Results:There was a striking overlap of tau deposition, hypoperfusion and cortical thinning in the AD group (Figure 2). Relative to healthy controls, the AD group showed a widespread increase in tau, together with an overlapping but more restricted pattern of hypoperfusion and cortical thinning in temporo-parietal cortices (Figure 3). The three markers of pathology were highly intercorrelated in AD (Figure 4). Tau Z (3.0 61.4) significantly exceeded both atrophy Z (0.8 6 0.7, p < 0.001) and hypoperfusion Z (0.4 6 0.5, p<0.001) (Figure 5). MCI showed increased tau in the left inferior temporal cortex compared to healthy controls. In MCI, tau Z was significantly correlated with atrophy Z (r 1⁄4 0.4, p 1⁄4 0.002), but tau Z was similar compared to atrophy Z. Conclusions:The wider extent and greater severity of tau relative to atrophy and hypoperfusion provide preliminary in vivo evidence to support a model in which tau pathology precedes neurodegeneration in AD. This hierarchy was not observed in the MCI group, and may suggest an acceleration of tau during the progression from MCI to AD.

SHORT-TERM REHABILITATION FOR LINGUISTIC IMPAIRMENTS IN PRIMARY PROGRESSIVE APHASIA: A CASE SERIES

(2.3) mL/kg/min, p< 0.001). Brain metabolic analysis revealed a bilateral reduction of rBGM in both anterior temporal poles, left frontal gyrus, left anterior cingulate cortex, right hippocampus, left medial frontal gyrus and bilateral caudate nuclei. In contrast, there was an increase in rBGM in the right precuneus and left inferior frontal gyrus (Figure1). Factorial models were used to create latent variables reflecting the salience network (SN) and default mode network (DMN) based on regions with rBGM changes found after the AT. A confirmatory factor model was used to test the hypothesis that ATwould induce rBGM changes (decrease) in regions of the SN. This decrement may reflect improved control of other networks and ultimately, would induce an increment in rBGM in the precuneus, an important node of the DMN. Regions of the temporal pole were in between these regions and are highly connected with both networks. Values of model fit reached statistical significance (figure2), demonstrating that this model explain the variance of the measured data. Conclusions: AT improved aerobic fitness, cognition and changed rBGM in nodes od the DMN and SN in subjects with MCI.

The structural basis of performance in an episodic memory test in an elderly population with heterogeneous educational level: The pietà study

patients with confirmed diagnosis of AD (11.8% increase V1⁄449, p<.05; Figure 2) and those with confirmed diagnosis of non-AD (13.6% increase; V1⁄40, p<.05; Figure 3). 243 PET scans were evaluated by two nuclear medicine physicians, who disagreed on 32 cases (rate of concordance: 86.8%). Conclusions:Data are in line with previous reports. Based on preliminary results, amyloid PET with 18F-Florbetapir has a significant impact on diagnosis and diagnostic confidence of dementia experts.