High cortisol levels are associated with cognitive impairment no-dementia (CIND) and dementia

BACKGROUND

This study aimed to compare serum cortisol concentrations in cognitively healthy elderly and in subjects with cognitive impairment no dementia (CIND) and dementia, besides to evaluate these concentrations according to apolipoprotein E genotype (APOE).

METHODS

Three-hundred and nine elderly enrolled in the Pietà Study (Brazil) were divided in 3 groups: control (n=158), CIND (n=92) and dementia (n=59) and had concentrations of morning serum cortisol measured. Hormone concentrations were measured by chemiluminescence and APOE genotypes were determined by PCR followed by restriction fragment length polymorphism (RFLP).

RESULTS

Medians of cortisol concentrations (μg/dl) for the groups were 12.14 (interquartile range - IQR 6.34) for control, 13.65 (IQR 5.88) for CIND and 14.47 (IQR 7.35) for dementia. Significant differences were observed for control vs. CIND (P=0.003), control vs. dementia (P=0.001), but not for CIND vs. dementia (P=0.269). No association was observed between cortisol concentrations and APOE genotype among the groups (P=0.348).

CONCLUSIONS

The elevation in cortisol concentrations is associated with dementia, independently of APOE genotypes. Further studies are required to understand if elevation of cortisol is an initial event and how hippocampal damage and the loss of hypothalamus-pituitary-adrenal (HPA) axis inhibition may affect its concentrations.

Primary progressive aphasia: classification of variants in 100 consecutive Brazilian cases

Primary progressive aphasia (PPA) is a neurodegenerative clinical syndrome characterized primarily by progressive language impairment. Recently, consensus diagnostic criteria were published for the diagnosis and classification of variants of PPA. The currently recognized variants are nonfluent/agrammatic (PPA-G), logopenic (PPA-L) and semantic (PPA-S).

Analysis of a case series of behavioral variant frontotemporal dementia: emphasis on diagnostic delay

INTRODUCTION

Despite many advances in the characterization of the behavioral variant of frontotemporal dementia (bvFTD), the diagnosis of this syndrome poses a significant challenge, while delays or diagnostic mistakes may impact the proper clinical management of these patients.

OBJECTIVE

To describe the clinical profile at first evaluation of a sample of patients with bvFTD from a specialized outpatient neurological unit, with emphasis on the analysis of the delay between the onset of symptoms and diagnosis.

METHODS

We selected 31 patients that fulfilled international consensus criteria for possible or probable bvFTD. Patients' medical admission sheets were thoroughly reviewed.

RESULTS

Patients' mean age was 67.9±8.2 years; 16 (51.6%) were men. Mean number of years of formal education was 7.7±4.0 years. Mean age at onset was 62.2±7.7 years, indicating a mean of 5.8 years of diagnostic delay. Thirteen patients (41.9%) presented with initial behavioral complaints only, eleven patients (35.5%) had mixed behavioral and memory complaints, five patients (16.1%) presented with memory complaints only, and two patient (6.4%) had behavioral and speech problems. Nine patients (29%) were admitted with alternative diagnoses. Mean and standard deviation scores for the mini-mental state examination, animal category fluency and memory test for drawings (five-minute delayed recall) were 19.3±6.3, 8.3±4.1and 3.7±2.7, respectively.

CONCLUSION

Most patients from this sample were evaluated almost six years after the onset of symptoms and performed poorly on both cognitive screening tests and functional evaluation measures.

Prevalence and clinical classification of tremor in elderly--a community-based survey in Brazil

Prevalence data on different types of tremor among the elderly population are very scarce. The objective of this study was to study the prevalence of tremor in a community-dwelling elderly population in the town of Bambuí, Brazil. The authors studied 1186 inhabitants aged≥64 years. This was a 2-phase study in which all participants who screened positive in a questionnaire for tremor and parkinsonism or who used drugs capable of causing/suppressing tremor were examined. In this population, the prevalence rate was 17.4% for tremor, 7.4% for essential tremor, 5.6% for parkinsonian tremor, 2.8% for enhanced physiological tremor, and 1.6% for other causes. There were no gender differences in prevalence rates for all types. Patients who had Parkinson's disease with tremor were older than those who had essential tremor, whereas patients who had enhanced physiological tremor were significantly younger. The age-specific prevalence of tremor increased with advancing age for both men and women. The prevalence of tremor in the studied population was high and increased with advancing age. Essential tremor, parkinsonian tremor, and enhanced physiological tremor were the most commonly identified causes. © 2013 Movement Disorder Society.

Functional profile of patients with behavioral variant frontotemporal dementia (bvFTD) compared to patients with Alzheimer's disease and normal controls

There are few studies describing the functional changes in behavioral variant frontotemporal dementia (bvFTD) and it is not clear which aspects of functionality are affected by the disease.

Alzheimer's disease qEEG: spectral analysis versus coherence. Which is the best measurement?

There is evidence in electroencephalography that alpha, theta and delta band oscillations reflect cognitive and memory performances and that quantitative techniques can improve the electroencephalogram (EEG) sensitivity. This paper presents the results of comparative analysis of qEEG variables as reliable markers for Alzheimer's disease (AD). We compared the sensitivity and specificity between spectral analysis (spectA) and coherence (Coh) within the same group of AD patients. SpectA and Coh were calculated from EEGs of 40 patients with mild to moderate AD and 40 healthy elderly controls. The peak of spectA was smaller in the AD group than in controls. AD group showed predominance of slow spectA in theta and delta bands and a significant reduction of inter-hemispheric Coh for occipital alpha 2 and beta 1 and for frontal delta sub-band. ROC curve supported that alpha band spectA was more sensitive than coherence to differentiate controls from AD.

NEUROPSI battery subtest profile in subcortical vascular dementia and Alzheimer's disease

Objective

To investigate the diagnostic value of subtests of the NEUROPSI battery for differentiating subcortical vascular dementia (SVaD) from Alzheimer's disease (AD).

Methods

Thirteen patients with mild SVaD, 15 patients with mild probable AD, and 30 healthy controls, matched for age, education and dementia severity (in the case of patients), were submitted to the Mini-Mental State Examination (MMSE) and NEUROPSI battery. The performance of AD and SVaD groups on NEUROPSI subtests was compared. The statistical analyses were performed using Kruskal-Wallis, Chi-square and Mann-Whitney tests. The results were interpreted at the 5% significance level (p<0.05). Bonferroni's correction was applied to multiple comparisons (α=0.02).

Results

SVaD and AD patients showed no statistical difference in MMSE scores (SVaD=20.8 and AD=21.0; p=1.0) or in NEUROPSI total score (SVaD=65.0 and AD=64.3; p=0.56), suggesting a similar severity of dementia. The AD group performed worse on memory recall (<0.01) and SVaD group was worse in verbal fluency subtests (p=0.02).

Conclusion

NEUROPSI's memory and language subtests can be an auxiliary tool for differentiating SVaD from AD.

Vascular Parkinsonism and cognitive impairment: literature review, Brazilian studies and case vignettes

Vascular Parkinsonism (VP) is a form of secondary Parkinsonism resulting from cerebrovascular disease. Estimates of the frequency of VP vary greatly worldwide; 3% to 6% of all cases of Parkinsonism are found to have a vascular etiology. In a Brazilian community-based study on Parkinsonism, 15.1% of all cases were classified as VP, the third most common form, with a prevalence of 1.1% in an elderly cohort. Another Brazilian survey found a prevalence of 2.3% of VP in the elderly. VP is usually the result of conventional vascular risk factors, particularly hypertension, leading to strategic infarcts of subcortical gray matter nuclei, diffuse white matter ischaemic lesions and less commonly, large vessel infarcts. Patients with VP tend to be older and present with gait difficulties, symmetrical predominant lower-body involvement, poor levodopa responsiveness, postural instability, falls, cognitive impairment and dementia, corticospinal findings, urinary incontinence and pseudobulbar palsy. This article intends to provide physicians with an insight on the practical issues of VP, a disease potentially confounded with vascular dementia, idiopathic Parkinson's disease, dementia with Lewy bodies and other secondary causes of Parkinsonism.

Spectrum of cognitive impairment in neurocysticercosis: differences according to disease phase

OBJECTIVES

Cognitive decline related to neurocysticercosis (NC) remains poorly characterized and underdiagnosed. In a cross-sectional study with a prospective phase, we evaluated cognitive decline in patients with strictly calcified form (C-NC), the epidemiologically largest subgroup of NC, and investigated whether there is a spectrum of cognitive abnormalities in the disease.

METHODS

Forty treatment-naive patients with C-NC aged 37.6 ± 11.3 years and fulfilling criteria for definitive C-NC were submitted to a comprehensive cognitive and functional evaluation and were compared with 40 patients with active NC (A-NC) and 40 healthy controls (HC) matched for age and education. Patients with dementia were reassessed after 24 months.

RESULTS

Patients with C-NC presented 9.4 ± 3.1 altered test scores out of the 30 from the cognitive battery when compared to HC. No patient with C-NC had dementia and 10 patients (25%) presented cognitive impairment-no dementia (CIND). The A-NC group had 5 patients (12.5%) with dementia and 11 patients (27.5%) with CIND. On follow-up, 3 out of 5 patients with A-NC with dementia previously still presented cystic lesions with scolex on MRI and still had dementia. One patient died and the remaining patient no longer fulfilled criteria for either dementia or CIND, presenting exclusively calcified lesions on neuroimaging.

CONCLUSIONS

Independently of its phase, NC leads to a spectrum of cognitive abnormalities, ranging from impairment in a single domain, to CIND and, occasionally, to dementia. These findings are more conspicuous during active vesicular phase and less prominent in calcified stages.

Frontal assessment battery in a Brazilian sample of healthy controls: normative data

OBJECTIVE

To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE).

METHODS

Two hundred and seventy-five healthy individuals with mean age of 66.4 ± 10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level.

RESULTS

Mean total FAB scores according to the educational level were 10.9 ± 2.3, for one to three years; 12.8 ± 2.7, for four to seven years; 13.8 ± 2.2, for eight to 11 years; and 15.3 ± 2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p<0.0001) and MMSE scores (r=0.39; p<0.0001). No correlation emerged between FAB scores, age, and gender.

CONCLUSION

In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.

Verbal fluency tests reliability in a Brazilian multicentric study, ELSA-Brasil

Verbal Fluency Tests (VFT) are commonly used to assess executive functions and language in clinical and epidemiological studies. These tests were included to access cognitive function and predictors to its decline in ELSA-Brasil (Longitudinal Study of Adults' Health), a cohort that investigates incidence and predictors of chronic diseases among 15,000 civil servants from six public educational institutions.

OBJECTIVE

To investigate the reliability of VFT scoring by supervisors of. ELSA research centers, who independently judged 120 category (animals) and 120 phonemic (F letter) tests.

METHOD

Their scores were compared to a reference standard score obtained by independent judgment of two experts. Intraclass correlation coefficient ratings reliability and Bland-Altman plot examined patterns of ratings disagreement.

RESULTS

Scores were very similar among ELSA centers and a high level of agreement was observed between each center and the reference standard.

CONCLUSION

The high consistency of VFT scores confirms reliability and validity of the test and assures quality for its use in multicenter studies.

Factors influencing possible delay in the diagnosis of Alzheimer's disease: Findings from a tertiary Public University Hospital

Alzheimer's disease (AD) is characterized by impairment in memory and autonomy, causing excessive pressure on family and an overburdened health care system. Early diagnosis, with the appropriate treatment, is important to reduce the pattern of disease progression.

[Human T cell lymphotropic virus (HTLV-1): when to suspect infection?]

Human T-cell lymphotropic virus (HTLV) infections have occurred for thousands of years. However, knowledge about their pathogenesis is recent. The virus is endemic in several regions around the world. In Brazil, it is present in all states at varying prevalence rates and it has been estimated that around 2.5 million Brazilians are infected. Genetic and immunological parameters of the host are the most important determinants of the clinical manifestations associated with infection. These can be divided into three categories: neoplastic, inflammatory and infectious. HTLV-associated myelopathy (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL) were the first diseases to be related to this retrovirus. More recently, countless other diseases have been correlated with the virus. The objective of this review is to provide an update on epidemiological, pathophysiologic, therapeutic and, primarily, diagnostic knowledge about HTLV, in order to encourage etiologic suspicion of HTLV in all its diverse clinical manifestations, which are currently rarely associated with this agent.

Impact of obstructive sleep apnea on cognitive performance

OBJECTIVE: To evaluate the impact of obstructive sleep apnea (OSA) on cognition. METHOD: We compared the performance of 17 patients with polysomnographic diagnosis of OSA in brief cognitive tests to that of 20 healthy controls, matched for age and education. The testing battery included the Mini-Mental State Examination (MMSE), Brief Cognitive Screening Battery (BCSB), Digit-Symbol (DS) and Phonemic Verbal Fluency (FAS). Anthropometric measures and scores from the Epworth Sleepiness Scale were also recorded. RESULTS: OSA patients performed significantly worse than controls in the MMSE, in memory items from the BCSB, in DS and also in FAS. OSA patients also exhibited higher body mass index, increased neck circumference and higher scores in Epworth Sleepiness Scale than controls. CONCLUSION: OSA significantly impairs cognitive performance, especially within the domains of attention, memory and executive functioning. These deficits may be detected by brief and easy-to-administer cognitive tests.

The Pietà study: epidemiological investigation on successful brain aging in Caeté (MG), Brazil. Methods and baseline cohort characteristics

OBJECTIVES: To present the methods and baseline characteristics of the Pietà study, a population-based survey investigating successful brain aging in the oldest-old. METHOD: The study was conducted in Caeté (MG), Brazil. In 2007, 1,251 individuals aged 75+ years were living in the city and were invited to participate. Participants responded to a general health questionnaire and were submitted to clinical, neurological, cognitive, psychiatric and functional evaluations. A subgroup was submitted to neuropsychological testing, blood tests and magnetic resonance of the skull. Individuals were classified as having cognitive impairment-no dementia, dementia, parkinsonism, psychiatric disorders or successful brain aging. RESULTS: We evaluated 639 individuals (51.1% of the target population; 64% women), aged 81.4±5.2 years and with 2.7±2.6 years of schooling. Almost 30% of the elderly were illiterates and 82.1% belonged to middle/middle-low socioeconomic levels. Almost 50% were widows, but only 14.3% were living alone. CONCLUSION: The Pietà cohort is representative of the oldest-old Brazilian population. We believe the results of the study may contribute to increase our knowledge about healthy and pathological brain aging in the oldest-old.