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de Oliveira FF. Shedding Light on the Effects of Blood Pressure on Cognitive Decline and Dementia Risk by Way of Neurobiological Evidence. J Alzheimers Dis 2024:JAD240032. [PMID: 38701148 DOI: 10.3233/jad-240032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Midlife cerebrovascular risk factors increase risk of late life cognitive impairment and dementia, while their presence in patients with dementia may lead to cognitive improvement or stabilization in late life. Defining the best measure of blood pressure (BP) to be associated with cognitive decline remains debatable, also due to possible bidirectionality. BP variability, pulse pressure, systolic and diastolic BP have been associated with cognitive status, dementia risk and Alzheimer's disease biomarkers. Proper BP control notwithstanding, BP variability increases risk for pathophysiological change in the Alzheimer's disease continuum, implying the need for selection of anti-hypertensive drugs with neurobiological evidence of benefits.
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Oliveira FFD, Almeida SSD, Chen ES, Smith MC, Bertolucci PHF. Pharmacogenetics of angiotensin modulators according to APOE-ϵ4 alleles and the ACE insertion/deletion polymorphism in Alzheimer's disease. Acta Neuropsychiatr 2023; 35:346-361. [PMID: 37605989 DOI: 10.1017/neu.2023.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
OBJECTIVE In Alzheimer's disease (AD), angiotensin II receptor blockers (ARBs) could reduce cerebrovascular dysfunction, while angiotensin-converting enzyme inhibitors (ACEis) might increase brain amyloid-β by suppressing effects of the angiotensin-converting enzyme 1, an amyloid-β-degrading enzyme. However, ACEis could benefit patients with AD by reducing the amyloidogenic processing of the amyloid precursor protein, by central cholinergic and anti-inflammatory mechanisms, and by peripheral modulation of glucose homeostasis. We aimed to investigate whether the ACE insertion/deletion polymorphism is associated with clinical changes in patients with AD, while considering apolipoprotein E (APOE)-ϵ4 carrier status and blood pressure response to angiotensin modulators. METHODS Consecutive outpatients with late-onset AD were screened with cognitive tests and anthropometric measurements, while their caregivers were queried for functional and caregiver burden scores. Prospective pharmacogenetic associations were estimated for 1 year, taking APOE-ϵ4 carrier status and genotypes of the ACE insertion/deletion polymorphism into account, along with treatment with ACEis or ARBs. RESULTS For 193 patients (67.4% women, 53.4% APOE-ϵ4 carriers), the ACE insertion/deletion polymorphism was in Hardy-Weinberg equilibrium (p = 0.281), while arterial hypertension was prevalent in 80.3% (n = 124 used an ACEi, n = 21 used an ARB). ARBs benefitted mostly APOE-ϵ4 carriers concerning caregiver burden variations, cognitive and functional decline. ACEis benefitted APOE-ϵ4 non-carriers concerning cognitive and functional decline due to improved blood pressure control in addition to possible central mechanisms. The ACE insertion/deletion polymorphism led to variable response to angiotensin modulators concerning neurological outcomes and blood pressure variations. CONCLUSION Angiotensin modulators may be disease-modifiers in AD, while genetic stratification of samples is recommended in clinical studies.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Beghi E, Ivashynka A, Logroscino G, de Oliveira FF, Fleisher JE, Dumitrascu OM, Patel R, Savica R, Kim YJ. Pitfalls and biases in neuroepidemiological studies of COVID-19 and the nervous system: a critical appraisal of the current evidence and future directions. J Neurol 2023; 270:5162-5170. [PMID: 37682315 DOI: 10.1007/s00415-023-11981-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurological manifestations frequently occur in individuals with COVID-19, manifesting during the acute phase, persisting beyond the resolution of acute symptoms, and appearing days or weeks after the initial onset of COVID-19 symptoms. However, predicting the incidence, course, and outcome of these neurological manifestations at the individual patient level remains challenging. Biases in study design and limitations in data collection may contribute to the inconsistency and limited validity of the reported findings. Herein, we focused on critically appraising pitfalls and biases of prior reports and provide guidance for improving the quality and standardization of future research. Patients with COVID-19 exhibit diverse demographic features, sociocultural backgrounds, lifestyle habits, and comorbidities, all of which can influence the severity and progression of the infection and its impact on other organ systems. Overlooked or undocumented comorbidities and related treatments may contribute to neurological sequelae, which may not solely be attributable to COVID-19. It is crucial to consider the potential side effects of vaccines in relation to neurological manifestations. CONCLUSION To investigate neurological manifestations of COVID-19, it is essential to employ valid and reliable diagnostic criteria and standard definitions of the factors of interest. Although population-based studies are lacking, well-defined inception cohorts, including hospitalized individuals, outpatients, and community residents, can serve as valuable compromises. These cohorts should be evaluated for the presence of common comorbidities, alongside documenting the primary non-neurological manifestations of the infectious disease. Lastly, patients with COVID-19 should be followed beyond the acute phase to assess the persistence, duration, and severity of neurological symptoms, signs, or diseases.
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Affiliation(s)
- Ettore Beghi
- Department of Neuroscience, Istituto di Ricerch Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrei Ivashynka
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, Italy
| | | | - Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Oana M Dumitrascu
- Departments of Neurology and Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA
| | - Roshni Patel
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Neurology Service, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Jalan Sunsuria, Bandar Sunsuria, 43900, Sepang, Selangor, Malaysia.
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Oliveira FFD. Looking Behind the Curtain: Patient Stratification According to Genetic or Demographic Factors May Yield Unexpected Results in Studies of Neurodegenerative Diseases. J Alzheimers Dis 2023:JAD230561. [PMID: 37393510 DOI: 10.3233/jad-230561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023]
Abstract
Amyloid-PET studies of neurodegenerative diseases may yield inconclusive findings due to lacking stratification according to genetic or demographic variants. APOEɛ4 alleles are the major variants to increase disease susceptibility and cause earlier onset and more behavioral features in patients with late-onset Alzheimer's disease, but have no linear effects on cognitive or functional decline; thus, sample stratification according to APOEɛ4 carrier status may be the best option. Interactions among APOEɛ4 alleles, sex, and age on amyloid-β deposition may reveal even more innovative findings with sufficiently large samples, suggesting variable genomic effects of cognitive reserve, sex differences, and cerebrovascular risk on neurodegeneration.
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de Oliveira FF, Miraldo MC, de Castro-Neto EF, de Almeida SS, Matas SLDA, Bertolucci PHF, Naffah-Mazzacoratti MDG. Differential associations of clinical features with cerebrospinal fluid biomarkers in dementia with Lewy bodies and Alzheimer's disease. Aging Clin Exp Res 2023:10.1007/s40520-023-02452-5. [PMID: 37264166 DOI: 10.1007/s40520-023-02452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Abstract
AIM To explore associations of cerebrospinal fluid biomarkers of neurodegeneration and amyloidosis with caregiver burden, cognition and functionality in dementia with Lewy bodies (DLB) paired with late-onset Alzheimer's disease (AD) and healthy older people. METHODS Consecutive outpatients with DLB were matched with outpatients with AD according to sex, cognitive scores and dementia stage, and with cognitively healthy controls according to age and sex to investigate associations of cerebrospinal fluid amyloid-β (Aβ42,Aβ40,Aβ38), tau, phospho-tau Thr181, ubiquitin, α-synuclein and neurofilament light with caregiver burden, functionality, reverse digit span, a clock drawing test, Mini-Mental State Examination (MMSE) and Severe MMSE, adjusted for sex, age, education, dementia duration and APOE-ε4 alleles. RESULTS Overall, 27 patients with DLB (78.98 ± 9.0 years-old; eleven APOE-ε4 +) were paired with 27 patients with AD (81.50 ± 5.8 years-old; twelve APOE-ε4 +) and 27 controls (78.98 ± 8.7 years-old; four APOE-ε4 +); two-thirds were women. In AD, Aβ42/Aβ38 and Aβ42 were lower, while tau/Aβ42 and phospho-tau Thr181/Aβ42 were higher; α-synuclein/Aβ42 was lower in DLB and higher in AD. The following corrected associations remained significant: in DLB, instrumental functionality was inversely associated with tau/phospho-tau Thr181 and tau/Aβ42, and reverse digit span associated with α-synuclein; in AD, instrumental functionality was inversely associated with neurofilament light, clock drawing test scores inversely associated with phospho-tau Thr181/Aβ42 and α-synuclein/Aβ42, and Severe MMSE inversely associated with tau/Aβ42 and tau/phospho-tau Thr181. CONCLUSIONS Cerebrospinal fluid phospho-tau Thr181 in DLB was similar to AD, but not Aβ42. In associations with test scores, biomarker ratios were superior to isolated biomarkers, while worse functionality was associated with axonal degeneration only in AD.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-900, Brazil.
| | - Marjorie Câmara Miraldo
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-900, Brazil
| | - Eduardo Ferreira de Castro-Neto
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-900, Brazil
| | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Luiz de Andrade Matas
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-900, Brazil
| | - Paulo Henrique Ferreira Bertolucci
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-900, Brazil
| | - Maria da Graça Naffah-Mazzacoratti
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), Rua Botucatu 740, Vila Clementino, São Paulo, SP, 04023-900, Brazil
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de Oliveira FF, de Almeida SS, Chen ES, Smith MC, Bertolucci PHF. APOE ε4 Carrier Status as Mediator of Effects of Psychotropic Drugs on Clinical Changes in Patients With Alzheimer's Disease. J Neuropsychiatry Clin Neurosci 2022; 34:351-360. [PMID: 35272493 DOI: 10.1176/appi.neuropsych.21060160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Neuropsychiatric syndromes have been associated with memory dysfunction and risk of and earlier onset of dementia, but how psychotropic drugs affect clinical changes in Alzheimer's disease is not entirely clear. This study aimed to assess the prospective effects of psychotropic drugs on cognitive and functional changes in Alzheimer's disease according to APOE ε4 carrier status. METHODS The study included consecutive outpatients with late-onset Alzheimer's disease (N=193) and examined score variations at 1 year on the following tests: Clinical Dementia Rating sum of boxes, Mini-Mental State Examination, Severe Mini-Mental State Examination (SMMSE), Brazilian version of the Zarit Caregiver Burden Interview, Index of Independence in Activities of Daily Living, and Lawton's Instrumental Activities of Daily Living Scale. Analyses of score variations accounted for the use of psychotropic drugs or the number of different medications in use, as well as APOE ε4 carrier status, with significance at p<0.05. RESULTS For APOE ε4 noncarriers (N=90), cholinesterase inhibitors were beneficial regarding caregiver burden (p=0.030) and basic functionality (p=0.046), memantine was harmful regarding SMMSE score changes (p=0.032), second-generation antipsychotics had nonsignificant harmful effects on SMMSE score changes (p=0.070), and antiepileptic therapy (p=0.001) and the number of different medications in use (p=0.006) were harmful in terms of basic functionality. APOE ε4 carriers (N=103) did not experience any effects of isolated psychotropic drugs on clinical changes, including antidepressants. CONCLUSIONS Results support the harmful prospective effects of second-generation antipsychotics and antiepileptic drugs on cognitive and functional changes in Alzheimer's disease, particularly for APOE ε4 noncarriers, whereas antidepressants may be safer options for behavioral enhancement.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery (de Oliveira, Bertolucci), Department of Biophysics (de Almeida), Department of Morphology and Genetics (Chen, Smith), Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Sandro Soares de Almeida
- Department of Neurology and Neurosurgery (de Oliveira, Bertolucci), Department of Biophysics (de Almeida), Department of Morphology and Genetics (Chen, Smith), Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Elizabeth Suchi Chen
- Department of Neurology and Neurosurgery (de Oliveira, Bertolucci), Department of Biophysics (de Almeida), Department of Morphology and Genetics (Chen, Smith), Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Marilia Cardoso Smith
- Department of Neurology and Neurosurgery (de Oliveira, Bertolucci), Department of Biophysics (de Almeida), Department of Morphology and Genetics (Chen, Smith), Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Paulo Henrique Ferreira Bertolucci
- Department of Neurology and Neurosurgery (de Oliveira, Bertolucci), Department of Biophysics (de Almeida), Department of Morphology and Genetics (Chen, Smith), Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Silva NCBS, Bracko O, Nelson AR, de Oliveira FF, Robison LS, Shaaban CE, Hainsworth AH, Price BR. Vascular cognitive impairment and dementia: An early career researcher perspective. Alzheimers Dement (Amst) 2022; 14:e12310. [PMID: 35496373 PMCID: PMC9043906 DOI: 10.1002/dad2.12310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/07/2023]
Abstract
The field of vascular contributions to cognitive impairment and dementia (VCID) is evolving rapidly. Research in VCID encompasses topics aiming to understand, prevent, and treat the detrimental effects of vascular disease burden in the human brain. In this perspective piece, early career researchers (ECRs) in the field provide an overview of VCID, discuss past and present efforts, and highlight priorities for future research. We emphasize the following critical points as the field progresses: (a) consolidate existing neuroimaging and fluid biomarkers, and establish their utility for pharmacological and non-pharmacological interventions; (b) develop new biomarkers, and new non-clinical models that better recapitulate vascular pathologies; (c) amplify access to emerging biomarker and imaging techniques; (d) validate findings from previous investigations in diverse populations, including those at higher risk of cognitive impairment (e.g., Black, Hispanic, and Indigenous populations); and (e) conduct randomized controlled trials within diverse populations with well-characterized vascular pathologies emphasizing clinically meaningful outcomes.
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Affiliation(s)
- Nárlon C. Boa Sorte Silva
- Djavad Mowafaghian Centre for Brain HealthDepartment of Physical TherapyFaculty of MedicineThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Oliver Bracko
- Department of BiologyThe University of MiamiCoral GablesFloridaUSA
| | - Amy R. Nelson
- Department of Physiology and Cell BiologyUniversity of South AlabamaMobileAlabamaUSA
| | | | - Lisa S. Robison
- Department of Psychology and NeuroscienceNova Southeastern UniversityFort LauderdaleFloridaUSA
| | | | - Atticus H. Hainsworth
- Molecular & Clinical Sciences Research InstituteSt George's University of London, UKDepartment of NeurologySt George's University Hospitals NHS Foundation Trust LondonLondonUK
| | - Brittani R. Price
- Department of NeuroscienceTufts University School of MedicineBostonMassachusettsUSA
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MC. Pharmacogenetic Analyses of Therapeutic Effects of Lipophilic Statins on Cognitive and Functional Changes in Alzheimer’s Disease. J Alzheimers Dis 2022; 87:359-372. [DOI: 10.3233/jad-215735] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Pharmacogenetic effects of statins on clinical changes in Alzheimer’s disease (AD) could be mediated by epistatic interactions among relevant genetic variants involved in cholesterol metabolism. Objective: To investigate associations of HMGCR (rs3846662), NR1H2 (rs2695121), or CETP (rs5882&rs708272) with cognitive and functional changes in AD, with stratification according to APOE ɛ4 carrier status and lipid-lowering treatment with lipophilic statins. Methods: Consecutive outpatients with late-onset AD were screened with cognitive tests, while caregivers scored functionality and global ratings, with prospective neurotranslational associations documented for one year. Results: Considering n = 190:142 had hypercholesterolemia, 139 used lipophilic statins; minor allele frequencies were 0.379 (rs2695121-T:46.3% heterozygotes), 0.368 (rs5882-G:49.5% heterozygotes), and 0.371 (rs708272-A:53.2% heterozygotes), all in Hardy-Weinberg equilibrium. For APOE ɛ4 carriers: rs5882-GG protected from cognitive decline; rs5882-AA caused faster cognitive decline; carriers of rs2695121-CC or rs5882-AA were more susceptible to harmful cognitive effects of lipophilic statins; carriers of rs5882-GG or rs708272-AG had functional benefits when using lipophilic statins. APOE ɛ4 non-carriers resisted any cognitive or functional effects of lipophilic statins, while invariability of rs3846662 (all AA) prevented the assessment of HMGCR effects. When assessing CETP haplotypes only: rs5882-GG protected from cognitive and functional decline, regardless of lipophilic statin therapy; lipophilic statins usually caused cognitive and functional harm to carriers of rs5882-A and/or rs708272-A; lipophilic statins benefitted cognition and functionality of carriers of rs5882-G and/or rs708272-G. Conclusion: Reportedly protective variants of CETP and NR1H2 also slowed cognitive and functional decline particularly for APOE ɛ4 carriers, and regardless of cholesterol variations, while therapy with lipophilic statins might affect carriers of specific genetic variants.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Morphology and Genetics and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Elizabeth Suchi Chen
- Department of Morphology and Genetics and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Boccardi M, Monsch AU, Ferrari C, Altomare D, Berres M, Bos I, Buchmann A, Cerami C, Didic M, Festari C, Nicolosi V, Sacco L, Aerts L, Albanese E, Annoni JM, Ballhausen N, Chicherio C, Démonet JF, Descloux V, Diener S, Ferreira D, Georges J, Gietl A, Girtler N, Kilimann I, Klöppel S, Kustyniuk N, Mecocci P, Mella N, Pigliautile M, Seeher K, Shirk SD, Toraldo A, Brioschi-Guevara A, Chan KCG, Crane PK, Dodich A, Grazia A, Kochan NA, de Oliveira FF, Nobili F, Kukull W, Peters O, Ramakers I, Sachdev PS, Teipel S, Visser PJ, Wagner M, Weintraub S, Westman E, Froelich L, Brodaty H, Dubois B, Cappa SF, Salmon D, Winblad B, Frisoni GB, Kliegel M. Harmonizing neuropsychological assessment for mild neurocognitive disorders in Europe. Alzheimers Dement 2022; 18:29-42. [PMID: 33984176 PMCID: PMC9642857 DOI: 10.1002/alz.12365] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 03/11/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Harmonized neuropsychological assessment for neurocognitive disorders, an international priority for valid and reliable diagnostic procedures, has been achieved only in specific countries or research contexts. METHODS To harmonize the assessment of mild cognitive impairment in Europe, a workshop (Geneva, May 2018) convened stakeholders, methodologists, academic, and non-academic clinicians and experts from European, US, and Australian harmonization initiatives. RESULTS With formal presentations and thematic working-groups we defined a standard battery consistent with the U.S. Uniform DataSet, version 3, and homogeneous methodology to obtain consistent normative data across tests and languages. Adaptations consist of including two tests specific to typical Alzheimer's disease and behavioral variant frontotemporal dementia. The methodology for harmonized normative data includes consensus definition of cognitively normal controls, classification of confounding factors (age, sex, and education), and calculation of minimum sample sizes. DISCUSSION This expert consensus allows harmonizing the diagnosis of neurocognitive disorders across European countries and possibly beyond.
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Affiliation(s)
- Marina Boccardi
- DZNE - Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald site, Rostock, Germany
- LANVIE - Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
| | - Andreas U Monsch
- Memory Clinic, University Department of Geriatric Medicine FELIX PLATTER, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Clarissa Ferrari
- Unit of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Daniele Altomare
- LANVIE - Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
- Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Manfred Berres
- Department of Mathematics and Technology, University of Applied Sciences Koblenz, Koblenz, Germany
| | - Isabelle Bos
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Andreas Buchmann
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Chiara Cerami
- Institute for Advanced Studies (IUSS-Pavia), Pavia, Italy, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Mira Didic
- APHM, Timone, Service de Neurologie et Neuropsychologie, Hôpital Timone Adultes, Marseille, France
- Aix-Marseille Université, Inserm, INS, UMR_S 1106, 13005, Marseille, France
| | - Cristina Festari
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Valentina Nicolosi
- Laboratory of Alzheimer's Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Leonardo Sacco
- Clinic of Neurology, Neurocenter of Southern Switzerland, EOC, Lugano, Switzerland
| | - Liesbeth Aerts
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | - Jean-Marie Annoni
- Department of Neuroscience and Movement Sciences, University of Geneva and Fribourg Hospital, Geneva, Switzerland
| | - Nicola Ballhausen
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | | | - Jean-François Démonet
- Leenaards Memory Centre-CHUV, Clinical Neuroscience Department, Cité Hospitalière CHUV, Lausanne, Switzerland
| | - Virginie Descloux
- Department of Neuroscience and Movement Sciences, University of Geneva and Fribourg Hospital, Geneva, Switzerland
| | - Suzie Diener
- Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | | | - Anton Gietl
- Institute for Regenerative Medicine, University of Zurich, Schlieren, Switzerland
| | - Nicola Girtler
- Clinical Psychology and Psychotherapy, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dept of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Ingo Kilimann
- DZNE - Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald site, Rostock, Germany
| | - Stefan Klöppel
- Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Nicole Kustyniuk
- Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Patrizia Mecocci
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Nathalie Mella
- Cognitive Aging Lab, University of Geneva, Geneva, Switzerland
| | - Martina Pigliautile
- Department of Medicine and Surgery, Institute of Gerontology and Geriatrics, University of Perugia, Perugia, Italy
| | - Katrin Seeher
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Steven D Shirk
- VISN 1 New England MIRECC and VISN 1 New England GRECC, Bedford VA Healthcare System, Bedford, Department of Psychiatry and Population and Quantitative Health Sciences, University of Massachusetts Medical School, Massachusetts, USA
| | - Alessio Toraldo
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy, Milan Center for Neuroscience, Milan, Italy
| | - Andrea Brioschi-Guevara
- Leenaards Memory Centre-CHUV, Clinical Neuroscience Department, Cité Hospitalière CHUV, Lausanne, Switzerland
| | - Kwun C G Chan
- National Alzheimer's Coordination Center (NACC), Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Paul K Crane
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Alessandra Dodich
- Neuroimaging and Innovative Molecular Tracers Laboratory, and Division of Nuclear Medicine, Diagnostic Departement, University of Geneva, University Hospitals of Geneva, Geneva, Switzerland
- Centre for Mind/Brain Sciences, University of Trento, Rovereto, Italy
| | - Alice Grazia
- DZNE - Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald site, Rostock, Germany
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | - Flavio Nobili
- Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Dept of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy
| | - Walter Kukull
- National Alzheimer's Coordination Center (NACC), Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Oliver Peters
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité, Universitätsmedizin Berlin, Berlin, Germany, ZNE, German Center for Neurodegenerative Diseases, Berlin, Germany
| | - Inez Ramakers
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Stefan Teipel
- DZNE - Deutsches Zentrum für Neurodegenerative Erkrankungen, Rostock-Greifswald site, Rostock, Germany
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
| | - Michael Wagner
- DZNE, German Center for Neurodegenerative Diseases, Bonn, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Eric Westman
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lutz Froelich
- University of Heidelberg, Heidelberg, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Bruno Dubois
- Hôpital Pitié-Salpêtrière, AP-HP, Alzheimer Research Institute (IM2A), and Institut du cerveau et la moelle (ICM), Sorbonne Université, Paris, France
| | - Stefano F Cappa
- Institute for Advanced Studies (IUSS-Pavia), Pavia, Italy, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - David Salmon
- Department of Neurosciences, University of California San Diego School of Medicine, San Diego, USA
| | - Bengt Winblad
- Dept NVS, Center for Alzheimer Research, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Giovanni B Frisoni
- LANVIE - Laboratory of Neuroimaging of Aging, University of Geneva, Geneva, Switzerland
- Memory Center, Geneva University Hospitals, Geneva, Switzerland
| | - Matthias Kliegel
- Cognitive Aging Lab, Department of Psychology, University of Geneva, Geneva, Switzerland
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Oliveira FFD, de Almeida SS, Smith MC, Bertolucci PHF. Behavioural effects of the ACE insertion/deletion polymorphism in Alzheimer's disease depend upon stratification according to APOE-ϵ4 carrier status. Cogn Neuropsychiatry 2021; 26:293-305. [PMID: 34034613 DOI: 10.1080/13546805.2021.1931085] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The inherited risk of late-onset Alzheimer's disease (AD) is genetically determined. We aimed to examine associations of genetic variants of APOE and ACE with age at AD onset and with neuropsychiatric symptoms according to each dementia stage.Methods: Consecutive outpatients with AD were assessed for demographic features, Clinical Dementia Rating scores, and the 10-item Neuropsychiatric Inventory, and genotyped for rs7412 and rs429358 (APOE haplotypes, Real-Time Polymerase Chain Reactions), and the ACE insertion/deletion polymorphism (Polymerase Chain Reactions). Combined genetic variants of APOE and ACE were associated with age at dementia onset, and with neuropsychiatric symptoms in each dementia stage (adjusted for sex and age at dementia onset).Results: Over two-thirds of the 238 patients were women, whereas the mean age at dementia onset was 73.82 ± 6.2 years-old. APOE-ϵ4/ϵ4 carriers had earlier dementia onset (p<.001). The ACE insertion/deletion polymorphism was in Hardy-Weinberg equilibrium (p=.37) but was not associated with age at dementia onset, regardless of APOE-ϵ4 carrier status. The only results that survived corrections for false discovery rates were higher scores of dysphoria for APOE-ϵ4 carriers (n=122) who also carried ACE deletion/deletion (p=.031). No results survived corrections for false discovery rates for APOE-ϵ4 non-carriers (n=116).Conclusions: Though only the APOE-ϵ4/ϵ4 haplotype affected AD onset, effects of the ACE insertion/deletion polymorphism over behavioural features might differ according to APOE-ϵ4 carrier status in genetic associations.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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11
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de Oliveira FF, Miraldo MC, de Castro-Neto EF, de Almeida SS, Matas SLDA, Bertolucci PHF, Naffah-Mazzacoratti MDG. Associations of Neuropsychiatric Features with Cerebrospinal Fluid Biomarkers of Amyloidogenesis and Neurodegeneration in Dementia with Lewy Bodies Compared with Alzheimer's Disease and Cognitively Healthy People. J Alzheimers Dis 2021; 81:1295-1309. [PMID: 33935098 DOI: 10.3233/jad-210272] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Behavioral features may reflect proteinopathies predicting pathophysiology in neurodegenerative diseases. OBJECTIVE We aimed to investigate associations of cerebrospinal fluid biomarkers of amyloidogenesis and neurodegeneration with neuropsychiatric features in dementia with Lewy bodies (DLB) compared with late-onset Alzheimer's disease (AD) and cognitively healthy people. METHODS Consecutive outpatients with DLB were paired with outpatients with AD according to sex, dementia stage, and cognitive scores, and with cognitively healthy controls according to sex and age to investigate associations of cerebrospinal fluid amyloid-β (Aβ)42, Aβ40, Aβ38, total tau, phospho-tau Thr181, α-synuclein, ubiquitin, and neurofilament light with neuropsychiatric features according to APOEɛ4 carrier status. RESULTS Overall, 27 patients with DLB (78.48±9.0 years old, eleven APOEɛ4 carriers) were paired with 27 patients with AD (81.00±5.8 years old, twelve APOEɛ4 carriers) and 27 controls (78.48±8.7 years old, four APOEɛ4 carriers); two thirds were women. Behavioral burden was more intense in DLB. Biomarker ratios reflecting amyloidogenesis and neurodegeneration in DLB were more similar to those in AD when patients carried APOEɛ4 alleles. After corrections for false discovery rates, the following associations remained significant: in DLB, dysphoria was associated with tauopathy and indirect measures of amyloidogenesis, while in AD, agitation, and night-time behavior disturbances were associated with tauopathy, and delusions were associated with tauopathy and indirect measures of amyloidogenesis. CONCLUSION Biomarker ratios were superior to Aβ and tau biomarkers predicting neuropsychiatric symptoms when associations with isolated biomarkers were not significant. At the end, APOEɛ4 carrier status influenced amyloidogenesis and tau pathology in DLB and in AD, and axonal degeneration only in DLB.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marjorie Câmara Miraldo
- Department of Neurology and Neurosurgery Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Eduardo Ferreira de Castro-Neto
- Department of Neurology and Neurosurgery Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Luiz de Andrade Matas
- Department of Neurology and Neurosurgery Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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12
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Marin SDMC, Mansur LL, Oliveira FFD, Marin LF, Wajman JR, Bahia VS, Bertolucci PHF. Swallowing in behavioral variant frontotemporal dementia. Arq Neuropsiquiatr 2021; 79:8-14. [PMID: 33656114 DOI: 10.1590/0004-282x20200060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases of swallowing. OBJECTIVE To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features. METHODS Consecutive outpatients with bvFTD in mild, moderate and severe dementia stages were recruited along with their caregivers. Patients and caregivers were screened with the following scales: "Mini-Mental State Examination", "Severe Mini-Mental State Examination", "FTLD-modified Clinical Dementia Rating", "Neuropsychiatric Inventory", "Frontal Assessment Battery", "Index of Independence in Activities of Daily Living", "Swallowing Rating Scale" and "Assessment of Feeding and Swallowing Difficulties in Dementia". RESULTS Overall, thirty patients with bvFTD were included along with their caregivers. Patients with bvFTD showed feeding and swallowing difficulties such as: messy to eat, passivity, coughing and choking, difficulty with some food consistencies and with specific food. Swallowing problems in bvFTD correlated with impaired functionality (p<0.05) and cognition (p<0.05), executive dysfunction (p<0.01) and behavioral features (p<0.01). Caregivers had great difficulty in managing the feeding situation during mealtime, with different characteristics in each dementia stage. CONCLUSION Patients with bvFTD had inappropriate speed eating, passivity, coughing and choking starting in the mild dementia stage, and these problems worsen in the severe stage. Such difficulties affected caregiver performance during mealtime. The correlations indicated that swallowing difficulties tend to follow cognitive and behavioral decline in patients with bvFTD.
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Affiliation(s)
- Sheilla de Medeiros Correia Marin
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.,Universidade de São Paulo, Departamento de Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Letícia Lessa Mansur
- Universidade de São Paulo, Departamento de Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil
| | - Fabricio Ferreira de Oliveira
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - Luis Fabiano Marin
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
| | - José Roberto Wajman
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil
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13
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Parra MA, Baez S, Sedeño L, Gonzalez Campo C, Santamaría‐García H, Aprahamian I, Bertolucci PHF, Bustin J, Camargos Bicalho MA, Cano‐Gutierrez C, Caramelli P, Chaves MLF, Cogram P, Beber BC, Court FA, de Souza LC, Custodio N, Damian A, de la Cruz M, Diehl Rodriguez R, Brucki SMD, Fajersztajn L, Farías GA, De Felice FG, Ferrari R, de Oliveira FF, Ferreira ST, Ferretti C, Figueredo Balthazar ML, Ferreira Frota NA, Fuentes P, García AM, Garcia PJ, de Gobbi Porto FH, Duque Peñailillo L, Engler HW, Maier I, Mata IF, Gonzalez‐Billault C, Lopez OL, Morelli L, Nitrini R, Quiroz YT, Guerrero Barragan A, Huepe D, Pio FJ, Suemoto CK, Kochhann R, Kochen S, Kumfor F, Lanata S, Miller B, Mansur LL, Hosogi ML, Lillo P, Llibre Guerra J, Lira D, Lopera F, Comas A, Avila‐Funes JA, Sosa AL, Ramos C, Resende EDPF, Snyder HM, Tarnanas I, Yokoyama J, Llibre J, Cardona JF, Possin K, Kosik KS, Montesinos R, Moguilner S, Solis PCL, Ferretti‐Rebustini REDL, Ramirez JM, Matallana D, Mbakile‐Mahlanza L, Marques Ton AM, Tavares RM, Miotto EC, Muniz‐Terrera G, Muñoz‐Nevárez LA, Orozco D, Okada de Oliveira M, Piguet O, Pintado Caipa M, Piña Escudero SD, Schilling LP, Rodrigues Palmeira AL, Yassuda MS, Santacruz‐Escudero JM, Serafim RB, Smid J, Slachevsky A, Serrano C, Soto‐Añari M, Takada LT, Grinberg LT, Teixeira AL, Barbosa MT, Trépel D, Ibanez A. Dementia in Latin America: Paving the way toward a regional action plan. Alzheimers Dement 2021; 17:295-313. [PMID: 33634602 PMCID: PMC7984223 DOI: 10.1002/alz.12202] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. Finally, we describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF.
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Affiliation(s)
- Mario Alfredo Parra
- School of Psychological Sciences and HealthGraham Hills BuildingGlasgow, G1 1QE, UK, Universidad Autónoma del CaribePrograma de PsicologíaUniversity of StrathclydeBarranquillaColombia
| | | | - Lucas Sedeño
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)Buenos AiresArgentina
| | - Cecilia Gonzalez Campo
- Cognitive Neuroscience Center (CNC)Universidad de San AndresConsejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)Buenos AiresArgentina
| | - Hernando Santamaría‐García
- Pontificia Universidad JaverianaMedical School, Physiology and Psychiatry DepartmentsMemory and Cognition Center IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Ivan Aprahamian
- Department of Internal MedicineFaculty of Medicine of JundiaíGroup of Investigation on Multimorbidity and Mental Health in Aging (GIMMA)JundiaíState of São PauloBrazil
| | - Paulo HF Bertolucci
- Department of Neurology and NeurosurgeryEscola Paulista de MedicinaFederal University of São Paulo ‐ UNIFESPSão PauloBrazil
| | - Julian Bustin
- INECO FoundationInstitute of Cognitive and Translational Neuroscience (INCYT)Favaloro UniversityBuenos AiresArgentina
| | | | - Carlos Cano‐Gutierrez
- Medical SchoolGeriatric Unit, Memory and Cognition Center‐IntellectusAging InstituteHospital Universitario San IgnacioPontificia Universidad JaverianaBogotáColombia
| | - Paulo Caramelli
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Marcia L. F. Chaves
- Neurology ServiceHospital de Clínicas de Porto Alegre e Universidade Federal do Rio Grande do SulBrazil
| | - Patricia Cogram
- Laboratory of Molecular NeuropsychiatryINECO FoundationNational Scientific and Technical Research CouncilInstitute of Cognitive and Translational Neuroscience (INCyT)Favaloro UniversityBuenos AiresArgentina
| | - Bárbara Costa Beber
- Department of Speech and Language PathologyAtlantic Fellow for Equity in Brain HealthFederal University of Health Sciences of Porto Alegre (UFCSPA)Porto AlegreBrazil
| | - Felipe A. Court
- Center for Integrative BiologyFaculty of SciencesFONDAP Center for GeroscienceBrain Health and Metabolism, Santiago, Chile, The Buck Institute for Research on AgingUniversidad Mayor, ChileNovatoCAUSA
| | | | - Nilton Custodio
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Andres Damian
- Centro Uruguayo de Imagenología Molecular (CUDIM)Centro de Medicina Nuclear e Imagenología MolecularHospital de ClínicasUniversidad de la RepúblicaMontevideoUruguay
| | - Myriam de la Cruz
- Global Brain Health Institute, University of CaliforniaSan FranciscoUSA
| | - Roberta Diehl Rodriguez
- Behavioral and Cognitive Neurology UnitDepartment of Neurology and LIM 22University of São PauloSão PauloBrazil
| | | | - Lais Fajersztajn
- Laboratory of Experimental Air Pollution (LIM05)Department of PathologySchool of MedicineGlobal Brain Health Institute, University of CaliforniaSan Francisco (UCSF)University of São PauloSão PauloSao PauloBrazil
| | - Gonzalo A. Farías
- Department Neurology and Neurosurgery North/Department of NeurosciencesCenter for Advanced Clinical Research (CICA)Faculty of MedicineUniversidad de ChileSantiagoChile
| | | | - Raffaele Ferrari
- Department of Neurodegenerative DiseaseUniversity College LondonLondonESUK
| | - Fabricio Ferreira de Oliveira
- Department of Neurology and NeurosurgeryEscola Paulista de MedicinaFederal University of São Paulo ‐ UNIFESPSão PauloBrazil
| | - Sergio T. Ferreira
- Institute of Medical Biochemistry Leopoldo de Meis & Institute of Biophysics Carlos Chagas FilhoFederal University of Rio de JaneiroRio de JaneiroRJBrazil
| | - Ceres Ferretti
- Division of NeurologyUniversity of São PauloSão PauloBrazil
| | | | | | - Patricio Fuentes
- Geriatrics Section Clinical Hospital University of Chile, Santos Dumont 999 IndependenciaSantiagoChile
| | - Adolfo M. García
- Cognitive Neuroscience Center (CNC)Faculty of EducationNational University of Cuyo (UNCuyo)Universidad de San Andres. National Scientific and Technical Research Council (CONICET)MendozaArgentina
| | | | - Fábio Henrique de Gobbi Porto
- Laboratory of Psychiatric Neuroimaging (LIM‐21)Instituto de PsiquiatriaHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao PauloSao PauloBrazil
| | | | | | | | - Ignacio F. Mata
- Department of Genomic MedicineLerner Research InstituteCleveland ClinicOHUSA
| | - Christian Gonzalez‐Billault
- Center for GeroscienceBrain Health and Metabolism (GERO), Santiago, Chile, and Department of Biology, Faculty of SciencesUniversity of ChileSantiagoChile
| | - Oscar L. Lopez
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPAUSA
| | - Laura Morelli
- Fundacion Instituto Leloir‐IIBBA‐CONICET. AveArgentina
| | - Ricardo Nitrini
- Department of NeurologyUniversity of São Paulo Medical SchoolSão PauloBrazil
| | | | - Alejandra Guerrero Barragan
- Trinity College Dublin, Dublin, Departamento de Neurologia Hospital Occidente de KennedyGlobal Brain Health InstituteUniversidad de la SabanaBogotaColombia
| | - David Huepe
- Center for Social and Cognitive Neuroscience (CSCN)School of PsychologyUniversidad Adolfo IbañezSantiagoChile
| | - Fabricio Joao Pio
- Department of NeurologyHospital Governador Celso RamosFlorianopolisBrazil
| | | | - Renata Kochhann
- Graduate Program in PsychologySchool of Health SciencesHospital Moinhos de VentoPontifical Catholic University of Rio Grande do Sul—PUCRS and Researcher OfficePorto AlegreBrazil
| | - Silvia Kochen
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp, El Cruce “N. Kirchner”, Univ. National A, Jauretche (UNAJ), F. Varela, Prov. Buenos Aires. Fac. MedicineUniv Nacional de Buenos Aires (UBA)Buenos AiresArgentina
| | - Fiona Kumfor
- Brain and Mind Centre and School of PsychologyUniversity of SydneySydneyNSWAustralia
| | - Serggio Lanata
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | - Bruce Miller
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | | | - Mirna Lie Hosogi
- Behavioral and Cognitive Unit of Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism, Santiago, Chile, Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de MedicinaUniversidad de ChileSantiagoChile
| | | | - David Lira
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Francisco Lopera
- Neuroscience Research GroupUniversidad de AntioquiaMedellínColombia
| | - Adelina Comas
- Department of Health Policy at the London School of Economics and Political ScienceLondonUK
| | | | - Ana Luisa Sosa
- Instituto Nacional de Neurología y NeurocirugíaCiudad de MéxicoMéxico
| | - Claudia Ramos
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | | | | | - Ioannis Tarnanas
- Global Brain Health Institute, University of CaliforniaSan FranciscoUSA
- Altoida Inc.HoustonTexasUSA
| | - Jenifer Yokoyama
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | | | | | - Kate Possin
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | - Kenneth S. Kosik
- Neuroscience Research Institute and Dept of Molecular Cellular and Developmental BiologyUniversity of California SantaBarbaraCaliforniaUSA
| | - Rosa Montesinos
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Sebastian Moguilner
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | - Patricia Cristina Lourdes Solis
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp, El Cruce “N. Kirchner”, Univ. National A, Jauretche (UNAJ), F. Varela, Prov. Buenos Aires. Fac. MedicineUniv Nacional de Buenos Aires (UBA)Buenos AiresArgentina
| | | | - Jeronimo Martin Ramirez
- Departamen de Admision Continua Adultos Hospital General La Raza Instituto Mexicano del Seguro SocialGlobal Brain Health Institute, Trinity College Dublin, DublinCiudad de MexicoMexico
| | - Diana Matallana
- Medical SchoolAging Institute and Psychiatry DepartmentPontificia Universidad Javeriana. Memory and Cognition Center‐IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Lingani Mbakile‐Mahlanza
- Global Brain Health InstituteUniversity of California San Francisco, University of BotswanaGaboroneBotswana
| | | | | | - Eliane C Miotto
- Department of NeurologyUniversity of Sao PauloSao PauloBrazil
| | | | | | - David Orozco
- Cognitive Neuroscience Development LaboratoryAxis NeurocienciasUniversidad Nacional del Sur, Cognitive Impairment and Behavior Disorders UnitBahía BlancaArgentina
| | - Maira Okada de Oliveira
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | - Olivier Piguet
- School of Psychology and Brain and Mind CentreUniversity of SydneyCamperdownNSWAustralia
| | - Maritza Pintado Caipa
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | | | - Lucas Porcello Schilling
- Department of NeurologyPontificia Universidade Catolica do Rio Grande do Sul (PUCRS)Porto AlegreBrazil
| | - André Luiz Rodrigues Palmeira
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Neurologia, Porto Alegre, BrazilHospital Ernesto DornellesServiço de Neurologia e NeurocirurgiaPorto AlegreBrazil
| | | | - Jose Manuel Santacruz‐Escudero
- Medical School and Psychiatry DepartmentMemory and Cognition Center‐ IntellectusPontificia Universidad JaverianaHospital Universitario San IgnacioBogotáColombia
| | | | - Jerusa Smid
- Department of NeurologyUniversity of Sao PauloSão PauloBrazil
| | - Andrea Slachevsky
- Neurology DepartmentGeroscience Center for Brain Health and Metabolism, Santiago, Chile, Laboratory of Neuropsychology and Clinical Neuroscience (LANNEC), Physiopathology Program‐ICBM, East Neurologic and Neurosciences Departments, Faculty of MedicineHospital del Salvador and Faculty of Medicine University of Chile. Servicio de NeurologíaDepartamento de MedicinaClínica Alemana—Universidad del DesarrolloUniversity of Chile, Neuropsychiatry and Memory Disorders clinic (CMYN)SantiagoChile
| | | | | | | | - Lea Tenenholz Grinberg
- Departments of NeurologyPathology and Global Brain Health InstituteUCSF ‐ USA, Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Antonio Lucio Teixeira
- Laboratório Interdisciplinar de Investigação MédicaFaculdade de MedicinaAv. Alfredo Balena, 110Universidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Maira Tonidandel Barbosa
- Faculdade de Medicina da Universidade Federal de Minas Gerais e Faculdade deCiências Médicas de Minas GeraisBelo HorizonteBrazil
| | - Dominic Trépel
- Global Brain Health Institute (GBHI)Trinity College DublinDublin
| | - Agustin Ibanez
- Cognitive Neuroscience Center (CNC) Buenos Aires, Argentina; Universidad Autonoma del Caribe, Barranquilla, Colombia; Global Brain Health Institute (GBHI), USUniversidad de San AndresCONICETUniversidad Autonoma del CaribeUniversidad Adolfo IbanezUCSFUSA
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Canella M, de Oliveira Souza NV, Bertolucci PHF, de Oliveira FF. Vascular cognitive impairment due to dilated perivascular spaces in putamen: Connections with the ventrolateral prefrontal cortex and neurological deficits. Alzheimers Dement 2020. [DOI: 10.1002/alz.046439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marcelo Canella
- Federal University of São Paulo ‐ UNIFESP São Paulo Brazil
- Military Hospital of São Paulo ‐ HMASP São Paulo Brazil
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15
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Canella M, Baptista RM, de Oliveira FF, Bertolucci PHF. Klüver‐Bucy syndrome due to stroke in the left temporal lobe. Alzheimers Dement 2020. [DOI: 10.1002/alz.044233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Marcelo Canella
- Federal University of São Paulo ‐ UNIFESP São Paulo Brazil
- Military Hospital of São Paulo ‐ HMASP São Paulo Brazil
- Brazilian Navy Medical Officer São Paulo Brazil
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Ibanez A, Santamaria‐Garcia H, Guerrero Barragan A, Kornhuber A, Ton AMM, Slachevsky A, Teixeira AL, Mar Meza BM, Serrano CM, Cano C, Arias Gonzalez C, Gonzalez‐Billault C, Butler C, Bustin J, Duran‐Aniotz C, Acosta D, Matallana DL, Acosta‐Alvear D, Trépel D, Resende EDPF, de Oliveira FF, Ibanez F, De Felice FG, Navarrete G, Tarnanas I, Meier IB, Smid J, Llibre‐Guerra J, Llibre‐Rodriguez JJ, Fajersztajn L, Takada LT, Duque L, Okada de Oliveira M, Bicalho MAC, Behrens MI, Pintado‐Caipa M, Parra M, Wilson MZ, De La Cruz Puebla M, Custodio N, Santibanez R, Serafim RB, Tavares RM, Piña Escudero SD, Leon Rodriguez T, Dawson W, Miller BL, Kosik KS. The impact of SARS-CoV-2 in dementia across Latin America: A call for an urgent regional plan and coordinated response. Alzheimers Dement (N Y) 2020; 6:e12092. [PMID: 33283036 PMCID: PMC7683959 DOI: 10.1002/trc2.12092] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 01/15/2023]
Abstract
The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.
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Affiliation(s)
- Agustin Ibanez
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Cognitive Neuroscience Center (CNC)Universidad de San AndrésBuenos AiresArgentina
- National Scientific and Technical Research Council (CONICET)Buenos AiresArgentina
- Center for Social and Cognitive Neuroscience (CSCN)Universidad Adolfo Ibanez, School of Psychology, Adolfo Ibañez UniversitySantiagoChile
- Universidad Autónoma del CaribeBarranquillaColombia
| | - Hernando Santamaria‐Garcia
- Pontificia Universidad Javeriana, Bogotá, Departamentos de Psiquiatría, Instituto de Envejecimiento, Centro de Memoria y Cognición IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Alejandra Guerrero Barragan
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Servicio de NeurologíaSubred de Servicios de Salud SuroccidenteBogotáColombia
| | - Alexander Kornhuber
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Alyne Mendonca Marques Ton
- Laboratory of Translational Physiology and PharmacologyPharmaceutical Sciences Graduate Program, Vila Velha UniversityVila VelhaEspírito SantoBrazil
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic (CMYN), Neurology DepartmentDel Salvador Hospital and University of Chile Faculty of MedicineSantiagoChile
- Geroscience Center for Brain Health and Metabolism (GERO), Faculty of MedicineUniversity of ChileSantiagoChile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department ‐ ICBM, Neuroscience and East Neuroscience Departments, Faculty of MedicineUniversity of ChileSantiagoChile
- Department of Neurology and PsychiatryClínica Alemana‐Universidad del DesaConcepciónChile
| | | | - Beatriz Marcela Mar Meza
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Cecilia M. Serrano
- Cognitive Neurology, Department of NeurologyCésar Milstein Hospital, ALMA (Asociación de Lucha contra el Mal de Alzheimer y alteraciones semejantes de la República Argentina), Research Ethics Committee, Ministry of Health of Buenos AiresBuenos AiresArgentina
| | - Carlos Cano
- Pontificia Universidad Javeriana, Bogotá, Departamentos de Psiquiatría, Instituto de Envejecimiento, Centro de Memoria y Cognición IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Carolina Arias Gonzalez
- Neuroscience Research Institute and Department of Molecular Cellular and Developmental BiologyUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Christian Gonzalez‐Billault
- Geroscience Center for Brain Health and Metabolism (GERO), Faculty of MedicineUniversity of ChileSantiagoChile
| | - Christopher Butler
- Department of Brain SciencesImperial CollegeLondonUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Department of NeurologyPontificia Universidad Católica de ChileSantiagoChile
| | - Julian Bustin
- Instituto de Neurología CognitivaINCYTBuenos AiresArgentina
| | - Claudia Duran‐Aniotz
- Center for Social and Cognitive Neuroscience (CSCN)Universidad Adolfo Ibanez, School of Psychology, Adolfo Ibañez UniversitySantiagoChile
- Geroscience Center for Brain Health and Metabolism (GERO), Faculty of MedicineUniversity of ChileSantiagoChile
- Biomedical Neuroscience Institute, Faculty of MedicineUniversity of ChileSantiagoChile
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine DepartmentGeriatric SectionSanto DomingoDominican Republic
| | - Diana L. Matallana
- Pontificia Universidad Javeriana, Bogotá, Departamentos de Psiquiatría, Instituto de Envejecimiento, Centro de Memoria y Cognición IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Diego Acosta‐Alvear
- Neuroscience Research Institute and Department of Molecular Cellular and Developmental BiologyUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Dominic Trépel
- Global Brain Health InstituteTrinity College DublinDublinIreland
| | - Elisa De Paula França Resende
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Instituto de Ensino e PesquisaSanta Casa BHBelo HorizonteBrazil
- Federal University of Rio de JaneiroRio de JaneiroBrazil
| | - Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de MedicinaFederal University of São Paulo ‐ UNIFESPSão PauloBrazil
| | | | - Fernanda G. De Felice
- Federal University of Rio de JaneiroRio de JaneiroBrazil
- Queen's UniversityKingstonOntarioCanada
| | - Gorka Navarrete
- Center for Social and Cognitive Neuroscience (CSCN)Universidad Adolfo Ibanez, School of Psychology, Adolfo Ibañez UniversitySantiagoChile
| | - Ioannis Tarnanas
- Altoida Inc.HoustonTexasUSA
- Swiss National Task Force for DementiaGenevaSwitzerland
| | - Irene B. Meier
- Altoida Inc.HoustonTexasUSA
- Swiss National Task Force for DementiaGenevaSwitzerland
| | - Jerusa Smid
- Department of NeurologyUniversity of Sao Paulo; Institute of Infectious Diseases Emilio RibasSão PauloBrazil
| | - Jorge Llibre‐Guerra
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Department of NeurologyWashington University School of MedicineSt LouisUSA
| | | | - Laís Fajersztajn
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Department of Pathology, Laboratory of Experimental Air PollutionUniversity of São Paulo School of MedicineSao PauloBrazil
| | | | - Lissette Duque
- Cognitive Disorders Unit, NeuromedicenterNational Commission in BioethicsQuitoEcuador
| | - Maira Okada de Oliveira
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Hospital das ClinicasUniversity of Sao Paulo Medical SchoolSao PauloBrazil
- Hospital Santa MarcelinaSao PauloBrazil
| | | | - María Isabel Behrens
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department ‐ ICBM, Neuroscience and East Neuroscience Departments, Faculty of MedicineUniversity of ChileSantiagoChile
- FCEFyNUniversidad Nacional de San JuanSan JuanArgentina
- Departamento de Neurología and Neurocirugía Hospital Clínico, Departamento de NeurocienciasCentro de Investigación Clínica Avanzada (CICA) Facultad de Medicina, Hospital Clínico, Universidad de ChileSantiagoChile
| | - Maritza Pintado‐Caipa
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology Center, Peruvian Institute of NeurosciencesLimaPeru
| | | | - Maxwell Z. Wilson
- Neuroscience Research Institute and Department of Molecular Cellular and Developmental BiologyUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
| | - Myriam De La Cruz Puebla
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Vall d'Hebron Research Institute (VHIR)Autonome University of BarcelonaBarcelonaSpain
| | - Nilton Custodio
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology Center, Peruvian Institute of NeurosciencesLimaPeru
| | - Rodrigo Santibanez
- Department of NeurologyPontificia Universidad Católica de ChileSantiagoChile
- Neurology ServiceComplejo Asistencial Dr. Sótero del RíoSantiagoChile
| | | | - Ronnielly Melo Tavares
- Federal University of Rio de JaneiroRio de JaneiroBrazil
- Behavioral Neurology ClinicSanta Casa de Belo HorizonteMGBrazil
| | | | - Tomas Leon Rodriguez
- Memory and Neuropsychiatric Clinic (CMYN), Neurology DepartmentDel Salvador Hospital and University of Chile Faculty of MedicineSantiagoChile
| | - Walter Dawson
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Department of NeurologySchool of Medicine, Oregon Health and Science UniversityPortlandOregonUSA
- Institute on AgingCollege of Urban and Public Affairs, Portland State UniversityPortlandOregonUSA
| | - Bruce L. Miller
- Global Brain Health Institute (GBHI)University of California San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Kenneth S. Kosik
- Neuroscience Research Institute and Department of Molecular Cellular and Developmental BiologyUniversity of California Santa BarbaraSanta BarbaraCaliforniaUSA
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Bateman DR, Gill S, Hu S, Foster ED, Ruthirakuhan MT, Sellek AF, Mortby ME, Matušková V, Ng KP, Tarawneh RM, Freund-Levi Y, Kumar S, Gauthier S, Rosenberg PB, Ferreira de Oliveira F, Devanand DP, Ballard C, Ismail Z. Agitation and impulsivity in mid and late life as possible risk markers for incident dementia. Alzheimers Dement (N Y) 2020; 6:e12016. [PMID: 32995467 PMCID: PMC7507499 DOI: 10.1002/trc2.12016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022]
Abstract
To identify knowledge gaps regarding new-onset agitation and impulsivity prior to onset of cognitive impairment or dementia the International Society to Advance Alzheimer's Research and Treatment Neuropsychiatric Syndromes (NPS) Professional Interest Area conducted a scoping review. Extending a series of reviews exploring the pre-dementia risk syndrome Mild Behavioral Impairment (MBI), we focused on late-onset agitation and impulsivity (the MBI impulse dyscontrol domain) and risk of incident cognitive decline and dementia. This scoping review of agitation and impulsivity pre-dementia syndromes summarizes the current biomedical literature in terms of epidemiology, diagnosis and measurement, neurobiology, neuroimaging, biomarkers, course and prognosis, treatment, and ongoing clinical trials. Validations for pre-dementia scales such as the MBI Checklist, and incorporation into longitudinal and intervention trials, are needed to better understand impulse dyscontrol as a risk factor for mild cognitive impairment and dementia.
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Affiliation(s)
- Daniel R Bateman
- Department of Psychiatry Indiana University School of Medicine Indianapolis Indiana
- Indiana University Center for Aging Research Regenstrief Institute Indianapolis Indiana
| | - Sascha Gill
- Department of Clinical Neurosciences; and the Ron and Rene Ward Centre for Healthy Brain Aging Research; Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
| | - Sophie Hu
- Community Health Sciences, and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
| | - Erin D Foster
- Ruth Lilly Medical Library Indiana University School of Medicine Indianapolis Indiana
- University of California Berkeley Berkeley CA
| | - Myuri T Ruthirakuhan
- Hurvitz Brain Sciences Research Program Sunnybrook Research Institute Toronto Ontario Canada
- Department of Pharmacology and Toxicology University of Toronto Ontario Canada
| | | | - Moyra E Mortby
- School of Psychology University of New South Wales Sydney New South Wales Australia
- Neuroscience Research Australia University of New South Wales Sydney New South Wales Australia
| | - Veronika Matušková
- International Clinical Research Center St. Anne's University Hospital Brno Brno Czech Republic
- Memory Disorders Clinic, Department of Neurology, 2nd Faculty of Medicine Charles University in Prague and Motol University Hospital Prague Czech Republic
| | - Kok Pin Ng
- Department of Neurology National Neuroscience Institute Singapore Singapore
| | - Rawan M Tarawneh
- Department of Neurology, College of Medicine The Ohio State University Columbus Ohio USA
| | - Yvonne Freund-Levi
- Center for Alzheimer Research, Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society Karolinska Institute Stockholm Sweden
- School of Medical Sciences Örebro University Örebro Sweden
| | - Sanjeev Kumar
- Centre for Addiction and Mental Health Toronto Ontario Canada
- Department of Psychiatry University of Toronto Ontario Canada
| | - Serge Gauthier
- McGill Center for Studies in Aging McGill University Montreal Quebec Canada
| | - Paul B Rosenberg
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral, Sciences Johns Hopkins University School of Medicine Baltimore Maryland
| | - Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina Federal University of São Paulo (UNIFESP), São Paulo São Paulo Brazil
| | - D P Devanand
- New York State Psychiatric Institute and Department of Psychiatry and Department of Psychiatry, College of Physicians and Surgeons Columbia University New York New York
| | - Clive Ballard
- College of Medicine and Health The University of Exeter Exeter UK
| | - Zahinoor Ismail
- Department of Clinical Neurosciences; and the Ron and Rene Ward Centre for Healthy Brain Aging Research; Hotchkiss Brain Institute University of Calgary Calgary Alberta Canada
- Community Health Sciences, and O'Brien Institute for Public Health University of Calgary Calgary Alberta Canada
- Department of Psychiatry, and the Mathison Centre for Mental Health Research & Education Cumming School of Medicine, University of Calgary Calgary Alberta Canada
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18
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de Oliveira FF, Machado FC, Sampaio G, Marin SDMC, Naffah-Mazzacoratti MDG, Bertolucci PHF. Neuropsychiatric feature profiles of patients with Lewy body dementia. Clin Neurol Neurosurg 2020; 194:105832. [DOI: 10.1016/j.clineuro.2020.105832] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 02/22/2020] [Accepted: 04/02/2020] [Indexed: 01/17/2023]
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de Oliveira FF, Berretta JM, de Almeida Junior GV, de Almeida SS, Chen ES, Smith MC, Bertolucci PHF. Pharmacogenetic analyses of variations of measures of cardiovascular risk in Alzheimer's dementia. Indian J Med Res 2020; 150:261-271. [PMID: 31719297 PMCID: PMC6886147 DOI: 10.4103/ijmr.ijmr_1209_17] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background & objectives: Neurodegeneration affects blood pressure variations, while renal function and cerebral perfusion are impaired by vascular risk factors. This study was aimed to estimate variations of measures of cardiovascular risk in Alzheimer's dementia by pharmacogenetic analyses of the effects of angiotensin-converting enzyme (ACE) inhibitors and statins. Methods: Consecutive patients were prospectively followed to study variations of creatinine clearance and blood pressure for one year, estimated by correlating the effects of ACE inhibitors with the ACE Alu I/D polymorphism and genotypes or haplotypes of rs1800764 or rs4291, and the effects of statins with LDLR (low-density lipoprotein receptor) genotypes or haplotypes of rs11669576 (exon 8) or rs5930 (exon 10), or genotypes of rs2695121 (liver X receptor β gene). Variations of the coronary heart disease (CHD) risk according to these cardiovascular measures were also explored. Results: All polymorphisms of the 193 patients were in Hardy-Weinberg equilibrium. Genetic determinants of cardiovascular effects affected the individual variability of the response to ACE inhibitors and statins. ACE inhibitors, but not statins, reduced blood pressure for all patients. ACE inhibitors protected carriers of alleles that supposedly decrease serum ACE levels (rs1800764-T, rs4291-A, Alu II) regarding creatinine clearance variations (P<0.005), but carriers of Alu DD (P<0.02), rs1800764-C (P<0.05), or rs4291-AT (P<0.04) showed better blood pressure lowering effects. The presence of rs2695121-T (P=0.007) or rs5930-A (P=0.039) was associated with systolic blood pressure lowering, whereas rs5930-AA was protective against decrease in creatinine clearance (P=0.019). Statins lowered creatinine clearance for carriers of rs2695121-CT (P=0.026). Interpretation & conclusions: Pharmacological response of blood pressure and creatinine clearance to ACE inhibitors and statins may be genetically mediated.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology & Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Juliana Marília Berretta
- Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | | | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology & Genetics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology & Genetics, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
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de Oliveira FF, de Almeida SS, Chen ES, Smith MC, Naffah-Mazzacoratti MDG, Bertolucci PHF. Lifetime Risk Factors for Functional and Cognitive Outcomes in Patients with Alzheimer's Disease. J Alzheimers Dis 2019; 65:1283-1299. [PMID: 30149448 DOI: 10.3233/jad-180303] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Lifetime risk factors for cognitive and functional decline in Alzheimer's disease (AD) are not fully understood, and were prospectively evaluated in patients with low mean schooling from São Paulo, Brazil. Consecutive outpatients with late-onset AD were assessed for APOE haplotypes and the following potential baseline predictors: gender, schooling, age at dementia onset, lifetime urban living and sanitary conditions, occupational complexity, cognitive and physical activities, cerebrovascular risk factors (obesity, lifetime alcohol use and smoking, length of arterial hypertension, diabetes mellitus, and a dyslipidemic profile), use of a pacemaker, creatinine clearance, body mass index, waist circumference, head traumas with unconsciousness, treated systemic bacterial infections, amount of surgical procedures under general anesthesia, and family history of AD. Participants were followed from October 2010 to May 2017 for baseline risk factor associations with time since dementia onset for Clinical Dementia Rating and Mini-Mental State Examination score changes. For 227 patients (154 women, 119 APOE ε 4 carriers), later AD onset (mean 73.60±6.4 years-old, earlier for APOE ε 4/ε 4 carriers, p < 0.001) was the only variable hastening all endpoints, baseline creatinine clearance and lifetime alcohol use were hazardous for earlier cognitive and functional endpoints, women had earlier cognitive endpoints only, and schooling had a cumulative protective effect over later cognitive endpoints, particularly for carriers of APOE ε 4. Exclusively for carriers of APOE ε 4, head traumas with unconsciousness were hazardous for earlier cognitive endpoints, while lifetime sanitary conditions were protective regarding later cognitive endpoints. Functional and cognitive outcomes in AD represent probable interactions between effects of brain reserve and cerebral perfusion over neurodegeneration.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sandro Soares de Almeida
- Department of Biophysics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Ferreira de Oliveira F, Miraldo MC, Castro-Neto EF, Machado FC, Soares de Almeida S, Luiz de Andrade Matas S, Ferreira Bertolucci PH, da Graça Naffah-Mazzacoratti M. P4-180: BEHAVIORAL CORRELATES OF CEREBROSPINAL FLUID BIOMARKERS ACCORDING TO APOE-ε4 CARRIER STATUS IN DEMENTIA WITH LEWY BODIES COMPARED WITH ALZHEIMER'S DEMENTIA AND COGNITIVELY HEALTHY PEOPLE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Ferreira de Oliveira F, Miraldo MC, Castro-Neto EF, Machado FC, Soares de Almeida S, Luiz de Andrade Matas S, Ferreira Bertolucci PH, da Graça Naffah-Mazzacoratti M. O2-02-06: CEREBROSPINAL-FLUID-BASED BIOMARKER EVIDENCE OF AMYLOIDOGENESIS IN DEMENTIA WITH LEWY BODIES DEPENDS UPON APOE
-ε4 CARRIER STATUS. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.4462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Canella M, Andrade AC, Ferreira de Oliveira F, Ferreira Bertolucci PH. P1-323: PRISON WITHOUT WALLS: A CASE REPORT OF SEMANTIC VARIANT PRIMARY PROGRESSIVE APHASIA. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Marcelo Canella
- Federal University of São Paulo - UNIFESP; São Paulo Brazil
- Military Hospital Area of São Paulo - HMASP; São Paulo Brazil
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de Oliveira FF, Chen ES, Smith MC, Bertolucci PHF. Pharmacogenetics of Angiotensin-Converting Enzyme Inhibitors in Patients with Alzheimer's Disease Dementia. Curr Alzheimer Res 2019; 15:386-398. [PMID: 29034839 DOI: 10.2174/1567205014666171016101816] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 10/14/2017] [Accepted: 10/14/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND While the angiotensin-converting enzyme degrades amyloid-β, angiotensinconverting enzyme inhibitors (ACEis) may slow cognitive decline by way of cholinergic effects, by increasing brain substance P and boosting the activity of neprilysin, and by modulating glucose homeostasis and augmenting the secretion of adipokines to enhance insulin sensitivity in patients with Alzheimer's disease dementia (AD). We aimed to investigate whether ACE gene polymorphisms rs1800764 and rs4291 are associated with cognitive and functional change in patients with AD, while also taking APOE haplotypes and anti-hypertensive treatment with ACEis into account for stratification. METHODS Consecutive late-onset AD patients were screened with cognitive tests, while their caregivers were queried for functional and caregiver burden scores. Prospective pharmacogenetic correlations were estimated for one year, considering APOE and ACE genotypes and haplotypes, and treatment with ACEis. RESULTS For 193 patients, minor allele frequencies were 0.497 for rs1800764 - C (44.6% heterozygotes) and 0.345 for rs4291 - T (38.9% heterozygotes), both in Hardy-Weinberg equilibrium. Almost 94% of all patients used cholinesterase inhibitors, while 155 (80.3%) had arterial hypertension, and 124 used ACEis. No functional impacts were found regarding any genotypes or pharmacological treatment. Either for carriers of ACE haplotypes that included rs1800764 - T and rs4291 - A, or for APOE4- carriers of rs1800764 - T or rs4291 - T, ACEis slowed cognitive decline independently of blood pressure variations. APOE4+ carriers were not responsive to treatment with ACEis. CONCLUSION ACEis may slow cognitive decline for patients with AD, more remarkably for APOE4- carriers of specific ACE genotypes.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Rua Botucatu 740, Vila Clementino, CEP 04023-900, Sao Paulo, SP, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Paulo Henrique Ferreira Bertolucci
- Universidade Federal de Sao Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Rua Botucatu 740, Vila Clementino, CEP 04023-900, Sao Paulo, SP, Brazil
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Ferreira de Oliveira F, Soares de Almeida S, Chen ES, Cardoso Smith MA, Graça Naffah-Mazzacoratti M, Ferreira Bertolucci PH. P4‐156: GENETICALLY MEDIATED LIFETIME RISK FACTORS FOR COGNITIVE AND FUNCTIONAL DECLINE IN PATIENTS WITH ALZHEIMER'S DEMENTIA FROM SÃO PAULO, BRAZIL. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ferreira de Oliveira F, Miraldo MC, Castro-Neto EF, Machado FC, Soares de Almeida S, Luiz de Andrade Matas S, Ferreira Bertolucci PH, Graça Naffah-Mazzacoratti M. P2‐225: COGNITIVE AND FUNCTIONAL CORRELATES OF CEREBROSPINAL FLUID CONCENTRATIONS OF AMINOACIDS AND MONOAMINE METABOLITES ACCORDING TO
APOE
‐ε4 CARRIER STATUS IN DEMENTIA WITH LEWY BODIES COMPARED WITH ALZHEIMER'S DEMENTIA AND COGNITIVELY HEALTHY PEOPLE. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Ferreira de Oliveira F, Soares de Almeida S, Chen ES, Cardoso Smith MA, Ferreira Bertolucci PH. P3‐282:
APOE
‐DEPENDENT PSYCHOTROPIC EFFECTS OVER CLINICAL CHANGES IN ALZHEIMER'S DISEASE DEMENTIA. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.1642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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de Oliveira FF, Chen ES, Smith MC, Bertolucci PHF. Associations of Blood Pressure with Functional and Cognitive Changes in Patients with Alzheimer's Disease. Dement Geriatr Cogn Disord 2018; 41:314-23. [PMID: 27398980 DOI: 10.1159/000447585] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Midlife hypertension followed by late life hypotension resulting from neurodegeneration increases amyloidogenesis and tauopathy. METHODS Consecutive outpatients with late-onset Alzheimer's disease (AD) at various stages and their respective caregivers were assessed for score variations in 1 year of tests assessing caregiver burden, functionality and cognition according to blood pressure (BP) variations and APOE haplotypes, while also taking into account differential effects of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, calcium channel blockers, diuretics, or no antihypertensive medication on score changes. The diagnosis and treatment of arterial hypertension followed the JNC 7 report. RESULTS Variations in systolic BP (-11.76 ± 17.1 mm Hg), diastolic BP (-4.92 ± 10.3 mm Hg) and pulse pressure (-6.84 ± 12.6 mm Hg) were significant after 1 year (n = 191; x03C1; < 0.01). For APOE4+ carriers, rises in systolic or diastolic BP improved Clinical Dementia Rating Scale Sum of Boxes scores (x03C1; < 0.04), with marginally significant improvements in Mini-Mental State Examination scores resulting from risen systolic (x03C1; = 0.069) or diastolic BP (x03C1; = 0.079), and in basic independence only regarding risen diastolic BP (x03C1; = 0.055). APOE4- carriers resisted any functional or cognitive effects of BP variations. No differences were found regarding any antihypertensive class for variations in BP or any test scores, regardless of APOE haplotypes. CONCLUSIONS Targeting mild BP elevations brings better functional and cognitive results for APOE4+ carriers with AD.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Departments of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of Sx00E3;o Paulo (UNIFESP), Sx00E3;o Paulo, Brazil
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de Oliveira FF, Pereira FV, Pivi GAK, Smith MC, Bertolucci PHF. Effects of APOE haplotypes and measures of cardiovascular risk over gender-dependent cognitive and functional changes in one year in Alzheimer's disease. Int J Neurosci 2017; 128:472-476. [DOI: 10.1080/00207454.2017.1396986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Fernando Vieira Pereira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Glaucia Akiko Kamikado Pivi
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
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Abstract
BACKGROUND More than 95% of right-handed individuals, as well as almost 80% of left-handed individuals, have left hemisphere dominance for language. The perisylvian networks of the dominant hemisphere tend to be the most important language systems in human brains, usually connected by bidirectional fibres originated from the superior longitudinal fascicle/arcuate fascicle system and potentially modifiable by learning. Neuroplasticity mechanisms take place to preserve neural functions after brain injuries. Language is dependent on a hierarchical interlinkage of serial and parallel processing areas in distinct brain regions considered to be elementary processing units. Whereas aphasic syndromes typically result from injuries to the dominant hemisphere, the extent of the distribution of language functions seems to be variable for each individual. METHOD Review of the literature Results: Several theories try to explain the organization of language networks in the human brain from a point of view that involves either modular or distributed processing or sometimes both. The most important evidence for each approach is discussed under the light of modern theories of organization of neural networks. CONCLUSIONS Understanding the connectivity patterns of language networks may provide deeper insights into language functions, supporting evidence-based rehabilitation strategies that focus on the enhancement of language organization for patients with aphasic syndromes.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
| | - Sheilla de Medeiros Correia Marin
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
| | - Paulo Henrique Ferreira Bertolucci
- a Department of Neurology and Neurosurgery , Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP) , São Paulo , SP , Brazil
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Ferreira de Oliveira F, Chen ES, Cardoso Smith MA, Ferreira Bertolucci PH. P3‐292: Effects of Apoe Gene Haplotypes and Measures of Cardiovascular Risk Over Cognitive and Functional Decline in one Year in Patients with Alzheimer's Disease Dementia. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.1956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ferreira de Oliveira F, Berretta JM, Suchi Chen E, Cardoso Smith M, Ferreira Bertolucci PH. Pharmacogenetic effects of angiotensin-converting enzyme inhibitors over age-related urea and creatinine variations in patients with dementia due to Alzheimer disease. Colomb Med (Cali) 2016; 47:76-80. [PMID: 27546928 PMCID: PMC4975126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Renal function declines according to age and vascular risk factors, whereas few data are available regarding genetically-mediated effects of anti-hypertensives over renal function. OBJECTIVE To estimate urea and creatinine variations in dementia due to Alzheimer disease (AD) by way of a pharmacogenetic analysis of the anti-hypertensive effects of angiotensin-converting enzyme inhibitors (ACEis). METHODS Consecutive outpatients older than 60 years-old with AD and no history of kidney transplant or dialytic therapy were recruited for prospective correlations regarding variations in fasting blood levels of urea and creatinine in one year, considering ACE genotypes of rs1800764 and rs4291 and their respective haplotypes, and treatment with ACEis along with blood pressure variations. RESULTS For 190 patients, 152 had arterial hypertension, and 122 used ACEis. Minor allele frequencies were 0.492 for rs1800764-C and 0.337 for rs4291-T, both in Hardy-Weinberg equilibrium. There were no overall significant yearly variations in levels of urea and creatinine, but their concurrent variations were positively correlated (ρ <0.0001). Each A allele of rs4291 led to an yearly urea increase of 3,074 mg/dL, and an yearly creatinine increase of 0.044 mg/dL, while the use of ACEis was protective regarding creatinine variations. The use of ACEis was also protective for carriers of rs1800764-CT/rs4291-AA, while carriers of rs1800764-CT/rs4291-AT had steeper reductions in creatinine levels, particularly when they were treated with ACEis. CONCLUSIONS Effects of ACEis over creatinine variations are genetically mediated and independent of blood pressure variations in older people with AD.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Juliana Marília Berretta
- Department of Medicine, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Ferreira de Oliveira F, Marília Berretta J, Suchi Chen E, Cardoso Smith M, Ferreira Bertolucci PH. Pharmacogenetic effects of angiotensin-converting enzyme inhibitors over age-related urea and creatinine variations in patients with dementia due to Alzheimer disease. Colomb Med (Cali) 2016. [DOI: 10.25100/cm.v47i2.2188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background:
Renal function declines according to age and vascular risk factors, whereas few data are available regarding genetically-mediated effects of anti-hypertensives over renal function.
Objective:
To estimate urea and creatinine variations in dementia due to Alzheimer disease (AD) by way of a pharmacogenetic analysis of the anti-hypertensive effects of angiotensin-converting enzyme inhibitors (ACEis).
Methods:
Consecutive outpatients older than 60 years-old with AD and no history of kidney transplant or dialytic therapy were recruited for prospective correlations regarding variations in fasting blood levels of urea and creatinine in one year, considering ACE genotypes of rs1800764 and rs4291 and their respective haplotypes, and treatment with ACEis along with blood pressure variations.
Results:
For 190 patients, 152 had arterial hypertension, and 122 used ACEis. Minor allele frequencies were 0.492 for rs1800764-C and 0.337 for rs4291-T, both in Hardy-Weinberg equilibrium. There were no overall significant yearly variations in levels of urea and creatinine, but their concurrent variations were positively correlated (ρ <0.0001). Each A allele of rs4291 led to an yearly urea increase of 3.074 mg/dL, and an yearly creatinine increase of 0.044 mg/dL, while the use of ACEis was protective regarding creatinine variations. The use of ACEis was also protective for carriers of rs1800764-CT/rs4291-AA, while carriers of rs1800764-CT/rs4291-AT had steeper reductions in creatinine levels, particularly when they were treated with ACEis.
Conclusions:
Effects of ACEis over creatinine variations are genetically mediated and independent of blood pressure variations in older people with AD.
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Pereira FV, Oliveira FFD, Schultz RR, Bertolucci PHF. Balance impairment does not necessarily coexist with gait apraxia in mild and moderate Alzheimer's disease. Arq Neuropsiquiatr 2016; 74:450-455. [PMID: 27332069 DOI: 10.1590/0004-282x20160063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/22/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To assess correlations among gait apraxia, balance impairment and cognitive performance in mild (AD1, n = 30) and moderate (AD2, n = 30) AD. METHOD The following evaluations were undertaken: gait apraxia (Assessment Walking Skills); balance performance (Berg Balance Scale); Clinical Dementia Rating and Mini-mental State Examination (MMSE). RESULTS While disregarding AD subgroups, Berg Balance Scale and the MMSE correlated significantly with Assessment Walking Skills and 23% of all subjects scored below its cut-off. After stratification, Berg Balance Scale correlated significantly with Assessment Walking Skills in both AD subgroups, and with the MMSE only in AD1. CONCLUSIONS Balance impairment does not necessarily coexist with gait apraxia. Gait apraxia is more prevalent in moderate AD when compared with mild AD.
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Affiliation(s)
- Fernando Vieira Pereira
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Fabricio Ferreira de Oliveira
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Rodrigo Rizek Schultz
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Paulo Henrique Ferreira Bertolucci
- Universidade Federal de São Paulo, Universidade Federal de São Paulo, São Paulo SP , Brasil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
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Marin SDMC, Bertolucci PHF, Marin LF, de Oliveira FF, Wajman JR, Bahia VS, Mansur LL. Swallowing in primary progressive aphasia. NeuroRehabilitation 2016; 38:85-92. [DOI: 10.3233/nre-151299] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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de Oliveira FF, de Barros LAV, Bertolucci PHF. A patient with agrammatic primary progressive aphasia developing frontotemporal dementia. Acta Neurol Belg 2015; 115:763-6. [PMID: 25739362 DOI: 10.1007/s13760-015-0446-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022]
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de Oliveira FF, Pivi GAK, Chen ES, Smith MC, Bertolucci PHF. Risk factors for cognitive and functional change in one year in patients with Alzheimer's disease dementia from São Paulo, Brazil. J Neurol Sci 2015; 359:127-32. [DOI: 10.1016/j.jns.2015.10.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/09/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
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de Oliveira FF, Wajman JR, Bertolucci PHF, Chen ES, Smith MC. Correlations among cognitive and behavioural assessments in patients with dementia due to Alzheimer's disease. Clin Neurol Neurosurg 2015; 135:27-33. [DOI: 10.1016/j.clineuro.2015.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 12/30/2014] [Accepted: 05/09/2015] [Indexed: 11/30/2022]
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MC. Brain-penetrating angiotensin-converting enzyme inhibitors and cognitive change in patients with dementia due to Alzheimer's disease. J Alzheimers Dis 2015; 42 Suppl 3:S321-4. [PMID: 24577465 DOI: 10.3233/jad-132189] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Controversy over benefits of angiotensin-converting enzyme inhibitors (ACEIs) for treatment of dementia due to Alzheimer's disease (AD) led to this alternative investigational approach by the employment of pharmacogenetic methods, correlating the cognitive change of patients with late-onset AD with the presence of common ACE gene promoter polymorphisms, and stratifying the sample in groups of patients who responded or not to the brain-penetrating ACEIs Captopril or Perindopril. A trend was found for treatment with brain-penetrating ACEIs to slow cognitive decline in AD patients with the haplotype rs1800764 (CC): rs4291 (TT) (p = 0.024), and also non-significantly for independent carriers of rs1800764 or rs4291.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | | | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Marilia Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MDAC. Assessment of sleep satisfaction in patients with dementia due to Alzheimer’s disease. J Clin Neurosci 2014; 21:2112-7. [DOI: 10.1016/j.jocn.2014.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 05/15/2014] [Indexed: 12/11/2022]
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MC. Risk factors for age at onset of dementia due to Alzheimer's disease in a sample of patients with low mean schooling from São Paulo, Brazil. Int J Geriatr Psychiatry 2014; 29:1033-9. [PMID: 24596166 DOI: 10.1002/gps.4094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 01/23/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE In view of the mild effects of pharmacological treatment for dementia due to Alzheimer's disease (AD), the search for modifiable risk factors is an important challenge. Although risk factors for AD are widely recognized, elements that influence the time of onset of the dementia syndrome have not been comprehensively reported. We aimed to investigate which risk factors might be associated with the age at onset of AD in a sample of patients with low mean schooling from São Paulo, Brazil. METHODS We included 210 consecutive patients with late-onset AD to investigate whether education, gender, nationality, urban living and sanitation, occupation, cognitive and physical inactivity, head trauma, depression, systemic infections, surgical interventions, cerebrovascular risk factors, family history of neurodegenerative diseases or cardiovascular diseases and apolipoprotein E gene (APOE) haplotypes might be related to the age at AD onset. RESULTS Each copy of APOE-ε4 led to onset of AD almost 2 years earlier, while depression, smoking, higher body mass index and family history of cardiovascular diseases were also highly significant. Protective factors included non-Brazilian nationality, use of a pacemaker and waist circumference. Cerebrovascular risk factors had a mild combined effect for earlier onset of AD. CONCLUSION APOE haplotypes, depression, nationality and cerebrovascular risk factors were the most important elements to influence the age at AD onset in this sample, whereas gender, education, occupation and physical activities had no isolated effects over the age at onset of this dementia syndrome.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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de Oliveira FF, Correia Marin SDM, Ferreira Bertolucci PH. Communicating with the non-dominant hemisphere: Implications for neurological rehabilitation. Neural Regen Res 2014; 8:1236-46. [PMID: 25206418 PMCID: PMC4107603 DOI: 10.3969/j.issn.1673-5374.2013.13.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/13/2013] [Indexed: 11/18/2022] Open
Abstract
Aphasic syndromes usually result from injuries to the dominant hemisphere of the brain. Despite the fact that localization of language functions shows little interindividual variability, several brain areas are simultaneously activated when language tasks are undertaken. Mechanisms of language recovery after brain injury to the dominant hemisphere seem to be relatively stereotyped, including activations of perilesional areas in the acute phase and of homologues of language areas in the non-dominant hemisphere in the subacute phase, later returning to dominant hemisphere activation in the chronic phase. Plasticity mechanisms reopen the critical period of language development, more specifically in what leads to disinhibition of the non-dominant hemisphere when brain lesions affect the dominant hemisphere. The non-dominant hemisphere plays an important role during recovery from aphasia, but currently available rehabilitation therapies have shown limited results for efficient language improvement. Large-scale randomized controlled trials that evaluate well-defined interventions in patients with aphasia are needed for stimulation of neuroplasticity mechanisms that enhance the role of the non-dominant hemisphere for language recovery. Ineffective treatment approaches should be replaced by more promising ones and the latter should be evaluated for proper application. The data generated by such studies could substantiate evidence-based rehabilitation strategies for patients with aphasia.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sheilla de Medeiros Correia Marin
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil
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Oliveira FFD, Wajman JR, Bertolucci PHF. Caregiver awareness of cerebrovascular risk of patients with dementia due to Alzheimer's disease in São Paulo, Brazil. ARCH CLIN PSYCHIAT 2014. [DOI: 10.1590/0101-60830000000015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ferreira de Oliveira F, Ferreira Bertolucci PH, Chen ES, Cardoso Smith MA. P2‐025: PHARMACOGENETICS OF CHOLESTEROL‐LOWERING DRUGS IN PATIENTS WITH DEMENTIA DUE TO ALZHEIMER'S DISEASE. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ferreira de Oliveira F, Ferreira Bertolucci PH, Chen ES, Cardoso Smith MA. P2‐024: PHARMACOGENETICS OF BRAIN‐PENETRATING ANGIOTENSIN‐CONVERTING ENZYME INHIBITORS IN DEMENTIA DUE TO ALZHEIMER'S DISEASE. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Wajman JR, Oliveira FFD, Schultz RR, Marin SDMC, Bertolucci PHF. Educational bias in the assessment of severe dementia: Brazilian cutoffs for severe Mini-Mental State Examination. Arq Neuro-Psiquiatr 2014; 72:273-7. [DOI: 10.1590/0004-282x20140002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 12/06/2013] [Indexed: 11/22/2022]
Abstract
Cognitive assessment in advanced stages of Alzheimer’s disease (AD) is limited by the imprecision of most instruments. Objective: To determine objective cognitive responses in moderate and severe AD patients by way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores. Method: Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores. Results: Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001). Conclusion: The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.
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de Oliveira FF, Bertolucci PHF, Chen ES, Smith MDAC. Pharmacological modulation of cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease. J Neurol Sci 2013; 336:103-8. [PMID: 24189208 DOI: 10.1016/j.jns.2013.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 10/01/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
To evaluate correlations of pharmacological treatment with cognitive and behavioral symptoms in patients with dementia due to Alzheimer's disease with low schooling, subjects were assessed for demographic features, neuropsychiatric symptoms, cognitive decline, functionality, caregiver burden, APOE haplotypes and pharmacological treatment. Among 217 patients, use of cholinesterase inhibitors with or without Memantine was associated with less neuropsychiatric symptoms, while anti-psychotics and/or anti-epileptic drugs were associated with lower instrumental functionality. Anti-psychotics were also associated with more neuropsychiatric symptoms in moderately impaired patients, possibly reflecting the greater need for such treatment when behavioral symptoms are present. Patients receiving more medications were usually younger, obese, married, with higher schooling and more neuropsychiatric symptoms. APOE4+ haplotypes were correlated with earlier dementia onset, but not with pharmacological treatment. Higher caregiver burden was associated with more psychotropic drugs. A trend was found for treatment with cholinesterase inhibitors and Memantine to be associated with longer lengths of dementia for moderately impaired but not for severely impaired patients, regardless of APOE haplotypes, translating into a synergistic effect among such medications for slowing cognitive decline but not for prolonging survival. Further longitudinal studies may be required to assess dose-response relationships regarding treatment with psychotropics for patients with dementia.
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Affiliation(s)
- Fabricio Ferreira de Oliveira
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Paulo Henrique Ferreira Bertolucci
- Department of Neurology and Neurosurgery, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Elizabeth Suchi Chen
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
| | - Marilia de Arruda Cardoso Smith
- Department of Morphology and Genetics, Escola Paulista de Medicina, Federal University of São Paulo (UNIFESP), São Paulo, SP, Brazil.
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Vaz TS, Bertolucci PHF, Oliveira FFD. A patient with primary progressive aphasia developing dementia due to Alzheimer's disease. Arq Neuro-Psiquiatr 2012; 70:551-2. [DOI: 10.1590/s0004-282x2012000700016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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de Oliveira FF, Damasceno BP. A topographic study on the evaluation of speech and language in the acute phase of a first stroke. Arq Neuro-Psiquiatr 2011; 69:790-8. [DOI: 10.1590/s0004-282x2011000600013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 05/30/2011] [Indexed: 11/22/2022]
Abstract
Evaluation of speech and language may help in localization of site and extension of brain lesions, particularly in the absence of other neurological signs or radiologically defined injuries. OBJECTIVE: To verify what language tasks are best correlated to which brain regions, in order to develop a test for neurologists in emergency settings. METHOD: Thirty-seven adult first-stroke patients were submitted to cognitive and language tests, and then paired with thirty-seven healthy controls. Patients underwent CT and/or MRI for topographic correlation with test results (p<0.05). RESULTS: All tests were able to distinguish patients from controls, but only word/sentence repetition, naming, ideomotor praxis and, non-significantly, comprehension and counting 1-20 predicted left hemisphere lesions. Repetition was related to perisylvian structures, comprehension to the posterior portion of the middle cerebral artery territory, and fluency to frontal lesions, while naming was accurate only for lesion side. CONCLUSION: Language and cognitive tasks can help in the localization of acute stroke lesions.
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Oliveira FFD, Damasceno BP. Global aphasia as a predictor of mortality in the acute phase of a first stroke. Arq Neuropsiquiatr 2011; 69:277-82. [PMID: 21625750 DOI: 10.1590/s0004-282x2011000300002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2010] [Accepted: 11/29/2010] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To establish whether vascular aphasic syndromes can predict stroke outcomes. METHOD Thirty-seven adults were evaluated for speech and language within 72 hours after a single first-ever ischemic brain lesion, in blind association to CT and/or MR. RESULTS Speech or language disabilities were found in seven (87.5%) of the eight deceased patients and twenty-six (89.7%) of the twenty-nine survivors. Global aphasia was identified in eleven patients, all with left hemisphere lesions (nine mute; five deceased), consisting on a risk factor for death in the acute stroke phase (ρ=0.022). Age (z=1.65; ρ>0.09), thrombolysis (ρ=0.591), infarct size (ρ=0.076) and side (ρ=0.649) did not significantly influence survival. Absence of aphasia did not predict a better evolution, regardless of the affected hemisphere. Prevalence of cardiovascular risk factors was similar for all patient groups. CONCLUSION Global aphasia in acute stroke can adversely affect prognosis, translated into impairment of dominant perisylvian vascular territories, with mutism as an important semiological element.
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