RESUMO Introdução: Os problemas na situação de alimentação e deglutição podem ocorrer com a progressão da variante comportamental da demência frontotemporal (DFT-vc) e alterar as fases antecipatória e preparatória oral da deglutição. Objetivo: Caracterizar os problemas de deglutição e a situação de alimentação de pacientes com DFT-vc e correlacionar os problemas de deglutição com a funcionalidade, funções executivas, aspectos cognitivos e comportamentais. Métodos: Foram recrutados pacientes ambulatoriais com DFT-vc nas fases leve, moderada e grave da demência, e seus respectivos cuidadores. Os pacientes e cuidadores foram avaliados com as escalas: “Mini-Exame do Estado Mental”, “Mini-Exame do Estado Mental Grave”, “Escala de Avaliação Clínica da Demência Modificada - DFT”, “Inventário Neuropsiquiátrico”, “Bateria de Avaliação Frontal”, “Índice de Independência nas Atividades da Vida Diária”, “Escala Funcional de Avaliação da Deglutição” e “Avaliação das Dificuldades de Alimentação e Deglutição na Demência”. Resultados: Foram incluídos 30 pacientes com DFT-vc, e seus cuidadores. Pacientes com DFT-vc apresentaram dificuldades de alimentação e deglutição como: confusão na alimentação, passividade, tosse e asfixia, dificuldades com algumas consistências alimentares e alimentos específicos. Problemas de deglutição na DFT-vc correlacionaram-se com funcionalidade prejudicada (p<0,05) e cognição (p<0,05), disfunção executiva (p<0,01) e características comportamentais (p<0,01). Os cuidadores tiveram grande dificuldade em gerenciar a situação de alimentação diante de diferentes problemas em cada fase da demência. Conclusão: Pacientes com DFT-vc apresentaram velocidade de alimentação inapropriada, passividade, tosse e engasgos já na fase leve da doença, com piora na fase grave. As correlações indicaram que as alterações de deglutição tendem a seguir o declínio cognitivo e comportamental na DFT-vc.

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.

Abstract Background Lewy body dementia (LBD) impairs performance in daily activities and affects motor, language and visuospatial tasks. Objective We aimed to correlate neuropsychiatric and motor assessments with language and visual organization tests in LBD. Methods Twenty-two patients with dementia with Lewy bodies and ten patients with Parkinson’s disease dementia participated on a cross-sectional study that assessed cognition, functionality, caregiver burden, verbal fluency, the primer-level dictation section of the Boston Diagnostic Aphasia Examination (PLD-BDAE), the Hooper Visual Organization Test, the Neuropsychiatric Inventory and the Movement Disorder Society – Unified Parkinson’s Disease Rating Scale. Results Language and visuospatial test results followed motor impairment and general cognitive performance. Whereas visual organization did not predict performance in the PLD-BDAE, visuospatial abilities and verbal fluency were concurrently associated, suggesting that linguistic impairment in LBD may be attributed to neuropsychological components of cognition and language. Only visual organization was associated with behaviour, suggesting that neuropsychiatric symptoms associate with differential impairment of visual organization in comparison with language in LBD. Schooling did not affect visual organization or language test performance, while the length of dementia was negatively associated with visual organization and verbal fluency. Discussion Though visual organization tests follow behaviour and motor performance in LBD, there is differential impairment regarding language skills.

RESUMO Apraxia da marcha e desequilíbrio são condições subinvestigadas na doença de Alzheimer (DA) leve e moderada. Objetivo Verificar a correlação da apraxia da marcha com desequilíbrio e cognição em 30 idosos com DA leve (DA1) e 30 idosos com DA moderada (DA2). Método Foram feitas as seguintes avaliações: apraxia da marcha (Assessment Walking Skills); equilíbrio (Berg Balance Scale); Clinical Dementia Rating e Mini-exame do estado mental – MEEM. Resultados Desconsiderando-se os grupos, Berg Balance Scale e MEEM correlacionaram-se significativamente com a Assessment Walking Skills, enquanto 23% dos participantes pontuaram abaixo da note de corte da mesma. Considerando-se os grupos, Berg Balance Scale correlacionou-se significativamente com a Assessment Walking Skills em ambos os grupos, embora o MEEM o tenha feito apenas em DA1. Conclusões Desequilíbrio e apraxia da marcha não necessariamente coexistem com apraxia da marcha. Prevalência de apraxia da marcha foi maior na DA moderada do que na DA leve.

ABSTRACT Currently, there are no studies reporting how much balance impairment coexists with gait apraxia in mild and moderate Alzheimer’s disease (AD). 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.

The aims of this study were to investigate risk factors for cognitive and functional decline among 193 patients with Alzheimer’s disease dementia (AD), and to conduct pharmacogenetic analysis on cerebrovascular metabolism modulators, taking into account APOE haplotypes and the genotypes of ACE, CETP, LDLR and the LXR-β gene. For all patients, later age at AD onset was the most important risk factor for faster cognitive and functional decline, while the late-life coronary heart disease risk was inversely related to cognitive decline only for carriers of APOE4+ haplotypes. Schooling was protective against cognitive decline only for women and carriers of APOE4+ haplotypes, while higher body mass index in late life was protective against cognitive decline only for men. Carriers of the APOE-ε4/ε4 haplotype had earlier AD onset, whereas genotypes of CETP and LDLR that had traditionally been associated with higher risk of AD were associated with later onset of dementia. Angiotensin-converting enzyme inhibitors caused a 50% reduction in Mini-Mental State Examination score changes, and had better disease-modifying properties than did centrally-acting angiotensin-converting enzyme inhibitors alone. Angiotensin receptor blockers had genetically mediated effects that led to faster cognitive and functional decline, while patients with genetic tendencies towards faster cognitive and functional decline had maximum benefits when they used lipophilic statins, and vice versa.

Contexto O risco cerebrovascular é fundamental na etiologia da demência da doença de Alzheimer (DA), sendo importante seu controle adequado. Objetivo Investigar se o conhecimento dos cuidadores sobre o controle do risco cerebrovascular tem impacto sobre a saúde de pacientes com DA. Métodos Pacientes consecutivos com DA foram avaliados quanto a dados demográficos, Clinical Dementia Rating, risco cerebrovascular, tratamento farmacológico, dietoterapia e prática de atividades físicas. Pacientes e cuidadores foram questionados quanto à importância de medidas para controle do risco cerebrovascular. Chi-quadrado foi empregado na análise estatística, significância com ρ < 0,05. Resultados No total, 217 pacientes foram incluídos; enquanto 149 cuidadores (68,7%) conheciam a necessidade de controle do risco cerebrovascular, somente 11 pacientes (5,1%) simultaneamente praticavam exercícios e recebiam tratamento farmacológico e dietoterápico. Pacientes com hipertensão arterial e diabetes mellitus tinham maiores chances de receber dietotetapia (ρ = 0,007). Homens estavam mais engajados em atividades físicas (ρ = 0,018). Pacientes em estágios precoces da DA praticavam exercícios (ρ = 0,0003) e recebiam farmacoterapia mais frequentemente (ρ = 0,0072). O conhecimento dos cuidadores acerca do controle do risco cerebrovascular era maior quando os pacientes tinham hipertensão arterial (ρ = 0,024) e/ou dislipidemia (ρ = 0,006), e influenciou a adesão à dietoterapia (ρ = 0,002) e à farmacoterapia (ρ = 0,001). Conclusão O conhecimento dos cuidadores acerca do risco cerebrovascular tem impactos positivos para pacientes com DA.

Background Proper control of cerebrovascular risk is essential to prevent cognitive change in dementia due to Alzheimer’s disease (AD). Objective To investigate whether caregiver awareness to control cerebrovascular risk impacts the lifestyles of patients with AD. Methods Consecutive outpatients with AD were assessed for demographic features, Clinical Dementia Rating scores, cerebrovascular risk, pharmacotherapy, dietary therapy and practice of physical activities. Patients and caregivers were inquired on awareness of the importance of measures to control cerebrovascular risk. Chi-square test was employed for statistics, significance at ρ < 0.05. Results A total of 217 patients were included; whereas 149 caregivers (68.7%) were aware of the need to control cerebrovascular risk, only 11 patients (5.1%) simultaneously practiced physical activities and received pharmacological treatment and dietary therapy. Patients with hypertension and diabetes mellitus were more likely to receive dietary therapy (ρ = 0.007). Male patients were more engaged in physical activities (ρ = 0.018). Patients in earlier AD stages exercised (ρ = 0.0003) and received pharmacological treatment more often (ρ = 0.0072). Caregiver awareness of the need to control cerebrovascular risk was higher when patients had hypertension (ρ = 0.024) and/or hypercholesterolemia (ρ = 0.006), and influenced adherence to dietary therapy (ρ = 0.002) and to pharmacological treatment (ρ = 0.001). Discussion Caregiver awareness of the need to control cerebrovascular risk has positive impacts for patients with AD.

A avaliação cognitiva na doença de Alzheimer (DA) avançada é insuficiente pela imprecisão dos instrumentos. Objetivo: Determinar respostas cognitivas objetivas em pacientes com DA moderada e grave por meio do Mini-Exame do Estado Mental Grave (MEEM-g) e correlacionar o seu desempenho com o Mini-Exame do Estado Mental (MEEM). Método: Pacientes consecutivos com DA moderada e grave (Clinical Dementia Rating – CDR: 2.0 e 3.0) foram avaliados e comparados conforme seus intervalos nos testes MEEM e MEEM-g. Resultados: Dentre 400 pacientes incluídos, 67,5% foram mulheres, com média de idade 76.6±6.7 anos. Não houve impacto significativo de gênero ou idade nas pontuações do MEEM ou MEEM-g. A escolaridade média foi de 4.4±2.5 anos, impactando nos escores do MEEM-g (p=0.008). Pontuações no MEEM e MEEM-g correlacionaram-se significativamente (F-ratio=690.6325, p<0.0001). Conclusão: O MEEM-g sofre influência da escolaridade, mas não de idade ou gênero, contribuindo para a precisão na avaliação da DA moderada ou grave.

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.

Avaliação de fala e linguagem pode ajudar na localização do sítio e da extensão de lesões cerebrais, especialmente quando ausentes outros sinais neurológicos ou radiológicos. OBJETIVO: Verificar quais tarefas linguísticas se correlacionam melhor com quais regiões cerebrais, a fim de desenvolver um teste para uso pelos neurologistas em emergências. MÉTODO: 37 pacientes e 37 controles pareados passaram por avaliação linguístico-cognitiva. Pacientes foram submetidos a TC e/ou RM para correlação topográfica com os resultados da avaliação (p<0,05). RESULTADOS: Todos os testes diferenciaram pacientes de controles, mas apenas os de repetição de palavras/sentenças, nomeação, praxia ideomotora e, de forma não-significativa, compreensão e contagem 1-20 puderam predizer lesões no hemisfério esquerdo. Os testes de repetição estavam relacionados com estruturas perisylvianas, compreensão com a porção posterior do território da artéria cerebral média, e fluência com regiões frontais, enquanto os de nomeação localizavam apenas o lado das lesões. CONCLUSÃO: Testes linguístico-cognitivos podem ajudar a localizar infartos cerebrais agudos.

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.