Resumo Comprometimento cognitivo leve (CCL) foi definido por Petersen et al. (1999) como uma perda progressiva da memória, pródromo da doença de Alzheimer. CCL é uma entidade bem estabelecida que tanto pode ser um diagnóstico na prática clínica como um alvo válido para terapias preventivas da doença de Alzheimer. Recentemente, o CCL expandiu-se para incorporar outros domínios cognitivos com outras causas potenciais: CCL amnésico, de múltiplos domínios e de um único domínio não-amnéstico. Sintomas comportamentais no CCL são associados com risco mais elevado de demência, mas sua associação com o risco de demência na ausência de comprometimento cognitivo não é conhecida. O objetivo deste artigo foi o de verificar se pacientes idosos com sintomas comportamentais constituem população de risco para demência. Comprometimento comportamental leve caracteriza-se como uma síndrome que se manifesta em idosos constituída por sintomas psiquiátricos e sintomas comportamentais relacionados na ausência de sintomas cognitivos mais evidentes. O comprometimento comportamental leve parece ser um estado de transição entre o envelhecimento normal e demência e pode conferir um risco maior para demência do que o CCL. Um subgrupo de pacientes com comprometimento comportamental leve provavelmente está na fase prodrômica de demência frontotemporal (DFT). Nós propomos que se considerem quatro grupos de pacientes com risco de demência: CCL amnéstico (que segundo se admite evolui preferencialmente para doença de Alzheimer), CCL de múltiplos domínios (que pode representar envelhecimento normal ou pode evoluir para comprometimento cognitivo vascular ou para doença neurodegenerativa), CCL de único domínio não-amnéstico e Comprometimento Comportamental Leve (que pode evoluir para DFT, demência com corpúsculos de Lewy ou doença de Alzheimer). Concluímos que o Comprometimento Comportamental Leve é uma complementação ao CCL como um estado de transição entre o envelhecimento normal e demência. Estes achados têm implicações para a detecção precoce, prevenção e tratamento de demência de instalação tardia.

Abstract Mild cognitive impairment (MCI) was defined by Petersen et al. (1999) as progressive memory loss, a prodrome of Alzheimer's disease. MCI is a well-established entity that can be both a diagnosis in medical practice and a valid target of Alzheimer's prevention therapy. More recently MCI has expanded to include other cognitive domains with other potential causes: amnestic MCI, multiple domains MCI, and single domain non-amnestic MCI. Behavioral symptoms in MCI are associated with a higher risk of dementia, but their association with dementia risk in patients without MCI is unknown. The objective of our paper was to address the question of whether aging patients with behavioral symptoms with or without cognitive impairment represent a population at risk for dementia. Mild Behavioral Impairment (MBI) defines a late life syndrome with prominent psychiatric and related behavioral symptoms in the absence of major cognitive symptoms. MBI also appears to be a transitional state between normal aging and dementia. MBI may carry a higher risk for dementia than MCI. A subgroup of MBI patients is likely to exhibit symptoms of a frontotemporal dementia (FTD) prodrome. We proposed 4 subtypes of patients at risk for dementia: amnestic MCI (which is said to progress preferentially to Alzheimer's disease), multiple domain MCI (which may represent normal aging or may progress to vascular cognitive impairment or a neurodegenerative disorder), single domain non-amnestic MCI, and MBI (which may progress to frontotemporal dementia, Lewy Body dementia or Alzheimer's disease). We concluded that MBI is a counterpart of MCI as a transitional state between normal aging and dementia. These findings have implications for early detection, prevention, and treatment of patients with late-life dementia.

Background and Objectives: In the past, Psychosomatic Medicine (PM) has had ambiguous connotations, and there have been many other names for this specialized fields, including Consultation-Liaison Psychiatry. The objective of this report is to briefly review the background, the history and current status of PM, which recently was recognized in the U.S. a psychiatric subspecialty. Methods: Historical review and review of the literature. Results: PM has a rich history. Psychoanalysts and psychophysiologists pioneered the study of mind-body interactions, and crucial events in the development include the funding of PM units in several U.S. teaching hospitals by the Rockefeller Foundation, and the training grants and a research development program funded by the National Institute of Mental Health. By the 1980s, all psychiatry residency programs were requiered to provide substancial clinical experience in the field, and as of 2005 there were 32 fellowship programs in the Academy of Psychosomatic Medicine's (APM) directory. In 2001, The Academy of Psychosomatic Medicine (APM) applied for the recognition of PM as a subspecialty of psychiatry, and formal approval was granted by the American Board of Medical Specialties (ABMS) in March 2003. The foundation of PM is a specialized body of scientific knowledge regarding psychiatric aspects of medical illness. This has been articulated in contemporary textbooks, journals and regular scientificic meetings of national and international societies A cadre of scholars and researchers has emerged, and important contributions have occurred. A major goal of the PM field is to improve the psychiatric care of patients with complex medical conditions. There are a number of obstacles and challenges ahead in pursuing optimal integration of PM services into existing service delivery systems of care, but anticipated expansion of accredited fellowship programs in PM will hopefully help address this shortfall. In the past 20 years an international PM network has developed with increasing scientific exchanges, and the US paradigm is regarded as important for the development of PM as a subspecialty internationally. Conclusion: Formal recognition as a subspecialty in the U.S. has and will strengthen PM and will enhance its growth internationally.