Anacardic acid (AA) is a bioactive phytochemical found in the nutshell of Anacardium occidentale, a tropical plant originally from Brazil. In this work, cross-linked anacardic acid nanocapsules (NC) were obtained by interfacial polymerization carried out using the inverse miniemulsion technique with 2,4-toluene diisocyanate (TDI). For this purpose, a functionalized monomer from AA was synthesized for formation of lipase-cleavable ester linkages by coupling of amino acids. The synthesis was planned so that when these ester linkages get exposed to an enzyme, they are broken down and released AA. Furthermore, the N-termini of the coupled amino compounds were used as sites for the polyaddition with TDI at the droplet interface in the inverse miniemulsion. The permeability of the shell was studied on the fluorescent dye, sulforhodamine 101 (SR101), using fuorescence spectroscopy After redispersion in water, the enzymatic cleavage of NC and the release of the SR101 were both monitored in real time. The released AA was proven to be active in vitro against Bacillus subtilis colonies in the bacterial tests. The results indicate that the use of NC is a promising strategy, which can make feasible the application of AA for therapeutic purposes and as nanocarriers for the delivery of active components.

RESUMO O objetivo do estudo é discutir a reflexividade de crianças do sexo feminino vítimas de violência sexual durante uma intervenção psicossocial de orientação psicodramática, buscando apreender a perspectiva dos significados presentes nos diálogos e brincadeiras. As participantes da pesquisa foram 13 meninas vítimas de violência sexual perpetrada por adolescente parente próximo. Utilizou-se o registro de duas sessões grupais com foco na interpretação da reflexividade sobre o tema da proteção. Os resultados descrevem as sessões segundo organização de aquecimento, dramatização e compartilhamento. A discussão foca os ganhos que a brincadeira e o jogo dramático trazem para a reflexividade, sobre tema tão árduo como o da violência sexual. A criação de ambiente lúdico favorece o diálogo entre vítimas e adolescentes ofensores.

ABSTRACT This study aims to discuss the reflexivity of female children victims of sexual violence during a psychosocial intervention with a psychodramatic orientation, seeking out to understand the meanings present in the dialogues and plays. The research participants were 13 girls victims of sexual violence perpetrated by an adolescent close relative. Two group sessions records were used to focus on the interpretation of reflexivity on the theme of protection. The results describe the sessions in the organization: warm-up, dramatization and sharing. The discussion focuses on the earnings that play and dramatic plays bring to reflexivity about a topic such as arduous as sexual violence. The creation of a playful environment favors a dialogue between victims and adolescent offenders.

RESUMEN El objetivo del estudo es discutir la reflexividad de las niñas víctimas de violencia sexual durante una intervención psicosocial con orientación psicodramática, buscando aprehender la perspectiva de los significados presentes en los diálogos y juegos. Los participantes de la investigación fueron 13 niñas víctimas de violencia sexual perpetrada por un familiar cercano adolescente. Se utilizaron dos sesiones grupales para centrarse en la interpretación de la reflexividad sobre el tema de la protección. Los resultados describen las dos sesiones en su organización de calentamiento, dramatización y compartilhamento. La discusión se centra en las ganancias que el juego y el juego dramático aportan a la reflexividad, sobre un tema tan arduo como la violencia sexual. La creación de un ambiente lúdico favorece el diálogo entre víctimas y adolescentes infractores.

Micelles have aroused interest due to their ability to assist in the transport of poorly soluble drugs. In this study the mixture of copolymers F127/E45S8 in different proportions (F/ES 30/70, 50/50 and 70/30) was performed to improve the bioavailability of griseofulvin and quercetin. The results of cytotoxicity (MTT assay) revealed that the copolymers F127 and E45S8 had considerable biocompatibility and did not affect the metabolism of human neutrophils. The binary systems were also evaluated by critical micellar concentration (CMC) and thermoresponsive behavior. The CMC values were intermediate to those of the isolated copolymers. The systems maintained the thermoresponsive properties present in F127 making the systems interesting for subcutaneous administration. The systems presented small size, an average range in size from 17 to 38 nm, and the samples prepared with higher hydrophobic proportion presented more uniform sizes. Results suggest stability and the increasing of the nanosystems circulation time. The F/ES 30/70 system has polydispersity smaller than 0.1 and showed an increase of 129 times for quercetin solubility. Thus, it is possible to consider F127/E45S8 micelles as potential nanosystems for poorly soluble drug delivery.

Alkyl polyglycosides (APGs) are new biodegradable surfactants, non-toxic, synthesized from abundant renewable sources, potentially more appropriate than anionic surfactants. A range of glycosides denoted APG-Cy was synthesized by the Köenig-Knorr reaction using C10, C16 and C18 alcohols and derived from the degradation of amylose from English potato. The molecular structures of the glycosides were characterized by Nuclear Magnetic Resonance (1H and 13C NMR) together with Infrared Spectroscopy (FTIR) and Gel Permeation Chromatography (GPC). The study by NMR allowed the junctions between hydrophilic head groups and hydrophobic tail-groups to be characterized in detail. Conformation of the glycosidic units is 4C1 type with a b anomeric configuration. The formation of glycosides with five glucose rings linked to the alkyl chain was confirmed by 1H NMR and GPC. Liquid crystals identified by the presence of double melting points were observed by Differential Scanning Calorimetry (DSC) showing thermotropic properties. The surface tension (γ) and critical micelle concentration (cmc) were determined by du Noüy method, noting that increasing the length of alkyl chain led to the expected reduction in the cmc. The energies of adsorption and micellization processes calculated from isotherms γ versus ln c (g.dm-3) indicate cooperativeness of hydrophilic and hydrophobic groups.

RESUMO Infartos talâmicos bilaterais são em geral ocasionados por oclusão da "Artéria de Percheron" (AdP). A síndrome talamopeduncular está entre as apresentações clínicas mais comuns da oclusão da AdP. Um homem de 59 anos apresentou rebaixamento abrupto do nível de consciência. Após algumas semanas, ao recobrar a consciência, apresentava anormalidades oculomotoras, marcha atáxica, distonia cervical e alterações cognitivas e comportamentais. A imagem por ressonância magnética evidenciou infartos talâmico, subtalâmico, mamilar e mesencefálico. O quadro clínico foi sugestivo de síndrome talamopeduncular. Além da presença de comprometimento cognitivo e transtornos de comportamento, estava presente distonia cervical, que pode resultar da interrupção das interconexões entre gânglios da base, tálamo, subtálamo, mesencéfalo e cerebelo.

ABSTRACT Bilateral thalamic infarctions are usually caused by occlusion of the "Artery of Percheron" (AoP). Thalamopeduncular syndrome is among the most common presentations of AoP occlusion. A 59-year-old male presented abrupt decreased level of consciousness. After several weeks, on regaining consciousness, he exhibited oculomotor abnormalities, ataxic gait, cervical dystonia, and cognitive and behavioral changes. Magnetic resonance imaging disclosed thalamic, subthalamic, mammillary and midbrain infarction. Clinical features suggestive of bilateral thalamopeduncular syndrome were identified. Besides the presence of cognitive impairment and behavioral symptoms, cervical dystonia was evident, possibly resulting from interruption of the interconnections among basal ganglia, thalamus, subthalamus, midbrain and cerebellum.

RESUMO O reconhecimento precoce da Doença Cerebrovascular (DCV) pode permitir o controle de fatores de risco e a prevenção de demência. Contudo, critérios operacionais em seus estágios sintomáticos não-demenciais apresentam problemas, já que critérios atuais requerem a presença de extensa doença isquêmica subcortical. OBJETIVO Identificar o perfil de neuroimagem do Comprometimento Cognitivo Leve Vascular (CCLV), o impacto destes aspectos sobre a cognição e os testes neuropsicológicos que distinguem CCLV de outros grupos. MÉTODOS Foram realizadas buscas no Scopus, ISI e PsycINFO, usando a estratégia: "vascular mild cognitive impairment" OR "vascular cognitive impairment no dementia" OR "vascular cognitive impairment not demented" OR "subcortical mild cognitive impairment". RESULTADOS De 249 artigos, 20 foram selecionados. 10 destes incluíram apenas pacientes com hiperintensidades de substância branca (HSB) graves, enquanto 10 outros admitiram pacientes com HSB moderadas-a-graves. Ambos os grupos apresentaram desempenho pobre em tarefas de Função Executiva (FE) em comparação com controles normais e outras categorias diagnósticas. Dentre os testes de FE, aqueles que avaliam FE "complexas" diferiram consistentemente CCLV de outros grupos, independentemente da gravidade de HSB. Sujeitos com CCLV e HSB graves ou moderadas-a-graves apresentaram dificuldades cognitivas quando comparados aos demais grupos. Testes que avaliam FE "complexa" foram os mais úteis na diferenciação destes pacientes dos outros grupos. CONCLUSÃO A ocorrência de VaMCI pode estar associada à presença de HSB moderadas; a detecção precoce do dano vascular permitiria a adoção de medidas terapêuticas com tamanhos de efeito significativos.

ABSTRACT The recognition of Cerebrovascular Disease (CVD) at earlier clinical stages may favor the control of vascular risk factors and prevention of dementia. However, operational criteria for symptomatic phases at non-dementia stages are often difficult, as the current criteria normally require the evidence of extensive subcortical disease. OBJECTIVE To identify the neuroimaging profile of Vascular Mild Cognitive Impairment (VaMCI), the impact of those aspects over cognition and the neuropsychological tests that distinguished VaMCI from other groups. METHODS Searches were performed in Scopus, ISI and PsycINFO, using the following key terms: "vascular mild cognitive impairment" OR "vascular cognitive impairment no dementia" OR "vascular cognitive impairment not demented" OR "subcortical mild cognitive impairment". RESULTS Of 249 papers, 20 studies were selected. Ten of those included only patients with severe White Matter Hyperintensities (WMH), whereas 10 others admitted subjects with moderate-to-severe WMH. Both groups showed poor performances in Executive Function (EF) tasks in comparison to normal controls and other diagnostic groups. Among EF tests, those assessing "complex" EF abilities consistently distinguished VaMCI from other groups, regardless of the severity of WMH. VaMCI subjects with severe or moderate-to-severe WMH showed cognitive deficits in comparison with other groups. "Complex" EF tests were the most useful in differentiating those patients from the other groups. CONCLUSION The occurrence of VaMCI may be associated with the presence of CVD at moderate levels; the detection of vascular damage at earlier stages may allow the adoption of therapeutic actions with significant effect-sizes.

Sintomas Neuropsiquiátricos ou Sintomas de Comportamento e Psicológicos da Demência (SCPD) são comuns e aparecem em algum ponto no curso da enfermidade, mediado por doenças cerebrovasculares e processos neurodegenerativos. Poucos estudos compararam os perfis dos SCPD no Comprometimento Cognitivo Vascular (CCV) de diferentes subtipos (subcortical ou córtico-subcortical) e diferentes estágios clínicos (Comprometimento Cognitivo Vascular Não Demência [CCV-ND] e Demência Vascular [DV]). Objetivo: Revisar os SCPD associados aos diferentes subtipos e estágios do CCV, com o Inventário Neuropsiquiátrico (INP). Métodos: Medline, Scielo e Lilacs foram pesquisados de janeiro de 2.000 até dezembro de 2.014, com as palavras chaves: "BPSD AND Vascular Dementia", "NPI AND Vascular Dementia" e "NPI AND VCI". Uma análise quantitativa foi feita nos estudos que avaliaram sintomas comportamentais no CCV através do INP. Resultados: Um total de 82 estudos foram identificados e 13 estudos foram considerados elegíveis e incluídos. Destes artigos, 4 compararam SCPD entre DV Córtico-Subcortical (DVCS) e DV Subcortical (DVS), 3 artigos compararam DVS e CCVND, 1 artigo analisou diferenças entre DVCS e CCVND, e 5 estudos avaliaram os SCPD em DVCS. Tanto a DVCS quanto a DVS associaram-se principalmente a Apatia e Depressão. O CCVND pode apresentar menos sintomas comportamentais que a DV. Conclusão: O perfil dos SCPD difere entre diferentes estágios do CCV. O entendimento dos SCPD mais prevalentes nos subtipos do CCV poderia ser útil para facilitar o diagnóstico precoce e o manejo desses sintomas.

Neuropsychiatric symptoms or Behavioral and Psychological Symptoms of Dementia (BPSD) are common and invariably appear at some point during the course of the disease, mediated both by cerebrovascular disease and neurodegenerative processes. Few studies have compared the profiles of BPSD in Vascular Cognitive Impairment (VCI) of different subtypes (subcortical or cortical) and clinical stages (Vascular Cognitive Impairment No Dementia [VaCIND] and Vascular Dementia [VaD]). Objective: To review the BPSD associated with different subtypes and stages of VCI using the Neuropsychiatric Inventory (NPI). Methods: Medline, Scielo and Lilacs databases were searched for the period January 2000 to December 2014, with the key words: "BPSD AND Vascular Dementia, "NPI AND Vascular Dementia" and "NPI AND VCI. Qualitative analysis was performed on studies evaluating BPSD in VCI, using the Neuropsychiatric Inventory (NPI). Results: A total of 82 studies were retrieved of which 13 were eligible and thus included. Among the articles selected, 4 compared BPSD in Subcortical Vascular Dementia (SVaD) versus Cortical-Subcortical Vascular Dementia (CSVaD), 3 involved comparisons between SVaD and VaCIND, 1 study analyzed differences between CSVaD and VaCIND, while 5 studies assessed BPSD in CSVaD. Subcortical and Cortical-Subcortical VaD were associated predominantly with Apathy and Depression. VaCIND may present fewer behavioral symptoms than VaD. Conclusion: The profile of BPSD differs for different stages of VCI. Determining the most prevalent BPSD in VCI subtypes might be helpful for improving early diagnosis and management of these symptoms.

Management of children with HIV/AIDS is specially challenging. Age-related issues do not allow for direct transposition of adult observations to this population. CXCR4 tropism has been associated with disease progression in adults. The geno2pheno web-base is a friendly tool to predict viral tropism on envelope V3 sequences, generating a false positive rate for a CXCR4 prediction. We evaluated the association of HIV-1 tropism prediction with clinical and laboratory outcome of 73 children with HIV/AIDS in São Paulo, Brazil. The CXCR4 tropism was strongly associated with a lower (nadir) CD4 documented during follow-up (p < 0.0001) and with disease severity (clinical event and/or CD4 below 200 cells/mm3) at the last observation, using commonly applied clinical cutoffs, such as10%FPRclonal (p = 0.001). When variables obtained during follow-up are included, both treatment adherence and viral tropism show a significant association with disease severity. As for viremia suppression, 30% (22/73) were undetectable at the last observation, with only adherence strongly associated with suppression after adjustment. The study brings further support to the notion that antiretroviral treatment adherence is pivotal to management of HIV disease, but suggests that tropism prediction may provide an additional prognostic marker to monitor HIV disease in children.

Comprometimento cognitivo leve vascular (CCLV) representa um estágio sintomático precoce do comprometimento cognitivo vascular e associa-se à disfunção fronto-executiva.MétodosVinte e seis indivíduos (idade: 73,11±7,90 anos; 65,4% mulheres; escolaridade: 9,84±3,61 anos) foram selecionados por meio de avaliação cognitiva e neuroimagem. Os dados clínicos e de neuroimagem do grupo CCLV (n=15) foram comparados com controles normais (CN; n=11) e correlacionados com a escala de Fazekas.ResultadosCCLV apresentaram piores desempenhos que CN no Trail-Making Test (TMT) B, erros no TMT B, diferença TMT B-A e pontuação final do Cambridge Cognitive Examination (CAMCOG). Verificaram-se correlações entre escala de Fazekas e desempenhos no TMT B (tempo total e erros), diferença TMT B-A e a pontuação final do CAMCOG.ConclusãoA extensão das hiper-intensidades de substância branca, no grupo CCLV, correlacionou-se com pior desempenho cognitivo global e com comprometimento em um grupo de funções fronto-executivas, como velocidade e alternância cognitiva e controle inibitório.

Vascular mild cognitive impairment (VaMCI) represents an early symptomatic stage of vascular cognitive impairment and might be associated to fronto-executive dysfunction.MethodsTwenty-six individuals (age: 73.11±7.90 years; 65.4% female; schooling: 9.84±3.61 years) were selected through neuropsychological assessment and neuroimaging. Clinical and neuroimaging data of VaMCI individuals (n=15) were compared to normal controls (NC, n=11) and correlated with Fazekas scale.ResultsVaMCI performed significantly worse than NC in Trail-Making Test (TMT) B, errors in TMT B, difference TMT B-A and Cambridge Cognitive Examination (CAMCOG) final scores. Correlations were found among scores in modified Fazekas scale and performances in TMT B (time to complete and errors), difference TMT B-A and CAMCOG total score.ConclusionExtension of white matter hyperintensities might be correlated to poorer global cognition and impairments in a set of fronto-executive functions, such as cognitive speed, set shifting and inhibitory control in VaMCI.

RESUMO Objetivo: Comprometimento Cognitivo Leve Vascular (CCLV) não-amnésico disexecutivo pode representar a fase pré-clínica da Demência Vascular (DV). Este estudo tem por objetivo descrever os aspectos clínicos, cognitivos e de neuroimagem do CCLV, além de avaliar padrões de progressão para demência. Métodos: Foram realizadas buscas nas bases de dados ISI Web of Knowledge, PubMed e Lilacs, usando os termos "comprometimento cognitivo leve" e "função executiva". Ao todo, 944 artigos foram obtidos. Resultados: Pacientes com CCLV apresentaram piores desempenhos em tarefas fronto-executivas, histórico de acidentes vasculares encefálicos, presença de hiperintensidades da substância branca periventriculares e profundas, e mais, sinais extrapiramidais e sintomas comportamentais. A disfunção executiva parece se relacionar à desconexão de circuitos fronto-parieto-subcorticais. A progressão para demência relacionou-se a déficits em linguagem, função executiva e atenção sustentada à primeira avaliação, e a hiperintensidades na substância branca periventricular extensas. Discussão: O CCLV cursa com comprometimento cognitivo em domínios não-memória e alterações da substância branca subcortical à imagem por RM alinhadas com os achados característicos da DV.

ABSTRACT Objective: Non-amnestic dysexecutive Vascular Mild Cognitive Impairment (VaMCI) may represent preclinical Vascular Dementia (VaD). The aim of this study was to summarize the clinical, neuropsychological and neuroimaging aspects of VaMCI; and to assess its patterns of progression to dementia. Methods: Searches were made in the ISI Web of Knowledge, PubMed and Lilacs databases, using the terms "mild cognitive impairment" and "executive function". Altogether, 944 articles were retrieved. Results: VaMCI cases had poorer performances on fronto-executive tasks, a higher prevalence of stroke, presence of periventricular and profound white matter hyperintensities on MRI images, as well as more extrapyramidal signs and behavioral symptoms. Executive dysfunction might be associated with disconnection of fronto-parietal-subcortical circuits. Progression to dementia was associated with baseline deficits in executive function, in simple sustained attention and language, and large periventricular WMH. Discussion: VaMCI develops with impairment in non-memory domains and subcortical white matter changes on MRI images, which are consistent with clinical and neuroimaging findings in VaD.

Resumo Introdução: Sintomas neuropsiquiátricos são comuns em pacientes com déficits cognitivos associados a processos neurodegenerativos e à doença cerebrovascular. Estudos apontaram que os Sintomas Comportamentais e Psicológicos da Demência (SCPD) podem ter relação com a gravidade do declínio cognitivo. Até o presente, o impacto da associação entre hiperintensidades da substância branca (HSB) e atrofia hipocampal (AH) sobre esses sintomas foi pouco explorado na literatura. Objetivo: Este estudo transversal objetiva descrever as características clínicas de uma amostra com extensas HSB, examinando a influência de diferentes graus de AH sobre os aspectos cognitivos, comportamentais e funcionais. Métodos: Cinquenta idosos atendidos em ambulatório (idade média: 76.86±8.70 anos; 58% mulheres; escolaridade média: 7.44±4.69 anos), com extensas HSB (escala modificada de Fazekas=3) e diferentes graus de AH (de acordo com a escala de de Leon) foram submetidos à avaliação cognitiva, funcional e comportamental. Resultados: Pacientes com AH leve-moderada a grave apresentaram piores pontuações no Mini-Exame do Estado Mental, Avaliação Cognitiva de Cambridge, Estadiamento Clínico da Demência e Questionário de Atividades Funcionais de Pfeffer, em comparação com indivíduos com AH ausente ou questionável. Apetite/Comportamento Alimentar foi o único grupo de sintomas neuropsiquiátricos associados à presença de AH em indivíduos com Comprometimento Cognitivo Vascular. Discussão: Embora a AH pareça apresentar impacto sobre desempenho cognitivo e funcional, parece apresentar pouca influência sobre sintomas comportamentais em pacientes com extensas HSB.

ABSTRACT Background: Neuropsychiatric symptoms are common in patients with cognitive impairments, mediated by both neurodegenerative processes and cerebrovascular disease. Previous studies have reported that Behavioral and Psychological Symptoms of Dementia (BPSD) might correlate with severity of cognitive decline. Thus far, the impact of the association between white-matter hyperintensities (WHM) and hippocampal atrophy (HA) on the incidence of these symptoms has been less studied. Objective: This cross-sectional study aimed to describe the clinical profile of a sample with large extensions of WMH, examining the association between different degrees of HA and cognitive, functional, and behavioral status. Methods: Fifty outpatients (mean age: 76.86±8.70 years; 58% female; mean schooling: 7.44±4.69 years) with large extensions of WMH (modified-Fazekas scale=3) on MRI and different degrees of hippocampal atrophy (according to de Leon Score) underwent cognitive, functional, and behavioral assessments. Results: Patients with mild-moderate to severe HA had worse performance on the Mini-Mental State Examination, Cambridge Cognitive Examination, Clinical Dementia Rating and Pfeffer's Functional Activities Questionnaire, compared to the group with none or questionable HA. Appetite/Eating Behavior was the only cluster of neuropsychiatric symptoms associated with presence of HA in Vascular Cognitive Impairment patients. Discussion: Although HA may exhibit distinct impact on cognitive performance and functional status, it appears to have little effect on behavioral symptoms in patients with high severity WMH.

RESUMO A doença cérebro-vascular (DCV) está frequentemente presente na idade avançada, podendo se associar à patologia microscópica da substância branca (SB) e à disfunção cognitiva. A presente revisão investiga a relação entre DCV, status cognitivo e a integridade da SB, através da avaliação pelo tensor de difusão (DTI). Métodos: Os estudos em DTI foram selecionados a partir das bases ISI e Pubmed entre 2002 e 2012. Resultados: Os estudos evidenciaram alterações do DTI na SB associadas à doença vascular e fornecem evidencia importante para o DTI como um método valioso para a detecção precoce da DCV. Conclusão: Os parâmetros do DTI podem servir como importantes biomarcadores na monitoração da doença vascular quanto a sua progressão e resposta terapêutica e parecem representar um marcador substituto da integridade da SB.

ABSTRACT Cerebrovascular disease (CVD) is often present in old age and may be associated with microstructural pathology of white matter (WM) and cognitive dysfunction. The current review investigated the relationship between CVD, cognitive status and WM integrity as assessed by diffusion tensor imaging (DTI). Methods: DTI studies were searched on ISI and Pubmed databases from 2002 to 2012. Results: Studies evidenced DTI changes in WM as associated with vascular disease and provide increasing support for DTI as a valuable method for early detection of CVD. Conclusion: DTI parameters can serve as important biomarkers in monitoring vascular disease progression and treatment response and may represent a surrogate marker of WM tract integrit.

INTRODUÇÃO: A depressão geriátrica (DG) representa um dos mais frequentes transtornos psiquiátricos em ambulatórios especializados em idosos. OBJETIVO: Discutir a evolução da DG por meio de dois casos ilustrativos, destacando-se as variáveis relacionadas ao prognóstico da doença e à conversão para quadros cognitivos mais graves como demência vascular (DV). MÉTODOS: Os casos foram acompanhados por quatro anos com medidas do desempenho cognitivo, funcional, sintomas depressivos, juntamente com as alterações de estruturas cerebrais, como hiperintensidades da substância branca (HSB), dimensões hipocampais, e a integridade microestrutural da SB, por meio de imagens com tensor de difusão. RESULTADOS: Caso 1, com grave intensidade de HSB, evoluiu com piora cognitiva e funcional. Caso 2, com leve intensidade de HSB, evoluiu com melhora cognitiva após o tratamento da depressão. CONCLUSÕES: A existência de diferentes subtipos de DG, como apresentado neste relato, aponta para a heterogeneidade da fisiopatologia da DG, sugerindo um possível continuum entre depressão vascular (DpVa) e comprometimento cognitivo vascular (CCV).

INTRODUCTION: The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment. OBJECTIVE: The course of two illustrative cases of GD is discussed, highlighting its clinical picture after antidepressant treatment and underlining variables related to disease prognosis, treatment effectiveness and conversion to major cognitive disorders such as vascular dementia (VD). METHODS: The cognitive performance, depressive symptoms, autonomy and brain structural measurements as white matter hyperintensities (WMH) and hippocampal size, and microstructural integrity of WM with diffusion tensor imaging were followed during four years. RESULTS: Case 1, with a severe degree of WMH, was associated with worsening cognition and increasing functional disability. Case 2, with mild WMH, an improvement of cognitive functioning could be seen. CONCLUSIONS: The existence of different subtypes of GD, as presented in this report, points a pathophysiological heterogeneity of GD, and suggests a possible continuum vascular depression (VaDp) and vascular cognitive impairment (VCI).

Resumo A demência vascular (DV) é a forma mais prevalente de demência secundária e asegunda forma mais comum. O presente artigo visa definir recomendações dos princípios básicos para tratamento dos pacientes com suspeita de DV (e comprometimento cognitivo leve sem demência) usando uma abordagem sistematizada baseada em evidências. O conhecimento usado para definir estas recomendações foi recuperado de pesquisa de várias bases de dados (Medline, Scielo, Lilacs) contendo artigos científicos, revisões sistemáticas, meta-análises, publicados nos últimos 15 anos, ou antes, se pertinente. As informações recuperadas e selecionadas pela relevância foram usadas para analisar os critérios diagnósticos e propor um sistema diagnóstico incluindo critérios diagnósticos, anamnese, bem como exames complementares (neuroimagem e laboratório). Sempre que possível, os instrumentos foram selecionados com versões previamente adaptadas e validadas para uso no Brasil, segundo escolaridade e idade. Os protocolos propostos para exames complementares basearam-se no grau de prioridade, para aplicação na prática clínica ou em pesquisa.

Abstract Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based, systematized approach. The knowledge used to define these guidelines was retrieved from searches of several databases (Medline, Scielo, Lilacs) containing scientific articles, systematic reviews, meta-analyses, largely published within the last 15 years or earlier when pertinent. Information retrieved and selected for relevance was used to analyze diagnostic criteria and to propose a diagnostic system encompassing diagnostic criteria, anamnesis, as well as supplementary and clinical exams (neuroimaging and laboratory). Wherever possible, instruments were selected that had versions previously adapted and validated for use in Brazil that take into account both schooling and age. This task led to proposed protocols for supplementary exams based on degree of priority, for application in clinical practice and research settings.