Objective: Alzheimer’s disease occurs at a higher prevalence and an earlier age in individuals with Down syndrome (DS) than typically developing individuals. However, diagnosing dementia in individuals with intellectual disability remains a challenge due to pre-existing cognitive deficits. The aim of this study was to investigate the validity and reliability of the Brazilian version of the Cambridge Examination for Mental Disorders of Older People with Down’s syndrome and Others with Intellectual Disabilities (CAMDEX-DS) for individuals with DS. Methods: Two psychiatrists, working independently, evaluated 92 adults with DS ≥ 30 years of age. The concurrent validity of the CAMDEX-DS was analyzed in relation to the gold standard of established international criteria. In a subgroup of 20 subjects, the concurrent validity of the CAMDEX-DS was analyzed in relation to an independent objective assessment of cognitive decline over three years. We analyzed the inter-rater reliability of cognitive assessment. Results: The diagnostic accuracy of the CAMDEX-DS compared to the gold standard was 96.7%. CAMDEX-DS-based diagnosis was considered consistent with cognitive decline. The probability of a participant with dementia having cognitive decline was 83%. Inter-rater reliability for the participant assessment was good, with a kappa of > 0.8 for 93% of the CAMDEX-DS items. Conclusion: The CAMDEX-DS can be considered the first valid and reliable instrument for evaluating dementia in adults with DS in Brazil. Its use in such individuals could improve clinical practice and research.

Abstract Background With the growth of the elderly population in Brazil and the increasing impact of depression and anxiety, the importance of preventing these disorders has been highlighted. Studies have shown an inverse relationship between rates of depression/anxiety and physical activity, pointing out its role as a possible protective factor. Objectives To conduct a randomized study with elderly adults in the community, who present with subsyndromal depression and anxiety, that will evaluate the effectiveness of physical activity with a collaborative stepped-care strategy; and to compare the effectiveness of physical activity in preventing subsyndromal depression and anxiety, with regard to the usual care group. Methods The article contains the methodological description of an arm of a large study entitled “Prevention and Treatment of Depression in Elderly”, in which 2,566 Brazilian older adults were screened to identify clinically significant depressive and anxiety symptoms. Those with clinically significant depressive or anxiety symptoms, not meeting criteria for depressive or anxiety disorder, will be invited to participate in a randomized clinical trial with 2 intervention groups: a step-by-step preventive care programme using physical activity, and usual care. The effectiveness of physical activity in the prevention of depressive and anxiety disorders will be evaluated. Discussion New health policies could be implemented, aiming to reduce the number of elderly people with depression and anxiety in primary care. In addition, training may be implemented for family health teams so that screening tools could be used to make an early identification of individuals with (or at risk of developing) mental disorders.

Objective: To conduct the first support vector machine (SVM)-based study comparing the diagnostic accuracy of T1-weighted magnetic resonance imaging (T1-MRI), F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and regional cerebral blood flow single-photon emission computed tomography (rCBF-SPECT) in Alzheimer’s disease (AD). Method: Brain T1-MRI, FDG-PET and rCBF-SPECT scans were acquired from a sample of mild AD patients (n=20) and healthy elderly controls (n=18). SVM-based diagnostic accuracy indices were calculated using whole-brain information and leave-one-out cross-validation. Results: The accuracy obtained using PET and SPECT data were similar. PET accuracy was 68∼71% and area under curve (AUC) 0.77∼0.81; SPECT accuracy was 68∼74% and AUC 0.75∼0.79, and both had better performance than analysis with T1-MRI data (accuracy of 58%, AUC 0.67). The addition of PET or SPECT to MRI produced higher accuracy indices (68∼74%; AUC: 0.74∼0.82) than T1-MRI alone, but these were not clearly superior to the isolated neurofunctional modalities. Conclusion: In line with previous evidence, FDG-PET and rCBF-SPECT more accurately identified patients with AD than T1-MRI, and the addition of either PET or SPECT to T1-MRI data yielded increased accuracy. The comparable SPECT and PET performances, directly demonstrated for the first time in the present study, support the view that rCBF-SPECT still has a role to play in AD diagnosis.

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0–4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%–80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

RESUMO Objetivo: Avaliar a presença de depressão, violência doméstica e uso de substâncias em gestantes com história de perdas gestacionais de repetição. Métodos: Foram utilizados os instrumentos: Edinburgh Postnatal Depression Scale (EPDS), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Abuse Assessment Screen (AAS), além de um questionário com dados sociodemográficos e clínicos elaborado pelos investigadores. As variáveis que apresentaram associação com depressão na análise bivariada (p < 0,10), tais como número de abortos e violência durante a vida, entraram no modelo de regressão logística. Resultados: Foram entrevistadas 46 pacientes, sendo encontrada uma prevalência de depressão de 41,3% (intervalo de confiança [IC] de 95% 1/4 28,3-55,7%). Com relação à violência contra a mulher, um terço das gestantes (32,6%) foi vítima de violência emocional ou física pelo seu parceiro ou por alguém próximo a elas. O abuso e/ou dependência de tabaco estava presente em 13% das gestantes, segundo o ASSIST. Na análise bivariada, observou-se uma associação significativa entre histórico de doença psiquiátrica e depressão em mulheres com abortamento de repetição (p 1/4 0,005). Observamos também uma tendência de associação entre depressão, número de abortos (p 1/4 0,071) e histórico de violência durante a vida (p 1/4 0,073) . Conclusão: Depressão é uma doença frequente entre as gestantes com abortamento de repetição. A sobreposição entre depressão, violência doméstica e uso de substâncias aponta para a necessidade do rastreio sistemático dessas condições no pré-natal de gestantes com perdas gestacionais de repetição.

ABSTRACT Objective: To assess depression, domestic violence and the use of substances in women with recurrent miscarriages. Methods: The Abuse Assessment Screen (AAS), the Edinburgh Postnatal Depression Scale (EPDS) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess violence, depression and the use of substances among women with recurrent miscarriages. The population corresponded to patients receiv-ing prenatal care from June to August 2014. Multiple logistic regression was used to assess the multivariable relationship between depression and sociodemographic, psychosocial and medical characteristics (p < 0,10). Results: The prevalence of depression was of 41.3% (95% confidence interval [CI] 1/4 28.3-55.7%). One third of the pregnant women (32.6%) reported emotional or physical violence, and 13% were classified as abusing or addicted to tobacco according to ASSIST. History of psychiatric diseases was associated with depression (p 1/4 0.005). Violence during life demonstrated a modest association (p 1/4 0.073) with depression, as well as the number of miscarriages (p 1/4 0.071). Conclusion: Depression is a frequent disease among pregnant women with recurrent miscarriages. The results of this investigation suggest that a systematic assessment of depression and its associated conditions, such as domestic violence and the use of substances, should be part of the prenatal follow-up visits for women with recurrent miscarriages.

Abstract Background Generalized anxiety disorder (GAD) has negative implications for people’s lives, but is often underdiagnosed in the elderly. There is a shortage of instruments to assess geriatric anxiety. Objectives To analyze the applicability and psychometric properties of the Portuguese version of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) within primary care. Methods Fifty-five seniors were classified as non-demented by a multidisciplinary panel. The protocol included the GAI, the Self-Reporting Questionnaire (SRQ-20), the Depression Scale D-10, Mini-Mental State Examination (MMSE), Bayer Scale for Activities of Daily Living (B-ADL) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A sub-sample also completed the Beck Anxiety Inventory (BAI). Results The GAI and GAI-SF showed good internal consistency (0.89; 0.62, respectively) and test-retest stability (0.58, 0.97). The GAI and GAI-SF correlated significantly with the SRQ-20 (0.74, 0.55) and BAI (0.75, 0.58). Discussion The psychometric characteristics of the Brazilian versions of the GAI and GAI-SF suggest these instruments are suitable for application in the Brazilian elderly population within the primary care setting.

RESUMO Medidas de metamemória fornecem informações acerca da memória subjetiva e são relevantes para se compreender a habilidade de memória no envelhecimento. Todavia, há uma falta de instrumentos de metamemória disponíveis no Brasil. Objetivo: O presente trabalho teve como objetivo examinar as propriedades psicométricas da versão brasileira do Questionário Multifatorial de Memória (MMQ), que avalia diferentes aspectos da memória subjetiva, como Sentimentos, Habilidade e Estratégias usadas na vida diária. Métodos: O MMQ foi traduzido para o Português e administrado em 30 idosos brasileiros. Os participantes realizaram testes cognitivos, escalas de humor e questionários de metamemória. Resultados: Análises revelaram boa consistência interna (coeficiente a de Cronbach's variou de 0.75 a 0.89) e validade teste-reteste para cada dimensão do MMQ (correlações positivas entre as duas aplicações variou de 0.75 a 0.8). Validade convergente do MMQ foi identificada através de correlações positivas (0.47 a 0.68) com as dimensões do Metamemory In Adulthood Questionnaire (MIA) (i.e., Habilidade, Controle, Autoeficácia e Estratégia). Validade discriminante revelou ausência de associação entre MMQ e performance cognitiva, sugerindo uma fraca correspondência entre metamemória e memória objetiva. Além disto, observou-se uma correlação negativa entre os escores da subscala MMQ-Habilidade e sintomas do humor (-0.63 para sintomas ansiosos, e -0.54 para sintomas depressivos); e o MMQ Brasileiro se mostrou comparável a traduções do MMQ em outros idiomas. Conclusão: O MMQ Brasileiro apresenta boas propriedades psicométricas e parece ser promissor para o uso clínico e de pesquisa. Estudos adicionais são necessários para investigar caracteristicas psicométricas do MMQ Brasileiro em uma amostra maior.

ABSTRACT Metamemory measures provide subjective memory information and are relevant to investigate memory ability in aging. However, there is a lack of metamemory instruments available in Brazil. Objective: The aim of this study was to examine the psychometric properties of the Brazilian version of the Multifactorial Memory Questionnaire (MMQ), which evaluates different dimensions of subjective memory functioning, such as Feelings, Abilities and Strategies used in everyday life. Methods: The MMQ was translated into Portuguese and administered to 30 Brazilian elderly subjects. The participants underwent cognitive tests, mood scales and metamemory instruments. Results: Analyses revealed good internal consistency (Cronbach's a coefficient ranged from 0.75 to 0.89) and test-retest validity for each MMQ dimensions (positive correlations between two applications ranged from 0.75 to 0.8). Convergent validity evidence for the MMQ was confirmed by significant positive correlations (0.47 to 0.68) with dimensions of the Metamemory in Adulthood scale (MIA) (i.e., the Ability, Control, Self-efficacy and Strategy dimensions). Discriminant validity revealed no associations between the MMQ and cognitive performance, suggesting a weak metamemory-objective memory correspondence. Moreover, there was a negative correlation between MMQ-Ability subscale scores and mood symptoms (-0.63 for anxious symptoms, and -0.54 for depressive symptoms); and the Brazilian MMQ was comparable with MMQ translations to other languages. Conclusion: The Brazilian MMQ exhibits good psychometric properties and appears promising for clinical and research purposes. Additional studies are needed to further examine the psychometric properties of the Brazilian MMQ in a larger sample.

RESUMO Objetivo Este estudo tem como objetivo apresentar dados normativos para o teste de Fuld Object Memory Evaluation estratificada por sexo, idade e educação para a população idosa brasileira. Método Foram avaliados 2.132 idosos saudáveis de ambos os sexos com idade média de 70,30 anos (± 7,28) a partir de duas amostras de base comunitária no Brasil provenientes de diferentes áreas economicas que foram selecionados com testes cognitivos e funcionais e o teste de memória. Resultados As análises estatísticas mostraram que os escores de memória tendem a melhorar significativamente com o aumento de anos de educação e diminuir significativamente o aumento da idade. Conclusão Conclui-se que gênero , escolaridade e idade tem efeito sobre o desempenho no teste Fuld Object Memory Evaluation nesta amostra da comunidade brasileira.

ABSTRACT Objective This study aims to present normative data for Fuld Object Memory Evaluation test stratified by sex, gender, age, and education for the Brazilian elderly population. Method We evaluated 2.132 healthy elderly both genders, with a mean age of 70.30 years (± 7.28) from two community-based samples in Brazil drawn from different economic areas who were screened with cognitive and functional tests and the memory test. Statistical analyses were performed by independent t-test, one-way analysis of variance and multiple linear regression. Results Statistical analyses showed that memory scores tend to improve significantly with increasing years of education and decrease significantly as age increased. Conclusion We conclude that gender, education and age had effect on the Fuld Object Memory Evaluation performance in this Brazilian community-based sample.

RESUMO Redução do metabolismo cerebral regional glicolítico (MRG) medido pela PET-18FDG no giro do cíngulo posterior (GCP) está relacionada a maior conversão para doença de Alzheimer (DA) em sujeitos com comprometimento cognitivo leve (CCL). Espectroscopia por ressonância magnética (MRS), um biomarcador promissor, demonstra redução de Naa/mI no GCP na DA. Raros estudos avaliam relações entre Naa/mI e MRG. OBJETIVO Avaliar diferenças e possíveis correlações entre MRG com PET-18FDG e Naa/mI por MRS no GCP de sujeitos com DA, CCL e voluntários normais. MÉTODOS Sujeitos com DA (N=32), CCL amnéstico (N=27) e voluntários idosos normais (GC, N=28), foram submetidos a PET-18FDG e análise de Naa/mI no GCP. A performance de ambos os métodos foi então comparada e verificou-se a existência de correlações entre os achados da PET e da MRS. RESULTADOS Observou-se hipometabolismo glicolítico nos pacientes com DA no GCP em relação ao GC, porém não no CCL. A MRS demonstrou valores menores de Naa/mI no CP do grupo DA em relação ao GC, porém também sem diferenças entre CCL e GC. A área sob a curva ROC demonstrou valor de 0,70 para MRS e 0,93 para o MRG no GCP para diferenciar DA do GC. Houve correlação positiva entre o MRG e o Naa/mI no GCP. CONCLUSÃO Os valores de metabolismo de glicose à PET e de Naa/mI à MRS no giro do cíngulo posterior apresentaram correlação positiva estatisticamente significante na presente amostra. Houve ainda superioridade da PET-18FDG para diferenciar DA do GC.

ABSTRACT Reduction of regional brain glucose metabolism (rBGM) measured by [18F]FDG-PET in the posterior cingulate cortex (PCC) has been associated with a higher conversion rate from mild cognitive impairment (MCI) to Alzheimer's disease (AD). Magnetic Resonance Spectroscopy (MRS) is a potential biomarker that has disclosed Naa/mI reductions within the PCC in both MCI and AD. Studies investigating the relationships between the two modalities are scarce. OBJECTIVE To evaluate differences and possible correlations between the findings of rBGM and NAA/mI in the PCC of individuals with AD, MCI and of cognitively normal volunteers. METHODS Patients diagnosed with AD (N=32) or MCI (N=27) and cognitively normal older adults (CG, N=28), were submitted to [18F]FDG-PET and MRS to analyze the PCC. The two methods were compared and possible correlations between the modalities were investigated. RESULTS The AD group exhibited rBGM reduction in the PCC when compared to the CG but not in the MCI group. MRS revealed lower NAA/mI values in the AD group compared to the CG but not in the MCI group. A positive correlation between rBGM and NAA/mI in the PCC was found. NAA/mI reduction in the PCC differentiated AD patients from control subjects with an area under the ROC curve of 0.70, while [18F]FDG-PET yielded a value of 0.93. CONCLUSION rBGM and Naa/mI in the PCC were positively correlated in patients with MCI and AD. [18F]FDG-PET had greater accuracy than MRS for discriminating AD patients from controls.

Cyberbullying, uma nova forma de violência expressa por meio da mídia eletrônica, tem preocupado pais, educadores e pesquisadores. A associação entre cyberbullying e a saúde mental dos adolescentes será revisada. Revisão sistemática em duas bases de dados: PubMed e a Biblioteca Virtual em Saúde (BVS). A prevalência do cyberbullying variou entre 6,5% a 35,4%. Bullying tradicional prévio ou atual estava associado às vítimas e agressores do cyberbullying. Uso diário de três ou mais horas de Internet, web câmera, mensagens de texto, postar informações pessoais e assediar outros online estavam associados ao cyberbullying. "Cybervítimas" e cyberbullies tinham mais problemas emocionais, psicossomáticos, dificuldades sociais, e não se sentiam seguros e cuidados na escola. O cyberbullying estava associado à sintomatologia depressiva moderada e grave, uso de substâncias, ideação e tentativas de suicídio. Profissionais de saúde devem conhecer as interações de natureza violenta que ocorrem no ambiente virtual e de seus agravos para a saúde mental dos adolescentes.

Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. In this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). The prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents.

Se revisa la asociación entre el acoso cibernético y la salud mental de los adolescentes. Se realiza una revisión sistemática de dos bases de datos: PubMed y la Biblioteca Virtual en Salud (BVS). La prevalencia de ciberacoso varió de un 6,5% a un 35,4%. Los acosos cibernéticos tradicionales -pasados o actuales- se asociaron con las víctimas y los acosadores cibernéticos. El uso diario de tres o más horas de Internet, cámara web, mensajes de texto, la publicación de información personal y acosar a los demás se asociaron con el acoso cibernético. Cibervíctimas y acosadores cibernéticos tenían más problemas emocionales, psicosomáticos, dificultades sociales y no se sentían seguros y cuidados en la escuela. El ciberacoso se asoció con síntomas de moderados a graves de depresión, abuso de sustancias, ideación suicida e intentos de suicidio. Los profesionales de salud deben conocer la naturaleza violenta de las interacciones que se producen en el entorno virtual y sus peligros para la salud mental de los adolescentes.

Cyberbullying, uma nova forma de violência expressa por meio da mídia eletrônica, tem preocupado pais, educadores e pesquisadores. A associação entre cyberbullying e a saúde mental dos adolescentes será revisada. Revisão sistemática em duas bases de dados: PubMed e a Biblioteca Virtual em Saúde (BVS). A prevalência do cyberbullying variou entre 6,5% a 35,4%. Bullying tradicional prévio ou atual estava associado às vítimas e agressores do cyberbullying. Uso diário de três ou mais horas de Internet, web câmera, mensagens de texto, postar informações pessoais e assediar outros online estavam associados ao cyberbullying. "Cybervítimas" e cyberbullies tinham mais problemas emocionais, psicossomáticos, dificuldades sociais, e não se sentiam seguros e cuidados na escola. O cyberbullying estava associado à sintomatologia depressiva moderada e grave, uso de substâncias, ideação e tentativas de suicídio. Profissionais de saúde devem conhecer as interações de natureza violenta que ocorrem no ambiente virtual e de seus agravos para a saúde mental dos adolescentes.

Cyberbullying is a new form of violence that is expressed through electronic media and has given rise to concern for parents, educators and researchers. In this paper, an association between cyberbullying and adolescent mental health will be assessed through a systematic review of two databases: PubMed and Virtual Health Library (BVS). The prevalence of cyberbullying ranged from 6.5% to 35.4%. Previous or current experiences of traditional bullying were associated with victims and perpetrators of cyberbullying. Daily use of three or more hours of Internet, web camera, text messages, posting personal information and harassing others online were associated with cyberbullying. Cybervictims and cyberbullies had more emotional and psychosomatic problems, social difficulties and did not feel safe and cared for in school. Cyberbullying was associated with moderate to severe depressive symptoms, substance use, ideation and suicide attempts. Health professionals should be aware of the violent nature of interactions occurring in the virtual environment and its harm to the mental health of adolescents.

Se revisa la asociación entre el acoso cibernético y la salud mental de los adolescentes. Se realiza una revisión sistemática de dos bases de datos: PubMed y la Biblioteca Virtual en Salud (BVS). La prevalencia de ciberacoso varió de un 6,5% a un 35,4%. Los acosos cibernéticos tradicionales -pasados o actuales- se asociaron con las víctimas y los acosadores cibernéticos. El uso diario de tres o más horas de Internet, cámara web, mensajes de texto, la publicación de información personal y acosar a los demás se asociaron con el acoso cibernético. Cibervíctimas y acosadores cibernéticos tenían más problemas emocionales, psicosomáticos, dificultades sociales y no se sentían seguros y cuidados en la escuela. El ciberacoso se asoció con síntomas de moderados a graves de depresión, abuso de sustancias, ideación suicida e intentos de suicidio. Los profesionales de salud deben conocer la naturaleza violenta de las interacciones que se producen en el entorno virtual y sus peligros para la salud mental de los adolescentes.

O fenômeno da transição demográfica nas últimas décadas aumentou o número de indivíduos idosos no Brasil, promovendo um avanço de condições crônico-degenerativas, particularmente demência e outros distúrbios cognitivos relacionados. OBJETIVO: A intenção deste estudo foi avaliar a evolução da produção científica brasileira em demência e condições relacionadas de 1999 a 2013. MÉTODOS: Pesquisamos artigos publicados durante esse período em três bancos de dados eletrônicos: Scopus, Medline (via PubMed) e Lilacs (via BVS). As palavras-chave utilizadas foram doença de Alzheimer, demência e comprometimento cognitivo leve, com o Brasil como país de afiliação. RESULTADOS: Um total de 1.657 artigos cumpriram as condições para inclusão no estudo. A produção de pesquisadores brasileiros na área de distúrbios cognitivos aumentou 11,38 vezes no período de análise e 4,98 vezes de 2003 a 2013. Mais da metade dos artigos (53%) foi publicada em periódicos internacionais. A maioria das instituições envolvidas em publicações eram universidades públicas e 19% eram estudos colaborativos envolvendo instituições brasileiras e internacionais. CONCLUSÃO: Apesar do crescimento expressivo, o número de publicações cientificas brasileiras na área de comprometimento cognitivo e demência é ainda baixo. Mais esforços são necessários para melhorar a produção de pesquisadores e instituições brasileiras. Possíveis estratégias para cumprir essa tarefa poderiam ser encorajar residentes a participar de publicações de artigos científicos durante seu programa de residência e aumentar as colaborações entre diferentes instituições brasileiras e com a comunidade científica internacional.

The phenomenon of demographic transition in recent decades has increased the number of elderly people in Brazil, promoting an escalation in chronic-degenerative conditions, particularly dementia and cognitive related disorders. OBJECTIVE: The aim of this study was to assess the evolution of the Brazilian scientific publications on dementia and related conditions from 1999 to 2013. METHODS: Articles published during the analysis period were searched on three electronic databases: Scopus, Medline (via PubMed) and Lilacs (via BVS). The keywords used were Alzheimer's disease, dementia and mild cognitive impairment, with Brazil as the country of affiliation. RESULTS: A total of 1,657 articles met the conditions for inclusion in the study. The output of Brazilian researchers in the area of cognitive disorders increased 11.38-fold in the fifteen-year period of analysis and 4.98-fold from 2003 to 2013. More than half of the articles (53%) were published in international journals. The majority of institutions involved in publications were public universities while 19% were collaborative studies involving Brazilian and international institutions. CONCLUSION: Despite marked growth, the number of Brazilian scientific publications in the area of cognitive impairment and dementia is still low. More effort is required to improve the output of Brazilian researchers and institutions. Possible strategies to accomplish this increase could be to encourage residents to participate in publications of scientific papers during their residence program and to increase the collaborations between different institutions within Brazil and with the international scientific community.

Os efeitos da galantamina (GAL) sobre qualidade de vida (QdV) e velocidade de processamento cognitivo, bem como da combinação com nimodipina (NIM) no tratamento da doença de Alzheimer (DA) com doença cerebrovascular (demência mista) ainda não foram investigados. Método : Estudo multicêntrico brasileiro, duplo-cego, controlado com placebo, avaliando os efeitos de GAL/NIM x GAL/placebo (PLA) na demência mista leve a moderada. Pacientes receberam tratamento com GAL/NIM ou GAL/PLA por 24 semanas. Medidas de eficácia primária foram as variações no desempenho em bateria de testes neuropsicológicos computadorizados e na escala QdV-DA ao final do estudo. Resultados : Vinte um pacientes receberam pelo menos uma dose da droga (9 GAL/NIM e 12 GAL/PLA). Os grupos foram emparelhados por idade, sexo, escolaridade, escores cognitivos e de QdV na linha de base. Não foram observadas diferenças significativas entre os dois grupos nas medidas de eficácia primária e secundária. Na avaliação de todos os pacientes que receberam GAL, houve melhora significativa (p<0,05) em QdV-DA e desempenho cognitivo. Os eventos adversos foram predominantemente leves a moderados. Conclusão : O tratamento com GAL proporcionou melhora da QdV na demência mista, além dos benefícios cognitivos previamente conhecidos. A combinação GAL/NIM não foi vantajosa. O reduzido tamanho amostral impede conclusões definitivas.

The effects of galantamine (GAL) on quality of life (QoL) and cognitive speed, as well its effects combined with nimodipine (NIM) in Alzheimer disease (AD) with cerebrovascular disease (mixed dementia), have not been explored. Method : Double-blind, placebo-controlled, multicenter Brazilian trial, studying the effects of GAL/NIM vs. GAL/placebo (PLA) in mild to moderate mixed dementia. Patients were randomized to receive GAL/NIM or GAL/PLA for 24 weeks. Primary efficacy measures were changes on a computerized neuropsychological battery (CNTB) and QoL Scale in Alzheimer's Disease (QoL-AD) from baseline to week 24. Results : Twenty-one patients received at least one drug dose (9 GAL/NIM and 12 GAL/PLA). Groups were matched for age, sex, education, cognitive and QoL scores at baseline. No significant differences were observed between groups on primary or secondary measures. QoL and cognitive performance showed significant improvement (p<0.05) from baseline when all GAL-treated patients were analyzed. Adverse events were predominantly mild to moderate. Conclusion : GAL treatment improved QoL in mixed dementia, in addition to its previously known cognitive benefits. The combination GAL/NIM was not advantageous. However, the small sample size precludes any definitive conclusions. Trial registered at ClinicalTrials.gov: NCT00814658