Abstract The cognitive profile of patients with anorexia nervosa is characterized by difficulties in central coherence and mental flexibility. Central coherence is defined by the ability to integrate incoming information in its own context, and weakness in central coherence is characterized by poor overall processing and superior detail processing. Mental flexibility is defined by the ability to change the course of a thought or action according to the demands of the environment. Alterations in this cognitive domain generate rigid and inflexible behavior. An open question in the literature is whether these cognitive characteristics are a transient state derived from the disease or whether they are stable traits associated with anorexia nervosa and endophenotypical features of this disease. The concept of endophenotype refers to the internal phenotype that is not clinically appreciable but can be observed indirectly through deficits that arise in the performance of certain neuropsychological tests. In recent years the search for endophenotypes has been renewed in the field of psychiatry as they would constitute an important route for the understanding of the biological and genetic bases of mental illnesses, constituting markers that allow a diagnosis before the onset of clinical symptomatology. For a cognitive marker to be considered an endophenotype it must meet a series of characteristics such as being measurable, inherited, found in patients with and without active disease and in first-degree relatives not affected by the disease. The aim of the present study was to assess whether difficulties in central coherence and mental flexibility are shared by unaffected first-degree relatives of patients with anorexia nervosa and thus constitute an endophenotypical feature of this disease. This is a cross-sectional, descriptive-comparative study in which 34 women participated: 17 unaffected first-degree relatives of patients with anorexia nervosa (mothers and sisters) and 17 healthy controls matched by age and education. For the study of central coherence the copy of Rey’s Complex Figure was used and to assess set-shifting the Stroop test, the Trail Making Test B and the Phonological Fluency test were used. Demographic and clinical aspects such as age, educational level, body mass index, anxiety, depression, obsessive-compulsive and eating disorder related symptoms were also evaluated. First-degree relatives of patients with anorexia nervosa showed lower performance on measures of central coherence (p < .05) and phonological fluency (p < .05) than healthy controls. A correlation was observed between the Stroop test and depression and eating disorders symptoms (p < .05). The results of this study show that unaffected first-degree relatives of patients with anorexia nervosa presented alterations in central coherence and, to a lesser degree, in mental flexibility. These results, in addition to previous research in which difficulties persisted even after recovery, indicate that these alterations could be genetically mediated, constituting a characteristic trait of anorexia nervosa and therefore a possible candidate for neuropsychological endophenotype of this disease. Regarding practical implications of the study, the findings reinforce the importance of cognitive remediation treatments not only for patients with anorexia nervosa but also emphasize that they could be useful for unaffected family members. Taking into account that family intervention is a widely used tool in the psychological treatment of anorexia, improving the perception of the patient and his relatives about cognitive biases, could contribute to raising awareness of the disease, something that patients with anorexia nervosa do not usually have, and generate a positive impact on the response to treatment as a whole.

Resumen El perfil cognitivo de los pacientes con anorexia nerviosa se caracteriza por dificultades en la flexibilidad mental y en la coherencia central. El objetivo de este trabajo fue analizar si los familiares de primer grado no afectados de los pacientes presentan estas dificultades cognitivas, que podrían representar rasgos endofenotípicos de la enfermedad. Fueron estudiadas 34 mujeres: 17 familiares de primer grado (madres y hermanas) de pacientes con anorexia nerviosa y 17 controles sanos agrupados por edad y escolaridad. Se consideraron el índice de masa corporal, la ansiedad, la depresión, los síntomas obsesivo-compulsivos y los relacionados con los trastornos alimentarios. Se evaluó la coherencia central, mediante la copia de la Figura Compleja de Rey, y la flexibilidad mental, mediante el test de Stroop, el test de los trazos B y el test de fluencia fonológica. Los familiares de pacientes con anorexia nerviosa presentaron un menor rendimiento en las medidas de coherencia central (p < .05) y en fluencia fonológica (p < .05) que los controles sanos. Se observó una correlación entre el test de Stroop y los síntomas de depresión y trastornos alimentarios (p < .05). Los familiares de primer grado no afectados de pacientes con anorexia nerviosa presentaron dificultades en la coherencia central y, en menor grado, en la flexibilidad mental. Los resultados en los familiares indican que este perfil podría ser mediado genéticamente, constituyendo un rasgo característico de la anorexia nerviosa y, por ende, un posible candidato a endofenotipo neuropsicológico de esta enfermedad.

It is estimated that two thirds of people who have suffered a stroke have sequels that condition their quality of life. The rehabilitation of the stroke is a complex process, which requires the multidisciplinary approach of specialized professionals (doctors, kinesiologists, nurses, occupational therapists, phonoaudiologists, neuropsychologists and nutritionists). Currently, the practices carried out are a consequence of the combination of evidence and consensus, most of them through international stroke rehabilitation guides. The objective of this review is to adjust the international recommendations on stroke rehabilitation to what is applied to daily practice, in order to unify the criteria of the recommendations and to reduce the variability of the practices carried out. This work is a review of the literature on stroke rehabilitation guides developed in the last 10 years. Each section was supervised by different professionals specialized in these areas. We analyze the time and organization necessary to develop rehabilitation, recommendations for motor, cognitive and visual rehabilitation, the management of dysphagia and nutrition, the approach of comorbidities (venous thrombosis, skin ulcers, pain, psychiatric disorders and osteoporosis) and the necessary tasks to favor the return to the activities of daily life.

Se estima que dos tercios de las personas que han sufrido un accidente cerebrovascular (ACV) tienen secuelas que condicionan su calidad de vida. La rehabilitación del ACV es un proceso complejo, que requiere de un equipo multidisciplinario de profesionales especializados (médicos, kinesiólogos, enfermeros, terapistas ocupacionales, fonoaudiólogos, neuropsicólogos y nutricionistas). Actualmente, las prácticas realizadas en rehabilitación son consecuencia de la combinación de evidencia y consenso, siendo la mayoría aportadas a través de guías internacionales de rehabilitación en ACV. El objetivo de esta revisión es ajustar las recomendaciones internacionales sobre rehabilitación a lo aplicado a la práctica diaria, a fin de unificar criterios en las recomendaciones y reducir la variabilidad de las prácticas empleadas. En este trabajo, se realizó una revisión de la literatura sobre las guías de rehabilitación en ACV realizadas en los últimos 10 años y cada apartado fue supervisado por distintos profesionales especializados en dichas áreas. Se analizaron los tiempos y organización necesaria para desarrollarla, las recomendaciones para la rehabilitación motora, cognitiva y visual, el tratamiento de la disfagia y nutrición, de las comorbilidades (trombosis venosa, úlceras cutáneas, dolor, trastornos psiquiátricos, osteoporosis) y las tareas necesarias para favorecer el retorno a las actividades de la vida diaria.

ABSTRACT The risk of recurrence of new amnesia events in patients having previously experienced transient global amnesia (TGA) ranges between 2.9-23.8%. Objective: Our objective was to search for recurrence predictors in TGA patients. Methods: Retrospective analysis to identify recurrence predictors in a cohort of 203 TGA patients from a single center in Buenos Aires, Argentina, diagnosed between January 2011 and March 2017 Clinical features and complementary studies (laboratory results, jugular vein Doppler ultrasound and brain MRI) were analyzed. Comparison between patients with recurrent versus single episode TGA was performed, applying a multivariate logistic regression model. Results: Mean age at presentation was 65 years (20-84); 52% were female. Median time elapsed between symptom onset and ER visit was two hours, with the average episode duration lasting four hours. Mean follow-up was 22 months. Sixty-six percent of patients referred to an identifiable trigger. Jugular reflux was present in 66% of patients; and 22% showed images with hippocampus restriction on diffusion-weighted MRI. Eight percent of patients had TGA recurrence. Patients with recurrent TGA had a more frequent history of migraine than patients without recurrence (37.5% vs. 14%; p = 0.03). None of the other clinical characteristics and complementary studies were predictors of increased risk of recurrence. Conclusions: Patients with migraine may have a higher risk of recurrent TGA. None of the other clinical characteristics evaluated allowed us to predict an increased risk of recurrence. Although the complementary studies allowed us to guide the diagnosis, they did not appear to have a significant impact on the prediction of recurrence risk.

RESUMEN El riesgo de recurrencia de nuevos eventos de amnesia en pacientes que han experimentado previamente Amnesia Global Transitoria (AGT) oscila entre el 2.9-23.8%. Objetivo: Nuestro objetivo fue buscar predictores de recurrencia en pacientes con AGT. Métodos: Análisis retrospectivo de una cohorte de 203 pacientes con AGT de un único centro en Buenos Aires, Argentina, diagnosticados entre enero-2011 y marzo-2017 Se analizaron las características clínicas y los estudios complementarios (laboratorio, Doppler de vena yugular y RM encéfalo). Se comparó el grupo de AGT recurrente versus episodio único, aplicando un modelo de regresión logística multivariada. Resultados: la edad promedio de presentación fue de 65 años (20-84); 52% mujeres. La mediana del tiempo transcurrido entre el inicio de los síntomas y la visita a la sala de emergencia fue de 2 horas, con una duración promedio del episodio de 4 horas. El seguimiento medio fue de 22 meses. 66% de los pacientes tuvieron un desencadenante identificable. El reflujo yugular estuvo presente en el 66% de los pacientes y el 22% mostró imágenes restrictivas en DWI a nivel hipocampal. 8% de los pacientes presentaron recurrencia. Los pacientes con AGT recurrente tuvieron un historial de migraña más frecuente (37.5% vs. 14%; p=0.03). Ninguna de las otras características clínicas y estudios complementarios fueron predictores de mayor riesgo de recurrencia. Conclusiones: los pacientes con migraña pueden tener un mayor riesgo de recurrencia de AGT. Ninguna de las otras características clínicas evaluadas nos permitió predecir un mayor riesgo de recurrencia. Aunque los estudios complementarios nos permitieron orientar el diagnóstico, no pareció tener un impacto significativo en la predicción del riesgo de recurrencia.

Resumo Neste artigo, investigamos dois sujeitos com memória superior ou hipermemória: Solomon Shereshevsky, que foi seguido clinicamente por anos por A. R. Luria, e Funes o memorioso, um personagem fictício criado por J. L. Borges. Os sujeitos possuem hipermemória, sinestesia e sintomas do que hoje chamamos de transtorno do espectro autista (TEA). Vamos discutir interações dessas características e seu possível papel na hipermemória. Nosso estudo sugere que a hipermemória em nossos sujeitos sinestésicos pode ser devido às suas características de síndrome do TEA-savant. No entanto, esse talento foi acentuadamente diminuído pelo profundo déficit de categorização, abstração e funções metafóricas. Conforme investigado por estudos anteriores, sugerimos que há conectividade alterada entre o lobo temporal medial e suas conexões com o cingulado pré-frontal e amígdala, devido à falta de neurônios específicos ou a uma disfunção neuronal mais geral.

Abstract In this paper, we investigated two subjects with superior memory, or hyper memory: Solomon Shereshevsky, who was followed clinically for years by A. R. Luria, and Funes the Memorious, a fictional character created by J. L. Borges. The subjects possessed hyper memory, synaesthesia and symptoms of what we now call autistic spectrum disorder (ASD). We will discuss interactions of these characteristics and their possible role in hyper memory. Our study suggests that the hyper memory in our synaesthetes may have been due to their ASD-savant syndrome characteristics. However, this talent was markedly diminished by their severe deficit in categorization, abstraction and metaphorical functions. As investigated by previous studies, we suggest that there is altered connectivity between the medial temporal lobe and its connections to the prefrontal cingulate and amygdala, either due to lack of specific neurons or to a more general neuronal dysfunction.

ABSTRACT The Argentina-Alzheimer's disease neuroimaging initiative (Arg-ADNI) study is a longitudinal prospective cohort of 50 participants at a single institution in Buenos Aires, Argentina. Longitudinal assessments on a neuropsychological test battery were performed on 15 controls, 24 mild cognitive impairment (MCI) patients and 12 Alzheimer's disease (AD) dementia patients. In our study population, there was a high prevalence of positive AD biomarkers in the AD group, 92.3% (12/13); and a low prevalence in the normal controls, 20%; almost half (48%) of the patients diagnosed with MCI had positive amyloid detection. After a one year, the significant differences found at baseline on neuropsychological testing were similar at the follow-up assessment even though the AD group had significantly altered its functional performance (FAQ and CDR). The exception was semantic fluency, which showed greater impairment between the AD group and MCI and normal controls respectively. For these tests, the addition of AD biomarkers as a variable did not significantly alter the variations previously found for the established clinical group's model. Finally, the one-year conversion rate to dementia was 20% in the MCI cohort.

RESUMO El estudio de Argentina-Alzheimer's Disease Neuroimaging Initiative (Arg-ADNI) es una cohorte prospectiva de 50 pacientes seguidos en una misma institución. Fueron evaluados cognitivamente 15 controles normales (CN), 24 sujetos con deterioro cognitivo leve (DCL) y 12 con demencia tipo Alzheimer (DTA) leve. En los DTA, 92,3% tuvieron biomarcadores positivos para Alzheimer y 20% en los CN. Casi la mitad de los DCL presentaron biomarcadores positivos. Después de un año de seguimiento, la diferencias significativas halladas en la visita de inicio en las pruebas cognitivas fueron similares al año aunque los DTA tuvieron empeoramiento funcional medido en el FAQ y CDR. La excepción fue la fluencia semántica, la cual mostró mayor declinación entre DTA y los demás grupos. La incorporación de los biomarcadores como variable no alteró significativamente los hallazgos de grupo. La tasa de conversión a demencia anual fue del 20%.

Resumen Objetivo: La fibromialgia (FM) es un síndrome de dolor crónico generalizado, asociado a alteraciones emocionales y comportamentales. El objetivo de este estudio fue identificar los síntomas afectivo-conductuales y las estrategias cognitivas de afrontamiento en la percepción de dolor de pacientes con FM. Material y métodos: Se realizó un estudio de corte transversal, con análisis de casos y controles, con una muestra de dos grupos de mujeres, en la ciudad de Barranquilla (Colombia): 34 con diagnóstico de FM y 30 controles, a quienes se les realizó evaluación de síntomas psicológicos y de percepción de dolor. Resultados: Los pacientes con FM presentan significativamente mayores síntomas afectivo-conductuales (ansiedad, depresión, insomnio, somatización y disfunción social) que los sujetos controles (p<0.001), así como una tendencia a utilizar la retirada social como estrategia de afrontamiento (p<0.005). De acuerdo con el análisis factorial, la percepción de dolor y los síntomas afectivo-conductuales en pacientes con FM se agruparon en un mismo factor, lo cual demostró interdependencia de las variables. Conclusiones: Los síntomas afectivo-conductuales se asocian a la percepción de dolor y se relacionan con la utilización de estrategias pasivas y centradas en la emoción como mecanismo para afrontar la experiencia de dolor.

Abstract Objective: Fibromyalgia (FM) is a syndrome of chronic widespread pain associated with emotional and behavioral disorders. The purpose of the study was to identify the affective -behavioral symptoms and cognitive coping strategies involved in the perception of pain in patients with FM. Material and methods: A cross-sectional study was performed, with analysis of cases and controls, with a sample of two groups of women, in the city of Barranquilla (Colombia). Affective - behavioral symptoms and cognitive coping strategies were assessed in 34 patients with FM and 30 controls matched by age and educational level. Results: Our findings indicate greater affective and behavioral symptoms in patients with FM (anxiety, depression, insomnia, somatization and social dysfunction) (p<0.001) and a tendency to use social withdrawal as a coping strategy (p<0.005). According to factor analysis, pain perception and affective-behavioral symptoms were grouped in a single factor, demonstrating interdependence between variables. Conclusions: The affective-behavioral symptoms are associated with perception of pain and are relate to the use of passive strategies, and focused on emotion as a mechanism to confront the experience of pain.

RESUMO "Esquecimento" é queixa frequente no envelhecimento normal e também ocorre nos primeiros estágios de síndromes demenciais. Testes de memória episódica são fundamentais para detectar comprometimento cognitivo amnéstico (CCL). O teste de Memória Associativa (Memory Binding Test-MBT) é um teste fácil e breve para detectar a fase inicial de perda de memória episódica. Objetivo: Validar a versão argentina do MBT e estimar a sua acurácia como instrumento diagnóstico para a detecção precoce do CCL. Métodos: 88 indivíduos (46 controles saudáveis e 42 pacientes com CCL amnéstico), emparelhados por idade e nível educacional, foram avaliados com extensa bateria neuropsicológica e o MBT. Resultados: Um desempenho significativamente melhor foi detectada no grupo controle; todas as escalas do MBT foram preditivas do diagnóstico de CCL (p<0,01). O MBT apresentou alta sensibilidade (69%) e alta especificidade (88%), com valor preditivo (VP) positivo de 93% e e VP negativo de 55% para a recordação dos itens associados (associative paired recall). Diferença estatisticamente significativa (c2=14,164, p<0,001) foi obtida quando foram comparadas as áreas sob as curvas (AUC) do MBT (0,88) e o Mini-Exame do Estado Mental (MEEM) (0,70). Conclusão: A versão argentina do MBT correlacionou-se significativamente com o MEEM e com a bateria de memória e é uma ferramenta útil na detecção de CCL. As características operacionais do MBT são bem adequadas, superando outros testes usualmente utilizados para a detecção de CCL.

ABSTRACT Background: "Forgetfulness" is frequent in normal aging and characteristic of the early stages of dementia syndromes. The episodic memory test is central for detecting amnestic mild cognitive impairment (MCI). The Memory Binding Test (MBT) is a simple, easy and brief memory test to detect the early stage of episodic memory impairment. Objective: To validate the Argentine version of the MBT in a Latin American population and to estimate the diagnostic accuracy as a tool for early detection of MCI. Methods: 88 subjects (46 healthy controls and 42 patients with amnestic MCI) matched for age and educational level were evaluated by an extensive neuropsychological battery and the memory binding test. Results: A significantly better performance was detected in the control group; all MBT scales were predictive of MCI diagnosis (p<.01). The MBT showed high sensitivity (69%) and high specificity (88%), with a PPV of 93% and a NPV of 55% for associative paired recall. A statistically significant difference (c2=14,164, p<.001) was obtained when comparing the area under the curve (AUC) of the MBT (0.88) and the MMSE (0.70). Conclusion: The Argentine version of the MBT correlated significantly with the MMSE and the memory battery and is a useful tool in the detection of MCI. The operating characteristics of the MBT are well suited, surpassing other tests commonly used for detecting MCI.

O envelhecimento da população idosa tem aumentado mundialmente, mesmo em países em desenvolvimento. Estes países têm grupos populacionais de poucos recursos, com necessidades básicas não satisfatórias, frequentemente omitidas nos estudos epidemiológicos. OBJETIVO: O propósito deste estudo foi determinar a prevalência de comprometimento cognitivo (CC) e demência em uma população socioeconomicamente vulnerável na Argentina. MÉTODOS: Foi realizada pesquisa observacional de base populacional porta-a-porta entre adultos acima de 60 anos numa área de vulnerabilidade social em Matanza Riachuelo, no subúrbio de Buenos Aires, Argentina. Psicólogos treinados entrevistaram o sujeito e um acompanhante. Um protocolo estandardizado que incluiu um questionário sociodemográfico, o MEEM, a escala de depressão geriátrica e um inventário funcional para ABVD e AIVD foram administrados. Os diagnósticos foram divididos em três categorias: função cognitiva normal, comprometimento cognitivo sem demência (CCSD) e demência. RESULTADOS: Foram avaliados um total de 2437 de idosos, dos quais 73,6% preencheram os critérios de inclusão. A prevalência de CC entre aqueles acima de 60 anos foi de 26,4% (18,1% CCSD e 8,3% de demência) com maiores prevalência de demência em indivíduos mais jovens do que os reportados em países desenvolvidos, provavelmente devido a controle inadequado dos fatores de risco vasculares. CONCLUSÃO: Esta informação pode contribuir para tomada de decisões em saúde pública para geração de programas e planos que apontem para a prevenção, diagnóstico e tratamento de CC neste tipo de população em vulnerabilidade social.

Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. OBJECTIVE: The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. METHODS: A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. RESULTS AND CONCLUSIONS: A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population.

Dados epidemiológicos em demência e comprometimento cognitivo são escassos na América do Sul. Na Argentina, não há estudos epidemiológicos de base populacional de comprometimento cognitivo/demência. O Estudo Ceibo é um estudo epidemiológico de base populacional a ser conduzido. O presente artigo reporta os resultados da fase piloto (pesquisa de comprometimento cognitivo) conduzido em Cañuelas (província de Buenos Aires). MÉTODOS: Numa pesquisa porta-a-porta, estudantes treinados avaliaram 1453 indivíduos de 60 anos ou mais em uma visita, usando dados demográficos e questionários de fatores de risco, o Mini-Exame do Estado Mental (MEEM) e a escala de Depressão Geriátrica (GDS). RESULTADOS: A idade média foi de 70,9 (±7,5) anos, 61.4% eram mulheres, escolaridade média foi de 5,5 (±3,5) anos. O escore médio do MEEM foi de 24,5 (±4,7) anos e média do GDS de 3,1 (±2,7). Os fatores de risco mais prevalentes foram: hipertensão (40,6%), tabagismo (35,1%), consumo de álcool (32,8%), colesterol elevado (16,1%), diabetes (12,5%), trauma craniano com perda de consciência (12,5%), 7 pontos ou mais no GDS (11,7%). A prevalência de comprometimento cognitive na amostra total foi de 23% e em 16,9% nos sujeitos entre 60-69 anos, 23,3% entre 70-79 e 42,5% naqueles com 80 ou mais. Correlações significativas de comprometimento cognitivo com idade, analfabetismo functional, trauma craniano, hipertensão arterial, inatividade e depressão foram encontradas. CONCLUSÃO: Neste estudo piloto a prevalência de comprometimento cognitivo foi comparável aos estudos prévios internacionais.

Epidemiological data on dementia and cognitive impairment are scarce in South America. In Argentina, no dementia/cognitive impairment population-based epidemiological studies are available. The Ceibo Study is a population-based epidemiological study of dementia and cognitive impairment in individuals over 60 to be conducted. The present paper reports the results of the pilot phase (survey of cognitive impairment) conducted in Cañuelas (province of Buenos Aires). METHODS: In a door-to-door survey, trained high school students evaluated 1453 individuals aged 60 years and over in one day using a demographic data and risk factors questionnaire, the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS). RESULTS: Mean age of the individuals was 70.9 (±7.5) years, 61.4% were women, mean schooling was 5.5 (±3.5) years. Mean MMSE score was 24.5 (±4.7) and mean GDS 3.1 (±2.7). Risk factors of higher prevalence in the population under study were: hypertension (40.6%), smoking (35.1%), alcohol consumption (32.8%), high cholesterol (16.1%), diabetes (12.5%), cranial trauma with loss of consciousness (12.5%), 7 points or more on the GDS (11.7%). Prevalence of cognitive impairment for the whole sample was 23%, and 16.9% in subjects aged 60-69, 23.3% in 70-79 and 42.5% in subjects aged 80 or over . A significant correlation of cognitive impairment with age, functional illiteracy, cranial trauma, high blood pressure, inactivity and depression was found. CONCLUSION: In this pilot study, the prevalence of cognitive impairment was comparable with previous international studies.

Resumo O paciente com doença de Alzheimer (DA) sofre comprometimento progressivo cognitivo, comportamental e funcional, que resulta numa grande sobrecarga aos pacientes, familiares e à saúde pública. A DA inclui custos diretos e indiretos. Os custos indiretos (como perda ou redução dos ganhos pelo paciente ou membros da família) são os mais importantes custos dos pacientes leves e na comunidade. Os custos diretos (tais como tratamento médico ou serviços sociais) aumentam com a progressão da doença, quando o paciente é institucionalizado ou quando um cuidador formal é requerido. A terapia com drogas representam um aumento nos custos diretos, mas podem reduzir alguns outros custos diretos ou indiretos envolvidos. Vários estudos projetam uma economia global da sociedade quando é usada terapia com drogas e todos os custos relevantes são considerados; e os resultados dependerão de um paciente específico e características do meio envolvido no cuidado. A demência pode ser um assunto de análise quando as políticas de saúde são desenhadas. Os países da América do Sul deveriam fortalecer suas políticas e capacidades de planejamento, pela geração de maiores evidências locais sobre a sobrecarga da DA e como poderia ser norteada pelas opções de tratamento.

Abstract Alzheimer's disease (AD) patients suffer progressive cognitive, behavioral and functional impairment which result in a heavy burden to patients, families, and the public-health system. AD entails both direct and indirect costs. Indirect costs (such as loss or reduction of income by the patient or family members) are the most important costs in early and community-dwelling AD patients. Direct costs (such as medical treatment or social services) increase when the disorder progresses, and the patient is institutionalized or a formal caregiver is required. Drug therapies represent an increase in direct cost but can reduce some other direct or indirect costs involved. Several studies have projected overall savings to society when using drug therapies and all relevant cost are considered, where results depend on specific patient and care setting characteristics. Dementia should be the focus of analysis when public health policies are being devised. South American countries should strengthen their policy and planning capabilities by gathering more local evidence about the burden of AD and how it can be shaped by treatment options.

Resumo Reserva cognitiva é a habilidade em otimizar o desempenho através do recrutamento de redes neurais, que talvez reflitam o uso de estratégias cognitivas alternativas. Objetivos: Identificar fatores relacionados à reserva cognitiva associados à progressão do comprometimento cognitivo leve (CCL) para demência degenerativa. Métodos: Uma coorte de 239 indivíduos com CCL (idade: 72.2±8.1 anos, 58% mulheres, educação: 12 anos) foram avaliados e seguidos por cinco anos (2001-2006). Resultados: No primeiro ano 13.7% dos CCL converteram para demência e 34.7% em três anos (78.3% converteram para doença de Alzheimer). Os fatores de risco para aqueles que converteram foram: educação menor do que 12 anos, MMSE menor do que 27, teste de Nomeação de Boston menor do que 51, QI (Quociente de Inteligência) menor do que 111, idade superior a 75 anos, falta de ocupação na aposentadoria, e presença de intrusões na memória de evocação (todos contando para 56% da variabilidade de conversão). Conclusões: Pacientes com CCL são uma população de risco para demência. O estudo dos fatores de risco (como QI, educação e ocupação), principalmente, aqueles relacionados à reserva cognitiva podem contribuir para uma evidência importante para o processo de decisões na atividade clínica e na saúde pública.

Abstract Cognitive reserve is the ability to optimize performance through differential recruitment of brain networks, which may reflect the use of alternative cognitive strategies. Objectives: To identify factors related to cognitive reserve associated with progression from mild cognitive impairment (MCI) to degenerative dementia. Methods: A cohort of 239 subjects with MCI (age: 72.2±8.1 years, 58% women, education: 12 years) was assessed and followed for five years (2001 to 2006). Results: In the first year, 13.7% of MCI converted to dementia and 34.7% converted within three years (78.3% converted to Alzheimer's dementia). Risk factors for those who converted were education less than 12 years, MMSE score less than 27, Boston naming test score less than 51, IQ (Intelligence Quotient) less than 111, age over 75 years, lack of occupation at retirement, and presence of intrusions in memory recall (all account for 56% of the variability of conversion). Conclusions: MCI patients are a population at high risk for dementia. The study of risk factors (e.g. IQ, education and occupation), particularly those related to cognitive reserve, can contribute important evidence to guide the decision-making process in routine clinical activity and public health policy.

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.

Resumo Comprometimento cognitivo leve (CCL) é um estágio de transição entre o envelhecimento normal e a doença de Alzheimer (DA). Comprometimento da memória semântica tem sido demonstrado como um fator crítico na DA precoce. O Teste de Nomeação de Boston (TNB) é um meio fácil para examinar o processamento semântico e viso-espacial e também um instrumento potencial de diagnóstico. Objetivo: Examinar a habilidade de nomeação e discriminar os tipos de erros em pacientes com CCL amnéstico (CCLa). Métodos: Vinte pacientes com CCLa, 20 pacientes com DA e 21 controles normais pareados por idade, sexo e nível educacional foram avaliados. Como parte da avaliação neuropsicológica a todos foi administrado o TNB. Uma ampla classificação dos tipos de erros foi realizada a fim de comparar o desempenho e conhecer a origem semântica ou perceptiva dos erros. Resultados: Os pacientes com DA obtiveram piores escores totais no TNB do que os pacientes com CCLa e controles. Os pacientes com CCLa não tiveram diferenças significativas nos escores totais, porém, mostraram um número maior e significativo de erros semânticos comparados aos controles. Conclusão: Este estudo revela que o processamento semântico está comprometido durante a nomeação por confrontação no CCLa.

Abstract Mild cognitive impairment (MCI) is the transitional stage between normal aging and Alzheimer's disease (AD). Impairments in semantic memory have been demonstrated to be a critical factor in early AD. The Boston Naming Test (BNT) is a straightforward method of examining semantic or visuo-perceptual processing and therefore represents a potential diagnostic tool. The objective of this study was to examine naming ability and identify error types in patients with amnestic mild cognitive impairment (aMCI). Methods: Twenty aMCI patients, twenty AD patients and twenty-one normal controls, matched by age, sex and education level were evaluated. As part of a further neuropsychological evaluation, all subjects performed the BNT. A comprehensive classification of error types was devised in order to compare performance and ascertain semantic or perceptual origin of errors. Results: AD patients obtained significantly lower total scores on the BNT than aMCI patients and controls. aMCI patients did not obtain significant differences in total scores, but showed significantly higher semantic errors compared to controls. Conclusion: This study reveals that semantic processing is impaired during confrontation naming in aMCI.

AIM: To investigate whether the cerebellum could participate in social cognition (SC). METHOD: General neuropsychological tests, executive tests (EF), social cognition tests, which assess the ability to infer other peoples’ mental states, and the Beck Depression Inventory were given to 10 non-demented patients with isolated cerebellar degenerative disease, and to 10 healthy controls matched for sex, age, and years of education. ANOVA and correlation coefficients were employed for the statistical analysis. RESULTS: Patients within the cerebellar group were significantly impaired (p?0.05) in EF test [Wisconsin Card Sorting Test (WSCT)] and belief questions (BQ) from Theory of Mind (ToM) tests. Performance in control questions (CQ) from ToM tests was similar for both groups. Lower scores in BQ correlated with a lower conceptual ability, the severity of apathy (NPI) and static ataxia. CQ correlated with measures of attention and free recall. CONCLUSION: The cerebellum may contribute in the control of social behavior through the processing of multimodal data, motor, cognitive and emotional.

OBJETIVO: Investigar la hipótesis según la cual, el cerebelo podría participar en las alteraciones de la cognición social (CS). MÉTODO: Se administraron tests neuropsicológicos generales, de función ejecutiva (FE), de CS que evaluaban la capacidad de inferir el estado mental de otras personas y la escala de Depresión de Beck a 10 pacientes adultos con enfermedad cerebelosa adquirida aislada (GEC) y a 10 controles (GCO) apareados por edad, sexo y educación. Se analizaron los datos mediante ANOVA y correlación. RESULTADOS: El GEC obtuvo puntajes significativamente menores (p?0,05) que el grupo GCO en tareas de FE (Test de Wisconsin) y preguntas de creencia (PCr) de Teoría de la Mente (ToM). El rendimiento en las preguntas de control (PCo) de ToM fue similar en ambos grupos. El menor rendimiento en las PCr correlacionó significativamente con una menor habilidad conceptual, la severidad de la apatía (NPI) y de la ataxia estática. Las PCo correlacionaron con medidas de atención y de recuerdo diferido libre. CONCLUSÍON: El cerebelo contribuiría en el monitoreo de la conducta mediante el control de datos multimodales motores, cognitivos y emocionales.