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

A short review of dementia in adults was done, stressing the initial approach and neuropsychological scales currently used, and possible errors in the interpretation of performance scores. Causes are grouped according to the more common etiologies of dementia in young adults as dementia associated with drug abuse, infections (with emphasis in AIDS), environmental contamination and drugs side effects, and neurological disorders. Suggestions of clues to the differential diagnosis are given.

There is a limited choice of psychometric tests for Portuguese speaking people which have been evaluated in well defined groups. A Portuguese version of CERAD neuropsychological battery was applied to a control group of healthy elderly (CG) (mean age 75.1 years/ education 7.9 years), 31 Alzheimer disease (AD) patients classified by clinical dementia rating (CDR) as CDR1 (71.4/ 9.0) and 12 AD patients CDR 2 (74.1/ 9.3). Cut-off points were: verbal fluency-11; modified Boston naming-12; Mini-mental State Examination (MMSE) -26; word list memory-13; constructional praxis-9; word recall-3, word recognition-7; praxis recall-4. There was a significant difference between CG and AD-CDR1 (p<0.0001) for all tests. There was a less significant difference for constructional praxis and no difference for Boston naming. Comparison between AD-CDR1 and AD-CDR2 showed difference only for MMSE, verbal fluency, and Boston naming. The performance of CG was similar to that of a US control sample with comparable education level. These results indicate that this adaptation may be useful for the diagnosis of mild dementia but further studies are needed to define cut-offs for illiterates/low education people.

Purpose:to verify the correlation of the ingested diet with the nutritional status of Alzheimer disease (AD) patients; observation of fiber and fluid consumption and intestinal function. Methods: Cross-sectional study with 77 patients of both genders and their caregivers who were referred to nutritional status care in the three phases (CDR) of the AD. All answered the food anamnesis where it was possible to establish the amount of calories, macronutrients and micronutrients. Anthropometric measurements of weight, height, BMI, AC, TSF and AMC were collected.For the continuous variables, a descriptive statistical analysis was performed and for the analytical statistic the Poisson regression was used. Results:Most of the patients were eutrophic. The studied macronutrients were found to be adequate, except for the protein intake that was higher in the mild phase. No group achieved fiber intake. It was not found significant correlations between fiber consumption and intestinal function. In relation to micronutrients, adequate consumption of iron, vitamins A and B12 were found. Vitamin C intake did not reach DRI in mild patients and zinc consumption was low for patients who belonged to the group with moderated patients. Conclusions:Although it does not reflect the nutritional reality of Brazilian patients with probable AD, this study provided important characteristics of the diet composition that already allow us to establish nutritional action strategies.

Abstract Prosopagnosia is a visual agnosia characterized by an inability to recognize previously known human faces and to learn new faces. The aim of this study was to present a forty-six year-old woman with congenital prosopagnosia, and to discuss the neural bases of perception and recognition of faces. The patients had a lifetime impairment in recognizing faces of family members, close friends, and even her own face in photos. She also had impairment in recognizing animals such as discriminating between cats and dogs. The patient's basic visual skills showed impairment in identifying and recognizing the animal form perception on the coding subtest of the WAIS-R, recognizing overlapping pictures (Luria), and in identifying silhouettes depicting animals and objects (VOSP). Unconventional tests using pictures evidenced impairment in her capacity to identify famous faces, facial emotions and animals. Her face perception abilities were preserved, but recognition could not take place. Therefore, it appears that the agnosia in this case best fits the group of categories termed "associative".

ABSTRACT The measurement of cognitive abilities of patients with severe dementia can serve a wide range of methodological and clinical needs. Objective: To validate a proposed severe impairment battery SIB-8 for a Brazilian population sample as part of the neuropsychological assessment of patients with Alzheimer's disease (AD) in advanced stages. Methods: After a systematic process of translation and back-translation, the SIB-8 was applied to 95 patients with AD at different stages; moderate, moderately severe and severe according to FAST subdivisions (5, 6 and 7), with scores on the Mini-Mental State Examination (MMSE) of between 5 and 15 and followed by the Division of Behavioral Neurology and the Center for Aging Brain of the Federal University of São Paulo - UNIFESP. Results: Inferential data revealed that the SIB-8 instrument behaved differently at each stage of the disease with a statistical value of sensitivity p<0.001, gradually reflecting the expected course of the dementia, inherent with the decline of cognitive functions. Conclusion: Findings indicated that the SIB-8 is a useful tool for the evaluation and prospective comparison of AD patients in advanced stages, retaining its original characteristics in our population.

ABSTRACT. Relatives and caregivers receive little information and have poor knowledge about cognitive impairment and dementia. Objective: This study aimed to identify beliefs about cognitive impairment and aging among people who are in contact with older people with and without cognitive impairment, hypothesizing that the fact of being a close relative influences or modifies these beliefs. Methods: Seventy-eight participants were classified into two groups; group 1: relatives of patients with cognitive impairment or dementia from a behavioral neurology outpatient clinic (n1=48); and group 2: relatives of patients without objective cognitive impairment from different services of a geriatric outpatient clinic (n2=30). All subjects were asked to answer a questionnaire containing single choice and true/false questions about causes and risk factors for dementia. Results: Participants were mainly females and first-degree relatives. No statistical differences were observed for age, schooling, or follow-up time between groups. Participants recognized Alzheimer’s disease as the main cause of memory loss in older adults (group 1=34 vs. group 2=15); when asking about sources of information about cognitive impairment, the three more common answers were doctors and health professionals, Internet, and journals/books. Group 1 got higher scores on questions about causes and risk factors for dementia, but no statistical differences were found. Conclusions: Dementia literacy is low even among the people in contact with this syndrome; caring for someone with dementia changes the concepts about memory and aging but only in a small proportion. Educational strategies to deal with misinformation can help to control risk factors and reduce the incidence of dementia.

Neurocysticercosis is a parasitic disease that affects the central nervous system. The objective of this study was to investigate the correlation between neuronal death evaluated by the quantification of Fas apoptotic factor and the different evolutive forms of neurocysticercosis accompanied or not by epileptic seizures. METHODS: Cerebrospinal fluid samples from 36 patients with a diagnosis of neurocysticercosis divided into the following groups: active cystic form (n=15), 9 patients with and 6 without seizures, and calcified form (=21), 9 with and 12 without seizures. Fourteen patients comprised the control group. Fas protein concentrations were determined by ELISA. RESULTS: Only the group of patients with calcified cysts without seizures presented cerebrospinal fluid levels of Fas similar to those of the control group. Higher levels were observed for the other groups. CONCLUSIONS: The present finding suggests high cerebrospinal fluid levels of soluble Fas protein, except for patients with calcified cysts without seizures. Significant differences were observed for the group with calcified cysts and seizures, suggesting greater neuronal damage in these patients. Replacement of the term inactive cyst with reactive inactive cyst is suggested.

A doença de Alzheimer (DA) está associada a alterações cognitivas, de linguagem e de comportamento que se agravam durante seu curso. O objetivo deste estudo foi verificar a presença de alterações de linguagem, em pacientes com DA em fase inicial. Foram avaliados 12 pacientes com diagnóstico de provável (DA). Todos tinham pontuação no Mini Exame do Estado Mental acima de 23 pontos. Os pacientes foram submetidos à aplicação do Teste de Boston e os resultados comparados aos da população normal. Todos os pacientes apresentaram alterações de linguagem. Foram encontradas diferenças estatisticamente significantes nas tarefas de Compreensão auditiva e na tarefa de denominação. Nas demais tarefas de expressão e compreensão oral, bem como nas de leitura e escrita, os pacientes tiveram desempenho similar aos normais. Embora com um grupo pequeno,esta investigação identificou alterações bem definidas de linguagem em uma fase bastante inicial da DA.

A doença de Meige é distúrbio de movimento que consiste no aparecimento espontâneo de blefarospasmo associado a movimentos distônicos de musculatura orofacial. Associadamene podem ser encontrados torcicolo espasmódico, disfonia espástica e distonia de extremidades. Várias hipóteses foram formuladas para explicar esse distúrbio, tendo em vista a resposta a drogas com ação conhecida nos sistemas de neurotransmissores do cérebro. Algumas evidências apontam para um estado de preponderância dopaminérgica e, nesse sentido, justifica-se a estimulação da atividade GABA, sabendo-se que esse neurotrans-missor age sobre uma das alças de controle da produção de dopamina na substância negra. Por essa razão investigamos a ação de um agonista GABA, o baclofen, sobre a doença de Meige. Foram incluídos no protocolo 5 pacientes, 4 mulheres e um homem, com idade variando entre 50 e 63 anos e duração da doença variando entre 4 meses e 18 anos. Todos apresentavam blefaros-pasmo-distonia orofacial e, além disso três apresentavam disfonia espástica e um distonia de extremidades. A droga era iniciada em dose de 20mg/dia, aumentada em lOmg a cada três dias até ser obtida resposta ou surgirem efeitos colaterais. Um dos pacientes apresentou melhora marcada do blefaros-pasmo-distonia orofacial e outro melhora moderada dos mesmos sintomas, em avaliação 30 dias após estabilização da dose. Não houve melhora da disfonia espástica e ocorreu melhora moderada da distonia de extremidades. Não podemos afirmar que a melhora observada ao fim de um mês se mantenha, ou mesmo que melhora mais significativa fosse observada em avaliação feita mais tardiamente. Concluimos que o baclofen pode ser útil, pelo menos por algum tempo, na doença de Meige.