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Background Short-term memory binding (STMB) tests assess conjunctive binding, in which participants should remember the integration of features, such as shapes (or objects) and colors, forming a unique representation in memory. In this study, we investigated two STMB paradigms: change detection (CD) and free recall (FR). Objective To investigate the cognitive profile in the CD and FR tasks of three diagnostic groups: cognitively unimpaired (CU), mild cognitive impairment (MCI), and Alzheimer's clinical syndrome (ACS). In addition, we aimed to calculate and compare the accuracy of the CD and FR tasks to identify MCI and ACS. Methods Participants were 24 CU, 24 MCI, and 37 ACS. The cognitive scores of the clinical groups were compared using analysis of variance (ANOVA) and receiver-operating characteristic (ROC) analyses were carried out to verify the accuracy of the STMB tasks. Results In the CD task, CU was different from MCI and ACS (CU > MCI = ACS), while in the FR task all groups were different (CU > MCI > ACS). The ROC analyses showed an area under the curve (AUC) of 0.855 comparing CU with MCI for the CD task and 0.975 for the FR. The AUC comparing CU and ACS was 0.924 for the CD and 0.973 for the FR task. The FR task showed better accuracy to identify MCI patients, and the same accuracy to detect ACS. Conclusion The present findings indicate that impairments in CD and FR of bound representations are features of the cognitive profiles of MCI and ACS patients.

Distonia é o terceiro distúrbio do movimento mais comum. Caracteriza-se por contrações musculares sustentadas ou intermitentes que podem gerar posturas anormais. Nos últimos anos, muitos estudos tentaram relacionar a presença de sintomas não motores como parte da manifestação clínica dessa patologia; no entanto, os resultados ainda são controversos. Objetivo: Avaliar a prevalência de sintomas não motores em pacientes com distonia focal ou segmentar idiopática e seu impacto na qualidade de vida. Métodos: Foram avaliados 80 pacientes e 80 controles sem patologias neurológicas pareados para sexo, idade e anos de estudo. Os pacientes foram questionados quanto ao tempo e gravidade de doença. Dados demográficos, comorbidades e medicações em uso foram coletados de ambos os grupos. Os sintomas não motores foram avaliados por meio de escalas validadas para a população brasileira. Foram avaliados sintomas de depressão, ansiedade, fobia social, apatia, sonolência diurna, qualidade do sono, cognição e dor, assim como qualidade de vida. Resultados: 80 pacientes foram avaliados: 28 com diagnóstico de blefaroespasmo ou distonia de Meige, 28 com distonia cervical ou orocervical e 24 com distonia de membro, em sua maioria, distonia tarefa-específica da escrita (cãibra do escrivão). Os pacientes apresentaram mais sintomas de depressão, ansiedade e apatia do que os controles, assim como uma pior qualidade do sono e mais queixas de dor. Ao avaliarmos pelo tipo de distonia, os pacientes com blefaroespasmo foram os mais sintomáticos com relação a esses sintomas. Qualidade de vida foi pior nos pacientes que nos controles. Conclusões: Pacientes com distonia, principalmente com blefaroespasmo, apresentaram maior prevalência de sintomas de depressão, de ansiedade, de apatia, pior qualidade do sono e dor. Esses sintomas causaram impacto negativo na qualidade de vida desses pacientes Dystonia is the third most common movement disorder. It´s characterized by sustained or intermittent muscle contractions causing abnormal postures. In recent years many studies have sought to relate the presence of non-motor symptoms as part of clinical manifestation of this disease, however, results are still controversial. Objective: To assess prevalence of non-motor symptoms in patients with idiopathic focal or segmental dystonia and its impact in life quality. Methods: We evaluated 80 patients and 80 healthy controls matched for sex, age and years of schooling. Questions about the time at onset and severity of illness were asked to patients. Clinical and demographic data were noted in both groups. Non-motor symptoms were assessed using validated scales for Brazilian population. We assessed symptoms of depression, anxiety, social phobia, apathy, daytime sleepiness, sleep quality, cognition and pain, as well as quality of life. Results: We evaluated 80 patients: 28 with blepharospasm or Meige syndrome, 28 with cervical or orocervical dystonia and 24 with limb dystonia, mostly with specific writing task dystonia (writer´s cramp). Patients had more symptoms of depression, anxiety and apathy than controls, as well as worse quality of sleep and more pain complaints. Analysing by type of dystonia, patients with blepharospasm were the most symptomatic group in relation to these symptoms. Quality of life was worse in dystonic patients. Conclusions: Patients with dystonia, mainly those with blepharospasm, had a higher prevalence of symptoms of depression, anxiety, apathy, worse quality of sleep and pain. These symptoms had a negative impact on these patients\' quality of life

Background: The Montreal Cognitive Assessment (MoCA) is a short global cognitive scale, and some studies suggest it is useful for evaluating cognition in patients with Parkinson's disease (PD). However, its accuracy has been questioned in studies involving patients with low education. Objective: We sought to assess whether some of the MoCA subtests contribute to the low accuracy of the test. Methods: We performed a cross-sectional retrospective analysis of clinical data in a cohort of 71 patients with PD, most with less than 8 years of education. Patients were examined using the MDS-UPDRS, Hoehn and Yahr and the MoCA. The data were analyzed using mainly descriptive statistics. Results: We analyzed the data of 66 patients that were not demented according to the clinical evaluation and classified them using the proposed cut-off MoCA scores for diagnosis of MCI and dementia. Thirteen patients (19.7%) were classified as having normal cognition, 24 (36.3%) MCI and 29 (43.9%) dementia. Patients with dementia had longer disease duration (p=0.016) and lower education (p=0.0001). Total MoCA scores had a an almost normal distribution with a wide range of scores and only one maximum score. Performance on the MoCA was highly correlated with education (correlation coefficient=0.66, p=0.0001). At least five of the 10 MoCA subtests showed significant floor effects. Conclusion: We believe that some of the MoCA subtests may be too difficult to be completed by PD patients with low educational level, thus contributing to the test's poor diagnostic accuracy. RESUMO Embasamento: A MoCA é uma escala cognitiva global breve, e alguns estudos sugerem que ela seria útil para avaliar a cognição em pacientes com doença de Parkinson (DP). No entanto, sua acurácia foi questionada em estudos em pacientes com baixa escolaridade. Objetivo: Pretendeu-se avaliar se alguns dos subtestes da MoCA poderiam contribuir para a baixa precisão do teste. Métodos: Foi realizada uma análise transversal e retrospectiva de dados clínicos de uma coorte de 71 pacientes com DP, a maioria com menos de 8 anos de escolaridade. Os pacientes foram examinados usando o MDS-UPDRS, a Hoehn e Yahr e a MoCA. Os dados foram principalmente analisados pela estatística descritiva. Resultados: Foram analisados os dados de 66 pacientes que não foram diagnosticados com demência de acordo com a avaliação clínica. Eles foram em seguida classificados, usando as notas de corte MoCA propostos para diagnóstico de comprometimento cognitivo leve (CCL) e demência. Dessa forma, treze pacientes (19,7%) foram classificados como com a cognição normal, 24 pacientes (36,3%) com CCL e 29 pacientes (43,9%) como com demência. Os pacientes com demência tiveram maior duração da doença (p=0,016) e menor escolaridade (p=0,0001). A distribuição dos escores totais da MoCA apresentaram forma de distribuição normal com uma vasta gama de pontuações e apenas uma pontuação máxima. O desempenho no MoCA foi altamente correlacionado à escolaridade (coeficiente de correlação=0,66, p=0,0001). Pelo menos cinco dos 10 subtestes da MoCA mostraram efeitos piso significativos. Conclusão: Alguns dos subtestes MoCA podem ser muito difíceis de completar por pacientes com DP com baixa escolaridade, contribuindo assim para a baixa precisão diagnóstica do teste.

Parkinson's disease is a neurodegenerative disorder predominantly resulting from dopamine depletion in the substantia nigra pars compacta. Some psychiatric disorders may have dopaminergic dysfunction as their substrate. We describe a well-documented case of Parkinson's disease associated with Bipolar Disorder. Although there is some knowledge about the association between these diseases, little is known about its pathophysiology and correlation. We believe that among various hypotheses, many neurotransmitters are linked to this pathophysiology.

Dystonia is a relatively common movement disorder but some of its epidemiological and clinical aspects have not been well characterized in Brazilian patients. Also, a new clinical classification for the disorder has been proposed and its impact on clinical practice is unclear. We aimed to describe the clinical and demographic characteristics of a Brazilian series of patients with primary dystonia, to estimate its local prevalence, and to explore the impact of using a new classification for dystonia. We identified 289 patients with primary dystonia over a 12-month period, of whom235 underwent a detailed evaluation. Patients with primary dystoniamade up one-sixth of all patients evaluated at the service where the study was conducted, with an estimated local prevalence of 19.8/100,000 inhabitants. The clinical and demographic characteristics of the patients were similar to those described elsewhere, with blepharospasm as the most common focal dystonia and most patients using sensory tricks that they judged useful on a day-to-day basis. The application of the new classification was easy and simple, and the systematic approach allowed for a better clinical characterization of our patients. We recognized two dystonic syndromes that were not described in the original article that proposed the classification, and suspected that the arbitrary distinction between generalized and multifocal dystonia seems not to be useful for patients with primary dystonia. In conclusion, the prevalence and clinical characteristics of our patients were not distinct from other studies and the new classification was shown to be practical and useful to characterize patients with dystonia.