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Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Arquivos de Neuro-Psiquiatria is the property of Thieme Medical Publishing Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Research on Cognitive and Behavioral Neurosciences (CBN) is currently significant in our country, by taking into consideration the increasing number of papers published by Brazilian authors in important national and international journals, the frequent occurrence of specific events and the increasing time dedicated to the area in general scientific events. The increasing number of professionals interested in this area is engaged in basic and clinical research related to their different backgrounds. Not translated terms are commonly used in papers published in our country. Although the translation may be difficult in several cases, most of times the use of foreign words is not necessary. On the other hand, the same term may receive different translations according to the knowledge and interpretation of the authors. Either situation may compromise the text comprehension. A glossary of terms of frequent use in CBN translated to Portuguese is proposed with the objective of turning the translations to our language more uniform. Its use is encouraged because it is the result of a consensual work, nevertheless it must be stressed that this initial list is very limited and only represents the beginning of a work to be continued. [ABSTRACT FROM AUTHOR]

Objective: To analyze the clinical and autonomical profile of patients with Alzheimer's disease or mixed dementia (MD)., Methods: Fifty-four patients with indication for cholinesterase inhibitors use were evaluated through clinical examination, rest electrocardiogram, and spectral analysis of heart rate (HR) variability through digital Holter system recordings., Results: Overall, 61.1% of patients were female and were, on average, 77.1 years of age, 3.3 years of schooling and scored 16.4 points on the Mini Mental State Examination. The gap between symptom onset and diagnosis was 26.2 months. Almost all patients (90.7%) presented at least one clinical comorbidity, and each patient took, on average, 3.7 drugs to control them. Thirty-one patients had some alteration on the electrocardiogram and nine (16.6%) had orthostatic hypotension (OH). The latter was associated with the diagnosis of MD (p=0.001), with lower values of low (LF) and high (HF) frequency components of the spectral analysis in the supine position (p=0.000 and p=0.017, respectively) and with lower values of LF in the orthostatic position (p=0.006). Diagnosis of MD was associated with lower values of LF in both positions (p=0.003 and p=0.007)., Conclusion: This sample of patients had frequent comorbidities, which resulted in the prescription of multiple drugs. Signs of autonomic dysfunction resulting in OH were found mainly in those with MD., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)

Human T-cell lymphotropic virus (HTLV) infections have occurred for thousands of years. However, knowledge about their pathogenesis is recent. The virus is endemic in several regions around the world. In Brazil, it is present in all states at varying prevalence rates and it has been estimated that around 2.5 million Brazilians are infected. Genetic and immunological parameters of the host are the most important determinants of the clinical manifestations associated with infection. These can be divided into three categories: neoplastic, inflammatory and infectious. HTLV-associated myelopathy (HAM/TSP) and adult T-cell leukemia/lymphoma (ATLL) were the first diseases to be related to this retrovirus. More recently, countless other diseases have been correlated with the virus. The objective of this review is to provide an update on epidemiological, pathophysiologic, therapeutic and, primarily, diagnostic knowledge about HTLV, in order to encourage etiologic suspicion of HTLV in all its diverse clinical manifestations, which are currently rarely associated with this agent.

Elderly subjects may present stress symptoms due to physical, psychological and social changes during aging process. The aim of this study was to identify stress symptoms in elderly subjects and the coping strategies they used, verifying the relationship between these variables. The Stress Symptoms List (SSL) and the Jalowiec Coping Scale were administered to 41 healthy elderly subjects. Elderly subjects presented stress symptoms with a mean score of 42.8. Although problem-focused coping was predominantly observed, no significant difference was observed between mean SSL scores among elderly subjects who used problem-focused or emotion-focused coping. Although elderly subjects mainly elected problem-focused coping, stress intensity was independent of the coping style, showing that both problem- and emotion-focused coping are associated with similar stress levels.

Objective: Translating and adapting the Cornell scale for depression in dementia to the Portuguese language and verifying the interrater and test-retest reliability of the translated and adapted version., Method: The Cornell scale was translated into Portuguese and back translated into English. Divergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers., Results: The Cornell Scale presented good interrater (Kappa=0,77; p<0,001) and test-retest reliability (Kappa=0,76; p<0,001). The final version was easy to administer and well understood by the caregivers., Conclusion: The Brazilian version of the Cornell Scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evaluation and follow-up of depressed patients with dementia in our population and may also be used in multicentric studies with Brazilian population.

The original version of the Disability Assessment for Dementia (DAD) was translated into Portuguese and back translated to English. The divergences of translation were identified and discussed, resulting in a version that was used in a preliminary investigation for cross-cultural adaptation. The final version was administered to 29 patients with mild to moderate probable Alzheimer's disease. The correlation coefficients of DAD were 0.929 and 0.932 for the inter-examiner and test-retest evaluations respectively. The reliability indexes were also high (Kappa 0.72 p<0.001 inter-examiners and 0.85 p<0.001 test-retest). The Brazilian version of DAD was easy to administer and had good reliability to assess the functional status of demented patients. It will contribute to the follow-up of these patients in our population. Moreover, it can be used in transcultural studies on functional abilities in dementia.

Introduction: Cognitive evaluation is usually performed in the assessment of patients with suspected dementia, but is not generally performed in patients with other neurological diseases., Objective: To investigate the relevance of a systematic cognitive examination in patients with different neurological conditions., Method: One-hundred and five patients consecutively attended over a one-year period in a general Neurology outpatient clinic from a public-affiliated hospital, with no complaints of cognitive changes, were submitted to the following cognitive tests: Mini-Mental State Examination (MMSE), digit span (forward and backward), delayed recall of ten simple figures, category fluency and clock drawing. Whenever possible, the cut-off scores were adjusted as function of educational level., Results: Nearly 2/3 of the patients presented impaired performance in at least one of the tests. The MMSE was altered in 20% of the patients. Performance at digit span was impaired in 50.4% of cases (29.5% forward and 20.9% backward), delayed recall in 14.2% of the patients, category fluency in 27.6% and clock drawing in 40.0%., Conclusion: These results reinforce the need of including cognitive evaluation as a routine part of the neurological examination, independently of the presence of specific complaints in this domain.

Apathy is the most common neuropsychiatry syndrome in Alzheimer's disease affecting 30-60% of patients. It can be defined as a loss of motivation and manifests in affect, cognition and behavioral changes, determining blunted emotional response, lack of insight and social retraction, respectively. In this paper, the clinical features and the therapeutic perspectives of apathy are presented. There is considerable overlap between apathy and depression in Alzheimer's disease, but both are considered discrete syndromes. Pharmacological interventions for apathy include psychostimulants, such as methylphenidate, dopaminergic agents and cholinesterase inhibitors, but the results are controversial and there is no established treatment.

We report on a case of a 40 year-old man with Fahrs disease, defined by idiopathic bilateral basal ganglia calcification, who developed depressive disorder, motor and phonic tics, stereotyped behaviors such as punding and personality changes with significant social and familiar implications. We discuss about the psychopathology of Fahrs disease and the relevance of the basal ganglia in the determination of humans behavior.

Background: There are several ethical aspects related to the medical assistance of patients with Alzheimer's disease (AD) including diagnostic disclosure to the patient, performance of autopsy for diagnostic confirmation, and also topics pertaining to the caregivers constantly subjected by these patients to physical and mental stress. This work investigates some of these issues, by comparing family caregivers of patients with AD followed-up at both public and private health services., Methods: Twenty family caregivers of AD patients followed up at a public university hospital and 20 family caregivers of AD patients followed up at a private clinic were interviewed using a specific questionnaire comprised of 36 questions about diagnosis, treatment and prognosis of the disease., Results: The two groups presented similar age and gender distributions while the socioeconomic level was higher for the private clinic group. No differences were found between opinions of both groups regarding diagnostic disclosure to the patients, with 42.5% of the total in favor of disclosing the information only to the family. The number of caregivers who agreed with performance of autopsy was significantly higher in the public service (35% against 30% in the private clinic). Twenty caregivers (50% of the total sample) spontaneously manifested the wish to allow an autopsy for research purposes., Conclusion: Disclosure of AD diagnosis to patients was approved by more than half of all family caregivers and these rates were not correlated to the socioeconomic level. This variable, however, influenced the concordance rate related to the post-mortem neuropathological examination.

This panel had the objective of recommending evidence-based guidelines for the clinical diagnosis of Alzheimer's disease (AD) in Brazil. Guidelines from other countries and papers on the diagnosis of AD in Brazil were systematically evaluated in a thorough research of PUBMED and LILACS databases. The panel concluded that dementia diagnosis should be based on the DSM criteria and AD diagnosis, on the McKhann et al. criteria (NINCDS-ADRDA). The recommended auxiliary tests are: blood cell count, blood urea nitrogen, serum levels of creatinine, free-thyroxine, thyroid-stimulant hormone, albumin, hepatic enzymes, vitamin B12 and calcium, serological tests for syphilis and, for those aged less than 60 years, serological tests for HIV. Cerebrospinal fluid examination is recommended in special situations. Computed tomography (or preferentially magnetic resonance imaging, when available) is mandatory and has the main objective of excluding other diseases. SPECT and EEG are optional diagnostic methods.

The educational and cultural heterogeneity of the Brazilian population leads to peculiar characteristics regarding the diagnosis of Alzheimer's disease (AD). This consensus had the objective of recommending evidence-based guidelines for the clinical diagnosis of AD in Brazil. Studies on the diagnosis of AD published in Brazil were systematically evaluated in a thorough research of PUBMED and LILACS databases. For global cognitive evaluation, the Mini-Mental State Examination was recommended; for memory evaluation: delayed recall subtest of CERAD or of objects presented as drawings; attention: trail-making or digit-span; language: Boston naming, naming test from ADAS-Cog or NEUROPSI; executive functions: verbal fluency or clock-drawing; conceptualization and abstraction: similarities from CAMDEX or NEUROPSI; construction: drawings from CERAD. For functional evaluation, IQCODE, or Pfeffer Questionnaire or Bayer Scale for Activities of Daily Living was recommended. The panel concluded that the combined use of cognitive and functional evaluation based on interview with informant is recommended.

Decline of cognitive capacity (DCC) is due to normal physiological aging processes or to pre-dementia stage. Epidemiological studies show that elderly with decline of cognitive capacity have higher risk to develop Alzheimer's disease (AD), especially those with episodic memory deficits. This review presents the most important diagnosis criteria, neuropathological and neuropsychological findings of decline of cognitive capacity during aging.

We studied the occipital inter-hemispheric coherence of Electroencephalogram (electrodes O1-O2) for alpha band (alpha1--8.0 to 10.0 Hz and alpha2--10.1 to 12.5 Hz) in two groups of healthy individuals (young adults and subjects older than 50 years-old), to assess if there is significant difference between this two age groups. No significant difference in alpha band coherences was found between these two age groups.

Unlabelled: Mini-metal state examination (MMSE) is a screening test to detect cognitive impairment. The objectives of the present study are to describe some adaptations for use of MMSE in Brazil and to propose rules for its uniform application., Method: We evaluated 433 healthy subjects using the MMSE and verified the possible influence of demographic variables on total scores., Results: Educational level was the main factor that influenced performance, demonstrated by ANOVA: F(4,425) = 100.45, p<0.0001. The median values for educational groups were: 20 for illiterates; 25 for 1 to 4 yrs; 26.5 for 5 to 8 yrs; 28 for 9 to 11 yrs and 29 for higher levels., Conclusion: The MMSE is an excellent screening instrument and definitive rules are necessary for comparison purposes.

Objective: to analyze the clinical features and associated morbidity in a group of patients with vascular dementia (VD)., Methods: we retrospectively evaluated 25 patients with diagnosis of VD, based on the State of California Alzheimers Disease Diagnostic and Treatment Centers (ADDTC) criteria. Clinical and neuroimaging data and laboratory test results were obtained for the characterization of the sample., Results: the mean age was 68.7 +/- 14.6 years (64.0% men), with mean educational level of 5.2 +/- 4.4 years. Sudden onset of symptoms was observed in 48.0% of patients and stepwise deteriorating and fluctuating courses being observed in 4.0% and 16% respectively. Focal neurologic deficits were the first symptom in 48.0%, with focal deficits being observed in 80% on examination. The main morbidity were: hypertension (92.0%); hypercholesterolemia (64.0%); coronary heart disease (40.0%); smoking (40.0%); hypertriglyceridemia (36.0%); diabetes mellitus (32.0%); Chagas' disease (8.0%)., Conclusions: we observed strong association between VD and hypertension and hypercholesterolemia. The observation of two patients presenting Chagas' disease suggests that this endemic condition may be considered a possible regional risk factor.

Thirty patients with dementia defined by DSM-III-R criteria (Alzheimer's disease (22), vascular dementia (3), Parkinson's disease, frontal lobe dementia, possible diffuse Lewy body dementia, normal pressure hydrocephalus and uncertain diagnosis), with scores below 24 points in the Mini-Mental Status Examination and more than 4 years of education were submitted to a neuropsychological evaluation. The scores in the neuropsychological tests were compared to those obtained by thirty normal volunteers paired for age, sex and education. Sensitivity, specificity and accuracy of the tests in the distinction of demented and normal volunteers were determined. The accuracies were calculated using ROC curves. Blessed's information-memory-concentration test showed greatest accuracy, followed by copy of simple figures, delayed memory of 10 figures (after 5 minutes), recognition of 10 figures and verbal fluency test (animals). A linear discriminant function, composed by 6 tests: visual perception, incidental memory, delayed memory (after 5 minutes), drawing of a clock, verbal fluency (animals) and calculation tests, was able to discriminate all controls from patients and only one patient was wrongly classified as normal control. These tests were chosen because they can be applied in less than 10 minutes and are very easy to interpret. This discriminant function must be applied in another group of patients and controls in order to demonstrate its value. When associated to the MMSE it may be useful to discriminate patients with dementia from normal people in epidemiological studies.

A 69 years old man with pulmonary embolism early after coronary bypass surgery complicated by ischemic stroke received thrombolytic therapy. Reperfusion of the pulmonary artery was achieved. Conversion of the ischemic stroke to hemorrhagic infarction was observed at the CT-Scan without neurological impairment.

Paracoccidioidomycosis is a systemic mycosis, endemic in South and Central America, that affects the central nervous system in almost 10% of the cases. Neurological involvement includes to different clinical forms: meningeal and granulomatous form, also known as pseudotummoral form. Five patients with intracranial paracoccidioidomycosis were submitted to MR examination in a 1.5T system. All patients presented multiple round or lobulated lesions, hyperintense in T1-weighted images and predominantly hypointese in T2-weighted images. The lesions were distributed diffusely, with a slight predominance in the supratentorial compartment, although infratentorial lesions were also observed, mainly in the cerebellum. All lesions had ring or nodular contrast enhancement. Three patients were reexamined for treatment control, with disappearance of the lesions in two, with persistence of hypointense area in T2-weighted images. MR imaging proves to be a good method to evaluate the neurological involvement in paracoccidioidomycosis, mainly due to its high sensitivity for posterior fossa lesions. Further studies are needed to correlate the MR findings and the changes found in MR examination after treatment.