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Background: Alzheimer's disease (AD) affects not only memory but also other cognitive functions, such as orientation, language, praxis, attention, visual perception, or executive function. Most studies on oral communication in AD focus on aphasia; however, speech and orofacial apraxias are also present in these patients. the aim of this study was to investigate the presence of speech and orofacial apraxias in patients with AD with the hypothesis that apraxia severity is strongly correlated with disease severity.Methods: Ninety participants in different stages of AD (mild, moderate, and severe) underwent the following assessments: Clinical Dementia Rating, Mini-Mental State Examination, Lawton Instrumental Activities of Daily Living, a specific speech and orofacial praxis assessment, and the oral agility subtest of the Boston diagnostic aphasia examination.Results: the mean age was 80.2 +/- 7.2 years and 73% were women. Patients with AD had significantly lower scores than normal controls for speech praxis (mean difference = -2.9, 95% confidence interval (CI) = -3.3 to -2.4) and orofacial praxis (mean difference = -4.9, 95% CI = -5.4 to -4.3). Dementia severity was significantly associated with orofacial apraxia severity (moderate AD: beta = -19.63, p = 0.011; and severe AD: beta = -51.68, p < 0.001) and speech apraxia severity (moderate AD: beta = 7.07, p = 0.001; and severe AD: beta = 8.16, p < 0.001).Conclusion: Speech and orofacial apraxias were evident in patients with AD and became more pronounced with disease progression. Universidade Federal de São Paulo, Dept Speech Pathol, BR-04023900 São Paulo, Brazil Universidade Federal de São Paulo, Dept Neurol & Neurosurg, BR-04023900 São Paulo, Brazil Universidade Federal de São Paulo, Dept Prevent Med, BR-04023900 São Paulo, Brazil Universidade Federal de São Paulo, Dept Speech Pathol, BR-04023900 São Paulo, Brazil Universidade Federal de São Paulo, Dept Neurol & Neurosurg, BR-04023900 São Paulo, Brazil Universidade Federal de São Paulo, Dept Prevent Med, BR-04023900 São Paulo, Brazil Web of Science

Alzheimer's disease (AD) is a highly prevalent type of dementia in the elderly population. AD is a complex neurodegenerative disorder. Thus, epigenetic mechanisms that regulate gene expression might have an important role in AD. CNP (2',3'-Cyclic Nucleotide 3' Phosphodiesterase) gene encodes a protein used as an index of myelin alterations. DPYSL2 (Dihydropyrimidinase-like 2) is described as acting in structural and regulatory processes in the central nervous system, such as neural differentiation, neurotransmitter release, and stabilization of microtubules. In this study, we evaluated gene expression and epigenetic regulation of CNP and DPYSL2 genes in three postmortem brain regions (entorhinal and auditory cortices and hippocampus) of AD patients and healthy elderly controls. mRNA quantification was performed using qRT-PCR, and promoter DNA methylation patterns were determined by mass spectrometry using the Sequenom EpiTYPER platform. We observed CNP mRNA downregulation in entorhinal and auditory cortex in relation to the same regions of the control group. CNP alterations in the brain might suggest impairment in myelination leading to a synaptic and cognition loss. No AD-associated differences in CNP and DPYSL2 promoter DNA methylation were observed, suggesting that other mechanisms may be involved in mediating the observed CNP gene expression.

1. Ommaya AK. Cerebrospinal fluid rhinorrhea. Neurology 1964;14:106-113. 2. Telera S, Conte A, Cristalli G, Occhipinti E, Pompili A. Spontaneous cerebrospinal fluid rhinorrhea as the presenting symptom of sellar pathologies: three demonstrative cases. Neurosurg Rev 2007;30:78-82.3. Elrahman HA, Malinvaud D, Bonfils NA, Daoud R, Mimoun M, Bonfils P. Endoscopic management of idiopathic spontaneous skull base fistula through the clivus. Arch Otolaryngol Head Neck Surg 2009;135:311-315.

Cognitive and olfactory impairments have previously been demonstrated in patients with spinocerebellar ataxia type 3 (SCA3), also known as Machado-Joseph disease (MJD)-SCA3/MJD. We investigated changes in regional cerebral blood flow (rCBF) using single-photon emission computed tomography (SPECT) imaging in a cohort of Brazilian patients with SCA3/MJD. The aim of the present study was to evaluate the correlation among rCBF, cognitive deficits, and olfactory dysfunction in SCA3/MJD. Twenty-nine genetically confirmed SCA3/MJD patients and 25 control subjects were enrolled in the study. The severity of cerebellar symptoms was measured using the International Cooperative Ataxia Rating Scale and the Scale for the Assessment and Rating of Ataxia. Psychiatric symptoms were evaluated by the Hamilton Anxiety Scale and Beck Depression Inventory. The neuropsychological assessment consisted of Spatial Span, Symbol Search, Picture Completion, the Stroop Color Word Test, Trail Making Test (TMT), and Phonemic Verbal Fluency. Subjects were also submitted to odor identification evaluation using the 16-item Sniffin' Sticks. SPECT was performed using ethyl cysteine dimer labeled with technetium-99m. SCA3/MJD patients showed reduced brain perfusion in the cerebellum, temporal, limbic, and occipital lobes compared to control subjects (pFDR

An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

O Mini-Exame do Estado Mental (MEM) foi aplicado em 530 indivíduos, classificados segundo suas idades e escolaridades, para avaliarmos o desempenho dessa população de nosso meio. Constatou-se que, para essa amostra, a idade não interferiu nos escores alcançados. Entretanto, ao comparar quatro níveis de escolaridade (analfabetos, baixa, média e alta) obtivemos diferença estatística significante (p 8 years), was a significant predictor of performance (p < 0.0001). Nevertheless, the total scores were not significantly different among the age-groups, young (< or = 50 years), middle age 51 to 64 years) and elderly (> or = 65 years). The reference cut-off values were taken from the fifth percent lowest score for each group: illiterate, 13; elementary and middle, 18; and high, 26. When compared to 94 pacients with cognitive impairment, our cut-off values achieved high sensitivity (82.4% for illiterates; 75.6% for elementary and middle; 80% for high) and specificity (97.5% for illiterate; 96.6% for elementary and middle; 95.6% for high educational level). Education-specific reference values for the MMSE are necessary in interpreting individual test results in populations of low educational level, in order to reduce the false positive results.

Background Weight loss in patients with Alzheimer's disease (AD) is a common clinical manifestation that may have clinical significance. Objectives To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD. Methods A randomized, prospective 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups: Control Group (CG) [n = 27], Education Group (EG) [n = 25], which participated in an education program and Supplementation Group (SG) [n = 26], which received two daily servings of oral nutritional supplementation. Subjects were assessed for anthropometric data (weight, height, BMI, TSF, AC and AMC), biochemical data (total protein, albumin, and total lymphocyte count), CDR (Clinical Dementia Rating), MMSE (Mini-mental state examination), as well as dependence during meals. Results The SG showed a significant improvement in the following anthropometric measurements: weight (H calc = 22.12, p =< 0.001), BMI (H calc = 22.12, p =< 0.001), AC (H calc = 12.99, p =< 0.002), and AMC (H calc = 8.67, p =< 0.013) compared to the CG and EG. BMI of the EG was significantly greater compared to the CG. There were significant changes in total protein (H calc = 6.17, p =< 0.046), and total lymphocyte count in the SG compared to the other groups (H cal = 7.94, p = 0.019). Conclusion Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status.

OBJETIVO: Identificar as manifestações práxicas de pacientes com doença de Alzheimer em diferentes estágios da doença e verificar as similaridades entre as suas ocorrências. MÉTODOS: Foram avaliados noventa pacientes com doença de Alzheimer, 30 em cada fase da doença (leve, moderada e grave), por meio dos instrumentos: Escala de Avaliação Clínica da Demência (CDR), Mini-Exame do Estado Mental (MEEM), Avaliação das Atividades Instrumentais de Vida Diária (Índice Lawton) e Protocolo de Avaliação da Apraxia Verbal e Não-verbal. Foram avaliados 66 pacientes do gênero feminino e 24 do masculino, a média da idade foi 80,2±7,2 e da escolaridade foi 4,2±3,5 anos. RESULTADOS: Na fase leve, as proporções de ensaio, repetição e adição foram semelhantes, assim como omissão, substituição e autocorreção. Na fase moderada foram semelhantes: ensaio e repetição, substituição, omissão e adição, e autocorreção. Na fase grave, todas as manifestações se assemelharam, exceto a adição. O erro do tipo adição diferenciou os pacientes em relação às fases da doença. CONCLUSÃO: Os pacientes dos três estágios da doença apresentam diferentes padrões de manifestações práxicas verbais. PURPOSE: To identify praxic speech manifestations in patients diagnosed with different stages of Alzheimer's disease, and to verify similarities among their occurrences. METHODS: Participants were 90 patients with Alzheimer's, 30 in each stage of the disease (mild, moderate and severe), who were assessed using the following instruments: Clinical Dementia Rating (CDR), Mini-Mental State Examination (MMSE), Lawton Instrumental Activities of Daily Living, and the Assessment Protocol of Verbal and Orofacial Apraxia. Sixty six female subjects and 24 male subjects were assessed; mean age was 80.2±7.2 years, and mean level of education was 4.2±3.5 years. RESULTS: In the mild stage, the proportions of trial-and-error, repetition and addition were similar, as well as omission, substitution and self-correction. In the moderate stage, the following items were similar: trial-and-error and repetition, substitution, omission and addition, and self-correction. In the severe stage, all manifestations were similar, except addition. The error type addition differentiated the patients regarding the stages of the disease. CONCLUSION: Patients in the three stages of Alzheimer's disease showed distinct patterns of verbal praxic manifestations.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Associação Fundo de Incentivo à Pesquisa (AFIP) Novartis Janssen OBJETIVO: Explorar as possíveis diferenças nas avaliações subjetivas dos estímulos emocionais do International Affective Picture System entre idosos e jovens. MÉTODO: 187 indivíduos idosos avaliaram as imagens do International Affective Picture System de acordo com o Manual de Aplicação do Teste. Os escores obtidos pelos idosos foram então comparados com os escores obtidos da normatização do International Affective Picture System para jovens. RESULTADOS: Há diferença nos níveis de alerta e valência afetiva entre idosos e jovens. Há uma forte e negativa correlação entre valência afetiva e nível de alerta na amostra estudada. As frequências esperadas versus observadas das imagens do International Affective Picture System entre idosos e jovens mostram diferenças estatísticas. CONCLUSÃO: Este estudo mostra uma diferença interetária na avaliação de imagens do International Affective Picture System. OBJECTIVE: To explore the possible differences in subjective analysis of the emotional stimuli from the International Affective Picture System between elderly and young samples. METHOD: 187 elderly subjects ranked the International Affective Picture System images according to the directions from the Manual of Affective Ratings. Their scores were compared to those obtained from International Affective Picture System studies with young people. RESULT: There is an age-related difference in arousal and valence in the International Affective Picture System rating. The correlation between affective valence and arousal is strong, and negative for the elderly. The expected versus the observed frequency of International Affective Picture System images between elderly and young samples show a statistical difference. CONCLUSION: This study shows an inter-age statistical dichotomy in how elderly and young people subjectively evaluate International Affective Picture System images. Associação Portuguesa de Beneficência de São Paulo Geriatric Medicine Nucleus Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Neurology Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Psychobiology UNIFESP, EPM, Department of Neurology UNIFESP, EPM, Department of Psychobiology SciELO

Illiterates represent a significant proportion of the world's population. Written language not only plays a role in mediating cognition, but also extends our knowledge of the world. Two major reasons for illiteracy can be distinguished, social (e.g., absence of schools), and personal (e.g., learning difficulties). Without written language, our knowledge of the external world is partially limited by immediate sensory information and concrete environmental conditions. Literacy is significantly associated with virtually all neuropsychological measures, even though the correlation between education and neuropsychological test scores depends on the specific test. The impact of literacy is reflected in different spheres of cognitive functioning. Learning to read reinforces and modifies certain fundamental abilities, such as verbal and visual memory, phonological awareness, and visuospatial and visuomotor skills. Functional imaging studies are now demonstrating that literacy and education influence the pathways used by the brain for problem-solving. The existence of partially specific neuronal networks as a probable consequence of the literacy level supports the hypothesis that education impacts not only the individual's day-to-day strategies, but also the brain networks. A review of the issues related to dementia in illiterates is presented, emphasizing that the association between the education level and age-related cognitive changes and education remains controversial. The analysis of the impact of illiteracy on neuropsychological test performance represents a crucial approach to understanding human cognition and its brain organization under normal and abnormal conditions.

Background: Alzheimer's disease (AD) is characterized by memory loss and cognitive impairment. Phonological, syntactic, semantic and discursive aspects of language may also be affected. Analysis of micro- and macrolinguistic abilities of discourse may assist in diagnosing AD. The aim of this study was to identify changes in the discourse (lexical errors and syntactic index) of AD patients.Methods: 121 elderly subjects narrated a story based on a seven-figure picture description.Results: Patients with AD presented more word-finding difficulties, revisions and repetitions, and the syntactic index was lower than controls.Conclusion: Performance in microlinguistics at the lexical and syntactic levels was lower than expected in participants with AD.

An inflammatory process has been involved in numerous neurodegenerative disorders such as Parkinson’s disease, stroke and Alzheimer’s disease (AD). In AD, the inflammatory response is mainly located in the vicinity of amyloid plaques. Cytokines, such as interleukin-8 (IL-8) and interleukin-1α (IL-1α), have been clearly involved in this inflammatory process. Polymorphisms of several interleukin genes have been correlated to the risk of developing AD. The present study investigated the association of AD with polymorphisms IL-8 -251T > A (rs4073) and IL-1α-889C > T (rs1800587) and the interactive effect of both, adjusted by the Apolipoprotein E genotype. 199 blood samples from patients with AD, 146 healthy elderly controls and 95 healthy young controls were obtained. DNA samples were isolated from blood cells, and the PCR-RFLP method was used for genotyping. The genotype distributions of polymorphisms IL-8, IL-1α and APOE were as expected under Hardy-Weinberg equilibrium. The allele frequencies did not differ significantly among the three groups tested. As expected, the APOE4 allele was strongly associated with AD (p < 0.001). No association of AD with either the IL-1α or the IL-8 polymorphism was observed, nor was any interactive effect between both polymorphisms. These results confirm previous studies in other populations, in which polymorphisms IL-8 -251T > A and IL-1α-889C > T were not found to be risk factors for AD.

Tardive dyskinesia (TD), a serious complications of neuroleptic chronic use, has no effective therapy yet. We performed an experiment to study the action on TD, of the calcium channel blockers (CCB) drugs, verapamil and flunarizine. We obtained the TD model in rats, administering haloperidol for a 21-day period. After this, the stereotyped movement induced by apomorphyne was rated. The CCB drugs were administered in acute (in the 28th. day) and chronic (for 8 days, after the 25th day) experiments. Acutely, verapamil increased the stereotyped behaviour, and promoted a reduction of it in the chronic experiment. The results suggest that CCB drugs should be tested in clinical trials of TD. A discinesia tardia (DT) é complicação decorrente do uso prolongado de neuro-lépticos. Até o presente, nenhum tratamento provou ser eficaz na DT. Evidências indiretas apontam para a ação de drogas bloqueadoras de canais de cálcio (BCC) em algumas vias neurais. A ação de duas dessas drogas, verapamil e flunarizina, foi testada em modelo experimental de DT em rato, neste estudo. O haloperidol foi administrado por 21 dias e indução de movimentos estereotipados era obtida no 24º dia, com a injeção de apomorfina. As drogas BCC foram administradas por uma vez no 28º dia (experimento agudo) e por 8 dias, após o 25º dia (experimento crônico). A flunarizina não induziu modificação no padrão de estereotipia dos animais, mas o verapamil levou a aumento no experimento agudo e a diminuição no experimento crônico. Estes achados indicam que as drogas BCC podem ter alguma ação sobre a DT e que ensaios clínicos devem ser feitos para se comprovar se tal ação ocorre no homem.

TEMA: os déficits de comunicação na doença de Alzheimer (DA) interferem na qualidade de vida do demenciado e do cuidador, mas podem ser amenizados por estratégias comunicativas. OBJETIVO: verificar a eficácia de um programa de orientação sobre estratégias comunicativas a cuidadores de idosos com DA moderada. MÉTODO: verificaram-se o uso e a eficácia de estratégias comunicativas, antes e depois de treinamento em grupo destas, mediante análise de questionários e interações filmadas entre cuidadores e demenciados. O programa foi aplicado a sete cuidadoras. RESULTADOS: depois do programa, verificaram-se: aumento estatisticamente significante na freqüência de uso das estratégias, segundo relato das cuidadoras e observação de examinadoras; ausência de diferenças estatisticamente significantes na eficácia destas estratégias, segundo relato das cuidadoras e observação de examinadoras; ausência de mudanças na correlação entre uso e eficácia, e relato de outras mudanças relacionadas à comunicação. CONCLUSÃO: houve eficácia do programa, uma vez que se verificaram mudanças no comportamento comunicativo dos cuidadores. BACKGROUND: the communication decline in Alzheimer's disease (AD) may have a significant impact on the quality of life of demented elderly and their caregivers. This can be subsided by the use of communicative strategies. AIM: to evaluate the effectiveness of a communication strategies training program for caregivers of patients with moderate AD. METHOD: this study identified the use and effectiveness of communication strategies used by caregivers, prior to and after training. This was done through the analyses of a questionnaire and the videotaped interactions between caregivers and patients. The program was used with seven caregivers. RESULTS: after the program the following was observed: significant statistical increase in the use of the proposed strategies, according to the reports made by the caregivers and to the observations made by the examiners; absence of statistical difference in the effectiveness of these strategies, also according to the reports made by the caregivers and to the observations made by the examiners; absence of changes in the correlation between use and effectiveness, and report of other changes related to communication. CONCLUSION: the training program was effective in changing the communicative behavior of caregivers.

Objectives – A highly adaptive aspect of human memory is the enhancement of explicit, consciously accessible memory by emotional stimuli. We studied the performance of Alzheimer’s disease (AD) patients and elderly controls using a memory battery with emotional content, and we correlated these results with the amygdala and hippocampus volume. Methods – Twenty controls and 20 early AD patients were subjected to the International Affective Picture System (IAPS) and to magnetic resonance imaging-based volumetric measurements of the medial temporal lobe structures. Results – The results show that excluding control group subjects with 5 or more years of schooling, both groups showed improvement with pleasant or unpleasant figures for the IAPS in an immediate free recall test. Likewise, in a delayed free recall test, both the controls and the AD group showed improvement for pleasant pictures, when education factor was not controlled. The AD group showed improvement in the immediate and delayed free recall test proportional to the medial temporal lobe structures, with no significant clinical correlation between affective valence and amygdala volume. Conclusion – AD patients can correctly identify emotions, at least at this early stage, but this does not improve their memory performance.

INTRODUÇÃO: A literatura científica indica a possibilidade de a percepção da emoção e a formação da memória emocional serem discordantes entre jovens e idosos. A mesma é pobre ao explorar essa possibilidade. Neste estudo, relatamos os resultados obtidos em um experimento-piloto com uma amostra de idosos brasileiros, que classificaram subjetivamente, através da escala Self Assessment Manikin, imagens oriundas do International Affective Picture System. MÉTODO: Quarenta e oito idosos voluntários da Universidade Aberta da Terceira Idade, saudáveis clínica e cognitivamente, avaliaram o caráter alertante e a valência afetiva de 71 imagens do International Affective Picture System, aleatoriamente escolhidas. RESULTADOS: O grau de alerta reportado por idosos diante de um estímulo emocional é tanto maior quanto menor o prazer provocado por essa imagem-estímulo, resultando na existência de uma forte correlação negativa (r = 0,93) entre o grau de alerta e o estímulo desprazeroso. Em uma comparação do acima obtido com outro experimento normativo semelhante feito com jovens brasileiros e americanos, apontou-se para uma possível diferença cultural na forma de relatar subjetivamente um estímulo emocional. CONCLUSÕES: Os resultados obtidos com esta amostra estudada sugerem que pode existir uma diferença nos relatos afetivos entre os jovens e idosos, onde uma normatização do International Affective Picture System para uma amostra maior, representativa da população de idosos, seria útil para responder esta questão.

their memory loss and it is often necessary to count with information by caregivers. An instrument to assess memory complaints by interviewing both patient and caregiver could be useful to point out early problems. The Memory Complaints Questionnaire (MCQ) has been developed in the Behavioral Neurology Group of Clinics Hospital of the Ribeira o Preto Faculty of Medicine, University of Sa o Paulo. MCQ consists of seven questions about memory problems, each of them with three alternatives, scored 0, 1 or 2. The objetive of this study was to verify whether MCQ is useful to discriminate AD patients from healthy elderly people. M thods: Two groups were studied: 31 Alzheimer’s patients (AD) and 31 healthy people named controls (C). They were paired by gender: 21 women (67.7%); by mean age: AD 72.77 1.42 y, C 72.74 1.45 y [ t(60) 0.016, p(2tailed) 0.987]; and by mean education: AD 2.32 0.55 y, C 2.35 0.57 y [t(60) 0.041, p(2-tailed) 0.967]. They were assessed through Mini-Mental State Examination (MMSE), digit span task, word list (immediate and late recall, recognizing), verbal fluency test and MCQ. In AD group, the MCQ was applied to both patients (responding about themselves) and caregivers (responding about patients). One looked for differences between the groups. Results: There were significant differences between groups in reference to MMSE scores [ t(49) 4.327, p(2-tailed) 0.001]; digit span inverse [t(56) 3.490, p(2-tailed) 0.001]; word list immediate recall [ t (56) 7.119, p(2-tailed) 0.001], late recall [ t(55) 5.473, p(2-tailed) 0.001] and recognizing [t(42) 4.124, p(2-tailed) 0.001]; verbal fluency semantic (animals) [t(55) 3.056, p(2-tailed) 0.004] and fonemic (”A” words) [ t(43) 3.026, p(2-tailed 0.004]. Concerning to MCQ, there was no significant difference between AD (patients responding) and C groups [ t(60) 0.646, p(2tailed) 0.521] however there was significant difference between the AD (caregivers responding) [ t(58) 6.278, p(2-tailed) 0.001] and C groups (t(58) 5.392, p(2-tailed) 0.001]; also, there was significant difference ingroup between responses by patients and by caregivers [t(58) -6,278, p(2tailed) 0.001]. Conclusions: Alzheimer s patients are not aware of their memory deficits and do not present subjective complaints. MCQ seems to be a suitable to assess memory complaints in AD patients since it also counts with surrogate informants.

Longevity related genes were investigated concerning promoter methylation. SIRT3, SMARCA5, HTERT and CDH1 promoters were analyzed in peripheral blood in relation to gender, age and Alzheimer's disease (AD). Methylation Specific PCR assay (MSP) was used. There were no significant differences in methylation frequencies of SIRT3, SMARCA5 and CDH1 among young, elderly and AD groups (p> 0.05), showing no association with aging or AD. On the other hand, HTERT methylation frequency was associated with the aging process, in that AD patients differed from elderly controls (p=0.0086), probably due to telomere and immune dysfunctions involved in AD pathogenesis.

the communication decline in Alzheimer's disease (AD) may have a significant impact on the quality of life of demented elderly and their caregivers. This can be subsided by the use of communicative strategies.to evaluate the effectiveness of a communication strategies training program for caregivers of patients with moderate AD.this study identified the use and effectiveness of communication strategies used by caregivers, prior to and after training. This was done through the analyses of a questionnaire and the videotaped interactions between caregivers and patients. The program was used with seven caregivers.after the program the following was observed: significant statistical increase in the use of the proposed strategies, according to the reports made by the caregivers and to the observations made by the examiners; absence of statistical difference in the effectiveness of these strategies, also according to the reports made by the caregivers and to the observations made by the examiners; absence of changes in the correlation between use and effectiveness, and report of other changes related to communication.the training program was effective in changing the communicative behavior of caregivers.

Uma mulher de 45 anos apresentou quadro de perda da iniciativa, dificuldade de memória, choro imotivado e distúrbio de comportamento, rapidamente progressivos ao longo de 6 meses, quando tornou-se não responsiva a estímulos verbais e totalmente apática. Um EEG mostrou atividade periódica bilateral, sugerindo doença de Creutzfeldt-Jacob (DCJ), mas a investigação para outras causas de demência mostrou hypercalcemia e hipofoefatemia que, exames posteriores, indicaram dever-se a adenoma de células oxífilas de paratireóide. Com a correção do distúrbio eletrolítico e posterior cirurgia houve normalização tanto do EEG como do exame neurológico. Não temos conhecimento de outros relatos de hiperparatireoidismo associado a síndrome demencial e atividade periodica no EEG. Este deveria ser am diagnóstico diferencial em todos os casos de DCJ recente. A 45 years-old woman presented with loss of iniciative and memory, imotivated ciy and behaviour disturbance with childish traits, quickly progressive along 6 months until total apathy. An EEG showed periodic activity with bilateral triphasic waves against a flattened background activity suggesting Creutzfeldt-Jacob disease (CJD), but investigation for treatable causes of dementia disclosed hypercalcemia and hypophosphatemia. Further investigation showed a mass at the thyroid region that at surgery was identified as an oxyphilic ceils adenoma. With electrolyte disturbance correction and posterior surgery there was normalization of both EEG and clinical status. Though it was previously reported mental confusion and EEG alteration associated with hyperparathyroidism we do not know of any previous case o>: confusion associated with periodic activity in EEG as in this disease. Hyperparathyroidism should be a differential diagnosis in every «de novo» case of CJD. Escola Paulista de Medicina UNIFESP, EPM SciELO