Resumo A Neuropsicologia se concentra em disciplinas oriundas da interface entre a neurociência e a psicologia cognitiva, e sua pesquisa converge da relação entre o cérebro e o comportamento. Como se ...tem observado em diversos centros de referência no Brasil, a difusão da Neuropsicologia vem ocorrendo de maneira vertiginosa, embora o estabelecimento de diretrizes de educação e treinamento ainda se encontrem despadronizados. O presente artigo descreve o desenvolvimento histórico da Neuropsicologia, enfocando seus fundamentos teóricos e metodológicos, sua condição regulatória atual, além de perspectivas futuras na criação de diretrizes para capacitação profissional. Pesquisas vêm demonstrando uma tendência em caracterizar a atividade do neuropsicólogo nos mais diversos locais nos quais a neuropsicologia é ensinada, praticada e difundida. No Brasil, faz-se necessária uma taxonomia acerca do ofício do profissional especialista em neuropsicologia, seja em relação à sua formação ou sua atuação profissional.
Abstract Neuropsychology focuses on disciplines arising from the interface between neuroscience and cognitive psychology, and its research converges on the relationship between the brain and behavior. As has been observed in several reference centers in Brazil, the spread of Neuropsychology has been occurring in a dizzying way, although the establishment of education and training guidelines are still out of standard. This article describes the historical development of Neuropsychology, focusing on its theoretical and methodological foundations, its current regulatory condition, as well as future perspectives in the creation of guidelines for professional training. Studies have shown a tendency to characterize the activity of the neuropsychologist in the most diverse fields in which it is taught, practiced, and diffused. In Brazil, it is necessary a taxonomy about the profession of the specialist in neuropsychology, whether in relation to his training or his professional performance.
Swallowing in behavioral variant frontotemporal dementia MARIN, Sheilla de Medeiros Correia; MANSUR, Letícia Lessa; OLIVEIRA, Fabricio Ferreira de ...
Arquivos de Neuro-Psiquiatria,
01/2021, Volume:
79, Issue:
1
Journal Article
Peer reviewed
Open access
ABSTRACT
Background:
Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases ...of swallowing.
Objective:
To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features.
Methods:
Consecutive outpatients with bvFTD in mild, moderate and severe dementia stages were recruited along with their caregivers. Patients and caregivers were screened with the following scales: “Mini-Mental State Examination”, “Severe Mini-Mental State Examination”, “FTLD-modified Clinical Dementia Rating”, “Neuropsychiatric Inventory”, “Frontal Assessment Battery”, “Index of Independence in Activities of Daily Living”, “Swallowing Rating Scale” and “Assessment of Feeding and Swallowing Difficulties in Dementia”.
Results:
Overall, thirty patients with bvFTD were included along with their caregivers. Patients with bvFTD showed feeding and swallowing difficulties such as: messy to eat, passivity, coughing and choking, difficulty with some food consistencies and with specific food. Swallowing problems in bvFTD correlated with impaired functionality (p<0.05) and cognition (p<0.05), executive dysfunction (p<0.01) and behavioral features (p<0.01). Caregivers had great difficulty in managing the feeding situation during mealtime, with different characteristics in each dementia stage.
Conclusion:
Patients with bvFTD had inappropriate speed eating, passivity, coughing and choking starting in the mild dementia stage, and these problems worsen in the severe stage. Such difficulties affected caregiver performance during mealtime. The correlations indicated that swallowing difficulties tend to follow cognitive and behavioral decline in patients with bvFTD.
This study is aimed to evaluating the underlying cognitive strategies used during Semantic Verbal Fluency (SVF) performance and comparing the differences between cognitively healthy controls (CHC), ...amnestic and amnestic-multiple domain mild cognitive impairment (a-MCI and a-md-MCI), Alzheimer's disease (AD), Lewy body dementia (LBD), and behavioral variant frontotemporal dementia (bvFTD). The cross-sectional study comprised 236 participants involving 78 CHC individuals, 33 a-MCI and 48 a-md-MCI, 39 AD, 22 LBD, and 16 bvFTD patients. Scores differed significantly when comparing CHC with dementia groups, showing medium to large variances. The best components in distinguishing between CHC and the dementia groups were the SVF-Total score and SVF-Cluster Size variables. CHC showed different performance in the SVF-Cluster Size variable compared with a-md-MCI, AD, and bvFTD; whereas, in the SVF-Mean Cluster Size, CHC differed from MCI's, AD, and LBD. The switching component displayed smaller capacity to differentiate between the clinical groups. The effect size was large comparing AD with bvFTD (1.267) and medium comparing AD with LBD (0.689) using the SVF-Cluster Size variable, but small using the other variables for the comparisons between dementia groups. Quanti-qualitative examination of the SVF may provide a valuable clue in distinguishing CHC from MCI and different dementia subtypes.
Cognitive assessment in advanced stages of Alzheimer's disease (AD) is limited by the imprecision of most instruments.
To determine objective cognitive responses in moderate and severe AD patients by ...way of the Severe Mini-Mental State Examination (SMMSE), and to correlate performances with Mini-Mental State Examination (MMSE) scores.
Consecutive outpatients in moderate and severe stages of AD (Clinical Dementia Rating 2.0 or 3.0) were evaluated and compared according to MMSE and SMMSE scores.
Overall 400 patients were included, 67.5% females, mean age 76.6±6.7 years-old. There was no significant impact of age or gender over MMSE or SMMSE scores. Mean schooling was 4.4±2.5 years, impacting SMMSE scores (p=0.008). Scores on MMSE and SMMSE were significantly correlated (F-ratio=690.6325, p<0.0001).
The SMMSE is influenced by schooling, but not by age or gender, and is an accurate test for assessment of moderate and severe AD.
La enfermedad de Parkinson (EP) es una afección crónico-degenerativa asociada con la pérdida de inervación dopaminérgica en el cuerpo estriado. La intervención neuroquirúrgica funcional en la EP ...tiene como objetivo, principalmente, restaurar las funciones neurológicas y promover la calidad de vida. La terapia de Estimulación Cerebral Profunda (ECP) consiste fundamentalmente en la implantación de electrodos en dianas cerebrales específicas y predeterminadas, especialmente en el Núcleo Subtalámico (STN) y en el Globo Pálido interno (GPi). Usando un dispositivo telemétrico con un programa de software específico es posible seleccionar qué zonas de contacto estarán activas además de la configuración de una variedad de parámetros eléctricos, con el fin de minimizar los síntomas motores y no motores. Además los aspectos neuropsicológicos, una lista de conceptos básicos como criterios de elección para ECP; posibles complicaciones quirúrgicas; configuración del dispositivo; multidisciplinariedad; terapias combinadas; aspectos éticos y desafíos futuros se abordarán de manera sucinta en este breve artículo teórico de revisión. Palabras Clave: Enfermedad de Parkinson; Estimulación Cerebral Profunda; Neuropsicologia; Multidisciplinariedad; Ética. Parkinson's disease (PD) is a chronic-degenerative condition associated with the loss of dopaminergic innervation in the striatum. The functional neurosurgical intervention in PD aims, primarily, to restore neurological functions, promoting quality of life. Deep Brain Stimulation (DBS) therapy, in essence, consists of implanting electrodes in specific and predetermined brain targets, mainly in the Subthalamic Nucleus (STN) and the Globus Pallidus interna (GPi). Using a telemetric device with a specific software program, it is possible to select which zones of contact will be active, in addition to the configuration of a variety of electrical parameters, so as to minimize motor and non-motor symptoms. Neuropsychological aspects and a list of basic concepts such as election criteria for DBS; possible surgical complications; device settings; multidisciplinarity; combined therapies; ethical aspects, and future challenges will be succinctly addressed in this theoretical rapid-review article. Keywords: Keywords: working memory--training--children--academic achievement. A doença de Parkinson (DP) é uma condição crônico-degenerativa associada à perda da inervação dopaminérgica no corpo estriado. A intervenção neurocirúrgica funcional na DP objetiva, principalmente, restaurar as funções neurológicas e promover qualidade de vida. A terapia de Estimulação Cerebral Profunda (ECP) consiste, fundamentalmente, no implante de eletrodos em alvos cerebrais específicos e pré-determinados, especialmente no Núcleo Subtalâmico (STN) e no Globo Pálido interno (GPi). Utilizando um dispositivo telemétrico com programa de software específico é possível selecionar quais zonas de contato estarão ativas, além da configuração de diversos parâmetros elétricos, de forma a minimizar sintomas motores e não motores. Aspectos neuropsicológicos e uma lista de conceitos básicos como critérios eletivos para ECP; possíveis complicações cirúrgicas; configurações do dispositivo; multidisciplinaridade; terapias combinadas; aspectos éticos e desafios futuros serão abordados de forma sucinta neste breve artigo teórico de revisão. Palavras-chave: Doença de Parkinson; Estimulação Cerebral Profunda; Neuropsicologia; Multidisciplinaridade; Ética.
Neuropsychology focuses on disciplines arising from the interface between neuroscience and cognitive psychology, and its research converges on the relationship between the brain and behavior. As has ...been observed in several reference centers in Brazil, the spread of Neuropsychology has been occurring in a dizzying way, although the establishment of education and training guidelines are still out of standard. This article describes the historical development of Neuropsychology, focusing on its theoretical and methodological foundations, its current regulatory condition, as well as future perspectives in the creation of guidelines for professional training. Studies have shown a tendency to characterize the activity of the neuropsychologist in the most diverse fields in which it is taught, practiced, and diffused. In Brazil, it is necessary a taxonomy about the profession of the specialist in neuropsychology, whether in relation to his training or his professional performance.
Neuropsychology focuses on disciplines arising from the interface between neuroscience and cognitive psychology, and its research converges on the relationship between the brain and behavior. As has ...been observed in several reference centers in Brazil, the spread of Neuropsychology has been occurring in a dizzying way, although the establishment of education and training guidelines are still out of standard. This article describes the historical development of Neuropsychology, focusing on its theoretical and methodological foundations, its current regulatory condition, as well as future perspectives in the creation of guidelines for professional training. Studies have shown a tendency to characterize the activity of the neuropsychologist in the most diverse fields in which it is taught, practiced, and diffused. In Brazil, it is necessary a taxonomy about the profession of the specialist in neuropsychology, whether in relation to his training or his professional performance. KEYWORDS: neuropsychology, history of psychology, professional education A Neuropsicologia se concentra em disciplinas oriundas da interface entre a neurociencia e a psicologia cognitiva, e sua pesquisa converge da relacao entre o cerebro e o comportamento. Como se tem observado em diversos centros de referencia no Brasil, a difusao da Neuropsicologia vem ocorrendo de maneira vertiginosa, embora o estabelecimento de diretrizes de educacao e treinamento ainda se encontrem despadronizados. O presente artigo descreve o desenvolvimento historico da Neuropsicologia, enfocando seus fundamentos teoricos e metodologicos, sua condicao regulatoria atual, alem de perspectivas futuras na criacao de diretrizes para capacitacao profissional. Pesquisas vem demonstrando uma tendencia em caracterizar a atividade do neuropsicologo nos mais diversos locais nos quais a neuropsicologia e ensinada, praticada e difundida. No Brasil, faz-se necessaria uma taxonomia acerca do oficio do profissional especialista em neuropsicologia, seja em relacao a sua formacao ou sua atuacao profissional. PALAVRAS-CHAVE: neuropsicologia, historia da psicologia, formacao profissional
Abstract Objective: to verify if the prevalence of dementia differs between widowed and non-widowed elderly persons and between genders, and to analyse if there is an association with ...sociodemographic and clinical characteristics. Method: a retrospective cross-sectional observational study of patients treated at a Behavioral Neurology outpatient clinic from 1999 to 2009 was carried out, employing anamnesis, physical and neurological examination, the Clinical Dementia Rating Scale (CDR) and the Mini Mental State Examination (MMSE). Sociodemographic (schooling and age) and clinical (age of onset of symptoms and time since onset of symptoms, MMSE and CDR) variables were analyzed. The differences were evaluated by the Mann Whitney test, using a significance value of p<0.05. Results: of 208 patients diagnosed with dementia, 73 (35.1%) were widowed and 135 (64.9%) were non-widowed. Those who were widowed were older than those who were non-widowed (p<0.001) when diagnosed with dementia. This difference in age remained when gender (p<0.001), widowed and widowed women (p<0.001) and widowed and non-widowed men (p<0.001) were compared. The time from onset of symptoms to diagnosis was greater in widowed than in non-widowed men 55.6 (± 86.3) vs. 43.4 (± 44.8) months, although the difference was not statistically significant. Widowed patients with dementia had lower schooling, regardless of gender (p<0.05). Conclusion: the prevalence of dementia differed between widowed and non-widowed individuals, being higher among non-widows. There was an association between widowhood and the clinical and sociodemographic characteristics, with differences between the genders. The loss of a spouse can generate different outcomes among men and women, necessitating measures with a specific focus on prevention and strategies of care in dementia.
Resumo Objetivo: Verificar se a prevalência de demência difere entre viúvos e não viúvos, e analisar se há associação com características sociodemográficas e clínicas, bem como diferenças entre os sexos. Método: Estudo observacional transversal retrospectivo que analisou prontuários de pacientes atendidos em um ambulatório de Neurologia do Comportamento de 1999 a 2009 através de anamnese, exame físico e neurológico, Clinical Dementia Rating Scale (CDR) e Miniexame do Estado Mental (MEEM). Avaliou-se variáveis sociodemográficas (escolaridade e idade) e clínicas (idade e tempo do início dos sintomas, MEEM e CDR). As diferenças foram avaliadas pelo teste de Mann Whitney, admitindo-se p<0,05. Resultados: Dos 208 pacientes com diagnóstico de demência, 73 (35,1%) eram viúvos e 135 (64,9%) não viúvos. Os viúvos eram mais velhos que os não viúvos (p<0,001) quando foram diagnosticados com demência. Essa diferença na idade manteve-se comparando os sexos (p<0,001), mulheres viúvas e não viúvas (p<0,001) e homens viúvos e não viúvos (p<0,001). O tempo do início dos sintomas até o diagnóstico foi maior em homens viúvos quando comparado aos não viúvos 55,6 (±86,3) vs 43,4 (±44,8) meses mas sem significância estatística. Os viúvos com demência tinham menor escolaridade, independente do sexo (p<0,05). Conclusão: A prevalência de demência diferiu entre viúvos e não viúvos, sendo maior nos não viúvos. Houve associação da viuvez com características clínicas e sociodemográficas com diferença entre os sexos. A perda do cônjuge pode gerar diferentes desfechos entre homens e mulheres, necessitando de medidas com enfoque específico na prevenção e estratégias de cuidado na demência.
La enfermedad de Parkinson (EP) es una afección crónico-degenerativa asociada con la pérdida de inervación dopaminérgica en el cuerpo estriado. La intervención neuroquirúrgica funcional en la EP ...tiene como objetivo, principalmente, restaurar las funciones neurológicas y promover la calidad de vida. La terapia de Estimulación Cerebral Profunda (ECP) consiste fundamentalmente en la implantación de electrodos en dianas cerebrales específicas y predeterminadas, especialmente en el Núcleo Subtalámico (STN) y en el Globo Pálido interno (GPi). Usando un dispositivo telemétrico con un programa de software específico es posible seleccionar qué zonas de contacto estarán activas además de la configuración de una variedad de parámetros eléctricos, con el fin de minimizar los síntomas motores y no motores. Además los aspectos neuropsicológicos, una lista de conceptos básicos como criterios de elección para ECP; posibles complicaciones quirúrgicas; configuración del dispositivo; multidisciplinariedad; terapias combinadas; aspectos éticos y desafíos futuros se abordarán de manera sucinta en este breve artículo teórico de revisión. Palabras Clave: Enfermedad de Parkinson; Estimulación Cerebral Profunda; Neuropsicologia; Multidisciplinariedad; Ética. Parkinson's disease (PD) is a chronic-degenerative condition associated with the loss of dopaminergic innervation in the striatum. The functional neurosurgical intervention in PD aims, primarily, to restore neurological functions, promoting quality of life. Deep Brain Stimulation (DBS) therapy, in essence, consists of implanting electrodes in specific and predetermined brain targets, mainly in the Subthalamic Nucleus (STN) and the Globus Pallidus interna (GPi). Using a telemetric device with a specific software program, it is possible to select which zones of contact will be active, in addition to the configuration of a variety of electrical parameters, so as to minimize motor and non-motor symptoms. Neuropsychological aspects and a list of basic concepts such as election criteria for DBS; possible surgical complications; device settings; multidisciplinarity; combined therapies; ethical aspects, and future challenges will be succinctly addressed in this theoretical rapid-review article. Keywords: Keywords: working memory--training--children--academic achievement. A doença de Parkinson (DP) é uma condição crônico-degenerativa associada à perda da inervação dopaminérgica no corpo estriado. A intervenção neurocirúrgica funcional na DP objetiva, principalmente, restaurar as funções neurológicas e promover qualidade de vida. A terapia de Estimulação Cerebral Profunda (ECP) consiste, fundamentalmente, no implante de eletrodos em alvos cerebrais específicos e pré-determinados, especialmente no Núcleo Subtalâmico (STN) e no Globo Pálido interno (GPi). Utilizando um dispositivo telemétrico com programa de software específico é possível selecionar quais zonas de contato estarão ativas, além da configuração de diversos parâmetros elétricos, de forma a minimizar sintomas motores e não motores. Aspectos neuropsicológicos e uma lista de conceitos básicos como critérios eletivos para ECP; possíveis complicações cirúrgicas; configurações do dispositivo; multidisciplinaridade; terapias combinadas; aspectos éticos e desafios futuros serão abordados de forma sucinta neste breve artigo teórico de revisão. Palavras-chave: Doença de Parkinson; Estimulação Cerebral Profunda; Neuropsicologia; Multidisciplinaridade; Ética.
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