[show abstract][hide abstract] ABSTRACT: Vascular mild cognitive impairment (VaMCI) represents an early symptomatic stage of vascular cognitive impairment and might be associated to fronto-executive dysfunction. Methods Twenty-six individuals (age: 73.11±7.90 years; 65.4% female; schooling: 9.84±3.61 years) were selected through neuropsychological assessment and neuroimaging. Clinical and neuroimaging data of VaMCI individuals (n=15) were compared to normal controls (NC, n=11) and correlated with Fazekas scale. Results VaMCI performed significantly worse than NC in Trail-Making Test (TMT) B, errors in TMT B, difference TMT B-A and Cambridge Cognitive Examination (CAMCOG) final scores. Correlations were found among scores in modified Fazekas scale and performances in TMT B (time to complete and errors), difference TMT B-A and CAMCOG total score. Conclusion Extension of white matter hyperintensities might be correlated to poorer global cognition and impairments in a set of fronto-executive functions, such as cognitive speed, set shifting and inhibitory control in VaMCI.
Arquivos de neuro-psiquiatria 07/2013; 71(7). · 0.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Introduction: The Cambridge Cognitive Examination (CAMCOG)
is a brief tool for cognitive assessment. It is composed of subscales
that represent various cognitive domains (orientation, language,
memory, attention, praxis, perception, calculation and abstract
thinking). Appropriate total scores permit to define impairment in the
dementia level. However, such total scores do not always represent
the real performance of the subject as it is possible to obtain low scores
in certain domain(s) yet maintaining a total score in the normal
range. Objective: To obtain data of CAMCOG total and subscales
scores of normal elderly subjects with different educational levels.
The growing interest in defining pre-dementia stages is an important
reason of the present study. Methods: Community living normal elderly,
divided in three groups according to their education level were
assessed with CAMCOG. Statistic analysis was performed to compare
significance of the scores (total and subscales) among the groups.
Results: Total CAMCOG mean values increased with education, and
the same was observed in relation to the subscales scores. Conclusion:
CAMCOG subscales related to education levels are necessary
to identify subjects who present decreased values on one or more
cognitive domain despite total scores within normal range, which
may characterize a pre-dementia cognitive impairment state.
revista brasileira de neurologia. 02/2013; 49(1):32-36.
[show abstract][hide abstract] ABSTRACT: Alzheimer´s disease (AD) represents the most prevalent neurodegenerative disorder that causes cognitive decline in old age. In its early stages, AD is associated with microstructural abnormalities in white matter (WM). In the current study, multiple indices of diffusion tensor imaging (DTI) and brain volumetric measurements were employed to comprehensively investigate the landscape of AD pathology. The sample comprised 58 individuals including cognitively normal subjects (controls), amnestic mild cognitive impairment (MCI) and AD patients. Relative to controls, both MCI and AD subjects showed widespread changes of anisotropic fraction (FA) in the corpus callosum, cingulate and uncinate fasciculus. Mean diffusivity and radial changes were also observed in AD patients in comparison with controls. After controlling for the gray matter atrophy the number of regions of significantly lower FA in AD patients relative to controls was decreased; nonetheless, unique areas of microstructural damage remained, e.g., the corpus callosum and uncinate fasciculus. Despite sample size limitations, the current results suggest that a combination of secondary and primary degeneration occurrs in MCI and AD, although the secondary degeneration appears to have a more critical role during the stages of disease involving dementia.
PLoS ONE 12/2012; 7(12):e52859. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: Strategic regions correspond to associative, limbic and paralimbic structures and related circuits, that underpin cognitive/behavioral functions. Strokes in these eloquent sites produce pictures of vascular dementia with syndromic features due to specific site lesion and/or interruption of their interconnections. This study aims at analysing subcortical strategic strokes that express similar cognitive/behavioral elements, by sharing common pathways. Patients (n=6) who attended in specialized ambulatory, were submitted to neuropsychological and neuroimaging assessments through MRI (GE Signa Horizon 1.5T) and brain SPECT (Millennium MG, ECD [TC-99m]). Stroke locations and respective main symptoms were: 1. anteromedian thalamus [L]: anterograde and retrograde amnesia (ARA), expression aphasia (EA), executive dysfunction (ED), apathy, and depression; 2. anterior thalamus [R]: ARA, inattention, apathy, and aggressiveness; 3. dorsomedian thalamus [L]: inattention, ED, anosognosia, and aggressiveness; 4. central paramedian thalamus [R]: EA, visual perception deficits (VPD), ED, infantility, and personality disorder; 5. caudate nucleus (ventral-head) [L]: VPD, ED, delirium, visual hallucinations, and personality disorder; and 6. anterior capsule [L]: VPD, ED, apathy, and depression. Vascular strategic syndromes connote the predominantly impaired cognitive/behavioral symptom of each site. Temporal and frontal disconnection symptoms were produced by disrupted MTT/hippocampal and IML/amygdala circuits expressing amnesic syndrome associated with heterogeneous dysexecutive syndrome, in all the cases, by disrupting frontal-basal ganglia-thalamus-cortical net, in three different levels of their pathway.
Journal of the neurological sciences 08/2012; 322(1-2):176-83. · 2.32 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective: Non-amnestic dysexecutive Vascular Mild Cognitive Impairment (VaMCI) may represent preclinical Vascular Dementia (VaD). The aim of this study was to summarize the clinical, neuropsychological and neuroimaging aspects of VaMCI; and to assess its patterns of progression to dementia. Methods: Searches were made in the ISI Web of Knowledge, PubMed and Lilacs databases, using the terms "mild cognitive impairment" and "executive function". Altogether, 944 articles were retrieved. Results: VaMCI cases had poorer performances on fronto-executive tasks, a higher prevalence of stroke, presence of periventricular and profound white matter hyperintensities on MRI images, as well as more extrapyramidal signs and behavioral symptoms. Executive dysfunction might be associated with disconnection of fronto-parietal-subcortical circuits. Progression to dementia was associated with baseline deficits in executive function, in simple sustained attention and language, and large periventricular WMH. Discussion. VaMCI develops with impairment in non-memory domains and subcortical white matter changes on MRI images, which are consistent with clinical and neuroimaging findings in VaD. RESUMO: Objetivo: Comprometimento Cognitivo Leve Vascular (CCLV) não-amnésico disexecutivo pode representar a fase pré-clínica da Demência Vascular (DV). Este estudo tem por objetivo descrever os aspectos clínicos, cognitivos e de neuroimagem do CCLV, além de avaliar padrões de progressão para demência. Métodos: Foram realizadas buscas nas bases de dados ISI Web of Knowledge, PubMed e Lilacs, usando os termos "comprometimento cognitivo leve" e "função executiva". Ao todo, 944 artigos foram obtidos. Resultados: Pacientes com CCLV apresentaram piores desempenhos em tarefas fronto-executivas, histórico de acidentes vasculares encefálicos, presença de hiperintensidades da substância branca periventriculares e profundas, e mais, sinais extrapiramidais e sintomas comportamentais. A disfunção executiva parece se relacionar à desconexão de circuitos fronto-parieto-subcorticais. A progressão para demência relacionou-se a déficits em linguagem, função executiva e atenção sustentada à primeira avaliação, e a hiperintensidades na substância branca periventricular extensas. Discussão: O CCLV cursa com comprometimento cognitivo em domínios não-memória e alterações da substância branca subcortical à imagem por RM alinhadas com os achados característicos da DV. Palavras-chave: comprometimento cognitivo leve, demência vascular, função executiva, neuropsicologia, neuroimagem, doença cerebrovascular.
Dementia e Neuropsychologia 07/2012; 6(3):145-151.
[show abstract][hide abstract] ABSTRACT: Caring for a demented family member has been associated with burden. Studies concerning health self-perception of family caregivers are still scarce.
To investigate caregivers perceived health and to look into relationships with patients and caregivers' sociodemographic and clinical data.
Dyads of dementia outpatients and family caregivers (n=137) were assessed with Mini Mental State Examination, Functional Activities Questionnaire, Neuropsychiatric Inventory and Clinical Dementia Rating. Caregivers answered Sociodemographic Questionnaire, Beck Depression and Anxiety Inventories, Zarit Burden Interview and Maslach Burnout Inventory.
Caregivers poor perceived health was associated with emotional exhaustion, burden, depression and anxiety. Logistic regression analyses revealed caregivers' age, anxiety and physical problem as the main predictors of health self-perception.
Aged family caregivers with anxiety who also report physical problem characterize a group at risk for poor self-perceived health. Evaluation of health self-perception may be useful for designing interventions to improve anxiety and physical health.
Arquivos de neuro-psiquiatria 10/2011; 69(5):739-44. · 0.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Cerebrovascular disease (CVD) is associated with cognitive deficits. This cross-sectional study examines differences among healthy elderly controls and patients with vascular mild cognitive impairment (VaMCI) and vascular dementia (VaD) in performances on CAMCOG subscales.
Elderly individuals (n=61) were divided into 3 groups, according to cognitive and neuroimaging status: 16 controls, 20 VaMCI and 25 VaD. VaMCI and VaD individuals scored over 4 points on the Hachinski Ischemic Scale.
Significant differences in total CAMCOG scores were observed across the three groups (p<0.001). VaD subjects performed worse than those with VaMCI in most CAMCOG subscales (p<0.001). All subscales showed differences between controls and VaD (p<0.001). Performance on abstract thinking showed difference between VaMCI and controls (p<0.001).
CAMCOG discriminated controls from VaMCI and VaD. Assessment of abstract thinking may be useful as a screening item for diagnosis of VaMCI.
Arquivos de neuro-psiquiatria 04/2010; 68(2):179-84. · 0.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Vascular white matter lesions (WML) represent one of the main neuroimage findings in individuals older than 65 years and its clinical significance is still partially understood.
To describe and analyze the clinical profile of a high severity sample with WML focusing on the frontal executive control.
Outpatients (n=20) with high severity WML evaluated with magnetic resonance imaging were selected using the Fazekas scale.
Most patients (n=17; 85%) presented an altered Trail Making Test ratio (section B/section A); on verbal fluency, 15 individuals (75%) performed below the cutoff score. Apathy (5.9 +/- 4.65) and depression (3.05+/-3.67) were frequent as assessed by the Neuropsychiatric Inventory. The impairment in functional activities strongly correlated with apathy (r=0.814, p<0.001) and verbal fluency (r=0.744, p<0.001).
Executive dysfunction, apathy, and ratio depression were the main characteristics found. Extension of WML may have distinct impact on the clinical picture, but further studies with methodological adjustments are necessary to provide more definitive conclusions.
Arquivos de neuro-psiquiatria 06/2009; 67(2A):173-8. · 0.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: To study the integrity of the white matter in Binswanger's disease (BD) patients with quantitative fractional anisotropy (DTI-FA).
Controls (12) and patients with BD (12) were included. Scans performed with MR (GE Signa Horizon/1.5T). Fazekas's score=6 with white matter hyperintensities extension >75% assessed on FLAIR scans. Standard parameters for DTI-FA were used. ROIs placed in symmetrical regions on two axial planes, data pooled in anterior (frontal) and posterior (temporo-parieto-occipital) regions. Analysis with Functool. Statistics for anterior and posterior regions comparison.
DTI-FA showed reduction of anisotropy, reflecting axonal damage and demyelination of fibers, more prominent in anterior in relation to posterior region, in BD patients in comparison to controls.
Loss of integrity of fiber tracts reflects interruption of neural networks that subserve cognitive, behavioral, and motor integration. The more severely affected frontal region is related to executive dysfunction, a characteristic feature of Binswanger's disease.
Arquivos de neuro-psiquiatria 06/2009; 67(2A):179-84. · 0.55 Impact Factor
[show abstract][hide abstract] ABSTRACT: Subcortical Ischemic Vascular Disease (SIVD) is underdiagnosed. This review investigates the re- lationship among SIVD severity, cognitive status and neuroimaging markers. Methods: Cohort, cross-sectional and case control studies were searched on ISI, Medline, Scielo, PsychoInfo and LILACS databases published between 1995 and 2006. Results: The most impaired cognitive domains were executive, attentional and memory retrieval mechanisms. These cognitive features were frequently associated to White Matter Lesions (WML). Conclusions: WML is an independent factor in cognitive decline. However, the threshold for this impact is not yet clearly established .