Paulo Caramelli

Faculty of Medicine - Universidade Federal de Minas Gerais · Internal Medicine

Background LatAm‐FINGERS is a non‐pharmacological multicenter randomized clinical trial aimed at preventing cognitive impairment. The intervention advocates for a lifestyle change based on diet, exercise, risk factor control, cognitive training, and socialization. However, the baseline assessment lacks a evaluation of the participants sociability b...

Background LatAm‐FINGERS is the first non‐pharmacological multicenter randomized clinical trial aimed at preventing cognitive impairment in Latin America. It encompasses twelve countries that collectively represent 45% of the territory in the Americas. Its objective is to reach populations that, despite sharing commonalities such as language, are c...

Background Education is a recognized modifiable dementia risk factor. To boost cognitive reserve and reduce dementia risk in Brazil’s vulnerable populations, we conceived a literacy program (PROAME trial) targeting low‐educated adults, aiming to explore how executive function and individual differences influence program effectiveness. Method We sc...

Background Hearing rehabilitation has been a promising approach to improve cognitive outcomes. An ongoing study identified some barriers to engage patients in counseling sessions and using their hearing devices. Here we present the results from the first stage of a Sense‐Cog Brazil pilot study, the recruitment phase. Method Observational pilot stu...

Background Recruiting and retaining older adults for clinical trials is challenging, especially in low‐resource settings. Such challenges led to a systematic exclusion of such participants from clinical trials, compromising the generalizability of the results obtained in high income countries. Objective Here we describe the strategies we used in t...

Background LatAm‐FINGERS ‐ the first non‐pharmacological multicenter randomized clinical trial in Latin America ‐ is a valuable opportunity to study lifestyle in a heterogeneous and multiethnic population exposed to a large number of cardiovascular risk factors. Our aims are to study the risk distribution in the LatAm‐FINGERS cohort and to explore...

Background The LatAm‐FINGERS trial marks a pioneering initiative as the first non‐pharmacological clinical trial encompassing participants from 12 Latin American countries, including Argentina, Brazil, Bolivia, Chile, Colombia, Costa Rica, Ecuador, Dominican Republic, Mexico, Peru, Puerto Rico, and Uruguay. This initiative represents a significant...

Background Tinnitus has variable prevalence in the general population and is often associated with some degree of hearing loss. There are few studies on tinnitus in people with dementia. The objective of the study was to investigate the occurrence of tinnitus complaints in patients with dementia and evaluate possible relationships with hearing acui...

Background Tau PET provides continuous measurements of tau tangle pathology in the human brain. However, establishing cutoffs is crucial for selecting individuals for treatment in clinical trials or practice. In the absence of postmortem data, PET cutoffs must be established using statistical methods based on what is considered normal tracer uptake...

Background Tau PET provides continuous measurements of tau tangle pathology in the human brain. However, establishing cutoffs is crucial for selecting individuals for treatment in clinical trials or practice. In the absence of postmortem data, PET cutoffs must be established using statistical methods based on what is considered normal tracer uptake...

Background Dementia prevalence in Latin America is higher in rural than urban areas. This discrepancy may be explained by inequities over the lifespan in access to health and educational services. However, there is no evidence of potential adverse long‐standing effects of living in rural areas during childhood in current urban adults. This work inv...

Background Cardiovascular risk factors (CVRF) are among the main modifiable risk factors for dementia in Latin America (LA). Therefore, improving cardiovascular health (CVH) is one of the main objectives of the LatAm‐FINGERS trial, the largest non‐pharmacological (lifestyle improvement) randomized trial in LA. But, to fully comprehend CVH it is nec...

Background Despite the increasing number of people with dementia, it remains underdetected worldwide, even in high‐income countries. In Brazil, the number of people with dementia is expected to triple by 2050 and diagnosis can be challenging, contributing to high and growing rates of underdiagnosis. At the moment, there is no national estimate of u...

Background Language impairment manifestations in patients with the semantic variant of primary progressive aphasia (S‐PPA) include surface dysgraphia. Word and pseudoword dictation helps characterize errors in these patients’ writing to better conduct their therapeutic strategies. Few studies have addressed written language in patients with dementi...

Background ApoE has been linked to individual differences in risk and resilience to neurodegeneration in normal aging. The ApoE4 genotype has been associated with an increased risk of developing late‐onset Alzheimer’s disease (age 65 and older). Within the cognitively healthy population, important differences have been reported in the distribution...

Background The salience network (SN) functions as a dynamic switch between the default mode network (DMN) and the frontoparietal network (FPN), aligning with salience and cognitive demand. Dysfunctions in SN activity within the cognitive and affective domains are linked to a wide range of deficits and maladaptive behavioral patterns in various clin...

Objectives: Despite the increasing number of people with dementia (PWD), detection remains low worldwide. In Brazil, PWD is expected to triple by 2050, and diagnosis can be challenging, contributing to high and growing rates of underdiagnosis. At the moment, there is no national estimate of the under detection or characteristics of its distribution...

Frontotemporal dementia (FTD) is one of the leading causes of young‐onset dementia before age 65, typically manifesting as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). Although FTD affects all populations across the globe, knowledge regarding the pathophysiology and genetics derives primaril...

In recent years, the diagnostic accuracy of Alzheimer’s disease has been enhanced by the development of different types of biomarkers that indicate the presence of neuropathological processes. In addition to improving patient selection for clinical trials, biomarkers can assess the effects of new treatments on pathological processes. However, there...

Novel therapies for Alzheimer’s disease, particularly anti-amyloid drugs like lecanemab and donanemab, have shown modest clinical benefits but also significant risks. The present paper highlights the challenges of access to diagnosis, cost-effectiveness, safety, and the need for more representation of diverse populations in clinical trials. Recomme...

Importance Since 2018, a movement has emerged to define Alzheimer disease (AD) as a purely biological entity based on biomarker findings. The recent revision of the Alzheimer Association (AA) criteria for AD furthers this direction. However, concerns about a purely biological definition of AD being applied clinically, the understanding of AD by soc...

Accurate diagnosis of frontotemporal dementia (FTD) with right anterior temporal lobe (RATL) predominance remains challenging due to lack of clinical characterization, and standardized terminology. The recent research of the International Working Group (IWG) identified common symptoms but also unveiled broad terminologies lacking precision and oper...

Background: The significant increase in Alzheimer’s disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). Objective: The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. Methods: We...

INTRODUCTION The influence of hippocampal connectivity on memory performance is well established in individuals with high educational attainment. However, the role of hippocampal connectivity in illiterate populations remains poorly understood. METHODS Thirty‐five illiterate adults were administered a literacy assessment (Test of Functional Health...

Background: The Addenbrooke’s Cognitive Examination-Revised (ACE-R) is an accessible cognitive tool that supports the early detection of mild cognitive impairment (MCI), Alzheimer’s disease (AD), and behavioral variant frontotemporal dementia (bvFTD). Objective: To investigate the diagnostic efficacy of the ACE-R in MCI, AD, and bvFTD through the i...

INTRODUCTION Although frontotemporal dementia (FTD) with right anterior temporal lobe (RATL) predominance has been recognized, a uniform description of the syndrome is still missing. This multicenter study aims to establish a cohesive clinical phenotype. METHODS Retrospective clinical data from 18 centers across 12 countries yielded 360 FTD patien...

Background: The assumption that hearing rehabilitation could improve quality of life and reduce dementia risk in people with hearing loss is a subject that needs further studies, especially clinical trials. It is necessary to determine the effects of hearing aid use, as part of hearing rehabilitation, among people diagnosed with dementia. Objecti...

The majority of people with dementia live in low or middle-income countries (LMICs) where resources that play a crucial role in brain health, such as quality education, are still not widely available. In Brazil, illiteracy remains a prevalent issue, especially in communities with lower socioeconomic status (SES). The PROAME study set out to explore...

The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multid...

Background Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. Objective To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. Methods Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent th...

The relationship between alcohol consumption and cognition is still controversial. This is a cross-sectional population-based study conducted in Caeté (MG), Brazil, where 602 individuals aged 75+ years, 63.6% female, and with a mean education of 2.68 years, were submitted to thorough clinical assessments and categorized according to the number of a...

Dementia research lacks appropriate representation of diverse groups who often face substantial adversity and greater risk of dementia. Current research participants are primarily well‐resourced, non‐Hispanic White, cisgender adults who live close to academic medical centers where much of the research is based. Consequently, the field faces a knowl...

Background: Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective: To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods: This study analyzed t...

Alzheimer's disease (AD) is the most common type and accounts for 60%–70% of the reported cases of dementia. MicroRNAs (miRNAs) are small non‐coding RNAs that play a crucial role in gene expression regulation. Although the diagnosis of AD is primarily clinical, several miRNAs have been associated with AD and considered as potential markers for diag...

Introduction Key component of early detection of dementia is a brief and culturally appropriate cognitive screening tool. This study aimed to perform a cultural adaptation of the Brief Cognitive Screening Battery (BCSB) and to obtain normative data from the older adult population. Methods Cross-cultural adaptation process to develop BCSB-INA was p...

Background and Purpose Frontotemporal dementia (FTD) is the second most common cause of presenile dementia. The clinical distinction between FTD, Alzheimer's disease (AD), and other dementias is a clinical challenge. Brain perfusion SPECT may contribute to the diagnosis of FTD, but its value is unclear. Methods We performed a systematic review to...

Background The ACE‐R is an accurate and brief cognitive battery for the detection of mild dementia, especially for the discrimination between Alzheimer’s disease (AD) and behavioral variant frontotemporal dementia (bvFTD). The aim of this study was to develop a logarithm based on discriminative items of the ACE‐R for AD combined with relevant demog...

Background Multicentric initiatives to study brain cognition in the elderly offers us a unique collection of brain imaging data accompanied by detailed neuroclinical and neuropsychological evaluations. U.S. POINTER and LatAm‐FINGERS, part of the World Wide FINGERS, are both large‐scale investigations of lifestyle interventions and its impact on cog...

Background Brazil has a population of 11 million illiterate individuals. This percentage among Brazilians over 60 equals 18%. In view of this, researchers from the Colleges of Medicine and Education from Federal University of Minas Gerais, Brazil, created Alfabetização e Memória (PROAME) – a project that investigates the relations of late literacy...

Background Education level is a well established modifiable risk factor for dementia prevention. Aiming to improve cognitive reserve and reduce dementia risk in vulnerable populations in Brazil, we created a literacy training program targeting low educated and illiterate adults. In this study, we intend to analyze how executive functioning and cogn...

Background The worldwide COVID‐19 pandemic has been a major challenge for the health system in the past years. From March 2020 until 2022 there were extensive lockdowns in Latin America to ensure physical distance and reduce virus transmission. Previous studies reported the negative impact of social isolation on people living with dementia, however...

Background Lifestyle and cardiovascular risk factors were combined in the Life’s simple 7 (LS7) index to evaluate cardiovascular health, and this index has been previously associated with cognitive decline. The Life’s Essential 8 (LE8) is an update of LS7, which now includes sleep health as an additional factor. We aimed to verify the association b...

Background Multidomain lifestyle interventions hold great promise world‐wide as interventions to slow cognitive aging, and delay and prevent Alzheimer’s Disease and Related Disorders (ADRD). To have the greatest reach, they must be tailored for and assessed within local cultures in clinical trials. For trials to have the greatest impact, it’s impor...

Background Approximately 55 million people live with dementia, and 10 million cases are diagnosed each year worldwide (1). Alzheimer’s disease (AD) is the most common type of dementia and accounts for 60% ‐ 70% of reported cases (1). MicroRNAs are small non‐coding RNAs that present highly conserved sequences, involved in gene modulation and several...

Background the study of the medium and long‐term consequences of coronavirus infection (SARS‐CoV‐2) is of great relevance from the clinical and public health perspective. Recent evidence has shown that patients may present cognitive complaints after overcoming the acute stage of infection, particularly memory disturbances. Although significant prog...

Background The prevalence of anxiety symptoms is estimated to be equal to or higher than the prevalence of depressive symptoms in family carers of people with dementia. However, anxiety is currently somehow neglected in the carer literature. Previous studies demonstrated that Acceptance and Commitment Therapy (ACT) is effective for treating anxiety...

Background LatAm‐FINGERS is the first non‐pharmacological multicenter randomized clinical trial to prevent cognitive impairment in Latin America (LA). The trial congregates the effort of 12 Countries, including Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, and Uruguay. The main aim...

Background Formal education acquired early in life protects against dementia, but whether acquiring education later in life can decrease dementia risk is less clear. Episodic memory impairment is one of the first symptoms of Alzheimer’s Disease. Therefore, we aimed to identify whether a late life literacy training delivered to illiterate adults cou...

Background The role of education is a well established protective factor regarding dementia but not much is known as to the effect of literacy acquisition in adults. Therefore, our study aims to determine whether adults enrolled in late‐life literacy programs will improve memory and cognitive reserve and the role of socioeconomic status in learning...

Background Apathy is a multidimensional neuropsychiatric feature that affect behaviour, cognition, and emotional reaction. Hence exploring its neuroanatomic substrates offers the possibility of understanding the variability of this symptom. Method 20 Healthy Controls (HC), 19 patients with AD and 20 patients with bvFTD, matched for age, sex, educa...

Background Life's Simple 7, a lifestyle and cardiovascular index associated with cognition, has been updated to Life's Essential 8 (LE8) to include sleep. LE8 has been related to cardiovascular outcomes but its association with cognition is unclear. Methods In this longitudinal analysis of the Brazilian Longitudinal Study of Adult Health (ELSA‐Bra...

Studies targeting amyloid-ß in patients with Alzheimer’s disease (AD) have conflicting results and early initiation of therapy may yield better outcomes. We systematically searched PubMed, Embase, Cochrane Library, and Clinicaltrials.gov for randomized trials comparing monoclonal antibodies (mAbs) with placebo in MCI or mild dementia due to AD. Nin...

Background: The diagnosis of Alzheimer's disease (AD) can bring financial and emotional consequences to patients and caregivers. Whether or not the diagnosis should be disclosed to patients is a matter of debate amongst physicians and can be influenced by culture and experience. Objective: To investigate the current practice of physicians who atten...

Objective There are scarce data comparing Parkinson’s disease (PD) and Progressive Supranuclear Palsy (PSP) in social cognition (SC). We aimed to compare patients with PSP and PD in SC. Methods We included three groups: PD (n = 18), PSP (n = 20) and controls (n = 23). Participants underwent neuropsychological exams, including the mini-version of t...

Introduction The Brazilian population in the United States (U.S.), a Latinx subgroup, is rapidly growing and aging but remains underrepresented in U.S. health research. In addition to group‐specific genetic and environmental risks, Brazilian immigrants and their offspring in the U.S. likely have cumulative risks for health inequities. It is estimat...

Background: Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) are important causes of dementia with challenging differential diagnoses in many cases. Addenbrooke's Cognitive Examination-Revised (ACE-R) is a cognitive battery that may be useful to differentiate the two disorders. Objective: The objectibe of this stud...

Objective: To investigate the clinical and epidemiological characteristics of a large sample of patients with dementia due to Alzheimer's disease (AD) who were followed up at a cognitive neurology outpatient clinic. Methods: Retrospective, longitudinal, and descriptive design. We collected data from patients with dementia due to AD who visited t...

Background Frontotemporal dementia (FTD) is a frequent cause of young-onset dementia and represents a major challenge for the diagnosis and clinical management. It is essential to evaluate the difficulties faced by physicians on the diagnostic workup and on patient care. Objective The aim of this study was to investigate the current practices and t...

Background Parkinsonism is strongly associated with ageing, and many studies have suggested that parkinsonian signs may affect up to half of older adults and is associated with a wide range of adverse health outcomes. We compared clinical and functional characteristics of oldest-old community-dwelling individuals with parkinsonism (parkinsonian gro...