Transtorno bipolar do humor e gênero

Although the bipolar disorder (BD) occurs almost with the same frequency in both genders, the phenomenology and the outcome of the illness differ between them. Nevertheless, there is evidence that women with BD show, more than men, delayed beginning, especially in their fifth decade, more rapid cycling outcome, more depressive episodes, more dysphoric mania, more mixed states and more BD type II. Even so, the findings are not always consistent. Although the risk of comorbidities in BD includes, for both the sorts, excessive alcoholic consumption and drugs, bipolar men would have greater probability of being alcohol dependent, of not seeking treatment and of committing suicide. Suggested hypotheses to explain such differences vary from those centered in cultural or psychological aspects to those that focus on the steroids hormones, and other hormones such as cortisol, thyroid hormones and even on the cerebral anatomy. The reproductive cycle (menstrual cycle, pregnancy and menopause) influences on the BD phenomenology and its relevance to the therapeutical options in the treatment of the BD in women are presented in the last part of this review. Further investigations must to be done in order to clarify this controversy. However, up to now the data indicate that estrogen therapy is not to be primarily indicated to prevent depression, Alzheimer disease or cognition impairment.

The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): Reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia

Background: Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). Methods: Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. Results: Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. Conclusion: Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies. Copyright © 2010 International Psychogeriatric Association.

Advances in drug design based on the amino acid approach: Taurine analogues for the treatment of CNS diseases

Amino acids are well known to be an important class of compounds for the maintenance of body homeostasis and their deficit, even for the polar neuroactive aminoacids, can be controlled by supplementation. However, for the amino acid taurine (2-aminoethanesulfonic acid) this is not true. Due its special physicochemical properties, taurine is unable to cross the blood-brain barrier. In addition of injured taurine transport systems under pathological conditions, CNS supplementation of taurine is almost null. Taurine is a potent antioxidant and anti-inflammatory semi-essential amino acid extensively involved in neurological activities, acting as neurotrophic factor, binding to GABA A/glycine receptors and blocking the excitotoxicity glutamate-induced pathway leading to be a neuroprotective effect and neuromodulation. Taurine deficits have been implicated in several CNS diseases, such as Alzheimer's, Parkinson's, epilepsy and in the damage of retinal neurons. This review describes the CNS physiological functions of taurine and the development of new derivatives based on its structure useful in CNS disease treatment.&; 2012 by the authors; licensee MDPI, Basel, Switzerland.

Mild cognitive impairment (part 1): Clinical characteristics and predictors of dementia

Objective: To critically review and evaluate existing knowledge on the conceptual limits and clinical usefulness of the diagnosis of mild cognitive impairment (MCI) and the neuropsychological assessment and short- and long-term prognosis thereof. Methods: We conducted a systematic search of the PubMed and Web of Science electronic databases, limited to articles published in English between 1999 and 2012. Based on the search terms mild cognitive impairment or MCI and epidemiology or diagnosis, we retrieved 1,698 articles, of which 248 were critically eligible (cross-sectional and longitudinal studies); the abstracts of the remaining 1,450 articles were also reviewed. Results: A critical review on the MCI construct is provided, including conceptual and diagnostic aspects; epidemiological relevance; clinical assessment; prognosis; and outcome. The distinct definitions of cognitive impairment, MCI included, yield clinically heterogeneous groups of individuals. Those who will eventually progress to dementia may present with symptoms consistent with the definition of MCI; conversely, individuals with MCI may remain stable or return to normal cognitive function. Conclusion: On clinical grounds, the cross-sectional diagnosis of MCI has limited prognostic relevance. The characterization of persistent and/or progressive cognitive deficits over time is a better approach for identification of cases at the pre-dementia stages, particularly if these cognitive abnormalities are consistent with the natural history of incipient Alzheimer's disease. © 2013 Associação Brasileira de Psiquiatria.

Validation of the brazilian version of the apathy inventory

Background Apathy is a frequent neuropsychiatric condition in neurodegenerative disorders, depression, and often in mild cognitive impairment. The Apathy Inventory (AI) is a reliable instrument for improving the accuracy of the apathy diagnosis. The aim was to establish the validity of the Apathy Inventory for the Brazilian community. Methods We established the concurrent validity, internal consistency, inter-rater reliability, and the sensitivity and specificity of AI for the Brazilian community in a cohort of 175 individuals with Alzheimer's disease, Parkinson's disease, depression, mild cognitive impairment, and healthy controls. The three dimensions of the AI (emotional blunting, lack of initiative, and lack of interest) were compared with the Apathy domain of the Neuropsychiatric Inventory-Clinician rating scale (NPI-C) in an independent scheme. Results The analyses demonstrated high correlation coefficients in AI's individual dimensions and in AI-total score (F = 0.965). Concerning the NPI-C/Apathy domain, intra-class correlation coefficients were also high (F = 0.977). Concurrent validity was high according to both raters on AI dimensions × NPI-C/Apathy domain and regarding total score (rater 1: rho = 0.956 vs. rater 2: rho = 0.970). The internal consistency of the AI was also high concerning the AI's individual dimensions and total score (rater 1: 0.945 vs. rater 2: 0.958). Conclusion We observed high internal consistency, high concurrent validity, and inter-rater reliability of the Apathy Inventory. In addition, we found that its sensitivity and specificity were high. We suggest that the Brazilian version of the Apathy Inventory would be an appropriate instrument to identify the apathy syndrome in Brazilian patients. © 2012 John Wiley & Sons, Ltd.

Isolamentos e caracterização de DETs(Differentially Expressed Transcripts) em espécies de peixes: Leporinus macrocephalus(Characiformes) e Danio rerio (Cypriniformes)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Clinical feasibility of cognitive testing in dogs (Canis lupus familiaris)

Several cognitive tests have been developed to evaluate specific aspects of human and animal learning and memory. These tests have been used for early detection of cognitive deficits and to monitor the treatment of dogs with cognitive impairment. Thus, this article evaluated the feasibility of cognitive tests for use in canine neurology clinical routines and the suitability of the different tests to accomplish this aim. Fifteen healthy adult dogs were used for the cognitive tests of reward approach learning, object approach learning, object discrimination learning, reversal learning, delayed non-matched to position, and delayed non-matched to sample to assess different aspects of memory. No difference was observed between tests of delayed non-matched to position (3.13 +/- 2.23 days) and delayed non-matched to sample (3.20 +/- 2.40 days) (P = 0.944). However, dogs had greater difficulty in reversal learning (8.47 +/- 2.61 days) than in object discrimination learning (4.60 +/- 1.64 days) (P <= 0.001). Based on the tests performed, the delayed non-matched to position test may be performed in clinical routine if the owner and the veterinarian have time available, because this test is sensitive to evaluate dogs with cognitive impairments, but requires approximately 10 days of training. Thus, elderly dogs are excellent experimental models to study pathological aging based on their similarities with some human brain diseases, such as Alzheimer disease. (C) 2014 Elsevier Inc. All rights reserved.

Relevant aspects of human toxoplasmosis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Síndrome da disfunção cognitiva em cães

Cognitive dysfunction syndrome (CDS) is a progressive degenerative disorder of older dogs, characterized by a decline in cognitive function. The main clinical signs consistent with CDS are: disorientation, changes in socio-environmental interaction, sleep-wake cycle disturbance, changes in hygiene habits, urinate and/or defecate in unusual places, decreased physical activity, anxiety and eating disorders. There are no specific diagnostic tests for this condition in vivo, but alterations in neurological examination, cognitive tests and magnetic resonance imaging can be observed. The diagnosis is confirmed by histopathological examination of brain tissue. Diets rich in antioxidants, environmental enrichment with exercise and the use of selegiline and L-deprenyl have been recommended for the treatment of CDS.

Elderly Individuals with Diabetes: Adding Cognitive Training to Psychoeducational Intervention

The present research examined the effects of a cognitive training program combined with psychoeducational intervention for diabetic elderly patients. Specifically, it aimed at assessing the effects of an eight-session cognitive training and educational program in diabetic elderly individuals and investigating changes in their awareness about specific aspects of diabetes. The final sample consisted of 34 individuals-19 in the experimental group (EG) and 15 in the control group (CG), all residing in the eastern region of the city of Sao Paulo. The protocol included clinical and sociodemographic questions; the Diabetes Attitudes Questionnaire (ATT-19); Diabetes Knowledge Scale (DKN-A); Mini Mental State Examination (MMSE); Verbal Fluency-animal category (VF); Geriatric Depression Scale (GDS); Short Cognitive Performance Test (SKT); and the Rivermead Behavioral Memory Test (RBMT). Results pointed to a significant difference between the two groups for the ATT-19, DKN, and SKT-memory and SKT-total, and a marginally significant difference for the RBMT history in the posttest. As for the remaining cognitive variables, no changes were observed. Retest effects were not observed in the CG. We concluded that cognitive training combined with psychoeducational intervention in diabetic elderly individuals may be effective in producing cognitive gains as well as attitude and knowledge improvement concerning diabetes mellitus (DM).

Vascular dementia

The epidemic growth of dementia causes great concern for the society. It is customary to consider Alzheimer's disease (AD) as the most common cause of dementia, followed by vascular dementia (VaD). This dichotomous view of a neurodegenerative disease as opposed to brain damage caused by extrinsic factors led to separate lines of research in these two entities. Indeed, accumulated data suggest that the two disorders have additive effects and probably interact; however it is still unknown to what degree. Furthermore, epidemiological studies have shown "vascular" risk factors to be associated with AD. Therefore, a clear distinction between AD and VaD cannot be made in most cases, and is furthermore unhelpful. In the absence of efficacious treatment for the neurodegenerative process, special attention must be given to the vascular component, even in patients with presumed mixed pathology. Symptomatic treatment of VaD and AD is similar, although the former is less effective. For prevention of dementia it is important to treat all factors aggressively, even in stroke survivors who do not show evidence of cognitive decline. In this review, we will give a clinical and pathological picture of the processes leading to VaD and discuss its interaction with AD. (c) 2012 Elsevier B.V. All rights reserved.

Normative Data for Healthy Middle-Aged and Elderly Performance on the Addenbrooke Cognitive Examination-Revised

Objective: To provide normative data for healthy middle-aged and elderly Brazilians' performance on the Addenbrooke Cognitive Examination-Revised (ACE-R) and to investigate the effects of age, sex, and schooling on test performance. Background: The ACE-R is a brief cognitive battery that assesses various aspects of cognition. Its 5 subdomains (Attention and Orientation, Memory, Verbal Fluency, Language, and Visuospatial Abilities) are commonly impaired in Alzheimer disease or frontotemporal dementia. Methods: We evaluated 144 cognitively healthy volunteers (50% men, 50% women) aged 50 to 93 years, with 4 to 24 years of schooling. We divided the participants into 4 age groups, each of which was then stratified into 3 groups according to years of education. We assessed all participants with the ACE-R, the Mattis Dementia Rating Scale, and the Cornell Scale for Depression in Dementia. Results: Years of education affected all ACE-R subscores. Age influenced the Verbal Fluency subscore (P < 0.001) and the ACE-R total score (P < 0.05). Sex affected the Attention and Orientation (P = 0.037) and Mini-Mental State Examination subscores (P = 0.048), but not the ACE-R total score (P > 0.05). Conclusions: The performance of healthy middle-aged and elderly individuals on the ACE-R battery is strongly influenced by education and, to a lesser extent, by age. These findings are of special relevance in countries with populations that have marked heterogeneity in educational levels.

Semantic Dementia Versus Nonfluent Progressive Aphasia Neuropsychological Characterization and Differentiation

Background: Early progressive nonfluent aphasia (PNFA) may be difficult to differentiate from semantic dementia (SD) in a nonspecialist setting. There are descriptions of the clinical and neuropsychological profiles of patients with PNFA and SD but few systematic comparisons. Method: We compared the performance of groups with SD (n = 27) and PNFA (n = 16) with comparable ages, education, disease duration, and severity of dementia as measured by the Clinical Dementia Rating Scale on a comprehensive neuropsychological battery. Principal components analysis and intergroup comparisons were used. Results: A 5-factor solution accounted for 78.4% of the total variance with good separation of neuropsychological variables. As expected, both groups were anomic with preserved visuospatial function and mental speed. Patients with SD had lower scores on comprehension-based semantic tests and better performance on verbal working memory and phonological processing tasks. The opposite pattern was found in the PNFA group. Conclusions: Neuropsychological tests that examine verbal and nonverbal semantic associations, verbal working memory, and phonological processing are the most helpful for distinguishing between PNFA and SD.

Muscarinic and Nicotinic Modulation of Thalamo-Prefrontal Cortex Synaptic Pasticity In Vivo

The mediodorsal nucleus of the thalamus (MD) is a rich source of afferents to the medial prefrontal cortex (mPFC). Dysfunctions in the thalamo-prefrontal connections can impair networks implicated in working memory, some of which are affected in Alzheimer disease and schizophrenia. Considering the importance of the cholinergic system to cortical functioning, our study aimed to investigate the effects of global cholinergic activation of the brain on MD-mPFC synaptic plasticity by measuring the dynamics of long-term potentiation (LTP) and depression (LTD) in vivo. Therefore, rats received intraventricular injections either of the muscarinic agonist pilocarpine (PILO; 40 nmol/mu L), the nicotinic agonist nicotine (NIC; 320 nmol/mu L), or vehicle. The injections were administered prior to either thalamic high-frequency (HFS) or low-frequency stimulation (LFS). Test pulses were applied to MD for 30 min during baseline and 240 min after HFS or LFS, while field postsynaptic potentials were recorded in the mPFC. The transient oscillatory effects of PILO and NIC were monitored through recording of thalamic and cortical local field potentials. Our results show that HFS did not affect mPFC responses in vehicle-injected rats, but induced a delayed-onset LTP with distinct effects when applied following PILO or NIC. Conversely, LFS induced a stable LTD in control subjects, but was unable to induce LTD when applied after PILO or NIC. Taken together, our findings show distinct modulatory effects of each cholinergic brain activation on MD-mPFC plasticity following HFS and LFS. The LTP-inducing action and long-lasting suppression of cortical LTD induced by PILO and NIC might implicate differential modulation of thalamo-prefrontal functions under low and high input drive.