Neurostimulation Combined With Cognitive Intervention in Alzheimer’s Disease (NeuroAD): Study Protocol of Double-Blind, Randomized, Factorial Clinical Trial

Despite advances in the treatment of Alzheimer’s disease (AD), there is currently no prospect of a cure, and evidence shows that multifactorial interventions can benefit patients. A promising therapeutic alternative is the use of transcranial direct current stimulation (tDCS) simultaneously with cognitive intervention. The combination of these non-pharmacological techniques is apparently a safe and accessible approach. This study protocol aims to compare the efficacy of tDCS and cognitive intervention in a double-blind, randomized and factorial clinical trial. One hundred participants diagnosed with mild-stage AD will be randomized to receive both tDCS and cognitive intervention, tDCS, cognitive intervention, or placebo. The treatment will last 8 weeks, with a 12-month follow-up. The primary outcome will be the improvement of global cognitive functions, evaluated by the AD Assessment Scale, cognitive subscale (ADAS-Cog). The secondary outcomes will include measures of functional, affective, and behavioral components, as well as a neurophysiological marker (Brain-derived neurotrophic factor, BDNF). This study will enable us to assess, both in the short and long term, whether tDCS is more effective than the placebo and to examine the effects of combined therapy (tDCS and cognitive intervention) and isolated treatments (tDCS vs. cognitive intervention) on patients with AD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02772185—May 5, 2016

Eficácia da estimulação transcraniana por corrente contínua associada ao treino cognitivo nos domínios da linguagem e praxia de pacientes com doença de alzheimer na fase leve / Transcranial direct current stimulation associated with cognitive training

A Doença de Alzheimer (DA) é uma desordem neurodegenerativa progressiva, com apresentação de declínio das funções cognitivas e, consequentemente, perda gradual da autonomia, de acordo com a evolução da doença. O objetivo do presente estudo foi avaliar os efeitos da técnica de Estimulação Transcraniana por Corrente Contínua (ETCC) associada ao Treino Cognitivo (COG) nos domínios cognitivos responsáveis pela Linguagem e Praxia em sujeitos que se encontram na fase leve da DA. Trata-se de um estudo tipo relato de caso com 2 sujeitos, em que ambos foram submetidos ao protocolo de intervenção de ETCC e COG aplicados simultaneamente. Foi realizada uma análise descritiva dos resultados obtidos através dos subtestes do ADAS-Cog (Nomeação de objetos e dedos, Compreensão de ordens, Capacidade construtiva, Praxia ideativa, Linguagem oral, Dificuldade em encontrar palavras em um discurso espontâneo, Compreensão da linguagem oral), do Teste de Fluência Verbal (FAS) e do Teste de Figuras Sobrepostas de Poppelreuter aplicados nos períodos pré e pós-tratamento que avaliaram os domínios estudados no presente trabalho. Após realizado o protocolo de intervenção, observou-se melhora significativa no desempenho dos sujeitos por meio dos instrumentos de avaliação utilizados. A abordagem terapêutica empregada mostrou-se um método eficaz para o tratamento da DA na fase leve, atuando na manutenção e preservação das funções cognitivas dos sujeitos.Abstract Alzheimer's disease (AD) is a progressive neurodegenerative disorder, presenting a decline in cognitive functions and, consequently, a gradual loss of autonomy, according to the evolution of the disease. The objective of the present study was to evaluate the effects of the Transcranial Direct Current Stimulation (tDCS) technique associated with Cognitive Training (COG) in the cognitive domains responsible for Language and Praxis in subjects who are in the light phase of AD. This is a case-report study with 2 subjects, in which both were submitted to the tDCS and COG intervention protocol applied simultaneously. A descriptive analysis of the results obtained through ADAS-Cog subtests (Naming of objects and fingers, Order comprehension, Constructive capacity, Praxis ideal, Oral language, Difficulty finding words in a spontaneous speech, Understanding of oral language), The Verbal Fluency Test (FAS) and the Poppelreuter Overlap Test applied in the pre- and post-treatment periods that evaluated the domains studied in the present study. After the intervention protocol, a significant improvement in the performance of the subjects was observed through the evaluation instruments used. The therapeutic approach employed was an effective method for the treatment of AD in the light phase, acting in the maintenance and preservation of the cognitive functions of the subjects.Keywords: Alzheimer’s disease, Transcranial Direct Current Stimulation, Cognitive Training, Language, Praxis.Resumen La enfermedad de Alzheimer (DA) es un desorden neurodegenerativo progresivo, con una presentación de declive de las funciones cognitivas y, consecuentemente, pérdida gradual de la autonomía, de acuerdo con la evolución de la enfermedad. El objetivo del presente estudio fue evaluar los efectos de la técnica de Estimulación Transcraniana por Corriente Continua (ETCC) asociada al Entrenamiento Cognitivo (COG) en los dominios cognitivos responsables del Lenguaje y Praxia en sujetos que se encuentran en la fase leve de la DA. Se trata de un estudio tipo relato de caso con 2 sujetos, en que ambos fueron sometidos al protocolo de intervención de ETCC y COG aplicados simultáneamente. Se realizó un análisis descriptivo de los resultados obtenidos a través de los subtítulos del ADAS-Cog (Nombramiento de objetos y dedos, Comprensión de órdenes, Capacidad constructiva, Praxia ideativa, Lenguaje oral, Dificultad en encontrar palabras en un discurso espontáneo, Comprensión del lenguaje oral), de la Prueba de Fluencia Verbal (FAS) y del Prueba de Figuras superpuestas de Poppelreuter aplicadas en los períodos pre y post-tratamiento que evaluaron los dominios estudiados en el presente trabajo. Después de realizado el protocolo de intervención, se observó una mejora significativa en el desempeño de los sujetos por medio de los instrumentos de evaluación utilizados. El abordaje terapéutico empleada se mostró un método eficaz para el tratamiento de la DA en la fase leve, actuando en el mantenimiento y preservación de las funciones cognitivas de los sujetos.Palabras clave: Enfermedad de Alzheimer, Estimulación Transcraniana por Corriente Continua, Entrenamiento Cognitivo, Lenguaje, Praxia. </p

Neurostimulation Combined With Cognitive Intervention in Alzheimer’s Disease (NeuroAD): Study Protocol of Double-Blind, Randomized, Factorial Clinical Trial

[EN]Despite advances in the treatment of Alzheimer’s disease (AD), there is currently no prospect of a cure, and evidence shows that multifactorial interventions can benefit patients. A promising therapeutic alternative is the use of transcranial direct current stimulation (tDCS) simultaneously with cognitive intervention. The combination of these non-pharmacological techniques is apparently a safe and accessible approach. This study protocol aims to compare the efficacy of tDCS and cognitive intervention in a double-blind, randomized and factorial clinical trial. One hundred participants diagnosed with mild-stage AD will be randomized to receive both tDCS and cognitive intervention, tDCS, cognitive intervention, or placebo. The treatment will last 8 weeks, with a 12-month follow-up. The primary outcome will be the improvement of global cognitive functions, evaluated by the AD Assessment Scale, cognitive subscale (ADAS-Cog). The secondary outcomes will include measures of functional, affective, and behavioral components, as well as a neurophysiological marker (Brain-derived neurotrophic factor, BDNF). This study will enable us to assess, both in the short and long term, whether tDCS is more effective than the placebo and to examine the effects of combined therapy (tDCS and cognitive intervention) and isolated treatments (tDCS vs. cognitive intervention) on patients with AD

Núcleos de Ensino da Unesp: artigos 2008

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq

Brazilian Flora 2020: Leveraging the power of a collaborative scientific network

International audienceThe shortage of reliable primary taxonomic data limits the description of biological taxa and the understanding of biodiversity patterns and processes, complicating biogeographical, ecological, and evolutionary studies. This deficit creates a significant taxonomic impediment to biodiversity research and conservation planning. The taxonomic impediment and the biodiversity crisis are widely recognized, highlighting the urgent need for reliable taxonomic data. Over the past decade, numerous countries worldwide have devoted considerable effort to Target 1 of the Global Strategy for Plant Conservation (GSPC), which called for the preparation of a working list of all known plant species by 2010 and an online world Flora by 2020. Brazil is a megadiverse country, home to more of the world's known plant species than any other country. Despite that, Flora Brasiliensis, concluded in 1906, was the last comprehensive treatment of the Brazilian flora. The lack of accurate estimates of the number of species of algae, fungi, and plants occurring in Brazil contributes to the prevailing taxonomic impediment and delays progress towards the GSPC targets. Over the past 12 years, a legion of taxonomists motivated to meet Target 1 of the GSPC, worked together to gather and integrate knowledge on the algal, plant, and fungal diversity of Brazil. Overall, a team of about 980 taxonomists joined efforts in a highly collaborative project that used cybertaxonomy to prepare an updated Flora of Brazil, showing the power of scientific collaboration to reach ambitious goals. This paper presents an overview of the Brazilian Flora 2020 and provides taxonomic and spatial updates on the algae, fungi, and plants found in one of the world's most biodiverse countries. We further identify collection gaps and summarize future goals that extend beyond 2020. Our results show that Brazil is home to 46,975 native species of algae, fungi, and plants, of which 19,669 are endemic to the country. The data compiled to date suggests that the Atlantic Rainforest might be the most diverse Brazilian domain for all plant groups except gymnosperms, which are most diverse in the Amazon. However, scientific knowledge of Brazilian diversity is still unequally distributed, with the Atlantic Rainforest and the Cerrado being the most intensively sampled and studied biomes in the country. In times of “scientific reductionism”, with botanical and mycological sciences suffering pervasive depreciation in recent decades, the first online Flora of Brazil 2020 significantly enhanced the quality and quantity of taxonomic data available for algae, fungi, and plants from Brazil. This project also made all the information freely available online, providing a firm foundation for future research and for the management, conservation, and sustainable use of the Brazilian funga and flora