Bateria de avaliação frontal em uma amostra brasileira de controles saudáveis: dados normativos

Objective: To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE). Methods: Two hundred and seventy-five healthy individuals with mean age of 66.4 +/- 10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level. Results: Mean total FAB scores according to the educational level were 10.9 +/- 2.3, for one to three years; 12.8 +/- 2.7, for four to seven years; 13.8 +/- 2.2, for eight to 11 years; and 15.3 +/- 2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p&lt;0.0001) and MMSE scores (r=0.39; p&lt;0.0001). No correlation emerged between FAB scores, age, and gender. Conclusion: In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.OBJETIVO: Avaliar o desempenho de indivíduos brasileiros saudáveis na Bateria de Avaliação Frontal (FAB) correlacionado com gênero, idade, educação e escores do Exame do Mini-Mental (MMSE). \ud MÉTODOS: Foram avaliados 275 controles saudáveis com média de idade de 66,4±10,6 anos. Os escores médios foram estabelecidos de acordo com o nível educacional. \ud RESULTADOS: Os escores médios da FAB em relação ao nível educacional foram 10,9±2,3 para um a três anos; 12,8±2,7 para quatro a sete anos; 13,8±2,2 para oito a 11 anos e 15,3±2,3 para 12 ou mais anos. Os escores totais da FAB se correlacionaram significativamente com o nível educacional (r=0,47; p<0,0001) e com os escores do MMSE (r=0,39; p<0,0001). Não foram observadas correlações significativas entre os escores da FA, o gênero e a idade. \ud CONCLUSÃO: Na presente amostra, a versão brasileira da FAB sofreu influência do nível de escolaridade, mas não da idade e do gênero

BRUXA RADIOTIVA: RADIANT WITCH

No decorrer da história da humanidade, a mulher sempre sofreu preconceitos e enfrentou diversas barreiras em busca de seus direitos. Nesta incessante busca, diversas mulheres contribuíram significativamente para o desenvolvimento da ciência. Diante disto, no presente trabalho será abordado a vida e a carreira da brilhante cientista Marie Curie, a qual tornou-se a primeira mulher a ser laureada no prêmio Nobel, e a única pessoa a ser laureada em campos científicos diferentes. Sua vida foi repletas de desafios e êxitos, desde a saída de sua cidade natal, seu casamento com Pierre Curie, seu romance com Paul Langevi, e o mais importante os seus trabalhos sobre a radioatividade, a descoberta do polônio e do rádio. Marie se tornou um símbolo para as mulheres cientistas, a “bruxa” perpassa seus ensinamentos de coragem, perseverança e ensinamento científico, mesmo após a sua morte. 

Profiles of cognitive impairment in the continuum from normal cognition to Alzheimer's Clinical Syndrome:Contributions of the Short-term Memory Binding tests

Background: Short-term memory binding (STMB) tests assess conjunctive binding, in which participants should remember the integration of features, such as shapes (or objects) and colors, forming a unique representation in memory. In this study, we investigated two STMB paradigms: change detection (CD) and free recall (FR). Objective: To investigate the cognitive profile in the CD and FR tasks of three diagnostic groups: cognitively unimpaired (CU), mild cognitive impairment (MCI), and Alzheimer's clinical syndrome (ACS). In addition, we aimed to calculate and compare the accuracy of the CD and FR tasks to identify MCI and ACS. Methods: Participants were 24 CU, 24 MCI, and 37 ACS. The cognitive scores of the clinical groups were compared using analysis of variance (ANOVA) and receiver-operating characteristic (ROC) analyses were carried out to verify the accuracy of the STMB tasks. Results: In the CD task, CU was different from MCI and ACS (CU > MCI = ACS), while in the FR task all groups were different (CU > MCI > ACS). The ROC analyses showed an area under the curve (AUC) of 0.855 comparing CU with MCI for the CD task and 0.975 for the FR. The AUC comparing CU and ACS was 0.924 for the CD and 0.973 for the FR task. The FR task showed better accuracy to identify MCI patients, and the same accuracy to detect ACS. Conclusion: The present findings indicate that impairments in CD and FR of bound representations are features of the cognitive profiles of MCI and ACS patients

Recalling feature bindings differentiates Alzheimer’s disease from Frontotemporal Dementia

It has been challenging to identify clinical cognitive markers that can differentiate patients with Alzheimer’s disease (AD) from those with behavioral variant frontotemporal dementia (bvFTD). The Short-term Memory Binding (STMB) test assesses the ability to integrate colors and shapes into unified representations and to hold them temporarily during online performance. The objective of this study is to investigate whether free recall deficits during short-term memory binding (STMB) test can differentiate patients with AD from those with bvFTD and controls. Participants were 32 cognitively intact adults, 35 individuals with AD and 18 with bvFTD. All patients were in the mild dementia stage. Receiver-operating characteristics (ROC) analyses were used to examine the diagnostic accuracy of the STMB. The results showed that AD patients performed significantly worse than controls and bvFTD patients in the STMB test, while the latter groups showed equivalent performance. The bound condition of the STMB test showed an AUC of 0.853, with 84.4% of sensitivity and 80% of specificity to discriminate AD from controls and an AUC of 0.794, with 72.2% of sensitivity and 80% of specificity to differentiate AD from bvFTD. Binding deficits seem specific to AD. The free recall version of the STMB test can be used for clinical purposes and may aid in the differential diagnosis of AD. Findings support the view that the STMB may be a suitable cognitive marker for AD

Perfil funcional de pacientes com demência frontotemporal variante comportamental (bvDFT) em comparação com pacientes com doença de Alzheimer e controles normais

There are few studies describing the functional changes in behavioral variant frontotemporal dementia (bvFTD) and it is not clear which aspects of functionality are affected by the disease. Objective: The aim of the present investigation was to characterize the functional profile of patients previously diagnosed with bvFTD. Methods: The sample consisted of 31 patients diagnosed with bvFTD, who were compared to patients with Alzheimer’s disease (AD) (n=31) and to healthy control subjects (NC) (n=34), matched for schooling and age. bvFTD and AD patients were matched by severity of dementia. The protocol included the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Direct Assessment of Functional Status (DAFS-BR), Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD) and the Clinical Dementia Rating scale (CDR). Results: The group with bvFTD showed worse performance on Initiation and Planning/Organization in the DAD and on ability to feed oneself in the DAFS-BR, as well as higher scores on the PFAQ, \ud suggesting greater dependence in the bvFTD group. Conclusion: The results suggest that individuals with bvFTD display greater functional impairment compared to AD patients with a similar degree of dementia severity and to healthy controls. Direct assessment of functionality proved unable to clearly differentiate between the dementia subtypes.Existem poucos estudos sobre alterações funcionais na variante comportamental da demência frontotemporal (DFTvc). Objetivo: Caracterizar o desempenho funcional de pacientes com diagnóstico prévio de DFTvc. Métodos: Trinta e um pacientes com DFTvc foram comparados a pacientes com doença de Alzheimer (DA) (n=31) e adultos saudáveis (NC) (n=34), pareados para idade e escolaridade. Os pacientes com DFTvc e DA foram pareados pela gravidade da demência. O protocolo incluiu o Mini Exame do Estado Mental, Escala de Depressão Geriátrica (GDS), Direct Assessment of Functional \ud Status (DAFS-BR), Disability Assessment for Dementia (DAD), Functional Activities Questionnaire (PFAQ) e Clinical Dementia Rating scale (CDR). Resultados: O grupo com DFTvc apresentou pior desempenho em Iniciação e Planejamento/Organização na DAD, em Alimentação na DAFS-BR e pontuação mais elevada na PFAQ, sugerindo que a dependência na DFTvc é mais acentuada. Conclusão: Os resultados apresentados sugerem que indivíduos com DFTvc apresentam maior prejuízo funcional, quando comparados com participantes com DA com grau semelhante de gravidade e com adultos saudáveis. A avaliação direta da funcionalidade não ajudou a diferenciar os subtipos de demência de modo significativo

Disease progression in frontotemporal dementia and Alzheimer disease: the contribution of staging scales

Introduction: There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD). Objectives: To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA) and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale - frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR). Methods: The sample consisted of 70 individuals, aged 40+ years, with at least two years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant) and 27 with AD. The FTD-FRS, the CDR and the two additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke’s Cognitive Examination-Revised (ACE-R) was completed by patients. After 12 months, the same protocol was applied. Results: The FTD-FRS, CDR-FTLD and CDR detected significant decline after 12 months in the three clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages. Conclusions: The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum

Primary School Education May Be Sufficient to Moderate a Memory-Hippocampal Relationship

According to the cognitive reserve theory, intellectual stimuli acquired during life can prevent against developing cognitive impairment. The underlying cognitive reserve mechanisms were underexplored in low-educated individuals. Because episodic memory impairment due to hippocampal dysfunction is a key feature of Alzheimer’s dementia (AD), we sought to look at a possible cognitive reserve mechanism by determining whether few years of education moderated the relationship between the hippocampal volumes and the episodic-memory scores. The sample was composed by 183 older adults, 40.1% male, with the median age of 78[76,82] years and the median years of education of 4[2,10] who had undergone an episodic-memory test and a 3-Tesla MRI scan to access the hippocampal volumes. Overall, 112 were cognitively healthy, 26 had cognitive impairment-no dementia (CIND) and 45 had dementia. We used multiple linear regression to assess whether the interaction between years of education and each hippocampal volume significantly predicted the episodic-memory scores’ variance, controlling for cognitive diagnosis and nuisance variables. The interaction term with the left hippocampus (ß = 0.2, p = 0.043, CI = 1.0, 1.4), but not with the right (ß = 0.1, p = 0.218, CI = 0.9, 1.2) significantly predicted the variation on memory scores. The mechanism by which the left hippocampus seems to play a more important role on memory processing in more educated individuals needs to be further investigated and might be associated with a better use of mnemonic strategies or higher hippocampal connectivity. Because the sample’s median years of education was four, which corresponds to primary school, we may infer that this level might be sufficient to contribute for building cognitive reserve

Tradução, adaptação transcultural e aplicabilidade da escala de estadiamento e progressão da degeneração lobar frontotemporal

Background: Staging scales for dementia have been devised for grading Alzheimer’s disease (AD) but do not include the specific symptoms of frontotemporal lobar degeneration (FTLD). Objective: To translate and adapt the Frontotemporal Dementia Rating Scale (FTD-FRS) to Brazilian Portuguese. Methods: The cross-cultural adaptation \ud process consisted of the following steps: translation, back-translation (prepared by independent translators), discussion with specialists, and development of a final version after minor adjustments. A pilot application was carried out with 12 patients diagnosed with bvFTD and 11 with AD, matched for disease severity (CDR=1.0). The evaluation protocol included: Addenbrooke’s Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Executive Interview (EXIT-25), Neuropsychiatric Inventory (NPI), Frontotemporal Dementia Rating Scale (FTD-FRS) and Clinical Dementia Rating scale (CDR). Results: The Brazilian version of the FTD-FRS seemed appropriate for use in this country. Preliminary results revealed greater levels of disability in bvFTD than in AD patients (bvFTD: 25% mild, 50% moderate and 25% severe; AD: 36.36% mild, 63.64% moderate). It appears that the CDR underrates disease severity in bvFTD since a relevant proportion of patients rated as having mild dementia (CDR=1.0) in fact had moderate or severe levels of disability according to the FTD-FRS. Conclusion: The Brazilian version of the FTD-FRS seems suitable to aid staging and determining disease progression.Introdução: As escalas de estadiamento das demências, como a Clinical Dementia Rating (CDR), foram elaboradas para graduar a doença de Alzheimer (DA) e não incluem os sintomas específicos da degeneração lobar frontotemporal (DLFT). Objetivo: Realizar a tradução e adaptação cultural da Frontotemporal Dementia Rating Scale (FTD-FRS) para o contexto brasileiro e apresentar dados preliminares da sua aplicabilidade. Métodos: O processo de adaptação transcultural consistiu em: tradução, retrotradução (realizadas por tradutores independentes), discussão com especialistas sobre a versão em português e equivalência com a versão original, desenvolvimento da versão final com pequenos ajustes. Foi feita uma aplicação piloto em 12 pacientes com diagnóstico de demência frontotemporal variante comportamental (DFTvc) e 11 com DA, pareados quanto à gravidade da demência (CDR=1). O protocolo de avaliação incluiu a Addenbrooke’s Cognitive Examination-Revised (ACE-R), Mini Exame do Estado Mental (MEEM), Executive Interview (EXIT-25), Inventário Neuropsiquiátrico (INP) e a Escala de Avaliação Clínica da Demência (CDR). Resultados: A FTD-FRS na versão brasileira \ud pareceu apropriada. Resultados preliminares revelaram maiores níveis de incapacidade na DFTvc do que em pacientes com DA (DFTvc: 25% leve, 50% moderado, 25% grave; AD: 36.36% leve, 63.64% moderado). A CDR parece subestimar a gravidade da demência na DFTvc, uma vez que uma relevante proporção dos pacientes classificados com leves (CDR=1) de fato apresentaram nível moderado ou grave de comprometimento na FTD-FRS. Conclusão: A versão brasileira da FTD-FRS pode se mostrar adequada para auxiliar no estadiamento e determinar a progressão da DLFT

ASSISTÊNCIA DOS PROFISSIONAIS DE ENFERMAGEM AO PACIENTE COM SEPTICEMIA: UM ESTUDO DE REVISÃO INTEGRATIVA

This study aims to describe the assistance provided by nursing professionals to patients with sepsis, according to the literature of the last five years. This is an integrative literature review study. The bibliographic survey was carried out between July and August 2023, in the LILACS, SCIELO and Periódico CAPES databases. To increase the scope of the review, the Boolean AND operator was used. The descriptors were used: sepsis “AND” nursing, which are registered in the Health Sciences Descriptors (DeCS) and which were defined according to the proposed theme. The inclusion criteria for this study were original articles published in full, available in indexed databases, written in Portuguese and published between the period 2018 to 2023. After crossing the descriptors with Boolean in the databases, we found 55 studies in LILACS, 23 in SCIELO and 153 in CAPES. After analyzing, reading the articles and applying the inclusion and exclusion criteria, a total of 8 studies were selected to compose the integrative review, as these covered the proposed theme and achieved the proposed objectives. Regarding the approach of the selected studies, 1 was cross-sectional descriptive, 1 observational retrospective study, 1 cross-sectional study, descriptive of a documental nature, 2 qualitative descriptive studies, 1 cross-sectional with a retrospective approach, 1 exploratory descriptive with a qualitative approach and 1 descriptive in nature quantitative. It was evident that many nursing professionals had scientific knowledge for the recognition and management of patients with septicemia. However, some still lack training, as they confuse the signs and symptoms of sepsis with other pathologies and even fail to provide efficient assistance, as they do not carry out a rigorous evaluation of the patient to identify the signs of septicemia.Esse estudo tem como objetivo descrever a assistência realizada pelos profissionais de enfermagem ao paciente com sepse, conforme a literatura dos últimos cinco anos. Trata-se de um estudo de revisão de literatura do tipo integrativa. O levantamento bibliográfico foi realizado entre os meses de julho e agosto de 2023, nas bases de dados LILACS, SCIELO e Periódico CAPES. Para aumentar o escopo da revisão foi utilizado o operador booleano AND. Foram utilizados os descritores: sepse “AND” enfermagem, que estão registrados nos Descritores em Ciências da Saúde (DeCS) e que foram definidos conforme a temática proposta. Os critérios de inclusão desse estudo foram os artigos originais publicados na íntegra, disponíveis nas bases de dados indexadas, escritos em língua portuguesa e publicados entre o período de 2018 a 2023. Após o cruzamento dos descritores com o booleano nas bases de dados, foram encontrados 55 estudos no LILACS, 23 no SCIELO e 153 no CAPES. Após a análise, leitura dos artigos e aplicação dos critérios de inclusão e exclusão, foram selecionados um total de 8 estudos para compor a revisão integrativa, pois esses abrangeram a temática proposta e atingiram os objetivos propostos. Em relação à abordagem dos estudos selecionados, 1 foi transversal descritivo,&nbsp; 1 estudo observacional retrospectivo, 1 estudo transversal, descritivo de caráter documental, 2 estudos qualitativos descritivos, 1 corte transversal com abordagem retrospectiva, 1 exploratório descritivo com abordagem qualitativa e 1 descritivo de natureza quantitativa. Ficou evidente que muitos profissionais de enfermagem apresentaram conhecimentos científicos para o reconhecimento e manejo do paciente com septicemia. Entretanto, alguns ainda carecem de capacitações, visto que confundem os sinais e sintomas da sepse com outras patologias e até mesmo deixam de realizar uma assistência eficiente, pois não fazem uma avaliação rigorosa do paciente para identificar os sinais de septicemia. Palavras-chave: Enfermagem, Pacientes, Sepse