Vascular dementia: Diagnostic criteria and supplementary exams: Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part I.

Abstract Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based, systematized approach. The knowledge used to define these guidelines was retrieved from searches of several databases (Medline, Scielo, Lilacs) containing scientific articles, systematic reviews, meta-analyses, largely published within the last 15 years or earlier when pertinent. Information retrieved and selected for relevance was used to analyze diagnostic criteria and to propose a diagnostic system encompassing diagnostic criteria, anamnesis, as well as supplementary and clinical exams (neuroimaging and laboratory). Wherever possible, instruments were selected that had versions previously adapted and validated for use in Brazil that take into account both schooling and age. This task led to proposed protocols for supplementary exams based on degree of priority, for application in clinical practice and research settings

Vascular dementia Cognitive, functional and behavioral assessment Recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Part II.

Abstract Vascular dementia (VaD) is the most prevalent form of secondary dementia and the second most common of all dementias. The present paper aims to define guidelines on the basic principles for treating patients with suspected VaD (and vascular cognitive impairment - no dementia) using an evidence-based approach. The material was retrieved and selected from searches of databases (Medline, Scielo, Lilacs), preferentially from the last 15 years, to propose a systematic way to assess cognition, function and behavior, and disease severity staging, with instruments adapted for our milieu, and diagnosis disclosure. The present proposal contributes to the definition of standard diagnostic criteria for VaD based on various levels of evidence. It is noteworthy that only around half of the population of patients with vascular cognitive impairment present with dementia, which calls for future proposals defining diagnostic criteria and procedures for this condition

Permanent global amnesia: case report

Purpose: To present a case of permanent global amnesia related to hippocampal damage. Permanent global amnesia is a very rare condition of unknown etiology; lesions restricted to the hippocampus are uncommon, which hinders investigations of this pattern of memory loss. This case is unusually well documented, as the patient underwent extensive neuropsychological evaluations. Clinical features: A cheerful right-handed, 83-year-old retired electrician was first evaluated in 1990 for progressive difficulty in learning new information and in recalling events over the preceding 3-4 years. Tests over the next 5 years showed that the impairment was confined to episodic declarative memory. New verbal information could be stored only in episodic memory in a restricted manner, limited by short-term memory capacity. A relatively mild retrograde amnesia was detected. Semantic and implicit memory was spared, as were other functions evaluated. The patient's language and executive function were strikingly efficient. Magnetic resonance imaging of the brain showed bilateral atrophy of the hippocampi and amygdalae, ruling out conditions such as tumour growth. A diagnosis of permanent global amnesia was made. In the ensuing years, the retrograde amnesia worsened, but no new deficits were identified. Conclusion: This case, the first with a detailed cognitive examination, is evidence of a relatively pure hippocampal pattern for memory loss in permanent global amnesia.Univ Fed Sao Paulo, Dept Neurol & Neurosurg, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychobiol, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychiat, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Neurol & Neurosurg, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychobiol, BR-04023900 Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Psychiat, BR-04023900 Sao Paulo, BrazilWeb of Scienc

Another locus for autosomal dominant late onset Alzheimers disease in Brazilian families?

Univ Sao Paulo, Dept Biol, Sao Paulo, BrazilUniv Calif Los Angeles, Dept Neurol, Los Angeles, CA 90024 USAUniv Fed Pernambuco, Ctr Neurol Cognit & Comportamento, Recife, BrazilUSP, Fac Med, Dept Neurol, Sao Paulo, BrazilUNIFESP, Dept Neurol & Neurocirurgia, Sao Paulo, BrazilUNIFESP, Dept Neurol & Neurocirurgia, Sao Paulo, BrazilWeb of Scienc

Endovascular treatment of carotid artery stenosis: retrospective study of 79 patients treated with stenting and angioplasty with and without cerebral protection devices Tratamento endovascular das lesões estenóticas em bifurcação carotídea: estudo retrospectivo de 79 pacientes tratados por "stent" e angioplastia com e sem mecanismos de proteção cerebral

We evaluate the results of stenting and angioplasty on carotid bifurcation stenotic lesions using protection systems, emphasizing the indications and technical aspects. Seventy-nine patients, mean age 64.5 years were treated from February,1998 to March, 2003. All patients were included in NASCET study criteria. Forty three patients were treated without the protection systems and thirty six were treated with carotid protection filtering system (Angioguard, EPI). Technical success and 6-months carotid Doppler ultrasound follow-up showing stent patency were achieved in all patients. One major stroke and one death due to intracranial reperfusion bleeding occurred in patients treated without cerebral protection devices. Only one patient presenting hyper perfusion syndrome improving after 7 days, was found in the group treated with the cerebral protection filter mechanism, no other neurologic symptom or death occured in this group. Stenting and angioplasty with protection systems for thromboembolic debris is a safe endovascular method to treat stenotic lesions in the carotid bifurcation with low morbidity and mortality.<br>Este estudo mostra a experiência e resultados da terapêutica endovascular nas lesões estenóticas em bifurcação carotídea. Entre fevereiro de 1998 e março de 2003 foram tratados 79 pacientes com idades entre 57 e 72 anos (média 64,5 anos) sendo 45 do masculino e 34 do feminino. Todos os pacientes enquadravam-se nos critérios do estudo "NASCET" com comprometimento das artérias carótidas internas. Dos 79 pacientes, 43 foram tratados sem os sistemas de proteção e 36 pacientes foram tratados com sistema de proteção. Dos 36 pacientes tratados com sistema de proteção foram utilizados filtros de proteção (Angioguard e EPI). Observou-se melhora angiográfica em todos os 79 pacientes tratados. Ultrasom Doppler realizado após 6 meses mostrou artérias pérvias em todos os pacientes. Nos 43 pacientes tratados por "stent"/angioplastia sem a utilização de sistemas de proteção tivemos um paciente com déficit neurológico que perdurou por mais de 30 dias ("stroke major") e um óbito por transformação hemorrágica devido à reperfusão. Ocorreu síndrome de hiperperfusão em 1 paciente dos 36 pacientes tratados com o sistema de proteção, regredindo em 7 dias, sendo que nos demais não houve morbi-mortalidade. A angioplastia e "stent" no território carotídeo com a utilização de sistema de proteção é um método seguro com reduzida morbidade e mortalidade estando indicada nas lesões estenóticas das bifurcações carotídeas