Evaluating the effect of Brainfood groups for people with mild cognitive impairment and mild dementia: preliminary mixed-methodology study

Background: Brainfood is a 5-week group intervention for people with mild cognitive impairment and mild dementia, promoting cognitive health through a Mediterranean-style diet, exercise, mindfulness and health self-management. Aims: To evaluate Brainfood acceptability and the feasibility of conducting a randomised controlled trial; in a single group study in two National Health Service (NHS) memory services. Method: Participants self-completed quantitative and semi-structured questionnaires. Recruitment, attendance and outcome completion were the primary outcomes. Results: In total, 30 of 59 people invited to Brainfood attended; of the 26 (87%) who completed baseline measures: 25 (96%) completed post-intervention quantitative measures, 16 (67%) qualitative questions and 21 (81%) attended ≥3/5 sessions. Compared with baseline, participants reported significantly higher quality of life, Mediterranean diet adherence and exercising more, up to 2 months after the groups. Participants valued the groups and felt enabled to improve their well-being. Conclusions: Brainfood was acceptable and feasible to implement in an NHS setting. Declaration of interest: A.B. and C.C. developed Brainfood - they hold a creative commons license for the manual and make it available to use for free to all. The manual evolves iteratively, but the manual used in this research study is provided in an online supplement

Synthesis, Magnetic & Spectral Studies On Some Adducts of Manganese(II) Acetylacetonate

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Toxina botunílica tipo B no manejo de distonia não-responsiva a toxina botunílica tipo A Botulinum toxin type B in the management of dystonia non-responsive to botulinum toxin type A

Injeção de toxina botulínica (BTX) é o tratamento de escolha para distonias focais. Contudo, 10% ou mais dos pacientes que recebem injeções repetitivas de BTX tipo A (BTX-A) perdem resposta (não-respondedores secundários). Uma das estratégias para o manuseio destes pacientes é tratá-los com outros serotipos de BTX. O objetivo deste artigo é descrever minha experiência com BTX tipo B (BTX-B) no manejo de pacientes com distonia focal não-respondedores secundários a BTX-A. MÉTODO: Uso aberto e não controlado de injeções de BTX-B para tratar pacientes com distonia não-respondedores secundários a BTX-A. Resposta ao tratamento foi avaliada em uma escala 0-4 (Jankovic). RESULTADOS: Quatro pacientes entraram no estudo. Paciente 1- Aos 48 anos este homem desenvolveu distonia cervical idiopática, sendo notado blefaroespasmo e distonia oromandibular cinco anos mais tarde. Ele foi tratado com 7604U de BTX-A ao longo de 23 sessões separadas por intervalo médio de 18,8 semanas (variação 6-39). Perda da resposta foi percebida após a sétima sessão. Primeiro tratamento com BTX-B produziu resposta grau 3 e duração de 3 semanas. Segunda sessão, 23500U, resultou em grau 4 com duração de 12 semanas. Paciente 2- Este homem, com síndrome de Tourette desde os 8 anos, desenvolveu blefaroespasmo tardio aos 51 anos. Em 8 sessões de injeções de BTX-A ele recebeu 550U com intervalo médio entre sessões de 8,8 semanas (intervalo 6-12). Declínio da resposta foi notado após a quinta sessão. Primeiro tratamento com BTX-B, injeção de 3000U, teve resposta grau 3 e duração de 12 semanas. Segunda sessão, 6000U, produziu escore 4. Paciente 3- Esta mulher apareceu com blefaroespasmo aos 58 anos, desenvolveu distonias laríngea e oromandibular um ano mais tarde e, aos 65 anos, surgiu distonia cervical. Em outras instituições ela recebeu 6 sessões de BTX-A. No meu serviço ela recebeu 1404U ao longo de 8 sessões com intervalo médio entre sessões de 17,4 semanas (variação 16-18). Ela se tornou não-respondedora após a nona sessão. Primeiro tratamento com BTX-B, 6000U, recebeu escore 0. A segunda sessão, 12000U, produziu escore 4.Paciente 4- Com a idade de 69 anos este homem desenvolveu distonia cranial idiopática. Antes de ser atendido por mim, ele recebeu 6 sessões de BTX-A em outros serviços. Na minha instituição ele foi tratado com dose acumulada de 730U em 4 sessões com intervalo médio entre sessões de 16,3 semanas (variação 15-18), havendo perdido a resposta na sexta sessão. Tratamento com BTX-B, 12000U, produziu escore 4 e durou 20 semanas. Efeitos colaterais: dor local (todos os pacientes) e ressecamento da boca e ptose palpebral (um paciente cada). CONCLUSÃO: Meus achados confirmam que injeções de BTX-B são eficazes e seguras para pacientes não-respondedores secundários a BTX-A. Os resultados também mostram ser necessário individualizar a dose de BTX-B para se alcançar melhores resultados.<br>BACKGROUND: Botulinum toxin (BTX) injection is the first choice treatment for focal dystonias. However 10% or more of patients who receive repetitive injections of BTX type A (BTX-A) lose response (secondary non-responders). One of the strategies to manage such patients is to treat them with another serotype. The aim of this article is to describe my experience with BTX type B (BTX-B) in the management of patients with focal dystonia who became secondary non-responders to BTX-A. METHOD: Open-label non-controlled use of BTX-B injections to treat dystonia patients who developed secondary nonresponse to BTX-A Response to treatment was rated on a 0-4 scale (Jankovic). RESULTS: Four patients entered the study. Pacient 1- At age 48 this man developed idiopathic cervical dystonia. Five years later he also presented with blepharospasm and idiopathic oromandibular dystonia. He was treated with 7604U of BTX-A along 23 sessions separated by a mean interval of 18.8 weeks (range 6-39). Loss of response was noticed after the seventh session. First treatment with BTX-B consisted of injection of 20000U with response rated 3 but duration of 3 weeks. Second session, 23500U, resulted in score 4 with response lasting 12 weeks. Patient 2- This man, with Tourette syndrome since age 8 years, developed tardive blepharospasm at age 51. On 8 sessions of BTX-A injections he received a cumulative dosage of 550U with a mean interval between sessions of 8.8 weeks (range 6-12). Decline of response was noticed after the fifth session. First treatment with BTX-B, 3000U, had a response rated 3 with duration of 12 weeks. Second session, 6000U, resulted in score 4. Patient 3- This woman noticed onset of blepharospasm at age 58 and developed oromandibular and laryngeal dystonia as well as cervical dystonia, respectively, at ages 59 and 65. In other institutions she received 6 sessions of BTX-A. In my service she received a dosage of 1404U along 8 sessions with a mean interval between sessions of 17.4 weeks (range 16-18). She became secondary non-responder after the ninth session. First treatment with BTX-B, 6000U, was rated 0. Second session, 12000U, was rated 4. Patient 4- At age 69 this man developed idiopathic cranial dystonia. Prior to follow up with me, he received 6 sessions of BTX-A in other services. In my institution he was treated with a cumulative dosage of 730U along 4 sessions with a mean interval between sessions of 16.3 weeks (range 15-18). He developed loss of response on the sixth session. Treatment with BTX-B, 12000U, was rated 4 and lasted 20 weeks. Side-effects: local pain (all patients) and dryness of mouth and ptosis (one patient each). CONCLUSION: My findings confirm that BTX-B injections are a safe and effective option for the management of dystonia patients who become secondary non-responders to BTX-A. The results also underscore the need of individualizing dosage regimens before optimum results are achieved