Treatment Of Alzheimer's Disease In Brazil: I. Cognitive Disorders [tratamento Da Doença De Alzheimer No Brasil: I. Dos Transtornos Cognitivos]

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD) in Brazil, with special focus on cognitive disorders. It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of cognitive disorders in AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of cognitive disorders encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine and other drugs and substances) and non-pharmacological (including cognitive rehabilitation, physical activity, occupational therapy, and music therapy) approaches. Recommendations for the treatment of behavioral and psychological symptoms of dementia due to Alzheimer's disease are included in a separate article of this edition.53178188Engelhardt, E., Brucki, S.M., Cavalcanti, J.L., Forlenza, O.V., Laks, J., Vale, F.A., Treatment of Alzheimer's disease: Recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2005) Arq Neuropsiquiatr., 63, pp. 1104-1112Gronseth, G., French, J., Practice parameters and technology assessments: What they are, what they are not, and why you should care (2008) Neurology, 71, pp. 1639-1643French, J., Gronseth, G., Lost in a jungle of evidence: We need a compass (2008) Neurology, 71, pp. 1634-1638McKhann, G.M., Knopman, D.S., Chertkow, H., The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 263-269McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M., Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDAWork Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease (1984) Neurology, 34, pp. 939-944Albert, M.S., Dekosky, S.T., Dickson, D., The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging and Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 270-279Sperling, R.A., Aisen, P.S., Beckett, L.A., Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup (2011) Alzheimers Dement., 7, pp. 280-292Nordberg, A., Nicotinic receptor abnormalities of Alzheimer's disease: Therapeutic implications (2001) Biol Psychiatry, 49, pp. 200-210Peters, B.H., Levin, H.S., Effects of physostigmine and lecitin on memory in Alzheimer's disease (1979) Ann Neurol, 6, pp. 219-221Sumers, W.K., Majovski, L.V., Marsh, G.M., Oral tetrahydroaminoacridine in long-term treatment of senile dementia, Alzheimer type (1986) N Eng J Med, 315, pp. 1241-1245Corey-Bloom, J., Anand, R., Veach, J., A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetyl-chonesterase inhibitor, in patients with mild to moderately severe Alzheimer's disease (1998) Int. J Geriatr Psychopharmacol, 1, pp. 55-65Rogers, S.L., Farlow, M., Mohs, R., A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease (1998) Neurology, 50, pp. 136-145Raskind, M.A., Perskind, E.R., Wessel, T., Galantamine in AD: A 6-month randomized, placebo-controlled trial with a 6-month extension (2000) Neurology, 554, pp. 2261-2268Hansen, R.A., Gartlehner, G., Webb, A.P., Efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer's disease: A systematic review and meta-analysis (2008) Clin Interv Aging, 3, pp. 211-225Lockhart, I.A., Mitchell, S.A., Kelly, S., Safety and tolerability of donepezil, rivastigmine and galantamine for patients with Alzheimer's disease: Systematic review of the "real-world" (2009) Dem Geriat Cog Dis, 28, pp. 389-403Winblad, B., Gauthier, S., Scinto, L., Safety and efficacy of galantamine in subjects with mild cognitive impairment (2008) Neurology, 70, pp. 2024-2035Burns, A., Bernabei, R., Bullock, R., Safety and efficacy of galantamine (Reminyl) in severe Alzheimer's disease (the CERAD study): A randomized, placebo-controlled, double-blind trial (2009) Lancet Neurol, 8, pp. 39-47Farlow, M., Grossberg, G.T., Meng, X., Rivastigmine transdermal patch and capsule in Alzheimer's disease: Influence of disease stage on response to therapy (2010) Int J Geriatr Psychiatry, , Dec;23. [Epub ahead of print]Winblad, B., Black, S.E., Homma, A., Donepezil treatment in severe Alzheimer's disease: A pooled analysis of three clinical trials (2009) Curr Med Res Opin, 25, pp. 2577-2587Jarvis, B., Figgitt, D.P., Memantine (2003) Drugs Aging, 20, pp. 465-476. , discussion 77-78Reisberg, B., Doody, R., Stoffler, A., Schmitt, F., Ferris, S., Mobius, H.J., Memantine in moderate-to-severe Alzheimer's disease (2003) N Engl J Med., 348, pp. 1333-1341Tariot, P.N., Farlow, M.R., Grossberg, G.T., Graham, S.M., McDonald, S., Gergel, I., Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: A randomized controlled trial (2004) JAMA, 291, pp. 317-324Winblad, B., Jones, R.W., Wirth, Y., Stoffler, A., Mobius, H.J., Memantine in moderate to severe Alzheimer's disease: A meta-analysis of randomised clinical trials (2007) Dement Geriatr Cogn Disord, 24, pp. 20-27Atri, A., Shaughnessy, L.W., Locascio, J.J., Growdon, J.H., Long-term course and effectiveness of combination therapy in Alzheimer disease (2008) Alzheimer Dis Assoc Disord, 22, pp. 209-221Shua-Haim, J., Smith, J., Picard, F., Steady-state pharmacokinetics of rivastigmine in patients with mild to moderate Alzheimer's disease not affected by co-administration of memantine: An open-label, crossover, single-centre study (2008) Clin Drug Investig., 28, pp. 361-374Grossberg, G.T., Edwards, K.R., Zhao, Q., Rationale for combination therapy with galantamine and memantine in Alzheimer's disease (2006) J Clin Pharmacol, 46 (7 SUPPL. 1), pp. 17S-26SZhu, C.W., Livote, E.E., Kahle-Wrobleski, K., Longitudinal Medication Usage in Alzheimer Disease Patients (2010) Alzheimer Dis Assoc Disord., , Jul 9. [Epub ahead of print]McShane, R., Areosa, S.A., N. M. Memantine for dementia (2011) Cochrane Database of Systematic Reviews, (3), pp. CD003154Peskind, E.R., Potkin, S.G., Pomara, N., Memantine treatment in mild to moderate Alzheimer disease: A 24-week randomized, controlled trial (2006) Am J Geriatr Psychiatry., 14, pp. 704-715Porsteinsson, A.P., Grossberg, G.T., Mintzer, J., Olin, J.T., Memantine treatment in patients with mild to moderate Alzheimer's disease already receiving a cholinesterase inhibitor: A randomized, double-blind, placebo-controlled trial (2008) Curr Alzheimer Res, 5, pp. 83-89Doody, R.S., Tariot, P.N., Pfeiffer, E., Olin, J.T., Graham, S.M., Meta-analysis of six-month memantine trials in Alzheimer's disease (2007) Alzheimers Dement, 3, pp. 7-17Schneider, L.S., Commentary on "Meta-analysis of six-month memantine trials in Alzheimer's disease. " Wuthering forest plots: Distinguishing the forest from the plots (2007) Alzheimers Dement, 3, pp. 18-20Knopman, D.S., Commentary on "Meta-analysis of six-month memantine trials in Alzheimer's disease. " Memantine has negligible benefits in mild to moderate Alzheimer's disease (2007) Alzheimers Dement, 3, pp. 21-22Schneider, L.S., Insel, P.S., Weiner, M.W., Treatment with cholinesterase inhibitors and memantine of patients in the Alzheimer's Disease Neuroimaging Initiative (2011) Arch Neurol, 68, pp. 58-66Luo, Y., Smith, J.V., Paramasivam, V., Inhibition of amyloid-beta aggregation and caspase-3 activation by the Ginkgo biloba extract EGb761 (2002) Proc Natl Acad Sci, 99, pp. 12197-12202Smith, J.V., Luo, Y., Elevation of oxidative free radicals in Alzheimer's disease models can be attenuated by Ginkgo biloba extract EGb 761 (2003) J Alzheimer's Dis, 5, pp. 287-300Mix, J.A., Crews Jr., W.D., A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: Neuropsychological findings (2002) Hum Psychopharmacol, 17, pp. 267-277Birks, J., Evans, G., Ginkgo biloba for cognitive impairment and dementia (2009) Cochrane Database Syst Rev, (1), pp. CD003120. , Jan 21Dodge, H.H., Zitzelberger, T., Oken, B.S., A randomized placebo-controlled trial of ginkgo biloba for the prevention of cognitive decline (2008) Neurology, 70, pp. 1809-1817DeKosky, S.T., Williamson, J.D., Annette, L., Ginkgo biloba for Prevention of Dementia: A Randomized Controlled Trial (2008) JAMA, 300, pp. 2253-2262Snitz, B.E., O'Meara, E.S., Carlson, M.C., Ginkgo biloba for Preventing Cognitive Decline in Older Adults: A Randomized Trial (2009) JAMA, 302, pp. 2663-2670Berman, K., Brodaty, H., Tocopherol (vitamin E) in Alzheimer's disease and other neurodegenerative disorders (2004) CNS Drugs, 18, pp. 807-825Morris, M.C., Evans, D.A., Bienias, J.L., Vitamin E and cognitive decline in older persons (2002) Arch Neurol, 59, pp. 1125-1132Sano, M., Ernesto, C., Thomas, R.G., A controlled trial of selegiline, alphatocopherol, or both as treatment for Alzheimer's disease. The Alzheimer's Disease Cooperative Study (1997) N Engl J Med, 336, pp. 1216-1222Petersen, R.C., Thomas, R.G., Grundman, Vitamin E and Donepezil for the Treatment of Mild Cognitive Impairment (2005) N Engl J Med, 352, pp. 2379-2388Isaac, M.G., Quinn, R., Tabet, N., Vitamin E for Alzheimer disease and mild cognitive impairment (2008) Cochrane Database Syst Rev, 3, pp. CD002854Miller III, E.R., Pastor-Barriuso, R., Dalal, D., Meta-analysis: High dosage vitamin E supplemention may increase all-cause mortality (2005) Ann Intern Med, 142, pp. 37-46Dysken, M.W., Kirk, L.N., Kuskowski, M., Changes in vitamin E prescribing for Alzheimer patients (2009) Am J Geriatr Psychiatry., 17, pp. 621-624Birks, J., Flicker, L., Selegiline for Alzheimer's disease (2003) Cochrane Database Syst Rev, 1, pp. CD000442Faxén-Irving, G., Freund-Levi, Y., Eriksdotter-Jönhagen, M., Basun, H., Omega-3 Fatty Acid Supplementation Effects on Weight and Appetite in Patients with Alzheimer's Disease: The Omega-3 Alzheimer's Disease Study (2009) J Am Geriatr Soc, 57, pp. 11-17Lim, W.S., Gammack, J.K., van Niekerk, J.K., Dangour, A., Omega 3 fatty acid for the prevention of dementia (2006) Cochrane Database Syst Rev, 1, pp. CD005379Freund-Levi, Y., Basun, H., Cederholm, T., Faxén-Irving, G., Omega-3 supplementation in mild to moderate Alzheimer's disease: Effects on neuropsychiatric symptoms (2008) Int J Geriatr Psychiatry, 23, pp. 161-169Dangour, A.D., Whitehouse, P.J., Rafferty, K., B-vitamins and fatty acids in the prevention and treatment of Alzheimer's disease and dementia: A systematic review (2010) J Alzheimers Dis, 22, pp. 205-224Aisen, P.S., Schneider, L.S., Sano, M., Alzheimer Disease Cooperative Study. High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: A randomized controlled trial (2008) JAMA, 300, pp. 1774-1783Ford, A.H., Flicker, L., Alfonso, H., Vitamins B(12), B(6), and folic acid for cognition in older men (2010) Neurology, 75, pp. 1540-1547Malouf, R., Grimley Evans, J., Folic acid with or without vitamin B12 for the prevention and treatment of healthy elderly and demented people (2008) Cochrane Database Syst Rev, 4, pp. CD004514Henderson, V.W., Paganini-Hill, A., Miller, B.L., Estrogen for Alzheimer's disease in women: Randomized, double-blind, placebo-controlled trial (2000) Neurology, 54, pp. 295-301Mulnard, R.A., Cotman, C.W., Kawas, C., Estrogen replacement therapy for treatment of mild to moderate Alzheimer disease: A randomized controlled trial. Alzheimer's Disease Cooperative Study (2000) JAMA, 283, pp. 1007-1015Shumaker, S.A., Legault, C., Rapp, S.R., Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: The Women's Health Initiative Memory Study: A randomized controlled trial (2003) JAMA, 289, pp. 2651-2662Shumaker, S.A., Legault, C., Kuller, L., Conjugated equine estrogens and incidence of probable dementia and mild cognitive impairment in postmenopausal women: Women's Health Initiative Memory Study (2004) JAMA, 291, pp. 2947-2958Henderson, V.W., Estrogen-containing hormone therapy and Alzheimer's disease risk: Understanding discrepant inferences from observational and experimental research (2006) Neuroscience., 138, pp. 1031-1039Sano, M., Jacobs, D., Andrews, H., A multi-center, randomized, double blind placebo-controlled trial of estrogens to prevent Alzheimer's disease and loss of memory in women: Design and baseline characteristics (2008) Clin Trials, 5, pp. 523-533Veld, B.A., Ruitenberg, A., Hofman, A., Nonsteroidal antiinflammatory drugs and the risk of Alzheimer's disease (2001) N Engl J Med, 345, pp. 1515-1521Aisen, P.S., Schafer, K.A., Grundman, M., Effects of rofecoxib or naproxen vs placebo on Alzheimer disease progression: A randomized controlled trial (2003) JAMA, 289, pp. 2819-2826Tabet, N., Feldmand, H., Ibuprofen for Alzheimer's disease (2003) Cochrane Database Syst Rev, 2, pp. CD004031de Jong, D., Jansen, R., Hoefnagels, W., No effect of one-year treatment with indomethacin on Alzheimer's disease progression: A randomized controlled trial (2008) PLoS One., 3, pp. e1475Martin, B.K., Szekely, C., Cognitive function over time in the Alzheimer's Disease Anti-inflammatory Prevention Trial (ADAPT): Results of a randomized, controlled trial of naproxen and celecoxib (2008) Arch Neurol., 65, pp. 896-905. , ADAPT Research GroupLi, G., Higdon, R., Kukull, W.A., Statin therapy and risk of dementia in the elderly: A community-based prospective cohort study (2004) Neurology, 63, pp. 1624-1628Zamrini, E., McGwin, G., Roseman, J.M., Association between statin use and Alzheimer's disease (2004) Neuroepidemiology, 23, pp. 94-98Zhou, B., Teramukai, S., Fukushima, M., Prevention and treatment of dementia or Alzheimer's disease by statins: A meta-analysis (2007) Dement Geriatr Cogn Disord, 23, pp. 194-201Feldman, H.H., Doody, R.S., Kivipelto, M., Randomized controlled trial of atorvastatin in mild to moderate Alzheimer disease: LEADe (2010) Neurology, 74, pp. 956-964McGuinness, B., O'Hare, J., Craig, D., Bullock, R., Malouf, R., Passmore, P., Statins for the treatment of dementia (2010) Cochrane Database Syst Rev., (8), pp. CD007514. , Aug 4van Paasschen, J., Clare, L., Woods, R.T., Linden, D.E., Can we change brain functioning with cognition-focused interventions in Alzheimer's disease? The role of functional neuroimaging (2009) Restor Neurol Neurosci, 27, pp. 473-491Chapman, S.B., Weiner, M.F., Rackley, A., Hynan, L.S., Zientz, J., Effects of cognitive-communication stimulation for Alzheimer's disease patients treated with donepezil (2004) J Speech Lang Hear Res, 47, pp. 1149-1163Requena, C., Maestú, F., Campo, P., Fernández, A., Ortiz, T., Effects of cholinergic drugs and cognitive training on dementia: 2-year follow-up (2006) Dement Geriatr Cogn Disord, 22, pp. 339-345Olazarán, J., Reisberg, B., Clare, L., Nonpharmacological Therapies in Alzheimer's Disease: A Systematic Review of Efficacy (2010) Dement Geriatr Cogn Disord, 30, pp. 161-178Cotelli, M., Calabria, M., Zanetti, O., Cognitive rehabilitation in Alzheimer's disease (2006) Aging Clin Exp Res, 18, pp. 141-143Onder, G., Zanetti, O., Giacobini, E., Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: Randomised controlled trial (2005) Br J Psychiatry, 187, pp. 450-455Yamaguchi, H., Maki, Y., Yamagami, T., Overview of non-pharmacological intervention for dementia and principles of brain-activating rehabilitation (2010) Psychogeriatrics, 10, pp. 206-213Haslam, C., Gilroy, D., Black, S., Beesley, T., How successful is errorless learning in supporting memory for high and low-level knowledge in dementia? (2006) Neuropsychol Rehabil, 16, pp. 505-536Rothi, L.J., Fuller, R., Leon, S.A., Errorless practice as a possible adjuvant to donepezil in Alzheimer's disease (2009) J Int Neuropsychol Soc, 15, pp. 311-322Yu, F., Rose, K.M., Burgener, S.C., Cognitive training for early-stage Alzheimer's disease and dementia (2009) J Gerontol Nurs, 35, pp. 23-29Hogan, D.B., Bailey, P., Black, S., Diagnosis and treatment of dementia: Nonpharmacologic and pharmacologic therapy for mild to moderate dementia (2008) CMAJ, 179, pp. 1019-1026Heyn, P., Abreu, B.C., Ottenbacher, K.J., The effects of exercise training on elderly persons with cognitive impairment and dementia: A meta-analysis (2004) Arch Phys Med Rehabil, 85, pp. 1694-1704Lautenschlager, N.T., Cox, K., Kurz, A.F., Physical activity and mild cognitive impairment and Alzheimer's disease (2010) Curr Neurol Neurosci Rep, 10, pp. 352-358Forbes, D., Forbes, S., Morgan, D.G., Markle-Reid, M., Wood, J., Culum, I., Physical activity programs for persons with dementia (2008) Cochrane Database Syst Rev, 16 (3), pp. CD006489Rolland, Y., Pillard, F., Klapouszczak, A., Reynish, E., Thomas, D., Andrieu, S., Exercise program for nursing home residents with Alzheimer's disease: A 1-year randomized, controlled trial (2007) J Am Geriatr Soc, 55, pp. 158-16

Treatment Of Alzheimer's Disease [tratamento Da Doença De Alzheimer]

[No abstract available]5SUPPL. 13448Engelhardt, E., Brucki, S.M., Cavalcanti, J.L., Forlenza, O.V., Laks, J., Vale, F.A., Treatment of Alzheimer's disease: Recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2005) Arq Neuropsiquiatr, 63, pp. 1104-1112. , Departamento de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de NeurologiaGronseth, G., French, J., Practice parameters and technology assessments: What they are, what they are not, and why you should care (2008) Neurology, 71, pp. 1639-643French, J., Gronseth, G., Lost in a jungle of evidence: We need a compass (2008) Neurology, 71, pp. 1634-1638McKhann, G.M., Knopman, D.S., Chertkow, H., The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 263-269McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M., Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease (1984) Neurology, 34, pp. 939-944Albert, M.S., Dekosky, S.T., Dickson, D., Dubois, B., Feldman, H.H., Fox, N.C., (2011) The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging and Alzheimer's Association workgroup, , Alzheimers Dement Apr 20Sperling, R.A., Aisen, P.S., Beckett, L.A., Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 280-292Nordberg, A., Nicotinic receptor abnormalities of Alzheimer's disease: Therapeutic implications (2001) Biol Psychiatry, 49, pp. 200-210Peters, B.H., Levin, H.S., Effects of physostigmine and lecitin on memory in Alzheimer's disease (1979) Ann Neurol, 6, pp. 219-221Summers, W.K., Majovski, L.V., Marsh, G.M., Tachiki, K., Kling, A., Oral tetrahydroaminoacridine in long-term treatment of senile dementia, Alzheimer type (1986) N Engl J Med, 315, pp. 1241-1245Corey-Bloom, J., Anand, R., Veach, J., A randomized trial evaluating the efficacy and safety of ENA 713 (rivastigmine tartrate), a new acetyl-chonesterase inhibitor, in patients with mild to moderately severe Alzheimer's disease (1998) Int. J Geriatr Psychopharmacol, 1, pp. 55-65Rogers, S.L., Farlow, M.R., Doody, R.S., Mohs, R., Friedhoff, L.T., A 24-week, double-blind, placebo-controlled trial of donepezil in patients with Alzheimer's disease. Donepezil Study Group (1998) Neurology, 50, pp. 136-145Raskind, M.A., Peskind, E.R., Wessel, T., Yuan, W., Galantamine in AD: A 6-month randomized, placebo-controlled trial with a 6-month extension. The Galantamine USA-1 Study Group (2000) Neurology, 54, pp. 2261-2268Hansen, R.A., Gartlehner, G., Webb, A.P., Morgan, L.C., Moore, C.G., Jonas, D.E., Efficacy and safety of donepezil, galantamine, and rivastigmine for the treatment of Alzheimer's disease: A systematic review and meta-analysis (2008) Clin Interv Aging, 3, pp. 211-225Lockhart, I.A., Mitchell, S.A., Kelly, S., Safety and tolerability of donepezil, rivastigmine and galantamine for patients with Alzheimer's disease: Systematic review of the "real-world" evidence (2009) Dement Geriatr Cogn Disord, 28, pp. 389-403Winblad, B., Gauthier, S., Scinto, L., Safety and efficacy of galantamine in subjects with mild cognitive impairment (2008) Neurology, 70, pp. 2024-2035. , GAL-INT-11/18 Study GroupBurns, A., Bernabei, R., Bullock, R., Safety and efficacy of galantamine (Reminyl) in severe Alzheimer's disease (the CERAD study): A randomized, placebo-controlled, double-blind trial (2009) Lancet Neurol, 8, pp. 39-47Farlow, M.R., Grossberg, G.T., Meng, X., Olin, J., Somogyi, M., (2010) Rivastigmine transdermal patch and capsule in Alzheimer's disease: Influence of disease stage on response to therapy, , Int J Geriatr Psychiatry Dec 23. [Epub ahead of print]Winblad, B., Black, S.E., Homma, A., Donepezil treatment in severe Alzheimer's disease: A pooled analysis of three clinical trials (2009) Curr Med Res Opin, 25, pp. 2577-2587Jarvis, B., Figgitt, D.P., Memantine (2003) Drugs Aging, 20 (6), pp. 465-76. , discussion 477-8Reisberg, B., Doody, R., Stöffler, A., Schmitt, F., Ferris, S., Möbius, H.J., Memantine in moderate-to-severe Alzheimer's disease (2003) N Engl J Med, 348, pp. 1333-1341. , Memantine Study GroupTariot, P.N., Farlow, M.R., Grossberg, G.T., Graham, S.M., McDonald, S., Gergel, I., Memantine treatment in patients with moderate to severe Alzheimer disease already receiving donepezil: A randomized controlled trial (2004) JAMA, 291, pp. 317-324. , Memantine Study GroupWinblad, B., Jones, R.W., Wirth, Y., Stoffler, A., Mobius, H.J., Memantine in moderate to severe Alzheimer's disease: A meta-analysis of randomised clinical trials (2007) Dement Geriatr Cogn Disord, 24, pp. 20-27Atri, A., Shaughnessy, L.W., Locascio, J.J., Growdon, J.H., Long-term course and effectiveness of combination therapy in Alzheimer disease (2008) Alzheimer Dis Assoc Disord, 22, pp. 209-221Shua-Haim, J., Smith, J., Picard, F., Steady-state pharmacokinetics of rivastigmine in patients with mild to moderate Alzheimer's disease not affected by co-administration of memantine: An open-label, crossover, single-centre study (2008) Clin Drug Investig, 28, pp. 361-374Grossberg, G.T., Edwards, K.R., Zhao, Q., Rationale for combination therapy with galantamine and memantine in Alzheimer's disease (2006) J Clin Pharmacol, 46 (7 SUPPL. 1), pp. S17-S26Zhu, C.W., Livote, E.E., Kahle-Wrobleski, K., (2010) Longitudinal medication usage in Alzheimer disease patients, , Alzheimer Dis Assoc Disord Jul 9McShane, R., Areosa, S.A.N.M., Memantine for dementia (2011) Cochrane Database of Systematic Reviews, p. 003154Peskind, E.R., Potkin, S.G., Pomara, N., Memantine treatment in mild to moderate Alzheimer disease: A 24-week randomized, controlled trial (2006) Am J Geriatr Psychiatry, 14, pp. 704-715Porsteinsson, A.P., Grossberg, G.T., Mintzer, J., Olin, J.T., Memantine treatment in patients with mild to moderate Alzheimer's disease already receiving a cholinesterase inhibitor: A randomized, double-blind, placebo-controlled trial (2008) Curr Alzheimer Res, 5, pp. 83-89. , Memantine MEM-MD-12 Study GroupDoody, R.S., Tariot, P.N., Pfeiffer, E., Olin, J.T., Graham, S.M., Meta-analysis of six-month memantine trials in Alzheimer's disease (2007) Alzheimers Dement, 3, pp. 7-17Schneider, L.S., Commentary on "Meta-analysis of six-month memantine trials in Alzheimer's disease. " Wuthering forest plots: Distinguishing the forest from the plots (2007) Alzheimers Dement, 3, pp. 18-20Knopman, D.S., Commentary on "Meta-analysis of six-month memantine trials in Alzheimer's disease. " Memantine has negligible benefits in mild to moderate Alzheimer's disease (2007) Alzheimers Dement, 3, pp. 21-22Schneider, L.S., Insel, P.S., Weiner, M.W., Treatment with cholinesterase inhibitors and memantine of patients in the Alzheimer's Disease Neuroimaging Initiative (2011) Arch Neurol, 68, pp. 58-66. , Alzheimer's Disease Neuroimaging InitiativeLuo, Y., Smith, J.V., Paramasivam, V., Inhibition of amyloid-beta aggregation and caspase-3 activation by the Ginkgo biloba extract EGb761 (2002) Proc Natl Acad Sci U S A, 99, pp. 12197-202Smith, J.V., Luo, Y., Elevation of oxidative free radicals in Alzheimer's disease models can be attenuated by Ginkgo biloba extract EGb 761 (2003) J Alzheimers Dis, 5, pp. 287-300Mix, J.A., Crews Jr., W.D., A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: Neuropsychological findings (2002) Hum Psychopharmacol, 17, pp. 267-277Birks, J., Evans, G., Ginkgo biloba for cognitive impairment and dementia (2009) Cochrane Database Syst Rev, (1), pp. CD003120Dodge, H.H., Zitzelberger, T., Oken, B.S., Howieson, D., Kaye, J., A randomized placebo-controlled trial of ginkgo biloba for the prevention of cognitive decline (2008) Neurology, 70, pp. 1809-1817de Kosky, S.T., Williamson, J.D., Fitzpatrick, A.L., Ginkgo biloba for prevention of dementia: A randomized controlled trial (2008) JAMA, 300, pp. 2253-2262. , Ginkgo Evaluation of Memory (GEM) Study InvestigatorsSnitz, B.E., O'Meara, E.S., Carlson, M.C., Ginkgo biloba for preventing cognitive decline in older adults: A randomized trial (2009) JAMA, 302, pp. 2663-2670. , Ginkgo Evaluation of Memory (GEM) Study InvestigatorsBerman, K., Brodaty, H., Tocopherol (vitamin E) in Alzheimer's disease and other neurodegenerative disorders (2004) CNS Drugs, 18, pp. 807-825Morris, M.C., Evans, D.A., Bienias, J.L., Tangney, C.C., Wilson, R.S., Vitamin E and cognitive decline in older persons (2002) Arch Neurol, 59, pp. 1125-1132Sano, M., Ernesto, C., Thomas, R.G., A controlled trial of selegiline, alphatocopherol, or both as treatment for Alzheimer's disease. 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Treatment Of Alzheimer's Disease In Brazil: Ii. Behavioral And Psychological Symptoms Of Dementia [tratamento Da Doença De Alzheimer No Brasil: Ii. Dos Sintomas Comportamentais E Psicológicos Da Demência]

This article reports the recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology for the treatment of Alzheimer's disease (AD) in Brazil, with special focus on behavioral and psychological symptoms of dementia (BPSD). It constitutes a revision and broadening of the 2005 guidelines based on a consensus involving researchers (physicians and non-physicians) in the field. The authors carried out a search of articles published since 2005 on the MEDLINE, LILACS and Cochrane Library databases. The search criteria were pharmacological and non-pharmacological treatment of the behavioral and psychological symptoms of AD. Studies retrieved were categorized into four classes, and evidence into four levels, based on the 2008 recommendations of the American Academy of Neurology. The recommendations on therapy are pertinent to the dementia phase of AD. Recommendations are proposed for the treatment of BPSD encompassing both pharmacological (including acetyl-cholinesterase inhibitors, memantine, neuroleptics, anti-depressives, benzodiazepines, anti-convulsants plus other drugs and substances) and non-pharmacological (including education-based interventions, physiotherapy, occupational therapy, music therapy, therapy using light, massage and art therapy) approaches. Recommendations for the treatment of cognitive disorders of AD symptoms are included in a separate article of this edition.53189197Engelhardt, E., Brucki, S.M., Cavalcanti, J.L., Forlenza, O.V., Laks, J., Vale, F.A., Treatment of Alzheimer's disease: Recommendations and suggestions of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology (2005) Arq Neuropsiquiatr, 63, pp. 1104-1112Gronseth, G., French, J., Practice parameters and technology assessments: What they are, what they are not, and why you should care (2008) Neurology, 71, pp. 1639-1643French, J., Gronseth, G., Lost in a jungle of evidence: We need a compass (2008) Neurology, 71, pp. 1634-1638McKhann, G.M., Knopman, D.S., Chertkow, H., The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 263-269McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., Stadlan, E.M., Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDAWork Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease (1984) Neurology, 34, pp. 939-944Albert, M.S., Dekosky, S.T., Dickson, D., The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging and Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 270-279Sperling, R.A., Aisen, P.S., Beckett, L.A., Toward defining the preclinical stages of Alzheimer's disease: Recommendations from the National Institute on Aging and the Alzheimer's Association workgroup (2011) Alzheimers Dement, 7, pp. 1-13Apostolova, L.G., Cummings, J.L., Neuropsychiatric manifestations in mild cognitive impairment: A systematic review of the literature (2008) Dement Geriatr Cogn Disord, 25, pp. 115-126Fillit, H.M., The pharmacoeconomics of Alzheimer's disease (2000) Am J Manag Care., 6 (22 SUPPL.), pp. S1139-S1144Buhr, G.T., White, H.K., Difficult behaviors in long-term care patients with dementia (2006) J Am Med Dir Assoc, 7, pp. 180-192Interpretive guidelines for long-term care facilities, , cms.hhs.gov/manuals/downloads/som107_pp_guidelines_ltcf.pdf, Department of Health and Human Services, State Operations Manual, Appendix PP-Guidance to Surveyors for Long Term Care Facilities, Accessed August 21, 2007Shekelle, P., Maglione, M., Bagley, S., Comparative effectiveness of off-label use of atypical antipsychotics (2007) Comparative Effectiveness Review, , Effectivehealthcare.ahrq.gov/repFiles/Atypical_Antipsychotics_Final_Report.pdf, No. 6. (Prepared by the Southern California/RAND Evidence-based Practice Center under Contract 290-02-003.) Rockville, MD:Agency for Healthcare Research and QualityJanuarySultzer, D.L., Davis, S.M., Tariot, P.N., CATIE-AD Study Group. Clinical symptom responses to atypical antipsychotic medications in Alzheimer's disease: Phase 1 outcomes from the CATIE-AD effectiveness trial (2008) Am J Psychiatry, 165, pp. 844-854Carson, S., McDonagh, M.S., Peterson, K., A Systematic Review of the Efficacy and Safety of Atypical Antipsychotics in Patients with Psychological and Behavioral Symptoms of Dementia (2006) JAGS, 54, pp. 354-361Tran-Johnson, T.K., Sack, D.A., Marcus, R.N., Auby, P., McQuade, R.D., Oren, D.A., Efficacy and safety of intramuscular aripiprazole in patients with acute agitation: A randomized, double-blind, placebo-controlled trial (2007) J Clin Psychiatry, 68, pp. 111-119Grossberg, G.T., Desai, A.K., Management of Alzheimer's Disease (2003) J Gerontol, 58 A, pp. 331-353Cummings, J.L., Benson, D.F., (1992) Dementia: A clinical approach, , (2nd ed.). Boston, MA: Butterworth-HeinemannLyketsos, C.G., Colenda, C.C., Beck, C., Position statement of the American Association for Geriatric Psychiatry regarding principles of care for patients with dementia resulting from Alzheimer disease (2006) Am J Geriatr Psychiatry, 14, pp. 561-572Ballard, C.G., Thomas, A., Fossey, J., A 3-month, randomized, placebo-controlled, neuroleptic discontinuation study in 100 people with dementia: The neuropsychiatric inventory median cutoff is a predictor of clinical outcome (2004) J Clin Psychiatry, 65, pp. 114-119Ballard, C., Lana, M.M., Theodoulou, M., A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial) (2008) PLoS Med, 5, pp. e76Sink, K.M., Holden, K.F., Yaffe, K., Pharmacologic treatment of neuropsychiatric symptoms of dementia: A review of the evidence (2005) JAMA, 293, pp. 596-608de Deyn, P.P., Katz, I.R., Brodaty, H., Lyons, B., Greenspan, A., Burns, A., Management of agitation, aggression, and psychosis associated with dementia: A pooled analysis including three randomized, placebo-controlled double blind trials in nursing home residents treated with risperidone (2005) Clin Neurol Neurosurg, 107, pp. 497-508Katz, I., de Deyn, P.P., Mintzer, J., Greenspan, A., Zhu, Y., Brodaty, H., The efficacy and safety of risperidone in the treatment of psychosis of Alzheimers disease and mixed dementia: A meta-analysis of 4 placebo controlled clinical trials (2007) Int J Geriatr Psychiatry, 22, pp. 475-484Schneider, L.S., Dagerman, K.S., Insel, P., Risk of death with atypical antipsychotic drug treatment for dementia: Meta-analysis of randomized placebo-controlled trials (2005) JAMA, 294, pp. 1934-1943Sink, K.M., Holden, K.F., Yaffe, K., Pharmacological treatment of neuropsychiatric symptoms of dementia: A review of the evidence (2005) JAMA, 293, pp. 596-608Guidelines abstracted from the American Academy of Neurology's dementia guidelines for early detection, diagnosis and management of dementia (2003) J Am Geriatr Soc, 51, pp. 869-873. , AGS Clinical Practice Committee(2005) AAGP Atypical Position Statement, , http://www.aagponline.org/prof/antipsychstat_0705.asp, American Academy for Geriatric Psychiatry, Retrieved March 26, 2008, fromMadhusoodanan, S., Shah, P., Brenner, R., Gupta, S., Pharmacological treatment of the psychosis of Alzheimer's Disease: What is the best approach? 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No. CD008191Weintraub, D., Rosenberg, P.B., Drye, L.T., Sertraline for the treatment of depression in Alzheimer's disease: Week-24 outcomes (2010) Am J Geriatr Psychiatry, 18, pp. 332-340Lyketsos, C.G., DelCampo, L., Steinberg, M., Treating depression in Alzheimer disease (2003) Arch Gen Psychiatry, 60, pp. 737-746Finkel, S.I., Mintzer, J.E., Dysken, M., A randomized, placebo-controlled study of the efficacy and safety of sertraline in the treatment of the behavioral manifestations of Alzheimer's disease in outpatients treated with donepezil (2004) Int J Geriatric Psychiatry, 19, pp. 9-18Nyth, A.L., Gerhard, G., The clinical efficacy of citalopram in treatment of emotional disturbances in dementia disorders: A Nordic multicenter study (1990) Br J Psychiatry, 157, pp. 894-901Pollock, B.G., Mulsant, B.H., Rosen, J., Comparison of citalopram, perphenazine, and placebo for the acute treatment of psychosis and behavioral disturbances in hospitalized, demented patients (2002) Am J Psychiatry, 159, pp. 460-465Suktzer, D.L., Gray, K.F., Gunay, I., Does behavioral improvement with haloperidol or trazodone treatment depend on psychosis or mood symptoms in patients with dementia? (2001) J Am Geriatrics Society, 49, pp. 1294-1300Barak, Y., Plopski, I., Tadger, S., Paleacu, D., Escitalopram versus risperidone for the treatment of behavioral and psychotic symptoms associated with Alzheimer's disease: A randomized double-blind pilot study (2011) Int Psychogeriatrics, 15, pp. 1-5Chibnall, J.T., Tait, R.C., Harman, B., Luebbert, R.A., Effect of acetaminophen on behavior, well-being, and psychotropic medication use in nursing home residents with moderate-to-severe dementia (2005) J Am Geriatrics Society, 53, pp. 1921-1929Lu, P.H., Masterman, D.A., Mulnard, R., Effects of testosterone on cognition and mood in male patients with mild Alzheimer disease and health elderly men (2006) Arch Neurol, 63, pp. 177-185Gehrman, P.R., Connor, D.J., Martin, J.L., Melatonin fails to improve sleep or agitation in a double-blind randomized placebo-controlled trial of institutionalized patients with Alzheimer's disease (2009) Am J Geriatr Psychiatry, 17, pp. 166-169Scripnikov, A., Khomeno, A., Napryeyenko, O., Effects of ginkgo biloba extract EGb 761 on neuropsychiatric symptoms of dementia: Findings from a randomized controlled trial (2007) Wien Med Wochenschr, 157, pp. 295-300Doody, R.S., Gavrilova, S.I., Sano, M., Effect od dimebon on cognition, activities of daily living, behavior, and global function in patients with mild-to-moderate Alzheimer's disease: A randomized, double blind, placebo-controlled study (2008) Lancet, 372, pp. 207-215Beer, C.D., Horner, B., Almeida, O.P., Dementia in residential care: Education intervention trial (DIRECT)protocol for a randomised controlled trial (2010) Trials, 11, p. 63Perry, M., Drašković, I., Achterberg, T., Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomized controlled trial (2008) BMC Health Serv Res, 8, p. 71Cerga-Pashoja, A., Lowery, D., Bhattacharya, R., Evaluation of exercise on individuals with dementia and their carers: A randomized controlled trial (2010) Trials, 11, p. 53Pitkala, K.H., Raivio, M.M., Laakkonen, M., Tilvis, R.S., Kautiainen, H., Strandberg, T.E., Exercise rehabilitation on home-dwelling patients with Alzheimer's disease-a randomized, controlled trial. Study protocol (2010) Trials., 11, p. 92Graff, M.J.L., Vernooil-Dassen, M.J.M., Thijssen, M., Dekker, J., Hoefnagels, W.H.L., Rikkert, M.G.M.O., Community based occupational therapy for patients with dementia and their care givers: Randomised controlled trial (2006) BMJ Online, pp. 1-6Ferrero-Arias, J., Goñis-Imízcoz, M., Gonzáles-Bernal, J., Ortega-Lara, F., Silva Gonzales, A., Díez-Lopes, M., The Efficacy of Nonpharmacological Treatment for Dementia-related Apathy (2011) Alzheimer Dis Assoc Disord, pp. 1-7Raglio, A., Bellelli, G., Traficante, D., Efficacy of Music Therapy in the Treatment of Behavioral and Psychiatric Symptoms of Dementia (2008) Alzheimer Dis Assoc Disord, 22, pp. 168-172Cooke, M., Moyle, W., Shum, D., Harrison, S., Murfield, J., A Randomized Controlled Trial Exploring the Effect of Music on Quality of Life and Depression in Older People with Dementia (2010) J Health Psychol, 15, pp. 765-77

Incidence Of Clavicular Rhomboid Fossa (impression For Costoclavicular Ligament) In The Brazilian Population: Forensic Application

In the last years, anthropology has been widely explored mainly when related to bones due to its morphologic characteristics, such as the rhomboid fossa of the clavicle. This study examined the incidence of the rhomboid fossa in paired clavicles of Brazilian subjects obtained from 209 adult bodies of known age and sex (107 males and 102 females) on which postmortem examinations had been performed by the senior author. The data were submitted to qualitative statistical analysis according to Fisher. There was a statistical difference (p= 5.98 xt 10-23) between sexes related to the frequency of the rhomboid fossa. The fossa was absent in 97,1% of the female clavicles and the incidence of bilateral fossa was present in 2,9% of females. The incidence of bilateral fossa was 29% for male clavicles. The sexual or side differences in the incidence of the fossa could be found in this study, and qualitative analysis can corroborate sex determination of unidentified bodies in forensic medicine.2711216(1992) Index for Radiological Diagnosis, , American College of Radiology, 4th ed. Reston, Va: American College of RadiologyCave, A.J.E., The nature and morphology of the costoclavicular ligament (1961) J Anat, 95, pp. 170-179Cho, B.P., Kang, H.S., Articular facets of the coracoclavicular joint in Koreans (1998) Acta Anat (Basel), 163, pp. 56-62Frutos, L.R., Determination of sex from the clavicle and scapula in a Guatemalan contemporary rural indigenous population (2002) Am J Forensic Med Pathol, 23, pp. 284-288Humphrey, L.T., Dean, M.C., Stringer, C.B., Morphological variation in great ape and modern human mandibles (1999) J Anat, 195, pp. 491-513Jit, I., Kaur, H., Rhomboid fossa in the clavicles of North Indians (1986) Am J Phys Anthropol, 70, pp. 97-103Kaur, H., Jit, I., Brief communication: Coracoclavicular joint in Northwest Indians (1991) Am J Phys Anthropol, 85, pp. 457-460Molnar, P., Tracing prehistoric activities: Musculoskeletal stress marker analysis of a Stone-Age population on the island of Gotland in the Baltic Sea (2006) Am J Phys Anthropol, 129, pp. 12-23Parsons, F.G., On the proportions and characteristics of the modern English clavicle (1916) J Anat, 51, pp. 71-93Rogers, N.L., Flournoy, L.E., McCormick, W.F., The rhomboid fossa of the clavicle as a sex and age estimator (2000) J Forensic Sci, 45, pp. 61-67Wood, B.A., Li, Y., Willoughby, C., Intraspecific variation and sexual dimorphism in cranial and dental variables among higher primates and their bearing on the hominid fossil record (1991) J Anat, 174, pp. 185-20

Postprandial glycemia in healthy subjects: Which probiotic dairy food is more adequate?

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Sedimentação em leite UHT integral, semidesnatado e desnatado durante armazenamento Particle sedimentation in semi-skimmed, skimmed on whole milk UHT, during storage

Um dos maiores problemas do leite UHT é a sedimentação que ocorre durante o período de armazenamento, o que é muito reclamado pelos consumidores. O objetivo deste trabalho foi determinar a sedimentação em leite UHT integral, semidesnatado e desnatado, armazenados a 20°C e 30°C (±1°C) durante 120 dias. Nos leites pasteurizados que deram origem aos leites UHT, foram efetuadas análises físico-químicas e microbiológicas (bactérias mesófilas, psicrotróficas e láticas) e, nos leites UHT integral, semidesnatado e desnatado, avaliaram-se a acidez, pH, fervura, sensorial, integridade das embalagens e sedimentação, logo depois de embalados e no 30°, 60°, 90° e 120° dia de armazenamento. Os leites pasteurizados integral, semidesnatado e desnatado apresentaram resultados dentro dos padrões estipulados pela indústria para as bactérias mesófilas (log10 4,37 a log10 4,08UFC mL-1), psicrotróficas (log10 3,06 a log10 2,77UFC mL-1) e lácticas (log10 3,10 a log10 2,42UFC mL-1), que diferiram significativamente (P<0,05) das contagens dos leites in natura que lhes deram origem. Os valores de acidez (0,15% ácido láctico), crioscopia (-0,535 a -0,540°H), gordura, densidade (1,031 a 1,034g mL-1), ESD (8,65 a 8,93%) e pH (6,70 a 6,80) também ficaram dentro dos padrões. A partir do 60° dia de armazenamento foi observada sedimentação nos três tipos de leites UHT a 20°C (0,80 a 1,10g) e a 30°C (1,0 a 1,40g).<br>One of the biggest problems of UHT milk is the sedimentation of protein particles that occurs during the storage period, which faces rejection by the consumers. The aim of this study was to evaluate the particle sedimentation in semi-skimmed, skimmed and wholemilk, stored at 20°C, 30°C (±1) for 120 days. In pasteurized milk that yielded UHT milk physico-chemical and microbiological analisys (mesophilic, psychrotrophic and lactic acid bacteria) were carried out. In semi-skimmed, skimmed and whole milk, the acidity, pH, boiling, sensory analysis, integrity of packaging and sedimentation tests were carried out shortly after packing and at 30th, 60th, 90th and 120th days of storage. The pasteurized whole milk, semi skimmed and skimmed milk showed results within the required standards by the industry for mesophilic bacteria(log10 4.37 a log10 4.08UFC mL-1), psychrotrophic (log10 3.06 a log10 2.77UFC mL-1) and lactic acid (log10 3.10 a log10 2.42UFC mL-1) bacteria, that differed significantly (5%) of value of fresh milk from which they originate. The values of acidity (0.15% ác. láctic), freezing point (-0.535 a -0.540°H), fat, density (1.031 a 1.034g mL-1), pH (6.70 a 6.80) and degreased dry extract (8.65 a 8.93%) also were within the standards. From the 60th day of storage on, particle sedimentation was observed in the three types of UHT milk at the 20°C (0.80 a 1.10g) at the 30°C (1.0 a 1.40g)