Bipolar disorder and the risk of developing dementia : a literature review

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017In the last centuries, the concept of bipolar disorder has suffered multiple modifications at many levels, including the diagnosis and the recognition of the prognosis associated with it. Many authors, based on their clinical observations, have recently conducted studies in order to appraise the possible underlying neuroprogression of the bipolar disorder. Objectives: The aim of this review is to evaluate the existence of a correlation between bipolar disorder and the risk of developing dementia. If this proposition is verified, the target will also be determining which subtype of dementia is more often found in these patients. Methods: a literature review of key papers of all English language articles from a PubMed and b-on literature search (2007–2017) using the keywords “bipolar disorder”, “dementia”, “frontotemporal” and “staging”. In addition to all the articles identified as relevant, the search was augmented by manually reviewing bibliographies from identified reports and recent reviews. Articles were selected for review if their content was instructive to the current topic. Results: There is strong evidence that history of bipolar disorder significantly increased the risk of dementia, specifically behavioral variant frontotemporal dementia. Biomarkers, such as Brain-Derived Neurotrophic Factor and oxidative stress markers, and neuroimaging findings support the hypothesis of an underlying neuroprogression associated with bipolar disorder. Conclusion: A higher risk of dementia, specifically behavioral variant frontotemporal dementia, is patent in bipolar disorder patients. It is also evident that the likelihood of developing cognitive and functional impairment is elevated when there is inadequate treatment and, consequently, increased duration and number of the affective episodes per year. Future studies are necessary, in order to enhance these patients’ outcome, by clarifying the underlying mechanisms of this neuroprogression and, also, by defining the best possible interventions that might avoid developing dementia.Nos últimos séculos, o conceito de perturbação afetiva bipolar sofreu múltiplas modificações a diversos níveis, incluindo o diagnóstico e o reconhecimento do prognóstico associado. Vários autores, com base nas suas observações clínicas, realizaram, recentemente, estudos com o objetivo de avaliar a possível neuroprogressão subjacente a esta patologia. Objetivos: Esta revisão da literatura tem como propósito apreciar a existência de uma correlação entre perturbação afetiva bipolar e o risco de desenvolvimento de demência. Se esta proposição for verificada, o objetivo será também determinar que tipo de demência é mais frequentemente encontrado nestes pacientes. Métodos: Procedeu-se a uma revisão da literatura dos artigos em Língua Inglesa, resultantes de uma pesquisa nas plataformas PubMed e b-on (2007-2017), usando as palavras-chave “bipolar disorder”, “dementia”, “frontotemporal” e “staging”. Para além de todos os artigos identificados como relevantes, a pesquisa foi aumentada com uma revisão manual das bibliografias dos mesmos. Resultados: Há forte evidência que suporta a correlação entre o diagnóstico de perturbação afetiva bipolar e o posterior desenvolvimento de demência, especificamente a variante comportamental da demência frontotemporal. Biomarcadores e achados imagiológicos apoiam a hipótese de que há um possível mecanismo de neuroprogressão subjacente à perturbação afetiva bipolar. Conclusão: Um risco aumentado de demência, particularmente a variante comportamental da demência frontotemporal, parece estar patente nos doentes com perturbação afetiva bipolar. Também é evidente que a probabilidade de desenvolvimento de défices cognitivos e funcionais é superior, quando existe tratamento inadequado e, consequentemente, maior número e duração dos episódios afetivos. Estudos futuros são necessários, de modo a melhorar o outcome destes doentes, através do esclarecimento dos mecanismos de neuroprogressão subjacentes e, ainda, pela definição de quais as possíveis intervenções mais adequadas, de modo a evitar o desenvolvimento de demência

Growing knowledge: an overview of Seed Plant diversity in Brazil

Abstract An updated inventory of Brazilian seed plants is presented and offers important insights into the country's biodiversity. This work started in 2010, with the publication of the Plants and Fungi Catalogue, and has been updated since by more than 430 specialists working online. Brazil is home to 32,086 native Angiosperms and 23 native Gymnosperms, showing an increase of 3% in its species richness in relation to 2010. The Amazon Rainforest is the richest Brazilian biome for Gymnosperms, while the Atlantic Rainforest is the richest one for Angiosperms. There was a considerable increment in the number of species and endemism rates for biomes, except for the Amazon that showed a decrease of 2.5% of recorded endemics. However, well over half of Brazillian seed plant species (57.4%) is endemic to this territory. The proportion of life-forms varies among different biomes: trees are more expressive in the Amazon and Atlantic Rainforest biomes while herbs predominate in the Pampa, and lianas are more expressive in the Amazon, Atlantic Rainforest, and Pantanal. This compilation serves not only to quantify Brazilian biodiversity, but also to highlight areas where there information is lacking and to provide a framework for the challenge faced in conserving Brazil's unique and diverse flora