Search

Attention deficit hyperactivity disorder (ADHD) is one of the most frequent childhood psychiatric problems., Objective: The objective of this study was to identify, synthesize the results, and critically evaluate all Cochrane systematic reviews (SRs) on the pharmacological interventions for children and adolescents (up to age 18) diagnosed with ADHD., Methods: The search was performed in the Cochrane Database of Systematic Reviews (via Wiley) in July 2020., Results: The search strategy resulted in four SRs of high methodological quality, analyzing 51 randomized clinical trials (9,013 participants). Compared to placebo, treatment with tricyclic antidepressants (TCAs) (desipramine), amphetamine, and methylphenidate showed improvement in symptoms such as difficulty concentrating, impulsivity, and hyperactivity in the short term (up to 6 months). There was an increase in the occurrence of adverse events, such as reduced appetite, difficulty sleeping, and abdominal pain. Insufficient evidence was found to support the effects of supplementation with polyunsaturated fatty acids., Conclusions: The use of TCAs, amphetamine, and methylphenidate in children and adolescents with ADHD seems to present positive effects and higher rates of minor adverse events when compared to placebo., Competing Interests: Disclosure: The authors report no conflicts of interest.

The world population is aging fast and not all cities are prepared to cope with the needs of the elderly people. Cities need to develop strategies for senior citizens including the aspects of health, nutrition, consumer protection, housing, transportation, environment, social welfare, income, employment, safety, and education. The World Health Organization (WHO) created a program dedicated to older adults called the age-friendly city . This program is about creating the environment and opportunities that enable older people to be and do what they value throughout their lives. Most of the elderly population lives in urban spaces, and aging represents a challenge as well as opportunities to the cities all over the world. Recently, only 16 Brazilian cities have received the seal of international certification by meeting the requirements stipulated by the WHO. In the State of Sao Paulo, only two cities have been qualified for this seal. Therefore, the aims of this article are (a) to provide a brief history of this important initiative taken by the WHO and (b) to urge the decision-makers of Brazilian municipalities to develop effective initiatives for their cities to be prepared for this demographic modification., Competing Interests: Disclosure: The authors report no conflicts of interest.

Alexithymia is a personality trait characterized by difficulties identifying and describing feelings. Some researchers describe high levels of alexithymia among patients with multiple sclerosis (MS) but literature data on this subject are scarce., Objective: The objective of the present study was to characterize findings of alexithymia in patients with MS., Methods: This cross-sectional case-control study included 180 patients with MS and a matched control group. Data for patients with MS included disease duration, number of demyelinating relapses and degree of neurological disability, as assessed by the Expanded Disability Scale Score (EDSS). In addition, the Hospital Anxiety and Depression (HAD) scale and the Toronto Alexithymia Scale (TAS) were used., Results: There were 126 women and 54 men in each group, with median age of 37 years and median education of 16 years. Patients with MS had higher degrees of depression (p<0.01), anxiety (p=0.01) and alexithymia (p<0.01) than did control subjects. For individuals with MS, depressive traits (p<0.01), anxious traits (p=0.03), higher age (p=0.02), lower education level (p=0.02), higher degree of disability (p<0.01) and not being actively employed (p=0.03) were associated with higher rates of alexithymia., Conclusion: Alexithymia was a relevant finding in patients with MS., Competing Interests: Disclosure: The authors report no conflicts of interest.

Background: Over the last 30 years, a variety of studies reporting the effects of vitamin A on memory have been published., Objective: To perform a rigorous systematic review of the literature on vitamin A and memory in order to organize evidence-based data on the subject., Methods: Four authors carried out the systematic review in accordance with strict guidelines. The terms "vitamin A" OR "retinol" OR "retinoic acid" AND "memory" OR "cognition" OR "Alzheimer" were searched in virtually all medical research databases., Results: From 236 studies containing the key words, 44 were selected for this review, numbering 10 reviews and 34 original articles. Most studies used animal models for studying vitamin A and cognition. Birds, mice and rats were more frequently employed whereas human studies accounted for only two reports on brain tissue from autopsies and one on the role of isotretinoin in cognition among individuals taking this medication to treat acne., Conclusion: Vitamin A may be an important and viable complement in the treatment and prevention of Alzheimer's disease. Clinical trials are imperative and, at present, there is no evidence-based data to recommend vitamin A supplementation for the prevention or treatment of Alzheimer's disease., Competing Interests: Disclosure: The authors report no conflicts of interest.

Background: The association between diabetes mellitus and cognitive dysfunction is becoming increasingly clear, rendering it necessary for physicians in charge of diabetic patients to have the means to assess cognitive performance. Simple tests that can be applied during routine consultations may be useful for monitoring cognitive function during the course of diabetes., Objective: The objective of the present study was to assess cognition in diabetes mellitus type II (DM-II) using simple tests that can be incorporated into routine medical practice., Methods: A cross-sectional study including healthy controls and DM-II patients was carried out between May and September 2011. Volunteers aged 60 years and over were assessed by means of figure recognition, verbal fluency and the 10×36 tests., Results: A group of 100 participants was divided into a subgroup of 50 DM-II patients and a subgroup of 50 healthy volunteers. No statistical difference regarding demographic characteristics was found between the two groups. Results on the 10×36 test showed significantly worse performance among DM-II patients (p<0.0001). Assessment of the DM-II subgroup in terms of disease duration showed statistically significant differences (p<0.001) on figure recognition and verbal fluency, with worse cognitive performance among individuals with longer disease duration, irrespective of gender or age., Conclusion: Figure recognition, verbal fluency and 10×36 tests are easy to apply and could be used in routine medical practice for the early detection of cognitive dysfunction among patients with DM-II., Competing Interests: Disclosure: The authors report no conflicts of interest.

Objectives: To report on four new cases of severe cognitive impairment in the early stages of multiple sclerosis (MS) and to review data on the subject since few cases have been reported worldwide., Methods: Retrospective evaluation of medical records of patients with severe cognitive impairment within the first five years of MS diagnosis. Results on neuropsychological tests and magnetic resonance imaging (MRI) were disclosed., Results: Four patients from different Brazilian neurological departments in Brazil were evaluated, all presenting with severe cognitive dysfunction classified as rapidly developing dementia. MRI images showed severe brain atrophy and basal ganglia lesions in all patients., Conclusions: Although rare, severe cognitive impairment in MS represents an important disability and may ultimately constitute another form of the disease., Competing Interests: Disclosure: The authors report no conflicts of interest.