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The following chapter is going to encompass a different perspective of concussion and chronic traumatic encephalopathy (CTE) linked to the National Football League (NFL). The existence of brain trauma/concussion centers, specialized neurologists, and multidisciplinary care teams and the creation of concussion policies and action plans are results of the last two decades of scientific findings. Over this long period of time, concussion protocols to be applied during football games were created and updated. Concussion policies and laws were built and approved in several states all over the USA. There were educating programs for coaches, physical trainers, and teachers in local schools and teams. Information about concussion in sport was broadcasted widely and local communities became engaged in protecting their players/students. At present, it’s safer to play American football than 20 years ago.

Made available in DSpace on 2021-07-14T10:40:09Z (GMT). No. of bitstreams: 0 Previous issue date: 2011. Added 1 bitstream(s) on 2021-07-14T11:35:25Z : No. of bitstreams: 1 S1980-57642011000400288.pdf: 1214611 bytes, checksum: ecec34466cc7e7ca04559a53f83bec5c (MD5) Em 2005, o Departamento Científico de Neurologia Cognitiva e do Envelhecimento da ABN publicou as recomendações para o diagnóstico da Doença de Alzheimer. Essas recomendações foram revisadas através de buscas em bases de dados PUBMED, SCIELO e LILACS, buscando evidências nacionais e internacionais sobre esses temas. Este artigo de revisão tem como objetivos: 1) apresentar as evidências encontradas em bases de dados brasileiras (LILACS, SCIELO) e internacionais (MEDLINE), até maio de 2011, sobre o diagnóstico diferencial desses transtornos psiquiátricos com demência, tendo como foco especial a demência de Alzheimer e a demência vascular, incluindo os exames complementares que podem auxiliar neste processo diagnóstico; e 2) propor recomendações que podem ser úteis a clínicos e pesquisadores envolvidos com o diagnóstico de pacientes com demência. O diagnóstico diferencial entre demência e outros transtornos neuropsiquiátricos deve sempre incluir a avaliação de depressão, delirium, e o uso de substâncias psicoativas, tais como benzodiazepínicos, antiepilépticos e o padrão de consumo de bebidas alcoólicas. In 2005, the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology published recommendations for the diagnosis of Alzheimer's disease These recommendations were updated following a review of evidence retrieved from national and international studies held on PUBMED, SCIELO and LILACS medical databases. The main aims of this review article are as follows: 1) to present the evidence found on Brazilian (LILACS, SCIELO) and International (MEDLINE) databases from articles published up to May 2011, on the differential diagnosis of these psychiatric disorders and dementia, with special focus on Dementia due to Alzheimer's and vascular dementia, including a review of supplementary exams which may facilitate the diagnostic process; and 2) to propose recommendations for use by clinicians and researchers involved in diagnosing patients with dementia. Differential diagnosis between dementia and other neuropsychiatric disorders should always include assessments for depression, delirium, and use of psychoactive substances, as well as investigate the use of benzodiazepines, anti-epileptics and pattern of alcohol consumption. University of São Paulo School of Medicine, Institute of Psychiatry of Clínicas Hospital Universidade Federal de Ciências da Saúde de Porto Alegre, Hospital de Clínicas de Porto Alegre University of São Paulo, School of Medicine Universidade Estadual Paulista, Faculdade de Filosofia e Ciências Universidade Estadual Paulista, Faculdade de Filosofia e Ciências

ObjectiveWe aimed to evaluate the self-reported concussion knowledge of the general population, to observe and describe any gaps in the knowledge and misconceptions, and to identify the variables that influence the concussion knowledge.BackgroundConcussion represents 80–90% of Traumatic Brain Injury (TBI) causes and its higher incidence is related to sports. The United States Centers for Disease Control estimates a TBI annual incidence ranging from 1.6 to 3.8 million cases, including concussions related to sport. Thus, it is seen as a public health priority. Adequate general population knowledge is a critical issue to correct diagnosis and management of concussion.Design/MethodsWe conducted a cross-sectional descriptive survey. A Concussion knowledge Questionnaire (CKQ) was created to capture data on concussion identification and causes, concussion consequences, recovery and management, and sport-related concussion The number of the sample correct and incorrect answers was calculated to measure the percent of concussion knowledge by CKQ domain.ResultsThe sample was formed by 1247 Brazilian adults with a mean age of 41.7 (±11.8) years and high level of schooling. The total score in the CKQ was a mean of 20 (±10) points, which corresponds to a rate of 41.6% of correct answers. Thus, there is poor knowledge in all domains of the CKQ. Only 35.5% of correct answers were registered regarding the main symptoms of a concussion. Similarly, the higher number of incorrect answers was related to questions about recovery and management of a concussion.ConclusionsOur study is the first to examine the concussion knowledge in a sample of Brazilian adults and provide useful information for development of concussion education programs. Our findings suggest very poor concussion knowledge in sample studied. More larger and meaningful research is needed to investigate the concussion knowledge and the variables that may interfere in the knowledge of the Brazilian general.

Este trabalho investigou a existencia de dissociacao entre seres vivos e artefatos em dois estudos: um com adultos tipicos e outro com a descricao dedois pacientes que receberam diagnosticos de Demencia Semântica (DS) ou de Doenca de Alzheimer (DA). Para tanto, foram utilizadas as provasde fluencia verbal, nomeacao, compreensao e definicao da Bateria de Memoria Semântica de Cambridge. Entre os adultos tipicos, o numero deacertos em seres vivos foi maior na nomeacao, definicao e fluencia verbal. Diante do controle das covariaveis sociodemograficas correlacionadas comas tarefas, nao se encontraram diferencas significativas. Ja a investigacao dos dois casos identificou diferentes perfis de disturbio nas provas. Sugere-seque o paciente com DS teve dupla-dissociacao em relacao aos controles e a paciente com DA. Os resultados foram discutidos com base em modelosde organizacao do conhecimento semântico e correlatos neuroanatomicos.

Background: The assessment of activities of daily living (ADL) is important both for the diagnosis and staging of dementia. The objective of this study was to verify the applicability and validity of the Brazilian version of the Disability Assessment for Dementia (DAD-Br). Methods: The DAD was applied to caregivers of 89 patients with probable Alzheimer disease (AD) and to 40 elderly individuals without cognitive impairment (controls). We assessed the construct validity of the scale and its diagnostic accuracy (sensitivity, specificity, and predictive value). In addition, intergroup and intragroup analyses were conducted to characterize patient performance on basic and instrumental ADL and to determine underlying deficits (initiation, planning, or effective execution). Results: AD patients and controls had mean ages of 76.4 ± 6.9 years and 74.5 ± 7.3 years (P = 0.08), respectively. Mean Mini-Mental State Examination scores were 17.4 ± 5.0 and 26.1 ± 5.1 (P < 0.001) and scores on the DAD were 68.4 ±19.0 and 99.8 ± 0.9 (P < 0.001), for patients and controls, respectively. The DAD scale showed good internal consistency (Cronbach α = 0.77) and correlation with the Mini-Mental State Examination (r = 0.44; P < 0.001). The AD group did better on basic ADL than on instrumental ADL (P < 0.001). As expected, controls did not exhibit significant deficits on the items evaluated. Conclusion: The Brazilian version of the DAD is an adequate and reliable tool for assessing functional ability in AD patients.

The Brief Cognitive Battery-Edu (BCB-Edu) contains nine tests, seven of which are related to the memory of drawings, and has good accuracy in the diagnosis of cognitive impairment. Objectives: To evaluate the influence of age, gender and educational level on the performance in tests related to memory of drawings of the BCB-Edu in healthy subjects. Methods: Participants were adult volunteers; exclusion criteria were illiteracy, neurologic or psychiatric disorders, visual or hearing impairment, untreated chronic clinical conditions, alcoholism, use of drugs, and for those aged 65 or over, an informant report of cognitive or functional impairment. We evaluated 325 individuals (207 women), with a mean age of 47.1 (±16.8) years, ranging from 19 to 81, and a mean of 9.8 (±5.0) schooling-years. Univariate analyses, correlations and logistic regression were employed (a=0.05). Results: There were significant negative correlations between age and the scores in four of the seven tests. However, schooling-years were positively correlated to the scores, where schooling-years decreased with age in this sample (rho= -0.323; p

A versão original da Escala de Avaliação de Incapacidade em Demência (Disability Assessment for Dementia, DAD) foi traduzida para a língua portuguesa e retrotraduzida para o inglês. Divergências de tradução foram identificadas e discutidas, chegando-se a uma versão que foi submetida a pré-teste para adaptação sócio-cultural. A versão final foi administrada a amostra de 29 pacientes com doença de Alzheimer provável de leve a moderada. Os coeficientes de correlação da DAD foram 0,929 e 0,932 nas avaliações inter e intra-examinadores respectivamente. Os índices de confiabilidade também foram elevados (Kappa=0,72; p

A dementia pugilistica é caracterizada clinicamente por declínio cognitivo, alterações de comportamento e sinais parkinsonianos. Do ponto de vista neuropatológico, o achado mais marcante é o de numerosos emaranhados neurofibrilares no córtex cerebral na virtual ausência de placas senis. O objetivo deste artigo é apresentar revisão do tema, enfatizando as alterações cognitivas, epidemiologia, neuropatologia, estratégias de detecção precoce e relação com a doença de Alzheimer.Dementia pugilistica is characterized by cognitive decline, behavioral changes, and parkinsonian signs. The most remarkable neuropathological finding is the large amount of neurofibrillary tangles and virtual absence of senile plaques. The aim of the study is to revise the subject, particularly the clinical picture, epidemiology, neuropathology, the strategies for early detection of cognitive signs, and its relation with Alzheimer's disease.

Lung disease with chronic hypoxia has been associated with cognitive impairment of the subcortical type. Objectives: To review the cognitive effects of chronic hypoxia in patients with lung disease and its pathophysiology in brain metabolism. Methods: A literature search of Pubmed data was performed. The words and expressions from the text subitems including "pathophysiology of brain hypoxia", "neuropsychology and hypoxia", "white matter injury and chronic hypoxia", for instance, were key words in a search of reports spanning from 1957 to 2009. Original articles were included. Results: According to national and international literature, patients with chronic obstructive pulmonary disease and sleep obstructive apnea syndrome perform worse on tests of attention, executive functions and mental speed. The severity of pulmonary disease correlates with degree of cognitive impairment. These findings support the diagnosis of subcortical type encephalopathy. Conclusion: Cognitive effects of clinical diseases are given limited importance in congresses and symposia about cognitive impairment and its etiology. Professionals that deal with patients presenting cognitive loss should be aware of the etiologies outlined above as a major cause or potential contributory factors, and of their implications for treatment adherence and quality of life. Resumo As doenças pulmonares que cursam com hipóxia crônica tem sido associadas à alteração cognitiva do tipo subcortical. Objetivo: Revisar os efeitos cognitivos da hipóxia crônica em pacientes com doenças pulmonar e sua fisiopatologia. Métodos: Foi utilizado o banco de dados do Pubmed. As palavras e expressões foram os temas dos subitens da revisão como, por exemplo, "fisiopatologia e hipóxia cerebral", "neuropsicologia e hipoxia", "lesões de substância branca e hipóxia crônica", variando de 1957 to 2009. Artigos originais foram incluídos. Resultados: De acordo com a literatura nacional e internacional, pacientes com doença pulmonar obstrutiva crônica e síndrome da apnéia obstrutiva do sono apresentam desempenho pior em testes neuropsicológicos que avaliam atenção, funções executivas e velocidade de processamento mental. Esses achados configuram uma encefalopatia do tipo subcortical. Conclusion: É dada importância limitada às conseqüências cognitivas das doenças clínicas em congressos e simpósios sobre cognição e suas etiologias. Profissionais que lidam com pacientes que apresentam perda cognitiva devem suspeitar das etiologias mencionadas acima com causa principal ou como co-fatores, assim com suas implicações na aderência ao tratamento e qualidade de vida.

The Informant Questionnaire on Cognitive Decline in the Elderly with the Proxy (IQCODE) was developed as a screening tool for cognition alterations. Objectives: 1) To verify the applicability of IQCODE in the elderly with limited schooling, 2) To verify the reliability of the responses supplied by the aged and their proxies. Methods: Individuals of a Community Group were evaluated using the Mini-Mental State Examination (MMSE), IQCODE and Geriatric Depression Scale (GDS). The IQCODE was applied to informants and proxies. Results: We analyzed 44 individuals, aged between 58-82 years (M=66.8, SD=5.97) with mean elderly-schooling level of 3.75, SD=2.82 and 44 proxies aged 44.5 (SD=13.3), with mean schooling level of 8.25 (SD=4.3). The mean GDS was 8.22, SD=4.90 and 13 participants presented a score suggestive of depressive symptoms. The mean elderly IQCODE score was 3.26, SD=0.69 and 3.21, SD=0.65, for proxy responses. There was no statistical difference between these means. On the MMSE, the mean score was 24.20, SD=4.14 and 18 participants presented scores below the cut-off. The IQCODE answers by the elderly in this latter group were more congruent with MMSE than the answers of proxies. Conclusions: The applicability of the IQCODE in a population with little schooling was verified in that the proxy-report was similar to the elderly report. We can affirm that the elderly answers were more accurate than the proxies, as they were closer to MMSE score. The inclusion of a greater number of participants from community-dwelling settings is necessary to confirm the results obtained in this study. Resumo O questionário ao informante sobre declínio cognitivo do idoso (IQCODE) foi desenvolvido como instrumento de detecção de alterações cognitivas. Objetivos: 1) Verificar a aplicabilidade do questionário IQCODE a idosos com escolaridade restrita e 2) verificar a concordância de respostas entre eles e seus representantes. Métodos: Foram examinados indivíduos de um grupo comunitário com o Mini-Exame do Estado Mental (MEEM), IQCODE e Escala de Depressão Geriátrica (GDS). O IQCODE foi aplicado aos idosos e seus representantes. Resultados: Foram avaliados 44 indivíduos, com idade entre 58 a 82 anos (M=66,8, DP=5,97) escolaridade média de 3,75 (DP=2,82) e 44 representantes cuja média de idade foi de 44.5 (DP=13.3) e média de escolaridade de 8.25 (DP=4.3). A média do GDS aplicado aos idosos foi de 8,22, DP=4,90 e 13 indivíduos apresentaram escore sugestivo de sintomas depressivos. A média do IQCODE dos idosos foi de 3,26 (DP=0,69) e dos representantes 3,21 (DP=0,65). Não houve diferença estatística entre essas médias. O escore médio do MEEM foi de 24,20 (DP=4,14) e 18 participantes apresentaram pontuação abaixo da nota de corte para escolaridade. As respostas dos idosos ao IQCODE nesse último grupo foram mais congruentes com os escores do Mini-exame do estado mental do que as dos representantes. Conclusões: A aplicabilidade do IQCODE diretamente ao idoso com restrita escolaridade foi possível. As respostas dos representantes foram similares a dos idosos. Podemos admitir que as respostas dos idosos foram mais acuradas, uma vez que estavam mais próximas das notas do MEEM. A ampliação da amostra e incluindo participantes de outras comunidades é necessária para comprovação dos resultados obtidos.

OBJETIVO: Tradução e adaptação da escala Cornell de depressão em demência e verificação da confiabilidade entre e intra-examinadores da versão na língua portuguesa. MÉTODO: A versão original da Escala Cornell foi traduzida para o português por firma especializada em tradução de textos médicos e retrotraduzida para o inglês por outros dois tradutores independentes. As divergências de tradução foram identificadas e discutidas, chegando-se à versão que foi submetida à pré-teste para adaptação sócio-cultural. Após esta adaptação, obteve-se a versão final que foi administrada a amostra de 29 pacientes com doença de Alzheimer provável e aos seus cuidadores. RESULTADOS: A versão final da escala mostrou-se de fácil aplicação e obteve boa confiabilidade intra-examinador (Kappa=0,77; p

A 61-year-old ex-boxer presented with a three-year history of progressive memory decline. During a seven-year follow-up period, there was a continuous cognitive decline, very similar to that usually observed in Alzheimer's disease. Parkinsonian, pyramidal or cerebellar signs were conspicuously absent. Neuropathological examination revealed the typical features of dementia pugilistica: cavum septi pellucidi with multiple fenestrations, numerous neurofibrillary tangles in the cerebral isocortex and hippocampus (and rare senile plaques). Immunohistochemistry disclosed a high number of tau protein deposits and scarce beta-amyloid staining. This case shows that dementia pugilistica may present with clinical features practically undistinguishable from Alzheimer's disease. Um ex-boxeador de 61 anos apresentou-se com história de três anos de perda progressiva de memória e evoluiu com declínio cognitivo lentamente progressivo, sugestivo de doença de Alzheimer, durante seguimento de sete anos. Sinais parkinsonianos, piramidais ou cerebelares estiveram ausentes durante toda a evolução. Exame neuropatológico evidenciou características típicas de dementia pugilistica: cavum do septo pelúcido com múltiplas fenestrações, numerosos emaranhados neurofibrilares no isocórtex cerebral e hipocampo (e raras placas senis). Imuno-histoquímica confirmou número elevado de depósitos de proteína tau e raros de beta-amilóide. Este caso demonstra que dementia pugilistica pode apresentar quadro clínico indistinguível daquele da doença de Alzheimer.

Translating and adapting the Cornell scale for depression in dementia to the Portuguese language and verifying the interrater and test-retest reliability of the translated and adapted version.The Cornell scale was translated into Portuguese and back translated into English. Divergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers.The Cornell Scale presented good interrater (Kappa=0,77; p0,001) and test-retest reliability (Kappa=0,76; p0,001). The final version was easy to administer and well understood by the caregivers.The Brazilian version of the Cornell Scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evaluation and follow-up of depressed patients with dementia in our population and may also be used in multicentric studies with Brazilian population.

High signal in the cerebral cortex and/or basal ganglia on diffusion-weighted magnetic resonance imaging (DW-MRI) has been described as a good diagnostic marker for sporadic Creutzfeldt-Jakob disease (sCJD). We report a case of sCJD with atypical clinical evolution and unusual DW-MRI findings. A 53-year-old man was seen with a 2-year history of a rapidly progressive dementia and cerebellar ataxia. Cerebrospinal fluid analysis, including the test for 14-3-3 protein, was normal. EEG did not show periodic activity. However, DW-MRI showed gyriform hyperintensity involving practically the entire cortical ribbon of the left hemisphere, whilst being limited to the posterior cingulate gyrus in the right hemisphere. DNA analysis showed no mutations or insertions in the prion protein gene, and homozigozity for methionine in codon 129. A subsequent brain biopsy confirmed the diagnosis of CJD. Thus, high signal on DW-MRI may be limited to the cerebral cortex and may present a very asymmetric distribution in sCJD. Hipersinal no cortex cerebral e/ou nos gânglios da base observado com a técnica de difusão da ressonância magnética (RM-DIF) tem sido descrito como bom marcador diagnóstico da doença de Creutzfeldt-Jakob esporádica (DCJe). Relatamos caso de DCJe com evolução clínica atípica e achados incomuns na RM-DIF. Homem de 53 anos foi examinado com história de dois anos de demência rapidamente progressiva e ataxia cerebelar. Exame do líquido cefalorraqueano, incluindo pesquisa da proteína 14-3-3, foi normal; EEG não revelou atividade periódica; RM-DIF mostrou hiperintensidade nos giros que afetava quase inteiramente o manto cortical do hemisfério cerebral esquerdo e que no hemisfério direito se limitava à parte posterior do giro cíngulo. Análise do DNA revelou ausência de mutação ou de inserção no gene da proteína priônica e a presença de homozigose para metionina no códon 129. Biópsia cerebral confirmou o diagnóstico de DCJ. Hipersinal na RM-DIF pode ser limitado ao córtex cerebral e pode distribuir-se de modo muito assimétrico na DCJe.

A dementia pugilistica é caracterizada clinicamente por declínio cognitivo, alterações de comportamento e sinais parkinsonianos. Do ponto de vista neuropatológico, o achado mais marcante é o de numerosos emaranhados neurofibrilares no córtex cerebral na virtual ausência de placas senis. O objetivo deste artigo é apresentar revisão do tema, enfatizando as alterações cognitivas, epidemiologia, neuropatologia, estratégias de detecção precoce e relação com a doença de Alzheimer. Dementia pugilistica is characterized by cognitive decline, behavioral changes, and parkinsonian signs. The most remarkable neuropathological finding is the large amount of neurofibrillary tangles and virtual absence of senile plaques. The aim of the study is to revise the subject, particularly the clinical picture, epidemiology, neuropathology, the strategies for early detection of cognitive signs, and its relation with Alzheimer's disease.

Introdução: O traumatismo cranioencefálico (TCE) caracteriza-se por ser uma lesão não degenerativa e não congênita e que é provocado por uma força mecânica externa. Espera-se um prejuízo, permanente ou temporário, nas funções cognitiva, física e psicossocial, com diminuição ou alteração do estado de consciência. As consequências residuais pós-TCE acometem de forma diferente cada paciente. A maioria das pessoas que sofrem traumas leves tem um processo de recuperação sem grandes complicações, e são capazes de retornar às suas atividades pré-trauma. Entretanto, a maioria dos pacientes que sofrem de TCE moderado e grave apresentam sequelas e limitações. Uma das opções medicamentosas vigentes e descritas em relatos de casos são os inibidores de acetilcolinesterase que mostram benefícios significativos quanto a melhora atencional e principalmente da memória quando utilizados em paciente na fase crônica pós TCE. Objetivo: Investigar a eficácia da rivastigmina em pacientes com comprometimento cognitivo crônico após o TCE. Métodos: Foi realizado um estudo duplo-cego, controlado com placebo em pacientes com TCE. Catorze pacientes com TCE (sete que tomaram o remédio ativo e sete que tomaram placebo) entre 18 e 70 anos completaram o estudo. Os pacientes foram randomizados em dois grupos, para receber rivastgmina ou placebo. Utilizou-se para análise dos dados comparativos entre grupo medicamento e placebo, análise estatística Z escore, teste T, qui-quadrado, correlação com o EEG e teste de correlação. Resultados: Observou-se que os pacientes que receberam a rivastigmina apresentaram melhora nos testes Cubos, BAI e memória visual de evocação imediata. No entanto, estas diferenças não foram estatisticamente significativas pelos padrões usualmente utilizados em trabalhos da área médica (alfa de 5%). Conclusão: Os resultados obtidos em pacientes com TCE apontam uma tendência que o tratamento medicamentoso com rivastigmina (medicação anti-colinesterásica) pode favorecer a estabilização ou resultar até mesmo em melhora dos déficits cognitivos, emocionais e funcionais. São necessários mais estudos com número maior de pacientes para aprofundarmos os achados aqui encontrados Introduction: Traumatic brain injury (TBI) is characterized by a nondegenerative and non-congenital injury and is caused by an external mechanical force. Permanent or temporary impairment is expected in cognitive, physical and psychosocial functions, with a decrease or alteration of the state of consciousness. The residual consequences after TBI affect each patient differently. Most people who suffer mild trauma have a recovery process without major complications and are able to return to their pre-trauma activities. However, most patients suffering from moderate and severe TBI have sequelae and limitations. One of the current and described drug options in case reports are acetylcholinesterase inhibitors that show significant benefits in terms of attentional and especially memory improvement when used in patients in the chronic phase after TBI. Objective: To investigate the efficacy of rivastigmine in patients with chronic cognitive impairment after TBI. Methods: A double-blind, placebo-controlled study was performed in patients with TBI. Fourteen patients with TBI (seven who took the active drug and seven who took placebo) between 18 and 70 years completed the study. Patients were randomized into two groups to receive rivastgmin or placebo. To analyze the comparative data between drug group and placebo, statistical analysis Z score, T test, chi-square, correlation with the EEG and correlation test were used. Results: It was observed that the patients who received rivastigmine presented improvement in the Cubus, BAI and visual memory of immediate recall. However, these differences were not statistically significant by the standards commonly used in medical papers (5% alpha). Conclusion: The results obtained in patients with TBI point to a tendency that drug therapy with rivastigmine (anti-cholinesterase medication) may favor stabilization or even result in improvement of cognitive, emotional and functional deficits. Further studies with a larger number of patients are needed to deepen the findings found here