Faculdade de Psicologia

This article approaches the study of skin illnesses in their relational aspects. To achieve that, we walk the path of ego building, focusing on the relational aspect imminently present, through the theories of Winnicott, Anzieu and McDougall. We approach the relational construction of the ego that occurs by the way of the body, on which the first affective records are printed, particularly discussing the skin as a relational organ.

The increase in life expectancy can influence the prevalence of dementias in the population. Instruments that evaluate cognitive functions such as the Mini Mental State Examination (MMSE) are necessary for the investigation of dementia. The supposition that patient score on the MMSE can be influenced by academic level points to the need for establishing cut-off values that take into account educational level. The aim of this study was to review MMSE cut-off values adjusted for schooling in a large southern Brazilian sample. Method: Demographic data and MMSE scores of 968 subjects, of which 162 were dementia patients and 806 healthy participants, were analyzed. The sample was grouped according to education. The cut-off values were established by ROC Curve analysis. Results: The total sample mean age was 70.6±7.3 years, and the mean years of education was 7.2±5.3. The cut-off score of 23 points (sensitivity=86%, specificity=83%) was observed as the optimal level to detect dementia on the MMSE instrument for the overall sample. Regarding level of schooling, the cutoff values were: 21 for the illiterate group (sensitivity=93%, specificity=82%), 22 for the low education group (sensitivity=87%, specificity=82%), 23 for the middle education group (sensitivity=86%, specificity=87%) and 24 for the high education group (sensitivity=81%, specificity=87%). Conclusions: The cut-off values revealed by this analysis, and adjusted for level of schooling, can improve the clinical evaluation of cognitive deficits.

This study aims to evaluate patient and caregiver's characteristics related with neuropsychiatric symptoms. Methods: A cross-sectional study was conducted in a sample of 58 probable Alzheimer's disease (AD) patients (NINCDS-ADRDA criteria). The neuropsychiatric symptoms were evaluated by the Brazilian version of the Neuropsychiatric Inventory (NPI). The dementia severity was assessed with the Clinical Dementia Rating (CDR), Brazilian version. The analyzed patient's variables were sex, age, age of onset of AD symptoms and education. The analyzed caregiver's variables were sex, type of relationship, age, education, time as caregiver, weekly time of care, residing with patient and type of job. Student's t test and one-way Anova were performed for parametric variables. Spearman's rho was used for correlations. Results: NPI intensity and distress were similar in both patient's sex (p ¼ 0.742 and p ¼ 0.902, respectively) and in the three stages of severity of dementia (F ¼ 1.951, p ¼ 0.152; F ¼ 0.763, p ¼ 0.471, respectively). Patient's education was inversely correlated with NPI frequency, intensity and distress (rho ¼ -0.283, rho ¼ -0.276, rho ¼ -0.262, p ¼ 0.05). NPI intensity and distress were similar in both caregiver's sex (p ¼ 0.809 and p ¼ 0.743, respectively), relationship type (p > 0.5) and caregiver's type of job (p > 0.5). However, a tendency for statistical difference was observed between caregivers who resided and those who not resided with patients (p ¼ 0.05), caregivers who resided with patients showed higher NPI intensity and NPI distress. Caregiver's education was inversely correlated with NPI frequency, intensity and distress (rho ¼ -0.302, rho ¼ -0. 272, rho ¼ -0. 300, p ¼ 0.05). Caregiver's age was inversely correlated with NPI severity (rho ¼ -0.270, p ¼ 0.05). Weekly time of care was correlated with NPI frequency (rho ¼ 0. 291, p ¼ 0.05). Conclusions: Some variables may interfere on neuropsychiatric symptoms evaluation by caregivers of AD patients, as age, education, weekly time of care and residing with patients. Some of them can be modified through different approaches improving quality of care.

Background: Due to its proximity to the brain, Cerebrospinal fluid (CSF) is a perfect source to search for new biomarkers to improve early diagnosis of neurological diseases. Standardization of pre-analytical handling of the sample is important to obtain acceptable analytical quality. Preanalytical in vitro factors occur before the final analysis and include both the collection of the specimen and the processing of it. The aim of the present study was to study the influence of some common preanalytical procedures on the CSF proteome analyzed by immunochemical techniques and SELDI-TOF MS. We aimed to clarify the effects of protease inhibitors, repeated freeze/thaw cycles, storage time and temperatures on the CSF proteome. Methods: CSF samples from ten patients were aliquoted into individual polypropylene tubes with or without protease inhibitor cocktail for general use from Sigma-Aldrich. The tubes were immediately stored at -80 C. The samples were subsequently subjected to one, two or three freeze/thaw cycles before analysis. Individual immunoassays were used for the measurement of CSF concentrations Ab 1-42 , Tau, Phosphorylated Tau and Cystatin C. Results: Ab 1-42 and Cystatin C were not susceptible to up to three freeze/thaw cycles. There was a significant difference in the concentrations of both Tau and Phosphorylated Tau after three freeze/thaw cycles when protease inhibitors were not added, ANOVA p values were 0.014 and < 0.0001, respectively. The most striking difference was seen in Phosphorylated Tau where significant higher concentrations were detected in the samples without protease inhibitor. Conclusions: Standarization of CSF collection protocols is of outmost importance, especially in the cases where samples have been collected and stored at different centres. Our study shows that Ab 1-42 and Cystatin C are not susceptible to up to three freeze/thaw cycles. In order to avoid false positive results, Tau and Phosphorylated Tau should not be analyzed in samples that have been frozen and thawed repeatedly. We recommend aliquoting the CSF immediately after sampling and centrifugation, and storage at -80 degrees Celsius without the addition of protease inhibitors.

ADϩ LBD). The clinical accuracy for AD was 97% but associated lesions were clinically missed in 10 cases (ϩ Va in 8, ϩ LBD in 1 and ϩ progressive supranuclear palsy in 1). 94.1% of ADϩ VaD cases and 70% of ADϩ LBD were confirmed at post mortem. Three ADϩ DLB patients were misdiagnosed with confirmed ADϩ Va. Finally, associated lesions were present in 36 out of 58 patients (62%) with confirmed AD (27 MAϩ Va, 8 ADϩ LBD and 1 ADϩ progressive supranuclear palsy). In 2 cases the clinical diagnosis of AD was wrong: the final diagnosis was pure vascular dementia (nϭ 1) and argyrophilic grains disease (nϭ 1). Conclusions: Our data show that superimposed cerebral lesions are highly prevalent in AD and contribute to the cognitive decline of these patients and the clinicians' diagnosis difficulties. We observed a frequent clinical overlap between AD and Va or LBD. We emphasize the need for improving the detection of associated vascular and neurodegenerative lesions during patient's life, especially in older persons. Clinicians also need to confirm AD pathology with biomarkers in case of additional pathologies that may explain at least part of the cognitive decline.

patients (p < 0.05) in comparison with CTRs in the right superior frontal cortex and left superior parietal cortex. Conclusions: The combination of TMS/ EEG allows objectively to measure brain responses to a direct cortical perturbation: therefore, it is not affected by the level of collaboration/performance of patients. These results show that the cortical circuits activated by a direct stimulation of the left frontal cortex are significantly impaired in AD. Finally, the specific alterations of cortical excitability and connectivity observed in MCI and AD patients as compared to CTRs are encouraging for the clinical application of TMS/EEG in the early identification of AD symptoms and in the monitoring of disease progression.

Caregiver burden is common in Alzheimer's disease (AD), decreasing the quality of life among caregivers and patients. Projections of aging and aging-related diseases such as AD in developing countries justify additional data about this issue because people living in these countries have shown similarly high levels of caregiver strain as in the developed world. Objective: The aim of this study was to analyze the association of AD caregivers' burden with patients' neuropsychiatric symptoms (NPS), cognitive status, severity of dementia, functional capacity, caregiver sociodemographic characteristics, and the characteristics of care provided by caregivers. Methods: A cross-sectional study was conducted in a sample of 39 consecutive AD patients and their primary caregivers. NPS were evaluated using the Neuropsychiatric Inventory (NPI). Severity of dementia was assessed with the Clinical Dementia Rating (CDR) scale. Functional capacity was assessed using the Katz and Lawton scales. The burden level was rated using the Burden Interview (BI). Sociodemographic characteristics of caregivers and the characteristics of care provided by them were evaluated. The Mann-Whitney U-test, Kruskal-Wallis test and Spearman's rho coefficient were performed. Results: The BI had a moderate correlation with NPI intensity (rho=0.563), p<001. Female caregivers reported a greater level of burden (p=0.031) than male caregivers. The other variables were not significantly associated to caregiver burden. Conclusion: NPS were the main determinant of burden in primary caregivers of AD patients. This result underscores the need for prevention and treatment of these symptoms. Sex also had an effect on caregiver burden, but the small male sample in this study precludes the generalization of this finding.

The aim of this study was to determine the diagnostic value and agreement analyses between Clinical Dementia Rating (CDR) and dementia diagnostic criteria (gold standard), Blessed Dementia Rating scale (BDRS), and Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition, Revised (DSM III-R) criteria for severity. In a sample of 343 Southern Brazilian participants, CDR was consecutively assessed in 295 dementia patients (Alzheimer disease, vascular dementia, and questionable) and 48 healthy elderly. The National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable Alzheimer disease and the National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherche´et l'Enseignement en Neurosciences (NINDS-AIREN) for probable vascular dementia were the gold standard. A battery of cognitive tests and the Mini Mental State Examination (as a screening test at study entry) were also applied. Sensitivity and specificity were obtained through contingency tables. Validity and reliability were measured through k coefficient, Kendall b, and percent agreement. CDR agreement among raters was demonstrated by percent agreement. Agreement to gold standard was good (k = 0.75), as well as to the Blessed scale (k = 0.73), and excellent to the DSM III-R (k = 0.78). CDR detection of dementia among healthy elderly or questionable dementia was 86% and 80% sensitive, respectively, and 100% specific for both settings. In conclusion, agreement of CDR global score with the gold standard was good, and diagnostic values were high.