MARCIA RADANOVIC
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/27 - Laboratório de Neurociências, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
22 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 22
- White matter abnormalities associated with Alzheimer's disease and mild cognitive impairment: a critical review of MRI studies(2013) RADANOVIC, Marcia; PEREIRA, Fabricio Ramos Silvestre; STELLA, Florindo; APRAHAMIAN, Ivan; FERREIRA, Luiz Kobuti; FORLENZA, Orestes Vicente; BUSATTO, Geraldo F.In this article, the authors aim to present a critical review of recent MRI studies addressing white matter (WM) abnormalities in Alzheimer's disease (AD) and mild cognitive impairment (MCI), by searching PubMed and reviewing MRI studies evaluating subjects with AD or MCI using WM volumetric methods, diffusion tensor imaging and assessment of WM hyperintensities. Studies have found that, compared with healthy controls, AD and MCI samples display WM volumetric reductions and diffusion tensor imaging findings suggestive of reduced WM integrity. These changes affect complex networks relevant to episodic memory and other cognitive processes, including fiber connections that directly link medial temporal structures and the corpus callosum. Abnormalities in cortico-cortical and cortico-subcortical WM interconnections are associated with an increased risk of progression from MCI to dementia. It can be concluded that WM abnormalities are detectable in early stages of AD and MCI. Degeneration of WM networks causes disconnection among neural cells and the degree of such changes is related to cognitive decline.
- screening for cognitive impairment in late onset depression in a Brazilian sample using the BBRC-edu(2012) NOVARETTI, Tânia Maria da Silva; RADANOVIC, Marcia; NITRINI, RicardoABSTRACT Depression and dementia are the most prevalent neuropsychiatric disorders in the elderly population. Alzheimer's disease is the leading cause of dementia in most countries, being responsible for more than half of all dementia cases. Late-onset depression is a frequent cause of cognitive decline in the elderly. Differentiating between cognitive impairment secondary to depression and incipient dementia poses a challenge in the clinical setting. Objective: To evaluate the performance of elderly depressed patients using the BBRC-Edu. Methods: We studied 25 patients with late onset depression (mean age: 73.6 y (6.6); schooling: 9.1 y (5.7)) and 30 patients with mild AD (mean age 76.6 y (5.4); schooling: 7.5 y (7.1)), who were compared to a control group of 30 healthy elderly (mean age 73.8 y (5.8); schooling: 9.1 y (5.4)) using the CERAD and BBRC-Edu batteries. Results: For the CERAD battery, depressed patients performed better than AD patients on all tasks (p<0.0001) except for Constructional Praxis (p>0.05), and performed poorer than controls on verbal fluency (animals) and Word List Recall tasks (p<0.0001). For the BBRC-Edu, depressed patients performed better than AD patients on all tasks (p<0.0001) except for Digit Span (direct order) (p=0.076) and Incidental Memory (p>0.05), and performed worse than controls on Learning (second presentation) and verbal fluency (fruits) tasks (p<0.0001). Conclusion: Overall performance on the BBRC-Edu allowed differentiation of controls and depressed patients from AD patients.
conferenceObject COGNITIVE PROFILE OF ADULTS AND SENIORS WITH DOWN'S SYNDROME: DATA FROM THE CAMBRIDGE EXAMINATION FOR MENTAL DISORDERS OF OLDER PEOPLE WITH DOWN SYNDROME BRAZILIAN VERSION - CAMDEX-DS ADAPTED AND VALIDATED FOR THE BRAZILIAN POPULATION(2019) CARVALHO, C. L.; ARAUJO, M. C. Cristianini; NOGUEIRA, C.; GONCALVES, A.; BELAN, A.; BRAM, J.; SANTANA, L.; BECKER, A.; RADANOVIC, M.; FORLENZA, O.- Inference comprehension from reading in individuals with mild cognitive impairment(2021) SILAGI, Marcela Lima; ROMERO, Vivian Urbanejo; OLIVEIRA, Maira Okada de; TRES, Eduardo Sturzeneker; BRUCKI, Sonia Maria Dozzi; RADANOVIC, Marcia; MANSUR, Leticia LessaInference comprehension is a complex ability that recruits distinct cognitive domains, such as language, memory, attention, and executive functions. Therefore, it might be sensitive to identify early deficits in subjects with MCI. To compare the performance of subjects with mild cognitive impairment (MCI) in an inference reading comprehension task, and to analyze the correlations between inferential comprehension and other cognitive functions. We studied 100 individuals aged 60 and over, divided into MCI (50) [aMCI (35), naMCI (15)], and cognitively healthy individuals [controls (50)]. The Implicit Management Test (IMT) was used to assess inference in reading comprehension in five categories: explicit, logical, distractor, pragmatic, and ""others"". MCI group performed worse than controls in logical, pragmatic, distractor, and ""others"" questions (p < 0.01). The aMCI and naMCI subgroups presented a similar performance in all types of questions (p > 0.05). We observed significant correlations between the total IMT score and the TMT-A in the naMCI group (r = - 0.562, p = 0.036), and the Rey-Osterrieth Complex Figure and RAVLT tasks in the aMCI group (r = 0.474, p = 0.010 and r = 0.593, p = 0.0001, respectively). The MCI group as a whole performed worse than controls on the logical, pragmatic, other and distractor questions, and consequently on the total score. There were no differences in explicit questions, which impose lower inferential demands. The aMCI group suffered a significant impact from memory on inference comprehension, and difficulties in executive functions impacted naMCI performance. The IMT was useful to differentiate MCI patients from cognitively healthy individuals, but not MCI subgroups among themselves.
- Cognitive impairment in late-life bipolar disorder is not associated with Alzheimer's disease pathological signature in the cerebrospinal fluid(2016) FORLENZA, Orestes V.; APRAHAMIAN, Ivan; RADANOVIC, Marcia; TALIB, Leda L.; CAMARGO, Marina Z. A.; STELLA, Florindo; MACHADO-VIEIRA, Rodrigo; GATTAZ, Wagner F.ObjectivesCognitive impairment is a common feature of late-life bipolar disorder (BD). Yet, there is limited information on the biological mechanisms associated with this process. It is uncertain whether cognitively impaired patients with BD may present the Alzheimer's disease (AD) bio-signature in the cerebrospinal fluid (CSF), defined as a combination of low concentrations of the amyloid-beta peptide (A(1-42)) and high concentrations of total tau (T-tau) and tau phosphorylated at threonine 181 (P-tau). In this study, we sought to determine whether cognitive impairment in elderly patients with BD is associated with the AD CSF bio-signature. MethodsSeventy-two participants were enrolled in the study. The test group comprised older adults with BD and mild cognitive impairment (BD-MCI; n=16) and the comparison groups comprised patients with dementia due to AD (n=17), patients with amnestic MCI (aMCI; n=14), and cognitively healthy older adults (control group; n=25). CSF samples were obtained by lumbar puncture and concentrations of A(1-42), T-tau and P-tau were determined. ResultsCSF concentrations of all biomarkers were significantly different in the AD group compared to all other groups, but did not differentiate BD-MCI subjects from aMCI subjects and controls. BD-MCI patients had a non-significant reduction in CSF A(1-42) compared to controls, but this was still higher than in the AD group. Concentrations of T-tau and P-tau in BD-MCI patients were similar to those in controls, and significantly lower than those in AD. ConclusionsCognitively impaired patients with BD do not display the so-called AD bio-signature in the CSF. We therefore hypothesize that cognitive deterioration in BD is not associated with the classical pathophysiological mechanisms observed in AD, i.e., amyloid deposition and hyperphosphorylation of microtubule-associated tau protein.
- Increased CSF levels of total Tau in patients with subcortical cerebrovascular pathology and cognitive impairment(2017) RADANOVIC, Márcia; STELLA, Florindo; SILVA, Lis Gomes; TALIB, Leda L.; FORLENZA, Orestes V.ABSTRACT. Cognitive impairment includes mild cognitive decline and dementia, such as Alzheimer's disease (AD) and cerebrovascular-related pathologies. Objective: To investigate the profile of AD-related CSF biomarkers in a sample of cognitively impaired and unimpaired older adults with concomitant subcortical cerebrovascular burden. Methods: Seventy-eight older adults attending an outpatient psychogeriatric clinic were enrolled. Diagnoses were based on clinical, neuropsychological, laboratory, and neuroimaging data. Participants were classified into: cognitively normal (controls, n = 30), mild cognitive impairment (MCI, n = 34), and dementia (AD, n = 14). All subjects were submitted to CSF analyses for determination of amyloid-beta (Aβ1-42), total tau (t-tau), phosphorylated tau (p-tau) and Aβ1-42/p-tau ratio according to the Luminex method. MRI was performed in all individuals, and was scored independently by two experts according to Fazekas scale. Statistical analyses were conducted with the aid of general linear model procedures, and the Chi-squared test. Results: T-tau levels were significantly associated with subcortical lesion pattern when Fazekas was considered as a group factor. CSF biomarkers were not associated with MCI, AD, or controls when considered separately. There was a tendency for reduction in CSF Aβ1-42 together with increasing Fazekas scores, but without statistical significance. Comparisons of Aβ1-42 and t-tau with each clinical group or with each neuroimaging pattern did not reach statistical differences. Likewise, Fazekas scores had no impact on CAMCOG scores. Conclusion: We found a significant association between t-tau levels and subcortical lesions when all Fazekas classifications were considered as a single group; comparisons of Fazekas subgroups and CSF biomarkers did not reach significance.
- Electroconvulsive therapy for treating patients with agitation and related behavioral disorders due to dementia: a systematic review(2023) STELLA, Florindo; RADANOVIC, Márcia; GALLUCCI-NETO, José; FORLENZA, Orestes VicenteABSTRACT Behavioral disturbances are clinically relevant in patients with dementia, and pharmacological regimens to mitigate these symptoms have provided limited results. Proven to be effective in several psychiatric conditions, electroconvulsive therapy is a potentially beneficial strategy for treating severe agitation due to dementia. Objective: This review aimed to examine the publications on the efficacy, safety and tolerability of electroconvulsive therapy in treating patients with agitation due to dementia. Methods: We performed a systematic analysis on the electroconvulsive therapy to treat patients with dementia and coexisting severe agitation. Articles were classified according to the level of evidence based on methodological design. Patients received an acute course of electroconvulsive therapy, often followed by maintenance intervention. Results: We selected 19 studies (156 patients; 64.1% women; 51–98 years old), which met the inclusion criteria: one case-control study by chart analysis (level of evidence 2); one open-label study (level of evidence 3); three historical/retrospective chart analyses (level of evidence 4); and 14 case series/reports (level of evidence 5). No randomized, sham-controlled clinical trials (level of evidence 1) were identified, which represents the main methodological weakness. Some patients had postictal delirium, cardiovascular decompensation and cognitive changes, lasting for a short time. Conclusions: Overall, patients achieved significant improvement in agitation. However, the main finding of the present review was the absence of methodological design based on randomized and sham-controlled clinical trials. Despite methodological limitations and side effects requiring attention, electroconvulsive therapy was considered a safe and effective treatment of patients with severe agitation and related behavioral disorders due to dementia.
conferenceObject SYMPTOMS OF DEPRESSION IN ADULTS AND ELDERS WITH DOWN SYNDROME: DATA FROM A PILOT STUDY IN BRAZIL(2019) NOGUEIRA, C.; CARVALHO, C. L.; GONCALVES, A.; BELAN, A.; BRAM, J.; SANTANA, L.; RADANOVIC, M.; BECKER, A.; FORLENZA, O.conferenceObject AVALIANDO A CARGA DE CUIDADORES E FAMILIARES DE ADULTOS E IDOSOS COM SINDROME DE DOWN: DADOS DA ESCALA DE ZARIT(2019) CARVALHO, C. L.; ARAUJO, M. C. C.; FERRO, K. N.; SENA, R. C.; KATSUKI, A. M. I.; NOGUEIRA, C.; BRAM, J.; SANTANA, L.; BELAN, A.; GONCALVES, A.; RADANOVIC, M.; FORLENZA, O.; DIAS, R.- Apolipoprotein E genotype is not associated with cognitive impairment in older adults with bipolar disorder(2016) KERR, Daniel Shikanai; STELLA, Florindo; RADANOVIC, Marcia; APRAHAMIAN, Ivan; BERTOLLUCCI, Paulo Henrique Ferreira; FORLENZA, Orestes VicenteObjectivesCognitive decline is part of the long-term outcome for many individuals with bipolar disorder (BD). The epsilon 4 allele (APOE*4) of apolipoprotein E (APOE) is a well-established risk factor for dementia in Alzheimer's disease (AD). However, its contribution to the risk of cognitive deterioration in BD has not yet been determined. Our aim was to analyze the APOE genotype association with cognitive status in a sample of older adults with BD and compare this to the association in individuals with AD, individuals with mild cognitive impairment (MCI), and healthy controls. MethodsParticipants (n=475) were allocated to four groups: individuals with BD (n=77), those with AD (n=211), those with MCI (n=43), and healthy controls (n=144) according to clinical and neuropsychological assessment. APOE was genotyped by real-time polymerase chain reaction. Tukey's honest significant difference test and Pearson's chi-squared test were used to compare diagnostic groups. ResultsSubjects with BD were similar to controls with respect to the distribution of the APOE genotype (p=0.636) and allele frequencies (p=0.481). Significant differences were found when comparing the AD group to the BD group or to controls (APOE genotype: p<0.0002; allele frequencies: p<0.001). APOE*4 was significantly increased in the AD group when compared to the BD group (p=0.031) and controls (p<0.0001). The cognitively impaired BD subgroup (Mini-Mental State Examination below the cutoff score and/or neuropsychological assessment compatible with MCI) had a statistically significant higher frequency of APOE*2 compared to the AD group (p=0.003). ConclusionsAPOE*4 is not associated with the diagnosis of BD and does not impact the occurrence of dementia in BD. Given the distinct clinical and biological features of cognitive impairment in BD, we hypothesized that dementia in BD is unrelated to AD pathological mechanisms.
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