SONIA MARIA DOZZI BRUCKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
17 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 17
- Effects of a Non-focal Plasticity Protocol on Apathy in Moderate Alzheimer's Disease: A Randomized, Double-blind, Sham-controlled Trial(2014) SUEMOTO, Claudia Kimie; APOLINARIO, Daniel; NAKAMURA-PALACIOS, Ester Miyuki; LOPES, Leonardo; LEITE, Renata Elaine Paraizo; SALES, Manuela Castro; NITRINI, Ricardo; BRUCKI, Sonia Maria; MORILLO, Lilian Shafirovitz; MAGALDI, Regina Miksian; FREGNI, FelipeBackground: Apathy is the most common neuropsychiatric symptom in Alzheimer's disease (AD) and it is associated with changes in prefrontal neural circuits involved with generation of voluntary actions. To date no effective treatment for apathy has been demonstrated. Objective: We aimed to investigate the effects and safety of repetitive transcranial direct current stimulation (tDCS) on apathy in moderate AD patients. Methods: Forty patients were randomized to receive either active or sham-tDCS over the left dorsolateral prefrontal cortex (DLPFC). Patients received six sessions of intervention during 2 weeks and were evaluated at baseline, at week 1 and 2, and after 1 week without intervention. Clinical raters, patients, and caregivers were blinded. The primary outcome was apathy. Global cognition and neuropsychiatric symptoms were examined as secondary outcomes. Results: The mean MMSE score at baseline was 15.2 +/- 2.9 and the mean Apathy Scale score was 27.7 +/- 6.7. Changes on apathy scores over time were not different between active and sham tDCS (P = 0.552 for repeated measures). Further analyses confirm that changes from baseline did not differ between groups after the sixth session (active tDCS -1.95 (95%CI -3.49, -0.41); sham-tDCS -2.05 (95% Cl -3.68, 0.42); P = 0.9891. Similarly, tDCS had no effect on secondary outcomes (P > 0.40). tDCS was well tolerated and not associated with significant adverse effects. Conclusion: In this adequately powered study for minimal clinically significant difference, our findings show that using the parameters we chose for this study, repeated anodal tDCS over the left DLPFC had no effect on apathy in elderly patients with moderate AD.
- Visuospatial processing: A review from basic to current concepts(2014) TRÉS, Eduardo Sturzeneker; BRUCKI, Sonia Maria DozziABSTRACT Introduction: Visuospatial processing is a fundamental aspect in human cognition, belonging to a complex and intricate network. It is, in other words, one of the building blocks of an individual's identity and behavior. Objective: To allow an overall and updated review of visuospatial processing and its related events, in light of new techniques and evidence, focusing on basic concepts of higher cortical functions, its pathways and associated systems. Methods: The study was conducted based on the national and international databases LILACS, MEDLINE, ScieLo and Pubmed; using the search word "visuospatial" in combination with "pathway", "processing", "function", "fMRI" and "attention". Results: A total of 77 references deemed relevant for its historical, conceptual or updated relevance were selected out of 1222 retrieved; including English, Spanish and Portuguese languages. A critical review was carried out and many new aspects discussed. Conclusion: A new functioning and construction of sight processing is being shaped, culminating now in a model based on dynamic and integrated interactions between pathways and systems
- Paraneoplastic limbic encephalitis with prominent neuropsychiatric apathy(2014) PORTO, Fabio Hernique de Gobbi; COUTINHO, Artur Martins Novaes; LUCATO, Leandro Tavares; SPINDOLA, Livia; ONO, Carla Rachel; BRUCKI, Sonia Maria Dozzi; BUCHPIGUEL, Carlos Alberto; NITRINI, RicardoThe spectrum of paraneoplastic neurologic syndromes has increased with the description of encephalitis associated with antibodies against cell surface and synaptic proteins. Subacute cognitive impairment, movement disorders, late onset epilepsy and neuropsychiatric syndromes were recently linked to paraneoplastic encephalitis. Despite that, probably some syndromes and antibodies are yet to be reported. Herein we reported the clinical and neuroimaging pictures of a patient with late onset medial temporal lobe epilepsy, subtle cognitive impairment, psychosis and severe apathy diagnosed with antibody-negative paraneoplastic encephalitis due to colonic adenocarcinoma. The apathy markedly improved after removal of the tumor, without concomitant immunotherapy (steroids, intravenous immunoglobulins, immunosuppressants, plasmapheresis, etc). Our report highlights the importance of a full clinical and neurologic investigation in cases of atypical neuropsychiatric presentations, particularly in the elderly and with the concomitance of epilepsy and cognitive decline. Even chronic presentations must be considered. Neuroimaging is an important tool to demonstrate structural and functional brain dysfunction in these cases. Colonic adenocarcinoma should be searched for in cases in which a typical tumor related to paraneoplastic neurologic syndromes is not found.
- Subjective memory complaints in the elderly: a sign of cognitive impairment?(2014) JACINTO, Alessandro Ferrari; BRUCKI, Sonia Maria Dozzi; PORTO, Claudia Sellitto; DE ARRUDA MARTINS, Milton; NITRINI, RicardoOBJECTIVES: Cognitive impairment in the elderly is frequently overlooked by general practitioners. The use of subjective memory complaints as a sign of cognitive impairment by the general practice is controversial. METHODS: Elderly individuals (N = 248) were asked whether they had memory complaints and underwent a cognitive impairment screening. Subjects classified as exhibiting “probable cognitive impairment” underwent a complete cognitive evaluation, and the final diagnoses were established by expert consensus. RESULTS: A total of 147 patients presented with subjective memory complaints, and 43 were further classified as demented or “cognitively impaired not demented”. Subjective memory complaints presented a sensitivity of 100% and a negative predictive value of 100%. CONCLUSION: Subjective memory complaints are an indicator for cognitive impairment screening.
- The S-TOFHLA as a Measure of Functional Literacy in Patients with Mild Alzheimer's Disease or Mild Cognitive Impairment(2014) OLIVEIRA, Maira Okada de; NITRINI, Ricardo; BRUCKI, Sonia Maria DozziIn developing countries, education levels vary dramatically, and the number of years of schooling does not always correlate with the true level of educational competency. This study was designed to verify the accuracy of the Short-Test of Functional Health Literacy in Adults (S-TOFHLA) in individuals with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD), when compared with healthy controls (HCs), in order to assess its utility as a measure of functional literacy. One hundred forty-eight subjects were divided into three groups: HC (n = 61), MCI patients (n = 42), and AD patients (n = 45). The S-TOFHLA does not seem to be suitable as an instrument to measure functional literacy for patients with advanced cognitive impairment, but proved to be appropriate in both the HC group and MCI patients in numeracy and prove to be useful as an adjuvant to estimate IQ, reading ability, and premorbid IQ, as an indicator of cognitive reserve.
- Vocabulary Is an Appropriate Measure of Premorbid Intelligence in a Sample with Heterogeneous Educational Level in Brazil(2014) OLIVEIRA, Maira Okada de; NITRINI, Ricardo; YASSUDA, Mnica Sanches; BRUCKI, Sonia Maria DozziCrystallized intelligence refers to one's knowledge base and can be measured by vocabulary tests. Fluid intelligence is related to nonverbal aspects of intelligence, depends very little on previously acquired knowledge, and can be measured by tests such as Block Design (BD) and Raven Colored Matrices (RCM). Premorbid intelligence quotient (IQ) refers to one's intellectual ability level previous to the onset of disorders like mild cognitive impairment (MCI) and Alzheimer's disease (AD) and it is important to estimate disease severity. The objective was to compare performance in tests that measure crystallized and fluid intelligence in healthy subjects and patients with amnestic MCI (aMCI) and AD. One hundred forty-four participants (aMCI (n = 38), AD (n = 45), and healthy controls (n = 61)) were submitted to neuropsychological tests (WAIS-III vocabulary, BD, and RCM). There were significant among groups, except for vocabulary, indicating a relative stability of crystallized intelligence in the continuum from normal to pathological cognitive decline. Vocabulary seems to be stable during the progression of the disease and useful as a measure of premorbid intelligence, that is, to estimate previous function in relation to the level of education and, as a collateral measure of cognition in people with low education.
- Detecting limited health literacy in Brazil: development of a multidimensional screening tool(2014) APOLINARIO, Daniel; MANSUR, Leticia Lessa; CARTHERY-GOULART, Maria Teresa; BRUCKI, Sonia Maria Dozzi; NITRINI, RicardoScreening questions have been proposed as practical tools for detecting limited functional health literacy, but have achieved only moderate accuracy in previous studies. We hypothesized that a combination of screening questions and demographic characteristics could better predict a patients functional health literacy. Three hundred and twenty-two hospital users from So Paulo, Brazil, were interviewed for demographic information and answered questions about literacy habits and perceived difficulties. The Short Test of Functional Health Literacy in Adults was used to classify individuals as having adequate or limited functional health literacy. Of the 322 participants, 102 (31.7) presented limited functional health literacy. The final logistic model included six predictors. The three demographic variables were educational attainment, mothers educational attainment and major lifetime occupation (manual or non-manual). The three questions concerned frequency of use of computers, difficulty with writing that have precluded the individual from getting a better job and difficulty reading the subtitles while watching a foreign movie. A simple score was derived to constitute a practical tool we named the Multidimensional Screener of Functional Health Literacy (MSFHL). The sensitivity of the MSFHL in detecting limited functional health literacy was 81.4 and the specificity was 87.7, with an area under receiver operating characteristic (ROC) curve of 0.93 (95 CI 0.890.95). The MSFHL was better than educational attainment in accurately classifying functional health literacy status (p 0.0018). We have developed a screening tool based on three demographic characteristics and three simple questions which provides an accurate prediction of a patients functional health literacy level.
- South America’s AD Clinical Trials Experience: Lessons Learned from Argentina and Brazil(2014) ALLEGRI, Ricardo F.; BAGNATI, Pablo; BRUCKI, Sonia; NITRINI, RicardoDementia is seriously disabling for those who have it and is often devastating for their caregivers and families. There are 7.7 million new cases of dementia each year, implying that there is a new case of dementia somewhere in the world every four seconds. The growth of dementia in the next 20 years will be much more acute in those countries with low and medium salaries. The World Health Organization wrote a report about dementia, calling on all governments to define dementia as a public health priority. Dementia clinical studies are becoming more and more complex with the number of enrolled patients increasing. Historically, the majority of patients recruited into clinical trials for medicine development have been from Western Europe and the US. However, clinical trials are increasingly recruiting patients from more countries, including developing countries. South America has larger urban populations than other emerging regions and could provide treatment-naïve patients for clinical trials.
- Suggested instruments for General Practitioners in countries with low schooling to screen for cognitive impairment in the elderly(2014) JACINTO, Alessandro Ferrari; BRUCKI, Sonia Maria Dozzi; PORTO, Claudia Sellitto; MARTINS, Milton de Arruda; CITERO, Vanessa de Albuquerque; NITRINI, RicardoBackground: General Practitioners (GPs) from underdeveloped countries apply cognitive impairment (CI) assessment tools translated and adapted to cultural setting from other idioms, mainly English. As schooling in elderly from underdeveloped countries tends to be relatively heterogeneous, it is necessary to establish normative and cut-off scores for these CI instruments that are based on studies conducted locally. Some CI screening instruments frequently used by Brazilian specialists in dementia were analyzed to determine which could be most useful to GPs in their working sets. Method: Two hundred forty-eight patients aged 65 years or older that had been assisted by GPs in a tertiary hospital in Brazil were evaluated. Based on the MMSE and/or Short-IQCODE scores, 52 probable cases were identified on the basis of clinical data, performances on the neuropsychological tests and questionnaires (Functional Assessment Questionnaire/FAQ, Category Verbal Fluency/CVF, Clock Drawing Test /CDT) and blood tests and brain CT. Results: The combination of a functional questionnaire with a cognitive instrument had higher sensitivity and specificity than using the instruments alone. A FAQ cut-off of 3 in conjunction with a CDT cut-off of 6 proved optimal (93% sensitivity and 92.5% specificity). A higher specificity (93.5%) was attained using a combination of the FAQ (cut-off of 3) with the CVF (cut-off of 10). Conclusions: For low schooling elderly, the combination of the FAQ and CVF represented a very simple method of increasing the chances of correct screening. For those with higher schooling, the combination of the FAQ and CDT was more suitable.
bookPart Transtorno neurocognitivo maior e menor nas demências degenerativas não Alzheimer(2014) BRUCKI, Sonia Maria Dozzi; BAHIA, Valéria Santoro; TAKADA, Leonel Tadao; GONçALVES, Marcia Rubia R.; HADDAD, Mônica Santoro; SMID, Jerusa; NITRINI, Ricardo