MONICA SANCHES YASSUDA
Projetos de Pesquisa
Unidades Organizacionais
EACH, EACH - Docente
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
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- Neuropsychiatric Symptoms in Behavioral Variant Frontotemporal Dementia and Alzheimer's Disease: A 12-Month Follow-Up Study(2021) SILVA, Thais Bento Lima Da; ORDONEZ, Tiago Nascimento; BREGOLA, Allan Gustavo; BAHIA, Valeria Santoro; CECCHINI, Mario Amore; GUIMARAES, Henrique Cerqueira; GAMBOGI, Leandro Boson; CARAMELLI, Paulo; BALTHAZAR, Marcio Luiz Figueredo; DAMASCENO, Benito Pereira; BRUCKI, Sonia Maria Dozzi; SOUZA, Leonardo Cruz de; NITRINI, Ricardo; YASSUDA, Monica SanchesIntroduction: Neuropsychiatric symptoms in patients with frontotemporal dementia (FTD) are highly prevalent and may complicate clinical managements. Objective: To test whether the Neuropsychiatry Inventory (NPI) could detect change in neuropsychiatric symptoms and caregiver's distress in patients diagnosed with behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) from baseline to a 12-month follow-up and to investigate possible predictors of change in NPI scores. Methods: The sample consisted of 31 patients diagnosed with bvFTD and 28 patients with AD and their caregivers. The Mini-Mental State Examination (MMSE), Addenbrooke's Cognitive Examination Revised (ACE-R), the INECO Frontal Screening (IFS), the Frontal Assessment Battery (FAB), the Executive Interview (EXIT-25) and the NPI were applied. Descriptive statistics, Mann-Whitney U test, Wilcoxon test, Chi square (chi(2)) test and Linear Regression Analysis were used. Results: NPI total and caregiver distress scores were statistically higher among bvFTD patients at both assessment points. MMSE, ACE-R scores significantly declined and NPI Total and Distress scores significantly increased in both groups. In the bvFTD group, age was the only independent predictor variable for the NPI total score at follow up. In the AD group, ACE-R and EXIT-25, conjunctively, were associated with the NPI total score at follow up. Conclusions: In 12 months, cognition declined and neuropsychiatric symptoms increased in bvFTD and AD groups. In the AD group only, cognitive impairment was a significant predictor of change in neuropsychiatric symptoms.
- Disinhibition in Frontotemporal Dementia and Alzheimer's Disease: A Neuropsychological and Behavioural Investigation(2020) I, Luciano Mariano; O'CALLAGHAN, Claire; GUIMARAES, Henrique C.; GAMBOGI, Leandro B.; SILVA, Thais B. L. da; YASSUDA, Monica S.; AMARAL, Juliana S.; CARAMELLI, Paulo; HORNBERGER, Michael; TEIXEIRA, Antonio L.; SOUZA, Leonardo C. deObjective: Cognitive tests of inhibitory control show variable results for the differential diagnosis between behavioural variant of Frontotemporal Dementia (bvFTD) and Alzheimer's disease (AD). We compared the diagnostic accuracies of tests of inhibitory control and of a behavioural questionnaire, to distinguish bvFTD from AD. Methods: Three groups of participants were enrolled: 27 bvFTD patients, 25 AD patients, and 24 healthy controls. Groups were matched for gender, education, and socio-economic level. Participants underwent a comprehensive neuropsychological assessment of inhibitory control, including Hayling Test, Stroop, the Five Digits Test (FDT) and the Delay Discounting Task (DDT). Caregivers completed the Barratt Impulsiveness Scale 11th version (BIS-11). Results: bvFTD and AD groups showed no difference in the tasks of inhibitory control, while the caregiver questionnaire revealed that bvFTD patients were significantly more impulsive (BIS-11: bvFTD 76.1+9.5, AD 62.9+13, p < .001). Conclusions: Neuropsychological tests of inhibitory control failed to distinguish bvFTD from AD. On the contrary, impulsivity caregiver-completed questionnaire provided good distinction between bvFTD and AD. These results highlight the current limits of cognitive measures of inhibitory control for the differential diagnosis between bvFTD and AD, whereas questionnaire information appears more reliable and in line with clinical diagnostics.
- Tackling dementia globally: the Global Dementia Prevention Program (GloDePP) collaboration(2019) CHAN, Kit Yee; ADELOYE, Davies; ASANTE, Kwaku Poku; CALIA, Clara; CAMPBELL, Harry; DANSO, Samuel O.; JUVEKAR, Sanjay; LUZ, Saturnino; MOHAN, Devi; MUNIZ-TERRERA, Graciela; NITRINI, Ricardo; NOROOZIAN, Maryam; NULKAR, Amit; NYAME, Solomon; PARALIKAR, Vasudeo; RODRIGUEZ, Mario A. Parra; POON, Adrienne N.; REIDPATH, Daniel D.; RUDAN, Igor; STEPHAN, Blossom C. M.; SU, TinTin; WANG, Huali; WATERMEYER, Tam; WILKINSON, Heather; YASSUDA, Monica Sanches; YU, Xin; RITCHIE, Craig
- Validity and Reliability of the Frontotemporal Dementia Rating Scale (FTD-FRS) for the Progression and Staging of Dementia in Brazilian Patients(2018) LIMA-SILVA, Thais B.; BAHIA, Valeria S.; CECCHINI, Mario A.; CASSIMIRO, Luciana; GUIMARAES, Henrique C.; GAMBOGI, Leandro B.; CARAMELLI, Paulo; BALTHAZAR, Marcio; DAMASCENO, Benito; BRUCKI, Sonia M. D.; SOUZA, Leonardo C. de; NITRINI, Ricardo; MIOSHI, Eneida; YASSUDA, Monica S.Introduction:Few studies on instruments for staging frontotemporal dementia (FTD) have been conducted.Objective:The objective of this study was to analyze the factor structure, internal consistency, reliability, and convergent validity of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS).Methods:A total of 97 individuals aged 40 years and above with >2 years' education took part in the study, 31 patients diagnosed with behavioral variant FTD (bvFTD), 8 patients with primary progressive aphasia, 28 with Alzheimer disease, 8 with mild cognitive impairment, and a control group of 22 healthy subjects. The FTD-FRS was completed by family members or caregivers, and Neurologists completed the 8-item Clinical Dementia Rating for Frontotemporal Lobar Degeneration (CDR-FTLD) scale (6 original domains plus Language and Behavior). The Alzheimer disease and FTD patients had equivalent disease severity level.Results:The internal consistency of the FTD-FRS, estimated by Cronbach , was 0.975 whereas test-retest reliability was 0.977. Scree plot and exploratory factor (Varimax rotation) analyses revealed the existence of 4 factors, with eigenvalues >1, which together explained 77.13% of the total variance with values of 1.28 to 17.52. The domains of the Brazilian version of the FTD-FRS scale correlated with the domains of the CDR-FTLD.Conclusions:The present study is the first to document the factorial structure of the FTD-FRS and its convergent validity with the CDR-FTLD. These tools are key to determine dementia severity in FTD. The Brazilian FTD-FRS demonstrated adequate psychometric properties for use in Brazil. This instrument may contribute to disease staging in FTD and may help to document intervention-related changes.
- The Brain Metabolic Signature in Superagers Using In Vivo H-1-MRS: A Pilot Study(2021) GODOY, L. L. de; STUDART-NETO, A.; WYLEZINSKA-ARRIDGE, M.; TSUNEMI, M. H.; MORAES, N. C.; YASSUDA, M. S.; COUTINHO, A. M.; BUCHPIGUEL, C. A.; NITRINI, R.; BISDAS, S.; LEITE, C. da CostaBACKGROUND AND PURPOSE: Youthful memory performance in older adults may reflect an underlying resilience to the conventional pathways of aging. Subjects having this unusual characteristic have been recently termed ?superagers.? This study aimed to explore the significance of imaging biomarkers acquired by H-1-MRS to characterize superagers and to differentiate them from their normal-aging peers. MATERIALS AND METHODS: Fifty-five patients older than 80?years of age were screened using a detailed neuropsychological protocol, and 25 participants, comprising 12 superagers and 13 age-matched controls, were statistically analyzed. We used state-of-the-art 3T H-1-MR spectroscopy to quantify 18 neurochemicals in the posterior cingulate cortex of our subjects. All H-1-MR spectroscopy data were analyzed using LCModel. Results were further processed using 2 approaches to investigate the technique accuracy: 1) comparison of the average concentration of metabolites estimated with Cramer-Rao lower bounds?<20%; and 2) calculation and comparison of the weighted means of metabolites? concentrations. RESULTS: The main finding observed was a higher total N-acetyl aspartate concentration in superagers than in age-matched controls using both approaches (P =?.02 and P =?.03 for the weighted means), reflecting a positive association of total N-acetyl aspartate with higher cognitive performance. CONCLUSIONS: H-1-MR spectroscopy emerges as a promising technique to unravel neurochemical mechanisms related to cognitive aging in vivo and providing a brain metabolic signature in superagers. This may contribute to monitoring future interventional therapies to avoid or postpone the pathologic processes of aging.
- Apathy and functional disability in behavioral variant frontotemporal dementia(2018) YASSUDA, Monica S.; SILVA, Thais B. Lima da; O'CONNOR, Claire M.; MEKALA, Shailaja; ALLADI, Suvarna; BAHIA, Valeria S.; ALMARAL-CARVALHO, Viviane; GUIMARAES, Henrique C.; CARAMELLI, Paulo; BALTHAZAR, Marcio L. F.; DAMASCENO, Benito; BRUCKI, Sonia M. D.; NITRINI, Ricardo; HODGES, John R.; PIGUET, Olivier; MIOSHI, EneidaBackground Behavioral variant frontotemporal dementia (bvFTD) has profound consequences on patients and their families. In this multicenter study, we investigated the contribution of cognitive and neuropsychiatric factors to everyday function at different levels of overall functional impairment. Methods In a retrospective cross-sectional study, 109 patients with bvFTD from 4 specialist frontotemporal dementia centers (Australia, England, India, and Brazil) were included. The measures administered evaluated everyday function (Disability Assessment for Dementia [DAD]), dementia staging (Clinical Dementia Rating [CDR]), general cognition (Addenbrooke's Cognitive Examination-revised [ACE-R]), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). Patients were then subdivided according to functional impairment on the DAD into mild, moderate, severe, and very severe subgroups. Three separate multiple linear regression analyses were run, where (1) total DAD, (2) basic activities of daily living (BADL), and (3) instrumental activities of daily living (IADL) scores were dependent variables; ACE-R total score and selected NPI domains (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) were used as independent variables. Age, sex, education, and country of origin were controlled for in the analyses. Results Cognitive deficits were similar across the mild, moderate, and severe subgroups but significantly worse in the very severe subgroup. NPI domain scores (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) did not differ across the DAD subgroups. In the multiple regression analyses, a model including ACE-R and NPI apathy explained 32.5% of the variance for total DAD scores. For IADL, 35.6% of the variance was explained by the ACE-R only. No model emerged for BADL scores. Conclusions Cognitive deficits and apathy are key contributors to functional disability in bvFTD but factors underlying impairment in BADLs remain unclear. Treatments targeting reduction of disability need to address apathy and cognitive impairment to ensure greater efficacy, especially in regards to IADLs.
- Phenotyping Superagers Using Resting-State fMRI(2023) GODOY, L. L. de; STUDART-NETO, A.; PAULA, D. R. de; GREEN, N.; HALDER, A.; ARANTES, P.; CHAIM, K. T.; MORAES, N. C.; YASSUDA, M. S.; NITRINI, R.; DRESLER, M.; LEITE, C. da Costa; PANOVSKA-GRIFFITHS, J.; SODDU, A.; BISDAS, S.BACKGROUND AND PURPOSE: Superagers are defined as older adults with episodic memory performance similar or superior to that in middle-aged adults. This study aimed to investigate the key differences in discriminative networks and their main nodes between superagers and cognitively average elderly controls. In addition, we sought to explore differences in sensitivity in detecting these functional activities across the networks at 3T and 7T MR imaging fields. MATERIALS AND METHODS: Fifty-five subjects 80 years of age or older were screened using a detailed neuropsychological protocol, and 31 participants, comprising 14 superagers and 17 cognitively average elderly controls, were included for analysis. Participants underwent resting-state-fMRI at 3T and 7T MR imaging. A prediction classification algorithm using a penalized regression model on the measurements of the network was used to calculate the probabilities of a healthy older adult being a superager. Additionally, ORs quantified the influence of each node across preselected networks. RESULTS: The key networks that differentiated superagers and elderly controls were the default mode, salience, and language networks. The most discriminative nodes (ORs > 1) in superagers encompassed areas in the precuneus posterior cingulate cortex, prefrontal cortex, temporoparietal junction, temporal pole, extrastriate superior cortex, and insula. The prediction classification model for being a superager showed better performance using the 7T compared with 3T resting-state-fMRI data set. CONCLUSIONS: Our findings suggest that the functional connectivity in the default mode, salience, and language networks can provide potential imaging biomarkers for predicting superagers. The 7T field holds promise for the most appropriate study setting to accurately detect the functional connectivity patterns in superagers.
- Disease Progression in Frontotemporal Dementia and Alzheimer Disease: The Contribution of Staging Scales(2021) LIMA-SILVA, Thais Bento; MIOSHI, Eneida; BAHIA, Valeria Santoro; CECCHINI, Mario Amore; CASSIMIRO, Luciana; GUIMARAES, Henrique Cerqueira; GAMBOGI, Leandro Boson; CARAMELLI, Paulo; BALTHAZAR, Marcio; DAMASCENO, Benito; BRUCKI, Sonia M. D.; SOUZA, Leonardo Cruz de; NITRINI, Ricardo; YASSUDA, Monica SanchesIntroduction: There is a shortage of validated instruments to estimate disease progression in frontotemporal dementia (FTD). Objectives: To evaluate the ability of the FTD Rating Scale (FTD-FRS) to detect functional and behavioral changes in patients diagnosed with the behavioral variant of FTD (bvFTD), primary progressive aphasia (PPA), and Alzheimer disease (AD) after 12 months of the initial evaluation, compared to the Clinical Dementia Rating scale-frontotemporal lobar degeneration (CDR-FTLD) and the original Clinical Dementia Rating scale (CDR). Methods: The sample consisted of 70 individuals, aged 40+ years, with at least 2 years of schooling, 31 with the diagnosis of bvFTD, 12 with PPA (8 with semantic variant and 4 with non-fluent variant), and 27 with AD. The FTD-FRS, the CDR, and the 2 additional CDR-FTLD items were completed by a clinician, based on the information provided by the caregiver with frequent contact with the patient. The Addenbrooke Cognitive Examination-Revised was completed by patients. After 12 months, the same protocol was applied. Results: The FTD-FRS, CDR-FTLD, and CDR detected significant decline after 12 months in the 3 clinical groups (exception: FTD-FRS for PPA). The CDR was less sensitive to severe disease stages. Conclusions: The FTD-FRS and the CDR-FTLD are especially useful tools for dementia staging in AD and in the FTD spectrum.