Doentes que apresentam comprometimento cognitivo, como a doença de Alzheimer (DA), podem apresentar maior prevalência de infecções bucais. Entre elas, a periodontite crônica é uma infecção frequente associada ao aumento do nível sérico de marcadores inflamatórios, e recentemente tem sido apontada como um fator que pode relacionar-se à progressão da DA através de seus mecanismos sistêmicos. O objetivo deste trabalho foi verificar a prevalência de infecções bucais e os níveis séricos de IL-1beta, TNF- alfa e IL-6 em doentes com DA, comprometimento cognitivo leve (CCL) e idosos não-demenciados. Foram avaliados 65 idosos (25 com DA, 19 com CCL e 21 saudáveis). A avaliação incluiu o Mini Exame do Estado Mental, Questionário de Atividades Funcionais (Pfeffer), Avaliação Periodontal, índice CPOD, Questionário de Avaliação Clínica Orofacial (EDOF-HC) e avaliação de concentração sérica de IL-1beta, TNF-alfa e IL-6. Os doentes com DA e CCL apresentaram maior quantidade de dentes ausentes e por um período maior de tempo do que os idosos saudáveis (P= 0.038) e a doença periodontal (DP) foi a causa principal das perdas dentárias (P= 0.035). Os doentes apresentaram maior prevalência de candidose do que os controles (P= 0.05). As análises de correlação demonstraram que quanto maior a concentração de IL-6, pior a funcionalidade pelo índice de Pfeffer (P < 0,001; Pearson) e pior o índice cognitivo (P=0,018; Pearson). Por outro lado, quanto maior a concentração de TNF-alfa, piores os índices IS, PCS média e máxima e PCI média e máxima (P < 0,001; Pearson), maior o tempo de uso de próteses (P=0,010; Pearson) e pior o índice de placa O´Leary (P=0,008; Pearson). IL-6 e TNF-alfa se correlacionaram positivamente (P < 0,001; Pearson). Conclui-se que há um aumento sérico de citocinas associado ao comprometimento cognitivo e à doença periodontal. Estudos futuros poderão esclarecer os mecanismos que determinam aumento de IL-6 nas demências e aumento de TNF-alfa nas infecções periodontais e elucidar possíveis associações entre eles / Patients that present cognitive impairment, as Alzheimer´s Disease (AD), may have high prevalence of oral infections. Among them, chronic periodontitis is often associated to the increase of seric inflammatory biomarkers, and it recently has been referred as a factor than can change the progression of AD by its systemic mechanisms. The objective of this study was to investigate the prevalence of oral infections and seric levels of IL-1alfa, TNF-alfa and IL-6 in patients with AD, mild cognitive impairment (MCI) and non demented elderly. Sixty-five elderly were evaluated (21 with AD, 8 with MCI and 15 healthy). The evaluation included the Mini Mental State Exam, Questionnaire of Functional Activities (Pfeffer), periodontal evaluation, DMFT, Clinical Orofacial Questionnaire (EDOF-HC) and seric concentrations of IL-1beta, TNF-alfa and IL-6. The patients with AD and MCI had more absent teeth and for a longer period of time than the healthy elderly (P= 0.038) and periodontal disease (PD) was the main cause of teeth losses (P= 0.035). The patients had higher prevalence of candidiasis than the controls (P= 0.05). The serum level of IL-6 was higher in the patients that showed bad performance in the MMSE (P=0.018; Pearson) and daily life activities - Pfeffer (P < 0.001; Pearson). The TNF-alfa serum level was more elevated when patients had PPD, CAL, BI (P < 0.001; Pearson) and O\'Leary plaque index (P=0.008; Pearson). IL-6 e TNF-alfa were positively correlated (P < 0.001; Pearson). In conclusion, there is a seric increase of cytokines associated with the cognitive impairment and periodontal disease. Future studies are necessary to clarify the mechanisms that underlie the increase of IL-6 in dementias and the increase of TNF-alfa in periodontal infections and possible associations between them

A doença de Alzheimer (DA) é a doença degenerativa cerebral adquirida mais comum e a principal causa de demência nos paises ocidentais. Sua fisiopatologia pode envolver anormalidades neuronais além do processo inflamatório. As infecções odontogênicas são frequentes nestes doentes, e são importantes causas de dor e inflamação crônicas. Os objetivos desta pesquisa foram avaliar as características odontológicas e de dor orofacial de doentes com DA leve comparados aos controles, e verificar aspectos cognitivos, funcionais e emocionais após o tratamento das infecções odontogênicas presentes. Foram avaliados 29 doentes e 30 controles, sendo que os doentes foram tratados e reavaliados posteriormente em dois momentos (após um mês e após seis meses). Foram utilizados os seguintes instrumentos de avaliação: ficha clínica da Equipe de Dor Orofacial; Critérios de diagnóstico em Pesquisa para Disfunção Temporomandibular; questionário de dor McGill; qualidade de vida relacionada à saúde oral (OHIP); avaliação clínica periodontal; índice CPOD-d; índice de placa OLeary; Mini-Exame do Estado Mental (MEEM); escala funcional de Pfeffer. No grupo de estudo, houve maior prevalência de dor orofacial (20,7%, P<0,001), alterações nas articulações temporomandibulares (P<0,05), e infecção periodontal (P=0,002). Após o tratamento, a dor diminuiu (P=0,014), assim como as limitações mandibulares (P=0,011) e os índices periodontais (P<0,05), havendo melhora na qualidade de vida (P=0,009), índice funcional (P=0,001) e índice cognitivo (P=0,048). Como conclusão, a dor orofacial e infecções odontogênicas foram mais comuns em idosos com DA leve do que em idosos saudáveis e seu tratamento resultou em melhora funcional desses indivíduos / Alzheimer\'s disease (AD) is the most common acquired cerebral degeneration and the main cause of dementia in Western countries. Its physiopathology involves neuronal abnormalities and an inflammatory process. Dental infections are frequent in these patients, and important causes of pain and chronic inflammation. The objectives of this research were to evaluate the dental characteristics and orofacial pain of patients with mild AD compared to controls, and to verify cognitive, functional and emotional aspects after the treatment of present oral infections. Twenty-nine patients (29) and 30 controls were evaluated, and the patients were treated and reevaluated in two moments (after one month and after six months). The following instruments were used: clinical questionnaire (Clinical Questionnaire of Orofacial Pain); Research Diagnostic Criteria for Temporomandibular Disorders; McGill Pain Questionnaire; Oral Health Impact Profile (OHIP); periodontal clinical evaluation; DMFT; Plaque index of O´Leary; Mini-Mental State Exam; functional scale of Pfeffer. In the study group, there was a higher prevalence of orofacial pain (20.7%, P<0.001), articular abnormalities at temporomandibular joints (P<0.05) and periodontal infections (P=0,002). After the treatment, the pain reduced (P=0,014), as well as mandibular limitations (P=0.011) and periodontal indexes (P<0.05), and there was an improvement in quality of life (P=0.009), functional index (P<0.001) and cognition (P=0.048). In conclusion, orofacial pain and periodontal infections were more common in patients with mild AD than in healthy subjects and their treatment resulted in better functionality of them

A Escala de Avaliação de Demência (Dementia Rating Scale -DRS), proposta por Steven Mattis (1988), tem sido bastante utilizada na avaliação de pacientes com demência tanto na atividade clínica como na pesquisa. Consiste de 5 subescalas: Atenção, Iniciativa/Perseveração, Construção, Conceituação e Memória. Neste estudo, a Escala de Avaliação de Demência foi aplicada em 56 pacientes com doença de Alzheimer com demência de intensidade leve; 55 pacientes com diagnóstico de comprometimento cognitivo leve; e, 60 indivíduos controles. Na diferenciação entre pacientes com doença de Alzheimer e controles a nota de corte de < 128 demonstrou 90,0% de sensibilidade e 89,3 % de especificidade; e, entre pacientes com doença de Alzheimer e comprometimento cognitivo leve, a nota de corte foi < 123 com sensibilidade de 78,2% e 76,8% de especificidade. Na diferenciação entre pacientes com comprometimento cognitivo leve e controles, a nota de corte foi de < 134 com 73,3% de sensibilidade e 72,7% de especificidade. A DRS demonstrou ser um instrumento com boa acurácia diagnóstica na discriminação entre pacientes com doença de Alzheimer de intensidade leve e indivíduos controles. A DRS também foi capaz de diferenciar entre pacientes com comprometimento cognitivo leve de controles, e pacientes com comprometiemnto cognitivo leve de pacientes com doença de Alzheimer de intensidade leve. As subescalas Memória e Iniciativa/Perseveração demonstraram maior acurácia diagnóstica em todas as situações analisadas quando comparadas às demais subescalas. / The Dementia Rating Scale (DRS), proposed by Steven Mattis (1988), it has been very used to assess patients with dementia both in clinical practice and research. Consists of 5 subscales: Attention, Initiation/Perseveration, Construction, Conceptualization and Memory. The Dementia Rating Scale was applied to 56 patients with Alzheimer´s disease, witha dementia of mild intensity; 55 patients with diagnosis of mild cognitive impairment; and, 60 controls. Between patients with Alzheimer´s disease and controls the cutoff score of <128 showed a 90.0% of sensitivity and 89.3% of specificity; and, between patients with Alzheimer´s disease and mild cognitive impairment, the cutoff score was <123 with sensitivity of 78.2% e 76.8% of specificity. In the analysis between patients with mild cognitive impairment and controls, the cutoff score was <134 with 73.3% of sensitivity and 72.7% of specificity. The Dementia Rating Scale showed to be a instrument with good diagnostic accuracy in the discrimination between patients with mild Alzheimer´s disease and controls. The Dementia Rating Scale also was able to discriminated between patients mild cognitive impairment and controls, and between patients with mild cognitive impairment and mild Alzheimer´s disease. The Memory and Initiation/Perseveration subscales showed good diagnostic accuracy in all analysed situations.

No description available.

Les expériences qui jalonnent la vie favorisent la survenue de modifications cérébrales durables et pouvant impacter les fonctions cognitives, ainsi que le développement de troubles cérébraux. L'hippocampe est une structure cérébrale qui joue un rôle essentiel dans l'apprentissage et la mémoire. Dans la première étude, nous avons montré comment l'activité neuronale sous-tendant les processus de la mémoire influence fortement l'intégration des nouveaux neurones hippocampiques dans le cerveau adulte, suggérant une modulation durable de la fonction hippocampique. Dans la deuxième étude, nous avons montré que le séjour en milieu enrichi qui prévient les déficits mnésiques liés à l'âge et induit également des modifications épigénétiques dans le cerveau sain et modèle de la maladie d'Alzheimer. Ceci suggére que des règulations épigénétiques durables pourraient soutenir les effets promnésiques de l'enrichissement environnemental. Ainsi, cette thèse a mis en évidence dans l'hippocampe, l'existence de plasticité dépendante de l'activité dans le cerveau sain et modèle de la maladie d'Alzheimer. Cette plasticité pourrait être une cible pertinente dans le traitement de certaines conditions pathologiques. / Throughout life, environmental challenges promote long-lasting changes within the brain that can affect cognitive function, as well as the development of brain disorders. Within the brain, the hippocampus plays a key role in learning and memory processes. In the first study, we demonstrate how neuronal activity triggered by the learning and memory enhances the synaptic integration of adult-born hippocampal neurons that could support hippocampal function. In the second study, we show that enriched environment prevents age-related memory deficits and induces epigenetic modifications in both healthy and Alzheimer's disease conditions. This suggests that long-lasting epigenetic regulations may participate in sustaining the promnesic effects of environmental enrichment. Altogether, this thesis provides evidence of activity-dependent plasticity in the hippocampus in healthy and diseased brain, and suggests that stimulating such plasticity may contribute to improve pathological conditions.

El cerebro está constituido por numerosos elementos que se encuentran interconectados de forma masiva y organizados en módulos que forman redes jerárquicas. Ciertas patologías cerebrales, como la enfermedad de Alzheimer y el trastorno por consumo de alcohol, se consideran el resultado de efectos en cascada que alteran la conectividad cerebral. La presente tesis tiene como objetivo principal la aplicación de las técnicas de análisis de la ciencia de redes para el estudio de las redes estructurales y funcionales en el cerebro, tanto en un estado control como en un estado patológico. Así, en el primer estudio de la presente tesis se examina la relación entre la conectividad estructural y funcional en la corteza cerebral de la rata. Se lleva a cabo un análisis comparativo entre las conexiones estructurales en la corteza cerebral de la rata y los valores de correlación calculados sobre las mismas regiones. La información acerca de la conectividad estructural se ha obtenido a partir de estudios previos, mientras que la conectividad funcional se ha calculado a partir de imágenes de resonancia magnética funcional. Determinadas propiedades topológicas, y extraídas de la conectividad estructural, se relacionan con la organización modular de las redes funcionales en estado de reposo. Los resultados obtenidos en este primer estudio demuestran que la conectividad estructural y funcional cortical están altamente relacionadas entre sí. Estudios recientes sugieren que el origen de la enfermedad de Alzheimer reside en un mecanismo en el cual depósitos de ovillos neurofibrilares y placas de beta-amiloide se acumulan en ciertas regiones cerebrales, y tienen la capacidad de diseminarse por el cerebro actuando como priones. En el segundo estudio de la presente tesis se investiga si las redes estructurales que se generan con la técnica de resonancia magnética ponderada en difusión podrían ser de utilidad para el diagnóstico de la pre-demencia causada por la enfermedad de Alzheimer. Mediante el uso de imágenes procedentes de la base de datos ADNI, se aplican técnicas de aprendizaje máquina con el fin de identificar medidas de centralidad que se encuentran alteradas en la demencia. En la segunda parte del estudio, se utilizan imágenes procedentes de la base de datos NKI para construir un modelo matemático que simule el proceso de envejecimiento normal, así como otro modelo que simule el proceso de desarrollo de la enfermedad. Con este modelado matemático, se pretende estimar la etapa más temprana que está asociada con la demencia. Los resultados obtenidos de las simulaciones sugieren que en etapas tempranas de la enfermedad de Alzheimer se producen alteraciones estructurales relacionados con la demencia. La cuantificación de la relación estadística entre las señales BOLD de diferentes regiones puede informar sobre el estado funcional cerebral característico de enfermedades neurológicas y psiquiátricas. En el tercer estudio de la presente tesis se estudian las alteraciones en la conectividad funcional que tienen lugar en ratas dependientes del consumo de alcohol cuando se encuentran en estado de reposo. Para ello, se ha aplicado el método NBS. El análisis de este modelo de rata revela diferencias estadísticamente significativas en una subred de regiones cerebrales que están implicadas en comportamientos adictivos. Por lo tanto, estas estructuras cerebrales podrían ser el foco de posibles dianas terapéuticas. La tesis aporta tres innovadoras contribuciones para entender la conectividad cerebral bajo la perspectiva de la ciencia de redes, tanto en un estado control como en un estado patológico. Los resultados destacan que los modelos basados en las redes cerebrales permiten esclarecer la relación entre la estructura y la función en el cerebro. Y quizás más importante, esta perspectiva de red tiene aplicaciones que se podrían trasladar a la práctica clínica. / The brain is composed of massively connected elements arranged into modules that form hierarchical networks. Experimental evidence reveals a well-defined connectivity design, characterized by the presence of strategically connected core nodes that critically contribute to resilience and maintain stability in interacting brain networks. Certain brain pathologies, such as Alzheimer's disease and alcohol use disorder, are thought to be a consequence of cascading maladaptive processes that alter normal connectivity. These findings have greatly contributed to the development of network neuroscience to understand the macroscopic organization of the brain. This thesis focuses on the application of network science tools to investigate structural and functional brain networks in health and disease. To accomplish this goal, three specific studies are conducted using human and rodent data recorded with MRI and tracing technologies. In the first study, we examine the relationship between structural and functional connectivity in the rat cortical network. Using a detailed cortical structural matrix obtained from published histological tracing data, we first compare structural connections in the rat cortex with their corresponding spontaneous correlations extracted empirically from fMRI data. We then show the results of this comparison by relating structural properties of brain connectivity to the functional modularity of resting-state networks. Specifically, we study link reciprocity in both intra- and inter-modular connections as well as the structural motif frequency spectrum within functionally defined modules. Overall, our results provide further evidence that structural connectivity is coupled to and shapes functional connectivity in cortical networks. The pathophysiological process of Alzheimer's disease is thought to begin years before clinical decline, with evidence suggesting pahtogenic seeding and subsequent prion-like spreading processes of neurofibrillary tangles and amyloid plaques. In the second study of this thesis, we investigate whether structural brain networks as measured with dMRI could serve as a complementary diagnostic tool in prodromal dementia. Using imaging data from the ADNI database, we first aim to implement machine learning techniques to extract centrality features that are altered in Alzheimer's dementia. We then incorporate data from the NKI database and create dynamical models of normal aging and Alzheimer's disease to estimate the earliest detectable stage associated with dementia in the simulated disease progression. Our model results suggest that changes associated with dementia begin to manifest structurally at early stages. Statistical dependence measures computed between BOLD signals can inform about brain functional states in studies of neurological and psychiatric disorders. Furthermore, its non-invasive nature allows comparable measurements between clinical and animal studies, providing excellent translational capabilities. In the last study, we apply the NBS method to investigate alterations in the resting-state functional connectivity of the rat brain in a PD state, an established animal model of clinical relevant features in alcoholism. The analysis reveal statistically significant differences in a connected subnetwork of structures with known relevance for addictive behaviors, hence suggesting potential targets for therapy. This thesis provides three novel contributions to understand the healthy and pathological brain connectivity under the perspective of network science. The results obtained in this thesis underscore that brain network models offer further insights into the structure-function coupling in the brain. More importantly, this network perspective provides potential applications for the diagnosis and treatment of neurological and psychiatric disorders. / El cervell està constituït per nombrosos elements que es troben interconnectats de forma massiva i organitzats en mòduls que formen xarxes jeràrquiques. Certes patologies cerebrals, com la malaltia d'Alzheimer i el trastorn per consum d'alcohol, es consideren el resultat d'efectes en cascada que alteren la connectivitat cerebral. La present tesi té com a objectiu principal l'aplicació de les tècniques d'anàlisi de la ciència de xarxes per a l'estudi de les xarxes estructurals i funcionals en el cervell, tant en un estat control com en un estat patològic. Així, en el primer estudi de la present tesi s'examina la relació entre la connectivitat estructural i funcional en l'escorça cerebral de la rata. Es du a terme una anàlisi comparativa entre les connexions estructurals en l'escorça cerebral de la rata i els valors de correlació calculats sobre les mateixes regions. La informació sobre la connectivitat estructural s'ha obtingut a partir d'estudis previs, mentre que la connectivitat funcional s'ha calculat a partir d'imatges de ressonància magnètica funcional. Determinades propietats topològiques, i extretes de la connectivitat estructural, es relacionen amb l'organització modular de les xarxes funcionals en estat de repòs. Els resultats obtinguts en este primer estudi demostren que la connectivitat estructural i funcional cortical estan altament relacionades entre si. Estudis recents suggereixen que l'origen de la malaltia d'Alzheimer resideix en un mecanisme en el qual depòsits d'ovulets neurofibrilars i plaques de beta- miloide s'acumulen en certes regions cerebrals, i tenen la capacitat de disseminar-se pel cervell actuant com a prions. En el segon estudi de la present tesi s'investiga si les xarxes estructurals que es generen amb la tècnica de la imatge per ressonància magnètica ponderada en difusió podrien ser d'utilitat per al diagnòstic de la predemència causada per la malaltia d'Alzheimer. Per mitjà de l'ús d'imatges procedents de la base de dades ADNI, s'apliquen tècniques d'aprenentatge màquina a fi d'identificar mesures de centralitat que es troben alterades en la demència. En la segona part de l'estudi, s'utilitzen imatges procedents de la base de dades NKI per a construir un model matemàtic que simule el procés d'envelliment normal, així com un altre model que simule el procés de desenrotllament de la malaltia. Amb este modelatge matemàtic, es pretén estimar l'etapa més primerenca que està associada amb la demència. Els resultats obtinguts de les simulacions suggereixen que en etapes primerenques de la malaltia d'Alzheimer es produeixen alteracions estructurals relacionats amb la demència. La quantificació de la relació estadística entre els senyals BOLD de diferents regions pot informar sobre l'estat funcional cerebral característic de malalties neurològiques i psiquiàtriques. A més, a causa de la seua naturalesa no invasiva, és possible comparar els resultats obtinguts entre estudis clínics i estudis amb animals d'experimentació. En el tercer estudi de la present tesi s'estudien les alteracions en la connectivitat funcional que tenen lloc en rates dependents del consum d'alcohol quan es troben en estat de repòs. Per a realitzar-ho, s'ha aplicat el mètode NBS. L'anàlisi d'aquest model de rata revela diferències estadísticament significatives en una subxarxa de regions cerebrals que estan implicades en comportaments addictius. Per tant, estes estructures cerebrals podrien ser el focus de possibles dianes terapèutiques. La tesi aporta tres innovadores contribucions per a entendre la connectivitat cerebral davall la perspectiva de la ciència de xarxes, tant en un estat control com en un estat patològic. Els resultats destaquen que els models basats en les xarxes cerebrals permeten aclarir la relació entre l'estructura i la funció en el cervell. I potser més important, esta perspectiva de xarxa té aplicacions que es podrien traslladar a la pràcti / Díaz Parra, A. (2018). A network science approach of the macroscopic organization of the brain: analysis of structural and functional brain networks in health and disease [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/106966 / TESIS

Tauopathien sind Krankheiten, die mit einer abnormen intrazellulären Tau-Protein-Faltung, Tau-Protein-Aggregation und Filament-Bildung im ZNS und PNS einhergehen. Die Alzheimer Demenz stellt die häufigste Tauopathie dar. Bei ihr kommt es zu einer intra- und extrazellulären Ablagerung fehlgefalteter amyloidogener Proteinaggregate, welche durch β Amyloid und Tau gebildet werden. Es resultiert eine Neurodegeneration. Ein multifaktorieller Prozess führt bei den Tauopathien zur Umwandlung des Tau-Proteins hin zu unlöslichen Fibrillenbündeln. Primär kommt es zur Bildung eines Dimers, das durch Disulfid- und Wasserstoffbrückenbindungen stabilisiert wird. Durch die Zusammenlagerung mehrer Dimere entstehen Tau-Oligomere. Diese gelten als die neurotoxischen Komponenten. Die Primärstruktur des Tau-Proteins beeinflusst den Aggregationsprozess. Dabei spielen die Anwesenheit der Aggregationsdomänen PHF6* und PHF6 und die Anzahl der Cystein-Seitenketten überragende Rollen. In dieser Arbeit wurden durch ortsspezifische Mutagenesen Tau-Konstrukte generiert, die sich in ihrer Anzahl der Aggregationsdomänen und der Cystein-Reste unterschieden. Es konnte gezeigt werden, dass die Aggregationstendenz der Tau-Proteine mit nur einer Aggregationsdomäne und keinem Sulfhydryl-Rest stark sinkt. Auch durch Veränderungen des Redoxmilieus lässt sich das Tau-Aggregationsverhalten beeinflussen. Es wurde gezeigt, dass die Substanz TCEP als starkes Reduktionsmittel die Aggregation der 2 humanen Tau-Isoformen 2N3R und 2N4R wirkungsvoll inhibiert. Auch GSSG als Oxidationsmittel verhinderte in bestimmten Konzentrationen die Aggregation dieser 2 Isoformen. Es wird angenommen, dass die Verhinderung der Bildung einer intermolekularen Disulfidbrückenbindung zu diesem Phänomen führt.

No description available.

Clinical findings have linked multiple risk factors and associated pathologies to Alzheimer\''s disease (AD). Amongst them are vascular risk factors such as hypertension and pathologies such as stroke. Coexistence of AD and these associated pathologies worsenes dementia, the clinical hallmark of the disease, as compared to pure AD. One general common denominator of these associated pathologies is the presence of hypoxic tissue conditions. It was asked the question, whether there exists a mutual, causal interaction between hypoxia and AD pathology, that could explain the clinical observations. Alternatively, the worsened clinical state of multiple brain pathologies could \"simply\" be the consequence of multimorbidity, i.e. accumulated disease load, without any causal interaction between the constituents. To approach this question whether hypoxia influences AD progression, use was made of a murine animal model of AD (transgenic mice: APPswe, PSEN1dE). Animals of two ages (8 and 14 months, \"young\" and \"old\" respectively) and two genotypes (transgenic and wild- type) were either treated under hypoxia or normoxia, corresponding to 8% and 21% oxygen, for 20 consecutive days. The resulting changes in the brain were assessed with a variety of techniques, namely by histology, ELISA, dot and Western blotting. Additional experiments in primary cell cultures were performed. Animals exposed to hypoxia showed an increased hematocrit (HCT), weight loss, reactive angiogenesis, but no infarctions. This illustrates that our hypoxic treatment put significant stress on the animals, without causing major pathologies. A large number of variables exists that could potentially be measured to assess the effect of hypoxia on AD. The focus was put on three of them: First, there is the Abeta1-42- protein, known to be the Abeta- isoform associated with the most detrimental disease progression. In AD, the self-combinatory Amyloid- beta peptide (Abeta) accumulates in the brain in so- called plaques, which is a main histologic finding of the disease. Its quantity was determined through histology and ELISA. Secondly, it was attempted to estimate the structural quality of the Abeta- protein by assessing the amount of A!- oligomers present. Abeta- protein does self- accumulate in various grades of complexity, i.e. as monomer, oligomer or fibril. Since oligomers are known to be the most neurotoxic \"species\" of the Abeta- protein, it was hypothesized that under hypoxic treatment their quantity could increase. And third, the organism\''s response to the Abeta- protein stimulus was investigated. Microglial cells have been described as the first cells to encounter the Abeta- protein \"threat\" in the shape of plaques, i.e. Abeta- protein aggregates. They then try to encapsulate and subsequently degrade them. Therefore, the attention was put on this cellular population. It was asked whether hypoxia could change the Abeta- protein quantity in the brain. This was assessed in two ways: First histologically, by staining for Abeta- protein depositions and quantifying them. Second, an ELISA was performed. Our findings state that hypoxic treatment does not alter the Abeta1-42 protein load in the brain, neither in young nor old animals, as assessed by histology and by total ELISA quantification of Abeta1-42 protein. Since hypoxia did not alter the quantity of the Abeta- protein, it was asked whether it influenced it qualitatively? If hypoxia increased oligomer formation, this change in the spectrum of the Abeta- species could, without any change in total Abeta- protein load, lead to increased neurotoxicity in animals under hypoxia. Initial experiments showed that oligomer formation in the brain seems to increase. However, this was not statistically significant and future experiments are necessary to evaluate this hypothesis further. It was then asked, whether hypoxia alters the cellular response to the protein. The total number of microglia in the hippocampal dentate gyrus, our structure of interest for practical purposes, and, it can be argued, by extension the brain, changes dynamically with various factors. First, transgenic animals present an increase in microglia. Second, microglia increase with age. Third, microglia decrease under hypoxia, but only do so significantly in old animals. Next, a parameter called \"plaque occupancy\" was coined to assess the microglia function to confront Abeta- plaques. Plaque occupancy is defined as the number of microglia in spatial proximity to one square millimeter of Abeta- plaque. This means, that microglia restricting one plaque are counted, and then normalized to this plaque\''s area. It was hypothesized that hypoxia would decrease plaque occupancy. Indeed, plaque occupancy roughly halved under hypoxia. Summarizing, our results demonstrate that long- term exposure to hypoxia significantly reduces the number of microglia. The reduced number results in significantly reduced plaque occupancy and compromizes the function of microglia to confront Abeta- plaques. The Abeta1-42 load, however, is not affected. On the other hand, Abeta shows an increased trend towards oligomer formation. A variety of possible explanations to these phenomena have been presented, that in our opinion deserve further investigation.

O lítio é freqüentemente utilizado no tratamento do Transtorno Bipolar, doença associada a um risco aumentado para demência. Evidências experimentais sugerem efeitos neuroproterores do lítio. O lítio inibe a amiloidogênese e a fosforilação da proteína tau tanto in vitro como in vivo. Estes são processos importantes na patogênese da doença de Alzheimer. O objetivo este estudo foi a investigação do efeito do lítio na prevalência de Transtorno Cognitivo Leve e doença de Alzheimer em 114 bipolares idosos eutímicos. Todos os sujeitos completaram uma avaliação catamnéstica, psicopatológica e cognitiva que incluía o mini-exame do estado mental (Mini-mental), o teste cognitivo de Cambridge (CAMCOG) e o questionário do informante sobre o declínio cognitivo do idoso (IQCODE). Foi feita uma comparação da prevalência de Transtorno Cognitivo Leve e doença de Alzheimer entre pacientes em uso de lítio e pacientes em uso de outros estabilizadores de humor. Os sujeitos que entraram na pesquisa tinham em média 68,2 ± 5,0 anos e preenchiam os critérios da Décima Revisão da Classificação Internacional de Doenças e Problemas de Saúde Relacionados (CID-10) para o transtorno bipolar. Durante a avaliação os bipolares estavam eutímicos. Eutimia foi definida como uma pontuação máxima de 7 pontos na escala de Hamilton de 21 pontos para Depressão e 4 na escala de Young para mania. 66 pacientes em uso contínuo do lítio por 6 anos em média foram comparados com 48 pacientes em tratamento com outros estabilizadores de humor. O diagnóstico de Transtorno Cognitivo Leve foi feito de acordo com os critérios de Petersen(1999) e de doença de Alzheimer de acordo com o critério do “National Institute for Communicative Disorders and Stroke - Alzheimer’s Disease and Related Disorders Association" (NINCDS/ADRDA). A prevalência de demência nesta amostra (19,4%) foi mais elevada do que o esperado para uma população comparável (7,1%). A prevalência de doença de Alzheimer entre aqueles com lítio foi 4,5% quando comparada com 33,3% entre aqueles sem lítio. Controlando idade e outras variáveis relacionadas ao curso da doença, o efeito do lítio na prevalência de doença de Alzheimer permaneceu significativo (OR = 0,079; p < 0,001). Nenhuma associação foi encontrada com Transtorno Cognitivo Leve. A alta da prevalência de doença de Alzheimer neste estudo está de acordo com as evidências de risco aumentado para demência em pacientes bipolares. Nesta amostra o tratamento com lítio reduziu a prevalência de Alzheimer aos níveis da população idosa em geral. Estes achados estão de acordo com os efeitos neuroprotetores do lítio em eventos cruciais para a patologia da doença de Alzheimer. Estudos prospectivos são necessários para avaliar se o lítio também pode ser efetivo na prevenção de doença de Alzheimer em outras populações. / Lithium is widely used in the treatment of bipolar disorder, a condition associated with an increased risk for dementia. Experimental evidence suggests that lithium has a neuroprotective effect. Both in vitro and in vivo, lithium inhibits amyloidogenesis and phosphorilation of tau protein, which are two crucial processes in the pathogenesis of Alzheimer’s disease. The objective of this study was to investigate the effect of lithium on the prevalence of Mild Cognitive Impairment and Alzheimer’s disease in 114 elderly euthymic bipolar patients. Subjects completed a thorough catamnestic, psychopathological and cognitive tests evaluation including the Mini-mental state evaluation, Cambridge cognitive test (CAMCOG) and the informant questionnaire on cognitive decline in the elderly (IQCODE). The prevalence of Mild Cognitive Impairment and Alzheimer’s disease between patients on lithium therapy and patients on treatment with other mood-stabilizing drugs was compared. Patients were 68.2 ± 5.0 years old and fulfilled of the International Classification of Diseases - 10th Revision (ICD-10) diagnosis for bipolar disorder. At the time of the evaluation patients were euthymic, as defined by a maximum score of 7 in the 21-item Hamilton Rating Scale for Depression, and 4 in the Young Mania Rating Scale. Sixty-six patients were continuously being treated with lithium for six years, on average, and 48 patients were receiving other mood-stabilizing drugs. Diagnosis of Mild Cognitive Impairment was made according to Petersen (1999) and of Alzheimer’s disease was made according to the National Institute for Communicative Disorders and Stroke - Alzheimer’s Disease and Related Disorders Association (NINCDS/ADRDA) criteria. The overall prevalence of dementia in our sample (19.4%) was higher than the prevalence expected in the age-comparable general population (7.1%). The prevalence of Alzheimer’s disease among lithium users was 4.5% as compared to 33.3% among non-users. After controlling for age and other variables related to the clinical course of the bipolar disorder, the effect of lithium on Alzheimer’s disease prevalence remained significant (OR = 0.079; p < 0.001). No association was found with Mild Cognitive Impairment. The higher prevalence of Alzheimer’s disease in our study supports the reports of increased risk for dementia in bipolar patients. In our sample, lithium treatment reduced the prevalence of Alzheimer’s disease to the levels of the general elderly population. This finding is in line with the neuroprotective effects of lithium on crucial events for the pathology of Alzheimer’s disease. Further prospective studies are needed to clarify whether lithium may also be effective in the prevention of Alzheimer’s disease in the general population.