O Acidente Vascular Cerebral (AVC) é uma doença prevalente e incapacitante, cujo atendimento no Brasil é insuficiente e concentrado em poucos centros de alta complexidade. A telemedicina possibilita assistência à saúde através do uso de tecnologias de comunicação entre dois ou mais profissionais, ou entre o profissional e o paciente, que estejam em locais distintos, permitindo aumento do acesso a tratamentos especializados, podendo ser útil na assistência do AVC agudo. Os objetivos deste estudo foram avaliar a viabilidade de uma rede de telemedicina para o AVC no Sistema Único de Saúde na região de Ribeirão Preto e desenvolver um sistema de telemedicina para o AVC. Para a análise da viabilidade, foram realizados o levantamento de indicadores demográficos e epidemiológicos da população de municípios que constituem o Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) e uma análise técnica e econômica relacionada à estrutura necessária. O sistema de registro eletrônico e videoconferência foi desenvolvido por equipe multiprofissional, baseado em diretrizes nacionais para sistemas de informação em saúde e protocolos padronizados para o atendimento do AVC agudo. Concluiu-se que uma rede de telemedicina entre o Hospital das Clínicas de Ribeirão Preto e os outros hospitais que possuem os pré-requisitos para cadastramento como Unidade de AVC no DRS XIII será estratégica para a expansão do atendimento qualificado do AVC na região, e sua viabilidade depende do cadastro destes serviços junto ao Ministério da Saúde, financiamento dos equipamentos e treinamento das equipes assistenciais. O sistema de telemedicina desenvolvido possibilitará o registro seguro dos atendimentos, a educação permanente das equipes e base de dados para pesquisas clínicas, contribuindo para a concretização desta e de outras redes de telemedicina brasileiras. / Stroke is a prevalent and disabling disease, whith insufficient treatment in Brazil, where is concentrated in a few high complexity centers. Telemedicine enables health care through communication technology between two or more professionals, or between the professionals and patients, in different locations, allowing increased access to specialized treatments, therefore useful in acute stroke treatment. This study objectives were to evaluate the feasibility of a public stroke telemedicine network at Ribeirão Preto region and to develop a stroke telemedicine eletronic system. For feasibility study, populational demographic and epidemiological indicators were compiled for the cities that constitute the Regional Health Department of Ribeirão Preto (DRS XIII) and a technical and economic analysis related to the necessary structure was performed. The electronical record and videoconference system was developed by a multiprofessional team, based on national guidelines for health information systems and standardized protocols for acute stroke care. A telemedicine network between the Hospital das Clínicas of Ribeirão Preto and the other hospitals that meet criteria for enrollment as Stroke Units in DRS XIII will be strategic for the expansion of regional qualified stroke care. Its viability depends on the registration of these services at the Health Ministry, equipment financing and assistance teams training. The developed telestroke system will enable the secure record of calls, the permanent education of the teams and a database for clinical research, contributing to the realization of this and other telemedicine networks.

La migration vers la résolution HD de la plupart des applications multimédias visuelles a nécessité la création de nouveaux standards de compression vidéo tels que le H264/AVC (Advanced Video Coding) et le HEVC (High Efficiency Video Coding). Ces standards sont caractérisés par des hautes performances de codage en termes de taux de compression et qualité vidéo par rapport aux normes précédentes. Cependant, ces performances entraînent de grandes complexités de calcul ce qui rend difficile d'assurer un encodage en temps réel pour la résolution HD sur des processeurs monocœurs programmables qui sont les plus répandus. De plus, comme actuellement les systèmes embarqués sont de plus en plus utilisés dans diverses applications multimédias, concevoir une solution logicielle embarquée pour l'encodeur H264/AVC constitue ainsi un défit très difficile puisqu'il faut répondre aux exigences de l'embarqué au niveau des ressources matérielles comme la mémoire et de la consommation d'énergie. Les récents systèmes embarqués dotés de la technologie multicœur représentent une solution attractive pour surmonter ces problèmes. Dans ce contexte, cette thèse s'intéresse à exploiter la performance de la nouvelle génération de DSP multicœurs de Texas Instruments pour concevoir un encodeur H264/AVC embarqué de résolution HD fonctionnant en temps réel. Nous visons une solution logicielle, caractérisée par une forte flexibilité, par rapport aux IPs existants, qui permet de tout paramétrer (qualité, débit etc). Cette flexibilité logicielle permet aussi l'évolutivité de système en suivant les améliorations de codage comme la migration vers la nouvelle norme HEVC, partiellement abordée dans cette thèse. Nous présentons ainsi les diverses optimisations appliquées que ce soient algorithmiques, architecturales et structurelles afin d'améliorer la vitesse d'encodage sur un seul cœur DSP avant de passer à une implémentation multicœur. Ensuite, nous proposons des implémentations parallèles de l'encodeur H264/AVC sur différentes unités de calcul en exploitant le parallélisme potentiel au sein de la chaîne d'encodage afin de satisfaire la contrainte de temps réel tout en assurant une bonne performance de codage en termes de qualité vidéo et débit binaire. Nous étudions également le problème d'allocation des ressources (ressources de calcul, ressources mémoire, ressources de communication) avec de fortes contraintes temporelles d'exécution. Finalement, cette thèse ouvre la voie vers l'implémentation de la nouvelle norme de codage vidéo HEVC sur deux systèmes embarqués monocœurs dans le but de préparer une solution logicielle embarquée pour les futurs travaux de recherche / The trend toward HD resolution in most of visual multimedia applications has involved the emergence of a large number of video compression standards such as H.264/AVC (Advanced Video Coding) and HEVC (High Efficiency Video Coding). These standards are characterized by high coding performances in terms of compression ratio and video quality compared to previous standards. However, these performances come with large computational complexities which make it difficult to meet real-time encoding for HD resolution on the most common single-core programmable processors. Moreover, as embedded systems have become increasingly used in various multimedia applications, designing an embedded software solution for the H264/AVC encoder represents another difficult challenge since we have to meet the embedded requirements in terms of hardware resources such as memory and power consumption. The new embedded systems with multicore technology represent an attractive solution to overcome these problems. In this context, this thesis is interested in exploiting the performance of the new generation of Texas Instruments multicore DSPs to design an embedded real-time H264/AVC high definition video encoder. We aim a software solution, characterized by high flexibility that allows setting all parameters (quality, bitrate etc) compared to existing IPs. This software flexibility allows also the system scalability by following the coding enhancements as the migration to the newest HEVC standard. Thus, we present the algorithmic, architectural, and structural optimizations which are applied to improve the encoding speed on a single DSP core before moving to a multicore implementation. Then, we propose parallel implementations of the H264/AVC encoder exploiting the multicore architecture of our platform and the potential parallelism in the encoding chain in order to meet real-time constraints while ensuring a good performance in terms of bitrate and video quality. We also explore the problem of resources allocation (computing resources, storage resources, communication resources) with hard execution time constraints. Finally, this thesis opens the way towards the implementation of the new HEVC video coding standard on two embedded systems in order to prepare a software solution for future research

L’utilisation de plusieurs cœurs pour l’exécution des applications mobiles sera l’approche dominante dans les systèmes embarqués pour les prochaines années. Cette approche permet en générale d’augmenter les performances du système sans augmenter la vitesse de l’horloge. Grâce à cela, la consommation d’énergie reste modérée. Toutefois, la concurrence entre les tâches doit être exploitée afin d’améliorer les performances du système dans les différentes situations où l’application peut s’exécuter. Les applications multimédias comme la vidéoconférence ou la vidéo haute définition, ont de nombreuses nouvelles fonctionnalités qui nécessitent des calculs complexes par rapport aux normes précédentes de codage vidéo. Ces applications créent une charge de travail très importante sur les systèmes multiprocesseurs. L’exploitation du parallélisme pour les applications multimédia, comme le codec vidéo H.264/AVC, peut se faire à différents niveaux : au niveau de données ou bien au niveau tâches. Dans le cadre de cette thèse de doctorat, nous proposons de nouvelles solutions pour une meilleure exploitation du parallélisme dans les applications multimédia sur des systèmes embarqués ayant une architecture parallèle symétrique (ou SMP pour Symmetric Multi-Processor). Des approches innovantes pour le décodeur H.264/AVC qui traitent des composantes de couleur et des blocs de l’image en parallèle sont proposées et expérimentées. / Parallel computing is currently the dominating architecture in embedded systems. Concurrency improves the performance of the system rather without increasing the clock speed which affects the power consumption of the system. However, concurrency needs to be exploited in order to improve the system performance in different applications environments. Multimedia applications (real-Time conversational services such as video conferencing, video phone, etc.) have many new features that require complex computations compared to previous video coding standards. These applications have a challenging workload for future multiprocessors. Exploiting parallelism in multimedia applications can be done at data and functional levels or using different instruction sets and architectures. In this research, we design new parallel algorithms and mapping methodologies in order to exploit the natural existence of parallelism in multimedia applications, specifically the H.264/AVC video decoder. We mainly target symmetric shared-Memory multiprocessors (SMPs) for embedded devices such as ARM Cortex-A9 multicore chips. We evaluate our novel parallel algorithms of the H.264/AVC video decoder on different levels: memory load, energy consumption, and execution time.

La présente thèse aborde le sujet de tatouage du flux MPEG-4 AVC sur ses deux volets théoriques et applicatifs en considérant deux domaines applicatifs à savoir la protection du droit d’auteur et la vérification de l'intégrité du contenu. Du point de vue théorique, le principal enjeu est de développer un cadre de tatouage unitaire en mesure de servir les deux applications mentionnées ci-dessus. Du point de vue méthodologique, le défi consiste à instancier ce cadre théorique pour servir les applications visées. La première contribution principale consiste à définir un cadre théorique pour le tatouage multi symboles à base de modulation d’index de quantification (m-QIM). La règle d’insertion QIM a été généralisée du cas binaire au cas multi-symboles et la règle de détection optimale (minimisant la probabilité d’erreur à la détection en condition du bruit blanc, additif et gaussien) a été établie. Il est ainsi démontré que la quantité d’information insérée peut être augmentée par un facteur de log2m tout en gardant les mêmes contraintes de robustesse et de transparence. Une quantité d’information de 150 bits par minutes, soit environ 20 fois plus grande que la limite imposée par la norme DCI est obtenue. La deuxième contribution consiste à spécifier une opération de prétraitement qui permet d’éliminer les impactes du phénomène du drift (propagation de la distorsion) dans le flux compressé MPEG-4 AVC. D’abord, le problème a été formalisé algébriquement en se basant sur les expressions analytiques des opérations d’encodage. Ensuite, le problème a été résolu sous la contrainte de prévention du drift. Une amélioration de la transparence avec des gains de 2 dB en PSNR est obtenue / The present thesis addresses the MPEG-4 AVC stream watermarking and considers two theoretical and applicative challenges, namely ownership protection and content integrity verification.From the theoretical point of view, the thesis main challenge is to develop a unitary watermarking framework (insertion/detection) able to serve the two above mentioned applications in the compressed domain. From the methodological point of view, the challenge is to instantiate this theoretical framework for serving the targeted applications. The thesis first main contribution consists in building the theoretical framework for the multi symbol watermarking based on quantization index modulation (m-QIM). The insertion rule is analytically designed by extending the binary QIM rule. The detection rule is optimized so as to ensure minimal probability of error under additive white Gaussian noise distributed attacks. It is thus demonstrated that the data payload can be increased by a factor of log2m, for prescribed transparency and additive Gaussian noise power. A data payload of 150 bits per minute, i.e. about 20 times larger than the limit imposed by the DCI standard, is obtained. The thesis second main theoretical contribution consists in specifying a preprocessing MPEG-4 AVC shaping operation which can eliminate the intra-frame drift effect. The drift represents the distortion spread in the compressed stream related to the MPEG encoding paradigm. In this respect, the drift distortion propagation problem in MPEG-4 AVC is algebraically expressed and the corresponding equations system is solved under drift-free constraints. The drift-free shaping results in gain in transparency of 2 dB in PSNR

Cette thèse a pour ambition d’explorer d’un point de vue théorique et applicatif le paradigme de l’in-band enrichment. Emergence de la société des connaissances, le concept de média enrichi renvoie à toute association de métadonnée (textuelle, audiovisuelle, code exécutable) avec un média d’origine. Un tel principe peut être déployé dans une large variété d’applications comme la TVNi - Télévision Numérique interactive, les jeux ou la fouille des données. Le concept de l’inband enrichement conçu et développé par M. Mitrea et son équipe au Département ARTEMIS de Télécom SudParis, suppose que les données d’enrichissement sont insérées dans le contenu même à enrichir. Ainsi, un tel concept peut-il tirer parti de techniques de tatouage, dès lors que celles-ci démontrent qu’elles ont la capacité d’insérer la quantité d’information requise par ce nouveau type d’application : i.e. 10 à 1000 fois plus grande que celle nécessaire pour les enjeux d’authentification ou de protection de droit d’auteur. Si par tradition la marque est insérée dans le domaine non compressé, les contraintes relatives aux nombreuses applications émergentes (comme la VoD – Vidéo à la Demande ou la TVNi) font du tatouage en temps réel dans le domaine compressé un important défi théorique et applicatif. Cependant, le tatouage dans le domaine compressé est une alliance de mots contradictoires puisque la compression (élimination de la redondance) rend l’hôte plus sensible aux modifications et l’association hôte/marque, plus fragile / The present thesis, developed at Institut Télécom Télécom SudParis under the “Futur et Rupture” framework, takes the challenge of exploring from both theoretical and applicative points of views the in band enrichment paradigm. Emerged with the knowledge society, the enriched media refers to any type of association which may be established between some metadata (textual, audio, video, exe codes...) and a given original media. Such a concept is currently deployed in a large variety of applications like the iDTV (interactive Digital TV), games, data mining... The incremental notion of in band enrichment advanced at the ARTEMIS Department assumes that the enrichment data are directly inserted into the very original media to be enriched. In real life, in band enrichment can be supported by the watermarking technologies, assuming they afford a very large data payload, i.e. 10 to 1000 larger than the traditional copyright applications. The nowadays advent of the ubiquous media computing and storage applications imposes an additional constraint on the watermarking techniques: the enrichment data should be inserted into some compressed original media. A priori, such a requirement is a contradiction in terms, as compression eliminates the visual redundancy while the watermarking exploits the visual redundancy in order to imperceptibly insert the mark

Today, eavesdropping is becoming a common issue in the rapidly growing digital network and has foreseen the need for secret communication channels embedded in digital media. In this paper, a novel steganography technique designed for Standard Definition Digital Television (SDTV) H.264/AVC encoded video sequences is presented. The algorithm introduced here makes use of the compression properties of the Context Adaptive Variable Length Coding (CAVLC) entropy encoder to achieve a low complexity and real-time inserting method. The chosen scheme hides the private message directly in the H.264/AVC bit stream by modifying the AC frequency quantized residual luminance coefficients of intrapredicted I-frames. In order to avoid error propagation in adjacent blocks, an interlaced embedding strategy is applied. Likewise, the steganography technique proposed allows self-detection of the hidden message at the target destination. The code source was implemented by mixing MATLAB 2010 b and Java development environments. Finally, experimental results have been assessed through objective and subjective quality measures and reveal that less visible artifacts are produced with the technique proposed by reaching PSNR values above 40.0 dB and an embedding bit rate average per secret communication channel of 425 bits/sec. This exemplifies that steganography is affordable in digital television.

Chez les personnes post-AVC (Accident Vasculaire Cérébral), spasticité, faiblesse et toute autre coactivation anormale proviennent de limitations dans la régulation de la gamme des seuils des réflexes d'étirement. Nous avons voulu savoir si les déficits dans les influences corticospinales résiduelles contribuaient à la limitation de la gamme des seuils et au développement de la spasticité chez les patients post-AVC. La stimulation magnétique transcranienne (SMT) a été appliquée à un site du cortex moteur où se trouvent les motoneurones agissant sur les fléchisseurs et extenseurs du coude. Des potentiels évoqués moteurs (PEM) ont été enregistrés en position de flexion et d'extension du coude. Afin d'exclure l'influence provenant de l'excitabilité motoneuronale sur l'évaluation des influences corticospinales, les PEM ont été suscités lors de la période silencieuse des signaux électromyographiques (EMG) correspondant à un bref raccourcissement musculaire juste avant l'enclenchement de la SMT. Chez les sujets contrôles, il y avait un patron réciproque d'influences corticospinales (PEM supérieurs en position d'extension dans les extenseurs et vice-versa pour les fléchisseurs). Quant à la plupart des sujets post-AVC ayant un niveau clinique élevé de spasticité, la facilitation corticospinale dans les motoneurones des fléchisseurs et extenseurs était supérieure en position de flexion (patron de co-facilitation). Les résultats démontrent que la spasticité est associée à des changements substantiels des influences corticospinales sur les motoneurones des fléchisseurs et des extenseurs du coude. / In post-stroke patients, spasticity, weakness and abnormal coactivation result from limitations in the range of regulation of stretch reflex thresholds. We investigated whether the deficits in residual corticospinal influences contribute to the limitation in the regulation of those thresholds and as a result to spasticity in post-stroke subjects. A single-pulse transcranial magnetic stimulation (TMS) was applied to the site of the motor cortex projecting to motoneurons of elbow flexors and extensors. Responses to TMS (motor evoked potentials or MEPs) were recorded at a flexion and an extension position of the elbow joint. To exclude the influence of background motoneuronal excitability on the evaluation of corticospinal influences, MEPs were elicited during the electromyographic (EMG) silent period produced by brief muscle shortening prior to TMS. In control subjects, corticospinal facilitation of flexor motoneurons was usually larger whereas that of extensor motoneurons was smaller during actively maintained flexion than when the extension position was maintained (reciprocal pattern of position-related changes in flexor and extensor MEPs). In most post-stroke subjects with high clinical spasticity scores, corticospinal facilitation of both flexor and extensor motoneurons was greater at the actively established flexion position (co-facilitation pattern). Results show that spasticity is associated with substantial changes in the corticospinal influences on flexor and extensor motoneurons. Corticospinal co-facilitation of the two groups of motoneurons may be related to the necessity to overcome resistance of spastic muscles during active changes in the elbow joint angle.

L'inhibition du protéasome a un effet anti-inflammatoire en bloquant l'activation de NF-êB. Dans ce travail, nous avons étudié cette propriété anti-inflammatoire dans deux modèles animaux de maladies neurologiques: la sclérose en plaques et l'AVC. Nous avons utilisé le ritonavir, un antiprotéase du VIH et qui a des effets de modulation sur le protéasome. Ainsi l'administration du ritonavir a permis d'inhiber l'EAE modèle animal de SEP. D'autre part, un effet anti-ischémique cérébral a été obtenu ches les animaux ayant subi une occlusion de l'artère cérébrale moyenne, modèle animal d'AVC. Ces effets neuroprotecteurs ont été corrélés à une inhibition de la réponse inflammatoire chez les animaux traités. Ces résultats ouvrent des nouvelles perspectives thérapeutiques dans les maladies inflammatoires basées sur la modulation du protéasome / The inhibition of the proteasome has an anti-inflammatory effect by blocking the activation of NF-êB. In this work, we studied this anti-inflammatory property in two animal models of neurological diseases: the multiple sclerosis and stroke. We used the ritonavir, an antiprotease of the HIV and which has effects of modulation on the proteasome. So the administration of the ritonavir allowed to inhibit the animal model EAE of MS. On the other hand, an anti-ischemic effect was obtained in animal model of stroke. These neuroprotective effects were correlated with an inhibition of the inflammatory response. These results open new therapeutic perspectives in the inflammatory diseases based on the modulation of the proteasome.

O acidente vascular cerebral (AVC) é a principal causa de mortes no Brasil entre os óbitos por doenças cerebrovasculares e a principal causa de incapacidade no mundo. Este é um problema substancial de saúde pública e econômico, representa mais da metade dos pacientes neurológicos hospitalizados e muitos apresentam sequelas como hemiparesia, dependência completa ou parcial, afasias e dificuldade na deambulação. Um recurso para potencializar a reabilitação é a \"Telereabilitação\" (TR), que usa as tecnologias de informação e comunicação (TIC\'s) para acompanhamento à distância. Inúmeros benefícios da telessaúde e TR já foram descritos, incluindo um melhor acesso aos serviços de saúde, custo-eficácia, mais oportunidades educacionais, melhoria dos resultados na recuperação, melhor qualidade dos cuidados, melhor qualidade de vida e reforço dos suportes sociais. O presente trabalho realizou um levantamento da percepção dos profissionais e das ferramentas utilizadas por terapeutas ocupacionais para acompanhamento à distância de pacientes com seqüelas de AVC, assim como introduziu ferramentas de TR (mensagens de texto, telefonemas, chats online, etc) em serviços de reabilitação da cidade de Ribeirão Preto e verificou sua viabilidade de uso com estes pacientes. O estudo se desenvolveu em duas partes: 1) levantamento da percepção dos profissionais e das tecnologias usadas nos serviços de terapia ocupacional através de um questionário semi-estruturado; 2) implantação de ferramentas de acompanhamento à distância integradas ao acompanhamento convencional. A parte de implantação foi dividida em duas fases. Na primeira com o uso de somente uma ferramenta para acompanhamento do paciente (por exemplo a mensagem de texto via celular) e a segunda com o uso de duas ferramentas em conjunto (telefonemas e mensagens de texto). O acompanhamento dos pacientes em cada fase foi pelo período de no máximo dois meses. A viabilidade de uso das tecnologias foi avaliada nos aspectos de tempo dispensado para uso, facilidade, percepção de utilidade e adesão à ferramenta, que foram analisados através de questionários estruturados aplicados com o terapeuta do serviço e o paciente. Obteve-se como resultado da primeira parte do estudo um levantamento com 27 terapeutas ocupacionais. Na segunda parte as ferramentas foram introduzi das no tratamento de 9 pacientes. Foi verificado que muitos profissionais já utilizam na clínica as tecnologias de informação e comunicação para acompanhamento à distância. Pôde-se discutir sobre a importância da ética no uso de tecnologias para acompanhamento à distância, da consideração de aspectos como da confiabilidade da informação fornecida pela tecnologia, avaliação das habilidades do paciente para uso, uso de tecnologias de uso prévio do paciente, avaliação da sua rotina e hábitos de vida no momento da escolha da ferramenta. Os pacientes acompanhados não apresentaram dificuldades no uso das ferramentas introduzidas, relataram satisfação com uso e foi observado pelos terapeutas a facilitação do processo de reabilitação através da maior adesão das orientações, monitoramento do paciente e motivação na terapia. / Stroke is the leading cause of death in Brazil between deaths due to cerebrovascular disease and the leading cause of disability worldwide. This is an issue of substantial public health and economic accounts for more than half of patients hospitalized and many have neurological sequelae such as hemiparesis, partial or complete dependence, aphasia and difficulty in walking. A resource for enhancing rehabilitation is \"Telereabilitação\" (TR), which uses communication technologies for distance care. Numerous benefits of telehealth and TR have been described, including improving access to health services, cost-effective, more educational opportunities, improved results in recovery, better quality of care, better quality of life and strengthening social supports. This study conducted a survey of the perceptions of professionals and the tools used by occupational therapists for remote monitoring of patients with sequelae of stroke, as well as introduced the TR (text messages, phone calls, online chats, etc.) tools in rehabilitation services the city of Ribeirão Preto and verifted its feasibility of use with these patients. The study was conducted in two parts: 1) raising the awareness of professionals and technology used in occupational therapy services through a semi-structured questionnaire; 2) implementation of the integrated monitoring to conventional monitoring tools away. The deployment part was divided into two phases. At first only with the use of a tool for monitoring the patient (e.g. via mobile text message), and the second using two tools together (phone calls and text messages). Monitoring of patients in each phase was the period of maximum two months. The feasibility of using technology was evaluated in the aspects of time allocated for use, ease, perceived usefulness and adherence to the tool, which were analyzed using structured questionnaires with the therapist and the patient service. Obtained as a result of the first part of the study a survey of 27 occupational therapists. In the second part the tools were made in the treatment of patients 9. It was found that many professionals now use in clinical information technology and communication for remote monitoring. We can discuss about the importance of ethics in the use of technology for remete monitoring, the consideration of aspects such as the reliability of the information provided by the technology, skills assessment of the patient to use, use of prior patient use technologies, assessment of your routine and lifestyle in their choice of tool. The patients monitored had no difficulties in using the tools introduced, reported satisfaction with use and was observed by the therapists facilitating the rehabilitation process through greater adherence to the guidelines, patient monitoring and motivation in therapy.

Doenças como AVC e Epilepsia estão constantemente associadas à manifestação de comprometimentos cognitivos e demência, tendo como característica principal os déficits de memória. Atualmente,o instrumento Mini Exame do Estado Mental (MEEM) é o teste de rastreio de comprometimento cognitivo mais utilizado no mundo, individualmente ou como parte integrante em baterias de avaliação neuropsicológica. Devido afalta de instrumentos específicos pararastreiode comprometimento cognitivo de indivíduos com sintomas de demênciavítimas de AVC e/ou Epilepsia em Angola, África, fez se necessária aadaptação evalidação de instrumentos confiáveis.O presente estudoteve por objetivo a avaliação clínicada versão brasileira do instrumento MEEM adaptado por Brucki, para uso na população adulta de Angola.Trata-se de um estudo clínico comparado, envolvendo três populações. Foram incluídos neste estudo 85 indivíduos acometidos por AVC, 40 por Epilepsia e como grupo de comparação, 87 indivíduos de 20 a 65 anos de idade, supostamente saudáveis. A escolaridade mínima para inclusão do estudo foi definida em 4 anos de ensino formal. O presente estudo foi desenvolvido em parceria com o Serviço de Neurologia do Hospital Américo Boavida e com a Faculdade de Medicina da Universidade Agostinho Neto (FMUAN), ambos localizados ao norte da cidade de Luanda, capital de Angola, África.Toda a amostra foi submetida à coleta de dados sócio demográficos e avaliação neuropsicológica, através do instrumento MEEM. O instrumento consistiu no rastreio de comprometimento cognitivo, contemplando funções como orientação temporal e espacial, memória, cálculo, linguagem e capacidade construtivavisual.No presente estudo, encontramos dados que apontam um desempenho significativamente pior das funções cognitivas em pacientes acometidos por AVC quando comparados a pacientes com Epilepsia e grupo dossaudáveis. Esses achados confirmam a validade do instrumento MEEM, em função das características apresentadas pela doença, sendo possível discriminar com clareza os grupos AVC, Epilepsia e Controles Saudáveis. Os dados obtidos indicam uma boa qualidade da versão na língua portuguesa angolana, sendo a consistência interna da versão adaptada com ? de Cronbach = 0,736, semelhante aos dados de referência. Este estudo pioneiro preenche uma importante lacuna na produção de conhecimento em Angola, abrindo um leque de possibilidades para outros trabalhos científicos no país, facilitando a aplicação dos resultados tanto na área acadêmica-científica, quanto na clínica. É necessário aos profissionais de saúde que se apropriem de mais conhecimentos, para que possam propor intervenções adequadas, que auxiliam nos direitos de saúde e bem-estarda população angolana. / Diseases such as stroke and epilepsy are constantly associated with the manifestation of cognitive impairment and dementia, having as main feature the memory deficits (Caramelli & Castro, 2005). Currently, the instrument Mini Mental State Examination (MMSE) is the screening test of cognitive impairment most used in the world, individually or as an integrated part in neuropsychological assessment battery (Melo & Barbosa, 2015). Due to the lack of specific instruments for screening cognitive impairment of individuals with dementia symptoms victims of stroke and / or epilepsy in Angola, Africa, it was necessary to adapt and validate reliable instruments. The presentestudy had as objective the clinical evaluationof the brazilian version of the MMSE instrument adapted by Brucki et al. (2003), for use in the adult population of Angola, Africa. It is a comparative clinical study involving three populations. This studyincluded 85 individuals affected by stroke, 40 by Epilepsy, and as a comparison group, 87 individuals, 20 to 65 years of age, who were supposed to be healthy. The minimum schooling for inclusion of the study was defined in 4 years of formal education. Thepresent study was developed in partnership with the Neurology Service of the Américo Boavida Hospital and the Faculty of Medicine of the Agostinho Neto University (FMUAN), both located north of the city of Luanda, the capital of Angola, Africa. All the sample was submitted to the collection of sociodemographic data and neuropsychological evaluation, through the MMSE instrument. The instrument consisted in the screening of cognitive impairment, including functions such as temporal and spatial orientation, memory, calculus, language and visual constructive capacity.In the presente study, we found data that indicate a significantly worse performance of cognitive functions in patients with stroke when compared to patients with epilepsy and healthy group. These findings confirm the validity of theinstrument MMSE in, due to the characteristics of the disease, being possible to discriminate with clarity the groups Stroke, Epilepsy and Healthy Controls. The data obtained indicate a good quality of the Angolan Portuguese language version, being the internal consistency of the adapted versionwhit the Cronbach\'s alpha = 0.736, similar to the reference data.This pioneering study fills animportant gap in knowledge production in Angola, opening up a range of possibilities for other scientific papers in the country, facilitating the application of the results both in the academic and scientific area, as at the clinic. It is necessary that health professional take ownership of more knowledge, so that they can propose appropriate interventions that assist in health and welfare rights of the Angolan population.