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The aim of this study is to establish a brief screening tool to classify PD patients as PD with normal cognition (PD-N), PD patients with mild cognitive impairment (PD-MCI) and PD patients with dementia (PD-D). There has been emerging evidence that the MoCA (Montreal Cognitive Assessment) shows potential for the brief assessment of cognition to differentiate among PD patients. One possible solution to further improve the discrimination among PD-D, PD-MCI and PD-N groups is to examine Instrumental Activities of Daily Living (IADL) measures in conjunction with the MoCA. A convenience sample of 162 patients suffering from PD and 53 volunteer control subjects were examined in a movement disorders center. Extensive neuropsychological testing was done to classify the PD patients into PD-N, PD-MCI or PD-D. The 24 patients were diagnosed as PD-D based on the Movement Disorders Society Task Force criteria. For PD-MCI, two criteria were used: 1.5SD:2 in one-domain (1.5 SD below the norms on two measures in at least one of four cognitive domains) and 1.5SD:1 in two-domains (1.5 SD below normative data in at least one measure but in two domains) which made a diagnosis of 34 and 39 PD-MCI patients respectively. The remaining patients were classified as PD-N. For both the MCI criteria, the results suggest that 1) for discriminating PD-MCI from PD-N, the MoCA is a sufficiently suitable screening measure that is not improved by adding ADL measures, 2) for distinguishing PD-D from PD-MCI, the MoCA and the full ADL-IS questionnaire can be administered to a patient suffering from PD. When time is limited and depending on the possibility of answering the questions regarding the ADL-IS items, the MoCA along with the Muddled and Complex Medication ADL-IS items should be administered. When no scores are obtained for Muddled, then MoCA along with Complex Medication ADL-IS item is sufficient to discriminate PD-D from PD-MCI. However, if no scores are obtained for Complex Medication item, then an average of four ADL-IS items should be taken along with the MoCA. This attractive brief screening tool helps in detection of cognitive impairment in the elderly.

Introdução: A doença de Parkinson (DP) é uma doença neurodegenerativa cujo quadro clínico é essencialmente motor, no entanto as manifestações não motoras frequentemente estão presentes e muitas vezes são negligenciadas. Dentre as manifestações não motoras o declínio cognitivo tem ganhado destaque sendo causa de maior morbidade e mortalidade. A prevalência da demência na doença de Parkinson (DDP) varia de acordo com a população estudada e no momento do diagnóstico até 20% dos pacientes já apresentam algum grau de declínio cognitivo e com a evolução da doença até 80% dos pacientes apresentaram um quadro demencial associado a DP. Como A DP apresenta características clinico e patológicas sobrepostas à Doença de Alzheimer (DA) e a Apolipoproteína (ApoE) é o principal preditor de risco para desenvolvimento de demência na DA aventou-se a hipótese de que o alelo ?4 da ApoE pudesse ter relação com o risco de o paciente com DP desenvolver quadro demencial. Objetivo: analisar a relação entre o polimorfismo do gene ApoE com o desempenho cognitivo, avaliado pela MoCA, de pacientes com doença de Parkinson e descrever prevalência de cada alelo do gene em uma amostra de pacientes com DP da população brasileira. Método: estudo transversal onde foram analisados 186 pacientes em seguimento nos ambulatórios especializados em Distúrbios do Movimento do Hospital das Clínicas de Ribeirão Preto - HCFMRP e do Hospital São Paulo da Universidade Federal de São Paulo - UNIFESP, no período entre os anos de 2007 e 2014. Foi realizada a genotipagem dos alelos da ApoE e a avaliação cognitiva foi realiza através do MoCA. Para análise da amostra os pacientes foram classificados em portadores ou não do alelo ?4. Os grupos foram comparados utilizando o teste do Qui-quadrado para a variável sexo e o teste nãoparamétrico de Mann-Whitney para idade, tempo de doença e anos de estudo. Resultados: A análise dos escores da MoCA nos grupos com e sem o alelo ?4 não revelou diferença estatisticamente significativa entre os grupos (p=0,20). A frequência genotípica foi semelhante à descrita nos demais estudos sobre o assunto. Conclusão: a presença do alelo ?4 não está associada, em nossa amostra, a um pior desempenho cognitivo, quando este é avaliado pela escala cognitiva global MoCA. / Introduction: The Parkinson\'s disease (DP) is a neurodegenerative disorder where clinical findings are primarily motor however non-motor manifestations are often present and are frequently neglected. Among the non-motor events cognitive decline has gained prominence because it is cause of increased morbidity and mortality. The prevalence of Parkinson\'s disease dementia (PDD) varies depending on the population studied but at the time of diagnosis about 20% of patients already have some degree of cognitive decline and the progression of the disease up to 80% of patients demonstrated PDD. As DP has overlapping clinical and pathological features with Alzheimer\'s disease (DA) and apolipoprotein (ApoE) is the main predictor of risk for developing dementia in AD the hypothesis has suggested that the allele ?4 of ApoE could be related to the risk of the patient with PD develop dementia. Objective: analyze the relationship between ApoE gene polymorphism with the cognitive performance of patients with Parkinson\'s disease and describe prevalence of each allele of the gene in a sample of with PD in a Brazilian population. Method: cross-sectional study which analyzed 186 patients in follow-up in specialized of Hospital das Clínicas de Ribeirão Preto - HCFMRP and Hospital São Paulo of Universidade Federal de São Paulo - UNIFESP, between the years 2007 and 2014. Was made the genotyping for assessing the ApoE allele and cognitive assessment was carried out through the MoCA. For sample analysis, patients were classified as carriers or not allele ?4. The groups were compared using the chi-square test for gender and non-parametric Mann-Whitney test for age, disease duration and years of study. Results: The analysis of MoCA scores in the groups with and without the ?4 allele revealed no statistically significant difference between groups (p = 0.20). The genotypic frequency was similar to that described in other studies

Introdução: A doença de Parkinson (DP) é uma doença neurodegenerativa cujo quadro clínico é essencialmente motor, no entanto as manifestações não motoras frequentemente estão presentes e muitas vezes são negligenciadas. Dentre as manifestações não motoras o declínio cognitivo tem ganhado destaque sendo causa de maior morbidade e mortalidade. A prevalência da demência na doença de Parkinson (DDP) varia de acordo com a população estudada e no momento do diagnóstico até 20% dos pacientes já apresentam algum grau de declínio cognitivo e com a evolução da doença até 80% dos pacientes apresentaram um quadro demencial associado a DP. Como A DP apresenta características clinico e patológicas sobrepostas à Doença de Alzheimer (DA) e a Apolipoproteína (ApoE) é o principal preditor de risco para desenvolvimento de demência na DA aventou-se a hipótese de que o alelo ?4 da ApoE pudesse ter relação com o risco de o paciente com DP desenvolver quadro demencial. Objetivo: analisar a relação entre o polimorfismo do gene ApoE com o desempenho cognitivo, avaliado pela MoCA, de pacientes com doença de Parkinson e descrever prevalência de cada alelo do gene em uma amostra de pacientes com DP da população brasileira. Método: estudo transversal onde foram analisados 186 pacientes em seguimento nos ambulatórios especializados em Distúrbios do Movimento do Hospital das Clínicas de Ribeirão Preto - HCFMRP e do Hospital São Paulo da Universidade Federal de São Paulo - UNIFESP, no período entre os anos de 2007 e 2014. Foi realizada a genotipagem dos alelos da ApoE e a avaliação cognitiva foi realiza através do MoCA. Para análise da amostra os pacientes foram classificados em portadores ou não do alelo ?4. Os grupos foram comparados utilizando o teste do Qui-quadrado para a variável sexo e o teste nãoparamétrico de Mann-Whitney para idade, tempo de doença e anos de estudo. Resultados: A análise dos escores da MoCA nos grupos com e sem o alelo ?4 não revelou diferença estatisticamente significativa entre os grupos (p=0,20). A frequência genotípica foi semelhante à descrita nos demais estudos sobre o assunto. Conclusão: a presença do alelo ?4 não está associada, em nossa amostra, a um pior desempenho cognitivo, quando este é avaliado pela escala cognitiva global MoCA. / Introduction: The Parkinson\'s disease (DP) is a neurodegenerative disorder where clinical findings are primarily motor however non-motor manifestations are often present and are frequently neglected. Among the non-motor events cognitive decline has gained prominence because it is cause of increased morbidity and mortality. The prevalence of Parkinson\'s disease dementia (PDD) varies depending on the population studied but at the time of diagnosis about 20% of patients already have some degree of cognitive decline and the progression of the disease up to 80% of patients demonstrated PDD. As DP has overlapping clinical and pathological features with Alzheimer\'s disease (DA) and apolipoprotein (ApoE) is the main predictor of risk for developing dementia in AD the hypothesis has suggested that the allele ?4 of ApoE could be related to the risk of the patient with PD develop dementia. Objective: analyze the relationship between ApoE gene polymorphism with the cognitive performance of patients with Parkinson\'s disease and describe prevalence of each allele of the gene in a sample of with PD in a Brazilian population. Method: cross-sectional study which analyzed 186 patients in follow-up in specialized of Hospital das Clínicas de Ribeirão Preto - HCFMRP and Hospital São Paulo of Universidade Federal de São Paulo - UNIFESP, between the years 2007 and 2014. Was made the genotyping for assessing the ApoE allele and cognitive assessment was carried out through the MoCA. For sample analysis, patients were classified as carriers or not allele ?4. The groups were compared using the chi-square test for gender and non-parametric Mann-Whitney test for age, disease duration and years of study. Results: The analysis of MoCA scores in the groups with and without the ?4 allele revealed no statistically significant difference between groups (p = 0.20). The genotypic frequency was similar to that described in other studies

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...

OF MASTER THESIS Author: Bc. Kateřina Králová Supervisor: MUDr. Tereza Gueye Title of master thesis: Evaluation of Occupational Therapy Intervention in Acute Inpatient Rehabilitation of Cerebrovascular Units Abstract This diploma thesis deals with the evaluation of occupational interventions on the specific separation of beds of early rehabilitation of the cerebrovascular center of the General University Hospital in Prague. The subject of interest is primarily the results of the assessment obtained through the Functional Independence Measure (FIM) and the Montreal Cognitive Assessment. The thesis has two main objectives, namely mapping and analyzing the tools used to assess self-sufficiency and cognitive functions in the department. You can find the description of the evaluation tools in the theoretical part of the thesis. It is also an overview of the topic of the selected topic and a brief description of the system of cerebrovascular care in the Czech Republic. The second objective was to evaluate variables such as length of hospitalization and cognitive status in relation to patient self-sufficiency at the end of hospitalization. Three hypotheses have been identified to meet this goal. The practical part describes the results of the used tools for a particular department. The research group...

Il existe une association étroite entre la santé cardiovasculaire et la santé cognitive au cours du vieillissement. Bien que la recherche dans le domaine de la santé cardiovasculaire soit vaste, le lien entre l'électrophysiologie cardiaque et la cognition est peu étudié. La présente thèse met en évidence les liens entre l'électrophysiologie cardiaque et la cognition en examinant la régulation autonomique chez les individus sains et des marqueurs de maladie chez les patients souffrant de fibrillation auriculaire (FA ; maladie du rythme cardiaque la plus prévalente). Les résultats présentés dans le chapitre 2 démontrent pour une première fois qu'un marqueur de repolarisation cardiaque, le QTcD, est lié aux performances cognitives (fonctions globales et exécutives) chez des personnes âgées sédentaires en bonne santé. Ces observations étaient plus évidentes chez les personnes présentant des valeurs élevées de QTcD, suggérant que des altérations plus importantes du rythme cardiaque pourraient avoir une association plus forte avec les performances cognitives. Les résultats présentés au chapitre 3 montrent que chez les patients souffrant de FA, une plus grande morbidité (mesurée par le sous-type de FA) serait associée à une performance cognitive plus faible (fonctions globales et exécutives). Cette même étude démontre que le volume de l'oreillette gauche agît comme facteur modérateur de l’association entre le sous-type de FA et la performance cognitive. Ceci suggère que plus l'arythmie est sévère, plus le déficit cognitif observé est important. Le chapitre 4 présente les résultats d'une étude pilote portant sur les changements dans les performances cognitives et l'oxygénation régionale du tissu cérébral chez les patients souffrant de FA qui subissent une cardioversion électrique (une procédure visant à rétablir du rythme sinusal). Les résultats de cette étude pilote montrent qu'un tel devis est effectivement réalisable et pourrait permettre de détecter des changements cognitifs dans cet échantillon. Bien que la modification de l'oxygénation du tissu cérébral en lien avec la cardioversion n’ait pas été démontrée pour le moment, des changements au niveau de la cognition ont été observé, ce qui pourrait être partiellement expliqué par la réduction des symptômes liés à la FA post-cardioversion. Parmi toutes les capacités cognitives, la flexibilité (mesurée par le Trail-Making Test) semble être plus sensible aux détériorations du rythme cardiaque, tant chez les individus sains que chez les patients souffrant de FA, dans toutes les études présentées. Les résultats sont discutés dans le contexte d'un continuum cœur-cerveau dans lequel les détériorations du cœur ou du cerveau peuvent avoir des impacts bidirectionnels et altérer davantage le fonctionnement de cet axe. Les orientations futures porteront sur les avantages potentiels de la prévention cognitive par l'exercice et la stimulation cognitive chez les personnes présentant des détériorations électrophysiologiques cardiaques. / There is a close association between cardiovascular and cognitive health in aging. While the cardiovascular health domain is vast, the link between cardiac electrophysiology and cognition is understudied. The present thesis will bring evidence linking cardiac electrophysiology and cognition by looking at autonomic regulation in healthy older individuals and disease markers in patients with atrial fibrillation (AF; most prevalent disease of heart rhythm). Chapter 2 shows for the first time that a cardiac repolarization marker, QTcD, is linked to cognitive performance (global and executive functions) in healthy sedentary older individuals. This relationship was more evident in individuals with elevated QTcD values suggesting that higher impairments in cardiac rhythm might have stronger association with cognitive performance. Results presented in Chapter 3 show that among patients with AF, higher disease burden (as measured by the subtype of AF) was associated with lower cognitive performance (global and executive functions). The study also found that the left atrial volume was a moderator of this association between AF subtype and cognitive performance. This shows that the more severe the condition is the higher the cognitive deficit observed. Chapter 4 shows the results of a pilot study investigating the changes in cognitive performance and regional cerebral tissue oxygenation in AF patients undergoing electrical cardioversion (a sinus rhythm restoration procedure). The pilot results show that such a study is indeed feasible and could detect cognitive changes in this sample. While the change in cerebral tissue oxygenation is unconclusive at this moment, the recorded change in cognition could partially be explained by the reduction in AF related symptoms. Among all cognitive abilities, switching (as measured with the Trail-Making Test) appears to be more sensitive to deteriorations in heart rhythm both in healthy individuals and patients with AF across all studies presented. The results are discussed in the context of a heart-brain continuum in which deteriorations from either the heart or the brain can have bidirectional impacts and further impair the functioning of this axis. Future directions will address the potential benefit of cognitive prevention through exercise and cognitive stimulation in older individuals with cardiac electrophysiological deteriorations.

Submitted by admin tede (tede@pucgoias.edu.br) on 2016-12-12T17:45:59Z No. of bitstreams: 1 IVONETE FERREIRA DA COSTA.pdf: 1144206 bytes, checksum: 112aea88b52fbaed3f56007447beaf47 (MD5) / Made available in DSpace on 2016-12-12T17:46:00Z (GMT). No. of bitstreams: 1 IVONETE FERREIRA DA COSTA.pdf: 1144206 bytes, checksum: 112aea88b52fbaed3f56007447beaf47 (MD5) Previous issue date: 2016-03-23 / The text brings the analysis of aspects of the literary discourse as the processes of construction of the scenes and the magical universe, in which the narratives of Marina Colasanti are realized, having as it shows the tales of the works Doze reis e a moca no labirinto do vento (2006): "The woman ramada", Uma ideia toda azul (2006): "Beyond the frame", "Between the leaves of green ó" and "Yarn after yarn". The general and specific objectives are to highlight and distinguish the encompassing and generic scenes present in the narratives, to identify the nature of the verbal sign in its relation to the nonverbal sign, and to analyze intertext resources, paratext, among others, as an artistic procedure. The narrative plans are approached, in which the characters are realized mimically, starting from the initial assumption formulated by Dominique Maingueneau. Non-verbal language is an invitation to read verbal language and vice versa. Both are associated with the signs that are constructed through the textual writing: loom and fabric. They can be seen now either explicitly or implicitly, and put in the service of a power that is realized by the act of reading. Thus, in the narrative text, there are traces of a speech in which the text is staged. / O texto traz a análise de aspectos do discurso literário como os processos de construção das cenas e o universo mágico, em que se realizam as narrativas de Marina Colasanti, tendo como mostra os contos das obras Doze reis e a moca no labirinto do vento (2006): “A mulher ramada”, Uma ideia toda azul (2006): “Além do bastidor”, “Entre as folhas do verde ó” e “Fio após fio”. Os objetivos geral e específicos são destacar e distinguir as cenas englobante e genérica presentes nas narrativas, identificar a natureza do signo verbal na sua relação com o signo não verbal e analisar recursos de intertexto, paratexto, entre outros, como procedimento artístico. Abordam-se os planos narrativos, nos quais se dá a realização dos personagens mimeticamente, partindo do pressuposto inicial formulado por Dominique Maingueneau. A linguagem não verbal é um convite à leitura da linguagem verbal e vice-versa. Ambas se associam aos signos que se constroem por meio da escritura textual: tear e tecido. Elas podem ser vistas ora de modo explícito, ora implícito, e se colocam a serviço de um poder que se realiza pelo ato de leitura. Assim, no texto narrativo, há rastros de um discurso em que o texto é encenado.