This quasi-experimental study investigates neuropsychological functioning differences between 63 active duty soldiers who were placed into three groups (MTBI, PTSD, control) to provide better information for differentiating PTSD and MTBI. The ANAM and MicroCog were utilized to measure psychomotor speed, memory, and attention. Participants with PTSD performed worse on most measures of psychomotor speed and attention, and endorsed more symptoms of depression and anxiety when compared to MTBI and control participants. Further, attention appears to be the best cognitive domain for differentiating PTSD from MTBI, whereas memory variables did not differentiate these groups. Clinical and research implications of these findings are discussed.

L’apnée obstructive du sommeil (AOS) est l’un des troubles du sommeil les plus fréquents chez l’adulte et sa prévalence augmente avec l’âge. Elle se caractérise par des arrêts répétés de la respiration au cours du sommeil, menant à la présence de fragmentation du sommeil et à de l’hypoxémie intermittente. Lorsque non traité, ce trouble peut mener à diverses conséquences non négligeables sur la santé des individus qui en sont atteints, incluant sur la santé du cerveau. L’AOS est d’ailleurs de plus en plus reconnue comme étant un possible facteur de risque de déclin cognitif et de démence. Dans ce contexte, quelques études transversales ont caractérisé le volume de la substance grise cérébrale chez des adultes vieillissants atteints d’AOS, avec des résultats variables. En effet, certaines études ont noté de plus grands volumes de substance grise chez les personnes avec une AOS plus sévère, alors que d’autres ont retrouvé des plus petits volumes chez cette même population. Ce qui explique la variabilité entre les études demeure à ce jour mal compris, bien que certaines hypothèses aient émergé. Ainsi, cette thèse vise à évaluer l’association entre la sévérité de l’AOS et le volume de substance grise cérébrale chez des personnes d’âge moyen et âgées de manière transversale et longitudinale. La première étude de cette thèse se base sur des techniques de neuroimagerie afin d’évaluer les liens entre la sévérité de l’AOS et le volume de la substance grise cérébrale des sous-régions du lobe temporal médian, soit l’hippocampe, le cortex entorhinal et le cortex parahippocampique. Celles-ci ont été ciblées puisqu’elles peuvent être affectées tôt dans la progression de la pathologie de la maladie d’Alzheimer (MA). De plus, nous avons testé l’effet d’une correction de la portion d’eau libre sur les volumes cérébraux. Finalement, nous avions comme objectif de mieux comprendre si certaines caractéristiques démographiques ou cliniques de nos participants pouvaient avoir un impact sur les associations observées. Nous avons observé qu’une AOS plus sévère était associée à des volumes de substance grise plus grands de certaines sous-régions du lobe temporal médian (hippocampe et cortex entorhinal), mais seulement chez des groupes de participants spécifiques, soit les femmes, les participants plus âgés et ceux présentant un trouble cognitif léger de type amnésique. Le fait d’apporter une correction pour la portion d’eau libre aux volumes mesurés a rendu non significatives les associations observées. Il est donc possible que la présence accrue d’eau extracellulaire, suggérant de l’œdème cérébral, puisse expliquer la présence de plus grands volumes chez les participants présentant une AOS plus sévère. La deuxième étude visait quant à elle à évaluer les changements structurels des sous-régions du lobe temporal médian associés à la sévérité de l’AOS chez des personnes d’âge moyen et âgées sur une période d’environ 2 ans. Nous avons démontré que chez nos participants n’ayant pas utilisé un traitement pour l’AOS, la présence d’interaction entre la sévérité de l’AOS et l’âge permettait d’expliquer les changements annuels de volume de substance grise. De fait, les participants plus jeunes de notre échantillon (< 65 ans) avec une AOS plus sévère présentaient un plus grand taux de changement annuel de volume de substance grise, soulignant la présence d’hypertrophie dans ce sous-groupe. Ceci a été mis en lumière pour l’ensemble des sous-régions du lobe temporal médian. Chez les participants âgés entre 65 et 75 ans, aucune association entre la sévérité de l’AOS et les changements de volume au fil du temps n’a pu être soulignée. Les participants plus âgés (> 75 ans) avec une plus grande sévérité d’AOS présentaient quant à eux une plus grande atrophie au fil du temps dans certaines régions, soit l’hippocampe et le cortex entorhinal. Ces résultats supportent donc une hypothèse biphasique des changements au niveau de la substance grise cérébrale chez les gens présentant de l’AOS, avec une première phase caractérisée par des augmentations de volume chez les adultes plus jeunes, menant éventuellement à de l’atrophie chez les personnes plus âgées. Cette thèse permet d’avoir un portrait plus clair sur la nature des changements et des mécanismes impliqués dans l’association entre la sévérité de l’AOS et les volumes de substance grise. L’un des apports importants est l’utilisation d’une nouvelle méthodologie afin d’obtenir une portion d’eau libre, ce qui a permis de mieux comprendre l’apport potentiel de mécanismes pouvant sous-tendre les changements structuraux observés, notamment l’œdème cérébral. De plus, l’évaluation des caractéristiques individuelles des participants a permis d’expliquer partiellement les incongruences entre les études précédentes. Dans le cadre des études incluses dans cette thèse, nous avons observé des changements plus marqués chez les femmes. Nous avons également pu démontrer que l’âge des individus atteints d’AOS pouvait influencer significativement le patron de changements observés. Les résultats de cette thèse pourraient donc permettre de mieux cibler les personnes avec AOS qui pourraient le plus bénéficier d’un traitement pour maintenir leur santé cérébrale. / Obstructive sleep apnea (OSA) is one of the most common sleep disorders in adults, and its prevalence increases with age. It is characterized by repeated pauses in breathing during sleep, leading to sleep fragmentation and intermittent hypoxemia. If left untreated, this disorder can have numerous consequences, including on the brain’s health. OSA is increasingly recognized as a risk factor for cognitive decline and dementia. In this context, cross-sectional studies have characterized brain gray matter volume in aging adults with OSA, with variable results. Indeed, some studies have noted greater gray matter volumes in people with more severe OSA, while others have found smaller volumes in this same population. What explains the variability between studies remains poorly understood, although some hypotheses have emerged. Thus, this thesis aims to assess the association between OSA severity and cerebral gray matter volume in middle-aged and elderly individuals using cross-sectional and longitudinal designs. The first study in this thesis uses neuroimaging techniques to assess the links between OSA severity and cerebral gray matter volume of the medial temporal lobe subregions, i.e. the hippocampus, entorhinal cortex and parahippocampal cortex. These were chosen as they can be affected early in the progression of Alzheimer's disease (AD) pathology. We also corrected our brain volumes for free-water portion. Finally, we aimed to better understand whether certain demographic or clinical characteristics of our participants might have an impact on the associations observed. We noted that more severe OSA was associated with larger gray matter volumes in certain subregions of the medial temporal lobe (hippocampus and enthorinal cortex), but only in specific groups of participants: women, older participants and those with amnestic mild cognitive impairment. Correcting our volumes for free-water portion rendered the associations nonsignificant. It is therefore possible that the presence of extracellular water, suggestive of cerebral edema, could explain the presence of larger volumes in participants with more severe OSA. The second study aimed to assess longitudinal structural changes associated with OSA severity in middle-aged and elderly people over a period of around 2 years. We found that in participants who did not use treatment for OSA, the presence of interactions between OSA severity and age were associated with the annual changes in gray matter volume. Indeed, younger participants (< 65 years old) in our sample with more severe OSA showed a greater rate of annual change in gray matter volume, highlighting the presence of hypertrophy in this subgroup. This was underlined in all medial temporal lobe subregions. In participants aged between 65 and 75, no association between OSA severity and volume changes over time could be highlighted. Older participants (>75 years old) with greater OSA severity showed greater hippocampal and entorhinal cortex atrophy over time. These results therefore support a biphasic hypothesis of changes in cerebral gray matter in people with OSA, with an initial phase characterized by volume increases in younger adults, eventually leading to atrophy in older people. This thesis provides a clearer picture of the nature of the changes and mechanisms involved in the association between OSA severity and gray matter volumes. An important contribution is the use of a new methodology to obtain a free-water portion, which allows to better understand the potential contribution of mechanisms that may underlie the structural changes observed, notably cerebral edema. In addition, the assessment of participants' individual characteristics helped to partially explain incongruities between previous studies. Indeed, in the studies included in this thesis, we observed more marked changes in certain subgroups of participants, notably women. We were also able to demonstrate that the age of individuals with OSA could significantly influence the pattern of changes observed, either gray matter hypertrophy or atrophy. The results of this thesis could therefore make it possible to target specific subgroups of individuals suffering from OSA who may be at greater risk of displaying changes in gray matter structure, and thus promote screening and treatment when necessary.

The thesis provides an analysis and comparison of Geography textbooks for children with hearing impairment, children with a mild intellectual disability and children in mainstream elementary schools. The aim of the thesis is to highlight the current state of Geography textbooks for children with hearing impairment and, by means of combining findings on deaf education and the didactics of Geography, suggest specific solutions for improving the quality of education of children with hearing impairment through raising the standard for didactic materials used for teaching. The introduction of the thesis explores the position of Geography as a field of study within the School and Framework Educational Programmes; the objectives of teaching Geography at the second stage of elementary school are examined in relation to the target groups whose the textbooks are analysed in this thesis. Further, the thesis focuses directly on textbooks. The functions of the textbook in the educational process are introduced, as well as its structural components with a particular emphasis on the textual elements. Drawing on relevant academic literature, the characteristic features of these elements are described with special attention paid to learning from text - predominantly with regards to deaf children who typically...

In the Apartheid South Africa, repression and the heightening of the Blacks' struggle for political emancipation, prompted artists to challenge the system through their music, oral poetry and writing. Most produced works of protest in English to reach a wider audience. This led to the general misconception that literatures in the indigenous languages of South Africa were insensitive to the issues of those times. This study seeks firstly to put to rest such misconception by proving that there is Commitment in these literatures as exemplified in the poetry of S.F. Motlhake. Motlhake not only expresses protest against the political system of the time, but also questions some religious and socio-cultural practices and institutions among his people. The study also examines his selected works as genuine poetry, which does not sacrifice art on the altar of propaganda. / African Languages / M.A. (African Languages)

The main assertion in this dissertation is that there is a lack of adequate and appropriate parental involvement in the education of learners with mild intellectual impairment in mainstream schools in Sisonke District. Empirical research was conducted to understand the perceptions of parents and teachers of the involvement of parents in the education of learners with mild intellectual impairment in mainstream schools. The focus was on parents and teachers in an extreme poverty context in Sisonke District of KwaZulu-Natal. A qualitative investigation of parental involvement in five mainstream schools was conducted by collecting data through interview, observation and documents analysis with ten parents and five teachers. The literature that was reviewed focused on the factors that increase and hinder parental involvement, prevalence of intellectual impairment, theories related to family, school and community partnership and inclusive education. The research has revealed that the lack of adequate and appropriate parental involvement at mainstream schools admitting learners with mild intellectual impairment is influenced by factors such as poor socio-economic background, high illiteracy, cultural beliefs, and parents’ denial of intellectual impairment, diversity, lack of teacher training in parental involvement, lack of healthy inclusive climate characteristics, parents’ attitudes and perceptions. The investigation further found that there is an urgent need for teachers to acquire knowledge, skills and strategies for active involvement of parents in inclusive mainstream schools. Each School Management Team (SMT) should strive to create a climate of inclusion that displays healthy school characteristics in order to improve parental involvement in mainstream schools. / Inclusive Education / M. Ed. (Inclusive Education)

The main purpose of this project is to investigate different tool steels in terms of their ability to withstand material transfer buildup, so-called galling, occurring in SMF (sheet metal forming) operations. The ability to withstand galling is vital to optimize cost-effectiveness and increase the work tool’s effective operational time. This investigation studies four different tool steels, including a TiN-coating, with the intention of evaluating the microstructures, chemical composition and hardness effect on galling resistance in dry conditions using a slider-on-flatsurface (SOFS) tribo-tester which measures the coefficient of friction during sliding. An OP (optical profilometer) was used to measure the size and geometry of lump growth on the tool and damage on the work sheet. A scanning electron microscope (SEM) was used to identify the interacting tribological mechanisms exhibited at different stages during the slide. The SEM figures confirmed three different types of characteristic patterns exhibited in the tracks after tribo- testing which were categorized as mild adhesive, abrasive and severe adhesive damage. A SEM figure that illustrates a ragged contact surface and an obvious change in the sheet materials plastic behavior is in this report regarded as a sign of severe adhesive contact, the characteristics could possibly be explained by local high temperature and high pressure followed by a sudden pressure drop and creation of hardened welds or solders between the two surfaces which increase the frictional input needed for further advancement. Friction coefficients observed in the initial 100% mild adhesive stage were, μ=0,22-0,26 succeeded by abrasive SEM characteristics often in association with mild adhesive contact and friction values between μ=0,25-0,4 which where sometimes followed by severe adhesive SEM characteristics in 100% of the contact zone with friction values between μ=0,34- 0,9 respectively. The tool material that performed best according to the friction detection criteria was Sv21 closely followed by Sleipner (TiN coated) and Va40 (HRC 63.3). Unfortunately was the friction criteria, a significant raise in friction for defining a sliding length to galling, not adequate for dry conditions due to immediate material transfer succeeded by cyclic changes between partial or 100% abrasive+mild adhesive and severe adhesive contact. The mechanism that change abrasive wear in association with mild adhesive contact, (moderate friction input), to sever adhesive wear, (higher friction input), is dependent on lump shape (lump geometry) and can appear at comparably low speeds 0,04-0,08 [m/s] and low friction energy input (μ=0,34), the magnitude of the change in friction is therefore not always significant and hardly detectable on the friction graph. This was quite unexpected but could be explained by concentration of friction energy rater than the absolute amount. The problem with using friction graphs for galling evaluation was increased even further when a very small lump size and low corresponding rate of material transfer to the tool surface caused a sustainable high raise in friction (μ≈0,3→0,6) on a TiN-coated tool steel called Sleipner. A hardly detectable or similar friction raise for Sv21 and Va40 showed much larger corresponding lump size and rate of material transfer. This means that friction graphs demonstrate a clear problem with quantifying lump size [m3] and rate of  material transfer [m3/s]. Another phenomenon called stick slip behavior, material transfer and lump growth followed by a sudden decrease in lump size and transfer of material back to the work sheet, is also not possible to detect on a friction graph. Because a drop in friction can easily be a change in contact temperature and lump attack angle due to a growing lump and not a decreasing lump.   The conclusion, a friction graph is not suited for galling evaluation and ranking in dry SOFS conditions. A ranking should primarily be based on dimensional OP measurements of the cross section of formed tracks and scratches or preferably by repeated OP measurements of the tool surface during a single test, the last revel the exact lump growth history and true lump growth even in the sliding direction. / civilingenjörsexamen

Le traumatisme craniocérébral léger (TCCL) a des effets complexes sur plusieurs fonctions cérébrales, dont l’évaluation et le suivi peuvent être difficiles. Les problèmes visuels et les troubles de l’équilibre font partie des plaintes fréquemment rencontrées après un TCCL. En outre, ces problèmes peuvent continuer à affecter les personnes ayant eu un TCCL longtemps après la phase aiguë du traumatisme. Cependant, les évaluations cliniques conventionnelles de la vision et de l’équilibre ne permettent pas, la plupart du temps, d’objectiver ces symptômes, surtout lorsqu’ils s’installent durablement. De plus, il n’existe pas, à notre connaissance, d’étude longitudinale ayant étudié les déficits visuels perceptifs, en tant que tels, ni les troubles de l’équilibre secondaires à un TCCL, chez l’adulte. L’objectif de ce projet était donc de déterminer la nature et la durée des effets d’un tel traumatisme sur la perception visuelle et sur la stabilité posturale, en évaluant des adultes TCCL et contrôles sur une période d’un an. Les mêmes sujets, exactement, ont participé aux deux expériences, qui ont été menées les mêmes jours pour chacun des sujets. L’impact du TCCL sur la perception visuelle de réseaux sinusoïdaux définis par des attributs de premier et de second ordre a d’abord été étudié. Quinze adultes diagnostiqués TCCL ont été évalués 15 jours, 3 mois et 12 mois après leur traumatisme. Quinze adultes contrôles appariés ont été évalués à des périodes identiques. Des temps de réaction (TR) de détection de clignotement et de discrimination de direction de mouvement ont été mesurés. Les niveaux de contraste des stimuli de premier et de second ordre ont été ajustés pour qu’ils aient une visibilité comparable, et les moyennes, médianes, écarts-types (ET) et écarts interquartiles (EIQ) des TR correspondant aux bonnes réponses ont été calculés. Le niveau de symptômes a également été évalué pour le comparer aux données de TR. De façon générale, les TR des TCCL étaient plus longs et plus variables (plus grands ET et EIQ) que ceux des contrôles. De plus, les TR des TCCL étaient plus courts pour les stimuli de premier ordre que pour ceux de second ordre, et plus variables pour les stimuli de premier ordre que pour ceux de second ordre, dans la condition de discrimination de mouvement. Ces observations se sont répétées au cours des trois sessions. Le niveau de symptômes des TCCL était supérieur à celui des participants contrôles, et malgré une amélioration, cet écart est resté significatif sur la période d’un an qui a suivi le traumatisme. La seconde expérience, elle, était destinée à évaluer l’impact du TCCL sur le contrôle postural. Pour cela, nous avons mesuré l’amplitude d’oscillation posturale dans l’axe antéropostérieur et l’instabilité posturale (au moyen de la vitesse quadratique moyenne (VQM) des oscillations posturales) en position debout, les pieds joints, sur une surface ferme, dans cinq conditions différentes : les yeux fermés, et dans un tunnel virtuel tridimensionnel soit statique, soit oscillant de façon sinusoïdale dans la direction antéropostérieure à trois vitesses différentes. Des mesures d’équilibre dérivées de tests cliniques, le Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2) et le Balance Error Scoring System (BESS) ont également été utilisées. Les participants diagnostiqués TCCL présentaient une plus grande instabilité posturale (une plus grande VQM des oscillations posturales) que les participants contrôles 2 semaines et 3 mois après le traumatisme, toutes conditions confondues. Ces troubles de l’équilibre secondaires au TCCL n’étaient plus présents un an après le traumatisme. Ces résultats suggèrent également que les déficits affectant les processus d’intégration visuelle mis en évidence dans la première expérience ont pu contribuer aux troubles de l’équilibre secondaires au TCCL. L’amplitude d’oscillation posturale dans l’axe antéropostérieur de même que les mesures dérivées des tests cliniques d’évaluation de l’équilibre (BOT-2 et BESS) ne se sont pas révélées être des mesures sensibles pour quantifier le déficit postural chez les sujets TCCL. L’association des mesures de TR à la perception des propriétés spécifiques des stimuli s’est révélée être à la fois une méthode de mesure particulièrement sensible aux anomalies visuomotrices secondaires à un TCCL, et un outil précis d’investigation des mécanismes sous-jacents à ces anomalies qui surviennent lorsque le cerveau est exposé à un traumatisme léger. De la même façon, les mesures d’instabilité posturale se sont révélées suffisamment sensibles pour permettre de mesurer les troubles de l’équilibre secondaires à un TCCL. Ainsi, le développement de tests de dépistage basés sur ces résultats et destinés à l’évaluation du TCCL dès ses premières étapes apparaît particulièrement intéressant. Il semble également primordial d’examiner les relations entre de tels déficits et la réalisation d’activités de la vie quotidienne, telles que les activités scolaires, professionnelles ou sportives, pour déterminer les impacts fonctionnels que peuvent avoir ces troubles des fonctions visuomotrice et du contrôle de l’équilibre. / Mild traumatic brain injury (mTBI) has complex effects on several brain functions that can be difficult to assess and follow-up. Visual and balance problems are frequently reported after an mTBI. Furthermore, these problems can still affect mTBI individuals far beyond the acute stage of injury. However, standard clinical assessments of vision and balance most often fail to objectivize these symptoms, especially if they are lingering. Moreover, to our knowledge, no longitudinal study investigated either mTBI-related deficits of visual perception per se, or mTBI-related balance deficits in adults. The aim of this project was to determine the nature and duration of the effects of such a traumatism on visual perception as well as on postural stability, by evaluating mTBI and control adults over a one-year period. Exactly the same subjects participated in both experiments, which took place on the same days for every subject. The impact of mTBI on the visual perception of sine-wave gratings defined by first-and second-order characteristics was, first, investigated. Fifteen adults diagnosed with mTBI were assessed at 15 days, 3 months and 12 months after injury. Fifteen matched controls followed the same testing schedule. Reaction times (RTs) for flicker detection and motion direction discrimination were measured. Stimulus contrast of first- and second-order patterns was equated to control for visibility, and correct-response RT means, standard deviations (SDs), medians, and interquartile ranges (IQRs) were calculated. The level of symptoms was also evaluated to compare it to RT data. In general in mTBI, RTs were longer and more variable (ie., larger SDs and IQRs), than those of controls. In addition, mTBI participants’ RTs to first-order stimuli were shorter than those to second-order stimuli, and more irregular for first- than for second-order stimuli in the motion condition. All these observations were made over the 3 sessions. The level of symptoms observed in mTBI was higher than that of control participants and this difference did also persist up to one year after the brain injury, despite an improvement. The second experiment, then, investigated the impact of mTBI on postural control. To achieve that, antero-posterior body sway amplitude (BSA) and postural instability (given by body sway velocity root mean square, vRMS) during upright stance, feet together, on a firm surface, were measured in five different conditions: with eyes closed and in a 3D virtual reality tunnel, either static or sinusoidally moving in the antero-posterior direction at 3 different velocities. Balance measures derived from clinical tests, Bruininks-Oseretsky Test of Motor Proficiency 2nd edition (BOT-2) and Balance Error Scoring System (BESS), were also used. Participants diagnosed with mTBI exhibited more postural instability (i.e. higher body sway vRMS) than control participants at 2 weeks and at 3 months post-injury, regardless of the testing condition. These mTBI-related balance deficits were no longer present one year postinjury. These results also suggest that visual processing impairments revealed in the first experiment might have contributed to mTBI-related balance deficits. Anteroposterior BSA as well as measures derived from clinical tests for balance assessment did not appear to be sensitive enough to quantify postural deficits of mTBI participants. The combination of RT measures with particular stimulus properties appeared to be a highly sensitive method for measuring mTBI-induced visuomotor anomalies, and to provide a fine probe of the underlying mechanisms when the brain is exposed to mild trauma. Likewise, postural instability measures prove to be sensitive enough for measuring mTBI-induced balance deficits. Developing screening tests in this respect intended for early post-mTBI use would be of interest. Also, studying relationships of such deficits with performance in daily life activities, such as school, work, or sports, is crucial in order to determine the functional impacts of these alterations in visuomotor and balance functions.

The thesis deals with problems of disabled pupils'education financing at secondary schools. Its aim is to create the integral survey about the disabled pupils'schooling, to compare and analyse normative financing of the most expanded educational specialization in accordance with regions. Theoretical part includes national educational concepts and programs directed at handicapped pupils. Besides detailed characterization of the health troubles'single types there are also described institutial schooling and normative financing of handicapped pupils. There are the analysed reports of MŠMT (Ministry of education and youth's psychical education) about handicapped pupils at the research part. Charts and graphs contain datas of pupils in the Czech republic according to health trouble's type, number of pupils at special classrooms and of integrated pupils during 2007-2012. The inseparable component of the research there is survey of pupils'schooling in accordance with the schools'promoters. Conclusion is devoted to detailed comparison of normative financing of the most expanded educational specialization 65-51-E/01 Stravovací a ubytovací služby (The board and accommodational service) in the first place for mental disabled pupils and pupils suffering with developmental disorders of learning and behaviour.

Introdução: A tomografia por emissão de pósitrons (PET) permite a avaliação in vivo de alvos moleculares em doenças neurodegenerativas, como a doença de Alzheimer (DA). A deposição de placa Beta-amiloide pode ser avaliada por PET 11C-PIB, enquanto o PET 18F-FDG é utilizado para avaliar o metabolismo da glicose cerebral, que pode ser um indicador de lesão neuronal e disfunção sináptica. Além disso, a captação cerebral precoce de radiofármacos de PETamiloide pode determinar o fluxo sanguíneo cerebral regional. Mais estudos correlacionando a fase inicial de perfusão do 11C-PIB (11C-pPIB) e 18F-FDG ainda são necessários, considerando que o fluxo sanguíneo e o metabolismo da glicose cerebral são geralmente acoplados em repouso e durante as ativações neuronais. Objetivo: Avaliar se existe concordância diagnóstica e/ou topográfica entre a imagem na fase de perfusão do 11C-PIB (11C-pPIB), obtida entre 0 e 10 minutos, e a imagem metabólica de PET 18F-FDG através da quantificação por SPM (Statistical Parametric Mapping) e por análise visual, em sujeitos com DA e CCLa comparados aos controles idosos saudáveis. Métodos: CAPEPesq: Nº1.454.598. Noventa e três sujeitos foram alocados em três grupos de acordo com o diagnóstico clínico: doença de Alzheimer (DA - n = 27); Comprometimento Cognitivo Leve amnéstico (CCLa - n = 39); Controle idosos saudáveis (n = 27), estes foram submetidos a exames de imagens de RM ponderada em T1 e de PET/CT. A PET/CT 18F-FDG foi realizada 30 minutos após a injeção do radiofármaco e a PET/CT 11C-pPIB foi adquirida imediatamente após a injeção do radiofármaco, e os primeiros 10 minutos da aquisição foram considerados na análise. Imagens de PET foram corrigidas para efeito de volume parcial e as imagens foram espacialmente normalizadas utilizando um modelo anatômico personalizado da própria amostra (template), para análise por Mapa Estatístico Paramétrico (SPM8). A análise visual e individual foi realizada por dois médicos nucleares com experiência na área, cegos em relação à identificação das imagens, seus respectivos radiofármacos e diagnóstico clínico. Eles foram solicitados a fornecer um diagnóstico e indicar uma classificação com base na inspeção visual das imagens de 18F-FDG e 11CpPIB, e também na avaliação individual dos mapas-t de SPM (análise baseada em voxel comparando um único sujeito do grupo DA com um grupo de controle cognitivamente normal). Resultados e Discussão: Na análise por SPM, o 11CpPIB mostrou menor captação difusa cortical do que 18F-FDG. Na análise entre grupos, há uma diferença na captação de 11C-pPIB e 18F-FDG, o que é esperado, uma vez que a biodistribuição é uma propriedade particular de cada biomarcador de PET. Na comparação do grupo DA em relação ao grupo controle, os indivíduos com DA apresentaram diminuição da captação de 11C-pPIB nas regiões temporo-límbicas: amígdala e hipocampo (E = esquerdo) P = 0,006, amígdala e hipocampo (D = direito) P = 0,023; giro parahipocampal (E) P = 0,008 (D) P = 0,015; temporal superior (E) P = 0,012 (D) P = 0,015. No 18F-FDG, houve diminuição da captação no grupo DA comparado ao grupo controle nas seguintes regiões: córtex do cíngulo posterior (E) P = 0,028; pré-cuneus (E) P= 0,029; giro temporal médio (E) P = 0,039; giro temporal inferior (E) P = 0,044. Na comparação do grupo CCLa em relação ao grupo controle, os indivíduos com CCLa apresentaram diminuição da captação de 11C-pPIB na região do giro parahipocampal (E) P = 0,012. Na identificação visual, 100% das imagens PET 18F-FDG e 99% das imagens PET 11C-pPIB foram corretamente identificadas. Na análise visual e individual, foram observadas reduções na captação de 11CpPIB envolvendo a região temporal medial nos indivíduos com DA que não foi detectada pelo 18F-FDG. Isso poderia significar algum tipo de dissociação entre a perfusão e o metabolismo. Conclusão: Nossos achados sugerem que não há concordância diagnóstica e topográfica perfeita entre a imagem do metabolismo de glicose por PET com 18F-FDG e o padrão de perfusão cerebral usando o marcador PET 11C-PIB em certas estruturas cerebrais em idosos saudáveis, CCLa e pacientes com DA, na quantificação por SPM e na análise visual. Como um biomarcador duplo, a PET 11C-pPIB pode fornecer informações complementares sobre alterações fisiológicas no envelhecimento, e ajudar a elucidar e entender melhor a patologia das doenças relacionadas a memória / Introduction: Positron emission tomography (PET) allows in vivo evaluation of molecular targets in neurodegenerative diseases, such as Alzheimer´s Disease (AD). Beta-amyloid plaque deposition can be assessed by 11C-PIB PET while 18FFDG PET is used to assess cerebral glucose metabolism, which can be an indicator for neuronal injury and synaptic dysfunction. In addition, early cerebral uptake of PET-amyloid radiopharmaceuticals can determine regional cerebral blood flow. More studies correlating early-phase 11C-PIB (11C-pPIB) and 18F-FDG are still needed considering that blood flow and cerebral glucose metabolism are usually coupled at rest and during neuronal activations. The aim of this study is to evaluate topographic similarities and differences between cerebral perfusion images obtained with early 11C-PIB PET images and the metabolic images obtained with 18F-FDG PET. Methods: CAPEPesq: Nº1.454.598. Ninety-three subjects were allocated into three groups according to clinical diagnosis: Alzheimer\'s disease (AD, n=27); Mild Cognitive Impairment amnestic (aMCI, n=39); Elderly healthy control (n=27), they underwent T1-weighted MRI and PET/CT imaging. 18F-FDG PET/CT acquisition was performed 30 minutes after tracer injection and 11C-pPIB PET/CT was acquired immediately after the tracer injection and the first 10 minutes of the acquisition was considered in the analysis. PET images were corrected for partial volume effect and the images were spatially normalized using a custom anatomical template of the sample itself, for analysis by Statistical Parametric Mapping (SPM8). Visual and individual analysis were performed by two experient nuclear medicine physicians, blind in relation to the identification of the images, their respective radiopharmaceuticals and clinical diagnosis. They were asked to provide a diagnosis and to indicate their level of confidence on the basis of visual inspection of 18F-FDG and 11C-pPIB images, and also individual assessment of SPM t-maps (voxel-based analysis comparing a single subject of AD group to a cognitively normal control group). Results and Discussion: In the analysis by SPM, the 11C-pPIB showed lower cortical diffuse uptake than 18F-FDG. In the analysis between groups, there is a difference in 11CpPIB and 18F-FDG uptake, what is expected since biodistribution is a particular propriety of each PET tracer. The control group versus the AD group, individuals with AD presented a decreased 11C-pPIB uptake in the temporo-limbic regions: amygdala and hippocampal (L = left) P = 0.006; amygdala and hippocampal (R = right) P = 0.023; parahippocampal gyrus (L) P = 0.008 (R) P = 0.015; and superior temporal (L) P = 0.012 (R) P = 0.015. In the 18F-FDG, there was a decreased uptake in the AD group compared to the control group in the following regions: posterior cingulate cortex (L) P = 0.028; precuneus (L) P= 0.029; medial temporal gyrus (L) P = 0.039; and inferior temporal gyrus (L) P = 0.044. In the comparison of aMCI group versus the control group, individuals with aMCI presented a decreased 11C-pPIB uptake in the region: parahippocampal gyrus (L) P = 0.012. In the visual identification, 100% of 18F-FDG PET images and 99% of 11C-pPIB PET images were correctly recognized. In the visual and individual analysis, it was observed reductions in 11C-pPIB uptake involving medial temporal region in the AD subjects that was not detected by 18F-FDG.This could mean some kind of decoupling between perfusion and metabolism. Conclusion: Our findings suggest that there is no perfect diagnostic and topographical concordance between the imaging of 18F-FDG PET glucose and the cerebral perfusion pattern using the 11C-PIB PET marker in certain brain structures in healthy elderly, aMCI and patients suggestive of AD, quantification by SPM and visual analysis. As a double biomarker, 11C-PIB can provide complementary information on pathological aging of the brain, and it could help elucidate and better understand the pathology of memory-related diseases

Introdução: segundo a literatura, sais de lítio podem produzir redução da função renal. A magnitude dessa informação é debatível, uma vez que não há estudo clínico randomizado e controlado entre usuários de lítio, em sua maioria pacientes com depressão ou transtorno bipolar. A possibilidade do uso do lítio para o tratamento da demência de Alzheimer prodrômica reforça a necessidade de maior investigação de efeitos adversos atribuídos ao lítio, especialmente com relação à função renal. Objetivos: avaliar a segurança da utilização do lítio em baixa dosagem com relação à função renal de pacientes idosos. Como objetivos secundários serão avaliadas: a segurança clínica através de exame e questionário específico, as funções tireoidiana, imunológica e o metabolismo glicêmico. Métodos: estudo randomizado e placebo controlado de 2 anos, seguido de fase aberta por mais 2 anos. Foram avaliados 59 idosos com comprometimento cognitivo leve com seguimento mínimo de dois anos (fase controlada). A função renal foi estimada através das fórmulas aMDRD e CKD- EPI, a partir de exames laboratoriais e dados clínicos coletados durante o estudo. As funções tireoidiana, imunológica e glicêmica foram avaliadas respectivamente através de TSH, T4 livre, leucócitos total, neutrófilos, linfócitos, glicemia e insulinemia de jejum, e HOMA-IR. A segurança clínica foi avaliada através de entrevista sistemática realizada a cada 3 meses, utilizando exame físico e a escala UKU para efeitos adversos. Resultados: não houve piora da função renal com o uso do lítio (litemia entre 0,25-0,5 mmol/l) tanto pela aMDRD (p=0,453) como pela CKD-EPI (p=0,181). Houve aumento significativo de neutrófilos (p=0,038) e do TSH (p=0,034). O grupo lítio apresentou incidência significativamente maior de diabetes mellitus (p=0,037) e arritmias (p=0,028), maior ganho de peso (p=0,015), mais sintomas na escala UKU (p=0,045), e maior interferência dos efeitos adversos do lítio em atividades diárias (p<0,001). Houve correlação entre a opinião de médico e do paciente nas interferências das atividades diárias atribuídas aos sintomas adversos (p<0,001). Conclusões: o uso de lítio em baixa dose não alterou a função renal, produziu alterações no sistema imunológico e tireoidiano sem impacto clínico, e foi seguro clinicamente. As razões do aumento de incidência de diabetes e arritmias merecem investigação posterior / Introduction: according to the literature, lithium salts may produce a reduction in kidney function. The magnitude of this information is debatable because there is no randomized and controlled clinical trial among lithium users, being mostly patients with depression or bipolar disorder. The possibility of using lithium for the treatment of prodromal Alzheimer\'s disease dementia increases the need for further investigation of adverse effects attributed to lithium, especially regarding to renal function. Objectives: To evaluate the safety of using low-dose lithium with respect to renal function in elderly patients. Secondary objectives were the evaluation of the clinical safety through specific questionnaire and clinical assessment, and to assess thyroid, immunological and glycemic function. Methods: a randomized and placebo controlled study for 2 years, followed by an open label follow-up of 2 years. We evaluated 59 elderly patients with mild cognitive impairment with accomplishment of at least two years of the controlled phase. Renal function was estimated by the aMDRD and CKD-EPI equation, and by laboratory and clinical data collected during the trial. The thyroid, immunological and glycemic functions were respectively evaluated by TSH, free T4, leukocyte count, neutrophil count, lymphocyte count, fasting plasma glucose and insulin, and the HOMA-IR. The clinical safety was evaluated through systematic examination performed every 3 months, with physical examination, clinical interview and UKU scale for adverse effects. Results: There was no decline of renal function with the use of lithium (litemia between 0.25-0.5 mmol/l) both in the aMDRD (p=0.453) and CKD-EPI (p=0.181) equations. A significant increase of neutrophils (p=0.038) and TSH (p=0.034) were observed. The lithium group showed significantly higher incidence of diabetes mellitus (p=0.037), arrhythmias (p=0.028), weight gain (p=0.015), more symptoms of UKU scale (p=0.045), and greater interference from the adverse effects of lithium during daily activities (p<0.001). There was an observed correlation between the opinion of the attending physician and the patient in respect to the interference in daily activities secondary to the adverse symptoms (p<0.001). Conclusions: The use of lithium in low doses did not result in renal function impairment, produced subtle changes in the immunological system and thyroid function, and was clinically safe for adverse effects. The reasons for the increased incidence of arrhythmias and diabetes mellitus deserve further investigation