Language batteries used to assess the skills of elderly individuals, such as naming and semantic verbal fluency, present some limitations in differentiating healthy controls from patients with amnestic mild cognitive impairment (a-MCI). Deficits in narrative discourse occur early in dementia caused by Alzheimer's disease (AD), and the narrative discourse abilities of a-MCI patients are poorly documented. The present study sought to propose and evaluate parameters for investigating narrative discourse in these populations. After a pilot study of 30 healthy subjects who served as a preliminary investigation of macro- and micro-linguistic aspects, 77 individuals (patients with AD and a-MCI and a control group) were evaluated. The experimental task required the participants to narrate a story based on a sequence of actions visually presented. The Control and AD groups differed in all parameters except narrative time and the total number of words recalled. The a-MCI group displayed mild discursive difficulties that were characterized as an intermediate stage between the Control and AD groups' performances. The a-MCI and Control groups differed from the AD group with respect to global coherence, discourse type and referential cohesion. The a-MCI and AD groups were similar to one another but differed from the Control group with respect to the type of words recalled, the repetition of words in the same sentence, the narrative structure and the inclusion of irrelevant propositions in the narrative. The narrative parameter that best distinguished the three groups was the speech effectiveness index. The proposed task was able to reveal differences between healthy controls and groups with cognitive decline. According to our findings, patients with a-MCI already present narrative deficits that are characterized by mild discursive difficulties that are less severe than those found in patients with AD.

BackgroundMetabolic Syndrome (MetS) refers to a cluster of metabolic disturbances which is associated with increased risk for vascular and degenerative conditions in general population. Although the relationship between vascular risk factors and dementia is undisputable, additional hazard for cognitive decline in older population with concurrent metabolic disorders still waits to be demonstrated. The present review aims to analyze data on MetS and risk for cognitive decline in elderly persons.MethodsDatabase searches were performed in Medline, ISI and PsycINFO for articles assessing cognitive performances of older subjects with MetS.ResultsOf a total of 505 studies, 25 were selected for the review. Risk of selection biases was identified in all the studies. Although all articles followed recognized diagnostic recommendations for MetS, minor criteria modifications were detected in most of them. Hyperglycemia was consistently associated with impaired cognitive performances in older individuals, but the role of MetS for cognitive decline and for the onset of dementia showed heterogeneous results.DiscussionCurrent available data in the literature concerning the impact of MetS on the cognition of older population is inconclusive and based on inconsistent evidence. Differential effects of individual MetS components and factors associated with the age of the sample may have accounted for divergent findings among articles, but larger and higher quality studies in this field are still needed.

A formação de profissionais de saúde com as competências para prestação de cuidados básicos deve ser iniciada na graduação. Entretanto, o treinamento na rede básica de saúde (RBS) ainda encontra barreiras nas esferas docente, discente e nas unidades das Secretarias Municipais de Saúde (SMS). Considerando a relevância do papel dos preceptores na formação dos estudantes da área da saúde, avaliamos a opinião dos profissionais de saúde da RBS da SMS do Rio de Janeiro sobre a atividade de preceptoria. Um questionário foi respondido por 351 profissionais de saúde de 13 das 67 unidades da RBS. Destes, 77% consideram que a preceptoria faz parte das atribuições do profissional e 61% gostariam de assumir esta tarefa. Várias dificuldades foram apontadas, incluindo problemas estruturais e de recursos humanos. Os resultados responsabilizam, de alguma forma, as instituições de ensino superior (IES) e o Estado pela pouca valorização e estímulo às ações de preceptoria, na medida em que apontam a necessidade de rever as condições de trabalho e de ensino na RBS. Destacam-se a melhoria dos salários e da infraestrutura e a oportunidade de capacitação profissional, o que implica parcerias efetivas entre as IES e as SMS.

Introduction: Irisin is a novel hormone originally identified for its role as a regulator of peripheral metabolism and recently found to protect synapses and rescue memory in mouse models of Alzheimer's disease (AD). However, whether and how cerebrospinal fluid (CSF) irisin varies in relation to canonical AD biomarkers and cognition in humans remains unknown. Methods: We determined CSF levels of irisin and brain‐derived neurotrophic factor (BDNF) and examined their correlations with CSF amyloid beta (Aβ)42, total tau, and Mini‐Mental State Exam (MMSE) scores in a cohort comprising AD patients (n = 14) and non‐demented controls (NDC; n = 25). Results: CSF irisin correlated positively with BDNF, Aβ42, and MMSE scores, but not with CSF total tau. Discussion: Results indicate that CSF irisin and BDNF are directly correlated with Aβ pathology and cognition in AD.

Background: Narrative discourse (ND) refers to one’s ability to verbally reproduce a sequence of temporally and logically-linked events. Impairments in ND may occur in subjects with Amnestic Mild Cognitive Impairment (aMCI) and Alzheimer’s Disease (AD), but correlates across this function, neuroimaging and cerebrospinal fluid (CSF) AD biomarkers remain understudied.Objectives: We sought to measure correlates among ND, Diffusion Tensor Imaging (DTI) indexes and AD CSF biomarkers in patients within the AD spectrum.Results: Groups differed in narrative production (NProd) and comprehension. aMCI and AD presented poorer inference abilities than controls. AD subjects were more impaired than controls and aMCI regarding WB (p<0.01). ROIs DTI assessment distinguished the three groups. Mean Diffusivity (MD) in the uncinate, bilateral parahippocampal cingulate and left inferior occipitofrontal fasciculi negatively correlated with NProd. Changes in specific tracts correlated with T-tau/Aβ1-42 ratio in CSF.Conclusions: AD and aMCI patients presented more ND impairments than controls. Those findings were associated with changes in ventral language-associated and in the inferior parahippocampal pathways. The latest were correlated with biomarkers’ levels in the CSF.Methods: AD (N=14), aMCI (N=31) and Control (N=39) groups were compared for whole brain (WB) and regions of interest (ROI) DTI parameters, ND and AD CSF biomarkers.