ABSTRACT. Frontotemporal dementia (FTD) presents clinically in three variants: one behavioral and two with progressive primary aphasia - non-fluent/agrammatic and semantic. Defined by the degenerative process and cerebral atrophy, olfactory dysfunction occurs in up to 96% of previous FTD case series. Objective: the present study aims to critically synthesize data about the relationship between FTD and olfactory impairment to analyze the usefulness of olfactory evaluation tests as a complementary element in early diagnosis. Methods: a database search was performed using the keywords “olfactory OR smell OR olfaction AND frontotemporal dementia”. We included studies that evaluated olfactory function in patients diagnosed with frontotemporal dementia, all subtypes, compared with age-matched healthy controls. For comparative purposes, the effect size was calculated using Cohen’s D. The studies selected were categorized according to dementia variant and olfactory test type. A meta-analysis was performed using forest plots - homogeneity was evaluated by statistical tests (i2 and Cochran Q). Results: ten articles met the inclusion criteria. Heterogeneity was classified as low for semantic dementia olfactory identification and behavioral variant olfactory discrimination groups (i2 = 0 and 3.4%, respectively) and as moderate for the behavioral variant olfactory identification group (i2 = 32.6%). Conclusion: patients with the frontotemporal dementia behavioral variant seem to present with alterations in odor identification, but with preserved discrimination. Scent identification also seems to be impaired in semantic dementia. Therefore, we conclude that olfactory evaluation in these patients is possibly impacted by cognitive alterations and not by sensory deficits. Application of olfactory tests may prove important in differentiating prodromal states from other types of dementia with more pronounced olfactory impairment.

Background: Migraine pain location and trigeminocervical convergence have limited diagnostic value and have usually been assessed using non-standard verbal descriptors in a small number of centers. Objective: To use non-verbal descriptors of migraine pain location to determine the prevalence of trigeminocervical convergence mechanisms in patients with episodic and chronic migraine. In addition, we explored the factors associated with the presence of convergence. Methods: A multicenter study was carried out. The explicit pain location was explored by asking subjects to indicate, on an electronic form, three points on the anterolateral side and three points on the posterolateral side of the head and neck that represented the common locations of their migraine pain. We evaluated associations of the pain pattern with demographic and psychological features, comorbidities, lifestyle and other headache characteristics. Results: 97 episodic and 113 chronic migraine patients were included. Convergence was present in 116 migraineurs (55%) who indicated dominance of pain in the posterior cervical region. This site was more often involved in the chronic migraine group (21 vs. 33%; p=0.034). The number of migrainous/altered sensitivity symptoms (OR=1.39; 95%CI 1.14–1.71) was associated with convergence independently of the chronification status. In this symptom group, there were statistical associations between convergence and vomiting (p=0.045), tactile allodynia (p<0.001), nuchal rigidity (p<0.001) and movement allodynia (p=0.031). Conclusions: Trigeminocervical convergence is common in migraineurs and, in practice, it might be found frequently in chronic migraineurs. Some features commonly found in this group, such as altered sensitivity symptoms, are associated with this phenomenon.

IntroduçãoOs ataques de migrânea são caracterizados por sintomas álgicos e não álgicos. Além disso, a migrânea ocorre associada a diversas comorbidades. Tanto os sintomas não álgicos como as comorbidades podem se caracterizar por sintomas autonômicos. Este trabalho tem por objetivo avaliar a disautonomia em migranosos e diferenças relacionadas entre os grupos episódico (ME) e crônico (MC).Material e MétodosEstudo transversal de pacientes atendidos em ambulatório especializado, diagnosticados pela International Classification of Headache Disorders 3 como ME ou MC, convidados de forma consecutiva e utilizando entrevistas semi-estruturadas. O questionário Composite Autonomic Symptom Score (COMPASS) foi utilizado para avaliação de sintomas autonômicos, o Patient Health Questionnaire (PHQ) 9 para avaliação de sintomas depressivos e o Short Form (SF) 36 para avaliação de qualidade de vida. O estudo foi aprovado pelo comitê de ética do HC- UFPR.ResultadosForam incluídos 210 pacientes dos quais 97 (46%) apresentavam ME e 113 (54%) MC. Destes, 78 (69%) consumiam analgésicos excessivamente. A média de idade era de 39,5±12,6 anos e 189 (90%) pacientes eram do sexo feminino. O grupo CM apresentou um escore COMPASS mais alto (34,7±18,3) que o grupo EM (26,4±14,8). A regressão múltipla foi empregada para analisar a associação das variáveis clínicas com o COMPASS. O modelo final ajustado mostra que para cada sintoma não álgico tipicamente vistos na aura de tronco encefálico, há um incremento médio de 2,17-6,3 no COMPASS. Para cada ponto a mais no PHQ9, o COMPASS eleva-se entre 0,78-1,84 em média. Todos os processos de inferência consideraram um valor alpha de 0.05.ConclusãoO processo de cronificação pode cursar com mais sintomas disautonômicos. Estes, por sua vez, estão associados a mais sintomas atribuídos a alterações de tronco e à depressão, indicando esta área como potencialmente envolvida nesta gama de sintomas.

Introduction: When migraine evolves from episodic to chronic form, it becomes more disabling, due to refractory treatment and the arising of comorbidities. Bruxism has already been associated with migraine in adults, with a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and wake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with chronification. Methods: 210 patients were allocated to the study, 97 with episodic migraine (EM) and 113 with chronic migraine (CM). The patients were submitted to face-to-face interviews with a neurologist to confirm the diagnosis and fill in the scales: specific questionnaire for the diagnosis of sleep and wake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (sleepness), MIDAS and HIT-6 scales to assess the migraine disability and the headache impact on patients. Results: The prevalence of sleep and wake bruxism was similar in patients with EM versus CM (p=0.300 and p=0.238). The correlation of patients with both bruxism forms at the same time with the high scores on the migraine disability and the headache impact, was higher among patients with chronic migraine than in patients with chronic migraine. episodic migraine (p <0.001). Conclusion: Sleep and wake bruxism alone aren’t more prevalent in chronic migraine when compared to episodic migraine. In patients affected with both bruxism forms, bruxism only causes a greater impact and disability on individuals with chronic migraine.

IntroductionWhen migraine undergoes transformation from episodic to chronic form it becomes more disabling due to the refractoriness in treatment and the emergence of comorbidities, with the establishment of a bidirectional relationship between sleep bruxism and chronic migraine. This study aimed to assess whether sleep and awake bruxism are more prevalent in chronic migraine when compared to episodic migraine and also to establish possible clinical correlations with the process of chronification.Methods210 patients were allocated to the study, 97 with episodic migraine and 113 with chronic migraine, who underwent face-to-face interviews with the completion of the scales: specific questionnaire for the diagnosis of sleep and awake bruxism, PHQ-9 (depression), GAD-7 (anxiety), Epworth Scale (daytime sleepiness), MIDAS (migraine incapacity) and HIT-6 (impact of headache). ResultsThe prevalence of sleep and awake bruxism was similar in patients with episodic versus chronic migraine (p = 0.300 and p = 0.238). The correlation of patients with concomitant awake and sleep bruxism and with high scores on the migraine incapacity (MIDAS) and headache impact (HIT-6) scales was higher among patients with chronic migraine than in patients with episodic migraine. (p <0.001 and p <0.001). ConclusionSleep and awake bruxism alone are not more prevalent in chronic migraine when compared to episodic migraine, although bruxism causes greater impact and disability on individuals with chronic migraine.