Papers by Marcia Radanovic
Journal of Affective Disorders
Arquivos de neuro-psiquiatria, Nov 1, 2017
T he earliest known description of a case of apraxia is attributed to Hughlings Jackson (1861) 1 ... more T he earliest known description of a case of apraxia is attributed to Hughlings Jackson (1861) 1 , although he did not give a specific name to the disorder. The term "apraxia", from the Greek apraksía (απραξια-"inaction") was first used in the modern era by Steinthal 2 to describe deficits in planning and execution of motor actions due to neurological injury. However, it was the German neurologist Hugo Karl Liepmann who established the conceptual foundations of apraxia in its various forms of presentation at the beginning of the twentieth century 3 , and these foundations have continued to influence research and theoretical speculations on the subject to this day. With some minor variations among authors and schools, there is a theoretical consensus that apraxia of the limbs corresponds to an "acquired deficit in the execution of purposive (voluntary/intentional or skilled) movements, as a consequence of neurological dysfunction, which cannot be fully or satisfactorily explained by elementary motor or sensory impairment, comprehension problems, coordination deficits in object recognition, intellectual impairment or uncooperativeness 4,5. This places apraxia in the very peculiar position of being neither a cognitive nor a motor disorder, but rather, something that stands at the cognitive-motor interface. Although limb apraxia may follow neurological dysfunction of any etiology, it is most commonly caused by stroke or Alzheimer's disease, and it constitutes a hallmark of corticobasal degeneration 6. Over the years, apart from conceptual difficulties, it became clear from clinical observations that limb apraxia predominantly follows left-hemisphere lesions, and is frequently associated with aphasia. Furthermore, limb apraxia often affects not only internally generated gestures (i.e. those primarily conceived by the individual to achieve a specific purpose), but also imitation (pantomime), communicative gestures and use of objects and tools in different combinations. These observations have given rise to attempts to bring the theoretical conceptions regarding praxis and its disorders closer to those from the better-understood language system. Hence, in addition to the classical forms of "ideational apraxia", "ideomotor apraxia", "melokinetic apraxia" and "callosal apraxia", new classifications such as "conduction apraxia", "verbal dissociation apraxia" and "conceptual apraxia" have been introduced and it has been learned that apraxia may selectively impair meaningless gestures rather than meaningful gestures, and that the latter can be classified as transitive or intransitive, which renders the analogy to the language system complete 6,7. In this sense, current cognitive models for normal praxis propose that, similarly to what happens in language processing, a visual or auditory stimulus triggers an action input lexicon, which activates an action semantic system and leads to selection of an appropriate gesture from the action output lexicon. The selected gesture is then "put into motion" through the motor system. In such cognitive models, the auditory stimulus may be represented by a command (e.g. "Show me how you would comb your hair" or "Show me how you would wave goodbye"), and visual stimuli may comprise seeing an actual tool or object that has to be properly manipulated (e.g. "How would you use this?", while showing a pair of scissors), or a gesture that has to be imitated (e.g. "Do the same thing I'm doing", while demonstrating a meaningful or meaningless action). Limb apraxia may arise from deficits in the semantic system (when conceptual deficits are observed) or be "procedural" in nature, such that the semantic system appears to be intact, but the production of gestures is impaired 8 .
PloS one, 2018
Right-hemisphere lesions (RHL) may impair inference comprehension. However, comparative studies b... more Right-hemisphere lesions (RHL) may impair inference comprehension. However, comparative studies between left-hemisphere lesions (LHL) and RHL are rare, especially regarding reading comprehension. Moreover, further knowledge of the influence of cognition on inferential processing in this task is needed. To compare the performance of patients with RHL and LHL on an inference reading comprehension task. We also aimed to analyze the effects of lesion site and to verify correlations between cognitive functions and performance on the task. Seventy-five subjects were equally divided into the groups RHL, LHL, and control group (CG). The Implicit Management Test was used to evaluate inference comprehension. In this test, subjects read short written passages and subsequently answer five types of questions (explicit, logical, distractor, pragmatic, and other), which require different types of inferential reasoning. The cognitive functional domains of attention, memory, executive functions, lan...
CoDAS, Jan 12, 2018
To characterize the linguistic profile of adults and elderly with Down Syndrome (DS) using the Ar... more To characterize the linguistic profile of adults and elderly with Down Syndrome (DS) using the Arizona Battery for Communication Disorders of Dementia (ABCD). Thirty adult individuals with DS were evaluated through the MoCA cognitive battery, four functional scales (Pfeffer, Lawton-IADL, Katz-IADL and IQCODE) and the ABCD battery, which evaluates Mental State, Episodic Memory, Linguistic Expression, Linguistic Comprehension and Visuospatial Construction. The scores obtained by the individuals in the ABCD were correlated to those obtained on the Lawton-IADL scale. Individuals with DS had significantly lower performance than cognitively normal adults and elderly as described in Brazilian studies. Due to the lack of similar studies in our country, we compared our results to those of elderly with Alzheimer's Disease (AD), verifying that the performance of the DS population is similar to that of AD patients, although the former presented better scores on episodic immediate memory tes...
Dementia & neuropsychologia
Cognitive impairment includes mild cognitive decline and dementia, such as Alzheimer's diseas... more Cognitive impairment includes mild cognitive decline and dementia, such as Alzheimer's disease (AD) and cerebrovascular-related pathologies. To investigate the profile of AD-related CSF biomarkers in a sample of cognitively impaired and unimpaired older adults with concomitant subcortical cerebrovascular burden. Seventy-eight older adults attending an outpatient psychogeriatric clinic were enrolled. Diagnoses were based on clinical, neuropsychological, laboratory, and neuroimaging data. Participants were classified into: cognitively normal (controls, n = 30), mild cognitive impairment (MCI, n = 34), and dementia (AD, n = 14). All subjects were submitted to CSF analyses for determination of amyloid-beta (Aβ), total tau (t-tau), phosphorylated tau (p-tau) and Aβ/p-tau ratio according to the Luminex method. MRI was performed in all individuals, and was scored independently by two experts according to Fazekas scale. Statistical analyses were conducted with the aid of general linear ...
Neuropsychology, development, and cognition. Section B, Aging, neuropsychology and cognition, Jan 9, 2016
Association between cognitive impairment and gait performance occurs in mild cognitive impairment... more Association between cognitive impairment and gait performance occurs in mild cognitive impairment (MCI) and Alzheimer's disease (AD), particularly under "divided attention" conditions, leading to a greater risk of falls. We studied 36 controls, 42 MCI, and 26 mild AD patients, using the Timed Up-and-Go test (TUG) under four conditions: TUG single - TUG1; TUG cognitive - TUG2; TUG manual -TUG3; TUG cognitive and manual - TUG4. Cognition was assessed using the MMSE, SKT, Exit25, and TMT (A and B). We found significant correlations between cognitive scores and TUG2 [r values (MMSE: -0.383, TMT-A: 0.430, TMT-B: 0.386, Exit25: 0.455, SKT: 0.563)] and TUG4 [(MMSE: -0.398, TMT-A: 0.384, TMT-B: 0.352,Exit25: 0.466, SKT: 0.525)] in the AD group, and between all TUG modalities and SKT in MCI and AD. Our results revealed that functional mobility impairment in cognitive dual tasks correlated to cognitive decline in AD patients and to attention and memory impairment in MCI.
International Psychogeriatrics, 2017
Background: Verbal fluency (VF) tasks are widely used in neuropsychological evaluations, as a mea... more Background: Verbal fluency (VF) tasks are widely used in neuropsychological evaluations, as a measure of executive/semantic dysfunction. The revised criteria for Alzheimer's disease (AD) diagnosis (National Institute on Aging and the Alzheimer Association, 2011) incorporating biomarkers has increased the interest in finding algorithms that combine neuropsychological and biomarkers features to better predict conversion from mild cognitive impairment (MCI) to AD. Our aim was to compare the most frequently used VF categories to determine which best discriminated cognitively healthy elderly from MCI patients, and whether cerebrospinal fluid (CSF) biomarkers levels (Aβ42, P-tau, T-tau, and Aβ42/P-tau) correlated with patient's performance in MCI. Methods: We studied 37 cognitively healthy elderly and 30 MCI patients in five VF tasks (animal, fruits, means of transportation, FAS-COWA, and verbs); 23 controls and 19 MCI patients had their CSF biomarkers for AD determined. Results: ...
Dementia & Neuropsychologia, 2011
This article presents a review of the recommendations on supplementary exams employed for the cli... more This article presents a review of the recommendations on supplementary exams employed for the clinical diagnosis of Alzheimer's disease (AD) in Brazil published in 2005. A systematic assessment of the consensus reached in other countries, and of articles on AD diagnosis in Brazil available on the PUBMED and LILACS medical databases, was carried out. Recommended laboratory exams included complete blood count, serum creatinine, thyroid stimulating hormone (TSH), albumin, hepatic enzymes, Vitamin B12, folic acid, calcium, serological reactions for syphilis and serology for HIV in patients aged younger than 60 years with atypical clinical signs or suggestive symptoms. Structural neuroimaging, computed tomography or - preferably - magnetic resonance exams, are indicated for diagnostic investigation of dementia syndrome to rule out secondary etiologies. Functional neuroimaging exams (SPECT and PET), when available, increase diagnostic reliability and assist in the differential diagnos...
International Journal of Geriatric Psychiatry, Nov 1, 2008
Background The CAMCOG is a brief neuropsychological battery designed to assess global cognitive f... more Background The CAMCOG is a brief neuropsychological battery designed to assess global cognitive function and ascertain the impairments that are required for the diagnosis of dementia. To date, the cutoff scores for mild cognitive impairment (MCI) have not been determined. Given the need for an earlier diagnosis of mild dementia, new cutoff values are also necessary, taking into account cultural and educational effects. Methods One hundred and fifty-seven older adults (mean age: 69.6 AE 7.4 years) with 8 or more years of formal education (mean years of schooling 14.2 AE 3.8) attending a memory clinic at the Institute of Psychiatry University of Sao Paulo were included. Subjects were divided into three groups according to their cognitive status, established through clinical and neuropsychological assessment: normal controls, n ¼ 62; MCI, n ¼ 65; and mild or moderate dementia, n ¼ 30. ROC curve analyses were performed for dementia vs controls, MCI vs controls and MCI vs dementia. Results The cutoff values were: 92/93 for dementia vs controls (AUC ¼ 0.99: sensitivity: 100%, specificity: 95%); 95/96 for MCI vs controls (AUC ¼ 0.83, sensitivity: 64%, specificity: 88%), and 85/86 for MCI vs dementia (AUC ¼ 0.91, sensitivity: 81%, specificity: 88%). The total CAMCOG score was more accurate than its subtests Mini-mental State Examination, Verbal Fluency Test and Clock Drawing Test when used separately. Conclusions The CAMCOG discriminated controls and MCI from demented patients, but was less accurate to discriminate MCI from controls. The best cutoff value to differentiate controls and demented was higher than suggested in the original publication, probably because only cases of mild to moderate dementia were included. This is important given the need for a diagnostic at earlier stages of Alzheimer's disease.
Bipolar disorders, 2016
Cognitive decline is part of the long-term outcome for many individuals with bipolar disorder (BD... more Cognitive decline is part of the long-term outcome for many individuals with bipolar disorder (BD). The ε4 allele (APOE*4) of apolipoprotein E (APOE) is a well-established risk factor for dementia in Alzheimer's disease (AD). However, its contribution to the risk of cognitive deterioration in BD has not yet been determined. Our aim was to analyze the APOE genotype association with cognitive status in a sample of older adults with BD and compare this to the association in individuals with AD, individuals with mild cognitive impairment (MCI), and healthy controls. Participants (n = 475) were allocated to four groups: individuals with BD (n = 77), those with AD (n = 211), those with MCI (n = 43), and healthy controls (n = 144) according to clinical and neuropsychological assessment. APOE was genotyped by real-time polymerase chain reaction. Tukey's honest significant difference test and Pearson's chi-squared test were used to compare diagnostic groups. Subjects with BD were...
Bipolar disorders, 2016
Cognitive impairment is a common feature of late-life bipolar disorder (BD). Yet, there is limite... more Cognitive impairment is a common feature of late-life bipolar disorder (BD). Yet, there is limited information on the biological mechanisms associated with this process. It is uncertain whether cognitively impaired patients with BD may present the Alzheimer's disease (AD) bio-signature in the cerebrospinal fluid (CSF), defined as a combination of low concentrations of the amyloid-beta peptide (Aβ1-42 ) and high concentrations of total tau (T-tau) and tau phosphorylated at threonine 181 (P-tau). In this study, we sought to determine whether cognitive impairment in elderly patients with BD is associated with the AD CSF bio-signature. Seventy-two participants were enrolled in the study. The test group comprised older adults with BD and mild cognitive impairment (BD-MCI; n = 16) and the comparison groups comprised patients with dementia due to AD (n = 17), patients with amnestic MCI (aMCI; n = 14), and cognitively healthy older adults (control group; n = 25). CSF samples were obtain...
Dement Neuropsychol, Dec 1, 2010
Revista da Associação Médica Brasileira (1992)
Cerebral vasospasm accounts for an increased morbidity and mortality in patients with spontaneous... more Cerebral vasospasm accounts for an increased morbidity and mortality in patients with spontaneous subarachnoid hemorrhage (SAH). Its early and non invasive detection by transcranial Doppler (TCD) may contribute to a better prognosis in such cases. To discuss the use of transcranial Doppler (TCD) in the detection of cerebral vasospasm secondary cerebral to spontaneous subarachnoid hemorrhage (SAH). We analyzed the flow velocities registered by TCD in intracranial arteries in 31 patients with SAH, performed sequentially, associated with neurological examinations. All patients (except one) had intracranial aneurysms. Clinical vasospasm was found in 11 patients (36,6% from the total), with correspondent sonographic vasospasm present in 9 cases (82%). In 3 cases (33.3%) the flow velocity alterations preceded the clinical symptoms. Between the 20 asymptomatic patients, 15 (75%) had normal flow velocity, with evidence of sonographic vasospasm without clinical repercussion in 5 (25%). The i...
Subcellular Biochemistry, 2012
Http Dx Doi Org 10 1080 23279095 2014 881367, Aug 25, 2014
Inferences are mental representations derived from the interaction between explicit linguistic in... more Inferences are mental representations derived from the interaction between explicit linguistic information and an individual's world knowledge. The right hemisphere (RH) is the main region responsible for this ability, particularly with regard to pictorial stimuli. The aims of this study were to evaluate the performance of RH-damaged patients on an inference comprehension task based on pictorial stimuli and to compare the effect of different lesion sites on this performance. We compared the inferential abilities of 75 healthy controls and 50 patients with RH damage of vascular origin using 13 pictorial stimuli from the instrument "300 Exercises of Comprehension of Logical and Pragmatic Inferences and Causal Chains." RH-damaged patients performed worse than controls in comprehending logical and pragmatic visual inferences independent of lesion site (p < .0001). The subgroup with posterior lesions performed worse than the other subgroups.
To identify the CAMCOG sub-items that best contribute for the identification of patients with mil... more To identify the CAMCOG sub-items that best contribute for the identification of patients with mild cognitive impairment (MCI) and incipient Alzheimer's disease (AD) in clinical practice. Cross-sectional assessment of 272 older adults (98 MCI, 82 AD, and 92 controls) with a standardized neuropsychological battery and the CAMCOG schedule. Backward logistic regression analysis with diagnosis (MCI and controls) as dependent variable and the sub-items of the CAMCOG as independent variable was carried out to determine the CAMCOG sub-items that predicted the diagnosis of MCI. Lower scores on Language, Memory, Praxis, and Calculation CAMCOG sub-items were significantly associated with the diagnosis of MCI. A composite score obtained by the sum of these scores significantly discriminated MCI patients from comparison groups. This reduced version of the CAMCOG showed similar diagnostic accuracy than the original schedule for the identification of patients with MCI as compared to controls (AUC = 0.80 ± 0.03 for the reduced CAMCOG; AUC = 0.79 ± 0.03 for the original CAMCOG). This reduced version of the CAMCOG had similar diagnostic properties as the original CAMCOG and was faster and easier to administer, rendering it more suitable for the screening of subtle cognitive deficits in general clinical practice.
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Papers by Marcia Radanovic
A ideia de escrever este livro nasceu, então, da minha vivência sobre a grande motivação que os alunos e profissionais que atendem pacientes neurológicos têm em compreender melhor as doenças e os fundamentos da Neurologia. Por isso, busquei dar ênfase aos aspectos clínicos e fisiopatológicos das doenças; também por isso, priorizei os grupos de doenças em que a intervenção multiprofissional se faz mais necessária.
Este livro é a somatória de todas as aulas, discussões de caso e horas dedicadas à condução de projetos de pesquisa em conjunto com alunos e profissionais da área de Saúde. Meu desejo é contribuir para que haja cada vez mais aproximação entre os componentes da equipe multidisciplinar, e acredito que o conhecimento compartilhado é um passo essencial para que isso aconteça. A Neurologia é uma especialidade fascinante e o paciente neurológico, muito especial.
Com meu respeito e admiração a todos vocês que trabalham sem parar para melhorar a qualidade de vida das pessoas,
Esperamos ter atingido nosso objetivo, e que este livro possa contribuir para disseminar o fascínio que sentimos pela Neurociência em todas as suas formas.