Objectives: Myelopathy is a well-established long-term clinical manifestation of HTLV-1 infection. Besides motor dysfunction, cognitive impairment may be another consequence of HTLV-1 infection. Moreover, inflammatory markers may be associated with cognitive impairment in these patients. The present study compared the cognitive performance of HAM/TSP patients with healthy controls and investigated the associations between cognitive performance, proviral load and blood inflammatory markers. Methods: Eighty-three patients fulfilling diagnostic criteria for HAM/TSP were submitted to a comprehensive clinical, cognitive and functional evaluation, brain magnetic resonance imaging and determination of levels of IL-1β, IL-6, TNF-α, immunoglobulins and HTLV-1 proviral load in blood and cerebrospinal fluid. The control group was composed of 88 cognitively healthy subjects, matched for age, sex and educational level. Results: Compared to healthy subjects, HAM/TSP patients displayed significant global cognitive impairment and executive function deficits. HAM/TSP cognitive impairment was significantly associated with altered levels of IgM, IgG, IL-6 and TNF-α in blood. There was no association between HAM/TSP cognitive impairment and HTLV-1 proviral load. Conclusions: This study suggests cognitive impairment may be a long-term clinical manifestation of HTLV-1 infection, which seems to be linked to the persistent inflammatory activity that is found in the disease.

HTLV-I-associated myelopathy (HAM/TSP) is the most common neurological manifestation of HTLV-I, causing progressive weakness, sensory disturbance, and sphincter dysfunction. Although motor disorders have been well described, few studies have associated cognitive disorders and HTLV-I infection. In areas endemic for HTLV-I infection, the differential diagnosis between HAM/TSP and other myelopathy etiologies can be difficult, particularly if the patient has signs and symptoms of brain involvement, since seropositive HTLV-I patients can present other neurological diseases. Here, we report one case initially diagnosed as Multiple Sclerosis (MS) which, upon further investigation, was found to be HTLV-I seropositive.

Normative studies of neuropsychological tests were performed in Brazil in recent years. However, additional data are needed because of the heterogeneity of education of the Brazilian population. Objective: The present study provides normative data of executive function tests for middle-aged Brazilians and investigates the influence of age, sex, education and intelligence quotient (IQ) on performance in these tests. Methods: A total of 120 healthy staff and caregivers from a hospital were randomly selected and submitted to Fluency – animals and FAS, Trail Making Test (TMT) and Clock Drawing Test (CDT). They were divided into six groups of 20: two groups for age (45-54 and 55-64 years) and three groups for years of schooling (4-7; 8-11; 12+ years). Results: Normative data are presented in mean values and percentiles. Education influenced differences in the tests, except the CDT. Post hoc analyses revealed differences between the three educational levels on the TMT and FAS. Age differences emerged on the TMT and fluency letter F. Moderate correlation was found between schooling and results on TMT and Fluency. The correlations for IQ were similar. Conclusion: This study provides normative data for middle-aged Brazilians with four or more years of schooling in frequently used cognitive tests to assess executive functions. The results confirm the strong influence of education, even in the comparison between middle and higher levels.

ABSTRACT. Despite the advances in the diagnosis of dementia, neuropsychological assessment remains an important tool. The Mattis Dementia Rating Scale (DRS) was designed to evaluate people with suspected dementia and allows for the analysis of different cognitive domains. Considering the numerous cases of early-onset dementia, specific reference standards aimed at the middle-aged population are necessary. Objective: To provide normative data for the middle-aged Brazilian population in DRS and to investigate the influence of education level, age, sex, and intelligence quotient (IQ) on the results. Methods: Overall, 120 healthcare professionals and caregivers from a hospital, who were healthy, aged between 45 and 64 years, and had at least four years of formal education, were included in the study. They were equally divided into six groups. In each age group (45–54 and 55–64 years), there were three educational levels: 4–7, 8–11, and 12 or more (12+) years of formal education. The results are presented as mean values, standard deviations, and percentiles. Comparisons between groups were carried out for age, sex, and education level. Age, years of formal education, and IQ were also analyzed as continuous variables by Spearman's correlation. Results: Concerning education level, the comparison between groups showed differences in the results for the total scale and subscales, except for the Construction subscale. No differences were found for age and sex. Correlations observed for years of formal education and IQ were similar. No correlation was found for age. Conclusions: The present study contributes to the evaluation of dementia concerning people younger than 65 years of age and reinforces the importance of education in the interpretation of the scores.

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