Alzheimer’s disease (AD), a neurodegenerative condition, is one of the most prevalent kinds of dementia, whose frequency doubles for every 5 years of age in elderly.Objective:To determine the correlation between AD and olfactory alterations, identifying the most affected domains and exploring the utility of olfactory tests for complementing early diagnosis.Methods:Databases were searched using the terms “olfactory OR smell OR olfaction AND alzheimer” for articles related to the proposed theme. The selected studies were categorized and evaluated separately depending on the method of analysis of the olfactory tests: identification of odors, discrimination and recognition, and a meta-analysis was carried out.Results:Fifty-one articles were selected for analysis. The effect size for most studies was large, as were the summary values for each category of individualized olfactory analysis.Conclusion:Among the olfactory domains, except memory, identification appears to be the most altered in AD. The possibility of including tests that specifically evaluate the identification of odors as an item in early diagnostic evaluation should be explored. PROSPERO registration: CRD42018089076.

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.

Jean-Martin Charcot (1825-1893), considered the father of modern neurology, had a particular interest in pathology and learned to value anatomical findings. Among his main contributions is the use of the anatomo-clinical method in neurology. Although described as cold and impatient in his interpersonal relations, Charcot had a great affection for animals. He had two dogs in his home, which he called Carlo and Sigurd, and a little monkey, Rosalie. Despite his fascination with neuropathology and anatomo-clinical correlations, Charcot disapproved of studies using animal species other than humans, a seemingly paradoxical attitude. As a result, Charcot's human studies resulted in important advances in neurology as, prior to his research, anatomical observations of animals were extrapolated to humans, leading to conceptual errors.

Restless legs syndrome (RLS) is a disorder commonly found in patients with Parkinson's disease, with descriptions for both conditions impairing dopaminergic transmission in central nervous system. Previous studies in varied populations indicate an association between the presence of RLS and increased cardiovascular risk and, so far, there are no consistent studies of this association in Parkinson's disease. Objective: To analyze the influence of RLS on cardiovascular risk in patients with Parkinson's disease. Methods: We reviewed the medical records of 202 patients diagnosed with Parkinson's disease and verified the presence of RLS, cardiovascular comorbidities, blood pressure measurements, lipid profiles and Framingham Risk Scores. Results: Statistically significant higher values of total cholesterol were found for the RLS group (mean 216.6 mg/dL), as well as for LDL cholesterol (mean 145 mg/dL). No statistical difference was found among the other factors. Conclusion: Patients with Parkinson's disease and RLS have a higher prevalence of dyslipidemia than patients without RLS, suggesting a correlation between restless legs and hyperlipidemia. It is questioned whether the dopaminergic substrate is the main factor in the genesis of the syndrome, as even with the use of dopaminergic agonists by both groups, it was possible to observe differences between groups. The hypothesis of the real interference of the syndrome treatment as a protective factor for cardiovascular risk was generated.

Background: Neurological complaints are frequent in emergency department routine. Among them, headache is a common disorder, which requires a certain degree of knowledge on Neurology because of its extensive differential diagnosis. Objective: To assess general practice physicians’ level of knowledge about headaches, in addition to outlining the profile of professionals who attend in emergency departments, as well as the profile of their respective workplaces in terms of neurological approach. Methods: We included in evaluation physicians who attend emergency care units for adult public as general practitioners. A questionnaire was applied with questions regarding participants’ general knowledge on headache, neurological approach, demographic profile, and workplace profile. Results: 159 physicians answered the questionnaire. The professionals’ profile corresponded to recently graduated individuals (mean of 6.31 years). Knowledge about headache management was regular. Those who do not have any specialization or are not majoring a specialization were statistically significantly more confident in neurological patients care (p=0.006). Only 18.24% reported access to Magnetic Resonance Imaging and 35.85% had no access to any type of neuroimaging. Conclusions: General practice physicians often do not feel confident when performing neurological exams, demonstrating low knowledge about the topic. The profile of professionals working in these departments is predominantly of newly graduates, which may affect in some way on care quality. There was also a lack of structure for adequate care.

RESUMO Objetivo Realizar uma revisão sistemática com metanálise visando evidenciar as ferramentas de rastreio psiquiátrico mais adequadas na abordagem de pacientes adultos com esclerose múltipla avaliadas por estudos de acurácia diagnóstica. Métodos As bases de dados Medline, SciELO, PubMed e Lilacs foram utilizadas para pesquisa de artigos referentes ao tema proposto. Para essa busca, foram utilizados os termos “ multiple sclerosis psychiatric symptoms ” e “ multiple sclerosis psychiatric screening ”, sendo incluídos artigos na língua portuguesa e inglesa publicados entre 2007 e 2017. A qualidade dos estudos incluídos foi avaliada utilizando o método QUADAS. Uma metanálise foi conduzida com o auxílio do programa RevMan 5.3. Resultados Sete artigos foram selecionados para análise. A concordância dos revisores foi calculada com um kappa de 0,95. A maioria dos estudos selecionados realizou avaliação de ferramentas de rastreio para depressão, tendo apenas dois deles abordado a busca de transtornos de ansiedade. O rastreio de transtorno depressivo foi realizado a partir da avaliação de 11 instrumentos diferentes, enquanto o de ansiedade, por apenas dois. A maior parte dos testes analisados apresentou boa acurácia, e a ferramenta BAI foi a única com desempenho regular na análise da curva ROC (0,77 de área sob a curva). Os demais testes apresentaram desempenho bom ou excelente, cursando com mais de 83% na avaliação de área sob a curva. Conclusões As ferramentas HADS ( Hospital Anxiety and Depression Scale ), CESD ( Center for Epidemiological Scale – Depression ) e PHQ-9 ( Patient Health Questionnaire-9 ) parecem ser as mais indicadas para o rastreio psiquiátrico de pacientes com esclerose múltipla. Registro PROSPERO: CRD42017082741.

Patients with epilepsy face innumerable obstacles in daily life, related to work, permission to drive and interpersonal relationships, which require medical guidance. This paper reports a literature review based on scientific articles and civil and traffic system, as a way to resolve doubts about medical obligations in the patient’s permission to drive and work. An employment agreement requires the contractor to guarantee safety conditions as well as requiring the patient, at the pre-employment medical examination, to let the physician know previous medical conditions, including epilepsy. More than 90% of patients with epilepsy omit this information during the application assessment, thus being subject to imputation of ideological falsehood crime as disposied on article 299 of Brazilian Penal Code. Medical confidentiality breaches may only occur in specific situations. In Brazil, the authorization and driver’s license renewal is governed by the Brazilian Traffic Code (Federal Law n° 9503/1997). For patient evaluations, two groups are considered: those on antiepileptic medication and those on medication withdrawal. A favorable report from the attending physician is also required, in both categories. Seizures that occur exclusively during sleep, and focal aware events or prolonged aura are not differentiated from other seizure types disposed in the traffic law. It is the responsibility of the attending physician to analyze each patient individually to resolve conflicts between public safety and the individual patient’s independence. A frank and honest doctor-patient relationship is essential for the patient to understand the public and individual consequences of epileptic seizures and to feel comfortable seeking medical help.