-A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptuted cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.KEY WORDS: headache, migraine, tension-type, CT scan, basilar impression, cysticercosis. T T T T Tomografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional omografia computadorizada do crânio em pacientes com migrânea ou cefaléia tensional RESUMO -Um estudo retrospectivo foi realizado visando avaliar a frequência de anormalidades encontradas durante a realização de estudo por tomografia computadorizada (TC) em 78 pacientes com migrânea ou cefaléia do tipo tensional. A TC foi normal em 61,5% dos pacientes examinados. Em um terço dos pacientes estudados foram detectadas anormalidades, como doença inflamatória dos seios paranasais (19,2%), cisticercose (3,9%), aneurisma cerebral não-roto (2,6%), impressão basilar (2,6%), lipoma intracraniano (2,6%), cisto aracnoideo (2,6%), sela vazia (2,6%), neoplasia intracraniana (2,6%) e outras afecções (2,6%). Nenhuma destas lesões era sintomática (achado incidental). Concluindo, o encontro fortuito de algumas anormalidades na TC é frequentemente mais elevado do que se prediz em pacientes com cefaléia primária. Nós discutimos brevemente alguns aspectos clínicos, epidemiológicos e da conduta terapêutica-cirúrgica sobre algumas das anomalias diagnosticadas pela TC. Também levantamos, ou questionamos, aspectos éticos que determinam o limite entre o direito do paciente e o direito do médico em afirmar que um indivíduo com dor de cabeça não é portador de lesão intracraniana, baseado na história clínica e no exame físico do paciente.

Objetivo: Analisar de forma sistemática o conhecimento da doença de Alzheimer (DA) e as estratégias adotadas pelo cuidador para lidar com os sintomas apresentados pelo idoso com DA. Métodos: Levantamento de estudos publicados nas bases de dados PubMed, MedLine, Lilacs e SciELO, utilizando os seguintes descritores e termos livres para estratégia de busca, de acordo com suas definições no DeCS e no MeSH: “cuidadores” or “educação em saúde” or “treinamento” or “cuidadores de idosos” and “doença de Alzheimer”; “elderly caregiving” or “training” or “health education” or “caregivers” and “Alzheimer disease”; “cuidadores de personas mayores” or “formación” or “educación en salud” or “cuidadores” and “enfermedad de Alzheimer”. Resultados: Foram eleitos 12 artigos para análise e leitura na íntegra. Os artigos foram classificados em três categorias: 1) Conhecimento acerca do declínio cognitivo e funcional da doença de Alzheimer; 2) Conhecimento acerca dos sintomas psicológicos e comportamentais da demência (SPCD); 3) Conhecimento acerca do comprometimento da linguagem. Na maioria dos estudos, verificou-se que a orientação a respeito do que é a enfermidade e a sua evolução pode interferir na maneira como o cuidador planeja e executa as ações de cuidado. Conclusão: É extremamente necessário criar oportunidades para que os cuidadores familiares e profissionais conheçam a doença para compreender o paciente e, consequentemente, as possibilidades de atuação (seguras e eficazes) nesse paciente. Isso é possível mediante implementação de programas psicoeducativos capazes de fornecer informações e orientações práticas para melhorar a assistência oferecida por cuidadores aos pacientes com DA.

Elderly individuals with mild cognitive impairment (MCI) are part of a continuum between normal aging with its cognitive difficulties and fully-fledged dementia. However, there is a growing body of evidence suggesting that MCI might precede the onset of Alzheimer' s disease (AD). Longitudinal studies have demonstrated that subjects with MCI present a progression rate of 10-15% per year to AD, contrasting with 1-2%, in a similar analysis, in the general population using a similar age range 1 .Declarative memory is related to the involvement of mesial structures of the temporal lobe, especially the hippocampus 2,3 . Studies using magnetic resonance imaging (MRI) may provide in vivo analysis of specific regions of the temporal lobe showing a strong correlation between abnormal neuroimaging findings and the scores obtained on cognitive tests 4,5 . A number of authors have reported that volumetric-structural study and spectroscopy analysis might be useful in the investigation of patients with MCI in order to diagnose patients with a higher risk of developing AD 6-8 .In advanced phases of AD, major hippocampus atrophy with a decrease in N-acetyl aspartate (NAA) and an increase ABSTRACTObjective: To evaluate the volumetric and spectroscopy aspects of hippocampus in patients with mild Alzheimer's disease (AD) and mild cognitive impairment (MCI). Methods: A series of patients older than 65 years and with memory deficit were studied. Results: The evocation of words test presented a significant reduction in the number of words recalled by the patients with MCI and mild AD as compared with the control group. Bilateral reduction of the hippocampus volume in the AD group was observed when compared to the control group. There were no statistical differences in the values of NAA/Cr, mI/Cr, Cho/Cr and mI/NAA between the groups. Conclusions: Magnetic resonance imaging study failed to individually distinguish patients with MCI, mild AD and normal aging. However, patients with mild AD presented loss of asymmetry between the right and left hippocampus, and a reduction in hippocampus volume.Key words: Alzheimer disease, dementia, mild cognitive impairment, hippocampus, magnetic resonance imaging, spectroscopy. RESUMO Objetivo:Avaliar volume e espectroscopia do hipocampo em pacientes com doença de Alzheimer leve e declínio cognitivo leve. Métodos: Foi estudada uma série de pacientes com 65 anos de idade ou mais, com déficit de memória. Resultados: O teste de evocação de palavras mostrou redução significativa no número de palavras lembradas pelos pacientes com declínio cognitivo leve e doença de Alzheimer leve, em comparação com o grupo controle. Foi observada redução bilateral do volume do hipocampo no grupo com doença de Alzheimer quando comparado com o grupo controle. Não houve diferença estatística nos valores de NAA/Cr, mI/Cr, Cho/Cr e mI/NAA entre os grupos. Conclusão: Estudo pela ressonância magnética não diferencia individualmente os pacientes com declínio cognitivo leve, doença de Alzheimer leve e envelhecimento normal. No en...

N europsychiatrist, master, and doctor in dementia (neurology), Leonardo Caixeta joined 38 Brazilian experts in psychiatry, neuropsychology, neuropsychiatry, and neurogeriatrical areas to organize a work that presents updated and comprehensive information on Alzheimer's disease (AD), which reaches more than 25 million people around the world. With a clear language, the experts produced a book not only for the medical community, but also for professionals from other areas related to taking care of people who live with the disease. The work is divided into three sections: general; diagnosis and evaluation; and management, treatment and prevention. The first section is divided into five chapters that bring reflections and discussions on recent developments in the concept of AD, its neurobiology and other dementias, its genetic basis, epidemiology and cross-cultural aspects. In this first part of the book, it is also important to highlight the chapter rich in details that lead the reader to a historical retrospective of discovery and description of the disease by Aloysius Alzheimer in 1907. This period was when the clinical features of the disease were designed in a woman who presented jealousy of her husband (behavioral disorders) as the first obvious symptom of AD. Gradually, she suffered progressive loss of memory, language and critical, until her death. Also in this chapter, the author explains in details how AD migrated from one extreme to another when left in a condition that was considered rare (almost until the 1970s) to become an epidemic in present days. The second section of the book consists of 16 chapters that present and discuss relevant topics for professionals who wish to study more on such disease. In this part of the book, the readers get to know the new diagnostic criteria and biomarkers of AD, which were published in 2011. Thus, the experts who subscribed it accentuate these following terminologies to classify individuals with AD: probable AD; possible AD; and probable or possible AD dementia with evidence of its pathophysiological process. The first two are intended for using in all clinical settings, and the third is currently intended for research purposes. Another highlight of the second section of the book is the chapter that approaches the language impairment in Alzheimer's dementia. The aim is to present the main language disorders in patients with AD and the communication difficulties they have, as well as the most used neuropsychological assessments and rehabilitation strategies that promote a better quality of life for patients, their families and caregivers. At the end of that chapter, the authors present a framework with communication guidelines for caregivers. Along the way, the third and final section of the book includes ten chapters with topics that update clinicians and researchers in scientific areas related to Alzheimer's dementia. It is also important the chapter about nonpharmacological treatments in AD, which is recommended as the most appropriate initial strategy for the man...