Background: Dementia is a progressive neurodegenerative disorder characterized by cognitive decline and its incidence in Brazil is 5 times higher in illiterates. Early life education is a well-established modifiable risk factor for dementia prevention. However, whether learning to read and write in adulthood contributes to brain health is still unknown. Objective: To elucidate the effects of a late-life literacy intervention on cognitive reserve and brain connectivity in illiterate adults. We conducted a longitudinal clinical trial within an adult-literacy program targeting low-educated adults which is called PROAME (“Programa de Alfabetização e Memória”) Methods: First, 130 illiterate adults were screened at the basic education program for adults called EJA (“Educação de Jovens e Adultos”). After applying the exclusion criteria, 108 were recruited. Participants were divided into two groups: the control group (50 participants) attended the regular classes (literature, math, geography, history and sciences) and the intervention group (58 participants) attended part of the regular classes plus a specific training focused on learning how to read and write. Both groups attended their activities 4 days a week for 6 months. At the 6 month follow up visit, 77 participants successfully completed all required clinical assessments and interviews. Interviews were conducted to gather basic socio-demographic information, past and current medical history, use of tobacco, alcohol and illicit substances, physical activity levels and the presence of anxiety and depression. Participants also underwent a comprehensive cognitive assessment, which included executive functions assessment (digit span backwards, rapid number naming and phonemic verbal fluency), a functional brain MRI was performed to assess brain connectivity, especially the frontoparietal network, and a blood sample collection to measure plasma neurofilament levels. Results: We observed a significant increase in the episodic memory and executive functions in all participants, without a significant difference between the groups (control x intervention). When we adjusted the model for age, sex, reason for illiteracy and executive functions at baseline, we saw a significant improvement of executive functions in the intervention group. Factors that influenced in this result were attendance to classes combined with intensive literacy training, previous illiteracy related to rural areas residency, low executive performance at the baseline and lower levels of serum neurofilaments at baseline. In terms of brain connectivity, we saw that the intervention group had an increase in the frontal parietal and in the left hippocampal-temporal connectivity. Conclusion: Late life literacy training seems to improve executive functions, with and underlying rearrangement of the hippocampal and frontal connectivity.
Microribonucleic acids (miRNAs) are small non-coding RNA molecules that regulate gene expression post-transcriptionally and play essential roles in muscle differentiation, regeneration, and metabolism. A specific subset, known as myomiRs, is predominantly expressed in muscle tissue and has been implicated in key molecular pathways underlying muscular dystrophies and myopathies. Due to their stability in biological fluids, myomiRs have emerged as non-invasive biomarkers. The present narrative review summarizes selected studies addressing myomiR expression patterns, functional roles, and translational implications in muscular dystrophies and myopathies, particularly Duchenne muscular dystrophy (DMD), myotonic dystrophy type 1 (DM1), limb-girdle muscular dystrophy (LGMD), McArdle disease, and myofibrillar myopathy (MFM), highlighting their biological relevance and clinical potential. The available evidence indicates that myomiRs such as miR-1, miR-133a/b, miR-206, miR-29b, miR-31, and miR-486 are differentially expressed across these disorders and are involved in processes including muscle degeneration, regeneration, fibrosis, and inflammation. In DMD, several myomiRs are upregulated, reflecting ongoing muscle damage and regenerative activity, whereas in DM1, downregulation of miR-1, miR-133a/b, and miR-29b contributes to impaired muscle maturation and fibrosis. In contrast, miR-206 appears increased as part of a regenerative response, whereas miR-223–3p may reflect inflammatory activity or muscle damage. Evidence for McArdle disease remains scarce, underscoring the need for further investigation. In conclusion, understanding miRNA signatures may facilitate earlier diagnosis, disease stratification, and the development of targeted therapies in muscular dystrophies and myopathies.
Abstract Cerebral embolic protection (CEP) devices have been developed to reduce postoperative neurological outcomes after transcatheter aortic valve implantation (TAVI); however, their effectiveness remains controversial. To evaluate the impact of CEP use during TAVI on the occurrence in clinical outcomes. Databases were used to search for randomized clinical trials. The occurrence of all strokes, of disabling strokes specifically, transient ischemic attacks (TIAs), all-cause mortality, and vascular complications were analyzed. Conventional meta-analysis was conducted using fixed-effects modeling and trial sequential analysis (TSA: type I error of 5%, power of 90%). The systematic review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251081075). In total, eight clinical trials were included, gathering 11,589 patients randomized between those who used the devices (5,943) and those who did not (5,646). The meta-analysis demonstrated no significant association between CEP use and reduced odds of all-cause stroke (OR = 0.92, 95% CI: 0.73–1.15, p = 0.46) and disabling stroke (OR = 0.80, 95% CI: 0.57–1.13, p = 0.20). The sequential analysis identified a lack of evidence for all strokes (required sample size [rSS] = 38,626; 10.53%), disabling strokes (rSS = 59,732; 17.05%). In terms of mortality, there was no significance in the use of devices (OR = 1.09, 95% CI: 0.71–1.69, p = 0.69), reaching evidence for support (rSS = 7,053; 42.25%); The data on the use of CEP is insufficient to support meta-analytic conclusions regarding cerebrovascular outcomes. Nevertheless, TSA demonstrated evidence supporting futility regarding mortality reduction.
Abstract Population aging in Brazil has increased dementia prevalence and the demand for caregivers. Caregiver knowledge is essential for care quality and clinical outcomes. Robust instruments are needed to assess dementia-related knowledge. The Dementia Knowledge Assessment Tool Version Two (DKAT2) has been transculturally adapted for Brazil. To evaluate the psychometric properties of the Brazilian version of the DKAT2. A multicenter cross-sectional psychometric study was conducted with caregivers of older adults. Content validity was assessed using the content validity index (CVI). Structural validity was analyzed through exploratory factor analysis after factorability assessment with the Kaiser-Meyer-Olkin index and Bartlett's test. Internal consistency was estimated using the Kuder-Richardson Formula 20 (KR-20). Item discrimination was examined using point-biserial and tetrachoric correlations. Temporal stability was evaluated with the intraclass correlation coefficient (ICC). Item response theory (IRT) models were used to estimate discrimination, difficulty, and guessing parameters. A total of 234 caregivers were enrolled, 19 of whom completed a retest assessment. Content validity was adequate (CVI = 0.85). The internal consistency of the original 21-item instrument was low (KR-20 = 0.49). Eleven items showed poor discrimination and were excluded, resulting in a 10-item version with modest improvement (KR-20 = 0.59). Factor analysis suggested unidimensionality, although item correlations were weak. Test-retest reliability was moderate (ICC = 0.67). The IRT analysis indicated limited information across the latent trait continuum. The Brazilian DKAT2 showed adequate content validity and moderate temporal stability, but insufficient internal consistency and limited construct coherence. It may be used cautiously as a preliminary screening instrument, but more robust culturally-appropriate measures are needed.
