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.
Background:Stroke is the second leading cause of mortality in the general population. Spatial neglect syndrome is one of the most common complications following stroke and is associated with poor prognosis, including prolonged hospitalization. Objective:To examine the main clinical signs and symptoms associated with spatial neglect in stroke patients in the literature. Methods:The present systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. The Grading of Recommendations Assessment, Development and Evaluation approach was applied to assess the certainty of evidence, and the data were processed with RevMan Web (The Cochrane Collaboration). Results:A total of 362 articles were assessed, out of which 23 were included. A strong correlation was observed between clinical events and the presence of spatial neglect syndrome compared to control groups (oculomotor exploratory behavior [p < 0.00001; 95% CI 4.03-22.41], difficulty detecting stimuli on the left side (p < 0.0001; 95% CI 3.20-24.89), and prolonged reaction time to left-sided stimuli (p = 0.004; 95% CI 1.11-273.20). The present study confirms that spatial neglect syndrome presents as a clinically diverse condition. The quantitative analysis demonstrated that abnormal oculomotor behavior is the most robust and consistent clinical predictor for diagnosis. Other frequent symptoms included delayed reaction times and impaired detection of stimuli in the left visual field. Additionally, the presence of hemianopia and the crossed legs sign were also associated with spatial neglect syndrome among others. Conclusion:The symptomatology described may serve as an indication of spatial neglect syndrome. Therefore, the present meta-analysis highlights the clinical importance of early identification and targeted evaluation in stroke cases.
Background:The Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) is a standard tool for evaluating functional decline in patients with ALS. Despite its clinical value, administration by healthcare professionals can be time-consuming and resource intensive. Objective:To assess the reliability and feasibility of a self-administration version of the ALSFRS-R as an alternative for use in clinical and research settings. Methods:The present was an observational, analytical, prospective, single-center study involving ALS patients followed at the Neurology Outpatient Clinic of the Hospital Universitário Onofre Lopes (HUOL). Three independent assessments of the ALSFRS-R were conducted: one self-administered version and two interviewer-administered versions performed by different researchers during face-to-face consultations. Interrater reliability was assessed using intraclass correlation coefficients (ICCs), and agreement among the three versions was analyzed using Bland-Altman plots. Results:A total of 43 participants were included in the study, with a mean age of 57 ± 11.67 years. The ICCs indicated high reliability for both the total ALSFRS-R score and its functional domains. Linear regression analyses demonstrated strong agreement between the two researchers (R2 = 0.98, p < 0.001), as well as between each researcher and the self-administered version (R2 = 0.90 and 0.88, respectively). Bland-Altman analyses showed minimal bias and acceptable limits of agreement across all comparisons. Conclusion:The self-administered version of the ALSFRS-R demonstrated high reliability and strong agreement with the researcher-administered versions, supporting its potential use for remote monitoring of ALS patients. Nonetheless, it should not replace professional assessments in clinical trial settings. Further research is warranted to validate its applicability in broader clinical contexts and diverse patient populations.
Background:Migraine and voice are related because of the shared pathophysiological mechanisms involving the vagus nerve, which also innervates the larynx. Objective:To conduct acoustic voice analysis and evaluate voice-related quality of life in women with migraine, in comparison with a control group. Methods:In the current cross-sectional study, we performed voice recordings and used the Voice-Related Quality of Life and migraine characteristics questionnaires. The variables included loudness, fundamental frequency, jitter, shimmer, glottal-to-noise excitation ratio, and phonatory deviation diagram. Results:The sample comprised 193 women (55 in the control group and 138 in the migraine group). No statistically significant differences were observed between the groups regarding the acoustic variables studied. The migraine group reported poorer scores in the physical domain of the Voice-Related Quality of Life questionnaire (p = 0.003) compared to the control group. The Random Forest statistical model predicted group allocation with 76% of precision. Conclusion:In the studied sample, no differences were observed between women with migraine and the control group regarding the parameters of acoustic voice analysis. Women with migraine presented poorer voice-related quality of life compared to the control group.
Background:Behavior change remains challenging despite a vast body of evidence linking health behaviors with several health outcomes. Over the past few decades, various health behavioral change theories and techniques have emerged, leading to significant advances in the field. However, although some existing theories provide competent models for structuring approaches, they do not provide a unified neurobiological foundation. Objective:To outline the connections between neuroscientific foundations in Part 1 and behavioral change theories in Part 2 and propose an overarching neuroscientific perspective. Methods:A narrative review of the relevant history and background of the most widely adopted behavior change theories and integrates them into the proposed framework of the Behavior Change Resource Model described in Part 1. Results:A structured overview of selected theories was performed. The main theories and techniques described were Social Cognitive Theory, Self-Determination Theory, Motivational Interviewing, Behavioral Activation, Transtheoretical Model, Cognitive Behavioral Therapy, Mindfulness Meditation, Positive Psychology, and Health and Lifestyle Coaching. Finally, their relation to motivation science and the Behavior Change Resource Model was detailed. Conclusion:By bridging the Behavior Change Resource Model (Part 1), and an array of related theories and techniques (Part 2) it was possible to provide a conceptual perspective to further support and propel the scientific understanding of human behavior, especially towards keeping and expanding health through lifespan and across society.
