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Gross anatomy of the longitudinal fascicle of Sapajus sp.
(2021) Aversi-Ferreira, Tales Alexandre; Borges, Kellen Christina Malheiros; Mendes, Maria Tereza Gonçalves; Caixeta, Leonardo Ferreira
Opposing genetic and cultural-social explanations for the origin of language are currently the focus of much discussion. One of the functions linked to the longitudinal fascicle is lan guage, which links Wernicke’s area and Broca’s area in the brain, and its size should indi cate the brain increase in the evolution. Sapajus is a New World primate genus with high cognition and advanced tool use similar to that of chimpanzees. A study of the gross anat omy of the longitudinal fascicle of Sapajus using Kingler’s method found it to differ from other studied primates, such as macaques and chimpanzees, mainly because its fibers join the cingulate fascicle. As in other non-human primates, the longitudinal fascicle of Sapajus does not reach the temporal lobe, which could indicate a way of separating these fascicles to increase white matter in relation to individual function. The study of anatomical structures seems very promising for understanding the basis of the origin of language. Indeed, socio historical-cultural philosophy affirms the socio-cultural origin of speech, although consider ing the anatomical structures behind it working as a functional system.
Clinical applications of exercise in Parkinson’s disease: what we need to know?
(2022) Machado, Sergio Eduardo de Carvalho; Teixeira, Diogo dos Santos; Monteiro, Diogo Manuel Teixeira; Imperatori, Claudio; Murillo-Rodriguez, Eric; Rocha, Fernanda Pereira da Silva; Yamamoto, Tetsuya; Fernández, Sandra Amatriain; Budde, Henning; Carta, Mauro Giovanni; Caixeta, Leonardo Ferreira
Introduction Exploring the potential of exercise in the rehabilitation process of patients with Parkinson’s (PD) may be an interesting treatment perspective. Exercise-induced responses derived from neurotrophic elements appear to ameliorate the decline in neurodegeneration. Despite this understanding, the literature needs to be updated. Areas covered Our review focuses on: a) the key mechanisms of exercise on PD, highlighting mainly the responses related to neuroplasticity; b) the effects induced by different traditional types of exercise, also highlighting the effects of complementary therapies related to movement; c) the volume of exercise required to support efficient results are explored in the context of PD. Additionally, the proposition of new clinical application strategies in the context of PD will also be determined. Expert opinion It is suggested that different intensities of aerobic exercise be explored for the treatment of PD. The results associated with high intensity seem promising for performance, physiological and clinical parameters, such as BDNF production and cognition. On the other hand, the diversification of tasks and repetition of motor gestures appear as consistent arguments to exercise prescription. Finally, for future investigations, the neuromodulation strategy in association with aerobic exercise appears as a potential inducer of benefits on gait and cognitive function.
Right temporal lobe variant of frontotemporal dementia
(2022) Campos, Danilo Fiorotto; Rocca, Andrey Rocha; Caixeta, Leonardo Ferreira
Frontotemporal dementia corresponds to a heterogenous group of syndromes characterized by progressive changes in behavior and/or language. Approximately 30% of patients with primary progressive aphasia, semantic variant (semantic dementia), present with atrophy in the right cerebral hemisphere, in a rare clinical condition called right temporal variant of frontotemporal dementia (rtvFTD). The objective of the study is to present the main demographic, clinical, neuropsychological, neuroimaging, and pathologic characteristics of rtvFTD patients. A systematic review of the literature was carried out in the PubMed, LILACS, and SCIELO databases between January and March 2022. After the evaluation process, 41 articles were selected, published between 1993 and 2021. We found that rtvFTD presents with severe and progressive prosopagnosia (related to anterior temporal lobe injury) associated with behavioral symptoms—desinibition (51%), apathy (39%), obsessive-compulsive symptoms (37%), changes in eating habits (33%), and depression (28%), which is different from semantic dementia. The most common pathologic pattern is TDP-43, type C. This field of knowledge has few studies (mainly reports and case series) and heterogenous nomenclature, which is a limitation. A multinational longitudinal registry of people with rtvFTD, with standardized assessment and description of symptoms, is necessary to elucidate the characteristics of this entity.
A randomized pharmacokinetic and pharmacodynamic trial of two regular human insulins demonstrates bioequivalence in type 1 diabetes and availability of biosimilar insulin may improve access to this medication
(2022) Vencio, Sérgio Alberto Cunha; Vencio, Rafael Caiado Caixeta; Caixeta, Leonardo Ferreira; Masierek, Małgorzata; Mlynarski, Wojciech; Drzewoski, Józef; Gregory, Justin M.
Aims To compare the pharmacokinetic (PK) and pharmacodynamic (PD) effects and safety of therapeutic dosages of a regular insulin (experimental drug) produced by Bioton S.A. (Warsaw, Poland) versus Humulin® R, a regular insulin (reference drug) produced by Eli Lilly (Indianapolis, Indiana). Materials and Methods In a single-centre, randomized, double-blinded phase 1 crossover study, we used the manual euglycaemic clamp technique to compare PK and PD profiles between single subcutaneous doses (0.3 units/kg) of the two regular insulins in participants with type 1 diabetes (T1DM) with a washout period of 14 (± 7) days between tests. Results We evaluated 56 participants. The mean participant age and body mass index were 32.9 years and 22.9 kg/m2, respectively. The ratios (experimental/reference) of the geometric means of maximum plasma insulin concentration and for plasma insulin area under the curve (AUC) were 0.909 (90% confidence interval [CI] 0.822-1.01) and 0.993 (90% CI 0.944-1.04), respectively. The ratios of the geometric means of maximum glucose infusion rate (GIR) and for GIR AUC were 0.999 (95% CI 0.912-1.09) and 1.04 (95% CI 0.962-1.12), respectively. Conclusions The experimental product regular human insulin and comparator Humulin® R are bioequivalent in patients with T1DM. Wider entry to the pharmaceutical market of affordable, biosimilar regular insulins may substantially improve access to insulin for many socioeconomically disadvantaged patients with diabetes.
Immunopsychiatry: an update on autoimmune encephalitis for neuropsychiatrists
(2022) Marques, Frederico Moraes Cardoso; Nardi, Antonio Egidio; Teixeira Junior, Antonio Lucio; Caixeta, Leonardo Ferreira
Introduction Autoimmune encephalitis (AIE) is a group of immune-mediated inflammatory processes of the brain with marked psychiatric features. Although relatively rare, they might offer difficult differential diagnosis with psychiatric conditions, especially catatonia and psychotic syndromes. Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is the most common AIE, presenting with psychiatric syndromes in 90% of cases. The associated psychopathology is complex, pleomorphic, and best characterized when there is involvement of a psychiatrist in the assessment. Areas covered This text will review the main aspects of AIE to psychiatrists and/or neuropsychiatrists. Expert opinion Immune system dysfunction has been implicated in the pathophysiology of psychiatric symptoms and disorders. The use of diagnostic criteria for possible AIE, especially when specific antibodies of AIE are not available, allows early diagnosis and prompt treatment which are associated with better clinical outcomes. The study of the psychiatric aspects of AIE can broaden our knowledge of the underlying mechanisms of various psychiatric manifestations.
Teoria da mente: uma revisão com enfoque na sua incorporação pela psicologia médica
(2002) Caixeta, Leonardo Ferreira; Nitrini, Ricardo
A concept derived from cognitive psychology which refers to the ability to impute mental states to the self and others, termed Theory of Mind, has been disseminated to others fields of knowledge and has been more recently incorporated by medical psychology with the intention of explaining behavior disturbances that constitute the core features of disorders such as Infantile Autism, Schizophrenia and related Psychosis. Such incorporation has given rise to the necessity of designing a methodological approach to measure and define Theory of Mind in neurobiological terms. The aim of this work is related to describe the mechanisms by which Theory of Mind has been contributed to the elucidation of some mental phenomena, as well as enroll the methodological difficulties related to this attitude. Before that, a review of the field of Theory of Mind is do ne, focusing on the more relevant aspects of this concept. There are a few articles in Brazil about this theme, thats why the prese nt work is justified.
Attention deficit/hyperactivity disorder symptoms in indigenous children from the Brazilian Amazon
(2010) Azevêdo, Paulo Verlaine Borges e; Caixeta, Leonardo Ferreira; Andrade, Laura Helena Silveira Guerra de; Bordin, Isabel Altenfelder Santos
The clinical constructs of attention deficit/hyperactivity disorder (ADHD) have been described in several cultures worldwide. Yet this symptomatic presentation still remains to be assessed in remote population groups. Objective: To explore the possibility of the existence of ADHD symptoms among settlement-dwelling indigenous children of the Karajá ethnic group in the Brazilian Amazon and to estimate the rate of ADHD symptoms among 7-16-year-olds. Method: All parents/caretakers of 7-16-year olds from all (N=5) most populated indigenous groups were invited to participate, if they were worried about their children emotional/behavioural problems. Fifty three parents spontaneously came for a psychiatric interview (DSM-IV criteria applied), individually conducted at the settlement’s health post by a child psychiatrist. Results: The estimated rate of ADHD symptoms in problematic indigenous children aged 7-16 years was 24.5% (95% CI: 13.6-35.4) since 13 out of 53 parents/caretakers reported the classical triad of ADHD symptoms (inattentiveness, hyperactivity, impulsiveness). Conclusion: ADHD is a clinically relevant construct in the Karajá indigenous population, representing a major concern among parents/caretakers of children and adolescents from this ethnic group.
HIV-associated dementia in older adults: clinical and tomographic aspects
(2011) Silva, Emanuela Torreão Brito e; Caixeta, Leonardo Ferreira; Soares, Vânia Lúcia Dias; Rodrigues, Gisele; Sagawa, Fonseca
Background: Elderly adults with human immunodeficiency virus (HIV) are at greater risk of developing cognitive impairment. The purpose of this study was to describe clinical and tomographic characteristics of HIV-1 associated dementia (HIVD) in older adults. Methods: A descriptive study was carried out involving eight HIVD patients. Seven tests were employed for cognitive assessment and transformed to whole number z-scores using appropriate normative sets. Results: The average age of the patients was 71 years; seven cases described the route of HIV infection as being heterosexual; and mean schooling was 6.5 years. Six subjects were using highly active anti-retroviral therapy (HAART), with an average CD4 count of 407.8 cells/mm3. Mild dementia was detected in most cases (87.5%). Deficits on neuropsychological tests showed results similar to multi-center transversal studies on HIVD. The classic HIVD triad observed in younger adults was also seen in this population: i.e. cognitive changes, psychiatric changes and motor impairment. Cortical injury shown by dyscalculia, visual-spatial change and language deficits were frequent. Brain images showed cortical atrophy in all patients but was restricted to frontal lobes in five cases. Conclusion: The findings on brain imaging were non-specific, revealing images similar to those of the elderly brain and to HIVD in younger adults. HIVD in the elderly is a challenge and become an increasingly significant differential diagnosis for cognitive loss in old age. This dementia must be clinically suspected and image exams are useful in excluding other central disorders. Prospective studies of HIV-positive elderly people are warranted to better understand HIVD.
Anterior temporal white matter lesions in adult-form myotonic dystrophy type 1
(2014) Caixeta, Leonardo Ferreira; Reis, Giane Divina de Souza; Vilela, Ana Caroline Marques
Sofrimento mental: avaliação em uma universidade americana
(2016) Araújo, Karla Jéssica Santos de; Silva, Andréia Moreira da; Silva Junior, George Martins Ney da; Carrijo, João Baptista; Caixeta, Leonardo Ferreira; Bagasra, Anisah
Objective: To verify the presence of mental suffering in international students at an American university. Methods: Field research, with a quantitative approach, that analyzed, through the Self-reporting Questionnaire 20, the factors that influence the adjustment of the students to a new culture. Results: 58% of the participants were male, 51% Asian. The prevalence of mental distress was 22% among women representing 89% of this number (p=0,001). The mean age of the participants was 21 ± 1,83 years and the average length of stay in the USA was 20 ± 17,1 months. The mental distress was found to be associated with the difficulty with the language and the non participation in activities in College (both: p=0,01). Conclusion: Women presented higher frequency of mental distress more frequently and scored higher than men on the questionnaire, which confirmed what is said in the world literature. Moreover, facilitating improvement in the foreign language and encouraging participation in activities in College are strategies that can be used to reduce mental distress.
Treatment of cognitive deficits in alzheimer's disease: a psychopharmacological review
(2016) Campos, Carlos Miguel Martins; Rocha, Nuno Barbosa F.; Vieira, Renata Teles; Rocha, Susana A.; Correia, Diogo Telles; Paes, Flavia; Tifei, Yuan; Nard, Antonio Egidio; Carrión, Oscar Arias; Machado, Sergio; Caixeta, Leonardo Ferreira
The growing and aging population has contributed to the increased prevalence of Alzheimer's disease (AD) and other types of dementia in the world. AD is a progressive and degenerative brain disease with an onset characterized by episodic memory impairments, although progressive deficits can be observed in several domains including language, executive functions, attention and working memory. The relationship between cognitive impairments and the topography and progression of brain neuropathology is well established. The pathophysiologic mechanisms and processes that underline the course of cognitive and clinical decline have been the theoretical support for the development of pharmacological treatments for AD. Cholinesterase inhibitors (ChEIs) and N-methyl-D-aspartate (NMDA) antagonists are the main drugs used in the management of global cognitive impairment and several studies also explore the effects of both in specific cognitive measures. Recent research trends also examine the effects of combination therapy using both compounds. This review aims to update practical recommendations for the treatment of global cognitive functioning and specific neurocognitive deficits in AD using ChEIs, NMDA antagonists and combination therapy with both drugs.
Mania as the first manifestation of Wilson's disease
(2008) Machado, Alexandre Aluizio Costa; Deguti, Marta Mitiko; Spitz, Mariana; Caixeta, Leonardo Ferreira; Lucato, Leandro Tavares; Barbosa, Egberto Reis
Background: Although mental changes are frequent in Wilson’s disease, severe psychiatric disorders occur uncommonly and usually accompany the neurological picture. There are few reports in the literature of Wilson’s disease patients with typical bipolar affective disorder (BPAD). Case report: The authors report the case of a patient with Wilson’s disease whose initial manifestation was a manic episode followed by depression. Tremor in the upper limbs appeared one year after the onset of symptoms. The diagnosis of Wilson’s disease was established three years after the first symptoms appeared, based on the neuropsychiatric picture, the detection of Kayser–Fleischer rings and the results of diagnostic tests indicating chronic liver disease and copper excess. ATP7B genotyping and magnetic resonance imaging of the brain with proton spectroscopy study were also performed. The patient became asymptomatic two years after starting treatment with penicillamine and remained non-symptomatic controlled during the eight-year follow-up period, without any specific treatment for the BPAD. Conclusions: To our knowledge, this is a singular report of a case of Wilson’s disease in which a manic episode preceded the onset of neurological symptoms. The association between Wilson’s disease and bipolar disorder is discussed.
Prevalence of attention deficit hyperactivity disorder (ADHD) symptoms and comorbidities in children and adolescents from a Brazilian isolated black community
(2017) Carvalho, Karla Cristina Naves de; Caixeta, Leonardo Ferreira; Garcia, Camila Silva; Garcia, Gabriella Silva
Objective: To assess prevalence of attention deficit hyperactivity disorder (ADHD) symptoms and comorbidities in children and adolescents aged 6 to 18 from a Kalunga community in the state of Goiás, Brazil. Case description: A sample of 204 Kalunga children and adolescents was evaluated based on the responses of their parents/guardians and teachers to the Child Behavior Checklist for ages 6–18 (CBCL/6–18) and the Teacher’s Report Form for ages 6–18 (TRF/6–18), respectively. ADHD and attention deficit disorder (ADD) symptoms and comorbidities were detected in 5.9%, 5.4%, 16.2%, and 15.2% of the individuals assessed, by parents and teachers, respectively. Prevalence of ADD was higher than the national average, while ADHD presented prevalence similar to that of the world population. According to the evaluations of parents/guardians and teachers, the estimated prevalences of comorbid disorders in children and adolescents with signs and symptoms of ADHD and ADD were, respectively, 83%, 90%, 60.6%, and 64% with oppositional defiant disorder and 58.3%, 63.6%, 75.7%, and 80.6% with anxiety disorders. Conclusions: Due to the high prevalence of ADHD comorbidities found herein, further studies are necessary to assess the prevalence of other mental diseases in the studied community. Therefore, deeper knowledge on such a relevant theme can be generated.
Executive function is selectively impaired in old age bipolar depression
(2017) Caixeta, Leonardo Ferreira; Soares, Vânia Lúcia Dias; Vieira, Renata Teles; Soares, Cândida Dias; Caixeta, Victor de Melo; Ferreira, Sandra de Fátima Barboza; Aversi-Ferreira, Tales Alexandre
Background: Little is known about the cognitive signature of bipolar disorder (BD) in elderly brains. The neuropsychological features of depressive elderly with early-onset BD are largely unknown. This issue is relevant because cognitive impairment can produce an additional impact on the already compromised functionality of elderly with BD. The aim of this study is to assess executive functions (EFs) in the depressive phase of elderly outpatients with early-onset BD. Methods: Forty-nine elderly outpatients with early-onset BD were assessed with several neuropsychological tests for EF in the depressive phase of the disorder. Results: Executive dysfunction is very common in old age bipolar depression. Thirteen patients (26.5%) had a pseudodementia presentation. The worst performances were observed in the following tests: Trail Making B, Stroop Test 3, Backward Digit Span and Wisconsin Card Sorting Test. Conclusion: Executive dysfunction profile in elderly BD is complex and heterogeneous, but most cases display difficulties in working memory, inhibitory control, mental flexibility, and information processing speed. The performance of elderly with bipolar depression in executive assessment can be divided into two main categories: (1) Single EF domain impairment; and (2) Multiple EF domain impairment with or without a pseudodementia syndrome. Executive dysfunction in old age bipolar depression may be explained by lack of sufficient mental energy to run those cognitive processes that require larger amounts of effort to be performed.
Extending the range of differential diagnosis of chronic traumatic encephalopathy of the boxer: insights from a case report
(2018) Caixeta, Leonardo Ferreira; Dangoni Filho, Iron; Sousa, Rafael Dias de; Soares, Pedro Paulo Dias; Rabelo, Andreia Costa
Sports activities associated with repetitive cranial trauma have become a fad and are popular in gyms and even among children. It is important to consistently characterize the consequences of such sports activities in order to better advise society on the real risks to the central nervous system. We present the case of a former boxer reporting cognitive and behavioral symptoms that began six years after his retirement as a boxer, evolving progressively with parkinsonian and cerebellar features suggestive of probable chronic traumatic encephalopathy (CTE). Using our case as a paradigm, we extended the range of differential diagnosis of CTE, including corticobasal degeneration, multiple system atrophy, vitamin B12 deficiency, neurosyphilis, frontotemporal dementia and Alzheimer’s disease.
Dementia and behavioral disorders in Progressive Multifocal Leukoencephalopathy (PML) - case report
(2018) Lopes, Danielly Bandeira; Caixeta, Leonardo Ferreira
Psychiatric disturbances in Progressive Multifocal Leukoencephalo pathy (PML) are rarely adressed and its study can offer insights into the neurobiology of psychosis. The authors report a case of male pa tient, 42 years old, HIV positive, with PML and psychotic symptoms. The present case shows the need for regular neurological and neu ropsychological evaluations of HIV positive patients and the impor tance of studying diseases that cause lesions in the white matter, such as PML, to elucidate the neurobiology of psychosis.
Incidence of dementia in a community-dwelling brazilian population
(2024) Nitrini, Ricardo; Caramelli, Paulo; Herrera Junior, Emilio; Bahia, Valéria Santoro; Caixeta, Leonardo Ferreira; Radanovic, Marcia; Anghinah, Renato; Fichman, Helenice Charchat; Porto, Cláudia Sellitto; Hartmann, A. P. J.
The authors report the incidence of dementia in a community-dwelling Brazilian population. In 1997, 1656 individuals aged 65 years or more, the majority being of very low educational level, were screened at their homes in Catanduva, Brazil, and dementia was diagnosed in 118 cases. The remaining 1538 individuals were rescreened 3.25 years later applying a health questionnaire, the Mini-Mental State Examination (MMSE) and the Pfeffer Functional Activities Questionnaire (PFAQ). According to PFAQ and MMSE scores, selected subjects were submitted to clinical, neurologic, and cognitive evaluations. The subjects diagnosed with dementia underwent laboratory tests and brain computed tomography. A total of 1119 individuals were rescreened and 50 incident cases of dementia (28 with Alzheimer disease [AD]) were identified. The incidence rate of dementia was 13.8 and of AD was 7.7 per 1000 person-years for individuals aged 65 years or older. The incidence rates of dementia almost doubled with every 5 years of age. There was no difference according to gender, but women had a higher incidence of dementia, predominantly AD, in very old age. There was a trend for higher incidence of dementia in illiterates (p = 0.07), but multivariate analysis disclosed significant association only between age and higher incidence of dementia. The incidence rates of dementia in this Brazilian community are comparable to those reported in Western and Asian studies.
Suggestive diagnosis of attention-deficit/hyperactivity disorder in indigenous children and adolescents from the Brazilian Amazon
(2020) Azevêdo, Paulo Verlaine Borges e; Caixeta, Leonardo Ferreira; Taveira, Daniela Londe Rabelo; Giglio, Margareth Rocha Peixoto; Rosário, Maria Conceicao do; Rohde, Luis Augusto Paim
The prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms has been scarcely studied in indigenous cultures that preserve ancestral cultural characteristics. The objective of the study is to estimate the prevalence of suggestive diagnosis of ADHD among indigenous children and adolescents from villages in the Amazon. This is an analytical cross-sectional study using instruments to track ADHD symptoms (the Child Behaviour Checklist for ages 6–18: CBCL/6–18 and the teacher report form for ages 6–18: TRF/6–18) and to investigate their negative impact on the patients (using the Strengths and Difficulties Questionnaire—SDQ). The prevalence of a suggestive ADHD diagnosis according to the CBCL/TRF DSM-IV ADHD subscale without and with negative impact as assessed by the SDQ was 4.3% and 1.1%, respectively. Comorbid oppositional-defiant, conduct problems and anxious symptoms were present in all cases screening positive for ADHD. We also presented a case report as an illustration of the observed clinical presentation. ADHD is a recognizable disorder even in a culture that preserves millennial characteristics. Furthermore, the presence of ADHD symptoms was associated with significant impairment.
Differential diagnosis between anomalous experiences and dissociation disorder using the Dissociative Disorders Interview Schedule (DDIS)
(2019) Vencio, Sérgio Alberto Cunha; Vencio, Rafael Caiado Caixeta; Caixeta, Leonardo Ferreira
Background. It is important to understand the most diverse cultural aspects related to religiosity. Scientifically, it is important to understand religious manifestations and their relation to health, and to differentiate them from psychopathological manifestations. Objective. To evaluate the mental health of a group of mediums and compare it with that of a control group from the same religious context who do not manifest mediumship, using the Dissociative Disorders Interview Schedule (DDIS). Methods. This was a cross-sectional study, evaluating 47 mediums (Group 1) and comparing them with 22 non-medium volunteers from the same religious context (Group 2) using the DDIS questionnaire. All results were matched with historical data from patients with dissociative identity disorder (DID) who answered the DDIS. Results. Scores obtained from the DDIS were similar in both groups. The number of positive symptoms was comparable in a wide range of analyzed areas, involving but not being restricted to somatization disorder, major depressive episode, borderline personality disorder, extrasensory/paranormal experiences, physical/sexual abuse and five dissociative disorders. There were considerable differences when we compared these results with historical data from patients with DID. Conclusion. In agreement with the extant literature, these results showed that mediumship can be considered a non-pathological form of dissociative phenomena.
Mortality from dementia in a community-dwelling Brazilian population
(2005) Nitrini, Ricardo; Caramelli, Paulo; Herrera Junior, Emilio; Castro, Isac de; Bahia, Valéria Santoro; Anghinah, Renato; Caixeta, Leonardo Ferreira; Radanovic, Marcia; Fichman, Helenice Charchat; Porto, Cláudia Sellitto
Background The influence of dementia on mortality has not yet been reported for a Latin American country. Objectives To evaluate the influence of dementia on mortality of a community-dwelling elderly population in Brazil, and to verify the extent to which the diagnosis of dementia is reported on death certificates. Methods A cohort of 1,656 individuals, aged 65 and over, was screened for dementia at their domiciles, in 1997. The same population was re-evaluated in 2000, and information on deaths was obtained from relatives and from the municipal obituary service. Kaplan-Meier curves were used for the survival analysis, and the mortality risk ratio (MMR) was calculated using Cox proportional hazards models. Results We obtained data from 1,393 subjects, corresponding to 84.1% of the target population. The number of deaths was 58 (51.3%) among the patients with dementia and 163 (12.7%) among those without dementia in 1997 (p < 0.0001). Dementia and Alzheimer's disease (AD) decreased survival, with hazards ratios of 5.16 [95% Confidence Interval (CI): 3.74–7.12] for dementia and 4.76 (95% CI: 3.16–7.18) for AD. The Cox proportional hazards model identified dementia (MMR = 3.92, 95% CI: 2.80–5.48) as the most significant predictor of death, followed by age, history of stroke, complaints of visual impairment and heart failure and by severe arterial hypertension in the baseline evaluation. Dementia and/or AD were mentioned in only 12.5% of the death certificates of individuals with dementia. Conclusions Dementia causes a significant decrease in survival, and the diagnosis of dementia is rarely reported on death certificates in Brazil. Copyright © 2005 John Wiley & Sons, Ltd.

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