Post-Mortem diagnosis of dementia by informant interview.

The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. Objectives:To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. Methods:A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. Results:Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. Conclusions:The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition

Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) for the early diagnosis of dementia across a variety of healthcare settings

Background: The Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) is a structured interview based on informant responses that is used to assess for possible dementia. IQCODE has been used for retrospective or contemporaneous assessment of cognitive decline. There is considerable interest in tests that may identify those at future risk of developing dementia. Assessing a population free of dementia for the prospective development of dementia is an approach often used in studies of dementia biomarkers. In theory, questionnaire-based assessments, such as IQCODE, could be used in a similar way, assessing for dementia that is diagnosed on a later (delayed) assessment. Objectives: To determine the diagnostic accuracy of IQCODE in a population free from dementia for the delayed diagnosis of dementia (test accuracy with delayed verification study design). Search methods: We searched these sources on 16 January 2016: ALOIS (Cochrane Dementia and Cognitive Improvement Group), MEDLINE Ovid SP, Embase Ovid SP, PsycINFO Ovid SP, BIOSIS Previews on Thomson Reuters Web of Science, Web of Science Core Collection (includes Conference Proceedings Citation Index) on Thomson Reuters Web of Science, CINAHL EBSCOhost, and LILACS BIREME. We also searched sources specific to diagnostic test accuracy: MEDION (Universities of Maastricht and Leuven); DARE (Database of Abstracts of Reviews of Effects, in the Cochrane Library); HTA Database (Health Technology Assessment Database, in the Cochrane Library), and ARIF (Birmingham University). We checked reference lists of included studies and reviews, used searches of included studies in PubMed to track related articles, and contacted research groups conducting work on IQCODE for dementia diagnosis to try to find additional studies. We developed a sensitive search strategy; search terms were designed to cover key concepts using several different approaches run in parallel, and included terms relating to cognitive tests, cognitive screening, and dementia. We used standardised database subject headings, such as MeSH terms (in MEDLINE) and other standardised headings (controlled vocabulary) in other databases, as appropriate. Selection criteria: We selected studies that included a population free from dementia at baseline, who were assessed with the IQCODE and subsequently assessed for the development of dementia over time. The implication was that at the time of testing, the individual had a cognitive problem sufficient to result in an abnormal IQCODE score (defined by the study authors), but not yet meeting dementia diagnostic criteria. Data collection and analysis: We screened all titles generated by the electronic database searches, and reviewed abstracts of all potentially relevant studies. Two assessors independently checked the full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool, and reported quality using the STARDdem tool. Main results: From 85 papers describing IQCODE, we included three papers, representing data from 626 individuals. Of this total, 22% (N = 135/626) were excluded because of prevalent dementia. There was substantial attrition; 47% (N = 295) of the study population received reference standard assessment at first follow-up (three to six months) and 28% (N = 174) received reference standard assessment at final follow-up (one to three years). Prevalence of dementia ranged from 12% to 26% at first follow-up and 16% to 35% at final follow-up. The three studies were considered to be too heterogenous to combine, so we did not perform meta-analyses to describe summary estimates of interest. Included patients were poststroke (two papers) and hip fracture (one paper). The IQCODE was used at three thresholds of positivity (higher than 3.0, higher than 3.12 and higher than 3.3) to predict those at risk of a future diagnosis of dementia. Using a cut-off of 3.0, IQCODE had a sensitivity of 0.75 (95%CI 0.51 to 0.91) and a specificity of 0.46 (95%CI 0.34 to 0.59) at one year following stroke. Using a cut-off of 3.12, the IQCODE had a sensitivity of 0.80 (95%CI 0.44 to 0.97) and specificity of 0.53 (95C%CI 0.41 to 0.65) for the clinical diagnosis of dementia at six months after hip fracture. Using a cut-off of 3.3, the IQCODE had a sensitivity of 0.84 (95%CI 0.68 to 0.94) and a specificity of 0.87 (95%CI 0.76 to 0.94) for the clinical diagnosis of dementia at one year after stroke. In generaI, the IQCODE was sensitive for identification of those who would develop dementia, but lacked specificity. Methods for both excluding prevalent dementia at baseline and assessing for the development of dementia were varied, and had the potential to introduce bias. Authors' conclusions: Included studies were heterogenous, recruited from specialist settings, and had potential biases. The studies identified did not allow us to make specific recommendations on the use of the IQCODE for the future diagnosis of dementia in clinical practice. The included studies highlighted the challenges of delayed verification dementia research, with issues around prevalent dementia assessment, loss to follow-up over time, and test non-completion potentially limiting the studies. Future research should recognise these issues and have explicit protocols for dealing with them

A internacionalização de empresas e o desempenho organizacional: o caso da TownSq

Este trabalho tem como objetivo analisar a influência da estratégia de internacionalização da empresa no desempenho organizacional de uma startup brasileira. Para tanto, foi realizada uma pesquisa qualitativa através do estudo de caso de uma startup nascida em Porto Alegre, levando em consideração dados de performance da empresa, dos números antes e depois da internacionalização, e entrevistas em profundidade. A análise dos dados coletados baseou-se nas quatro perspectivas estratégicas do Balanced Scorecard: financeira; do cliente; dos processos internos; e de aprendizado e crescimento. Como contribuições trazidas com o estudo, para a empresa trabalhada são levados diversos insights , ; para o ecossistema local de startups também são trazidos diversos processos e possibilidades a partir do estudo que identificou fatores importantes que levaram o TownSq ao patamar que hoje encontra-se. Quanto aos fatores de desempenho, pode-se concluir que, de maneira geral, a internacionalização trouxe melhorias em produto e financeiramente, mas o foco na expansão dos negócios para outro mercado pode ter consequências negativas na operação nacional e suas variáveis internas.The objective of this study is to analyse the influence of the internationalization strategy of the company in the organizational performance of a brazilian startup. For this purpose, a qualitative research is done through the case study of a startup that was born in Porto Alegre, considering data from the company performance, the numbers before and after the internationalization, and in-depth interviews. The collected data analysis was based on the four strategic perspectives of the Balanced Scorecard: financial; of the client; of internal processes; and of learning and growth. As research outcomes, for the studied company plenty of insights are taken; for the local startups ecosystem, are also brought plenty of processes and possibilities from the study that identified important factors that took TownSq to the threshold that it is today. In terms of performance factors, we can conclude that, in general, the internationalization brings improvements in product and financially, but the focus on the business expansion to another market may have caused negative consequences in the national operations and its internal variables

A internacionalização de empresas e o desempenho organizacional: o caso da TownSq

Este trabalho tem como objetivo analisar a influência da estratégia de internacionalização da empresa no desempenho organizacional de uma startup brasileira. Para tanto, foi realizada uma pesquisa qualitativa através do estudo de caso de uma startup nascida em Porto Alegre, levando em consideração dados de performance da empresa, dos números antes e depois da internacionalização, e entrevistas em profundidade. A análise dos dados coletados baseou-se nas quatro perspectivas estratégicas do Balanced Scorecard: financeira; do cliente; dos processos internos; e de aprendizado e crescimento. Como contribuições trazidas com o estudo, para a empresa trabalhada são levados diversos insights , ; para o ecossistema local de startups também são trazidos diversos processos e possibilidades a partir do estudo que identificou fatores importantes que levaram o TownSq ao patamar que hoje encontra-se. Quanto aos fatores de desempenho, pode-se concluir que, de maneira geral, a internacionalização trouxe melhorias em produto e financeiramente, mas o foco na expansão dos negócios para outro mercado pode ter consequências negativas na operação nacional e suas variáveis internas.The objective of this study is to analyse the influence of the internationalization strategy of the company in the organizational performance of a brazilian startup. For this purpose, a qualitative research is done through the case study of a startup that was born in Porto Alegre, considering data from the company performance, the numbers before and after the internationalization, and in-depth interviews. The collected data analysis was based on the four strategic perspectives of the Balanced Scorecard: financial; of the client; of internal processes; and of learning and growth. As research outcomes, for the studied company plenty of insights are taken; for the local startups ecosystem, are also brought plenty of processes and possibilities from the study that identified important factors that took TownSq to the threshold that it is today. In terms of performance factors, we can conclude that, in general, the internationalization brings improvements in product and financially, but the focus on the business expansion to another market may have caused negative consequences in the national operations and its internal variables

Nível de tecnologia e retorno ao capital em propriedades especializadas em bovinos de corte - Barretos e Colômbia, Estado de São Paulo, 1969/70

O presente trabalho propôs-se, fundamentalmente, a testar a influência que o nível de tecnologia das propriedades de uma região predominantemente agropecuária do Estado de São Paulo pudesse estar exercendo sobre a taxa de retorno ao fator capital alcançada por seus empresários. Mais especificamente, foram os seguintes os objetivos: 1. Estimar a eficiência com que estão sendo utilizados os recursos disponíveis, através dos Índices de produtividade parcial e considerando as propriedades segundo o tamanho, a atividade principal e o tipo do gado. 2. Identificar o atual nível de tecnologia das propriedades agropecuárias dos municípios de Barretos e Colômbia, através da relação produção total/insumo total. 3. Estimar as taxas de retorno ao fator capital para as diferentes propriedades e relacioná-las com os respectivos Índices tecnológicos. 4. Fornecer subsídios aos Órgãos competentes no que se refere a melhor alocação de recursos e políticas a serem adotadas. Partimos da hipótese de que, nas condições atuais, a níveis cada vez mais elevados de tecnologia empregada nas propriedades agropecuárias da região, correspondem taxas decrescentes de retorno ao capital e apresentamos justificativa para esta suposição no capítulo dedicado à revisão de literatura. A informação básica analisada na pesquisa foi obtida através de entrevistas diretas com os empresários agrícolas de uma amostra extraída, ao acaso, do rol de proprietários cadastrados no INCRA, nos municípios de Barretos e Colômbia. Foram colhidos dados de sessenta e nove propriedades, relativos ao ano agrícola de 1969/70, porém, em virtude da incoerência constatada nas informações de algumas delas, tornou-se necessária a sua eliminação, baseando-se a pesquisa em sessenta e quatro observações. As propriedades foram classificadas segundo o tamanho, a atividade principal e o tipo do gado, a fim de determinar os efeitos que estas características possam exercer sobre a eficiência no uso dos recursos e sobre o nível de tecnologia. A análise dos resultados constou, em uma primeira parte, de um estudo relativamente descritivo em que são abordados, essencialmente, os seguintes itens: 1. Distribuição das observações da amostra. 2. Dados médios relativos à posse e uso da terra, segundo os diferentes grupos de propriedades. 3. Considerações sobre uso, vantagens e natureza das pastagens artificiais encontradas na amostra. 4. Constituição média do rebanho bovino, expressa em número por vaca, em percentagem e, no total, em unidades-animal. 5. Valores médios dos Índices de lotação constatados nas propriedades e expressos como carga-animal. Análise de variância para testar, estatisticamente, a ocorrência ou não de diferenças significativas entre os grupos de propriedades. 6. Composição da Produção Total. Na segunda parte da análise, buscamos satisfazer ao nosso primeiro objetivo, determinando os Índices de produtividade parcial, segundo as três classificações adotadas, e testando as suas diferenças através da análise de variância. Os Índices estimados, a fim de julgar a eficiência com que estão sendo utilizados os recursos produtivos, foram os seguintes: I1= Renda Bruta (Cr$) / Área Total Explorada (ha) - I2= Renda Bruta (Cr$)/ Área em pastagens (ha) - I3= Renda Bruta (Cr$)/ Capital médio investido em terra ( Cr$) - I4= Renda Bruta (Cr$)/Investimento Médio Total (Cr$) - I5= Renda Bruta ( Cr$)/ Mão-de-Obra Utilizada (Eq./H.) - I6= Renda Bruta (Cr$)/ Mão-de-Obra Utilizada (Cr$) - I7= Renda Líquida (Cr$) / Área Total Explorada (ha) - I8= Renda Líquida (Cr$)/ Área em Pastagens (ha) - I9= Renda Líquida (Cr$)/ Capital médio investido em terra (Cr$) - I10= Renda Líquida (Cr$)/Investimento Médio Total (Cr$) - I11= Renda Líquida (Cr$)/Mão-de-Obra Utilizada (Eq./H.) - I12= Renda Líquida (Cr$)/Mão-de-Obra Utilizada(Cr$). Finalmente, atendendo aos objetivos finais do trabalho, passamos a estimar os Índices de produtividade total e a variável taxa de retorno ao fator capital, cujos valores médios foram testa dos pela análise de variância. Com o intuito de estudar a ocorrência de uma relação linear entre o Índice de produtividade total que, admitidas as devidas pressuposições, está representando o nível de tecnologia da propriedade, e a variável taxa de retorno ao capital, foi usado o seguinte modelo estatístico: Yi = a+ b Xi + e i, onde, Yi = taxa de retorno ao fator capital e Xi = Índice tecnológico. Uma vez ajustada a regressão linear simples aos dados, obtivemos a seguinte equação: Y=-9,2348 + 20,0332 X, cujo coeficiente ele correlação (r) é igual a O. 8616, e onda o valor de t, igual a 13.368, revela ser esta inferência significante ao nível de 0.1% de probabilidade. Procuramos ajustar, também, regressões linear e curvilínea aos dados de Índice tecnológico e investimento total médio, bem como aos de despesas operacionais e nível tecnológico, mas verificou-se a não existência de correlação entre os mesmos. Quando se considerou, no entanto, os pares de variáveis: Índice tecnológico-carga animal e taxa de retorno ao capital-carga animal, encontramos as equações lineares: Y = 0,4430 + 0,3264 X, com r = 0.45020 e t = 3,97, onde, Y = Índice tecnológico - X= carga animal e Y = -0,6824 + 6,9237 X, com r = 0.41074 e t = 3,55 para Y = taxa de retorno ao capital e X= carga animal. Os coeficientes de correlação revelaram-se significantes ao nível de 0.1% de probabilidade.This research proposed, fundamentally, to test the influence that the level of technology employed on farms might exert on the rate of return to capital in a region which specializes predominantly in livestock. More specifically, the objectives were the following: 1. To resources are estimate the efficiency being utilized using partial with which available and differentiating the farms according to productivity indices size, major type of livestock activity, and type of cattle. 2. To identify present level of technology on farms in the municipios of Barretos and Colombia using total output/total input relationships. 3. To estimate the rate of return to capital for the different farms and relate them to their respective technological indices. 4. To make recommendations to interested agencies with regard to better allocation of resources and policies to be adopted. It was hypothesized that, under present conditions, increasing levels of technology employed on the farms of the region correspond to decreasing rates of return to capital justification for this presumption was presented in the chapter devoted to literature review. The basic information analyzed in this research was obtained through direct interviews with farmers selected by a random sample from a list of farmers registered at the INCRA (Instituto de Colonização e Reforma Agrária) in the municipios of Barretos and Colombia. Data were collected on sixty-nine farms for the crop year 1969/70; however fiv0 observations were eliminated due to inconsistencies found in the information so the research was based on the remaining sixty-four observations. The farms were classified according to size, major type of livestock activity and type of cattle in order to determine the effects that these characteristics may exert on the efficiency of resource use and level of technology. In the first part of the study, the analysis of results consisted of a descriptive study in which the following items were considered: 1. Distribution of sample observations; 2. Data relative to tenure and land use, according to different groups of farms; 3. Considerations on use, advantages and nature of artificial pasture found in the sample; 4. Average composition of cattle herd expressed in cow units, in percentages and in animal units; 6. Composition of total production. In the second part of the analysis, we attempted to fulfill our first objective by determining partial productivity índices and testing their differences through analysis of variance. The índices estima ted in arder to determine the efficiency wi th which the productive resources were utilized, were the following: I1= Gross Farm Incarne (Cr$) / Total area operated (ha) - I2= Gross Farm Income ( Cr$) / Area in pasture (ha) - I3= Gross Farm Income (Cr$)/ Average capital invested in land ( Cr$) - I4= Gross Farm lncome (Cr$)/ Average total investment (Cr$) - I5= Gross Farm Income ( Cr$)/ Labor Utilized (Man-Eq) - I6= Gross Farm lncome (Cr$)/ Labor Utilized (Cr$) - I7= Net Farm lncome (Cr$) / Total Area Operated (ha) - I8= Net Farm lncome (Cr$)/ Area in pasture (ha) - I9= Net Farm lncome (Cr$)/ Average capital invested in land (Cr$) - I10= Net Farm Income (Cr$)/ Average Total lnvestment (Cr$) - I11= Net Farm Income (Cr$)/ Labor Utilized (Man-Eq)- I12= Net Farm lncome (Cr$)/ Labor Utilized ( Cr$). To fulfill the other objectives of the study, we estimated total productivity indices and rate of return to capital. The differences in these average values were tested by analysis of variance. ln order to test the existence of a linear relationship between the total productivity index assumed to represent the technology level of the farm and the rate of return to capital, the following statistical model was considered: Yi = a+ b Xi + e i -where, Yi. = rate of return to capital J. Xi + e i. = technological index. Once the simple linear regression was adjusted to the data, the following equation was obtained: Y = -9,2348 + 20,0332 X, with the correlation coefficient (r) equal to 0.8616 1 and the t value equal to 13.368, indicating that the inference was significant at the 0.1% level of probability. An attempt was also made to adjust linear and curvilinear regressions to the variables technological index and average total investment, and operational expenses and technological level, but no significant correlation was found in either case. However, when the pairs of variables technological index animal units per hectare, and rate of return to capital-animal units per hectare were considered, we found the following linear equations: Y = 0,4430 + 0,3264 X, with r = 0.45020 and t = 3.97 where, Y = technological index X= animal units per hectare and Y = -0,6824 + 6,9237 X 1 with r = 0.41074 and t = 3.55 where, Y = rate of return to capital X= animal units per hectare The correlation coefficients were significant at the 0.1% level of probability

Evaluation of volumetric changes, metabolic, and functional activities in Alzheimer\'s disease, in mild cognitive impairment and in the normal aging

O presente estudo consistiu-se na avaliação clínica e aplicação de testes cognitivos, além da realização de ressonância magnética (RM), de 3 tesla, do cérebro, processada com a técnica de \"Voxel-based Morphometry\" (VBM) e \"Skull Strip\", e 18F-FDG PET -CT processado com \"Statistical Parametric Mapping\" (SPM8) e correção de volume parcial (PVELab), em idosos sem déficits cognitivos (CDR=0), com comprometimento cognitivo leve amnéstico (CCL) (CDR=0,5) e com Doença de Alzheimer leve (DA leve)(CDR de 0,5 a 1). Os objetivos foram comparar os padrões de neuroimagem estrutural e metabólica entre os grupos, assim como correlacionar alterações estruturais volumétricas da RM e alterações metabólicas cerebrais do PET-CT, a um teste funcional, o \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE), nessa mesma amostra. Cada um dos grupo 3 grupos, pareados por idade, contém 30 indivíduos, totalizando amostra de 90. Os resultados dos exames de Neuroimagens, divididos por comparações entre os grupos, e corrigidos pela escolaridade, foram considerados significativos todos os achados nos quais a significância corrigida for <= 0,05 (p-FWEcorr <= 0,05). No CCL x DA foi observado hipometabolismo Giro do Cíngulo à Direita. No grupo DA x CCL foram observados hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Esquerdo, Precuneus Direito e na parte inferior do Lobo Parietal Esquerdo. Na DA x Controle, utilizando-se pesquisa de área a priori e filtros gaussiano de 8mm e 4mm, foi observada redução estatisticamente significante quanto ao volume de substância cinzenta na Amígdala Esquerda e na Amígdala Direita. No PET - CT, da DA, em relação ao grupo controle foram observadas áreas de hipometabolismos no Giro do Cíngulo à Esquerda, no Precuneus Direito e no Giro Temporal Medial Direito. Na correlação direta do IQCODE, na comparação DA x Controle, no PET - CT evidenciou-se hipometabolismo no Giro Fusiforme Direito. Em conclusão, os resultados das comparações entre os grupos foram semelhantes ao encontrado na literatura para fases iniciais (leves) da patologia e mostraram, ainda, uma tendência a um \"continuum\" do controle até a DA. Por outro lado à correlação do IQCODE no DA x Controle carece de comprovação por outros trabalhos e com outros constructos estatísticosThis study consisted in the clinical evaluation and application of cognitive tests, in addition to magnetic resonance imaging (MRI) of 3 Tesla, of brain, processed with the technique of \"Voxel-based Morphometry\" (VBM) and \"Skull Strip\", and 18F-FDG PET-CT processed by \"Statistical Parametric Mapping\" (SPM8) and partial volume correction (PVELab) in subjects without cognitive impairment (CDR = 0), with amnestic mild cognitive impairment (MCI)(CDR = 0.5) and with mild Alzheimer \'s disease (AD mild)(CDRs of 0.5 to 1). The objectives were to compare the patterns of structural and metabolic neuroimaging between groups, as well as correlate MRI\'s volumetric structural changes and PET-CT\'s metabolic brain with a functional test, the \"Informant Questionnaire on Cognitive Decline in the Elderly\" (IQCODE) in this same sample. Each one of three groups, matched by age, contains 30 subjects, totaling 90. The test results of neuroimaging, divided by comparisons between groups, and corrected by education, were considered significant the findings that corrected significance is <= 0.05 (p-FWEcorr <= 0.05). In CCL x DA was observed hypometabolism right cingulate gyrus. In DA x CCL hypometabolism were observed in the left cingulate gyrus, the left precuneus, right precuneus and left inferior parietal lobe. In DA x Control, using the \"a priori\" research area and gaussian filters 8mm and 4mm was observed statistically significant reduction on the volume of gray matter in the left and right amygdala. In PET - CT of DA relative to control group were observed areas of hypometabolisms in left cingulate, right precuneus and in the right medial temporal gyrus. In direct correlation of the IQCODE, compared DA x Control on PET - CT revealed a hypometabolism in the right fusiform gyrus. In conclusion, the results of the comparisons between groups were similar to those found in the literature for early (mild) pathology and showed a \"continuum\" of control to the DA. On the other hand the correlation of the IQCODE in DA x Control lacks confirmation by other studies and other statistical construct

Dementia post-radiotherapy: improvement with acetylcholinesterase inhibitor A case report

Abstract Cognitive decline associated with radiotherapy is a progressive complication that affects many patients submitted to this form of treatment. The lack of an effective treatment drives research for new treatment options to improve the quality of life of patients with this disorder. We report the case of a 64 year-old man who developed a severe dementia of the frontal subcortical type, which was associated with subcortical frontal lesions and appeared as a late complication of radiotherapy used to treat a pituitary tumor. After many pharmacological attempts to improve his cognitive and behavioral problems, the patient showed a significant improvement in the cognitive, functional and behavioral impairments after treatment with an acetylcholinesterase inhibitor. This report discusses hypotheses for the positive effect of this treatment