Luísa Alves - Academia.edu (original) (raw)

Papers by Luísa Alves

Purpose Histogram-based metrics extracted from diffusion-tensor imaging (DTI) have been suggested... more Purpose Histogram-based metrics extracted from diffusion-tensor imaging (DTI) have been suggested as potential biomarkers for cerebral small vessel disease (SVD), but methods and results have varied across studies. This work aims to assess the impact of mask selection for extracting histogram-based metrics of fractional anisotropy (FA) and mean diffusivity (MD) on their sensitivity as SVD biomarkers.Methods DTI data were collected from 17 SVD patients and 12 healthy controls. For each participant, FA and MD maps were estimated; from these, histograms were computed on two alternative whole-brain white-matter masks: normal-appearing white-matter (NAWM) and mean FA tract skeleton (TBSS). Histogram-based metrics (median, peak height, peak width, peak value) were extracted from the FA and MD maps. These were compared between patients and controls, and correlated with the patients’ cognitive scores (executive function and processing speed).Results White matter mask selection significantly...

Arachnoiditis is an inflammation of the arachnoid layer. When the condition is accompanied by acc... more Arachnoiditis is an inflammation of the arachnoid layer. When the condition is accompanied by accumulation of fibrinous adhesive bands leading to reduced blood supply, tethering and encapsulation/tethering of nerve roots and spinal cord, the term adhesive arachnoiditis (AA) is employed. AA resulting from procedures involving spinal anaesthesia and presenting with severe neurological debilitation is extremely rare but may present in many different forms. Such findings may develop anywhere from minutes to months after the procedures, and response scenarios can vary from spontaneous resolutions to intractable states. We herein present the cases of two patients with severe neurological sequalae after neuraxial anaesthesia and their respective management. Several distinct, probably concomitant and somewhat unpredictable factors may lead to or promote the development of AA after spinal anaesthesia. Nonetheless, even if not completely avoidable, awareness for the condition may allow for an...

European Geriatric Medicine, 2016

Journal of Psychiatric Research, 2021

Background: Subjective Memory Complaints (SMC) along with cognitive deficits are frequently obser... more Background: Subjective Memory Complaints (SMC) along with cognitive deficits are frequently observed in patients with Major Depressive Disorder (MDD). The relationship between SMC and objective memory performance in patients with MDD was evaluated, in comparison with patients with Mild Cognitive Impairment due to Alzheimer's Disease (MCI-AD) and healthy controls (HC). Methods: Patients with MDD (n = 47), MCI-AD (n = 43) and HC (n = 45) were assessed with a self-report memory complaints scale (SMCS) and underwent a comprehensive clinical and neuropsychological assessment. A discrepancy score between the Logical Memory delayed recall and the SMCS total score was calculated as a measure of memory awareness. Results: Patients with MDD (12.5 ± 4.4) and patients with MCI-AD (10.9 ± 4.1) had not significantly different SMCS total scores, whereas HC showed significantly lower scores (4.0 ± 3.0). As much as 74.5% of patients with MDD patients and 65.1% of patients with MCI-AD reported prominent memory complaints, whereas only 4.4% of HC did. Patients with MDD had relatively preserved memory tests, resulting in a higher discrepancy score than both patients with MCI-AD and HC. The SMCS total score correlated positively with depressive symptoms in the 3 groups of participants. Conclusions: Patients with MDD showed inaccurate memory self-awareness as they underestimated their memory functioning, a pattern distinct from both patients with MCI-AD and HC.

Journal of Alzheimer's Disease, 2020

Background: Diagnosis of Alzheimer's disease (AD) confirmed by biomarkers allows the patient to m... more Background: Diagnosis of Alzheimer's disease (AD) confirmed by biomarkers allows the patient to make important life decisions. However, doubt about the fleetness of symptoms progression and future cognitive decline remains. Neuropsychological measures were extensively studied in prediction of time to conversion to dementia for mild cognitive impairment (MCI) patients in the absence of biomarker information. Similar neuropsychological measures might also be useful to predict the progression to dementia in patients with MCI due to AD. Objective: To study the contribution of neuropsychological measures to predict time to conversion to dementia in patients with MCI due to AD. Methods: Patients with MCI due to AD were enrolled from a clinical cohort and the effect of neuropsychological performance on time to conversion to dementia was analyzed. Results: At baseline, converters scored lower than non-converters at measures of verbal initiative, non-verbal reasoning, and episodic memory. The test of non-verbal reasoning was the only statistically significant predictor in a multivariate Cox regression model. A decrease of one standard deviation was associated with 29% of increase in the risk of conversion to dementia. Approximately 50% of patients with more than one standard deviation below the mean in the z score of that test had converted to dementia after 3 years of follow-up.

Journal of Alzheimer's Disease, 2019

Journal of Alzheimer's Disease, 2018

BMJ case reports, Jan 7, 2016

We present a case of a 60-year-old Caucasian man recently returned from Angola, where he had been... more We present a case of a 60-year-old Caucasian man recently returned from Angola, where he had been successfully treated for a severe (non-cerebral) falciparum malaria infection. He was presented to the emergency room, with a subacute onset encephalopathy, ataxia and a generalised tonic-clonic seizure. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis (123 cells/µL) and hyperproteinorrhachia (188 mg/dL). Brain MRI and EEG were unremarkable. CSF PCR testing for neurotropic viruses was negative as were CSF and blood cultures. The patient was treated with ceftriaxone and acyclovir, with full recovery on the second day of treatment. We believe post-malaria neurological syndrome, a rare self-limited encephalopathy, should be considered in the differential diagnosis. Nevertheless, the presentation, lack of changes on brain MRI and EEG, along with possible false-negative CSF viral PCR, could still represent a viral encephalitis, which brings to question the treatment approa...

Journal of Neuropsychology, 2020

IntroductionPatients diagnosed with amnestic mild cognitive impairment (aMCI) are at high risk of... more IntroductionPatients diagnosed with amnestic mild cognitive impairment (aMCI) are at high risk of progressing to dementia. It became possible, through the use of biomarkers, to diagnose those patients with aMCI who have Alzheimer's disease. However, it is presently unfeasible that all patients undergo biomarker testing. Since neuropsychological testing is required to make a formal diagnosis of aMCI, it would be interesting if it could be used to predict the amyloid status of patients with aMCI.MethodsParticipants with aMCI, known amyloid status (Aβ+ or Aβ−) and a comprehensive neuropsychological evaluation, were selected from the Cognitive Complaints Cohort database for this study. Neuropsychological tests were compared in Aβ+ and Aβ− aMCI patients. A binary logistic regression analysis was conducted to model the probability of being amyloid positive.ResultsOf the 216 aMCI patients studied, 117 were Aβ+ and 99 were Aβ−. Aβ+ aMCI patients performed worse on several memory tests, ...

Normal pressure hydrocephalus: a qualitative study on outcome Hidrocefalia de pressão normal: his... more Normal pressure hydrocephalus: a qualitative study on outcome Hidrocefalia de pressão normal: história natural e prognóstico após cirurgia

Clinical Neurology and Neurosurgery, 2014

Objectives: Although dementia is one of the most relevant symptoms of the idiopathic Normal-Press... more Objectives: Although dementia is one of the most relevant symptoms of the idiopathic Normal-Pressure Hydrocephalus (iNPH) syndrome, some doubts remain about the nature of cognitive deficits in this disease. We aimed to determine the neuropsychological profile in iNPH and its relation with ventricular size, white matter vascular lesions (WML) and gait dysfunction. Methods: Seventeen iNPH patients and a control group (n = 14) were assessed with a battery of neuropsychological tests and a timed walk test. We calculated measures of frontal horn, occipital horn and third ventricle sizes and assessed white matter lesion (WML) load with a validated visual scale. Results: Patients differed significantly from controls in all cognitive tests, but did worse on the Rey Complex Figure test. We found no significant correlations between cognitive and imaging results in iNPH. Cognitive function was related to gait in controls, but not in iNPH patients. Conclusions: Patients presented widespread cognitive dysfunction with a predominance of visuo-spatial deficits. Dissociation between gait and cognitive dysfunction in iNPH patients suggests the existence of different pathophysiological mechanisms.

Clinical Neurology and Neurosurgery, 2007

To test relations between white matter lesions (WML) load in Normal Pressure Hydrocephalus (NPH) ... more To test relations between white matter lesions (WML) load in Normal Pressure Hydrocephalus (NPH) patients and gait characteristics at baseline, duration of symptoms, gait improvement after lumbar puncture (LP), vascular risk factors. Fifteen idiopathic NPH patients. Patients underwent a timed walking test, before and after LP. Five gait variables were assessed and improvement percentages were calculated. WML load was rated regionally and globally in T2 weighted MRI images, using a simple visual scale. Spearman or Pearson correlation coefficients were used to test relations between variables. Significant negative correlations were found between WML scores and gait improvement after CSF removal but not with duration of symptoms or gait variables before LP. WML seem to contribute to the irreversibility of symptoms in NPH but not to the pathophysiological mechanisms that lead to them.

Arquivos de Neuro-Psiquiatria, 2013

Objective To describe the natural history and shunt outcome in patients with normal pressure hydr... more Objective To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.

American journal of Alzheimer's disease and other dementias, Jan 3, 2015

Subjective cognitive complaints (SCCs) are frequent in the elderly population. The majority of in... more Subjective cognitive complaints (SCCs) are frequent in the elderly population. The majority of individuals with subjective complaints never progress to significant cognitive decline, but some of them have a higher risk of progression to objective cognitive impairment than persons with no cognitive concerns. We performed a systematic review of community-based studies that focused on the progression risk associated with SCC and on the complainers' characteristics associated with progression. Seventeen studies were included. As a group, SCCs are associated with a significantly higher risk of progression to dementia. Worried complainers, persons who refer an impact of their complaints on activities of daily living, and those whose complaints are also noticed by an informant have the highest risk of progression. Taking into account the fluctuating course of SCC and their frequent reversion, care should be taken to not overvaluate them. Further studies are necessary to better define r...

Investigation in the field of Alzheimer's disease (AD), the commonest cause of dementia, has been... more Investigation in the field of Alzheimer's disease (AD), the commonest cause of dementia, has been very active in recent years and it may be difficult for the clinician to keep up with all the innovations and to be aware of the implications they have in clinical practice. The authors, thus, reviewed recent literature on the theme in order to provide the clinician with an updated overview, intended to support decision-making on aspects of diagnosis and management. This article begins to focus on the concept of AD and on its pathogenesis. Afterward, epidemiology and non-genetic risk factors are approached. Genetics, including genetic risk factors and guidelines for genetic testing, are mentioned next. Recommendations for diagnosis of AD, including recently proposed criteria, are then reviewed. Data on the variants of AD is presented. First approach to the patient is dealt with next, followed by neuropsychological evaluation. Biomarkers, namely magnetic resonance imaging, single photon emission tomography, FDG PET, PiB PET, CSF tau, and Aβ analysis, as well as available data on their diagnostic accuracy, are also discussed. Factors predicting rate of disease progression are briefly mentioned. Finally, non-pharmacological and pharmacological treatments, including established and emerging drugs, are addressed.

Acta Médica Portuguesa

Introduction: People with dementia and their relatives should have timely access to formal care i... more Introduction: People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments.Material and Methods: Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia.Results: People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present...

European Journal of Internal Medicine, 2009

European Journal of Internal Medicine, 2009

mortality at tender age. The case we describe is such an example.

European Journal of Internal Medicine, 2009

Purpose Histogram-based metrics extracted from diffusion-tensor imaging (DTI) have been suggested... more Purpose Histogram-based metrics extracted from diffusion-tensor imaging (DTI) have been suggested as potential biomarkers for cerebral small vessel disease (SVD), but methods and results have varied across studies. This work aims to assess the impact of mask selection for extracting histogram-based metrics of fractional anisotropy (FA) and mean diffusivity (MD) on their sensitivity as SVD biomarkers.Methods DTI data were collected from 17 SVD patients and 12 healthy controls. For each participant, FA and MD maps were estimated; from these, histograms were computed on two alternative whole-brain white-matter masks: normal-appearing white-matter (NAWM) and mean FA tract skeleton (TBSS). Histogram-based metrics (median, peak height, peak width, peak value) were extracted from the FA and MD maps. These were compared between patients and controls, and correlated with the patients’ cognitive scores (executive function and processing speed).Results White matter mask selection significantly...

Arachnoiditis is an inflammation of the arachnoid layer. When the condition is accompanied by acc... more Arachnoiditis is an inflammation of the arachnoid layer. When the condition is accompanied by accumulation of fibrinous adhesive bands leading to reduced blood supply, tethering and encapsulation/tethering of nerve roots and spinal cord, the term adhesive arachnoiditis (AA) is employed. AA resulting from procedures involving spinal anaesthesia and presenting with severe neurological debilitation is extremely rare but may present in many different forms. Such findings may develop anywhere from minutes to months after the procedures, and response scenarios can vary from spontaneous resolutions to intractable states. We herein present the cases of two patients with severe neurological sequalae after neuraxial anaesthesia and their respective management. Several distinct, probably concomitant and somewhat unpredictable factors may lead to or promote the development of AA after spinal anaesthesia. Nonetheless, even if not completely avoidable, awareness for the condition may allow for an...

European Geriatric Medicine, 2016

Journal of Psychiatric Research, 2021

Background: Subjective Memory Complaints (SMC) along with cognitive deficits are frequently obser... more Background: Subjective Memory Complaints (SMC) along with cognitive deficits are frequently observed in patients with Major Depressive Disorder (MDD). The relationship between SMC and objective memory performance in patients with MDD was evaluated, in comparison with patients with Mild Cognitive Impairment due to Alzheimer's Disease (MCI-AD) and healthy controls (HC). Methods: Patients with MDD (n = 47), MCI-AD (n = 43) and HC (n = 45) were assessed with a self-report memory complaints scale (SMCS) and underwent a comprehensive clinical and neuropsychological assessment. A discrepancy score between the Logical Memory delayed recall and the SMCS total score was calculated as a measure of memory awareness. Results: Patients with MDD (12.5 ± 4.4) and patients with MCI-AD (10.9 ± 4.1) had not significantly different SMCS total scores, whereas HC showed significantly lower scores (4.0 ± 3.0). As much as 74.5% of patients with MDD patients and 65.1% of patients with MCI-AD reported prominent memory complaints, whereas only 4.4% of HC did. Patients with MDD had relatively preserved memory tests, resulting in a higher discrepancy score than both patients with MCI-AD and HC. The SMCS total score correlated positively with depressive symptoms in the 3 groups of participants. Conclusions: Patients with MDD showed inaccurate memory self-awareness as they underestimated their memory functioning, a pattern distinct from both patients with MCI-AD and HC.

Journal of Alzheimer's Disease, 2020

Background: Diagnosis of Alzheimer's disease (AD) confirmed by biomarkers allows the patient to m... more Background: Diagnosis of Alzheimer's disease (AD) confirmed by biomarkers allows the patient to make important life decisions. However, doubt about the fleetness of symptoms progression and future cognitive decline remains. Neuropsychological measures were extensively studied in prediction of time to conversion to dementia for mild cognitive impairment (MCI) patients in the absence of biomarker information. Similar neuropsychological measures might also be useful to predict the progression to dementia in patients with MCI due to AD. Objective: To study the contribution of neuropsychological measures to predict time to conversion to dementia in patients with MCI due to AD. Methods: Patients with MCI due to AD were enrolled from a clinical cohort and the effect of neuropsychological performance on time to conversion to dementia was analyzed. Results: At baseline, converters scored lower than non-converters at measures of verbal initiative, non-verbal reasoning, and episodic memory. The test of non-verbal reasoning was the only statistically significant predictor in a multivariate Cox regression model. A decrease of one standard deviation was associated with 29% of increase in the risk of conversion to dementia. Approximately 50% of patients with more than one standard deviation below the mean in the z score of that test had converted to dementia after 3 years of follow-up.

Journal of Alzheimer's Disease, 2019

Journal of Alzheimer's Disease, 2018

BMJ case reports, Jan 7, 2016

We present a case of a 60-year-old Caucasian man recently returned from Angola, where he had been... more We present a case of a 60-year-old Caucasian man recently returned from Angola, where he had been successfully treated for a severe (non-cerebral) falciparum malaria infection. He was presented to the emergency room, with a subacute onset encephalopathy, ataxia and a generalised tonic-clonic seizure. Cerebrospinal fluid (CSF) analysis revealed lymphocytic pleocytosis (123 cells/µL) and hyperproteinorrhachia (188 mg/dL). Brain MRI and EEG were unremarkable. CSF PCR testing for neurotropic viruses was negative as were CSF and blood cultures. The patient was treated with ceftriaxone and acyclovir, with full recovery on the second day of treatment. We believe post-malaria neurological syndrome, a rare self-limited encephalopathy, should be considered in the differential diagnosis. Nevertheless, the presentation, lack of changes on brain MRI and EEG, along with possible false-negative CSF viral PCR, could still represent a viral encephalitis, which brings to question the treatment approa...

Journal of Neuropsychology, 2020

IntroductionPatients diagnosed with amnestic mild cognitive impairment (aMCI) are at high risk of... more IntroductionPatients diagnosed with amnestic mild cognitive impairment (aMCI) are at high risk of progressing to dementia. It became possible, through the use of biomarkers, to diagnose those patients with aMCI who have Alzheimer's disease. However, it is presently unfeasible that all patients undergo biomarker testing. Since neuropsychological testing is required to make a formal diagnosis of aMCI, it would be interesting if it could be used to predict the amyloid status of patients with aMCI.MethodsParticipants with aMCI, known amyloid status (Aβ+ or Aβ−) and a comprehensive neuropsychological evaluation, were selected from the Cognitive Complaints Cohort database for this study. Neuropsychological tests were compared in Aβ+ and Aβ− aMCI patients. A binary logistic regression analysis was conducted to model the probability of being amyloid positive.ResultsOf the 216 aMCI patients studied, 117 were Aβ+ and 99 were Aβ−. Aβ+ aMCI patients performed worse on several memory tests, ...

Normal pressure hydrocephalus: a qualitative study on outcome Hidrocefalia de pressão normal: his... more Normal pressure hydrocephalus: a qualitative study on outcome Hidrocefalia de pressão normal: história natural e prognóstico após cirurgia

Clinical Neurology and Neurosurgery, 2014

Objectives: Although dementia is one of the most relevant symptoms of the idiopathic Normal-Press... more Objectives: Although dementia is one of the most relevant symptoms of the idiopathic Normal-Pressure Hydrocephalus (iNPH) syndrome, some doubts remain about the nature of cognitive deficits in this disease. We aimed to determine the neuropsychological profile in iNPH and its relation with ventricular size, white matter vascular lesions (WML) and gait dysfunction. Methods: Seventeen iNPH patients and a control group (n = 14) were assessed with a battery of neuropsychological tests and a timed walk test. We calculated measures of frontal horn, occipital horn and third ventricle sizes and assessed white matter lesion (WML) load with a validated visual scale. Results: Patients differed significantly from controls in all cognitive tests, but did worse on the Rey Complex Figure test. We found no significant correlations between cognitive and imaging results in iNPH. Cognitive function was related to gait in controls, but not in iNPH patients. Conclusions: Patients presented widespread cognitive dysfunction with a predominance of visuo-spatial deficits. Dissociation between gait and cognitive dysfunction in iNPH patients suggests the existence of different pathophysiological mechanisms.

Clinical Neurology and Neurosurgery, 2007

To test relations between white matter lesions (WML) load in Normal Pressure Hydrocephalus (NPH) ... more To test relations between white matter lesions (WML) load in Normal Pressure Hydrocephalus (NPH) patients and gait characteristics at baseline, duration of symptoms, gait improvement after lumbar puncture (LP), vascular risk factors. Fifteen idiopathic NPH patients. Patients underwent a timed walking test, before and after LP. Five gait variables were assessed and improvement percentages were calculated. WML load was rated regionally and globally in T2 weighted MRI images, using a simple visual scale. Spearman or Pearson correlation coefficients were used to test relations between variables. Significant negative correlations were found between WML scores and gait improvement after CSF removal but not with duration of symptoms or gait variables before LP. WML seem to contribute to the irreversibility of symptoms in NPH but not to the pathophysiological mechanisms that lead to them.

Arquivos de Neuro-Psiquiatria, 2013

Objective To describe the natural history and shunt outcome in patients with normal pressure hydr... more Objective To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.

American journal of Alzheimer's disease and other dementias, Jan 3, 2015

Subjective cognitive complaints (SCCs) are frequent in the elderly population. The majority of in... more Subjective cognitive complaints (SCCs) are frequent in the elderly population. The majority of individuals with subjective complaints never progress to significant cognitive decline, but some of them have a higher risk of progression to objective cognitive impairment than persons with no cognitive concerns. We performed a systematic review of community-based studies that focused on the progression risk associated with SCC and on the complainers' characteristics associated with progression. Seventeen studies were included. As a group, SCCs are associated with a significantly higher risk of progression to dementia. Worried complainers, persons who refer an impact of their complaints on activities of daily living, and those whose complaints are also noticed by an informant have the highest risk of progression. Taking into account the fluctuating course of SCC and their frequent reversion, care should be taken to not overvaluate them. Further studies are necessary to better define r...

Investigation in the field of Alzheimer's disease (AD), the commonest cause of dementia, has been... more Investigation in the field of Alzheimer's disease (AD), the commonest cause of dementia, has been very active in recent years and it may be difficult for the clinician to keep up with all the innovations and to be aware of the implications they have in clinical practice. The authors, thus, reviewed recent literature on the theme in order to provide the clinician with an updated overview, intended to support decision-making on aspects of diagnosis and management. This article begins to focus on the concept of AD and on its pathogenesis. Afterward, epidemiology and non-genetic risk factors are approached. Genetics, including genetic risk factors and guidelines for genetic testing, are mentioned next. Recommendations for diagnosis of AD, including recently proposed criteria, are then reviewed. Data on the variants of AD is presented. First approach to the patient is dealt with next, followed by neuropsychological evaluation. Biomarkers, namely magnetic resonance imaging, single photon emission tomography, FDG PET, PiB PET, CSF tau, and Aβ analysis, as well as available data on their diagnostic accuracy, are also discussed. Factors predicting rate of disease progression are briefly mentioned. Finally, non-pharmacological and pharmacological treatments, including established and emerging drugs, are addressed.

Acta Médica Portuguesa

Introduction: People with dementia and their relatives should have timely access to formal care i... more Introduction: People with dementia and their relatives should have timely access to formal care in the community. The EU-Actifcare project analysed access to and use of formal services, as related to unmet needs for care. We describe the cohort study implementation and baseline results in Portugal, with a focus on needs for care and service use assessments.Material and Methods: Our convenience sample consisted of 66 dyads of community-dwelling people with mild to moderate dementia and no significant use of formal services, and their informal carers. Measures included the Camberwell Assessment of Need for the Elderly and Resources Utilization in Dementia.Results: People with dementia had unmet needs (mean 1.1; SD 1.7), mainly regarding company (23%), psychological distress (20%), and daily activities (14%). Family caregivers spent 150 minutes/day (median) providing support, and 44% had psychological distress unmet needs. Problems with access to or use of formal services, when present...

European Journal of Internal Medicine, 2009

European Journal of Internal Medicine, 2009

mortality at tender age. The case we describe is such an example.

European Journal of Internal Medicine, 2009