BackgroundFear of falling can be present in the daily lives of patients with Parkinson's disease (PD) due to their predisposition to falls.ObjectiveThe main objective of this study was to translate the Fear of Falls Scale (FFS) into Brazilian Portuguese, adapt it cross-culturally, and validate it.MethodsA multicenter, cross-sectional study was conducted with PD patients fluent in Brazilian Portuguese, recruited from five research centers in Brazil. Descriptive analysis characterized the sample and compared the data. Cronbach's α and McDonald's ω coefficients were used to assess the internal consistency of the scale.ResultsNo significant differences were observed between the translated versions T1 and T2. The B1 and B2 versions did not present significant divergences in the back-translation from the original scale. The Movement Disorder Society – Unified Parkinson Disease Rating Scale (MDS-UPDRS) part III significantly correlated with motor skills (rho = 0.56, 0.43–0.67;p≤ 0.001) and fear of falling (rho = 0.48, 0.34–0.60;p≤ 0.001). Higher stages on the modified Hoehn & Yahr scale were associated with a greater decline in motor skills and a greater fear of falling (p < 0.001). The total internal consistency of balance-related motor skills and fear of falling was considered sufficiently reliable. Cronbach's α values were 0.96, 0.91, and 0.90; while McDonald's ω values were 0.96, 0.92, and 0.91, respectively.ConclusionThe Brazilian version of the FFS proved to be valid and reliable for assessing fear of falling in people with PD.

BackgroundDeep brain stimulation (DBS) is a treatment for dystonia, with most trials conducted in developed countries. Data from developing countries like Brazil are limited.ObjectiveTo evaluate the landscape of DBS for dystonia in Brazil, assessing motor outcomes compared with the existing literature.MethodsA retrospective multicenter cohort study was conducted via medical record review. Demographics and motor outcomes were collected and analyzed using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) from patients across four of Brazil's five macro-regions.ResultsThe cohort included 60 patients (44.3% female), with DBS primarily targeting the globus pallidus internus (73.3%) or subthalamic nucleus (18.3%). The BFMDRS motor scores decreased from 63.0 ± 26.2 (n = 24) at baseline to 36.7 ± 24.6 at 1-year post-DBS (n = 22,p = 0.0018) and 43.6 ± 35.0 at the last assessment (n = 13,p = 0.0327).ConclusionThe use of DBS yielded significant, sustained motor improvements, consistent with developed countries, highlighting its feasibility and effectiveness in Brazil within diverse healthcare settings.

Dengue encephalitis is an uncommon neurological complication of dengue virus infection. In immunocompromised patients, such as solid organ transplant recipients, the clinical presentation may be atypical and nonspecific, posing significant diagnostic and therapeutic challenges. We report a clinical case and use it as a framework to discuss key considerations for suspicion of dengue encephalitis. Topics include optimal timing for clinical suspicion, essential differential diagnoses, and the most appropriate diagnostic strategies. Emphasis is placed on the correct interpretation of cerebrospinal fluid findings and recognition of subtle brain magnetic resonance imaging changes that may support the diagnosis. The discussion also reviews current evidence on dengue encephalitis in immunocompromised populations, highlighting implications for timely diagnosis and management in this vulnerable group.

BackgroundSuperAgers(SA) are adults aged ≥ 80 years with memory equivalent to individuals 20 to 30 years younger. Few studies have evaluated multimodal neuroimaging approach in the same SA cohort.ObjectiveTo investigate neurobiological mechanisms underlying exceptional cognitive aging by evaluating cortical amyloid deposition, regional cerebral glucose metabolism (rBGM), and gray matter volume (GMV), and their associations with neuropsychological performance and subjective cognitive decline (SCD).MethodsThe participants were classified as SA (n = 11), age-matched healthy controls (HC80; n = 23), and healthy controls aged 60 to 69 years (HC60; n = 23). Positron-emission tomography (PET) using11C-PIB and18F-FDG were analyzed using semiquantitative three-dimensional stereotactic surface projection (3D-SSP), with group comparisons using Statistical Parametric Mapping 8 (SPM8).ResultsThe median ages were 81 years (interquartile range [IQR] = 5.0) for SA, 83 years (IQR = 5.0) for HC80, and 66 years (IQR = 3.0) for HC60. All groups had a median of 16 years of schooling (IQR for SA = 7, for HC80 and HC60 = 5). There were 4 PIB-PET positive individuals (36.4%) in the SA group, which is similar to the HC80 group (40.9%). Also, 6 SA had SCD, with 3 being PIB-positive. In SA, composite SUVr predicted RAVLT delayed recall (β = −0.666,p = 0.011, adjusted R2 = 0.748), controlling for age, sex, and schooling. Compared to HC80, the SA group showed increased metabolism in the anterior cingulate gyrus and caudate, as well as increased GMV in the putamen.ConclusionThe SA group exhibited similar amyloid burden to HC80, yet amyloid deposition specifically impaired their memory. Increased rBGM and GMV in the salience network and striatum suggest these regions support successful cognitive aging.

Double-seronegative neuromyelitis optica spectrum disorder (DS-NMOSD) encompasses a heterogeneous spectrum, including monophasic and relapsing phenotypes. While 1/3 patients may follow a monophasic course, lifelong immunotherapy remains common practice due to the fear of relapse. However, this strategy may unnecessarily expose stable patients to long-term adverse effects and economic burden. The condition lacks the relapse-associated mechanisms observed in aquaporin 4 (AQP4)-positive disease, questioning the generalizability of prior treatment-withdrawal studies. Although predictive markers for relapse are still lacking, the median time to relapse is of approximately 3.4 (range: 0–7) years; hence, sustained remission beyond 10 years may indicate a subgroup of patients with low relapse risk. Until prospective data are available, individualized, cautious treatment interruption should be considered, guided by shared decision-making.

BackgroundTarsila do Amaral's painting “Abaporu” is a seminal work in Brazilian modernist art, yet its interpretation continues to intrigue scholars due to its complex symbolism.ObjectiveTo examine “Abaporu” through the perspective of neuroesthetics, exploring potential parallels between its visual elements and sensory disturbances characteristics of migraine aura.MethodsA structured review of primary and secondary art-historical sources and a systematic literature search in PubMed and Google Scholar were conducted. The analysis focused on Amaral's recurrent use of disproportion and gigantism in the 1920s and on evaluating the plausibility of a neuroesthetic hypothesis in this art-historical context.ResultsOur analysis indicated that the gigantism and deliberate deformation in “Abaporu” belong to a consistent program already evident in Amaral's 1920s painting. From this perspective, the painting's oversized feet and hands contrasting with a diminutive head evoke perceptual alterations reminiscent of macropsia and micropsia, phenomena linked to Alice in Wonderland Syndrome and migraine aura. Its vibrant palette and melancholic undertones, likewise, resound the sensory disturbances and affective dimensions associated with migraine, suggesting that Amaral's programmatic distortions also invite a neuroesthetic reading.ConclusionWhile no evidence supports a medical diagnosis of migraine in Amaral, the visual motifs and techniques in “Abaporu” can be read both as deliberate esthetic strategies of her Pau-Brasil and Anthropophagic phases and as intuitively resonant with neurological models of altered perception. This dual lens enriches our understanding of art's capacity to embody complex perceptual experiences and encourages further interdisciplinary dialogue between art history and neuroscience.

BackgroundAging is accompanied by an increasing incidence of dementia. Alzheimer's disease (AD) is the leading cause of dementia, and it impairs autonomic function. Heart rate variability (HRV) is a marker of autonomic function, but findings in AD are conflicting, and there is scant information on the association of HRV with falls in dementia patients.ObjectiveTo assess autonomic activity in older adults with AD, comparing these patients to older adults without dementia (the control group, CG), and to investigate the relationship between HRV and falls.MethodsThe HRV was analyzed in older adults without dementia and in those with AD using a heart rate monitor. The measurements were made on a single day in the supine and orthostatic positions for 10 minutes each. The HRV components in the time and frequency domains were assessed, along with the history of falls in the past 3 years.ResultsThe groups were homogenous, with a predominance of female individuals, and mean ages of 81 (AD) and 79 (CG) years. A reduction in the R-R interval upon changing from the supine to the orthostatic positions was evident in both groups, but the AD group showed reduced parasympathetic components in the orthostatic position. For the frequency domain, a reduction in high frequency (HF) and increases in low frequency (LF) and in the LF/HF ratio were observed, suggesting increased sympathetic and reduced parasympathetic activities. The AD group presented more falls, whose incidence was associated with HRV components.ConclusionAlzheimer's disease was associated with worse autonomic dysfunction, increased sympathetic activity and greater parasympathetic impairment, a high incidence of falls and interaction with HRV components.

BackgroundThe Activity Limitation Measure (ACTIVLIM) is a self-reported instrument consisting of 22 daily activity items graded on 3 levels (easy, difficult, or impossible).ObjectiveTo translate, culturally adapt, and validate the Brazilian Portuguese version of the ACTIVLIM for individuals with neuromuscular disorders.MethodsThe present was a cross-sectional observational study. The translation process followed standardized guidelines, including steps such as forward translation, synthesis, back-translation, expert committee review, and pretesting (psychometric analysis). A total of 268 individuals with neuromuscular disorders filled out the Brazilian ACTIVLIM. Test-retest reliability was assessed in a subgroup of 60 participants, who were evaluated twice by the same physiotherapist with an interval of one month.ResultsThe intraclass correlation coefficient (ICC) for intrarater reliability was of 0.95. Internal consistency was high (Cronbach's alpha = 0.940). External validity showed strong correlations involving ACTIVLIM scores and the scores on the Vignos scale (r = −0.907), the Brooke scale (r = −0.908), and the Functional Independence Measure (r = 0.864), all withp < 0.001. Proximal muscle strength in the upper (r = 0.748) and lower limbs (r = 0.793), measured through the Medical Research Council scale, also correlated significantly with ACTIVLIM scores. Linear regression identified that the scores on the Vignos (R2 = 0.8236), and Brooke scales (R2 = 0.8132), as well as proximal muscle strength in the lower (R2 = 0.6480) and upper limbs (R2 = 0.5805), were the main predictors of ACTIVLIM variance.ConclusionThe Brazilian Portuguese version of the ACTIVLIM demonstrated strong reliability and validity. Its scores were significantly associated with disability level, functional independence, and muscle strength in individuals with neuromuscular disorders.