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RESUMO Apresentamos o relato de caso de um participante do sexo masculino, 61 anos, com afasia de condução crônica e agrafia profunda após acidente vascular cerebral isquêmico que recebeu treinamento de escrita sob ditado associado à estimulação transcraniana por corrente contínua. O tratamento consistiu em cinco sessões de 50 minutos de escrita sob ditado com aplicação de 2 mA de estimulação transcraniana por corrente contínua anódica durante 20 minutos sobre o córtex occipitotemporal esquerdo. O participante apresentou melhora na produção escrita de pseudopalavras e de palavras regulares de baixa frequência, via rota fonológica, além de uma pequena melhora na produção de palavras irregulares, via rota lexical. Após o treinamento, houve também pequena melhora da escrita de estímulos não treinados, sugerindo generalização. Na avaliação realizada 5 meses após o término do tratamento, o benefício foi mantido para estímulos processados via rota fonológica. Os resultados são promissores dada a gravidade e cronicidade do caso e sugerem que a estimulação transcraniana por corrente contínua associada à terapia de escrita representa possível alternativa clínica para pacientes com agrafia profunda.

Objective: To evaluate the impact of a multicomponent physical exercise program on clinical variables associated with the glymphatic clearance system, sleep-awake patterns, and cognitive function in individuals with mild cognitive impairment or mild Alzheimer’s disease. Methods: This is a single-center parallel randomized controlled trial involving pre- and post-intervention assessments. The intervention consists of a 12 (±3)-week multicomponent aerobic and resistance physical exercise program of moderate intensity divided into 2 groups: an experimental group (undergoing multicomponent training) and a control group (no intervention). Eligible participants are those diagnosed with probable mild cognitive impairment or mild Alzheimer’s disease. Expected results: Anticipated outcomes suggest that the multicomponent training protocol, incorporating both aerobic and resistance physical exercises at a moderate intensity, will yield improvements in glymphatic clearance dynamics, sleep-awake parameters, and performance on cognitive, functional, and behavioral tasks among eligible patients. Relevance: The need to move beyond cognitive clinical testing justifies our trial, which proposes an assessment employing neuroimaging techniques and the analysis of biomarkers present in cerebrospinal fluid in conjunction with clinical tests for physical and cognitive assessment.

Unintentional weight loss in older adults is linked to multiple factors, being most often associated with comorbidities such as cancer, dementia syndromes, chronic obstructive pulmonary disease, and chronic kidney disease. Difficulty in managing this condition can quickly lead to malnutrition and, consequently, a state of cachexia. There is a dearth of studies in the literature regarding pharmacotherapeutic interventions for this population, with megestrol acetate (MA) being the most commonly studied medication. In this systematic review, we evaluated the use of MA to improve appetite and treat unintentional weight loss and/or the anorexia-cachexia syndrome in older adults. Randomized studies published up to December 2023 in three languages (Portuguese, Spanish, or English) were retrieved from five databases. We included 25 studies, most of which addressed the use of MA for treatment of patients diagnosed with cancer and the anorexia-cachexia syndrome. We used the PEDro scale to assess methodological quality of the included studies and calculated measures of heterogeneity, such as the tau-squared (τ2 ), I-squared (I2 ), and Q test, to assess consistency across studies. Although the studies selected for the systematic review suggest that patients with the anorexia-cachexia syndrome secondary to cancer may benefit from MA therapy, a meta-analysis of 8 selected studies (total n = 592) did not confirm this effect (p = 0.104). The indication of MA for treatment of patients with weight loss required further studies with better methodological designs to evaluate the efficacy and safety profile of this medication in older adults.