Awarded Brazilian study analyzes possible causes of Alzheimer's progression

A collaboration between the Ministry of Health and Einstein Israelite Hospital resulted in the development of an artificial intelligence-based system intended to assist public health professionals in screening and identifying dermatological diseases.

This initiative, named CUTIS-AI, operates using images of the patient's skin lesions, along with clinical, epidemiological, and sociodemographic data that reflect Brazilian reality.

Among the pathologies the system is capable of recognizing are sporotrichosis, cutaneous leishmaniasis, leprosy, chromoblastomycosis, lobomycosis, cutaneous tuberculosis, as well as lesions caused by loxoscelic accidents, such as brown spider bites.

The application that enables the use of this AI, although still in the study phase, was conceived after interviews conducted with primary care health professionals. An important feature is that it can be operated even in areas without internet access, currently showing an accuracy rate close to 80%.

It is essential to emphasize that the intention of CUTIS-AI is to serve as an artificial intelligence support tool, not as a substitute for clinical evaluation conducted by health professionals.

Isabelle Carvalho, a data scientist at Einstein Israelite Hospital, emphasized that CUTIS-AI was created to increase the capacity to detect these diseases, which can be an obstacle for professionals, especially in locations with a shortage of specialists. She added that by compiling images of the lesions, a solid database is being established, which will benefit the development of practical technology on the front lines, especially for Primary Health Care.

The study conducted with the application has already evaluated approximately 1,400 patients and has over 4,000 lesion images. This variety of patients helps in training the artificial intelligence with diverse examples, making the model better able to recognize the characteristics of the lesions.

Fabiano Geraldo Pimenta Junior, Secretary of Health and Environmental Surveillance of the Ministry of Health, reinforced the importance of data quality and diversity when it comes to artificial intelligence applied to health. He warned that a technology created from a restricted population may not perform the same way when applied to other groups. For this reason, he considered essential the construction of a Brazilian database that includes different skin phototypes, regions, living conditions, and epidemiological profiles.

In early October, American singer Billy Joel, 77, announced that he underwent brain surgery to treat an unusual and reversible form of dementia. The diagnosed condition was Normal Pressure Hydrocephalus (NPH), whose signs are often confused with other cognitive losses, such as Alzheimer's, but which has the characteristic of being curable if identified and treated at the appropriate time.

NPH is more prevalent in individuals over 60 years old, affecting, on average, one in every hundred people in this age group. It arises due to the abnormal accumulation of cerebrospinal fluid, the fluid that protects and nourishes the brain, specifically in the areas that produce this fluid. Symptoms manifest gradually, only when this fluid begins to exert pressure on the neurons. Prolonging the condition without treatment worsens brain damage, resulting in more frequent symptoms and decreasing the chance of full recovery.

Symptoms and Diagnosis

According to neurologist Iron Dangoni Filho, from Einstein Israelite Hospital in Goiânia, primary signs include changes in gait, characterized by a more robotic walk, occurrence of urinary incontinence or urgent need to urinate, in addition to slower mental processing. It is important to note that not all patients exhibit all these symptoms simultaneously.

The ambiguous nature of NPH signs contributes significantly to delayed diagnosis. Dangoni warns that family members often associate the symptoms with the natural aging process. Additionally, when there is an intention to seek medical help, patients tend to consult other specialists, such as urologists and orthopedists, wasting valuable time that could optimize the response to treatment.

The diagnosis of NPH is established by observing clinical indicators and confirmed through an MRI scan, which helps detect changes in the ventricles filled with cerebrospinal fluid. If the diagnosis is early, surgery is performed that can reverse the disease and achieve a complete cure. This procedure involves implanting a valve that diverts excess fluid into the abdominal cavity, where it will be reabsorbed by the body.

Surgical Evaluation and Tap Test

However, the surgical procedure presents complexities, especially in elderly patients, and is not indicated for everyone. International guidelines suggest that only about six to eight out of ten people with the disease will benefit from symptom reversal through surgery. This occurs because prolonged coexistence with NPH causes deterioration in the neural structures themselves, and this recovery is not possible even with pressure reduction.

To assess potential benefits, there is an examination called the Tap test. This technique allows for temporary relief of pressure by draining cerebrospinal fluid via lumbar puncture, making it a much less invasive method than surgery. After collection, it is checked whether there has been an improvement in gait and urinary control. The test can be repeated up to 48 hours after the first puncture to assess the effectiveness of proceeding to definitive treatment.

Although the Tap test is available in private centers in Brazil, it is not part of the mandatory list of exams covered by health insurance plans or the Unified Health System (SUS). However, some public health services perform a subjective analysis, where punctures are made, but evaluations depend on the patient's report.

The doctor at Einstein in Goiânia commented that a positive result on the Tap test offers greater security for performing surgery, as it proves the benefits. For healthcare professionals, receiving a positive test and conducting a successful surgery is a source of satisfaction. In Goiânia, the exam is available completely, using a set of sensors called baiobit, which makes the evaluation more precise and objective, standardizing measurement and allowing for the observation of subtle improvements.

Iron Dangoni added that in neurological practice, they deal with various progressive dementias, which are at best controllable. He finds it extremely gratifying to see a patient who had mobility difficulties moving freely and recovering their own memories.

In Billy Joel's specific case, the surgery was performed, allowing for the reversal of symptoms. In his weekly radio show, he reported noticing improvements in memory and balance shortly after the procedure, without returning to NPH symptoms. The neurologist concluded that knowing cases of famous personalities helps raise awareness about the disease, which can save lives, reinforcing that the earlier the diagnosis is made, the higher the chances of post-surgical therapeutic success.

A systematic review published in the Journal of Aging and Physical Activity concluded that older individuals who engage in more physical activities exhibit greater brain volume, notably in regions associated with cognition, memory, and reasoning. The analysis gathered data from nearly 2,700 people aged 60 or older, demonstrating a consistent correlation between high levels of daily movement and a structurally better-preserved brain, underscoring the relevance of exercise in preventing cognitive decline.

The research was conducted by student Sara Oliveira Dias de Lucena, a FAPESP scholarship holder, under the guidance of Lucas Melo Neves, a professor in the Physical Education Department of the Institute of Biosciences of the State University of São Paulo (IB-Unesp), on the Rio Claro campus. The researchers examined 19 observational studies, covering data from 2,684 participants with an average age of 70, evaluating 76 distinct brain structures and regions.

The involved studies measured brain volume through magnetic resonance imaging and participants' physical activity levels using questionnaires or accelerometers. The results indicated that the most active elderly had a higher total brain volume, in addition to showing greater volume in regions crucial for cognition, such as the hippocampus.

Lucas Melo Neves commented that while the population associates exercise with muscle hypertrophy, this study suggests a parallel in the brain: greater physical activity leads to a more preserved brain. He expressed hope that this connection between movement and brain health will become as evident as the relationship between training and muscle mass gain in the coming years.

According to Neves, it is natural for the brain to undergo gradual structural changes with aging. From middle age, a progressive reduction in brain volume is observed, caused by neuronal loss, decrease in neural connections, and alterations in white matter, which is responsible for brain communication.

He emphasized that this process is part of healthy aging but can affect functions such as attention, memory, and reasoning speed. Regions like the hippocampus, vital for forming new memories, are particularly vulnerable over the years. However, the intensity of this loss varies individually and can be modulated by factors such as lifestyle, level of physical activity, management of chronic diseases, and continuous cognitive stimulation.

The hippocampus is a widely studied area and is among the first structures to show atrophy with aging or in conditions such as Alzheimer's. The review of studies confirmed the link between physical activity and a larger hippocampus volume. Neves classified this data as clinically relevant, given that the hippocampus is very sensitive to aging.

In some studies included in the review, elderly individuals who met the minimum physical activity recommendation of the World Health Organization (WHO)—approximately 150 minutes per week—showed a hippocampus 7% to 10% larger compared to their less active peers. The professor clarified that although the percentages may seem modest, the difference is clinically significant because a more preserved hippocampus is linked to better memory performance and greater cognitive reserve.

White matter, another structure with a positive association in the review, remained preserved in more active people. It functions as a network of brain connections, facilitating efficient communication between different parts of the brain. Changes in this area are associated with slow thinking and executive difficulties; keeping this network intact can promote faster information processing during aging.

The mechanisms behind this relationship have been the subject of scientific study for some time. One hypothesis is that regular exercise stimulates the production of neurotrophic factors, such as BDNF, which promote neuronal survival and plasticity. Furthermore, regular practice improves cerebral blood flow, encourages the creation of new vessels, and may reduce chronic inflammatory processes. Neves stated that physical activity establishes a biological environment more conducive to brain health, aiming not only at preservation but also at stimulating structural adaptations.

Despite the consistency of the findings, Neves emphasized that the analyzed studies are observational in nature, which prevents stating causality. It is possible that individuals with structurally more preserved brains have a greater predisposition to be active. To overcome this methodological limitation, the authors are developing a new review focused on intervention studies, which monitor elderly people in structured exercise programs to verify a direct effect on brain volume preservation or increase.

In conclusion, Neves reiterated that the main message is clear: regular movement is associated with a healthier brain in old age. In a scenario of population aging and increasing dementias, preventive strategies are becoming increasingly urgent.