Subjective cognitive decline, mild cognitive impairment, and dementia - syndromic approach: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

Smid, Jerusa; Studart-Neto, Adalberto; César-Freitas, Karolina Gouveia; Dourado, Marcia Cristina Nascimento; Kochhann, Renata; Barbosa, Breno José Alencar Pires; Schilling, Lucas Porcello; Balthazar, Márcio Luiz Figueiredo; Frota, Norberto Anízio Ferreira; Souza, Leonardo Cruz de; Caramelli, Paulo; Bertolucci, Paulo Henrique Ferreira; Chaves, Márcia Lorena Fagundes; Brucki, Sonia Maria Dozzi; Nitrini, Ricardo; Resende, Elisa de Paula França; Vale, Francisco Assis Carvalho

doi:10.1590/1980-5764-DN-2022-S101EN

Jerusa Smid

concept

drafting of the manuscript

critical revision of the manuscript for important intellectual content

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

http://orcid.org/0000-0001-9513-0964

Adalberto Studart-Neto

concept

drafting of the manuscript

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

http://orcid.org/0000-0003-2260-5986

Karolina Gouveia César-Freitas

concept

drafting of the manuscript

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

http://orcid.org/0000-0001-9617-9567

Marcia Cristina Nascimento Dourado

concept

drafting of the manuscript

Universidade Federal do Rio de Janeiro,Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.

http://orcid.org/0000-0001-6267-8202

Renata Kochhann

concept

drafting of the manuscript

Hospital Moinhos de Vento, Porto Alegre RS, Brazil.

http://orcid.org/0000-0002-6328-8131

Breno José Alencar Pires Barbosa

concept

critical revision of the manuscript for important intellectual content

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área Acadêmica de Neuropsiquiatria, Recife PE, Brazil.

Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brazil.

http://orcid.org/0000-0003-4333-2024

Lucas Porcello Schilling

concept

critical revision of the manuscript for important intellectual content

Pontifícia Universidade do Rio Grande do Sul, Escola de Medicina, Serviço de Neurologia, Porto Alegre RS, Brazil.

Pontifícia Universidade do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.

Pontifícia Universidade do Rio Grande do Sul, Programa de Pós-Graduação em Gerontologia Biomédica, Porto Alegre RS, Brazil.

http://orcid.org/0000-0002-9923-6982

Márcio Luiz Figueiredo Balthazar

critical revision of the manuscript for important intellectual content

Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.

http://orcid.org/0000-0002-4780-444X

Norberto Anízio Ferreira Frota

critical revision of the manuscript for important intellectual content

Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.

Universidade de Fortaleza, Fortaleza CE, Brazil.

http://orcid.org/0000-0002-2828-5664

Leonardo Cruz de Souza

critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0001-5027-9722

Paulo Caramelli

critical revision of the manuscript for important intellectual content

Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0002-4786-6990

Paulo Henrique Ferreira Bertolucci

critical revision of the manuscript for important intellectual content

Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.

http://orcid.org/0000-0001-7902-7502

Márcia Lorena Fagundes Chaves

critical revision of the manuscript for important intellectual content

Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.

Universidade Federal do Rio Grande do Sul, Faculdade de Medicina,Departamento de Medicina Interna, Porto Alegre RS, Brazil.

http://orcid.org/0000-0002-1940-4043

Sonia Maria Dozzi Brucki

critical revision of the manuscript for important intellectual content

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

http://orcid.org/0000-0002-8303-6732

Ricardo Nitrini

critical revision of the manuscript for important intellectual content

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

http://orcid.org/0000-0002-5721-1525

Elisa de Paula França Resende

concept

drafting of the manuscript

Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte MG, Brazil.

http://orcid.org/0000-0002-9758-6452

Francisco Assis Carvalho Vale

concept

drafting of the manuscript

critical revision of the manuscript for important intellectual content

Universidade Federal de São Carlos, Departamento de Medicina, Centro de Ciências Biológicas da Saúde, São Carlos SP, Brazil.

http://orcid.org/0000-0001-8826-2010

Correspondence: Jerusa Smid; Email: jsmid77@hotmail.com.

Conflict of interest:

JS: Participation as speaker in symposia sponsored by Roche laboratory; LPS: Participation in advisory boards for Biogen. Participation as speaker in symposia sponsored by Aché, Apsen, and Biogen laboratories; MLFB: Participation in advisory boards for Biogen. Development of material for continuous medical education and participation as speaker in symposia sponsored by EMS and Torrent laboratories; PC: Participation as principal investigator in clinical trials for the Novo Nordisk and Roche laboratories. Participation in advisory boards for the Aché, Biogen, EMS, Nutricia, and Roche laboratories. Development of material for continuous medical education and participation as speaker in symposia sponsored by the Aché, Nutricia, Libbs, Roche, Sandoz, Torrent, and Zodiac laboratories; PHFB: Participation in advisory boards for the Biogen and Novo Nordisk laboratories. Supervision of training activities for Biogen, Janssen-Cilag, and Novo Nordisk laboratories and for Quintiles. Participation as speaker in symposia sponsored by the Apsen, Nutricia, Roche, and Sandoz laboratories; EPFR: funding by the Alzheimer’s Association, the World Federation of Neurology, and the National Institute of Health (grant number R21AG069252); LCS: Participation in advisory board for Biogen. Participation as speaker in symposia sponsored by Biogen; RN: Participation in advisory board for Biogen; KGCF, MCND, RK, ASN, BJAPB, NAFF, MLFC, SMDB, FACV: There is no conflict of interest to declare.

Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.

Universidade Federal do Rio de Janeiro,Instituto de Psiquiatria, Rio de Janeiro RJ, Brazil.

Hospital Moinhos de Vento, Porto Alegre RS, Brazil.

Universidade Federal de Pernambuco, Centro de Ciências Médicas, Área Acadêmica de Neuropsiquiatria, Recife PE, Brazil.

Instituto de Medicina Integral Prof. Fernando Figueira, Recife PE, Brazil.

Pontifícia Universidade do Rio Grande do Sul, Escola de Medicina, Serviço de Neurologia, Porto Alegre RS, Brazil.

Pontifícia Universidade do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.

Pontifícia Universidade do Rio Grande do Sul, Programa de Pós-Graduação em Gerontologia Biomédica, Porto Alegre RS, Brazil.

Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Neurologia, Campinas SP, Brazil.

Hospital Geral de Fortaleza, Serviço de Neurologia, Fortaleza CE, Brazil.

Universidade de Fortaleza, Fortaleza CE, Brazil.

Universidade Federal de Minas Gerais, Departamento de Clínica Médica, Belo Horizonte MG, Brazil.

Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.

Hospital de Clínicas de Porto Alegre, Serviço de Neurologia, Porto Alegre RS, Brazil.

Universidade Federal do Rio Grande do Sul, Faculdade de Medicina,Departamento de Medicina Interna, Porto Alegre RS, Brazil.

Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte MG, Brazil.

Universidade Federal de São Carlos, Departamento de Medicina, Centro de Ciências Biológicas da Saúde, São Carlos SP, Brazil.

Cognitive symptoms	Attention	Does the patient get more confused or disoriented sometimes?
		Is the patient easily distracted?
		Is the patient missing objects?
	Memory	Does the patient have more difficulties remembering recent facts than remote ones?
		Has the patient shown temporal disorientation?
		Is the patient more repetitive and asking the same questions many times?
		Does the patient need more annotations to remember appointments?
		Has the patient forgotten appointments?
	Language	Does the patient have difficulties finding words?
		Is the patient having difficulties naming objects?
		Is the patient having difficulties articulating words?
		Is the patient having difficulties understanding what you say to them?
	Spatial orientation	Has the patient got lost in previously known routes?
		Is the patient having difficulties learning new routes?
		Is the patient having difficulties locating themselves inside the house?
	Praxies	Is the patient having difficulties using utensils?
	Praxies	Is the patient having difficulties dressing themselves?
	Executive functions	Is the patient having difficulties planning or organizing activities and travels?
		Is the patient having difficulties multitasking?
		Is the patient having difficulties solving daily problems?
		Is the patient having difficulties making decisions?
Functionality	Instrumental activities of daily living (IADLs)	Is the patient having difficulties managing their own finances?
		Is the patient having difficulties shopping?
		Is the patient having problems at work?
		Is the patient having cooking problems?
	Basic activities of daily living (BADLs)	Is the patient capable of doing the activities below independently?
	Basic activities of daily living (BADLs)	Dressing/Bathing/Hygiene/Feeding/Transference/Continence
Behavior and neuropsychiatric symptoms	Humor	Does the patient look sad, dejected or cry easily?
		Does the patient not see pleasure in life or says they have no future?
		Is the patient more irritable or impatient?
		Is the patient isolating themself, not getting along with others?
	Anxiety	Is the patient worried about planned events?
		Is the patient unable to relax or is excessively tense?
		Does the patient worry excessively about even trivial things?
	Apathy	Does the patient have no interest in the world around them?
		Does the patient have more difficulty engaging in conversations or tasks?
		Is the patient more indifferent?
	Disinhibition	Does the patient act impulsively, without thinking?
		Has the patient been saying things that should not be said in public?
		Has the patient acted in an embarrassing way?
		Did the patient suffer personality changes? Is the patient more socially isolated?
	Agitation	Is the patient uncooperative?
		Does the patient not allow to be helped?
		Is the patient verbally or physically aggressive?
		Does the patient repeatedly move objects around them?
		Does the patient have ritualistic or compulsive behavior?
	Delusions	Does the patient believe in things that are not real?
		Does the patient think someone is trying to harm or rob him?
		Does the patient claim that their relatives are not who they say they are?
		Does the patient claim that the house they live in is not theirs?
	Hallucinations	Does the patient report hearing voices or act as if they heard voices that are not heard by others?
		Does the patient speak to themself?
		Does the patient see people or animals that are not seen by others?
		Does the patient behave as if they saw something that others do not see?
	Appetite	Did the patient have any change in eating habits?
	Appetite	Has the patient changed food preference (e.g., they started to prefer sweets)?
	Sleep	Does the patient have difficulty initiating or maintaining sleep?
		Does the patient speak or move in sleep as if they were awake?
		Does the patient often have vivid dreams or nightmares?
		Does the patient snore, wake up fatigued, or have daytime sleepiness?

Cognitive Test	Cognitive domains	Suggested cut-off scores for the Brazilian population
Mini Mental State Examination (MMSE) ⁽⁵5. Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr. 2003;61(3B):777-81. doi:10.1590/S0004-282X2003000500014. https://doi.org/10.1590/S0004-282X200300...	Temporal and spatial orientation	According to education level:
	Verbal episodic memory	Illiterate: ≤19
	Attention and calculation	1-4 years: ≤24
	Language	5-8 years: ≤26
	Visual constructive skills	9-11 years: ≤27
	≥ 12 years: ≤28
Brief Cognitive Screening Battery (BCSB) ⁽²⁴24. Nitrini R, Bucki SMD, Yassuda MS, Fichman HC, Caramelli P. The Figure Memory Test: diagnosis of memory impairment in populations with heterogeneous educational background. Dement Neuropsychol. 2021;15(2):173-85. doi:10.1590/1980-57642021dn15-020004. https://doi.org/10.1590/1980-57642021dn1...		Figure Memory Subtest:
		Incidental memory: ≤4
		Immediate memory: ≤6
		Learning: ≤6
	Visual and verbal episodic memory	Delayed recall: ≤5
	Executive functions	Recognition: ≤7
	Visual constructive skills
		Semantic Verbal Fluency (animals) by education level²⁶
		Illiterate: ≤8
		1-7 years: ≤11
		≥ 8 years: ≤12
Montreal Cognitive Assessment (MoCA) ⁽¹²12. Cesar KG, Yassuda MS, Porto FHG, Brucki SMD, Nitrini R. MoCA Test: normative and diagnostic accuracy data for seniors with heterogeneous educational levels in Brazil. Arq Neuropsiquiatr. 2019;77(11):775-81. doi:10.1590/0004-282X20190130. https://doi.org/10.1590/0004-282X2019013...		For Dementia (by education level):
		Illiterate: ≤8
	Executive functions	1-4 years: ≤15
	Visual constructive skills	5-8 years: ≤16
	Verbal episodic memory	9-11 years: ≤19
	Attention	≥ 12 years: ≤21
	Language	For cognitive impairment no dementia [CIND] (by education level):
	Abstraction	Illiterate: ≤11
	Temporal and spatial orientation	1-4 years: ≤17
		5-8 years: ≤19
		9-11 years: ≤19
		≥ 12 years: ≤21

Criteria 1 and 2 must be present:
1. Self-experienced persistent decline in cognitive capacity in comparison with a previously normal status, unrelated to an acute event.
2. Normal performance on standardized cognitive tests, which are used to classify mild cognitive impairment (MCI) (adjusted for age, gender, and education level).
Exclusion criteria:
1. Diagnosis of mild cognitive impairment or dementia.
2. Cannot be explained by a psychiatric* or neurologic disease (apart from AD), medical disorder, medication, or substance use.

Clinical and cognitive characteristics
Cognitive worries reflecting a change in cognition reported by patients, informants or clinicians (i.e., historical or observed evidence of decline over time)
Objective evidence of impairment in one or more cognitive domains, typically including memory (i.e., formal, or bedside testing to establish level of cognitive function in multiple domains)
Preservation of independence in functional abilities. They may show slight problems performing complex tasks, such as taking longer to complete the task or making some mistakes
Not demented
Etiology of MCI consistent with AD pathophysiological process
Rule out vascular, traumatic, medical causes of cognitive decline, where possible
Provide evidence of longitudinal decline in cognition, when feasible
Report history consistent with AD genetic factors

1. Dementia is diagnosed when there are cognitive or behavioral (neuropsychiatric) symptoms that:

1.1. Interfere with the ability to work or to carry out usual activities

1.2. Represent a decline from previous levels of functioning and performance;

1.3. Cannot be explained by delirium or major psychiatric disorder.

2. Cognitive impairment is detected and diagnosed by a combination of:

2.1. Medical history with the patient and a reliable informant; and

2.2. An objective cognitive assessment, either a “bedside” mental status examination or neuropsychological testing. Neuropsychological testing should be performed when medical history and bedside mental status examination cannot provide a confident diagnosis.

3. Cognitive or behavioral impairment involves a minimum of two of the following domains:

3.1. Memory: impaired ability to acquire and remember new information - symptoms include repetitive questions or conversations, misplacing personal belongings, forgetting events or appointments, getting lost on a familiar route;

3.2. Executive functions: impaired reasoning and carrying out complex tasks and judging - symptoms include poor understanding of safety risks, inability to manage finances, poor decision-making ability, inability to plan complex or sequential activities;

3.3. Visuospatial abilities: symptoms include inability to recognize faces or common objects or to find objects in the visual field, inability to handle utensils and dressing oneself for reasons other than visual or motor deficiency.

3.4. Language (speaking, reading, writing): symptoms include difficulty in finding common words while speaking, hesitations; speech, spelling, and writing errors and exchange of words or phonemes, unexplicable by a sensory or motor deficit.

3.5. Behavior or personality: symptoms include uncharacteristic mood fluctuations such as agitation, impaired motivation, initiative, apathy, loss of drive, social withdrawal, decreased interest in previous activities, loss of empathy, compulsive or obsessive behaviors, and socially unacceptable behaviors.

Patient Name:		_______________________________________________________________
Date:		____/____/____
Informant(s):	________________________	(degree of kinship or function):	_________________________
1) Do they handle their own money?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
2) Can they buy clothes, food, objects for their home by themselves?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
3) Can they heat water to make coffee and turn off the stove?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
4) Can they prepare a meal?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
5) Can they keep up with current events or community or neighborhood ones?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
6) Can they pay attention, understand, and discuss a radio or television show or newspaper and magazine news?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
7) Can they remember commitments, family events, and holidays?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
8) Can they handle their own medications?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
9) Can they walk around the neighborhood and find their way back home?
0 = Normal		0 = Never did, but could do it now
1 = Does, with difficulty		1 = Never did it and now would have difficulty
2 = Needs help
3 = Unable
10) Can they be safely left at home alone?
0 = Normal		0 = Never stayed, but could stay now
1 = Yes, but with precautions		1 = Never stayed and now would have difficulty
2 = Yes, for short periods
3 = No

	Memória incidental	Memória imediata	Aprendizado	Memória tardia	Reconhecimento
Sapato
Casa
Pente
Chave
Avião
Balde
Tartaruga
Livro
Colher
Árvore
Pontos (respostas corretas)
Intrusões
				Reconhecimento

Nome do paciente:		_______________________________________________
Encontro:	____/____/____
Informante(s):	_______________________________	(grau de parentesco ou função):	_____________
1) Ele (Ela) manuseia seu próprio dinheiro?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
2) Ele (Ela) é capaz de comprar roupas. comida, coisas para casa sozinho(a)?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
3) Ela (Ela) é capaz de esquentar a água para o café e apagar o fogo?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
4) Ele (Ela) é capaz de preparar uma comida?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
5) Ele (Ela) é capaz de manter-se em dia com as atualidades, com os acontecimentos da comunidade ou da vizinhança?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
6) Ele (Ela) é capaz de prestar atenção, entender e discutir um programa de rádio ou televisão, um jornal ou uma revista?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
7) Ele (Ela) é capaz de lembrar-se de compromissos, acontecimentos familiares, feriados?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
8) Ele (Ela) É capaz de manusear seus próprios remédios?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
9) Ele (Ela) é capaz de passear pela vizinhança e encontrar o caminho de volta para casa?
0 = Normal		0 = Nunca o fez, mas poderia fazê-lo agora
1 = Faz, com dificuldade		1 = Nunca o fez e agora teria dificuldade
2 = Necessita de ajuda
3 = Não é capaz
10) Ele (Ela) pode ser deixado(a) em casa sozinho(a) de forma segura?
0 = Normal		0 = Nunca ficou, mas poderia ficar agora
1 = Sim, mas com precauções		1 = Nunca ficou e agora teria dificuldade
2 = Sim, por períodos curtos
3 = Não poderia

[1] Correspondence: Jerusa Smid; Email: jsmid77@hotmail.com.

Antiarrhythmic Disopyramide	Antimuscarinics (urinary incontinence) Darifenacin Fesoterodine Flavoxate Oxybutynin Solifenacin Tolterodine Trospium
Antidepressants Amitriptyline Amoxapine Desipramine Desipramina Doxepin (>6mg) Imipramine Nortriptyline Paroxetine Protriptyline Trimipramine
	Antiparkinsonian agents Biperiden Trihexyphenidyl Benztropine
Antiemetics Prochlorperazine Promethazine	Antipsychotics Chlorpromazine Clozapine Loxapine Olanzapine Perphenazine Thioridazine Trifluoperazine

Antihistamines (first generation) Brompheniramine Carbinoxamine Chlorpheniramine Clemastine Cyproheptadine Dexbrompheniramine Dexchlorpheniramine Dimenhydrinate Diphenhydramine (oral) Doxylamine Hydroxyzine Meclizine Clidinium-chlordiazepoxide Dicyclomine Homatropine (excludes ophthalmic) Hyoscyamine Methscopolamine Propantheline Promethazine Pyrilamine Triprolidine
	Antispasmodics Atropine (excludes ophthalmic) Belladonna alkaloids Scopolamine (excludes ophthalmic)
	Skeletal muscle relaxants Cyclobenzaprine Orphenadrine

Brasil

Brasil

Subjective cognitive decline, mild cognitive impairment, and dementia - syndromic approach: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

ABSTRACT