RESUMO
The prognostic capacity of the diffusion tensor imaging measures fractional anisotropy (FA) and mean diffusivity (MD) to detect mild cognitive impairment (MCI) progression to Alzheimer's disease (AD) was assessed in 135 MCI patients and 72 healthy subjects over a median follow-up of 40 months. Forty-nine MCI patients (36.3%) developed AD. The factors MD left hippocampus, FA left cingulate, and FA left hippocampus emerged as predictors of progression. Age (hazard ratio [HR] 1.21), delayed text recall (HR 0.89), FA left uncinate (HR 1.90), FA left hippocampus (HR 2.21), and carrying at least one ApoE4 allele (HR 2.86) were associated with a high conversion rate. FA measures revealed the greatest discriminative capacity (Harrell's C = 0.73 versus 0.65 without FA; p = 0.034). The inclusion of FA structural connectivity data in our model improved discrimination between subjects with MCI progressing or not to dementia.
Assuntos
Doença de Alzheimer/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão , Idoso , Idoso de 80 Anos ou mais , Apolipoproteínas E/genética , Disfunção Cognitiva/diagnóstico por imagem , Diagnóstico Diferencial , Progressão da Doença , Diagnóstico Precoce , Feminino , Seguimentos , Humanos , Masculino , Rememoração Mental , Vias Neurais/diagnóstico por imagem , Testes Neuropsicológicos , Sintomas Prodrômicos , Estudos ProspectivosRESUMO
OBJECTIVE: Nowadays, it is accepted that to identify the biological basis of psychiatric illnesses it would be useful to deconstruct them into the most basic manifestations, such as cognitive deficits. The aim of this study was to set attention deficit as a stable vulnerability marker of bipolar disorder. METHOD: Sustained attention was evaluated by the Continuous Performance Test (DS-CPT) in 143 euthymic bipolar patients and 105 controls. To estimate the influence of clinical profile in attention, patients completed a semi-structured interview. RESULTS: Bipolar patients showed a deficit in attention during euthymic periods. This disturbance correlated with years of evolution, age of onset and age of first hospitalisation; and was not influenced by other clinical data. CONCLUSION: Sustained attention may be considered as an endophenotype of the illness.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Atenção , Transtorno Bipolar/diagnóstico , Endofenótipos , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Bipolar/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria/estatística & dados numéricos , Tempo de Reação , Valores de Referência , Reprodutibilidade dos TestesRESUMO
Few studies have compared neurocognitive performance in euthymic patients with bipolar disorder (BD), stabilized patients with schizophrenia (SC) and normal controls (NC) using a comprehensive neuropsychological battery, and those that have been conducted have yielded discrepant results. We evaluated the neurocognitive profile shown by 73 euthymic patients with BD, 89 stabilized patients with SC and 67 NC. All participants completed a cognitive battery in which the domains evaluated were executive functioning, sustained attention, and verbal and visual memory. Individuals with BD were administered the Quality of Life Scale (QLS). Patients with BD manifested dysfunction in executive functioning (moderate-to-large effect size), sustained attention (moderate effect size) and verbal/visual memory (large effect size) compared with NC. Verbal memory deficit in patients with BD was related to poor functional outcome on the QLS and Global Assessment of Functioning (GAF). Patients with BD performed significantly better than patients with SC on the Trail Making Test (TMT) part B, backward digit span, and California Verbal Learning Test (CVLT) learning trials. Other neuropsychological measures showed no significant differences between the two patient groups. These findings support the notion that euthymic BD patients suffer from an extensive neurocognitive deficit that affects all cognitive domains and is qualitatively similar to that in SC patients. Persistent verbal memory impairment in BD has clinical relevance because it is associated with poor psychosocial function.