Neuropsychological frontal impairments and negative symptoms in schizophrenia.

Negative symptoms have been associated with frontal lobe dysfunction in schizophrenia. However, neuropsychological studies that evaluated the correlation between performance in tests sensitive to the dorsolateral prefrontal cortex (DLPFC) and negative symptoms have shown inconsistent results. Growing evidence has appeared that not only the DLPFC but other prefrontal regions could be involved in schizophrenia. We evaluated schizophrenic patients and healthy controls using three "frontal tests": the Wisconsin Card Sorting Test (WCST), the Iowa Gambling Task (GT) and a Theory of Mind test (Faux Pas), and studied the relationship between performance in these tests and negative symptomatology. Schizophrenic patients had worse performance than normal controls on the WCST, GT and Faux Pas test. The severity of the negative symptoms showed a moderate to high correlation with performance in the Faux Pas test. Our findings support the idea that different prefrontal regions could be affected in people with schizophrenia and that the damage to each of these regions could be, at least in part, independent of the damage to the others. Some negative symptoms could be associated with frontal medial cortex dysfunction.

Economic impact of dementia in developing countries: an evaluation of costs of Alzheimer-type dementia in Argentina.

BACKGROUND: There is no previous information about economic costs of Alzheimer's disease (AD) in South America. The objective of this study was to evaluate the costs of AD in Argentina. METHODS: Eighty community-dwelling patients, 20 institutionalized AD patients and their respective primary caregivers, and 25 healthy elderly subjects participated in this study. The cognitive and neuropsychiatric impairments and severity of dementia were assessed with the Mini-mental State Examination, Neuropsychiatric Inventory and Clinical Dementia Rating, respectively. A structured interview about health and health-care resources used during the past 3 months was administered to family caregivers. The time devoted by carers to looking after the patients and the caregiver burden (Zarit's Burden Interview) were recorded. RESULTS: The annual direct costs of the disease increased with cognitive deterioration from US$3420.40 in mild to US$9657.60 in severe AD, and with institutionalization (US$3189.20 outpatient vs. US$14,447.68 institutionalized). Most direct costs were paid for by the family. CONCLUSIONS: With the projected increase in the number of persons at risk for developing AD in emerging countries, the family cost of the disease will be significant. Dementia costs should be a matter of analysis when health policies are being designed in developing countries.

Neuropsychiatric symptoms as a predictor of caregiver burden in Alzheimer's disease.

AIMS: Patients with Alzheimer's disease need assistance and supervision of their daily activities. They survive for protracted periods of time, placing an extensive burden of care on the caregiver prior to the patient's death. The present study addressed the predictive value of behavior-related burden on Alzheimer's disease caregivers. PARTICIPANTS: 82 patients with probable Alzheimer's (73.7 +/- 8.1 years), and their primary caregivers (59.6 +/- 14.8 years, 81.5% women), were assessed. METHODS: Cognitive impairment, neuropsychiatric symptoms, and dementia severity were assessed with Mini Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Clinical Dementia Rating (CDR), respectively. Caregivers were given Zarit's Burden Interview and Carer Activity Inventory. RESULTS: Neuropsychiatric symptoms like delusions, hallucinations, restlessness, anxiety, euphoria, disinhibition, unusual motor behavior, sleep disturbances, and appetite alterations were the best caregiver burden predictors (NPI r = 0.482, p < 0.001). No correlation with cognition, disease stage, or negative neuropsychiatric symptoms (depression and apathy) was found. CONCLUSION: Increased caregiver burden was related to increased levels of patient behavioral disturbance. Of these symptoms, hallucinations, unusual (motor) behavior, and abnormal behavior at nighttime were the most significant. No correlation with neuropsychiatric symptoms such as apathy and depression was found. This may have relevance to appropriate interventions for caregivers.

[Cognition in dysthymia]. / Cognición en distimia.

UNLABELLED: Depression is named as one of the most prevalent Mental Health problem, affecting almost 10 % of the population. According to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) different subtypes are included. Dysthymic Disorder is characterized by a depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least 2 years. The aim of this study was to investigate the neuropsychological profile of dysthymic disorder. Ninety three patients fulfilling criteria for dysthymia were examined on a variety of cognitive tasks, neurological exam and a semi-structured psychiatric interview. Forty one non-depressed individuals served as controls. Significant differences between groups were found in digit span; immediate and delayed recall of a story; and semantic and phonologic fluency. Logic memory was worse than serial learning task, and has a correlation with attention deficit and depressive features. CONCLUSIONS: This results indicate that the neuropsychological performance of patients with dysthymic disorder exhibit impairments in attention and memory. Attentional deficits appear to be the key of cognitive deficits in dysthymia.

[Neuropsychological tools for the study of depression]. / Herramientas neuropsicológicas en el estudio de la depresión.

Depression is a common disorder, affecting approximately one in ten of the population at some time in their lives. The nature and extent of such changes, however, is less clear, and their specificity to mood disorder, their existence before the onset of affective symptoms, their etiology and their relation ship to underlying neuroanatomical abnormalities remain poorly understood. Our objective is to present a comprehensive review of the existing neuropsychological literature on bipolar affective disorder, mayor depression and the differential diagnosis between geriatric depression and the depression as early symptom of Alzheimer's disease. The most critical neuropsychological assessment to study this patients will be discussed. Depression is associated with dysexecutive syndrome which correlate with fronto subcortical diseases. Cognitive impairment include attention disorders, memory difficulties type forgetfulness and executive dysfunction (planning and executions of complex behaviors, monitoring of performance, feedback, decision making etc). Cortical neuropsychological profile in a depressive patients represent Alzheimer's disease associate. Neuropsychological assessment is useful to detect both different cognitive profiles (Cortical vs Subcortical).

A cognição social e o córtex cerebral / Social cognition and the brain cortex

A cognição social é o processo que orienta condutas frente a outros indivíduos da mesma espécie. Várias estruturas cerebrais têm um papel chave para controlar as condutas sociais: o córtex pré-frontal ventromedial, a amígdala, o córtex somatosensorial direito e a ínsula. O córtex pré-frontal ventromedial está comprometido com o raciocínio social e com a tomada de decisões; a amígdala com o julgamento social de faces; o córtex somatosensorial direito, com a empatia e com a simulação; enquanto que a insula, com a resposta autonômica. Estes achados estão de acordo com a hipótese do marcador somático, um mecanismo específico por meio do qual adquirimos, representamos ou memorizamos os valores de nossas ações. Estas estruturas cerebrais atuam como mediadores entre as representações perceptuais dos estímulos sensoriais e a recuperação do conhecimento que o estímulo pode ativar. O sistema límbico é a zona limítrofe; nela, a psicologia se encontra com a neurologia. A correta sincronização destas zonas e estruturas, no adulto, é a chave para uma situação livre de patologia(AU)

A cognição social e o córtex cerebral / Social cognition and the brain cortex

A cognição social é o processo que orienta condutas frente a outros indivíduos da mesma espécie. Várias estruturas cerebrais têm um papel chave para controlar as condutas sociais: o córtex pré-frontal ventromedial, a amígdala, o córtex somatosensorial direito e a ínsula. O córtex pré-frontal ventromedial está comprometido com o raciocínio social e com a tomada de decisões; a amígdala com o julgamento social de faces; o córtex somatosensorial direito, com a empatia e com a simulação; enquanto que a insula, com a resposta autonômica. Estes achados estão de acordo com a hipótese do marcador somático, um mecanismo específico por meio do qual adquirimos, representamos ou memorizamos os valores de nossas ações. Estas estruturas cerebrais atuam como mediadores entre as representações perceptuais dos estímulos sensoriais e a recuperação do conhecimento que o estímulo pode ativar. O sistema límbico é a zona limítrofe; nela, a psicologia se encontra com a neurologia. A correta sincronização destas zonas e estruturas, no adulto, é a chave para uma situação livre de patologia

Fluencia verbal en español. Datos normativos en Argentina / Spanish verbal fluency. Normative data in Argentina

Las pruebas de fluencia verbal semántica y fonológica son usadas para evaluar la capacidad de almacenamiento semántico, la habilidad de recuperación de la información y la indemnidad de las funciones ejecutivas. Las normas originales fueron hechas sobre muestras anglosajonas y existen pocos trabajos en otras lenguas. El objetivo del presente estudio es obtener datos normativos de la fluencia semántica y la fonológica en una muestra argentina de sujetos normales y estudiar el efecto de edad, el sexo, la escolaridad, y el estado cognitivo. Fueron evaluados 266 sujetos de habla hispana con edad entre 16 y 86 años (185 mujeres, 81 varones). La escolaridad media fue de 12.8 +/- 4 años. A cada uno se le administró una batería neuropsicológica completa que incluyó el Mini Mental State Examination, la batería Mnésica de Signoret, el test de Denominación de Boston, y el Trail Making Test. Para la evaluación de la fluencia semántica se solicitó al sujeto evocar la mayor cantidad de animales en un minuto, y para la fluencia fonológica, aquellas palabras que se inicien con la letra "p" en un minuto. La muestra fue estratificada en un grupo de sujetos menores de 45 años, y en grupos cada 10 años, hasta mayores de 75 años con 3 niveles de escolaridad. Se obtuvieron las medias y el desvío estándar de cada uno de los grupos útiles para su aplicación en una población de habla castellana. La edad, los años de escolaridad y el nivel cognitivo son predictores del rendimiento en ambas pruebas.