Multivariate Base Rates of Low Scores on Tests of Learning and Memory Among Latino Adult Populations.

OBJECTIVE: To determine the prevalence of low scores for two neuropsychological tests with five total scores that evaluate learning and memory functions. METHOD: N = 5402 healthy adults from 11 countries in Latin America and the commonwealth of Puerto Rico were administered the Rey-Osterrieth Complex Figure (ROCF) and the Hopkins Verbal Learning Test (HVLT-R). Two-thirds of the participants were women, and the average age was 53.5 ± 20.0 years. Z-scores were calculated for ROCF Copy and Memory scores and HVLT-R Total Recall, Delayed Recall, and Recognition scores, adjusting for age, age2, sex, education, and interaction variables if significant for the given country. Each Z-score was converted to a percentile for each of the five subtest scores. Each participant was categorized based on his/her number of low scoring tests in specific percentile cutoff groups (25th, 16th, 10th, 5th, and 2nd). RESULTS: Between 57.3% (El Salvador) and 64.6% (Bolivia) of the sample scored below the 25th percentile on at least one of the five scores. Between 27.1% (El Salvador) and 33.9% (Puerto Rico) scored below the 10th percentile on at least one of the five subtests. Between 5.9% (Chile, El Salvador, Peru) and 10.3% (Argentina) scored below the 2nd percentile on at least one of the five scores. CONCLUSIONS: Results are consistent with other studies that found that low scores are common when multiple neuropsychological outcomes are evaluated in healthy individuals. Clinicians should consider the higher probability of low scores when evaluating learning and memory using various sets of scores to reduce false-positive diagnoses of cognitive deficits.

Effect of an action-research nutrition intervention on the Global Diet Quality Score of Colombian adolescents.

Strategies to address the nutritional needs of adolescent girls and young women often focus on supplementation. In this study, an action-research approach involving a nutrition education and entrepreneurship intervention was carried out among adolescent girls and young women in poor neighborhoods of Medellín, Colombia. The intervention group significantly increased its intake of several nutrients, including energy, protein, total fat, saturated fat, monounsaturated fat, polyunsaturated fat, cholesterol, dietary fiber, calcium, zinc, and vitamins A, B2, B3, B9, and C. A significant increase was observed in the intake of the Global Diet Quality Score (GDQS) healthy food groups (other fruits, other vegetables, legumes, high-fat dairy products), accompanied by a decrease in the consumption of some unhealthy food groups (sweets and ice creams). A multivariate regression controlling for age, socioeconomic status, occupation, Household Hunger Scale, mean probability of adequacy, physical activity, and body self-perception showed that the nutrition intervention improved the total GDQS by 33% in the intervention group-a substantial improvement notwithstanding the study group's precarious social and economic conditions. We conclude that nutrition education and entrepreneurship models based on this approach may improve the dietary profile of this population and reduce future pressures from nutrition-related chronic diseases.

The usefulness of self-generation to improve learning and memory in Spanish-speaking individuals with traumatic brain injury from Colombia.

OBJECTIVE: To examine the effect of self-generation on learning and memory in Spanish-speaking individuals with traumatic brain injury (TBI). METHOD: Thirty Spanish-speaking individuals with moderate-to-severe TBI and 31 healthy controls were recruited to read 32 individual sentences and required to remember the last word in each sentence. Target words were presented both in a self-generated and provided condition for each participant. Recall and recognition of the words were examined immediately, after 30 minutes and after 1 week. RESULTS: Findings indicated that both healthy controls and individuals with TBI showed significantly better recall and recognition for words in the generated condition than words that had been provided to them at immediate, 30-minute and 1-week time intervals. CONCLUSION: The self-generation technique effectively improves learning and memory in Spanish-speaking individuals with TBI. Results should encourage researchers and clinicians to use the principles of cognitive psychology to adapt (as opposed to simply translate) cognitive rehabilitation protocols for use in Spanish-speaking populations with neurological conditions.

Family needs in caregivers of individuals with traumatic brain injury from Colombia, South America.

OBJECTIVE: The aim of the present study was to determine the most and least important family needs in a group of family caregivers of individuals with TBI from Cali, Colombia, and to examine which of those needs were more likely to be met and unmet. DESIGN: Cross-sectional descriptive study. SETTING: Valle University Hospital in Cali, Colombia. PARTICIPANTS: Twenty-nine family caregivers of individuals with traumatic brain injury. OUTCOME MEASURE: The Family Needs Questionnaire, a 40-item questionnaire divided into six sub-scales. RESULTS: Health Information, Community Support Network and Professional Support Network sub-scales were the most important needs reported by this group of Colombian TBI family caregivers. The most frequently met needs in the present study fell within Health Information, Involvement with Care and Instrumental Support sub-scales and the most frequently unmet needs fell within the Emotional Support, Instrumental Support and Professional Support sub-scales. CONCLUSIONS: Family needs in caregivers of individuals with TBI from Colombia are similar, but more likely to be unmet, than those reported in previous studies. Interventions designed to meet family caregivers' needs in these areas should be implemented in Colombia.

The ties that bind: the relationship between caregiver burden and the neuropsychological functioning of TBI survivors.

Advances in medical and assistive technology have increased the likelihood of survival following a traumatic brain injury (TBI). Consequently, families frequently must provide care to individuals with TBI. Because they are rarely prepared for the associated demanding medical needs and financial burden, family caregivers are at risk for physical and emotional problems, which can negatively influence their individual and family functioning. Whereas scholars have examined the influence of survivor functioning on caregiver burden, few have explicitly recognized that caregiver burden also influences survivor functioning. Results of a multivariate linear regression suggest that, in a sample of 51 pairs of TBI survivors and their caregivers living in Colombia, survivors receiving care from a family member who reported a higher level of burden had poorer objective neuropsychological functioning than those receiving care from a family member who reported a lower level of burden, after controlling for survivor education and history of occupational therapy. Therefore, a family-focused approach might maximize intervention effectiveness, especially for Latin American and Hispanic families, which tend to be characterized by a strong sense of familism. The emphasis on family can create problems in a healthcare system that views the individual as the primary unit.

Factors associated with depression and burden in Spanish speaking caregivers of individuals with traumatic brain injury.

OBJECTIVE: To determine which factors are highly associated with burden and depression in a group of caregivers of persons with Traumatic Brain Injury (TBI) in Colombia, South America. DESIGN: Prospective. PARTICIPANTS: Fifty-one pairs of individuals with TBI and their caregivers from two major cities in Colombia completed a comprehensive psychosocial evaluation that included information related to patient and caregiver sociodemographic factors, patient factors, and caregiver estimation of patient neurobehavioral functioning. OUTCOME MEASURES: Caregiver burden (Zarit Burden Interview) and caregiver depression (PHQ-9). RESULTS: Generalized linear models revealed that patient language problems and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver burden. Caregiver socioeconomic status and caregiver perception of patient functioning on six neurobehavioral domains were related to caregiver depression. These variables were then selected as candidates for the multiple regression models, which were fit separately for caregiver depression and burden, and revealed that caregivers' perception of patient depression was the only factor associated with both caregiver burden and depression. CONCLUSION: Caregivers' perception of patient depression was the single best predictor of both caregiver burden and depression. Implications for treatment based on these preliminary findings are discussed.

Rehabilitación neuropsicológica en un caso de TDAH con predominio impulsivo / Neuropsychological rehabilitation in a case of ADHD with impulsive predominance

En Trastorno por déficit de atención e hiperactividad (TDAH) el síntoma central desde la neuropsicología es el deficiente desarrollo de la organización de su conducta, específicamente de las formas de actividad consciente e intencionalmente orientada. Los niños presentan dificultades en la organización y autorregulación de la conducta y un comportamiento inapropiado respecto a lo que se espera para su edad y desarrollo intelectual, aunque el niño es capaz de formar un propósito para su actividad, no logra mantenerse en ella, es incapaz de planear y seguir una secuencia de acciones para alcanzar el objetivo que se había planteado, los estímulos auditivos y visuales externos lo distraen con facilidad desviándolo de su propósito. El objetivo de este artículo es mostrar un programa de intervención Neuropsicológica en un caso de un niño con TDH de predominio impulsivo fundamentado en la identificación de la falla en el mecanismo de regulación y control que afecta la función reguladora del lenguaje para lograr una actividad voluntaria y organizada, se muestran los resultados de la valoración pre, el programa de intervención, la valoración pos y un análisis comparativo. La discusión se establece a partir de la importancia de la función reguladora del Lenguaje para la organización de la actividad voluntaria...

In the Attention Deficit Hyperactivity Disorder (ADHD), the central symptoms from the neuropsychology aspect, is the poor development of the organization of the behavior, specifically for conscious and intentionally targeted activities. Children have difficulties in self-regulation and organization of their behavior as well as an inappropriate conduct in respect to what is expected for their age and intellectual development. Although the child is capable of developing a purpose for their activity, the child is unable to plan and follow a sequence of actions, and maintain the focus to achieve the objective established. External visual and/or acoustic stimulus can easily distract and deflect them from their activities. The aim of this paper is to show a Neuropsychological intervention program for a case of a child with ADHD with impulsive predominance, based on the identification of the fault in the regulation and control’s mechanism that affects the language regulatory function to achieve an organized and voluntary activity. This paper shows the results of the pre-assessment, intervention program, the post assessment and the comparative analyzes. The discussion is set as regards as the importance of the language regulatory function in organizing a voluntary activity...

La memoria audioverbal en adultos mayores con deterioro cognitivo leve y un grupo control / Auditory verbal memory in elderly people with Mild Cognitive Impairment MCI and a control group

El Deterior Cognitivo Leve (DCL) se caracteriza por una queja subjetiva de pérdida de memoria, déficit de memoria objetivado mediante test cognitivos, cognición general normal, actividades de la vida diaria conservadas y ausencia de criterios diagnósticos de demencia. Su prevalencia es de 9.7% en personas mayores de 50 años y en la población colombiana existen pocos estudios. El objetivo fue describir la memoria audioverbal, en un grupo de 10 adultos mayores con DCL en comparación a un grupo control. Para la evaluación se utilizó la escala del NEUROPSI atención y memoria. Los resultados indican cambios estadísticamente significativos (p≤0.05) en las medias de la memoria audioverbal, el porcentaje de la curva de aprendizaje, recobro espontáneo, por claves y en el reconocimiento. Mostrando que los adultos mayores con DCL presentan dificultades en la fase de registro de información, afectando a su vez los procesos de almacenamiento y evocación, con incremento de intrusiones.

Mild Cognitive Impairment (MCI) is characterized by a subjective complaint of memory loss, memory deficit by cognitive tests, normal general cognition, preserved daily life activities, lack of diagnostic criteria for dementia, The prevalence is 9.7% in people over 50 years, and there are few studies in our population. The objective of this study was to describe auditory verbal memory in a group of ten elderly people with MCI compared to a control group. The NEUROPSI attention and memory scale was used. Results indicate statistically significant changes (p ≤ 0.05) in audio verbal memory, the learning curve rate, spontaneous recovery, cued recall and recognition. The elderly people’s group with MCI shows difficulty in the phase of information processing that affects the storage and recall process, with increased intrusions.

Neuropsicología del trauma craneoencefálico en Cali, Colombia / Traumatic brain injury neuropsychology in Cali, Colombia / Neuropsicologia do traumatismo cranioencefálico em Cali, na Colômbia

Objetivo: realizar un análisis comparativo entre un grupo control y pacientes con trauma craneoencefálico (TCE) para determinar si existen diferencias neuropsicológicas a los seis meses de evolución y así orientar programas de intervención acordes con las necesidades de esta población. Materiales y métodos: se evaluó un total de setenta y nueve pacientes con antecedente de TCE con mínimo de seis meses de evolución y setenta y nueve sujetos en grupo control, el cual presentó una escolaridad promedio de once años frente a nueve años del grupo de TCE; ambos grupos con una media de treinta y cuatro años de edad, sin antecedentes neurológicos y/o psiquiátricos. La media del Glasgow en el grupo de TCE se ubicó en un rango moderado con una puntuación de once. Se aplicó la evaluación neuropsicológica breve en español Neuropsi a los dos grupos. Resultados: los grupos muestran diferencias significativas (p ≤ 0,05) en las tareas de orientación, atención, memoria, lenguaje, lectura y escritura. Conclusiones: el TCE deja secuelas neuropsicológicas significativas, aun seis meses después de ocurrido el evento traumático. Estos hallazgos sugieren que los pacientes con TCE requieren de tratamiento después de superar la etapa inicial.

Objetive: comparative analysis between control group and patients with TBI to determine whether there neuropsychological differences at 6 months of evolution, to guide timely intervention commensurate with the needs of this population. Materials and methods: a total of 79 patients with a history of TBI with a minimum of 6 months of evolution and 79 control subjects were evaluated. Both groups with a mean age of 34 and without previous neurological or psychiatric disorders and an average schooling of 11 years for the control group and 9 years for the TBI group. The Glasgow Coma Scale in the TBI group was classified as moderate with 11 points. The Brief Neuropsychological Evaluation in Spanish Neuropsi was applied to both groups. Results: significant differences (p≤0.05) in the tasks of orientation, attention, memory, language, reading and writing were found. Conclusions: TBI generates significant neuropsychological changes, even six months after discharge from the health service. It suggests that patients with head injury require treatment after overcoming the initial stage.

Objetivo: realizar uma análise comparativa entre um grupo controle e pacientes com traumatismo cranioencefálico, TCE, para determinar se existem diferenças neuropsicológicas aos seis meses de evolução e assim orientar programas de intervenção conforme com as necessidades desta população. Materiais e métodos: avaliou-se um total de setenta e nove pacientes com antecedente de TCE com um mínimo de seis meses de evolução e setenta e nove pessoas em grupo controles, que apresentou uma escolaridade média de onze anos frente a nove anos do grupo de TCE; ambos os grupos com uma média de trinta e quatro anos de idade, sem antecedentes neurológicos ou psiquiátricos. A média de Glasgow no grupo de TCE localizou-se em uma distância moderada com uma pontuação de onze. Aplicou-se a avaliação neuropsicológica breve em espanhol Neuropsi aos dois grupos. Resultados: os grupos mostram diferenças significativas (p≤0,05) nas tarefas de orientação, atenção, memória, linguagem, leitura e escrita. Conclusões: o TCE deixa sequelas neuropsicológicas significativas, ainda seis meses depois de acontecido o evento traumático. Estas descobertas sugerem que os pacientes com TCE requerem de tratamento depois de superar a etapa inicial.

Alteraciones cognitivas, emocionales y comportamentales a largo plazo en pacientes con trauma craneoencefálico en Cali, Colombia / Cognitive, emotional, and behavioral disorders in patients with long-term traumatic brain injury in Cali, Colombia

Introducción: El trauma craneoencefálico (TCE) es una de las principales causas de muerte y discapacidad en personas jóvenes en Colombia. Aquellos que logran sobrevivir a un TCE suelen quedar con secuelas de problemas cognitivos, emocionales y comportamentales que interfieren con su vida familiar, social y laboral. Pese a la importancia de estos problemas, no existen investigaciones en Colombia en esta área. Objetivo: Determinar a largo plazo las alteraciones cognoscitivas, emocionales y neurocomportamentales de un grupo de pacientes con TCE de la ciudad de Cali, Colombia. Método: A cada uno de los 60 participantes (30 sujetos con trauma de cráneo moderado y severo del Hospital Universitario del Valle y del Centro de Rehabilitación Neurológica Teravida y 30 controles) se le administró la batería neuropsicológica breve (Neuropsi) y el Inventario de Funcionamiento Neurocomportamental (IFN). Resultados: Comparado con el grupo control, los pacientes con TCE presentaron puntuaciones significativamente más bajas en las pruebas de atención y concentración, memoria a corto y largo plazo, lenguaje y funciones ejecutivas, y más altas en depresión, síntomas somáticos y problemas de comunicación. Conclusión: Los pacientes con TCE a largo plazo tienen no sólo dificultades cognitivas, sino síntomas depresivos, somáticos y problemas de comunicación, que señalan la necesidad de que reciban atención desde los servicios de salud en estas dos áreas (cognitivo y emocional-comportamental), involucrándolos en programas de rehabilitación cognoscitiva, psicoterapéuticos y psicoeducativos, que permitan mejorar la calidad de vida tanto de los pacientes como de sus familias...

Introduction: Traumatic Brain Injury (TBI) is one of the primary causes of death and disability in Colombia. The objective of the present study was to determine the cognitive, emotional, and neurobehavioral functioning of a group of individuals with TBI in Cali, Colombia. Method: A neuropsychologist administered a comprehensive neuropsychological evaluation (Neuropsi) and the Spanishlanguage version of the Neurobehavioral Functional Inventory (NFI) to 30 individuals with TBI from Teravida Neurological Rehabilitation Center and del Valle University Hospital in Cali, Colombia and 30 healthy controls. Results: Compared to controls, the patients scored significantly worse on attention, memory, executive functioning, and language tests. The patients scored significantly higher than controls on three sub-scales of the NFI: Depression, somatic symptoms, and communication problems. Conclusion: Patients with long-term TBI not only have cognitive difficulties, but also depressive symptoms, somatic, and communication problems, which underlines the need for these patients to receive care from health services in these two areas (cognitive and emotionalbehavioral), involving them in programs of cognitive rehabilitation, psychotherapy, and psychoeducation to improve the quality of life of the patients and their families...

Las alteraciones de la atención y su rehabilitación en trauma craneoencefálico

El déficit de la atención es uno de los problemas más comunes después de una lesión cerebral, incidiendo a su vez en el funcionamiento de otros procesos cognitivos importantes como la memoria, funciones ejecutivas, orientación, concentración, entre otros. Este artículo tiene como objetivo describir la atención y las alteraciones que se producen como consecuencia del trauma craneoencefálico y revisar los aportes de la rehabilitación neuropsicológica para el manejo de estos pacientes. Para lograrlo, se realizó una búsqueda de información siete años atrás y algunos pioneros en el tema. Se encontró que la atención es un mecanismo esencial en la actividad humana, que no depende de un área especializada exclusiva, sino que es el resultado de la interacción entre los componentes de una red, por tanto, las alteraciones que se presentan después de un trauma craneoencefálico producen profundos déficit en la atención afectando la autonomía del paciente. La rehabilitación neuropsicológica se constituye en una forma de intervención ideal para estos casos, teniendo en cuenta que debe hacerse de manera integral y continua en el tiempo; ésta influye sobre otras esferas, como conductual, emocional y social, que le permiten al paciente reinsertarse en mejores condiciones a las actividades de la vida diaria.

Attention deficit is one of the most common problems after a brain injury, affecting also the proper functioning of other important cognitive processes like memory, executive functions, orientation, concentration, amongst others. This article has for objective, to describe the attention and the alterations that are produced as a consequence of craneoencephalic trauma and to review the contributions of the neuropsychological rehabilitation in the management of these patients. To achieve this, a search for information was performed seven years back and some pioneers on the subject. It was found that the attention is an essential mechanism in human activity that does not depend on an exclusive specialized area, but is the result of the interaction between the components of a net, therefore, the alterations that are present after a craneoencephalic trauma produce profound deficits in the attention and affecting the autonomy of the patient. The neuropsychological rehabilitation constitutes itself in an ideal intervention for this cases, considering that it should be done in an integral and continuous way in time, this influences other spheres, like conductual, emotional and social, that allow the patient to reinsert himself in better conditions to the daily life activities.

O déficit da atenção é um dos problemas mais comuns depois que uma lesão cerebral, incidindo, no funcionamento de outros processos cognitivos importantes como a memória, funções executivas, orientação, concentração, entre outros. Este artigo tem como objetivo descrever a atenção e as alterações que se produzem como conseqüência do trauma craneoencefálico e revisar os aportes da reabilitação neuropsicológica para o uso destes pacientes. Se realizou uma busca de informação sete anos atrás e alguns pioneiros no tema. Se encontrou, que a atenção é um mecanismo essencial na atividade humana, que não depende de uma área especializada exclusiva, mas é o resultado da interação entre os componentes de uma rede, portanto, as alterações que se apresentam depois que um Trauma craneoencefálico, produzem profundos déficit na atenção afetando a autonomia do paciente. A reabilitação neuropsicológica se constitui em uma forma de intervenção ideal para estes casos, levando em conta, que deve fazer-se de maneira integral e contínua no tempo, esta influi sobre outras esferas, como na conduta, emocional e social, que lhe permitem ao paciente reinsertarse em melhores condições nas atividades da vida diária.