RESUMEN
BACKGROUND: With improvements in stroke treatments, the number of patients with dramatic recovery is increasing. However, many of them are still complaining of difficulties in returning to work and every day activities. The aim was to assess work and social dysfunctioning in patients with minor to moderate stroke and explore its contributing factors. METHODS: Consecutive patients were prospectively included at a median 7 months after a first-ever stroke. Scores on the Work and Social Adjustment Scale (WSAS), a generic self-reported scale for assessing social functioning, were correlated with scores on the National Institutes of Health Stroke Scale (NIHSS), activities of daily living, Hospital Anxiety and Depression scale (HAD) and MMSE, Iowa Scale of Personality Changes and return to work at 1 year. RESULTS: Among the 84 included patients (mean age 43.5 years), 57 (68%; 95% CI 57 to 78%) complained of significant perturbation of functioning attributed to stroke. WSAS was highly significantly related to modified Rankin scale, daily living activities, Iowa Scale of Personality Changes and return to work at 1 year. Using ordinal logistic regression, the contributors to WSAS were initial neurological severity (NIHSS at admission), HAD and MMSE. CONCLUSIONS: The study showed that up to 68% of our patients complained of significant work and social dysfunction due to stroke, despite a good clinical outcome. This self-estimation was correlated to external validation criteria, stressing the high burden of stroke from the patient's viewpoint. Moreover, when compared across diseases, social dysfunctioning after mild stroke was as important as in other major disabling diseases.
Asunto(s)
Trastorno de la Conducta Social/etiología , Trastorno de la Conducta Social/psicología , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/psicología , Actividades Cotidianas , Adolescente , Adulto , Anciano , Interpretación Estadística de Datos , Femenino , Humanos , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Pruebas de Personalidad , Pronóstico , Estudios Prospectivos , Psicometría , Ajuste Social , Conducta Social , Trabajo , Adulto JovenRESUMEN
BACKGROUND AND AIMS: Social functioning is impaired in approximately two-thirds of stroke patients of vocational age, even several months after a first ever mild to moderate stroke. The known predictors of social functioning are initial stroke severity, anxiety and depression, and the Mini-Mental State Evaluation, suggesting that cognitive deficits contribute to post-stroke social dysfunctioning. The aim of this study was to evaluate whether cognitive domains correlated with social functioning and to determine the cognitive predictors of social dysfunctioning. METHODS: 74 patients were prospectively included 6 months after a first ever stroke. National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale, depression and anxiety were recorded. Social functioning was recorded using the Work and Social Adjustment Scale (WSAS). An extensive neuropsychological test battery explored general cognitive functioning, episodic memory, instrumental functions, executive functions and working memory. Univariate comparisons assessed the relationships between the neuropsychological tests and scores on the WSAS. Predicting factors for WSAS were determined using ordinal logistic regression. RESULTS: 52 patients (70%; 95% confidence interval 58% to 80%) complained of significant perturbations in work and social functioning. In univariate comparisons, general cognitive functioning, memory, instrumental functions, executive functions and working memory significantly correlated with social functioning. Working memory was the most affected domain. With multivariate modelling, the NIHSS at admission, Hospital Anxiety Depression scale and Owen's Spatial Working Memory test were independent predictors of WSAS. CONCLUSIONS: All cognitive domains were associated with social functioning, working memory being the main cognitive determinant. Our results suggest that cognitive impairment impacts on social dysfunctioning, which is known to be a component of quality of life.
Asunto(s)
Cognición/fisiología , Conducta Social , Accidente Cerebrovascular/psicología , Adulto , Anciano , Interpretación Estadística de Datos , Depresión/etiología , Depresión/psicología , Femenino , Humanos , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Memoria/fisiología , Memoria a Corto Plazo/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Oportunidad Relativa , Desempeño Psicomotor/fisiología , Adulto JovenRESUMEN
We have previously described impairments of cognitive executive functions in 17 patients with OSAS in comparison with 17 normal controls, as assessed by various frontal-lobe-related tests. In the present study, 10 of these OSAS patients treated with continuous positive airway pressure (CPAP) were reevaluated after 4-6 months of treatment. Neuropsychological tasks explored attention, short-term memory span, learning abilities, planning capacities, categorizing activities, and verbal fluency. Patients were found to have normalized most of their cognitive executive and learning disabilities, but all the short-term memory tests remained unchanged. These findings are discussed in light of the contribution of the frontal-lobe-related systems to short-term memory functions, and the eventual pathogenic role played by sleep fragmentation and nocturnal hypoxemia, which are related to the occurrence of apneic and hypopneic events. In conclusion, short-term memory impairment was persistent in OSAS patients despite CPAP treatment for 4-6 months.
Asunto(s)
Trastornos del Conocimiento/etiología , Respiración con Presión Positiva/métodos , Síndromes de la Apnea del Sueño/complicaciones , Síndromes de la Apnea del Sueño/terapia , Adulto , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/fisiopatología , Lóbulo Frontal/fisiopatología , Humanos , Aprendizaje/fisiología , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores de TiempoRESUMEN
Impairment of cognitive executive functions previously has been suspected to occur in association with sleep apnea syndrome (SAS), as suggested by some neuropsychological studies. However, such functions have not been assessed directly. In the present study, 17 patients with SAS were evaluated with various focused frontal lobe-related tests in comparison with 17 normal controls. Such tasks explored attention, short-term memory spans, learning abilities, planning and programming capacities, categorizing activities and verbal fluency. Patients were found to have a significantly decreased ability to initiate new mental processes and to inhibit automatic ones, in conjunction with a tendency for preservative errors. They were also affected with deficits of verbal and visual learning abilities and had reduced memory spans. Such defects were further evaluated via logistic regression against two criteria of the severity of the disease: the number of apneas and hypopneas per hour of sleep and the level of nocturnal hypoxemia. Memory deficits were rather related to the former, whereas typical frontal lobe-related abnormalities seemed rather consistent with the latter. These findings are discussed in light of data from the literature concerning cognitive impairments described for patients with isolated daytime sleepiness versus hypoxemia, as illustrated in other pathological or physiological circumstances.
Asunto(s)
Trastornos de la Memoria/etiología , Síndromes de la Apnea del Sueño/complicaciones , Adulto , Anciano , Atención , Índice de Masa Corporal , Lóbulo Frontal/fisiología , Humanos , Aprendizaje , Masculino , Trastornos de la Memoria/diagnóstico , Memoria a Corto Plazo , Persona de Mediana Edad , Pruebas Neuropsicológicas , Conducta Verbal , Percepción VisualRESUMEN
Cognitive impairments in Parkinson's disease (PD) could be explained by a central executive (CE) deficit in A. D. Baddeley's (1986) working memory model. To test this hypothesis, verbal, spatial, and double span tasks were given to 12 medicated PD patients and control participants, with varying recall delays. The double span task was assigned to explore the coordinating and integrating function of the CE, and lengthening the recall delay was expected to implicate more attentional resources. PD patients had lower spans relative to controls in all tasks. However, the more specific implication of the CE was difficult to prove. One reason could be that PD patients were on dopaminergic treatment when tested. To control this effect, 12 PD patients on and off medication were studied in a second experiment using the same tasks. PD patients off medication had lower spans only in the double task; this result underlines the role of dopamine on working memory processes.
Asunto(s)
Antiparkinsonianos/administración & dosificación , Antiparkinsonianos/efectos adversos , Dopaminérgicos/administración & dosificación , Dopaminérgicos/efectos adversos , Memoria/efectos de los fármacos , Enfermedad de Parkinson/psicología , Adulto , Anciano , Análisis de Varianza , Atención/efectos de los fármacos , Estudios de Casos y Controles , Cognición/efectos de los fármacos , Femenino , Humanos , Masculino , Recuerdo Mental/efectos de los fármacos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedad de Parkinson/tratamiento farmacológicoRESUMEN
Impairments of cognitive executive functions has been previously suspected to occur in Sleep Apnea Syndrome (SAS), as suggested by some neuropsychological studies. However such functions have not been assessed directly. In the present study, ten patients with SAS were evaluated with various focused frontal lobe-related tests in comparison with ten matched normal controls. Such tasks explored attention, short term memory spans, learning abilities, planning and programming capacities, categorizing activities and verbal fluency. Patients were found with a significant decreased ability to initiate new mental processes and to inhibit automatic ones in conjunction with a tendency for perseverative errors. They were also affected with deficits of verbal and visual learning abilities and they had reduced spans. Patients were submitted to continuous positive airway pressure (CPAP) and further reevaluated after 4-6 months of treatment. Patients were found to have normalized most of their cognitive executive and learning disabilities, except for all the short-term memory tests which remained unchanged. These findings are discussed in light of data from the literature concerning cognitive impairments described for patients with isolated daytime sleepiness versus hypoxemia, as illustrated in other pathological or physiological circumstances. The contribution of frontal lobe-related systems in short-term memory functions is also taken into account.
Asunto(s)
Cognición/fisiología , Lóbulo Frontal/fisiopatología , Síndromes de la Apnea del Sueño/fisiopatología , Síndromes de la Apnea del Sueño/psicología , Adulto , Atención , Lóbulo Frontal/fisiología , Humanos , Aprendizaje , Masculino , Memoria , Memoria a Corto Plazo , Persona de Mediana Edad , Pruebas Neuropsicológicas , Valores de ReferenciaRESUMEN
Twenty-two patients who underwent surgery for ruptured aneurysm of the anterior communicating artery were investigated by a battery of neuropsychological tests, including memory evaluation tests. According to the results obtained at these tests the patients were divided into three groups: 1) 7 patients had no memory disorders; 2) 10 patients presented with memory disorders affecting memory; their complaints concerned behavior, and the memory deficit was discovered at neuropsychological examination; 3) 5 patients presented with an obvious amnesic syndrome, and the tests confirmed a severe learning deficit and a severe forgetting while recognition remained normal in 4 patients. Age, residual lesions at CT and electrophysiological signs of focalization correlated well with the residual neuropsychological disorders. Leaving aside quantitative aspects, the memory deficits observed in the second and third groups seemed to be qualitatively different and might correspond to different anatomical and functional sequelae.
Asunto(s)
Aneurisma Intracraneal/complicaciones , Trastornos de la Memoria/etiología , Adulto , Femenino , Humanos , Aneurisma Intracraneal/diagnóstico por imagen , Masculino , Trastornos de la Memoria/clasificación , Trastornos de la Memoria/diagnóstico por imagen , Persona de Mediana Edad , Pruebas Neuropsicológicas , Pronóstico , Rotura Espontánea , Tomografía Computarizada por Rayos XRESUMEN
A dysfunction of dorsolateral prefrontal cortex (DLPF) in major depression is suggested by functional imagery and comparative neuropsychology. However, assessment of frontal lobe syndrome with DLPF-dependent tests led to controversial results. To clarify these findings, we administered 5 of these tests (Wisconsin Card Sorting Test, Stroop Test, Trail Making Test, Tower of Toronto, verbal fluency) to 16 major depressive subjects and their 16 controls, before and after 21 days of treatment. Furthermore, we tried to assess the prognostic value of frontal lobe dysfunction, and its relation with the endogenous or exogenous nature of the depression on the one hand, the severity of the depression on the other hand. Our results suggest that the presence of a frontal lobe syndrome (defined by impaired performances at 3 tests or more) is only noted in endogenous depression; after treatment, no impairment is detected. No correlation is found with the severity of the depression. Frontal lobe syndrome does not seem to indicate poorer prognosis for current depressive episode.
Asunto(s)
Trastorno Depresivo/diagnóstico , Lóbulo Frontal/fisiopatología , Trastornos Neurocognitivos/diagnóstico , Pruebas Neuropsicológicas , Corteza Prefrontal/fisiopatología , Adulto , Antidepresivos/administración & dosificación , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/fisiopatología , Trastorno Depresivo/psicología , Femenino , Fluoxetina/administración & dosificación , Estudios de Seguimiento , Lóbulo Frontal/efectos de los fármacos , Humanos , Masculino , Mianserina/administración & dosificación , Persona de Mediana Edad , Trastornos Neurocognitivos/tratamiento farmacológico , Trastornos Neurocognitivos/fisiopatología , Trastornos Neurocognitivos/psicología , Paroxetina/administración & dosificación , Corteza Prefrontal/efectos de los fármacos , Pronóstico , Resultado del TratamientoRESUMEN
The impairment in tasks requiring intact frontal lobe functions has been repeatedly shown in schizophrenics. However, the relative roles of confounding factors, like duration of the disease, social withdrawal, or antidopaminergic medication, are not clearly demonstrated. We studied the performance of 12 young active patients, with chronic residual schizophrenia that had recent onset, and 12 control subjects, with frontal lobe tests and with a battery designed to explore working memory. The results show normal performance in schizophrenia. The small number of patients does not allow definitive conclusions, but this study suggests that a frontal dysfunction may not be present early in the evolution of schizophrenia in active patients.
Asunto(s)
Atención/fisiología , Lóbulo Frontal/fisiopatología , Recuerdo Mental/fisiología , Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Adulto , Femenino , Humanos , Masculino , Trastornos Neurocognitivos/diagnóstico , Trastornos Neurocognitivos/fisiopatología , Trastornos Neurocognitivos/psicología , Pruebas Neuropsicológicas , Corteza Prefrontal/fisiopatología , Escalas de Valoración Psiquiátrica , Esquizofrenia/diagnósticoRESUMEN
Several lines of evidence seem to indicate that some neurocognitive measures could be phenotypic markers of predisposition to schizophrenia. The aim of this study was to investigate 21 patients with schizophrenia, 51 of their first-degree relatives and 46 nonpsychiatric controls, with a series of tests known to be sensitive to prefrontal cortical damage--the Trail Making Test, part B (TMT B), the Wisconsin Card Sorting Test (WCST) and a verbal fluency test (VFT)- and/or sensitive to temporo-hippocampic dysfunctions: verbal and visual memory and verbal learning tests from the Wechsler Memory Scale-Revised (Wechsler, 1987). Since parents and siblings share on average 50% of their genes with the schizophrenic proband, firstly we predicted that the first-degree relatives' performance would be at an intermediate level between patients and control subjects and secondly, we expected that a higher proportion of relatives than of control subjects would be impaired. The patients demonstrated deviant patterns of neuropsychological performance on the three tests sensitive to frontal dysfunctions and on most of the memory and learning tests. In the relative group, performance on the TMT B, VFT, immediate verbal recall and verbal learning was at an intermediate level between both other groups and significantly impaired compared to control subjects. However, the relative group did not differ from the control group on the WCST, immediate visual recall, and delayed verbal and visual recalls. Furthermore, compared to the control group, the percentages of patients and relatives who scored one standard deviation below the mean control group were significantly higher for the VFT and immediate verbal recall scores. Among all the tests studied, the verbal fluency and the immediate verbal recall appeared to be valuable phenotypic markers of schizophrenia since: (i) their mean scores were poorer in the patient and in the relative groups, (ii) the percentages of patients and relatives with poor performance were higher than the percentage of controls, (iii) these deficits were not due to poorer general intellectual abilities in the relative group, (iv) these deficits did not correlate with anxiety or depression scores.
Asunto(s)
Recuerdo Mental , Reconocimiento Visual de Modelos , Esquizofrenia/genética , Psicología del Esquizofrénico , Trastorno de la Personalidad Esquizotípica/genética , Aprendizaje Verbal , Adulto , Femenino , Marcadores Genéticos/genética , Pruebas Genéticas , Humanos , Masculino , Memoria a Corto Plazo , Persona de Mediana Edad , Pruebas Neuropsicológicas , Fenotipo , Retención en Psicología , Esquizofrenia/diagnóstico , Trastorno de la Personalidad Esquizotípica/diagnóstico , Trastorno de la Personalidad Esquizotípica/psicologíaRESUMEN
Sleepiness is considered to be the major cause of increased traffic accidents in patients with obstructive sleep apnoea syndrome (OSAS). Until now, OSAS patients' driving ability has been assessed using driving simulators, but no assessment in a more natural driving environment has been carried out to date. The aim of the present study was to evaluate driving parameters in OSAS and in controls on a road safety platform, and to compare them with attentional in-laboratory measures before and after continuous positive airway pressure treatment. The parameters measured were: reaction time; distance to stop and number of collisions on the platform; maintenance of wakefulness; and sustained, selective and divided attention in laboratory. Patients exhibited much longer reaction times than controls, leading to a lengthening of the vehicle's stopping distance of 8.8 m at 40 km.h(-1) and to twice the number of collisions. Patients did not demonstrate objective sleepiness or selective and sustained attention deficits. Divided attention deficits were found. However, they did not allow the prediction of real driving impairment. After CPAP treatment, there was no longer any difference between patients and controls regarding driving and attention performances. Driving abilities are significantly impaired in obstructive sleep apnoea syndrome. After continuous positive airway pressure treatment, deficits were normalised. This stresses the importance of evaluating attentional parameters in apnoeic patients and of offering continuous positive airway pressure treatment even to non-sleepy subjects.
Asunto(s)
Conducción de Automóvil , Presión de las Vías Aéreas Positiva Contínua , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapia , Atención/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Polisomnografía , Tiempo de Reacción/fisiología , Análisis y Desempeño de Tareas , Resultado del TratamientoRESUMEN
Excessive daytime sleepiness, fatigue and altered attention are often experienced by obstructive sleep apnoea (OSA) patients. Although attentional problems are presumably responsible for part of the daytime functioning impairment in OSA, thorough investigation is unusual. Clinicians usually attribute these symptoms to somnolence. In clinical practice, only one isolated test is generally used to assess vigilance and attentional defects. It was hypothesised that most OSA patients exhibit a broad range of attentional deficits, beyond impaired maintenance of wakefulness, and a specific battery of tests is needed to correctly assess them. Three attentional tests were performed at 9:00, 11:00 and 13:30 h, measuring maintenance of wakefulness, sustained attention and divided attention. Twenty OSA patients (aged 51+/-12 yrs, apnoea/hypopnoea index 45+/-22 h) and 40 control subjects (aged 48.4+/-9.9 yrs) were tested. OSA patients performed significantly less well on the three tests than the controls at the three sessions. This battery of tests demonstrated that 95% of patients had vigilance and/or attentional impairment. Impairment patterns varied between patients. Vigilance is impaired in obstructive sleep apnoea patients over a wide range of attentional processes. Not only is their ability to remain awake in monotonous situations impaired but their ability to maintain attention in more stimulating conditions is also affected. A single test of vigilance is not sufficient and could underestimate impaired vigilance and attention in some patients.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/etiología , Trastornos de Somnolencia Excesiva/etiología , Polisomnografía/métodos , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Adulto , Distribución por Edad , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estudios de Casos y Controles , Trastornos de Somnolencia Excesiva/diagnóstico , Trastornos de Somnolencia Excesiva/epidemiología , Electroencefalografía , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Probabilidad , Pronóstico , Tiempo de Reacción , Valores de Referencia , Medición de Riesgo , Muestreo , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Distribución por Sexo , Vigilia/fisiologíaRESUMEN
At the first International Conference for Health Promotion, Canada presented "Achieving Health for All: A Framework for Health Promotion". This document reflects current thinking and proposes a conceptual base for the analysis of contemporary and emerging health issues. The approach is founded on the principles of health promotion developed by the World Health Organization and assimilates the themes which subsequently emerged in the Ottawa Charter. As such, Canada's framework presents a context for discussing chronic illnesses and for identifying opportunities that will lead to an intersectoral course of action. The salient features of this framework (Fig. 1) are briefly discussed.
Asunto(s)
Enfermedad Crónica , Directrices para la Planificación en Salud , Promoción de la Salud/métodos , Canadá , HumanosRESUMEN
OBJECTIVE: To test the verbal subsystem of Baddeley's working memory model (the phonological loop) in patients with Parkinson's disease. METHODS: Fifteen patients with idiopathic Parkinson's disease and 15 controls were tested with a span paradigm to assess the effects reflecting the functioning of the phonological loop: the phonological similarity effect (in verbal and visual presentation), and the word length effect (in visual presentation). RESULTS AND CONCLUSIONS: The patients did not show any dysfunction of the phonological loop, reflected by the presence of phonological similarity and word length effects, but had lower spans than controls. The implications of these results for the working memory model are discussed.
Asunto(s)
Antiparkinsonianos/farmacología , Antiparkinsonianos/uso terapéutico , Agonistas de Dopamina/farmacología , Agonistas de Dopamina/uso terapéutico , Levodopa/farmacología , Levodopa/uso terapéutico , Enfermedad de Parkinson/tratamiento farmacológico , Fonética , Piribedil/farmacología , Piribedil/uso terapéutico , Conducta Verbal/efectos de los fármacos , Anciano , Femenino , Lóbulo Frontal/efectos de los fármacos , Humanos , Pruebas del Lenguaje , Masculino , Memoria/efectos de los fármacos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To determine whether a deficit of the central executive can explain the attentional deficits of patients with Parkinson's disease. METHODS: Fifteen patients with idiopathic Parkinson's disease and 15 controls were given a dual task paradigm minimising motor demands and combining verbal, visual, or spatial span with two conditions of articulatory suppression. RESULTS: Although the spans were systematically lower in medicated parkinsonian patients than in controls, suggesting a decrease of central processing resources, there was no direct evidence for a deficit of the central executive. CONCLUSIONS: A deficit of the central executive either is not an inevitable feature of the disease, or is dependent on the nature of task (visuomotor v cognitive), or is corrected by dopaminergic medication.
Asunto(s)
Atención/efectos de los fármacos , Trastornos de la Memoria/psicología , Enfermedad de Parkinson/psicología , Anciano , Estudios de Casos y Controles , Dopaminérgicos/farmacología , Femenino , Humanos , Masculino , Trastornos de la Memoria/etiología , Trastornos de la Memoria/fisiopatología , Procesos Mentales/efectos de los fármacos , Pruebas Neuropsicológicas , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/fisiopatología , Desempeño Psicomotor/efectos de los fármacosRESUMEN
Several studies have shown subtle neuropsychological deficits in healthy relatives of schizophrenic patients. However, older relatives and parents have been less frequently assessed than younger adult relatives and siblings. Furthermore, some areas of neuropsychological functioning such as memory and learning have been little studied. Thirty-seven 22-70-year-old non-psychotic parents and siblings of schizophrenic patients were compared to 37 healthy control subjects on a battery of neuropsychological tests (Trail Making, parts A and B, verbal fluency, Wisconsin Card Sorting Test, and four subtests of the Wechsler Memory Scale-Revised: logical memory, design reproduction, verbal paired associates and digit span). Relatives did not differ from control subjects on Wisconsin Card Sorting Test performance and on visual memory, but were significantly impaired on verbal fluency; more subtle deficits were found on Trail Making, part B, digit span and paired associates. A higher proportion of relatives than control subjects showed impairment on verbal fluency and verbal memory. These neuropsychological weaknesseswere present as much in siblings as in parents of schizophrenic patients, and age did not cancel differences between relatives and control subjects. Thus, these subtle deficits seem to be potential phenotypic markers of schizophrenia.