Proposed diagnostic criteria for mild cognitive impairment in Down syndrome population.

BACKGROUND: Despite presenting higher risk of dementia, mild cognitive impairment (MCI) is not well defined in Down syndrome population. OBJECTIVE: We aimed to describe cognitive and neuropsychological patterns associated with MCI in Down syndrome individuals. METHOD: Two groups of adults with Down syndrome (control and prodromal) were studied throughout 3 years. Two linear mixed models and a model including the variables that best predicted group membership were built. RESULTS: Behavioural Regulation Index (BRI) (Behaviour Rating Inventory of Executive Function test) and the model composed of BRI, abstraction and delayed verbal memory were the variable and model best predicting group membership, respectively. CONCLUSION: Suggest a diagnosis of MCI when BRI is the earliest change perceived by caregivers and this is combined with low scores in abstract thinking, and when an amnesic pattern in delayed verbal memory is observed, but adaptive skills are preserved.

Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain.

The pandemic caused by Covid-19 has been an unprecedented social and health emergency worldwide. This is the first study in the scientific literature reporting the psychological impact of the Covid-19 outbreak in a sample of the Spanish population. A cross-sectional study was conducted through an online survey of 3480 people. The presence of depression, anxiety and post-traumatic stress disorder (PTSD) was evaluated with screening tests from 14 March. Sociodemographic and Covid-19-related data was collected. Additionally, spiritual well-being, loneliness, social support, discrimination and sense of belonging were assessed. Descriptive analyses were carried out and linear regression models compiled. The 18.7% of the sample revealed depressive, 21.6% anxiety and 15.8% PTSD symptoms. Being in the older age group, having economic stability and the belief that adequate information had been provided about the pandemic were negatively related to depression, anxiety and PTSD. However, female gender, previous diagnoses of mental health problems or neurological disorders, having symptoms associated with the virus, or those with a close relative infected were associated with greater symptomatology in all three variables. Predictive models revealed that the greatest protector for symptomatology was spiritual well-being, while loneliness was the strongest predictor of depression, anxiety and PTSD. The impact on our mental health caused by the pandemic and the measures adopted during the first weeks to deal with it are evident. In addition, it is possible to identify the need of greater psychological support in general and in certain particularly vulnerable groups.

Confirmatory factor analysis of the Revised UCLA Loneliness Scale (UCLA LS-R) in individuals over 65.

GOALS: The UCLA LS-R is the most extensively used scale to assess loneliness. However, few studies examine the scale's use on older individuals. The goal of the study is to analyse the suitability of the scale´s structure for assessing older individuals. METHOD: The UCLA LS-R scale was administered to a random sample of 409 community-dwelling residents of Madrid (53% women) aged 65-84 years (obtained from the MentDis_ICF65+ study). Confirmatory factor analysis was used to assess the factor structure of the UCLA LS-R. RESULTS: The internal consistency of the scale obtained a Cronbach's alpha of .85. All the analysed models of factor structure of the UCLA LS-R achieved a fairly good fit and RMSEA values over .80. The models that best fit the empirical data are those of Hojat (1982) and Borges et al. (2008). CONCLUSION: The data suggest an equivalent effectiveness of UCLA LS-R in adults under 65 and over 65, which may indicate a similar structure of the loneliness construct in both populations. This outcome is consistent with the idea that loneliness has two dimensions: emotional loneliness and social loneliness. The use of short measures that are easy to apply and interpret should help primary care professionals identify loneliness problems in older individuals sooner and more accurately.

Characterizing visual asymmetries in contrast perception using shaded stimuli.

Previous research has shown a visual asymmetry in shaded stimuli where the perceived contrast depended on the polarity of their dark and light areas (Chacón, 2004). In particular, circles filled out with a top-dark luminance ramp were perceived with higher contrast than top-light ones although both types of stimuli had the same physical contrast. Here, using shaded stimuli, we conducted four experiments in order to find out if the perceived contrast depends on: (a) the contrast level, (b) the type of shading (continuous vs. discrete) and its degree of perceived three-dimensionality, (c) the orientation of the shading, and (d) the sign of the perceived contrast alterations. In all experiments the observers' tasks were to equate the perceived contrast of two sets of elements (usually shaded with opposite luminance polarity), in order to determine the subjective equality point. Results showed that (a) there is a strong difference in perceived contrast between circles filled out with luminance ramp top-dark and top-light that is similar for different contrast levels; (b) we also found asymmetries in contrast perception with different shaded stimuli, and this asymmetry was not related with the perceived three-dimensionality but with the type of shading, being greater for continuous-shading stimuli;

Mental health in a heterogeneous clinical sample. A cross-sectional study of predictors and gender differences.

Introduction: Women have been shown to be a vulnerable group in relation to mental health problems over time. Despite this, gender-focused studies are uncommon. The aim of this research is to study mental health in a sample of people with mental health problems and to analyze the differences and predictors focusing on gender. Methods: A cross-sectional study is conducted in a heterogeneous clinical sample in terms of mental health problems (N = 160). Interviews with hetero-reported standardized questionnaires to collect the data are conducted. Descriptive analyses, mean difference and a regression analysis on mental health are carried out taking into account different sociodemographic, clinical and psychosocial variables. Results: Women in the study present worse levels of mental health and subjective severity of the disorder. The main predictors of mental health are being female, followed by severity, shorter time with the diagnosis and internalized stigma. Conclusion: Being female is the most robust predictor of worse mental health and symptomatology. Recommendations according to the results found proposing a gender perspective are suggested.

Evolution of intersectional perceived discrimination and internalized stigma during COVID-19 lockdown among the general population in Spain.

BACKGROUND: Stigma and discrimination have been associated with different diseases and pandemics, with negative consequences for the people who suffered them and for their communities. Currently, COVID-19 has become a new source of stigmatization. AIMS: The aim of the present study is to analyze longitudinally the evolution of intersectional perceived discrimination and internalized stigma among the general population of Spain, at three points in time throughout the confinement. METHOD: Participants completed an online survey. RESULTS: Results show an increase in both variables from the first to the second evaluation, and a slight decrease from the second to the third evaluation. Moreover, these changes are explained by depression, anxiety and family support. CONCLUSIONS: These findings indicate the factors that need to be considered to reduce the perception of discrimination and the internalization of stigma, and their detrimental consequences, during an especially stressful event such as the current pandemic outbreak.

The Role of the Sense of Belonging During the Alarm Situation and Return to the New Normality of the 2020 Coronavirus Pandemic (COVID-19) in Spain.

In this study we intend to understand the impact of the COVID-19 crisis and the subsequent stay-at-home orders, on the Spanish population's sense of belonging at three moments in time: at the beginning of the lockdown, after one month of lockdown and with the return to the "new normality". A cross-sectional study was conducted through an online survey (N0 = 3480; N1 = 1041; N2 = 569). The sense of belonging was evaluated by means of four Likert-type items. These questions included membership in different groups: work/studies, friends, family and neighborhood or community. Sociodemographic and COVID-19-related data were collected. Additionally, mental health, spiritual well-being, loneliness, social support and discrimination were assessed. Descriptive analyses were carried out and linear regression models compiled. The sense of belonging increased significantly during confinement, dropping dramatically with the start of the return to the "new normality" process. The only variable that showed interaction with time and sense of belonging was discrimination. Work condition (not working providing the lowest sense of belonging scores), social support from friends and loneliness were the main predictors of the sense of belonging. The impact caused by the pandemic and the actions adopted during the first weeks regarding the sense of belonging is evident. It has been a key variable in dealing with COVID-19. Actions are now needed to increase our sense of belonging to face the post-epidemic crisis and avoid a greater impact in other areas.

Executive Functions Influence on Memory Process in Patients with Paranoid Schizophrenia and Bipolar Disorders with and without Psychotic Symptoms. A Pilot Study.

The objective of the present study was to evaluate whether declarative memory deficits are related to executive function deficits (EF), since they could be a consequence of a poor organization of the material to memorize. This interaction between both cognitive processes can be studied simultaneously in a single task such as the Test of Memory Strategies (TSM). 23 patients with paranoid schizophrenic disorder, 11 with bipolar disorder with psychotic symptoms, 13 with bipolar disorder without psychotic symptoms and 15 healthy subjects were evaluated with the TSM; with the memory test Texts A and B (subtest of the Barcelona neuropsychological assessment battery), which assesses short-term and immediate recall without the influence of EF; and with the Trail Making Test (TMT): Part A (sustained attention) and Part B (executive control). The patients groups and the control group showed an improvement in memory performance across each of the TSM conditions. However, this facilitating effect of the strategies differed among the groups (the patients with higher EF deficits showed less improvement). Regarding these results, we conclude that this cognitive process cannot be independent of EF. However, due to the pilot nature of this study, it would be recommended to replicate these findings in new studies.

Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life.

The prevalence of anxiety disorders over the last year among seniors ranged from 3.6% to 17.2%. The most prevalent disorders are specific phobias. Data are needed concerning the consequences of specific phobia disorder on the level of functioning and quality of life of older people, the age of onset of specific phobia disorder, and the duration of episodes. In total, 555 community-dwelling people aged between 65 and 84 years who lived in Madrid (Spain) were assessed (Composite International Diagnostic Interview for people over 65 years (CIDI65+), WHO Disability Assessment Schedule (WHODAS II), Health of the Nation Outcome Scales for Older Adults (HoNOS65+), World Health Organization Quality of Life Brief (WHOQOL-BREF). Prevalence rates and odds ratio, t-tests, binary logistic regression, and point-biserial correlations were calculated. A total of 12.07% of the sample suffered a specific phobia disorder over the last year. The average age at onset of the specific phobia was 38.78 (sd = 21.61) years. The mean duration of the phobia was approximately 20 (sd = 20) years. A significant effect of the specific phobia was found for the current levels of functioning and quality of life: WHOQOL-BREF total score (p < 0.05), WHODAS II overall score (p < 0.01), and HoNOS65+ total score (p < 0.001). Having specific phobia disorder decreased the level of functioning and negatively affected the quality of life. These data suggest the need for primary healthcare professionals to include the detection of specific phobia disorders in their protocols because people do not receive treatment for this problem, and they might carry it throughout their lives.

A Network Analysis of Major Depressive Disorder Symptoms and Age- and Gender-Related Differences in People over 65 in a Madrid Community Sample (Spain).

Major depressive disorder (MDD) is one of the most prevalent conditions among mental disorders in individuals over 65 years. People over 65 who suffer from MDD are often functionally impaired, chronically physically ill, and express cognitive problems. The concordance between a clinician-assessed MDD diagnosis in a primary care setting and MDD assessed with a structured clinical interview in older adults is only approximately 18%. Network analysis may provide an alternative statistical technique to better understand MDD in this population by a dimensional approach to symptomatology. The aim of this study was to carry out a network analysis of major depressive disorder (MDD) in people over 65 years old. A symptom network analysis was conducted according to age and gender in 555 people over 65, using a sample from the MentDis_ICF65+ Study. The results revealed different networks for men and women, and for the age groups 65-74 and 75-84. While depressive mood stood out in women, in men the network was more dispersed with fatigue or loss of energy and sleep disturbances as the main symptoms. In the 65-74 age group, the network was complex; however, in the 75-84 age group, the network was simpler with sleep disturbances as the central symptom. The gaps between the networks indicate the different characteristics of MDD in the elderly, with variations by gender and age, supporting the idea that MDD is a complex dynamic system that has unique characteristics in each person, rather than a prototypical classification with an underlying mental disorder. These unique characteristics can be taken into account in the clinical practice for detection and intervention of MDD.

Mental Health Consequences of the Coronavirus 2020 Pandemic (COVID-19) in Spain. A Longitudinal Study.

Background: Covid-19 remains a pandemic that most countries in the world are still dealing with. This is study aims to report the psychological impact of Covid-19 over time on the Spanish population. Methods: A longitudinal study (N = 1041) was carried out with two measurements: after 2 and 5 weeks starting from the declaration of the state of emergency in Spain. The presence of depressive symptoms, anxiety, and posttraumatic stress disease (PTSD) was evaluated by means of screening tests. Sociodemographic data, variables about Covid-19, loneliness, spiritual well-being, social support, discrimination, and a sense of belonging were collected. Results: The data showed how depressive symptomatology increased significantly over time, while anxiety and PTSD did not show statistically significant changes. Spiritual well-being and loneliness were the main predictors of psychological impact. A younger age was a significant predictor of depression and anxiety, while female gender was associated with anxiety and PTSD. Conclusions: The impact of the pandemic is sustained over time, even increasing in depression, and vulnerable groups that need greater psychological health support could be identified.

Case Report: Propranolol increases the therapeutic response to temozolomide in a patient with metastatic paraganglioma.

This case report presents the clinical evolution and management of a patient with a hereditary paraganglioma syndrome. This disease is characterized by rare tumors of neural crest origin that are symmetrically distributed along the paravertebral axis from the base of the skull and neck to the pelvis. In addition, these patients may develop renal cancer, gastrointestinal stromal tumors, pituitary adenomas, and bone metastasis in some cases. To date no successful therapeutic treatment has been reported. Total resection with postoperative radiotherapy and chemotherapy have been advocated, especially for the multiple metastasis. Here we show how the combination of high doses of the beta blocker propranolol (3 mg/Kg/day) and the DNA intercalating agent, temozolomide, has been successful in the treatment of a SDHA metastatic paraganglioma.

Knitting Mochilas: A Sociocultural, Developmental Practice in Arhuaco Indigenous Communities.

The purpose of this article is to analyze the psycho-cultural processes involved in knitting "mochilas" (traditional bags), a common craft in the Arhuaco indigenous community located in the Sierra Nevada de Santa Marta, Colombia. The article is structured in three parts, as follows: first, issues related to child development are discussed; then, the analysis method used to study the processes involved in the practice of knitting is presented and, finally, we reflect on the importance of recovering the sense and meaning of this everyday practice as a way to study child development.

Reversible myocardial dysfunction after cardiopulmonary resuscitation.

OBJECTIVE: Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease. DESIGN: Descriptive study of a case series. SETTING: The intensive care unit (ICU) of a provincial hospital. PATIENTS AND PARTICIPANTS: The study period was from April 1999 to June 2001. All patients admitted to the ICU with critical, non-coronary artery pathology, with no past history of cardiac disease, and those who were resuscitated after cardio-respiratory arrest, were included in the study. MEASUREMENTS AND RESULTS: Transthoracic and transoesophageal echocardiography was used to assess left ventricular ejection fraction (LVEF) and disturbances of segmental contractility. This study was carried out within the first 24h after admission, during the first week, during the second or third week, after 1 month, and between 3 and 6 months. Twenty-nine patients with a median age of 65 years (range 24--76) were included in the study. Twelve patients died. Twenty patients developed myocardial dysfunction; the initial LVEF in these patients was 0.28 (0.12--0.51), showing improvement over time in the patients who survived. All of these patients presented disturbances of segmental contractility which also became normal over time. CONCLUSIONS: After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.

Impulsive Driving: Definition and Measurement Using the I-Driving Scale (IDS).

Impulsivity has been widely studied in the context of traffic. The trait is believed to be the root of some accidents, along with other variables like aggression and anger. The present research objective is to develop a new scale - the I-Driving Scale (IDS) - to evaluate and measure the construct of impulsivity in specific driving situations. To that end, two studies were conducted, with 162 and 107 participants, respectively. In both studies, participants were recruited via their social networks, and answered anonymously. In addition to the IDS, they completed the Use the Vehicle to Express Anger subscale of the Driving Anger Expression Inventory (DAX), the Driving Anger Scale (DAS), and the Barratt Impulsivity Scale (BIS11), and also provided demographic information. The final scale had 11 items falling into two factors: impatience, and aggressiveness/abruptness. The results show a high consistency (αT = .81, αI = .70, and αA = .85 in the first study; αT = .83, αI = .80, and αA = .88 in the second study). Statistical results of Exploratory Factor Analysis in the first sample indicated goodness of fit to a two-factor model (RMSR = .057, GFI = .98). The second study confirmed that factorial structure (χ2/df = 80.50/43 = 1.87, RMSEA = .088, CFI = .94, TLI = .92). Correlations with other measures indicated the Impatience subscale is associated with different expressions of anger behind the wheel, and directly correlated with the loss of driver's license points. Furthermore, the Aggressiveness or Abruptness subscale was associated with more mechanical aspects, and correlated inversely with age.

The Relationship Between Educational Years and Phonemic Verbal Fluency (PVF) and Semantic Verbal Fluency (SVF) Tasks in Spanish Patients Diagnosed With Schizophrenia, Bipolar Disorder, and Psychotic Bipolar Disorder.

Semantic and verbal fluency tasks are widely used as a measure of frontal capacities. It has been well described in literature that patients affected by schizophrenic and bipolar disorders present a worse execution in these tasks. Some authors have also noted the importance of educational years. Our objective is to analyze whether the effect of cognitive malfunction caused by apathology is superior to the expected effect of years of education in phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) task execution. A total of 62 individuals took part in this study, out of which 23 were patients with schizophrenic paranoid disorder, 11 suffered from bipolar disorder with psychotic symptomatology, 13 suffered from bipolar disorder without psychotic symptomatology, and 15 participants were nonpathological individuals. All participants were evaluated with the PVF and SVF tests (animals and tools). The performance/execution results were analyzed with a mixed-model ANCOVA, with educational years as a covariable. The effect of education seems to be more determined by PVF FAS tests than by SVF. With PVF FAS tasks, the expected effect of pathology disappears when the covariable EDUCATION is introduced. With SVF tasks, the effect continues to be significant, even though the EDUACTION covariable dims such effect. These results suggest that SVF tests (animals category) are better evaluation tools as they are less dependent on the patients' education than PVF FAS tests.

Influence of age on clinical course, management and mortality of acute myocardial infarction in the Spanish population.

BACKGROUND: To assess age-related differences in cardiovascular risk factors, clinical course and management of patients with acute myocardial infarction (AMI) in intensive care (ICU) or coronary care units (CCU). METHODS: A retrospective cohort study was conducted of all AMI patients listed in the ARIAM register (Analysis of Delay in AMI), a multi-centre register in which 119 Spanish hospitals participated. The study period was from January 1995 to January 2001. A univariate analysis was carried out to evaluate differences between different age groups. Multivariate analysis was used to assess whether age difference was an independent predisposing factor for mortality and for differences in patient management. RESULTS: 17,761 patients were admitted to the ICUs/CCUs with a diagnosis of AMI. The distribution by ages was: <55 years, 3,954 patients (22.3%); 55-64 years, 3,593 (22.2%); 65-74 years, 5,924 (33.4%); 75-84 years, 3,686 (20.8%); and >84 years, 604 (3.4%) (P<0.0001); 24.6% of the patients were female, and the relative proportion of females increased with age. There were clear differences in risk factors between the different age groups, with a predominance of tobacco, cholesterol and family history of heart disease in the younger patients. The incidence of complications, including haemorrhagic complications, increased significantly with age. The older age groups had a lower rate of thrombolysis and less use of revascularisation techniques. The mortality of the above groups was 2.6, 5.4, 10.7, 17.7 and 25.8%, respectively. Age difference was an independent predictive variable for mortality and the administration of thrombolysis. CONCLUSIONS: The distinct age groups differed in cardiovascular risk factors, management and mortality. Age is a significant independent predictive variable for mortality and for the administration of thrombolysis.

Reversible myocardial dysfunction, a possible complication in critically ill patients without heart disease.

PURPOSE: Reversible myocardial dysfunction or myocardial stunning is frequently described in patients with episodes of acute coronary syndrome and has recently been reported in critically ill patients without ischaemic heart disease. This article presents a study and description of the possible existence of myocardial dysfunction in critically ill patients in our setting who present no acute episode or history of cardiovascular disease. DESIGN: Prospective, descriptive study. SETTING: The intensive care unit of a district hospital. PATIENTS AND PARTICIPANTS: The study included all patients admitted to the intensive care unit between March 1998 and March 2001 for noncardiac causes and with no history of heart disease, and who underwent echocardiographic examination for electrocardiographic changes, signs of cardiac insufficiency, persistent arrhythmias, or any other indication. Patients with sepsis or other critical illness known to be associated with myocardial dysfunction were excluded from the study. The study was carried out on those selected patients who developed myocardial dysfunction. MEASUREMENTS AND RESULTS: Transthoracic and transoesophageal echocardiography were carried out to assess the left ventricular ejection fraction and any segmental contractility disturbances. These investigations were carried out within 24 hours of admission, during the first week, during the second or third week, after one month and after three to 6 months. The electrocardiogram was assessed on admission and the changes over time were studied. Thirty-three patients were included in the study after detecting myocardial dysfunction; the median age of these patients was 63 years [range, 23-82 years]. Seven patients died. The median initial left ventricular ejection fraction was 0.34 [range, 0.16-0.48] and improved with time. Segmental contractility disturbances were detected initially in all patients and also normalized with time. All patients presented electrocardiogram changes that normalised in line with the echocardiographic changes. CONCLUSIONS: Reversible myocardial dysfunction can be develop in critically ill patients without primary heart disease. This syndrome is associated with systolic dysfunction, segmental contractility disturbances and electrocardiographic changes.

Alteplase: double bolus versus accelerated regimen.

BACKGROUND: The purpose of our study was to compare the efficacy and safety of alteplase in acute myocardial infarction (AMI), when administered in a double bolus regimen or an accelerated regimen during admission to an intensive care or coronary care unit (ICU/CCU). MATERIAL/METHODS: A retrospective cohort study including all the AMI patients treated with alteplase recorded in the ARIAM register (Analysis of Delay in AMI), a multi-center register in which 77 Spanish hospitals participate. The study period was from January 1995 to January 2000. RESULTS: 4,615 AMI patients were studied. The accelerated regimen (Group I) was administered to 57.51% (2,654 patients) and the remaining 42.49% (1,961 patients) received the double bolus regimen (Group II). There were no differences in mortality or in the incidence of hemorrhagic stroke between the groups. The mortality was 7.15% in Group I versus 6.43% in Group II (not significant). The incidence of hemorrhagic stroke was 1.09% in Group I versus 1.22% in Group II (not significant). Fewer coronary angiographies were required in Group I (6.28% vs. 8.99%; p<0.001) and fewer rescue angioplasties (10.67% vs. 21.88%, p=0.03). Group I also showed a smaller requirement for stent insertion (2.45% vs. 4.77%; p<0.0001) and for assistance using intra-aortic balloon contrapulsation (0.47% vs. 1.36%; p=0.02). CONCLUSIONS: The two regimens appear to be similar in efficacy and safety. Nevertheless, from these results it may be hypothesized that further revascularization techniques are required after double bolus administration.