Altered Trajectories: Considering the Long-Term Impact of Educational Disruption during the COVID-19 Pandemic on Neurodevelopment and a Call to Action for Neuropsychology.

OBJECTIVE: The COVID-19 pandemic resulted in educational disruption of historic breadth and duration. The impact of school closures and remote learning have been evaluated in recent studies and reflect critical data for neuropsychologists who routinely assess brain development as it relates to diagnosis, recommendations, and informing public policy. METHOD: Pre-pandemic and contemporaneous literature was summarized, including data on educational disruption and child and adolescent mental health challenges reported during the pandemic, and research on the impact of stress, social isolation, educational achievement, and other factors on brain development during critical developmental windows. RESULTS: Studies indicate that prolonged educational disruption has resulted in attenuated learning gains, most remarkably for those already at risk for educational disparities. Studies have shown increased mental health challenges for youth during the pandemic, with higher rates of mood and eating disorders, and suicidal ideation. Given that some skills develop optimally within specific time periods, pandemic-related disruption has likely contributed to altered developmental trajectories. CONCLUSION: Trajectory of neuropsychological development of children and adolescents, especially marginalized students, may be affected by effects on learning and mental health due to prolonged educational disruption and psychological stressors. Evaluation and treatment may be delayed due to backlog and increased demand. Clinical neuropsychological practice recommendations are presented with a call to action for the field in moving forward flexibly to increase access to evaluation services.

Neuropsychology of epilepsy surgery and theory-based practice: an opinion review.

The present review attempts to discuss how some of the central concepts from the Lurian corpus of theories are relevant to the modern neuropsychology of epilepsy and epilepsy surgery. Through the lenses of the main Lurian concepts (such as the qualitative syndrome analysis), we discuss the barriers to clinical reasoning imposed by quadrant-based views of the brain, or even atheoretical, statistically-based and data-driven approaches. We further advice towards a systemic view inspired by Luria's clinical work and theorizing, given their importance towards our clinical practice, by contrasting it to the modular views when appropriate. Luria provided theory-guided methods of assessment and rehabilitation of higher cortical functions. Although his work did not specifically address epilepsy, his theory and clinical approaches actually apply to the whole neuropathology spectrum and accounting for the whole panorama of neurocognition. This holistic and systemic approach to the brain is consistent with the network approach of the neuroimaging era. As to epilepsy, the logic of cognitive functions organized into complex functional systems, contrary to modular views of the brain, heralds current knowledge of epilepsy as a network disease, as well as the concept of the functional deficit zone.

A presente revisão tenta discutir como alguns dos conceitos centrais do corpus de teorias lurianas são relevantes para a moderna neuropsicologia da epilepsia e cirurgia da epilepsia. Através das lentes dos principais conceitos lurianos (como a análise qualitativa de síndromes), discutimos as barreiras ao raciocínio clínico impostas por visões do cérebro baseadas em quadrantes, ou mesmo abordagens ateóricas, baseadas em estatísticas e orientadas por dados. Aconselhamos ainda uma visão sistêmica inspirada na clínica e na teorização de Luria, dada sua importância para nossa prática clínica, contrastando-a com as visões modulares quando apropriado. Luria forneceu métodos teóricos de avaliação e reabilitação de funções corticais superiores. Embora seu trabalho não abordasse especificamente a epilepsia, sua teoria e abordagens clínicas na verdade se aplicam a todo o espectro da neuropatologia e respondem por todo o panorama da neurocognição. Essa abordagem holística e sistêmica do cérebro é consistente com a abordagem de rede da era da neuroimagem. Quanto à epilepsia, a lógica das funções cognitivas organizadas em sistemas funcionais complexos, ao contrário das visões modulares do cérebro, anuncia o conhecimento atual da epilepsia como uma doença em rede, bem como o conceito de zona de déficit funcional.

The Evolving Need for Neuropsychology in Neurosurgical Settings: Challenges Facing Transformative Care.

Clinical neuropsychology has been a valuable asset to neurologic surgery, contributing to lateralization and localization of pathologic brain tissue, identification of eloquent cortex, and evaluation of postoperative neuropsychological functioning. Moreover, neuropsychologists provide empirically driven interventions aimed at supporting preparation and/or recovery of neurosurgery patients. Nonetheless, several challenges may limit the reliability, validity, and generalizability of the assessment data obtained and reduce the usefulness of other neuropsychological services provided. Specifically, linguistic, cultural, educational, and other biases associated with demographic characteristics can lead to a narrowed view of an individual's life experiences, which must be confronted to fulfill the mission of ensuring that all patients have access to care that is appropriate to their needs. Instead of perceiving these challenges as insurmountable barriers, such issues can be viewed as opportunities to catalyze change and foster innovation for the future of neuropsychological care in neurosurgical settings. In addition to reviewing the possible mechanisms of these obstacles, the current article offers tangible solutions at both a macro level (e.g., discipline-wide transformations) and micro level (e.g., individualized patient-centric approaches). Outlined are practical techniques to potentially improve consensus and standardization of methods, advance and globalize research, expand representativeness of measures and practices to serve diverse individuals, and increase treatment adherence through engagement of patients and their families.

Cognitive disorders in epilepsy II: Clinical targets, indications and selection of test instruments.

This is the second of two narrative reviews on cognitive disorders in epilepsy (companion manuscript: Cognitive disorders in epilepsy I: Clinical experience, real-world evidence and recommendations). Its focus is on the clinical targets, indications, and the selection of neuropsychological test instruments. Cognitive assessment has become an essential tool for the diagnosis and outcome control in the clinical management of epilepsy. The diagnostics of basic and higher brain functions can provide valuable information on lateralized and localized brain dysfunctions associated with epilepsy, its underlying pathologies and treatment. In addition to the detection or verification of deficits, neuropsychology reveals the patient's cognitive strengths and, thus, information about the patient reserve capacities for functional restitution and compensation. Neuropsychology is an integral part of diagnostic evaluations mainly in the context of epilepsy surgery to avoid new or additional damage to preexisting neurocognitive impairments. In addition and increasingly, neuropsychology is being used as a tool for monitoring of the disease and its underlying pathologies, and it is suited for the quality and outcome control of pharmacological or other non-invasive medical intervention. This narrative review summarizes the present state of neuropsychological assessments in epilepsy, reveals diagnostic gaps, and shows the great need for education, homogenization, translation and standardization of instruments.

Teleneuropsychology in the time of COVID-19: The experience of The Australian Epilepsy Project.

PURPOSE: Traditional neuropsychological testing carries elevated COVID-19 risk for both examinee and examiner. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during the pandemic. METHODS: The AEP includes adults (age 18-60) with a first unprovoked seizure, new diagnosis of epilepsy or drug resistant focal epilepsy. Shortly after launching the study, COVID-related restrictions necessitated adaptation to teleNP, including delivery of verbal tasks via videoconference; visual stimulus delivery via document camera; use of web-hosted, computerised assessment; substitution of oral versions for written tests; online delivery of questionnaires; and discontinuation of telehealth incompatible tasks. RESULTS: To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9 %) have been invalidated, for a variety of reasons (technical, procedural, environmental). Data confirm typical patterns of epilepsy-related deficits (p < .05) affecting processing speed, executive function, language and memory. Questionnaire responses indicate elevated rates of patients at high risk of mood (34 %) and anxiety disorder (38 %). CONCLUSION: Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers an opportunity to expand the reach and breadth of neuropsychological services.

Rehabilitación neuropsicológica en un caso de trastorno límite de la personalidad / Neuropsychological rehabilitation in a case of borderline personality disorder

La rehabilitación neuropsicológica es una terapia que busca mejorar la independencia y autonomía en pacientes que presentan dificultades cognitivas. El objetivo de la investigación fue determinar la eficacia de un programa de rehabilitación neuropsicológica en una paciente con diagnóstico de trastorno neurocognitivo leve, tipo ejecutivo, asociado a trastorno límite de la personalidad, mediante el fortalecimiento de la atención y de los procesos ejecutivos implicados en la memoria, bajo los principios de sustitución y restitución. Los instrumentos para establecer línea base y para medir el efecto del tratamiento fueron la escala de trastornos de la memoria y la escala de criterios del trastorno límite de la personalidad (TLP) basados en el DSM-V; estos instrumentos se le aplicaron a la paciente y también a su informador para comparar los datos. Los resultados arrojaron una mejoría estadística en las puntuaciones de la escala de trastornos de la memoria y de la escala de criterios para el TLP-DSM-V; pasando de tener una puntuación en memoria de 36 en línea base a 16 después de la intervención, también pasó de tener 3 criterios para impulsividad a 1 criterio después de la intervención. Finalmente se establece la eficacia de la rehabilitación neuropsicológica en los pacientes con TLP, no solo se evidencia mejoría en los síntomas cognitivos asociados a las dificultades en la memoria, sino que también se muestra disminución en los síntomas psiquiátricos asociados con el control de los impulsos.

Neuropsychological rehabilitation is a therapy that seeks to improve independence and autonomy in patients with cognitive difficulties. The objective of the investigation was to determine the efficacy of a neuropsychological rehabilitation program in a patient diagnosed with a mild neurocognitive disorder, executive type, associated with borderline disorder personality, by strengthening attention and executive processes involved in memory, under the principles of substitution and restitution. The instruments to establish a baseline and to measure the effect of treatment were the memory disorders scale and the DSM-V-based borderline personality disorder (BPD) criteria scale; these instruments were applied to the patient and also to her informant to compare the data. The results showed a statistical improvement in the scores of the memory disorders scale and the criteria scale for the BPD-DSM-V; going from having a memory score of 36 at baseline to 16 after the intervention, it also went from having three criteria for impulsivity to one criterion after the intervention. Finally, the efficacy of neuropsychological rehabilitation in patients with BPD is established, not only is there an improvement in the cognitive symptoms associated with memory difficulties, but also a decrease in the psychiatric symptoms associated with impulse control.

Complejo de esclerosis tuberosa: perfil neuropsicológico y propuesta de intervención / Tuberous Sclerosis Complex: neuropsychological profile and intervention proposal

El Complejo de Esclerosis Tuberosa (CET) es un trastorno genético de heren-cia autosómica dominante causado por la mutación en uno de los genes TSC1 o TSC2. Los pacientes con una afectación CET grave de tipo neurológica posible-mente presentarán epilepsia, discapacidad intelectual, problemas específicos del aprendizaje y trastornos de la conducta, por lo que la evaluación neuropsicológica en individuos con esta patología cobra un carácter importante al proporcionar información sobre los déficits cognitivos que subyacen en la afectación cerebral, que alteran el funcionamiento intelectual y los aspectos adaptativos. El actual tra-bajo presenta el perfil de una paciente adulta femenina con antecedente de CET, epilepsia y discapacidad intelectual, así como la descripción de una propuesta de intervención neuropsicológica basada en el funcionamiento ejecutivo dorsolateral.

Tuberous Sclerosis Complex (TSC) is an autosomal dominant inherited genetic disorder caused by mutation in one of the TSC1 or TSC2 genes. Patients with severe neurological-type CET involvement may have epilepsy, intellectual disability, specific learning problems, and behavioral disorders. For this reason, the neuropsychological evaluation in individuals with this pathology becomes an important character by providing information on the cognitive deficits that underlie brain involvement that alter intellectual functioning and adaptive aspects. The current work presents the cognitive profile of a female adult patient with a history of TSC, epilepsy and intellectual disability and the description of a proposed neuropsychological intervention based on dorsolateral executive functioning.

Role of clinical neuropsychology in deep brain stimulation: Review of the literature and considerations for clinicians.

Deep Brain Stimulation (DBS) is an effective surgical therapy for several neurological movement disorders. The clinical neuropsychologist has a well-established role in the neuropsychological evaluation and selection of surgical candidates. In this article, we argue that the clinical neuropsychologist's role is much broader, when considered in relation to applied psychologists' core competencies. We consider the role of the clinical neuropsychologist in DBS in relation to: assessment, formulation, evaluation and research, intervention or implementation, and communication. For each competence the relevant evidence-base was reviewed. Clinical neuropsychology has a vital role in presurgical assessment of cognitive functioning and psychological, and emotional and behavioral difficulties. Formulation is central to the selection of surgical candidates and crucial to intervention planning. Clinical neuropsychology has a well-established role in postsurgical assessment of cognitive functioning and psychological, emotional, and behavioral outcomes, which is fundamental to evaluation on an individual and service level. The unique contribution clinical neuropsychology makes to pre- and postsurgical interventions is also highlighted. Finally, we discuss how clinical neuropsychology can promote clear and effective communication with patients and between professionals.

Perfil neuropsicológico de pacientes com amputação maior de membros inferiores por etiologia vascular / Neuropsychological aspects of a population of patients with vascular lower extremity amputations

Objetivo: O estudo objetivou traçar um perfil neuropsicológico breve de pacientes com amputação maior de membros inferiores por etiologia vascular e investigar a existência de correlações dos aspectos cognitivos com fatores sociodemográficos e clínicos. Método: Trata-se de um estudo transversal descritivo, realizado em um centro de reabilitação física de São Paulo - Brasil, em que foram aplicados: um instrumento de avaliação neuropsicológica breve (Neupsilin), um questionário de caracterização da amostra próprio e a Escala de Ansiedade e Depressão Hospitalar (HAD). Resultados: O desempenho cognitivo foi pior em funções que requerem habilidades aritméticas (42,2% dos pacientes com desempenho abaixo do esperado); percepção (46,3% dos pacientes abaixo do esperado); funções executivas, notadamente nas tarefas praxia construtiva (40,6% abaixo do esperado) e fluência verbal (35,9% abaixo do esperado), e linguagem (31,2% abaixo do esperado). Conclusão: O perfil cognitivo dos pacientes deste estudo revelou dificuldades relevantes das funções cognitivas avaliadas, especialmente em funções diretamente relacionadas à funcionalidade do paciente.

Objective: To describe the neuropsychological profile of patients with major lower limb amputation and to investigate the existence of correlations between these cognitive aspects, socio-demographic and clinical aspects. Method: This is a cross-sectional, analytic, descriptive study carried out at an outpatient rehabilitation center. The instruments used were Hospital Anxiety and Depression Scale (HADS), a brief neuropsychological assessment instrument (Neupsilin) along with a questionnaire to characterize the sample. Results: Cognitive performance was worse in functions that require arithmetic skills (42,2% of the patients underperformed); perception (46,3% underperformed); executive functions, notably in constructive praxis (40,6% underperformed) and verbal fluency (35,9% underperformed) and language (31,2% underperformed). The best performances were in spacial orientation (92,2% performed as expected) and verbal memory (87,5% performed as expected). Conclusion: The cognitive profile of these patients revealed alterations in most of the assessed cognitive functions, especially in functions directly related to functionalities of the patient.

A reabilitação das alterações cognitivas após o acidente vascular encefálico / The rehabilitation post stroke cognitive changes

O Acidente Vascular Encefálico (AVE) exerce forte impacto no panorama global da saúde do país, sendo a uma das maiores causas de deficiências no mundo, pois geram sequelas motoras, sensitivas, de linguagem, cognitivas, emocionais e comportamentais. A pessoa que sofreu um AVE necessita de atendimento integrativo, motivo que o presente artigo visa demonstrar como o Serviço de Psicologia no Instituto de Medicina Física de Reabilitação do Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (IMREA HC FMUSP) atua no estado da arte da reabilitação neuropsicológica/cognitiva, em que se faz necessário conceituar a Neuropsicologia e sua interface com o diagnóstico diferencial, com compreensão do funcionamento das atividades mentais na normalidade e suas alterações, para finalmente discorrer sobre a estruturação do programa de reabilitação neuropsicológica/cognitiva no processo de Reabilitação Integral da pessoa vítima de AVE no IMREA FMUSP

The Stroke has a strong impact on the country's global health context, being considered one of the major causes of disability in the world, as it generates motor, sensory, language, cognitive, emotional and behavioral sequelae. The person with stroke needs integration, and this article aims to demonstrate how the Psychology Service at the Institute of Rehabilitation Medicine, Hospital das Clinicas, Faculty of Medicine, University of São Paulo (IMREA HC FM USP) uses state of the art of neuropsychological / cognitive rehabilitation, in which it is necessary to conceptualize Neuropsychology and its interface with the differential diagnosis, with an understanding of the functioning of mental activities towards normality and its alterations, to finally discuss the structuring of the program of neuropsychological / cognitive in the process of Integral Rehabilitation of the person victim of AVE in IMREA FMUSP

Some Clinically Useful Information that Neuropsychology Provides Patients, Carepartners, Neurologists, and Neurosurgeons About Deep Brain Stimulation for Parkinson's Disease.

Deep brain stimulation (DBS) is an effective (but non-curative) treatment for some of the motor symptoms and treatment complications associated with dopaminergic agents in Parkinson's disease (PD). DBS can be done relatively safely and is associated with quality of life gains. In most DBS centers, neuropsychological evaluations are performed routinely before surgery, and sometimes after surgery. The purpose of such evaluation is not to decide solely on its results whether or not to offer DBS to a given candidate, but to provide the patient and treatment team with the best available information to make reasonable risk-benefit assessments. This review provides information relevant to the questions often asked by patients and their carepartners, neurologists, and neurosurgeons about neuropsychological outcomes of DBS, including neuropsychological adverse event rates, magnitude of cognitive changes, outcomes after unilateral versus bilateral surgery directed at various targets, impact of mild cognitive impairment (MCI) on outcome, factors implicated in neurobehavioral outcomes, and safety of newer interventions or techniques such as asleep surgery and current steering.

Potential implications of Luria's work for the neuropsychology of epilepsy and epilepsy surgery: A perspective for re-examination.

The pioneeristic work of Alexander Romanovic Luria into the field of human neuropsychology offered eminent contributions to clinical praxis by providing theory guided methods and instruments for the study of higher cortical functions. However, lots of this knowledge corpus either remains untranslated and thus inaccessible, or in some cases selectively overlooked by academic authorities and consequently not passed to the future generations of experts. Although Luria was not exclusively devoted to the study of epilepsy, his theories and clinical approaches actually penetrate the whole neuropathology spectrum. His holistic and systemic approach to the brain sounds nowadays more than opportune and consistent with the network approach of the modern neuroimaging era. As to epilepsy, the logic underlying the Lurian approach (cognitive functions organized into complex functional systems with intra- and/or inter-hemispheric distribution, as opposed to the modularistic view of the brain) seems consistent with our current knowledge in epileptology with respect to epileptic networks, as well as the modern construct of the functional deficit zone. These contributions seem to be highly promising for the neuropsychology of epilepsy and epilepsy surgery, since they provide clinicians with valuable methods and theories to assist them in the localization -and lateralization- of cognitive deficits. Consequently they are of great applicability in the context of the preoperative neuropsychological monitoring of patients candidates for epilepsy surgery, where neuropsychologist are called upon to provide surgeons with anatomical data.

ILAE survey of neuropsychology practice in pediatric epilepsy surgery evaluation.

To determine the extent to which specific neuropsychological measures are in common use around the world for the assessment of children who are candidates for epilepsy surgery. As part of the work of the International League Against Epilepsy Pediatric Surgical Task Force, a survey was developed and distributed online. The survey consisted of questions related to demographics, training experience, general practice, and specific measures used and at what frequency. Seventy-eight clinicians with an average of 13.5 years of experience from 19 countries responded to the survey; 69% were English-speaking. Pre- and post-neuropsychological evaluations were conducted with a majority of children undergoing surgical resection for epilepsy. There was high consistency (>90%) among the domains evaluated, while consistency rate among specific measures was more variable (range: 0-100%). Consistency rates were also lower among respondents in non-English-speaking countries. For English-speaking respondents, at least one measure within each domain was used by a majority (>75%) of clinicians; 19 specific measures met this criterion. There is consensus of measures used in neuropsychological studies of pediatric epilepsy patients which provides a basis for determining which measures to include in establishing a collaborative data repository to study surgical outcomes of pediatric epilepsy. Challenges include selecting measures that promote collaboration with centers in non-English-speaking countries and providing data from children under age 5.

How neuropsychology can improve the care of individual patients with epilepsy. Looking back and into the future.

Some of the roots of current clinical neuropsychology go back to the early days of epilepsy surgery. Looking back a huge number of publications have dealt with cognition in epilepsy. The major factors driving this work were questions relating to surgery, antiepileptic drugs and, more recently, also to underlying pathology. However, most factors affecting cognition in epilepsy have been discerned many years ago. The body of neuropsychological literature in this field has accumulated much knowledge, raising the question why, apart from epilepsy surgery settings, neuropsychology has still not been fully integrated in the routine care of patients with epilepsy. This review on the occasion of Seizure's 25th anniversary attempts to summarize clinically relevant diagnostic advances following a question guided, modular, and evidence-based approach. In doing so, we hope to attract the interest of readers to an exciting mode of assessment which does not only have theoretical but also practical relevance. The comorbidities of epilepsy are becoming an increasingly relevant topic. It is now widely accepted that, while epilepsy may be defined by the occurrence of epileptic seizures, these seizures represent only one of several possible sources of cognitive impairment. It is well-established that there are complex interactions between epilepsy, cognition and behavior, and that both seizures and problems with cognition or behavior may result from a common underlying pathology requiring treatment. With this review we aim to demonstrate that neuropsychology can make a highly valuable contribution to the care of individual patients by contributing to the diagnostic process and by serving as a tool for the monitoring of disease and treatment, thereby improving the quality and safety of patient care. On a national, European, and international level, first efforts are being made to homogenize diagnostics across epilepsy centers and countries in order to achieve a common language and core standards. This should improve communication within and outside the speciality, and help to generate the data required to allow the field to make further progress.

Elementos para la comprensión del trastorno de espectro autista / Elements for the understanding of autistic spectrum disorder

En el 2015, el Ministerio Colombiano de Salud y Protección Social, socializó el protocolo de evaluación e intervención para pacientes con Trastorno de espectro autista, aceptando las referencias del DSM-5; este protocolo incluyó técnicas de evaluación e intervención integral, que si bien son significativas, no resultan suficientes para la atención de una población vulnerable con múltiples dificultades. Por tal razón, se ha sugerido continuar con procesos de educación, sensibilización y justificación en un plano científico y político para la comprensión y análisis de una problemática en la que aún no se tiene grandes certezas.

In 2015, the Colombian Ministry of Health and Social Protection, socialized the evaluation and intervention protocol for patients with Autism Spectrum Disorder, accepting DSM-5 references; This protocol included comprehensive evaluation and intervention techniques, which, although significant, are not sufficient for the care of a vulnerable population with multiple difficulties. For this reason, it has been suggested to continue with processes of education, awareness and justification in a scientific and political level for the understanding and analysis of a problem in which we do not yet have great certainties.

Computerized training improves verbal working memory in patients with myalgic encephalomyelitis/chronic fatigue syndrome: A pilot study.

OBJECTIVE: Patients with myalgic encephalomyelitis/chronic fatigue syndrome experience cognitive difficulties. The aim of this study was to evaluate the effect of computerized training on working memory in this syndrome. DESIGN: Non-randomized (quasi-experimental) study with no-treatment control group and non-equivalent dependent variable design in a myalgic encephalomyelitis/chronic fatigue syndrome-cohort. SUBJECTS: Patients with myalgic encephalomyelitis/chronic fatigue syndrome who participated in a 6-month outpatient rehabilitation programme were included in the study. Eleven patients who showed signs of working memory deficit were recruited for additional memory training and 12 patients with no working memory deficit served as controls. METHODS: Cognitive training with computerized working memory tasks of increasing difficulty was performed 30-45 min/day, 5 days/week over a 5-week period. Short-term and working memory tests (Digit Span - forward, backward, total) were used as primary outcome measures. Nine of the 11 patients were able to complete the training. RESULTS: Cognitive training increased working memory (p = 0.003) and general attention (p = 0.004) to the mean level. Short-term memory was also improved, but the difference was not statistically significant (p = 0.052) vs prior training. The control group did not show any significant improvement in primary outcome measures. CONCLUSION: Cognitive training may be a new treatment for patients with myalgic encephalomyelitis/chronic fatigue syndrome.

Intervención neuropsicológica en la consolidación de la memoria en pacientes con afasia acústico-amnésica: Estudio exploratorio y preliminar / Neuropsychological intervention in memory consolidation in patients with acoustic-mnestic aphasia: An exploratory and preliminary study

Las alteraciones neuropsicológicas tras un ictus dependen del tipo y de la localización. Los ictus pueden producir discapacidades cognoscitivas, emocionales y sociales; las deficiencias pueden dificultar las actividades cotidianas motoras, del lenguaje así como de la memoria a corto y largo plazo. Los pacientes que han sufrido un ictus temporal izquierdo pueden presentar una afasia acústico-amnésica y mostrar alteraciones de la consolidación de la memoria. El objetivo de esta presentación de casos fue evaluar la intervención neuropsicológica mediante un Programa de Reforzamiento de la Memoria en pacientes con afasia acústico-amnésica y conocer si promueve la consolidación de la información para mejorar la calidad de vida del paciente. Se estudiaron dos casos, antes y tras la aplicación de un Programa de Reforzamiento de la Memoria con diagnóstico de afasia acústico-amnésica y con problemas de memoria. El programa contó con 20 categorías supraordinadas con 10 palabras subordinadas cada una, con un total de 200 palabras para evocar. Se encontraron diferencias significativas tras la administración del programa con un aumento en la cantidad de palabras evocadas, así como su consolidación en memoria a largo plazo en ambos sujetos estudiados. Este estudio sugiere que el uso del Programa de Reforzamiento de la Memoria en sujetos con afasia acústico-amnésica podría ser útil en la rehabilitación de los problemas de la memoria en estos pacientes.

Neuropsychological alterations after stroke depend on the type and site of the injury and may result in cognitive, mood or social disabilities. The disorders may disturb daily motor activities and may alter language and short- and long-term memory. Patients that have suffered a stroke in the left temporal hemisphere may present acoustic-mnestic aphasia and memory alterations. Our objective was to evaluate the results of the implementation of a memory reinforcement training program in patients with acoustic-mnestic aphasia, and to know if the program improves memory consolidation for a better patient´s quality of life. We performed a case-report study, before and after implementation of a memory reinforcement program in two patients with acoustic-mnestic aphasia and memory alterations. The program was constructed with 20 supra-ordinal categories, each with 10 sub-ordinal words, with a total of 200 words to evoke. We found significant differences in the number of evoked words and in memory consolidation after the implementation of the program in the two studied patients. Our observations suggest that implementation of a memory reinforcement program in subjects with acoustic-mnestic aphasia may be useful in the rehabilitation of memory alterations in these patients.

Implicaciones neuropsicológicas, neurológicas y psiquiátricas en un caso de intoxicación por escopolamina / Neuropsychological, neurological and psychiatric implications in a case of poisoning scopolamine

Resumen En los últimos años se han incrementado los casos de intoxicación por escopolamina con fines delictivos, con importantes repercusiones médicas, cognitivas y sociales, que requieren ser estudiadas, por ello, y ante la escasa investigación realizada en este tema, el objetivo del presente estudio es registrar las implicaciones neurológicas, neuropsicológicas y psiquiátricas en un caso de intoxicación por escopolamina mediante un diseño de caso único basado en el reporte de un hombre de 43 años de edad quien fue expuesto a una intoxicación por escopolamina cuatro meses previos a la valoración. Se realizó la valoración de la ejecución cognitiva del sujeto frente a su coeficiente intelectual y áreas relacionadas con su atención, memoria de trabajo, praxias, lenguaje, memoria, regulación emocional y funciones ejecutivas. También se aplicó la prueba de personalidad MMPI con el fin de ampliar información sobre aspectos de la personalidad del sujeto o alteraciones psiquiátricas derivadas de la intoxicación. Entre los resultados se hallaron dificultades en atención, memoria, control emocional y funciones ejecutivas; además se encontraron consecuencias psiquiátricas y neurológicas, evidenciando que la exposición a un agente tóxico que bloquee el sistema colinérgico, en especial los canales muscarinicos, puede causar la exacerbación de una enfermedad psiquiátrica premórbida.

Abstract In recent years scopolamine intoxication cases for criminal purposes has increased, with important medical, cognitive and social sequels, that need to be studied, therefore, and given the limited research on this topic, the aim of this study was to record together the implications neurological, neuropsychological and psychiatric case of poisoning scopolamine using a single case design based on the report of scopolamine intoxication about five months of a 43 year old. For this assessment was made of the subject's cognitive performance in front of their IQ and related areas with attention, working memory, praxis, language, memory, emotion regulation and executive functions. Also applied MMPI personality test to expand the information about the subject's personality or psychiatric disorders resulting from intoxication. Among the results there were found difficulties in attention, memory, emotional control and executive functions, and is a high relationship between psychiatric and neurological area, which explains that exposure to a toxic agent that blocks the cholinergic system, especially the channels muscarinic, can cause exacerbation of premorbid psychiatric illness.

La funcionalidad de la entrevista clínica en la evaluación, diagnóstico e intervención neuropsicológica / Clinical interview's functionality in evaluation, diagnosis and neuropsicological intervention

El presente artículo de reflexión se deriva de la investigación denominada Estandarización de pruebas Neurocognitivas en sujetos normales colombianos, y desarrolla las características de la entrevista en el proceso de evaluación, diagnóstico e intervención dentro de la Neuropsicología clínica. Los hallazgos bibliográficos retoman ciertas sutilezas de la historia clínica o anamnesis, otros se concentran en analizar los factores de riesgo que deban identificarse como información crucial para el diagnóstico, pero se evidencia un vacío en publicaciones relacionadas con las especificidades de la clínica neuropsicológica en las fases de evaluación, diagnóstico e intervención. Tras la escasez de investigaciones y literatura que explique y analice la importancia de este pilar fundamental en las diferentes fases de la clínica neuropsicológica, el artículo busca analizar y profundizar sobre la estructuración de la entrevista clínica en las fases ya referidas, sus características y funcionalidades para cumplir con el objetivo primordial de la neuropsicología clínica, que radica en establecer una evaluación ideográfica, para llegar a un diagnóstico (probablemente nomotético) que marque la línea para establecer un plan de tratamiento acorde y a la medida, con relación a la información que se obtiene del paciente a través de las sesiones de evaluación y tratamiento. Los autores asumimos una posición que posibilite visualizar las especificidades y generalidades de la entrevista para el proceso clínico neuropsicológico.

This theoretical article develops the interview's features in the assessment process, diagnostic and intervention in clinical neuropsychology. The findings bibliographic retake certain subtleties of the clinical history or anamnesis, others concentrate on analyzing the risk factors to be identified as crucial information for diagnostics, but it shows a gap in publications related to clinical Neuropsychological specificities in stage of assessment, diagnostic and intervention. Because of the shortage of research and literature to explain and analyze the importance of this fundamental pillar in several stages of neuropsychological clinic, the article attempts to analyze and deepen about clinical interview structuration in stage of assessment, diagnostic and intervention, its characteristics and functionalities to reach with the primordial objective elaborates on the structure of clinical interviews, features and functionalities to reach the primary objective of clinical Neuropsychology, which emerges on setting up a ideographical assessment, to get a diagnostic (probably nomothetic) which indicates the line to set up a treatment plan, consistent and tailored to the nomothetic relation and ideographical, which comes from the patient through assessment sessions and treatment. Authors assume a position that enables the specific and general view of the interview for clinical neuropsychological process.