Changes in patients' religiosity related to dementia / Cambios en la religiosidad del paciente relacionados con la demencia.

Dementia is characterized by the presence of progressive cognitive and behavioral symptoms which affect normal functioning. With the purpose of determining if there are any changes related to patients' religiosity due to dementia, we developed a questionnaire aiming to evaluate changes pre and post diagnostic. In effect, we observed that patients with dementia might experience a reduction of the importance given to religion and its associated practices with the disease progression. However, God's belief did not show any changes despite the diagnosis. Therefore, we point out the relevance of incorporating religiosity as another aspect to take into account in the cognitive rehabilitation treatments.

La demencia se caracteriza por un inicio gradual y un deterioro cognitivo y conductual progresivo, que provoca un significativo impacto en el funcionamiento normal del paciente. Con el objetivo de determinar si hay cambios en la religiosidad de los pacientes con demencia, desarrollamos un cuestionario con el propósito de evaluar cambios en aspectos relacionados con la religiosidad de los pacientes 10 años atrás y en la actualidad. Este formulario fue contestado por familiares y cuidadores. El estudio mostró que los pacientes con demencia podrían experimentar una reducción de la importancia dada a la religión y a sus prácticas asociadas durante el curso de la enfermedad. Sin embargo, la creencia en Dios no se vería modificada a pesar del diagnóstico. Por lo tanto, y dado que se ha visto que la religiosidad puede ayudar en pacientes con demencia, señalamos la relevancia de tener en cuenta dicha variable y de incorporar estrategias para los tratamientos de rehabilitación cognitiva y para la psicoeducación del entorno del paciente.

A Prospective Study on Cognitive Impairment in Middle-aged Adults With Newly Diagnosed Celiac Disease.

AIMS: Our objectives were to: (1) determine whether celiac disease (CD) patients have cognitive impairment at diagnosis; and (2) compare their cognitive performance with nonceliac subjects who have similar chronic symptoms and healthy controls. MATERIALS AND METHODS: Fifty adults (age range: 18 to 50 y) with symptoms and signs compatible with CD were enrolled in a prospective cohort irrespective of the final diagnosis. At baseline, all individuals underwent cognitive functional and psychological evaluation. CD patients were compared with subjects in whom CD was ruled out and with healthy controls matched by sex, age, and years of schooling. RESULTS: Thirty-three subjects (66%) were diagnosed with CD. Compared with the healthy controls (n=26), CD cases and disease controls (n=17; mostly irritable bowel syndrome) had impaired cognitive performance (P=0.02 and P=0.04, respectively), functional impairment (P<0.01), and higher depression (P<0.01). CD patients had similar cognitive performance and anxiety, but nonsignificant lower depression scores compared with disease controls. CONCLUSIONS: Abnormal cognitive functions detected in newly diagnosed CD adult patients seem not to be disease specific. Our results suggest that cognitive dysfunction could be related to the presence of prolonged symptoms due to a chronic disease.

[Head turn sign as a marker of dementia diagnosis]. / Signo del giro de la cabeza como marcador para el diagnóstico de demencia.

Due to the phenomenon of ageing population, cognitive impairment has become more prevalent, and any marker able to improve its detection becomes of significant importance. With that objective in mind, a prospective observational study was performed in a medical consultation related to cognitive impairment. 150 subjects (58% women) were included with an average age of 76 years (SD 8.6). The Head Turn sign was positive for 32 subjects with a sensitivity of 41.7% for dementia, a specificity of 93.7% and a negative predictive value of 64.4%. This study shows the semiologic value of a simple clinical sign, easy to spot in the daily practice and most helpful to alert physicians about a likely dementia diagnosis.

[Comparative analysis about hospitalization characteristics in the mental health unit of a general acute care hospital]. / Análisis comparativo sobre las características de las internaciones en una sala de Salud Mental en un hospital general de agudos.

INTRODUCTION: In Argentina, like in the rest of the world, deinstitutionalization policies have been implemented. In our country, the shortage of epidemiologic data regarding admissions in mental health is a limitation for the discussion about how this changes should be implemented and its effect. OBJECTIVES: Epidemiologic data of inpatients of the Mental Health Unit of the Teodoro Álvarez General Hospital between June 2012 and May 2013 has been analyzed in order to elaborate a comparative analysis with a previous study that took place in the same unit on the years 2004-2005. MATERIALS AND METHODS: This is naturalistic, descriptive and retrospective study about adult male inpatients admitted in the psychopathology ward of the Álvarez Hospital. Data was taken from the patient's medical history report. RESULTS: There were 51 hospitalizations during the study (versus 82 hospitalizations in the previous one). The average age was 34.4 years. The average patient hospitalization was 46.2 days (versus 45.4), 84% (vs 89.7%) of hospitalizations lasted less than 90 days, although there was an increase in hospitalization that lasted between 90 and 179 days (7.3% vs 13.7%). The most frequent reason for hospitalization was acute psychotic syndrome, 62.7% (versus 48.8%) of the patients had previous psychiatric hospitalizations. The most frequent diagnosis at discharge were: 38.4% schizophrenia and other psychotic disorders (vs 38.1%), 21.5% personality disorders (vs 25%), 17% mood disorders (vs 17.7%), 15.4% substance use related (vs 22.1%). CONCLUSION: There has been a considerable decrease (from 82 to 51) in the total number of hospitalizations and also a decrease in the BTR (bed turnover ratio) from 4.1 to 2.6 and an increase in hospitalizations with a duration superior to 90 days and inferior to 179 days.

Different levels of implicit emotional recognition in posterior cortical atrophy (PCA).

Previous single-case reports in posterior cortical atrophy (PCA) have shown preserved nonconscious visual recognition despite the absence of explicit recognition. In this study, we investigated three levels of visual recognition in both a female patient with PCA and a control group during the presentation of neutral, positive, and negative affective stimuli. Our results confirmed the profile of impaired explicit recognition and intact psychophysiological responses in the patient. In addition, she was able to implicitly recognize the valence and intensity of arousal of these stimuli. We suggest that implicit emotional awareness may mediates explicit and psychophysiological recognition in PCA.

[COGNITIVE SCREENING IN HIV-1 INFECTED YOUNG ADULTS AT BUENOS AIRES. PRELIMINARY DATA]. / Screening cognitivo en adultos jóvenes infectados con VIH-1 en Buenos Aires. Datos preliminares.

Cognitive impairment is highly prevalent in HIV-1 infected patients, even in younger individuals. These symptoms usually are not recognized by health professionals or even patients themselves. However, they can represent a major cause of functional impairment and failure in treatment compliance. In our country we lack both sufficient epidemiological information on the true impact of these symptoms and screening tests with local validation needed to be used by health professionals during the medical assessment. Therefore we designed a prospective study to compare the performance of four brief cognitive tests and a new screening tool with the neuropsychological assessment (gold standard) in a population of young adults infected with HIV-1 in Argentina, in order to assess their sensitivity and specificity in our culture and language. Different confounding conditions were taken into account. Preliminary data were analyzed after the enrollment of 19 subjects. NEURA screening correlated significantly with the neuropsychological assessment (rho = 0.496, p = .031). In terms of sensitivity and specificity, NEURA performance was superior to other screening tests routinely used in our country: IHDS (S 27%/E 5%), MMSE (S/E 0%), ACE (S 9%/E 100%) and IFS (S 36%/E 80%).

[Structural neuroimaging in dementia for outpatient clinic visit]. / Neuroimágenes estructurales en demencias para el consultorio general.

Dementia is a common illness to find in a psychiatric consultation and its incidence is rising as the aged population increases. Traditionally the imagines in dementia were used to rule out etiologies that had pharmacological o surgery treatments. However, in the last years neuroimaging has played a very important role in the field of dementia. Structural imaging (particularly MRI) has become an important tool in the diagnosis of degenerative dementias because of findings that help us to support the diagnosis of different etiologies. Different patterns of atrophy can be identified on visual inspection of MRI in various neurodegenerative conditions. However, it's sometimes difficult to recognize or acknowledge these patterns during a regular outpatient clinic visit. In this review we describe the most important findings in structural neuroimaging in the most common causes of dementia and we analyze the most useful visual scales that can help us in the differential diagnosis of dementia during a regular outpatient clinic visit.

[Depressive pseudodementia. Differential diagnosis or meeting point?]. / Pseudodemencia depresiva ¿Diagnóstico diferencial o punto de encuentro?

Depressive pseudodementia is a major depressive disorder in which the cognitive deficits secondary to the affective disorder is so significant that clinicians are obliged to consider dementia as a differential diagnosis. The relationship between depression and dementia is complex and intricate. Even after depressive pseudodementia has remitted, certain cognitive deficits may persist and the risk of developing dementia increases. The concept of depressive pseudodementia continues to be useful in clinical practice in spite of its limitations.

Uso de benzodiazepinas en el manejo de la Hipertensión Arterial / Use of Benzodiazepines in Hypertension Treatment

RESUMEN La hipertensión arterial es una enfermedad de alta prevalencia mundial y es uno de los principales factores de riesgo cardiovascular. Hoy en día vivimos como sociedad en una época donde predomina el estrés, la depresión y la ansiedad: trastornos que generan una alta descarga simpática, lo cual resulta perjudicial para la salud cardiovascular. Es habitual que como médicos nos encontremos frente a pacientes que en consultorio y/o en salas de emergencias presentan algún grado de ansiedad asociado a registros elevados de presión arterial, y es frecuente que en estos casos el tratamiento elegido para la disminución de la presión arterial sean los ansiolíticos, y específicamente las benzodiazepinas. Actualmente no existen guías que avalen el uso de drogas ansiolíticas para el manejo de la hipertensión arterial, por lo que decidimos realizar una revisión bibliográfica para evaluar las evidencias sobre su indicación en el manejo de la hipertensión arterial.

ABSTRACT Hypertension is a worldwide prevalent disease and one of the main cardiovascular risk factors. Today we live in a society dominated by stress, depression and anxiety, disorders generating a high sympathetic discharge which is damaging for the cardiovascular health. It is usual that as physician we meet patients who in the office and/or emergency departments present some degree of anxiety associated with elevated blood pressure, and in these cases, the treatment chosen to decrease blood pressure is frequently anxiolytics, specially benzodiazepines. As currently no guidelines support the use of anxiolytics for blood pressure management, we decided to carry out a bibliographic review to assess the evidences of their indication to treat hypertension.

[Operative data of a psychiatric inpatient unit of general hospital during one year]. / Datos operacionales de la Sala de Internación de Psicopatología de un hospital general a lo largo de un año.

OBJECTIVE: Due to the scarcity of data and psychiatric inpatient beds in general hospitals it is a priority to generate information about the service provided in an inpatient unit of a general hospital. METHOD: Between June 1st 2004 and may 31 2005 a naturalistic, prospective and descriptive study took place in the psychiatric inpatient unit of Hospital "T. Alvarez". RESULTS: The average age of intern patients was 36.7 years, the reason for admission was mostly due to psychotic states and self injury risk. 82 admissions took place during a one year follow up (for 71 patients admitted during that time) and 68 were discharged. 48.8% had previously been admitted and 25.6% of them had been admitted 4 o more times. 29.3% were admitted through judicial intervention. 19.1% were discharged without their corresponding medical advice. The most frequent diagnosis were: schizophrenia (29.4%), Substance abuse (22.1%); Borderline Personality (10.3%), Bipolar disorder (8.8%), and Depressive Disorder (7.4%). The average length of stay was 45.4 days (bed turn: 4.1) with 90% of them lasting less than 90 days. CONCLUSIONS: These data may be compared to other data produced in other psychiatric units of our city and shed light on the problems to follow the classical WHO advice to use general hospital facilities for psychiatric inpatients.

Contribución por grupos de edad a la mortalidad esperada por COVID-19 en Argentina y Colombia / Age-Specific Contribution to expected COVID-19 mortality in Argentina and Colombia

INTRODUCCIÓN: Este estudio tuvo como objetivo explorar la serie de posibles heterogeneidades que subyacen a la aparente similitud en ciertos indicadores no refinados de mortalidad por COVID-19 -como las tasas brutas de mortalidad o las muertes por millón de habitantes- en Argentina y Colombia. MÉTODOS: Se realizó un estudio en el que se utilizaron datos agregados de los informes diarios de vigilancia epidemiológica proporcionados por los ministerios de salud de Argentina y de Colombia, para explorar diferenciales en el nivel poblacional mediante el uso de técnicas clásicas de estandarización demográfica. RESULTADOS: Se detectó que el impacto de la mortalidad y la letalidad de casos es mayor en Colombia, debido a que tiene una estructura poblacional y de casos positivos de menor edad que Argentina. En especial, la mayoría de las diferencias entre países puede explicarse por ciertos grupos de edad. DISCUSIÓN: El hallazgo principal ha sido que la gran mayoría de las defunciones esperadas en Argentina y Colombia ocurrió en los grupos de 50 y de 80 años, lo que implica que el riesgo real de muerte para la población colombiana puede ser mayor que el observado para dichos grupos etarios

Age-Specific Contribution to expected COVID-19 mortality in Argentina and Colombia / Contribución por grupos de edad a la mortalidad esperada por covid-19 en argentina y colombia

RESUMEN INTRODUCCIÓN: Este estudio tuvo como objetivo explorar la serie de posibles heterogeneidades que subyacen a la aparente similitud en ciertos indicadores no refinados de mortalidad por COVID-19 -como las tasas brutas de mortalidad o las muertes por millón de habitantes- en Argentina y Colombia. MÉTODOS: Se realizó un estudio en el que se utilizaron datos agregados de los informes diarios de vigilancia epidemiológica proporcionados por los ministerios de salud de Argentina y de Colombia, para explorar diferenciales en el nivel poblacional mediante el uso de técnicas clásicas de estandarización demográfica. RESULTADOS: Se detectó que el impacto de la mortalidad y la letalidad de casos es mayor en Colombia, debido a que tiene una estructura poblacional y de casos positivos de menor edad que Argentina. En especial, la mayoría de las diferencias entre países puede explicarse por ciertos grupos de edad. DISCUSIÓN: El hallazgo principal ha sido que la gran mayoría de las defunciones esperadas en Argentina y Colombia ocurrió en los grupos de 50 y de 80 años, lo que implica que el riesgo real de muerte para la población colombiana puede ser mayor que el observado para dichos grupos etarios.

ABSTRACT INTRODUCTION: This study aimed to explore the series of possible heterogeneities that could be found beneath the apparent similarity in COVID-19 mortality indicators (such as crude death rates or deaths per million inhabitants) in Argentina and Colombia. METHODS: We performed a study using aggregate data of the epidemiological surveillance daily reports provided by the Health Ministry from Argentina and Colombia to explore differentials at a population level, by using classic demographic standardization techniques. RESULTS: We could identify that the impact of mortality and case fatality ratio is higher in Colombia, due to having a younger population structure and a younger positive cases age structure than Argentina. Specially, the largest contributions in mortality differentials across countries were found in some specific age groups. DISCUSSION: The main finding is that the majority of the difference in expected deaths between Colombia and Argentina was concentrated in the age groups that were between ages 50 and 80, which implies that mortality risks for the Colombian population may be higher than the ones observed for those ages.

Behavioral and Electrophysiological Correlates of Memory Binding Deficits in Patients at Different Risk Levels for Alzheimer's Disease.

Deficits in visual short-term memory (VSTM) binding have been proposed as an early and specific marker for Alzheimer's disease (AD). However, no studies have explored the neural correlates of this domain in clinical categories involving prodromal stages with different risk levels of conversion to AD. We assessed underlying electrophysiological modulations in patients with mild cognitive impairment (MCI), patients in the MCI stages of familial AD carrying the mutation E280A of the presenilin-1 gene (MCI-FAD), and healthy controls. Moreover, we compared the behavioral performance and neural correlates of both patient groups. Participants completed a change-detection VSTM task assessing recognition of changes between shapes or shape-color bindings, presented in two consecutive arrays (i.e., study and test) while event related potentials (ERPs) were recorded. Changes always occurred in the test array and consisted of new features replacing studied features (shape-only) or features swapping across items (shape-color binding). Both MCI and MCI-FAD patients performed worse than controls in the shape-color binding condition. Early electrophysiological activity (100-250 ms) was significantly reduced in both clinical groups, particularly over fronto-central and parieto-occipital regions. However, shape-color binding performance and their reduced neural correlates were similar between MCI and MCI-FAD. Our results support the validity of the VSTM binding test and their neural correlates in the early detection of AD and highlight the importance of studies comparing samples at different risk for AD conversion. The combined analysis of behavioral and ERP data gleaned with the VSTM binding task can offer a valuable memory biomarker for AD.

Psychiatrists' approach to vascular risk assessment in Latin America.

AIM: To explore the way in which Latin American psychiatrists approach the screening of vascular risk factors in patients receiving antipsychotic medication. METHODS: This was a descriptive, cross sectional study that surveyed Latin-American physicians to evaluate differences between groups divided in three main sections. The first section included demographic and professional data. The second section asked about the available medical resources: weighing scales, sphygmomanometer and measuring tape. Finally, the third section aimed at looking into the attitudes towards cardiovascular prevention. The latter was also divided into two subsections. In the first one, the questions were about weight, blood pressure and waist perimeter. In the second subsection the questions asked about the proportion of patients: (1) that suffered from overweight and/or obesity; (2) whose lipids and glycemia were controlled by the physician; (3) that were questioned by, and received information from the physician about smoking; and (4) that received recommendations from the physician to engage in regular physical activity. The participants were physicians, users of the medical website Intramed. The visitors were recruited by a banner that invited them to voluntarily access an online self-reported structured questionnaire with multiple options. RESULTS: We surveyed 1185 general physicians and 792 psychiatrists. Regarding basic medical resources, a significantly higher proportion of general physicians claimed to have weighing scales (χ(2) = 404.9; P < 0.001), sphygmomanometers (χ(2) = 419.3; P < 0.001), and measuring tapes (χ(2) = 336.5; P < 0.001). While general physicians measured overweight and metabolic indexes in the general population in a higher proportion than in patients treated with antipsychotics (Z = -11.91; P < 0.001), psychiatrists claimed to measure them in patients medicated with antipsychotics in a higher proportion than in the general population (Z = -3.26; P < 0.001). Also general physicians tended to evaluate smoking habits in the general population more than psychiatrists (Z = -7.02; P < 0.001), but psychiatrists evaluated smoking habits in patients medicated with antipsychotics more than general physicians did (Z = -2.25; P = 0.024). General physicians showed a significantly higher tendency to control blood pressure (χ(2) = 334.987; P < 0.001), weight (χ(2) = 435.636; P < 0.001) and waist perimeter (χ(2) = 96.52; P < 0.001) themselves and they did so in all patients. General physicians suggested physical activity to all patients more frequently (Z = -2.23; P = 0.026), but psychiatrists recommended physical activity to patients medicated with antipsychotics more frequently (Z = -7.53; P < 0.001). CONCLUSION: Psychiatrists usually check vascular risk factors in their patients, especially in those taking antipsychotics. General practitioners check them routinely without paying special attention to this population.

The Spanish version of the Addenbrooke's Cognitive Examination - Revised (ACE-R) in subcortical ischemic vascular dementia.

Vascular dementia (VaD) is one of the most prevalent causes of dementia, and it is frequently misdiagnosed and undertreated in clinical practice. Because neuropsychological outcome depends, among other factors, on the size and location of the vascular brain injury, characterizing the cognitive profile of VaD has been especially challenging. Yet, there has been sufficient evidence to show a marked impairment of attention and executive functions, in particular in relation to Alzheimer disease. Being able to detect these deficits at bedside is crucial for everyday clinical practice, and yet, brief cognitive screening toots such as the Mini-Mental Sate Examination (MMSE) may overlook at cognitive deficits typical of patients with VaD. The Addenbrooke's Cognitive Examination Revised (ACE-R) is also a brief cognitive screening tool designed to incorporate the items of the MMSE and further extend the test to assess orientation, attention, verbal fluency, memory, language, and visuospatial abilities. In this study, we investigated the ability of the Spanish version of the ACE-R to detect the cognitive impairment showed in patients with subcortical ischemic vascular dementia, and we compared its usefulness to that of the MMSE in this population. Scores on these tests were compared to those of patients with Alzheimer disease and matched healthy controls. The 88-point cut-off proposed for the ACE-R was associated with a sensitivity of 100% and a specificity of 100% for the detection of cognitive impairment, demonstrating a stronger capacity than the MMSE (sensitivity of 42% with its 23-point cut-off score). We also found that the verbal fluency subtest of the ACE-R may be potentially useful in discriminating patients with subcortical ischemic vascular dementia from patients with AD. We discuss the utility of these findings in the context of everyday clinical practice and we propose that future studies should evaluate the potential usefulness of combining the ACE-R with a brief screening tool of executive functioning.

Screening cognitivo en adultos jóvenes infectados con VIH-1 en Buenos Aires / Cognitive screening in hiv-1 infected young adults at Buenos Aires, Argentina

El deterioro cognitivo es altamente prevalente en pacientes infectados con VIH-1, aún en individuos jóvenes. En nuestro país, la información epidemiológica sobre el impacto del deterioro es escasa y carecemos de pruebas de screening con la validación local necesaria como para ser utilizadas como herramientas diagnósticas. Por ello, diseñamos un estudio prospectivo con el objetivo de estimar la prevalencia de dete-rioro cognitivo y comparar el rendimiento de 5 pruebas de screening breves entre sí (incluyendo un nuevo test que denominamos NEURA cuyos componentes están validados en español) y con la evaluación cognitiva completa (goldstandard) en una población de adultos jóve-nes infectados con VIH-1, para determinar su sensibilidad y especifici-dad en nuestra cultura e idioma. Desde 02/2015 a 02/2016 se incluye-ron individuos argentinos de entre 18-50 años, fluentes en español, con educación formal >12 años, bajo tratamiento antirretroviral estable y vi-remia suprimida. Los pacientes completaron: una entrevista psiquiá-trica; el screening cognitivo mediante 5 pruebas rápidas; la evaluación neuropsicológica; y una evaluación funcional. Se estudiaron 45 suje-tos, presentando una prevalencia de deterioro cognitivo del 9 % (n = 4). El rendimiento de NEURA fue superior al demostrado por otros testsde screening (Sensibilidad 75 %, Especificidad 98 %).La prevalencia de trastorno cognitivo en esta pobla-ción ha sido baja en relación a la reportada por otras cohortes de pacientes jóvenes avirémicos. Los testsde screening de uso habitual en nuestro país no tu-vieron un buen rendimiento para detectar deterioro cognitivo en comparación con el nuevo test NEURA

Neurocognitive disorders are highly prevalent in HIV-1 infected patients, even in younger individuals. In our country we lack both sufficient epidemiological information on the true impact of these disorders and screening tests with the local validation needed to be used for diagnosis. Therefore we designed a prospective study to estimate the prevalence of these disorders and to compare the performance of five brief cognitive tests between them (including a new screening tool named NEURA with each of its components validated in spanish) and with the complete neuropsychological assessment (gold standard) in a young adult HIV-1 infected population from Argentina, in order to assess their sensitivity and specificity in our language and culture. Different confounding conditions were taken into account. From 02/2015 to 02/2016 native spanish-speakers outpatients, among 18-50 years, with a minimum of 12 years of formal education, under stable antiretroviral therapy and virological suppression were enrolled. They completed: a psychiatric interview; five brief cognitive screening tests; the neuropsychological battery and a functional assessment. We include 45 patients, with a prevalence of neurocognitive impairment (NCI) of 9% (n=4). In terms of sensitivity and specificity, NEURA performance was superior to the comparative tests (75% and 98%, respectively).We observed a lower prevalence of NCI in our population compared with those reported in young adult aviremic cohort studies. NEURA test seems to be a rapid and more accurate screening test than others routinely used in our country