Efficacy of a cognitive intervention program in patients with mild cognitive impairment.

BACKGROUND: Mild cognitive impairment (MCI) is a transitional state between normal aging and dementia. Identifying this condition would allow early interventions that may reduce the rate of progression to Alzheimer's disease (AD). We examined the efficacy of a six-month cognitive intervention program (CIP) in patients with MCI and to assess patients' condition at one-year follow-up. METHODS: Forty-six MCI participants assessed with neuropsychological, neurological, neuropsychiatry, and functional procedures were included in this study and followed up during a year. The sample was randomized into two subgroups: 24 participants (the "trained group") underwent the CIP during six months while 22 (control group) received no treatment. Sixteen participants dropped out of the study. The intervention focused on teaching cognitive strategies, cognitive training, and use of external aids, in sessions of two hours, twice per week for six months. Cognitive and functional measures were used as primary outcome and all were followed up at one year. RESULTS: The intervention effect (mean change from baseline) was significant (p < 0.05) on the Mini-Mental State Examination (1.74), the Clinical Dementia Rating Scale (0.14), the Boston Naming Test (2.92), block design (-13.66), matrix reasoning (-3.07), and semantic fluency (-3.071) tasks. Four patients (one trained and three controls) progressed to dementia after one year of follow-up. CONCLUSIONS: These results suggest that persons with MCI can improve their performance on cognitive and functional measures when provided with early cognitive training and it could persist in a long-term follow-up.

Clinical and economic characteristics associated with direct costs of Alzheimer's, frontotemporal and vascular dementia in Argentina.

BACKGROUND: The economic cost of dementia is high and can be predicted by cognitive and neuropsychiatric profiles. The differential costs of the various subtypes of dementia are unknown in Argentina, and this study therefore aimed to compare these costs. METHODS: Patients with a diagnosis of dementia of Alzheimer-type (DAT), frontotemporal dementia (FTD) and vascular dementia (VaD), and their primary caregivers, were evaluated between 2002 and 2008. RESULTS: 104 patients with dementia (DAT = 44, FTD = 34, VaD = 26) were screened and matched by age and educational level with 29 healthy subjects. Demographic variables showed no significant differences among dementia patients. The annual direct costs were US$4625 for DAT, US$4924 for FTD, and US$5112 for VaD (p > 0.05 between groups). In the post hoc analysis VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher anti-dementia drug costs; FTD had higher psychotropic costs. In the multivariate analysis, depression, activities of daily living, and caregiver burden were correlated with direct costs (r2 = 0.76). CONCLUSIONS: The different dementia types have different costs. Overall, costs increased with the presence of behavioral symptoms, depression and functional impairment of activities of daily living.

[Use and abuse of drugs in cognitive impairment patients]. / Usos y abusos de fármacos en pacientes con deterioro cognitivo.

INTRODUCTION: Irrational use of drugs for the treatment of cognitive impairment can increase health costs in developing countries. OBJECTIVE: to analyze the pattern of drug prescription related to the treatment of patients with dementia and to compare them with the income of patients. PATIENTS: 313 community-based outpatients that seeked medical advice for memory problems, in the Memory Center of Zubizarreta General Hospital (Buenos Aires, Argentina), were prospectively assessed during a period of a year. RESULTS: Patients' mean income was 502.81 "Pesos Argentinos" which is equivalent to US$152 per month (2007). Fourty one point fifty five percent (41.55%) of the patients had dementia, 15.65% psychiatric diseases, 15.01% mild cognitive impairment and 27.79% were normal. Patients received an average of 2.84 drugs/day, 20% of the patients took at least one drug for cognitive impairment (9.85% memantine, 6.38% donepezil and 4% nootropics, cerebral vasodilators or antioxidants), and 39.3% received psychotropic medication (28.11% benzodiazepines and 9.26 % atypical antipsychotics). Twelve point seventy six percent (12.76%) of the patients with mild cognitive impairment were treated with antidementials, 5.74% of normal subjects received antidementials. 4% of patients were exclusively treated with free samples. CONCLUSION: In our sample irrational degree of using antidemential drugs and psychotropic agents was found.

Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly.

The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. OBJECTIVE: To validate the MoCA in the elderly and study its usefulness in MCI and MD. METHODS: This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with<3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. RESULTS: Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p<0.0001). MoCA-A performance correlated with educational level (r: 0.406 p<0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD ​​100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. CONCLUSION: The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.

O MoCA é um teste breve e útil para diagnosticar comprometimento cognitivo leve (CCL) e demência leve. Até o momento, nenhuma validação argentina com adaptação transcultural da versão em espanhol havia sido relatada. OBJETIVO: Validar o MoCA em idosos e estudar sua utilidade no CCL e demência leve. MÉTODOS: Este estudo incluiu 399 indivíduos acima de 60 anos avaliados no departamento cognitivo-comportamental (2017-2018). Foram excluídos pacientes com menos de 3 anos de escolaridade, com distúrbios sensoriais, distúrbios psiquiátricos e demência moderada a grave. O grupo controle foi cognitivamente normal. Eles foram classificados de acordo com a avaliação neuropsicológica e os critérios clínicos padrão em Controles, MCI e demência leve. A versão adaptada do MoCA (MOCA-A) foi administrado aos pacientes e controles. RESULTADOS: Média de escolaridade: 10,34 anos (DP: 3,5). O escore MoCA-A foi significativamente diferente entre os grupos (p<0,0001). O MoCA-A correlacionou-se com a escolaridade (r=0,406 p<0,00001). Com uma pontuação de corte ≥25 (IY=0,55), a sensibilidade para CCL foi de 84,8% e para demência leve 100%, com especificidade de 69,7%. Adicionando um ponto único à pontuação em pacientes com menos de 12 anos de escolaridade, a especificidade do teste atingiu 81%. CONCLUSÃO: O MoCA-A é um teste de rastreamento preciso e confiável para MCI e demência leve na Argentina.

[Cognitive performance in schizophrenia (paranoid vs residual subtype)]. / Estudio de los rendimientos cognitivos en pacientes esquizofrénicos (forma paranoide vs residual).

INTRODUCTION: Several studies refer to the relationship between schizophrenia and cognitive dysfunctions. The most frequent disturbances accepted are the deficits in the executive, memory and verbal tests. However, there are few comparative data about the cognitive functioning of the different subtypes of schizophrenia. OBJECTIVE: Analyze and compare the neuropsychological disturbances present in patients with paranoid and residual schizophrenia. MATERIALS AND METHOD: Eleven patients with paranoid schizophrenia, eleven patients with residual schizophrenia (DSM-IV criteria), and thirty one normal subjects matched by age, educational level, and general cognitive level (Mini Mental State Examination (Folstein, 1975), were assessed with a semistructured psychiatric examination and an extensive neuropsychological battery. RESULTS: Significant differences were found in memory, language, and executive functions when schizophrenics were compared with normal subjects. Differences in similarities were found between paranoid and residual schizophrenics. Residual schizophrenics had more disturbances in neuropsychological tests in comparison with paranoid schizophrenics. CONCLUSION: Schizophrenics demonstrated disturbances in memory, language, executive functions and attention. Residual schizophrenics had more impairment in neuropsychological tests than paranoid schizophrenics.

Validation of the Argentine version of the Memory Binding Test (MBT) for Early Detection of Mild Cognitive Impairment.

BACKGROUND: "Forgetfulness" is frequent in normal aging and characteristic of the early stages of dementia syndromes. The episodic memory test is central for detecting amnestic mild cognitive impairment (MCI). The Memory Binding Test (MBT) is a simple, easy and brief memory test to detect the early stage of episodic memory impairment. OBJECTIVE: To validate the Argentine version of the MBT in a Latin American population and to estimate the diagnostic accuracy as a tool for early detection of MCI. METHODS: 88 subjects (46 healthy controls and 42 patients with amnestic MCI) matched for age and educational level were evaluated by an extensive neuropsychological battery and the memory binding test. RESULTS: A significantly better performance was detected in the control group; all MBT scales were predictive of MCI diagnosis (p<.01). The MBT showed high sensitivity (69%) and high specificity (88%), with a PPV of 93% and a NPV of 55% for associative paired recall. A statistically significant difference (c2=14,164, p<.001) was obtained when comparing the area under the curve (AUC) of the MBT (0.88) and the MMSE (0.70). CONCLUSION: The Argentine version of the MBT correlated significantly with the MMSE and the memory battery and is a useful tool in the detection of MCI. The operating characteristics of the MBT are well suited, surpassing other tests commonly used for detecting MCI.

"Esquecimento" é queixa frequente no envelhecimento normal e também ocorre nos primeiros estágios de síndromes demenciais. Testes de memória episódica são fundamentais para detectar comprometimento cognitivo amnéstico (CCL). O teste de Memória Associativa (Memory Binding Test-MBT) é um teste fácil e breve para detectar a fase inicial de perda de memória episódica. OBJETIVO: Validar a versão argentina do MBT e estimar a sua acurácia como instrumento diagnóstico para a detecção precoce do CCL. MÉTODOS: 88 indivíduos (46 controles saudáveis ​​e 42 pacientes com CCL amnéstico), emparelhados por idade e nível educacional, foram avaliados com extensa bateria neuropsicológica e o MBT. RESULTADOS: Um desempenho significativamente melhor foi detectada no grupo controle; todas as escalas do MBT foram preditivas do diagnóstico de CCL (p<0,01). O MBT apresentou alta sensibilidade (69%) e alta especificidade (88%), com valor preditivo (VP) positivo de 93% e e VP negativo de 55% para a recordação dos itens associados (associative paired recall). Diferença estatisticamente significativa (c2=14,164, p<0,001) foi obtida quando foram comparadas as áreas sob as curvas (AUC) do MBT (0,88) e o Mini-Exame do Estado Mental (MEEM) (0,70). CONCLUSÃO: A versão argentina do MBT correlacionou-se significativamente com o MEEM e com a bateria de memória e é uma ferramenta útil na detecção de CCL. As características operacionais do MBT são bem adequadas, superando outros testes usualmente utilizados para a detecção de CCL.

Validation of the Argentine version of the Montreal Cognitive Assessment Test (MOCA): A screening tool for Mild Cognitive Impairment and Mild Dementia in Elderly / Validação da versão argentina do teste montreal cognitive assessment test (moca): um instrumento de triagem para comprometimento cognitivo leve e demência leve em idosos

ABSTRACT. The MoCA is a brief useful test to diagnose mild cognitive impairment (MCI) and mild dementia (MD). To date, no Argentine cross-cultural adapted validations of the Spanish version have been reported. Objective: To validate the MoCA in the elderly and study its usefulness in MCI and MD. Methods: This study included 399 individuals over 60 years old evaluated in the Cognitive-Behavioral Department (2017-2018). Patients with<3 years of education, sensory disturbances, psychiatric disorders, or moderate-severe dementia were excluded. The control group comprised cognitively normal subjects. Participants were classified according to neuropsychological assessment and clinical standard criteria into Control, MCI or MD groups. A locally adapted MoCA (MOCA-A) was administered to the patients and controls. Results: Mean educational level was 10.34 years (SD 3.5 years). MoCA-A score differed significantly among groups (p<0.0001). MoCA-A performance correlated with educational level (r: 0.406 p<0.00001). Adopting a cut-off score ≥25 (YI=0.55), the sensitivity for MCI was 84.8% and for MD ​​100%, with specificity of 69.7%. When adding a single point to the score in patients with ≤12 years of education, the specificity of the test reached 81%. Conclusion: The MoCA-A is an accurate reliable screening test for MCI and MD in Argentina.

RESUMO. O MoCA é um teste breve e útil para diagnosticar comprometimento cognitivo leve (CCL) e demência leve. Até o momento, nenhuma validação argentina com adaptação transcultural da versão em espanhol havia sido relatada. Objetivo: Validar o MoCA em idosos e estudar sua utilidade no CCL e demência leve. Métodos: Este estudo incluiu 399 indivíduos acima de 60 anos avaliados no departamento cognitivo-comportamental (2017-2018). Foram excluídos pacientes com menos de 3 anos de escolaridade, com distúrbios sensoriais, distúrbios psiquiátricos e demência moderada a grave. O grupo controle foi cognitivamente normal. Eles foram classificados de acordo com a avaliação neuropsicológica e os critérios clínicos padrão em Controles, MCI e demência leve. A versão adaptada do MoCA (MOCA-A) foi administrado aos pacientes e controles. Resultados: Média de escolaridade: 10,34 anos (DP: 3,5). O escore MoCA-A foi significativamente diferente entre os grupos (p<0,0001). O MoCA-A correlacionou-se com a escolaridade (r=0,406 p<0,00001). Com uma pontuação de corte ≥25 (IY=0,55), a sensibilidade para CCL foi de 84,8% e para demência leve 100%, com especificidade de 69,7%. Adicionando um ponto único à pontuação em pacientes com menos de 12 anos de escolaridade, a especificidade do teste atingiu 81%. Conclusão: O MoCA-A é um teste de rastreamento preciso e confiável para MCI e demência leve na Argentina.

MM1+2C sporadic Creutzfeldt-Jakob disease presenting as rapidly progressive nonfluent aphasia.

We report a 77-year-old man, presenting with progressive aphasia as an initial symptom, who developed severe dementia over the course of 20 months. Frontal cortex PrPSc western blot was type 2 and codon 129 was MM; brain neuropathology showed cortical vacuoles with perivacuolar PrP immunostaining characteristic of MM2C. Cerebellum showed focal coarse, patchy staining in different sections of the molecular layer, diffuse fine punctuate and coarse PrP immunopositive deposits in the granule cell layer, and focal synaptic immunostaining in the molecular layer, suggestive of MM1+2C by histotyping. This clinical presentation has not yet been described in an MM1+2C subtype by histotyping.

Diagnostic accuracy of the Phototest for cognitive impairment and dementia in Argentina.

Phototest is a simple, easy and very brief test with theoretical advantages over available dementia screening tests in Spain. The objective of this study was to estimate the diagnostic accuracy of the Phototest for cognitive impairment and dementia and to compare it with that of the MMSE and the Clock Drawing Test (CDT) in an Argentine population. A phase II cross-sectional study of diagnostic tests evaluation was performed in a sample of 30 controls, 61 with amnestic mild cognitive impairment (a-MCI), and 56 with mild Alzheimer type dementia (DAT). The diagnostic accuracy (DA) was assessed in relation to the clinical diagnosis by calculating the area under the ROC curve (UAC), Sensitivity (Sn), and Specificity (Sp).The DA of the Phototest for a-MCI and DAT (0.93 and 0.97 [UAC]) was higher than that of the MMSE and the CDT. The cut-off points of 27/28 for DAT (Sn = 89.29 [78.1-96.0], Sp = 96.67 [82.8-99.9]) and 30/31 for a-MCI (Sn = 85.25 [73.8-93.0], Sp = 90.00 [73.5-97.9]) maximized the sum of Sn and Sp. Phototest correlates significantly with MMSE and CDT. The Phototest is an efficient instrument for the detection of mild dementia or MCI, with good accuracy and good correlation with tests measuring overall cognitive impairment.

Theory of mind and central coherence in eating disorders: two sides of the same coin?

The aim of this study was to evaluate central coherence and theory of mind (ToM) and explore the relationships between these domains in patients with eating disorders (ED). ToM and central coherence were assessed in 72 women [24 with anorexia nervosa (AN), 24 with bulimia nervosa (BN) and 24 healthy controls (HC)]. The Reading the Mind in the Eyes (RME) and the Faux Pas Test (FPT) to measure ToM, and the copy strategy of the Rey-Osterrieth Complex Figure Test to assess central coherence were used. It was observed that patients with ED had a decrease in central coherence skills compared with the control group; that patients with anorexia had a poor performance on RME ToM task compared with BN patients and HCs, and also that these measures were related in both clinical groups. The statistically significant correlation between them suggests that the central coherence and ToM measures might involve common cognitive processes. These results provide a better understanding of the nature of the socio-cognitive deficits observed in patients with eating disorders.

Relación entre actividades de tiempo libre y cognición en adultos mayores: una revisión de estudios argentinos e iberoamericanos / Relationship between leisure activities and cognition in elderly adults: a review of argentine and Iberoamerican studies

El envejecimiento poblacional implica un desafío para la salud pública por las patologías cuyos casos aumentan con la extensión de la vida. Se ha propuesto que ciertas actividades de la vida diaria (AVDs) avanzadas de tiempo libre poseen un efecto bené+co en la cognición de los adultos mayores. El objetivo de este trabajo fue relevar estudios empíricos presentando evidencia respecto a la relación entre dichas actividades y el funcionamiento cognitivo, para países iberoamericanos. Se incluyeron trabajos escritos en español, portugués e inglés, de enero de 2012 a mayo de 2017, involucrando a adultos de 60 y más años de edad no institucionalizados. Se hallaron 15 trabajos. Considerados en su conjunto, existiría evidencia de una relación entre las mencionadas actividades y el rendimiento cognitivo. Los trabajos de diseño prospectivo y los de intervención indicarían que la realización de dichas actividades avanzadas incide bene+ciosamente en el funcionamiento cognitivo.

Population aging implies a challenge to public health for the pathologies whose cases increase with the extension of life. It has been proposed that certain leisure advanced activities of daily living (ATLs) have a bene+cial effect on the cognition of the elderly. The objective of this work was to relieve empirical studies presenting evidence regarding the relationship between these activities and cognitive functioning, for Iberoamerican countries. Works written in Spanish, Portuguese and English were included from January 2012 to May 2017, involving non-institutionalized adults aged 60 and over. Fifteen papers were found. Considered as a whole, there would be evidence of a relationship between these activities and cognitive performance. Prospective design and interventional studies would indicate that such advanced activities has a bene+cial impact on cognitive functioning.

Validation of the Argentine version of the Memory Binding Test (MBT) for Early Detection of Mild Cognitive Impairment / Validação da versão argentina do Memory Binding Test (MBT) para a detecção precoce do transtorno cognitivo leve

ABSTRACT. Background: "Forgetfulness" is frequent in normal aging and characteristic of the early stages of dementia syndromes. The episodic memory test is central for detecting amnestic mild cognitive impairment (MCI). The Memory Binding Test (MBT) is a simple, easy and brief memory test to detect the early stage of episodic memory impairment. Objective: To validate the Argentine version of the MBT in a Latin American population and to estimate the diagnostic accuracy as a tool for early detection of MCI. Methods: 88 subjects (46 healthy controls and 42 patients with amnestic MCI) matched for age and educational level were evaluated by an extensive neuropsychological battery and the memory binding test. Results: A significantly better performance was detected in the control group; all MBT scales were predictive of MCI diagnosis (p<.01). The MBT showed high sensitivity (69%) and high specificity (88%), with a PPV of 93% and a NPV of 55% for associative paired recall. A statistically significant difference (c2=14,164, p<.001) was obtained when comparing the area under the curve (AUC) of the MBT (0.88) and the MMSE (0.70). Conclusion: The Argentine version of the MBT correlated significantly with the MMSE and the memory battery and is a useful tool in the detection of MCI. The operating characteristics of the MBT are well suited, surpassing other tests commonly used for detecting MCI.

RESUMO. "Esquecimento" é queixa frequente no envelhecimento normal e também ocorre nos primeiros estágios de síndromes demenciais. Testes de memória episódica são fundamentais para detectar comprometimento cognitivo amnéstico (CCL). O teste de Memória Associativa (Memory Binding Test-MBT) é um teste fácil e breve para detectar a fase inicial de perda de memória episódica. Objetivo: Validar a versão argentina do MBT e estimar a sua acurácia como instrumento diagnóstico para a detecção precoce do CCL. Métodos: 88 indivíduos (46 controles saudáveis ​​e 42 pacientes com CCL amnéstico), emparelhados por idade e nível educacional, foram avaliados com extensa bateria neuropsicológica e o MBT. Resultados: Um desempenho significativamente melhor foi detectada no grupo controle; todas as escalas do MBT foram preditivas do diagnóstico de CCL (p<0,01). O MBT apresentou alta sensibilidade (69%) e alta especificidade (88%), com valor preditivo (VP) positivo de 93% e e VP negativo de 55% para a recordação dos itens associados (associative paired recall). Diferença estatisticamente significativa (c2=14,164, p<0,001) foi obtida quando foram comparadas as áreas sob as curvas (AUC) do MBT (0,88) e o Mini-Exame do Estado Mental (MEEM) (0,70). Conclusão: A versão argentina do MBT correlacionou-se significativamente com o MEEM e com a bateria de memória e é uma ferramenta útil na detecção de CCL. As características operacionais do MBT são bem adequadas, superando outros testes usualmente utilizados para a detecção de CCL.

Late- versus early-onset geriatric depression in a memory research center.

OBJECTIVE: To contrast early-onset (<60 years) and late-onset (>60 years) depression in geriatric patients by evaluating differences in cognition, vascular comorbidity and sociological risk factors. Both patient groups were compared with normal subjects. MATERIALS AND METHODS: We recruited 76 patients with depressive symptoms (37 late onset and 39 early onset) and 17 normal controls matched by age and educational level. All subjects were assessed using a semistructured neuropsychiatric interview and an extensive neuropsychological battery. Vascular and sociological risk factors were also evaluated. RESULTS: We found a significant variation in performance between depressive patients and normal controls in most cognitive functions, especially memory (P < 0.0001), semantic fluency (P < 0.0001), verbal fluency, and digit-symbol (P < 0.0001). Late-onset depression patients scored lower and exhibited more severe impairment in memory domains than early-onset depression patients (P < 0.05). Cholesterol levels and marital status were significantly (P < 0.05) different between the depressive groups. Both depressed groups (early- and late-onset) were more inactive than controls (P < 0.05; odds ratio: 6.02). CONCLUSION: Geriatric depression may be a manifestation of brain degeneration, and the initial symptom of a dementia. It is important to consider this in the treatment of patients that exhibit late-onset depressive symptoms.

Síntomas neuropsiquiátricos en la afasia progresiva primaria / No disponible

No disponible

Del discurso de la palabra al discurso de la acción: ¿Una amenaza a la cultura de las instituciones de Salud-Enfermedad? / From discourse to action: A menace to the culture of Health/Disease institutions?

Todo discurso que pretenda ser válido debe acompañarse en forma coherente con conductas que lo representen. El "como si" debe ser reemplazado por acciones que comprometan teoría y práctica. Las teorías son instrumentos para resolver problemas reales, no debiendo estar dichos problemas al servicio de las teorías. El discurso de la interdisciplina debe salir del "como si" y operativizarse en la realidad. Todos los integrantes del equipo de salud necesitan comprender que los problemas que ellos abordan exigen esta concepción integradora. El paciente es cuerpo, mente y ecosistema socio-cultural. Este espacio virtual no puede ser negado y toda lectura reduccionista es una severa distorsión que impide leer los procesos de salud y enfermedad en su auténtica dimensión. Este artículo, surgido de la experiencia en una institución hospitalaria, muestra que es posible operativizar los enunciados previos y coloca al problema del SIDA como una enfermedad que trasciende lo biológico y determina variables psico-sociales que explican el sufrimiento de aquellos que lo padecen, permitiendo la oportunidad de un abordaje más eficaz y eficiente.