Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms.

OBJECTIVES: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. METHODS: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. RESULTS: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. CONCLUSIONS: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

Hanseníase Neural Primária - Dr. Diogo Fernandes

Conferência Hanseníase Neural Primária: aspectos clínicos, sorológicos, neurofisiológicos, histopatológico e molecular ministrada pelo Dr. Diogo Fernandes no 2º Simpósio Cearense de Hansenologia

Activity limitations in leprosy and their association to cognition and neuropsychiatric symptoms / Limitaciones de tarea en la enfermedad de Hansen y su relación con cognición y síntomas neuropsiquiátricos / Limitações de tarefa na hanseníase e sua associação com cognição e sintomas neuropsiquiátricos

ABSTRACT Objectives: to analyze activity limitations in patients with leprosy and their association to cognition and neuropsychiatric symptoms. Methods: this cross-sectional design study included sixty patients with multibacillary leprosy assisted at a reference center. Participants were divided according to their physical disability and submitted to instruments assessing daily activities (basic and instrumental), cognitive functions, and neuropsychiatric symptoms. The order of the instruments was random to avoid any interference of test sequence on the results. Results: fifty-five percent of the participants presented physical disabilities. All patients were independent in performing basic activities but sixty-six percent presented difficulties in performing instrumental activities. Cognitive decline and neuropsychiatric symptoms were seen in advanced stages of the disease, but they were more associated to patient age than to leprosy. Conclusions: leprosy patients presented physical disabilities and difficulties in performing instrumental daily activities. Cognitive decline and neuropsychiatric symptoms were more associated to aging than to leprosy itself.

RESUMEN Objetivo: analizar limitaciones de tarea en pacientes con Lepra y su relación con cognición y síntomas neuropsiquiátricos. Métodos: este estudio transversal incluyó 60 pacientes con Lepra multibacilar atendidos en centro de referencia. Participantes fueron divididos segundo la disfunción física y evaluados cuanto a las actividades diarias (básicas y instrumentales), funciones cognitivas y síntomas neuropsiquiátricos. Orden de aplicación de los instrumentos aleatoria para evitar interferencia de la secuencia de tests sobre los resultados. Resultados: de los participantes, 55% presentaron disfunción física. Todos pacientes eran independientes en las actividades básicas, pero 66% mostraron dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos fueron observados en etapas avanzadas de la enfermedad, pero estos estaban más relacionados a la edad del paciente que a la Lepra. Conclusiones: pacientes con Lepra evidenciaron disfunción física y dificultades en las actividades instrumentales. Declive cognitivo y síntomas neuropsiquiátricos están más relacionados al envejecimiento que a la Lepra.

RESUMO Objetivo: analisar as limitações de tarefa em pacientes com hanseníase e sua associação com cognição e sintomas neuropsiquiátricos. Métodos: este estudo transversal incluiu 60 pacientes com hanseníase multibacilar atendidos em um centro de referência. Os participantes foram divididos segundo a disfunção física e avaliados quanto às atividades diárias (básicas e instrumentais), às funções cognitivas e aos sintomas neuropsiquiátricos. A ordem de aplicação dos instrumentos foi aleatória para evitar interferência da sequência dos testes sobre os resultados. Resultados: dos participantes, 55% apresentaram disfunção física. Todos os pacientes eram independentes nas atividades básicas, mas 66% mostraram dificuldades nas atividades instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos foram observados em estágios avançados da doença, porém estes estavam mais associados à idade do paciente do que à hanseníase. Conclusões: pacientes com hanseníase evidenciaram disfunção física e dificuldades nas atividades diárias instrumentais. Declínio cognitivo e sintomas neuropsiquiátricos estão mais associados ao envelhecimento do que à hanseníase.

[Current status of dementia in admitions to national leprosariums nationwide].

The purpose of this study was to get an overview of the following aspects of people admitted to 13 national leprosariums in Japan: the prevalence of dementia, medical and nursing systems, and facilities and equipment. Subjects included 1733 people admitted to wards for patients or disabled people in these leprosariums. Subjects were examined for cognitive function using Nishimura's behavioral rating scale for the mental states of the elderly (NMS), and for the prevalence of behavioral and psychological symptoms of dementia (BPSD). We also investigated medical and nursing systems, facilities and equipment, and status of nursing education. The results showed that, 288 subjects (16.6%) had a diagnosis of dementia. According to the NMS, 47.5% of the subjects were categorized as mild to severe dementia, while cognitive dysfunction was observed in 63.5% if borderline cases were included. Non-specialist physicians managed 30.8% of the subjects in 4 institutions, and there were no certified nurses specialized in dementia management. Results from this study suggest that there is need for the placement of dementia specialists', improvement of specialized medical services, and human resource development of specialized nurses in leprosariums where many elderly people live.

Functional connectivity metrics during stroke recovery.

We explore functional connectivity in nine subjects measured with 1.5T fMRI-BOLD in a longitudinal study of recovery from unilateral stroke affecting the motor area (Small et al., 2002). We found that several measures of complexity of covariance matrices show strong correlations with behavioral measures of recovery. In Schmah et al. (2010), we applied Linear and Quadratic Discriminants (LD and QD) computed on a principal components (PC) subspace to classify the fMRI volumes into "early" and "late" sessions. We demonstrated excellent classification accuracy with QD but not LD, indicating that potentially important differences in functional connectivity exist between the early and late sessions. Motivated by Mclntosh et al. (2008), who showed that EEG brain-signal variability and behavioral performance both increased with age during development, we investigated complexity of the covariance matrix for this longitudinal stroke recovery data set. We used three complexity measures: the sphericity index described by Abdi (2010); "unsupervised dimensionality", which is the number of PCs that minimizes unsupervised generalization error of a covariance matrix (Hansen et al., 1999); and "QD dimensionality", which is the number of PCs that minimizes the classification accuracy of QD. Although these approaches measure different kinds of complexity, all showed strong correlations with one or more behavioral tests: nine-hole peg test, hand grip test and pinch test. We could not demonstrate that either sphericity or unsupervised dimensionality were significantly different for the "early" and "late" sessions using a paired Wilcoxon test. However, the amount of relative behavioral improvement was correlated with sphericity of the overall covariance matrix (pooled across all sessions), as well as with the divergence of the eigenspectra between the "early" and "late" covariance matrices. Complexity measures that use the number of PCs (which optimize QD classification or unsupervised generalization) were correlated with the behavioral performance of the final session, but not with the relative improvement. These are suggestive, but limited, results given the sample size, restricted behavioral measurements and older 1.5T BOLD data sets. Nevertheless, they indicate one potentially fruitful direction for future data-driven fMRI studies of stroke recovery in larger, better-characterized longitudinal stroke data sets recorded at higher field strength. Finally, we produced sensitivity maps (Kjems et al., 2002) corresponding to both linear and quadratic discriminants for the "early" vs. "late" classification. These maps measure the influence of each voxel on the class assignments for a given classifier. Differences between the scaled sensitivity maps for the linear and quadratic discriminants indicate brain regions involved in changes in functional connectivity. These regions are highly variable across subjects, but include the cerebellum and the motor area contralateral to the lesion.

A importância de incluir neurossífilis no diagnóstico diferencial de pacientes com déficit cognitivo e alteração do comportamento / The importance of including neurosyphilis in the differential diagnosis of patients with cognitive decline and behavior disturbances

É resultado da infecção do cérebro, das meninges ou medula espinhal pelo Treponema pallidum e desenvolve-se em cerca de 25-40% das pessoas que não são tratadas para a sífilis. A demência por neurossífilis é uma manifestação tardia da sífilis e era causa frequente de deterioração cognitiva antes do aparecimento e da disseminação do uso da penicilina no tratamento das fases iniciais da doença. Embora incomum nos dias de hoje, a demência por neurossífilis ainda constitui diagnóstico diferencial a considerar-se, diante de síndromes demenciais atípicas ou com manifestações frontais, particularmente em populações menos favorecidas socialmente. Esse caso destaca a importância do diagnóstico precoce da neurossífilis, e que os médicos devem se alertar para a possibilidade desta doença em pacientes que apresentam demência, principalmente por pertencer ao grupo das demências potencialmente reversíveis,pois o tratamento adequado pode reverter o declínio cognitivo. E ainda, pelo aumento no número de casos de sífilis na última década, particularmente pela coinfecção com HIV, que pode acelerar o curso e alterar a resposta ao tratamento da sífilis. Este aumento da incidência de sífilis, observado também na Europa e nos Estados Unidos, poderá traduzir-se num acréscimo do número de casos de neurossífilis observados na prática clínica.

Neurosyphilis results from infection of the brain, meninges or spinal cord by Treponema pallidum and develops in about 25-40% of persons who are not treated for syphilis. Dementia by neurosyphilis is a late manifestation of syphilis and was a frequent cause of dementia before the advent and widespread use of penicillin in the treatment of early stages of the disease. Although uncommon today, dementia of neurosyphilis still a differential diagnosis to consider in the face of atypical dementia or with manifestations front, particularly in socially disadvantaged populations socially. This case underscores the importance of early diagnosis of neurosyphilis, which clinicians should alert the possibility of neurosyphilis in patients who present with dementia, mainly belonging to the group of potentially reversible dementias, because proper treatment can reverse cognitive decline. And also, by increasing the number of syphilis cases in the last decade, particularly in combination with HIV, which can acelerate the course and alter the response to treatment of syphilis. This increasedincidence of syphilis, also observed in Europe and the United States, could result in an increase in the number of cases of neurosyphilis observed in clinical practice.

Young children follow pointing over words in interpreting acts of reference.

Adults refer young children's attention to things in two basic ways: through the use of pointing (and other deictic gestures) and words (and other linguistic conventions). In the current studies, we referred young children (2- and 4-year-olds) to things in conflicting ways, that is, by pointing to one object while indicating linguistically (in some way) a different object. In Study 1, a novel word was put into competition with a pointing gesture in a mutual exclusivity paradigm; that is, with a known and a novel object in front of the child, the adult pointed to the known object (e.g. a cup) while simultaneously requesting 'the modi'. In contrast to the findings of Jaswal and Hansen (2006), children followed almost exclusively the pointing gesture. In Study 2, when a known word was put into competition with a pointing gesture - the adult pointed to the novel object but requested 'the car'- children still followed the pointing gesture. In Study 3, the referent of the pointing gesture was doubly contradicted by the lexical information - the adult pointed to a known object (e.g. a cup) but requested 'the car'- in which case children considered pointing and lexical information equally strong. Together, these findings suggest that in disambiguating acts of reference, young children at both 2 and 4 years of age rely most heavily on pragmatic information (e.g. in a pointing gesture), and only secondarily on lexical conventions and principles.

Quickly tapping targets that are flashed during smooth pursuit reveals perceptual mislocalisations.

In various studies subjects have been shown to misperceive the positions of targets that are flashed during pursuit eye movements. They mislocalise them in the direction of pursuit. Nevertheless, Hansen (1979) found that subjects accurately hit targets that are flashed during pursuit with a quick hammer blow. We examined whether this is because there is a fundamental difference between the information that determines our perceptual judgements of a target's position and the information that is used to guide our hand to a similar target. Subjects were asked to quickly tap targets that were flashed during pursuit with their index finger. They systematically tapped ahead of the position of the flash, in accordance with the above-mentioned perceptual mislocalisations. Thus the lack of systematic errors in Hansen's study is not a general property of fast motor responses.