The Integrated Care Team Approach of the Department of Veterans Affairs (VA): Geriatric Primary Care.

Historically, integrated mental and behavioral healthcare in the Department of Veterans Affairs (VA) commenced with initiatives in geriatrics. Innovation and system-wide expansion has occurred over decades and culminated in a unified vision for training and practice in the VA medical home model: Patient Aligned Care Team or PACT approach. In one VA hospital, the integration of neuropsychological services in geriatric primary care is pivotal and increases access for patients, as well as contributing to timely and effective care on an interprofessional team. The development and innovative use of an algorithm to identify problems with cognition, health literacy, and mental and behavioral health has been pragmatic and provides useful information for collaborative treatment planning in GeriPACT, VA geriatric primary care. Use of the algorithm also assists with decision-making regarding brief versus comprehensive neuropsychological assessment in the primary care setting. The model presented here was developed by supervising neuropsychologists as part of a postdoctoral residency program in geropsychology. However, postdoctoral residency programs in neuropsychology, as well as neuropsychological clinics, can also use this model to integrate neuropsychological assessment and interventions in geriatric primary care settings.

Neuropsychologists as primary care providers of cognitive health: A novel comprehensive cognitive wellness service delivery model.

By virtue of their extensive knowledge base and specialized training in brain-behavior relationships, neuropsychologists are especially poised to execute a unique broad-based approach to overall cognitive wellness and should be viewed as primary care providers of cognitive health. This article will describe a novel comprehensive cognitive wellness service delivery model including cognitive health, anti-aging, lifelong wellness, and longevity-oriented practices. These practice areas include brain-based cognitive wellness, emotional and spiritually centric exploration, and related multimodality health interventions. As experts in mind-body connections, neuropsychologists can provide a variety of evidence-based treatment options, empowering patients with a sense of value and purpose. Multiple areas of clinical therapy skill-based learning, tailor-made to fit individual needs, will be discussed including: brain stimulating activities, restorative techniques, automatic negative thoughts and maladaptive thinking reduction, inflammation and pain management techniques, nutrition and culinary focused cognitive wellness, spirituality based practices and mindfulness, movement and exercise, alternative/complimentary therapies, relationship restoration/social engagement, and trauma healing/meaning. Cognitive health rests upon the foundation of counteracting mind-body connection disruptions from multiple etiologies including inflammation, chronic stress, metabolic issues, cardiac conditions, autoimmune disease, neurological disorders, infectious diseases, and allergy spectrum disorders. Superimposed on these issues are lifestyle patterns and negative health behaviors that develop as ill-fated compensatory mechanisms used to cope with life stressors and aging. The brain and body are electrical systems that can "short circuit." The therapy practices inherent in the proposed cognitive wellness service delivery model can provide preventative insulation and circuit breaking against the shock of illness.

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.

Effectiveness of hypnosis therapy and Gestalt therapy as depression treatments / Eficacia de la terapia de hipnosis y de la terapia gestáltica como tratamientos de la depresión

We analyzed the effectiveness of two psychological therapies to treat depression in the Culiacan population, Mexico. According to criteria of MINI (international Neuropsychiatric interview), 30 individuals from a total of 300 were selected and diagnosed with some kind of depression. Patients were divided in three groups: 1) treatment with hypnosis therapy, 2) treatment with Gestalt-hypnosis therapy, and 3) control group. Before and after the treatments the Beck Anxiety Inventory (BAI) was applied to know the depression level of the analyzed groups. The results show that the three groups were presenting a moderated level of depression. The groups under hypnosis therapy and Gestalt-hypnosis therapy show statistical differences between pre-test and post-test. The hypnosis therapy shows significant statistic differences to treat depression with respect to the other two groups. In conclusion, the therapeutic hypnosis is an effective treatment and has relevance to treat depression, while other therapeutic treatments tend to be slow and with minor result. This study is the first of this kind carried out in Culiacan in Sinaloa, Mexico

En este estudio se analiza la eficacia de dos terapias psicológicas para tratar la depresión en la población de Culiacán, México. Según los criterios de la MINI (entrevista neuropsiquiátrica internacional) se seleccionó a 30 sujetos de un total de 300 y se les diagnosticó de algún tipo de depresión. Se dividió a los pacientes en tres grupos: 1) tratamiento con terapia hipnosis, 2) tratamiento con terapia gestalt-hipnosis y 3) grupo control. Antes y después de los tratamientos se aplicó el Inventario de Ansiedad de Beck (BAI) para conocer el grado de depresión de los grupos analizados. Los resultados muestran que los tres grupos presentaban un grado moderado de depresión. Los grupos de hipnosis y gestalt-hipnosis muestran diferencias estadísticas entre el pretest y el postest. La terapia de hipnosis muestra diferencias estadísticamente significativas para tratar la depresión con respecto a los otros dos grupos. En conclusión, la hipnosis terapéutica es un tratamiento eficaz y es relevante para tratar la depresión, mientras que otros tratamientos terapéuticos tienden a ser más lentos y tener peores resultados. Se trata del primer estudio de este tipo llevado a cabo en Culiacán, Sinaloa, México

Mindfulness for neuropathic pain: a case study

Neuropathic pain (NP) is a debilitating chronic pain state that affects approximately 6-8% of the general population. Limited success in pharmacological treatments has led to the rise of psychological therapy in attempts to reduce pain intensity. One such therapy is Mindfulness: a meditative practice concerned with purposeful and non-judgemental awareness of the present moment. Whilst Mindfulness has demonstrated its effectiveness in alleviating symptoms of a number of psychological disorders and symptoms of chronic pain, little evidence is available to determine whether its practice is associated with improvements in pain intensity in individuals suffering from NP. The following is a case study of a 62-year-old female (LU), who for the past 18 years has experienced chronic Neuropathic Pain (NP) as a result of a stroke. The current study examined the relationship between 12 weeks of daily Mindfulness practice and immediate, short-term and long-term self-reported pain levels. An additional goal was to explore the impact of Mindfulness on psychological functioning and well-being following the 12-week period of Mindfulness practice. LU showed a clinically meaningful reduction in pain immediately following Mindfulness practice. An overall reduction in ‘Continuous’, ‘Neuropathic’ and ‘Affective’ type pain was observed at post intervention but was not maintained at follow up. The results of the psychological functioning and well-being measures were mixed, with a notable reduction in in the domains of emotional reactivity, depression and stress. These results provide preliminary support for the use of Mindfulness in managing chronic pain of a neuropathic nature. The results are discussed in relation to practice factors (AU)

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Nutrición y deterioro cognitivo / Nutrition and cognitive impairment

La demencia, estrechamente ligada a factores predisponentes ambientales como la dieta, supone un problema de salud pública de magnitud creciente: actualmente más de 35 millones de pacientes presentan demencia tipo Alzheimer, y se espera que se superen los 135 millones en 2050. Si conseguimos retrasar el desarrollo de la demencia 5 años, reduciremos su prevalencia en un 50%. Los pacientes con demencia alteran su dieta y se han reportado déficits, entre otros, de ácido fólico, vitaminas B12, B6 , C, E, A, D, K, betacarotenos y omega tres, que deben ser resueltos con una dieta adecuada y, en según qué casos, con aportes extra. Pero para reducir o al menos retrasar la prevalencia debemos preconizar la prevención mediante una dieta adecuada desde el inicio de la vida, idea reforzada por el hecho de que los factores de riesgo cardiovascular se relacionen de forma directa con el desarrollo de demencia. Disponemos de abundante bibliografía que, aunque con límites, nos permite hacer recomendaciones nutricionales para prevenir el deterioro cognitivo. Se han conseguido mejores resultados cuando se han estudiado dietas completas que cuando se han considerado nutrientes específicos. De especial interés es la dieta mediterránea, que garantiza un aporte elevado de vegetales, frutas, frutos secos, legumbres, cereales, pescado y aceite de oliva, y moderado de carne, productos lácteos y alcohol, y en la que nos centraremos en este artículo (AU)

Dementia, closely linked to environmental predisposing factors such as diet, is a public health problem of increasing magnitude: currently there are more than 35 million patients with Alzheimer´s disease, and is expected to exceed 135 million by 2050. If we can delay the development of dementia 5 years will reduce its prevalence by 50%. Patients with dementia modify their diet, and it has been reported in them deficits, among others, of folic acid, vitamin B12, B6 , C, E, A, D, K, beta carotene and omega 3 fatty acids, that must be resolved with proper diet and with extra contributions if needed in some cases. But to reduce, or at least delay, the prevalence of dementia we advocate prevention through proper diet from the beginning of life, an idea that is reinforced given that cardiovascular risk factors are related directly to the development of dementia. A lot of literature are available that, although with limits, allows us to make nutritional recommendations for preventing cognitive impairment. Better results are achieved when complete diets have been studied and considered over specific nutrients separately. Particularly, the Mediterranean diet has great interest in this disease, since it ensures a high intake of vegetables, fruits, nuts, legumes, cereals, fish and olive oil, and moderate intake of meat, dairy products and alcohol. We will focus more on this article in this type of diet (AU)

Efectos de los inductores antiepilépticos en la neuropsicofarmacología: una cuestión ignorada. Parte II: cuestiones farmacológicas y comprensión adicional / The effects of antiepileptic inducers in neuropsychopharmacology, a neglected issue. Part II: pharmacological issues and further understanding

La literatura sobre los inductores en la epilepsia y el trastorno bipolar está contaminada por falsos negativos. Esta segunda parte de una revisión exhaustiva sobre los fármacos antiepilépticos (FAE) con propiedades inductoras aporta más material educativo a los clínicos acerca de la complejidad de interpretar sus interacciones farmacológicas. Se revisa la farmacología básica de la inducción incluyendo los citocromos P450 (CYP), las enzimas de glucuronización (UGT) y la glucoproteína P (P-gp). Los CYP2B6 y CYP3A4 son muy sensibles a la inducción. El CYP1A2 es moderadamente sensible. Los el CYP2C9 y el CYP2C19 son solo levemente sensibles. El CYP2D6 no puede ser inducida por los fármacos. La inducción de las enzimas metabólicas, los CYP o las UGT, y los transportadores como la P-gp, se debe a un incremento de la síntesis de estas proteínas mediado por los denominados receptores nucleares (receptores constitutivo de androstano, de los estrógenos, de los glucocorticoides y de pregnano X). Aunque la primera parte de este artículo describe los factores de corrección para los antiepilépticos inductores, la extrapolación de estos valores desde un paciente promedio a un individuo concreto está influenciada por la ruta de administración, la carencia de la enzima metabólica debida a razones genéticas, y la presencia de inhibidores, u otros inductores. También pueden ser importantes las interacciones farmacológicas de los FAE al nivel de los mecanismos farmacodinámicos. Se describen 6 pacientes con una sensibilidad extrema a los inductores antiepilépticos (AU)

The literature on inducers in epilepsy and bipolar disorder is seriously contaminated by false negative findings. Part II of this comprehensive review on antiepileptic drug (AED) inducers provides clinicians with further educational material about the complexity of interpreting AED drug-drug interactions. The basic pharmacology of induction is reviewed including the cytochrome P450 (CYP) isoenzymes, the Uridine Diphosphate Glucuronosyltransferases (UGTs), and P-glycoprotein (P-gp). CYP2B6 and CYP3A4 are very sensitive to induction. CYP1A2 is moderately sensitive while CYP2C9 and CYP2C19 are only mildly sensitive. CYP2D6 cannot be induced by medications. Induction of UGT and P-gp are poorly understood. The induction of metabolic enzymes such as CYPs and UGTs, and transporters such as P-gp, implies that the amount of these proteins increases when they are induced; this is almost always explained by increasing synthesis mediated by the so-called nuclear receptors (constitutive androstane, estrogen, glucocorticoid receptors and pregnane X receptors). Although part i provides correction factors for AEDs, extrapolation from an average to an individual patient may be influenced by administration route, absence of metabolic enzyme for genetic reasons, and presence of inhibitors or other inducers. AED pharmacodynamic DDIs may also be important. Six patients with extreme sensitivity to AED inductive effects are described (AU)

Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study.

BACKGROUND: Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients' care. This study reports initial feasibility and outcomes from a five month music therapy programme including weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. METHODS: 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The cluster randomised, controlled trial included baseline, 3-month, 5-month and post-intervention 7-month measures of residents' symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers' feedback through semi-structured interviews, programme evaluations and track records of the study. RESULTS: The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (-0.74, 95 % CI: [-1.15 to -0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. CONCLUSION: The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The intervention is feasible with modifications in a more rigorous evaluation of a larger sample size. TRIAL REGISTRATION: Clinicaltrials.gov, number NCT01744600.

Efectos de un programa de intervención neuropsicológica basado en mindfulness sobre la enfermedad de Alzheimer: ensayo clínico aleatorizado a doble ciego / Effects of a neuropsychology program based on mindfulness on Alzheimer's disease: randomized double-blind clinical study

Introducción. Evaluar los efectos de un programa de intervención neuropsicológica basado en mindfulness en la evolución clínica de la enfermedad de Alzheimer. Material y método. Se realizó un ensayo clínico aleatorizado de dos años de duración a doble ciego. En el estudio participaron 127 personas mayores con enfermedad de Alzheimer probable según criterios de la NINCDS-ADRDA. Se agruparon los enfermos en tres grupos experimentales (estimulación cognitiva, relajación muscular progresiva y mindfulness) y un grupo control. Todos los enfermos estaban en tratamiento con donepezilo. Se evaluaron las capacidades cognitivas con el CAMCOG y MMSE, el área funcional con el RDRS-2 y el área psicopatológica con el NPI. Se desarrollaron tres sesiones a la semana durante 2 años con medidas semestrales de seguimiento. Resultados. Las mediciones de la función cognitiva global, la funcionalidad y los trastornos de conducta asociados a la demencia indicaron que los enfermos del grupo experimental basado en mindfulness se han mantenido estables durante los dos años, mientras que los controles y el resto de los grupos experimentales muestran un leve pero significativo empeoramiento de sus capacidades mentales. Conclusión. El programa de intervención neuropsicológica basado en mindfulness se ha asociado con la estabilidad cognitiva y funcional y mejoras significativas en la situación psicopatológica de los enfermos de Alzheimer en fase leve y moderada. Estos resultados apoyan la idea de que la intervención basada en mindfulness puede producir un beneficio clínicamente relevante en el tratamiento de la demencia. Se debe seguir trabajando en esta línea para confirmar estos datos (AU)

Introduction. The purpose of this research was to assess effects of a mindfulness based neuropsychological intervention on the clinical course of Alzheimer's disease. Material and method. A two year randomized and double blind clinical trial was conducted on 127 probable Alzheimer's disease patients, according to NINCDS-ADRDA scale. Patients were grouped into three experimental groups (cognitive stimulation, progressive muscular relaxation, and mindfulness) plus a control group. All participants were receiving donepezil. Cognitive skills were assessed with CAMCOG and MMSE, functional area with RDRS-2, and NPI was used for psychopathology screening. Three treatment sessions per week were carried out for two years, and follow up measurements were taken every six months. Results. The global cognitive function, functionality and behavioral disorders measurements indicated that patients from the experimental group based on mindfulness were stable during the two years, while patients from the control group, as well as the other experimental groups, showed a mild but significant worsening of their mental capacities. Conclusion. The mindfulness based neuropsychological program showed better cognitive and functional stability, as well as significant improvement in the psychopathological condition of mild to moderate Alzheimer’ patients. These results support the idea that a mindfulness based intervention can produce a clinically relevant improvement in the treatment of dementia. More research is needed to confirm these data (AU)

Private pediatric neuropsychology practice multimodal treatment of ADHD: an applied approach.

As neuropsychologists and psychologists specializing in the assessment and treatment of pediatric mental health concerns, one of the most prominent diagnoses we encounter is attention-deficit hyperactivity disorder (ADHD). Following a pediatric neuropsychological evaluation, parents often request recommendations for treatment. This article addresses our approach to the treatment of ADHD from the private practice perspective. We will review our primary treatment methodology as well as integrative and alternative treatment approaches.

[Decoding subjective mental states from FMRI activity patterns].

In recent years, functional magnetic resonance imaging (fMRI) decoding has emerged as a powerful tool to read out detailed stimulus features from multi-voxel brain activity patterns. Moreover, the method has been extended to perform a primitive form of 'mind-reading,' by applying a decoder "objectively" trained using stimulus features to more "subjective" conditions. In this paper, we first introduce basic procedures for fMRI decoding based on machine learning techniques. Second, we discuss the source of information used for decoding, in particular, the possibility of extracting information from subvoxel neural structures. We next introduce two experimental designs for decoding subjective mental states: the "objective-to-subjective design" and the "subjective-to-subjective design." Then, we illustrate recent studies on the decoding of a variety of mental states, such as, attention, awareness, decision making, memory, and mental imagery. Finally, we discuss the challenges and new directions of fMRI decoding.

Stimulus control: the sought or unsought influence of the objects we tend to

Does the mere presence of the things we have tended to influence our actions systematically, in ways that escape our awareness? For example, while entering a tool shed, does perceiving objects that we once tended to (e.g., tools, musical instruments) influence how we then execute a simple action (e.g., flicking the shed’s light switch)? Ancient traditions (e.g., feng shui) and contemporary approaches to action production (e.g., continuous flow and cascade models) hypothesize that the answer is yes. Although relevant to several fields (e.g., motor cognition, social cognition), for various reasons this hypothesis cannot be tested by traditional choiceresponse time interference paradigms, which involve more complex processes than our tool shed scenario. Using new paradigms that resemble detection tasks, three studies demonstrated that ‘very incidental’ actionrelated distracters systematically interfere with simple, repeated actions that involve minimal response selection and decision-making processes. In Study 2, incidental musical notation interfered more with the simple actions of expert sight-readers than with the same actions of non-musicians. A similar pattern of effects was obtained with a fully experimental design. The implications for theories of action production, environmentally-driven automaticity, and social cognition are discussed(AU)

Auditory and cognitive deficits associated with acquired amusia after stroke: a magnetoencephalography and neuropsychological follow-up study.

Acquired amusia is a common disorder after damage to the middle cerebral artery (MCA) territory. However, its neurocognitive mechanisms, especially the relative contribution of perceptual and cognitive factors, are still unclear. We studied cognitive and auditory processing in the amusic brain by performing neuropsychological testing as well as magnetoencephalography (MEG) measurements of frequency and duration discrimination using magnetic mismatch negativity (MMNm) recordings. Fifty-three patients with a left (n = 24) or right (n = 29) hemisphere MCA stroke (MRI verified) were investigated 1 week, 3 months, and 6 months after the stroke. Amusia was evaluated using the Montreal Battery of Evaluation of Amusia (MBEA). We found that amusia caused by right hemisphere damage (RHD), especially to temporal and frontal areas, was more severe than amusia caused by left hemisphere damage (LHD). Furthermore, the severity of amusia was found to correlate with weaker frequency MMNm responses only in amusic RHD patients. Additionally, within the RHD subgroup, the amusic patients who had damage to the auditory cortex (AC) showed worse recovery on the MBEA as well as weaker MMNm responses throughout the 6-month follow-up than the non-amusic patients or the amusic patients without AC damage. Furthermore, the amusic patients both with and without AC damage performed worse than the non-amusic patients on tests of working memory, attention, and cognitive flexibility. These findings suggest domain-general cognitive deficits to be the primary mechanism underlying amusia without AC damage whereas amusia with AC damage is associated with both auditory and cognitive deficits.

Efecto regional, de la edad y el sexo en la espectroscopia por resonancia magnética cerebral / Regional effects of age and sex in magnetic resonance spectroscopy

Objetivo. Estudiar con espectroscopia univóxel por resonancia magnética (1,5T) el efecto regional, de la edad y el sexo en las ratios metabólicas del lóbulo temporal medial, la región cerebral posteromedial (RPM) y el lóbulo frontal. Material y métodos. Estudiamos 31 personas sanas mayores de 55 años (grupo 1) y 20 menores de 30 años (grupo 2) con espectroscopia univóxel en el lóbulo frontal izquierdo, el lóbulo temporal medial izquierdo y la RPM, especialmente afectadas por las enfermedades neurodegenerativas. Se calcularon las ratios NAA/Cr, NAA/Cho, NAA/mI, Cho/Cr, y mI/Cr, de cada vóxel. En cada grupo se compararon regionalmente las ratios metabólicas, y se estudió la correlación ratio-edad dentro de sus rangos de edad. Finalmente, se analizaron las diferencias de las ratios metabólicas entre grupos y entre sexos. Resultados. En el grupo 1, las ratios Cho/Cr frontal y NAA/mI temporal se correlacionaron negativamente con la edad. En el grupo 2, las correlaciones con la edad fueron negativas para las ratios temporales mI/Cr y NAA/Cho, y positiva para la NAA/mI temporal. En el lóbulo frontal y la RPM, las ratios NAA/Cr, NAA/Cho y NAA/mI fueron menores en el grupo 1 (P<=0,003). Las ratios Cho/Cr y mI/Cr nunca mostraron diferencias entre grupos. Los valores de las ratios difirieron regionalmente en todos los casos (P<0,001). NAA/Cr y Cho/Cr en el lóbulo temporal medial fueron mayores en las mujeres (P<=0,034). Conclusiones. Cuando se utilice la espectroscopia univóxel por resonancia magnética, en particular en las enfermedades neurodegenerativas, siempre deben considerarse las variaciones inducidas por la región, la edad y el sexo (AU)

Objective. To determine the regional effects of age and sex on the metabolic ratios obtained in the medial temporal lobe, the posteromedial region, and the frontal lobe at 1.5T single-voxel magnetic resonance spectroscopy. Material and methods. We used single-voxel magnetic resonance spectroscopy to study the areas of the brain most affected in neurodegenerative disease (the left frontal lobe, the left medial temporal lobe, and the posteromedial region) in 31 healthy subjects older than 55 years of age (group 1) and in 20 healthy subjects under 30 years of age (group 2). We calculated the following ratios for each voxel: N-acetyl-aspartate/creatine-phosphocreatine (NAA/Cr), N-acetyl-aspartate/choline (NAA/Cho), N-acetyl-aspartate /myoinositol (NAA/mI), choline/creatine-phosphocreatine (Cho/Cr), and myoinositol (mI/Cr). We compared the metabolic ratios in each region in each group and the correlation between age and the ratios within age ranges. Finally, we analyzed the differences in the metabolic ratios between groups and between sexes. Results. In group 1, we found negative correlations between age and Cho/Cr in the frontal region and NAA/mI in the temporal region. In group 2, we found negative correlations between age and mI/Cr and NAA/Cho in the temporal region as well as a positive correlation between age and NAA/mI in the temporal region. In the frontal lobe and the posteromedial region, NAA/Cr, NAA/Cho, and NAA/mI were lower in group 1 (P<=0.003). No differences between groups were seen in Cho/Cr or mI/Cr. The values of the ratios differed regionally in all cases (P<0.001). In the temporal lobe, NAA/Cr and Cho/Cr were higher in women (P<=0.034). Conclusions. When using single-voxel magnetic resonance spectroscopy, especially in patients with neurodegenerative disease, variations due to region, age, and sex should always be taken into account (AU)

Higher-level motor processes.

Traditionally the motor system was thought of as a movement output device that, after brain damage, can impede patients from correctly planning and executing an action. In the last 20 years neuropsychological observations have contributed to the development of a new view that attributes higher-level functions to this system. Rapidly, this area of investigation has grown very popular, with motor representations being considered critical for action and object recognition, imagery and even language understanding. At present, we can distinguish between embodied and disembodied theories. The former predominantly are built on associations of deficits in these abilities whereas the latter rely on dissociations between deficits. Neuroimaging research has also showed that different action-related functions activate either overlapping or discrete regions, thus sustaining either association-based or dissociation-based models. Although no convincing theory is, to date, available to explain both sets of observations, cognitive neuroscientists have begun to explore this intermediate hypothesis space. Here we suggest that concepts like strategy and simulation seem promising in explaining how the cognitive system alternates between action-related functions.

Chronic detachable headphones for acoustic stimulation in freely moving animals.

A growing number of studies of auditory processing are being carried out in awake, behaving animals, creating a need for precisely controlled sound delivery without restricting head movements. We have designed a system for closed-field stimulus presentation in freely moving ferrets, which comprises lightweight, adjustable headphones that can be consistently positioned over the ears via a small, skull-mounted implant. The invasiveness of the implant was minimized by simplifying its construction and using dental adhesive only for attaching it to the skull, thereby reducing the surgery required and avoiding the use of screws or other anchoring devices. Attaching the headphones to a chronic implant also reduced the amount of contact they had with the head and ears, increasing the willingness of the animals to wear them. We validated sound stimulation via the headphones in ferrets trained previously in a free-field task to localize stimuli presented from one of two loudspeakers. Noise bursts were delivered binaurally over the headphones and interaural level differences (ILDs) were introduced to allow the sound to be lateralized. Animals rapidly transferred from the free-field task to indicate the perceived location of the stimulus presented over headphones. They showed near perfect lateralization with a 5 dB ILD, matching the scores achieved in the free-field task. As expected, the ferrets' performance declined when the ILD was reduced in value. This closed-field system can easily be adapted for use in other species, and provides a reliable means of presenting closed-field stimuli whilst monitoring behavioral responses in freely moving animals.

Atención interdisciplinar del daño cerebral / Interdisciplinary attention of the head injury

El daño cerebral constituye una de las principales causas de discapacidad en nuestra sociedad actual y puede comportar cambios físicos, cognitivos, emocionales y del comportamiento que deben abordarse desde distintas disciplinas, por lo que la atención interdisciplinar es fundamental en todo el proceso de rehabilitación. Además, las secuelas derivadas del daño cerebral conllevan problemas de dependencia que afectarán tanto al propio paciente, como a sus familiares, los cuales deberán asumir el rol de cuidadores principales, con las consiguientes repercusiones en su calidad de vida. Los diferentes profesionales implicados en el proceso de recuperación, deberán atender a las personas afectadas desde una perspectiva interdisciplinar en base a su especialización, favoreciendo una atención integral de los pacientes afectados y de sus familias. Tanto la valoración logopédica como la neuropsicológica, deben realizarse desde la fase aguda y también a lo largo de todo el proceso de rehabilitación. A su vez, logopedas y neuropsicólogos deberán trabajar de forma coordinada y también conjuntamente con todos los profesionales del equipo de rehabilitación, puesto que los trastornos del lenguaje y de la comunicación, así como los déficit cognitivos, emocionales y del comportamiento afectan muy directamente al funcionamiento del paciente y a su relación con la familia y el entorno. En la actualidad, los programas de rehabilitación del daño cerebral deben plantearse desde una aproximación holística, según la cual el tratamiento se realiza desde una perspectiva global, incluyendo también a la familia en todo el proceso de recuperación y fomentando, a su vez, la readaptación profesional y social del paciente, siendo por tanto fundamental el trabajo interdisciplinar (AU)

Head injury constitutes one of the main causes of disability in our society and produces physical, cognitive, emotional and behavioral changes, that have to be assisted from different disciplines and interdisciplinary attention is very important in all of the rehabilitation process. Moreover, squeals derived from head injury produce dependence problems that will affect patients and their relatives, who will have to take care of them and this would affect their quality of live. Professionals that take part in the rehabilitation process have to work from an interdisciplinary perspective according to their specialty, with an integrated attention to patients and relatives. Both, speech and language assessment and neuropsychological assessment have to be made since the acute phase and during all the rehabilitation process. Moreover, speech and language therapists and neuropsychologists have to work in a coordinated way and together with all professionals of the rehabilitation team, as language and communicative disorders, and cognitive, emotional and behavioral changes affect directly patients functioning and their relationship with relatives. Nowadays, head injury rehabilitation programs are based on the holistic approach, in which patients receive treatment from a global perspective, including their relatives in all the recovery process, and helping patients in their professional and social outcome, working from an interdisciplinary way (AU)

A neural network model for transference and repetition compulsion based on pattern completion.

In recent years because of the fascinating growth of the body of neuroscientific knowledge, psychoanalytic scientists have worked on models for the neurological substrates of key psychoanalytic concepts. Transference is an important example. In this article, the psychological process of transference is described, employing the neurological function of pattern completion in hippocampal and thalamo-cortical pathways. Similarly, repetition compulsion is seen as another type of such neurological function; however, it is understood as an attempt for mastery of the unknown, rather than simply for mastery of past experiences and perceptions. Based on this suggested model of neurological function, the myth of the psychoanalyst as blank screen is seen as impossible and ineffective, based on neurofunctional understandings of neuropsychological process. The mutative effect of psychoanalytic therapy, correcting patterns of pathological relatedness, is described briefly from conscious and unconscious perspectives. While cognitive understanding (insight) helps to modify transferentially restored, maladaptive patterns of relatedness, the development of more adaptive patterns is also contingent upon an affective experience (working through), which alters the neurological substrates of unconscious, pathological affective patterns and their neurological functional correlates.

Iron states and cognitive abilities in young adults: neuropsychological and neurophysiological assessment.

Many investigators found that iron deficiency anemia (IDA) had a great influence on cognitive functions in infants and children. However, studies of such topic in adults are few and controversial. We prospectively assessed the possible influence of IDA and iron supplementation (for 3 months) on cognitive function and intelligence of 28 young adults with IDA. We used group of hematological, cognitive, neurophysiological tests for assessment including: mini-mental state examination (MMSE), Wechsler memory scale-revised (WMS-R), Wechsler adult intelligence scale-revised (WAIS-R), event-related potentials (ERPs), and electroencephalography (EEG). Compared to controls, patients demonstrated lower scores of different cognitive tests (MMSE, WMS-R, and WAIS-R), which showed significant improvement after treatment. Prolongation of ERPs latencies (N200 and P300) and reduction in their amplitudes (P200 and P300) were identified with significant increase in amplitude occurred after treatment. EEG abnormalities were observed in 55% of patients which showed improvement in 35% after treatment. Positive correlation was identified before and after treatment between hemoglobin levels and MMSE (P=0.01, 0.05), total verbal (P=0.04) and performance (P=0.05, 0.04) IQ scores. Negative correlation was identified between before and after treatment between P300 latency and total IQ of WAIS-R (P=0.03, 0.008) and hemoglobin level (P=0.4, 0.01). Positive correlation was found before and after treatment between P300 amplitude and total IQ (P=0.028, 0.01) and serum iron (P=0.01, 0.001). In conclusion, IDA is a significant factor in cognitive performance in adult population, which can be partially reversed by treatment.

A quest for antipsychotic drug actions in the brain: personal experiences from 50 years of neuropsychiatric research at Karolinska Institutet.

The exploration of physiological and molecular actions of psychoactive drugs in the brain represents a fundamental approach to the understanding of emerging psychological phenomena. The author gives a personal account of his medical training and research career at Karolinska Institutet over the past 50 years. The paper aims at illustrating how a broad medical education and the integration of basic and clinical neuroscience research is a fruitful ground for the development of new methods and knowledge in this complicated field. Important aspects for an optimal research environment are recruitment of well-educated students, a high intellectual identity of teachers and active researchers, international input and collaboration in addition to good physical resources. In depth exploration of specific signaling pathways as well as an integrative analysis of genes, molecules and systems using multivariate modeling, and bioinformatics, brain mechanisms behind mental phenomena may be understood at a basic level and will ultimately be used for the alleviation and treatment of mental disorders.