Neuropsychological Stimulation Program for Children from Low Socioeconomic Backgrounds: Study Protocol for a Randomized Controlled Trial.

BACKGROUND: Guatemala remains one of the poorest countries in Central America and suffers from high rates of social inequality and violence. In addition to the negative impact that two years without attending school has had on Guatemalan children due to the consequences of the COVID-19 pandemic, this unfavourable socioeconomic context poses a risk to children's emotional and cognitive development. This work presents a protocol for implementing a cognitive and emotional stimulation program aimed at increasing the academic performance of these children and consequently improving their quality of life. METHODS: The protocol proposes the implementation of a randomized controlled trial to assess the efficacy of a 24-session-long stimulation program. It targets the cognitive functions of attention, language, executive functions, and social cognition, using the digital neurorehabilitation platform NeuronUP. The participants (n = 480) will be randomly assigned to an Experimental or Control group. Pre- and post-intervention assessments will be carried out, together with a follow-up in the next academic year, in which both groups will change roles. Results will be compared for the first and second years, looking for differences in academic and cognitive performance between groups. DISCUSSION: Mid- and long-term outcomes are still unknown, but effective interventions based on this protocol are expected to facilitate the following benefits for participants: (1) improved cognitive and emotional development; (2) improved academic performance; (3) improved well-being. We expect to create a validated neuropsychological stimulation program that could be applied in similar socioeconomically disadvantaged contexts around the world to help these children improve their life chances.

Factors associated with cognitive impairment in Latin American older adults: A cross-sectional observational study of COVID-19 confinement.

INTRODUCTION: The effects of COVID-19 confinement have been severe, especially in older adults. Therefore, we analyzed the factors associated with cognitive impairment (CI) in Latin America (LA). METHODS: We conducted a cross-sectional observational study with a total of 5245 older adults from 10 countries in LA. Measurement: We used the Telephone Montreal Cognitive Assessment (T-MoCA) and the Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) scale. RESULTS: We found that age, depressive symptomatology, bone fractures, being widowed, having a family member with dementia, and unemployment were associated with an increased risk of CI. In contrast, higher education, hypertension with continuous treatment, quarantine, and keeping stimulating cognitive and physical activities were associated with a lower probability of CI. No significant association was found between suffering from diabetes or being retired and CI. DISCUSSION: It is essential to conduct follow-up studies on these factors, considering their relationship with CI and the duration of confinement.

Normative Data for Ten Neuropsychological Tests for the Guatemalan Pediatric Population Updated to Account for Vulnerability.

The Guatemalan pediatric population is affected by a high incidence of poverty and violence. The previous literature showed that these experiences may ultimately impact cognitive performance. The aim of this article is to update the standardized scores for ten neuropsychological tests commonly used in Guatemala considering vulnerability. A total of 347 healthy children and adolescents from 6 to 17 years of age (M = 10.83, SD = 3) were assessed, controlling for intelligence, mental health and neuropsychological history. The standard scores were created using multiple linear regression and standard deviations from residual values. The predictors included were the following: age, age squared (age2), mean parental education (MPE), mean parental education squared (MPE2), gender, and vulnerability, as well as their interaction. The vulnerability status was significant in the scores for language, attention and executive functions. To the best of our knowledge, this is the first study that includes the condition of vulnerability in the calculation of neuropsychological standard scores. The utility of this update is to help in the early detection of special needs in this disadvantaged population, promoting more accurate interventions in order to alleviate the negative effects that living in vulnerable conditions has on children and adolescents.

How Living in Vulnerable Conditions Undermines Cognitive Development: Evidence from the Pediatric Population of Guatemala.

Low-socioeconomic backgrounds represent a risk factor for children's cognitive development and well-being. Evidence from many studies highlights that cognitive processes may be adversely affected by vulnerable contexts. The aim of this study was to determine if living in vulnerable conditions affects childhood cognitive development. To achieve this, we assessed the performance of a sample of 347 Guatemalan children and adolescents aged from 6 to 17 years (M = 10.8, SD = 3) in a series of 10 neuropsychological tasks recently standardized for the pediatric population of this country. Two-fifths of the sample (41.5%) could be considered to have vulnerable backgrounds, coming from families with low-socioeconomic status or having had a high exposure to violence. As expected, results showed lower scores in language and attention for the vulnerable group. However, contrary to expectations, consistent systematic differences were not found in the executive function tasks. Vulnerable children obtained lower scores in cognitive flexibility compared to the non-vulnerable group, but higher scores in inhibition and problem-solving tasks. These results suggest the importance of developing pediatric standards of cognitive performance that take environmental vulnerable conditions into consideration. These findings, one of the first obtained in the Guatemalan population, also provide relevant information for specific educational interventions and public health policies which will enhance vulnerable children and adolescent cognitive development.

Normative data for verbal fluency in healthy Latin American adults: Letter M, and fruits and occupations categories.

OBJECTIVE: To generate normative data for the verbal fluency tests (VFT-letter M, fruits, and occupations categories) in Spanish-speaking adult populations, with country-specific adjustments for age, education, and sex when appropriate. METHOD: The sample consisted of 3,977 healthy adults from 11 countries in Latin America (Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico; sample size per country ranged between n = 184 and n = 1,300). Each participant was administered the VFT as part of a larger neuropsychological battery. Scores for letter M, fruits, and occupations categories were normed using multiple linear regressions. The country-specific regression models included age, age2, education, education2, and sex as predictors. RESULTS: The final multiple linear regression models showed that age affected the performance on these tests but not uniformly. For example, M letter scores decrease linearly with age except for Argentina, Guatemala, and Mexico, in which quadratic age effect was found. Scores also increase linearly as a function of education but not in all countries. For example, a quadratic education effect was found for the fruits category in Bolivia, Honduras, and Paraguay. Sex had a significant impact on the M letter category fluency in Guatemala, fruits category in Guatemala and Peru, and occupations' category in Mexico. CONCLUSIONS: This study presents verbal fluency test normative data across 11 countries in Latin America. These norms are expected to be useful for neuropsychologists of these countries. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Conciencia sobre intimidación en la formación de maestras de párvulos / Bullying awareness in pre-school teacher training

Para el éxito de la prevención e intervención de la intimidación es necesario tener conciencia sobre el problema; el objetivo del presente trabajo fue conocer la relación entre el nivel de conciencia sobre intimidación y el programa "Bully Busters, Un Manual Para Maestros". Participaron 150 estudiantes para maestras de párvulos en la ciudad de Guatemala. Se llevó a cabo un estudio pre-test/post-test de series temporales interrumpidas formando un grupo control y uno experimental, se utilizó como instrumento de medición el Inventario de Habilidades y Conocimientos para Profesores (TISK siglas en inglés). Los resultados se analizaron a través de pruebas "t" de medias para grupos independientes, encontrando diferencias entre las medias de ambos grupos. Las alumnas que recibieron el programa incrementaron la conciencia respecto al nivel inicial y en comparación al grupo control. Se recomienda incluir en la formación de los profesores el entrenamiento sobre intimidación, con el fin de detectar y prevenir episodios de violencia en el aula

Perfil socioeconómico y dinámica familiar del paciente con enfermedad de Huntington / Socioeconomic profile and familiy dynamic in patients with Huntington's disease

La enfermedad de Huntington (EH) es un padecimiento neurodegenerativo y autosómico dominante, caracterizado por movimientos involuntarios, alteraciones de la conducta y demencia. El diagnóstico confirmativo trae consigo una serie de reacciones en la familia y en el paciente; ambas se ven en la necesidad de hacer cambios en su estilo de vida. La economía se ve afectada directamente, pues el paciente ya no contribuye al ingreso familiar; todo esto trae como consecuencia que la dinámica familiar se vea afectada teniendo que adaptarse a nuevas situaciones. El presente trabajo tiene como objetivo conocer el perfil socioeconómico y la dinámica familiar de 36 familias con EH estudiadas en el departamento de neurogenética del Instituto Nacional de Neurología y Neurocirugía, se aplicó un cuestionario estructurado con 16 reactivos que recabaron información sociodemográfica, económica y familiar. En las 36 familias había hasta el momento de la investigación, 41 pacientes vivos y 243 personas en riesgo de éstas 116 ya son padres de familia. La situación socioeconómica encontrada fue precaria debido a que el ingreso mensual sólo alcanza para cubrir las necesidades básicas. En importante mencionar que el 4 por ciento de las familias sufrió modificaciones con respecto a la comunicación que mantenían antes del diagnóstico y el 19 por ciento sufrió ruptura total de la convivencia. Es importante seguir fomentando la participación de los familiares en el grupo de apoyo para incrementar los conocimientos acerca de la enfermedad y así contribuir a la mejor adaptación y aceptación del paciente

Los grupos de apoyo para pacientes neurológicos y psiquiátricos en México / Support groups in Mexico for neurologic and psychiatric patients

En los últimos años, la sociedad civil se ha organizado en forma relativamente eficiente, con el fin de cumplir las demandas que las instituciones médicas tanto gubernamentales como privadas no han podido satisfacer en muchos de los ámbitos de la vida comunitaria de sus enfermos. Esto se asocia con un aumento en las patologías crónicas para las cuales aún no se han encontrado remedios terapéuticos eficaces; entre estos padecimientos, las enfermedades neurológicas tales como la enfermedad cerebro vascular, la epilepsia y las enfermedades degenerativas, sobre todo las asociadas con el envejecimiento, constituyen una prioridad para los grupos de apoyo. Los objetivos de un grupo de apoyo son: ofrecer información adecuada sobre la enfermedad; introducir estrategias de manejo en el hogar; proporcionar un espacio para que los pacientes, miembros de la familia y en especial el cuidador primario no se sientan solos en su lucha diaria. En el presente trabajo se hace una revisión de los grupos de apoyo que existen en los diferentes institutos y hospitales del sector salud de la ciudad de México y se describen los grupos de apoyo para pacientes neurológicos y psiquiátricos, que se han formado en el Instituto Nacional de Neurología y Neurocirugía

El envejecimiento a través del P300 en una población mexicana / Aging through P300 in a Mexican population

En los últimos años se ha investigado la relación entre los potenciales relacionados a eventos y el procesamiento de información en el cerebro; uno de los potenciales ampliamente estudiados es el componente P300, que se ha utilizado para evaluar las bases neurofisiológicas de los cambios que ocurren en el envejecimiento normal y patológico. El propósito del presente trabajo fue establecer datos normativos del P300 (latencia y amplitud) en una población mexicana. Para ello se estudiaron a 106 sujetos neurológicamente intactos entre los 20 y los 100 años de edad, divididos en 7 grupos. Se realizó una valoración electrofisiológica usando el paradigma clásico para generar el P300, utilizando registros monopolares referidos a los lóbulos auriculares cortocircuitados en las derivaciones Fz, Cz, Pz, monitoreándose el movimiento ocular. Se aplicó un análisis de varianza con el fin de conocer los efectos de la edad en la latencia y e la amplitud del componente N100 y P300 para cada uno de las derivaciones. Este análisis reveló diferencias estadísticamente significativas con un nivel p< 0.05 entre los siete grupos de edad. El análisis de regresión lineal mostró un incremento por año de edad de la latencia del P300 de 0.38 ms. (r=0.3804 p< 0.001) y un decremento en la amplitud de -0.20 mV r=0.2036 p<0.03. Los datos normativos del componente P300 en nuestra población mexicana, aportarón una referencia objetiva para hacer un diagnóstico diferencial y una identificación temprana entre los enfermos con procesos demenciales y los que realmente cursan con un envejecimiento normal.

Attitudes regarding molecular diagnosis in mexican families at risk of inheriting huntington's disease

Fifty-eight, at risk subjects were studied. 81 percent of the group wished to know whether they had inherited Huntington's disease, even though only 79 percent would undergo testing. The subjects reported a favorable attitude toward a probable positive result in 81 percent of cases. Neversthheless, 52 percent reported they would become depressed, and a small group referred suicidal ideation as response to a probable positive result. Regarding genetic counseling, 59 percent reported that an at-risk person should not have children, although this increased to 82 percent if the person knew with certainty that they would develop the disease. Prenatal testing was favored in 74 percent, and less than half would be willing to have an abortion. Genetic counseling must be carefully made, and the characteristics of the Mexican population must be taken into account

Predictive and prenatal diagnosis of Hunington's disease: attitudes of mexican neurologists, psychiatrists, and psychologists

Background. Huntington's disease (HD) is a hereditary disease of the central nervous system. Its molecular diagnosis has allowed predictive and prenatal diagnosis to be done, and it is now a model for the study of the ethical, legal, and social problems arising from the diagnosis of such diseases. Methods. This study explores the knowledge and attitudes of a groups of Mexican specialistis regarding the disease and its diagnosis. A self-administered, 30-item multiple-choice questionnaire was completed anonymously by neurologists, psychiatrists, and psychologists. Results. Fifty-five percent of the professionals had experience with HD patients, 59 percent claimed to know the hereditary risk, and 20 percent answered incorrectly concerning the risks. Neurologists had the most exposure to HD; 74 percent acknowledged the existence of predictive diagnosis, although only 10 percent knew the international guidelines for testing. Eighty-six percent of the participants recommended predictive diagnosis, the reasons being: 55 percent, if the patients considered having offspring; 41 percent, for the patients's professional reasons; 6 percent, if a treatment was available, and 12 percent did not answer. In cases in which the patient wanted to have offspring, 38 percents thought that this should be avoided. Thirty-six percent of the subto have offspring, 38 percent thought that this should be avoided. Thirty-six percent of the subjects considered prenatal diagnosis justified in a couple with a carrier, and 51 percent justified abortion affected fetuses. Conclusions. Genetic counseling and predictive diagnosis in Mexico must be the responsibility of genetic units and specialists who are of inheritance risks and of guidelines for HD programs. The number of patients requiring such attention is increasing rapidly

El papel del psiquiatra en el diagnóstico predicitivo en la enfermedad de huntington / The part of psychiatra in genetic prediction of Huntington's disease

Acualmente el diagnóstico predictivo de la enfermedad de Huntington (EH) se efectúa por medio de un equipo multidisciplinario. El psiquiatra es importante durante la evaluación de los candidatos que desean que se les realice el diagnóstico predictivo para la EH. Ya que pueden presentarse diversos problemas psiquiátricos por el hecho de saberse en riesgo, y posteriormente al recibir el resultado. La adaptación al resultado sea este positivo o negativo es difícil. Este artículo describe la experiencia psiquiátrica obtenida en nuestra investigación en el Instituto Nacional de Neurología y Neurocirugía de México