ABSTRACT
Frontostriatal networks play critical roles in grounding action semantics and syntactic skills. Indeed, their atrophy distinctively disrupts both domains, as observed in patients with Huntington's disease (HD) and Parkinson's disease, even during early disease stages. However, frontostriatal degeneration in these conditions may begin up to 15 years before the onset of clinical symptoms, opening avenues for pre-clinical detection via sensitive tasks. Such a mission is particularly critical in HD, given that patients' children have 50% chances of inheriting the disease. Against this background, we assessed whether deficits in the above-mentioned domains emerge in subjects at risk to develop HD. We administered tasks tapping action semantics, object semantics, and two forms of syntactic processing to 18 patients with HD, 19 asymptomatic first-degree relatives, and sociodemographically matched controls for each group. The patients evinced significant deficits in all tasks, but only those in the two target domains were independent of overall cognitive state. More crucially, relative to controls, the asymptomatic relatives were selectively impaired in action semantics and in the more complex syntactic task, with both patterns emerging irrespective of the subjects' overall cognitive state. Our findings highlight the relevance of these dysfunctions as potential prodromal biomarkers of HD. Moreover, they offer theoretical insights into the differential contributions of frontostriatal hubs to both domains while paving the way for innovations in diagnostic procedures.
Subject(s)
Cognitive Dysfunction/etiology , Huntington Disease/complications , Language Disorders/etiology , Semantics , Adult , Female , Humans , Male , Middle Aged , Neuropsychological Tests , Statistics, NonparametricABSTRACT
Nuestro país ha avanzado con la incorporación del tratamiento de la depresión unipolar a todo paciente, con acceso universal y garantías de tratamiento con oportunidad y calidad. Como resultado de esto el manejo de la depresión en la atención primaria ha mejorado en la última década. Diversos estudios han mostrado que alrededor de un 25 por ciento de los pacientes correspondería a las depresiones en trastornos en el espectro bipolar, cifra que aumenta al 40 por ciento en depresión recurrente. Se hace necesario diseñar un enfrentamiento clínico rápido para el reconocimiento de características indicadoras de un trastorno afectivo bipolar (TAB), considerando que estos pacientes no responden bien al tratamiento con antidepresivos, se deterioran más, o son más refractarios a tratamiento, con mayor riesgo de suicidio, incluso con el riesgo de gatillar episodios maniacos o hipomaniacos. El estudio presenta una breve revisión sobre bipolaridad y desarrolla un método clínico, basado en un cuestionario breve diseñado a partir de pruebas de tamizaje estándares, para poder reconocer con mayor facilidad a pacientes que estén con mayor riesgo de presentar un trastorno afectivo bipolar.
In the last decade, Chile has improved its primary care service by providing timely and good quality assistence to all patients treated with mayor depression. Different studies show that 25 percent of patients treated with depression are within the spectrum of bipolar affective disorders (TAB), figure that rises up to 40 percent in recurrent depression. These patients did not respond to the treatment with antidepressant, or more refractory to treatment, and have a higuer rate of suicide, even with the risk of triggering manic or hypomanic episodes. Therefore, it is necessary to design fast clinical clues to recognize features that may be indicative of TAB. Based on a standard screening tests, this study presents a brief review about bipolarity disorders and develops a clinical method to suspect patients that are at risk of presenting TAB in an easier way.