The relationship between changes in functional networks and cognitive changes and PTSD symptoms in maltreated children before and after TF-CBT.

Several studies have found that maltreated children show neuropsychological deficits in various cognitive domains such as memory and attention, language, visuospatial skills, emotional regulation, social cognition, and executive functioning. In terms of functional connectivity, abused children show an increased connectivity in the salience network (SN) as opposed to a decreased connectivity within the default (DMN) and executive networks (CEN). Children who suffer maltreatment may develop post-traumatic stress disorder (PTSD), which in turn, can increase psychological and cognitive sequelae. The present study examined the relation between resting state functional connectivity (RSFC), PTSD symptoms and neuropsychological profiles in abused children before and after following a psychological therapy named Trauma Focused Cognitive Behavioral therapy (TF-CBT). Resting state functional magnetic resonance imaging, neuropsychological (attention, memory and executive functions) and clinical evaluations were performed in 13 abused children with PTSD (mean age=8.77 years old, S.D.=1.83) recruited from a non-governmental shelter in Mexico and in a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender. Changes in PTSD symptoms correlated with changes in the left insula node. Additionally, significant correlations were identified between changes in the average connectivity of the DMN, intra-nodal connectivity of lateral parietal and medial prefrontal regions, and performance in attention and memory tasks.

Brain structural change associated with Cognitive Behavioral Therapy in maltreated children.

BACKGROUND: Severely maltreatment child is a harmful social factor that can disrupt normal neurodevelopment. Two commonly reported effects of maltreatment are post-traumatic stress disorder (PTSD) symptoms and brain structural and functional alteration. While Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is effectively used to reduce PTSD symptoms in maltreated children, yet, its impact on brain structural alterations has not been fully explored. This study investigated whether TF-CBT can attenuate alterations in brain structures associated with PTSD in middle childhood. METHODS: The study evaluated the longitudinal effects of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) on post-traumatic stress disorder (PTSD) symptoms and gray matter volume (GMV) in two groups of children under 12 years old: maltreated children (MC) and healthy non- maltreatmentd children (HC). Structural magnetic resonance images T1 were obtained before and after TF-CBT in the MC group, while the HC group was scanned twice within the same time interval. Voxel-based morphometry (VBM) was used to analyze GMV changes over time. RESULTS: After TF-CBT, maltreated children showed significantly reduced PTSD symptoms. Furthermore, a significant group-by-time interaction effect was observed in certain areas of the Left Temporal, Left Occipital, and bilateral Frontal Cortex, the Basal Ganglia and Cerebellum. These interaction effects were driven by a GMV decrease in the MC group compared to the HC group. GMV changes can be predicted with clinical improvement in the left Middle Temporal gyrus, left Precuneus, and Cerebellum. CONCLUSIONS: Our results suggest that TF-CBT intervention in very young maltreated children may have an effect on gray matter. This evidence demonstrates the importance of timely intervention when neuroplasticity mechanisms may be activated.

Can psychopathy be prevented? Clinical, neuroimaging, and genetic data: an exploratory study.

The aim of the study was to explore the relationship among brain functional activations elicited by an emotional paradigm, clinical scores (PTSD, anxiety, and depression), psychopathic traits, and genetic characteristics (5-HTTLPR) in a group of severely maltreated children compared to a healthy control group before and after the implementation of a Trauma Focused-Cognitive Behavioral Therapy. The final sample consisted of an experimental group of 14 maltreated children (mean age = 8.77 years old, S.D. = 1.83) recruited from a non-governmental shelter in Mexico City for children who had experienced child abuse and a control group of 10 children from the general population (mean age = 9.57 years old, S.D. = 1.91). Both groups were matched according to age and gender and were assessed before and after the implementation of the aforementioned therapy by means of clinical scales and an emotional paradigm that elicited brain activations which were recorded through functional magnetic resonance imaging. Genotyping of the 5-HTTLPR polymorphism was made at first assessment. A region of interest analysis showed amygdala hyperactivation during exposure to fear and anger stimuli in the maltreated children before treatment. Following therapy, a decrease in brain activity as well as a decrease in clinical symptoms were also observed. 5-HTTLPR polymorphism did not show any effect on the severity of clinical symptoms in maltreated children. Trauma-Focused Behavioral Therapy may help reorganize the brain's processing of emotional stimuli. These observations reveal the importance of an early intervention when the mechanisms of neuroplasticity may be still recruited.

What do neuropsychological tests assess?

Background. Contemporary neuroimaging techniques, particularly fMRI and PET, have demonstrated that cognitive abilities do not strictly depend on specific brain areas, but rather on complex brain circuits or systems.Methods. Using PubMed and Google Scholar databases, a search for functional studies (fMRI and PET) during the performance of several neuropsychological tests was done. The pattern of brain activity found during the solution of some executive functions, language, memory, calculation, and visuospatial/visuoconstructive abilities is reviewed.Results. Brain activity supporting the performance in these tests is usually quite extended, and involves not only those brain areas traditionally assumed in neuropsychology, but also other cortical and sometimes subcortical regions.Conclusions. Most neuropsychological tests are simultaneously evaluating different cognitive abilities associated with the activity of diverse brain areas. "Cognitive/anatomical" correlations could only be established for some relatively simple functions. This change in the understanding about the brain organization of cognition has not been reflected in the interpretation of the neuropsychological tests yet. The interpretation of neuropsychological tests should be based not only in clinical observations but also in functional studies. This is a necessary further step in clinical neuropsychology.

Early traumatic events in psychopaths.

The relationship between diverse early traumatic events and psychopathy was studied in 194 male inmates. Criminal history transcripts were revised, and clinical interviews were conducted to determine the level of psychopathy using the Psychopathy Checklist-Revised (PCL-R) Form, and the Early Trauma Inventory was applied to assess the incidence of abuse before 18 years of age. Psychopathic inmates presented a higher victimization level and were more exposed to certain types of intended abuse than sociopathic inmates, while the sum of events and emotional abuse were associated with the PCL-R score. Our studies support the influence of early adverse events in the development of psychopathic offenders.

Linkage of functional and structural anomalies in the left amygdala of reactive-aggressive men.

Amygdala structural and functional abnormalities have been associated to reactive aggression in previous studies. However, the possible linkage of these two types of anomalies has not been examined. We hypothesized that they would coincide in the same localizations, would be correlated in intensity and would be mediated by reactive aggression personality traits. Here violent (n = 25) and non-violent (n = 29) men were recruited on the basis of their reactive aggression. Callous-unemotional (CU) traits were also assessed. Gray matter concentration (gmC) and reactivity to fearful and neutral facial expressions were measured in dorsal and ventral amygdala partitions. The difference between responses to fearful and neutral facial expressions was calculated (F/N-difference). Violent individuals exhibited a smaller F/N-difference and gmC in the left dorsal amygdala, where a significant coincidence was found in a conjunction analysis. Moreover, the left amygdala F/N-difference and gmC were correlated to each other, an effect mediated by reactive aggression but not by CU. The F/N-difference was caused by increased reactivity to neutral faces. This suggests that anatomical anomalies within local circuitry (and not only altered input) may underlie the amygdala hyper-reactivity to social signals which is characteristic of reactive aggression.

Efectos del polimorfismo Val108/158Met del gen dopaminérgico Catecol-O-metiltransferasa COMT en las funciones ejecutivas de preescolares / Effects of dopamine gene polymorphism Val108/158Met Catechol-O-methyltransferase COMT in executive functions in preschool

El nivel de Dopamina en la Corteza Prefrontal se ha relacionado al desempeño de las Funciones Ejecutivas (FE). El objetivo de este estudio es explorar el efecto del polimorfismo funcional del gen COMT (Val/Val,Val/Met y Met/Met) en las FE de preescolares. Se utilizó la Batería Neuropsicológica de Funciones Ejecutivas para niños, y se extrajo el ADN genómico según metodología estándar (N=248) de 3 a 6 años de edad (M=4.6). Se estudiaron las frecuencias genotípicas del gen COMT y se realizó un análisis de varianza (ANOVA one-way) estableciendo diferencias significativas con una p<0.05. Los niños con el polimorfismo de baja actividad Met/Met puntúan significativamente mejor en relación a los niños con polimorfismo Val/Val en pruebas que requieren de Inhibición y los niños con el polimorfismo de alta actividad Val/Val resultan con un mejor rendimiento en pruebas relacionadas a MT, Planeación y Abstracción que los niños con polimorfismo Met/Met y Val/Met. Estos resultados parecen reflejar el papel de la enzima COMT como regulador de DA y que tanto el hipermetabolismo como el hipometabolismo tiene implicaciones importantes en las FE.

The level of DA in the prefrontal cortex has been related to the performance on executive functions (EF). The objective of this study was to explore the effect of the COMT polymorphism (Val/Val, Val/Met, Met/Met) in the performance of EF in a population of preschool children. All subjects were evaluated with a Neuropsychological Battery and genomic DNA was extracted according to standard methodology (N=248) from 3 to 6 years of age (M=4.6). We studied genotypic frequencies of the COMT gene and an analysis of variance (one-way ANOVA) with post hoc analysis, establishing significant differences at p<0.05. In Children with a low activity polymorphism Met/Met scored significantly better in relation to the children with polymorphism Val/Val in tests requiring inhibition and children with high activity polymorphism Val/Val had better performance on tests related to working memory, planning and abstraction that children with polymorphism Met/Met and Val/Met. These results seem to reflect the role of COMT enzyme as a regulator of DA and that both hypermetabolism and hypometabolism has important implications for the EF.

Estructura de las funciones ejecutivas en la edad preescolar / Structure of Executive Functions in Preschool Age

Una forma de entender la estructura de las Funciones Ejecutivas (FE), es su estudio en el desarrollo temprano y el uso de métodos estadísticos avanzados que permiten entender la interrelación de los distintos componentes. Los hallazgos en la etapa adulta, apoyan la idea multifactorial de componentes relacionados, pero separables; mientras que evidencias recientes, en la etapa preescolar sugieren que la estructura de las FE, puede ser descrita por un solo factor. La estructura de las FE fue examinada en 128 niños de 3 a 6 años de edad, usando un análisis factorial confirmatorio. Los preescolares completaron una batería de tareas de FE, que evaluaban procesos de inhibición y memoria de trabajo, con sensibilidad adecuada para la edad. En la edad preescolar la estructura del funcionamiento ejecutivo puede ser diferenciada en dos procesos relacionados pero independientes: memoria de trabajo e inhibición. Las relaciones entre los componentes parecen cambiar en el desarrollo. La unidad estructural de las FE en edades muy tempranas, cambia a través del desarrollo, siendo cada vez más multifacética, que se relaciona con la maduración e integración de diferentes circuitos frontosubcorticales.

One way to understand the structure of executive functions (EF) is their study in early development and use of advanced statistical methods that allow us to understand the interrelationship of various components. The findings in the adult age, support the idea multifactorial of related components, but separable, while recent evidence in the preschool years suggest that the structure of the FE, can be described by a single factor. The structure of the EF was examined in 128 children aged 3 to 6 years of age, using a confirmatory factor analysis. Preschoolers completed a battery of EF tasks, assessing processes of inhibition and working memory with age-appropriate sensitivity. In the preschool the structure of executive functioning can be differentiated into two related but independent processes: working memory and inhibition. The relationships between the components seem to change in development. The structural unit of the FE at very early ages, it changes through the development, becoming more multifaceted, which is associated with the maturation and integration of different frontal-subcortical circuits.

Efecto del nivel socioeconómico en el control inhibitorio durante la edad preescolar / Effect of Socioeconomic Status in Inhibitory Control During Preschool Age

Recientemente se ha señalado que el nivel socioeconómico (NSE) juega un papel importante en el logro académico y en el funcionamiento de distintos sistemas cognitivos. El lenguaje y las funciones ejecutivas son los procesos donde se encuentran más diferencias significativas en función del NSE, debido a que son funciones que tardan en desarrollarse y por ellos están sujetas a los efectos adversos asociados al NSE. El objetivo de este estudio fue identificar las diferencias en el desempeño en tareas de control inhibitorio entre niños preescolares de NSE alto y bajo. Se evaluó una muestra de 231 niños de 4 a 6 años que cursaban el jardín de Niños. Los resultados muestran que el desempeño en tareas que evalúan la inhibición de respuestas cognitivas y motoras hay un efecto significativo del NSE, los niños de NSE alto obtienen mayores puntajes que los niños de NSE bajo, mientras que en una tarea de demora de gratificación los niños de NSE bajo cometen menos errores. EL NSE es un factor que determina en gran medida el desarrollo de la capacidad de inhibir respuestas dominantes durante la edad preescolar, lo cual es relevante para la autoregulación y facilitación del desarrollo de otras funciones ejecutivas.

Socioeconomic status (SES) is associated with cognitive ability and school achievement during childhood and adolescence. Previous studies have pointed out that executive functioning and language are key processes affected by variations in SES. These effects can be found even in the preschool age and subsist probably into adulthood. Among executive functions, inhibitory control plays a crucial role in allowing preschool children to engage efficiently in more complex tasks and in enhancing the development of other executive functions, thus allowing self regulation, which is particularly important during this developmental stage. Inhibitory control is a complex construct characterized as the ability to suppress a dominant response while a subdominant one is activated, or the delaying of responses and slowing of motor activity. Furthermore, due to its protracted development from infancy through adolescence and even adulthood, this cognitive process results especially susceptible to the influence of the adverse factors associated with low SES. The purpose of this study was to identify differences in inhibitory control in preschool children from high and low SES. We assessed a sample of 231 preschool children between 4 and 6 years old. In order to assess different components of inhibitory control, selection of measures included tasks of cognitive and motor inhibition (stroop like tasks and a motor tapping test) as well as a gratification delay task (gift delay task). Results showed that measures of cognitive and motor inhibition were affected by SES, suggesting that this variable is crucial in determining the development of the ability to suppress dominant responses through the usage of effective strategies. The ability to delay a response to obtain a reward seems to depend on other variables possibly linked to temperament and parenting, due to children of low SES outperforming children from high SES. These data agree with existing results in terms of the relevance of SES to account for the differences observed in cognitive performance, and highlight the need of studying the exact mechanism through which SES influences cognition.

Interacción de temperamento y MAO-A en pruebas de inhibición en preescolares / Interactions of the Temperament and Mao-A in Preschooler Children's Inibition Tests

Las Funciones Ejecutivas permiten organizar nuestro comportamiento, regular nuestras emociones y en general, nuestro comportamiento. Estas funciones van incrementando su complejidad conforme el organismo crece y madura, acorde a las demandas ambientales y al desarrollo neurológico de los lóbulos frontales principalmente, sin embargo existen distintas variables que favorecerían su óptima ejecución, como la enzima MAO-A encargada de metabolizar neurotransmisores como la serotonina, involucrada en la regulación de conductas impulsivas. Así como el Temperamento que facilita la capacidad de autoregular la propia conducta, inhibiendo los impulsos en presencia de demandas no solo cognitivas sino también emocionales. Mediante la aplicación de pruebas de Inhibición en niños en edad preescolar y tomando en cuenta estos factores se observó que aquellos niños con la variación de MAO-A de Baja actividad Transcripcional y un Temperamento de Autocontrol tendían a tener mejores resultados para inhibir sus conductas en favor de un mejor resultado en la pruebas; contribuyendo al propósito de analizar distintas variables que permitan un mejor desarrollo de las Funciones Ejecutivas.

The executive functions allow to organize our behavior, to regulate our emotions and in general terms, our behavior. This function increases its complexity when the organism grows up and matures, in accordance with the environment conditions and the forebrain's neurological development. Nevertheless, there are different variables that can help its optimal execution like the MAO-A, in charge of the metabolism of the neurotransmissors, like the serotonin, in charge of the impulsive manners. Like the Temperament that makes easier the capability to regulate the self-behavior, through the inhibition of the impulses when the demands are not only cognitive, also with the emotional demands. With the application of the inhibition's tests in preschoolers children and these factors like reference. It was possible to watch that the preschoolers children with a low metabolic activity in the MAO-A and a self-control temperament, have developed a better results to inhibit their behavior in order to have a better result in the tests; this, represents a contribution to the purpose to analyze different variables that allow a better development of this executive functions.

Desempeño neuropsicológico prefrontal en sujetos violentos de la población general / Neuropsychological Performance in Violent Men: a Community Sample

Las investigaciones acerca de la neurobiología de la violencia apuntan a que existe una alteración relacionada con la corteza prefrontal (CPF). Sin embargo, la mayor parte de los estudios se han llevado a cabo en poblaciones institucionalizadas. Por lo tanto, el objetivo del presente estudio fue evaluar el funcionamiento cognitivo de la CPF en sujetos violentos de la población general por medio de una batería neuropsicológica que proporciona 3 índices: dorsolateral, orbitomedial y pre frontal anterior; y demostrar si su desempeño es similar al que se ha encontrado en poblaciones institucionalizadas. Participaron 60 hombres adultos de la Cd. de México que respondieron la escala de Escala agresión Reactiva-Proactiva (Raine, 2006), versión en español (Andreu, Peña & Ramírez, 2009) y fueron divididos en violentos (n=30) y controles (n=30). Se encontraron diferencias sólo en el total orbitomedial mostrando el grupo de violentos el menor desempeño. Los resultados encontrados coinciden con los que se han reportado en la literatura en sujetos institucionalizados en referencia al bajo desempeño orbitomedial, sin embargo se discute el papel que podría jugar el componente antisocial de la personalidad en la conducta violenta y el desempeño neuropsicológico.

Recent neurobiology research about violent behavior points out to the existence of a disorder associated with the prefrontal cortex (PFC). However, most studies are carried out on institutionalized samples. Hence, the aim of the present study was to evaluate cognitive frontal functioning in violent men from a community sample with a neuropsychological battery that measures different prefrontal areas: dorsolateral (working memory and executive functions) orbital (decision making) and medial (inhibition); and to demonstrate if their neuropsychological performance is in any way similar to that found in institutionalized samples. 60 adult male subjects from a community sample of Mexico City participated in this study. Subjects were divided into violent (n=30) and nonviolent (n=30) using a screening questionnaire (Reactive and Proactive Aggression Questionnaire; Raine, 2006) in its Spanish adapted version (Andreu, Peña & Ramírez, 2009). We found that violent individuals compared to nonviolent controls exhibited a worse performance in overall tasks, but the only statistical difference we found was in tasks related to the orbitomedial functioning. Our results matched with previous studies carried out on institutionalized samples that referred a low orbitomedial performance; however we discussed the possible role of the antisocial component in violent behavior and neuropsychological performance.

Efecto de la portación de alelos de riesgo de MAO-A y DRD4 sobre mediciones de agresión / Effect of Risk Alleles MAO-A and DRD4 on Aggression Measures

Entre los diversos factores asociados con la predisposición a la conducta violenta se encuentra la portación de alelos de riesgo. Para investigar el efecto de dos alelos de riesgo (baja actividad de MAO-A y 7 repeticiones DRD4) sobre mediciones de agresión, se evaluaron mediante escalas psicológicas a 60 hombres sanos. Los resultados indicaron que tanto el efecto principal de cada uno de los alelos de riesgo, como su interacción impactan sobre mediciones de hostilidad, enojo, impulsividad, empatía y rasgos antisociales de psicopatía. Se concluye que es necesario investigar el efecto de estos alelos sobre la estructura y función cerebrales, además estos alelos aparentemente confieren riesgo para el desarrollo de conductas violentas.

Among the factors associated with the predisposition to violent behavior is the bearing of risk alleles. To investigate the effect of two risk alleles (low activity of MAO-A and 7 repeat DRD4) 60 healthy men were assessed on psychological scales of aggression. The results indicated that both the main effect of each of the risk alleles, and their interaction impact on measures of hostility, anger, impulsivity, empathy and antisocial traits of psychopathy. We conclude that it is necessary to investigate the effect of these alleles on brain structure and function; these alleles apparently also confer risk for the development of violent behavior.

Flexibilidad cognitiva después de un traumatismo craneoencefálico / Cognitive Flexibility after Traumatic Brain Injury

La flexibilidad cognitiva es la capacidad para realizar cambios entre diferentes desplegados de respuestas, ya sea de pensamientos o de acciones, en dependencia de las demandas de la situación. Al ser un proceso crucial de las funciones ejecutivas, puede ser extremadamente susceptible a daño, como en el caso del traumatismo craneoencefálico (TCE). El propósito del estudio fue evaluar el desempeño en tareas de flexibilidad cognitiva de un grupo de pacientes con TCE. Fueron evaluados 25 pacientes con TCE (Moderado=10; edad M=34.60; Severo= 15; edad: M=29.73), pareados con un grupo Control sano. Se aplicaron 4 pruebas de flexibilidad cognitiva: Fluidez verbal (verbos), Clasificación Semántica (animales), la Torre de Hanoi y la Clasificación de Cartas de Wisconsin (WCST). El análisis con ANOVA de una vía mostró que el grupo con TCE-Severo tuvo un desempeño menor en todas las tareas, seguido del TCE-Moderado. En general requirieron mayor tiempo para realizar las tareas, cometieron más errores perseverativos y tuvieron dificultades al cambiar de un set cognitivo a otro, esto evidencia su pobre flexibilidad cognitiva. Los hallazgos del estudio permitirán la elección de tareas de evaluación apropiadas para los pacientes con TCE, a su vez ayudará en la generación de programas de intervención cognitiva y conductual.

Cognitive flexibility is the ability to make changes between different responses, either of thought or action, depending on the demands of the situation. Like a crucial process of executive functions, can be extremely susceptible to damage as in the case of traumatic brain injury (TBI). Approximated a third of the population have a secondary brain damage due to TBI. The purpose of this study was to evaluate the performance on tasks of cognitive flexibility in a group of patients with TBI. Were evaluated 25 patients with TBI, 10 Moderate-TBI (age M = 34.60; education: M=14.70) and 15 with Severe-TBI (age: M= 29.73; education: M=13.88) matched with a healthy control group by age, sex, and education. Were applied 4 tests of cognitive flexibility: Verbal Fluency (verbs), Semantic Classification (animals), the Tower of Hanoi (3 and 4 desks) and the Wisconsin Card Sorting Test (WCST), that are included in the Battery of Executive Functions and Frontal Lobes. Analysis with one-way ANOVA to compare the three groups showed that the Severe-TBI group had a lower performance on all tasks, mainly in semantic classification and WCST, followed by TCE-Moderate, this last group had a similar performance to control group for this reason few significant statistical differences were found. Overall patients required more time to perform the tasks, made more perseverative errors and had difficulty in shifting between cognitive set, making that their performance significantly decrease, also this is evidence of a poor cognitive flexibility. In conclusion the severity of TBI are related with a poor performance on executive functions, negatively influencing in learning, to generate new strategies to solve a problem, in divided attention and the capacity to process new information. The study findings will allow the selection of appropriate assessment tasks for patients with TBI and influence on the generation of cognitive and behavioral intervention.

Evaluación electrofisiológica de la memoria semántica en la enfermedad de Alzheimer / Electrophysiological assessment of semantic memory in Alzheimer's disease

El presente estudio utilizó la técnica de los Potenciales Relacionados a Eventos (PREs) para analizar la actividad eléctrica cerebral de un grupo de diez pacientes con enfermedad de Alzheimer (EA) y un grupo de 10 ancianos asintomáticos ante una prueba de categorización semántica. La tarea se conformó de 118 parejas de dibujos de objetos y animales comunes. El 50 por ciento de las parejas pertenecían a un mismo grupo supraordinado y constituía la condición congruente (ej. guitarra-violín), el otro 50 por ciento pertenecía a diferentes grupos supraordinados y constituía la condición incongruente (ej. casco-violín). Al comparar los PREs de ambos grupos, se observó una reducción significativa del componente N400 en los pacientes con EA. Esta reducción se debió a una pronunciada positividad de la actividad eléctrica cerebral ante la condición incongruente. La disminución del N400 en los PREs de los pacientes con EA apoya la hipótesis sobre la existencia de dificultades para acceder y utilizar la información semántica de manera eficiente

EL homotransplante fetal humano al sistema nigroestriado para el tratamiento de la enfermedad de Parkinson / Human fetal homotransplant to the nigrostrial system as treatment for Parkinson's disease

Se describen 4 casos de transplante fetal al cerebro (estriado) de área mesencefálica ventral (AMV) y 3 de glándula adrenal (A) a pacientes parkinsonianos como una nueva alternativa para la mejoría de esta enfermedad. Los pacientes que recibieron AMV demostraron una mejoría muy significativa de la rigidez, la bradicinecia, las alteraciones de la marcha y de la postura, así como de la expresión facial. Tres de estos cuatro pacientes han regresado a trabajar. El grupo que recibió tejido A, revelaron discreta mejoría de la rigides y la bradicinecia, pero sin presentar cambios significativos en los demás signos de la enfermedad. Estos pacientes pueden realizar sus actividades básicas diarias, pero dos de ellos no están en condiciones de regresar a trabajar. Las diferencias observadas entre los pacientes transplantados de AMV y A, pueden estar relacionadas a la heterogenicidad de la enfermedad, pero creemos que fundamentalmente son responsabilidad del tipo de injerto implantado. Nuestros resultados con el uso de AMV así como de los otros grupos del mundo son alentadores. Es importante establecer claramente, que se trata de un procedimiento aún en fase experimental, por lo que debe actuarse con cautela, limitando su realización a los centros de investigación clínica altamente calificados

Actividad cognoscitiva y nivel sociocultural / Cognitive activity and sociocultural level

Se tomaron 109 sujetos normales con un promedio de edad de 25 años provenientes de dos niveles socioculturales (alto y bajo) de la ciudad de México. Se diseñó un procedimiento de evaluación de la actividad cognoscitiva, compuesta por nueve áreas diferentes: funciones motoras, conocimiento somatosensorial, reconocimiento espacial y visoespacial, conocimiento auditivo y lenguaje, procesos intelectuales, leaguaje, lectura, escritura y cálculo. Los resultados mostraron que el grupo de nivel sociocultural alto obtuvo mejores puntajes en todas las áreas que el grupo del nivel sociocultural bajo. Se observó una interacción significativa con el sexo; sin embargo, las diferencias entre sexos aparecen sólo en el nivel bajo. Se analizan las diferencias halladas y sus implicaciones