Screening cognitivo en adultos jóvenes infectados con VIH-1 en Buenos Aires / Cognitive screening in hiv-1 infected young adults at Buenos Aires, Argentina

El deterioro cognitivo es altamente prevalente en pacientes infectados con VIH-1, aún en individuos jóvenes. En nuestro país, la información epidemiológica sobre el impacto del deterioro es escasa y carecemos de pruebas de screening con la validación local necesaria como para ser utilizadas como herramientas diagnósticas. Por ello, diseñamos un estudio prospectivo con el objetivo de estimar la prevalencia de dete-rioro cognitivo y comparar el rendimiento de 5 pruebas de screening breves entre sí (incluyendo un nuevo test que denominamos NEURA cuyos componentes están validados en español) y con la evaluación cognitiva completa (goldstandard) en una población de adultos jóve-nes infectados con VIH-1, para determinar su sensibilidad y especifici-dad en nuestra cultura e idioma. Desde 02/2015 a 02/2016 se incluye-ron individuos argentinos de entre 18-50 años, fluentes en español, con educación formal >12 años, bajo tratamiento antirretroviral estable y vi-remia suprimida. Los pacientes completaron: una entrevista psiquiá-trica; el screening cognitivo mediante 5 pruebas rápidas; la evaluación neuropsicológica; y una evaluación funcional. Se estudiaron 45 suje-tos, presentando una prevalencia de deterioro cognitivo del 9 % (n = 4). El rendimiento de NEURA fue superior al demostrado por otros testsde screening (Sensibilidad 75 %, Especificidad 98 %).La prevalencia de trastorno cognitivo en esta pobla-ción ha sido baja en relación a la reportada por otras cohortes de pacientes jóvenes avirémicos. Los testsde screening de uso habitual en nuestro país no tu-vieron un buen rendimiento para detectar deterioro cognitivo en comparación con el nuevo test NEURA

Neurocognitive disorders are highly prevalent in HIV-1 infected patients, even in younger individuals. In our country we lack both sufficient epidemiological information on the true impact of these disorders and screening tests with the local validation needed to be used for diagnosis. Therefore we designed a prospective study to estimate the prevalence of these disorders and to compare the performance of five brief cognitive tests between them (including a new screening tool named NEURA with each of its components validated in spanish) and with the complete neuropsychological assessment (gold standard) in a young adult HIV-1 infected population from Argentina, in order to assess their sensitivity and specificity in our language and culture. Different confounding conditions were taken into account. From 02/2015 to 02/2016 native spanish-speakers outpatients, among 18-50 years, with a minimum of 12 years of formal education, under stable antiretroviral therapy and virological suppression were enrolled. They completed: a psychiatric interview; five brief cognitive screening tests; the neuropsychological battery and a functional assessment. We include 45 patients, with a prevalence of neurocognitive impairment (NCI) of 9% (n=4). In terms of sensitivity and specificity, NEURA performance was superior to the comparative tests (75% and 98%, respectively).We observed a lower prevalence of NCI in our population compared with those reported in young adult aviremic cohort studies. NEURA test seems to be a rapid and more accurate screening test than others routinely used in our country

[COGNITIVE SCREENING IN HIV-1 INFECTED YOUNG ADULTS AT BUENOS AIRES. PRELIMINARY DATA]. / Screening cognitivo en adultos jóvenes infectados con VIH-1 en Buenos Aires. Datos preliminares.

Cognitive impairment is highly prevalent in HIV-1 infected patients, even in younger individuals. These symptoms usually are not recognized by health professionals or even patients themselves. However, they can represent a major cause of functional impairment and failure in treatment compliance. In our country we lack both sufficient epidemiological information on the true impact of these symptoms and screening tests with local validation needed to be used by health professionals during the medical assessment. Therefore we designed a prospective study to compare the performance of four brief cognitive tests and a new screening tool with the neuropsychological assessment (gold standard) in a population of young adults infected with HIV-1 in Argentina, in order to assess their sensitivity and specificity in our culture and language. Different confounding conditions were taken into account. Preliminary data were analyzed after the enrollment of 19 subjects. NEURA screening correlated significantly with the neuropsychological assessment (rho = 0.496, p = .031). In terms of sensitivity and specificity, NEURA performance was superior to other screening tests routinely used in our country: IHDS (S 27%/E 5%), MMSE (S/E 0%), ACE (S 9%/E 100%) and IFS (S 36%/E 80%).

Cognitive but not affective theory of mind deficits in mild relapsing-remitting multiple sclerosis.

OBJECTIVE: We studied theory of mind (ToM) in patients with mild relapsing-remitting multiple sclerosis (MS), seeking possible dissociations between its 2 components: cognitive ToM (the ability to infer others' intentions) and affective ToM (the ability to infer others' emotional states). We analyzed the relationship of ToM to executive function, depression, and fatigue. BACKGROUND: Dissociations between cognitive and affective ToM have been found in several neurologic and neuropsychiatric diseases. Most ToM studies in patients with MS have shown general ToM deficits but have not analyzed the cognitive and affective aspects individually. METHODS: We used the Faux Pas test of ToM and tests of executive function to assess 18 patients with mild relapsing-remitting MS and 16 control participants. RESULTS: Our patients showed deficits in cognitive ToM, but their affective ToM seemed to be spared. Their cognitive ToM deficits were not related to executive dysfunction, depression, or fatigue. CONCLUSIONS: Our study is the first differential analysis showing cognitive but not affective ToM deficits in mild relapsing-remitting MS. Further research is needed to determine the exact nature and the real impact of these deficits, and to establish their relationship with the neuropathology and progression of MS.

Impaired theory of mind but intact decision-making in Asperger syndrome: implications for the relationship between these cognitive domains.

The relationship between decision making and theory of mind (TOM) has been hardly investigated in patients with asperger syndrome (AS). Here, we show that the AS group (n=25) exhibited deficits on a complex TOM task, yet were unimpaired in a decision-making test. No association was found between these two domains.

Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism.

Faced with a moral dilemma, conflict arises between a cognitive controlled response aimed at maximizing welfare, i.e. the utilitarian judgment, and an emotional aversion to harm, i.e. the deontological judgment. In the present study, we investigated moral judgment in adult individuals with high functioning autism/Asperger syndrome (HFA/AS), a clinical population characterized by impairments in prosocial emotions and social cognition. In Experiment 1, we compared the response patterns of HFA/AS participants and neurotypical controls to moral dilemmas with low and high emotional saliency. We found that HFA/AS participants more frequently delivered the utilitarian judgment. Their perception of appropriateness of moral transgression was similar to that of controls, but HFA/AS participants reported decreased levels of emotional reaction to the dilemma. In Experiment 2, we explored the way in which demographic, clinical and social cognition variables including emotional and cognitive aspects of empathy and theory of mind influenced moral judgment. We found that utilitarian HFA/AS participants showed a decreased ability to infer other people's thoughts and to understand their intentions, as measured both by performance on neuropsychological tests and through dispositional measures. We conclude that greater prevalence of utilitarianism in HFA/AS is associated with difficulties in specific aspects of social cognition.