Estructura del sueño y funciones ejecutivas en niños con depresión / Sleep architecture and executive functions in children with depression

Sleep disturbance is a common complaint in depression. However, objective data in relation to the architecture of sleep associated with depression in childhood have been inconsistent. The objective measurement of sleepiness and executive functions is little known in depressive children. The objective of this study was to determine the differences in the sleep architecture, daytime sleepiness and executive functions in children with and without depression. Method The participants were 20 children with an average of 10.5 (SD=1.5) years old; nine were girls. Ten met the diagnostic criteria for major depression and ten were control. There were no differences by sex and age between groups with and without depression (p>.05). The instruments were: Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), the Children Depression Inventory, and the Battery of Executive Frontal Functions. Also, there were two consecutive nights of polysomnographic recording and Multiple Sleep Latency Test (MSLT). Results No differences were found in the architecture of sleep, sleep efficiency was greater than 90% in both groups and the indexes of initiation and sleep maintenance did not show statistically significant differences. There were no differences in daytime sleepiness, sleep onset latency in the MSLT was 22.8 (SD=6.4) minutes for the group with depression and 23.7 (SD=4.1) for the control. The executive functions showed differences in tasks involving: visual-motor and impulse control, working memory and identification of the risk-benefit ratio. Conclusions The results suggest that prefrontal structures are more vulnerable to depression than the structures that regulate the circadian and homeostatic sleep.

La alteración del sueño es una queja común en la depresión. Sin embargo, los datos objetivos sobre las alteraciones en la estructura del sueño asociadas a la depresión infantil han sido inconsistentes. Por otro lado, el estudio objetivo de la somnolencia y las funciones ejecutivas en niños con depresión es poco conocida. El objetivo fue conocer si existen diferencias en la estructura del sueño, la somnolencia diurna y las funciones ejecutivas en niños con y sin depresión. Método Participaron 20 niños con promedio de 10.5 (DE=1.5) años de edad, de los cuales 45% fueron niñas. Diez cumplieron los criterios diagnósticos de depresión mayor y 10 fueron controles. No hubo diferencias por sexo y edad entre los grupos (p>.05). Los instrumentos fueron: La entrevista Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), el Inventario de Depresión Infantil, y la Batería de Funciones Frontales y Ejecutivas. Asimismo, se realizaron dos noches consecutivas de registro polisomnográfico y la Prueba de Latencias Múltiples a Sueño (PLMS). Resultados No se encontraron diferencias en la estructura del sueño, la eficiencia del sueño fue mayor al 90% en ambos grupos y no hubo diferencias en los índices de inicio y continuidad del sueño, así como en las diferentes etapas de sueño. Tampoco se obtuvieron diferencias en la somnolencia diurna, la latencia al inicio de sueño en la PLMS fue de 22.8 (DE=6.4) minutos para el grupo con depresión y 23.7 (DE=4.1) para el control. Las funciones ejecutivas mostraron diferencias en tareas que implican: control visomotor y de impulsos, memoria de trabajo e identificación de la relación riesgo-beneficio. Conclusiones Los resultados sugieren que las estructuras prefrontales son más vulnerables a la depresión que las estructuras que regulan el ritmo circadiano y homeostático del sueño.

Assessment of emotional distress in chronic kidney disease patients and kidney transplant recipients.

OBJECTIVE: To assess the presence of emotional distress in patients with chronic kidney disease (CKD), and the effect of kidney transplant on these symptoms. MATERIAL AND METHODS: This was a two-part study. Part one was cross-sectional, observational, and descriptive, where 75 patients with CKD were evaluated for emotional distress with the Hospital Anxiety and Depression Scale (HAD) and the Symptom Checklist 90 (SCL-90). In part two, we longitudinally followed 19% of the study cohort to examine symptomatological changes after their kidney transplantation. RESULTS: The results of the HAD indicated that 30.7% of the study cohort with End-Stage Renal Disease (ESRD) showed anxious symptoms, and 25.3% showed depressive symptoms. The change in the HAD total score before and after kidney transplant was not significant. However, a significant decrease in total score on the SCL-90 was observed before and after transplantation. CONCLUSION: Improvement on emotional distress was found after kidney transplantation.

Neurocognitive profile of an adult sample with chronic kidney disease.

Chronic kidney disease (CKD) is a common and debilitating illness that impacts neurocognitive function. However, the majority of previous studies varied in methodologic design and rigor, thus minimizing definitive conclusions. The present study was designed to determine the impact of CKD on neurocognitive function through specific examination of CKD factors and therapeutic interventions. We evaluated 120 CKD outpatients and 41 healthy donors (controls) in terms of neurocognitive function, anxiety, and depressive symptomatology, and somnolence. Information regarding medical and treatment history was recorded. Twenty-three percent of CKD patients presented with cognitive impairment. Stage 5 patients had lower scores (p < .05) compared with controls and patients in stage 3 and 4 on measures of global cognitive function. No differences in global cognitive function were found between stage 3 and 4 patients and controls. A greater proportion of patients undergoing hemodialysis relative to those treated with peritoneal dialysis showed impairment on measures of memory functions. Results suggest that stage 5 CKD patients may present with impaired cognitive functions. Anemia appeared to be a key variable that may explain the memory impairment in this sample. Future longitudinal investigations of CKD are warranted to determine the trajectory of cognitive impairment.

Illiteracy: the neuropsychology of cognition without reading.

Illiterates represent a significant proportion of the world's population. Written language not only plays a role in mediating cognition, but also extends our knowledge of the world. Two major reasons for illiteracy can be distinguished, social (e.g., absence of schools), and personal (e.g., learning difficulties). Without written language, our knowledge of the external world is partially limited by immediate sensory information and concrete environmental conditions. Literacy is significantly associated with virtually all neuropsychological measures, even though the correlation between education and neuropsychological test scores depends on the specific test. The impact of literacy is reflected in different spheres of cognitive functioning. Learning to read reinforces and modifies certain fundamental abilities, such as verbal and visual memory, phonological awareness, and visuospatial and visuomotor skills. Functional imaging studies are now demonstrating that literacy and education influence the pathways used by the brain for problem-solving. The existence of partially specific neuronal networks as a probable consequence of the literacy level supports the hypothesis that education impacts not only the individual's day-to-day strategies, but also the brain networks. A review of the issues related to dementia in illiterates is presented, emphasizing that the association between the education level and age-related cognitive changes and education remains controversial. The analysis of the impact of illiteracy on neuropsychological test performance represents a crucial approach to understanding human cognition and its brain organization under normal and abnormal conditions.

Trasplante renal: efectos en el perfil cognoscitivo / Impact of kidney transplantation on cognitive profile

Objetivo. Valorar el impacto del Trasplante Renal exitoso sobre el funcionamiento cognoscitivo de los pacientes con Insuficiencia Renal Crónica (IRC). Método. Se aplicó el Neuropsi Atención y Memoria, el Hospital Anxiety and Depression Scale, la Escala de Somnolencia de Epworth y la Escala Isquémica de Hachinski a 42 pacientes con IRC y 41 donadores vivos sanos (grupo control). De los 42 pacientes que fueron sometidos a trasplante renal, se evaluó con los mismos instrumentos a 28 de ellos en un tiempo de 6 meses posterior a su trasplante. Se valoró en los mismos tiempos a sus donadores renales (grupo control). Resultados. El funcionamiento cognoscitivo global del grupo IRC mejoró después del trasplante renal aún controlando los efectos de aprendizaje. Las áreas en las que el grupo postrasplantado mejoraron fueron el Stroop y la evocación verbal a largo plazo haciendo uso de claves. Conclusiones. El trasplante renal se aprecia como una solución ideal que elimina factores (medibles o no medibles) que están impactando en el funcionamiento cognoscitivo.

Aim. To assess the impact of kidney transplantation on neuropsychological functioning of Chronic Kidney Disease(CKD) patients. Methods.: 42 kidney transplant (KT) recipients and 41 healthy living donors –control group- were tested by a comprehensive neuropsychological battery: Neuropsi Attention and Memory, the Hospital Anxiety and Depression Scale, The Epworth Sleepiness Scale and the Hachinski Ischemic Scale. 28 patients were followed up 6 months after KT. Their kidney donors were evaluated pre as well as post donation (at same time of study group) for comparison. Results. An improvement in global cognitive functioning after KT was found (when learning effects were controlled). Patients improved in Stroop test and auditory/verbal delayed recall using cues. Conclusions. Renal transplant is suggested as an ideal solution as it eliminates factors (measurable or not) that have an impact over cognitive functioning.

Evaluación neuropsicológica en internos penitenciarios mexicanos / Neuropsychological evaluation in Mexican prison inmates

El objetivo de esta investigación fue evaluar psicológica y neuropsicológicamente a un grupo de internos violentos de una Penitenciaría Federal en México y caracterizarlos de acuerdo con la clasificación de impulsividad y premeditación de Barratt (Barratt, Stanford, Lynn, Liebman y Kent, 1999) y utilizando la clasificación de Hare (1991) de psicopatía, para analizar las diferencias entre los grupos de acuerdo a diferentes clasificaciones. La muestra fue integrada por 75 participantes, 50 internos y 25 controles para el estudio 1 (impulsivos vs premeditados) y 54 sujetos para el estudio 2 (no psicópatas vs psicópatas). Se administraron la Escala de Impulsividad de Plutchik, el Inventario de Hostilidad de Buss-Durkee, la batería neuropsicológica NEUROPSI ATENCIÓN y MEMORIA (Ostrosky-Solís, Gómez, Ardila, Rosselli, Pineda y Matute; 2003) y la batería de Funciones Frontales y Ejecutivas (Flores, Ostrosky y Lozano, 2008). Los resultados indican que las poblaciones violentas independientemente de su clasificación pueden ser diferenciadas de la población no violenta. Sin embargo, no se encontraron diferencias significativas en las evaluaciones neuropsicológicas entre los grupos impulsivo y premeditado, mientras que los resultados entre los no psicópatas y psicópatas muestran diferencias significativas en distintos dominios cognoscitivos. Los resultados se discuten en términos de la base anatómica que subyace a dichos procesos.

The objective of this research was to assess psychological and neuropsychological a violent internal group of a Federal Prison in Mexico and characterized according to the Barratt’s classification of impulsivity and premeditation scale (Barratt, Stanford, Lynn, Liebman and Kent, 1999) and using the classification of Hare (1991) of psychopathy, to analyze differences between groups according to different classifications. The sample was composed of 75 participants, 50 inmates and 25 controls for study 1 (impulsive vs. premeditated) and 54 subjects for study 2 (nonpsychopaths vs psychopaths. Were administered the Scale of the Plutchik Impulsivity, Hostility Inventory Buss-Durkee, neuropsychological battery neuropsychiatric attention and memory (Ostrosky-Solís, Gomez, Ardila, Rosselli,Pineda and Matute, 2003) and the battery of frontal function and Executive (Flores, Ostrosky and Lozano, 2008). Results indicate that violent populations regardless of classification can be differentiated psychological and neuropsychological nonviolent population. However, there were no significant differences in neuropsychological evaluations among impulsive and premeditated groups, while, results between psychopaths and psychopaths do not show significant differences in various cognitive domains. The results are discussed in terms of the anatomical basis underlying these processes.

Differences in gastrointestinal symptoms according to gender in Rome II positive IBS and dyspepsia in a Latin American population.

OBJECTIVES: Irritable bowel syndrome (IBS), constipation, and bloating are more prevalent in women than men, but gender differences associated with dyspepsia are inconsistent.The aim of this study was to determine gender differences in the prevalence of symptoms diagnostic for functional gastrointestinal disorders (FGIDs) in subjects with IBS and dyspepsia, as well as in controls in Mexico. METHODS: A database of 1,021 subjects (61% women) who completed the Rome II Modular Questionnaire (RIIMQ) in Spanish Mexico was analyzed. Gender differences in the frequency of all symptoms included in the RIIMQ between those fulfilling criteria for IBS (28.9%), dyspepsia (4.0%) and controls without any FGIDs (38.2%) were studied. Subjects fulfilling criteria only for other FGIDs were excluded. RESULTS: There were higher proportions of women with IBS (67.8%) and dyspepsia (85.4%) compared with the control group (55.9%) (P<0.001). In IBS, women more frequently reported changes in the number of bowel movements (BMs) associated with the onset of abdominal discomfort/pain, fewer than three BMs/week and abdominal fullness/bloating/swelling than men. Men with IBS more frequently reported swallowing air to belch and abdominal pain that improved after a BM than women. In controls, burping and hard or lumpy stools were both more frequent in men. CONCLUSIONS: In Mexico, gender differences in FGIDs exist, with both IBS and dyspepsia being more common in women than men. In IBS, symptoms related to constipation and bloating were more common in women, but the dyspepsia group was too small to draw any conclusions. Finally, this is the first study to report that belching is more common in men than women controls not fulfilling criteria for any FGID.

Secuelas en las funciones ejecutivas posteriores al traumatismo craneoencefálico en el adulto / Executive functions after traumatic brain injury in adults

Las funciones cognitivas, entre ellas las ejecutivas (FE), después de un traumatismo craneoencefálico (TCE) presentan alteraciones, que afecta la vida cotidiana de los pacientes. El propósito del estudio fue evaluar las funciones ejecutivas de pacientes adultos con TCE moderado y severo, para conocer las características neuropsicológicas distintivas de la intensidad de la lesión. Participaron 26 pacientes, 10 con TCE Moderado (edad=34.80+/-14.45; escolaridad=15.20+/-2.525 años); y 16 con TCE Severo (edad=32.17+/-9.42; escolaridad= 12.11+/-4.15 años), pareados por edad y escolaridad con un grupo control sano. Evaluados individualmente con la Batería de Funciones Ejecutivas y Frontales(Flores, Ostrosky-Solís y Lozano, 2008). Los resultados indican que los pacientes con TCE presentan principalmente problemas en el WCST, torre de Hanoi, la Iowa Gambling Task, memoria de trabajo, y habilidades semánticas. Además muestran compromiso en la velocidad del procesamiento de información, comete errores perseverativos, y dificultades en la flexibilidad mental. Los resultados sugieren mayor afección en tareas de la corteza prefrontal dorso lateral. Estos datos permitirán diseñar e implementar programas dedicados a la intervención cognitiva enfocados la mejoría de las FE.

Cognitive functions including executive functions (FE) are affected following a traumatic brain injury (TBI), diminished patient’s daily life. The purpose of the present study was measuring EF of adult moderate and severe TBI patients, and knows the neuropsychological profile related with lesion intensity. Participated 26 patients, divided in 10 with Moderate TBI (age=34.80+/-14.45; education= 15.20+/-2.525 years); and 16 with Severe TBI (age=32.17+/-9.42; education= 12.11+/-4.15 years), matched by age and level of education with a healthy control group. Participants were individually assessing with the Executive Function and Frontal Lobes Neuropsychological Battery (Flores, Ostrosky-Solís y Lozano, 2008). Results show that TBI patients mainly had problems in resolve the WCST, Hanoi Tower, Iowa Gambling Task, working memory and in process semantic information. At the same time shows decreased time in processing information, perseverations,intrusions, and less mental flexibility. Data suggest a major affection on dorso lateral prefrontal cortex tasks. This data would help to design rehabilitation programs to cognitive intervention focused on EF.

Los eventos traumáticos tempranos y su relación con la psicopatía criminal / Early traumatic events and its relationship with criminal psychopathy

INTRODUCCION: Son diversos los factores que intervienen en el desarrollo de la psicopatía. Se ha observado una predisposición genética que al interactuar con la vivencia de eventos traumáticos en edades tempranas, potencia el desarrollo de este trastorno conductual, fuente de actos agresivos y violentos en contra de la sociedad. OBJETIVO: Conocer la incidencia de eventos traumáticos (p.ej. eventos estresantes, abuso físico, abuso emocional y abuso sexual) y su influencia en el nivel de psicopatía de adultos convictos masculinos. PARTICIPANTES Y MATERIAL: Se realizó una revisión del historial criminal y una entrevista semiestructurada para clasificar a los internos de acuerdo a su nivel de psicopatía. Se les aplicó el Inventario de Eventos Traumáticos para conocer la frecuencia y diversidad de eventos sufridos antes de los 18 años. RESULTADOS: Los internos con alta psicopatía presentaron una alta incidencia de eventos traumáticos, específicamente de eventos estresantes, de abuso emocional y de abuso sexual y un total de eventos significativamente mayor que el grupo con psicopatía baja. Los eventos traumáticos y el abuso emocional fueron variables que contribuyeron significativamente al nivel de psicopatía de los internos. CONCLUSIONES: Los eventos traumáticos vividos durante la infancia y la adolescencia favorecen la manifestación de conductas violentas a través de la afectación de los mecanismos neurobiológicos que subyacen a la psicopatía, en donde se puede observar una asociación entre la frecuencia de eventos vividos y el grado de psicopatía presentes en la vida adulta.

INTRODUCTION: The factors that interact to drive the development of psychopathy are diverse. A genetic predisposition has been observed that, when coupled with the experience of traumatic events at a young age, potentiates the development of this behavioral and affective disorder that leads to aggressive and violent acts against society. OBJECTIVES: To understand the incidence of traumatic events (e.g., stressful events, physical abuse, emotional abuse, and sexual abuse) and their influence in the psychopathy of adult male convicts. PARTICIPANTS AND MATERIALS: Background criminal career reviews and semi-structured interviews were conducted to classify the inmates according to their psychopathy level utilizing the Revised Hare Psychopathic Scale. In addition, the Early Trauma Inventory was applied to assess the frequency and diversity of events experienced before the participants were 18 years of age. RESULTS: Inmates with high psychopathy also presented with a high incidence of traumatic events, as well as stressful events, emotional and sexual abuse in a higher frequency than the group with low psychopathy. The incidence of traumatic events and emotional abuse were found to predict the degree of psychopathy among the inmates. CONCLUSIONS: Traumatic events experienced during infancy and adolescence seem to favor the manifestation of violent conduct by interacting with neurobiological factors that underlie psychopathy, such that an association may be observed between the frequency of childhood traumatic events and the level of psychopathy present in adult life.

Asociaciones implícitas como método para la detección de violencia y psicopatía / Implicit associations as a method for detection of violence and psychopathy

La psicopatía es un trastorno de la personalidad que caracterizado por rasgos interpersonales, afectivos, conductuales y de estilo de vida. Está asociada con conducta violenta, existen pocos estudios que evalúen la tendencia hacia la violencia en psicópatas mediante técnicas de asociaciones implícitas como el Test de Asociaciones Implícitas (IAT). Se desarrolló el IAT-violencia, para evaluar las distorsiones cognitivas acerca de la violencia en 195 reos de acuerdo al nivel de psicopatía y al tipo de delito, se exploró el desempeño en la prueba de acuerdo a los niveles de los factores 1 y 2 de psicopatía. Los resultados indican que los sujetos violentos con alta psicopatía presentan distorsiones cognitivas acerca de la violencia. Aquellos con alto factor 2 de psicopatía presentan distorsiones cognitivas acerca de la violencia. Se discute la relación entre los factores 1 y 2 con la conducta violenta y la importancia de contar con instrumentos breves, confiables y objetivos. Las entrevistas semi-estructuradas requieren 1.5-3.5 horas, un entrenamiento especializado para evaluar el grado de psicopatía. Se discute el potencial para detectar sujetos que estén en riesgo de cometer alguna ofensa violenta mediante el IAT-violencia que toma 15 minutos y cuya calificación es automatizada.

Psychopathy is a personality disorder characterized by interpersonal, affective, behavioral and life-style traits. There is a relationship between psychopathy and violent behavior but few studies assess the tendency toward violence in psychopaths by implicit association methods like the Implicit Association Test (IAT). The violent-IAT was developed to assess the cognitive distortions about violence of 195 male inmates according to their psychopathy level and the offense committed, in addition, the performance in the test according to the factor level 1 and 2 of psychopathy was assessed. The results showed that psychopath-violent inmates had cognitive distortions about violence; and those with high factor 2 of psychopathy level inmates had a tendency toward violence. The discussion focused in the relationship between both psychopathy factors and violent behavior; and the importance to have reliable, objective and brief instruments like violent-IAT to measure the tendency toward violent behavior. The semi-structured interviews need a long time and a specialized training to assess the psychopathy level. The potential to detect subjects in high risk of committing extreme violent offenses by violent-IAT, that only need 15 minutes and gives an automatic-scored, is also discussed.

A middle-aged female serial killer.

The case of a 48-year-old woman accused of killing at least 12 elderly women and attempting to kill another one during the last 3 years is presented. Extensive neuropsychological, electrophysiological, and neuropsychiatric testing showed no evidence of a DSM-IV-TR Axis I diagnosis, but a decrease in executive functions and abnormalities in the processing of affective stimuli were found. Behavioral and psychophysiological studies revealed dissociation between knowing how to behave and actually behaving in socially acceptable ways. According to the woman, killing was just her response to "humiliating situations." Two potentially significant conditions in her past history are found: (i) childhood abuse; and (ii) multiple head injuries. It is conjectured that the nature of her crimes, paranoid and personality traits, a probable frontal brain dysfunction, as well as a specific demographic and social context represent unusual factors accounting for her violent behavior.

Applicability of the abbreviated neuropsychologic battery (NEUROPSI) in Alzheimer disease patients.

NEUROPSI is a brief neuropsychologic battery developed to briefly assess a wide spectrum of cognitive functions. The aim of this study was to examine the applicability of a Portuguese version of this battery and verify the efficacy in detecting cognitive impairment in Alzheimer disease (AD) patients. NEUROPSI was applied to 75 elderly people, 25 patients with probable AD in mild stage (AD1), 25 patients in moderate stage (AD2), and 25 healthy elderly persons (control group), matched with the AD patients for age and schooling. Before testing all participants were applied the Mini-Mental State Examination. Results showed significant differences in total scores of the tests; NEUROPSI (P<0.001) and Mini-Mental State Examination (P<0.001), and the control group scored highest in both of the tests followed by groups AD1 and AD2. Differences were also found between the initial phase and the moderate phase. Results indicate that NEUROPSI is an efficient instrument for detecting AD patients in the initial stage of the disease.

Evaluación de las funciones ejecutivas, inteligencia e impulsividad en mujeres con trastorno límite de la personalidad (TLP) / Evaluation of executive functions, intelligence and impulsivity in women with borderline personality disorder

Las funciones neurocognitivas básicas como el control ejecutivo cognoscitivo representan un endofenotipo prometedor que puede mejorar el entendimiento del desarrollo y la expresión del TLP. Evaluamos la asociación entre el funcionamiento en una Batería de Funciones Ejecutivas y el TLP. Se estudió a 10 mujeres diagnosticadas con TLP a quienes por separado se les administró esta batería y fueron comparadas con un grupo control no clínico que constó de 10 sujetos. El desempeño en los participantes con TLP fue menor en la batería de Función Ejecutiva (U=18, p=0,015) y fueron más impulsivo que el grupo de control (U=21, p=0,28); por otra parte no hubo diferencias entre ambos grupos sobre la inteligencia (U=28, p=0,096). Los pacientes con TLP demostraron impedimentos significativos en la prueba de toma de decisiones y planeación lo que puede sugerir la disfunción del lóbulo frontal.

Basic neurocognitive functions such as executive cognitive control represent promising endophenotypes that may improve understanding of the development and expression of TLP. We evaluated the association between performance on a Battery of Executive Functions and the TLP psychopathology. 10 TLP-diagnosed women were evaluated with this battery and their results were compared with those of a non clinical control group, consisting of 10 subjects. It was found that TLP participants performed more poorly than controls in the Executive Function Battery (U=18, p=0,015) and were more impulsive than the control group (U=21, p=0,28); on the other hand, there were no differences between both groups in intelligence (U=28, p=0,096) It was concluded that patients with TLPexhibited significant impairments in test of decision-making and planning, suggesting frontal lobe dysfunction.

NEUROPSI ATTENTION AND MEMORY: a neuropsychological test battery in Spanish with norms by age and educational level.

Health care professionals are now faced with a growing number of patients from different ethnic groups, and from different socioeconomical backgrounds. In the field of neuropsychology there is an increasing need of reliable and culturally fair assessment measures. Spanish is the official language in more than 20 countries and the second most spoken language in the world. The purpose of this research was to develop and standardize the neuropsychological battery NEUROPSI ATTENTION AND MEMORY, designed to assess orientation, attention and concentration, executive functions, working memory and immediate and delayed verbal and visual memory. The developmental sequences of attention and memory as well as the educational effects were analyzed in a sample of 521 monolingual Spanish Speaking subjects, aged 6 to 85 years. Educational level ranged from 0 to 22 years of education. The consideration of the developmental sequence, and the effects of education, can improve the sensitivity and specificity of neuropsychological measures.

Same or different? Semantic verbal fluency across Spanish-speakers from different countries.

Several investigations have suggested that age, education and culture affect semantic fluency. To date, there is no research work indicating whether there are differences among speakers of the same language but from different countries. It has been proposed that despite having the same language, each Spanish-speaking country should have its normative data. The purpose of this study was to analyze the contribution of age, education and culture to semantic fluency in Spanish-speakers. Age and level of education are determining factors in semantic fluency performance. The differences found may be due to the variability in the administration and scoring of the tests, rather than to a cultural effect. A standardized method is proposed for the application of the test.

Comparative analysis of cognitive impairment among Mexicans and Spanish-speaking immigrant's elders.

OBJECTIVE: This study aims to compare the prevalence of cognitive impairment among older Mexicans and Spanish-speaking U.S. immigrants. METHODS: The relationship of cognitive impairment with social and demographic variables was explored using data from five different population based survey studies. RESULTS: Prevalence rates increased with age, with low educational level, didn't show a clear association with gender and decreased in married subjects. Estimates of cognitive and functional impairment combined are greater in the immigrant samples than those for Mexican residents. Primary memory measures are the least discriminative for cognitive impairment, whereas orientation, attention, and secondary verbal memory measures discriminate better. DISCUSSION: Mexicans and Spanish-speaking USA immigrants have similar prevalence estimates of cognitive impairment. However, prevalence of functional impairment differs between Mexicans and immigrants because of measurement issues and cultural factors.

Attention and memory evaluation across the life span: heterogeneous effects of age and education.

The developmental sequences of attention and memory were studied by utilizing normative data derived from the neuropsychological battery named NEUROPSI ATTENTION AND MEMORY. A sample of 521 Spanish-speaking individuals, aged 6 to 85 years, participated in this study. In the adult sample, educational level ranged from 0 to 22 years of education. Data from subtests measuring orientation, attention and concentration, executive functions, working memory, immediate and delayed verbal memory, and immediate and delayed visual memory were included. The factor structure of the analyzed battery is presented. The effects of age and education on this structure were analyzed. Results suggested that although attention and memory are related, their developmental sequences are separated from one another. During childhood, the development of selective and sustained attention, attentional-working memory, and executive functions showed a fast improvement in performance. Development of verbal memory and place and person orientation showed a slower increment in scores. In the adult sample it was found that factors related to memory are sensitive to age, whereas those related to attention and executive functions are sensitive to education. The consideration of both the developmental sequence, as well as differential effects of education, can improve the sensitivity and specificity of neuropsychological measures, allowing early diagnosis of cognitive dysfunction and implementation of adequate rehabilitation programs.

Cognition, functional status, education, and the diagnosis of dementia and mild cognitive impairment in Spanish-speaking elderly.

A group of 314 Spanish-speaking elders were classified in 55 participants with mild to moderate dementia, 74 participants with mild cognitive impairment (MCI), and 185 control participants, according to clinical evaluation derived. Sensitivity, specificity, and detection characteristics of frequently cognitive and functional tests were calculated in comparison with the clinical evaluation: Minimental State Examination, Brief Neuropsychological Test Battery, Short Blessed test, Pfeffer Functional Activities Questionnaire, and Blessed Dementia Scale. Influence of education on sensitivity and specificity values varied along the tests. For all the cognitive and functional measures, a great number of MCI participants who fulfilled Mayo's (Mayo's Clinical School) clinical criteria (Petersen et al., 1999) were misclassified as controls and a few were misclassified as demented. Level of education plays a very important role in both cognitive and functional assessment. The cognitive tests that are commonly used to screen demented patients may fail to detect MCI particularly in high-functioning individuals as well as those who are well educated.

Influencias de la edad y de la escolaridad en el examen breve del estado mental (Mini-Mental State Examination) en una población hispano-hablante / Influence of age and education in the Mini Mental State Examination in a Spanish speaking population

Se aplicó el Examen Breve del Estado Mental (Mini-Mental State examination o MMSE) a 430 sujetos neurológicamente intactos entre 16 y 85 años de edad. La muestra se estratificó de acuerdo a la edad en tres grupos: 16-50 años, 51-65 años y 66-89 años y dentro de cada rango de edad se consideraron 4 niveles educativos: nulo (cero a los de estudio), bajo (1-4 años de estudio), medio (5-9 años) y alto (10 o más años de estudio). El nivel de escolaridad mostró un efecto significativo en el puntaje total. Los individuos sanos y funcionalmente independientes con escolaridad nula, obtuvieron puntajes que los clasificaron dentro de un cuadro de demencia severa (promedio = 17.67) mientras que los puntajes de aquellos con escolaridad de 1 a 4 años fueron semejantes a los de demencia leve (promedio = 20.61). Para establecer la especificidad y la sensibilidad del instrumento se estudió una muestra de 40 sujetos con diagnóstico clínico de demencia. Los sujetos fueron comparados por pares con el grupo control de acuerdo a la edad y a la escolaridad. Se utilizó el punto de corte propuesto por Folstein y cols. (1975), de 23/24 puntos y se encontraron bajos niveles de especificidad y sensibilidad en sujetos sin escolaridad y con escolaridad de 1 a 4 años, 50 por ciento y 72.73 por ciento respectivamante. El ajuste del punto de corte en función del desempeño promedio del grupo de sujetos neurológicamente instactos incrementó la especificidad (90 por ciento), pero disminuyó considerablemente la sensibilidad (86.36 por ciento) fueron más altos. En la población hispano-hablante el MMSE puede ser útil para confirmar la presencia de alteraciones cognoscitivas severas en sujetos con más de 5 años de escolaridad, pero no debe considerarse para detectar alteraciones leves. En sujetos de baja escolaridad con el MMSE se obtiene un alto índice de falsos positivos. El MMSE es un instrumento de poca utilidad para el diagnóstico de alteraciones en poblaciones hispano-hablantes sin escolaridad

Características neuropsicológicas y genéticas de la enfermedad de Alzheimer. Una entidad heterogénea / Neuropsychoilogical and genetic characteristics of Alsheimer illness An heterogenousillness

Entre las enfermedades del sistema nervioso central de mayor incidencia en la vejez se encuentran las demencias. Los resultados de estudios clínicos-anatómicos han revelado que entre los diferentes tipos de demencias, la enfermedad de Alzheimer (EA), sola o en combinación con otras condiciones, constituye el 60 por ciento de todas las demencias. La EA es un trastorno neurodegenerativo, clínica y etiológicamente heterogéneo, caracterizado por un deterioro temprano y progresivo de las funciones cognositivas. Su diagnóstico se realiza por la exclusión de síntomas propios de otros síndromes demenciales y sólo se confirma mediante la biopsia a autopsia. Algunos criterios clínicos para su diagnóstico han sido formulados por el Manual de Diagnóstico y Estadística de los Desórdenes Mentales (DSM-IV) y los creados en 1984 por el Instituo Nacional de Desórdenes Neurológicos Comunicativos e Infarto en colaboración con la Asociación de la Enfermedad de Alzheimer y Trastornos Relacionados (NINCDS-ADRDA). Hasta la fecha la etiología de la enfermedad se desconoce; sin embargo, se han planteado diversas hipótesis para explicar su origen, entre las cuales se encuentran: intoxicación por aluminio, trastornos en el sistema inmunológico, infección viral, déficits en la formación de filamentos, deficiencia en algunos neurotransmisores y alteraciones genéticas. La EA se ha subdividido en Enfermedad de Alzheimer de tipo Esporádico, la cual constituye el 60 por ciento de los casos y Enfermedad de Aizheimer Familiar, que representa el 40 por ciento restante. Estas dos formas, etiológicamente distintas, presentan cambios neuropatológicos similares (atrofia cortical difusa, proliferación de la glia, placas seniles, degeneración fibrilar y granulovacular, etc), Sin embargo, las características clínicas han cuestionado la existencia de entidades cualitativamente distintas. Existen diferencias relacionadas a la edad de inicio de la enfermedad y a la presentación de los síntomas. Los pacientes cuyas alteraciones se presentan antes de los 65 años tienen mayores anormalidades neurológicas y cognoscitivas focales así como una progresión más rápida de la enfermedad. Así mismo se ha encontrado que los pacientes con Enfermedad de Alzheimer Familiar muestran alteraciones cognoscitivas más severas, particularmente afasia y apraxia...