RESUMEN
OBJECTIVE: To increase understanding of the impact of cannabidiol (CBD) on outcomes beyond seizure control among individuals with Dravet syndrome or Lennox-Gastaut syndrome. METHODS: Qualitative interviews were conducted with caregivers of individuals with Dravet syndrome or Lennox-Gastaut syndrome treated with plant-derived, highly purified CBD medicine (Epidiolex in the USA; Epidyolex in Europe; 100â mg/mL oral solution). Symptoms and impacts of Dravet syndrome and Lennox-Gastaut syndrome on individuals were explored, as were the effects of CBD. Data were analyzed using thematic analysis. RESULTS: Twenty-one caregivers of individuals with Dravet syndrome (n = 14) and Lennox-Gastaut syndrome (n = 7) aged 4-22 years participated. Health-related quality of life improvements associated with CBD included cognitive function, communication, behavior, mobility, and participation in daily activities. Seizure frequency reduction was commonly reported (n = 12), resulting in caregivers having greater freedom and family life being less disrupted. Adverse events were reported by 10 caregivers. CONCLUSION: In addition to reduced seizure frequency, CBD may have a wide range of beneficial effects beyond seizure control that warrant further investigation.
Asunto(s)
Cannabidiol , Cuidadores , Epilepsias Mioclónicas , Síndrome de Lennox-Gastaut , Investigación Cualitativa , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Síntomas Conductuales/tratamiento farmacológico , Cannabidiol/administración & dosificación , Cannabidiol/uso terapéutico , Cuidadores/psicología , Cognición/efectos de los fármacos , Comunicación , Epilepsias Mioclónicas/tratamiento farmacológico , Epilepsias Mioclónicas/complicaciones , Entrevistas como Asunto , Síndrome de Lennox-Gastaut/complicaciones , Síndrome de Lennox-Gastaut/tratamiento farmacológico , Calidad de Vida , Convulsiones/tratamiento farmacológico , Convulsiones/complicaciones , Conducta Verbal/efectos de los fármacosRESUMEN
There is good evidence that cocoa flavonoids can acutely improve cognitive function in humans, possibly via mechanisms such as increased cerebral blood flow. To date, much of the evidence is based on measures of executive function with extracts and cocoa-based interventions with a high flavonoid content. The aim of the present study was to explore whether benefits to episodic verbal memory and mood are observed two hours post consumption of a commercially available dark chocolate (DC) bar relative to a 35 g white chocolate bar (WC). Ninety-eight healthy young adults (n = 57 females) aged 18-24 years consumed either a 35 g DC bar or a calorie-matched low flavonoid WC bar. Verbal episodic memory and mood were assessed pre consumption and 2 h post consumption. An ANOVA analysis showed that the DC was associated with better verbal memory performance for several outcome measures of the Rey Auditory Verbal Learning Test relative to the WC, however, there were no effects on mood. These findings lend support to the notion that everyday available portions of dark chocolate can confer benefits to the brain in healthy consumers.
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Chocolate , Cognición/efectos de los fármacos , Función Ejecutiva/efectos de los fármacos , Flavonoides/aislamiento & purificación , Flavonoides/farmacología , Memoria Episódica , Memoria/efectos de los fármacos , Polifenoles/aislamiento & purificación , Polifenoles/farmacología , Conducta Verbal/efectos de los fármacos , Adolescente , Afecto , Chocolate/análisis , Femenino , Humanos , Aprendizaje/efectos de los fármacos , Masculino , Factores de Tiempo , Adulto JovenRESUMEN
Expectancies of nicotine content have been shown to impact smokers' subjective responses and smoking behaviors. However, little is known about the neural substrates modulated by verbally induced expectancies in smokers. In this study we used functional magnetic resonance imaging (fMRI) to investigate how verbally induced expectations, regarding the presence or absence of nicotine, modulated smokers' neural response to a nicotine-free odor. While laying in the scanner, all participants (N = 24) were given a nicotine-free odor, but whereas one group was correctly informed about the absence of nicotine (control group n = 12), the other group was led to believe that the presented odor contained nicotine (expectancy group n = 12). Smokers in the expectancy group had significantly increased blood-oxygen-level-dependent (BOLD) responses during the presentation of the nicotine-free odor in the left ventral tegmental area (VTA), and in the right insula, as compared to smokers in the control group (Regions of interest analysis with pFWE-corrected p ≤ 0.05). At a more liberal uncorrected statistical level (p-unc ≤ 0.001), increased bilateral reactivity in the dorsolateral prefrontal cortex (dlPFC) was also observed in the expectancy group as compared with the control group. Our findings suggest that nicotine-expectancies induced through verbal instructions can modulate nicotine relevant brain regions, without nicotine administration, and provide further neural support for the key role that cognitive expectancies play in the cause and treatment of nicotine dependence.
Asunto(s)
Fumar Cigarrillos/psicología , Nicotina/administración & dosificación , Odorantes , Olfato/fisiología , Área Tegmental Ventral/diagnóstico por imagen , Conducta Verbal/fisiología , Adulto , Femenino , Humanos , Masculino , Motivación/efectos de los fármacos , Motivación/fisiología , Olfato/efectos de los fármacos , Área Tegmental Ventral/efectos de los fármacos , Conducta Verbal/efectos de los fármacos , Adulto JovenRESUMEN
There is ample evidence that phosphodiesterase 4 (PDE4) inhibition can improve memory performance in animal studies. In the present study, we examined the acute effects of the PDE4 inhibitor roflumilast on memory performance in healthy individuals (60-80 years of age). We tested the effects of acute roflumilast administration (100, 250, 1000 µg) in a double-blind, placebo-controlled, 4-way crossover design. Participants were first screened for their verbal word memory performance to ensure normal memory performance (within 0.5 standard deviation from norm score; n = 20) Drug effects on memory performance were tested in a verbal memory test and a spatial memory test. Reported side effects of drug treatment were registered. Roflumilast (100 µg) improved the delayed recall performance of the participants (Cohen's d, 0.69). No effects were observed in the spatial memory task. Roflumilast was well tolerated at this low dose. Although no clear adverse side effects were reported at the low dose, mild adverse events (including headache, dizziness, insomnia, and diarrhea) were reported after the 1000 µg dose. The present study provides first evidence that the PDE4 inhibitor roflumilast improves verbal memory performance in old participants. The current data encourage further development of PDE4 inhibitors for improving memory.
Asunto(s)
Aminopiridinas/administración & dosificación , Aminopiridinas/farmacología , Benzamidas/administración & dosificación , Benzamidas/farmacología , Envejecimiento Saludable/psicología , Memoria/efectos de los fármacos , Inhibidores de Fosfodiesterasa 4/administración & dosificación , Inhibidores de Fosfodiesterasa 4/farmacología , Conducta Verbal/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Aminopiridinas/efectos adversos , Benzamidas/efectos adversos , Cognición/efectos de los fármacos , Estudios Cruzados , AMP Cíclico/fisiología , Ciclopropanos/administración & dosificación , Ciclopropanos/efectos adversos , Ciclopropanos/farmacología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Humanos , Recuerdo Mental/efectos de los fármacos , Persona de Mediana Edad , Inhibidores de Fosfodiesterasa 4/efectos adversos , Estimulación QuímicaRESUMEN
Klinefelter syndrome (KS, 47,XXY) is the most common sex chromosome aneuploidy in males. A variety of complex clinical needs is associated with KS, including physical, cognitive and psychosocial impairments. Standard treatment for KS consists of androgen replacement therapy in adolescence to offset testosterone deficiency. Such treatment has a beneficial effect on the physical and behavioral manifestations of this syndrome. Whether androgen supplementation has a significant influence on the brain, however, is unknown. In the current study, we examined regional gray matter volume in boys with KS to assess whether treatment with oxandrolone, a synthetic hormone analog of testosterone, was associated with structural changes in the brain. Specifically, we focused our investigation on the hippocampus, given (1) its involvement in KS, and (2) the high concentration of androgen receptors found in this region. Structural magnetic resonance imaging data was acquired from a subsample of boys who completed a 2-year double-blind clinical trial in which patients were randomized to treatment with oxandrolone or to placebo, as well as from a sample of typically developing (TD) boys. Group differences in hippocampal volume were examined. A significant main effect of group was observed. Pairwise comparisons indicated smaller hippocampal volume in the placebo group relative to the oxandrolone group, as well as smaller volume in the placebo group relative to the TD control group. No difference in volume was observed between the treatment and TD groups. Moreover, across KS subgroups, a significant positive association was observed between hippocampus volume and performance on a spatial memory task, indicating treatment-based changes in brain structure may underlie cognitive change. These findings confirm prior reports implicating a role of the hippocampus in KS and are important in extending previous research by demonstrating a significant effect of androgens on brain structure.
Asunto(s)
Hipocampo/efectos de los fármacos , Síndrome de Klinefelter/tratamiento farmacológico , Oxandrolona/uso terapéutico , Adolescente , Andrógenos/farmacología , Andrógenos/uso terapéutico , Encéfalo/efectos de los fármacos , Encéfalo/crecimiento & desarrollo , Encéfalo/patología , Niño , Desarrollo Infantil/efectos de los fármacos , Método Doble Ciego , Hipocampo/diagnóstico por imagen , Hipocampo/crecimiento & desarrollo , Hipocampo/patología , Humanos , Inteligencia/efectos de los fármacos , Síndrome de Klinefelter/diagnóstico , Síndrome de Klinefelter/patología , Imagen por Resonancia Magnética , Masculino , Oxandrolona/farmacología , Conducta Verbal/efectos de los fármacosRESUMEN
A number of near-infrared spectroscopy (NIRS) studies in schizophrenia have shown that there is a significant dysfunction of the prefrontal cortex (PFC) in patients with schizophrenia, but it remains unclear how atypical antipsychotics affect the function of the PFC. To investigate the changes in brain activation patterns in schizophrenia who accepted antipsychotic treatment, we used NIRS to measure the hemodynamic changes of the PFC in patients with schizophrenia at the time of enrollment and after 4 weeks of treatment during a verbal fluency task (VFT). We included 16 schizophrenia and 17 sex- and age- matched healthy controls. Compared with the healthy controls, the VFT performance was significantly worse in patients with schizophrenia, as was the activation of the PFC. Furthermore, after 4 weeks of treatment, there was no significant improvement in VFT performance and the activation of the PFC in schizophrenia. Our results suggest that the function of the PFC and cognitive skills in schizophrenia were significantly impaired and do not improve from a short-term treatment of atypical antipsychotics.
Asunto(s)
Antipsicóticos/farmacología , Corteza Prefrontal/fisiopatología , Esquizofrenia/fisiopatología , Espectroscopía Infrarroja Corta , Conducta Verbal/fisiología , Adulto , Femenino , Neuroimagen Funcional/métodos , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Corteza Prefrontal/efectos de los fármacos , Esquizofrenia/diagnóstico por imagen , Espectroscopía Infrarroja Corta/métodos , Conducta Verbal/efectos de los fármacos , Adulto JovenRESUMEN
OBJECTIVE: To examine the effect of maternal folic acid supplementation and maternal plasma folate and antiepileptic drug (AED) concentrations on language delay in AED-exposed children of mothers with epilepsy. METHODS: Children of mothers with and without epilepsy enrolled from 1999 to 2008 in the Norwegian Mother and Child Cohort study were included. Information on medical history, AED use, and folic acid supplementation during pregnancy was collected from parent-completed questionnaires. Maternal plasma folate and maternal plasma and umbilical cord AED concentrations were measured in blood samples from gestational weeks 17 to 19 and immediately after birth, respectively. Language development at 18 and 36 months was evaluated by the Ages and Stages Questionnaires. RESULTS: A total of 335 AED-exposed children of mothers with epilepsy and 104,222 children of mothers without epilepsy were surveyed. For those with no maternal periconceptional folic acid supplementation, the fully adjusted odds ratio (OR) for language delay in AED-exposed children compared to the controls at 18 months was 3.9 (95% confidence interval [CI] 1.9-7.8, p < 0.001) and at 36 months was 4.7 (95% CI 2.0-10.6, p < 0.001). When folic supplementation was used, the corresponding ORs for language delay were 1.7 (95% CI 1.2-2.6, p = 0.01) and 1.7 (95% CI 0.9-3.2, p = 0.13), respectively. The positive effect of folic acid supplement use on language delay in AED-exposed children was significant only when supplement was used in the period from 4 weeks before the pregnancy and until the end of the first trimester. CONCLUSION: Folic acid use early in pregnancy may have a preventive effect on language delay associated with in utero AED exposure.
Asunto(s)
Ácido Fólico/metabolismo , Trastornos del Desarrollo del Lenguaje/etiología , Efectos Tardíos de la Exposición Prenatal/metabolismo , Efectos Tardíos de la Exposición Prenatal/fisiopatología , Conducta Verbal/fisiología , Adolescente , Adulto , Factores de Edad , Anticonvulsivantes/efectos adversos , Preescolar , Estudios de Cohortes , Epilepsia/tratamiento farmacológico , Femenino , Edad Gestacional , Humanos , Masculino , Relaciones Madre-Hijo , Noruega , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Estadísticas no Paramétricas , Conducta Verbal/efectos de los fármacos , Adulto JovenRESUMEN
Background: Previous epidemiological and clinical studies have shown that dairy products have beneficial effects on cognitive decline and dementia. Enzymatic digestion of whey protein produces a whey peptide rich in tryptophan-tyrosine-related peptides which improve cognitive performance in mice. We evaluated the effects of whey peptides on cognitive functions in healthy adults in a randomized, double-blind, placebo-controlled design. Methods: 101 healthy adults (45 to 64 years), with a self-awareness of cognitive decline received either whey peptide or placebo supplements for 12 weeks. Changes in cognitive function were assessed using neuropsychological tests at 6 and 12 weeks after the start of supplementation. Results: Verbal fluency test (VFT) score changes tended to be higher in the whey peptide group compared with the placebo at 12 weeks. Subgroup analysis classified by the degree of subjective fatigue showed that changes in the VFT as well as the Stroop and subjective memory function tests between baseline and 6 weeks of intervention were significantly better in subjects with high-level fatigue from the whey peptide group as compared to the placebo group. CONCLUSIONS: Intake of whey peptide might improve cognitive function in healthy middle- and older-aged adults with high subjective fatigue levels. Further studies will elucidate the relationship among cognitive improvement, whey peptides, and psychological fatigue.
Asunto(s)
Cognición/efectos de los fármacos , Disfunción Cognitiva/dietoterapia , Suplementos Dietéticos , Fatiga Mental/dietoterapia , Triptófano/administración & dosificación , Tirosina/administración & dosificación , Proteína de Suero de Leche/administración & dosificación , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Método Doble Ciego , Femenino , Voluntarios Sanos , Humanos , Japón , Masculino , Memoria/efectos de los fármacos , Fatiga Mental/diagnóstico , Fatiga Mental/psicología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores de Tiempo , Resultado del Tratamiento , Conducta Verbal/efectos de los fármacosRESUMEN
It is now generally accepted that diabetes increases the risk for cognitive impairment, but the precise mechanisms are poorly understood. A critical problem in linking diabetes to cognitive impairment is that patients often have multiple comorbidities (e.g., obesity, hypertension) that have been independently linked to cognitive deficits. In the study reported here we focused on young adults with and without type 1 diabetes who were virtually free of such comorbidities. The two groups were matched on major health and demographic factors, and all participants completed a verbal working memory task during magnetoencephalographic brain imaging. We hypothesized that patients would have altered neural dynamics in verbal working memory processing and that these differences would directly relate to clinical disease measures. Accordingly, we found that patients had significantly stronger neural responses in the superior parietal cortices during memory encoding and significantly weaker activity in parietal-occipital regions during maintenance compared with control subjects. Moreover, disease duration and glycemic control were both significantly correlated with neural responses in various brain regions. In conclusion, young healthy adults with type 1 diabetes already have aberrant neural processing relative to their peers without diabetes, using compensatory responses to perform the task, and glucose management and duration may play a central role.
Asunto(s)
Enfermedades Asintomáticas , Disfunción Cognitiva/diagnóstico por imagen , Diabetes Mellitus Tipo 1/complicaciones , Nefropatías Diabéticas/diagnóstico por imagen , Memoria a Corto Plazo , Adulto , Disfunción Cognitiva/complicaciones , Disfunción Cognitiva/fisiopatología , Comorbilidad , Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Diabetes Mellitus Tipo 1/fisiopatología , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/prevención & control , Progresión de la Enfermedad , Femenino , Neuroimagen Funcional , Hemoglobina Glucada/análisis , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Hipoglucemiantes/uso terapéutico , Insulina/uso terapéutico , Magnetoencefalografía , Masculino , Memoria a Corto Plazo/efectos de los fármacos , Nebraska/epidemiología , Lóbulo Occipital/diagnóstico por imagen , Lóbulo Occipital/efectos de los fármacos , Lóbulo Occipital/fisiopatología , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/efectos de los fármacos , Lóbulo Parietal/fisiopatología , Conducta Verbal/efectos de los fármacos , Aprendizaje Verbal/efectos de los fármacos , Adulto JovenRESUMEN
We sought to determine whether high-dose folinic acid improves verbal communication in children with non-syndromic autism spectrum disorder (ASD) and language impairment in a double-blind placebo control setting. Forty-eight children (mean age 7 years 4 months; 82% male) with ASD and language impairment were randomized to receive 12 weeks of high-dose folinic acid (2 mg kg-1 per day, maximum 50 mg per day; n=23) or placebo (n=25). Children were subtyped by glutathione and folate receptor-α autoantibody (FRAA) status. Improvement in verbal communication, as measured by a ability-appropriate standardized instrument, was significantly greater in participants receiving folinic acid as compared with those receiving placebo, resulting in an effect of 5.7 (1.0,10.4) standardized points with a medium-to-large effect size (Cohen's d=0.70). FRAA status was predictive of response to treatment. For FRAA-positive participants, improvement in verbal communication was significantly greater in those receiving folinic acid as compared with those receiving placebo, resulting in an effect of 7.3 (1.4,13.2) standardized points with a large effect size (Cohen's d=0.91), indicating that folinic acid treatment may be more efficacious in children with ASD who are FRAA positive. Improvements in subscales of the Vineland Adaptive Behavior Scale, the Aberrant Behavior Checklist, the Autism Symptom Questionnaire and the Behavioral Assessment System for Children were significantly greater in the folinic acid group as compared with the placebo group. There was no significant difference in adverse effects between treatment groups. Thus, in this small trial of children with non-syndromic ASD and language impairment, treatment with high-dose folinic acid for 12 weeks resulted in improvement in verbal communication as compared with placebo, particularly in those participants who were positive for FRAAs.
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Leucovorina/farmacología , Conducta Verbal/efectos de los fármacos , Trastorno del Espectro Autista/tratamiento farmacológico , Trastorno Autístico/tratamiento farmacológico , Niño , Trastornos Generalizados del Desarrollo Infantil/tratamiento farmacológico , Preescolar , Método Doble Ciego , Femenino , Receptor 1 de Folato/metabolismo , Humanos , Trastornos del Desarrollo del Lenguaje/tratamiento farmacológico , Trastornos del Lenguaje/tratamiento farmacológico , Leucovorina/metabolismo , Masculino , Efecto Placebo , Receptores de Péptidos/metabolismo , Resultado del TratamientoRESUMEN
The objective of this study was to assess cognitive performance and behavioral symptoms in a sample of children diagnosed with partial epilepsy who were seizure controlled on AED monotherapy for one year. Ninety-eight seizure-controlled children on AED monotherapy were included in this study. Specific AEDs examined included topiramate, divalproex sodium, lamotrigine, levetiracetam, and oxcarbazepine. Groups did not differ on age, region of focal epilepsy, or Full-Scale IQ. Direct measures included the WISC-IV and selected tests from the DKEFS (Verbal Fluency and Trail Making Test). Parent report measures included the BRIEF and the BASC-PRS. A series of ANOVAs revealed significant differences across the AED cohorts within many domains of cognitive functioning and behavioral presentation. Children prescribed divalproex sodium or topiramate demonstrated weaker working memory and verbal fluency, when compared with children prescribed other AEDs. Additionally, parents of children prescribed topiramate reported greater executive functioning and adaptive skills deficits. The pattern of findings suggests that children prescribed divalproex sodium or topiramate generally demonstrated a higher risk of cognitive and behavioral impairments compared to the other AEDs. Future prospective studies are required in order to better understand the relationship between AED type and these outcomes to inform clinical practice.
Asunto(s)
Anticonvulsivantes/efectos adversos , Trastornos de la Conducta Infantil/inducido químicamente , Trastornos del Conocimiento/inducido químicamente , Epilepsias Parciales/tratamiento farmacológico , Adolescente , Niño , Epilepsias Parciales/fisiopatología , Epilepsias Parciales/psicología , Función Ejecutiva/efectos de los fármacos , Femenino , Humanos , Pruebas de Inteligencia , Masculino , Memoria a Corto Plazo/efectos de los fármacos , Pruebas Neuropsicológicas , Padres/psicología , Desempeño Psicomotor/efectos de los fármacos , Resultado del Tratamiento , Conducta Verbal/efectos de los fármacosRESUMEN
Patients with macrophagic myofasciitis (MMF) present with diffuse arthromyalgias, chronic fatigue, and cognitive disorder. Representative features of MMF-associated cognitive dysfunction include attentional dysfunction, dysexecutive syndrome, visual memory deficit and left ear extinction. Our study aims to reevaluate the neuropsychological profile of MMF. 105 unselected consecutive MMF patients were subjected to a neuropsychological battery of screen short term and long-term memory, executive functions, attentional abilities, instrumental functions and dichotic listening. From these results, patients were classified in four different groups: Subsymptomatic patients (n=41) with performance above pathological threshold (-1.65 SD) in all tests; Fronto-subcortical patients (n=31) who showed pathological results at executive functions and selective attention tests; Papezian patients (n=24) who showed pathological results in storage, recognition and consolidation functions for episodic verbal memory, in addition to fronto-subcortical dysfunction; and Extinction patients (n=9) who had a left ear extinction at dichotic listening test in association to fronto-subcortical and papezian dysfunction. In addition, inter-test analysis showed that patients with apparently normal cognitive functions (Subsymptomatic group) performed significantly worse to attention tests compared to others. In conclusion, our study shows that (i) most patients have specific cognitive deficits; (ii) all patients with cognitive deficit have impairment of executive functions and selective attention; (iii) patients without measurable cognitive deficits display significant weakness in attention; (iv) episodic memory impairment affects verbal, but not visual, memory; (v) none of the patients show an instrumental dysfunction.
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Adyuvantes Inmunológicos/efectos adversos , Hidróxido de Aluminio/efectos adversos , Disfunción Cognitiva/etiología , Fascitis/fisiopatología , Miositis/fisiopatología , Síndromes de Neurotoxicidad/fisiopatología , Enfermedades Asintomáticas , Atención/efectos de los fármacos , Estudios de Cohortes , Diagnóstico Diferencial , Pruebas de Audición Dicótica , Función Ejecutiva/efectos de los fármacos , Fascitis/inducido químicamente , Fascitis/diagnóstico , Fascitis/diagnóstico por imagen , Femenino , Francia , Hospitales Especializados , Hospitales Universitarios , Humanos , Imagen por Resonancia Magnética , Masculino , Memoria Episódica , Miositis/inducido químicamente , Miositis/diagnóstico , Miositis/diagnóstico por imagen , Neuroimagen , Pruebas Neuropsicológicas , Síndromes de Neurotoxicidad/diagnóstico , Síndromes de Neurotoxicidad/diagnóstico por imagen , Estudios Retrospectivos , Conducta Verbal/efectos de los fármacosRESUMEN
OBJECTIVE: Few studies have investigated verbal working memory-related functional connectivity patterns in participants with attention-deficit/hyperactivity disorder (ADHD). Thus, we aimed to compare working memory-related functional connectivity patterns in healthy children and those with ADHD, and study effects of methylphenidate (MPH). METHOD: Twenty-two boys with ADHD were scanned twice, under either MPH (single dose, 10 mg) or placebo, in a randomised, cross-over, counterbalanced placebo-controlled design. Thirty healthy boys were scanned once. We used fMRI during a numerical n-back task to examine functional connectivity patterns in case-control and MPH-placebo comparisons, using independent component analysis. RESULTS: There was no significant difference in behavioural performance between children with ADHD, treated with MPH or placebo, and healthy controls. Compared with controls, participants with ADHD under placebo showed increased functional connectivity within fronto-parietal and auditory networks, and decreased functional connectivity within the executive control network. MPH normalized the altered functional connectivity pattern and significantly enhanced functional connectivity within the executive control network, though in non-overlapping areas. CONCLUSION: Our study contributes to the identification of the neural substrates of working memory. Single dose of MPH normalized the altered brain functional connectivity network, but had no enhancing effect on (non-impaired) behavioural performance.
Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Memoria a Corto Plazo/efectos de los fármacos , Metilfenidato/farmacología , Metilfenidato/uso terapéutico , Vías Nerviosas/efectos de los fármacos , Conducta Verbal/efectos de los fármacos , Adolescente , Trastorno por Déficit de Atención con Hiperactividad/psicología , Encéfalo/efectos de los fármacos , Estimulantes del Sistema Nervioso Central/uso terapéutico , Niño , Estudios Cruzados , Humanos , Imagen por Resonancia Magnética , MasculinoRESUMEN
OBJECTIVES: Epilepsy heavily affects the quality of life (QoL) of patients with brain tumor because in addition to taking treatments for the oncological illness, patients are required to live with the long-term taking of antiepileptic drugs (AEDs). The AEDs' adverse effects are common in these patients and can negatively influence their perceptions of their QoL.We conducted an observational pilot study in patients with brain tumor-related epilepsy to verify efficacy, tolerability, and impact on QoL and global neurocognitive performances of zonisamide (ZNS) in add-on. MATERIALS AND METHODS: We recruited 13 patients (5 females, 8 males; mean age, 49.6 years) presenting uncontrolled seizures. At first visit and at final follow-up at 6 months, patients underwent neurological examination, evaluation of adverse events, and cognitive and QoL tests. A seizure diary was given. RESULTS: Eight patients underwent chemotherapy, 3 underwent radiotherapy, and 5 had disease progression. Mean dosage of ZNS at final follow-up was 300 mg/d.Of 9 patients who reached the sixth month follow-up, the mean weekly seizure number before ZNS had been 3.2 ± 5.0, and at final follow-up, the mean weekly seizure number was 0.18 ± 0.41 (P = 0.05).Compared with baseline, we observed stability in all cognitive domains, except for verbal fluency that significantly worsened.Results on QoL tests showed that QoL remained unchanged over time, which could indicate that ZNS did not influence the patients' perceived QoL. CONCLUSIONS: Zonisamide as add-on in our patients seems to be well tolerated and efficacious in controlling seizures. Despite having limitations represented by the fact that our study is observational, with a small study population and a short follow-up period, our results confirm that when choosing an AED, in addition to efficacy, the drug's effect on patients' QoL also needs to be considered, especially for patients facing many psychosocial challenges, such as those with brain tumor-related epilepsy.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Neoplasias Encefálicas/fisiopatología , Disfunción Cognitiva/prevención & control , Epilepsia/tratamiento farmacológico , Isoxazoles/uso terapéutico , Nootrópicos/uso terapéutico , Calidad de Vida , Antineoplásicos/efectos adversos , Antineoplásicos/uso terapéutico , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Disfunción Cognitiva/inducido químicamente , Disfunción Cognitiva/etiología , Disfunción Cognitiva/fisiopatología , Terapia Combinada/efectos adversos , Resistencia a Medicamentos , Quimioterapia Combinada/efectos adversos , Epilepsia/inducido químicamente , Epilepsia/etiología , Epilepsia/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Italia , Trastornos del Lenguaje/inducido químicamente , Trastornos del Lenguaje/etiología , Trastornos del Lenguaje/fisiopatología , Trastornos del Lenguaje/prevención & control , Masculino , Persona de Mediana Edad , Proyectos Piloto , Radioterapia/efectos adversos , Índice de Severidad de la Enfermedad , Conducta Verbal/efectos de los fármacos , ZonisamidaRESUMEN
Autism spectrum disorder (ASD) is characterized by impairments in social communication as well as restricted, repetitive behaviors. Evidence suggests that some individuals with ASD have cognitive impairments related to weak central coherence and hyperrestricted processing. Reducing noradrenergic activity may improve aspects of network processing and thus improve cognitive abilities, such as verbal problem solving, in individuals with ASD. The present pilot study explores the effects of acute administration of the beta-adrenergic antagonist propranolol on verbal problem solving in adults and adolescents with ASD. In a within-subject crossover-design, 20 participants with ASD received a single dose of propranolol or placebo on one of two sessions in a double-blinded, counterbalanced manner. Verbal problem solving was assessed via an anagram task. Baseline measurements of autonomic nervous system functioning were obtained, and anxiety was assessed at baseline and following drug administration. Participants solved the anagrams more quickly in the propranolol condition, as compared to the placebo condition, suggesting a potential cognitive benefit of this agent. Additionally, we observed a negative linear relationship between response to propranolol on the anagram task and two measures of baseline autonomic activity, as well as a positive linear relationship between drug response and baseline anxiety. These relationships propose potential markers for treatment response, as propranolol influences both autonomic functioning and anxiety. Further investigation is needed to expand on the present single-dose psychopharmacological challenge and explore the observed effects of propranolol in a serial-dose setting.
Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico , Trastorno del Espectro Autista/tratamiento farmacológico , Trastorno del Espectro Autista/psicología , Solución de Problemas/efectos de los fármacos , Propranolol/uso terapéutico , Conducta Verbal/efectos de los fármacos , Adolescente , Adulto , Ansiedad/psicología , Sistema Nervioso Autónomo/efectos de los fármacos , Estudios Cruzados , Método Doble Ciego , Femenino , Humanos , Masculino , Proyectos Piloto , Desempeño Psicomotor/efectos de los fármacos , Resultado del Tratamiento , Adulto JovenRESUMEN
3,4-Methylenedioxymethamphetamine (MDMA) administered as an adjunct to talk therapy influences patient speech content and increases improvement in treatment-resistant posttraumatic stress disorder (PTSD). Data came from the recordings of Mithoefer et al. (2011). In the third therapeutic session studied, patients were assigned, double blind, to an MDMA or a placebo group. Condition-blind scorers listened to therapy recordings and scored utterances where patients initiated topics that were empathic (regarding others' emotions), entactic (requesting or appreciating physical touch), or ensuic (describing a change in their sense of themselves). Patients who received MDMA produced high levels of ensuic, empathic, and entactic utterances compared with those who received the placebo. Interrater discourse scoring was reliable. The relationship between the number of scored utterances and the Clinician Administered PTSD Scale scores measuring PTSD severity after the treatment was significant, and reanalysis grouped bimodally into "many" or "few" such utterances remained significant. MDMA assisted these patients in having meaningful and disorder-resolving thoughts and discourse in talk therapy.
Asunto(s)
N-Metil-3,4-metilenodioxianfetamina/farmacología , Evaluación de Resultado en la Atención de Salud/métodos , Psicoterapia/métodos , Serotoninérgicos/farmacología , Trastornos por Estrés Postraumático/terapia , Conducta Verbal/efectos de los fármacos , Adulto , Terapia Combinada , Método Doble Ciego , Femenino , Humanos , Masculino , N-Metil-3,4-metilenodioxianfetamina/administración & dosificación , Serotoninérgicos/administración & dosificación , Trastornos por Estrés Postraumático/tratamiento farmacológicoRESUMEN
BACKGROUND AND OBJECTIVE: The purpose of the present review was to study the impact of endocrine therapy (ET) on the cognitive outcomes of breast cancer patients. MATERIALS AND METHODS: We systematically searched the literature using the MEDLINE (1966-2015), Scopus (2004-2015), ClinicalTrials.gov (2008-2015) and Cochrane Central Register (CENTRAL) databases, as well as the references of the electronically retrieved articles. RESULTS: Twelve studies were included in the present systematic review, which assessed the cognitive function of 2756 patients. Among these patients, 2381 received ET, whereas the remaining 375 served as controls (placebo or no therapy). The majority of patients were postmenopausal, and the minimum follow-up period was 3 months and the maximum 2 years. Treatment with ET seems to be accompanied by altered cognitive abilities, including verbal memory, verbal fluency, motor speed, attention and working memory. Tamoxifen seems to be related to decreased cognitive performances compared with treatment with an aromatase inhibitor. CONCLUSIONS: ET among breast cancer patients seems to negatively alter the cognitive outcomes of breast cancer patients. However, the methodological heterogeneity of the included studies, as well as the relatively small follow-up period, render imperative the conduct of further studies in the field.
Asunto(s)
Inhibidores de la Aromatasa/efectos adversos , Neoplasias de la Mama/prevención & control , Cognición/efectos de los fármacos , Moduladores Selectivos de los Receptores de Estrógeno/efectos adversos , Atención/efectos de los fármacos , Neoplasias de la Mama/psicología , Femenino , Humanos , Memoria/efectos de los fármacos , Desempeño Psicomotor/efectos de los fármacos , Conducta Verbal/efectos de los fármacosRESUMEN
BACKGROUND: The brain is a major target organ for cortisol considering its high density of glucocorticoid receptors. Several states of hypothalamus-pituitary-adrenal dysregulation point towards impairments in cognitive functioning. However, there is a very limited body of research on the effects of hypocortisolism on cognitive functioning. AIM: To evaluate cognitive functioning in patients with hypocortisolism (i.e., primary adrenal insufficiency (PAI)) and to examine the possible effect of postponing early-morning hydrocortisone intake on cognitive functioning. METHODS: Thirty-one patients with PAI on regular morning hydrocortisone intake and 31 healthy matched controls underwent nine neuropsychological tests, evaluating memory and executive functioning. In addition, the effect of normal timing and postponement of morning hydrocortisone intake on neuropsychological tests were assessed in an additional 29 patients with PAI. RESULTS: Compared to controls, patients with PAI performed worse on auditory and visual memory tasks (all P ≤ 0.024) and executive functioning tasks (all P ≤ 0.012). In contrast, patients performed better on a concentration and an attention task (both P<0.05). Postponement of hydrocortisone intake in the morning did not affect the outcomes of neuropsychological tests. CONCLUSION: Patients on long-term hydrocortisone replacement for PAI show mild cognitive deficits compared to controls. There was no effect of postponement of regular hydrocortisone intake on cognition.
Asunto(s)
Enfermedad de Addison/complicaciones , Enfermedad de Addison/tratamiento farmacológico , Enfermedad de Addison/psicología , Disfunción Cognitiva/complicaciones , Hidrocortisona/uso terapéutico , Enfermedad de Addison/epidemiología , Adulto , Cognición/efectos de los fármacos , Disfunción Cognitiva/tratamiento farmacológico , Disfunción Cognitiva/epidemiología , Función Ejecutiva/efectos de los fármacos , Femenino , Terapia de Reemplazo de Hormonas , Humanos , Masculino , Memoria/efectos de los fármacos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Conducta Verbal/efectos de los fármacos , Vigilia/efectos de los fármacosRESUMEN
BACKGROUND/AIMS: Fampridine is sometimes reported to improve cognition and especially the information-processing speed. Motor improvement might be a confounding factor. The aim of this study was to evaluate the effects of fampridine on verbal fluencies in patients with multiple sclerosis (MS). METHODS: Fifty MS patients were included in a prospective monocentric open label trial with a mean Expanded Disability Status Scale of 5.3 ± 1.1. Assessments of verbal phonological and semantic fluencies were repeated twice (within 1 week) before fampridine treatment and twice after fampridine treatment in order to have the maximal practice effect. Gait velocity and fatigue (visual analogical scale) were also assessed. Distribution into gait responders, gait non-responders, fluency responders and fluency non-responders, was described. RESULTS: Verbal fluencies were significantly higher after fampridine treatment. No correlation was observed between phonological fluency improvement and semantic fluency improvement. Gait responders and gait non-responders did not present significant differences in verbal fluency performance and fatigue score. No correlation between gait velocity improvement and fatigue improvement compared with verbal fluency improvement was observed. CONCLUSION: Our results suggest that fampridine could have a selective procognitive effect on phonological fluency in MS, even in the gait non-responder patients.
Asunto(s)
4-Aminopiridina/uso terapéutico , Trastornos del Conocimiento/tratamiento farmacológico , Apraxia de la Marcha/tratamiento farmacológico , Esclerosis Múltiple/tratamiento farmacológico , Trastornos del Habla/tratamiento farmacológico , Medición de la Producción del Habla , Conducta Verbal/efectos de los fármacos , Adulto , Evaluación de la Discapacidad , Femenino , Francia , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
In the course of human evolution, the brain has evolved into a highly sensitive detector of social signals. As a consequence of this socially driven adaptation, humans display a tendency to anthropomorphize, that is they attribute social meaning to non-social agents. The evolutionarily highly conserved hypothalamic peptide oxytocin (OXT) has been identified as a key factor attaching salience to socially relevant cues, but whether it contributes to spontaneous anthropomorphism is still elusive. In the present study involving 60 healthy female participants, we measured salivary OXT concentrations and explored the effect of a single intranasal dose of synthetic OXT (24 IU) or placebo (PLC) on anthropomorphic tendencies during participants׳ verbal descriptions of short video clips depicting socially and non-socially moving geometric shapes. Our results show that endogenous OXT concentrations at baseline positively correlated with the attribution of animacy to social stimuli. While intranasal OXT had no modulatory effect on arousal ratings and did not make the participants more talkative, the treatment boosted anthropomorphic descriptions specifically for social stimuli. In conclusion, we here provide first evidence indicating that spontaneous anthropomorphism in women is facilitated by oxytocin, thereby enabling a context-specific upregulation of the propensity to anthropomorphize environmental cues.