Encontro com Especialistas - Aspectos neurocomportamentais do recém-nascido

Encontro com os Especialistas Sérgio Marba, médico neonatologista da Unicamp, e Roberta Albuquerque, médica neonatologista do Hospital Universitário Materno Infantil da UFMA.

Procesos cognitivos en trombosis de seno longitudinal superior: reporte de caso / Cognitive processes in superior longitudinal sinus thrombosis: case report

INTRODUCCIÓN: la trombosis de seno longitudinal superior es una enfermedad de difícil detección a causa de sus diferentes causas y debido al polimorfismo de sus manifestaciones neurológicas; además es común en el sexo femenino relacionado a los estímulos estrogénicos y otros factores hormonales, pero poco probable en menor de 40 años. PACIENTE: paciente menor de 40 años posterior a presentar dos episodios de accidentes cerebrovasculares isquémicos, se evalúa un año después de la lesión el estado cognitivo y funcional mediante la batería Neuropsi Atención y Memoria y el Inventario de Adaptabilidad Mayo-Portland; los procesos cognitivos afectados en un nivel de clasificación leve fueron la atención y concentración, el funcionamiento ejecutivo; en el estado funcional reportado por el cónyuge sugiere afectación de síntomas clínicos como irritabilidad, ira agresividad, dolores de cabeza, cansancio y reacciones a síntomas menores e interacción inadecuada, estos síntomas no fueron reportados por la paciente sugiriendo posible anosognosia en su proceso de adaptabilidad CONCLUSIÓN: Tras un proceso de lesión cerebral por afectación trombótica, las secuelas cognitivos y funcionales permanecen posterior a la recuperación espontanea, llevando a emplear procesos de rehabilitación.

INTRODUCTION: the superior longitudinal sinus thrombosis is a disease difficult to detect because of its different causes and because of the polymorphism of its neurological manifestations; It is also common in females related to estrogen stimuli and other hormonal factors, but unlikely in younger than 40 years. PATIENT: a patient younger than 40 years after having two episodes of ischemic strokes, cognitive and functional status is assessed one year after the injury using the neuropsi battery attention and memory and the mayo-portland adaptability inventory; Cognitive processes affected at a slight level of classification were attention and concentration, executive functioning; In the functional status reported by the spouse suggests involvement of clinical symptoms such as irritability, anger, aggression, headaches, fatigue and reactions to minor symptoms and inadequate interaction, these symptoms were not reported by the patient suggesting possible anosognosia in her process of adaptability CONCLUSIÓN: After a process of brain injury due to thrombotic involvement, the cognitive and functional sequelae remain after spontaneous recovery, suggesting the import of rehabilitation processes.

Efectos de una carrera en condiciones de calor sobre el rendimiento cognitivo / Cognitive impacts of running under hot weather conditions

En hombres activos, una carrera de alrededor de 1 hora bajo condiciones ambientales de calor mejora el rendimiento cognitivo en relación con el tiempo de reacción en tareas complejas, mientras que deteriora el campo de visión y precisión de dichas tareas.

Evaluación breve del estado cognitivo de la demencia en estadios avanzados: resultados preliminares de la validación española del Severe Mini-Mental State Examination / Short evaluation of cognitive state in advanced stages of dementia: preliminary results of the Spanish validation of the Severe Mini-Mental State Examination

Introducción. La evaluación cognitiva de pacientes con demencias avanzadas es una necesidad no cubierta de forma adecuada, por lo que es necesario desarrollar herramientas que permitan obtener información del estado cognitivo y los recursos con los que aún cuentan estos sujetos. El presente trabajo realiza el estudio de validación al castellano de la escala Severe Mini-Mental State Examination (SMMSE). Material y métodos. Participaron 47 sujetos con demencia avanzada (Mini-Examen Cognoscitivo [MEC] < 11), evaluados con las escalas Global Deterioration Scale de Reisberg, MEC, SMMSE y Severe Cognitive Impairment Profile. Resultados. Todos los ítems que componen la prueba mostraron una buena capacidad de diferenciación. La prueba mostró una alta consistencia interna (α=0,88), y buena fiabilidad test-retest (0,64-1,00; p<0,01) e interjueces (0,69-1,00; p<0,01), tanto para la puntuación total como para cada uno de los ítems. La validez de constructo se analizó mediante la correlación con el MEC (r=0,59; p<0,01). Además, se dividió la muestra entre sujetos con MEC 0-5 y MEC>5, hallando que la correlación entre las puntuaciones en SMMSE y MEC era significativa en el grupo de MEC 0-5 (r=0,55; p<0,05), mientras que no lo era en aquellos con MEC>5. Asimismo se encontraron diferencias de puntuación en SMMSE, pero no en MEC, entre los tres grupos de GDS (5, 6 y 7) (H=11,1; p<0,05). Conclusiones. El SMMSE es un instrumento de evaluación del deterioro cognitivo avanzado que amplía el rango inferior de medida del MEC evitando el «efecto suelo». A partir de nuestros resultados el instrumento puede ser considerado válido y fiable, así como rápido y fácil de administrar(AU)

Introduction. The cognitive assessment of patients with advanced dementia needs proper screening instruments that allow obtain information about the cognitive state and resources that these individuals still have. The present work conducts a Spanish validation study of the Severe Mini Mental State Examination (SMMSE). Material and methods. Forty-seven patients with advanced dementia (Mini-Cognitive Examination [MEC]<11) were evaluated with the Reisberg's Global Deterioration Scale, MEC, SMMSE and Severe Cognitive Impairment Profile scales. Results. All test items were discriminative. The test showed high internal (α=0.88), test-retest (0.64 to 1.00, P<.01) and between observers reliabilities (0.69-1.00, p<0.01), both for scores total and for each item separately. Construct validity was tested through correlations between the instrument and MEC scores (r=0.59, P< 0 .01). Further information on the construct validity was obtained by dividing the sample into groups that scored above or below 5 points in the MEC and recalculating their correlations with SMMSE. The correlation between the scores in the SMMSE and MEC was significant in the MEC 0-5 group (r=0.55, P<.05), but not in the MEC>5 group. Additionally, differences in scores were found in the SMMSE, but not in the MEC, between the three GDS groups (5, 6 and 7) (H=11.1, P<.05). Conclusions. The SMMSE is an instrument for the assessment of advanced cognitive impairment which prevents the floor effect through an extension of lower measurement range relative to that of the MEC. From our results, this rapid screening tool and easy to administer, can be considered valid and reliable(AU)

Eficacia del entrenamiento cognitivo basado en nuevas tecnologías en pacientes con demencia tipo Alzheimer / Efficacy of cognitive training programs based on new software technologies in patients with Alzheimer-Type dementia

El estudio pretende evaluar la eficacia del ‘Big Brain Academy’ (BBA), un programa de entrenamiento cognitivo (EC) computarizado basado en un videojuego, frente al Programa de Psicoestimulación Integral (PPI), un instrumento típico de EC, en pacientes con Enfermedad de Alzheimer (EA). Un total de 45 pacientes con EA, en fase leve, fueron asignados de manera aleatoria a tres condiciones experimentales. Se establecieron dos grupos de tratamiento, donde los pacientes recibieron o bien un programa de estimulación con BBA (EABB), o bien un programa estimulación tradicional (EAPI), basado en tareas de papel y lápiz, durante doce semanas. Un tercer grupo, que no recibió ningún tratamiento durante este período, se le asignó la condición de grupo control (EANT). La eficacia diferencial de los programas se evaluó mediante un diseño pre-post, a través de medidas neuropsicológicas, conductuales y funcionales estandarizadas. El grupo EABB mostró un declive cognitivo significativamente más lento en comparación a los grupos EAPI y EANT. Además, el grupo EABB manifestó una reducción de la sintomatología depresiva significativamente mayor en relación a los grupos EAPI y EANT. El BBA fue más efectivo que el PPI para reducir el declive cognitivo y los síntomas depresivos en los pacientes con EA (AU)

The study aims to assess the efficacy of the Big Brain Academy (BBA), a computerized cognitive training program (CT) based on video games, compared to the Integrated Psychostimulation Program (IPP), a classical CT tool for patients with Alzheimer’s disease (AD). A total of 45 patients with AD at the mild stage were randomly assigned to three experimental conditions. Two treatment groups were established, in which patients received either a stimulation program with BBA (EABB) or a traditional stimulation program (EAPI), based on paper-and-pencil tasks, for twelve weeks. A third group, the control group (EANT), did not receive any treatment during this period. The differential effectiveness of the programs was evaluated through pre-post design, considering neuropsychological, behavioral, and functional standard measures as outcome variables. The EABB group showed significantly slower rates of cognitive decline compared to the EAPI and EANT groups. Furthermore, the EABB group reported significantly greater decrease in depressive symptoms in comparison with the EAPI and EANT groups. The BBA program was more effective than IPP to reduce cognitive decline and depressive symptoms in patients with AD (AU)

Una revisión de la investigación sobre lenguaje en el deterioro cognitivo leve / Research on language in mild cognitive impairment: a review

Aunque existen muchas investigaciones sobre el perfil neuropsicológico del deterioro cognitivo leve (DCL), los estudios centrados en analizar específicamente sus características psicolingüísticas no son concluyentes. El objetivo de este estudio es revisar las evidencias disponibles sobre la caracterización lingüística del DCL e identificar los mejores candidatos a predecir el DCL. Los estudios poblacionales han encontrado que medidas de fluidez verbal, denominación y memoria de palabras son buenas predictoras de la evolución del DCL hacia la demencia. Los estudios experimentales que comparan DCL con otros grupos proponen las tareas de fluidez verbal y de denominación, y en menor medida otras dimensiones, como la comprensión de oraciones y de textos, o la producción narrativa en cuanto a contenido semántico y estructuración sintáctica. Se informa de los hallazgos de algunos estudios que han buscado los correlatos neurológicos de los procesos implicados en el deterioro del lenguaje en el DCL. La presente revisión subraya la necesidad de estudiar nuevas dimensiones lingüísticas, sus relaciones con otros procesos cognitivos y sus fundamentos psicofisiológicos. Se menciona también la necesidad de realizar experiencias de intervención que permitan disminuir el deterioro y evitar en la medida de lo posible su evolución a la demencia (AU)

There are many studies on the neuropsychological profi le of mild cognitive impairment (MCI) but the results of investigations specifi cally addressing its psycholinguistic characteristics have been inconclusive. The present article aims to review the main population-based and experimental studies on language in MCI and to identify the features that help to predict deterioration. Population-based studies have found that the main predictors of MCI and its progression to dementia are measures of verbal fluency, naming and word memory. Experimental studies comparing patients with MCI and matched healthy controls have mainly analyzed performance in different fl uency and naming tasks and, to a lesser extent, other dimensions such as comprehension of sentences and texts and production of narrative speech, taking into account its semantic content and syntactic structures. The results of studies seeking neurological correlates of the processes involved in language deterioration in MCI are discussed. The present review highlights the need to explore new linguistic features of MCI, their relationships with other cognitive processes and their psychophysiological bases. The need for interventions to attenuate deterioration and avoid progression to dementia as far as possible is also discussed (AU)

Alterações neuro-comportamentais em ratos machos adultos em modelos de programação pela hiperleptinemia na lactação / Neuro-behavioral alterations in adult male rats in programming models for hyperleptinemia in lactation

Existe uma grande associação entre alterações em parâmetros nutricionais, hormonais ou ambientais durante estágios iniciais da vida, particularmente durante os períodos gestacional e de lactação, e o surgimento de doenças crônicas na vida adulta tais como obesidade, diabetes, doenças cardiovasculares, ansiedade e depressão. Neste trabalho, foram avaliados os efeitos cognitivo-comportamentais, em ratos Wistar adultos, da administração de leptina (8ug/100g, dia, sc) durante os primeiros 10 dias de lactação: 1) diretamente nos filhotes; 2) nas progenitoras. A memória e o aprendizado, os níveis de comportamento associados à ansiedade e à busca pela novidade foram avaliados em animais adultos através, respectivamente, dos seguintes testes comportamentais: labirinto aquático radial de 8 braços, labirinto em cruz elevado e campo vazado. No primeiro modelo (injeção nos filhotes), foram observados altos níveis de ansiedade e de busca por novos estímulos, enquanto que a memória e aprendizagem e atividade locomotora não foram afetados. No segundo modelo (injeção nas progenitoras), foram detectados redução dos níveis de ansiedade e melhora no desempenho associado à memória e ao aprendizado. Porém, não houve diferença nos níveis de busca por novos estímulos e no nível de atividade locomotora. Também são observadas diferenças em parâmetros somáticos, endócrinos e metabólicos entre modelos. O primeiro modelo resulta em hiperfagia, maior peso corporal por aumento de massa magra, hiperleptinemia, hipertireoidismo, hipertrigliceridemia, hiperinsulinemia e hipoadiponectinemia, hipertensão, aumento de catecolamina e de corticosterona, além de resistência hipotalâmica à leptina. O segundo modelo induz hiperfagia e maior peso corporal por acúmulo de gordura, hiperleptinemia, hiperglicemia, eutireoidismo, normoinsulinemia e resistência central à leptina. As seguintes possibilidades podem explicar as diferenças cognitivos-comportamentais observadas entre os modelos estudados ...

A considerable association exists between variations in the gestational and lactation periods, and the appearance of chronic diseases in adult life, such as obesity, diabetes, cardiovascular diseases, anxiety and depression. In the present study, the cognitive and behavioral effects of leptin injection (8ug/100g/day, sc) during the first 10 days of lactation were evaluated in adult male Wistar rats. In the first part of the study, leptin was injected directly in the offspring. In the second part of the study, leptin was injected in the lactation dams. Memory and learning, levels of anxiety-like behavior and levels of novelty-seeking behavior were evaluated by testing animals in, respectively, the radial-arm water maze, the elevated plus maze and the hole board arena. In the first model (offspring injection), high levels of anxiety and of novelty-seeking behavior were observed. Memory/learning and locomotor activity were unaffected. In the second model (dam injection), reduced levels of anxiety and better memory/learning performance were observed. Conversely, novelty-seeking and locomotor behavior were unaffected. Differences between models regarding somatic, endocrine and metabolic parameters are also observed. The first model presents hyperphagia, higher lean body mass, hyperleptinemia, hyperthyroidism, hipertrigliceridemia, hiperinsulinemia and hypoadiponectinemia, hypertension, increased levels of catecholamines and corticosterone, and hypothalamic leptin resistance. The second model induces hyperphagia, higher body mass, thou by accumulation of fat, hyperleptinemia, hyperglycemia, euthyroidism, normoinsulinemia and central mechanism of leptin resistance. The following possibilities may explain the cognitive-behavioral differences observed between models in the present study: 1) differences in somatic, endocrine and metabolic parameters; 2) modifications of the relationship between dams and their offspring, since leptin injection in the dams may reduce ...

Naming faces: a multidisciplinary and integrated review / Denominando caras: una revisión e integración multidisciplinar

Naming faces is a common area of study from a wide range of perspectives in social sciences, including cognitive psychology and several branches of cognitive neuroscience. This paper provides a comprehensive review of the cognitive models that have been proposed to explain the diverse aspects of face naming, taking into account face processing and language production models. In addition, a review of the neuroscientific data from event-related potential studies (when) and functional neuroimaging studies (where) is presented. Thus, an integrated view of the cognitive models and the data relating the different processes involved in naming faces to the brain activity is provided (AU)

La denominación de caras es un área de interés para diversas perspectivas en ciencias sociales, incluyendo la psicología cognitiva y diversas ramas de neurociencia cognitiva. Este artículo proporciona una revisión de los modelos cognitivos que han sido propuestos para explicar los diversos aspectos de la denominación de caras. Además, se presenta una revisión de los datos neurocientíficos de potenciales evocados (cuándo) y de estudios de neuroimagen funcional (dónde). Así, se presenta una visión integrada de los modelos cognitivos y los datos relacionando los distintos procesos implicados en la denominación de caras y la actividad cerebral (AU)

El estilo de personalidad en jugadores de fútbol de competición y diferencias en función de la demarcación / The style of personality in competition football players and differences according to the demarcation

En las investigaciones sobre personalidad en el contexto deportivo, se observa una falta de conclusiones definitivas, que se derivan principalmente de problemas metodológicos, estadísticos e interpretativos, recomendándose una aproximación desde diferentes modelos y metodologías (Cox, 2002; Vealey 2002). En este sentido, el modelo de personalidad de Millon (2001) puede ser un complemento a las teorías tradicionales en el estudios de la personalidad con deportistas. Los objetivos del presente trabajo de investigación son dobles: a) replicar los estudios realizados por García-Naveira (2004, 200B) con jugadores de fútbol de competición desde el modelo de personalidad de Millon y b) estudiar las posibles diferencias en personalidad en función de la demarcación que ocupan los jugadores dentro del equipo. La muestra está constituida por 209 jugadores de fútbol de competición d ela Comunidad de Madrid, con una edad comprendida entre los 18 y 25 años (M=22,30, DT 2,12). Los jugadores se reparten en las demarcaciones de delanteros (n=49), centrocampistas (n=94) y defensas (n=66). El instrumento seleccionado para la evaluación de la personalidad de los deportistas fue el Inventario de Estilos de Personalidad de Millon (2001). Los resultados indican que los jugadores de fútbol de competición se caracterizan por un determinado Estilo de Personalidad y se diferencian en función de la demarcación (AU)

In research about personality in the sport context, there is a lack of definitive conclusion, which derive mainly from methodological, statistical and interpretive problems, recommending an approximation from different models and methodologies (Cox, 2002); Vealey, 2002). In this sense, the Millon model of personality (2001) can be a complement to traditional theories in the study of personality with athletes. The objectives of this research work are double: a) to replicate Garcia-Naveira´s studies (2004, 2007b) with competition football players from the Millon model of personality, and b) to study possible personality differences based on the demarcation that the players hold within the team. The sample consisted of 209 competition football players of the Community of Madrid, aged between 18 and 25 years old (M)22,30, DT 2,12). The players are divided into forwards (n=49), personality of the athletes was Millon Index of Personality Styles (2001). The results indicate that the competition football players are characterized by a particular personality style and it depends on the demarcation they hold (AU)

La reserva cognitiva mejora la velocidad de procesamiento de los componentes centrales del tiempo de reacción en adultos mayores pero no en jóvenes / The cognitive reserve improves processing speed of central components of reaction time in aged subjets but not in young

Dos cuestiones actuales en el estudio de la reserva cognitiva (RC) son, por un lado, si su influencia tiene un carácter selectivo o general sobre los diferentes componentes de procesamiento de información y, por otro, si se trata de un proceso normal utilizado por el cerebro sano o un mecanismo de compensación que el cerebro desarrolla a lo largo de la vida, pero que sólo es funcional ante las limitaciones que impone la patología o el deterioro natural de la edad. El presente estudio ha evaluado ambas hipótesis al comparar un grupo de adultos mayores sanos y un grupo de control joven a través de tres tareas de TRD de demandas crecientes de procesamiento central pero con demandas de respuesta constantes. Los componentes centrales y motores del TR fueron registrados separadamente. Dentro de cada grupo los sujetos fueron clasificados de acuerdo con dos niveles de RC: alto o bajo. Los resultados indican, primero, que la RC mejora la velocidad de procesamiento en los adultos mayores de alta RC pero que este efecto sólo tiene lugar en los componentes centrales del TR y, segundo, que ella representa un mecanismo de compensación o alternativo que interviene ante el deterioro de los mecanismos normales de procesamiento e, inclusive, sólo ante elevadas demandas de procesamiento(AU)

Two questions are currently considered in the study of cognitive reserve (CR). By one hand, if its influence is general o specific to some components of information processing and, by the other, if it represents a normal mechanism available by the healthy brain at any moment or a compensatory one developed throughout the life span but only functional in conditions raised by brain pathology or by the natural decline of aging. The present study has approached both hypotheses by comparing two groups: one of healthy older and one of healthy younger subjects using three DRT tasks of increasing demands of processing except by the motor response requirements. The central and motor components of the RT were registered separately. Within each group, subjects were classified according two levels of CR: high or low. The results suggest first, that RC improves the speed of processing in high CR older but, only for the central component and second, that it represents a compensatory brain mechanism to ameliorate for the cognitive decline accompanying aging process, particularly, in conditions of increasing processing demands(AU)

Amnesia global transitoria: una revisión. II. Análisis neurocognitivo / Transient global amnesia: a review. II. Neurocognitive analysis

La amnesia global transitoria (AGT) es un síndrome neuropsicológico caracterizado por una pérdidasúbita y pasajera de la capacidad para crear nuevos recuerdos y cuya etiología continúa sin estar clara. Objetivo. Revisar el conocimiento existente sobre qué sucede con los diferentes sistemas de memoria cuando se padece AGT y una vez superado el episodio amnésico. Desarrollo. Se ha analizado, por una parte, la concepción actual de la memoria en la que se consideraa ésta como una entidad con diferentes sistemas y, por otra, cómo afecta la AGT a tales sistemas de memoria. Asimismo, se han revisado los niveles de recuperación de los diferentes sistemas tras el episodio de AGT. Conclusiones. El estado actual del conocimiento sobre los déficit de memoria asociados a la AGT sigue siendo limitado y quedan aún determinadas cuestiones sin una respuesta clara, sobre todo, la relativa a la recuperación. Además, los estudios de los que se dispone presentan en muchos casos ciertas inconsistencias teóricas o metodológicas

Transient global amnesia (TGA) is a neuropsychological syndrome characterized by an abrupt andtemporary loss of capacity of creating new memories and whose etiology is still unclear. Aim. To review available knowledge about the status of different memory systems when TGA is suffered and when an amnesic episode is over. Development. Two topics have been analysed: first, the current conception of memory as an entity with different systems and, second, how different memory systems are affected by TGA. Finally, levels of recovery of the different systems after a TGA episode are analysed. Conclusions. The present state of knowledge about memory deficits associated with TGA is still limited and there are still some questions without a clear answer, particularly regarding recovery. Furthermore, studies often present theoreticaland/or methodological inconsistencies

Evolución de los síntomas cognitivos en la esquizofrenia: una revisión de la literatura / Course of cognitive symptoms in schizophrenia: a review of the literature

Los estudios longitudinales son los únicos capaces de dar respuesta a la cuestión de si los déficit cognitivos presentes en la esquizofrenia siguen un curso estable y establecer cuál es su relación evolutiva con otros síntomas clínicos de la enfermedad. Este artículo revisa un total de 30 estudios publicados en pacientes bien con un primer episodio psicótico, como crónicos o geriátricos con un período mínimo de seguimiento de 1 año. La disparidad de criterios y metodologías empleadas limita significativamente las conclusiones que pueden extraerse sobre esta materia. Sin embargo, la tendencia global a la que apuntan los resultados sugiere que ya en el inicio de la enfermedad están presentes síntomas cognitivos significativos y medibles que permanecen estables en el período posterior entre los 2 y los 5 años y cuyo deterioro se acentúa con la evolución de la enfermedad, especialmente en los pacientes institucionalizados, sin llegar a superar el nivel de deterioro que presentan otras patologías degenerativas. Los autores son conscientes de que la unificación de criterios de investigación y la superación de las limitaciones metodológicas pueden ofrecer en el futuro resultados que modifiquen las conclusiones aquí recogidas

Longitudinal studies are the only ones capable of responding to the question of whether cognitive deficits present in schizophrenia follow a stable course and establishing its evolutive relationship with other clinical symptoms of the disease. This article reviews a total of 30 studies published in patients with a first psychotic episode or chronic or geriatric patients, with a minimum follow-up period of 1 year. The diversity in criteria and methods used significantly limits the conclusions that can be drawn on this subject. However, the global tendency of the results suggests that significant and measurable cognitive symptoms are present at the onset of the disease and these remain stable in the subsequent period between 2 and 5 years. Their deterioration increases with the course of the disease, especially in hospitalized patients, it not exceeding the deterioration level presented in other degenerative diseases. The authors are aware that unifying research criteria and overcoming the methodological limitations may offer results that change the conclusions herein gathered in the future

Sintomas depressivos e deficts cognitivos em idosos atendidos no núcleo de atenção à pessoa idosa do Hospital Universitário Oswaldo Cruz, GERO-HUOC / Depressive symptoms and cognitive deficit in an elderly population attended at the elderly unit of the Oswaldo Cruz University Hospital GERO-HUOC

O envelhecimento populacional é um fenômeno mundial. Alguns dos problemas de saúde mais freqüentes em idosos são: o déficit cognitivo e os transtornos depressivos, que provocam prejuízos à saúde física e mental. Este trabalho teve por objetivo avaliar os níveis de afetividade e os déficits das funções cognitivas de 100 idosos atendidos no Núcleo de Estudo e Atenção a Pessoa Idosa do Hospital Universitário Oswaldo Cruz em Recife – PE, utilizando o Mini Exame do Estado Mental de Folstein e a Escala de Depressão Geriátrica de Yasavage. Um percentual de 45 da amostra analisada apresentou resultados compatíveis com sintomas depressivos e 53,1 com deficits cognitivos. O diagnóstico e a intervenção precoce nos quadros de deficit cognitivo e transtornos depressivos nos idosos, possibilitam o desenvolvimento de ações e políticas de saúde que visem à manutenção da autonomia funcional e melhoria da qualidade de vida desta população.

Deterioro ejecutivo y sintomatología en la esquizofrenia / Executive impairment and symptomathology in the schizophrenia

Introducción: Las observaciones acerca de la disfunción cognitiva en la esquizofrenia en relación con la sintomatología son antiguas y numerosas. Revisamos la literatura sobre la función ejecutiva y síntomas positivos y negativos. Objetivo: Demostrar la hipótesis nula de que la mayor disfunción cognitiva vinculada tanto a los síntomas positivos como a los negativos de la esquizofrenia es debida al azar. Metodología: Un número de 101 pacientes tratados en nuestro hospital durante el año 2002, diagnosticados de esquizofrenia según CIE-10, fueron estudiados mediante la escala PANSS para medir el estado clínico y el test de Wisconsin para medir la función ejecutiva. Resultados: En nuestro estudio no se pudo demostrar la hipótesis nula planteada respecto a la sintomatología negativa, pues obtuvimos una correlación estadísticamente significativa entre dicha sintomatología negativa, medida por la PANSS, y las variables: número de categorías completadas, respuestas de nivel conceptual e intentos de completar la primera categoría del test de Wisconsin. Así mismo, existe significatividad en la relación entre la PANSS total y el ítem, intentos de completar la primera categoría. Conclusiones: De acuerdo con otros trabajos anteriores, en nuestros pacientes esquizofrénicos los síntomas negativos se asocian con una afectación de la función ejecutiva, no así los síntomas positivos (AU)

Relación entre síntomas cognitivos y no cognitivos en lademencia / Relationship between the cognitive and non cognitive sympotoms of dementia

Objetivo: analizar la influencia en las distintas funciones neuropsicológicas de los síntomas no cognitivos de la demencia. Material y método: se estudiaron 79 pacientes diagnosticados de síndrome demencial e ingresados en un Centro de Día Psicogeriátrico. Se recogieron variables sociodemográficas y clínicas, incluyendo en éstas las alteraciones neuropsiquiátricas (INP) y el deterioro cognitivo medido a través de MEC y Test Barcelona abreviado (TBA). Resultados: las distintas funciones neuropsicológicas exploradas a través del protocolo se relacionaban con ciertos síntomas psiquiátricos como eran los delirios (p=0,02; r=-0,25), depresión, euforia, apatía, desinhibición e irritabilidad (p=0,007; r=0,30). El diagnóstico de demencia tipo Alzheimer determinaba mayor deterioro cognitivo (p=0,001; F=4,95) que otras demencias. El deterioro no correlacionaba con la edad del paciente, con los años de escolarización ni con la duración de la enfermedad. El sexo tampoco determinaba diferencias. Conclusión: el deterioro cognitivo de los pacientes con demencia empeoraba con la frecuencia y severidad de ciertos síntomas neuropsiquiátricos como eran los delirios, depresión, euforia, apatía, desinhibición e irritabilidad (AU)

Loss of nucleus basalis neurons containing trkA immunoreactivity in individuals with mild cognitive impairment and early Alzheimer's disease.

Recent studies indicate that there is a marked reduction in trkA-containing nucleus basalis neurons in end-stage Alzheimer's disease (AD). We used unbiased stereological counting procedures to determine whether these changes extend to individuals with mild cognitive impairment (MCI) without dementia from a cohort of people enrolled in the Religious Orders Study. Thirty people (average age 84.7 years) came to autopsy. All individuals were cognitively tested within 12 months of death (average MMSE 24.2). Clinically, 9 had no cognitive impairment (NCI), 12 were categorized with MCI, and 9 had probable AD The average number of trkA-immunoreactive neurons in persons with NCI was 196, 632 +/- 12,093 (n = 9), for those with MCI it was 106,110 +/- 14,565, and for those with AD it was 86,978 +/- 12,141. Multiple comparisons showed that both those with MCI and those with AD had significant loss in the number of trkA-containing neurons compared to those with NCI (46% decrease for MCI, 56% for AD). An analysis of variance revealed that the total number of neurons containing trkA immunoreactivity was related to diagnostic classification (P < 0.001), with a significant reduction in AD and MCI compared to NCI but without a significant difference between MCI and AD. Cell density was similarly related to diagnostic classification (P < 0.001). There was a significant correlation with the Boston Naming Test and with a global score measure of cognitive function. The number of trkA-immunoreactive neurons was not correlated with MMSE, age at death, education, apolipoprotein E allele status, gender, or Braak score. These data indicate that alterations in the number of nucleus basalis neurons containing trkA immunoreactivity occurs early and are not accelerated from the transition from MCI to mild AD.

Cognitive impairment in systemic lupus erythematosus: a follow-up study.

We evaluated outcome and the clinical value of cognitive impairment in systemic lupus erythematosus (SLE). Fifty-one consecutive SLE subjects with or without overt nervous system involvement received two comprehensive neuropsychiatric and neuropsychological assessments, including the Mental Deterioration Battery, the Mini Mental State Examination (MMSE), and tests from the Wechsler Adult Intelligence Scale. The two neuropsychological assessments were made when subjects were in stable neurological condition. Twenty-seven patients were found to have neuropsychiatric symptoms (NP-SLE) at the first assessment, and three others developed them during the follow-up. Fifteen patients (10 NP-SLE) had cognitive impairment at the first assessment. At retest the cognitive deficit persisted in all patients but one (non-NP-SLE) and had developed in four others. In the cognitively impaired subjects scores on MMSE approached the cutoff for an overt dementing condition. No progressively decreasing scores were found on any of the tests. No relationships were shown between neuropsychological diagnosis and neuropsychiatric disorder, neuroradiological findings, disease activity, or steroid and nonsteroid immunosuppressive therapy. Cognitive impairment thus seems to be a stable symptom of CNS involvement in SLE. It corresponds to the subjective complaint of intellectual difficulties and marginal performance on the MMSE. Intellectual deterioration may occur in patients without other symptoms of NP-SLE. Standardized neuropsychological testing methods should be used routinely to assess SLE patients.

Converging evidence for a cognitive anomaly in early psychopathology.

Subcomponents of the N200 component of the event-related brain potential believed to be differentially sensitive to involuntary and voluntary cognitive processes were examined. Nonpatients (N = 131) identified initially by the Chapman and Depue research scales and classified later on the basis of diagnostic symptom clusters and family psychiatric history provided converging evidence for an intact mismatch negativity subcomponent. In contrast, the N2b subcomponent distinguished several groups of subjects. Results suggested abnormal voluntary cognitive processing, perhaps reflecting compensatory efforts in subjects at risk for or manifesting psychopathology, particularly those showing negative symptoms.

Cortical brain dysfunction in early schizophrenia: secondary pathogenetic hierarchy of neuroplasticity, psychopathology and social impairment.

Schizophrenia has the quality of a 'top-down' disorder with perturbation of self, and malattuned appraisal of basic experience of the outside world, and of intentionality. There is dissonance between the faculties of consciousness. The neuronal cortical network displays distributed activation of the sensory cortices during perception, and retroactivation during recall. This multimodal organization is sensitive to aberrations of structure and informational content during the metabolically dynamic phases of expansion and pruning in childhood and adolescence. There is substantial evidence of deviant function of the cortical network in schizophrenia. This includes increased neuronal density, reduced prefrontal capacity for activation, impaired fronto-temporal interaction during language production, defect monitoring of inner speech, activation of secondary sensory cortices during hallucinations, reduced cortical and thalamic volume, reduced thalamic activation (filtering) and sensitization of dopaminergic modulation. As a hypothesis the cortical defects lead to secondary causation of abnormalities at the levels of neuroplasticity, symptomatology and social competence. Suggestions for empirical testing are presented for the hypothesis that neocortical defects are primary, thalamic defects secondary and dopaminergic aberrations tertiary in the schizophrenic process. This testing of hypotheses involves prospective studies of patient groups at various ages of onset, as well as comparison of neurobiological measures in remitting vs. treatment-resistant cases.

Control functions of the frontal lobes. Modularity of the central-supervisory system?

Lesions of the prefrontal cortex result in a wide variety of neuropsychological disorders. Despite recent advances, the executive processes and their functional architecture remain poorly specified. This study assessed control processes operating in novel, conflicting and combined tasks in patients with lesion of the prefrontal or posterior cortices. Experiments used two-choice reaction time tests with similar perceptuo-motor and decision processes. It mainly showed (1) impaired short term memory in posterior patients, and (2) impairment of response inhibition and tasks combination in some frontal patients. Selective deficits with double dissociations were evidenced on novel, conflicting and combined tasks. This study provides additional evidence for the prominent role of the frontal lobes in control processes. The demonstration of selective deficits of specific control processes suggests that executive functions depend on multiple separable control processes, and that their operations can be specified in cognitive terms.