Benefits of combined interventions for cognitive enhancement in older adults / Benefícios de intervenções combinadas para aprimoramento cognitivo em idosos

Objective: To investigate the effects of different combined interventions (Stimullus, MEMO, physical activity, and psychoeducation) on the cognitive performance of older adults. Methods: This is a quasi-experimental study with pre- and post-intervention. Thirty-four older adults underwent different combined interventions for a period of 48 weeks and were evaluated at three different points (pre-intervention; post-cognitive intervention; post-physical activity or psychoeducation intervention). Cognitive domains (verbal episodic memory, executive function, general cognitive performance) and depressive symptoms were evaluated. Results: Postintervention gains in global, attentional, and mnemonic cognition were observed, as well as a reduction in depressive symptoms. The MEMO intervention + physical activity or psychoeducation resulted in greater cognitive gains, while Stimullus + psychoeducation showed benefits only in evocation and the free learning index, while Stimullus + physical activity resulted in improvement in the investigated variables. Conclusion: The results of these combined interventions appear promising for healthy older adults and the impact of these interventions should be discussed with individual older patients and evaluated more broadly in the context of public health.

Objetivo: Investigar os efeitos de diferentes intervenções combinadas (Stimullus, MEMO, física e psicoeducacional) no desempenho cognitivo de idosos. Metodologia: Trata-se de um estudo quase experimental com pré e pós-intervenção. Trinta e quatro idosos foram submetidos a diferentes intervenções combinadas pelo período de 48 semanas e avaliados em três tempos diferentes (pré-intervenção; pós-intervenção cognitiva; pós-intervenção física ou psicoeducacional), nos quais foram analisados domínios cognitivos (memória episódica verbal, funções executivas, desempenho cognitivo geral) e sintomas depressivos. Resultados: Após as intervenções, observaram-se ganhos na cognição global, atencional e mnemônica, bem como redução dos sintomas depressivos. A intervenção MEMO (física ou psicoeducacional) resultou em maiores ganhos cognitivos, enquanto Stimullus + psicoeducacional demonstrou benefícios apenas no índice de evocação e aprendizagem livre, e Stimullus + atividades físicas não apresentou melhora em nenhuma das variáveis investigadas. Conclusão: Os achados positivos dessas intervenções combinadas parecem promissores no contexto de idosos saudáveis, e o impacto dessas intervenções deve ser discutido em relação às especificidades de cada indivíduo idoso e avaliado mais amplamente no contexto de saúde pública.

Parents' mental health and children's emotional regulation during the COVID-19 pandemic / Saúde mental parental e regulação emocional infantil durante a pandemia de COVID-19 / Salud mental parental y regulación emocional infantil durante la pandemia de COVID-19

ABSTRACT The objectives of the study were to investigate parents' mental health before and during the COVID-19 pandemic; to find correlations between parents' mental health and their perceptions of risk, virus exposure, use of preventive measures, COVID-19 knowledge, and social distancing practices; and to analyze correlations between parents' mental health and their perception about children's emotional regulation (ER). Participants were 69 parents of children aged between 5 and 12. The instruments used were ERC, HADS, ABEP, and a questionnaire about COVID-19. Descriptive analyses, the Wilcoxon test, and Spearman's correlation were conducted. The results indicated increased parental anxiety and depression during the pandemic, and a weak negative correlation between parental anxiety and their children's ER. The pandemic acts as a stressor, which impacts the mental health of both parents and children.

RESUMO Os objetivos do estudo foram investigar a saúde mental parental antes e durante a pandemia da COVID-19; verificar as associações entre saúde mental parental e suas percepções de risco, exposição ao vírus, uso de medidas preventivas, conhecimento sobre a COVID-19 e práticas de distanciamento social; e analisar as relações entre saúde mental parental e suas percepções sobre a Regulação Emocional (RE) infantil. Os participantes desta pesquisa foram 69 pais de crianças entre 5 e 12 anos. Os instrumentos utilizados foram: ERC, HADS, ABEP e questionário sobre a COVID-19. Foram realizadas análises descritivas, Teste de Wilcoxon e correlação de Spearman. Foram encontrados aumento dos níveis de ansiedade e depressão parental durante a pandemia, bem como uma correlação negativa fraca entre ansiedade parental e RE infantil. A pandemia, enquanto agente estressor, tende a impactar a saúde mental de pais e crianças.

RESUMEN Los objetivos del estudio fueron investigar la salud mental de los padres antes y durante la COVID-19; comprobar relaciones entre la salud mental de los padres y sus percepciones de riesgo, exposición a virus, uso de medidas preventivas, conocimiento de COVID-19 y prácticas de distanciamiento social y analizar las correlaciones entre la salud mental de los padres y su percepción sobre la Regulación Emocional (RE) de los niños. Los participantes fueron 69 padres de niños de entre 5 y 12 años. Los instrumentos utilizados fueron ERC, HADS, ABEP y un cuestionario sobre COVID-19. Se realizaron análisis descriptivos, la prueba de Wilcoxon y la correlación de Spearman. Los resultados indicaron aumento en la ansiedad y depresión de los padres; correlación negativa débil entre la ansiedad de los padres y la ER de sus hijos. La pandemia actúa como un factor de estrés, que tiene un impacto en la salud mental de padres e hijos.

Comparative study of esketamine and racemic ketamine in treatment-resistant depression: Protocol for a non-inferiority clinical trial.

INTRODUCTION: The use of ketamine as an option in the treatment of depressive disorder is growing rapidly, supported by numerous clinical trials attesting its efficacy and safety. Esketamine, the S (+) enantiomer of ketamine, is the most widely used form in the anesthetic environment in some countries, and new studies have shown that it may also be effective in depression and with better tolerability. However, no study so far has directly compared esketamine with racemic ketamine. Here we propose a protocol of a clinical trial to evaluate esketamine as a noninferior medication when compared to ketamine in the treatment of patients with treatment-resistant depression. METHODS/DESIGN: This study protocol is for a randomized, controlled, double-blind noninferiority clinical trial. Subjects will be 18 years or older, with major depression characterized as treatment-resistant. Participants will receive a single infusion of either esketamine (0.25 mg/kg) or ketamine (0.5 mg/kg) over 40 minutes. The primary outcome will be the difference in remission rates between the 2 treatment arms at 24 and 72 hours after drug infusion. Secondary outcomes will include other timepoints, measurements of cognition, dissociation, and blood biomarkers. DISCUSSION: A head-to-head study is the best way to evaluate whether the esketamine is in fact comparable to the racemic ketamine in terms of both efficacy and safety, and, if positive, it would be an initial step to increase the access to that type of treatment worldwide. ETHICS AND DISSEMINATION: The study was approved by the local Institutional Review Board (University Hospital Professor Edgard Santos-Federal University of Bahia-Number: 46657415.0.0000.0049). Subjects will only participate after voluntarily agreeing and signing the Informed Consent Form. The study findings will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION: This trial has been registered in the Japan Primary Registries Network (JPRN): UMIN000032355, which is affiliated with the World Health Organization.

Airborne manganese exposure and neurobehavior in school-aged children living near a ferro-manganese alloy plant.

Excessive exposure to Mn can lead to its accumulation in the brain with neurotoxic consequences. In children, elevated Mn has been associated with deficits in certain neuropsychological domains such as cognition, motor function, memory and attention, and in some instances, hyperactivity and behavioral problems. The aim of this study was to evaluate behavioral effects in school-aged children living near a ferro-manganese alloy plant and examine their association with Mn exposure. Occipital hair, toenails and blood samples were collected from 225 children (7-12 years old) enrolled in four elementary schools with different levels of exposure to Mn, based on dust Mn deposition rates. Full data set collection was completed and run from 165 children. Mn in hair (MnH), toenails (MnTn), blood (MnB) and blood lead levels (PbB) were determined by graphite furnace atomic absorption spectrometry. Children's behavior was assessed with the Child Behavior Check List (CBCL) reported by parents. Median levels and range of MnH, MnT and MnB were, respectively, 0.73 µg/g (0.16-8.79), 0.84 µg/g (0.15-9.29) and 8.98 µg/L (1.51-40.43). Median and range of PbB were 1.2 µg/dL (0.2-15.6). MnH and MnB were not associated with any scale of the CBCL behavior scores. We found a positive association between logMnTn and raw total CBCL score (ß = 10.17, p = 0.034), adjusting for sex, age, maternal IQ and logPbB. Analyses using Generalized Additive Model showed non-linear associations between MnTn and externalizing behavior (p = 0.035), as well as with the related subscales: aggressive behavior (p = 0.045) and rule-breaking behavior (p = 0.024). Further positive associations were observed between MnTn and thought problems (p = 0.031) and social problems (p = 0.027). These findings corroborate previous studies showing an association between Mn exposures and externalizing behavior. Our results suggest that toenail Mn, as a biomarker of environmental exposure, is associated with disruptive behavior in children living near a ferro-manganese alloy plant.

Evaluation of the Psychometric Properties of the Cognitive Distortions Questionnaire (CD-Quest) in a Sample of Undergraduate Students.

OBJECTIVE: The aim of the study was to assess the initial psychometric properties of the Cognitive Distortions Questionnaire (CD-Quest) in its Brazilian Portuguese version tested in adult undergraduate students. METHODS: Brazilian undergraduate medical and psychology students comprising the sample (n=184) completed the following measures: Cognitive Distortions Questionnaire, Beck Depression Inventory and Beck Anxiety Inventory. These self-report instruments were administered collectively in classrooms. RESULTS: The Cognitive Distortions Questionnaire showed adequate internal consistency (Cronbach's alpha=0.85) and concurrent validity with Beck Depression Inventory (r=0.65, p<0.001) and Beck Anxiety Inventory (r=0.52, p<0.001). Furthermore, it was able to discriminate between groups possessing depressive (Beck Depression Inventory composite score ≥12) and anxious (Beck Anxiety Inventory composite score ≥ 11) indicators from those not possessing them (p<0.001). Principal components showed the measure was unidimensional, and it explained about 29 percent of the data variance. A confirmatory factor analysis showed that all the regression coefficients are greater than or equal to 0.40 CONCLUSION: The original Brazilian version of the Cognitive Distortions Questionnaire is adequate for use in the context of national undergraduate students and is able to separate different cognitive distortions. However, further studies using clinical samples are needed.

Avaliação neuropsicológica em pacientes com epilepsia do lobo temporal: dissociação interhemisférica das alterações de memória

Epilepsia do Lobo Temporal (ELT) tem sido associada na literatura a vários distúrbios cognitivos. Dentre estes, mais freqüentemente observam-se as alterações de memória. A Epilepsia do Lobo Temporal Esquerdo (ELTE) tem sido descrita com distúrbio da memória verbal enquanto à direita (ELTD) observam-se alterações da memória não-verbal figurativa e espacial. Abrahams e Cole. (1997, 1999) utilizando um instrumento para avaliação neuropsicológica similar ao labirinto radial de 8 braços utilizado com animais, desenvolveram estudos indicando alterações de memória espacial em pacientes com ELTD, na evocação e reconhecimento de informações espaciais nas categorias operacional de referência, que corroboram a teoria do mapeamento espacial. Por outro lado, a teoria da memória operacional preconiza que a região do Lobo Temporal Mesial estaria envolvida na codificação dependente do contexto por um curto período de tempo. Nosso estudo teve por objetivo avaliar e comparar o desempenho de pacientes com ELTD e ELTE no Nine-Box Maze, um instrumento que permite avaliar os componentes de memória espacial e para objetos, nas categorias operacional e de referência. Vinte sujeitos (nELTE=10; nELTD=10), sendo 10 mulheres e 10 homens, e dezoito (18) controles saudáveis compuseram a amostra deste estudo. Idade, dominância manual, nível de escolaridade, freqüência das crises, idade da primeira crise, última crise e período máximo sem crise foram comparados entre os grupos sem diferença significativa. O teste teve duas aplicações a fim de avaliar efeito de pistas alocêntricas sobre o desempenho dos sujeitos. Além disso, quatro sub-testes da Bateria WAIS (Span Normal, Span Invertido, Raciocínio Lógico e Raciocínio por Semelhança) foram incluídos, bem como o Califórnia Card Sorting Test (CCST), para avaliar funções de planejamento e execução dos lobos frontais. Nossos resultados mostraram um efeito significante nas provas de memória...(AU)