"Influence of modifiable and non-modifiable variables on functioning in bipolar disorder: a path analytical study".

OBJECTIVE: The aim of this study was to investigate the influence of modifiable (mood, cognitive reserve, cognitive performance) and non-modifiable factors (diagnosis, suicide attempts, substance use, age) on self-reported functioning in BD. METHODS: 103 adults with no mood disorders and 95 individuals with BD completed the WHODAS 2.0, in addition to a neuropsychological battery and diagnostic assessments. Path analysis was then used to analyse the relationships between modifiable and non-modifiable predictors of functioning in the sample. RESULTS: Cognitive reserve and age had an indirect influence on individual functioning, mediated by cognitive performance. The influence of diagnosis and depressive symptoms on functioning was partly direct, and partly mediated by cognition. The presence of psychiatric comorbidities in addition to BD also had a significant influence on individual functioning. CONCLUSIONS: Initiatives focussed on modifiable factors such as depressive symptoms and cognitively stimulating activities, which increase cognitive reserve, may be a useful complement to existing treatments and help patients achieve functional recovery. KEY POINTS Individual functioning was influenced by cognitive performance, cognitive reserve, age, diagnosis and depressive symptoms. Executive functioning mediated the influence of age and cognitive reserve on individual functioning. Interventions focussed on depressive symptoms and cognitive stimulation may help patients achieve functional recovery.

Stressful Events and Executive Functioning in Adolescents with and without History of Grade Repetition / Eventos estresores y funcionamiento ejecutivo en adolescentes con y sin historia de repetición escolar

Abstract A number of studies have investigated the association between psychiatric disorders and alterations in cognitive development, academic performance, and learning ability. However, few studies have explored the relationship between stressful events and grade repetition. Therefore, the main goal of the present study was to compare the frequency of exposure to stressful events, academic performance, executive functioning, and performance on working memory tasks between adolescents with and without a history of grade repetition. This was a cross-sectional study. The sample was composed of 83 adolescents divided into two groups: (1) individuals with a history of grade repetition (n = 39) and (2) participants who had never repeated a grade (n = 44). Participants were administered tests to assess executive functions, intelligence, exposure to stressful events, and academic performance. Results showed that individuals with a history of grade repetition reported to experiencing a higher number of stressful events in adolescence, had worse academic performance, and obtained lower scores on executive functioning and working memory tasks than non-repeaters.

Resumen Varios estudios han investigado la asociación entre trastornos psiquiátricos y alteraciones en el desarrollo cognitivo, el rendimiento académico y la capacidad de aprendizaje. Sin embargo, pocos estudios han explorado la relación entre los eventos estresantes y la repetición escolar. Por lo tanto, el objetivo principal de este estudio fue comparar la frecuencia de exposición a eventos estresantes, el rendimiento académico, el funcionamiento ejecutivo y el desempeño en tareas de memoria de trabajo en los adolescentes con y sin antecedentes de repetición escolar. Se trata de un estudio transversal. La muestra estuvo constituida por 83 adolescentes, divididos en dos grupos: (1) los individuos con antecedentes de repetición escolar (n = 39) y (2) los participantes que nunca repitieron un año escolar (n = 44). Los participantes fueron sometidos a pruebas para evaluar las funciones ejecutivas, la inteligencia, la exposición a eventos estresantes y el rendimiento académico. Los resultados mostraron que los individuos con historia de repetición escolar relataron la ocurrencia de un mayor número de eventos estresantes durante la adolescencia, tuvieron un peor rendimiento académico y obtuvieron puntuaciones más bajas en las tareas de funcionamiento ejecutivo y memoria de trabajo que los que no repitieron.

Neuropsychological Clustering in Bipolar and Major Depressive Disorder.

OBJECTIVES: Cognitive dysfunction is a key feature of major depressive (MDD) and bipolar (BD) disorders. However, rather than a single cognitive profile corresponding to each diagnostic categories, recent studies have identified significant intra- and cross-diagnostic variability in patterns of cognitive impairment. The goal of this study was to contribute to the literature on cognitive heterogeneity in mood disorders by identifying cognitive subprofiles in a population of patients with MDD, BD type I, BD type II, and healthy adults. METHODS: Participants completed a neuropsychological battery; scores were converted into Z-scores using normative data and submitted to hierarchical cluster analysis. RESULTS: Three distinct neuropsychological clusters were identified: (1) a large cluster containing mostly control participants, as well as some patients with BD and MDD, who performed at above-average levels on all neuropsychological domains; (2) a cluster containing some patients from all diagnostic groups, as well as healthy controls, who performed worse than cluster 1 on most tasks, and showed impairments in motor inhibition and verbal fluency; (3) a cluster containing mostly patients with mood disorders with severe impairments in verbal inhibition and cognitive flexibility. CONCLUSIONS: These findings revealed multiple cognitive profiles within diagnostic categories, as well as significant cross-diagnostic overlap, highlighting the importance of developing more specific treatment approaches which consider patients' demographic and cognitive profiles in addition to their diagnosis. (JINS, 2017, 23, 584-593).

The predictive role of daily cognitive stimulation on executive functions in bipolar disorder.

This study aimed to estimate the predictive role of clinical and demographic variables on the three core executive functions (EF) - working memory (WM), inhibitory control (IC) and cognitive flexibility (CF) - in bipolar disorder (BD). The sample consisted of 38 patients with BD type I, 39 with BD type II, and 106 control participants with no mood disorders. Subjects completed the Hayling Test, Trail Making Test, Digit Span Backwards, Sentence Word Span Test, and Stroop Color-Word Test. Composite scores for WM, IC and CF were calculated, and their correlations with clinical and demographic variables were analyzed. Stepwise hierarchical regression models including all significant correlates, gender, and diagnosis, revealed that the frequency of reading and writing habits (FRWH), IQ and diagnosis predicted 38.1% of the variance in IC. Diagnosis and IQ predicted 24.9% of the variance in WM scores. CF was predicted by the FRWH only, which accounted for 7.6% of the variance in this construct. These results suggest that daily cognitive stimulation through reading and writing make a significant positive contribution to executive functioning in BD, even in the absence of continued education. These and other forms of routine cognitive stimulation should be further emphasized in intervention programs for BD.

Brain morphology and cortical thickness variations in systemic lupus erythematosus patients: Differences among neurological, psychiatric, and nonneuropsychiatric manifestations.

PURPOSE: To determine whether systemic lupus erythematosus (SLE) affecting subcortical white matter volumes, deep gray matter volumes, and cortical thickness differ between groups of SLE patients with psychiatric (P-SLE), neurological (N-SLE), or nonneuropsychiatric (non-NPSLE) presentations. MATERIALS AND METHODS: Sixty-seven participants were divided into three groups (P-SLE [n = 19], N-SLE [n = 12], and non-NPSLE [n = 36]) and examined with a 1.5T MRI scanner. The images were segmented in FreeSurfer software into volumetric and cortical thickness measures using T1 3D magnetization prepared rapid gradient echo-weighted imaging. For comparative analyses of volume, multivariate analyses of covariance (MANCOVA) were applied followed by Bonferroni post-hoc tests, with age as a covariate. For cortical thickness analyses, the groups were compared with the Query Design Estimate Contrast tool adjusted for age. RESULTS: Globus pallidus volumes in both left (P ≤ 0.01) and right (P ≤ 0.05) hemispheres were larger in the N-SLE group than in the non-NPSLE group, and the left GP volume was greater in the N-SLE group than in the P-SLE group (P ≤ 0.05) (MANCOVA, post-hoc Bonferroni). The P-SLE group presented with thinning of cortical areas relative to the N-SLE (predominantly in the left parietal and right frontal and parietal regions) (P ≤ 0.05) and non-NPSLE (predominantly in parietal and occipital regions) (P ≤ 0.05) groups, whereas the N-SLE group presented with thickening of cortical areas (mostly right frontal and left parietal regions) relative to the non-NPSLE (P ≤ 0.05) and P-SLE groups. CONCLUSION: N-SLE patients had greater local volumes and cortical thicknesses than the other two groups, whereas P-SLE patients presented with decreased volumes and cortical thinning. These findings provide evidence of distinct neuroanatomical abnormalities in neurological versus psychiatric manifestations of SLE. LEVEL OF EVIDENCE: 2 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:150-158.

Frequência de déficits neuropsicológicos após traumatismo cranioencefálico / Frequency of neurolopsychological deficits after traumatic brain injury / Frecuencia de déficits neuropsicológicos posteriores a lesión cerebral traumática

O traumatismo cranioencefálico (TCE) pode acarretar mudanças no cotidiano e prejuízos social, laboral, comunicativo e cognitivo (dificuldades atencionais, mnemônicas e executivas). Este estudo buscou caracterizar a ocorrência de déficits neuropsicológicos após o TCE em uma amostra de adultos e verificar se há impacto do nível de severidade do trauma no desempenho cognitivo dos pacientes. Participaram 96 adultos, divididos em dois grupos: TCE leve (n=39) e grave (n=57). A gravidade do trauma foi classificada pela Escala de Coma de Glasgow, pela duração da perda de consciência, ou pela amnésia pós-traumática. Não houve diferença nas variáveis sociodemográficas idade e escolaridade entre os grupos. Para a comparação entre grupos quanto a ocorrência de déficits neuropsicológicos, utilizou-se o Qui-quadrado. Tarefas verbais e visuoespaciais de funções executivas, habilidades linguísticas, mnemônicas verbais compuseram uma bateria neuropsicológica flexível.Os pacientes com TCE leve tiveram menos déficits comparados aos com TCE grave (erros e categorias completadas do Wisconsin Teste de Classificação de Cartas; erros da parte B do Teste Hayling; e na interferência pró e retroativa do teste de aprendizagem verbal de Rey). A severidade do trauma parece diferenciar indivíduos no desempenho de memória episódica no contexto de maior sobrecarga de informações novas e no controle da interferência entre memórias; o mesmo se aplica às funções de flexibilidade e inibição. Faz-se necessário um maior investimento em ações de políticas públicas de saúde, priorizando intervenção neurognitiva remediativa e métodos de prevenção para acidentes relacionados a lesões traumáticas com alta ocorrência de sequelas.

Traumatic brain injury (TBI) can lead to significant changes in daily life, as well as in social, labor, communicative, and cognitive domains (attention, memory and executive functions). This study aimed to characterize the occurrence of post-TBI neuropsychological deficits as well as to determine whether there is an impact related to the level of severity of the trauma on the patient's performance. Ninety-six adults participated in the study, who were divided in two groups to assess the trauma's level of severity: mild TBI (n=39) and severe TBI (n=57). This severity was classified by the Glasgow Coma Scale, by the duration of consciousness loss, or by post-traumatic amnesia. There were no differences between the groups regarding variables of age and years of schooling. A Chi- square test was used to do a comparison between the two groups in terms of occurrence of neuropsychological deficits. Verbal, visuospatial, mnemonic, linguistic and executive tests composed a flexible neuropsychological battery. Patients with mild TBI had better scores compared to those with severe TBI (number of errors and in completed categories of the Modified Wisconsin Card Sorting Test (MWCST); errors in Part B of The Hayling Test; and proactive and retroactive interference in the Rey Auditory Verbal Learning Test (RAVLT). The severity of the trauma seems to differentiate individual's performance on episodic memory of new information and in the control of interference between memories; the same is applied to flexibility and inhibition functions. These results suggest the need for more investments in public health policy actions, prioritizing neurocognitive remedial intervention and prevention methods for such condition with high incidence of sequelae.

El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.

Working Memory and Fluid Intelligence: The Role Executive Processes, Age and School Type in Children / Memoria de trabajo e inteligencia fluida: el papel de los procesos ejecutivos, según edad, tipo de escuela en niños

The aim of this study was to verily which components of the working memory (WM) model (phonological, visuospatial and central executive) predict the performance in fluid intelligence (FI), considering age, schooling and school type. The participants were 419 children aged between six and 12 years old, from the first year to the sixth grade of Primary School from public and private schools of Rio Grande do Sul, Brazil. The WM subtests ofthe NEUPSILIN-Inf- Brazilian Brief Neuropsychological Assessment Battery - for children - were administered, and Raven's Colored Progressive Matrices Test served as FI measure. In the linear regression analysis, the executive component primarily explained the relationship between WM and FI in children, rather than phonological component. When sociodemographic variables were included, age, school type and the executive component explained 47% ofFI variance, but the predictive power of the executive component was reduced. The results reinforce the primary relationship between executive processing ofWM and FI, as well as the importance of taking into account sociodemographic variables, so the relationship between these constructs are not overestimated.

El objetivo de este estudio fue constatar qué componentes del modelo de memoria de trabajo (MT): fonológico, visuoespacial y ejecutivo central, predicen el rendimiento en la inteligencia fluida (IF), teniendo en cuenta edad, nivel de educación y tipo de escuela. Participaron 419 niños, entre seis y 12 años, del primero al sexto grado de primaria de escuelas públicas y privadas de Río Grande del Sur (Brasil). Se aplicaron los subtests de MT del Instrumento de Evaluación Neuropsicológica Breve Infantil (NEUPSILIN-Inf) y el Test de Matrices Progresivas de Colores de Raven como medida de IF. En el análisis de regresión lineal, el componente ejecutivo explicó principalmente la relación entre MT y IF en la infancia, en lugar del componente fonológico. Cuando se incluyeron variables sociodemográficas, edad, tipo de escuela y el componente ejecutivo explicaron 47 % de la varianza de la IF, pero hubo una reducción en el poder predictivo del componente ejecutivo. Los resultados refuerzan la relación entre el procesamiento ejecutivo y la FI, así como la importancia de tener en cuenta las variables sociodemográficas, de modo que la magnitud de la relación entre estos constructos no se sobrevalore.

Comparison of neuropsychological performance between students from public and private Brazilian schools

Neuropsychological assessment reveals that certain cognitive changes that take place during the neural development process may be associated with biopsychosocial issues. A substantial body of research has focused on cognitive development in children and adults, but few such studies have been carried out on adolescents. Therefore, research into the processing of neuropsychological functions in adolescents, taking into account the role of major socio-cultural factors such as school type (public vs. private), is highly relevant. The present study sought to assess whether differences in neuropsychological development exist between adolescent students of public (government-funded) and private schools. A total of 373 grade-matched students between the ages of 12 and 18, 190 from public schools and 183 from private schools, took part in the study. All subjects had no self-reported neurologic or psychiatric conditions and sensory disorders. The NEUPSILIN Brazilian Brief Neuropsychological Assessment Battery was administered to this sample. Comparison of mean scores (one-way ANCOVA with socioeconomic score and age as covariates) showed that adolescents attending private schools generally outperformed their public-school peers in tasks involving sustained attention, memory (working and visual), dictated writing, and constructional and reflective abilities. We conclude that school type should be taken into account during standardization of neuropsychological assessment instruments for adolescent and, probably, child populations (AU)

La evaluación neuropsicológica evidencia los cambios cognitivos durante el proceso de neurodesarrollo que pueden asociarse a cuestiones biopsicosociales. Existe un número considerable de investigaciones sobre el desarrollo cognitivo en niños y adultos, pero pocos estudios con adolescentes. Por tanto es relevante investigar cómo los adolescentes procesan las funciones neuropsicológicas, considerando el papel de factores socioculturales importantes como el tipo de escuela (pública o privada). El objetivo del presente estudio fue investigar si existen diferencias neuropsicológicas de ejecución entre adolescentes de en escuelas públicas y privadas. Participaron del estudio 373 estudiantes, 190 de escuela pública y 183 de escuela privada, con edades entre 12 y 18 años, emparejados por grado escolar. Ninguno de los sujetos mostraba alteraciones neurológicas, psiquiátricas o sensoriales auto relatadas. Esta muestra fue examinada con el Instrumento Brasileño de Evaluación Neuropsicológica Breve NEUPSILIN. La comparación de medias (ANCOVA unidireccional con puntuación socioeconómica y edad como covariantes) mostró que en general los estudiantes de escuela privada superan a sus pares de escuela publica en atención concentrada, memoria (de trabajo y visual), lenguaje escrito, capacidades constructivas y reflexivas. De esta forma, se concluye que el tipo de escuela debe tenerse en cuenta durante la normalización de instrumentos de evaluación neuropsicológica para adolescentes, y probablemente, población infantil (AU)

The effect of age on decision making according to the Iowa gambling task

Aging has been associated with several brain changes that often affect the cognitive functioning of adults, but changes in executive functions, particularly in the field of decision making, have not been fully investigated. The Iowa Gambling Task (IGT) is a widely used tool to evaluate decision making, but little is known about the effect of age on its results. This study used the IGT and compared healthy young (n= 40) and elderly (n = 40) adults to evaluate their decision making processes. There were significant differences in the learning curve of the two age groups, but no difference in overall IGT performance. The results for the first IGT block were different from those of the rest of the task, and the group of elderly adults had a better performance in this block. Elderly adults also showed a preference for deck A, the one that resulted in greater losses. Findings confirmed the results of other studies, which reported that the IGT block score is the variable with the greatest sensitivity to age in this instrument (AU)

El envejecimiento se ha asociado con diversos cambios en el cerebro que a menudo afectan al funcionamiento cognitivo de los adultos, pero los cambios en las funciones ejecutivas, en particular en el ámbito de la toma de decisiones, no han sido investigados a fondo. La Iowa Gambling Task (IGT) es una herramienta ampliamente utilizada para evaluar la toma de decisiones, pero se sabe poco sobre el efecto que tiene la edad en sus resultados. Este estudio utilizó la IGT y comparó adultos jóvenes (n = 40) y adultos mayores (n = 40) sanos para evaluar sus procesos de toma decisiones. Se encontraron diferencias significativas en la curva de aprendizaje de los dos grupos de edad, pero ninguna diferencia en el rendimiento general de la IGT. Los resultados del primer bloque de la IGT fueron diferentes de los resultados de los bloques restantes, y el grupo de adultos mayores tuvo un mejor rendimiento en este primer bloque. Los adultos mayores también mostraron preferencia por la sección A, la que dio como resultado valores inferiores. Los hallazgos confirman los resultados de otros estudios, los cuales informaron que la puntuación del primer bloque de la IGT es la variable con mayor sensibilidad a la edad de este instrumento (AU)

Brazilian Version of the Protocole Montréal d’Évaluation de la Communication (Protocole MEC): Normative and Reliability Data

The lack of standardized instruments to evaluate communication disorders related to the right hemisphere was verified.A new evaluation tool was developed: Protocole Montréal d’Évaluation de la Communication - Protocole MEC, adapted to Brazilian Portuguese - Bateria Montreal de Avaliação da Comunicação - Bateria MAC (Montreal Evaluation of Communication Battery). The purpose was to present stratified normative data by age and educational level, and to verify the reliability parameters of the MEC Battery. 300 individuals, between the ages of 19 and 75 years, and levels of formal education between 2 and 35 years, participated in this study. They were divided equally into six normative groups, according to three age categories (young adults, intermediary age, and seniors) and two educational levels (low and high). Two procedures were used to check reliability: Cronbach alpha and reliability between evaluators. Results were established at the 10th percentile, and an alert point per task for each normative group. Cronbach's alpha was, in general, between .70 and .90 and the average rate of agreement between evaluators varied from .62 to.94. Standards of age and education were established. The reliability of this instrument was verified. The psychometric legitimization of the MEC Battery will contribute to the diagnostic process for communicative disorders (AU)

Se verificó la falta de instrumentos estandarizados para evaluar los trastornos de comunicación relacionados con el hemisferio derecho. Se desarrolló una herramienta de evaluación nueva: el Protocole Montréal d'Évaluation de la Communication - Protocolo MEC, adaptado al portugués brasileño - Bateria Montreal de Avaliação da Comunicação - Batería MAC (Batería de Evaluación de la Comunicación de Montreal). El objetivo fue presentar datos normativos estratificados por edad y nivel académico, y verificar los parámetros de fiabilidad de la batería MEC. 300 individuos, de edades entre los 19 y los 75 años y con 2 a 35 años de educación formal, participaron en este estudio. Se dividieron en seis grupos normativos, en función de tres categorías de edad (adultos jóvenes, edad mediana y mayores) y dos niveles educacionales (bajo y alto). Se emplearon dos procedimientos para confirmar la fiabilidad: alfa de Cronbach y fiabilidad inter-jueces. Se establecieron los resultados en el percentil 10 con un punto de alerta por tarea para cada grupo normativo. Los valores de alfa de Cronbach eran, en general, entre 0.70 y 0.90 y el grado de acuerdo entre los evaluadores variaba entre 0.62 y 0.94. Se establecieron normas de edad y educación. Se verificó la fiabilidad de este instrumento. La legitimación psicométrica de la Batería MEC contribuirá al proceso diagnóstico de los trastornos de comunicación (AU)