Effects of computerized cognitive training as add-on treatment to stimulants in ADHD: a pilot fMRI study.

The neurofunctional effects of Cognitive training (CT) are poorly understood. Our main objective was to assess fMRI brain activation patterns in children with ADHD who received CT as an add-on treatment to stimulant medication. We included twenty children with ADHD from a clinical trial of stimulant medication and CT (10 in medication + CT and 10 in medication + non-active training). Between-group differences were assessed in performance and in brain activation during 3 fMRI paradigms of working memory (N-back: 0-back, 1-back, 2-back, 3-back), sustained attention (Sustained Attention Task - SAT: 2 s, 5 s and 8 s delays) and inhibitory control (Go/No-Go). We found significant group x time x condition interactions in working memory (WM) and sustained attention on brain activation. In N-back, decreases were observed in the BOLD signal change from baseline to endpoint with increasing WM load in the right insula, right putamen, left thalamus and left pallidum in the CT compared to the non-active group; in SAT - increases in the BOLD signal change from baseline to endpoint with increasing delays were observed in bilateral precuneus, right insula, bilateral associative visual cortex and angular gyrus, right middle temporal, precentral, postcentral, superior frontal and middle frontal gyri in the CT compared to the non-active group. CT in ADHD was associated with changes in activation in task-relevant parietal and striato-limbic regions of sustained attention and working memory. Changes in brain activity may precede behavioral performance modifications in working memory and sustained attention, but not in inhibitory control.

Cardiovascular risk factors in children and adolescents with anxiety disorders and their association with disease severity.

INTRODUCTION: Studies suggest that anxiety is an independent predictor of adverse cardiovascular events. However, few studies have investigated the association between cardiovascular risk factors (RF) and severity of anxiety disorders (AD) in childhood and adolescents. OBJECTIVES: To assess the prevalence of cardiovascular RF in children and adolescents with anxiety disorders and their association with disease severity. METHOD: Cross-sectional study assessing nutritional and anthropometric RF, as well as % body fat (BF), blood pressure (BP), physical activity level, anxiety symptoms and severity of the anxiety disorder of children and adolescents. RESULTS: A total of 65 children and adolescents (8.6 } 1.7 years) took part in the study. Excess saturated fatty acid intake (52.3%), high body mass index (50.8%), high BP (50.8%) and physical inactivity (50.0%) were the most prevalent cardiovascular RF. There was a significant association between the severity of the anxiety and the presence of ≥ 6 RF per patient (p=0.026), excess abdominal body fat as assessed by waist circumference (p=0.019) and conicity index (p=0,053), and excess % BF (p=0.035). Generalized anxiety disorder was significantly associated with high BP (p=0.044). CONCLUSION: A high prevalence of cardiovascular RF was found in the present sample, and individuals with more severe anxiety had greater cardiovascular risk. The characterization of the cardiovascular risk in young populations, especially in individuals with AD who are therefore more susceptible to CVD, is crucial for the development of lifestyle interventions in these patients.

Introducción: Evidencias sugieren que la ansiedad es una prediciente independiente de los eventos cardiovasculares adversos. Entretanto, pocos estudios evaluaron la presencia de factores de riesgo (FR) para estas enfermedades en ninos y adolescentes. Objetivos: Identificar la prevalencia de FR cardiovasculares en ninos y adolescentes diagnosticados con disturbio de ansiedad y su asociacion con la gravedad de la enfermedad. Metodología: Estudio transversal que avaluo FR nutricional, antropometricos, % de gordura corporal (CG), presion arterial (PA), nivel de actividad fisica y escalas de sintomas y gravedad de la ansiedad. Resultados: 65 ninos y adolescentes (8.6 } 1.7 anos) fueron incluidos en el estudio. Cuanto a los FR, el consumo excesivo de acidos grasos saturados (52.3%), indice de masa corporal alto (50.8%), PA alterada (50.8%) y la falta de ejercicio fisico (50.0%) fueron los mas prevalecientes. Hubo asociacion significativa entre la mayor gravedad del disturbio y el acumulo de ≥ 6 FR (p=0,026), exceso de gordura abdominal medida por la circunferencia de cintura (p=0.019) y por el indice de conicidad (p=0.053) y exceso en el % GC (p=0.044). Conclusión: Los resultados encontrados indican que hay una alta prevalencia de FR cardiovascular en la amuestra estudiada y los pacientes mas graves presentaron mayor riesgo. La caracterizacion del perfil de riesgo en las poblaciones con predisposicion a las enfermedades cardiovasculares es crucial para la elaboracion de estrategias de intervencion que oportunicen la reduccion en la prevalencia de estas enfermedades.