Performance on the Latin American version of the Face-Name Associative Memory Exam (LAS-FNAME) distinguishes individuals with Mild Cognitive Impairment from age-matched controls in a sample from Argentina.

INTRODUCTION: The Latin American Spanish version of the Face-Name Associative Memory Exam (LAS-FNAME) has shown promise in identifying cognitive changes in those at risk for Alzheimer's disease (AD). However, its applicability for Mild Cognitive Impairment (MCI) detection in the Latin American population remains unexplored. This study aims to analyze the psychometric properties in terms of validity and reliability and diagnostic performance of the LAS-FNAME for the detection of memory disorders in patients with amnestic MCI (aMCI). MATERIALS AND METHODS: The study included 31 participants with aMCI, diagnosed by a neurologist according to Petersen's criteria, and 19 healthy controls. Inclusion criteria for the aMCI group were to be 60 years of age or older, report cognitive complaints, have a memory test score (Craft Story 21) below a -1.5 z-score and have preserved functioning in activities of daily living. Participants completed LAS-FNAME and a comprehensive neuropsychological assessment. RESULTS: LAS-FNAME showed the ability to discriminate against healthy controls from patients with aMCI (AUC= 75) in comparison with a gold-standard memory test (AUC = 69.1). LAS-FNAME also showed evidence of concurrent and divergent validity with a standard memory test (RAVLT) (r = 0.58, p < .001) and with an attention task (Digit Span) (r = -0.37, p = .06). Finally, the reliability index was very high (α = 0.88). DISCUSSION: LAS-FNAME effectively distinguished aMCI patients from healthy controls, suggesting its potential for detecting early cognitive changes in Alzheimer's prodromal stages among Spanish speakers.

Biomarkers of Alzheimer's disease in mild cognitive impairment: Experience in a memory clinic from Latin America. / Biomarcadores de enfermedad de Alzheimer en deterioro cognitivo leve: experiencia en una clínica de memoria de Latinoamérica.

OBJECTIVE: This study aimed to investigate the role and prognosis of Alzheimer disease biomarkers in patients with mild cognitive impairment (MCI) at a memory clinic in Latin America. METHODS: We studied 89 patients with MCI, 43 with Alzheimer-type dementia, and 18 healthy controls (matched for age, sex, and educational level) at our memory clinic (Instituto FLENI) in Buenos Aires, Argentina. Patients and controls underwent an extensive demographic, neurological, and neuropsychological assessment. All subjects underwent a brain MRI scan; FDG-PET scan; amyloid PET scan; apolipoprotein E genotyping; and cerebrospinal fluid concentrations of Aß1-42, tau, and phosphorylated tau. Patients were categorised as positive or negative for the presence of amyloid pathology and neurodegeneration. RESULTS: Amyloid pathology was observed in cerebrospinal fluid results in 18% of controls, 64% of patients with MCI, and 92% of patients with Alzheimer-type dementia. Suspected non-Alzheimer disease pathophysiology was found in 11% of controls, 6% of patients with MCI, and 8% of patients with Alzheimer-type dementia. At 30 months of follow-up, 45% of amyloid-positive patients with MCI and 20% of amyloid-negative patients with MCI showed progression to dementia. CONCLUSIONS: This study demonstrates biomarker-based MCI prognosis and supports its role in clinical decision-making in daily practice.

[Jose Ingenieros and the amusias: the beginning of the neuropsychology in Argentina]. / Jose Ingenieros y las amusias, sobre los origenes de la neuropsicologia argentina.

The Argentine neuropsychological school is born of the hand of the European school and is part of the beginning of the Experimental Psychology. In 1896 Horacio Pinero creates the first Department of Psychology at the University of Buenos Aires and in 1898 the first laboratory of Experimental Psychology is annexed. Jose Ingeniero, psychiatrist, neurologist, politician and above all sociologist publishes in France his work about the musical aphasia, the first neuropsychological work with international significance. In the same redeems to Charcot instead of to Knoblauch like the first one to describe the amusias, it speaks of an intelligence instead of a musical language and proposes a new classification and a methodology of assessment with a neurological-psychiatric integrative perspective. This article gave rise to this book in French on the musical language and its hysterical alterations awarded by the Academy of Medicine of Paris.

TITLE: Jose Ingenieros y las amusias, sobre los origenes de la neuropsicologia argentina.La escuela neuropsicologica argentina nace de la mano de la escuela europea y forma parte del inicio de la psicologia experimental. En 1896, Horacio Pinero crea la primera catedra de psicologia de la Universidad de Buenos Aires, y en 1898 se anexa el primer laboratorio de psicologia experimental. Jose Ingenieros, psiquiatra, neurologo, politico y, sobre todo, sociologo publica en Francia su trabajo sobre afasias musicales, el primer estudio neuropsicologico argentino con trascendencia internacional. En el redime a Charcot y no a Knoblauch como el primero en describir la amusia, habla de una inteligencia y no de un lenguaje musical, y propone una clasificacion y una metodologia de evaluacion con una perspectiva integradora neurologica-psiquiatrica. Este articulo dio origen a su libro en frances sobre el lenguaje musical y sus alteraciones histericas, premiado por la Academia de Medicina de Paris.

Utility of the Spanish version of the Everyday Cognition scale in the diagnosis of mild cognitive impairment and mild dementia in an older cohort from the Argentina-ADNI.

INTRODUCTION: The performance of activities of daily living in elderly patients with memory disorders is directly related to living independently and to autonomy. Documenting and assessing functional capacity through detailed scales is important for both diagnostic and treatment recommendations. The Everyday Cognition (ECog) scale is a relatively new informant-rated measure of cognitive and functional abilities. In the present study, the discriminant validity of the ECog scale was evaluated in cognitively intact controls (CN) and in patients with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) from the Argentina-ADNI cohort to establish diagnostic accuracy. In addition, we compared the sensitivity and specificity of ECog against Functional Assessment Questionnaire (FAQ) scale to discriminate among the three groups. METHODS: We evaluated 15 CN, 28 MCI, and 13 mild AD subjects. External, convergent and divergent validity and internal consistency were examined. RESULTS: The average total score on the ECog was significantly different across the three diagnostic syndromes (p < .05). The ECog was more sensitive than FAQ in discriminating between CN and MCI patients and between MCI and AD subjects. The ECog showed a strong correlation with FAQ, and moderate correlations with neuropsychological tests. Cronbach's alpha was .98. CONCLUSIONS: The ECog scale is an efficient instrument for the differentiation of individuals with mild dementia or MCI from normal older adults, with good accuracy and good correlation with other tests measuring daily and cognitive functions. Comparing against FAQ, ECog was more useful in assessing changes in functionality in MCI patients.

Obesity, metabolic profile, and inhibition failure: Young women under scrutiny.

BACKGROUND: The prevalence of obesity, as well as evidence about this pathology as a risk factor for cognitive decline and dementia in the elderly, is increasing worldwide. Executive functions have been found to be compromised in most studies, although the specific results are dissimilar. Obese young women constitute an interesting study and intervention group, having been found to be unaffected by age and hormonal negative effects on cognition and considering that their health problems affect not only themselves but their families and offspring. The objective of the present study was to compare the executive performance of obese young women with that of a healthy control group. METHODS: A cross-sectional study was done among premenopausal women from a public hospital in Buenos Aires. The sample comprised 113 participants (32 healthy controls and 81 obese women), who were evaluated for depressive and anxiety symptoms (Beck Depression Inventory-II and State-Trait Anxiety Inventory) and executive functioning (Trail-Making Test B, Stroop Color and Word Test, Wisconsin Card Sorting Test, and verbal fluency test). Statistical analysis was done by using the SPSS version 20.0 software. RESULTS: Among executive functions, a significant difference was found between groups in inhibition (p<0.01). No correlation was found between psychopathologic measures and Stroop Test Interference results. We found slight correlations between Stroop Test Interference results, waist circumference, fat mass and HDL-cholesterol. In obese group, there was a negative slightly correlation between this cognitive test and 2h post-load glucose level. CONCLUSIONS: Inhibition was decreased in our obese young women group, and glucose/lipid metabolism may be involved in this association. The cognitive impairment is comparable with that described in addictive conditions. Our conclusions support the concept of multidisciplinary management of obese patients from the time of diagnosis. Detecting and understanding cognitive dysfunction in this population is essential to providing appropriate treatment.

Relevancia del efecto de posición serial en el diagnóstico diferencial entre el deterioro cognitivo leve, la demencia de tipo Alzheimer y el envejecimiento normal / Relevance of the serial position effect in the differential diagnosis of mild cognitive impairment, Alzheimer-type dementia, and normal ageing

Los efectos de posición serial son estudiados cuando se memoriza una serie de palabras que excede el span atencional. En sujetos normales son recordadas más frecuentemente las palabras del inicio y final de una lista reflejando el funcionamiento de la memoria episódica a corto y largo plazo. Objetivos: Estudiar el efecto de principio y el de fin de lista en pacientes con deterioro cognitivo leve (DCL) y compararlo con demencia tipo Alzheimer (DTA) y sujetos con envejecimiento normal (SN). Métodos: Fueron evaluados neurológica y neuropsicológicamente 30 pacientes con DTA, 25 con DCL y 20 SN. Se utilizó el Test de aprendizaje auditivo de una lista de palabras de Rey en donde se evaluó el efecto de principio, medio y fin de lista en cada ensayo y su efecto en el recuerdo diferido. Resultados: Los sujetos con DCL mostraron un patrón general de memoria similar a los sujetos con DTA, caracterizado por una reducción en el aprendizaje, olvido acelerado y un claro efecto de fin de lista en el aprendizaje. A nivel del recuerdo diferido mostraron un patrón diferencial recordando palabras de principio y medio más cercano a los normales pero no recordando las finales de la lista como las DTA. Conclusiones: La prueba de aprendizaje de una lista de palabras es una herramienta que nos permite discriminar entre pacientes con DCL y SN. El índice de recencia en el recuerdo diferido es un indicador útil para diferenciar el envejecimiento normal de los pacientes con DCL (AU)

Serial position effects are observed when a person memorises a series of words exceeding his or her attention span. Cognitively normal individuals recall words at the beginning and end of the list more frequently than those in the middle, which reflects the way that short- and long-term episodic memory works. Objective: To study the serial position effect in patients with mild cognitive impairment (MCI) compared to subjects with Alzheimer-type dementia (AD) or normal ageing (NA). Methods: 30 AD, 25 MCI and 20 NA subjects underwent neurological and neuropsychological assessment. The Rey Auditory Verbal Learning Test (RAVLT) was used to study primacy, middle, and recency effects and delayed recall for each group. Results: The general memory pattern of MCI subjects was very similar to that of AD subjects, and was characterised by reduced learning capacity, rapid forgetfulness and clear recency effect in learning. With regard to delayed recall, however, there were differences in performance; MCI subjects’ ability to recall words at the beginning and middle of the list was similar to that of normal subjects, while their memory of words at the end of the list was poor, as in AD subjects. Conclusions: RAVLT is a tool permitting us to distinguish between MCI and NA subjects. The recency index for the delayed recall task is a valid indicator for distinguishing between MCI patients and patients with normal ageing (AU)

Relevance of the serial position effect in the differential diagnosis of mild cognitive impairment, Alzheimer-type dementia, and normal ageing.

UNLABELLED: Serial position effects are observed when a person memorises a series of words exceeding his or her attention span. Cognitively normal individuals recall words at the beginning and end of the list more frequently than those in the middle, which reflects the way that short- and long-term episodic memory works. OBJECTIVE: To study the serial position effect in patients with mild cognitive impairment (MCI) compared to subjects with Alzheimer-type dementia (AD) or normal ageing (NA). METHODS: 30 AD, 25 MCI and 20 NA subjects underwent neurological and neuropsychological assessment. The Rey Auditory Verbal Learning Test (RAVLT) was used to study primacy, middle, and recency effects and delayed recall for each group. RESULTS: The general memory pattern of MCI subjects was very similar to that of AD subjects, and was characterised by reduced learning capacity, rapid forgetfulness and clear recency effect in learning. With regard to delayed recall, however, there were differences in performance; MCI subjects' ability to recall words at the beginning and middle of the list was similar to that of normal subjects, while their memory of words at the end of the list was poor, as in AD subjects. CONCLUSIONS: RAVLT is a tool permitting us to distinguish between MCI and NA subjects. The recency index for the delayed recall task is a valid indicator for distinguishing between MCI patients and patients with normal ageing.

Cerebrolysin improves symptoms and delays progression in patients with Alzheimer's disease and vascular dementia.

Dementia is the result of various cerebral disorders, leading to an acquired loss of memory and impaired cognitive ability. The most common forms are Alzheimer's disease (AD) and vascular dementia (VaD). Neurotrophic factors are essential for the survival and differentiation of developing neurons and protecting them against damage under pathologic conditions. Cerebrolysin is a peptide preparation that mimics the pleiotropic effects of neurotrophic factors. Several clinical trials investigating the therapeutic efficacy of Cerebrolysin in AD and VaD have confirmed the proof of concept. The results of these trials have shown statistically significant and clinically relevant treatment effects of Cerebrolysin on cognitive, global and functional domains in mild to moderately severe stages of dementia. Doses of 10 and 30 mL were the most effective, but higher doses of up to 60 mL turned out to be most effective in improving neuropsychiatric symptoms, which become relevant at later stages of the disease. Combining treatment with cholinesterase inhibitors and Cerebrolysin indicated long-term synergistic treatment effects in mild to moderate AD. The efficacy of Cerebrolysin persisted for up to several months after treatment suggesting Cerebrolysin has not merely symptomatic benefits, but a disease-delaying potential. This paper reviews the clinical efficacy of Cerebrolysin in the treatment of dementia. Data were obtained from international, multicenter, randomized clinical trials performed in compliance with Good Clinical Practice and the principles of the Declaration of Helsinki (1964) and subsequent revisions.

Behavioral flexibility impairment with negative feedback in refractory temporal lobe epileptic patients with unilateral amygdala and hippocampal resection.

INTRODUCTION: Patients with amygdala dysfunction generally have behavioral impairment. Temporal lobe surgery might be a model of study of unilateral amygdala resection. The objective of this study was to evaluate behavioral flexibility in epileptic patients who undergo amygdala resection for epilepsy surgery and evaluate its relationship with their neuropsychiatric symptoms. MATERIAL AND METHODS: Ten epileptic patients who underwent amygdala and hippocampal resection (6 left and 4 right) matched by age and educational level with 10 healthy controls were tested with an extensive neuropsychological and neuropsychiatric battery. Psychiatric symptomatology was measured with the positive and negative syndrome scale (PANSS) and the Beck depression inventory. To assess behavioral flexibility the emotion-related visual reversal-learning task (O'Doherty et al., 2001) and the gambling task (Bechara et al., 1994) were used. RESULTS: Patient's mean scores were: Beck: 8 +/- 1.5; PANSS positive: 10 +/- 1.3, and negative: 14.4 +/- 2.2; intellectual quotient (IQ): 101.4 +/- 6.3; category number in Wisconsin card sorting test: 4.6 +/- 2.4. The emotion-related visual reversal-learning task showed significance differences in the number of reversion: healthy controls: 9.3; epileptic patients: 4.23 (p < 0.001); in the number of trials to the first reversion: healthy controls: 5; epileptic patients: 23.42 (p < 0.05). There was no correlation between reversion and depression, PANSS and IQ. CONCLUSIONS: Patients with epilepsy who undergo unilateral hippocampal and amygdala resection appear to have alterations in the reversion capacity with an emotional component that would explain the lack of behavior flexibility that they sometimes have and that are not related with either the isolated presence of executive alterations or low intellectual quotient.

Flexibilidad conductual ante un feedback negativo en pacientes epilépticos temporales refractarios con resección amigdalohipocámpica unilateral / Behavioral flexibility impairment with negative feedback in refractory temporal lobe epileptic patients with unilateral amygdala and hippocampal resection

Introducción. Los pacientes con disfunciones amigdalinas suelen presentar alteraciones en su conducta. La cirugía de epilepsia temporal proporciona un modelo de estudio de la resección amigdalina unilateral. El objetivo de este trabajo fue estudiar la flexibilidad conductual ante un feedback afectivo negativo en pacientes con resección de amígdala por cirugía de epilepsia y evaluar su relación con los síntomas neuropsiquiátricos. Material y métodos. Diez pacientes con epilepsia del lóbulo temporal (ELT) con resección de amígdala e hipocampo, 6 derechas y 4 izquierdas, apareados por edad y nivel de educación con 10 sujetos controles normales, fueron evaluados con una extensa batería neuropsicológica y neuropsiquiátrica que incluyó la Escala de síndromes positivos y negativos (PANSS) y la Escala de depresión de Beck. Para estudiar la adaptabilidad conductual se utilizaron el Test de Aprendizaje y reversión afectiva (O'Doherty et al., 2001) y el Test del Casino (Bechara et al., 1994). Resultados. Los pacientes tenían los siguientes puntajes (en media ± DE): escala de Beck de 8 ± 1,5, PANSS positiva de 10 ± 1,3 y negativa de 14,4 ± 2,2, un cociente intelectual (CI) de 101,4 ± 6,3, las categorías completadas en el Test de las cartas de Wisconsin fueron de 4,6 ± 2,4. En el test de aprendizaje y reversión afectiva mostraron diferencias significativas en el número de reversiones: controles, 9,3; ELT, 4,23 (p < 0,001), y en los ensayos para lograr la primera reversión: controles, 5; ELT, 23,42 (p < 0,05). No hubo correlación significativa entre las variables de reversión, depresión, la puntuación de la PANSS o el CI. Conclusiones. Los pacientes epilépticos con resección amigdalohipocámpica unilateral tendrían alteraciones en la capacidad de reversión con componente afectivo que explicarían la falta de flexibilidad conductual que a veces presentan los mismos y que no se relacionan ni con la presencia aislada de alteraciones ejecutivas ni con un bajo cociente intelectual

Introduction. Patients with amygdala dysfunction generally have behavioral impairment. Temporal lobe surgery might be a model of study of unilateral amygdala resection. The objective of this study was to evaluate behavioral flexibility in epileptic patients who undergo amygdala resection for epilepsy surgery and evaluate its relationship with their neuropsychiatric symptoms. Material and methods. Ten epileptic patients who underwent amygdala and hippocampal resection (6 left and 4 right) matched by age and educational level with 10 healthy controls were tested with an extensive neuropsychological and neuropsychiatric battery. Psychiatric symptomatology was measured with the positive and negative syndrome scale (PANSS) and the Beck depression inventory. To assess behavioral flexibility the emotion-related visual reversal-learning task (O'Doherty et al., 2001) and the gambling task (Bechara et al., 1994) were used. Results. Patient's mean scores were: Beck: 8 ± 1.5; PANSS positive: 10 ± 1.3, and negative: 14.4 ± 2.2; intellectual quotient (IQ): 101.4 ± 6.3; category number in Wisconsin card sorting test: 4.6 ± 2.4. The emotion-related visual reversal-learning task showed significance differences in the number of reversion: healthy controls: 9.3; epileptic patients: 4.23 (p < 0.001); in the number of trials to the first reversion: healthy controls: 5; epileptic patients: 23.42 (p < 0.05). There was no correlation between reversion and depression, PANSS and IQ. Conclusions. Patients with epilepsy who undergo unilateral hippocampal and amygdala resection appear to have alterations in the reversion capacity with an emotional component that would explain the lack of behavior flexibility that they sometimes have and that are not related with either the isolated presence of executive alterations or low intellectual quotient

[Visual art, creativity and dementia]. / Arte visual, creatividad y demencia.

BACKGROUND: Visual art is an expression of neurological function and how it organizes and interprets perception. The art is predominantly in the right hemisphere, in contrast, the left side, have inhibitory effects on artistic expression. In normal subjects, inhibitory and excitatory mechanisms could interact in a complex harmony, reflecting a paradoxical functional facilitation. Brain diseases such as dementia could change this harmony and then, alter the artistic abilities. OBJECTIVE: Evaluate the art expression in the degenerative diseases. PATIENTS AND METHODS: Artistic abilities of 3 painters with degenerative diseases were assessment. RESULTS: Patient 1: A 83 - year old right handed female, diagnosis: Alzheimer's disease. Artistic description: low productivity, simplified versions of earlier and alteration of the visuospatial organization. Patient 2: A 78-year-old right handed female, diagnosis: Primary Progressive Aphasia (PPA); Artistic description: oversimplified drawings which maintaining overall spatial organization, without impair artistic skills. Patient 3: A 68 year-old right handed woman, diagnosis: Fronto-Temporal Dementia (FTD). Artistic description: Increased artistic activity, originality, freedom, utilization of intense colours with perseverative and repetitive copying of similar paintings of her own work. CONCLUSIONS: Visual art in Alzheimer's disease is a consequence of visuospatial and constructive disabilities. In contrast, the conservation of this cognitive functions and left asymmetrical involved, in FTD and PPA respectively, suggest artistic preservation, independently of the language injury. The disproportionate functional prevalence of the right over the left could lead to a release of novelty - seeking in art and can contribute to emergent creativity. These observations suggest an organization for art in the brain and proposed bases for further investigations in dementias.

Afasia progresiva primaria: variabilidad clínica. Análisis de 15 casos / Primary progressive aphasia: its clinical variability. An analysis of 15 cases

Introducción. La APP representa un síndrome ligado a etiología degenerativa, que lo diferencia de los cuadros afásicos secundarios. Se caracteriza principalmente por la pérdida aislada y progresiva del lenguaje, al menos durante los dos primeros años de evolución. Objetivo. Evaluar el perfil neuropsicológico, neuropsiquiátrico y lingüístico de la APP. Pacientes y métodos. Se evaluó a 15 pacientes con APP con una extensa batería de lenguaje, neuropsicológica y neuropsiquiátrica. Se les realizó examen neurológico y neuroimágenes cerebrales estáticas (tomografía computarizada o resonancia magnética) y funcionales (tomografía computarizada por emisión de fotón único). Resultados. Se clasificó a los pacientes según el tipo de afasia. Se observó una clara distinción entre los patrones de expresión oral. La anomia fue el síntoma más frecuente de presentación. Siete pacientes mostraron afasia de Broca, cuatro pacientes afasia transcortical sensorial, dos pacientes afasia de Wernicke y dos pacientes afasia anómica. Los síntomas neuropsiquiátricos más prevalentes fueron depresión, apatía, ansiedad e irritabilidad. Conclusiones. La APP es un término sindrómico que reúne una gran variabilidad de manifestaciones clínicas; incluye formas afásicas tanto fluentes como no fluentes. Si bien se considera un trastorno exclusivamente cognitivo, está asociado con una alta prevalencia de manifestaciones psiquiátricas. Son necesarios mayores estudios para evaluar la implicación pronóstica de la presencia de los mismos. El deterioro lento y progresivo del lenguaje ofrece una importante oportunidad para investigar la neurodegeneración focal y los mecanismos neuropsicológicos involucrados en los procesos lingüísticos (AU)

Introduction. Primary progressive aphasia (PPA) represents a clinical syndrome linked to multiple degenerative diseases. The diagnosis of PPA is made when language is the only area of salient and progressive dysfunction for at least the first two years of the disease. Aim. To evaluate the neuropsychological, neuropsychiatric and language characteristics of the PPA. Patients and methods. 15 patients with PPA underwent language, neuropsychological and neuropsychiatric evaluation, magnetic resonance imaging, computerized tomography and single photon emission computerized tomography. Results. We observed a clear distinction between the oral expression patterns; the patients were classificated by type of aphasia. The most common sign of PPA was a word finding deficit, also known as anomia. Seven aphasia type Broca, four sensorial transcortical aphasia, two aphasia type Wernicke and two anomic aphasia were found in our patients. Depression, apathy, anxiety and irritability were the most prevalent neuropsychiatric sign. Conclusions. PPA is a language-based syndrome, that include fluent (normal articulation, flow and number of words per utterance) and nonfluent form of aphasia. It has been considered a cognitive term, however, PPA is associated with high prevalence of psychiatric manifestations. More research it will be necessary to evaluate the prognostic value of them. The slow and progressive deterioration of language provides an interesting model to understand the mechanisms and biological bases involved in the linguistic process (AU)

[Primary progressive aphasia: its clinical variability: an analysis of 15 cases]. / Afasia progresiva primaria: variabilidad clínica. Análisis de 15 casos

INTRODUCTION: Primary progressive aphasia (PPA) represents a clinical syndrome linked to multiple degenerative diseases. The diagnosis of PPA is made when language is the only area of salient and progressive dysfunction for at least the first two years of the disease. AIM: To evaluate the neuropsychological, neuropsychiatric and language characteristics of the PPA. PATIENTS AND METHODS: 15 patients with PPA underwent language, neuropsychological and neuropsychiatric evaluation, magnetic resonance imaging, computerized tomography and single photon emission computerized tomography. RESULTS: We observed a clear distinction between the oral expression patterns; the patients were classificated by type of aphasia. The most common sign of PPA was a word finding deficit, also known as anomia. Seven aphasia type Broca, four sensorial transcortical aphasia, two aphasia type Wernicke and two anomic aphasia were found in our patients. Depression, apathy, anxiety and irritability were the most prevalent neuropsychiatric sign. CONCLUSIONS: PPA is a language-based syndrome, that include fluent (normal articulation, flow and number of words per utterance) and nonfluent form of aphasia. It has been considered a cognitive term, however, PPA is associated with high prevalence of psychiatric manifestations. More research it will be necessary to evaluate the prognostic value of them. The slow and progressive deterioration of language provides an interesting model to understand the mechanisms and biological bases involved in the linguistic process.

A double-blind, randomized clinical trial to assess the augmentation with nimodipine of antidepressant therapy in the treatment of "vascular depression".

BACKGROUND: Cerebrovascular disease may cause "vascular depression" (VaD). Calcium channel-blockers are presumed treatments for cerebrovascular disease and might be expected to improve depression and prevent recurrence. OBJECTIVE: To examine the efficacy and tolerability of the use of nimodipine as an augmentation of fluoxetine in the treatment of VaD. DESIGN: A double-blind, randomized clinical trial in which 101 patients with VaD (Alexopoulos criteria) were treated with fluoxetine at standard doses. Patients were randomized to placebo (n=51) or nimodipine (n=50). Treatment outcomes were assessed using the Hamilton Depression Rating Scale (HDRS) regularly up to 8 months after treatment initiation. RESULTS: Depression was reduced in 63% of patients, but those whose treatment was enhanced with nimodipine had greater improvements overall by repeated measures analysis of covariance (ANCOVA) (F(1.80) = 9.76, p=0.001). In addition, a greater proportion of patients treated with fluoxetine-nimodipine (54% vs. 27%) exhibited full remission (chi2(d.f. 1)= 7.3, p = 0.006), with the number needed to treat (NNT) equal to 4 (95% CI 2-12). Of those experiencing full remission in the first 61 days, fewer patients on fluoxetine-nimodipine (3.7%) developed recurrence of major depression as compared to those on fluoxetine alone (35.7%) (chi2(d.f. 1) = 7.56, p = 0.006), NNT 3 (95% CI 2-9). Side-effects were noted in 33.3% of patients in the control group and 48% of the experimental group (chi2(d.f. 1) = 2.25, p = 0.133). CONCLUSIONS: In treating VaD, augmentation of fluoxetine with nimodipine led to better treatment results and lower rates of recurrence. These findings support the argument that augmentation of antidepressant therapy might be helpful in the treatment of cerebrovascular disease, which is involved in the pathogenesis of this type of depression.

[Neuropsychological study of 12 patients with pure degenerative cerebellar disease]. / Evaluación cognitiva en 12 pacientes con enfermedad cerebelosa degenerativa pura.

INTRODUCTION: The cerebellum has been traditionally associated with motor control learning and performance. However, since 1970 a growing body of clinical and experimental evidences has suggested that the cerebellum may be involved in nonmotor cognitive functions as well. OBJECTIVE: To explore the presence of eventual cognitive impairment in non-demented patients with isolated degenerative cerebellar diseases. PATIENTS AND METHODS: Twelve patients with the diagnosis of selective degenerative cerebellar disorders, either inherited or sporadic, were selected (mean age: 40.42 +/- 13.49 years; mean education level: 9.92 +/- 3.99 years; duration of illness: 12.13 +/- 11.27 years, MMSE: 26.75 +/- 1.5) and evaluated through a standardized neuropsychological tests battery. Normalized Z scores were estimated and compared against 0, employing the t test for one sample. RESULTS: Significant cognitive deficits were found in the following domains: executive, visuo-spatial, memory and attention functions. Performance on the Wisconsin test showed a significative number of perseverative errors. Memory deficits included verbal learning and free recall difficulties, with good recognition of the material presented. CONCLUSIONS: The findings of this study are consistent with the role of the cerebellum as modulator of mental functions. The cognitive deficits resulting from cerebellar pathology may be related with the disruption of cerebello-cortical connexions involving a complex network which includes the prefrontal region, suggesting that the cerebellum may process cortical information coming from different areas linked with the control of cognition.

Evaluación cognitiva de 12 pacientes con enfermedad cerebelosa degenerativa pura / Neuropsychological study of 12 patients with pure degenerative cerebellar disease

Introducción. El cerebelo se ha asociado tradicionalmente con el aprendizaje y el control motor. Sin embargo, en las últimas tres décadas se ha obtenido evidencia clínica y experimental que sugiere que el cerebelo podría intervenir en el procesamiento cognitivo no motor. Objetivo. Estudiar el rendimiento neuropsicológico de pacientes con enfermedad cerebelosa degenerativa pura no dementes. Pacientes y métodos. Se evaluaron 12 pacientes con enfermedad cerebelosa degenerativa pura, de causa hereditaria o de presentación esporádica (edad: 40,42 13,49 años; educación: 9,92 3,99 años; tiempo de evolución: 12,13 11,27 años; MMSE: 26,75 1,5) por medio de una batería neuropsicológica estandarizada. Se calcularon puntuaciones normalizadas Z, que se compararon contra 0 mediante el empleo de pruebas de t de una muestra. Resultados. Se observaron alteraciones significativas en las pruebas de función ejecutiva, visuoespacial, memoria y atención. En el test de Wisconsin se registró un número significativo de errores perseverativos. Los fallos en memoria se caracterizaron por dificultades en el aprendizaje y la evocación diferida, con buen desempeño en el reconocimiento del material presentado. Los déficit cognitivos no se correlacionaron con la gravedad del déficit motor elemental. Conclusiones. Los datos obtenidos sugieren la participación del cerebelo en la modulación de las funciones mentales

Introduction. The cerebellum has been traditionally associated with motor control learning and performance. However, since 1970 a growing body of clinical and experimental evidences has suggested that the cerebellum may be involved in nonmotor cognitive functions as well. Objective. To explore the presence of eventual cognitive impairment in non-demented patients with isolated degenerative cerebellar diseases. Patients and methods. Twelve patients with the diagnosis of selective degenerative cerebellar disorders, either inherited or sporadic, were selected (mean age: 40.42 ± 13.49 years; mean education level: 9.92 ± 3.99 years; duration of illness: 12.13 ± 11.27 years, MMSE: 26.75 ± 1.5) and evaluated through a standardized neuropsychological tests battery. Normalized Z scores were estimated and compared against 0, employing the t test for one sample. Results. Significant cognitive deficits were found in the following domains: executive, visuo-spatial, memory and attention functions. Performance on the Wisconsin test showed a significative number of perseverative errors. Memory deficits included verbal learning and free recall difficulties, with good recognition of the material presented. Conclusions. The findings of this study are consistent with the role of the cerebellum as modulator of mental functions. The cognitive deficits resulting from cerebellar pathology may be related with the disruption of cerebello-cortical connexions involving a complex network which includes the prefrontal region, suggesting that the cerebellum may process cortical information coming from different areas linked with the control of cognition

Arte visual, creatividad y demencia / [Visual art, creativity and dementia]

BACKGROUND: Visual art is an expression of neurological function and how it organizes and interprets perception. The art is predominantly in the right hemisphere, in contrast, the left side, have inhibitory effects on artistic expression. In normal subjects, inhibitory and excitatory mechanisms could interact in a complex harmony, reflecting a paradoxical functional facilitation. Brain diseases such as dementia could change this harmony and then, alter the artistic abilities. OBJECTIVE: Evaluate the art expression in the degenerative diseases. PATIENTS AND METHODS: Artistic abilities of 3 painters with degenerative diseases were assessment. RESULTS: Patient 1: A 83 - year old right handed female, diagnosis: Alzheimer’s disease. Artistic description: low productivity, simplified versions of earlier and alteration of the visuospatial organization. Patient 2: A 78-year-old right handed female, diagnosis: Primary Progressive Aphasia (PPA); Artistic description: oversimplified drawings which maintaining overall spatial organization, without impair artistic skills. Patient 3: A 68 year-old right handed woman, diagnosis: Fronto-Temporal Dementia (FTD). Artistic description: Increased artistic activity, originality, freedom, utilization of intense colours with perseverative and repetitive copying of similar paintings of her own work. CONCLUSIONS: Visual art in Alzheimer’s disease is a consequence of visuospatial and constructive disabilities. In contrast, the conservation of this cognitive functions and left asymmetrical involved, in FTD and PPA respectively, suggest artistic preservation, independently of the language injury. The disproportionate functional prevalence of the right over the left could lead to a release of novelty - seeking in art and can contribute to emergent creativity. These observations suggest an organization for art in the brain and proposed bases for further investigations in dementias.

Arte visual, creatividad y demencia. / [Visual art, creativity and dementia]

BACKGROUND: Visual art is an expression of neurological function and how it organizes and interprets perception. The art is predominantly in the right hemisphere, in contrast, the left side, have inhibitory effects on artistic expression. In normal subjects, inhibitory and excitatory mechanisms could interact in a complex harmony, reflecting a paradoxical functional facilitation. Brain diseases such as dementia could change this harmony and then, alter the artistic abilities. OBJECTIVE: Evaluate the art expression in the degenerative diseases. PATIENTS AND METHODS: Artistic abilities of 3 painters with degenerative diseases were assessment. RESULTS: Patient 1: A 83 - year old right handed female, diagnosis: Alzheimers disease. Artistic description: low productivity, simplified versions of earlier and alteration of the visuospatial organization. Patient 2: A 78-year-old right handed female, diagnosis: Primary Progressive Aphasia (PPA); Artistic description: oversimplified drawings which maintaining overall spatial organization, without impair artistic skills. Patient 3: A 68 year-old right handed woman, diagnosis: Fronto-Temporal Dementia (FTD). Artistic description: Increased artistic activity, originality, freedom, utilization of intense colours with perseverative and repetitive copying of similar paintings of her own work. CONCLUSIONS: Visual art in Alzheimers disease is a consequence of visuospatial and constructive disabilities. In contrast, the conservation of this cognitive functions and left asymmetrical involved, in FTD and PPA respectively, suggest artistic preservation, independently of the language injury. The disproportionate functional prevalence of the right over the left could lead to a release of novelty - seeking in art and can contribute to emergent creativity. These observations suggest an organization for art in the brain and proposed bases for further investigations in dementias.

[Musical memory preserved in an amnesic syndrome]. / Preservación de la memoria musical en un síndrome amnésico.

INTRODUCTION: In amnesic syndromes, it's usually to see dissociation between episodic, semantic and procedural memory. However, a few reports have been found about musical memory's processing and the relation with classic memory systems. AIM: To describe the musical's abilities preserved in a patient with amnesic syndrome and discuss possible neuropsychological and neurobiological bases implicated. CASE REPORT: A 28-years-old woman presenting with amnesic syndrome is reported. Following a carbon monoxide encephalophaty and subsequent hypoxia she remained in coma for 10 days with evidence of bilateral temporal changes, mainly affecting basal ganglia areas. The patient showed anterograde amnesia and semantic memory impairment, with disproportionately spared musical abilities' performance, either music perception (discrimination and recognition of tonal melodies, musical sight-reading) or music production (song and instrumental performance) or musical memory. CONCLUSIONS: This case suggests that the music require elaborate bihemispheric processing and may implicate different forms of information processing. The neural network involved in musical memory can be different that the declarative memory systems (episodic and semantic).