Effect of Nordic Sensi® Chair on Behavioral and Psychological Symptoms of Dementia in Nursing Homes Residents: A Randomized Controlled Trial.

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are present in most people with dementia (PwD), including Alzheimer's disease. There is consensus that non-pharmacological therapies represent the first line of treatment to address BPSD. OBJECTIVE: We explore the efficacy of the use of a rocking chair (Nordic Sensi® Chair, NSC) in the treatment of BPSD in nursing home residents with moderate and severe dementia. METHODS: We carried out a 16-week randomized, single-blind, controlled, clinical trial with PwD admitted to nursing homes. Participants were assigned to a treatment group (n = 40) that received three times a week one session per day of 20 minutes in the NSC and a control group (n = 37). The Neuropsychiatric Inventory-Nursing Home (NPI-NH) was used as primary efficacy outcome. Occupational distress for the staff was evaluated using the NPI-NH Occupational Disruptiveness subscale (NPI-NH-OD). Statistical analyses were conducted by means of a Mixed Effects Model Analysis. RESULTS: Treatment with the NSC was associated with a beneficial effect in most of BPSD, as reflected by differences between the treatment and control group on the NPI-NH total score (mean change score -18.87±5.56 versus -1.74±0.67, p = 0.004), agitation (mean change score -2.32±2.02 versus -0.78±1.44, p = 0.003) and irritability (mean change score -3.35±2.93 versus -1.42±1.31, p = 0.004). The NPI-NH-OD total score also improved the most in the treatment group (mean change score -9.67±7.67 versus -7.66±6.08, p = 0.003). CONCLUSIONS: The reduction in overall BPSD along with decreased caregiver occupational disruptiveness represent encouraging findings, adding to the potential of nonpharmacological interventions for nursing home residents living with dementia.

Effects of GLP-1 receptor agonists on neurological complications of diabetes.

Emerging evidence suggests that treatment with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) could be an interesting treatment strategy to reduce neurological complications such as stroke, cognitive impairment, and peripheral neuropathy. We performed a systematic review to examine the evidence concerning the effects of GLP-1 RAs on neurological complications of diabetes. The databases used were Pubmed, Scopus and Cochrane. We selected clinical trials which analysed the effect of GLP-1 RAs on stroke, cognitive impairment, and peripheral neuropathy. We found a total of 19 studies: 8 studies include stroke or major cardiovascular events, 7 involve cognitive impairment and 4 include peripheral neuropathy. Semaglutide subcutaneous and dulaglutide reduced stroke cases. Liraglutide, albiglutide, oral semaglutide and efpeglenatide, were not shown to reduce the number of strokes but did reduce major cardiovascular events. Exenatide, dulaglutide and liraglutide improved general cognition but no significant effect on diabetic peripheral neuropathy has been reported with GLP-1 RAs. GLP-1 RAs are promising drugs that seem to be useful in the reduction of some neurological complications of diabetes. However, more studies are needed.

Evidence of Animal-Assisted Therapy in Neurological Diseases in Adults: A Systematic Review.

BACKGROUND: In recent years, the possibility of intervening humans with animal-assisted therapy (AAT) has been growing due to numerous physical, psychological, and social benefits provided to humanity, enabling them to maintain or improve their quality of life. There exist different animals through which this therapy can be performed. The purpose of this systematic review will focus on the effects of AAT in several neurological diseases. METHODS: The search of clinical trials was carried out in the PubMed, Scielo, Embase and PEDro databases. The selection of articles was made according to the different inclusion and exclusion criteria, incorporating those that approached neurological diseases to be reviewed. RESULTS: Twenty-five clinical trials were identified, seventeen of which were finally included in the review. The results indicate that animal-assisted therapy (AAT) in different neurological diseases has many benefits in several areas, for example, in motor and physical ability as well as in mental and behavioural health. CONCLUSIONS: This systematic review provides occupational therapy practitioners with evidence on the use of activity based on animal-assisted therapy as a novel field of intervention that can complement other therapies and obtain benefits in different populations.

Alzheimer's Disease, Mild Cognitive Impairment and Mediterranean Diet. A Systematic Review and Dose-Response Meta-Analysis.

Alzheimer's Disease (AD) is a pathology with increasing prevalence in the context of a more long-lived society and it is the first cause of dementia in western countries. It is important to investigate factors that can be protective and may influence its development, in order to act on them trying to reduce AD incidence and its progression. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of a higher adherence to Mediterranean diet (MD) on Mild Cognitive Impairment (MCI) and AD. A literature search in PubMed, The Cochrane Library Plus and Scopus was conducted, selecting articles that analyzed associations between MD adherence and AD biomarkers (Volumetry assessed by MRI and betamiloide and Tau deposits by PET); cognitive performance in patients at risk or presenting MCI and AD; and incidence or progression from MCI to AD. Out of the 589 studies screened, 22 studies met eligibility criteria for the systematic review and qualitative synthesis. Finally, 11 studies were included in the meta-analysis (12,458 participants). Higher adherence to MD was associated with a significantly lower risk of MCI (RR = 0.91, 95%CI = 0.85-0.97) and lower risk of AD (RR = 0.89, 95% CI = 0.84-0.93). Our results enhance the importance of taking health-promoting lifestyle measures like following Mediterranean dietary patterns in order to reduce AD risk.

Usefulness of magnetic resonance spectroscopy in mesial temporal sclerosis: a systematic review.

BACKGROUND: Magnetic resonance spectroscopy (MRS) provides non-invasive information about metabolic features in different regions of the brain affected by mesial temporal sclerosis (MTS). PURPOSE: To review articles analyzing the most common alterations in biochemical parameters in MTS and the applications of MRS in presurgical assessment. METHODS: We undertook a systematic literature search for MRS in MTS in PubMed, SCOPUS, and Cochrane based on the MESH terms ""Magnetic Resonance Spectroscopy", "Proton Magnetic Resonance Spectroscopy", "Carbon-13 Magnetic Resonance Spectroscopy", "1H-MRS", "31P-MRS", "mesial temporal sclerosis", "hippocampal sclerosis", "mesial temporal seizure", and "mesial temporal epilepsy". RESULTS: Of the initial 134 articles found, 30 were selected after the exclusion process. Of these, 13 detected a decrease in N-acetylaspartate (NAA), 9 showed a decreased in the ratio NAA/Cho+Cr, and 8 demonstrated a decreased in the ratio NAA/Cr, all of them in the ipsilateral hippocampus. Nine studies also found reduced NAA levels in extrahippocampal regions. CONCLUSIONS: The main findings were a decrease in NAA in the ipsilateral hippocampus. In addition, NAA levels were low outside the hippocampus so MTS could be a more extensive disease. Patients without MTS also presented a decrease in NAA in the ipsilateral hippocampus although NAA was even lower in the MTS patients. Thus, MRS could be useful in the presurgical evaluation to locate the epileptogenic focus, but not specific for the diagnosis of MTS.

Relación entre estrés y malestar psicológico de los padres y problemas emocionales y conductuales en niños preescolares con trastorno del espectro autista / Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder

INTRODUCCIÓN: Los trastornos del espectro autista (TEA) se caracterizan por deficiencias generalizadas en la comunicación social, estereotipias e intereses restringidos. Los TEA presentan una alta prevalencia de trastornos psiquiátricos adicionales que empeoran su funcionamiento diario y reducen la calidad de vida de ellos y sus familias. MATERIAL Y MÉTODO: En el esfuerzo de identificar características ambientales que expliquen esta alta comorbilidad, esta investigación se ha centrado en la sintomatología de estrés y malestar psicológico de los padres como posibles factores de riesgo. Se realizó un estudio transversal de asociación entre estrés y malestar psicológico de padres de niños preescolares con TEA (2-6 años) y su relación con psicopatología coexistente en niños con TEA. RESULTADOS Y CONCLUSIONES: Altos niveles de estrés y malestar psicológico en los padres están asociados ya desde la primera infancia con psicopatología coexistente en dicha población, específicamente con problemas emocionales y conductuales (p < 0,05). Sin embargo, se necesitan futuros estudios longitudinales para entender mejor la relación causal entre estas variables y su posible relación bidireccional

INTRODUCTION: The Autistic Spectrum Disorders (ASD) are characterised by general deficits in social communication, stereotypes, and restricted interests. The ASD have a high prevalence of additional psychiatric disorders that make their daily functioning worse, and reduces the quality of life of them and their families. MATERIAL AND METHODS: In an effort to identify family environmental characteristics that may influence in the course of additional psychiatric disorders, this study has focused on the symptoms of parental stress and psychological distress as possible risk factors. A cross-section study was carried out on the relationship between the stress and psychological distress of the parents and its relationship with co-existing psychopathology in a population of pre-school children with ASD (2-6 years). RESULTS AND CONCLUSIONS: High levels of stress and psychological distress of the parents arealready associated, since early childhood, with co-existing psychiatric symptoms, specifically with emotional and behavioural problems (p < 0.05). However, further longitudinal studies are needed for a better understanding of the causal relationship between these variables and their possible bidirectional relationship

Correlation between retinal nerve fibre layer thickness and white matter lesions in Alzheimer's disease.

OBJECTIVES: Early diagnosis in Alzheimer's disease (AD) is crucial in order to implement new therapeutic strategies. The retina is embryologically related to the brain. Thus, the possible usefulness of optical coherence tomography (OCT) in the early detection of AD is currently being studied. Our aim was to study the relationship between retinal nerve fiber layer (RNFL) thickness and AD. METHODS: We undertook an observational, analytical, cross-sectional study with consecutive sampling of 32 patients with AD or mild cognitive impairment and a group of healthy controls (C). The total number of eyes studied was 64. An ophthalmological and a comprehensive neuropsychological evaluation were performed in all participants. Quantification of white matter lesions and study of atrophy of the hippocampus by cerebral magnetic resonance were also performed. RESULTS: We observed a significant linear trend towards a thinning of RNFL as the degree of cognitive deterioration increased, in the superior and temporal quadrants of the retina. A significant correlation was also noted between the mean thickness of the RNFL of the left temporal quadrant and occipital white matter lesions (r = -0.579, p = 0.038). CONCLUSIONS: OCT could be a safe, rapid noninvasive tool providing useful biomarkers in the early detection of cognitive deterioration and AD.

[Relationship between parental stress and psychological distress and emotional and behavioural problems in pre-school children with autistic spectrum disorder]. / Relación entre estrés y malestar psicológico de los padres y problemas emocionales y conductuales en niños preescolares con trastorno del espectro autista.

INTRODUCTION: The Autistic Spectrum Disorders (ASD) are characterised by general deficits in social communication, stereotypes, and restricted interests. The ASD have a high prevalence of additional psychiatric disorders that make their daily functioning worse, and reduces the quality of life of them and their families. MATERIAL AND METHODS: In an effort to identify family environmental characteristics that may influence in the course of additional psychiatric disorders, this study has focused on the symptoms of parental stress and psychological distress as possible risk factors. A cross-section study was carried out on the relationship between the stress and psychological distress of the parents and its relationship with co-existing psychopathology in a population of pre-school children with ASD (2-6 years). RESULTS AND CONCLUSIONS: High levels of stress and psychological distress of the parents arealready associated, since early childhood, with co-existing psychiatric symptoms, specifically with emotional and behavioural problems (p < 0.05). However, further longitudinal studies are needed for a better understanding of the causal relationship between these variables and their possible bidirectional relationship.

Pontine A5 region modulation of the cardiorespiratory response evoked from the midbrain dorsolateral periaqueductal grey.

Connections between the midbrain dorsolateral periaqueductal grey (dlPAG) and the pontine A5 region have been shown. The stimulation of both regions evokes similar cardiovascular responses: tachycardia and hypertension. Accordingly, we have studied the interactions between dlPAG and A5 region in spontaneously breathing anesthetized rats. dlPAG was electrically stimulated (20-30 µA 1-ms pulses were given for 5 s at 100 Hz). Changes in the evoked cardiorespiratoy response were analysed before and after ipsilateral microinjections of muscimol (GABAergic agonist, 50 nl, 0.25 nmol, 5 s) within the A5 region. Electrical stimulation of the dlPAG produces, in the rat, a response characterized by tachypnoea (p < 0.001), hypertension (p < 0.001) and tachycardia (p < 0.001). The increase in respiratory rate was due to a decrease in expiratory time (p < 0.01). Pharmacological inhibition of the A5 region with muscimol produced a marked reduction of the tachycardia (p < 0.001) and the tachypnoea (p < 0.01) evoked from the dlPAG. Finally, to assess functional interactions between A5 and dlPAG, extracellular activity of putative A5 neurones were recorded during dlPAG electrical stimulation. Forty A5 cells were recorded, 16 of which were affected by dlPAG stimulation (40%). 4 cells showed activation, 5 cells excitation and 7 cells decreased spontaneous activity to dlPAG stimulation (p < 0.001). These results confirm a link between the A5 region and dlPAG. The potential role of these connections in the modulation of dlPAG evoked cardiorespiratory responses and their possible clinical implications are discussed.

Satisfacción del alumnado en actividades de grupo reducido en Medicina mediante el uso de mandos de respuesta interactiva basados en radiofrecuencias / Student satisfaction in small group activities in Medicine using interactive response controls based on radio frequencies

INTRODUCCIÓN: El proceso docente actual necesita cambios mediante la introducción de las nuevas tecnologías de la información y la comunicación (TIC) por medio de nuevos sistemas de hardware y software. Tras unos primeros años de introducción y adaptación, hoy en día, el uso de equipos informáticos fijos, portátiles, móviles y tabletas se ha convertido en un aspecto cotidiano para todos los individuos, permitiendo que nuevas tecnologías se puedan implantar de una manera más natural. En este sentido, la Facultad de Medicina de Málaga se ha planteado el uso de mandos de respuesta interactivos mediante radiofrecuencias en actividades de grupo reducido ya que se postulan como una herramienta de gran utilidad que podrían mejorar la calidad de la docencia, permitiendo una evaluación de la misma en tiempo real, superando la realizada por los métodos más clásicos como el examen escrito u oral. MATERIAL Y MÉTODOS: Tras realizar cursos de formación al personal implicado y dotar las aulas con el hardware preciso, se procedió a entregar a todos los alumnos un mando de respuesta interactiva por radiofrecuencia de forma gratuita para realizar diversas actividades en grupos reducidos un total de 12 asignaturas (6 básicas y 6 clínicas) mediante preguntas tipo test unirrespuesta y posteriormente una encuesta de satisfacción. Se analizó la estadística descriptiva y comparativa de los datos obtenidos. RESULTADOS Y DISCUSIÓN: Los objetivos de nuestro estudio han ido enfocados a comprobar la eficacia de la implantación de los mandos de respuesta interactiva en las actividades de grupo reducido en el grado en Medicina. Todos los resultados mostraron una distribución normal. El número de alumnos que participaron en la experiencia fue de 1.645, divididos en 6 asignaturas básicas y 6 clínicas. En el análisis conjunto el promedio de aciertos en las actividades de evaluación de la docencia en grupos reducidos mediante test unirrespuesta fue de 73,3±2,7% con un grado de satisfacción de 4,3±0,2 sobre 5. En el análisis comparativo entre asignaturas básicas y clínicas mediante t de Student, se observó un mayor promedio de aciertos en las asignaturas básicas (79,3±2,9 vs. 67,3±3,1) con un grado de satisfacción similar (4,3±0,3 vs. 4,2±0,2). El uso de mandos de radiofrecuencia se ha mostrado como una herramienta útil como apoyo a la docencia en grupos reducidos, facilitando una buena adquisición de competencias específicas y un elevado grado de satisfacción por parte del alumnado

INTRODUCTION: The current teaching process needs changes with the introduction of new information and communications technology (ICT) using new hardware and software systems. After a few years of introduction and adaptation, the use of computers, laptops, mobile phones, and tablets is now normal for everyone, allowing new technologies to be implemented more naturally. The Faculty of Medicine of Malaga has proposed the use of interactive response controls through radio frequencies in small group activities, because they can be a very useful tool to improve the quality of teaching, allowing an evaluation in real time, and exceeding the classical methods, such as a written or oral examination. MATERIAL AND METHODS: After giving training courses for the staff involved and setting-up of classrooms with the necessary hardware, all students were given a remote interactive response radiofrequency control for free to be used in small groups for 12 teaching subjects (6 basic and 6 clinical) to answer single-response test questions. They then completed a satisfaction questionnaire. A descriptive and comparative statistical analysis was performed on the data obtained. RESULTS AND DISCUSSION: The objectives of our study were to test the effectiveness of the implementation of interactive response control in small group activities in the Faculty of Medicine. All the results showed a normal distribution. The number of students who participated were 1645, divided into 6 basic and 6 clinical subjects. The mean of correct responses in small activities in both groups using a single answer test was 73.32% ±2.7%, with a satisfaction level of 4.3±0.2 out of 5. In the comparative analysis between basic subjects and clinical subject, using Student's t test, a higher mean was observed in the basic subjects (79.3±2.9 vs 67.3±3.1), with a similar level of satisfaction (4.3±0.3 vs 4.2±0.2). These results show that the use of radiofrequency controls are a useful tool to support teaching in small groups, helping to acquire specific skills and a high level of satisfaction by the students

Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis / Comorbilidades psiquiátricas en los trastornos del espectro autista: estudio comparativo entre los criterios DSM-IV-TR y DSM-5

Background/Objective: The heterogeneous clinical presentations of individuals with Autism Spectrum Disorders (ASD) pose a significant challenge for sample characterization. Therefore the main goal of DSM-5 must be to identify subgroups of ASD, including comorbidity disorders and severity. The main goal of this study is to explore the psychiatric comorbidities and the severity of symptoms that could be relevant for the phenotype characterization in ASD and also to compare these results according to the different classification criteria between the DSM-IV-TR and the DSM-5. Method: A comparative study of severity and psychiatric comorbidities was carried out between a sample of participants that only met criteria for Pervasive Developmental Disorder (PDD) according to the DSM-IV-TR and a sample of participants that also met ASD criteria according to DSM-5 classification. The recruitment of children was via educational (N=123). The psychiatric symptoms, comorbid disorders and severity of symptoms were assessed through The Nisonger Child Behavior Rating Form, clinical interview and The Inventory of Autism Spectrum Disorder, respectively. The psychiatric comorbidities considered were: anxiety, eating behavioural problems, self-aggressiveness, hetero-aggressiveness, self-harm, obsessive compulsive disorder and attention deficit and hyperactivity disorder. Results: Statistically significant differences between both groups were found regarding obsessive compulsive disorder, eating behavioural problems and severity. Conclusions: The results support the hypothesis that patients who meet the DSM-5 criteria have more severe symptoms, not only regarding the core autistic symptoms but also in relation with psychiatric comorbidities (AU)

Antecedentes/Objetivo: Los Trastornos del Espectro Autista (TEA) incluyen un grupo heterogéneo en cuanto a su presentación clínica, que supone un desafío a nivel de caracterización diagnóstica. Por consiguiente, el objetivo principal de la clasificación DSM-5 debería de ser identificar subgrupos de TEA incluyendo severidad y comorbilidades psiquiátricas. El objetivo principal de este estudio es explorar las comorbilidades diagnósticas que pueden ser relevantes como descriptores de fenotipos autistas así como la severidad de los síntomas de autismo y comparar los resultados de las diferentes criterios de clasificación entre el DSM-IV-TR y el DSM-5. Método: Se realiza un estudio comparativo de severidad y comorbilidades psiquiátricas entre una muestra con diagnóstico de Trastorno Generalizado del Desarrollo, según criterios DSM-IV-TR, y una muestra que cumplía también criterios para TEA según la clasificación DSM-5. La muestra fue obtenida en centros educativos (N=123). Las comorbilidades psiquiátricas y la severidad de los síntomas se evaluaron a través del The Nisonger Child Behavior Rating Form, entrevista clínica y el Inventario de Trastorno del Espectro Autista, respectivamente. Las comorbilidades estudiadas fueron ansiedad, alteraciones de la conducta alimentaria, auto-agresividad, hetero-agresividad, autolesiones, trastorno obsesivo-compulsivo y déficit de atención e hiperactividad. Resultados: Se encontraron diferencias estadísticamente significativas entre ambos grupos para trastorno obsesivo-compulsivo, alteraciones de la conducta alimentaria y severidad. Conclusiones: Se apoya la hipótesis de que los individuos que cumplen criterios diagnósticos según DSM-5 tienen mayor severidad sintomática, no sólo con respecto a los síntomas autistas centrales, sino también en relación con comorbilidades psiquiátricas (AU)

Importancia de la privación de sueño como mecanismo activador de paroxismos epileptiformes intercríticos / The importance of sleep deprivation as a mechanism for activating interictal epileptiform paroxysms

Introducción. Aunque la privación de sueño se ha utilizado durante años en electroencefalografía (EEG) como método de activación de descargas epileptiformes intercríticas (DEI) en pacientes con alta sospecha de epilepsia, su sensibilidad y especificidad están aún en discusión. Pacientes y métodos. Estudio descriptivo y retrospectivo de pacientes pediátricos derivados a neurofisiología clínica para valoración de epilepsia. Se han comparado los resultados de los EEG de privación de sueño (EEG-PS) con los EEG de vigilia (EEG-V) en cada paciente para describir su rendimiento como mecanismo activador de DEI. Resultados. Se han analizado 500 pacientes (830 EEG-PS y 1.018 EEG-V). En los EEG-V se detectaron DEI en el 44%. El EEG-PS aumentó en un 35% la capacidad del test para detectar las DEI. En los EEG-PS en los que se alcanzó sueño espontáneo se observaron DEI (no detectadas en el EEG-V) en un 25,1%. En el grupo de epilepsias focales se constató que el EEG-V detectó DEI en el 60,1% frente al 79,12% demostradas con el EEG-PS. En las epilepsias generalizadas esta diferencia fue más marcada (27,2% y 77,2%, respectivamente). En los pacientes en los que tras un EEG-PS no se detectaron DEI (23,7%) y la sospecha clínica de epilepsia seguía siendo alta, se realizó polisomnografía nocturna y se llegó a objetivar actividad epileptiforme intercrítica en un 13,6%. Conclusiones. El EEG-PS aumenta la posibilidad de recoger DEI en un 35% con respecto al EEG-V. La privación de sueño es un método activador de paroxismos epileptiformes, independientemente de si hay sueño o no durante la realización del EEG, aunque este efecto es más marcado en los pacientes que alcanzan sueño (AU)

Introduction. Although sleep deprivation has been used for years in electroencephalography (EEG) as a method for activating interictal epileptiform discharges (IED) in patients with a strong suspicion of epilepsy, its sensitivity and specificity are still under discussion. Patients and methods. We conducted a descriptive retrospective study of paediatric patients who were referred to a neurophysiology clinic for epilepsy assessment. The results of the sleep-deprived EEG (SD-EEG) were compared with those of the wakefulness EEG (W-EEG) carried out in each patient in order to describe the performance of each method as a mechanism for activating IED. Results. A total of 500 patients were analysed (830 SD-EEG and 1018 W-EEG). IED were detected in 44% of the W-EEG. SDEEG increased the capacity of the test to detect IED by 35%. IED (not detected in the W-EEG) were detected in 25.1% of the SD-EEG in which spontaneous sleep was achieved. In the group of focal epilepsies, it was found that W-EEG detected IED in 60.1% versus the 79.12% displayed with SD-EEG. In generalised epilepsies this difference was more marked (27.2% and 77.2%, respectively). In patients in whom no IED were detected following an SD-EEG (23.7%) and the clinical suspicion of epilepsy was still high, nocturnal polysomnography was performed and interictal epileptiform activity was observed in 13.6%. Conclusions. SD-EEG increases the chances of recording IED by 35% with respect to W-EEG. Sleep deprivation is a method for activating epileptiform paroxysms, regardless of whether the EEG is performed while sleeping or not, although this effect is more pronounced in patients who do manage to sleep (AU)

[The importance of sleep deprivation as a mechanism for activating interictal epileptiform paroxysms]. / Importancia de la privacion de sueño como mecanismo activador de paroxismos epileptiformes intercriticos.

INTRODUCTION: Although sleep deprivation has been used for years in electroencephalography (EEG) as a method for activating interictal epileptiform discharges (IED) in patients with a strong suspicion of epilepsy, its sensitivity and specificity are still under discussion. PATIENTS AND METHODS: We conducted a descriptive retrospective study of paediatric patients who were referred to a neurophysiology clinic for epilepsy assessment. The results of the sleep-deprived EEG (SD-EEG) were compared with those of the wakefulness EEG (W-EEG) carried out in each patient in order to describe the performance of each method as a mechanism for activating IED. RESULTS: A total of 500 patients were analysed (830 SD-EEG and 1018 W-EEG). IED were detected in 44% of the W-EEG. SD-EEG increased the capacity of the test to detect IED by 35%. IED (not detected in the W-EEG) were detected in 25.1% of the SD-EEG in which spontaneous sleep was achieved. In the group of focal epilepsies, it was found that W-EEG detected IED in 60.1% versus the 79.12% displayed with SD-EEG. In generalised epilepsies this difference was more marked (27.2% and 77.2%, respectively). In patients in whom no IED were detected following an SD-EEG (23.7%) and the clinical suspicion of epilepsy was still high, nocturnal polysomnography was performed and interictal epileptiform activity was observed in 13.6%. CONCLUSIONS: SD-EEG increases the chances of recording IED by 35% with respect to W-EEG. Sleep deprivation is a method for activating epileptiform paroxysms, regardless of whether the EEG is performed while sleeping or not, although this effect is more pronounced in patients who do manage to sleep.

TITLE: Importancia de la privacion de sueño como mecanismo activador de paroxismos epileptiformes intercriticos.Introduccion. Aunque la privacion de sueño se ha utilizado durante años en electroencefalografia (EEG) como metodo de activacion de descargas epileptiformes intercriticas (DEI) en pacientes con alta sospecha de epilepsia, su sensibilidad y especificidad estan aun en discusion. Pacientes y metodos. Estudio descriptivo y retrospectivo de pacientes pediatricos derivados a neurofisiologia clinica para valoracion de epilepsia. Se han comparado los resultados de los EEG de privacion de sueño (EEG-PS) con los EEG de vigilia (EEG-V) en cada paciente para describir su rendimiento como mecanismo activador de DEI. Resultados. Se han analizado 500 pacientes (830 EEG-PS y 1.018 EEG-V). En los EEG-V se detectaron DEI en el 44%. El EEG-PS aumento en un 35% la capacidad del test para detectar las DEI. En los EEG-PS en los que se alcanzo sueño espontaneo se observaron DEI (no detectadas en el EEG-V) en un 25,1%. En el grupo de epilepsias focales se constato que el EEG-V detecto DEI en el 60,1% frente al 79,12% demostradas con el EEG-PS. En las epilepsias generalizadas esta diferencia fue mas marcada (27,2% y 77,2%, respectivamente). En los pacientes en los que tras un EEG-PS no se detectaron DEI (23,7%) y la sospecha clinica de epilepsia seguia siendo alta, se realizo polisomnografia nocturna y se llego a objetivar actividad epileptiforme intercritica en un 13,6%. Conclusiones. El EEG-PS aumenta la posibilidad de recoger DEI en un 35% con respecto al EEG-V. La privacion de sueño es un metodo activador de paroxismos epileptiformes, independientemente de si hay sueño o no durante la realizacion del EEG, aunque este efecto es mas marcado en los pacientes que alcanzan sueño.

Psychiatric comorbidities in autism spectrum disorder: A comparative study between DSM-IV-TR and DSM-5 diagnosis.

Background/Objective: The heterogeneous clinical presentations of individuals with Autism Spectrum Disorders (ASD) pose a significant challenge for sample characterization. Therefore the main goal of DSM-5 must be to identify subgroups of ASD, including comorbidity disorders and severity. The main goal of this study is to explore the psychiatric comorbidities and the severity of symptoms that could be relevant for the phenotype characterization in ASD and also to compare these results according to the different classification criteria between the DSM-IV-TR and the DSM-5. Method: A comparative study of severity and psychiatric comorbidities was carried out between a sample of participants that only met criteria for Pervasive Developmental Disorder (PDD) according to the DSM-IV-TR and a sample of participants that also met ASD criteria according to DSM-5 classification. The recruitment of children was via educational (N = 123). The psychiatric symptoms, comorbid disorders and severity of symptoms were assessed through The Nisonger Child Behavior Rating Form, clinical interview and The Inventory of Autism Spectrum Disorder, respectively. The psychiatric comorbidities considered were: anxiety, eating behavioural problems, self-aggressiveness, hetero-aggressiveness, self-harm, obsessive compulsive disorder and attention deficit and hyperactivity disorder. Results: Statistically significant differences between both groups were found regarding obsessive compulsive disorder, eating behavioural problems and severity. Conclusions: The results support the hypothesis that patients who meet the DSM-5 criteria have more severe symptoms, not only regarding the core autistic symptoms but also in relation with psychiatric comorbidities.

Antecedentes/Objetivo: Los Trastornos del Espectro Autista (TEA) incluyen un grupo heterogéneo en cuanto a su presentación clínica, que supone un desafío a nivel de caracterización diagnóstica. Por consiguiente, el objetivo principal de la clasificación DSM-5 debería de ser identificar subgrupos de TEA incluyendo severidad y comorbilidades psiquiátricas. El objetivo principal de este estudio es explorar las comorbilidades diagnósticas que pueden ser relevantes como descriptores de fenotipos autistas así como la severidad de los síntomas de autismo y comparar los resultados de las diferentes criterios de clasificación entre el DSM-IV-TR y el DSM-5. Método: Se realiza un estudio comparativo de severidad y comorbilidades psiquiátricas entre una muestra con diagnóstico de Trastorno Generalizado del Desarrollo, según criterios DSM-IV-TR, y una muestra que cumplía también criterios para TEA según la clasificación DSM-5. La muestra fue obtenida en centros educativos (N = 123). Las comorbilidades psiquiátricas y la severidad de los síntomas se evaluaron a través del The Nisonger Child Behavior Rating Form, entrevista clínica y el Inventario de Trastorno del Espectro Autista, respectivamente. Las comorbilidades estudiadas fueron ansiedad, alteraciones de la conducta alimentaria, auto-agresividad, hetero-agresividad, autolesiones, trastorno obsesivo-compulsivo y déficit de atención e hiperactividad. Resultados: Se encontraron diferencias estadísticamente significativas entre ambos grupos para trastorno obsesivo-compulsivo, alteraciones de la conducta alimentaria y severidad. Conclusiones: Se apoya la hipótesis de que los individuos que cumplen criterios diagnósticos según DSM-5 tienen mayor severidad sintomática, no sólo con respecto a los síntomas autistas centrales, sino también en relación con comorbilidades psiquiátricas.

EFFECTS OF FOOD AND DRINK INGESTION ON BODY COMPOSITION VARIABLES OF ABDOMINAL BIOELECTRICAL IMPEDANCE.

OBJECTIVE: to know the changes in trunk fat and visceral fat level determined by abdominal bioelectrical impedance (BIA) as well as other anthropometric measures related to the central or abdominal fat after the ingestion of a lunch. METHODS: the experimental study was conducted to assess a longitudinal intervention descriptive study. PARTICIPANTS: 21 subjects (10 male and 11 female), volunteers who have access to a medical assessment, with an age of 74 ± 13.43 years. MEASUREMENTS: Maximal waist circumference in standing position, waist circumference at navel level in supine position and sagittal abdominal diameter (SAD). In the same position trunk fat and visceral fat level by abdominal bioelectrical impedance analysis with Tanita AB-140 (ViScan) were obtained before and after meal. RESULTS: anthropometric measures as waist circumference in supine position and SAD did not show significant differences (P > 0.05), after food ingestion, except for a significant increase of the maximal waist circumference in standing position (P < 0.05). In addition trunk fat and visceral fat ratio did not change (P > 0.05). The percentage changes of the measures were less than 2% for waist circumference in standing position, waist circumference by Viscan, sagittal abdominal diameter and trunk fat and 5.9% for visceral fat ratio. CONCLUSIONS: the effects on trunk fat and visceral fat ratio by abdominal bioelectrical impedance are minimal after the ingestion of a portion of food and drink, although it is always recommended to do it in fasting conditions.

Objetivo: conocer los cambios en la grasa del tronco y el nivel de grasa visceral determinado por BIA abdominal, así como otras medidas antropométricas relacionadas con la grasa abdominal o central después de la ingestión de una comida. Métodos: se realizó un protocolo experimental para evaluar un estudio descriptivo de intervención longitudinal. Los participantes fueron 21 sujetos (10 hombres y 11 mujeres), voluntarios que tuvieron acceso a una evaluación médica, con una edad de 74 años ± 13,43. Las mediciones antropométricas fueron: circunferencia de la cintura máxima en posición de pie, circunferencia de la cintura a nivel del ombligo en posición de decúbito supino y diámetro sagital abdominal (SAD). Además se obtuvo la grasa del tronco y el nivel de grasa visceral, por análisis de impedancia bioeléctrica abdominal, con un dispositivo Tanita AB-140 (ViScan), todo ello antes y después de una ración de comida. Resultados: las medidas antropométricas, como la circunferencia de la cintura en posición supina y SAD, no mostraron diferencias significativas (P > 0,05), después de la ingestión de alimentos, a excepción de un aumento significativo de la circunferencia de la cintura máxima en posición de pie (P < 0,05). Además, la relación entre la grasa visceral y en tronco no cambió (P > 0,05). Los cambios porcentuales de las medidas fueron menores del 2% para la circunferencia de la cintura en posición de pie, para la circunferencia de cintura por Viscan, para el diámetro sagital abdominal y la grasa del tronco, y un 5,9% para el nivel de grasa visceral. Conclusiones: los efectos de una comida y bebida sobre la grasa del tronco y el nivel de grasa visceral, medidas por impedancia bioeléctrica abdominal, son mínimas, aunque siempre es recomendable hacerlo en condiciones de ayuno.

Effects of food and drink ingestion on body composition variables of abdominal bioelectrical impedance / Efectos de la comida y la bebida sobre las variables de composición corporal en la bioimpedancia abdominal

Objective: to know the changes in trunk fat and visceral fat level determined by abdominal bioelectrical impedance (BIA) as well as other anthropometric measures related to the central or abdominal fat after the ingestion of a lunch. Methods: the experimental study was conducted to assess a longitudinal intervention descriptive study. Participants: 21 subjects (10 male and 11 female), volunteers who have access to a medical assessment, with an age of 74±13.43 years. Measurements: Maximal waist circumference in standing position, waist circumference at navel level in supine position and sagittal abdominal diameter (SAD). In the same position trunk fat and visceral fat level by abdominal bioelectrical impedance analysis with Tanita AB-140 (ViScan) were obtained before and after meal. Results: anthropometric measures as waist circumference in supine position and SAD did not show significant differences (P>0.05), after food ingestion, except for a significant increase of the maximal waist circumference in standing position (P0.05). The percentage changes of the measures were less than 2% for waist circumference in standing position, waist circumference by Viscan, sagittal abdominal diameter and trunk fat and 5.9% for visceral fat ratio. Conclusions: the effects on trunk fat and visceral fat ratio by abdominal bioelectrical impedance are minimal after the ingestion of a portion of food and drink, although it is always recommended to do it in fasting conditions (AU)

Objetivo: conocer los cambios en la grasa del tronco y el nivel de grasa visceral determinado por BIA abdominal, así como otras medidas antropométricas relacionadas con la grasa abdominal o central después de la ingestión de una comida. Métodos: se realizó un protocolo experimental para evaluar un estudio descriptivo de intervención longitudinal. Los participantes fueron 21 sujetos (10 hombres y 11 mujeres), voluntarios que tuvieron acceso a una evaluación médica, con una edad de 74 años ± 13,43. Las mediciones antropométricas fueron: circunferencia de la cintura máxima en posición de pie, circunferencia de la cintura a nivel del ombligo en posición de decúbito supino y diámetro sagital abdominal (SAD). Además se obtuvo la grasa del tronco y el nivel de grasa visceral, por análisis de impedancia bioeléctrica abdominal, con un dispositivo Tanita AB-140 (ViScan), todo ello antes y después de una ración de comida. Resultados: las medidas antropométricas, como la circunferencia de la cintura en posición supina y SAD, no mostraron diferencias significativas (P > 0,05), después de la ingestión de alimentos, a excepción de un aumento significativo de la circunferencia de la cintura máxima en posición de pie (P < 0,05). Además, la relación entre la grasa visceral y en tronco no cambió (P > 0,05). Los cambios porcentuales de las medidas fueron menores del 2% para la circunferencia de la cintura en posición de pie, para la circunferencia de cintura por Viscan, para el diámetro sagital abdominal y la grasa del tronco, y un 5,9% para el nivel de grasa visceral. Conclusiones: los efectos de una comida y bebida sobre la grasa del tronco y el nivel de grasa visceral, medidas por impedancia bioeléctrica abdominal, son mínimas, aunque siempre es recomendable hacerlo en condiciones de ayuno (AU)

Predicción del síndrome metabólico por bioimpedancia abdominal y antropometría en hombres de mediana edad / Abdominal bioelectrical impedance analysis and anthropometry for predicting metabolic syndrome in middle aged men

Objetivo: la obesidad central tiene una gran relación con el síndrome metabólico. Estudiar la relación de la grasa del tronco, el índice de grasa visceral y las medidas antropométricas con el síndrome metabólico. Métodos: diseño: transversal descriptivo y correlacional. Participaron 75 varones, voluntarios, de distintas profesiones, que accedieron a un reconocimiento médico-laboral, con un rango de edad de 21 a 59 años. Mediciones de peso, talla, índice de masa corporal, perímetro abdominal, perímetro glúteo, índice cintura-cadera y grasa de tronco y nivel de grasa visceral mediante bioimpedanciometría (Tanita AB-140-ViScan) y parámetros bioquímicos: glucosa, colesterol total y triglicéridos. Así mismo, se midió la presión arterial sistólica y diastólica. Se comparan los estados de síndrome metabólico, sobrepeso y obesidad. Resultados: existen correlaciones de las medidas antropométricas con la de grasa de tronco y el nivel de grasa visceral, así como con los parámetros bioquímicos (p < 0,001). Un análisis de curvas ROC muestra que los puntos de corte a partir de los cuales se puede presentar el síndrome metabólico son de 32,7% de grasa de tronco y de 13 para el nivel de grasa visceral, con una alta sensibilidad y especificidad. Se obtienen los mismos puntos de corte para el estado de obesidad y síndrome metabólico. Conclusiones: la grasa de tronco y los niveles de grasa visceral son muy sensibles y específicos para la detección del síndrome metabólico y la obesidad, aunque no superan a las variables e índices antropométricos. En la condición de sobrepeso, la grasa de tronco y visceral son medidas algo más predictivas que las variables antropométricas (AU)

Objective: central obesity has a higher risk of metabolic syndrome. The present work aimed to study the relationship of trunk fat and the visceral fat index, and other anthropometric indices in relation to the metabolic syndrome in middle aged male Methods: design: transversal descriptive and correlational study. Participants: 75 male, volunteers who have access to a medical assessment, with an age range of 21 to 59 years, from different professions. Measurements: Weight, height, body mass index, waist circumference, gluteal circumference, waist-to-hip ratio, waist-to-height ratio, trunk fat and visceral fat level by bioelectrical abdominal impedance analysis with Tanita AB-140 (ViScan) and biochemical markers: fasting glucose, total cholesterol, and triglycerides. Likewise, the systolic and diastolic blood pressure was measured. Results: there are significant correlations of anthropometric measurements with trunk fat and visceral fat level and the same with biochemical variables. Receptor-operator curves (ROC curve) analysis shows that the cutoff points from which arises the metabolic syndrome are 32.7% of trunk fat and a level of visceral fat of 13 with a high sensitivity and specificity, attaining the same cut-off points for the metabolic syndrome and obesity status. Conclusions: trunk fat and visceral fat levels determined by bioelectrical abdominal impedance analysis, values are variables very sensitive and specific for the detection of metabolic syndrome and obesity, though not over the variables and anthropometric indices. In the condition of the overweight, trunk fat and visceral fat level are more predictive than anthropometric measures (AU)

[ABDOMINAL BIOELECTRICAL IMPEDANCE ANALYSIS AND ANTHROPOMETRY FOR PREDICTING METABOLIC SYNDROME IN MIDDLE AGED MEN]. / PREDICCIÓN DEL SÍNDROME METABÓLICO POR BIOIMPEDANCIA ABDOMINAL Y ANTROPOMETRÍA EN HOMBRES DE MEDIANA EDAD.

OBJECTIVE: central obesity has a higher risk of metabolic syndrome. The present work aimed to study the relationship of trunk fat and the visceral fat index, and other anthropometric indices in relation to the metabolic syndrome in middle aged male Methods: design: transversal descriptive and correlational study. PARTICIPANTS: 75 male, volunteers who have access to a medical assessment, with an age range of 21 to 59 years, from different professions. MEASUREMENTS: Weight, height, body mass index, waist circumference, gluteal circumference, waist-to-hip ratio, waist-to-height ratio, trunk fat and visceral fat level by bioelectrical abdominal impedance analysis with Tanita AB-140 (ViScan) and biochemical markers: fasting glucose, total cholesterol, and triglycerides. Likewise, the systolic and diastolic blood pressure was measured. RESULTS: there are significant correlations of anthropometric measurements with trunk fat and visceral fat level and the same with biochemical variables. Receptor-operator curves (ROC curve) analysis shows that the cutoff points from which arises the metabolic syndrome are 32.7% of trunk fat and a level of visceral fat of 13 with a high sensitivity and specificity, attaining the same cut-off points for the metabolic syndrome and obesity status. CONCLUSIONS: trunk fat and visceral fat levels determined by bioelectrical abdominal impedance analysis, values are variables very sensitive and specific for the detection of metabolic syndrome and obesity, though not over the variables and anthropometric indices. In the condition of the overweight, trunk fat and visceral fat level are more predictive than anthropometric measures.

Objetivo: la obesidad central tiene una gran relación con el síndrome metabólico. Estudiar la relación de la grasa del tronco, el índice de grasa visceral y las medidas antropométricas con el síndrome metabólico. Métodos: diseño: transversal descriptivo y correlacional. Participaron 75 varones, voluntarios, de distintas profesiones, que accedieron a un reconocimiento médico- laboral, con un rango de edad de 21 a 59 años. Mediciones de peso, talla, índice de masa corporal, perímetro abdominal, perímetro glúteo, índice cintura-cadera y grasa de tronco y nivel de grasa visceral mediante bioimpedanciometría (Tanita AB-140-ViScan) y parámetros bioquímicos: glucosa, colesterol total y triglicéridos. Así mismo, se midió la presión arterial sistólica y diastólica. Se comparan los estados de síndrome metabólico, sobrepeso y obesidad. Resultados: existen correlaciones de las medidas antropométricas con la de grasa de tronco y el nivel de grasa visceral, así como con los parámetros bioquímicos (p < 0,001). Un análisis de curvas ROC muestra que los puntos de corte a partir de los cuales se puede presentar el síndrome metabólico son de 32,7% de grasa de tronco y de 13 para el nivel de grasa visceral, con una alta sensibilidad y especificidad. Se obtienen los mismos puntos de corte para el estado de obesidad y síndrome metabólico. Conclusiones: la grasa de tronco y los niveles de grasa visceral son muy sensibles y específicos para la detección del síndrome metabólico y la obesidad, aunque no superan a las variables e índices antropométricos. En la condición de sobrepeso, la grasa de tronco y visceral son medidas algo más predictivas que las variables antropométricas.

Sleep disturbances in Alzheimer's disease are associated with neuropsychiatric symptoms and antidementia treatment.

Sleep disturbances (SDs) in Alzheimer's disease (AD) may significantly affect the behavioral, functional, and cognitive capacities of patients to the point of becoming a major determinant of caregiver burden. We conducted a cross-sectional study in 125 patients with probable AD to assess the association of SDs with neuropsychiatric symptoms, cognitive and functional status of patients, and severity and duration of dementia and to ascertain the role of antidementia drugs in the treatment of SD. SDs were assessed using the questionnaire on sleep disorders in the Neuropsychiatric Inventory. The prevalence of SDs in this sample was 36%. SDs in patients with AD are significantly associated with depression (Wald's test, 3.983; p < 0.05), disinhibition (Wald's test, 5.522; p < 0.05), and aberrant motor behavior (Wald's test, 7.430; p < 0.01). The patients treated with memantine presented lower mean SDs scores (t = 2.76; p < 0.001). These results highlight the need for a standardized and validated approach to the assessment of SDs in AD.