RESUMO
Introduction: Older-age bipolar disorder (OABD) may involve neurocognitive decline and behavioral disturbances that could share features with the behavioral variant of frontotemporal dementia (bvFTD), making the differential diagnosis difficult in cases of suspected dementia. Objective: To compare the neuropsychological profile, brain morphometry, and structural connectivity patterns between patients diagnosed with bvFTD, patients classified as OABD with an early onset of the disease (EO-OABD), and healthy controls (HC). Methods: bvFTD patients (n = 25, age: 66 ± 7, female: 64%, disease duration: 6 ± 4 years), EO-OABD patients (n = 17, age: 65 ± 9, female: 71%, disease duration: 38 ± 8 years), and HC (n = 28, age: 62 ± 7, female: 64%) were evaluated through neuropsychological tests concerning attention, memory, executive function, praxis, and language. Brain morphometry was analyzed through surface-based morphometry (SBM), while structural brain connectivity was assessed through diffusion tensor imaging (DTI). Results: Both bvFTD and EO-OABD patients showed lower performance in neuropsychological tests of attention, verbal fluency, working memory, verbal memory, and praxis than HC. Comparisons between EO-OABD and bvFTD showed differences limited to cognitive flexibility delayed recall and intrusion errors in the memory test. SBM analysis demonstrated that several frontal, temporal, and parietal regions were altered in both bvFTD and EO-OABD compared to HC. In contrast, comparisons between bvFTD and EO-OABD evidenced differences exclusively in the right temporal pole and the left entorhinal cortex. DTI analysis showed alterations in association and projection fibers in both EO-OABD and bvFTD patients compared to HC. Commissural fibers were found to be particularly affected in EO-OABD. The middle cerebellar peduncle and the pontine crossing tract were exclusively altered in bvFTD. There were no significant differences in DTI analysis between EO-OABD and bvFTD. Discussion: EO-OABD and bvFTD may share an overlap in cognitive, brain morphometry, and structural connectivity profiles that could reflect common underlying mechanisms, even though the etiology of each disease can be different and multifactorial.
RESUMO
En el siglo XXI, las transformaciones al sistema social han generado alternativas educativas en las que el fonoaudiólogo adopta un papel importante, por ser un promotor de habilidades comunicativas. La educación en casa es una opción, sin embargo, existen controversias sobre su impacto en el desarrollo de habilidades sociales en los niños. Este artículo realiza una revisión panorámica de la literatura que explora la relación entre el Homeschooling y el desarrollo de la comunicación social. Se incluyen estudios publicados entre el 2000 y el 2020, en idioma español o inglés, con resumen y texto completo. Se excluyeron aquellos que incluían participantes con discapacidad cognitiva o trastornos del aprendizaje. En total de 328 artículos encontrados, sólo 9 cumplieron con los criterios de inclusión. Los documentos seleccionados se analizaron de acuerdo con los componentes de la comunicación social: interacción, cognición social y pragmática en comunicación verbal y no verbal. Existen discrepancias entre los resultados. Algunos autores afirman que las habilidades de comunicación social de los niños que aprenden en sus casas son mejores que las de los niños que van a la escuela, pero, en otros casos, estos solo cumplen con estándares esperados para su edad. Se identificó como determinante el papel de los padres o educadores. Sobre habilidades pragmáticas no se encontraron estudios. En conclusión, la limitación en el número de artículos y la heterogeneidad en las metodologías presentadas no permiten generalizar los resultados a la población. Es evidente la necesidad de realizar estudios en esta área, especialmente en este momento de confinamiento debido a la pandemia por el COVID-19.
In the 21st century, transformations to the social system have generated educational alternatives in which the speech language pathologist as a promoter of communicative skills takes an important role. Home education is an option, however, there are controversies about its impact on children's social skills development. This article is a scoping review that explores the relationship between Homeschooling and the social communication development. Studies published between 2000 and 2020, Spanish or English, with summary and full text are included. Those that included participants with cognitive disabilities or learning disorders were excluded. In total of 328 items found, only 9 met the inclusion criteria. The selected documents were analyzed according to the components of social communication: interaction, social and pragmatic cognition in verbal and nonverbal communication of children. There are discrepancies between the results. Some authors claim that social communication skills of children in homeschooling are better than those of children going to school, but in other cases, theymeet expected standards for their age. The role of parents or educators was identified as decisive. No studies were found in pragmatic skills. In conclusion, the limitation on the number of articles and heterogeneity in the methodologies presented does not allow the results to be generalized to the population. The need for studies in this area is evident, especially at this time of confinement due to the COVID-19 pandemic.
