[Emotion recognition rehabilitation combined with cognitive stimulation for people with Alzheimer's disease. Efficacy for cognition and functional aspects]. / Rehabilitacion del reconocimiento de emociones combinada con estimulacion cognitiva para personas con enfermedad de Alzheimer. Eficacia sobre aspectos cognitivos y funcionales.

INTRODUCTION: The ability to recognize facial emotional expression is essential for social interactions and adapting to the environment. Emotion recognition is impaired in people with Alzheimer's disease (AD), thus rehabilitation of these skills has the potential to elicit significant benefits. AIM: To assess the efficacy of a combined treatment of rehabilitation of emotion recognition (RER) and cognitive stimulation (CS) for people with AD, due to its potential implications for more effective psychosocial interventions. SUBJECTS AND METHODS: 36 patients were assigned to one of three experimental conditions: an experimental group (EG) that received 20 sessions of RER and 20 sessions of CS; a control group (CG) that received 40 sessions of CS, and a treatment as usual group (TAU). RESULTS: 32 patients completed the treatment (77.53 ± 5.43 years). Significant differences were found in MMSE30 (F = 5.10; p = 0.013), MMSE35 (F = 4.16; p = 0.026), affect recognition (Z = -2.81; p = 0.005) and basic activities of daily living (Z = -2.27; p = 0.018) favouring the efficacy of the combined treatment. The TAU group showed a decline in depression (Z = -1.99; p = 0.048), apathy (Z = -2.30; p = 0.022) and anosognosia (Z = -2.19; p = 0.028). CONCLUSIONS: The combined treatment of RER + CS was more effective than TAU and CS alone for the treatment of patients with AD. This is the first study about the rehabilitation of affect recognition in AD.

TITLE: Rehabilitacion del reconocimiento de emociones combinada con estimulacion cognitiva para personas con enfermedad de Alzheimer. Eficacia sobre aspectos cognitivos y funcionales.Introduccion. Se han encontrado deficits en el reconocimiento de emociones en personas con enfermedad de Alzheimer (EA), pero no se ha informado de ningun tratamiento rehabilitador de esta capacidad en esta poblacion. Objetivo. Evaluar la eficacia de un tratamiento combinado de rehabilitacion del reconocimiento de emociones (RRE) y estimulacion cognitiva (EsC) sobre las funciones cognitivas, el estado de animo, la anosognosia, la capacidad funcional y el reconocimiento de emociones de personas con EA. Sujetos y metodos. En un diseño cuasi experimental, 36 pacientes con EA fueron asignados a tres condiciones: un grupo experimental, que recibio 20 sesiones de RRE y 20 sesiones de EsC; un grupo control, que recibio 40 sesiones de EsC, y un grupo que recibio tratamiento usual (GTU). Resultados. Completaron el estudio 32 pacientes, con una edad media de 77,53 ± 5,43 años. Se observo mejoria en el Minimental State Examination en su version de 30 items (F = 5,10; p = 0,013) y en la de 35 (F = 4,16; p = 0,026), reconocimiento de afectos (Z = ­2,81; p = 0,005) y actividades basicas de la vida diaria (Z = ­2,27; p = 0,018) a favor del grupo experimental. El grupo que recibio tratamiento usual empeoro en depresion (Z = ­1,99; p = 0,048), apatia (Z = ­2,30; p = 0,022) y anosognosia (Z = ­2,19; p = 0,028). Conclusiones. El tratamiento combinado de RRE y EsC fue mas eficaz que la EsC y que el tratamiento usual. Es la primera vez que se informa de un tratamiento rehabilitador del reconocimiento de emociones en personas con EA.

Visual form-processing deficits: a global clinical classification.

INTRODUCTION: Patients who have difficulties recognising visual form stimuli are usually labelled as having visual agnosia. However, recent studies let us identify different clinical manifestations corresponding to discrete diagnostic entities which reflect a variety of deficits along the continuum of cortical visual processing. DEVELOPMENT: We reviewed different clinical cases published in medical literature as well as proposals for classifying deficits in order to provide a global perspective of the subject. Here, we present the main findings on the neuroanatomical basis of visual form processing and discuss the criteria for evaluating processing which may be abnormal. We also include an inclusive diagram of visual form processing deficits which represents the different clinical cases described in the literature. Lastly, we propose a boosted decision tree to serve as a guide in the process of diagnosing such cases. CONCLUSIONS: Although the medical community largely agrees on which cortical areas and neuronal circuits are involved in visual processing, future studies making use of new functional neuroimaging techniques will provide more in-depth information. A well-structured and exhaustive assessment of the different stages of visual processing, designed with a global view of the deficit in mind, will give a better idea of the prognosis and serve as a basis for planning personalised psychostimulation and rehabilitation strategies.

[Mild cognitive impairment: early detection and new perspectives]. / Deterioro cognitivo leve: deteccion temprana y nuevas perspectivas.

INTRODUCTION. Along past years, interest in mild cognitive impairment (MCI) research and its early detection has been increased. Unlike first theories, international current proposals suggest that MCI is a syndrome characterized by an impairment in one or more cognitive functions without interfering in daily functional abilities and it is also accompanied by a concern because of the cognitive change. Although early MCI detection is usually made by cognitive screening tests, most of them do not seem to correctly detect MCI, but dementia. AIM. To expose an analysis of the cognitive screening tests more suitable for clinical MCI detection, according to current researches. DEVELOPMENT AND CONCLUSIONS. There are three kind of cognitive screening tests: general cognitive screening tests, specific cognitive screening tests and MCI-subtype cognitive screening test. We observe that most of the tests don't follow current MCI criteria. In this respect we propose to jointly apply tests, as well as the necessity of a carefully test choice to effectively detect MCI in clinical practice.

[Mnemonic performance in patients following surgery to treat an aneurysm affecting the anterior circulation of the brain]. / Rendimientos mnésicos en pacientes intervenidos de un aneurisma de la circulación cerebral anterior.

INTRODUCTION: Patients submitted to surgery to treat a brain aneurysm, who have suffered a subarachnoid haemorrhage, sometimes present cognitive disorders that can affect their social, familial, academic or occupational relationships. Memory disorders are frequent, although other cognitive functions may also be affected. AIMS: The purpose of this research work was to study performance in logical verbal memory and visual-constructional memory in subjects following a surgical intervention (at least a year ago) to treat an aneurysm in the territory of the anterior circulation of the brain. We also wanted to analyse whether the location of the aneurysm in the brain had any effect on memory performance. PATIENTS AND METHODS: We examined a sample of 24 adult subjects of both sexes, with no previous history of cognitive or psychiatric disorders, who had undergone surgical treatment of brain aneurysms in the middle cerebral, anterior communicating and posterior communicating arteries. Neuropsychological tests were performed to assess the general cognitive status, as well as logical verbal and visual-constructional memory. RESULTS: 79% of the patients present a general cognitive status within the range of what could be considered to be normal. In logical verbal memory, 92% present performances within the limits of the expected range of values and 83% did the same in visual-constructional memory. Depending on the location of the aneurysm, significant differences were only found in the delayed evocation of logical verbal material. CONCLUSIONS: A year after the intervention, most of the patients present a pattern of normality in the general cognitive status, and in logical verbal and visual-constructional memory. Yet, in spite of the good neurological resolution, alterations to memory are still to be found, although less frequently. The anatomical location of the aneurysm in the brain affects performance in tasks involving delayed logical verbal memory.

[Neurofunctional aspects of the thalamus]. / El talamo: aspectos neurofuncionales.

AIM: To carry out a revision of the principal neurofunctional aspects of the thalamus. DEVELOPMENT: Following the anatomical location of this cerebral structure in the diencephalon, we'll analyze the macroscopic characteristics of the thalamus establishing its anatomical limits. We'll study the main thalamic nuclei, taking into account different criteria: evolution, anatomical and functional, cytoarchitectonic, and connective fibers as well as the principal projections which reach and leave the thalamus, allowing an adequate information processing. The last part of this paper is dedicated to study of the aspects related with the participation of the thalamus in the basic psychofunctional processes and superior processes. CONCLUSIONS: The thalamus, in addition to its implication along with the cerebral cortex in the analysis and integration of sensitive and motor functions, is implied in superior functions like the attention, language, memory and executive function. The pulvinar nucleus, the lateral nuclear group and the anterior nuclear group take part in the language, fundamentally. In the mnesic processes, the scientific studies show that the midline nuclei, mediodorsal thalamic nuclei and intralaminar nuclei of the thalamus are implied in this superior function. Lesions of the thalamus can cause alterations in the executive functions, attention, initiative and temporal organization of the conduct. The mediodorsal nuclei, the intralaminar nuclei and the midline nuclei has been shown to have a critical role in executive function.

[Mnemonic performance in mild traumatic brain injury]. / Rendimientos mnésicos en el traumatismo craneoencefálico leve.

INTRODUCTION: Over the past few years there has been a lot of discussion over whether the mnemonic disorders that can appear after a mild traumatic brain injury (TBI) present as transitory deficits or can remain as permanent sequelae. AIMS: To study whether there are mnemonic disorders in mild TBI or not, and to examine their evolution over the first year. PATIENTS AND METHODS: 60 adult subjects of both sexes with mild TBI, all of whom satisfied the criteria of the Mild Traumatic Brain Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine, were studied at four different moments of their evolution (during the first seven days, at one month, at six months and at one year after the traumatism). The sample was completed with 60 normal adult subjects who shared similar demographic characteristics. MATERIAL: clinical scales for measuring TBI, cognitive screening tests and neuropsychological mnemonic tests that measure verbal learning, immediate and delayed logical verbal memory, visuospatial and visuo constructive memory. STATISTICAL ANALYSIS: data were analysed using ANOVA of repeated measures and a posteriori testing using Scheffe F test. CONCLUSIONS: Memory was affected in these patients for at least the first week after the traumatic injury took place. At one month, immediate and delayed logical verbal memory and visuo constructive memory showed cognitive performances that were similar to the control group. Learning and the verbal auditory capacity to retain a list of words were still altered one year after the traumatic injury occurred.

[Cognitive deterioration in Parkinson's disease]. / Deterioro cognitivo en la enfermedad de Parkinson.

INTRODUCTION: Whether there are mental changes in Parkinson s disease (EP) or not, has been a confused and contradictory subject since the earliest studies and semiological definition of the disorder. James Parkinson himself, in his study An essay on the shaking palsy (1817), stated that in the condition he described, the sense and intellect were not damaged. DEVELOPMENT: Thanks to the development of cognitive neuropsychology, at the present time there are rather more precise concepts regarding this fascinating area of neurology. We give a summary, as schematic as possible, of theory relating to the known data. 1. The presence or absence of cognitive deterioration in EP 2. The neuropsychological characteristics of cognitive involvement in EP, cognitive defects in incipient EP and in established EP. 3. The risk factor involved in the occurrence of cognitive deterioration. CONCLUSIONS: This knowledge should be used for better understanding of the patient s mental state at every stage of the disease, during follow up studies and for the neuro conductual therapeutic and socio familial approach in each case.

[Neuropsychological assessment in posttraumatic amnesia disorder]. / Evaluación neuropsicológica en el síndrome amnésico postraumático.

INTRODUCTION: The neuropsychological evaluation of memory is an essential investigation in all patients with head injuries, since alterations occur in a high proportion of injured persons and are one of the commonest sequelae. OBJECTIVE: To analyse aspects of the neuropsychological evaluation of memory in head injuries, and the influence of other factors on memory. DEVELOPMENT: Regarding the study of memory capacity, other aspects relative to the presence or absence of posttraumatic amnesia (its characteristics and duration), lacunar-type disorders, retrograde amnesia, anterograde amnesia, ability to learn new information and the position of explicit and implicit memory should be considered. We analyze the instruments for measurement most commonly used for neuropsychological evaluation of memory in patients with head injuries, and the main batteries, tests and scales used for objective evaluation of the presence or absence of memory deficit. We review the main limitations and methodological problems presented by the tests and scales for measurement in this type of population. The instruments of measurement, except for those adapted for the detection of common alterations in head injuries often present serious problems when used to detect posttraumatic deficits. CONCLUSION: Clinically, evaluation of memory should show a profile of the patient's capacities, measure the changes in memory function over time, and predict memory function in everyday activities.

[Classification of the aphasic syndrome]. / Clasificación del síndrome afásico.

INTRODUCTION: The clinical examination of language should form part of the general examination of the mental state in patients with diffuse cognitive disorders, intellectual disorders, disorders of memory, etc. OBJECTIVE: To focus the examination of language towards understanding and classification of linguistic activity, through study of aphasia. DEVELOPMENT: We analyze the semiological diversity of aphasia and most relevant clinical forms using a diagnostic decision tree to consider the clinical, neuropsychological and neuroanatomical characteristics. The more detailed the study of the aphasic disorder, the more difficult it is to fit the case into a particular clinical type. In fact, as may be seen from current publications, there are more and more studies of aphasic persons considered to have unclassifiable aphasia. The more and more detailed studies of neuropsychological disorders mean that we now find terms such as primary progressive aphasia, semantic dementia and anarthria or progressive aphemia. This groups of abnormal linguistic features appearing in patients with focal degenerative illness may lead to some confusion, not only in the clinicosemiological sphere but also with regard to diagnosis, classification and evolution of the disorder. CONCLUSIONS: By studying aphasia we may study the anatomofunctional basis of language more fully, investigate the different systems for processing information, study cases with particular dysfunctions and specifically evaluate, case by case, the numerous, complex components of linguistic activity.

[Neuropsychological evaluation of patients with perceptual and/or motor deficits]. / Evaluación neuropsicológica en pacientes con déficit sensitivo y/o motor.

INTRODUCTION: The task of neuropsychology should be based on confirmation of the suspected deterioration, definition of the degree of deterioration and differentiation between focal and diffuse lesions, and should also apply to the results obtained in different evolutionary assessments. In subjects with particular characteristics--such as is the case of persons with motor and/or sensory deficits--neuropsychological evaluation should take into account the possible defects and be adapted more closely to each individual patient. In spite of the rigorous methodology necessary in all evaluations, the application of protocols should be adapted to each case. The examination of the patient should be varied according to what is required and the particular condition of each patient. We must consider that some aspects of neuropsychological evaluation are specifically related to the neurological function--muscle, tone, reflexes, sensitivity, perception, etc.--which may be affected. Residual disability often includes motor difficulties and problems of perception which should be considered. DEVELOPMENT: In this paper we show the need for the relevant selection of tests and careful interpretation of the results in persons with sensory and/or motor defects, and we describe some tests which are useful for the neuropsychological evaluation of general functions in patients with visual and auditory functions respectively. CONCLUSIONS: It is necessary to know exactly which dysfunction is involved and whether the person is conscious of the deficit. Evaluation should also cover cognitive, social and affective-emotional aspects. It is necessary to work on creating specific tests for particular populations.