Relación entre funciones ejecutivas y trastornos neuropsiquiátricos en pacientes con Alzheimer de diferente grado de severidad / Relationship Between Executive Functions and Neuropsychiatric Disorders in Patients with Alzheimer's Disease of Different Degrees of Severity / Relação entre funções executivas e transtornos neuropsiquiátricos em pacientes com Alzheimer de diferentes estágios de gravidade

El objetivo del estudio fue investigar las funciones ejecutivas (fe) y los trastornos neuropsiquiátricos (tn) en pacientes con enfermedad de Alzheimer (ea), en función del grado de severidad, en comparación con sujetos sin deterioro cognitivo (ssdc). Se estudia-ron 50 pacientes con ea y 60 ssdc en un estudio no experimental-transversal con un muestreo no probabilístico basado en una serie de criterios de inclusión. Se aplicó la batería de evaluación frontal y el inventario neuropsiquiátrico, y los resultados mostraron que existe una relación negativa de intensidad moderada entre las fe y lostn, con independencia del grado de severidad de la ea. Se puede concluir que, en fase leve, la euforia se relaciona tanto con la sensibilidad hacia la interferencia como con el control inhibitorio; en fase moderada, la irritabilidad se relaciona de manera positiva con la sensibilidad hacia la interferencia, y en la fase moderadamente grave, la programación motora se relaciona de manera negativa con la agitación.

The aim of the study was to investigate executive func-tions (ef) and neuropsychiatric disorders (nd) in pa-tients with Alzheimer's disease (ad) according to the degree of severity, compared to subjects without cognitive impairment (swci). Fifty patients with ad and 60 swci were studied in a non-experimental-cross-sectional study with non-probabilistic sampling based on a series of inclusion criteria. The frontal evaluation battery and the neuropsychiatric inventory were applied and the results showed that there is a negative relationship of moderate intensity between ef and nd, regardless of the degree of severity of ad. It can be concluded that, in the mild phase, euphoria is related both to sensitivity towards interference and to inhibitory control; in moderate phase irritability is positively related to sensitivity towards interference; and in the moderately severe phase, motor programming is nega-tively related to agitation.

O objetivo do estudo foi investigar as funções executivas (fe) e os transtornos neuropsiquiátricos (tn) em pacien-tes com doença de Alzheimer (da) de acordo com o estágio de gravidade, em comparação com sujeitos sem comprometimento cognitivo (sscc). Foram avaliados 50 pacientes com da e 60 sscc em um estudo transversal não experimental com amostragem não probabilística baseada em uma série de critérios de inclusão. A bateria de avaliação frontal e o inventário neuropsiquiátrico foram aplicados e os resultados mostraram que existe uma relação negativa de intensidade moderada entre a fe e os tn, independente do estágio de gravidade da da. Pode-se concluir que, na fase leve, a euforia está rela-cionada tanto à sensibilidade à interferência quanto ao controle inibitório; na fase moderada, a irritabilidade está positivamente relacionada à sensibilidade à inter-ferência e; na fase moderadamente grave, a programação motora está negativamente relacionada à agitação.

Perceptions of Older People with Cognitive Impairment, Caregivers, and Professionals about ehcoBUTLER (Tablet Health Care Platform): A Qualitative Focus Group Study.

EhcoBUTLER is a tablet platform mainly aimed at the elderly with mild cognitive impairment (MCI) to promote their well-being and health. The main objective of this study was to explore the perceptions and feedback level of the ehcoBUTLER potential users and stakeholders to improve its development. Through this exploration, the secondary objective was to contribute to the development of software/apps that promote their integral health. Focus groups were conducted (13 elderly with MCI, 13 with dementia, 12 caregivers, 11 professionals). The content and feedback level were analyzed. Participants liked the appearance of ehcoBUTLER, would like to use it, and were mainly interested in the emotional, healthy lifestyle, cognitive, and ergonomic tools. It is necessary to have prior training, more intuitive/customizable apps, low-price/free, offline/USB content, and add other activities/features. EhcoBUTLER is well-oriented to meet the needs and preferences of potential users. However, improvements in its usability, accessibility, and sustainability are needed. The participants' perspectives provided a comprehensive view to improve ehcoBUTLER, so that in the future, it can benefit the elderly to be active agents in their health; support caregivers in their role and to have a respite; and professionals to have a multi-intervention platform. The present findings can contribute to the development of tablet software/apps that promote the integral well-being of this population.

Programas de formación para el apoyo entre iguales en salud mental en España / Training programs for peer support in mental health in Spain

Resumen Los problemas de salud mental son un tema relevante en todo el mundo. Pese a los avances, es necesario continuar trabajando para mejorar la calidad de vida del colectivo. La educación y el apoyo entre iguales son estrategias muy adecuadas para contribuir a su integración socio-laboral. Se ha realizado una revisión bibliográfica en bases de datos y páginas web para identificar experiencias españolas de formación de personas con Trastorno Mental Severo (TMS) basadas en el apoyo entre iguales. Se han encontrado siete experiencias de formación para el colectivo, cinco de ellas centradas en el apoyo entre iguales y otras en la figura de el/la asistente personal. El número de experiencias encontradas en España es muy reducido. Aunque los objetivos son comunes, se observan enfoques diferentes (entorno sanitario, laboral, social) que pueden ser muy relevantes para el diseño y aplicación de otras experiencias en diferentes contextos.

Abstract Mental health problems are a relevant issue all around the world. Mental illness affects one in four people throughout their lives, causing serious socio-economic and human rights-related consequences. In Spain, despite the progress made with psychiatric reform and the promotion of a community model, it is necessary to continue working to improve the quality of life of people with mental health problems. Education and peer support are highly recommended strategies to contribute to their social and occupational integration. Peer support is a relationship based on mutual support. It is established between two people: the person with mental health problems trained to provide the support and the person who receives it. This support enhances the recovery process. For this support to be effective, it is essential to previously train the person who will undertake the counselling functions. The relationship of support offers practical advice, suggestions, strategies and emotional and psychological support. In addition, maintaining an non-professional perspective is essential to help people to rebuild their sense of community after an unknown experience. Peer support brings benefits to all parties involved: support providers, receivers and implementing organizations or institutions. However, training programs for peer support are not widespread. In Spain, despite the recognition of the need to integrate people with mental health problems into society and to respond to their needs, there is no published research on guidelines for such training programs. For this reason, this research identifies the peer support training programs which have been or are being carried out in Spain and describe their formal characteristics. A bibliographic review of databases and web pages has been undertaken to identify Spanish experiences of training people with Severe Mental Disorder (SMD) based on peer support and to describe their formal characteristics (duration, methodology, evaluation and workplace). A total of 77 programs found in the electronic databases, 75 of which have been excluded as they are not Spanish experiences. Five programs were found in the searches carried out on the reports of conferences, congresses and websites of Spanish organizations and institutions. Finally, seven training experiences were selected for the group, five of them focused on peer support and others on the figure of the personal assistant. The study of the programs is carried out following the indications of the content analysis model. The training programs described have common objectives, however, they vary considerably in their approach, duration, names of support and evaluation providers and, to a lesser extent, in the contents, methodology and workplaces. Despite the expansion of peer support in mental health, the number of experiences found in Spain is limited. Any program must be adapted to the strengths of the individuals, the type of work, as well as to the needs of the community. Furthermore, if this new professional profile is regulated at work, it will contribute to improving the rates of social and occupational integration of people with mental health problems. It is necessary to continue developing and implementing experiences of these characteristics and to investigate their efficiency and effectiveness in order to be able to provide guidelines on peer support in the Spanish population.

Usability and User Experience of Cognitive Intervention Technologies for Elderly People With MCI or Dementia: A Systematic Review.

INTRODUCTION: Incorporating technology in cognitive interventions represents an innovation, making them more accessible, flexible, and cost-effective. This will not be feasible without adequate user-technology fit. Bearing in mind the importance of developing cognitive interventions whose technology is appropriate for elderly people with cognitive impairment, the objective of this systematic review was to find evidence about usability and user experience (UX) measurements and features of stimulation, training, and cognitive rehabilitation technologies for older adults with mild cognitive impairment (MCI) or dementia. METHOD: The Medline, PubMed, Scopus, ScienceDirect, and PsycINFO databases were searched for literature published in the last 10 years (2009-2019), and three researchers independently reviewed potentially eligible studies, following specific inclusion criteria. A systematic review of the studies was conducted, presenting a qualitative synthesis of usability and UX measures with their outcomes, study characteristics and features of the cognitive intervention technologies. RESULTS: Ten studies were selected: five were cognitive stimulation and five were cognitive training. Most of them (60%) were computer-based programs with a serious game format. Efficiency and effectiveness were the most frequent measurements used for collecting objective usability data, showing that elderly people with cognitive impairment require more time (45%) and help (40%) but can complete tasks (60%). Regarding UX or subjective usability data, questionnaires and scales were the most used methods, reporting positive experience despite certain difficulties with the interface in five studies. CONCLUSION: Measuring usability and UX in cognitive intervention technologies for older adults with MCI or dementia provides an integrated view that can contribute to their development according to the needs and characteristics of the target population. More research is required to include this population group in usability and UX studies, as well as standardized tools and consensus on the relationship of these terms to guarantee the future effectiveness of cognitive intervention technologies. REVIEW REGISTRATION: This review was registered in the PROSPERO (CRD42020158147) International Register of Systematic Review Protocols.

Memory and Executive Dysfunction Predict Complex Activities of Daily Living Impairment in Amnestic Multi-Domain Mild Cognitive Impairment.

BACKGROUND: Specific cognitive alterations could be one of the predictors that lead to the complex activities of daily living (CADL) impairment in mild cognitive impairment (MCI) and, hence, help to explain the continuum between MCI and dementia. OBJECTIVE: We aimed to reevaluate the existing uncertainty regarding the impact of memory and executive functions on CADL in patients with MCI. METHODS: Caregivers of 161 patients with amnestic multi-domain MCI and of 150 patients with incipient Alzheimer's disease as well as 100 age-, sex-, and education-matched controls, completed the Interview for Deterioration in Daily Living Activities in Dementia, a suitable instrument for the description and discrimination of CADL. In addition, all patients and controls were assessed with a neuropsychological battery to measure explicit memory and executive functions performance. RESULTS: Multiple regression analyses showed that in the group of patients with amnestic multi-domain MCI, 67.4% of the variability of the CADL impairment was explained by worse performance on executive functions tests (p < 0.0001) and 41.8% by different explicit memory components impairment (p < 0.0001). Further, in patients with incipient AD, 44.0% of the variability of CADL impairment was explained by worse performance on executive functions tests (p < 0.0001) and 39.9% by different explicit memory components worsening (p < 0.0001). CONCLUSIONS: Memory and executive functions alterations impact similarly on the CADL in both amnestic multi-domain MCI and incipient Alzheimer's disease. Given the continuum that exists between both conditions, we conclude that CADL impairment may be an important early step in the evolution towards Alzheimer's disease from amnestic multi-domain MCI.

Study on the Acceptability of an ICT Platform for Older Adults with Mild Cognitive Impairment.

EhcoBUTLER is an Information and Communication Technology (ICT) solution funded by the European Union (H2020; ID: 643566) and intended especially for elderly people with mild cognitive impairment (MCI) to improve their health, independence and quality of life, particularly at the social level. The purpose of this study is to assess the acceptability of ehcoBUTLER based on a survey delivered to potential users and actors involved in their care, exploring their expectations and preferences, while anticipating the system's functional requirements. The survey was delivered online to 313 participants (11% end users, 25% informal caregivers, 48% formal caregivers and 16% administration/management staff) from eight countries. Participants rated the different functionalities of ehcoBUTLER positively, 86.1% perceiving it as an interesting and useful system. Likewise, they assessed it as a commercially attractive product (75.1%). End users expressed a stronger preference for the social module. Nevertheless, they would be ready to pay a low monthly price for ehcoBUTLER. Professionals would be willing to pay choosing its functionalities modularly, but they would also expect it to be funded by the National Health System, centres or businesses. The conclusion is that all participants found ehcoBUTLER interesting, useful and ergonomic. However, to effectively implement it, it is necessary to bridge the digital gap and address the issue of insufficient investment in products aimed at older adults with cognitive impairment. To supplement cognitive training systems with social, emotional or entertainment functionalities could improve adherence to their use.

Síntomas disejecutivos y reflejos frontales en pacientes con enfermedad de Alzheimer / Dysexecutive symptoms and frontal reflexes in patients with Alzheimer disease

INTRODUCCIÓN. La enfermedad de Alzheimer, supone la primera causa de demencia y produce múltiples alteraciones cognitivas como la afectación de las funciones ejecutivas. Esos pacientes presentan síntomas disejecutivos y alteración en los reflejos de liberación frontal, aunque se desconoce si están afectados en función del grado de severidad de la demencia. OBJETIVO. Determinar si existe una relación entre los Síntomas Disejecutivos y los Reflejos de Liberación Frontal en pacientes con enfermedad de Alzheimer. MATERIALES Y MÉTODOS. Se realizó un estudio descriptivo, retrospectivo; se analizaron 23 pacientes con demencia tipo Alzheimer del Centro de Referencia Estatal de Atención a Personas con Enfermedad de Alzheimer, durante el periodo 2013-2014. Los datos fueron obtenidos mediante el cuestionario disejecutivo, y analizados mediante la prueba X2 y la U de Mann-Whitney. RESULTADOS. Las edades de los participantes oscilaron entre 55 y 90 años. La media de puntuaciones según el cuestionario disejecutivo, arrojó un valor de 21,69. En la planificación se observó diferencias significativas entre los pacientes con Alzheimer leve y moderado (p=0,020); así como, entre la fase leve y la moderadamente grave (p=0,014). En la conciencia social resultó similar entre la etapa leve y la moderada (p=0,036). CONCLUSIÓN. Los reflejos de liberación frontal y los síntomas disejecutivos estuvieron afectados, pero no se evidenció relación entre estos y el grado de severidad de enfermedad de Alzheimer. Se refutó la hipótesis que, a mayor grado de severidad, mayor afectación disejecutiva y de los reflejos de liberación frontal.

INTRODUCTION. Alzheimer's disease is the leading cause of dementia and produces multiple cognitive disorders such as the involvement of executive functions. These patients present with dysexecutive symptoms and impaired frontal release reflexes, although it is unknown whether they are affected depending on the severity of the dementia. OBJECTIVE. To determine if there is a relationship between the Dissecutive Symptoms and the Frontal Release Reflexes in patients with Alzheimer's disease. MATERIALS AND METHODS. A descriptive, retrospective study was carried out; 23 patients with Alzheimer's dementia from the State Reference Center for Care for People with Alzheimer's Disease were analyzed during the 2013-2014 period. The data were obtained through the dissertation questionnaire, and analyzed using the X2 test and the Mann-Whitney U test. RESULTS. The ages of the participants ranged from 55 to 90 years. The average of scores according to the executive questionnaire showed a value of 21,69. In the planning, significant differences were observed between patients with mild and moderate Alzheimer's disease (p = 0.020); as well as between the mild and moderately severe phase (p = 0.014). In social consciousness it was similar between the mild and moderate stages (p = 0.036). CONCLUSION. Frontal release reflexes and dissecting symptoms were affected, but no relationship between them and the severity of Alzheimer's disease was evident. The hypothesis was refuted that, to a greater degree of severity, greater disejecutiva involvement and frontal release reflexes.

Función ejecutiva en pacientes con trastorno bipolar tipo I durante la fase asintomática / Executive functions in patients with bipolar disorder type I during asymptomatic phase

La función ejecutiva se ve involucrada en la mayor parte de las actividades que realizamos a diario, repercutiendo en la calidad de vida de las personas. Los rendimientos ejecutivos en el trastorno bipolar tipo I pueden fluctuar en función de la fase clínica en la que se encuentra el paciente. El objetivo de este trabajo se centra en revisar los hallazgos encontrados respecto a la función ejecutiva durante la fase asintomática del trastorno bipolar tipo I. Se han analizado 37 artículos científicos que abordan el rendimiento ejecutivo de pacientes eutímicos con trastorno bipolar tipo I. Se puede concluir que la mayoría de los estudios reportan dificultades ejecutivas en estos pacientes, aunque no parece existir consenso en los diferentes trabajos al indicar el tipo de déficit. Esta falta de acuerdo podría ser debida a aspectos metodológicos de los estudios y a distintas variables clínicas y farmacológicas. Las alteraciones ejecutivas en la eutimia son menores que en las fases agudas del trastorno y afectan sobre todo a la velocidad de procesamiento de la información. Los déficits ejecutivos de los pacientes podrían estar vinculados a posibles alteraciones funcionales a nivel de la corteza prefrontal, así como al propio efecto de los psicofármacos utilizados. Sería de especial relevancia que el tratamiento de estos pacientes incorporase estas alteraciones, lo que podría conseguirse mediante un enfoque neurocognitivo dentro de un abordaje terapéutico integrado...

Executive function is present in most of dairy activities, so it influences in quality of life. Executive performances in bipolar disorder type I can change in function of clinical phase that patient is. The aim of this work is to review the studies that have investigated executive function during asymptomatic phase in bipolar disorder type I. It has been analyzed 37 scientific articles that examine executive performance in euthymic patients with bipolar disorder type I. It can be concluded that bipolar patients in asymptomatic phase suffer executive difficulties, but it doesn’t seem to exist consensus regarding the type of deficits. This lack of agreement could be due to methodological diversity in studies, as well as the influence of different clinical or pharmacological variables. Executive alterations in euthymic phase are lower than the acute phases in bipolar disorder and affect mainly to processing speed. Executive deficits in patients could be linked to possible functional alterations in prefrontal cortex, as well as the psychopharmacological effect. It would be specially relevant treatment in bipolar disorder keep in mind this alterations, which it can get it with a neurocognitive approach within integrate treatment...

Rehabilitación Cognitiva en pacientes con Enfermedad de Alzheimer / Cognitive Rehabilitation in patients with Alzheimer's Disease

La enfermedad de Alzheimer ( EA) es una enfermedad crónica que se caracteriza por la presencia de síntomas cognitivos, problemas físicos y alteraciones emocionales y/o comportamentales. Actualmente más de 24 millones de personas en el mundo han sido diagnosticadas con EA, y se calcula que para 2040 el número será de 81 millones. El objetivo de este artículo es hacer una revisión detallada de las diferentes técnicas y/o tratamientos cognitivos que se han venido utilizando en la rehabilitación de las alteraciones cognitivas de personas con EA, así como de los estudios existentes que evalúan su eficacia. Los principales resultados de la revisión evidencian la aplicación de tratamientos cognitivos mediante técnicas como estimulación cognitiva, aprendizaje sin error, recuperación espaciada, imaginería visual, desvanecimiento de pistas y ayudas externas. La mayoría de tratamientos revisados utilizaron técnicas de manera combinada, las cuales se implementaron en etapas iniciales de la EA; varios de los estudios revisados demostraron el mantenimiento a largo plazo de las ganancias obtenidas en algunos tratamientos.

Alzheimer's disease ( AD) is a chronic illness characterized by the presence of cognitive and physical impairments and emotional and/or behavioral disturbances. Nowadays, over 24 million people around the world are diagnosed with AD and it is estimated that in 2040 this number will rise to 81 million. The objective of this article was to review in detail the different techniques and/or cognitive treatments that have been developed in the rehabilitation of cognitive impairments of population with AD, and the existing papers that test their efficacy. The main results evidence the use of techniques such as cognitive stimulation, errorless learning, spaced retrieval, visual imagery, vanishing cues and external aids. Most of the reviewed treatments used these techniques combined, with patients in the initial stages of AD; many of the papers reviewed demonstrated long term maintenance of the positive results of some treatments.

[Primary progressive non-fluente aphasia]. / Afasia progressiva primária de tipo não fluente.

When a subject shows changes in his/her ability to express himself/herself verbally or to understand the messages from the people he/she relates with, it is customary to say that such a person has a language disorder, nosologically classified in the field of aphasias. In this article, we show the case of a patient diagnosed with progressive aphasia, where such a diagnosis describes the data resulting from the neuropsychological assessment process. Finally, we provide a few reflections with regard to the case.