Cognitive impairment in hoarding disorder: a systematic review.

OBJECTIVE: In the present study, we aimed to perform a systematic review evaluating the cognitive performance of patients with hoarding disorder (HD) compared with controls. We hypothesized that HD patients would present greater cognitive impairment than controls. METHODS: A systematic search of the literature using the electronic databases MEDLINE, SCOPUS, and LILACS was conducted on May 2020, with no date limit. The search terms were "hoarding disorder," "cognition," "neuropsychology," "cognitive impairment," and "cognitive deficit." We included original studies assessing cognitive functioning in patients with HD. RESULTS: We retrieved 197 studies initially. Of those, 22 studies were included in the present study. We evaluated 1757 patients who were 41 to 72 years old. All selected studies comprised case-control studies and presented fair quality. Contrary to our hypothesis, HD patients showed impairment only in categorization skills in comparison with controls, particularly at confidence to complete categorization tasks. Regarding attention, episodic memory, working memory, information-processing speed, planning, decision-making, inhibitory control, mental flexibility, language, and visuospatial ability, HD patients did not show impairment when compared with controls. There is a paucity of studies on social cognition in HD patients, although they may show deficits. The impact of emotion in cognition is also understudied in HD patients. CONCLUSION: Except for categorization skills, the cognitive performance in HD patients does not seem to be impaired when compared with that in controls. Further work is needed to explore social cognition and the impact of emotion in cognitive performance in HD patients.

Interview-based assessment of cognition is a strong predictor of quality of life in patients with schizophrenia and severe negative symptoms

Objective: To analyze the correlation between quality of life, symptoms, and cognition assessed by the interview-based Schizophrenia Cognition Rating Scale (SCoRS). Methods: Seventy-nine outpatients diagnosed with schizophrenia were evaluated with the Quality of Life Scale – Brazilian version (QLS-BR), the SCoRS, and symptoms scales (Positive and Negative Syndrome Scale [PANSS]). After determining the potential explanatory variables using Spearman’s correlation and Student’s t test results, we ran simple, multivariate, and decision-tree regression analyses to assess the impact of SCoRS and PANSS ratings on mean overall quality of life. Results: Cognitive deficits and negative symptoms were the best predictors of quality of life. A low degree of negative symptoms (PANSS negative < 11) was a strong predictor of better quality of life (QLS ∼ 75), regardless of SCoRS rating. Among participants with more severe negative symptoms, elevated cognitive impairment (interviewer SCoRS ∼ 44) was a predictor of worse quality of life (QLS ∼ 44). Conclusions: Cognitive impairment determined by interview-based assessment seems to be a strong predictor of quality of life in subjects with severe negative symptoms. These results support the usefulness of SCoRS for cognitive assessment that is relevant to the everyday life of patients with schizophrenia.

Interview-based assessment of cognition is a strong predictor of quality of life in patients with schizophrenia and severe negative symptoms.

OBJECTIVE: To analyze the correlation between quality of life, symptoms, and cognition assessed by the interview-based Schizophrenia Cognition Rating Scale (SCoRS). METHODS: Seventy-nine outpatients diagnosed with schizophrenia were evaluated with the Quality of Life Scale - Brazilian version (QLS-BR), the SCoRS, and symptoms scales (Positive and Negative Syndrome Scale [PANSS]). After determining the potential explanatory variables using Spearman's correlation and Student's t test results, we ran simple, multivariate, and decision-tree regression analyses to assess the impact of SCoRS and PANSS ratings on mean overall quality of life. RESULTS: Cognitive deficits and negative symptoms were the best predictors of quality of life. A low degree of negative symptoms (PANSS negative < 11) was a strong predictor of better quality of life (QLS ∼ 75), regardless of SCoRS rating. Among participants with more severe negative symptoms, elevated cognitive impairment (interviewer SCoRS ∼ 44) was a predictor of worse quality of life (QLS ∼ 44). CONCLUSIONS: Cognitive impairment determined by interview-based assessment seems to be a strong predictor of quality of life in subjects with severe negative symptoms. These results support the usefulness of SCoRS for cognitive assessment that is relevant to the everyday life of patients with schizophrenia.

Decreased plasma neurotrophin-4/5 levels in bipolar disorder patients in mania

Objective: To evaluate two poorly explored neurotrophins (NT), NT-3 and NT-4/5, in bipolar disorder (BD). Methods: Forty patients with type I BD (18 in remission and 22 in mania) and 25 healthy controls matched for age, gender, and educational attainment were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview; the Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to evaluate severity of symptoms in BD patients. Plasma levels of NT-3 and NT-4/5 were measured by enzyme-linked immunosorbent assay (ELISA). Results: BD patients in mania presented decreased NT-4/5 plasma levels in comparison with controls (p < 0.05). There were no significant differences in NT-3 plasma levels between BD patients and controls. Conclusion: These findings corroborate the view that neurotrophin dysfunction is associated with mood states in patients with BD. .

Decreased plasma neurotrophin-4/5 levels in bipolar disorder patients in mania.

OBJECTIVE: To evaluate two poorly explored neurotrophins (NT), NT-3 and NT-4/5, in bipolar disorder (BD). METHODS: Forty patients with type I BD (18 in remission and 22 in mania) and 25 healthy controls matched for age, gender, and educational attainment were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatric Interview; the Young Mania Rating Scale and the Hamilton Depression Rating Scale were used to evaluate severity of symptoms in BD patients. Plasma levels of NT-3 and NT-4/5 were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS: BD patients in mania presented decreased NT-4/5 plasma levels in comparison with controls (p < 0.05). There were no significant differences in NT-3 plasma levels between BD patients and controls. CONCLUSION: These findings corroborate the view that neurotrophin dysfunction is associated with mood states in patients with BD.

Antidepressants for depression in Parkinson's disease: systematic review and meta-analysis.

Depression is common in Parkinson's disease (PD) and is associated with several poor outcomes. However the literature regarding treatment with antidepressants in this population is controversial. The aim of this paper was to systematically review all randomized controlled trials that studied the efficacy of antidepressants for depression in PD (dPD). Studies were retrieved from PubMed (1966-July 2012), Cochrane Library (-July 2012, issue 7), Embase (1980-July 2012), PsycINFO (1980-July 2012), Lilacs (1982-July 2012), secondary references, clinical trials registries and a thesis database. Only double-blind, randomized controlled trials in which an antidepressant was given as the main treatment and compared with placebo and/or another antidepressant were included. Out of the 1438 studies retrieved, only six could be included. Taking into account the five placebo-controlled trials, the overall risk ratio (RR) for response was 1.36 (0.98, 1.87), indicating no statistically significant superiority of antidepressants over placebo. However, in the sensitivity analysis, the RR for response was 1.41 (1.01, 1.96) and 1.48 (1.05, 2.10) after exclusion of one study with questionable results, and when only studies with low risk of bias were considered, respectively. No specific antidepressant class was superior to placebo. In general antidepressant medications were well tolerated. The results suggest antidepressants may be efficacious in the treatment of dPD. However, the results were unstable. In fact, the small number of trials and methodological drawbacks preclude definitive conclusions about their efficacy and tolerability in dPD.

Neuropsychological performance and menstrual cycle: a literature review.

Approximately 80% of all women of reproductive age experience psychological and physical changes associated with the premenstrual phase. Cognitive alterations are among the most common complaints. In this context, studies have assessed cognitive performance across the menstrual cycle in healthy women and also in women with premenstrual syndrome (PMS). The main objective of the present study was to review the literature on cognitive function in different phases of the menstrual cycle in women of reproductive age, both healthy and with PMS, in particular premenstrual dysphoric disorder (PMDD). We searched MEDLINE and LILACS databases. A total of 27 studies were selected. The studies used heterogeneous methodologies. Most studies suggested that healthy women show small fluctuations in cognitive performance across the menstrual cycle, with low performance scores in the luteal phase for visuospatial and motor skills, attention and concentration, verbal memory, visual memory, working memory, and reaction time. Among women with PMS or PMDD, low performance scores for visuospatial and motor skills, attention and concentration, verbal memory, working memory, reaction time and impulsivity were also detected in the luteal phase. Symptoms observed in PMS/PMDD patients showed low intensity, but greater when compared with healthy women. Evidence indicates fluctuations in cognitive performance in the different phases of the menstrual cycle in healthy and PMS women, with worse performance for women with PMS/PMDD in the luteal phase. However, methodological limitations prevent us from drawing solid conclusions. Further studies are needed to investigate the impact of these cognitive fluctuations on patients' daily activities.

Desempenho neuropsicológico e ciclo menstrual: revisão da literatura / Neuropsychological performance and menstrual cycle: a literature review

Approximately 80% of all women of reproductive age experience psychological and physical changes associated with the premenstrual phase. Cognitive alterations are among the most common complaints. In this context, studies have assessed cognitive performance across the menstrual cycle in healthy women and also in women with premenstrual syndrome (PMS). The main objective of the present study was to review the literature on cognitive function in different phases of the menstrual cycle in women of reproductive age, both healthy and with PMS, in particular premenstrual dysphoric disorder (PMDD). We searched MEDLINE and LILACS databases. A total of 27 studies were selected. The studies used heterogeneous methodologies. Most studies suggested that healthy women show small fluctuations in cognitive performance across the menstrual cycle, with low performance scores in the luteal phase for visuospatial and motor skills, attention and concentration, verbal memory, visual memory, working memory, and reaction time. Among women with PMS or PMDD, low performance scores for visuospatial and motor skills, attention and concentration, verbal memory, working memory, reaction time and impulsivity were also detected in the luteal phase. Symptoms observed in PMS/PMDD patients showed low intensity, but greater when compared with healthy women. Evidence indicates fluctuations in cognitive performance in the different phases of the menstrual cycle in healthy and PMS women, with worse performance for women with PMS/PMDD in the luteal phase. However, methodological limitations prevent us from drawing solid conclusions. Further studies are needed to investigate the impact of these cognitive fluctuations on patients' daily activities.

Cerca de 80% das mulheres em idade fértil apresentam alterações psicológicas e físicas associadas à fase pré-menstrual. Dentre as queixas mais comuns estão as alterações cognitivas. Nesse contexto, tem-se estudado o desempenho cognitivo ao longo do ciclo menstrual de mulheres com e sem síndrome pré-menstrual (SPM). O objetivo principal deste estudo foi revisar a literatura acerca do desempenho das funções cognitivas nas diferentes fases do ciclo menstrual de mulheres em idade reprodutiva, sadias ou portadoras de SPM, em particular o transtorno disfórico pré-menstrual (TDPM). Foram revisadas as bases de dados MEDLINE e LILACS. Um total de 27 estudos foram selecionados. Os estudos eram heterogêneos em suas metodologias. Em sua maioria, os trabalhos evidenciaram que mulheres sadias apresentam variações leves no desempenho cognitivo ao longo do ciclo menstrual, obtendo menor pontuação, durante a fase lútea, nas habilidades visuoespaciais e motoras, atenção e concentração, memória verbal, memória visual, memória de trabalho e tempo de reação. Entre as mulheres com SPM ou TDPM, foi identificada, na fase lútea, redução no desempenho das habilidades visuoespaciais e motoras, atenção e concentração, memória verbal, memória de trabalho, tempo de reação e impulsividade. Tais sintomas apresentaram intensidade leve, porém superior à observada em mulheres sadias. As evidências indicam a existência de variações no desempenho cognitivo ao longo das diferentes fases do ciclo menstrual de mulheres sadias ou com SPM, com desempenho cognitivo pior em mulheres com SPM/TDPM na fase lútea. Entretanto, limitações metodológicas impedem conclusões sólidas. Novos estudos são necessários para investigar o impacto dessas oscilações cognitivas nas atividades cotidianas dos pacientes.

Association between sleep duration and all-cause mortality in old age: 9-year follow-up of the Bambuí Cohort Study, Brazil.

This study investigates the association of sleep duration with risk of all-cause mortality among elderly Brazilians using data from a 9-year population-based cohort study and applying a multivariable longitudinal categorical and continuous analysis using Cox's proportional hazards models. This analysis used data from the Bambui Health and Ageing Study (BHAS), conducted in Bambuí city (approximately 15000 inhabitants) in southeastern Brazil. The study population comprised 1512 (86.8%) of all eligible 1742 elderly residents. In multivariable analysis, using sleep duration as categorical variable and controlling for multiple measures of sociodemographic and health status, those who slept 9h or more per night were found to be at higher risk of mortality than those who slept 7h [hazard ratio (HR): 1.53; 95% confidence interval (CI): 1.12-2.09]. Excluding those whose deaths occurred within 2years after entry, this association remained significant (HR: 1.56; 95% CI: 1.12-2.18). In analyses using sleep duration as a continuous variable, a linear correlation was found between sleep duration and mortality in all adjusted models in the whole sample (HR: 1.08; 95% CI: 1.02-1.15) and following exclusion of those whose deaths occurred within 2years after entry (HR: 1.13; 95% CI: 1.06-1.21). Both linear and quadratic terms were significant, reflecting a predicted relationship, with mortality predominantly increasing in association with long sleep duration but with the addition of a slight decrease in association with shorter sleep duration. In conclusion, long rather than short sleep duration was associated principally with all-cause mortality in this sample. It is therefore reasonable to suggest that clinicians should be aware of the potential adverse prognosis associated with prolonged sleep.

Higher rate of major depression among blood donor candidates infected with human t-cell lymphotropic virus type 1.

OBJECTIVE: Viral infections have been previously associated with psychiatric disorders. This work aimed to study the relationship between the human T-cell lymphotropic virus type 1 (HTLV-1) and depression. METHOD: A case-control study with prevalent cases was conducted from April 2004 to June 2005. Participants were from a public transfusion center in Belo Horizonte, Brazil. The base population was composed of blood donor candidates infected with HTLV-1 (asymptomatic carriers), followed-up in a cohort study. As a control group, HTLV-1 seronegative blood donors were selected in a random fashion. Study participants underwent psychiatric evaluation using a structured diagnostic instrument, the Mini International Neuropsychiatry Interview (MINI), to estimate the rate of depression. The interviewer was unaware of participants' HTLV-1 serostatus. The co-variables studied were gender, age, formal education, personal income, and the presence of other psychiatric diagnoses. Logistic regression was used to examine the relation between HTLV-1 infection and depression. RESULTS: The final sample was composed of 74 individuals infected with HTLV-1 and 24 uninfected controls. The rate of depression was significantly higher in HTLV-1 carriers when compared with controls (39% vs. 8%; p-value = 0.005). HTLV-1 infection was independently associated with depression (OR = 6.17; CI 95% = 1.32-28.82). CONCLUSIONS: The results showed a higher rate of depression in HTLV-1 infected individuals. It was not possible to determine whether depression was related to knowledge of chronic retroviral infection or related to a biological effect of the retroviral infection.

Eletroconvulsoterapia na terapêutica da mania em paciente com hidrocefalia / Eletroconvulsotherapy in the treatment of patient with mania and hydrocephalus

A evidência de segurança e eficácia do emprego de eletroconvulsoterapia (ECT) no tratamento de transtornos psiquiátricos em pacientes com distúrbios neurológicos é fundamentada, em geral, em relatos de casos. Em relação ao emprego em pacientes com hidrocefalia, há apenas oito casos descritos: seis abordando o tratamento de episódios depressivos, um para estado catatônico e um relato em paciente com auto-agressão. Os autores descrevem o caso de um paciente com 20 anos de idade, diagnóstico de hidrocefalia aos 12 anos, internado em ala psiquiátrica com episódio maníaco com sintomas psicóticos. Houve remissão completa da sintomatologia após quatro sessões de ECT. Não houve deterioração neurológica ou outros efeitos colaterais. O resultado sugere que a ECT é segura e eficaz no tratamento de episódios maníacos em pacientes com hidrocefalia.

Safety and efficacy evidence on the use of electroconvulsive therapy (ECT) in the treatment of psychiatric patients with neurological diseases is generally based on case reports. In relation to the use of ECT on patients with hydrocephalus, there are only eight case reports: six for depressive episodes, one for catatonic state and one for self-aggression. In this article the authors describe the case of a 20-year-old male patient, with a hydrocephalus diagnosis since the age of 12, admitted to a psychiatric hospital suffering from a manic episode with psychotic symptoms. There was complete remission of symptoms after four sessions of ECT, with no neurological damage or other side effects. The result suggests that ECT is safe and effective in treating manic episodes in patients with hydrocephalus.

Prevalence of undernutrition in elderly patients hospitalized in a geriatric unit in Belo Horizonte, MG, Brazil.

OBJECTIVES: We evaluated, from anthropometric and biochemical indicators, the prevalence of undernutrition within an elderly population hospitalized in Belo Horizonte, Minas Gerais, Brazil, and identified social demographic, clinical and biochemical factors associated with undernutrition. METHODS: A transverse sectional study involving 197 elderly patients was conducted. Anthropometric data were obtained from subjects directly or indirectly; clinical characteristics, including health problems, functional and cognitive abilities, and use of medication, were gathered from medical records; social demographic information was acquired by interviewing the subject or carer. Logistic regression analysis was employed to identify factors associated with undernutrition. RESULTS: According to the body mass index cutoff points recommended by the World Health Organization, 29.7% of subjects were classified as undernourished and 43.8% as eutrophic. Application of the Nutrition Screening Initiative system gave rise to an inverse situation in which 54.7% of subjects were considered undernourished and only 29.2% were eutrophic. Statistical analysis of the studied variables showed that calf circumference < or =31 cm was significantly associated with undernutrition (P < 0.0001) irrespective of the classification system employed, and may thus be considered a strong marker for undernutrition. In contrast, total serum cholesterol level > or =4.14 mmol/L was identified as a protective factor against undernutrition (P = 0.01). CONCLUSION: The prevalence of undernutrition among the hospitalized elderly in Brazil is very high. The measurement of calf circumference is a non-invasive and economical approach that can facilitate evaluation of the nutritional status of elderly individuals.

Síndrome metabólica em pacientes psiquiátricos: orientações para prevenção, diagnóstico e tratamento / Metabolic syndrome in psychiatric patients: guidelines to prevention, diagnosis and treatment

Objetivo: Pacientes que padecem de transtornos mentais apresentam morbidade elevada e são freqüentemente negligenciados em termos de assistência a doenças não-psiquiátricas. Estudos recentes têm apontado para uma alta prevalência de síndrome metabólica (SM) nessa população. Este estudo propõe-se a estabelecer orientações quanto às condutas a serem tomadas para detecção, prevenção e tratamento da SM em pacientes psiquiátricos. Método: Procedeu-se a uma pesquisa eletrônica na base de dados MEDLINE e na Literatura Latino-Americana e do caribe em Ciências da Saúde (LILACS) até junho de 2005, buscando-se artigos que versassem sobre tratamento de SM e, em especial, de SM e de transtornos metabólicos correlatos em pacientes psiquiátricos. Resultados: Medidas visando à melhora dos hábitos dietéticos e ao aumento da atividade física são fundamentais no tratamento da SM. Atenção especial deve ser dada a sua prevenção e detecção precoce, em especial naqueles pacientes que estão utilizando ou iniciarão o uso de antipsicóticos ou estabilizadores de humor. Em se tratando de pacientes de risco para o desenvolvimento da SM, o psiquiatra deve optar por psicofármacos com poucos efeitos adversos metabólicos. Os medicamentos para tratamento dos distúrbios metabólicos devem ser reservados a pacientes não-aderentes ou refratários a essas medidas, devendo-se considerar as interações com drogas psiquiátricas e com os transtornos mentais. Conclusões: A prevenção e a detecção precoce da SM são de grande importância em populações psiquiátricas. Medidas visando a incentivar hábitos de vida saudáveis devem ser salientadas. O perfil de efeitos adversos metabólicos deve ser considerado quando da prescrição de psicofármacos em pacientes de maior risco.