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1.
Harefuah ; 158(6): 347-351, 2019 Jun.
Artigo em Hebraico | MEDLINE | ID: mdl-31215184

RESUMO

INTRODUCTION: During midlife and aging, subjective reports regarding cognitive decline increase in frequency. Age-associated cognitive impairment, mild cognitive impairment and dementia, increase in prevalence and are frequently diagnosed. Background medical conditions and risk factors are often regarded as contributing to the cognitive decline. The contribution of prior undiagnosed ADHD (Attention Deficit Hyperactive Disorder) is seldom considered. The aim of the current study was to examine whether childhood or adult ADHD should be considered relevant in the differential diagnosis of cognitive complaints during midlife and aging. METHODS: Thirty-six subjects, aged 50-70 years, diagnosed with probable ADHD (pADHD) and 29 controls participated in the present study. The pADHD group included 12 individuals self-referred due to self-complaints regarding cognitive decline or memory impairment, previously undiagnosed with ADHD (ADHD-A) but with lifelong symptomatology of ADHD and fulfilling ADHD criteria and 24 individuals, parents of diagnosed ADHD children and reporting ADHD symptoms (ADHD-B) , without complaints regarding recent cognitive decline. The neuropsychological evaluation included the Conners' Adult ADHD Rating Scale-SL, Beck Depression Inventory, and the following cognitive tests: logical memory subscale (LM- WMS), California Verbal study was conducted at the Cognitive Neurology Clinic - Rambam Health Care Campus and was granted the approval of the local IRB committee. RESULTS: ADHD-A were impaired on attention parameters while memory and executive functions were intact. ADHD-B did not present measurable attention or other neuropsychological deficits as compared to the control group. Neither group fulfilled criteria for MCI or dementia. CONCLUSIONS: ADHD should be considered as a new/additional entity in the differential diagnosis of subjective cognitive complaints among middle-aged and older persons. The recognition of the specific cognitive and behavioral profiles of ADHD should contribute to the ability to reach optimal differentiation from pre-dementia conditions in order to tailor appropriate therapies. The pathophysiology and future trajectory of the emerging ADHD symptomatology in older patients fulfilling lifelong ADHD symptomatology remains to be clarified. When examining older adults, ADHD should be considered as a differential diagnosis.


Assuntos
Envelhecimento , Transtorno do Deficit de Atenção com Hiperatividade , Demência , Idoso , Idoso de 80 Anos ou mais , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Demência/diagnóstico , Diagnóstico Diferencial , Humanos , Transtornos da Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos
2.
Nicotine Tob Res ; 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31246259

RESUMO

INTRODUCTION: One session of water-pipe tobacco smoking (WPS) can increase carboxyhemoglobin (COHb) to levels comparable to those reported in carbon monoxide poisoning, which may cause memory impairment and confusion. METHODS: A prospective study evaluating healthy volunteers pre- and post- 30-minutes of WPS session. Primary outcome parameters were executive cognitive measures [digit span test and Paced Auditory Serial Addition Test (PASAT)]. The effect of repeated cognitive testing 30 minutes apart without WPS was evaluated in age and sex matched healthy volunteers. Secondary outcome parameters included cardio-pulmonary, COHb, serum nicotine and cytokines changes. RESULTS: Thirty-five subjects aged 25.6±4.5 years smoked water-pipe for a 30-minute session. Control group included 20 subjects aged 25.2±5.1 years. Digit span test median score decreased after WPS (16 and 15, respectively, p=0.003); insignificant decrease in controls. Median PASAT score increased after WPS (49 and 52, respectively, p=0.009); however, a much larger significant increase was observed in controls (p=<0.001). One WPS session resulted in significant increases in heart and respiratory rates, and significant decrease in FEF25-75%. Post WPS, median COHb levels increased (from 2.2% to 10.7%, p<0.0001) as did median serum nicotine levels (from 1.2 to 26.8 ng/mL, p<0.0001). Serum cytokines levels: IL-2 and IL-6 increased (p<0.0001 for each), and IL-10 and IL-5 decreased (p<0.0001 and p=0.04, respectively). CONCLUSIONS: One session of WPS resulted in significant negative effects on cognitive executive measures, significant increases in COHb and serum nicotine levels, and significant changes in serum cytokines. Our findings call for increasing awareness towards the possible consequences of cognitive alterations following a 30-minute session of WPS. IMPLICATIONS: One 30-minute session of water-pipe smoking resulted in negative effects on executive cognitive measures, increased carboxyhemoglobin and serum nicotine, and significant changes in serum cytokine levels.

3.
Anticancer Drugs ; 30(1): 91-97, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30540595

RESUMO

OBJECTIVES: In patients with cancer, the use of medical cannabis has increased significantly during the recent years. There is evidence that cannabis consumption may affect cognitive performance; however, this potential effect has not been investigated prospectively in patients with cancer to date. We aimed to evaluate the effect of cannabis consumption on cognitive abilities as well as on symptom relief in patients with cancer during chemotherapy treatment. PATIENTS AND METHODS: A prospective study was carried out on a group of 17 patients on cannabis treatment (case) who were compared with 17 patients not on cannabis treatment (control). Participants completed self-reported questionnaires (the Hospital Anxiety and Depression Scale, Brief Fatigue Inventory, European Organization of Research and Treatment of Cancer core questions on the Quality of Life Questionnaire) and underwent the following neurocognitive tests: Montreal Cognitive Assessment, Digit Symbol Substitution subtest (WAIS III) and Digital-Finger Tapping Test. The evaluation was conducted before the initiation of cannabis consumption and 3 months later during the period of cannabis use. RESULTS: Improvement in executive functioning was demonstrated in the case group. In aspects of symptoms, improvement in fatigue, appetite and sleep disorder was demonstrated after cannabis consumption. Patients consuming cannabis did not differ from the control group in cognitive functioning over 3 months of use. No significant cognitive decline was observed in either group over time. CONCLUSION: These preliminary findings suggest that the short-term use of cannabis during chemotherapy treatment improved disease-related symptoms and did not affect cognitive skills in patients with cancer.

4.
Br J Haematol ; 182(5): 670-678, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29974933

RESUMO

Cancer-related cognitive impairment (CRCI) is commonly reported post-chemotherapy in adults with solid tumours. Hodgkin lymphoma (HL) mostly affects young adults. Data regarding CRCI in HL survivors (HLS) are scarce. The current study aimed to objectively assess CRCI incidence and characteristics in HLS. HLS, who completed first-line (chemotherapy ± radiation) therapy and remained in complete remission for 6 months to 5 years from therapy end, were evaluated. Age- and education-matched healthy individuals served as controls (n = 14). Test results were compared to population norms and healthy controls. Study participants completed self-reported questionnaires evaluating fatigue, depression, anxiety, quality of life and cognitive function. Subjects underwent neurocognitive evaluation, assessing processing speed, memory, attention, executive functions and intelligence domains. The present study included 51 HLS with a median age of 28 years, mean education of 14·5 ± 2·5 years. Complaints related to cognitive deterioration and fatigue were significantly more severe and frequent in HLS compared to healthy controls. Objective neurocognitive evaluation demonstrated that 30% of HLS were impaired in ≥2 cognitive domains. In conclusion, the present study demonstrates that fatigue and cognitive impairment, predominantly in executive functions and memory, constitute frequent and alarming findings in HLS. These adverse effects can persist and exert an impact on all aspects of life.


Assuntos
Disfunção Cognitiva/etiologia , Doença de Hodgkin/complicações , Sobreviventes/psicologia , Adulto , Estudos de Casos e Controles , Função Executiva , Fadiga , Feminino , Humanos , Incidência , Masculino , Memória , Qualidade de Vida , Inquéritos e Questionários
5.
Resuscitation ; 126: 65-71, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29474878

RESUMO

OBJECTIVE: To examine the effects of brief hypoxia (<7 min) due to cardiac arrest on the integrity of the brain and performance on memory and executive functions tasks. METHODS: Patients after out-of-hospital cardiac arrest (CA) (n = 9), who were deemed neurologically intact on discharge, were compared to matched patients with myocardial infarction (MI) (n = 9). A battery of clinical and experimental memory and executive functions neuropsychological tests were administered and MRI scans for all patients were collected. Measures of subcortical and cortical volumes and cortical thickness were obtained using FreeSurfer. Manual segmentations of the hippocampus were also performed. APACHE-II scores were calculated based on metrics collected at admission to ICCU for all patients. RESULTS: Significant differences between the two groups were observed on several verbal memory tests. Both hippocampi were significantly reduced (p < 0.05) in the CA patients, relative to MI patients. Hippocampal subfields segmentation showed significantly reduced presubiculum volumes bilaterally. CA patients had on average 10% reduction in volumes bilaterally across hippocampal subfields. No cortical thickness differences survived correction. Significant correlations were observed in the CA group only between the hippocampal volumes and performance on verbal memory tasks, including recollection. Hippocampal volumes and several memory measures (but not other cognitive domains) were strongly correlated with APACHE-II scores on admission in the CA group, but not in the MI group CONCLUSIONS: Chronic patients with cardiac arrest who were discharged from hospital in "good neurological condition" showed an average of 10% reduction in hippocampal volume bilaterally and significant verbal memory deficits relative to matched controls with myocardial infarction, suggesting even brief hypoxic periods suffice to lead to specific hippocampal damage.


Assuntos
Hipocampo/patologia , Hipóxia Encefálica/complicações , Transtornos da Memória/etiologia , Parada Cardíaca Extra-Hospitalar/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , APACHE , Adulto , Estudos de Casos e Controles , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Fatores de Tempo
6.
J Neurol Sci ; 363: 104-6, 2016 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-27000231

RESUMO

OBJECTIVE: To study the effects of closed-loop auditory feedback cues, corresponding to patient self-motion, on the walking abilities of patients with Parkinson's disease, in comparison to the effects of open-loop (metronome-like) auditory cues. METHODS: Sixteen patients on their regular medication schedule participated. A device which translates patient steps into a clicking cue sounded by earphones provides auditory feedback for gait pattern correction. Walking speed and stride length are measured. Device-on performance is compared to device-off performance and to baseline performance, and short-term residual performance following 15 min rest is compared to baseline performance. RESULTS: Device-on performance was found to represent, on average, 10.72%±19.53% improvement in walking speed and 6.77%±6.57% improvement in stride length with respect to device-off performance, and an average improvement of 12.37%±18.37% in walking speed and 4.30%±3.64% in stride length with respect to baseline performance, with 87.5% and 81.25% of the patients improving their walking speed and stride length, respectively. Average short-term residual performance showed 9.09%±6.34% improvement in walking speed and 6.52%±4.36% improvement in stride length, compared to baseline performance, with 85.71% of the patients improving in both walking speed and stride length. CONCLUSIONS: Closed-loop auditory feedback improves walking speed and stride length in patients with Parkinson's disease. Improvement in walking speed is more pronounced than improvement in stride length. Yet, in contrast to previously studied open-loop auditory cues, training with closed-loop auditory feedback results in non-negligible on-line improvement in stride length. Moreover, in contrast to previously reported results of open-loop auditory cuing, training with closed-loop auditory feedback has residual effects, which suggest the examination of this approach in a comprehensive therapy program.


Assuntos
Estimulação Acústica/métodos , Retroalimentação Sensorial/fisiologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/diagnóstico , Doença de Parkinson/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Marcha/fisiologia , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Distribuição Aleatória
7.
Front Aging Neurosci ; 8: 330, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28119599

RESUMO

As the world ages, it becomes urgent to unravel the mechanisms underlying brain aging and find ways of intervening with them. While for decades cognitive aging has been related to localized brain changes, growing attention is now being paid to alterations in distributed brain networks. Functional connectivity magnetic resonance imaging (fcMRI) has become a particularly useful tool to explore large-scale brain networks; yet, the temporal course of connectivity lifetime changes has not been established. Here, an extensive cross-sectional sample (21-85 years old, N = 887) from a public fcMRI database was used to characterize adult lifespan connectivity dynamics within and between seven brain networks: the default mode, salience, dorsal attention, fronto-parietal control, auditory, visual and motor networks. The entire cohort was divided into young (21-40 years, mean ± SD: 25.5 ± 4.8, n = 543); middle-aged (41-60 years, 50.6 ± 5.4, n = 238); and old (61 years and above, 69.0 ± 6.3, n = 106) subgroups. Correlation matrices as well as a mixed model analysis of covariance indicated that within high-order cognitive networks a considerable connectivity decline is already evident by middle adulthood. In contrast, a motor network shows increased connectivity in middle adulthood and a subsequent decline. Additionally, alterations in inter-network interactions are noticeable primarily in the transition between young and middle adulthood. These results provide evidence that aging-related neural changes start early in adult life.

8.
Cereb Cortex ; 26(12): 4590-4601, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-26428951

RESUMO

The ventromedial prefrontal cortex (vmPFC) prominently and separately features in neurobiological models of decision-making (e.g., value-encoding) and of memory (e.g., automatic veracity-monitoring). Recent decision-making models propose value judgments that inherently comprise of second-order confidence estimates. These demonstrate quadratic relationships with first-order judgments and are automatically encoded in vmPFC activity. Memory studies use Quantity-Accuracy Profiles to capture similar first-order and second-order meta-mnemonic processes, suggesting convergence across domains. Patients with PFC damage answered general knowledge questionnaires under 2 conditions. During forced report, they chose an answer and rated the probability of it being correct (first-order "monitoring"). During free report, they could choose to volunteer or withhold their previous answers (second-order "control") to maximize performance. We found quadratic relationships between first-order and second-order meta-mnemonic processes; voxel-based lesion-symptom mapping demonstrated that vmPFC damage diminished that relationship. Furthermore, damage to subcallosal vmPFC was specifically associated with impaired monitoring and additional damage to posterior orbitofrontal cortex led to deficient control. In decision-making, these regions typically support valuation and choice, respectively. Persistent spontaneous confabulation (false memory production) confirmed the clinical relevance of these dissociations. Compared with patients with no confabulation history, patients who currently confabulate were impaired on both monitoring and control, whereas former confabulators demonstrated impaired monitoring but intact control.


Assuntos
Tomada de Decisões/fisiologia , Memória/fisiologia , Córtex Pré-Frontal/fisiopatologia , Adulto , Idoso , Função Executiva/fisiologia , Feminino , Humanos , Idioma , Imagem por Ressonância Magnética , Masculino , Transtornos da Memória/diagnóstico por imagem , Transtornos da Memória/etiologia , Transtornos da Memória/fisiopatologia , Metacognição/fisiologia , Pessoa de Meia-Idade , Testes Neuropsicológicos , Córtex Pré-Frontal/diagnóstico por imagem , Análise de Regressão , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
9.
J Alzheimers Dis ; 50(1): 249-60, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26639975

RESUMO

Biomarkers for Alzheimer's disease (AD) are vital for disease detection in the clinical setting. Discovered in our laboratory, activity-dependent neuroprotective protein (ADNP) is essential for brain formation and linked to cognitive functions. Here, we revealed that blood borne expression of ADNP and its paralog ADNP2 is correlated with premorbid intelligence, AD pathology, and clinical stage. Age adjustment showed significant associations between: 1) higher premorbid intelligence and greater serum ADNP, and 2) greater cortical amyloid and lower ADNP and ADNP2 mRNAs. Significant increases in ADNP mRNA levels were observed in patients ranging from mild cognitive impairment (MCI) to AD dementia. ADNP2 transcripts showed high correlation with ADNP transcripts, especially in AD dementia lymphocytes. ADNP plasma/serum and lymphocyte mRNA levels discriminated well between cognitively normal elderly, MCI, and AD dementia participants. Measuring ADNP blood-borne levels could bring us a step closer to effectively screening and tracking AD.


Assuntos
Doença de Alzheimer/sangue , Doença de Alzheimer/fisiopatologia , Proteínas de Homeodomínio/sangue , Inteligência/fisiologia , Proteínas do Tecido Nervoso/sangue , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/líquido cefalorraquidiano , Doença de Alzheimer/patologia , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Biomarcadores/metabolismo , Distribuição de Qui-Quadrado , Disfunção Cognitiva/sangue , Estudos de Coortes , Feminino , Humanos , Vida Independente , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Fragmentos de Peptídeos/líquido cefalorraquidiano , RNA Mensageiro/metabolismo , Proteínas tau/líquido cefalorraquidiano
10.
Handb Clin Neurol ; 130: 297-323, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26003251

RESUMO

Sexual dysfunction (SD) is common among patients with Parkinson's disease (PD), Alzheimer's disease (AD), and other dementias. Sexual functioning and well-being of patients with PD and their partners are affected by many factors, including motor disabilities, non-motor symptoms (e.g., autonomic dysfunction, sleep disturbances, mood disorders, cognitive abnormalities, pain, and sensory disorders), medication effects, and relationship issues. The common sexual problems are decreased desire, erectile dysfunction, difficulties in reaching orgasm, and sexual dissatisfaction. Hypersexuality is one of a broad range of impulse control disorders reported in PD, attributed to antiparkinsonian therapy, mainly dopamine agonists. Involvement of a multidisciplinary team may enable a significant management of hypersexuality. Data on SD in demented patients are scarce, mainly reporting reduced frequency of sex and erectile dysfunction. Treatment of SD is advised at an early stage. Behavioral problems, including inappropriate sexual behavior (ISB), are distressing for patients and their caregivers and may reflect the prevailing behavior accompanying dementia (disinhibition or apathy associated with hyposexuality). The neurobiologic basis of ISB is still only vaguely understood but assessment and intervention are recommended as soon as ISB is suspected. Management of ISB in dementia demands a thorough evaluation and understanding of the behavior, and can be treated by non-pharmacologic and pharmacologic interventions.


Assuntos
Doença de Alzheimer/complicações , Doença de Parkinson/complicações , Disfunções Sexuais Fisiológicas/etiologia , Sexualidade/fisiologia , Demência/complicações , Feminino , Humanos , Masculino
11.
Neuropsychologia ; 64: 157-68, 2014 11.
Artigo em Inglês | MEDLINE | ID: mdl-25261613

RESUMO

Human creativity is thought to entail two processes. One is idea generation, whereby ideas emerge in an associative manner, and the other is idea evaluation, whereby generated ideas are evaluated and screened. Thus far, neuroimaging studies have identified several brain regions as being involved in creativity, yet only a handful of studies have examined the neural basis underlying these two processes. We found that an individual with left temporoparietal hemorrhage who had no previous experience as an artist developed remarkable artistic creativity, which diminished as the hemorrhage receded. We thus hypothesized that damage to the evaluation network of creativity during the initial hematoma had a releasing effect on creativity by "freeing" the idea generation system. In line with this hypothesis, we conducted a subsequent fMRI study showing that decreased left temporal and parietal activations among healthy individuals as they evaluated creative ideas selectively predicted higher creativity. The current studies provide converging multi-method evidence suggesting that the left temporoparietal area is part of a neural network involved in evaluating creativity, and that as such may act as inhibitors of creativity. We propose an explanatory model of creativity centered upon the key role of the left temporoparietal regions in evaluating and inhibiting creativity.


Assuntos
Hemorragia Cerebral/psicologia , Criatividade , Lateralidade Funcional/fisiologia , Lobo Parietal/diagnóstico por imagem , Acidente Vascular Cerebral/psicologia , Lobo Temporal/diagnóstico por imagem , Adulto , Arte , Mapeamento Encefálico , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Lobo Parietal/fisiopatologia , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia , Lobo Temporal/fisiopatologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-24719779

RESUMO

BACKGROUND: Our aim was to study the effects of visual feedback cues, responding dynamically to patient's self-motion and provided through a portable see-through virtual reality apparatus, on the walking abilities of patients with Parkinson's disease. METHODS: Twenty patients participated. On-line and residual effects on walking speed and stride length were measured. RESULTS: Attaching the visual feedback device to the patient with the display turned off showed a negligible effect of about 2%. With the display turned on, 56% of the patients improved either their walking speed, or their stride length, or both, by over 20%. After device removal, and waiting for 15 minutes, the patients were instructed to walk again: 68% of the patients showed over 20% improvement in either walking speed or stride length or both. One week after participating in the first test, 36% of the patients showed over 20% improvement in baseline performance with respect to the previous test. Some of the patients reported that they still walked on the tiles in their minds. DISCUSSION: Improvements in walking abilities were measured in patients with Parkinson's disease using virtual reality visual feedback cues. Residual effects suggest the examination of this approach in a comprehensive therapy program.

13.
Semin Thromb Hemost ; 39(8): 928-34, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24129683

RESUMO

Gaucher disease (GD) is a lysosomal disorder caused by inherited deficiency of glucocerebrosidase (GCase), resulting in the accumulation of glucocerebroside in macrophages, termed "Gaucher cells," leading to multiorgan involvement, with hepatosplenomegaly, cytopenias, pulmonary hypertension, and skeletal complications. Various mutations, encoding the GCase gene, cause acute or chronic neuronopathic forms of the disease. The hallmark of GD is the macrophages infiltrating organs, bone marrow, and nervous system compromising their function by inflammation, infarcts, fibrosis, and neuronal damage. Coagulation abnormalities are frequent among GD patients due to reduced production and chronic consumption of coagulation factors. Splenic and bone infarcts often occur in GD patients, but hypercoagulability is not frequent. Detection of thrombophilic risk factors in GD patients may predict a more severe course of the disease. Clinical and genetic studies revealed an association between reduced GCase activity in carriers of GD mutations and GD patients and occurrence of Parkinson disease (PD) and showed that GCase gene mutations are risk factors for PD development. The mechanisms underlying the association of PD and GD are not yet elucidated and should be further explored, particularly the potential involvement of inflammation and coagulation in the neurovascular unit.


Assuntos
Doença de Gaucher/complicações , Doença de Parkinson/complicações , Trombofilia/complicações , Fatores de Coagulação Sanguínea/genética , Fatores de Coagulação Sanguínea/metabolismo , Doença de Gaucher/classificação , Doença de Gaucher/genética , Glucosilceramidase/deficiência , Glucosilceramidase/genética , Humanos , Mutação , Doença de Parkinson/genética , Fatores de Risco , Trombofilia/genética , alfa-Sinucleína/genética , alfa-Sinucleína/metabolismo
14.
Am J Geriatr Psychiatry ; 21(9): 832-9, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23871119

RESUMO

OBJECTIVE: Although poststroke depression (PSD) and reduction in quality of life (QOL) are prevalent among stroke patients, little is known about the contribution of personality traits to such impairments. This study examines whether particular personality traits predict PSD symptoms (PSDS) and reduction in QOL among stroke survivals using Cloninger's biopsychosocial personality model. We hypothesized that harm avoidance (HA), expressing the tendency to respond intensely to adverse stimuli, characterizes stroke survivors at risk for PSDS and reduction in QOL. METHODS: Hospitalized stroke patients (N = 84, age 63.5 ± 9.7 years) prospectively completed Cloninger's Tridimensional Personality Questionnaire, defining HA dominancy by scoring the three personality dimensions: reward dependence, novelty seeking, and HA. The level of neurologic deficit was evaluated by the National Institutes of Health Stroke Scale. At the 3-month follow-up visit, depressive symptoms and QOL scores were assessed using the Beck Depression Inventory and the Stroke Specific Quality of Life questionnaire. RESULTS: Regression analyses revealed that higher HA scores independently predicted PSDS and reduction in QOL. After controlling for the relative contribution of stroke type and health-related variables, HA and neurologic deficit were significant risk factors for poststroke negative outcomes. CONCLUSION: Our findings emphasize the relevance of Cloninger's theory (manifested by individual HA behavior) as a distinctive means to identifying patients at risk for PSDS and lower QOL after stroke. The role of specific psychological and neurologic aspects involved in the mechanism of PSD should be further explored using biopsychosocial models.


Assuntos
Depressão/psicologia , Personalidade , Qualidade de Vida/psicologia , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Depressão/complicações , Feminino , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Análise Multivariada , Inventário de Personalidade , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Inquéritos e Questionários
15.
Nanomedicine (Lond) ; 8(1): 43-56, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23067372

RESUMO

AIM: To study the feasibility of a novel method in nanomedicine that is based on breath testing for identifying Alzheimer's disease (AD) and Parkinson's disease (PD), as representative examples of neurodegenerative conditions. PATIENTS & METHODS: Alveolar breath was collected from 57 volunteers (AD patients, PD patients and healthy controls) and analyzed using combinations of nanomaterial-based sensors (organically functionalized carbon nanotubes and gold nanoparticles). Discriminant factor analysis was applied to detect statistically significant differences between study groups and classification success was estimated using cross-validation. The pattern identification was supported by chemical analysis of the breath samples using gas chromatography combined with mass spectrometry. RESULTS: The combinations of sensors could clearly distinguish AD from healthy states, PD from healthy states, and AD from PD states, with a classification accuracy of 85, 78 and 84%, respectively. Gas chromatography combined with mass spectrometry analysis showed statistically significant differences in the average abundance of several volatile organic compounds in the breath of AD, PD and healthy subjects, thus supporting the breath prints observed with the sensors. CONCLUSION: The breath prints that were identified with combinations of nanomaterial-based sensors have future potential as cost-effective, fast and reliable biomarkers for AD and PD.


Assuntos
Doença de Alzheimer/diagnóstico , Testes Respiratórios , Nanoestruturas , Doença de Parkinson/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Pessoa de Meia-Idade
16.
J Int Neuropsychol Soc ; 18(6): 952-61, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23158227

RESUMO

This study aimed to examine the relationship between perspective-taking and impaired decision-making in patients with ventromedial prefrontal (VM) lesions, using the Ultimatum Game (UG). In the UG, two players split a sum of money and one player proposes a division while the other can accept or reject this. Eight patients with VM damage and 18 healthy controls participated as responders in a modified version of the UG, in which identical offers can generate different rejection rates depending on the other offers available to the proposer. Participants had to either accept or reject offers of 2:8 NIS (2NIS for them and 8 NIS for the proposer), which were paired with one of four different possible offers (5:5, 4:6, 2:8, 8:2). Results indicate that the controls more often rejected offers of 2:8 when the alternative was 4:6 (a greedy alternative) than when the alternative was 5:5 (fair alternative), whereas the VM patients showed the opposite pattern of decision-making. Additionally, the overall rejection rates were higher in patients as compared to controls. Furthermore, scores on a perspective-taking scale were negatively correlated with rejection rates in the patient group, suggesting that perspective-taking deficits may account for impaired decision-making in VM patients.


Assuntos
Lesões Encefálicas , Transtornos Cognitivos/etiologia , Tomada de Decisões/fisiologia , Intenção , Córtex Pré-Frontal/patologia , Assunção de Riscos , Adulto , Análise de Variância , Lesões Encefálicas/complicações , Lesões Encefálicas/patologia , Lesões Encefálicas/psicologia , Comportamento de Escolha/fisiologia , Feminino , Jogos Experimentais , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
17.
J Integr Neurosci ; 11(3): 225-42, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22934806

RESUMO

The current study explores sentence comprehension impairments among adults following moderate closed head injury. It was hypothesized that if the factor of syntactic complexity significantly affects sentence comprehension in these patients, it would testify to the existence of syntactic processing deficit along with working-memory problems. Thirty-six adults (18 closed head injury patients and 18 healthy controls matched in age, gender, and IQ) participated in the study. A picture-sentence matching task together with various tests for memory, language, and reading abilities were used to explore whether sentence comprehension impairments exist as a result of a deficit in syntactic processing or of working-memory dysfunction. Results indicate significant impairment in sentence comprehension among adults with closed head injury compared with their non-head-injured peers. Results also reveal that closed head injury patients demonstrate considerable decline in working memory, short-term memory, and semantic knowledge. Analysis of the results shows that memory impairment and syntactic complexity contribute significantly to sentence comprehension difficulties in closed head injury patients. At the same time, the presentation mode (spoken or written language) was found to have no effect on comprehension among adults with closed head injury, and their reading abilities appear to be relatively intact.


Assuntos
Transtornos Cognitivos/fisiopatologia , Compreensão/fisiologia , Traumatismos Cranianos Fechados/fisiopatologia , Testes de Linguagem , Semântica , Adulto , Transtornos Cognitivos/etiologia , Feminino , Traumatismos Cranianos Fechados/complicações , Humanos , Masculino , Memória de Curto Prazo/fisiologia , Índices de Gravidade do Trauma , Adulto Jovem
18.
Mol Neurodegener ; 7: 26, 2012 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-22651796

RESUMO

BACKGROUND: The search for biomarkers in Parkinson's disease (PD) is crucial to identify the disease early and monitor the effectiveness of neuroprotective therapies. We aim to assess whether a gene signature could be detected in blood from early/mild PD patients that could support the diagnosis of early PD, focusing on genes found particularly altered in the substantia nigra of sporadic PD. RESULTS: The transcriptional expression of seven selected genes was examined in blood samples from 62 early stage PD patients and 64 healthy age-matched controls. Stepwise multivariate logistic regression analysis identified five genes as optimal predictors of PD: p19 S-phase kinase-associated protein 1A (odds ratio [OR] 0.73; 95% confidence interval [CI] 0.60-0.90), huntingtin interacting protein-2 (OR 1.32; CI 1.08-1.61), aldehyde dehydrogenase family 1 subfamily A1 (OR 0.86; 95% CI 0.75-0.99), 19 S proteasomal protein PSMC4 (OR 0.73; 95% CI 0.60-0.89) and heat shock 70-kDa protein 8 (OR 1.39; 95% CI 1.14-1.70). At a 0.5 cut-off the gene panel yielded a sensitivity and specificity in detecting PD of 90.3 and 89.1 respectively and the area under the receiving operating curve (ROC AUC) was 0.96. The performance of the five-gene classifier on the de novo PD individuals alone composing the early PD cohort (n = 38), resulted in a similar ROC with an AUC of 0.95, indicating the stability of the model and also, that patient medication had no significant effect on the predictive probability (PP) of the classifier for PD risk. The predictive ability of the model was validated in an independent cohort of 30 patients at advanced stage of PD, classifying correctly all cases as PD (100% sensitivity). Notably, the nominal average value of the PP for PD (0.95 (SD = 0.09)) in this cohort was higher than that of the early PD group (0.83 (SD = 0.22)), suggesting a potential for the model to assess disease severity. Lastly, the gene panel fully discriminated between PD and Alzheimer's disease (n = 29). CONCLUSIONS: The findings provide evidence on the ability of a five-gene panel to diagnose early/mild PD, with a possible diagnostic value for detection of asymptomatic PD before overt expression of the disorder.


Assuntos
Doença de Parkinson/sangue , Doença de Parkinson/genética , Idoso , Doença de Alzheimer/sangue , Biomarcadores/sangue , Feminino , Expressão Gênica , Marcadores Genéticos , Predisposição Genética para Doença/genética , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Valor Preditivo dos Testes , Sensibilidade e Especificidade
19.
Int Psychogeriatr ; 24(11): 1756-70, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22687191

RESUMO

BACKGROUND: Health communication studies emphasize the importance of addressing the needs and expectations of patients and families with the disclosure of grave medical conditions. However, little attention has focused on their expectations and experiences of the clinical encounters in diagnosis disclosure of dementia. METHODS: In-depth post-encounter interviews with ten patients and 17 companions from two memory clinics in Israel were analyzed using grounded theory. The analysis focused on identifying their expectations, their experiences, and their perceptions of the process and outcomes. RESULTS: Major differences exist between patients' and companions' expectations. Patients' expectations were an expression of the lack of knowledge/understanding of the visit's purpose and of insight into the memory deterioration. Companions had more clear-cut expectations: some desired confirmation of the legitimacy and pertinence of their concerns about their relatives' memory problem, whereas others hoped to allay their concerns. Patients' dissatisfaction stemmed mostly from their perceptions of the process, communication, and outcome. Companions' dissatisfaction stemmed from lack of information or of tailored follow-up processes for implementing recommendations provided by the clinic. CONCLUSIONS: Our findings expose two main issues challenging fulfillment of the different and frequently opposing expectations of patients and companions. The first is a consequence of the multi-participant nature of the encounter and the second relates to the character and severity of the disease itself. The discordance between the expectations of the two participants generates conflicts that interfere with meeting their diverse needs within the encounters - with consequent disappointment. The implications of these issues merit consideration in the planning of dementia management.


Assuntos
Centros Comunitários de Saúde Mental/normas , Demência , Preferência do Paciente/psicologia , Relações Profissional-Família , Relações Profissional-Paciente , Revelação da Verdade , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Demência/psicologia , Demência/terapia , Inteligência Emocional , Feminino , Serviços de Saúde para Idosos/normas , Humanos , Israel , Masculino , Pessoas Mentalmente Doentes/psicologia , Navegação de Pacientes/métodos , Navegação de Pacientes/normas , Melhoria de Qualidade , Inquéritos e Questionários
20.
Artigo em Inglês | MEDLINE | ID: mdl-23440912

RESUMO

BACKGROUND: Essential tremor (ET) and Parkinson's disease (PD) are probably the most common movement disorders. As ethnic differences have been reported in ET, we designed the present study to evaluate the prevalence of ET and that of Parkinson's disease (PD) in the Druze villages of northern Israel. METHODS: A two-phase, door-to-door survey was undertaken. Residents aged ≥51 years who agreed to participate and answered "yes" to tremor or PD-related screening questions and 3% of subjects who screened negative were evaluated. Diagnostic criteria for ET were similar to those used in Sicilian and Spanish studies. PD was diagnosed according to Gelb's criteria. RESULTS: The target population consisted of 9,086, the study cohort of 3,980 residents. Tremor was observed in 36 subjects. In 27, the tremor fully met the criteria for ET. The prevalence of ET (age ≥65) was 1.49% (95% CI 0.91-2.07%). PD was diagnosed in 23 subjects. The prevalence of PD (age ≥65) was 1.13 (95% CI 0.62-1.64%). Leucine-rich repeat protein kinase 2 (G2019S mutation) was evaluated in subjects diagnosed with tremor PD and those screened for assessment of the validity of the questionnaire. None carried the mutation. DISCUSSION: The prevalence of ET in the Druze population is low and similar to the prevalence of PD.

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