Outcomes and Factors Affecting Transcranial Direct Current Stimulation in Alzheimer's Disease Patients: A Systematic Review.

INTRODUCTION: Alzheimer's disease (AD) is the most common form of dementia. There have been various proposed pharmacologic and non-pharmacologic treatments proposed for preventing cognitive decline in AD patients. Transcranial Direct Current Stimulation (tDCS) is a neuromodulation technique used to enhance cognitive functions and motor skills of the brain. Our study aimed to assess the effects of tDCS in AD patients, including effects on general cognitive status, memory, attention, executive functions, language, IQ, and neuropsychological effects, along with the factors influencing the outcomes. METHODS: Systematic searches were conducted for relevant evidence using PubMed, ScienceDirect, and Cochrane Library databases for (Transcranial Direct Current Stimulation) and (Alzheimer's). Duplicates were removed, and the remaining articles were screened for double-blind, placebo-controlled, randomized clinical trials (Phase III), case studies, and case series on patients diagnosed with AD using tDCS. The articles were assessed for full text, and studies were selected and analyzed to include in the review. RESULTS: Overall, 20 studies were reviewed. Cognitive status, executive function and working memory, recognition memory, and language function may improve following AtDCS depending on the stimulation polarity and area stimulated. No significant effects of tDCS were seen on attention, associative memory, recall memory, visuospatial ability, and neuropsychiatric symptoms. DISCUSSION: Therapy outcomes and the factors that could affect them were analyzed, which included the number of sessions taken, current density, stimulation polarity (cathodal/anodal/dual), area stimulated, training(s) given, and study timeline. CONCLUSION: tDCS is a well-tolerated therapy that can be used for improving several cognitive domains in patients having Alzheimer's disease. Its treatment outcomes are affected by polarity (cathodal/ anodal), site of stimulation, number of sessions taken, and any training(s) given during the study.

Efectos secundarios neuropsicológicos de los anticonceptivos hormonales combinados para el tratamiento de síntomas leves. Valoración bioética de su adecuación / Neuropsychological side effects of combined hormonal contraceptives for the treatment of mild symptoms. Bioethical assessment of its adequacy

Desde el comienzo de la comercialización, en 1960, de los anticonceptivos hormonales combinados deestrógenos y progestágenos (ACH), se ha generalizado su utilización para otras indicaciones no anticoncep-tivas: dismenorrea, ciclos de duración irregular, hipermenorrea y acné, entre otros (Lete, 2009; Barranco,2016). En todos los casos se tratan de patologías leves o síntomas menores para los que existen alternativasterapéuticas eficaces. Millones de mujeres en el mundo reciben este tratamiento, que actúa inhibiendoel eje hormonal hipotalámico-hipofisárico-ovárico (Eje HHO), eje central y regulador de toda la fisiologíasexual y reproductiva de la mujer. Pese a la existencia de una enorme cantidad de mujeres sometidas a estainhibición (actualmente los ACH son utilizados por unos 214 millones de mujeres alrededor del mundo,con un mercado anual cercano a los 18.000 millones de dólares), se ha investigado muy poco sobre lasconsecuencias de la supresión del eje HHO. Sólo en los últimos años, y en paralelo a la demostración de laexistencia de receptores funcionales para las gonadotropinas a diferentes niveles en los sistemas nerviososcentral y periférico, comienzan a aparecer publicaciones sobre los efectos neuropsicológicos de los ACH.Llama también la atención que, pese a ser los fármacos más empleados y desde hace más tiempo para eltratamiento de las alteraciones funcionales ginecológicas, su uso esté al margen de la ficha técnica (es de-cir, se les da un uso diferente a los recogidos en la indicación oficial aprobada en su ficha técnica y que figu-ra en el prospecto). Aunque el uso de estos productos hormonales causa efectos secundarios muy variados,y ampliamente estudiados en la literatura médica, en el presente estudio se plantea, tras una exposiciónde los distintos aspectos del uso de los ACH, una revisión pormenorizada de la bibliografía disponible sobrelos efectos neuropsicológicos debidos a la anulación del eje HHO.(AU)

Since the beginning of the commercialization, in 1960, of combined estrogen-progestin hormonal con-traceptives (CHCs), their use has become widespread for other non-contraceptive indications: dysmenorrhea,irregular cycle length, hypermenorrhea and acne, among others (Lete, 2009; Barranco, 2016). In all cases, the-se are mild pathologies or minor symptoms for which there are effective therapeutic alternatives. Millions ofwomen in the world receive this treatment, which acts by inhibiting the hypothalamic-pituitary-ovarian hor-monal axis (HHO Axis), the central axis and regulator of the entire sexual and reproductive physiology of wo-men. Despite the existence of an enormous number of women subjected to this inhibition (ACHs are currentlyused by some 214 million women around the world, with an annual market of close to 18 billion dollars), verylittle research has been done on the consequences of suppressing the HHO axis. Only in recent years, and inparallel to the demonstration of the existence of functional receptors for gonadotropins at different levelsin the central and peripheral nervous systems, have publications on the neuropsychological effects of HCAsbegun to appear. It is also striking that, despite being the most widely used drugs and for the longest timefor the treatment of functional gynecological disorders, their use is outside the technical data sheet (i.e., theyare used for purposes other than those listed in the official indication approved in their technical data sheetand which appear in the package insert). Although the use of these hormonal products causes a wide varietyof side effects, which have been widely studied in the medical literature, the present study proposes, afteran exposition of the different aspects of the use of HCAs, a detailed review of the available literature on theneuropsychological effects due to the annulment of the HHO axis.(AU)

Nontraditional Aspects of Sporadic Primary Hyperparathyroidism.

Nontraditional aspects of primary hyperparathyroidism refer to the condition's rheumatic, gastrointestinal, cardiovascular, and neuropsychological effects. Although gastrointestinal and rheumatic symptomatology were features of classical primary hyperparathyroidism, they do not seem to be a part of the modern presentation of primary hyperparathyroidism. In contrast, neuropsychological symptoms such as altered mood and cognition, as well as cardiovascular disease, have been associated with the form of primary hyperparathyroidism seen today, but the relationship is not clearly causal. Evidence does not support reversibility after parathyroidectomy and therefore none of the nontraditional manifestations are considered sole indications for recommending surgery at this time.

Psychological and Emotional Effects of Digital Technology on Children in COVID-19 Pandemic.

COVID-19 has caused obstacles in continuing normal life almost everywhere in the world by causing the implementation of social distancing and eventually imposing the lockdown. This has become the reason for the increase in technology usage in daily life for professional work as well as for entertainment purposes. There has been an increased prevalence of technology usage in adolescents and children during lockdown leaving its impact on their lives either in a positive or negative aspect. The overall documented percentage increase of technology usage in children was about 15%, of which smartphone usage has 61.7% of prevalence. Disturbance in brain functioning is suggested to be originated by compromise of neuroplasticity of the nerves. The radiofrequency (RF) radiations emitting from the smartphone are of doubtful concern as a brain tumor risk factor in children. The increased usage can have effects on brain functioning that will compromise sleep and cognitive abilities and develop risk for certain mental illnesses including, but not limited to, depression, anxiety, Alzheimer's disease, and attention-deficit/hyperactive disorder (ADHD). Despite being a threat for developing mental illness, video games are proven to reduce depression and anxiety, and increase creativity, skills, and cognition in children. The increased usage of technology can have a positive and negative impact on the mental development of adolescents and children depending on the trends in the usage. However, parents should be monitoring their children's mental health and behavior in these difficult times of pandemic.

Subacute and chronic neuropsychological sequalae of acute organophosphate pesticide self-poisoning: a prospective cohort study from Sri Lanka.

CONTEXT: Some epidemiological evidence implicates acute organophosphate (OP) pesticide poisoning in long-term neurocognitive deficits. However, no study has prospectively followed up poisoned patients long-term from the time of intoxication. We aimed to determine whether clinically significant acute OP self-poisoning leads to subacute and chronic neurocognitive deficits, in a prospective follow up study. METHODS: Employing Mini Mental State Examination, Digit Span and Cambridge Neuropsychological Test Automated Battery (CANTAB), we compared multiple cognitive functions in 222 patients hospitalized with acute OP pesticide self-poisoning with a control group of 52 patients hospitalized with paracetamol overdose, at three time points: on discharge following clinical recovery, 6 weeks and 6 months post-ingestion. Intergroup comparisons at each time point were done in multiple regression models, adjusting for sex, age, education and psychiatric comorbidities. OP within-group analysis was done to determine a dose-response relationship. RESULTS: After adjusting for covariates, the OP poisoned group had significantly poorer working memory (Digit Span) and episodic memory (CANTAB Paired Associates Learning); impaired spatial planning (CANTAB Stocking of Cambridge); and slower response speed in the sustained attention task (CANTAB Rapid Visual Information Processing), in the post-discharge assessment. Only working memory and episodic memory measures were impaired in the OP group at 6 weeks, whereas no significant intergroup differences were observed at 6 months. The OP subgroup who had complete red cell acetylcholinesterase inhibition on admission had poorer episodic memory when tested post-discharge than those who had partial inhibition, but no significant subgroup differences were observed at 6 weeks or 6 months. DISCUSSION: Acute OP pesticide poisoning may cause neuropsychological impairment that outlasts the cholinergic phase on a subacute time scale; but does not cause measurable chronic neuropsychological deficits.

A Survey of Cannabis Acute Effects and Withdrawal Symptoms: Differential Responses Across User Types and Age.

OBJECTIVES: There is a rapidly evolving legal and medical culture around cannabis, with corresponding changes in the demographics of users. For instance, the percentage of the aging population accessing cannabis is growing substantially, outpacing other age groups. The goals of this study were to describe the acute effects of cannabis, subjective experiences of withdrawal, and beliefs around the addictiveness of cannabis, as well as to determine whether these effects differ as a function of age or reason for use (medical vs. recreational use). It was hypothesized that medical users and younger users would report fewer adverse effects. SUBJECTS: Survey responses from 2905 cannabis users were analyzed. RESULTS: Hierarchical logistic regression analyses were used to compare group percentages after statistically controlling for confounding differences in their demographic and cannabis use characteristics. The most commonly endorsed acute effects were improved sleep, more calm/peaceful, desire to eat, more creative, and dry mouth; while the most commonly endorsed withdrawal symptoms were irritability, insomnia, and anxiety. Relative to recreational users, medical users were less likely to report undesirable acute effects but were more likely to report undesirable withdrawal symptoms. Older (50+) individuals reported fewer undesirable acute effects and withdrawal symptoms compared with younger users (18-29). Only 17% of the total sample reported believing that cannabis is addictive, and this did not vary as a function of reason for use. CONCLUSIONS: Older people and medical users appear to experience acute and withdrawal effects of cannabis differently than recreational and younger users, perhaps because these groups benefit more from the medicinal properties of cannabis. These data can provide descriptive information to help inform health care providers and potential consumers about effects of cannabis use.

Are There Subconcussive Neuropsychological Effects in Youth Sports? An Exploratory Study of High- and Low-Contact Sports.

This exploratory study was designed to examine the neuropsychological effects of sports-related head trauma-specifically, repetitive subconcussive impacts or head blows that do not result in a diagnosable concussion. The researchers compared the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) neurocognitive test scores of 2 groups of nonconcussed youth athletes (n = 282), grouped according to the frequency of concussions in their respective sports, with the assumption that more subconcussive impacts occur in sports in which there are more reported concussions. The results indicated that high-contact-sport (football) athletes had significantly poorer performance in processing speed and reaction time compared with athletes in low-contact sports (wrestling, soccer, baseball, judo, and basketball). This study into the effects of repetitive subconcussive head trauma tentatively raises concern that participation in high-contact sports, even without evidence of a diagnosable concussion, could result in lowered neuropsychological functioning among high school athletes. Limitations of this exploratory research effort are discussed.

An assessment of WISC-IIIUK on children with HIV infection.

The Wechsler Intelligence Scale for Children - Third Edition UK test was administered to groups of children between the ages of 6 and 12 years with vertically transmitted HIV infection (n = 70) and a control group who were not infected by the virus (n = 70). The study was conducted in India. The two groups were matched for general verbal abilities, age and gender. The children were assessed for Verbal IQ, Performance IQ and Full-Scale IQ. The Verbal Comprehension Index, Perceptual Organization Index and Freedom from Distractibility Index were also obtained. A three-factor analysis of variance disclosed that school-age children with vertically transmitted HIV infection notched below in the areas of Verbal IQ, Performance IQ, Full-Scale IQ, Verbal Comprehension Index, Perceptual Organization Index and Freedom from Distractibility Index when collated with normal uninfected cohorts. Findings are discussed in the light of both theoretical and clinical implications.

Traumatic brain injury-related attention deficits: treatment outcomes with lisdexamfetamine dimesylate (Vyvanse).

BACKGROUND AND OBJECTIVES: Attention deficits are often among the most persistent and debilitating impairments resulting from traumatic brain injury (TBI). This study examined the effects of lisdexamfetamine dimesylate (Vyvanse) in treating attention deficits due to moderate-to-severe TBI. It was the first study of lisdexamfetamine dimesylate with this population and, in fact, was the first controlled trial in this area examining a stimulant medication option other than methylphenidate. METHODS: This was a 12-week, randomized, double-blind, placebo-controlled, cross-over trial. A total of 22 rigorously selected cases were enrolled, 13 of whom completed the trial. They were 16-42 years of age and had newly acquired attention deficits persisting for 6-34 months post-injury. They were assessed on a broad range of neuropsychological and behavioural measures at baseline, 6-weeks and at 12-weeks. RESULTS AND CONCLUSIONS: Positive treatment effects were found involving selective measures of sustained attention, working memory, response speed stability and endurance and in aspects of executive functioning. No major problems with safety or tolerability were observed. Some moderating treatment effects were found from a broad range of pre-treatment subject characteristics and injury variables examined. Avenues for further research and treatment applications in this area are discussed.

Noninvasive biomarkers of manganese exposure and neuropsychological effects in environmentally exposed adults in Brazil.

Manganese (Mn), an essential element to humans, in excess can cause neurotoxic damage. So far, Mn exposure assessment has no ideal biomarker. This study aims to investigate the association between Mn exposure, using noninvasive biomarkers, and neuropsychological effects in environmentally exposed adults. The residents of two communities near to a ferromanganese refinery in Bahia, Brazil were evaluated. Volunteers aged 15-55 of both sexes provided scalp hair, axillary hair, fingernail and saliva specimens for Mn determination by electrothermal absorption spectrometry. Several neuropsychological tests were used to evaluate cognitive, attention, memory, motor and executive functions. Significant correlations were observed between Mn in hair (MnH, median 8.95 µg/g), axillary hair (MnAxH,18.49 µg/g) and fingernail (MnFN, 6.91 µg/g) with the performances in several neuropsychological tests. No association was observed between manganese levels in saliva (MnSal, 4.2 µg/L) and any neuropsychological function. Multiple regression analysis detected an inverse association between Log MnH and IQ (ß=-4.76 [CI 95% -9.17 to -0.36]) and between Log MnFN and visual working memory (ß=-3.33 [CI 95% -6.15 to -0.52]). Direct association was observed between Log MnFN and time of completion in the cognitive flexibility task (ß=56.29 [CI 95% 2.41-110.18]). The Mn biomonitoring using noninvasive biomarkers was able to detect high exposure levels, which were associated with detrimental neuropsychological effects in adults exposed to industrial emissions.