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1.
Nat Commun ; 10(1): 3497, 2019 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-31375668

RESUMO

Human memory is thought to depend on a circuit of connected brain regions, but this hypothesis has not been directly tested. We derive a human memory circuit using 53 case reports of strokes causing amnesia and a map of the human connectome (n = 1000). This circuit is reproducible across discovery (n = 27) and replication (n = 26) cohorts and specific to lesions causing amnesia. Its hub is at the junction of the presubiculum and retrosplenial cortex. Connectivity with this single location defines a human brain circuit that incorporates > 95% of lesions causing amnesia. Lesion intersection with this circuit predicts memory scores in two independent datasets (N1 = 97, N2 = 176). This network aligns with neuroimaging correlates of episodic memory, abnormalities in Alzheimer's disease, and brain stimulation sites reported to enhance memory in humans.


Assuntos
Amnésia/patologia , Encéfalo/patologia , Conectoma , Memória/fisiologia , Rede Nervosa/patologia , Adulto , Idoso , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico por imagem , Doença de Alzheimer/patologia , Amnésia/diagnóstico por imagem , Amnésia/etiologia , Encéfalo/diagnóstico por imagem , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia
2.
Bull Exp Biol Med ; 167(1): 1-6, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31177445

RESUMO

Administration of 5-HT receptor antagonist to snails trained in conditioned food aversion prior to reminding of the conditioning stimulus caused amnesia. At the early period of amnesia (day 3), injections of protein synthesis inhibitor cycloheximide without reminder or reminder alone were ineffective. At the same time, injections of the inhibitor combined with reminder led to memory recovery; this effect in most animals persisted for at least 10 days. In the rest snails, aversive responses to presentations of the conditioning stimulus persisted for 2 days. Cycloheximide injection and reminder in 10 days after induction of amnesia did not affect its development or caused a transient memory recovery (2 days). We hypothesized that amnesia is an active process unfolding in time. One of mechanism of this process is reminder-induced and protein synthesis-depended reactivation of amnesia. Inhibitor of protein synthesis disturbed this reactivation and led to recovery of the initial memory of conditioned food aversion.


Assuntos
Amnésia/tratamento farmacológico , Amnésia/etiologia , Cicloeximida/uso terapêutico , Transtornos da Memória/induzido quimicamente , Memória/efeitos dos fármacos , Metiotepina/farmacologia , Inibidores da Síntese de Proteínas/uso terapêutico , Antagonistas da Serotonina/farmacologia , Animais , Caramujos
3.
BMJ Case Rep ; 12(4)2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30992284

RESUMO

We present the case of a 77-year-old patient with a rapid onset of delusions, amnesia, agitation, insomnia and no previous psychiatric history, who was diagnosed with anti-N-methyl-d-aspartate receptor encephalitis. This case report highlights the importance of including autoimmune encephalitis in the differential diagnosis of older patients presenting with rapid onset psychiatric episodes.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Receptores de N-Metil-D-Aspartato/imunologia , Doença Aguda , Idoso , Amnésia/etiologia , Encefalite Antirreceptor de N-Metil-D-Aspartato/líquido cefalorraquidiano , Encefalite Antirreceptor de N-Metil-D-Aspartato/tratamento farmacológico , Delusões/etiologia , Diagnóstico Diferencial , Humanos , Imunoglobulina A/administração & dosagem , Masculino , Agitação Psicomotora/etiologia
4.
Food Funct ; 10(5): 2439-2449, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-30968880

RESUMO

The peptide derived from Anchovy hydrolysates, Pro-Ala-Tyr-Cys-Ser (PAYCS), was reported to display a neuroprotective effect in vitro in our previous study. The in vivo memory improving effects of PAYCS were investigated in this study. Prior to the scopolamine-induced amnesia mice trial, the stability of PAYCS during digestion was detected and the digestive products were identified. The results showed that PAYCS was susceptible to proteolytic degradation after incubation with pepsin and pancreatin and Pro-Ala-Tyr (PAY) was released and survived during the simulated GI digestion. The results of scopolamine-induced amnesia model trials showed that PAYCS and PAY treatment exhibited cognitive improvement effects in the behavioral tests and different pathways were determined. The results indicated that only PAYCS facilitated cholinergic activity by up-regulating the amount of acetylcholine (Ach) and acetylcholine receptor (AChR). Additionally, both PAYCS and PAY enhanced the superoxide dismutase (SOD) activity. Furthermore, PAYCS was found to be beneficial for the expression of the nuclear factor (erythroid-derived2)-like 2 protein (Nrf2), brain-derived neurotrophic factor (BDNF) and cAMP response element binding protein (CREB). This indicated that PAYCS could regulate the oxidative stress by activating the Nrf2/antioxidant response elements (Nrf2/ARE) pathway. In our study, we demonstrated that the memory improving effects conferred by PAYCS on amnesia mice were linked to the attenuation of the cholinergic system and the activation of Nrf2/ARE and BDNF/CREB signaling.


Assuntos
Amnésia/tratamento farmacológico , Amnésia/psicologia , Proteínas de Peixes/química , Trato Gastrointestinal/metabolismo , Peptídeos/administração & dosagem , Peptídeos/química , Acetilcolina/metabolismo , Acetilcolinesterase/genética , Acetilcolinesterase/metabolismo , Amnésia/etiologia , Amnésia/metabolismo , Animais , Fator Neurotrófico Derivado do Encéfalo/genética , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Cognição/efeitos dos fármacos , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/genética , Proteína de Ligação ao Elemento de Resposta ao AMP Cíclico/metabolismo , Feminino , Peixes , Humanos , Masculino , Memória/efeitos dos fármacos , Camundongos , Fármacos Neuroprotetores/administração & dosagem , Peptídeos/metabolismo , Escopolamina/efeitos adversos
5.
Rev. neurol. (Ed. impr.) ; 68(7): 295-300, 1 abr., 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183314

RESUMO

Introducción. La amnesia aguda aislada es una forma excepcional de presentación del ictus talámico. Se analizan el perfil clínico, el diagnóstico, el tratamiento y el pronóstico de estos pacientes. Casos clínicos. Revisión retrospectiva de los casos de infarto talámico que se presentaron exclusivamente como amnesia aguda en nuestro hospital terciario universitario (n = 3) y revisión de casos similares en PubMed (n = 20). El 48% presentaba al menos un factor de riesgo de ictus (hipertensión arterial, dislipidemia, diabetes mellitus, fibrilación auricular o ictus previo). La amnesia fue anterógrada en tres casos (13%) y global en los otros 20 (87%). El infarto se detectó en estudio de neuroimagen en las primeras 24 horas en un paciente (4%) y posteriormente en los demás, y la media de días hasta el diagnóstico fue de 11. La tomografía computarizada inicial fue normal en cinco (22%) pacientes. Precisaron estudio por resonancia magnética ocho (35%) casos para detectar el infarto. De éstos, cuatro sujetos se estudiaron directamente con resonancia magnética. La amnesia presentó una mejoría clara en ocho (35%) pacientes, y la recuperación fue completa en tres (13%). Las secuelas mnésicas que interferían la capacidad funcional se presentaron en 15 pacientes (65%). La clínica persistió menos de 24 horas en dos pacientes (9%). Ningún caso recibió tratamiento revascularizador en fase aguda. Conclusión. Los infartos talámicos que comienzan de forma exclusiva con amnesia presentan notables dificultades diagnósticas que repercuten negativamente en su tratamiento en la fase aguda. Estos infartos pueden producir un déficit mnésico funcionalmente discapacitante en un porcentaje elevado de pacientes


Introduction. Isolated acute amnesia is an exceptional presenting symptom of thalamic stroke. This study analyses the clinical profile, the diagnosis, the treatment and the prognosis of these patients. Case reports. We conducted a retrospective review of the cases of thalamic infarct that presented exclusively as acute amnesia in our university tertiary hospital (n = 3) and a review of similar cases in PubMed (n = 20). 48% presented at least one risk factor of stroke (arterial hypertension, dyslipidaemia, diabetes mellitus, atrial fibrillation or a previous stroke). Amnesia was anterograde in three cases (13%) and global in the remaining 20 (87%). The infarct was detected in neuroimaging studies carried out within the first 24 hours in one patient (4%) and later in all the others; the average time until a diagnosis was established was 11 days. The initial CT scan was normal in five patients (22%). Eight cases (35%) required magnetic resonance imaging to detect the infarct. Of these, four subjects were studied directly with MR imaging. Amnesia clearly improved in eight patients (35%), and three of them (13%) made a full recovery. Fifteen patients (65%) presented mnemonic sequelae that interfered with their functional capacity. The clinical picture lasted less than 24 hours in two patients (9%). None of the cases received revasculisation therapy in the acute phase. Conclusion. The diagnosis of thalamic infarcts that begin exclusively with amnesia is very difficult and this has negative repercussions on their treatment in the acute phase. These infarcts can produce a functionally disabling memory deficit in a high percentage of patients


Assuntos
Humanos , Masculino , Idoso , Doenças Talâmicas/complicações , Doenças Talâmicas/diagnóstico , Infarto Cerebral/complicações , Infarto/diagnóstico por imagem , Amnésia/etiologia , Tomografia Computadorizada por Raios X , Imagem por Ressonância Magnética , Infarto/terapia , Doença Aguda , Prognóstico
6.
Neuroimage Clin ; 22: 101785, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30927603

RESUMO

Traumatic axonal injury (TAI), a signature injury of traumatic brain injury (TBI), is increasingly known to involve myelin damage. The objective of this study was to demonstrate the clinical relevance of myelin water imaging (MWI) by first quantifying changes in myelin water after TAI and then correlating those changes with measures of injury severity and neurocognitive performance. Scanning was performed at 3 months post-injury in 22 adults with moderate to severe diffuse TBI and 30 demographically matched healthy controls using direct visualization of short transverse component (ViSTa) MWI. Fractional anisotropy (FA) and radial diffusivity (RD) were also obtained using diffusion tensor imaging. Duration of post-traumatic amnesia (PTA) and cognitive processing speed measured by the Processing Speed Index (PSI) from Wechsler Adult Intelligence Scale-IV, were assessed. A between-group comparison using Tract-Based Spatial Statistics revealed that there was a widespread reduction of apparent myelin water fraction (aMWF) in TBI, consistent with neuropathology involving TAI. The group difference map of aMWF yielded topography that was different from FA and RD. Importantly, aMWF demonstrated significant associations with PTA (r = -0.564, p = .006) and PSI (r = 0.452, p = .035). In conclusion, reduced myelin water, quantified by ViSTa MWI, is prevalent in moderate-to-severe diffuse TBI and could serve as a potential biomarker for injury severity and prediction of clinical outcomes.


Assuntos
Água Corporal/diagnóstico por imagem , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesão Axonal Difusa/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Bainha de Mielina , Índice de Gravidade de Doença , Adulto , Amnésia/etiologia , Biomarcadores , Lesões Encefálicas Traumáticas/complicações , Disfunção Cognitiva/etiologia , Lesão Axonal Difusa/complicações , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Neuropsychol Rehabil ; 29(10): 1655-1670, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29516771

RESUMO

It is uncertain whether therapy delivered during posttraumatic amnesia (PTA) following traumatic brain injury can be effective due to risk of agitation and poor learning capacity. This study used goal attainment scaling (GAS) to assess gains in activities of daily living (ADL) retraining during PTA. Occupational therapists' perspectives on goal setting and therapy delivery were also explored qualitatively. Forty-nine rehabilitation inpatients were provided with manualised ADL retraining following errorless and procedural learning principles during PTA. From 104 GAS goals, 90% were achieved at PTA emergence. GAS T-scores changed significantly (p < .001) from baseline (M = 26.94, SD = 4.90) to post-intervention (M = 61.44, SD = 11.45). Mean post-intervention T-scores correlated significantly (p < .001) with change in Functional Independence Measure scores. The four therapists reported that GAS was unfamiliar and time-consuming initially, although it aided goal-directed therapy and measurement of patient performance. Application of manualised skill retraining using errorless and procedural learning techniques was described as novel and challenging, but providing valuable structure. The intervention reportedly promoted therapeutic alliance, skill-building and meaningful time-use without elevating agitation, but fatigue impeded therapy. Overall, GAS captured positive individual change following ADL retraining during PTA and therapists indicated that the intervention and use of GAS was generally beneficial and feasible within clinical practice.


Assuntos
Atividades Cotidianas , Amnésia/psicologia , Amnésia/reabilitação , Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/reabilitação , Metas , Adulto , Amnésia/etiologia , Lesões Encefálicas Traumáticas/complicações , Feminino , Humanos , Aprendizagem , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Resultado do Tratamento
8.
Mil Med ; 184(1-2): e266-e271, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30137456

RESUMO

Differentiation of symptoms associated with post-traumatic amnesia (PTA) versus post-traumatic stress symptoms (PTSS) following trauma presents many treatment challenges among veterans and active duty service members receiving rehabilitation after traumatic brain injury (TBI). The acute phase of rehabilitation poses difficulties for amnestic individuals that may elicit classic PTA symptoms as well as premorbid PTSS, thereby activating maladaptive cognitions and an increase in agitation and arousal. Historically, explicit learning and memory strategies were considered non-efficacious with amnestic individuals until PTA resolves; therefore, rehabilitation therapies have utilized implicit learning in the initial phases of recovery. However, cognitive-behavioral therapy (CBT), which uses explicit learning and memory strategies based on cognitive, trauma, and neuropsychology lowers agitation and confusion for amnestic individuals with PTSS. In this paper, two case studies present preliminary evidence for effective implicit learning following a CBT intervention for individuals in PTA after a severe TBI receiving care. Notably, following a CBT intervention, agitation, confusion, and arousal were diminished despite having no recollection of the intervention. Thus, these cases suggest amnestic individuals in the acute recovery stage after severe TBI benefit from CBT to replace maladaptive attributions minimizing PTA and PTSS (e.g., confusion, arousal, and agitation) and improving motivation, participation, and recovery.


Assuntos
Amnésia/etiologia , Amnésia/terapia , Lesões Encefálicas Traumáticas/complicações , Terapia Cognitivo-Comportamental/normas , Acidentes de Trânsito/psicologia , Adulto , Ansiedade/epidemiologia , Ansiedade/etiologia , Lesões Encefálicas Traumáticas/psicologia , Lesões Encefálicas Traumáticas/terapia , Terapia Cognitivo-Comportamental/métodos , Humanos , Masculino
9.
J Affect Disord ; 243: 1-7, 2019 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-30218878

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is the major public health problem worldwide, particularly in the Middle East. Diffuse axonal injury (DAI) is commonly found in TBI. Although DAI can lead to physical and psychosocial disabilities, its prognostic value is still a matter of debate. Magnetic Resonance (MR) is more sensitive for detecting DAI lesions. OBJECTIVE: To identify the radiological and clinical factors associated with the functional capacity one year after the traumatic brain injury. METHODS: The study included 251 patients with severe head trauma for whom Brain MRI was done within one month after injury. Demographic, clinical, and radiological data were collected during hospitalization. Neurocognitive and psychiatric evaluation were done one year thereafter. RESULTS: DAI was more frequent in our patients. Psychiatric disorders, cognitive impairment, and poor functional outcome were more common in patients with DAI especially those with cerebral hemisphere and brain stem lesion, and mixed lesions. Duration of post traumatic amnesia (DPTA), lost consciousness and hospital stay (DHS) as well as the volume of diffuse axonal injury (DAI) were associated with poor neurocognitive outcome. DPTA, and DAIV may be considered independent factors that could predict the neurocognitive outcome. CONCLUSION: MRI following traumatic brain injury yields important prognostic information, with several lesion patterns significantly associated with poor long-term neurocognitive and psychiatric outcomes.


Assuntos
Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesão Axonal Difusa/diagnóstico por imagem , Imagem por Ressonância Magnética/estatística & dados numéricos , Transtornos Mentais/etiologia , Adulto , Amnésia/etiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Estado de Consciência , Estudos Transversais , Lesão Axonal Difusa/etiologia , Lesão Axonal Difusa/psicologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos
10.
Psychol Trauma ; 11(5): 513-520, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30211601

RESUMO

OBJECTIVE: Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals' severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID. METHOD: Utility statistics classify individuals' TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators. RESULTS: Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group's TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID. CONCLUSION: The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno Dissociativo de Identidade/diagnóstico , Testes de Memória e Aprendizagem , Adolescente , Adulto , Amnésia/diagnóstico , Amnésia/etiologia , Transtornos Autoinduzidos/diagnóstico , Feminino , Humanos , Entrevista Psicológica , Masculino , Simulação de Doença/diagnóstico , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Adulto Jovem
11.
Appl Neuropsychol Child ; 8(1): 61-69, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29058469

RESUMO

The aim of this study was to assess the validity (developmental, concurrent, and predictive) of the Sydney Post-Traumatic Amnesia Scale (SYPTAS) for assessment of post-traumatic amnesia (PTA) in 4 to 7 year old children with traumatic brain injury (TBI). The design of this study is a retrospective cohort study. The SYPTAS was administered to 35 children (26 boys) aged 4.0 to 7.8 years who were consecutively admitted to a children's hospital with mild (n = 26), moderate (n = 3), or severe (n = 7) TBI. Concurrent validity of the SYPTAS was assessed against the Glasgow Coma Scale Scores (GCS). Predictive validity of the SYPTAS for functional outcomes was evaluated against the King's Outcome Scale for Childhood Head Injury (KOSCHI) at discharge and outpatient follow-ups. The length of PTA, measured by the SYPTAS, was invariant of children's chronological age, confirming the scale's developmental validity. Longer PTA was associated with lower GCS, endorsing concurrent validity of PTA duration measured by the SYPTAS, as a clinical indicator of TBI severity. PTA duration measured by the SYPTAS was a significant predictor of functional outcomes on the KOSCHI at discharge and follow-ups. This study provides evidence that the SYPTAS has good developmental, concurrent and predictive validity for assessment of PTA in children aged 4 to 7 years. PTA duration assessed by the SYPTAS is a clinical indicator of TBI severity and can aid rehabilitation planning post TBI.


Assuntos
Amnésia/diagnóstico , Lesões Encefálicas Traumáticas/reabilitação , Testes de Memória e Aprendizagem/normas , Índice de Gravidade de Doença , Amnésia/etiologia , Lesões Encefálicas Traumáticas/complicações , Criança , Pré-Escolar , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos
12.
Neuropsychol Rehabil ; 29(3): 325-338, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28316271

RESUMO

Korsakoff's syndrome (KS) is a neuropsychiatric disorder characterised by severe amnesia. Although the presence of impairments in memory has long been acknowledged, there is a lack of knowledge about the precise characteristics of declarative memory capacities in order to implement memory rehabilitation. In this study, we investigated the extent to which patients diagnosed with KS have preserved declarative memory capacities in working memory, long-term memory encoding or long-term memory recall operations, and whether these capacities are most preserved for verbal or visuospatial content. The results of this study demonstrate that patients with KS have compromised declarative memory functioning on all memory indices. Performance was lowest for the encoding operation compared to the working memory and delayed recall operation. With respect to the content, visuospatial memory was relatively better preserved than verbal memory. All memory operations functioned suboptimally, although the most pronounced disturbance was found in verbal memory encoding. Based on the preserved declarative memory capacities in patients, visuospatial memory can form a more promising target for compensatory memory rehabilitation than verbal memory. It is therefore relevant to increase the number of spatial cues in memory rehabilitation for KS patients.


Assuntos
Amnésia/psicologia , Síndrome de Korsakoff/psicologia , Aprendizagem , Percepção Espacial , Percepção da Fala , Percepção Visual , Adulto , Idoso , Amnésia/etiologia , Feminino , Humanos , Síndrome de Korsakoff/complicações , Masculino , Pessoa de Meia-Idade
13.
Neuro Endocrinol Lett ; 39(2): 95-98, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-30183203

RESUMO

The aim of this study is to remind the possibility of co-occurrence of epilepsy and narcolepsy. In the first case report, narcolepsy type 1 was diagnosed in 29-year-old female. After one year of the treatment with modafinil a new episodes of automatic behavior appeared. Patient was reevaluated and the diagnosis of focal epilepsy with partial complex seizures was established. Patient was treated with modafinil and lamotrigine and became seizure-free. In the second case report a 21-year-old female was referred with a typical history of narcolepsy type 1, but also with atypical episodes of gazing and automatic behavior with amnesia for these episodes. Narcolepsy type 1 and focal epilepsy was diagnosed. Some clinical symptoms of narcolepsy (cataplexy, automatic behavior, episodes of sleep attacks) need to be carefully analyzed by EEG and video-EEG not to overlook the epilepsy.


Assuntos
Epilepsias Parciais/complicações , Narcolepsia/complicações , Adulto , Amnésia/etiologia , Amnésia/psicologia , Anticonvulsivantes/uso terapêutico , Comportamento , Estimulantes do Sistema Nervoso Central/uso terapêutico , Eletroencefalografia , Epilepsias Parciais/psicologia , Feminino , Humanos , Lamotrigina/uso terapêutico , Modafinila/uso terapêutico , Narcolepsia/tratamento farmacológico , Narcolepsia/psicologia , Resultado do Tratamento , Adulto Jovem
14.
J Neurotrauma ; 35(23): 2755-2775, 2018 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-29969935

RESUMO

Many individuals in post-traumatic amnesia (PTA) following traumatic brain injury (TBI) experience neurobehavioral symptoms (NBS) in addition to disorientation and amnesia. These symptoms are associated with low rehabilitation engagement, self-inflicted harm, and risk of violence. The aim of this systematic review was to evaluate the efficacy and harms of pharmacological interventions for NBS in PTA following TBI in adults. Studies in English published before December 2017 were reviewed. Six databases were searched, with additional hand searching of key journals, clinical trials registries, and international drug regulators. Evidence quality was assessed using Joanna Briggs Institute Critical Appraisal Instruments. Thirteen studies were identified: three randomized controlled trials (RCTs), three cohort studies, and seven case series. In the RCTs, neither amantadine nor sertraline reduced NBS. Less rigorous studies reported reduced NBS in patients administered haloperidol, ziprasidone, carbamazepine, amitriptyline, desipramine, and varied neuroleptics. There is a paucity of well-designed, adequately powered and controlled studies of pharmacological interventions for NBS in PTA. More research is needed to provide evidence-based treatment recommendations and improve care.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Fármacos do Sistema Nervoso Central/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/etiologia , Síndrome Pós-Concussão/tratamento farmacológico , Amnésia/etiologia , Amnésia/psicologia , Lesões Encefálicas Traumáticas/psicologia , Feminino , Humanos , Masculino
16.
Rev Neurol ; 66(S01): S83-S89, 2018 Mar 01.
Artigo em Espanhol | MEDLINE | ID: mdl-29516458

RESUMO

AIM: To contribute to neuropsychological profiling of developmental amnesia subsequent to bilateral damage to both hippocampi in early age. SUBJECTS AND METHODS: The total sample of 24 schoolchildren from both sexes is distributed in three groups: perinatal hypoxic-ischaemic encephalopathy and everyday complaints of memory in school age (n = 8); perinatal hypoxic-ischaemic encephalopathy without memory complaints (n = 7); and a group of typically developing (n = 9). All participants in every groups did have normal general intelligence and attention. Both clinical groups had, as another clinical consequence, spastic cerebral palsy (diplegia). Neuropsychological exam consisted on tests of general intelligence, attentional abilities, declarative memory and semantic knowledge. All participants had a brain magnetic resonance image and spectroscopy of hippocampi. Scheltens criteria were used for visual estimation of hippocampal atrophy. Parametric and non-parametric statistical contrasts were made. RESULTS: Despite preservation of semantic and procedural learning, declarative-episodic memory is impaired in the first group versus the other two groups. A significant proportion of bilateral hippocampal atrophy is only present in the first group versus the other two non-amnesic groups using Scheltens estimation on MRI. Two cases without evident atrophy did have diminished NAA/(Cho + Cr) index in both hippocampi. CONCLUSIONS: Taken together, these results contribute to delineate developmental amnesia as an specific impairment due to early partial bihippocampal damage, in agreement with previous studies. After diagnosis of developmental amnesia, a specific psychoeducational intervention must be made; also this impairment could be candidate for pharmacological trials in the future.


Assuntos
Amnésia/etiologia , Hipocampo/lesões , Neuroimagem , Adolescente , Amnésia/diagnóstico por imagem , Amnésia/metabolismo , Amnésia/patologia , Ácido Aspártico/análogos & derivados , Ácido Aspártico/análise , Atrofia , Paralisia Cerebral/psicologia , Criança , Colina/análise , Creatina/análise , Feminino , Hipóxia Fetal/complicações , Hipóxia Fetal/psicologia , Hipocampo/química , Hipocampo/patologia , Hipocampo/fisiopatologia , Humanos , Hipóxia-Isquemia Encefálica/complicações , Hipóxia-Isquemia Encefálica/psicologia , Imagem por Ressonância Magnética , Espectroscopia de Ressonância Magnética , Masculino , Testes Neuropsicológicos
17.
Eur J Neurol ; 25(5): 787-789, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29427459

RESUMO

BACKGROUND AND PURPOSE: Acute onset of amnestic syndrome may represent a challenging diagnostic issue. In addition to non-vascular etiology, thalamic strokes or infarction involving several temporal lobe structures have been reported. METHODS: We describe three patients in whom an isolated bilateral anterior fornix infarction presented with an acute amnestic syndrome. Clinical presentation, differential diagnosis and magnetic resonance images are discussed for each patient and vascular anatomy of the involved brain regions is also considered. RESULTS: Bilateral anterior columns of the fornix showed cytotoxic edema and bilateral narrowing of anterior cerebral artery was demonstrated. CONCLUSIONS: We suggest that bilateral fornix infarction should always be considered in the diagnostic work-up of an amnestic syndrome with acute onset.


Assuntos
Amnésia/etiologia , Infarto Cerebral/complicações , Fórnice/patologia , Acidente Vascular Cerebral/complicações , Idoso , Amnésia/diagnóstico por imagem , Amnésia/patologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/patologia , Feminino , Fórnice/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/patologia
18.
Brain Inj ; 32(5): 563-568, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29400569

RESUMO

OBJECT: To identify the risk factors for post-traumatic amnesia (PTA) and to document the incidence of PTA after mild traumatic brain injuries. METHODS: This was a prospective study, affecting mild TBI (mTBI) (Glasgow Coma Scale 14-15) cases attending to the Emergency Department between January 2009 and April 2012 (40 months duration). Patients were divided into two groups (Group A: without PTA, and Group B: with PTA, and they were assessed according to the risk factors. RESULTS: A total of 1762 patients (males: 1002, 56.8%) were meeting study inclusion criteria [Group A: n = 1678 (83.8%), Group B: n = 84 (4.2%)]. Age, CT findings: (traumatic focal HCs in the frontal and temporal lobes or more diffuse punctate HCs, and skull base fractures), anticoagulation therapy and seizures were independent factors of PTA. There was no statistically significant correlation between PTA and sex, convexity fractures, stroke event, mechanism of mTBI (fall +/or beating), hypertension, coronary heart disease, chronic smokers and diabetes (p > 0.005). CONCLUSION: CT findings: (traumatic focal HCs in the frontal and temporal lobes or more diffuse punctate HCs and skull base fractures), age, seizures and anticoagulation/antiplatelet therapy, were independent factors of PTA and could be used as predictive factors after mTBI.


Assuntos
Amnésia/etiologia , Lesões Encefálicas Traumáticas/complicações , Causalidade , Gerenciamento Clínico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amnésia/diagnóstico por imagem , Lesões Encefálicas Traumáticas/classificação , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Feminino , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Tomógrafos Computadorizados , Adulto Jovem
19.
J Neurol ; 265(5): 1050-1058, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29478221

RESUMO

Approximately 30% of Parkinson's disease (PD) patients show impaired cognitive performance, which is suggestive of Mild Cognitive Impairment (MCI), representing a predictor of dementia, especially when present at diagnosis. The objective of the study was to evaluate the frequency and clinical predictors of MCI in a large hospital-based cohort of PD patients. We collected cross-sectional data from the Parkinson's disease cognitive impairment study (PACOS), a multicenter study involving two Movement Disorder centers, which are located in south Italy. The PD subjects were diagnosed according to the UK Brain Bank criteria and they underwent an extensive neuropsychological assessment. PD-MCI was diagnosed according to the Movement Disorder Society task force criteria for MCI. PD severity was evaluated in accordance with the Unified PD Rating Scale-Motor Examination (UPDRS-ME) and the Hoehn and Yahr scales. The study included 659 PD patients (57.5% men; mean age 67.0 ± 9.7 years), with a mean disease duration of 3.8 ± 4.6 years and a mean UPRDS-ME score of 25.8 ± 12.3. PD-MCI was diagnosed in 261 (39.6%) subjects and in 82 (31.7%) of 259 newly diagnosed patients (disease duration ≤ 1 year). An amnestic MCI multidomain phenotype was the most frequent MCI subtype (39.1% of the overall sample and 43.9% in newly diagnosed PD). A positive significant association between MCI, age and motor scores was found at multivariate logistic regression analysis, while a negative association was observed between educational level and MCI. In conclusion and in agreement with the literature data, the prevalence of MCI recorded in the PACOS sample was approximately 40 and 32% amongst newly diagnosed patients.


Assuntos
Disfunção Cognitiva/etiologia , Doença de Parkinson/complicações , Idade de Início , Idoso , Amnésia/epidemiologia , Amnésia/etiologia , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Análise Multivariada , Testes Neuropsicológicos , Razão de Chances , Doença de Parkinson/epidemiologia , Doença de Parkinson/psicologia , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
J Neurosurg ; 128(6): 1731-1736, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-28574307

RESUMO

Korsakoff syndrome is a chronic memory disorder caused by a severe deficiency of thiamine that is most commonly observed in alcoholics. However, some have proposed that focal structural lesions disrupting memory circuits-in particular, the mammillary bodies, the mammillothalamic tract, and the anterior thalamus-can give rise to this amnestic syndrome. Here, the authors present 4 patients with reversible Korsakoff syndromes caused by suprasellar retrochiasmatic lesions compressing the mammillary bodies and adjacent caudal hypothalamic structures. Three of the patients were found to have large pituitary macroadenomas in their workup for memory deficiency and cognitive decline with minimal visual symptoms. These tumors extended superiorly into the suprasellar region in a retrochiasmatic position and caused significant mass effect in the bilateral mammillary bodies in the base of the brain. These 3 patients had complete and rapid resolution of amnestic problems shortly after initiation of treatment, consisting of resection in 1 case of nonfunctioning pituitary adenoma or cabergoline therapy in 2 cases of prolactinoma. The fourth patient presented with bizarre and hostile behavior along with significant memory deficits and was found to have a large cystic craniopharyngioma filling the third ventricle and compressing the midline diencephalic structures. This patient underwent cyst fenestration and tumor debulking, with a rapid improvement in his mental status. The rapid and dramatic memory improvement observed in all of these cases is probably due to a reduction in the pressure imposed by the lesions on structures contiguous to the third ventricle, rather than a direct destructive effect of the tumor, and highlights the essential role of the caudal diencephalic structures-mainly the mammillary bodies-in memory function. In summary, large pituitary lesions with suprasellar retrochiasmatic extension and third ventricular craniopharyngiomas can cause severe Korsakoff-like amnestic syndromes, probably because of bilateral pressure on or damage to mammillary bodies, anterior thalamic nuclei, or their major connections. Neuropsychiatric symptoms may rapidly and completely reverse shortly after initiation of therapy via surgical decompression of tumors or pharmacological treatment of prolactinomas. Early identification of these lesions with timely treatment can lead to a favorable prognosis for this severe neuropsychiatric disorder.


Assuntos
Doenças Cerebelares/complicações , Doenças Cerebelares/cirurgia , Síndrome de Korsakoff/etiologia , Síndrome de Korsakoff/cirurgia , Corpos Mamilares/cirurgia , Síndromes de Compressão Nervosa/complicações , Síndromes de Compressão Nervosa/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adenoma/complicações , Adenoma/cirurgia , Adulto , Amnésia/etiologia , Cabergolina/uso terapêutico , Craniofaringioma/psicologia , Craniofaringioma/cirurgia , Antagonistas de Dopamina/uso terapêutico , Humanos , Síndrome de Korsakoff/psicologia , Masculino , Transtornos Mentais/etiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/cirurgia , Prolactinoma/tratamento farmacológico , Prolactinoma/cirurgia , Resultado do Tratamento
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