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1.
Psychiatr Prax ; 47(1): 29-34, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910458

RESUMO

Formal thought disorders are common in people diagnosed with schizophrenia. Among them, concretism stands for deficiencies in the understanding of idiomatic expressions, metaphors and proverbs. However, little is known as to whether concretism is a correlate of the acuteness or severity of schizophrenia within patients. In this pilot study data of 28 patients was collected in the process of implementing a proverb test for screening purposes as part of an enhancement to the standard assessment of the general cognitive functioning of the patients. Our findings support the argument for such a coherence as a significant correlation between the degree of acuteness and concretism was found. However, the proverb test also correlated significantly with our standard cognitive assessment so the question as to which degree the proverb test will add further information regarding the general cognitive functioning needs to be addressed. Finally, the question as to whether there is an indication to specifically approach concretism in the treatment of patients with schizophrenia is discussed.


Assuntos
Transtornos Cognitivos , Esquizofrenia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/terapia , Alemanha , Humanos , Metáfora , Projetos Piloto , Esquizofrenia/diagnóstico , Esquizofrenia/terapia
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 119(9. Vyp. 2): 10-17, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825384

RESUMO

Cognitive decline is one of the main manifestations of brain damage especially in the elderly. In some cases, cognitive dysfunction stayed within normal aging and do not lead to social dis-adaptation, while in other cases severe cognitive impairment develops when daily activity and domestic independence is affected. However, these disturbances are preceded by prolonged intermediate stage, when cognitive deficit do not reach the degree of dementia, but already do not match normal aging. Initial terms (for example benign senescent forgetfulness) were interpreted as aging phenomena. Later this state named as mild cognitive impairment (MCI) is considered as prodromal phase of demented disease. Up to date studies allow us consider MCI as an integral part of the complex structure of overlapping syndromes ('pre-cognitive impairment'), the allocation of which have not only theoretical, but also pragmatic meaning, allow us, on the one hand, to plan clinical trials series with various therapeutic targets, and, on the other hand, to form rational approach to the modern management of patients with MCI and pre-MCI in clinical practice.


Assuntos
Transtornos Cognitivos , Disfunção Cognitiva , Demência , Idoso , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/diagnóstico , Progressão da Doença , Humanos , Transtornos da Memória
3.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 54(11-12): 652-667, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31805585

RESUMO

Perioperative neurocognitive disorders (pNCD) are relevant to long term treatment outcome after elective surgery. The detection of pNCD is challenging and based on extended neuropsychological testing that often is not feasible due to economy driven time constraints during preoperative risk assessment. Only recently new recommendations for the nomenclature of cognitive change associated with anaesthesia and surgery facilitated the transition of the former research diagnosis postoperative cognitive dysfunction (POCD) as a clinical diagnosis based on DSM-5 criteria. In our article we provide an overview of the new recommended diagnostic criteria for pNCD based on the publication by the Nomenclature Consensus Working Group in November 2018. We discuss ideas for the implementation of clinical routine pNCD screening in patients aged 70 years or older with elective surgery and possible options for further support of patients screened positively and their families and care givers.


Assuntos
Anestesia , Transtornos Cognitivos , Delírio , Idoso , Anestesia/efeitos adversos , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Delírio/diagnóstico , Delírio/etiologia , Humanos , Transtornos Neurocognitivos , Complicações Pós-Operatórias
4.
Pan Afr Med J ; 34: 58, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762923

RESUMO

Introduction: Five-word test (5WT) is a memory test to assess the verbal episodic memory. It measures the memory of subjects with memory impairment, in particular within the framework of the diagnosis of Alzheimer's disease, where it is sensitive and specific. The purpose of our study was to evaluate the effect of different sociodemographic parameters on subject's performance, to set standards relevant to Tunisian population and to compare our results to previous studies. Methods: We report 5WT calibration in 315 normal subjects aged 40 to 90 years (169 men, 146 women), divided into four age groups (40-49,50-59,60-69 and 70 years) having three levels of education (I: primary, II:secondary and III:higher). We calculated the mean score (standard deviation) for the different scores: Total Score (TS), Total Weighted Score (TWS), Delayed Free Recall (DFR), Total Delayed Recall (TDR) and Total Free Recall (TFR). Results: The average age of subjects was 57.29 years (11.02). Performances appeared to be better in youngest and better educated subjects, without any significant difference between the two sexes. Standards were calculated on the basis of age and levels of education. Conclusion: Five-word test allows rapid screening of patients in whom complementary neuropsychological assessment is essential for the diagnosis of cognitive disorders.


Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos da Memória/diagnóstico , Memória Episódica , Testes Neuropsicológicos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Sensibilidade e Especificidade , Tunísia
5.
Cochrane Database Syst Rev ; 9: CD011414, 2019 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521064

RESUMO

BACKGROUND: The diagnosis of Alzheimer's disease dementia and other dementias relies on clinical assessment. There is a high prevalence of cognitive disorders, including undiagnosed dementia in secondary care settings. Short cognitive tests can be helpful in identifying those who require further specialist diagnostic assessment; however, there is a lack of consensus around the optimal tools to use in clinical practice. The Mini-Cog is a short cognitive test comprising three-item recall and a clock-drawing test that is used in secondary care settings. OBJECTIVES: The primary objective was to determine the diagnostic accuracy of the Mini-Cog for detecting Alzheimer's disease dementia and other dementias in a secondary care setting. The secondary objectives were to investigate the heterogeneity of test accuracy in the included studies and potential sources of heterogeneity. These potential sources of heterogeneity will include the baseline prevalence of dementia in study samples, thresholds used to determine positive test results, the type of dementia (Alzheimer's disease dementia or all causes of dementia), and aspects of study design related to study quality. SEARCH METHODS: We searched the following sources in September 2012, with an update to 12 March 2019: Cochrane Dementia Group Register of Diagnostic Test Accuracy Studies, MEDLINE (OvidSP), Embase (OvidSP), BIOSIS Previews (Web of Knowledge), Science Citation Index (ISI Web of Knowledge), PsycINFO (OvidSP), and LILACS (BIREME). We made no exclusions with regard to language of Mini-Cog administration or language of publication, using translation services where necessary. SELECTION CRITERIA: We included cross-sectional studies and excluded case-control designs, due to the risk of bias. We selected those studies that included the Mini-Cog as an index test to diagnose dementia where dementia diagnosis was confirmed with reference standard clinical assessment using standardised dementia diagnostic criteria. We only included studies in secondary care settings (including inpatient and outpatient hospital participants). DATA COLLECTION AND ANALYSIS: We screened all titles and abstracts generated by the electronic database searches. Two review authors independently checked full papers for eligibility and extracted data. We determined quality assessment (risk of bias and applicability) using the QUADAS-2 tool. We extracted data into two-by-two tables to allow calculation of accuracy metrics for individual studies, reporting the sensitivity, specificity, and 95% confidence intervals of these measures, summarising them graphically using forest plots. MAIN RESULTS: Three studies with a total of 2560 participants fulfilled the inclusion criteria, set in neuropsychology outpatient referrals, outpatients attending a general medicine clinic, and referrals to a memory clinic. Only n = 1415 (55.3%) of participants were included in the analysis to inform evaluation of Mini-Cog test accuracy, due to the selective use of available data by study authors. There were concerns related to high risk of bias with respect to patient selection, and unclear risk of bias and high concerns related to index test conduct and applicability. In all studies, the Mini-Cog was retrospectively derived from historic data sets. No studies included acute general hospital inpatients. The prevalence of dementia ranged from 32.2% to 87.3%. The sensitivities of the Mini-Cog in the individual studies were reported as 0.67 (95% confidence interval (CI) 0.63 to 0.71), 0.60 (95% CI 0.48 to 0.72), and 0.87 (95% CI 0.83 to 0.90). The specificity of the Mini-Cog for each individual study was 0.87 (95% CI 0.81 to 0.92), 0.65 (95% CI 0.57 to 0.73), and 1.00 (95% CI 0.94 to 1.00). We did not perform meta-analysis due to concerns related to risk of bias and heterogeneity. AUTHORS' CONCLUSIONS: This review identified only a limited number of diagnostic test accuracy studies using Mini-Cog in secondary care settings. Those identified were at high risk of bias related to patient selection and high concerns related to index test conduct and applicability. The evidence was indirect, as all studies evaluated Mini-Cog differently from the review question, where it was anticipated that studies would conduct Mini-Cog and independently but contemporaneously perform a reference standard assessment to diagnose dementia. The pattern of test accuracy varied across the three studies. Future research should evaluate Mini-Cog as a test in itself, rather than derived from other neuropsychological assessments. There is also a need for evaluation of the feasibility of the Mini-Cog for the diagnosis of dementia to help adequately determine its role in the clinical pathway.


Assuntos
Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Demência/diagnóstico , Testes de Estado Mental e Demência , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Progressão da Doença , Humanos , Testes de Estado Mental e Demência/normas , Atenção Secundária à Saúde , Sensibilidade e Especificidade
6.
Orv Hetil ; 160(38): 1495-1502, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31537098

RESUMO

A significant proportion of cancer patients reports a decline in their usual cognitive functions. This impairment may be the consequence of either the malignant disorder itself or the side-effect of the treatment. This impairment in cognitive skills was referred to with a sticky witty name as chemobrain or chemofog, reflecting on the old conception based on the assumption that solely the neurotoxic effect of chemotherapy was responsible for this kind of disturbances. However, today there is increasing evidence proving that such hypotheses can only partially explain the cognitive decline of cancer patients and cancer survivors. As a matter of fact, the cognitive impairment of cancer patients is a much more complex consequence of the malignant disorder than chemobrain or chemofog. Nowadays, this process is described as "cancer-related cognitive impairment" (CRCI). Orv Hetil. 2019; 160(38): 1495-1502.


Assuntos
Antineoplásicos/efeitos adversos , Transtornos Cognitivos/induzido quimicamente , Disfunção Cognitiva/induzido quimicamente , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Neoplasias/tratamento farmacológico , Antineoplásicos/uso terapêutico , Cognição , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/diagnóstico , Humanos , Neoplasias/complicações
7.
Dev Neuropsychol ; 44(6): 443-451, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31537099

RESUMO

The influence of fear of re-injury that this variable has on recovery outcomes following sports-related concussion remains unknown. We examined changes in fear of re-injury throughout concussion recovery, and compared changes in neurocognitive, symptom, vestibular/ocular motor, and recovery time outcomes between concussed adolescent athletes who endorsed high and low fear of re-injury. Individuals with high fear of re-injury were more symptomatic and more likely to exhibit vestibular/ocular motor symptoms over clinical cutoffs than those with low fear of re-injury. Recovery time was not significantly different between the groups. These findings may help explain performance on more subjective concussion assessments.


Assuntos
Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/psicologia , Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Transtornos Cognitivos/diagnóstico , Medo , Adolescente , Atletas , Feminino , Humanos , Masculino , Testes Neuropsicológicos , Estudos Prospectivos , Instituições Acadêmicas , Esportes
8.
Psychiatr Danub ; 31(Suppl 3): 261-264, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488738

RESUMO

BACKGROUND: Schizophrenia can be interpreted as a pathology involving the neocortex whose cognitive dysfunctions represent a central and persistent characteristic of the disease, as well as one of the more important symptoms in relation to the impairment of psychosocial functioning and the resulting disabilities. Given the implication of cognitive functions in everyday life, they can better predict the degree of schizophrenia. The study proposes to use Machine Learning techniques to identify the specific cognitive deficits of schizophrenia that mostly characterize the disorder, as well as to develop a predictive system that can diagnose the presence of schizophrenia based on neurocognitive tests. BACKGROUND: The study employs a dataset of neurocognitive assessments carried out on 201 people (86 schizophrenic patients and 115 healthy patients) recruited by the Neuroscience Group of the University of Bari "A. Moro". A data analysis process has been carried out, with the aim of selecting the most relevant features as well as to prepare data for training a number of "off-the-shelf" machine learning methods (Decision Tree, Random Forest, Logistic Regression, k-Nearest Neighbor, Neural Network, Support Vector Machine), which have been evaluated in terms of classification accuracy according to stratified 20-fold cross-validation. RESULTS: Among all variables, 14 were selected as the most influential for the classification problem. The variables with greater influence are related to working memory, executive functions, attention, verbal fluency, memory. The best algorithms turned out to be Support Vector Machine (SVM) and Neural Network, showing an accuracy of 87.8% and 84.8% on a test set. CONCLUSIONS: Machine Learning provides "cheap" and non-invasive methods that potentially enable early intervention with specific rehabilitation interventions. The results suggest the need to integrate a thorough neuropsychological evaluation into the more general diagnostic evaluation of patients with schizophrenia disorder.


Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/diagnóstico , Disfunção Cognitiva/complicações , Disfunção Cognitiva/diagnóstico , Aprendizado de Máquina , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Cognição , Humanos , Testes Neuropsicológicos , Psicologia do Esquizofrênico
9.
West Afr J Med ; 36(2): 158-164, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31385602

RESUMO

OBJECTIVE: Previous reports has shown that asthmatic patients with poor asthma control exhibited cognitive dysfunction. However, there is paucity of information on the cognitive functions of patients with clinically stable asthma particularly in sub-Saharan Africa. Subjects, study setting, materials and methods: This was a cross-sectional study conducted at the Federal Medical Centre, Owo, South West Nigeria from 2014-2016. Forty patients with mild to moderate asthma and forty matched (age, sex and educational status) non-asthmatic control subjects were included. Spirometry was done for all participants. Cognitive performance on domains of psychomotor speed, attention/concentration, memory and vigilance were assessed in all the participants using the Fepsy neuropsychological test battery Results: The mean age of the patients with asthma in years was 38.65±16.67 while that of the control subjects was 39.18±11.64 years. The patients with asthma had prolonged visual and binary choice reaction time relative to controls. Older asthmatic patients had prolonged visual and binary choice reaction time when compared to controls (p<0.05) while other socio-demographic clinical characteristics of the patients did not have impact on their cognitive performance (p>0.05). CONCLUSION: Cognitive performance was similar between the patients with mild to moderate asthma and non-asthmatic controls. Older asthmatic patients have impaired psychomotor speed relative to younger asthmatic patients.


Assuntos
Asma/diagnóstico , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Desempenho Psicomotor/fisiologia , Adolescente , Adulto , Fatores Etários , Asma/complicações , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Estudos Transversais , Humanos , Memória , Pessoa de Meia-Idade , Testes Neuropsicológicos , Nigéria
10.
Chirurg ; 90(11): 930-935, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31468065

RESUMO

BACKGROUND: Gastrointestinal cancer is a frequent diagnosis in older patients. A curative resection, possibly in combination with radiotherapy and/or chemotherapy, is the standard therapy. The advanced age of the patients with an increasing number of comorbidities and often the presence of cognitive impairment represents a high risk for perioperative complications and a longer stay in hospital. The challenge in the clinical routine is to recognize a cognitive impairment in older patients and to prepare these patients for the operative intervention in the best possible way. OBJECTIVE: This retrospective analysis was carried out to find out whether preoperative cognitive impairment is a prognostic factor for the postoperative outcome. METHODS: In patients over the age of 75 years who were prepared for abdominal surgery of gastrointestinal cancer in the preoperative consultation, the mini mental state examination (MMSE) and the clock test were carried out. The results of the tests were retrospectively compared with the complication rate and the duration of hospital stay. RESULTS: Low MMSE values were significantly associated with the complication rate and the development of a severe complication (Clavien-Dindo grade ≥ 3a). A cut-off value of 24 points in the MMSE was predictive for the development of complications and a longer hospital stay. The age of the patients was not associated with the MMSE. CONCLUSION: Cognitive impairment is an important prognostic factor for the development of perioperative complications and the duration of the hospital stay in patients undergoing extensive abdominal surgery for gastrointestinal cancer. Therefore, a preoperative assessment, for example with the MMSE, is recommended in order to identify high-risk patients.


Assuntos
Transtornos Cognitivos/diagnóstico , Cognição , Hospitalização , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Feminino , Humanos , Tempo de Internação , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos
11.
Psychol Aging ; 34(6): 766-779, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393145

RESUMO

Hearing impairment is associated with poorer cognitive function in later life. We tested for the potential contribution of childhood cognitive ability to this relationship. Childhood cognitive ability is strongly related to cognitive function in older age, and may be related to auditory function through its association with hearing impairment risk factors. Using data from the Lothian Birth Cohort, 1936, we tested whether childhood cognitive ability predicted later-life hearing ability then whether this association was mediated by demographic or health differences. We found that childhood cognitive ability was negatively associated with hearing impairment risk at age 76 (odds ratio = .834, p = .042). However, this association was nonsignificant after subsequent adjustment for potentially mediating demographic and health factors. Next, we tested whether associations observed in older age between hearing impairment and general cognitive ability level or change were accounted for by childhood cognitive ability. At age 76, in the minimally adjusted model, hearing impairment was associated with poorer general cognitive ability level (ß = -.119, p = .030) but was not related to decline in general cognitive ability. The former association became nonsignificant after additional adjustment for childhood cognitive ability (ß = -.068, p = .426) suggesting that childhood cognitive ability contributes (potentially via demographic and health differences) to the association between levels of hearing and cognitive function in older age. Further work is needed to test whether early life cognitive ability also contributes to the association (documented in previous studies) between older-age hearing impairment and cognitive decline. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Envelhecimento/fisiologia , Transtornos Cognitivos/etiologia , Cognição/fisiologia , Envelhecimento Cognitivo/psicologia , Disfunção Cognitiva/complicações , Disfunção Cognitiva/fisiopatologia , Perda Auditiva/complicações , Fatores Etários , Idoso , Envelhecimento/psicologia , Criança , Transtornos Cognitivos/diagnóstico , Feminino , Perda Auditiva/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Testes Neuropsicológicos , Fatores de Risco
12.
Dement Geriatr Cogn Disord ; 47(4-6): 315-322, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31390625

RESUMO

BACKGROUND/AIMS: This study aimed to adapt the Modified Mini-Mental State Examination (3MS) and determine its normative values in Turkey. METHODS: After translation and cultural adaptation processes, a population-based study was conducted between February and June 2016 in Ankara with individuals over the age of 55 years. Subjects with a previous diagnosis of dementia along with neuropsychiatric disorders that might affect cognition were excluded. Data analyses were performed to assess the association of sociodemographic variables with 3MS scores. RESULTS: Two versions of the Turkish 3MS (for educated and minimally educated individuals) were developed. A total of 2,235 participants were included in the field study. After exclusion, the data on the final sample of 1,909 individuals were analyzed, where age, gender, and education accounted for variance in 3MS scores. Younger age and higher educational attainment were associated with better 3MS performance. CONCLUSIONS: A widely applicable dementia screening test was adapted to Turkish and its normative values were determined. The test will make it possible to evaluate the cognitive performance of both educated and minimally educated elderly individuals based on their age, gender, and educational level.


Assuntos
Testes de Estado Mental e Demência/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Cultura , Escolaridade , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência/normas , Pessoa de Meia-Idade , Valores de Referência , Reprodutibilidade dos Testes , Fatores Sexuais , Fatores Socioeconômicos , Traduções , Turquia
13.
Psiquiatr. biol. (Internet) ; 26(2): 62-65, mayo-ago. 2019.
Artigo em Espanhol | IBECS | ID: ibc-185032

RESUMO

La anosognosia es una característica común pero variable en la enfermedad de Alzheimer (EA). Se define como la incapacidad de introspección del paciente respecto a los déficits cognitivos y a las alteraciones del comportamiento. La anosognosia podría considerarse como un fenómeno temprano de la EA, pero debido a su carácter multifactorial existen dificultades en el proceso de detección, al no existir pruebas estandarizadas. Se presenta un caso clínico de una mujer de 57años con antecedentes de trastorno depresivo que ingresa por conductas bizarras, desorganizadas, lenguaje escaso y sin déficits cognitivos relevantes. A nivel clínico no se aprecia sintomatología afectiva o psicótica, siendo lo más relevante la presencia por parte de la paciente de anosognosia de cualquier alteración de conducta. La evolución tórpida y los resultados de la tomografía computarizada por emisión de fotón único (SPECT) y el líquido cefalorraquídeo orientan a un estadio preclínico de la EA, previo a la presencia de deterioro cognitivo. La anosognosia como síntoma orientador en el inicio de la EA puede ayudar a realizar un diagnóstico y abordaje terapéutico precoz de la EA


Anosognosia is a common but variable feature in Alzheimer's disease (AD). It is defined as the lack of awareness of the patient as regards cognitive deficits and behavioural alterations. Anosognosia could be considered as an early phenomenon of AD, but due to its multifactorial nature there are difficulties in the detection process, as there are no standardised tests. A clinical case is presented of a 57year-old woman with a history of depressive disorder, who was admitted for bizarre and disorganised behaviour and poor language, but no relevant cognitive deficits. At the clinical level, there were no affective or psychotic symptoms, with the most relevant signs being the presence of anosognosia in any behaviour changes by the patient. The lack of progression, the single photon emission computed tomography (SPECT), and cerebrospinal fluid results, pointed to a pre-clinical stage of AD, prior to the presence of cognitive impairment. Anosognosia as a guiding symptom in the onset of AD can help to make an early diagnosis and provide an early therapeutic approach to AD


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos do Comportamento Social/diagnóstico , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Transtorno Depressivo/complicações , Líquido Cefalorraquidiano/citologia
14.
Neurología (Barc., Ed. impr.) ; 34(6): 353-359, jul.-ago. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-185452

RESUMO

Introducción: La neurofibromatosis tipo 1 (NF1) es un síndrome neurocutáneo frecuente que en muchos casos se asocia a dificultades cognitivas específicas que habitualmente no son tenidas en cuenta en el seguimiento médico de estos pacientes. Objetivo: Trazar el perfil cognitivo de pacientes con NF1 detectando trastornos en funciones superiores asociados al mismo. Identificar motivos de consulta de pacientes pediátricos con NF1 en relación con su desempeño escolar. Métodos: Trabajo descriptivo transversal. Se evaluó neuropsicológicamente a 24 pacientes con NF1 con edades comprendidas entre los 5 y los 16 años de edad. Resultados: Los motivos de consulta más frecuentes fueron: problemas atencionales (58,33%), aprendizaje (25%), coordinación motora (25%) y lenguaje (0,8%). Si bien el estudio reveló que el 96% de los pacientes tenía compromiso en al menos una de las áreas evaluadas, solo el 83,34% de los padres las refirieron. El 58,33% presentó trastorno por déficit de atención con hiperactividad (TDAH), el 33,33% trastorno de aprendizaje no verbal (TANV), el 20,83% dificultades en aspectos expresivos del lenguaje, el 8,33% coeficiente intelectual (CI) limítrofe, el 4,16% retraso mental y el 4,16% no mostró dificultades. Conclusiones: Existe alta frecuencia de trastornos en funciones superiores en niños con NF1. Aunque muchos padres detectan dichos trastornos, se ha observado que otros son subestimados. Consideramos conveniente que todos los niños con NF1 cuenten con una evaluación neuropsicológica a fin de poder detectar dificultades existentes en cada caso y así poder elaborar una estrategia de rehabilitación cognitiva precoz y efectiva


Introduction: Neurofibromatosis type 1 (NF1) is a common neurocutaneous syndrome often associated with specific cognitive deficits that are rarely monitored during follow-up of these patients. Objective: The purpose of our study is two-fold. First, we aimed to describe the cognitive profile of patients with NF1 and detect disorders in higher brain functions associated with the disease. Second, we identified the reasons for consultation associated with school performance in these patients. Methods: We conducted a descriptive cross-sectional study of 24 paediatric patients (ages 5 to 16) with NF1 who underwent neuropsychological assessment. Results: The most frequent reasons for consultation were attention deficits (58.33%), learning disorders (25%), poor motor coordination (25%), and language impairment (0.8%). Although 96% of the patients displayed impairments in at least one of the assessed areas, only 83.34% of the parents had reported such impairments. Attention-deficit/hyperactivity disorder was present in 58.33% of the patients, whereas 33.33% had nonverbal learning disabilities, 20.83% had expressive language disorder, 8.33% had borderline intellectual functioning, 4.16% had mental retardation, and only 4.16% showed no cognitive impairment. Conclusion: Higher brain functions are frequently impaired in paediatric patients with NF1. Although many parents report such disorders, they can go undetected in some cases. Neuropsychological assessment is recommended for all paediatric patients with NF1 to detect cognitive impairment and provide early, effective rehabilitation treatment


Assuntos
Humanos , Masculino , Feminino , Criança , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/epidemiologia , Transtornos da Linguagem/diagnóstico , Transtornos de Aprendizagem/diagnóstico , Neurofibromatose 1/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Estudos Transversais , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/epidemiologia , Transtornos da Linguagem/epidemiologia , Transtornos de Aprendizagem/epidemiologia , Testes Neuropsicológicos/estatística & dados numéricos
15.
Cien Saude Colet ; 24(7): 2513-2530, 2019 Jul 22.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31340270

RESUMO

Detecting and monitoring cognitive deficits in elderly populations are necessary, as they can impact individuals´ functionality. This integrative review aims to analyze the scientific production on the use of cognitive assessment instruments in Brazilian elderly individuals through articles published in the last five years, indexed in the Web of Science, Pubmed, Scopus and Bireme databases. Inclusion criteria were original articles published in English and Portuguese from 2012 to 2016, the age criterion to define elderly individuals and scores higher than 6 in the adapted CASP. The exclusion criterion was conference abstracts submitted for publication. The final sample consisted of 100 articles. Sixty-one cognitive assessment instruments were used in the studies, especially the Mini-Mental State Examination. This review features the use of cognitive instruments in the Brazilian literature, their different versions and domains evaluated. The literature includes a large number of instruments. The most used tests were the MMSE (version proposed by Brucki et al.), the Verbal Fluency Test ("animal" category) and the Digit Span Memory Test (forward span and backward span). The findings presented in this review are relevant not only for observational and experimental research but also for clinical practice.


Assuntos
Transtornos Cognitivos/diagnóstico , Avaliação Geriátrica/métodos , Testes de Estado Mental e Demência , Idoso , Brasil , Humanos
16.
Dement Geriatr Cogn Disord ; 47(4-6): 254-263, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31315124

RESUMO

BACKGROUND/AIMS: Canonical definitions of the dementia construct encompass deficits in both cognition and function, but most screening instruments for possible dementia address only cognitive abilities. Free-Cog is a recently described brief screening instrument for dementia designed to address not only cognitive but also functional abilities. METHODS: A pragmatic test accuracy study of Free-Cog was undertaken in consecutive patients seen over 1 year in a secondary care setting. The performance of Free-Cog for diagnosis of dementia and mild cognitive impairment (MCI) was compared to that of Mini-Addenbrooke's Cognitive Examination (MACE). RESULTS: In a cohort of 141 patients (prevalence of dementia and MCI 11 and 32%, respectively) both Free-Cog and MACE were quick and easy to use and acceptable to patients. Both tests had high sensitivity (1.00) and large effect sizes (Cohen's d) for diagnosis of dementia, but Free-Cog was more specific. For diagnosis of MCI, Free-Cog lacked sensitivity (0.58) but was specific (0.81), whereas MACE was sensitive (0.91) but not specific (0.35). Weighted comparison suggested equivalence for dementia diagnosis but a net benefit for MACE regarding MCI diagnosis. CONCLUSION: Free-Cog is an acceptable and accurate test for dementia screening in a dedicated cognitive disorders clinic, but it appears less sensitive than MACE for the identification of MCI.


Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Cognição , Função Executiva , Testes de Estado Mental e Demência , Adulto , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Estudos de Coortes , Demência/diagnóstico , Demência/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Valores de Referência , Sensibilidade e Especificidade
17.
PLoS Med ; 16(7): e1002852, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31276501

RESUMO

BACKGROUND: Acute illness requiring hospitalization frequently is a sentinel event leading to long-term disability in older people. Prolonged bed rest increases the risk of developing cognitive impairment and dementia in acutely hospitalized older adults. Exercise protocols applied during acute hospitalization can prevent functional decline in older patients, but exercise benefits on specific cognitive domains have not been previously investigated. We aimed to assess the effects of a multicomponent exercise intervention for cognitive function in older adults during acute hospitalization. METHODS AND FINDINGS: We performed a secondary analysis of a single-blind randomized clinical trial (RCT) conducted from February 1, 2015, to August 30, 2017 in an Acute Care of the Elderly (ACE) unit in a tertiary public hospital in Navarre (Spain). 370 hospitalized patients (aged ≥75 years) were randomly allocated to an exercise intervention (n = 185) or a control (n = 185) group (usual care). The intervention consisted of a multicomponent exercise training program performed during 5-7 consecutive days (2 sessions/day). The usual care group received habitual hospital care, which included physical rehabilitation when needed. The main outcomes were change in executive function from baseline to discharge, assessed with the dual-task (i.e., verbal and arithmetic) Gait Velocity Test (GVT) and the Trail Making Test Part A (TMT-A). Changes in the Mini Mental State Examination (MMSE) test and verbal fluency ability were also measured after the intervention period. The physical exercise program provided significant benefits over usual care. At discharge, the exercise group showed a mean increase of 0.1 m/s (95% confidence interval [CI], 0.07, 0.13; p < 0.001) in the verbal GVT and 0.1 m/s (95% CI, 0.08, 0.13; p < 0.001) in the arithmetic GVT over usual care group. There was an apparent improvement in the intervention group also in the TMT-A score (-31.1 seconds; 95% CI, -49.5, -12.7 versus -3.13 seconds; 95% CI, -16.3, 10.2 in the control group; p < 0.001) and the MMSE score (2.10 points; 95% CI, 1.75, 2.46 versus 0.27 points; 95% CI, -0.08, 0.63; p < 0.001). Significant benefits were also observed in the exercise group for the verbal fluency test (mean 2.16 words; 95% CI, 1.56, 2.74; p < 0.001) over the usual care group. The main limitations of the study were patients' difficulty in completing all the tasks at both hospital admission and discharge (e.g., 25% of older patients were unable to complete the arithmetic GVT, and 47% could not complete the TMT-A), and only old patients with relatively good functional capacity at preadmission (i.e., Barthel Index score ≥60 points) were included in the study. CONCLUSIONS: An individualized, multicomponent exercise training program may be an effective therapy for improving cognitive function (i.e., executive function and verbal fluency domains) in very old patients during acute hospitalization. These findings support the need for a shift from the traditional (bedrest-based) hospitalization to one that recognizes the important role of maintaining functional capacity and cognitive function in older adults, key components of intrinsic capacity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02300896.


Assuntos
Repouso em Cama/efeitos adversos , Transtornos Cognitivos/prevenção & controle , Cognição , Terapia por Exercício , Hospitalização , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Função Executiva , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Fatores de Risco , Método Simples-Cego , Fatores de Tempo , Resultado do Tratamento , Comportamento Verbal , Velocidade de Caminhada
18.
J Stroke Cerebrovasc Dis ; 28(9): 2376-2387, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31285116

RESUMO

BACKGROUND AND PURPOSE: Silent brain infarct (SBI), which has traditionally been considered clinically silent, has been proposed as a subclinical risk marker for future cognitive function decline. METHODS: We conducted a systematic review of literature in the Cochrane Library, MEDLINE, EMBASE, and the China National Knowledge Infrastructure database. RESULTS: In the end, 19 case-control studies, comprising 6712 participants, and 3 prospective cohort studies comprising 4433 participants, met all inclusion criteria and were included in the systematic review. Meta-analysis of 9 studies showed that SBI was an important factor in cognitive function decline (Mini-Mental State score) (standardized mean difference -.47, 95% confidence interval; -.72 to -.22). Another meta-analysis of 4 studies reported the SBI was an independent factor in cognitive dysfunction (Montreal Cognitive Assessment Scale) (standardized mean difference -3.36, 95% confidence interval; -5.90 to -.82). Ten studies further reported that SBI was associated with decreases in specific areas of cognitive function. CONCLUSIONS: These results suggest that rather than being clinically silent, SBI might be a factor inducing cognitive dysfunction.


Assuntos
Infarto Encefálico/complicações , Transtornos Cognitivos/etiologia , Cognição , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Infarto Encefálico/diagnóstico , Infarto Encefálico/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
19.
Mayo Clin Proc ; 94(8): 1516-1523, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31280871

RESUMO

OBJECTIVE: To compare the Short Test of Mental Status (STMS) with the Montreal Cognitive Assessment (MoCA) for predicting and detecting mild cognitive impairment (MCI). PARTICIPANTS AND METHODS: Participants from the community-based Mayo Clinic Study of Aging (MCSA) (November 24, 2010, through May 19, 2012) and an academic referral Alzheimer's Disease Research Center (ADRC) (March 16, 2015, through September 5, 2018) were analyzed. All participants were evaluated using a standardized neuropsychological battery, and a multidisciplinary consensus diagnosis was assigned. The MCSA and ADRC samples included 313 and 106 stable cognitively normal (CN) participants, 72 and 8 CN participants at baseline who developed incident MCI or dementia, 114 and 96 participants with prevalent MCI, and 25 and 132 participants with dementia, respectively. RESULTS: There were no statistically significant differences between the 2 tests in 6 of 7 diagnostic comparisons across academic referral and community populations. The STMS had a better area under the curve (0.90; 95% CI, 0.87-0.93) for differentiating prevalent MCI from CN participants in the MCSA cohort compared with the MoCA cohort (0.85; 95% CI, 0.81-0.89; P=.01). In addition, 53% of the stable CN participants (222 of 419) scored less than 26 on the MoCA, with specificity of 47% for diagnosing prevalent MCI. CONCLUSION: We provide evidence that the STMS performs similarly to the MoCA in a variety of settings and neurodegenerative syndromes. These results suggest that the current recommended MoCA cutoff score may be overly sensitive, consistent with previous studies. We also provide a conversion table for comparing the 2 cognitive tests.


Assuntos
Envelhecimento/fisiologia , Doença de Alzheimer/diagnóstico , Transtornos Cognitivos/diagnóstico , Testes de Estado Mental e Demência , Centros Médicos Acadêmicos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Área Sob a Curva , Transtornos Cognitivos/epidemiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estudos de Coortes , Diagnóstico Diferencial , Progressão da Doença , Feminino , Avaliação Geriátrica/métodos , Humanos , Vida Independente , Masculino , Pessoa de Meia-Idade , Minnesota , Testes Neuropsicológicos , Valor Preditivo dos Testes , Prevalência , Curva ROC , Estudos Retrospectivos , Medição de Risco
20.
Epileptic Disord ; 21(S1): 15-21, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262717

RESUMO

Encephalopathy with continuous spike-waves during slow-wave sleep (CSWS) evolves over time, and three stages can be recognized: before the onset of CSWS, during CSWS, and after the CSWS period. Clinical seizures tend to remit spontaneously around puberty. This pattern is independent of the etiological lesion. The CSWS also disappears in all cases. Focal abnormalities instead, may persist for some time after the disappearance of CSWS. The disappearance of the clinical seizures and CSWS may be simultaneous or seizures may disappear before or after disappearance of the CSWS pattern on the EEG. Electroclinical parameters in the pre-CSWS period that have been proposed to predict a poor outcome are early-onset seizures, appearance of new seizures, and a significant increase in seizure frequency. From the electrical point of view, an increase in the frequency of the interictal EEG paroxysms while awake and during sleep and bilateral spike-and-wave paroxysms may also be predictive of a poor evolution in CSWS. When CSWS disappears, neurocognitive and behavioral status improve, but in most patients, residual moderate to severe neurocognitive impairments remain. In non-lesional epilepsy, cognitive recovery after cessation of the CSWS depends on the severity and duration of the initial regression. The duration of the CSWS seems to be the most important predictor of cognitive outcome. Early recognition and effective therapy to reduce the seizures and resolve the CSWS may be crucial to improve long-term prognosis. Cognitive recovery is observed in patients who respond well to AED treatment and outcome depends on the etiology.


Assuntos
Transtornos Cognitivos/psicologia , Epilepsia/psicologia , Convulsões/fisiopatologia , Sono/fisiologia , Encefalopatias/fisiopatologia , Transtornos Cognitivos/diagnóstico , Eletroencefalografia/métodos , Humanos , Estudos Longitudinais , Prognóstico , Convulsões/diagnóstico , Sono de Ondas Lentas
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