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1.
Fortschr Neurol Psychiatr ; 88(1): 33-39, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31986550

RESUMO

The present review focuses on cognitive and participation impairments after aneurysmal subarachnoidal hemorrhage (aSAH). Such impairments may be present even in cases without evidence of damage in the neuropsychologically expected brain area. Neuroinflammation and oxidative stress may be responsible for this finding. Most frequently, cognitive impairment can be found in the verbal memory domain, visuospatial skills and memory domain, attention and working memory domain, executive functions (planning, central control, problem solving, attention, decision making), psychomotor speed and language domain. The presence of cognitive deficits is a major risk factor not to return to work again. Together with cognitive impairment, psychiatric symptoms like anxiety, depression and fatigue may be observed. Psychiatric disturbances result in impairments of social and vocational participation and - consecutively - worsening of quality of life.


Assuntos
Transtornos Cognitivos/complicações , Transtornos Cognitivos/fisiopatologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Transtornos Cognitivos/psicologia , Função Executiva , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Testes Neuropsicológicos , Qualidade de Vida , Hemorragia Subaracnóidea/psicologia
2.
Clin Interv Aging ; 14: 1503-1514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31686795

RESUMO

Introduction: We compared Nordic walking training (NW) to a multicomponent training (MCT) program of an equivalent intensity, in older adults. Our main hypothesis was that MCT would result in larger effects on cognitive processes than NW. Methods: Thirty-nine healthy older adults, divided into two groups (NW and MCT), took part in the study (17 males, 22 females, mean age =70.8±0.8 years). They were tested for cardiovascular fitness, motor fitness and cognitive performance during the two weeks preceding and following the 12-week training session (3 times/week), respectively. For both the NW and MCT interventions, the training sessions were supervised by a trainer. Heart rate of participants was monitored during the sessions and then used to make training loads as similar as possible between the two groups (TRaining IMPulse method). Results: Results showed that training resulted in better performance for cardiovascular and motor fitness tests. Among these tests, only two revealed a significant difference between the two groups. The NW group progressed more than the MCT group in the 30 Seconds Chair Stand test, while in the One Leg Stance test, the MCT group progressed more. For the cognitive assessment, a significant effect of training was found for executive functions, spatial memory score, and information processing speed response time, with no differences between the two groups. Conclusion: The study confirmed that physical exercise has a positive impact on cognitive processes with no advantage of MCT intervention over NW training. A possible reason is that NW intervention not only improved cardiovascular capacities, but also motor fitness, including coordination capacities.


Assuntos
Transtornos Cognitivos/terapia , Terapia por Exercício/métodos , Caminhada/normas , Idoso , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Função Executiva/fisiologia , Terapia por Exercício/estatística & dados numéricos , Feminino , Frequência Cardíaca , Humanos , Masculino , Aptidão Física , Caminhada/fisiologia
3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 66(9): 579-587, nov. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184381

RESUMO

El síndrome de Prader-Willi es un trastorno genético causado por alteraciones cromosómicas en el segmento 15q11-q13 que incluye sintomatología cognitiva, mental y conductual, así como un fenotipo somático específico. Tanto las alteraciones psicopatológicas más comunes (discapacidad intelectual, obsesiones, impulsividad, comportamientos de tipo autista, autolesiones) como las comorbilidades principales (cuadros afectivos, psicosis, trastorno obsesivo-compulsivo, trastorno del espectro autista) se caracterizan por una gran heterogeneidad, lo que justifica la necesidad de una mayor caracterización de su frecuencia y modo de presentación. Además de sus efectos sobre la composición corporal y la hipotonía, la hormona del crecimiento ha demostrado utilidad en el control conductual, así como algunos psicofármacos. También se han descrito alternativas a nivel experimental que están mostrando resultados alentadores. Un adecuado conocimiento de la psicopatología asociada a este síndrome permitiría mejorar el abordaje clínico, la identificación de los síntomas, la detección de comorbilidades y la instauración de un tratamiento más efectivo


Prader-Willi syndrome is a genetic disorder caused by chromosomal changes in segment 15q11-q13 including cognitive, mental, and behavioral symptoms, as well as a specific physical phenotype. Both the most common psychopathological changes (intellectual disability, obsessions, impulsivity, autism spectrum disorders, self-injuries) and the main psychiatric comorbidities (affective disorders, psychosis, obsessive-compulsive disorder, autism spectrum disorder) are characterized by a great heterogeneity, which warrants the need for better identification of their frequency and clinical signs. In addition to its effects on body compositionand hypotony, growth hormone has been shown to be useful for regulating patient behavior, and psychoactive drugs are also an option. Other alternatives have shown promising results in experimental trials. Adequate understanding of the psychopathology associated to Prader-Willi syndrome would allow for improving clinical approach, symptom identification, detection of comorbidities, and administration of more effective treatments, leading to better clinical outcomes


Assuntos
Humanos , Adolescente , Adulto , Síndrome de Prader-Willi/complicações , Síndrome de Prader-Willi/psicologia , Comorbidade , Comportamento do Adolescente , Síndrome de Prader-Willi/tratamento farmacológico , Psicopatologia , Comportamento Autodestrutivo/complicações , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , Transtorno do Espectro Autista/complicações , Transtorno da Personalidade Compulsiva , Transtorno do Deficit de Atenção com Hiperatividade
4.
J Abnorm Psychol ; 128(8): 806-812, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31657595

RESUMO

Individuals with anorexia nervosa (AN) often present inflexible behaviors and rigid thinking styles, which may contribute to disorder maintenance. Studies of set shifting have documented impairments in AN, but results have varied across samples. Moreover, the hypothesis that deficient set shifting may constitute an endophenotype rests largely on observations made with neuropsychological tests with limited ability to isolate component cognitive control processes. The current behavioral study used a task switching paradigm with a demonstrated ability to fractionate the hierarchical organization underlying task- and response-set shifting in 22 weight-recovered women with a history of AN (recAN) relative to 22 age-matched healthy controls. Whereas recAN performed generally more accurately than healthy controls, they also responded more slowly. Despite slower performance, however, recAN error rates did not exhibit the characteristic improvement in task switching on trials with a concurrent response switch-an interaction thought to index efficient action sequencing and the hierarchical control of behavior. These results were not mediated by comorbid symptoms, but no relationships with clinical measures were detected. Inefficient set shifting in AN may be related to a general tendency to sustain a high level of cognitive control (as evident here in a robust speed-accuracy trade-off), which interferes with context-sensitive regulation of processing priorities (as evident here in an atypical interaction between task and response switching). Although scarring effects cannot be excluded and the generalizability of our findings needs to be tested, the current observations in recAN provide novel evidence that altered set shifting may be a trait marker of the disorder. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Anorexia Nervosa/complicações , Anorexia Nervosa/psicologia , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , Adolescente , Adulto , Feminino , Humanos , Testes Neuropsicológicos/estatística & dados numéricos , Adulto Jovem
5.
Psychopathology ; 52(4): 265-270, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31614360

RESUMO

BACKGROUND: Suicide is known to be closely related to depression, which is accompanied by cognitive decline. OBJECTIVE: This study examined whether memory performance and cortical networking differ between high suicide risk and control groups depending on task difficulty. METHODS: The participants were 28 high school students consisting of 14 suicide risk and 14 control subjects. Real-time electroencephalography signals were collected during a working memory task. Inter- and intrahemispheric coherences were analyzed. RESULTS: Higher cortical networking during memory encoding was found in suicide risk adolescents compared to the control group. An increase in task difficulty heightened interhemispheric coherence. CONCLUSIONS: Higher cortical networking in suicide risk adolescents seems to reflect activation of compensatory mechanisms in an attempt to minimize behavioral decline.


Assuntos
Transtornos Cognitivos/psicologia , Eletroencefalografia/métodos , Memória de Curto Prazo/fisiologia , Suicídio/psicologia , Adolescente , Feminino , Humanos , Masculino , Fatores de Risco
6.
Psychiatr Danub ; 31(3): 355-357, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31596829

RESUMO

We aimed to compare processing speed (PS) and its subcomponents in schizophrenia (SC) and schizoaffective disorder (SA). Thirty-five patients were divided into two groups (SC=18; SA=17). PS tasks from the MATRICS Consensus Cognitive Battery Central/South America version were used. Additional PS subcomponents were analyzed (i.e., behavioral execution, response processing, and accuracy). SA obtained significant higher scores than SC in response processing, verbal fluency and the PS general domain. Our results indicate that PS is a potential cognitive marker to differentiate between SC and SA. Further research with larger samples must be conducted.


Assuntos
Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Transtornos Psicóticos/fisiopatologia , Transtornos Psicóticos/psicologia , Esquizofrenia/fisiopatologia , Psicologia do Esquizofrênico , Transtornos Cognitivos/complicações , Humanos , Testes Neuropsicológicos , Projetos Piloto , Transtornos Psicóticos/complicações , Esquizofrenia/complicações
7.
J Consult Clin Psychol ; 87(11): 1030-1042, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31613137

RESUMO

OBJECTIVE: Sluggish cognitive tempo refers to a constellation of symptoms that include slowed behavior/thinking, reduced alertness, and getting lost in one's thoughts. Despite the moniker "sluggish cognitive tempo," the evidence is mixed regarding the extent to which it is associated globally with slowed (sluggish) mental (cognitive) information processing speed (tempo). METHOD: A well-characterized clinical sample of 132 children ages 8-13 years (M = 10.34, SD = 1.51; 47 girls; 67% White/non-Hispanic) were administered multiple, counterbalanced neurocognitive tests and assessed for sluggish cognitive tempo symptoms via multiple-informant reports. RESULTS: Bayesian linear regressions revealed significant evidence against associations between sluggish cognitive tempo and computationally modeled processing speed (BF01 > 3.70), and significant evidence for associations with slower working memory manipulation speed. These findings were consistent across parent and teacher models, with and without control for attention-deficit/hyperactivity disorder inattentive symptoms and IQ. There was also significant evidence linking faster inhibition speed with higher parent-reported sluggish cognitive tempo symptoms. CONCLUSIONS: These findings provide strong evidence against characterizing children with sluggish cognitive tempo symptoms as possessing a globally sluggish cognitive tempo. Instead, these symptoms appear to be related, to a significant extent, to executive dysfunction characterized by working memory systems that are too slow and inhibition systems that are too fast. Behaviorally, these findings suggest that requiring extra time to rearrange the active contents of working memory delays responding, whereas an overactive inhibition system likely terminates thoughts too quickly and therefore prevents intended behaviors from starting or completing, thereby giving the appearance that children are absent-minded or failing to act when expected. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Transtornos Cognitivos/complicações , Transtornos Cognitivos/fisiopatologia , Memória de Curto Prazo , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Teorema de Bayes , Criança , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Fatores de Tempo
8.
Cogn Behav Neurol ; 32(3): 201-207, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31517704

RESUMO

BACKGROUND: Cognitive impairment is one of the most common consequences of multiple sclerosis (MS), yet there is a shortage of data regarding how cognition changes during the life span of individuals with MS. This information is of increasing importance given the growing proportion of older adults with MS. OBJECTIVE: To study possible changes in cognitive function in correlation with increasing age in individuals with MS. METHODS: Participants (N=129) were recruited and a priori allocated into one of three age groups (young, middle-aged, and older). All participants completed the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) during a single laboratory testing session. The BICAMS measures cognitive processing speed as well as verbal and visuospatial learning and memory. RESULTS: A multivariate analysis of variance indicated that cognitive function significantly differed by age group, and these differences were not explained by amount of physical activity, years of education, years since diagnosis, or race. Older adults displayed significantly worse cognitive processing speed than young and middle-aged adults. The older and middle-aged adults also demonstrated significantly worse visuospatial learning and memory than the younger adults. Effect sizes indicated that cognitive processing speed and verbal learning and memory were more affected in late adulthood than early adulthood, whereas visuospatial learning and memory was affected similarly in early and late adulthood. CONCLUSIONS: Older adults with MS demonstrated significant impairments in cognitive function compared to young and middle-aged adults with MS. Future studies should determine the predictors of cognitive decline in this age cohort.


Assuntos
Transtornos Cognitivos/diagnóstico , Esclerose Múltipla/complicações , Adulto , Fatores Etários , Idoso , Transtornos Cognitivos/psicologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/psicologia , Adulto Jovem
9.
Behav Neurol ; 2019: 9268179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31481980

RESUMO

Traumatic brain injury (TBI) is the most common cause of long-term disability and death among young adults, and it represents an enormous socioeconomic and healthcare burden. Our purpose is to evaluate the effects of a virtual reality training with BTs-Nirvana (BTs-N) on the recovery of cognitive functions in TBI subjects, using the interactive semi-immersive program. One hundred patients with TBI were enrolled in this study and randomized into either the Traditional Cognitive Rehabilitation Group (TCRG: n = 50) or the Virtual Reality Training Group (VRTG: n = 50). The VRTG underwent a VRT with BTs-N, whereas the TCRG received a standard cognitive treatment. Each treatment session lasted 60 minutes and was repeated three times a week for 8 weeks. All of the patients were evaluated by a specific psychometric battery before (T0) and immediately (T1) after the end of the training. VRTG and TCRG had a significant improvement in cognitive functioning and in mood, but only VRTG presented with a significant increase in cognitive flexibility and shifting skills and in selective attention. In conclusion, our results suggest that VR may be a useful and effective approach for the rehabilitation of patients with TBI, leading to better cognitive and behavioral outcomes.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Cognição/fisiologia , Terapia de Exposição à Realidade Virtual/métodos , Adulto , Atenção/fisiologia , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/psicologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Realidade Virtual
10.
Int. j. clin. health psychol. (Internet) ; 19(3): 228-236, sept. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184969

RESUMO

Background/Objective: The current study aimed to examine the relationship between Posttraumatic Stress Disorder (PTSD) symptoms and executive dysfunction in children and adolescents after psychological trauma. Method: Participants were 13,438 of children and adolescents aged 6 to 18 years exposed to the 2008 Wenchuan earthquake. PTSD and dysexecutive symptoms were assessed using the UCLA PTSD Reaction Index for Children and the Self-Report Dysexecutive Questionnaire. Latent Profile Analysis (LPA) was conducted using Mplus version 7.4. Subgroup differences in trauma exposure and quality of life were calculated using ANCOVA. Results: A 4-class parallel model was found to best describe latent PTSD symptom profiles and executive dysfunction. Individuals in higher symptom groups showed more trauma exposure and lower quality of life. Conclusions: This LPA study shed light on the relationship between PTSD and executive dysfunction symptoms in children and adolescents. The correlation between PTSD and executive dysfunction was maintained after individual differences were taken into consideration. Our findings provide a new view on how PTSD relates to executive dysfunction and several suggestions for treating child and adolescent PTSD patients


Antecedentes/Objetivo: Se plantea examinar la relación entre síntomas del Trastorno de Estrés Postraumático (TEPT) y disfunción ejecutiva en niños y adolescentes después de un trauma psicológico. Método: Los participantes fueron 13,438 niños y adolescentes de 6 a 18 años de edad expuestos al terremoto de Wenchuan de 2008, a los que se le evaluaron síntomas de TEPT utilizando el UCLA PTSD Reaction Index for Children y síntomas de disfunción ejecutiva mediante el Self-Report Dysexecutive Questionnaire. Se realizó un Análisis de Perfil Latente (APL) mediante Mplus versión 7.4. Las diferencias de subgrupos en la exposición al trauma y la calidad de vida se calcularon utilizando ANCOVA. Resultados: Un modelo paralelo de 4-clases describe mejor los perfiles de síntomas de TEPT latentes y disfunción ejecutiva. Los grupos con síntomas más intensos mostraron mayor exposición al trauma y menor calidad de vida. Conclusiones: Se aclara la relación TEPT-síntomas de disfunción ejecutiva en niños y adolescentes. La correlación entre el trastorno de estrés postraumático y la disfunción ejecutiva se mantuvo después de considerar la heterogeneidad de la población. Se ofrece una nueva visión de cómo el TEPT se relaciona con la disfunción ejecutiva y varias sugerencias para tratar a pacientes jóvenes con TEPT


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Qualidade de Vida , Inquéritos e Questionários
11.
Nutrients ; 11(8)2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31443192

RESUMO

Anorexia nervosa (AN) is an eating disorder often occurring in adolescence. AN has one of the highest mortality rates amongst psychiatric illnesses and is associated with medical complications and high risk for psychiatric comorbidities, persisting after treatment. Remission rates range from 23% to 33%. Moreover, weight recovery does not necessarily reflect cognitive recovery. This issue is of particular interest in adolescence, characterized by progressive changes in brain structure and functional circuitries, and fast cognitive development. We reviewed existing literature on fMRI studies in adolescents diagnosed with AN, following PRISMA guidelines. Eligible studies had to: (1) be written in English; (2) include only adolescent participants; and (3) use block-design fMRI. We propose a pathogenic model based on normal and AN-related neural and cognitive maturation during adolescence. We propose that underweight and delayed puberty-caused by genetic, environmental, and neurobehavioral factors-can affect brain and cognitive development and lead to impaired cognitive flexibility, which in turn sustains the perpetuation of aberrant behaviors in a vicious cycle. Moreover, greater punishment sensitivity causes a shift toward punishment-based learning, leading to greater anxiety and ultimately to excessive reappraisal over emotions. Treatments combining physiological and neurobehavioral rationales must be adopted to improve outcomes and prevent relapses.


Assuntos
Comportamento do Adolescente , Desenvolvimento do Adolescente , Anorexia Nervosa/fisiopatologia , Anorexia Nervosa/psicologia , Encéfalo/crescimento & desenvolvimento , Transtornos Cognitivos/psicologia , Cognição , Comportamento Alimentar , Adolescente , Fatores Etários , Anorexia Nervosa/diagnóstico por imagem , Anorexia Nervosa/terapia , Encéfalo/diagnóstico por imagem , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/fisiopatologia , Feminino , Humanos , Imagem por Ressonância Magnética , Saúde Mental , Puberdade Tardia/fisiopatologia , Puberdade Tardia/psicologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
13.
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
14.
Artigo em Inglês | MEDLINE | ID: mdl-31288465

RESUMO

(1) Background: Work-related stress is a major contributor to human error. One significant workplace stressor is job insecurity, which has been linked to an increased likelihood of experiencing burnout. This, in turn, might affect human error, specifically attention-related cognitive errors (ARCES) and the ability to detect errors. ARCES can be costly for organizations and pose a safety risk. Equally detrimental effects can be caused by failure to detect errors before they can cause harm. (2) Methods: We gathered self-report and behavioral data from 148 employees working in educational, financial and medical sectors in China. We designed and piloted an error detection task in which employees had to compare fictitious customer orders to deliveries of an online shop. We tested for indirect effects using the PROCESS macro with bootstrapping (3) Results: Our findings confirmed indirect effects of job insecurity on both ARCES and the ability to detect errors via burnout. (4) Conclusions: The present research shows that job insecurity influences making and detecting errors through its relationship with burnout. These findings suggest that job insecurity could increase the likelihood for human error with potential implications for employees' safety and the safety of others.


Assuntos
Atenção , Esgotamento Profissional/psicologia , Transtornos Cognitivos/psicologia , Satisfação no Emprego , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
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
16.
NeuroRehabilitation ; 44(4): 545-554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282434

RESUMO

BACKGROUND: Neurosensory stimulation is effective in enhancing the recovery process of severely brain-injured patients with disorders of consciousness. Multisensory environments are found in nature, recognized as beneficial to many medical conditions. Recent advances detected covert cognition in patients behaviorally categorized as un- or minimally responsive; a state described as cognitive motor dissociation (CMD). OBJECTIVE: To determine effectiveness of a neurosensory stimulation approach enhanced by outdoor therapy, in the early phases of recovery in patients presenting with CMD. METHODS: A prospective non-randomized crossover study was performed. A two-phase neurosensory procedure combined identical individually goal assessed indoor and outdoor protocols. All sessions were video-recorded and observations rated offline. The frequency of volitional behavior was measured using a behavioral grid. RESULTS: Fifteen patients participated in this study. The outdoor group patients had statistically significant higher number of intentional behaviors than the indoor group on seven features of the grid. Additionally, for all items assessed, total amount of behaviors in the outdoor condition where higher than those in the indoor condition. CONCLUSIONS: Although preliminary, this study provides robust evidence supporting the effectiveness and appropriateness of an outdoor neurosensory intervention in patients with covert cognition, to improve adaptive goal-oriented behavior. This may be a step towards helping to restore functional interactive communication.


Assuntos
Lesões Encefálicas/terapia , Transtornos Cognitivos/terapia , Cognição/fisiologia , Recuperação de Função Fisiológica/fisiologia , Terapia Recreacional/métodos , Sensação/fisiologia , Adulto , Idoso , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/psicologia , Transtornos Cognitivos/fisiopatologia , Transtornos Cognitivos/psicologia , Estado de Consciência/fisiologia , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Ocupacional/métodos , Terapia Ocupacional/psicologia , Modalidades de Fisioterapia/psicologia , Estudos Prospectivos , Terapia Recreacional/psicologia , Adulto Jovem
17.
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
18.
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
19.
J Neurooncol ; 144(3): 511-518, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31342318

RESUMO

PURPOSE: Progressive disease in patients with high-grade glioma may be reflected in cognitive decline. However, the cognitive functions most sensitive to progression may differ between patients. We investigated whether decline on a personalized selection of tests predicted progressive disease according to RANO criteria in high-grade glioma patients. METHODS: Starting one day before surgery, patients underwent neuropsychological assessment every three months during standard treatment and clinical follow-up. We first made a personalized selection of three tests that showed the highest Reliable Change Index (RCI) values, i.e., most positive change, at the first post-surgical assessment for each patient. In subsequent follow up, a decline of RCI ≤ - 1 on at least two of the three tests in the selection was considered cognitive decline. We performed a discrete Cox proportional hazards model including a time-dependent coefficient cognitive decline (vs. stability) and covariate age to predict progressive disease. RESULTS: Twenty five patients were included. Cognitive decline on the personalized test selection preceded or had occurred by the time progression was established in 9/15 patients with RANO confirmed progressive disease (60%). Decline was absent in 8/10 patients (80%) with stable disease during participation. The independent hazard ratio for progression in case of cognitive decline was 5.05 (p < 0.01) compared to stable performance. CONCLUSIONS: Using only three patient-specific neuropsychological tests, we found a fivefold increased chance of disease progression in case of cognitive decline as compared to stable performance. Brief, patient-tailored cognitive assessment may be a noninvasive addition to disease monitoring without overburdening patients and clinical care.


Assuntos
Neoplasias Encefálicas/cirurgia , Transtornos Cognitivos/diagnóstico , Glioma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Medicina de Precisão , Medição de Risco/métodos , Adulto , Idoso , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/psicologia , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Progressão da Doença , Feminino , Seguimentos , Glioma/patologia , Glioma/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Valor Preditivo dos Testes , Fatores de Risco , Adulto Jovem
20.
Anesthesiol Clin ; 37(3): 521-536, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31337482

RESUMO

Postoperative delirium and postoperative cognitive dysfunction (POCD) occur commonly in older adults after surgery and are frequently underrecognized. Delirium has been associated with worse outcomes, and both delirium and cognitive dysfunction increase the risk of long-term cognitive decline. Although the pathophysiology of delirium and POCD have not been clearly defined, risk factors for both include increasing age, lower levels of education, and baseline cognitive impairment. In addition, developing delirium increases the risk of POCD. This article examines interventions that may reduce the risk of developing delirium and POCD and improve long-term recovery and outcomes in the vulnerable older population.


Assuntos
Encéfalo/crescimento & desenvolvimento , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Complicações Pós-Operatórias/psicologia , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/prevenção & controle , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/prevenção & controle , Delírio do Despertar/epidemiologia , Delírio do Despertar/prevenção & controle , Delírio do Despertar/psicologia , Humanos , Complicações Pós-Operatórias/prevenção & controle
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