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1.
Neurología (Barc., Ed. impr.) ; 36(1): 9-15, ene.-feb. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192836

RESUMO

INTRODUCCIÓN: Varios países del mundo padecen una grave carga en sus sistemas de salud como consecuencia de la pandemia por COVID-19. Esta realidad pone en riesgo el seguimiento de patologías crónicas como las demencias. Asimismo, la atención de las posibles complicaciones neuropsiquiátricas relacionadas con el aislamiento preventivo de la población (cuarentena), que en el caso de Argentina se considera la más prolongada de Latinoamérica. El objetivo del presente trabajo es determinar la frecuencia de las distintas modalidades de consulta médica en relación con la patología neurocognitiva del paciente y las variables predictoras de consulta desde el inicio de la cuarentena. MÉTODOS: Estudio descriptivo observacional y transversal basado en la recolección de datos a través de una encuesta. RESULTADOS: Hubo 324 participantes, 165 (50,9%) de los cuales realizaron al menos una consulta médica. Frecuencia de modalidades de consulta: teléfono, 109 (33,6%); correo electrónico, 62 (19,1%); videoconsulta, 30 (9,3%); servicio de emergencias, 23 (7,1%). Predictores de consulta: Clinical Dementia Rating ≥ 1 (p < 0,001); diagnóstico: Alzheimer (p = 0,017). Se encontraron puntajes más altos del Inventario Neuropsiquiátrico (NPI) en el grupo que ha realizado consultas médicas (p < 0,001). Dicha diferencia no fue observada en el puntaje de la escala de carga del cuidador (Zarit). CONCLUSIÓN: Evidenciamos alta prevalencia de trastornos conductuales en pacientes y de sobrecarga en cuidadores durante la cuarentena. Solamente el 50% accedió a una consulta médica (52,7% por modalidad telefónica y correo electrónico). Es necesario extremar los cuidados en personas con demencia, garantizando el seguimiento de su patología


INTRODUCTION: Health systems in numerous countries around the world are suffering a serious burden as a consequence of the COVID-19 pandemic. As a result of this situation, the follow-up of such chronic diseases as dementia may be at risk. Similarly, neuropsychiatric complications related to lockdown measures may also be neglected; Argentina's lockdown has been the longest implemented in Latin America. This study aims to determine the frequency of the different types of medical consultations for neurocognitive disorders and the predictors for requiring consultation since the beginning of the lockdown. METHODS: We performed a descriptive, observational, cross-sectional study based on data collected through an online survey. RESULTS: Data were collected on 324 participants, with 165 (50.9%) having had at least one medical consultation. Consultations were held by telephone in 109 cases (33.6%), by e-mail in 62 (19.1%), by video conference in 30 (9.3%), and at the emergency department in 23 (7.1%). Predictors of requiring consultation were Clinical Dementia Rating scores ≥1 (P < .001) and diagnosis of Alzheimer disease (P = .017). Higher Neuropsychiatric Inventory scores were found in the group of respondents who did require medical consultation (P < .001), but no significant differences were found between groups for Zarit Burden Interview scores. CONCLUSION: We identified a high prevalence of behavioural disorders and caregiver burden during lockdown. Nevertheless, only 50% of respondents had sought medical consultation (by telephone or email in 52.7% of cases). Care of people with dementia must be emphasised, guaranteeing follow-up of these patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Encaminhamento e Consulta/estatística & dados numéricos , Transtornos Neurocognitivos , Cuidadores , Doença de Alzheimer , Demência , Inquéritos e Questionários , Seguimentos , Estudos Transversais , Argentina/epidemiologia
2.
Neurologia ; 36(1): 9-15, 2021.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32921515

RESUMO

INTRODUCTION: Health systems in numerous countries around the world are suffering a serious burden as a consequence of the COVID-19 pandemic. As a result of this situation, the follow-up of such chronic diseases as dementia may be at risk. Similarly, neuropsychiatric complications related to lockdown measures may also be neglected; Argentina's lockdown has been the longest implemented in Latin America. This study aims to determine the frequency of the different types of medical consultations for neurocognitive disorders and the predictors for requiring consultation since the beginning of the lockdown. METHODS: We performed a descriptive, observational, cross-sectional study based on data collected through an online survey. RESULTS: Data were collected on 324 participants, with 165 (50.9%) having had at least one medical consultation. Consultations were held by telephone in 109 cases (33.6%), by e-mail in 62 (19.1%), by video conference in 30 (9.3%), and at the emergency department in 23 (7.1%). Predictors of requiring consultation were Clinical Dementia Rating scores ≥1 (P<.001) and diagnosis of Alzheimer disease (P=.017). Higher Neuropsychiatric Inventory scores were found in the group of respondents who did require medical consultation (P<.001), but no significant differences were found between groups for Zarit Burden Interview scores. CONCLUSION: We identified a high prevalence of behavioural disorders and caregiver burden during lockdown. Nevertheless, only 50% of respondents had sought medical consultation (by telephone or email in 52.7% of cases). Care of people with dementia must be emphasised, guaranteeing follow-up of these patients.


Assuntos
/epidemiologia , Continuidade da Assistência ao Paciente , Transtornos Neurocognitivos/diagnóstico , Encaminhamento e Consulta , Idoso , Doença de Alzheimer/diagnóstico , Argentina/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Inquéritos e Questionários
3.
Brain Dev ; 43(2): 230-233, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33082059

RESUMO

BACKGROUND: Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum, emerging related to encephalitis, seizures, antiepileptic drug withdrawal, or metabolic disturbances. Among RESLES, mild encephalitis/encephalopathy with reversible splenial lesion (MERS) has been defined as a distinct clinicoradiologic syndrome associated with viral infections. CASE PRESENTATION: We report two children with multisystem inflammatory syndrome-children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed RESLES during the disease course. Encephalopathy was the main central nervous system symptom. Both of the children showed a rapid recovery, and brain magnetic resonance imaging revealed complete resolution of the splenial lesion within 1 week. CONCLUSION: The complete resolution of the splenial lesion and rapid recovery from encephalopathy in RESLES associated with SARS CoV-2 were similar to observed in MERS.


Assuntos
Encefalopatias/diagnóstico por imagem , Corpo Caloso/diagnóstico por imagem , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico por imagem , Encefalopatias/tratamento farmacológico , Encefalopatias/fisiopatologia , /tratamento farmacológico , Criança , Dispneia/fisiopatologia , Eletroencefalografia , Exantema/fisiopatologia , Feminino , Febre/fisiopatologia , Glucocorticoides/uso terapêutico , Alucinações/fisiopatologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Transtornos Neurocognitivos/diagnóstico por imagem , Transtornos Neurocognitivos/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Taquipneia/fisiopatologia
5.
J Comput Assist Tomogr ; 44(6): 947-952, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33196602

RESUMO

OBJECTIVE: The objective of this study was to investigate clinical neurocognitive performance and microstructural white matter (WM) alterations in infants of mothers with gestational diabetes mellitus (GDM) using diffusion tensor imaging. MATERIALS AND METHODS: Infants (corrected gestational age, 33.42-36.00 weeks) of mothers with GDM (n = 31) and gestational age- and sex-matched unexposed controls (n = 31) accomplished 3-T diffusion tensor imaging scans and neurocognitive tests. Diffusion tensor imaging measures, mainly referring to fractional anisotropy (FA) values, were compared between 2 groups, and within-group analysis of correlation between FA values and neurocognitive testing outcomes in GDM-exposed infants was conducted subsequently. RESULTS: Fractional anisotropy was significantly decreased in the splenium of corpus callosum, posterior limb of internal capsule, thalamus in infants of mothers with GDM when compared with controls (P < 0.05), reflecting microstructural WM abnormalities in the GDM group. Decreased FA was associated with worse neurocognitive performance in the exposed group (P < 0.05). CONCLUSIONS: Individuals of mothers with GDM showed microstructural WM abnormalities in different brain regions, which were significantly related to worse neurocognitive performance. This might reveal that GDM directly insults the brain development of the offspring.


Assuntos
Encéfalo/fisiopatologia , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/fisiopatologia , Imagem de Tensor de Difusão/métodos , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/fisiopatologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/crescimento & desenvolvimento , Causalidade , China , Feminino , Humanos , Recém-Nascido , Masculino , Testes de Estado Mental e Demência/estatística & dados numéricos , Mães , Transtornos Neurocognitivos/diagnóstico , Gravidez , Substância Branca/diagnóstico por imagem , Substância Branca/fisiopatologia
7.
J Stud Alcohol Drugs ; 81(5): 584-594, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33028471

RESUMO

OBJECTIVE: Existing studies relating to the prevalence of alcohol-related neurocognitive disorders (ARNDs; e.g., Korsakoff's Syndrome, alcohol-related dementia) are now outdated and few have been undertaken in the United Kingdom. The aim of this study was to estimate the prevalence of ARNDs in South Wales, U.K., and determine the specific diagnostic terms and criteria used in clinical practice. METHOD: A naturalistic, survey-based prevalence study was undertaken wherein data were collected retrospectively for all individuals with ARNDs attending services during all of 2015 and 2016. A diverse sample of health and social care services (N = 60) in South Wales took part in the study. RESULTS: A total of 490 individuals with ARNDs were identified by participating services, equating to an age-specific rate of 34 individuals per 100,000 inhabitants. Variability was observed across age ranges and genders, with most identified in the 45-64 year age range and a male:female ratio of 2.6:1. Twenty-three individuals younger than age 35 were identified, demonstrating an increase in younger cases compared with previous studies. Various diagnostic terms were used, with "alcohol-related brain damage" being most common. Only 6.3% of cases were diagnosed according to specific criteria and 44.3% were reported as having a "probable" ARND, meaning no official diagnosis had been designated but initial assessments indicated that they likely had an ARND. CONCLUSIONS: Findings provide a novel understanding of ARND prevalence in a previously understudied area, although the prevalence estimate is conservative and should be interpreted cautiously for reasons discussed. Findings also highlight an inconsistency between diagnoses presented in nosological systems (e.g., International Classification of Diseases-10th Revision) and those used in practice and therefore a need to evaluate novel diagnostic conceptualizations of alcohol-related neurocognitive impairment.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Neurocognitivos/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Etanol/administração & dosagem , Etanol/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Reino Unido , Adulto Jovem
8.
Rev. neurol. (Ed. impr.) ; 71(7): 237-245, 1 oct., 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-195708

RESUMO

INTRODUCCIÓN: El trastorno neurocognitivo asociado al virus de la inmunodeficiencia humana (VIH) es un problema emergente a pesar del tratamiento antirretroviral. Los test de cribado que mejor se adaptan a la población española son la Brief Neurocognitive Scale (BNCS) y el Neu Screening. Desconocemos la magnitud del trastorno neurocognitivo en la población con VIH. OBJETIVOS: Comprobar si existe asociación entre la infección por el VIH y el trastorno neurocognitivo, y conocer su prevalencia. SUJETOS Y MÉTODOS: Estudio observacional, descriptivo y transversal que compara a 24 pacientes con VIH y a 21 controles sanos, pareados por sexo, edad y nivel de estudios. Se utilizó la Hospital Anxiety and Depression Scale, el Neu Screening y la BNCS para el cribado neuropsicológico. Se consideró positivo un cribado con una alteración en uno o más test. RESULTADOS: Un 33,3% de los pacientes con VIH y un 33,3% de los controles sanos tuvieron un cribado positivo, sin diferencias significativas entre ambos grupos. El cribado positivo presentó una relación significativa con ansiedad y depresión. Existe una correlación lineal positiva entre niveles nadir de CD4 y resultados del Digit Symbol, y entre nadir de CD4 y fluencia verbal. No hubo relación significativa entre VIH positivo y cribado positivo. CONCLUSIONES: Los pacientes con VIH con buen control clínico presentan un perfil neurocognitivo sin diferencias significativas frente a la población control. Los niveles de CD4 son posiblemente una variable predictora para el desarrollo de trastorno neurocognitivo. La BNCS y el Neu Screening son buenas alternativas, pero resulta necesario un abordaje neuropsiquiátrico concomitante. Se precisan estudios con muestras mayores para confirmar la hipótesis alternativa


INTRODUCTION: Neurocognitive impairment associated to human immunodeficiency virus (HIV) is a current problem despite the effectiveness of antiretroviral treatment. The screening tests which best suit to Spanish population are Brief Neuro¬cognitive Scale (BNCS) and Neu Screening. We are unaware of our HIV populations neurocognitive impairment magnitude. AIMS. To verify if association between HIV and neurocognitive impairment does exist and to know its prevalence. SUBJECTS AND METHODS: An observational, descriptive and transversal study comparing 24 HIV-outpatients and 21 non-HIV-healthy control matched by age, gender and educational level. Hospital Anxiety and Depression Scale, Neu Screening and BNCS were used as neurocognitive impairment screening. Positive screening was considered with one or more abnormal test. RESULTS: 33.3% of VIH+ and 33.3% of healthy controls had positive screening without significant difference between both populations. Positive screening was significantly associated with anxiety-punctuation and depression-punctuation. A lineal correlation between CD4-nadir-levels and Digit Symbol and between CD4-nadir-levels and verbal fluency results were found. There was no significant relationship between HIV serology and screening result. CONCLUSIONS: HIV-patients clinically controlled had no significantly different neurocognitive profile compared to control population. CD4-nadir levels may be a predictor variable in terms of neurocognitive impairment development. BNCS and Neu Screening are reasonable alternatives for neurocognitive impairment screening. A concomitant psychiatric and neuro¬psychological assessment is necessary. Further studies with bigger samples are necessary in order to confirm the alternative hypothesis


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Transtornos Neurocognitivos/complicações , Infecções por HIV/complicações , Testes Neuropsicológicos , Infecções por HIV/psicologia , Estudos Transversais , Ansiedade/epidemiologia , Ansiedade/psicologia , Depressão/epidemiologia , Depressão/psicologia , Fatores de Risco
9.
Pediatrics ; 146(5)2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33028661

RESUMO

The current coronavirus disease 2019 (COVID-19) pandemic has triggered an intense global research effort to inform the life-saving work of frontline clinicians who need reliable information as soon as possible. Yet research done in pressured circumstances can lead to ethical dilemmas, especially for vulnerable research subjects. We present the case of a child with neurocognitive impairment who is diagnosed with COVID-19 infection after presenting with fever and a seizure. The child lives in a group home and is in the custody of the state; her parents lost parental rights many years ago. Some members of the health care team want to enroll her in a randomized clinical trial evaluating an experimental treatment of COVID-19. For minor patients to enroll in this clinical trial, the institutional review board requires assent of patients and consent of guardians. An ethics consult is called to help identify relevant concerns in enrollment. In the accompanying case discussion, we address historical perspectives on research involving people with disabilities; proper management of research participation for people with disabilities including consent by proxy, therapeutic misconception, and other threats to the ethical validity of clinical trials; and the potentially conflicting obligations of researchers and clinicians.


Assuntos
Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Competência Mental , Transtornos Neurocognitivos/complicações , Pneumonia Viral/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Consentimento do Representante Legal/ética , Criança , Infecções por Coronavirus/complicações , Feminino , Humanos , Pandemias , Pneumonia Viral/complicações
10.
PLoS One ; 15(10): e0240128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048965

RESUMO

Physical inactivity and a sedentary lifestyle are associated with a chronic low-level inflammatory state which has been implicated in the pathogenesis of cardiovascular disease. There is growing interest in exercise programs as part of surgical 'prehabilitation'. We therefore studied preoperative physical activity levels of patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery, and performed an exploratory analysis of the influence of physical activity on postoperative outcome. The Short Questionnaire to Assess Health (SQUASH) was used to assess physical activity among 100 patients, of mean (SD) age 65.4 (7.6) years. Additionally, handgrip strength was measured, and the get-up-and-go test was conducted. Anxiety, depression, and quality of life were assessed, and a computerised cognitive test battery was used to assess cognitive performance preoperatively, and three months after surgery. Preoperatively, 76% of patients met the recommended national guidelines for physical activity. The incidence of pre-existing medical conditions, and other pre-operative patient features were similar in active and inactive patients. Preoperative physical activity was significantly inversely related to the logistic EuroSCORE. The level of physical activity was also significantly inversely related with preoperative C-reactive protein (CRP) and peak postoperative CRP, but physical activity did not appear to be associated with any adverse postoperative outcomes or extended length of hospital stay. The incidence of postoperative neurocognitive disorder (PNCD) at 3 months postoperatively was 26%. Cognitive performance was not related with physical activity levels. In summary, this was the first study to assess activity levels of cardiac surgical patients with the SQUASH questionnaire. The majority of patients were physically active. Although physical activity was associated with lower levels of inflammation in this pilot study, it was not associated with an improved clinical or cognitive postoperative outcome.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença das Coronárias/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Exercício Físico/fisiologia , Transtornos Neurocognitivos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Doença das Coronárias/complicações , Doença das Coronárias/fisiopatologia , Estudos de Viabilidade , Feminino , Seguimentos , Fragilidade/diagnóstico , Fragilidade/etiologia , Fragilidade/fisiopatologia , Força da Mão/fisiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/diagnóstico , Transtornos Neurocognitivos/etiologia , Transtornos Neurocognitivos/fisiopatologia , Testes Neuropsicológicos/estatística & dados numéricos , Projetos Piloto , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Qualidade de Vida , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Sarcopenia/fisiopatologia , Comportamento Sedentário
11.
J Stroke Cerebrovasc Dis ; 29(11): 105249, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066928

RESUMO

BACKGROUND: Subarachnoid hemorrhage (SAH) results in neurocognitive dysfunction and anxiety in humans and in animal models. Neurobehavioral tests such as the Morris Water Maze (MWM) and Elevated Plus Maze (EPM) tests are validated in several models of SAH but have not been tested in the murine cisternal blood injection SAH model. METHODS: Adult C57BL/6 mice (n=16) were randomized into two groups. Group 1 (n=8) received sham surgery. Group 2 (n=8) underwent SAH with 60 µL of autologous blood injected into the cisterna magna. Mice were then tested using the Modified Garcia Score on post-operative day 2 (POD2), EPM on POD5 & POD16, and MWM on POD6-16.Brain tissues harvested on POD16 were stained with Fluoro-Jade C to identify neurodegeneration in the hippocampus and cortex and Iba-1 immunofluorescence staining for microglial activation in the dentate gyrus and CA1 region of the hippocampus. RESULTS: SAH mice showed increased escape latency on POD10. Swim distance was significantly increased on POD9-10 and swim speed was significantly decreased on POD6&POD10 in SAH mice. SAH mice exhibited a trend for lowered proportion of covered arm entries in EPM on POD16. Modified Garcia Score was not significantly different between the groups on POD2. The area of microglial activation in the dentate gyrus and CA1 region of the hippocampus was mildly increased but not significantly different at day 16 after SAH. Similarly, no significant differences were noted in the number of Fluoro-Jade C (+) cells in cortex or hippocampus. CONCLUSIONS: Cisternal single blood injection in mice produces mild neurocognitive deficits most pronounced in spatial learning and most evident 10 days after SAH.


Assuntos
Comportamento Animal , Encéfalo/fisiopatologia , Aprendizagem em Labirinto , Transtornos Neurocognitivos/etiologia , Hemorragia Subaracnóidea/etiologia , Animais , Encéfalo/patologia , Cisterna Magna , Modelos Animais de Doenças , Reação de Fuga , Injeções , Masculino , Camundongos Endogâmicos C57BL , Degeneração Neural , Transtornos Neurocognitivos/patologia , Transtornos Neurocognitivos/fisiopatologia , Transtornos Neurocognitivos/psicologia , Tempo de Reação , Hemorragia Subaracnóidea/patologia , Hemorragia Subaracnóidea/fisiopatologia , Hemorragia Subaracnóidea/psicologia , Natação , Fatores de Tempo
12.
13.
Artigo em Russo | MEDLINE | ID: mdl-32929943

RESUMO

The article presents current literature data on genetic studies of neurocognitive deficit in schizophrenia, including the genes of neurotransmitter systems (dopaminergic, glutamatergic, and serotonergic); genes analyzed in genome-wide association studies (GWAS), as well as other genetic factors related to the pathophysiological mechanisms underlying schizophrenia and neurocognitive disorders.


Assuntos
Estudo de Associação Genômica Ampla , Esquizofrenia , Humanos , Transtornos Neurocognitivos , Neurotransmissores
15.
An. psicol ; 36(2): 271-282, mayo 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-192064

RESUMO

Un número considerable de estudiantes presenta dificultades de aprendizaje y bajo rendimiento académico, sin embargo su evaluación no siempre deriva en un diagnóstico concreto. Son categorizados como inmaduros, pero no se determinan ni la naturaleza ni las características de sus dificultades. El objetivo fue identificar los dominios evolutivos afectados en niños con retraso del desarrollo (RD) y valorar el concepto de dificultades neuroevolutivas como constructo comprensivo de las dificultades generalizadas de aprendizaje. Para ello, se realizó una revisión sistemática en las bases electrónicas Medline, PsycINFO, WOS, Eric, Dialnet y CSIC y, tras aplicar los criterios de inclusión, se seleccionaron 18 artículos. Los resultados confirman que RD se utiliza como etiqueta diagnóstica para caracterizar a niños con retrasos significativos en uno o varios ámbitos del desarrollo, pero no existe una definición de consenso ni criterios específicos para su diagnóstico, y solo sería de aplicación a niños de corta edad. Los dominios afectados coinciden con funciones neuroevolutivas y, en su etiología, destacan factores de riesgo biológico y ambiental. Se constata la persistencia en la niñez de las dificultades neuroevolutivas y su asociación con las dificultades generalizas en el aprendizaje de años escolares, apuntando a las primeras como constructo explicativo de las segundas


A considerable number of students have learning difficulties and low academic performance, yet their evaluation does not always lead to a concrete diagnosis. They are categorized as immature, but neither the nature nor the characteristics of their difficulties are determined. The aim of this study was to identify the developmental domains which are affected in children with developmental delay (DD) in order to assess the concept of neurodevelopmental difficulties as a comprehensive category and profile of generalized learning difficulties. To this end, a systematic review was carried out on the electronic databases Medline, PsycINFO, WOS, Eric, Dialnet and CSIC and, after applying the inclusion criteria, 18 articles were selected. The results confirm that DD is used as a diagnostic label to characterize children with significant delays in one or more developmental domains, but there is no definition of consensus nor specific criteria for its diagnosis, and it would only be applicable to young children. The affected domains coincide with neurodevelopmental functions, and biological and environmental risk factors stand out in their aetiology. Neurodevelopmental difficulties would encompass a wide spectrum of deficits with different levels of severity that, on interacting with each other, give rise to a variety of profiles


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Deficiências do Desenvolvimento/diagnóstico , Deficiências da Aprendizagem/psicologia , Transtornos Neurocognitivos/psicologia , Baixo Rendimento Escolar , Deficiências do Desenvolvimento/psicologia , Testes Neuropsicológicos , Fatores de Risco , Desenvolvimento Infantil/fisiologia
17.
Neurology ; 95(19): e2610-e2621, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-32887786

RESUMO

OBJECTIVE: To characterize the prevalence and burden of HIV-associated neurocognitive disorder (HAND) and assess associated factors in the global population with HIV. METHODS: We searched PubMed and Embase for cross-sectional or cohort studies reporting the prevalence of HAND or its subtypes in HIV-infected adult populations from January 1, 1996, to May 15, 2020, without language restrictions. Two reviewers independently undertook the study selection, data extraction, and quality assessment. We estimated pooled prevalence of HAND by a random effects model and evaluated its overall burden worldwide. RESULTS: Of 5,588 records identified, we included 123 studies involving 35,513 participants from 32 countries. The overall prevalence of HAND was 42.6% (95% confidence interval [CI] 39.7-45.5) and did not differ with respect to diagnostic criteria used. The prevalence of asymptomatic neurocognitive impairment, mild neurocognitive disorder, and HIV-associated dementia were 23.5% (20.3-26.8), 13.3% (10.6-16.3), and 5.0% (3.5-6.8) according to the Frascati criteria, respectively. The prevalence of HAND was significantly associated with the level of CD4 nadir, with a prevalence of HAND higher in low CD4 nadir groups (mean/median CD4 nadir <200 45.2% [40.5-49.9]) vs the high CD4 nadir group (mean/median CD4 nadir ≥200 37.1% [32.7-41.7]). Worldwide, we estimated that there were roughly 16,145,400 (95% CI 15,046,300-17,244,500) cases of HAND in HIV-infected adults, with 72% in sub-Saharan Africa (11,571,200 cases, 95% CI 9,600,000-13,568,000). CONCLUSIONS: Our findings suggest that people living with HIV have a high burden of HAND in the antiretroviral therapy (ART) era, especially in sub-Saharan Africa and Latin America. Earlier initiation of ART and sustained adherence to maintain a high-level CD4 cell count and prevent severe immunosuppression is likely to reduce the prevalence and severity of HAND.


Assuntos
Complexo AIDS Demência/epidemiologia , Disfunção Cognitiva/epidemiologia , África ao Sul do Saara/epidemiologia , Doenças Assintomáticas/epidemiologia , Contagem de Linfócito CD4 , Disfunção Cognitiva/etiologia , Saúde Global , Infecções por HIV/complicações , Humanos , América Latina/epidemiologia , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/etiologia , Prevalência
18.
Sci Rep ; 10(1): 15209, 2020 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938988

RESUMO

HIV-1 associated neurocognitive disorder (HAND) is characterized by neuroinflammation and glial activation that, together with the release of viral proteins, trigger a pathogenic cascade resulting in synaptodendritic damage and neurodegeneration that lead to cognitive impairment. However, the molecular events underlying HIV neuropathogenesis remain elusive, mainly due to lack of brain-representative experimental systems to study HIV-CNS pathology. To fill this gap, we developed a three-dimensional (3D) human brain organoid (hBORG) model containing major cell types important for HIV-1 neuropathogenesis; neurons and astrocytes along with incorporation of HIV-infected microglia. Both infected and uninfected microglia infiltrated into hBORGs resulting in a triculture system (MG-hBORG) that mirrors the multicellular network observed in HIV-infected human brain. Moreover, the MG-hBORG model supported productive viral infection and exhibited increased inflammatory response by HIV-infected MG-hBORGs, releasing tumor necrosis factor (TNF-α) and interleukin-1 (IL-1ß) and thereby mimicking the chronic neuroinflammatory environment observed in HIV-infected individuals. This model offers great promise for basic understanding of how HIV-1 infection alters the CNS compartment and induces pathological changes, paving the way for discovery of biomarkers and new therapeutic targets.


Assuntos
Encéfalo/citologia , Infecções por HIV/complicações , HIV-1/patogenicidade , Transtornos Neurocognitivos/patologia , Organoides/citologia , Encéfalo/metabolismo , Encéfalo/patologia , Encéfalo/virologia , Diferenciação Celular , Meios de Cultura/química , Células HEK293 , Infecções por HIV/metabolismo , Infecções por HIV/patologia , Humanos , Interleucina-1beta/metabolismo , Modelos Anatômicos , Células-Tronco Neurais/citologia , Células-Tronco Neurais/metabolismo , Células-Tronco Neurais/patologia , Células-Tronco Neurais/virologia , Transtornos Neurocognitivos/etiologia , Transtornos Neurocognitivos/metabolismo , Técnicas de Cultura de Órgãos , Organoides/metabolismo , Organoides/patologia , Organoides/virologia , Fator de Necrose Tumoral alfa/metabolismo , Replicação Viral
19.
Tijdschr Gerontol Geriatr ; 51(2)2020 Jun 04.
Artigo em Holandês | MEDLINE | ID: mdl-32951382

RESUMO

The starting point of this study is that comorbid maladaptive personality traits (CMPT) influence behavioral and psychological symptoms of dementia (BPSD). The purpose of this study was to develop and investigate the feasibility of the Cognitive Model for Behavioral Interventions (CoMBI). Forty patients with BPSD and CMPT from two geriatric psychiatric departments were treated with CoMBI. Feasibility was assessed through patient flow, compliance to, and acceptability of the treatment for family members and psychiatric nurses. CMPT was assessed using informant-based questionnaires. Change in BPSD was assessed using pre- and posttests. To determine differences in BPSD, Wilcoxon signed rank tests were conducted and effect sizes were computed. Of 312 patients admitted to the geriatric psychiatric wards, 138 patients were found eligible. 64 (46.4%) patients were discharged from the wards before or shortly after the pretest, in 28 (20.3%) cases CoMBI could not be not applied. Eventually, forty (29.0%) patients were included for analysis. Wilcoxon signed rank tests demonstrated a significant decrease of BPSD with medium (r=0.45) to large (r=0.56) effect sizes. CoMBI is highly feasible for treating challenging behavior in patients with BPSD and CMPT. CoMBI is associated with a significant decrease of challenging behaviors regardless of etiology.


Assuntos
Transtornos Neurocognitivos/terapia , Personalidade , Idoso , Cognição , Comorbidade , Humanos
20.
Crit Care ; 24(1): 476, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736572

RESUMO

BACKGROUND: Patients in the intensive care unit (ICU) are known to be at increased risk of developing delirium, but the risk of subsequent neuropsychiatric disorders is unclear. We therefore sought to examine the association between the presence of delirium in the ICU and incident neuropsychiatric disorders (including depressive, anxiety, trauma-and-stressor-related, and neurocognitive disorders) post-ICU stay among adult medical-surgical ICU patients. METHODS: Retrospective cohort study utilizing clinical and administrative data from both inpatient and outpatient healthcare visits to identify the ICU cohort and diagnostic information 5 years prior to and 1 year post-ICU stay. Patients ≥ 18 years of age admitted to one of 14 medical-surgical ICUs across Alberta, Canada, January 1, 2014-June 30, 2016, and survived to hospital discharge were included. The main outcome of interest was a new diagnosis of any neuropsychiatric disorder 1 year post-ICU stay. The exposure variable was delirium during the ICU stay identified through any positive delirium screen by the Intensive Care Unit Delirium Screening Checklist (ICDSC) during the ICU stay. RESULTS: Of 16,005 unique patients with at least one ICU admission, 4033 patients were included in the study of which 1792 (44%) experienced delirium during their ICU stay. The overall cumulative incidence of any neuropsychiatric disorder during the subsequent year was 19.7% for ICU patients. After adjusting for hospital characteristics using log-binomial regression, patients with delirium during the ICU stay had a risk ratio (RR) of 1.14 (95% confidence interval [CI] 0.98-1.33) of developing any neuropsychiatric disorder within 1 year post-ICU compared to those who did not experience delirium. Delirium was significantly associated with neurocognitive disorders (RR 1.59, 95% CI 1.08-2.35), but not depressive disorders (RR 1.16, 95% CI 0.92-1.45), anxiety (RR 1.16, 95% CI 0.92-1.47), and trauma-and-stressor-related (RR 0.82, 95% CI 0.53-1.28) disorders. CONCLUSIONS: The diagnosis of new onset of neurocognitive disorders is associated with ICU-acquired delirium. In this study, significant associations were not observed for depressive, anxiety, and trauma-and-stressor-related disorders.


Assuntos
Delírio/terapia , Unidades de Terapia Intensiva , Transtornos Neurocognitivos/epidemiologia , Idoso , Alberta/epidemiologia , Delírio/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos
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