The role of neurocognitive functioning, substance use variables and the DSM-5 severity scale in cocaine relapse: A prospective study.

BACKGROUND: The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD). METHODS: 128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge. RESULTS: Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse. CONCLUSIONS: Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.

The benign spectrum of hypothalamic hamartomas: infrequent epilepsy and normal cognition in patients presenting with central precocious puberty.

PURPOSE: Hypothalamic hamartoma (HH) is the main structural cause of central precocious puberty (CPP). HH is frequently associated with cognitive impairment and epileptic encephalopathies. Disease severity in case series from neurology services may be biased towards more neurologically impaired patients. AIM: To perform a prospective cognitive evaluation in patients with HH presenting with CPP in an endocrinology outpatient clinic setting. METHODS: We evaluated fifteen consecutive patients with CPP due to HH presenting to an endocrinology outpatient clinic. CPP was diagnosed at a median age of 0.7 yr (0.4-7 yr). Mean age at neurologic evaluation was 13.9 yrs. Eight patients (53.3%) were male. Epileptic seizures occurred in 5/15 (33%) patients. Two patients presented a single unprovoked seizure (SUS). Three patients were diagnosed with epilepsy. Cognitive evaluation, using age-appropriate Wechsler Intelligence Scale, was performed in 11 patients. RESULTS: All patients without epilepsy, including two patients with a history of a SUS, had normal neurologic and cognitive evaluation. Epilepsy and SUS were only seen in patients with sessile HH. Three patients with epilepsy presented cognitive or behavioral findings. Reduced intelligence quotients (IQ), in the borderline range, were noted in both patients with epilepsy who underwent full cognitive evaluation. We found no significant correlation between HH diameter or shape and mean full-scale IQ. CONCLUSIONS: Patients who presented with isolated CPP without epilepsy displayed normal cognition when evaluated after a mean period of 13 years. Occurrence of epilepsy, seen in a minority of patients, but not of a single seizure, was associated with mild cognitive deficit and behavioral disturbances in this case series.

Funcionamento cerebral de repouso em idosos e recuperação de memória autobiográfica: um estudo de ressonância magnética funcional / Brain function at rest and recovery of autobiographical memory in the elderly: a functional magnetic resonance imaging study

INTRODUÇÃO: As bases neurofisiológicas do declínio cognitivo associado ao envelhecimento normal ainda não são adequadamente conhecidas. Estudos sobre conectividade funcional cerebral estimada através de imagens por ressonância magnética funcional durante o repouso têm identificado diminuições de conectividade dentro da rede de modo padrão (default mode network) em idosos e correlações entre desempenho cognitivo e conectividade funcional. Há evidências de que idosos apresentam maior dificuldade em recuperar informações episódicas de eventos autobiográficos mas não existem investigações sobre a relação entre tal função cognitiva e conectividade de repouso. Além disso, estudos desta área geralmente não têm utilizado entrevista psiquiátrica para seleção da amostra, apesar de transtornos psiquiátricos apresentarem alta prevalência, serem subdiagnosticados e afetarem o funcionamento cerebral. OBJETIVOS: caracterizar as mudanças de conectividade funcional de repouso associadas a idade e a desempenho cognitivo, em especial à função de memória autobiográfica, em uma amostra de adultos de diferentes idades e livres de deficiências cognitivas e de transtornos psiquiátricos. MÉTODOS: adultos jovens, de meia idade e idosos sem transtornos cognitivos ou psiquiátricos foram selecionados através de avaliação neuropsicológica e entrevista psiquiátrica estruturada. Quantificamos o desempenho em recuperar informações episódicas de eventos autobiográficos. Conectividade funcional cerebral foi estimada a partir de imagens de ressonância magnética funcional adquiridas durante o repouso vigil, utilizando um atlas de 278 regiões englobando todo o cérebro. As relações entre conectividade e idade e conectividade e desempenho cognitivo foram avaliadas através do método dos quadrados parciais mínimos. RESULTADOS: em uma amostra de 59 adultos (19 jovens, 20 de meia idade e 20 idosos), idade apresentou correlação negativa com desempenho cognitivo geral, mas sua relação com memória...

INTRODUCTION: The neurophysiological basis of the cognitive decline associated with aging is not yet known. Brain functional connectivity studies using functional magnetic resonance images acquired during rest have shown that aging is associated with decreases in connectivity within the default mode network. Moreover, cognitive performance has been associated with resting functional connectivity. There is evidence that older adults present worse performance during retrieval of episodic information from autobiographical events but there is no investigation regarding the relationship between functional connectivity at rest and this cognitive function. Moreover, studies in this field have not applied a structured psychiatric interview to select the sample, although it is known that psychiatric disorders present high prevalence, are underdiagnosed and are associated with functional abnormalities. OBJECTIVES: to characterize changes in resting-state functional connectivity associated with age and cognitive performance, especially with autobiographical memory, in adults from different ages, free of cognitive deficits and psychiatric disorders. METHODS: using a neuropsychological evaluation and a structured psychiatric interview we selected a sample of young, middle aged and elderly adults free of cognitive and psychiatric disorders. We measured the performance to recover episodic information from autobiographical events. Brain functional connectivity was estimated from resting-state functional magnetic resonance images acquired during rest, using a whole-brain 278-region atlas. We used partial least squares to characterize the relationships between connectivity and age and connectivity and cognitive performance. RESULTS: in a sample of 59 adults (19 young, 20 middle aged and 20 elderly), age was negatively correlated with general cognitive performance but its relationship with autobiographical memory was not statistically significant. The pattern of...

Experimental model for composite tissue allotransplantations

Nos transplantes alógenos de membro a grande variabilidade de tecidos (pele, subcutâneo, músculo, osso, medula óssea, gânglios linfáticos, cartilagem, nervo, vasos, tendão, articulação) leva a grande variação dentro do processo de rejeição e consequentemente a sua imunologia é bastante complexa. Os transplantes alógenos de tecido composto representam o modelo experimental para se estudar o transplante homólogo (de um indivíduo para outro) de unidades músculo cutâneas inervadas, vascularizadas, articulações, osso ou mesmo de todo o membro. Os receptores foram randomizados e os grupos controle foram estabelecidos como: grupo controle A: transplante autógeno de membro em que ratos F344 tiveram o seu membro reimplantado e nenhuma medicação foi administrada e grupo controle B: transplante alógeno de membro (TAM) em que o membro dos ratos BN foi transplantado para os ratos F344 cujo membro havia sido amputado. Os transplantes homólogos de tecido composto (THTC) que possibilitam a inclusão de unidades músculo-cutâneas inervadas, articulação e osso ou mesmo de todo o membro, tem considerável aplicação nos casos de ausência ou deformidade congênita, trauma ou ressecção maior devido a tumor maligno. Para muitas deformidades complexas, estes THTC permitiriam uma reconstrução mais precisa do que as atuais técnicas reconstrutoras correntes.