Categoría: Papers con abstracts

Verbal learning and memory (VLM) following pediatric stroke was characterized in a cross-sectional neuropsychological and neuroimaging study of 26 subjects, aged 5 to 17, with a history of pediatric stroke and 26 age, SES, and gender matched orthopedic controls. Further comparisons were made between the VLM profiles of stroke subjects with right versus left hemisphere lesions and early ( < 12 months) versus late (12 months) strokes. Overall, stroke subjects scored significantly lower than control subjects on several VLM indices (California Verbal Learning Test-Children; CVLT-C), as well as on measures of intellectual functioning (IQ) and auditory attention/working memory (Digit Span). Subgroup analyses of the stroke population found no significant differences in VLM, Digit Span, Verbal IQ or Performance IQ when left-hemisphere lesion subjects were compared to right-hemisphere lesion subjects. In contrast, early strokes were associated with significantly fewer words recalled after delay, reduced discriminability (fewer correct hits relative to false positive errors on recognition testing), and relatively worse auditory attention/working memory scores (Digit Span). These findings indicate that pediatric stroke subjects demonstrated more VLM impairment than control subjects, and early strokes were associated with greater recall and recognition deficits. In stark contrast with adult-onset stroke, both left- and right-hemisphere lesions during childhood resulted in similar VLM performance.

BACKGROUND: Recent studies have reported deficits in measures of decision making in pathologic gamblers (PGs) suggesting an involvement of the prefrontal cortex in the pathophysiology of this disorder. As only 7% to 12% of PGs are thought to seek treatment, most of the studies have relied on few specifically selected groups of PGs recruited from psychiatric units who were undergoing or seeking treatment and therefore their results are poorly representative of the general PG population. METHODS: The present study compared decision making and executive functions among 11 PGs who were selected from an ecologic setting and 11 healthy controls. RESULTS: The PG group selected fewer advantageous cards on a decision-making task, the Iowa Gambling Task, and made more commission errors on the Go-No Go task, a test of inhibitory control, compared with controls. CONCLUSIONS: The impairments in decision making are similar to those previously reported in individuals with prefrontal lesions and treatment-seeking PGs. PGs also presented impairment in tasks of inhibitory control suggesting an involvement of the prefrontal cortex in the pathophysiology of pathologic gambling (PG). The deficits in decision making and inhibition of irrelevant information observed in this study may have distinct but additive effects upon the development of PG behavior.

We investigated attentional outcome after childhood stroke and orthopedic diagnosis in medical controls. Twenty-nine children with focal stroke lesions and individually matched children with clubfoot or scoliosis were studied with standardized attention and neuroimaging assessments. Stroke lesions were quite varied in location and commonly involved regions implicated in Posner’s model of attention networks. Children with stroke lesions performed significantly more poorly regarding attention function compared with controls. Performance on the Starry Night, a test demanding alerting and sensory-orienting but not executive attention function, was significantly associated with lesion size in the alerting and sensory-orienting networks but not the executive attention network. Furthermore, earlier age at lesion acquisition was significantly associated with poorer attention function even when lesion size was controlled. These findings support the theory of dissociable networks of attention and add to evidence from studies of children with diffuse and focal brain damage that early insults are associated with worse long-term outcomes in many domains of neuropsychological function. In addition, these results may provide clues towards the understanding of mechanisms underlying attention in children.

Cognitive function and diffusion tensor imaging were assessed in a group of 12 patients with early relapsing-remitting multiple sclerosis (disease duration 3 years), and mild clinical disability (expanded disability status scale =2), as well as in 12 control subjects. Patients showed impairment in immediate logical memory and delayed recall with the Rey auditory verbal learning test. No significant differences in classical executive tests were observed. In contrast, differences were found for specific executive tests including IOWA Gambling Task, multiple errands test hospital version (MET) and Hotel Task, as well as in Paced-Auditory Serial Addition Test (PASAT). Significant correlation was found between PASAT performance and FA measures (r = 0.64, P = 0.03), the apparent diffusion coefficients and the MET (r = 0.72, P = 0.01), as well as in one subtask of Hotel (r = -0.68, P = 0.02). Thus, executive deficits can best be appreciated at early stages of MS when a more specific battery of tests is used for patient evaluation. In this series, test failures observed correlated with changes in fronto-subcortical fiber tracts.

INTRODUCTION: The Addenbrooke’s Cognitive Examination (ACE) is a brief bedside test battery to detect mild dementia and differentiate frontotemporal dementia (FTD) from Alzheimer’s disease (AD). AIM: To validate the ACE in Spanish. PATIENTS AND METHODS: The study evaluated the Spanish version of ACE on 128 subjects consisting in two groups a patient group (n = 76) and a control subjects group (n = 52). The patient group was divided in AD (n = 54) based on the NINCDS-ADRDA criteria and FTD (n = 22) based on the Lund y Manchester criteria. All patients underwent clinical, neuropsychological, radiologic (MRI, CT, and SPECT), and laboratory evaluations. Group’s differences were evaluated using ANOVA. The internal consistency of the Spanish version of the ACE was measured using the Cronbach’s alpha coefficient. The discriminative capability of the Spanish version of the ACE was examined by the receiver operating characteristic (ROC) analysis. RESULTS: The cut-off score of 86 showed a sensitivity of 92% (CI 95% = 83.6-97.0) and a specificity of 96.2% (CI 95% = 86.8-99.4). The ROC curve showed higher sensitivity and specificity of the ACE than the Mini-Mental State Examination in discriminating the dementia and control group. The VLOM ratio (verbal fluency + language)/(orientation + memory) of < 1.82 discriminated for FTD and > 4.87 discriminated for AD. CONCLUSION: The Spanish version of ACE is a brief and reliable instrument for early detection of dementia in highly educated people and offers a simple objective index to differentiate AD and FTD. More studies in less educated people are warranted.

Detecting cognitive impairment in patients with Parkinson´s disease is crucial for good clinical practice given the new therapeutic possibilities available. When full neuropsychological evaluations are not available, screening tools capable of detecting cognitive difficulties become crucial. Objective: The goal of this study was to investigate whether the Spanish version of the Addenbrooke´s Cognitive Examination (ACE) is capable of detecting cognitive difficulties in patients with Parkinson´s disease and discriminating their cognitive profile from patients with dementia. Methods: 77 early dementia patients (53 with Alzheimer´s Disease and 24 with Frontotemporal Dementia), 22 patients with Parkinson´s disease, and 53 healthy controls were evaluated with the ACE. Results: Parkinson´s disease patients significantly differed from both healthy controls and dementia patients on ACE total score. Conclusions: This study shows that the Spanish version of the ACE is capable of detecting patients with cognitive impairment in Parkinson´s disease and is able to differentiate them from patients with dementia based on their general cognitive status.

OBJECTIVE: To investigate the association between focal stroke lesions of Posner’s executive attention network and a specific region of interest in the frontal lobes (orbital frontal and mesial frontal) and either attention-deficit/hyperactivity disorder (ADHD) or traits of the disorder (ADHD symptomatology). METHOD: Twenty-nine children with focal stroke lesions were studied with standardized psychiatric assessments and anatomical brain magnetic resonance imaging. The pattern of lesion overlap in subjects with ADHD symptomatology was determined. RESULTS: Fifteen of 28 subjects with no prestroke ADHD were diagnosed with ADHD symptomatology at the time of assessment. The extent of lesions within the executive attention network was marginally related to ADHD symptomatology (p = .088; effect size = 0.66), whereas the extent of lesions in the specific frontal region of interest was significantly related to ADHD symptomatology (p = .040; effect size = 0.82). CONCLUSIONS: Lesions within Posner’s executive attention network and its orbital frontal connections may be linked to important mechanisms in the expression of ADHD symptomatology after childhood stroke. These findings are consistent with functional and structural imaging findings in studies of idiopathic ADHD.

The consensus guidelines of argentine experts in the treatment of bipolar disorders are the result of three days of work of the 10 main local experts under the organization of the Argentine Association of Biological Psychiatry (AAPB). It was adopted a mixed criterion for its preparation: all the recent data of the evidence medicine based published until now were discussed and were balanced with the knowledge acquired from clinical experience of the local experts on the bipolar field. It presents general recommendations and suggested therapeutic sequences for the phase of maintenance, the manic/hypomanic or mixed episode and the depressive episode. These have been divided according to the classification in type I and II; with or without rapid cycling. Since the group of experts identified the delay and miss-diagnoses like the most important barrier for a suitable treatment enclosed a series of recommendations for differential diagnosis of bipolar disorders.

We compared symptom severity and quality of life (QOL) in schizophrenic patients adequately treated with typical antipsychotics (TAP) or clozapine (CZP). Groups did not differ in symptom severity or QOL. Clozapine caused fewer extrapyramidal symptoms. Negative and extrapyramidal symptoms predicted QOL. Similar outcome in both groups suggests a common ceiling to antipsychotic efficacy.

F.Assessing Level of Consciousness and Cognitive Changes from Vegetative State to Full Recovery. Autores Bekinschtein T, Tiberti C, Niklison J 3rd, Tamashiro M, Ron M, Carpintiero S, Villarreal M, Forcato C, Leiguarda R, Manes Año 2005 Journal  Bekinschtein T, Tiberti C, Niklison J 3rd, Tamashiro M, Ron M, Carpintiero S, Villarreal M, Forcato C, Leiguarda R, Manes Volumen 15(3-4): 307-322 Abstract   Otra información