Mes: junio 2015

Objective: To investigate the presence of dysfunctional cognitions in adults with ADHD and to determine whether these cognitions are associated with emotional symptoms, maladaptive coping, and functional impairment, as predicted by the cognitive-behavioral model. Method: A total of 35 adult participants with ADHD, 20 nonclinical controls, and 20 non-ADHD clinical controls were assessed with measures of ADHD symptoms, dysfunctional cognitions, depression and anxiety symptoms, coping strategies, and quality of life. Results: ADHD group showed elevated scores of dysfunctional cognitions relative to nonclinical control group and comparable with clinical control group. Dysfunctional cognitions were strongly associated with emotional symptoms. ADHD group also showed elevated scores in maladaptive coping strategies of the escape-avoidance type. Life impairment was satisfactorily predicted in data analysis when ADHD symptoms, dysfunctional cognitions, and emotional symptoms were fitted into a regression model. Conclusion: Cognitive-behavioral therapy model appears to be a valid complementary model for understanding emotional and life impairment in adults with ADHD.

Objective: Several longitudinal studies had shown that early deprivation and institutionalization during the first six months of life affects the emotional, cognitive, social and neurophysiologic development. Nevertheless, our understanding of possible similar effects of delayed institutionalization, in preschool-age remains unclear to this day. The goal of this study is to evaluate the cognitive performance of institutionalized children with history of preschool-age physical abandonment. Method: 18 male institutionalized children with history of abandonment during the preschool-age (2-5 years old) and comparison group matched by age, handedness, gender, educational and socioeconomic level were tested on multiple tasks of attention, memory and executive functions. Results: We found a cognitive impairment in the institutionalized children in several measures of attention, memory and executive functions. This is the first report of cognitive impairment related to late abandonment and institutionalization effects (after 2 years old), extending the already known effects on early institutionalization. Conclusions: This preliminary study suggests that environmental factors including abandonment and institutional care, can affect not only the infancy period, but also the preschool period providing new insights into our understanding of neurocognitive development.

OBJECTIVE: Most neurocognitive studies have not taken into account the fact that older patients with bipolar disorder (BD) are a heterogeneous population. The main goal of this study was to compare neurocognitive performance and extrapyramidal symptoms in older patients with early-onset BD (EO-BD) and late-onset BD (LO-BD).METHODS: Euthymic older patients with EO-BD (n=20), LO-BD (n=20), and healthy controls (n=20) were evaluated with traditional clinical instruments and measures of exposure to psychotropic drugs, as well as extrapyramidal symptoms. All subjects completed an extensive neuropsychological battery.RESULTS: Patients with EO-BD showed poorer performance than healthy controls in two measures of verbal memory and two measures of executive functions, whereas patients with LO-BD exhibited lower performance scores than healthy controls in almost all of the measures assessed. Impairments in the LO-BD group included even neurocognitive domains typically spared in mixed-age patients. Additionally, there was a trend toward displaying higher extrapyramidal symptoms in the LO-BD group compared with both EO-BD and healthy control groups. In both patient groups, psychosocial functioning was related with executive dysfunction and extrapyramidal symptoms.CONCLUSIONS: Patients with LO-BD may have more extensive and severe cognitive impairments, as well as higher vulnerability to extrapyramidal symptoms, compared with patients with EO-BD. Cognitive-motor disturbances may help to explain impairments in daily functioning among older patients with EO-BD and LO-BD during remission.

OBJECT: Executive functions are crucial for organizing and integrating cognitive processes. While some studies have assessed the effect of carotid artery stenting (CAS) on cognitive functioning, results have been conflicting. The object of this study was to assess the effect of CAS on cognitive status, with special interest on executive functions, among patients with severe asymptomatic internal carotid artery (ICA) stenosis. METHODS: The authors prospectively assessed the neuropsychological status of 20 patients with unilateral asymptomatic extracranial ICA stenosis of 60% or more by using a comprehensive assessment battery focused on executive functions before and after CAS. Individual raw scores on neuropsychological tests were converted into z scores by normalizing for age, sex, and years of education. The authors compared baseline and 3-month postoperative neuropsychological scores by using Wilcoxon signed-rank tests. RESULTS: The mean preoperative cognitive performance was within normal ranges on all variables. All patients underwent a successful CAS procedure. Executive function scores improved after CAS, relative to baseline performance as follows: set shifting (Trail-Making Test Part B: -0.75 ± 1.43 vs -1.2 ± 1.48, p = 0.003) and processing speed (digit symbol coding: -0.66 ± 0.85 vs -0.97 ± 0.82, p = 0.035; and symbol search: -0.24 ± 1.32 vs -0.56 ± 0.77, p = 0.049). The benefit of CAS for working memory was marginally significant (digit span backward: -0.41 ± 0.61 vs -0.58 ± 0.76, p = 0.052). Both verbal (immediate Rey Auditory Verbal Learning Test: 0.35 ± 1.04 vs -0.22 ± 0.82, p = 0.011) and visual (delayed Rey-Osterrieth Complex Figure: 0.27 ± 1.26 vs -0.22 ± 1.01, p = 0.024) memory improved after CAS. CONCLUSIONS: The authors found a beneficial effect on executive function and memory 3 months after CAS among their prospective cohort of consecutive patients with unilateral and asymptomatic ICA stenosis of 60% or more.

Topics in dementia: papers from the WFN-RGACD 2010 meeting . Autores Manes F.  Año 2012 Journal  Manes F.  Volumen 25(1): 1-2 Abstract   Otra información    

Letter by Sposato and Saposnik regarding article, «Socioeconomic status and stroke: an updated review». Autores Sposato L, Saposnik G.  Año 2012 Journal  Sposato L, Saposnik G.  Volumen 43(8): 77 Abstract   Otra información    

Psychiatric Conditions That Can Mimic Early Behavioral Variant Frontotemporal Dementia: The Importance of the New Diagnostic Criteria. Autores Manes F, Báez S, Couto JB, Herrera E, Trujillo-Orrego N, Cardona JF, Ibanez A.  Año 2012 Journal  Manes F, Báez S, Couto JB, Herrera E, Trujillo-Orrego N, Cardona JF, Ibanez A.  Volumen 14(5): 450-452 Abstract   Otra información  La publicación trata sobre la importancia de los nuevos criterios en … Leer más

Many adult ADHD patients with a convincing history of real-life executive deficits perform entirely within normal limits or with minimally impaired performance in classical executive tests. The authors assessed a group of high cognitive functioning adult ADHD participants on «ecological»and «highly demanding» executive tasks. METHOD: A total of 117 adult ADHD participants were classified as showing either a high-functioning (Hi-ADHD) or a low-functioning (Lo-ADHD) neuropsychological profile based on standard assessment. Their performance was compared with healthy controls (n = 21) on an ecological task of executive function (the hotel task) and computerized tasks of high cognitive demand. RESULTS: ADHD significantly differed from controls on multiple standard neuropsychological variables as well as on the experimental tasks. Hi-ADHD and healthy controls did not differ significantly on any of the standard neuropsychological variables, but a significant difference was found between the groups on measures of the experimental tasks. CONCLUSION: Real-life executive dysfunction of patients with ADHD who perform within normal range on standard assessment can be detected with the use of more ecological and highly demanding tasks.

Loss in insight is a major feature of frontotemporal dementia (FTD) but has been investigated relatively little. More importantly, the neural basis of insight loss is still poorly understood. The current study investigated insight deficit profiles across a large cohort of neurodegenerative patients (n = 81), including FTD and Alzheimer’s disease (AD) patients. We employed a novel insight questionnaire, which tapped into changes across different domains: social interaction, emotion, diagnosis/treatment, language, and motivation. FTD subtypes varied considerably for insight loss, with the behavioral variant worst and the progressive non-fluent variant least affected. All other subtypes and AD showed milder but consistent insight loss. Voxel-based morphometry analysis revealed that overall insight loss correlated with ventromedial and frontopolar prefrontal atrophy, with exception of social interaction and emotion insight loss, which additionally correlated with lateral temporal and amygdala atrophy, respectively. Our results show that patients with neurodegenerative conditions show variable loss of insight, with ventromedial and frontopolar cortex regions appearing to be particularly important for insight.

Only a small proportion of individuals with Mild Cognitive Impairment (MCI) will convert to dementia. Methods currently available to identify risk for conversion do not combine enough sensitivity and specificity, which is even more problematic in low-educated populations. Current guidelines suggest the use of combined markers for dementia to enhance the prediction accuracy of assessment methods. The present study adhered to this proposal and investigated the sensitivity and specificity of the electrophysiological component P300 and standard neuropsychological tests to assess patients with Alzheimer´s disease (AD) and MCI recruited from a low-income country. The neuropsychological battery comprised tests of memory, attention, language, praxis and executive functions. The P300 was recorded using a classical visual odd-ball paradigm. Three variables were found to achieve sensitivity and specificity values above 80% (Immediate and Delayed recall of word list – CERAD – and the latency of P300) for both MCI and AD. When they entered the model together (i.e., combined approach) the sensitivity for MCI increased to 96% and the specificity remained high (80%). Our preliminary findings suggest that the combined use of sensitive neuropsychological tasks and the analysis of the P300 may offer a very useful method for the preclinical assessment of AD, particularly in populations with low socioeconomic and educational levels. Our results provide a platform and justification to employ more resources to convert P300 and related parameters into a biological marker for AD.