Categoría: Papers con abstracts

We compared the utility of two executive-function brief screening tools, the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) and the Frontal Assessment Battery (FAB), in their ability to detect executive dysfunction in a group of behavioral variant frontotemporal dementia (bv-FTD, n = 25) and Alzheimer’s disease (AD, n = 25) patients in the early stages of their disease and in comparison to a group of age, gender, and education-matched controls (n = 26). Relative to the FAB, the IFS showed (a) better capability to differentiate between types of dementia; (b) higher sensitivity and specificity for the detection of executive dysfunction; (c) stronger correlations with standard executive tasks. We conclude that while both tools are brief and specific for the detection of early executive dysfunction in dementia, the IFS is more sensitive and specific in differentiating bvFTD from AD, and its use in everyday clinical practice can contribute to the differential diagnosis between types of dementia.

INTRODUCTION: The processing of the emotion of disgust is attributed to the insular cortex (IC), which is also responsible for social emotions and higher-cognitive functions. We distinguish the role of the IC from its connections in regard to these functions through the assessment of emotions and social cognition in a double case report. These subjects were very rare cases that included a focal IC lesion and a subcortical focal stroke affecting the connections of the IC with frontotemporal areas. MATERIALS & METHODS: Both patients and a sample of 10 matched controls underwent neuropsychological and affective screening questionnaires, a battery of multimodal basic emotion recognition tests, an emotional inference disambiguation task using social contextual clues, an empathy task and a theory of mind task. RESULTS: The insular lesion (IL) patient showed no impairments in emotion recognition and social emotions and presented with a pattern of delayed reaction times (RTs) in a subset of both groups of tasks. The subcortical lesion (SL) patient was impaired in multimodal aversive emotion recognition, including disgust, and exhibited delayed RTs and a heterogeneous pattern of impairments in subtasks of empathy and in the contextual inference of emotions. CONCLUSIONS: Our results suggest that IC related networks, and not the IC itself, are related to negative emotional processing and social emotions. We discuss these results with respect to theoretical approaches of insular involvement in emotional and social processing and propose that IC connectivity with frontotemporal and subcortical regions might be relevant for contextual emotional processing and social cognition.

We compared the utility of two executive-function brief screening tools, the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) and the Frontal Assessment Battery (FAB), in their ability to detect executive dysfunction in a group of behavioral variant frontotemporal dementia (bv-FTD, n = 25) and Alzheimer’s disease (AD, n = 25) patients in the early stages of their disease and in comparison to a group of age-, gender-, and education-matched controls (n = 26). Relative to the FAB, the IFS showed (a) better capability to differentiate between types of dementia; (b) higher sensitivity and specificity for the detection of executive dysfunction; (c) stronger correlations with standard executive tasks. We conclude that while both tools are brief and specific for the detection of early executive dysfunction in dementia, the IFS is more sensitive and specific in differentiating bvFTD from AD, and its use in everyday clinical practice can contribute to the differential diagnosis between types of dementia.

La escala de impulsividad de Barratt es un instrumento diseñado para evaluar el constructo impulsividad en tres dimensiones: atencional, motora y no planeada. La escala ha sido aplicada en pacientes con diferentes diagnósticos, en los cuales la sintomatología de impulsividad es característica. En Argentina no existen estudios que evalúen las propiedades psicométricas del instrumento en población clínica. El objetivo del trabajo fue evaluar las propiedades psicométricas de la escala en una muestra de la Ciudad de Buenos Aires. Se seleccionaron 150 sujetos adultos: 67 no presentaban diagnóstico psiquiátrico relevante, 56 cumplían criterios de trastorno bipolar y 27 presentaban diagnóstico de trastorno por déficit de atención. Se evaluaron la consistencia interna, la validez de constructo, la validez discriminativa y la estructura factorial. El alfa de Cronbach fue de 0,84 para la escala total. Asimismo, el instrumento ha demostrado indicadores aceptables de validez de constructo y validez discriminativa. Se encontraron diferencias al comparar la estructura factorial original con los resultados del presente estudio. Los resultados apoyan la utilidad de la escala en el contexto psiquiátrico, científico y clínico para evaluar el constructo de impulsividad. El puntaje total de la escala ha obtenido los indicadores más robustos de confiabilidad y validez.

A commentary on ERP investigation of study-test back- ground mismatch during face recognition in schizophrenia by Guillaume et al. (2012). Schizophr. Res. 134, 101–109.

La interocepción como censado del estado homeostático y visceral, ha sido recientemente postulada como requisito para la conciencia de estados emocionales corporales (Craig, 2009). Vías parasimpáticas y espinotalámicas que codifican esta información corporal tienen relevo en la corteza insular. Simultáneamente, han sido descriptas otras funciones insulares implicadas en procesos conscientes, como la intencionalidad, la toma de decisiones, la conciencia sensorio-motora, la percepción temporal, reconocer la imagen visual de uno mismo o percibir confiables a otros individuos (Craig, 2009; Ibanez, Gleichgerrcht, & Manes, 2010). Esta evidencia, sumada a resultados de estudios de lesión y neuroimágenes funcionales, sugiere que la corteza insular anterior (IA) sería la encargada de integrar señales multimodales cognitivas, emocionales y sociales para dirigir las conductas motivacionales que entrañan la supervivencia del individuo. En esta revisión analizamos el cúmulo de evidencia que involucran a la interocepción y al procesamiento insular integrativo en el surgimiento de estados emocionales conscientes, a través de estudios de lesiones y de técnicas de conectividad funcional en resonancia magnética funcional (RMF).

Atrial fibrillation (AF) is the major cause of cardioembolic stroke. It often remains occult when asymptomatic and paroxysmal. We hypothesized that the detection of AF after acute ischemic stroke (AIS) or transient ischemic attack (TIA) could be improved by using continuous cardiac monitoring (CCM) immediately after admission. We sought to determine the detection rate of AF by immediate in-hospital CCM after cryptogenic and noncryptogenic AIS or TIA in patients without a previous diagnosis of AF. We retrospectively studied a cohort of 155 patients with cryptogenic and noncryptogenic AIS or TIA without known AF. We compared the detection rates of newly diagnosed AF (NDAF) in patients admitted to areas with CCM and those never admitted to these areas. We developed a multiple logistic regression model for identifying predictors of NDAF. We characterized NDAF episodes and analyzed how the availability of CCM data changed secondary prevention strategies. We detected NDAF in 21 patients (13.5%). Diagnostic rates of NDAF in patients who underwent CCM and those who did not undergo CCM were 18.2% and 2.2%, respectively (P = .005). The median time from admission to recognition of NDAF was 2.0 days. Most NDAFs were paroxysmal (95.2%) and lasted less than 1 hour (85.7%). Diabetes mellitus and infarct size were predictors of NDAF. Detection of NDAF prompted the initiation of anticoagulation therapy in 8.2% of the patients admitted to areas with CCM availability. Our findings suggest that immediate and prolonged CCM significantly improves the detection of NDAF after cryptogenic and noncryptogenic AIS or TIA, and that diabetes mellitus and infarct size are significantly associated with NDAF.

Attention-deficit/hyperactivity disorder (ADHD) and Asperger’s Syndrome (AS) share a heterogeneous cognitive profile. Studies assessing executive functions (EF) and social cognition in both groups have found preserved and impaired performances. These inconsistent findings would be partially explained by the cognitive variability reported in these disorders. First, the present study explored the inter-individual variability in EF and social cognition in both patient groups. Second, we compared differential characteristics and commonalities in the cognitive profiles of EF and social cognition between ADHD, AS and control adults. We assessed 22 patients with ADHD, 23 adults with AS and 21 matched typically developing subjects using different measures of EF (working memory, cognitive flexibility and multitasking) and social cognition (theory of mind and decision-making). Group comparisons and multiple case series analyses (MCSA) were conducted. The between-group comparisons showed an EF deficit in working memory in ADHD and a theory of mind (ToM) impairment in AS. The MCSA evidenced that, compared to controls, ADHD patients had a higher inter-individual variability in EF, while individuals with AS had a more heterogeneous profile in social cognition tasks compared to both groups. Finally, the AS and ADHD groups presented higher task-related variability compared to controls and shared a common heterogeneous profile in EF. This is the first study to compare variability in EF and social cognition profiles of ADHD and AS. We propose that heterogeneity in EF performance is a link between ADHD and AS which may explain the overlap of symptomatology between both diagnoses. In addition, patients with AS seem to show a unique heterogeneous profile in ToM which may explain the low probability of finding AS symptoms in patients with ADHD.

BACKGROUND: A growing body of evidence suggests that patients with bipolar disorder (BD) have cognitive impairments even during euthymic periods. The main cognitive domains affected are verbal memory, attention, and executive function. Nevertheless, some studies suggest that at least a subgroup of euthymic patients demonstrates intact executive functioning in classic neuropsychological tests, which could be due to the lack of real-life, or ecological validity. OBJECTIVE: In this study, we highlight the usefulness of incorporating more ecological tests of executive function in assessment batteries in order to detect specific cognitive deficits in BD patients with otherwise normal performance in standard executive tests. METHODS: Nineteen euthymic BD patients and 15 healthy controls completed a standard neuropsychological battery assessment and two experimental tasks (the Multiple Errands Test-Hospital Version and the Hotel Task) to measure executive functioning in highly demanding cognitive settings that mimic real-life scenarios. RESULTS: No significant differences were found between the groups’ demographic variables. We found, as predicted, that the group of euthymic BD patients who had control-comparable performance in classic executive tasks showed important deficits in more ecological tasks of executive functioning of the type that mimic real-life scenarios. CONCLUSIONS: Together, these data suggest that the inclusion of ecological tests in the assessment of BD patients can contribute to providing a more realistic cognitive profile of this patient population, which will undoubtedly allow for a better design of therapeutic and rehabilitation strategies that can help patients to minimize impact in real-life settings.

BACKGROUND: Adults with bipolar disorder (BD) have cognitive impairments that affect face processing and social cognition. However, it remains unknown whether these deficits in euthymic BD have impaired brain markers of emotional processing. METHODOLOGY/PRINCIPAL FINDINGS: We recruited twenty six participants, 13 controls subjects with an equal number of euthymic BD participants. We used an event-related potential (ERP) assessment of a dual valence task (DVT), in which faces (angry and happy), words (pleasant and unpleasant), and face-word simultaneous combinations are presented to test the effects of the stimulus type (face vs word) and valence (positive vs. negative). All participants received clinical, neuropsychological and social cognition evaluations. ERP analysis revealed that both groups showed N170 modulation of stimulus type effects (face > word). BD patients exhibited reduced and enhanced N170 to facial and semantic valence, respectively. The neural source estimation of N170 was a posterior section of the fusiform gyrus (FG), including the face fusiform area (FFA). Neural generators of N170 for faces (FG and FFA) were reduced in BD. In these patients, N170 modulation was associated with social cognition (theory of mind). CONCLUSIONS/SIGNIFICANCE: This is the first report of euthymic BD exhibiting abnormal N170 emotional discrimination associated with theory of mind impairments.