Categoría: Papers con abstracts

Diagnosis of behavioral variant frontotemporal dementia (bvFTD) can be especially challenging during the early stages for several reasons, including the fact that (a) behavioral disturbances in bvFTD can mimic the symptomatic profile of psychiatric disorders; (b) neuropsychological performance may be relatively spared; and (c) changes in structural neuroimaging may go undetected. Most frequently, bvFTD is not included as part of medical or residency training outside the field of cognitive neurology. The present study aimed at examining bvFTD-related practices concerning academic and professional training, diagnosis, and treatment across Latin America. We surveyed the academic and professional aspects of clinical practice related to bvFTD of 596 physicians from different fields throughout the continent. We discuss several aspects concerning Latin American physicians’ training on dementia and bvFTD, the way in which they approach the differential diagnosis of bvFTD, and their most frequent strategies for the treatment of this condition. We conclude that information about bvFTD deserves more attention in both undergraduate and postgraduate medical education in Latin America, and that understanding clinical practices related to FTD can help design more efficient training programs for physicians in this and other world regions.

El trastorno obsesivo-compulsivo es un trastorno psiquiátrico que en un 87% de los casos se vuelve crónico. Se caracteriza por una serie de síntomas que pueden ser agrupados en obsesiones y compulsiones, que pueden llegar a ser altamente invalidantes y afectar el estilo de vida de quienes lo padecen. Es importante entender los mecanismos neurológicos del trastorno obsesivo-compulsivo para poder abordar de manera más eficaz los tratamientos. Este trabajo plantea al modelo frontoestriado como aquel que provee mayor evidencia y explica de manera más acabada los fenómenos neuropsicológicos del TOC, con las áreas cerebrales que se encuentran implicadas en él córtex cingulado anterior, los ganglios basales, y la corteza órbito-frontal. Luego, se vinculan estos resultados con aquellos hallazgos de estudios de potenciales evocados relacionados a eventos (especialmente ERN, N200 y P300) con el fin de explicar más íntegramente lascaracterísticas del trastorno. Las funciones cognitivas que se pueden vincular con loshallazgos de neuroimágenes y ERPs son relativas al procesamiento de la información,decodificación, planificación, atención voluntaria, control inhibitorio, y funcionesejecutivas en general.

Employment is an indicator of socioeconomic status. Unemployment is a worldwide social challenge, especially in emerging countries, accounting for a proportion of the overall higher mortality rates found in these nations. We assessed the relationship between employment status and in-hospital mortality among acute ischemic stroke patients participating in the Argentinean National Stroke Registry (ReNACer), a prospective, country-wide, hospital-based stroke registry aimed at improving quality of stroke care in Argentina. We compared demographic and socioeconomic characteristics, risk factors, acute treatment, and stroke severity between employed and unemployed patients with acute ischemic stroke participating in ReNACer. We developed a multiple logistic regression model to identify predictors of in-hospital mortality. Among the 726 patients with acute ischemic stroke included in the study, 39.5% were unemployed. In-hospital mortality was higher in the patients who were unemployed at the time of the stroke compared with those who were employed (12.0% vs 5.0%; P = .003). On multivariate analysis, being unemployed (odds ratio [OR], 3.58; 95% confidence interval [CI], 1.36-7.37; P = .005), stroke severity (OR, 3.54; 95% CI 1.11-10.40; P = .018), and infarct size >15 mm (OR, 2.80; 95% CI, 1.18-6.60; P = .019) were associated with in-hospital mortality after adjusting for relevant covariates. Social factors may influence poor outcomes after stroke. In the present study, unemployment was associated with a higher risk of adjusted in-hospital mortality. Strategies targeting individuals at high risk of cardiovascular diseases and poorer outcomes should be implemented to reduce stroke impact.

Human communication in a natural context implies the dynamic coordination of contextual clues, paralinguistic information and literal as well as figurative language use. In the present study we constructed a paradigm with four types of video clips: literal and metaphorical expressions accompanied by congruent and incongruent gesture actions. Participants were instructed to classify the gesture accompanying the expression as congruent or incongruent by pressing two different keys while electrophysiological activity was being recorded. We compared behavioral measures and event related potential (ERP) differences triggered by the gesture stroke onset. Accuracy data showed that incongruent metaphorical expressions were more difficult to classify. Reaction times were modulated by incongruent gestures, by metaphorical expressions and by a gesture-expression interaction. No behavioral differences were found between the literal and metaphorical expressions when the gesture was congruent. N400-like and LPC-like (late positive complex) components from metaphorical expressions produced greater negativity. The N400-like modulation of metaphorical expressions showed a greater difference between congruent and incongruent categories over the left anterior region, compared with the literal expressions. More importantly, the literal congruent as well as the metaphorical congruent categories did not show any difference. Accuracy, reaction times and ERPs provide convergent support for a greater contextual sensitivity of the metaphorical expressions.

Increase in use of atypical antipsychotics has been paralleled by an increase in the incidence of intentional and nonintentional overdose. Pediatric cases are uncommon, but may be severe. We describe a case of a child presenting with severe extrapiramidal symptoms, initially interpreted as seizures, caused by a nonintentional intoxication with risperidone, and review management options and the literature.

Neuroleptics having dopamine receptor-blocking properties are frequently responsible for the development of movement disorders. This has been known for many years as these adverse events were identified soon after the introduction of these drugs for the treatment of psychiatric disorders. Parkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesias are the different clinical presentations of these disorders. Tardive dyskinesia is the most problematic among them as it may persist even after discontinuation of the offending drug, and become an irreversible phenomenon. The term «tardive dyskinesia » encompasses a variety of clinical phenomena including stereotypic behaviors, dystonia, myoclonus, and tics. Stereotypies and orobuccolingual dyskinesias are the most frequently observed tardive disorders, particularly in the elderly population exposed to neuroleptics, while dystonic phenomena are more prevalent in younger individuals. The development of these disorders is dependent on the potency of the drug, duration of exposure, and a number of predisposing factors, including age, gender, and presence of organic brain disease. The pathophysiology is rather complex and involves changes in the dopamine synapse both at the pre- and postsynaptic level, as well as plastic changes involving transcription factors and activation of different molecular cascades downstream of the dopamine receptor. The introduction of more novel pharmacological agents, like the so-called atypical neuroleptics, has significantly reduced the incidence of these disorders; however, the prescribing physician has to be aware that a lower risk is not synonymous with absence of risk.

Beyond extrastriate body area (EBA) and fusiform body area (FBA): Context integration in the meaning of actions. Autores Amoruso L, Couto JB, Ibanez A. Año 2011 Journal  Amoruso L, Couto JB, Ibanez A. Volumen (5): 124 Abstract   Otra información    

Language, memory and the temporal lobes. Autores Manes F, Gleichgerrcht E. Año 2011 Journal  Manes F, Gleichgerrcht E. Volumen 24(4): 263-264 Abstract   Otra información    

BACKGROUND: Information regarding predisposing factors, frequency, and prognostic implications of new onset atrial fibrillation (NOAF) after carotid endarterectomy (CEA) is scarce. We assessed the frequency, risk factors, and the prognostic impact of NOAF after CEA. METHODS: We assessed every patient undergoing CEA (n = 186) at our academic hospital between 2006 and 2009. Patients underwent continuous electrocardiographic monitoring during surgery and during the rest of hospital stay. We performed univariate and multivariate analyses for identifying variables associated with NOAF and for individualizing variables related to four perioperative adverse outcome measures: a) ischemic stroke; b) ischemic stroke and myocardial infarction, c) ischemic stroke and death, and d) ischemic stroke, myocardial infarction, and death. RESULTS: The study cohort comprised 186 patients. Overall, NOAF was detected in 7 cases (3.8%). The only variable associated with NOAF was intraoperative hypotension (OR 9.6, 95% CI 1.9-47.4, P = .006). There were no perioperative deaths. NOAF was associated with perioperative ischemic stroke and with the combined outcome of ischemic stroke and myocardial infarction. CONCLUSIONS: We found a low frequency of NOAF after CEA. Intraoperative hypotension was associated to a higher risk of NOAF. In turn, NOAF was related to adverse postoperative outcome. Further research is needed to clarify the pathophysiological relation between intraoperative hypotension, NOAF, and adverse CEA outcome.

Language, memory and the temporal lobes. Autores Manes F, Gleichgerrcht E.  Año 2011 Journal  Manes F, Gleichgerrcht E.  Volumen 24(4): 263-264 Abstract   Otra información