Categoría: Papers con abstracts

Real life Executive Deficits in Patients with Focal Vascular Lesions Affecting the Cerebellum. Autores Manes F, Ruiz Villamil A, Ameriso S, Roca M, Torralva T.  Año 2009 Journal  Manes F, Ruiz Villamil A, Ameriso S, Roca M, Torralva T.  Volumen 283(1-2): 95-98 Abstract   Otra información    

A large proportion of human social neuroscience research has focused on the issue of decision-making. Impaired decision-making is a symptomatic feature of a number of neurodegenerative diseases, but the nature of these decision-making deficits depends on the particular disease. Thus, examining the qualitative differences in decision-making impairments associated with different neurodegenerative diseases could provide valuable information regarding the underlying neural basis of decision-making. Nevertheless, few comparative reports of decision-making across patient groups exist. In this Review, we examine the neuroanatomical substrates of decision-making in relation to the neuropathological changes that occur in Alzheimer disease, frontotemporal dementia, Parkinson disease and Huntington disease. We then examine the main findings from studies of decision-making in these neurodegenerative diseases. Finally, we suggest a number of recommendations that future studies could adopt to aid our understanding of decision-making cognition.

BACKGROUND: A 69 year-old woman presented to an interdisciplinary medical group with pathological gambling, and went on to develop disinhibition, loss of empathy, and perseverative, stereotyped and ritualistic behavior. An initial neuropsychological evaluation showed selective impairment on the Iowa Gambling Task similar to that of patients with behavioral variant frontotemporal dementia, despite normal performance on standard neuropsychological tasks. MRI scans showed frontal lobe atrophy, which was consistent with findings on hexamethylpropyleneamine oxime single photon emission CT (HMPAO-SPECT). INVESTIGATIONS: Physical examination, neuropsychiatric and neuropsychological assessments, MRI brain scan, HMPAO-SPECT. DIAGNOSIS: Behavioral variant frontotemporal dementia. MANAGEMENT: Pharmacological treatment with the selective serotonin reuptake inhibitor paroxetine for impulsive behavior and carbamazepine to stabilize mood. The patient and her family also received counseling to advise on behavioral and legal issues.

BACKGROUND: A reliable and valid questionnaire for screening restless legs syndrome (RLS) is essential for determining accurate estimates of disease frequency. In a 2002 NIH-sponsored workshop, experts suggested three mandatory questions for identifying RLS in epidemiologic studies. We evaluated the reliability and validity of this RLS-NIH questionnaire in a community-based sample and concurrently developed and evaluated the utility of an expanded screening questionnaire, the RLS-EXP. METHODS: The study was conducted at Kaiser Permanente of Northern California and the Stanford University Sleep Clinic. We evaluated test-retest reliability in a random sample of subjects with prior physician-assigned RLS (n=87), subjects with conditions frequently misclassified as RLS (n=31), and healthy subjects (n=9). Validity of both instruments was evaluated in a random sample of 32 subjects, and in-person examination by two RLS specialists was used as the gold standard. RESULTS: For the first three RLS-NIH questions, the kappa statistic for test-retest reliability ranged from 0.5 to 1.0, and sensitivity and specificity was 86% and 45%, respectively. For the subset of five questions on RLS-EXP that encompassed cardinal features for diagnosing RLS, kappas were 0.4-0.8, and sensitivity and specificity were 81% and 73%, respectively. CONCLUSIONS: Sensitivity of RLS-NIH is good; however, the specificity of the instrument is poor when examined in a sample that over-represents subjects with conditions that are commonly misclassified as RLS. Specificity can be improved by including separate questions on cardinal features, as used in the RLS-EXP, and by including a few questions that identify RLS mimics, thereby reducing false positives.

BACKGROUND: Alcohol use has been previously associated with neurocognitive impairments, especially in decision-making cognition. However, some studies have shown little to no decision-making deficits in relation to different characteristics of people with drinking problems. Relapsing to driving under the influence (DUI) of alcohol is an important issue with legal and psychosocial aspects. We evaluated decision-making performance in second-time DUI offenders by using the Iowa Gambling Task (IGT). METHOD: Thirty-four male second-time DUI offenders who had been selected for an official psychoeducational rehabilitation program and 31 healthy controls that were matched for age, education, and alcohol use were included. Along with psychiatric assessment, we applied conventional neuropsychological testing comprising cognitive set-shifting, response inhibition, attention, and visuospatial abilities. Also, we used the Temperament and Character Inventory (TCI) to assess personality patterns. A computerized version of IGT was used. RESULTS: No significant differences were found between the groups in regard to sociodemographics and conventional neuropsychological testing. DUI participants had significantly higher scores only in «self-transcendence » subdomain of TCI. On the fifth block of the IGT, DUI participants had significantly lower net scores than controls (U = 380.0, p < 0.05). Also, DUI participants chose significantly more risky decks compared to controls. CONCLUSIONS: Our results suggest that there may be subtle decision-making deficits in DUI participants, which goes undetected on conventional neuropsychological testing and which is not correlated with TCI subdomains related with impulsivity patterns.

BACKGROUND: The main aim of this study was to compare a large population of patients with bipolar disorder (BD) types I and II strictly defined as euthymic with healthy controls on measures of decision making. An additional aim was to compare performance on a decision-making task between patients with and without a history of suicide attempt.MethodEighty-five euthymic patients with BD-I or BD-II and 34 healthy controls were included. All subjects completed tests to assess verbal memory, attention and executive functions, and a decision-making paradigm (the Iowa Gambling Task, IGT). RESULTS: Both groups of patients had worse performance than healthy controls on measures of verbal memory, attention and executive function. No significant differences were found between BD-I, BD-II and healthy controls on measures of decision making. By contrast, patients with a history of suicide attempt had lower performance in the IGT than patients without a history of suicide attempt. CONCLUSIONS: Patients with euthymic BD-I and BD-II had intact decision-making abilities, suggesting that this does not represent a reliable trait marker of the disorder. In addition, our results provide further evidence of an association between impairments in decision making and vulnerability to suicidal behavior.

BACKGROUND: The aim of this study was to estimate the predictive value of cognitive impairments and time spent ill in long-term functional outcome of patients with bipolar disorder (BD). METHODS: Thirty five patients with euthymic BD completed a neurocognitive battery to assess verbal memory, attention, and executive functions at study entry. The course of illness was documented prospectively for a period longer than 12 months using a modified life charting technique based on the NIMH life-charting method. Psychosocial functioning was assessed with the General Assessment of Functioning (GAF) and the Functioning Assessment Short Test (FAST) at the end of follow-up period when patients were euthymic. RESULTS: Impairments in verbal memory and in attention, as well as subsyndromal depressive symptomatology were independent predictors of GAF score at the end of the study explaining 43% of variance. Similarly, impairments in attention and executive functioning were independent predictors of FAST score explaining 28% of variance. LIMITATIONS: We did not control factors that could affect functional outcome such as psychosocial interventions, familiar support and housing and financial resources. CONCLUSIONS: Both cognitive impairments and time spent with subsyndromal depressive symptomatology may be illness features associated with poorer long-term functional outcome. Developing strategies to treat these illness features might contribute to enhance long-term functional outcome among patients with BD.

Brain processes and social processes are not as separated as many of our Social Psychology and Neuroscience departments. This paper discusses the potential contribution of social neuroscience to the development of a multi-level, dynamic, and context-sensitive approach to prejudice. Specifically, the authors review research on event related potentials during social bias, stereotypes, and social attitudes measurements, showing that electrophysiological methods are powerful tools for analyzing the temporal fine-dynamics of psychological processes involved in implicit and explicit prejudice. Meta-theoretical implications are drawn regarding the social psychological modeling of social attitudes, and for the integration of social neuroscience into a multi-level account of cultural behavior.

Determining conscious processing in unresponsive patients relies on subjective behavioural assessment. Using data from hand electromyography, the authors studied the occurrence of subthreshold muscle activity in response to verbal command, as an objective indicator of awareness in 10 disorders of consciousness patients. One out of eight vegetative state patients and both minimally conscious patients (n = 2) demonstrated an increased electromyography signal specifically linked to command. These findings suggest electromyography could be used to assess awareness objectively in pathologies of consciousness.

En la actualidad los recursos tecnológicos constituyen herramientas cotidianas, sobre todo en el mundo de los niños y adolescentes. La psicoterapia ha tendido a dejar de lado el uso de los mismos. Según un consenso de expertos la evolución posible de la psicoterapia apuntaría a la incorporación de dichos recursos. Datos preliminares en una encuesta realizada a psicólogos de la Ciudad Autónoma de Buenos Aires y Conurbano bonaerense arrojan que, a pesar de que un alto porcentaje considera que los recursos tecnológicos pueden ser úiles para el desarrollo de la alianza y la optimización de las técnicas, al mismo tiempo manifiestan tener poco conocimiento acerca de los mismos y utilizarlos con poca frecuencia. El propósito de este artículo es revisar creencias y actitudes de los terapeutas respecto a la incorporación de dichas herramientas a la práctica clínica.