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ABSTRACT. The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.
RESUMO. A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.
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Humanos , AncianoRESUMEN
The COVID-19 pandemic has shown the need for neuropsychological care for older adults with memory complaints in different contexts, including rural areas or areas with difficult access. Objective: This study aimed to analyze the clinical utility of the Phototest, through telemedicine, to identify mild cognitive impairment in rural older adults with memory complaints, during the COVID-19 pandemic. Methods: We performed a cross-sectional, case-control, and clinical utility comparison of brief cognitive tests (BCTs). The sample included 111 rural elderly people with mild cognitive impairment (MCI) and 130 healthy controls from the Los Lagos region, Chile. The instruments adopted were modified Mini-Mental State Examination (MMSEm) and adapted version of the Phototest (PT) for Chile. Results: To identify mild cognitive impairment, using a cutoff score of 27-28 points, the Phototest showed a sensitivity of 96.6% and a specificity of 81.8%; indicators superior to those of the MMSEm. Conclusions: The Phototest is more accurate than the MMSEm in identifying cognitive alterations in rural older adults with cognitive memory complaints through telemedicine. Therefore, its use in primary care is recommended in order to perform early detection of preclinical cognitive alterations in mild cognitive impairment or neurodegenerative diseases.
A pandemia de COVID-19 mostrou a necessidade de cuidados neuropsicológicos para adultos idosos com queixas de memória em diferentes contextos, incluindo áreas rurais ou áreas de difícil acesso. Objetivo: Analisar a utilidade clínica do Phototest, por meio da telemedicina, para identificar uma leve deficiência cognitiva em adultos idosos rurais com queixas de memória, durante a pandemia de COVID-19. Métodos: Realizamos uma comparação transversal, caso-controle e utilidade clínica dos testes cognitivos breves. Amostra: Cento e onze idosos rurais com deficiência cognitiva leve (DCL) e 130 controles saudáveis da região de Los Lagos, Chile. Instrumentos: Minimental modificado (MMSEm) e versão do teste fotográfico (PT) adaptada para o Chile. Resultados: Para identificar a DCL, usando pontuação de corte de 27-28 pontos, o Phototest mostrou sensibilidade de 96,6% e especificidade de 81,8%; indicadores superiores aos do MMSEm. Conclusões: O Phototest é mais preciso que o MMSEm para identificar, por meio da telemedicina, alterações cognitivas em adultos idosos rurais com queixas de memória cognitiva. Sendo assim, seu uso na atenção primária é recomendado para realizar a detecção precoce de alterações cognitivas pré-clínicas em DCL ou doenças neurodegenerativas.
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INTRODUCTION: In recent years, an important number of studies have emphasized the psychopharmacological actions of cycloleucine (1-aminocyclopentanecarboxylic acid) acting on the NR1 subunit (glycine allosteric site) of NMDA (N-methyl-D-aspartic acid) receptor. We studied the effects of its injection in an anxiety test. METHODS: The elevated plus maze test was used. Male rats bilaterally cannulated into the nucleus accumbens septi (NAS) were employed. Rats were divided into 5 groups that received either 1 µL injections of saline or cycloleucine (0.5, 1, 2, or 4 µg) 15 min before testing. RESULTS: Time spent in the open arm was significantly increased by cycloleucine treatment with all doses (1 and 2 µg, p < 0.05; 0.5 and 4 µg, p < 0.01), like number of extreme arrivals (0.5 and 1 µg, p < 0.05; 2 µg, p < 0.01; and 4 µg, p < 0.001). Open arm entries were increased by the highest dose only (4 µg, p < 0.01). DISCUSSION/CONCLUSION: Present results show no difference between all doses in the time spent in the open arm, suggesting an indirect, noncompetitive action of the drug. The increase in extreme arrivals and open arm entries suggests a dose influence in these parameters. We conclude that cycloleucine influence on the NMDA receptors within NAS leads to anxiolytic-like effects and behavioral disinhibition, which once more confirms the involvement of NAS in anxiety processing.
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Ansiolíticos/farmacología , Conducta Animal/efectos de los fármacos , Cicloleucina/farmacología , Prueba de Laberinto Elevado , Núcleo Accumbens/efectos de los fármacos , Desempeño Psicomotor/efectos de los fármacos , Animales , Ansiolíticos/administración & dosificación , Cicloleucina/administración & dosificación , RatasRESUMEN
In previous studies we have found that blockade of NMDA (N-Methyl-D-Aspartic-Acid)-type glutamatergic receptor with intracerebroventricular (ICV) selective drugs induces an inhibition of lordosis in ovariectomized (OVX) estrogen primed rats receiving progesterone or luteinizing hormone releasing hormone (LHRH). By the opposite way, stimulation with NMDA in OVX estrogen primed rats induced a significant increase of lordosis. In the present study the action of an alpha1-noradrenergic antagonist, HEAT (BE 2254/2-beta-4-Hydroxyphenyl-Ethyl-Aminomethyl-1-Tetralone), and Metoprolol, a beta-noradrenergic antagonist, were studied injecting them ICV previously to NMDA administration in treated OVX estrogen primed rats. In experiment 1, the enhancing effect on lordosis induced by NMDA at high dose (1 microg) was abolished by HEAT administration (P < 0.001 for 3 and 6 microg), and the LH plasma levels were decreased only with the higher dose (P < 0.05), suggesting that behavioral effects are quite more sensitive to the alpha-blockade than hormonal effects. In experiment 2, enhancing effects on lordosis behavior were not observed with neither the NMDA at low dose (0.5 microg) nor the metoprolol alone (5.71 microg), but a synergism was observed when both were simultaneously administered (P < 0.001). The LH plasma levels were increased by Metoprolol alone (P < 0.05), and powered by the combination with NMDA at low dose (P < 0.01 vs. SAL and NMDA alone); no differences were observed with Metoprolol. LH increase was observed with Metoprolol even without behavioural modifications. These findings strongly suggest that facilitatory and inhibitory effects of NMDA in this model are mediated by alpha- and beta-adrenergic transmission in both, behavioral and hormonal effects.