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OBJECTIVE: To compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) tests for the identification of cognitive deficit (CD) in elderly patients with heart failure (HF). METHODS: This was a cross-sectional study with an observational design involving 43 elderly patients with HF of both sexes, treated by the Unified Health System, who were able to understand and follow the study instructions. A sociodemographic and clinical questionnaire and the MMSE and MoCA neurocognitive tests were applied. RESULTS: The mean age of the patients was 67 years; 67.44% were male; 53.49% were white; 58.14% had 1-4 years of schooling; 58.14% had an income of half to one minimum wage; 55.81% were married; 53.49% had a family history of HF; 90.7% denied smoking; 83.72% denied alcohol intake; 65.12% did not practice physical activity; 83.72% were hypertensive; 30.23% were diabetic; 57.89% had LVEF ≥ 50%; 39.53% have NYHA II; and 88.37% did not have a pacemaker. In the identification of CD, the MMSE test detected it in 25.58% of the patients, while the MoCA test identified it in 23.26% (p=0.043). CONCLUSION: It was concluded that the MMSE test performed better than the MoCA test in the identification of CD in elderly patients with HF.
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Insuficiencia Cardíaca , Pruebas de Estado Mental y Demencia , Humanos , Femenino , Masculino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/psicología , Anciano , Estudios Transversales , Anciano de 80 o más Años , Persona de Mediana Edad , Factores Socioeconómicos , Cognición/fisiología , Evaluación Geriátrica/métodos , Pruebas Neuropsicológicas , Trastornos del Conocimiento/diagnóstico , Disfunción Cognitiva/fisiopatología , Disfunción Cognitiva/diagnósticoRESUMEN
Objective: To critically analyze the evidence regarding changes in verbal and performance intelligence quotient (IQ) in patients with schizophrenia.Data Sources: An English-language-only search was conducted in the PubMed, Cochrane Library, and LILACS databases for articles with study objectives that included Wechsler Adult Intelligence Scale (WAIS) assessment of cognitive functions in patients with schizophrenia. Descriptors were defined based on Medical Subject Headings, where associations of psychotic disorders related to the schizophrenia spectrum were suggested, as well as the "Wechsler Scales" descriptor. The search was conducted in November 2022 with no restriction on the date of publication to select studies that used any of the WAIS editions.Study Selection: Articles that met the inclusion criteria were selected after title and summary identification and full-text review.Results: A total of 28 articles were identified. All studies presented total IQ scores, but only 20 showed results for verbal IQ (n = 20) or performance IQ (n = 19). Analyzed data indicated patients had average performance on verbal comprehension features but low average performance on perceptual reasoning, working memory, and processing speed indices.Conclusions: Executive function deficits were found in the analyzed studies, which reflect difficulties in planning and impulse control-characteristics present in the diagnosis of schizophrenia. The identification of this neuropsychological functioning contributes to the understanding of the cognitive dynamics found in schizophrenia and may help in early diagnosis, reinforcing the hypothesis that cognitive performance may be one of the indicators of psychopathologic expression.Prim Care Companion CNS Disord 2023;25(5):22r03456. Author affiliations are listed at the end of this article.
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Trastornos del Conocimiento , Trastornos Psicóticos , Esquizofrenia , Humanos , Adulto , Trastornos del Conocimiento/diagnóstico , Esquizofrenia/complicaciones , Esquizofrenia/diagnóstico , Trastornos Psicóticos/diagnóstico , Cognición , InteligenciaRESUMEN
BACKGROUND: The Mini-Mental State Examination (MMSE) is one of the most widely used tests to assess the global cognitive deterioration of older adults. There are many versions of this Test in Spanish. A validation study was previously conducted in Chile, but to date, no standards computed from a large population sample are available. AIM: to develop normative scores according to age and educational level for older people living in Chile. METHOD: Data were collected from a sample of 1199 subjects between 50 and 91 years of age from various research centers. RESULTS: We present the normative scores in percentiles calculated according to age (50-64, 65-74, 75-91 years of age) and educational level (1-12 years and more than 13 years of formal schooling). CONCLUSION: This article provides normative scores for the MMSE that should be useful in clinical practice as they may help better interpret the performances of Chilean older adults who seek consultation for cognitive impairment.
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Escolaridad , Pruebas de Estado Mental y Demencia , Humanos , Anciano , Chile , Anciano de 80 o más Años , Masculino , Femenino , Pruebas de Estado Mental y Demencia/normas , Pruebas de Estado Mental y Demencia/estadística & datos numéricos , Persona de Mediana Edad , Valores de Referencia , Factores de Edad , Evaluación Geriátrica/métodos , Disfunción Cognitiva/diagnóstico , Reproducibilidad de los Resultados , Trastornos del Conocimiento/diagnósticoRESUMEN
INTRODUCTION: Hypertension is the main cause of cognitive impairment and the executive dysfunction the most com- mon cognitive domain affected. The aims of this research have been to characterize the cognitive profiles (s) in hypertensive patients and to identify the most usefulness Test (s) in the routine clinical practice to identify them. METHODS: We assessed the cognitive status in 69 hypertensive patients who were administered a battery of cognitive Tests that included the MMSE, the Mini-Boston Naming Test, verbal fluency and the Clock drawing Test. RESULTS: The average of the sample was 72.2±10.1 years. The Clock-drawing Test and the Mini-Boston Naming Test differentiated 3 cognitive profiles: no cognitive impairment, minor cognitive disorder and major cognitive disorder. A strong association was observed between the semantic (0.87) and executive (0.75) components of the Clock-drawing Test with the Mini-Boston Naming Test (0.96). The analysis of clusters and switchings in the verbal fluency Test differentiated the severe forms of cognitive impairment. CONCLUSION: The results obtained confirm the value of the Clock-drawing Test to identify the different cognitive profiles in hypertensive patients, becoming a valid screening test to be used in routine clinical practice and a potential biomarker of cognitive dysfunction in hypertensive patients.
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Trastornos del Conocimiento , Disfunción Cognitiva , Hipertensión , Cognición , Trastornos del Conocimiento/diagnóstico , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Humanos , Hipertensión/complicaciones , Hipertensión/diagnóstico , Pruebas NeuropsicológicasRESUMEN
Background: Dysexecutive syndrome is a prominent and functionally significant cognitive feature of schizophrenia. This study assesses and correlates executive function (EF) deficits and dysexecutive behavior (DB) in first-episode schizophrenia (FES) patients and healthy participants. Methods: We evaluated 22 FES patients (aged 17-29 years, history of single episode of schizophrenia, treated with atypical antipsychotics) and 20 controls matched for gender, age, and education. EF was evaluated using the Modified Six Elements Test (MSET), Modified Wisconsin Card Sorting Test (M-WCST), and Frontal Assessment Battery (FAB). DB was evaluated using the Dysexecutive Questionnaire (DEX) and Behavioral Dysexecutive Syndrome Inventory (BDSI). Results: FES patients had marked dysexecutive behaviors and executive function impairments as compared to controls. Our findings suggest that executive function scores on standardized neuropsychological tests may be ecologically valid predictors of dysexecutive behavior. Conclusion: DB is common during first-episode schizophrenia and may be a primary impairment throughout disease progression. The present results inform clinical practice by providing insight into first-episode schizophrenia specific features of dysexecutive behavior. Understanding the associations between executive function tests and dysexecutive behaviors helps to explain the social adjustment disorders associated with schizophrenia. This knowledge may be used to improve diagnostic and therapeutic tools; for example, clarifying the implications of specific DEX and BDSI dimensions could increase the efficacy of individual or familial psychotherapy and cognitive rehabilitation interventions.
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Trastornos del Conocimiento , Esquizofrenia , Humanos , Trastornos del Conocimiento/complicaciones , Trastornos del Conocimiento/diagnóstico , Función Ejecutiva , Pruebas Neuropsicológicas , Esquizofrenia/complicaciones , Encuestas y CuestionariosRESUMEN
The cerebellar cognitive affective syndrome (CCAS) has been consistently described in patients with acute/subacute cerebellar injuries. However, studies with chronic patients have had controversial findings that have not been explored with new cerebellar-target tests, such as the CCAS scale (CCAS-S). The objective of this research is to prove and contrast the usefulness of the CCAS-S and the Montreal Cognitive Assessment (MoCA) test to evaluate cognitive/affective impairments in patients with chronic acquired cerebellar lesions, and to map the cerebellar areas whose lesions correlated with dysfunctions in these tests. CCAS-S and MoCA were administrated to 22 patients with isolated chronic cerebellar strokes and a matched comparison group. The neural bases underpinning both tests were explored with multivariate lesion-symptom mapping (LSM) methods. MoCA and CCAS-S had an adequate test performance with efficient discrimination between patients and healthy volunteers. However, only impairments determined by the CCAS-S resulted in significant regional localization within the cerebellum. Specifically, patients with chronic cerebellar lesions in right-lateralized posterolateral regions manifested cognitive impairments inherent to CCAS. These findings concurred with the anterior-sensorimotor/posterior-cognitive dichotomy in the human cerebellum and revealed clinically intra- and cross-lobular significant regions (portions of right lobule VI, VII, Crus I-II) for verbal tasks that overlap with the "language" functional boundaries in the cerebellum. Our findings prove the usefulness of MoCA and CCAS-S to reveal cognitive impairments in patients with chronic acquired cerebellar lesions. This study extends the understanding of long-term CCAS and introduces multivariate LSM methods to identify clinically intra- and cross-lobular significant regions underpinning chronic CCAS.
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Enfermedades Cerebelosas , Trastornos del Conocimiento , Accidente Cerebrovascular , Cerebelo , Cognición , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Trastornos del Conocimiento/patología , Humanos , Imagen por Resonancia Magnética , Accidente Cerebrovascular/complicacionesRESUMEN
La evaluación cognitiva en personas adultas con esclerosis múltiple (EM) es un área fundamental a tener en cuenta en el proceso de intervención, debido a la alta prevalencia de deterioro cognitivo. En la actualidad, se ha recomendado la evaluación cognitiva por medio de la BICAMS (del inglés Brief International Cognitive Assessment for MS), que es una batería específica para evaluar a personas con EM, pero que no cuenta con validación en nuestro país. El presente estudio tiene como objetivo identificar el impacto de algunos factores clínicos (meses de evolución de la enfermedad y nivel de discapacidad) y personales (sexo, años de escolaridad y edad) que influyen en las medidas cognitivas de la BICAMS, a fin de contar con información relevante y precisa en un futuro proceso de validación. La muestra estuvo constituida por 38 personas con Esclerosis Múltiple Remitente Recurrente (EMRR). Los resultados mostraron que de los cinco factores clínicos observados, solo edad y sexo influyeron de manera significativa sobre los puntajes de las tres pruebas de la BICAMS. Por lo tanto, la validación de esta batería para la población chilena debiera incluir y/o controlar ambas variables de edad y sexo.
The evaluation of cognitive aspects among individuals with multiple sclerosis (MS) is key when considering intervention, because of high prevalence of cognitive impairments. At present, cognitive evaluation has been recommended by means of BICAMS (Brief International Cognitive Assessment for MS), which is a battery specifically constructed to assess individuals with MS. However, the battery has not been validated in Chile.The present study aims atdetermining the impact of clinical factors (months since condition's diagnosis and severeness level) and individual factors (sex, age, and years of schooling), which is expected to be accurate and valuable input for future validation processes. Sample consisted of 38 people with remittent-recurrent multiple sclerosis (RRMS). Results showed that only age and gender do significantly impact cognitive performance on all of three BICAMs subtests. Therefore, when validating this battery for Chilean individuals, both age and gender should be included and or controlled.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/etiología , Esclerosis Múltiple Recurrente-Remitente/complicaciones , Pruebas Neuropsicológicas , Chile , Estudios Transversales , Reproducibilidad de los Resultados , Cognición , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/etiología , Hospitales Públicos , MemoriaRESUMEN
Chromosome 5p13 duplication syndrome represents a contiguous gene syndrome involving duplication of several genes on chromosome 5p13. Some clinical phenotypes are related to it, such as: obsessive-compulsive behavior, small palpebral fissures, intellectual disability, global development delay and ocular hypertelorism. The exact mechanism behind these changes has not well known and further studies are needed for this purpose. Since it is a rare and uncommon clinical situation, the case report contributes to the knowledge of the disease and early diagnosis. This condition mainly affects the cognitive neuromuscular system. We describe an 8-year-old Brazilian patient with the duplication of chromosome 5p13.2, karyotype, whose neurodevelopmental evaluation presented cognitive impairment, severe language delay and atypical physical examination, with ocular hypertelorism, right auricular tags, congenital heart defect and long fingers. The patient was diagnosed by comparative genomic hybridization (CGH)-array revealing a 204Kb of DNA duplication. The exact mechanism behind these structural disorders is still unclear and further studies are needed for this purpose. Nevertheless, the diagnostic suspicion of this genetic alteration that, in general, presents late diagnosis, should be considered to enable better clinical support to the patients and family genetic counseling.
A síndrome da duplicação do cromossomo 5p13 representa uma síndrome genética contígua envolvendo a duplicação de vários genes contidos nesta região. Alguns fenótipos clínicos estão relacionados com ela, tais como: comportamento obsessivo compulsivo, fissuras palpebrais pequenas, déficit intelectual, atraso no desenvolvimento global e hipertelorismo ocular. Por ser uma situação clínica rara, o relato do caso contribui para a disseminação do conhecimento acerca da condição, assim como para seu diagnóstico precoce. Descrevemos uma paciente brasileira de oito anos com a duplicação do cromossomo 5p13.2, que na avaliação do neurodesenvolvimento apresentou comprometimento cognitivo, grave atraso da linguagem e dismorfismos como hipertelorismo ocular, apêndice auricular direito, sopro cardíaco, relacionado a defeito do septo ventricular, e dedos alongados. A paciente foi diagnosticada por meio da pesquisa molecular (CGH)-array com ganho de 204Kb de DNA. O mecanismo exato por trás dessas alterações estruturais ainda não está claro e são necessários mais estudos para este fim. Não obstante, a suspeita diagnóstica dessa alteração genética que, em geral, apresenta diagnóstico tardio, deve ser aventada para viabilizar melhor suporte clínico aos pacientes e aconselhamento genético familiar.
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Humanos , Femenino , Niño , Duplicaciones Segmentarias en el Genoma , Duplicación Cromosómica/genética , Pruebas Genéticas/métodos , Trastornos del Conocimiento/diagnóstico , Insuficiencia de Crecimiento , Hibridación Genómica Comparativa , Trastornos del Desarrollo del Lenguaje/diagnósticoRESUMEN
BACKGROUND: The Clinical Dementia Rating (CDR) scale is commonly used to stage cognitive impairment, despite having educational limitations. In elderly with low education, a previous study has shown that intraindividual variability of reaction time (CV) and commission errors (CE), measured using a culture-free Go/No-Go task, can reliably distinguish early Alzheimer's disease (AD) from mild cognitive impairment (MCI) and healthy controls. OBJECTIVE: We aimed to extend the clinical utility of this culture-free Go/No-Go task in a sample with high educational disparity. METHODS: One hundred and ten participants with a wide range of years of formal education (0-14 years) were randomly selected from a geriatric unit and divided based on their CDR scores into cognitively unimpaired (CDRâ=â0), MCI (CDRâ=â0.5), and early AD (CDRâ=â1). All underwent a 90-s reaction-time test that measured the variables previously found to predict CDR in low educated elderly. Here we added years of formal education (educational level) to the model. Multivariate analyses compared differences in group means using educational level as confounding factor. A confirmatory discriminant analyses was performed, to assess if CDR scores could be predicted by the two Go/No-Go variables in a sample with high educational disparity. RESULTS: Over all three groups, differences in both CE and CV reached statistical significance (pâ<â0.05). The discriminant analysis demonstrated that CV and CE discriminated cognitively impaired from cognitively normal elderly. These results remained similar when discriminating MCI from cognitively unimpaired elderly. CONCLUSION: The Go/No-Go task reliably discriminates elderly with MCI from elderly without cognitive impairment independent of educational disparity.
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Enfermedad de Alzheimer/fisiopatología , Atención/fisiología , Trastornos del Conocimiento/fisiopatología , Disfunción Cognitiva/fisiopatología , Análisis y Desempeño de Tareas , Anciano , Anciano de 80 o más Años , Enfermedad de Alzheimer/diagnóstico , Cognición/fisiología , Trastornos del Conocimiento/diagnóstico , Disfunción Cognitiva/diagnóstico , Progresión de la Enfermedad , Escolaridad , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia , Índice de Severidad de la EnfermedadRESUMEN
Patients with psychiatric disorders often have cognitive impairment. Several deficits have been recognized in patients with mood and/or psychotic disorders. We hypothesized that differences in the levels of deterioration exist between patients with bipolar disorder (BD), major depressive disorder (MDD), and schizoaffective disorder (SAD). The mini-mental state examination, version 2 (MMSE-2), was used with a sample of 160 psychiatric patients to measure cognitive impairment. The aims of this studyssss were as follows: (1) To characterize the differences in cognitive deterioration among patients diagnosed with BD, MDD, or SAD; (2) to explore item difficulty and cutoff points based on the educational level and other variables which are significant for our psychiatric population. Descriptive statistics were used for categorical variables. In addition, a Bonferroni post hoc test and an analysis of covariance (ANCOVA) for the continuous dependent variable were performed. Psychiatric diagnosis and years of education adjusted by several covariates proved to be significant. The 25th percentile were obtained to establish the cutoff points. Each item's difficulty was analyzed using means and chi-square tests. Cognitive deterioration was found in 51% of the patients with SAD, in 31% with BD, and in 18% with MDD.
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Trastorno Bipolar , Trastornos del Conocimiento , Trastorno Depresivo Mayor , Cognición , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Humanos , Puerto Rico/epidemiologíaRESUMEN
OBJECTIVE: Declines in physical and cognitive functioning often co-exist through aging. Gait-related parameters have been related to cognitive function, although it is unclear whether other measures of physical functioning are similarly related to cognition. Here, we analyzed the relationship between physical functioning with cognition in older adults. METHODS: In total, baseline data of 116 dementia-free older adults recruited from two separated clinical trials (RCT) were included (M age = 69 years, SD = 6; 71% women). We quantified cognitive functioning using the Montreal Cognitive Assessment (MoCA) and executive functioning tasks (Digit Span Forward minus Backward and verbal fluency FAS and animal naming). Physical function measures included gait speed, Short-physical Performance Battery (SPPB), five-times Sit-to-Stand Test, the Timed Up and Go (TUG) test, the Six-minute Walk Test (6MWT), and lower extremity muscle strength. We used multiple linear regression analyses to explore the association between cognitive measures and each measure of physical functioning, adjusting for age, sex, education, and RCT. Regression coeficients (b), standard error (SE) and 95% confidence intervals (CI) were used to summarize main results. RESULTS: We observed a positive association between muscle strength and the MoCA (b = 0.84, SE = 0.40, 95%CI 0.051.64) after controlling for covariates. Significant associations were also found between the five-times-sit-to-stand test (b = -0.63, SE = 0.26, 95%CI -1.15-0.12), TUG (b = -1.13, SE = 0.57, 95%CI -2.26-0.01), 6MWT (b = 0.04, SE = 0.02, 95%CI 0.010.07), and lower extremity muscle strength (b = 1.92, SE = 0.93, 95%CI 0.093.77) with the FAS verbal fluency test, and between the TUG (b = -0.62, SE = 0.24, 95%CI -1.11-0.14) with animal naming. CONCLUSION: In community-dwelling older adults, higher levels of muscle strength, dynamic balance and cardiorespiratory fitness were positively related with global cognition and executive control measures.
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Humanos , Masculino , Femenino , Anciano , Ejercicio Físico , Evaluación Geriátrica/métodos , Cognición/fisiología , Trastornos del Conocimiento/diagnóstico , Fuerza Muscular/fisiología , Marcha/fisiología , Estudios TransversalesRESUMEN
INTRODUCTION: Normotensive hydrocephalus is a differential diagnosis in the evaluation of the dementia syndrome. The diagnostic protocols would allow detecting this pathology that has more effective treatment than other dementias. OBJECTIVE: To describe a population with clinical suspicion of normal pressure hydrocephalus evaluated in a Colombian psychiatric hospital and discuss the possible reasons for its diagnostic and therapeutic delay. MATERIALS AND METHODS: We conducted a retrospective study of medical records to identify patients with suspected normal pressure hydrocephalus during a 5-year period. RESULTS: Thirty-five patients with suspected normal pressure hydrocephalus underwent diagnostic lumbar puncture and five of them were considered candidates for a peritonealvenous shunt, but none underwent this surgical procedure. After three to six months of the lumbar puncture, the gait pattern improved in 22.8% of the patients, cognition in 22.8%, and sphincter control in 11.4%. Improvement was not sustained in the long term (1 year) in any of them. CONCLUSION: This study suggests the poor implementation of the protocols for evaluating patients with cognitive deficits and delays in the diagnosis of normal pressure hydrocephalus. A small number of patients were identified as candidates for treatment. Normal pressure hydrocephalus is a potentially reversible clinical entity with the placement of a peritoneal ventricular shunt, but delays in diagnosis and treatment have deleterious consequences for patients and their families.
Introducción. La hidrocefalia normotensiva es un diagnóstico diferencial en la evaluación del síndrome demencial. Los protocolos diagnósticos permitirían detectar esta condición, cuyo tratamiento es más efectivo que el de otras demencias. Objetivo. Describir una población con sospecha clínica de hidrocefalia normotensiva evaluada en un hospital psiquiátrico colombiano y discutir las posibles razones de la demora en el diagnóstico y en la terapia de esta condición clínica. Materiales y métodos. Se hizo un estudio retrospectivo de los registros médicos para detectar pacientes con sospecha de hidrocefalia normotensiva durante un período de cinco años. Resultados. A 35 pacientes con sospecha de hidrocefalia normotensiva se les hizo una punción lumbar diagnóstica. Cinco de ellos se consideraron candidatos para una derivación ventrículo-peritoneal, pero ninguno se sometió a este procedimiento quirúrgico. A los 3-6 meses de la punción lumbar, se observó una mejoría del patrón de la marcha en el 22,8 % de los pacientes, de la cognición en el 22,8 % y del control del esfínter en el 11,4 %. La mejoría no se mantuvo a largo plazo (un año) en ningún paciente. Conclusión. Se encontró una implementación deficiente de los protocolos de evaluación de los pacientes con déficit cognitivos y demoras en el diagnóstico de la hidrocefalia normotensiva, así como un número reducido de pacientes clasificados como candidatos para el tratamiento. La hidrocefalia normotensiva es una condición clínica potencialmente reversible con la colocación de una derivación ventrículo-peritoneal. Los retrasos en el diagnóstico y en el tratamiento tienen consecuencias perjudiciales para los pacientes y sus familias.
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Diagnóstico Tardío , Hidrocéfalo Normotenso/diagnóstico , Punción Espinal/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Canal Anal/fisiología , Trastornos del Conocimiento/diagnóstico , Colombia , Demencia/diagnóstico , Femenino , Análisis de la Marcha , Humanos , Hidrocéfalo Normotenso/cirugía , Masculino , Persona de Mediana Edad , Derivación Peritoneovenosa , Estudios Retrospectivos , Evaluación de Síntomas/métodos , Factores de TiempoRESUMEN
Objective: To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). Methods: Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. Results: BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. Conclusion: Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.
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Humanos , Masculino , Femenino , Adulto , Atención/fisiología , Suicidio/psicología , Trastorno de Personalidad Limítrofe/diagnóstico , Trastornos del Conocimiento/diagnóstico , Trastornos Disociativos/diagnóstico , Conducta Impulsiva , Inventario de Personalidad/estadística & datos numéricos , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno de Personalidad Limítrofe/psicología , Estudios de Casos y Controles , Pruebas de Estado Mental y Demencia , Pruebas Neuropsicológicas/estadística & datos numéricosRESUMEN
Introducción: Existen pocos estudios sobre alteraciones cognitivas en niños realizados en las provincias centrales cubanas. Objetivo: Determinar la prevalencia de niños preescolares con alteraciones cognitivas. Métodos: De un universo de 25 600 niños de la provincia de Cienfuegos entre 0-6 años, se seleccionaron 825 niños preescolares entre 4 y 6 años de varias instituciones educativas y médicas. Todos se evaluaron con la prueba neuropsicológica Luria Inicial. Se usó la norma cubana de la prueba para obtener la prevalencia: percentiles 30 - 35, niños con trastornos del neurodesarrollo, y percentiles 40 - 45, niños con alteraciones cognitivas asociadas a factores psicosociales. Resultados: El 3,9 por ciento de los niños presentaron alteración cognitiva asociada a factores psicosociales, mientras que 1,4 por ciento presentaron alteraciones asociada a trastornos del neurodesarrollo. Las principales alteraciones se resumieron en cuatro tareas: cálculos sencillos, psicomotricidad, lenguaje y memoria de trabajo. En las instituciones educativas, 1 de 10 niños presentaron trastorno del neurodesarrollo, mientras que 3 de 10 niños presentaron alteraciones explicadas por causas educativas. En las instituciones médicas, el 58,0 por ciento de los niños presentó alteraciones explicadas también por causas educativas. Conclusiones: En la provincia de Cienfuegos la prevalencia de niños preescolares con alteraciones cognitivas es moderadamente alta. En especial, las alteraciones se encuentran en las funciones ejecutivas, lingüísticas y en las habilidades relacionadas con el procesamiento numérico. En las instituciones médicas, el niño con alteraciones en las funciones ejecutivas y lingüísticas es frecuente, mientras que en las instituciones educativas prevalecen las alteraciones en las funciones ejecutivas y en el procesamiento numérico(AU)
Introduction: There are few studies on cognitive alterations in children that have been carried out in the Cuban provinces of the central region. Objective: To determine the prevalence of pre-school children with cognitive alterations. Methods: From a group sample of 25 600 children from 0 to 6 years old of Cienfuegos province, there were selected 825 pre-school children in the ages from 4 to 6 years from different educational and health institutions. All the children were evaluated with the Luria Incial neuropsychological test. It was used the Cuban standard of the test to obtain the prevalence data: percentiles 30 - 35, children with neurodevelopmental disorders, and percentiles 40 - 45, children with cognitive alterations related to psychosocial factors. Results: The 3.9 percent of the children presented cognitive alterations related to psychosocial factors, while the 1.4 percent presented alterations related to neurodevelopmental disorders. The main alterations were comprised in 4 tasks: simple calculations, psychomotricity, language and working memory. In the educational institutions, 1 of 10 children presented a neurodevelopmental disorder, while 3 of 10 children presented alterations due to educative causes. In the health institutions, 58,0 percent of the children presented alterations due to educative causes. Conclusions: In Cienfuegos province, the prevalence of pre-school children with cognitive alterations is moderately high. The alterations are specially found in the executive and linguistic functions and in the abilities related with the numbers processing. In the health institutions, it is common to have children with alterations in the executive and linguistic functions, while in the educative institutions prevail the alterations in the executive functions and the numbers processing(AU)
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Humanos , Masculino , Femenino , Preescolar , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , CubaRESUMEN
OBJECTIVE: To examine the contribution of anesthesia exposure during treatment for childhood medulloblastoma to neurocognitive outcomes 3 years after tumor diagnosis. STUDY DESIGN: In this retrospective study, anesthesia data were abstracted from medical records for 111 patients treated with risk-adapted protocol therapy at St Jude Children's Research Hospital. Neurocognitive testing data were obtained for 90.9% of patients. RESULTS: For the 101 patients (62.4% male) who completed testing, mean age at diagnosis was 10.1 years, and 74.3% were staged to have average-risk disease. Anesthesia exposure during treatment ranged from 1 to 52 events (mean = 19.9); mean cumulative duration per patient was 21.1 hours (range 0.7-59.7). Compared with normative expectations (16%), the group had a significantly greater frequency of at-risk scores (<1 SD) on measures of intelligence (28.7%), attention (35.2%), working memory (26.6%), processing speed (46.7%), and reading (25.8%). Including anesthesia exposure duration to linear regression models accounting for age at diagnosis, treatment intensity, and baseline IQ significantly increased the predicted variance for intelligence (r2 = 0.59), attention (r2 = 0.29), working memory (r2 = 0.31), processing speed (r2 = 0.44), and reading (r2 = 0.25; all P values <.001). CONCLUSIONS: In survivors of childhood medulloblastoma, a neurodevelopmentally vulnerable population, greater exposure to anesthesia significantly and independently predicts deficits in neurocognitive and academic functioning. When feasible, anesthesia exposure during treatment should be reduced.
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Anestesia/métodos , Atención/fisiología , Neoplasias Cerebelosas/terapia , Trastornos del Conocimiento/etiología , Meduloblastoma/terapia , Memoria a Corto Plazo/fisiología , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Adolescente , Neoplasias Cerebelosas/complicaciones , Neoplasias Cerebelosas/fisiopatología , Niño , Preescolar , Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/fisiopatología , Terapia Combinada/métodos , Femenino , Humanos , Masculino , Meduloblastoma/complicaciones , Meduloblastoma/fisiopatología , Pruebas de Estado Mental y Demencia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/fisiopatología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). METHODS: Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. RESULTS: BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. CONCLUSION: Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.
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Atención/fisiología , Trastorno de Personalidad Limítrofe/diagnóstico , Trastornos del Conocimiento/diagnóstico , Trastornos Disociativos/diagnóstico , Conducta Impulsiva , Suicidio/psicología , Adulto , Trastorno por Déficit de Atención con Hiperactividad/diagnóstico , Trastorno por Déficit de Atención con Hiperactividad/psicología , Trastorno de Personalidad Limítrofe/psicología , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Pruebas de Estado Mental y Demencia , Pruebas Neuropsicológicas/estadística & datos numéricos , Inventario de Personalidad/estadística & datos numéricosRESUMEN
OBJECTIVE: To externally validate the independent value of objectively diagnosed diffuse white matter abnormality (DWMA; also known as diffuse excessive high signal intensity) volume to predict neurodevelopmental outcomes in very preterm infants (≤31 weeks of gestational age). STUDY DESIGN: A prospective, multicenter, regional population-based cohort study in 98 very preterm infants without severe brain injury on magnetic resonance imaging (MRI). DWMA volume was diagnosed objectively on structural MRI at term-equivalent age using our published algorithm. Multivariable linear regression was used to assess the value of DWMA volume to predict cognitive and language scores on the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) at 2 years corrected age. RESULTS: Of the infants who returned for follow-up (n = 74), the mean (SD) gestational age was 28.2 (2.4) weeks, and 42 (56.8%) were boys. In bivariable analyses, DWMA volume was a significant predictor of Bayley-III cognitive and language scores. In multivariable analyses, controlling for known predictors of Bayley-III scores (ie, socioeconomic status, gestational age, sex, and global brain abnormality score), DWMA volume remained a significant predictor of cognitive (P < .001) and language (P = .04) scores at 2 years. When dichotomized, objectively diagnosed severe DWMA was a significant predictor of cognitive and language impairments, whereas visual qualitative diagnosis of DWMA was a poor predictor. CONCLUSIONS: In this multicenter, prospective cohort study, we externally validated our previous findings that objectively diagnosed DWMA is an independent predictor of cognitive and language development in very preterm infants. We also demonstrated again that visually-diagnosed DWMA is not predictive of neurodevelopmental outcomes.
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Trastornos del Conocimiento/diagnóstico , Recien Nacido Extremadamente Prematuro , Trastornos del Desarrollo del Lenguaje/diagnóstico , Imagen por Resonancia Magnética , Sustancia Blanca/anomalías , Sustancia Blanca/diagnóstico por imagen , Algoritmos , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Análisis Multivariante , Sensibilidad y EspecificidadRESUMEN
OBJECTIVES: To describe elderly performance in the Bender Gestalt Test (BGT) and to discriminate its score by using types of errors as comparison among healthy controls, Alzheimer's disease (AD) patients, and vascular dementia (VD) patients. METHODS: We performed a cross-sectional analysis of 285 elderly individuals of both sexes, all over 60 years old and with more than 1 year of schooling. All participants were assessed through a detailed clinical history, laboratorial tests, neuroimaging, and neuropsychological tests including the BGT, the Cambridge Cognitive Examination (CAMCOG), the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Pfeffer Functional Activities Questionnaire (PFAQ). The BGT scores were not used to establish diagnosis. RESULTS: Mean BGT scores were 3.2 for healthy controls, 7.21 for AD, and 8.04 for VD with statistically significant differences observed between groups (p<0.0001). Logistic regression analysis was used to identify the main risk factors for the diagnostic groups. BGT's scores significantly differentiated the healthy elderly from those with AD (p<0.0001) and VD (p<0.0001), with a higher area under the curve, respectively 0.958 and 0.982. BGT's scores also showed that the AD group presented 12 types of errors. Types of errors evidenced in the execution of this test may be fundamental in clinical practice because it can offer differential diagnoses between senescence and senility. CONCLUSION: A cut-off point of 4 in the BGT indicated cognitive impairment. BGT thus provides satisfactory and useful psychometric data to investigate elderly individuals.