RESUMO
Objective: To assess swallowing progression and its association with the extension of brain damage and cognitive impairment during the acute phase of ischemic stroke. Methods: Cross-sectional, observational study with 50 patients, who were admitted to a Stroke Unit with cerebral ischemia, with a maximum stroke time of 24 h. The following clinical tools were used: National Institutes of Health Stroke Scale, Mini-Mental State Examination, Frontal Battery Assessment, and the Alberta Stroke Program Early CT Score for neuroimaging. The Gugging Swallowing Screen and the Functional Oral Intake Scale were used to assess swallowing. The patients were assessed at three different time-points: at hospital admission, after 72 h of hospitalization, and at hospital discharge. Results: The mean age of patients was 65.5 years. The frequency of dysphagic patients was 50.0%, 18.0%, and 12.0% at admission, after 72 h of hospitalization, and at discharge, respectively. Scores on the Frontal Battery Assessment and the Alberta Stroke Program Early CT Score were associated with dysphagia progression. Conclusion: Dysphagia is a common complication in the acute phase of stroke, and is associated with the extension of brain damage and cognitive impairment.
Assuntos
Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/psicologia , Isquemia Encefálica/complicações , Córtex Cerebral , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/psicologia , Transtornos de Deglutição/etiologia , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Dano Encefálico Crônico/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/psicologia , Disfunção Cognitiva/diagnóstico por imagem , Estudos Transversais , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/psicologia , Progressão da Doença , Feminino , Humanos , Masculino , Testes de Estado Mental e Demência , Pessoa de Meia-Idade , Fatores Socioeconômicos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/psicologia , Tomografia Computadorizada por Raios XRESUMO
Previous research has attributed to the right hemisphere (RH) a key role in eliciting false memories to visual emotional stimuli. These results have been explained in terms of two right-hemisphere properties: (i) that emotional stimuli are preferentially processed in the RH and (ii) that visual stimuli are represented more coarsely in the RH. According to this account, false emotional memories are preferentially produced in the RH because emotional stimuli are both more strongly and more diffusely activated during encoding, leaving a memory trace that can be erroneously reactivated by similar but unstudied emotional items at test. If this right-hemisphere hypothesis is correct, then RH damage should result in a reduction in false memories to emotional stimuli relative to left-hemisphere lesions. To investigate this possibility, groups of right-brain-damaged (RBD, N=15), left-brain-damaged (LBD, N=15) and healthy (HC, N=30) participants took part in a recognition memory experiment with emotional (negative and positive) and non-emotional pictures. False memories were operationalized as incorrect responses to unstudied pictures that were similar to studied ones. Both RBD and LBD participants showed similar reductions in false memories for negative pictures relative to controls. For positive pictures, however, false memories were reduced only in RBD patients. The results provide only partial support for the right-hemisphere hypothesis and suggest that inter-hemispheric cooperation models may be necessary to fully account for false emotional memories.
Assuntos
Dano Encefálico Crônico/psicologia , Emoções , Lateralidade Funcional , Reconhecimento Psicológico , Acidente Vascular Cerebral/psicologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
INTRODUCTION: Different contributions to the scientific literature made over the last few decades have confirmed the prefrontal cortex as the neurobiological basis of the executive functions. Today, both the evaluation protocols for carrying out diagnoses and the structuring of the treatment and neurocognitive stimulation plans must interpret each of the prefrontal syndromes (dorsolateral, medial or of the anterior cingulate, and orbitofrontal) involved in the aetiopathogenesis of the different neurodevelopmental and adult disorders in which the executive functions are affected. AIMS: To report on the latest advances in diagnosis and treatment of the executive functions and to stress the importance of identifying and understanding the three syndromes of prefrontal dysfunction in the phase of diagnosis and in neurocognitive rehabilitation. DEVELOPMENT: The authors carry out a review of the literature on the latest advances in neuroscience as regards the neurobiological and neuropsychological foundations of the executive functions and their diagnosis and treatment. CONCLUSIONS: Every day, the scientific community confirms the importance of identifying and understanding the brain circuits in the diagnostic stage, especially the prefrontal dysfunction syndromes involved in the neuropsychological deficits of the different neurodevelopmental and adult disorders, so as to be able to establish effective neurocognitive stimulation protocols.
TITLE: Trastornos de las funciones ejecutivas. Diagnostico y tratamiento.Introduccion. Los diferentes aportes de la literatura cientifica ratifican, desde hace un par de decadas, a la corteza prefrontal como base neurobiologica de las funciones ejecutivas. En la actualidad, tanto los protocolos de evaluacion para la realizacion del diagnostico como la estructuracion de los planes de tratamiento y estimulacion neurocognitiva deben hacer la lectura de cada uno de los sindromes prefrontales (dorsolateral, medial o del cingulo anterior, y orbitofrontal) implicados en la etiopatogenia de los diferentes trastornos del neurodesarrollo y del adulto en los que se ven afectadas las funciones ejecutivas. Objetivos. Exponer los ultimos avances sobre diagnostico y tratamiento de las funciones ejecutivas y resaltar la importancia de identificar y comprender en la fase diagnostica y en la rehabilitacion neurocognitiva los tres sindromes de disfuncion prefrontal. Desarrollo. Se realiza una revision bibliografica sobre los ultimos avances neurocientificos alrededor de las bases neurobiologicas, neuropsicologicas, diagnostico y tratamiento de las funciones ejecutivas. Conclusion. Cada dia la comunidad neurocientifica ratifica la importancia de identificar y comprender en la etapa diagnostica los circuitos cerebrales, especificamente los sindromes de disfuncion prefrontal implicados en los deficits neuropsicologicos de los diferentes trastornos del neurodesarrollo y del adulto para poder establecer protocolos eficaces de estimulacion neurocognitiva.
Assuntos
Transtornos Cognitivos/diagnóstico , Função Executiva , Adolescente , Adulto , Algoritmos , Terapia Comportamental , Dano Encefálico Crônico/complicações , Dano Encefálico Crônico/psicologia , Criança , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/etiologia , Transtornos do Comportamento Infantil/fisiopatologia , Pré-Escolar , Transtornos Cognitivos/classificação , Transtornos Cognitivos/psicologia , Transtornos Cognitivos/reabilitação , Transtornos Cognitivos/terapia , Função Executiva/fisiologia , Lobo Frontal/fisiopatologia , Giro do Cíngulo/fisiopatologia , Humanos , Lactente , Testes Neuropsicológicos , Córtex Pré-Frontal/fisiopatologia , Distúrbios da Fala/diagnóstico , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia , Adulto JovemRESUMO
INTRODUCTION: Aphasia tests validated according to the brain injury side are necessary, especially for Spanish instruments. OBJECTIVES: To study the concurrent validity of this Brief Aphasia Evaluation (BAE) to differentiate patients with left cerebral lesions (LC) from patients with right cerebral lesions (RC) as well as LC from healthy participants (HP). To study, through an unrestricted-sub-test-factor analysis, the BAE conceptual and content validity to generate a verbal homogeneous construct. MATERIALS AND METHODS: Data were obtained from a sample of 109 right-handed volunteers: 37 LC, 34 RC and 38 HP. The three groups were matched according to gender, age and education. RESULTS: Both groups of patients were similar in type and site of lesion, time since onset of condition, risk factors, presence of hemianopsia and hemiparesis and number of hospital visits. The Cronbach's alpha coefficient indicated an internal consistency of 0.99 for the total score and 0.88 or above for any of the sub-tests. All sub-tests (with loadings of 0.65 or above) grouped in one factor which explained 78% of the variance. The BAE showed a sensitivity and specificity of 0.84 or above to identify the LC (median as cut-off point). CONCLUSIONS: This test of free distribution demonstrated a satisfactory validity.
Assuntos
Dano Encefálico Crônico/diagnóstico , Dominância Cerebral/fisiologia , Lateralidade Funcional/fisiologia , Aprendizagem Verbal/fisiologia , Adulto , Análise de Variância , Dano Encefálico Crônico/patologia , Dano Encefálico Crônico/fisiopatologia , Dano Encefálico Crônico/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , EspanhaRESUMO
OBJECTIVE: To identify the main determinants of health-related quality of life (HRQoL) in Brazilian stroke survivors. METHODS: Patients were assessed with the NIH Stroke Scale, Barthel index (BI), Lawton scale, modified-Rankin scale, Cumulative Illness Rating Scale for Geriatrics, Mini-Mental State Examination, Hospital Anxiety and Depression Scale, and Stroke Impact Scale (SIS) 3.0. RESULTS: 260 stroke survivors were assessed (mean age: 55.9 years; 55.2% males). Eighty-eight per cent of patients had an ischemic infarction. Approximately one third (31.5%) had a BI score < or = 60 (severe disability), and 34.5% were independent in the activities of daily living. Prevalence of post-stroke depression was significantly higher in females than in males (25% vs 15.4%; p=0.05). Post-stroke depression was associated with female sex, disability, and lower cognitive functioning (p<0.001). SIS Physical Composite Domain mean score was 46.6. Hand Function (26.5), Strength (47.6), Mobility (50.1), Social participation (50.6), and Emotion (52.2) were the most affected domains. HRQoL of stroke survivors decreased in a significant way as motor impairment severity, disability, functional status and mood worsened (ANOVA, p<0.0001). Motor impairment, disability, and mood disturbances were independent predictors of HRQoL in the multivariate regression analysis. CONCLUSIONS: Post-stroke depression and disability are consistent determinants of HRQoL in Brazilian stroke patients.
Assuntos
Pessoas com Deficiência/psicologia , Qualidade de Vida , Acidente Vascular Cerebral/psicologia , Sobreviventes/psicologia , Adulto , Idoso , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/psicologia , Brasil , Transtornos Cognitivos/epidemiologia , Transtornos Cognitivos/etiologia , Comorbidade , Depressão/epidemiologia , Depressão/etiologia , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos do Humor/epidemiologia , Transtornos do Humor/etiologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/epidemiologia , Sobreviventes/estatística & dados numéricosRESUMO
The purpose of this study was: (a) to assess and to compare anxiety and depression symptoms in mothers of preterm neonates during hospitalization in the Neonatal Intensive Care Unit, after discharge, and at the end of the infants' first year of life; and (b) to assess the child's development at 12 months of chronological corrected age (CCA). Thirty-six mothers, with no psychiatric antecedents assessed with the SCID-NP, were evaluated by STAI and BDI. The infants were assessed with Bayley-II Scales. There was a significant decrease in clinical symptoms of state-anxiety in mothers (p = .008), comparing the period during hospitalization and after discharge of the infants. Clinical symptoms of anxiety and depression were observed in 20% of the mothers at the end of the infants' first year of age. The majority of the infants exhibited normal development on Bayley-II at 12 months CCA; however, 25% of the infants displayed cognitive problems and 40% motor problems. The mothers' anxiety and depression symptoms decreased at the end of the first year of life of the pre-term infants and the children showed predominately normal development at this phase.
Assuntos
Ansiedade/psicologia , Depressão Pós-Parto/psicologia , Deficiências do Desenvolvimento/psicologia , Doenças do Prematuro/psicologia , Mães/psicologia , Adolescente , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/epidemiologia , Dano Encefálico Crônico/psicologia , Estudos Transversais , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/epidemiologia , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Alta do Paciente , Inventário de Personalidade , Fatores SocioeconômicosRESUMO
OBJECTIVE: Although the classic features of fetal alcohol syndrome have been recognized since 1968, research on alcohol teratogenesis has only recently demonstrated that the brain is the organ in the body most vulnerable to the effects of prenatal alcohol exposure. In this present article, we reviewed the literature focusing mainly on behavioral disturbances related to prenatal ethanol exposure. SOURCES: We performed a PubMed search on the literature published between 1968 and 2006 using the terms ethanol, pregnancy and behavior. We limited our search to studies on humans. SUMMARY OF THE FINDINGS: The data presented in this review suggested that youths with fetal alcohol spectrum disorder are at risk of disruptive social behavior, among other neurobehavioral abnormalities. CONCLUSIONS: Although it is still impossible to completely separate brain teratogenesis secondary to alcohol exposure from environmental postnatal influences as the definite cause for these outcomes, the pediatrician should be encouraged to early diagnose children affected by fetal alcohol syndrome and fetal alcohol spectrum disorder. This provides proper management and care and avoids long-term consequences on their behavior, besides ensuring better and productive school and social adaptation.
Assuntos
Comportamento/efeitos dos fármacos , Dano Encefálico Crônico/diagnóstico , Etanol/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/psicologia , Anormalidades Induzidas por Medicamentos/psicologia , Dano Encefálico Crônico/psicologia , Pré-Escolar , Diagnóstico Precoce , Feminino , Humanos , Pediatria , Papel do Médico , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco , Comportamento Sexual/psicologiaRESUMO
OBJETIVO: Ainda que as características clássicas da síndrome fetal alcoólica tenham sido descritas desde 1968, a pesquisa sobre a teratogênese do álcool apenas recentemente demonstrou que o cérebro é o órgão do corpo mais vulnerável aos efeitos da exposição pré-natal ao álcool. No presente artigo, fazemos uma revisão da literatura focalizando principalmente os distúrbios comportamentais relacionados à exposição pré-natal ao álcool. FONTES DOS DADOS: Foi realizada uma pesquisa com base no PubMed sobre a literatura publicada entre 1968 e 2006, com as palavras-chave etanol, gestação e comportamento. Foram estabelecidos limites a estudos em humanos. SÍNTESE DOS DADOS: Os dados apresentados nesta revisão sugerem que jovens com efeitos do espectro do álcool fetal estão sob risco maior de terem comportamento social disruptivo, entre outros problemas neurocomportamentais. CONCLUSÕES: Ainda que seja impossível separar completamente a teratogênese sobre o cérebro decorrente da exposição ao álcool de influências ambientais pós-natais como a causa definitiva desses resultados, o pediatra deve ser estimulado ao diagnóstico precoce de crianças afetadas pela síndrome fetal alcoólica e efeitos do espectro do álcool fetal. Isso permite iniciar o manejo e cuidados apropriados para evitar as conseqüências em longo prazo no comportamento e assegurar uma adaptação social e escolar melhor e mais produtiva.
OBJECTIVE: Although the classic features of fetal alcohol syndrome have been recognized since 1968, research on alcohol teratogenesis has only recently demonstrated that the brain is the organ in the body most vulnerable to the effects of prenatal alcohol exposure. In this present article, we reviewed the literature focusing mainly on behavioral disturbances related to prenatal ethanol exposure. SOURCES: We performed a PubMed search on the literature published between 1968 and 2006 using the terms ethanol, pregnancy and behavior. We limited our search to studies on humans. SUMMARY OF THE FINDINGS: The data presented in this review suggested that youths with fetal alcohol spectrum disorder are at risk of disruptive social behavior, among other neurobehavioral abnormalities. CONCLUSIONS: Although it is still impossible to completely separate brain teratogenesis secondary to alcohol exposure from environmental postnatal influences as the definite cause for these outcomes, the pediatrician should be encouraged to early diagnose children affected by fetal alcohol syndrome and fetal alcohol spectrum disorder. This provides proper management and care and avoids long-term consequences on their behavior, besides ensuring better and productive school and social adaptation.
Assuntos
Pré-Escolar , Feminino , Humanos , Gravidez , Comportamento/efeitos dos fármacos , Dano Encefálico Crônico/diagnóstico , Etanol/efeitos adversos , Transtornos do Espectro Alcoólico Fetal/psicologia , Anormalidades Induzidas por Medicamentos/psicologia , Dano Encefálico Crônico/psicologia , Diagnóstico Precoce , Pediatria , Papel do Médico , Efeitos Tardios da Exposição Pré-Natal , Fatores de Risco , Comportamento Sexual/psicologiaRESUMO
The investigation of the neural and cognitive mechanisms underlying the moral mind is of paramount importance for understanding complex human behaviors, from altruism to antisocial acts. A new study on patients with prefrontal damage provides key insights on the neurobiology of moral judgment and raises new questions on the mechanisms by which reason and emotion contribute to moral cognition.
Assuntos
Emoções/fisiologia , Teoria Ética , Julgamento/fisiologia , Princípios Morais , Córtex Pré-Frontal/fisiopatologia , Dano Encefálico Crônico/fisiopatologia , Dano Encefálico Crônico/psicologia , Mapeamento Encefálico , Comportamento de Escolha/fisiologia , Dominância Cerebral/fisiologia , Lobo Frontal/fisiopatologia , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância MagnéticaRESUMO
INTRODUCTION: Psychometric studies with this confrontation- naming test have not been reported in Spanish speakers. OBJECTIVES: To study the internal consistency (N = 304), test-retest (N = 33) and inter-scorer (N = 37) reliability on healthy subjects. To study the concurrent validity (preliminary data) in 46 patients with unilateral brain lesions (left: 18, right: 28) including healthy subjects (N = 101), and in 28 patients referred for suspected dementia. MATERIAL: the test was based initially on the nouns used by Oldfield and Wingfield in English. Data were obtained from consecutive patients and healthy volunteers. Lateral lesions were confirmed by neuroimages and surgery. The three groups of the validity study with lateral lesions were matched by gender, age, education and manual preference. Both groups of the dementia validity study were matched by gender, age, education and presence of vascular lesion. Patients who scored < 24 points in the mini- mental test and>9 points in the Blessed behavioral rating scale were operationally defined as patients with dementia (N=15). STATISTICAL ANALYSIS: For reliability studies: Cronbach's alpha, Pearson and intraclass correlation coefficients were used. Differences between scorers and between tests were analyzed by dependent sample Student's t tests. For the validity study with lateral lesions, ANOVA was employed. For the dementia validity study: independent sample Student's t test was used. RESULTS: All reliability coefficients were > 0.82 without differences in the t tests between scorers and tests. Validity was verified by the significant differences obtained between all the pairs of groups analyzed. DISCUSSION: The test demonstrated a suitable validity and reliability.
Assuntos
Dano Encefálico Crônico/psicologia , Demência/psicologia , Testes de Linguagem , Complicações Pós-Operatórias/psicologia , Adulto , Idoso , Encéfalo/cirurgia , Dano Encefálico Crônico/diagnóstico , Demência/diagnóstico , Diagnóstico Diferencial , Dominância Cerebral , Feminino , Lateralidade Funcional , Humanos , Idioma , Masculino , Transtornos da Memória/diagnóstico , Transtornos da Memória/etiologia , Transtornos da Memória/psicologia , Pessoa de Meia-Idade , Nomes , Testes Neuropsicológicos , Complicações Pós-Operatórias/diagnóstico , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Espanha/epidemiologia , Aprendizagem VerbalRESUMO
INTRODUCTION: A significant number of patients who have had cerebrovascular illness apparently recover their former abilities completely but return to normal life with subtle cognitive deficits which may affect their daily lives. Such is the situation of patients with transitory ischemic accidents who present with sustained, undiagnosed attention deficits. OBJECTIVES: To identify subclinical alterations due to attention deficits in patients with transitory ischemic accidents, and to contribute to the study of the physiopathological mechanisms involved in the integration of this function. PATIENTS AND METHODS: We examined 44 persons, divided into three groups for this study: one group had vertebro-basilar transitory ischemic accidents, a second group had supratentorial infarct and a third was healthy. All were given a specially designed computerized test of continuous work to evaluate the sustained attention component. RESULTS: Significant differences were found between the transitory ischemic accidents and healthy groups, regarding the variables including correct answers, omissions and indications of attention. This was not seen with the variables involving reaction time and number of errors. This demonstrated the existence of attention disorders involving omission in the group of patients with transitory ischemic accidents. CONCLUSION: These findings suggest the hypothesis that in the vertebro-basilar region there are important mechanisms involved in the process of sustained attention.
Assuntos
Atenção , Ataque Isquêmico Transitório/psicologia , Insuficiência Vertebrobasilar/psicologia , Doença Aguda , Idoso , Atenção/fisiologia , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/psicologia , Tronco Encefálico/fisiopatologia , Infarto Cerebral/complicações , Infarto Cerebral/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Ninety-two brain-damaged patients and 111 normal control subjects were tested on their orientation to date; sequencing of events; discrimination of simultaneity and succession; conditioning to time; comparison, production and reproduction of durations; conservation of velocity in clocks; construction of time units; and psychological time. Temporal disorientation was related to advanced age, low educational level, amnesia, dementia and limbic or diffuse brain lesions. Only multifocal-diffuse lesions accompanied by dementia could disintegrate the concept of metric time, while sparing psychological time, discrimination of durations and sequencing of canonically recurring events. Reproduction of durations and verbally mediated temporal conditioning were impaired in frontal and temporal-limbic lesions, which left intact the concept of time. The results support the hypothesis that temporal perception is accomplished by a complex functional system, regarding both its psychological structure and cerebral organization.
Assuntos
Dano Encefálico Crônico/psicologia , Encéfalo/fisiopatologia , Transtornos Cognitivos/psicologia , Testes Neuropsicológicos , Percepção do Tempo/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amnésia , Afasia , Apraxias , Encéfalo/diagnóstico por imagem , Dano Encefálico Crônico/etiologia , Dano Encefálico Crônico/fisiopatologia , Transtornos Cognitivos/classificação , Transtornos Cognitivos/etiologia , Discriminação Psicológica , Educação , Eletroencefalografia , Feminino , Humanos , Masculino , Matemática , Pessoa de Meia-Idade , Valores de Referência , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
The aim of this study is to quantify the intelligence output in our pediatric population on continuous ambulatory peritoneal dialysis (CAPD) treatment. A total of 30 children were studied, with an age range of eight to 18 years. For evaluating a global intelligence quotient (IQ), the Wechsler test was applied according to their age. And, as a complement, a Bender test was also requested to deny or confirm brain damage. The Wechsler test showed an average intelligence quotient in most of the children (76.7%); a small group (16.7%) was classified as dull normal, 1 child had mild retardation, and 1 was borderline. All of them had a Bender test that did not correlate with brain damage. Most of them maintained a very high verbal IQ, but, when the performance IQ was qualified, 34% got a low score, and a certain difficulty in solving this part of the test was observed. Maybe this was influenced by chronicity of the sickness and/or the blood urea nitrogen level. In conclusion, the child's plasticity is his best quality to cope with uremia and the alterations caused by it. Therefore the idea is to consider the intelligence quotient as the capacity that the subjects have to use their own resources to cope with their environment. And, even though the neurological alterations exist, the child's plasticity helps him/her maintain a good global intelligence quotient, even though he/she is not having immediate transplantation.
Assuntos
Dano Encefálico Crônico/psicologia , Inteligência , Falência Renal Crônica/psicologia , Diálise Peritoneal Ambulatorial Contínua/psicologia , Adolescente , Teste de Bender-Gestalt , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/etiologia , Criança , Feminino , Humanos , Deficiência Intelectual/diagnóstico , Deficiência Intelectual/etiologia , Deficiência Intelectual/psicologia , Falência Renal Crônica/etiologia , Falência Renal Crônica/terapia , Masculino , Valores de Referência , Fatores de Risco , Escalas de WechslerRESUMO
The present study was aimed at using both semiotic and symbolic spaces as an exploratory method of the simultaneous synthesis, and interhemispherical transfers among hemiplegic patients. Thirty-six hemiplegic patients with an established neurological deficit were selected, then split into two groups: 19 patients with their dominant hemispheres affected, 17 patients with their subordinate hemispheres affected. The following types of patients have been excluded from this study: Patients with cerebral degenerative and/or progressive alterations, patients with sensory aphasias, and damage to the counterlateral side opposite the hemiplegic side. Age range was 67.2 (with 45-year-old as a minimum, and 70-year-old as a maximum). Subjects were 11 females and 25 males. Both the semiotic, and the symbolic spaces have been explored as well as the existence of a parietal, sensitive syndrome, and damage topography by means of a scanner device. A major damage of the symbolic space in patients with their dominant hemispheres affected was observed. Conversely, semiotic space, in its figurative trait, was most affected in patients with their subordinate hemispheres affected.
Assuntos
Dano Encefálico Crônico/fisiopatologia , Hemiplegia/fisiopatologia , Percepção Espacial/fisiologia , Idoso , Automatismo , Dano Encefálico Crônico/psicologia , Dominância Cerebral , Feminino , Hemiplegia/psicologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Apathy and depression are discriminable but related dimensions of behavior. The purpose of this study was to evaluate the source of the overlap between measures of apathy and depression. We evaluated the intercorrelations between the Apathy Evaluation Scale (AES) and the Hamilton Rating Scale for Depression (HamD) in 107 subjects, aged 53-85, who met research criteria for normal aging, left or right cerebral hemisphere stroke, probable Alzheimer's disease, or major depression. We determined the correlation between the individual items on the HamD and the total scores on the AES and the HamD. The HamD items having the strongest correlations with AES total score were diminished work/interest, psychomotor retardation, anergy, and lack of insight. The correlation between AES and HamD total scores was nonsignificant when major depression subjects and these variables most closely related to apathy were excluded from consideration. These findings indicate that the convergence between HamD and AES is attributable to (i) a subset of HamD items which are consistent with the syndrome of apathy and (ii) the fact that major depression is associated with both apathy and depression. Clinical and research applications of these results are discussed.
Assuntos
Nível de Alerta , Transtorno Depressivo/diagnóstico , Motivação , Atividades Cotidianas/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Dano Encefálico Crônico/diagnóstico , Dano Encefálico Crônico/psicologia , Infarto Cerebral/complicações , Infarto Cerebral/psicologia , Transtorno Depressivo/psicologia , Dominância Cerebral/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade/estatística & dados numéricos , PsicometriaRESUMO
To evaluate the possibility of an underlying dimension of organicity in borderline personality disorder (BPD), a carefully diagnosed group of borderline patients was assessed across a wide range of neuropsychological functions and then was compared to an age- and education-matched non-patient control group. The BPD group had significantly lower Verbal, Performance, and Full Scale IQ scores on the WAIS-R. The BPD group also was impaired significantly on motor skills, figural memory, complex visuomotor integration, social or interpersonal intelligence, and on a measure of susceptibility to interference. This pattern of deficits localized to the fronto-temporal regions and became more pronounced when a subgroup analysis was performed. This study suggests that subtle organic factors may be operative in some, but not all, BPD patients.
Assuntos
Transtorno da Personalidade Borderline/diagnóstico , Dano Encefálico Crônico/diagnóstico , Testes Neuropsicológicos/estatística & dados numéricos , Adulto , Transtorno da Personalidade Borderline/psicologia , Dano Encefálico Crônico/psicologia , Feminino , Humanos , Inteligência , Bateria Neuropsicológica de Luria-Nebraska/estatística & dados numéricos , MMPI/estatística & dados numéricos , Psicometria , Fatores de Risco , Escalas de Wechsler/estatística & dados numéricosRESUMO
A young adult with no prior history of affective disease suffered the onset of a rapid cycling bipolar illness, marginally responsive to psychotropic medications, following a mild closed-head injury, and persisting after the cognitive effects of the injury had resolved. A concurrence of findings on the neurological examination, neurobehavioural examination, SPECT scan, EEG and neuropsychological test battery suggested the presence of a diffuse cerebral injury with a predominance of left frontotemporal findings. This case demonstrates that a severe and disabling mood disorder may follow a mild head injury, and that its course may be independent of cognitive impairment and recovery.
Assuntos
Transtorno Bipolar/fisiopatologia , Dano Encefálico Crônico/fisiopatologia , Traumatismos Cranianos Fechados/fisiopatologia , Transtornos Neurocognitivos/fisiopatologia , Periodicidade , Adulto , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/psicologia , Dano Encefálico Crônico/tratamento farmacológico , Dano Encefálico Crônico/psicologia , Carbamazepina/uso terapêutico , Dominância Cerebral/fisiologia , Quimioterapia Combinada , Lobo Frontal/lesões , Lobo Frontal/fisiopatologia , Haloperidol/uso terapêutico , Traumatismos Cranianos Fechados/tratamento farmacológico , Traumatismos Cranianos Fechados/psicologia , Humanos , Imipramina/uso terapêutico , Carbonato de Lítio/uso terapêutico , Masculino , Transtornos Neurocognitivos/tratamento farmacológico , Transtornos Neurocognitivos/psicologia , Testes Neuropsicológicos , Lobo Temporal/lesões , Lobo Temporal/fisiopatologiaRESUMO
The brainstem-cerebellar circuitry has been implicated in the pathophysiology of autism for several decades. Recent magnetic resonance imaging (MRI) studies of the posterior fossa have reported various abnormalities, the most noteworthy of which has been selective hypoplasia of the neocerebellar vermis. However, these initial MRI studies are limited by problems in both subject and control selection. The present study was undertaken to further investigate these MRI findings and the role of the cerebellum in autism, taking into consideration these methodologic issues. Eighteen high-functioning autistic subjects were recruited and matched with 18 normal controls on the basis of age, gender, IQ, race and socioeconomic status (SES). The midsagittal areas of the cerebellar vermis, vermal lobes, and the fourth ventricle were measured on 3 mm contiguous magnetic resonance images. Mean areas and standard deviations were comparable for all regions of interest and no statistically significant between-group differences were found. These negative findings argue against theories of autism based on gross structural abnormalities of the cerebellum. Previous reports of posterior fossa abnormalities may be related to technical and methodological factors, based on comparison of extant literature and recently available normative data.
Assuntos
Transtorno Autístico/diagnóstico , Dano Encefálico Crônico/diagnóstico , Tronco Encefálico/anormalidades , Cerebelo/anormalidades , Imageamento por Ressonância Magnética , Adolescente , Adulto , Transtorno Autístico/psicologia , Dano Encefálico Crônico/psicologia , Tronco Encefálico/patologia , Cerebelo/patologia , Ventrículos Cerebrais/patologia , Criança , Fossa Craniana Posterior , Feminino , Humanos , Masculino , Valores de ReferênciaRESUMO
The authors describe 20 neuropsychiatric inpatients consecutively evaluated in the context of routine clinical care. Patients had both a neurological and psychiatric disorder. Each was clinically evaluated as part of a psychiatric hospitalization. DSM-III-R diagnoses, electroencephalograms, magnetic resonance imaging (MRI) or computed tomography (CT) scans of the brain, single photon emission computed tomography (SPECT) scans of the brain, and cognitive testing are reported. In only three cases were SPECT, MRI (or CT), and electroencephalogram all normal. SPECT abnormalities were associated with behavioral and cognitive presentations and with the hypothesized anatomical areas of dysfunction in 16 cases. In six cases SPECT and MRI were equivalent, involving structural lesions or normal scans. In only one case did MRI (or CT) detect deficits not revealed by SPECT, which were nonspecific white matter lesions and atrophy. The authors conclude that SPECT scans may be superior to structural brain scans in detecting clinically relevant deficits in neuropsychiatric patients, particularly when physiological lesions are involved.
Assuntos
Dano Encefálico Crônico/diagnóstico por imagem , Encéfalo/irrigação sanguínea , Transtornos Neurocognitivos/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Dano Encefálico Crônico/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Neurocognitivos/psicologia , Testes Neuropsicológicos , Fluxo Sanguíneo Regional/fisiologiaRESUMO
The behaviour of 18 children with severe malnutrition between the ages of six and 24 months was observed. They were compared with 21 age-matched adequately nourished children in hospital with other diseases, and were given regular developmental assessments with the Griffiths test. On admission to hospital the malnourished children were less active and more apathetic than the controls when alone in their cots, while the controls were more distressed. When given toys, initially the malnourished children explored them less, using fewer play actions and touching fewer toys. These differences were not present on recovery. Initial behaviour did not predict later developmental levels.