Evaluación neuropsicológica en 129 pacientes chilenos con esclerosis múltiple recurrente remitente previo a inicio de fármacos inmunomoduladores / Neuropsychological assessment of patients with relapsing remitting multiple sclerosis prior to the use of immunomodulatory drugs

Background: The detection of cognitive changes (CC) and psychiatric disorders in relapsing remitting multiple sclerosis (MS-RR) contributes to patient clinical monitoring. Aim: To assess the frequency and characteristics of CC and psychiatric disorders in Chilean patients with MS-RR, before starting immunomodulatory treatment. Patients and Methods: Retrospective review of data that was obtained following a standard assessment protocol. It consisted in the application of the Expanded Disability Status Scale of Kurtzke (EDSS), Multiple Sclerosis Functional Composite (MSFC), fatigue intensity scale of Krupp, brief repeatable battery of neuropsychological Rao (BRN-R) and Hamilton's depression and anxiety questionnaires. Results: We evaluated 129 patients aged between 12 and 60 years of age (69% women). Ninetyfour percent of patients had eight or more years of schooling. The average EDSS score was 2.83. CC were detected in 62% of participants, in at least one subtest of the BRN-R. The main changes were verbal memory and speed in the processing information. The frequency of cognitive impairment (CI), defined as at least two BRN-R subtests altered, was 36%. The figures decreased to 17% when significant major depression or associated fatigue were excluded. Depressive symptoms were observed in 58% and anxiety in 76.7%. Conclusions: The results are consistent with those described in the literature. The type of instruments used in the investigation of CC and the definition of CI in MS should be standardized.

Valoración del impacto funcional producido en participantes de taller laboral protegido / Functional impact assessment of participation in los Coihues sheltered workshop

El objetivo principal del estudio es demostrar que el área de desempeño del trabajo tiene una influencia determinante en el quehacer funcional de las personas. Por otra parte es importante poder evaluar y objetivar los logros de los programas de acción dirigidos hacia personas discapacitadas. Para ello se propone el siguiente instrumento de evaluación: la Pauta de Independencia Funcional (PIF) Este instrumento fue aplicado a una población de 14 pacientes que han sufrido un accidente de trabajo y/o trayecto y cuya condición actual es de institucionalización, De estos el 80 por ciento secuelados de TEC y 20 por ciento lesionados medulares que asisten al Taller Laboral Protegido durante un período de 2 años, rango de edad entre 29 y 74 años (promedio 56 años y tiempo de institucionalización de 8 años promedio). La evaluación PIF consideró 5 áreas en su desempeño y habilidades: motora, social, cognitiva, actividades de la vida diaria y laboral. En todas ellas se observaron logros, principalmente en el área social y laboral, siendo facilitadas también las otras áreas. Los pacientes muestran altos niveles de satisfacción personal y beneficios directos en relaciones interpersonales, ánimo. Es importante destacar el sentido de pertenencia al grupo, mayor identidad en roles sociales y un discreto cambio en la expresión verbal y no verbal que manifiesta indicadores volicionales inherentes al ser humano como persona, estos factores se reflejan en la pauta PIF.

The main goal of this study is to demonstrate that maintaining an active work life has a determining impact on people’s functional tasks. We also considered important to objectively assess the benefits of programs developed for disabled adults. We propose the use of the Functional Independence Assessment (FIA) to fulfil these goals. This instrument was administered to 14 inpatients, 80 percent of which had suffered disabling traumatic brain injury, and 20 percent with spinal cord injury, all of whom have had attended the sheltered workshop of Clínica Los Coihues during a two year period. Their ages ranged between 29 and 74 years old, with an average of 56 years, and their average time of hospitalisation was of 8 years. The FIA considers five performance areas and abilities: motor, social, cognitive, activities of daily living, and work. We observed achievements in all of these areas, specially in the social and work aspects, although all areas were facilitated. Patients demonstrated high levels of personal satisfaction as well as direct benefits in their interpersonal relationships and mood. It is important to emphasize a sense of belonging to a group, a greater identity in social roles, and an increase in significant verbal and non verbal expression, which represent volitional indicators that are inherent to the human being as a person. These factors are demonstrated in the FIA.