Screening for neurocognitive deficits in adult populations reliant on toxic cassava as the main source of food

Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was 949.5+518.3 mol/l after adjusting Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed, and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was . for age, gender, nutritional status, and history of konzo, neurocognition domain-specific deficits were independently associated with either hypertension or USCN (350mol / l incremental increase in excretion Functional impairments in daily-life activities increased as subjects poorly performed at the CSID screening (Spearman r = - .2, p < 0.01). Conclusion. Neurocognitive deficits in adults are common in Congolese adults relying on cyanogenic cassava as the main source of food. Our study findings warrant further studies to elucidate the overall lifespan brain/behavioral burden and mechanisms of cassava toxicity among adults with dietary dependency on cyanogenic cassava as the main source of food

Alteraciones cognitivas en pacientes operados de aneurismas cerebrales en el Hospital de Clínicas

RESUMEN Introducción: la hemorragia subaracnoidea por sí misma puede dar lugar a un daño cerebral, por esto, en pacientes sin complicaciones los trastornos cognitivos pueden estar presentes. Objetivos: analizar las alteraciones neuropsicológicos en los pacientes operados de aneurismas cerebrales y los factores que se asocian a su desarrollo. Metodología: estudio analítico, observacional, ambispectivo, 2013-2020, que incluyó pacientes operados de aneurismas cerebrales rotos en el Hospital de Clínicas. La evaluación cognitiva se realizó con el mini examen cognitivo de Lobo. Se consideró alterado cuando la puntuación fue menor a 27. Se analizaron 12 variables asociando las mismas con el tema de estudio. Los datos fueron analizados con Epiinfo 7.2. Resultados: La edad mayor a 60 años se asoció al déficit cognitivo de forma significativa, así como también la lateralidad a izquierda, el uso de clipado temporario durante la cirugía, la ruptura del aneurisma en el intraoperatorio, el vasoespasmo y la hidrocefalia. No se asoció significativamente con el desarrollo de un trastorno cognitivo; el sexo, el nivel de escolaridad, la cantidad de sangre cisternal, la localización del aneurisma, el Glasgow de ingreso ni la fase en la cual se realzó la cirugía. Discusión: en general los hallazgos coinciden con la literatura. Llamó la atención que la escala de Fisher en la muestra estudiada no demostró tener una asociación significativa con el trastorno cognitivo, sin embargo, hay datos en la literatura que sostienen que la cantidad de sangre cisternal al ingreso es un fuerte predictor del estado cognitivo del paciente al alta.

ABSTRACT Introduction: subarachnoid hemorrhage itself can lead to brain damage, so in uncomplicated patient's cognitive disorders may be present. Objective: To analyze the cognitive impairments in patients following clipping of ruptured aneurysms and the factors that are associated with their development. Methodology: analytical, observational, ambispective study, 2013-2020, including patients operated for ruptured aneurysms at the Hospital de Clínicas. The cognitive evaluation was performed with the Lobo mini cognitive exam. It was considered altered when the score was less than 27. Twelve variables were analyzed associating them with the study topic. The data was analyzed with Epiinfo 7.2. Results: Age over 60 years was significantly associated with cognitive deficit, as well as left laterality, the use of temporary clipping during surgery, intraoperative aneurysm rupture, vasospasm, and hydrocephalus. It was not significantly associated with the development of a cognitive disorder; sex, level of education, amount of cisternal blood, location of the aneurysm, admission Glasgow, and the timing in which the surgery was performed. Discussion: In general, the findings coincide with the literature. It was noteworthy that the Fisher scale in the studied sample did not show to have a significant association with cognitive disorder, however, there are data in the literature that maintain that the amount of cisternal blood on admission is a strong predictor of the patient's cognitive state at discharge.

Schisantherin B Improves the Pathological Manifestations of Mice Caused by Behavior Desperation in Different Ages-Depression with Cognitive Impairment

Depression is a major mood disorder. Abnormal expression of glial glutamate transporter-1 (GLT-1) is associated with depression. Schisantherin B (STB) is one bioactive of lignans isolated from Schisandra chinensis (Turcz.) Baill which has been commonly used as a traditional herbal medicine for thousands of years. This paper was designed to investigate the effects of STB on depressive mice induced by forced swimming test (FST). Additionally, we also assessed the impairment of FST on cognitive function in mice with different ages. FST and open field test (OFT) were used for assessing depressive symptoms, and Y-maze was used for evaluating cognition processes. Our study showed that STB acting as an antidepressant, which increased GLT-1 levels by promoting PI3K/AKT/mTOR pathway. Although the damage is reversible, short-term learning and memory impairment caused by FST test is more serious in the aged mice, and STB also exerts cognition improvement ability in the meanwhile. Our findings suggested that STB might be a promising therapeutic agent of depression by regulating the GLT-1 restoration as well as activating PI3K/AKT/mTOR pathway.

Comparative study of neurocognitive deficits in bipolar disorder and schizophrenia

Background: The central features of schizophrenia are cognitive impairments and are related to functional status and other aspects of the illness. Aim: The aim of the study was to compare the neurocognitive deficits in patients with bipolar disorder and schizophrenia. Materials and methods: 50 Schizophrenia patients and 50 Bipolar Disorder patients who were diagnosed as per ICD-10 attending the OPD of Santhiram Medical College and General Hospital, Nandyal were included in the study. Results: The current study measured phonemic fluency using controlled oral word association test, category fluency using animal names test and working memory using N-Back tests (verbal and visual) and the patients with BPAD performed better than schizophrenia patients. The pattern of similarity varied between the two groups in that more number of BPAD patients were able to tell words in the higher ranges and more number of schizophrenia patients were able to tell words in the lower ranges. On N-Back tests the patients with schizophrenia consistently performed poorer than bipolar disorder patients in the higher ranges of performance as shown by the results of both verbal and visual 1-back and 2-back tests hits and errors where the patients with bipolar disorder produced more hits and less errors than the patients with schizophrenia. The mean values showed that patients D. Ravi Kiran, N. Kavitha Prassana, A. Sreelakshmi Latha, C. Gowtham Reddy. Comparative study of neurocognitive deficits in bipolar disorder and schizophrenia. IAIM, 2019; 6(3): 291-299. Page 292 with bipolar disorder produced more hits and less errors than the patients with schizophrenia. On the domain of executive functions, BPAD patients were performing better than schizophrenia patients on all tests with statistically significant differences on N-back tests and statistically no significant differences on Controlled oral word association and Animal names tests. Conclusion: The pattern of non-significant differences between the two disorders followed a trend, which suggests that patients with BPAD were performing better than those with schizophrenia.

A Study of Factors Influencing Subjective Memory Complaints among Community Dwelling Elderly

OBJECTIVE: We examined the factors influencing subjective memory complaints among community dwelling elderly in urban area. METHODS: The subjects of this research were 160 community-dwelling elderly people without dementia and major depressive disorder. The questionnaires regarding the socio-demographic characteristics were conducted by each person. They include Korean version of Subjective Memory Complaints Questionnaires (SMCQ), Korean version of Short Geriatric Depression Scale (SGDS-K) and Korean version of Mini-Mental State Examination (K-MMSE). Subjective memory complaints were defined as above 4 points of SMCQ. RESULTS: 39.38% of the subjects had subjective memory complaints. There were significant associations between subjective memory complaints and SGDS-K (p < 0.001), physical illness (p=0.001), but there was no association with K-MMSE (p=0.383). CONCLUSION: There is a discrepancy between subjective memory complaints and actual cognitive impairments. This discrepancy suggests that the depressive disorders including minor depressive disorder and subsyndromal depression, might play a role in the subjective memory complaints rather than actual cognitive impairments in community-dwelling elderly people. Therefore, the treatments for the depressive disorders should be considered in dealing with the subjective memory complaints.

Clinical analysis of prognosis at 18 months after attack in patients with mild ischemic stroke / 中华老年医学杂志

Objective To investigate activities of daily living,depression,anxiety,fatigue and cognitive impairments at 18 months after attack in patients with mild ischemic stroke.Methods In this cross-sectional study,86 patients with acute ischemic stroke were hospitalized in the Neurology Department of Shanghai Ruijin Hospital from January 2013 to April 2013.Among them,58 cases who were eventually interviewed and selected,were divided into mild stroke group[NIHSS ≤3,n=37]and medium-severe stroke group[NIHSS＞3,n=21]according to the admission score of the National Institutes of Health Stroke Scale (NIHSS).Follow-up was done at 1.5 years after stroke to assess NIHSS,modified Rankin scale(mRS),Stroke Impact Scale(SIS),Hamilton depression scale(HAMD),Hamilton Anxiety Scale(HAMA),Modified Fatigue Impact Scale(MFIS)and Montreal Cognitive Assessment(MoCA).Meanwhile,35 patients with high risk of ischemic cerebrovascular disease were evaluated by HAMD,HAMA,MFIS and MoCA.Results Patients in the mild stroke group showed significantly better prognoses identified by the assessed scores of NIHSS[median(M) =0,interquartile range(IQR) =0,z =-3.879],mRS[M=1,IQR =1,z =-2.381],SIS-total score[697.36 ± 85.66,t =2.351] and SIS-Stroke recovery score (84.15 ± 11.94,t-3.696),as well as the SIS partial items,including strength (79.49 ± 15.88,t =2.099),instrumental activities of daily living[M=97.5,IQR=10,z=-2.858],locomotivity[M=97.2,IQR=0,z=3.083],hand function[M 100,IQR=20,z=-2.259]and social participation[M=90.6,IQR=28,z=2.582],at 1.5 year follow-up.These parameters were markedly different from those in the medium-severe group(all P＜0.05).Additionally,the high-risk group for cerebrovascular disorder showed no case with depression,anxiety and fatigue,but showed 10 cases(28.6 ％) with cognitive impairments.Furthermore,the mild stroke group versus the medium-severe stroke group showed a similar incidences of depression (16.2 ％ vs.38.1％,P =0.061),anxiety(10.8 ％ vs.19.0 ％,P =0.443),fatigue (35.1％ vs.38.1％,P =0.822) and cognitive impairments (59.5％ vs.66.7％,P=0.587).Conclusions The motor function-evaluated activities of daily living are little affected in mild ischemic stroke at 18months follow-up,but rates of depression,anxiety,fatigue and cognitive decline are not uncommon.

Correlation of the serum decorin levels and the cognitive function in first-episode drug-native patients with schizophrenia / 中华行为医学与脑科学杂志

Objective To explore the role of decorin (DCN) on the pathogenesis of schizophrenia by analyzing the correlation between serum DCN levels and cognitive impairment in the first-episode drug-native (FEDN) patients with schizophrenia.Methods 30 FEDN patients with schizophrenia and 30 age and gender matched healthy volunteers (control group) were enrolled.The psychopathological symptoms were assessed by the PANSS and the cognitive function was assessed by the MATRICS Consensus Cognitive Battery (MCCB).The serum DCN levels were measured by using enzyme linked immunosorbent assay (ELISA).The difference of DCN levels between the two groups were compared and the correlations of serum DCN levels to age,sex,the score of the MCCB and PANSS were analyzed.Results The serum DCN levels were lower in patients with schizophrenia than those in control group ((1.56±0.96) ng/ml vs (3.35± 1.71) ng/ml,P＜ 0.01).The serum DCN levels were positively correlated with the positive symptom score (r=0.41,P=0.03).The serum DCN levels were significantly negatively correlated with MCCB verbal fluency (r =-0.40,P =0.04),verbal memory (r=-0.42,P=0.02),visual memory (r=-0.39,P=0.04),continuous operation (r=-0.41,P=0.03),encoding symbols (r=-0.49,P=0.01),T line (r=-0.42,P=0.02) and total score (r=-0.55,P＜0.01),and after controlling the age and gender,the relationships were still exist.Conclusion It suggests that serum DCN levels are associated with cognitive function in first-episode patients with schizophrenia,and that DCN may be involved in the pathogenesis of schizophrenia.

Validation of MoCA-MMSE Conversion Scales in Korean Patients with Cognitive Impairments

BACKGROUND AND PURPOSE: Two conversion scales between the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) have been validated for Korean patients with Parkinson's disease. The aim of the present study was to validate these conversion scales for all patients with cognitive impairments regardless of dementia subtype. METHODS: Medical records of 323 subjects who completed both MMSE and MoCA on the same day were retrospectively reviewed. Mean, median, and root mean squared error (RMSE) of the difference between true and equivalent MMSE scores were calculated. Intraclass correlation coefficients (ICCs) between true and equivalent MMSE scores were also calculated. The validity of MoCA-MMSE conversion scales was evaluated according to educational level (low educated: ≤6 years; high educated: ≥7 years) and subtypes of cognitive impairment. RESULTS: The difference between true and equivalent MMSE scores had a median value of 0, a mean value of 0.19 according to the van Steenoven scale, a mean value of 0.57 according to the Lawton scale, RMSE value of 2.2 according to the van Steenoven scale, and RMSE value of 0.42 according to the Lawton scale. Additionally, ICCs between true and equivalent MMSE scores were 0.92 and 0.90 on van Steenovan and Lawton conversion scales, respectively. These results were maintained in subgroup analyses. CONCLUSIONS: Findings of the present study suggest that both van Steenovan and Lawton MoCA-MMSE conversion scales are applicable to transforming MoCA scores into MMSE scores in patients with cognitive impairments regardless of dementia subtype or educational level.

Demencia frontotemporal y esclerosis lateral amiotrófica: presentación de un caso clínico / Frontotemporal dementia and amyotrophic lateral sclerosis: a case report

For a long time amyotrophic lateral sclerosis was seen as an exclusively motor disease, however, a lot of investigations have proved the existence of cognitive symptoms similar to frontotemporal dementia that could precede, coexist or appear after the motor symptoms. We report the case of a 69 years old hispanic man who consults about progressive swallowing impairments. In the speech languagepathologist assessment, we detected cognitive impairments that made necessary to complete the workout with specific test. The results of the assessment, shown disturbance in swallowing with suggestive symptomatology of motor neuron disease, besides cognitive impairments in executive functions, visuospatial abilities, memory, language and behaviors and conductual abnormalities. A few months after speech language pathologist assessment, the diagnosis of amyotrophic lateral sclerosis was given. This case emphasize in the importance of a exhaustive anamnesis and clinical assessment, as well as early diagnosis focused on opportune interventions. Additionally, it’s important to note the need for professionals with update knowledge in neuropsychology, to support interventions.

Durante mucho tiempo se pensó que la esclerosis lateral amiotrófica era una enfermedad exclusivamente motora, sin embargo, diversos estudios han mostrado la existencia de síntomas cognitivos que pueden manifestarse antes, durante o después de los síntomas motores y que serían compatibles con una demencia frontotemporal. Se presenta un caso de un hombre de 69 años que consulta por dificultades de deglución de carácter progresivo. En la evaluación fonoaudiológica se pesquisan dificultades cognitivas, por lo cual se decide aplicar diversas pruebas con el objetivo de aclarar estas alteraciones. Los resultados de la evaluación revelan alteraciones a nivel de deglución, con sintomatologia sugerente de enfermedad de motoneurona, además de alteraciones cognitivas a nivel de funciones ejecutivas, habilidades visuoespaciales, memoria, lenguaje y alteraciones en conducta y comportamiento. En el transcurso de unos meses, posterior a la evaluación fonoaudiológica, se realiza el diagnóstico de esclerosis lateral amiotrófica. Se enfatiza en la importancia de la anamnesis y evaluación clínica, el diagnóstico precoz enfocado en la intervención oportuna y la relevancia de contar con profesionales competentes y capaces, con conocimientos sobre neuropsicología que puedan ser de apoyo para la intervención.

Cognitive Impairments in Clinically Stable Late-Life Depression : Relationship to Cardiovascular Risk : A Pilot Study

OBJECTIVE: The purpose of this study was to test the hypothesis that cardiovascular risk is associated with cognitive impairments in clinically stable late-life depression. METHODS: A total of 59 clinically stable late-life depression patients over age 60 were enrolled in a cross-sectional study. Evaluation tools used in this study include Hamilton Rating Scale for Depression, Geriatric Depression Scale, State-Trait Anxiety Inventory, the Framingham general cardiovascular disease risk profile and the cognitive function battery designed for this study. Correlation analysis, analysis of variance and analysis of covariance were performed. RESULTS: Patients with higher cardiovascular risk performed significantly poorer in the domains of executive function and short-term or long-term memory. In models adjusted for age, sex, education, 10% higher cardiovascular risk was associated with poorer executive function. CONCLUSION: Our findings suggested that cardiovascular risk could be a significant factor associated with poor executive function in clinically stable late-life depression and the management which is necessary as a component of treatment planning. This pilot study provided good prospects for future studies to document this relationship on larger samples.

Epigenetic mechanism in cognitive function / 中国药理学通报

The definition of epigenetics and its cellular basis are introduced firstly in the paper. Then, the research progress on the relationship between cognition and epigenetic changes is re-viewed in detail. In conclusion, epigenetic modifications occur-ring in hippocampus, cortex and other brain areas such as methy-lation , phosphorylation , ubiquitination , poly ( ADP-ribos ) poly-merases and DNA methylation may certainly change animal be-haviors including learning, memory, synaptic plasticity, depres-sion, drug abuse and so on. Long-term memory and long-term potentiation( LTP) , activation of AMPK-ERK signal transduction path-way and activation of key gene regulated by CREB-ABP transcriptional complex as well as transcription and expression of memory and synaptic plasticity related genes ( Zif/268, Creb, Bdnf, reelin ) are required. In contrast, epigenetic abnormal changes such as histone and DNA hypomethylation and increase of HDAC activity are observed in brains of aging and neurodegen-erative diseases. Therefore, the main epigenetic treatments for cognitive impairments are increasing histone and DNA methyla-tion, using HDAC inhibitors and RNA interference ( RNAi) to promote formation of long term memory and long term potentia-tion, block learning and memory decline.

Psychological intervention for specific learning disability: A case report.

Cognitive deficits resulting in poor scholastic performance are common among children with specific learning disabilities. Current study was carried out to identify areas of deficits leading to poor academic performance followed by a home based remediation program for rehabilitation of impaired skills. Single case study method was opted and assessment of academic skills was done using NIMHANS Index for Specific Learning Disability (SLD). Assessment findings revealed significant impairment in scholastic skills and attention processes. Management of identified deficits was planned and weekly sittings of remediation were provided for six months. Monitoring of the rehabilitation package was done on every visit using charting method. Improvement in academic skills/ performance was seen in later sessions.

Relationship between Sleep Disturbances and Cognitive Impairments in Older Adults with Depression / 수면정신생리

OBJECTIVES: Depression, sleep complaints and cognitive impairments are commonly observed in the elderly. Elderly subjects with depressive symptoms have been found to show both poor cognitive performances and sleep disturbances. However, the relationship between sleep complaints and cognitive dysfunction in elderly depression is not clear. The aim of this study is to identify the association between sleep disturbances and cognitive decline in late-life depression. METHODS: A total of 282 elderly people who underwent nocturnal polysomnography in a sleep laboratory were enrolled in the study. The Korean version of the Neuropsychological Assessment Battery developed by the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K) was applied to evaluate cognitive function. Depressive symptoms were assessed with the geriatric depression scale (GDS) and subjective sleep quality was measured using the Pittsburg sleep quality index (PSQI). RESULTS: The control group (GDS< or =9) when compared with mild (10< or =GDS< or =16) and severe (17< or =GDS) depression groups, had significantly different scores in the Trail making test part B (TMT-B), Benton visual retention test part A (BVRT-A), and Stroop color and word test (SCWT)(all tests p<0.05). The PSQI score, REM sleep duration, apnea-hypopnea index and oxygen desaturation index were significantly different across the three groups (all indices, p<0.05). A stepwise multiple regression model showed that educational level, age and GDS score were predictive for both TMT-B time (adjusted R2=35.6%, p<0.001) and BVRT-A score (adjusted R2=28.3%, p<0.001). SCWT score was predicted by educational level, age, apnea-hypopnea index (AHI) and GDS score (adjusted R2=20.6%, p<0.001). Poor sleep quality and sleep structure alterations observed in depression did not have any significant effects on cognitive deterioration. CONCLUSION: Older adults with depressive symptoms showed mild sleep alterations and poor cognitive performances. However, we found no association between sleep disturbances (except sleep apnea) and cognitive difficulties in elderly subjects with depressive symptoms. It is possible that the impact of sleep disruptions on cognitive abilities was hindered by the confounding effect of age, education and depressive symptoms.

Cognitive Impairments in Patients with Depressive Disorder and Bipolar Disorder / 신경정신의학

OBJECTIVES: The purpose of this study is to investigate the differences of cognitive impairment between depressive disorder and bipolar disorder. METHODS: Participants were adults between the ages of 18 and 65, and included 40 healthy control subjects, 40 outpatients diagnosed with depressive disorder, and 35 outpatients diagnosed with bipolar disorder. Full-Scale Intelligence Quotients (FIQ) were measured using the Korean-Wechsler Adult Intelligence Scale. The levels of Memory Quotients (MQ) were yielded on a Rey-Kim Memory Test, and executive functions were assessed using Kim's Frontal-Executive Function Test. Scores of each scale were compared among the three groups using ANOVA. RESULTS: With respect to FIQ, Performance Intelligence Quotient, block design, object assembly, Executive Intelligence Quotient, Stroop test-interference trial, verbal fluency, design fluency, MQ, and recall, depressive disorder patients and bipolar disorder patients showed similar results, and both patient groups were impaired compared to normal controls. The depressive disorder group showed significantly lower scores on Digit Symbol and the Stroop Test than both normal control and bipolar disorder groups did. The bipolar disorder group showed significantly lower scores on the Verbal Learning Test and Recognition task than both the normal control and depressive disorder groups did. CONCLUSION: A similar deficit profile was observed in both patient groups, involving poorer visual-spatial function, cognitive flexibility, and overall executive function/memory. Depressed patients showed particular difficulties with tasks requiring sustained effort, such as word learning and free recall. In contrast with depressed patients, Bipolar patients showed particular difficulties with higher conceptualization, selective attention/control, and recognition.

Autoeficácia entre estudantes universitários ingressantes e veteranos de dois cursos / Cognitive impairments and communicational accessibility in schools: contributions from Vygotsky's theory

As pessoas que fazem parte do grupo com impedimentos cognitivos são aquelas que apresentam deficiência intelectual ou outras deficiências que tem como fator secundário a deficiência intelectual, podendo apresentar dificuldades na comunicação oral. Nesta revisão de literatura, que tem por objetivo refletir sobre as contribuições da teoria sócio-histórica de Vygotsky para a aprendizagem de pessoas com deficiência e com impedimentos cognitivos, destacam-se os processos de compensação como uma possibilidade de ampliação das potencialidades dessas pessoas a partir do uso dos sistemas/artefatos culturais de comunicação nas/pelas interações sociais, sobretudo na escola. Tais processos podem contribuir para a diminuição das barreiras impostas pela sociedade ao não segregar as pessoas com deficiência, que é o que caracteriza a deficiência secundária. A escola tem o papel de diminuir as barreiras e garantir a acessibilidade de todos os alunos, com a utilização de recursos de tecnologia assistiva, que no caso dos impedimentos comunicacionais, referem-se a formas alternativas de comunicação. © Cien. Cogn. 2011; Vol. 16 (3): 043-056.

People with cognitive impairments are those who present intellectual deficiency or other deficiencies, which have intellectual deficiency as the secondary hindrance. These impairments can possibly cause complications in oral communication. The revision of the literature aims to reflect on the contributions of the socio-historical theory of Vygotsky over the learning process of people with deficiencies and with cognitive impairments. Here, we emphasize compensation processes as a possible way of widening the potential of these people through the use of cultural systems/artifacts of communication in social interactions, especially at schools. Such processes can contribute to the reduction of barriers imposed by society when people with deficiencies are not segregated, which characterizes a secondary deficiency. The school has the role of reducing barriers and guaranteeing the accessibility of all students, using assistive technological resources, which in the case of communicational impairments it refers to alternative ways of communication. © Cien. Cogn. 2011; Vol. 16 (3): 043-056.

Relações entre abuso sexual na infância, transtorno de estresse pós-traumático (TEPT) e prejuízos cognitivos / Relaciones entre abuso sexual en la infancia, trastorno de estrés post-traumático (TEPT) y perjuicios cognitivos / Relationships between sexual abuse in childhood, post-traumatic stress disorder (PTSD) and cognitive impairments

Este estudo teórico aponta as relações entre abuso sexual infantil, transtorno de estresse pós-traumático (TEPT) e prejuízos cognitivos. A perspectiva cognitiva dos efeitos do abuso sexual e do TEPT foi adotada nesta revisão. O abuso sexual contra crianças pode ser considerado um fator de risco para o desenvolvimento infantil, devido às severas seqüelas cognitivas, emocionais e comportamentais relacionadas à sua ocorrência, podendo seu impacto envolver efeitos a curto e longo prazos e estender-se até a idade adulta. Os estudos de revisão fortalecem a associação entre eventos traumáticos (abuso sexual), TEPT e alterações, tanto estruturais quanto funcionais, em áreas cerebrais envolvidas nos sistemas neurais de resposta ao estresse. Finalmente, é discutida a necessidade de pesquisas que investiguem os efeitos do estresse e do trauma no neurodesenvolvimento infantil.

Current theoretical study shows relationships between sexual abuse during childhood, post-traumatic stress disorder (PTSD) and cognitive impairments. The cognitive perspective of sexual abuse effects and PTSD has been undertaken. Child sexual abuse against children is considered a risk factor in child development due to severe cognitive, emotional and behavioral sequences related to the event. The impact of sexual abuse involves short and long term effects and may be seen during adulthood. Review studies foreground the association between traumatic events (sexual abuse), PTSD, and alterations, structural and functional, in cerebral areas related to biological stress response systems. The necessity of future researches investigating the effects of stress and trauma in the child's neurodevelopment will be discussed.

Este estudio teórico apunta las relaciones entre abuso sexual infantil, trastorno de estrés post-traumático (TEPT) y perjuicios cognitivos. La perspectiva cognitiva de los efectos del abuso sexual y del TEPT fue adoptada en esta revisión. El abuso sexual contra niños puede ser considerado un factor de riesgo para el desarrollo infantil, debido a las severas secuelas cognitivas, emocionales y conductuales, que son relacionadas a su ocurrencia, siendo que su impacto puede envolver efectos a corto y a largo plazo, extendiéndose hasta la edad adulta. Los estudios de revisión fortalecen la asociación entre eventos traumáticos (abuso sexual), TEPT y alteraciones, tanto estructurales cuanto funcionales, en áreas cerebrales envueltas en los sistemas neuronales de respuesta al estrés. Finalmente, es discutida la necesidad de investigaciones futuras que investiguen los efectos del estrés y del trauma en el neurodesarrollo infantil.

Multicenter Investigation on Clinical Characteristics, Cognitive Impairments, Behavioral and Psychological Symptoms of Demented Elderly in Busan-Gyeongnam Province

OBJECTIVES: The purpose of this study is to examine the state of demographic findings with clinical characteristics, cognitive impairment and behavioral psychological symptoms of demented elderly in Busan-Gyeongnam Province. METHODS: Patients with dementia who were registered at nine medical centers in Busan Metropolitan City and Gyeongnam Province were the major subjects of this study. Data was collected by face-to-face interview. The final sample consisted of 144 cases after eliminating several incomplete questionnaires. Based on the collected data, the authors evaluated demographic findings, clinical characteristics, and cognitive impairment and behavioral psychological symptoms of the patients with dementia using statistical analyses. All of the patients were taken the Korean version of Mini-Mental State Examination(K-MMSE), the Clinical Dementia Rating Scale(CDR) and the the Korean version of Neuropsychiatric Inventory(K-NPI). RESULTS: Approximately 61% of the patients with dementia in Busan-Gyeongnam Province were women, and their mean age was 72.9(SD=8.3) years old. Their average education level was 2.3(SD=1.3) years. Among the demented elderly, Alzheimer's disease accounted for 68% compared with vascular dementia(32%) and the proportion of mild stage of dementia was above 50%. The mean K-MMSE score was 16.7(SD=6.2), the mean CDR score was 1.3(SD=0.8), and the Barthel Index with K-IADL score were 16.7(SD=5.4) and 1.5(SD=0.9). The average score of K-NPI was 22.6(SD=22.5) and the number of manifested K-NPI was 4.9(SD=2.8). The K-NPI score has increased in demented elderly as the severity of dementia getting worse according to the CDR score. The number of manifested K-NPI was significantly more prevalent in patients with AD than that of patients with VD. CONCLUSION: This study is a meaningful approach to the state of demographic findings, clinical characteristics, cognitive impairment and behavioral psychological symptoms associated with the dementied elderly who were comprehensively examined in Busan-Gyeongnam Province. Based on this study, we found that the demographic information was comparable with other epidemiologic study in Korea and our study patients were relatively mild stage of demenitia according to the assessment of cognition and behavioral symptom scales.

Symptom Patterns of Depressive Disorder in the Elderly Medical Inpatients: Focused on Major Depressive Disorder

OBJECTS: Depressive symptoms are common in the elderly medical inpatients. But depressive disorders are considerably underdiagnosed and undertreated. Especially in major depressive disorder, patients show cognitive impairments and do not respond adequately to medical treatment. The goals of this study were to examine what are the patterns of depressive symptoms of major depressive disorders which differentiate from minor depressive disorders in the elderly medical inpatients. METHODS: A 4-month prospective study of 312 patients (65 years and older) was conducted in a general hospital. Depression was screened with Hamilton Depression Rating Scale and cognitive function was screened with Mini-Mental State Examination-K. The subjects were diagnosed according to DSM-IV for depression. And according to DSM-IV diagnosis, HDRS and MMSE-K subscales were analysed. RESULTS: In the 228 patients who were investigated, 16 (7%) patients were major depressive disorder, 53 (23%) were minor depressive disorder. Females were more depressed than males but there was no statistical significance. While the patients of major depressive disorder complained of depression and anxiety, the control subjects complained of loss of body weight, somatic symptoms and somatic anxiety, and the minor depressive disorders shows mixed symptoms of the two. The complaining frequency of the somatic symptoms and somatic anxiety were similar among the three groups. Significant differences were found among the three groups in terms of HDRS total scores. Among the three groups in terms of HDRS subscale scores all subscale scores except for the genital symptoms and body weight were significantly high in depressive disorders. Initial insomnia (p<0.01), middle insomnia (p<0.05), GI symptoms (p<0.01) and somatic symptomgeneral (p<0.05) were significantly different between the control subjects and the depressive disorder group. The subscales of terminal insomnia, agitation and loss of insight were significantly different between the minor depressives and major depressives (p<0.01), but no difference between the control subjects and the minor depressives. MMSE total scores were significantly correlated in major depressive disorders among the 3 groups. Comparing subscales of the three groups, significant correlation were found in time orientation, attention and calculation (p<0.05) and language (p<0.01). CONCLUSION: Major depressive disorder patients in elderly medical inpatients chiefly complained of depression and anxiety, but they also complained somatic symptoms. If elderly medical inpatients complain of agitation, terminal insomnia, cognitive impairment associated with depressive symptoms, consultants will pay attention for the major depressive disorders. This study suggests that further systematic study is necessary for the recognition of major depressive disorder in the elderly medical inpatients.