Clinical analysis of neuropsychological and behavioral symptoms in a patient of frontal variant Alzheimer disease / 中国综合临床

Although the neuropathologic changes and diagnostic criteria for the neurodegenerative disorder Alzheimer′s diseasehave been established, the clinical symptoms are very different largely.The clinical symptoms of its special type frontal lobe variant and behavioral variant frontotemporal dementia are very similar, which brings great challenges to the differential diagnosis.Therefore, we report a patient with progressive cognitive impairment, early significant executive dysfunction and abnormal behavior, and magnetic resonance imaging showed significant frontotemporal atrophy.It is easy to be misdiagnosed as behavioral variant frontotemporal dementia.However, multimodal functional neuroimaging results show that neuropathological changes are more likely to be frontal variant Alzheimer′s disease.This study shows that the use of detailed neuropsychological tests, biological markers and multimodal neuroimaging to identify these atypical syndromes will help to improve the accuracy of diagnosis and patient management.

Executive dysfunction in idiopathic epilepsy: the journey so far

Epilepsy is one of the most common neurological disorders known to man with a high global prevalence. This disease process affects the overall quality of life. In recent times the concept of executive dysfunction in patients with epilepsy has emerged. This phenomenon has widespread therapeutic implications. This review hence aims to summarize our current understanding of the topic, highlighting the results of benchmark studies and outlining the aspects that require further research. The keywords epilepsy, executive dysfunction and cognitive retraining were used in the search engines of Pubmed and Google scholar and articles identified were extensively reviewed. The consensus of this review is that executive dysfunction is a phenomenon that occurs in patients with epilepsy irrespective of epilepsy type, however the magnitude varies with contributory factors which include poor seizure control. Furthermore, patients with cognitive dysfunction have a further decline over the course of the disease process, however longitudinal studies in regard to the same are lacking and there is a need for additional research in this regard.

Executive functions: neuropsychological assessment in women with breast cancer / Funções executivas: avaliação neuropsicológica em mulheres com câncer de mama / Funciones ejecutivas: evaluación neuropsicológica en mujeres con cáncer de mama

Cognitive changes may occur during chemotherapy to treat cancer and, therefore, it is necessary to identify them since they represent neurological complications with a high rate of improvement when treated. This research evaluated executive functions in women with breast cancer undergoing chemotherapy. Were examined 171 women divided into three groups contrasted with the use of neuropsychological tests. Performance losses were found in the Digit Span both direct (p < 0.001) and indirect sequence task (p < 0.001), Victoria Stroop Test (p = 0.017) and BIS-11 (p = 0.004). It is concluded that there were impairments in executive functions related to working memory, focused attention, inhibitory control and general impulsivity in the group of women with breast cancer who received chemotherapy. Studies have corroborated these results, but there are still gaps in the literature. Discussion on the topic is encouraged with the goal of building intervention strategies.

Alterações cognitivas podem ocorrer durante a quimioterapia no tratamento de câncer e, portanto, faz-se necessário a identificação destas, já que representam complicações neurológicas com alto índice de melhora quando tratadas. Essa pesquisa avaliou as funções executivas em mulheres com câncer de mama submetidas à quimioterapia. Foram examinadas 171 mulheres divididas em três grupos contrastados com o uso de testes neuropsicológicos. Foram encontrados prejuízos de desempenho nas tarefas de sequência direta do Digit Span (p = 0,000), de sequência indireta do mesmo (p = 0,000), Victória Stroop Test (p = 0,017) e BIS-11 geral (p = 0,004). Conclui-se que houve prejuízos das funções executivas relativas à memória de trabalho, atenção focada, controle inibitório e impulsividade geral no grupo de mulheres com câncer de mama que receberam quimioterapia. Estudos tem corroborado com tais resultados, mas ainda há lacunas na literatura. Espera-se fomentar discussão sobre o tema e contribuir na construção de estratégias de intervenção.

Los cambios cognitivos pueden ser causados durante la quimioterapia en el tratamiento del cáncer y, por lo tanto, es necesario identificarlos, ya que representan complicaciones neurológicas con una alta tasa de mejora cuando se tratan. Esta investigación evaluó las funciones ejecutivas en mujeres con cáncer de seno sometidas a quimioterapia. Se examinaron 171 mujeres, divididas en tres grupos, en contraste con el uso de pruebas neuropsicológicas. Se encontraron pérdidas de rendimiento en las tareas de secuencia directa de Digit Span (p = 0.000), secuencia indirecta de la misma (p = 0.000), Victória Stroop Test (p = 0.017) y general BIS-11 (p = 0.004). Se concluye que hubo deficiencias en las funciones ejecutivas relacionadas con la memoria de trabajo, atención focalizada, control inhibitorio e impulsividad general en el grupo de mujeres con cáncer de seno que recibieron quimioterapia. Los estudios han corroborado estos resultados, pero todavía hay lagunas en la literatura. Se espera que fomente la discusión sobre el tema y contribuya a la construcción de estrategias de intervención.

INECO Frontal Screening (IFS): una herramienta psicométrica para evaluar la disfunción ejecutiva en policonsumidores / INECO frontal screening (IFS): A test battery to assess executive dysfunction in polyconsumers

Resumen La presente investigación tiene como objetivo analizar las propiedades psicométricas del INECO frontal screening (IFS) en una población de policonsumidores de la ciudad de Medellín, Colombia. El instrumento se administró a una muestra de 69 sujetos con consumo de sustancias psicoactivas y 69 sujetos control. Los análisis psicométricos evidencian una consistencia aceptable del test: 0.7; con respecto a su utilidad diagnóstica se estimó un punto de corte de 22.5 con una sensibilidad del 80% y una especificidad del 91%. Se encontró evidencia de validez de criterio al comparar el desempeño cognitivo entre el grupo caso y control obteniendo diferencias significativas: p<0.05 en cada escala y puntaje total. Por último, se realizó la validez de constructo mediante el análisis factorial exploratorio, encontrando una varianza explicada total de la prueba del 56%, proponiendo tres factores, lo cual contribuye a la eficacia del IFS para identificar déficits cognitivos en población con algún compromiso neurológico o alteraciones neuropsicológicas.

Abstract This study analyzed the psychometric properties of the INECO Frontal Screening, IFS, in a population of polyconsumers of the city of Medellín, Colombia. The Psychometric analysis showed an acceptable consistency of the test: 0.7; with respect to its diagnostic utility, a cutoff point of 22.5 was estimated with a sensitivity of 80% and a specificity of 91%. As to its validity, evidence of criterion validity was found when comparing cognitive performance between the case and control group, obtaining significant differences: p <0.05, in each scale and total score. Finally, construct validity was performed through exploratory factor analysis, and the total variance explained of the 56% test was found, suggesting three factors, which contribute to the effectiveness of the IFS test to identify cognitive deficits in people with some type of neurological and neuropsychological dysfunction.

Executive function performance in patients with obesity: a systematic review / Desempeño en tareas de funcionamiento ejecutivo en pacientes con obesidad: una revisión sistemática

Abstract Executive dysfunction is associated with the inability to control aberrant behaviors, such as chronic overeating (Moore, Sabino, Koob, & Cottone, 2017). Obese individuals often report great difficulties controlling eating behaviors, despite a desire to successfully lose weight (Dohle, Diel, & Hofmann, 2018). However, current literature lacks a systematic review about the relationship between executive dysfunction and Obesity. The aim of this study is to present the most important findings about this matter. First, a bibliometric analysis shows the evolution of the topic. Then, the Tree of Science tool is used to show a chronological review that provides a general description of the roots and current perspectives of the state of literature. Finally, clustering analysis of the co-citation network was employed to identify the different perspectives of the topic. The main findings suggest four approaches: (1) effects of body mass index on executive functioning, (2) executive functioning in children with overweight and obesity, (3) physical activity for adult obesity and (4) structural and functional brain changes in obesity. Preliminary data state that in obesity, poor food choices may be associated with frontal cognitive impairments that contribute to reduced orbitofrontal cortex volume.

Resumen Las alteraciones en el funcionamiento ejecutivo están relacionadas con la incapacidad de controlar conductas como comer en exceso. Pacientes con diagnóstico de obesidad reportan dificultades para controlar las conductas alimentarias, a pesar del deseo de perder peso. Sin embargo, la literatura actual carece de una revisión sistemática sobre la relación entre las alteraciones del funcionamiento ejecutivo y la obesidad. El objetivo de este estudio es presentar los hallazgos más importantes sobre este tema. Primero, un análisis bibliométrico muestra la evolución del tema. Luego, desde la herramienta Tree of Science se presenta una revisión cronológica que proporciona una descripción general de estudios seminales y perspectivas actuales del estado de la literatura. Finalmente, se empleó el análisis de agrupamiento de la red de co-citaciones para identificar las diferentes perspectivas del tema. Los hallazgos sugieren cuatro perspectivas: (1) los efectos del índice de masa corporal en el funcionamiento ejecutivo, (2) el funcionamiento ejecutivo en niños con sobrepeso y obesidad, (3) la actividad física en adultos con obesidad y (4) los cambios cerebrales estructurales y funcionales en la obesidad. Los datos preliminares sugieren que, en la obesidad, la mala elección de alimentos puede asociarse con deficiencias cognitivas frontales que pueden ser el resultado de disminuciones en el volumen de la corteza orbitofrontal.

Trastorno por déficit de atención/hiperactividad: Hábitos de estudio / Attention deficit/hyperactivity disorder. Study habits

El trastorno por déficit de atención/hiperactividad (TDAH) es uno de los trastornos más prevalentes en la población infanto-juvenil, con un impacto ya conocido sobre el aprendizaje y rendimiento escolar. La falta de atención, la disfunción ejecutiva asociada y los problemas comórbidos -particularmente los relacionados con el aprendizaje y la ansiedad-, condicionan marcadamente este dominio conceptual. Los jóvenes afectos, tienen más problemas para la toma de apuntes, finalización de trabajos, programación escolar y menor motivación al estudio. A pesar de una mayor dedicación al estudio y mayor uso de recursos de apoyo, el fracaso escolar y la no consecución de objetivos curriculares son más frecuentes en estos pacientes. El diagnóstico temprano del TDAH y sus comorbilidades, la intervención psicoeducativa y farmacológica adecuada e individualizada, han demostrado mejorar el pronóstico académico a corto y largo plazo. Para este propósito, es imprescindible la participación activa de profesionales de la salud y la educación.

Attention deficit / hyperactivity disorder (ADHD) is one of the most prevalent disorders in the child-youth population, with a known impact on learning and school performance. Lack of attention, associated executive dysfunction and comorbid problems -particularly those related to learning and anxiety-, strongly determine this conceptual domain. Affected youths have more problems for taking notes, completion of homework, school programming and less motivation to study. Despite greater dedication to homework and greater use of support resources, school failure and non-achievement of curricular objectives are more frequent in these patients. The early diagnosis of ADHD and its comorbidities, the adequate and individualized psychoeducational and pharmacological intervention, have been shown to improve academic prognosis in the short and long term. For this purpose, the active participation of health and education professionals is essential.

Converted auditory training can improve executive function among breast cancer patients undergoing chemotherapy / 中华物理医学与康复杂志

Objective To observe the effect of Tomatis converted auditory training on the executive functioning of breast cancer patients undergoing chemotherapy.Methods Eighty breast cancer patients with the executive dysfunction who were undergoing chemotherapy were divided into a control group and an experimental group,each of 40.The experimental group was given Tomatis high and low frequency auditory training,while the control group was given ordinary music training.The patients in both groups were treated in 4 stages,each of 5 consecutive days with intervals of 21 days.The Chinese Version of the Behavioral Assessment of Dysexecutive Syndrome (BADS) was used to evaluate both groups before and after the intervention,including rule transformation ability,problem solving ability,planning ability,supervising ability and organizing ability.Results After the intervention,the experimental group had a significantly higher average score than before the intervention in the rule-switching card test,the action planning test,the key-finding test,and the modified six-element test.Their average BADS score was also significantly improved.The control group showed a significantly better average score only in the key-finding test and in its average BADS total score.After the intervention,the experimental group had a significantly higher average score than the control group in the rule-switching card test and the action planning and six-element tests.Its average BADS rating was also significantly better.Conclusion Tomatis high and low frequency auditory training can improve the executive function of patients undergoing chemotherapy for breast cancer.Its effect is better than that of ordinary music training.

Association between Frontal-Executive Dysfunction and Speech-in-Noise Perception Deficits in Mild Cognitive Impairment

BACKGROUND AND PURPOSE: Speech-in-noise perception deficits have been demonstrated in patients with mild cognitive impairment (MCI). However, it remains unclear whether the impairment of speech perception varies between MCI subtypes. The purpose of this study was twofold: 1) to compare speech perception performance among MCI subgroups, and 2) to identify the cognitive domains specifically related to speech-in-noise perception. METHODS: We studied 46 patients with MCI and 39 hearing-threshold-matched cognitively normal elderly (CNE) subjects. Two different patient classifications were used: 1) patients with amnestic mild cognitive impairment (aMCI) (n=21) or nonamnestic mild cognitive impairment (naMCI) (n=25), and 2) patients with frontal-executive dysfunction (FED) (n=16) or without FED (n=30). All of the subjects underwent audiometric, neuropsychological, and speech perception assessments. Speech-in-noise perception was measured using sentence recognition tests in the presence of two types of background noise at four levels. RESULTS: First, as the level of background noise increased, the MCI with FED group scored lower than both the MCI without FED and CNE groups under both types of noise. Second, both the naMCI and aMCI groups scored lower than the CNE group, but there were no differences between the naMCI and aMCI groups in sentence recognition under any noise conditions. Third, significant correlations were found between sentence recognition and executive function scores both in the MCI groups and in the CNE group. CONCLUSIONS: Our findings suggest that frontal-executive function is strongly related to speech-in-noise perception and that MCI patients with FED have greater deficits in speech-in-noise perception compared to other subgroups of MCI.

Executive dysfunction in patients with idiopathic epilepsy

Background: Idiopathic epilepsy is defined as disorder in which there is no underlying cause or structural pathology other than a possible hereditary predisposition for generating seizures which can be generalized or focal in nature. Objective: To study the occurrence of executive dysfunction in patients with idiopathic epilepsy and its association with age, gender, seizure type, duration of epilepsy, age at seizure onset, antiepileptic drug therapy and seizure control &the association of the interictal EEG pattern. Materials and methods: 100 cases of epileptic patients with normal CT scan brain / MRI brain were studied. Frontal Assessment Battery &The Executive Interview (EXIT) were used to assess the executive functions. Results: The FAB score were normal in 46% and abnormal in 54% of the cases. Executive dysfunction as per the FAB score was mild in 32% and moderately severe in 22% of the cases. Impairment in Executive function as per EXIT score was mild in 84% and moderate in 16 % of the cases. Executive Dysfunction was more in cases with either primary or secondarily generalized seizures, cases with a higher seizure frequency, longer duration of epilepsy, uncontrolled epilepsy and seen in 17.5% with normal and 10% cases with an abnormal EEG. Conclusion: Our study found a significant proportion of patients with idiopathic epilepsy have Executive Dysfunction, which adds to the seizure burden by reducing the capacity of an individual to successfully engage in self-care, social, academic and occupational pursuits.

Impact of repetitive transcranial magnetic stimulation on executive dysfunction after stroke / 实用医学杂志

Objective To explore the impact of low frequency repetitive transcranial magnetic stimula tion (rTMS) on executive dysfunction after stroke by magnetic resonance spectroscopy (MRS) and neuropsychological scale.Methods 60 stroke patients with executive dysfunction were recruited and randomly divided into a study group and a control group,with 30 in each.The study group was treated with rTMS in addition to routine treatment,while the control group received routine treatment only.Before and after treatment,the neuropsychological scale and MRS were measured in both groups.Results After treatment,the scores on the LOTCA and FAB of neuropsychological scale in the treatment group were (87.10 ± 3.16) and (11.97 ± 0.48),significantly better than before the baselines.NAA/Cr was (1.64 ± 0.08) and Cho/Cr was (1.17 ± 0.07),which were significantly better than the baselines.In the control group,significant differences were also observed in the scores of the neuropsychological scale and in the indicators of MRS before and after treatment.Conclusions rTMS can effectively improve executive function in patients with cerebral apoplexy by influencing the metabolites related with cognitive function in the brain.Magnetic resonance spectroscopy can show the therapeutic effect at molecular level.

Frequência de déficits neuropsicológicos após traumatismo cranioencefálico / Frequency of neurolopsychological deficits after traumatic brain injury / Frecuencia de déficits neuropsicológicos posteriores a lesión cerebral traumática

O traumatismo cranioencefálico (TCE) pode acarretar mudanças no cotidiano e prejuízos social, laboral, comunicativo e cognitivo (dificuldades atencionais, mnemônicas e executivas). Este estudo buscou caracterizar a ocorrência de déficits neuropsicológicos após o TCE em uma amostra de adultos e verificar se há impacto do nível de severidade do trauma no desempenho cognitivo dos pacientes. Participaram 96 adultos, divididos em dois grupos: TCE leve (n=39) e grave (n=57). A gravidade do trauma foi classificada pela Escala de Coma de Glasgow, pela duração da perda de consciência, ou pela amnésia pós-traumática. Não houve diferença nas variáveis sociodemográficas idade e escolaridade entre os grupos. Para a comparação entre grupos quanto a ocorrência de déficits neuropsicológicos, utilizou-se o Qui-quadrado. Tarefas verbais e visuoespaciais de funções executivas, habilidades linguísticas, mnemônicas verbais compuseram uma bateria neuropsicológica flexível.Os pacientes com TCE leve tiveram menos déficits comparados aos com TCE grave (erros e categorias completadas do Wisconsin Teste de Classificação de Cartas; erros da parte B do Teste Hayling; e na interferência pró e retroativa do teste de aprendizagem verbal de Rey). A severidade do trauma parece diferenciar indivíduos no desempenho de memória episódica no contexto de maior sobrecarga de informações novas e no controle da interferência entre memórias; o mesmo se aplica às funções de flexibilidade e inibição. Faz-se necessário um maior investimento em ações de políticas públicas de saúde, priorizando intervenção neurognitiva remediativa e métodos de prevenção para acidentes relacionados a lesões traumáticas com alta ocorrência de sequelas.

Traumatic brain injury (TBI) can lead to significant changes in daily life, as well as in social, labor, communicative, and cognitive domains (attention, memory and executive functions). This study aimed to characterize the occurrence of post-TBI neuropsychological deficits as well as to determine whether there is an impact related to the level of severity of the trauma on the patient's performance. Ninety-six adults participated in the study, who were divided in two groups to assess the trauma's level of severity: mild TBI (n=39) and severe TBI (n=57). This severity was classified by the Glasgow Coma Scale, by the duration of consciousness loss, or by post-traumatic amnesia. There were no differences between the groups regarding variables of age and years of schooling. A Chi- square test was used to do a comparison between the two groups in terms of occurrence of neuropsychological deficits. Verbal, visuospatial, mnemonic, linguistic and executive tests composed a flexible neuropsychological battery. Patients with mild TBI had better scores compared to those with severe TBI (number of errors and in completed categories of the Modified Wisconsin Card Sorting Test (MWCST); errors in Part B of The Hayling Test; and proactive and retroactive interference in the Rey Auditory Verbal Learning Test (RAVLT). The severity of the trauma seems to differentiate individual's performance on episodic memory of new information and in the control of interference between memories; the same is applied to flexibility and inhibition functions. These results suggest the need for more investments in public health policy actions, prioritizing neurocognitive remedial intervention and prevention methods for such condition with high incidence of sequelae.

El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.

Effects of Instructional Video Modeling on Executive Dysfunction after Stroke：Implication of Human Mirror Neuron System / 中国康复理论与实践

Objective To explore the effect of a training based on instructional video modeling designed from the mirror neuron theory on executive dysfunction after stroke. Methods 40 stroke inpatients with executive dysfunction from July, 2014 to July, 2015 were divided into control group (n=20) and observation group (n=20). The control group accepted executive rehabilitation training, while the observation group were asked to see the video of executive rehabilitation task before training. They were assessed with Behavioral Assessment of the Dysexecutive Syndrome (BADS) before and after intervention. Results The total score and scores of subtests except Rule Shift Cards and Key Search increased more in the observation group than in the control group (t>2.9, P<0.05). Conclusion Rehabilitation video as a visual stimulus for exercise training based on the mirror neuron theory could improve executive function recovery of stroke patients with executive dysfunction.

Encefalopatía hipóxico isquémica secundaria a intoxicación por opioides / Hypoxic ischemic encephalopathy secondary to opioid toxicity

La encefalopatía hipóxico isquémica es una causa importante de ingreso a unidad de cuidados intensivos. Dicha patología puede ser secundaria a múltiples causas, de las cuales la más común es post paro cardíaco. Sin embargo, no se deben desconocer causas menos comunes como las intoxicaciones, que no necesariamente tendrían un pronóstico tan ominoso, entre las que figuran las medicamentosas, como en este caso por opioides. En este artículo se presenta el caso de una paciente de 31 años con uso crónico de analgésicos para manejo de dolor crónico lumbar, quien acude a un centro hospitalario y recibe múltiples dosis de opioides, desencadenando una depresión respiratoria. Posterior a esto, se documenta un empeoramiento importante de su Glasgow hasta 4, por lo cual requirió manejo en UCI con Ventilación mecánica. La paciente ingresó con gran deterioro con posturas de descerebración, se realizaron neuro imágenes que apoyaron el diagnóstico de encefalopatía hipóxico isquémica propuesto y se realizaron electroencefalogramas que mostraron patrón encefalopático. Sin embargo, la paciente recuperó adecuadamente su funcionalidad y evaluaciones posteriores solo reportaron disfunción ejecutiva en pruebas neuro psicologicas, pero sin repercusión en su vida cotidiana.

Hypoxic ischemic encephalopathy is a major cause for admission to the intensive care unit. This disease can be secondary to multiple causes, of which the most common is post cardiac arrest; however, less common causes, such as poisoning by drugs, as in this case by opioids, which tend to prognosis not necessarily as ominous, should not be ignored. In this paper we present the case of a 31-year-old patient with chronic use of analgesics for the management of chronic low back pain. She went to a hospital and received multiple doses of opioids, triggering respiratory depression. Afterwards, an important worsening of Glasgow coma scales to 4 was documented, which required Intensive care unit and management with mechanical ventilation. The patient was admitted with severe deterioration with decerebrate postures; the performed neuroimaging supported the proposed diagnosis of hypoxic ischemic encephalopathy and the conducted EEG showed encephalopathic pattern. However, the patient recovered her functionality and subsequent assessments reported only executive dysfunction in neuro psychological tests, which did not have an impact upon her daily life.

Correlation between sleep disorder screening and executive dysfunction in children with attention deficit-hyperactivity disorder / Correlacao entre rastreamento dos disturbios do sono e funcoes executivas em criancas com transtorno do deficit de atencao/hiperatividade

Objective To compare frequency of sleep disorders (SD) and executive dysfunction (ED) in children with attention deficit-hyperactivity disorder (ADHD) and a control group. Method We studied 156 children with ADHD with a mean age of 8.5 years, and a control group with 111 children with a mean age of 8.3 years. We utilized the Pediatric Sleep Questionnaire (PSQ) to screen SD and the working memory measurement from the Wechsler intelligence scale for children (WISC-IV) to screen ED. Results We did not observe an increased frequency of SD in children with ADHD compared with the controls. However, we did identify ED in children with ADHD; additionally a significant correlation was observed between the type of ADHD and SD and among ED, WISC-IV measurements, and type of SD in children with ADHD. Conclusion An increase of SD frequency in children with ADHD was not observed, but we did identify ED in children with ADHD. Additionally, a correlation among ADHD types, SD, ED, and WISC-IV measurements was observed in children with ADHD. .

Objetivo Comparar la frecuencia de trastornos del sueño (TS) y disfunción ejecutiva (DE) en niños con trastorno por déficit de atención-hiperactividad (TDA-H) y un grupo control. Método Estudiamos 156 niños con TDA-H con una media de 8,5 años. El grupo control incluyó 111 niños con una media de 8,3 años. Utilizamos la versión traducida del Cuestionario pediátrico del sueño (CPS) para tamizar TS. Para estudiar la DE, usamos la medición de la memoria de trabajo de la escala de inteligencia de Wechsler para niños-IV (WISC-IV). Resultados No encontramos una mayor frecuencia de TS en niños con TDA-H. Sin embargo, encontramos DE y correlaciones entre los diferentes tipos de TDA-H, y entre los TS, DE y de mediciones del WISC-IV. Conclusión No hallamos un incremento en la frecuencia de TS en niños con TDA-H. Encontramos evidencia de DE y correlaciones entre el tipo de TDA-H, TS, DE y medidas del WISC-IV. .

The INECO Frontal Screening tool differentiates behavioral variant - frontotemporal dementia (bv-FTD) from major depression / Rastreio frontal INECO diferencia a variante comportamental da demência frontotemporal de depressão maior

Executive dysfunction may result from prefrontal circuitry involvement occurring in both neurodegenerativediseases and psychiatric disorders. Moreover, multiple neuropsychiatric conditions, may present with overlapping behavioraland cognitive symptoms, making differential diagnosis challenging, especially during earlier stages. In this sense, cognitiveassessment may contribute to the differential diagnosis by providing an objective and quantifiable set of measures that hasthe potential to distinguish clinical conditions otherwise perceived in everyday clinical settings as quite similar. Objective:The goal of this study was to investigate the utility of the INECO Frontal Screening (IFS) for differentiating bv-FTD patientsfrom patients with Major Depression. Methods: We studied 49 patients with bv-FTD diagnosis and 30 patients diagnosedwith unipolar depression compared to a control group of 26 healthy controls using the INECO Frontal Screening (IFS), the MiniMental State Examination (MMSE) and the Addenbrooke?s Cognitive Examination-Revised (ACE-R). Results: Patient groupsdiffered significantly on the motor inhibitory control (U=437.0, p<0.01), verbal working memory (U=298.0, p<0.001), spatialworking memory (U=300.5, p<0.001), proverbs (U=341.5, p<0.001) and verbal inhibitory control (U=316.0, p<0.001)subtests, with bv-FTD patients scoring significantly lower than patients with depression. Conclusion: Our results suggestthe IFS can be considered a useful tool for detecting executive dysfunction in both depression and bv-FTD patients and,perhaps more importantly, that it has the potential to help differentiate these two conditions.

A disfunção executiva pode resultar de envolvimento do circuito pré-frontal que ocorre em doençasneurodegenerativas e distúrbios psiquiátricos. Além disso, várias condições neuropsiquiátricas, podem apresentarsobreposição de sintomas comportamentais e cognitivos, tornando o diagnóstico diferencial um desafio, especialmentedurante as fases iniciais. Neste sentido, a avaliação cognitiva pode contribuir para o diagnóstico diferencial, fornecendoum conjunto de medidas objetivas e quantificáveis com potencial para distinguir as condições clínicas percebidas emambientes clínicos comuns como bastante similar. Objetivo: O objetivo deste estudo foi o de investigar a utilidade do RastreioFrontal INECO (IFS) em diferenciar pacientes bv-FTD de pacientes com depressão maior. Métodos: Foram estudados 49pacientes com diagnóstico de bv-FTD e 30 pacientes com diagnóstico de depressão unipolar, que foram comparados comum grupo controle de 26 controles saudáveis usando o IFS, o Mini Exame do Estado Mental (MMSE) e Exame Cognitivode Addenbrooke-revisado (ACE-I). Resultados: Os grupos de pacientes diferiram significativamente no controle inibitóriomotor (U=437,0, p<0,01), memória de trabalho verbal (U=298,0, p<0,001), a memória de trabalho espacial (U=300,5,p<0,001), provérbios (U=341,5, p<0,001) e no controle inibitório verbal (U=316,0, p<0,001), com pacientes com bv-FTDtendo pontuação significativamente menor do que os pacientes com depressão. Conclusão: Nossos resultados sugeremque o IFS pode ser considerado uma ferramenta útil para detectar a disfunção executiva em depressão e pacientes bv-FTDe, talvez mais importante, que tem o potencial de ajudar na diferenciação dessas duas condições.

The correlation between abnormal metabolism in anterior cingulum cortex and executive dysfunction with major depression patients before and after antidepressant treatment / 中华行为医学与脑科学杂志

Objective To investigate neuro-biochemical changes of bilateral anterior cingulate cortex (ACC) in the patients with major depressive disorder (MDD) and the correlation between abnormal metabolism and the cognitive function before and after treatment.Methods Fifteen patients with major depression and 15age-,sex-and education-matched healthy controls (HC) were involved.The neurochemical abnormalities including the levels of N-acetylaspartate (NAA),choline-containing compounds,glutamate/glutamine and myoinostol were measured by single-voxel proton magnetic resonance spectroscopic (1H-MRS).The subjects were then assessed with executive function with neuropsychological tests including Wisconsin cards sorting test (WCST),verbal fluency Task (vF),StrooP Color and Word Test (SCWT).After this,the patients took selectivity serotonin reuptake inhibitors (SSRIs) for eight weeks.Then,we examined the changes in NAA,Cho,Glx and MI in ACC of patients and assessed their executive function with the neuropsychological tests again.Results 1) In ACC,baseline NAA ((7.36 ± 1.67) mmol/L),GLx ((11.68 ± 1.65) mmol/L) and MI levels ((5.28 ± 0.66) mmol/L) were significantly lower in MDD compared to those of HC (NAA (9.27 ± 1.37)mmol/L,Glx (15.20 ± 1.91)mmol/L,MI (7.80 ± 2.73) mmol/L) (P ＜0.01) ; After treatment,the NAA ((9.34 ± 2.45) mmol/L) and Glx ((16.79 ±3.96) mmol/L) increased significantly after treatment compared to those prior to pretreatment (NAA(7.36 ± 1.67)mmol/L,Glx(11.68±1.65)mmol/L,P＜0.05).2) The normal controls exhibited better in Performance of WCST and Performance of completion time of SCWT than our MDD patients (P＜0.05 or P＜0.01).The patients made significant improvements in Performance of WCST and completion time of SCWT(C form) after treatment (P＜0.05 or P＜0.01).3) In post-treatment MDD,the ACC Glx level was significantly positively correlated with the categories completes of WCST (r=0.739,P=0.009) and inversely related with the numbers to complete the first categories of WCST (r=-0.699,P=0.017) and the completion time of SCWT(C form) (r=-0.651,P=0.030) ;elevated MI(r=-0.705,P=0.023) and NAA(r=-0.735,P=0.010) levels in ACC of post-treatment MDD were both negatively correlated with the numbers to complete the first categories of WCST.Conclusion The ACC may be a key region involved in antidepressant treatment in MDD.The increased ACC NAA,Glx and MI in MDD after treatment may be significantly correlated with the improve of executive function.

Advance in Rehabilitation for Post-stroke Executive Dysfunction (review) / 中国康复理论与实践

Executive dysfunction is one of the cognitive impairment in patients with stroke. This paper reviewed the assessment tools and rehabilitation approaches for post-stroke executive dysfunction, and the interactive game such as Xbox Kinect may be prospective reha-bilitation for executive dysfunction.

Depression and Executive Dysfunction in Stroke

Depression and executive dysfunction are common neuropsychiatric sequelae of stroke. Patients with stroke are more predisposed to depression and executive dysfunction compared to patients with similar degree of physical disability. Both depression and executive dysfunction are also associated with poor prognosis such as high mortality and delayed recovery after stroke. Complex neurobiological and anatomical mechanisms are associated with the development of depression and executive dysfunction after stroke. Activation of pro-inflammatory cytokines is thought to be associated with onset of depression, whereas injuries in frontal-subcortical circuit are thought to be a link between depression and executive dysfunction. Early detection of depressive symptoms and both pharmacological and non-pharmacological treatment would be helpful. In this review paper, the authors investigated 1) biological and neuroanatomical substrate for poststroke depression and executive dysfunction, 2) the relationship and common etiopathology for poststroke depression and executive dysfunction, and 3) pharmacological and non-pharmacological treatment for poststroke depression. The contents of the paper are as follows : the prevalence, clinical manifestation, and biological etiology for poststroke depression, neuroanatomical abnormalities as a common etiological factor for depression and executive dysfunction, pharmacotherapy and non-pharmacological approach.

The Relation between Bathing Habits, Cognitive Impairment, and Depressive State in Patients with Alzheimer Disease / 日本温泉気候物理医学会雑誌

 Because bathing frequency decrease as Alzheimer disease (AD) worsens, we investigated the relation between cognitive disfunction and bathing frequency.<br> We asked AD patients and their caregivers about the number of times the patient bathed per week before onset of dementia and the time of first clinical consultation. We investigated the relation between scores from a cognitive function test (Hasegawa’s Dementia Scale-Revised [HDS-R], the Mini Mental State Examination [MMSE] and Wechsler Adult Intelligence Scale-Revised [WAIS-R]), and a depression assessment (Zung Self-rating Depression Scale [SDS]) and number of baths taken per week.<br> Before onset of dementia, the average number of baths taken by 89 AD patients (26 men, 63 women; range: 63-90 years, average: 79.8 years), was 6.6 times/week. At evaluation time, this number had decreased significantly to 5.3 times/week (p<0.001). A significant positive correlation was found between perfomance Intelligence Quotient (IQ) and total IQ of the WAIS-R and number of baths (p<0.001, p<0.01, respectively). No significant correlation coefficient was found between HDS-R, MMSE, verbal IQ of the WAIS-R and the SDS and number of baths. Reasons of the patients gave for less frequent bathing were that bathing was troublesome or was forgotten and that thermoregulation of bath water had become impossible.<br> The results suggested that in AD patients, number of baths taken decreased with aggravation of cognitive dysfunction and that there were multiple participating factors including memory disturbance, depressive state, and, particularly, executive dysfunction.

The Relation between Bathing Habits, Cognitive Impairment, and Depressive State in Patients with Alzheimer Disease / 日本温泉気候物理医学会雑誌

 Because bathing frequency decrease as Alzheimer disease (AD) worsens, we investigated the relation between cognitive disfunction and bathing frequency.  We asked AD patients and their caregivers about the number of times the patient bathed per week before onset of dementia and the time of first clinical consultation. We investigated the relation between scores from a cognitive function test (Hasegawa’s Dementia Scale-Revised [HDS-R], the Mini Mental State Examination [MMSE] and Wechsler Adult Intelligence Scale-Revised [WAIS-R]), and a depression assessment (Zung Self-rating Depression Scale [SDS]) and number of baths taken per week.  Before onset of dementia, the average number of baths taken by 89 AD patients (26 men, 63 women; range: 63-90 years, average: 79.8 years), was 6.6 times/week. At evaluation time, this number had decreased significantly to 5.3 times/week (p<0.001). A significant positive correlation was found between perfomance Intelligence Quotient (IQ) and total IQ of the WAIS-R and number of baths (p<0.001, p<0.01, respectively). No significant correlation coefficient was found between HDS-R, MMSE, verbal IQ of the WAIS-R and the SDS and number of baths. Reasons of the patients gave for less frequent bathing were that bathing was troublesome or was forgotten and that thermoregulation of bath water had become impossible.  The results suggested that in AD patients, number of baths taken decreased with aggravation of cognitive dysfunction and that there were multiple participating factors including memory disturbance, depressive state, and, particularly, executive dysfunction.