Applicability of tactile memory examination as an option to visual- and verbal-based batteries / A aplicabilidade da avalição da memória tátil como uma opção para as baterias visuais a verbais

ABSTRACT The validity and applicability of tactile battery tests for the diagnosis and medical follow-up of patients with Alzheimer's disease and other dementia syndromes do not have their usefulness well understood in clinical practice. While haptic abilities in older individuals receive less attention, in earlier stages of human life they are well focused on. There are even fewer studies on tactile memory, including episodic memory of demented individuals with or without sensorial limitations. The applicability of a new haptic memory battery was evaluated in patients with Alzheimer's disease with mild or moderate commitment. Objective: The aim of this study is to apply a battery based on tactile perception, recognition, and recollection of everyday objects in patients with Alzheimer's disease, testing tactile delayed recall memory discrimination and late recognition to compare validated visual and verbal tests. Methods: Tactile-, visual-, and verbal-based memory performance was registered in 21 patients diagnosed with Alzheimer's disease. Results: Except for tactile identification, it showed that there was a close relationship between the three sensory modalities of memory, with an apparent better performance of tactile incidental memory and recognition compared with the test with pictures. Conclusions: The haptic evaluation of memory demonstrated applicability in the evaluation of memory dysfunction in patients with Alzheimer's disease. Further studies are needed to establish the sensibility and specificity of the proposed test that had a small sample size and many limitations.

RESUMO A aplicação de baterias baseadas em informações táteis para diagnóstico e acompanhamento de pacientes com doença de Alzheimer e outras demências não é muito difundida na prática clínica. Ao passo que a capacidade de reconhecimento tátil de objetos em crianças recebe bastante atenção dos pesquisadores, o mesmo não ocorre com indivíduos mais idosos. Existem ainda menos estudos abordando avaliação de memória episódica em pacientes idosos, com ou sem limitações sensoriais, como cegueira e surdez. O presente estudo propõe avaliar aplicabilidade de teste para avaliação de memória tátil em paciente com doença de Alzheimer. Objetivo: Aplicar em pacientes com doença de Alzheimer uma bateria baseada na percepção e reconhecimento táctil de objetos de uso cotidiano, avaliando a memória e reconhecimento tardio, comparado com testes visuais e verbais validados. Métodos: Foi avaliado o desempenho de baterias baseadas em informação táteis, visuais e verbais em 21 pacientes diagnosticados com a doença de Alzheimer. Resultados: Com a exceção da percepção tátil, foi demonstrada uma boa correlação entre as três modalidades de apresentação das informações a serem resgatadas tardiamente. Houve um desempenho aparentemente melhor do reconhecimento tátil quando comparado com apresentação de figuras impressas. Conclusões: A determinação da memória tátil em pacientes com doença de Alzheimer demonstrou ser aplicável como instrumento de avaliação dos distúrbios de memória presentes em portadores de doença de Alzheimer com comprometimento leve a moderado. As limitações do estudo, com reduzido tamanho da amostra, aponta para a necessidade de novos estudos com a devida validação, incluindo determinação de sensibilidade e especificidade, assim como pareamento, de acordo com sexo e idade com grupo controle.

Análisis bibliométrico de las funciones ejecutivas de adultos mayores en Iberoamérica / Bibliometric analysis of executive functions of older adults in Ibero-America

RESUMEN Objetivos: a) Verificar la cantidad de estudios efectuados en Iberoamérica sobre función ejecutiva (FE) en adultos mayores; b) Identificar los instrumentos utilizados para medir las FE en adultos mayores durante los años 2009-2018. Material y métodos: Se efectuó un estudio bibliométrico sobre las FE en adultos mayores de Iberoamérica. La búsqueda de información se hizo en las base de datos Scopus y Scielo. Se consideraron estudios iberoamericanos publicados en idioma español y portugués, utilizándose ocho palabras clave y cinco indicadores registrados. Resultados: Se identificaron un total de 12 investigaciones originales en seis países iberoamericanos (España, Argentina, Chile, Colombia, Cuba, y Perú). La mayor cantidad de investigaciones relacionadas con FE en asultos mayores tuvo lugar en los periodos 2009-2010 y 2013-2014. En estos estudios, se han utilizado varios instrumentos con el Trail Making Test (TMT) y la Frontal Assessment Battery (FAB) como los de uso más frecuente. Conclusiones: Parece existir un interés limitado por investigar las FE en adultos mayores de Iberoamérica. La mayoría de los estudios idntificados en esta indagación utilizaron como tests cognitivos el TMT y la FAB.

SUMMARY Objectives: a) To verify the number of studies on executive functions (EF) in older adults carried out in Ibero-America; b) To identify the instruments used to measure EF in older adults during the years 2009-2018. Material and methods: A bibliometric study on EF in older adults in Latin America was carried out through the Scopus and Scielo databases. Studies published in Spanish and Portuguese languages using eight keywords and five registered indicators. Results: Between 2009 and 2018, a total of 12 original investigations have been carried out in six Iberoamerican countries (Spain, Argentina, Chile, Colombia, Cuba, and Peru). Most EF-related investigations were reported duing the 2010-2009 and 2013-2014 periods. Several instruments were used, the Trail Making Test and the Frontal Assessment Battery being the most frequent. Conclusions: There seems to be a limited interest in investigating EF in older adults in Ibero-America. Most of these studies identified in this inquiry used the TMT and the FAB as cognitive tests.

Learning and memory and its relationship with the lateralization of epileptic focus in subjects with temporal lobe epilepsy / Aprendizagem e memória e sua relação com a lateralização do foco epileptogênico em sujeitos com epilepsia do lobo temporal

Background: In medial temporal lobe epilepsy (MTLE), previous studies addressing the hemispheric laterality of epileptogenic focus and its relationship with learning and memory processes have reported controversial findings. Objective: To compare the performance of MTLE patients according to the location of the epileptogenic focus on the left (MTLEL) or right temporal lobe (MTLER) on tasks of episodic learning and memory for verbal and visual content. Methods: One hundred patients with MTLEL and one hundred patients with MTLER were tested with the following tasks: the Rey Auditory Verbal Learning Test (RAVLT) and the Logical Memory-WMS-R to evaluate verbal learning and memory; and the Rey Visual Design Learning Test (RVDLT) and the Visual Reproduction-WMS-R to evaluate visual learning and memory. Results: The MTLEL sample showed significantly worse performance on the RAVLT (p < 0.005) and on the Logical Memory tests (p < 0.01) than MTLER subjects. However, there were no significant between-group differences in regard to the visual memory tests. Discussion: Our findings suggest that verbal learning and memory abilities are dependent on the structural and functional integrity of the left temporal lobe, while visual abilities are less dependent on the right temporal lobe...

Contexto: Estudos anteriores abordando a lateralidade hemisférica de foco epiléptico na epilepsia do lobo temporal mesial (ELTM) e sua relação com os processos de aprendizagem e memória têm relatado resultados controversos. Objetivo: Comparar o desempenho de pacientes com ELTM de acordo com a localização do foco epiléptico à esquerda (ELTME) ou à direita (ELTMD) em tarefas de aprendizagem e memória episódica para conteúdo verbal e visual. Métodos: Cem pacientes com ELTME e cem pacientes com ELTMD foram avaliados com os seguintes testes: Teste de Aprendizagem Auditiva Verbal de Rey (RAVLT) e Memória Lógica – WMS-R para avaliar aprendizagem e memória verbal e o Teste de Aprendizagem Visual para Desenhos de Rey (RVDLT) e Reprodução Visual – WMS-R para avaliar a aprendizagem e memória visual. Resultados: A amostra com ELTME mostrou desempenho significativamente pior no RAVLT (p < 0,005) e na Memória Lógica (p < 0,01) em comparação aos indivíduos ELTMD. No entanto, não houve diferenças significativas entre os grupos no que diz respeito aos testes de aprendizagem e memória visual. Conclusão: Nossos resultados sugerem que a aprendizagem e a memória verbais são dependentes da integridade estrutural e funcional do lobo temporal esquerdo, enquanto as capacidades de aprendizagem e memória visual são menos dependentes do lobo temporal direito...

Validación en español del test TYM para cribado de demencia en una población argentina / Spanish Validation of the TYM Test for Dementia Screening in an Argentine Population

El objetivo del presente trabajo fue validar y determinar los puntos de corte de un test neurocognitivo rápido de cribado de demencia llamado Test Your Memory ([TYM]; Test Your Memory - Evalúa Tu Memoria), traducido y modificado para adaptarlo a las características de una muestra de sujetos procedente de la ciudad de Rosario. Se compararon los resultados entre pacientes con demencia y controles normales apareados por edad y sexo. Para la validación y selección de puntos de corte del TYM se lo comparó con otros test estandarizados testigos (Test de Lobo o MEC, Addenbrook 's Cognitive Test en Español-Revisado o ACE-R y Test de Pfeiffer o PFAQ) en dos muestras de sujetos formadas por 50 pacientes dementes y 100 controles normales. Los pacientes con demencia completaron el TYM con puntaje promedio de 37/50 mientras que los controles puntuaron 47/50. La correlación con los otros tests fue muy buena. Un puntaje < 40/50 tuvo sensibilidad de 84% (95% CI 82.2-88.7%) y especificidad de 95% (95% CI 92.1-96.9%) en demencia. Los puntos de corte se establecieron usando curvas ROC. El TYM detectó 97% de pacientes con demencia mientras que MEC y ACER detectaron 78%. El valor predictivo negativo y positivo del TYM con un punto de corte de < 40 fue de 95% y 45%, respectivamente para una prevalencia de demencia de 5%. Este punto de corte se redujo a 39/50 para el caso de sujetos con bajo nivel de escolaridad (< 6 años de estudios). El TYM es simple y económico, se completó rápida y sencillamente por los pacientes y controles y constituyó una herramienta de cribado válida para la detección de demencia. Sin embargo se previene de su uso indiscriminado sin control por agentes sanitarios o clínicos, quienes deben estar a cargo de la puntuación e interpretación de los resultados.

The aim of this study is the validation and identification of cut-off scores for a fast neuro-cognitive test, called TYM (Test Your Memory) which goal is dementia screening. It was translated and adapted to meet a sample profiles that dwell in Rosario. Results between patients and normal controls matched for age and gender were compared. To establish cut-off points the TYM test was compared against other standardized well-known test (Test de Lobo or MEC, Addenbrook Cognitive Test in Spanish -Revised or ACE-R and Pfeiffer Test or PFAQ) in two samples of subjects with 50 demented patients and 100 normal controls each one. Patients with dementia completed the TYM with a mean score of 37/50 and controls scored 47/50. Correlation with the other tests was good. A score of <40/50 had a sensibility of 84% (95% CI 82.2-88.7%) and specificity of 95% (95% CI 92.1-96.9%) in dementia. Cut-off scores were settled using ROC curves. TYM detected 97% of dementia patients while MEC and ACE-R detected 78%. Positive and negative predictive value of the TYM with a cut-off score of <40 was 45% y 95% respectively, with a dementia prevalence rate of 5%. This cut-off score was reduced to 39/50 for those subjects with low level education (< 6 years of education). The TYM reveals as a simple, low cost test. Patients and controls completed the test fast and easily and it stands as a valid tool for dementia screening. A prevention must be made, however, against using it with no control by sanitary agents or clinics, who must be in charge of scoring and interpretation of the test results.

Cognitive Abilities and Auditory Event Related Potentials in Patients with Schizophrenia

OBJECTIVES: Event-related potentials have been suggested as an objective marker for brain functions in psychiatric disorders. This study was aimed to investigate the relationships between P300, the mismatch negativity (MMN), the loudness dependence of the auditory evoked potential (LDAEP), demographic and clinical variables including neurocognitive abilities in patients with schizophrenia. METHODS: P300, the MMN, and the LDAEP were measured and the Korean Stroop color-word test (K-stroop test) and the Wisconsin Card Sorting Test (WCST) were performed in 43 patients with schizophrenia. The relationship of the latency and amplitude of P300 and the MMN as well as regression slope of the LDAEP with demographic and clinical variables were analyzed by t-test and correlation analyses for categorical and continuous variables, respectively. RESULTS: After controlling for age, the latency of central (Cz) and parietal (Pz) P300 posivitively correlated with GAF at admission (Cz ; gamma = 0.385, p = 0.047, Pz ; gamma = 0.421, p = 0.029). The amplitude of parietal P300 correlated with the correction rate of the K-stroop test (gamma = 0.575, p = 0.002). In addition, the frontal (Fz) P300 latency tended to negatively correlated with the correction rate of the WCST (gamma = -0.371, p = 0.057). CONCLUSIONS: Our findings suggest that the values of P300 latency and amplitude might be correlated with GAF at admission and working memory measured by the K-Stroop test and the WCST. Meanwhile, the MMN and the LDAEP did not correlate with demographic and clinical variables. These results support the results of previous studies showing associations with P300 and impaired cognitive ability.

Factor Structure of the Neurocognitive Tests: An Application of the Confirmative Factor Analysis in Stabilized Schizophrenia Patients

The purpose of the present study was to identify the factor structure of neurocognitive tests used on schizophrenia patients by using the confirmative factor analysis, and to assess the factor score differences of schizophrenia patients and healthy controls. Comprehensive neurocognitive tests were administered to stabilized schizophrenia patients (N=114) and healthy controls (N=120). In the results of factor analyses on patients, the multifactorial-6-factor model, which included the speed of processing, working memory, verbal learning and memory, visual learning and memory, attention/vigilance, and reasoning/problem solving as suggested by the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS), showed the better goodness of fit than any of the other models tested. And assessing the group differences of factor scores, we found the patients performed worse than the controls in all factors, but the result showed meaningful variations of impairments across the cognitive factors. Our study identifies the six major domains with multifactorial structure of cognitive abilities in schizophrenia patients and confirms the distinctive impairment patterns of each cognitive domain. These results may have utility in better understanding the pathology of schizophrenia as well as in genetic studies.

Computerized Assessment of Neurocognitive function for Traumatic Brain Injury Patients / 신경정신의학

Irrespective of focal lesion in brain imaging study, the deficits in cognitive function have been reported in mild traumatic brain injury patients. Therefore, they have been asked sensitive and objective assessment tools measuring cognitive deficits. In this study, traumatic brain injury patients were classified into lesion group and non-lesion group by presence of focal lesion in brain imaging study. At the same time, Results of Bender-Gestalt test, Standard Progressive Matrices, Cognitrone, and Signal Detection were analyzed among the groups. We assessed usefulness of Standard Progressive Matrices as assessment tool of intelligence in traumatic brain injury patients by correlation coefficients between KWIS and Standard Progressive Matrices intelligence quotients. 1) Most lesion group showed severe deficits in cognitive function, and most non-lesion group showed severe somatic symptoms. 2) The lesion group showed higher Bender-Gestalt test total error score than non-lesion group. 3) There was no difference in HWIS intelligence quotients between lesion and non-lesion group. 4) The lesion group showed lower performance than normal control and non-lesion group as increasing complexity of Standard Progressive Matrices subset. 5) The lesion group showed poor performance than normal control group in Cognitrone. 6) There were higher correlation coefficients than normal control group between Standard Progressive Matrices intelligence quotients and KWIS intelligence quotients in traumatic brain injury patients. According to the above results, lesion group showed deficits in space-construction ability, fine-motor coordination ability, form-memory ability, and delayed response-time. Although there are no statistical significance, comparing with normal control group, non-lesion group showed different response-trend in Cognitrone. Considering somatic symptoms in most non-lesion group and contribution of psychological factors in maintenance of symptoms in mild traumatic brain injury patients, the differences in Cognitrone must be interpreted carefully. These result suggest than Standard Progressive Matrices can be a useful tool for assessment of intelligence in traumatic brain injury patients who showed deficits in cognitive function.

Correlation of Cognitive Function and Proton Magnetic Resonance Spectroscopic(1H MRS) Findings in Subclinical Hepatic Encephalopathy / 신경정신의학

OBJECTIVES: To investigate the relationship of neurochemical changes of brain in SCHE patients and the level of cognitive function, the authors measured hydrogen containing neurochemicals in two brain regions using 1H MRS, and compared those changes with the level of cognitive performances such as attention, visual analysis, or fine motor function. METHODS: A total of patients with liver cirrohosis were defined as SCHE, for they performed poorly(out of 1 SD of normative data) in more than one neuropsychological tests conventionally used(digit symbol and block design tests in KWIS, trail making test A and B). They were further evaluated in attentional ability and efficacy of visual analysis using Cognitrone subtest in Vienna Neurocognitive Test battery. Fine motor coordination were also measured by Grooved Pegboard test. Patients and 20 normal controls underwent proton MRS study. Proton containing neurochemicals, such as myoinositol(mI), N-acetyl-L-aspartate(NAA), creatine(Cr), choline(Cho) were measured from 2*2*2cm3 voxel of basal ganglia and parietal white matter using 1.5 tesla clinical MRI/MRS system. The ratios of above metabolites to Cr were analyzed. RESULTS: 1) Patients with SCHE showed reductions in Cho/Cr and mI/Cr in both basal ganglia and parietal white matter compared to normal subjects. 2) Performance of Grooved Pegboard test were negatively correlated with mI level of basal ganglia and with Cho level of parietal white matter(r=-0.59, p<.05). 3) Mean time of correct responses in Cognitrone test showed negative correlation with NAA level of parietal white matter(r=-0.55, p<.05). CONCLUSION: Certain neurocognitive disturbances in SCHE patients seemed to be related with neurochemical changes in basal ganglia or parietal white matter. To further elucidate the relationship of focal biochemical changes and neurocognitive deficits in SCHE patients, however, follow-up study according to the illness stage must be performed. Studies on other disorders showing similar cognitive deficit patterns would be helpful.