Características Cognitivas e Comportamentais Associadas à Distrofia Muscular de Duchenne: Revisão Integrativa / Cognitive and Behavioral Characteristics Associated with Duchenne Muscular Dystrophy: Integrative Review / Características Cognitivas y de Comportamiento Asociadas con la Distrofia Muscular de Duchenne: Revisión Integrativa

A Distrofia Muscular de Duchenne (DMD) é uma doença neuromuscular progressiva recessiva causada por mutações genéticas ligadas ao cromossomo X. Além do enfraquecimento muscular progressivo, a condição é associada a alterações neuropsicológicas. O objetivo deste estudo foi realizar uma revisão sistematizada da temática, para investigar os aspectos cognitivos e comportamentais associados à DMD pela literatura, nos últimos dez anos (2011-2021). Realizou-se uma revisão integrativa da literatura, com o propósito de sintetizar e analisar o conhecimento sobre o tema no campo científico, sendo efetuada busca nas bases de dados e motores de busca Science Direct, SciELO, PubMed e BVS. Após consideração dos critérios de inclusão e exclusão, foram selecionados 29 artigos para análise. Os resultados endossaram que alterações cognitivas e do neurodesenvolvimento, bem como de problemas comportamentais parecem ser mais prováveis na DMD, em comparação com a população geral. Verificou-se escassez de estudos empíricos brasileiros e a necessidade de avaliar e intervir nos âmbitos neuropsicológico e psicossocial, de forma precoce, contínua e multidisciplinar, no intuito de atender às necessidades desse grupo.

Duchenne Muscular Dystrophy (DMD) is a recessive progressive neuromuscular disease caused by X-linked genetic mutations. In addition to progressive muscle weakness, the condition is associated with neuropsychological alterations. The aim of this study was to perform a systematic review about the theme, to investigate the cognitive and behavioral aspects associated with DMD in the literature, over the last ten years (2011-2021). An integrative literature review was carried out, with the purpose of synthesizing and analyzing the knowledge on the subject in the scientific field, with a search in the databases and search engines Science Direct, SciELO, PubMed and BVS. After considering the inclusion and exclusion criteria, 29 articles were selected for analysis. The results endorsed that cognitive and neurodevelopmental alterations and behavioral problems seem to be more likely in DMD, when compared to the general population. There was a lack of brazilian empirical studies and the need to assess and intervene in the neuropsychological and psychosocial spheres was observed, in an early, continuous and multidisciplinary way, in order to meet the needs of this group.

La distrofia muscular de Duchenne (DMD) es una enfermedad neuromuscular progresiva recesiva causada por mutaciones genéticas ligadas al cromosoma X. Además de la debilidad muscular progresiva, la afección se asocia con cambios neuropsicológicos. El objetivo de este estudio fue realizar una revisión sistemática del tema, para investigar los aspectos cognitivos y conductuales asociados a la DMD en la literatura, en los últimos diez años (2011-2021). Se realizó una revisión integradora de la literatura, con el propósito de sintetizar y analizar el conocimiento sobre el tema en el campo científico, mediante una búsqueda en las bases de datos y motores de búsqueda Science Direct, SciELO, PubMed y BVS. Después de considerar los criterios de inclusión y exclusión, se seleccionaron 29 artículos para su análisis. Los resultados respaldaron que alteraciones cognitivas y del neurodesarrollo, así como problemas del comportamiento parecen ser más probables en la DMD en comparación con la población general. Se observó la escasez de estudios empíricos brasileños, así como la necesidad de evaluar e intervenir en los ámbitos neuropsicológico y psicosocial, de forma precoz, continua y multidisciplinar, para atender las necesidades de esta población.

Perfil neuropsicológico en pacientes con trauma craneoencefálico atendidos en un hospital de alta complejidad de Medellín, Colombia / Neuropsychological profile of patients with traumatic brain injury evaluated in a high complexity hospital in Medellin, Colombia

RESUMEN INTRODUCCIÓN: El trauma craneoencefálico (TCE) es una de las principales causas de daño cerebral y discapacidad en personas menores de 40 años. Según su severidad, se puede clasificar en leve, moderado o grave, en función de la escala de coma de Glasgow. Muchos pacientes quedan con secuelas neuropsicológicas y comportamentales que pueden afectar en mayor o menor grado su funcionalidad. El objetivo del estudio fue determinar las diferencias en el perfil neuropsicológico, las características clínicas y el compromiso funcional en pacientes con TCE según la clasificación de la severidad. METODOLOGÍA: Se realizó un estudio observacional, analítico, de corte transversal. Se revisaron las historias clínicas y los reportes neuropsicológicos de adultos con TCE evaluados por neuropsicología entre los años 2014 y 2019. Se compararon los resultados de pruebas neuropsicológicas, síndromes neuropsicológicos y funcionalidad según la severidad del TCE. RESULTADOS: Se estudiaron 48 pacientes, 38 de ellos hombres (73 %), con una mediana de edad de 35 años (RI: 25-51). En 14 casos el TCE fue leve, en 18 moderado y en 16 severo. El síndrome neuropsicológico más frente fue el amnésico (100 %), seguido del disejecutivo (79 %) y el compromiso en la atención (77 %). No se encontraron diferencias según severidad del TCE. Cuarenta y un pacientes (85 %) presentaron cambios comportamentales, 14 (29 %) experimentaron alteración en las actividades básicas de la vida diaria y 32 (68 %) en las actividades instrumentales. CONCLUSIONES: Las alteraciones neuropsicológicas, comportamentales y funcionales posteriores a un TCE son frecuentes, sin embargo, no se encontraron diferencias significativas según severidad del trauma.

ABSTRACT INTRODUCTION: Traumatic Brain Injury (TBI) is one of the main causes of brain damage and disability in people under 40 years of age. The severity of TBI can be classified as mild, moderate, or severe based on the Glasgow coma scale. Many patients are left with neuropsychological and behavioral sequelae that can affect functionality to a greater or lesser degree. The objective of the study was to determine the differences in the neuropsychological profile, clinical characteristics and functional impairment in patients with TBI according to severity. METHODOLOGY: An observational, analytical, cross-sectional study was carried out. The clinical records and neuropsychological reports of adults with TBI evaluated between 2014 and 2019 were reviewed. The results of neuropsychological tests, neuropsychological syndromes, and functionality according to severity of TBI were compared. RESULTS: 48 patients were studied, 35 were males (73 %), the median age was 35 years (IR: 25-51). In 14 TBI was mild, in 18 moderate and 16 severe. The most common neuropsychological syndrome was amnesic (100 %) followed by dysexecutive (79 %) and attentional commitment (77 %). No differences were found according to severity of TBI. 41 patients (85 %) presented behavioral changes, 14 (29 %) presented alteration in basic activities of daily life and 32 (68 %) in instrumental activities. CONCLUSIONS: Neuropsychological, behavioral and functional alterations are frequent after TBI; however, no significant differences were found according to the severity of the trauma.

Cognitive Deficits And Alcohol Dependence Syndrome – A Paradigm Relationship

@#Objectives: Background- Chronic alcohol use causes not only physical consequences but causes cognitive deficits also. 50 and 80% of the Alcohol dependent syndrome patients present with cognitive deficits. These cognitive deficits will significantly contribute to poor functional outcomes which lead to reduced health related quality of life. Objectives- To assess Cognitive deficits in Alcohol Dependent syndrome (ADS). To find the relationship between early onset of alcohol use, duration of Alcohol use and large quantity of alcohol use with Cognitive deficit pattern. MethodA cross sectional study was done on 38 patients with ADS, aged 18- 45 years, education ≥7th std, with no major psychiatric or medical co- morbidities. AUDIT scale was administered to look for dependence pattern, CIWA scale was applied to look for withdrawal symptoms. MoCA scale was applied to screen for cognitive impairment in patient with MMSE score (25 and above). In subjects with cognitive impairment on MoCA scale (25 and below), neuropsychological assessment was done using neuropsychological battery of test from NIMHANS Neuropsych battery standardised on Indian Population. Results- There was impairment in the Cognitive domains as follows, speed of processing (BACS - 100%), attention (DF- 97%) working memory (DF-97%, DB-100%, LNS - 84%), visual memory (100%), visuospatial memory (78%), executive functions (CT2 -92%), reasoning and problem solving (maze- 81%) in majority and a significant relation between early onset of alcohol use, duration of Alcohol use. Conclusions- There is a significant impairment in the areas of speed of processing, attention, executive functions, reasoning and problem solving domains. Significant association between Age of onset of ADS (Early onset) with Executive functions. Attention domain was found to be associated with longer duration of alcohol intake, whereas working memory deficits was associated with large quantity of alcohol intake.

Eficacia de la rehabilitación cognitiva en un paciente con esclerosis múltiple progresiva primaria / Efficacy of cognitive rehabilitation in a patient with primary progressive multiple sclerosis

La esclerosis múltiple (EM) es una enfermedad inflamatoria crónica que cursa con la desmielinización y la neurodegeneración a nivel del sistema nervioso central. Existen tres tipos de EM en función de la progresión de la enfermedad, pero la mayor parte de los pacientes tienden a presentar déficits cognitivos. Por lo tanto, resulta imprescindible el desarrollo de programas de entrenamiento cognitivos dirigidos a la mejora de estos déficits y, en definitiva, a la mejora de la calidad de vida de estos pacientes. En este sentido, el objetivo principal de este estudio fue la puesta en marcha de un programa de entrenamiento cognitivo dirigido a un paciente con esclerosis múltiple progresiva primaria (EMPP) a lo largo de un año. Los resultados pusieron de manifiesto que algunos de los déficits cognitivos que presentó inicialmente el paciente mejoraron tras varios meses de intervención. En este sentido, el paciente presentó notables mejoras en el control inhibitorio y la flexibilidad cognitiva. No obstante, los déficits en la velocidad de procesamiento se mantuvieron constantes a lo largo de toda la intervención. Asimismo, aparecieron otros déficits a lo largo de la intervención que remitieron tras la adecuación de los objetivos de intervención. Por todo ello, nuestro estudio reforzó la importancia de la puesta en marcha de los programas de rehabilitación cognitiva dirigidos a pacientes con enfermedades desmielinizantes para paliar las secuelas cognitivas derivadas de las mismas. Además, es importante que estos programas de entrenamiento cognitivo sean revisados periódicamente para adecuar los objetivos del tratamiento.

Multiple sclerosis (MS) is a chronic inflammatory disease that involves demyelination and neurodegeneration at the level of the central nervous system. Despite the different characteristics of each of the three types of MS, most patients with this disease present significant cognitive deficits. Therefore, it is essential to develop cognitive training programs to improve these deficits and, ultimately, increase the quality of life of these patients. Thus, the main objective of this study was to implement a one-year cognitive training program with a patient with progressive primary multiple sclerosis (PPMS). The results showed that some of the cognitive deficits the patient initially presented improved after several months of intervention. In this regard, the patient presented noteworthy improvements in inhibitory control and cognitive flexibility. However, deficits in processing speed remained constant throughout the intervention. Likewise, other deficits appeared during the intervention that remitted after adapting the intervention objectives to the patient's needs. Therefore, our study reinforces the importance of implementing cognitive rehabilitation programs for patients with demyelinating diseases to alleviate the cognitive sequelae they produce. In addition, it is important to evaluate these cognitive training programs periodically in order to adapt the objectives and improve the patient's functionality.

Clinical characteristics of cognitive deficits in major depressive disorder: a 6-month prospective study

Abstract Background Previous studies have shown that major depressive disorder (MDD) is associated with a variety of cognitive deficits, which can persist even in remitted states. Nevertheless, the relationship between the cognitive and affective symptoms in depression remains obscure. The aim of the present study was to explore the clinical characteristics and correlates of the cognitive deficits in patients with MDD. Methods Clinical and neuropsychological assessments were conducted at baseline and 6-month follow-ups. The severity of the disease and the effect of treatment were assessed with the Hamilton Depression Scale-17. Neuropsychological tests, including the digital symbol substitution test and digit span test, were administered to 67 depressed patients and 56 healthy participants. Results MDD patients showed impairments in memory, attention, and executive function at baseline. After the 6-month treatment phase, patients in remission showed significant alleviation of these cognitive deficits, although impairments in attention and executive function were still present when compared to controls. Discussion Significant cognitive deficits are present in MDD. The speed of remission of cognitive functions seems to be slower than and inconsistent with emotional symptoms, which provides new support for the argument that cognitive deficits are independent factors from the emotional symptoms in MDD.

Frequency of Impairment of Executive Functioning among Patients having Obsessive-Compulsive Disorder

Introduction: Obsessive-compulsive Disorder (OCD) isa highly debilitating neuropsychiatric condition with anestimated lifetime prevalence of 2-3 percent. Executivefunction refers to the ability to use high level oversightfunctions to modulate memory, sensory information,cognition, and affect as a situation evolves, and use ofstrategies that must shift to maintain performance. Impairmentof nonverbal memory has been reported in studies of patientswith OCD. The objective of present study was to determinethe frequency of impairment of executive functioning amongpatients having obsessive-compulsive disorder.Material and methods: A total of 150 patients fulfillingselection criteria were enrolled through the OutpatientsDepartment of Psychiatry, Services hospital Lahore. Aftertaking informed consent, the demographic data i.e. name, age,gender and duration of OCD were noted. All patients werescreened using the frontal lobe assessment battery (FAB) bythe researcher himself. Impaired executive functioning wascategorized as a calculated FAB score <12.Results: The study revealed that, out of 150 cases of OCD,frequency of impairment of executive functioning amongpatients was calculated as 22.67%(n=34). 65.33%(n=98)participants were between 18-30 years of age (M=30.05,S.D+5.83 years), 54.67%(n=82) were male and 45.33%(n=68)were females.Conclusion: Thus, it is concluded that executive functioningis impaired frequently among patients having obsessivecompulsive disorder. So, it is recommended that executivefunctioning should be monitored among patients who presentwith OCD. However, it is also required that every setup shouldhave their surveillance in order to know the frequency of theproblem.

Steroid induced psychiatric adverse effects: an overview of risk factors, clinical features and management

Corticosteroids have been in use since the past five decades as anti-inflammatory and immunosuppressive drugs for the treatment of several pathologies such as asthma, allergy, rheumatoid arthritis, and dermatological disorders. Adverse effects include growth retardation in children, immunosuppression, hypertension, hyperglycemia, inhibition of wound repair, osteoporosis, metabolic disturbances, glaucoma, and cataracts. The psychiatric effects of steroids are due to the wide expression of Glucocorticoid Receptors in the brain, and their long-term modulation can lead to functional and anatomical alterations along with hippocampal dysfunction. In most cases, the psychiatric symptoms disappear on cessation of steroid therapy; others may require some form of therapeutic management. A search was conducted for clinically relevant articles from 1971 to 2016 by including the terms corticosteroids, mania, depression, psychosis and cognitive defects. About one-fifth of patients receiving high doses of corticosteroids develop psychiatric symptoms. These symptoms are observed to be dose-dependent and generally occur during the first few weeks of therapy. Lithium has a preventive as well as therapeutic role, while antipsychotics are reserved for high risk cases with predominant psychotic symptoms. Psychiatric effects of long term steroid therapy have become increasingly common nowadays due to long duration of treatment of many chronic respiratory and orthopedic illnesses. Reduction in the dose or complete discontinuation of steroid therapy has been proven beneficial in many patients. Among the therapeutic options, lithium has a definitive role, both in the prevention as well as treatment of psychiatric symptoms. Better co-ordination between the physician and psychiatrist can go a long way to improve the quality of life in these patients.

Periodontal disease and cognitive deficits: A systematic review and meta-analysis

@#Background: Previous studies showed controversial findings for correlation of periodontal disease and cognitive deficits. Methods: We searched systematically for studies pertaining to correlation of periodontal disease and cognitive deficits published between August 1980 and December 2019 on Web of Science and PubMed. We combined the data extracted from the included studies to determine the correlation between periodontal disease and cognitive deficits. Results: Our analysis indicated a higher risk of cognitive deficits in those with moderate to severe periodontal disease when compared to those with mild or no periodontal disease (odds ratio (OR) = 1.38 (95% confidence intervals (CI): 1.28-1.48). Subgroup analysis showed significant correlations in only case-control and cohort studies (case-control studies: OR = 1.49 (95% CI: 1.24-1.80); cohort studies: relative risk (RR) = 1.33 (95% CI: 1.22-1.45)). Subgroup analysis also indicated that moderate to severe periodontal disease was correlated to increased dementia and Alzheimer disease risks, whereas no significant correlation was found between periodontal disease and mild cognitive impairment (dementia: OR/RRs = 1.32 (95% CI: 1.22-1.44); Alzheimer disease: OR/RRs = 1.51 (95% CI: 1.20-1.90); Mild cognitive impairment: OR/RRs = 1.31 (95% CI: 0.89-1.94)). Furthermore, subgroup analysis showed significant correlations between cognitive deficits and tooth loss, periodontitis, whereas no significant correlation was found between deep periodontal pockets and cognitive deficits (tooth loss: OR/RRs = 1.57 (95% CI: 1.39- 1.77); periodontitis: OR/RRs = 1.43 (95% CI: 1.03-2.00); deep periodontal pockets: OR/RRs = 1.24 (95% CI: 0.77-2.00)). Conclusions: This review suggests a significant correlation between periodontal disease and cognitive deficits. Interventional studies for periodontal disease may be beneficial for patients with cognitive deficits

Monitoreo de fuente y funcionamiento cognitivo en personas con enfermedades mentales severas / Source monitoring and cognitive functioning in people with severe mental illness

Resumen Monitoreo de Fuente, se define como "establecimiento del origen de memorias, conocimientos y creencias". Por su dependencia del funcionamiento cognitivo, el objetivo de esta investigación es evaluar, en una prueba de Monitoreo de Fuente, a un grupo de personas con trastornos psiquiátricos (esquizofrenia, bipolaridad), caracterizados por la presencia de alteraciones cognitivas significativas. Métodos: 90 sujetos (20-55 años), con diagnóstico de esquizofrenia, trastorno bipolar y controles sanos. Todos los pacientes se encontraban estables en su condición clínica. Los sujetos participantes completaron una evaluación neuropsicológica y una prueba de Monitoreo de Fuente, consistente en identificar el origen propio o ajeno, de una lista de palabras. Resultados: Ambos grupos de pacientes, mostraron un peor desempeño que el grupo control, en la prueba de Monitoreo de Fuente. Los resultados se correlacionaron, con las pruebas de aprendizaje verbal, atención visual y flexibilidad cognitiva. La regresión lineal múltiple, muestra que las fallas en reconocer las palabras ajenas, se explican por el diagnóstico de trastorno afectivo bipolar y el desempeño en la función de aprendizaje verbal, mientras que las fallas del reconocimiento de las palabras propias, se explican por el diagnóstico de los sujetos. Adicionalmente, las personas con esquizofrenia mostraron una mayor tendencia a atribuirse a sí mismas, palabras de origen externo. Conclusiones: Ambos grupos de pacientes, rindieron menos que el grupo control, en la prueba de Monitoreo de Fuente, pero sólo algunos de los resultados se asocian directamente con el funcionamiento cognitivo, por lo que podría tratarse más bien de una habilidad metacognitiva.

Source Monitoring, is defined as "establishing the origin of memories, knowledge and beliefs" Considering its dependence on cognitive functioning, our aim was to assess the performance in a Source Monitoring test, of a group of people with psychiatric disorders (schizophrenia, bipolar disorder), characterized by the presence of significant cognitive deficits. Methods: 90 subjects (20-55 years) with diagnosis of schizophrenia, bipolar disorder and healthy controls. All patients were stable in their clinical condition. Participant completed a neuropsychological evaluation and a Source Monitoring test, in which they were asked to identify the origin (own- other..) of a list of words. Results: Both groups of patients had a worse performance than the control group, in the Source Monitoring test. The results were correlated, with verbal learning, visual attention and cognitive flexibility tests. Multiple linear regression shows that failures in recognizing the foreign words are explained by the diagnosis of bipolar affective disorder and performance in the verbal learning function, whereas the failures of the recognition of the own words are explained by the diagnosis of subjects. In addition, people with schizophrenia showed a greater tendency to attribute to themselves, words of external origin. Conclusions: Both groups of patients performed worse than the control group in the source monitoring test, but only some of the results were directly associated with cognitive functioning. The authors propose that source monitoring may depend of metacognitive abilities.

Persistently Upregulated Hippocampal mTOR Signals Mediated by Fecal SCFAs Impair Memory in Male Pups with SMM Exposure in Utero / 生物医学与环境科学（英文）

OBJECTIVE@#To investigate the molecular mechanisms of the adverse effects of exposure to sulfamonomethoxin (SMM) in pregnancy on the neurobehavioral development of male offspring.@*METHODS@#Pregnant mice were randomly divided into four groups: control- (normal saline), low- [10 mg/(kg•day)], middle- [50 mg/(kg•day)], and high-dose [200 mg/(kg•day)] groups, which received SMM by gavage daily during gestational days 1-18. We measured the levels of short-chain fatty acids (SCFAs) in feces from dams and male pups. Furthermore, we analyzed the mRNA and protein levels of genes involved in the mammalian target of rapamycin (mTOR) pathway in the hippocampus of male pups by RT-PCR or Western blotting.@*RESULTS@#Fecal SCFA concentrations were significantly decreased in dams. Moreover, the production of individual fecal SCFAs was unbalanced, with a tendency for an increased level of total fecal SCFAs in male pups on postnatal day (PND) 22 and 56. Furthermore, the phosphatidylinositol 3-kinase (PI3k)/protein kinase B (AKT)/mTOR or mTOR/ribosomal protein S6 kinase 1 (S6K1)/4EBP1 signaling pathway was continuously upregulated until PND 56 in male offspring. In addition, the expression of Sepiapterin Reductase (SPR), a potential target of mTOR, was inhibited.@*CONCLUSION@#In utero exposure to SMM, persistent upregulation of the hippocampal mTOR pathway related to dysfunction of the gut (SCFA)-brain axis may contribute to cognitive deficits in male offspring.

Perfil neuropsicológico y efectos de la rehabilitación cognitiva en la leucemia linfoblástica aguda: a propósito de un caso / Neuropsychological profile and cognitive rehabilitation training effects on acute lymphoblastic leukaemia: a case study

La Leucemia Linfoblástica Aguda (LLA) infantil es el cáncer pediátrico más frecuente. Actualmente cuenta con un alto porcentaje de supervivencia, pero dichos pacientes presentan secuelas cognitivas secundarias a la enfermedad debidas, principalmente, al tratamiento médico recibido para evitar la recidiva del cáncer. Por lo tanto, resulta necesaria la implementación de programas de rehabilitación cognitiva específicos para este tipo de población. Es por ello que el objetivo del presente estudio fue describir los déficits cognitivos en un varón de 17 años que fue diagnosticado con LLA a los 9 años. Tras la valoración neuropsicológica inicial se desarrolló un programa de rehabilitación cognitiva intensivo durante dos años consecutivos. Realizamos un estudio pre-post en el que administramos el Conners Continuous Performance Test (CPT-II) y la Escala de Inteligencia de Wechsler para niños (WISC-IV). Los resultados, antes de la intervención, mostraron que el paciente manifestaba una menor velocidad de procesamiento y dificultades de atención sostenida y alternante, comprensión verbal y razonamiento perceptivo. Además, también presentó un número considerable de errores perseverativos, signo de dificultades de flexibilidad cognitiva y control inhibitorio. Dichos déficits mejoraron notablemente tras el programa de rehabilitación cognitiva. En conclusión, nuestro estudio pone de manifiesto la necesidad de aplicar programas de rehabilitación cognitiva tempranos para paliar las secuelas cognitivas derivadas de la LLA y de su tratamiento médico, así como mejorar la calidad de vida del paciente, ya que las mejoras cognitivas redundarán en su rendimiento académico y en su funcionamiento cotidiano.

Childhood Acute Lymphoblastic Leukemia (ALL) is the most common pediatric cancer. It currently has a high survival rate, but these patients have cognitive sequelae secondary to the disease, mainly due to the medical treatment received to prevent cancer recurrence. Therefore, it is necessary to implement specific cognitive rehabilitation programs for this type of population. Hence, the main objective of this study was to describe cognitive deficits in a 17-year-old male who was diagnosed with ALL when he was 9 years old. After the initial neuropsychological evaluation, an intensive cognitive rehabilitation program was developed during two consecutive years. We conducted a pre-post study in which we administered the Conners Continuous Performance Test (CPT-II) and the Wechsler Intelligence Scale for Children (WISC-IV). Results, before the intervention, showed that the patient presented a lower processing speed and difficulties of sustained and alternating attention, verbal comprehension and perceptive reasoning; in addition to a large number of perseverative errors, sign of self-monitoring difficulties and inhibitory control. These deficits improved markedly after a program of cognitive rehabilitation. In conclusion, our study highlights the need to apply early cognitive rehabilitation programs to alleviate the cognitive sequelae derived from ALL and its medical treatment. In addition, any improvement in their cognitive capabilities will have a positive impact in their academic performance and quality of life.

Analysis of the influencing factors for the cognitive deficits in schizophrenic patients with diabetes / 中华行为医学与脑科学杂志

Objective To investigate the influencing factors of the cognitive deficits in schizophrenic patients with diabetes.Methods 578 inpatients with schizophrenia and 400 healthy adults were collected.578 schizophrenic patients were divided into schizophrenia group with type 2 diabetes (combined group,n=277) and schizophrenia without type 2 diabetes (single disease group,n=301).The cognitive function of all subjects were examined by the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS).The clinical symptoms of patients with schizophrenia were measured with the Positive and Negative Syndrome Scale (PANSS).Fasting glucose,lipids,hemoglobin A1c (HbA1c) and insulin levels were measured.Results The total score and factor scores of RBANS in the combined group were lower than those in the healthy control group (total score (70.51 ± 14.43) vs (80.04 ± 15.14),immediate memory (62.65 ± 16.81) vs (75.66± 17.33),visual span(83.60±20.81) vs (87.61 ± 15.61),verbal function(85.58± 14.64) vs (93.88± 13.10),attention function (73.66± 17.52) vs (87.42±20.37),delayed memory(75.27± 17.80) vs (86.27± 15.27),all P＜0.05).The total score of RBANS,immediate memory and attention function factor were lower in the combined group than that in the single disease group ((70.51±14.43) vs (75.02±15.25),(62.65±16.81) vs (67.37±19.12),(73.66±17.52) vs (84.17±15.22),all P＜0.05).Multiple linear stepwise regression analysis showed that education,negative symptoms,positive symptoms,BMI,HbAc 1,course of disease and antipsychotic type were the influencing factors of cognitive impairment in schizophrenic patients with diabetes.Conclusion The cognitive impairment of schizophrenic patients with diabetes is more serious and affected by many factors.Targeted early intervention can help reduce cognitive impairment.

Interventions for children with dyslexia: A review on current intervention methods

@#Introduction: Dyslexia is a neurobiological impairment that primarily affects reading ability. It is commonly known as a reading disorder which is likely to be present at birth and is generally identified at pre-school level. Dyslexia is manifested through difficulties with accurate word recognition and also by poor performance in reading and writing. Method: The main objective of this paper is to review the various methods or treatments that are used to manage the literacy and cognitive abilities for children with dyslexia particularly in Malaysia. The articles were obtained from online databases such as PubMed, Ebscohost and Medline during the time frame of six years starting from 2000 until 2016. An initial count of 300 articles were generated but only 13 articles met the inclusive criteria. Results: There are a few types of interventions such as the multisensory method, the phonological intervention, and the cognitive training method which can be used to improve literacy and cognitive deficits among children with dyslexia. In Malaysia, most of the treatments are focused on the aspects of language such as word mastery, alphabet identification and writing skills. The cognitive training were carried out to improve specific domain such as visuospatial skills, memory skills and psychomotor skills. Conclusion: There is yet no studies which has employed the comprehensive method of combining the intervention of cognitive functions and linguistics-literacy deficits. It is imperative that researchers in Malaysia go beyond literacy skills and take into consideration the underlying cognitive functions which contribute to the specific reading and writing difficulties of Malaysian children with dyslexia.

Mild cognitive impairment and progression to dementia of Alzheimer's disease / Comprometimento cognitivo leve e progressão para a demência da doença de Alzheimer

Summary The increase in life expectancy in the Brazilian population raises questions about the preparation of the public health system in identifying elderly patients with signs of cognitive impairment. Currently, as a consequence of the long duration of preclinical phase of Alzheimer's disease, efforts of early detection have been emphasized. Clinical dementia presents an important impact on the individual's caregivers, family, society and economy. Identifying individuals who already have some cognitive impairment, despite remaining functional, as well as analyzing associated comorbidities, constitutes an opportunity to analyze possibilities for future interventions. Dementias are clinical conditions that impose a burden on the health system with its high costs, whereas the identification of individuals with cognitive impairment without dementia can aid patients and their families to plan the future and mitigate costs. This narrative revision can provide general practitioners with more information on the subject.

Resumo O aumento da expectativa de vida da população brasileira faz surgir questões sobre o preparo do sistema de saúde pública na identificação de pacientes idosos com sinais de alteração cognitiva. Atualmente, como consequência da longa duração da fase pré-clínica da doença de Alzheimer (DA), existe maior ênfase sobre a detecção precoce. A demência apresenta um importante impacto sobre a família, os cuidadores, a sociedade e a economia. Identificar indivíduos que já apresentam algum comprometimento cognitivo, embora eles mantenham a funcionalidade, bem como analisar as comorbidades associadas constituem oportunidades para direcionar futuras intervenções. Demências são doenças que impõem sobrecarga ao sistema público de saúde, com altos custos. A identificação de indivíduos com alteração cognitiva sem demência pode adicionar planejamentos futuros por parte do próprio doente, da sua família e dos cuidadores, resultando em menor sobrecarga física e emocional para todos os envolvidos. Esta revisão narrativa tem como objetivo ajudar os clínicos gerais a atuar na detecção dos idosos que se encontram em risco de desenvolver demência.

El déficit cognitivo en lupus eritematoso: a propósito de un caso / Cognitive impairment in lupus erythematosus: a case report

RESUMEN El lupus eritematoso es una enfermedad autoinmune sistémica de etiología desconocida, que afecta principalmente a mujeres entre 20 y 50 años de edad, puede manifestarse de diversas maneras clínicas. El déficit cognitivo es uno de los síndromes neuropsiquiátricos más prevalentes en dicha enfermedad, pero no se ha descrito un perfil específico del deterioro. Existen dificultades en el proceso de detección del déficit cognitivo, debido a la propia variabilidad de la clínica y a las limitaciones de los instrumentos de valoración existentes. Se recomienda el uso de pruebas de neuroimagen y la exploración neuropsicológica como formas de evaluación. La evolución y el tratamiento, tanto farmacológico como la rehabilitación cognitiva, están influidos por la etiología del deterioro. Paciente mujer de 54 años diagnosticada de lupus eritematoso, se deriva para estudio neuropsicológico por problemas de concentración y de memoria reciente, presentó alteración en pruebas de neuroimagen, pero no se presentó repercusión en la autonomía personal. Las pruebas de cribado de déficit cognitivo presentan una controvertida fiabilidad para personas con lupus eritematoso. Es necesario realizar una exploración neuropsicológica exhaustiva que incluya la valoración del rendimiento cognitivo y de la funcionalidad. Los déficits (cognitivos) son variados y el curso y el tratamiento dependerán de la etiología del déficit (primario vs. secundario).

SUMMARY Lupus erythematosus is a systemic autoimmune disease with unknown etiology that mainly affects women aged 20-50 years and it can have very different clinical manifestations. Cognitive deficit is one of the most prevalent neuropsychiatric syndromes in lupus erythematosus, but a specific profile was never described for it. There are difficulties in the assessment process due to the variability of clinical symptoms and tools limitations. Neuroi-maging and neuropsychological examination are recommended to assess cognitive impairment. The evolution and treatment (pharmacological and cognitive rehabilitation) are influenced by etiology. Case: Woman (54 years) diagnosed with lupus erythematosus who was sent to a neuropsychological study due to her concentration and short-term memory problems. She showed alteration in neuroimaging studies, but she maintains personal autonomy. Conclusion: screening tests of cognitive impairment present reliability controversial for people with lupus erythematosus. An extensive neuropsychological assessment is necessary, including cognitive performance and functionality. Cognitive Impairment are varied, and the course and treatment depend on the etiology (primary vs. secondary).

Recent progress in study onneuroprotection of phosphodiesterase 5 inhibitors / 中国药理学通报

In recent years,the role of phosphodiesterase 5(PDE5)has been highlighted in the development and progression of neurological disease.PDE5 inhibitors show significant effect of neruoprotection,which may be related with some effects such as resistance to stroke,anti-oxidation,inhibition of neuroinflammation and amelioration of cognitive deficits.Based on the domestic and overseas researches about PDE5,this review systematically summarized the neuroprotection of PDE5 and their related mechanisms.

Cognitive training in patients with schizophrenia: Principles, methods and prospects / 中国心理卫生杂志

Cognitive deficits are considered to be core features of schizophrenia These deficits are an important predictor of poor functional outcome by negatively influencing patients' ability to perform activities of daily living or maintain stable social relationships.Much of this evidence has come from studies suggested that cognitive deficits may be related to neuronal plasticity.Cognitive training designed according to the principle of neural plasticity may be an effective treatment for patientsin schizophrenia.This review introduces the main principles of cognitive training and its development prospects are discussed.

Effects of icarisid Ⅱ on cognitive deficits and expression of synaptophysin in chronic cerebral hypoperfusion ;rat models / 中国基层医药

Objective To observe the effects of icarisid Ⅱ (ICS Ⅱ)on cognitive deficits and expression of synaptophysin(SYN)in chronic cerebral hypoperfusion(CCH)rat models.Methods 40 male SD rats were randomly divided into four groups:normal group,sham operation group,model group and ICSⅡgroup.The model was established by permanent bilateral common carotid artery occlusion(BCCAO).ICS Ⅱ group was administered ICS Ⅱ at a dose of 8mg·kg -1 ·d -1 by gavage on 1st day after modeling.Sham group and CCH group were injected double -distilled water.The escape latency(s)and spatial probe times were measured by water maze test.Then,the morphology change and expression of SYN in hippocampal were assayed by HE and immunohistochemistry analysis.Results At the 1st month and 2nd month,the escape latency in the model group[(40.02 ±4.95)s,(42.29 ±5.75)s]were significantly prolonged compared with the sham operation group[(26.43 ±2.68)s,(26.84 ±2.06)s](t =4.89,5.06,all P 0.05 ). Conclusion ICS Ⅱ can improve the cognitive deficits in CCH rat models and this effect may be associated with increased expressions of SYN in hippocampal.

Memantine improves cognitive deficits by activiating NGF/TrkA signaling in APP/PS1 transgenic mice / 中国药理学通报

Aims To study the role of NGF/Trk A sig-naling pathway in Memantine ( MEM) improving APP/PS1 transgenic mice cognitive deficits and to explore its possible mechanisms. Methods Cognitive perform-ance was assessed by Morris water maze( MWM) , pas-sive avoidance test( PAT) and locomotivity test. Aβ1-42 protein levels were determined by immunohistochemis-try. The activities of AChE and ChAT were also exam-ined by ELISA and colorimetry. Western blot was used to detect the expression levels of NGF and its receptor TrkA and the downstream ERK pathway. Results MEM treatment significantly ameliorated the cognitive deficits, dramatically reduced the Aβ1-42 overexpres-sion. MEM increased the activity of choline acetyl-transferase( ChAT) , while decreased that of acetylcho-line esterase( AChE) . Moreover, MEM activiated NGF signaling by increasing the phosphorylation of TrkA fol-lowing the increased phosphorylation of c-Raf, ERK1/2 and downstream effector CREB after MEM treatment. Conclusion MEM treatment may activate the NGF/TrkA signaling in APP/PS1 mice to reduce amyloidosis and cognitive deficits.

Depressive symptoms and cognitive deficits in a cancer patient submitted to chemotherapy with 5-Fluoracil: a case report / Sintomas depressivos e déficits cognitivos em paciente com câncer submetido a quimioterapia com 5-fluoracil: relato de caso

Cognitive deficits in cancer patients can be related to depression, anxiety, and the side effects of treatments such as fatigue. In this case report, we described an elderly patient with rectal adenocarcinoma, which presented depressive symptoms and memory complaints after treatment with 5-Fluoracil and Leucovorin. Depressive symptoms improved after two months but cognitive and functional impairment worsened suggesting the diagnosis of mild dementia. Structural and functional brain changes were seen on neuroimaging exams. Rivastigmine was introduced up to 12 mg/day, and after a one-year follow up the patient remained stable. Cognitive deficits can be a consequence of cancer therapies and a protocol to investigate deficits cognitive could be useful to the diferential diagnosis and management of elderly cancer patients submitted to chemotherapy.

Déficits cognitivos em pacientes com câncer podem estar relacionados à depressão, ansiedade e aos efeitos colaterais dos tratamentos, como fadiga. Neste relato de caso, descrevemos um paciente idoso com adenocarcinoma do reto, que apresentou sintomas depressivos e queixas de memória, após o tratamento com 5-Fluoracil e Leucovorin. Os sintomas depressivos melhoraram após dois meses, mas o comprometimento cognitivo e functional pioraram, sugerindo o diagnóstico de demência leve. Mudanças cerebrais estruturais e funcionais foram vistos em exames de neuroimagem. Rivastigmina foi introduzida até 12 mg/dia, e após um ano de seguimento o paciente permanecia estável. Déficits cognitivos podem ser consequência das terapias anti-neoplásicas e um protocolo para investigar déficits cognitivos pode ser útil para o diagnóstico diferencial e manejo de pacientes idosos com câncer submetidos à quimioterapia.