Las funciones ejecutivas: su significado y aplicación clínica / Executive functions: meaning and clinical application

Las funciones ejecutivas generalmente se conceptualizan como un conjunto de procesos generales de control de orden superior que trabajan juntos para dirigir y gestionar las funciones cognitivas, emocionales y conductuales, especialmente durante la resolución activa de problemas. Su disfunción es frecuente de ser detectada como comorbilidad de otros trastornos del neurodesarrollo, causa o efecto? La detección precoz de la disfunción ejecutiva y su abordaje terapéutico temprano, mejora el pronóstico global madurativo en el periodo infantojuvenil. Esta sucinta revisión de las funciones ejecutivas intenta resaltar su importancia para el pediatra y su mirada de los trastornos del neurodesarrollo (AU)

Executive functions are typically understood as a set of general higher-order control processes that collectively direct and manage cognitive, emotional, and behavioral functions, especially during active problem solving. Their dysfunction is often detected as a comorbidity of other neurodevelopmental disorders; cause or effect? Early detection of executive dysfunction and a prompt therapeutic approach improves the overall developmental prognosis in childhood and adolescence. This brief review of executive functions aims to highlight their importance for the pediatrician and his/her view of neurodevelopmental disorder (AU)

Relación entre actividad física, rendimiento académico y funciones ejecutivas en adolescentes: una revisión sistemática / Relationship between physical activity, academic performance and executive functions in adolescents: a systematic review / Relação entre atividade física, Rendimento acadêmico e funções executivas em adolescentes: uma revisão sistemática

El objetivo de este estudió fue analizar la producción científica actual sobre el nivel de actividad física, rendimiento académico y funciones ejecutivas, con el fin de relacionar los beneficios del ejercicio con los procesos cognitivos de escolares. Metodología: Para la revisión y selección de artículos, se siguió la metodología de revisión sistemática basada en las declaraciones internacionales PRISMA. Las principales bases de datos utilizadas son; Dimensions, LILAC, PubMed, Scielo, Scopus y Dialnet. Búsqueda de artículos de intervención y de revisión publicados entre 2013 y 2020, con un rango etario de 10 a 18 años y escritos en idioma español. Los resultados indican que los estudios centran sus objetivos en analizar y comparar las relaciones entre las variables AF, RE y FE. Se concluye que existe una influencia positiva de la actividad física sobre las variables de rendimiento académico y funciones ejecutivas, lo que se traduce principalmente en una mejora en matemáticas y/o lectura, en la memoria y la atención.

The objective of this study was to analyze the current scientific production on the level of physical activity, academic performance, and executive functions, in order to relate the benefits of exercise to the cognitive processes of schoolchildren. Methodology: For the review and selection of articles, we followed the systematic review methodology based on the PRISMA international declarations. The main databases used are: Dimensions, LILAC, PubMed, Scielo, Scopus, and Dialnet. The search focused on intervention and review articles published between 2013 and 2020, with an age range of 10 to 18 years old and written in Spanish. The results indicate that the studies focus their objectives on analyzing and comparing the relationships between the FA, AP, and EF variables. It is concluded that there is a positive influence of physical activity on the variables of academic performance and executive functions, which mainly translates into an improvement in mathematics and/or reading, as well as in memory and attention.

O objetivo deste estudo foi analisar a produção científica atual sobre o nível de atividade física, rendimento acadêmico e funções executivas, a fim de relacionar os benefícios do exercício físico com os processos cognitivos de escolares. Metodologia: para a revisão e seleção dos artigos, seguiu-se a metodologia de revisão sistemática baseada nas declarações internacionais PRISMA. As principais bases de dados utilizadas são: Dimensões, LILAC, PubMed, Scielo, Scopus e Dialnet. Pesquisa de artigos de intervenção e revisão publicados entre 2013 e 2020, com faixa etária de 10 a 18 anos e escritos em espanhol. Os resultados indicam que os estudos focam seus objetivos em analisar e comparar as relações entre as variáveis AF, RE e FE. Conclui-se que existe uma influência positiva da atividade física nas variáveis de desempenho acadêmico e funções executivas, o que se traduz principalmente em melhora em matemática e/ou leitura, em memória e atenção.

Influencia de la actividad deportiva en el funcionamiento ejecutivo de los lóbulos frontales / Influence of sports activity on executive functioning of the frontal lobes

Esta investigación tuvo como objetivo determinar la influencia de la práctica deportiva sobre el desempeño de las funciones ejecutivas y, a su vez, indagar si la ejecución individual y/o grupal del deporte establece diferencias en el desarrollo de estas habilidades cognitivas y las posibles relaciones asociadas a los tiempos de entrenamiento. Para esto, se estableció una metodología cuantitativa, de diseño comparativo-correlacional. La muestra estuvo conformada por 100 participantes entre 18 y 25 años de edad de ambos géneros, distribuidos en tres grupos, uno de deportes de ejecución individual, otro de deportistas de actividad grupal y un grupo control con personas sin participación en actividades deportivas. Se encontraron, por ejemplo, mayores desempeños en funciones de planeación, memoria de trabajo, control inhibitorio y subtipos de atención por parte de quienes practicaban algún tipo de deporte, independiente de la modalidad de ejecución; pese a que, para algunas funciones cognitivas el participar de un deporte grupal generaba mayores puntuaciones en las tareas propuestas y, en otras, la ventaja la presentaron los integrantes de deportes individuales. Asimismo, se pudo establecer que existe una relación entre el tiempo semanal de entrenamiento y el funcionamiento de la actividad ejecutiva; esto, permitió corroborar la influencia de la actividad deportiva sobre el funcionamiento cognitivo subyacente en los lóbulos frontales.

This research aimed to determine the influence of sports practice on the performance of executive functions and, in turn, to inquire whether the individual and/or group performance of sports establishes differences in the development of these cognitive skills and the possible associated relationships to training times. To do this, a quantitative, comparative-correlational design methodology was established. The sample consisted of 100 participants between 18 and 25 years of age of both genders, divided into three groups, one for individual sports, another for athletes with group activity, and a control group with people without participation in sports activities. For example, greater performance was found in planning functions, working memory, inhibitory control and attention subtypes by those who practiced some type of sport, independent of the execution modality; Despite the fact that, for some cognitive functions, participating in a group sport generated higher scores in the proposed tasks and, in others, the advantage was presented by the members of individual sports. Likewise, it was established that there is a relationship between weekly training time and the performance of executive activity; This allowed to corroborate the influence of sports activity on underlying cognitive functioning on the frontal lobes.

Funções executivas em crianças que apresentam dificuldades de aprendizagem / Executive functions in children with learning disabilities

As Funções Executivas (FE) podem ser definidas como um grupo complexo e integrado de recursos cognitivos que permitem ao sujeito efetuar comportamentos voltados a fins previamente decididos. Alterações nessas habilidades, preditoras de uma boa prática acadêmica, podem desencadear dificuldades no processo de aprendizagem de crianças. Logo, objetivou-se apurar a relação entre FE e dificuldades de aprendizagem em crianças com idades entre 7 e 11 anos de ambos os sexos, atendidas em um centro especializado nessa demanda para o público infantil. Foram utilizadas as ferramentas Five Digit Test(FDT) e um questionário sociodemográfico para a coleta de dados. Foram feitos estudos estatísticos descritivos e correlacionais por meio do software SPSS para Windows, a partir dos quais descrevemos correlações significativas entre os componentes executivos 'Controle Inibitório' e 'Flexibilidade Cognitiva' e as dificuldades de aprendizagem, o que nos indica a importância destes para a execução acadêmica, bem como a relevância de métodos de avaliação das FE na primeira fase escolar, para assim prevenir/minimizar o impacto dessas dificuldades no curso do aprendizado. Pontua-se que foram descobertos impasses normativos para correção de erros no teste aplicado, criando limitações na pesquisa, assim, propõe-se uma ampliação de normatizações.

Executive Functions (FE) can be defined as a complex and integrated group of cognitive resources that allow the subject to perform behaviors aimed at previously decided ends. Changes in these skills, predictors of good academic practice, can trigger difficulties inthe learning process of children. Thus, the objective was to investigate the relationship between EF and learning difficulties in children aged between 7 to 11 years of both sexes, attended at a specialized center in this demand for children. Five Digit Test (FDT) tools and a sociodemographic questionnaire were used for data collection. Descriptive and correlational statistical studies were carried out using PSS for Windows software, from which we describe significant correlations between the executive components 'Inhibitory Control' and 'Cognitive Flexibility' and the learning disabilities, which indicates the importance of these for academic performance, as well as the relevance of EF assessment methods in the first school phase, in order to prevent/minimize the impact of these difficulties on the learning course. It is pointed out that normative impasses were found to correct errors in the applied test, creating limitations in the research, thus, an expansion of norms is proposed.

Does ADHD worsen inhibitory control in preschool children born very premature and/or with very low birth weight?

Abstract Introduction Deficits in executive functioning, especially in inhibitory control, are present in children born very premature and/or with very low birth weight (VP/VLBW) and in children with attention-deficit/hyperactivity disorder (ADHD). Objective To evaluate whether ADHD imposes additional inhibitory control (IC) deficits in preschoolers born VP/VLBW. Methods 79 VP/VLBW (4 to 7 years) children were assessed for ADHD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL). IC was measured with Conners' Kiddie Continuous Performance Test (K-CPT 2) and the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P).Results: No significant differences were found between ADHD (n = 24) and non-ADHD children (n = 55) for any of the measures (p = 0.062 to p = 0.903). Both groups had deficits in most K-CPT 2 scores compared to normative samples, indicating poor IC and inconsistent reaction times. Conclusions ADHD does not aggravate IC deficits in VP/VLBW children. Either neuropsychological tasks and parent reports of executive functions (EFs) may not be sensitive enough to differentiate VP/VLBW preschoolers with and without ADHD, or these children's EFs are already so impaired that there is not much room for additional impairments imposed by ADHD.

Neurofuncionalidad de los procesos de memoria y funciones ejecutivas en pacientes con lupus eritematoso sistémico / Neurofunctionality of memory and executive functions processes in patients with systemic lupus erythematosus / Neurofuncionalidade dos processos de memória e funções executivas em pacientes com lúpus eritematoso sistêmico

Esta investigación se propuso determinar el funcionamiento neuropsicológico de los procesos de memoria y funciones ejecutivas en el lupus eritematoso sistémico (LES). Se planteó como un estudio con enfoque cuantitativo, de diseño comparativo-correlacional y siguiendo un modelo no probabilístico para la selección de la muestra. Participaron 68 personas divididas en dos grupos equitativos, homólogos en edad, género y nivel de escolaridad. Se emplearon escalas para la medición de la funcionalidad en actividades cotidianas, y test estandarizados para la medición de los procesos de memoria y funciones ejecutivas. Se encontró que, el LES afecta la memoria verbal para información con contexto, tanto en almacenes de corto como de largo plazo, y la memoria visual a largo plazo; los pacientes presentan mayores fenómenos patológicos asociados a intrusiones y perseveraciones, y afecta el reconocimiento de la información; también altera la regulación conductual y la velocidad de procesamiento de la información, entre otras capacidades cognitivas, destacándose la tendencia al pensamiento concreto. Logró determinarse que el LES dificulta el funcionamiento de estos procesos cognitivos de forma diversa en sus diferentes formas de actividad funcional, siendo susceptible de modificar su influencia al considerarse factores como la edad, el tiempo en que tarda en establecerse el diagnóstico y el tiempo en tratamiento.

This research aimed to determine the neuropsychological functioning of memory and executive functions processes in systemic lupus erythematosus (SLE). It was proposed as a study with a quantitative approach, comparative-correlational design followed by a non-probabilistic model for sample selection. 68 participants were divided into two equitable groups, peers in age, gender and level of education. Scales were used to measure functionality in daily activities, and standardized tests for the measurement of memory and executive functions processes. It was found that SLE affects verbal memory for information with context in both short and long-term stores and long-term visual memory, patients present greater pathological phenomena associated with intrusions and perseverations and affects the recognition of information; it also alters the behavioral regulation and the speed of information processing, among other cognitive abilities, highlighting the tendency to concrete thinking. It was determined that SLE hinders the functioning of these cognitive processes in different ways and different forms of functional activity, being able to modify their influence by considering factors such as age, time it takes to establish the diagnosis and time in treatment.

Esta pesquisa teve como objetivo determinar o funcionamento neuropsicológico dos processos de memória e funções executivas nos lúpus eritematoso sistêmico (LES). Para isso, foi proposto um estudo com abordagem quantitativa, design comparativo-correlacional e seguindo um modelo não probabilístico para a seleção da amostra. Participaram 68 pessoas que foram divididas em dois grupos equitativos, pares em idade, gênero e nível de educação. Foram usadas escalas para medir a funcionalidade em atividades diárias, bem como testes padronizados para a medição de processos de memória e funções executivas. Verificou-se que o LES afeta a memória verbal para informações com contexto em armazenes de curto e longo prazo e em memória visual de longo prazo; os pacientes apresentam mais fenômenos patológicos associados às intrusões e perseverações, e afeta o reconhecimento da informação; altera também a regulação comportamental e a velocidade do processamento da informação, entre outras habilidades cognitivas, destacando a tendência ao pensamento concreto. Assim, determinou-se que o LES dificulta o funcionamento desses processos cognitivos de diferentes formas de atividade funcional, sendo suscetível de modificar sua influência quando são considerados fatores como a idade, o tempo em que tardou para estabelecer-se o diagnóstico e o tempo sob tratamento.

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.

Systemic arterial hypertension and cognition in adults: effects on executive functioning / Hipertensão arterial sistêmica e cognição em adultos: efeitos no funcionamento executivo

ABSTRACT Background: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (WAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37±12.29) and education (10.98±4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.

RESUMO Introdução: As alterações do sistema nervoso central associadas à hipertensão arterial sistêmica (HAS) são progressivas e podem ocasionar efeitos negativos no desempenho cognitivo. O objetivo deste estudo foi investigar a relação entre a HAS e os componentes das funções executivas (FE), controle inibitório (CI), atualização e alternância, comparando um grupo controle (sem HAS) a pacientes com HAS, em dois níveis de gravidade. Métodos: O protocolo incluiu os seguintes testes para avaliar os componentes das FE: T.O.V.A. Test (CI), Dígitos Ordem Indireta da Escala de Inteligência Wechsler para Adultos (Wechsler Adults Intelligence Scale - WAIS-III), Fluência Verbal fonêmica e semântica (atualização) e Teste de Trilhas parte B (alternância). Resultados: Foram incluídos 204 participantes, sendo 56 do Grupo Controle (GC), 87 HAS estágio 1 (HAS 1) e 61 de HAS estágio 2 (HAS 2). Os grupos não foram diferentes em relação à idade (52,37±12,29) e escolaridade (10,98±4,06). Em relação à pressão arterial (PA) controlada, tempo de tratamento da HAS e número de medicações, o grupo HAS 2 apresentou pior controle de PA, mais tempo de tratamento da HAS e uso de maior número de medicações quando comparado ao grupo HAS 1. Os achados revelaram que os pacientes com HAS em estágio mais grave apresentaram pior desempenho nos testes de alternância (Teste de Trilhas parte B) e atualização (Dígitos Ordem Indireta, FV fonêmica e semântica). Conclusão: Esses resultados sugerem que pacientes com a HAS possuem prejuízo significativo em FE, especificamente em alternância e atualização, e que esse prejuízo pode ser diretamente proporcional à gravidade da HAS. Sugere-se que, em estudos futuros, incluam-se exames de neuroimagem com o objetivo de excluir possíveis doenças cerebrovasculares.

Unveiling sleep mysteries: functions / Revelando mistérios do sono: funções

Sleep occupies roughly one-third of human lives, yet it is still not entirely scientifically clear about its purpose or function. However, the latest research achievement concluded that sleeping has much more effect on the brain than formerly believed. Much of these studies are about the effects of sleep deprivation, and the glymphatic pathway initially identified in the rodent brain. In this paper, it is presented some of the theories about sleep functions, besides a review of some physiologic function of sleep. Now, it is accepted that sleep is involved with cleaning the brain toxins, physical restoration, information processing and recall, regulation, besides strengthening the immune system. Sleep implies in a neuronal activity markedly different along with its phases. It is regulated by two parallel mechanisms, homeostatic and circadian. Besides, the sleep-waking cycle involves diverse brain circuits and neurotransmitters and their interaction is explained using a flip-flop model. Several theories may help clarify the reasons human beings spend an important part of their lives sleeping such as those of Inactivity, Energy Conservation, Restorative, and Brain Plasticity. Recently, it was emphasized the importance of the glymphatic system that is a waste clearence system that acts mainly during sleep support efficient removal of soluble proteins and metabolites from the central nervous system. Indeed, sleep meet the needs of higher brain functions along with basic vital processes.

O sono ocupa cerca de um terço da vida humana, mas ainda não é totalmente claro cientificamente o seu propósito ou função. No entanto, a mais recente pesquisa concluiu que dormir tem muito mais efeito no cérebro do que se pensava anteriormente. Muitos desses estudos são sobre os efeitos da privação do sono e o sistema glinfático inicialmente identificada no cérebro de roedores. Neste artigo, são apresentadas algumas das teorias sobre as funções do sono, além de uma revisão de algumas funções fisiológicas do sono. Agora, aceita-se que o sono esteja envolvido com a limpeza de toxinas cerebrais, restauração física, processamento e memorização de informações, regulação do humor, além de fortalecer o sistema imunológico. O sono implica em uma atividade neuronal marcadamente diferente ao longo de suas fases. É regulado por dois mecanismos paralelos, homeostático e circadiano. Além disso, o ciclo de vigília envolve diversos circuitos cerebrais e neurotransmissores e sua interação é explicada por meio de um modelo de flip-flop. Várias teorias podem ajudar a esclarecer as razões pelas quais o ser humano passa uma parte importante de suas vidas dormindo, como as de inatividade, conservação de energia, restauração e plasticidade cerebral. Recentemente, enfatizou-se a importância do sistema glinfático agir principalmente durante o sono, que é um sistema de eliminação de resíduos para apoiar a remoção eficiente de proteínas e metabólitos solúveis do sistema nervoso central. De fato, o sono atende às necessidades de funções cerebrais superiores, juntamente com processos vitais básicos.

Cognición social y funcionamiento ejecutivo en hombres jóvenes con consumo de marihuana / Social cognition and executive functioning in young male cannabis users

El consumo temprano de marihuana afecta la maduración de habilidades cognitivas complejas que ocurre durante la adolescencia y adultez temprana; sin embargo, los estudios acerca del efecto del consumo sobre las habilidades de cognición social no son concluyentes. En el presente estudio se analizó el desempeño en tareas de razonamiento social y funciones ejecutivas de 18 adultos jóvenes hombres con consumo de marihuana (edad: 18.94 años, DE = 3.4) y que fueron comparados con un grupo sin consumo de sustancias (edad: 19.22 años; DE = 2.5). Los hombres jóvenes con consumo de marihuana puntuaron significativamente más bajo que el grupo sin consumo en las cuatro subpruebas de razonamiento social (juicio: p = .007, absurdos: p = .001, causas: p = .034 y consecuencias: p = .01) y en tres de las cinco tareas de funcionamiento ejecutivo utilizadas (aciertos en clasificación de cartas: p = .01, clasificación semántica: p = .03, errores en metamemoria: p = .047). El tiempo de consumo (p = .008) y el nivel de dependencia (p = .004) correlacionaron negativamente con la puntuación en la subprueba de identificación de causas sociales y con los puntajes de clasificación semántica. El consumo de marihuana durante la adolescencia afecta la capacidad de emitir juicios, detectar causas y consecuencias con un contenido social; el tiempo de consumo y el nivel de dependencia muestran un mayor efecto negativo sobre estas habilidades de cognición social.

Early marihuana consumption impact on the development of complex cognitive abilities, that occurs during adolescence. However, studies about drug consumption and social reasoning are not conclusive. In the present study we analyzed the performance on social reasoning and executive functions tasks in 18 male adolescents who used cannabis (age: 18.94, SD = 3.4). Their executions were compared with the ones of the group of non-consumers (age: 19.22; SD = 2.5). Adolescents that used marihuana performed significantly lower than non-users on all social cognition subtests (judgment: p = .007, absurds: p = .001, causes: p = .034 and consequences: p = .01) and on three of the five executive functions tasks (card sorting test: p = .01, semantic classification: p = .03, metamemory: p = .047). Time of consumption (p = .008) and level of dependence (p = .004) negatively correlate with absurd recognition and semantic classification subtests. Cannabis consumption significantly affect the capacity to elaborate judgements, and to detect causes and consequences with a social content; time of marihuana consumption and the level of dependence show the bigger negative effect on social cognition abilities.

Rehabilitación de las funciones ejecutivas en un caso de oligoastrocitoma frontal derecho / Rehabilitation of executive functions in a case of right frontal oligoastrocytoma

El desarrollo tecnológico y científico en salud de los últimos años ha permitido mejoras en el diagnóstico y mayor eficacia en el tratamiento de pacientes con tumores cerebrales, generado un aumento no solo en la supervivencia, sino también una mayor demanda de los servicios de neuropsicología y rehabilitación, debido a las alteraciones cognitivas asociadas y dificultades en cuanto a la funcionalidad e independencia, disminuyendo significativamente la calidad de vida de estos pacientes. La presente investigación documenta el caso de un paciente masculino de 43 años, remitido al servicio de neuropsicología tras la resección de oligoastrocitoma frontal derecho, en la evaluación neuropsicológica se evidenció alteraciones en funciones ejecutivas, fluidez de lenguaje discursivo y dificultad en habilidades instrumentales. La investigación se realizó bajo el diseño cuasi experimental de caso único, donde se aplicó en repetidas ocasiones a lo largo del tratamiento el Inventario de Adaptabilidad Mayo-Portland (MPAI-4) para determinar las dificultades funcionales del paciente. El objetivo de la rehabilitación neuropsicológica se centró en implementar estrategias de autoinstrucciones y automonitoreo, que pudieran ser aplicadas en contextos cotidianos y en intereses específicos del paciente. Los resultados indican que el proceso de rehabilitación neuropsicológica demostró tener un efecto positivo en la funcionalidad del paciente y las estrategias aprendidas pueden ser trasladadas a su vida cotidiana

The technological and scientific development on health in recent years has allowed improvements in diagnosis and treatment on brain tumor patients, have increase not only their survivor rate but also their need of neuropsychology and rehabilitation services due to cognitive alterations associated and the subsequent struggling with independence and functionality that reduces significantly their life quality. The present research documents the case of a male patient, 43 years old, referred to the service after resection of right frontal oligoastrocytoma, in the neuropsychologic evaluation evidenced executive functions, discursive language fluency alterations and difficulties in instrumental skills. The research was carried out under the quasi experimental design of a single case where there will be applied repeatedly during the course of treatment the Mayo-Portland Adaptability Inventory (MPAI-4) to identify functional difficulties on the patient. The objective of the neuropsychological rehabilitation focuses on implementing self-instruction and self-observance strategies in order to apply them on an ordinary context and the patient's specific areas of interest. The results indicate that the neuropsychological rehabilitation treatment has shown a positive effect on the patient's functionality and an improvement on his ability to apply the learned strategies to his day to day life.

Association of vitamin d with mild cognitive impairment and alzheimer's dementia in older mexican adults

ABSTRACT Background It has been proposed that Vitamin D helps reduce the accumulation of cerebral β-amyloid-42 by innate immune stimulation and phagocytosis activation. An association between low Vitamin D levels and Alzheimer’s dementia (AD) has been established. We determined the association between Vitamin D, mild cognitive impairment (MCI), and AD in older Mexican adults (> 65 years) Methods Cross-sectional study conducted at the memory clinic in a tertiary-level hospital in Mexico City. We evaluated subjects with MCI, AD, and normal cognition (NC) with available serum Vitamin D [25(OH)D] levels (past 6 months). Three categories were assigned according to 25(OH)D levels: sufficiency (> 30 ng/mL), insufficiency (21-29 ng/mL), and deficiency (≤ 20 ng/mL). Descriptive statistics, means and standard deviations were used. Logistic regression analyses adjusted by age, sex, and educational level were performed Results We evaluated 208 patients. Mean age was 79 ± 1 year, 65% (n = 136) were female; and mean educational level was 6.7 ± 2.3 years. Thirty-one subjects (14%) had NC; 42% (n = 88) had MCI; and 43% (n = 89) had AD. Prevalence of Vitamin D deficiency was 54%, more frequent in the AD group (64%) followed by the MCI (59%) and NC (13%) (p < 0.001) groups. In the multivariate logistic regression analysis, Vitamin D deficiency was associated with MCI (HR 25.02 [confidence interval 95% 4.48-139]; p < 0.001) and AD (HR 41.7 [5.76-301]; p < 0.001) after adjusting for confounders Conclusions Serum Vitamin D deficiency was associated with MCI and dementia; low levels produced a greater effect over executive functions.

Fluidez verbal, inteligencia y velocidad de procesamiento en adultos jóvenes con y sin actividad escolar: el impacto de la reserva cognitiva en adultos jóvenes / Verbal fluency, intelligence and processing speed in young adults with and without school activity: The impact of the cognitive reserve in young adults

Es conocido el impacto positivo de la reserva cognitiva y de mantenerse activo intelectualmente en el funcionamiento cognitivo en el adulto mayor, sin embargo, el impacto de dichas variables en funciones ejecutivas en jóvenes apenas ha sido investigada. Por ello, el objetivo de la presente investigación fue comparar el desempeño de la fluidez verbal (fonológica, semántica y de verbos), inteligencia (fluida y cristalizada) y velocidad de procesamiento entre jóvenes con diferentes grados académicos y personas con el mismo grado, pero que han dejado de estudiar. Participaron 68 adultos, de 20 a 35 años de edad; todos ellos sanos y residentes de la ciudad de Morelia. Los resultados señalan que el grupo sin actividad escolarizada (con nivel de licenciatura) obtuvo peor rendimiento respecto a los grupos activamente escolarizados (de licenciatura y maestría) en las pruebas de fluidez verbal semántica y de verbos, mientras que no se reportan diferencias significativas entre los grupos conformados por estudiantes activos. En fluidez fonológica el grupo con grado de licenciatura inactivo obtuvo menor rendimiento que el grupo de mayor grado escolar activo. Se concluye que la actividad escolar incide favorablemente en el desempeño de fluidez verbal en jóvenes adultos. Ello no sólo puede ser un elemento que a largo plazo puede transferirse en reserva cognitiva, sino que también puede tener una injerencia notable en la propia vida adulta a nivel laboral.

The positive impact of cognitive reserve and of being intellectually active in cognitive functioning in the elderly is known, however, the impact of these variables on executive functions in young people has hardly been investigated. Therefore, the objective of this research was to compare the performance of verbal fluency (phonological, semantic and verbs), intelligence (fluid and crystallized) and processing speed among young people with different academic degrees and people with the same degree, but who have stopped studying. 68 adults participated, from 20 to 35 years of age; all of them healthy and residents of the city of Morelia. The results indicate that the group with no school activity (with a bachelor's degree) performed worse than the groups actively enrolled (undergraduate and master's degree) in verbal semantic fluency and verbs, while no significant differences were reported between the groups made up of active students. In phonological fluency, the group with an inactive bachelor's degree obtained lower performance than the group with the highest active school grade. It is concluded that school activity has a favorable impact on the performance of verbal fluency in young adults. This can not only be an element that can be transferred in cognitive reserve in the long term, but it can also have a notable interference in adult life at work level.

Funciones ejecutivas y bienestar subjetivo en alumnos que presentan trastorno del espectro autista e inteligencia sobre el rango promedio / Executive functions and subjective well-being of students that presents both above-average intelligence and autism spectrum disorder

Los estudiantes con doble excepcionalidad son alumnos que presentan dos condiciones fuera de lo común, típicamente una condición asociada a talento y otra condición a discapacidad. Este estudio buscó determinar un perfil de funcionamiento ejecutivo (FE) y bienestar subjetivo (BS) de alumnos con doble excepcionalidad (DE) que presentan trastorno del espectro autista (TEA) e inteligencia sobre el rango promedio, para compararlo con estudiantes con desarrollo normativo e inteligencia Promedio de la comuna de Concepción. Los alumnos fueron pareados por sexo, edad y nivel socio económico. Mediante un método cuantitativo, descriptivo, comparativo y transversal, se evaluaron a 10 varones; cinco alumnos DE (M= 12,65 [4,18]) y cinco del grupo comparativo (M=12,48 [4,10]). Al comparar funcionamiento ejecutivo entre grupos, se observó que los alumnos con DE presentan mejor desempeño en Razonamiento Fluido (p=0,04) y, según la percepción de los docentes, un mejor control Inhibitorio (p=0,04). A pesar de que no se encontraron otras diferencias significativas entre grupos, el perfil de alumnos DE si mostró un déficit en funciones ejecutivas, pero únicamente en la manifestación conductual de las mismas. Los resultados asociados al bienestar subjetivo, indican que no existen diferencias significativas entre grupos. El perfil de alumnos DE refleja que mantienen "moderada" satisfacción con la vida y mayor Afecto Positivo que Negativo.

Students with double exceptionality are those who present two out of the ordinary conditions: one associated with outstanding skill and the other associated with a disability. This study sought to determine a profile of executive functioning and subjective well-being of students with double exceptionality (DE) which presented both above-average intelligence and Autism Spectrum Disorder (ASD). The results were compared with a control group of equally numbered students. The students were paired by sex, age, and socio-economic level. Through a quantitative, descriptive, comparative and cross-cutting method, 10 males were evaluated: five DE students (M=12.65 [4.18]) and five control group Students (M=12.48 [4.10]). The results of executive functioning show that DE Students present higher performance in Fluid Reasoning (p=0.04) and, according to teachers' perception, a better Inhibitory Control (p=0.04). Although no other significative differences were found between groups, DE students' profile did show a deficiency in executive functioning, but only in its behavioral manifestation. Results associated with subjective well-being didn't show any significative differences between groups. DE students' profile reflects that they maintain moderate satisfaction with life and higher positive affect than negative.

Desempeño neuropsicológico ejecutivo de adultos mayores con riesgo cardiovascular: evidencia desde el departamento del Quindío, Colombia / Executive neuropsychological performance of older adults with cardiovascular risk: evidence from Quindío, Colombia

El presente artículo introduce un estudio cuantitativo en el que se compararon los desempeños neuropsicológicos ejecutivos en 20 adultos mayores con antecedentes de riesgo cardiovascular o ACV y sus pares sin dicha condición. Para dicho objetivo se empleó el tamizaje mini mental como criterio de inclusión en la muestra. Igualmente, la investigación indagó la correlación entre el nivel de rendimiento ejecutivo ante la batería neuropsicológica de funciones ejecutivas BANFE 2 y los factores de riesgo cardiovascular. Finalmente, los resultados indicaron que sujetos con historial de ACV presentaron un desempeño más bajo en las funciones ejecutivas orbito frontales y frontal anterior.

The following article introduces a quantitative study in which executive neuropsychological performances were compared in 20 older adults with a history of cardiovascular risk or stroke and their peers without such condition. Mini-mental screening was used as a criterion for inclusion in the sample. The research investigated the correlation between the level of executive performance in the neuropsychological battery of executive functions BANFE 2 and cardiovascular risk factors. Finally, the results indicated that subjects with a history of stroke presented a lower performance in executive functions at the orbitofrontal and frontal lobe.

Funciones ejecutivas y ajuste clínico en adolescentes colombianos policonsumidores / Executive functions and clinical adjustment in Colombian adolescents polydrug

Resumen El estudio tuvo como objetivo analizar el funcionamiento ejecutivo y el ajuste clínico en una muestra de adolescentes colombianos policonsumidores. Se efectuó un estudio ex post facto con 204 participantes entre 12 y 17 años (M = 14,50, DT = 1,71). Se aplicó la Batería Neuropsicológica de Funciones Ejecutivas y Lóbulos Frontales BANFE-2 y para la evaluación clínica se utilizó la Escala de Autoestima de Rosenberg, Cuestionario de Afrontamiento COPE, Escala de Impulsividad de Dickman y Cuestionario de 90 Síntomas SCL-90-R. Se identificó un rendimiento significativamente inferior del grupo policonsumidor en las funciones ejecutivas, bajos niveles de autoestima, altos niveles de impulsividad disfuncional y de diversidad psicopatológica, así como estilo de afrontamiento a través del consumo de sustancias. Así mismo, se detectó un efecto predictor de la interacción edad x tiempo de consumo en el funcionamiento ejecutivo, observándose un menor rendimiento de los policonsumidores más jóvenes a medida que se incrementaba el tiempo de consumo.

Abstract The research aim was to analyze the executive functioning and the clinical adjustment in a sample of Colombian teen polydrug users. An ex post facto study was carried out with 204 participants, 12-17 years old (M= 14,50, SD = 1,71). The neuropsychological test BANFE-2 was applied for analyzing frontal lobes and executive functioning and the Rosenberg self esteem scale, a COPE questionnaire, the Dickman impulsivity scale and the SCL-90-R questionnaire were used for clinical adjustment respectively. A lower executive functioning throughput were observed in polydrug users. Low self-esteem, high dysfunctional impulsivity, high diverse psychopathologies and coping strategies for drug use were also observed. A predictor effect between age and consumption time on the executive functioning were also determined. A lower throughput in younger polydrug users increase through consumption time.

Dutch translation and adaptation of the Barkley Deficits in Executive Functioning Scale (BDEFS)

Abstract Background Based on his model of self-regulation and executive functions, Barkley developed a self- and other-report questionnaire (the Barkley Deficits in Executive Functioning Scale - BDEFS). The BDEFS measures deficits in executive functions as expressed in daily life activities like self-management of time, self-organization, self-restraint, self-motivation, and self-regulation of emotion. Objectives This study created and analyzed a Dutch translation and adaptation in conformance with official guidelines. Methods The Dutch and English BDEFS were completed by 25 bilingual Dutch adults to evaluate semantic correspondence. Consequently, 60 Dutch participants completed the Dutch BDEFS, Barratt Impulsiveness Scale-Eleventh edition (BIS-11) and the Dysexecutive Questionnaire (DEX) to evaluate concurrent validity and internal consistency. Results The versions demonstrated sufficient semantic equivalence and Spearman's rho of total scores was high; items mostly showed moderate-to-high correlations. Regression analysis showed no proportional bias. Internal consistency was also high. Correlations between BDEFS, BIS-11 and DEX supported concurrent validity. Discussion We conclude that a successful BDEFS translation and adaptation was created with satisfactory reliability and validity. Further research should assess the utility of the BDEFS in Dutch clinical practice.

Executive functions in children with dyslexia / Funções executivas em crianças com dislexia

ABSTRACT This study aimed to verify whether children with dyslexia have difficulties in executive functions (shifting, working memory, inhibition). Methods: A sample of 47 children (ages 8-13 years) participated in the study: 24 who were dyslexic and 23 controls with typical development. A battery of neuropsychological tests was used. Results: Results revealed executive function difficulties among the dyslexic children when compared with controls, encompassing selective attention modulation processes, shifting, and inhibitory control. These difficulties appeared to be affected by phonological working memory deficits, typically associated with dyslexia. Conclusion: Our findings support the consensus among scholars regarding the central involvement of phonological skill dysfunctions in dyslexia.

RESUMO O objetivo deste estudo foi verificar se crianças com dislexia têm dificuldades nas habilidades de funções executivas (shifting, memória operacional e inibição). Métodos: Uma amostra de 47 crianças (idades entre 8 e 13 anos) participaram do estudo: 24 crianças disléxicas e 23 crianças com desenvolvimento típico. Uma bateria de avaliação neuropsicológica foi usada. Results: Os resultados revelaram dificuldades nas funções executivas nas crianças disléxicas quando comparadas com as controle, envolvendo processos de modulação de atenção seletiva, shifting e controle inibitório. Essas dificuldades parecem ser afetadas pelos déficits na memória operacional fonológica, tipicamente associada à dislexia. Conclusion: Assim, nossos achados suportam o consenso de que a disfunção central da dislexia está nas habilidades fonológicas.

Component mechanisms of executive function in schizophrenia and their contribution to functional outcomes

Objective: In schizophrenia, scores reflecting deficits in different cognitive processes are strongly correlated, making it difficult to establish a solid relationship between different cognitive mechanisms and other features of this disorder. The objective of this study was to explore whether three frequently postulated executive functions (updating, shifting, and inhibition) could be compared between groups and considered independently in terms of their respective roles in functional outcome. Methods: This study relied on confirmatory factor analysis of schizophrenia patients (n=141) and healthy controls (n=119). The main analyses examined the degree to which three executive functions (updating, set-shifting, and inhibition) could be separated in schizophrenia and compared this model among groups. Structural equation modeling analysis was also performed to examine the extent to which executive function components contribute to functional outcome in schizophrenia. Results: Multiple-group confirmatory factor analysis with unconstrained model parameters indicated that the full three-factor model may fit the data in both groups (χ2 = 61.48, degrees of freedom = 34, p < 0.001, comparative fit index = 0.95; standardized root mean square residual = 0.037; root mean square error of approximation = 0.04; Akaike's information criteria = 169.49; normed fit index = 0.90), although there was also a good data fit for the patient group with a two-factor model. In the patient group, structural equation modeling suggested that shifting and (principally) updating were associated with the general measure of functional outcome (regression path coefficients: 0.34, p < 0.005; 0.39, p < 0.005, respectively), although when combined the mechanisms fail to contribute. Conclusion: This data suggests that the factor structure may be similar but not identical between groups, and both updating and shifting may play an important role in functional outcome in schizophrenia.

Caracterización cognitiva del trastorno de Tourette con comorbilidad TDAH: un estudio de caso / Cognitive characterization of Tourette disorder with ADHD comorbidity: a case study

El trastorno de Tourette (TT) es un trastorno del neurodesarrollo que aparece en la primera infancia caracterizado por la presencia de tics fónicos y motores que dificultan la socialización y el proceso de aprendizaje escolar. El TT posee una variada comorbilidad que incluye el trastorno por déficit de atención con hiperactividad (TDAH), el trastorno obsesivo compulsivo (TOC), y dificultades de aprendizaje y del comportamiento. Presentamos el caso de un adolescente de 13 años diagnosticado con TT y con TDAH a los 6 y 10 años respectivamente. El paciente ha tenido una escolarización dificultosa y se encuentra con tratamiento médico de clozapina, aripiprazol, haloperidol y litio. Se aplica una batería neuropsicológica para evaluar la atención e inhibición, organización visuoespacial, memoria de trabajo, flexibilidad cognitiva, memoria verbal y memoria no-verbal, con el propósito de describir su perfil cognitivo de funciones ejecutivas y memoria. El estudio reveló que la atención está deteriorada pero que la inhibición se encuentra preservada; esto confirma el diagnóstico de TDAH y establece el subtipo de inatento para el caso en estudio. Las demás funciones ejecutivas evaluadas se encuentran severamente descendidas, situación que es coincidente con el perfil desarrollado por otros autores para el TT con comorbilidad TDAH. Sin embargo, no es claro si la disfuncionalidad ejecutiva se debe al TDAH que presenta, o a factores sociales y culturales derivados de las dificultades de escolarización causadas por el TT.

Tourette's disorder (TD) is a neurodevelopmental disorder that appears in early childhood characterized by the presence of phonic and motor tics that hinder socialization and the school learning process. TD has a varied comorbidity that includes attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), learning and behavioral difficulties. We present the case of a 13-year-old adolescent diagnosed with TD and with ADHD at 6 and 10 years old respectively. The patient has had a difficult schooling and is under medical treatment of clozapine, aripiprazole, haloperidol and lithium. A neuropsychological battery is applied to evaluate the attention and inhibition, visuospatial organization, working memory, cognitive flexibility, verbal memory and non-verbal memory, with the purpose of describing its cognitive profile of executive functions and memory. The study revealed that the attention is impaired but that the inhibition is preserved; This confirms the diagnosis of ADHD and establishes the inattentive subtype for the case under study. The other executive functions evaluated are severely descended, a situation that coincides with the profile developed by other authors for TD with comorbid ADHD. However, it is not clear if the executive dysfunctionality is due to the ADHD it presents, or to social and cultural factors derived from the difficulties of schooling caused by the TD.