Moduladores de la expresión de la alta capacidad intelectual / Modulation of the expression of high intellectual capacity

La investigación reciente desmitifica y redefine la alta capacida d intelectual (ACI) frente al concepto tradicional monolítico y estático, basado en la heredabilidad e identificación mediante un alto cociente intelectual. Este concepto se sustituye por otro en el que la ACI es entendida como un fenómeno complejo de naturaleza genética y ambiental, multidimensional, diverso, moldeable, dinámico y en desarrollo, resultado de la covariación a lo largo de la trayectoria de vida entre fuerzas endógenas y exógenas, que van modulando y diferenciando el alto potencial (factor predictor) en competencias hacia la óptima expresión, o no, de la eminencia en la adultez. La ACI supone la conjunción de una diversidad biológica de partida (el alto potencial), una diversidad psicológica (explotación de los recursos biológicos en funciones útiles y conocimiento), y una diversidad contextual configurada por diferentes condiciones familiares, y contextos socioculturales y económicos. El objetivo del trabajo es presentar una revisión de la investigación actual sobre los factores predictores y moduladores de la ACI, desde una perspectiva neuroconstructivista. Se concluye y discute la incidencia de variables moduladoras en las diversas trayectorias de desarrollo del potencial hacia la posible eminencia adulta, y las implicaciones diagnósticas y educativas que se derivan.

Recent research demystifies and redefines high intellectual ability (HIA) against the traditional monolithic and static concept which was based on heritability and identification through an intelligence quotient. This concept is replaced by another in which the HIA is understood as a complex phenomenon of a genetic and environmental nature This is the result of a covariation along the life path between endogenous and exogenous forces, modulators of the high potential (predictor factor) towards the optimal expression, or not, of its eminence in adulthood. Then, HIA implies the conjunction of a starting biological diversity (the high potential), a psychological diversity related to the exploitation of biological resources in useful functions and knowledge, and a contextual diversity configured by different family conditions, as well as socio-cultural and economic contexts. The aim of this work is to present from a neuroconstructivist perspective a review of the current HIA research on the predictive and modulating factors. In the conclusions, we discuss the incidence of the modulating variables in the various trajectories of potential development towards possible adult eminence and the diagnostic and educational implications that are derived.

Semantic memory, but not education or intelligence, moderates cognitive aging: a cross-sectional study

Objective: Aging studies regularly assume that years of education are a protective factor for baseline cognition. In developing countries with specific sociocultural issues, this relationship may not work as expected, and an unmet need remains for alternative resilience factors. This study aimed to analyze different moderators for the relationship between aging and general cognition that could reflect better protective factors. Methods: One hundred and fourteen Brazilian older adults, deemed healthy by global cognition, absence of psychiatric symptoms, or neurological history, participated in this cross-sectional study. Moderators for the relationship between age and global cognition included education, intelligence, and occupational factors. Semantic memory was added as a protective factor reflecting culturally acquired conceptual knowledge. Results: As expected, age alone is a predictor of global cognitive scores; surprisingly, however, education, intelligence, and occupation were not moderators of the association. Semantic memory was a significant moderator (p = 0.007), indicating that knowledge acquired during life may be a protective factor. Conclusion: In developing countries, the use of resilience factors based only on years of education may be misleading. Sociocultural issues influence the educational system and achievement and, consequently, affect the use of this simple measure. Resilience-factor studies should consider using crystallized abilities when studying populations with sociocultural particularities.

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.

Development of a word accentuation test for predicting cognitive performance in Portuguese-speaking populations / Desenvolvimento de um teste de acentuação de palavras em português para predição de desempenho cognitivo

ABSTRACT The Word Accentuation Test (WAT) has been used to predict premorbid intelligence and cognitive performance in Spanish-speaking populations. It requires participants to read a list of words without the accent marks that indicate the stressed syllable. Objective: As Portuguese pronunciation is also strongly based on accent marks, our aim was to develop a Brazilian version of the WAT. Methods: An initial pool of 60 items was constructed and a final version of 40 items (named WAT-Br) was derived by item response theory. A sample of 206 older adults underwent the WAT-Br and a standardized neuropsychological battery. Independent ratings were performed by two observers in 58 random participants. Results: The items showed moderate to high discrimination (α between 0.93 and 25.04) and spanned a wide range of difficulty (β between −2.07 and 1.40). The WAT-Br was shown to have an excellent internal consistency (Kuder-Richardson Formula 20 = 0.95) and inter-rater reliability (intraclass correlation coefficient = 0.92). It accounted for 61% of the variance in global cognitive performance. Conclusion: A version of the WAT for Portuguese-speaking populations was developed and proved to be a valuable tool for estimating cognitive performance.

RESUMO O Teste de Acentuação de Palavras (TAP) tem sido utilizado para predizer inteligência pré-mórbida e desempenho cognitivo em populações de língua espanhola. Requer que os sujeitos leiam uma lista de palavras sem os sinais gráficos de acentuação que indicam a sílaba tônica. Objetivo: Como a pronúncia da língua portuguesa também é fortemente baseada em acentos gráficos, nosso objetivo foi desenvolver uma versão brasileira do TAP. Métodos: Um conjunto inicial de 60 itens foi construído e uma versão final de 40 itens (denominada TAP-Br) foi derivada por teoria da resposta ao item. Uma amostra de 206 idosos foi submetida ao TAP-Br e a uma bateria neuropsicológica padronizada. Registros de pontuação independentes foram realizados por dois observadores em uma subamostra de 58 participantes aleatórios. Resultados: Os itens apresentaram moderada a alta discriminação (α entre 0,93 e 25,04) e abrangeram uma ampla gama de dificuldades (β entre −2,07 e 1,40). O TAP-Br apresentou excelente consistência interna (Fórmula de Kuder-Richardson 20 = 0,95) e confiabilidade inter-examinador (Coeficiente de Correlação Intraclasse = 0,92). O escore do TAP-Br explicou 61% da variância do desempenho cognitivo global. Conclusão: Uma versão do TAP para as populações de língua portuguesa foi desenvolvida e mostrou-se uma ferramenta útil para estimar desempenho cognitivo.

Batería de Rendimiento Intelectual para niños escolares cubanos / Battery intellectual performance for Cuban children

En Cuba, no existen instrumentos propios para la evaluación de la inteligencia. Para solucionar el problema, el Centro de Neurociencias de Cuba, y en especial, el Departamento de Neurociencias Educacionales, diseñó una Batería de Rendimiento Intelectual (BRI) para niños escolares cubanos (conformado por Escala capacidad Intelectual, ECI y Analogías verbales, AV). Objetivos: (1) Completar y validar la BRI para la evaluación de Gf y Gc en niños cubanos de edad escolar, (2) Método. Determinar la contribución única de Gf y Gc, evaluada con la BRI, en el aprovechamiento académico en niños cubanos. Se aplicaron dos estudios. a) Validación de la ECI con una muestra de 370 niños entre 7 y 11 años (N1 ­ 270 para calcular punto de corte y N2 para validar los puntos de corte). b) Diseño de la AV con una muestra de 36 niños entre 10 y 11 años. Resultados. La ECI resulta una prueba apropiada para detectar al niño escolar con riesgo intelectual. El resultado se sustenta en la alta coincidencia (89%) con el WISC-R para clasificar niños con trastornos intelectuales. El diseño de la AV presenta apropiadas propiedades psicométricas, pues presenta significativas correlaciones con la sub-prueba de Vocabulario del WISC-R. Conclusiones. La BRI presenta apropiadas propiedades psicométricas para detectar el riesgo intelectual en niños cubanos.

In Cuba not have own instruments for the assessment of intelligence. To resolve the problem, the Neuroscience Center of Cuba, and the Department of Educational Neuroscience, design a Battery of Intellectual Performance (BIP) for school children (Intellectual Capacity Scale, ICE and Verbal Analogy, VA). Objectives: (1) to complete and validate the BIP for the evaluation of Gf and Gc in cuban children of school age, (2) Method. Determine the unique contribution of Gf and Gc, evaluated with the BIP, on academic achievement in Cuban children. Two studies were applied. a) Validation of the ICE with a sample of 370 children between 7 and 11 years (N1 - 270 to calculate the cut-off point and N2 to validate the cut-off points). b) Design of the VA with a sample of 36 children between the ages of 10 and 11 years. Results. The ICE is a proper test to detect the child with intellectual risk. The result is based on the high coincidence (89%) with the WISC-R to classify children with intellectual disorders. The design of the VA presents appropriate psychometric properties, because it presents significant correlations with the sub-vocabulary test of the WISC-R. Conclusions. The BIP presents appropriate psychometric properties to detect risk Cuban intellectual in school children.

Attention deficit hyperactivity disorder and intellectual giftedness: a study of symptom frequency and minor physical anomalies

Objective: To evaluate the presence of symptoms of attention deficit and hyperactivity disorder (ADHD) in intellectually gifted adults and children. Methods: Two cross-sectional studies were performed in children and adults whose intelligence quotient (IQ) had been previously evaluated using Raven’s Progressive Matrices (RPM) test. Seventy-seven adults displaying IQ scores above the 98th percentile were assessed using the Adult Self-Report Scale (ASRS-18) for signs of ADHD and a modified Waldrop scale for minor physical anomalies (MPAs). Thirty-nine children (grades 1-5) exhibiting IQ scores above the 99th percentile, as well as an equally matched control group, were assessed for ADHD by teachers using the Swanson, Nolan and Pelham IV Rating Scale (SNAP-IV) as used in the NIMH Collaborative Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA-SNAP-IV). Results: In gifted adults, the frequency of ADHD-positive cases was 37.8%, and the total MPA score was significantly associated with ADHD (p < 0.001). In children, the ADHD-positive case frequency was 15.38% in the gifted group and 7.69% in the control group (odds ratio [OR] = 2.18, p = 0.288). Conclusions: The high frequency of ADHD symptoms observed, both in gifted adults and in gifted (and non-gifted) children, further supports the validity of this diagnosis in this population. Furthermore, the significant association between MPAs and ADHD suggests that a neurodevelopmental condition underlies these symptoms.

ADHD inattentive symptoms mediate the relationship between intelligence and academic performance in children aged 6-14

Objective: Fluid intelligence and the behavioral problems of attention-deficit/hyperactivity disorder (ADHD) are related to academic performance, but how this association occurs is unclear. This study aimed to assess mediation and moderation models that test possible pathways of influence between these factors. Methods: Sixty-two children with ADHD and 33 age-matched, typically developing students were evaluated with Raven's Colored Progressive Matrices and the spelling and arithmetic subtests of the Brazilian School Achievement Test. Dimensional ADHD symptomatology was reported by parents. Results: Our findings suggest that fluid intelligence has a significant impact on academic tests through inattention. The inattentive dimension was the principal behavioral source of influence, also accounting for the association of hyperactive-impulsive manifestations with school achievement. This cognitive-to-behavioral influence path seems to be independent of diagnosis related group, and gender, but lower socioeconomic status might increase its strength. Conclusion: Fluid intelligence is a relevant factor in the influence of ADHD behavioral symptoms on academic performance, but its impact is indirect. Therefore, early identification of both fluid intelligence and inattentive symptoms is of the utmost importance to prevent impaired academic performance and future difficulties in functioning. .

Influence of memory, attention, IQ and age on auditory temporal processing tests: preliminary study / Influência da memória, atenção, QI e idade em testes de processamento auditivo temporal: estudo preliminar

PURPOSE: To investigate the existence of correlations between the performance of children in auditory temporal tests (Frequency Pattern and Gaps in Noise - GIN) and IQ, attention, memory and age measurements. METHOD: Fifteen typically developing individuals between the ages of 7 to 12 years and normal hearing participated in the study. Auditory temporal processing tests (GIN and Frequency Pattern), as well as a Memory test (Digit Span), Attention tests (auditory and visual modality) and intelligence tests (RAVEN test of Progressive Matrices) were applied. RESULTS: Significant and positive correlation between the Frequency Pattern test and age variable were found, which was considered good (p<0.01, 75.6%). There were no significant correlations between the GIN test and the variables tested. CONCLUSIONS: Auditory temporal skills seem to be influenced by different factors: while the performance in temporal ordering skill seems to be influenced by maturational processes, the performance in temporal resolution was not influenced by any of the aspects investigated. .

OBJETIVO: Investigar a existência de correlações entre o desempenho de crianças com desenvolvimento típico em testes temporais auditivos (Padrão de Frequência e Gaps in Noise - GIN) e medidas de memória, atenção, quociente intelectual e a idade. MÉTODO: Quinze participantes, com idades entre 7 e 12 anos, sem queixas envolvendo audição e desenvolvimento cognitivo, foram submetidos aos testes de processamento temporal auditivo (GIN e Padrão de Frequência), teste de Memória (Span de Dígitos), Atenção (auditiva e visual) e testes de inteligência (Matrizes Progressivas de Raven). RESULTADOS: Foram encontradas correlações significantes e positivas entre o teste Padrão de Frequência e a variável idade, sendo essa considerada boa (p<0,01, 75,6%). Não foram verificadas correlações significantes entre o teste GIN e as variáveis testadas. CONCLUSÃO: As habilidades temporais consideradas parecem ser influenciadas por diferentes fatores: enquanto a habilidade de ordenação temporal parece ser influenciada por processos maturacionais, o desempenho para a habilidade de resolução temporal não foi influenciado por nenhum dos aspectos investigados. .

Clinical and neuropsychological correlation in patients with rolandic epilepsy / Correlação entre achados clínicos e neuropsicológicos em pacientes com epilepsia rolândica

OBJECTIVES: To evaluate the presence of neurological soft signs (NSS) and to correlate them with the Wechsler Intelligence Scale for Children (WISC III) in patients with rolandic epilepsy (RE). METHODS: Forty children and adolescents aged between 9 and 15 years were studied. They were divided into two groups: G1 - patients with RE (n=20) - and G2 - healthy controls without epilepsy (n=20). They were assessed with the Quick Neurological Screening Test (QNST II) - clinical trial to search for NSS -, and the WISC III - neuropsychological test. RESULTS: No statistical difference between groups was found in WISC III and QNST II. However, children with poorer motor skills had worse performance in the QNST II and also in the execution intelligence quotient - IQ (p=0.001) and in total IQ (p=0.004), thus showing a positive correlation between them. CONCLUSIONS: The QNST II is a good screening tool for the neurologist to detect abnormalities in fine motor skills.

OBJETIVOS: Avaliar a presença de sinais neurológicos menores (SNM) e correlacioná-los com o Escala de Inteligência de Wechsler para Crianças (WISC III) em pacientes com epilepsia rolândica (ER). MÉTODOS: Foram estudados 40 crianças ou adolescentes entre 9 e 15 anos, divididos em dois grupos: G1 - pacientes com ER (n=20); G2 - controles saudáveis sem epilepsia (n=20). Foram avaliados por meio do QNST II - teste clínico que pesquisa SNM - e do WISC III - teste neuropsicológico. RESULTADOS: Não foi encontrada nenhuma diferença estatística entre os grupos no WISC III e QNST II. Entretanto, crianças com habilidades motoras pobres tiveram pior desempenho no QNST II, assim como no quociente de inteligência (QI) de execução (p=0,001) e no QI total (p=0,004), mostrando, portanto, correlação positiva entre os dois instrumentos. CONCLUSÕES: O QNST II é uma boa ferramenta de rastreamento para o neurologista detectar anormalidades nas habilidades motoras finas.

Risk factors for cognitive impairment in school-age children born preterm: application of a hierarchical model / Fatores de risco para alteração cognitiva em escolares nascidos pré-termo: aplicação de modelo hierarquizado

The purpose was to analyze factors associated with cognitive impairment in very low birth weight (VLBW) children born preterm. A prospective cohort of 65 VLBW children was assessed at the age of eight years using the Wechsler Intelligence Scale for Children. A model for the relationship of variables with the cognitive impairment outcome attributed hierarchical levels: distal (socioeconomic variables), intermediate I and II (perinatal and neonatal variables, post-neonatal variables) and proximal (child health and psychosocial stimulation). A multivariate logistic regression was performed. In the multivariate hierarchical logistic regression, the maternal education (OR=0.77, 95%CI 0.63-0.94) and number of prenatal visits (OR=0.73, 95%CI 0.54-0.99) showed a protective association, but the male (OR=7.3, 95%CI 1.54-35.3) was associated with worse results. The VLBW children cognitive performance in the age of eight years benefits from more educated mothers, better prenatal care, and the baby gender as female.

O objetivo foi analisar fatores associados à alteração cognitiva na idade escolar de crianças nascidas prematuras de muito baixo peso (PMBP). Uma coorte prospectiva de 65 crianças PMBP foi avaliada aos oito anos através da Escala de Inteligência Wechsler para Crianças. Um modelo para relação das variáveis com o desfecho alteração cognitiva reconheceu níveis hierárquicos: distal (variáveis socioeconômicas), intermediário I e II (variáveis perinatais e neonatais; variáveis pós-neonatais) e proximal (saúde da criança e estímulo psicossocial). Foi realizada análise de regressão logística multivariada. Na regressão logística hierarquizada multivariada, a escolaridade materna (OR=0,77; IC95% 0,63-0,94) e o número de consultas no pré-natal (OR=0,73; IC95% 0,54-0,99) mostraram uma associação protetora; porém o sexo masculino (OR=7,3; IC95% 1,54-35,3) foi associado a piores resultados. O desempenho cognitivo dos PMBP na idade de oito anos é beneficiado pela maior escolaridade das mães, melhor assistência pré-natal e pelo bebê ser do sexo feminino.

Effect of low-level environmental lead exposure intellectual functions of children of EI-Minia city, EI-Minia Governorate, Egypt

Lead [Pb] is a confirmed neurotoxin. Clear adverse effects of blood Pb level [BLL] >/= 10 microg/dl have been documented in children, but questions remain about Pb-associated intellectual disorders at these BLL and whether lower exposures are associated with greater disorders. To study the intellectual functions associated with environmental low-level Pb exposure in children of the villages of the east coast of the River Nile of EI-Minia city that located nearby EI-Minia industrial area. This study was conducted at Suzan Mubarak Hospital, EI-Minia University during the period from 1[th] August, 2008 to the 31[st] of July, 2010. It included 120 children aged 7-9 from the nearest 2 villages to EI-Minia industrial area [60 children each] namely, EI-Newayrat and AI-Shorafaa, and 60 children from Talla, a village located to the west of EI-Minia city far away from EI-Minia industrial area, as a control group. For all patients, BLL had been estimated, and intellectual functions has been evaluated using Wechsler's Intelligence Scale for Children, 3[rd] ed. BLL of children of EI-Newayrat and AI-Shorafaa were significantly increased when compared to that of Talla children with higher affection reported with EI-Newayrat. The outcome of Wechsler's Intelligence Scale revealed a significant reduction of verbal, performance and full scale IQs in EI-Newayrat and AI-Shorafaa when compared to Talla with higher affection reported with EI-Newayrat, with a strong negative correlation to BLL of 5-10 microg/dl. It could not be estimated that every microg/dl increase in BLL was accompanied by a fixed lowered score. There was no statistically significant difference between males and females regarding the BLL and Wechsler's Intelligence Scale scores. in conclusion, Low-level Pb exposure in children of the villages of the east coast of the River Nile of in EI-Minia city that located nearby EI-Minia industrial area was accompanied with intellectual function impairment which is not associated with sex and reported to be nonlinear relationship. It is advised to perform a national study to evaluate how big the problem is and to put Pb-toxicity in the list of the national health problems

Funcionamento intelectual em pacientes pediátricos com epilepsia: comparação de crianças controladas com medicação, não controladas com medicação e controladas com cirurgia / Intellectual functioning in pediatric patients with epilepsy: a comparison of medically controlled, medically uncontrolled and surgically controlled children

OBJETIVO: Comparar o quociente intelectual (QI) em três grupos de crianças com epilepsia: 1) controlados com medicação, 2) não controlados com medicação e 3) controlados com cirurgia. MÉTODOS: Noventa e oito pacientes pediátricos, com idades entre 6 e 12 anos, foram selecionados de dezembro de 2007 a julho de 2008. A Escala de Inteligência Wechsler para Crianças - terceira edição (WISC-III) foi utilizada para a avaliação neuropsicológica dos pacientes. Os resultados foram relacionados com a síndrome epiléptica, a etiologia da epilepsia, o tratamento medicamentoso, a idade do paciente no início da epilepsia e a duração da epilepsia. RESULTADOS: Os escores da WISC foram significativamente melhores no grupo controlado com medicação quando comparados aos do grupo não controlado com medicação. O grupo controlado com medicação obteve um desempenho significativamente melhor na maioria dos subtestes da WISC quando comparado ao grupo não controlado com medicação: vocabulário, aritmética, compreensão, memória de dígitos, completar figuras, arranjo de figuras e cubos. Um número significativamente maior de pacientes com epilepsia idiopática e uso de monoterapia foi observado no grupo controlado com medicação quando comparado ao grupo não controlado. O grupo controlado com cirurgia não apresentou diferença significativa no desempenho do QI quando comparado ao grupo controlado com medicação. CONCLUSÕES: As crianças com um bom controle de crises tiveram um melhor desempenho no QI geral, verbal e de execução quando comparadas às crianças com epilepsia refratária. Esses resultados podem ser influenciados por fatores clínicos como o uso de monoterapia, o tipo de droga antiepiléptica utilizada, a síndrome epiléptica e a etiologia da epilepsia. A cirurgia de epilepsia pode causar um impacto positivo no desempenho cognitivo das crianças que ficaram livres de crises após o procedimento cirúrgico.

OBJECTIVE: To compare the intellectual coefficient (IQ) of three groups of children with epilepsy: 1) medically controlled, 2) medically uncontrolled and 3) surgically controlled. METHODS: From December 2007 until July 2008, 98 pediatric patients were selected, with an age range between 6 and 12 years. Neuropsychological assessment included the Wechsler Intelligence Scale for Children - third edition (WISC-III). Results are related to epileptic syndrome, etiology of epilepsy, drug therapy, age at epilepsy onset and epilepsy duration. RESULTS: WISC scores were significantly better in the medically controlled group when compared to the medically uncontrolled group. The medically controlled group performed significantly better in the majority of the WISC subtests when compared to the medically uncontrolled group: vocabulary, arithmetic, comprehension, digit span, picture completion, picture arrangement, and block design. A significantly higher number of idiopathic epilepsy and monotherapy cases was observed in the medically controlled group when compared to the medically uncontrolled group. Surgically controlled children had no significant differences in IQ performance when compared to medically controlled children. CONCLUSIONS: Children with good seizure control have higher general, verbal and performed intelligence when compared to children with refractory epilepsy. These results may be influenced by clinical factors such as use of monotherapy, drug type and epileptic syndrome and etiology. Epilepsy surgery can have a positive impact on cognitive performance of children who were free of seizures after surgery.

Avaliação do desempenho escolar e praxias em crianças com Epilepsia Rolândica / School performance and praxis assessment in children with Rolandic Epilepsy

TEMA: Epilepsia Rolândica é a forma mais freqüente de epilepsia da infância. Ela é classificada como idiopática, idade-dependente e de evolução benigna. A ausência de comprometimento neuropsicológico faz parte dos critérios de benignidade desta síndrome epiléptica.Entretanto, recentemente têm sido sugeridos vários déficits relacionados à atenção e linguagem. OBJETIVO: o objetivo desse trabalho foi avaliar o desempenho escolar e investigar dificuldades práxicas em pacientes com epilepsia rolândica e comparar a um grupo controle composto por crianças normais com idade, gênero e nível escolar equivalentes. MÉTODO: dezenove pacientes com idade entre 7 e 12 anos foram submetidos a avaliação neurológica clínica, avaliação psicológica, através das Escalas Weschsler de Inteligência e avaliação fonoaudiológica, onde foram avaliados o desempenho escolar e a investigação da presença ou não de dificuldades práxicas. RESULTADOS: os dados mostraram que apesar da eficiência intelectual (medida pelo Quociente Inteligência - QI) estar dentro da média, crianças com epilepsia rolândica mostraram um desempenho significativamente mais pobre do que o grupo controle em provas de escrita, aritmética e leitura. Outro aspecto importante evidenciado foi a ausência de apraxia orofacial nas crianças do grupo afetado. CONCLUSÃO: deve ser ressaltado que a avaliação de crianças com epilepsia é necessária porque isso pode revelar distúrbios específicos que exigem ajuda profissional apropriada. Analisando a ocorrência de distúrbios de linguagem oral e/ou escrita nessas crianças, pode-se evitar um maior prejuízo acadêmico, social e emocional, afinal o prognóstico de uma síndrome epiléptica não depende exclusivamente do controle de crises, pois problemas sociais ou culturais podem interferir tanto quanto as crises na qualidade de vida dos pacientes.

BACKGROUND: Rolandic Epilepsy is the most common form of childhood epilepsy. It is classified as idiopathic, age-related epileptic syndrome with benign evolution. The absence of neuropsychological impairment is part of the criteria of benignity of this epilepsy syndrome. Recently, however, several deficits related to attention and language have been suggested. AIM: to assess school performance and to investigate praxis problems in patients with rolandic epilepsy in comparison to a control group of normal children, paired by age, gender and educational level. METHOD: nineteen patients aged between 7 and 12 years underwent clinical neurological evaluation, psychological assessment, through the Weschsler Scales of Intelligence, and language evaluation, to assess the academic performance and to investigate the presence or absence of praxis difficulties. Result: the obtained data indicate that although intellectual efficiency (measured through the Intelligence Quatient - IQ) was within average, children with rolandic epilepsy presented a significantly poorer performance when compared to the control group in tests involving writing, arithmetic and reading. Another important aspect was the absence of orofacial apraxia in children with epilepsy. CONCLUSION: the results of the study suggest that the assessment of children with epilepsy is necessary to investigate specific deficits that require appropriate professional assistance. Regarding the presence of oral language and/or writing disorders in these children, academic, social and emotional deficits can be avoided. The prognosis of epileptic syndrome does not exclusively depend on the control of the crises, since social or cultural problems can interfere in life quality as much as the crisis.

Efectos clínicos a largo plazo en niños intoxicados con plomo en una región del sur de Chile / Long term consequences among children exposed to lead poisoning

Background: In 1996 there was a massive lead poisoning in a southern rural community in Chile. The contamination source was a mill whose grinding stone was repaired with lead and contaminated the flour. Aim: To assess the presence of sequelae ten years later, among subjects that were exposed to lead on that occasion. Material and methods: Cross sectional study of 77 individuals (47 males), aged 10 to 25 years, that were exposed to lead in 1996 and were treated with EDTA. Results: Twenty one percent of subjects had a subnormal intellingence quotient (IQ). The risk of having a low IQ was significantly higher among those exposed before the age of six years. IQ was significantly lower among subjects that, immediately after the exposure, had a lead level over 48 fig/dl, compared with those that had a lead level below 43 fig/dl (86.7±7.3 and 93±11.6 respectively). No subjects with high blood pressure or evidences of nephrotoxicity were detected. Conclusions: Subjects aged ¡ess than six years at the moment of lead exposure had a lower IQ when assessed ten years later.

Status cognitivo-comportamental de prematuros de baixo peso ao nascimento em idade pré-escolar que vivem em país em desenvolvimento / Cognitive and behavioral status of low birth weight preterm children raised in a developing country at preschool age

OBJETIVO: Avaliar o desenvolvimento cognitivo e comportamental em idade pré-escolar de crianças prematuras com baixo peso ao nascimento que vivem em um país em desenvolvimento. MÉTODOS: Estudo transversal prospectivo de 80 recém-nascidos de um hospital universitário no sul do Brasil. A avaliação neuropsicológica aos 4-5 anos de idade incluiu a Escala de Inteligência de Wechsler para a Idade Pré-Escolar e Primária (WPPSI), a Escala de Conners para Pais Revisada (CPRS-R), o teste de Denver e exames neurológicos. As informações de desenvolvimento neuropsicomotor inicial e perinatal foram coletadas a partir do banco de dados durante o acompanhamento. Os resultados foram relacionados com o peso ao nascimento, o sexo e a idade gestacional. RESULTADOS: Os escores da WPPSI foram: quociente de inteligência (QI) total 88,00±16,96, QI verbal 89,72±16,72 e QI executivo 88,12±15,71 para o grupo com menos de 1.500 gramas; e QI total 91,11±14,73, QI verbal 93,36±12,65 e QI executivo 90,20±16,06 para o grupo entre 1.500 e 2.500 gramas. Os melhores escores foram obtidos em testes que avaliaram a capacidade de abstração e simbolização, completar figuras e percepção comum, nos quais apenas 5 e 6,3 por cento das crianças apresentaram resultados anormais, respectivamente. Os menores escores foram obtidos em testes que avaliam a coordenação visual-motora e a flexibilidade-velocidade de raciocínio, nos quais 27,5 e 16,3 por cento das crianças tiveram resultados anormais, respectivamente. No total, 32,5 por cento das crianças tiveram resultados anormais em testes aritméticos. Comportamentos relacionados com transtorno do déficit de atenção com hiperatividade (TDAH) foram observados em 48 por cento da amostra. Os baixos resultados na Escala Mental de Bayley e o resultado anormal no teste de Denver apresentaram correlação significativa com o TDAH (p = 0,017 e p = 0,004). Os resultados anormais na Escala Mental de Bayley (p < 0.001), teste de Denver (p < 0,001)...

OBJECTIVE: To assess cognitive and behavioral development at preschool age of children born preterm and with low birth weight and raised in a developing country. METHODS: Prospective cross-sectional study of 80 neonates born in a university hospital in southern Brazil. Neuropsychological assessment at age 4-5 years included the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Conners' Parent Rating Scale-Revised, Denver test and neurological examination. Perinatal and early neuropsychomotor development information was collected from the database during follow-up. Results were related to birth weight, sex and gestational age. RESULTS: WPPSI scores were: total IQ 88.00±16.96, verbal IQ 89.72±16.72, and executive IQ 88.12±15.71 for the group with less than 1,500 grams; and total IQ 91.11±14.73, verbal IQ 93.36±12.65, and executive IQ 90.20±16.06 for the group between 1,500 and 2,500 grams. The best scores were obtained in tests that evaluated capacity of abstraction and symbolization, picture completion and common perception, in which only 5 percent and 6.3 percent of the children had abnormal results, respectively. The lowest scores were obtained in tests that evaluated visual-motor coordination and flexibility-speed of reasoning, in which 27.5 percent and 16.3 percent of the children had abnormal results, respectively. A total of 32.5 percent had abnormal results in the arithmetic tests. Behaviors related to attention deficit/hyperactivity disorder (ADHD) were observed in 48 percent of the sample. Low score in the Bayley Mental Scale and abnormal result in the Denver test were significantly correlated to ADHD (p = 0.017 and p = 0.004). Abnormal results in the Bayley Mental Scale (p < 0.001), Denver test (p < 0.001) and neurological examination (p = 0.002) were associated with lower IQ. CONCLUSIONS: The results revealed an increased incidence of behavioral and cognitive disorders at preschool age.

El accidente de phineas gage: su legado a la neurobiología

Phineas Gage es a no dudar, uno de los pacientes más famosos de la historia de la neurología, una cita indefectible en textos neurológicos y objeto de numerosos artículos científicos a lo largo de más de ciento cincuenta años. Este caso tan excepcional ha permitido establecer el papel principal que en el pensamiento y en la capacidad de sociabilizar tienen las regiones frontales del cerebro, especialmente la porción ventromedial, así como los circuitos y sistemas relacionados con las emociones, cuya activación conjunta con las regiones frontales, participa de forma fundamental en la planificación y toma de decisiones, y contribuye a determinar el tono afectivo de nuestras relaciones sociales. Una revisión sumaria de la historia de la medicina nos indica que es inusual que el nombre de un paciente y no el del médico que describe una situación clínica, sea mencionado para la posteridad. ¿Por qué entonces se recuerda el nombre de Gage y no el de su médico tratante y acusioso descriptor de su insania, John Martyn Harlow? Quizá porque el caso es todavía considerado como una de las mejores descripciones de un desorden "psicopático" del comportamiento relacionado con una lesión traumática del córtex prefrontal, donde la correlación anatomoclínica ha sido intentada empleando diversas concepciones y métodos a la usanza de los diversos momentos históricos. La ocasión de este relato permitirá al lector pasearse a través de la fascinante evolución y perfeccionamiento de las ideas que han llevado al conocimiento actual de la localización de las funciones neurológicas, y a atisbar el desentrañamiento de los loci de la mente y del espíritu

Phineas Gage is doubtless one of the most famous patients in the history of neurology. An infallible quote in neurology textbooks and the object of numerous scientific articles for over one hundred and fifty years. This exceptional case has allowed investigators to establish the role of the frontal cortex, specifically its ventromedial portion in the development of human thought and his/her capacity to socialize and also the close relationship of these structures with emotion-related circuits and systems which participate in the decision-making process and contributes to determine the affective tone of social interaction. A brief glance at the history of medicine shows it is exceedingly infrequent for a patient's name to transcend into posterity. Why then is the name Gage remembered instead of John Martin Harlow's, the keen describer of Gage's insanity? Perhaps because Gage's case is still considered one of the salient descriptions of a "psychopathic" disorder of behavior directly related to a traumatic lesion of the prefrontal cortex in which an anatomoclinical correlation has been attempted through diverse conceptions and methods tailored to each historical period of time. Gage's tale will take the reader for a ride along the fascinating evolutional pathways of medical thinking that have permitted the acquisition of knowledgeable localization of neurological function and allowed scientists to peep into the entangled realm of the mind and spirit

Intelligence functions disorders in patients with complex partial epilepsy

OBJETIVO: Comparar o desempenho de pacientes com epilepsia parcial complexa e de sujeitos-controles quanto ao desempenho nos subtestes de um instrumento para avaliação das funções da inteligência. MÉTODO: Foram estudados 50 pacientes epilépticos em série consecutiva, com idade entre 19 e 49 anos. Também foram avaliados 20 sujeitos-controles, sem enfermidades neuropsiquiátricas, para efeito comparativo. Foi aplicado teste de inteligência para adultos de Wechsler-Bellevue em dois grupos, de pacientes e controles. Este teste é constituído de vários subtestes que avaliam funções cognitivas específicas. Os procedimentos de análise estatística foram efetuados segundo testes não-paramétricos. RESULTADOS: Em todos os subtestes do Wechsler-Bellevue, os pacientes apresentaram desempenho das funções da inteligência significativamente inferior ao dos controles (p<0,05), resultados corroborados pelas queixas dos mesmos quanto às funções cognitivas. CONCLUSAO: Pacientes com epilepsia parcial complexa apresentaram resultados significativamente inferiores no teste de inteligência quando comparados aos dos sujeitos sem epilepsia.

Algunas ideas sobre la verdad, el amor, la voluntad y la ética del libro del desasosiego de Bernardo Soares, de Fernando Pessoa / Some ideas on the truth, the love, the will and the ethics of the book of the uneasiness or Bernardine Soares, Fernando Pessoa

Fernando Pessoa (1888-1935) es uno de los escritores más famosos del siglo XX, en lengua portuguesa, ampliamente leído en varios idiomas y cada vez más estudiado. A través de su legado literario, con ocasión del análisis de algunos de sus textos, redactados con reconocida maestría y estética, se intenta entrever algo de su realidad más íntima en lo referente a temas relacionados con la verdad, el amor, la voluntad y la ética. Se recogen algunas ideas de un hombre cuya vida parece marcada por la tristeza de no hallar un sentido para existir, que a su vez sea referencia para desplegar todas las dimensiones de su ser

Event related evoked potential responses in epileptic patients.

The effect of epilepsy on cognitive functions has been investigated in this study. The P300 auditory event related potentials (AERP), Wechsler Adult Performance Intelligence Scale (WAPIS--Indian Adaptation) & Digit Span Test (DST) have been used to assess the cognitive status. Twenty primary generalised epilepsy patients and 20 normal controls were subjected to WAPIS & DST testing and their AERP recorded. On comparative statistical analysis, epileptic subjects were found to have significantly higher N2 & P300 latencies and lower P300 amplitude, WAPIS-IQ scores & DST scores. These findings suggest that there is a general decline of cognitive functions in epileptics especially the memory, attention, concentration and speed of mental processing and as also corroborated by P300 and that P300 can be used as an additional sensitive parameter to assess the cognitive status.