Estudio longitudinal del efecto del confinamiento por COVID-19 en la aparición de trastornos del sueño en una muestra clínica de niños y adolescentes españoles / Longitudinal study of the impact of confinement in a sample of Spanish children and adolescents

Aunque abundantes estudios aportan evidencia sobre el impacto del confinamiento en el sueño en población adulta, ésta resulta escasa en población infanto-juvenil. Así, el estudio surge de la necesidad de ampliar el conocimiento al respecto para amortiguar la urgencia clínica actual. El presente trabajo se propone estudiar el efecto de las restricciones debidas a la COVID-19 en las alteraciones del sueño de una muestra de niños y adolescentes que fueron atendidos en la consulta de psicología clínica del servicio público de salud. Se contó con una muestra de pacientes de entre 3 y 16 años, (Medad = 10.51, DT = 3.28). Como instrumentos de medida se utilizaron la Escala de Alteraciones del Sueño de Bruni, en tres momentos de medida, y un cuestionario con variables sociodemográficas. Se realiza un análisis descriptivo de evolución de la prevalencia y comparaciones de proporciones. Los resultados muestran que un 82% de la muestra tenía una alteración del sueño, que se mantuvo 6 meses y un descenso significativo al 22% un año después, coincidiendo con la flexibilización de las medidas. También se encuentran diferencias significativas entre la presencia o la ausencia de alteración del sueño y algunas de las variables recogidas: consumo de psicofármacos de los padres y uso de pantallas. Estos datos sugieren que el confinamiento tuvo un impacto emocional en la población infanto-juvenil, en concreto sobre el sueño. (AU)

This study highlights the need to expand the evidence on the impact of lockdown on the sleep of children and adolescents. Although several studies provide evidence in this regard, research on child and adolescent population is still scarce. The paper also aims at exploring whether the possible effects vanish over time. The sample is formed by patients ranging from 3 to 16 years old. The mean age was 10.51 and the SD was 3.28. Two assessment instruments were used: the Sleep Disturbances Scale for Children (SDSC) and a socieconomic questionnaire. The SDSC was measured three times during one year and a descriptive analysis of the sample and the evolution of the prevalence according to the results of the scale was executed. A comparison of proportions was made in those patients who exceeded the cut-off point in the different variables collected. The results indicate that 82% of the sample had a sleep disorder, which remained for 6 months and it experienced a significant decrease to 22% after one year, when COVID-19 restrictions were relaxed. There are also significant differences between sleep disorder and some of the variables collected: parents’ use of psychotropic drugs and use of screens. This data suggests that lockdown had an emotional impact on children and adolescent population, specifically on their sleep. (AU)

Sleep Time Estimated by an Actigraphy Watch Correlates With CSF Tau in Cognitively Unimpaired Elders: The Modulatory Role of APOE.

There is increasing evidence of the relationship between sleep and neurodegeneration, but this knowledge is not incorporated into clinical practice yet. We aimed to test whether a basic sleep parameter, as total sleep estimated by actigraphy for 1 week, was a valid predictor of CSF Alzheimer's Disease core biomarkers (amyloid-ß-42 and -40, phosphorylated-tau-181, and total-tau) in elderly individuals, considering possible confounders and effect modifiers, particularly the APOE ε4 allele. One hundred and twenty-seven cognitively unimpaired volunteers enrolled in the Valdecilla Study for Memory and Brain Aging participated in this study. Seventy percent of the participants were women with a mean age of 65.5 years. After adjustment for covariates, reduced sleep time significantly predicted higher t-tau and p-tau. This association was mainly due to the APOE ε4 carriers. Our findings suggest that total sleep time, estimated by an actigraphy watch, is an early biomarker of tau pathology and that APOE modulates this relationship. The main limitation of this study is the limited validation of the actigraphy technology used. Sleep monitoring with wearables may be a useful and inexpensive screening test to detect early neurodegenerative changes.

Major Surgery Affects Memory in Individuals with Cerebral Amyloid-ß Pathology.

BACKGROUND: Major surgery has been associated with perioperative neurocognitive disorders (PND), but the contributing factors and long-term prognosis are uncertain. We hypothesize that preclinical Alzheimer's disease (AD) might predispose to cognitive deterioration after surgery. OBJECTIVE: To analyze the effect of amyloid-ß on the cognitive trajectory after orthopedic surgery in a sample of non-demented subjects. METHODS: Non-demented individuals older than 65 years that were on the waiting list for orthopedic surgery with spinal anesthesia underwent a neuropsychological assessment before and after surgery. During surgery, cerebrospinal fluid samples were obtained to determine AD biomarkers. RESULTS: Cumulative incidence of PND was 55.2%during a mean follow-up of nine months. The most affected cognitive domains were executive function and constructional praxis. The presence of abnormal levels of amyloid-ß was associated to a postoperative impairment in verbal and visual memory tests. According to their AD biomarker profile, participants were categorized as either Amyloid Positive (A+) or Amyloid Negative (A-). The incidence of PND did not differ between both groups. The A- group showed a tendency similar to the global sample, worsening in executive function tests and improving on memory scales due to practice effects. In contrast, the A + group showed a notable worsening on memory performance. CONCLUSION: Our findings support the hypothesis that surgery may promote or accelerate memory decline in cognitively asymptomatic subjects with brain amyloid-ß deposits.

A snake that bites its own tail. Acquisition and loss of concepts in children and semantic dementia patients through the analysis of drawings.

OBJECTIVE: The structure of the semantic network is constructed and organized during childhood development. Previous publications have hypothesized that neurodegenerative diseases would lead to a disruption of this network reversing the steps acquired in childhood. Semantic Dementia (SD) is a subtype of frontotemporal lobe degeneration in which the main symptom is a specific loss of semantic memory. We aimed to describe the sequential acquisition of concepts in 3-8 years old children evaluated through the production of drawings and, in parallel, their progressive loss in SD patients. METHODS: 104 children between 40 and 96 months categorized into tertiles according to their age, 21 SD patients categorized into tertiles according to their score on a category fluency task and 34 healthy volunteers were asked to draw 12 items with, a priori, different age of acquisition and familiarity, belonging to four different semantic categories. We employed the drawings of the healthy volunteers to build a scoring scheme. We considered that a concept was acquired in children when 50% or more of its features were present in their drawings, and it was lost in patients when more than 50% were missing. RESULTS: Those concepts which the children were able to acquire earlier, according to our scoring scheme, tended to remain in patients with more advanced SD. While the items that children acquired later, were, in general, those that the SD patients lost at earlier disease stages. CONCLUSION: The patterns of concept acquisition in children were the mirror image of the loss in patients with SD. Our study supports the hypothesis that the sequence of concept acquisition in childhood is reversed in SD patients.

Distinctive Oculomotor Behaviors in Alzheimer's Disease and Frontotemporal Dementia.

Oculomotor behavior can provide insight into the integrity of widespread cortical networks, which may contribute to the differential diagnosis between Alzheimer's disease and frontotemporal dementia. Three groups of patients with Alzheimer's disease, behavioral variant of frontotemporal dementia (bvFTD) and semantic variant of primary progressive aphasia (svPPA) and a sample of cognitively unimpaired elders underwent an eye-tracking evaluation. All participants in the discovery sample, including controls, had a biomarker-supported diagnosis. Oculomotor correlates of neuropsychology and brain metabolism evaluated with 18F-FDG PET were explored. Machine-learning classification algorithms were trained for the differentiation between Alzheimer's disease, bvFTD and controls. A total of 93 subjects (33 Alzheimer's disease, 24 bvFTD, seven svPPA, and 29 controls) were included in the study. Alzheimer's disease was the most impaired group in all tests and displayed specific abnormalities in some visually-guided saccade parameters, as pursuit error and horizontal prosaccade latency, which are theoretically closely linked to posterior brain regions. BvFTD patients showed deficits especially in the most cognitively demanding tasks, the antisaccade and memory saccade tests, which require a fine control from frontal lobe regions. SvPPA patients performed similarly to controls in most parameters except for a lower number of correct memory saccades. Pursuit error was significantly correlated with cognitive measures of constructional praxis and executive function and metabolism in right posterior middle temporal gyrus. The classification algorithms yielded an area under the curve of 97.5% for the differentiation of Alzheimer's disease vs. controls, 96.7% for bvFTD vs. controls, and 92.5% for Alzheimer's disease vs. bvFTD. In conclusion, patients with Alzheimer's disease, bvFTD and svPPA exhibit differentiating oculomotor patterns which reflect the characteristic neuroanatomical distribution of pathology of each disease, and therefore its assessment can be useful in their diagnostic work-up. Machine learning approaches can facilitate the applicability of eye-tracking in clinical practice.