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.

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.

Activación conductual para el control de la depresión en pacientes oncológicos: una revisión / Behavioral activation for the control of depression in cancer patients: a review

La Activación Conductual (AC) se define como un proceso terapéutico focalizado a incrementar conductas que coloquen al paciente en un ambiente que proporcione contingencias reforzantes. Este tipo de terapia está validada empíricamente como tratamiento no farmacológico para la depresión y se caracteriza por ser flexible y estar centrada en las necesidades únicas del paciente. El objetivo de este trabajo fue revisar la literatura disponible relacionada a los efectos de la terapia de activación conductual sobre el Trastorno Depresivo Mayor en pacientes con cáncer. Se realizó una revisión bibliográfica sistemática en siete bases de datos, utilizando el sistema PICO para la identificación de los artículos. Se incluyeron estudios en idioma inglés y español publicados en el período 2000-2016 localizados con los descriptores "depresión", "terapia de activación conductual" y "pacientes con cáncer". Se encontraron un total de 373 artículos, de los cuales sólo diez cumplieron con los criterios establecidos para esta revisión. Los estudios se realizaron en pacientes con cáncer no hospitalizados, atendidos en la consulta externa y la intervención se realizó de manera individualizada. Los estudios reportan la utilidad de la AC para el tratamiento del Trastorno Depresivo Mayor en población oncológica. Se sugiere realizar una evaluación clínica para implementar la AC, considerando: la biología del tumor, el estadio clínico, la modalidad de tratamiento y los efectos adversos derivados del mismo, la toxicidad acumulada y la historia natural de la enfermedad (AU)

Behavioral activation (AC) is defined as a therapeutic process focused in increasing patient’s behaviors through an environment that provides the patient reinforcing contingencies. This therapy is empirically validated as a non-pharmacological treatment for depression because of its flexibility and its patient-tailored focus. The purpose of this work was to do a literature review about behavioral activation and major depressive disorder in cancer patients. We conducted a systematic review into seven databases using the PICO system in order to identify the articles. Studies in both English and Spanish published between 2000-2016 were included; the keywords "depression", "behavioral activation therapy" and "cancer patients" were used in the search. 373 articles were found, however only 10 fulfilled the required criteria. The studies were carried out with non-hospitalized ambulatory patients; all the interventions were conducted individually. Results showed the relevance of behavioral activation as the main treatment of Major Depressive Disorder in an oncological population. We suggest to perform a clinical evaluation before applying AC considering: the tumor characteristics, clinical stage, type of treatment, collateral or adverse effects, cumulative toxicity and the natural story of the disease (AU)

Escala de estrategias de enfrentamento para cuidadores primarios informales de pacientes con cáncer / Scale for coping strategies for informal caregivers of patients with cancer

Objetivo: Analizar propiedades psicométricas de un nuevo instrumento válido y confiable, que evalúa las estrategias de enfrentamiento en cuidadores primarios informales (CPI) de pacientes oncológicos. El Instrumento de Estrategias de Enfrentamiento en Cuidadores Primarios Informales (IEECPI), consta de 2 factores (Dirigido a la emoción) y 3 indicadores (Dirigido al problema). Método: Se evaluó a 20 CPI de pacientes oncológicos mediante un cuestionario de preguntas abiertas, para obtener información sobre la conceptualización de las dimensiones teóricas de las estrategias de enfrentamiento obteniendo 216 indicadores, agrupados en dos categorías (Dirigido a la emoción y al problema), de los cuales se generaron 55 reactivos que se aplicaron a 255 CPI. Una vez obtenidos los datos se siguió el procedimiento propuesto por Nunnally y Bernstein (1994) y el de Reyes-Lagunes, García y Barragán (2008) que consiste en: Análisis de frecuencia de cada reactivo, para conocer el tipo de distribución predominante, discriminación y direccionalidad de los reactivos, confiabilidad inicial, análisis de correlación, análisis factorial y confiabilidad total y por factores. Resultados: Los resultados muestran que de los 55 reactivos iniciales, posterior al análisis estadístico, finalmente se obtuvieron 15 reactivos divididos en 2 factores (Dirigido a la emoción evitativo y Dirigido a la emoción emocional negativo) y 3 indicadores (Dirigido al problema directo, Dirigido al problema revaluación cognitiva positiva y Revaluación cognitiva negativa). Conclusión: El IEECPI, es un instrumento válido, confiable y culturalmente relevante para evaluar estrategias de enfrentamiento en CPI de pacientes oncológicos y detectar necesidades con necesidad de intervención (AU)

Objective: Analize the psychometric properties of a new instrument valid and reliable instrument, which assesses the coping strategies in informal primary caregivers (IPC) of patients with cancer. The Instrument of Coping Strategies in Primary Informal Caregivers (IEECPI), consists in 2 factors (EmotionFocused) and 3 indicators (Problem-Focused). Method: Has been evaluated 20 IPC cancer patients with a questionnaire of open questions, to get information about the conceptualization of the theoretical dimensions of the coping strategies, been getting 216 indicators, that were grouped in two categories: Focused emotion and Focused problem, of which 55 reagents that were applied to 255 IPC were generated. Once the data proposed by Nunnally and Bernstein (1994) y el de Reyes-Lagunes, García y Barragán (2008) procedure is followed: frequency analysis of each item, to determine the predominant type of distribution, discrimination and directionality item, starting reliability, correlation analysis, factor analysis and full and reliability factors. Results: The results show that the 55 items at the begging, after statistical analysis, finally 15 items divided into two factors (Appraisal Focused strategies to the avoidant emotion and focused to the negative emotion emotional) and 3 indicators (Focused- problem were obtained focused problem positive and negative cognitive, appraisal cognitive). Conclusion: The IEECPI, it is a valid, reliable and culturally relevant to evaluate coping strategies in ICP of cancer patients and identify needs of intervention instrument (AU)