Cognitive phenotypes in patients with drug-resistant temporal lobe epilepsy: Relationships with cortisol and affectivity.

OBJECTIVE: Drug-resistant temporal lobe epilepsy (TLE) is a neurological disorder characterized by cognitive deficits. This study examined whether patients with TLE and different cognitive phenotypes differ in cortisol levels and affectivity while controlling for demographic and clinical variables. Methods: In this cross-sectional study, 79 adults with TLE underwent neuropsychological evaluation in which memory, language, attention/processing speed, executive function, and affectivity were assessed. Six saliva samples were collected in the afternoon to examine the ability of the hypothalamic-pituitary-adrenal (HPA) axis to descend according to the circadian rhythm (C1 to C6). The cortisol area under the curve concerning ground (AUCg) was computed to examine global cortisol secretion. RESULTS: Three cognitive phenotypes were identified: memory impairment, generalized impairment, and no impairment. The memory-impairment phenotype showed higher cortisol levels at C4, C5, and C6 than the other groups (p = 0.03, η2 = 0.06), higher cortisol AUCg than the generalized-impairment phenotype (p = 0.004, η2 = 0.14), and a significant reduction in positive affectivity after the evaluation (p = 0.026, η2 = 0.11). Higher cortisol AUCg and reductions in positive affectivity were significant predictors of the memory-impairment phenotype (p < 0.001; Cox and Snell R2 = 0.47). CONCLUSIONS: Patients with memory impairment had a slower decline in cortisol levels in the afternoon, which could be interpreted as an inability of the HPA axis to inhibit itself. Thus, chronic stress may influence hippocampus-dependent cognitive function more than other cognitive functions in patients with TLE.

Prospective study of cenobamate on cognition, affectivity, and quality of life in focal epilepsy.

OBJECTIVE: Cenobamate is a recently approved antiseizure medication that proved to be safe and effective in randomized controlled trials. However, little is known about its impact on some areas frequently affected by epilepsy. For this reason, we explored the effects of cenobamate on cognitive performance, as well as on negative affectivity and quality of life in a sample of patients with drug-resistant epilepsy. METHODS: Two prospective cohort studies were carried out. In Study 1, 32 patients (22 men and 10 women) underwent a baseline (T0) and a short-term (T1) neuropsychological assessment after 3 months of cenobamate administration. In Study 2, 22 patients (16 men and 6 women) from the T1 sample also underwent a baseline and a follow-up evaluation (T2) 6 months after T0. RESULTS: No significant differences were found in cognitive variables, negative affectivity, and quality of life either in Study 1 or Study 2. Similarly, based on the reliable change index, it was found that most patients showed no changes in these variables. SIGNIFICANCE: These results suggest that cenobamate is a safe antiseizure medication in terms of cognition, negative affectivity, or quality of life since no adverse events have been found after 3 and 6 months of treatment. PLAIN LANGUAGE SUMMARY: Cenobamate is a new antiseizure medication. In patients with epilepsy, cenobamate seems to not affect cognition, anxiety, depression, or quality of life.

Impact of Polytherapy on Memory Functioning in Patients With Drug-Resistant Epilepsy: The Role of Attention and Executive Functions.

OBJECTIVE: The aim was to examine the effect of polytherapy (i.e., the number of administered anti-seizure medications (ASMs)) on memory, and whether the interaction between the number of ASMs and attentional/executive functioning affect presurgical memory functioning and postsurgical memory changes in patients with drug-resistant epilepsy. METHODS: Two studies were carried out. Study 1 consisted of a presurgical assessment of 125 adult patients, in which attention/executive function (EpiTrack screening tool) and memory were assessed (cross-sectional study). Of them, 72 patients underwent a second postsurgical evaluation, in which memory was assessed (Study 2). Patients were distributed into groups based on EpiTrack performance and number of ASMs. RESULTS: The interaction between the number of ASMs and the attentional/executive functioning significantly affected presurgical memory, with patients with impaired EpiTrack performance taking three-four ASMs having poorer scores than patients with intact EpiTrack performance taking three-four ASMs (for all, p < .0001). This interaction also affected postsurgical memory changes, with patients with impaired Epitrack performance taking three-four ASMs having higher postsurgical decline than those with intact Epitrack performance taking three-four ASMs (for all, p < .005). No differences were found in patients taking two ASMs. Furthermore, the number of ASMs was associated with presurgical memory performance and postsurgical memory changes only in patients with impaired EpiTrack performance (for all, p < .05). CONCLUSIONS: Our findings underline the utility of EpiTrack, together with the clinical information on the number of prescribed ASMs, to corroborate the impact of polytherapy on memory and to optimize the prediction of postsurgical memory changes.

Stress phenotypes in epilepsy: impact on cognitive functioning and quality of life.

Introduction: Drug-resistant epilepsy has been proposed as a chronic stress model. Stress can be measured in terms of chronicity (epilepsy duration) and intensity (comorbidities), with depression and anxiety among the most important comorbidities in epilepsy due to its prevalence and its relationship with cognitive functioning and quality of life. This study aims to establish phenotypes according to how patients face a stressful condition (epilepsy) and examine differences in cognition and quality of life depending on these phenotypes. We hypothesize that there will be an interrelationship between epilepsy duration and negative affectivity, and these variables will influence cognition and quality of life. Methods: 170 patients (82 men and 88 women) underwent a neuropsychological evaluation in which trait anxiety, depression, attention and executive function, verbal and visual memory, language, emotional recognition, and quality of life were assessed. Hierarchical clustering was performed using z-scores for three variables: trait anxiety; depression; and epilepsy duration. Results: Three clusters were found: vulnerable (high negative affectivity and short duration); resilient (moderate negative affectivity and long duration); and low-impact group (low negative affectivity and short duration). Results show that the vulnerable group had poorer cognitive functioning and quality of life than the other groups. Specifically, the vulnerable group had poorer scores than the low-impact group on verbal memory, visual confrontation naming, and quality of life (except seizure worry). Furthermore, resilient patients had better scores than the low-impact group on cognitive flexibility variables, but lower scores on some quality-of-life subscales (i.e., overall quality of life, emotional well-being, and energy). Finally, the vulnerable group had poorer scores than the resilient group in executive functioning, naming, and quality of life. Discussion: These results suggest that dealing with stress in patients with epilepsy is related to cognitive performance and quality of life. These findings underline the relevance of considering comorbidities in epilepsy and may be useful for detecting vulnerable or resilient profiles as risk or protective factors for cognitive and quality of life decline.

Risk and Protective Factors Associated with Drug Use in Healthcare Professionals: A Systematic Review.

Healthcare professionals are exposed to stressful situations that may favor substance use vulnerability. This systematic review aims to synthesize the risk and protective factors associated with use, abuse, and dependence of alcohol, tobacco, psychoactive drugs, and cannabis in healthcare professionals. Following PRISMA recommendations, a systematic search was performed in PsycINFO, Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane Library. The search yielded 1523 studies, of which 19 were selected. The identified risk factors were demographic factors (i.e. male gender, and single/divorced marital status), psychopathological factors, social factors, positive attitudes toward drugs, unhealthy lifestyle habits, the COVID-19 pandemic, and the coexistence of the use of several substances. The protective factors were demographic factors (i.e. ethnicity and having dependent children), healthy lifestyle habits, and workplace anti-drug policies (i.e. restriction of tobacco use). These findings highlight the need for preventive actions against drug use in healthcare professionals to improve their health and reduce the possible negative impact on their healthcare practice. Knowledge of modifiable risk and protective factors allows their incorporation as components in preventive actions, and non-modifiable factors (e.g. demographic variables) may contribute to the detection of groups of greater vulnerability to propose selective prevention actions in this population.

Effectiveness of virtual reality-based neuropsychological interventions in improving cognitive functioning in patients with mild cognitive impairment: A systematic review and meta-analysis.

Objective: Increased prevalence of mild cognitive impairment (MCI) has led to a need for new neuropsychological intervention tools in this population. This meta-analysis aimed to learn about the efficacy of virtual reality (VR)-based neuropsychological interventions in improving cognitive functioning in patients with MCI. Method: This review followed the recommendations of the PRISMA statement, and it was registered in PROSPERO. The studies examined were collected from the PsycINFO, Web of Science, Pubmed/MEDLINE, Embase, Scopus, and Cochrane Library databases. Results: The systematic search yielded 258 articles, of which 13 randomized controlled trials were selected. VR-based neuropsychological interventions had moderate effects on global cognition (g = 0.30; 95% CI = 0.05, 0.56; p = 0.02), small effects on attention (g = 0.27; 95% CI = 0.04, 0.49; p = 0.02), and large effects on executive function (g = 0.60; 95% CI = 0.38, 0.81; p < 0.0001), but non-significant effects on working memory, episodic memory, language, or visuoconstruction. When the length of the intervention was considered, VR-based interventions of 15 or more hours had moderate effects on working memory (g = 0.55; 95% CI = 0.11, 0.99; p = 0.01), and large effects on language (g = 0.60; 95% CI = 0.01, 1.20; p = 0.05) and visuoconstruction (g = 1.13; 95% CI = 0.58, 1.67; p < 0.0001). Conclusions: Results suggest that VR-based interventions are beneficial for improving cognitive functioning in patients with MCI, and allow us to make recommendations that could have implications for clinical decision-making in this population.

The relationship between memory and quality of life is mediated by trait anxiety in patients with temporal lobe epilepsy.

PURPOSE: Memory deficits are very frequent in patients with drug-resistant epilepsy, but they predict a small proportion of variance of their quality of life (QOL) in previous studies, possibly due to the lack of consideration of mediating factors of this relationship. This study aimed to examine whether trait anxiety mediates the relationship between memory and QOL in this population, controlling the influence of demographic and seizure-related factors. METHODS: In this cross-sectional study, 119 adults with drug-resistant temporal lobe epilepsy (TLE) underwent a neuropsychological evaluation, in which memory, anxiety, and QOL were assessed. RESULTS: In the total sample, better delayed memory had an effect on better QOL indirectly through lower trait anxiety (B = 0.13, SE = 0.06, p = 0.04, abcs = 0.13; κ2 = 0.18; PMind = 0.76). Additionally, delayed memory has not a direct association with QOL (B = 0.04, SE = 0.09, p = 0.64, Cohen's f 2 = 0.005; PMdir = 0.24), and the total effect of delayed memory on QOL tended to reach statistical significance (B = 0.17, SE = 0.10, p = 0.08). The proposed mediation model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, SRMR = 0.009, and χ2 (1) = 0.50, p = 0.48) and explained 38% of the variance of QOL. CONCLUSION: These findings suggest that trait anxiety is an important factor in understanding the relationship between memory and QOL in patients with TLE, considering the influence of demographic and seizure-related variables, and may have relevant implications for decision-making in this population.

[Effects of cannabis use on attention and memory in adolescent population: a systematic review.] / Efectos del consumo de cannabis en la atención y la memoria en población adolescente: una revisión sistemática.

OBJECTIVE: Cannabis is an illegal drug whose use has increased in recent years, especially among adolescents. Despite its popularity, its use and abuse brings with it health consequences, being greater if consumption occurs in the adolescent stage, since the brain is in full development. The objective of this systematic review was to determine the effects of cannabis use on cognitive functions of attention and memory in adolescent population. METHODS: A systematic review of the literature was carried out in the main search portals (Pubmed, Web of Science, SciELO, Cochrane) referring to the last 10 years, following the PRISMA criteria. The systematic search strategy was carried out in the period from March to May 2021, applying the PICO method and the PEDro scale to guarantee the methodological quality of the included studies. RESULTS: Both attention and memory are affected by cannabis use; however, memory functions improve with abstinence, not being so for attention. Memory deficits are an indicator of therapeutic abandonment of addiction treatment. In relation to psychosocial interventions aimed at improving memory, the contingency management, educational interventions and motivational interviewing have not been shown to be effective on the effects of substances. Working memory training offers positive results, although not clinically significant. Finally, memory deficits are an indicator of therapeutic abandonment of pharmacological treatment for cannabis addiction. Therefore, research is needed aimed both at reducing the side effects of drugs on memory processes and at establishing to what extent memory deficits associated with cannabis use can facilitate therapeutic abandonment. CONCLUSIONS: More research is necessary, considering the dual consumption of cannabis-tobacco and the effects that both substances may have jointly and separately on attention and memory processes.

OBJETIVO: El cannabis es una droga ilegal cuyo consumo se ha visto incrementado en los últimos años, especialmente en población adolescente. A pesar de su popularidad, su uso y abuso trae consigo consecuencias para la salud, siendo mayores si el consumo se produce en la etapa adolescente, ya que el cerebro se encuentra en pleno desarrollo. El objetivo de esta revisión sistemática fue determinar los efectos del consumo de cannabis en las funciones cognitivas de atención y memoria en población adolescente. METODOS: Se llevó a cabo una revisión sistemática de la literatura en los principales portales de búsqueda (Pubmed, Web of Science, SciELO, Cochrane) referida a los últimos diez años, siguiendo los criterios PRISMA. La estrategia de búsqueda sistemática se realizó en el periodo de tiempo comprendido entre los meses de marzo a mayo de 2021, aplicándose el método PICO y la escala PEDro para garantizar la calidad metodológica de los estudios incluidos. RESULTADOS: Tanto la atención como la memoria se ven afectadas por el consumo de cannabis; sin embargo, la memoria mejora su funcionamiento con la abstinencia, no ocurriendo lo mismo con la atención. Los déficits de memoria son un indicador de abandono terapéutico del tratamiento para la adicción. En relación con las intervenciones psicosociales orientadas a la mejora de la memoria, tanto el manejo de contingencias como las intervenciones educativas y la entrevista motivacional no se han mostrado efectivas sobre los efectos de las sustancias. El entrenamiento en la memoria de trabajo ofrece resultados positivos, aunque clínicamente no significativos. Finalmente, los déficits de memoria son un indicador de abandono terapéutico del tratamiento farmacológico para la adicción al cannabis, por lo que se precisa investigación orientada tanto a reducir los efectos secundarios de los fármacos sobre los procesos mnésicos como a establecer en qué medida los déficits de memoria asociados al consumo de cannabis pueden facilitar el abandono terapéutico. CONCLUSIONES: Se precisa mayor investigación, considerando el consumo dual de cannabis-tabaco y los efectos que ambas sustancias pueden tener, conjuntamente y por separado, sobre los procesos de atención y memoria.

Efectos del consumo de cannabis en la atención y la memoria en población adolescente: una revisión sistemática / Effects of cannabis use on attention and memory in adolescent population: a systematic review

FUNDAMENTOS: El cannabis es una droga ilegal cuyo consumo se ha visto incrementado en los últimos años, especialmente en población adolescente. A pesar de su popularidad, su uso y abuso trae consigo consecuencias para la salud, siendo mayores si el consumo se produce en la etapa adolescente, ya que el cerebro se encuentra en pleno desarrollo. El objetivo de esta revisión sistemática fue determinar los efectos del consumo de cannabis en las funciones cognitivas de atención y memoria en población adolescente. MÉTODOS: Se llevó a cabo una revisión sistemática de la literatura en los principales portales de búsqueda (Pubmed, Web of Science, SciELO, Cochrane) referida a los últimos diez años, siguiendo los criterios PRISMA. La estrategia de búsqueda sistemática se realizó en el periodo de tiempo comprendido entre los meses de marzo a mayo de 2021, aplicándose el método PICO y la escala PEDro para garantizar la calidad metodológica de los estudios incluidos. RESULTADOS: Tanto la atención como la memoria se ven afectadas por el consumo de cannabis; sin embargo, la memoria mejora su funcionamiento con la abstinencia, no ocurriendo lo mismo con la atención. Los déficits de memoria son un indicador de abandono terapéutico del tratamiento para la adicción. En relación con las intervenciones psicosociales orientadas a la mejora de la memoria, tanto el manejo de contingencias como las intervenciones educativas y la entrevista motivacional no se han mostrado efectivas sobre los efectos de las sustancias. El entrenamiento en la memoria de trabajo ofrece resultados positivos, aunque clínicamente no significativos.(AU)

BACKGROUND: Cannabis is an illegal drug whose use has increased in recent years, especially among adolescents. Despite its popularity, its use and abuse brings with it health consequences, being greater if consumption occurs in the adolescent stage, since the brain is in full development. The objective of this systematic review was to determine the effects of cannabis use on cognitive functions of attention and memory in adolescent population. METHODS: A systematic review of the literature was carried out in the main search portals (Pubmed, Web of Science, SciELO, Cochrane) referring to the last 10 years, following the PRISMA criteria. The systematic search strategy was carried out in the period from March to May 2021, applying the PICO method and the PEDro scale to guarantee the methodological quality of the included studies. RESULTS: Both attention and memory are affected by cannabis use; however, memory functions improve with abstinence, not being so for attention. Memory deficits are an indicator of therapeutic abandonment of addiction treatment. In relation to psychosocial interventions aimed at improving memory, the contingency management, educational interventions and motivational interviewing have not been shown to be effective on the effects of substances. Working memory training offers positive results, although not clinically significant. Finally, memory deficits are an indicator of therapeutic abandonment of pharmacological treatment for cannabis addiction. Therefore, research is needed aimed both at reducing the side effects of drugs on memory processes and at establishing to what extent memory deficits associated with cannabis use can facilitate therapeutic abandonment. CONCLUSIONS: More research is necessary, considering the dual consumption of cannabis-tobacco and the effects that both substances may have jointly and separately on attention and memory processes.(AU)

Effects of psychological stress and cortisol on decision making and modulating factors: A systematic review.

Evidence suggests that psychological stress has effects on decision making, but the results are inconsistent, and the influence of cortisol and other modulating factors remains unclear. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, 18 studies carried out between 2015 and 2020 that examined the effects of psychological stress on decision making and measured cortisol levels were selected. Eight studies employed uncertainty-based economic tasks, five studies used decision-making tasks in hypothetical situations that can be encountered in real life or in a specific setting and five studies employed prosocial decision tasks. Seventeen studies assessed acute stress, and two assessed chronic stress; eight evaluated the influence of sex. Most of the studies that explored the association between stress and decision making using uncertainty-based economic tasks found statistically significant differences as a function of stress exposure and the cortisol response to stress, whereas most of the studies that employed non-economic decision-making tasks in hypothetical situations did not find statistically significant differences. When prosocial decision making was evaluated, more altruistic decisions were found after acute stress, and these decisions were positively associated with cortisol. Half of the studies that assessed the role of sex observed a greater impact on decision making after stress in women. Results suggest that it is important to consider modulating factors-the type of decision-making task, the cortisol response to stress, the characteristics of the psychological stressor or the subject's sex-when trying to understand psychosocial stress phenomena.

Síndrome de West y trastorno del espectro del autismo asociado: una propuesta de protocolo de evaluación e intervención neuropsicológica / West syndrome and associated autism spectrum disorder: proposal for a neuropsychological assessment and intervention protocol

Los pacientes con Síndrome de West y Trastorno del Espectro del Autismo (TEA) asociado presentan déficits cognitivos (i.e., alteraciones atencionales, mnésicas, visuoperceptivas, en función ejecutiva y lenguaje) que pueden afectar a su calidad de vida. Tras delimitar el perfil cognitivo de estos pacientes, este estudio pretende diseñar un protocolo de evaluación e intervención neuropsicológica específico, desde un enfoque holístico e integrativo. El programa consta de 48 sesiones planificadas en seis meses, incluyendo sesiones de evaluación neuropsicológica (antes, a mitad y al final de la intervención) y sesiones de intervención focalizadas en los dominios cognitivos afectados, los aspectos socioemocionales y la mejora de la autonomía y funcionalidad. Se espera que el programa propuesto sea eficaz para mejorar el funcionamiento cognitivo y la calidad de vida de esta población, contribuyendo a optimizar la atención sanitaria.(AU)

Patients with West Syndrome and associated Autism Spectrum Disorder (ASD) have cognitive deficits (i.e., attentional, mnestic, visuoperceptive, executive function, and language impairments) that may affect their quality of life. After delimiting the cognitive profile of these patients, this study aims to design a specific neuropsychological assessment and intervention protocol, from a holistic and integrative approach. The program consists of 48 sessions planned over six months, including neuropsychological assessment sessions (before, halfway through, and at the end of the intervention) and intervention sessions focused on the affected cognitive domains, socioemotional aspects, and the improvement of autonomy and functionality. The proposed program is expected to be effective in improving cognitive functioning and quality of life in this population, contributing to optimize health care.(AU)

Optimism as a protective factor against the psychological impact of COVID-19 pandemic through its effects on perceived stress and infection stress anticipation.

The 2019 coronavirus disease (COVID-19) and the recommended social isolation presented a challenge to people's mental health status. Optimism is a psychological factor that plays a key role in the evaluation of stressful situations. The purpose of this study was to investigate the mediating role of perceived stress and Covid-19-related stress anticipation in the relationship between optimism and post-traumatic stress symptoms. Our sample included 1015 participants ranging in age from 18 to 79 years, 80% of whom were Spaniards. At the beginning of the worldwide pandemic, participants were confined to their homes for at least seven days and completed an online survey measuring various sociodemographic and psychological variables. We found an indirect effect of optimism on intrusion and hyperarousal through perceived stress and stress anticipation. In addition, we observed an indirect effect of optimism on avoidance through perceived stress. Finally, the results showed a significant indirect effect of optimism on the total post-traumatic stress symptoms score through perceived stress and stress anticipation. Our results indicate that positive beliefs inherent to optimism are related to less psychological impact of the COVID-19 outbreak.

Clinical utility of Epitrack for differentiating profiles and patterns of post-surgical change in memory and quality of life in patients with drug-resistant epilepsy.

PURPOSE: To assess whether performance in attention and executive functions evaluated with the Epitrack screening tool before surgery can differentiate memory and quality of life (QOL) profiles, and detect different post-surgical change patterns in these variables in patients with epilepsy. METHODS: This is a longitudinal study. Seventy-seven patients with drug-resistant epilepsy (mean age = 37.91) underwent a neuropsychological assessment before and one year after surgery. Epitrack, a screening tool that exclusively evaluates attention and executive functioning, was administered in the pre-surgical assessment, and verbal and visual memory and QOL were assessed before and after surgery. RESULTS: Patients with impaired Epitrack performance had poorer verbal and visual memory than those with intact Epitrack performance, regardless of the time point (for all, p < 0.0001). They also showed a post-surgical decline in immediate verbal recall (p = 0.04) and discriminability (p = 0.001). Patients with intact Epitrack performance did not exhibit this decline. Epitrack total score significantly contributed to 13 and 11% of the variance of post-surgical changes in immediate verbal recall and discriminability, respectively. Epitrack groups did not differ in QOL profiles or changes, but post-surgical immediate verbal recall improvements were related to post-surgical QOL improvements. CONCLUSION: Our findings underline the utility of Epitrack screening tool to detect different patterns of verbal and visual memory dysfunction, as well as to predict post-surgical verbal memory decline in patients with drug-resistant epilepsy. Patients with lower pre-surgical Epitrack scores appear to be at increased risk for post-surgical memory decline.

Cardiovascular response to stress in patients with drug-resistant epilepsy: preliminary data / Respuesta cardiovascular al estrés en pacientes con epilepsia farmacorresistente: datos preliminares

Stress is a risk factor for cardiovascular diseases in the general population. Epilepsy has been considered a suitable model of chronic stress with a higher incidence of cardiovascular mortality than the general population. This study provides preliminary data about cardiovascular response to a cognitive stressor and a neuropsychological assessment in patients with epilepsy. It also explores the relationship between cardiovascular response and cognitive performance, depending on the side of seizure focus. Thirty-five patients with drug-resistant epilepsy, 17 with epileptogenic area (EA) in the left hemisphere (LH) and 18 with EA in the right hemisphere (RH), underwent a cognitive stressor and a neuropsychological assessment. The cardiovascular response was recorded throughout both conditions. Results showed that a long-lasting neuropsychological assessment was capable of producing a hemisphere-modulated cardiovascular response with heart rate (HR) decreases (and R-R interval increases) more pronounced in the LH patients than in the RH patients at the post-assessment period (p = .05 and p = .01, respectively). The hemisphere of EA moderated the relationship between cardiovascular response and cognitive performance (for all, p < .03). Our findings may have clinical implications from a preventive perspective since the EA hemisphere may be a relevant factor for coping with stress in people with drug-resistant epilepsy.(AU)

El estrés es un factor de riesgo para las enfermedades cardiovasculares en la población general. La epilepsia se ha considerado un modelo adecuado de estrés crónico, con mayor incidencia de mortalidad cardiovascular que la población general. Este estudio proporciona datos preliminares sobre la respuesta cardiovascular ante un estresor cognitivo y una evaluación neuropsicológica en pacientes con epilepsia, explorando las relaciones entre la respuesta cardiovascular y el rendimiento cognitivo dependiendo del hemisferio responsable de la epilepsia. Treinta y cinco pacientes con epilepsia farmacorresistente, 17 con el área epileptógena (AE) en el hemisferio izquierdo (HI) y 18 con AE en el hemisferio derecho (HD), se sometieron a un estres cognitivo y una evaluación neuropsicológica. La respuesta cardiovascular se registró durante toda la sesión en ambas condiciones. Los resultados mostraron que una evaluación neuropsicológica de larga duración fue capaz de producir una respuesta cardiovascular modulada por el hemisferio, con disminuciones de la frecuencia cardíaca (y aumentos del intervalo RR) más pronunciadas en el período post-evaluación en pacientes con epilepsia del HI que en pacientes con epilepsia del HD (p = .05, p = .01, respectivamente). El hemisferio del AE moderó la relación entre la respuesta cardiovascular y el rendimiento cognitivo (para todos, p < .03). Nuestros hallazgos podrían tener implicaciones clínicas desde una perspectiva preventiva, ya que sugieren que el hemisferio del AE podría ser un factor relevante en el afrontamiento del estrés en personas con epilepsia farmacorresistente.(AU)

Drug load and memory during intracarotid amobarbital procedure in epilepsy.

BACKGROUND: Anti-seizure medications (ASMs) have been related to poor cognitive function, but their relationship with intracarotid amobarbital procedure (IAP) results remains unclear. AIMS OF THE STUDY: To elucidate whether the number and drug load of ASMs are associated with memory scores of the IAP and the neuropsychological assessment. METHODS: Fifty-nine adult patients with drug-resistant epilepsy (mean age = 36.1, SD = 11.6) underwent bilateral IAP (with drawings and words as memory items) and a neuropsychological assessment to assess the risk of post-surgical memory decline. Total ASM drug load was calculated by summing the daily dose/defined daily dose ratio of every ASM of each patient. Pearson's correlations and hierarchical regressions were computed. RESULTS: Total IAP memory score was associated with total ASM drug load (r = -0.30, p = 0.02) and seizure frequency (r = -0.25, p = 0.05). After controlling clinical variables, total ASM drug load explained 16% of the variance of total IAP memory score. This relationship was especially prominent in patients with left hemisphere focus (r = -0.33, p = 0.04). The number of current ASMs was not related to IAP memory score (r = -0.16, p = 0.24). The number or drug load of ASMs were not related to neuropsychological assessment results (for all, p > 0.07). CONCLUSIONS: Our findings suggest that total drug load can be a confounding variable in the IAP memory performance that could explain, at least in part, the reverse asymmetries reported in different studies.

Optimismo Disposicional Y Estrés: Claves Para Promover El Bienestar Psicológico / Dispositional Optimism And Stress: Keys To Promoting Psychological Well-Being

Numerosos estudios señalan que los factores psicológicos afectan de forma importante al funcionamiento fisiológico del organismo. El optimismo disposicional considerado un rasgo unidimensional de personalidad, se relaciona con las expectativas de éxito futuro según la Self-Regulatory Behavior Theory. En diversos estudios, el optimismo se propone como factor modulador de la respuesta de estrés tanto crónico como agudo ya que altos niveles en la dimensión se asocian con bajos niveles de estrés percibido y cortisol. Además, el optimismo parece ser una variable clave en la regulación del ritmo circadiano del eje Hipotálamo-Hipófiso Adrenal (HHA). Esta influencia se ha estudiado con datos de cortisol en pelo, la respuesta matutina de cortisol y el nivel de cortisol a lo largo del día, encontrando resultados inconsistentes hasta el momento. En el presente trabajo se analiza la relación entre el optimismo y la respuesta de estrés acorde al eje HHA que ha mostrado ser relevante en la promoción del bienestar físico y psicológico. Asimismo, se reflexiona sobre la incorporación del optimismo disposicional en los programas de intervención psicológica como estrategia para promover el bienestar psicológico y prevenir la enfermedad en la población dada su relación con el desarrollo de alteraciones físicas y psicológicas como resultado de estados disfuncionales de estrés. (AU)

Numerous studies indicate that psychological factors significantly affect the physiological functioning of the body. Dispositional optimism, considered a one-dimensional personality trait, is related to expectations of future success according to self-regulatory behavior theory. In various studies, optimism is proposed as a modulating factor of both the chronic and acute stress response, since high levels in optimism have been associated with low levels of perceived stress and cortisol. Furthermore, optimism appearsto be a key variable in the regulation of the circadian rhythm of the hypothalamic-pituitary-adrenal (HPA) axis. This influence has been studied with data on hair cortisol, the awakening cortisol response, and the cortisol level throughout the day, with inconsistent results being found so far. In the present work, the relationship between optimism and the stress response according to the HPA axis is analyzed, which has been shown to be relevant in promoting physical and psychological well-being. Likewise, the incorporation of dispositional optimism in psychological intervention programs is considered as a strategy to promote psychological well-being and prevent disease in the population, given its relationship with the development of physical and psychological alterations as a result of dysfunctional states of stress. (AU)

Educational level as a protective factor against the influence of depressive symptoms on cognition in older adults: implications for functional independence during a 10-year follow-up.

OBJECTIVES: To examine whether the educational level moderates the relationship between baseline depressive symptoms and cognitive functioning at 5- and 10-year follow-ups in older adults, considering the association between cognitive functioning and difficulty with activities of daily living (ADL). DESIGN: Using a prospective design, a path analysis was performed. SETTING: In-home, face-to-face interviews and self-administered questionnaires, within the National Social Life, Health, and Aging Project. PARTICIPANTS: In total, 1,461 participants (mean age = 66.62) were followed up from Wave 1 (baseline) to Wave 2 (at 5 years) and Wave 3 (at 10 years). MEASUREMENTS: Depressive symptoms were assessed at baseline. Cognitive functioning and difficulty with ADL were assessed at baseline and at 5 and 10 years. RESULTS: Educational level moderates the relationship between depressive symptoms and cognitive functioning at 5 years (ß = 0.07, SE = 0.03, p = 0.04, Cohen's f2 = 0.02), being depressive symptoms related to poor cognitive functioning only at low educational levels. Cognitive functioning predicts difficulty with ADL at 5 and 10 years (ß = -0.08, SE = 0.03, p = 0.008, Cohen's f2 = 0.01; ß = -0.09, SE = 0.03, p = 0.006, Cohen's f2 = 0.02). The proposed model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, 90% CI 0.0001-0.03, SRMR = 0.004, and χ2(8) = 7.16, p = 0.52). CONCLUSIONS: Cognitive reserve may act as a protective factor against the effect of depressive symptoms on cognition in older adults, which, in turn, is relevant to their functional independence.

The number of anti-seizure medications mediates the relationship between cognitive performance and quality of life in temporal lobe epilepsy.

OBJECTIVES: To assess whether cognitive performance predicts quality of life (QOL) in patients with drug-resistant temporal lobe epilepsy (TLE), using the Epitrack cognitive screening tool, while considering the mediating role of the number of anti-seizure medications (ASMs) and controlling for seizure-related, social, and emotional factors. METHODS: Seventy-five adult patients with drug-resistant TLE (mean age = 39.76 years, SD = 11.66) underwent a presurgical neuropsychological assessment. MAIN OUTCOME MEASURES: Cognitive performance (Epitrack), depression (BDI-II), trait anxiety (STAI); and QOL (QOLIE-31) were assessed. RESULTS: Adjusting for seizure-related, social, and emotional factors, the Epitrack total score significantly contributed to QOL composite score, and energy and cognitive self-rating subscales. We found a significant indirect effect of the Epitrack total score on QOL composite score and seizure worry and social functioning subscales via the number of ASMs. CONCLUSION: Our findings underline the relevance of cognitive functioning on QOL and the clinical utility of Epitrack to track cognitive side effects of ASMs and, consequently, to predict and manage QOL in this population.

Epilepsy surgery beyond 50 years: Long-term seizure and cognitive outcomes.

INTRODUCTION: Surgery is a well-demonstrated effective treatment for patients with refractory epilepsy. However, there are scarce data about the efficacy in older patients. Endpoint was to evaluate the outcome of epilepsy surgery in pharmacorresistant patients operated in middle-late adulthood. METHODS: We conducted a retrospective observational study including patients who underwent a epilepsy surgery at age ≥ 50. Presurgical clinical data, type of surgery, and postsurgical seizure outcome and neurological complications, including neuropsychological assessment were analyzed. Minimum post-surgical follow-up was 1 year. RESULTS: We identified 38 patients (22 males, 17 females) out of 350 patients who underwent a resective surgery with curative intention in our Epilepsy Unit (12%). Median age at surgery was 56 years (50-69), with median epilepsy duration of 42 years (4-67). Neuroimaging showed focal epileptogenic lesions in 37 patients, mainly mesial temporal sclerosis (21). Presurgical neuropsychological evaluation was available in 38 patients: 35 had deficits, mostly in verbal or visual memory. Twenty-eight patients underwent standard temporal lobectomy with amygdalohippocampectomy, 7 lesionectomy and 4 lobectomy. Median follow-up was 4.46 years (1-9.75). A good outcome was achieved by 86.8% (28 Engel I; 5 Engel II); 5 patients were studied with SEEG, without any complications. None had postsurgical permanent neurological complications. From 22 patients with available post-surgical neuropsychological assessment, 16 scored lower than in pre-surgical one, mainly in memory domain. CONCLUSION: Surgical treatment of long-term refractory epilepsy in patients ≥50 years can be effective and safe. Post-surgical memory decline is a frequent side effect, but with a low impact in daily life.

Hippocampal Shape Is Associated with Memory Deficits in Temporal Lobe Epilepsy.

OBJECTIVE: Cognitive problems, especially disturbances in episodic memory, and hippocampal sclerosis are common in temporal lobe epilepsy (TLE), but little is known about the relationship of hippocampal morphology with memory. We aimed to relate hippocampal surface-shape patterns to verbal and visual learning. METHODS: We analyzed hippocampal surface shapes on high-resolution magnetic resonance images and the Adult Memory and Information Processing Battery in 145 unilateral refractory TLE patients undergoing epilepsy surgery, a validation set of 55 unilateral refractory TLE patients, and 39 age- and sex-matched healthy volunteers. RESULTS: Both left TLE (LTLE) and right TLE (RTLE) patients had lower verbal (LTLE 44 ± 11; RTLE 45 ± 10) and visual learning (LTLE 34 ± 8, RTLE 30 ± 8) scores than healthy controls (verbal 58 ± 8, visual 39 ± 6; p < 0.001). Verbal learning was more impaired the greater the atrophy of the left superolateral hippocampal head. In contrast, visual memory was worse with greater bilateral inferomedial hippocampal atrophy. Postsurgical verbal memory decline was more common in LTLE than in RTLE (reliable change index in LTLE 27% vs RTLE 7%, p = 0.006), whereas there were no differences in postsurgical visual memory decline between those groups. Preoperative atrophy of the left hippocampal tail predicted postsurgical verbal memory decline. INTERPRETATION: Memory deficits in TLE are associated with specific morphological alterations of the hippocampus, which could help stratify TLE patients into those at high versus low risk of presurgical or postsurgical memory deficits. This knowledge could improve planning and prognosis of selective epilepsy surgery and neuropsychological counseling in TLE. ANN NEUROL 2020 ANN NEUROL 2020;88:170-182.