88 research outputs found
Estimulación cognitiva en personas adultas con síndrome de Down que mantienen una vida activa. Prevención del deterioro cognitivo y seguimiento neuropsicológico en el proceso de envejecimiento
Introducció: El procés d’envelliment de les persones amb síndrome de Down (SD) es caracteritza per dos aspectes fonamentals: l’augment de l’esperança de vida en els darrers anys, i la relació que existeix entre la SD i una major probabilitat de desenvolupar processos neurodegeneratius. Quant a l’evolució dels canvis neuropsicològics en el procés d’envelliment, s’ha descrit que mostren dificultats en atenció sostinguda i selectiva, memòria verbal, memòria a curt i llarg termini, planificació, fluïdesa verbal, inhibició, llenguatge expressiu i pràxies, essent fonamental valorar la seva evolució. S’han desenvolupat diferents intervencions per a optimitzar les capacitats cognitives de les persones amb SD, com els programes d’estimulació cognitiva, que tenen com a base neurobiològica la neuroplasticitat. Un dels programes d’estimulació cognitiva en format digital és el NeuronUP, que permet dissenyar sessions d’entrenament cognitiu adaptades a les necessitats de la persona. A més d’aquestes intervencions, és important mantenir una vida activa i saludable realitzant activitats estimulants com l’esport, l’oci o participant en programes de formació i ocupació.
Objectius: L’objectiu general de la tesi consisteix en estudiar el rendiment cognitiu i l’evolució dels canvis neuropsicològics associats al procés d’envelliment de les persones adultes amb SD que mantenen una vida activa, i determinar els efectes de l’aplicació d’un programa d’estimulació cognitiva adaptat al perfil neuropsicològica d’aquesta població.
Mètode: El primer estudi segueix una metodologia selectiva i un disseny experimental d’enquesta transversal; i es compon d’una mostra de 79 participants amb SD. Com a instruments, s’utilitza l’Screening de Evaluación y Seguimiento Neuropsicológico (SAS-NPS), que avalua l’atenció, la memòria, el llenguatge, les pràxies i les funcions executives. El segon estudi utilitza una metodologia selectiva i un disseny experimental d’enquesta longitudinal; en que s’ha analitzat el rendiment cognitiu de 79 participants amb SD i s’ha avaluat l’evolució en cinc grups en un període de 10 a 15 anys, i en un interval de 4 a 6 anys entre grups, mitjançant l’aplicació del SAS-NPS. El tercer estudi emplea una metodologia quasi-experimental i un disseny experimental pretest-posttest amb grup control no equivalent (no fet a l’atzar); i compta amb un grup experimental de 14 participants amb SD i un grup control d’uns altes 14 participants amb SD. Com a instruments, s’utilitzen el SAS-NPS i el programa d’estimulació cognitiva NeuronUP.
Resultats: Del primer estudi s’extrau que el rendiment neuropsicològica es manté estable entre les persones adultes amb SD que mantenen una vida activa, tant pels menors de 38 anys com pels majors de 38 anys. Al segon estudi, es pot observar que el rendiment neuropsicològica de les persones adultes amb SD que mantenen una vida activa es manté estable en un interval de 10 a 15 anys, és a dir, a les 5 avaluacions longitudinals de seguiment neuropsicològica dutes a terme cada 2-3 anys. En el cas de l’anàlisi dels resultats obtinguts a l’interval de 4 a 6 anys, s’observa un nivell significativament inferior a la intel·ligència general i un nivell superior a les praxis. En el tercer estudi, el programa d’estimulació cognitiva NeuronUP i la metodologia basada en l’aprenentatge mediat de Feuerstein afavoreix que les funcions cognitives es mantinguin estables en persones adultes amb SD que mantenen una vida activa, tant abans com després dels 38 anys. En aquest cas, s’observa una tendència que, tot i no ser estadísticament significativa, indica que les dones milloren el seu rendiment en Fluïdesa verbal després de la intervenció.
Conclusió: En conjunt, els resultats de la present tesi mostren que el rendiment cognitiu de les persones adultes amb SD que mantenen una vida activa es manté estable durant el seu procés d’envelliment. A més, els programes d’estimulació cognitiva promouen la neuroplasticitat i la reserva cognitiva, afavorint un rendiment cognitiu òptim i un envelliment saludable al llarg del cicle vital de les persones adultes amb SD.Introducción: El proceso de envejecimiento de las personas con síndrome de Down (SD) se caracteriza por dos aspectos fundamentales: el aumento de la esperanza de vida en los últimos años, y la relación que existe entre el SD y la mayor probabilidad de desarrollar procesos neurodegenerativos. En cuanto a la evolución de los cambios neuropsicológicos en el proceso de envejecimiento, se ha descrito que muestran dificultades en atención sostenida y selectiva, memoria verbal, memoria a corto y largo plazo, planificación, fluidez verbal, inhibición, lenguaje expresivo y praxias, siendo fundamental valorar su evolución. Se han desarrollado diferentes intervenciones para optimizar las capacidades cognitivas de las personas con SD, como los programas de estimulación cognitiva, cuya base neurobiológica es la neuroplasticidad. Uno de estos programas de estimulación cognitiva en formato digital es el NeuronUP, que permite diseñar sesiones de entrenamiento cognitivo adaptado a las necesidades de la persona. Además de estas intervenciones, es importante mantener una vida activa y saludable realizando actividades estimulantes como deporte, ocio o participando en programas de formación y ocupación.
Objetivos: El objetivo general de la tesis consiste en estudiar el rendimiento cognitivo y la evolución de los cambios neuropsicológicos asociados al proceso de envejecimiento de las personas adultas con SD que mantienen una vida activa, y determinar los efectos de la aplicación de un programa de estimulación cognitiva adaptado al perfil neuropsicológico de esta población.
Método: El primer estudio sigue una metodología selectiva y un diseño experimental de encuesta transversal; y se compone de una muestra de 79 participantes con SD. Como instrumentos se utiliza el Screening de Evaluación y Seguimiento Neuropsicológico (SAS-NPS), que evalúa la atención, la memoria, el lenguaje, las praxis y las funciones ejecutivas. El segundo estudio utiliza una metodología selectiva y un diseño experimental de encuesta longitudinal; en el que se ha analizado el rendimiento cognitivo de 79 participantes con SD y se ha evaluado su evolución en cinco grupos en un periodo de 10 a 15 años, y en un intervalo de 4 a 6 años entre grupos, mediante la aplicación del SAS-NPS. El tercer estudio emplea una metodología cuasi-experimental y un diseño experimental pretest-posttest con grupo control no equivalente (no hecho al azar); y cuenta con un grupo experimental de 14 participantes con SD y un grupo control de otros 14 participantes con SD. Como instrumentos, se utilizan el SAS-NPS y el programa de estimulación cognitiva NeuronUP.
Resultados: Del primer estudio se extrae que el rendimiento neuropsicológico se mantiene estable en el proceso de envejecimiento de las personas adultas con SD que mantienen una vida activa, tanto para los menores de 38 años como para los mayores de 38 años. En el segundo estudio, se puede observar que el rendimiento neuropsicológico de las personas adultas con SD que mantienen una vida activa se mantiene estable en un intervalo de 10 a 15 años, es decir, en las 5 evaluaciones longitudinales de seguimiento neuropsicológico llevadas a cabo cada 2-3 años. En el caso del análisis de los resultados obtenidos en el intervalo de 4 a 6 años, se observa un nivel significativamente inferior en la inteligencia general y un nivel superior en las praxias. En el tercer estudio, tanto el programa de estimulación cognitiva NeuronUP como la metodología basada en el aprendizaje mediado de Feuerstein, favorecen que las funciones cognitivas se mantengan estables en personas adultas con SD que mantienen una vida activa, tanto antes como después de los 38 años. En este caso, se observa una tendencia que, pese a no ser estadísticamente significativa, indica que las mujeres mejoran su rendimiento en fluidez verbal después de la intervención.
Conclusión: En conjunto, los resultados de la presente tesis muestran que el rendimiento cognitivo de las personas adultas con SD que mantienen una vida activa se mantiene estable durante su proceso de envejecimiento. Además, los programas de estimulación cognitiva promueven la neuroplasticidad y la reserva cognitiva, favoreciendo un rendimiento cognitivo óptimo y un envejecimiento saludable a lo largo del ciclo vital en las personas adultas con SD.Introduction: The aging process of people with Down syndrome (DS) is characterized by two fundamental aspects: the increase in life expectancy in the last years, and the relationship between DS and the higher probability of developing neurodegenerative processes. Regarding the evolution of neuropsychological changes in the aging process, it has been described that they show difficulties in sustained and selective attention, verbal memory, short- and long-term memory, planning, verbal fluency, inhibition, expressive language and praxis, being essential to assess its evolution. Different interventions have been developed to optimize the cognitive abilities of people with DS, such as cognitive stimulation programs, whose neurobiological basis is neuroplasticity. One of these cognitive stimulation programs in digital format is NeuronUP, which allows you to design cognitive training sessions adapted to the person’s needs. In addition to these interventions, it is important to maintain an active and healthy life by engaging in stimulating activities such as sport, leisure or participating in training and employment programs.
Objectives: The general objective of the thesis is to study the cognitive performance and the evolution of the neuropsychological changes associated with the aging process in adults with DS who maintain an active life, and to determine the effects of applying a cognitive stimulation program adapted to the neuropsychological profile of this population.
Method: The first study follows a selective methodology and a cross-sectional survey experimental design; and is composed of a sample of 79 participants with DS. As instruments, the Screening de Evaluación y Seguimiento Neuropsicológico (SAS-NPS) is used, which evaluates attention, memory, language, praxis and executive functions. The second study uses a selective methodology and a longitudinal survey experimental design; in which the cognitive performance of 79 participants with DS has been analyzed and their evolution has been evaluated in five groups in a period of 10 to 15 years, and in an interval of 4 to 6 years between groups, through the application of the SAS-NPS. The third study uses a quasi-experimental methodology and a pretest-posttest experimental design with a non-equivalent control group (not random); and it has an experimental group of 14 participants with DS and a control group of another 14 participants with DS. As instruments, the SAS-NPS and the NeuronUP cognitive stimulation program are used.
Results: From the first study it was found that neuropsychological performance is stable among adults with DS who maintain an active life, both those under 38 years of age and those over 38 years of age. According to the second study, it can be observed that the neuropsychological performance of adults with DS who maintain an active life remains stable in an interval of 10 to 15 years, that is, in the 5 longitudinal evaluations of neuropsychological follow-up carried out each 2-3 years. In the analysis of the results obtained in the interval of 4 to 6 years, a significantly lower level is observed in general intelligence and a higher level in praxis. In the third study, the NeuronUP cognitive stimulation program and the methodology based on Feuerstein's mediated learning favor the stability of cognitive functions in adults with DS who maintain an active life, both before and after 38 years. In these cases, a trend is observed that, although not statistically significant, indicates that women improve their performance in verbal fluency after the intervention.
Conclsion: Overall, the results of this thesis show that the cognitive performance of adults with DS who maintain an active life remains stable during their aging process. In addition, cognitive stimulation programs promote neuroplasticity and cognitive reserve, favoring optimal cognitive performance and healthy aging throughout the life cycle in adults with DS
Sleep in Childhood Attention Deficit Hyperactivity Disorder
Background
Sleep impairments frequently co-occur in children with Attention Deficit Hyperactivity Disorder (ADHD), and the nature of their relationship is bidirectional. Sleep problems in this population manifest as difficulties falling asleep, maintaining sleep and in poorer sleep quality, greater daytime sleepiness, altered sleep duration and increased limb movement in sleep. These concerns affect the quality of life, academic performance, cognitive functions, behavioural and family health of the child, negatively impacting their functional outcomes. Early identification and management of sleep problems in this population therefore has deep-rooted clinical utility. In this thesis we aimed to comprehensively delineate the nature of sleep problems in children with ADHD, explore the possible ADHD related cognitive/behavioural facets and environmental factors that might be influencing the child’s sleep and translate our understanding to the design of ADHD-specific sleep assessment tool for clinical utility.
Methods and Results
Chapter 2 reports the systematic review of studies investigating sleep in children between the age of 5-13 years who are diagnosed with ADHD. 148 empirical studies published between 2009-2019 were reviewed and a narrative synthesis was presented categorising studies into five sections. These included studies exploring the nature of these difficulties (subjective reports, sleep macrostructure and microstructure); studies exploring circadian rhythm patterns in this population, consequences of sleep problems, non-pharmacological interventions affecting sleep and ADHD symptoms, and pharmacological interventions affecting sleep in this population. We found that sleep disturbances may worsen behavioral outcomes; moreover, sleep interventions may improve ADHD symptoms, and pharmacotherapy for ADHD may
impact sleep. Gaps in research focussed on the need for using mixed methodologies utilizing objective and subjective reports of sleep, designing well powered studies that define the role of sleep in ADHD clinical picture and facilitate assessment and management of sleep problems.
Chapter 3 qualitatively investigated the nature of sleep problems and sleep related behaviours in children with ADHD. 26 parents of children diagnosed with ADHD aged between 6-12 years were interviewed about their child’s sleep. Thematic analysis of the interviews generated three broad themes which revolved around facets of children’s sleep difficulties as perceived by parents, the perceived impacts of these difficulties, and steps taken by parents to improve their child’s sleep. Parents expressed that sleep problems can be a significant disruptor for their children’s functioning and the wider household. Parents reported using need-based individualised behavioural and sleep hygiene approaches to counter their child’s sleep problems.
Chapter 4 examined the associations of parent-rated sleep problems and sleep timings of pre-adolescent ADHD children with parental insomnia symptoms, ADHD (screener based) features and dysfunctional attitudes and beliefs about sleep (in 120 parent-child pairs). 82% of children exceeded the threshold for a paediatric sleep disorder, and parental insomnia, ADHD symptoms and dysfunctional beliefs about sleep were associated with childrens’s sleep problem scores, and with the subfactors of sleep anxiety and parasomnias. Sleep was poorer for children whose parents were both insomnia probable and had ADHD consistent features, thereby underlying the significant double impact of both on the child.
In Chapter 5, a thirty-five-item parent rated sleep problems questionnaire for children with ADHD was developed. This questionnaire, called Childhood ADHD Sleep Scale (CASS), included 5 domains: Bedtime, Behaviours in Sleep, Sleep Quality, Daytime Functions and Impacts on Family, where the respondent has to choose one out of five options for a sleep
problem statement (‘strongly agree’, ‘somewhat agree’, ‘neither agree or disagree’, ‘somewhat disagree’, and ‘strongly disagree’). CASS showed acceptable test-retest reliability and good internal consistency. Exploratory factor analysis of the CASS generated the 4-factor reduced CASS including sleep problems and impacts, executive and sensory regulation, daytime functions, and parasomnias. The reduced CASS demonstrated good test-retest reliability and internal consistency. Both unreduced CASS and reduced CASS were compared with scores from Child Sleep Habits Questionnaire (CSHQ) and Brown Executive Functions and Attention Scales (Brown -EFA). Differences in the trends of associations were discussed, to understand the utility of an ADHD specific sleep assessment questionnaire.
In Chapter 6, we used an emotional Stroop test to assess the presence of sleep related attentional bias in 155 young adults and examined whether their Stroop test performance and sleep bias scores would associate with their ADHD screener-based symptom scores. Sleep quality scores, insomnia probability scores and social jetlag and chronotype. ADHD consistency scores, and insomnia probability scores were not found to be associated with sleep attentional bias scores. Sleep attentional bias also did not associate with chronotype or social jetlag, but it was found that habitual use of alarm clocks on workfree days did associate with greater sleep attentional bias, indicating that curtailed sleep due to functional demands on these days might increase attention towards sleep related stimulus.
Conclusion
This thesis highlighted how sleep functioning manifests in the clinical picture of childhood ADHD. The bidirectional relationship between the two entities were explored through varied methodological approaches to draw associations between the child’s environment, their own neurodevelopmental diversity and the accompanying sleep features that define their ADHD specific sleep functioning. We aimed at creating a framework within
which sleep problems in ADHD can be understood and utilized for clinical utility, both in terms of assessment and management of these concerns. We also found that social demands can enhance cognitive processing of sleep related stimulus in older cohorts with or without ADHD features
Improving Sleep for Older Adults: A Feasibility Study
Background: Cognitive Behavioural Therapy for Insomnia (CBT-I) and Brief Behavioural Treatment for Insomnia (BBTI) are recommended interventions for older adults with insomnia. However, adherence to these interventions can be difficult for older adults. One way to increase adherence is to utilise a modified method called countercontrol. Research in this area is lacking despite the negative impact insomnia has on older adults’ sleep, wellbeing, and cognition.
Methods: A systematic review explored the effects of CBT-I on cognitive performance for older adults with insomnia. An empirical study explored the feasibility and acceptability of BBTI with countercontrol in older adults with insomnia. Secondary aims of the study explored whether BBTI with countercontrol lead to measurable changes in sleep quality, cognition, and mental wellbeing in older adults with insomnia, and explored how the objective and self-reported measures of sleep compare to each other.
Results: Seven original papers were included in the systematic review. Most found CBT-I improved cognitive performance in one or more domains of cognitive performance: overall cognitive function, memory, executive function, and attention. The empirical study found BBTI with countercontrol to be feasible and acceptable to older adults with insomnia. All participants were retained and adhered to the intervention. Participants in the BBTI group cited countercontrol as one of the most useful elements of the intervention. Results also revealed that BBTI with countercontrol significantly improved self-reported measures of sleep, wellbeing, and cognition. Clear discrepancies were observed between the objective and self-reported measures of sleep.
Conclusions: BBTI with countercontrol is a feasible and acceptable intervention for older adults with insomnia, and leads to improved sleep, wellbeing, and cognition. However further research in this field is required to contribute to the knowledge and clinical practice of older adults with insomnia
Age differences in conspiracy beliefs around Covid-19 pandemic and (dis)trust in the government
Objective: Times of societal crisis, such as the COVID-19 pandemic, during which people need to make sense of a chaotic world and to protect their health and lives, according to psychological research, represent suitable ground for the development of conspiracy theories about origins, spread, and treatment of the threat (coronavirus). Although numerous studies have been conducted on this issue since the beginning of the pandemic until today, most of the studies were conducted on the adult population with limited insights into development of the conspiracy beliefs in adolescence or over the lifespan. Objective of this study is precisely to explore how conspiracy beliefs regarding COVID-19 pandemic differentiate between multiple age groups (cross-sectional design), what are their sources and contexts, and how do they relate with the tendency to trust the government.
Methodology: Data were gathered through eight focus group discussions with four age groups (11-12, 14-15, 18-19, 30+) in Serbia.
Results: Based on critical discourse analysis, this paper identifies the differences in content and the
sources of conspiracy thinking and how it relates to trust in the government. Study shows that high
distrust in Serbian government is associated with conspiracy beliefs both within youth and adults.
However, while among adolescents this finding is exclusively related with their beliefs that ruling
structures have financial gain from the pandemic, against the interests of citizens, among adults it is related to the belief that the government (un)intentionally submits to the new global order that is
managed by one or more powerful actors who are coordinated in secret action to achieve an outcome that is of public interest, but not public knowledge.
Conclusion: The results will be discussed within current socio-political climate in Serbia, as well as the basis for understanding psychological factors which may underlie these tendencies in conspiracy theorizing, such as social identification, collective narcissism, authoritarianism, and social dominance orientation
With an open mind:Psychopathology and brain development throughout childhood and adolescence
This thesis addresses the development of psychopathology across childhood and adolescence. Studies address the continuity of psychopathology, associations with cognition and sleep, as well as brain development in children and adolescents with psychopathology. As a secondary goal, work in this thesis stimulates the use of open research practices
With an open mind:Psychopathology and brain development throughout childhood and adolescence
This thesis addresses the development of psychopathology across childhood and adolescence. Studies address the continuity of psychopathology, associations with cognition and sleep, as well as brain development in children and adolescents with psychopathology. As a secondary goal, work in this thesis stimulates the use of open research practices
The Neural Mechanisms of Sleep and Migraine
Whilst a bidirectional relationship between sleep and migraine has long been postulated, this remains mainly speculative, and the underlying neural mechanisms remain to be determined. In this thesis we sought to explore this with clinical and preclinical methodologies. It was hypothesised that disrupted sleep-wake and nociception-regulating neural networks including key brainstem and diencephalic structures alter the thresholds for attack initiation and increase migraine susceptibility.Firstly, we used a meta-analytic approach to determine whether migraine patients have altered sleep, identifying that they have poorer subjective sleep quality and altered sleep physiology including reduced rapid-eye-movement sleep, compared to healthy controls. By collating data from users of the Migraine Buddy application (Healint Ltd.) and conducting Bayesian regression models we explored whether changes in sleep were predictors of an attack and conversely whether experiencing an attack would predict changes in subsequent sleep. We determined that interrupted sleep and deviations from typical sleep were potential predictors of a next day migraine attack but having an attack did not predict sleep duration.Secondly, we utilised mouse models of sleep deprivation and demonstrated that this led to orofacial mechanical allodynia - a commonly reported migraine phenotype indicative of sensitisation of the trigeminovascular system. Mechanistic insight was provided in that orexin-A, a hypothalamic arousal-promoting peptide which stabilises sleep-wake transitions reversed this phenotype.Finally, we explored whether familial natural short sleepers (FNSS) which are reported to have increased orexin expression, are less susceptible to migraine-related phenotypes using a transgenic mouse line harbouring the P384R mutation in the hDEC2 gene. We observed no significant differences in migraine-related phenotypes at baseline, however, when exposed to a clinical migraine trigger (nitroglycerin) FNSS mice demonstrated reduced orofacial hypersensitivity and photophobia, indicative of decreased migraine susceptibility. FNSS also displayed alterations in metabolites underlying energy metabolism and oxidative stress, suggesting a potential link between metabolism and headache pathophysiology.Taken together, the data in this thesis has shed light on the relationship between sleep and migraine, highlighting alterations in sleep as a potential precipitant of migraine attacks, and identifying genetic mechanisms underlying sleep regulation which may curtail migraine development, as well as possible therapeutic targets based on the orexinergic system. Although further work is needed to fully understand this neural basis, this has promising clinical implications and has furthered our understanding of migraine pathophysiology.<br/
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