Hipermemória, sinestesia, savants: Luria e Borges revisitados

In this paper, we investigated two subjects with superior memory, or hyper memory: Solomon Shereshevsky, who was followed clinically for years by A. R. Luria, and Funes the Memorious, a fictional character created by J. L. Borges. The subjects possessed hyper memory, synaesthesia and symptoms of what we now call autistic spectrum disorder (ASD). We will discuss interactions of these characteristics and their possible role in hyper memory. Our study suggests that the hyper memory in our synaesthetes may have been due to their ASD-savant syndrome characteristics. However, this talent was markedly diminished by their severe deficit in categorization, abstraction and metaphorical functions. As investigated by previous studies, we suggest that there is altered connectivity between the medial temporal lobe and its connections to the prefrontal cingulate and amygdala, either due to lack of specific neurons or to a more general neuronal dysfunction.Neste artigo, investigamos dois sujeitos com memória superior ou hipermemória: Solomon Shereshevsky, que foi seguido clinicamente por anos por A. R. Luria, e Funes o memorioso, um personagem fictício criado por J. L. Borges. Os sujeitos possuem hipermemória, sinestesia e sintomas do que hoje chamamos de transtorno do espectro autista (TEA). Vamos discutir interações dessas características e seu possível papel na memória hiper. Nosso estudo sugere que a hipermemória em nossos sujeitos sinestésicos pode ser devido às suas características de síndrome do DSA-savant. No entanto, esse talento foi acentuadamente diminuído pelo profundo déficit de categorização, abstração e funções metafóricas. Conforme investigado por estudos anteriores, sugerimos que há conectividade alterada entre o lobo temporal medial e suas conexões com o cingulado e a amígdala pré-frontal, devido à falta de neurônios específicos ou a uma disfunção neuronal mais geral.Fil: Fornazzari, Luis. University of Toronto; CanadáFil: Leggieri, Melissa. University of Toronto; CanadáFil: Schweizer, Tom A.. University of Toronto; CanadáFil: Arizaga, Raúl Luciano. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Fischer, Corinne E.. University of Toronto; Canad

La demencia en Latinoamérica

La demencia es un síndrome clínico que comienza con pérdida progresiva de memoria avanzando a una limitación cognitiva total, con compromiso conductal-psiquiátrico y funcional. Debido al aumento en todo el mundo de la expectativa de vida, la demencia se está convirtiendo en un serio problema de salud pública. En la mayoría de los países latinoamericanos, los médicos generalistas creen que los trastornos de la memoria se asocian con el proceso de envejecimiento, por eso no realizan estudios y los pacientes llegan tarde a los centros especializados. Los estudios epidemiológicos son escasos, sólo cuentan con ellos Chile, Brasil y Uruguay. En la mayoría de estos países los problemas económicos determinan serias dificultades para que los pacientes puedan acceder a toda la batería de exámenes complementarios necesarias para el diagnóstico de los deterioros cognitivos. Está proyectado que para el 2020 las personas mayores de 65 años tendrán un crecimiento acelerado en todos los países latinoamericanos incluso con un mayor incremento que en los países desarrollados pero con una menor infraestructura médica, social y económica que aquéllos. Todo esto determina que las demencias serán un grave problema para la salud pública en los países desarrollados y mucho más en aquéllos como los latinoamericanos que arribarán sin conciencia ni medios para los mismos.Dementia is a clinical syndrome that begins with a progressive memory loss and advances to a complete cognitive impairment with behavioral and functional impairment. Around the world life expectancy has increased and so does the risk to develop a dementia syndrome and it is becoming to be a very serious public health problem. In most of the Latin American countries contacted General Practitioners consider memory problems within the normal aging process and they do not perform a very meticulous study. The patients arrive late to a specialized center. In Latin America epidemiological studies are scarce, only Chile, Brazil and Uruguay have it. In most of the Latin American countries, patient cannot have access to a full dementia diagnostic battery for economic problems. It is stipulated that by the year 2020 the population over 65 years of age will have a great increase even more that in the developed countries but with less medical, social and economic infrastructure.Fil: Allegri, Ricardo Francisco. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET.; ArgentinaFil: Arizaga, Raúl Luciano. Instituto Nacional de Servicios Sociales para Jubilados y Pensionados; ArgentinaFil: Mangone, Carlos Antonio. Gobierno de la Ciudad de Buenos Aires. Hospital de Agudos "D. F. Santojanni"; ArgentinaFil: Ollari, Juan A.. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; Argentin

Comprometimento cognitivo e prevalência dos fatores de risco em uma população acima de 60 anos na Argentina

Epidemiological data on dementia and cognitive impairment are scarce in South America. In Argentina, no dementia/cognitive impairment population-based epidemiological studies are available. The Ceibo Study is a populationbased epidemiological study of dementia and cognitive impairment in individuals over 60 to be conducted. The present paper reports the results of the pilot phase (survey of cognitive impairment) conducted in Cañuelas (province of Buenos Aires). Methods: In a door-to-door survey, trained high school students evaluated 1453 individuals aged 60 years and over in one day using a demographic data and risk factors questionnaire, the Mini-Mental State Examination (MMSE) and the 15-item Geriatric Depression Scale (GDS). Results: Mean age of the individuals was 70.9 (±7.5) years, 61.4% were women, mean schooling was 5.5 (±3.5) years. Mean MMSE score was 24.5 (±4.7) and mean GDS 3.1 (±2.7). Risk factors of higher prevalence in the population under study were: hypertension (40.6%), smoking (35.1%), alcohol consumption (32.8%), high cholesterol (16.1%), diabetes (12.5%), cranial trauma with loss of consciousness (12.5%), 7 points or more on the GDS (11.7%). Prevalence of cognitive impairment for the whole sample was 23%, and 16.9% in subjects aged 60- 69, 23.3% in 70-79 and 42.5% in subjects aged 80 or over . A significant correlation of cognitive impairment with age, functional illiteracy, cranial trauma, high blood pressure, inactivity and depression was found. Conclusion: In this pilot study, the prevalence of cognitive impairment was comparable with previous international studies.Dados epidemiológicos em demência e comprometimento cognitivo são escassos na América do Sul. Na Argentina, não há estudos epidemiológicos de base populacional de comprometimento cognitivo/demência. O Estudo Ceibo é um estudo epidemiológico de base populacional a ser conduzido. O presente artigo reporta os resultados da fase piloto (pesquisa de comprometimento cognitivo) conduzido em Cañuelas (província de Buenos Aires). Métodos: Numa pesquisa porta-aporta, estudantes treinados avaliaram 1453 indivíduos de 60 anos ou mais em uma visita, usando dados demográficos e questionários de fatores de risco, o Mini-Exame do Estado Mental (MEEM) e a escala de Depressão Geriátrica (GDS). Resultados: A idade média foi de 70,9 (±7,5) anos, 61.4% eram mulheres, escolaridade média foi de 5,5 (±3,5) anos. O escore médio do MEEM foi de 24,5 (±4,7) anos e média do GDS de 3,1 (±2,7). Os fatores de risco mais prevalentes foram: hipertensão (40,6%), tabagismo (35,1%), consumo de álcool (32,8%), colesterol elevado (16,1%), diabetes (12,5%), trauma craniano com perda de consciência (12,5%), 7 pontos ou mais no GDS (11,7%). A prevalência de comprometimento cognitive na amostra total foi de 23% e em 16,9% nos sujeitos entre 60-69 anos, 23,3% entre 70-79 e 42,5% naqueles com 80 ou mais. Correlações significativas de comprometimento cognitivo com idade, analfabetismo functional, trauma craniano, hipertensão arterial, inatividade e depressão foram encontradas. Conclusão: Neste estudo piloto a prevalência de comprometimento cognitivo foi comparável aos estudos prévios internacionais.Fil: Arizaga, Raúl Luciano. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Unidad de Investigación en Neurología Cognitiva; ArgentinaFil: Gogorza, Roxana E.. Unidad de Investigación en Neurología Cognitiva; ArgentinaFil: Allegri, Ricardo Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Baumann, Patricia D.. Unidad de Investigación en Neurología Cognitiva; ArgentinaFil: Morales, Maria C.. Unidad de Investigación en Neurología Cognitiva; ArgentinaFil: Harris, Paula. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Pallo, Vicente. Gobierno de la Ciudad de Buenos Aires. Hospital de Agudos "D. F. Santojanni"; ArgentinaFil: Cegarra, Maria M.. Unidad de Investigación en Neurología Cognitiva; Argentin

A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo Study. Preliminary Results

Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. OBJECTIVE: The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. METHODS: A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. RESULTS AND CONCLUSIONS: A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population

A population-based study of cognitive impairment in socially vulnerable adults in Argentina. The Matanza Riachuelo Study. Preliminary Results

Population aging has taken place intensively worldwide, even in developing countries. These countries have population groups with low resources and basic unmet needs that are frequently omitted from epidemiological studies. OBJECTIVE: The purpose of this study was to determine the prevalence of cognitive impairment (CI) and dementia in an economic and socially vulnerable population from Argentina. METHODS: A door-to-door observational population-based survey among adults over 60 years of cognitive impairment and dementia in the social vulnerable area of the Matanza Riachuelo Basin, in the suburban area of Buenos Aires, Argentina was conducted. Trained psychologists interviewed subjects and a proxy informant. A standardized protocol including a socio-demographic questionnaire, the Mini-Mental State Examination, the Geriatric Depression Scale and a functional inventory for IADL and ADL was administered. Diagnoses were divided into three general categories: normal cognitive function, cognitive impairment-no dementia (CIND) and dementia. RESULTS AND CONCLUSIONS: A total of 2437 elderly persons were assessed, of which 73.6% fulfilled inclusion criteria. The prevalence of CI among those over 60 was 26.4% (18.1% CIND and 8.3% dementia) with higher prevalence of dementia in younger individuals than rates reported in developed counties, probably due to low control of vascular risk factors. This information can help inform health public decisions in the generation of programs and plans for the prevention, diagnosis and treatment of cognitive impairment in this type of socially vulnerable population

Care arrangements for people with dementia in developing countries.

BACKGROUND: Rapid demographic ageing will soon lead to large increases in the numbers of persons with dementia in developing countries. This study is the first comprehensive assessment of care arrangements for people with dementia in those regions. METHODS: A descriptive and comparative study of dementia care; caregiver characteristics, the nature of care provided, and the practical, psychological (Zarit Burden Interview, General Health Questionnaire) and economic impact upon the caregiver in 24 centres in India, China and South East Asia, Latin America and the Caribbean and Africa. RESULTS: We interviewed 706 persons with dementia, and their caregivers. Most caregivers were women, living with the person with dementia in extended family households. One-quarter to one-half of households included a child. Larger households were associated with lower caregiver strain, where the caregiver was co-resident. However, despite the traditional apparatus of family care, levels of caregiver strain were at least as high as in the developed world. Many had cutback on work to care and faced the additional expense of paid carers and health services. Families from the poorest countries were particularly likely to have used expensive private medical services, and to be spending more than 10% of the per capita GNP on health care. CONCLUSIONS: Older people in developing countries are indivisible from their younger family members. The high levels of family strain identified in this study feed into the cycle of disadvantage and should thus be a concern for policymakers in the developing world