Correlations between the performance of older adults in conditional discrimination training and in a screening test for Alzheimer’s Disease

The prevalence of neurocognitive disorders has been rising and Alzheimer's Disease (AD) is the most common cause. Studies on conditional discrimination have contributed to understand the variables associated with the cognitive function. However, the relationship of such studies with cognitive impairment in older adults remains under-explored. This research aims to compare the performances of older adults during tasks involving conditional discrimination training with their performances on Addenbroke's Cognitive Examination, a widely used screening test for cognitive impairments. The sample was composed of 45 older adults. The participants performed a computerized task consisting on establishing arbitrary conditional relations between three pairs of stimuli. Addenbrooke's Cognitive Examination was administered to assess the cognitive performance. The analysis revealed a positive correlation between the performance in conditional discrimination and in the cognitive assessment. This correlation was observed only among participants who did not reported having AD in use of anti-cholinesterase drugs (30 participants). These findings demonstrate a direct relationship between learning difficulties, when it comes to learning arbitrary conditional relations, and the occurrence of cognitive decline. Therefore, the administration of the conditional relations tasks could be useful for distinguishing older adults with and without AD. Keywords: Conditional discrimination; neuropsychological tests; elderly; Alzheimer's Disease

Diagnostic criteria and prevalence of mild cognitive impairment in older adults living in the community: a systematic review and meta-analysis

Background: Mild Cognitive Impairment (MCI) is a disorder in which the patient presents a cognitive decline, but without negative impact on the activities of daily living. Objective: To carry out a systematic review of published studies that analyzed the prevalence of Mild Cognitive Impairment (MCI) in older adults living in the community, and the criteria used for the diagnosis of this disorder. Methods: A search was carried out in May 2017 using the descriptors: “epidemiology” or “prevalence”, “mild cognitive impairment”, and “community” in the PubMed, PsycInfo, SciELO, Web of Science, and Scopus databases. Two independent researchers extracted and documented the data. We used a random effect model to calculate pooled prevalence of MCI for overall studies and for each subgroup divided by diagnostic criteria. Results: We found initially 1996 articles, and we selected 35 studies. The prevalence of MCI in the selected studies ranged from 0.5% to 41.8%. The overall pooled prevalence of MCI was 17.3% (CI 95%, 13.8-20.8), with significant heterogeneity between estimates (I2 = 99.6%). Discussion: The standardization of the diagnostic criteria for MCI, as well as the tests used in the cognitive evaluation, could allow the comparison between the studies and would be an important step in the researches of this area

Em pacientes com doença de Parkinson, a depressão aumenta de acordo com o aumento da gravidade do comprometimento cognitivo

Objective : To test the hypothesis that severity of cognitive impairment modifies the association between depression and Parkinson’s disease (PD). Method : One-phase population-based door-to-door surveys. This is a secondary analysis of 1,451 people aged 65 years and older with cognitive impairment living in defined catchment areas. Depression was estimated according to ICD-10, self-reported PD, disability according to WHODAS-II and cognitive status according to the CSI-D. Results : The mean age of the sample was 79.3 years old and most (69%) were women. Of the total sample, 16.1% had depression and it was significantly higher among participants with PD. There was an increase on the ORs of the association between depression and PD with decreased scores in the cognitive test (Adjusted OR from 0.98 to 8.04). Conclusion : The association between depression and PD increases with the severity of the cognitive impairment.Objetivo : Testar a hipótese que a gravidade do prejuízo cognitivo modifica a associação entre depressão e doença de Parkinson (DP). Método : Estudo populacional através da análise secundária de 1.451 pessoas com idade maior ou igual a 65 anos com prejuízo cognitivo que residiam em áreas de abrangência definidas. A depressão foi estimada de acordo com a CID-10, auto-relato de DP, incapacidade conforme a WHODAS-II e nível cognitvo de acordo com a CSI-D. Resultado : A média de idade foi 79,3 anos, predominaram as mulheres (69%). Do total de indivíduos, 16,1% tinham depressão, significantemente maior entre os participantes com DP. Houve aumento gradativo na OR relativa à associação entre depressão e DP com a diminuição do escore no teste cognitivo (OR ajustado variou de 0,98 a 8,04). Conclusão : A associação entre depressão e DP parece aumentar com a gravidade do prejuízo cognitivo.Universidade de São Paulo Departamento de Neurociências e Ciências do ComportamentoUniversidade Federal de São Paulo (UNIFESP) Laboratório Interdisciplinar de Neurociências Clínicas Departamento de PsiquiatriaHospital Israelita Albert Einstein Instituto Israelita de Ensino e PesquisaNational Institute of Neurology and Neurosurgery of MéxicoUniversidade Federal de São Paulo (UNIFESP) Departamento de PsicobiologiaUNIFESP, Laboratório Interdisciplinar de Neurociências Clínicas Depto. de PsiquiatriaUNIFESP, Depto. de PsicobiologiaSciEL

Neuroimagem do transtorno de fobia específica: uma revisão sistemática da literatura

OBJECTIVE: Specific phobia (SP) is characterized by irrational fear associated with avoidance of specific stimuli. In recent years, neuroimaging techniques have been used in an attempt to better understand the neurobiology of anxiety disorders. The objective of this study was to perform a systematic review of articles that used neuroimaging techniques to study SP. METHOD:A literature search was conducted through electronic databases, using the keywords: imaging, neuroimaging, PET, spectroscopy, functional magnetic resonance, structural magnetic resonance, SPECT, MRI, DTI, and tractography, combined with simple phobia and specific phobia. One-hundred fifteen articles were found, of which 38 were selected for the present review. From these, 24 used fMRI, 11 used PET, 1 used SPECT, 2 used structural MRI, and none used spectroscopy. RESULT: The search showed that studies in this area were published recently and that the neuroanatomic substrate of SP has not yet been consolidated. CONCLUSION: In spite of methodological differences among studies, results converge to a greater activation in the insula, anterior cingulate cortex, amygdala, and prefrontal and orbitofrontal cortex of patients exposed to phobia-related situations compared to controls. These findings support the hypotheses of the hyperactivation of a neuroanatomic structural network involved in SP

Delirium como fator de risco para demência em idosos: uma atualização

RESUMO Objetivo Realizar uma revisão atualizada dos estudos que avaliaram o delirium como fator de risco para o desenvolvimento de demência em idosos. Métodos A revisão foi realizada utilizando-se a base de dados do PubMed, com o seguinte cruzamento de descritores: risk factors and (delirium or acute confusional state) and dementia. Apenas estudos do tipo coorte publicados entre janeiro de 2000 a maio de 2015 foram considerados. Resultados Foram selecionados oito estudos de acordo com os critérios de inclusão e exclusão. Todos os estudos apontaram para um aumento do risco de demência ou declínio cognitivo após a ocorrência de delirium, apesar das diferenças entre os estudos em relação à causa do delirium. Conclusões Os estudos atuais apontam para uma clara associação entre delirium e aumento do risco de demência. Dessa forma, psiquiatras e médicos generalistas precisam ficar atentos aos indícios de declínio cognitivo após a ocorrência do delirium em idosos