Evaluación teleneuropsicológica en América del Sur: Una perspectiva desde los pacientes y los neuropsicólogos

Teleneuropsychology (teleNP) in Argentina was promoted by the COVID-19 pandemic. This investigation aimed to evaluate patients’ and neuropsychologists’ satisfaction with teleNP and to identify the advantages and disadvantages of its use. 41 patients with mild cognitive impairment and 35 neuropsychologists from Argentina were surveyed. Both groups were sent a questionnaire by e-mail to evaluate their satisfaction and preferences regarding teleNP. Patients were sent the survey after being cognitively evaluated by teleNP. Outcomes reflected a 91% degree of satisfaction with teleNP, with no differences between patients and specialists (p = 0.112). Regarding patients, 50% had no predilection regarding evaluation modality, and 35.7% preferred teleNP. The main benefits identified were accessibility to remote areas (72.4%), and comfort of performing the assessment at home (57.14%). Moreover, 74.3% of practitioners reported that the principal difficulty was the patient’s lack of familiarity with the technology, and 60% a deficiency in environmental control. TeleNP cognitive evaluation has a high degree of acceptability for practitioners and patients. The main obstacles identified are network connection problems and the lack of familiarity with technology. The principal advantages come from accessing isolated areas. This suggests that this practice will remain relevant beyond the pandemic context.La teleneuropsicología (teleNP) en Argentina fue promovida por la pandemia del COVID-19. Esta investigación se propuso evaluar la satisfacción de pacientes y neuropsicólogos con la teleNP e identificar las ventajas y desventajas de su uso. Se encuestaron 41 pacientes con deterioro cognitivo leve y 35 neuropsicólogos de Argentina. A ambos grupos se les envió un cuestionario por correo electrónico para evaluar su satisfacción y preferencias respecto a la teleNP. A los pacientes se les envió la encuesta después de ser evaluados cognitivamente mediante teleNP. Los resultados reflejaron un grado de satisfacción con la teleNP del 91%, sin diferencias entre pacientes y especialistas (p = 0.112). En cuanto a los pacientes, el 50% no tenía predilección por ninguna modalidad de evaluación, y el 35.7% prefería la telePN. Los principales beneficios identificados fueron la accesibilidad a zonas remotas (72.4%), y la comodidad de realizar la evaluación en casa (57.14%). Por otra parte, el 74.3% de los profesionales informaron de que la principal dificultad era la falta de familiaridad del paciente con la tecnología, y el 60% una deficiencia en el control del entorno. La evaluación cognitiva TeleNP tiene un alto grado de aceptabilidad para los profesionales y los pacientes. Los principales obstáculos identificados son los problemas de conexión a la red y la falta de familiaridad con la tecnología. Las principales ventajas provienen del acceso a zonas aisladas. Esto sugiere que esta práctica seguirá siendo relevante más allá del contexto pandémico

La Cognición Social en la Esclerosis Múltiple Temprana: Enfoque neuropsicológico y anatómico

Cognitive impairment and deficits in social cognition (SC) are frequent in patients with multiple sclerosis (MS). The aim of the present work is to study SC in patients with early MS and to analyze its neuroanatomical correlation. Thirty-four patients with relapsing remitting MS, with ≤ 2 years of disease progression and EDSS and ≤2, and 30 healthy control subjects matched for age, sex, and educational level were recruited. Subjects performed a comprehensive neuropsychological assessment (Rao BRB). SC was assessed using the International Affective Picture System IAPS, The Eyes in the Mind Test, the Empathy Quotient, and the Faux Pas Test. The anatomical correlation of patients with deficits in social cognition was studied through brain MRI and voxel-based morphometric for which cortical reconstruction and volumetric segmentation were performed using Freesurfer processing software. Patients showed significant deficits in executive functions, verbal memory and language tests. SC assessment showed that patients presented greater difficulties in the Faux Pas Test (p = 0.023), The Mind in the Eyes Test (p = 0.014), and presented a positive bias in the interpretation of neutral images of the IAPS (P = 0.023). Furthermore, patients with CS deficits presented less cortical thickness in areas of the right supramarginal gyrus, pars opercularis, and anterior cingulum

Neuropsychological profile of Alzheimer's disease based on amyloid biomarker findings results from a South American cohort.

Objective: Increased life expectancy and exponential growth of adults suffering from Alzheimer's disease (AD) worldwide, has led to biomarkers incorporation for diagnosis in early stages. Use of neuropsychological testing remains limited. This study aimed to identify which neuropsychological tests best indicated underlying AD pathophysiology.Methods: One hundred and forty-one patients with MCI (Mild Cognitive Impairment) were studied. A neuropsychological test battery based on the Uniform Data Set (UDS) from the Alzheimer's Disease Centers program of the National Institute on Aging (NIA) was performed and amyloid markers recorded; according to presence or absence of amyloid identified by positive PIB-PET findings, or low CSF Aβ42 levels, patients were separated into MCI amyloid-(n:58) and MCI amyloid + (n = 83) cases.Results: Statistical differences were found in all memory tests between groups. Delayed recall score at thirty minutes on the Rey Auditory Verbal Learning Test (AVLT) was the best predictor of amyloid pathology presence (AUC 0.68), followed by AVLT total learning (AUC 0.66) and AVLT Recognition (AUC 0.59) scores, providing useful cut off values in the clinical setting.Conclusions: Use of neuropsychological testing, specifically AVLT scores with cutoff values, contributed to the correct diagnosis of MCI due to AD in this SouthAmerican cohor

Addressing the disparities in dementia risk, early detection and care in Latino populations: Highlights from the Second Latinos and Alzheimer's Symposium

The Alzheimer's Association hosted the second Latinos & Alzheimer's Symposium in May 2021. Due to the COVID-19 pandemic, the meeting was held online over 2 days, with virtual presentations, discussions, mentoring sessions, and posters. The Latino population in the United States is projected to have the steepest increase in Alzheimer's disease (AD) in the next 40 years, compared to other ethnic groups. Latinos have increased risk for AD and other dementias, limited access to quality care, and are severely underrepresented in AD and dementia research and clinical trials. The symposium highlighted developments in AD research with Latino populations, including advances in AD biomarkers, and novel cognitive assessments for Spanish-speaking populations, as well as the need to effectively recruit and retain Latinos in clinical research, and how best to deliver health-care services and to aid caregivers of Latinos living with AD

Advancements in dementia research, diagnostics and care in Latin America : highlights from the 2023 Alzheimer's association international conference satellite symposium in Mexico City

While Latin America (LatAm) is facing an increasing burden of dementia due to the rapid aging of the population, it remains underrepresented in dementia research, diagnostics and care. In 2023, the Alzheimer’s Association hosted its eighth Satellite Symposium in Mexico, highlighting emerging dementia research, priorities, and challenges within LatAm. A wide range of topics were covered, including epidemiology, social determinants, dementia national plans, risk reduction, genetics, biomarkers, biobanks, and advancements in treatments. Large initiatives in the region including intra-country support showcased their efforts in fostering national and international collaborations; genetic studies unveiled the unique genetic admixture in LatAm; emerging clinical trials discussed ongoing culturally specific interventions; and the urgent need to harmonize practices and studies, improve diagnosis and care and implement affordable biomarkers in the region was highlighted

Utility of a spanish version of three words-three shapes test to detect memory impairment in primary progressive aphasia

Introduction: Three Words-Three Shapes (3W3S) is a bedside test that assesses verbal and non-verbal memory and has proven useful in staging memory decline in amnestic disorders and primary progressive aphasia. Given its simple structure, the 3W3S can be easily adapted to other languages maintaining the original shapes and only modifying the words. We aim to validate a Spanish version of the 3W3S test and establish whether memory loss patterns present in amnesic disorders associated with Alzheimer's etiology and PPA were correctly characterized. Method: The translation and adaptation of the 3W3S were performed according to standardized guidelines and applied to a cohort of patients with Dementia of Alzheimer's type (DAT = 20), mild cognitive impairment (aMCI= 20), primary progressive aphasia (PPA = 20), and healthy controls (HC = 20). Results: In verbal memory performance, PPA patients' score was lower than that of MCI and HC and similar to DAT's in the effortless encoding (p < 0.001), delayed recall (p < 0.001), and recognition (p < 0.012). For non-verbal performance, PPA patients performed better than DAT and similar to HC and MCI subjects (p < 0.001). Conclusions: Results show good applicability of 3W3S to determine memory function in PPA patients, independently from language ability. Visual and verbal components of memory are dissociated in PPA.Fil: Calandri, Ismael Luis. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Crivelli, Lucia. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; ArgentinaFil: Morello García, Florentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Psicología. Instituto de Investigaciones; ArgentinaFil: Allegri, Ricardo Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia; Argentin

Computational basis of decision-making impairment in multiple sclerosis

Background: Multiple sclerosis (MS) is commonly associated with decision-making, neurocognitive impairments, and mood and motivational symptoms. However, their relationship may be obscured by traditional scoring methods. Objectives: To study the computational basis underlying decision-making impairments in MS and their interaction with neurocognitive and neuropsychiatric measures. Methods: Twenty-nine MS patients and 26 matched control subjects completed a computer version of the Iowa Gambling Task (IGT). Participants underwent neurocognitive evaluation using an expanded version of the Brief Repeatable Battery. Hierarchical Bayesian Analysis was used to estimate three established computational models to compare parameters between groups. Results: Patients showed increased learning rate and reduced loss-aversion during decision-making relative to control subjects. These alterations were associated with: (1) reduced net gains in the IGT; (2) processing speed, executive functioning and memory impairments; and (3) higher levels of depression and current apathy. Conclusion: Decision-making deficits in MS patients could be described by the interplay between latent computational processes, neurocognitive impairments, and mood/motivational symptoms

Utilidad de un test de Screening (MoCa) para predecir Fisiopatología Amiloide en Deterioro Cognitivo Leve

Introduction: The MoCa (Montreal Cognitive Assessment) Screening test has become relevant in recent years in the screening of patients with Mild Cognitive Impairment (MCI). It is important to seek and study simple and reliable tools in clinical practices that correlate with biological markers that have been used to predict conversion from MCI to AD. Objective: To analyze the MOCA and its cognitive sub-scores and the relationship with Amyloid pathophysiology in Alzheimer’s Disease. Methodology: 32 patients with MCI were studied, they were separated according positive (n: 20) and negative (n: 12) underlying amyloid pathology. The patients performed a extensive cognitive assessment that included MoCa Test. Results: MoCa Total Scores showed significantly different results between groups (p &lt;0.001) as well as the Memory Score (MoCa MIS), the Executive (MoCa EIS), the Attentional Score (MoCa AIS)) (p &lt; 0.001) and the Orientation Score (MoCa OIS)) (p &lt; 0.05) with worse performance of patients with amyloid pathophysiology. Score of MoCa a cut-off point of &lt; 24 was established, since the diagnostic sensitivity at this point was 83% and the specificity 70%. Conclusions: The MoCa is a useful tool to differentiate biomarker status in MCI. Future studies should study this tool in the prodromal phases of the disease.Introducción: El MoCa (Montreal Cognitive Assesment) ha cobrado relevancia en los últimos años en el cribaje de pacientes con Deterioro Cognitivo Leve (DCL). El uso de herramientas clinicas simples y confiables con alta capacidad de predicción de la conversion del DCL a Enfermedad de Alzheimer (EA) es de gran importancia. Objetivo: Analizar la capacidad del MoCa y sus sub-scores cognitivos para la detección de fisiopatología amiloide en un grupo de pacientes con DCL. Metodología: Se estudiaron 32 pacientes con DCL, se los separó según fisiopatología amiloide subyacente positiva (n:20) y negativa (n:12). Los pacientes realizaron una extensa evaluación cognitiva qu&nbsp; incluyó en MoCA. Resultados: El Score Total del MoCa arrojó resultados significativamente diferentes entre grupos (p &lt; 0.001) así como el Score de Memoria (MoCa MIS), el Ejecutivo (MoCa EIS), el Score Atencional (MoCa AIS) ) (p &lt; 0.001) y el de Orientación (MoCa OIS) ) (p &lt; 0.05) obteniendo un peor desempeño los pacientes con fisiopatología amiloide. Se establecio un punto de corte de &lt; 24 para el Score Total del MoCa, ya que la sensibilidad en este punto fue de 83% y la especificidad de 70%. Conclusiones: El MoCa es una herramienta útil para utilizar en pacientes con Deterioro Cognitivo Leve debido a Enfermedad de Alzheimer. Futuros estudios deberían estudiar esta herramienta en las fases prodrómicas de la enfermedad

Fleni CoGlioma: Batería para la detección de compromiso cognitivo en pacientes con Glioma de bajo grado

New surgical procedures have benefited patients with Low-Grade Gliomas (LGG), who have a longer life expectancy. For this reason there is a growing interest in protecting cognition and improving their quality of life. The objectives of the study were: (1) To construct and administer a neuropsychological battery to examine the pre-surgical cognitive profile in patients with LGG and to determine the post-surgical effects. (2) To design an intra-surgical intervention for patients with lesions in the left hemisphere in order to minimize possible later deficits. 19 patients were evaluated with a pre-surgical battery that assesses different cognitive domains: memory, language, attention, executive functions, visuospatial skills, social cognition, praxias and gnosias. Patients also completed neuropsychiatric questionnaires to assess functionality, mood and quality of life. Patients presented deficits in multiple cognitive domains in the pre-surgical evaluation, when comparing their performance with normative values adjusted for age, sex and education. The results of the present study demonstrate the importance of the administration of the neuropsychological battery specifically designed for LGG patients and the assessment of cognitive domains to achieve detection and follow-up of possible cognitive disorders.Los nuevos procedimientos quirúrgicos han beneficiado a los pacientes con Gliomas de Bajo Grado (GBG), quienes tienen una mayor esperanza de vida. Por este motivo existe un creciente interés en proteger la cognición y mejorar su calidad de vida. Los objetivos del estudio fueron: (1) Construir y administrar una batería neuropsicológica que permita examinar el perfil cognitivo prequirúrgico en pacientes con GBG y determinar los efectos posquirúrgicos. (2) Diseñar una intervención intraquirúrgica para pacientes con lesiones en el hemisferio izquierdo a fin de minimizar posibles déficits posteriores. Se evaluaron 19 pacientes con una batería prequirúrgica que evalúa los distintos dominios cognitivos: memoria, lenguaje, atención, funciones ejecutivas, habilidades visuoespaciales, cognición social, praxias y gnosias. Asimismo, los pacientes completaron cuestionarios neuropsiquiátricos con el fin de valorar funcionalidad, estado anímico y calidad de vida. Los pacientes presentaron déficit en múltiples dominios cognitivos en la evaluación pre-quirúrgica, al comparar su rendimiento con valores normativos ajustados por edad, sexo y educación. Los resultados del presente estudio demuestran la importancia de la administración de la batería neuropsicológica específicamente diseñada para pacientes con GBG y la evaluación de los dominios cognitivos para lograr la detección y el seguimiento de posibles trastornos cognitivos