Are cognitive interventions effective in alzheimer´s disease? a controlled meta-analysis of the effects of bias

Objective: There is limited evidence about the efficacy of cognitive interventions for Alzheimer's disease (AD). However, aside from the methodological quality of the studies analyzed, the methodology used in previous meta-analyses is itself a risk of bias as different types of effect sizes (ESs) were calculated and combined. This study aimed at examining the results of nonpharmacological interventions for AD with an adequate control of statistical methods and to demonstrate a different approach to meta-analysis. Method: ESs were calculated with the independent groups pre/post design. Average ESs for separate outcomes were calculated and moderator analyses were performed so as to offer an overview of the effects of bias. Results: Eighty-seven outcomes from 19 studies (n 812) were meta-analyzed. ESs were small on average for cognitive and functional outcomes after intervention. Moderator analyses showed no effect of control of bias, although ESs were different from zero only in some circumstances (e.g., memory outcomes in randomized studies). Cognitive interventions showed no more efficacy than placebo interventions, and functional ESs were consistently low across conditions. Conclusions: cognitive interventions delivered may not be effective in AD probably due to the fact that the assumptions behind the cognitive interventions might be inadequate. Future directions include a change in the type of intervention as well as the use of outcomes other than standardized tests. Additional studies with larger sample sizes and different designs are needed to increase the power of both primary studies and meta-analyses

Neuropsicología del trastorno de tourette: cognición, neuroimagen y creatividad

Introducción. El trastorno de Tourette es el resultado de una disfunción cerebral frontoestriatal que afecta a personas de todas las edades, con un inicio en la primera infancia y continuación en la adolescencia y la adultez. Desarrollo. Este artículo revisa los principales aspectos cognitivos, de neuroimagen funcional y estudios relacionados con la creatividad en un trastorno caracterizado por un exceso de dopamina en el cerebro. Conclusiones. Dada la especial configuración cerebral de estos pacientes, deberían esperarse alteraciones neuropsicológicas, especialmente en las funciones ejecutivas. Sin embargo, los hallazgos son poco concluyentes y están condicionados por factores como la comorbilidad con el trastorno por déficit de atención/hiperactividad y el trastorno obsesivo compulsivo, la edad o variables metodológicas. Por otro lado, los estudios de neuroimagen realizados a lo largo de la última década han podido explicar la sintomatología clínica de pacientes con trastorno de Tourette, con especial relevancia del área motora suplementaria y el giro cingulado anterior. Finalmente, a pesar de no existir una relación lineal entre el exceso de dopamina y la creatividad, la literatura científica destaca una asociación entre el trastorno de Tourette y la creatividad musical, lo que podría traducirse en programas de intervención basados en la música

Drogas emergentes: catinonas sintéticas ('sales de baño')

Las catinonas sintéticas son una nueva clase de drogas de diseño de tipo psicoestimulante y alucinógeno y con efectos similares a la cocaína, la metilendioximetanfetamina (MDMA) u otras anfetaminas. El abuso de catinonas sintéticas, con frecuencia incluidas en los productos vendidos como 'sales de baño', se puso de moda a principios de 2009, lo que llevó a la clasificación legislativa en toda Europa en 2010 y a la lista I de clasificación de drogas dentro de los Estados Unidos en 2011. Los estudios clínicos recientes indican que el mecanismo de acción de la catinona sintética afecta a los sistemas centrales de monoaminas. En esta revisión abordaremos la historia de estas drogas, su mecanismo de acción, la toxicología y los aspectos legales.Synthetic cathinones are a new class of designer drug of the hallucinogenic stimulant type with effects similar to cocaine, methylenedioxymethamphetamine (MDMA) and other amphetamines. The abuse of synthetic cathinones often included in products sold as 'bath salts' became fashionable in early 2009, which led to legislative classification across Europe in 2010 and Schedule I drug classification in the USA in 2011. Recent clinical studies indicate that the action mechanism of synthetic cathinone affects the central monoamine systems. In this paper we will review the history of these drugs, their action mechanism, toxicology and legal aspects

Drogas legales emergentes: marihuana sintética, kratom, salvia divinorum, metoxetamina y los derivados de la piperazina

A pesar de su amplia oferta y disponibilidad a través de internet, muchas de las drogas de abuso emergentes siguen siendo desconocidas para un gran número de médicos y profesionales sanitarios. Las alternativas herbales a la marihuana (también conocidas como marihuana sintética), tales como el K2 o el spice, son un grupo de hierbas que contienen una mezcla de materia vegetal además de cannabinoides de origen sintético. El Kratom, es un producto vegetal derivado de Mitragyna speciosa Korth que tiene efectos similares a los de los opioides, y que se emplea para el tratamiento del dolor crónico y el alivio de los síntomas de retirada de los opiáceos. La Salvia divinorum es un alucinógeno con una farmacología muy singular que tiene cierto potencial terapéutico, pero que ha sido prohibido en muchos estados debido a las preocupaciones con respecto a sus efectos adversos de tipo psiquiátrico. La Metoxetamina se ha convertido recientemente en la 'ketamina legal' disponible a través de internet. Además, los derivados de la piperazina, una clase de compuestos similares a la anfetamina que incluyen la BZP y TMFPP, han aparecido como una versión legal del 'éxtasis'. Todos estos compuestos psicoactivos son percibidos como drogas seguras por los usuarios y están disponibles en internet a un golpe de ratón. Desafortunadamente, estas drogas tienen efectos indeseables dependiendo de la dosis y de la mezcla de drogas y oscilan de efectos mínimos a efectos serios sobre la salud. Este artículo revisa la farmacología, los efectos clínicos, la toxicidad y el manejo de su intoxicación para que los profesionales de la salud conozcan todas estas drogas emergentes de origen sintéticoDespite its wide range and availability over the Internet, many emerging abuse drugs remain unknown to many doctors and health professionals. Herbal marijuana alternatives (also known as synthetic marijuana), such as K2 or 'spice', are a group of herbal mixtures containing vegetable matter in addition to synthetic cannabinoids. Kratom is a plant product derived from Mitragyna speciosa Korth that has similar effects to opioids, and is used for the treatment of chronic pain and alleviating the symptoms of opioid withdrawal. Salvia divinorum is a hallucinogenic drug with a therapeutic potential, but has been banned in many states due to concerns about its psychiatric effects. Methoxetamine has recently become the 'legal ketamine' available over the Internet. In addition, piperazine derivatives, a class similar to amphetamine including BZP and TMFPP compounds have emerged as a legal version of 'ecstasy' All these psychoactive compounds are perceived as safe drugs for people and are available online. Unfortunately, these drugs have side effects depending on the dose and the mixture of drugs with health effects ranging from slight to serious. This article reviews the pharmacology, clinical effects, toxicity and managing of these drugs

Individual alpha peak frequency, an important biomarker for live Z-Score training neurofeedback in adolescents with learning disabilities

Learning disabilities (LDs) have an estimated prevalence between 5% and 9% in the pediatric population and are associated with difficulties in reading, arithmetic, and writing. Previous electroencephalography (EEG) research has reported a lag in alpha-band development in specific LD phenotypes, which seems to offer a possible explanation for differences in EEG maturation. In this study, 40 adolescents aged 10–15 years with LDs underwent 10 sessions of Live Z-Score Training Neurofeedback (LZT-NF) Training to improve their cognition and behavior. Based on the individual alpha peak frequency (i-APF) values from the spectrogram, a group with normal i-APF (ni-APF) and a group with low i-APF (li-APF) were compared in a pre-and-post-LZT-NF intervention. There were no statistical differences in age, gender, or the distribution of LDs between the groups. The li-APF group showed a higher theta absolute power in P4 (p = 0.016) at baseline and higher Hi-Beta absolute power in F3 (p = 0.007) post-treatment compared with the ni-APF group. In both groups, extreme waves (absolute Z-score of ≥1.5) were more likely to move toward the normative values, with better results in the ni-APF group. Conversely, the waves within the normal range at baseline were more likely to move out of the range after treatment in the li-APF group. Our results provide evidence of a viable biomarker for identifying optimal responders for the LZT-NF technique based on the i-APF metric reflecting the patient’s neurophysiological individualit

Efficacy of Live Z-Score Neurofeedback Training for Chronic Insomnia: A Single-Case Study

Objective/Background: Insomnia is the most common sleep disorder in the general population. Pharmacological treatments have shown efficacy in the short term, yet the symptoms return once the treatment has been withdrawn. In the search for treatment options with long-lasting effects, neurofeedback (NF) has arisen as a therapeutic option. Neurofeedback is the application of operant conditioning to brain activity. The aim of this work is to show the effectiveness of Live Z-Score NF training (LZT), a paradigm within the field of NF, in a case of insomnia. Participants: A 32-year-old male with chronic insomnia since his adolescence. Methods: Thirty 35-min sessions of qEEG-guided LZT using patient’s highly preferred feedback. The main outcomes of this study were the patient’s qEEG metrics and a visual analog scale of sleep quality throughout the intervention. Results: qEEG-guided LZT showed an improvement of 90.63% of the patient’s qEEG metrics and an 82.55% relief of the clinical symptoms after 30 NF sessions. Conclusions: Although more research is needed to establish that NF based on Live Z-Score is effective for insomnia, our results suggest that NF might be a therapeutic alternative for the treatment of insomnia

Cognition or genetics? Predicting Alzheimer's disease with practice effects, APOE genotype, and brain metabolism

As practice effects are common in neuropsychological assessment, this study analyzed their utility to identify individuals with amnestic mild cognitive impairment (aMCI) at the greatest risk for Alzheimer's disease (AD-risk) and compared practice effects with APOE and brain metabolism biomarkers. We regressed Auditory Verbal Learning Test delayed recall (AVLT-DR) at 6 months on baseline AVLT-DR scores in 394 individuals with normal cognition from the Alzheimer's Disease Neuroimaging Initiative database and dichotomized 816 individuals with aMCI as showing practice effect or not showing practice effects (PE−) when the discrepancy between observed and predicted scores was found in less than 10%, 7%, and 5% of normal cognition. Cox regressions analyzed the AD-risk at 6 years. More than 60% of aMCI were showing practice effects. Controlling for age, sex, education, and baseline Mini-Mental State Examination and AVLT-DR scores, the AD-risk was associated with PE− [hazard ratio (HR) = 1.93], lower brain metabolism (HR = 0.95), and APOE genotype (HR = 1.92), with narrower risk estimates for PE−. The lack of practice effects during a 6-month period might be as precise as biomarkers for predicting the 6-year AD-risk.Data collection and sharing for this project were funded by the Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant U01 AG024904) and DOD ADNI (Department of Defense award number W81XWH-12-2-0012)

Enhancing the effects of neurofeedback training: the motivational value of the reinforcers

The brain activity that is measured by electroencephalography (EEG) can be modified through operant conditioning, specifically using neurofeedback (NF). NF has been applied to several disorders claiming that a change in the erratic brain activity would be accompanied by a reduction of the symptoms. However, the expected results are not always achieved. Some authors have suggested that the lack of an adequate response may be due to an incorrect application of the operant conditioning principles. A key factor in operant conditioning is the use of reinforcers and their value in modifying behavior, something that is not always sufficiently taken into account. This work aims to clarify the relevance of the motivational value versus the purely informational value of the reinforcer. In this study, 113 subjects were randomly assigned two different reinforcer conditions: a selected reinforcer—the subjects subjectively selected the reinforcers—or an imposed reinforcer— the reinforcers were assigned by the experimenter—and both groups undertook NF sessions to enhance the sensorimotor rhythm (SMR). In addition, the selected reinforcer group was divided into two subgroups: one receiving real NF and the other one sham NF. There were no significant differences between the groups at baseline in terms of SMR amplitude. After the intervention, only those subjects belonging to the selected reinforcer group and receiving real NF increased their SMR. Our results provide evidence for the importance of the motivational value of the reinforcer in Neurofeedback succes

Entrenamiento en remediación cognitiva y habilidades emocionales en formato grupal para pacientes con obesidad. Un estudio piloto

Abstract: Group cognitive remediation and emotion skills training for patients with obesity. A pilot study. Cognitive remediation and emotion skills training was initially designed by the Tchanturia group for individual intervention in patients with eating disorders. The purpose of the present study is to present its adaptation to patients with obesity in group format. It is structured in 8 weekly sessions that work on central executive functions, the relation between emotion and thought, and emotion regulation in oneself and others. In addition, we present the preliminary results of its application to a group of 5 participants with morbid obesity to assess its possible efficacy. The results indicate that, after the intervention, the patients showed improvement in their cognitive and emotional skills, as well as in their behaviors related to eating and weight. This program can be a useful complementary intervention in the initial stages of obesity treatment. Resumen: El entrenamiento en remediación cognitiva y habilidades emocionales fue diseñado inicialmente por el grupo de Tchanturia para la intervención individual de pacientes con trastornos alimentarios. El objetivo del presente trabajo es exponer su adaptación a pacientes con obesidad en formato grupal. Se estructura en 8 sesiones semanales en las que se trabaja funciones de ejecutivo central, la relación entre emoción y pensamiento, y el manejo emocional en un mismo y en los demás. Además, presentamos los resultados preliminares de su aplicación a un grupo de 5 participantes con obesidad mórbida con el fin de valorar su posible eficacia. Los resultados indican que tras la intervención, las pacientes mostraron una mejoría en sus habilidades cognitivas y emocionales, así como en las conductas relacionadas con la alimentación y el peso. Este programa puede ser una intervención útil complemento del tratamiento de la obesidad en sus fases iniciales.

Relationships between Problematic Cannabis Use and Risky Behaviors in Spanish Adolescents

This study examined the relations between problematic cannabis use, physical assault, and getting involved in a motor vehicle accident under the influence of cannabis in a sample of adolescents randomly selected from 25 public and semiprivate high schools in Alicante (Spain). Participants (n = 648) completed The Spanish National Standardized Survey about drug use in high school adolescents (ESTUDES, 2017), which includes the cannabis abuse screening test (CAST). Prevalence of cannabis use across the life-span and within the past 30 days was 37.5% and 17.4%, respectively. CAST scores were associated with an increased risk of driving under the effects of cannabis, riding shotgun, and physical assault, but not with an increased risk of having a motor vehicle accident. There were no differences between boys and girls in the association of problematic cannabis use with risky behaviors. This result highlights the importance of comprehensive prevention and education strategies for adolescents at high risk of cannabis use.This study has been funded by Ayuntamiento de Alicante. Plan Municipal de Drogodependencia (AYTOALICANTE3-18I). Delegación del Gobierno para el Plan Nacional sobre Drogas