Cognitive performance in chronic migraine

© SciELO - Scientific Electronic Library OnlineMigraine is a ubiquitous disorder that affects 15% of the world population, particularly women during their most productive years. Migraine produces a variety of symptoms, but its most common presentation consists of recurrent attacks of disabling headaches associated to nausea and intolerance to all sensory stimuli. During attacks, patients often experience cognitive difficulties, with poor ability to concentrate or think clearly, and are unable to deal with multiple tasks. The cause of this transient cognitive dysfunction is not known but has been attributed to the complex and widespread brain dysfunction underlying the development of the attacks, because it cannot be simply explained by pain. In fact, it is not observed in other primary headaches, and the cognitive difficulties are often present during the premonitory and resolution phases of migraine, i.e., both before the onset and after the resolution of pain.info:eu-repo/semantics/publishedVersio

May subjective language complaints predict future language decline in community-dwelling subjects?

Subjective cognitive complaints are rather prevalent in the elderly population and are associated with an increased risk of cognitive impairment and dementia. However, the predictive role of specific types of cognitive complaints has been less systematically assessed. The aim of the present study is to examine the predictive value of language complaints for cognitive and language decline in a cohort of community-dwelling healthy older adults, followed longitudinally over a 5-year period. A total of 402 subjects were enrolled in a prospective longitudinal study on aging and cognition. Participants answered a cognitive complaints questionnaire including two questions directed to language and were classified at baseline as having “Language Complaints” (LC) or “No Language Complaints” (NLC). They also performed a neuropsychological assessment tackling attention/processing speed, memory, executive functioning, and language at baseline. From these, 275 (68.4%) participated in a follow-up evaluation 4.9 (±0.6) years later. At re-evaluation, subjects had a mean age of 70.4 (±8.3) years, 7.5 (±4.4) years of education, and 63.3% were female. Multivariate linear regression analysis was used to investigate whether language complaints at baseline predicted poorer language performance at follow-up or increased the risk of cognitive decline, with correction for sex, depressive symptoms, living status, baseline performance, and composite memory and executive performance. Results indicated that LC subjects had significantly worse performances than NLC subjects on semantic fluency 5 years later, but with a similar rate of decline overtime that was not associated with a follow-up outcome of cognitive decline/dementia. Language difficulties may represent a specific type of age-related cognitive complaints. Longer follow-ups are necessary to understand if they are associated with an increased risk of language or cognitive decline.info:eu-repo/semantics/publishedVersio

Avaliação da afasia pelo Médico de Família

A linguagem é um processo complexo que envolve múltiplas estruturas do hemisfério cerebral esquerdo, hemisfério dominante para a linguagem nos indivíduos dextros e, mesmo na maioria dos indivíduos canhotos. Designa-se por Afasia a perturbação de linguagem resultante de uma lesão cerebral que compromete vários aspectos da comunicação, nomeadamente a expressão oral, a compreensão de linguagem, a leitura e a escrita. São diversos os tipos de afasia, dependendo da localização da lesão cerebral. A Afasia é uma sequela frequente de Acidente Vascular Cerebral, de traumatismos crânio-encefálicos e, embora mais rara, de tumores cerebrais ou de doenças infecciosas. Pretende-se, neste artigo, descrever uma avaliação de linguagem passível de ser feita à cabeceira do doente ou numa consulta pelo médico de família. A avaliação consiste em quatro provas cardinais que permitem diagnosticar o tipo de afasia: fluência, nomeação de objectos, repetição de palavras e compreensão de ordens simples. Além destes, outros testes de leitura e de escrita permitem caracterizar melhor o defeito

Cranial autonomic symptoms and neck pain in differential diagnosis of migraine

Cranial autonomic symptoms and neck pain have been reported to be highly prevalent in migraine, although they are rarely considered in clinical evaluation. The aim of this review is to focus on the prevalence, pathophysiology, and clinical characteristics of these two symptoms, and their importance in the differential diagnosis between migraines and other headaches. The most common cranial autonomic symptoms are aural fullness, lacrimation, facial/forehead sweating, and conjunctival injection. Migraineurs experiencing cranial autonomic symptoms are more likely to have more severe, frequent, and longer attacks, as well as higher rates of photophobia, phonophobia, osmophobia, and allodynia. Cranial autonomic symptoms occur due to the activation of the trigeminal autonomic reflex, and the differential diagnosis with cluster headaches can be challenging. Neck pain can be part of the migraine prodromal symptoms or act as a trigger for a migraine attack. The prevalence of neck pain correlates with headache frequency and is associated with treatment resistance and greater disability. The convergence between upper cervical and trigeminal nociception via the trigeminal nucleus caudalis is the likely mechanism for neck pain in migraine. The recognition of cranial autonomic symptoms and neck pain as potential migraine features is important because they often contribute to the misdiagnosis of cervicogenic problems, tension-type headache, cluster headache, and rhinosinusitis in migraine patients, delaying appropriate attack and disease management.info:eu-repo/semantics/publishedVersio

Cefaleia em salvas: Fisiopatogenia, clínica e tratamento

A Cefaleia em Salvas é, dentro das cefaleias primárias, a que apresenta a constelação clínica mais característica, tornando o diagnóstico bastante acessível. No entanto, dada a sua raridade, esta entidade é frequentemente ignorada pelos clínicos no diagnóstico diferencial das cefaleias. A importância do diagnóstico correcto é fundamental, pois esta violenta cefaleia tem uma abordagem terapêutica particular e, geralmente, bastante eficaz. Nesta breve revisão pretende-se fazer um enquadramento etiológico e fisiopatogénico desta patologia, descrever as suas características clínicas, com base nos critérios de diagnóstico existentes e relacionando-os com a realidade das séries descritas, abordar alguns aspectos relevantes do diagnóstico diferencial e propor os princípios de abordagem terapêutica mais consensuais e eficazes

Clinical presentation and neural correlates of stroke‐associated spatial delusions

© 2022 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.Background and purpose: Incongruent beliefs about self-localization in space markedly disturb patients' behavior. Spatial delusions, or reduplicative paramnesias, are characterized by a firm conviction of place reduplication, transformation, or mislocation. Evidence suggests they are frequent after right hemisphere lesions, but comprehensive information about their clinical features is lacking. Methods: We prospectively screened 504 acute right-hemisphere stroke patients for the presence of spatial delusions. Their behavioral and clinical features were systematically assessed. Then, we analyzed the correlation of their duration with the magnitude of structural disruption of belief-associated functional networks. Finally, we described the syndrome subtypes and evaluated whether the clinical categorization would be predicted by the structural disruption of familiarity-associated functional networks using an unsupervised k-means clustering algorithm. Results: Sixty patients with spatial delusions were identified and fully characterized. Most (93%) localized the misidentified places closer to home than the hospital. The median time duration was 3 days (interquartile range = 1-7 days), and it was moderately correlated with the magnitude of structural-functional decoupling of belief-associated functional networks (r = 0.39, p = 0.02; beta coefficient regressing for lesion volume = 3.18, p = 0.04). Each clinical subtype had characteristic response patterns, which were reported, and representative examples were provided. Clustering based on structural disruption of familiarity- and unfamiliarity-associated functional networks poorly matched the clinical categorization (lesion: Rand index = 0.47; structural disconnection: Rand index = 0.51). Conclusions: The systematic characterization of the peculiar clinical features of stroke-associated spatial delusions may improve the syndrome diagnosis and clinical approaches. The novel evidence about their neural correlates fosters the clarification of the pathophysiology of delusional misidentifications.This work was supported by the following grants: PRÉMIO JOÃO LOBO ANTUNES 2018–SCML and Bolsa de Investigação em Doenças Vasculares Cerebrais 2017–SPAVC.info:eu-repo/semantics/publishedVersio

Avaliação da afasia: impacto do material no desempenho da nomeação

Background: Naming and lexical retrieval difficulties are common symptoms of aphasia. Naming abilities are usually evaluated by means of real objects or pictures or line drawings that are printed. Objective: The aim of this study was to investigate whether the ability to name objects among individuals with aphasia is influenced by the dimensions of the visual stimuli and to understand whether the order of presentation of the stimuli, number of years of education and length of time post-onset are involved in the success of naming. Methods: The naming abilities of healthy controls and patients with acute or chronic aphasia due to stroke were assessed through presentation of two sets of 24 stimuli consisting of real objects and color photographs of the same objects presented on a screen. The results obtained under these two conditions were compared by means of within-subject paired ANOVA, controlling for presentation order. Results: 40 patients (62.4 ± 17.3 years old; 70% females; mean education level of 8.5 ± 5.3 years; and 60% evaluated within the first eight days after stroke) and 50 controls that were age, gender and education-matched were included. Object naming was significantly better than naming color photographs among the patients (p = 0.001), but no differences were observed among the controls. Age, education, length of time postonset and presentation sequence did not have any impact on naming performance. Conclusion: These results suggest that use of digital color photographs for naming objects in assessment of aphasia may be associated with lower naming performance, compared with use of real objects. This needs to be taken into account when different forms of stimuli are presented in sequential aphasia evaluations.info:eu-repo/semantics/publishedVersio

Working memory during spontaneous migraine attacks: an fMRI study

Objective: To investigate the neural correlates of working memory during a spontaneous migraine attack compared to the interictal phase, using functional magnetic resonance imaging (fMRI). Background: Cognitive disturbances are commonly observed during migraine attacks, particularly in the headache phase. However, the neural basis of these changes remains unknown. Methods: In a fMRI within-subject test-retest design study, eleven women (32 years of age, average) with episodic migraine were evaluated twice, first during a spontaneous migraine attack, and again in a pain-free period. Each session consisted in a cognitive assessment and fMRI while performing a working memory task (N-back). Results: Cognitive test scores were lower during the ictal session than in the pain-free session. Regions typically associated with working memory were activated during the N-back task in both sessions. A voxel wise between session comparison showed significantly greater activation in the left frontal pole and orbitofrontal cortex during the attack relative to the interictal phase. Conclusion: Migraine patients exhibited greater activation of the left frontal pole and orbitofrontal cortex while executing a verbal working memory task during a spontaneous migraine attack when compared to the interictal state. Given the association of these regions with pain processing and inhibitory control, these findings suggest that patients recruit inhibitory areas to accomplish the cognitive task during migraine attacks, a neural signature of their cognitive difficulties.info:eu-repo/semantics/publishedVersio

Cognitive performance along the migraine cycle: a negative exploratory study

Migraine patients frequently report cognitive difficulties in the proximity and during migraine attacks. We performed an exploratory comparison of executive functioning across the four stages of the migraine cycle. Consecutive patients with episodic migraine undertook cognitive tests for attention, processing speed, set-shifting, and inhibitory control. Performance was compared between patients in different migraine stages, controlling for attack frequency and prophylactic medication. One hundred forty-three patients (142 women, average age 36.2 ± 9.9 years) were included, 28 preictal (≤48 h before the attack), 21 ictal (during the attack), 18 postictal (≤24 h after attack), and 76 interictal. Test performance (age and literacy adjusted z-scores) was not significantly different across migraine phases, despite a tendency for a decline before the attack. This negative study shows that cognitive performance fluctuates as patients approach the attack. To control for individual variability, this comparison needs to be better characterized longitudinally with a within-patient design.info:eu-repo/semantics/publishedVersio