La Desintegración de la somatognosia en las lesiones cerebrales difusas

Descripció del recurs: 13 octubre 201

Comportamiento de la escala Parkinsońs Disease - Cognitive Rating Scale (PD - CRS) en patologías diferentes a la enfermedad de Parkinson

En el presente estudio se han llevado a cabo dos líneas de investigación con el objetivo de comprobar cómo se comportan dos escalas diseñadas originariamente para pacientes con enfermedad de Parkinson (EP). En la primera línea de investigación hemos analizado cómo se comporta la escala Parkinsońs Disease Cognitive Rating Scale (PD - CRS) en condiciones de deterioro cognitivo diferentes a la EP (Deterioro Cognitivo Leve (DCL) en tres subtipos DCL amnésico, DCL Multidominios y DCL en EP) y en demencia (enfermedad de Alzheimer (EA), Demencia Vascular (DV) y Demencia en EP (EPD)). Si la escala PD - CRS ha demostrado su sensibilidad tanto a la disfunción fronto - subcortical como cortical en la EP, se espera que actúe de la misma manera en otras patologías diferentes, tanto en aquellas que presentan un patrón cortical como en aquellas que el perfil característico es más subcortical. Por tanto, hemos explorado si la escala detectaba el patrón de alteración neuropsicológica típica de la EP o por el contrario, era capaz de detectar el perfil de alteración cognitiva en diferentes patrones de deterioro cognitivo. Para ello, hemos comparado la precisión diagnóstica de la PD - CRS con otras escalas cognitivas no específicas para capturar el deterioro cognitivo en una muestra amplia de sujetos. Los resultados obtenidos han demostrado que la escala PD-CRS es un instrumento válido, es decir, presenta alta sensibilidad y especificidad para evaluar las disfunciones cognitivas presentes en EA, DV, DCL-A y DCL-MD, junto con DCL en EP y EPD. Además, permite distinguir entre dos grandes grupos: pacientes con demencia frente a pacientes que no cumplen criterios diagnósticos de demencia. En la segunda línea de investigación hemos analizado cómo se comporta la escala Parkinsońs Disease Cognitive Functional Rating Scale (PD - CFRS) en condiciones de deterioro cognitivo diferentes a la EP (Deterioro Cognitivo Leve (DCL) en tres subtipos DCL amnésico, DCL Multidominios y DCL en EP) y en demencia (enfermedad de Alzheimer (EA), Demencia Vascular (DV) y Demencia en EP (EPD)). La escala PD - CFRS fue originariamente diseñada para capturar el espectro completo de deterioro funcional asociado al deterioro cognitivo en la EP con el fin de discriminar la funcionalidad en pacientes intactos cognitivamente, con DCL y con demencia. La escala fue creada con el propósito de discriminar la funcionalidad asociada al deterioro cognitivo, minimizando el sesgo que puedan producir los aspectos motores intrínsecos a la enfermedad. La escala ha demostrado ser un instrumento válido y fiable para capturar los cambios funcionales relevantes relacionados con el deterioro cognitivo en la EP. Por lo tanto, en nuestra investigación se comparó la habilidad y precisión diagnóstica de la escala PD - CFRS con la de otras escalas no específicas de AIVD́s en la captura del deterioro funcional relacionado con la disfunción cognitiva en una muestra amplia de individuos con diversos grados y diagnósticos de deterioro cognitivo. Los resultados obtenidos han demostrado que la escala PD-CFRS es un instrumento útil para detectar las alteraciones funcionales que tienen lugar en diferentes condiciones que cursan con deterioro cognitivo y que se comporta de forma similar en los pacientes con alteraciones cognitivas cuando se compara con escalas de reconocida validez. Por lo tanto, podemos concluir a partir de los datos obtenidos en el presente estudio que tanto la escala PD-CRS como la escala PD-CFRS son herramientas útiles y su utilización en la praxis clínica diaria puede suponer un avance científico y clínico.In the present study we have carried out two lines of research in order to check how two scales designed originally for patients with Parkinson's disease (PD) behave. At the first line of research has been analyzed how the Parkinson's disease Cognitive Rating Scale (PD - CRS) behaves under other cognitive impairment conditions different than PD. These conditions are three mild cognitive impairment types (MCI) (amnestic, multidomains, and MCP-PD) and three dementia types (Alzheimer's disease (AD), vascular dementia (DV) and dementia at Parkinson's disease (EPD) The PD-CRS has demonstrated sensitivity to both fronto-subcortical and cortical dysfunctions at Parkinson's disease that is why we expect the same results at other pathologies that have subcortical or cortical profiles. In summary, we have explored if the PD-CRS only detects the PD's typical neuropsychological profile or is able to detect different types patterns of cognitive impairment. In order to evaluate this hypothesis we have compared the PD-CRS accuracy to detect cognitive impairment with other non-specific cognitive scales at a large patients sample. The results have shown that PD-CRS is a valid instrument (has high sensitivity and specificity) to evaluate the cognitive dysfunctions present in AD, VD, MCIa, MCImd, MCI-PD and PDD. Also, allows us to differentiate between two diagnostic categories: patients with dementia versus patients without dementia or patients that not meet dementia's criteria. At the second line of research we have analyzed how the Parkinson's Disease Cognitive Functional Rating Scale (PD-CFRS) behaves at others cognitive impairment conditions different than PD. The pathologies included at this part of the study are the same that ones included at the first part (mild cognitive impairment MCI amnesic, multidomain, MCI-PD, Alzheimer's disease, vascular dementia, and PDD). The PD-CFRS was originally designed to capture the full spectrum of functional impairment associated to Parkinson's disease in order to discriminate the functionality of patients cognitively intact from those with mild cognitive impairment or dementia. This scale was created to discriminate the functionality associated with cognitive impairment avoiding some biases caused by the intrinsic motor aspects of the disease. The scale has proven to be a valid and reliable instrument to capture the relevant functional changes associated to cognitive impairment at PD. Our research compared the PD-CFRS's ability and diagnostic precision to detecting functional impairment at to cognitive dysfunction with other scales not AIVD specifics in a large sample of individuals with varying diagnostics and degrees of cognitive impairment. The results have shown that PD-CFRS scale is a useful instrument to detect functional alterations that occur in different conditions with cognitive impairment. Also has similar results that others scales with recognized validity when evaluate at cognitive impairment's patients. Therefore, we are able to conclude that both the PD-CRS scale and the PD-CFRS are useful tools and their use in daily clinical practice can be a scientific and clinical advancement

Unexpected online gambling disorder in late-life : a case report

Background: The lifetime prevalence of problem or Gambling disorder (GD) in the elderly (i.e., those over 60 years old) is reported to range from 0.01 to 10.9%. Research has identified several specific risk factors and vulnerabilities in the elderly. Since the late 1990s, an increase in online GD has been observed in the youth population, whereas casinos, slot machines, and bingo seem to be the activities of choice among the elderly. Interestingly, online GD has not been described in the elderly to date. Case Description: We report an 83-year-old man who started online casino gambling from the age of 80 years, leading to debts that exceeded €30,000. He underwent a full clinical and neuropsychological assessment, without any evidence of cognitive impairment or any associated neurodegenerative disease. However, he had risk factors for GD, including adjustment disorder, stressful life events, previous offline casino GD when 50 years old, and dysfunctional personality traits. The change to online GD may have been due to his isolation, movement difficulties, and his high level of education, which facilitated his access to the Internet. Care management focused on individual cognitive-behavioral therapy. Conclusion: The prevalence of online GD may be underestimated among the elderly, and may increase among isolated old people with movement difficulties and ready access to the Internet. However, late-life GD should be considered a diagnosis of elimination, requiring a full medical, psychiatric (including suicide risk), and cognitive assessment. Specific therapeutic approaches need to be proposed and developed

Entrepreneurial intentions and entrepreneurship education to University students in Portugal

[EN] This article analyzes entrepreneurial intentions and motivations that encourage university students of Tourism to create their own company. Methodology is based on an empirical study, using a questionnaire adapted from a model of Veciana and Urbano (Actitudes de los estudiantes universitarios hacia la creación de empresas: un estudio empírico comparativo entre Catalunya y Puerto Rico. El emprendedor innovador y la creación de empresas de I + D + I, University of Valencia, pp 35 58, 2004), including the desirability and viability concepts. One hundred and sixty students answered the questionnaire from a total study population of 243 official Tourism degree students of the Superior Institute of Accounting and Management of Porto. This research finds out that the university students have a very positive perception about the desire to create their own company; a 90 % of students express their desire to do it, and 83.5 % express their intention. Moreover, a 57.5 % think that within actual crisis it is more difficult to do than before it. This research lets us get an in-depth study of a student of Tourism degree, finding out his entrepreneurial attitudes. It can be the first step to wake up and encourage students interest for starting up their own business.Del Rio-Rama, MDLC.; Peris-Ortiz, M.; Álvarez García, J.; Rueda Armengot, C. (2016). Entrepreneurial intentions and entrepreneurship education to University students in Portugal. Technology, Innovation and Education. 2(7):1-11. doi:10.1186/s40660-016-0013-5S11127Ajzen I (1991) The theory of plannes behavior. Organ Behav Hum Decis Process 50:179–211Aponte M (2002) Factores condicionantes de la creación de empresas en Puerto Rico: un enfoque institucional. Doctoral dissertation, Autonomous University of BarcelonaAponte M, Urbano D, Veciana JM (2006) Actitudes hacia la creación de empresas: un estudio comparativo entre Catalunya y Puerto Rico. Centro de Investigaciones Comerciales e Iniciativas Académicas de la Facultad de Administración de Empresas. Forum Empresarial 11(2):52–75Bae TJ, Qian S, Miao C, Fiet JO (2014) The relationship between entrepreneurship education and entrepreneurial intentions: a meta-analytic review. Entrep Theory Pract 38(2):217–254Brice J (2004) The role of personality dimensions on the formation of entrepreneurial intentions. USASBE Small Business Advancement National Center. University of Central Arkansas, USACabana-Villca R, Cortes-Castillo I, Plaza-Pasten D, Castillo-Vergara M, Alvarez-Marin A (2013) Análisis de las capacidades emprendedoras potenciales y efectivas en alumnos de centros de educación superior. J Technol Manag Innov 8(1):65–75Davidsson P (1989) Continued entrepreneurship and small firm business. Stockholm School of Economics, StockholmDavidsson P (1995) Culture, structure and regional levels of entrepreneurship. Entrep Reg Dev 7(1):41–62De Jorge-Moreno J, Castillo LL, Triguero MS (2012) The effect of business and economics education programs on students’ entrepreneurial intention. Eur J Train Dev 36(4):409–425Díaz JC, Hernández RM, Barata ML (2007) Estudiantes universitarios y creación de empresas. Un análisis comparativo entre España y Portugal. In Ayala, J.C. (coord.) Conocimiento, innovación y emprendedores: camino al futuro. Grupo FEDRA, MadridDo Paço AMF, Ferreira JM, Raposo M, Rodrigues RG, Dinis A (2011) Behaviours and entrepreneurial intention: empirical findings about secondary students. J Int Entrep 9(1):20–38Dohse D, Walter SG (2010) The role of entrepreneurship education and regional context in forming entrepreneurial intentions (No. 2010, 18). Document de treball de l’IEBEuropean Commission (2006). Entrepreneurship education in Europe: Fostering entrepreneurial mindsets through education and learning, Final Proceedings of the Conference on Entrepreneurship Education in OsloEurostat (2014) Informes sobre el empleo en la Unión Europea. Available in: http://europa.eu/publications/statistics/index_es.htmFuentes F, Saco F, Rodríguez P (2013) Estudio sobre el perfil emprendedor en el alumnado universitario de Córdoba. UCO Consejo Social de la Universidad de Córdoba, III Edición, Córdoba, pp 1–180Fuentes García FJ (2007) Análisis del Perfil Emprendedor del alumnado universitario y preuniversitario de Córdoba. Consejo Social Universidad de Córdoba, pp 1–105Genesca Garrigosa E, Veciana Verges JM (1984) Actitudes hacia la creación de empresas. Información Comercial Española 611:147–155Gerba DT (2012) Impact of entrepreneurship education on entrepreneurial intentions of business and engineering students in Ethiopia. Afr J Econ Manag Stud 3(2):258–277Gorman G, Hanlon D, King W (1997) Some research perspectives on entrepreneurship education and education for small business management: a ten-year literature review. Int Small Bus J 15(3):56–77Guerrero M, Rialp J, Urbano D (2008) The impact of desirability and feasibility on entrepreneurial intentions: a structural equation model. Int Entrep Manag J 4(1):35–50Haynie JM, Shepherd DA, McMullen JS (2009) An opportunity for me? The role of resources in opportunity evaluation decisions. J Manage Stud 46(3):337–361Hernangomez J, Martín N, Rodriguez AI, Saboia F (2005) El emprendedor nace o se hace? Un análisis de los determinantes del espíritu emprendedor. XVI Spanish-Portuguese Meeting of Scientic Management. Sevilla:33–44Hmieleski KM, Corbett AC (2006) Proclivity for improvisation as a predictor of entrepreneurial intentions. J Small Bus Manage 44(1):45–63Honjo Y (2004) Growth of new start-up firms: evidence from the Japanese manufacturing industry. Appl Econ Lett 11(1):21–32Hyde GC (1989) The relationship between policy and research. In Rosa, P.; Birley, S. Cannon, T. and O´Neill, K. The Role and Contribution of Small Business Research, Chap. 3:55–77, Institute ReportKolvereid L (1996) Prediction of employment status choice intentions. Entrep Theory Pract 21(1):47–57Kourilsky ML, Walstad WB (1998) Entrepreneurship and female youth: knowledge, attitude, gender differences, and educational practices. J Bus Ventur 13(1):77–88Krueger N, Brazeal D (1994) Entrepreneurial Potencial and Potencial Entrepreneurs. Entrep Theory Pract 18(3):91–104Krueger NF, Carsrud AL (1993) Entrepreneurial intentions: applying the theory of planned behaviour. Entrep Reg Dev 5(4):315–330Lanero A, Vázquez JL, Gutiérrez P, García MP (2011) The impact of entrepreneurship education in European universities: an intention-based approach analyzed in the Spanish area. Int Rev Public Nonprofit Marketin 8(2):111–130Miller BK, Bell JD, Palmer M, González A (2009) Predictors of entrepreneurial intentions: a quasi-experiment comparing students enrolled in introductory management and entrepreneurship classes. J Bus Entrep 21(2):39–62Neck HM, Zacharakis AL, Bygrave WD, Reynolds PD (2003) Global entrepreneurship monitor: 2002 executive report. Babson College, Babson, MANorth DC (1990) Institutions, Institutional Change and Economic Performance. Cambridge University Press, Cambridge (UK)North D (1993) Instituciones, cambio institucional y desempeño económico. Fondo de Cultura Económica, MéxicoNorth DC (2005) Understanding the Process of Economic Change. Academic Foundation. University Press, PrincentonGEM Portugal (2012) Estudo sobre o Empreendedorismo. Global Entrepreneruship Monitor (GEM). Instituto Universitário de Lisboa (ISCTEIUL) http://web.spi.pt/GEMportugal2012/files/GEM_PORTUGAL_2012.pdfRaposo M, do Paço A, Ferreira J (2008a) Entrepreneur’s profile: a taxonomy of attribu tes and motivations of university students. J Small Bus Enterp Dev 15(2):405–420Raposo MLB, Ferreira JJM, do Paço AMF, Rodrigues RJG (2008b) Propensity to firm creation: empirical research using structural equations. Int Entrep Manag J 4(4):485–504Robinson PB, Stimpson DV, Huefner JC, Hunt HK (1991) An attitude approach to the prediction of entrepreneurship. Entrep Theory Pract 15(4):13–31Samad Aghayi J (2008) Entrepreneurship organization. Public Administration Training Center Publications, TehranScherer RF, Adams JS, Carley S, Wiebe FA (1989) Role model performance effects on development of entrepreneurial career preference. Entrep Theory and Pract, spring:53–71Scherer RF, Brodzinski JD, Wiebe F (1991) Examining the relationship between personality and entrepreneurial career preference. Entrep Reg Dev 3(2):195–206Shane S (2003) A General Theory of Enttrepreneurship- The Individual Oportunity Nexus. Edward Elgar EditoresShapero A (1982) Social dimensions of entrepreneurship. In: Kent CA et al (eds) The encyclopedia of entrepreneurship. Prentice-Hall, Englewood Cliffs, pp 72–89Shapero A, Sokol L (1982) The social dimensions of entrepreneurship.Encyclopedia of Entrepreneurship:72–90Storey DJ (1994) Employment. In Storey, D.J. Understanding the small business sector. Capítulo 6, pp. 160–203. London: RoutledgeToledano N, Urbano D (2008) Promoting entrepreneurial mindsets at universities: a case study in the South of Spain. Eur J Int Manag 2(4):382–399Trequattrini R, Lombardi R, Lardo A, Cuozzo B (2015). The Impact of Entrepreneurial Universities on Regional Growth: a Local Intellectual Capital Perspective. Journal of the Knowledge Economy, 1–13Urbano D (2006) La creación de empresas en Catalunya. Organismos de apoyo y actitudes hacia la actividad emprendedora, Ed. Generalitat de Catalunya-CIDEM, BarcelonaUrbano D, Toledano N (2008) The systems of university education and their influence on the students’ attitudes in the business world: a multiple case study. Oikos 25:87–103Veciana JM (1989) Características del empresario en España. Papeles de Economía Española 39:19–36Veciana JM, Urbano D (2004) Actitudes de los estudiantes universitarios hacia la creación de empresas: un estudio empírico comparativo entre Catalunya y Puerto Rico. El emprendedor innovador y la creación de empresas de I + D + I, University of Valencia, pp 35–58Veciana JM, Aponte M, Urbano D (2005) University student’s attitudes towards entrepreneurship: a two countries comparison. Int Entrep Manag J 1:165–182Wang CK, Wong PK (2004) Entrepreneurial interest of university students in Singapore. Technovation 24(2):163–172White SB, Reynolds PD (1996) Government programs and high growth new firms. Frontiers of Entrepreneurship Research. Center for Entrepreneurial Studies Babson College. Wellesley, MA.: 621–635Yari A, Toulabi Z, Pourashraf Y (2013) Designing propensity to entrepreneurship paradigm in Ilam universities (structural equation model approach). J Novel Appl Sci 2:872–88

Prognostic value of cortically induced motor evoked activity by TMS in chronic stroke: caveats from a very revealing single clinical case

Background: We report the case of a chronic stroke patient (62 months after injury) showing total absence of motor activity evoked by transcranial magnetic stimulation (TMS) of spared regions of the left motor cortex, but near-to-complete recovery of motor abilities in the affected hand. Case presentation: Multimodal investigations included detailed TMS based motor mapping, motor evoked potentials (MEP), and Cortical Silent period (CSP) as well as functional magnetic resonance imaging (fMRI) of motor activity, MRI based lesion analysis and Diffusion Tensor Imaging (DTI) Tractography of corticospinal tract (CST). Anatomical analysis revealed a left hemisphere subinsular lesion interrupting the descending left CST at the level of the internal capsule. The absence of MEPs after intense TMS pulses to the ipsilesional M1, and the reversible suppression of ongoing electromyographic (EMG) activity (indexed by CSP) demonstrate a weak modulation of subcortical systems by the ipsilesional left frontal cortex, but an inability to induce efficient descending volleys from those cortical locations to right hand and forearm muscles. Functional MRI recordings under grasping and finger tapping patterns involving the affected hand showed slight signs of subcortical recruitment, as compared to the unaffected hand and hemisphere, as well as the expected cortical activations. Conclusions: The potential sources of motor voluntary activity for the affected hand in absence of MEPs are discussed. We conclude that multimodal analysis may contribute to a more accurate prognosis of stroke patients