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Estudo prospectivo dos aspectos neuropsicológicos e da qualidade de vida de doentes com lesão axonial difusa traumática / Prospective study of the neuropsychological aspects and quality of life of patients with traumatic diffuse axonal injuryAna Luiza Costa Zaninotto 29 July 2016 (has links)
Introdução: O traumatismo cranioencefálico (TCE) é o maior problema de saúde pública nos países ocidentais. A lesão axonial difusa (LAD) é uma das mais importantes causas de sequelas neurológicas e resultam do comprometimento da substância branca causada por forças rotacionais e/ou aceleração/ desaceleração no parênquima encefálico que tensiona e lesa os axônios. Apesar dos doentes com TCE apresentarem déficits neurológicos transitórios, as mudanças cognitivas podem ser persistentes, especialmente em lesões moderadas e severas. Até o momento poucos estudos analisaram aspectos neuropsicológicos de doentes com LAD. Método: Estudo unicêntrico, prospectivo, exploratório, com braço único e três níveis de medidas repetidas. Quarenta doentes com LAD de ambos os sexos, com idade entre 18 e 55 anos foram avaliados na fase 1 (até 3 meses após o trauma), fase 2 (6 meses) e fase 3 (12 meses). Na fase 1 avaliou-se os sintomas depressivos (BDI), ansiosos (IDATE), qualidade de vida (QV SF-36) e sobrecarga do cuidador (Zarit Burden Interview). Na fase foram avaliadas as mesmas variáveis, acrescida da avaliação cognitiva (QI, memória episódica verbal e visuoespacial, processos atencionais, funções executivas, coordenação motora). Na fase 3 repetimos o procedimento da fase 2. Resultados: Não houve diferença significativa dos sintomas depressivos, de ansiedade, sobrecarga do cuidador nas fases 1, 2 e 3. Constatamos melhora significativa na memória episódica verbal e visuoespacial (p < 0,05), dos processos atencionais (p < 0,05). O QI e a idade do doente foram preditores para desempenho dos doentes em diversos testes, o mesmo não foi observado em relação a gravidade do trauma. Conclusão: O estudo mostrou melhora espontânea da memória episódica e dos processos atencionais em doentes com LAD no primeiro ano após o trauma. Esses resultados foram independentes da gravidade do trauma e dos sintomas depressivos, ansiosos e da QV dos doentes. Esses achados podem estar associados à neuroplasticidade, evidenciando-se janela terapêutica importante no primeiro ano após o trama / Introduction: Traumatic brain injury (TBI) is a major public health problem in Western countries. Diffuse axonal injury (DAI) is one of the most important causes of neurological damage and result of white matter impairment caused by rotational forces and / or acceleration / deceleration in the brain parenchyma tenses and damages the axons. Although patients with TBI present transient neurological deficits, cognitive changes may be persistent, especially in moderate and severe injuries. To date few studies have examined neuropsychological aspects of patients with DAI. Method: single-center study, prospective, exploratory, with one arm design and three levels of repeated measures. Forty patients with LAD, both sexes, aged 18 to 55 were evaluated in phase 1 (up to 3 months after the trauma), phase 2 (6 months) and phase 3 (12 months). In phase 1 we evaluated depressive symptoms (BDI), anxiety (STAI), quality of life (QoL SF-36) and caregiver burden (Zarit Burden Interview). In phase 2 were evaluated the same variables, plus the cognitive assessment (IQ, verbal and visuospatial episodic memory, attentional processes, executive functions, motor coordination). In phase 3 we repeat the procedure from step 2. Results: No significant differences in depressive symptoms, anxiety, and caregiver burden in phases 1, 2 and 3. We found significant improvement in verbal and visuospatial episodic memory (p < 0.05), of the attentional processes (p < 0.05). The IQ and patient age were predictors for performance of patients in several tests, the same was not observed for the severity of the trauma. Conclusion: The study showed spontaneous improvement of episodic memory and attentional processes in patients with LAD in the first year after the trauma. These results were independent of the severity of the trauma and depressive symptoms, anxiety and QoL of the patients. These findings may be associated with neuroplasticity, demonstrating important therapeutic window in the first year after the trauma
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O papel da escolaridade, do alfabetismo funcional e dos fatores sociodemográficos na avaliação cognitiva do idoso / The role of formal education, functional literacy, and demographic factors on the cognitive assessment of older adultsDaniel Apolinario 06 August 2013 (has links)
INTRODUÇÃO: A busca pelo diagnóstico cada vez mais precoce das demências traz a necessidade de estratégias mais eficientes na utilização dos testes cognitivos. A definição dos parâmetros de normalidade para esses testes é particularmente desafiadora no contexto brasileiro de baixa escolaridade e grande heterogeneidade sociocultural. OBJETIVO: Avaliar os efeitos de diferentes estratégias de ajuste de normas nas propriedades do Mini-Exame do Estado Mental (MEEM). MÉTODOS: Duzentos e trinta idosos encaminhados a um serviço de Geriatria por suspeita de comprometimento cognitivo foram recrutados sequencialmente e submetidos ao MEEM. Todos os pacientes passaram por uma segunda avaliação cega para o resultado do MEEM, constituída de testagem neuropsicológica e entrevista com um informante para obtenção de diagnóstico padrão-ouro. Para o ajuste de normas, quatro fatores preditores foram testados: (1) características sociodemográficas; (2) uma classificação simples de alfabetismo funcional com quatro níveis; (3) um questionário de habilidades cognitivas pré-morbidas respondido pelo informante; (4) um teste de leitura de palavras aplicado diretamente ao paciente. Três técnicas de predição foram testadas: (1) agrupamento em níveis; (2) regressão linear; (3) regressão não-linear por modelo polinomial fracional. As combinações de fatores preditores e técnicas de predição deram origem a vinte modelos que foram testados individualmente na comparação com o MEEM sem ajuste. Os desfechos avaliados foram a acurácia do modelo na detecção de comprometimento cognitivo e a variação da sensibilidade e da especificidade entre os níveis socioeconômicos. RESULTADOS: Entre os 230 idosos recrutados, 106 (46%) apresentavam envelhecimento cognitivo normal, 56 (24%) comprometimento cognitivo sem demência e 68 (29%) demência. A classificação de alfabetismo funcional, o questionário de habilidades cognitivas pré-mórbidas e o teste de leitura de palavras não apresentaram propriedades adequadas para ajuste de normas, mas as limitações podem estar relacionadas a problemas específicos dos instrumentos utilizados e não devem ser generalizadas. Alguns modelos baseados em fatores sociodemográficos foram capazes de melhorar a acurácia do MEEM, resultado que diverge da literatura atual e que deve ser confirmado em outros estudos com populações de baixa escolaridade. Um modelo polinomial fracional utilizando variáveis sociodemográficas apresentou propriedades ótimas de acurácia e promoveu estabilização da sensibilidade e da especificidade entre os níveis socioeconômicos. A partir das equações geradas por esse modelo podem ser construídas tabelas simples de uso clínico para converter o resultado bruto em escore z ou percentil. CONCLUSÕES: Nossos resultados apontam o modelo polinomial fracional baseado em variáveis sociodemográficas como a melhor opção para ajuste de normas de testes cognitivos em nosso meio / INTRODUCTION: The need for diagnosing dementia early demands effective strategies on the use of cognitive tests. Establishing criteria of normality for these tests is a challenging task in environments of low education and enormous sociocultural heterogeneity such as observed in Brazil. OBJETIVE: To evaluate how different strategies for adjusting norms can change the properties of the Mini-Mental Status Examination (MMSE). METHODS: Two hundred and thirty older adults referred for a geriatric service because of suspected cognitive impairment were recruited sequentially and completed the MMSE. All the patients underwent a second assessment, blind to the result of the MMSE, which was composed of a neuropsychological battery and an interview with a close informant for the establishment a gold-standard diagnosis. For the adjustment of the norms, four predictive factors were evaluated: (1) demographic characteristics; (2) a simple classification of functional literacy with four levels; (3) a premorbid abilities questionnaire; (4) a word-reading test. Three techniques of prediction were evaluated: (1) grouping in demographic or ability levels; (2) simple or multivariate linear regression; (3) nonlinear regression by using a fractional polynomial model. Some possible combinations of predictive factors and prediction techniques originated twenty models that were assessed individually in comparison with the raw MMSE scores. The endpoints assessed were accuracy of the model for detecting cognitive impairment and the variation of the sensibility and specificity across socioeconomic levels. RESULTS: Of the 230 older adults recruited, 106 (46%) had normal cognitive aging, 56 (24%) presented cognitive impairment no dementia (CIND) and 68 (29%) had dementia. The functional literacy classification, the premorbid cognitive abilities questionnaire and the word-reading test did not present adequate properties for the adjustment of norms, but the limitations may be associated to specific problems of the instruments an cannot be generalized. Some models based on the demographic characteristics were able to improve the accuracy of the MMSE. This finding diverges from the currently available literature and should be confirmed in further studies with low-educated populations. A fractional polynomial model employing demographic factors presented very good properties and was able to stabilize the sensibility and the specificity across the socioeconomic levels. The equations generated by this model can be employed to construct practical tables for converting raw scores into z scores and percentiles. CONCLUSIONS: Our results point to the fractional polynomial model based on demographic variables as the best choice to adjust norms for cognitive tests in our context
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Malperformance in Verbal Fluency and Delayed Recall as Cognitive Risk Factors for Impairment in Instrumental Activities of Daily LivingKöhler, Mirjam, Kliegel, Matthias, Wiese, Birgitt, Bickel, Horst, Kaduszkiewicz, Hanna, Bussche, Hendrik van den, Eifflaender-Gorfer, Sandra, Eisele, Marion, Fuchs, Angela, König, Hans-Helmut, Leicht, Hanna, Luck, Tobias, Maier, Wolfgang, Mösch, Edelgard, Riedel-Heller, Steffi, Tebarth, Franziska, Wagner, Michael, Weyerer, Siegfried, Zimmermann, Thomas, Pentzek, Michael January 2011 (has links)
Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed. Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits. Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication. Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.
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Maternal alcohol consumption and socio-demographic determinants of neurocognitive function of school children in the rural Western CapeViglietti, Paola 02 March 2021 (has links)
Background. Within the South African context there is a large body of research regarding the associations between maternal gestational drinking and diagnosable child FASDs. However, there remains a paucity of local research regarding the impacts of other kinds of maternal drinking behaviours (e.g. past and present maternal drinking) and related socio-demographic factors on developmentally sensitive areas of child neurocognitive functioning, such as executive functioning (EF). Methods. This study was cross-sectional in design, utilising a gender balanced sample of N=464 children between the ages of 9.00 and 15.12 (year.months) in three rural areas within the Western Cape. Information regarding maternal drinking behaviours (before, during and after pregnancy) and related socio-demographic factors was collected via structured interviews with mothers or proxy respondents. Six subtests from the Cambridge Automated Neuropsychological Battery (CANTAB), were used to assess three aspects of child EF namely: (1) processing speed, assessed by the MOT and RTI subtests, (2) attention, assessed by the MTT and RVP subtests and (3) memory, assessed by the SWM and PAL subtests. Findings. For all three maternal alcohol use behaviours examined, there was an apparent non-significant trend whereby children of mothers who reported alcohol use (before, during and after pregnancy) performed worse (on average) than children of mothers reporting non-alcohol use on the EF subtests. Several of the socio-demographic factors were found to act as significant predictors of subtest specific EF performance including child sex (RTI: B=.46, p<. 01; MTT: B=.05, p<.05), child age (RTI: B=.27, p<.05; MTT: B=.11, p<.01), home language (MOT: B=- .13, p<.05), maternal employment (MTT: B=-.04, p<.05) and household size (SWM: B=-1.29, p<.05). Conclusions. These study findings provide initial insights into the impacts of different types of maternal drinking behaviours and related socio-demographic factors on child EF outcomes within the context of an LMIC, South Africa.
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Malperformance in Verbal Fluency and Delayed Recall as Cognitive Risk Factors for Impairment in Instrumental Activities of Daily LivingKoehler, Mirjam, Kliegel, Matthias, Wiese, Birgitt, Bickel, Horst, Kaduszkiewicz, Hanna, van den Bussche, Hendrik, Eifflaender-Gorfer, Sandra, Eisele, Marion, Fuchs, Angela, Koenig, Hans-Helmut, Leicht, Hanna, Maier, Wolfgang, Moesch, Edelgard, Riedel-Heller, Steffi, Tebarth, Franziska, Wagner, Michael, Weyerer, Siegfried, Zimmermann, Thomas, Pentzek, Michael 04 August 2020 (has links)
Background: Maintaining independence in instrumental activities of daily living (IADL) is crucial for older adults. This study explored the association between cognitive and functional performance in general and in single IADL domains. Also, risk factors for developing IADL impairment were assessed.
Methods: Here, 3,215 patients aged 75–98 years were included. Data were collected during home visits.
Results: Cognitive functioning was associated with IADL both cross-sectionally and longitudinally. Regarding the single IADL domains cross-sectionally, executive functioning was especially associated with shopping, while episodic memory was associated with responsibility for own medication.
Conclusion: Reduced performance in neuropsychological tests is associated with a greater risk of current and subsequent functional impairment.
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Neuropsihloški korelati mikrostrukturnih promena mozga utvrđenih metodom magnetne rezonance kod obolelih od blagog kognitivnog poremećaja i Alchajmerove bolesti / Neuropsychological correlates of microstructural brain damage visualized by magnetic resonance imaging in patients with mild cognitive impairment and Alzheimer's diseaseVujanić Stankov Tijana 24 October 2019 (has links)
<p>Alchajmerova bolest je najčešća demencija od svih demencija i karakteriše je depozicija senilinih plakova i neurofibrilarnih klubadi u kortikalnim moždanim regionima, koje daljim razvojem bolesti postaju atrofične. Klinički se karakteriše smetnjma na planu pamćenja, egzekutivnih funkcija, pažnje i ostalih kognitivnih funkcija uz odustsvo sposobnosti samostalnog funkcionisanja u svakodnevnom životu. Blagi kognitivni poremeća (BKP) je klinički entitet koji se smatra početnim stadijumom demencije u kom se registruju smetnje na planu pamćenja, ali i drugih kognitvnih funkcija, uz očuvanu funkcionalnost u svakodnevnom životu. Kod obe bolesti je utvrđeno da pored kortikalnog zahvatanja, patološkim procesom je zahvaćena i bela masa mozga. U današnje vreme se mirkostrukturno oštećenje bele mase mozga može ispitati difuzionim tenzorskim imidžinogom (DTI) na magnentoj rezonanci mozga (MR). Cilj: Utvrditi razlike neuropsiholoških skorova i razlike DTI parametara između obolelih od AB, BKP i kontrolne grupe zdravih ispitanika, kao i utvrditi da li postoji korelacija između neuropsiholoških skorova i DTI parametara kod BKP i AB. Metode: U istraživanje je uključeno tri ispitivane grupe od po 30 ispitanika: oboleli od AB u blagom stadijumu bolesti, oboleli od amnestičkog multi-domen BKP i kontrolna grupa zdravih ispitanika. Dijagnoza kod obolelih u obe grupe je postavljena na osnovu kliničkih kriterijuma aktuelnih dijagnostičkih kriterijuma iz 2011. godine. Kod svih ispitanika je sprovedeno detaljno neuropsihološko testiranje u cilju procene kognitivnih funkcija (smetnji na planu pamćenja, egzekutivnih funkcija, pažnje, govora, vizuospacijalnih i vizuokonstrukcionih sposobnosti), depresivnosti i drugih neuropsihijatrijskih simptoma i kvaliteta života. Samo je kod obolelih od AB dopunski vršena procena sposobnosti svakodnevnog funkcionisanja. Kognitivne funkcije su ispitane formiranjem kognitivnih domena, na osnovu pretpostavke o zajedničkom predmetu merenja korišćenih testova. Potom je načinjen MR mozga, u okviru koje je analiziran i DTI. Dalja obrada DTI je sprovedena primenom TBSS metode, čime su dobijene vrednosti DTI parametara: frakcione anizotropije (FA), srednje difuzivnosti (SD), radijalne difuzivnosti (RD) i aksijalne difuzivnosti (DA). Nakon toga je načinjena korelacija neuropsihološkog postignuća i DTI parametara korišćenjem Pirsonovog, odnosno Spirmanovog koeficijenta korelacije. Rezultati: Oboleli od AB su imali lošije postignuće na planu vizuelnog pamćenja, verbalnog pamćenja, neposrednog upamćivanja, odloženog prisećanja, pažnje, govora, egzekutivnih funkcija, mišljenja, radne memorije i vizuospacijalnih i vizuokonstrukcionih sposobnosti u odnosu na kontrolnu grupu zdravih. Oboleli od BKP su imali lošije postignuće u odnosu na kontrolnu grupu zdravih u domenima vizuelno pamćenje, neposredno upamćivanje, odloženo prisećanje, govor, mišljenje i vizuospacijalne i vizuokonstrukcione sposobnosti. Obe grupe obolelih su ispoljile više depresivnih simptoma u odnosu na kontrolnu grupu zdravih ispitanika. Takođe, obe grupe obolelih ispoljavaju statistički značajno više neuropsihijatrijskih simptoma u odnosu na zdrave ispitanike, gde se kod obolelih od AB registruju sumanute ideje, halucinacije, agitacija, euforija, dezinhibicija, ritabilnost i apatija, dok se kod obolelih od BKP registruju anksioznost i iritabilnost. Oboleli od AB imaju lošiji kvalitet života u odnosu na zdrave ispitanike, dok između oboleli od BKP i zdravih ispitanika nema razlike u proceni kvaliteta života. Što se tiče DTI parametara, oboleli od AB imaju niži FA i višu SD, RD i DA u odnosu na zdrave ispitanike na više puteva bele mase: prednji krak kapsule interne, prednja korona radijata, telo korpusa kalozuma, cingulum, kapsula eksterna, fornix-strija terminalis, koleno korpusa kalozuma, donji fronto-okcipitalni fascikulus, zadnja korona radijata, gornji fronto-okcipitalni fascikulus, gornji longitudinalni fascikulus i fascikulus uncinatus. Oboleli od BKP imaju sniženu FA i povišenu SD, RD i DA u regiji forniksa u odnosu na zdrave ispitanike. Kod obolelih od AB registrovane su značajne povezanosti mikrostrukturnog oštećenja bele mase i oštećenja svih kognitivnih domena, izuzev domena mišljenje, dok su kod obolelih od BKP registrovane značajne povezanosti mikrostrukturnog oštećenja bele mase i oštećenja svih kognitivnih domena, izuzev domena egzekutivne funkcije. U grupi obolelih od BKP je bilo više registrovanih korelacija oštećenja domena verbalno pamćenje, odloženo prisećanje i govor sa oštećenjem bele mase mozga, dok je kod AB bilo više registrovanih korelacija oštećenja domena vizuelno pamćenje, neposredno upamćivanje, pažnja, radna memorija i vizuospacijalne i vizuokontrukcione sposobnosti sa oštećenjem bele mase mozga. Depresivnost je jedino u grupi BKP značajno korelirala sa oštećenjem određenih puteva bele mase mozga. Zaključak: U blagom stadijumu obolelih od AB se registruje kognitivno oštećenje svih ispitivanih domena, više su ispoljeni depresivni simptomi, utvrđen je veliki broj neuropsihijatrijskih simptoma i narušen je kvalitet života u odnosu na zdrave ispitanike. Kod obolelih od BKP je registrovano kognitivno oštećenje više od pola procenjivanih kognitivnih funkcija, više su ispoljeni depresivni simptomi i utvrđeno prisustvo anksioznosti i iritabilnosti, dok kvalitet života nije narušen u ovoj fazi bolesti u odnosu na zdrave ispitanike. Rezultati vezani za mikrostrukturno oštećenja mozga u najranijim fazama AB ukazuju da je neuronska mreža značajno oštećena u najranijim kliničkim fazama bolesti, dok je u stadijumu BKP izolovana na oštećenje u regiji forniksa. U grupi obolelih od BKP je bilo više registrovanih korelacija oštećenja domena verbalno pamćenje, odloženo prisećanje i govor sa oštećenjem bele mase mozga, dok je kod AB bilo više registrovanih korelacija oštećenja domena vizuelno pamćenje, neposredno upamćivanje, pažnja, radna memorija i vizuospacijalne i vizuokontrukcione sposobnosti sa oštećenjem bele mase mozga. Stepen depresivnosti i oštećenje bele mase mozga je povezano isključivo na nivou BKP.</p> / <p>Alzheimer's disease (AD) is the most common dementia of all dementia with deposition of senile plaques and neurofibrillary tangles in cortical brain regions, which become atrophic in the further disease development. It`s main clinical characteristics are impairment of memory, executive function, attention and other cognitive functions with impairment in daily living activities. Mild cognitive impairment (MCI) is a clinical entity considered as an initial stage of dementia with present memory impairment, as well as other cognitive functions, while maintaining the functionality of the everyday life. In both diseases, pathological processes affect also the white matter of the brain. Nowadays, microstructural damage of the brain white matter is diagnosed by using diffusion tensor imaging (DTI) in the brain magnetic resonance imaging (MR). Objective: The aim of this study was to determine differences in neuropsychological scores and differences in DTI parameters between patients with AD, MCI and control groups of healthy subjects, as well as to determine whether there is a correlation between scores and DTI parameters in MCI and AD. Methods: The study included three groups of 30 patients each: of AD patients in the mild stage of the disease, patients with multi-domain amnestic MCI, and healthy controls. The patient’s diagnosis are based upon clinical criteria of current diagnostic criteria proposed in 2011. All patients had assessment of cognitive functions (impairment of memory, executive function, attention, language, visuospatial and construction abilities), depressive symptoms and other behavioral disorders and quality of life. Only in patients with AD, we also assessed ability of daily living activities. Cognitive functions were tested by forming cognitive domains, based on the assumption of a common object of measurement of analyzed tests. Further, participants had MRI scan, in which DTI was analyzed. DTI post-processing was carried out by using TBSS method, whereby the values of DTI parameters were: fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (DA). We conducted correlation analysis of the neuropsychological achievements and DTI parameters using Pearson or Spearman’s correlation coefficient, dependent on variable distribution. Results: The patients with AD had lower scores in the field of visual memory, verbal memory, immediate and delayed recall, attention, language, executive functions, reasoning, working memory and visuospatial and construction abilities compared to the control group. Patients with MCI had lower scores compared to the control group in the domains of visual memory, immediate and delayed recall, language, reasoning, and visuospatial and construction abilities. Both groups of patients have more depressive symptoms in relation to the control group of healthy subjects. In addition, both groups of patients exhibited a significantly higher degree of behavioral disorders as compared to healthy subjects, where AD patients experienced delusions, hallucinations, agitation, euphoria, disinhibition, irritability and apathy, while MCI patients experienced anxiety and irritability. Patients with AD had a poor quality of life compared to healthy subjects, whereas people with MCI did not. As for the parameters of DTI, AD patients had decrease of FA and increase of MD, RD, and DA compared to the healthy subjects in the multiple white matter tracts: anterior limb of internal capsule, anterior part of corona radiata, the body of the corpus callosum, cingulum, external capsule, fornix- striae terminalis, genu of the corpus callosum, inferior frontal-occipital fasciculus, posterior corona radiata, superior frontal-occipital fasciculus, superior longitudinal fasciculus and fasciculus uncinatus. Patients with MCI had decreased FA and increased MD, RD and DA in the fornix compared to healthy subjects. In AD patients, there was significant association between microstructural white matter brain damage and all cognitive domains, except domain reasoning, while in patients with MCI significant association was evident between microstructural white matter damage and all cognitive domains, except the domain of executive function. Results related to the microstructural white matter brain damage in mild AD indicates that wide neural network is significantly damaged at the earliest clinical stages of the disease, while in MCI stage only fornix shows microstructural white matter brain damage. Level of impairment of verbal memory, delayed recall and language correlates more frequently in MCI group compared to mild AD group, where impairment in the field of visual memory, immediate recall, attention, working memory and visuospatial and construction abilities correlates more frequently with white matter brain damage. Association of depressive symptoms and white matter brain damage was significant in MCI patients. Conclusion: In mild AD, cognitive impairment is present in all cognitive domains; patients experience more depressive symptoms and wider spectrum of behavioral disorders with compromised quality of life compared to healthy subjects. In MCI patients, cognitive impairment is present in more than half of the assessed cognitive functions; patients also experience more depressive symptoms, as well as anxiety and irritability without quality of life deterioration compared to healthy subjects. Results related to the microstructural white matter brain damage in mild AD indicates that wide neural network is significantly damaged at the earliest clinical stages of the disease, while in MCI stage only fornix shows microstructural white matter brain damage. Level of impairment of verbal memory, delayed recall and language correlates more frequently in MCI group compared to mild AD group, where impairment in the field of visual memory, immediate recall, attention, working memory and visuospatial and construction abilities correlates more frequently with white matter brain damage. The degree of depression correlated significantly with white matter brain damage solely at the level of MCI.</p>
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Neuropsychological predictors of treatment outcome in obsessive compulsive disorder (OCD)Motaghi, Mohammad Javad 08 1900 (has links)
No description available.
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Day Master - Redesigning a planning board for people with cognitive disorder / Day Master – Omdesign av en planeringstavla för personer med kognitiv funktionsnedsättningBygge, Mattias, Strand, Sofie January 2019 (has links)
In assistive technology, there are mainly two different users that needs to be taken into account when developing products. The first, and most important, is the end-user who requires the product in order to function and live a normal life. The second is the support person who, for some products, needs to assist the end-user by preparing it to be used. This report presents the master thesis project conducted by Mattias Bygge and Sofie Strand at KTH Royal Institute of Technology in Stockholm. The client was Abilia, a company that research, develop, manufacture and sell assistive technology to people with impairments. This main goal of this project was to redesign a cognitive planning board. The product is used as a visual aid by people who has difficulties in planning daily activities and keeping track of time. In order to develop the product in a suitable way, a literature study and interviews with Abilia’s employees laid the foundation for the user studies that were conducted with end-users and support people. Several concepts were generated and five were evaluated against the original product and presented to the company. The two concepts that received the highest ranking, (1) Extra Hours and (2) Extra Hours Bistable, were further investigated and were eventually developed into one single hybrid concept. The final design proposal is Day Master, a flexible planning board intended for people with a cognitive impairment that impedes their ability to plan daily activities and keep track of time. The product visually displays time and weekdays by using coloured LED lights, which support people may program without difficulty to fit the end-user’s preference. The amount of hours is changeable with a range of 12-18 hours of daytime and with the remaining hours distributed to night-time. The accessories that have been developed for this products are a simple protective cover, and two holders, one for images and one for whiteboard markers. All accessories attaches to the planning board with magnets. / I hjälpmedelsteknologi är det fler än en användare som man måste ta hänsyn till när man utvecklar produkter. Den första och viktigaste är slutanvändaren som är den som behöver produkten i vardagen för att kunna leva ett någorlunda normalt liv. Den andra är stödpersonen som i många fall är den som förbereder produkten för användning av slutanvändaren. Denna rapport presenterar masterexamensarbetet utfört av Mattias Bygge och Sofie Strand på KTH Kungliga Tekniska Högskola i Stockholm. Kunden för projektet var Abilia, ett företag som utvecklar, tillverkar, och säljer hjälpmedel till personer med funktionsnedsättning. Målet med detta projekt var att omdesigna deras kognitiva planeringstavla. Produkten används som ett visuellt hjälpmedel av personer som har problem med tidsuppfattning och planering av aktiviteter. Projektet inleddes genom en literaturstudie och intervjuer med personal på Abilia. Detta lade grunden för användarstudierna där både slutanvändare och stödpersoner deltog. Utifrån användarstudierna så genererades ett flertal koncept varav fem stycken evaluerades mot original produkten och som presenterades för företaget under en delpresentation. De två koncept som erhöll högsta ranking i evalueringen var (1) Extra Hours och (2) Extra Hours Bistable. Koncepten undersöktes ytterligare och kom slutligen att kombineras till ett gemensamt koncept. Det slutgiltiga designförslaget är Day Master, en flexibel planeringstavla som riktar sig mot personer med en kognitiv funktionsnedsättning som försvårar för dem att hålla koll på tiden och planera aktiviteter. Produkten visar tid och veckodagar visuellt med hjälp av färgade LED lampor som stödpersonerna lätt och intuitivt kan programmera för att passa slutanvändarens individuella behov. Day Master ger möjligheten att själv bestämma antalet timmar som distribueras mellan dag och natt. Den har ett spann på 12-18 timmar för dagtid och återstående timmar läggs på natttid. Tillbehören som har utvecklats för denna produkt är ett enkelt magnetiskt plastskydd och två stycken olika ställ, ett för bilder och ett för whiteboardpennor. Alla tillbehör fästs på whiteboardtavlan med hjälp av magneter.
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[pt] EFEITOS DA EXPOSIÇÃO PRÉ-NATAL AO ÁLCOOL DURANTE O DESENVOLVIMENTO DO SISTEMA NERVOSO CENTRAL: FOCO EM ESTUDOS PRÉCLÍNICOS E CLÍNICOS / [en] EFFECTS OF PRENATAL ALCOHOL EXPOSURE DURING THE DEVELOPMENT OF THE CENTRAL NERVOUS SYSTEM: FOCUS ON PRECLINICAL AND CLINICAL STUDIESMARTINA VIRAG KOVACS 28 April 2023 (has links)
[pt] O consumo de álcool durante gravidez pode alterar o desenvolvimento neural do feto,
causando defeitos ao longo da vida. As consequências são diversas e compõe o termo
coletivo: Transtorno do Espectro Alcoólico Fetal (TEAF). Esse transtorno é considerado
a causa mais comum de deficiência cognitiva evitável no mundo. Estimativas apontam
que no Brasil entre 1 e 1,5% das crianças nascem com alterações no sistema nervoso
devido à exposição ao álcool in útero. O consumo do álcool é frequente entre mulheres
grávidas muitas vezes por desconhecimento dos seus efeitos adversos no
desenvolvimento do feto. Outra droga comumente utilizada por mulheres grávidas é a
maconha com intuito de amenizar o enjoo durante a gestação. A presente dissertação
explora os efeitos da exposição pré-natal ao álcool no feto (em conjunto ou não do uso da
maconha) em estudos pré-clínicos e clínicos. Dois artigos foram gerados para a realização
deste trabalho. O primeiro artigo relata os mecanismos e as consequências do consumo
simultâneo de álcool e maconha durante gravidez, cujo efeito é ainda mais nocivo ao
desenvolvimento do feto do que apenas a exposição ao álcool. Dados recentes
demonstram a interação do etanol e da maconha com o sistema Endocanabinoide, que
tem um papel importante no neurodesenvolvimento. Depois do fechamento do tubo
neural, que acontece durante a terceira semana da gestação humana, os olhos e o cérebro
se desenvolvem do neuroepitélio. Ambos, o álcool e maconha interferem sinergicamente
nesse processo via receptores canabinóides, alterando assim a sinalização “sonichedgehog”,
que por sua vez, resulta em alterações morfológicas e comportamentais em
modelos animais. Além disso, o artigo relata os mais recentes achados de estudos clínicos
sobre a combinação da dose e tipo de constituintes químicos da machonha, bem como os
desfechos morfológicos e neurocomportamentais da exposição conjunta do álcool e da
maconha. O segundo artigo é uma revisão sistemática que investiga as pesquisas
realizadas no Brasil sobre o TEAF, com ênfase nos instrumentos usados para a avaliação
neuropsicológica de indivíduos com TEAF. Enquanto países desenvolvidos têm décadas
de pesquisa sobre o TEAF, no Brasil, inúmeros fatores comprometem o progresso nesta e outras áreas de pesquisa. Entre esses fatores podemos citar, divergências
socioeconômicas, culturais e geopolíticas, que dificultam o desenvolvimento, adaptação
e validação de instrumentos utilizados no diagnóstico e na avaliação neuropsicológica do
TEAF. Além disso, vale ressaltar que a vulnerabilidade socioeconômica da população
brasileira é um fator importante no aumento da ocorrência de formas mais graves de
TEAF. A revisão sistemática aponta para a necessidade da validação das ferramentas
neuropsicológicas de diagnóstico e avaliação cognitiva de pessoas com TEAF e da
participação de uma equipe multidisciplinar no diagnóstico do TEAF. / [en] Alcohol consumption during pregnancy may damage the development of the fetus, resulting
in the most common preventable cause of neurodevelopmental disability in the world: Fetal
Alcohol Spectrum Disorders (FASD). The present dissertation aims to discuss the effects of
alcohol on the developing CNS through two articles. The first article elucidates the
mechanisms and outcomes of the combined alcohol and cannabis exposure in the offspring
through preclinical studies. Alcohol teratogenesis is more potent when administered with
cannabis and has more negative effects on the fetus than alcohol alone. Recent data
demonstrate the interaction of ethanol and cannabis with the Endocannabinoid system,
which plays an important role in neurodevelopment and explains the morphological and
behavioral changes seen in preclinical studies. The second article is a systematic review that
investigates Brazilian research on FASD, focusing on the instruments used for the
neuropsychological assessment of individuals with FASD. While developed countries have
decades of research on FASD, in Brazil numerous factors slow down the progress of in this
and other areas of research. Socioeconomic status, cultural, and geopolitical divergences are
some of these factors, which hinder the development, adaptation, and validation of
instruments used in the diagnosis and neuropsychological assessment of FASD. In addition,
it is worth noting that the socioeconomic vulnerability of the Brazilian population is an
important factor in the increase in the occurrence of more severe forms of FASD. The
systematic review points to the need to validate neuropsychological tools for the diagnosis
and cognitive assessment of individuals with FASD in Brazil, and the participation of a
multidisciplinary team in the diagnosis of FASD.
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Day Master - Redesigning a planning board for people with cognitive disorder. / Day Master – Omdesign av en planeringstavla för personer med kognitiv funktionsnedsättning.BYGGE, MATTIAS, STRAND, SOFIE January 2019 (has links)
In assistive technology, there are mainly two different users that needs to be taken into account when developing products. The first, and most important, is the end-user who requires the product in order to function and live a normal life. The second is the support person who, for some products, needs to assist the end-user by preparing it to be used. This report presents the master thesis project conducted by Mattias Bygge and Sofie Strand at KTH Royal Institute of Technology in Stockholm. The client was Abilia, a company that research, develop, manufacture and sell assistive technology to people with impairments. This main goal of this project was to redesign a cognitive planning board. The product is used as a visual aid by people who has difficulties in planning daily activities and keeping track of time. In order to develop the product in a suitable way, a literature study and interviews with Abilia’s employees laid the foundation for the user studies that were conducted with end-users and support people. Several concepts were generated and five were evaluated against the original product and presented to the company. The two concepts that received the highest ranking, (1) Extra Hours and (2) Extra Hours Bistable, were further investigated and were eventually developed into one single hybrid concept. The final design proposal is Day Master, a flexible planning board intended for people with a cognitive impairment that impedes their ability to plan daily activities and keep track of time. The product visually displays time and weekdays by using coloured LED lights, which support people may program without difficulty to fit the end-user’s preference. The amount of hours is changeable with a range of 12-18 hours of daytime and with the remaining hours distributed to night-time. The accessories that have been developed for this products are a simple protective cover, and two holders, one for images and one for whiteboard markers. All accessories attaches to the planning board with magnets. / I hjälpmedelsteknologi är det fler än en användare som man måste ta hänsyn till när man utvecklar produkter. Den första och viktigaste är slutanvändaren som är den som behöver produkten i vardagen för att kunna leva ett någorlunda normalt liv. Den andra är stödpersonen som i många fall är den som förbereder produkten för användning av slutanvändaren. Denna rapport presenterar masterexamensarbetet utfört av Mattias Bygge och Sofie Strand på KTH Kungliga Tekniska Högskola i Stockholm. Kunden för projektet var Abilia, ett företag som utvecklar, tillverkar, och säljer hjälpmedel till personer med funktionsnedsättning. Målet med detta projekt var att omdesigna deras kognitiva planeringstavla. Produkten används som ett visuellt hjälpmedel av personer som har problem med tidsuppfattning och planering av aktiviteter. Projektet inleddes genom en literaturstudie och intervjuer med personal på Abilia. Detta lade grunden för användarstudierna där både slutanvändare och stödpersoner deltog. Utifrån användarstudierna så genererades ett flertal koncept varav fem stycken evaluerades mot original produkten och som presenterades för företaget under en delpresentation. De två koncept som erhöll högsta ranking i evalueringen var (1) Extra Hours och (2) Extra Hours Bistable. Koncepten undersöktes ytterligare och kom slutligen att kombineras till ett gemensamt koncept. Det slutgiltiga designförslaget är Day Master, en flexibel planeringstavla som riktar sig mot personer med en kognitiv funktionsnedsättning som försvårar för dem att hålla koll på tiden och planera aktiviteter. Produkten visar tid och veckodagar visuellt med hjälp av färgade LED lampor som stödpersonerna lätt och intuitivt kan programmera för att passa slutanvändarens individuella behov. Day Master ger möjligheten att själv bestämma antalet timmar som distribueras mellan dag och natt. Den har ett spann på 12-18 timmar för dagtid och återstående timmar läggs på natttid. Tillbehören som har utvecklats för denna produkt är ett enkelt magnetiskt plastskydd och två stycken olika ställ, ett för bilder och ett för whiteboardpennor. Alla tillbehör fästs på whiteboardtavlan med hjälp av magneter.
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