Benign focal seizures of adolescence and neuropsychological findings in patients from community

RATIONALE: Benign focal seizures of adolescence (BFSA) described by Loiseau et al in 1972, is considered a rare entity, but maybe underdiagnosed. Although mild neuropsychological deficits have been reported in patients with benign epilepsies of childhood, these evaluations have not so far been described in BFSA. The aim of this study is to evaluate neuropsychological functions in BFSA with new onset seizures (<12 months). METHODS: Eight patients with BFSA (according to Loiseau et al, 1972, focal or secondarily tonic clonic generalized seizures between the ages of 10-18 yrs., normal neurologic examination, normal EEG or with mild focal abnormalities) initiated in the last 12 months were studied between July 2008 to May 2009. They were referred from the Pediatric Emergency Section of the Hospital Universitário of the University of Sao Paulo, a secondary care regionalized facility located in a district of middle-low income in Sao Paulo city, Brazil. The study was approved by the Ethics Committee of the Institution. All patients performed neurological, EEG, brain CT and neuropsychological evaluation which consisted of Raven's Special Progressive Matrices - General and Special Scale (according to different ages), Wechsler Children Intelligence Scale-WISC III with ACID Profile, Trail Making Test A/B, Stroop Test, Bender Visuo-Motor Test, Rey Complex Figure, Rey Auditory Verbal Learning Test-RAVLT, Boston Naming Test, Fluency Verbal for phonological and also conceptual patterns - FAS/Animals and Hooper Visual Organization Test. For academic achievement, we used a Brazilian test for named "Teste do Desempenho Escolar", which evaluates abilities to read, write and calculate according to school grade. RESULTS: There were 2 boys and 6 girls, with ages ranging from 10 yrs. 9 m to 14 yrs. 3 m. Most (7/8) of the patients presented one to two seizures and only three of them received antiepileptic drugs (AEDs). Six had mild EEG focal abnormalities and all had normal brain CT. All were literate, attended regular public schools and scored in a median range for IQ, and seven showed discrete higher scores for the verbal subtests. There were low scores for attention in different modalities in six patients, mainly in alternated attention as well as inhibitory subtests (Stroop test and Trail Making Test part B). Four of the latter cases who showed impairment both in alternated and inhibitory attention were not taking AEDs. Visual memory was impaired in five patients (Rey Complex Figure). Executive functions analysis showed deficits in working memory in five, mostly observed in Digits Indirect Order and Arithmetic tests (WISC III). Reading and writing skills were below the expected average for school grade in six patients according to the achievement scholar performance test utilized. One patient of this series who had the best scores in all tests was taking phenobarbital. CONCLUSIONS: Neuropsychological imbalance between normal IQ and mild dysfunctions such as in attention domain and in some executive abilities like working memory and planning, as well as difficulties in visual memory and in reading and writing, were described in this group of patients with BFSA from community. This may reflect mild higher level neurological dysfunctions in adolescence idiopathic focal seizures probably caused by an underlying dysmaturative epileptogenic process. Although academic problems often have multiple causes, a specific educational approach may be necessary in these adolescents, in order to improve their scholastic achievements, helping in this way, to decrease the stigma associated to epileptic seizures in the community.

Categorization skills and recall in brain damaged children: a multiple case study

During development, children become capable of categorically associating stimuli and of using these relationships for memory recall. Brain damage in childhood can interfere with this development. This study investigated categorical association of stimuli and recall in four children with brain damages. The etiology, topography and timing of the lesions were diverse. Tasks included naming and immediate recall of 30 perceptually and semantically related figures, free sorting, delayed recall, and cued recall of the same material. Traditional neuropsychological tests were also employed. Two children with brain damage sustained in middle childhood relied on perceptual rather than on categorical associations in making associations between figures and showed deficits in delayed or cued recall, in contrast to those with perinatal lesions. One child exhibited normal performance in recall despite categorical association deficits. The present results suggest that brain damaged children show deficits in categorization and recall that are not usually identified in traditional neuropsychological tests.

Avaliação da memória de trabalho em crianças com transtorno do déficit de atenção e hiperatividade

Esse projeto investigou as habilidades cognitivas da Memória de Trabalho de crianças e adolescentes com o “Transtorno do Déficit de Atenção e Hiperatividade” (TDAH). Foi aplicado teste TIHC - Teste Infantil de Habilidades Cognitivas informatizado, avaliando principalmente cinco habilidades cognitivas Raciocínio Indutivas (RI), Memória de Armazenamento Auditiva (MAA) e Visual e Memória de Trabalho Auditiva (MTA) e Visual (MTV) usando o modelo de Cattell-Horn-Carroll. O teste foi aplicado em 62 sujeitos sendo 32 com TDAH do Hospital das Clínicas-SEPIA-USP e 30 sujeitos controle “normal” do Ensino Fundamental da rede municipal de 1ª à 8ª séries com idades entre 7 e 15 anos, de ambos os sexos. As análises executadas indicaram a existência de diferenças em diversos aspectos relacionados à memória nos tipos peculiares de crianças com TDAH. Verificou-se que as crianças com TDAH obtiveram bom desempenho nas provas de memória visual em detrimento as provas de memória auditiva. A correlação dos resultados do TIHC verificara que o tempo de reação da prova de memória de armazenamento visual manteve uma correlação significativa com a prova de cálculo.

A reabilitação neuropsicológica sob a ótica da psicologia comportamental

CONTEXTO: A reabilitação neuropsicológica é um dos componentes do tratamento de clientes* com lesões cerebrais e/ou distúrbios neurológicos e neuropsiquiátricos. Os programas de reabilitação podem se beneficiar do emprego de procedimentos** comportamentais, principalmente porque a ciência da análise do comportamento dispõe de ferramentas valiosas para a modificação do comportamento e o auxílio nos processos de aprendizagem. OBJETIVOS: Este artigo objetiva discursar sobre a interação entre as áreas de reabilitação neuropsicológica e análise do comportamento. MÉTODOS: Inicia-se esta empreitada apresentando o que é a reabilitação neuropsicológica, passando pela clarificação do emprego de procedimentos comportamentais tanto na avaliação como na reabilitação neuropsicológicas e quais os cuidados necessários na preparação de um programa. RESULTADOS: Objetiva-se, assim, despertar o interesse pelo desenvolvimento de novos estudos neste vasto campo e chamar a atenção dos neuropsicólogos para a importância da aquisição de conhecimentos básicos em análise do comportamento. CONCLUSÃO: Isso parece ser conseqüência não da escassez de estudos sobre o emprego de procedimentos comportamentais em programas de reabilitação neuropsicológica, mas sim da falta de percepção, por parte dos profissionais de reabilitação, de que muitos procedimentos por eles empregados são comportamentais. Ou pode ainda refletir um desconhecimento sobre a existência da vertente da neuropsicologia comportamental, ou ainda ser apenas reflexo dos preconceitos de que a análise do comportamento é alvo.

Short Cognitive Performance Test: Diagnostic Accuracy and Education Bias in Older Brazilian Adults

The ""Short Cognitive Performance Test"" (Syndrom Kurztest, SKT) is a cognitive screening battery designed to detect memory and attention deficits. The aim of this study was to evaluate the diagnostic accuracy of the SKT as a screening tool for mild cognitive impairment (MCI) and dementia. A total of 46 patients with Alzheimer`s disease (AD), 82 with MCI, and 56 healthy controls were included in the study. Patients and controls were allocated into two groups according to educational level (< 8 years or > 8 years). ROC analyses suggested that the SKT adequately discriminates AD from non-demented subjects (MCI and controls), irrespective of the education group. The test had good sensitivity to discriminate MCI from unimpaired controls in the sub-sample of individuals with more than 8 years of schooling. Our findings suggest that the SKT is a good screening test for cognitive impairment and dementia. However, test results must be interpreted with caution when administered to less-educated individuals.

Use of peripheral vision in the interception of moving targets

Use of peripheral vision to organize and reorganize an interceptive action was investigated in young adults. Temporal errors and kinematic variables were evaluated in the interception of a virtual moving target, in situations in which its initial velocity was kept unchanged or was unexpectedly decreased. Observation of target approach was made through continuous visual pursuit (focal vision) or keeping visual focus at the origin of the trajectory or at the contact spot (peripheral vision). Results showed that visual focus at the contact spot led to temporal errors similar to focal vision, although showing a distinct kinematic profile, while focus at the origin led to an impoverished performance

How Much Older Do You Get When a Wrinkle Appears on Your Face? Modifying Age Estimates by Number of Wrinkles

The present study investigated the influence of wrinkles on facial age judgments. In Experiment 1, preadolescents, young adults, and middle-aged adults made categorical age judgments for male and female faces. The qualitative (type of wrinkle) and quantitative (density of wrinkles and depth of furrows) contributions of wrinkles were analyzed. Results indicated that the greater the number of wrinkles and the depth of furrows, the older a face was rated. The roles of the gender of the face and the age of the participants were discussed. In Experiment 2, participants performed relative age judgments by comparing pairs of faces. Results revealed that the number of wrinkles had more influence on the perceived facial age than the type of wrinkle. A MDS analysis showed the main dimensions on which participants based their judgments, namely, the number of wrinkles and the depth of furrows. We conclude that the quantitative component is more likely to increase perceived facial age. Nevertheless, other variables, such as the gender of the face and the age of the participants, also seem to be involved in the age estimation process.

Cancellation task in very low educated people

Cancellation tasks have been largely used to evaluate visuospatial function and attention. Cognitive evaluation of low literacy subjects remains a challenge in developing countries, when it becomes necessary to distinguish between what is pathological and what is biased by low education. Performance of river bank dwellers of the Amazon region was studied, in a structured nonverbal cancellation task, verifying their searching strategies (randomized/organized), time of completion, number of correct cancelled targets and number of false-positive targets. A difference was observed in performance and searching strategies between illiterates and literates with only a few years of schooling (mean= 0.8, S.D.=1.6 years of education) across all measures. There was a significant difference between literate groups in the searching strategy, as well as between illiterates who had never attended school and those who had, showing that a minimal contact with graphic presentations and organization of writing was able to modify this cognitive function. (C) 2007 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.

The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility

Substance-dependence is highly associated with executive cognitive function (ECF) impairments. However. considering that it is difficult to assess ECF clinically, the aim of the present study was to examine the feasibility of a brief neuropsychological tool (the Frontal Assessment Battery FAB) to detect specific ECF impairments in a sample of substance-dependent individuals (SDI). Sixty-two subjects participated in this study. Thirty DSM-IV-diagnosed SDI, after 2 weeks of abstinence, and 32 healthy individuals (control group) were evaluated with FAD and other ECF-related tasks: digits forward (DF), digits backward (DB), Stroop Color Word Test (SCWT), and Wisconsin Card Sorting Test (WCST). SDI did not differ from the control group on sociodemographic variables or IQ. However, SDI performed below the controls in OF, DB, and FAB. The SDI were cognitively impaired in 3 of the 6 cognitive domains assessed by the FAB: abstract reasoning, motor programming, and cognitive flexibility. The FAB correlated with DF, SCWT, and WCST. In addition, some neuropsychological measures were correlated with the amount of alcohol, cannabis, and cocaine use. In conclusion, SDI performed more poorly than the comparison group on the FAB and the FAB`s results were associated with other ECF-related tasks. The results suggested a negative impact of alcohol, cannabis, and cocaine use on the ECF. The FAB may be useful in assisting professionals as an instrument to screen for ECF-related deficits in SDI. (C) 2010 Elsevier Ltd. All rights reserved.

Cognitive functioning in subjects with recent-onset psychosis from a low-middle-income environment: Multiple-domain deficits and longitudinal evaluation

Cognitive deficits are a key feature of recent-onset psychosis, but there is no consensus on whether such deficits are generalized or confined to specific domains. Besides, it is unclear whether cognitive deficits: a) are found in psychotic patients in samples from outside high-income countries; and b) whether they progress uniformly over time in schizophrenia and affective psychoses. We applied 12 tests organized into eight cognitive domains, comparing psychosis patients (n = 56, time from initial contact = 677.95+/-183.27 days) versus healthy controls (n = 70) recruited from the same area of Sao Paulo, Brazil. Longitudinal comparisons (digit span and verbal fluency) were conducted between a previous assessment of the subjects carried out at their psychosis onset, and the current follow-up evaluation. Psychosis patients differed significantly from controls on five domains, most prominently on verbal memory. Cognitive deficits remained detectable in separate comparisons of the schizophrenia subgroup and, to a lesser extent, the affective psychosis subjects against controls. Longitudinal comparisons indicated significant improvement in schizophrenia, affective psychoses, and control subjects, with no significant group-by-time interactions. Our results reinforce the view that there are generalized cognitive deficits in association with recent-onset psychoses, particularly of non-affective nature, which persist over time. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Psychometric characteristics of the Rivermead Behavioural Memory Test (RBMT) as an early detection instrument for dementia and mild cognitive impairment in Brazil

Background: The Rivermead Behavioural Memory Test (RBMT) assesses everyday memory by means of tasks which mimic daily challenges. The objective was to examine the validity of the Brazilian version of the RBMT to detect cognitive decline. Methods: 195 older adults were diagnosed as normal controls (NC) or with mild cognitive impairment (MCI) or Alzheimer`s disease (AD) by a multidisciplinary team, after participants completed clinical and neuropsychological protocols. Results: Cronbach`s alpha was high for the total sample for the RBMT profile (PS) and screening scores (SS) (PS=0.91, SS=0.87) and for the AD group (PS=0.84, SS=0.85), and moderate for the MCI (PS=0.62, SS=0.55)and NC (PS=0.62, SS=0.60) groups. RBMT total scores, Appointment, Pictures, Immediate and Delayed Story, Immediate and Delayed Route, Delayed Message and Date contributed to differentiate NC from MCI. ROC curve analyses indicated high accuracy to differentiate NC from AD patients, and, moderate accuracy to differentiate NC from MCI. Conclusions: The Brazilian version of the RBMT seems to be an appropriate instrument to identify memory decline in Brazilian older adults.

Cross-cultural Adaptation, Reliability and Validity of the DAFS-R in a Sample of Brazilian Older Adults

The Direct Assessment of Functional Status-Revised (DAFS-R) is an instrument developed to objectively measure functional capacities required for independent living. The objective of this study was to translate and culturally adapt the DAFS-R for Brazilian Portuguese (DAFS-BR) and to evaluate its reliability and validity. The DAFS-BR was administered to 89 older patients classified previously as normal controls, mild cognitive impairment (MCI) and Alzheimer`s disease (AD). The results indicated good internal consistency (Cronbach`s alpha = 0.78) in the total sample. The DAFS-BR showed high interobserver reliability (0.996; p < .001) as well as test-retest stability over 1-week interval (0.995; p < .001). Correlation between the DAFS-BR total score and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was moderate and significant (r = -.65, p < .001) in the total sample, whereas it did not reach statistical significance within each diagnostic group. Receiver operating characteristic curve analyses suggested that DAFS-BR has good sensitivity and specificity to identify MCI and AD. Results suggest that DAFS-BR can document degrees of severity of functional impairment among Brazilian older adults.

Profiles of functional deficits in mild cognitive impairment and dementia: benefits from objective measurement

The magnitude Of functional impairment that may indicate the threshold between MCI and incipient Alzheimer`s disease (AD) has not been clearly defined. The objective was to examine the pattern of functional impairment in the continuum MCI-AD. Eighty-nine older adults (32 cognitively unimpaired, 31 MCI, and 26 AD patients) were examined with the Brazilian version of the Direct Assessment of Functional Status (DAFS-BR) at a University-based memory clinic. MCI patients were sub-divided according to the progression to AD upon follow-up, and had baseline cognitive, functional and biological variables analyzed. MCI patients displayed mild deficits in functional abilities, with intermediate scores as compared to controls and AD. The DAFS-BR items that differentiated MCI from controls involved the ability to deal with finances and shopping skills. At baseline, scores obtained by MCI patients who converted to AD were not significantly different from scores of nonconverters. The magnitude of functional deficits was associated with AD-like pathological findings in the CSF. In conclusion, MCI patients present with early functional changes in complex, instrumental abilities that require the integrity of memory and executive functions. The objective measurement of the functional state may help identify older adults with increased risk of developing dementia in the MCI-AD continuum. (JINS, 2010, 16, 297-305.)

Frontal Assessment Battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users

Background: Cannabis is the most used illicit drug in the world, and its use has been associated with prefrontal cortex (PFC) dysfunction, including deficits in executive functions (EF). Considering that EF may influence treatment outcome, it would be interesting to have a brief neuropsychological battery to assess EF in chronic cannabis users (CCU). In the present study, the Frontal Assessment Battery (FAB), a brief, easy to use neuropsychological instrument aimed to evaluate EF, was used to evaluate cognitive functioning of CCU. Methods: We evaluated 107 abstinent CCU with the FAB and compared with 44 controls matched for age, estimated IQ, and years of education. Results: CCU performed poorly as compared to controls (FAB total score = 16.53 vs. 17.09, p .05). CCU had also a poor performance in the Motor Programming subtest (2.47 vs. 2.73, p .05). Conclusion: This study examined effects of cannabis in executive functioning and showed evidence that the FAB is sensitive to detect EF deficits in early abstinent chronic cannabis users. Clinical significance of these findings remains to be investigated in further longitudinal studies. FAB may be useful as a screening instrument to evaluate the necessity for a complete neuropsychological assessment in this population.

Assessment of psychosocial adjustment in patients with temporal lobe epilepsy using a standard measure

Despite the growing evidence of poor psychosocial adjustment, at present there is no formal method of assessment of social adjustment in patients with temporal lobe epilepsy (TLE). First, we assessed social adjustment in patients with TLE using a self-report questionnaire and compared the results with those from quality-of-life (QOL) scales. Second, we verified the influence of cognitive performance and clinical variables of epilepsy on social adjustment and QOL We evaluated 35 people with TLE and 38 healthy controls. Patients had worse social adjustment, and it was correlated with worse perception of cognitive function. Attention and verbal memory dysfunctions were negatively correlated with social adjustment. However, there was no significant correlation between cognitive performance and QOL Regarding clinical variables, persons with left TLE showed worse social adjustment and patients with frequent seizures showed worse QOL These findings indicate the relevance of evaluating social adjustment and emphasize the importance of cognitive rehabilitation to improved social adjustment. (c) 2010 Elsevier Inc. All rights reserved.