Efecto del traumatismo craneoencefálico en la toma de decisiones sociales

The effect of traumatic brain injury on social decision making

INTRODUCTION. 

Patients with traumatic brain injury (TBI) can present difficulties in making decisions of a social nature. Such difficulties condition complicate their personal relationships. AIMS. To assess social decision-making in a sample of patients with moderate and severe TBI, and to empirically contrast if, as Ochsner’s social-emotional processing model proposes, the ability to recognize and respond to socio-affective stimuli is related to the ability to regulate sensitive responses to the context based on the proposed assessment tests.

SUBJECTS AND METHODS. 

Twenty-one patients with a moderate and severe TBI (experimental group) matched by gender, age and years of education with 24 healthy subjects (control group). Social decision making was measured through the Social Decision Making Test (SDMT), and the ability to recognize and respond to socio-affective stimuli through the Pictures of Facial Affect (PoFA) test.

RESULTS. 

Statistically significant differences in the SDMT were obtained between the experimental group and the control group. Regarding PoFA, the performance of the control group was also significantly better than that of the experimental group. However, no relationship was observed between the performance in the SDMT and the PoFA for any of the groups.

CONCLUSIONS. 

The SDMT seems to be a sensitive test to detect alterations in social decision making in patients with moderate or severe TBI. No relationship was observed between the results in the SDMT and the PoFA.

Vinculan la anemia durante el embarazo con una mayor probabilidad de autismo y TDAH en los niños

Association of Prenatal Maternal Anemia With Neurodevelopmental Disorders

Abstract

Importance  Given the critical role that iron plays in neurodevelopment, an association between prenatal iron deficiency and later risk of neurodevelopmental disorders, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability (ID), is plausible.

Objective  To test the a priori hypothesis that anemia diagnosed in mothers during pregnancy is associated with an increased risk of ASD, ADHD, and ID in offspring and that the magnitude of the risk varies with regard to the timing of anemia in pregnancy.

Design, Setting, and Participants  This cohort study used health and population register data from the Stockholm Youth Cohort to evaluate 532 232 nonadoptive children born from January 1, 1987, to December 31, 2010, in Sweden, with follow-up in health registers until December 31, 2016. Data analysis was performed from January 15, 2018, to June 20, 2018.

Exposures  Registered diagnoses of anemia during pregnancy. Gestational timing of the first recorded anemia diagnosis (≤30 weeks or >30 weeks) was considered to assess potential critical windows of development.

Main Outcomes and Measures  Registered diagnoses of ASD, ADHD, or ID or co-occurring combinations of these disorders.

Results  The cohort included 532 232 individuals (272 884 [51.3%] male) between 6 and 29 years of age at the end of follow-up (mean [SD] age, 17.6 [7.1] years) and their 299 768 mothers. The prevalence of ASD, ADHD, and ID was higher among children born to mothers diagnosed with anemia within the first 30 weeks of pregnancy (4.9% ASD, 9.3% ADHD, and 3.1% ID) compared with mothers with anemia diagnosed later in pregnancy (3.8% ASD, 7.2% ADHD, and 1.1% ID) or mothers not diagnosed with anemia (3.5% ASD, 7.1% ADHD, and 1.3% ID). Anemia diagnosed during the first 30 weeks of pregnancy but not later was associated with increased risk of diagnosis of ASD (odds ratio [OR], 1.44; 95% CI, 1.13-1.84), ADHD (OR, 1.37; 95% CI, 1.14-1.64), and ID (OR, 2.20; 95% CI, 1.61-3.01) in offspring in models that included socioeconomic, maternal, and pregnancy-related factors. Early anemia diagnosis was similarly associated with risk of ASD (OR, 2.25; 95% CI, 1.24-4.11) and ID (OR, 2.59; 95% CI, 1.08-6.22) in a matched sibling comparison. Considering mutually exclusive diagnostic groups, we observed the strongest association between anemia and ID without co-occurring ASD (OR, 2.72; 95% CI, 1.84-4.01). Associations of these disorders with anemia diagnosed later in pregnancy were greatly diminished.

Conclusions and Relevance  In contrast to maternal anemia diagnosed toward the end of pregnancy, anemia diagnosed earlier in pregnancy was associated with increased risk of the development of ASD, ADHD, and particularly ID in offspring. Given that iron deficiency and anemia are common among women of childbearing age, our findings emphasize the importance of early screening for iron status and nutritional counseling in antenatal care.

El cerebro tiene células madre capaces de generar neuronas después de nacer

Lineage Tracing and Cell Potential of Postnatal Single Progenitor Cells In Vivo

Summary

Understanding the contribution of adult neural progenitor cells (NPCs) and their lineage potential is a great challenge in neuroscience. To reveal progenitor diversity and cell-lineage relationships of postnatal NPCs in the subventricular zone (SVZ), we performed in vivo lineage-tracing genetic analysis using the UbC-StarTrack. We determined the progeny of single SVZ-NPCs, the number of cells per clone, the dispersion of sibling cells, and the cell types within clones. Long-term analysis revealed that both the cell-dispersion pattern and number of cells comprising clones varied depending on the glial/neuronal nature of sibling cells. Sibling-olfactory interneurons were primarily located within the same layer, while sibling-glial cells populated SVZ-adjacent areas. Sibling astrocytes and interneurons did not form big clones, whereas oligodendroglial-lineage clones comprised the largest clones originated in adult brains. These results demonstrate the existence of SVZ postnatal bipotential progenitors that give rise to clones widely dispersed across the olfactory bulb and SVZ-adjacent areas.

Graphical Abstract

Identifican tres categorías de genes implicados en la enfermedad de Alzheimer

Genome-wide association analysis of dementia and its clinical endophenotypes reveal novel loci associated with Alzheimer's disease and three causality networks: The GR@ACE project.

Abstract

Background Genetics plays a major role in Alzheimer’s Disease (AD). To date, 40 genes associated with AD have been identified, although most remain undiscovered. Clinical, neuropathological and genetic variability might impact genetic discoveries and complicate dissection of the biological pathways underlying AD.

Methods GR@ACE is a genome-wide study of dementia and its clinical endophenotypes that encompasses 4,120 cases and 3,289 controls from Spain. GR@ACE phenotypes were defined according to AD’s clinical certainty and the presence of vascular co-morbidity. To explore whether clinical endophenotypes reflect variation in underlying biological pathways, we first assessed the impact of known AD loci across endophenotypes to generate three loci categories. Next, we incorporated gene co-expression data and conducted pathway analysis on each category. To assess the impact of heterogeneity in the GWAS findings, the GR@ACE series were meta-analyzed with: 1) genotype-level data from dbGaP (N=21,235); and 2) summary statistics from IGAP Stages I and II (n=61,571 and n=81,455 respectively).

Findings We classified known AD loci in three categories, which might reflect the disease clinical heterogeneity, from vascular and mixed forms to pure AD pathology. Immune system pathways were detected in all categories. Intriguingly, vascular processes were only detected as a causal mechanism in probable AD. A meta-analysis of GR@ACE with additional GWAS datasets revealed the ANKRD31-rs4704171 signal in the HMGCR genomic region. We confirmed NDUFAF6-rs10098778 and SCIMP-rs7225151, which were previously detected by IGAP, to be suggestive signals. We also confirmed CD33-rs3865444 to be genome-wide significant.

Interpretation The regulation of vasculature is a prominent causal component of probable AD. In that context, cerebral amyloid angiopathy, the unique identified link between the vascular and amyloid hypotheses, deserves further investigation. The GR@ACE meta-analysis revealed novel AD genetic signals. GWAS results are strongly driven by the presence of clinical heterogeneity in the AD series.

Funding Grifols SA, Fundación bancaria “La Caixa”, Fundació ACE and ISCIII (Instituto de Salud Carlos III).

Profunda degeneración de las neuronas que promueven la vigilia en la enfermedad de Alzheimer

Profound degeneration of wake‐promoting neurons in Alzheimer's disease

Abstract

Introduction

Sleep‐wake disturbances are a common and early feature in Alzheimer's disease (AD). The impact of early tau pathology in wake‐promoting neurons (WPNs) remains unclear.

Methods

We performed stereology in postmortem brains from AD individuals and healthy controls to identify quantitative differences in morphological metrics in WPNs. Progressive supranuclear palsy (PSP) and corticobasal degeneration were included as disease‐specific controls.

Results

The three nuclei studied accumulate considerable amounts of tau inclusions and showed a decrease in neurotransmitter‐synthetizing neurons in AD, PSP, and corticobasal degeneration. However, substantial neuronal loss was exclusively found in AD.

Discussion

WPNs are extremely vulnerable to AD but not to 4 repeat tauopathies. Considering that WPNs are involved early in AD, such degeneration should be included in the models explaining sleep‐wake disturbances in AD and considered when designing a clinical intervention. Sparing of WPNs in PSP, a condition featuring hyperinsomnia, suggest that interventions to suppress the arousal system may benefit patients with PSP.

Un número considerable de personas que padecen dolores de cabeza pueden experimentar dolor facial

Facial presentations of migraine, TACs, and other paroxysmal facial pain syndromes

Abstract

Objective
To assess the prevalence of facial pain (V2 and/or V3) presentations among nearly 3,000 patients with headache treated in a university tertiary care center.
Methods
Between 2010 and 2018, we routinely assessed the prevalence of facial pain presentations of all patients with primary headaches.
Results
Of 2,912 patient datasets, 291 patients reported facial pain either as an independent or as an additional symptom. Among patients with migraine, 2.3% (44 of 1,935) reported a facial involvement, most commonly in V2. Of these, 18 patients (40.9%) experienced the pain predominantly in the face. In patients with cluster headache, 14.8% (42 of 283) reported a facial involvement, of which 31.0% perceived the pain predominantly in the face. A facial involvement was seen in 45.0% of patients with paroxysmal hemicrania (9 of 20), 21.4% of patients with hemicrania continua (9 of 42), and 20.0% of patients with short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (3 of 15). In addition, we present 6 patients who reported a constant side-locked facial pain with superseded well-defined facial pain attacks of 10- to 30-minute duration that appeared several times per day.
Conclusion
Our data suggest that a facial involvement in primary headaches is infrequent but not uncommon. A sole facial presentation of primary headache symptomatology seems to be exceptionally rare. We describe 3 different types of facial pain involvement and, in this context, distinguish patients with paroxysmal orofacial pain syndromes that have not been previously described. These patients may represent a new entity that could tentatively be called constant unilateral facial pain with added attacks.

Efectos de la realidad virtual sobre el equilibrio y la marcha en el ictus

Effects of virtual reality on balance and gait in stroke: a systematic review and meta-analysis

INTRODUCTION. Stroke is the leading cause of disability in adulthood. Recently the improvement of virtual reality technologies has been used in the rehabilitation of stroke patients.

AIM. To review published research literature on the effects of the virtual reality interventions vs conventional therapy on balance and gait in stroke.

PATIENTS AND METHODS. A systematic and a meta-analysis of randomized controlled trials was performed during March 2018 in the databases: PubMed, PEDro, Web of Science, Scopus, Cochrane Library and Medline at EBSCO. The selection criteria were: randomized controlled trials published in English or Spanish during the past ten years. The PEDro scale evaluated the quality of the methods used in the studies. A total of 14 clinical trials were included in the systemic review, of which 10 contributed information to the meta-analysis.

RESULTS. Favourable results were found on balance (Berg Balance Scale: standardized mean difference, SMD = -1.89; 95% CI: -2.72 to -1.07; Timed Up & Go, SMD: 1.42; 95% CI: 1.03-1.81), and gait (GaitRite platform: cadence, SMD: -1.51, 95% CI: -2.05 to -0.97; step length, SMD: -1.63, 95% CI: -2.18 to -1.08; stride length, SMD: -1.63, 95% CI: -2.18 to -1.08; velocity, SMD: -1.58, 95% CI: -2.97 to -0.18). CONCLUSION. The results show the potential benefit of virtual reality interventions to recover balance and gait after stroke.

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Keywords Balance Gait Rehabilitation Stroke

Virtual reality

Déficits en el reconocimiento facial de emociones y trastornos neurológicos

Facial emotion recognition in neurological disorders: a narrative review

Facial emotion recognition refers to a person’s interpretation of facial features of another to identify a particular emotional state. It is essential in human evolution and encompasses distinct neural networks. Facial emotion recognition is altered in most neurodegenerative diseases, but literature just focus on single neurological pathologies or limited comparison with psychiatric pathologies. It is unknown if a common pattern of affection through pathologies exists or if facial emotion recognition changes according to the underlying pathology. This review discusses its development in healthy population, synthesizes facial emotion recognition studies regarding most common neurological diseases, as well as most relevant findings in neuroimaging and current treatments. Facial emotion recognition, especially negative emotions, is altered in all described neurodegenerative diseases and could constitutes an early marker of cognitive deterioration.

Síntomas de depresión podrían ser parte de las etapas preclínicas de demencia

Longitudinal Association of Depression Symptoms With Cognition and Cortical Amyloid Among Community-Dwelling Older Adults

Abstract

Importance  Depressive symptoms are prevalent among older adults and may be early manifestations of Alzheimer disease (AD) before onset of mild cognitive impairment. However, it remains unclear whether worsening depressive symptoms in the presence of AD pathology are associated with cognitive decline in older adults.

Objective  To determine the longitudinal association between depressive symptoms, cognition, and cortical amyloid in community-dwelling older adults.

Design, Setting, and Participants  Participants from the Harvard Aging Brain Study, a cohort study, underwent annual assessments of depression and cognition and baseline cortical amyloid measurement (mean, 4.42 years; range, 2-7 years). Data collection was from September 2010 to August 2017 in a convenience sample of community-dwelling adults (276 participants, all cognitively unimpaired) with at most mild depression at entry.

Main Outcomes and Measures  Depression (Geriatric Depression Scale [GDS]), cognition (Preclinical Alzheimer Cognitive Composite [PACC]), and a continuous measure of cortical amyloid (Pittsburgh Compound-B positron emission tomography imaging). Change in GDS and baseline amyloid were examined as interactive predictors of PACC decline in a linear mixed model with backward elimination, adjusting for age, sex, and education.

Results  Participants were 164 women and 112 men (mean [SD] age, 73.5 [6.0] years). At baseline, the mean (SD) GDS score was 3.0 (2.8) (range, 0-12), the mean (SD) PACC score was −0.004 (0.67) (range, −2.32 to 1.88), and the mean (SD) amyloid positron emission tomography distribution volume ratio was 1.16 (0.20) (range, 0.92-1.94). At last follow-up, the mean (SD) GDS score was 3.9 (2.9) (range, 0-12), and the mean (SD) PACC score was −0.09 (1.27) (range, −5.66 to 1.67). The interaction between cortical amyloid and increasing GDS was associated with declining cognition (β = −0.19; 95% CI, −0.27 to −0.12; P < .001).

Conclusions and Relevance  In this study, cortical amyloid moderated the association between worsening depressive symptoms and declining cognition in older adults. While future work is needed to better understand causal associations, these findings may enhance early detection and prevention of AD clinical symptoms.

Niveles altos de estrógenos en el útero podrían aumentar el riesgo de autismo

Foetal oestrogens and autism

Abstract

Elevated latent prenatal steroidogenic activity has been found in the amniotic fluid of autistic boys, based on measuring prenatal androgens and other steroid hormones. To date, it is unclear if other prenatal steroids also contribute to autism likelihood. Prenatal oestrogens need to be investigated, as they play a key role in synaptogenesis and corticogenesis during prenatal development, in both males and females. Here we test whether levels of prenatal oestriol, oestradiol, oestrone and oestrone sulphate in amniotic fluid are associated with autism, in the same Danish Historic Birth Cohort, in which prenatal androgens were measured, using univariate logistic regression (n = 98 cases, n = 177 controls). We also make a like-to-like comparison between the prenatal oestrogens and androgens. Oestradiol, oestrone, oestriol and progesterone each related to autism in univariate analyses after correction with false discovery rate. A comparison of standardised odds ratios showed that oestradiol, oestrone and progesterone had the largest effects on autism likelihood. These results for the first time show that prenatal oestrogens contribute to autism likelihood, extending the finding of elevated prenatal steroidogenic activity in autism. This likely affects sexual differentiation, brain development and function.

Videojuego para reducir la impulsividad en niños con TDAH

Novel Interactive Eye-Tracking Game for Training Attention in Children With Attention-Deficit/Hyperactivity Disorder

Objective: To assess whether the eye-tracking approach of the RECOGNeyes game has potential therapeutic benefits for children with neurodevelopmental disorders, in particular attention-deficit/hyperactivity disorder (ADHD). RECOGNeyes is a computer game that is played using the eyes as the game controller. The rationale behind the game is that individuals with ADHD have an underdeveloped attention control system. This attention control system is underdeveloped not because they lack this capacity but because this ability has not been sufficiently developed. The game was designed as an intervention for training visual attention in ADHD.

Methods: The sample included 28 children aged 8–15 years (18 aged < 12 y and 10 aged ≥ 12 y) previously diagnosed with ADHD (DSM-5 criteria). The participants were randomly divided into 2 groups. The experimental group played RECOGNeyes with eye-tracker for 3 weeks (3 times/week) at home, while the control group played the game using the mouse. Different attentional parameters were assessed before and after training. The study was conducted from January 2018–June 2018.

Results: Participants from the eye-tracker group showed an improvement posttest compared to pretest in impulsivity (P = .0067), reaction time (P < .0001), and fixation gaze control (P < .0001). No changes were found in mouse control between pretest and posttest assessments.

Conclusion: RECOGNeyes is a child-friendly, interactive game combined with eye-tracking technology that seems to provide an improvement in the visual attention system, which is especially indicated for ADHD patients. This game might be used as an alternative to pharmacologic therapy and may provide new insights into the treatment of ADHD.​