Alzheimer’s dementia (AD) produces multiple alterations, both in the cognitive, behavioral and functional spheres. The basic activities of daily living (BADL) are affected in patients with AD, compared with subjects without cognitive impairment (SWCI). In this research, 50 patients with AD who met the diagnostic criteria established in the DSM-IV-TR and the NINCDSADRDA and 60 SWCI with similar sociodemographic characteristics were analyzed. The results show that the most affected BADL are the capacities of food, washing, dressing, arranging, transferring, walking, going up and down stairs and the least affected BADL were urination and the ability to go to the toilet, not being affected differentially in the deposition ability. These findings confirm the general hypothesis that patients with AD have involvement of the BADL compared with the SWCI.
Artículos Originales
Actividades básicas e instrumentales de la vida diaria en pacientes con demencia tipo Alzheimer. Basic and instrumental activities of daily living in patients with Alzheimer’s dementia.
Disappointing agreement in the interpretation of neurological adverse events following immunization with SARS-CoV-2 vaccines. A case-series study. Pobre concordancia en la interpretación de eventos adversos neurológicos después de la inmunización con vacunas contra el SARS-CoV-2. Estudio de una serie de casos.
Background: A sizable proportion of the world’s population has been vaccinated to prevent SARS-CoV-2 infections. In clinical practice, however, almost any neurological manifestation occurring after vaccination has been attributed to the vaccine, generating doubts on their safety. In 2013, the WHO created the Adverse Event Following Immunization (AEFI) criteria to establish the relationship between a vaccine and side effects, but they seem not to dispel doubts regarding severity and causality of neurological events following SARS-CoV-2 vaccination. This study aims to analyze consistency of the AEFI to designate probable side effects of SARSCoV-2 vaccines among patients who develop neurological symptoms after vaccination.
Methods: We measured the level of agreement using the Fleiss kappa methodology. Seventeen observers (five neurologists, four infectious disease specialists, and eight internal medicine residents) independently rated 11 cases treated in our service presenting neurological symptoms within 21 days after SARS-CoV-2 vaccination according to the AEFI criteria.
Results: We found low concordance agreements among the 17 raters regarding severity (k=0.088) and causality (k=0.025). When analyzing by raters’ subgroups, agreement for severity was moderately higher among neurologists (k=0.383) and for causality among internal medicine residents (k=0.117).
Conclusions: AEFI criteria do not allow, by themselves, to establish the relationship between a vaccine and adverse neurological effects. Therefore, it is essential to create more useful tools that allow doctors and lay people to be more confident in this challenge.
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Predictores de ansiedad durante la pandemia COVID-19 en estudiantes de medicina de Morelos, México. Predictors of anxiety during the COVID-19 pandemic in medical students from Morelos, Mexico.
Introduction: Medical students are a group of concern in the face of COVID-19, as social distancing measures may affect their anxiety and be vulnerable to the emotional impact, since the profession is part of the first line of care in the face of this pandemic.
Objective: To describe the prevalence and predictors of anxiety caused by the COVID-19 pandemic in university medical students from Morelos, Mexico.
Method: Cross-sectional descriptive observational study using an online questionnaire, with Sociodemographic Characterization, Generalized Anxiety Disorder-7 (GAD-7), Passion for Study, Self Compassion Scale (SCS), Connor-Davidson Resilience Scale (CDRISC), Life Satisfaction and Demoralization Scale (DS).
Results: In a sample of 292 medical students, women (62.8%), older than 21 years (66.9%), 72.7% reported anxiety and 65.5% sleep problems. The multiple regression model shows that dysphoria is the variable that reports the greatest predictive capacity of importance with 34.8%, followed by having trouble sleeping with 24.4%, discouragement 22.4%, over-identification 13.9% and concern about getting infected 4.5%.
Conclusions: Concern and uncertainty in the hospital environments where medical students are prepared and trained increase the risk of anxiety, due to the perception of adverse conditions and frustration as part of their profession.
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Evaluación de la función cognitiva diaria del adulto y adulto mayor mediante el uso del ECog (everyday cognition). Evaluation of the daily cognitive function of adults and elderly adults through the use of ECog (everyday cognition).
Introduction: Older adulthood is the stage of life where significant biological changes occur, such as a decrease in cognitive function. The ECog is a valuable tool for detecting early changes in declining cognitive function and subjective cognitive impairment. It can be answered by an informant (relative) without needing the patient to be present. It can be applied to patients with a low educational level or some disability without this limitation.
Objective: To know the changes in the daily cognitive function of adults and older adults for decades. (50-59, 60-69, >70 years) using the ECog.
Methods: Descriptive, cross-sectional, randomized, survey-type study. Patients over 50 who attended a Family Medicine consultation for any reason other than dementia were included, patients who did not wish to participate were excluded, and incomplete surveys were eliminated. The n was 180 patients, 60 for each age group (group 1=50-59 years, group 2=60-69 years, and group 3=>70 years). The ECog was applied to the patients (answered by an informant). The means were calculated by age group, the variation between each group was calculated using a means comparison formula, the prevalence of Subjective Cognitive Impairment (cut-off point in ECog>1.36) was calculated by age group, and the most affected domains.
Results: The decrease in cognitive function measured by the ECog increased significantly with age in each group (Anova p value less than 0.001) and the prevalence of cases with Subjective Cognitive Impairment. The most affected functions were memory, attention and organization. The least affected domain was language.
Conclusion: A significant decline in cognitive function was observed with advancing age. The ECog is an excellent tool, easy
and straightforward to use for the Primary Care physician.
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Correlación entre la calidad de sueño y actividad de la enfermedad en pacientes con Espondiloartritis. Correlation between sleep quality and disease activity in patients with Spondyloarthritis.
Objective: To evaluate the quality of sleep and its relationship with disease activity in patients with spondyloarthritis (SpA).
Methodology: Observational, cross-sectional study, in patients of 18 to 65 years of age with a diagnosis of SpA. The Pittsburgh Sleep Quality Index (PSQI) questionnaire was used to measure sleep quality, and the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS-CRP), Disease Activity in PSoriatic Arthritis (DAPSA) instruments were used to assess disease activity.
Results: 72 were evaluated with SpA. The overall median age was 42 (IQ 33.75 – 56.25), the mean sleep quality measured by PSQI was 9.15 ± 4.11. Scores 8 and 9 presenting more frequently with 10 subjects each, followed by score 10, present in 9 individuals. 59 patients with SpA were found to have a PSQI score>5 or poor sleep quality. A significant association was observed for sleep quality measured by PSQI, and disease activity assessed by BASDAI (r 0.530; P<0.001), ASDAS-CRP (r 0.533; P<0.001), DAPSA (r 0.368; P=0.002), VGP (r 0.478; P<0.001), VGM (r 0.382; P=0.001), VAS (r 0.522; P<0.001), SJC/66 (r 0.286; P=0.019), ESR (r -0.363; P =0.021). An association was observed between the use of antidepressants and gabapentinoids with sleep quality by PSQI, showing r 0.30; P=0.005, and r 0.25; P=0.029, respectively.
Conclusion: In patients with SpA, poor sleep quality is an independent factor of greater disease activity.
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Validez y confiabilidad de la tarea experimental de Redes Atencionales para investigaciones de neuropsicología en el contexto ecuatoriano. Validity and reliability of the experimental task of Attentional Networks for neuropsychological research in the Ecuadorian context
The main experimental tasks in the area of neuroscience and psychology have been performed in industrialized populations, but they have not been developed and adapted in a Latin population. The aim of this study was to validate the attentional networks task in an Ecuadorian sample. For this purpose, a construct validity analysis was carried out through an analysis of variance and correlation between the networks; and a reliability analysis for the global components of the attentional networks.
The results showed main and interaction effects proving construct validity in the population. Likewise, for the interaction validity, a high significant correlation was found between all conditions of the attentional networks. For the reliability analysis, a moderate and high relationship was found for the orientation and cognitive control network, but not for the alertness network.
At the end, the importance of the validation of the experimental tasks in the Latin American population and the clinical relevance in the field of neuropsychology are discussed.
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Neuroeducación física: Efectos del ejercicio aeróbico en la atención alternante, planificación y memoria visuoconstructiva en estudiantes universitarios. Physical neuroeducation: Effects of aerobic exercise on alternating attention, planning and visuoconstructive memory in university students
Introduction: There are numerous reports of the positive effects of physical exercise on various cognitive variables such as attention, mental flexibility, memory, inhibitory control, etc. The aim of the present study was to determine the effects of an aerobic exercise session on alternating attention, planning and visual constructive memory in physical education students from a university in Santiago de Chile.
Methodology: Quantitative with a quasi-experimental design. The sample consisted of physical education pedagogy students, where 15 were the control group was 15, and 20 subjects were the experimental group. The instruments used were the symbols and digits test of Smith, Tower of Hanoi and Rey Complex Figure Test.
Results: There was significative improvement in the experimental group: alternating attention (p=0.018), at the time of the planning test (p=0.005), visuoconstructive memory (p=0.000).
Conclusions and Recommendations: Aerobic exercise improves attention, memory, and planning functions, which could promote the line of study of neurophysical education, so it is suggested within the projections to investigate with different intensities, age ranges and other cognitive variables.
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Insomnio y factores asociados entre los estudiantes de medicina que se recuperaron de la infección aguda por COVID-19. Insomnia and associated factors among medical students recovering from acute COVID-19 infection
Introduction: The SARS-CoV-2 pandemic significantly affected the mental health of a large portion of the population, with sleep disorders, including insomnia, being notable after COVID-19 infection. One of the populations most affected were university students in the healthcare field, which was the focus of our study.
Objective: To evaluate the relationship between factors associated with insomnia in medical students during the Long-Covid period.
Methods: Data was collected through a survey that included questions about sociodemographic aspects, health habits, sleep disturbances such as insomnia, and COVID-19 history. The severity of insomnia and subjective sleep quality were measured using the Insomnia Severity Index (ISI) and the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics, Spearman and Kendall correlations, one-way ANOVA, and odds ratios were evaluated.
Results: A total of 117 students were included in the study, with a mean age of 21.8 ± 1.96 years and 58.1% being female. It was found that 65% of medical students experienced some degree of insomnia, while 78.6% reported difficulty sleeping. The Kendall and Spearman correlation coefficients between PSQI and ISI were 0.49 and 0.55, respectively (p < 0.001). Significant correlations were found between self-reported physical health, emotional health, among others.
Discussion: The prevalence of subclinical insomnia (39.3%) and moderate sleep difficulty (47%) is noteworthy. Significant correlations were found between insomnia scales, sleep quality, and an inverse correlation with emotional health. Limitations of the study include the use of ordinal and nominal variables, as well as the number of participants. It is recommended to replicate the study with a larger sample size and utilize a longitudinal design to assess the evolution of insomnia and sleep difficulty over time.
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Propiedades psicométricas de un Instrumento de Tamizaje para Autismo (ITEA) en niños y adolescentes del Ecuador. Psychometric properties of an Autism Screening Instrument (ITEA) in children and adolescents from Ecuador
This study explores factorial validity of the Autism Spectrum Screening Test (ITEA) for the identification of autism in schooled children and adolescents in Ecuador. The psychometric study analyzes the validity and reliability, as well as internal consistency of the elements of the scale. The sample consisted of 848 autistic people, and 350 non-autistic, of ages between 4 and 17 years old, who attended regular schools. The Confirmatory Factor Analysis shows that the ITEA adjustment model behaves adequately for the Ecuadorian population, corroborated by means of a model of four first-order factors and a second-order general agglutinating factor with 32 items, in fact, the absolute, relative, and non-centrality-based fit indicators confirm this. In addition, the scale is highly reliable in terms of internal consistency with ω= .92 [.91 – .93], since it allows obtaining greater precision in the evaluation of the studied construct. It can be concluded that evidence of factorial validity and reliability show that the ITEA, in its structural model, is adequately adjusted for the screening of autism in schooled children with ages between 4 to 17 years old
in Ecuador. According to Support Vector Machines (SVM), which allows information regarding the accuracy of each evaluated item, the set of 42 items reached 89.04% Analysis using the Request for Evidence test (RFE) showed that, in order to increase the accuracy level of ITEA, 31 items exceeded the global value. Regarding the 7 categories evaluated (language, communication, social skills, affectivity, information processing, inflexibility, and sensory perception), a value of 89.387% was obtained, according to the SVM algorithm with “rbf” kernel. The data shows the ability of ITEA to show specific characteristics to identify autism
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Trail Making Test TMT: Primera aproximación a las propiedades psicométricas en población ecuatoriana adulta. Trail Making Test TMT: First approach to the psychometric properties in the adult Ecuadorian population
Background: The Trail Making Test (TMT) is the most widely used test in Latin America to measure sustained attention (Part A) and executive function (Part B). However, the scales used show differences in the references averages between groups of populations.
Objective: To determine the referential averages of the TMT test, considering the effect of the sociodemographic factor, in order to provide normative data in Ecuadorian adult population, from 18 to 90 years of age.
Method: A quantitative method was developed, with a non-experimental design, based on psychometric techniques in a nonprobabilistic sample of a total of 1679 Ecuadorian participants . The TMT test, part A and B, was administered.
Results: 57.4% of the sample corresponded to female participants, while 42.6% consisted of male participants. The majority coming from the city of Quito (41.7%). The mean age was 34 years, and most reported higher education. The weightings of the referential averages in part A for the general sample were (M: 34.1; SD: 13.2), while in part B it was (M: 77.9; SD: 39.8). Comparing the scores obtained by gender and by age groups, no significant differences were observed; however, in the TMT-B part, the group with higher education (> 12 years) obtained a better performance, compared to the groups with fewer years of education (P=0,000).
Conclusions: the referential averages for the TMT test in the Ecuadorian population show dependence on the sociodemographic factor associated with schooling. In addition, those obtained were observed slightly below the scales provided in other Latino populations. Therefore, it suggests the construction of a referential scale for the TMT test, adapted to the Ecuadorian cultural context
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Number of Neurologists and Neurology Training Programs available in the Public Health System of Ecuador: Analysis and Recommendations. Número de Neurólogos y Programas de Entrenamiento en Neurología disponibles en el Sistema de Salud Público del Ecuador: Análisis y Recomendaciones.
Introduction: In 2008, Ecuador’s neurologic healthcare profile displayed significant needs, a lack of neurologists, and neurology training accessibility. In that year, a new constitution introduced universal health care. No publication analyzes Ecuador’s neurological Public Healthcare capacity. Hence, an up-to-date analysis of the number of neurologists and neurology training programs is required.
Objective: Determine if Ecuador’s public healthcare meets the minimum ideal ratio recommended by the World Health Organization of 1 neurologist per 100,000 population and the numb er of neurology training programs in Ecuador.
Methods: Cross-sectional analysis of public data until November 2022 from Ecuador’s Public Health System (PHS) and the Council of Higher Education. Ratios were calculated using the N ational Institute of Statistics and Censuses’ information.
Results: The public health network had ninety-four neurologists. Most found in Pichincha (37/39.4%) and Guayas (24/25.5%). There was one per province in five provinces. No neurologists were available in eight provinces. Two provinces met the ideal ratio. Ecuador’s ratio was 0.54:100,000 neurologists per population. One neuro logy training program was found in Quito.
Conclusion: Ecuador’s PHS has a shortage of neurologists, unfulfilling the minimum ideal ratio, and a severe lack of neurology training. Decentralizing neurological services, primary care support, and governmental funding for neurology training are an urgent need.
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Análisis Clínico y Evolutivo de Pacientes Con Estado Epiléptico Refractario Acorde el Esquema de Tratamiento de Tercera Línea Utilizado. Clinical And Outcome Analysis Of Patients With Refractory Status Epilepticus According To The Third-Line Treatment Scheme Used
Introduction: The evidence available in the treatment of refractory status epilepticus (RSE) is limited.
Objective: Evaluate the clinical and outcome factors in patients with refractory status epilepticus (RSE) according the third line treatment used (midazolam-MDL and/or propofol-PRO).
Methods: Retrospective cohort study included 34 patients treated by RSE during November 2015 to June 2018.Variables: Age, severity and etiology of RSE, pretreatment level of consciousness, anesthetic drugs (MDL-PRO), outcome at hospital discharge and 3 months according Rankin score.
Results: Mean of age of the patients was 51.21±22.3 years and 32.4% (11) had previous history of epilepsy. Super RSE (SSRE) was diagnosed in 35.3% (12) of sample. Mortality reached up 50% of patients and extended to 55.9% at 3 months. Patients treated with MDL had higher rate of vasopressor needs (71.4% vs 50.0%) and the group who received a scheme of combined treatment MDL-PRO included mainly a SSRE patients (p≤0.01), higher rate of tracheostomy (p=0.03), vasopressor drugs (p=0.01) and diminished dosage of anesthetic drugs (p=0.05). Surveillance analysis according Kaplan Meier curve did not found significant differences at 3 months in survival rate between groups. MDL vs PRO (Log Rank=0. 17), MDL vs MDL-PRO (Log Rank=0. 49) y PRO vs MDL-PRO (Log Rank=0. 48).
Conclusion: Patients with RSE had a high mortality, without evidence of increase of mortality in groups according anesthetic drugs used and schemed of treatment applied.
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Causas de Traumatismo Intracraneal en Pacientes Atendidos en el Servicio de Emergencias del Hospital de Especialidades Teodoro Maldonado Carbo de Guayaquil. Causes Of Traumatic Brain Injury In Patients Admitted To The Emergency Department Of A Specialty Hospital In Guayaquil
Introduction: Traumatic brain injury (TBI) is defined as an alteration in brain function caused by an external force. The most common causes of TBI are falls and traffic accidents, the latter being the most c ommon in low-income countries.
Methodology: A cross-sectional study was conducted in patients with a diagnosis of intracranial trauma in the emergency department of the Teodoro Maldonado Carbo Hospital from January 2017 to December 2020 with the aim of analyzing its causes, clinical and radiological characteristics.
Results: 324 patients were analyzed within the study, evidencing that the most common cause of TBI was traffic accident followed by falls. TBI is more common in men with a mean age of 40 years. Using Pearson’s chi-square and Kruskal-Wallis tests, a statistically significant association was found between cause with age and length of hospital stay (p<0.001). However, there were no significant associations between the specific cause of TBI with patient clinical variables or mortality (p>0.05).
Conclusion: The most prevalent cause of intracranial trauma was traffic accident. There is an association between the cause of TBI and length of hospital stay.
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White matter hyperintensities severity and progression are not related to earlobe crease presence. A cross-sectional and longitudinal prospective study in community-dwelling older adults. La severidad y progresión de hiperintensidades de la sustancia blanca no están relacionados con la presencia del pliegue del lóbulo de la oreja. Un estudio transversal y longitudinal prospectivo en una población de adultos mayores
Background: Earlobe crease (ELC) has been associated with coronary atherosclerosis. Recently, ELC has been associated with white matter hyperintensities (WMH) of presumed vascular origin. However, the results are heterogeneous among studies. We aimed to assess whether ELC is associated with WMH severity and progression in community-dwelling older adults.
Methods: Atahualpa Project Cohort participants received earlobe photographs and brain MRIs to assess the association between ELC and WMH severity, as well as the relationship between ELC and WMH progression using ordinal logistic and Poisson regression models, respectively.
Results: The cross-sectional component of the study included 359 individuals aged ≥60 years. ELC was present in 175 subjects. On MRI, 107 participants did not have WMH, 174 had mild, 56 had moderate, and 22 had severe WMH. A multivariate ordinal logistic regression model did not show a significant association between the main variables investigated (OR: 0.72; 95% C.I.: 0.48 – 1.06). The longitudinal component included 252 individuals, 126 of whom had ELC and 103 had WMH progression. A Poisson regression model showed no association between ELC and WMH progression (IRR: 1.02; 95% C.I.: 0.69 – 1.51).
Conclusions: ELC is not related to WMH severity and progression in the study population.
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Evaluación de la calidad de las guías de práctica clínica sobre enfermedad vascular cerebral aguda mediante la herramienta AGREE II. Quality assessment of clinical practice guidelines on stroke using the AGREE II tool
Objetive: Evaluate the quality assessment of the treatment guidelines for stroke between 2010 and 2021.
Methods: Evaluation by AGREE II instrument. Intraclass correlation was performed for two observers, and it was analyzed the consensus on blood pressure goals and the use of prehospital scales.
Results: 21 clinical practice guidelines were included. The consensus between observers was 0.88 (95% CI: 0.69-0.95). The highest score was for clarity of presentation, while the lowest was for applicability. Nine guidelines (42.9%) were “recommended,” seven were “not recommended” (33.3%) and five were “recommended, but with modifications.” There is consensus on the blood pressure goals in the initial phase. The Fast scale was the most recommended.
Conclusions: Less than half of the guidelines analyzed were recommended for clinical use. Since 2016, the guidelines have shown substantial improvements in their quality. Implementing and actively utilizing the guidelines demands strengthening the applicability and editorial independence.
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Escala de Conocimiento de la Enfermedad de Alzheimer: Adaptación y Análisis de las Propiedades Psicométricas en Estudiantes Universitarios Ecuatorianos. Alzheimer’s Disease Knowledge Scale: Adaptation and Analysis of Psychometric Properties in Ecuadorian University Students
The aim of this study was to develop a linguistic adaptation of the Alzheimer’s Disease Knowledge Scale (ADKS), and to provide evidence on the reliability and validity of the adapted test. The ADKS is a self-administered instrument that examines knowledge about risk factors, assessment and diagnosis, symptoms, course, impact on life, care and treatment and management of Alzheimer’s disease (AD).
Methods: An instrumental study was implemented. The ADKS items were adapted to the Ecuadorian use of the Spanish language through an iterative process of translation by experts. Next, a sample of 523 university students completed the adapted scale together with a set of other instruments to analyze the fiability and criterion validity of the scale.
Results: ADKS Ecuador showed good internal consistency (Cronbach’s α=.78), adequate test-retest reliability, p > .05, and convergent and discriminatory evidence of validity when related to other variables.
Conclusion: ADKS Ecuador is an adequate instrument to assess general knowledge about AD in young highlgy educated Ecuadorian population with low dom ain knowledge.
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Prevalencia de deterioro cognitivo leve en peruanos adultos mayores y de mediana edad. Cognitive impairment prevalence in peruvian middle-age and elderly adults
Appraisals of dementias worldwide envisage an unfavorable scenario, especially in developing countries. Since factors such as education, socioeconomic status and healthiness play an important role in the development of Alzheimer’s disease and other dementias. It is known that pathophysiological features begin up to 20 years before an Alzheimer’s diagnosis and that the disease transits through three stages that include normal aging, mild cognitive impairment, and Alzheimer’s disease. The objective of this study was to determine the prevalence of cognitive impairment in a sample of middle-aged and older adults in southern Peru. A discriminant cognitive evaluation is performed for the absence or presence of cognitive alteration, focused especially on memory, language, visuoperception/visuoconstruction and other cognitive domains. Mini-Mental State Examination, Clock´s Test, and Verbal Fluency test were used, obtaining prevalence data for cognitive impairment with adjusted cut-off points according to age ranges (50-98 years) sex and education. Parametric and non-parametric statistics, logistic regression, Pearson correlation and ANCOVA were performed. The most suitable cut points for our population were selected through the ROC curves and the Youden index. The percentage of global mild cognitive deterioration was 58.80%. It is necessary to generate more effective mental health policies, especially referring to the middle-aged and elderly population, that address the early detection of MCI and Alzheimer’s disease.
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Testing the reliability of the Downton Fall Risk Index for predicting incident falls in community-dwelling older adults. A prospective population-based study. Evaluación de la confiabilidad del “Índice Downton de riesgo de caídas” como predictor de caídas incidentes en adultos mayores que viven en la comunidad. Estudio poblacional prospectivo.
Background: Accidental falls are a major cause of disability and death in older adults. However, the reliability of instruments designed to estimate the risk of future falls has not been adequately established in community dwellers.
Methods: Departing from a previous cross-sectional study of older adults living in rural Ecuador that estimated the potential risk of future falls, we carried out a prospective longitudinal study to assess the reliability of the Downton Fall Risk Index (DFRI) as a predictor of incident falls during three years of follow-up.
Results: Of 254 individuals, 158 (62%) experienced incident falls. The mean score of the baseline DFRI was 1.6±1.3 points, with 54 (21%) individuals showing an increased risk for future falls (DFRI score ≥3 points). Forty-seven of the 54 individuals with a positive DFRI had incident falls as opposed to 111/200 individuals with a negative DFRI (p<0.001). An adjusted logistic regression model found that individuals with a positive DFRI have a fivefold increase in incident falls compared with those having a negative DFRI (OR: 4.91; 95% C.I.: 1.94 – 12.4). Receiver operator characteristics curve analysis showed an area under the curve (AUC) of 0.612 (95% C.I.: 0.568 – 0.657) for a positive DFRI to predict incident falls. However, the AUC for the predictive value of incident falls given a history of previous falls (as a single variable) was 0.908 (95% C.I.: 0.875 – 0.942).
Conclusions: The DFRI has only a moderate predictive value for the occurrence of incident falls that is surpassed by that of previous falls.
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Memoria episódica evaluada a partir de estímulos neutros y emocionales en pacientes con antecedentes de trauma craneoencefálico y grupo control. Episodic memory evaluated from neutral and emotional stimuli in patients with a history of traumatic brain injury and a control group
Objective: To compare the performance in episodic memory evaluated with neutral and emotional stimuli in patients with a history of traumatic brain injury and a control group.
Method: This research had a non-experimental quantitative methodology, it was a quasi-experimental study of descriptive scope of comparison between groups; the group with a history was made up of 15 patients from the Hospital Universitario del Valle in the city of Cali, of which 8 were men and 7 women; the control group consisted of 15 participants: 5 men and 10 women. Episodic memory with emotional and neutral stimuli was assessed with the Auditory-Visual Emotional Memory Test and the California Verbal Learning Test (CVLT), respectively.
Results: Statistically significant differences were found in most of the episodic memory subtests evaluated with neutral stimuli, at the level of storage, interference, short- and long-term memory, and semantic false positives; Regarding the memory evaluated with emotional stimuli, significant differences were identified in encoding and recall.
Conclusion: There is evidence of a lower performance of patients with TBI in memory storage with neutral stimuli, which influences their low score in recall, in relation to the emotional they present a lower performance in the ability to estimate the value or general emotional weight of the story, which seems to influence proper encoding.
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Ejecución en el Test de Fluidez Verbal en pacientes con Trastorno Neurocognitivo Leve. Verbal fluency performance in patients with Mild Neurocognitive Disorder
Aim. To compare quantitative and qualitative aspects of semantic (i.e., animals) and phonological (i.e., F, A, S, M) verbal fluency test (VFT) in Mild Neurocognitive Disorder (mNCD) patients and healthy controls.
Method. The sample was comprised by 70 participants: 35 mNCD patients, with a mean age of 71.5 (± 8) years old and 13.1 (± 3.6) years of formal education; and 35 healthy controls, with a mean age of 72.1 (± 7.1) years old, and 13.2 (± 3.7) years of formal education. A VFT analysis, in terms of hits and errors, clusters’ number and size, and number of switches was performed.
Results. No significant differences among groups were observed in hits and errors. However, statistical differences were found regarding the employed strategies, whereas healthy controls achieved more clusters than the mNCD group in both semantic and phonological VFT. Moreover, the clusters´ size of phonological VFT was larger in healthy controls than mNCD. No differences were found among groups in number of switches.
Conclusions. Qualitative analysis of VFT provide more specific information regarding cognitive processing and may be a useful tool to differentiate the executive functioning of healthy aging and mNCD, in a brief period of time.
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Factores asociados al tiempo libre de discapacidad en pacientes con Esclerosis Múltiple de un instituto de neurología en Medellín, Colombia. Factors associated with disability-free time in patients with Multiple Sclerosis of a neurology institution in Medellin, Colombia
Introduction: Multiple Sclerosis is the leading neurological cause of disability in young adults. The objective of this study was to describe the time free from disability since diagnosis and to analyze associated factors.
Method: Retrospective follow-up study of a cohort based on records of patients who consulted the Neurological Institute of Colombia between 2013 and 2021. Progression to disability was defined as the time to obtain a value greater than 3.5 on the EDSS scale. Parametric survival model for interval censored data with Weibull distribution was used to estimate survival function and Hazard Ratios.
Results: 216 patients were analyzed. The median disability-free time was 12 years (95% CI 7.56-17.66). Cerebellar complications (aHR = 8.18; 95% CI 4.09-16.35), vision (aHR = 2.25; 95% CI 1.25-4.05) and age at diagnosis over 40 (aHR = 1 .28; 95% CI 0.68-2.4) were associated with shorter time to progression, other initial symptoms (aHR = 0.35; 95% CI 0.18-0.68), stem lesions (aHR = 0.6; 95% CI 0.33-1.1), MSRR (aHR = 0.17; 95% CI 0.08-0.33) and women were associated with a longer time to progression.
Conclusion: Clinical and imaging factors allow identifying patients at high risk of rapid progression to disability.
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Correlación entre variables clínicas sugestivas de hipertensión intracraneal y alteraciones en la neuroimagen en trauma craneoencefálico. Correlation between clinical variables suggestive of intracranial hypertension and alterations in neuroimaging in traumatic brain injury
Methods: Retrospective observational cohort study where patients admitted for TBI to the ICU area of the HLV were included.
Results: We included a total of 297 subjects. The most common neuroimaging lesion was multiple lesions (35.4%). We found that there is a significant correlation between the presence of lesion in neuroimaging and the presence of fixed pupils at admission (p = <0.001), score ≤ 8 on the Glasgow scale (p = <0.001) and need for orotracheal intubation (p = <0.001). Similarly, the same 3 variables were significant when related to the score ≥ III on the Marshall scale. In the logistic regression model, pupil fixation was the only one that was shown to increase the risk of a score ≥ III on the Marshall scale (OR: 3.50, 95% CI 1.53-7.99).
Conclusion: The clinical variables: pupil fixation, need for endotracheal intubation and Glasgow ≤ 8 are related to the development and severity of lesion on neuroimaging in patients with TBI.
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Entrenamiento sensoriomotor en casa en personas mayores con Enfermedad Parkinson durante el periodo de confinamiento por COVID-19: Estudio piloto. Sensorimotor training at home in elderly people with Parkinson’s Disease during the period of confinement due to COVID-19: A pilot study
The pandemic caused those therapeutic activities associated with people with Parkinson’s disease to be suspended (PD) with the aim of preventing COVID-19 infections by increasing motor and non-motor symptoms, due to social isolation and stress. Therefore, there was a rise of care based on telemedicine to continue the treatment in the context of a health emergency, promoting training at home. The objective of this experimental research was to document the effects of a sensorimotor training program (NM-FITT®) in people with PD through weekly telematic follow-up during the COVID-19 pandemic. A quasi-experimental study was carried out with pre, inter and post test evaluations that characterized the physical, functional condition and quality of life, in an intervention group (n=5) and a control group (n=5) of elderly people (69.5 ±4.5 years) with PD in Hoehn & Yahr stages 1 to 3, for 18 weeks, through an exercise manual, video calls and telephone follow-up. Favorable and significant effects were demonstrated on all the parameters studied after the application of the intervention in detriment of the health condition of the persons who did not participate in the home training program.
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Caracterización histológica de las dendritas de la amígdala por alto consumo de fructosa en un modelo experimental de isquemia cerebral. Histological features of dendrites in the amygdala due to high fructose consumption in an experimental model of cerebral ischemia
Introduction. High fructose consumption has been shown to magnify cerebral ischemic injury in the ischemic focus and penumbra region. However, ischemia also produces changes in exofocal areas such as the amygdala, an important structure in emotional processing. Therefore, the objective of the investigation was to characterize the histological changes of the amygdala dendrites caused by high fructose consumption in an experimental model of cerebral ischemia.
Method. Wistar rats fed with standard food were used; the control group was given water and the fructose (HDF) group was given add libitum 20% fructose in water for 11 weeks. Some rats were subjected to cerebral ischemia. Therefore, there were four experimental groups: Sham control, Sham HDF, Ischemia control, Ischemia HDF. 50 um coronal sections of the brains were made and microtubule-associated protein 2 (MAP2) immunohistochemistry was performed. Images were captured and processed in Image J software.
Results. Loss of dendrite immunoreactivity was found in ischemic groups, and also cluster-type MAP2 immunoreactivity in HDF groups.
Conclusion. According to the above, both ischemia and high fructose consumption generate dendritic alterations in the amygdala.
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Relación entre factores de riesgo y la distribución topográfica en niños con parálisis cerebral. Relationship between etiological factors and topographic distribution in children with cerebral palsy
Introduction: Cerebral palsy is a health condition that seriously impacts the life condition of children and their family. Different risk factors are becoming increasingly important in its etiology.
Objective: The aim of this study was to analyze the most frequent risk factors for cerebral palsy and their association with topographic distribution in children aged 0 to 15 years in the city of Barranquilla.
Methods: An analytical observational cross-sectional survey type study was conducted with a sample of 78 children diagnosed with cerebral palsy in the city of Barranquilla, where the association of the most frequent risk factors of this condition with the topographic distribution was analyzed.
Results: The risk factors associated with cerebral palsy in order of importance were: perinatal hypoxia, gestational history of maternal infections, maternal trauma and congenital malformations. There was statistically significant association between gestational weeks at birth and GMFCS level (p<0.05) and between gestational weeks and topographic distribution.
Conclusions: Subjects with higher gestational age presented greater involvement at the level of motor function and a more extensive topographic distribution.
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Hipernatremia como factor pronóstico de mortalidad en trauma encefalocraneano severo. Hypernatremia as a prognostic factor of mortality in patients with severe traumatic brain injury
Background: A severe traumatic brain injury is a frequent pathology, it implies a non-negligible morbidity and mortality. Hypernatremia could be considered a factor associated with poor prognosis in order to optimize treatment in the group of high-risk patients. We aim to determine if hypernatremia is a prognostic factor of mortality in patients with severe traumatic brain injury in a public hospital which is a local reference center in trauma.
Material and Methods: We performed a non-probabilistic sampling of adult patients of both sexes with severe traumatic brain injury from the Intensive Care Unit of the Hospital Regional Docente de Trujillo, Perú during the 2015–2018 period.
Results: Mortality in the group with and without hypernatremia was 38% and 6% respectively (p=0.001). The difference in natremia mean values between the group with and without mortality was 21,86 (95% CI 18.2-25.5) (p=0.000). In the multivariate analysis, we found hypernatremia with adjusted OR of 16.73 (95% CI 1.96-142.82) (p=0.01). The ROC curve showed adequate performance to predict mortality, with an AUC 0.878 (95% CI 0.77-0.97) (p=0.00).
Conclusion: Hypernatremia is a prognostic factor of mortality in patients with severe traumatic brain injury.
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Psychiatrists available in the Ecuadorian public health system and psychiatry residency programs in Ecuador – A cross-sectional analysis. Psiquiatras disponibles en el sistema de salud público y programas de residencia en psiquiatría del Ecuador – Un análisis transversal
Introduction: In 2008, Ecuador’s mental health profile displayed deficiencies due to the lack of psychiatrists and psychiatry residency programs. The same year, access to universal health care, was instituted as a right in the Constitution. There are no studies on the Public Health System’s capacity to provide mental health services, hence an updated analysis of the number of psychiatrists and psychiatry training programs available is required.
Objective: To determine the number of psychiatrists available through the Public Health System and to calculate the ratio of psychiatrist per 10,000 population; to establish the number of residency programs available.
Methods: Cross-sectional analysis of the data available from the Ecuadorian Public Health System and the Higher Education Council of Ecuador. Ratios were calculated using data from the National Institute of Statistics and Censuses.
Results: Ecuador’s psychiatrists ratio is 0.08:10,000 and the adjusted ratio (psychiatrists and psychologists) is 0.65:10,000. The Public Health System has 138 psychiatrists, concentrated in Pichincha (n=51) and Guayas (n=27). Three provinces had no psychiatrists available. There are two psychiatry training programs in Quito.
Conclusion: Ecuadorian Public Healthcare holds a shortage of psychiatrists which inhibit the minimum ideal ratio fulfillment, along with a noticeable lack of psychiatric training programs availability.
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Limited value of blood pressure levels in predicting white matter hyperintensities progression among community dwelling older adults living in a rural setting. Utilidad limitada de los niveles de presión arterial como predictor de progresión de hiperintensidades de sustancia blanca en adultos mayores que viven en un entorno rural
Introduction: This study aims to assess the impact of blood pressure (BP) on progression of white matter hyperintensities (WMH) of presumed vascular origin in community-dwelling older adults living in rural Ecuador.
Methods: Atahualpa residents aged ≥60 years receiving baseline and follow-up brain MRIs after a median of 6.5 years were included. Multilevel logistic regression models, which accounted for WMH severity at baseline, were fitted to assess the risk of WMH progression according to BP levels and other covariates.
Results: Analysis included 263 participants. WMH progression increased 3.45 times (95% C.I.: 1.94 – 4.96) among non-hypertensive individuals but 6.15 times (95% C.I.: 3.18 – 9.12) among those with arterial hypertension. However, overlapping of confidence intervals make such difference non-significant. Likewise, no differences in WMH progression were noticed when steady and pulsatile components of BP were used as independent variables.
Conclusions: High BP is not an independent predictor of WMH progression in the study population.
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Conducta adaptativa en estudiantes chilenos sin discapacidad intelectual: Diferencias por género y edad. Adaptative behavior in chilean students with intellectual disability: Differences by gender and age
Adaptive Behavior (CA) is a set of skills learned and performed by people in their daily lives, which are categorized in the conceptual, social and practical domains. The objective of the research was to compare the CA skills according to sex and age range (under 10, between 10 and 16 and over 16) of the participants. A comparative-correlational design was used, which evaluated 457 students (between 5 and 18 years old) with the ABAS-II questionnaire. The results report that CA does not have significant differences when compared by sex, but in age ranges. Downward associations were observed as age increases when relating conceptual skills to social and practical domains. It is concluded that there are no differences in skills according to sex, but there are differences by age ranges and high positive correlations in the younger group, which tend to decrease in the other groups as they advance in age. It is believed necessary to continue deepening the evaluation of CA in children of typical development using the four dimensions of the instrument (conceptual, social, practical, work) in order to obtain results that allow generating comprehensive support for the better development of boys and girls.
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Rehabilitación neuropsicológica en memoria declarativa y la funcionalidad en un adulto con epilepsia y lobectomía temporal izquierda. Neuropsychological rehabilitation program on declarative memory and functionality in an adult with epilepsy and left temporary lobectomy
Introduction: Surgical intervention is a treatment option for refractory epilepsy, and after this procedure cognitive alterations may occur. Software-based intervention approaches represent an alternative to traditional approaches.
Objective: To identify the effect of a neuropsychological rehabilitation plan for declarative memory in an adult with left temporal lobectomy, on their functional abilities.
Methodology: A single-case quasi-experimental design was used; the participant was a 45-year-old woman with memory problems and difficulties in performing daily activities. The intervention was carried out using the CogniFit rehabilitation software, and the Functioning Classification Scale and the Quality of Life Questionnaire in Epilepsy were used for the measurement.
Results: A large effect (NAP; 95%) was found in both indices.
Conclusions: The implementation of a software-based program allows a comprehensive rehabilitation.
