The mechanism of neurocognitive failure in Alzheimer's disease remains obscure. While the mainstream hypothesis in the field posits that brain tau pathology is the only process that drives cognitive decline in AD, other complementary mechanisms link vascular brain lesions with beta-amyloid pathology as an important factor leading to neurodegeneration. Recently, it was also proposed that the brain's network's functional imbalance could primarily drive cognitive decline in neurodegenerative diseases. Here, we investigated whether the anticorrelation between the default mode (DMN) and dorsal attention networks (DAN) reveals different pathology burdens in the AD spectrum. We grouped individuals based on their PET amyloid and cognitive status. Using cross-validated regression models, we investigated whether cognitive impairment can be predicted based on rs-fMRI DMN-DAN anticorrelation. We found that the DMN-DAN anticorrelation differentiates between pathology burdens in AD, as quantified by PET amyloid imaging and cognitive performance. We found that an attenuated DMN-DAN anticorrelation predicted cognitive decline, which was controlled by sex, age, education, and brain tau pathology. Education level, measuring cognitive reserve, did not modulate the association between DMN-DAN anticorrelation and cognitive decline. We demonstrate that the attenuation of the anticorrelation between DMN and DAN is associated with a mechanism of cognitive dysfunction independent of tau pathology and proxies of resilience to cognitive decline or cognitive reserve. Our results also suggest the existence of an alternative mechanism of neurocognitive breakdown independent of advanced medial temporal cortex pathology and protective factors of cognitive decline, such as cognitive reserve.
Martha R. Alvarez S, Ronald G. García, Federico Arturo Silva S
La cefalea por uso excesivo de medicamentos (CUEM) se define como la presencia de cefalea diaria o casi diaria (15 días o más de evolución), que se produce en pacientes con antecedente de cefalea primaria que usan excesivamente medicamentos. Está entidad está asociada a coomorbilidad psiquiátrica, por lo que las características clínicas se hacen más complejas con el paso del tiempo. El manejo fundamental se basa en la suspensión del medicamento sobre el que se centra el abuso (analgésicos, ergotamina, triptanes y opioides). Sin embargo, es necesario tomar en consideración que la suspensión de estos medicamentos puede asociarse a otros problemas como “cefalea de rebote”, síndrome de abstinencia o convulsiones epilépticas; incrementando las tasas de recaída en estos pacientes.
Vinicius de Maria Gadotti, Flavia Tasmin Techera Antunes, Gerald W. Zamponi
Abstract Delta-9-tetrahydrocannabinol (Δ9-THC) is known to produce systemic analgesia that involves CB1 and CB2 cannabinoid receptors. However, there is compelling evidence that Δ9-THC can potently inhibit Cav3.2T-type calcium channels which are highly expressed in dorsal root ganglion neurons and in the dorsal horn of the spinal cord. Here, we investigated whether spinal analgesia produced by Δ9-THC involves Cav3.2 channels vis a vis cannabinoid receptors. We show that spinally delivered Δ9-THC produced dose-dependent and long-lasting mechanical anti-hyperalgesia in neuropathic mice, and showed potent analgesic effects in models of inflammatory pain induced by formalin or Complete Freund’s Adjuvant (CFA) injection into the hind paw, with the latter showing no overt sex differences. The Δ9-THC mediated reversal of thermal hyperalgesia in the CFA model was abolished in Cav3.2 null mice, but was unaltered in CB1 and CB2 null animals. Hence, the analgesic effects of spinally delivered Δ9-THC are due to an action on T-type calcium channels, rather than activation of spinal cannabinoid receptors.
Maksim V. Agarkov, Alexey A. Safuanov, Svetlana T. Evreeva
et al.
We describe a case of 72-year-old patient with recurrent transient ischemic attacks in the right internal carotid artery (ICA) territory associated with uncontrolled hypertension. Duplex ultrasonography und carotid angiography showed a 60% stenosis with signs of a vulnerable plaque in the cervical segment, as well as a 90% stenosis in the cavernous segment of the right ICA. After further examination the patient was diagnosed with an 80% renal artery stenosis. First, the patient had a single-stage stenting for extracranial and intracranial stenoses of the right ICA, then left renal artery stenting. No intraoperative and postoperative complications were observed. These results show that this surgical treatment is minimally invasive, safe, and effective in symptomatic patients and may be considered for the disease.
Paul Carrillo-Mora, Yesenia Lugo Rodríguez, Kenia F. Franyutti-Prado
et al.
It is increasingly common for healthy people to seek means to improve their alertness, or to try to get better their performance in some cognitive functions; this with the aim of increasing their performance and productivity in the academic or work environment. Several stimulant drugs have been used for many decades and have recently become very popular especially among young people. However, general practitioners and even specialists are rarely informed of their real benefits or potential adverse effects. This review provides an updated overview of the effects (positive and adverse) of some stimulant drugs that have been used to maintain alertness or improve cognitive performance in healthy subjects. For stimulant drugs, the positive effects improving the subjective symptoms of sleep deprivation are well established. However, the cognitive effects of stimulant drugs are still highly variable and inconsistent, since there are few studies that have been carried out with adequate methodological design. In addition, there are several adverse effects, from mild to severe that can be observed and there is a concern of potential addiction effect to some of them. Some stimulant drugs can improve alertness, but their positive effects improving cognition are not yet fully proven.
Suicidality in patients with major depressive disorder (MDD) has been an urgent affair during the COVID-19 pandemic. It is well-established that impulsivity and trait anxiety are two risk factors for suicidal ideation. However, literature is still insufficient on the relationships among impulsivity, (state/trait) anxiety and suicidal ideation in individuals with MDD. The present study aims to explore the relationships of these three variables in MDD patients during the COVID-19 pandemic through three scales, including Barrett Impulsivity Scale (BIS), State-Trait Anxiety Scale (STAI) and Self-rating Idea of Suicide Scale (SIOSS). Sixty-three MDD patients (low SIOSS group and high SIOSS group, which were split by the mean score of SIOSS) and twenty-seven well-matched healthy controls were analyzed. Our results showed that the high SIOSS group had higher trait anxiety (p < 0.001, 95% CI = [−19.29, −5.02]) but there was no difference in state anxiety (p = 0.171, 95% CI = [−10.60, 1.25]), compared with the low SIOSS group. And the correlation between impulsivity and suicidal ideation was significant in MDD patients (r = 0.389, p = 0.002), yet it was not significant in healthy controls (r = 0.285, p = 0.167). Further, mediation analysis showed that trait anxiety significantly mediate impulsivity and suicidal ideation in patients with depression (total effect: β = 0.304, p = 0.002, 95% CI = [0.120, 0.489]; direct effect: β = 0.154, p = 0.076, 95% CI = [−0.169, 0.325]), indicating impulsivity influenced suicidal ideation through trait anxiety in MDD patients. In conclusion, our results suggested that trait anxiety might mediate the association of impulsivity and suicidal ideation in MDD patients. Clinicians may use symptoms of trait anxiety and impulsivity for screening when actively evaluating suicidal ideation in MDD patients, especially in the setting of COVID-19 pandemic.
J. C. P. Leendertse, J. C. P. Leendertse, A. I. Wierdsma
et al.
Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions).Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests.Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = −0.44, 95%CI −0.50 to −0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48–0.63), meaning in life (r = 0.48, 95%CI 0.38–0.58) and empowerment (r = 0.53, 95%CI 0.42–0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43–0.65) and identity (r = 0.43, 95%CI 0.35–0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences.Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time.
Keith J. Kincaid, Justin C. Kung, Alexander J. Senetar
et al.
Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or “long-COVID” complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence.
Kali S. Barawi, Catrin Lewis, Natalie Simon
et al.
Objective Psychological interventions for post-traumatic stress disorder (PTSD) are not always effective and can leave some individuals with enduring symptoms. Little is known about factors that are associated with better or worse treatment outcome. Our objective was to address this gap. Method We undertook a systematic review following Cochrane Collaboration Guidelines. We included 126 randomized controlled trials (RCTs) of psychological interventions for PTSD and examined factors that were associated with treatment outcome, in terms of severity of PTSD symptoms post-treatment, and recovery or remission. Results Associations were neither consistent nor strong. Two factors were associated with smaller reductions in severity of PTSD symptoms post-treatment: comorbid diagnosis of depression, and higher PTSD symptom severity at baseline assessment. Higher education, adherence to homework and experience of a more recent trauma were associated with better treatment outcome. Conclusion Identifying and understanding why certain factors are associated with treatment outcome is vital to determine which individuals are most likely to benefit from particular treatments and to develop more effective treatments in the future. There is an urgent need for consistent and standardized reporting of factors associated with treatment outcome in all clinical trials.
Gunes Sevinc, Jonathan Greenberg, Britta K. Hölzel
et al.
Abstract Introduction Mindfulness meditation has successfully been applied to cultivate skills in self‐regulation of emotion, as it employs the unbiased present moment awareness of experience. This heightened attention to and awareness of sensory experience has been postulated to create an optimal therapeutic exposure condition and thereby improve extinction learning. We recently demonstrated increased connectivity in hippocampal circuits during the contextual retrieval of extinction memory following mindfulness training. Methods Here, we examine the role of structural changes in hippocampal subfields following mindfulness training in a randomized controlled longitudinal study using a two‐day fear‐conditioning and extinction protocol. Results We demonstrate an association between mindfulness training‐related increases in subiculum and decreased hippocampal connectivity to lateral occipital regions during contextual retrieval of extinguished fear. Further, we demonstrate an association between decreased connectivity and decreases in self‐reported anxiety following mindfulness training. Conclusions The results highlight the role of the subiculum in gating interactions with contextual stimuli during memory retrieval and, also, the mechanisms through which mindfulness training may foster resilience.
O presente artigo apresenta como Jacques Lacan inaugura uma nova maneira de abordar a experiência mística à luz da psicanálise. Contrapondo-se a tendências no campo da psicologia, da psiquiatria e da psicanálise de patologizar esse fenômeno, reduzindo-o à sintomatologia histérica ou psicótica, o mestre francês aproximou o percurso do analista daquele empreendido pelo místico, traçando uma íntima conexão entre o fim da análise e a conquista de uma abertura para o campo do feminino. Nas trilhas abertas por esse autor, propomos diferenciar as noções de gozo Outro e gozo do Outro, indicando elementos para um diagnóstico diferencial entre experiência mística (marcada pela dessubjetivação) e surto psicótico (marcado pelo aniquilamento subjetivo).