RESUMO
Background: Patients with breast cancer may experience cognitive difficulties from chemotherapy. This alteration is called Chemoinduced Cognitive Impairment, also known as Chemobrain or Chemofog. Objective: To identify the cognitive profile and the characteristics of the neuropsychological assessment in this population. Method: PubMed, SpringerLink and SciELO databases were revised. Articles from 1994 to September 2021 were selected. Keywords related to the study topic were used. Results: Chemotherapy can cause cognitive impairment between 15 and 50% of women. This disturbance may be from multiple aetiologies and can be associated with biological factors and functional and/or structural changes of the CNS. Sociodemographic, clinical and psychological factors should be considered as modulating variables. It manifests mainly with memory problems, executive function, attention and processing speed impairment. It can be measured through neuropsychological evaluation instruments. Discussion and conclusion: We suggest that chemo-induced cognitive impairment should be included to the informed consent. Further development of longitudinal studies complemented with neuroimages that allow us to advance in the knowledge of this problem is recommended. A neuropsychological protocol is proposed, which includes screening tests, clinical scales, specific cognitive tests and quality of life questionnaires, within the recommendations of the International Cognition and Cancer Task Force.
ANTECEDENTES: Los pacientes con cáncer de mama pueden experimentar dificultades cognitivas por recibir quimioterapia. Dicha alteración es denominada Deterioro Cognitivo Quimioinducido, también es conocida como Chemobrain o Chemofog. OBJETIVO: Identificar el perfil cognitivo y las características de la evaluación neuropsicológica de esta población. Método: Se consultaron las bases de datos PubMed, SpringerLink y SciELO. Se seleccionaron artículos de 1994 hasta septiembre de 2021. Fueron utilizadas palabras claves relacionadas con el tema de estudio. RESULTADOS: La quimioterapia puede producir un deterioro cognitivo entre el 15 y el 50% de las mujeres. Dicha alteración es de etiología múltiple y puede asociarse a factores biológicos y a cambios funcionales y/o estructurales del SNC. Se deben de considerar los factores sociodemográficos, clínicos y psicológicos como variables moduladoras. Se manifiesta principalmente en problemas de memoria, función ejecutiva, atención y velocidad de procesamiento. Esta alteración puede ser mensurada a través de los instrumentos de evaluación neuropsicológica disponibles. Discusión y conclusión: Se sugiere que la afectación cognitiva quimioinducida sea incorporada en el consentimiento informado. Se recomienda un mayor desarrollo de estudios longitudinales que se complementen con técnicas de neuroimágenes que permitan avanzar en el conocimiento de esta problemática. Se propone un protocolo de evaluación neuropsicológica, que incluye pruebas de screening, escalas clínicas, test neuropsicológicos específicos y de calidad de vida, según las recomendaciones del International Cognition and Cancer Task Force.
Assuntos
Neoplasias da Mama , Transtornos Cognitivos , Disfunção Cognitiva , Humanos , Feminino , Neoplasias da Mama/tratamento farmacológico , Qualidade de Vida/psicologia , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/epidemiologia , Transtornos Cognitivos/induzido quimicamente , Transtornos Cognitivos/complicações , Transtornos Cognitivos/psicologia , CogniçãoRESUMO
Introducción. La evaluación sistemática del desarrollo infantil durante los primeros años de vida es un componente esencial en el control de salud pediátrico. El Cuestionario de Edades y Etapas, tercera edición (Ages and Stages Questionnarie; ASQ-3, por sus siglas en inglés), es la escala con más estudios de validación y recomendada por el Fondo de las Naciones Unidas para la Infancia (UNICEF) para verificar que el neurodesarrollo de los niños sea normal. Es una herramienta de monitoreo que evalúa las principales áreas de desarrollo, como comunicación, motricidad gruesa, fina, socioindividual y de resolución de problemas, que permite la comparación de la población local con los estándares internacionales de desarrollo. Objetivo. Realizar la validación del ASQ-3 en un grupo de población infantil. Métodos. Se evaluaron niños en un hospital público de 1 a 66 meses de edad, por profesionales de la salud pediatras, psicólogos y psicopedagogas. Se utilizó el paquete SSPS para la determinación de los baremos de la población. Resultados. En la muestra de 630 niños, con una distribución homogénea por sexos, se establecieron una sensibilidad del 88%, especificidad del 94%, como valores predictivos positivos del 88% y negativos del 96%, comparados con la Prueba Nacional de Pesquisa (PRUNAPE) y los puntajes de corte para cada edad. Conclusión. El ASQ-3 pudo discriminar que el 19,5% de los niños estaban en riesgo de sufrir trastornos del neurodesarrollo. Cumplió con las propiedades psicométricas comparado con el estándar de oro PRUNAPE para la evaluación dirigida y sistemática de hitos madurativos en el control de salud, de manera rápida, sencilla y económica, por lo que resultó una herramienta útil en el monitoreo del neurodesarrollo infantil.
Introduction. The systematic assessment of child development in the first years of life is an essential component of pediatric health checkups. The Ages and Stages Questionnaire, third edition (ASQ-3) is the most validated scale, and has been recommended by the UNICEF to verify if children have a normal neurological development. It is a monitoring instrument to assess the main developmental areas, including communication, gross motor, fine motor, personal-social, and problem solving skills, and to compare the local population to the international development standards. Objective. To validate the ASQ-3 in a pediatric population group. Methods. Children aged 1-66 months were assessed at a public hospital by pediatricians, psychologists, and educational psychologists. The SSPS software package was used to determine population scales. Results. In 630 children, who had a homogeneous sex distribution, an 88% sensibility and a 94% specificity were determined, with a positive predictive value of 88% and a negative predictive value of 96%, compared to the National Screening Test (Prueba Nacional de Pesquisa, PRUNAPE) and the cut-off scores for each age group. Conclusion. The ASQ-3 established that 19.5% of children were at risk of experiencing neurodevelopmental disorders. The ASQ-3 met psychometric properties compared to the PRUNAPE, which is the gold standard for the targeted and systematic assessment of developmental milestones during health checkups in a rapid, simple and cost-effective manner, so it was considered useful to monitor child neurological development.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Inquéritos e Questionários , Transtornos do Neurodesenvolvimento/diagnóstico , Argentina , Fatores Etários , Técnicas de Diagnóstico NeurológicoRESUMO
INTRODUCTION: The systematic assessment of child development in the first years of life is an essential component of pediatric health checkups. The Ages and Stages Questionnaire, third edition (ASQ-3) is the most validated scale, and has been recommended by the UNICEF to verify if children have a normal neurological development. It is a monitoring instrument to assess the main developmental areas, including communication, gross motor, fine motor, personal-social, and problem solving skills, and to compare the local population to the international development standards. OBJECTIVE: To validate the ASQ-3 in a pediatric population group. METHODS: Children aged 1-66 months were assessed at a public hospital by pediatricians, psychologists, and educational psychologists. The SSPS software package was used to determine population scales. RESULTS: In 630 children, who had a homogeneous sex distribution, an 88% sensibility and a 94% specificity were determined, with a positive predictive value of 88% and a negative predictive value of 96%, compared to the National Screening Test (Prueba Nacional de Pesquisa, PRUNAPE) and the cut-off scores for each age group. CONCLUSION: The ASQ-3 established that 19.5% of children were at risk of experiencing neurodevelopmental disorders. The ASQ-3 met psychometric properties compared to the PRUNAPE, which is the gold standard for the targeted and systematic assessment of developmental milestones during health checkups in a rapid, simple and cost-effective manner, so it was considered useful to monitor child neurological development.
INTRODUCCIÓN: La evaluación sistemática del desarrollo infantil durante los primeros años de vida es un componente esencial en el control de salud pediátrico. El Cuestionario de Edades y Etapas, tercera edición (Ages and Stages Questionnarie; ASQ-3, por sus siglas en inglés), es la escala con más estudios de validación y recomendada por el Fondo de las Naciones Unidas para la Infancia (UNICEF) para verificar que el neurodesarrollo de los niños sea normal. Es una herramienta de monitoreo que evalúa las principales áreas de desarrollo, como comunicación, motricidad gruesa, fina, socioindividual y de resolución de problemas, que permite la comparación de la población local con los estándares internacionales de desarrollo. OBJETIVO: Realizar la validación del ASQ-3 en un grupo de población infantil. MÉTODOS: Se evaluaron niños en un hospital público de 1 a 66 meses de edad, por profesionales de la salud pediatras, psicólogos y psicopedagogas. Se utilizó el paquete SSPS para la determinación de los baremos de la población. RESULTADOS: En la muestra de 630 niños, con una distribución homogénea por sexos, se establecieron una sensibilidad del 88%, especificidad del 94%, como valores predictivos positivos del 88% y negativos del 96%, comparados con la Prueba Nacional de Pesquisa (PRUNAPE) y los puntajes de corte para cada edad. CONCLUSIÓN: El ASQ-3 pudo discriminar que el 19,5% de los niños estaban en riesgo de sufrir trastornos del neurodesarrollo. Cumplió con las propiedades psicométricas comparado con el estándar de oro PRUNAPE para la evaluación dirigida y sistemática de hitos madurativos en el control de salud, de manera rápida, sencilla y económica, por lo que resultó una herramienta útil en el monitoreo del neurodesarrollo infantil.
Assuntos
Transtornos do Neurodesenvolvimento/diagnóstico , Inquéritos e Questionários , Fatores Etários , Argentina , Pré-Escolar , Técnicas de Diagnóstico Neurológico , Feminino , Humanos , Lactente , MasculinoRESUMO
ASD might be associated with alterations in excitation/inhibition ratio and GABA(A) has been implicated since it mediates synaptic inhibition. Polymorphisms in GABA receptor (GABAR) were studied: significant differences in allele and genotype frequencies observed between cases and controls (rs1912960, GABRA4). Haplotype analysis: rs1912960 (GABRA4) and rs211037 (GABRG2) overrepresented in cases. Rs1912960 has been associated with ASD and rs211037 with epilepsy. GABRA4 is associated with autism in the Argentinean dataset independently or in combination with GABRG2.
Assuntos
Transtorno do Espectro Autista/diagnóstico , Transtorno do Espectro Autista/genética , Estudos de Associação Genética/métodos , Polimorfismo de Nucleotídeo Único/genética , Receptores de GABA-A/genética , Argentina/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Estudos de Casos e Controles , Feminino , Predisposição Genética para Doença/genética , Haplótipos/genética , Humanos , Masculino , Subunidades Proteicas/genéticaRESUMO
We studied behavior in a group of children with specific language impairment in its 2 subtypes (expressive and mixed receptive/expressive). After exclusion of other psychiatric conditions, we evaluated 114 children of ages 2 to 7 years using language developmental tests and behavioral screening scales. Behavior problems appeared in 54% of the children. Withdrawn was the most frequently found syndrome in preschool children, whereas anxious/depressed and social problems were the most frequent in older children. The high frequency of behavioral syndromes in children with specific language impairment is remarkable and requires the awareness of primary attendants and specialists. Anxiety, depression, social isolation, and aggressive and rule-breaking behavior can obscure identification of the language impairment. Taking into account this relationship would improve the chances of a timely and appropriate intervention.
Assuntos
Transtornos do Comportamento Infantil/complicações , Transtornos do Desenvolvimento da Linguagem/complicações , Fatores Etários , Criança , Transtornos do Comportamento Infantil/epidemiologia , Pré-Escolar , Feminino , Humanos , Testes de Inteligência , Transtornos do Desenvolvimento da Linguagem/epidemiologia , Testes de Linguagem , Masculino , Prevalência , Testes PsicológicosRESUMO
Autism spectrum disorders (ASD) can be conceptualized as a genetic dysfunction that disrupts development and function of brain circuits mediating social cognition and language. At least some forms of ASD may be associated with high level of excitation in neural circuits, and gamma-aminobutyric acid (GABA) has been implicated in its etiology. Single-nucleotide polymorphisms (SNP) located within the GABA receptor (GABAR) subunit genes GABRA1, GABRG2, GABRB3, and GABRD were screened. A hundred and thirty-six Argentinean ASD patients and 150 controls were studied, and the contribution of the SNPs in the etiology of ASD was evaluated independently and/or through gene-gene interaction using multifactor dimensionality reduction (MDR) method. From the 18 SNP studied, 11 were not present in our Argentinean population (patients and controls) and 1 SNP had minor allele frequency < 0.1%. For the remaining six SNPs, none provided statistical significant association with ASD when considering allelic or genotypic frequencies. Non-significant association with ASD was found for the haplotype analysis. MDR identified evidence for synergy between markers in GABRB3 (chromosome 15) and GABRD (chromosome 1), suggesting potential gene-gene interaction across chromosomes associated with increased risk for autism (testing balanced accuracy: 0.6081 and cross-validation consistency: 10/10, P < 0.001). Considering our Argentinean ASD sample, it can be inferred that GABRB3 would be involved in the etiology of autism through interaction with GABRD. These results support the hypothesis that GABAR subunit genes are involved in autism, most likely via complex gene-gene interactions.
Assuntos
Transtornos Globais do Desenvolvimento Infantil/genética , Marcadores Genéticos/genética , Genética Populacional , Subunidades Proteicas/genética , Receptores de GABA-A/genética , Criança , Epistasia Genética/genética , Frequência do Gene , Predisposição Genética para Doença , Genótipo , Haplótipos , Humanos , Redução Dimensional com Múltiplos Fatores , Polimorfismo de Nucleotídeo Único/genética , Valores de ReferênciaRESUMO
OBJECTIVE: Assess the usefulness of the SNAP-IV scale as an instrument for detecting attention deficit hyperactivity disorder (ADHD) in Argentine children aged 4 to 14 years. METHODS: The SNAP-IV scale was adapted and administered to a group of 1 230 schoolchildren in the province of Buenos Aires, Argentina. The diagnosis was determined with the clinical control, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The sensitivity and specificity, as well as the cut-off scores for the SNAP-IV scale in the population studied, were determined. RESULTS: The score on the SNAP-IV scale with the best correlation between sensitivity and specificity was established in order to determine the true positive cases that in fact had a clinical diagnosis. The cut-off scores obtained were: 1.66 (15/27 points) for the attention deficit subscale and 1.77 (16/27 points) for hyperactivity/impulsivity in the population studied. CONCLUSIONS: The SNAP-IV scale for detection of ADHD is considered to be valid in the population studied as long as the cut-off scores are modified to obtain the best sensitivity/specificity ratio based on the cultural and socioeconomic features of the population.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Testes Psicológicos , Inquéritos e Questionários , Adolescente , Argentina , Criança , Pré-Escolar , Feminino , Humanos , MasculinoRESUMO
OBJETIVO: Valorar la utilidad de la escala SNAP IV como instrumento de detección de trastorno por déficit de atención con hiperactividad (TDAH) en niños argentinos de 4 a 14 años de edad. MÉTODOS: Se adaptó y se administró la escala SNAP IV a un grupo de 1 230 escolares de la provincia de Buenos Aires, Argentina. Se determinó el diagnóstico con el control clínico de acuerdo a los criterios del Manual diagnóstico y estadístico de los trastornos mentales, 4.ª edición. Se determinaron la sensibilidad y especificidad así como los puntajes de corte para la escala SNAP IV en la población estudiada. RESULTADOS: Se estableció el puntaje en la escala SNAP IV que tuviera la mejor correlación entre sensibilidad y especificidad para determinar los casos verdaderos positivos que realmente tuvieran un diagnóstico clínico. Los puntajes de corte obtenidos fueron: un índice de 1,66 (15/27 puntos) para la subescala déficit de atención y de 1,77 (16/27 puntos) para hiperactividadimpulsividad en la población estudiada. CONCLUSIONES: La escala SNAP IV para detección de TDAH se considera válida en el caso de la población estudiada, siempre y cuando se modifiquen los puntajes de corte para obtener la mejor relación sensibilidad/especificidad, con base en las particularidades culturales y socioeconómicas de dicha población.
OBJECTIVE: Assess the usefulness of the SNAP-IV scale as an instrument for detecting attention deficit hyperactivity disorder (ADHD) in Argentine children aged 4 to 14 years. METHODS: The SNAP-IV scale was adapted and administered to a group of 1 230 schoolchildren in the province of Buenos Aires, Argentina. The diagnosis was determined with the clinical control, based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. The sensitivity and specificity, as well as the cut-off scores for the SNAP-IV scale in the population studied, were determined. RESULTS: The score on the SNAP-IV scale with the best correlation between sensitivity and specificity was established in order to determine the true positive cases that in fact had a clinical diagnosis. The cut-off scores obtained were: 1.66 (15/27 points) for the attention deficit subscale and 1.77 (16/27 points) for hyperactivity/impulsivity in the population studied. CONCLUSIONS: The SNAP-IV scale for detection of ADHD is considered to be valid in the population studied as long as the cut-off scores are modified to obtain the best sensitivity/specificity ratio based on the cultural and socioeconomic features of the population.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Testes Psicológicos , Inquéritos e Questionários , ArgentinaRESUMO
OBJECTIVES: To describe behavioral descompensation in adolescents with autistic spectrum disorders (ASD). METHODS: We analyzed in a prospective study the stories of 11 children and adolescents with ASD, their demographic characteristics, initial symptoms of descompensation at pubertal or adolescence stages, interventions developed and evolution with them. RESULTS: We studied the clinical stories of eleven patients, 8 men and 3 women, who consulted with behavioral descompensation periods at a mean age of 13 years (range 10- 16 years). They presented with hyperactivity/agitation (6), injuries and aggression against others or themselves (6), irritability/ emotional labiality (6), inappropriate shouting (6), inflexibility/ rituals (4) and catatonia (2). Almost all patients had received psychiatric medication before descompensation, except patients with catatonia. Four of 11 presented two episodes and seven patients only one episode during a period of 2.7 years of follow-up (range 1- 6 years). Eight of 11 patients recovered with psychological and pharmacological (a medium of 2 drugs) interventions in a mean time of 4 months. Both patients with catatonia didn't recovered, and one more patient didn't improved with pharmacological treatment. CONCLUSIONS: Behavioral descompensations are very frequent complications in patients with autism at puberty or adolescence stages. Most of them recover with very close combined interventions and familial support.