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The Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled Trial.

P Anderberg, P Barnestein-Fonseca, J Guzman-Parra, M Garolera, M Quintana, F Mayoral-Cleries, E Lemmens, J Sanmartin Berglund.

ABSTRACT: BACKGROUND: Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments.

OBJECTIVE: A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination.

METHODS: A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads-split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information. RESULTS: Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit.

CONCLUSIONS: This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field. TRIAL REGISTRATION: NCT03325699; INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/13711.

JMIR Res Protoc. 2019 Jun 21;8(6):e13711. doi: 10.2196/13711.

Acceptability of a lifelogging wearable camera in older adults with mild cognitive impairment: a mixed-method study.

O Gelonch, M Ribera, N Codern-Bové, S Ramos,M Quintana, G Chico, N Cerulla, P Lafarga, P Radeva, M Garolera

ABSTRACT: BACKGROUND:The main objective of this research was to evaluate the acceptance of technology based on a wearable lifelogging camera in a sample of older adults diagnosed with mild cognitive impairment (MCI).

METHODS:A mixed-method design was used, consisting of a self-report questionnaire, numerous images taken by users, and a series of focus group discussions. The patients were involved in an individualized training programme.

RESULTS:Nine MCI patients and their caregiver relatives were included. They showed good acceptance of the camera and downloaded an appropriate number of images on a daily basis. Perceived severity and ease of use were the main factors associated with the intention to use the device.

CONCLUSIONS:Older adults with MCI can become competent users of lifelogging wearable cameras with a good level of acceptance. Privacy concerns are outweighed by the potential benefits for memory. Limitations, strengths and implications for future research are discussed.

BMC Geriatr. 2019 Apr 16;19(1):110. doi: 10.1186/s12877-019-1132-0.

Allostatic load and executive functions in overweight adults.

J Ottino-González, MA Jurado, I García-García, X Caldú, X Prats-Soteras, E Tor, MJ Sender-Palacios, M Garolera

ABSTRACT: BACKGROUND/OBJECTIVE: Overweight is linked to inflammatory and neuroendocrine responses potentially prompting deregulations in biological systems harmful to the brain, particularly to the prefrontal cortex. This structure is crucial for executive performance, ultimately supervising behaviour. Thus, in the present work, we aimed to test the relationship between allostatic load increase, a surrogate of chronic physiological stress, and core executive functions, such as cognitive flexibility, inhibitory control, and working memory.

METHOD: Forty-seven healthy-weight and 56 overweight volunteers aged from 21 to 40 underwent medical and neuropsychological examination.

RESULTS: Overweight subjects exhibited a greater allostatic load index than healthy-weight individuals. Moreover, the allostatic load index was negatively related to inhibitory control. When separated, the link between allostatic load index and cognitive flexibility was more marked in the overweight group.

CONCLUSIONS: An overweight status was linked to chronic physiological stress. The inverse relationship between the allostatic load index and cognitive flexibility proved stronger in this group. Set-shifting alterations could sustain rigid-like behaviours and attitudes towards food.

Psychoneuroendocrinology. 2019 Aug;106:165-170. doi: 10.1016/j.psyneuen.2019.04.009. Epub 2019 Apr 8.

Effect of the catechol-O-methyltransferase Val 158 Met polymorphism on theory of mind in obesity.

X Caldú, J Ottino-González, C Sánchez-Garre, I Hernan, E Tor, MJ Sender-Palacios, JC Dreher, M Garolera, MA Jurado

ABSTRACT: Obesity is often accompanied with psychosocial adjustment problems, such as difficulties in social interactions and social withdrawal. A key aspect of social cognition is theory of mind, which allows inferring mental states, feelings, motivations, and beliefs of others and to use this information to predict their future behaviour.

Theory of mind is highly dependent on prefrontal dopaminergic neurotransmission, which is regulated by catechol-O-methyltransferase (COMT) activity. We aimed at determining whether theory of mind is altered in obesity and if this ability is modulated by COMT. Fifty patients with obesity and 47 normal-weight individuals underwent the Reading the Mind in the Eyes Test, the Wisconsin Card Sorting Test, and the Vocabulary subscale of the Wechsler Adult Intelligence Scale. The genotype for the COMT Val 158Met functional polymorphism was determined for all subjects. Patients with obesity obtained significantly lower scores in the negative items of the Reading the Mind in the Eyes Test than normal-weight subjects.

Further, an interaction effect was observed between group and COMT genotype. Specifically, the presence of the Met allele was associated to a better identification of negative mental states only in patients with obesity. Our results indicate that obesity is accompanied with difficulties in theory of mind and that this ability is influenced by the COMT genotype.

Eur Eat Disord Rev. 2019 Jul;27(4):401-409. doi: 10.1002/erv.2665. Epub 2019 Feb 13.

NEU Screen Shows High Accuracy in Detecting Cognitive Impairment in Older Persons Living With HIV.

A Prats, E López-Masramon, N Pérez-Álvarez, M Garolera, CR Fumaz, MJ Ferrer, B Clotet, JA Muñoz-Moreno

ABSTRACT: The NEUrocognitive (NEU) Screen is a practical tool proposed to screen for HIV-associated cognitive impairment in the clinical setting. This is a pencil-and-paper method that can be applied rapidly (≤10 minutes for administration) and has no copyright limitations. In this study, we aimed at investigating its diagnostic accuracy in an older population of persons living with HIV (PLWH), with cutoffs set at 30, 40, 50, and 60 years. Data were collected from a sample of 368 PLWH who underwent a comprehensive neuropsychological tests battery (gold standard).

Results of statistical tests showed that accuracy of the NEU Screen increased with age of the participants. The highest degree of precision, with a sensitivity of 91% and specificity of 92%, was obtained for people ages 60 years or older (correct classification: 91%). These optimal results point to the great potential of the NEU Screen as a tool for detecting cognitive disorders in older PLWH.

J Assoc Nurses AIDS Care. 2019 Jan-Feb;30(1):35-41. doi: 10.1097/JNC.0000000000000003.

Cognitive impairment following chemotherapy for breast cancer: The impact of practice effect on results.

N Cerulla, À Arcusa, JB Navarro, N de la Osa, M Garolera, C Enero, G Chico, L Fernández-Morales.

ABSTRACT: Chemotherapy-Related Cognitive Impairment (CRCI) can be an adverse effect in women treated for breast cancer. Some longitudinal studies reported deficits in attention, memory, and executive function following treatment, but other studies did not find cognitive changes. It is known that practice effects (PE) on repeated assessments with cognitive tests contribute to the discrepancies in these results, but its influence on scores has not been systematically explored. The present study examines the impact of PE on retest scores in a group of women with breast cancer treated with chemotherapy and evaluated longitudinally.

METHOD: 51 women with breast cancer treated with a combination of 5-fluorouracil, epirubicin, and cyclophosphamide with or without taxanes were assessed after surgery but before chemotherapy (T1), post-chemotherapy (T2), and at one year after T2 (T3). Longitudinal changes on cognitive performance were analyzed twice: when retest scores were not corrected for PE and when correction for PE was applied to T2 and T3 scores.

RESULTS: When PE was not corrected, progressive improvement over time in measures of memory and divided attention at T2 and T3 was observed. In contrast, when PE was corrected, worsening was found in measures of memory, fluency, executive function, and attention at T2 and in attention and executive function at T3. Results after correction for PE are in line with previous longitudinal studies that report cognitive impairment after treatment with chemotherapy for breast cancer.

CONCLUSION: Accounting for PE is recommended to identify true change on cognition through treatment with chemotherapy for breast cancer.

J Clin Exp Neuropsychol. 2019 Apr;41(3):290-299. doi: 10.1080/13803395.2018.1546381. Epub 2018 Nov 26.

Allostatic load and disordered white matter microstructure in overweight adults.

J Ottino-González, MA Jurado, I García-García, B Segura, I Marqués-Iturria, MJ Sender-Palacios, E Tor, X Prats-Soteras, X Caldú, C Junqué, O Pasternak, M Garolera.

ABSTRACT: Overweight and stress are both related to brain structural abnormalities. The allostatic load model states that frequent disruption of homeostasis is inherently linked to oxidative stress and inflammatory responses that in turn can damage the brain. However, the effects of the allostatic load on the central nervous system remain largely unknown. The current study aimed to assess the relationship between the allostatic load and the composition of whole-brain white matter tracts in overweight subjects. Additionally, we have also tested for grey matterchanges regarding allostatic load increase.

Thirty-one overweight-to-obese adults and 21 lean controls participated in the study. Our results showed that overweight participants presented higher allostatic load indexes. Such increases correlated with lower fractional anisotropy in the inferior fronto-occipital fasciculi and the right anterior corona radiata, as well as with grey matter reductions in the left precentral gyrus, the left lateral occipital gyrus, and the right pars opercularis. These results suggest that an otherwise healthy overweight status is linked to long-term biological changes potentially harmful to the brain.

Sci Rep. 2018 Oct 26;8(1):15898. doi: 10.1038/s41598-018-34219-8

Transcranial magnetic stimulation intervention in Alzheimer's disease: a research proposal for a randomized controlled trial.

EM Marron, R Viejo-Sobera, M Quintana, D Redolar-Ripoll, D Rodríguez, M Garolera

ABSTRACT: OBJECTIVE: Alzheimer's disease is a major health problem in our society. To date, pharmacological treatments have obtained poor results and there is a growing interest in finding non-pharmacological interventions for this disease. Transcranial magnetic stimulation (TMS) is a non-invasive technique that is able to induce changes in brain activity and long-term modifications in impaired neural networks, becoming a promising clinical intervention. Our goal is to study the benefit of individualized TMS targeting based on the patient's functional connectivity (personalized targeting), and short duration TMS protocol, instead of current non-individualized and longer session approaches. A double blind randomized controlled trial will be conducted to assess the effects of TMS treatment immediately, 1 month, 3 months and 6 months after the end of the intervention. Fifty-four patients with a diagnosis of Alzheimer's disease will be randomly allocated into experimental (active TMS), sham control, or conventional intervention control group. We will quantify changes in cognitive, functional, and emotional deficits in Alzheimer patients, as well as the functional connectivity changes induced by the TMS treatment.

RESULTS: We expect to demonstrate that personalized TMS intervention has a measurable positive impact in cognition, emotion, daily living activities and brain connectivity, thus representing a potential treatment for Alzheimer's disease. Trial registration The trial has been prospectively registered at, identifier NCT03121066. Date of registration: 04/19/2017.

BMC Res Notes. 2018 Sep 5;11(1):648. doi: 10.1186/s13104-018-3757-z.

The effect of depressive symptoms on cognition in patients with fibromyalgia.

O Gelonch, M Garolera M, Valls J, Castellà G, Varela O, Rosselló L, Pifarre J.

ABSTRACT: BACKGROUND: Fibromyalgia (FM) patients frequently complain of cognitive problems, but it remains unclear whether these cognitive complaints can be attributed to a dysfunction of the central nervous system or if they can be explained by other factors associated with the disease, such as depression, anxiety and sleep dysfunction.

METHODS: One hundred and ten patients with FM were compared with thirty-three patients diagnosed with a depressive disorder (DD) and fifty healthy controls (HC). Several measures of attention and executive functions were used to make these comparisons and the patientswere also asked to complete questionnaires on depression, anxiety and sleep quality. Univariate analyses of covariance (ANCOVA) were performed to identify and control confounders and multiple linear models were used to examine the effects of fibromyalgia and depression on cognitive measures.

RESULTS: FM and HC differed significantly with respect to depression, anxiety and sleep dysfunction, whereas FM and DD did not differ in terms of symptoms of depression and anxiety. However, FM was associated with a worse quality of sleep than DD. Comparisons of cognitive performance between groups showed that short-term and working memory and inattention measures were only associated with symptoms of depression, whereas selective attention was associated with both depression and fibromyalgia, and processing speed, cognitive flexibility and inhibitory control showed a significant interaction between depression and fibromyalgia. Moreover, cognitive flexibility and inhibition abilities were specifically associated with FM.

CONCLUSION: FM patients show a cluster of cognitive impairment in the attentional and executive domains, although some of the symptomsobserved could be explained by the severity of the symptoms of depression, while others seem to depend on the effects of fibromyalgia. Implications of the findings for the understanding and management of cognitive impairment of FM patients are discussed.

PLoS One. 2018 Jul 5;13(7):e0200057. doi: 10.1371/journal.pone.0200057. eCollection 2018.

Anxiety, hospital fears and conduct and behavioral alterations during pediatric hospitalization.

B De Mula-Fuentes, M Quintana, J Rimbau, A Martínez-Mejías, MS Úriz, C Rivera-Pérez, M Garolera.

ABSTRACT: INTRODUCTION: A hospital admission is an experience capable of generating emotional and behavioral alterations at any age. This study pretends to analyze the response of anxiety, fears and/or behavioral alterations in pediatric patients exposed to a conventional non-surgical hospital admission and the existing relationship between these responses and certain modulating variables. Metodology. Design of cohorts. Data collection was carried out in three stages (M1: at admission; M2: at discharge; M3: 2 weeks after discharge), on a 30 patient sample between the ages of 6 to 15 years and 30 caregivers. A comparison was made on the mean of the repeated measurements (Student t) of the respond variables and their correlation (Pearson’s Coefficient Correlation) with modulating variables.

RESULTS: The results of the intra-subject analysis showed significance in terms of anxiety levels state in patients in M1 versus M3 (t=3.93, p<.0001, d=0.69) and the magnitude of the total behavioral alterations registered in M1 versus M3 (t=-5.02, p<.0001, d=0.60). It was observed that a significant relationship between modulating variables of patients (anxiety risk) and of the caregiver (anxiety character state, strategy of confrontation) and the variables of response of the anxiety and behavioral alterations of the patient.

CONCLUSIONS: Exposure of a conventional non-surgical hospital admission may have negative consequences at an emotional and behavioral level in children, present far beyond the hospital admission. Certain variables, from the patient and the caregiver, are psychological vulnerability factors before a hospitalization process.

Actas Esp Psiquiatr. 2018 Mar;46(2):42-50. Epub 2018 Mar 1.

Aging in HIV-Infected Subjects: A New Scenario and a New View.

E Negredo, D Back, JR Blanco, J Blanco, KM Erlandson, M Garolera, G Guaraldi, P Mallon, J Moltó, JA Serra, B Clotet.

ABSTRACT: The prevalence of HIV-infected people aged 50 years or older is increasing rapidly; the proportion will increase from 28% to 73% in 2030. In addition, HIV-infected individuals may be more vulnerable to age-related condition. There is growing evidence that the prevalence of comorbidities and other age-related conditions (geriatric syndromes, functional or neurocognitive/mental problems, polypharmacy, and social difficulties) is higher in the HIV-infected population than in their uninfected counterparts.

However, despite the potential impact of this situation on health care, little information exists about the optimal clinical management of older HIV-infected people. Here we examine the age-related conditions in older HIV-infected persons and address clinical management according to author expertise and published literature. Our aim is to advance the debate about the most appropriate management of this population, including less well-studied aspects, such as frequency of screening for psychological/mental and social and functional capabilities.

Biomed Res Int. 2017;2017:5897298. doi: 10.1155/2017/5897298. Epub 2017 Dec 21. Review.

Allostatic Load Is Linked to Cortical Thickness Changes Depending on Body-Weight Status.

J Ottino-González, MA Jurado, I García-García, B Segura, I Marqués-Iturria, MJ Sender-Palacios, E Tor, X Prats-Soteras, X Caldú, C Junqué, M Garolera.

ABSTRACT: Objective: Overweight (body mass index or BMI ≥ 25 kg/m2) and stress interact with each other in complex ways. Overweight promotes chronic low-inflammation states, while stress is known to mediate caloric intake. Both conditions are linked to several avoidable health problems and to cognitive decline, brain atrophy, and dementia. Since it was proposed as a framework for the onset of mental illness, the allostatic load model has received increasing attention. Although changes in health and cognition related to overweight and stress are well-documented separately, the association between allostatic load and brain integrity has not been addressed in depth, especially among overweight subjects. Method: Thirty-four healthy overweight-to-obese and 29 lean adults underwent blood testing, neuropsychological examination, and magnetic resonance imaging to assess the relationship between cortical thickness and allostatic load, represented as an index of 15 biomarkers (this is, systolic and diastolic arterial tension, glycated hemoglobin, glucose, creatinine, total cholesterol, HDL and LDL cholesterol, triglycerides, c-reactive protein, interleukin-6, insulin, cortisol, fibrinogen, and leptin). 

Results: Allostatic load indexes showed widespread positive and negative significant correlations (p < 0.01) with cortical thickness values depending on body-weight status. 

Conclusion: The increase of allostatic load is linked to changes in the gray matter composition of regions monitoring behavior, sensory-reward processing, and general cognitive function.

Front Hum Neurosci. 2017 Dec 22;11:639. doi: 10.3389/fnhum.2017.00639. eCollection 2017

Neuropsychological Outcome One Year after Carotid Revascularization: A before-and-after Study.

L Casas-Hernanz, M Garolera, D Badenes, S Quintana, S Millán, N Calzado, J de Francisco, J Royo, M Aguilar.

ABSTRACT: PURPOSE: The aim of our study was to determine the clinical profile of patients considered cognitive 'responders' to surgery in order to establish clinical variables associated with a favorable cognitive performance.

MATERIALS AND METHODS: A total of 70 patients were included in the study. A well-validated, comprehensive standardized neurocognitive battery of tests of about 2 hours was administered. Patients were examined twice, 1-week before surgery and 1-year postoperatively. The criterion to be included in the 'responder' group was the following: to obtain a positive difference between post-revascularization and pre-revascularization neuropsychological assessment ≥1 standard deviation in ≥2 tests.

RESULTS: Twenty-seven patients (38.6%) were cognitive responders to treatment. In bivariate analysis between responders and non-responders, presence of atrophy (P=0.003), small vessels (P=0.577), symptoms (P=0.046), and age (P=0.030) were the factors statistically significant. When comparing cognitive performance before and after carotid revascularization, significant differences were observed in semantic fluency with a lower performance after 12 months (P=0.004, d=0.29), and in the Language index (Repeatable Battery for the Assessment of Neuropsychological Status) (P=0.005, d=0.34).

CONCLUSION: Patients without neurological symptoms, of a younger age and without atrophy and white matter small vessel lesions are better cognitive responders 1-year after carotid revascularization.

Vasc Specialist Int. 2017 Dec;33(4):146-155. doi: 10.5758/vsi.2017.33.4.146. Epub 2017 Dec 31

Transdermal rivastigmine for HIV-associated cognitive impairment: A randomized pilot study.

JA Muñoz-Moreno, A Prats, J Moltó, M Garolera, N Pérez-Álvarez, C Díez-Quevedo, C Miranda, CR Fumaz, MJ Ferrer, B Clotet; TRIANT-TE Study Group.

ABSTRACT: OBJECTIVE: To assess the efficacy and safety of transdermal rivastigmine for the treatment of HIV-associated cognitive impairment.

METHODS: We recruited HIV-infected patients with cognitive impairment on stable antiretroviral therapy in a randomized controlled pilot trial with a 48-week follow-up. An additional assessment was held at 12 weeks. Participants received transdermal rivastigmine (9.5 mg daily), lithium (400 mg twice daily, titrated progressively), or remained in a control group (no new medication). The primary efficacy endpoint was change in a global cognitive score (NPZ-7). Secondary endpoints included change in specific cognitive measures, domains, and functional parameters. Safety covered the frequency of adverse events and changes in laboratory results.

RESULTS: Seventy-six subjects were screened, and 29 were finally enrolled. Better cognitive outcomes were observed in all groups, although there were no significant differences between the arms (mean NPZ-7 change [SD]): rivastigmine, 0.35 (0.14); lithium, 0.25 (0.40); control, 0.20 (0.44) (p = 0.78). The rivastigmine group showed the highest positive trend (mean NPZ-7 [SD], baseline vs week 48): rivastigmine, -0.47 (0.22) vs -0.11 (0.29), p = 0.06; lithium, -0.50 (0.40) vs -0.26 (0.21), p = 0.22; control, -0.52 (0.34) vs -0.32 (0.52), p = 0.44. The cognitive domains with the highest positive trends were information processing speed at week 12 and executive function at week 48 (rivastigmine vs control): information processing speed, 0.35 (0.64) vs -0.13 (0.25), p = 0.17, d = 0.96; and executive functioning, 0.73 (0.33) vs 0.03 (0.74), p = 0.09, d = 1.18. No relevant changes were observed regarding functional outcomes. A total of 12 (41%) individuals dropped out of the study: 2 (20%) were due to medication-related effects in the rivastigmine group and 4 (36%) in the lithium group. No severe adverse events were reported.

CONCLUSIONS: The results from this small randomized trial indicate that transdermal rivastigmine did not provide significant cognitivebenefits in people with HAND on stable antiretroviral therapy, even though positive trends were found in specific cognitive domains. Relevant tolerability issues were not observed.

PLoS One. 2017 Aug 30;12(8):e0182547. doi: 10.1371/journal.pone.0182547. eCollection 2017.

Relationship between neuropsychological tests and driver's license renewal tests in Parkinson's disease.

D Badenes, M Garolera, L Casas, JC Cejudo-Bolivar, S Zaragoza, N Calzado, M Aguilar.

ABSTRACT: OBJECTIVE: To determine whether the standard Spanish driving test (ASDE test) was able to identify patients with Parkinson's disease (PD) at risk of unsafe driving and to examine the relationship between the ASDE test and the Useful Field of View (UFOV) as well as with a battery of neuropsychological tests in drivers with PD.

METHODS: Thirty-seven patients with PD and 33 controls matched by age and education level were included in an observational study. All participants were active drivers and patients with PD underwent study procedures after taking the medication in the "on" period. Subjects with a Mini-Mental State Examination (MMSE) score ≤ 24 were excluded. Neuropsychological tests (Repeatable Battery for NeuropsychologicalStatus [RBANS], Trail Making Test [TMT-A and -B], and Block Design test), driving performance tests (ASDE Driver Test and UFOV), and daytime sleepiness (Epworth Sleepiness Scale) were assessed.

RESULTS: The PD group performed significantly worse than healthy controls in the ASDE Motor Coordination tests. No significant differences were observed in anticipation speed, multiple reaction time, concentrated attention, and resistance to monotony. All participants successfully completed the UFOV tests. Statistically significant differences between patients with PD and controls were found in processing speed (UFOV1; P =.03) and more patients with PD were found in the categories of higher driving risk levels (P =.03). In addition, patients with PD showed worse scores than healthy controls in visuospatial capacities (Line Orientation), psychomotor speed (Coding and TMT-A), memory (List Recognition, Story Recall), and executive function (TMT-B). The driving tests (ASDE and UFOV) showed a low sensitivity and a high specificity but a higher percentage of patients in the PD group failed in multiple reaction time, concentrated attention, and resistance to monotony. In addition, 18.9% of patients with PD showed a cutoff of 4 for UFOV risk. In the discriminant analysis, Line Orientation (visuospatial/constructive domain) and Figure Recall (delayed memory) were found to be statistically significant with a rate of correct classification of unsafe drivers with PD of 78.2%. In addition, normal results on the Line Orientation item were associated with a 1.5 times higher probability of non-risky driving in the multivariate analysis.

CONCLUSIONS: At early stages of the disease, about 19% of patients with PD showed difficulties that may affect their driving capabilities. Line Orientation and Figure Recall are useful to alert clinicians to the risk of unsafe driving. For this reason, patients with PD should be evaluated for driving abilities more regularly to determine the extent of deficits that may influence driving performance.

Traffic Inj Prev. 2018 Feb 17;19(2):125-132. doi: 10.1080/15389588.2017.1360491. Epub 2017 Oct 11.

Role of taxanes in chemotherapy-related cognitive impairment: A prospective longitudinal study.

N Cerulla, À Arcusa, JB Navarro, M Garolera, C Enero, G Chico, L Fernández-Morales.

ABSTRACT: PURPOSE: The aim of this study is to elucidate the role of taxanes on cognition when they are administered as a part of the treatment with a fluorouracil, epirubicin and cyclophosphamide (FEC) regimen for breast cancer (BC).

METHODS: Two groups of women (n = 51) with a novel diagnostic of BC that were treated with a combination of FEC alone (6 cycles of FEC) or with taxanes (4 cycles of FEC plus 8 cycles of taxanes) were compared at three moments: before chemotherapy, after its completion (short-term evaluation) and at a mean of 74.5 weeks from baseline as a long-term evaluation.

RESULTS: Both groups showed worsening in tests of attention and executive functions on the short-term assessment, with the group treated with taxanes showing more number of affected cognitive measures at this time point, including verbal learning and speed measures. At the long-term evaluation, cognitive dysfunction was still found in attention and executive functions in both groups.

CONCLUSION: Our results suggest that chemotherapy for BC with a FEC regimen can have a negative effect on cognition. Acute deficits seem to be larger when taxanes are added, but treatment seems to affect cognition also at long term.

Breast Cancer Res Treat. 2017 Jul;164(1):179-187. doi: 10.1007/s10549-017-4240-6. Epub 2017 Apr 18.

Cognitive complaints in women with fibromyalgia: Are they due to depression or to objective cognitive dysfunction?

O Gelonch, M Garolera, J Valls, L Rosselló, J Pifarré.

ABSTRACT: INTRODUCTION: Cognitive complaints are common in fibromyalgia, but it is unclear whether they represent an objective cognitive dysfunction or whether they could be explained by depressive symptoms. Here, we aim to elucidate the frequency of subjective cognitivecomplaints in a sample of women with fibromyalgia, in addition to analyzing associations between these subjective complaints and objectivemeasures linked to the attention and executive cognitive domains. Finally, we aim to investigate the ability of demographic, clinical, and psychological variables to explain the subjective complaints observed.

METHOD: One hundred and five women aged 30-55 years diagnosed with fibromyalgia completed a neuropsychological assessment, which included measures of attention and executive functions. They also completed self-report inventories of subjective cognitive complaints, depression, anxiety, intensity of pain, sleep quality, everyday physical functioning, and quality of life.

RESULTS: Eighty-four percent of the patients reported subjective cognitive complaints. Depression scores, everyday physical functioning, and working memory performance were most strongly associated with subjective cognitive complaints. These three variables were significant predictors for subjective cognitive complaints with a final model explaining 32% of the variance.

CONCLUSIONS: Cognitive complaints are very frequent in patients with fibromyalgia, and these are related to functional and cognitiveimpairment as well as to depressive symptoms.

J Clin Exp Neuropsychol. 2017 Dec;39(10):1013-1025. doi: 10.1080/13803395.2017.1301391. Epub 2017 Mar 17.

Comparison of neuropsychological and functional outcomes in Alzheimer's disease patients with good or bad response to a cognitive stimulation treatment: a retrospective analysis.

M Martínez-Moreno, N Cerulla, G Chico, M Quintana, M Garolera.

ABSTRACT: BACKGROUND: The benefit of cognitive stimulation (CS) treatments in dementia is unequal. This study has sought to identify cognitive and functional measurements before and after the treatment which are indicative of a better response to a one-year CS program.

METHODS: A retrospective observational study was conducted between 2004 and 2012 in a sample of 60 users diagnosed with mild Alzheimer's disease (AD) who followed a one-year CS program and underwent a cognitive and functional assessment before and after the intervention. As a primary measure of treatment response, we used the annual change of the Mini-Mental State Examination (MMSE) scores, which distinguished good responders (R) from non-responders (NR).

RESULTS: 51.7% of patients classified as R at baseline had a higher cognitive performance in attention, immediate verbal memory, language, and working memory compared to NR. No initial statistically significant differences were found between R and NR in any sociodemographic variables, medical conditions, anxiety and/or depressive symptoms, treatment with cholinesterase inhibitors (ChEIs), level of insight, global cognitive function (MMSE), or functional capacity. After 12 months of treatment, R had significantly better results than NR on MMSE, temporal orientation, category evocation, and Philadelphia Geriatric Center-Instrumental Activities of Daily Living (PGC-IADL).

CONCLUSION: The response to a CS treatment of some subjects over others is linked to cognitive and functional capacity. This research contributes to characterize the neuropsychological profile that differentiates subjects who respond better than others before and after the treatment. This should contribute to customize and optimize neuropsychological interventions in patients with AD.

Int Psychogeriatr. 2016 Nov;28(11):1821-1833. Epub 2016 Aug 9.

Neuropsychological performance of young familial hypercholesterolemia patients.

M Ariza, N Cuenca, M Mauri, MA Jurado, M Garolera.

ABSTRACT: Eur J Intern Med. 2016 Oct;34:e29-e31. doi: 10.1016/j.ejim.2016.05.009. Epub 2016 Jun 2. No abstract available.

BMC Res Notes. 2018 Sep 5;11(1):648. doi: 10.1186/s13104-018-3757-z.

Executive function in fibromyalgia: Comparing subjective and objective measures.

O Gelonch, M Garolera, J Valls J, L Rosselló L, J Pifarré

ABSTRACT: BACKGROUND: There is evidence to suggest the existence of an executive dysfunction in people diagnosed with fibromyalgia, although there are certain inconsistencies between studies. Here, we aim to compare executive performance between patients with fibromyalgia and a control group by using subjective and objective cognitive tests, analyzing the influence of patient mood on the results obtained, and studying associations between the two measures.

METHOD: 82 patients diagnosed with fibromyalgia and 42 healthy controls, matched by age and years of education, were assessed using the Behavioral Rating Inventory of Executive Function - Adult Version (BRIEF-A) as a subjective measure of executive functioning. A selection of objective cognitive tests were also used to measure a series of executive functions and to identify symptoms of depression and anxiety.

RESULTS: Patients with fibromyalgia perceived greater difficulties than the control group on all of the BRIEF-A scales. However, after adjustments were made for depression and anxiety the only differences that remained were those associated with the working memory scale and the Metacognition and Global Executive Composite index. In the case of the objective cognitive tests, a significantly worse overall performance was evidenced for the fibromyalgia patients. However, this also disappeared when adjustments were made for depression and anxiety. After this adjustment, fibromyalgia patients only performed significantly worse for the interference effect in the Stroop Test. Although there were no significant associations between most of the objective cognitive tests and the BRIEF-A scales, depression and anxiety exhibited strong associations with almost all of the BRIEF-A scales and with several of the objective cognitive tests.

CONCLUSIONS: Patients with fibromyalgia showed executive dysfunction in subjective and objective measures, although most of this impairment was associated with mood disturbances. Exceptions to this general rule were observed in the impairment of working memory evidenced on the BRIEF-A scale and the inhibition impairment exhibited by the interference effect from the Stroop Test. The two types of measurement provide different yet complementary information.

Compr Psychiatry. 2016 Apr;66:113-22. doi: 10.1016/j.comppsych.2016.01.002. Epub 2016 Jan 20.

Long-term far-transfer effects of working memory training in children with ADHD: a randomized controlled trial.

A Bigorra A, M Garolera , S Guijarro , A Hervás.

ABSTRACT: ADHD affects working memory (WM) and other executive functions (EFs) and thereby negatively impacts school performance, clinical symptoms and functional impairment. The main aim of this study was to analyse the efficacy of computerized WM training (CWMT) on EF rating scales. A secondary objective was to assess its efficacy on performance-based measures of EF (PBMEF), learning, clinical symptoms and functional impairment. 66 children with combined-type ADHD between 7 and 12 years of age from the Child and Adolescent Psychiatric Unit (Spain) were included in this randomized, double-blind, placebo-controlled, parallel-group clinical trial. The participants were randomized (1:1) to an experimental group (EG) (CWMT) (n = 36) or a control group (CG) (placebo training). Assessments were conducted at baseline (T0), 1-2 weeks (T1), and 6 months post-intervention (T2) with the administration of EF rating scales, PBMEF, measures of academic achievement, and questionnaires regarding clinical symptoms and functional impairment.

Participants, parents, teachers and professionals who performed the cognitive assessments were blinded. Adjusted multiple linear regression analysis showed significant improvements in EF scales-parent version, from T1 to T2, on the metacognition index [p = 0.03, d' = -0.78 (95 % CI -1.28 to -0.27)] and on WM (also significant at T2-T0) and plan/organize subscales. Significant improvements were also noted in EF scales-teacher version, from T0 to T1 and T2, on the metacognitive index [p = 0.05, d' = -0.37 (95 % CI -0.86 to 0.12) T1-T0, p = 0.02, d' = -0.81 (95 % CI -1.31 to -0.30) T2-T0] and on the initiate, WM, monitor and shift subscales. There were also significant improvements in PBMEF, ADHD symptoms, and functional impairment. CWMT had a significant impact on ADHD deficits by achieving long-term far-transfer effects.

Eur Child Adolesc Psychiatry. 2015 Dec 15. [Epub ahead of print]

Affected connectivity organization of the reward system structure in obesity

I Marqués-Iturria, L H Scholtens, M Garolera, R Pueyo, I García-García, P González-Tartiere, B Segura, C Junqué, M J Sender-Palacios, M Vernet-Vernet, C Sánchez-Garre, M.A. De Reus, M.A. Jurado, M P Van den Heuvel

ABSTRACT: With the prevalence of obesity rapidly increasing worldwide, understanding the processes leading to excessive eating behavior becomes increasingly important. Considering the widely recognized crucial role of reward processes in food intake, we examined the white matter wiring and integrity of the anatomical reward network in obesity. Anatomical wiring of the reward network was reconstructed derived from diffusion weighted imaging in 31 obese participants and 32 normal-weight participants. Network wiring was compared in terms of the white matter volume as well as in terms of white matter microstructure, revealing lower number of streamlines and lower fiber integrity within the reward network in obese subjects. Specifically, the orbitofrontal cortex and striatum nuclei including accumbens, caudate and putamen showed lower strength and network clustering in the obesity group as compared to healthy controls.

Our results provide evidence for obesity-related disruptions of global and local anatomical connectivity of the reward circuitry in regions that are key in the reinforcing mechanisms of eating-behavior processes. Copyright © 2015 Elsevier Inc. All rights reserved.

NeuroImage. 02/2015; 111. DOI: 10.1016

Reward processing in obesity, substance addiction and non-substance addiction

I. García‐García, A. Horstmann, M. A. Jurado, M. Garolera, S. J. Chaudhry, D. S. Margulies, A. Villringer, J. Neumann

ABSTRACT: Similarities and differences between obesity and addiction are a prominent topic of ongoing research. We conducted an activation likelihood estimation meta-analysis on 87 studies in order to map the functional magnetic resonance imaging (fMRI) response to reward in participants with obesity, substance addiction and non-substance (or behavioural) addiction, and to identify commonalities and differences between them.

Obesity Reviews 10/2014;

Classification Models for Neurocognitive Impairment in HIV Infection Based on Demographic and Clinical Variables.

Jose A Muñoz-Moreno, Núria Pérez-Álvarez, Amalia Muñoz-Murillo, Anna Prats, Maite Garolera, M Àngels Jurado, Carmina R Fumaz, Eugènia Negredo, Maria J Ferrer, Bonaventura Clotet

ABSTRACT: We used demographic and clinical data to design practical classification models for prediction of neurocognitive impairment (NCI) in people with HIV infection.

PLoS ONE 09/2014; 9(9):e107625.

Driving competences and neuropsychological factors associated to driving counseling in multiple sclerosis.

Dolors Badenes, Maite Garolera, Laura Casas, Juan Carlos Cejudo-Bolivar, Jorge de Francisco, Silvia Zaragoza, Noemi Calzado, Miquel Aguilar

ABSTRACT: Multiple Sclerosis (MS) significantly impacts daily living activities, including car driving. To investigate driving difficulties experienced with MS, we compared 50 MS patients with minor or moderate disability and 50 healthy controls (HC) using computerized driving tests (the ASDE driver test and the Useful Field of View (UFOV) test) and neuropsychological tests. Inclusion criteria included being active drivers. We evaluated whether cognitive deterioration in MS is associated with the results of driving tests by comparing MS patients without cognitive deterioration with HC. The results indicated that the MS patients performed worse than the HCs in attention, information processing, working memory and visuomotor coordination tasks. Furthermore, MS patients with cognitive impairments experienced more difficulties in the driving tests than did the non-impaired MS patients. Motor dysfunction associated with MS also played an important role in this activity.

The results of this study suggest that MS should be assessed carefully and that special emphasis should be placed on visuomotor coordination and executive functions because patients with minor motor disability and subtle cognitive impairments can pass measures predictive of driving safety. (JINS, 2014, 20, 555-565).

Journal of the International Neuropsychological Society 05/2014; 20(5):555-65.

The interaction effect between BDNF val66met polymorphism and obesity on executive functions and frontal structure.

Idoia Marqués-Iturria, Maite Garolera, Roser Pueyo, Bàrbara Segura, Imma Hernan, Isabel García-García, Consuelo Sánchez-Garre, María Vernet-Vernet, María José Sender-Palacios, Ana Narberhaus, Mar Ariza, Carme Junqué, María Ángeles Jurado

ABSTRACT: The prevalence of obesity is increasing worldwide. Previous research has shown a relationship between obesity and both executive functioning alterations and frontal cortex volume reductions. The Brain Derived Neurotrophic Factor val66met polymorphism, involved in eating behavior, has also been associated with executive functions and prefrontal cortex volume, but to date it has not been studied in relation to obesity. Our aim is to elucidate whether the interaction between the Brain Derived Neurotrophic Factor val66met polymorphism and obesity status influences executive performance and frontal-subcortical brain structure. Sixty-one volunteers, 34 obese and 27 controls, age range 12-40, participated in the study. Participants were assigned to one of two genotype groups (met allele carriers, n = 16, or non-carriers, n = 45). Neuropsychological assessment comprised the Trail Making Test, the Stroop Test and the Wisconsin Card Sorting Test, all tasks that require response inhibition and cognitive flexibility. Subjects underwent magnetic resonance imaging in a Siemens TIM TRIO 3T scanner and images were analyzed using the FreeSurfer software. Analyses of covariance controlling for age and intelligence showed an effect of the obesity-by-genotype interaction on perseverative responses on the Wisconsin Card Sorting Test as well as on precentral and caudal middle frontal cortical thickness: obese met allele carriers showed more perseverations on the Wisconsin Card Sorting Test and lower frontal thickness than obese non-carriers and controls.

In conclusion, the Brain Derived Neurotrophic Factor may play an important role in executive functioning and frontal brain structure in obesity. © 2014 Wiley Periodicals, Inc.

American Journal of Medical Genetics Part B Neuropsychiatric Genetics 03/2014; 165(3).

Active labeling application applied to food-related object recognition

Marc Bolaños, Maite Garolera, Petia Radeva

ABSTRACT: Every day, lifelogging devices, available for recording different aspects of our daily life, increase in number, quality and functions, just like the multiple applications that we give to them. Applying wearable devices to analyse the nutritional habits of people is a challenging application based on acquiring and analyzing life records in long periods of time. However, to extract the information of interest related to the eating patterns of people, we need automatic methods to process large amount of life-logging data (e.g. recognition of food-related objects).

Creating a rich set of manually labeled samples to train the algorithms is slow, tedious and subjective. To address this problem, we propose a novel method in the framework of Active Labeling for construct- ing a training set of thousands of images. Inspired by the hierarchical sampling method for active learning [6], we pro- pose an Active forest that organizes hierarchically the data for easy and fast labeling. Moreover, introducing a classifier into the hierarchical structures, as well as transforming the feature space for better data clustering, additionally im- prove the algorithm.

Our method is successfully tested to label 89.700 food-related objects and achieves significant reduction in expert time labelling.

Proceedings of the 5th international workshop on Multimedia for cooking & eating activities; 10/2013

Frontal cortical thinning and subcortical volumen reductions in early adulthood obesity

Idoia Marqués-Iturria, Roser Pueyo, Maite Garolera, Bàrbara Segura, Carme Junqué, Isabel García-García, Maria José Sender-Palacios, Maria Vernet-Vernet, Ana Narberhaus, Mar Ariza, María Ángeles Jurado

ABSTRACT: Obesity depends on homeostatic and hedonic food intake behavior, mediated by brain plasticity changes in cortical and subcortical structures. The aim of this study was to investigate cortical thickness and subcortical volumes of regions related to food intake behavior in a healthy young adult sample with obesity. Thirty-seven volunteers, 19 with obesity (age=33.7±5.7 (20–39) years body-mass index (BMI)=36.08±5.92 (30.10–49.69)kg/m2) and 18 controls (age=32.3±5.9 (21–40) years; BMI=22.54±1.94 (19.53–24.97)kg/m2) participated in the study. Patients with neuropsychiatric or biomedical disorders were excluded. We used FreeSurfer software to analyze structural magnetic resonance images (MRI) and obtain global brain measures, cortical thickness and subcortical volume estimations. Finally, correlation analyses were performed for brain structure data and obesity measures. There were no between-group differences in age, gender, intelligence or education.

Results showed cortical thickness reductions in obesity in the left superior frontal and right medial orbitofrontal cortex. In addition, the obesity group had lower ventral diencephalon and brainstem volumes than controls, while there were no differences in any other subcortical structure. There were no statistically significant correlations between brain structure and obesity measures. Overall, our work provides evidence of the structural brain characteristics associated with metabolically normal obesity. We found reductions in cortical thickness, ventral diencephalon and brainstem volumes in areas that have been implicated in food intake behavior.

Psychiatry Research Neuroimaging 09/2013

Computer-assisted cognitive remediation therapy: Cognition, self-esteem and quality of life in schizophrenia.

Gemma Garrido, Maite Barrios, Rafael Penadés, Maria Enríquez, Maite Garolera, Núria Aragay, Marta Pajares, Vicenç Vallès, Luis Delgado, Joan Alberni, Carlota Faixa, Josep M Vendrell

ABSTRACT: Quality of life (QoL) is an important outcome in the treatment of schizophrenia. Cognitive deficits have an impact on functional outcomes. Cognitive remediation therapy is emerging as a psychological intervention that targets cognitive impairment, but the effect of computer-assisted cognitive remediation on neuropsychology and social functioning and wellbeing remains unclear. The aim of the current study is to investigate the neurocognitive outcomes of computer-assisted cognitive remediation (CACR) therapy in a sample of schizophrenia patients, and to measure the quality of life and self-esteem as secondary outcomes. Sixty-seven people with schizophrenia were randomly assigned to computer-assisted cognitive remediation or an active control condition. The main outcomes were neuropsychological measures and secondary outcomes (self-esteem and quality of life).

Measurements were recorded at baseline and post-treatment. The CACR therapy group improved in speed of processing, working memory and reasoning and problem-solving cognitive domains. QoL and self-esteem measures also showed significant improvements over time in this group. Computer-assisted cognitive remediation therapy for people with schizophrenia achieved improvements in neuropsychological performance and in QoL and self-esteem measurements.

Schizophrenia Research 09/2013

A brief and feasible paper-based method to screen for neurocognitive impairment in HIV-infected patients: the NEU screen.

Muñoz-Moreno JA, Prats A, Pérez-Álvarez N, Fumaz CR, Garolera M, Doval E, Negredo E, Ferrer MJ, Clotet B, NEU Study Group

ABSTRACT: Objective: Practical screening methods are necessary to detect neurocognitive impairment (NCI) in HIV-infected patients. We aimed to find a brief and feasible paper-based tool to facilitate the diagnosis of an HIV-associated neurocognitive disorder. Methods: A total of 106 HIV-infected outpatients with variable clinical characteristics were recruited in a multicenter investigation. NCI was diagnosed using a standardized neuropsychological tests battery (7 areas, 21 measures, ;2 hours). Multiple score combinations were compared to find a paper-based method that took #10 minutes to apply. The presence of NCI was considered the gold standard for comparisons, and the sensitivity and specificity were calculated. Results: Subjects were mostly middle-aged (median, 44 years) men (87%) on antiretroviral treatment. NCI was detected in 51 individ- uals (48%) and was associated with lower nadir CD4 count (P , 0.001), receiving antiretroviral therapy (P = 0.004), fewer years of education (P = 0.009), and presence of comorbidities (P , 0.001). The score combination that showed the highest sensitivity (74.5%) and specificity (81.8%) detecting NCI included 3 measures of atten- tion/working memory, executive functioning, and verbal fluency (part A of Trail Making Test, part B of Trail Making Test, and Controlled Oral Word Association Test scores). A broader paper- based selection of measures covering 7 areas indicated a sensitivity of 100% and a specificity of 96.3% (7 measures, ;35 minutes).

Conclusions: The combination of the 3 measures presented in this study seems to be a rapid and feasible screening mean for NCI in HIV- infected patients. This approach, combined with screening for potential comorbidities and daily functioning interference, could help in the initial stages of a HIV-associated neurocognitive disorder diagnosis and in settings with limited access to neuropsychological resources.

Journal of acquired immune deficiency syndromes 08/2013; 5(585):592.

Disfunción cognitiva en la fibromialgia (Cognitive dysfunction in fibromyalgia)

Gelonch O, Garolera M, Rossello L, Pifarre J

ABSTRACT: INTRODUCTION. People with a fibromyalgia diagnosis complain of having very poor cognitive functioning. In recent years, there has been an increasing interest to investigate which cognitive impairment is present in this disease. AIM. To review the published research on fibromyalgia and cognitive dysfunction.

DEVELOPMENT. A literature search was performed with a time interval from 1995 to 2012. Search terms included the keywords 'fibromyalgia' and 'cognition', 'attention', 'memory', 'language', 'perception', 'executive functions' and 'dis-executive syndrome'. 64 records were selected after applying inclusion criteria.

CONCLUSIONS. Studies that have examined cognitive function in people diagnosed with fibromyalgia have been few and mostly with small samples. Deficits have been identified mainly in working memory and complex attentional functions, where the distraction factor has an important significance. Impairment has also been identified in long-term memory and executive functions. There is consensus among the studies in which the degree of pain is directly related to the level of cognitive dysfunction, while no full consensus to explain the influence of depression and anxiety on cognitive functioning in these patients.

Revista de neurologia 06/2013; 11(56):573-88

Neural Responses to Visual Food Cues: Insights from Functional Magnetic Resonance Imaging

I García-García, A Narberhaus, I Marqués-Iturria, M Garolera, A Rădoi, B Segura, R Pueyo, M Ariza, M A Jurado

ABSTRACT: The aim of this paper is to describe the patterns of functional magnetic resonance imaging activation produced by visual food stimuli in healthy participants, as well as in those with anorexia nervosa, bulimia nervosa, binge eating disorder and obesity. We conducted a system-atic review of studies published in the last decade on normal and abnormal eating. This review suggested the existence of neural differences in response to the sight of food between healthy individuals, those with an eating disorder and obese subjects. Differences were identified in two brain circuits: (i) limbic and paralimbic areas associated with salience and reward processes and (ii) prefrontal areas supporting cognitive control processes.

European Eating Disorders Review 03/2013; 21(2)

Functional connectivity in obesity during reward processing.

I García-García, M A Jurado, M Garolera, B Segura, I Marqués-Iturria, R Pueyo, M Vernet-Vernet, M J Sender-Palacios, R Sala-Llonch, M Ariza, A Narberhaus, C Junqué

ABSTRACT: Obesity is a health problem that has become a major focus of attention in recent years. There is growing evidence of an association between obesity and differences in reward processing. However, it is not known at present whether these differences are linked exclusively to food, or whether they can be detected in other rewarding stimuli. We compared responses to food, rewarding non-food and neutral pictures in 18 young adults with obesity and 19 normal-weight subjects using independent component analysis. Both groups modulated task-related activity in a plausible way.

However, in response to both food and non-food rewarding stimuli, participants with obesity showed weaker connectivity in a network involving activation of frontal and occipital areas and deactivation of the posterior part of the default mode network. In addition, obesity was related with weaker activation of the default mode network and deactivation of frontal and occipital areas while viewing neutral stimuli. Together, our findings suggest that obesity is related to a different allocation of cognitive resources in a fronto-occipital network and in the default mode network.

NeuroImage 10/2012

The Effect of Carotid Occlusion in Cognition before Endarterectomy.

Laura Casas-Hernanz, Maite Garolera, Dolors Badenes-Guia, Juan Carlos Cejudo-Bolivar, Josep Royo, Miquel Aguilar

ABSTRACT: The role of carotid stenosis on cognition remains to be determined. To study whether people with stenosis of the carotid artery have increased cognitive impairments, we studied 53 patients with moderate or severe carotid stenosis (with no symptoms of stroke or dementia) and 53 controls. We describe which cognitive functions were impaired in the patients and whether there were differences based on the side, the severity of the stenosis or the presence of neurological symptoms. Using the Repeatable Battery for the Assessment of Neuropsychological Status, we found that the patients with carotid stenosis had lower cognitive performances in attention, verbal memory, visuospatial capacity and verbal fluency. Patients with lesser degrees of stenosis than healthy control patients had better scores in learning and memory.

The results from this study suggest that patients with severe carotid stenosis have a lower cognitive status than healthy control patients, which is associated with the degree of total carotid stenosis.

Archives of Clinical Neuropsychology 10/2012

Dopamine Genes (DRD2/ANKK1-TaqA1 and DRD4-7R) and Executive Function: Their Interaction with Obesity

Mar Ariza, Maite Garolera, Maria Angeles Jurado, Isabel Garcia-Garcia, Imma Hernan, Consuelo Sá Nchez-Garre, Maria Vernet-Vernet, Jose Maria, Sender-Palacios, Idoia Marques-Iturria, Roser Pueyo, Barbara Segura, Ana Narberhaus

ABSTRACT: Obesity is a multifactorial disease caused by the interaction between genotype and environment, and it is considered to be a type of addictive alteration. The A1 allele of the DRD2/ANKK1-TaqIA gene has been associated with addictive disorders, with obesity and with the performance in executive functions. The 7 repeat allele of the DRD4 gene has likewise been associated with the performance in executive functions, as well as with addictive behaviors and impulsivity. Participants were included in the obesity group (N = 42) if their body mass index (BMI) was equal to or above 30, and in the lean group (N = 42) if their BMI was below 25. The DRD2/ANKK1-TaqIA and DRD4 VNTR polymorphisms were obtained.

All subjects underwent neuropsychological assessment. Eating behavior traits were evaluated. The 'DRD2/ANKK1-TaqIA A1-allele status' had a significant effect on almost all the executive variables, but no significant 'DRD4 7R-allele status' effects were observed for any of the executive variables analyzed. There was a significant 'group' x 'DRD2/ANKK1-TaqIA A1-allele status' interaction effect on LN and 'group' x 'DRD4 7R-allele status' interaction effect on TMT B-A score. Being obese and a carrier of the A1 allele of DRD2/ANKK1-TaqIA or the 7R allele of DRD4 VNTR polymorphisms could confer a weakness as regards the performance of executive functions.

PLoS ONE 07/2012; 7(7):e41482.

Alterations of the salience network in obesity: A resting-state fMRI study.

Isabel García-García, María Ángeles Jurado, Maite Garolera, Bàrbara Segura, Roser Sala-Llonch, Idoia Marqués-Iturria, Roser Pueyo, María José Sender-Palacios, Maria Vernet-Vernet, Ana Narberhaus, Mar Ariza, Carme Junqué

ABSTRACT: Obesity is a major health problem in modern societies. It has been related to abnormal functional organization of brain networks believed to process homeostatic (internal) and/or salience (external) information. This study used resting-state functional magnetic resonance imaging analysis to delineate possible functional changes in brain networks related to obesity. A group of 18 healthy adult participants with obesity were compared with a group of 16 lean participants while performing a resting-state task, with the data being evaluated by independent component analysis. Participants also completed a neuropsychological assessment.

Results showed that the functional connectivity strength of the putamen nucleus in the salience network was increased in the obese group. We speculate that this abnormal activation may contribute to overeating through an imbalance between autonomic processing and reward processing of food stimuli. A correlation was also observed in obesity between activation of the putamen nucleus in the salience network and mental slowness, which is consistent with the notion that basal ganglia circuits modulate rapid processing of information. Hum Brain Mapp, 2012. © 2012 Wiley Periodicals, Inc.

Human Brain Mapping 04/2012;

Efficacy of an adjunctive computer-based cognitive training program in amnestic mild cognitive impairment and Alzheimer's disease: a single-blind, randomized clinical trial.

Adrian Gaitán, Maite Garolera, Noemí Cerulla, Gloria Chico, Mariona Rodriguez-Querol, Jaume Canela-Soler

ABSTRACT: OBJECTIVE: This study evaluates the efficacy at 12 months of a computer-based cognitive training (CBCT) program, adjunctive to traditional cognitive training (TCT), on the basis of pen-and-paper exercises.

METHODS: Sixty patients with multi-domain mild cognitive impairment and mild Alzheimer's disease who were already receiving cognitive training, recruited from a day hospital, were assigned into two groups following a simple randomization procedure (computerized random numbers): (i) a group that received CBCT during 3 months and TCT (CBCT + TCT), n = 37, and (ii) a group that received only TCT, n = 23. Patients were assessed at baseline and after 3 and 12 months of treatment by a neuropsychologist blinded to group assignment, with a neuropsychological battery (primary outcomes) and measures of decision making, memory complaints, and emotional disturbances.

RESULTS: With the use of repeated-measures analyses of covariance, the CBCT + TCT group showed less anxiety symptoms (F = 5.13, p = 0.03, d = 1.12) and less disadvantageous choices (F = 4.70, p = 0.04, d = 0.89) in decision making than the TCT group at 12 months. No significant improvement or worsening was observed in the other measures examined. However, positive effect sizes favoring the CBCT + TCT group were observed in all variables.

CONCLUSIONS: The addition of a CBCT program was effective in anxiety and decision making but had no significant effects on outcomes in basic cognitive functions in patients who were already receiving cognitive training, possibly due to a ceiling effect. Future studies should compare the efficacy of CBCT with TCT in naïve patients. Copyright © 2012 John Wiley & Sons, Ltd.

International Journal of Geriatric Psychiatry 04/2012

Functional impairment as a defining feature of: amnestic MCI cognitive, emotional, and demographic correlates.

Igor Bombin, Sandra Santiago-Ramajo, Maite Garolera, Eva M Vega-González, Noemí Cerulla, Alfonso Caracuel, Alicia Cifuentes, M Teresa Bascarán, Julio Bobes

ABSTRACT: Early definitions of mild cognitive impairment (MCI) excluded the presence of functional impairment, with preservation of a person's ability to perform activities of daily living (ADL) as a diagnostic criterion. However, recent studies have reported varying degrees of functional impairment associated with MCI. Hence, we aimed to test the potential functional impairment associated with MCI and its predictors. Sixty-nine healthy elderly subjects, 115 amnestic single-domain MCI subjects (a-MCI), and 111 amnestic multi-domain MCI subjects (md-MCI) were assessed using a battery of neuropsychological tests including measures of attention, memory, working memory, executive functions, language, and depression. Additionally, functional ability was assessed by both qualitative (WHO-DAS II) and quantitative (CHART) instruments.

Cognitive and functional performance was compared between groups, and regression analyses were performed to identify predictors of functional ability. The md-MCI group was more impaired than the a-MCI group, and both were more impaired than healthy subjects in all cognitive measures, in total CHART score, CHART cognitive and mobility subscores, and WHO-DAS II communication and participation subscales. For the rest of the functional measures, the md-MCI group was more impaired than healthy controls. Prediction of functional ability by cognitive measures was limited to md-MCI subjects and was higher for the CHART than for the WHO-DAS II. The WHO-DAS II was largely influenced by depressive symptoms.

Functional impairment is a defining feature of MCI and is partially dependent on the degree of cognitive impairment. Quantitative measures of functional ability seem more sensitive to functional impairment in MCI than qualitative measures, which seem to be more related to depression.

International Psychogeriatrics 04/2012; 24(9):1494-504.

Awareness of dysphagia in Parkinson's disease

Àngels Bayés-Rusiñol, Maria J Forjaz, Alba Ayala, M de la Cruz Crespo, Anna Prats, Esther Valles, Cristina Petit, Mercè Casanovas, Maite Garolera-Freixa

ABSTRACT: In order to be able to assess the level of awareness of swallowing disorders in Parkinson's disease (PD), a specific questionnaire was designed and validated: the Dysphapark questionnaire. A total of 470 persons with PD were asked whether they believe they have problems swallowing or not, and then they filled in a self-administered questionnaire that evaluates the effectiveness and safety of swallowing. The Dysphapark questionnaire was validated by means of Rasch analysis and classical psychometric methods. The safety and effectiveness dimensions of the Dysphapark fit the Rasch model well.

The efficacy dimension showed significant differences for gender, length of the illness, awareness of dysphagia and length of meals. Significant differences were also found in the safety dimension for length and severity of illness, awareness of dysphagia, speech therapy and knowledge of thickening agents. Despite the fact that 90% of patients had problems concerning effectiveness and safety in swallowing, 79.45% were not aware that they suffered from dysphagia. The Dysphapark questionnaire is a suitable measure of dysphagia in PD, according to the Rasch analysis.

A high proportion of patients with PD have dysphagia, although it has been observed that they have a low level of awareness of the condition, of the consequences it may have and of the possibility of using thickening agents. Given that some of the swallowing disorders in PD are asymptomatic and that the level of awareness of the disorder is low, we recommend including specific questionnaires as well as clinical and instrumental evaluation of dysphagia in clinical practice.

Revista de neurologia 12/2011; 53(11):664-72.

Improvement of cognitive flexibility and cingulate blood flow correlates after atypical antipsychotic treatment in drug-naive patients with first-episode schizophrenia.

Bernardo M Pardo, Maite Garolera, Mar Ariza, Deborah Pareto, Manel Salamero, Vicenç Valles, Luis Delgado, Joan Alberni

ABSTRACT: The aim of this study was to examine the changes in cognitive flexibility and associated cerebral blood flow in the anterior cingulate lobe of drug-naive patients with first-episode schizophrenia who were treated with atypical antipsychotics for 6 weeks. Single photon emission computed tomography (SPECT) images were obtained from 8 healthy subjects both at rest and while performing the flexibility subtest of the TAP (Test for Attentional Performance). SPECT images were obtained in parallel from 8 first-episode drug-naive schizophrenic patients while they were performing the same task both before and after 6 weeks of neuroleptic treatment. In the control group, an increase in the perfusion indices of the dorsal section of the anterior cingulate gyrus was observed in the activation condition. Task performance was altered and the level of perfusion of the brain region related to the task execution was significantly decreased in the patients at baseline. After treatment, there was a significant improvement in both task performance and the level of perfusion of the dorsal section of the anterior cingulate.

We conclude that treatment with second-generation neuroleptics improves cognitive flexibility, and there was a relationship between such improvements and normalization of perfusion indices of the involved brain areas.

Psychiatry Research 10/2011; 194(3):205-11.

Impaired preparatory re-mapping of stimulus-response associations and rule-implementation in schizophrenic patients--the role for differences in early processing.

Mareike Finke, Francisco Barceló, Maite Garolera, Miriam Cortiñas, Gemma Garrido, Marta Pajares, Carles Escera

ABSTRACT: An accurate representation of task-set information is needed for successful goal directed behavior. Recent studies point to disturbances in the early processing stages as plausible causes for task-switching deficits in schizophrenia. A task-cueing protocol was administered to a group of schizophrenic patients and compared with a sample of age-matched healthy controls. Patients responded slower and less accurate compared with controls in all conditions. The concurrent recording of event-related brain potentials to contextual cues and target events revealed abnormalities in the early processing of both cue-locked and target-locked N1 potentials. Abnormally enhanced target-locked P2 amplitudes were observed in schizophrenic patients for task-switch trials only, suggesting disrupted stimulus evaluation and memory retrieval processes. The endogenous P3 potentials discriminated between task conditions but without further differences between groups.

These results suggest that the observed impairments in task-switching behavior were not specifically related to anticipatory set-shifting, but derived from a deficit in the implementation of task-set representations at target onset in the presence of irrelevant and conflicting information.

Biological psychology 05/2011; 87(3):358-65.

Pathological gambling in a psychiatric sample.

Núria Aragay, Alba Roca, Berta Garcia, Cristina Marqueta, Silvina Guijarro, Luís Delgado, Maite Garolera, Joan Alberni, Vicenç Vallès

ABSTRACT: This study determines the prevalence of gambling difficulties in a consecutive sample of psychiatric inpatients and compares it with a nonpsychiatric inpatient sample. In addition, the gambling prevalence among all psychiatric disorders is analyzed. An observational study was conducted in psychiatric patients and sex- and age-matched nonpsychiatric patients. The psychiatric group (n = 100) included all consecutive patients admitted to the psychiatric unit of our hospital. The nonpsychiatric group (n = 100) included psychiatrically healthy inpatients from any other hospital unit. The National Opinion Research Center Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Screen for Gambling Problems was used to screen for gambling behavior. Gambling difficulties were experienced by 3% (2% pathological gambling and 1% problem gambling) of nonpsychiatric inpatients and 9% (8% pathological gambling and 1% problem gambling) of psychiatric inpatients, including 6 with psychotic disorders, 1 with mood disorder, 1 with adjustment disorder, and 1 with eating disorder.

There were no statistical differences in gambling prevalence between groups. In terms of comorbidity, patients with psychotic disorder had a higher prevalence of gambling problems than other psychiatric disorders (P = .045). A higher prevalence of gambling disorders was found in psychiatric inpatients than in nonpsychiatric inpatients. It may be advisable for therapists to routinely assess for gambling difficulties as part of the psychiatric evaluation.

Comprehensive psychiatry 04/2011; 53(1):9-14.

Blind randomized controlled study of the efficacy of cognitive training in Parkinson's disease.

Anna Prats París, Heidi Guerra Saleta, Maria de la Cruz Crespo Maraver, Emmanuel Silvestre, Maite Garolera Freixa, Cristina Petit Torrellas, Silvia Alonso Pont, Marc Fabra Nadal, Sheila Alcaine Garcia, Maria Victoria Perea Bartolomé, Valentina Ladera Fernández, Angels Rusiñol Bayés

ABSTRACT: The aim of this study was to analyze the efficacy of a cognitive training program on cognitive performance and quality of life in nondemented Parkinson's disease patients. Participants who met UK Brain Bank diagnosis criteria for Parkinson's disease, with I-III Hoehn & Yahr, aged 50-80, and nondemented (Mini-Mental State Examination ≥ 23) were recruited. Patient's cognitive performance and functional and quality-of-life measures were assessed with standardized neuropsychological tests and scales at baseline and after 4 weeks. Subjects were randomly and blindly allocated by age and premorbid intelligence (Vocabulary, Wechsler Adult Intelligence Scale-III) into 2 groups: an experimental group and a control group. The experimental group received 4 weeks of 3 weekly 45-minute sessions using multimedia software and paper-and-pencil cognitive exercises, and the control group received speech therapy. A total of 28 patients were analyzed. Compared with the control group participants (n = 12), the experimental group participants (n = 16) demonstrated improved performance in tests of attention, information processing speed, memory, visuospatial and visuoconstructive abilities, semantic verbal fluency, and executive functions. There were no observable benefits in self-reported quality of life or cognitive difficulties in activities of daily living.

We concluded that intensive cognitive training may be a useful tool in the management of cognitive functions in Parkinson's disease. © 2011 Movement Disorder Society.

Movement Disorders 03/2011; 26(7):1251-8.

Interruptions of antiretroviral therapy in human immunodeficiency virus infection: are they detrimental to neurocognitive functioning?

Jose A Muñoz-Moreno, Carmina R Fumaz, Anna Prats, Maria J Ferrer, Eugènia Negredo, Núria Pérez-Alvarez, José Moltó, Guadalupe Gómez, Maite Garolera, Bonaventura Clotet

ABSTRACT: Because interruptions of antiretroviral treatment may entail clinical risks for human immunodeficiency virus (HIV)-infected individuals, we investigated their impact on neurocognitive functioning. Cross-sectional study was carried out, comparing HIV-infected persons who had interrupted antiretroviral therapy in the past (interruption group, IG) with persons who had never discontinued therapy (noninterruption group, NIG). Interruption was defined as the discontinuation of highly active antiretroviral therapy (HAART) for more than 15 days after previous treatment of at least 15 days. All the participants were on therapy. Demographic, clinical, and neurocognitive variables were assessed. The primary end point was the percentage of people with neurocognitive impairment. The score in different neurocognitive domains was a secondary end point. A total of 83 subjects participated in the study (IG: n = 27; NIG: n = 56). Demographic and clinical characteristics were balanced between the groups, except for years since HIV diagnosis (IG, 13.8; NIG, 10.2 [P = .003]). The percentage of people with neurocognitive impairment was significantly higher in the IG group (IG, 59.25%; NIG, 33.92% [P = 0.02]).

As for scores in neurocognitive domains, individuals in the IG showed worse neurocognitive functioning, and significant differences in attention/working memory and information processing speed were found. The adjusted analysis supported the unadjusted analysis. In this study, a higher prevalence of neurocognitive impairment was detected in HIV-infected persons who had interrupted antiretroviral therapy in the past. Additionally, neurocognitive functioning was observed to be more impaired in the same individuals. Further studies should examine the potential negative effects of antiretroviral therapy interruptions on neurocognitive functioning.

Journal of NeuroVirology 06/2010; 16(3):208-18.

Nadir CD4 cell count predicts neurocognitive impairment in HIV-infected patients.

Jose A Muñoz-Moreno, Carmina R Fumaz, Maria J Ferrer, Anna Prats, Eugènia Negredo, Maite Garolera, Núria Pérez-Alvarez, José Moltó, Guadalupe Gómez, Bonaventura Clotet

ABSTRACT: Though antiretroviral therapy attenuates neurocognitive disruption, impairment is still observed. We studied the nadir CD4 cell count as a predictor of neurocognitive changes. This cross-sectional study assessed 64 HIV-infected patients in two groups: G1 (n = 26, nadir CD4 < or =200 cells/ml) and G2 (n = 38, nadir CD4 >200 cells/ml).

Percentages of patients showing neurocognitive impairment were compared according to different nadir CD4 cutoffs (200, 250, 300, and 350 cells/ml). From G2, we also took the subgroup of patients receiving treatment (G3) and compared this group with G1, in which all patients were being treated. Demographic and clinical variables were evaluated, as were differences in neurocognitive function. Neurocognitive impairment tended to be more prevalent in G1 [19 patients (73.1%)] than in G2 [20 (52.6%), p = 0.123]. When nadir CD4 cutoffs were compared, there was a trend toward more impaired subjects as the CD4 nadir decreased. Significantly different functioning was found in attention/working memory (digit span backward, p = 0.032) and executive functions (trail making test, part B, p = 0.020), with better performance in G2. Comparison between G1 and G3 confirmed those findings. We found differences in neurocognitive functioning in relation to nadir CD4 count in HIV-infected patients. Attention should be given to this value in the management of neurocognitive protection in HIV infection.

AIDS research and human retroviruses 10/2008; 24(10):1301-7.

Reduced novelty-P3 associated with increased behavioral distractibility in schizophrenia.

Miriam Cortiñas, María-José Corral, Gemma Garrido, Maite Garolera, Marta Pajares, Carles Escera

ABSTRACT: Behavioral and electrophysiological brain responses were used to examine the relationship between the vulnerability to distraction and the orienting response in schizophrenia. Nineteen schizophrenics and nineteen matched healthy controls were instructed to ignore task-irrelevant auditory stimuli while they classified capital letters and digits. The auditory sequences contained repetitive standard tones occasionally replaced by complex novel sounds. Relative to controls, patients showed an increased behavioral distraction, as indicated by a larger response time increase caused by novel sounds, and a disturbance in the attention orienting toward distracting stimuli, as indicated by a reduced novelty-P3.

This behavioral-electrophysiological dissociation may stem from a limited pool of available resources. Thus, the few attentional resources directed toward novel stimuli would be sufficient to cause an important decrease of the similarly reduced amount of resources assigned to task-relevant stimuli, resulting in a striking impairment of the ongoing task performance.

Biological Psychology 08/2008; 78(3):253-60.

393 – Cognitive predictors of daily life style in schizophrenic patients

M. Garolera, N. Tortajada, S. Guijarro, G. Garrido, V. Vallès

Schizophrenia Research 02/2008; 98:196-196.

Amygdala activation in affective priming: a magnetoencephalogram study.

Maite Garolera, Richard Coppola, Karen E Muñoz, Brita Elvevåg, Frederick W Carver, Daniel R Weinberger, Terry E Goldberg

ABSTRACT: We employed magnetoencephalography (MEG) to examine amygdala activity during a linguistic affective priming task. The experimental design included positive and negative word pairs. Using synthetic aperture magnetometry in the analysis of MEG data, we identified a left amygdala power increase in the theta frequency range during priming involving negative words. We found that the amygdala displayed a time-dependent intensification in responsiveness to negative stimuli, specifically between 150 and 400 ms after target presentation. This study provides evidence for theta power changes in the amygdala and demonstrates that the analysis of brain oscillations provides a powerful tool to explore mechanisms implicated in emotional processing.

Neuroreport 10/2007; 18(14):1449-53.

Research with spanish-speaking populations in the United States: lost in the translation. A commentary and a plea.

Lidia Artiola I Fortuny, Maite Garolera, David Hermosillo Romo, Esther Feldman, Héctor Fernández Barillas, Richard Keefe, Monique J Lemaître, Amparo Ortiz Martín, Allan Mirsky, Inés Monguió, Gloria Morote, Sa Parchment, L Jaime Parchment, Eileen Da Pena, Daniel G Politis, Manuel A Sedó, Irene Taussik, Francisco Valdivia, Laura Elisa De Valdivia, Katia Verger Maestre

ABSTRACT: Verbal material used to assess the cognitive abilities of Spanish-speakers in the the United States is frequently of linguistically unacceptable quality. The use of these materials in research settings is thought to pose a serious threat to test validity and hence to the validity of claimed results or conclusions. The authors explain how and why incorrect language finds its way into cognitive tests used in research and other settings and suggest solutions to this serious problem.

Journal of Clinical and Experimental Neuropsychology 08/2005; 27(5):555-64.

Depression in Parkinson's disease: clinical correlates and outcome.

A Rojo, M Aguilar, M T Garolera, E Cubo, I Navas, S Quintana

ABSTRACT: Depression has been shown to be more common in Parkinson's disease (PD) than in other chronic and disabling disorders. Neurochemical and functional disturbances are important etiopathogenic factors. The prevalence and clinical features associated with depression in PD remain controversial. The purpose of this study is to estimate the prevalence of depressive symptoms in our patients, as related to other clinical data, and to assess clinical outcomes of these symptoms. A series of PD patients were evaluated over a 9-year period, using the Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage (HY), Schwab and England Scale (SE), Mini-Mental State Examination (MMSE), and Yesavage Geriatric Depression Scale (GDS). Presence of depressive symptoms was considered if GDS score was higher than 10: mild-moderate (MD) for GDS scores between 11 and 20 and moderate-severe (SD) for GDS scores greater than 20. Three hundred and fifty-three patients were included in this study and additional follow up information was obtained for 184 patients. MD and SD were found in 40.2 and 16.7% of PD patients, respectively. Female gender, high HY, high UPDRS total and subtotal, and low MMSE and SE scores were significantly associated with depressive symptoms.

According to changes in GDS score, 34% of patients remained stable, 35% showed an improvement, and 30.9% worsened in the follow up study. Gender, age, age of onset, HY, UPDRS, and PD duration are not related to depression outcome.

Parkinsonism & Related Disorders 11/2003; 10(1):23-8.

[Bipolar disorder. Follow-up of lithium therapy in a clinic].

M D Agulló Hernández, M T Sanz Osorio, M Barbarà Berdaguer, V Vallès i Callol, M Garolera Freixa, L Delgado Cruz, J Alberni i Coderch

ABSTRACT: Lithium carbonate is the drug of choice in the prophylactic treatment of bipolar disorder. The purpose of this article is to describe the effective functioning of lithium in a clinical way in our hospital under the control of university graduates in nursing. During the first ten months of its use, 40 patients have been included which led to 122 appointments, absenteeism being 8.62%. 20% (8/40) of the lithium intoxications at the start of the follow-up were inferior to 0.5% mmol/l while at the end, only 5.3% (2/38) fell below 0.5% mmol/l. The average of the lithium intoxications at the end of the study period was significantly higher than in the moment of entrance to the program (p = 0.009). During the study period, three relapses were registered.

Revista de enfermeria (Barcelona, Spain) 04/2000; 23(3):177-80.

[Evaluation of presurgical anxiety].

M C Crespo, M Garolera, V Vallès

Medicina Clínica 01/1998; 109(20):818.

[Psychiatric disorders in cerebral ischemia].

M Aguilar Barbera, C Teixidó Perramón, J M Gómez Gómez, M Garolera Freixa

Revista Clínica Española 12/1996; 196 Suppl 3:62-6

[Psychiatric diseases and ictus].

M Aguilar, M Garolera

Revista de neurologia 02/1995; 23 Suppl 1:S113-22.

Uso de un programa de rehabilitación cognitiva informatizada en la esclerosis múltiple / Aplication of a computerized cognitive rehabilitation program in multiple sclerosis

J. M. Vendrell, M. Renom, M. Garolera, I. González, P. Maguet, I. Galán

ABSTRACT: Background: It is well known that the subcortical cognitive impairment pattern is frequent in MS. Evidence of impaired high level language function has recently been reported. Such disturbances have marked consequences on many aspects of everyday life. Objectives: The object of this study was to evaluate the efficacy of a specific computerized battery of stimulation exercises for attention and executive functions, in terms of changes in cognitive and high-level language performance, quality of life and emotional state. Method: During the study period (1998-2001), a standard assessment protocol which included neuropsychological, psychosocial and medical parameters was administered to 48 patients with MS, half of whom followed a 6 month rehabilitation program specifically designed for the MS impairment pattern. Conclusions: Preliminary data available to date according to the results of two rehabilitation exercises, show an improvement in performance both in attentional and executive tasks with earlier progress in attentional tasks than in executive tasks.

Predicting HIV-Related Neurocognitive Dysfunction: the Relevance of Clinical Factors

Jose A Muñoz-Moreno, Núria Pérez-Álvarez, Scott Letendre, Mariana Cherner, Carmina R Fumaz, Anna Prats, Maria J Ferrer, Eugènia Negredo, Maite Garolera, Bonaventura Clotet

ABSTRACT: E-122 Study Participants: A total of 172 patients receiving care in the HIV unit of the Germans Trias i Pujol University Hospital (Barcelona, Spain). All participants were at least 18 years old, and were excluded those with a prior or current opportunistic infection involving the CNS, reporting Ambien drug use, or with a prior or current psychiatric disorder. Objectives: -To identify variables strongly associated with HIV-related neurocognitive impairment in HIV infection. -To find relevant cut-points regarding numerical variables in association with HIV-related neurocognitive impairment. -To obtain different predictive models focused on estimating the appearance of HIV-related neurocognitive impairment. Statistical Analyses: Classification and regression trees were used to determine the significance of the following variables in the onset of HIV-related neurocognitive dysfunction: Age, gender, infection route, time with HIV, AIDS diagnosis, CD4 cell count, nadir CD4 cell count, plasma viral load, highest plasma viral load, coinfection with HCV, time since ART therapy initiation, time on current ART regimen, CPE rank of the current ARV regimen, and therapy interruption in the past. Data analyses were performed according to naïve (n=30) or treatment-experienced (n=142) patients. The existence of neurocognitive dysfunction was based on the determination of neurocognitive impairment assessed by a comprehensive neuropsychological tests battery.

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