Browsing by Author "Slachevsky, Andrea"

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    Allostatic-Interoceptive Overload in Frontotemporal Dementia
    (2022) Birba, Agustina; Santamaria-Garcia, Hernando; Prado, Pavel; Cruzat, Josefina; Sainz Ballesteros, Agustin; Legaz, Agustina; Fittipaldi, Sol; Duran-Aniotz, Claudia; Slachevsky, Andrea; Santibanez, Rodrigo; Sigman, Mariano; Garcia, Adolfo M.; Whelan, Robert; Moguilner, Sebastian; Ibanez, Agustin
    BACKGROUND: The predictive coding theory of allostatic-interoceptive load states that brain networks mediating autonomic regulation and interoceptive-exteroceptive balance regulate the internal milieu to anticipate future needs and environmental demands. These functions seem to be distinctly compromised in behavioral variant frontotemporal dementia (bvFTD), including alterations of the allostatic-interoceptive network (AIN). Here, we hypothesize that bvFTD is typified by an allostatic-interoceptive overload.
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    Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia
    (FRONTIERS MEDIA SA, 2022) Musa Salech, Gada; Lillo, Patricia; van der Hiele, Karin; Mendez Orellana, Carolina; Ibanez, Agustin; Slachevsky, Andrea
    Background: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD.Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology-Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables.Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (beta = 0.33, p = 0.02) and disinhibition (beta = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (beta = 0.71, p < 0.001), deficits in executive function (beta = -0.36, p = 0.002), and lack of emotion recognition (beta = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (beta = 0.59, p < 0.001).Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.
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    Biomarkers for dementia in Latin American countries: Gaps and opportunities
    (2023) Parra, Mario A.; Orellana, Paulina; Leon, Tomas; Victoria, Cabello G.; Henriquez, Fernando; Gomez, Rodrigo; Avalos, Constanza; Damian, Andres; Slachevsky, Andrea; Ibanez, Agustin; Zetterberg, Henrik; Tijms, Betty M.; Yokoyama, Jennifer S.; Pina-Escudero, Stefanie D.; Cochran, J. Nicholas; Matallana, Diana L.; Acosta, Daisy; Allegri, Ricardo; Arias-Suarez, Bianca P.; Barra, Bernardo; Behrens, Maria Isabel; Brucki, SoniaM. D.; Busatto, Geraldo; Caramelli, Paulo; Castro-Suarez, Sheila; Contreras, Valeria; Custodio, Nilton; Dansilio, Sergio; De la Cruz-Puebla, Myriam; de Souza, Leonardo Cruz; Diaz, Monica M.; Duque, Lissette; Farias, Gonzalo A.; Ferreira, Sergio T.; Guimet, Nahuel Magrath; Kmaid, Ana; Lira, David; Lopera, Francisco; Meza, Beatriz Mar; Miotto, Eliane C.; Nitrini, Ricardo; Nunez, Alberto; O'Neill, Santiago; Ochoa, John; Pintado-Caipa, Maritza; Resende, Elisa de Paula Franca; Risacher, Shannon; Rojas, Luz Angela; Sabaj, Valentina; Schilling, Lucas; Sellek, Allis F.; Sosa, Ana; Takada, Leonel T.; Teixeira, Antonio L.; Unaucho-Pilalumbo, Martha; Duran-Aniotz, Claudia
    Limited knowledge on dementia biomarkers in Latin American and Caribbean (LAC) countries remains a serious barrier. Here, we reported a survey to explore the ongoing work, needs, interests, potential barriers, and opportunities for future studies related to biomarkers. The results show that neuroimaging is the most used biomarker (73%), followed by genetic studies (40%), peripheral fluids biomarkers (31%), and cerebrospinal fluid biomarkers (29%). Regarding barriers in LAC, lack of funding appears to undermine the implementation of biomarkers in clinical or research settings, followed by insufficient infrastructure and training. The survey revealed that despite the above barriers, the region holds a great potential to advance dementia biomarkers research. Considering the unique contributions that LAC could make to this growing field, we highlight the urgent need to expand biomarker research. These insights allowed us to propose an action plan that addresses the recommendations for a biomarker framework recently proposed by regional experts.
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    Neuroanatomical basis of behavioral disturbances in patients with prefrontal lesions
    (2006) Slachevsky, Andrea; Pena, Marcela; Perez, Carolina; Bravo, Eduardo; Alegria, Patricia
    The role of the frontal lobe in control of behavioral and cognitive abilities is explored in a group of 34 patients with brain lesions restricted to the prefrontal cortex. The scores in both structured behavioral questionnaires and standard neuropsychological tests were analyzed using the injured area of the frontal lobe as the independent variable. Our results show that patients with simultaneous lesions in supero- and inferomedial areas of the prefrontal cortex exhibit higher behavioral disturbances. Bilateral lesions also are associated with greater behavioral troubles. On the contrary. cognitive abilities are globally impaired in prefrontal patients. Results are discussed in relation to Current models of the organization of the prefrontal cortex and its role on behavior control.
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    Normalization of Rowland Universal Dementia Assessment Scale (RUDAS) in Chilean older people
    (2023) Sepúlveda Ibarra, Consuelo; Henríquez Chaparro, Fernando; Marcotti, Anthony; Soto, Guillermo; Slachevsky, Andrea
    Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive screening that evaluates older people with low educational levels. In Chile, there are no normative data to assess this population. Objective: To obtain normative data on RUDAS in older Chilean people with up to 12 years of schooling, and to determine whether age and schooling years influence a person’s performance on RUDAS and on the items that constitute it. Methods: A group of cognitively healthy people 60 years old or over, with up to 12 schooling years was evaluated (n=135). Multiple regression models were applied to obtain normative data on RUDAS, according to age and schooling years, and to measure the effects of schooling on different items. Results: Regression analysis showed that none of the items had schooling as a significant predictor, except for the visuoconstruction item. The variables age and schooling explained 12.6% (R^2=0.126) of the RUDAS total score variance. The item visuoconstruction was the most associated with the educational level (OR=1,147). Conclusion: This study showed that RUDAS is a recommended instrument for evaluating older people with low educational levels. However, more studies are needed to prove the validity of the RUDAS on Chilean older people.
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    The impact of SARS-CoV-2 in dementia across Latin America: A call for an urgent regional plan and coordinated response
    (2020) Ibanez, Agustin; Santamaria-Garcia, Hernando; Guerrero Barragan, Alejandra; Kornhuber, Alexander; Marques Ton, Alyne Mendonca; Slachevsky, Andrea; Lucio Teixeira, Antonio; Mar Meza, Beatriz Marcela; Serrano, Cecilia M.; Cano, Carlos; Arias Gonzalez, Carolina; Gonzalez-Billault, Christian; Butler, Christopher; Bustin, Julian; Duran-Aniotz, Claudia; Acosta, Daisy; Matallana, Diana L.; Acosta-Alvear, Diego; Trepel, Dominic; Franca Resende, Elisa De Paula; Ferreira Oliveira, Fabricio; Ibanez, Francisco; De Felice, Fernanda G.; Navarrete, Gorka; Tarnanas, Ioannis; Meier, Irene B.; Smid, Jerusa; Llibre-Guerra, Jorge; Llibre-Rodriguez, Juan J.; Fajersztajn, Lais; Takada, Leonel Tadao; Duque, Lissette; de Oliveira, Maira Okada; Camargos Bicalho, Maria Aparecida; Isabel Behrens, Maria; Pintado-Caipa, Maritza; Parra, Mario; Wilson, Maxwell Z.; De la Cruz Puebla, Myriam; Custodio, Nilton; Santibanez, Rodrigo; Serafim, Rodrigo Bernardo; Tavares, Ronnielly Melo; Pina Escudero, Stefanie Danielle; Leon Rodriguez, Tomas; Dawson, Walter; Miller, Bruce L.; Kosik, Kenneth S.
    The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.
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    The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games
    (2023) Martinez-Pernia, David; Olavarria, Loreto; Fernandez-Manjon, Baltasar; Cabello, Victoria; Henriquez, Fernando; Robert, Philippe; Alvarado, Luis; Barria, Silvia; Antivilo, Andres; Velasquez, Juan; Cerda, Mauricio; Farias, Gonzalo; Torralva, Teresa; Ibanez, Agustin; Parra, Mario A.; Gilbert, Sam; Slachevsky, Andrea
    Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.