INTRODUCTION: About 30% to 40% of elderly people with depression have a reversible cognitive impairment, commonly referred to as pseudodementia, the treatable condition most often confused with dementia. Our objective was to review the existing evidence on cognitive dysfunction in depression and the main differences in diagnosis, approach, and prognosis, in comparison with dementia.METHODS: Literature review using the following MeSH terms: “Depressive Disorder”, “Cognitive Dysfunction” and “Dementia”.RESULTS AND CONCLUSION: Many situations may present as a cognitive deficit, warranting a complete clinical history and assessment of the independent living skills of the patient. Neurological examination should always be performed, as well as the exclusion of the main organic causes of cognitive impairment. The role of the family doctor is important in the guidance of a patient with memory complaints and depressive symptoms. In some cases, this may imply a multidisciplinary approach between Family Medicine, Psychiatry and Neurology.

Schizophrenia (SCZ) and bipolar disorder (BPD) are severe mental disorders whose distinction, namely in early phases, might be challenging to clinicians. While it is true that these conditions share some similarities and overlap in symptoms, treatment, genetic predisposition, and outcome, some dimensions of the disease have not been thoroughly studied, namely in Portuguese patients.Neurocognition is an area worth evaluating, given its repercussions on patients' functioning and quality of life. With this study, we set out to analyze and compare neurocognitive performance in patients suffering from SCZ and BPD and compared the results with healthy controls. To achieve this, we gathered information from 210 Portuguese participants: 70 were diagnosed with BPD, 70 had SCZ, and 70 were healthy individuals. Based on available gold-standard neurocognitive tests and data derived from previous studies of our group, we decided to evaluate four major neurocognitive areas: thought velocity, memory and verbal fluency, visuospatial capacity, and executive function. Our results show a statistically significant decline in neurocognitive function when comparing clinical and control groups, though less evident when comparing BPD with SCZ.Although comparisons can be made because there is a general decline in cognitive function in both disorders, our study has revealed significant differences between these diseases. When looking at cognitive dimensions, patients diagnosed with SCZ, showed more severe impairments in tests like Stroop – Color test, and the Wisconsin Card Sorting Test (WCST) total errors, when compared to BPD. Furthermore, some cognitive tasks had greater specificity and sensitivity in distinguishing between the clinical and control groups.This study demonstrated that, in line with international data, there is a decline in neurocognitive function in Portuguese individuals with BPD or SCZ, with consistently worse results in people facing SCZ.

The aims of this article were to explore the relationship between depressive symptoms and neuropsychological performance in a sample of HIV-infected women, and to examine the contribution of demographic, HIV-related variables, and depressive symptoms to neurocognitive performance. In this cross-sectional study, a sample of 103 HIV-infected women, recruited from February to December 2010, were assessed for depressive symptoms (with the Beck Depression Inventory) and neurocognitive performance (with the HIV Dementia Scale). Severe depressive symptoms were reported by 31.1% of the women. Findings indicated that severe levels of depressive symptoms were significantly associated with reduced cognitive functioning in HIV-infected women, particularly in domains of attention, psychomotor speed, and construction. Older age and low education level were significantly associated with neurocognitive impairment in univariate analyses. In the multivariate model, only depressive symptoms were significantly related to neurocognitive impairment. Compared to participants with none/minimal depressive symptoms, those with moderate and severe depressive symptoms had odds ratios for neurocognitive impairment of 5.03 (95% CI, 1.33-18.99) and 3.22 (95% CI, 1.15-9.06), respectively. These findings support continued investigation of the presence of neurocognitive impairment, particularly among women, and may help mental health providers with early detection, planning, and implementation of more effective interventions.

The impact of prior neuro-ophthalmic syndromes on the performance on vision-based neuropsychological tasks in patients with multiple sclerosis (MS) is unknown. Two groups of MS participants, one with (Msos+) and the other without (Msos-), a history of neuro-ophthalmic syndromes, underwent neuropsychological assessment and were compared with healthy age- and education-matched controls (HC). Participants with Msos+ performed significantly worse on the symbol digit modalities test than the Msos- (P < 0.03) and the HC groups (P < 0.01) and coding (P < 0.01). A clinical history of neuro-ophthalmic syndromes is associated with reduced performance on visual processing speed tasks.

Panayiotopoulos syndrome (PS) is a common epilepsy syndrome associated with rare clinical seizures and unknown localization of the epileptogenic area. Despite findings of normal development in patients with PS, recent neuropsychological studies point to subtle and diverse cognitive impairments. No well-outlined hypothesis about the localization of the brain dysfunction responsible for these impairments has been proposed. We further explored the cognitive dysfunctions in PS and made inferences on the most likely anatomical localization of brain impairment. A group of 19 patients (aged 6-12) with PS was rated according to spike activity and lateralization. The patients were submitted to a neuropsychological evaluation to assess general intelligence, memory, language, visual-perceptual abilities, attention, and executive functions. Using 35-channel scalp EEG recordings, the N170 face-evoked event-related potential (ERP) was obtained to assess the functional integrity of the ventral pathway. All patients with PS showed normal IQ but subtle and consistent neurocognitive impairments. Namely, we found abnormalities in the copy task of the Rey-Osterrieth Complex Figure and in the Narrative Memory Test. There was no correlation between neuropsychological impairments with spike activity and hemispheric spike lateralization. The N170 ERP was normal in all patients except for one. Our neuropsychological findings demonstrate impairments in visual-perceptual abilities and in semantic processing. These findings, paired with the absence of occipital lobe dysfunction in all neuropsychological studies of PS performed to this date, support the existence of parietal lobe dysfunction.

This study analysed the usefulness of the Wechsler Intelligence Scale for Children-Third Edition in identifying specific cognitive impairments that are linked to developmental dyslexia (DD) and the diagnostic utility of the most common profiles in a sample of 100 Portuguese children (50 dyslexic and 50 normal readers) between the ages of 8 and 12 years. Children with DD exhibited significantly lower scores in the Verbal Comprehension Index (except the Vocabulary subtest), Freedom from Distractibility Index (FDI) and Processing Speed Index subtests, with larger effect sizes than normal readers in Information, Arithmetic and Digit Span. The Verbal-Performance IQs discrepancies, Bannatyne pattern and the presence of FDI; Arithmetic, Coding, Information and Digit Span subtests (ACID) and Symbol Search, Coding, Arithmetic and Digit Span subtests (SCAD) profiles (full or partial) in the lowest subtests revealed a low diagnostic utility. However, the receiver operating characteristic curve and the optimal cut-off score analyses of the composite ACID; FDI and SCAD profiles scores showed moderate accuracy in correctly discriminating dyslexic readers from normal ones. These results suggested that in the context of a comprehensive assessment, the Wechsler Intelligence Scale for Children-Third Edition provides some useful information about the presence of specific cognitive disabilities in DD. Practitioner Points. Children with developmental dyslexia revealed significant deficits in the Wechsler Intelligence Scale for Children-Third Edition subtests that rely on verbal abilities, processing speed and working memory. The composite Arithmetic, Coding, Information and Digit Span subtests (ACID); Freedom from Distractibility Index and Symbol Search, Coding, Arithmetic and Digit Span subtests (SCAD) profile scores showed moderate accuracy in correctly discriminating dyslexics from normal readers. Wechsler Intelligence Scale for Children-Third Edition may provide some useful information about the presence of specific cognitive disabilities in developmental dyslexia.

Background The increase in average life expectancy increases the risk of illness and frailty in the elderly, especially in the cognitive arena. This study has the objective to estimate the prevalence and incidence of cognitive impairment, in a representative sample of 65 to 85 years old followed for a mean period of 6-years. Methods Subjects aged 65–85 years (n = 586) were screened at baseline (1999–2004) to estimate the prevalence of cognitive impairment using the Mini-Mental State Examination. A total of 287 individuals with a normal MMSE at baseline were reassessed after 6.2 mean years (± 4.30 years) to evaluate the incidence of cognitive impairment, defined as scoring below the age and education-adjusted MMSE cut-off points adapted for the Portuguese population. We did not exclude Dementia. Results The baseline prevalence of cognitive impairment was 15.5% (95% CI: 12.7–18.7). Higher in women (18.9%; 95% CI: 14.9–23.3), that in men (10.4%; 95% CI: 6.7–15.1). Increased with age and was highest for participants without any schooling. The overall incidence rate was 26.97 per 1000 person-years; higher in women (33.8 per 1000 person-years) than in men (18.0 per 1000 person-years). Higher for the oldest participants and those with no schooling. Taking the standard European population, we estimated a prevalence of 16.5% and an incidence of 34.4 per 1000 person-years. Conclusion The prevalence of cognitive impairment in Portugal is within the estimated interval for the European population, and the incidence is lower than for the majority of the European countries. Women, senior and elders without education have a higher risk of cognitive impairment. In our sample, neither employment nor marital status has a significant effect on cognitive impairment.

A cognição constitui um processo complexo que integra funções mentais como memória, linguagem, atenção, perceção e raciocínio, sendo determinante para a autonomia e identidade da pessoa. O seu comprometimento repercute-se nas atividades básicas e instrumentais de vida diária, com impacto significativo no funcionamento global. Neste contexto, o Enfermeiro Especialista em Enfermagem de Saúde Mental e Psiquiátrica detém competências específicas para planear e implementar intervenções terapêuticas dirigidas à manutenção, recuperação ou otimização das funções cognitivas. O presente relatório tem como objetivos demonstrar a aquisição de competências comuns, específicas e de mestre em Enfermagem de Saúde Mental e Psiquiátrica, bem como evidenciar o desenvolvimento de competências especializadas na intervenção à pessoa adulta com diagnóstico de enfermagem de cognição comprometida. A metodologia adotada foi descritiva, analítica e reflexiva integrando, de forma crítica, as experiências vivenciadas durante os diversos estágios incluídos neste mestrado. No que respeita às competências comuns, estas foram desenvolvidas nos três contextos de estágio, com destaque para o respeito pela ética e dignidade da pessoa, a gestão dos cuidados baseada na individualidade de cada utente, a melhoria contínua da qualidade dos cuidados prestados, e o constante foco no desenvolvimento profissional. Em relação às competências específicas destaca-se o planeamento e implementação de intervenções especializadas com destaque para a estimulação cognitiva, sempre adaptados às necessidades individuais de cada um e o trabalho em colaboração com as equipas multidisciplinares. No que diz respeito às competências de mestre, o estágio permitiu desenvolver a capacidade de integrar conhecimento teórico-prático com pensamento crítico e ético, mas também da atitude de pesquisa adotada ao longo de todo o processo, recorrendo-se à evidência científica, à reflexão sistemática, crítica e reflexiva. Acrescenta-se a elaboração de um protocolo de uma revisão integrativa da literatura “Intervenções Terapêuticas de Enfermagem de Saúde Mental e Psiquiátrica na Pessoa com Cognição Comprometida” que consolidou esta aquisição de competência de mestre. Entende-se que a articulação de conhecimentos, práticas e reflexão crítica me permitiu alcançar os objetivos definidos e consolidar uma identidade profissional enquanto especialista e mestre em Enfermagem de Saúde Mental e Psiquiátrica. A imersão em realidades distintas, a multiplicidade das experiências e os desafios vividos vieram reforçar a importância da intervenção especializada e fundamentada junto da pessoa com cognição comprometida, proporcionando um significativo crescimento profissional e pessoal.

This is an exploratory, descriptive and qualitative study with the aim of analyzing the knowledge of nurses in an intensive care unit about delirium in critically ill patients. Study participants were fourteen ICU nurses from a public hospital. Data were collected through semi-structured interviews and analyzed using the Collective Subject Discourse technique. Five features were identified after data analysis: signs and symptoms, use of sedatives, physical restraint, environment and lack of professional preparation. It was found that nurses have doubts concerning delirium, its management in intensive care, the use of scales and nursing interventions. This study points to the need for education on the subject and further research on the management of delirium in nursing.

ABSTRACT Background: Swallowing and feeding problems may occur with the progression of behavioral variant frontotemporal dementia (bvFTD) and can impair the anticipatory and oral preparatory phases of swallowing. Objective: To characterize swallowing problems and the feeding situation of patients with bvFTD and to correlate the swallowing problems with functionality, executive functions, cognitive and behavioral features. Methods: Consecutive outpatients with bvFTD in mild, moderate and severe dementia stages were recruited along with their caregivers. Patients and caregivers were screened with the following scales: “Mini-Mental State Examination”, “Severe Mini-Mental State Examination”, “FTLD-modified Clinical Dementia Rating”, “Neuropsychiatric Inventory”, “Frontal Assessment Battery”, “Index of Independence in Activities of Daily Living”, “Swallowing Rating Scale” and “Assessment of Feeding and Swallowing Difficulties in Dementia”. Results: Overall, thirty patients with bvFTD were included along with their caregivers. Patients with bvFTD showed feeding and swallowing difficulties such as: messy to eat, passivity, coughing and choking, difficulty with some food consistencies and with specific food. Swallowing problems in bvFTD correlated with impaired functionality (p<0.05) and cognition (p<0.05), executive dysfunction (p<0.01) and behavioral features (p<0.01). Caregivers had great difficulty in managing the feeding situation during mealtime, with different characteristics in each dementia stage. Conclusion: Patients with bvFTD had inappropriate speed eating, passivity, coughing and choking starting in the mild dementia stage, and these problems worsen in the severe stage. Such difficulties affected caregiver performance during mealtime. The correlations indicated that swallowing difficulties tend to follow cognitive and behavioral decline in patients with bvFTD.