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Cognitive Neurology, Neuropsychology and Neuropsychiatry
Chief: MD. Leiguarda, Ramón C.
» Diseases
» Clinical Practice
» Multidisciplinary Staff
» Academic Projects
» Research
» Consultation
The Cognitive Neurology and Neuropsychiatry Section at FLENI Montañeses and Escobar Centers offer diagnostic services, treatment, and long-term follow-up for patients with a variety of disorders including adult developmental learning disorders, cognitive deficits resulting from stroke, head-injury, infection, tumor, epilepsy, and toxins, and degenerative disorders such as Alzheimer's Disease, Parkinson's Disease, and others. Problems with memory, attention, perception, language, visual cognitive behavior, personality, and emotion that result from these disorders are evaluated to make a diagnosis and to address issues of treatment. Inpatient evaluations are arranged when necessary.
The team comprises neurologists, neuropsychiatrists, occupational therapists, educational consultants, neuropsychologists and speech and language pathologists. Cognitive disorders, behavioral, emotional and decision-making disorders are often associated with several neurological illnesses; therefore, our section works in collaboration with other branches of neurology (Neurovascular Clinic, Abnormal Movements Clinic, Comprehensive Epilepsy Center, Pain Clinic, and Multiple Sclerosis Clinic), psychiatry, internal medicine, neurosurgery, and speech and language pathology.
The Cognitive Neurology Section is following eight fundamental lines of investigation
a. The Executive Functions Research group is studying the neural bases of Decision-Making, Moral Behavior, and Planning. The Section is developing neuropsychological tests for the early detection of frontal dysfunctions present in several disorders.
b. The Memory Research group is studying the neural bases of the Working Memory, Autobiographical Memory and the Long Term Consolidation Memory.
c. The Consciousness Research group is studying the levels of consciousness of patients in a state of coma using cognitive neurophysiologic studies and Functional Magnetic Resonance Imaging (fMRI).
d. The Language Disturbances Research group is studying the cognitive mechanisms in patients with Aphasia, using functional imaging (fMRI). This group also studies new rehabilitation techniques for patients with Aphasia.
e. The Attention and Visual Spatial Research group is studying new treatments for Spatial Neglect and other Visual Spatial disorders and executive functions in adults with Attention Deficit Hyperactivity Disorder (ADHD).
f. The Neuropsychiatry Research group is studying emotional disturbances secondary to brain injury (Stroke and Head Trauma) and neurological illnesses (Parkinson, Epilepsy, among others).
g. The Dementia Research group is studying different cognitive and emotional aspects of several types of dementia.
h. The Cognitive Rehabilitation Research group studies new methods of cognitive rehabilitation to improve the performance of patients with intellectual and cognitive deficits.
1. Diseases
• Dementia (click here to find information about the following deseases)
o Alzheimer ´s Disease (AD)
o Frontotemporal Dementia (FTD)
o Vascular Dementia
o Dementia with Lewy Bodies
o Secondary Dementia. Alcoholism. Korsakoff syndrome
o Creutzfeldt-Jacob Disease
• Mild Cognitive Impairment
• Attention Deficit Hyperactivity Disorder in Adults (ADHD)
Cognitive deficits resulting from:
• Parkinson’s disease
• Multiple Sclerosis
• Head Trauma
• Cerebrovascular Diseases
• Epilepsy
• Tumors of the Nervous System
• Infections of the Nervous System
2. Clinical Practice
1. The Cognitive Neurology and Neuropsychiatry Section comprises:
• Memory Clinic
• Attention Deficit Hyperactivity Disorder in Adults Clinic
• Support System for the Family of patients with Mild Cognitive Impairment
• Day Care Clinic for patients with Cognitive Impairment
2. The Neuropsychology Section comprises:
• Neuropsychological and Language Evaluation and
Cognitive and Language Rehabilitation
• Cognitive Therapy
• Memory Workgroup- Neuropage
• Problem Solving Disorders Support Group
• Inhibit Impulsive Behavior Support Group
• Occupational Therapy for patients with Cognitive Impairment
• Dyslexia in Adults Clinic.
Cognitive Neurology and Neuropsychiatry Section
1- Cognitive Neurology
The Cognitive Neurology Section offers diagnosis, treatment and follow up for patients with cognitive dysfunctions, providing a multidisciplinary approach. Neurologists, psychiatrists, neuropsychologists, speech and language pathologists, and occupational therapists work in collaboration with specialists belonging to other areas such as internal medicine and neurosurgery.
The most frequent diseases seen at the Cognitive Neurology and Neuropsychiatry Section are:
• All diseases affecting cognitive and behavioral processes.
Memory, attention, perception and language, visual spatial, personality and emotional disorders are evaluated in order to offer treatment, education, suggestions and advice to patients, family and caregivers. Treatment is individual and carefully tailored to meet the needs of each patient and family.
Services:
- Clear and accurate diagnosis of behavior and cognitive impairments to plan and develop pharmachological treatment and rehabilitation programs customized for each patient.
- Medical Treatment and consultation
- Education and advice to patients and family
- Therapeutic trials
Information for the First Visit
The Cognitive Neurology Section offers a comprehensive approach for the diagnosis and treatment of ADHD in Adults, Alzheimer’s Disease and other degenerative disorders, cognitive and neurospychiatric disorders resulting from stroke, head-injury, infection, tumor, epilepsy, and toxins, providing a coordinated treatment with specialist in neurology, neuropsychology, occupational therapy and cognitive rehabilitation. Please contact FLENI to schedule an appointment with the medical team comprising: Dr. Ramón Leguarda, Dr. Salvador Guinjoan, Dr.Griselda Russo and Dr. Campos.
Initial Assessment
The initial assessment is the first step in developing a comprehensive treatment plan. Every patient is evaluated by a Cognitive Neurologist or a Neuropsychiatrist.The assessment includes an evaluation of the present symptoms of the patient, a medical history and a neurological evaluation plus an evaluation of the superior mental functions. The physician decides upon the complementary tests to be used.
Following the initial assessment, the family and the patient meet the physician to discuss diagnosis and treatment options. Treatment plans are carefully tailored to meet the needs of each patient based on evidence supported by the neuropsychological tests and based on the difficulties the patient undergoes in his daily life. Medication management is discussed, focused on the condition and on the symptoms of the patient.
This program offers training in different strategies to mitigate the effects of memory loss in everyday life. Practical clinical care and advice help the patient to adjust to the new condition with the passing of time, always focusing on feeling self-assured and independent, and improving life quality of the patient and family.
2- Neuropsychiatry
This section offers neurospychiatric services to patients with epilepsy, dementia, stroke, head trauma, tumors, ADHD, infectious diseases with the following symptoms:
• Emotional Disorders
• Anxiety Disorders
• Changing mental states
• Behavior Disorders
• Adaptative Disorders
• Psychosis
• Sleep Disorders
• Second Opinion
• Others
This approach requires an ongoing multidisciplinary collaboration, enabling a comprehensive discussion of diagnosis, treatment, and strategies of treatment.
Neurospychiatric Evaluation:
Patients are evaluated by an experienced Neuropsychiatrist to determine the psychiatric diagnosis according to the DSM –IV.
An in-depth report comprising two interviews includes the results of the evaluations and the scales applied with the presumptive or definite diagnosis and the treatment options. The report also includes psychopharmacological treatment, psychotherapy as well as interviews with the family, occupational therapy and, psycho-educational clinic.
Memory Disorders Clinic
The Memory Disorders Clinic offers a multidisciplinary approach, diagnosis, evaluation and treatment of the disorders affecting memory, such as Alzheimer’s disease (AD), Stroke, Traumatic Brain Injury, Movements Disorders, Depression among other neurological and neurospychiatric illnesses.
Information for the First Visit
Please contact FLENI at 5777-3200 to schedule an appointment.
Most Frequent Conditions seen at the Memory Clinic
- Memory Loss
- Language and Communication Disorders
- Problem Solving Disorders
- Difficulty to handle everyday situations
- Changes in character or mood
- Decline in motivation and loss of initiative
- Sleep Disorders
- Irritability and Aggressive behavior
- Anxiety and Panic Disorders
- Difficulty to adjust to changes
- Difficulty to recognize familiar places and people
The Adults Attention Deficit Hyperactivity Disorder Clinic
This clinic offers a multidisciplinary approach, diagnosis and treatment of Adults with ADHD.
Information for the First Visit
Please schedule an appointment with:
• Dr. Salvador Guinjoan
What is Attention Deficit Hyperactivity Disorder?
In the past ADHD was called hyperkinesia or minimal brain dysfunction; at present it is one of the most frequent neurobiological disorders in children. It occurs two or three times more often in boys than in girls. ADHD may continue during adolescence and well into adulthood and it can be very irritating and emotionally frustrating and have long term adverse effects. There is a wide variety of medication, of therapies, and optional treatments to help people with ADHD to develop their level of concentration, enhance their self esteem, and perform in new appropriate ways of functioning.
What are the symptoms of ADHD?
ADHD refers to a disorder interfering with children and adults’ capacity to regulate certain behavioral patterns during a period of time. The most frequent behavioral patterns fall into three categories: inattention, hyperactivity, and impulsivity.
Inattention: people who are inattentive find it difficult to focus on one thing at a time and get bored easily only in a few minutes. They pay automatic attention without any conscious effort if they are set on completing a task they enjoy; but focusing on deliberate, conscious tasks and organizing or completing tasks or learning may be very difficult for them.
Hyperactivity: Hyperactive adolescents and adults may become really restless. They may be noisy or try to do many things at a time, going from one activity to another.
Impulsivity: people who are very impulsive seem to be unable to control their immediate reactions or think before they act. As a result, they blurt out with inappropriate comments. They may also cross the street in a hurry without looking. Their impulsivity may make it hard for them to wait for things they want or to wait for their turn.
Not all people suffering from hyperactivity, or inattention or impulsivity have an Attentional Deficit Disorder.
Is ADHD accompanied by other disorders?
One of the difficulties in diagnosing ADHD is that it is often accompanied by other disorders; several people with ADHD also suffer from anxiety disorders and depression. Both anxiety and depression can be treated successfully and this contributes towards facing and overcoming the effects of ADHD.
Which are the most frequent treatments used in ADHD?
During decades, drugs have been used in ADHD treatment. Among the most effective drugs for children and adults, we find three: methylphenidate, dextroanphetamine and pemoline. At present, in our country there is a new drug called atomoxetine. These drugs drastically reduce hyperactivity and improve the capacity to concentrate, work and learn in ADHD patients. These medications also improve motor coordination: handwriting and physical skills. Unfortunately, when people see such an immediate recovery they think that they need medication alone. But medication alone does not cure the disorder, it only controls the symptoms temporarily. Drugs without therapy and a support group can do very little. That is why physicians suggest mixed treatment for a long lasting cure; and it is hard work. Specialists believe that long lasting cures are the result of a combination of the appropriate medication, cognitive therapy, psychological support and a practical support system. Several studies suggest that mixed treatment of medication and cognitive therapy may be more effective than drug therapy alone.
Support Group for Families of patients with Alzheimer Disease (AD)
People with a sick relative or friend very often wonder how they can help their loved ones. But no matter how hard they try, they may be experiencing frustration, loss of hope, resentment and anger. The following suggestions are a recollection of conversations with patients on how to deal with people belonging to their support system: caregivers, family, friends, and neighbors, among others.
• Be patient!
Changing behavioral patterns takes a long time and it is a long and difficult process.
Just like other chronic illnesses, diabetes for instance, which lasts a lifetime, the reasonable attitude to take would be to learn how to live with the disease and not to cure it.
• Praise the positive attitudes in the patient.
There must be something that a patient with AD does well; having a mental illness does not imply that everything they do is wrong! Having AD very often diminishes self esteem and makes the patient place his/her attention on what they cannot do properly instead of what they can do right.
• Try to pay attention to the patient’s improvements even to the most insignificant ones, instead of focusing on what the person needs to improve or on how well she/he did things in the past. Praise efforts in the use of new abilities and strategies to solve problems, or new medications no matter the adverse effects the medication may have.
• Be ready for drawbacks.
Handling a chronic illness is tough and very often the course of the illness has its ups and downs, spells of progress and drawbacks. Don’t make a mountain out of a molehill! A downfall is not the FALL! Obstacles are frequent and very often temporary and sometimes they come in handy because they make the patient aware of the fact that he is to handle his illness proactively. Try not to make the patient feel guilty when the illness gets worse. It is very hard for people with mental illnesses to recognize their own limitations and adding guilt keeps people who are willing to help at a distance.
• Support the patient in his search for help and try to help him follow the treatment but hand the full responsibility of the treatment over to the patient. You cannot force someone to undergo treatment. And you cannot control somebody else’s illness and above all, you cannot cure the patient.
• Focus your frustration and anger on the illness not on the ill person.
The patient hates his illness more than you do. Don’t blame the person for being ill. They did not choose to be ill. Try to think of the person as having the illness not as being the illness itself.
• Do not criticize or show disapproval.
Disabled people are quite often very self critical. Derogative comments diminish their self esteem and increase their inferiority feelings.
• Keep updated.
Read as much as you can about your relative’s disease but do not try to be his/her psychiatrist or her/his counselor.
• Identify the negative family patterns contributing to create difficulties. Try to identify interaction generated arguments and conflicts and try to save the conflicts. Search for family therapy or for couple therapy (counseling), if there is a history of lack of communication or of misunderstandings in the family.
• Take care of yourself.
If a member of the family has been ill for a long time, family life becomes dysfunctional and the members of the family may have given up gratifying activities. The family and friends of a patient with AD must make time for them and carry on with pleasant and gratifying activities.
Stress of the caregivers and family: I have no time for myself.
Does all this sound familiar? If it does, then you are in real danger. As the caregiver of the person with a severe disease, you devote most of your time and energy to looking after him/her. Most probably you feel moments of strain, and sometimes the feeling can be extremely overwhelming. And very often, caregivers do not recognize their own needs, or simply do not know when or how to ask for help. This is the reason why caregivers are called the second victims of the disease or the hidden victim.
The Ten Signals of Stress of Caregivers of patients with AD
The following stress indicators experienced frequently or at the same time may lead to severe health problems. You must learn to identify these signals if you are experiencing them yourself. Taking care of yourself will make you an efficient caregiver.
1. Denying the disease and its effects on the loved person
“I know that Mom will get better”.
2. Anger against the sick person or others; anger because there is no effective treatment at present; anger because people do not understand what is going on.
“ If she/he calls me again, I’ll burst”.
3. Social seclusion from friends and avoiding pleasant activities turns you into a hermit
“ I’m just not interested in going out with my friends”.
4. Anxiety and not being able to face another day and what the future holds
“ What ‘s going to happen to her /him when what I do for her/him is not enough?”
5. Depression that breaks your spirit gradually and diminishes your capacity to face problems.
”I don’t care anymore”.
6. Exhaustion, feeling worn out; you feel that it is practically impossible to complete your daily chores and routines
“I’m through with this, I’m dead tired…can’t take anymore”
7.Insomnium, caused by an unending list of worries
“And if I fall asleep and something happens to him/her?”
8. Irritation leading to bad temper, changing humor, answering back and negative behavior.
“Leave me alone!”
9. Lack of concentration; it is hard to remember all the daily tasks
“I was so busy that I forgot I had an appointment”.
10. Health problems that become overt both physically and mentally
“I just simply can’t remember the last time I felt well”.
At the Cognitive Neurology section at FLENI there is a Support Group for Family of patients with Alzheimer (AD). If you are experiencing any of these stress symptoms, please contact FLENI at 5777-3200 extension 2801
Alzheimer’s and related diseases Day Care Clinic
The AD Day Care Clinic at FLENI Escobar covers the needs of patients suffering from Dementia requiring a Cognitive Stimulation Program.
It is a multidisciplinary day care service for elderly people with cognitive and functional impairment who do not suffer from severe AD supporting familial caregiving.
Description:
- The AD Day Care Clinic provides service to people suffering from dementia, living at home, in Buenos Aires City and in Greater Buenos Aires.
- Opening hours: Monday to Friday from 11 am to 4.30 pm.
- Participation depends on patients and family needs and wishes.
Description of the facilities
- AD Day Care Clinic facilities are designed specifically to compensate for the patients’ impairments and disabilities.
- AD Day Care Clinic facilities are designed to provide leisure, open air recreation and sports.
- Customized facilities to improve the ability to perform daily activities.
- Urban adaptation area including streets, street lights and crossings, among others.
AD Day Care Objectives:
- The AD Day Care Clinic aims at helping patients to achieve as much autonomy as possible and to improve life quality through psychocognitive and physical stimulation programs, preserving the uninjured abilities and rehabilitating the impaired disabilities, in a supportive and caring atmosphere integrating the family.
- The AD Day Care Clinic aims at diminishing the caregiver’s burden, a situation producing high levels of stress and emotional effects as well as providing useful tips, recommendations and guidance on healthcare of AD patients.
- The AD Day Care Clinic seeks to avoid early or frequent admissions at hospital or geriatric homes taking into account emotional and financial aspects.
The AD Day Care Clinic provides:
- Evaluation
- Treatment based on customized activities.
- Nutrition (breakfast, lunch and tea) with a diet supervised by a Nutritionist.
- Assistance in activities of daily life.
- Family education and support.
Professionals in charge of AD Day Care Clinic:
- Neurologists
- Psychiatrists
- Occupational Therapists
- Neuropsychologists
- Kinesiologists
- Nurses
NEUROPSYCHOLOGY AND SPEECH PATHOLOGY AREA- (Cognitive and Language Rehabilitation)
Chief: Sabe, Liliana, PhD.
The Neuropsychology area offers evaluation and treatment both at Belgrano Center and at Escobar Center to adults with:
• Dementia
• Traumatic Brain Injury
• Stroke
• Depression
• Abnormal Movements
• Learning Disorders
• Attention Deficit Disorders
• Language and Communication Disorders.
The rehabilitation of cognitive functions such as language and memory is considered to be very important. Therefore a huge area of the RC (Rehabilitation Center at FLENI Escobar) is assigned to Cognitive Neurology. The RC facilities are ideal for the multidisciplinary approach in cognitive disorders as a result of brain injury (head trauma or stroke) within a traditional holistic therapeutic framework. The objective of the Neuropsychologic Evaluation is to quantify and qualify deficit and identify possible origins. Besides, the evaluation is used as a starting point of learning strategies to perform every day life activities such as: driving a car, keeping accounts in order or decision-making, if such cognitive functions have remained unimpaired.
The Role of the Neuropsychologist
The neuropsycholgist provides information to patients and family about the consequences of the brain injury patients have suffered and evaluates the changes in thinking and behavior; and also, through neuropsychological evaluations. The neuropsychologist assesses cognitive changes and provides information to patient and family on how to deal with a new life and adjust to its changes. Within a therapeutic framework, the neuropsychologist trains patients in the specific impaired cognitive areas, using compensation to mitigate the deficit and alternative approach to face obstacles.
The Role of the Speech and Language pathologist
Within the cognitive functions, language is one of the areas most frequently affected; the Speech and Language pathologist is qualified to offer the appropriate therapeutic approach. The skill to use and understand language is a basic human ability and language dysfunction constitutes one of the most severe effects of brain injury. Based upon tests to establish a treatment plan it is necessary to determine which linguistic skills have been affected and to what extent the damage has affected the patient.
Neuropsychological Evaluations
1. Evaluation of Cognitive Functions
The evaluation of cognitive functions comprises an analysis of the I.Q, memory, visual spatial functions, attention, orientation, language and executive functions. All patients with cognitive disorders are primary candidates for an evaluation, particularly patients suffering from:
a) Dementia
b) Movements Disorders
c) Epilepsy
d) Traumatic Brain Injury
e) Multiple Sclerosis
f) Infectious Diseases
g) Stroke
2. Other Neuropsychological evaluations
When certain cognitive areas have to be studied in depth, a specific test battery applied for each case in particular, for instance:
a) Neuropsychological evaluation for candidates to Epilepsy Surgery or Parkinson Surgery
b) Frontal Lobe Battery
c) Visual Spatial Functions Battery
d) Semantics Battery
Language Rehabilitation
Language rehabilitation is performed in collaboration with all the rehabilitation team, devoting special attention to informing and educating the family of the patient. Making the best of the family’s contribution is felt to be important; they can participate actively or observe through the one-way mirror.
During different stages, different aspects of communication shall be dealt with:
• Comprehension
• Evocation
• Receptive and expressive vocabulary
• Fluency
• Discourse and pragmatic abilities
• Reading
• Writing
• Swallowing
• Orofacial Practice
Several language aspects are dealt with during individual sessions through specially designed computer programs.
Once patients are familiar with the use of programs they are free to use the Computer Lab for Patients.
When language disorders are so severe that they make it impossible for patients to communicate orally, they are provided with Augmentative and Alternative Communication devices.
Cognitive Rehabilitation
Within the facilities of FLENI Escobar, programs of Cognitive Rehabilitation designed within a holistic and traditional framework are offered by the Cognitive Neurology multidisciplinary Team.
Cognitive Rehabilitation is an active process of learning and re-learning and compensating deficits of cognitive skills such as reading, writing, superior visual functions, dyscalculia, memory, attention and operative or executive functions (decision-making and planning). Cognitive Rehabilitation also comprises treating social and emotional skills secondary to brain injury.
The objective of rehabilitation is to help people suffering from intellectual impairment to regain a higher level of independence at home and in society.
Each Program of Cognitive rehabilitation is customer designed based on findings of tests.
Who can benefit from the program of cognitive /language rehabilitation?
» Adults (older than 16 years of age)
» Patients with non-progressive brain injury: Traumatic brain injury, stroke, encephalitis and anoxias, among others
» Patients with memory, attention, problem-solving, planning and organization deficits, and language impairments
» Clinical stable patients
» Patients without severe psychiatric disturbances
The program includes:
» Cognitive strategies: patients are taught the benefit of using strategies to compensate deficits.
» Memory Workgroups deal with “what memory is” and how to use external clues to recover memory.
» Understanding brain injury: the objective is to help patients and family understand what happened to their brain during injury and which the consequences are.
» Daily Living Skills Group: all cognitive rehabilitation patients get together to organize and plan daily activities and to discuss the most important news, reading the newspaper. Through these activities, patients develop and use cognitive strategies learnt during individual sessions.
» Psychological Support: each patient has the chance to discuss his emotional difficulties within the supportive context of the group or individually.
» Study Group: at the group study techniques, note taking strategies, reading and underlying strategies, planning and self evaluation strategies are developed.
» Family and Caregivers Support Group offers psychological support and education for the family about issues related to care and the progress of the illness, through educational lessons and booklets, among others.
» Problem Solving Disorders Support Group: at the group patients learn to acknowledge, come to terms with the problem, understand it, choose and follow the best treatment.
Cognitive Rehabilitation is effective because it reduces the effect of cognitive, social and emotional problems, promoting a higher level of independence in patients, allowing a return to work and, at the same time, diminishing stress at home.
Definition of Cognitive Therapy
Cognitive therapy is an active, directive, structured and limited in time process used to treat different psychiatric illnesses (depression, anxiety and phobias, among others) related to different neurological or neuropsychiatric illnesses.
It is based on the assumption that affection and behavior in an individual is determined mostly by the way in which the person construes the world (Beck, 1976). His/her cognitions are based on attitudes or assumptions (presuppositions) deriving from previous experiences. For instance, if someone interprets all his/her experiences in terms of whether he/she is competent or not and in fact the person is competent, his/her thinking may be permeated by the pattern “If I don’t do it to perfection, I’m a failure”. Thus this person responds to situations in terms of approval, even when the situation does not require such thing.
Therapeutic techniques belong to a cognitive framework model, which identifies and modifies distortions and false assumptions (schemes) underlying beneath such distortions.
Cognitive therapy is supported by a wide range of cognitive and behaviorist strategies. The objective of cognitive techniques is to set a limit, to put to trial false beliefs and specific dysadaptative presuppositions of patients. The method is based on very specific learning experiences aiming at teaching patients the following operations:
» Control automatic negative thinking
» Identify the relationship between cognition, affection and behavior
» Weigh advantages and disadvantages in ones distorted thinking
» Substitute such distorted cognition for more realistic interpretations
» Learn to identify and modify false beliefs that make one prone to distort reality.
Cognitive Therapy: characteristics
Cognitive therapy differs from conventional therapy in two fundamental aspects: in the formal structure of the sessions and in the kind of problems it deals with.
“Collaborative Empires”: In contrast to traditional therapy, such as psychoanalytical therapy or patient-oriented therapy, the therapist remains constantly active and interacts purposively with the patient.
Cognitive therapy evolves around “current” problems. Little or no attention is paid to childhood unless it clarifies present problems. The main objective is to investigate the thoughts and feelings of the patient during therapy and in between sessions. Unconscious thoughts are not interpreted.
Memory Groups
The Section of Cognitive Neurology holds Memory Groups at FLENI Escobar and FLENI Belgrano for patients with mild to moderate memory deficits and other cognitive disorders resulting from non-progressive brain injury.
In the group patients learn to cope with memory problems and the effects they have on everyday life. Patients are taught to use external strategies (diaries, recorders, notebooks, among others) and internal strategies for memory and learning (association techniques, mnemonics, techniques to recover written information, among others), and the application of such strategies and aids at work, at home and during leisure, enhancing autonomy in everyday life. Both individual and team work is encouraged, assisting patients in the development of their capacity of self monitoring and self evaluation.
Admission Criteria
» Adults
» Non-progressive brain injury: Traumatic brain injury, stroke, encephalitis and, anoxias, among others.
» Mild to moderate memory, attention, problem-solving, planning and organization deficits, language impairment
» Mild comprehension impairment.
» Clinical stability
Frequency: once a week (45 minutes session) in groups including up to 5 patients
Neuropage
Present technological progress has given way to designing an external aid system; using the Neuropage for patients with memory deficit has the following advantages:
- It is easy to handle
- It is stress reducing for caregivers and family.
- It reduces quite significantly everyday loss of memory and planning in patients with brain injury.
- It is useful to establish routines and achieve a more autonomous life.
- Vocational/ professional orientation (in process)
- It is useful at the Driving Simulator
- It is handy at the Urban Center
Attention and Problem Solving Group
The Cognitive Neurology Section holds an Attention and Problem Solving Group both at FLENI Escobar and at FLENI Belgrano for patients with mild to moderate deficits of the executive functions resulting from non-progressive brain injury.
Such groups last approximately eight weeks depending on each case and the objective is to help patients to compensate attention and planning deficits and the effects they have in every day life. Although problem solving has several intermediate stages and deficits may appear individually in each stage, the present model works at solving the problem without focusing on a unique aspect of the process. During the first sessions attention is drawn to attention disorders themselves, then the problem solving model is introduced; after that the model practice is drilled as a means of internalization and automation.
Some of the stages in Problem Solving
» To become aware, monitor and evaluate the problem
» To develop a plan
» To set it into action
» To make a general evaluation
Frequency: Once a week in a 60 minute session in groups gathering up to 6 persons.
Inhibit Impulsive Behavior Support Group
Adapted from the STEPPS group, System Approach to emotional predictability and problem solving, Nancee Blum, 1998.
One of the fundamental objectives of such model is training patients in a series of skills for behavioral and emotional management as well as family education and support. The model is divided into three stages: awareness of the illness, management and emotional training and training in behavioral management. The suggested planning is a weekly session lasting two hours with two trained specialists and six to eight participants during 16 weeks (4 months).
Please contact FLENI at 5777-3200 extension 2801 for an appointment with Cognitive Neurology and Neuropsychiatry.
Occupational Therapy for persons with Cognitive Impairment
The Cognitive Neurology Section offers Occupational Therapy for patients with Cognitive Impairment, especially dementia. Milagros Rossello, the Occupational Therapist in charge, was trained in Canada at the Baycrest Centre for Geriatric Care. Dementia produces a triple reduction of the abilities of patients: disintegration of cognitive functions, motor disabilities and behavior disorders affecting the necessary skills for living.
So a person with dementia experiments progressive difficulties in carrying out daily activities; such as, taking a bath, eating, getting dressed, handling personal grooming or coping with daily tasks at home, meals, medication control, control of expenses, the use of the phone, or in the organization of routines, such as leisure, looking for interesting and stimulating things to do, and at home identifying potential danger and risk and arranging for adjustments.
Therefore the Occupational Therapist (OT) operates at three levels: safety, adapting to and complementing the deficit, as well as sustaining and training the unimpaired abilities. Working in collaboration with family/caregiver that spends most of the time with the patient, the therapist implements adaptation tasks, using compensatory strategies, home evaluations to detect potential risk situations, reinforcing safety and adaptative equipment to prevent functional disability and dependence. An ongoing and essential role of the OT is to set guidelines for family and caregivers about the process of the illness, management of the patient, organization of daily routines and techniques for commitment to occupational therapy. Customized treatment improves the quality of life of patients with dementia, delaying situations of dependence, improving unimpaired abilities in a stimulating and facilitating atmosphere, providing relief to patients with dementia and their family.
Adult Dyslexia Clinic
Dyslexia is described as a reading disorder occurring in children and adults.
Reading disorders may occur as a result of brain damage in the posterior region of the left side of the brain producing Acquired Dyslexia in Adults.
Developmental Dyslexia is a disorder showing difficulty in learning to read in children, and in reading in adults who have attended school, and have an appropriate level of education, intelligence and socio-cultural motivation to acquire fluent reading. Developmental dyslexia depends fundamentally on cognitive disorders of constitutional origin.
In the DSM IV dyslexia is placed within the Learning Difficulties under the denomination Reading Disabilities. Defining criteria is the following:
A. The level of reading, individually measured by standardized reading comprehension tests is substantially below chronological age, intelligence and education standards.
B. The issue in criterion “A” interferes significantly with academic performance or daily activities requiring reading skills.
C. If there is a sensory deficit, reading disabilities are greater than those associated with such deficit.
The present classification of reading disabilities comprises the cognitive model of language in which different cognitive processes are present in the creation of language; such cognitive processes may be affected in an independent way. The classification includes: Visual Analysis Processes, Lexical Processes, and Sub-lexical Processes.
3. Staff
• Leiguarda, Ramón C. , MD. Chief of Cognitive Neurology and Neuropsychiatry at Belgrano Center and Escobar Center, Consultation Offices at Belgrano y Escobar.
• Dr. Salvador Guinjoan
• Sabe, Liliana, PhD. Chief of Speech and Language Pathology and Neuropsychology both at Belgrano Center and Escobar Center, Consultation Offices at Belgrano and Escobar.
• Jorge Campos, MD. Cognitive Neurologist
• Griselda Russo, MD. Neuropsychiatrist.
• Lilia Canevaro, MD. Family Support Group.
• María Ester Vescovo, MD. Neuropsychiatrist.
• Cristina Medina, PhD. Speech and Language Pathologist, Dyslexia Clinic at Belgrano.
• Cecilia Tiberti, PhD. Neuropsychology, Consultation Office at Belgrano and Escobar.
• Maria Eugenia Martín, PhD. Neuropsychology, Consultation office at Belgrano.
• Valeria Grondona, PhD. Neuropsychology, Consultation Office at Escobar.
• García Cuerva Agustina, PhD. Speech and Language Pathologist, Consultation Office at Belgrano.
• Valeria Prodan, PhD. Speech and Language Pathologist, Consultation Office at Escobar.
• Maria Marta Saavedra, PhD. Speech and Language Pathologist, Consultation Office at Escobar.
• Soledad Melián, PhD. Speech and Language Pathologist, Consultation Offices at Escobar and Belgrano.
• Milagros Roselló, Occupational Therapist, Consultation Offices at Belgrano y Escobar.
• Angeles Moravek, PhD. Pain Clinic at Escobar.
• Natalia Restano, PhD. Pain Clinic at Escobar.
• Alejandra Mazzola, PhD. Pain Clinic at Belgrano.
• Silvina Alcaraz, PhD. Speech and Language Therapist at Escobar.
• Ana de Estrada, Fellow, Speech and Language Pathologist at Escobar.
• Verónica Castaño, Fellow at Neuropsychology at Escobar.
• Josefina Courtis, Fellow at Speech and Language Pathology Section at Escobar.
• Nadia Salmoiraghi, Fellow at Neuropsychology at Escobar.
• Carolina Plotkin, PhD. Cognitive Therapy at Escobar.
• Tristan Bekinschtein, Biologist. Ph D student.
• Guillermina Bonorino, PhD. Speech and Language Pathologist at Escobar.
• M. Laura Pascual, PhD. Speech and Language Pathologist at Escobar.
• Silvia Castro, PhD. Educational Therapist and Visual-spatial Rehabilitation.
• Ana Puz, Occupational Therapist Visual-spatial Rehabilitation.
• Agustina Lacroze, Psychologist. Investigation at Escobar.
• Julián Cardozo, Biologist, .Investigation at Escobar.
• Lila Isacovich, PhD. Family Support Groups.
• Lucia Crivelli, PhD. Neuropsychology at Belgrano.
• Agustina Ruiz Villamil, MD. Ph D student.
• Noelia Pontello, Medical Student. Investigation.
• Jorge Niklison , Psychology Student. Investigation.
• Cecilia Forcato, Biology Student, Writing Thesis for Licenciatura.
4. Academic Activities
Refer to "Agenda" (spanish version)
5. Present Investigation Projects
- Autobiographical Memory.
- Consolidation of Long Term Memory in Persons with Minimal Cognitive Impairment
- Cognitive Profile in Patients with Cluster Headache (in collaboration with Pain Clinic, FLENI.
- Consciousness: Study of the Cognitive reserve in Patients in Persistent Vegetative state as assessed by fMRI (in collaboration with Neuroimaging Section, FLENI).
- Cerebellum and Cognition (in collaboration with Cerebrovascular Diseases section, FLENI).
- Consolidation of Long Term Memory in Patients with Temporal and Extra temporal Epilepsy (in collaboration with Epilepsy section, FLENI).
- Acquired Sociopathy following Frontal Lobe Dysfunction and Decision-Making in Neuropsychiatric Disorders.
- Validation of the Addembroke´s Cognitive Examination en Spanish.
- Cognitive and Neuropsychiatric Profile of the Patient with Alzheimer’s Disease.
- Frontal and Temporal Dementia and Dementia with Lewy Bodies.
- Validation of the Cambridge Behavioral Inventory en Spanish.
- Cognitive and Neuropsychiatric Disorders after Strokes in Children (in collaboration with the Children’s Hospital and Health Center, San Diego USA)
- Frontal Lobe and Cognition (in collaboration with the Cognition and Brain Sciences Unit, Cambridge, England).
- The Role of Sleep and Consolidation of Memory (in collaboration with the Sleep Department, FLENI).
- Effects of the inhibitors of the acetyl cholinesterase in the cerebral cortex (in collaboration with the University of Miami, Departments of Neurology and Psychiatry.)
6. For further inquiries please contact
Cognitive Neurology and Neuropsychiatry
FLENI Institute
Montañeses 2325 (1428)
Buenos Aires
Argentina
Phone Number: 00 5411-5777- 3200; Extension number 2801 o 2804
e-mail: recepcioncognitiva@fleni.org.ar
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