Background : To study the extent to which neuropsychiatric symptoms (NPS) influence the cognitive and functional decline in frontotemporal degeneration (FTD) and Alzheimer’s disease (AD). Methods : We assessed the progression of NPS and their influence on cognitive and functional progression in a group of FTD ( n = 36) and AD patients ( n = 47) at two different stages of the disease (2.5 years). A standardized scale was used to assess NPS—the Columbia University Scale for Psychopathology in Alzheimer’s Disease (CUSPAD)—which tracks different symptoms including depression, psychotic symptoms, as well as sleep and conduct problems. In addition, in a subsample of patients (AD n = 14 and FTD n = 14), we analyzed another group of NPS by using the Neuropsychiatric Inventory (NPI). Cognitive declines were tracked by using the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE), while functionality was tracked by using the Lawton scale and the Barthel Index. Results : The presence of NPS impacts cognitive and functional decline in both groups of patients 2.5 years after disease onset. However, we observed a dissociable profile of the affectation of NPS in each group. In the AD group, results indicate that the progression of depressive symptoms and sleep problems predict cognitive and functional decline. In contrast, the progression of a mixed group of NPS, including conduct problems and delusions, predicts cognitive and functional decline in FTD. Conclusion : The presence of NPS has a critical impact on the prediction of cognitive decline in FTD and AD patients after 2.5 years of disease progression. Our results demonstrate the importance of assessing different types of NPS in neurodegenerative disorders which, in turn, predict disease progression. Future studies should assess the role of NPS in predicting different neurocognitive pathways and in neurodegeneration.
La discapacidad ha tenido diferentes conceptualizaciones, incluyendo aportes religiosos, científicos, médicos y sociales. El modelo médico es fundamental en la prevención y la rehabilitación adecuada, sin embargo, es también un gran generador de discapacidad. El objetivo de este trabajo es presentar la relación del modelo médico de discapacidad y el enfoque biomédico como generadores de discapacidad y proponer una aproximación teórica a nuevos modelos y enfoques que permitan un abordaje ético-ontológico. El presente es un artículo de exposición en dos etapas: en la primera se hizo una revisión de literatura sobre discapacidad. En la segunda, se presentan los resultados de la discusión entre los autores para comparar e identificar argumentos y contraargumentos de los modelos tradicionales, con respecto a las nuevas formas de análisis con una visión desde la bioética. Una de las principales conclusiones de este análisis es que el modelo médico ha hecho aportes fundamentales en la conceptualización y clasificación de la discapacidad; sin embargo, el enfoque monocausal positivista termina favoreciendo la medicalización, la discapacidad y demanda más recursos. La discapacidad es un asunto en evolución en el que interactúan las deficiencias individuales y las barreras personales y ambientales, por lo que es necesario superar el paradigma médico y fortalecer el biopsicosocial.
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