Decision Making in Traumatic Brain Injury: Different Paradigms of Assessment

El traumatismo craneoencefálico (TCE) se caracteriza por presentar complejidad clínica y frecuente ocurrencia en funciones ejecutivas como la toma de decisión (TD), los cuales aún permanecen insuficientemente investigados. El objetivo de la revisión sistemática fue caracterizar investigaciones empíricas que midieran la TD con instrumentos de evaluación de desempeño en adultos post-TCE, en cuanto a los objetivos, paradigmas utilizados, muestras de base y principales hallazgos. Fueron consultadas las bases Web of Science, PubMed/ MEDLINE y PsycInfo por publicaciones entre 2003 y 2013, con las palabras clave “decision making” AND “traumatic brain injury”. De los 800 abstracts inicialmente encontrados, 16 estudios fueron incluidos en la revisión después del análisis doblemente ciego. Los principales paradigmas utilizados fueron, en orden decreciente, Iowa Gambling Task, Cambridge Gambling Task, Simple/Choice Reaction Time, Tarea de Descuento Temporal e o Game of Dice Task. Los estudios evaluados dejaron en evidencia prejuicios ejecutivos de TD en pacientes post-TCE. Sin embargo, dos estudios no encontraron impacto en la TD de factores como el lugar de las lesiones encefálicas o el nivel de severidad del TCE. Algunas limitaciones se destacan, como la variabilidad en el tiempo post-lesión y ausencia o bajo control de variables psicopatológicas

Déficits Primários e Secundários de Funções Executivas Pós-TCE: análise de dissociações

The present study evaluated the presence of associations and dissociations between impairments in episodic memory and executive functions in patients with traumatic brain injury (TBI), and verified whether these deficits were primary or secondary. Eighty-one patients with TBI were assessed using the Rey Auditory Verbal Learning Test and the Hayling Test. The results suggest that impairments in inhibition speed may contribute to deficits in episodic memory, and that initiation and inhibition abilities may be complementary and the first precedes the second. Our findings highlighted that primary executive impairment following TBI may lead to episodic memory deficits.Este estudo avaliou as associações e dissociações encontradas entre déficits de memória episódica em relação aos de funções executivas e verificou se estes déficits encontrados eram primários ou secundários. Os 81 pacientes pós-Traumatismo Cranioencefálico (TCE) foram avaliados por meio do Teste de Aprendizagem Auditivo-Verbal de Rey e do Teste Hayling. Os resultados sugerem que prejuízo na velocidade de controle inibitório pode contribuir para déficit na memória episódica e que as velocidades de iniciação e inibição parecem ser complementares, mas a primeira precede a segunda. Nossos achados ressaltam que os prejuízos executivos provavelmente sejam primários em nossa amostra de pacientes pós-TCE e que estes prejuízos podem causar déficits na memória episódica

Naturally occurring circadian rhythm and sleep duration are related to executive functions in early adulthood

Experimental sleep deprivation studies suggest that insufficient sleep and circadian misalignment associates with poorer executive function. It is not known whether this association translates to naturally occurring sleep patterns. A total of 512 of full-term-born members of the Arvo Ylppö Longitudinal Study [mean age = 25.3, standard deviation (SD) = 0.65] (44.3% men) wore actigraphs to define sleep duration, its irregularity and circadian rhythm (sleep mid-point) during a 1-week period (mean 6.9 nights, SD = 1.7). Performance-based executive function was assessed with the Trail-Making Test, Conners’ Continuous Performance Test and Stroop. The self-rated adult version of Behavior Rating Inventory of Executive Function was used to assess trait-like executive function. We found that performance-based and self-reported trait-like executive function correlated only modestly (all correlations ≤0.17). Shorter sleep duration associated with more commission errors. Later circadian rhythm associated with poorer trait-like executive function, as indicated by the Brief Metacognitive Index and the Behavior Regulation Index. Those belonging to the group with the most irregular sleep duration performed slower than others in the Trail-Making Test Part A. All associations were adjusted for sex, age, socioeconomic status and body mass index. In conclusion, naturally occurring insufficient sleep and later circadian rhythm showed modest associations with poorer executive function. Shorter habitual sleep duration was associated with lower scores of performance-based tests of executive function, and later circadian rhythm was associated mainly with poorer trait-like executive function characteristics. Our findings suggest additionally that sleep duration and circadian rhythm associate with different domains of executive function, and there are no additive effects between the two

O Papel de Variáveis Sócio-Demográficas na Tomada de Decisão: Uma Revisão Sistemática sobre o Iowa Gambling Task

There is a growing interest in the role of socio-demographic variables in cognitive processing in recent years. Some studies in neuropsychology have been showing that socio-cultural factors can be important variables in the execution of neuropsychological tasks. However, investigations with healthy samples are still new in the field. This paper aims to present a systematic review of the literature about the role of the socio-demographic variables education, age and gender in the decision making processing assessed by the Iowa Gambling Task (IGT). MEDLINE, PUBMED, PSYCINFO and WEB OF SCIENCE databases were searched, from 2000 to 2010, with the following syntax keywords “education OR schooling AND Iowa Gambling Task” OR “somatic marker”; “age” OR “aging” AND “Iowa Gambling Task” OR “somatic marker”; and, “sex” OR “gender” AND “Iowa Gambling Task” OR “somatic marker”. Among the abstracts which fulfilled the inclusion criteria, 9 full-text papers were analyzed for the age factor, 3 papers for education and 6 for gender. Only a few studies were found about age, education and gender and their impact on IGT performance. The most studied variable was age. The majority of the studies showed that young adults presented better learning during the task when compared to elderly ones, but there were no differences regarding the total IGT score. When it comes to education few studies were found, and as regards gender, the results were contradictory. In this way the need of more studies with healthy samples which can clarify the role of age, schooling and gender in the decision making process evaluated by IGT was highlighted.El interés por estudiar el papel de las variables sociodemográficas en el funcionamiento cognitivo ha ido ganando atención en los últimos años. Algunos estudios en neuropsicología han demostrado que los factores socioculturales pueden ser variables importantes en el desempeño en las tareas neuropsicológicas. Sin embargo, las investigaciones con poblaciones saludables son aún recientes en el área. Este artículo tiene como objetivo realizar una revisión sistemática de la literatura sobre el papel de las variables sociodemográficas educación, edad y género en la toma de decisión evaluada por el Iowa Gambling Task (IGT). Fueron consultadas las bases de datos Medline, PubMed, Psycinfo y Web of Science, de 2000 hasta 2010, con las siguientes palabras en la sintaxis “education OR schooling AND Iowa Gambling Task” o “somatic marker” para la variable escolaridad; “age” o “aging” y “Iowa Gambling Task” o “somatic marker” para la variable edad y; “sex” o “gender” y “Iowa Gambling Task” o “somatic marker” para la variable sexo. De los resúmenes que cumplen los criterios de inclusión, fueron examinados nueve artículos completos para la variable edad, tres artículos para la variable escolaridad y seis artículos para la variable género. Se encontraron pocos estudios sobre los factores edad, escolaridad y género y su impacto sobre el desempeño en el IGT. La variable más estudiada ha sido la edad. La mayoría de los estudios demostraron que los adultos jóvenes presentaron un mejor aprendizaje a lo largo de la tarea, en comparación con los adultos mayores, pero no tuvieron diferencias en el rendimiento global del instrumento. En cuanto al factor escolaridad se han encontrado pocos estudios y con respecto a la variable de género los resultados son contradictorios. Por lo tanto, es evidente la necesidad de un mayor número de investigaciones con poblaciones saludables para aclarar la función de las variables edad, educación y género en la toma de decisión evaluada por el IGT.O interesse em estudar o papel de variáveis sócio-demográficas no funcionamento cognitivo vem ganhando destaque nos últimos anos. Alguns estudos em neuropsicologia têm mostrado que os fatores sócio-culturais podem ser variáveis importantes na execução de tarefas neuropsicológicas. No entanto, pesquisas com populações saudáveis ainda são recentes na área. O presente artigo teve por objetivo realizar uma revisão sistemática da literatura sobre o papel das variáveis sócio-demográficas escolaridade, idade e gênero no processamento da tomada de decisão avaliado pelo Iowa Gambling Task (IGT). Foram consultadas as bases de dados Medline, Pubmed, Psycinfo e Web of Science, no período de 2000 até 2010, com as seguintes palavras-chaves na sintaxe “education OR schooling AND Iowa Gambling Task” OR “somatic marker” para a variável escolaridade; “age” OR “aging” AND “Iowa Gambling Task” OR “somatic marker” para a variável idade e; “sex” OR “gender” AND “Iowa Gambling Task” OR “somatic marker” para a variável sexo/gênero. Dos abstracts que preenchiam os critérios de inclusão, foram examinados 9 artigos completos para a variável idade, 3 artigos para a variável escolaridade e 6 artigos para a variável gênero. Foram encontrados poucos estudos sobre os fatores idade, escolaridade e gênero e seu impacto no desempenho do IGT. A variável mais estudada foi a idade. A maioria dos estudos mostrou que os adultos jovens tiveram uma melhor aprendizagem ao longo da tarefa do que os adultos idosos, mas não tiveram diferenças quanto ao desempenho total no instrumento. Já quanto ao fator escolaridade poucos estudos foram encontrados e quanto à variável gênero os resultados são contraditórios. Assim, evidencia-se a necessidade de um maior número de investigações com populações saudáveis que esclareçam o papel das variáveis idade, escolaridade e gênero na tomada de decisão mensurada pelo IGT

To Fear is to Gain? The Role of Fear Recognition in Risky Decision Making in TBI Patients and Healthy Controls

Fear is an important emotional reaction that guides decision making in situations of ambiguity or uncertainty. Both recognition of facial expressions of fear and decision making ability can be impaired after traumatic brain injury (TBI), in particular when the frontal lobe is damaged. So far, it has not been investigated how recognition of fear influences risk behavior in healthy subjects and TBI patients. The ability to recognize fear is thought to be related to the ability to experience fear and to use it as a warning signal to guide decision making. We hypothesized that a better ability to recognize fear would be related to a better regulation of risk behavior, with healthy controls outperforming TBI patients. To investigate this, 59 healthy subjects and 49 TBI patients were assessed with a test for emotion recognition (Facial Expression of Emotion: Stimuli and Tests) and a gambling task (Iowa Gambling Task (IGT)). The results showed that, regardless of post traumatic amnesia duration or the presence of frontal lesions, patients were more impaired than healthy controls on both fear recognition and decision making. In both groups, a significant relationship was found between better fear recognition, the development of an advantageous strategy across the IGT and less risk behavior in the last blocks of the IGT. Educational level moderated this relationship in the final block of the IGT. This study has important clinical implications, indicating that impaired decision making and risk behavior after TBI can be preceded by deficits in the processing of fear

Interface entre neuropsicologia e psicopatologia: fun??es executivas, vari?veis cl?nicas, qualidade de vida e funcionalidade na depress?o e no transtorno bipolar

Submitted by Setor de Tratamento da Informa??o - BC/PUCRS ([email protected]) on 2015-08-27T00:04:11Z No. of bitstreams: 1 472635 - Texto Parcial.pdf: 385091 bytes, checksum: 0749f1d7cc35f32e2f887e3f10ad9d0f (MD5)Made available in DSpace on 2015-08-27T00:04:11Z (GMT). No. of bitstreams: 1 472635 - Texto Parcial.pdf: 385091 bytes, checksum: 0749f1d7cc35f32e2f887e3f10ad9d0f (MD5) Previous issue date: 2015-03-11Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPESSeveral neuropsychological and psychopathological studies have sought to identify the cognitive features associated with different psychiatric conditions and their relationship with clinical and demographic variables, functioning and quality of life. Major depressive (MDD) and bipolar disorder (BD) have been the subject of several such investigations, although findings are still preliminary and limited in their clinical applicability and generalizability due to the methodological heterogeneity of studies in the area. Therefore, the goal of this research was to investigate the relationship between cognitive, clinical and demographic features as well as quality of life and functioning in a naturalistic sample of patients with MDD and TB as compared to healthy subjects. The first study investigated differences between the cognitive performance of patients with MDD, BDI, BDII and adults with no mood disorders. Patients with MDD showed impairments in sustained and divided attention, working memory, verbal fluency, inhibitory control and decision making, especially in timed tasks. Patients with BDII showed variable performance and high rates of impairment in attentional interference control. Finally, patients with BDI showed consistently poorer performance than the remaining groups on most cognitive tasks, as well as greater impairments in attention and inhibition than individuals with MDD. In light of these findings and studies regarding the variability of cognitive profiles within diagnostic categories, the second study aimed to identify executive functioning profiles in mood disorders using hierarchical cluster analysis. Four distinct groups of participants were identified. The first was characterized by the absence of executive impairment and was mostly composed of control participants, while the second group showed slight impairments in inhibitory control, divided attention, working memory and verbal fluency. Clusters 3 and 4, composed clinical participants only, showed impairments in inhibitory control and working memory (cluster 3), and inhibitory control and cognitive flexibility (cluster 4). Given the heterogeneity of profiles identified, and the known impact of cognition on functional outcome and quality of life in mood disorders, the third study sought to identify profiles of functioning and quality of life in MDD and BD, as well as their association with clinical, demographic and cognitive variables. The subscales of the WHODAS 2.0 and WHOQOL-BREF questionnaires were submitted to a hierarchical cluster analysis, which assigned patients into three groups. The first, composed mostly of control participants and a small percentage of psychiatric patients, had the highest scores on these measures. The second group obtained intermediate scores, and contained mostly individuals with MDD and BDII, and, to a lesser extent, BDI and control participants. Lastly, cluster 3 had the worst overall performance and was composed predominantly of patients with TBI, and some patients with TBII and TDM. No control participants were included in this group. Poor functioning and quality of life were associated with impairments in inhibitory control, decision making and attentional control. Together, these studies provided important data regarding cognition, functioning and quality of life in mood disorders, revealing a continuum of severity and several possible targets for therapeutic approaches developed specifically for these diagnostic categories.Atualmente a neuropsicologia contribui ? psicopatologia pela busca e identifica??o de caracter?sticas cognitivas de diferentes quadros psicopatol?gicos, e sua rela??o com fatores cl?nicos, demogr?ficos, de capacidade funcional e qualidade de vida. Neste contexto, o transtorno depressivo maior (TDM) e o transtorno bipolar (TB) tem sido alvo de diversas investiga??es, embora ainda preliminares e com limitada aplicabilidade cl?nica e generalizabilidade devido a sua heterogeneidade metodol?gica. Assim, o objetivo desta pesquisa foi investigar a interrela??o entre fatores cognitivos, cl?nicos, demogr?ficos, a qualidade de vida e funcionalidade de amostra natural?stica de pacientes com TDM e TB, comparados a participantes saud?veis. O primeiro estudo visou a identificar diferen?as entre o TDM, TBI, TBII e participantes controles quanto aos processos neurocognitivos de fun??es executivas, atenc?o e velocidade de processamento. Pacientes com TDM apresentaram preju?zos na aten??o sustentada e dividida, mem?ria de trabalho, flu?ncia verbal livre, controle inibit?rio e tomada de decis?o, especialmente em tarefas envolvendo avalia??es temporais de desempenho. Pacientes com TBII apresentaram desempenho heterog?neo, e alta preval?ncia de d?ficits no controle de interfer?ncias atencionais. Por ?ltimo, pacientes com TBI apresentaram maior n?mero de componentes executivos prejudicados quando comparados ao restante dos grupos, al?m de maior preju?zo atencional e inibit?rio do que o TDM. Com base nestes achados e evid?ncias quanto ? variabilidade de perfis cognitivos dentro de diferentes categorias diagn?sticas, o segundo estudo buscou identificar perfis de funcionamento executivo nos transtornos do humor por meio de an?lise de clusters. Foram solicitados quatro agrupamentos distintos de participantes. O primeiro caracterizou-se pela aus?ncia de preju?zos executivos e predomin?ncia de participantes controles, e o segundo por preju?zos leves no controle inibit?rio, aten??o dividida, mem?ria de trabalho e flu?ncia verbal. Os clusters 3 e 4, compostos unicamente por participantes cl?nicos, apresentaram preju?zos inibit?rios e mnem?nicos de trabalho (cluster 3) e comprometimento no controle inibit?rio e flexibilidade cognitiva (cluster 4). Em vista da heterogeneidade de perfis identificados, e do conhecido impacto da cogni??o no desfecho funcional e na qualidade de vida de pacientes com transtornos do humor, o terceiro estudo buscou especificar perfis de funcionalidade e qualidade de vida no TDM e TB, e sua associa??o com vari?veis cl?nicas, demogr?ficas e cognitivas. A an?lise de clusters hier?rquicos baseada nas subescalas dos question?rios WHODAS 2.0 e WHOQOL-BREF identificaram tr?s perfis de qualidade de vida e de funcionalidade. No perfil 1, enquadraram-se a maioria dos participantes controle, assim como alguns membros dos grupos cl?nicos, apresentando os maiores escores de funcionalidade e qualidade de vida da amostra. O cluster 2, em posi??o intermedi?ria, foi composto em maior parte por pacientes portadores de TDM e TBII e em menor propor??o por pacientes com TBI e controles. Por ?ltimo, o cluster 3 apresentou o pior desempenho geral e foi composto predominantemente por pacientes portadores de TBI, alguns pacientes com TBII e com TDM, e aus?ncia de controles. Preju?zos na funcionalidade e qualidade de vida associaram-se a altera??es no controle inibit?rio, tomada de decis?o e controle atencional. Em conjunto, os estudos ofereceram dados importantes a respeito dos perfis cognitivos, de funcionalidade e qualidade de vida nos transtornos do humor, permitindo a identifica??o de um continuum de gravidade e apontando poss?veis focos para abordagens terap?uticas desenvolvidas para estas categorias diagn?sticas

Tomada de decisão no traumatismo cranioencefálico: diferentes paradigmas de avaliação

El traumatismo craneoencefálico (TCE) se caracteriza por presentar complejidad clínica y frecuente ocurrencia en funciones ejecutivas como la toma de decisión (TD), los cuales aún permanecen insuficientemente investigados. El objetivo de la revisión sistemática fue caracterizar investigaciones empíricas que midieran la TD con instrumentos de evaluación de desempeño en adultos post-TCE, en cuanto a los objetivos, paradigmas utilizados, muestras de base y principales hallazgos. Fueron consultadas las bases Web of Science, PubMed/ MEDLINE y PsycInfo por publicaciones entre 2003 y 2013, con las palabras clave “decision making” AND “traumatic brain injury”. De los 800 abstracts inicialmente encontrados, 16 estudios fueron incluidos en la revisión después del análisis doblemente ciego. Los principales paradigmas utilizados fueron, en orden decreciente, Iowa Gambling Task, Cambridge Gambling Task, Simple/Choice Reaction Time, Tarea de Descuento Temporal e o Game of Dice Task. Los estudios evaluados dejaron en evidencia prejuicios ejecutivos de TD en pacientes post-TCE. Sin embargo, dos estudios no encontraron impacto en la TD de factores como el lugar de las lesiones encefálicas o el nivel de severidad del TCE. Algunas limitaciones se destacan, como la variabilidad en el tiempo post-lesión y ausencia o bajo control de variables psicopatológicas.Traumatic Brain Injury (TBI) is associated with significant cognitive impairment, especially in executive functions such as decision making (DM). However, the nature of such impairments has not been sufficiently investigated. The aim of the present review was to analyze current research on DM following TBI involving behavioral tests, describing and discussing the objectives, method, and findings of these studies. Articles published between 2003 and 2013 were retrieved from the Web of Science, PubMed/MEDLINE and PsycInfo databases using the keywords “decision making” AND “traumatic brain injury.” Sixteen of the 800 abstracts located were selected by two independent researchers for inclusion in the review. The most commonly used instruments for assessing TD were, in descending order: Iowa Gambling Task, Cambridge Gambling Task, Simple/Choice Reaction Time, Temporal Discounting Task and the Game of Dice Task. Although patients with TBI tended to exhibit DM impairments, two studies found no associations between DM impairment, TBI severity or the location of brain lesions. Limitations of the studies reviewed included the variability in time since TBI at assessment and the lack of control of psychopathological variables.O Traumatismo Cranioencefálico (TCE), caracteriza-se por complexidade clínica e frequente ocorrência de dé- ficits em funções executivas como a tomada de decisão (TD), os quais permanecem ainda insuficientemente investigados. O objetivo da revisão sistemática foi caracterizar investigações empíricas que mensuraram a TD com instrumentos de avaliação de desempenho em adultos pós-TCE, quanto aos objetivos, paradigmas utilizados, amostras de base e principais achados. Foram consultadas as bases Web of Science, PubMed/MEDLINE e PsycInfo por publicações entre 2003 e 2013, com as palavras-chave “decision making” e “traumatic brain injury”. Dos 800 abstracts inicialmente encontrados, 16 estudos foram incluídos na revisão após análise duplocega. Os principais paradigmas utilizados foram, em ordem decrescente, Iowa Gambling Task, Cambridge Gambling Task, Simple/Choice Reaction Time, Tarefa de Desconto Temporal e o Game of Dice Task. Os estudos avaliados evidenciaram prejuízo executivos de TD em pacientes pós-TCE. Ainda, dois estudos não encontraram impacto na TD de fatores como o local das lesões encefálicas ou o nível de severidade do TCE. Algumas limitações são apontadas como a variabilidade no tempo pós-lesão e ausência ou baixo controle de variáveis psicopatológica