Attention impairment in bipolar disorder: a systematic review

Bipolar disorder (BD) has been associated with marked cognitive impairment, including euthymic periods. Attention is among the most compromised functions in BD. Changes related to learning, memory, and visuospatial abilities can be derived from these attention impairments. The objective of this article is to review the scientific literature on the performance of BD patients in attention tests. A systematic review was performed of controlled studies that assessed attention in patients diagnosed with BD aged between 18 and 65 years. The databases included Medline, LILACS, Cochrane Library, Institute for Scientific Information Web of Knowledge, and Scientific Electronic Library Online (SciELO), and the search encompassed the period from 2008 to 2013. Only studies that had a minimum sample of 10 patients were included. A total of 110 articles fulfilled the inclusion criteria. Compared with healthy control subjects, bipolar patients showed poorer attention performance. Compared with other mental disorders, BD was associated with poorer performance than unipolar depression but better performance than schizophrenia. When bipolar patients in different phases of the disease were compared with one another, the performance of euthymic patients was similar to or better than patients in a depressive state; moreover, manic patients performed worse than depressive patients. Attention is significantly impaired in BD. Attention impairment in BD is milder than in schizophrenia but greater than in unipolar depression. Attention impairment is possibly more severe in manic and depressed episodes than in euthymic periods...

Efeito de um programa de treinamento da memória de trabalho em adultos idosos / Effect of a working memory training program in older adults

Este estudo objetivou examinar os efeitos de um Treinamento da Memória de Trabalho (TMT) em idosos saudáveis. Vinte participantes compuseram a amostra final, onze do grupo experimental (TMT) e nove do controle (socialização). Todos foram submetidos a uma avaliação neuropsicológica pré e pós-intervenção. Os encontros foram realizados uma vez por semana, durante três meses. Houve melhora significativa, no grupo experimental, em atenção concentrada, aprendizagem, memória de curto prazo e episódica, e no grupo controle, em um menor número de variáveis, na atenção concentrada e memória episódica. O TMT parece ter promovido efeito de transferência, principalmente na memória episódica, que é relacionada diretamente aos subsistemas da memória de trabalho (MT), sugerindo que o TMT pode ser útil no contexto da neuropsicologia do envelhecimento.

The present study examined the effects of a Working Memory Training (WMT) in healthy elderly. Twenty participants comprised the final sample, eleven from the experimental group (WMT) and nine from the control group (socialization). Every subject underwent a neuropsychological evaluation pre and post-intervention. The meetings were held once a week, for three months. Results indicated that subjects in the experimental group improved cognitive functions related to concentrated attention, learning, short-term and episodic memory. Subjects in the control group also demonstrated, in a smaller number of variables, improvement in concentrated attention and episodic memory. WMT seems to have generated a transfer effect, especially to episodic memory, which is directly related to the subsystem of working memory (WM), suggesting that WMT may be useful in the context of the neuropsychology of aging.

Reabilitação da memória em idosos com queixas mnemônicas e sintomas depressivos: estudo piloto não controlado / Memory rehabilitation of elderly adults with mnemonic complaints and depressive symptoms: a pilot study

O presente estudo piloto investigou o efeito terapêutico de um programa de reabilitação da memória (RM), com avaliações pré e pós-intervenção, em um grupo de idosos com queixas mnemônicas e sintomas sugestivos de depressão. A amostra foi composta por sete idosos entre 65 a 80 anos de idade, acima de sete anos de estudo formal. A RM consistiu de 24 sessões, realizadas duas vezes por semana, cada com duração de 90 minutos. Esta intervenção incluiu técnicas de aprendizagem explícita e implícita, com estratégias mnemônicas internas e externas. Comparou-se o desempenho cognitivo pré e pós-intervenção pelo Teste Wilcoxon. Houve redução nas queixas de memória e nos sintomas sugestivos de depressão, aumento da velocidade de processamento atencional e aprimoramento da memória de trabalho. Sugere-se que este estudo seja replicado em amostras maiores, em grupos com déficits objetivos de memória e depressão clinicamente diagnosticada, comparados a grupos controles.

The present pilot study investigated the therapeutic effect of a memory rehabilitation program (MR), with pre and post-intervention assessment, in a group of elderly patients with mnemonic complaints and suggestive symptoms of depression. The sample was composed of seven older adults with ages between 65 to 80 years and formal education above seven years. The MR consisted of 24 sessions, twice weekly and each with 90 minutes duration. The intervention included implicit and explicit learning techniques, with internal and external mnemonic strategies. The cognitive performance, pre and post-interventions, were compared by the Wilcoxon test. There were reductions of suggestive symptoms of depression and of memory complaints, increase of attentional processing speed and improvement of working memory. This study should be replicated in larger samples, as well as, in groups with objective memory deficits and clinically diagnosed depression, compared to control groups.

Correlação entre espessura cortical frontal e desempenho de funções executivas em pacientes com infecção pelo vírus da imunodeficiência humana / Correlation between frontal cortical thickness and executive functions performance in patients with human immunodeficiency virus infection

OBJETIVO: Investigar a relação entre a espessura cortical medida pela ressonância magnética em regiões frontais e o desempenho em instrumentos que avaliam funções executivas em pacientes com HIV positivo. MATERIAIS E MÉTODOS: Participaram deste estudo 22 pacientes HIV-positivos, com déficits em funções executivas, sob terapia antirretroviral, idades entre 45 e 65 anos e escolaridade entre 3 e 20 anos. Foi realizada ressonância magnética com sequências convencionais, T1 3D, processado pelo Freesurfer para verificar espessura cortical. Instrumentos de avaliação das funções executivas: Teste de Trilhas, Wisconsin, Hayling, Dígitos (WAIS-III), fluência verbal ortográfica e Stroop. Para análise da relação espessura versus cognição, utilizou-se coeficiente de correlação de Pearson. RESULTADOS: Correlações significativas foram encontradas entre escores de: Wisconsin e espessura das regiões pré-central e orbitofrontal lateral à direita e pré-central esquerda; Teste de Trilhas e espessura da área pré-central direita e cíngulo anterior caudal esquerdo; e Teste Hayling e espessura da área lateral orbitofrontal esquerda. CONCLUSÃO: As correlações existentes entre medidas de espessura cortical pela ressonância magnética e desempenho cognitivo sugerem que os déficits executivos em pacientes HIV-positivos relacionam-se a uma redução da espessura cortical das regiões frontais.

OBJECTIVE: To investigate the correlation between frontal regions cortical thickness measured by magnetic resonance imaging of HIV-positive patients and their performance on instruments for assessing executive functions. MATERIALS AND METHODS: The present study included 22 HIV-positive patients in the age range from 45 to 65, schooling ranging between three and 20 years, with executive functions deficit and undergoing antiretroviral therapy. Magnetic resonance imaging was performed with conventional T1-weighted, 3D sequences and the images were processed with the Freesurfer software to measure cortical thickness. The following instruments were utilized to evaluate the patients' executive functions: Trail Making, Wisconsin, Hayling, working memory (WAIS-III), verbal fluency and Stroop tests. The Pearson's correlation coefficient was utilized in the data statistical analysis. RESULTS: Significant correlations were found between: Wisconsin scores and the thickness of the right pre-central, lateral and left pre-central orbitofrontal regions; Trail Making scores and thickness of right pre-central and left anterior caudal cingulate areas; and Hayling Test scores and thickness of the left lateral orbitofrontal area. CONCLUSION: Correlations between cortical thickness measurements by magnetic resonance imaging and cognitive performance suggest that the executive function deficit in HIV-positive patients are related to a reduction in the thickness of the frontal cortex.

Working memory interventionprograms for adults - a systematic review / Programas de intervenção de memória de trabalho em adultos - uma revisão sistemática

This systematic review aimed to identify the designs, procedures, and results of empirical studies that performed neuropsychological interventions on WM in adults. Methods: A PubMed and LILACS literature search was conducted using the keywords working memory AND (training OR rehabilitation OR intervention) AND adult. Results: Of the seven studies found, three were randomized controlled trials, two were case reports, one was a clinical trial, and one was an evaluation study. With regard to the type of programs and samples, three studies employed global programs with healthy elderly adults and four employed specific programs for samples with neurologically-impaired adults. Conclusions: The effectiveness of the WM intervention programs was more evident in studies that employed specific methods of rehabilitation for samples with neurological disorders than in those based on global programs with healthy adults. There is a need for more empirical studies to verify the effectiveness of WM intervention programs in order to provide adequate guidance for clinical neuropsychologists and future research.

Essa revisão sistemática teve como objetivo identificar os delineamentos, procedimentos, e resultados dos estudos empíricos que investigaram intervenções neuropsicológicas de memória de trabalho em adultos. Métodos: Foi realizada uma busca da literatura nas bases de dados PubMed e LILACS, utilizando as palavras-chave memória de trabalho working memory AND (training OR rehabilitation OR intervention) AND adult, ou memória de trabalho E (treino OU reabilitação OU intervenção) E adulto. Resultados: De sete estudos encontrados, três eram estudos randomizados controlados, dois eram relatos de casos, um era um ensaio clínico, e um estudo, de avaliação neuropsicológica. Em relação ao tipo de programa e amostra, três estudos foram conduzidos utilizando programas globais de intervenção com idosos saudáveis e quatro utilizaram-se de programas específicos de intervenção com amostras clínicas de pacientes neurológicos. Conclusões: A efetividade dos programas de intervenção em memória de trabalho foi mais evidente em estudos que empregaram métodos específicos de reabilitação com amostras clínicas neurológicas, quando comparados àqueles baseados em programas gerais de intervenção com adultos saudáveis. Existe necessidade de estudos empíricos que verifiquem a eficácia de programas de intervenção em memória de trabalho que possam contribuir com orientações adequadas para neuropsicológos clínicos e para futuras pesquisas.

Theoretical, behavioral and neuroimage evidence on discourse processing aging

A growing interest in cognition in aging has been observed because of both the epidemiologic factor of an increase in the lifespan of the world's population and the cognitive changes behaviorally and biologically detectable in this population. The most complex of language components and fundamental in social interaction, discourse production and comprehension are among the most scarcely explored cognitive functions in this context. This review presents and discusses discourse processing in healthy aging with regard to theoretical, behavioral, and neuroimaging evidence. Cognitive and neurobiological models are reviewed, such as the Hemispheric Asymmetry Reduction in Older Adults (HAROLD) model and the Posterior-Anterior Shift in Aging (PASA) model. Among the neuropsycholinguistic research developed to characterize discourse processing in aging individuals, which has contributed to the prevention and treatment of language impairment and the maintenance of communicative competence in aging, studies on the relationship between discourse and working memory, attention, and some executive components are discussed. Regarding neuroimaging data, very few studies that have included cognitive tasks and discourse stimuli were found. Such studies suggest that discourse processing requires not only the participation of both brain hemispheres, but also a more prominent activation of frontal regions. Considering the great complexity and usefulness of discourse in elderly adults' daily communication and the emergence of cognitive deficits related to aging in complex information processing, the necessity of further behavioral and neuroimaging studies, including discourse processing tasks, comparing tasks involving executive, attentional, and mnemonic demands becomes evident.