Effects of exercise training on brain metabolism and cognitive functioning in sleep apnea.

Impaired glucose metabolism reflects neuronal/synaptic dysfunction and cognitive function decline in patients with obstructive sleep apnea (OSA). The study investigated the extent to which exercise training (ET) improves cerebral metabolic glucose rate (CMRgl) and cognitive function in patients with OSA. Patients with moderate to severe OSA were randomly assigned to ET (3 times/week, n = 23) or no intervention (control, n = 24). Echocardiography and apolipoprotein ε4 (APOEε4) genotyping were obtained at baseline. Both groups underwent cardiopulmonary exercise testing, polysomnography, cognitive tests, brain magnetic resonance imaging, and 18F-fluoro-2-deoxy-D-Glucose positron emission tomography (18FDG-PET) at baseline and study end. Compared with control, exercise-trained group had improved exercise capacity, decreased apnea-hypopnea index (AHI), oxygen desaturation and arousal index; increased attention/executive functioning, increased CMRgl in the right frontal lobe (P < 0.05). After ET an inverse relationships occurred between CMRgl and obstructive AHI (r = - 0.43, P < 0.05) and apnea arousal index (r = - 0.53, P < 0.05), and between the changes in CMRgl and changes in mean O2 saturation during sleep and non-rapid eye movement sleep (r = - 0.43, P < 0.05), desaturation during arousal (r = - 0.44, P < 0.05), and time to attention function testing (r = - 0.46, P < 0.05). ET improves OSA severity and CMRg in the frontal lobe, which helps explain the improvement in attention/executive functioning. Our study provides promising data that reinforce the growing idea that ET may be a valuable tool to prevent hypoxia associated with decreased brain metabolism and cognitive functioning in patients with moderate to severe OSA.Trial registration: NCT02289625 (13/11/2014).

The route of administration exacerbates prefrontal functional impairments in crack cocaine users.

Studies have evidenced more severe health consequences in individuals who smoked crack cocaine as compared to intranasal cocaine users. Differential neurocognitive deficits between the crack and intranasal cocaine-addicted patients, associated with prefrontal cortex functions, have never been tested using complex cognitive tasks in humans. In this study, we examined possible distinct neurocognitive deficits in 43 crack-addicted patients (CrD) compared with 36 intranasal cocaine-addicted patients (CD) and 32 controls. CrD and CD were evaluated after 2 weeks of supervised detoxification in two inpatient treatment programs. All the subjects were evaluated using an extensive battery of neurocognitive tasks, including the Trail Making Test, the Stroop Color-Word Test, the Digits Forward and Digits Backward tasks, the Controlled Oral Word Association Test, the Wechsler Adult Intelligence Scale, and the Frontal Assessment Battery. Differences in performance in the neurocognitive tests between the three groups were investigated controlling for age, IQ, psychiatric symptoms, and years of education. Both intranasal and crack users were impaired on a variety of cognitive measures relative to controls. Crack users performed worse than intranasal cocaine users in inhibitory control (p < .05) and general executive functioning (p < .01). Crack use seems to be more deleterious to neurocognitive functions associated with the prefrontal cortex. This may predispose crack-addicted patients to more severe negative clinical outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[Neuropsychological impairments in crack cocaine-dependent inpatients: preliminary findings]. / Alterações neuropsicológicas em dependentes de cocaína/crack internados: dados preliminares.

OBJECTIVE: Although cocaine use is a significant public health problem, there is relative paucity of scientific data on long-term neurocognitive consequences of the exposure to the substance. METHODS: This study examined the association between crack cocaine dependence and neuropsychological performance. An extended battery of neuropsychological tests was administered to 15 abstinent cocaine abusers, inpatients in abstinence for two weeks, and 15 non-drug-using control subjects matched for age, gender, education, socio-economic status, handedness and IQ. RESULTS: The preliminary findings showed statistical significance (p<0.05) on differences of performance in attention, verbal fluency, verbal memory, visual memory, learning ability and executive functions. CONCLUSIONS: These results represent evidences that cocaine abuse is associated with decrements in cognitive functioning, similar to cognitive disorders associated to prefrontal and temporal brain impairments. Knowledge of specific cognitive deficits in cocaine abusers may be useful for designing more effective substance abuse prevention and treatment programs.

Alterações neuropsicológicas em dependentes de cocaína/crack internados: dados preliminares / Neuropsychological impairments in crack cocaine-dependent inpatients: preliminary findings

OBJETIVO: Embora o uso de cocaína seja um problema significativo de saúde pública, há uma relativa escassez de dados científicos sobre as conseqüências neurocognitivas decorrentes da exposição à substância. MÉTODOS: Esse estudo avaliou a associação entre dependência de cocaína e crack e desempenho cognitivo. Uma ampla bateria de testes neuropsicológicos foi aplicada a 15 dependentes de cocaína, em abstinência por duas semanas, em tratamento em regime de internação, e em 15 sujeitos controles, não usuários de drogas, pareados por idade, sexo, escolaridade, nível sócio-econômico, lateralidade e QI. RESULTADOS: Os resultados preliminares mostraram significação estatística (p<0,05) em testes de atenção, fluência verbal, memória visual, memória verbal, capacidade de aprendizagem e funções executivas. CONCLUSAO: Esses dados mostram evidências de que o abuso de cocaína está associado a déficits cognitivos, semelhantes aos que ocorrem em transtornos cognitivos, possivelmente relacionados a problemas em regiões cerebrais pré-frontais e temporais. O conhecimento dos danos neuropsicológicos específicos pode ser útil no planejamento de programas de prevenção e tratamento mais efetivo para abuso de cocaína/crack.

Avaliacão neurocognitiva no abuso e dependência do álcool: implicacões para o tratamento / Neurocognitive assessment in alcohol abuse and dependence: implications for treatment

A Neuropsicologia, aplicada ao abuso e dependência do álcool, busca a compreensão da relacão entre danos cerebrais e seus efeitos na cognicão e no comportamento do indivíduo. Estuda, ainda, os comprometimentos neurocognitivos dos pacientes, relacionando-os a achados estruturais e funcionais de neuroimagem (TC, RM, PET e SPECT). No uso agudo, o álcool tende a comprometer a atencão, memória, funcões executivas e viso-espaciais, enquanto no uso crônico altera a memória, aprendizagem, análise e síntese viso-espacial, velocidade psicomotora, funcões executivas e tomada de decisões, podendo chegar a transtornos persistentes de memória e demência alcoólica. Os déficits cognitivos encontrados nos dependentes de álcool, principalmente das funcões executivas (frontais), têm implicacão direta no tratamento, tanto para a escolha de estratégias a serem adotadas como para a análise do prognóstico. Ao final do artigo, é apresentado um instrumento útil e breve para rastreio de alteracões cognitivas, a Bateria de Avaliacão Frontal - FAB.15 Acredita-se que a Avaliacão Neuropsicológica pode ser muito importante para a deteccão e avaliacão da progressão destas alteracões e que a reabilitacão cognitiva tem papel relevante na recuperacão dos déficits e reinsercão psicossocial destes pacientes.

[Neurocognitive assessment in alcohol abuse and dependence: implications for treatment]. / Avaliação neurocognitiva no abuso e dependência do álcool: implicações para o tratamento.

The aim of the Neuropsychology applied to the Alcohol Dependence field is the comprehension of the effects of brain dysfunction on cognition and human behavior. It investigates neurocognitive impairments and associates them to structural and functional neuroimaging findings (CT, MRI, PET and SPECT). Acute use of alcohol impairs attention, memory, executive functions and visuospatial skills, while chronic abuse causes neurocognitive deficits in memory, learning, visuospatial functions, psychomotor speed processing, executive functions and decision-making, and may lead to persistent amnesic disorder and alcoholic dementia. Executive Dysfunction related to frontal lobe has direct implications on treatment, by the choosing of strategies and for prognostic evaluation. It is presented an easy tool to screen cognitive impairments, the Frontal Assessment Battery--FAB.15. Neuropsychological Assessment is useful for early detection of impairments and evaluation of their evolution and Cognitive Rehabilitation has a significant role on deficits recovery and psychosocial adjustment of these patients.