No description available.

L’impulsivité est une séquelle fréquente suite à un traumatisme cranio-cérébral (TCC) à laquelle sont associées de nombreuses conséquences néfastes et qui nécessite un investissement considérable de ressources. En ce sens, une évaluation adéquate de l’impulsivité est de mise dans un contexte de réadaptation. Par contre, malgré son importance, il n’existe pas de définition consensuelle de l’impulsivité post-TCC ni de mesure spécifique permettant de l’évaluer. Il est généralement admis, dans la littérature récente, que l’impulsivité est un construit multidimensionnel. Notamment, le modèle UPPS-P de l’impulsivité gagne un appui significatif et pourrait permettre une compréhension plus spécifique de l’impulsivité post-TCC. Selon ce modèle, il existe quatre dimensions à l’impulsivité soit l’urgence (tendance à agir ses impulsions dans un contexte d’émotions intenses), le manque de persévérance (difficulté au niveau du maintien de l’attention sur une tâche complexe et ennuyante et une susceptibilité à l’ennui), le manque de préméditation (difficulté de prévoir les conséquences d’un comportement avant de le poser) et la recherche de sensations (tendance à préconiser des activités jugées excitantes et l’ouverture à essayer de nouvelles expériences qui peuvent ou non, être dangereuses). Il a été proposé que l’urgence, le manque de persévérance et le manque de préméditation sont associés à des difficultés à inhiber la réponse automatique, à résister à l’interférence proactive et de la prise de décision, respectivement (Bechara et Van der Linden, 2005). Une telle conceptualisation offre une avenue prometteuse quant à l’évaluation de l’impulsivité post-TCC. Le présent projet vise à clarifier le construit de l’impulsivité post-TCC, à déterminer si les mêmes mécanismes cognitifs sont en lien avec les dimensions de l’impulsivité dans un contexte de réadaptation fonctionnelle intensive puis de déterminer quelles tâches de performance prédisent le mieux les comportements impulsifs dans ce milieu. D’abord, une recension des écrits portant sur l’impulsivité post-TCC donne un appui à la conceptualisation multidimensionnelle de l’impulsivité et fait ressortir les obstacles qui nuisent à l’étude de l’impulsivité post-TCC. Ensuite, l’utilisation de diverses tâches de performance permet d’évaluer le lien entre les dimensions de l’UPPS-P et les mécanismes cognitifs. Les résultats indiquent des atteintes sur les mécanismes liés à l’inhibition de la réponse automatique, à la résistance à l’interférence proactive ainsi qu’à la prise de décision. Toutefois, ils ne permettent pas de supporter les propositions de Bechara et Van der Linden quant aux mécanismes sous-jacents aux dimensions de l’impulsivité post-TCC chez les patients en réadaptation intensive. Finalement, les résultats permettent de faire ressortir la pertinence des tâches de performance écologiques dans la prédiction de comportements impulsifs dans la vie quotidienne. Les portées théoriques et cliniques des résultats sont discutées. / Impulsivity is a common sequela following traumatic brain injury (TBI) to which are associated many negative consequences and necessitates important resources. A thorough assessment of impulsivity is therefore necessary in a rehabilitation setting. However, there is no consensual definition of post TBI impulsivity nor is there a specific measure allowing its assessment. It is generally acknowledged, in recent literature, that impulsivity is a multidimensional construct. The UPPS-P model is gaining a significant amount of support and could allow a better understanding of post-TBI impulsivity. According to this model, there are four dimensions to impulsivity, namely urgency (tendency to experience and act on strong impulses frequently under conditions of strong affect), lack of perseverance (inability to remain focused on a task that may be boring or difficult), lack of premeditation (inability to think and reflect on the consequences of an act before engaging in that act) and sensation seeking (tendency to enjoy activities that are exciting and a willingness to try new experiences). It has been suggested that urgency, lack of perseverance and lack of premeditation are linked to impairments on prepotent response inhibition, on resistance to proactive interference and on decision making, respectively (Bechara and Van der Linden, 2005). This conceptualisation offers a promising avenue as to the assessment of post-TBI impulsivity. This project aims to clarify the construct of post-TBI impulsivity, to determine whether the same cognitive mechanisms come into play in the different dimensions of impulsivity in an intensive functional rehabilitation setting and to determine which performance tasks allow the prediction of impulsive behaviors in that setting. Firstly, a literature review among studies on post-TBI impulsivity gives support to a multidimensional conceptualisation of impulsivity and allows to bring out the obstacles which make the study of post-TBI impulsivity more complicated. Secondly, the use of different performance tasks is used to assess the links between UPPS-P dimensions and cognitive mechanisms. Results indicate impairments on the mechanisms linked to prepotent response inhibition, to resistance to proactive interference and to decision making. However, they do not support Bechara and Van der Linden’s (2005) propositions as to the underlying mechanisms to the dimensions of post-TBI impulsivity in an acute rehabilitation setting. Thirdly, the results show the relevance of ecological performance tasks as to the prediction of impulsive behaviors in everyday life. The theoretical and clinical implications of the results are discussed.

[pt] Diversos estudos apontam o efeito do nível de escolaridade parental no desenvolvimento das funções cognitivas, em especial a linguagem e as funções executivas. Evidenciam a importância da interação entre o cuidador e a criança, a qualidade da estimulação e a promoção de experiências de desenvolvimento, propiciadas a criança, como fundamentais para o desenvolvimento das funções executivas. Há poucos estudos desse efeito no desenvolvimento de crianças brasileiras. O objetivo da dissertação foi investigar o efeito do nível de escolaridade dos pais, separadamente, no desempenho em tarefas de memória de longo prazo, memória de trabalho, controle inibitório e flexibilidade cognitiva de crianças e adolescentes com baixo nível socioeconômico na cidade do Rio de Janeiro. Participaram do estudo 352 crianças entre 7 a 15 anos de escolas privadas com perfil de baixo nível socioeconômico na cidade do Rio de Janeiro. Os instrumentos utilizados foram a Figura Complexa de Rey, a Aprendizagem auditivo verbal de Rey, o paradigma de Stroop e as tarefas de Fluência Verbal fonêmica e semântica. Os resultados mostraram efeitos para a escolaridade de ambos os pais. Resultados sistemáticos aconteceram na fluência verbal, na faixa de 9-10 anos. Não foram encontrados efeitos significativos em controle inibitório e memória de trabalho. O efeito da escolaridade parental apareceu de forma sistemática em funções executivas, mas não em outras funções, em uma amostra homogênea, o que levanta a ideia de que outros fatores como a renda e a cultura, se somam ao efeito ambiental no desenvolvimento cognitivo. / [en] Several studies demonstrated the effect of parents educational level in the development of cognitive functions, especially language and executive functions. Highlight the importance of interaction between the caregiver and the child, the quality of stimulation and promotion of development experiences afforded the child, as fundamental for the development of executive functions. There are few studies of this effect in the development of Brazilian children. The objective of the study is to analyze the effect of the education level of parents, separately, in the cognitive performance of long-term memory, working memory, inhibitory control and cognitive flexibility in children and adolescents living at Rio de Janeiro with low socioeconomic status. The study included 352 children between 7-15 years of private schools with low socioeconomic profile students of city of Rio de Janeiro. The instruments used were the Rey–Osterrieth Complex Figure Test, the Rey Auditory Verbal Learning Test, the Stroop test (Victoria Version) and Verbal Fluency phonemic and semantic. The results showed effects on education of both parents. Systematic results happened in verbal fluency, in the 9-10 year group. There were no significant effects on inhibitory control and working memory. The effect of parental education appeared systematically in executive functions, but not in other functions, raises the idea that other factors such as income and culture add to the environmental effect on cognitive development.

[pt] O envelhecimento em todo o mundo é um dos maiores desafios da saúde. Nesse contexto, condições clínicas como demências e Comprometimento Cognitivo Leve (CCL) também aumentam suas prevalências. A causa de demência mais frequente e estudada é demência de Alzheimer (DA). Tradicionalmente, DA é caracterizada pelo déficit precoce na memória episódica. Entretanto, estudos atuais mostram que a DA apresenta heterogeneidade neuropsicológica e alguns pacientes apresentam déficits cognitivos precoces não-amnésticos. Essas apresentações são chamadas por alguns autores de DA atípica. Dessa forma, a primeira parte dessa tese dedicou-se a estudar a heterogeneidade neuropsicológica na DA através de dois estudos: uma revisão sistemática sobre heterogeneidade neuropsicológica na DA (publicado) e um estudo de casos sobre perfis típico e atípico na DA (publicado). A revisão sistemática tornou-se necessária já que foi a primeira revisão sistemática publicada sobre o tema. Os achados dos dois estudos mostraram que aspectos atípicos na DA precisam ser mais explorados, já que DA não é uma condição homogênea. Compreender esses perfis cognitivos na DA irá interferir nos métodos diagnósticos e intervenções terapêuticas, seja farmacológica ou comportamental. A segunda parte dessa tese explora esses aspectos atípicos em três amostras: envelhecimento normal, CCL e AD. Assim, um estudo transversal foi realizado para comparar medidas de velocidade de processamento (VP), controle inibitório e automonitoramento nas três amostras. Os resultados desse estudo mostram que medidas de VP podem ser indicadores precoces do declínio cognitivo envelhecimento. Ao comparar CCL com o grupo de envelhecimento saudável, os dados mostram diferença nas medidas de VP e erros cometidos nos testes de VP. Entretanto, as duas amostras não apresentaram diferenças nas medidas de funções executivas (FEs) e nas medidas de funcionalidade. CCL versus AD mostraram diferenças nas medidas de VP, funções executivas e funcionalidade. Dessa forma, esse estudo traz resultados relevantes para o diagnóstico precoce de CCL e novas diretrizes para o cenário clínico e pesquisa. Além disso, na segunda parte desta tese foi realizado um artigo sobre acurácia diagnóstica das medidas de VP nos casos de CCL e AD. A literatura mostra falta de estudos sobre diferenças nas medidas de VP no envelhecimento e parâmetros diagnósticos dos instrumentos de VP. Esse estudo mostrou que medidas de VP apresentam habilidades discriminativas, para DA e CCL. Esses dados são necessários, já que apresentamos um cenário de escassez de instrumentos com elevados parâmetros diagnósticos para medidas de VP no envelhecimento. Esse cenário torna-se ainda mais drástico, quando falamos de Brasil. / [en] Aging is a major healthcare challenge worldwide. With aging, the prevalence of conditions such as dementia and Mild Cognitive Impairment increase. The most frequent and studied cause of dementia is Alzheimer s dementia (AD). Traditionally, AD is characterized by early deficit in episodic memory. However, current studies show that AD presents heterogeneity in clinical manifestations, especially cognitive manifestations. Thus, some patients present a non-amnestic cognitive profile. These profiles are called by some authors as atypical AD. The first part of this thesis was aimed at studying the neuropsychological heterogeneity in AD by means of 2 studies: a systematic review on neuropsychological heterogeneity in AD (published) and cases of study with typical and atypical AD patients (published). The systematic review was necessary, as it was the first published review about the topic. The findings of the two studies show that atypical aspects in AD need to be further explored, since AD is not a homogeneous condition. Understanding these cognitive profiles in AD will interfere in diagnostic methods and therapeutic interventions, either pharmacological or behavioral ones. The second part of this thesis explores atypical aspects in three samples: normal aging, MCI and AD. Thus, a cross-sectional study was conducted to compare measures of processing speed (PS), inhibitory control, working memory and cognitive flexibility in the three samples. The results of this study showed that PS measures may be early indicators of cognition decline in aging. MCI versus normal aging showed differences in PS measures and errors in tests of PS. However, these samples did not show differences in executive function measures (EFs) and functional measures. Nevertheless, MCI versus AD show differences in PS measures, executive functions and functionality. Thus, this study showed relevant results for the diagnosis process of MCI and new guidelines for clinical settings and research. In addition, in the second part of this thesis an article was written on diagnostic accuracy of the PS measures used in cases of MCI and AD. The literature shows a lack of studies on differences in PS measures in aging and diagnostic parameters of PS instruments. This study showed that PS measures present discriminative abilities in AD and MCI. These data are important, as there is a lack of diagnostic tools for PS in aging, especially in the Brazilian scenario.