The work presented in this thesis aims to increase clinical capacity for magnetoencephalography (MEG) by developing an understanding of how, in healthy participants, individual differences in brain structure, personality, and demographics influence measurements of neural oscillatory responses and functional connectivity. To this end, a large cohort of normative data was acquired using MEG with additional data acquisition using high-field MRI and supplementary individual difference data collected via a psychometric battery and screening questionnaire. MEG data were analysed to elucidate both primary sensory responses to stimulation and functional connectivity within task and task-free acquisitions. Chapters two and three introduce the physiological origins of the MEG signal and the instrumentation required to record it. Chapter four describes data acquisition and preprocessing, from the methods used in the recruitment of participants to the scanning parameters employed for our MEG and MRI acquisitions. Chapters five to seven present three empirical studies. The first investigates the relationship between MEG derived measurements of functional connectivity and cortical myeloarchitecture. We demonstrate that covariation of cortical myelin is significantly predicted by MEG-derived measurements of functional connectivity both within individual frequency bands and by their linear and non-linear combination. Chapter six presents an exploratory analysis into the impact of aging and sex-differences on MEG derived measurements of sensorimotor responses and whole-brain functional connectivity. We find trends indicating increased oscillatory responses with age. Further, we find female volunteers to exhibit greater induced responses than males. Analysis of whole-brain functional connectivity revealed a near-global increase in connectivity in female participants as compared to males. The final empirical chapter assesses the shared neuronal representations between patients diagnosed with schizophrenia and healthy individuals scoring highly on a personality questionnaire measuring schizotypy. We found highly schizotypal individuals to exhibit attenuated sensorimotor responses akin to those previously observed in schizophrenia. Patients displayed reduced functional connectivity within an occipital network, identified in task and task free data. We found this aberrant network connectivity to also be present in healthy subjects scoring highly on a questionnaire assessing schizotypy. The thesis, in sum, presents work demonstrating the significant modulatory effects of individual differences ranging from sex differences to schizotypy. This work highlights the need for consideration of participant demographics and individual differences in both clinical and basic science studies. Further, the thesis presents a newly identified relationship between MEG-derived measurements of functional connectivity and cortical myeloarchitecture. Future work assessing the role of other sources of individual difference in modulating MEG measurements is required. Moreover, the framework for assessing the relationship between functional connectivity and cortical myeloarchitecture is well suited to application in clinical populations where this relationship is hypothesised to break down.

Tourette syndrome (TS) is a neurodevelopmental disorder characterised by vocal and motor tics. It is associated with cortical–striatal–thalamic–cortical (CSTC) circuit dysfunction and hyper-excitability of cortical motor regions. TS follows a developmental time course, in which tics often become increasingly more controlled during adolescence. Importantly, however, a substantial minority of patients continue to have debilitating tics into adulthood. This indicates that there may be important differences between adult TS patients and children and adolescents with the disorder. The first aim of my thesis was to explore the excitability of the primary motor cortex (PMC) at rest, during motor preparation, motor execution and the inhibition of action. In Chapters 3 and 4 I demonstrate that, in contrast to studies of adult patients, resting motor threshold (RMT) and the variability of motor-evoked potential (MEP) responses are increased in young people with TS, while the gain of motor excitability in reduced. Furthermore, these differences normalise with age over adolescence. I conclude that these effects are likely due to a developmental delay in the maturation of key brain networks in TS, consistent with recent brain imaging studies of structural and functional brain connectivity. Importantly, these findings suggest that the alterations in brain network structure and function associated with TS may be quite different in children and adult patients with the condition. In Chapter 4, I demonstrate that whilst there is evidence of reduced gain during motor execution in young people with TS relative to controls (Chapter 3), the reduction is likely driven by baseline differences and when corrected to baseline patients with TS show an increased ramping of motor excitability during motor execution. In fact, patients’ tic severity was inversely related to the modulation of motor excitability whereby those with the most severe tics were least able to increase excitability. Patients showed largely the same patterns of change in excitability during motor preparation and response inhibition. However, the extent to which patients could modulate excitability during motor preparation was related to phonic tic severity whereby those with the least severe tics had higher excitability change from baseline. In addition, those that were able to suppress motor excitability to a greater extent whilst inhibiting action had the least severe tics, likely engaging inhibitory mechanisms to a greater extent with the consequence of slower response times during the task. I conclude that the ability to modulate motor excitability is both related to pathology and adaptive compensatory mechanisms that may help in tic suppression. The second aim of this thesis was to explore effective connectivity, excitatory and inhibitory physiological mechanisms and the neurochemistry of PMC in young healthy adults. Subsequent experiments in Chapters 5 and 6 used various transcranial magnetic stimulation (TMS) techniques and proton magnetic resonance spectroscopy (1H-MRS) to investigate these issues. Chapter 5 explored interhemispheric facilitation and inhibition (IHI and IHF) in two directions between bilateral PMC. The results provided evidence for an asymmetry of interhemispheric interactions using dual site TMS (ds-TMS) whereby the left-to-right direction is more inhibitory than right-to-left. Furthermore, females appeared to show greater interhemispheric modulation than males and whilst there was robust evidence for IHI (in the left-to-right direction) IHF appeared to not be robust. Finally, Chapter 6 explored how TMS-induced measures of excitation and inhibition related to 1H-MRS measures of neurochemicals γ-aminobutyric acid (GABA), glutamate (Glu) and glutamine (Gln). GABA is the primary inhibitory neurotransmitter in the human brain and is critical for the regulation of neuronal excitability and the orchestration of neuronal networks and is critically important in neurodevelopmental disorders such as TS. GABA was not found to be related to measures of synaptic neurotransmission as assessed by TMS and neither was Gln. In contrast, Glu was found to be related to a hub of TMS measures, in particular, Glu was positively related to both intracortical facilitation (ICF) and long intracortical inhibition (LICI). Chapters 5 and 6 further uncovered relationships between ds-TMS, pp-TMS and 1H-MRS showing that these various measures likely have overlapping mechanisms. The final chapters extend our knowledge about the PMC and the methodologies used to assess its state. Chapter 5 extends our understanding of the communication between right and left PMC and highlights a normal asymmetry in communication. This is important for understanding neurodevelopmental disorders such as TS of which asymmetry in effective connectivity and brain volume have been implicated. Chapter 6 importantly shows that 1H-MRS measured GABA is likely irrelevant for assessing synaptic neurotransmission and thus its interpretations should be limited to non-synaptic levels of GABA. This is particularly important for TS research in which both changes in GABAA receptor activity is present in the PMC and abnormalities in GABA concentration have been shown.

Attention deficit and hyperactivity disorder (ADHD) is characterised by a range of behaviours that include excessive motor activity and distractibility. Motor coordination problem is often a feature. It is therefore likely that motor control mechanisms are implicated in ADHD and then executive function associated with it. After a literature review on the correlation between cognition and movement (chapter 1), the novel VSWM (chapter 2) and sequential learning (chapter 3) tasks are introduced. Based on the typical Corsi tapping task, participants were instructed to either move their hand to the stimulus presented on the computer screen or tap the keyboard when they saw it, while trying to remember the location and order of the stimuli. The results suggest that movements deteriorate VSWM in both ADHD and control groups (chapter 2) while they had a tendency to improve learning performance in healthy but not ADHD participants (chapter 3). It was posited that the results from both tasks could have been influenced by differences in the ability to concentrate on the task and difficulty in controlling movements. Two other experiments were used to test this assumption and eliminate any confounds from the memory and learning tasks. The results from chapter 4, which looks at divided attention, indicate a significantly higher response rate in the ADHD compared to the healthy participants, while showing no significant deficit in fine motor but rather on the attentional control (chapter 5) in ADHD participants. These findings are summarised in chapter 6 and discussed in terms of 1) the relationship between movement and cognitive function, 2) the causation of the VSWM deficit in ADHD, and 3) the potential use these tasks may have in a clinical setting as an assessment tool or cognitive training program for people with ADHD.

Numerous studies have suggested that neuropsychological test performance is affected by demographic variables such as age and education. This study examined the effects of age and education on the Trail Making Test, the Digit Symbol Sub-Test, and the Finger Tapping Test in a non-clinical sample of community dwellers with a relatively low level of education (8 to 12 years) in South Africa. The sample consisted of 161 participants across six age groups: 20-39, 40-59, 69-69, 70-79, 80-89 and 90-95 years. Results were examined for mean age effects and variability trends. Highly significant age effects were present across the age groups for all tests, however, there was no uniform pattern of variability across the tests. The Digit Symbol Substitution Test and the Finger Tapping Tests showed a pattern of increasing variability with increasing age, followed by a decrease in very old age while no trend was evident for the Digit Symbol extensions (the Immediate and Delayed Recall tests). The Trail Making Test, Parts A and B, showed a consistent trend of increasing variability across the age groups. Data from the present study was compared with existing data from two relatively high education samples, with equivalent age groupings, to examine education effects. Results showed an education effect for all tests with the high education groups outperforming the low education groups. Although the effects of education became less potent with advancing age, the mean performance of the oldest (80-89 years) high education age group was superior to that of the equivalent low education age group. Comparison of variability trends across both samples showed that the highest variability (the shuttle bulge) was present at the same point along the age axis, or at a later point, for the low education group, as that for the high education group. This finding is inconsistent with Jordan's (1997) 'shuttle model of variability' which predicts an earlier occurrence of the shuttle bulge (left shuttle shift effect) for a low education sample. This study demonstrated that performance on neuropsychological tests is influenced by age and education and highlighted the dangers inherent in unquestionably applying norms, which have not been corrected for age and education, when assessing the older adult.

Submitted by MARINA CRISTINA ZOTESSO null (marina.zotesso@gmail.com) on 2017-05-02T16:37:35Z No. of bitstreams: 1 Dissertação 13.pdf: 1151842 bytes, checksum: 7de43c7e71fde1a200048abf67441b10 (MD5) / Approved for entry into archive by Luiz Galeffi (luizgaleffi@gmail.com) on 2017-05-03T20:28:04Z (GMT) No. of bitstreams: 1 zotesso_mc_me_bauru.pdf: 1151842 bytes, checksum: 7de43c7e71fde1a200048abf67441b10 (MD5) / Made available in DSpace on 2017-05-03T20:28:04Z (GMT). No. of bitstreams: 1 zotesso_mc_me_bauru.pdf: 1151842 bytes, checksum: 7de43c7e71fde1a200048abf67441b10 (MD5) Previous issue date: 2017-03-20 / A obesidade possui alta prevalência no Brasil. É fator de risco para demências, doenças cardiovasculares, cânceres e diabetes, e está associada a transtornos psiquiátricos. A cirurgia bariátrica é uma alternativa para os casos de obesidade mórbida, pois, inibe a progressão de comorbidades. Contudo a literatura é escassa quanto ao funcionamento cognitivo e emocional dos pacientes que vivenciam a rápida redução de peso por meio do processo cirúrgico em contraste com a perda de peso lenta decorrente de reeducação alimentar. O objetivo deste estudo prospectivo foi avaliar o funcionamento emocional e mnemônico de indivíduos obesos, antes e quatro meses depois do emagrecimento. Participaram do estudo 76 voluntários divididos em dois grupos, conforme a fase do tratamento: redução de peso por meio de cirurgia bariátrica (RPCB, N=40) ou redução de peso preparatória para bariátrica (RPPB, N= 36), avaliados por meio de testes cognitivos para memória episódica e operacional, bem como escalas comportamentais. Os instrumentos utilizados para a avalição eram os mesmos em ambas as avaliações. O teste t de Student indicou diferença estatística entre a 1ª avaliação e a 2ª avaliação. Houve mudanças mais robustas para o grupo RPCB, que vivenciou o emagrecimento rápido no âmbito comportamental para os âmbitos de depressão, ansiedade, compulsão e obsessão, resiliência e em especial para cinco categorias da escala que medem a qualidade de vida. O grupo RPCB ainda teve melhor desempenho no seguimento quanto a capacidade de memória operacional, memória verbal e atenção avaliado pelo teste Span de Dígitos. A melhora do grupo RPPB na 2ª avaliação pode estar associada ao acompanhamento multidisciplinar como preparo para CB. O estudo evidencia, dessa forma, que a CB produziu benefícios menmônicos e emocionais aos pacientes. / Obesity has a high prevalence in Brazil. It is a risk factor for dementias, cardiovascular diseases, cancers and diabetes, and is associated with psychiatric disorders. Bariatric surgery is an alternative for cases of morbid obesity, since it inhibits the progression of comorbidities. However, the literature is scarce regarding the cognitive and emotional functioning of patients who experience rapid weight reduction through the surgical process in contrast to the slow weight loss due to dietary reeducation. The aim of this prospective study was to evaluate the emotional and mnemonic functioning of obese individuals, before and four months after their weight loss. Participants were 76 volunteers divided into two groups, according to the treatment phase: weight reduction through bariatric surgery (RPCB, N = 40) or preparatory weight reduction for bariatric (RPPB, N = 36) evaluated by means of Cognitive tests for episodic and operational memory, as well as behavioral scales. The instruments used for the assessment were the same in both evaluations. Student's t test indicated statistical difference between the 1st evaluation and the 2nd evaluation. There were more robust changes for the RPCB group, which experienced rapid weight loss in the behavioral setting for the areas of depression, anxiety, compulsion and obsession, resilience and in particular for five categories of the scale that measure quality of life. The RPCB group still had better performance in the follow-up regarding operational memory capacity, verbal memory and attention assessed by the Span Span test. The improvement of the RPPB group in the 2nd evaluation may be associated to the multidisciplinary follow-up as preparation for CB. The study shows, therefore, that CB produced men- mentic and emotional benefits to the patients.

Made available in DSpace on 2014-06-11T19:29:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-08-02Bitstream added on 2014-06-13T19:16:59Z : No. of bitstreams: 1 silva_pa_me_assis.pdf: 572416 bytes, checksum: ca6a9be38f640b2541a62154d228a67f (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A síndrome de imunodeficiência adquirida (AIDS) é causada por infecção pelo vírus da imunodeficiência humana (HIV). No Brasil, segundo o Ministério da Saúde (2010), de 1980 a meados de 2010 foram notificados no SINAN um total de 14.926 casos (acumulados) de crianças menores de 13 anos infectadas, das quais 85,1% foram infectadas através de transmissão vertical. Em 2009, das 304 notificações de novos casos de AIDS em crianças com menos de 13 anos de idade, 92,1% dos casos foram decorrentes deste tipo de transmissão. Anormalidades encefálicas associadas à infecção pelo HIV são comuns e são as que primeiro aparecem entre crianças infectadas verticalmente. Déficits cognitivos relacionados a estas alterações estão presentes nessas crianças, contudo os estudos sobre as alterações cognitivas nessa população apresentam diversas limitações, como o pequeno tamanho da amostra, medidas inespecíficas e ausência de grupo controle. O objetivo do estudo foi avaliar o perfil de desempenho em habilidades matemáticas e memória operacional de crianças infectadas pelo HIV por transmissão vertical em idade escolar por meio de bateria de testes específicos para matemática (ZAREKI-R) e para memória operacional (AWMA), analisando se esse perfil se relaciona a aspectos como estado clinicoimunológico, carga viral, TARV e adesão, qualidade de vida e humor. Participaram do estudo 26 crianças, divididas em dois grupos, experimental (GE; N=13) e controle (GC; N=13), segundo a presença ou não da infecção pelo HIV. As crianças do grupo experimental foi composta por crianças infectadas por transmissão vertical pelo HIV, assintomáticas, de idade entre 7 e 12 anos de ambos os sexos. / Acquired Immunodeficiency Syndrome (AIDS) is caused by infection with human immunodeficiency virus (HIV). In Brazil, according to the Ministry of Health (2010), from 1980 to mid-2010 there were notified in SINAN a total of 14,926 cases (cumulative) of infected children less than 13 years, of whom 85.1% were vertically infected. In 2009, from 304 notifications of new AIDS cases in children 92.1% were due to this type of transmission. Brain abnormalities associated with HIV infection are common and the first to manifest among vertically infected children. Cognitive deficits related to these changes are present in these children, but studies on cognitive impairment in this population have several limitations, including small sample sizes, nonspecific measures and lack of control groups. The purpose of this study was to evaluate the performance of mathematic skills and working memory of school-age children infected with HIV by vertical transmission through specific battery tests for mathematics (Zareki-R) and working memory (AWMA), analyzing if this profile is related to aspects such as clinico-imunological stage, viral load, antiretroviral therapy and adherence, quality of life and humor. The study included 26 children, divided into two groups, experimental (GE, N = 13) and control (GC, N = 13), according to the presence or absence of HIV infection. The experimental group was formed by children infected with HIV by vertical transmission, in asymptomatic stage, from 7 and 12 years-old, of both genders.

Foi estudado o efeito de priming negativo associado à supressão do distrator palavra-cor de Stroop (Estudo 1), à supressão do local (Estudo 2) e à identidade do distrator (Estudos 3 e 4). No Estudo 1 constatou-se que a prática prévia em palavras-cor eliminou o efeito da ordem das condições experimentais sobre o índice de priming negativo. No Estudo 2, o efeito de priming negativo foi observado somente no hemicampo direito. A execução concorrente de uma tarefa verbal eliminou os efeitos de lateralidade, mas o efeito de priming negativo permaneceu significante. Estes achados são discutidos em termos de processamento interhemisférico sob condições que exigiriam maior controle da atenção. Os estudos 3 e 4 apresentam tarefas de comparação de pares de dígitos. A versão de papel e lápis da tarefa de comparação de dígitos permitiu avaliar de maneira simples e rápida o efeito de priming negativo. A versão computadorizada, revelou uma interação entre os componentes espacial e de identidade. Ambos os grupos de adultos jovens e idosos revelaram priming negativo nas tarefas de Stroop e de localização espacial. Nas tarefas de identificação do alvo somente os adultos jovens mostraram efeito de priming negativo. Os presentes achados são consistentes com a proposta de mecanismos inibitórios diferenciados na supressão da identidade e de localização espacial. / The development of sensitive and simple tests for the assessment of the negative priming effect has theoretical relevance to the elucidation of selective attention models, and also practical and potential clinical implications. The negative priming effect has been regarded as an index of inhibitory attentional processing and was proposed for the detection of syndromes that involve cognitive impairment. Diminished negative priming was reported in studies of individual differences, developmental stage, and clinical populations. However, evidences suggest that tasks requiring responses to the color feature, location or object identity of the stimuli may comprise distinct types of negative priming tasks. The following studies presents data for computerized and paper-and-pencil tasks to examine negative priming for Stroop color-word, location and identity distractors. All four studies take into account aging effects across the tasks. For comparisons between age-groups, proportional performance scores (ratio) were used. A first study employed a reading-sheet Stroop-color-word task, in which the participant is asked to name the colors of the ink in which words with incongruent color names have been printed. Color-word interference is indicated by increased time to complete the conflicting color-word condition compared with a nonconflicting condition with patches of color or strings of Xs. The greater strength of the interference, when the target ink-color of the present stimulus is the distracting color name of the previous stimulus, is attributed to the negative priming effect. A pilot experiment showed that the order of the list conditions containing unrelated and related stimuli affected the negative priming index. The analysis of data demonstrated that a practice trial in color naming of conflicting color-words before the color-word conditions eliminated the effect of the order of the lists. In addition, there was a reliable Stroop reverse interference after practice in color naming, as indicated by the fact that the incongruent color-ink affected post-test word-reading, whereas it had no effect in the pretest word-reading. With practice procedure, older and younger subjects did not differ in their proportional interference scores, whereas the negative priming and reverse effects were increased for older adults. Study 2 examined the negative-priming effect in a spatial localization task under single- and dual-task conditions. The task required the subject to detect the location of a target letter, ‘O’, while ignoring a distractor letter, ‘X’, when it was present. Significant negative-priming effects were observed under both task conditions, with increased response times for trials in which target location had matched the location of the distractor on the preceding. The magnitude of the negative priming effect was not different for older and younger adults. The performance in the single-task condition showed laterality effects with a right visual field advantage for control and target-alone trials, but not for related trials. In consequence, in the single-task condition, negative priming was observed only for targets displayed in the right hemifield. However, a concurrent digit span task, with a load level that had shown no affect on the dual-task coordination capacity, eliminated the laterality effects, but the negative priming effect remained. These results are considered as neuropsychological evidence that interhemispheric processes may operate under more controlled conditions. Studies 3 and 4 examined negative priming by using an identity-based task that required participants to select the greater of two-digits display or the digit that was paired with an asterisk. Study 3 presents data for a computerized version of the task. Negative-priming was expressed as a slowing in the time to name the digit that had been ignored in the preceding trial, compared to control trials with consecutive targets and distractors always different. Analysis of data revealed that negative priming was reliable only for younger adults, and only when target probe and distractor prime appeared at the same location, suggesting that suppression for location of distractor was underpinning the negative priming effect. However, response latencies for the control trials were facilitated when the target probe and the distractor prime shared the same location. Thus, local suppression affected negative priming for attended distractors with a cost in the response latency for ignored-repetition trials and with a gain in response latency for control trials when the locus of target-probe and distractor-prime was the same. In contrast, older adults’ performance showed local suppression for both ignored-repetition and control trials. This may explain the lack of negative priming for older adults in the digit-comparison task. Study 4 presents data for a new paper-and-pencil version of the digit-comparison task to obtain a practical measure of negative priming that do not require cumbersome technical equipment. In that task, subjects were asked to circle digits that were paired with asterisks and the greater of two digits in a series of digit pairs listed on a sheet of paper. For younger participants, but not for older participants, the time to complete the sheet with related pairs was slower than for unrelated pairs. In addition, the reduced scores of negative priming in older adults were associated with the lowest sustained attention scores from Toulouse-Piéron test. These results suggest that older adults’ performance in the digit-comparison task were mainly related to flexibility and sustained attentional scores, and the lower sustained attentional coefficient seemed to be the best predictor of diminished or reversed negative priming in older adults. Younger adults showed reliable negative priming across all tasks. In contrast, older adults showed negative priming in Stroop and spatial tasks, when compared with younger subjects performance, but reduced negative priming in identity suppression tasks. The findings are consistent with neurophysiological and behavioural evidence that identity and location suppressing may rely on separate inhibitory mechanisms, and that not all of these processes are weakened by factors associated with age.

O autismo infantil vem sendo amplamente estudado desde sua primeira definição por Leo Kanner em 1943, sendo um dos mais graves distúrbios do desenvolvimento infantil. Diversas hipóteses etiológicas e propostas terapêuticas foram criadas, partindo-se de concepções psicodinâmicas bem como cognitivas e comportamentais. Atualmente observa-se a possibilidade de uma abordagem do autismo apoiada na compreensão de que os padrões de desenvolvimento atípicos destas crianças seriam essencialmente determinados por alterações primárias no funcionamento neuropsicológico, que afetariam os processos cognitivos e afetivos de modo abrangente. Estudos atuais acerca do processo de maturação cerebral indicam um tratamento particular das informações sensoriais no autismo e igualmente das mensagens sociais, como os gestos, as mímicas faciais, a palavra. Os estudos de Piaget nos permitem discutir esta abordagem contemporânea do autismo a partir de uma teoria clássica do desenvolvimento infantil considerando-se: os fatores necessários ao desenvolvimento, a base biológica das estruturas cognitivas, os níveis evolutivos do período sensório-motor e da construção do real, a noção de inter-ação, construção e coordenação dos esquemas. Tais conceitos nos permitem criar hipóteses sobre os processos interativos implicados no desenvolvimento atípico da criança com autismo, bem como compreender a influência das possíveis abordagens terapêuticas sobre estes processos, tais como a Terapia de Troca e de Desenvolvimento (Thérapie dÉchange et de Développement - TED, no original francês). A TED é uma proposta terapêutica criada progressivamente nos últimos trinta anos no serviço de psiquiatria infantil da Universidade de Tours, na França, a partir de uma compreensão neurofisiológica e desenvolvimentista do autismo. Ela conjuga um enquadre e intervenções particulares, buscando enriquecer as possibilidades de interação da criança autista, e reorganizar o funcionamento neurológico e cognitivo, base dos processos de troca com o ambiente e com o outro. O objetivo deste estudo foi o de articular a teoria de desenvolvimento de Piaget à proposta metodológica da TED, refletindo sobre as construções cognitivas e os processos evolutivos alterados no autismo. Para tanto, apresenta (a) uma breve introdução dos estudos anteriores ligados ao presente trabalho, (b) os principais constructos piagetianos sobre o desenvolvimento que permitem uma articulação com a TED, (c) uma apresentação preliminar da TED, incluindo-se seus princípios organizadores e sua técnica própria, para finalmente passar à (d) uma articulação teórica entre os conceitos piagetianos apresentados e a TED, baseada na apresentação de vinhetas clínicas. Os resultados apontaram para uma relação possível entre alguns dos conceitos mais centrais à teoria piagetiana e a proposta da TED, confirmando a hipótese de uma articulação possível entre a compreensão de desenvolvimento proposta por Piaget e os processos implicados no trabalho com crianças autistas, compreendidos a partir da Terapia de Troca e Desenvolvimento (TED) / Childhood autism has been widely studied since its first definition by Leo Kanner in 1943, being one of the most serious childhood development disorders. Several etiological hypothesis and therapeutic proposals were created, based on psychodynamic, cognitive or behavioral approaches. Presently, a new approach to autism is possible, in which the atypical developmental patterns observed in these children can be understood as essentially determined by primary neuropsychological impairments, which have an effect on cognitive and affective processes. Recent studies concerning the brain maturation process in autism indicate atypical sensory information treatment, as well as regarding social messages, such as gestures, facial expression and language. Piagets research allows the discussion of this contemporary approach to autism from the standpoint of a classical childhood development theory, considering: the necessary development factors; the biological basis of cognitive structures; the sensory-motor period evolutionary levels and the construction of the real; the inter-action, construction and coordination between schemes. Such concepts allow the creation of hypothesis about the interactive processes involved in the autistic childs atypical development, as well as enhance the understanding of the influence of possible therapeutic approaches on these processes, such as the Exchange and Development Therapy (EDT). The EDT is a therapeutic proposal progressively created over the past 30 years at the childhood psychiatric service at Tours University, in France, from a neurophysiological and developmental standpoint of autism. It combines a specific setting and interventions, seeking to enrich the child\'s interaction, and rearrange the neurological and cognitive functioning, which is the basis for the exchange with the environment and with the other. This research intended to associate Piagets development theory to EDTs methodological proposal, reflecting on cognitive construction and the developmental impairments in autism. In doing so, it presents (a) a brief introduction to previous studies related to this work, (b) piagetians main constructs on the development, that allow the parallel with the EDT, (c) a preliminary presentation of the EDT, including its organizing principles and its own technique, to finally move to (d) a theoretical association between the presented Piagetian constructs and EDT, based on the presentation of clinical extracts. It was concluded that the parallel between some of Piagetian central concepts and EDTs proposal is coherent, confirming the hypothesis of a possible relationship between Piagets development understanding and the processes involved in working with autistic children, considering the Exchange and Development Therapy (EDT)

A avaliação neuropsicológica de portadores de doença de Parkinson (DP) tem sido de fundamental importância para definição de resultados em procedimentos clínicos, cirúrgicos experimentais ou para diagnóstico de demência nestes doentes. No entanto, ainda não existe consenso quanto aos testes neuropsicológicos necessários e padrões de comprometimento esperados. Este estudo objetivou comparar a produtividade das funções neuropsicológicas entre portadores da Doença de Parkinson, em diferentes estágios da doença, em relação aos indivíduos normais. Foram analisados 60 sujeitos (32 homens e 28 mulheres), emparelhados em relação à idade (média de 65,6 +-9,2) e instrução (média de 5,9 =- 4,0), distribuídos entre normais (n=20) e portadores de DP ambulatoriais, nos estágios leve a moderado (n=20) ou moderado a grave (n=20), de acordo com a escala Hoehn & Yahr. A bateria utilizou 24 testes neuropsicológicos abrangendo as funções de raciocínio, percepção visuoespacial, visuoconstrução, linguagem, memória, atenção e função executiva. Os resultados apontaram diferenças significantes (p < 0,01) entre vários testes e em todas as funções, exceto linguagem. Alguns instrumentos se mostraram mais adequados e outros se mostraram pouco indicados para avaliar estes doentes. Diferenças entre os estágios da doença só se evidenciaram nos testes que exigiam destreza motora. Este trabalho estabelece a adequação dos instrumentos e propõe uma bateria específica para avaliação destes doentes. A investigação de estados situacionais (nível cultural, sintoma afetivo e/ou limitações funcionais), manifestos na avaliação, permitiu estabelecer parâmetros para discriminar o modo como estas variáveis interferem na produção dos doentes de Parkinson. E conclui-se apresentando um método inovador de classificação para subsidiar com objetividade o diagnóstico neuropsicológico diferencial na DP. / The neuropsychological assessment of patients with Parkinson disease (PD) has been very important to define the results in clinical, experimental surgeries procedures or in the diagnostic of dementia of these patients. However, there is no consensus about the necessary neuropsychological tests and about the expected commitment patterns. This study aimed to compare the productivity of the neuropsychological functions among patients with Parkinson Disease, in different stages of the disease, in relation to normal people. Sixty subjects were assessed (32 men and 28 women), pared in relation to the age (average of 65.6 +- 9.2) and age of study (average of 5.9 +- 4.0), distributed among normal (n=20) and outpatients with PD, in the mild to moderate stages (n=20) or moderate to severe (n=20), according to Hoehn & Yahr Scale. The battery used 24 neuropsychological tests comprising the thinking, visuospatial perception, visuoconstruction, language, memory, attention and executive function. The results showed significant differences (p < 0.01) among many tests and in all the functions, except language. Some instruments were more suitable and others proved to be less indicated to assess these patients. Differences in the stages of the disease were highlighted in the tests that required motor ability. This work establishes the adequacy of the instruments and proposes a specific battery to assess these patients. The investigation of the situational state (cultural level, affective symptom and/or functional limitations), that appeared in the assessment, allowed to establish parameters to find out the way that these variables interfered in the Parkinson patients’ production. The work concludes presenting an innovative classification method to objectively subside the neuropsychological differential diagnosis for PD.

Objetivos: avaliar a atenção e a memória de doentes com dor pélvica crônica (DPC) ou com síndrome complexa de dor regional (SCDR) e correlacionar os resultados à duração e intensidade da dor, à presença de transtornos do humor e à qualidade do sono comparando esses resultados aos do grupo controle composto por indivíduos sem dor. Métodos: sessenta indivíduos, de ambos os sexos, com idade variando de 18 a 60 anos e com escolaridade maior ou igual a quatro anos foram avaliados através de uma bateria neuropsicológica para avaliação de atenção e memória, escala para avaliação da intensidade da dor, do humor, e qualidade do sono. Os indivíduos foram organizados em três grupos. O grupo DPC, foi constituído de 20 doentes com dor pélvica; o grupo SCDR, de 20 doentes com síndrome complexa de dor regional; e o grupo controle foi constituído de 20 indivíduos sem dor. Resultados: prevaleceram indivíduos com idade entre 29 e 50 anos, casados, com atividade profissional regular e registrada e com escolaridade de nove a 12 anos. 65% eram mulheres. A maioria dos doentes apresentou dor de moderada a intensa com duração de seis a 15 anos e nenhum com duração de menos de cinco anos. Os doentes com dor apresentaram qualidade do sono pior que os indivíduos sem dor (p < 0,001), mais transtorno depressivo maior avaliado pelo PRIME-MD (p = 0,013) e mais alterações no MEEM (p = 0,001). Ocorreu maior número de doentes com DPC e SCDR com déficit na fluência verbal (p = 0,031), atenção concentrada abaixo da média (p = 0,027), e piores resultados no teste RAVLT quando comparados aos indivíduos sem dor. Os indivíduos com dores de moderada a intensa avaliada pela EAVN apresentaram piores escores nos testes de fluência verbal, DSI e teste de atenção concentrada. Neste estudo, o transtorno depressivo maior parece interferir na fluência verbal, na atenção e na memória. Os indivíduos com qualidade de sono ruim apresentaram piores escores nos testes cognitivos, com diferença estatística significativa em relação a população sem dor para os testes DSD, DSI, teste de atenção concentrada, fluência verbal e MEEM. Conclusão: os doentes com dor apresentaram maior déficit de acordo com os testes MEEM, FV, RAVLT e TAC, mais transtorno depressivo maior e qualidade do sono pior em relação à população sem dor. Indivíduos com dores de moderada à intensa avaliados pela EAVN apresentaram os piores escores nos testes de fluência verbal, atenção concentrada e DSI. O Transtorno depressivo maior parece interferir na fluência verbal, na atenção e na memória. Indivíduos com má qualidade de sono apresentaram os piores escores nos testes cognitivos, diferença esta estatisticamente significativa em relação à população sem dor quando avaliados com os testes de atenção concentrada, fluência verbal, MEEM, DSD e DSI . / Objectives: to assess attention and memory of patients who are chronic pelvic pain holders (CPP) and/or Complex Regional Pain Syndrome (CRPS) holders, and to correlate the results to the characteristics of the duration and intensity of the pain, and to the mood and to the sleep pattern disorders, by comparing such results to the control group of pain-free individuals. Methods: 35% male and 65% female individuals, 18 to 60 years old, with schooling higher or equal to four years, were evaluated through a series of neuropsychological tests directed to assess the attention and memory, pain intensity, mood, and sleep quality. They were organized in three groups: 20 Pelvic Pain Patients (CPP Group); 20 Complex Regional Pain Syndrome patients (CRPS Group); 20 pain-free individuals (Control Group). Results: there was prevalence of 29 to 50 year-old individuals with regular and formal professional activity and schooling of 9 to12 years. Most of them presented moderate to severe pain during the last 6 to 15 years (none of them during less than five years). Pain patients presented lower quality sleep than individuals pain free (p < 0, 001), more Major Depression Disorder assessed by PRIME-MD (p = 0, 013) and more changes in MEEM (p = 0, 001). There was more Verbal Fluency Deficit (p = 0,031), average Attention (p = 0,027) and lower scores in RAVLT test in CPP and CRPS groups than in non-pain individuals. The scores in the tests of Verbal Fluency, DSI and Attention were lower in patients with moderate to severe pain. Major Depression Disorder was related to Verbal Fluency, Attention and Memory impairment. The cognitive tests were significantly different in individuals with low-quality sleep than in the normal population. Conclusion: Pain patients showed greater deficit in the MEEM, Verbal Fluency Test, RAVLT, and in the Attention Test, and also Major Depression Disorder and lower quality of sleep when compared to the non-pain individuals. The Verbal Fluency, DSI and Attention scores were lower in patients with moderate to severe pain. Major Depression Disorder seems to interfere with Verbal Fluency, Attention and Memory. The cognitive function evaluated with DSD, DSI, Concentrated Attention, Verbal Fluency and MEEM tests score lower in individuals with low-quality sleep, and the difference was statistically significant to the normal population