<p>Cilj rada: Posmatrano je da li postoji povezanost kliničkih parametara, bihejvioralnih simptoma i postignuća na testovima kognitivnih funkcija sa karakteristikama hoda kod obolelih od Parkinsonove bolesti. Analizirana je i povezanost nalaza hiperehogenosti strukture substantia nigra dobijenog transkranijalnim parenhimskim ultrazvukom sa karakteristikama hoda.Materijal I metode: Istraživanjem je obuhvaćeno 60 obolelih od Parkinsonove bolesti (22 žene i 38 mu&scaron;karaca, sa trajanjem bolesti 5,06&plusmn;4,54 godina, ukupnim UPDRS 39,76&plusmn;36,65, UPDRS III 24,28&plusmn;15,18) koji su prema stadijumu bolesti po Hen i Jarovoj skali (H&amp;Y) podeljeni u tri podgrupe sa po 20 ispitanika: H&amp;Y 1, 2 i 3. Kontrolnu grupu činilo je 35 zdravih ispitanika (19 žena i 16 mu&scaron;karaca) koji se od grupe obolelih nisu razlikovali u pogledu godina starosti (oboleli 64,21&plusmn;6,92 godina, zdravi 63,45&plusmn;7,75, p=0,832) i godina obrazovanja (oboleli 12,63&plusmn;3,16 godina, zdravi 12,57&plusmn;2,87, p=0,954). Iz analize su isključeni ispitanici čiji je skor MMSE bio manji od 24. Procena težine motornih znakova Parkinsonove bolesti vr&scaron;ena je Unifikovanom skalom za kvantifikovanje Parkinsonove bolesti, treći deo (UPDRS III). Za globalnu procenu kognicije je kori&scaron;ćena Revidirana Adenbrukova kogntivna skala (ACE- R), a za procenu egzekutivnih funkcija su kori&scaron;ćeni baterija za procenu frontalnih funkcija (FAB) i Egzekutivni intervju (EXIT-25). Za evaluaciju depresije kori&scaron;ćene su Hamiltonova skala za procenu depresije (HAM- D) i Bekova skala depresivnosti (BDI II), za procenu anksioznosti Hamiltonova skala za procenu anksioznosti (HAM- A), a za procenu apatije Skala apatije (AS).Određivanje vremenskih i prostornih parametara hoda vr&scaron;eno je pomoću GAITRite sistema, tokom &bdquo;on&rdquo; perioda. Analizirano je osam parametara hoda: vreme dvokoraka (CT), dužina dvokoraka (SL), vreme zamaha (ST) i vreme dvostrukog oslonca (DS), kao i njihovi koeficijenti varijacija (CV). Posmatran je i uticaj dvostrukog zadatka na parametre hoda. Kao dodatni zadatak tokom hoda primenjen je kognitivni zadatak (oduzima -7 tokom hoda), motorni zadatak (nosi ča&scaron;u punu vode) i kombinovani zadatak (oduzima i nosi ča&scaron;u istovremeno). Veličina hiperehogenosti substantia nigra merena je transkranijalnim parenhimskim ultrazvukom. Rezultati: U poređenju sa zdravim vr&scaron;njacima, oboleli od Parkinsonove bolesti imali su značajno izraženiji varijabilitet koraka pri hodu bez zadatka (skraćen SL, povećan CVSL i CVCT, varijabilitet koraka bio je jo&scaron; izraženiji, dok je pri motornom zadatku postojala i značajna razlika DS i CVDS (p&lt;0,05), tj. parametara kojima se izražava ravnoteža koraka. U uslovima kombinovanog zadatka ove razlike su se potencirale. Parametri hoda (SL, VCSL, CVCT I CVST) minimalno su se razlikovali kod obolelih u najranijim stadijumima bolesti (H&amp;Y 1) u odnosu na zdrave, dok su razlike postajale izraženije kako je bolest bila u odmaklijim stadijumima (H&amp;Y 2 I H&amp;Y 3). U grupi zdravih starost ispitanika korelirala je sa varijabilitetom koraka jedino u uslovima dvostrukog zadatka. Kod obolelih ova povezanost je uočena i pri hodu bez zadatka, a povezanost je bila jača u uslovima dvostrukog zadatka. Starost ispitanika i težina motornih znakova na UPDRS III korelirali su sa parametrima hoda kod obolelih od PB. Skorovi apatije i depresivnosti korelirali su sa promenama parametara hoda kod obolelih, s tim &scaron;to je apatija bila prisutna već u najranijim, a depresija tek u kasnijim stadijumima bolesti. Niža postignuća na testovima egzekutivnih funkcija povezana su sa pogor&scaron;anjem svih parametara hoda. Sa pogor&scaron;anjem parametara hoda tokom trajanja bolesti koreliraju i niža postignuća na testovima jezičkih i vidno- prostornih funkcija, kao i deficit pamćenja. Veličina hiperehogenosti korelira sa CV svih parametara hoda. Zaključak: Kod obolelih od Parkinsonove bolesti značajno se razlikuju vremenski i prostorni parametri hoda u poređenju sa zdravim, pre svega oni kojima se opisuje varijabilitet koraka. Ovi parametri su izraženiji kada se tokom hoda obavlja i dodatni kognitivni zadatak. Kada se tokom hoda obavlja motorni ili kombinovani motorni i kognitivni zadatak, pored varijabiliteta koraka javlja se i značajno produžen DS koji ukazuje na poremećaj ravnoteže. Na parametre hoda utiču starost ispitanika, težina i stadijum Parkinsonove bolesti. Apatija i depresija takođe značajno utiču na parametre hoda kod obolelih. Apatija se javlja u najranijim, a depresivnost tek u kasnijim stadijumima bolesti, &scaron;to govori u prilog stanovi&scaron;ta da je apatija zaseban simptom bolesti povezan sa dopaminergičkom disfunkcijom. Pogor&scaron;anja parametara hoda koreliraju sa o&scaron;tećenjem kognitivnih funkcija, pre svega egzekutivnih. U odmaklim stadijumima bolesti sa pogor&scaron;anjem hoda povezana su i lo&scaron;ija postignuća na testovima vidno-prostornih funkcija i pamćenja. Hiperehogenost substantia nigra na transkranijalnom parenhimskom ultrazvuku, koja se značajno če&scaron;će javlja i značajno je veće povr&scaron;ine kod obolelih u odnosu na zdrave, korelira sa varijabilitetom koraka.</p> / <p>Objectives: The aim of the study was to assess the contribution of clinical presentation, behavioral symptoms and cognitive functioning to gait characteristics in Parkinson&rsquo;s disease (PD). Hyperechogenicity of the substantia nigra on transcranial parenchimal ultrasound and its correlations with gait characteristics was also analyzed. Material and Methods: The experimental group consisted of 60 patients suffering from Parkinson&rsquo;s disease (22 women and 38 men, disease duration 5.06&plusmn;4.54, Unified Parkinson&#39;s Disease Rating Scale (UPDRS) total 39.76&plusmn;36.65, and UPDRS III 24.28&plusmn;15.18), who were classified into three subgroups according to the Hoehn and Yahr (H&amp;Y) stage of the disease: H&amp;Y 1, H&amp;Y 2 and H&amp;Y 3, with each subgroup containing 20 patients. The control group included 35 healthy subjects (19 women and 16 men) who were matched for years of age (64.21&plusmn;6.92 years PD vs 63.45&plusmn;7.75 healthy; p= .832) and formal education (12.63&plusmn;3.16 years PD vs 12.57&plusmn;2.87 healthy, p= .954). The subjects with MMSE&lt;24 were concerned demented and excluded from further analysis. The disease severity was assessed by the UPDRS, motor part (UPDRS III). Addenbrooke&rsquo;s Cognitive Examination-Revised (ACE-R) was used in assessment of global cognition, while executive functions were examined by Frontal Assessment Battery (FAB) and Executive Interview (EXIT-25) Hamilton&rsquo;s Depression Rating Scale (HAM-D) and Beck&rsquo;s Depression Inventory (BDI II) were used to screen for symptoms of depression, and the Apathy Scale (AS) and Hamilton&rsquo;s Anxiety Rating Scale (HAM- A) were used to assess apathy and anxiety. The measurements of spatial and temporal parameters of gait were performed using the GAITRite system, during the &ldquo;on&rdquo; state. The following eight parameters were analyzed: Cycle Time (CT), Stride Length (SL), Swing Time (ST) and Double Support Time (DS), as well as their coefficients of variation (CV). The impact of dual task on gait parameters was also observed. The subjects were asked to walk and simultaneously perform cognitive task (subtracting -7), then motor task (carrying a glass of water) and eventually combined task (subtracting and carrying a glass of water), while walking on the GAITRite electronic pathway. Transcranial parenchymal ultrasound was used to measure hyperechogenicity of substantia nigra. Results: Compared to healthy controls, PD patients had significantly higher gait variability during gait without additional tasks (decreased SL, increased CVSL and CVCT; p&lt; .05), whereas with a cognitive task the variability was even higher. During the motor task DS and CVDS were significantly increased as well, implying gait instability. A combined task had similar effects as the motor task, affecting all parameters. When the experimental group was divided into subgroups, variability of gait (SL, VCSL, CVCTandCVST) was minor in subgroup H&amp;Y 1, but more pronounced in later stages (H&amp;Y 2 and H&amp;Y 3). The age correlated with gait variability (CVCT and CVSL) only during the dual task in healthy subjects, whereas in PD patients the association was significant during normal gait and increased on the dual task. The age and severity of the disease on the UPDRS III also correlated with gait parameters. Apathy and depression were also associated with gait variability. Symptoms of apathy were significant in the earliest stages (H&amp;Y 1), whereas depression was notable in the later stages (H&amp;Y 3). Worse scores on tests of executive functions correlated with impairment of gait parameters. The impact of diminished language, visuo-spatial and memory functions on gait was also significant. Hyperechogenicity of the substantia nigra on transcranial parenchymal ultrasound occurred more frequently and was larger in PD patients and correlated well with gait variability. Conclusion: There is a significant impairment of temporal and spatial gait parameters in PD patients compared to healthy subjects, particularly the parameters of gait variability. These parameters become even more impaired during a simultaneous cognitive task. When a motor or combined task is performed, there is additional increase of DS, implying impairment of stability. Also, age and disease severity affect gait in PD patients. Apathy is significant in early stages (H&amp;Y 1) and depression in later stages (H&amp;Y 3), the finding which may be explained by the dopaminergic origin of apathy. Impairment of cognitive functions, most importantly executive dysfunction, are also associated with gait variability. Lower scores at visuo-spatial, language and memory tests are associated with worsened gait parameters of gait in later stages of PD. Finally, hyperechogenicity of the substantia nigra on transcranial parenchymal sonography, which occurs more frequently and is larger in PD patients, correlates with gait variability.</p>

Introduction : La prise de décision (PD), les fonctions exécutives et l’apathie ont des processusneuropsychologiques et des substrats neuro-anatomiques communs. Tous trois sont altérés dans lamaladie d’Alzheimer (MA) mais aussi dans le Trouble Léger de la Cognition (TLC). Par ailleurs, ladéficience décisionnelle peut affecter l’autonomie.Méthode : Afin d’évaluer les corrélats exécutifs cognitifs et comportementaux de la PD, nous avonscomparé 20 sujets contrôles (CT), 20 patients ayant un TLC et 20 patients MA.Outre le MMSE et l’échelle de Beck (dépression), tous ont complété 3 épreuves exécutives liées aumodèle de Miyake (évaluant la flexibilité, l’inhibition et la mémoire de travail), 2 échelles d’apathie,une échelle de compétence (autonomie) et 2 tâches décisionnelles (sous ambiguïté et sous risque).3 études ont été finalisées : (1) Fonctions exécutives et PD, (2) Apathie et PD, (3) PD et autonomie.Résultats : Il existe une relative comparabilité des patients TLC et MA, inférieurs aux sujets CT, dupoint de vue de la PD, des fonctions exécutives, de l’apathie et de l’autonomie. La PD sous risqueimplique directement les fonctions exécutives et est associée à la composante cognitive de l’apathie,alors que celle sous ambiguïté les implique indirectement et est associée à la composantecomportementale de l’apathie. Il y a un effet équivalent de chacune des modalités décisionnelles surl’autonomie.Conclusion : La PD dans la MA et le TLC semble d’abord altérée par des facteurs exécutifs cognitifs,dont l’expression varie suivant la modalité décisionnelle. Les implications théoriques, cliniques et lavalidité écologique de ces outils d’évaluation sont discutées. / Introduction : Decision making (DM), executive functions and apathy have commonneuropsychological processes and neuroanatomical substrates. The three of them are impaired in theAlzheimer disease (AD) but also in the Mild Cognitive Impairment (MCI). Besides, decision deficitcan impair autonomy.Method : In order to estimate the behavioral and cognitive executive correlates of DM, we havecompared 20 Control subjects (CT), 20 patients with MCI and 20 patients with AD.In addition with the MMSE and the Beck Inventory (depression), all have performed 3 executive testslinked to the Miyake model (estimating flexibility, inhibition and working memory), two apathyscales, one competency scale (autonomy) and two decision tasks (under ambiguity and under risk).Three studies have been completed : (1) Executive functions and DM, (2) Apathy and DM, (3) DMand autonomy.Results : there is a relative comparability between MCI and AD patients, below CT subjects,regarding DM, executive functions, apathy and autonomy.DM under risk directly implies the executive functions and is associated with the cognitive componentof apathy, whereas DM under ambiguity implies them indirectly and is associated with the behavioralcomponent of apathy. There is a similar impact of both decision modes on autonomy.Conclusion : DM in AD and MCI seems first to be impaired by cognitive executive factors, whoseform varies according to the decision model. The theoretical, clinical involvements and the ecologicalvalidity of these evaluation tools are challenged.

There has been considerable progress in the clinical, pathological and genetic fractionation of frontotemporal lobar degeneration syndromes in recent years, driving the development of novel diagnostic criteria. However, phenotypic boundaries are not always distinct and syndromes converge with disease progression, limiting the insights available from traditional diagnostic classification. Alternative transdiagnostic approaches may provide novel insights into the neurobiological underpinnings of symptom commonalities across the frontotemporal lobar degeneration spectrum. In this thesis, I illustrate the use of transdiagnostic methods to investigate apathy and impulsivity. These two multifaceted constructs are observed across all frontotemporal lobar degeneration syndromes, including frontotemporal dementia, progressive supranuclear palsy and corticobasal syndrome. They cause substantial patient morbidity and carer distress, often coexist and are undertreated. Using data from the Pick’s disease and Progressive supranuclear palsy Prevalence and INcidence (PiPPIN) Study, I examine the frequency, characteristics and components of apathy and impulsivity across the frontotemporal lobar degeneration spectrum. A principal component analysis of the neuropsychological data identified eight distinct components of apathy and impulsivity, separating patient ratings, carer ratings and behavioural tasks. Apathy and impulsivity measures were positively correlated, frequently loading onto the same components and providing evidence of their overlap. The data confirmed that apathy and impulsivity are common across the spectrum of frontotemporal lobar degeneration syndromes. Voxel based morphometry revealed distinct neural correlates for the components of apathy and impulsivity. Patient ratings correlated with white matter changes in the corticospinal tracts, which may reflect retained insight into their physical impairments. Carer ratings correlated with grey and white matter changes in frontostriatal, frontotemporal and brainstem systems, which have previously been implicated in motivation, arousal and goal directed behaviour. Response inhibition deficits on behavioural tasks correlated with focal frontal cortical atrophy in areas implicated in goal-directed behaviour and cognitive control. Diffusion tensor imaging was highly sensitive to the white matter changes underlying apathy and impulsivity in frontotemporal lobar degeneration syndromes. Diffusion tensor imaging findings were largely consistent with voxel-based morphometry, with carer ratings reflecting widespread changes while objective measures showed changes in focal, task-specific brain regions. White matter abnormalities often extended beyond observed grey matter changes, providing supportive evidence that white matter dysfunction represents a core pathophysiology in frontotemporal lobar degeneration. Apathy was a significant predictor of death within two and a half years from assessment, consistent with studies linking apathy to poor outcomes. The prognostic importance of apathy warrants more accurate measurement tools to facilitate clinical trials. Although causality remains unclear, the influence of apathy on survival suggests effective symptomatic treatments may also prove disease-modifying. These findings have several implications. First, clinical studies for apathy/impulsivity in frontotemporal lobar degeneration syndromes should target patients who present with these symptoms, irrespective of their diagnostic category. Second, data-driven approaches can inform the choice of assessment tools for clinical trials, and their link to neural drivers of apathy and impulsivity. Third, the components and their neural correlates provide a principled means to measure (and interpret) the effects of novel treatments in the context of frontotemporal lobar degeneration.

Orbitofrontal metabolic impairment is characteristic of the frontal variant of frontotemporal dementia (fv-FTD), as are early changes in emotional and social conduct. Two main types of behavioral disturbances have been distinguished in fv-FTD patients: apathetic and disinhibited manifestations. In this study, we searched for relationships between brain metabolism and presence of apathetic or disinhibited behavior. Metabolic activity and behavioral data were collected in 41 fv-FTD patients from European PET centers. A conjunction analysis of the PET data showed an expected impairment of metabolic activity in the anterior cingulate, ventromedial and orbital prefrontal cortex, the dorsolateral prefrontal cortex and the left anterior insula in fv-FTD subjects compared to matched controls. A correlation was observed between disinhibition scores on the Neuropsychiatric Inventory scale and a cluster of voxels located in the posterior orbitofrontal cortex (6, 28, –24). Comparison of brain activity between apathetic and nonapathetic fv-FTD patients from two centers also revealed a specific involvement of the posterior orbitofrontal cortex in apathetic subjects (4, 22, –22). The results confirm that the main cerebral metabolic impairment in fv-FTD patients affects areas specializing in emotional evaluation and demonstrate that decreased orbitofrontal activity is related to both disinhibited and apathetic syndromes in fv-FTD. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

A côté de la triade motrice symptomatologique de la maladie de Parkinson (MP), des troubles comportementaux et cognitifs sont également fréquemment observés, incluant notamment l'apathie, définie comme une importante diminution des comportements motivés et qui est souvent associée à de l'anxiété et de la dépression. De façon intéressante, ces troubles neuropsychiatriques sont souvent observés chez des patients parkinsoniens traités par la stimulation cérébrale à haute fréquence du noyau sous-thalamique. Bien que les mécanismes physiopathologiques à l'origine de ces troubles restent aujourd'hui encore inconnus, il a été récemment suggéré qu'il pouvait exister un lien entre la diminution du traitement dopaminergique (DA) (rendue possible par les effets bénéfiques sur le plan moteur de la stimulation cérébrale profonde) et la résurgence du syndrome d'apathie chez ces patients parkinsoniens stimulés. Dans une première partie expérimentale, nous avons voulu déterminer le rôle du système DA dans l'émergence de ces troubles neuropsychiatriques d'identifier les projections DA ascendantes qui pourraient préférentiellement être impliquées. Notre modèle animal chez le rat, obtenu par des lésions neurotoxiques sélectives, bilatérales et partielles des différentes régions du continuum DA mésencéphalique nous a permis de mettre en évidence un rôle déterminant de la voie DA nigrostriatale dans les processus motivationnels et dans la régulation des comportements de type dépressif et anxieux, tout en s'affranchissant d'une altération des fonctions motrices. Dans une deuxième partie, une approche pharmacologique par des traitements chroniques à la L-DOPA ou au Ropinirole (agoniste D2/D3) nous a permis de vérifier de la bonne valeur prédictive de notre modèle animal vis-à-vis des traitements utilisés en clinique. L'administration de différents agonistes DA sélectifs des récepteurs de type D1, D2 et D3 nous a permis par la suite de montrer une implication majeure des récepteurs D3 dans la capacité à corriger le phénotype induit par la lésion de la voie nigrostriatale, ce qui ouvre ainsi la voie à de nouvelle cible thérapeutique. Au final, les données obtenues au cours de ce travail doctoral apportent de nouveaux arguments en faveur d'une implication de la voie DA nigrostriée dans l'émergence des troubles apathiques. Le modèle lésionnel mis en place pourra permettre de mieux appréhender le rôle de la dopamine dans les processus qui sous-tendent ces troubles motivationnels et thymiques dans la MP et identifier de nouvelles stratégies thérapeutiques mieux adaptées pour leur traitement. / Beyond the classical triad of motor symptoms observed in Parkinson's disease (PD), behavioural and cognitive disturbances are also commonly observed, including apathy, defined as a decrease in motivated directed behaviours, and which is often associated with anxiety and depression. Interestingly, these neuropsychiatric symptoms are frequently observed in parkinsonian patients with high frequency stimulation of the subthalamic nucleus. Although the pathophysiological mechanisms behind these troubles are still unknown, a link has been recently suggested between the reduction of dopaminergic drugs (DA) (made possible by the benefits on the motor ability of deep brain stimulation) and the resurgence of the apathetic syndrome in these stimulated patients. In a first set of experiments, we set out to determine the role of the DA system in the emergence of such neuropsychiatric symptoms and which part of the DA ascending pathway is more specifically involved. Our lesion model in rats, by neurotoxic partial, selective and bilateral lesions of different regions of the DA midbrain continuum were performed allowed us to highlight a key role of the nigrostriatal DA pathway in the motivational processes and in regulating depressive- and anxiety-like behaviours, while avoiding motor impairments. In the second part, a pharmacological approach by chronic treatment with L-DOPA or Ropinirole (D2/D3 agonist) allowed us to verify the predictive value of our animal model in regard to treatment classically used in clinic. The administration of different selective agonists of the D1, D2 and D3 DA receptors has allowed us to show the major involvement of the D3 receptors in the efficiency to reverse the phenotype induced by the nigrostriatal pathway lesion, which opens the way for new therapeutic targets. Finally, the data obtained during this doctoral work provides new arguments for an involvement of the nigrostriatal DA pathway in the emergence of the apathetic syndrome in PD. The lesion model developed can lead to a better understanding of the role of DA in the processes underlying these motivational and mood disorders in PD and to identify new therapeutic strategies, more suitable for further treatment.

Made available in DSpace on 2016-06-02T19:46:05Z (GMT). No. of bitstreams: 1 2429.pdf: 663520 bytes, checksum: eade8a60f2b578a2652f567441b6cffa (MD5) Previous issue date: 2009-03-06 / Motivation is usually defined as an inner strength or will, followed by an action towards a goal. Its importance to rehabilitation is established by its positive relation with better and faster functional recovery. Individuals with pathologies or injuries in the Central Nervous System may present motivational disorders. Apathy is the most common and the least intense motivational disorder. The general purpose of this research is to investigate the factors which would distinguish motivated people with physical disability from those demotivated, by using apathy as a reference of demotivation. The study was conducted in two studies. The first one, dealing with the cultural adaptation of the Apathy Evaluation Scale, and the second using all the tools selected to identify intrinsic and extrinsic factors that would influence the participants´ motivation. 14 participants were selected for the first study and 51 for the second, together with their caretakers. The participants were 33 to 89 years old and presented stroke sequelae, traumatic brain injury, Parkinson's disease and Alzheimer's disease. The caretakers responded to the Apathy Evaluation Scale and the patients completed the general characterization questionnaire, WHOQol-100 World Health Organization Quality of Life (WHOQOL-100) scale and Beck Depression Inventory (BDI). The data was analyzed through SPSS, with descriptive statistics, Pearson correlation test and Student´s t-test (regressive and inferential). The analysis of the Brazilian version of the Apathy Evaluation Scale, obtained in the first study, revealed its suitability to be used in the sample of this investigation. The final results demonstrated that Apathy is significantly correlated with age, degenerative diseases, right hemisphere lesions, general comorbidity, lack of energy, lack of leisure opportunities, and also lack of capacity to undertake physical and cognitive daily activities, and low self-esteem. Differences in self-esteem, work capacity, quality of sleep, day-to-day energy, personal relationship, leisure and physical domains were detected between apathetic and non-apathetic participants. Self-esteem, presence of general comorbidity and work capacity were the main factors to predict apathy. Therefore, both, intrinsic and extrinsic features determine apathy in this kind of population. Drug intervention and familiar guidance may help the rehabilitation professionals increase motivation to functional rehabilitation, which may lead patients to physical, psychological and social benefits. / A motivação tem sido comumente definida como uma força interior ou desejo seguido de uma ação para alcançar um objetivo. A sua importância na reabilitação é estabelecida pela relação positiva com uma recuperação funcional melhor e mais rápida. Indivíduos com patologias ou lesões no sistema nervoso central podem apresentar desordens motivacionais. A Apatia é a desordem motivacional menos intensa e mais comum. O objetivo geral da presente pesquisa foi investigar fatores que distinguiriam indivíduos portadores de deficiência física motivados daqueles não motivados, utilizando a apatia como referência de desmotivação. A pesquisa foi dividida em dois estudos, sendo o primeiro voltado à adequação cultural da Apathy Evaluation Scale e o segundo constituído da aplicação de todos os instrumentos escolhidos para coleta dos fatores intrínsecos e extrínsecos que poderiam influenciar a motivação dos participantes. No Estudo 1 foram selecionados 14 indivíduos e para o Estudo 2, 51, juntamente com seus cuidadores. Os participantes tinham idade entre 33 e 89 anos, e seqüelas de acidente vascular encefálico, traumatismo crânio encefálico, doença de Parkinson e demência de Alzheimer. Os cuidadores responderam à Escala de Avaliação da Apatia. Os clientes responderam ao questionário de caracterização geral, instrumento de qualidade de vida WHOQol-100 e Inventário de Depressão de Beck. Os dados foram analisados através do SPSS, com estatística descritiva, correlacional de Pearson, regressiva e inferencial (Teste t). A análise da versão brasileira da Escala de Avaliação da Apatia, descrita no Estudo 1, parece demonstrar a adequação da mesma para aplicação na amostra dessa pesquisa. Os resultados finais parecem indicar que a apatia está significativamente correlacionada à idade, doenças degenerativas, lesões do hemisfério direito, comorbidades gerais, falta de energia, de oportunidades de lazer, capacidade para realização das atividades cotidianas, físicas e cognitivas, e baixa auto-estima. Entre apáticos e não apáticos, houve diferença na auto-estima, capacidade para o trabalho, qualidade do sono, energia para o dia-adia, relações pessoais, lazer e domínio físico. A auto-estima, presença de comorbidades gerais e capacidade para o trabalho foram os principais fatores preditivos da apatia. Portanto, tanto características extrínsecas quanto intrínsecas ao indivíduo são determinantes da apatia nesse tipo de população. Intervenções medicamentosas e orientações à família de pessoas apáticas podem auxiliar os profissionais de reabilitação a aumentar a motivação para a recuperação funcional, que pode trazer, por sua vez, benefícios à dimensão física, psicológica e social dos indivíduos.

Orientador: Ana Archangelo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação / Made available in DSpace on 2018-08-13T21:34:54Z (GMT). No. of bitstreams: 1 Luz_TagianeMariadaRocha_M.pdf: 3234892 bytes, checksum: cc27719f4765eaa6ecf437acf3d5f194 (MD5) Previous issue date: 2009 / Resumo: Este trabalho diz respeito à compreensão de uma criança nomeada de apática, em sala de aula. Foi realizado em uma escola pública, localizada em um bairro considerado de alta exclusão social, em um município do interior do Estado de São Paulo. O fenômeno denominado de apatia, segundo professoras da referida escola, frequentemente traz consigo a dificuldade das crianças usufruírem, de forma enriquecedora, do ambiente escolar. O estudo sobre a apatia é baseado nos relatos de algumas professoras sobre atitudes de alunos que as preocupavam, como o fato de 'ficar apagado', 'esquecer rápido', 'ficar disperso', 'não dar continuidade à realização de atividades'. A investigação foi realizada à luz de teorias sobre o desenvolvimento emocional e guiada pela hipótese de que essa condição pode ter uma de suas raízes em dificuldades que extrapolam o desenvolvimento cognitivo, abrangendo o aspecto emocional. Para tanto, a pesquisa fundamentou-se em teorias da psicanálise, em especial, a winnicottiana. A apatia é analisada a partir de observações e intervenções junto à criança. Envolveu a participação em reuniões com professores da escola; observação em sala de aula; entrevista com mãe e encontros individuais para o brincar. A partir da interpretação do material da pesquisa empírica é apresentada a compreensão sobre dinâmicas emocionais que se fazem presentes na apatia, as quais envolvem a fragilidade na condição de integração do ego. A integração diz respeito ao estabelecimento do sentimento pessoal de unidade, traz consigo a idéia de fronteiras entre o eu e o não-eu e também a capacidade de criar e conhecer a externalidade. A integração fornece as bases para que os indivíduos sigam rumo à independência em relação ao ambiente. São apresentadas algumas necessidades emocionais da criança em sala de aula e idéias sobre a possibilidade de propiciar o cuidado descrito por Winnicott como holding ou aspecto facilitador do ambiente aos processos de maturação emocional. / Abstract: This work about the comprehension of a child which was apathetic in the classroom was done in a city in the state of São Paulo, at a public school in a neighborhood that is considered to be socially, extremely excluded. The so-called phenomenon "apathy", according to the teachers of the aforementioned school, frequently brings with it the difficulty of children to benefit from the school environment in a profitable manner. The study about apathy is based on reports of some teachers in relation to the attitudes of their students whom they were worried about as to: being disconnected with what was going on; scatter brained; forget quickly; not following up on class work and activities with homework or participation of any kind. The apathy is analyzed from observation and interaction with the child. The investigation is made with theories about emotional development, guided by the hypothesis that this condition can be one of the roots of the difficulties that extrapolates the cognitive development, embracing the emotional aspect. Therefore, the research is founded on psychoanalysis theories, in particular, the Winnicottian. It involved participating in meetings with the school teachers; observation in the classroom; interviews with the mother and meeting with the child at play time. After the interpretation of the empiric research material, the understanding about emotional dynamics that are present in the "apathy", which involve the fragility of the condition of the integration of the ego is presented. The integration tells about the establishment of personal sentiment and brings with it the idea of frontiers between the I and the not I and also the ability to create and to know externality. The integrations supplies the basis for which the individuals follow on the path to independence in relation to environment. Some emotional necessities of the child in the classroom and ideas about the possibility to propitiate the care describe by Winnicott as holding or a facilitating aspect of the environment to the processes of emotional maturity are presented. / Mestrado / Psicologia Educacional / Mestre em Educação

This dissertation deals with the nature of the black middle-class assimilation in the South African suburban space, a space that was the sole preserve of the white middle-class during apartheid. It explores the relationship between these races as they come to meet in this space and what new identities are being formed. It also explores the relationship between both the black and white suburbanites and the urban poor who stay in an adjacent area to the suburb. The study uses the Beacon Bay area, which is constituted by one of East London’s most affluent suburbs and a poor township, Nompumelelo, to show how the emergent black middle-class has managed to enter this space in the post-apartheid era. Previous studies by Richard Ballard (2004) and Grant Saff (2001) have shown how the white middle-class has always been against any form of race or class mixing. Within the suburb, the new black suburbanites in Beacon Bay appear to have been welcomed but with conditions by their fellow white counterparts. The relationship between these two races does not stretch beyond meet and greets and it is only in the second generation black middle-class that you find better and non-superficial relations with fellow white suburbanites. In the older generation, the generation that experienced apartheid, the relationship between these two races has been that of tolerance and serious escape of contact unless when necessary. The children of both white and black families, though, have a far better relationship in school and in sport than their parents. This has created another area of contact for both these races and it bears potential for meaningful integration in the suburban space. Externally as it relates to relations between the black middle-class and the urban poor, the findings show that these new black suburbanites express a similar discomfort as the white suburbanites about the urban poor’s presence in the area. This shows that the evolution of the Beacon Bay suburb, with its deep-rooted discourse of white middle-class exclusivity, has not been entirely about hatred of the urban poor necessarily but about an identity ascription of what it means to live in a suburb. Despite these realities traditional ceremonies organised by the black middle-class in the suburbs and the church appear to be playing a role in creating relations between these suburbanites and the Nompumelelo residents. This is why we have decided to use the conceptualisation of the 18th century frontier zone as the borders of segregation within the suburb and between the suburban residents and those of the township can be crossed and re-crossed.

Ce mémoire de recherche-création est d’abord un roman intitulé « Les fuckalls » portant sur les dérives quotidiennes d’un groupe d’amis résidant à Sherbrooke et leur tentative de former une communauté dans une société de performance. Seront considéré dans cette partie la conscience de la fiction, l’ennui, les relations et l’inertie. La partie analyse est une réflexion autour de l’idée de l’éloge de l’inertie, à travers le déploiement des mécanismes de l’ironie dans Document 1 de François Blais (2012), un récit de voyage subvertit par un duo de personnages ludiques, Tess et Jude. Cet essai investit d’abord la manière dont est inscrite l’inertie, notamment par l’exploration du quotidien et habitudes des personnages, mais aussi l’humour, aspect pouvant afficher le roman comme un hommage à L’hiver de force de Réjean Ducharme (1973). Le ton humoristique serait en lien avec la connivence que la narratrice tente de développer avec le lecteur, au travers d’une narration dite niaiseuse. Cette connivence est nécessaire à l’inscription de l’ironie dans le roman, qui passe entre autres par le récit et le discours de la narration, se déclinant autant les péripéties contradictoires qu’amène la quête falsifiée des personnages. L’analyse explore la façon dont est renversée cette doxa prônant le départ comme clé du bonheur, par l’exploration du territoire de proximité et la mise en abyme du récit. Au final, l’impossibilité même du départ traduit la fatalité inhérente au contexte dans lequel évolue les personnages, c’est-à-dire le confort et la raillerie. Les œuvres convoquées tissent entre elles des arguments amenant à la réflexion que l’ironie ici est le mécanisme portant l’éloge de l’inertie. / This memoir in creation-research is first and foremost a novel named “Les fuckalls”, in which is illustrated the aimless drifting of some teenagers in Sherbrooke, Québec as well as their attempt to form a community in a society that promotes productivity and appearance. Will be considered in this part the awareness of the fiction process, boredom, relationships and apathy. The research part focuses around the idea of the praise of apathy that comes from the mechanisms of irony in Document 1 by François Blais (2012), a road novel subverted by the playful duo formed by Tess and Jude. First, this essay dissects the way the notion of apathy is inserted in the daily lives of the characters, as well as the humor process, which can appear as a homage to the 1973 novel L’hiver de force, by Réjean Ducharme. This particular humoristic tone is linked to the complicity the narrator is trying to develop through a narration said to be mindless. This complicity is necessary to the inscription of irony in the text, which is manifesting itself through the story and the narration, as well as the contradictory twists that is brought by a falsified quest. This research explores the way that this doxa, which advocates that the key to happiness has to be somewhere else, is deflected by the author by the exploration of the adjacent territory and the mise en abyme of the story. In the end, the impossibility of any departure translates the inherent fatality of apathy, the state in which the characters are living their lives. The studied corpus links the irony as the mechanism that supports the praise of apathy.

Orbitofrontal metabolic impairment is characteristic of the frontal variant of frontotemporal dementia (fv-FTD), as are early changes in emotional and social conduct. Two main types of behavioral disturbances have been distinguished in fv-FTD patients: apathetic and disinhibited manifestations. In this study, we searched for relationships between brain metabolism and presence of apathetic or disinhibited behavior. Metabolic activity and behavioral data were collected in 41 fv-FTD patients from European PET centers. A conjunction analysis of the PET data showed an expected impairment of metabolic activity in the anterior cingulate, ventromedial and orbital prefrontal cortex, the dorsolateral prefrontal cortex and the left anterior insula in fv-FTD subjects compared to matched controls. A correlation was observed between disinhibition scores on the Neuropsychiatric Inventory scale and a cluster of voxels located in the posterior orbitofrontal cortex (6, 28, –24). Comparison of brain activity between apathetic and nonapathetic fv-FTD patients from two centers also revealed a specific involvement of the posterior orbitofrontal cortex in apathetic subjects (4, 22, –22). The results confirm that the main cerebral metabolic impairment in fv-FTD patients affects areas specializing in emotional evaluation and demonstrate that decreased orbitofrontal activity is related to both disinhibited and apathetic syndromes in fv-FTD. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.