O uso problemático de substâncias psicoativas (SPA) tem aumentado significativamente nos últimos anos. Os Transtornos Relacionados a Substâncias (TRS) têm sido associados a uma série de prejuízos cognitivos e comportamentais, dentre os quais destacam-se as disfunções executivas e os déficits envolvendo o controle dos impulsos. A presente tese teve como objetivo investigar as funções executivas, o controle inibitório e a agressividade em indivíduos com Transtornos por uso de álcool e crack. O propósito desta pesquisa foi o de investigar a cognição e o comportamento em amostras distintas de dependentes, visto que são poucos os estudos nessa área enfocando os perfis de déficits cognitivos e comportamentais de acordo com a droga de abuso. Essa tese é composta por um estudo de revisão da literatura e dois estudos empíricos. Foram avaliados 67 homens, com idades entre 18 - 65 anos, divididos em quarto grupos: dependentes de álcool, dependentes de crack, dependentes de álcool + crack e grupo controle. Os dependentes de álcool e/ou crack encontravam-se em abstinência e estavam internados em um programa de tratamento gratuito e voluntário de um Hospital Geral. O protocolo de pesquisa incluiu medidas psicológicas e neuropsicológicas. Os principais resultados deste estudo indicaram prejuízos das funções executivas e do controle inibitório e níveis mais elevados de agressividade nos grupos de dependentes, quando comparados ao grupo controle, tendo esses índices variado de acordo com a droga de abuso. Entre os indivíduos que faziam uso de álcool esses índices foram mais rebaixados, sugerindo que o consumo dessa substância pode estar associado a um maior comprometimento das habilidades de autorregulação e autocontrole. / The problematic use of psychoactive substances has increased significantly in recent years. The Substance-Related Disorders have been linked to a series of cognitive and behavioral impairments, among which is the executive dysfunction and deficits involving impulse control. This thesis aimed to investigate the executive functions, inhibitory control and aggression in individuals with alcohol and crack disorders. The choice of this theme aimed to investigate cognition and behavior in different dependent samples, since there are few studies in this area focusing on the profiles of cognitive and behavioral deficits according to the drug of abuse. This thesis is composed by a review of the literature study and two empirical studies. They were evaluated 67 men, aged 18 -65 years, divided into four groups: alcohol dependents, crack dependents, alcohol + crack dependents and control group. The alcohol and / or crack dependents were in abstinence and were inpatients in a free and voluntary treatment program of a General Hospital. The research protocol included psychological and neuropsychological measures. The main results of this study indicated losses of executive functions and inhibitory control and higher levels of aggression in dependent groups compared to the control group, and these impairments varied according to the drug of abuse. Alcohol dependents showed decreased performance, suggesting that alcohol consumption may be associated with a decrease of self-regulation and self-control skills.

L’objectif principal de cette thèse est d’évaluer l’impact thérapeutique d’une intervention de stimulation cognitive associée à un programme d’activité physique au stade léger à modéré de la maladie d’Alzheimer. Précisément, il s’agit de détailler les effets respectifs et combinés de ces interventions selon les trois dimensions suivantes : 1) le fonctionnement cognitif général, 2) le fonctionnement exécutif à travers la mise à jour, l’alternance, l’inhibition et la planification, 3) le fonctionnement psychosocial, intégrant l’anxiété et la dépression. L’étude principale de cette thèse a comparé les performances pré- et post-intervention de 67 patients répartis en quatre groupes (i.e., groupe stimulation cognitive, groupe activité physique, groupe stimulation cognitive plus activité physique, groupe contrôle). Les résultats ont montré que, 1) la stimulation cognitive permet l’amélioration du fonctionnement cognitif général et le maintien des capacités d’alternance et de mise à jour, 2) l’activité physique favorise l’amélioration des capacités d’inhibition et le maintien des capacités d’alternance, et 3), l’association de la stimulation cognitive et de l’activité physique permet l’amélioration du fonctionnement cognitif général, l’amélioration des performances d’alternance et d’inhibition et le maintien des capacités de mise à jour. L’ensemble de ces résultats met en évidence le potentiel thérapeutique de la stimulation cognitive et de l’activité physique dans le traitement de la maladie d’Alzheimer. De plus, les données recueillies montrent que les bénéfices des interventions sont d’autant plus importants lorsque le programme intègre les deux formes de prises en charge. Les mécanismes par lesquels s’opèrent les changements dans la cognition des personnes souffrant d’Alzheimer sont discutés à travers le concept de réserve cognitive. L’enjeu des futures recherches réside dans le développement de thérapies visant le maintien du fonctionnement exécutif à travers la stimulation des capacités physiques et cognitives. / The principal objective of this thesis was to evaluate the therapeutic impact of an intervention which combines a cognitive stimulation program and a physical activity program in mild to moderate Alzheimer's disease. Specifically, the objective was to detail the respective and combined effects of these interventions in the three following dimensions, 1) general cognitive functioning, 2) executive functioning with updating, switching, inhibition and planning, 3) psychosocial functioning, including anxiety and depression. The main study of this thesis examines the pre-and post-intervention scores of 67 patients assigned into four groups (i.e., cognitive stimulation, physical activity, cognitive stimulation combined with physical activity, and control). The data showed that, 1) cognitive stimulation improved general cognitive functioning and maintained updating and switching abilities, 2) physical activity improved inhibition and switching abilities, and 3) associate cognitive stimulation and physical activity allowed the improvement of general cognitive functioning, inhibition and switching abilities, and allowed remaining updating abilities. Taken together, these results demonstrate the therapeutic effects of cognitive stimulation and physical activity in Alzheimer's disease treatment. Moreover, the data collected showed that the benefits of the interventions were particularly important when the program included both interventions. Mechanisms of changes in cognition of Alzheimer's patients are discussed through the concept of cognitive reserve. The aim for future researches is to develop programs of cognitive stimulation and physical activities to preserve executive functioning.

INTRODUÇÃO: A memória autobiográfica é um tipo de memória episódica, que abrange os aspectos perceptuais, afetivos e espaço-temporais de um evento. Tais aspectos são organizados em representações que compõem uma história pessoal, sendo portanto fundamentais para a formação da identidade. Esse tipo de lembrança é uma construção transitória e dinâmica gerada a partir de uma base de conhecimento subjacente e esta base é armazenada em diferentes níveis de especificidade de detalhes. Por possuir grande conteúdo episódico, que é dependente das regiões frontais e temporomediais, áreas cerebrais conhecidas por sofrerem alterações significativas com o avanço da idade, é um sistema de memória que parece apresentar declínio com o avanço da idade. O presente estudo procurou investigar a relação entre a memória autobiográfica e o envelhecimento em 57 voluntários saudáveis, que foram divididos em dois grupos: adultos jovens (18 a 50 anos) e adultos mais velhos (51 a 75 anos). METODOLOGIA: A investigação utilizou uma entrevista de memória autobiográfica constituída de 5 eventos públicos marcantes (flashbulb memories), 4 estímulos de valência (positiva e negativa) e 1 evento importante ocorrido no último ano. As entrevistas foram avaliadas e pontuadas de acordo com sistema de categorização dos detalhes relatados em episódicos e semânticos. Também foi usada uma bateria de testes neuropsicológicos composta por 7 testes agrupados em 5 domínios cognitivos destinados a avaliar respectivamente: velocidade de processamento da informação, memória verbal, memória visual, funções executivas e funcionamento intelectual, para examinar possível déficits nesses domínios e suas correlações com o desempenho na entrevista autobiográfica. O nível de significância foi de p < 0.05. RESULTADOS: Não foram encontradas diferenças significativas entre os dois grupos na avaliação de memória autobiográfica, com sujeitos lembrando-se de quantidades semelhantes de detalhes episódicos. Tanto eventos de valência positiva como negativa foram lembrados com a mesma qualidade. Houve uma tendência a um pior desempenho de pessoas mais velhas para relatar lembranças pessoais recentes (que ocorreram no último ano). O grupo mais velho teve pior desempenho em atividades de velocidade de processamento, flexibilidade mental, controle inibitório, memória episódica verbal e memória visual. Foi observada uma correlação positiva entre o desempenho em tarefa padronizada de memória verbal episódica e a quantidade de detalhes episódicos na entrevista de memória autobiográfica. Houve uma relação inversa entre a quantidade de eventos episódicos relatados e a velocidade de processamento de informações apenas no grupo de adultos jovens. Não foram observadas correlações entre os demais domínios cognitivos e os resultados na atividade de memória autobiográfica. CONCLUSÃO: Os resultados obtidos sugerem que as memórias autobiográficas são mais resistentes aos efeitos do tempo. Eventos que têm importante significado pessoal e grande conteúdo emocional aparentam ficar bem preservados na memória / INTRODUCTION: The autobiographical memory is a kind of episodic memory that covers an event\'s aspects of perception, affection, space and time. These are organized in representations that make up a personal history. Therefore, they are paramount to the creation of identity. This type of memory is a transitory and dynamic construction, generated from a foundation of subjacent knowledge stored in details that are specific on different levels. Because it has a vast episodic content, that is dependent of the frontal and temporal medial regions (areas of the brain known for suffering meaningful changes with the aging process), it is a memory system that apparently shows decline with the aging process. This study sought to investigate the relationship between autobiographical memory and aging in 57 healthy subjects that were divided into two groups: young adults (18 to 50 years old) and seniors (51 to 75 years old). METHOD: The investigation used an autobiographical memory interview made up of 5 memorable public events (flashbulb memories), 4 valence stimuli (positive and negative) and 1 important event that happened in the last year. The interviews were evaluated and scored according to the sorting system of details determined either as episodic or semantic. A battery of neuropsychological tests was also used, it was constituted of 7 tests grouped in 5 cognitive domains destined to evaluate, respectively: processing speed, verbal memory, visual memory, executive functions and intellectual performance, to examine possible deficits in these domains and its correlation to the performance in the autobiographical interview. The level of significance was of p < 0.05. RESULTS: There were no meaningful differences between groups in the evaluation of autobiographical memory. Subjects remembered similar amounts of episodic details. Events of both negative and positive valence were recalled with the same quality. In seniors, a tendency towards a worse performance was found when they were asked to tell recent personal memories (that happened last year). The results demonstrate age-related difficulties in activities of speed processing, mental flexibility, inhibitory control, episodic verbal memory and visual memory. A positive correlation was found between the performance in a standardized episodic verbal memory task and the amount of episodic details in the autobiographical memory interview. There was a reverse relation between the amount of episodic events told and the speed of processing information only in the young adults group. No correlations were found between the other cognitive domains and the results in the autobiographical memory activity. CONCLUSION: The obtained results suggest that autobiographical memories are more resistant to the effects of time. Events that have important personal meaning and great emotional content seem to be well preserved in memory

No que diz respeito ao bilinguismo infantil, é grande o número de investigações que comprovam que o uso diário de duas ou mais línguas leva a um desenvolvimento acentuado de certos processos cognitivos (como a atenção seletiva e o controle inibitório), linguísticos e metalinguísticos em comparação com crianças monolíngues de mesma faixa etária (BIALYSTOK, 2001, 2005, 2006, dentre outros). Entretanto, assume-se que tais vantagens são evidentes apenas quando se trata de crianças bilíngues nativas ou com proficiência avançada nas duas línguas faladas. Nesse contexto se insere o presente estudo, que se propôs a investigar os efeitos cognitivos do bilinguismo no desenvolvimento do controle inibitório em um grupo de crianças que estudam em um contexto de escolaridade bilíngue, ou seja, crianças cuja segunda língua é aprendida e vivenciada exclusivamente em contexto escolar, em comparação com bilíngues que aprenderam a segunda língua em contexto familiar ou na comunidade em que vivem, população normalmente testada em experimentos desse tipo. Para isso, foram testadas 174 crianças entre 9 e 12 anos, sendo 75 oriundas de contexto escolar bilíngue (português/inglês), 57 de contexto familiar bilíngue (português/hunsrückisch) e 42 monolíngues do português. Duas tarefas que avaliam controle inibitório foram utilizadas: a Tarefa Simon de flechas e a Tarefa Stroop. Os resultados sugerem que as crianças que estudam em contexto escolar bilíngue, que são expostas e empregam a segunda língua diariamente, embora somente na escola, também parecem se beneficiar de uma experiência bilíngue. / Recent research on childhood bilingualism has indicated that the daily use of two or more languages sharpens the development of certain cognitive processes, such as selective attention and inhibitory control, as well as linguistic and metalinguistic processes, in bilingual children when compared to monolingual children of the same age (BIALYSTOK, 2001, 2005, 2006, amongst others). However, this advantage has only been observed with native bilingual children, or children with very high proficiency in both languages. To fill this gap, the present study aimed to investigate the effect of bilingualism on inhibitory control in bilingual children who experience bilingualism (or second language learning) exclusively in a school context, compared to the usual sample of bilingual children who experience bilingualism at home or in the community. Thus, 174 children of ages 9 to 12 from three different linguistic groups (75 school bilinguals; 57 home bilinguals and 42 monolinguals) participated in the study. Children completed both the Simon Arrows and the Stroop Tasks to assess their inhibitory control with both non-linguistic and linguistic stimuli. Results suggest that bilingual children from a school context, who deal with both languages on a daily basis, although only at school, also show cognitive advantages due to a bilingual experience.

La section 1 permet premièrement de constater que les fonctions exécutives (FE) sont plus sévèrement atteintes lorsqu'elles sont dans une période de développement rapide et que l'utilisation de tests papier-crayon sous-estime largement les conséquences du TC sur la vie quotidienne. Deuxièmement, elle confirme les conséquences du TC sur la mémoire prospective. Enfin, elle présente les résultats pilotes d'une évaluation multimodale de la métacognition et montre des dissociations de l'atteinte de ses différents composants chez des enfants cérébro-lésés. Elle propose également un modèle d'anosognosie de l'enfant, permettant de mieux adapter la rééducation cognitive aux capacités de l'enfant. La section 2 tente de proposer des moyens d'améliorer les FE. Une revue systématique de la littérature examine d'abord l'efficacité du Goal Management Training (GMT) chez l'adulte cérébro-lésé puis est décrit l'adaptation du GMT à l'enfant. Cette étude confirme la difficulté de rééduquer les FE, avec des résultats contradictoires entre les critères de jugement (certains enfants s'améliorant sur la tâche écologique des FE et d'autres sur les questionnaires de FE). De plus, quand ils étaient confrontés à une nouvelle recette de cuisine, les enfants revenaient à leur comportement dysexécutif, suggérant que la fonction d'adaptation à la nouveauté n'avait pas progressé. La discussion alerte sur la nécessité de mieux prendre en compte les aspects développementaux chez l'enfant cérébro-lésé, concernant l'anosognosie et l'utilisation de stratégies métacognitives. Elle propose également des critères de jugement et de méthodologies innovants pour la recherche sur la rééducation des FE de l'enfant. / Part one of this PhD explored executive functions (EF) and related impairments after childhood severe TBI. Executive dysfunction was worse when the injury occurred during the period of rapid development of EF. Paper and pencil tasks underestimated EF impairment in daily life. Impairment in prospective memory persisted at seven years post injury, and into adulthood. A model of child anosognosia, and directions for cognitive rehabilitation interventions, are proposed based on a study of self-awareness after childhood TBI. Part two of this PhD investigated methods of remediating EF dysfunction. A systematic review found that Goal Management Training (GMT) is effective in adults when coupled with personal goal setting, external cueing, personalised homework to increase patients' commitment and training intensity and daily life training activities. Based on this literature review, a paediatric GMT intervention was adapted and tested. The intervention showed limited effectiveness, with inconsistency across outcome measures. Children did not apply the metacognitive strategies taught during the training. Furthermore, there was no evidence of generalisation of task-specific improvements to a novel, parallel version of the secondary outcome measure (the Children’s Cooking Task). The adapted GMT did not seem developmentally coherent for younger children. It is clear that deficits in EF arising from TBI continue to be an important target for rehabilitation interventions in children. Proposals on how the use of novel innovative outcome measures and methodologies may improve the field of EF rehabilitation in children with TBI are presented.

Aim of the present study was to evaluate executive functions (EF) such as inhibition, planning, working memory, set-shifting in children with Attention Deficit / Hyperactivity Disorder (ADHD) via comparison of three ADHD subtype groups (ADHD-I, ADHD-C and ADHD-Comorbid) and a normal control group. Participants consist of 147 children. Total of 111 children were assigned into the ADHD groups of the study. Thirty seven children (5 girl and 32 boys) were assigned into the ADHD-Inattentive group, thirty seven children (6 girls and 31 boys) were assigned into the ADHD-Combined group / and thirty seven children (4 girls and 33 boys) were classified as ADHD-Comorbide group (ADHD-C with Oppositional Defiant Disorder consists of 4 girls and 31 boys, and/or Conduct Disorders consists of 2 boys). Thirty six children (6 girls and 30 boys / age range: 7- 12) were assigned as control group by matching with the ADHD groups according to the WISC-R Full Scale IQ score, sex and age. Conner&rsquo / s Parental and Teacher Rating Scales, Child Behavior Check List and Wechsler Intelligence Scale Revised, Tower of London Test, Wisconsin Card Sorting Test, Stroop Color Word Test, Cancellation Task, Trail Making Test, California Verbal List Test for Children, Verbal Fluency Test, Continuous Performance Test, Go-No-Go Task and Bender-Gestalt Test were used for the assessment of children. The data were analyzed by one-way within subject ANOVA for all dependent variables measured by the assessment tools. Additionally discriminant function analyses were conducted to determine the variables that differentiate the three ADHD groups and control group. Outcome of study indicated that subjects in ADHD-Comorbid group had more severe Executive Function (EF) deficits than subjects in ADHD-I and ADHD-C group. The findings were discussed in the light of the literature.

This study examined the impact of working memory deficits (WMD) on the academic achievement of adolescents with ADHD. Adolescents (n=79) aged 13 to 17 years with a clinical diagnosis of ADHD were subtyped into those with and without WMD based on impairment in at least two measures, and then compared on their academic achievement and clinical profile. Results indicated that adolescents with ADHD plus WMD (23%) manifest significantly lower academic achievement than those with adequate WM. By contrast, there were no group differences in psychiatric comorbidity, severity of ADHD symptoms and psychological adjustment. We also found a unique contribution of WM to academic achievement over and above that of other clinical features. These findings suggest that WMD compromise the educational attainment of a subgroup of individuals with ADHD. Individuals with ADHD should be screened for WMD to prevent academic failure and WM should be considered as a treatment target.

The aim of this thesis was to examine possible effects of omega-3 fatty acids on children’s cognition and behavior. Longitudinal as well as cross-sectional comparisons were made among children with typical development and children with ADHD /at risk developing ADHD. The specific purposes were to examine (1) breast-feeding in relation to cognition; (2) relation between long chain poly unsaturated fatty acids (LCPUFAs) in mothers breast-milk and children´s cognition; (3) effects of EPA supplementation on cognition and behavior in children with ADHD; (4) if LCPUFAs have differential effects on working memory, inhibition, problem-solving and theory of mind (ToM). The main conclusions were as follows; (1) duration of breast-feeding was positively correlated to children levels of intelligence (IQ); (2) LCPUFAs in breast-milk was related to children’s ToM and IQ, the quotient DHA/AA, together with length of breastfeeding and gestation week explained 76% of the variance of total IQ; (3) subtypes of children with ADHD responded to EPA supplementation with significant reductions in symptoms, but there were no effects in the whole group with ADHD; (4) ToM ability was related to LCPUFAs, but not to any other cognitive measures as working memory, inhibition and problem-solving. To conclude, these results indicate that fatty acid status in breast-milk at birth affect general cognitive function in children at 6.5 years of age, including ToM. Short-term intervention with omega-3 fatty acids does not affect cognition in children with ADHD, but improves clinical symptoms as assessed by means of teacher ratings. These results further indicate that hot executive function and social cognition may be an area of interest for future research. / Syftet med denna avhandling var att undersöka möjliga effekter av omega-3 fettsyror för barns kognition och beteende. Både kortsiktiga och långsiktiga effekter undersöktes och studierna involverade både barn med typisk utveckling och barn med ADHD. De specifika syftena var att undersöka; (1) amning i relation till barns kognitiva utveckling; (2), relationen mellan långa fleromättade fettsyror (LCPUFA) i mammans bröstmjölk och barns kognition; (3) effekter på kognition och beteenden hos barn med ADHD av ett EPA tillskott; (4) om LCPUFA hade några differentiella effekter på arbetsminne, inhibering eller Theory of Mind (ToM). De huvudsakliga slutsatserna var följande; (1) amningslängden var positivt korrelerad med barnens intelligenskvot (IK); (2) LCPUFA i bröstmjölken var associerad med barnens ToM och IK, kvoten DHA/AA, tillsammans med amningslängd och graviditetslängd förklarade 76% av variansen i totala IK; (3) subgrupper av barn med ADHD svarade på EPA behandlingen med signifikant reducerade symptom, men för hela gruppen med ADHD hittades inga effekter; (4) ToM var relaterat till LCPUFA, men inga andra kognitiva mått som arbetsminne, inhibering eller problemlösning. Sammanfattningsvis indikerar dessa resultat att fettsyrestatus i bröstmjölk påverkar generell kognitiv förmåga, samt ToM, hos barn 6,5 år gamla. Korttidsintervention med omega-3 fetter påverkar inte kognition hos skolbarn med ADHD, men minskar kliniska symptom skattade i lärarskattningsskalor. Vidare indikerar resultaten att ”heta” exekutiva funktioner och social kognition kan vara av intresse för framtida forskning.

Background: Old-old age (80+ years) is associated with substantial cognitive decline. In this population, training-induced cognitive plasticity has rarely been studied. While earlier findings on strategy trainings suggested reduced training gains in old-old age, recent results of an extensive process-based working memory (WM) training have been more positive. Objective: Following up on previous research, the present study aimed at examining the effects of a short WM training in old-old adults and the influence of baseline WM capacity on training gains. Methods: A training group (mean age: 86.8 years) and a matched control group (mean age: 87.1 years) participated in the study. The WM training consisted of five tasks that were trained in each of 10 sessions. To evaluate possible transfer effects, executive functions were assessed with two tests before and after training. The training group was divided via median split in high- and low-capacity individuals to determine the influence of baseline WM capacity on training gains. Results: The training group improved in four of the trained tasks (medium-to-large effects). Training gains were significantly larger in the training group than in the control group in only two of those tasks. The training effects were mainly driven by the low-capacity individuals who improved in all trained tasks. No transfer effects were observed. Conclusions: These positive effects of a short WM training, particularly for low-capacity individuals, emphasize the potential for cognitive plasticity in old-old age. The absence of transfer effects may also point to its limits. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This study examined the impact of working memory deficits (WMD) on the academic achievement of adolescents with ADHD. Adolescents (n=79) aged 13 to 17 years with a clinical diagnosis of ADHD were subtyped into those with and without WMD based on impairment in at least two measures, and then compared on their academic achievement and clinical profile. Results indicated that adolescents with ADHD plus WMD (23%) manifest significantly lower academic achievement than those with adequate WM. By contrast, there were no group differences in psychiatric comorbidity, severity of ADHD symptoms and psychological adjustment. We also found a unique contribution of WM to academic achievement over and above that of other clinical features. These findings suggest that WMD compromise the educational attainment of a subgroup of individuals with ADHD. Individuals with ADHD should be screened for WMD to prevent academic failure and WM should be considered as a treatment target.