Text in Afrikaans / Hierdie studie ondersoek die moontlikheid dat aandagtekort versteuring met hiperaktiwiteit(ATHV/H) verband hou met probleme met voortgesette aandag, terwyl aandagtekort versteuring sander hiperaktiwiteit(ATHV/SO) verband hou met probleme met gefokusde aandag. Neurosielkundige toetse waarmee voortgesette- en gefokusde aandag gemeet word, word gebruik om drie groepe, naamlik ATHV/H(n=24), ATHV/SO(n=l5) en 'n kontrole groep(n=21), met mekaar te vergelyk. Resul tate dui daarop dat die groep ATHV/SO beduidend swakker presteer as die ander twee groepe op sommige van die toetse van gefokusde aandag, en ook neig om swakker te presteer op die toets van voortgesette aandag. Die groep ATHV/SO se probleme blyk gekoppel te wees aan 'n stadiger spoed van kognitiewe prosessering en 'n toestand van hipoopwekking. Die groep ATHV/H presteer nie beduidend swakker as die ander twee groepe op die toets van voortgesette aandag nie, maar presteer wel swakker as die kontrole groep op die Stroop Colour-Word Test waar inhibisie van ontoepaslike response vereis word. Die groep ATHV /H se probleme blyk verband te hou met frontale disfunksie wat manifesteer as 'n neighing tot impulsiwiteit en gebrekkige gedragsregulering. / This study examined the possibility that attention deficit disorder with hyperactivity(ADHD/H) is related to problems with sustained attention, while attention deficit disorder without hyperactivity (ADHD/WO) is related to problems with focussed attention. The performance of three groups: ADHD/H (n=24), ADHD/WO(n=15) and a control group(n=21) were compared. Results indicated that the ADHD/WO group performed significantly poorer than the other two groups on some of the tests of focussed attention and also tended to perform poorer on the test assessing sustained attention. This groups' symtoms appear to be related to a slowed speed of processing and a state of hypo-arousal. The ADHD/H group did not perform poorer than the other two groups on the test assessing sustained attention. The ADHD/H groups' symptoms appear to be related to frontal dysfunction resulting in impulsivity and poor behavioural control. / Psychology / M.A. (Sielkunde)

Previous studies have found that poor effort can significantly impact psychometric performance by Traumatic Brain Injury (TBI) patients. So far, this impact has been relatively well studied in attention and memory. However, this is not the case for visual perception functions. Thus, the goal of this study was to determine to what extent TBI severity affect visual perception after controlling for effort. Results showed that mild TBI good effort group did not differ from a demographically matched control group. In contrast, a mild TBI poor effort group, a moderate-severe TBI group and a right hemisphere cerebro-vascular (CVA) group performed worse than the mild TBI good effort group and the control group. The results suggest a dose response relationship between injury severity and visual perception performance. After controlling for effort, results indicated that moderate-severe TBI, but not mild TBI, has long lasting effects on visual perception. Clinical implications are discussed.

Esta dissertação é composta por dois estudos conduzidos de acordo com a abordagem da Neuropsicologia Cognitiva, a fim de compreender os efeitos da idade, do tipo de escola e tipo de tarefa no desempenho da fluência verbal em crianças de 6 a 12 anos. No primeiro estudo descreveu-se a adaptação ao contexto brasileiro da metodologia para análises dos componentes cognitivos de clustering e switching em tarefas de fluência verbal semântica (FVS) e ortográfica (FVO). Nesse estudo foram descritas as etapas de adaptação, realizada análise de juízes para evidência de fidedignidade do método e disponibilizada a versão final para categorização das variáveis de clustering e switching para clínicos e pesquisadores. O segundo estudo buscou comparar o desempenho quanti e qualitativo (variáveis de clustering e switching) de três grupos etários de crianças (6-8 anos, 9-10 anos e 11-12 anos) de dois tipos de escola (pública e privada) em duas tarefas de fluência verbal (semântica e ortográfica), e ainda verificar associações entre as variáveis de desempenho da fluência verbal, idade e desempenho em tarefas de linguagem, memória de trabalho e de funções executivas. Foram encontradas diferenças significativas nos desempenhos quanti e qualitativos nos diferentes grupos etários e nos tipos de tarefas, mas não foram encontrados efeitos do tipo de escola. Na FVO o grupo de 11-12 anos apresentou desempenho superior aos demais, com aumento do número de clusters e de switches, o que parece estar associado à maturação das funções executivas. Na FVS as diferenças de desempenho aparecem já entre os grupos mais jovens, mas também se verifica mudanças nas variáveis referentes à recuperação estratégica (números de clusters e de switches). Todos os participantes apresentaram melhor desempenho na FVS em relação à FVO. Encontrou-se associação entre os desempenhos das variáveis de clustering e switching com o número de palavras evocadas em ambas as tarefas de FV, assim como com a idade e com o desempenho nas tarefas de linguagem, memória de trabalho e funções executivas. A presente dissertação destaca a importância de estudar os processamentos subjacentes ao desempenho em tarefas de FV, pois auxiliam a compreender quais habilidades neuropsicológicas estão envolvidas nas estratégias de evocação lexical, podendo ser úteis no prognóstico e no planejamento de intervenções em distúrbios neuropsicológicos/neuropsiquiátricos durante a infância. / This thesis consists of two studies conducted in accordance with the approach of Cognitive Neuropsychology, in order to understand the effects of age, type of school and type of task in verbal fluency (VF) performance in 6-12 years old children. The first study described the adaptation to the Brazilian context of the methodology for clustering and switching analysis in semantic (SVF) and phonemic (PVF) verbal fluency task. This study described the fitting process, performed analysis of judges for reliability evidence and presented the final version for clustering and switching variables to clinicians and researchers. The second study compared the quantitative and qualitative performance (clustering and switching variables) of three age groups of children (6-8 years, 9-10 years and 11-12 years), two types of school (public and private) and two verbal fluency tasks (semantic and phonemic), verified associations between verbal fluency performance on general scores and clustering e switching scores, age and performance on language, working memory and executive functions tasks. Age and type of tasks had a significant effect in the general and clustering and switching scores, but we haven’t found type of school effects on the variables. PVF performance improved at 11-12 years and appears to be associated with the maturation of executive functions, by the increasing of number of clusters and number of switches. SVF performance differences have already appeared among younger groups, but also observed changes in variables related to strategic recovery. All participants performed better in SVF regarding the PVF. An association was found in the performance of clustering and switching scores with the number of words retrieved in both VF tasks, as well as age and performance on language, working memory and executive functions tasks. This work highlights the importance of studying the underlying cognitive processes on the performance of VF tasks. Understanding these cognitive processes may be useful tools to investigate the prognosis and to plane neuropsychological interventions in neuropsychiatric disorders during childhood.

Made available in DSpace on 2014-12-17T15:39:02Z (GMT). No. of bitstreams: 1 RosaliaCLF_DISSERT.pdf: 7248091 bytes, checksum: 78f0c88f129b94ac237649d5f3159584 (MD5) Previous issue date: 2013-07-03 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / This research aimed to contribute to the characterization of a neuropsychological phenotype of adolescents with Down Syndrome (DS). A multicases study of six adolescents (three males and three females, aged 13 to 14 years) diagnosed with DS and treated at two institutions in the city of Natal (Brazil), was conducted. Participants were assessed using the methodological approach developed by Luria, which is composed by four complementary stages. The first one aimed to investigate the qualitative impact of DS in school life and social development of the adolescents; dimensions of behavior and social-affective aspects of the members of the study were investigated. In the second stage participants performed a battery of neuropsychological tests in order to identify strengths and weaknesses in their cognitive functioning. The third stage was incorporated into the second in order to analyze the quality of the activity of the participants along the quantitative evaluation, highlighting strategies used, errors produced among other indicators. Lastly, the fourth stage refers to the intervention with the participants. Although this is not a specific objective of the study, it is argued that the outcome of this research will subsidize the practice of different professionals working with this clinical group. The results of the first stage emphasized the presence of difficulties in social relationships and in school life of observed adolescents. In turn, the second and third stages pointed out to the presence of difficulties in tasks involving logical and abstract thinking, as well as difficulties in expressive language. In relation to visual memory, we observed a better performance in activities of lower complexity, ie, with less interference of executive functioning, particularly in terms of the functions of planning and initiative. Finally, it was found motor and mental retardation, affecting significantly the performance related to different cognitive areas. The results highlighted here can be considered as subsidies for future interventions, suggesting the need for developping projects that take into account different aspects constituents of the human subject, involving not only the individual with developmental changes, as well as their families, teachers, schools and society in general / A presente pesquisa teve como objetivo contribuir para a caracteriza??o de um fen?tipo neuropsicol?gico de adolescentes com S?ndrome de Down (SD). Foi realizado um estudo multicasos de seis adolescentes diagnosticados com SD, sendo tr?s do sexo masculino e tr?s do sexo feminino, na faixa et?ria de 13 e 14 anos, atendidos em duas institui??es da cidade de Natal. Os participantes foram avaliados a partir da metodologia desenvolvida por Luria, sendo esta constitu?da de quatro etapas complementares. A primeira teve como objetivo a investiga??o qualitativa do impacto da SD no cotidiano escolar e social dos adolescentes. Foram investigadas as dimens?es do comportamento e dos aspectos s?cio-afetivos dos integrantes do estudo. Na segunda etapa, os participantes realizaram uma bateria de testes neuropsicol?gicos com o intuito de identifica??o de pontos fortes e fragilidades em seu funcionamento cognitivo. A terceira etapa foi incorporada ? segunda e teve como objetivo central analisar a qualidade da atividade dos participantes ao longo da avalia??o quantitativa, destacando estrat?gias utilizadas, erros produzidos dentre outros indicadores. Por fim, a quarta etapa refere-se ? interven??o junto aos participantes. Apesar desta n?o ser um objetivo espec?fico do estudo, defende-se que o resultado final desta pesquisa subsidiar? a pr?tica significativa de diferentes profissionais que atuam junto a este grupo cl?nico. Os resultados da primeira etapa ressaltam a presen?a de dificuldades nos relacionamentos sociais e no cotidiano escolar deste subgrupo. Por sua vez, as etapas dois e tr?s apontam para a presen?a de dificuldades em tarefas que envolvem o pensamento l?gico e abstrato, bem como preju?zos significativos na linguagem expressiva. Em rela??o ? mem?ria visual, observou-se um desempenho melhor em atividades de menor complexidade, ou seja, com menos interfer?ncia do funcionamento executivo, notadamente em termos das fun??es de planejamento e iniciativa. Por fim, destaca-se a presen?a de lentifica??o motora e mental, repercutindo significativamente no desempenho de diferentes ?reas cognitivas. Nesse sentido, os resultados aqui destacados podem ser considerados enquanto subs?dios para interven??es futuras, sugerindo a necessidade do desenvolvimento de projetos que levem em considera??o os diferentes aspectos constituintes do sujeito humano, envolvendo n?o apenas o indiv?duo com altera??es desenvolvimentais, como tamb?m suas fam?lias, professores, escolas e a sociedade em geral

Made available in DSpace on 2014-12-17T15:39:06Z (GMT). No. of bitstreams: 1 SamanthaSAM_DISSERT.pdf: 2335718 bytes, checksum: c39ea0cf4b8a039d34d11d3360a230a1 (MD5) Previous issue date: 2014-04-25 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / O ano de 2013 marca o 70? anivers?rio da descri??o cl?ssica de Leo Kanner sobre o Autismo. Em 1994, na quarta edi??o do Manual Diagnostico e Estat?stico de Transtornos Mentais (DSM), o autismo foi inclu?do em uma nova classe diagn?stica denominada Transtornos Globais do Desenvolvimento (TGD), os quais incluem: o Transtorno Autista, Transtorno de Rett, Transtorno Desintegrativo da Inf?ncia, Transtorno Global do Desenvolvimento sem outra especifica??o e o Transtorno de Asperger. O DSM apresenta crit?rios bem espec?ficos que diferenciam os TGD, no entanto, estudos m?dicos discutem se o Transtorno de Asperger (TA) comp?e o Transtorno Autista, ou se ? qualitativamente distinto. Discute-se a reduzida valida??o emp?rica dos crit?rios diagn?sticos concernentes ao TA. Nessa perspectiva, o DSM ganhou uma quinta e pol?mica revis?o no ano de 2013. A pol?mica mudan?a centra-se na substitui??o de uma an?lise diagn?stica categorial para uma abordagem dimensional, a qual evidencia que a maior parte dos problemas psicopatol?gicos da inf?ncia e adolesc?ncia manifesta-se em um cont?nuo de frequ?ncia e intensidade. Diante da mudan?a na quinta edi??o do DSM, o presente estudo deparou-se com a problem?tica identificada no ?mbito cl?nico e cient?fico, qual seja, a heterogeneidade sintom?tica presente no espectro autista e, por conseguinte, as disson?ncias no estabelecimento de caracter?sticas cl?nicas e neuropsicol?gicas do espectro. Amparado pelo legado te?rico de Luria, buscou-se clarificar o perfil da cogni??o social, comportamento, s?cio afetividade e fun??es executivas em crian?as com diagn?stico de Transtorno Autista e Transtorno de Asperger, conforme crit?rios estabelecidos pelo quarta edi??o revisada do DSM. Para operacionaliza??o dos objetivos propostos, prop?s-se estudo multicasos de seis crian?as. O processo avaliativo foi composto por anamnese com os pais, entrevista com a escola e protocolo avaliativo composto por tarefas qualitativas e instrumentos psicom?tricos. A avalia??o neuropsicol?gica realizada foi guiada pela an?lise cl?nica-processual, conforme pressuposto te?rico de Luria. No tocante aos resultados, foi poss?vel identificar dificuldades nos relacionamentos sociais e no cotidiano escolar das crian?as avaliadas. De modo interdependente, falhas na teoria da mente, nas fun??es executivas e na linguagem versam como principais fragilidades neuropsicol?gicas dos grupos cl?nicos vigentes, notadamente do grupo que comp?e o Transtorno Autista. Os resultados encontrados demonstram que a cogni??o social e a habilidade social est?o altamente relacionadas. Ainda que se reconhe?am as limita??es inerentes ? proposi??o de pesquisas neuropsicol?gicas de vertente cl?nica/s?cio hist?rica, acredita-se que o desenho metodol?gico possibilitou compreender caracter?sticas neuropsicol?gicas das crian?as avaliadas, sem limitar-se ? mera descri??o. Espera-se que pais, profissionais cl?nicos e institui??es sociais, como a escola, compreendam a forma de individua??o do TGD, antes de classificarem ou proporem tratamentos as crian?as

Sabe-se que a epilepsia do lobo temporal associada à esclerose hipocampal (ELT-EH) é uma síndrome epiléptica frequente e de difícil controle medicamentoso. Além disso, esta condição acarreta em uma série de prejuízos cognitivos aos seus portadores antes e após a cirurgia para tratamento das crisesrefratárias. Alguns trabalhos mostram que o prognóstico cognitivo pode mudar dependendo da abordagem cirúrgica realizada. Dessa forma, este trabalho teve como objetivo verificar qual o papel do polo temporal no funcionamento cognitivo. Para isso, foi realizada uma análise retrospectiva dos prontuários médicos de 146 pacientes adultos com ELT-EH esquerda, destros, avaliados no Centro de Cirurgia de Epilepsia (CIREP) do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto (HCFMRP) - Universidade de São Paulo (USP). Os resultados mostraram um melhor desempenho na tarefa de nomeação por confronto visual nos pacientes que passaram por lobectomia temporal esquerda sem ressecção do polo (p=0.007). Quando realizada da análise do índicede mudança confiável (RCI) para verificar a relevância clínica dos achados, 39,4% dos pacientes que passaram pela cirurgia com ressecção do polo temporal mostraram uma piora significativa de desempenho no teste de nomeação por confronto visual no Boston Naming Test (BNT), enquanto apenas 16% dos que passaram pela cirurgia sem ressecção do polo mostraram piora significativa no mesmo teste (p=0.015). No entanto, este mesmo grupo mostrou um pior prognóstico de controle de crises quando comparado ao grupo com ressecção do polo (p=0.018). Assim, esses dadosindicam que o polo temporal pode estar envolvido em habilidades de nomeação. Nossos resultados sugerem, portanto, que a cirurgia para o tratamento das crises refratárias nos pacientes com ELT-EH esquerda poderiam considerar as diferenças individuais para decidir a melhor abordagem cirúrgica para cada paciente / It is known that the temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS) is a frequent epileptic syndrome with difficult medication control. In addition, this condition leads to a series of cognitive impairments to patients before and after surgery for the treatment of refractory crises. Studies shown that cognitive prognosis may change depending on the surgical approach. Thus, this study aimed to verify the role of temporal pole in cognitive functions. A retrospective analysis of medical records from 146 adult patients with left-sided TLE-HS - evaluated at the Center for Epilepsy Surgery (CIREP) of the Clinical Hospital from Ribeirão Preto Medical School was performed. The results showed a higherperformance on visual confrontation namingtests - according to the Boston Naming Test (BNT) - in patients submitted to left temporal lobectomy without pole resection (p=0.007). Reliable change index (RCI)analysis, for clinical relevance,revealed that 39.4% of the patients submitted to temporal pole resectionshowed significantly worse performance on visual confrontation naming and only 16% of the patients without pole resection were significantly worse in the same test (p=0.015). However, this same group showed a worse prognosis of crisis control when compared to the group with pole resection (p=0.018). Altogether, the present study suggest that the temporal pole may be involved in naming skills. Our results suggest that surgery for left TLE-HS should be performed considering individual differences to decide the best surgical approach for each patient

Objective: The Six Elements Task (SET; Shallice and Burgess, 1991; Burgess et al., 1996) measures examinees’ ability to plan and organize their behaviour, form strategies for novel problem solving, and self-monitor. The task has adequate specificity (Wilson et al., 1996), but questionable sensitivity to mild impairments in executive function (Jelicic, et al., 2001). The SET is vulnerable to practice effects. There is a limited range in possible scores, and ceiling effects are observed. This dissertation sought to evaluate the validity and clinical utility of a modification of the SET by increasing the difficulty of the test, and expanding the range of possible scores in order to make it more suitable for serial assessments. Participants and Methods: The sample included 26 individuals with mixed acquired brain injury, and 26 healthy matched controls (20 – 65 years). Participants completed a battery of neuropsychological tests on two occasions eight weeks apart. To control for confounding variables in executive function test performance, measures of memory, working memory, intelligence, substance abuse, pain, mood and personality were included. Self and informant reports of executive dysfunction were also completed. The two groups’ performances on the various measures were compared, and the external validity of the 12ET was examined. In addition, normative data and information for reliable change calculations were tabulated. Results: The ABI group exhibited very mild executive function deficits on established measures. The matched control group attempted more tasks on the 12ET, but the difference was non significant. Neither group tended to break the rule of the task. The 12ET showed convergent validity with significant correlations with measures of cognitive flexibility (Trailmaking B and Ruff Figural Fluency), and a measure of planning (Tower of London). The 12ET and published measures were also significantly correlated with intelligence in the brain-injured group. The 12ET did not show divergent validity with a test of visual scanning speed (Trailmaking A). No demographic variables were found to be significant predictors of 12ET performance at Time 2 over and above performance at Time 1, and both participant groups obtained the same benefit from practice. The 12ET did not suffer from ceiling effects on the second administration, and the test-retest reliability of the 12ET variables ranged from low (r = .22 for Rule Breaks in the brain-injured group) to high (r = .78 for Number of Tasks Attempted in the control group). Conclusions: Despite their (often severe) brain injuries, this sample of brain injured participants did not demonstrate executive impairments on many published tests and their scores were not significantly different from the control group’s scores. Therefore, it was not possible to determine if the 12ET was a more sensitive measure of mild executive deficits than the SET. However, the increase in range did reduce the tendency for participants to perform at ceiling levels. The 12ET showed a number of significant correlations with other executive measures, particularly for the brain-injured group, though these correlations may have been moderated by general intelligence. Two variables of the 12ET, deviation from the optimal amount of time per task and Number of Tasks Completed, showed promise as measures of reliable change in this sample over an 8-week interval.

The absence of gold standard criteria for mild cognitive impairment (MCI) impedes the comparison of research findings and the development of primary and secondary prevention strategies addressing the possible conversion to dementia. The objective of Study 1 was to compare the predictive ability of different MCI models as markers for incipient dementia in a longitudinal population-based Canadian sample. The utility of well-documented MCI criteria using data from persons who underwent a clinical examination in the second wave of the Canadian Study of Health and Aging (CSHA) was examined. Demographic characteristics, average neuropsychological test performance, and prevalence and conversion rates were calculated for each classification. Receiver operating characteristic (ROC) analyses were employed to assess the predictive power of each cognitive classification. The highest prevalence and conversion rates were associated with case definitions of multiple-domain MCI. The only diagnostic criteria to significantly predict dementia five years later was the Cognitive Impairment, No Dementia (CIND) Type 2 case definition. It is estimated that more restrictive MCI case definitions fail to address the varying temporal increases in decline across different cognitive domains in the progression from normal cognitive functioning to dementia. Using data from the CSHA, the objective of Study 2 was to elucidate the clinical correlates that best differentiate between cognitive classifications. A machine learning algorithm was used to identify the symptoms that best discriminated between: 1) not cognitively impaired (NCI) and CIND; 2) CIND & demented; and 3) converting and non-converting CIND participants. Poor retrieval was consistently a significant predictor of greater cognitive impairment across all three questions. While interactions with other predictors were noted when differentiating CIND from NCI and demented from non-demented participants, retrieval was the sole predictor of conversion to dementia over five years. Importantly, the limited specificity and predictive values of the respective algorithms caution against their use as clinical markers of CIND, dementia, or conversion. Rather, it is recommended that the predictors serve as markers for ongoing monitoring and assessment. Overall, the results of both studies suggest that the architecture of pathological cognitive decline to dementia may not be captured by a single set of diagnostic criteria.

The absence of gold standard criteria for mild cognitive impairment (MCI) impedes the comparison of research findings and the development of primary and secondary prevention strategies addressing the possible conversion to dementia. The objective of Study 1 was to compare the predictive ability of different MCI models as markers for incipient dementia in a longitudinal population-based Canadian sample. The utility of well-documented MCI criteria using data from persons who underwent a clinical examination in the second wave of the Canadian Study of Health and Aging (CSHA) was examined. Demographic characteristics, average neuropsychological test performance, and prevalence and conversion rates were calculated for each classification. Receiver operating characteristic (ROC) analyses were employed to assess the predictive power of each cognitive classification. The highest prevalence and conversion rates were associated with case definitions of multiple-domain MCI. The only diagnostic criteria to significantly predict dementia five years later was the Cognitive Impairment, No Dementia (CIND) Type 2 case definition. It is estimated that more restrictive MCI case definitions fail to address the varying temporal increases in decline across different cognitive domains in the progression from normal cognitive functioning to dementia. Using data from the CSHA, the objective of Study 2 was to elucidate the clinical correlates that best differentiate between cognitive classifications. A machine learning algorithm was used to identify the symptoms that best discriminated between: 1) not cognitively impaired (NCI) and CIND; 2) CIND & demented; and 3) converting and non-converting CIND participants. Poor retrieval was consistently a significant predictor of greater cognitive impairment across all three questions. While interactions with other predictors were noted when differentiating CIND from NCI and demented from non-demented participants, retrieval was the sole predictor of conversion to dementia over five years. Importantly, the limited specificity and predictive values of the respective algorithms caution against their use as clinical markers of CIND, dementia, or conversion. Rather, it is recommended that the predictors serve as markers for ongoing monitoring and assessment. Overall, the results of both studies suggest that the architecture of pathological cognitive decline to dementia may not be captured by a single set of diagnostic criteria.

Submitted by Oliveira Santos Dilzaná (dilznana@yahoo.com.br) on 2014-01-21T12:42:45Z No. of bitstreams: 1 Dissertação de Chrissie de Carvalho - Efeitos Neuropsicológicos da exposição ao manganês em crianças (dissertação de mestrado.pdf: 2969048 bytes, checksum: ba97ca375d35d6b397a49238b02b559d (MD5) / Approved for entry into archive by Ana Portela (anapoli@ufba.br) on 2014-02-03T15:10:24Z (GMT) No. of bitstreams: 1 Dissertação de Chrissie de Carvalho - Efeitos Neuropsicológicos da exposição ao manganês em crianças (dissertação de mestrado.pdf: 2969048 bytes, checksum: ba97ca375d35d6b397a49238b02b559d (MD5) / Made available in DSpace on 2014-02-03T15:10:24Z (GMT). No. of bitstreams: 1 Dissertação de Chrissie de Carvalho - Efeitos Neuropsicológicos da exposição ao manganês em crianças (dissertação de mestrado.pdf: 2969048 bytes, checksum: ba97ca375d35d6b397a49238b02b559d (MD5) / FAPESB - CAPES / O Manganês (Mn) é um elemento essencial ao corpo humano. O funcionando do Mn no organismo ocorre através de um mecanismo homeostático eficaz que mantem os níveis deste metal em concentrações ótimas. No entanto, altas concentrações de Mn no organismo podem acarretar prejuízos ao Sistema Nervoso Central, uma vez que, possui um potencial neurotóxico. O excesso de Mn no organismo tem sido associado a prejuízos neuropsicológicos em crianças e adultos. Os estudos com crianças expostas ao Mn retratam associações com a diminuição do desempenho em testes de Coeficiente Intelectual (QI), Desenvolvimento Psicomotor, Memória, Atenção e Função Motora. Objetivos: O presente trabalho tem por objetivo avaliar o desempenho neuropsicológico e comportamental de crianças em idade escolar e a associação com a exposição ao manganês. Materiais e Métodos: Participaram deste estudo 78 díades criança-mãe/responsável, crianças com idades entre 7 e 12 anos, e residentes em duas comunidades, Cotegipe e Santa Luzia, do município de Simões-Filho, situadas na região metropolitana de Salvador - Bahia, Brasil. Essas comunidades estão sob influência da poluição atmosférica gerada pelo processo de produção de ligas ferro-manganês de uma metalúrgica. Foi aplicada uma bateria neuropsicológica nas crianças compreendendo os domínios cognitivos: Inteligência, Memória, Atenção, Funções Executivas e Função Motora. Os pais ou responsáveis responderam a um questionário sociodemográfico e ao Child Behavior Checklist (CBCL), enquanto que os professores responderam à Escala Abreviada de Conners. Os níveis de Mn foram determinados por espectrometria de absorção atômica com forno de grafite e os resultados expressos em μg/g de Mn no cabelo (MnC). O desempenho neuropsicológico das crianças das duas comunidades foi comparado segundo testes estatísticos paramétricos e não paramétricos. Realizaram-se análises de correlação bivariada e análise de regressão múltipla para a investigação das associações entre o desempenho neuropsicológico e os níveis de Mn no cabelo. Resultados: Encontramos um desempenho inferior das crianças da comunidade de Santa Luzia, situada entre 2,5 a 3,5 km da fábrica, em relação à comunidade de Cotegipe situada até 2 km da Fábrica, nos seguintes testes: Fluência Fonológica (p=0,03), Cubos-WISC-III (p=0,04), Dígitos Ordem Indireta (OI) (p=0,002), Cubos de Corsi Ordem Direta (OD) (p=0,006), e maior quantidade de Erros em Nomeação (p=0,047). A análise do tamanho de efeito revelou que as diferenças entre as comunidades foi pequena, apenas a diferença entre o desempenho em Fluência Fonológica obteve uma magnitude de efeito moderada (d de 11 cohen= 0,56). Considerando os demais testes, o desempenho neuropsicológico das comunidades de Cotegipe e Santa Luzia foi semelhante. A análise do desempenho neuropsicológico geral das crianças das duas comunidades evidenciou escores abaixo da média que crianças com desenvolvimento típico em: Cubos (WISC-III), Tempo de Reação e Erros por Ação (TAVIS-III), Produzindo Palavras (Fluência Fonológica) e Soma dos Erros em Inibindo Respostas (NEPSY-II). A análise de rede das variáveis que estiveram correlacionadas significativamente (p<0,05) evidenciou uma rede coesa e com grau de nós interligados alto. As variáveis que apresentaram maior grau de correlações significativas com as demais foram: os escores em Dígitos OI, Cubos de Corsi OI, Fluência Fonológica, e o tempo total do Grooved Pegboard em ambas as mãos. O QI da criança correlacionou-se diretamente e moderadamente com o QI materno (r=0,47; p<0,001). Foram encontradas associações inversas entre log de MnC e os escores dos testes de QI, Dígitos OD e OI e recordação livre imediata em Memória para Lista (NEPSY-II). Observou-se a associação positiva entre log de MnC e velocidade motora, problemas de atenção, hiperatividade e comportamentos externalizantes. Conclusão: Os resultados confirmam que as crianças estão sob efeito da exposição crônica ao Mn advindo das emissões da planta metalúrgica. Concentrações elevadas de MnC foram associadas a um menor desempenho em medidas neuropsicológicas e comportamentais. Os resultados corroboram evidências crescentes que indicam aumento de comportamentos de impulsividade e externalizantes, assim como dificuldade de inibição de respostas, associados a exposição ao Mn e com possíveis efeitos sob o sistema dopaminérgico e de auto-regulação. Manganese (Mn) is an essential element to the human body. The functioning of Mn in the body occurs through a homeostatic mechanism that maintains effective levels of this metal in optimal concentrations. However, high concentrations of Mn in the body may cause damage to the central nervous system, assuming that Mn has a neurotoxic potential. Excess Mn in the body has been associated with neuropsychological impairments in children and adults. Studies with children exposed to Mn indicate associations with decreased performance on tests of intellectual coefficient (IQ), Psychomotor Development, Memory, Attention and Motor Function. Objectives: The aim of this study is to assess the behavioral and neuropsychological performance in school age children and the association with manganese exposure. Materials and Methods: The study included 78 dyads children-mother/caregiver, children aged between 7 and 12 years old, and residents in two communities, Cotegipe and Santa Luzia, in the district of Simões-Filho, located in the state of Bahia, Brazil. These communities are under the influence of pollution generated by the production process of a iron-manganese alloy plant. Was administered a neuropsychological battery for children including the cognitive domains: Intelligence, Memory, Attention, Executive Functions and Motor Function. Parents or caregivers answered a sociodemographic questionnaire and the Child Behavior Checklist (CBCL), while teachers answered to the Abbreviated Conners Scale. The levels of Mn were determined by atomic absorption spectrometry with graphite furnace and the results expressed in μg/g-Mn in the hair (MnH). The neuropsychological performances of children of both communities were compared according to parametric and non-parametric statistical tests. Bivariate correlations and multiple regression analysis were applied to investigate the associations between neuropsychological performance and manganese biomarkers’ levels. Results: We found a lower performance of children in the community of Santa Luzia, located between 2.5 to 3.5 km radius from the iron-manganese alloy plant, in relation to the community of Cotegipe located within 2 km radius of the plant, in the following tests: Phonologic Fluency (p = 0.03 ), Block Design -WISC-III (p = 0.04), Digit Span-Indirect Order (IO) (p = 0.002), Corsi Block - Direct Order (DO) (p = 0.006), and greater number of Naming Errors (p = 0.047). The effect size analysis revealed that the differences between communities was small, only the difference between the performance on Phonologic Fluency obtained a moderate effect size (Cohen d = 0.56). Considering the other tests, neuropsychological performance of both communities was similar. The analysis of general neuropsychological performance of 13 children of both communities showed below average scores than children with typical development in: Block Design (WISC-III), Reaction Time and Commission Errors (TAVIS-III), Word Generation (Phonologic Fluency) and Total Inhibition Errors (NEPSY-II). A network analysis of the variables that were significantly correlated (p <0.05) showed a cohesive network with a high degree of interconnected nodes. The variables that have higher degree of significant correlations with the others were: Digit Span IO, Corsi Block IO, Phonologic Fluency, and Grooved Pegboard total time on both hands. The child's IQ correlated directly and moderately with maternal IQ (r = 0.47, p <0.001). We found inverse associations between log MnH and scores on IQ, Digit Span DO and IO and immediate free recall in Memory List (NEPSY-II). We observed a positive association between log MnH and motor speed, attention problems, hyperactivity and externalizing behaviors. Conclusion: The results showed that the children of these communities are under the effect of chronic exposure to Mn emissions arising from the iron-manganese alloy plant. High levels of MnH were associated with lower performance on neuropsychological and behavioral measures. The results corroborate growing evidence that indicate increased impulsivity and externalizing behaviors, as well as difficulty to inhibition of responses, associated with Mn exposure and possible effects on the dopamine system and self-regulation.