HOMERO PINTO VALLADA FILHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Cardiovascular risk in cognitively preserved elderlies is associated with glucose hypometabolism in the posterior cingulate cortex and precuneus regardless of brain atrophy and apolipoprotein gene variations(2013) TAMASHIRO-DURAN, Jaqueline Hatsuko; SQUARZONI, Paula; DURAN, Fabio Luis de Souza; CURIATI, Pedro Kallas; VALLADA, Homero Pinto; BUCHPIGUEL, Carlos Alberto; LOTUFO, Paulo Andrade; WAJNGARTEN, Mauricio; MENEZES, Paulo Rossi; SCAZUFCA, Marcia; ALVES, Tania Correa de Toledo Ferraz; BUSATTO, Geraldo FilhoCardiovascular risk factors (CVRF) possibly contribute to the emergence of Alzheimer's disease (AD). Fluorodeoxyglucose-positron emission tomography (FDG-PET) has been widely used to demonstrate specific patterns of reduced cerebral metabolic rates of glucose (CMRgl) in subjects with AD and in non-demented carriers of the apolipoprotein epsilon 4 (APOE epsilon 4) allele, the major genetic risk factor for AD. However, functional neuroimaging studies investigating the impact of CVRF on cerebral metabolism have been scarce to date. The present FDG-PET study investigated 59 cognitively preserved elderlies divided into three groups according to their cardiovascular risk based on the Framingham 10-year risk Coronary Heart Disease Risk Profile (low-, medium-, and high-risk) to examine whether different levels of CVRF would be associated with reduced CMRgl, involving the same brain regions affected in early stages of AD. Functional imaging data were corrected for partial volume effects to avoid confounding effects due to regional brain atrophy, and all analyses included the presence of the APOE epsilon 4 allele as a confounding covariate. Significant cerebral metabolism reductions were detected in the high-risk group when compared to the low-risk group in the left precuneus and posterior cingulate gyrus. This suggests that findings of brain hypometabolism similar to those seen in subjects with AD can be detected in association with the severity of cardiovascular risk in cognitively preserved individuals. Thus, a greater knowledge about how such factors influence brain functioning in healthy subjects over time may provide important insigths for the future development of strategies aimed at delaying or preventing the vascular-related triggering of pathologic brain changes in the AD.
- Complementary religious and spiritual interventions in physical health and quality of life: A systematic review of randomized controlled clinical trials(2017) GONCALVES, Juliane Piasseschi de Bernardin; LUCCHETTI, Giancarlo; MENEZES, Paulo Rossi; VALLADA, HomeroObjective To examine whether religious and spiritual interventions (RSIs) can promote physical health and quality of life in individuals. Methods The following databases were used to conduct a systematic review: PubMed, Scopus, Web of Science, EMBASE, PsycINFO, Cochrane, and Scielo. Randomized controlled trials that evaluated RSIs regarding physical health outcomes and/or quality of life in English, Spanish or Portuguese were included. RSI protocols performed at a distance (i.e. intercessory prayer) or for psychiatric disorders were excluded. This study consisted of two phases: (a) reading titles and abstracts, and (b) assessing the full articles and their methodological quality using the Cochrane Back Review Group scale. Results In total, 7,070 articles were identified in the search, but 6884 were excluded in phase 1 because they were off topic or repeated in databases. Among the 186 articles included in phase 2, 140 were excluded because they did not fit the inclusion criteria and 16 did not have adequate randomization process. Thus, a final selection of 30 articles remained. The participants of the selected studies were classified in three groups: chronic patients (e.g., cancer, obesity, pain), healthy individuals and healthcare professionals. The outcomes assessed included quality of life, physical activity, pain, cardiac outcomes, promotion of health behaviors, clinical practice of healthcare professionals and satisfaction with protocols. The divergence concerning scales and protocols proposed did not allow a meta-analysis. RSIs as a psychotherapy approach were performed in 40% of the studies, and the control group was more likely to use an educational intervention (56.7%). The results revealed small effect sizes favoring RSIs in quality of life and pain outcomes and very small effects sizes in physical activity, promotion of health behaviors and clinical practice of health professionals compared with other complementary strategies. Other outcomes, such as cardiac measures and satisfaction with the protocols, revealed no evidence for RSIs. Regarding the quality of the selected articles according to the Cochrane Back Review Group Scale, the average score was 6.83 (SD = 9.08) on a scale of 11, demonstrating robustness in the studies. Conclusion Clinical trials on RSIs demonstrated that they had small benefits compared with other complementary health therapies by reducing pain and weight, improving quality of life and promoting health behaviors. The lack of clinical trials that included biological outcomes and the diversity of approaches indicate a need for more studies to understand the possible mechanisms of action of RSIs and their roles in health care.
- Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials(2015) GONCALVES, J. P. B.; LUCCHETTI, G.; MENEZES, P. R.; VALLADA, H.Background. Despite the extensive literature assessing associations between religiosity/spirituality and health, few studies have investigated the clinical applicability of this evidence. The purpose of this paper was to assess the impact of religious/spiritual interventions (RSI) through randomized clinical trials (RCTs). Method. A systematic review was performed in the following databases: PubMed, Scopus, Web of Science, PsycINFO, Cochrane Collaboration, Embase and SciELO. Through the use of a Boolean expression, articles were included if they: (i) investigated mental health outcomes; (ii) had a design consistent with RCTs. We excluded protocols involving intercessory prayer or distance healing. The study was conducted in two phases by reading: (1) title and abstracts; (2) full papers and assessing their methodological quality. Then, a meta-analysis was carried out. Results. Through this method, 4751 papers were obtained, of which 23 remained included. The meta-analysis showed significant effects of RSI on anxiety general symptoms (p < 0.001) and in subgroups: meditation (p < 0.001); psychotherapy (p = 0.02); 1 month of follow-up (p < 0.001); and comparison groups with interventions (p < 0.001). Two significant differences were found in depressive symptoms: between 1 and 6 months and comparison groups with interventions (p = 0.05). In general, studies have shown that RSI decreased stress, alcoholism and depression. Conclusions. RCTs on RSI showed additional benefits including reduction of clinical symptoms (mainly anxiety). The diversity of protocols and outcomes associated with a lack of standardization of interventions point to the need for further studies evaluating the use of religiosity/spirituality as a complementary treatment in health care.
- Prefrontal-Parietal White Matter Volumes in Healthy Elderlies Are Decreased in Proportion to the Degree of Cardiovascular Risk and Related to Inhibitory Control Deficits(2017) SANTOS, Pedro P.; SILVEIRA, Paula S. Da; SOUZA-DURAN, Fabio L.; TAMASHIRO-DURAN, Jaqueline H.; SCAZUFCA, Marcia; MENEZES, Paulo R.; LEITE, Claudia Da Costa; LOTUFO, Paulo A.; VALLADA, Homero; WAJNGARTEN, Mauricio; ALVES, Tania C. De Toledo Ferraz; RZEZAK, Patricia; BUSATTO, Geraldo F.Cardiovascular risk (CVR) factors may be associated with poor cognitive functioning in elderlies and impairments in brain structure. Using MRI and voxel-based morphometry (VBM), we assessed regional white matter (WM) volumes in a population-based sample of individuals aged 65-75 years (n = 156), subdivided in three CVR subgroups using the Framingham Risk Score. Cognition was assessed using the Short Cognitive Performance Test. In high-risk subjects, we detected significantly reduced WM volume in the right juxtacortical dorsolateral prefrontal region compared to both low and intermediate CVR subgroups. Findings remained significant after accounting for the presence of the APOE epsilon 4 allele. Inhibitory control performance was negatively related to right prefrontal WM volume, proportionally to the degree of CVR. Significantly reduced deep parietal WM was also detected bilaterally in the high CVR subgroup. This is the first large study documenting the topography of CVR-related WM brain volume deficits. The significant association regarding poor response inhibition indicates that prefrontal WM deficits related to CVR are clinically meaningful, since inhibitory control is known to rely on prefrontal integrity.
- Framingham coronary heart disease risk score can be predicted from structural brain images in elderly subjects(2014) RONDINA, Jane Maryam; SQUARZONI, Paula; SOUZA-DURAN, Fabio Luis; TAMASHIRO-DURAN, Jaqueline Hatsuko; SCAZUFCA, Marcia; MENEZES, Paulo Rossi; VALLADA, Homero; LOTUFO, Paulo A.; ALVES, Tania Correade Toledo Ferraz; FILHO, Geraldo BusattoRecent literature has presented evidence that cardiovascular risk factors (CVRF) play an important role on cognitive performance in elderly individuals, both those who are asymptomatic and those who suffer from symptoms of neurodegenerative disorders. Findings from studies applying neuroimaging methods have increasingly reinforced such notion. Studies addressing the impact of CVRF on brain anatomy changes have gained increasing importance, as recent papers have reported gray matter loss predominantly in regions traditionally affected in Alzheimer's disease (AD) and vascular dementia in the presence of a high degree of cardiovascular risk. In the present paper, we explore the association between CVRF and brain changes using pattern recognition techniques applied to structural MRI and the Framingham score (a composite measure of cardiovascular risk largely used in epidemiological studies) in a sample of healthy elderly individuals. We aim to answer the following questions: is it possible to decode (i.e., to learn information regarding cardiovascular risk from structural brain images) enabling individual predictions? Among clinical measures comprising the Framingham score, are there particular risk factors that stand as more predictable from patterns of brain changes? Our main findings are threefold: (i) we verified that structural changes in spatially distributed patterns in the brain enable statistically significant prediction of Framingham scores. This result is still significant when controlling for the presence of the APOE 4 allele (an important genetic risk factor for both AD and cardiovascular disease). (ii) When considering each risk factor singly, we found different levels of correlation between real and predicted factors; however, single factors were not significantly predictable from brain images when considering APOE4 allele presence as covariate. (iii) We found important gender differences, and the possible causes of that finding are discussed.
- Education and WHO recommendations for fruit and vegetable intake are associated with better cognitive function in a disadvantaged Brazilian elderly population: a population-based cross-sectional study (vol 9, e94042, 2014)(2014) PASTOR-VALERO, M.; FURLAN-VIEBIG, R.; MENEZES, P. R.; SILVA, S. A. da; VALLADA, H.
- Age-Related Metabolic Profiles in Cognitively Healthy Elders: Results from a Voxel-Based [F-18]Fluorodeoxyglucose-Positron-Emission Tomography Study with Partial Volume Effects Correction(2011) CURIATI, P. K.; TAMASHIRO-DURAN, J. H.; DURAN, F. L. S.; BUCHPIGUEL, C. A.; SQUARZONI, P.; ROMANO, D. C.; VALLADA, H.; MENEZES, P. R.; SCAZUFCA, M.; BUSATTO, G. F.; ALVES, T. C. T. F.BACKGROUND AND PURPOSE: Functional brain variability has been scarcely investigated in cognitively healthy elderly subjects, and it is currently debated whether previous findings of regional metabolic variability are artifacts associated with brain atrophy. The primary purpose of this study was to test whether there is regional cerebral age-related hypometabolism specifically in later stages of life. MATERIALS AND METHODS: MR imaging and FDG-PET data were acquired from 55 cognitively healthy elderly subjects, and voxel-based linear correlations between age and GM volume or regional cerebral metabolism were conducted by using SPM5 in images with and without correction for PVE. To investigate sex-specific differences in the pattern of brain aging, we repeated the above voxelwise calculations after dividing our sample by sex. RESULTS: Our analysis revealed 2 large clusters of age-related metabolic decrease in the overall sample, 1 in the left orbitofrontal cortex and the other in the right temporolimbic region, encompassing the hippocampus, the parahippocampal gyrus, and the amygdala. The division of our sample by sex revealed significant sex-specific age-related metabolic decrease in the left temporolimbic region of men and in the left dorsolateral frontal cortex of women. When we applied atrophy correction to our PET data, none of the above-mentioned correlations remained significant. CONCLUSIONS: Our findings suggest that age-related functional brain variability in cognitively healthy elderly individuals is largely secondary to the degree of regional brain atrophy, and the findings provide support to the notion that appropriate PVE correction is a key tool in neuroimaging investigations.
- Education and WHO Recommendations for Fruit and Vegetable Intake Are Associated with Better Cognitive Function in a Disadvantaged Brazilian Elderly Population: A Population-Based Cross-Sectional Study(2014) PASTOR-VALERO, Maria; FURLAN-VIEBIG, Renata; MENEZES, Paulo Rossi; SILVA, Simon Almeida da; VALLADA, Homero; SCAZUFCA, MarciaBrazil has one of the fastest aging populations in the world and the incidence of cognitive impairment in the elderly is expected to increase exponentially. We examined the association between cognitive impairment and fruit and vegetable intake and associated factors in a low-income elderly population. A cross-sectional population-based study was carried out with 1849 individuals aged 65 or over living in Sao Paulo, Brazil. Cognitive function was assessed using the Community Screening Instrument for Dementia (CSI-D). Fruit and vegetable intake was assessed with a Food Frequency Questionnaire (FFQ) and categorized into quartiles of intake and into total daily fruit and vegetable intake using the cut-off points for the WHO recommendations (<400grams/day or >= 400 grams/day). The association between cognitive impairment and each quartile of intake, and WHO recommendation levels, was evaluated in two separate multivariate logistic models. The WHO recommendations for daily intakes >= 400 grams/day were significantly associated with 47% decreased prevalence of cognitive impairment. An effect modification was found in both models between cognitive impairment and ""years of education and physical activity'' and ""years of education and blood levels of HDL'' So that, having 1 or more years of education and being physically active or having 1 or more years of education and levels higher than 50 mg/dl of HDL-cholesterol strongly decreased the prevalence of cognitive impairment. In this socially deprived population with very low levels of education and physical activity and fruit and vegetable intake, those who attained WHO recommendations, had 1 year or more of education and were physically active had a significantly lower prevalence of cognitive impairment. A more comprehensive understanding of the social determinants of mental health is needed to develop effective public policies in developing countries.
- The role of religiosity and spirituality in interpersonal violence: a systematic review and meta-analysis(2023) GONCALVES, Juliane Piasseschi de Bernardin; LUCCHETTI, Giancarlo; MARALDI, Everton de Oliveira; FERNANDEZ, Paulo Eduardo Lahoz; MENEZES, Paulo Rossi; VALLADA, HomeroObjectives: Religiosity and spirituality (R/S) have been negatively associated with several mental health problems, including delinquency. The study aimed to investigate the relationship between R/S and interpersonal violence using a systematic review. Methods: We conducted a descriptive systematic review followed by meta-analyses using seven different databases. We included observational studies that assessed the relationship between R/S and different types of interpersonal violence (physical and sexual aggression and domestic violence).Results: A total of 16,599 articles were screened in the databases and, after applying the eligibility criteria, 67 were included in the systematic review and 43 were included in the meta-analysis. The results showed that higher levels of R/S were significantly associated with decreased physical and sexual aggression, but not domestic violence. All selected studies evidenced sufficient methodological quality, with 26.8% being cohort studies. In the subanalyses, the role of R/S was more prevalent among adolescents.Conclusion: There is an inverse relationship between R/S and physical and sexual aggression, suggesting a protective role. However, these results were not observed for domestic violence. Healthcare professionals and managers should be aware of their patients' beliefs when investigating interpersonal violence to create tailored interventions for reducing violent behavior.
article Investigating the role played by social support in the association between religiosity and mental health in low income older adults: results from the Sao Paulo Ageing & Health Study (SPAH)(2011) CORREA, Alexandre Augusto Macedo; MOREIRA-ALMEIDA, Alexander; MENEZES, Paulo R.; VALLADA, Homero; SCAZUFCA, MarciaObjective: Religiosity has been associated with mental health, especially in the elderly. There is a shortage of studies on the factors that mediate this association, including social support. The aim of this study was to assess the association between the various dimensions of religiosity and the prevalence of common mental disorders among the elderly, and to verify whether social support can work as a mechanism that explains such mediation. Method: The sample consisted of an elderly population living in a low income region of the city of Sao Paulo (N = 1,980). Data on the socio-demographic profile of this population and on the prevalence of common mental disorders were collected, and indicators of religiosity and social support were identified. Results: 90.7% of the sample considered themselves to be religious. In terms of denomination, 66.6% were Catholic. Forty-one per cent attended some kind of religious activity at least once or more times a week. The presence of common mental disorders was not associated with religious affiliation or subjective religiosity. The prevalence of common mental disorders in followers attending religious services was approximately half (OR between 0.43 and 0.55, p < 0.001) compared to those who never attend a religious service. Attending religious services was associated with higher levels of social support. The association between a higher attendance frequency and fewer common mental disorders did not change after the inclusion of relevant of social support variables. Conclusion: The study showed that subjects presented high levels of religiosity and that there is a strong association between religious attendance and the prevalence of common mental disorders, which could not be explained by social support.