PATRICIA RZEZAK TENCER
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- 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.
- Everyday memory impairment in patients with temporal lobe epilepsy caused by hippocampal sclerosis(2017) RZEZAK, Patricia; LIMA, Ellen Marise; GARGARO, Ana Carolina; COIMBRA, Erica; VINCENTIIS, Silvia de; VELASCO, Tonicarlo Rodrigues; LEITE, Joao Pereira; BUSATTO, Geraldo F.; VALENTE, Kette D.Objective: Patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) have episodic memory impairment. Memory has rarely been evaluated using an ecologic measure, even though performance on these tests is more related to patients' memory complaints. We aimed to measure everyday memory of patients with TLE-HS to age-and gender-matched controls. Methods: We evaluated 31 patients with TLE-HS and 34 healthy controls, without epilepsy and psychiatric disorders, using the Rivermead Behavioral Memory Test (RBMT), Visual Reproduction (WMS-III) and Logical Memory (WMS-III). We evaluated the impact of clinical variables such as the age of onset, epilepsy duration, AED use, history of status epilepticus, and seizure frequency on everyday memory. Statistical analyses were performed using MANCOVA with years of education as a confounding factor. Results: Patients showed worse performance than controls on traditional memory tests and in the overall score of RBMT. Patients had more difficulties to recall names, a hidden belonging, to deliver a message, object recognition, to remember a story full of details, a previously presented short route, and in time and space orientation. Clinical epilepsy variables were not associated with RBMT performance. Memory span and working memory were correlated with worse performance on RBMT. Significance: Patients with TLE-HS demonstrated deficits in everyday memory functions. A standard neuropsychological battery, designed to assess episodic memory, would not evaluate these impairments. Impairment in recalling names, routes, stories, messages, and space/time disorientation can adversely impact social adaptation, and we must consider these ecologic measures with greater attention in the neuropsychological evaluation of patients with memory complaints.
- Risk Factors for Diagnostic Delay in Psychogenic Nonepileptic Seizures Among Children and Adolescents(2017) VALENTE, Kette D.; ALESSI, Ruda; VINCENTIIS, Silvia; SANTOS, Bernardo dos; RZEZAK, PatriciaBACKGROUND: This study aims to analyze a series of pediatric patients with psychogenic nonepileptic seizures (PNES) to establish the diagnostic gap and possible risk factors for the delayed diagnosis in this age group. METHODS: We evaluated all children with PNES documented by video electroencephalography. None had a previous diagnosis of PNES. In total, we included 53 children (interquartile range: seven to 17 years; mean age 12.81 years [S.D. 3.15]; 60.4% girls) who underwent a protocol consisting of neurological and psychiatric interviews. RESULTS: The average time between seizure onset and referral was 17.76 months (interquartile range: 0.5 to 48 months; S.D. +/- 12.62). Earlier age of onset correlated with a later diagnosis (P < 0.001). The late referral group also presented with a history of psychological abuse (P = 0.018). CONCLUSION: Youth with PNES represent a diagnostic challenge. Identification of children at risk might lead to earlier diagnosis of PNES.
- The impact of intelligence on memory and executive functions of children with temporal lobe epilepsy: Methodological concerns with clinical relevance(2017) RZEZAK, Patricia; GUIMARAES, Catarina A.; GUERREIRO, Marilisa M.; VALENTE, Kette D.Purpose: Patients with TLE are prone to have lower IQ scores than healthy controls. Nevertheless, the impact of IQ differences is not usually considered in studies that compared the cognitive functioning of children with and without epilepsy. This study aimed to determine the effect of using IQ as a covariate on memory and attentional/executive functions of children with TLE. Methods: Thirty-eight children and adolescents with TLE and 28 healthy controls paired as to age, gender, and sociodemographic factors were evaluated with a comprehensive neuropsychological battery for memory and executive functions. The authors conducted three analyses to verify the impact of IQ scores on the other cognitive domains. First, we compared performance on cognitive tests without controlling for IQ differences between groups. Second, we performed the same analyses, but we included IQ as a confounding factor. Finally, we evaluated the predictive value of IQ on cognitive functioning. Results: Although patients had IQ score in the normal range, they showed lower IQ scores than controls (p = 0.001). When we did not consider IQ in the analyses, patients had worse performance in verbal and visual memory (short and long-term), semantic memory, sustained, divided and selective attention, mental flexibility and mental tracking for semantic information. By using IQ as a covariate, patients showed worse performance only in verbal memory (long-term), semantic memory, sustained and divided attention and in mental flexibility. IQ was a predictor factor of verbal and visual memory (immediate and delayed), working memory, mental flexibility and mental tracking for semantic information. Conclusion: Intelligence level had a significant impact on memory and executive functioning of children and adolescents with TLE without intellectual disability. This finding opens the discussion of whether IQ scores should be considered when interpreting the results of differences in cognitive performance of patients with epilepsy compared to healthy volunteers.
- The executive profile of children with Benign Epilepsy of Childhood with Centrotemporal Spikes and Temporal Lobe Epilepsy(2017) LIMA, Ellen M.; RZEZAK, Patricia; GUIMARAES, Catarina A.; MONTENEGRO, Maria A.; GUERREIRO, Marilisa M.; VALENTE, Kette D.Rationale: Benign Epilepsy of Childhood with Centrotemporal Spikes (BECTS) and temporal lobe epilepsy (TLE) represent two distinct models of focal epilepsy of childhood. In both, there is evidence of executive dysfunction. The purpose of the present study was to identify particular deficits in the executive function that would distinguish children with BECTS from children with TLE. Methods: We prospectively evaluated 19 consecutive children and adolescents with TLE with hippocampal sclerosis (HS) (57.9% male; mean 11.74 years [SD 2.05]; mean IQ 95.21 [SD 15.09]), 19with BECTS (36.8% male; mean 10.95 years [SD 2.33]; mean IQ 107.40 [SD 16.01]), and 21 age and gender-matched controls (33.3% male; mean 11.86 years [SD 2.25]; mean IQ 108.67 [15.05]). All participants underwent a neuropsychological assessment with a comprehensive battery for executive and attentional functions. We used ANOVA and chi-square to evaluate differences on demographic aspects among groups (BECTS, TLE-HS, and control groups). Group comparisons on continuous variables were complemented by MANOVA and Bonferroni posthoc comparisons. Results: Patients with BECTS had worse performance than controls in: Matching Familiar Figures Test, time (p = 0.001); Matching Familiar Figures Test, time x errors index (p < 0.001); Verbal Fluency for foods (p = 0.038); Trail Making Test, part B time (p = 0.030); Trail Making Test, part B number of errors (p = 0.030); and WCST, number of categories achieved (p = 0.043). Patients with BECTS had worse performance than patients with TLE-HS on Matching Familiar Figures Test, time (p = 0.004), and Matching Familiar Figures Test, time x errors index (p < 0.001). Patients with TLE-HS had worse performance than controls on the following tests: Verbal Fluency for foods (p = 0.004); Wisconsin Card Sorting Test, the number of categories achieved (p < 0.001); and Wisconsin Card Sorting Test, the number of perseverative errors (p = 0.028). Patients with TLE-HS had worse performance than patients with BECTS on Digit Backward (p = 0.002); and the Wisconsin Card Sorting Test, the number of perseverative errors (p < 0.001). Conclusions: Patients with TLE and BECTS present distinct cognitive profiles. Patients with TLE-HS had worse performance in mental flexibility, concept formation, and working memory compared to BECTS. Patients with BECTS had worse inhibitory control compared to children with TLE-HS. Both TLE-HS and BECTS had a higher number of errors on an inhibitory control test. However, patients with BECTS had a slower mental processing even when compared to patients with TLE-HS. Rehabilitation programs for children with epilepsy must include children with benign epilepsies and must take into account the epileptic syndrome and its particular neurocognitive phenotype.