ADRIANA BASTOS CONFORTO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/15 - Laboratório de Investigação em Neurologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients (vol 11, 1048, 2020)(2021) MIOTTO, Eliane C.; BAZAN, Paulo R.; BATISTA, Alana X.; CONFORTO, Adriana B.; FIGUEIREDO, Eberval G.; MARTIN, Maria da Graca M.; AVOLIO, Isabella B.; AMARO, Edson; TEIXEIRA, Manoel J.
- Association among depression, cognitive impairment and executive dysfunction after stroke(2012) TERRONI, Luisa; SOBREIRO, Matildes F.M.; CONFORTO, Adriana B.; ADDA, Carla C.; GUAJARDO, Valeri D.; LUCIA, Mara Cristina S. de; FRÁGUAS, RenérioABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.
- Behavioral and Neural Correlates of Cognitive Training and Transfer Effects in Stroke Patients(2020) MIOTTO, Eliane C.; BAZAN, Paulo R.; BATISTA, Alana X.; CONFORTO, Adriana B.; FIGUEIREDO, Eberval G.; MARTIN, Maria Graca M.; AVOLIO, Isabella B.; JR, Edson Amaro; TEIXEIRA, Manoel J.Stroke lesions are frequently followed by cognitive impairments. Cognitive training is a non-pharmacological intervention that can promote neural compensation mechanisms and strategies to remediate cognitive impairments. The aims of this study were: (1) To investigate the cognitive performance, generalization effects, and neural correlates of semantic organization strategy training (SOST) in patients with chronic left frontoparietal stroke and healthy controls (HC); and (2) to compare the behavioral effects and neural correlates of SOST with an active control psychoeducation intervention (PI). In this randomized controlled study, all participants were randomly allocated into two groups, one group received SOST, and the other received PI intervention. Participants underwent two fMRI sessions, one prior and the other, after intervention. In each fMRI session, images were obtained during memory encoding task using a list of semantically related words. We found improved post-intervention memory performance in participants that received SOST (both patients and controls), indicated by number of words recalled, word clustering scores, and performance in a generalization task. The fMRI analysis revealed negative correlation between task performance and regions of the default-mode network. These results suggest that cognitive training using semantic organization strategy can improve episodic memory performance and promote potential functional neuroplasticity in patients with ischemic stroke lesions.
- Corticomotor excitability is altered in central neuropathic pain compared with non-neuropathic pain or pain-free patients(2023) BARBOSA, Luciana Mendonca; VALERIO, Fernanda; SILVA, Valquiria Aparecida da; RODRIGUES, Antonia Lilian de Lima; GALHARDONI, Ricardo; YENG, Lin Tchia; JUNIR, Jefferson Rosi; CONFORTO, Adriana Bastos; LUCATO, Leandro Tavares; TEIXEIRA, Manoel Jacobsen; ANDRADE, Daniel Ciampi deObjectives: Central neuropathic pain (CNP) is associated with altered corticomotor excitability (CE), which can potentially provide insights into its mechanisms. The objective of this study is to describe the CE changes that are specifically related to CNP.Methods: We evaluated CNP associated with brain injury after stroke or spinal cord injury (SCI) due to neuromyelitis optica through a battery of CE measurements and comprehensive pain, neurological, functional, and quality of life assessments. CNP was compared to two groups of patients with the same disease: i. with non-neuropathic pain and ii. without chronic pain, matched by sex and lesion location.Results: We included 163 patients (stroke=93; SCI=70: 74 had CNP, 43 had non-neuropathic pain, and 46 were pain-free). Stroke patients with CNP had lower motor evoked potential (MEP) in both affected and unaffected hemispheres compared to non-neuropathic pain and no-pain patients. Patients with CNP had lower amplitudes of MEPs (366 mu V +/- 464 mu V) than non-neuro-pathic (478 +/- 489) and no-pain (765 mu V +/- 880 mu V) patients, p < 0.001. Short-interval intracorti-cal inhibition (SICI) was defective (less inhibited) in patients with CNP (2.6 +/- 11.6) compared to no-pain (0.80.7), p = 0.021. MEPs negatively correlated with mechanical and cold-induced allo-dynia. Furthermore, classifying patients' results according to normative data revealed that at least 75% of patients had abnormalities in some CE parameters and confirmed MEP findings based on group analyses.Discussion: CNP is associated with decreased MEPs and SICI compared to non-neuropathic pain and no-pain patients. Corticomotor excitability changes may be helpful as neurophysiological markers of the development and persistence of pain after CNS injury, as they are likely to pro-vide insights into global CE plasticity changes occurring after CNS lesions associated with CNP.(c) 2023 The Author(s).
- Repetitive Transcranial Magnetic Stimulation of the Contralesional Dorsal Premotor Cortex for Upper Extremity Motor Improvement in Severe Stroke: Study Protocol for a Pilot Randomized Clinical Trial(2022) LI, Xin; LIN, Yin-Liang; CUNNINGHAM, David A.; WOLF, Steven L.; SAKAIE, Ken; CONFORTO, Adriana B.; MACHADO, Andre G.; MOHAN, Akhil; O'LAUGHLIN, Kyle; WANG, Xiaofeng; WIDINA, Morgan; PLOW, Ela B.Up to 50% of stroke survivors have persistent, severe upper extremity paresis even after receiving rehabilitation. Repetitive transcranial magnetic stimulation (rTMS) can augment the effects of rehabilitation by modulating corticomotor excitability, but the conventional approach of facilitating excitability of the ipsilesional primary motor cortex (iM1) fails to produce motor improvement in stroke survivors with severe loss of ipsilesional substrate. Instead, the undamaged, contralesional dorsal premotor cortex (cPMd) may be a more suitable target. CPMd can offer alternate, bi-hemispheric and ipsilateral connections in support of paretic limb movement. This pilot, randomized clinical trial seeks to investigate whether rTMS delivered to facilitate cPMd in conjunction with rehabilitation produces greater gains in motor function than conventional rTMS delivered to facilitate iM1 in conjunction with rehabilitation in severely impaired stroke survivors. Twenty- four chronic (>= 6 months) stroke survivors with severe loss of ipsilesional substrate (defined by the absence of physiologic evidence of excitable residual pathways tested using TMS) will be included. Participants will be randomized to receive rTMS to facilitate cPMd or iM1 in conjunction with task-oriented upper limb rehabilitation given for 2 sessions/week for 6 weeks. Assessments of primary outcome related to motor impairment (upper extremity FuglMeyer [UEFM]), motor function, neurophysiology, and functional neuroimaging will be made at baseline and at 6-week end-of-treatment. An additional assessment of motor outcomes will be repeated at 3-month follow-up to evaluate retention. The primary endpoint is 6-week change in UEFM. This pilot trial will provide preliminary evidence on the effects and mechanisms associated with facilitating intact cPMd in chronic severe stroke survivors. The trial is registered on clinicaltrials.gov, NCT03868410. (c) 2022 S. Karger AG, Basel
- White Matter Integrity and Chronic Poststroke Upper Limb Function: An ENIGMA Stroke Recovery Analysis(2023) DOMIN, Martin; HORDACRE, Brenton; HOK, Pavel; BOYD, Lara A.; CONFORTO, Adriana B.; ANDRUSHKO, Justin W.; BORICH, Michael R.; CRADDOCK, Richard C.; DONNELLY, Miranda R.; DULA, Adrienne N.; WARACH, Steven J.; KAUTZ, Steven A.; LO, Bethany P.; SCHRANZ, Christian; SEO, Na Jin; SRIVASTAVA, Shraddha; WONG, Kristin A.; ZAVALIANGOS-PETROPULU, Artemis; THOMPSON, Paul M.; LIEW, Sook-Lei; LOTZE, MartinBACKGROUND:Integrity of the corticospinal tract (CST) is an important biomarker for upper limb motor function following stroke. However, when structurally compromised, other tracts may become relevant for compensation or recovery of function.METHODS:We used the ENIGMA Stroke Recovery data set, a multicenter, retrospective, and cross-sectional collection of patients with upper limb impairment during the chronic phase of stroke to test the relevance of tracts in individuals with less and more severe (laterality index of CST fractional anisotropy & GE;0.25) CST damage in an observational study design. White matter integrity was quantified using fractional anisotropy for the CST, the superior longitudinal fascicle, and the callosal fibers interconnecting the primary motor cortices between hemispheres. Optic radiations served as a control tract as they have no a priori relevance for the motor system. Pearson correlation was used for testing correlation with upper limb motor function (Fugl-Meyer upper extremity).RESULTS:From 1235 available data sets, 166 were selected (by imaging, Fugl-Meyer upper extremity, covariates, stroke location, and stage) for analyses. Only individuals with severe CST damage showed a positive association of fractional anisotropy in both callosal fibers interconnecting the primary motor cortices (r[21]=0.49; P=0.025) and superior longitudinal fascicle (r[21]=0.51; P=0.018) with Fugl-Meyer upper extremity.CONCLUSIONS:Our data support the notion that individuals with more severe damage of the CST depend on residual pathways for achieving better upper limb outcome than those with less affected CST.
- The association of post-stroke anhedonia with salivary cortisol levels and stroke lesion in hippocampal/parahippocampal region(2015) TERRONI, Luisa; AMARO JR., Edson; IOSIFESCU, Dan V.; MATTOS, Patricia; YAMAMOTO, Fabio I.; TINONE, Gisela; CONFORTO, Adriana B.; SOBREIRO, Matildes F. M.; GUAJARDO, Valeri D.; LUCIA, Mara Cristina S. De; MOREIRA, Ayrton C.; SCAFF, Milberto; LEITE, Claudia C.; FRAGUAS, RenerioBackground: Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume. Patients and methods: A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program according to the Brodmann Map to calculate the lesion volume. Results: Patients with anhedonia had significantly larger diurnal variation (P-value =0.017) and higher morning levels of salivary cortisol (1,671.9 +/- 604.0 ng/dL versus 1,103.9 +/- 821.9 ng/dL; P-value =0.022), and greater stroke lesions in the parahippocampal gyrus (Brodmann area 36) compared to those without anhedonia (10.14 voxels; standard deviation +/- 17.72 versus 0.86 voxels; standard deviation +/- 4.64; P-value =0.027). The volume of lesion in the parahippocampal gyrus (Brodmann area 36) was associated with diurnal variation of salivary cortisol levels (rho=0.845; P-value =0.034) only in anhedonic patients. Conclusion: Our findings suggest that anhedonia in stroke patients is associated with the volume of stroke lesion in the parahippocampal gyrus and with dysfunction of the hypothalamic-pituitary-adrenal axis.
- Ischemic stroke caused by large-artery atherosclerosis: a red flag for subclinical coronary artery disease(2023) ARAUJO, Ana Luiza Vieira de; SANTOS, Raul D.; BITTENCOURT, Marcio Sommer; DANTAS, Roberto Nery; OSHIRO, Carlos Andre; NOMURA, Cesar Higa; BOR-SENG-SHU, Edson; OLIVEIRA, Marcelo de Lima; LEITE, Claudia da Costa; MARTIN, Maria da Graca Morais; ALVES, Maramelia Miranda; SILVA, Gisele Sampaio; SILVA, Victor Marinho; CONFORTO, Adriana BastosBackgroundThe coronary calcium score (CAC) measured on chest computerized tomography is a risk marker of cardiac events and mortality. We compared CAC scores in two multiethnic groups without symptomatic coronary artery disease: subjects in the chronic phase after stroke or transient ischemic attack and at least one symptomatic stenosis >= 50% in the carotid or vertebrobasilar territories (Group(athero)) and a control group (Group(control)). MethodsIn this cross-sectional study, Group(athero) included two subgroups: Group(ExtraorIntra), with stenoses in either cervical or intracranial arteries, and Group(Extra&Intra), with stenoses in at least one cervical and one intracranial artery. Group(control) had no history of prior stroke/transient ischemic attacks and no stenoses >= 50% in cervical or intracranial arteries. Age and sex were comparable in all groups. Frequencies of CAC >= 100 and CAC > 0 were compared between Group(athero) and Group(control), as well as between Group(ExtraorIntr), Group(Extra&Intra), and Group(control), with bivariate logistic regressions. Multivariate analyses were also performed. ResultsA total of 120 patients were included: 80 in Group(athero) and 40 in Group(control.) CAC >0 was significantly more frequent in Group(athero) (85%) than Group(control) (OR, 4.19; 1.74-10.07; p = 0.001). Rates of CAC >= 100 were not significantly different between Group(athero) and Group(control) but were significantly greater in Group(Extra&Intra) (n = 13) when compared to Group(control) (OR 4.67; 1.21-18.04; p = 0.025). In multivariate-adjusted analyses, ""Group(athero)"" and ""Group(Extra&Intra)"" were significantly associated with CAC. ConclusionThe frequency of coronary calcification was higher in subjects with stroke caused by large-artery atherosclerosis than in controls.
- Access to rehabilitation after stroke in Brazil (AReA study): multicenter study protocol(2022) CACHO, Roberta de Oliveira; MORO, Carla Heloisa Cabral; BAZAN, Rodrigo; GUARDA, Suzete Nascimento Farias da; PINTO, Elen Beatriz; ANDRADE, Suellen Mary Marinho dos Santos; VALLER, Lenise; ALMEIDA, Kelson James; RIBEIRO, Tatiana Souza; JUCA, Renata Viana Brigido de Moura; MINELLI, Cesar; PIEMONTE, Maria Elisa Pimentel; PASCHOAL, Eric Homero Albuquerque; PEDATELLA, Marco Tulio Araujo; PONTES-NETO, Octavio Marques; FONTANA, Ana Paula; PAGNUSSAT, Aline de Souza; CONFORTO, Adriana BastosBackground Most of the Brazilian population relies on public healthcare and stroke is a major cause of disability in this country of continental dimensions. There is limited information about access to rehabilitation after stroke in Brazil. Objective To provide comprehensive information about Access to Rehabilitation After discharge from public hospitals in Brazil (AReA study), up to 6 months after stroke. Methods The present study intends to collect information from 17 public health centers in 16 Brazilian cities in the 5 macroregions of the country. Each center will include 36 participants ( n = 612). The inclusion criteria are: age >= 18 years old; ischemic or hemorrhagic stroke, from 6 months to 1 year prior to the interview; admission to a public hospital in the acute phase after stroke; any neurological impairment poststroke; patient or caregiver able to provide informed consent and answer the survey. Patients can only be recruited in public neurology or internal medicine outpatient clinics. Outcomes will be assessed by a standard questionnaire about rehabilitation referrals, the rehabilitation program (current status, duration in months, number of sessions per week) and instructions received. In addition, patients will be asked about preferences for locations of rehabilitation (hospitals, clinics, or at home). Conclusion The AReA study will fill a gap in knowledge about access to stroke rehabilitation in the public health system in different Brazilian regions.
- Editorial: Understanding stroke recovery to improve outcomes: From acute care to chronic rehabilitation(2022) CONFORTO, Adriana Bastos; LIEW, Sook-Lei; LUFT, Andreas R.; KITAGO, Tomoko; BERNHARDT, Julie; ARENILLAS, Juan Francisco