NATALIA CRISTINA MORAES
Projetos de Pesquisa
Unidades Organizacionais
LIM/45 - Laboratório de Fisiopatologia Neurocirúrgica, Hospital das Clínicas, Faculdade de Medicina
11 resultados
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conferenceObject Amyloid-beta Deposition, Brain Metabolism and Neuropsychological Profile in Elderly with Subjective Cognitive Decline and SuperAgers(2020) STUDART-NETO, Adalberto; COUTINHO, Artur; CARNEIRO, Camila de Godoi; MORAES, Natalia Cristina; SPERA, Raphael Ribeiro; YASSUDA, Monica Sanches; BRUCKI, Sonia Maria Dozzi; LEITE, Claudia; BUCHPIGUEL, Carlos; NITRINI, Ricardo- The Brain Metabolic Signature in Superagers Using In Vivo H-1-MRS: A Pilot Study(2021) GODOY, L. L. de; STUDART-NETO, A.; WYLEZINSKA-ARRIDGE, M.; TSUNEMI, M. H.; MORAES, N. C.; YASSUDA, M. S.; COUTINHO, A. M.; BUCHPIGUEL, C. A.; NITRINI, R.; BISDAS, S.; LEITE, C. da CostaBACKGROUND AND PURPOSE: Youthful memory performance in older adults may reflect an underlying resilience to the conventional pathways of aging. Subjects having this unusual characteristic have been recently termed ?superagers.? This study aimed to explore the significance of imaging biomarkers acquired by H-1-MRS to characterize superagers and to differentiate them from their normal-aging peers. MATERIALS AND METHODS: Fifty-five patients older than 80?years of age were screened using a detailed neuropsychological protocol, and 25 participants, comprising 12 superagers and 13 age-matched controls, were statistically analyzed. We used state-of-the-art 3T H-1-MR spectroscopy to quantify 18 neurochemicals in the posterior cingulate cortex of our subjects. All H-1-MR spectroscopy data were analyzed using LCModel. Results were further processed using 2 approaches to investigate the technique accuracy: 1) comparison of the average concentration of metabolites estimated with Cramer-Rao lower bounds?<20%; and 2) calculation and comparison of the weighted means of metabolites? concentrations. RESULTS: The main finding observed was a higher total N-acetyl aspartate concentration in superagers than in age-matched controls using both approaches (P =?.02 and P =?.03 for the weighted means), reflecting a positive association of total N-acetyl aspartate with higher cognitive performance. CONCLUSIONS: H-1-MR spectroscopy emerges as a promising technique to unravel neurochemical mechanisms related to cognitive aging in vivo and providing a brain metabolic signature in superagers. This may contribute to monitoring future interventional therapies to avoid or postpone the pathologic processes of aging.
- Applicability of the Test of Variables of Attention – T.O.V.A in Brazilian adults(2018) MEMÓRIA, Cláudia M.; MUELA, Henrique C.S.; MORAES, Natália C.; COSTA-HONG, Valéria A.; MACHADO, Michel F.; NITRINI, Ricardo; BORTOLOTTO, Luiz A.; YASSUDA, Monica S.ABSTRACT The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. Objective: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. Methods: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) and the Trail Making Test. Results: the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. Conclusion: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.
- Hypertension Severity Is Associated With Impaired Cognitive Performance(2017) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; MACEDO, Thiago A.; SHU, Edson B. S.; MASSARO, Ayrton R.; NITRINI, Ricardo; MANSUR, Alfredo J.; BORTOLOTTO, Luiz A.Background-Most evidence of target-organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. Methods and Results-In a cross-sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN-1: BP, 140-159/90-99 or use of 1 or 2 antihypertensive drugs; HTN-2: BP, >= 160/100 or use of >= 3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini-Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage-1, the severe HTN group had worse cognitive performance based on MiniMental State Examination (26.8 +/- 2.1 vs 27.4 +/- 2.1 vs 28.0 +/- 2.0; P= 0.004) or Montreal Cognitive Assessment (23.4 +/- 3.7 vs 24.9 +/- 2.8 vs 25.5 +/- 3.2; P< 0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. Conclusions-Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.
- Evaluation of cerebral autoregulation performance in patients with arterial hypertension on drug treatment(2020) MACHADO, Michel Ferreira; MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria Aparecida; YASSUDA, Monica Sanches; MORAES, Natalia Cristina; MEMORIA, Claudia Maia; BOR-SENG-SHU, Edson; MASSARO, Ayrton Roberto; NITRINI, Ricardo; BORTOLOTTO, Luiz Aparecido; NOGUEIRA, Ricardo de CarvalhoCerebral autoregulation (AR) keeps cerebral blood flow constant despite fluctuations in systemic arterial pressure. The final common AR pathway is made up of vasomotor adjustments of cerebrovascular resistance mediated by arterioles. Structural and functional changes in the arteriolar wall arise with age and systemic arterial hypertension. This study evaluated whether AR is impaired in hypertensive patients and whether this impairment differs with disease control. Three groups of patients were prospectively compared: hypertensive patients under treatment with systolic blood pressure (SBP) <140 and diastolic blood pressure (DBP) <90 mm Hg (n = 54), hypertensive patients under treatment with SBP > 140 or DBP > 90 mm Hg (n = 31), and normotensive volunteers (n = 30). Simultaneous measurements of cerebral blood flow velocity (CBFV) and BP were obtained by digital plethysmography and transcranial Doppler, and the AR index (ARI) was defined according to the step response to spontaneous fluctuations in BP. Compared to the uncontrolled hypertension, the normotensive individuals were younger (age 43.42 +/- 11.14,P < .05) and had a lower resistance-area product (1.17 +/- 0.24,P < .05), although age and greater arteriolar stiffness did not affect the CBFV mean of hypertensive patients, whether controlled or uncontrolled (62.85 x 58.49 x 58.30 cm/s,P = .29), most likely because their ARIs were not compromised (5.54 x 5.91 x 5.88,P = .6). Hypertensive patients under treatment, regardless of their BP control, have intact AR capacity.
- Systemic arterial hypertension and cognition in adults: effects on executive functioning(2020) MORAES, Natalia Cristina; MUELA, Henrique Cotchi Simbo; MEMORIA, Claudia Maia; COSTA-HONG, Valeria Aparecida da; MACHADO, Michel Ferreira; CECHINHI, Mario Amore; NITRINI, Ricardo; BORTOLOTTO, Luiz Aparecido; YASSUDA, Monica SanchesBackground: Central nervous system changes associated to systemic arterial hypertension (SAH) are progressive and may cause negative effects on cognitive performance. The objective of this study was to investigate the relation between SAH and the components of executive functions (EF), inhibitory control (IC), updating and shifting, comparing a control group (without SAH) to patients with SAH, in two levels of severity. Methods: The protocol included the following tests to evaluate EF components: T.O.V.A. Test (IC), Backward Digit Span from Wechsler Adults Intelligence Scale (VVAIS-III), Phonemic and Semantic Verbal Fluency (updating), and Trail Making Test Part B (shifting). Results: A total of 204 participants was included: 56 from the Control Group (CG), 87 SAH stage 1, and 61 SAH stage 2. The groups were not different for age (52.37 +/- 12.29) and education (10.98 +/- 4.06). As to controlled blood pressure (BP), duration of hypertension treatment and number of drugs, the SAH 2 group had a worse BP control, longer duration of hypertension treatment and use of more drugs when compared to the SAH 1. The findings revealed that patients with more severe hypertension presented worse performance in updating (Backward Digit Span, phonemic and semantics VF) and shifting (Trail Making Test Part B). Conclusion: The results suggest that patients with SAH have a significant impairment in EF, more specifically in updating and shifting. Besides that, such damage may be directly proportional to the severity of SAH. It is suggested that future studies include neuroimaging exams to exclude possible cerebrovascular diseases.
- Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension(2018) MUELA, Henrique C. S.; COSTA-HONG, Valeria A.; YASSUDA, Monica S.; MORAES, Natalia C.; MEMORIA, Claudia M.; MACHADO, Michel F.; BOR-SENG-SHU, Edson; NOGUEIRA, Ricardo C.; MANSUR, Alfredo J.; MASSARO, Ayrton R.; NITRINI, Ricardo; MACEDO, Thiago A.; BORTOLOTTO, Luiz A.Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8 +/- 2.1 vs 27.3 +/- 2.1 vs 28.0 +/- 2.0, P=.003) or the Montreal Cognitive Assessment test (23.4 +/- 3.5 vs 24.9 +/- 2.9 vs 25.6 +/- 3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.
- Impact of hypertension severity on arterial stiffness, cerebral vasoreactivity, and cognitive performance(2017) MUELA, Henrique Cotchi Simbo; COSTA-HONG, Valeria A.; YASSUDA, Monica Sanches; MACHADO, Michel Ferreira; NOGUEIRA, Ricardo de Carvalho; MORAES, Natalia C.; MEMÓRIA, Claudia Maia; MACEDO, Thiago A.; BOR-SENG-SHU, Edson; MASSARO, Ayrton Roberto; NITRINI, Ricardo; BORTOLOTTO, Luiz A.ABSTRACT. Aging, hypertension (HTN), and other cardiovascular risk factors contribute to structural and functional changes of the arterial wall. Objective: To evaluate whether arterial stiffness (AS) is related to cerebral blood flow changes and its association with cognitive function in patients with hypertension. Methods: 211 patients (69 normotensive and 142 hypertensive) were included. Patients with hypertension were divided into 2 stages: HTN stage-1 and HTN stage-2. The mini-mental state examination (MMSE), Montreal Cognitive Assessment (MoCA) and a battery of neuropsychological (NPE) tests were used to determine cognitive function. Pulse wave velocity was measured using the Complior®. Carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. Middle cerebral artery flow velocity was measured by transcranial Doppler ultrasonography. Results: Both arterial stiffness parameters and cerebral vasoreactivity worsened in line with HTN severity. There was a negative correlation between breath holding index (BHI) and arterial stiffness parameters. Cognitive performance worsened in line with HTN severity, with statistical difference occurring mainly between the HTN-2 and normotension groups on both the MMSE and MoCA. The same tendency was observed on the NPE tests. Conclusion: Hypertension severity was associated with higher AS, worse BHI, and lower cognitive performance.
- Executive function in systemic arterial hypertension: A systematic review(2019) MORAES, Natália Cristina; APRAHAMIAN, Ivan; YASSUDA, Mônica SanchesABSTRACT Systemic arterial hypertension (SAH) may be associated with worse cognitive performance, especially in tasks that evaluate the executive functions (EF). Objective: we aimed to review the evidence regarding which components of executive functions are most affected in adults with SAH. Methods: this systematic review used the PRISMA statement for searching Pubmed, Scielo and Lilacs databases with the keywords “executive function OR executive functioning AND hypertension”. Results: EF tasks were divided into shifting, inhibitory control and updating. A total of 9 cross-sectional and 3 longitudinal studies were selected. Only 3 studies did not report worse performance among SAH patients on EF tasks when compared to normotensive controls. The measures of shifting and inhibitory control were the most frequently investigated and reported as altered among SAH individuals, assessed mainly by the Stroop Test and Trail-Making Test part B, respectively. Conclusion: inhibitory control and shifting are the EF components most influenced by SAH. The results of this review may contribute to the devising of hypotheses about mechanisms underlying these cognitive impairments.
conferenceObject Hypertension Severity is Associated With Impaired Cognitive Performance(2015) MUELA, Henrique C.; COSTA-HONG, Valeria A.; MACHADO, Michel F.; MORAES, Natalia C.; MEMORIA, Claudia M.; YASSUDA, Monica S.; SHU, Edson B.; NOGUEIRA, Ricardo C.; MASSARO, Ayrton R.; FEITOSA, Raul R.; MERLIN, Silvia; TRES, Eduardo S.; NITRINI, Ricardo; MANSUR, Alfredo J.; BORTOLOTTO, Luiz A.