PAULO JANNUZZI CUNHA
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
9 resultados
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- Effects of exercise training on brain metabolism and cognitive functioning in sleep apnea(2022) UENO-PARDI, Linda M.; SOUZA-DURAN, Fabio L.; MATHEUS, Larissa; RODRIGUES, Amanda G.; BARBOSA, Eline R. F.; CUNHA, Paulo J.; CARNEIRO, Camila G.; COSTA, Naomi A.; ONO, Carla R.; BUCHPIGUEL, Carlos A.; NEGRAO, Carlos E.; LORENZI-FILHO, Geraldo; BUSATTO-FILHO, GeraldoImpaired glucose metabolism reflects neuronal/synaptic dysfunction and cognitive function decline in patients with obstructive sleep apnea (OSA). The study investigated the extent to which exercise training (ET) improves cerebral metabolic glucose rate (CMRgl) and cognitive function in patients with OSA. Patients with moderate to severe OSA were randomly assigned to ET (3 times/week, n = 23) or no intervention (control, n = 24). Echocardiography and apolipoprotein epsilon 4 (APOE epsilon 4) genotyping were obtained at baseline. Both groups underwent cardiopulmonary exercise testing, polysomnography, cognitive tests, brain magnetic resonance imaging, and F-18-fluoro-2-deoxy-d-Glucose positron emission tomography ((18)FDG-PET) at baseline and study end. Compared with control, exercise-trained group had improved exercise capacity, decreased apnea-hypopnea index (AHI), oxygen desaturation and arousal index; increased attention/executive functioning, increased CMRgl in the right frontal lobe (P < 0.05). After ET an inverse relationships occurred between CMRgl and obstructive AHI (r = - 0.43, P < 0.05) and apnea arousal index (r = - 0.53, P < 0.05), and between the changes in CMRgl and changes in mean O-2 saturation during sleep and non-rapid eye movement sleep (r = - 0.43, P < 0.05), desaturation during arousal (r = - 0.44, P < 0.05), and time to attention function testing (r = - 0.46, P < 0.05). ET improves OSA severity and CMRg in the frontal lobe, which helps explain the improvement in attention/executive functioning. Our study provides promising data that reinforce the growing idea that ET may be a valuable tool to prevent hypoxia associated with decreased brain metabolism and cognitive functioning in patients with moderate to severe OSA.
- The Route of Administration Exacerbates Prefrontal Functional Impairments in Crack Cocaine Users(2018) OLIVEIRA, Hercilio P.; GONCALVES, Priscila D.; OMETTO, Mariella; SANTOS, Bernardo; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; ANDRADE, Arthur G.; CUNHA, Paulo J.Studies have evidenced more severe health consequences in individuals who smoked crack cocaine as compared to intranasal cocaine users. Differential neurocognitive deficits between the crack and intranasal cocaine-addicted patients, associated with prefrontal cortex functions, have never been tested using complex cognitive tasks in humans. In this study, we examined possible distinct neurocognitive deficits in 43 crack-addicted patients (CrD) compared with 36 intranasal cocaine-addicted patients (CD) and 32 controls. CrD and CD were evaluated after 2 weeks of supervised detoxification in two inpatient treatment programs. All the subjects were evaluated using an extensive battery of neurocognitive tasks, including the Trail Making Test, the Stroop Color-Word Test, the Digits Forward and Digits Backward tasks, the Controlled Oral Word Association Test, the Wechsler Adult Intelligence Scale, and the Frontal Assessment Battery. Differences in performance in the neurocognitive tests between the three groups were investigated controlling for age, IQ, psychiatric symptoms, and years of education. Both intranasal and crack users were impaired on a variety of cognitive measures relative to controls. Crack users performed worse than intranasal cocaine users in inhibitory control (p = .05) and general executive functioning (p = .01). Crack use seems to be more deleterious to neurocognitive functions associated with the prefrontal cortex. This may predispose crack-addicted patients to more severe negative clinical outcomes.
- Decision-Making Deficits Linked to Real-life Social Dysfunction in Crack Cocaine-Dependent Individuals(2011) CUNHA, Paulo Jannuzzi; BECHARA, Antoine; ANDRADE, Arthur Guerra de; NICASTRI, SergioCrack cocaine-dependent individuals (CCDI) present abnormalities in both social adjustment and decision making, but few studies have examined this association. This study investigated cognitive and social performance of 30 subjects (CCDI x controls); CCDI were abstinent for 2 weeks. We used the Social Adjustment Scale (SAS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Disadvantageous choices on the IGT were associated with higher levels of social dysfunction in CCDI, suggesting the ecological validity of the IGT. Social dysfunction and decision making may be linked to the same underlying prefrontal dysfunction, but the nature of this association should be further investigated. (Am J Addict 2010;00: 1-9).
- Frontal Assessment Battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users(2011) FONTES, Maria Alice; BOLLA, Karen I.; CUNHA, Paulo Jannuzzi; ALMEIDA, Priscila Previato; JUNGERMAN, Flavia; LARANJEIRA, Ronaldo Ramos; BRESSAN, Rodrigo A.; LACERDA, Acioly L. T.Background: Cannabis is the most used illicit drug in the world, and its use has been associated with prefrontal cortex (PFC) dysfunction, including deficits in executive functions (EF). Considering that EF may influence treatment outcome, it would be interesting to have a brief neuropsychological battery to assess EF in chronic cannabis users (CCU). In the present study, the Frontal Assessment Battery (FAB), a brief, easy to use neuropsychological instrument aimed to evaluate EF, was used to evaluate cognitive functioning of CCU. Methods: We evaluated 107 abstinent CCU with the FAB and compared with 44 controls matched for age, estimated IQ, and years of education. Results: CCU performed poorly as compared to controls (FAB total score = 16.53 vs. 17.09, p .05). CCU had also a poor performance in the Motor Programming subtest (2.47 vs. 2.73, p .05). Conclusion: This study examined effects of cannabis in executive functioning and showed evidence that the FAB is sensitive to detect EF deficits in early abstinent chronic cannabis users. Clinical significance of these findings remains to be investigated in further longitudinal studies. FAB may be useful as a screening instrument to evaluate the necessity for a complete neuropsychological assessment in this population.
- Cannabis use before age 15 and subsequent executive functioning(2011) FONTES, Maria Alice; BOLLA, Karen I.; CUNHA, Paulo Jannuzzi; ALMEIDA, Priscila Previato; JUNGERMAN, Flavia; LARANJEIRA, Ronaldo Ramos; BRESSAN, Rodrigo A.; LACERDA, Acioly L. T.Background Many studies have suggested that adolescence is a period of particular vulnerability to neurocognitive effects associated with substance misuse. However, few large studies have measured differences in cognitive performance between chronic cannabis users who started in early adolescence (before age 15) with those who started later. Aims To examine the executive functioning of individuals who started chronic cannabis use before age 15 compared with those who started chronic cannabis use after 15 and controls. Method We evaluated the performance of 104 chronic cannabis users (49 early-onset users and 55 late-onset users) and 44 controls who undertook neuropsychological tasks, with a focus on executive functioning. Comparisons involving neuropsychological measures were performed using generalised linear model analysis of variance (ANOVA). Results The early-onset group showed significantly poorer performance compared with the controls and the late-onset group on tasks assessing sustained attention, impulse control and executive functioning. Conclusions Early-onset chronic cannabis users exhibited poorer cognitive performance than controls and late-onset users in executive functioning. Chronic cannabis use, when started before age 15, may have more deleterious effects on neurocognitive functioning.
- Motivational Interviewing combined with chess accelerates improvement in executive functions in cocaine dependent patients: A one-month prospective study(2014) GONCALVES, Priscila Dib; OMETTO, Mariella; BECHARA, Antoine; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; MARTINS, Paula A.; BERALDO, Livia; SANTOS, Bernardo dos; FUENTES, Daniel; ANDRADE, Arthur G.; BUSATTO, Geraldo F.; CUNHA, Paulo JannuzziBackground: In cocaine-dependent individuals, executive function (EF) deficits are associated with poor treatment outcomes. Psychological interventions and pharmacological approaches have produced only modest effect sizes. To date, studies of this topic have been few and limited. The aim of this study was to examine the effects of a new model of intervention, which integrates chess and Motivational Interviewing, Motivational Chess (MC) Methods: We evaluated 46 cocaine-dependent inpatients (aged 18-45), in two groups-MC (n=26); and active comparison-AC (n=20). Using neuropsychological tests and an impulsivity scale, we assessed the subjects before and after the study period (one month of abstinence monitored by urine toxicology screening). Results: The MC and AC groups did not differ at baseline. In the post-intervention assessment (after one month), both groups showed significant improvements in attention, mental flexibility, inhibitory control, abstraction abilities, and decision-making (p<0.01). In addition, the improvement in working memory was more significant in the MC group than in the AC group (group-by-time interaction, p=01). Conclusions: One month of abstinence was sufficient to improve various attentional and executive domains in cocaine-dependent subjects. The MC intervention was associated with greater improvements in EFs, especially working memory, suggesting that tailored interventions focusing on complex EFs accelerate the process of cognitive recovery during the initial period of abstinence.
- High IQ May ""Mask"" the Diagnosis of ADHD by Compensating for Deficits in Executive Functions in Treatment-Naive Adults With ADHD(2017) MILIONI, Ana Luiza Vidal; CHAIM, Tiffany Moukbel; CAVALLET, Mikael; OLIVEIRA, Nathalya Moleda de; ANNES, Marco; SANTOS, Bernardo dos; LOUZA, Mario; SILVA, Maria Aparecida da; MIGUEL, Carmen Silvia; SERPA, Mauricio Henriques; ZANETTI, Marcus V.; BUSATTO, Geraldo; CUNHA, Paulo JannuzziObjective: To evaluate and compare the performance of adults with ADHD with high and standard IQ in executive functions (EF) tasks. Method: We investigated the neuropsychological performance of 51 adults with ADHD, compared with 33 healthy controls (HC) while performing a wide battery of neuropsychological tests that measure executive functioning. Adults with clinical diagnosis of ADHD were divided into two groups according to their IQ level (IQ >= 110-ADHD group with more elevated IQ, and IQ < 110-ADHD group with standard IQ). Results: The ADHD group with standard IQ presented a worse executive functioning compared with the HC group in the following measures: Stroop 2 (p = .000) and 3 (p = .000), Trail Making Test (TMT) B (p = .005), Wisconsin Card-Sorting Test (WCST)-perseverative errors (p = .022) and failures to maintain set (p = .020), Continuous Performance Test (CPT)-omission errors (p = .005) and commission errors (p =.000), and Frontal Assessment Battery (FAB)-conceptualization (p = .016). The ADHD group with more elevated IQ presented only impairments in the CPT-commission errors (p = .019) when compared with the control group. Conclusion: Adults with ADHD and more elevated IQ show less evidence of executive functioning deficits compared with those with ADHD and standard IQ, suggesting that a higher degree of intellectual efficiency may compensate deficits in executive functions, leading to problems in establishing a precise clinical diagnosis.
- Influence of emotional stimulus valence on inhibitory control in adults with and without ADHD(2016) CAVALLET, Mikael; CHAIM-AVANCINI, Tiffany M.; BIAZOLI JR., Claudinei E.; BAZAN, Paulo R.; SILVA, Maria Aparecida da; CUNHA, Paulo Jannuzzi; MIGUEL, Carmen S.; BUSATTO, Geraldo F.; LOUZA, Mario R.; GAWRYSZEWSKI, Luiz G.Human behavior is influenced both by approach and avoidance automatic reactions to positive and negative stimulus, respectively, but these reactions have not been well studied in attention-deficit/hyperactivity disorder (ADHD) patients. Moreover, studies employing spatial stimulus-response compatibility tasks in ADHD and healthy control (HC) subjects are scarce and inconclusive. The present study investigated inhibitory control and emotional processing in ADHD adults with a modified stimulus-response compatibility task in which spatial and emotional features of affective stimuli had to be processed together to select the correct response. Manual responses to figures of Favorite and Rival soccer team players were measured, and compatible or incompatible responses were chosen according to the soccer team figure. Eighteen HC participants and sixteen ADHD adults performed the task. We found an ordinary spatial compatibility effect for the Favorite soccer team and a reversed one for the Rival team in the ADHD group but not in the HC group. The effects may be due to stronger approach and withdrawal reactions toward the Favorite soccer team and away from the Rival one, respectively, indicating poor inhibitory control for the ADHD group. These results show that differences between ADHD and HC subjects become prominent when response selection involves both emotional and spatial features of the stimulus.
- Cannabis use, cognition and brain structure in first-episode psychosis(2013) CUNHA, Paulo Jannuzzi; ROSA, Pedro Gomes P.; AYRES, Adriana de Mello; DURAN, Fabio L. S.; SANTOS, Luciana C.; SCAZUFCA, Marcia; MENEZES, Paulo R.; SANTOS, Bernardo dos; MURRAY, Robin M.; CRIPPA, Jose Alexandre S.; BUSATTO, Geraldo F.; SCHAUFELBERGER, Maristela S.Cannabis use is highly prevalent worldwide and it is associated with psychosis, but its effects on brain structure and cognition are still controversial. The aim of this paper is to investigate cognitive functioning and brain structure in patients with their first episode of psychosis who used Cannabis. We examined gray matter and lateral ventricle volumes in 28 patients with first-episode psychosis and a history of Cannabis use, 78 patients without a history of Cannabis use and 80 healthy controls who had not used Cannabis. Cognition was assessed using forward and backwards digit span tests, from the Wechsler Memory Scale-Third Edition (WMS-III) and the Controlled Oral Word Association Test (COWAT). Patients with a history of Cannabis use had less brain abnormalities, characterized by gray matter and lateral ventricle volume preservation, as well as less attentional and executive impairments compared to patients without a history of Cannabis use. Cannabis-using patients who develop psychosis have less neurodevelopmental impairment and better cognitive reserve than other psychotic patients; perhaps reflecting different etiological processes.