Daniel Fuentes

Impulsive behavior in adults with attention deficit/ hyperactivity disorder: Characterization of attentional, motor and cognitive impulsiveness

Attention-deficit/hyperactivity disorder (ADHD) is characterized by inattention and/or hyperactivity/impulsivity. Impulsivity persists in adults with ADHD and might be the basis of much of the impairment observed in the daily lives of such individuals. The objective of this study was to address the presence, and more importantly, the three dimensions of impulsivity: attentional, non-planning and motor, in how they may relate to neuropsychological mechanisms of impulse control. We studied a sample of 50 adults with ADHD and 51 healthy comparison controls using the Barratt Impulsivity Scale Version 11 (BIS), and neuropsychological tasks, namely the Continuous Performance Task (CPT-II) and the Iowa Gambling Task (IGT). The ADHD group showed more signs of impulsivity on the three dimensions of BIS, committed more errors of omission and commission on the CPT-II, and made more disadvantageous choices on the IGT. These results support the existence of deficits related to three components of impulsivity: motor, cognitive, and attentional among adults with ADHD. Most importantly, this study also highlights the complementary nature of self-report questionnaires and neuropsychological tasks in the assessment of impulsivity in ADHD adults.

Which factors may play a pivotal role on determining the type of psychiatric disorder in children and adolescents with epilepsy

Physicians have become aware of the high prevalence of psychiatric disorders (PDs) in children and adolescents with epilepsy; however, there are many controversies as to which factors may have an important role in the different types of PD. This study was designed to assess the main PD; verify the age of onset compared with the age of diagnosis of the PD; and determine which factors may be correlated with the type of PD described. For this purpose, a multidisciplinary team evaluated children and adolescents (4-18 years) with epilepsy and analyzed patient-related factors such as age (grouped according to Piagets cognitive scale: <6 years, 7-13 years, >13 years), sex, family history of PDs, and cognitive status. With respect to epilepsy features, we considered age of onset, duration, seizure control at the time of psychiatric evaluation, refractoriness, antiepileptic drugs (mono- vs polytherapy), seizure type (generalized vs focal), and epilepsy type (idiopathic vs symptomatic/probably symptomatic). Depression occurred in 36.4% and attention-deficit hyperactivity disorder (ADHD) in 29.1%, these being the most frequent PDs in this series. Focal epilepsy was significantly more frequent in children and adolescents with PDs. As to the type of PD, age was an important factor, with a predominance of ADHD in children and depression in adolescents (P<0.0001). Family history was contributory for depression, but not for others PDs (P<0.0001). Depression remained underdiagnosed and untreated for a longer period. Impact of early diagnosis and treatment remains unknown.

The Rey Auditory-Verbal Learning Test: applicability for the Brazilian elderly population

OBJECTIVE The Rey Auditory-Verbal Learning Test is a widely recognized test in neuropsychological literature to evaluate learning and memory. This paper presents the performance of six age groups of Brazilian elderly on the Rey Auditory-Verbal Learning Test. METHOD A version of the test was developed with a list of high-frequency one-syllable and two-syllable concrete Portuguese substantives. Two hundred and twenty-three subjects of both genders were allocated to 6 age groups (60-64, 65-69; 70-74; 75-79; 80-84 and 85-89 years old) and tested with the Rey Auditory-Verbal Learning Test. RESULTS Educational level and age had a positive and a negative correlation, respectively, with performance on the Rey Auditory-Verbal Learning Test. Women performed significantly better than men. Our results were similar to those found for the Rey Auditory-Verbal Learning Test English version, across similar age ranges. CONCLUSION Our results suggest that the Brazilian Portuguese Rey Auditory-Verbal Learning Test adaptation was adequate and applicable for evaluating the memory capacity of Brazilian subjects, across similar age and educational levels.

Suicide behavior and neuropsychological assessment of type I bipolar patients

BACKGROUND Neuropsychological deficits are often described in patients with bipolar disorder (BD). Some symptoms and/or associated characteristics of BD can be more closely associated to those cognitive impairments. We aimed to explore cognitive neuropsychological characteristics of type I bipolar patients (BPI) in terms of lifetime suicide attempt history. METHOD We studied 39 BPI outpatients compared with 53 healthy controls (HC) matched by age, educational and intellectual level. All subjects were submitted to a neuropsychological assessment of executive functions, decision-making and declarative episodic memory. RESULTS When comparing BDI patients, regardless of suicide attempt history or HC, we observed that bipolar patients performed worse than controls on measures of memory, attention, executive functions and decision-making. Patients with a history of suicide attempt performed worse than non-attempters on measures of decision-making and there were a significant negative correlation between the number of suicide attempts and decision-making results (block 3 and net score). We also found significant positive correlation between the number of suicide attempts and amount of errors in Stroop Color Word Test (part 3). LIMITATIONS The sample studied can be considered small and a potentially confounding variable - medication status - were not controlled. CONCLUSION Our results show the presence of neuropsychological deficits in memory, executive functions, attention and decision-making in BPI patients. Suicide attempts BPI scored worse than non-suicide attempt BPI on measures of decision-making. More suicide attempts were associated with a worse decision-making process. Future research should explore the relationship between the association between this specific cognitive deficits in BPIs, serotonergic function and suicide behavior in bipolar patients as well other diagnostic groups.

Self-reported and neuropsychological measures of impulsivity in pathological gambling.

Pathological Gambling is an impulse control disorder. Impulsivity has been investigated separately by neuropsychological tests and self-report scales. Although some studies have tried to correlate these approaches, their interaction has not been sufficiently explored among pathological gamblers (PG). In this study, we have compared 214 PG (162 with comorbidity and 52 with no comorbidity) to 82 healthy volunteers regarding the reaction time and number of errors at Go/No-go tasks, and scores on the Barratt Impulsiveness Scale (BIS). PG have committed more errors at the Go/No-go tasks and presented higher scores on the self-report scale. The neuropsychological tests and BIS composed a multinomial logistic model that discriminated PG from non-gamblers better than models having one or another type of measure. Impulsivity seems to be a multi-dimensional phenomenon, and PG a heterogeneous population in which different types of impulsivity are present.

Brazilian Portuguese version of the Iowa Gambling Task: transcultural adaptation and discriminant validity

OBJECTIVE The Iowa Gambling Task is a neuropsychological task developed in English, most widely used to assess decision-making. The aim of this work was to adapt the Iowa Gambling Task to Brazilian Portuguese, compare it with the original version and assess its validity. METHOD We assessed 75 Brazilian adults divided into three groups: 1) 25 healthy volunteers holding the Proficiency Certificate in English tested using the English version of the Iowa Gambling Task; 2) 25 healthy volunteers who did not speak or read English tested using the Iowa Gambling Task-Portuguese; 3) 25 Attention Deficit Hyperactivity Disorder subjects tested with the Iowa Gambling Task-Portuguese. RESULTS No difference between groups 1 and 2 was observed. Nonetheless, we found significant differences between Attention Deficit Hyperactivity Disorder subjects and the other 2 groups on blocks 3, 4, 5, and on net score. CONCLUSION Our results are similar to those previously described in the literature concerning adults without neuropsychiatric diseases. Since those two versions were equivalent and Attention Deficit Hyperactivity Disorder subjects performed significantly worse than healthy volunteers we can conclude that the adaptation of the Iowa Gambling Task to Brazilian Portuguese is valid and can be used for research purposes in the Brazilian context.

Neuropsychological assessment of impulsive behavior in abstinent alcohol-dependent subjects

OBJECTIVE Poor impulse control is thought to be one of the characteristics of alcohol addiction. The capacity to remain abstinent may be linked to cognitive bias related to three dimensions of impulsivity: motor, non-planning, and attentional impulsivity. The aim of this study was to evaluate the neuropsychological profile related to these impulsivity dimensions in alcohol-dependent patients within 15 -120 days of abstinence. METHOD We compared 31 alcohol-dependent patients to 30 matched healthy controls regarding their performances on the Continuous Performance Task, the Iowa Gambling Test, and the Wisconsin Card Sorting Test, each of which is thought to tax primarily one of the three dimensions of impulsivity just outlined. RESULTS When compared to controls, alcohol-dependent patients presented more commission errors on the Continuous Performance Task; made more disadvantageous choices on the Iowa Gambling Test; and made more perseverative errors on the Wisconsin Card Sorting Test. There was no significant correlation between performance on these tests and the length of abstinence. CONCLUSIONS These results suggest that deficits related to motor, non-planning and attentional components of impulsivity exist in alcohol-dependent patients, in the period immediately after acute alcohol withdrawal. These results may help guide interventions designed to prevent the risk of relapse in alcohol-abstinent patients.

Temporal Lobe Epilepsy in Childhood: Comprehensive Neuropsychological Assessment

The neuropsychological features of children with temporal lobe epilepsy are not yet well defined. The aim of this study was to identify the neuropsychological deficits in children with temporal lobe epilepsy. We evaluated 25 patients and compared them with 25 normal children. All children underwent a comprehensive neuropsychological assessment. We found a significant difference in favor of the control group in the following measures: IQ; forward digit; Trail Making Test for Children B; Wisconsin Card Sorting Test; block design; Boston naming test, verbal fluency; and Wide Range Assessment of Memory and Learning verbal learning, visual learning, verbal memory, visual memory, delayed recall of verbal learning, delayed recall of stories, and recognition of stories. Our findings show that children with temporal lobe epilepsy present with several neuropsychological deficits, despite normal IQ. These findings point to a dysfunction of cerebral areas other than temporal lobe, particularly the frontal lobes.

Tradução e adaptação cultural da Barratt Impulsiveness Scale (BIS-11) para aplicação em adultos brasileiros

OBJECTIVES: The objective of this study was to translate, make transcultural adaptation and assess the semantic, idiomatic and literal equivalence of the Barratt Impulsiveness Scale (BIS-11). METHODS:This scale assesses the presence of impulsive manifestations from the theoretical model proposed by Ernst Barratt. Firstly, the BIS-11 original version in English was translated to Portuguese by six bilingual researches. After this, was made the back-translation to English by a translator that was born in United States. Then, the three versions (original, translated and back-translated) were assessed by a specialists committee which made and analyze and comments about the process and then we reach the final translated version of BIS-11. The original and translated version of BIS-11 was applied in two samples from general population with proficiency both in English and Portuguese. This method was adopted to assess the literal, semantic e idiomatic equivalence of these versions by mean of correlation analyses. CONCLUSION: The final results of quantitative analyses show that the final version of BIS-11 is satisfactory.

Executive dysfunction in children and adolescents with temporal lobe epilepsy: is the Wisconsin Card Sorting Test enough?

The Wisconsin Card Sorting Test (WCST) is the gold standard in the evaluation of executive dysfunction (ED) in patients with temporal lobe epilepsy (TLE). We evaluated 35 children with TLE and 25 healthy controls with the WCST and with a more comprehensive battery. Among the children with TLE, 77.14% showed impairment on the WCST. On other tests (Wechsler Intelligence Scale for Children-Digit Forward, Matching Familiar Figures Test, Trail Making Test, Word Fluency, Finger Windows, and Number-Letter Memory), impairment was demonstrated in 94.29%. The authors concluded that the WCST is a good paradigm to measure executive impairment in children with TLE; however, it may be not enough. Evaluation performed only with the WCST not only underestimated the number of patients with ED, but also missed relevant information regarding the type of ED.