Déficits cognitivos sutis em adultos que apresentaram coréia de Sydenham durante a infância
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Data
2009-05-27
Autores
Cavalcanti, André de Souza [UNIFESP]
Orientadores
Hilário, Maria Odete Esteves [UNIFESP]
Tipo
Dissertação de mestrado
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Resumo
Há evidências da presença de déficits cognitivos relacionados aos circuitos frontoestriatais dos núcleos da base em crianças acometidas por coréia de Sydenham (CS). Contudo, não se sabe se tais déficits são persistentes na idade adulta ou não. Objetivos: Avaliar o perfil neuropsicológico e a qualidade de vida relacionada à saúde (QVRS) de adultos acometidos por febre reumática (FR) com e sem CS durante a infância. Métodos: Foram avaliados 3 grupos: (1) adultos que apresentaram FR com CS durante a infância (CS), (2) adultos que apresentaram FR sem CS durante a infância (FR) e (3) grupo controle (CT). Uma bateria de testes neuropsicológicos foi utilizada para avaliar diversos domínios cognitivos. O estado emocional e os sintomas relacionados ao transtorno de déficit de atenção/hiperatividade foram avaliados através de escalas específicas. A QVRS foi mensurada utilizando a versão brasileira do questionário Short Form-36 (SF-36). Resultados: Foram incluídos 20 pacientes no grupo CS (18 do sexo feminino, idade média 24,8 anos), 23 pacientes no grupo FR (14 do sexo feminino, idade média 24,2 anos) e 19 no grupo CT (15 do sexo feminino, idade média 24,1 anos). Os três grupos foram homogêneos em relação ao sexo, idade, escolaridade, classificação socioeconômica, coeficiente de inteligência (QI) e escala para ansiedade e depressão. O grupo CS apresentou desempenho inferior em testes que avaliam memória operacional, atenção e funções executivas e escore superior na escala para déficit de atenção quando comparados com os grupos FR e CT, além de uma tendência de escores mais baixos nos domínios aspectos físicos, vitalidade, aspectos emocionais e saúde mental do questionário SF-36. Conclusões: Pacientes acometidos por CS durante a infância podem apresentar desempenho inferior em tarefas que avaliam memória operacional, atenção e funções executivas na idade adulta. Portanto, há evidências indiretas da persistência de disfunções em circuitos cerebrais envolvidos com os núcleos da base.
There are evidences of the presence of cognitive deficits related to basal ganglia frontostriatal circuits in children with Sydenham’s chorea (SC). However, it is not known whether such deficits persist into adult life. Objectives: Evaluate the neuropsychological profile and health related quality of life (HRQL) of adults who had rheumatic fever (RF) with and without SC during childhood. Methods: Three groups of patients were assessed: (1) adults that had RF with SC during childhood (SC), (2) adults that had RF without SC during childhood (RF) and (3) a control group (CT). A range of neuropsychological tests looked at several cognitive domains. Specific scales were used to evaluate emotional state and symptoms related to attention deficit/hyperactivity disorder. HRQL was measured through a Brazilian version of Short Form-36 questionnaire (SF-36). Results: Twenty patients were included in the SC group (18 were female, average age 24.8 years), 23 patients were included in the RF group (14 were females, average age 24.2 years) and 19 patients were included in the CT group (15 were female, average age 24.1 years). The three groups were homogeneous regarding sex, age, schooling, socioeconomic status, intelligence quotient (IQ) and scale for anxiety and depression. SC group demonstrated inferior performances in tests that assessed working memory, attention and executive functions and higher scores for attention deficit scale when compared with the RF and CT groups, besides a tendency in lower scores in the domains physical aspects, vitality, emotional aspects and mental health in the questionnaire SF-36. Conclusions: Patients that had SC during childhood can exhibit inferior performance in tasks that evaluate working memory, attention and executive functions in adult life. Therefore, there are indirect evidences of the persistence of dysfunctions in cerebral circuits involved with basal ganglia.
There are evidences of the presence of cognitive deficits related to basal ganglia frontostriatal circuits in children with Sydenham’s chorea (SC). However, it is not known whether such deficits persist into adult life. Objectives: Evaluate the neuropsychological profile and health related quality of life (HRQL) of adults who had rheumatic fever (RF) with and without SC during childhood. Methods: Three groups of patients were assessed: (1) adults that had RF with SC during childhood (SC), (2) adults that had RF without SC during childhood (RF) and (3) a control group (CT). A range of neuropsychological tests looked at several cognitive domains. Specific scales were used to evaluate emotional state and symptoms related to attention deficit/hyperactivity disorder. HRQL was measured through a Brazilian version of Short Form-36 questionnaire (SF-36). Results: Twenty patients were included in the SC group (18 were female, average age 24.8 years), 23 patients were included in the RF group (14 were females, average age 24.2 years) and 19 patients were included in the CT group (15 were female, average age 24.1 years). The three groups were homogeneous regarding sex, age, schooling, socioeconomic status, intelligence quotient (IQ) and scale for anxiety and depression. SC group demonstrated inferior performances in tests that assessed working memory, attention and executive functions and higher scores for attention deficit scale when compared with the RF and CT groups, besides a tendency in lower scores in the domains physical aspects, vitality, emotional aspects and mental health in the questionnaire SF-36. Conclusions: Patients that had SC during childhood can exhibit inferior performance in tasks that evaluate working memory, attention and executive functions in adult life. Therefore, there are indirect evidences of the persistence of dysfunctions in cerebral circuits involved with basal ganglia.
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CAVALCANTI, André de Souza. Déficits cognitivos sutis em adultos que apresentaram coréia de Sydenham durante a infância. 2009. 77f. Dissertação (Mestrado) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2009.