Análise das alterações nas capacidades cognitivas, com foco na tomada de decisão, em indivíduos com transtorno por uso de álcool
Data
2022-03-30
Autores
Pereira, Laís da Silva 
Orientadores
Céspedes, Isabel Cristina
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: O transtorno por uso do álcool (TUA) é considerado um problema mundial e frequente. Dados da Organização Mundial da Saúde de 2018 mostraram que cerca de 2,3 bilhões de pessoas em todo o mundo consumiam álcool. O caráter multifatorial desse transtorno é influenciado por fatores genéticos, comportamentais e ambientais. As estruturas neurais que mais sofrem neuroplasticidade neste transtorno são aquelas envolvidas com os sistemas de recompensa, de estresse e de cognição. A cognição, em particular o processo de capacidade de tomada de decisão, é alvo dos efeitos deletérios do álcool, levando à manutenção de comportamentos de busca ao álcool. Objetivo: Avaliar as possíveis alterações nas capacidades cognitivas, com foco na tomada de decisão, associando-as com indicadores de depressão e ansiedade, nos níveis séricos de fatores neurotróficos, e com alterações morfométricas e funcionais de áreas cerebrais, em indivíduos com transtornos relacionados ao uso de álcool em comparação com indivíduos controle. Métodos: Participaram do estudo 100 indivíduos, dos quais 50 preenchiam critérios para transtornos por uso de álcool (AL) e 50 que não preenchiam tais critérios constituindo o grupo controle (CON). Aos dois grupos foram aplicados testes para avaliação da cognição (Lista de Palavras de Rey-RAVLT, Teste de Stroop e Tarefa de Jogos de Azar de Iowa-IGT) e para triagem de ansiedade (Inventário de Ansiedade Traço-Estado) e depressão (Inventário de Depressão de Beck). Amostras de sangue foram coletadas para mensuração da concentração plasmática de BDNF. Imagens de ressonância magnética morfológica e funcional em repouso foram obtidas para análise morfológica e do padrão de conectividade de redes neurais envolvidas na tomada de decisão. Resultados e Conclusão: Com base em nossos achados podemos concluir que em relação ao grupo controle, o grupo com transtorno por uso de álcool apresentou maiores níveis de atrofia de substância cinzenta na região do lobo frontal e disfunções no padrão de conectividade em redes de controle executivo e emocional, que se refletiram em alterações cognitivas (memória, atenção seletiva e funções inibitórias) e emocionais (depressão e ansiedade), as quais podem contribuir para uma tomada de decisão favorecendo a escolha de recompensa imediata sem considerar as consequências deletérias do consumo excessivo de álcool, comprometendo assim o tratamento e aumentando o número de recaídas. Contudo, o aumento sérico do BDNF observado durante a abstinência pode estar envolvido em um processo de neuroadaptação, indicando o desenvolvimento de funções compensatórias dos danos cerebrais promovidos pelo consumo crônico de álcool e contribuindo para a manutenção da abstinência.
Introduction: Alcohol use disorder (AU) is considered a worldwide frequent problem. World Health Organization data from 2018 showed that about 2.3 billion people worldwide consumed alcohol. The multifactorial character of this disorder is influenced by genetic, behavioral and environmental factors. The neural structures that suffer the most neuroplasticity in this disorder are those involved with the reward, stress, and cognition systems. Cognition, in particular the decision-making process, is the target of the deleterious effects of alcohol, leading to the maintenance of alcohol-seeking behaviors. Objective: Thus, this study aimed to evaluate possible changes in cognitive abilities, focusing on decision making, associating them with possible indicators of anxiety or depression, in the serum levels of neurotrophic factors, and with morphometric and functional changes in brain areas, in individuals with alcohol use disorders compared to control subjects. Methods: A total of 100 individuals participated in the study, of which 50 met the criteria for alcohol use disorders (AL) and 50 who did not meet these criteria, constituting the control group (CON). A total of 100 individuals participated in the study, of which 50 met the criteria for alcohol use disorders (AL) and 50 who did not meet these criteria, constituting the control group (CON). Both groups were given cognitive tests (Rey's Word List-RAVLT, Stroop Test and Iowa Gambling Task-IGT) and for screening for anxiety (State-Trait Anxiety Inventory) and depression (State-Trait Anxiety Inventory). Beck). Blood samples were collected to measure the plasma concentration of BDNF. Morphological and functional magnetic resonance images at rest were obtained for morphological analysis and the connectivity pattern of neural networks involved in decision making. Results and Conclusion: Based on our findings, we can conclude that chronic alcohol consumption promoted gray matter atrophy in the frontal lobe region and dysfunctions in the connectivity pattern in executive and emotional control networks, which were reflected in cognitive alterations (memory, selective attention and inhibitory) and emotional (depression and anxiety), which can contribute to decision making favoring the choice of immediate reward without considering the deleterious consequences of excessive alcohol consumption, thus compromising treatment and increasing the number of relapses. However, the increase in serum BDNF observed during abstinence may be involved in a neuroadaptation process, indicating the development of compensatory functions for brain damage promoted by chronic alcohol consumption, and contributing to the maintenance of abstinence.
Introduction: Alcohol use disorder (AU) is considered a worldwide frequent problem. World Health Organization data from 2018 showed that about 2.3 billion people worldwide consumed alcohol. The multifactorial character of this disorder is influenced by genetic, behavioral and environmental factors. The neural structures that suffer the most neuroplasticity in this disorder are those involved with the reward, stress, and cognition systems. Cognition, in particular the decision-making process, is the target of the deleterious effects of alcohol, leading to the maintenance of alcohol-seeking behaviors. Objective: Thus, this study aimed to evaluate possible changes in cognitive abilities, focusing on decision making, associating them with possible indicators of anxiety or depression, in the serum levels of neurotrophic factors, and with morphometric and functional changes in brain areas, in individuals with alcohol use disorders compared to control subjects. Methods: A total of 100 individuals participated in the study, of which 50 met the criteria for alcohol use disorders (AL) and 50 who did not meet these criteria, constituting the control group (CON). A total of 100 individuals participated in the study, of which 50 met the criteria for alcohol use disorders (AL) and 50 who did not meet these criteria, constituting the control group (CON). Both groups were given cognitive tests (Rey's Word List-RAVLT, Stroop Test and Iowa Gambling Task-IGT) and for screening for anxiety (State-Trait Anxiety Inventory) and depression (State-Trait Anxiety Inventory). Beck). Blood samples were collected to measure the plasma concentration of BDNF. Morphological and functional magnetic resonance images at rest were obtained for morphological analysis and the connectivity pattern of neural networks involved in decision making. Results and Conclusion: Based on our findings, we can conclude that chronic alcohol consumption promoted gray matter atrophy in the frontal lobe region and dysfunctions in the connectivity pattern in executive and emotional control networks, which were reflected in cognitive alterations (memory, selective attention and inhibitory) and emotional (depression and anxiety), which can contribute to decision making favoring the choice of immediate reward without considering the deleterious consequences of excessive alcohol consumption, thus compromising treatment and increasing the number of relapses. However, the increase in serum BDNF observed during abstinence may be involved in a neuroadaptation process, indicating the development of compensatory functions for brain damage promoted by chronic alcohol consumption, and contributing to the maintenance of abstinence.