Análise das capacidades cognitivas, com ênfase na tomada de decisão, em indivíduos com transtornos por uso de substâncias ilícitas
Data
2022-03-02
Autores
Gobbo, Denise Ribeiro [UNIFESP]
Orientadores
Céspedes, Isabel Cristina [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: Os transtornos por uso de substâncias (TUS) são caracterizados por um conjunto de comportamentos e alterações fisiológicas decorrentes do uso de substâncias psicotrópicas. Nesta condição, o indivíduo prioriza a busca e consumo da substância em relação a outros comportamentos. Estudos sugerem prejuízos cognitivos com o abuso destas substâncias, principalmente na tomada de decisão, devido a alterações neurobiológicas que dificultam a manutenção do tratamento. Abordagens multidimensionais são importantes para identificar componentes biológicos que possam contribuir na elaboração do diagnóstico e compreensão dos fatores de desenvolvimento do TUS. Objetivo: Comparar o desempenho de indivíduos controles com o de indivíduos diagnosticados com transtornos por uso de substâncias ilícitas em testes que avaliam capacidades cognitivas, com ênfase nas envolvidas nos processos de tomada de decisão. O objetivo secundário foi avaliar a influência de características sociodemográficas, estado afetivo, fator neurotrófico e conectividade funcional entre estruturas neurais envolvidas nestas capacidades cognitivas. Métodos: 50 indivíduos diagnosticados com transtornos por uso de substâncias (TUS) e 50 indivíduos controles, foram submetidos a testes cognitivos (Lista de Palavras de Rey-RALVT, Teste de Stroop), Tarefa de jogos de azar de Iowa -IGT), testes para avaliação de estados afetivos (Inventário de Ansiedade Traço-Estado-IDATE, Inventário de Beck para Depressão-BDI), exame de ressonância magnética funcional em estado de repouso (resting state) e coleta sanguínea para dosagem do fator neurotrófico derivado do cérebro (BDNF) por método ELISA. Para análise da conectividade funcional foi utilizado o software CONN-toolbox. Resultados: Observamos que indivíduos diagnosticados com transtorno por uso de substâncias, em especial os usuários de cocaína, mostraram desempenho prejudicado em testes de memória e controle inibitório, sem prejuízo em tarefa de tomada de decisão. O histórico familiar, o desempenho cognitivo na memória de reconhecimento e controle inibitório, além do estado afetivo, foram variáveis discriminantes para identificar os indivíduos com TUS. Não observamos alterações nas concentrações sanguíneas de BDNF, indicador de neuroplasticidade, mas observamos enfraquecimento da conectividade funcional nas vias tálamo-corticais, principalmente em estruturas frontais (giro frontal superior e polo frontal), e regiões integrantes da rede default mode (DMN) como o córtex pré-frontal medial, córtex cingulado posterior e polo lateral, por meio de imagens de ressonância magnética funcional.
Introduction: The substance use disorders (TUS) can be defined as a set of behavioral and physiological changes, resulting from the use of psychotropic substances. In this condition, the drug-seeking behavior becomes a priority over other behaviors of the greatest value for the life of the individual. Accurate diagnosis for TUS has been a challenge, as well as the efficacy of available treatments. Several reports suggest cognitive impairment, mainly in decision-making capacity, due to neurobiological alterations induced by this consume which make difficult the positive outcome of treatments. Further, multidimensional approaches are highlighting to identify biological markers to support diagnosis and to understand factors for TUS development. Objectives: The present study aimed to compare cognitive abilities, with emphasis in decisionmaking (DM), healthy controls subjects and individuals diagnosed with TUS. A secondary aim evaluated the influence of sociodemographic characteristics, affective state, neurotrophic factor and functional connectivity of brain structures involved on these cognitive processing. Methods: To perform this work, 50 individuals diagnosed with substances use disorders and 50 healthy control individuals were submitted to cognitive tests (RALVT, Stroop color, IGT), tests to evaluate affective states (STAI, BECK), a functional magnetic resonance (fMRI) in resting-state and blood sample collection to evaluate brain derived neurotrophic factor (BDNF) concentrations. For neuroimaging analysis of functional connectivity, the CONN-toolbox software was used. Results: TUS individuals, specifically cocaine users, showed impairment in memory and inhibitory control tests with preponderance of cocaine use, impaired results for memory and inhibitory control tests performances, however no decision-making effects. Family-history for TUS, cognitive performance for recognize memory and inhibitory control, further the affective state was evidenced as key variables to identify individuals belonging to TUS groups. No changes in BDNF concentrations were observed, a neuroplasticity indicator, however, we noted a weakness rsFC in thalamus-cortical pathways in TUS subjects, mainly in ROI frontal structures (SFG and FP), and DMN nodes as prefrontal cortex, posterior cingulated cortex and lateral pole (MPFC, PCC and LP), using functional resonance magnetic imaging.
Introduction: The substance use disorders (TUS) can be defined as a set of behavioral and physiological changes, resulting from the use of psychotropic substances. In this condition, the drug-seeking behavior becomes a priority over other behaviors of the greatest value for the life of the individual. Accurate diagnosis for TUS has been a challenge, as well as the efficacy of available treatments. Several reports suggest cognitive impairment, mainly in decision-making capacity, due to neurobiological alterations induced by this consume which make difficult the positive outcome of treatments. Further, multidimensional approaches are highlighting to identify biological markers to support diagnosis and to understand factors for TUS development. Objectives: The present study aimed to compare cognitive abilities, with emphasis in decisionmaking (DM), healthy controls subjects and individuals diagnosed with TUS. A secondary aim evaluated the influence of sociodemographic characteristics, affective state, neurotrophic factor and functional connectivity of brain structures involved on these cognitive processing. Methods: To perform this work, 50 individuals diagnosed with substances use disorders and 50 healthy control individuals were submitted to cognitive tests (RALVT, Stroop color, IGT), tests to evaluate affective states (STAI, BECK), a functional magnetic resonance (fMRI) in resting-state and blood sample collection to evaluate brain derived neurotrophic factor (BDNF) concentrations. For neuroimaging analysis of functional connectivity, the CONN-toolbox software was used. Results: TUS individuals, specifically cocaine users, showed impairment in memory and inhibitory control tests with preponderance of cocaine use, impaired results for memory and inhibitory control tests performances, however no decision-making effects. Family-history for TUS, cognitive performance for recognize memory and inhibitory control, further the affective state was evidenced as key variables to identify individuals belonging to TUS groups. No changes in BDNF concentrations were observed, a neuroplasticity indicator, however, we noted a weakness rsFC in thalamus-cortical pathways in TUS subjects, mainly in ROI frontal structures (SFG and FP), and DMN nodes as prefrontal cortex, posterior cingulated cortex and lateral pole (MPFC, PCC and LP), using functional resonance magnetic imaging.