Medical Express

ISSN (print): 2318-8111

ISSN (online): 2358-0429

Author's Articles

5 result(s) for: Nuno Barbosa F. Rocha

Working memory dysfunction in insomniac adults: a systematic metanalytical review

Bárbara Monteiro; Maristela Candida; Suzana Monteiro; Flávia Paes; Ti-Fei Yuan; Ang Li; Xin Sun; Nuno Barbosa F. Rocha; Carlos Campos; Antonio Egidio Nardi; Sergio Machado


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BACKGROUND: Insomnia is the most commonly occurring sleep disorder: recent reports estimate that 25-30% of adults in the general population occasional instances of experience insomnia, while 10% suffer from disturbances severe enough to meet diagnostic criteria for insomnia. Little is known about the mechanisms, causes, clinical course, and consequences of this condition. Over 30 studies have been published on the matter but only a small proportion has found differences in the working memory of individuals with vs. without insomnia.
OBJECTIVE: To summarize evidence regarding the differences in working memory performance between insomniac vs. normal adult sleepers.
METHODS: The survey was conducted using an advanced search in the ISI Web of Science and MEDLINE/PubMed with the terms "sleep", "insomnia" and "working memory" as major descriptors; these were crossed with the following keywords: "psychological tests", "neuropsychology" and "performance".
RESULTS: A total of 112 articles were identified in the search conducted in PubMed and Web of Science. After the screening, 102 articles unrelated to the proposed theme were excluded. Thus, 10 articles were analyzed by the eligibility and exclusion criteria, and included in this systematic review.
CONCLUSION: The information resulting from the analysis of the reviewed articles suggests that mild, but not definitive deficits in cognitive performance might be masked by insignificant disparities in studies comparing insomniac individuals with normal sleepers. This shortcoming can be circumvented by larger and better-characterized samples, together with optimized methodological control of factors which might otherwise result in confounding variations among participants.

Keywords: Insomnia, working memory, cognitive performance.

Aerobic exercise reduces anxiety symptoms and improves fitness in patients with panic disorder

Murilo Khede Lamego; Eduardo Lattari; Alberto Souza de Sá Filho; Flávia Paes; Jarbas Mascarenhas Jr.; Geraldo Maranhão Neto; Aldair José de Oliveira; Carlos Campos; Nuno Barbosa F. Rocha; Antonio E. Nardi; Sergio Machado


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OBJECTIVE: To investigate the effects of a regularly repeated aerobic exercise series on anxiety and maximum oxygen consumption (VO2max) in Panic Disorder patients.
METHODS: Ten previously sedentary female subjects diagnosed with Panic Disorder performed 36 sessions of aerobic exercise (at 70 to 75% of VO2max), 3 times per week during 12 weeks. A cardiopulmonary evaluation (ergospirometry test) was used to set the intensity of training as well as to establish baseline and post-training VO2max parameters. The assessment of anxiety symptoms was performed at baseline, at the end of the 6th and 12th weeks, using the Trait Anxiety Inventory (STAI-T) and State Anxiety Inventory (STAI-S), and the Subjective Units of Distress Scale (SUDS) questionnaires. One-way ANOVA for repeated measurements (at 3 moments: Baseline, 6th week (mid-training) and 12th week (post-training) was used to compare the evolution of the questionnaires; the Bonferroni post hoc test was applied to identify differences between moments. A dependent t-test was performed for measures of VO2max.
RESULTS: Compared to baseline, (a) STAI-T showed significant anxiety reductions at mid- and post-training moments; (b) STAI-S and SUDS recorded anxiety reductions only at Post-training; (c) VO2max showed a significant improvement at Post-training.
CONCLUSION: This protocol promoted beneficial effects on cardiorespiratory fitness and anxiety levels of Panic Disorder patients.

Keywords: Panic disorder, aerobic exercise, maximum oxygen consumption.

Effects of dual-task interventions on gait performance of patients with Parkinson’s Disease: A systematic review

Luís A. A. Santos; Carlos Campos; Teresa Bento; Eduardo Lattari; Antônio Egidio Nardi; Nuno Barbosa F. Rocha; Sérgio Machado


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OBJECTIVE: Parkinson's disease is characterized by motor and non-motor symptoms that impair patients' gait performance, especially while performing dual/concurrent tasks. These deficits impair patients' daily function, because dual-tasking is a crucial ability in terms of everyday living. The aim of this study was to systematically review the effects of dual task interventions on gait performance of patients with Parkinson's disease.
METHOD: Studies were retrieved from MEDLINE/PubMed, LILACS and SciELO. We used the PICOS strategy to determine eligibility criteria. The search strategy included an advanced search on the included databases, using the following search query: "Parkinson's Disease" AND "Double Task" OR "Concurrent Tasks" OR "Gait" AND "Walk". Study selection was carried out by two independent researchers and a third one was called when consensus was needed.
RESULTS: A total of 188 articles were identified: 169 articles from Medline/PubMed, 10 articles in SciELO, 8 articles in LILACS and 1 item from manual searches. A total of 56 articles were analyzed regarding the eligibility and exclusion criteria based on full text. A final total of 7 studies were included in the systematic review.
CONCLUSION: The different types of dual-task interventions reported (dance, sound stimuli, visual and somatosensory) were associated to improvements in several gait performance indicators of Parkinson's disease patients, including gait speed, stride time and length, cadence and step length. External stimuli seem to play a critical role on specific training effects on dual-task gait performance.

Keywords: Parkinson's disease, dual-task, gait.

Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings

Maristela Candida; Carlos Campos; Bárbara Monteiro; Nuno Barbosa F. Rocha; Flávia Paes; António Egídio Nardi; Sérgio Machado


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OBJECTIVE: Cognitive Behavioral Therapy (CBT) has been recommended by several international guidelines as the gold-standard treatment to address the needs of patients with schizophrenia. This review provides an overview on recent advances regarding CBT for schizophrenia.
METHODS: An electronic search was performed on PubMed/MEDLINE, Web of Science and Cochrane Database, using the key-words: "schizophrenia"; "psychosis"; "cognitive-behavioral therapy", "CBT"and "psychotherapy".
RESULTS: Numerous systematic reviews support the immediate and long-term efficacy of Cognitive Behavioral Therapy to reduce positive and negative symptoms in patients with schizophrenia. In the last decade, CBT for schizophrenia has been applied to clinical high-risk subjects and delivered using innovative approaches (low intensity, web-based and self-guided). Brain regions and networks which support high-level cognitive functions have been associated with CBT responsiveness. There is preliminary evidence indicating that CBT induces a prefrontal dependent increase in the top-down modulation of social threat activation.
CONCLUSION: In the last decade, CBT for schizophrenia has explored new treatment outcomes, targeted acute and pre-clinical populations and provided alternative methods to reach more patients and reduce intervention costs. The patients' neurocognitive profile seems to play a critical role in treatment response and combining CBT with cognitive remediation may allow to enhance therapeutic effects. Although CBT for schizophrenia is widely established as a gold-standard practice, future studies using innovative CBT protocols, exploring brain-related predictors and treatment outcomes may allow this intervention to be more effective, personalized and to reach a wider number of patients.

Keywords: Cognitive-behavioral therapy; Schizophrenia; Psychosis; Neurobiological; Neuroplasticity.

Association between depression severity and executive functioning in late-life depression: a systematic review

Suzana Monteiro; Bárbara Monteiro; Maristela Candida; Nathalia Adler; Carlos Campos; Nuno Barbosa F. Rocha; Flávia Paes; Antônio Egidio Nardi; Sergio Machado


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OBJECTIVE: Late-life depression is an under-diagnosed and under-treated disease that reduces the well-being of older adults. Executive dysfunction is another critical impairment in elderly depressed individuals which further disrupts their everyday functioning. This systematic review aims to analyze the association between executive function and depression severity in elderly individuals diagnosed with major depressive disorder.
METHOD: The studies were retrieved from MEDLINE/PubMed, ISI Web of Knowledge and PsychInfo, after a search strategy combining the terms "depression", "executive function", "neuropsychological assessment", "elderly" and "late life". Study selection, data collection and quality ratings was performed by two independent raters.
RESULTS: A total of 1,130 articles were found but only 8 studies met the defined eligibility criteria and evaluated the association between depression severity and executive functioning. Six out of 8 studies found an association between depression severity and executive function, with correlations ranging from small to large (r= -0.15 to -0.53). The included reports had several methodological limitations such as selective data reporting, non-comprehensive executive function assessment and not controlling potential biases.
CONCLUSION: Depression severity may be more strongly correlated with a specific set of executive abilities although it also seems to be a broad-based association with executive functioning as a whole. Future high-quality prospective studies are recommended in order to understand the causal relationship between depression severity and executive functioning taking into account possible mediators such as age-related or neurodegenerative cognitive impairment, educational level and other clinic characteristics (e.g. age of onset, medication).

Keywords: Late-life Depression, Major Depressive Disorder, Executive Function.