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Peshkovskaya A. Cognitive Alterations Associated with Remission and Alcohol Dependence Severity in Ethnically Diverse Patients of Siberia. Clin Pract Epidemiol Ment Health 2024; 20:e17450179297171. [PMID: 39130186 PMCID: PMC11311726 DOI: 10.2174/0117450179297171240522051748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/11/2024] [Accepted: 05/07/2024] [Indexed: 08/13/2024]
Abstract
Background Impaired cognition in individuals with alcohol dependence may be associated with increased relapse risk. It has been recorded in more than half of patients during six months after treatment. In certain ethnic groups, for example, Tuvinians, the indigenous people of Siberia, relapses occur in extremely short periods of one to three months after treatment. An approach currently used to alcohol dependence treatment may be less effective for these patients. Objective The study aimed to investigate cognitive sequelae in indigenous Tuvinian patients with alcohol dependence. Methods The sample included 166 patients, 74 of indigenous ethnicity (Tuvinians) and 92 non-indigenous white patients. Data on inhibitory control, cognitive flexibility, attention, and working memory were collected from all the patients and processed using cluster analysis. The clustering data were then complemented by indicators of disorder dynamics, impulsivity, and emotion regulation. Results The clustering procedure revealed groups with severe cognitive sequelae. More than four-fold attention decrease was found in 43.5% of non-indigenous patients, and more impaired cognitive flexibility was revealed among 60.8% of indigenous patients. Groups with severe cognitive sequelae had higher impulsivity, maladaptive emotion regulation, more hospitalizations, faster disease progression, and shorter remissions. The latter was significantly reduced to 90 days on average in the severe group of indigenous patients versus 135 days of remission in the non-indigenous severe group. Conclusion Results obtained may advance tailored intervention in alcohol-dependent patients of the indigenous Tuvinian ethnicity. While little is still known about the alcohol dependence course and consequences in the indigenous Tuvinians of Siberia, this study contributes to the global mental health data on alcohol abuse and dependence in indigenous communities.
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Affiliation(s)
- Anastasia Peshkovskaya
- Tomsk State University, Tomsk, Russia
- Mental Health Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
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Ferreira S, Virgolino A, Ribeiro C, Pombo S, Bacelar-Nicolau L. Effectiveness of Neuropsychological Rehabilitation in the Recovery of Executive Deficits in Patients with Alcohol Use Disorder: A Systematic Review Protocol. ACTA MEDICA PORT 2024; 37:262-266. [PMID: 37668530 DOI: 10.20344/amp.19804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/29/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Changes in executive functions associated with alcohol consumption are frequently found in alcohol use disorder. Neuropsychological rehabilitation can play an essential role as an effective treatment in the recovery from these deficits, leading to the maintenance of abstinence. However, there are still some uncertainties regarding its impact on the recovery of deficits in executive functions. Our purpose is to present a protocol for a systematic review aiming to assess which neuropsychological rehabilitation programs are effective in the recovery of executive deficits in patients with alcohol use disorder. METHODS We will search the following databases: PubMed, Cochrane Library (CENTRAL), Web of Science, and Scopus, as well as the list of references of the identified studies. Screening, data extraction, and synthesis, as well as evaluation of the risk of bias, will be carried out by two reviewers independently, using ROBINS-I and RoB 2. Disagreements will be resolved using a third additional reviewer. Primary outcomes will correspond to changes in executive functions, following a neuropsychological rehabilitation program in patients with alcohol use disorder. The evidence will be synthesized using a narrative description of neuropsychological rehabilitation programs and the indicators of their effectiveness will be identified. The neuropsychological rehabilitation programs for executive functions will be assessed considering their different components and their impact on the recovery of these functions. The review described in this protocol will allow the development of guidelines for the design of more effective rehabilitation programs for clinical populations with alcohol use disorder.
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Affiliation(s)
- Sónia Ferreira
- Unidade de Tratamento e Reabilitação de Alcoólicos. Centro Hospitalar Psiquiátrico de Lisboa. Lisboa; Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Ana Virgolino
- Instituto de Saúde Ambiental. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Laboratório Associado TERRA. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Cristina Ribeiro
- Faculdade de Medicina. Universidade de Lisboa. Lisboa; Instituto de Medicina Preventiva e Saúde Pública. Clínica Universitária de Medicina Geral e Familiar. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Samuel Pombo
- Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Leonor Bacelar-Nicolau
- Instituto de Saúde Ambiental. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Laboratório Associado TERRA. Faculdade de Medicina. Universidade de Lisboa. Lisboa; Instituto de Medicina Preventiva e Saúde Pública & Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática). Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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3
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Powell A, Sumnall H, Smith J, Kuiper R, Montgomery C. Recovery of neuropsychological function following abstinence from alcohol in adults diagnosed with an alcohol use disorder: Systematic review of longitudinal studies. PLoS One 2024; 19:e0296043. [PMID: 38166127 PMCID: PMC10760842 DOI: 10.1371/journal.pone.0296043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/05/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Alcohol use disorders (AUD) associate with structural and functional brain differences, including impairments in neuropsychological function; however, reviews (mostly cross-sectional) are inconsistent with regards to recovery of such functions following abstinence. Recovery is important, as these impairments associate with treatment outcomes and quality of life. OBJECTIVE(S) To assess neuropsychological function recovery following abstinence in individuals with a clinical AUD diagnosis. The secondary objective was to assess predictors of neuropsychological recovery in AUD. METHODS Following the preregistered protocol (PROSPERO: CRD42022308686), APA PsycInfo, EBSCO MEDLINE, CINAHL, and Web of Science Core Collection were searched between 1999-2022. Study reporting follows the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis, study quality was assessed using the JBI Checklist for Cohort Studies. Eligible studies were those with a longitudinal design that assessed neuropsychological recovery following abstinence from alcohol in adults with a clinical diagnosis of AUD. Studies were excluded if participant group was defined by another or co-morbid condition/injury, or by relapse. Recovery was defined as function reaching 'normal' performance. RESULTS Sixteen studies (AUD n = 783, controls n = 390) were selected for narrative synthesis. Most functions demonstrated recovery within 6-12 months, including sub-domains within attention, executive function, perception, and memory, though basic processing speed and working memory updating/tracking recovered earlier. Additionally, verbal fluency was not impaired at baseline (while verbal function was not assessed compared to normal levels), and concept formation and reasoning recovery was inconsistent. CONCLUSIONS These results provide evidence that recovery of most functions is possible. While overall robustness of results was good, methodological limitations included lack of control groups, additional methods to self-report to confirm abstinence, description/control for attrition, statistical control of confounds, and of long enough study durations to capture change.
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Affiliation(s)
- Anna Powell
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
| | - Harry Sumnall
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Jessica Smith
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Rebecca Kuiper
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
| | - Catharine Montgomery
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, United Kingdom
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Jia-Richards M, Sexton JN, Dolan SL. Predicting alcohol use with subjective and objective measures of cognitive function in healthy college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:2929-2937. [PMID: 34871531 DOI: 10.1080/07448481.2021.2007934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 08/04/2021] [Accepted: 10/17/2021] [Indexed: 06/13/2023]
Abstract
Objective: The current study examined the association between subjective and objective cognitive measures and alcohol use in college students. Objective cognitive impairment is associated with alcohol use, however subjective cognitive impairment remains understudied in at-risk populations. Participants: Data were collected from 140 undergraduate students at a mid-sized private university. Methods: We used the Behavior Rating Inventory for Executive Function-Adult (BRIEF-A) and the Rey-Osterrieth Complex Figure Task (ROCF) as our subjective and objective measures of cognitive functioning respectively. Results: In our regression model, the BRIEF-A was significantly associated with the AUDIT in college students such that more poorly perceived cognitive functioning predicted higher degrees of problematic drinking. However, the relationship between the ROCF and drinking was less clear. Conclusions: Our study shows that perception of one's cognitive functioning is related to alcohol use and may be a potential risk factor for hazardous drinking in college students. Our results also suggest that subjective functioning is more strongly related to alcohol use than objective functioning, however further research is needed to replicate our results.
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Affiliation(s)
- Meilin Jia-Richards
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Jennifer N Sexton
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Sara L Dolan
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
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Maurage P, Rolland B, Pitel AL, D'Hondt F. Five Challenges in Implementing Cognitive Remediation for Patients with Substance Use Disorders in Clinical Settings. Neuropsychol Rev 2023:10.1007/s11065-023-09623-1. [PMID: 37843739 DOI: 10.1007/s11065-023-09623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
Many patients with substance use disorders (SUDs) present cognitive deficits, which are associated with clinical outcomes. Neuropsychological remediation might help rehabilitate cognitive functions in these populations, hence improving treatment effectiveness. Nardo and colleagues (Neuropsychology Review, 32, 161-191, 2022) reviewed 32 studies applying cognitive remediation for patients with SUDs. They underlined the heterogeneity and lack of quality of studies in this research field but concluded that cognitive remediation remains a promising tool for addictive disorders. We capitalize on the insights of this review to identify the key barriers that currently hinder the practical implementation of cognitive remediation in clinical settings. We outline five issues to be addressed, namely, (1) the integration of cognitive remediation in clinical practices; (2) the selection criteria and individual factors to consider; (3) the timing to be followed; (4) the priority across trained cognitive functions; and (5) the generalization of the improvements obtained. We finally propose that cognitive remediation should not be limited to classical cognitive functions but should also be extended toward substance-related biases and social cognition, two categories of processes that are also involved in the emergence and persistence of SUDs.
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Affiliation(s)
- Pierre Maurage
- Louvain Experimental Psychopathology Research Group (LEP), Psychological Science Research Institute, UCLouvain, Louvain-La-Neuve, Belgium.
- Faculté de Psychologie, Place du Cardinal Mercier, 10, B-1348, Louvain-La-Neuve, Belgium.
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, CH Le Vinatier, Lyon, France & PSYR, CRNL, INSERM U1028, CNRS UMR5292, UCBL1, Lyon, France
| | - Anne-Lise Pitel
- Normandie Univ, UNICAEN, INSERM, U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), Institut Blood and Brain @ Caen-Normandie, Cyceron, France
| | - Fabien D'Hondt
- Univ. Lille, Inserm, CHU Lille, U1172-LilNCog-Lille Neuroscience & Cognition, Lille, France
- Centre National de Ressources Et de Résilience Lille-Paris (CN2R), Lille, France
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Ikuta T, Kessler PB, Swoboda AM, Fisher AK. Arcuate Fasciculus Microstructure Predicts Alcohol Dependence Risk through Higher IQ. Brain Sci 2023; 13:brainsci13010129. [PMID: 36672110 PMCID: PMC9856630 DOI: 10.3390/brainsci13010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/15/2022] [Accepted: 12/30/2022] [Indexed: 01/13/2023] Open
Abstract
IQ has been found to correlate with alcohol consumption, with a higher IQ being a risk for alcohol misuse. Furthermore, recent research has shown that the microstructure of the arcuate fasciculus is associated with IQ. This study therefore aimed to examine the association between the arcuate fasciculus microstructure, IQ, and alcohol dependence risk. In this study, we performed probabilistic tractography between Wernicke's and Broca's areas in the left and right hemispheres to examine the association of the arcuate fasciculus's integrity with IQ and alcohol dependence risk, using DTI data from 344 individuals. Data regarding IQ were obtained from the Wechsler Abbreviated Scale of Intelligence (WASI-II). Alcohol substance involvement (SI) score was derived using the National Institute on Drug Abuse (NIDA) Quick Screen and was used as an index for alcohol dependence risk. Both the left arcuate fasciculus and IQ were found to have a significant association with alcohol dependence risk. A mediation analysis revealed that this association between the left arcuate fasciculus microstructure and an alcohol dependence risk was mediated by IQ. It is suggested that the left arcuate fasciculus microstructure is associated with IQ which is associated with alcohol dependence risk. While alcohol consumption is known to be robustly toxic to the brain, the left arcuate fasciculus shows exceptional characteristics in which its microstructure integrity is positively associated with an alcohol dependence risk through higher IQ. Clinical implications are discussed.
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Affiliation(s)
- Toshikazu Ikuta
- Department of Communication Sciences and Disorders, University of Mississippi, Oxford, MS 38677, USA
- Correspondence:
| | - Paige B. Kessler
- Department of Communication Sciences and Disorders, University of Mississippi, Oxford, MS 38677, USA
| | - Alexandria M. Swoboda
- Department of Communication Sciences and Disorders, University of Mississippi, Oxford, MS 38677, USA
| | - Amy K. Fisher
- Department of Social Work, University of Mississippi, Oxford, MS 38677, USA
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Charlton AJ, Perry CJ. The Effect of Chronic Alcohol on Cognitive Decline: Do Variations in Methodology Impact Study Outcome? An Overview of Research From the Past 5 Years. Front Neurosci 2022; 16:836827. [PMID: 35360176 PMCID: PMC8960615 DOI: 10.3389/fnins.2022.836827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022] Open
Abstract
Excessive alcohol use is often associated with accelerated cognitive decline, and extensive research using animal models of human alcohol consumption has been conducted into potential mechanisms for this relationship. Within this literature there is considerable variability in the types of models used. For example, alcohol administration style (voluntary/forced), length and schedule of exposure and abstinence period are often substantially different between studies. In this review, we evaluate recent research into alcohol-induced cognitive decline according to methodology of alcohol access, as well as cognitive behavioral task employed. Our aim was to query whether the nature and severity of deficits observed may be impacted by the schedule and type of alcohol administration. We furthermore examined whether there is any apparent relationship between the amount of alcohol consumed and the severity of the deficit, as well as the potential impact of abstinence length, and other factors such as age of administration, and sex of subject. Over the past five years, researchers have overwhelmingly used non-voluntary methods of intake, however deficits are still found where intake is voluntary. Magnitude of intake and type of task seem most closely related to the likelihood of producing a deficit, however even this did not follow a consistent pattern. We highlight the importance of using systematic and clear reporting styles to facilitate consistency across the literature in this regard. We hope that this analysis will provide important insights into how experimental protocols might influence findings, and how different patterns of consumption are more or less likely to produce an addiction-vulnerable cognitive phenotype in animal models.
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Affiliation(s)
- Annai J. Charlton
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Christina J. Perry
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
- School of Psychological Sciences, Centre for Emotional Health, Macquarie University, North Ryde, NSW, Australia
- *Correspondence: Christina J. Perry,
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Ottonello M, Torselli E, Caneva S, Fiabane E, Vassallo C, Pistarini C. Mental Imagery Skills in Alcohol-Dependent Subjects and Their Associations With Cognitive Performance: An Exploratory Study During Residential Rehabilitation. Front Psychiatry 2021; 12:741900. [PMID: 34912249 PMCID: PMC8666508 DOI: 10.3389/fpsyt.2021.741900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/10/2021] [Indexed: 11/15/2022] Open
Abstract
People in alcohol-detoxification experience deficits in motor and non-motor functions including cognitive performance. Imagery, the cognitive process of generating visual, auditory or kinesthetic experiences in the mind without the presence of external stimuli, has been little studied in Alcohol Use Disorders (AUD). This pilot study aims to observe the cognitive abilities useful for the inspection, maintenance, generation and manipulation of images in these patients during residential rehabilitation and investigate the relationships with their cognitive performance. Thirty-six subjects who completed the 28-day rehabilitation program for alcohol addiction, completed the Mental Imagery Test (MIT) and Neuropsychological Battery (ENB-2). The global score at MIT did not show pathological scores. The 11.1% of AUD patients showed an impaired global score in the cognitive performance and the 5.7% with scoring at limits of norm. Significant correlations were found between Mental Imagery abilities and ENB-2 subscale and stepwise regression analysis showed the close association between the ability of imagery (Mental Imagery Test) and the overall cognitive performance (ENB-2) in alcohol dependent patients and this relationship is stronger than other cognitive tasks.
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Affiliation(s)
- Marcella Ottonello
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici (ICS) Maugeri Spa SB, Genoa, Italy
| | - Elisa Torselli
- School of Psychotherapy, Miller Institute for Behavioral and Cognitive Therapy, Genoa, Italy
| | - Stefano Caneva
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Elena Fiabane
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici (ICS) Maugeri Spa SB, Genoa, Italy
| | - Claudio Vassallo
- Department of Physical and Rehabilitation Medicine of Genova Nervi Institute, Istituti Clinici Scientifici (ICS) Maugeri Spa SB, Genoa, Italy
| | - Caterina Pistarini
- Department of Neurorehabilitation Medicine of Pavia Institute, Istituti Clinici Scientifici (ICS) Maugeri, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) Spa SB, Pavia, Italy
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Maillard A, Laniepce A, Cabé N, Boudehent C, Chételat G, Urso L, Eustache F, Vabret F, Segobin S, Pitel AL. Temporal Cognitive and Brain Changes in Korsakoff Syndrome. Neurology 2021; 96:e1987-e1998. [PMID: 33637634 DOI: 10.1212/wnl.0000000000011749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate cognitive and brain changes in patients with Korsakoff syndrome (KS) over months and up to 10 years after the diagnosis. METHODS Two groups of 8 patients with KS underwent neuropsychological, motor, and neuroimaging investigations, including structural MRI and 18F-fluorodeoxyglucose-PET. The KSC group, recruited at Caen University Hospital, was examined early after the KS diagnosis (KSC-T1) and 1 year later (KSC-T2). The KSR group, recruited at nursing home at Roubaix, was evaluated 10 years after the diagnosis. Longitudinal comparisons in KSC explored short-term changes, while cross-sectional comparisons between KSC-T1 and KSR informed about long-term changes. RESULTS No cognitive, motor, or brain deterioration occurred over time in patients with KS. There was no clear improvement either, with only modest recovery in the frontocerebellar circuit. Compared to the norms, KSC-T1 had severe episodic memory impairments, ataxia, and some executive dysfunctions. They also presented widespread atrophy and hypometabolism as well as cerebellar hypermetabolism compared to 44 healthy matched controls. Episodic memory remained significantly impaired in KSC-T2 and KSR. Contrary to KSC at T1 and T2, KSR had preserved inhibition abilities. Atrophy was similar but less extended in KSC-T2 and even more limited in KSR. At all times, the thalamus, hypothalamus, and fornix remained severely atrophied. Hypometabolism was still widespread in KSC-T2 and KSR, notably affecting the diencephalon. Cerebellar metabolism decreased over time and normalized in KSR, whereas motor dysfunction persisted. CONCLUSION In KS, structural and metabolic alterations of the Papez circuit persisted over time, in accordance with the irreversible nature of amnesia. There was neither significant recovery as observed in patients with alcohol use disorder nor progressive decline as in neurodegenerative diseases.
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Affiliation(s)
- Angéline Maillard
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Alice Laniepce
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Nicolas Cabé
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Céline Boudehent
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Gael Chételat
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Laurent Urso
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Francis Eustache
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - François Vabret
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Shailendra Segobin
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
| | - Anne-Lise Pitel
- From Normandie Université (A.M., A.L., N.C., C.B., F.E., F.V., S.S., A.-L.P.), UNICAEN, PSL Université Paris, EPHE, INSERM, U1077, CHU de Caen, GIP Cyceron, Neuropsychologie et Imagerie de la Mémoire Humaine; Service d'addictologie (N.C., C.B., F.V.), Centre Hospitalier Universitaire de Caen; Normandie Université (G.C.), UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders," Institut Blood and Brain at Caen-Normandie, Cyceron, Caen; Service d'addictologie (L.U.), Centre Hospitalier de Roubaix; and Institut Universitaire de France (A.-L.P.), Paris
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10
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Visuoperceptive Impairments in Severe Alcohol Use Disorder: A Critical Review of Behavioral Studies. Neuropsychol Rev 2021; 31:361-384. [PMID: 33591477 DOI: 10.1007/s11065-020-09469-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/29/2020] [Indexed: 01/13/2023]
Abstract
The present literature review is aimed at offering a comprehensive and critical view of behavioral data collected during the past seventy years concerning visuoperception in severe alcohol use disorders (AUD). To pave the way for a renewal of research and clinical approaches in this very little understood field, this paper (1) provides a critical review of previous behavioral studies exploring visuoperceptive processing in severe AUD, (2) identifies the alcohol-related parameters and demographic factors that influence the deficits, and (3) addresses the limitations of this literature and their implications for current clinical strategies. By doing so, this review highlights the presence of visuoperceptive deficits but also shows how the lack of in-depth studies exploring the visual system in this clinical population results in the current absence of integration of these deficits in the dominant models of vision. Given the predominance of vision in everyday life, we stress the need to better delineate the extent, the specificity, and the actual implications of the deficits for severe AUD.
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11
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Caballeria E, Oliveras C, Nuño L, Balcells-Oliveró M, Gual A, López-Pelayo H. A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions. Psychol Med 2020; 50:2113-2127. [PMID: 32840195 DOI: 10.1017/s0033291720002925] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Alcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.
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Affiliation(s)
- Elsa Caballeria
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Clara Oliveras
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Laura Nuño
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Mercedes Balcells-Oliveró
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
| | - Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic Barcelona, RETICS (Red de Trastornos adictivos), University of Barcelona, Villarroel, 170, 08036Barcelona, Spain
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12
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Antonucci LA, Nettis MA, Juckel G, Roser P, Pergola G, Thoma P. Selective recall deficits for heterogeneous associations in detoxified individuals with alcohol use disorder. Behav Brain Res 2020; 390:112688. [PMID: 32407822 DOI: 10.1016/j.bbr.2020.112688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 11/15/2022]
Abstract
AIM Alcohol use disorder (AUD) has been associated with recognition memory deficits. However, it remains unclear whether these deficits occur at the general recognition memory level or whether they selectively affect its subcomponents. Evidence suggests that recognition memory deficits may vary according to the heterogeneity of memory stimuli. Our aim was to investigate stimuli pair-dependent recognition memory deficits in AUD, using a cued recall task including homogeneous and heterogeneous stimuli pairs. METHODS Twenty-three patients with AUD (days since last alcohol consumption: 11.70 ± 10.20) and 23 healthy controls (HC) underwent a neuropsychological examination tapping attention, verbal fluency, logical, working and long-term memory, and a recognition and recall task involving both homogeneous (tool-tool) and heterogeneous (tool-scene, tool-animal) stimuli pairs. Group (AUD-HC) by condition (tool-tool, tool-scene, tool-animal) ANOVAs were performed on all neuropsychological indices. RESULTS In the neuropsychological examination, AUD individuals showed deficits in delayed recall and faster reaction times compared with HC. The administration of the recognition and recall task revealed specific performance decreases in cued recall occurring in the whole sample (AUD + HC) for heterogeneous (tool-scene, tool-animal) pairs compared with homogeneous pairs. Within this pattern, AUD patients showed a lower cued recall rate than HC only for tool-animal pairs. CONCLUSIONS Our results support the existence of specific recall/recollection deficits in AUD which occurred for heterogeneous, but not for homogeneous stimuli pairs. This finding calls for further neuroimaging investigations aimed at investigating the neurobiological substrate of (i) different recognition memory subcomponents, and (ii) the processing of stimuli with different degree or type of heterogeneity.
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Affiliation(s)
- Linda A Antonucci
- Department of Education, Psychology, Communication, University of Bari Aldo Moro, Bari, Italy; Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, Munich, Germany.
| | - Maria A Nettis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, United Kingdom
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Patrik Roser
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Giulio Pergola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy; Clinical Neuropsychology, Neuropsychological Therapy Centre, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany; Lieber Institute for Brain Development, Baltimore, USA
| | - Patrizia Thoma
- Clinical Neuropsychology, Neuropsychological Therapy Centre, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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13
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Maillard A, Poussier H, Boudehent C, Lannuzel C, Vicente A, Vabret F, Cabe N, Pitel AL. Short-term neuropsychological recovery in alcohol use disorder: A retrospective clinical study. Addict Behav 2020; 105:106350. [PMID: 32070907 DOI: 10.1016/j.addbeh.2020.106350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuropsychological impairments found in recently detoxified patients with alcohol use disorder (AUD) can limit the benefit of psychosocial treatments and increase the risk of relapse. These neuropsychological deficits are reversible with abstinence. The aim of this retrospective clinical study was to investigate whether a short-term stay as inpatients in a convalescent home enables neuropsychological deficits observed in recently detoxified AUD patients to recover and even performance to return to normal. METHODS Neuropsychological data were collected in 84 AUD patients. Five neuropsychological components were assessed before and after a three-week stay in a convalescent home offering multidisciplinary support. Baseline and follow-up performance were compared in the entire group of patients and in subgroups defined by the nature and intensity of the therapy (OCCASIONAL: occasional occupational and physical therapy; INTENSIVE: intensive occupational and physical therapy and neuropsychological training). RESULTS In the entire group of patients, neuropsychological performance significantly improved between baseline and follow-up for all 5 components and even returned to a normal level for 4 of them. The ratio of patients with impaired performance was significantly lower at follow-up than baseline examination for 3 components in the INTENSIVE group only. CONCLUSION Recently detoxified AUD patients with cognitive deficits benefit from a short-term stay in an environment ensuring sobriety and healthy nutrition. Cognitive recovery may be enhanced by intensive care including neuropsychological training. Alcohol programs could be postponed in patients with cognitive deficits in order to offer psychosocial treatment when patients are cognitively able to benefit from it.
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14
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Effects of abstinence of alcohol on neurocognitive functioning in patients with alcohol dependence syndrome. Asian J Psychiatr 2020; 50:101997. [PMID: 32145693 DOI: 10.1016/j.ajp.2020.101997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 11/20/2022]
Abstract
AIMS Alcohol dependence causes impairment of neurocognitive functions. Abstinence for some time leads to improvement in neurocognitive functions. This study was conducted with the aim to observe the effects of abstinence on neurocognition. METHODS The current study was an observational, single group with longitudinal design exploring the effect of abstinence on neuropsychological functioning and further exploring correlation of clinical factors with neuropsychological functioning in patients with Alcohol Dependence Syndrome (ADS). Sixty consecutive male patients of ADS meeting inclusion and exclusion criteria were inducted. Neurocognitive tests were applied at baseline, one month and three months of abstinence. RESULTS All neurocognitive functions showed significant improvement at three-time intervals (p < 0.05) except for visuomotor function, for which improvement was statistically insignificant (p > 0.05) at one month. The difference for scores on verbal fluency, working memory, set-shifting (WCST total trials and perseverative errors) and visuomotor function from 0 to 3 months was significant (p < 0.05). There was significant interaction (p < 0.05) between duration of regular but non-dependent use, total duration of use, duration of dependence, average intake per day, last intake and time period with verbal fluency, working memory, set -shifting (for WCST total trials, total errors, perseverative errors and non-perseverative errors) and visuomotor function. CONCLUSION The study showed improvement in neurocognitive functions with abstinence over three months, suggesting the need to address these cognitive deficits in the early part of abstinence. Also, correlates for drinking history were identified which may help in the future for the prevention and management of cognitive deficits in ADS patients.
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15
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Dixit V, Kumar S, Chaudhury S. Neuropsychological dysfunctions among chronic schizophrenia patients, alcohol dependence cases, and normal subjects: A comparative study. Ind Psychiatry J 2020; 29:105-122. [PMID: 33776284 PMCID: PMC7989451 DOI: 10.4103/ipj.ipj_70_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/27/2020] [Indexed: 11/04/2022] Open
Abstract
AIM The aim of this study is to assess the neuropsychological profiles of chronic schizophrenia and alcohol-dependent subjects. MATERIALS AND METHODS This hospital-based cross-sectional study included 30 chronic schizophrenia patients, 30 alcohol-dependent patients and 30-matched normal controls. Demographic and clinical data were collected on a self-designed pro forma. Positive and Negative Syndrome Scale (PANSS) and Severity of Alcohol Dependence Questionnaire (SADQ-C) were administered to chronic schizophrenia and alcohol-dependent patients, respectively. The AIIMS Comprehensive Neuropsychological Battery in Hindi (Adult Form) was used to assess neuropsychological dysfunctions. RESULTS Neuropsychological dysfunctions were found in 83.3% of chronic schizophrenia patients, 36.7% alcohol dependents and none of the normal subjects. In comparison to normal subjects, schizophrenia patients had significantly more dysfunctions in neuropsychological-domains such as motor, tactile, visual, receptive and expressive speech, reading, writing, arithmetic, memory, and intellectual processes. A significant positive correlation was found between the PANSS total score and T scores of most of the clinical scales except motor and visual scales; the PANSS general psychopathology score and T scores of most of the clinical scales except motor visual and pathognomonic scales; the PANSS negative score and T scores of most of the clinical scales except visual scale; and the PANSS positive score and T scores of receptive speech, arithmetic, and memory scales. In comparison to normal subjects, the alcohol dependents had significantly more dysfunctions in neuropsychological-domains such as motor, tactile, visual, receptive and expressive speech, reading, writing, arithmetic, and memory. A significant positive correlation was found between the SADQ total scale and T scores of clinical scales such as expressive speech, writing, arithmetic, intellectual processes, left hemisphere, and total battery scales. CONCLUSIONS Neuropsychological dysfunction was significantly more common and severe in chronic schizophrenia patients than in alcohol-dependent patients. In comparison to alcohol dependents, the chronic schizophrenia patients had more dysfunctions in neuropsychological-domains such as tactile, arithmetic, memory, and intellectual processes.
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Affiliation(s)
- Vidhata Dixit
- Department of Clinical Psychology, RINPAS, Ranchi, Jharkhand, India
| | - Santosh Kumar
- Department of Psychiatry, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
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Branco LD, Cotrena C, Shansis FM, Fonseca RP. Cognitive abilities underlying performance on the modified card sorting test: novel and traditional scores. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 28:544-555. [PMID: 31530030 DOI: 10.1080/23279095.2019.1663522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Modified Card Sorting Test (MCST) is a widely used variation of the Wisconsin Card Sorting Test. It is faster to administer, less frustrating for respondents and less ambiguous in its scoring but has been criticized for its task impurity and low discriminability between control participants and clinical groups prone to executive dysfunction. This study aimed to examine the executive functions (EF) underlying traditional (number of categories completed, perseverative errors) and novel scores for the MCST, and compare their ability to differentiate between control and clinical samples. Novel and traditional MCST scores were compared between 94 control participants, 87 with bipolar disorder and 64 with major depression. The relationship between MCST scores and traditional EF tasks was examined through correlation and regression analyses. All MCST scores were associated with at least one measure of EF, the most common of which were the Trail Making or Hayling Tests. IQ predicted most scores on the MCST, save for nonperseverative errors and categorizing efficiency. Traditional and novel scores differentiated between clinical and control groups. These findings support the utility of the MCST in detecting executive dysfunction and highlight the importance of new scoring methods in increasing the specificity and interpretability of this task.
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Affiliation(s)
- Laura Damiani Branco
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Charles Cotrena
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Rochele Paz Fonseca
- Graduate Department of Psychology, School of Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
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