Resumo

PALOMARES CASTILLO, Elizabeth et al. Cognitive function evaluation: attention and memory in panic disorder patients. Salud Ment [online]. 2010, vol.33, n.6, pp.481-488. ISSN 0185-3325.

Evidence from recent studies about the epidemiology of panic disorder (PD) indicates that it is present in 4.7% of general population. In Mexico City, 2.9% of females and 1.9% of males are affected by this disease. Due to the incidence cited above, it is considered an important mental health problem that has impacted social, labor and familiar areas. On the other hand, PD is frequently present in comorbidity with other disorders like major depression, social phobia and generalized anxiety disorder. Moreover, in some cases, it may lead to a suicide risk. PD is characterized by recurrent, unexpected panic attacks, and is commonly associated with agoraphobia. A panic attack is defined as a discrete period of fear or discomfort that includes physical, cognitive and behavioral symptoms. Physical symptoms comprise short breath, palpitations, sweating, dizziness, gastrointestinal discomfort, and chest pain. Cognitive symptoms are associated with catastrophic interpretation of bodily sensations; behavioral symptoms are mainly avoidant of different places, situations and actions that patient had associated with fear of loss of control. In the past few years there has been a growing interest in the neuropsychology of anxiety disorders. Neuropsychological evaluation is relevant because it implies an objective assessment of the cognitive and behavioral abilities and weaknesses that make possible the prediction of the course of the disorder and the effects of treatment modalities. One of the most important contributions of neuropsychological evaluation is the identification of stable patterns of cognitive profiles of a specific disorder considered as neurocognitive endophenotypes. Some recent studies have demonstrated the relationship between neuropsychological alterations and anxiety; nevertheless, most of them were observed in obsessive-compulsive disorder patients. On the other hand, studies examining neuropsychological functioning in PD patients are scarce and report conflicting results. The main objective of the present study was to evaluate whether PD patients with and without agoraphobia, who attended the National Institute of Psychiatry <<Ramón de la Fuente>> in Mexico City, showed neuropsychological impairments relative to healthy controls in attention, memory and executive functions. We studied a total sample of 48 subjects (24 patients with PD, the patients sample was selected according to a psychiatric evaluation, based on DSM-IV-TR criteria. Inclusion criteria were age between 19 and 56, men or women, without previous pharmacological or psychotherapeutically treatment; and 24 gender, age and education matched healthy control subjects). A neuropsychological test battery (Neuropsi Attention and Memory) in Spanish with norms by age and educational level was administered. The Neuropsi assesses orientation, attention and concentration, executive functions, working memory and immediate and delayed verbal and visual memory. Likewise, all patients were assessed with the Anxiety Sensitivity Index, Beck's Anxiety Inventory and Panic Disorder Severity Scale. According to this psychometric evaluation, the PD patients showed severe anxiety, high anxiety sensitivity, as well as a severe degree of panic symptoms. The differences between PD patients and control subjects in neuropsychological performance were determined through one way analysis of variance (p<0.05) with the assistance of the SPSS 12. The results of the present study indicate that the neuropsychological test performance of patients with PD is diminished relative to that of the health control. According to obtained results, there were significant differences in the total score of executive functions and attention, memory and global attention and memory between patients and healthy controls. In the analysis of different subscales, it was found that patients had reduced performance in visual search, digit backward span, world list free recall, Rey-Ostereith Complex Figure Test encoding and retrieval, word list cued recall, faces retrieval and in diverse executive functions like category formation test, semantic and phonological verbal fluency, as well as design fluency. This suggests that PD is associated with alterations in tasks that require flexibility in the mental processes, short-term memory, working memory, and in the generation of strategies to solve problems. However, it is possible that these alterations were present before the onset of panic disorder and predispose the ulterior development of this disorder. In the visual detection subscale, that evaluates selective attention, there were also differences in latency of response because patients were slower than healthy controls trying to find the correct figure. This deficiency is associated with the difficulty of PD patients to perceive important details of the environment due to the extreme attention in the corporal sensations. Besides, no group differences were found in orientation, attention and concentration. These findings are consistent with previous studies with PD patients, where impairments in verbal memory, executive functions and visuospatial memory were found. Nevertheless, these findings differ from the reported by others studies, where neuropsychological alterations in PD patients were found. These discrepancies could be due to methodological procedures in the sample selection, pharmacological treatment, intensity of anxiety, and the use of different neuropsychological instruments. In the present study, the clinical sample was characterized by absence of pharmacological and psychotherapeutic treatments before neuropsychological evaluation was done with the Neuropsi. A notable finding was that, in the face recognition subscale, patients had better scores than controls. This can be related to a previous reported finding, which suggested that PD patients pay more attention to the details of a face to evaluate if these are safe or unsafe before the possibility of having a panic attack. Also, it is possible to consider it like an special ability developed by these patients as a compensatory behavior before the disability caused by this disorder and the vulnerability they experience when not having control of their symptoms. In conclusion, we have demonstrated deficits in the visuospatial and verbal memory, and executive functions in PD patients. This finding supported a disturbance in the amygdaline fronto-temporal neural network in the disorder, related in the conditioned fear network involved in the etiology of panic disorder. Future neuropsychological studies will benefit from use of neuroimaging studies to examine pattern of brain activation and elucidate the pathophysiology features of the disorder. As well as determine whether cognitive performance varies as a function of severity of panic symptoms.

Palavras-chave : Panic disorder; neuropsychological assessment; memory; attention; executive functions.

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