Browsing by Author "Martins, Isabel Pavão"
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- Cognitive aging in migraine sufferers is associated with more subjective complaints but similar age-related decline: a 5-year longitudinal studyPublication . Martins, Isabel Pavão; Maruta, Carolina; Alves, Pedro Nacimento; Loureiro, Clara; Morgado, Joana; Tavares, Joana; Gil-Gouveia, RaquelObjectives and background: The effect of headache on cognitive performance is controversial, due to conflicting results obtained from studies in clinical or population settings. We aimed to understand if migraine and other headaches modify the rates of decline on different cognitive measures, during a 5-year interval. Design and method: A cohort of community dwelling adults (> 50 years) with migraine (MH), non-migraine headaches (NMH) and controls without headache (WoH), was assessed by a comprehensive neuropsychological battery with tests of memory, language and executive functions, repeated 5 years apart. Change in performance between baseline and reevaluation was compared between groups, and controlled for age, gender, literacy and depressive symptoms. Results: A total of 275 participants (78.5% WoH, 12.7% MH, 8.7% NMH) were reevaluated (average age 70.40 + 8.34 years, 64% females). Cognitive decline or dementia occurred in 11.4%, with a similar proportion among the three groups. Although MH participants had significantly more subjective cognitive complaints (p = 0.030, 95%CI:]-3.929,-0.014[), both MH and NMH subjects showed an age-associated decline identical to controls. Furthermore, migraine features (disease and attack duration, frequency and aura) were unrelated with cognitive performance. Conclusion: Migraine and non-migraine headache are not associated with increasing risk of dementia or cognitive decline at an older age although subjects with migraine have more cognitive complaints. Longer longitudinal studies are necessary to understand if this pattern persists for more than 5 years.
- Cognitive performance along the migraine cycle: a negative exploratory studyPublication . Quadros, Maria Ana; Granadeiro, Marta; Ruiz-Tagle, Amparo; Maruta, Carolina; Gil-Gouveia, Raquel; Martins, Isabel PavãoMigraine patients frequently report cognitive difficulties in the proximity and during migraine attacks. We performed an exploratory comparison of executive functioning across the four stages of the migraine cycle. Consecutive patients with episodic migraine undertook cognitive tests for attention, processing speed, set-shifting, and inhibitory control. Performance was compared between patients in different migraine stages, controlling for attack frequency and prophylactic medication. One hundred forty-three patients (142 women, average age 36.2 ± 9.9 years) were included, 28 preictal (≤48 h before the attack), 21 ictal (during the attack), 18 postictal (≤24 h after attack), and 76 interictal. Test performance (age and literacy adjusted z-scores) was not significantly different across migraine phases, despite a tendency for a decline before the attack. This negative study shows that cognitive performance fluctuates as patients approach the attack. To control for individual variability, this comparison needs to be better characterized longitudinally with a within-patient design.
- Cranial autonomic symptoms and neck pain in differential diagnosis of migrainePublication . Vicente, Beatriz Nunes; Oliveira, Renato; Martins, Isabel Pavão; Gil-Gouveia, RaquelCranial autonomic symptoms and neck pain have been reported to be highly prevalent in migraine, although they are rarely considered in clinical evaluation. The aim of this review is to focus on the prevalence, pathophysiology, and clinical characteristics of these two symptoms, and their importance in the differential diagnosis between migraines and other headaches. The most common cranial autonomic symptoms are aural fullness, lacrimation, facial/forehead sweating, and conjunctival injection. Migraineurs experiencing cranial autonomic symptoms are more likely to have more severe, frequent, and longer attacks, as well as higher rates of photophobia, phonophobia, osmophobia, and allodynia. Cranial autonomic symptoms occur due to the activation of the trigeminal autonomic reflex, and the differential diagnosis with cluster headaches can be challenging. Neck pain can be part of the migraine prodromal symptoms or act as a trigger for a migraine attack. The prevalence of neck pain correlates with headache frequency and is associated with treatment resistance and greater disability. The convergence between upper cervical and trigeminal nociception via the trigeminal nucleus caudalis is the likely mechanism for neck pain in migraine. The recognition of cranial autonomic symptoms and neck pain as potential migraine features is important because they often contribute to the misdiagnosis of cervicogenic problems, tension-type headache, cluster headache, and rhinosinusitis in migraine patients, delaying appropriate attack and disease management.
- Gestão das cefaleias em Portugal: consenso das Sociedades Portuguesas de cefaleias e neurologia, associação portuguesa de medicina geral e familiar e MiGRAPublication . Gil-Gouveia, Raquel; Parreira, Elsa; Martins, Isabel Pavão; Luzeiro, Isabel; Pereira, Raúl Marques; Plácido, Madalena; Palavra, FilipeAs cefaleias são uma causa significativa de incapacidade a nível global, com a enxaqueca a ocupar o segundo lugar entre as doenças com mais anos vividos com incapacidade. A maioria dos doentes com cefaleias, incluindo enxaqueca, podem e devem ser diagnosticados, tratados e acompanhados eficazmente nos cuidados de saúde primários. Isso não só reduz a incapacidade associada a estas patologias, mas também previne a progressão para formas crónicas ou o uso excessivo de medicamentos. A criação de uma rede eficiente de referenciação, envolvendo associações de doentes e profissionais de saúde além dos cuidados primários, é essencial para garantir o apoio necessário em casos mais complexos e para promover a saúde da população de forma ágil e atempada. Estas orientações para diagnóstico, terapêutica e referenciação resultam de um consenso entre a Sociedade Portuguesa de Cefaleias, Sociedade Portuguesa de Neurologia, Associação Portuguesa de Medicina Geral e Familiar, e a MiGRA Portugal, associação portuguesa de doentes com enxaqueca e cefaleias. Este documento foi elaborado para capacitar todos os médicos a contribuir de forma eficaz no tratamento destas patologias.
- Locations of objects are better remembered than their identities in naturalistic scenes: an eye-tracking experiment in mild cognitive impairmentPublication . Coco, Moreno I.; Maruta, Carolina; Martins, Isabel Pavão; Sala, Sergio DellaObjective: Retaining the identity or location of decontextualized objects in visual short-term working memory (VWM) is impaired by healthy and pathological ageing, but research remains inconclusive on whether these two features are equally impacted by it. Moreover, it is unclear whether similar impairments would manifest in naturalistic visual contexts. Method: 30 people with mild cognitive impairment (MCI) and 32 age-matched control participants (CPs) were eye-tracked within a change detection paradigm. They viewed 120 naturalistic scenes, and after a retention interval (1 s) asked whether a critical object in the scene had (or not) changed on either: identity (became a different object), location (same object but changed location), or both (changed in location and identity). Results: MCIs performed worse than CP but there was no interaction with the type of change. Changes in both were easiest while changes in identity alone were hardest. The latency to first fixation and first-pass duration to the critical object during successful recognition was not different between MCIs and CPs. Objects that changed in both features took longer to be fixated for the first time but required a shorter first pass compared to changes in identity alone which displayed the opposite pattern. Conclusions: Locations of objects are better remembered than their identities; memory for changes is best when involving both features. These mechanisms are spared by pathological ageing as indicated by the similarity between groups besides trivial differences in overall performance. These findings demonstrate that VWM mechanisms in the context of naturalistic scene information are preserved in people with MCI.
- May subjective language complaints predict future language decline in community-dwelling subjects?Publication . Maruta, Carolina; Martins, Isabel PavãoSubjective cognitive complaints are rather prevalent in the elderly population and are associated with an increased risk of cognitive impairment and dementia. However, the predictive role of specific types of cognitive complaints has been less systematically assessed. The aim of the present study is to examine the predictive value of language complaints for cognitive and language decline in a cohort of community-dwelling healthy older adults, followed longitudinally over a 5-year period. A total of 402 subjects were enrolled in a prospective longitudinal study on aging and cognition. Participants answered a cognitive complaints questionnaire including two questions directed to language and were classified at baseline as having “Language Complaints” (LC) or “No Language Complaints” (NLC). They also performed a neuropsychological assessment tackling attention/processing speed, memory, executive functioning, and language at baseline. From these, 275 (68.4%) participated in a follow-up evaluation 4.9 (±0.6) years later. At re-evaluation, subjects had a mean age of 70.4 (±8.3) years, 7.5 (±4.4) years of education, and 63.3% were female. Multivariate linear regression analysis was used to investigate whether language complaints at baseline predicted poorer language performance at follow-up or increased the risk of cognitive decline, with correction for sex, depressive symptoms, living status, baseline performance, and composite memory and executive performance. Results indicated that LC subjects had significantly worse performances than NLC subjects on semantic fluency 5 years later, but with a similar rate of decline overtime that was not associated with a follow-up outcome of cognitive decline/dementia. Language difficulties may represent a specific type of age-related cognitive complaints. Longer follow-ups are necessary to understand if they are associated with an increased risk of language or cognitive decline.
- Uncovering longitudinal changes in the brain functional connectome along the migraine cycle: a multilevel clinical connectome fingerprinting frameworkPublication . Esteves, Inês; Fouto, Ana R.; Ruiz-Tagle, Amparo; Caetano, Gina; Nunes, Rita G.; Silva, Nuno A. da; Vilela, Pedro; Martins, Isabel Pavão; Gil-Gouveia, Raquel; Caballero-Gaudes, César; Figueiredo, PatríciaChanges in large-scale brain networks have been reported in migraine patients, but it remains unclear how these manifest in the various phases of the migraine cycle. Case-control fMRI studies spanning the entire migraine cycle are lacking, precluding a complete assessment of brain functional connectivity in migraine. Such studies are essential for understanding the inherent changes in the brain of migraine patients as well as transient changes along the cycle. Here, we leverage the concept of functional connectome (FC) fingerprinting, whereby individual subjects may be identified based on their FC, to investigate changes in FC and its stability across different phases of the migraine cycle.
- Working memory during spontaneous migraine attacks: an fMRI studyPublication . Ruiz-Tagle, A.; Figueiredo, Patrícia; Pinto, Joana; Vilela, Pedro; Martins, Isabel Pavão; Gil-Gouveia, RaquelObjective: To investigate the neural correlates of working memory during a spontaneous migraine attack compared to the interictal phase, using functional magnetic resonance imaging (fMRI). Background: Cognitive disturbances are commonly observed during migraine attacks, particularly in the headache phase. However, the neural basis of these changes remains unknown. Methods: In a fMRI within-subject test-retest design study, eleven women (32 years of age, average) with episodic migraine were evaluated twice, first during a spontaneous migraine attack, and again in a pain-free period. Each session consisted in a cognitive assessment and fMRI while performing a working memory task (N-back). Results: Cognitive test scores were lower during the ictal session than in the pain-free session. Regions typically associated with working memory were activated during the N-back task in both sessions. A voxel wise between session comparison showed significantly greater activation in the left frontal pole and orbitofrontal cortex during the attack relative to the interictal phase. Conclusion: Migraine patients exhibited greater activation of the left frontal pole and orbitofrontal cortex while executing a verbal working memory task during a spontaneous migraine attack when compared to the interictal state. Given the association of these regions with pain processing and inhibitory control, these findings suggest that patients recruit inhibitory areas to accomplish the cognitive task during migraine attacks, a neural signature of their cognitive difficulties.