Nutrition, Cognition and Emotion: Neuropsychological Foundations and Tools for Nutritionists

artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

DOI: https://doi.org/10.36489/saudecoletiva.2020v10i56p3056-3079 Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

Nutrición, cognición y emoción: fundamentos neuropsicológicos y herramientas para nutricionistas Nutrição, cognição e emoção: bases e instrumentos neuropsicológicos para nutricionistas

ABSTRACT There are several studies on the relationship between nutrition and cognition or nutrition and emotion. But the science of nutrition transcends nourishment and eating. It involves interrelated factors that need to be verified and used to better understand the individual and the populations served by the nutritionist and the proposition of ways to solve and/or improve these demands. To this end, there are tools that enhance dietary and nutritional assessment and provide a better understanding of dietary habit formation. This theoretical essay on neuropsychological instruments used for assessment of adults and elderly contributes to nutritional assessment, specifying cognitive functions and their relationships with nutritional and emotional factors of the individual. A survey of neuropsychological assessment instruments or those with cognitive and emotional constructs was performed. Cognitive evaluation and the relationship of emotion with food were verified. It is thought that this is a basic guide for the nutritionist to increase his assessment beyond the traditional. DESCRIPTORS: Nutrition; Cognition; Emotion; Neuropsychological Tests.

RESUMEN Existen varios estudios sobre la relación entre nutrición y cognición o nutrición y emoción. Sin embargo, la ciencia de la nutrición trasciende la nutrición y la alimentación. Se trata de factores interconectados que deben ser verificados y utilizados para com- prender mejor al individuo y las poblaciones atendidas por el nutricionista y la propuesta de formas de resolver y / o mejorar estas demandas. Para ello, existen instrumentos que aumentan la valoración alimentaria y nutricional y permiten un mejor conocimiento de la formación de hábitos alimentarios. Este ensayo teórico sobre los instrumentos neuropsicológicos utilizados para evaluar a adultos y ancianos contribuye a la evaluación nutricional, especificando las funciones cognitivas y su relación con los factores nutricionales y emocionales del individuo. Se realizó una encuesta de instrumentos de evaluación neuropsicológica o que tengan constructos cognitivos y emocionales. Se verificó la evaluación cognitiva y la relación entre emoción y comida. Se cree que esta es una guía básica para que los nutricionistas aumenten su evaluación más allá de la tradicional. DESCRIPTORES: Nutrición; Cognición; Emoción; Pruebas neuropsicológicas.

RESUMO Há diversos de estudos sobre a relação entre nutrição e cognição ou nutrição e emoção. Porém a ciência da nutrição transcende o nutrir e o comer. Envolve fatores interligados que precisam ser verificados e utilizados para melhor compreensão do indivíduo e das populações atendidas pelo nutricionista e da proposição de modos de resolução e/ou melhora destas demandas. Para tanto, existem instrumentos que incrementam a avaliação alimentar e nutricional e proporcionam melhor compreensão da formação do hábito alimentar. Este ensaio teórico sobre instrumentos neuropsicológicos utilizados para avaliação de adultos e idosos contribui para a avaliação nutricional, especificando as funções cognitivas e suas relações com os fatores nutricionais e emocionais do indivíduo. Realizou-se levantamento dos instrumentos de avaliação neuropsicológica ou que possuam constru- tos cognitivos e emocionais. Verificou-se a avaliação cognitiva e a relação da emoção com a comida. Pensa-se que este seja um guia básico para o nutricionista incrementar sua avaliação para além da tradicional. DESCRITORES: Nutrição; Cognição; Emoção; Testes Neuropsicológicos.

RECEIVED ON: 07/22/2020 APPROVED ON: 08/13/2020

Helena Beatriz Rower Master in Public Health (University of Vale do Rio dos Sinos, Unisinos), Nutritionist ORCID:0000-0002-2192-8778

2020; (10) N.56 • saúdecoletiva 3068 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

Denise Ren da Fontoura PhD in Language Sciences (Universidade Nova de Lisboa, UNL), Speech Therapist. ORCID: 0000-0002-1146-1932

INTRODUCTION in professional nutritionist work was RESULTS carried out. It was verified not only the europsychology can be unders- cognitive evaluation, but also the rela- Assessment tools tood as an interdisciplinary tionship between emotion and food. First, a quick contextualization of N science that includes professio- Thus, it is thought that this trial can neuropsychology and cognitive func- nals from different backgrounds. The- become a basic guide for the clinical tions, as well as the concepts of cogni- re is still no consensus on the direction nutritionist. tion and emotion, is done here. With of the association between food and this, a better understanding of the mental health, since adequate food can METHOD topic is expected. positively influence the individual's li- Cognition, succinctly, is the way festyle and mental states. On the other This theoretical essay is based on a the brain perceives, learns, remembers hand, there are those who find that review of the available scientific lite- and thinks about the stimuli captured mental health and lifestyle influence rature on neuropsychological instru- from the environment and perceived by eating habits as well as those who claim ments used for the assessment of adults the senses. Act or process of acquiring to be a bidirectional relationship be- and the elderly, to contribute to nutri- knowledge that occurs through per- tween both. (1) tional assessment, about the cognitive ception, attention, memory, reasoning, Legally, when it comes to food and functions evaluated and their rela- judgment, imagination, thought and nutrition in Brazil, the nutritionist is tionship with the individual's nutritio- language. It encompasses a set of men- the professional qualified for this pur- nal and emotional factors. The advan- tal processes used to classify, recognize pose, since the dietary prescription ced online consultation was carried out and understand for judgment through is his exclusive (Federal Nutrition in the databases: Scientific Electronic reasoning for learning and problem Council [Conselho Federal de Nutri- Library On-line (SciELO), and Latin solving, providing adaptation and inte- ção - CFN]) (2). For that, there is an American and Caribbean Literature raction to the environment and other evaluation process for the prescription in Health Sciences (LILACS) for the individuals making it unique. (3) to be carried out and then nutritional descriptors in Portuguese and PubMed Cognitive functions include the monitoring. for the corresponding descriptors in mental capacity to perform processes Considering this whole process of English, aiming to review the national that involve perception, attention, evaluation and monitoring, as well as and international collection on the re- memory, planning, language, physi- the relationship between nutrition and searched theme. cal and emotional behaviors captured cognitive and emotional functions, it The following subject descriptors from stimuli from the outside world is believed that it is important for the in the list of Health Sciences Descrip- through the senses and stored in me- nutritionist to understand the areas tors (DeCS) were used: "Nutrition", mory. It is understood as the main cog- of neuropsychology. The knowledge "Cognition", "Emotion" "Eating Beha- nitive functions: attention, memory, of the neuropsychological assessment vior" "Neuropsychology", "Attention", language and executive functions that instruments that will assist in nutritio- "Memory", "Language" , “Executive will be deepened below (3) and are also nal qualification and that will increase function”, and the same terms in En- related to nutritional factors and ea- your daily practice is emphasized. glish that exist in the list of descrip- ting habits. (4)(5)(6) Thus, the objective of this article is tors from Medical Subject Headin- Several theories are used to defi- to carry out a theoretical essay on the gs (MeSH). The Boolean operator ne emotion. (3) Usually, emotion and neuropsychological instruments used “AND” was used in the process of feeling appear as synonyms, however, for the assessment of adults and the crossing the aforementioned descrip- according to Damásio (7), the rela- elderly, which can contribute to the tors. Finally, studies were found in the tionship between them is very narrow. nutritional assessment, specifying the bibliography of the articles found, as Emotion consists of a set of reactions cognitive functions evaluated and their well as through manual search. For of the body, automatic and uncons- relationship with the nutritional and the purpose of theoretical / histori- cious, which come from stimuli in the emotional factors of the individual. cal background and deepening of the environment where the human being A brief survey of tests and neuropsy- discussion, books, theses and official is inserted. When there is awareness chological tasks or that could be useful documents were also considered. of these emotions, then the feeling ari-

3069 saúdecoletiva • 2020; (10) N.56 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

ses, that is, the feeling occurs when the involved, restricted to the nutritionist. fessional, or standardized based on emotions are transferred to the brain, To do so, to know and understand the scientific studies that can be used where activation and coding occurs. In complex aspects involved in the act of with knowledge in the area. In recent a broader context than the concept of eating and nourishing the human being literature, standard task materials are emotion, conscious feelings, which are goes beyond food and nutrition issues available for use. The results obtained consciously accessible, coming from and goes through sociology, anthro- provide a qualitative assessment that the set of emotions and feelings that pology, economics, psychology and complements the assessment. (12) involve other dimensions such as cog- neuroscience, among others. And it is Neuropsychological tests (question- nition, are understood as affects. (8) in this transdisciplinary character that naires, scales, inventories) carry out a By neuropsychology, it is defined as nutrition and neuropsychology meet quantitative assessment and, in a con- an area with an interface between psy- and complement each other. crete way, show the individual preser- chology and neuroscience that studies In addition, the health of cognition ved, impaired and possible improve- cognitive, emotional and behavioral di- is linked to the health of the body as it ment cognitive aspects. (11)(13) Although sorders, as well as personality disorders goes through breaking the etiology of many evaluate more than a single caused or enhanced by brain injuries inflammation and infection, chronic function, Table 1 presents a summary or dysfunctions. These disorders can stress, metabolic, cardiac and neurolo- of those most commonly used and the be caused by congenital formations or gical changes and allergies. (10) By pro- main cognitive functions addressed. trauma. Of these traumas (emotional moting one, the other is promoted and, The relationship between food, cog- or mechanical), injuries or dysfunc- in this process, food is included. nition, food and emotion has been the tions occur. Injury is understood to be A structured nutritional assessment target of several researchers in view of direct damage to the brain tissue and, for neuropsychological care requires the role of dietary nutrients. In addi- usually, abrupt, such as Cranium-Brain the use of several instruments such as tion, the proper digestive process that Injury. Dysfunction occurs over time, anamnesis that investigates anthropo- occurs when respecting and stimulating without necessarily causing damage to metry, eating and living habits, as well the growth of beneficial bacterial flo- the brain parenchyma (psychological as emotional and cognitive prodromes. ra also improves human cognition and trauma, neurocognitive or mood disor- Questionnaires, tests, scales, tasks, emotion. Furthermore, it turns out that, ders, for example). The dysfunction, neuroimaging exams and neuropsycho- in fact, it consists of a two-way route of over time / years can become an ana- logical tests help to identify potential the brain-intestine axis. (14)(15) tomical-functional lesion. A profound losses and deficits resulting from life Executive functions are extensively and recurrent depression, for example, histories, and their impact on the indi- studied, especially in relation to obe- can progress to dementia. (9) vidual's daily life, with the aim of pro- sity and eating disorders. Changes in Neuropsychology complements diag- moting health by preventing losses or inhibitory control are associated with noses and participates in and in clinical recovering and rehabilitating people. them. However, other cognitive func- interventions aimed at alterations in the Daily Life Activities (ADLs) (9)(11), in- tions must also be observed in nutri- Central Nervous System (CNS), as well cluding those related to food and nu- tional assessment. (16) Thus, cognitive as in experimental and clinical research trition identified by demand or by the functions will be presented didactically in the presence or absence of patholo- professional. Several tests are for the in subtitles and their respective tests gies. Its objectives are to assist in the di- exclusive use of psychologists or speech for evaluation. fferential diagnosis of neurological and therapists, who will be exposed later in psychiatric disorders, to investigate the Table 1 and highlighted with Ψ and F, Atention origin, the size of cognitive and beha- respectively. This table summarizes the By definition, attention is the ga- vioral changes, and to monitor their list of tests validated by the Psycholo- teway to cognitive functions. Paying rehabilitation. (9) gical Test Assessment System (Sistema attention can be conceived as returning Different professionals form the de Avaliação de Testes Psicológicos - the perception to something, whether basis for the study of neuropsycholo- SATEPSI) of the Federal Council of from the external or internal environ- gy: speech therapists, psychologists, Psychology , as well as free access. ment. There are different theoretical pedagogues, linguists, neurologists Therefore, it is emphasized here the models used for a better understan- etc. Like the discipline, the science of importance of the joint action of the ding. Fuentes, Malloy-Diniz, Camargo nutrition is the study object of resear- different professionals in order to pro- e Cosenza(17) use the model proposed chers and professionals from different vide full monitoring to the individual. by Posner(18) where, in a succinct way, fields of knowledge, being the nutritio- The tasks consist of activities that there are three subsystems in which it nal prescription, and the whole process can be clinical, elaborated by the pro- is divided:

2020; (10) N.56 • saúdecoletiva 3070 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

although developed for anxiety and Doolan, Breslin, Hanna, Murphy e a) alert or vigil: related to the in- depression disorders, can also be used Gallagher (26) discuss the different me- ternal and external stimuli of to assess eating disorders when adap- thodologies used to assess attentional the environment. Such as su- ted for eating. (20. Overduin, Jansen bias in populations in order to measure permarket stimuli, colorful pa- e Louwerse(21) adapted the Stroop Test food consumption and relate to the in- ckaging and the organization of for food consumption. crease and maintenance of obesity. One shelves, or the smell of a certain Considered extremely important for of the most common tests to assess at- food, for example the smell of all aspects of cognitive functioning, tentional bias in research is Stroop. In bread or something spoiled; attentional resources are important their modified form, words and images b) guidance or automatic atten- predictors for learning and solving pro- of food activate the reward system whi- tional processes: directing the blems, from the simplest to the most ch could influence the test result since focus. It needs the performance complex, in all stages of development. hunger levels, energy density of visual of sensory and processing re- In adulthood, these resources are avai- food signals and individual food-style sources as well as the baggage lable at full power and decline when characteristics can influence visual at- acquired as reading and coun- following the timeline forming an in- tention. It is known that there is no sin- ting. Expressed by eye and ma- verted "U" curve. Attentional impair- gle model for research because obesity nual movements and expressive ment at older ages may be related to and other eating disorders are multifac- language. Related to the speed cognitive decline. (17) torial and, therefore, need more resear- of execution of both simple Attentional stimuli are launched at ch to create a standard. and complex tasks. Example: all times in the environment, including In addition to obesity, other eatin- selecting items to buy from the the choice of food in a simple trip to g-related disorders may be associated market, feeling the taste and the supermarket, for example. The with changes in selective attention, texture of a certain food while way in which the shelves are organi- which may be a cause of subsequent chewing; zed (non-perishable goods and ultra- food consumption. It is also important c) executive attention or control- -processed foods in the first aisles and to consider the motivations and the in- led attentional processes: rela- fruit and vegetable areas in the back), fluence of the environment by which ted to the actual execution of the making of packaging (colors, catch they can impact attention. (27)(28) tasks such as voluntarily chan- phrases), promotions (take 2 and pay ging the focus, fixing attention 1) are used to attract consumer atten- Memory and resolving attentional con- tion. Automatic attentional processes, Memory consists of the brain's abi- flicts in moments that require especially ocular ones, are constantly lity to recall information that has oc- inhibition (whether or not to required in these situations and this curred or felt. For this, it is necessary take a chocolate), flexibility bias falls mainly on high calorie and to acquire this information, form it, (choosing the fruit), alternation low nutritional value foods for both preserve it and evoke it when neces- (eating) in front of the TV). men, regardless of hunger, and for wo- sary. This process is closely related to men, regardless of hunger or BMI. (22) learning, as the human being does what Diamond(19) reports that controlled High calorie food images are also he knows. Based on the elaborated me- attentional processes are closely linked associated with an increase in the per- mories of the set of facts and emotions to executive functions, especially inhi- ception of pleasantness of their taste, involved in the process, creating false bitory control. which can influence food choices .(23) memories, building his autobiography, To quantitatively assess attention, Assessments carried out through elec- the individual shapes his personality, several tests can be used (Table 1), most troencephalogram examinations detec- his way of being and living, projects, of which are restricted to psycholo- ting Event-Related Potentials (ERP) chooses and decides his actions making gists such as: Psychological Battery for that detects the start of an event as a him unique. (29) Attention Assessment (BPA), Visual sensory or motor stimulus show that Learning and memory are two Selective Attention Scale (EASV), Vi- less palatable foods receive less atten- interrelated concepts. Learning de- sual Attention Test (TAVIS 4), Selec- tion compared to those of greater pa- pends on memory for its permanence. tive Attention Test (TAS), Attention latability. (24) Memory would not have “content” if Tests: Concentrated (TEACO-FF), Motor impulsivity (acting before there were no learning. Learning is Split (TEADI), Alternate (TEALD), thinking) related to food can predict wei- understood as the permanent change Cancellation Test of the Bells. The ght gain for those who demonstrate atten- in behavior due to past experiences. Dot Prob Task, a computerized test, tional bias for high-calorie foods. (25) While memory is the retention of a le-

3071 saúdecoletiva • 2020; (10) N.56 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

arning or experience in order to enable information acquired by the person is that the feeling of hunger was lower in its recovery. (17) with effort, that is, the information is people who thought they had ingested For better understanding, the me- transmitted, coded by the receiver and greater volumes of food compared to mory is divided into two large groups: stored, so that it can be repeated (like those who actually consumed it within explicit (declarative) and implicit eating); consequently, the action be- two to three hours after eating and af- (non-declarative). Explicit (declarati- comes automatic, being transformed ter the next 24 hours. ve) memory is divided into two types: into implicit memory. (17) If with an adult considered healthy, operational and long-term. These, in There are also sensory memories: deficiencies of episodic memory are turn, also branch out. Working me- olfactory, tactile, gustatory, visual and associated with perception of hunger mory, also known for short term, in- auditory, which, when related to food, and food choices, in obese individuals volves working memory. Long-term are fundamental for the construction or other eating disorders it is thought memory or declarative or explicit me- of eating habits. that it could be a consequence. Zhang mory is subdivided into episodic and All types of memories enter the cor- and Copppin(33) demonstrate that defi- semantic. Working memory comprises tex through the senses and find their cits in episodic and semantic memory the quick storage of information, such way into the brain, the precise place impair food choices in terms of both as memorizing the name of a culinary where the stimuli received depends on quality, quantity and variety. The mul- preparation and being responsible for the type of information they contain tifactorial cause of the condition is sending the information deemed ne- and the emotions related to them. The not excluded here, but they argue that, cessary for long-term memory. In lon- beliefs that can generate conditioned knowing how the individual's memory g-term memory, declarative or expli- and automated behaviors are part of works, it can assist in conducting best cit memory involves the storage and the implicit memory. rehabilitation practices. Furthermore, conscious recognition (recall) of facts Several tests can help the professio- they refer to the need for further rese- and events (facts, names, concepts). nal to check the memory in its diffe- arch on the role of semantic memory in Episodic memory makes it possible to rent biases (Table 1) such as Hopkins eating habits. remember facts that occurred in chil- Verbal Learning Test - Revised (HVL- The formation of memory is clo- dhood, for example, being associated T-R), Brief Visuospatial Memory Test sely linked to emotions in view of the with “what”. Semantics, on the other - Revised (BVMT-R), Rivermead that sum of experiences with food and ea- hand, is responsible for the associa- are freely accessible. The other tests ting habits. Smells, tastes, moments tion of objects with their respective belong to the psychologist's perfor- lived, expectations and beliefs formed names, for example, when talking mance, the most used being: Rey Com- in the construction of these habits and about apple (meaning) we remember plex Figures, Brief Neuropsychological the individual's relationship with food, the red and rounded figure (sign). In Assessment Instrument - Neupsilin, Se- how these affects influence assessment it, the acquisition of the concept of mantic Priming, Rey Auditory-Verbal methods related to memory, mood and knowledge - words, symbols, meanin- Learning Test (RAVLT, acronym for food. Therefore, more research is nee- gs - are not always remembered where Rey Auditory Verbal Learning Test). ded to establish more accurate methods and how they occurred. Semantic me- Assessing memory can be a way of of assessing the triad: memory, mood mory is closely linked to language. (17) assessing the individual's perception and feeding. (34) To memorize and learn there are and food choices. Martin, Davidson e two distinct thought processes: effort McCrory(30) verify that the control of Language and automatic. Effortless thinking food intake in healthy adults and the Language consists of a complex skill consists of the information entrance, ability to remember episodes that in- that uses all cognitive functions for its acquiring material or coding (using volve eating are associated with redu- execution. It comprises the reception selective attention) followed by sto- ced episodic memory, leaving room for and decoding (verbal comprehension) rage and repetition, rescue or retrieval eating improperly. A deficient episodic of the stimuli of the environment in- (through working memory) conside- memory is related to reduced percep- cluding hearing and reading. It also red explicit or declarative memory. tion of hunger and satiety and beco- comprises the coding of expression Automatic thinking, on the other mes a tendency to uncontrolled food, and production that includes speech, hand, is acquired through training as well as working memory, since they writing and signaling. The levels of (repetition) of the same movements, are fundamental cognitive processes the language representation comprise: such as walking, talking, eating as for decision-making related to food. semantic (meaning), phonetic (mecha- examples. Both processes go through (31) Brunstrom et al. (32), corroborating nics of sounds), phonological (distinc- a period of interaction, since the first the study described earlier, observed tion of speech sounds), morphological

2020; (10) N.56 • saúdecoletiva 3072 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

(study of the part or word isolated from or modular relationship between them. issues in food and nutrition among dia- the context), lexical (comprehension In relation to language, the importance betic patients and health volunteers. and production of words), syntactic of the attention and working memory The interaction and influence of family (sentence rules), pragmatic (language functions and the central executive sys- members on their children's food and usage and interpretation and the varia- tem are highlighted. (36)(37) nutrition education as well as on the bles between speaker and listener) and Working memory (working me- perception of satiety and its psycholo- prosodic (production of affective or mory) consists of the ability to tem- gical and social implications. (42) semantic meaning based on intonation, porarily store a set of information for Mondada(43) analyzes the rela- rhythm and elements that are not iden- the performance of an activity, being a tionships established between people tified in writing). (35) type of transient memory. It involves during the moments when they ate The assessment of language starts the temporary storage and manipula- their meals with their eating habits and at the first contact with the individual tion of information that is considered emotions related to the context. and, in the anamnesis, it is important necessary for a wide range of complex The importance and practical to check the education and reading cognitive activities. Therefore, it is di- applicability of CA in the field of food habits to observe the cognitive reser- rectly related to language acquisition and nutrition are highlighted by Tap- ve which are directly related. Assess- and processing. (36)(37) sel(44), which applies the methodology ment tasks usually involve expression Several semantic stimuli are inserted in a teaching environment to equip and understanding of words, phrases in tests adapted for cognitive assess- future professional nutritionists, for or speeches, the most commonly used ment of food consumption, as in the use in dialogues about eating habits tests being: Boston Naming Test, Se- Modified Stroop. Discreet reduction and their maintenance in patients. mantic Verbal Fluency Test (animal in the amplitude of these stimuli in Thompson, Blackshaw, Coulton, Al- category), Peabody Image Vocabulary people potentially or diagnosed with bury e Tedstone(45) use the methodo- Test, Tolken Test, Montreal Commu- anorexia, being a probable cause of the logy to support the development of a nication Assessment Battery (Protoco- result of chronic hunger, can predict guide to help health professionals talk le MEC), the Functional Assessment the development and / or maintenance about weight management with family of Communication Skills for Adults of the disorder. (38) The slowness of lan- members and children. (ASHA-Facs) and the Montreal-Tou- guage in identifying food and emotio- louse Language Assessment Battery nal stimuli may be indicative of altera- Executive functions (MTL – Brazil). All free access. The tions in selective attention in anorexics Executive functions comprise a set NEUPSILIN Brief Neuropsycholin- and bulimics. (39) of skills that control the conscious, guistic Assessment Instrument, and in Furthermore, in the course of the complex and non-automated cognitive its form adapted for expressive apha- anamnesis, since the semantics and processes of DLAs. sic patients, belongs exclusively to the prosody have a strong connection with Executive functions comprise a set use of speech therapists and psycholo- the affects related to life experiences, a of skills that control the conscious, gists. It should be noted that language methodology that can be used to help complex and non-automated cognitive also has non-linguistic characteristics better understand how the individual processes of DLAs. In adversities such regarding emotional content. In ge- expresses it is the Conversation Analy- as stress, sadness, lack of sleep as well neral terms grouped under the name sis (CA) or Speech-in-interaction (SII). as in psychiatric disorders (depression, "emotional prosody", which refer to This methodology, originating from bipolarity, among others) and neurolo- the inflections of the voice, which are sociology where Oliver Saks glimpsed gical conditions they are also the first very important during the communi- the analytical possibilities of conver- to change or become deficient. (19) cative process and the exchange of in- sation (conversation analysis) and his Functions are thus named, as they terpersonal information. (36)(37). interactions in daily life (speaking in are a set formed by Inhibitory Control For the elaboration of language, se- interaction), investigates how in these (IC), Working Memory (WM) and veral brain areas are required, which interactions people build their identi- Cognitive Flexibility (CF), these being shows the importance of other cogni- ties and relationships in ways that are the main ones and, often, they depend tive functions for proper functioning socially relevant. (40) on each other. Inhibitory control and consequently the activation of Tapsel, Brenninger e Barnard(41) works in conjunction with attention brain regions that also cover areas of describe the tool as a consistent way by filtering distracting stimuli, that is, expression and understanding. Cogni- of reporting on eating habits and iden- the ability to regulate automatic beha- tive functions cannot be seen indepen- tifying characteristics in the conver- vioral responses, such as shopping at dently, there is always a complementary sation when addressing problematic the supermarket or the amount of food

3073 saúdecoletiva • 2020; (10) N.56 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

eaten. On a cognitive level, you con- consumption of unhealthy foods and ve more stimuli related to food with trol thoughts by keeping them in your lower consumption of healthy foods improved preconscious processing, goals, ‘Am I hungry?’. Avoiding acting in people of adequate weight. The de- thus showing their greater sensitivity, automatically or impulsively consists crease in IC is associated with a gre- especially when it comes to the obe- in the behavioral action of the inhibi- ater intake of saturated fats and the sogenic environment and the predis- tory control, 'eating the first thing that superior ability to control impulses position to overeat. This study was appears'. Working memory, mentioned and monitor the intake of fruits and based on the Stroop test evaluating earlier, consists of short memory sto- vegetables. (46) Slow inhibitory control behavioral indices, verifying the reac- ring and manipulating information for and obesity are also linked. (47) tion time, and electrophysiological of quick use, such as constantly remem- The fundamental importance of the individuals. bering food in different situations of WM in the self-regulation of eating The Iowa Gambling Test (IGT) was the day. When there is a need to chan- behavior consists of its performance used to verify obesity decision-making ge perspectives, new behaviors and in the maintenance and persistence of (51) and binge eating disorders. (52) Ro- strategies, cognitive flexibility is the long-term goals in constant thinking tge, Poitou, Fossati, Aron-Wisnewsky resource used by the brain, such as the (4), as in the introduction and mainte- and Oppert(51) point out that the abi- acquisition of new attitudes and eating nance of new eating habits(5). The bet- lity to make decisions considered risky behaviors. (19) ter the WM's performance in initiating is impaired in this audience. However, There is a consensus among resear- attitudes and behaviors, the better its Danner, Ouwehand, van Haastert, chers where the set of the three forms the maintenance capacity and the elimi- Hornsveld and Ridder(52) demonstrated basis for the other executive functions nation of internal conflicts that may that both patients with binge eating di- that form the executive processes: deci- interfere in the process, as Allom e sorder and other eating disorders have sion making, planning and problem sol- Mullan(46) found in people with higher decision deficits and the lower the test ving. Decision making relates to reward consumption of fruits and vegetables. performance, the greater the severity of or avoidance processes and involves emo- In addition, there is a direct associa- the binge. tions or motivations, whether or not to tion between performance of visuos- Meule (53) discusses the mechanisms change eating habits. Planning requires patial memory (temporary memoriza- of impulsivity on the Body Mass Index establishing objectives and questions tion of information and creation and (BMI) where it highlights that the as- such as: what, where, how, why guide maintenance of mental images) and sociation between both consists of an the process. Problem solving leads to eating habits, given the greater ability indirect path, since the impulsive per- the achievement of the objective in its to allocate attentional resources to the sonality can influence positively or ne- different solutions for this. Uses mental proposed objectives. (4) gatively. He argues that personality im- representation, planning, strategy imple- The other components of executive pulses can trigger increased food intake mentation and monitoring. (19) For exam- functions also have a connection with and, possibly, weight gain. In contrast, ple, in a buffet, mentally visualize the food choices such as planning, cogni- constructs such as extraversion and preparations that will be served by selective flexibility and initiation. Skills the search for new sensations correlate ting what will be served, serving yourself most required when observing the ex- with greater physical activity, leading observing if the execution agrees with the ternal stimuli of the environment that to a better BMI in view of the mecha- initial proposal. favor excessive consumption of palata- nism used to drive impulsivity. With this, it is essential to know and ble food over healthy food. (6) In other There is a connection between cog- evaluate the executive functions for nu- words, the diversion of selective atten- nition and emotion. Rauch, Hume, tritional monitoring. Tests such as Trails, tion to these more palatable and high- Howells, Kroff e Lambert (54) demons- Verbal Fluency, FAB Battery, Hayling's -calorie foods. (27)(48) trate that, even in individuals who have Impulsivity Scales, Rey's Complex Figu- Brain reward systems are more ac- lost weight and maintained it for more re, Clock Drawing Test and Stroop are tivated when compared to foods with than a year, the action of the nervous among the most common. The Stroop higher levels of fats and refined car- system located in the heart maintained test has a modified version for food sti- bohydrates to the detriment of those the pattern of the period prior to wei- muli, Food Stroop. (21) with a high content of complex car- ght loss when Food Stroop activities Executive functioning is invol- bohydrates, low fat and high protein were performed. In addition, both pe- ved in eating behavior. Therefore, it value. The same occurs in comparison ople undergoing weight loss and those can be considered as a predictor of with vegetables. (49) undergoing maintenance showed gre- its self-regulation. (4) Changes in this Nijs, Franken e Muris(50) conclu- ater sensitivity to the stimuli related functioning correspond to higher ded that obese people tend to obser- to food from the tests used, demons-

2020; (10) N.56 • saúdecoletiva 3074 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

trating the relationship of an indirect borated by each professional adapting groups: cognitive restriction, emotio- path between stress as an inducer of the their practice or using those already va- nal eating and uncontrolled eating. act of eating. lidated by the literature. The food industry has used several Basically, according to their ob- questionnaires in order to know con- Emotions jectives, they are divided into three sumer preferences and develop new Even though the mechanism betwe- groups: quantitative assessment of products. These instruments, in addi- en nutrition, cognition and emotion is intake as a 24-hour food record and tion to the sensory characteristics of still not fully understood, it is known daily or food record; assessment of the food, are designed to verify the emo- that there is an influence of one on the consumption of foods or food groups tions evoked by food. Kaneko, Toet, other components of this triad. For that consists of the food frequency Brouwer, Kallen and van Erp (64), in a example, emotions can trigger various questionnaire and, finally, the asses- systematic review of 101 articles in behaviors, including eating. (1) Hence sment of the dietary pattern through English on the subject, they selected the importance of including the emo- food history. To Zuniga e Mcauley(61), instruments in two large groups: mea- tional question in the assessment, as it is essential to observe the influen- surement (physiological, cognitive and they may be the main or secondary cau- ce of cognition on dietary assessment behavioral) and emotional processing se of food consumption. and consider the need to adapt the (sensory unconscious, early percep- People who, for some reason, have instruments to the target audience. tion / cognition and conscious / deci- some difficulty in dealing with their For this purpose, eating behavior sion making). When categorized with emotions and get into psychological dis- is a way of expressing cognition and each other, they show diversity and for tress become candidates for developing related affects that go beyond the act what purposes they can be used, ran- mood disorders, with depression and of eating and nourishing. Kotait, Ba- ging from imaging exams, observation anxiety being the most common. Othe- rillari and Conti (62) verify that there of body microexpressions to question- rwise, cognitive changes may cause these are specific instruments for assessing naires and scales. Many of these ins- disorders as a comorbidity. (55) emotional and mental states both in truments have not yet been validated The Beck Depression Inventory populations and individuals and rein- in Brazil. An example of validation for (56) and the Depressive Thoughts force the need for professionals to ob- the Brazilian industry consists of the Scale (Escala de Pensamentos Depres- serve the context in which their target questionnaire on the impact of cogni- sivos – EPD) (57) are instruments used audience is inserted. The authors dis- tive and behavioral factors that affect by psychologists to assist in the diag- cuss: Eating Attitudes Test, Bulimic the acceptance of functional foods. (65) nosis of both situations, as well as ho- Investigatory Test Edinburg, Binge pelessness and suicidal ideation. With Eating Scale, Eating Behaviors and CONCLUSION free access, the Geriatric Depression Body lmage Test and Restraint Scale, Scale – GDS15 (58), specific for the their objectives of use and provide Assessing the person from the pers- elderly, and the Self-Reporting Ques- these instruments in the appendix. pective of cognition and emotion, tionnaire - SRQ-20 (59) assess mental The Three Factor Eating Question- going beyond food consumption, clini- suffering and screen for possible mood naire (TFEQ) used to evaluate both cal laboratory tests and anthropometry disorders. Even if they do not provide clinically and to conduct research as as well as socio-cultural aspects, raises a diagnosis, they show important indi- an isolated instrument (63) as in con- the level of performance of the nutri- cations for better management of the junction with other tools (48)(54) about tionist professional when understan- therapeutic process. emotional and cognitive factors related ding neuropsychological assessment to food, being considered a great indi- can point out the how and why of beha- Assessment of eating behavior cator of weight gain in the long term viors that refer to eating habits. There are several instruments for and a milestone for the inclusion of The conceptual review highlights food and nutrition assessment that, new strategies for food and nutrition that the person does not need to have together with anthropometry and cli- guidance. Seage and Lee (48) observed a a pathological condition to use instru- nical / laboratory exams, are part of prediction of an increase in attentional ments to understand eating habits and the framework of basic tools of the bias for high-calorie stimuli included behaviors. Given this, it can assist food nutritionist and traditionally applied in the questionnaire. In its reduced and nutritional rehabilitation and re-e- in anamnesis consultation. Fisberg, form (TFEQ-R21), it was translated ducation and, consequently, achieve or Marchioni e Colucci (60) briefly summa- and validated for Brazil by Natacci and maintain goals adjusted as appropriate rized the advantages and disadvantages Ferreira Júnior (63), which consists of in agreement with the individual him- of these instruments. These can be ela- 21 questions divided into three major self. For neuropsychological instru-

3075 saúdecoletiva • 2020; (10) N.56 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

ments can act as a metric of the indivi- bining nutrition with neuropsychology It is suggested to think about the dual's situation and evolution. can increase the nutritionist's unders- brain-heart-intestine route in addition The evaluation process is a constant tanding of a more global and more ef- to those already mentioned in the lite- in professional practice, since its appli- fective action on human beings. The re- rature: brain-intestine and brain-heart. cation makes it possible to measure and searches listed in the framework point Along this path, the nutritionist, in qualify the actions of dietary planning to relevant improvement in aspects possession of neuropsychological ins- and monitoring. Furthermore, even such as: paying attention to yourself, truments, is able to comprehensively though there is no gold standard for your needs and desires to learn, elabo- understand the behavioral and moti- this, the use of instruments can contri- rate, use and reframe eating and life ha- vational developments inherent to the bute to future research in the area. bits, helping and basing the best choi- change and maintenance of dietary and The findings demonstrate that com- ces appropriate for your well-being. health care routines.

REFERENCES

1. Rower HB, Olinto MTA, Gonçalves TR, Pattussi MP. O pa- 080/23279095.2018.1458505 pel dos estados emocionais no consumo de frutas e vege- 11. Strauss E, Sherman EMS, Spreen O. A compendium of neu- tais em adultos brasileiros. Ciência e Saúde Coletiva. 2017; ropsychological tests: administration, norms and commentary. 22(2):489-497. Retirado de https://dx.doi.org/10.1590/1413- 3. ed. New York: Oxford University Press; 2006. 81232017222.00982016 12. Zimmermann N, Fonseca RP (Orgs.). Avaliação de linguagem 2. Brasil. Presidência da República. Casa Civil. Subchefia para As- e funções executivas em adultos. São Paulo: Memnon; 2017. suntos Jurídicos. Lei nº 8.234, de 17 de setembro de 1991. Re- gulamenta a profissão de Nutricionista e determina outras pro- 13. Júlio-Costa A, Moura R, Haase VGH. (Orgs.). Compêndio de vidências. Brasília: DOU; 1991. Retirado de http://www.planalto. testes neuropsicológicos: atenção, funções executivas e memó- gov.br/ccivil_03/Leis/1989_1994/L8234.htm ria. São Paulo: Hogrefe; 2015. 3. Ward J. The student's guide to cognitive neuroscience. 3. ed. 14. Proctor C, Thiennimitr P, Chattipakorn N, Chattipakorn Hove, East Sussex: Psychology Press 27 Church Road; 2015. SC. Diet, gut microbiota and cognition. Metab Brain Dis. 2017; 32(1):1-17. Retirado de https://dx.doi.org/10.1007/s11011- 4. Dohle S, Diel K, Hofmann W. Executive functions and the self- 016-9917-8 -regulation of eating behavior: a review. Appetite. 2018; 124(1):4- 9. Retirado de https://dx.doi.org/10.1016/j.appet.2017.05.041 15. Sharon G, Sampson TR, Geschwind DH, Mazmanian SK. The central nervous system and the gut microbiome. Cell. 2016; 5. Whitelock V, Nouwen A, van den Akker O, Higgs S. The role 167(4):915-932. Retirado de https://dx.doi.org/10.1016/j. of working memory sub-components in food choice and dieting cell.2016.10.027 success. Appetite. 2018; 124(1):24-32. Retirado de https://dx. doi.org/10.1016/j.appet.2017.05.043 16. Houben K, Nederkoorn C, Higgs S. An introduction to the special issue on Executive function training and eating beha- 6. Wyckoff EP, Evans BC, Manasse SM, Butryn ML, Forman EM. viour. Appetite. 2017; 124(1):1-3. Retirado de https://dx.doi.or- Executive functioning and dietary intake: neurocognitive corre- g/10.1016/j.appet.2017.09.021 lates of fruit, vegetable, and saturated fat intake in adults with obesity. Appetite. 2017; 111(1):79-85. Retirado de https://dx.doi. 17. Fuentes D, Malloy-Diniz LF, Camargo CHP, Cosenza RM. org/10.1016/j.appet.2016.12.039 (Orgs.). Neuropsicologia: teoria e prática. 2. ed. Porto Alegre: Art- med; 2014. 7. Damásio AR. E o cérebro criou o homem. São Paulo: Cia das Letras; 2011. 18. Posner MI. Imaging attention networks. NeuroImage. 2012; 61(2):450-456. 8. Fredrickson BL. The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. 19. Diamond A. Executive functions. Annual Review of Psycholo- The American Psychologist. 2001; 56(3):218-226. gy. 2013; 64:135-168. 9. Haase VGH, Salles JF, Miranda MC, Malloy-Diniz L, Abreu N, 20. Dickson H, Brooks S, Uher R, Tchanturia K, Treasure J, Cam- Argollo N, et al. Neuropsicologia como ciência interdisciplinar: pbell IC. The inability to ignore: distractibility in women with consenso da comunidade brasileira de pesquisadores/clínicos restricting anorexia nervosa. Psychological Medicine. 2008; em Neuropsicologia. Revista Neuropsicologia Latinoamericana. 38(12):1741-1748. Retirado de https://dx.doi.org/10.1017/ 2012; 4(1):1-8. S0033291708002961. 10. Pimental PA, O'Hara JB, Jandak JL. Neuropsychologists as pri- 21. Overduin J, Jansen A, Louwerse E. Stroop interferen- mary care providers of cognitive health: a novel comprehensive ce and food intake. International. Journal of Eating Disorders. cognitive wellness service delivery model. Appl Neuropsychol 1995; 18(3):277-285. Retirado de https://dx.doi.org/10.1002/ Adult. 2018; 25(4):318-326. Retirado de https://dx.doi.org/10.1 1098-108x(199511)18:3.

2020; (10) N.56 • saúdecoletiva 3076 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

REFERENCES

22. Doolan KJ, Breslin G, Hanna D, Gallagher AM. Attentional bias mood: a psychological perspective on the measurement of to food-related visual cues: is there a role in obesity? Procee- food-related emotions in consumer research. Food Research dings of the Nutrition Society. 2014; 74(1):37-45. Retirado de International; 2015. Retirado de http://dx.doi.org/10.1016/j.foo- https://dx.doi.org/10.1017/s002966511400144x dres.2015.04.006 23. Ohla K, Toepel U, Le Coutre J, Hudry J. Visual-gustatory inte- 35. Salles JF, Rodrigues JC. In: Fuentes D, Malloy-Diniz LF, Camar- raction: orbitofrontal and insular cortices mediate the effect of go CHP, Cosenza RM (Orgs.). Neuropsicologia: teoria e prática. 2. high-calorie visual food cues on taste pleasantness. PLoS One. ed. Porto Alegre: Artmed; 2014. 2012; 7(3):324-334. Retirado de https://dx.doi.org/10.1371/ 36. Fontoura DR, Rodrigues JC, Mansur L, Monção AM, Salles JF. journal.pone.0032434 Neuropsychololinguistic profile of patients post-stroke in the 24. Carbine KA, Rodeback R, Modersitzki E, Miner M, LeChemi- left hemisphere with expressive afasia. Revista Neuropsicología, nant JD, Larson MJ. The utility of event-related potentials (ERPs) Neuropsiquiatría y Neurociencias. 2013; 13(2):91-110. in understanding food-related cognition: a systematic review 37. Fontoura DR, Rodrigues JC, Brandão L, Monção AM, Salles and recommendations. Appetite. 2018; 128(1):58-78. Retirado JF. Eficácia da terapia de entonação melódica adaptada: estudo de https://dx.doi.org/10.1016/j.appet.2018.05.135 de caso de paciente com afasia de broca. Disturb Comum. 2014; 25. Meule A, Platte P. Attentional bias toward high-calorie foo- 26(4):641-655. d-cues and trait motor impulsivity interactively predict weight 38. Nikendei C, Friederich HC, Weisbrod M, Walther S, Sharma gain. Health Psychol Open. 2016; 3(1). Retirado de https://dx.doi. A, Herzog W, et al. Event-related potentials during recognition org/10.1177/2055102916649585 of semantic and pictorial food stimuli in patients with anorexia 26. Doolan KJ, Breslin G, Hanna D, Murphy K, Gallagher AM. Visu- nervosa and healthy controls with varying internal states of hun- al attention to food cues in obesity: an eye-tracking study. Obe- ger. Psychosom Med. 2012; 74(2):136-145. Retirado de https:// sity (Silver Spring). 2014; 22(12):2501-2507. Retirado de https:// dx.doi.org/10.1097/PSY.0b013e318242496a dx.doi.org/10.1002/oby.20884 39. Stormarz KM, Torkildsen O. Selective processing of linguistic 27. Hou R, Mogg K, Bradley BP, Moss-Morris R, Peveler R, Ro- and pictorial food stimuli in females with anorexia and bulimia efs A. External eating, impulsivity and attentional bias to food nervosa. Eat Behav. 2004; 5(1):27-33. cues. Appetite. 2011; 56(2):424-427. Retirado de https://dx.doi. 40. Silva CR, Andrade DNP, Ostermann AC. Análise da conversa: org/10.1016/j.appet.2011.01.019 uma breve introdução. ReVEL. 2009; 7(13). 28. Werthmann J, Jansen A, Roefs A. Worry or craving? A selecti- 41. Tapsel L, Brenninger V, Barnard J. Applying conversation ve review of evidence for food-related attention biases in obese analysis to foster accurate reporting in the diet history interview. individuals, eating-disorder patients, restrained eaters and he- Journal of the American Dietetic Association. 2000; 100(7). althy samples. Proc Nutr Soc. 2015; 74(2):99-114. Retirado de https://dx.doi.org/10.1017/S0029665114001451 42. Laurier E, Wiggins S. Finishing the family meal: the interac- tional organisation of satiety. Appetite. 2011; 56(1):53-64. 29. Izquierdo I. Memórias. Estudos Avançados. 1989; 3(6):89-112. Retirado de https://dx.doi.org/10.1590/S0103- 43. Mondada L. The methodical organization of talking and ea- 40141989000200006 ting: assessments in dinner conversations. Food Quality and Preference; 2009. 30. Martin AA, Davidson TL, McCrory MA. Deficits in episodic memory are related to uncontrolled eating in a sample of healthy 44. Tapsel L. Using applied conversation analysis to teach novice adults. Appetite. 2018; 124(1):33-42. Retirado de https://dx.doi. dietians history taking skills. Human Studies. 2000; 23:281-307. org/10.1016/j.appet.2017.05.011 45. Thompson L, Blackshaw J, Coulton V, Albury C, Tedstone A. 31. Higgs S, Spetter MS. Cognitive control of eating: the role Let’s talk about weight: a step-by-step guide to conversations of memory in apetite and weight gain. Curr Obes Rep. 2018; about weight management with children and families for health 7(1):50-59. Retirado de https://dx.doi.org/10.1007/s13679- and care professionals. London: Public Health England; 2017. 018-0296-9 46. Allom V, Mullan B. Individual differences in executive 32. Brunstrom JM, Burn JF, Sell NR, Collingwood JM, Rogers PJ, function predict distinct eating behaviours. Appetite. 2014; Wilkinson LL, et al. Episodic memory and appetite regulation in 80(1):123-130. Retirado de https://dx.doi.org/10.1016/j. humans. PLoS One. 2012; 7(12):e50707. Retirado de https://dx. appet.2014.05.007 doi.org/10.1371/journal.pone.0050707 47. Wanderley MR, Hamdan AC. Relações entre obesidade e 33. Zhang Z, Coppin G. To what extent memory could contri- controle inibitório: uma revisão sistemática. Revista Neuropsico- bute to impaired food valuation and choices in obesity? Fron- logia Latinoamericana. 2015; 7(1):24-33. tiers in Psychology. 2018; 9(1):2523. Retirado de https://dx.doi. 48. Seage CH, Lee M. Do disinhibited eaters pay increased atten- org/10.3389/fpsyg.2018.02523 tion to food cues? Appetite. 2017; 108(1):151-155. Retirado de 34. Köster EP, Mojet J. From mood to food and fromfood to- https://dx.doi.org/10.1016/j.appet.2016.09.031

3077 saúdecoletiva • 2020; (10) N.56 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

REFERENCES

49. King JL, Fearnbach SN, Ramakrishnapillai S, Shankpal P, Gei- psicométricas da Escala de Pensamentos Depressivos (EPD). selman PJ, Martin CK, et al. Perceptual characterization of the Revista Brasileira de Terapias Cognitivas. 2012; 8(2):74-84. Re- Macronutrient Picture System (MaPS) for food image fMRI. tirado de http://pepsic.bvsalud.org/scielo.php?script=sci_arttex- Front Psychol. 2018; 9(1):17-18. Retirado de https://dx.doi. t&pid=S1808-56872012000200002&lng=pt&tlng=pt org/10.3389/fpsyg.2018.00017 58. Paradela EMP, Lourenço RA, Veras RP. Validação da escala de 50. Nijs IM, Franken IH, Muris P. Food-related Stroop interfe- depressão geriátrica em um ambulatório geral. Rev. Saúde Públi- rence in obese and normal-weight individuals: behavioral and ca. 2005; 6:918-923. electrophysiological indices. Eat Behav. 2010; 11(4):258-265. 59. Mari JJ, Iacopini E, Williams P, Simões O, Silva JBT. Detection Retirado de https://dx.doi.org/10.1016/j.eatbeh.2010.07.002 of psychiatric morbidity in the primary medical care settings in 51. Rotge JY, Poitou C, Fossati P, Aron-Wisnewsky J, Oppert JM. Brazil. Revista Saúde Pública. 1987; 21:501-507. Decision-making in obesity without eating disorders: a systema- 60. Fisberg RM, Marchioni DML, Colucci ACA. Avaliação do con- tic review and meta-analysis of Iowa gambling task performan- sumo alimentar e da ingestão de nutrientes na prática clínica. ces. Obes Rev. 2017; 18(8):936-942. Retirado de https://dx.doi. Arquivos Brasileiros de Endocrinologia e Metabologia. 2009; org/10.1111/obr.12549 53(5):617-624. Retirado de https://dx.doi.org/10.1590/S0004- 52. Danner UN, Ouwehand C, van Haastert NL, Hornsveld H, Ri- 27302009000500014 dder DT. Decision-making impairments in women with binge ea- 61. Zuniga K, Mcauley E. Considerations in selection of diet as- ting disorder in comparison with obese and normal weight wo- sessment methods for examining the effect of nutrition on cog- men. Eur Eat Disord Rev. 2012; 20(1):56-62. Retirado de https:// nition. J Nutr Health Aging. 2015; 19(3):333-340. Retirado de dx.doi.org/10.1002/erv.1098 https://dx.doi.org/10.1007/s12603-014-0566-5 53. Meule A. Commentary: questionnaire and behavioral task 62. Kotait MS, Barillari ML, Conti MA. Escalas de avaliação de measures of impulsivity are differentially associated with comportamento alimentar. In: Cordás TA, Kachani AT. Nutrição body mass index: a comprehensive meta-analysis. Front Psy- em Psiquiatria. Porto Alegre: Artmed; 2010. chol. 2017; 8:12-22. Retirado de https://dx.doi.org/10.3389/ fpsyg.2017.01222 63. Natacci LC, Ferreira Júnior M. The three factor eating questionnaire – R21: tradução para o português e aplicação em mulheres 54. Rauch HGL, Hume DJ, Howells FM, Kroff J, Lambert EV. Food brasileiras. Revista de Nutrição. 2011; 24(3):383-394. Retirado cue reactivity and the brain-heart axis during cognitive stress de https://dx.doi.org/10.1590/S1415-52732011000300002 following clinically relevant weight loss. Front Nutr. 2019; 5:135- 137. Retirado de https://dx.doi.org/10.3389/fnut.2018.00135 64. Kaneko D, Toet A, Brouwer AM, Kallen V, van Erp JBF. Me- thods for evaluating emotions evoked by food experiences: a 55. Schrag A, Taddei RN. Depression and anxiety in Parkinson's literature review. Front. Psychol. 2018; 9(1):9-11. Retirado de disease. Int Rev Neurobiol. 2017; 133:623-655. Retirado de ht- https://dx.doi.org/10.3389/fpsyg.2018.00911 tps://dx.doi.org/10.1016/bs.irn.2017.05.024 65. Corso MP, Benassi MT. Tradução e validação para a língua 56. Cunha JA. Manual da versão em português das escalas Beck. portuguesa de questionário sobre fatores cognitivos e compor- São Paulo: Casa do Psicólogo; 2001. tamentais que afetam a aceitação de alimentos funcionais. Alim. 57. Carneiro AM, Baptista MN. Desenvolvimento e propriedades Nutr. (Araraquara). 2012; 23(1):89-94.

ANNEX A

Table 1. Summary of neuropsychological tests and respective cognitive domains assessed TESTES AT MEM LIN FE Atenção Concentrada (AC) Ψ X Atenção Concentrada (AC15) Ψ X Avaliação Funcionas das Habilidades de Comunicação para Adultos (ASHA-FACS) X Bastões de Goldstein X X Bateria MAC X Bateria Psicológica para Avaliação da Atenção (BPA) Ψ X

2020; (10) N.56 • saúdecoletiva 3078 artigo Rower, H.B.; Fontoura, D.R.; Nutrition, cognition and emotion: neuropsychological foundations and tools for nutritionists

Bender Gestáltico X X X Blocos de Corsi X X BRIEF X Brief Visuospatial Memory Test – Revised X California Verbal Learning Test-II (CVLT-II) X X D2 Ψ X Escalas de Impulsividade de Hayling X Escalas Wechsler de Memória Ψ X Escala de Atenção Seletiva Visual – EASV Ψ X Frontal Assesment Batery – FAB X Figuras Complexas de Rey Ψ X X Fluência Verbal X X Hopkins Verbal Learning Test – Revised X Instrumento de Avaliação Neuropsicológica Breve – Neupsilin Ψ X X X X Iowa Gambling Test X X Bateria Montreal-Toulouse de Avaliação da Linguagem X Primimg semântico X Prova de Ritmo X Questionários de memória (MAC-Q e MAC-SV) X Repetição de Pseudo-palavras X Rivermead X Stroop de Cores Ψ X X Teste de Atenção Visual (TAVIS 4) Ψ X X Teste de Aprendizagem Auditivo-Verbal de REY Ψ X X Teste de Atenção Seletiva – TAS Ψ X Teste de Boston para Diagnóstico de Afasias F X Teste de Classificação de Cartas Wisconsin Ψ X Teste de Memória Visual – TMV X Teste de Nomeação de Boston X TESTES AT MEM LIN FE Teste de Retenção Visual de Benton X Teste de Trilhas Coloridas Ψ X Teste do Desenho do Relógio (FDR) X Teste dos Sinos X Teste de Wisconsin de Classificação de Cartas Ψ X Testes das Pirâmides e Palmeiras X Testes de Atenção: Concentrada (TEACO), Dividida (TEADI), Alternada (TEALD) Ψ X Token Test X Torre de Hanói X X Torre de Londres X Note: AT (attention), MEM (memory), LIN (language), FE (executive functions). Adapted from “A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary” by E. Strauss, E. M. S. Sherman, O. Spreen., 2006.

3079 saúdecoletiva • 2020; (10) N.56