Rendimiento Neuropsicológico De La Memoria Episódica En Jóvenes Con

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Rendimiento Neuropsicológico De La Memoria Episódica En Jóvenes Con UNIVERSIDAD COMPLUTENSE DE MADRID FACULTAD DE PSICOLOGÍA Departamento de Psicobiología TESIS DOCTORAL Contribuciones de la atención y el funcionamiento ejecutivo a la memoria episódica en jóvenes con consumo intensivo de alcohol MEMORIA PARA OPTAR AL GRADO DE DOCTOR PRESENTADA POR Claudia Porras Truque Directores María Montserrat Corral Varela Luis Miguel García Moreno Madrid, 2016 © Claudia Porras Truque, 2016 UNIVERSIDAD COMPLUTENSE DE MADRID FACULTAD DE PSICOLOGÍA Departamento de Psicobiología --- TESIS DOCTORAL CONTRIBUCIONES DE LA ATENCIÓN Y EL FUNCIONAMIENTO EJECUTIVO A LA MEMORIA EPISÓDICA EN JÓVENES CON CONSUMO INTENSIVO DE ALCOHOL Claudia Porras Truque DIRECTORES Dra. María Montserrat Corral Varela Dr. Luis Miguel García Moreno Madrid, 2015 A Dios, a mis padres, A mis amores: Nando y Pedro. A quien me da la vida, a quienes me amaron para vivir plenamente, a mi gran compañero de vivencias cuyas ideas me inspiran siempre y a quien me da el dulce desafío de ser madre; ellos me enseñan lo importante de la vida. AGRADECIMIENTOS Quiero iniciar agradeciendo a Luis Miguel García Moreno, por su paciencia, por la enorme cantidad de tiempo que me ha dedicado, por ver más allá de mis innumerables parones durante la tesis, pero sobre todo, gracias por ser ejemplo de vocación. Aprendo mucho de ti. A Montserrat Corral por sus palabras de comprensión y ánimo, por aportarme tranquilidad y siempre una perspectiva profesional, gracias por tu ayuda. Muchísimas Gracias a mi compañera Patricia, durante todo este proceso has sido mi hermana mayor y agradezco nuestras conversaciones de desahogo, los café de incertidumbre y las muchas formas de echarme una mano por tu parte; cuando recuerdo esta época de mucho trabajo me quedo con los momentos y años de apoyo que nos dimos hasta conseguirlo, vales muchísimo. A Xavier Ordoñez por sus aportaciones en el entorno estadístico unidas a reflexiones de la vida. Gracias a mis amigos, a aquellos que vieron que lo lograría a pesar de que para mí estaba muy distante. Por las risas y valiosísimos momentos de desconexión, por aguantar mis ausencias y mil ocupaciones: a Vicky y Paco por vuestras palabras y momentos de psico-apoyo, Vane por tus cuidados a Pedro, Verito siempre siendo todo colaboración, Caro, Jona y los peques gracias por vuestros miles de gestos admirables, Gaby y Samu por compartir nuestras ilusiones y ser parte de ellas, Eli y Juanma por vuestras palabras de fe, Hawee por ser leal amiga, Mauro y Jenny por vuestra cercanía y apoyo incondicional. Agradecer a mis amigos Jump y al equipo de alta influencia quienes son un gran motivo para que este esfuerzo fuera alcanzado. A los pastores Tomás Santa Marta y Moreiba por vuestro apoyo y las oportunidades que nos dais para crecer, sois de gran inspiración. En especial agradecer a mi hermosa familia, quienes se han entregado de todas las formas posibles para hacer este proyecto realidad. Abuelita Abigail gracias por tus nutritivas comidas después de días agotadores de trabajo, por ser ingeniosa y recursiva para siempre echar una mano, eres única. Merce, imposible si no hubieras estado cada tarde a nuestro lado, sé que has sacrificado varias cosas por respaldarnos en este proyecto y agradezco cada uno de tus esfuerzos y el amor de madre que recibo de tu parte. A mis padres gracias por darme las mejores experiencias que una hija puede tener; gran parte de este logro es vuestro. A mi madre, mi amiga del día a día, quién me da su apoyo de la forma que sea necesaria con tal de verme salir adelante; gracias por siempre darme lo mejor y porque son innumerables tus aportaciones en este trabajo, eres un tesoro, además de un gran ejemplo para mí, te amo. Al recuerdo de mi padre, a la memoria de millones de maravillosos momentos a su lado; si un bien hace la memoria episódica en mi vida, es el de hacerte presente y permitirme revivir infinidad de vivencias contigo, todas al final se unen y me sitúan aquí, en lo que soy hoy. Te marchaste durante la realización de este proyecto; fue difícil continuar con tu ausencia y aunque no podrás leer estas palabras, es justo que quien lo pueda hacer sepa que estuviste detrás, fuiste promotor e infundiste tanto amor y confianza en mí que al final no me rendí. Tu frase: “avanza con todo” aún me mueve, te amo papá y siempre te extrañare. Pensar en mi padre me lleva directamente a reconocer que todo tiene sentido por lo que Dios ha hecho en mí, gracias por la vida, por la que tuve día a día mientras soñé ciegamente en este proyecto, por darme paz en los momentos más complejos y al final ser todo AMOR, Gracias Dios, lo eres todo para mí. A Mi hijo Pedro, llegaste a nuestras vidas durante este reto; era el momento perfecto, fuiste mi alegría en una época que estaba destinada a ser de duelo. Probablemente no recordarás ningún suceso del periodo de la Tesis de Mamá, pero espero el momento en que puedas leer esta parte y entonces sepas que pusiste tu granito de arena ¿Cómo? ¡Siendo un bebé estupendo! jugando conmigo entre párrafo y párrafo, siendo mi motivo de esfuerzo, retándome a ser mejor persona, ayudándome a ser más práctica y dándome instantes dulces que quisiera fuesen eternos, valen más que nada; me enseñas una nueva forma de vivir, de amar, ahora estas en cada uno de mis sueños. A mi compañero de vida: ¡¡Mor lo conseguimos!! Cada día que hacías sacrificios por mí y por este proyecto, pensaba: “lo tendré en cuenta para escribirlo aquí y reconocerlo”, pero han sido tantos, tantos, que me es imposible plasmarlos todos. Así que sólo puedo agradecer tu amor, porque al final es lo que me has demostrado con todos los gestos pro-tesis. Soy afortunada, bendecida por tener alguien como tú a mi lado. Este es uno de nuestros logros. Te amo. ÍNDICE TÍTULO PÁGINAS RESUMEN 1 ABSTRACT 5 I. INTRODUCCIÓN 9 1. ALCOHOL Y CEREBRO ADOLESCENTE. 11 1.1. Alcohol y su consumo intensivo en jóvenes . 11 1.2. Desarrollo cerebral en la adolescencia . 13 1.3. Alteraciones cerebrales estructurales y funcionales por CIA . 16 2. MEMORIA EPISÓDICA. 23 2.1. Memoria episódica: aproximación conceptual. 23 2.1.1. Proceso de codificación. 25 2.1.2. Proceso de almacenamiento. 29 2.1.3. Proceso de recuperación. 30 2.1.4. Bases neurofuncionales de la memoria. 33 2.2. Atención, velocidad de procesamiento y memoria episódica. 38 2.2.1. La atención: aproximación conceptual. 39 2.2.2. Sistemas Top-down y Bottom-up. 40 2.2.3. Atención para la codificación. 42 2.2.4. Atención para la recuperación. 44 2.2.5. Velocidad de procesamiento para los procesos de memoria 45 2.3. Funcionamiento ejecutivo y memoria episódica. 46 3. CONSECUENCIAS NEUROPSICOLÓGICAS DEL CONSUMO 53 INTENSIVO DE ALCOHOL. 3.1. Memoria episódica y alcohol. 54 3.2. Alcohol, atención y funcionamiento ejecutivo. 62 II. PLANTEAMIENTO Y OBJETIVOS DEL ESTUDIO 67 III. MATERIAL Y MÉTODO 69 1. PARTICIPANTES. 69 I 2. MATERIAL. 73 2.1. Pruebas de filtrado, control y categorización. 74 2.2. Evaluación neuropsicológica. 76 3. PROCEDIMIENTO. 87 4. ANÁLISIS DE DATOS. 88 IV. RESULTADOS 97 1. PRIMER OBJETIVO. 97 1.1. Hipótesis uno. 97 1.1.1. Diferencia de medias. 97 1.2. Hipótesis dos. 102 1.2.1. Análisis de correlaciones. 102 2. SEGUNDO OBJETIVO. 105 2.1. Hipótesis tres. 105 2.1.1. Diferencia de medias. 105 2.2. Hipótesis cuatro. 112 2.2.1. Análisis de correlaciones. 112 3. TERCER OBJETIVO. 117 3.1. Hipótesis cinco. 117 3.1.1. Análisis por conglomerados (cluster). 117 3.2. Hipótesis seis. 121 4. CUARTO OBJETIVO. 123 4.1. Hipótesis siete. 123 4.1.1. Análisis por conglomerados (cluster). 123 5. QUINTO OBJETIVO. 131 5.1. Hipótesis Ocho. 131 5.1.1. Análisis de regresión. 133 V. DISCUSIÓN 145 VI. CONSIDERACIONES Y LIMITACIONES 165 VII. CONCLUSIONES 167 VIII. REFERENCIAS BIBLIOGRÁFICAS 169 II ÍNDICE DE TABLAS TÍTULO PG Tabla 1. Estudios sobre rendimiento en memoria en jóvenes con Patrón CIA. 57 Tabla 2. Criterios de exclusión empleados en la selección de la muestra 69 mediante el cuestionario colectivo. Tabla 3. Criterios de exclusión aplicados en la entrevista personal. 70 Tabla 4. Características sociodemográficas y clínicas de los participantes. 72 Tabla 5. Dominios e ítems del cuestionario AUDIT. 75 Tabla 6. Total uso de estrategias semánticas prueba TAVEC. 79 Tabla 7. Total uso de estrategias seriales prueba TAVEC. 79 Tabla 8. Total uso de estrategias prueba TAVEC. 80 Tabla 9. Variables procesos de memoria episódica: codificación, 90 almacenamiento y recuperación. Tabla 10. Media y desviación típica de las puntuaciones directas obtenidas en el 98 test TAVEC y su comparación con los grupos en función del patrón de consumo de alcohol. Tabla 11. Media y desviación típica de las puntuaciones directas obtenidas en la 100 prueba TEXTOS I y II, comparado con los grupos en función del patrón de consumo de alcohol. Tabla 12. Media y desviación típica de las puntuaciones directas obtenidas en el 102 test TAVEC y su comparación con los grupos en función del patrón de consumo de alcohol; sin los sujetos cuyo BAC es 0,06 y 0,07 g/dl. Tabla 13. Correlaciones entre las variables del test TAVEC y BAC. 103 Tabla 14. Correlaciones entre las variables de la prueba TEXTOS I y II y el nivel 104 BAC. Tabla 15. Media y desviación típica de las puntuaciones directas obtenidas en la 105 prueba d2 y su comparación con los grupos en función del patrón de consumo de alcohol. Tabla 16. Media y desviación típica de las puntuaciones directas obtenidas en la 106 prueba Localización espacial y su comparación con los grupos en función del patrón de consumo de alcohol.
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