Cognitive screening test in primary care: cut points for low education.

OBJECTIVE: To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS: Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS: Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS: The GPCOG-Br is clinically well-suited for use in primary care.

Cognitive screening test in primary care: cut points for low education

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

Review of Decision-Making in Game Tasks in Elderly Participants with Alzheimer Disease and Mild Cognitive Impairment.

BACKGROUND: Changes in decision-making (DM) have recently been investigated in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI). DM is highly relevant to everyday functioning and autonomy. It relies on several cognitive abilities, such as semantic and episodic memory, as well as aspects of executive functioning. We conducted a systematic review of DM in older adults with MCI and AD. SUMMARY: Only 5 studies whose main objective was to evaluate the DM performance were selected. The results extracted indicated that DM in ambiguity and in at-risk situations are both impaired in probable AD patients. MCI patients have difficulty making advantageous decisions under ambiguity and at risk, similar to patients with probable AD but they are less impaired. Key Messages: DM deficits may be a predictor of cognitive impairment and conversion to dementia and its potential clinical value should be further explored in longitudinal studies involving direct comparison between MCI and AD patients.

The Geriatric Anxiety Inventory in primary care: applicability and psychometric characteristics of the original and short form

Abstract Background Generalized anxiety disorder (GAD) has negative implications for people’s lives, but is often underdiagnosed in the elderly. There is a shortage of instruments to assess geriatric anxiety. Objectives To analyze the applicability and psychometric properties of the Portuguese version of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) within primary care. Methods Fifty-five seniors were classified as non-demented by a multidisciplinary panel. The protocol included the GAI, the Self-Reporting Questionnaire (SRQ-20), the Depression Scale D-10, Mini-Mental State Examination (MMSE), Bayer Scale for Activities of Daily Living (B-ADL) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A sub-sample also completed the Beck Anxiety Inventory (BAI). Results The GAI and GAI-SF showed good internal consistency (0.89; 0.62, respectively) and test-retest stability (0.58, 0.97). The GAI and GAI-SF correlated significantly with the SRQ-20 (0.74, 0.55) and BAI (0.75, 0.58). Discussion The psychometric characteristics of the Brazilian versions of the GAI and GAI-SF suggest these instruments are suitable for application in the Brazilian elderly population within the primary care setting.

Frontal Lobe Degeneration in Adults with Down Syndrome and Alzheimer's Disease: A Review.

BACKGROUND: There is a proven link between Down syndrome and the early development of the neuropathological features of Alzheimer's disease (AD). Changes in the personality and behavior of adults with Down syndrome might indicate the early stages of dementia or of frontotemporal lobar degeneration. The objective of this study was to investigate the executive functions and changes in behavior associated with frontal lobe degeneration in individuals with Down syndrome who develop AD. We conducted a systematic review selecting studies employing cognitive assessments. SUMMARY: We identified few studies using objective measurements to determine whether cognitive aspects associated with the frontal lobe correlate with dementia in this population. We observed a tendency toward such correlations. KEY MESSAGES: There is a need for further studies in which objective measures of cognitive and behavioral factors are evaluated together with data related to brain function and morphology.

The applicability of the cognitive abilities screening instrument-short (CASI-S) in primary care in Brazil.

BACKGROUND: The Cognitive Abilities Screening Instrument - Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care. OBJECTIVES: To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy. METHODS: In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients' health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status. RESULTS: The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = -0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%. CONCLUSIONS: The CASI-S can be useful for dementia screening in primary care in Brazil.

Cognitive screening for dementia in primary care: a systematic review.

BACKGROUND: Identifying dementia in primary care could minimize the impact of a late intervention; however, it shows high rates of misdiagnosis. One of the reasons seems to be the lack of knowledge of adequate cognitive screening instruments. This is a systematic review of the available instruments for the primary care context. METHOD: For this systematic review, articles were collected according to the following combined key terms: "cognitive screening" and "dementia" and "primary care" and "review". Studies should be reviews focusing on cognitive screening instruments best used in primary care setting. RESULTS: Thirteen reviews were selected. In total, it was considered 34 cognitive screening instruments. Half of the instruments can be applied in an adequate time-limit for primary care context. Memory is the most commonly assessed cognitive function (91%). Almost half of the tests are mentioned to have influence of education or cultural factors (44%). CONCLUSION: Tests such as 6CIT, AMT, GPCOG, Mini-Cog, MIS, MoCA, and STMS seem to be good alternatives to the use of the Mini-Mental State Examination when considering factors such as application time, sensitivity, specificity, and number of studies. However, there is a wide range of tests with different characteristics, therefore it is recommended that the professional gets some expertise in a few number of instruments in order to be able to choose which to use, or use in combination, depending on the setting and the profile of the patient.

Cognitive intervention in amnestic Mild Cognitive Impairment: a systematic review.

Mild Cognitive Impairment (MCI) represents a transitional state between normal aging and early dementia and is commonly associated with memory impairment (amnestic or A-MCI). Several studies have investigated therapeutic approaches to A-MCI, including cholinestherase inhibitors (I-ChEs), although this practice is still controversial. Thus, there is a current need to determine the effects of cognitive interventions either in combination with I-ChEs or alone. To assess the efficacy of such treatments, neuropsychological instruments and self-evaluated scoring of memory, mood, daily life activities and quality of life are employed. Recently, some studies have used functional magnetic resonance imaging (fMRI) in order to understand the neurobiological effects of these interventions. The aim of this systematic review is to investigate the effectiveness of cognitive interventions on the enhancement of learning abilities as well as their impacts on cognitive measurements of mood, everyday functioning and functional neuroimaging. This review also focused on the methodological aspects of such studies and attempted to introduce new perspectives on cognitive interventions in this population. The authors concluded that a-MCI patients are capable to learn new information and memory strategies. Although findings in standardized neuropsychological tests are limited, non-standardized cognitive measures and subjective measures show significant changes. Furthermore, fMRI reveals changes in the patterns of brain activation and increase of connectivity.

Movimentos sacádicos durante leitura de texto em crianças e universitários bons leitores / Los movimientos sacádicos durante la lectura de textos en niños y profesores de universidad considerados buenos lectores / Saccadic movements during reading of text in children and university professors considered good readers

O presente estudo avaliou crianças de quarta série e universitários considerados bons leitores em prova computadorizada de leitura de textos. Traçados dos movimentos oculares obtidos durante a leitura possibilitam comparar os dois grupos em: número de sacadas regressivas; tipo de sacada regressiva que podia ser intra-palavra ou entre-palavra; e classificação gramatical das palavras que sofreram regressão. Resultados mostram que crianças apresentaram maior número de sacadas regressivas do que universitários. Ambos os grupos realizaram mais regressões entre-palavras para a palavra imediatamente anterior à última fixação do que regressões intra-palavra. Os dois grupos realizaram mais sacadas regressivas intra-palavras nos seguintes tipos de palavras: substantivos, adjetivos e verbos. Regressões para a palavra anterior ocorreram principalmente nos pares de palavra: conjunção-verbo; adjetivo-substantivo e preposição-substantivo. De modo geral, os bons leitores realizam menos sacadas regressivas do que crianças em processo de alfabetização, no entanto o padrão das sacadas regressivas e o tipo de palavras que sofrem regressão são parecidos nos dois grupos. Também foi observado um maior número de sacadas regressivas no início de cada linha do texto, que pode ser explicado em função do processamento parafoveal na leitura. Regressões para a palavra anterior podem estar relacionadas ao fato de que, dependendo da classe gramatical da palavra, há uma maior possibilidade dela não ser fixada.

The present study evaluated 4-grade children and university professors considered good readers in a computerized test of text reading. Trajectories of eye movements obtained during reading made possible to compare the two groups regarding the number of regressive saccades; type of regressive saccade - that could be intra-word or inter-word; and grammatical classification of words that suffered regression. Results show that children presented a higher number of regressive saccades than university professors. Both groups carried out more inter-word regressions to the word immediately antecedent to the last fixation than intra-word regressions. The two groups carried out more intra-words regressive saccades in the following word types: nouns, adjectives and verbs. Regressions to the previous word took place principally in word couples conjunction-verb, adjective-noun, and preposition-noun. On the whole, good readers carry out fewer regressive saccades than children in the process of literacy, but the standard of regressive saccades and the type of words that suffer regression are similar in the two groups. Also a higher number of regressive saccades was observed in the beginning of each line of the text, which can be explained by paraphoveal processing in reading. Regressions to the previous word may be related to the fact that, depending on the grammatical class of the word, there is a higher possibility of its not fixed.

Este estudio evaluó a niños del 4° grado y profesores de universidad considerados buenos lectores en una prueba automatizada de lectura de texto. Trayectorias de movimientos del ojo obtenidos durante la lectura han hecho posible comparar los dos grupos en cuanto al número de movimientos sacádicos regresivos; el tipo de movimiento sacádico regresivo - que podría ser intrapalabra o interpalabra; y la clasificación gramatical de palabras que sufrieron la regresión. Los resultados muestran que los niños presentaron un número más alto de movimientos sacádicos regresivo que los profesores de universidad. Ambos grupos realizaron más regresiones interpalabra al la palabra inmediatamente antecedente a la última fixación que regresiones intrapalabra. Los dos grupos realizaron más movimientos sacádicos regresivos intrapalabras en los tipos de palabra siguientes: sustantivos, adjetivos y verbos. Las regresiones a la palabra anterior ocurrieron principalmente en parejas conjunción-verbo, sustantivo-adjetivo y preposición-sustantivo. En general, los buenos lectores realizan menos movimientos sacádicos regresivos que niños em el proceso del alfabetismo, pero el estándar de movimientos regresivos y el tipo de palabras que sufren la regresión son similares en los dos grupos. También un número más alto de estos movimientos fue observado al principio de cada línea del texto, lo que se puede explicar por el procesamiento parafoveal en la lectura. Las regresiones a la palabra anterior pueden estar relacionadas con el hecho que, según la clase gramatical de la palabra, hay una posibilidad más alta de su no fijación.

Processos perceptuais e cognitivos na leitura de palavras: propriedades dos movimentos oculares / Perceptual and cognitive processes in word reading: eye movement characteristics

A análise do padrão do movimento ocular auxilia discriminar leitores competentes daqueles com dificuldades de leitura. O padrão de leitura dos movimentos oculares é afetado por propriedades psicolingüísticas da palavra, tais como: comprimento, regularidade, freqüência e lexicalidade O objetivo do presente estudo foi analisar o padrão de movimentos oculares durante a leitura em português do Brasil e compará-lo com resultados de estudos de outras línguas. Os movimentos oculares durante a leitura de palavras e pseudopalavras foram analisados em 20 universitários com idade média de 20,5 anos (DP=2,9). Os resultados indicam que o número de fixações, tempo da primeira fixação e tempo total das fixações foram influenciados pelas variáveis, comprimento, lexicalidade e freqüência dos itens. Foi observado efeito de regularidade para todas as variáveis, exceto naquela do número de fixações. Os resultados obtidos foram semelhantes àqueles encontrados em outras línguas com predomínio de palavras regulares, mas não de palavras irregulares, como o inglês.(AU)

Analyses of eye movement's pattern contribute significantly to the discrimination between good and poor readers. The pattern of eye movements during reading is affected by psycholinguistic properties of words such as: length, regularity, and frequency. The objective of the present study was to analyze eye movements during words and non-words reading in Brazilian Portuguese and compare the results with the data from other languages. Eye movements during the words and non-words reading were recorded from 20 university students with the mean age of 20.5 years (SD=2.9). Results showed significant effect of word length, regularity and frequency on number of fixations, first fixation duration and gaze duration. Regularity showed effect on all of the variables except on number of fixations. The results are similar to those found in languages with predominantly regular orthographies, but not with the irregular ones such as English.(AU)

Processos perceptuais e cognitivos na leitura de palavras: propriedades dos movimentos oculares / Perceptual and cognitive processes in word reading: eye movement characteristics

A análise do padrão do movimento ocular auxilia discriminar leitores competentes daqueles com dificuldades de leitura. O padrão de leitura dos movimentos oculares é afetado por propriedades psicolingüísticas da palavra, tais como: comprimento, regularidade, freqüência e lexicalidade O objetivo do presente estudo foi analisar o padrão de movimentos oculares durante a leitura em português do Brasil e compará-lo com resultados de estudos de outras línguas. Os movimentos oculares durante a leitura de palavras e pseudopalavras foram analisados em 20 universitários com idade média de 20,5 anos (DP=2,9). Os resultados indicam que o número de fixações, tempo da primeira fixação e tempo total das fixações foram influenciados pelas variáveis, comprimento, lexicalidade e freqüência dos itens. Foi observado efeito de regularidade para todas as variáveis, exceto naquela do número de fixações. Os resultados obtidos foram semelhantes àqueles encontrados em outras línguas com predomínio de palavras regulares, mas não de palavras irregulares, como o inglês.

Analyses of eye movement's pattern contribute significantly to the discrimination between good and poor readers. The pattern of eye movements during reading is affected by psycholinguistic properties of words such as: length, regularity, and frequency. The objective of the present study was to analyze eye movements during words and non-words reading in Brazilian Portuguese and compare the results with the data from other languages. Eye movements during the words and non-words reading were recorded from 20 university students with the mean age of 20.5 years (SD=2.9). Results showed significant effect of word length, regularity and frequency on number of fixations, first fixation duration and gaze duration. Regularity showed effect on all of the variables except on number of fixations. The results are similar to those found in languages with predominantly regular orthographies, but not with the irregular ones such as English.