Decision-making executive function profile and performance in older adults with major depression: a case-control study.

OBJECTIVES: Decision making (DM) is a component of executive functioning, essential for choosing appropriate decisions. Executive dysfunctioning is particularly common in late-life depression, however the literature is scarce on DM. This case-control study aimed to evaluate the DM profile and performance in participants with and without unipolar major depression. METHOD: The DM profile and performance were assessed by the Melbourne Decision Making Questionnaire and the Iowa Gambling Task (IGT), respectively, in three groups of older adults from a university-based geriatric psychiatry clinic, i.e. current depression (n = 30), remitted depression (n = 43) and healthy controls (n = 59). The Hamilton Depression scale (HAM-D) 21 items, the Hamilton Anxiety scale, and the Mini-Mental State Examination were used to access depressive symptoms, anxiety symptoms, and cognitive impairment, respectively. Multinomial, nominal and binary logistic regression was used to evaluate the associations between depression, depressive symptomatology and DM. RESULTS: In comparison to the control group, patients with current depression presented higher scores in buck-passing and proscratination DM profiles. In the hypervigilance profile, there was a significant difference between current and remitted depression groups. A higher value ​in the HAM-D scale increased the probability of disadvantageous DM profiles. Depressive patients showed a tendency of a higher mean score in both disadvantageous decks (A and B) of IGT. Patients with current depression showed a worse performance compared to the remitted depression group in the IGT netscore. CONCLUSION: Older adults with current depression showed DM profiles considered maladaptive or disadvantageous compared to both remitted depression and healthy controls groups.

Could Frailty be an Explanatory Factor of the Association between Depression and Other Geriatric Syndromes in Later Life?

OBJECTIVES: This study aimed to investigate whether frailty could be an explanatory factor of the association between depression and the number of geriatric syndromes. METHODS: Cross-sectional baseline data from a cohort study (MiMiCS-FRAIL) were analyzed in a sample of 315 older adults. Depression was measured according to DSM-5 criteria and a self-report questionnaire (PHQ-9). Frailty was assessed according to the FRAIL questionnaire and a 30-item Frailty Index (FI). We considered six geriatric syndromes. Multiple linear regression analyses were performed and adjusted for potential confounders. RESULTS: Multiple linear regression analyses yielded significant associations between depression and geriatric syndromes. These associations decreased substantially in strength when frailty was added to the models. Findings were consistent for different definitions of depression and frailty. CONCLUSIONS: Among depressed patients, frailty may be hypothesized as a causal pathway toward adverse health outcomes associated with depression. Longitudinal studies should explore the causality of this association. CLINICAL IMPLICATIONS: Frailty should be treated or prevented in order to minimize the impact of other geriatric syndromes among depressed older adults. Screening for frailty would be of utmost importance in mental health care, as frailty is neglected especially in this field. Integrated care models are crucial for clinical practice in mental illness care.

Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms.

OBJECTIVE: Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment. DESIGN: Cross-sectional analysis of a cohort study on cognitive aging. PARTICIPANTS: 143 older adults. SETTING: University-based memory clinic. METHODS: Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles. RESULTS: The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007). CONCLUSION: Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

Relationship between affective temperament and major depressive disorder in older adults: A case-control study.

BACKGROUND: In clinical practice it is often challenging to determine whether mood disturbances should be considered a state or trait characteristics. This study is important to understand the influence of temperaments in the diagnosis of depression. The objective of the present study was to compare the frequency of three types of affective temperament (dysthymia, hyperthymia and cyclothymia) among older adults with major depression compared to non-psychiatric control patients. METHODS: A case-control study comparing 50 patients with major depression aged 65 years or above with a comparison group of 100 non-psychiatric controls. Affective temperaments were assessed using the TEMPS-A questionnaire. The 17-item Hamilton Depression Rating Scale and the Young mania Rating Scale were used for the assessment of symptoms of depression and mania, respectively. RESULTS: In the sample 80% had an affective temperament, most commonly hyperthymia (67.3%). In depressive patients 48% had criteria for hyperthymic temperament against 77% of the controls (OR= 0.3, 95%CI 0.1-0.7). 38.8% of these patients presented cyclothymic temperament, whereas among controls, 12% fulfilled criteria (OR= 2.9, 95%CI 1.1-7.2). LIMITATIONS: The sample was relatively small, and their educational level was very low. CONCLUSION: A cyclothymic temperament may predict major depression unlike hyperthymia. Whether the effectiveness of mood stabilizers in unipolar disorder is moderated by a cyclothymic temperament and should be explored in future randomized controlled trials.

Frailty as a Predictor of Cognitive Disorders: A Systematic Review and Meta-Analysis.

Background/Aim: Current evidence in the literature supports associations between frailty, cognitive impairment, and dementia. The study aim was to describe the risk of cognitive disorders associated with physical frailty in older adults from community-based studies. Methods: We performed a systematic review and meta-analysis, using MEDLINE, PsycINFO, Scopus, and Web of Science as databases for the search. Cohort and longitudinal studies were included in qualitative analysis and quantitative synthesis. For inclusion, studies had to assess dementia and cognitive impairment as a primary or secondary outcome, and describe the prevalence of frailty among participants at baseline and follow-up. Results: Of the 2,210 studies retrieved by the systematic review, 6 relevant studies were included in a meta-analysis. Baseline frailty was significantly associated with an increased risk of geriatric cognitive disorders (pooled OR = 1.80, 95% CI = 1.11-2.92; p = 0.02). Heterogeneity across the studies was significant (I 2 = 79%). Conclusions: The analyses confirmed that frail older adults were at higher risk of incident cognitive disorders than non-frail elders. Frailty status seems to be most associated with the risk of incident dementia. Frailty may represent a risk factor for dementia and could constitute a novel modifiable target in early cognitive impairment.

Subthreshold Depression Needs A Prime Time In Old Age Psychiatry? A Narrative Review Of Current Evidence.

This study aims to carry out a narrative review, aiming to update the literature on subsyndromic depression (SD), which is the most prevalent depressive disorder in older adults, and no formal guidelines or consensus are dedicated to this topic. We carried out an electronic search for articles on SD. Relevant articles were retrieved from Pubmed, EMBASE and Web of Science using the search terms "subthreshold depression," "prevalence," "treatment" and "older adults" in several combinations. Original articles in English were included from inception to 1st March 2019. No clear consensus exists in the literature on its nosologic classification, diagnostic tools, causes, course, outcomes or management. SD diagnosis should base in depressive symptoms scales and DSM criteria. Treatment relies mainly on collaborative care and psychotherapy. SD is relevant in clinical practice and research in geriatric psychiatry. Given the negative outcomes and potential benefits of treatment, we recommend brief psychotherapy as first-line treatment and use of psychotropic agents in cases with greater severity and/or functional impairment in association with psychotherapy. SD can precede major depressive disorder, but it also may consist of a primary depressive disorder in older adults. Furthermore, adequate treatment of SD can prevent or reduce negative outcomes associated with depressive symptoms such as worsening of clinical comorbidities, loss of functionality, increased demand for health services, and increased mortality.

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review.

INTRODUCTION: Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). OBJECTIVE: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. METHODS: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. RESULTS: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. CONCLUSION: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

Validity and reliability of the Brazilian Portuguese version of the Australian National University - Alzheimer's Disease Risk Index (ANU-ADRI).

The ANU-ADRI is a self-report tool that assesses risk for Alzheimer's Disease (AD). OBJECTIVE: To validate an adapted Portuguese version of this instrument and to carry out the reliability Test-Retest of the ANU-ADRI in Brazil. METHODS: In this longitudinal study, the sample was formed (n=100) by two groups (A and B): each comprising 50 patients assisted by GPs (general practitioners) or specialists in dementia. All participants were cognitively healthy upon screening using the MMSE. The ANU-ADRI was applied at baseline (Test) and again within 1 week of the test (Retest). RESULTS: There was a correlation between the mean scores of the ANU-ADRI Test and Retest (r=0.918, P<0.001). Group A had higher ANU-ADRI scores than those of group B (P<0.05). There was a moderate negative linear relation between the ANU-ADRI and MMSE scores (r= -0.353, P<0.001). CONCLUSION: The ANU-ADRI is a valid and reliable instrument to assess whether community-dwelling Brazilians are at greater risk for AD. Low levels of education were associated with higher risk scores on the ANU-ADRI.

O Índice de Risco da Doença de Alzheimer da "Australian National University" (ANU-ADRI) é uma ferramenta baseada em auto-relato que avalia o risco para Doença de Alzheimer (DA). OBJETIVO: Validar uma versão adaptada em português deste instrumento e realizar a confiabilidade Teste-Reteste do ANU-ADRI no Brasil. MÉTODOS: Neste estudo longitudinal, a amostra foi composta (n=100) por 2 grupos (A e B): cada um com 50 pacientes assistidos por clínicos gerais ou especialistas em demência. Todos os participantes eram cognitivamente normais após o rastreio usando o MEEM. O ANU-ADRI foi aplicado no início (Teste) e até uma semana após o teste (Reteste). RESULTADOS: Houve uma correlação entre a média de pontuações do ANU-ADRI no Teste e Reteste (r=0,918, P<0,001). O grupo A teve pontuações maiores no ANU-ADRI que as do grupo B (P<0,05). Houve uma relação moderada linear entre as pontuações do ANU-ADRI e MEEM (r= -0,353, P<0,001). CONCLUSÃO: ANU-ADRI é um instrumento válido e confiável para avaliar se brasileiros que vivem na comunidade estão à risco maior para DA. Baixos níveis de escolaridade foram relacionados às pontuações mais altas do ANU-ADRI.

Early-Onset Alzheimer Disease (EOAD) With Aphasia: A Case Report.

Background: Alzheimer's disease (AD) is traditionally subdivided into early onset (EOAD) and late onset (LOAD). EOAD has an onset before age 65 years and accounts for 1-5% of all cases. Two main presentation types of AD are familial and sporadic. Case presentation: The authors present the case of a 68-year-old retired white man, with a college level educational background. At 55 years of age, the patient presented cognitive decline with short-term memory impairment and slowed, hesitant speech. At 57 years, he was unable to remember the way to work, exhibiting spatial disorientation. PET-CT: revealed hypometabolism and atrophy in the left temporal lobe and posterior region of the parietal lobes. Disease course: Evolving with difficulties in comprehension and sentence repetition over past 3 years and with global aphasia in past 6 months, beyond progressive memory impairment. Discussion: Possibly due to the young age and atypical presentation, and the diagnosis of EOAD is often delayed. To the best of our knowledge, this case can be classified as a sporadic EOAD with aphasia. Clinical variant and neuroimaging findings were crucial to the diagnosis and treatment of this atypical presentation of AD.

Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder A systematic review.

Major Depressive Disorder (MDD) can occur in parallel with cognitive impairment. The search for a neuropsychological profile of depression has been pursued in the last two decades. However, scant research has been done on executive functions and decision-making ability (DM). OBJECTIVE: To perform a systematic review of the evidence of DM performance evaluated using the Iowa Gambling Task (IGT) in adults with MDD. METHODS: A systematic search according to the PRISMA statement was performed on MEDLINE for studies in English using the following keywords: 'depression', 'depressive', 'depressive symptoms' AND 'decision making' OR 'game task'. RESULTS: Five articles that met the inclusion and exclusion criteria were identified. Three reported significant differences between depressed and non-depressed individuals. The results indicated that young adults with MDD exhibited lower performance on all or almost all stages of the IGT. One study that evaluated DM in older adults with MDD showed that depressed non-apathetic participants failed to adopt any advantageous strategy and continued to make risky decisions during the task. CONCLUSION: Results suggest that performance on the DM task by young and old adults with MDD differed in comparison to non-depressed participants. Given the small number of articles, further studies should be performed.

O Transtorno Depressivo Maior (TDM) pode ocorrer em paralelo com o comprometimento cognitivo. A busca por um perfil neuropsicológico da depressão tem sido perseguida nas últimas duas décadas. No entanto, poucas pesquisas foram feitas sobre funções executivas e capacidade de decisão (DM). OBJETIVO: Realizar uma revisão sistemática das evidências do desempenho do DM avaliado pela Iowa Gambling Task (IGT) em adultos com TDM. MÉTODOS: Uma pesquisa sistemática de acordo com a declaração PRISMA foi realizada na MEDLINE para estudos em inglês usando as seguintes palavras-chave: "depressão", "depressivo", "sintomas depressivos" e "tomada de decisão" OU "tarefa de jogo". RESULTADOS: Foram identificados 5 artigos que atenderam aos critérios de inclusão e exclusão. Três relataram diferenças significativas entre indivíduos deprimidos e não deprimidos. Os resultados indicaram que os jovens adultos com TDM exibiram menor desempenho em todos ou quase todos os estágios da IGT. Um estudo que avaliou o DM em idosos com TDM mostrou que os participantes deprimidos não apáticos não adotaram nenhuma estratégia vantajosa e continuaram tomando decisões arriscadas durante a tarefa. CONCLUSÃO: Os resultados sugerem que o desempenho na tarefa de DM por jovens e adultos idosos com TDM diferiu em comparação com os participantes não deprimidos. Dado o pequeno número de artigos, mais estudos devem ser realizados.

Cross-cultural adaptation of the "Australian National University Alzheimer's Disease Risk Index" for the Brazilian population.

Alzheimer's disease (AD) represents a major public health problem and it is therefore crucial that modifiable risk factors be known prior to onset of dementia in late-life. The "Australian National University - Alzheimer's Disease Risk Index" (ANU-ADRI) is one of the potential tools for primary prevention of the disease. OBJECTIVE: The aim of this study was to devise an adapted version of the ANU-ADRI for use in Brazil. METHODS: The instrument was translated from its original language of English into Portuguese and then back-translated into English by bilingual translators. It was subsequently reviewed and evaluated as to the degree of translation issues and equivalence. In this study, the ANU-ADRI was applied using individual (face-to-face) interviews in a public hospital, unlike the original version which is applied online by self-report. The final version (pretest) was evaluated in a sample of 10 participants with a mean age of 60 years (±11.46) and mean education of 11 years (±6.32). RESULTS: The intraclass correlation coefficient (ICC) (inter-rater) was 0.954 (P<0.001 for a confidence interval (CI) of 95%=[0.932; 0.969]). Cultural equivalence was performed without the need for a second instrument application step. CONCLUSION: After cross-cultural adaptation, the language of the resultant questionnaire was deemed easily understandable by the Brazilian population.

A doença de Alzheimer (DA) tem sido um grande problema de saúde pública, portanto é crucial que fatores de risco modificáveis possam ser conhecidos antes da instalação da demência na fase final da vida. O "Australian National University - Índice de Risco da Doença de Alzheimer" (ANU-ADRI) é uma das ferramentas potenciais para a prevenção primária da doença. OBJETIVO: Este estudo teve como objetivo elaborar uma versão adaptada do ANU-ADRI para o uso no Brasil. MÉTODOS: O instrumento foi traduzido do idioma original, inglês para a língua portuguesa e retrotraduzido para o inglês por tradutores bilíngues. Foi posteriormente revisado e avaliado quanto ao grau de dificuldade da tradução e equivalência. Neste estudo, o ANU-ADRI foi aplicado em entrevistas individuais (face a face) num hospital público em vez da versão original que é aplicada on-line por meio de autorrelato. A versão final (pré-teste) foi avaliada numa amostra de 10 participantes com média de idade 60 anos (±11,46), e média de escolaridade 11 anos (±6,32). RESULTADOS: O coeficiente de correlação intraclasse entre os avaliadores foi 0,954 (P<0,001, intervalo de confiança de 95% IC=[0,932; 0,969]). A equivalência cultural foi realizada sem a necessidade de uma segunda etapa de aplicação do instrumento. CONCLUSÃO: Após a adaptação transcultural, a linguagem do questionário é descrita como de fácil compreensão pela população brasileira.

Screening for Alzheimer's disease in low-educated or illiterate older adults in Brazil: a systematic review / Rastreio para doença de Alzheimer em idosos brasileiros de baixa escolaridade ou analfabetos: revisão sistemática

ABSTRACT Cognitive screening instruments are influenced by education and/or culture. In Brazil, as illiteracy and low education rates are high, it is necessary to identify the screening tools with the highest diagnostic accuracy for Alzheimer's disease (AD). Objective: To identify the cognitive screening instruments applied in the Brazilian population with greater accuracy, to detect AD in individuals with a low educational level or who are illiterate. Methods: Systematic search in SciELO, PubMed and LILACS databases of studies that used cognitive screening tests to detect AD in older Brazilian adults with low or no education. Results: We found 328 articles and nine met the inclusion criteria. The identified instruments showed adequate or high diagnostic accuracy. Conclusion: For valid cognitive screening it is important to consider sociocultural and educational factors in the interpretation of results. The construction of specific instruments for the low educated or illiterate elderly should better reflect the difficulties of the Brazilian elderly in different regions of the country.

RESUMO Os instrumentos de rastreio cognitivo sofrem influência educacional e/ou cultural. No Brasil, como as taxas de analfabetismo e baixa escolaridade são altas, é necessário identificar os instrumentos com maior acurácia diagnóstica para a doença de Alzheimer (DA). Objetivo: identificar os instrumentos de rastreio cognitivo aplicados na população brasileira com maior acurácia para detectar DA em indivíduos com baixo nível de escolaridade ou que são analfabetos. Métodos: Busca sistemática de estudos que utilizaram testes de rastreio cognitivo para detectar DA em idosos brasileiros de baixa escolaridade ou analfabetos, nas bases de dados: SCIELO, PUBMED E LILACS. Resultados: Foram encontrados 328 artigos e 9 preencheram os critérios de inclusão. Os instrumentos identificados apresentaram acurácia diagnóstica adequada ou elevada. Conclusão: Para um rastreio cognitivo válido é importante considerar os fatores socioculturais e educacionais na interpretação dos resultados. A construção de instrumentos epecíficos para idosos de baixa escolaridade ou analfabetos deve ser incentivada para melhor refletir as dificuldades dos idosos brasileiros de diferentes regiões.

Validity and reliability of the Brazilian Portuguese version of the Australian National University - Alzheimer's Disease Risk Index (ANU-ADRI) / Validade e confiabilidade da versão brasileira do Índice de Risco da Doença de Alzheimer da "Australian National University" (ANU-ADRI)

ABSTRACT: The ANU-ADRI is a self-report tool that assesses risk for Alzheimer's Disease (AD). Objective: To validate an adapted Portuguese version of this instrument and to carry out the reliability Test-Retest of the ANU-ADRI in Brazil. Methods: In this longitudinal study, the sample was formed (n=100) by two groups (A and B): each comprising 50 patients assisted by GPs (general practitioners) or specialists in dementia. All participants were cognitively healthy upon screening using the MMSE. The ANU-ADRI was applied at baseline (Test) and again within 1 week of the test (Retest). Results: There was a correlation between the mean scores of the ANU-ADRI Test and Retest (r=0.918, P<0.001). Group A had higher ANU-ADRI scores than those of group B (P<0.05). There was a moderate negative linear relation between the ANU-ADRI and MMSE scores (r= -0.353, P<0.001). Conclusion: The ANU-ADRI is a valid and reliable instrument to assess whether community-dwelling Brazilians are at greater risk for AD. Low levels of education were associated with higher risk scores on the ANU-ADRI.

RESUMO: O Índice de Risco da Doença de Alzheimer da "Australian National University" (ANU-ADRI) é uma ferramenta baseada em auto-relato que avalia o risco para Doença de Alzheimer (DA). Objetivo: Validar uma versão adaptada em português deste instrumento e realizar a confiabilidade Teste-Reteste do ANU-ADRI no Brasil. Métodos: Neste estudo longitudinal, a amostra foi composta (n=100) por 2 grupos (A e B): cada um com 50 pacientes assistidos por clínicos gerais ou especialistas em demência. Todos os participantes eram cognitivamente normais após o rastreio usando o MEEM. O ANU-ADRI foi aplicado no início (Teste) e até uma semana após o teste (Reteste). Resultados: Houve uma correlação entre a média de pontuações do ANU-ADRI no Teste e Reteste (r=0,918, P<0,001). O grupo A teve pontuações maiores no ANU-ADRI que as do grupo B (P<0,05). Houve uma relação moderada linear entre as pontuações do ANU-ADRI e MEEM (r= -0,353, P<0,001). Conclusão: ANU-ADRI é um instrumento válido e confiável para avaliar se brasileiros que vivem na comunidade estão à risco maior para DA. Baixos níveis de escolaridade foram relacionados às pontuações mais altas do ANU-ADRI.

Decision Making assessed by the Iowa Gambling Task and Major Depressive Disorder: a systematic review / Tomada de decisão avaliada pela Iowa Gambling Task e pelo Transtorno Depressivo Maior: uma revisão sistemática

Abstract Major Depressive Disorder (MDD) can occur in parallel with cognitive impairment. The search for a neuropsychological profile of depression has been pursued in the last two decades. However, scant research has been done on executive functions and decision-making ability (DM). Objective: To perform a systematic review of the evidence of DM performance evaluated using the Iowa Gambling Task (IGT) in adults with MDD. Methods: A systematic search according to the PRISMA statement was performed on MEDLINE for studies in English using the following keywords: 'depression', 'depressive', 'depressive symptoms' AND 'decision making' OR 'game task'. Results: Five articles that met the inclusion and exclusion criteria were identified. Three reported significant differences between depressed and non-depressed individuals. The results indicated that young adults with MDD exhibited lower performance on all or almost all stages of the IGT. One study that evaluated DM in older adults with MDD showed that depressed non-apathetic participants failed to adopt any advantageous strategy and continued to make risky decisions during the task. Conclusion: Results suggest that performance on the DM task by young and old adults with MDD differed in comparison to non-depressed participants. Given the small number of articles, further studies should be performed.

Resumo O Transtorno Depressivo Maior (TDM) pode ocorrer em paralelo com o comprometimento cognitivo. A busca por um perfil neuropsicológico da depressão tem sido perseguida nas últimas duas décadas. No entanto, poucas pesquisas foram feitas sobre funções executivas e capacidade de decisão (DM). Objetivo: Realizar uma revisão sistemática das evidências do desempenho do DM avaliado pela Iowa Gambling Task (IGT) em adultos com TDM. Métodos: Uma pesquisa sistemática de acordo com a declaração PRISMA foi realizada na MEDLINE para estudos em inglês usando as seguintes palavras-chave: "depressão", "depressivo", "sintomas depressivos" e "tomada de decisão" OU "tarefa de jogo". Resultados: Foram identificados 5 artigos que atenderam aos critérios de inclusão e exclusão. Três relataram diferenças significativas entre indivíduos deprimidos e não deprimidos. Os resultados indicaram que os jovens adultos com TDM exibiram menor desempenho em todos ou quase todos os estágios da IGT. Um estudo que avaliou o DM em idosos com TDM mostrou que os participantes deprimidos não apáticos não adotaram nenhuma estratégia vantajosa e continuaram tomando decisões arriscadas durante a tarefa. Conclusão: Os resultados sugerem que o desempenho na tarefa de DM por jovens e adultos idosos com TDM diferiu em comparação com os participantes não deprimidos. Dado o pequeno número de artigos, mais estudos devem ser realizados.

Cross-cultural adaptation of the "Australian National University Alzheimer's Disease Risk Index" for the Brazilian population / Adaptação transcultural do índice de risco da doença de alzheimer da "australian national university" para a população brasileira

ABSTRACT. Alzheimer's disease (AD) represents a major public health problem and it is therefore crucial that modifiable risk factors be known prior to onset of dementia in late-life. The "Australian National University - Alzheimer's Disease Risk Index" (ANU-ADRI) is one of the potential tools for primary prevention of the disease. Objective: The aim of this study was to devise an adapted version of the ANU-ADRI for use in Brazil. Methods: The instrument was translated from its original language of English into Portuguese and then back-translated into English by bilingual translators. It was subsequently reviewed and evaluated as to the degree of translation issues and equivalence. In this study, the ANU-ADRI was applied using individual (face-to-face) interviews in a public hospital, unlike the original version which is applied online by self-report. The final version (pretest) was evaluated in a sample of 10 participants with a mean age of 60 years (±11.46) and mean education of 11 years (±6.32). Results: The intraclass correlation coefficient (ICC) (inter-rater) was 0.954 (P<0.001 for a confidence interval (CI) of 95%=[0.932; 0.969]). Cultural equivalence was performed without the need for a second instrument application step. Conclusion: After cross-cultural adaptation, the language of the resultant questionnaire was deemed easily understandable by the Brazilian population.

RESUMO. A doença de Alzheimer (DA) tem sido um grande problema de saúde pública, portanto é crucial que fatores de risco modificáveis possam ser conhecidos antes da instalação da demência na fase final da vida. O "Australian National University - Índice de Risco da Doença de Alzheimer" (ANU-ADRI) é uma das ferramentas potenciais para a prevenção primária da doença. Objetivo: Este estudo teve como objetivo elaborar uma versão adaptada do ANU-ADRI para o uso no Brasil. Métodos: O instrumento foi traduzido do idioma original, inglês para a língua portuguesa e retrotraduzido para o inglês por tradutores bilíngues. Foi posteriormente revisado e avaliado quanto ao grau de dificuldade da tradução e equivalência. Neste estudo, o ANU-ADRI foi aplicado em entrevistas individuais (face a face) num hospital público em vez da versão original que é aplicada on-line por meio de autorrelato. A versão final (pré-teste) foi avaliada numa amostra de 10 participantes com média de idade 60 anos (±11,46), e média de escolaridade 11 anos (±6,32). Resultados: O coeficiente de correlação intraclasse entre os avaliadores foi 0,954 (P<0,001, intervalo de confiança de 95% IC=[0,932; 0,969]). A equivalência cultural foi realizada sem a necessidade de uma segunda etapa de aplicação do instrumento. Conclusão: Após a adaptação transcultural, a linguagem do questionário é descrita como de fácil compreensão pela população brasileira.