The Von Restorff effect in the Brazilian version of the Rey Auditory Verbal Learning Test in an elderly population / Efeito de Von Restorff na versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey em idosos

ABSTRACT. The Von Restorff (isolation) effect refers to a stimulus that is more likely to be remembered amongst other stimuli in memory tasks. It has been demonstrated with different age ranges and methodologies. Objective: To investigate: a) the presence of the isolation effect in elders tested with the new Brazilian Portuguese version of the Rey Auditory Verbal Learning Task (RAVLT) in which a word with potential emotional weight (mother) was introduced; b) whether isolation effects persist in memory disorders of different degrees of severity (Mild Cognitive Impairment [MCI]; Alzheimer's Dementia [AD]). Methods: The RAVLT was administered to 287 consecutive volunteers. Individuals underwent medical and neuropsychological evaluation and were further sub-grouped into normal controls (n=114), MCI (n=87) and AD (n=86) patients. One-way analysis of variance (ANOVA) and Chi-squared tests were performed. Post-hoc Tukey analysis was conducted to assess significance of group differences. Results: There were significant group effects on the learning curve. A W-shape - instead of the classical U-shape - was found for the serial position curve in all groups. Conclusion: The new Brazilian version of the RAVLT exhibited the Von Restorff effect, where this phenomenon was evident not only in older adults but also patients with MCI and AD, providing further psychometric measures for inter-group analyses.

RESUMO. Efeito de von Restorff (efeito de isolamento) refere-se ao estímulo que é mais facilmente lembrado em relação a outros em tarefas de memória. Tal efeito foi demonstrado em diferentes faixas etárias com diferentes metodologias. Objetivo: Investigar: a) presença do efeito de isolamento numa população idosa avaliada com a nova versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT), em que uma palavra com potencial carga emocional ('mãe') foi introduzida; b) se o efeito de isolamento persiste em distúrbios de memória de diferentes gravidades (Comprometimento Cognitivo Leve [MCI]; Demência de Alzheimer [AD]). Métodos: RAVLT foi aplicado em 287 voluntários. Indivíduos participaram de avaliações médica e neuropsicológica e foram posteriormente agrupados em controles normais (n=114), MCI (n=87) e DA (n=86). Análises de variância e testes de Chi-quadrado foram realizados. Análises post-hoc foram conduzidas para avaliar diferenças de características entre os grupos. Resultados: Observaram-se efeitos significativos de grupo na curva de aprendizagem. Todos os grupos apresentaram curva de posição serial em formato W - invés do clássico formato em U. Conclusão: A nova versão brasileira do RAVLT evidenciou um efeito de von Restorff. Tal fenômeno foi visto não apenas em idosos, mas também em pacientes com MCI e AD, fornecendo medidas psicométricas adicionais para análises de diferenças intergrupais.

Dementia screening in Brazil: a systematic review of normative data for the mini-mental state examination

The Mini-Mental State Examination (MMSE) is the most widely used instrument for the screening of older adults with suspected cognitive impairment; the MMSE has been translated and validated in numerous languages and countries. The cultural and sociodemographic characteristics of the sample can influence performance on the test; therefore, applying the MMSE in different populations usually requires adjustments of those variables. From this perspective, the present study aims to review the normative data for the MMSE in the Brazilian older population, including those adaptations to the original test. Database searches were performed in Medline, Web of Knowledge, Scielo and Pepsic for articles assessing healthy elderly Brazilian samples using the MMSE. Heterogeneity across and within the studies was analyzed. Of a total of 1,085 retrieved articles, 14 were included. Significant differences across studies were identified for the characteristics of the samples, the presence of alterations to the MMSE subtests and the presentation of the results. The risk of biases was relevant for all the studies. Considering the large methodological heterogeneity among studies, the generalization of the available normative data for the MMSE may not be appropriate for the general elderly Brazilian population.

Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly

Objective: To investigate whether the level of awareness of memory deficits is useful for discriminating between major depressive disorder (MDD) and mild cognitive impairment (MCI) in the elderly. Methods: Sixty-three consecutively referred patients (38 women and 25 men) with memory concerns comprising three groups (clinical control, MDD and MCI) underwent a memory test (Rey Auditory Verbal Learning Test [RAVLT]) and completed the Memory Assessment Complaints-Questionnaire (MAC-Q). Level of awareness was estimated by the difference between the MAC-Q score and the score on the fifth presentation of the RAVLT. Memory performance, Mini-Mental State Examination (MMSE) and depressive symptoms (Geriatric Depression Scale [GDS]) were also assessed. Results: The control (n=25), MDD (n=16), and MCI (n=22) groups were similar in age, educational level, and MMSE (p > 0.05). Among the groups, the MDD group had the most memory complaints, whereas the MCI group had the worst objective memory performance. Level of awareness was capable of discriminating between MDD and MCI (p < 0.05), but not between MDD and clinical controls (p > 0.05). MDD subjects tended to underestimate their memory functioning as compared to controls (p < 0.05). Conclusion: Level of awareness of memory deficits was significantly useful to discriminate between MCI and MDD, which is a common difficulty faced by clinicians. Future studies with larger samples are needed to confirm these findings.

O atendimento psicanalítico com pacientes neurológicos / The psychoanalytical treatment with neurological patients

A clínica dos pacientes com lesão cerebral centra-se na neurologia e na neuropsicologia. Porém, não se deve reduzir seu atendimento somente aos aspectos relacionados à lesão, pois além dos aspectos das perdas cerebrais, motoras e cognitivas, ela também abrange uma experiência subjetiva transformadora e até traumática. Tais aspectos apresentam-se profundamente interligados. Propomos um atendimento psicanalítico que privilegie a relação do sujeito com sua doença e todas as suas conseqüências, sem negligenciar os aspectos fisiológicos e cognitivos existentes. Neste artigo, objetivamos apresentar as primeiras elaborações a respeito desta clínica, destacando alguns aspectos. De saída, formulamos os objetivos do atendimento psicanalítico de casos neurológicos, sublinhando suas diferenças e suas complementaridades relativamente ao atendimento neuropsicológico. A seguir, evidenciamos as contribuições que a psicanálise pode trazer para a abordagem destes casos no que diz respeito aos aspectos da perda, da falta e da temporalidade. Os fatores importantes e as fases do atendimento também são abordados, com destaque para as questões envolvendo a demanda de atendimento, a irrupção do Real e os lugares do corpo em tais casos. Finalmente, sistematizamos certos conjuntos significativos que podem ser observados no atendimento de tais casos. São eles: as feridas na identidade subjetiva, o problema da re-socialização, a presença de movimentos regressivos e da construção de mitos sobre o adoecimento, a presença da dúvida, as diferentes linguagens, a doença como passagem ao ato e, por fim, os aspectos da vergonha e da culpabilidade.

The treatment of patients with brain injuries is centered on neurology and neuro-psychology. However, brain injury treatment should not be reduced to aspects related to the lesion; for beyond the aspects of brain, movement and cognitive losses, it also encompasses a transforming and even traumatic subjective experience. These aspects are deeply interconnected. We propose a psychoanalytic treatment that privileges the subject?s relation to his/her disease and all of its consequences, one that does not neglect the physiological and cognitive aspects involved. In this article, we present the first elaborations regarding this clinic, highlighting a number of its aspects. From the outset, we conceive the objectives of psychoanalytic treatment of neurological cases, underscoring its differences and complementarities to neuropsychological treatment. We then elaborate the contributions that psychoanalysis can bring to bear upon the approach of such cases regarding aspects of loss, lack, and temporality. We also approach the important factors and phases of treatment, with emphasis on questions involving the demand for treatment, the irruption of the Real, and the body, in such cases. Finally we systematize certain significant patterns that may be observed in the treatment of such cases, among which are: the wounds in subjective identity, the problem of re-socialization, the presence of doubt, the different languages, disease as passage to the act and, finally, the aspects of shame and blame-liability.