Associação entre o desempenho linguístico-cognitivo e a autopercepção auditiva de idosos / Association between linguistic-cognitive performance and auditory self-perception of elderly

RESUMO Objetivo analisar os desempenhos linguístico e cognitivo, a presença de relato de mudança na audição, a queixa e a autopercepção auditiva de idosos frequentadores de um centro comunitário brasileiro e verificar a associação entre essas variáveis. Métodos foram analisados os dados demográficos de 61 indivíduos; a presença de relato de mudança na audição nos últimos cinco anos e de queixa auditiva; o desempenho linguístico, por meio da Bateria Montreal-Toulouse; os resultados do teste de rastreio cognitivo, por meio do Miniexame do Estado Mental e a autopercepção auditiva, por meio da versão reduzida do questionário de autoavaliação de restrição de participação auditiva para idosos. Resultados a média de idade foi de 71 anos e de escolaridade foi de seis anos. Os escores dos testes aplicados indicaram a presença de declínio cognitivo e de alteração em alguma tarefa de linguagem, especialmente do discurso narrativo. Quanto aos relatos sobre o quadro auditivo, 38 idosos referiram mudança auditiva nos últimos cinco anos. Houve associação estatisticamente significativa entre a presença de mudança e queixa auditiva e a alteração nos testes de rastreio cognitivo e de fluência verbal. Os escores do teste de autopercepção de restrição de participação auditiva estiveram associados aos escores do subteste linguístico de repetição. Conclusão os idosos de um centro comunitário brasileiro apresentaram alta prevalência de mudanças auditivas nos últimos cinco anos e queixas auditivas relacionadas ao envelhecimento, associadas ao desempenho linguístico-cognitivo, o que evidencia a relevância do acompanhamento longitudinal do desempenho comunicativo e cognitivo de idosos.

ABSTRACT Purpose To analyze the linguistic and cognitive performance, the presence of reports of changes in hearing, the complaint and the auditory self-perception of elderly people who attend a Brazilian community center, and to verify the relationship between these variables. Methods Demographic data of 61 subjects were analyzed; the presence of reports of changes in hearing in the last five years and hearing complaints; linguistic performance through the Montreal-Toulouse Battery; the results of the cognitive screening test through the Mini-Mental State Examination; and auditory self-perception by the short version of the self-assessment questionnaire on auditory participation restriction for the elderly. Results The mean age was 71 years and schooling was six years. The scores of the tests applied indicated the presence of cognitive decline and alteration in some language task, especially in the narrative speech. With regard to reports about the auditory condition, 38 elderly people reported hearing change in the last five years. There was a statistically significant association between the presence of hearing changes and complaints and changes in cognitive screening and verbal fluency tests. The scores of the self-perception of auditory participation restriction test were associated with the scores of the repetition linguistic subtest. Conclusion The elderly in a Brazilian community center showed a high prevalence of hearing changes in the last five years and hearing complaints related to aging, which were associated with linguistic-cognitive performance, which highlights the relevance of longitudinal monitoring of the communicative and cognitive performance of the elderly

Inhibitory control training in healthy and highly educated older adults.

Executive function training is considered a promising tool for delaying the natural effects of aging on cognition. However, there are still few studies that propose a unimodal intervention with a focus on inhibitory control, and none of them has studied the effect of this type of intervention on older adults (OA). OBJECTIVE: The aim of this study is to investigate the benefits of inhibitory control training in healthy OA by comparing the two assessment time points, namely, before and after training. METHODS: Twenty-seven participants were included after interview and checking the inclusion criteria. The training was based on the stop-signal paradigm and carried out in 21 sessions. RESULTS: Participants performed better after training by reducing the false alarm error rate (i.e., for stop-signal trials), reducing omission error rate, showing an increase in hit rate, Go response time (i.e., for go-signal trials), stop-signal response time, and showing a decrease in the level of anxiety. The executive function training had no significant impact on the scores obtained in the complementary neuropsychological tests. CONCLUSIONS: These results are consistent with previous studies that support the viability and effectiveness of cognitive intervention for executive functions in OA and suggest a positive effect of the intervention, which may be related to the learning experience of a new and challenging task.

O treinamento das funções executivas é considerado uma ferramenta promissora para retardar os efeitos naturais do envelhecimento na cognição. No entanto, ainda são poucos os estudos que propõem uma intervenção unimodal com foco no controle inibitório, e nenhum deles estudou o efeito desse tipo de intervenção em idosos. OBJETIVO: Investigar os benefícios do treinamento de controle inibitório em idosos saudáveis, comparando os dois momentos da avaliação: antes e depois do treinamento. Método: Um total de 27 participantes foi incluído após entrevista e verificação dos critérios de inclusão. O treinamento foi baseado no paradigma Stop-Signal e realizado em 21 sessões. RESULTADOS: Os participantes tiveram um melhor desempenho após o treinamento, reduzindo a taxa de erro de alarme falso (nas tentativas stop), reduzindo a taxa de omissões e mostrando aumento na taxa de acerto e GoTR (nas tentativas go), no SSRT e mostrando uma diminuição significativa no nível de ansiedade. O treinamento não teve impacto significativo nas pontuações obtidas nos testes neuropsicológicos complementares. CONCLUSÕES: Esses resultados são consistentes com estudos anteriores que sustentam a viabilidade e eficácia da intervenção cognitiva para funções executivas em idosos, além de sugerirem um efeito positivo da intervenção, que pode estar relacionado à experiência de aprendizagem de uma tarefa nova e desafiadora.

Inhibitory control training in healthy and highly educated older adults / Treinamento de controle inibitório em idosos saudáveis com alta escolaridade

ABSTRACT. Executive function training is considered a promising tool for delaying the natural effects of aging on cognition. However, there are still few studies that propose a unimodal intervention with a focus on inhibitory control, and none of them has studied the effect of this type of intervention on older adults (OA). Objective: The aim of this study is to investigate the benefits of inhibitory control training in healthy OA by comparing the two assessment time points, namely, before and after training. Methods: Twenty-seven participants were included after interview and checking the inclusion criteria. The training was based on the stop-signal paradigm and carried out in 21 sessions. Results: Participants performed better after training by reducing the false alarm error rate (i.e., for stop-signal trials), reducing omission error rate, showing an increase in hit rate, Go response time (i.e., for go-signal trials), stop-signal response time, and showing a decrease in the level of anxiety. The executive function training had no significant impact on the scores obtained in the complementary neuropsychological tests. Conclusions: These results are consistent with previous studies that support the viability and effectiveness of cognitive intervention for executive functions in OA and suggest a positive effect of the intervention, which may be related to the learning experience of a new and challenging task.

RESUMO. O treinamento das funções executivas é considerado uma ferramenta promissora para retardar os efeitos naturais do envelhecimento na cognição. No entanto, ainda são poucos os estudos que propõem uma intervenção unimodal com foco no controle inibitório, e nenhum deles estudou o efeito desse tipo de intervenção em idosos. Objetivo: Investigar os benefícios do treinamento de controle inibitório em idosos saudáveis, comparando os dois momentos da avaliação: antes e depois do treinamento. Método: Um total de 27 participantes foi incluído após entrevista e verificação dos critérios de inclusão. O treinamento foi baseado no paradigma Stop-Signal e realizado em 21 sessões. Resultados: Os participantes tiveram um melhor desempenho após o treinamento, reduzindo a taxa de erro de alarme falso (nas tentativas stop), reduzindo a taxa de omissões e mostrando aumento na taxa de acerto e GoTR (nas tentativas go), no SSRT e mostrando uma diminuição significativa no nível de ansiedade. O treinamento não teve impacto significativo nas pontuações obtidas nos testes neuropsicológicos complementares. Conclusões: Esses resultados são consistentes com estudos anteriores que sustentam a viabilidade e eficácia da intervenção cognitiva para funções executivas em idosos, além de sugerirem um efeito positivo da intervenção, que pode estar relacionado à experiência de aprendizagem de uma tarefa nova e desafiadora.

Intensive naming training for low-educated demented and non-demented elderly.

Complaints about naming difficulties may be common in the elderly. In dementia, anomia is the most frequent symptom of language disorders. Naming training can improve lexical access and promote better quality of communication for elderly with or without dementia. OBJECTIVE: To analyze naming scores, response time and the generalization of responses for naming of neurotypical and demented low-educated older adults before and after receiving a naming training program, with and without oral comprehension stimulation. METHOD: Twenty elderly participants, 10 with dementia and 10 neurotypical, were included after interview, screening for cognition and functionality. The naming training was based on retrieval practice and carried out in 5 sessions. Half of the group underwent exclusive naming training, while the other half received naming training associated with oral comprehension stimulation. RESULTS: Elderly people with dementia performed better after training for scores on oral naming and comprehension of oral words, except for object manipulation. The response time for naming trained and untrained stimuli was also better for elderly people with dementia. After the intervention, neurotypical individuals performed statistically better in comprehension time and in the score in oral naming, comprehension of oral words and object manipulation, for trained and untrained words. CONCLUSION: Naming training, exclusive or associated with oral comprehension, using the recovery technique benefits the language performance of neurotypical and demented elderly, and provides improvements even for untrained stimuli.

A queixa de dificuldades para nomear pode ser comum em idosos. Na demência, a anomia é a manifestação mais frequente dos transtornos de linguagem. O treino de nomeação beneficia o acesso lexical e promove maior qualidade de comunicação para idosos com ou sem demência. OBJETIVO: Analisar as respostas de nomeação, o tempo de resposta e a generalização das respostas de nomeação de idosos neurotípicos e com demência de baixa escolaridade antes e após um treinamento de nomeação, com e sem estimulação da compreensão oral. MÉTODO: Participaram deste estudo 20 idosos, 10 com demência e 10 neurotípicos, incluídos após entrevista, rastreio de cognição e funcionalidade. O treinamento de nomeação foi baseado na prática de recuperação e realizado em cinco sessões. Metade do grupo foi submetido ao treino de nomeação exclusivo e metade ao treinamento associado à estimulação de compreensão oral. RESULTADO: Idosos com demência apresentaram melhor desempenho após o treinamento para pontuações na nomeação oral e compreensão de palavras orais, exceto para manipulação de objetos. O tempo de resposta para nomear estímulos treinados e não treinados também foi melhor para idosos com demência. Após a intervenção, os indivíduos neurotípicos tiveram desempenho estatisticamente melhor no tempo de compreensão e no escore na nomeação oral, compreensão de palavras orais e manipulação de objetos, para palavras treinadas e não treinadas. CONCLUSÃO: O treino de nomeação, exclusivo ou associado ao de compreensão oral, por meio da técnica de recuperação, beneficia o desempenho de linguagem de idosos neurotípicos e com demência e proporciona melhoras inclusive para estímulos não treinados.

Intensive naming training for low-educated demented and non-demented elderly / Treino intensivo de nomeação para idosos de baixa escolaridade com e sem demência

ABSTRACT. Complaints about naming difficulties may be common in the elderly. In dementia, anomia is the most frequent symptom of language disorders. Naming training can improve lexical access and promote better quality of communication for elderly with or without dementia. Objective: To analyze naming scores, response time and the generalization of responses for naming of neurotypical and demented low-educated older adults before and after receiving a naming training program, with and without oral comprehension stimulation. Method: Twenty elderly participants, 10 with dementia and 10 neurotypical, were included after interview, screening for cognition and functionality. The naming training was based on retrieval practice and carried out in 5 sessions. Half of the group underwent exclusive naming training, while the other half received naming training associated with oral comprehension stimulation. Results: Elderly people with dementia performed better after training for scores on oral naming and comprehension of oral words, except for object manipulation. The response time for naming trained and untrained stimuli was also better for elderly people with dementia. After the intervention, neurotypical individuals performed statistically better in comprehension time and in the score in oral naming, comprehension of oral words and object manipulation, for trained and untrained words. Conclusion: Naming training, exclusive or associated with oral comprehension, using the recovery technique benefits the language performance of neurotypical and demented elderly, and provides improvements even for untrained stimuli.

RESUMO. A queixa de dificuldades para nomear pode ser comum em idosos. Na demência, a anomia é a manifestação mais frequente dos transtornos de linguagem. O treino de nomeação beneficia o acesso lexical e promove maior qualidade de comunicação para idosos com ou sem demência. Objetivo: Analisar as respostas de nomeação, o tempo de resposta e a generalização das respostas de nomeação de idosos neurotípicos e com demência de baixa escolaridade antes e após um treinamento de nomeação, com e sem estimulação da compreensão oral. Método: Participaram deste estudo 20 idosos, 10 com demência e 10 neurotípicos, incluídos após entrevista, rastreio de cognição e funcionalidade. O treinamento de nomeação foi baseado na prática de recuperação e realizado em cinco sessões. Metade do grupo foi submetido ao treino de nomeação exclusivo e metade ao treinamento associado à estimulação de compreensão oral. Resultado: Idosos com demência apresentaram melhor desempenho após o treinamento para pontuações na nomeação oral e compreensão de palavras orais, exceto para manipulação de objetos. O tempo de resposta para nomear estímulos treinados e não treinados também foi melhor para idosos com demência. Após a intervenção, os indivíduos neurotípicos tiveram desempenho estatisticamente melhor no tempo de compreensão e no escore na nomeação oral, compreensão de palavras orais e manipulação de objetos, para palavras treinadas e não treinadas. Conclusão: O treino de nomeação, exclusivo ou associado ao de compreensão oral, por meio da técnica de recuperação, beneficia o desempenho de linguagem de idosos neurotípicos e com demência e proporciona melhoras inclusive para estímulos não treinados.

Fluência verbal de adultos e idosos do Distrito Federal: proposta normativa piloto / Verbal fluency of younger and older adults from the Federal District: proposed normative values

RESUMO Objetivo Comparar o desempenho de adultos jovens e idosos do Distrito Federal com os dados normativos. Métodos Sessenta participantes hígidos responderam aos testes de fluência verbal semântica, livre e ortográfica da Bateria Montreal de Avaliação da Comunicação. Resultados Participantes do Distrito Federal obtiveram médias menores (<0,001), comparados à média normativa. Não houve diferença no desempenho entre os grupos etários, exceto ao compará-los com indivíduos com maior escolaridade. Conclusão Na amostra do Distrito Federal avaliada, o processo de envelhecimento típico não prejudicou a fluência verbal para indivíduos que concluíram o ensino fundamental. As médias menores, em relação aos dados normativos, evidenciaram a importância de padrões normativos regionais.

ABSTRACT Purpose To compare the performance of younger and older adults from the Federal District (FD) against normative data. Methods Sixty healthy participants completed the unconstrained, phonemic and semantic verbal fluency tests of the Montreal Communication Assessment Battery. Results The FD participants obtained lower mean scores (<0.001) compared to the normative average. There was no difference in performance between the age groups, except on the comparison with high-educated individuals. Conclusion In the FD, the typical aging process did not impact verbal fluency for individuals who were educated to primary level. The lower mean scores relative to normative data highlight the importance of regional normative standards.

Continuous Use of Combined Hormonal Contraceptive and the Effect on Blood Coagulation Factors in Female Capuchin Monkeys (Sapajus libidinosus).

This study aimed at evaluating the availability of the primate Sapajus libidinosus as an animal model for research assessing the physiological effects of the continuous use of combined hormonal contraceptives. In order to do this, six reproductively active female S. libidinosus from the Primate Research Center of the University of Brasília were selected to take part in this experiment. Every 21 days or so, each female received a single dose of combined hormonal contraceptive (algestone acetophenide and 17-enanthate estradiol) in a total of five doses throughout the experiment. The physiological parameters were accessed by means of 13 blood samples from each female, whereas three were gathered during the baseline and 10 samples were collected during the treatment phase. The results showed that the contraceptive use provoked changes in hematological coagulation factors such as an increase in the amount of platelets (p = 0.039) and a reduction in both prothrombin (p < 0.001) and thromboplastin coagulation time (p < 0.001). These results are similar to what has been observed in human patients; thus, it is concluded that S. libidinosus can be successfully used in studies about the physiological impact of hormonal contraceptives.

Nintendo Wii™ Versus Xbox Kinect™ for Assisting People With Parkinson's Disease.

This study investigated changes in motor and cognitive skills, anxiety levels, and quality of life perception among patients with Parkinson's Disease (PD) following training with different commercial gaming devices-Nintendo Wii™ and Xbox Kinect™. We used a quasi-experimental, simple blinded clinical trial, dividing 27 patients with PD into three equal groups of nine members: (a) Nintendo Wii™, (b) Xbox Kinect™, and (c) control group. After pretests, experimental group participants spent 10 sessions playing four games of the selected gaming device, while control group participants received no intervention. Only those engaged with the Nintendo Wii™ significantly improved their performance on single and dual task gait tests, decreased anxiety levels, and improved memory, attention, and reversibility. The control group showed no changes on any measures.

Planning ability impairments in probable Alzheimer's disease patients: Evidence from the Tower of London test.

Alzheimer's disease (AD) is associated with progressive impairment of higher-level cognitive abilities. Previous research suggests that early impairment of executive functions occurs during the course of the disease, but few studies have specifically investigated planning ability in an AD population. OBJECTIVE: The purpose of the current study was to examine whether AD patients retain the ability to plan ahead, by analyzing specificities of their behavior in successfully achieving a pre-established goal. METHODS: Twenty-one AD patients and thirty-three elderly controls underwent a problem-solving assessment using the Tower of London (TOL) test. RESULTS: AD patients were less accurate and less efficient than controls. AD patients also committed more mistakes. This indicates a decline in working memory and inhibitory deficits, resulting in impulsive and inappropriate behaviors. CONCLUSION: These results are in agreement with previous studies, showing executive function problems in patients with AD. Specifically, this study demonstrates the presence of planning ability deficits in AD, considering both qualitative and quantitative approaches. The wide range of analysis presented in this study can aid clinicians in identifying the nature of the poor performance of AD patients during a planning task.

A doença de Alzheimer (DA) é associada a um comprometimento progressivo das habilidades cognitivas superiores. Pesquisas anteriores sugerem que o comprometimento precoce das funções executivas ocorre durante o curso da doença, mas poucos estudos têm investigado especificamente a capacidade de planejamento em uma população com DA. OBJETIVO: O objetivo do presente estudo foi analisar se os pacientes com DA mantêm a capacidade de planejar antecipadamente, analisando as especificidades de seu comportamento para alcançar com êxito uma meta pré-estabelecida. MÉTODOS: Vinte e um pacientes com DA e trinta e três controles idosos foram submetidos a uma avaliação de resolução de problemas utilizando o teste de Torre de Londres (TOL). RESULTADOS: Os pacientes com DA foram menos precisos e menos eficientes do que os controles. Os pacientes com DA também cometeram mais erros. Isso indica um declínio na memória operacional e déficits inibitórios, resultando em comportamentos impulsivos e inadequados. CONCLUSÃO: Estes resultados estão de acordo com estudos anteriores, mostrando problemas de função executiva em pacientes com DA. Especificamente, este estudo demonstra a presença de déficits de capacidade de planejamento na DA, considerando abordagens qualitativas e quantitativas. A ampla gama de análises apresentadas neste estudo poderá auxiliar aos profissionais da área da saúde na identificação da natureza do baixo desempenho dos pacientes com DA durante uma tarefa de planejamento.

Therapeutic effect of transcranial direct current stimulation on neuropsychological symptoms of an elderly patient: A case report.

Although growing evidence points to the potential therapeutic effects of transcranial Direct Current Stimulation (tDCS), there is still no consensus on the most appropriate protocol to be used in specific neurological and neuropsychological symptoms. This case report evaluated the neuromodulatory therapeutic effects of two 15-day courses of tDCS on an elderly female patient, aged 78 years with mild neurocognitive disorder, chronic pain and depression-related symptoms. Results indicated an overall significant improvement of cognitive and executive functions, as well as reduction in both depression and chronic pain symptoms. These results highlight the potential of tDCS as a safe and useful neuromodulatory clinical tool in the rehabilitation of elderly patients.

Embora evidências crescentes apontem para os potenciais efeitos terapêuticos da estimulação transcraniana por corrente contínua (ETCC), ainda não há consenso sobre o protocolo mais adequado a ser usado em sintomas neurológicos e neuropsicológicos específicos. Este relato de caso avaliou os efeitos terapêuticos neuromoduladores de dois protocolos de 15 dias de ETCC em paciente idosa, com idade de 78 anos com comprometimento cognitivo leve, dor crônica e sintomas relacionados à depressão. Os resultados indicaram uma melhoria global significativa das funções cognitivas e executivas, bem como a redução tanto na depressão quanto nos sintomas da dor crônica. Isso destaca o potencial do ETCC como uma ferramenta clínica neuromoduladora segura e útil na reabilitação de pacientes idosos.

Negative Facial Expressions - But Not Visual Scenes - Enhance Human Working Memory in Younger and Older Participants.

Many studies have investigated the influence of emotion on memory processes across the human lifespan. Some results have shown older adults (OA) performing better with positive stimuli, some with negative items, whereas some found no impact of emotional valence. Here we tested, in two independent studies, how younger adults (YA) and OA would perform in a visuospatial working memory (VSWM) task with positive, negative, and neutral images. The task consisted of identifying the new location of a stimulus in a crescent set of identical stimuli presented in different locations in a touch-screen monitor. In other words, participants should memorize the locations previously occupied to identify the new location. For each trial, the number of occupied locations increased until 8 or until a mistake was made. In study 1, 56 YA and 38 OA completed the task using images from the International Affective Picture System (IAPS). Results showed that, although YA outperformed OA, no effects of emotion were found. In study 2, 26 YA and 25 OA were tested using facial expressions as stimuli. Data from this study showed that negative faces facilitated performance and this effect did not differ between age groups. No differences were found between men and women. Taken together, our findings suggest that YA and OA's VSWM can be influenced by the emotional valence of the information, though this effect was present only for facial stimuli. Presumably, this may have happened due to the social and biological importance of such stimuli, which are more effective in transmitting emotions than IAPS images. Critically, our results also indicate that the mixed findings in the literature about the influence of aging on the interactions between memory and emotion may be caused by the use of different stimuli and methods. This possibility should be kept in mind in future studies about memory and emotion across the lifespan.

Therapeutic effect of transcranial direct current stimulation on neuropsychological symptoms of an elderly patient: A case report / Efeito terapêutico da estimulação transcraniana de corrente direta nos sintomas neuropsicológicos de um paciente idoso: relato de caso

ABSTRACT Although growing evidence points to the potential therapeutic effects of transcranial Direct Current Stimulation (tDCS), there is still no consensus on the most appropriate protocol to be used in specific neurological and neuropsychological symptoms. This case report evaluated the neuromodulatory therapeutic effects of two 15-day courses of tDCS on an elderly female patient, aged 78 years with mild neurocognitive disorder, chronic pain and depression-related symptoms. Results indicated an overall significant improvement of cognitive and executive functions, as well as reduction in both depression and chronic pain symptoms. These results highlight the potential of tDCS as a safe and useful neuromodulatory clinical tool in the rehabilitation of elderly patients.

RESUMO Embora evidências crescentes apontem para os potenciais efeitos terapêuticos da estimulação transcraniana por corrente contínua (ETCC), ainda não há consenso sobre o protocolo mais adequado a ser usado em sintomas neurológicos e neuropsicológicos específicos. Este relato de caso avaliou os efeitos terapêuticos neuromoduladores de dois protocolos de 15 dias de ETCC em paciente idosa, com idade de 78 anos com comprometimento cognitivo leve, dor crônica e sintomas relacionados à depressão. Os resultados indicaram uma melhoria global significativa das funções cognitivas e executivas, bem como a redução tanto na depressão quanto nos sintomas da dor crônica. Isso destaca o potencial do ETCC como uma ferramenta clínica neuromoduladora segura e útil na reabilitação de pacientes idosos.

Planning ability impairments in probable Alzheimer's disease patients: Evidence from the Tower of London test / Alterações na habilidade de planejamento em pacientes com provável doença de alzheimer: evidências do teste torre de londres

ABSTRACT Alzheimer's disease (AD) is associated with progressive impairment of higher-level cognitive abilities. Previous research suggests that early impairment of executive functions occurs during the course of the disease, but few studies have specifically investigated planning ability in an AD population. Objective: The purpose of the current study was to examine whether AD patients retain the ability to plan ahead, by analyzing specificities of their behavior in successfully achieving a pre-established goal. Methods: Twenty-one AD patients and thirty-three elderly controls underwent a problem-solving assessment using the Tower of London (TOL) test. Results: AD patients were less accurate and less efficient than controls. AD patients also committed more mistakes. This indicates a decline in working memory and inhibitory deficits, resulting in impulsive and inappropriate behaviors. Conclusion: These results are in agreement with previous studies, showing executive function problems in patients with AD. Specifically, this study demonstrates the presence of planning ability deficits in AD, considering both qualitative and quantitative approaches. The wide range of analysis presented in this study can aid clinicians in identifying the nature of the poor performance of AD patients during a planning task.

RESUMO A doença de Alzheimer (DA) é associada a um comprometimento progressivo das habilidades cognitivas superiores. Pesquisas anteriores sugerem que o comprometimento precoce das funções executivas ocorre durante o curso da doença, mas poucos estudos têm investigado especificamente a capacidade de planejamento em uma população com DA. Objetivo: O objetivo do presente estudo foi analisar se os pacientes com DA mantêm a capacidade de planejar antecipadamente, analisando as especificidades de seu comportamento para alcançar com êxito uma meta pré-estabelecida. Métodos: Vinte e um pacientes com DA e trinta e três controles idosos foram submetidos a uma avaliação de resolução de problemas utilizando o teste de Torre de Londres (TOL). Resultados: Os pacientes com DA foram menos precisos e menos eficientes do que os controles. Os pacientes com DA também cometeram mais erros. Isso indica um declínio na memória operacional e déficits inibitórios, resultando em comportamentos impulsivos e inadequados. Conclusão: Estes resultados estão de acordo com estudos anteriores, mostrando problemas de função executiva em pacientes com DA. Especificamente, este estudo demonstra a presença de déficits de capacidade de planejamento na DA, considerando abordagens qualitativas e quantitativas. A ampla gama de análises apresentadas neste estudo poderá auxiliar aos profissionais da área da saúde na identificação da natureza do baixo desempenho dos pacientes com DA durante uma tarefa de planejamento.

Executive Dysfunctions: The Role in Attention Deficit Hyperactivity and Post-traumatic Stress Neuropsychiatric Disorders.

Executive functions (EFs) is an umbrella term for various cognitive processes controlled by a complex neural activity, which allow the production of different types of behaviors seeking to achieve specific objectives, one of them being inhibitory control. There is a wide consensus that clinical and behavioral alterations associated with EF, such as inhibitory control, are present in various neuropsychiatric disorders. This paper reviews the research literature on the relationship between executive dysfunction, frontal-subcortical neural circuit changes, and the psychopathological processes associated with attention deficit hyperactivity disorder (ADHD) and post-traumatic stress disorder (PTSD). A revision on the role of frontal-subcortical neural circuits and their presumable abnormal functioning and the high frequency of neuropsychiatric symptoms could explain the difficulties with putting effector mechanisms into action, giving individuals the necessary tools to act efficiently in their environment. Although, neuronal substrate data about ADHD and PTSD has been reported in the literature, it is isolated. Therefore, this review highlights the overlapping of neural substrates in the symptomatology of ADHD and PTSD disorders concerning EFs, especially in the inhibitory component. Thus, the changes related to impaired EF that accompany disorders like ADHD and PTSD could be explained by disturbances that have a direct or indirect impact on the functioning of these loops. Initially, the theoretical model of EF according to current neuropsychology will be presented, focusing on the inhibitory component. In a second stage, this component will be analyzed for each of the disorders of interest, considering the clinical aspects, the etiology and the neurobiological basis. Additionally, commonalities between the two neuropsychiatric conditions will be taken into consideration from the perspectives of cognitive and emotional inhibition. Finally, the implications and future prospects for research and interventions in the area will be outlined, with the intention of contributing scientific reference information that encompasses the knowledge and understanding of executive dysfunction and its relationship with these treated disorders.

Computerized spatial delayed recognition span task: a specific tool to assess visuospatial working memory.

A new tablet device version (IOS platform) of the Spatial Delayed Recognition Span Task (SDRST) was developed with the aim of investigating visuospatial Working Memory (WM) abilities based on touchscreen technology. This new WM testing application will be available to download for free in Apple Store app ("SDRST app"). In order to verify the feasibility of this computer-based task, we conducted three experiments with different manipulations and groups of participants. We were interested in investigating if (1) the SDRST is sensitive enough to tap into cognitive differences brought by aging and dementia; (2) different experimental manipulations work successfully; (3) cortical brain activations seen in other WM tasks are also demonstrated here; and (4) non-human primates are able to answer the task. Performance (scores and response time) was better for young than older adults and higher for the latter when compared to Alzheimer's disease (AD) patients. All groups performed better with facial stimuli than with images of scenes and with emotional than with neutral stimuli. Electrophysiology data showed activation on prefrontal and frontal areas of scalp, theta band activity on the midline area, and gamma activity in left temporal area. There are all scalp regions known to be related to attention and WM. Besides those data, our sample of adult captive capuchin monkeys (Sapajus libidinosus) answered the task above chance level. Taken together, these results corroborate the reliability of this new computer-based SDRST as a measure of visuospatial WM in clinical and non-clinical populations as well as in non-human primates. Its tablet app allows the task to be administered in a wide range of settings, including hospitals, homes, schools, laboratories, universities, and research institutions.

Age-related differences in cortical activity during a visuo-spatial working memory task with facial stimuli.

Emotion, importantly displayed by facial expressions, is one of the most significant memory modulators. The interaction between memory and the different emotional valences change across lifespan, while young adults (YA) are expected to better recall negative events (Negativity Bias Hypothesis), older adults (OA) tend to focus on positive stimuli (Positivity Effect Hypothesis). This research work aims at verifying whether cortical electrical activity of these two age groups would also be differently influenced by emotional valences in a visuo-spatial working memory task. 27 YA (13 males) and 25 OA (14 males), all healthy volunteers, underwent electroencephalographic recordings (21 scalp electrodes montage), while performing the Spatial Delayed Recognition Span Task using a touch screen with different stimuli categories: neutral, positive and negative faces and geometric pictures. YA obtained higher scores than OA, and showed higher activation of theta and alpha bands in the frontal and midline regions, besides a more evident right-hemispheric asymmetry on alpha band when compared to OA. For both age groups, performance in the task was worse for positive faces than to negative and to neutral faces. Facial stimuli induced a better performance and higher alpha activation on the pre-frontal region for YA, and on the midline, occipital and left temporal regions for OA when compared to geometric figures. The superior performance of YA was expected due to the natural cognitive deficits connected to ageing, as was a better performance with facial stimuli due to the evolutionary importance of faces. These results were related to cortical activity on areas of importance for action-planning, decision making and sustained attention. Taken together, they are in accordance with the Negativity Bias but do not support the Positivity Effect. The methodology used was able to identify age-related differences in cortical activity during emotional mnemonic processing and may be interesting to future investigations.

Cognitive anosognosia and behavioral changes in probable Alzheimers disease patients / Anosognosia cognitiva e alterações comportamentais em pacientes com provável doença de Alzheimer

Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. OBJECTIVE: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). METHODS: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. RESULTS: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic-DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. CONCLUSION: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo. OBJETIVO: Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles. MÉTODOS: vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados. RESULTADOS: Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais. CONCLUSÃO: Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.

Cognitive anosognosia and behavioral changes in probable Alzheimer's disease patients.

Anosognosia, impairment insight and unawareness of deficits are used as equivalent terms in this study. OBJECTIVE: To investigate the relationship between the presence of anosognosia symptoms and cognitive domains, functional abilities, and neuropsychiatric symptoms in patients with probable Alzheimer's disease (pAD) and elderly controls (EC). METHODS: Twenty-one pAD (14 women) and twenty-two EC (16 women) were submitted to a neuropsychological battery of tests assessing global cognitive status, and specific cognitive functions: memory, executive and attention functions, verbal fluency and visuoconstructive abilities. Additionally, functional abilities (FAQ) and neuropsychiatric symptoms (NPI) were measured. RESULTS: The linear regression statistical test found general anosognosia to be associated with subjective memory complaints, age and Arithmetic-DRS in the EC group. On the other hand, cognitive and functional abilities scores (Arithmetic-DRS, IQCODE and FAQ) were the best predictors in pAD patients, particularly for behavioral awareness. CONCLUSION: These results indicated that different variables are associated with self-awareness for pAD patients and EC, but for both groups executive functions appear to play an important role, contributing particularly to awareness of behavioral changes.

Anosognosia, comprometimento do insight e ausência de reconhecimento de déficits são usados como termos equivalentes neste estudo. OBJETIVO: Investigar a relação entre a presença de sintomas de anosognosia e domínios cognitivos, habilidades funcionais, e sintomas neuropsiquiátricos em pacientes com provável doença de Alzheimer (pAD) e idosos controles. MÉTODOS: vinte e um pDA (14 mulheres) e vinte e dois EC (16 mulheres) foram submetidos a uma bateria neuropsicológica de testes avaliando o estado cognitivo global, e funções cognitivas específicas: memória, funções executivas e atencionais, fluência verbal e habilidades visoconstrutivas. Adicionalmente, habilidades funcionais (FAQ) e sintomas neuropsiquiátricos (NPI) foram avaliados. RESULTADOS: Teste estatístico de regressão linear indicou uma associação entre anosognosia e queixas subjetivas de memória, idade e aritmética-DRS no grupo controle. Por outro lado, aritmetica-DRS, IQCODE e FAQ (habilidades cognitivas e funcionais) foram melhores predictores nos pacientes com pDA, especificamente para consciência das alterações comportamentais. CONCLUSÃO: Os resultados indicaram que diferentes variáveis estão associadas com auto-percepção nos pacientes com pDA e controles, porém para ambos os grupos parece que o funcionamento executivo tem um papel importante contribuindo principalmente na percepção das alterações comportamentais.

Neuropsychological performance differences bet ween two groups of probable-AD patients from different areas of Brazil / Desempenho neuropsicológico diferente entre dois grupos de pacientes de duas regiões do Brasil com provável diagnóstico de doença de Alzheimer

ABSTRACT. During normal aging there are some cognitive and behavioral changes similar to those observed in a transitional state or mild cognitive impairment (MCI) and early onset dementia, making it challenging for health care professionals to reach an accurate and reliable diagnosis. Objective: The current study examined the performance of two different groups of patients diagnosed with probable Alzheimer's disease (AD) on a neuropsychological test battery. Methods: Twenty-two AD patients from Brasília-DF (AD1) and thirty-four AD patients from Palmas-TO, northern Brazil (AD2), were selected and a short neuropsychological battery administered. To verify the reliability of these previous diagnoses of AD, both groups of patients were compared with a group of healthy controls. Results: AD patients showed cognitive deficit but scores were lower for the AD2 group compared with the AD1 group considering the cut-off point. Notably, patients from the AD1 group were older (p=0.004) and had less formal education (p<0.001) than those from the AD2 group. Comparing different cognitive domains between AD groups, post hoc analysis showed that the AD1 group was characterized by deficits in episodic memory retrieval (p<0.001), semantic memory (p<0.001) and verbal fluency (p<0.001). In contrast, the AD2 group showed lower scores in attention (p=0.007), executive functioning (p<0.001) and working memory (p<0.001). Conclusion: This pattern suggests that the Palma group of patients had a neuropsychological profile that was inconsistent with AD. Although the results of this study have important clinical implications, the effects of age, education, and gender on cognitive performance should be explored further.

RESUMO. Durante o envelhecimento normal existem algumas mudanças cognitivas e comportamentais similares àquelas observadas no estágio transicional ou declínio cognitivo leve e demência precoce, desafiando os profissionais da saúde a fazer um diagnóstico preciso e confiável. Objetivo: O presente estudo investigou o desempenho cognitivo de dois diferentes grupos de pacientes com provável diagnóstico de doença de Alzheimer (DA). Métodos: Vinte e dois pacientes de Brasília-DF (DA1) e trinta e quatro pacientes de Palmas-TO, norte do Brasil (DA2), foram submetidos a uma bateria neuropsicológica reduzida para verificar a confiabilidade do diagnóstico prévio de DA, comparando-se ambos os grupos a um grupo de idosos sadios. Resultados: Pacientes com DA mostraram déficit cognitivo; no entanto, os escores foram mais baixos para o grupo DA2, considerando-se o ponto de corte. É importante destacar que os pacientes do grupo DA1 foram mais velhos (p=0,004) e com menor nível de educação formal (p<0,001) que o grupo DA2. Quando comparados os diferentes domínios cognitivos entre os grupos com DA, a análise post hoc indicou que o grupo DA1 caracterizou-se por déficits em recuperação de informação episódica (p<0,001), memória semântica (p<0,001) e fluência verbal (p<0,001). Em contraste, o grupo DA2 mostrou escores menores em atenção (p=0,007), funcionamento executivo (p<0,001) e memória operacional (p<0,001). Conclusão: Estes resultados sugerem que o grupo de pacientes de Palmas apresentou um perfil neuropsicológico não compatível com DA. Embora os resultados deste estudo tenham importantes implicações clínicas, o efeito da idade, educação e gênero no desempenho cognitivo devem ser mais explorado

Philadelphia Brief Assessment of Cognition in healthy and clinical Brazilian sample / Avaliação Cognitiva Breve da Filadélfia numa amostra brasileira clínica e saudável

The Philadelphia Brief Assessment of Cognition (PBAC) is a neuropsychological screening instrument that assesses five cognitive domains: working memory, visuospatial functioning, language, episodic memory and comportment. The aim is to verify if PBAC can properly be used in the Brazilian sample. Participated in this study: (a) 200 healthy volunteers - 100 young [21.6(2.5) years old] and 100 older adults [70.1(7.3) years old]; >12 years of education; (b) 30 Alzheimer's patients (AD) [73.7(5.7) years old], 4-11 years in education. The PBAC scores: (a) 95.8(2.6), 90.0(4.4) and (b) 65.0(10.8) were correlated with the Mini-Mental State Examination (MMSE) for young 29.1(0.9), older adults 28.3(1.4) and AD 18.4(3.0) groups. A positive correlation between MMSE and PBAC (r=0.9, p<0.001) was found. Negative correlations were observed between PBAC domains [memory (-0.63), visuospatial abilities (-0.44) and working memory (-0.3) tasks]. MANOVA showed a better male performance in visuospatial functioning (F=8.5, p=0.004). The Brazilian version of PBAC proved to be a promising screening instrument for clinical purposes.

O instrumento de rastreio neuropsicológico Philadelphia Brief Assessment of Cognition (PBAC) avalia cinco domínios cognitivos: memória de trabalho, habilidade visuoespacial, linguagem, memória episódica e comportamento. O objetivo é verificar a viabilidade do PBAC em amostra brasileira. Participaram: (a) 200 voluntários - 100 jovens com 21,6(2,5) anos e 100 idosos com 70,1(7,3) anos, ambos com média de escolaridade maior que 12 anos; (b) 30 pacientes com Alzheimer, com 73,7(5,7) anos e escolaridade entre 4 e 11 anos. Os escores do PBAC para os respectivos grupos (a) 95,8(2,6), 90(4,4) e (b) 65(10,8) foram correlacionados com o Mini Exame do Estado Mental (MEEM). Houve correlação positiva (r=0,9; p<0,001) entre MEEM e PBAC, e negativas entre os domínios do PBAC [memória (-0,63), habilidades visuoespaciais (-0,44) e memória de trabalho (-0,3)]. Foi demonstrado pela MANOVA melhor desempenho no funcionamento visuoespacial em homens (F=8,5, p=0,004). A versão brasileira do PBAC provou ser promissora como um instrumento de rastreio para propósitos clínicos.