The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach.

The aim of this study was to characterize the oral discourse of CBS patients and to verify whether measures obtained during a semi-spontaneous speech production could differentiate CBS patients from controls. A second goal was to compare the performance of patients with CBS probably due to Alzheimer's disease (CBS-AD) pathology and CBS not related to AD (CBS-non-AD) in the same measures, based on the brain metabolic status (FDG-PET) and in the presence of amyloid deposition (amyloid-PET). Results showed that CBS patients were significantly different from controls in speech rate, lexical level, informativeness, and syntactic complexity. Discursive measures did not differentiate CBS-AD from CBS-non-AD. However, CBS-AD displayed more lexical-semantic impairments than controls, a profile that is frequently reported in patients with clinical AD and the logopenic variant of primary progressive aphasia (lvPPA). CBS-non-AD presented mainly with impairments related to motor speech disorders and syntactic complexity, as seen in the non-fluent variant of PPA.

Diagnosis of Alzheimer's disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology.

This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer's disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.

Este artigo apresenta o consenso realizado pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia sobre os critérios diagnósticos da Doença de Alzheimer (DA) no Brasil. Foi realizada uma revisão da literatura e dos critérios clínicos e de pesquisa para DA, sendo propostos protocolos para o diagnóstico de DA em níveis de atenção primária, secundária e terciária. Dentro deste cenário clínico, são apresentados os critérios diagnósticos para DA típica e atípica, além de instrumentos de avaliação clínica, cognitiva e funcional; bem como propedêutica complementar com exames laboratoriais e de neuroimagem. A utilização de biomarcadores é também apresentada, tanto para o diagnóstico clínico em situações específicas quanto para pesquisa.

Diagnóstico da doença de Alzheimer: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia / Diagnosis of Alzheimer's disease: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

RESUMO Este artigo apresenta o consenso realizado pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia sobre os critérios diagnósticos da Doença de Alzheimer (DA) no Brasil. Foi realizada uma revisão da literatura e dos critérios clínicos e de pesquisa para DA, sendo propostos protocolos para o diagnóstico de DA em níveis de atenção primária, secundária e terciária. Dentro deste cenário clínico, são apresentados os critérios diagnósticos para DA típica e atípica, além de instrumentos de avaliação clínica, cognitiva e funcional; bem como propedêutica complementar com exames laboratoriais e de neuroimagem. A utilização de biomarcadores é também apresentada, tanto para o diagnóstico clínico em situações específicas quanto para pesquisa.

ABSTRACT This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer's disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.

Textual Inference Comprehension in Mild Cognitive Impairment: The Influence of Semantic Processing and Verbal Episodic Memory.

Language complaints, especially in complex tasks, may occur in mild cognitive impairment (MCI). Various language measures have been studied as cognitive predictors of MCI conversion to Alzheimer's type dementia. Understanding textual inferences is considered a high-demanding task that recruits multiple cognitive functions and, therefore, could be sensitive to detect decline in the early stages of MCI. Thus, we aimed to compare the performance of subjects with MCI to healthy elderly in a textual inference comprehension task and to determine the best predictors of performance in this ability considering one verbal episodic memory and two semantic tasks. We studied 99 individuals divided into three groups: (1) 23 individuals with amnestic mild cognitive impairment (aMCI), (2) 42 individuals with non-amnestic mild cognitive impairment (naMCI), (3), and (4) 34 cognitively healthy individuals for the control group (CG). A reduced version of The Implicit Management Test was used to assess different types of inferential reasoning in text reading. MCI patients performed poorer than healthy elderly, and there were no differences between MCI subgroups (amnestic and non-amnestic). The best predictors for inference-making were verbal memory in the aMCI and semantic tasks in the naMCI group. The results confirmed that the failure to understand textual inferences can be present in MCI and showed that different cognitive skills like semantic knowledge and verbal episodic memory are necessary for inference-making.

Metabolic and Structural Signatures of Speech and Language Impairment in Corticobasal Syndrome: A Multimodal PET/MRI Study.

Introduction: Corticobasal syndrome (CBS) is a progressive neurological disorder related to multiple underlying pathologies, including four-repeat tauopathies, such as corticobasal degeneration and progressive supranuclear palsy, and Alzheimer's disease (AD). Speech and language are commonly impaired, encompassing a broad spectrum of deficits. We aimed to investigate CBS speech and language impairment patterns in light of a multimodal imaging approach. Materials and Methods: Thirty-one patients with probable CBS were prospectively evaluated concerning their speech-language, cognitive, and motor profiles. They underwent positron emission tomography with [18F]fluorodeoxyglucose (FDG-PET) and [11C]Pittsburgh Compound-B (PIB-PET) on a hybrid PET-MRI machine to assess their amyloid status. PIB-PET images were classified based on visual and semi-quantitative analyses. Quantitative group analyses were performed on FDG-PET data, and atrophy patterns on MRI were investigated using voxel-based morphometry (VBM). Thirty healthy participants were recruited as imaging controls. Results: Aphasia was the second most prominent cognitive impairment, presented in 67.7% of the cases, following apraxia (96.8%). We identified a wide linguistic profile, ranging from nonfluent variant-primary progressive aphasia to lexical-semantic deficits, mostly with impaired verbal fluency. PIB-PET was classified as negative (CBS-A- group) in 18/31 (58%) and positive (CBS-A+ group) in 13/31 (42%) patients. The frequency of dysarthria was significantly higher in the CBS-A- group than in the CBS-A+ group (55.6 vs. 7.7%, p = 0.008). CBS patients with dysarthria had a left-sided hypometabolism at frontal regions, with a major cluster at the left inferior frontal gyrus and premotor cortex. They showed brain atrophy mainly at the opercular frontal gyrus and putamen. There was a positive correlation between [18F]FDG uptake and semantic verbal fluency at the left inferior (p = 0.006, R 2 = 0.2326), middle (0.0054, R 2 = 0.2376), and superior temporal gyri (p = 0.0066, R 2 = 0.2276). Relative to the phonemic verbal fluency, we found a positive correlation at the left frontal opercular gyrus (p = 0.0003, R 2 = 0.3685), the inferior (p = 0.0004, R 2 = 0.3537), and the middle temporal gyri (p = 0.0001, R 2 = 0.3993). Discussion: In the spectrum of language impairment profile, dysarthria might be helpful to distinguish CBS patients not related to AD. Metabolic and structural signatures depicted from this feature provide further insights into the motor speech production network and are also helpful to differentiate CBS variants.

Language in corticobasal syndrome: a systematic review.

Language is commonly impacted in corticobasal syndrome (CBS). However, the profile and type of language assessment in CBS are poorly studied. OBJECTIVE: To identify language impairments in CBS. METHODS: A search was performed in the Medline/PubMed database, according to the PRISMA criteria, using the keywords "corticobasal syndrome" OR "corticobasal degeneration" AND "language". Articles on CBS covering language assessment that were written in English were included, with no constraints on the publication date. RESULTS: A total of 259 articles were found and 35 were analyzed, consisting of 531 participants. Twenty-eight studies showed heterogeneous language deficits and seven mentioned nonfluent primary progressive aphasia. The most used tests were the Western Aphasia Battery (8 studies) and the Boston Naming Test (8 studies). CONCLUSION: It was not possible to identify a unique linguistic profile in CBS.

A linguagem encontra-se comumente alterada na síndrome corticobasal (SCB). No entanto, o perfil e a forma de avaliação da linguagem na SCB são pouco estudados. OBJETIVO: identificar as alterações de linguagem na SCB. MÉTODO: Realizou-se uma busca na base de dados Medline/PubMed, com as palavras-chave "síndrome corticobasal" OU "degeneração corticobasal" E "linguagem". Artigos sobre SCB envolvendo avaliação de linguagem, escritos em inglês, foram incluídos, sem restrição de data de publicação. RESULTADOS: Foram encontrados 259 artigos, e 35 estudos foram analisados, abrangendo 531 sujeitos. Um total de 28 estudos mostraram déficits heterogêneos de linguagem, e sete mencionaram afasia progressiva primária não-fluente. Os testes mais utilizados foram Western Aphasia Battery (8 estudos) e o Teste de Nomeação de Boston (8 estudos). CONCLUSÃO: Não foi possível identificar um perfil linguístico único em pacientes com SCB.

Language in corticobasal syndrome: a systematic review / Linguagem na síndrome corticobasal: uma revisão sistemática

ABSTRACT. Language is commonly impacted in corticobasal syndrome (CBS). However, the profile and type of language assessment in CBS are poorly studied. Objective: To identify language impairments in CBS. Methods: A search was performed in the Medline/PubMed database, according to the PRISMA criteria, using the keywords "corticobasal syndrome" OR "corticobasal degeneration" AND "language". Articles on CBS covering language assessment that were written in English were included, with no constraints on the publication date. Results: A total of 259 articles were found and 35 were analyzed, consisting of 531 participants. Twenty-eight studies showed heterogeneous language deficits and seven mentioned nonfluent primary progressive aphasia. The most used tests were the Western Aphasia Battery (8 studies) and the Boston Naming Test (8 studies). Conclusion: It was not possible to identify a unique linguistic profile in CBS.

RESUMO. A linguagem encontra-se comumente alterada na síndrome corticobasal (SCB). No entanto, o perfil e a forma de avaliação da linguagem na SCB são pouco estudados. Objetivo: identificar as alterações de linguagem na SCB. Método: Realizou-se uma busca na base de dados Medline/PubMed, com as palavras-chave "síndrome corticobasal" OU "degeneração corticobasal" E "linguagem". Artigos sobre SCB envolvendo avaliação de linguagem, escritos em inglês, foram incluídos, sem restrição de data de publicação. Resultados: Foram encontrados 259 artigos, e 35 estudos foram analisados, abrangendo 531 sujeitos. Um total de 28 estudos mostraram déficits heterogêneos de linguagem, e sete mencionaram afasia progressiva primária não-fluente. Os testes mais utilizados foram Western Aphasia Battery (8 estudos) e o Teste de Nomeação de Boston (8 estudos). Conclusão: Não foi possível identificar um perfil linguístico único em pacientes com SCB.

Inference comprehension from reading in individuals with mild cognitive impairment.

Inference comprehension is a complex ability that recruits distinct cognitive domains, such as language, memory, attention, and executive functions. Therefore, it might be sensitive to identify early deficits in subjects with MCI. To compare the performance of subjects with mild cognitive impairment (MCI) in an inference reading comprehension task, and to analyze the correlations between inferential comprehension and other cognitive functions. We studied 100 individuals aged 60 and over, divided into MCI (50) [aMCI (35), naMCI (15)], and cognitively healthy individuals [controls (50)]. The Implicit Management Test (IMT) was used to assess inference in reading comprehension in five categories: explicit, logical, distractor, pragmatic, and "others". MCI group performed worse than controls in logical, pragmatic, distractor, and "others" questions (p < 0.01). The aMCI and naMCI subgroups presented a similar performance in all types of questions (p > 0.05). We observed significant correlations between the total IMT score and the TMT-A in the naMCI group (r = - 0.562, p = 0.036), and the Rey-Osterrieth Complex Figure and RAVLT tasks in the aMCI group (r = 0.474, p = 0.010 and r = 0.593, p = 0.0001, respectively). The MCI group as a whole performed worse than controls on the logical, pragmatic, other and distractor questions, and consequently on the total score. There were no differences in explicit questions, which impose lower inferential demands. The aMCI group suffered a significant impact from memory on inference comprehension, and difficulties in executive functions impacted naMCI performance. The IMT was useful to differentiate MCI patients from cognitively healthy individuals, but not MCI subgroups among themselves.

Treatment of agrammatism in oral and written production in patients with Broca's aphasia The use of implicit and explicit learning.

Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods. OBJECTIVE: To verify the effect of adapted Mapping Therapy and ORLA methods (explicit versus implicit learning) on the oral and written production in spontaneous language among agrammatic patients with Broca's aphasia. METHODS: Six individuals were submitted to Mapping Therapy and ORLA (Oral Reading for Language in Aphasia) treatments. Samples of oral and written production from a picture description task were compared pre and post-treatment. RESULTS: In Mapping Therapy, the patients presented better performance after the training for the variables related to written production: number of words, nouns, verbs, closed-class words, and number of complete sentences. Regarding oral output, the patients had similar performance before and after the therapeutic process. In ORLA, the patients presented a significant difference before and after the therapeutic process in the variables related to oral production, increasing the number of words, number of verbs, and speech rate. There was no difference in pre and post-treatment performance in written production. CONCLUSION: Both implicit and explicit learning can be used in the treatment of agrammatism. Mapping Therapy was more effective for the treatment of agrammatism in written production, while ORLA was more effective for the agrammatism in oral production.

Várias abordagens terapêuticas para a reabilitação do agramatismo utilizam métodos implícitos e explícitos de aprendizado. OBJETIVO: Verificar o efeito dos métodos adaptados Mapping Therapy e ORLA (aprendizagem explícita versus implícita) na produção oral e escrita de discurso em pacientes agramáticos com afasia de Broca. MÉTODOS: Seis indivíduos foram submetidos aos tratamentos Mapping Therapy e ORLA. Amostras das produções oral e escrita na tarefa de descrição da prancha foram comparadas antes e após o tratamento. RESULTADOS: No método Mapping Therapy, os pacientes apresentaram melhor desempenho após o tratamento nas seguintes variáveis ​​relacionadas à produção escrita: número de palavras, substantivos, verbos, palavras de classe fechada e número de frases completas. Em relação à emissão oral, os pacientes mantiveram desempenho semelhante pré e pós processo terapêutico. No método ORLA, os pacientes apresentaram diferença significativa antes e após o processo terapêutico nas variáveis ​​relacionadas à produção oral, com aumento no número de palavras, número de verbos e velocidade de fala. Não houve diferença no desempenho pré e pós tratamento na produção escrita. CONCLUSÃO: Tanto a aprendizagem implícita como a explícita têm o potencial de serem usadas no tratamento do agramatismo. A Mapping Therapy foi mais eficaz no tratamento do agramatismo na produção escrita, enquanto o ORLA foi mais eficaz para o agramatismo na produção oral.

Treatment of agrammatism in oral and written production in patients with Brocas aphasia The use of implicit and explicit learning / Tratamento do agramatismo na produção oral e escrita em pacientes com afasia de Broca: uso do aprendizado implícito e explícito

Abstract. Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods. Objective: To verify the effect of adapted Mapping Therapy and ORLA methods (explicit versus implicit learning) on the oral and written production in spontaneous language among agrammatic patients with Broca's aphasia. Methods: Six individuals were submitted to Mapping Therapy and ORLA (Oral Reading for Language in Aphasia) treatments. Samples of oral and written production from a picture description task were compared pre and post-treatment. Results: In Mapping Therapy, the patients presented better performance after the training for the variables related to written production: number of words, nouns, verbs, closed-class words, and number of complete sentences. Regarding oral output, the patients had similar performance before and after the therapeutic process. In ORLA, the patients presented a significant difference before and after the therapeutic process in the variables related to oral production, increasing the number of words, number of verbs, and speech rate. There was no difference in pre and post-treatment performance in written production. Conclusion: Both implicit and explicit learning can be used in the treatment of agrammatism. Mapping Therapy was more effective for the treatment of agrammatism in written production, while ORLA was more effective for the agrammatism in oral production.

Resumo. Várias abordagens terapêuticas para a reabilitação do agramatismo utilizam métodos implícitos e explícitos de aprendizado. Objetivo: Verificar o efeito dos métodos adaptados Mapping Therapy e ORLA (aprendizagem explícita versus implícita) na produção oral e escrita de discurso em pacientes agramáticos com afasia de Broca. Métodos: Seis indivíduos foram submetidos aos tratamentos Mapping Therapy e ORLA. Amostras das produções oral e escrita na tarefa de descrição da prancha foram comparadas antes e após o tratamento. Resultados: No método Mapping Therapy, os pacientes apresentaram melhor desempenho após o tratamento nas seguintes variáveis ​​relacionadas à produção escrita: número de palavras, substantivos, verbos, palavras de classe fechada e número de frases completas. Em relação à emissão oral, os pacientes mantiveram desempenho semelhante pré e pós processo terapêutico. No método ORLA, os pacientes apresentaram diferença significativa antes e após o processo terapêutico nas variáveis ​​relacionadas à produção oral, com aumento no número de palavras, número de verbos e velocidade de fala. Não houve diferença no desempenho pré e pós tratamento na produção escrita. Conclusão: Tanto a aprendizagem implícita como a explícita têm o potencial de serem usadas no tratamento do agramatismo. A Mapping Therapy foi mais eficaz no tratamento do agramatismo na produção escrita, enquanto o ORLA foi mais eficaz para o agramatismo na produção oral.

Inference comprehension in text reading: Performance of individuals with right- versus left-hemisphere lesions and the influence of cognitive functions.

BACKGROUND: Right-hemisphere lesions (RHL) may impair inference comprehension. However, comparative studies between left-hemisphere lesions (LHL) and RHL are rare, especially regarding reading comprehension. Moreover, further knowledge of the influence of cognition on inferential processing in this task is needed. OBJECTIVES: To compare the performance of patients with RHL and LHL on an inference reading comprehension task. We also aimed to analyze the effects of lesion site and to verify correlations between cognitive functions and performance on the task. METHODS: Seventy-five subjects were equally divided into the groups RHL, LHL, and control group (CG). The Implicit Management Test was used to evaluate inference comprehension. In this test, subjects read short written passages and subsequently answer five types of questions (explicit, logical, distractor, pragmatic, and other), which require different types of inferential reasoning. The cognitive functional domains of attention, memory, executive functions, language, and visuospatial abilities were assessed using the Cognitive Linguistic Quick Test (CLQT). RESULTS: The LHL and RHL groups presented difficulties in inferential comprehension in comparison with the CG. However, the RHL group presented lower scores than the LHL group on logical, pragmatic and other questions. A covariance analysis did not show any effect of lesion site within the hemispheres. Overall, all cognitive domains were correlated with all the types of questions from the inference test (especially logical, pragmatic, and other). Attention and visuospatial abilities affected the scores of both the RHL and LHL groups, and only memory influenced the performance of the RHL group. CONCLUSIONS: Lesions in either hemisphere may cause difficulties in making inferences during reading. However, processing more complex inferences was more difficult for patients with RHL than for those with LHL, which suggests that the right hemisphere plays an important role in tasks with higher comprehension demands. Cognition influences inferential processing during reading in brain-injured subjects.

Effect of education on listening comprehension of sentences on healthy elderly: analysis of number of correct responses and task execution time.

PURPOSE: To analyze the effect of education on sentence listening comprehension on cognitively healthy elderly. METHODS: A total of 111 healthy elderly, aged 60-80 years of both genders were divided into two groups according to educational level: low education (0-8 years of formal education) and high education (≥9 years of formal education). The participants were assessed using the Revised Token Test, an instrument that supports the evaluation of auditory comprehension of orders with different working memory and syntactic complexity demands. The indicators used for performance analysis were the number of correct responses (accuracy analysis) and task execution time (temporal analysis) in the different blocks. RESULTS: The low educated group had a lower number of correct responses than the high educated group on all blocks of the test. In the temporal analysis, participants with low education had longer execution time for commands on the first four blocks related to working memory. However, the two groups had similar execution time for blocks more related to syntactic comprehension. CONCLUSION: Education influenced sentence listening comprehension on elderly. Temporal analysis allowed to infer over the relationship between comprehension and other cognitive abilities, and to observe that the low educated elderly did not use effective compensation strategies to improve their performances on the task. Therefore, low educational level, associated with aging, may potentialize the risks for language decline.

Effect of education on listening comprehension of sentences on healthy elderly: analysis of number of correct responses and task execution time / Efeito da escolaridade na compreensão auditiva de sentenças em idosos saudáveis: análise do número de acertos e tempo de execução da tarefa

ABSTRACT Purpose To analyze the effect of education on sentence listening comprehension on cognitively healthy elderly. Methods A total of 111 healthy elderly, aged 60-80 years of both genders were divided into two groups according to educational level: low education (0-8 years of formal education) and high education (≥9 years of formal education). The participants were assessed using the Revised Token Test, an instrument that supports the evaluation of auditory comprehension of orders with different working memory and syntactic complexity demands. The indicators used for performance analysis were the number of correct responses (accuracy analysis) and task execution time (temporal analysis) in the different blocks. Results The low educated group had a lower number of correct responses than the high educated group on all blocks of the test. In the temporal analysis, participants with low education had longer execution time for commands on the first four blocks related to working memory. However, the two groups had similar execution time for blocks more related to syntactic comprehension. Conclusion Education influenced sentence listening comprehension on elderly. Temporal analysis allowed to infer over the relationship between comprehension and other cognitive abilities, and to observe that the low educated elderly did not use effective compensation strategies to improve their performances on the task. Therefore, low educational level, associated with aging, may potentialize the risks for language decline.

RESUMO Objetivo Analisar o efeito da escolaridade na compreensão auditiva de sentenças em idosos cognitivamente saudáveis. Método Foram avaliados 111 idosos normais, com idades entre 60 e 80 anos, de ambos os gêneros, divididos em dois grupos, de acordo com a escolaridade: baixa escolaridade (0 a 8 anos de ensino formal) e alta escolaridade (9 ou mais anos de ensino formal). Os indivíduos foram examinados por meio do Token Test Revisado, que dá suporte para a avaliação da compreensão auditiva de ordens com diferentes demandas de memória operacional e complexidade sintática. Os indicadores utilizados para análise do desempenho foram números de acertos (análise de acurácia) e tempo de execução da tarefa (análise temporal) nos diferentes blocos. Resultados O grupo de baixa escolaridade apresentou menor número de acertos que o grupo de alta escolaridade em todos os blocos do teste. Na análise temporal, os idosos de baixa escolaridade apresentaram maior tempo para execução das ordens nos primeiros quatro blocos, mais relacionados à memória operacional. Porém, os grupos apresentaram tempo de execução semelhante quanto aos blocos mais relacionados à compreensão sintática. Conclusão A escolaridade influenciou a habilidade de compreensão auditiva de sentenças em indivíduos idosos. A análise temporal permitiu inferir sobre a relação da compreensão com outras habilidades cognitivas e observar que os idosos de baixa escolaridade não utilizam estratégias eficazes de compensação para melhorar o desempenho na tarefa. Portanto, o baixo nível educacional, associado ao envelhecimento, pode potencializar os riscos para o declínio da linguagem.

Healthy Aging and Compensation of Sentence Comprehension Auditory Deficits.

OBJECTIVES: To analyze the effect of aging on sentence auditory comprehension and to study the relationship between this language skill and cognitive functions (attention, working memory, and executive functions). METHODS: A total of 90 healthy subjects were divided into three groups: adults (50-59 years), young-old (60-69 years), and old-old (70-80 years). Subjects were assessed using the Revised Token Test. The measures used for performance analysis were number of correct answers (accuracy) and execution time of commands on the different subtests. RESULTS: Regarding accuracy, groups showed similar performance on the first blocks, but the young-old and old-old performed worse than adults on blocks 9 and 10. With respect to execution time, groups differed from block 2 (i.e., the groups differed for all blocks, except for block 1), with the worst performance observed in the old-old group, followed by that of the young-old group. Therefore, the elderly required more time to attain performance similar to that of adults, showing that time measurements are more sensitive for detecting the effects of age. Sentence comprehension ability is correlated with cognitive test performance, especially for global cognition and working memory tests. CONCLUSIONS: Healthy aging is characterized by the ability to compensate for difficulties in linguistic processing, which allows the elderly to maintain functional communication.

Naming ability in patients with mild to moderate Alzheimer's disease: what changes occur with the evolution of the disease?

OBJECTIVES: Naming deficit is a linguistic symptom that appears in the initial phase of Alzheimer's disease, but the types of naming errors and the ways in which this deficit changes over the course of the disease are unclear. We analyzed the performance of patients with Alzheimer's disease on naming tasks during the mild and moderate phases and verified how this linguistic skill deteriorates over the course of the disease. METHODS: A reduced version of the Boston Naming Test was administered to 30 patients with mild Alzheimer's disease, 30 patients with moderate Alzheimer's disease and 30 healthy controls. Errors were classified as verbal semantic paraphasia, verbal phonemic paraphasia, no response (pure anomia), circumlocution, unrelated verbal paraphasia, visual errors or intrusion errors. RESULTS: The patients with moderate Alzheimer's disease had significantly fewer correct answers than did both the control group and the group with mild Alzheimer's disease. With regard to the pattern of errors, verbal semantic paraphasia errors were the most frequent errors in all three groups. Additionally, as the disease severity increased, there was an increase in the number of no-response errors (pure anomia). The group with moderate Alzheimer's disease demonstrated a greater incidence of visual errors and unrelated verbal paraphasias compared with the other two groups and presented a more variable pattern of errors. CONCLUSIONS: Performance on nominative tasks worsened as the disease progressed in terms of both the quantity and the type of errors encountered. This result reflects impairment at different levels of linguistic processing.

Naming ability in patients with mild to moderate Alzheimer’s disease: what changes occur with the evolution of the disease?

OBJECTIVES: Naming deficit is a linguistic symptom that appears in the initial phase of Alzheimer’s disease, but the types of naming errors and the ways in which this deficit changes over the course of the disease are unclear. We analyzed the performance of patients with Alzheimer’s disease on naming tasks during the mild and moderate phases and verified how this linguistic skill deteriorates over the course of the disease. METHODS: A reduced version of the Boston Naming Test was administered to 30 patients with mild Alzheimer’s disease, 30 patients with moderate Alzheimer’s disease and 30 healthy controls. Errors were classified as verbal semantic paraphasia, verbal phonemic paraphasia, no response (pure anomia), circumlocution, unrelated verbal paraphasia, visual errors or intrusion errors. RESULTS: The patients with moderate Alzheimer’s disease had significantly fewer correct answers than did both the control group and the group with mild Alzheimer’s disease. With regard to the pattern of errors, verbal semantic paraphasia errors were the most frequent errors in all three groups. Additionally, as the disease severity increased, there was an increase in the number of no-response errors (pure anomia). The group with moderate Alzheimer’s disease demonstrated a greater incidence of visual errors and unrelated verbal paraphasias compared with the other two groups and presented a more variable pattern of errors. CONCLUSIONS: Performance on nominative tasks worsened as the disease progressed in terms of both the quantity and the type of errors encountered. This result reflects impairment at different levels of linguistic processing. .

Inference comprehension during reading: influence of age and education in normal adults.

PURPOSE: To determine the effect of age and education on inferential comprehension from written texts in normal individuals. METHODS: A total of 224 normal adults were stratified into nine groups according to age (young: 18-39 years, adults: 40-59 years, and elderly: 60-79 years) and educational level (low ≤4 years, medium: 5-8 years and high >8 years) and were evaluated through the battery La gestion de l'implicite (Implicit Information Management Test) to determine the ability to make inferences through different types of questions: explicit, logical, distractor, pragmatic and others. RESULTS: The elderly showed worse performance for total score and distractor questions. Regarding educational level, all groups differed on explicit, logical, distractor questions, and on total test score. Subjects with high schooling performed better on pragmatic inferences and others. CONCLUSION: Age influence on the comprehension of inferences may be due to difficulties in attention and executive functions. The strong effect of education can be explained by the interaction of inferential abilities with other cognitive functions such as working memory, vocabulary span, as well as world knowledge.

Inference comprehension during reading: influence of age and education in normal adults / Compreensão de inferências durante a leitura: influência da idade e escolaridade em adultos normais

Purpose: To determine the effect of age and education on inferential comprehension from written texts in normal individuals. Methods: A total of 224 normal adults were stratified into nine groups according to age (young: 18–39 years, adults: 40–59 years, and elderly: 60–79 years) and educational level (low ≤4 years, medium: 5–8 years and high >8 years) and were evaluated through the battery La gestion de l'implicite (Implicit Information Management Test) to determine the ability to make inferences through different types of questions: explicit, logical, distractor, pragmatic and others. Results: The elderly showed worse performance for total score and distractor questions. Regarding educational level, all groups differed on explicit, logical, distractor questions, and on total test score. Subjects with high schooling performed better on pragmatic inferences and others. Conclusion: Age influence on the comprehension of inferences may be due to difficulties in attention and executive functions. The strong effect of education can be explained by the interaction of inferential abilities with other cognitive functions such as working memory, vocabulary span, as well as world knowledge.

Objetivo: Verificar o efeito da idade e escolaridade na compreensão de inferências a partir de textos escritos em indivíduos normais. Métodos: 224 adultos foram divididos em nove grupos, de acordo com a idade (jovens: 18–39 anos, adultos: 40–59 anos e idosos: 60–79 anos) e escolaridade (baixa ≤4 anos, média: 5–8 anos e alta >8 anos) e avaliados por meio da bateria La gestion de l'implicite (Teste de Gerenciamento do Implícito) para determinar a habilidade de compreender inferências, através de diferentes tipos de questões: explícitas, lógicas, distratoras, pragmáticas e outras. Resultados: Os idosos apresentaram pior desempenho na pontuação total do teste e nas questões distratoras. Quanto à escolaridade, todos os grupos se diferenciaram nas questões explícitas, lógicas, distratoras e na pontuação total do teste. Os sujeitos com alta escolaridade apresentaram melhor desempenho nas inferências pragmáticas e outras. Conclusão: A influência da idade na compreensão de inferências pode estar relacionada a dificuldades atencionais e de funções executivas. O forte efeito da escolaridade deve-se à interação da habilidade inferencial com diversas funções cognitivas, como linguagem e memória operacional, além de conhecimento de mundo.

Sentence production in rehabilitation of agrammatism: a case study / Produção de sentenças na reabilitação de agramatismo: um estudo de caso

Agrammatism is characterized by morphosyntactic deficits in production of sentences. Studies dealing with the treatment of these deficits are scarce and their results controversial. The present study describes the rehabilitation of a case diagnosed as chronic Broca?s aphasia, with agrammatism, using a method directed to sentence structural deficits. The method aims to expand the grammatical repertoire by training production of sentences with support from contexts that stimulate actions and dialogues. The patient showed positive results on all types of sentences trained and generalized the gains to spontaneous speech. However, these benefits were not sustained in the long term.

O agramatismo é marcado por déficits morfossintáticos na produção das sentenças. Estudos que abordam o tratamento destas dificuldades são escassos e controversos. O presente estudo descreveu a reabilitação de uma paciente com agramatismo associado à afasia de Broca em fase crônica, por meio de programa de estruturação de sentenças. Trata-se de método que visa à expansão do repertório gramatical através do treino com apoio de contextos que estimulam ações e diálogos. A paciente obteve resultados positivos em todos os tipos de frases treinadas, com ganhos generalizados para contextos de fala espontânea. No entanto, os benefícios não se mantiveram em longo termo.

Sentence production in rehabilitation of agrammatism: A case study.

Agrammatism is characterized by morphosyntactic deficits in production of sentences. Studies dealing with the treatment of these deficits are scarce and their results controversial. The present study describes the rehabilitation of a case diagnosed as chronic Broca's aphasia, with agrammatism, using a method directed to sentence structural deficits. The method aims to expand the grammatical repertoire by training production of sentences with support from contexts that stimulate actions and dialogues. The patient showed positive results on all types of sentences trained and generalized the gains to spontaneous speech. However, these benefits were not sustained in the long term.

O agramatismo é marcado por déficits morfossintáticos na produção das sentenças. Estudos que abordam o tratamento destas dificuldades são escassos e controversos. O presente estudo descreveu a reabilitação de uma paciente com agramatismo associado à afasia de Broca em fase crônica, por meio de programa de estruturação de sentenças. Trata-se de método que visa à expansão do repertório gramatical através do treino com apoio de contextos que estimulam ações e diálogos. A paciente obteve resultados positivos em todos os tipos de frases treinadas, com ganhos generalizados para contextos de fala espontânea. No entanto, os benefícios não se mantiveram em longo termo.