Brief instrument for direct complex functionality assessment: a new ecological tool.

Background: The Direct Assessment of Functional Status (DAFS) is the only instrument validated in Brazil that assesses functionality directly with the patient. However, this clinical tool takes a long time to be administered. This limits its use in hospitals and outpatient clinics that require brief assessment instruments. Additionally, we need to count with a direct assessment because the number of older adults living alone is increasing and we thus lack reliable informants. Objective: This study aimed to present the development and content validity evidence of a direct complex functionality test for older adults, the Brief Instrument for Direct Functionality Assessment (BIDFA). Method: A total sample of 30 older adults and eight expert judges took part in the study stages. The BIDFA construction stages were: (1) literature review of functionality instruments; (2) development of seven ecological tasks to evaluate the performance of daily complex activities with the older adults; (3) content analysis by eight expert judges; (4) pilot study with 30 older adults; (5) the ecological analysis of items; (6) focus group analysis; and (7) final version of the BIDFA. Results: The BIDFA had evidence of content validity with an agreement index of 96.5%. The final version of BIDFA was left with six domains of complex functionality divided into semantic memory and time orientation; shopping skills; executive attention, math and finance skills; organization; planning and procedural memory; and problem-solving. The complex functionality score by BIDFA ranges from 0 to 100 points. Conclusion: The BIDFA was found to have good content validity by the expert judges and by the ecological analysis of the items by the older adults. The new instrument is expected to help assess the functional status of older adults, in an abbreviated context including complex functionality demands, with a wider range of total and subdomain scores.

When should a university student be allowed academic accommodations for attention-deficit/hyperactivity disorder? A position statement for a unified procedure for use in Brazil

In higher education, reasonable accommodations are increasingly made for students with a wide range of disabilities. However, rigorous assessment is paramount to ensure these students are supported while preventing ineligible students from gaining unfair advantages. In this context, we sought to identify under which circumstances a university student should be allowed academic accommodation for attention-deficit/hyperactivity disorder (ADHD) and to outline an evidence-based policy for use in Brazil based on the global experience. We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodations for ADHD are provided (including detection of malingering) and scrutinized the eligibility criteria of leading universities worldwide. Finally, renowned experts in the field and national stakeholders were consulted. Despite an exhaustive search, we found no international standard for the assessment of students with ADHD who request academic accommodation; even renowned institutions worldwide differ in their approaches to granting accommodations on the grounds of ADHD. Therefore, we propose a unified set of nationwide criteria for Brazilian universities, which could be generalized internationally. Higher education institutions in Brazil and beyond may benefit from adoption of such criteria.

When should a university student be allowed academic accommodation For ADHD? A position statement for a unified procedure for use in Brazil.

OBJECTIVE: To identify under what circumstances a university student should be allowed academic accommodation for ADHD. To frame an evidence-based policy for use in Brazil based on a worldwide experience. METHODS: We reviewed the literature to acquire information on what documents are commonly required by disability services before accommodation for ADHD is made (including malingering detection). We scrutinized the eligibility criteria of the best universities worldwide. Renowned experts in the field and national stakeholders were consulted. RESULTS: We found no international standard for the assessment of students with ADHD who request academic accommodation. Even renowned institutions worldwide differ from one another in their approaches to academic accommodation on the grounds of ADHD. We propose a national unified set of criteria for Brazilian universities, which could generalize internationally. DISCUSSION: Rigorous assessment is paramount for aiding students with disabilities while preventing ineligible students gaining an unfair advantage. Higher education institutions nationwide and beyond may benefit from adopting a unified set of criteria for eligibility to ADHD accommodation programs.

Executive Functions Contribute to the Differences Between ADHD and Sluggish Cognitive Tempo (SCT) in Adults.

OBJECTIVES: This paper analyses the relationship between sociodemographic variables, executive dysfunctions, Sluggish Cognitive Tempo (SCT) and the mainly dimensions of ADHD: hyperactivity-impulsivity (ADHD-H/I) and inattention (ADHD-IN) in Brazilian adults. METHOD: A cross-sectional, exploratory, and comparative design was used. A total of 446 participants (295 women) aging from 18 to 63 years old (M = 3,499 years, SD = 10.7) were recruited on the internet. Correlations, t independent tests and regressions were conducted. RESULTS: Higher scores in ADHD dimensions were associated to more executive functioning problems and time perception distortions in comparison to those participants without significant ADHD symptoms. However, ADHD-IN dimension as well as SCT were higher associated with these dysfunctions than ADHD-H/I. The regression results showed that ADHD-IN was more related to Self-Management to time while ADHD-H/I to Self-Restraint and SCT to Self-Organization/Problem Solving. CONCLUSION: This paper contributed to the distinction between SCT and ADHD in adults in important psychological dimensions.

Does the frequency of reading and writing habits contribute to executive functions, intelligence, and learning in adolescents with healthy development?

The influence of the frequency of reading and writing habits (FRWH) on cognition has been investigated by several studies in the literature. However, the implications of FRWH on executive development, intelligence, and academic achievement are not yet clear in adolescents with healthy development. The aim was to verify whether there are differences in executive functions, intelligence, and academic achievement between adolescents with high and low FRWH. Moreover, we aimed to investigate if there are differences in the parental FRWH between adolescents with high and low FRWH. The sample was composed of 47 healthy adolescents, n = 24 with high FRWH and n = 23 with low FRWH. Adolescents with higher FRWH had better performance on measures of vocabulary, Speech Act analysis, and Oral Narrative Discourse. Therefore, a high FRWH has a positive influence on the cognitive development of healthy adolescents, especially with regard to pragmatic language. However, adolescents with low FRWH performed better than those with a high FRWH on an automatic counting task. The interpretation of cognitive performance and academic achievement scores in neuropsychological assessment should consider the FRWH of parents and adolescents. This factor should be targeted by early stimulation interventions to help adolescents achieve the highest possible levels of global development.

A longitudinal study of cognition, functional outcome and quality of life in bipolar disorder and major depression.

OBJECTIVE: Cognitive impairments are known to be a frequent cause of disability in bipolar disorder (BD) and major depression (MDD). Yet there is no consensus regarding the particular cognitive functions whose impairments can lead to disability in each domain of functioning. The aim of this study was to perform a longitudinal evaluation of working memory, inhibition, cognitive flexibility and attention in BD and MDD, investigate the relationship of these cognitive functions to disability and quality of life, and evaluate the impact of variables related to cognitive reserve (education and daily cognitive stimulation) on cognitive performance. METHOD: 31 participants (MDD = 12; BD = 19) were evaluated at baseline and after an average time of 2 years. RESULTS: the BD group showed improvements in attention while patients with MDD improved on measures of attention and working memory. In BD working memory performance was associated with the cognition and mobility domains of functioning, and with physical and environmental quality of life. In MDD, cognitive flexibility was related to social relationships and environmental quality of life. CONCLUSION: working memory and cognitive flexibility may be an interesting target for interventions aiming to improve everyday functioning and quality of life in BD and MDD.

Executive processing clusters in school-age children with ADHD

Este estudo buscou grupos de processamento executivo em crianças com diagnóstico de Transtorno de Déficit de Atenção/Hiperatividade (TDAH). Para tal, foram utilizadas medidas de flexibilidade cognitiva (FC), inibição (IN) e memória de trabalho (MT) e conduzidas análises de clusters hierárquicos e MANCOVA (p=0.05). Foram identificados três subgrupos com os seguintes perfis de processamento executivo: 1) déficits em FC e IN; 2) déficits em IN; 3) déficits em FC e MT. Esses resultados indicaram a presença de diferentes perfis de déficits em componentes executivos entre crianças com diagnóstico de TDAH. Esses achados podem contribuir para a elaboração de estratégias de intervenção e de programas de psicoeducação para estudantes com diagnóstico de TDAH em contextos clínicos e educacionais.(AU)

OBJECTIVE: This study aimed to characterize executive processing subgroups among children with Attention Deficit Hyperactivity Disorder (ADHD). METHOD: Sixty-one children with ADHD, with ages from six to twelve years old, were examined using instruments that evaluate the executive components of cognitive flexibility (CF), inhibition (IN) and working memory (WM). Analysis of hierarchical clusters and MANCOVA (p≤0.05) were conducted. RESULTS: Participants were divided in three clusters: 1) deficits in CF and in IN; 2) deficits in IN; 3) deficits in CF and in WM. CONCLUSIONS: the results indicated different neuropsychological profiles among children with ADHD, with different cognitive strengths and weaknesses. Clusters did not differ with respect to biological, clinical, and sociocultural factors. The findings may be useful for educational and health institutions, supporting psychoeducation programs and intervention strategies for students with ADHD.(AU)

Este estudio investigó grupos de procesamiento ejecutivo en niños diagnosticados con trastorno por déficit de atención e hiperactividad (TDAH). Para ello, se utilizaron medidas de flexibilidad cognitiva (FC), inhibición (IN) y memoria de trabajo (MT) y se realizaron análisis de conglomerados jerárquicos y MANCOVA (p=0.05). Se identificaron tres subgrupos con los siguientes perfiles de procesamiento ejecutivo: 1) déficits en FC e IN; 2) déficits en IN; 3) déficits en FC y MT. Estos resultados indicaron la presencia de diferentes perfiles de déficit en los componentes ejecutivos entre los niños diagnosticados con TDAH. Estos datos pueden contribuir al desarrollo de estrategias de intervención y programas de psicoeducación para estudiantes diagnosticados con TDAH en contextos clínicos y educativos.(AU)

Is it possible to promote executive functions in university students? Evidence of effectiveness of the πFEx-Academics.

Executive functions (EF) impact the success of university students. These skills appear to have a predictive role in academic performance. The aim of this study was to investigate the effectiveness of an intervention program in EF aimed at university students, the πFex-Academics, seeking to verify whether there are gains in EF, a reduction in inattention and hyperactivity indicators and a transfer to reading comprehension. Participants were two professors and their respective classes, totaling 129 students. The classes were divided into: experimental group (EG) (n = 66) and control group (CG) (n = 63). All students underwent a pre- and post-intervention assessment. The program implementation process was mediated by the EG professor. Although no direct gains were identified in the indices of EF difficulties, greater gains in the EG were verified in the hyperactivity/impulsivity and reading comprehension indices, when compared to the CG. These findings are promising, demonstrating the first evidence of the effectiveness of the πFex-Academics. The incorporation of interventions into the university context can provide various benefits for students, with improved behavior and written language processing, necessary for the best possible academic success. Activities of EF mediation for higher education learning can be incorporated into extension courses or the curriculum of university courses.

Pediatric bipolar disorder: Executive, linguistic, mnemonic, and cognitive efficiency mapping.

Neuropsychological assessment can enrich our understanding of Pediatric Bipolar Disorder (PB). This study aimed to: (1) analyze the occurrence of neuropsychological frequency of deficits and difficulties in children with PB; (2) verify whether there is a performance difference between PB type I (PB-I) and PB type II (PB-II)/unspecified, and between PB with and without ADHD; and (3) verify the cognitive efficiency differences within the PB group and control groups, and among clinical subgroups. Participants in the study were 16 children diagnosed with PB and 40 children with typical development (6-12 years old). The results indicated a high frequency of deficits/difficulties in verbal fluency, cognitive efficiency in performing basic abilities, inhibitory control, cognitive flexibility, and working memory, with emphasis on verbal and executive losses. There were indications that type PB-I and comorbidity with ADHD negatively impact a child's neuropsychological development. The clinical group showed more cognitive efficiency losses compared with the control group, and greater losses were observed in PB-I and in PB with ADHD. The role of neuropsychological evaluation in multidomain and nonlinear statistical analysis is critical to gaining an understanding of the clinical and cognitive heterogeneity of PB.

Do executive functions and gross motor skills predict writing and mathematical performance in children with developmental coordination disorder?

Aim: To examine whether executive functions, and gross motor skills were predictors for school performance in children with DCD, with risk for DCD (r-DCD), and with typical development (TD).Methods: Participants were 63 children with DCD (Mage = 8.70, SDage = .64), 31 children with r-DCD (Mage = 8.90, SDage = 0.74), and 63 typical development children (Mage = 8.74, SDage = .63). Wechsler Abbreviated Scale of Intelligence, Movement Assessment Battery for Children-2, Test of Gross Motor Development-3, Oral Word Span in Sentences, Odd-One-Out, Go/No-Go, Hayling Test, Trail Making Test, Five Digits Test, and the Test of School Performance-II were utilized.Results: In DCD, processing speed (ß = -.42, p = .005), and auditory-motor inhibition (ß = -.36, p = .009), and auditory-verbal inhibition (ß = -.38, p = .023) predicted math performance; and auditory-motor (ß = -.40, p = .38) and visuospatial working memory (ß = -.33 p = .011) predicted writing performance. In r-DCD, auditory-motor (ß = - .67; p = .002) and visual-motor (ß = -.40; p = .040) inhibition predicted math performance; visual-motor inhibition predicted writing performance (ß = -.47; p = .015).Conclusion: Lower inhibitory control and visuospatial working memory scores affect children with DCD and r-DCD' school performance.

Transtorno Depressivo Maior: Um Estudo Comparativo sobre Cognição Socioemocional e Funções Executivas / Major Depressive Disorder: A Comparative Study on Socio-Emotional Cognition and Executive Functions

Resumo O objetivo deste estudo foi avaliar a cognição socioemocional e as funções executivas em pacientes com Transtorno Depressivo Maior unipolar. A amostra incluiu 22 pacientes entre 36 e 93 anos de idade (M = 59,32; DP = 12,89) e 23 indivíduos controles entre 30 e 81 anos de idade (M = 63,00; DP = 13,56). Além de dados demográficos, foram avaliados sintomas de ansiedade e de depressão, empatia, teoria da mente, reconhecimento de emoções, controle inibitório, flexibilidade cognitiva e fluência verbal. Não houve diferença estatística significativa entre os grupos quanto à idade e à escolaridade. Os pacientes apresentaram significativamente mais ansiedade, depressão e angústia pessoal do que os controles. Indivíduos com sintomas depressivos mais graves apresentaram menor velocidade de processamento.

Abstract The present study aimed to assess socioemotional cognition and executive functions in patients with unipolar Major Depressive Disorder. The sample included 22 patients between 36 and 93 years of age (M = 59.32; SD = 12.89) and 23 patients between 30 and 81 years of age (M = 63.00; SD = 13.56) controls. In addition to demographic data, symptoms of anxiety and depression, empathy, theory of mind, recognition of emotions, inhibitory control, cognitive flexibility and phonemic verbal fluency were obtained. There was no statistical difference between the groups regarding age and education. Patients had significantly more anxiety, depression and personal distress than controls. Individuals with more severe depressive symptoms had a lower processing speed than the others.

Clustering and switching in verbal fluency: a comparison between control and individuals with brain damage / Clustering e switching na fluência verbal: comparação entre controles e indivíduos com prejuízo cerebral

ABSTRACT Purpose The aim of this study is to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic Verbal Fluency tasks. Methods The sample consisted of 104 participants divided into four groups (26 with left hemisphere damage and aphasia- LHDa, 28 with left hemisphere damage and no aphasia- LHDna, 25 with right hemisphere damage- RHD and 25 neurologically healthy control subjects). All participants were administered the phonemic ("M" letter-based) and semantic (animals) verbal fluency tasks from the Montreal-Toulouse Language Assessment Battery (MTL-BR). Results Patients in the LHDa group showed the worst performance (fewer words produced, fewer clusters and switches) in both types of fluency task. RHD group showed fewer switching productions when compared with controls and LHDna had fewer words productions than controls in the first 30 seconds block. Conclusion Our findings suggest that the LHDa group obtained lower scores in most measures of SVF and PVF when compared to the other groups.

RESUMO Objetivo analisar e comparar o desempenho e as estratégias utilizadas por indivíduos controle e pacientes com lesão cerebral unilateral em tarefas de Fluência Verbal fonêmica e semântica. Método A amostra foi composta por 104 participantes, divididos em quatro grupos (26 com lesão no hemisfério esquerdo e afasia - LHEa, 28 com lesão no hemisfério esquerdo e sem afasia - LHEna, 25 com lesão no hemisfério direito - LHD e 25 controles neurologicamente saudáveis). Todos os participantes realizaram tarefas de fluência verbal fonêmica - FVF (com letra "M") e semântica- FVS (animais) da Bateria Montreal-Toulouse de Avaliação da Linguagem (MTL-BR). Resultados Pacientes do grupo LHEa apresentaram pior desempenho (menos palavras produzidas, menos clusters e switching) nos dois tipos de tarefas de fluência. O grupo LHD mostrou menos produções de switching quando comparado aos controles. O grupo LHEna teve menos produções de palavras que os controles no primeiro bloco de 30 segundos. Conclusão Nossos achados concluem que o grupo LHEa obteve escores mais baixos na maioria das medidas de FVS e FVF quando comparado aos demais grupos.

Preliminary comparative study of cortical thickness in HIV-infected patients with and without working memory deficit.

PURPOSE: Changes in cerebral cortical regions occur in HIV-infected patients, even in those with mild neurocognitive disorders. Working memory / attention is one of the most affected cognitive domain in these patients, worsening their quality of life. Our objective was to assess whether cortical thickness differs between HIV-infected patients with and without working memory deficit. METHODS: Forty-one adult HIV-infected patients with and without working memory deficit were imaged on a 1.5 T scanner. Working memory deficit was classified by composite Z scores for performance on the Digits and Letter-Number Sequencing subtests of the Wechsler Adult Intelligence Scale (third edition; WAIS-III). Cortical thickness was determined using FreeSurfer software. Differences in mean cortical thickness between groups, corrected for multiple comparisons using Monte-Carlo simulation, were examined using the query design estimate contrast tool of the FreeSurfer software. RESULTS: Greater cortical thickness in left pars opercularis of the inferior frontal gyrus, and rostral and caudal portions of the left middle frontal gyrus (cluster 1; p = .004), and left superior frontal gyrus (cluster 2; p = .004) was observed in HIV-infected patients with working memory deficit compared with those without such deficit. Negative correlations were found between WAIS-III-based Z scores and cortical thickness in the two clusters (cluster 1: ρ = -0.59; cluster 2: ρ = -0.47). CONCLUSION: HIV-infected patients with working memory deficit have regions of greater thickness in the left frontal cortices compared with those without such deficit, which may reflect increased synaptic contacts and/or an inflammatory response related to the damage caused by HIV infection.

Cognitive reserve may outperform age, mood and psychiatric comorbidities as a predictor of executive functioning in bipolar disorder and healthy adults.

INTRODUCTION: Cognitive reserve plays a protective role against executive dysfunction in healthy adults and individuals with psychiatric illnesses such as bipolar disorder. However, the magnitude of the influence of cognitive reserve on specific executive functions (EFs), and its impact relative to variables such as depressive symptoms, age and psychiatric comorbidities, is unexplored. This study aimed to quantify the influence of cognitive reserve on specific EFs, and compare its impact with that of depressive symptoms, age and psychiatric comorbidities, in separate models for patients with bipolar disorder and healthy adults. METHOD: This was a cross-sectional study of 121 adults with no mood disorders and 109 with bipolar disorder, all of whom underwent a comprehensive psychiatric assessment and evaluation of the EFs. Cognitive reserve was measured using years of education, IQ and reading and writing habits. The association between EFs and predictors (cognitive reserve, depressive symptoms, age and psychiatric comorbidities) was evaluated through structural equation modeling. Four models were constructed for each group independently (bipolar disorder and control), one each for working memory, verbal fluency, inhibition and flexibility, due to group differences in age and cognitive reserve. RESULTS: Working memory, inhibition and flexibility were most significantly predicted by cognitive reserve and age. Verbal fluency was only predicted by cognitive reserve. Comorbidities and depressive symptoms were not significant in any of the models. Cognitive reserve had a positive influence on all EFs in models for patients with bipolar disorder and models for control participants. Age had a negative impact on three of the four EFs tested. CONCLUSION: Fostering cognitive reserve through continued education and cognitively stimulating leisure activities may be an effective intervention for executive dysfunction in patients and non-patients alike. In some cases, the effects of these interventions may outweigh the negative cognitive impact of aging, depressive symptoms and psychiatric conditions.

Clustering and switching in verbal fluency: a comparison between control and individuals with brain damage.

PURPOSE: The aim of this study is to analyze and compare the performance and strategies used by control subjects and patients with unilateral brain damage on phonemic and semantic Verbal Fluency tasks. METHODS: The sample consisted of 104 participants divided into four groups (26 with left hemisphere damage and aphasia- LHDa, 28 with left hemisphere damage and no aphasia- LHDna, 25 with right hemisphere damage- RHD and 25 neurologically healthy control subjects). All participants were administered the phonemic ("M" letter-based) and semantic (animals) verbal fluency tasks from the Montreal-Toulouse Language Assessment Battery (MTL-BR). RESULTS: Patients in the LHDa group showed the worst performance (fewer words produced, fewer clusters and switches) in both types of fluency task. RHD group showed fewer switching productions when compared with controls and LHDna had fewer words productions than controls in the first 30 seconds block. CONCLUSION: Our findings suggest that the LHDa group obtained lower scores in most measures of SVF and PVF when compared to the other groups.

Cognitive abilities underlying performance on the modified card sorting test: novel and traditional scores.

The Modified Card Sorting Test (MCST) is a widely used variation of the Wisconsin Card Sorting Test. It is faster to administer, less frustrating for respondents and less ambiguous in its scoring but has been criticized for its task impurity and low discriminability between control participants and clinical groups prone to executive dysfunction. This study aimed to examine the executive functions (EF) underlying traditional (number of categories completed, perseverative errors) and novel scores for the MCST, and compare their ability to differentiate between control and clinical samples. Novel and traditional MCST scores were compared between 94 control participants, 87 with bipolar disorder and 64 with major depression. The relationship between MCST scores and traditional EF tasks was examined through correlation and regression analyses. All MCST scores were associated with at least one measure of EF, the most common of which were the Trail Making or Hayling Tests. IQ predicted most scores on the MCST, save for nonperseverative errors and categorizing efficiency. Traditional and novel scores differentiated between clinical and control groups. These findings support the utility of the MCST in detecting executive dysfunction and highlight the importance of new scoring methods in increasing the specificity and interpretability of this task.

Development and content validity of the CENEES program - psychoeducation for health staff on neuropsychology of aging.

Worldwide life expectancy has increased dramatically in recent years. Also on the rise are incidents of pathologies related to aging, such as Mild Cognitive Impairment (MCI) or Alzheimer's Disease (AD). An inaccurate diagnosis impairs the well-being and the quality of life of patients and their relatives, as well as being a financial burden on the health system. Continued education pertaining to the neuropsychological field is uncommon for health workers involved in general practice. This article aims to present the process of development and content validity of the "CENEES Program - Psychoeducation for Health Staff on The Neuropsychology of Aging". The CENEES Program was developed in six steps which include: literature review, first draft, focal group, adjustments after focal group, judgment analysis (n = 4), and finally the last version. The inter-rater reliability index after judgment analysis was 0.785. The final version of the CENEES Program contains eight meetings, divided into 4 modules: 1) Fundamentals of Neuroscience; 2) Memory; 3) Executive Functions; and 4) Communication. The final meeting was called "Review". The CENEES Program is a new resource to help professionals who work within the general practice field, especially community health workers. As far as we know, there is no psychoeducation program on aging which contains the four subjects that are covered in the CENEES Program. The CENEES Program could assist the workers' daily activities and make them comfortable to offer and build actions in the community. A pilot and follow-up studies are suggested.

Motor and verbal inhibitory control: Development and validity of the go/No-Go app test for children with development coordination disorder.

A set of inhibitory control tasks for the smartphone (Go/No-Go App) was developed for typical children and children with development coordination disorder (DCD). The content, construct, and criterion validity was examined. The inhibitory control Go/No-Go App test is comprised of four tasks: auditory and visual stimuli with motor and verbal responses. Six experts in neuropsychology and 252 Brazilian children (139 boys; 113 girls) participated in the study, including a subgroup of children with DCD (n = 53). A high level of agreement for clarity and pertinence was observed among the experts (Gwet's Agreement Coefficients > .09), highlighting its content validity. Suitable Cronbach's alpha and McDonald's omega results were observed. The confirmatory factorial analysis (CFA) accepted the results for the Auditory-Motor (γ = .83), Visual-Motor (γ = .73), Auditory-Verbal (γ = .67) and Visual-Verbal (γ = .73) tasks. The model presented adequate adjustment indexes (Chi-square = .48, p = .787), 2/DF = .24; RMSEA = .00; GFI = .99; CFI = 1.00; AIC = 326.90. The Go/No-Go app is a test with adequate validity for the assessment of inhibition in children with DCD and may be very helpful due to the variation of the stimuli and the responses.

Verbal fluency in Alzheimer's disease and mild cognitive impairment in individuals with low educational level and its relationship with reading and writing habits.

Verbal fluency (VF) has contributed to building cognitive maps as well as differentiating healthy populations from those with dementia. OBJECTIVES: To compare the performance of healthy controls and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) in two semantic VF tasks (animals/clothes) and a phonemic VF task (letter P). Also, to analyze the relationship between the frequency of reading and writing habits (FRWH) and VF in individuals with low educational level. METHODS: Sixty-seven older adults aged 60-80 years and with 2-8 years of schooling were divided into three groups: controls (n=25), older adults with MCI (n=24), and older adults with AD (n=18). We analyzed the type, mean size, and number of clusters, switches, intersections, and returns. A post-hoc single-factor ANOVA analysis was conducted to verify differences between groups. RESULTS: Total words in the phonemic VF and the animal category discriminated the three groups. Regarding the animal category, AD patients performed worse than controls in the total number of words, taxonomic clusters, returns, and number of words remembered. We found a moderate correlation between FRWH and total number of words in the phonemic fluency. CONCLUSIONS: Semantic (animate) and phonemic (total words) VF differentiated controls and clinical groups from each other - the phonemic component was more related to FRWH than the semantic one. The phonemic VF seems to be more related to cognitive reserve. VF tasks, considering total words and cluster analyses, are a valuable tool to test healthy and cognitively impaired older adults who have a low educational level.

A tarefa de fluência verbal (FV) contribui para um mapeamento cognitivo e diferenciação entre populações saudáveis e com demência. OBJETIVOS: Comparar o desempenho em duas tarefas de FV semântica (animais/roupas) e uma fonêmica (letra P) entre controles saudáveis e pacientes com Comprometimento Cognitivo Leve (CCL) e Doença de Alzheimer (DA). Além disso, analisar a relação entre frequência de hábitos de leitura e escrita (FHLE) e a FV nesses grupos de baixa escolaridade. MÉTODOS: Sessenta e sete adultos idosos foram divididos em três grupos: controles (n=25), idosos com CCL (n=24) e idosos com DA (n=18), 60-80 anos de idade e 2-8 anos de escolaridade. Avaliaram-se tipo, tamanho médio e quantidade de agrupamentos, alternâncias, intersecções e retornos. Conduziu-se uma análise ANOVA de um fator com post hoc para verificar diferenças entre grupos. RESULTADOS: O total de palavras na FV fonêmica e a categoria animais discriminaram os três grupos. Na categoria animais, pacientes com DA demonstraram desempenho inferior ao dos controles no número total de palavras, agrupamentos taxonômicos, retornos e número de palavras evocadas. Houve correlação moderada entre FHLE e número total de palavras na FV fonêmica. CONCLUSÕES: O componente semântico (animado) e o fonêmico (total de palavras) da FV diferenciaram os controles e os grupos clínicos entre si; o fonêmico relacionou-se mais com a FHLE do que o semântico. A FV fonêmica parece ser mais relacionada à reserva cognitiva. Tarefas de FV, considerando o total de palavras e as análises de clusters, são ferramentas valiosas para testar adultos idosos saudáveis e com declínio cognitivo na baixa escolaridade.