Postpartum depression: A systematic review of the genetics involved.

Postpartum depression is one of the most prevalent psychopathologies. Its prevalence is estimated to be between 10% and 15%. Despite its multifactorial etiology, it is known that genetics play an important role in the genesis of this disorder. This paper reviews epidemiological evidence supporting the role of genetics in postpartum depression (PPD). The main objectives of this review are to determine which genes and polymorphisms are associated with PPD and discuss how this association may occur. In addition, this paper explores whether these genes are somehow related to or even the same as those linked to Major Depression (MD). To identify gaps in the current knowledge that require investigation, a systematic review was conducted in the electronic databases PubMed, LILACS and SciELO using the index terms "postpartum depression" and "genetics". Literature searches for articles in peer-reviewed journals were made until April 2014. PPD was indexed 56 times with genetics. The inclusion criteria were articles in Portuguese, Spanish or English that were available by institutional means or sent by authors upon request; this search resulted in 20 papers. Genes and polymorphisms traditionally related to MD, which are those involved in the serotonin, catecholamine, brain-derived neurotrophic factor and tryptophan metabolism, have been the most studied, and some have been related to PPD. The results are conflicting and some depend on epigenetics, which makes the data incipient. Further studies are required to determine the genes that are involved in PPD and establish the nature of the relationship between these genes and PPD.

Clinical applicability and cutoff values for an unstructured neuropsychological assessment protocol for older adults with low formal education.

BACKGROUND AND OBJECTIVES: The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. METHODS AND RESULTS: A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. CONCLUSION: The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.

The Tower of London Test: different scoring criteria for diagnosing Alzheimer's disease and mild cognitive impairment.

The Tower of London (TOL) is used for evaluating planning skills, which is a component of the executive functions. Different versions and scoring criteria were developed for this task, and some of them present with different psychometrical properties. This study aimed to evaluate two specific scoring methods of the TOL in diagnosing Mild Cognitive Impairment and probable Alzheimer's disease. The TOL total scores from 60 patients of each diagnosis were compared with the performance of 60 healthy-aged controls using receiver operating characteristics analysis and multinomial logistic regression. Krikorian method better diagnosed Alzheimer's disease, while Portellas's was better at discriminating healthy controls from Mild Cognitive Impairment, but were not efficient at comparing this last group with Alzheimer's patients. Regression analysis indicates that in addition to screening tests, TOL improves the classification of the three groups. The results suggest the two scoring methods used for this task may be useful for different diagnostic purposes.

Applicability of the Rey auditory-verbal learning test to an adult sample in Brazil.

OBJECTIVE: The Rey Auditory-Verbal Learning Test, which is used to evaluate learning and memory, is a widely recognized tool in the general literature on neuropsychology. This paper aims at presenting the performance of Brazilian adult subjects on the Rey Auditory-Verbal Learning Test, and was written after we published a previous study on the performance of Brazilian elderly subjects on this same test. METHOD: A version of the test, featuring a list of high-frequency one-syllable and two-syllable concrete Portuguese substantives, was developed. Two hundred and forty-three (243) subjects from both genders were allocated to 6 different age groups (20-24; 25-29; 30-34; 35-44; 45-54 and 55-60 years old). They were then tested using the Rey Auditory-Verbal Learning Test. RESULTS: Performance on the Rey Auditory-Verbal Learning Test showed a positive correlation with educational level and a negative correlation with age. Women performed significantly better than men. When applied across similar age ranges, our results were similar to those recorded for the English version of the Rey Auditory-Verbal Learning Test. CONCLUSION: Our results suggest that the adaptation of the Rey Auditory-Verbal Learning Test to Brazilian Portuguese is appropriate and that it is applicable to Brazilian subjects for memory capacity evaluation purposes and across similar age groups and educational levels.

Applicability of the Rey Auditory-Verbal Learning Test to an adult sample in Brazil / O Teste de Aprendizagem Auditivo-Verbal de Rey: aplicabilidade para uma amostra de adultos brasileiros

OBJECTIVE: The Rey Auditory-Verbal Learning Test, which is used to evaluate learning and memory, is a widely recognized tool in the general literature on neuropsychology. This paper aims at presenting the performance of Brazilian adult subjects on the Rey Auditory-Verbal Learning Test, and was written after we published a previous study on the performance of Brazilian elderly subjects on this same test. METHOD: A version of the test, featuring a list of high-frequency one-syllable and two-syllable concrete Portuguese substantives, was developed. Two hundred and forty-three (243) subjects from both genders were allocated to 6 different age groups (20-24; 25-29; 30-34; 35-44; 45-54 and 55-60 years old). They were then tested using the Rey Auditory-Verbal Learning Test. RESULTS: Performance on the Rey Auditory-Verbal Learning Test showed a positive correlation with educational level and a negative correlation with age. Women performed significantly better than men. When applied across similar age ranges, our results were similar to those recorded for the English version of the Rey Auditory-Verbal Learning Test. CONCLUSION: Our results suggest that the adaptation of the Rey Auditory-Verbal Learning Test to Brazilian Portuguese is appropriate and that it is applicable to Brazilian subjects for memory capacity evaluation purposes and across similar age groups and educational levels.

OBJETIVO: O Rey Auditory-Verbal Learning Test é um teste mundialmente reconhecido na literatura neuropsicológica que avalia o aprendizado e a memória. Na sequência de um estudo anterior, que apresentou o desempenho dos idosos brasileiros no Rey Auditory-Verbal Learning Test, este trabalho apresenta o desempenho dos adultos brasileiros no Rey Auditory-Verbal Learning Test. MÉTODO: Uma versão do teste foi desenvolvida com uma lista de alta frequência, com uma ou duas sílabas de substantivos concretos do português do Brasil. Duzentos e quarenta e três (243) indivíduos de ambos os sexos foram alocados para seis faixas etárias (20-24, 25-29, 30-34, 35-44, 45-54 e 55-60 anos) e avaliados com o Rey Auditory-Verbal Learning Test. RESULTADOS: O grau de escolaridade e idade mostrou correlação positiva e negativa, respectivamente, com o desempenho no Rey Auditory-Verbal Learning Test. As mulheres tiveram um desempenho significativamente melhor que os homens. Os resultados foram semelhantes aos encontrados para a versão em inglês do Rey Auditory-Verbal Learning Test por meio de faixas etárias semelhantes. CONCLUSÃO: Nossos resultados sugerem que a adaptação do Rey Auditory-Verbal Learning Test para o português brasileiro é adequada e aplicável para avaliação da capacidade de memória de indivíduos brasileiros, com idade e nível educacional similar.

Estudo Normativo do Token Test versão reduzida: dados preliminares para uma população de idosos brasileiros / Normative study of the Token Test (short version): preliminary data for a sample of Brazilian seniors

INTRODUÇÃO: A preservação das habilidades de compreensão da fala nos idosos está correlacionada com a preservação das funções cognitivas. Essa habilidade é característica fundamental para a comunicação e sua avaliação possibilita a identificação de déficits cognitivos mais específicos, além de facilitar o desenvolvimento de estratégias de intervenção mais precoces e eficientes. OBJETIVO: Disponibilizar normas contemporâneas para a utilização de um instrumento de avaliação da compreensão verbal, o Token Test, para idosos brasileiros saudáveis. MÉTODO: Uma amostra com 120 idosos (76 mulheres), com médias de 71,1 anos para idade e de 6,9 anos de educação formal para escolaridade, foi avaliada utilizando o Miniexame do Estado Mental, para identificação da existência de comprometimento cognitivo, e o Token Test, para avaliação da compreensão da fala. RESULTADOS: Foram encontradas correlações significativas (p < 0,01) entre o escore do Token Test e a educação formal e a idade, os quais corresponderam respectivamente a 5 por cento e 21 por cento da variância compartilhada. Tais variáveis foram consideradas nas tabelas normativas. CONCLUSÃO:Nossos dados indicam que as normas disponibilizadas aqui são suficientemente representativas. Este trabalho abre caminho para estudos futuros de comparação entre o desempenho no Token Test de idosos saudáveis e daqueles em processos de declínio cognitivo.

INTRODUCTION: The preservation of oral comprehension in the elderly is correlated with the preservation of their cognitive functions. Oral comprehension is a key feature for communication and its evaluation allows for the identification of more specific cognitive deficits, in addition to facilitating the development of more effective, early intervention strategies. OBJECTIVE: Provide contemporary standards for the use of an instrument to assess oral comprehension, the Token Test, in a sample of healthy seniors. METHOD: A sample of 120 patients (76 women) with mean age of 71.1 years and 6.9 years of formal education, was assessed using the Mini Mental State Examination to identify the existence of cognitive impairment, and the Token Test to assess oral comprehension. RESULTS: There were significant correlations (p < 0.01) between the token test scores for education and age, which accounted for 5 percent and 21 percent of shared variance, respectively. These two variables were considered on the normative data tables. DISCUSSION: The data obtained indicate that the standards provided here are sufficiently representative. This study identifies the need for future studies comparing the Token Test performance in elderly people either healthy or in the process of cognitive decline.

Propriedades psicométricas de um protocolo neuropsicológico breve para uso em populações geriátricas / Psychometric properties of a brief neuropsychological protocol for use in geriatric populations

CONTEXTO: O aumento na expectativa de vida e na proporção de idosos na população tem acarretado elevação nas taxas de prevalência de demências. O diagnóstico correto da demência é muito importante para o tratamento clínico e para um melhor prognóstico. Por isso, é necessário adaptar e desenvolver instrumentos para o diagnóstico diferencial entre os processos de envelhecimento normal e patológico. OBJETIVO: Avaliar as propriedades psicrométricas e a estrutura fatorial de um protocolo neuropsicológico usado para avaliação geriátrica. MÉTODO: Pacientes (n = 69) com queixas cognitivas heterogêneas foram avaliados no Núcleo de Geriatria e Gerontologia do Hospital das Clínicas da Universidade Federal de Minas Gerais, a partir de um protocolo composto pelo Miniexame do Estado Mental, Desenho do Relógio, Cubos de Corsi, Fluência Verbal, Span de Dígitos e Token Test. A análise estatística incluiu análise fatorial dos resultados dos testes, correlação de Pearson entre o fator obtido e a idade, escolaridade, anos de educação formal e a Classificação Clínica das Demências (CDR) e a área sob a curva ROC. RESULTADOS: A análise fatorial dos escores do teste mostrou um fator geral representativo que teve associação moderada e significativa com o CDR (r = -0,672; p < 0,001) e anos de educação formal (r = 0,455; p < 0,001). Esse fator teve fraca, mas significativa, correlação com a idade (r = -0,282; p < 0,05). CONCLUSÃO: Esses resultados apontam para uma boa validade de construto e de critério do protocolo na avaliação do declínio cognitivo de idosos. Estudos futuros sobre aplicabilidade e normas populacionais são necessários para aprimorar o uso clínico desse protocolo de avaliação.

BACKGROUND: The increase in life expectancy and proportion of elderly in the population is causing an increase in dementia prevalence rates. The correct, early dia gnosis of dementia is very important to clinical treatment and to improved prognosis. Therefore, it is necessary to adapt and develop assessment tools for the differential diagnosis between pathological and normal aging processes. OBJECTIVE: Assess the psychometric properties and the factorial structure of a neuropsychological protocol used in geriatric assessment. METHOD: Subjects (n = 69) with heterogeneous cognitive complaints were assessed at the Geriatric and Gerontologic Clinic at the Clinical Hospital of the Federal University of Minas Gerais using a protocol composed of the Mini-Mental State Examination, Clock Drawing, Corsi Blocks, Verbal Fluency, Digit Span and Token Test. Statistical analyses included factorial analyses of test results, Pearson's correlation between obtained factor, age, years of formal education and Clinical Dementia Rating (CDR) and area under the ROC curve. RESULTS: The factorial analyses of test scores showed a general representative factor that had moderate and significant association with CDR (r = -0.672; p < 0.001) and years of formal education (r = 0.455; p < 0.001), respectively. This factor had weaker and less significant correlation with age (r = -0.282; p < 0.05). DISCUSSION: These results point to the protocol's good construct and criteria validity in assessing cognitive decline in the elderly. Future works concerning applicability and populational norms are needed to improve the clinical use of this assessment protocol.