Decision-making profile in older adults: the influence of cognitive impairment, premorbid intelligence and depressive symptoms.

OBJECTIVE: Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment. DESIGN: Cross-sectional analysis of a cohort study on cognitive aging. PARTICIPANTS: 143 older adults. SETTING: University-based memory clinic. METHODS: Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles. RESULTS: The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007). CONCLUSION: Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.

Development of a word accentuation test for predicting cognitive performance in Portuguese-speaking populations.

The Word Accentuation Test (WAT) has been used to predict premorbid intelligence and cognitive performance in Spanish-speaking populations. It requires participants to read a list of words without the accent marks that indicate the stressed syllable. Label="OBJECTIVE">As Portuguese pronunciation is also strongly based on accent marks, our aim was to develop a Brazilian version of the WAT. METHODS An initial pool of 60 items was constructed and a final version of 40 items (named WAT-Br) was derived by item response theory. A sample of 206 older adults underwent the WAT-Br and a standardized neuropsychological battery. Independent ratings were performed by two observers in 58 random participants. RESULTS The items showed moderate to high discrimination (α between 0.93 and 25.04) and spanned a wide range of difficulty (ß between -2.07 and 1.40). The WAT-Br was shown to have an excellent internal consistency (Kuder-Richardson Formula 20 = 0.95) and inter-rater reliability (intraclass correlation coefficient = 0.92). It accounted for 61% of the variance in global cognitive performance. CONCLUSION A version of the WAT for Portuguese-speaking populations was developed and proved to be a valuable tool for estimating cognitive performance.

Development of a word accentuation test for predicting cognitive performance in Portuguese-speaking populations / Desenvolvimento de um teste de acentuação de palavras em português para predição de desempenho cognitivo

ABSTRACT The Word Accentuation Test (WAT) has been used to predict premorbid intelligence and cognitive performance in Spanish-speaking populations. It requires participants to read a list of words without the accent marks that indicate the stressed syllable. Objective: As Portuguese pronunciation is also strongly based on accent marks, our aim was to develop a Brazilian version of the WAT. Methods: An initial pool of 60 items was constructed and a final version of 40 items (named WAT-Br) was derived by item response theory. A sample of 206 older adults underwent the WAT-Br and a standardized neuropsychological battery. Independent ratings were performed by two observers in 58 random participants. Results: The items showed moderate to high discrimination (α between 0.93 and 25.04) and spanned a wide range of difficulty (β between −2.07 and 1.40). The WAT-Br was shown to have an excellent internal consistency (Kuder-Richardson Formula 20 = 0.95) and inter-rater reliability (intraclass correlation coefficient = 0.92). It accounted for 61% of the variance in global cognitive performance. Conclusion: A version of the WAT for Portuguese-speaking populations was developed and proved to be a valuable tool for estimating cognitive performance.

RESUMO O Teste de Acentuação de Palavras (TAP) tem sido utilizado para predizer inteligência pré-mórbida e desempenho cognitivo em populações de língua espanhola. Requer que os sujeitos leiam uma lista de palavras sem os sinais gráficos de acentuação que indicam a sílaba tônica. Objetivo: Como a pronúncia da língua portuguesa também é fortemente baseada em acentos gráficos, nosso objetivo foi desenvolver uma versão brasileira do TAP. Métodos: Um conjunto inicial de 60 itens foi construído e uma versão final de 40 itens (denominada TAP-Br) foi derivada por teoria da resposta ao item. Uma amostra de 206 idosos foi submetida ao TAP-Br e a uma bateria neuropsicológica padronizada. Registros de pontuação independentes foram realizados por dois observadores em uma subamostra de 58 participantes aleatórios. Resultados: Os itens apresentaram moderada a alta discriminação (α entre 0,93 e 25,04) e abrangeram uma ampla gama de dificuldades (β entre −2,07 e 1,40). O TAP-Br apresentou excelente consistência interna (Fórmula de Kuder-Richardson 20 = 0,95) e confiabilidade inter-examinador (Coeficiente de Correlação Intraclasse = 0,92). O escore do TAP-Br explicou 61% da variância do desempenho cognitivo global. Conclusão: Uma versão do TAP para as populações de língua portuguesa foi desenvolvida e mostrou-se uma ferramenta útil para estimar desempenho cognitivo.