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.

Executive function in children with and without developmental coordination disorder: A comparative study.

BACKGROUND: Children with motor impairments also show poor performance in some executive functions' components. However, there is no consensus on which specific executive subdomain is more impacted. AIM: The objective of this study was to compare executive functions in children with developmental coordination disorder (DCD), at risk for DCD (r-DCD), and in typically developing (TD) children. METHODS AND PROCEDURES: A sample of 397 children was assessed using the MABC-2. Two groups of children were identified; DCD (n = 63) and at r-DCD (n = 31). A third matched group of children with TD (n = 63) was formed. The MABC-2 checklist and the WASI tests were used as screening tools. Measures of executive function including verbal and nonverbal tasks for working memory, inhibitory control, and cognitive flexibility were tested. Multivariate analysis of variance followed by analyses of variance and Bonferroni tests were used to verify group effects on executive functions. RESULTS: A significant group effects were found for Working Memory, Λ = .78, F(4, 360) = 10.12, p ≤ .001, ηp2 = .12; Inhibitory Control, Λ = .59, F(16, 294) = 5.48, p ≤ .001, ηp2 = .23; and Cognitive Flexibility and Inhibitory Control, Λ = .60, F(22, 288) = 3.74, p ≤ .001, ηp2 = .22, with moderate effect sizes. The DCD group showed lower scores compared with the TD group on the visuospatial and verbal working memory; inhibitory control and in tasks of cognitive flexibility; the r-DCD group showed lower scores compared with the TD group for visuospatial working memory and for cognitive flexibility. CONCLUSIONS AND IMPLICATIONS: Poor performance in several measures of executive functions in children with DCD emphasized the need of motor/executive task-specific interventions. Furthermore, children at r-DCD showed low scores in several executive functions; therefore, preventive services should also be provided for this subclinical group.

Self-reported inhibition predicts history of suicide attempts in bipolar disorder and major depression.

BACKGROUND: Studies have reliably identified an association between suicide attempts and executive functions such as decision making (DM) and inhibitory control (IC) in patients with mood disorders. As such, the present study aimed to investigate the association between inhibition, DM, impulsivity and the history of suicide attempts in individuals with bipolar (BD) or major depressive disorder (MDD), identifying which assessment instruments may be most strongly associated with suicide in clinical samples. METHODS: The sample included 80 control subjects and two groups of patients with BD and MDD, matched by age and education (26 with a history of suicide attempts [MD+], and 26 with no such history [MD-]). Participants completed behavioral and self-report measures of DM and IC, which were compared between groups using ANCOVA, followed by logistic regression for patients with mood disorders only, and the presence or absence of a history of suicide as the outcome. RESULTS: Cognitive performance did not differ between groups. The MD+ group showed significantly higher motor and attentional impulsivity on the BIS-11 than the MD- and control groups. A regression analysis containing these scores showed that motor impulsivity was the only significant predictor of a history of suicide (OR = 1.14; 95%CI 1.00-1.30). CONCLUSIONS: Self-reported motor impulsivity was a significant predictor of suicide. These findings underscore the importance of self-report measures in neuropsychological assessment, and their contributions to the management and prognosis of patients with mood disorders. Lastly, they point to the role of impulsivity as a target for interventions and public policy on suicide prevention.

Longitudinal assessment of subcortical gray matter volume, cortical thickness, and white matter integrity in HIV-positive patients.

PURPOSE: To longitudinally evaluate the cortical thickness and deep gray matter structures volume, measured from T1 three-dimensional (3D) Gradient echo-weighted imaging, and white matter integrity, assessed from diffusion tensor imaging (DTI) of HIV-positive patients. MATERIALS AND METHODS: Twenty-one HIV-positive patients on stable highly active antiretroviral therapy (HAART) with CD4+ T lymphocytes count >200 cells/mL and viral load <50 copies/mL underwent two magnetic resonance imaging (MRI) scans with a median interval of 26.6 months. None of the patients had HIV-related dementia. T1 3D magnetization prepared rapid gradient echo-weighted imaging and DTI along 30 noncolinear directions were performed using a 1.5 Tesla MR scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of deep gray matter structures. For tract-based spatial statistics analysis, a white matter skeleton was created, and a permutation-based inference with 5000 permutations, with a threshold of P < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The median, radial, and axial diffusivities were also projected onto the mean FA skeleton. RESULTS: There were no significant differences in cortical thickness, deep gray matter structures volumes or diffusivity parameters between scans at the two time points (considering P < 0.05). CONCLUSION: No longitudinal differences in cortical thickness, deep gray matter volumes, or white matter integrity were observed in an HIV-positive population on stable HAART, with undetectable viral load and high CD4+ T lymphocytes count. J. Magn. Reson. Imaging 2016;44:1262-1269.

Evaluation of white matter integrity in systemic lupus erythematosus by diffusion tensor magnetic resonance imaging: a study using tract-based spatial statistics.

INTRODUCTION: The aim of this study was to evaluate the white matter integrity in brains of patients with systemic lupus erythematosus (SLE) using a voxel-based analyses of diffusion tensor imaging (DTI) data. METHODS: Fifty-seven patients with SLE were compared to 36 control patients who were matched by gender, age, education, and Mini Mental State Examination score. DTI was performed along 30 noncollinear directions in a 1.5 Tesla scanner. For tract-based spatial statistics (TBSS), a white matter skeleton was created, and a permutation-based inference with 5000 permutations and a threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The mean (MD), radial (RD), and axial diffusivities (AD) were also projected onto the mean FA skeleton. RESULTS: We found a significant decrease of global FA in SLE patients compared to controls. The areas of reduced FA included the right superior corona radiata, the right superior longitudinal fasciculus, the body of the corpus callosum, the right inferior fronto-occipital fasciculus, the right thalamic radiation, and the right uncinate fasciculus. Patients with SLE also had increased AD and RD in several areas. Substantial overlap of areas with increased AD and RD occurred and were spatially much more extensive than the areas of reduced FA. CONCLUSION: Significant increases of AD values were concordant to those of RD and MD and more extensive than FA changes. Analyzing all diffusivity parameters, using TBSS, can detect more white matter microstructural changes in patients with SLE than analyzing FA alone.

Diffusion tensor MR imaging of white matter integrity in HIV-positive patients with planning deficit.

INTRODUCTION: The aim of this study was to evaluate whether normal controls and human immunodeficiency virus (HIV) patients with and without planning deficits differ on white matter integrity. METHODS: A total of 34 HIV-positive patients with planning deficits were compared with 13 HIV-positive patients without planning deficits and 19 gender-, age-, and education-matched control subjects. Diffusion tensor imaging (DTI) was performed along 30 noncolinear directions in a 1.5-T scanner. For tract-based spatial statistics analysis, a white matter skeleton was created, and a permutation-based inference with 5000 permutations with a threshold of p < 0.05 was used to identify abnormalities in fractional anisotropy (FA). The median, radial, and axial diffusivities were also projected onto the mean FA skeleton. RESULTS: Compared with controls, HIV-positive patients with planning deficits had decreased FA in bilateral anterior thalamic radiations, bilateral inferior fronto-occiptal fasciculi, genu and splenium of the corpus callosum, bilateral superior longitudinal fascicule, and bilateral uncinate fasciculi. Compared to HIV-positive patients without planning deficits, patients with planning deficits had decreased FA in bilateral anterior thalamic radiations, bilateral inferior fronto-occiptal fasciculi, genu of the corpus callosum, bilateral superior longitudinal fascicule, and right uncinate fascicule. CONCLUSION: DTI can detect extensive white matter abnormalities in the normal-appearing white matter of HIV-positive patients with planning deficits compared with controls and HIV-positive patients without planning deficits.

Executive functions profiles in traumatic brain injury adults: Implications for rehabilitation studies.

PRIMARY OBJECTIVE: This study aimed to identify and characterize profiles of executive functions (EF) following traumatic brain injury (TBI). RESEARCH DESIGN: The sample was comprised of 84 adult outpatients with mild and moderate/severe TBI who were assessed by means of a battery of EF tasks. A Hierarchical Cluster analysis was performed with tasks Z-scores. Clusters were compared by means of ANOVA and Chi-square analyses. MAIN OUTCOMES AND RESULTS: Three clusters were characterized by deficits in: (1) inhibition, flexibility and focused attention; (2) inhibition, flexibility, working memory and focused attention; and (3) no expressive executive deficits. Clusters did not differ in clinical or demographical variables. CONCLUSIONS: The first cluster replicated findings of previous studies on TBI EF profiles. IT is suggested that TBI rehabilitation studies of EF must select participants by their EF profile rather than for clinical or demographical variables.

Childhood maltreatment and executive functions in adolescents.

BACKGROUND: The aim of this study was to investigate differences in executive functions between adolescents exposed to different forms of single- and multitype childhood maltreatment. METHOD: The sample was composed of 83 adolescents, divided into three groups: single-type maltreatment (n = 24), multitype maltreatment (n = 19), and no history of maltreatment (n = 40), matched for education and sex. RESULTS: The results showed that teenagers who suffered a single type of childhood maltreatment performed worse than the other two groups on tasks of cognitive flexibility and visual processing speed. Individuals who suffered multitype maltreatment had worse initiation and lower verbal processing speed than the other two groups. CONCLUSIONS: Childhood maltreatment may have a significant impact on executive functioning in adolescence.

False memories to emotional stimuli are not equally affected in right- and left-brain-damaged stroke patients.

Previous research has attributed to the right hemisphere (RH) a key role in eliciting false memories to visual emotional stimuli. These results have been explained in terms of two right-hemisphere properties: (i) that emotional stimuli are preferentially processed in the RH and (ii) that visual stimuli are represented more coarsely in the RH. According to this account, false emotional memories are preferentially produced in the RH because emotional stimuli are both more strongly and more diffusely activated during encoding, leaving a memory trace that can be erroneously reactivated by similar but unstudied emotional items at test. If this right-hemisphere hypothesis is correct, then RH damage should result in a reduction in false memories to emotional stimuli relative to left-hemisphere lesions. To investigate this possibility, groups of right-brain-damaged (RBD, N=15), left-brain-damaged (LBD, N=15) and healthy (HC, N=30) participants took part in a recognition memory experiment with emotional (negative and positive) and non-emotional pictures. False memories were operationalized as incorrect responses to unstudied pictures that were similar to studied ones. Both RBD and LBD participants showed similar reductions in false memories for negative pictures relative to controls. For positive pictures, however, false memories were reduced only in RBD patients. The results provide only partial support for the right-hemisphere hypothesis and suggest that inter-hemispheric cooperation models may be necessary to fully account for false emotional memories.

Impaired decision-making after traumatic brain injury: the Iowa Gambling Task.

SUMMARY: The aim of the present study was to use the Iowa Gambling Task (IGT) to investigate differences in decision-making (DM) between patients who sustained TBI and healthy subjects, while controlling for age, education and gender. METHODS: A hundred and ten participants, half of whom had severe or mild TBI, completed the IGT. RESULTS: Differences between control participants and patients with TBI were found regarding total net score, block score, number of selections from each deck and classification of performance as impaired or unimpaired. No significant differences in IGT performance were found between patients with and without frontal lesions and between patients with mild and severe TBI. CONCLUSIONS: Results indicate poor DM on the IGT in patients with TBI, regardless of lesion location and severity. The instrument proved to be equally sensitive to both frontal and extrafrontal lesions and did not differentiate between patients with mild and severe TBI.

Cross-cultural linguistic adaptation and development of three alternate forms of the Free and Cued Selective Reminding Test to the Brazilian context: The role of word familiarity.

In spite of its importance, studies presenting detailed development procedures of alternate forms of verbal memory paradigms remains limited and unclear in terms of word selection criteria, while failing to consider word familiarity factors, despite its crucial role on episodic memory retrieval and encoding mechanisms. The present study aims to present the cross-cultural linguistic adaptation and development procedures of alternate forms of the Free and Cued Selective Reminding Test to the Brazilian context (FCSRT) based on word familiarity. After translation and backtranslation procedures, 231 new words were gathered and underwent a step-by-step familiarity analysis. Initially, overall familiarity feel of each word was assessed through the Familiarity Form (FF) during phase 1, and exposure frequency to words were later assessed through the Familiarity Questionnaire (FQ) completed by healthy controls during phase 2 with the remaining words considered ambiguous in terms of familiarity. Three alternate forms of the FCRST were then developed and assessed in terms of familiarity by the FQ during phase 3, and later administered in healthy control groups during phase 4. Repeated measures analysis revealed no significant differences in terms of familiarity and memory performance among the developed forms. Limitations are discussed, and recommendations are offered for future studies.

A new neuropsychological tool for simultaneous reading and executive functions assessment: initial psychometric properties.

Introduction: The development of reading and complex executive functions is fundamental for achieving social, academic, and professional success. So far, there is no single neuropsychological instrument that comprehensively assesses the domains of inhibitory control, cognitive flexibility, working memory, and reading comprehension. To assess executive functions related to reading, the "Assessment of Reading and Executive Functions" (AREF) was developed. In this study, we show initial evidence of validity and reliability for four subtests - Graphophonological-Semantic Flexibility, Inhibitory Control, Flexibility, and Working Memory. Methods: A total of 93 students from 4th to 9th grade, aged 8-14, in public (n = 61) and private (n = 32) schools were evaluated. Tasks from the AREF instrument, as well as measures of reading comprehension, inhibitory control, cognitive flexibility, working memory, and intelligence, were administered. Correlations between AREF scores and the other measures were performed to assess external construct validity. Performance differences between school groups on AREF subtests were analyzed using ANOVA, t-test, and Mann-Whitney tests, and the internal consistency of the instrument's tasks was evaluated using Cronbach's alpha coefficient. Results: The scores of the AREF subtests demonstrated significant positive correlations with reading measures (ranging from 0.339 to 0.367) and executive functions (ranging from 0.209 to 0.396). Significant differences were found in the performance of some AREF tasks when comparing individuals from public and private schools, as well as between 4th and 5th graders compared to students in higher grades. The internal consistency of the tasks was low for Graphophonological-Semantic Flexibility (Cronbach's α = 0.566), moderate for Inhibitory Control and Flexibility (Cronbach's α = 0.768), and high for Working Memory (Cronbach's α = 0.881). Discussion: The results provide initial evidence of construct validity and reliability for the AREF subtests. It is expected that this new neuropsychological test will contribute to the assessment of reading skills and executive functions, assisting in guiding clinical and educational interventions for individuals with and without neurodevelopmental disorders.

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.

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.

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.

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.

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.

Communicative clusters after a right-hemisphere stroke: are there universal clinical profiles?.

OBJECTIVE: The current research aimed at classifying communication profiles among right-brain-damaged adults with an intercultural perspective, and so begins to fill in a long-standing gap in the literature. METHOD: The sample was made up of 112 right-brain-damaged individuals from three nationalities (Canadians, Brazilians and Argentineans). They were assessed using 13 language tasks from the Protocol MEC in Spanish, Brazilian Portuguese and French. RESULTS: A hierarchical cluster analysis led to four distinct clinical profiles of communication. Since only a few distinctions between nationalities were observed, the results suggest that there probably is a partial universality of clinical profiles of communication impairments after a right brain damage. CONCLUSIONS: This study proposes a preliminary taxonomy of communication disorders among right-brain-damaged individuals with cross-cultural implications. The exploration of associated stroke sites and neuropsychological concomitant deficits would contribute to the eventual development of a more accurate clinical intervention.

Comparison of neuropsychological performance between students from public and private Brazilian schools.

Neuropsychological assessment reveals that certain cognitive changes that take place during the neural development process may be associated with biopsychosocial issues. A substantial body of research has focused on cognitive development in children and adults, but few such studies have been carried out on adolescents. Therefore, research into the processing of neuropsychological functions in adolescents, taking into account the role of major socio-cultural factors such as school type (public vs. private), is highly relevant. The present study sought to assess whether differences in neuropsychological development exist between adolescent students of public (government-funded) and private schools. A total of 373 grade-matched students between the ages of 12 and 18, 190 from public schools and 183 from private schools, took part in the study. All subjects had no self-reported neurologic or psychiatric conditions and sensory disorders. The NEUPSILIN Brazilian Brief Neuropsychological Assessment Battery was administered to this sample. Comparison of mean scores (one-way ANCOVA with socioeconomic score and age as covariates) showed that adolescents attending private schools generally outperformed their public-school peers in tasks involving sustained attention, memory (working and visual), dictated writing, and constructional and reflective abilities. We conclude that school type should be taken into account during standardization of neuropsychological assessment instruments for adolescent and, probably, child populations.

The effect of age on decision making according to the Iowa gambling task.

Aging has been associated with several brain changes that often affect the cognitive functioning of adults, but changes in executive functions, particularly in the field of decision making, have not been fully investigated. The Iowa Gambling Task (IGT) is a widely used tool to evaluate decision making, but little is known about the effect of age on its results. This study used the IGT and compared healthy young (n = 40) and elderly (n = 40) adults to evaluate their decision making processes. There were significant differences in the learning curve of the two age groups, but no difference in overall IGT performance. The results for the first IGT block were different from those of the rest of the task, and the group of elderly adults had a better performance in this block. Elderly adults also showed a preference for deck A, the one that resulted in greater losses. Findings confirmed the results of other studies, which reported that the IGT block score is the variable with the greatest sensitivity to age in this instrument.