Caroline de Oliveira Cardoso

Estudo de fidedignidade do instrumento neuropsicológico Iowa Gambling Task

OBJECTIVE: This study aimed at evaluating reliability evidence of neuropsychological instrument Iowa Gambling Task (IGT) by the means of the test-retest method. METHOD: The sample was comprised of 50 healthy subjects, 19-75 years of age, with at least five years of formal education. The assessment was done individually, in two meetings with an interval from 1 to 6 months between test and retest. RESULTS: The findings showed a significant moderate positive correlation between test-retest in the overall calculation. In the analysis by segments, a significant moderate positive correlation was found for blocks 4 and 5, whereas there were no significant correlations for blocks 1, 2 and 3. CONCLUSION: These data corroborate recent studies that found moderate correlations between test-retest measures of executive functions, and suggest that the IGT can be used to assess decision making over time if specific analyses are taken into account.

Brazilian preliminary norms and investigation of age and education effects on the Modified Wisconsin Card Sorting Test, Stroop Color and Word test and Digit Span test in adults

Executive functions are involved in a series of human neurological and psychiatric disorders. For this reason, appropriate assessment tools with age and education adjusted norms for symptom diagnosis are necessary. Objective To present normative data for adults (19-75 year-olds; with five years of education or more) on the Modified Wisconsin Card Sorting Test (MWCST), Stroop color and word test and Digit Span test. Age and education effects were investigated. Methods Three samples were formed after inclusion criteria and data analysis: MWCST (n=124); Digit Span (n=123), and Stroop test (n=158). Groups were divided into young (19-39), middle-aged (40-59) and older (60-75) participants with five to eight years of education and nine years of education or more. Two-way ANOVA and ANCOVA analyses were used. Results Education effects were found in most variables of the three tasks. An age effect was only found on color naming and color-word naming speed from the Stroop test. No interactions were detected. Conclusion In countries with heterogeneous educational backgrounds, the use of stratified norms by education to assess at least some components of executive functions is essential for an ethical and accurate cognitive diagnosis.

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

Abstract 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.

The impact of frontal and cerebellar lesions on decision making: evidence from the Iowa Gambling Task

Although the frontal lobes have traditionally been considered the neural substrates of executive functioning (EF), recent studies have suggested that other structures, such as the cerebellum, may be associated with these abilities. The role of the cerebellum has only been sparsely investigated in connection with decision making (DM), an important component of EF, and the few results obtained on this front have been inconclusive. The current study sought to investigate the role of the cerebellum in DM by comparing the performance of patients with cerebellar strokes, frontal-damaged patients, and a healthy control group on the Iowa Gambling Task (IGT). A total of nine cerebellar-damaged adults participated in the study, as well as nine individuals with frontal strokes and 18 control individuals. Patients were administered a version of the IGT adapted to the population of Southern Brazil. There was a marginal difference in mean IGT net scores between the two clinical groups, although both displayed impaired performance as compared to the control group. Overall, the DM ability of patients with cerebellar damage proved to be more preserved than that of individuals with frontal lobe strokes, but less preserved than that of the control group. These data suggested that, while the frontal lobes may be the most important brain structures for DM, the cerebellum might also play an active role in this cognitive function. Future studies assessing participants with lesions in different cerebellar regions and hemispheres will prove invaluable for the understanding of the neural structures involved in DM, and make significant contributions to the globalist-localizationist debate in DM neuroscience.

Neuropsychological stimulation of executive functions in children with typical development: A systematic review

ABSTRACT This systematic review aimed to characterize empirical studies on neuropsychological interventions to stimulate executive functions in children with typical development. Searches were conducted according to the PRISMA method. Nineteen (19) studies on the analysis to evaluate the effectiveness of intervention programs in pre-school and school children were obtained. There was a predominance of studies that used computerized cognitive training, most of them involving the stimulation of working memory. Others used pen and paper forms, or hybrid tasks, and some programs used a school curriculum approach aiming to improve self-regulation. Results provide preliminary evidence on the effectiveness of such on the executive performance in children with typical development. Each executive component, as well as each type of intervention has its peculiarities. Computerized trainings and pen and paper tasks tend to improve the targeted executive functions, but transfer effects are still inconsistent. Regarding the effects of programs using school curriculum approach, they seem to be more generalizable, with functionality gains accomplishing mainly socio-emotional regulation. Multimodal approaches may be even more effective. Follow-up studies should be targeted in order to track the maintenance of direct and transfer effects regarding mainly cognitive and social development associated to school achievement.

The Predictive Impact of Biological and Sociocultural Factors on Executive Processing: The Role of Age, Education, and Frequency of Reading and Writing Habits

Although the impact of education and age on executive functions (EF) has been widely studied, the influence of daily cognitive stimulation on EF has not been sufficiently investigated. Therefore, the aim of the present study was to evaluate whether the age, education, and frequency of reading and writing habits (FRWH) of healthy adults could predict their performance on measures of inhibition and cognitive flexibility. Inhibition speed, inhibitory control, and set shifting were assessed using speed, accuracy, and discrepancy scores on the Trail-Making Test (TMT) and Hayling Test. Demographic characteristics and the FRWH were assessed using specialized questionnaires. Regression analyses showed that age and the FRWH predicted speed and accuracy on the TMT. The FRWH predicted both speed and accuracy on the Hayling Test, for which speed and accuracy scores were also partly explained by age and education, respectively. Surprisingly, only the FRWH was associated with Hayling Test discrepancy scores, considered one of the purest EF measures. This highlights the importance of regular cognitive stimulation over the number of years of formal education on EF tasks. Further studies are required to investigate the role of the FRWH so as to better comprehend its relationship with EF and general cognition.

Tomada de decisão em dependentes de crack: um estudo com o Iowa Gambling Task

Decision making in addiction to crack: a study with the Iowa Gambling Task. This study investigated how decision-making process occurs in crack dependents through the Iowa Gambling Task (IGT). 30 participants were selected to crack dependent group – GDC, and 15 non-users controls - GNU, from both sexes. We used the Cocaine Craving Questionnaire-Brief to assess the craving intensity. There were significant differences between groups both in the total-calculus score and in the blocks scores. The learning curve of the GDC was constant and negative during almost all game, except in the very ending when a suggestion of learning was observed. Regarding the task performance’s classification, the analysis showed that a significant number of controls participants achieved a non-impaired performance, opposed to GDC performance. The differences between groups investigated in the IGT corroborate with a previous study finding, about a worse decisionmaking process associated with cocaine and crack addiction.

Brazilian adaptation of the Hotel Task. A tool for the ecological assessment of executive functions

Over recent years, neuropsychological research has been increasingly concerned with the need to develop more ecologically valid instruments for the assessment of executive functions. The Hotel Task is one of the most widely used ecological measures of executive functioning, and provides an assessment of planning, organization, self-monitoring and cognitive flexibility. Objective The goal of this study was to adapt the Hotel Task for use in the Brazilian population. Methods The sample comprised 27 participants (three translators, six expert judges, seven healthy adults, ten patients with traumatic brain injuries and one hotel manager). The adaptation process consisted of five steps, which were repeated until a satisfactory version of the task was produced. The steps were as follows: (1) Translation; (2) Development of new stimuli and brainstorming among the authors; (3) Analysis by expert judges; (4) Pilot studies; (5) Assessment by an expert in business administration and hotel management. Results The adapted version proved adequate and valid for the assessment of executive functions. However, further research must be conducted to obtain evidence of the reliability, as well as the construct and criterion validity, sensitivity and specificity, of the Hotel Task. Conclusion Many neurological and/or psychiatric populations may benefit from the adapted task, since it may make significant contributions to the assessment of dysexecutive syndromes and their impact on patient functioning.

Contributions of the ecological approach to the neuropsychology of executive functions

Neurocognitive assessment involves several different types of processes, techniques and instruments. Traditionally, clinical and/or standardized methods have been the most extensively used in neuropsychological research and clinical practice. Ecological instruments are characterized by the standardized administration of tasks with similar cognitive demands to those observed in everyday situations. Although executive functions are often required in daily living tasks, the lack of a consensus as to their theoretical defi nition has posed several hurdles to their assessment and rehabilitation. The aim of this paper was to present the contributions of an ecological neuropsychological approach to assessment, rehabilitation, and neuroimaging, while discussing the theoretical implications of these processes on the neuropsychology of executive functions. This was achieved through a non-systematic review of classical and contemporary literature on ecological assessment tools. The use of an ecological approach has contributed to the understanding and assessment of functional impairment, as well as to the development of rehabilitation programs focusing on practical daily living activities, allowing for a clearer understanding of the neural correlates of complex environmental and individual factors, and for a more thorough reassessment of the validity of theoretical models of executive functions .

Tomada de decisão no IGT: estudo de caso pós-AVC de hemisfério direito versus esquerdo

This study aimed at conducting a comparative investigation of the decision-making process of two post-unilateral CVA adults as well as verifying the role of hemispheric laterality in the performance of Iowa Gambling Task (IGT). One adult with right hemisphere damage (RHD) and another with left hemisphere damage (LHD), both following a subcortical ischemic post-CVA. The IGT was used to evaluate the decision making. Patients had appropriate performance on the IGT suggesting a general good ability to make decisions. However, only the patient with LHD presented signs of ascendant learning curve. Conclusion: These data indicate that a subcortical lesion independent of the hemisphere may not influence on the IGT performance. It is suggested that comparative studies of groups should be conducted in order to compare patients with frontal and non-frontal lesions, helping to characterize the decision-making process in population with unilateral vascular damage.