Emylucy Martins Paiva Paradela

Validação da escala de depressão geriátrica em um ambulatório geral

OBJECTIVE The Geriatric Depression Scale for screening depressive symptoms in the elderly has not been assessed in elderly outpatients who seek primary health care in Brazil. The objective was to determine the validity of the Short Scale for Major Depressive Episode or Dysthymia (GDS-15) in elderly outpatients. METHODS The scale was applied in 302 subjects with 65 years and older and then examined by an independent geriatrician, blinded to the results. Major depression and dysthymia were diagnosed using the Diagnostic and Statistical Manual of Mental Disorders-IV criteria. Sensitivity and specificity were calculated at several cutoff values and a Receiver Operating Characteristic curve was plotted. RESULTS The best equilibrium was at the cutoff value of 5/6 showing 81% sensitivity and 71% specificity; the area under the Receiver Operating Characteristic curve was 0.85 (95% CI: 0.79-0.91). CONCLUSIONS The GDS-15 can be used for screening depressive symptoms in Brazilian elderly outpatients. The previously suggested cutoff value of 5/6 is adequate.OBJETIVO: A Escala de Depressao Geriatrica, utilizada para o rastreamento de sintomas depressivos em idosos, ainda nao teve suas caracteristicas de medida avaliadas em ambulatorios gerais no Brasil. O objetivo foi estudar a validade da Escala, com 15 itens (EDG-15), na identificacao de episodio de Depressao Maior ou Distimia em idosos atendidos em ambulatorio geral. METODOS: A Escala foi aplicada em 302 individuos com 65 anos ou mais, que em seguida foram examinados, de maneira independente, por um geriatra que nao tinha conhecimento dos resultados da Escala. Os diagnosticos de Depressao Maior ou Distimia foram feitos utilizando-se os criterios do Diagnostic and Statistical Manual of Mental Disorders-IV. A sensibilidade e a especificidade nos varios pontos de corte foram expressas pela curva Receiver Operating Characteristic. RESULTADOS: O ponto de corte de melhor equilibrio foi 5/6, obteve sensibilidade de 81% e especificidade de 71%; e o valor da area sob a curva Receiver Operating Characteristic foi de 0,85 (IC 95%: 0,79-0,91). CONCLUSOES: A Escala de Depressao Geriatrica pode ser utilizada para o rastreamento de sintomas depressivos na populacao geriatrica ambulatorial brasileira. O ponto de corte 5/6, sugerido inicialmente por outros autores, mostrou-se adequado.

Normative data for healthy elderly on the phonemic verbal fluency task - FAS

Phonemic verbal fluency tests assess the production of words beginning with specific letters. Of these letters, the most frequently used are F, A and S. It is a sensitive test for assessing frontal lobe functions. Objective To provide normative data for the elderly Brazilian population on the FAS test and to investigate the effects of age and schooling on test performance. Methods The individuals were divided into three age groups (60–69, 70–79 and =80 years), and into four groups according to education (1–3, 4–7, 8–11 and 12 years). All subjects were assessed by the Mini Mental State Examination and the FAS. Data were analyzed with Student’s t test, ANOVA, simple linear regression and Spearman’s correlation. Results We evaluated 345 cognitively healthy volunteers, 66.66% being female, aged 60 to 93 years, with an educational level ranging from one to 24 years. The average (number of items) ±SD for the whole sample was 28.28±11.53. No significant effect of gender was observed (p=0.5). Performance on the MMSE and education exerted a direct influence on FAS scores (p<0.001), with education being the most significant factor. A positive correlation was found between FAS and the MMSE (r=0.404; p<0.001). Conclusion The performance of Brazilian elderly on the phonemic verbal fluency tests-FAS is significantly influenced by education, where individuals with higher educational level present better performance than those with fewer years of schooling. Age and gender did not prove significant with the FAS.

Age and educational level effects on the performance of normal elderly on category verbal fluency tasks

Cognitive decline, particularly executive dysfunction, is observed in normal aging. In Brazil, the elderly population presents broad educational diversity. Category verbal fluency tests are frequently used to detect cognitive impairment, assessing executive function, language and semantic memory. Objective To investigate the effects of age and education on category animal fluency task (CAF) in healthy elderly. Methods We evaluated 319 healthy elderly from outpatient care units of two university reference centers of Rio de Janeiro and São Paulo. The sample was divided into two age, and five schooling subgroups. To be included participants had to demonstrate preservation of global cognitive functioning, independence for activities of daily living and not fulfill diagnostic criteria for dementia. All participants were submitted to neurological and neuropsychological evaluations. Results There was a correlation between age and CAF performance (r= –0.26, p<0.01), which was not confirmed when years of education were included as a covariant in univariate ANCOVA. Significant differences were found in CAF performance among the different educational level groups on correlation analysis (r=0.42, p<0.01) and ANCOVA analysis (F=18.8, p<0.05). Illiteracy was associated with worst CAF performance, while university level was associated with best performance. Conclusion The best CAF performance was found in the first years of schooling (literacy learning process) compared to illiteracy, and when finishing high school and starting university courses compared to all other educational levels. These stages are associated with significant gains in semantic memory and executive function which are critical for verbal fluency performance.

Relationship between activities of daily living and cognitive ability in a sample of older adults with heterogeneous educational level

Introduction: A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level. Objectives: The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults — with and without dementia — from a middle-income country. Sample: The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro. Results: Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors. Conclusions: These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.

Is the Cambridge Cognitive Examination – Revised a good tool for detection of dementia in illiterate Brazilian older adults?

Few studies have been published on the use of the Cambridge Cognitive Examination Test – Revised (CAMCOG‐R) for cognitive assessment of low educational level older adults. The aim of the present study was to determine the accuracy of the Brazilian version of the CAMCOG‐R (Br‐CAMCOG‐R) within a sample of low educational level and illiterate older adults.

Cross-cultural adaptation of the Western Aphasia Battery - Revised screening test to Brazilian Portuguese: a preliminary study

PURPOSE To assess the auditory perceptual performance of children in a task of identification of vowel contrasts, to classify which phonemes and vowel contrasts provide higher or lower degrees of difficulty, and to verify the influence of age in this performance. METHODS Data recordings of auditory perceptual performance of 66 children in a task of identification using the software Perception Evaluation Auditive & Visuelle (PERCEVAL) were selected from a database. The task consisted of presenting sound stimuli through headphones to children, who would then choose, from two pictures arranged on the computer screen, the one corresponding to the word they heard. The time between auditory inputs and the childs reaction was automatically computed in the software. RESULTS The perceptual accuracy was 88% and we found a positive correlation with the variable age. The time of response was significantly longer for incorrect answers as opposed to correct answers (p=0.00). Different degrees of similarity in auditory perception were observed, where front vowels were similar more often than back vowels. The tendency for errors was prevalent in the range of non-peripheral to peripheral vowels, which suggests that the latter may serve as a reference or perceptual anchor. CONCLUSION The auditory perceptual ability concerning the identification of vowel contrasts is not yet established in the age group studied. The auditory perception of vowel contrasts occurs gradually and asymmetrically, as the order of acquisition in terms of production and perception was not always the same.PURPOSE The purpose of this study was to translate and cross-culturally adapt the Western Aphasia Battery - Revised (WAB-R) screening test, thus contributing to future applications of the instrument with Brazilian adults. METHODS The adaptation was based on a universalist perspective. The steps for conceptual, item, semantic and operational equivalence were strictly followed, resulting in a short version used in the pretest. The study participants were 30 individuals, between 18 to 89 years old; all were Brazilian speakers, with Portuguese as their first language. However, only 28 volunteers met the criteria for inclusion in the study. Two participants were excluded because they had low scores on the mini-mental state examination and were referred to geriatric assessment. RESULTS The short version of the WAB-R screening test, used in the pretest, allowed us to observe the behavior and language of the individuals during interactions, to collect impressions of overall communication, and to quantify communication ability by calculating the aphasia quotient and the language quotient, according to parameters of the original instrument. CONCLUSION When adapting an instrument, it is important to maintain its original characteristics. However, the properties of measurement may not be in accordance with the psychometric properties of Brazilian culture. Therefore, we propose further analyses of the reliability and validation of the instrument in question in Brazil, which will occur by means of measurement and functional equivalence.

The CAMCOG for patients with Alzheimer's disease with low levels of education.

We would like to congratulate Aprahamian et al . (2011) for their initiative to investigate the psychometric properties of the Cambridge Cognition Examination (CAMCOG) in assessing the cognitive status of the Brazilian elderly. This instrument is very frequently used in Brazil, but its measure characteristics have not yet been fully determined. Of course, cross-cultural adaptation and validation are rarely a simple procedure, often demanding a research program to completely adapt the tool to the specific language, culture, and selected population. In our opinion, the paper “Can the CAMCOG be a good cognitive test for patients with Alzheimers disease with low levels of education?” (Aprahamian et al ., 2011) is welcome as another trial by Brazilian scientists in this ongoing process. Notwithstanding, we believe that some comments about the methodological aspects of the paper are in order.