Gigiane Gindri

Pragmatic and executive functions in traumatic brain injury and right brain damage: An exploratory comparative study

Objective To describe the frequency of pragmatic and executive deficits in right brain damaged (RBD) and in traumatic brain injury (TBI) patients, and to verify possible dissociations between pragmatic and executive functions in these two groups. Methods The sample comprised 7 cases of TBI and 7 cases of RBD. All participants were assessed by means of tasks from the Montreal Communication Evaluation Battery and executive functions tests including the Trail Making Test, Hayling Test, Wisconsin Card Sorting Test, semantic and phonemic verbal fluency tasks, and working memory tasks from the Brazilian Brief Neuropsychological Assessment Battery NEUPSILIN. Z-score was calculated and a descriptive analysis of frequency of deficits (Z< -1.5) was carried out. Results RBD patients presented with deficits predominantly on conversational and narrative discursive tasks, while TBI patients showed a wider spread pattern of pragmatic deficits. Regarding EF, RBD deficits included predominantly working memory and verbal initiation impairment. On the other hand, TBI individuals again exhibited a general profile of executive dysfunction, affecting mainly working memory, initiation, inhibition, planning and switching. Pragmatic and executive deficits were generally associated upon comparisons of RBD patients and TBI cases, except for two simple dissociations: two post-TBI cases showed executive deficits in the absence of pragmatic deficits. Discussion Pragmatic and executive deficits can be very frequent following TBI or vascular RBD. There seems to be an association between these abilities, indicating that although they can co-occur, a cause-consequence relationship cannot be the only hypothesis.

Depressive signs and cognitive performance in patients with a right hemisphere stroke

PURPOSE This study investigated the influence of suggestive signs of depression (SSD) in right-hemisphere brain-damaged (RHD) patients following a stroke on their cognitive performance measured by a brief neuropsychological assessment battery. METHODS Forty-two adults with RHD after a single episode of stroke and 84 matched controls participated in this study. They were assessed by means of the Geriatric Depression Scale and by Brief Neuropsychological Assessment Battery NEUPSILIN. RESULTS Almost half of the patients showed SSD. The RHD group with SSD (RHD+) showed poorer performance in at least one task among all evaluated cognitive domains (concentrated attention, visual perception, working memory, episodic verbal memory and semantic memory, auditory and written language, constructional praxia and verbal fluency). CONCLUSION The association of depression and RHD seems to enhance the occurrence and the severity of cognitive déficits. A brief neuropsychological assessment can be useful to identify cognitive impairment caused by this neuropsychiatric disorder.

Alterações de linguagem em pacientes idosos portadores de demência avaliados com a Bateria MAC

OBJETIVO: Identificar as alteracoes de linguagem em um grupo de pacientes idosos portadores de demencia nas tarefas de evocacao lexical livre, com criterio ortografico e com criterio semântico, interpretacao de metaforas e discurso narrativo da Bateria Montreal de Avaliacao da Comunicacao - Bateria MAC, bem como, verificar a frequencia de deficits. METODOS: Participaram do estudo 13 pacientes com demencia de grau leve a moderada, atendidos no Setor de Neurologia do Ambulatorio de Disturbios do Movimento e Demencias do Hospital Santa Clara da Irmandade Santa Casa de Misericordia de Porto Alegre (ISCMPA). O instrumento neuropsicologico de avaliacao foi a Bateria MAC e a aplicacao das tarefas seguiu a seguinte ordem: evocacao lexical livre, evocacao lexical com criterio ortografico, evocacao lexical com criterio semântico, interpretacao de metaforas e discurso narrativo. RESULTADOS: O grupo de pacientes com demencia apresentou desempenho deficitario em todas as tarefas da Bateria MAC que foram avaliadas, com diferenca significativa. Alem disso, os participantes apresentaram maior frequencia de deficits, em ordem decrescente, nas tarefas de reconto parcial do discurso narrativo (informacoes essenciais e presentes), seguidas pelas tarefas de evocacao lexical com criterio ortografico e com criterio semântico, e reconto integral do discurso narrativo. Pelo menos dois pacientes apresentaram alteracoes de desempenho em alguma das cinco tarefas realizadas da Bateria MAC. CONCLUSAO: A avaliacao de linguagem atraves da Bateria MAC permitiu a verificacao de alteracoes do processamento linguistico em idosos com demencia, o que caracteriza que tal instrumento tambem e aplicavel para esta populacao clinica.

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.

Rehabilitation of lexical and semantic communicative impairments: An overview of available approaches

Lexical-semantic impairments are common consequences of acquired neurological damage. However, little is known about the benefits of existing treatment methods for this type of language impairment. Objective To evaluate current research into lexical-semantic interventions for adults with dementia, TBI or stroke. Methods The PubMed, PsycInfo and SCOPUS databases were searched for studies related to rehabilitation, neurological conditions, communicative and lexical-semantic skills published between 2004 and 2014. Results Twenty-eight of the 453 abstracts found were selected for the review based on the PRISMA method. Most of the studies described treatments for anomia. Semantic tasks were the most commonly used, followed by phonological and gestural strategies. Interventions were individual and involved formal tasks, although the number, frequency and duration of sessions varied between studies. Conclusion Although lexical-semantic interventions lead to improvements in language abilities, they are still poorly described in the literature, and must be further investigated in terms of their efficacy, effectiveness and long-term effects.

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.

Relationship between the Brazilian version of the Montreal-Toulouse language assessment battery and education, age and reading and writing characteristics. A cross-sectional study

CONTEXT AND OBJECTIVE There is growing concern about understanding how sociodemographic variables may interfere with cognitive functioning, especially with regard to language. This study aimed to investigate the relationship between performance in the Brazilian version of the Montreal-Toulouse language assessment battery (MTL-BR) and education, age and frequency of reading and writing habits (FRWH). DESIGN AND SETTING Cross-sectional study conducted in university and work environments in Rio Grande do Sul, Brazil. METHOD The MTL-BR was administered to a group of 233 healthy adults, aged 19 to 75 years (mean = 45.04, standard deviation, SD = 15.47), with at least five years of formal education (mean = 11.47, SD = 4.77). RESULTS A stepwise multiple linear regression model showed that, for most tasks, the number of years of education, age and FRWH were better predictors of performance when analyzed together rather than separately. In separate analysis, education was the best predictor of performance in language tasks, especially those involving reading and writing abilities. CONCLUSION The results suggested that the number of years of education, age and FRWH seem to influence performance in the MTL-BR, especially education. These data are important for making diagnoses of greater precision among patients suffering from brain injuries, with the aim of avoiding false positives.

Reabilitação de déficits comunicativos pós-acidente vascular cerebral

Discursive, lexical-semantic, pragmatic-inferential and/or prosodic communication processing may be impaired following a cerebrovascular accident. These deficits require intervention methods and programmes for effective communication rehabilitation. Within this context, the aim of this systematic review was to identify and describe methods used for neuropsychological rehabilitation of the communication of adults after a stroke, more specifically, systematic intervention approaches for each communication processing. Abstracts published in the last ten years were selected in PubMed, using keywords related to rehabilitation, stroke and communication. For the communication topic, we also used specific keywords related to the four communication processing components. Initially, 914 abstracts were found; after exclusion of the repeated studies, 460 were analyzed. Full texts were examined if the abstract evidenced that the study was empirical, included at least one post-stroke patient, focused in communication rehabilitation, presented pre- and post-intervention assessments, and if it was published in English, French or Portuguese within the last ten years. Only four empirical studies accomplished such criteria, being conducted mainly with aphasic or aprosodic patients. These findings might be considered surprising and alarming, since there is a lack of systematic studies about rehabilitation of communication components. It is important to highlight the need to search for a detailed description of intervention procedures with specific goals, allowing studies to be replicated and also contributing for monitoring the effects of treatment. Communicative processing intervention programmes should be developed based on theoretical approaches, and studies with this focus should be conducted and published, in order to verify therapeutic effects.

Decision making in IGT: a case study of post-CVA of left versus right hemisphere

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.

Toma de decisión en el IGT: estudio de caso post-AVC de hemisferio derecho versus isquierdo

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.