Thaís Bento Lima-Silva

Effects of cognitive training based on metamemory and mental images

There is scant research evidence regarding training effects among elderly with limited educational experience. Research indicating an association between metamemory and memory performance is based on samples of older adults with at least 12 years of education. Objectives To test the efficacy of a cognitive training program based on the creation of mental images and changes in specific aspects of metamemory in individuals with 3 to 15 years of education (M=8.38, SD=4.24). Methods 37 older adults participated in five training sessions (Training Group (TG)) and 32 control subjects completed only pre and post test assessments (Control Group (CG)) including the Mini Mental Status Examination (MMSE), the Geriatric Depression Scale (GDS), the Brief Cognitive Screening Battery (BCSB)(naming and memorization of 10 pictures, animal category verbal fluency test, the Clock Drawing Test (CDT)), the Story subtest from the Rivermead Behavioural Memory Test (RBMT), the Memory Complaint Questionnaire (MAC-Q), and the Picture and Story domains from the Memory Self-Efficacy Questionnaire (MSEQ). Results The TG showed significant improvement between pre and post tests on the delayed recall of the 10 pictures and in self-efficacy for the memorization of stories. These same changes were not found in the CG. Conclusions Five-session cognitive training may lead to significant improvements in episodic memory and memory self-efficacy, an aspect of metamemory, in individuals with an average of 8 years of education.

Direct and Indirect Assessments of Activities of Daily Living in Behavioral Variant Frontotemporal Dementia and Alzheimer Disease

Background: There is limited information about the functional profile of behavioral variant frontotemporal dementia (bvFTD). Objective: To compare direct and indirect assessments of activities of daily living (ADLs) in bvFTD and Alzheimer disease (AD) and their relationship with cognitive performance. Methods: In all, 20 patients with bvFTD, 30 patients with AD, and 34 normal controls (NCs), matched for age, education, and severity of dementia, completed the Direct Assessment of Functional Performance (DAFS-BR) and usual cognitive measures. The Disability Assessment for Dementia (DAD) was completed by caregivers. Results: In DAFS-BR, patients with bvFTD and AD had similar performance but lower than NCs. In DAD, there were no significant differences for effective performance, but patients with bvFTD had lower scores for initiation and planning/organization. Patients with bvFTD were less impaired than AD in cognition. Conclusion: Functional changes in bvFTD seem to be better documented by indirect measures.

Functional Status in Behavioral Variant Frontotemporal Dementia: A Systematic Review

The aim was to conduct a systematic review of studies that described the functional profile of patients with behavioral variant frontotemporal dementia (bvFTD), published between 2000 and 2013. The bibliographic search was conducted using the terms “frontotemporal dementia” and “frontotemporal lobar degeneration” in combination with “independence,” “functionality,” “basic activities of daily living,” “disability,” and scales that measure functional performance: “Disability Assessment for Dementia-DAD,” “Functional Activities Questionnaire (FAQ),” “Direct Assessment of Functional Status (DAFS).” To be included in the review, the study had to mention the characterization of the functional status of patients with bvFTD in the objectives of the study, using a previously validated instrument of functional assessment. Fourteen studies met this criterion. The reviewed studies suggested that individuals with bvFTD have greater functional impairment when compared to those with other subtypes of frontotemporal lobar degeneration or Alzheimers disease. The studies documented a significant association between cognitive impairment and measures of functionality in these patients. The cognitive profile of patients may predict faster functional decline.

Effects of a psychoeducational intervention in family caregivers of people with Alzheimer's disease

Psychoeducational activities are a way of promoting help for caregivers of patients with Alzheimer’s disease, representing a forum for knowledge sharing, and in which the primary focus is on psychological themes aimed at carers developing coping skills and strategies. Objective The main objective of this study was to gauge perceptions about care and its impact among family caregivers of patients with AD participating in a psychoeducational group intervention, as well as the possible positive and negative aspects associated with this role. The subjective impact of AD on the lives of these caregivers was assessed on each of the dimensions of the Caregiver Burden Scale using a semi-directed interview on perceptions about care. Methods This was a prospective study, in which information was collected twice, before and after, psychoeducational intervention. Through the application of the scale, benefits were evident for all dimensions assessed in the instrument (general strain, isolation, disappointment, emotional involvement and environment). Results The results showed that after the psychoeducational intervention, caregivers felt less burdened by care compared to pre-intervention. Conclusion: These findings confirm that expanded implementation of psychoeducational interventions for caregivers of patients with AD can be beneficial for both caregivers and patients.

The relationship between memory complaints and age in normal aging

Normal aging can be characterized by a gradual decline in some cognitive functions, such as memory. Memory complaints are common among older adults, and may indicate depression, anxiety, or cognitive decline. Objectives To investigate the association between memory complaints and age in cognitively unimpaired older adults, and the relationship between memory complaints and memory performance. Methods Cognitive screening tests as well as memory complaint questionnaires validated for the Brazilian population were used: the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Memory Complaint Questionnaire (MAC-Q), Memory test of 18 pictures, Forward and Backward Digit Span (WAIS-III). Fifty seven regular members of the SESC social club participated (50 women), having a mean age of 71.4 years, and 4 to 8 years of education - 34 from 4 to 7 years and 23 with 8 years of education. Results Results revealed no significant association between cognitive complaints and age or cognitive performance. Older participants in this sample did not show worse performance or a higher level of complaints. There was no significant association between age and GDS scores. Conclusions The studied sample constitutes a particular group of older adults whose participation in activities may be protecting them from cognitive decline, thus highlighting the impact of lifestyle on cognitive performance during the aging process.

Subjective and psychological well-being of students of a University of the Third Age Benefits of continuing education for psychological adjustment in the elderly

Objectives The present study sought to characterize the degree of general satisfaction with life and degree of satisfaction on four domains: health, physical capacity, mental capacity and social involvement, and to determine the characteristics of self-reports of individuals enrolled on the program in relation to their psychological well-being focusing on the dimensions: autonomy, personal growth, control, positive relationships with others, purpose, personal acceptance and generativity, and to analyse the effect of time studying on level of well-being. Method A total of 140 elderly students of a University for the Third Age took part in the study. The Global Satisfaction With Life Scale and the Self Development Scale (with six psychological well-being subscales) were applied. Continuous variables for the two groups were compared using the Mann-Whitney test. Spearman’s correlation coefficient was used to analyze the relationship among numeric variables. Internal consistency of the instrument scales was analysed by calculating Cronbach’s alpha coefficient. Results Results showed that students who had attended the University of the Third Age for six months or longer had a higher level of satisfaction with life and greater psychological adjustment compared with new entrants to the same institution. Conclusion The study results confirmed the positive effects of continuing education on the well-being of elderly and its contribution to successful aging.

Treino cognitivo e intervenção psicoeducativa para indivíduos hipertensos: efeitos na cognição

OBJECTIVES: To evaluate the possibility of combining cognitive training to an educational intervention composed by eight sessions about hypertension for a better management of the disease among the elderly. METHODS: 64 older adults who reported having hypertension, divided into experimental group (EG, n=35) and control group (CG, n=29) participated in the study. Control participants received training after the post-test. The protocol contained socio-demographic and clinical data, Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Rivermead Behavioral Memory Test (RBMT), Verbal Fluency Animal Category (VF) and Short Cognitive Test (SKT). RESULTS: The EG showed better cognitive performance when compared with the CG, at post-test. CONCLUSION: Cognitive gains may occur after psychoeducational interventions for older adults with hypertension.

Translation, cross-cultural adaptation and applicability of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS)

BACKGROUND Staging scales for dementia have been devised for grading Alzheimers disease (AD) but do not include the specific symptoms of frontotemporal lobar degeneration (FTLD). OBJECTIVE To translate and adapt the Frontotemporal Dementia Rating Scale (FTD-FRS) to Brazilian Portuguese. METHODS The cross-cultural adaptation process consisted of the following steps: translation, back-translation (prepared by independent translators), discussion with specialists, and development of a final version after minor adjustments. A pilot application was carried out with 12 patients diagnosed with bvFTD and 11 with AD, matched for disease severity (CDR=1.0). The evaluation protocol included: Addenbrookes Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Executive Interview (EXIT-25), Neuropsychiatric Inventory (NPI), Frontotemporal Dementia Rating Scale (FTD-FRS) and Clinical Dementia Rating scale (CDR). RESULTS The Brazilian version of the FTD-FRS seemed appropriate for use in this country. Preliminary results revealed greater levels of disability in bvFTD than in AD patients (bvFTD: 25% mild, 50% moderate and 25% severe; AD: 36.36% mild, 63.64% moderate). It appears that the CDR underrates disease severity in bvFTD since a relevant proportion of patients rated as having mild dementia (CDR=1.0) in fact had moderate or severe levels of disability according to the FTD-FRS. CONCLUSION The Brazilian version of the FTD-FRS seems suitable to aid staging and determining disease progression.

Elderly patients with Alzheimer’s disease and their family relationships. Caregiver perspectives

Objective The present study was to investigate the status of the family relationships of elderly patients with Alzheimer’s disease from a caregiver’s perspective. Methods A total of sixteen relatives/caregivers of AD patients were assessed by applying a semi-structured questionnaire about family relationships. Frequency tables containing categorical variables (gender, schooling, personal income and current occupation) were compiled. Descriptive statistics were calculated of continuous variables such as age. Answers to open questions were submitted to Bardin’s content analysis. The data were held on the Epidata program and statistical analysis was performed using the SPSS v.17.0 software package. Results In line with the literature, the family was the main source of caregivers and the typical caregiver profile was female. In contrast to other studies, emotional burnout was not a major complaint in the sample studied. The ties created among family members and the life experience of each individual influences how interviewees cope with AD. Conclusion The family relationships of caregivers of AD patients represent a constant challenge, due to changes in roles within the family structure as well as to disease progression. However, participation in psychological and socio-educational activities run by pioneering institutions in Brazil, act as a mediator of stress in the lives of both caregivers and patients.

Recalling feature bindings differentiates Alzheimer’s disease from Frontotemporal Dementia

It has been challenging to identify clinical cognitive markers that can differentiate patients with Alzheimer’s disease (AD) from those with behavioral variant frontotemporal dementia (bvFTD). The short-term memory binding (STMB) test assesses the ability to integrate colors and shapes into unified representations and to hold them temporarily during online performance. The objective of this study is to investigate whether free recall deficits during short-term memory binding (STMB) test can differentiate patients with AD from those with bvFTD and controls. Participants were 32 cognitively intact adults, 35 individuals with AD and 18 with bvFTD. All patients were in the mild dementia stage. Receiver-operating characteristic (ROC) analyses were used to examine the diagnostic accuracy of the STMB. The results showed that AD patients performed significantly worse than controls and bvFTD patients in the STMB test, while the latter groups showed equivalent performance. The bound condition of the STMB test showed an AUC of 0.853, with 84.4% of sensitivity and 80% of specificity to discriminate AD from controls and an AUC of 0.794, with 72.2% of sensitivity and 80% of specificity to differentiate AD from bvFTD. Binding deficits seem specific to AD. The free recall version of the STMB test can be used for clinical purposes and may aid in the differential diagnosis of AD. Findings support the view that the STMB may be a suitable cognitive marker for AD.