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The Toulouse-Piéron Cancelation Test (TP) is a classic psychometric tool for the assessment of selective/sustained attention, processing speed and visuo-perceptual abilities. It is commonly used in neurological disorders such as epilepsy, multiple sclerosis or Alzheimer's disease. It encompasses two main indexes: Work-Efficiency (WE) and Dispersion-Index (DI). The aim of this study is to provide normative scores for the TP in a sample of Portuguese healthy adults. The TP was administered to a convenience sample of 357 cognitively-dwelling subjects aged between [45 and 86] years old, following a standard assessment protocol. The normative scores were adjusted for age and education. Education was the main predictor of TP-WE (R 2 = .310), whereas the influence of age on this score was lower (R 2 = .191). These two variables explained 50.1% of the variance of the results. Regarding TP-DI, education was also the main predictor of the results (R 2 = .039), whereas age was responsible for R 2 = .011 and together, they explained 5% of the variance of TP-DI. TP performances are strongly influenced by age and education. This is the first study focused on the establishment of normative data after the age of 45 in the Portuguese population, allowing a reliable assessment in both clinical and research contexts.

In the present study, trace elements (TE) levels were evaluated in scalp hair along the continuum from healthy subjects (HS) to patients suffering from subjective memory concerns (SMC), and/or mild cognitive impairment (MCI), and those with already installed dementia (DEM) in order to: (i) assess the effects of environmental and lifestyle factors on TE concentrations and (ii) evaluate the analyzed elements as possible diagnostic biomarkers for the disease. The study involved 79 mainly permanent residents, >55 years old, from the city of Estarreja (northern Portugal), a former industrial area. The health status of the participants was assessed by means of a complete socio-demographic questionnaire and through cognitive screening tests, namely the Mini-Mental State Examination (MMSE). The test scores were categorized and used in the statistical analysis. Hair samples were collected and analyzed by inductively coupled plasma-mass spectrometry (ICP-MS) ICP-MS for selected TE. Dementia appears to be associated with higher age, the female gender, lower education level, and longer residence time in the study area. In addition, most of the participants diagnosed with dementia frequently consume home-grown foodstuffs, some irrigated with contaminated well water. The calculation of the TE enrichment factors of soil samples collected in kitchen gardens/small farms in the vicinity of the Estarreja Chemical Complex (ECC) reinforces the degree of Hg soil contamination in the area, due to anthropogenic sources that can be a source for the population Hg exposure route among others. Mercury levels in hair differed significantly between the four individual groups (HS, SMC, MCI, and DEM), increasing from healthy to dementia participants. Improved diagnostic results can be obtained using hair TE signatures coupled with MMSE scores. This strategy may prove useful for predictive diagnosis in population screening for cognitive impairment.

We aimed to analyze the construct and concurrent validity of the Rapid Visual Information Processing (RVP), Paired Associates Learning (PAL), Reaction Time (RTI), and Spatial Working Memory (SWM) tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB®). Inclusion criteria were checked in a first session. The CANTAB and additional pencil-and-paper tests were administered within 1 week. The participants (aged 69-96 years) were 137 Portuguese adults without neuropsychiatric diagnoses and 37 adults with mild-to-moderate Alzheimer's disease dementia. Comparisons were made between the CANTAB tests and between these tests and the Rey Complex Figure Test (RCFT), Verbal Fluency (VF) test, and some Wechsler Memory Scale-III and Wechsler Adult Intelligence Scale-III subtests. Most intra-test correlations were stronger than the CANTAB inter-test correlations. The RVP correlated more with VF animals (.44), the PAL with RCFT immediate recall (-.52), the RTI with RVP mean latency (.42), and the SWM with Spatial Span backward (-.39).

Amnestic mild cognitive impairment (aMCI) patients carry a greater risk of conversion to Alzheimer's disease (AD). Therefore, the International Working Group (IWG) on AD aims to consider some cases of aMCI as symptomatic prodromal AD. The core diagnostic marker of AD is a significant and progressive memory deficit, and the Free and Cued Selective Reminding Test (FCSRT) was recommended by the IWG to test memory in cases of possible prodromal AD. This study aims to investigate whether the performance on the FCSRT would enhance the ability to predict conversion to AD in an aMCI group. A longitudinal study was conducted on 88 aMCI patients, and neuropsychological tests were analysed on the relative risk of conversion to AD. During follow-up (23.82 months), 33% of the aMCI population converted to AD. An impaired FCSRT TR was significantly associated with the risk of conversion to dementia, with a mean time to conversion of 25 months. The FCSRT demonstrates utility for detecting AD at its prodromal stage, thus supporting its use as a valid clinical marker., (© 2015 The British Psychological Society.)

Introduction: The Free and Cued Selective Reminding Test (FCSRT) is a memory test that controls attention and acquisition, by providing category cues in the learning process. Because it enables an assessment of memory not confounded by normal age-related changes in cognition and a high accuracy on Alzheimer's disease (AD) evaluation, it has been suggested by the International Working Group on AD. Our aim was to assess the construct related validity of the FCSRT in the AD spectrum disorders., Method: Patients were classified in two groups according to standard criteria: amnestic mild cognitive impairment (n = 100) and AD (n = 70). A matched control group (n = 101) of cognitively healthy subjects was included. The factorial structure of two models and respective construct and diagnostic validities were analyzed., Results: Both models revealed adequate fit values. The appropriated convergent validity and the lack of discriminant validity support the two factors as measuring the same construct (memory ability). The recalls of the FCSRT enabled high classification accuracy and diagnostic validity for both pathological groups., Conclusions: This study represents a novel contribution regarding the adequacy of the FCSRT in terms of construct and diagnostic validities and shows the interest of including both immediate (learning) and delayed (retention) recalls. It gives also new possibilities regarding the use of the FCSRT in the memory assessment of AD spectrum disorders.

The Selective Reminding Test (SRT) and the Free and Cued Selective Reminding Test (FCSRT) are multitrial memory tests that use a common "selective reminding" paradigm that aims to facilitate learning by presenting only the missing words from the previous recall trial. While in the FCSRT semantic cues are provided to elicit recall, in the SRT, participants are merely reminded of the missing items by repeating them. These tests have been used to assess age-related memory changes and to predict dementia. The performance of healthy elders on these tests has been compared before, and results have shown that twice as many words were retrieved from long-term memory in the FCSRT compared with the SRT. In this study, we compared the tests' properties and their accuracy in discriminating amnestic mild cognitive impairment (aMCI; n = 20) from Alzheimer disease (AD; n = 18). Patients with AD performed significantly worse than patients with aMCI on both tests. The percentage of items recalled during the learning trials was significantly higher for the FCSRT in both groups, and a higher number of items were later retrieved, showing the benefit of category cueing. Our key finding was that the FCSRT showed higher accuracy in discriminating patients with aMCI from those with AD.

The International Working Group on Alzheimer's disease (AD) suggested the free and cued selective reminding test (FCSRT) to assess memory, as it showed high sensitivity and specificity in the differentiation of AD from healthy controls and other dementias. The FCSRT involves the use of selective reminding with semantic cueing in memory assessment. This study aims to validate the FCSRT for mild cognitive impairment (MCI) and AD through the analysis of the diagnostic accuracy and the suggestion of cut-off scores. Patients were classified into two groups according to standard criteria: MCI (n = 100) and AD (n = 70). A matched control group (n = 101) of cognitively healthy subjects was included. The reliability and the validity of the FCSRT were analysed on the immediate (IR) and delayed (DR) recalls. The Cronbach's alpha was 0.915 for the IR and 0.879 for the DR. The total recall measures revealed good areas under the curve for MCI (IR: .818; DR: .828) and excellent for AD (IR: .987; DR: .991). Furthermore, the MCI group was subdivided with respect to a non-similar/similar AD pattern of impairment, with almost half of the subjects showing an AD-like decline. This analysis represents a novel contribution regarding the properties of the FCSRT in illustrating the heterogeneity of MCI at baseline. The FCSRT has proved to be a very useful tool in the characterization of the memory impairment of the AD spectrum., (© 2014 The British Psychological Society.)

Aim: The Logical Memory (LM) and the Verbal Paired Associative Learning (VPAL) are subtests from the Wechsler Memory Scale commonly used to characterize the memory deficit of amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD). The Free and Cued Selective Reminding Test (FCSRT) was suggested to assess the memory impairment of AD spectrum patients by the International Working Group on AD. In the present study, we compared the properties of the tests and their accuracy in classifying aMCI and AD., Methods: A group of aMCI patients (n = 85) and AD patients (n = 43) were included. The reliability and the validity of the three tests were analyzed., Results: AD patients showed a significant pattern of worse impairment on all tests than aMCI. The FCSRT was able to classify more patients as having memory impairment in the aMCI group rather than the WMS subtests. The FCSRT proved to be good in discriminating the two groups in both lower and higher educational levels, whereas the LM was more useful in higher educated patients., Conclusions: Although the instruments had good results, the FCSRT was more accurate in discriminating MCI from AD, and less influenced by the educational level., (© 2014 Japan Geriatrics Society.)

The psychometric properties of the Montreal Cognitive Assessment (MoCA) were examined by using the Partial Credit Model. The study sample included 897 participants who were distributed into two main subgroups: (I) the clinical group (90 patients with Mild Cognitive Impairment, 90 patients with Alzheimer's disease, 33 patients with Frontotemporal Dementia, and 34 patients with Vascular dementia, whose diagnoses were previously established according to a consensus that was reached by a multidisciplinary team, based on the international criteria) and (II) the healthy group (composed of 650 cognitively healthy community dwellers). The results show (i) an overall good fit for both the items and the persons' values, (ii) high variability for the cognitive performance level of the cognitive domains (ranging between 1.90 and -3.35, where "Short-term Memory" was the most difficult item and "Spatial Orientation" was the easiest item) and between the subjects on the scale, (iii) high reliability for the estimation of the persons' values, (iv) good discriminant validity and high diagnostic utility, and (v) a minimal differential item functioning effect related to of pathology, gender, age, and educational level. MoCA and its cognitive domains are suitable measures to use for screening the cognitive status of cognitively healthy subjects and patients with cognitive impairment., (© The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Memory impairment is often present in frontotemporal dementia (FTD) as a result of an inefficient use of learning strategies, sometimes leading to a misdiagnosis of Alzheimer's disease (AD). The Free and Cued Selective Reminding Test (FCSRT) is a memory test that controls attention and acquisition, by providing category cues in the learning process. The main goal of this study was to show the usefulness of the FCSRT in the distinction between behavioral (bv-) FTD and AD. Three matched subgroups of participants were considered: bv-FTD (n = 32), AD (n = 32), and a control group of healthy adults (n = 32). Results proved that while AD patients exhibited an overall impairment in FCSRT, bv-FTD subjects showed to benefit more from the controlled learning through category cues. AD patients were 25 times more likely to have an impaired FCSRT. The FCSRT has shown its utility in the distinction between bv-FTD and AD, therefore increasing the diagnostic accuracy., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

APA guidelines for the evaluation of age-related cognitive decline and dementia emphasize the need for baseline (premorbid) data against which current performance can be compared. As this information rarely exists, clinicians must rely on instruments especially designed for estimation of premorbid abilities. No such instrument was available in Portugal until the development of the TeLPI, an irregular words oral reading test. This study aims to examine TeLPI's validity as a measure of premorbid ability in the spectrum of aging cognitive decline, from mild cognitive impairment (MCI) to moderate Alzheimer disease (AD), by the analysis of its stability in normal versus impaired samples. A total of 104 patients, classified into 2 clinical groups, MCI (n=53) and probable mild to moderate AD (n=51), were compared with a group of cognitively healthy controls (C_MCI: n=53; C_AD: n=51) and matched for sex, age, education, and residence. As expected, the Mini-Mental State Examination and Montreal Cognitive Assessment results were significantly different between the groups (AD

Cognitive screening tests are well-established tools for detecting cognitive impairment, but concerns regarding the influence of premorbid intelligence on patient's performance and cognitive status classification remain. Risk of inaccurate assessment especially affects the elders with high or low premorbid intelligence (who are more likely to be misclassified). The present study examines the influence of premorbid intelligence assessed by the TeLPI (an irregular words reading test) on 2 cognitive screening tests, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), in healthy participants and patients with cognitive impairments (mild cognitive impairment and Alzheimer disease). Results show that premorbid IQ influences the MMSE and the MoCA scores in both the groups, predicting variance from 8.4% to 33.2%, according to test and group analyzed. Hence, we propose that whenever the MMSE or the MoCA is used, premorbid IQ evaluation should also be considered to ensure correct interpretation and classification.

The nature of visual impairments in Alzheimer's disease (AD) and their relation with other cognitive deficits remains highly debated. We asked whether independent visual deficits are present in AD and amnestic forms of mild cognitive impairment (MCI) in the absence of other comorbidities by performing a hierarchical analysis of low-level and high-level visual function in MCI and AD. Since parietal structures are a frequent pathophysiological target in AD and subserve 3D vision driven by motion cues, we hypothesized that the parietal visual dorsal stream function is predominantly affected in these conditions. We used a novel 3D task combining three critical variables to challenge parietal function: 3D motion coherence of objects of unknown orientation, with constrained temporal integration of these cues. Groups of amnestic MCI (n = 20), AD (n = 19), and matched controls (n = 20) were studied. Low-level visual function was assessed using psychophysical contrast sensitivity tests probing the magnocellular, parvocellular, and koniocellular pathways. We probed visual ventral stream function using the Benton Face Recognition task. We have found hierarchical visual impairment in AD, independently of neuropsychological deficits, in particular in the novel parietal 3D task, which was selectively affected in MCI. Integration of local motion cues into 3D objects was specifically and most strongly impaired in AD and MCI, especially when 3D motion was unpredictable, with variable orientation and short-lived in space and time. In sum, specific early dorsal stream visual impairment occurs independently of ventral stream, low-level visual and neuropsychological deficits, in amnestic types of MCI and AD.

The validity of the Cambridge Neuropsychological Automated Tests has been widely studied, but their reliability has not. This study aimed to estimate the test-retest reliability of these tests in a sample of 34 older adults, aged 69 to 90 years old, without neuropsychiatric diagnoses and living in retirement homes in the district of Lisbon, Portugal. The battery was administered twice, with a 4-week interval between sessions. The Paired Associates Learning (PAL), Spatial Working Memory (SWM), Rapid Visual Information Processing, and Reaction Time tests revealed measures with high-to-adequate test-retest correlations (.71-.89), although several PAL and SWM measures showed susceptibility to practice effects. Two estimated standardized regression-based methods were found to be more efficient at correcting for practice effects than a method of fixed correction. We also found weak test-retest correlations (.56-.68) for several measures. These results suggest that some, but not all, measures are suitable for cognitive assessment and monitoring in this population. [ABSTRACT FROM AUTHOR]

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the MMSE. The aim of the present study was to validate the MoCA as well as its short version, which was proposed by the NINDS-CSN VCI Harmonization Standards for screening Vascular Dementia (VaD) patients. The results, based on a homogeneous sample of 34 VaD patients, indicate that the MoCA is a psychometrically valid and reliable instrument for cognitive screening in VaD patients, showing excellent discriminant validity. Both the full and short versions of the MoCA had excellent diagnostic accuracy in discriminating VaD patients, exhibiting an area under curve (AUC) higher than the MMSE [AUC(MoCA full version) = .950; 95% IC = .868-.988; AUC(MoCA short version) = .936; 95% IC = .849-.981; AUC(MMSE) = .860; 95% IC = .754-.932]. With a cutoff below 17 on the MoCA full version and 8 on the short version, the results for sensitivity, specificity, positive and negative predictive values, and classification accuracy were superior compared to the MMSE. In conclusion, both versions of the MoCA are valid, reliable, sensitive and accurate screening instruments for VaD patients. [ABSTRACT FROM AUTHOR]

The Montreal Cognitive Assessment (MoCA) is a brief instrument developed for the screening of milder forms of cognitive impairment, having surpassed the well-known limitations of the Mini-Mental State Examination (MMSE). The aim of the present study was to validate the MoCA as a cognitive screening test for behavioral-variant frontotemporal dementia (bv-FTD) by examining its psychometric properties and diagnostic accuracy. Three matched subgroups of participants were considered: bv-FTD (n = 50), Alzheimer disease (n = 50), and a control group of healthy adults (n = 50). Compared with the MMSE, the MoCA demonstrated consistently superior psychometric properties and discriminant capacity, providing comprehensive information about the patients’ cognitive profiles. The diagnostic accuracy of MoCA for bv-FTD was extremely high (area under the curve AUC [MoCA] = 0.934, 95% confidence interval [CI] = 0.866-.974; AUC [MMSE] = 0.772, 95% CI = 0.677-0.850). With a cutoff below 17 points, the MoCA results for sensitivity, specificity, positive predictive value, negative predictive value, and classification accuracy were significantly superior to those of the MMSE. The MoCA is a sensitive and accurate instrument for screening the patients with bv-FTD and represents a better option than the MMSE. [ABSTRACT FROM AUTHOR]

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