Search

Background Patient Competency Rating Scale (PCRS-R-BR) is a clinical tool to evaluate the degree of competence in cognitive skills perceived by patients with brain injuries. However, no studies hav...

The purpose of this study was to examine the impact of age and education on the neural and behavioral correlates of verbal fluency. Forty-eight healthy adult participants were included: high-educated young and elderly, low-educated young and elderly. Participants performed semantic and phonemic and a control task during fMRI scanning. The phonemic fluency data showed an education effect across age groups. As for the semantic fluency data, there was an education effect only in young participants. The second-level fMRI results showed, in phonemic fluency, a main effect of age in the left posterior cingulate, superior temporal gyrus (STG) and right caudate, whereas the main effect of education involved activation in the right semantic fluency, there were a main effect of age in the left paracentral lobule and posterior cingulate, a main effect of education in the left claustrum and an interaction in the right claustrum and STG and the hippocampus bilaterally.

Purpose Changes in cerebral cortical regions occur in HIV-infected patients, even in those with mild neurocognitive disorders. Working memory / attention is one of the most affected cognitive domain in these patients, worsening their quality of life. Our objective was to assess whether cortical thickness differs between HIV-infected patients with and without working memory deficit. Methods Forty-one adult HIV-infected patients with and without working memory deficit were imaged on a 1.5 T scanner. Working memory deficit was classified by composite Z scores for performance on the Digits and Letter-Number Sequencing subtests of the Wechsler Adult Intelligence Scale (third edition; WAIS-III). Cortical thickness was determined using FreeSurfer software. Differences in mean cortical thickness between groups, corrected for multiple comparisons using Monte-Carlo simulation, were examined using the query design estimate contrast tool of the FreeSurfer software. Results Greater cortical thickness in left pars opercularis of the inferior frontal gyrus, and rostral and caudal portions of the left middle frontal gyrus (cluster 1; p = .004), and left superior frontal gyrus (cluster 2; p = .004) was observed in HIV-infected patients with working memory deficit compared with those without such deficit. Negative correlations were found between WAIS-III–based Z scores and cortical thickness in the two clusters (cluster 1: ρ = –0.59; cluster 2: ρ = –0.47). Conclusion HIV-infected patients with working memory deficit have regions of greater thickness in the left frontal cortices compared with those without such deficit, which may reflect increased synaptic contacts and/or an inflammatory response related to the damage caused by HIV infection.

Traumatic brain injury (TBI) can lead to significant changes in daily life, as well as in social, labor, communicative, and cognitive domains (attention, memory and executive functions). This study aimed to characterize the occurrence of post-TBI neuropsychological deficits as well as to determine whether there is an impact related to the level of severity of the trauma on the patient's performance. Ninety-six adults participated in the study, who were divided in two groups to assess the trauma's level of severity: mild TBI (n=39) and severe TBI (n=57). This severity was classified by the Glasgow Coma Scale, by the duration of consciousness loss, or by post-traumatic amnesia. There were no differences between the groups regarding variables of age and years of schooling. A Chi- square test was used to do a comparison between the two groups in terms of occurrence of neuropsychological deficits. Verbal, visuospatial, mnemonic, linguistic and executive tests composed a flexible neuropsychological battery. Patients with mild TBI had better scores compared to those with severe TBI (number of errors and in completed categories of the Modified Wisconsin Card Sorting Test (MWCST); errors in Part B of The Hayling Test; and proactive and retroactive interference in the Rey Auditory Verbal Learning Test (RAVLT). The severity of the trauma seems to differentiate individual's performance on episodic memory of new information and in the control of interference between memories; the same is applied to flexibility and inhibition functions. These results suggest the need for more investments in public health policy actions, prioritizing neurocognitive remedial intervention and prevention methods for such condition with high incidence of sequelae. O traumatismo cranioencefálico (TCE) pode acarretar mudanças no cotidiano e prejuízos social, laboral, comunicativo e cognitivo (dificuldades atencionais, mnemônicas e executivas). Este estudo buscou caracterizar a ocorrência de déficits neuropsicológicos após o TCE em uma amostra de adultos e verificar se há impacto do nível de severidade do trauma no desempenho cognitivo dos pacientes. Participaram 96 adultos, divididos em dois grupos: TCE leve (n=39) e grave (n=57). A gravidade do trauma foi classificada pela Escala de Coma de Glasgow, pela duração da perda de consciência, ou pela amnésia pós-traumática. Não houve diferença nas variáveis sociodemográficas idade e escolaridade entre os grupos. Para a comparação entre grupos quanto a ocorrência de déficits neuropsicológicos, utilizou-se o Qui-quadrado. Tarefas verbais e visuoespaciais de funções executivas, habilidades linguísticas, mnemônicas verbais compuseram uma bateria neuropsicológica flexível.Os pacientes com TCE leve tiveram menos déficits comparados aos com TCE grave (erros e categorias completadas do Wisconsin Teste de Classificação de Cartas; erros da parte B do Teste Hayling; e na interferência pró e retroativa do teste de aprendizagem verbal de Rey). A severidade do trauma parece diferenciar indivíduos no desempenho de memória episódica no contexto de maior sobrecarga de informações novas e no controle da interferência entre memórias; o mesmo se aplica às funções de flexibilidade e inibição. Faz-se necessário um maior investimento em ações de políticas públicas de saúde, priorizando intervenção neurognitiva remediativa e métodos de prevenção para acidentes relacionados a lesões traumáticas com alta ocorrência de sequelas. El traumatismo craneoencefálico (TCE) puede conllevar impactantes cambios en la vida cotidiana, que incluyen alteraciones a nivel social, profesional, comunicativo y cognitivo (dificultades atencionales, mnemónicas y ejecutivas). Este estudio tuvo por objeto caracterizar la ocurrencia de déficits neuropsicológicos post-TCE y constatar el impacto ocasionado por el nivel de severidad del trauma en el desempeño cognitivo de los pacientes. Participaron 96 adultos en la muestra total, que fue dividida en dos grupos para evaluar el nivel de severidad del trauma: TCE leve (n=39) y TCE grave (n=77). La gravedad de la lesión se clasificó por medio de la Escala de Coma de Glasgow, por la duración de la pérdida de consciencia, o por la amnesia post-traumática. No había diferencias entre la edad y la escolaridad de los participantes. Para la comparación entre los grupos en cuanto a la distribución de ocurrencia de déficits neuropsicológicos, se utilizó el Chi-cuadrado. Se utilizó una batería de evaluación neuropsicológica flexible conformada por tareas verbales y visoespaciales de habilidades lingüísticas, mnemónicas y ejecutivas. Los grupos no se diferenciaron en cuanto a las variables sociodemográficas. Los pacientes con TCE leve tuvieron mejores puntajes comparados con los de TCE grave (número de errores y categorías completadas del Test de clasificación de tarjetas de Wisconsin- [WCST, por sus siglas en inglés]; errores en la parte B del Test de Hayling; y en la interferencia retro y proactiva del Test de aprendizaje auditivo verbal de Rey [RAVLT, por sus siglas en inglés]. El nivel de severidad del trauma parece mostrar diferencias en los individuos en cuanto al desempeño en memoria episódica de información nueva y en el control de interferencia entre los recuerdos; lo mismo se aplica a las funciones de flexibilidad e inhibición. Estos resultados sugieren que es necesaria una mayor inversión en acciones de políticas públicas, priorizando intervenciones neurocognitivas reeducativas y métodos de prevención de accidentes relacionados con lesiones traumáticas que tengan alta incidencia de secuelas.

Verbal fluency (VF) is a widely used tool in neuropsychological assessment.We aimed to investigate the influence of age and educational level on clustering and switching in three VF modalities: phonemic (PVF), semantic (SVF) and unconstrained (UVF). We evaluated type of cluster, mean cluster size, and quantity of clusters, intersections, and returns. A total of 260 healthy subjects were assessed.Participants were divided into three age groups: young adults (18 to 39 years), middle-aged adults (40 to 59 years) and older adults (60 to 80 years) and into two groups of educational level: 1-8 years (low), 9 years or more (high). A two-way ANOVA analysis was conducted to analyze the effect of age and educational level and its interactions. A repeated measures ANOVA was performed to verify the performance during the task.A main effect of age was detected on the UVF and SVF scores for total switches, taxonomic clusters, and for the total semantic clusters on the SVF. There was a greater effect of educational level on total switches (UVF, PFV and SVF), taxonomic clusters (UVF and SVF), thematic clusters and total semantic cluster (UVF), phonemic and mixed clusters (PVF), mean cluster size (UVF and SVF) and intersections (SVF). Educational level had a greater effect on all three VF tasks.Fluência verbal (FV) são ferramentas amplamente utilizadas na avaliação neuropsicológica.Nosso objetivo foi investigar a influência da idade e do nível de escolaridade no agrupamento e alternância em três modalidades de fluência verbal: fonêmica (FVF), semântica (FVS) e livre (FVL).Avaliamos o tipo, tamanho médio e quantidade de agrupamentos, alternâncias, intersecções e retornos. Foram divididos 260 indivíduos, em três grupos etários: jovens adultos (18 a 39 anos), adultos de idade intermediária (40 a 59 anos) e idosos (60 a 80 anos) e dois grupos de escolaridade 1-8 (baixa), 9 ou mais (alto). Uma análise ANOVA de dois fatores foi conduzida para analisar o efeito da idade e do nível educacional e suas interações, além de uma ANOVA de medidas repetidas para verificar o desempenho ao longo da tarefa.Encontrou-se efeito principal da idade nas tarefas de FVL e FVS nos seguintes escores: total de alternâncias, agrupamento taxonômicos e no total de agrupamentos semânticos na FVS. Houve um efeito principal do nível educacional no total de alternâncias (FVL, FVF e FVS), agrupamento taxonômicos (FVL e FVS), agrupamento temáticos e cluster semântico total (FVL), clusters fonêmicos e mistos (FVF), tamanho médio de cluster (FVL e FVS) e, finalmente, interseções (FVS). O nível educacional teve efeito maior nas três tarefas de FV.

Objective: The purpose of this study was to investigate the contribution of executive functions (EF) components and episodic and working memory variables, as well as clinical and demographic factors, to awareness of cognitive ability in traumatic brain injury (TBI).Methods: Sixty-five TBI patients (mild: n = 26; moderate/severe: n = 39) took part in the study. Independent stepwise regression models were calculated for EF and memory predictors, with awareness being measured by patient/informant discrepancy in the Patient Competency Rating Scale.Results: Models with EF variables indicated that semantic verbal fluency and age are the best predictors of awareness, whereas models including mnemonic functions suggested verbal delayed episodic recall and TBI severity as predictors.Conclusions: These results are discussed in relation to clinical implications, such as the need to focus efforts of rehabilitation in the cognitive abilities related to awareness, and theoretical models.

Objectives To describe normative data for the Hayling Test and the Trail Making Test (TMT) in a sample of Brazilian adults, and to investigate the effects of age and education on test performance. Method A total of 313 (TMT) and 364 (Hayling) individuals with age ranges of 19-39, 40-59, and 60-75 years, and with at least 5 years of formal education, participated in this study. The tests were administered as part of a large battery of a normative project. Individuals were evaluated individually in silent, ventilated rooms at a university clinic. Instrument protocols were scored by trained research assistants and double-checked to ensure data reliability. Results There were major effects of age on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Errors B/15, B/45), and major effects of education on the TMT (Time B, Errors B, B-A) and on the Hayling Test (Time A, Errors B/15, B/45). Interaction effects were found in Time B and B-A for the Hayling Test and in Time A for the TMT. Conclusions Age and education were critical for performance on both verbal and non-verbal executive functions. Resumo Objetivos Descrever dados normativos do Teste Hayling e do Teste de Trilhas em uma amostra de adultos brasileiros e investigar os efeitos de idade e escolaridade no desempenho das tarefas. Método Participaram deste estudo um total de 313 (TMT) e 364 (Hayling) indivíduos com idades nos intervalos de 19-39, 40-59 e 60-75 anos e com pelo menos 5 anos de escolaridade formal. Os testes foram administrados como parte de uma bateria maior de um projeto de normatização. Os indivíduos foram avaliados individualmente em salas silenciosas e ventiladas em uma clínica universitária. As pontuações dos protocolos foram realizadas por assistentes de pesquisa treinados e foram checadas duplamente para garantir a fidedignidade dos dados. Resultados Foram encontrados efeitos principais de idade no TMT (Tempo B, Erros B e Tempo B-A) e no Teste Hayling (Erros B/15 e B/45), e efeitos principais de educação no TMT (Tempo B, Erros B e Tempo B-A) e no Teste Hayling (Tempo A, Erros B/15 e B/45). Foram encontrados efeitos de interação entre variáveis nos Tempos B e B-A do Teste Hayling e no Tempo A do TMT. Conclusões Idade e escolaridade foram fatores críticos para o desempenho em ambos os testes verbal e não-verbal de avaliação das funções executivas.

The present study examined the effects of a Working Memory Training (WMT) in healthy elderly. Twenty participants comprised the final sample, eleven from the experimental group (WMT) and nine from the control group (socialization). Every subject underwent a neuropsychological evaluation pre and post-intervention. The meetings were held once a week, for three months. Results indicated that subjects in the experimental group improved cognitive functions related to concentrated attention, learning, short-term and episodic memory. Subjects in the control group also demonstrated, in a smaller number of variables, improvement in concentrated attention and episodic memory. WMT seems to have generated a transfer effect, especially to episodic memory, which is directly related to the subsystem of working memory (WM), suggesting that WMT may be useful in the context of the neuropsychology of aging.

The history of Brazilian neuropsychology is traced at different neuropsycholinguistic stages with a focus on the importance of sociocultural factors. We first focus on language disorders, the sequelae of injuries in the left hemisphere, and neuropsychology restricted to the medical field in Europe, the United States, and Brazil. In the middle of the last century, attention to the interdisciplinary importance of studies on the right hemisphere began. Studies consequently emerged on the individual variability of brain function with both biological and cultural origins. Based on this approach, Brazilian studies on aphasic children and illiterate aphasic persons were disseminated internationally. In the 1970s, cognitive neuropsychology began in England, highlighting dysfunctions in reading and writing processes. The characteristics of writing systems within each language became relevant for the manifestations of acquired dyslexia. Brazilian studies showed deficits in Portuguese and Japanese writing caused by brain lesions. During this scientific journey, scientific societies and postgraduate programs in Brazil were created to facilitate exchanges and communication among young researchers. By the end of the last century and in the early 2000s, the growth of the neuropsychology of aging raised awareness of the complexity of sociocultural factors, not only on language research but also according to the level of education, frequency of reading and writing habits, school type, and interactions among these factors and biological factors, especially between the level of education and age. From this historical standpoint, we outline future directions and perspectives in the field of Brazilian neuropsychology.

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. Resumo Objetivo: Descrever a frequência de déficits pragmáticos e executivos em pacientes com lesão de hemisfério direito (LHD) e com traumatismo cranioencefálico (TCE), e verificar se existem dissociações entre pragmática e funções executivas nesses dois grupos. Métodos: A amostra foi composta de 7 casos de TCE e 7 casos de LHD. Todos os participantes foram avaliados por tarefas da Bateria Montreal de Avaliação da Comunicação e com testes de funções executivas como o Trail Making Test, Teste Hayling, Wisconsin Card Sorting Test, tarefas de fluência verbal semântica, fonêmica e livre, tarefas de memória de trabalho do Instrumento de Avaliação Neuropsicológica Breve NEUPSILIN. O escore Z foi calculado e a freqüência de déficits (Z< -1.5) foi descrita. Resultados: Os pacientes com LHD apresentaram déficits principalmente no discurso conversacional e narrativo, por enquanto que os pacientes com TCE demonstraram um padrão mais difuso de déficits pragmáticos. Quanto as FE, os déficits dos pacientes com LHD foram de memória de trabalho e iniciativa verbal, principalmente. Por outro lado, os pacientes com TCE apresentaram novamente um padrão mais geral de disfunção executiva, com prejuízos principalmente de memória de trabalho, iniciativa, inibição, planejamento e switching. Em geral, os déficits pragmáticos e executivos foram associados comparando os pacientes com LHD e com TCE, exceto por duas dissociações simples: dois casos de TCE demonstraram déficits executivos com ausência de déficits pragmáticos. Discussão: Os déficits pragmáticos e executivos podem ser muito frequentes após um TCE ou uma LHD. Parece haver uma associação entre essas habilidades, ressaltando-se que apesar de elas poderem co-ocorrer, uma relação de causa-consequência não parece ser a única hipótese.

Neuropsychological studies on the processing of some specific cognitive functions throughout aging are essential for the understanding of human cognitive development from ages 19 to 89. Objectives: This study aimed to verify the occurrence of differences in the processing of episodic memory, concentrated attention and speed of attentional processing among four age groups of adults. Methods: A total of 136 neurologically healthy adults, aged 19-89, with 9 or more years of schooling, took part in the study. Participants were divided according to four age groups: young, middle-aged, elderly and oldest old adults. Subtests of the Brief Neuropsychological Evaluation Instrument (NEUPSILIN) were applied for the cognitive assessment. Mean score of corrected answers and of response times were compared between groups by means of a one-way ANOVA test with post-hoc Scheffe procedures and ANCOVA including the co-variables of years of schooling and socio-economical scores. Results: In general, differences in performance were observed from 60 years old on. Only the episodic memory task of delayed recall reflected differences from the age of around 40 onwards and processing speed from around the age of 70 onwards. Thus, differences were found between the age groups regarding their cognitive performance, particularly between young adults and elderly adults, and young adults and oldest old adults. Conclusions: Our research indicates that the middle-aged group should be better analyzed and that comparative cross-sectional studies including only extreme groups such as young and elderly adults are not sufficient. Resumo Os estudos neuropsicológicos sobre o processamento de algumas funções cognitivas específicas no envelhecimento são essenciais para a compreensão do desenvolvimento humano na idade de 19 a 89 anos. Objetivos: Esse estudo teve como objetivo verificar a ocorrência de diferenças no processamento da memória episódica, atenção concentrada e velocidade de processamento entre quatro grupos etários. Métodos: Participaram desse estudo 136 adultos neurologicamente saudáveis de 19 a 89 anos, com 9 anos ou mais de escolaridade, divididos em quatro grupos etários: jovens, de idade intermediária, idosos e longevos. Subtestes do Instrumento de Avaliação Neuropsicológica Breve - NEUPSILIN foram utilizados para a avaliação cognitiva. A média dos escores e o tempo de resposta foram comparados entre os grupos através do teste one-way ANOVA, com o procedimento post-hoc Scheffe e uma ANCOVA com as co-variáveis anos de escolaridade e escore sócio-econômico. Resultados: De maneira geral, foram encontradas diferenças entre os grupos a partir dos 60 anos. Somente na tarefa de memória episódica tardia foram encontradas diferenças aproximadamente a partir dos 40 anos, e na velocidade de processamento, a partir dos 70 anos de idade. Dessa forma, houve diferenças entre os grupos no seu desempenho cognitivo, principalmente entre o grupo de adultos jovens e adultos idosos e adultos jovens e adultos longevos. Conclusões: Os resultados demonstraram, ainda, que o grupo de adultos de idade intermediária deve ser mais bem investigado e, a partir disso, que estudos comparativos incluindo grupos de faixas etárias extremas não são suficientes.

Social instigation is used in rodents to induce high levels of aggression, a pattern of behavior with certain parallels to that of violent individuals. This procedure consists of a brief exposure to a provocative stimulus male, before direct confrontation with an intruder. Studies using 5-HT1A and 5-HT1B receptor agonists show an effective reduction in aggressive behavior. An important site of action for these drugs is the ventral orbitofrontal cortex (VO PFC), an area of the brain which is particularly relevant in the inhibitory control of aggressive and impulsive behavior.The objectives of the study are to assess the anti-aggressive effects of 5-HT1A and 5-HT1B agonist receptors [8-hydroxy-2-(di-n-propylamino) tetralin hydrobromide (8-OH-DPAT) and CP-93,129] in the VO PFC of socially provoked male mice. To confirm the specificity of the receptor, 5-HT1A and 5-HT1B antagonist receptors (WAY-100,635 and SB-224,289) were microinjected into the same area, in order to reverse the agonist effects.8-OH-DPAT (0.56 and 1.0 microg) reduced the frequency of attack bites. The lowest dose of CP-93,129 (0.1 microg) also decreased the number of attack bites and lateral threats. 5-HT1A and 5-HT1B receptor agonists differed in their effects on non-aggressive activities, the former decreasing rearing and grooming, and the latter, increasing these acts. Specific participation of the 1A and 1B receptors was verified by reversal of anti-aggressive effects using selective antagonists WAY-100,635 (10.0 microg) and SB-224,289 (1.0 microg).The decrease in aggressiveness observed with microinjections of 5-HT1A and 5-HT1B receptor agonists into the VO PFC of socially provoked mice, supports the hypothesis that activation of these receptors modulates high levels of aggression in a behaviorally specific manner.

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.The goal of this study was to adapt the Hotel Task for use in the Brazilian population.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.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.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.A busca por validade ecológica dos instrumentos neuropsicológicos vem recebendo uma atenção especial nos últimos anos, especialmente daquelas ferramentas que avaliam funções executivas. A Tarefa do Hotel é uma das tarefas ecológicas de exame executivo mais reconhecida internacionalmente, por examinar planejamento, organização, automonitoramento e flexibilidade cognitiva.O objetivo deste estudo é apresentar o processo de adaptação da Tarefa do Hotel para uma versão brasileira.A amostra constitui-se de 27 indivíduos (três tradutores, seis juízes especialistas, sete adultos saudáveis, dez pacientes pós traumatismocranioencefálico e um gerente de hotel). Cinco etapas foram conduzidas, replicadas ao longo do processo:(1) tradução,(2) desenvolvimento de novos estímulos eA versão adaptada mostrou-se adequada e válida para avaliar componentes executivos, sendo necessários estudos futuros em busca de evidências de fidedignidade, validades de construto e de critério, sensibilidade e especificidade, considerando-se as particularidades de uma ferramenta ecológica.Muitas populações clínicas neurológicas e/ou psiquiátricas poderão se beneficiar do exame com a Tarefa do Hotel, por esta auxiliar no diagnóstico de síndrome disexecutiva relacionada à demanda de componentes executivos no cotidiano.

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. As funções executivas estão envolvidas em uma série de distúrbios neurológicos e psiquiátricos humanos. Por esta razão, instrumentos de avaliação adequados com normas estratificadas por idade e escolaridade são necessárias para diagnóstico dos sintomas. OBJETIVO: Apresentar dados normativos para adultos (19 a 75 anos de idade; a partir de cinco anos de educação) no Wisconsin Card Sorting Test Modificado (MWCST), teste Stroop de cores e palavras e no teste de Dígitos. Os efeitos de idade e escolaridade foram investigados. MÉTODOS: Três amostras foram formadas após a análise dos critérios de inclusão e dos dados: MWCST (n=124); Dígitos (n=123) e teste Stroop (n=158). Os grupos foram divididos em jovens (19-39), de meia-idade (40-59) e idosos (60-75) de cinco a oito anos de ensino e nove anos de escolaridade ou mais. Foram utilizados os testes Two-way ANOVA e ANCOVA. RESULTADOS: Efeitos de educação foram encontrados na maioria das variáveis das três tarefas. O efeito idade foi encontrado somente na velocidade de nomeação de cores e nomeação de cor-palavra do teste Stroop. Não foram detectadas interações. CONCLUSÃO: Em países com cenários educacionais heterogêneos, o uso de normas estratificadas por educação para avaliar, pelo menos alguns componentes, das funções executivas é essencial para um diagnóstico cognitivo ético e preciso.

Primary objective: This study aimed to identify and characterize profiles of executive functions (EF) following traumatic brain injury (TBI).Research design: The sample was comprised of 84 adult outpatients with mild and moderate/severe TBI who were assessed by means of a battery of EF tasks. A Hierarchical Cluster analysis was performed with tasks Z-scores. Clusters were compared by means of ANOVA and Chi-square analyses.Main outcomes and results: Three clusters were characterized by deficits in: (1) inhibition, flexibility and focused attention; (2) inhibition, flexibility, working memory and focused attention; and (3) no expressive executive deficits. Clusters did not differ in clinical or demographical variables.Conclusions: The first cluster replicated findings of previous studies on TBI EF profiles. IT is suggested that TBI rehabilitation studies of EF must select participants by their EF profile rather than for clinical or demographical variables.

This study aimed to verify dissociations in the performance of verbal fluency tasks with different production criteria and duration following vascular right-hemisphere damage. We tested the hypothesis that longer fluency tasks would be more sensitive in identifying deficits in the sample. The relationship between verbal fluency performance and sustained attention was also investigated. Forty adults with vascular right-hemisphere damage were assessed using verbal fluency tasks with three different production criteria (unconstrained, phonemic, and semantic fluencies from the Montreal Communication Evaluation Battery). Performance deficits in 1-min and 2-min fluency tasks were calculated (Z score) and compared (chi-square). Results did not suggest a difference in sensitivity between the task lengths in detecting cognitive impairment. However, double dissociations were found, highlighting the contribution of extended verbal fluency tasks to neuropsychological assessment. Analyses also showed that participants exhibited greater levels of impairment in the semantic fluency task. No relationship was identified between performance in sustained attention tasks and verbal fluency tasks, regardless of the latter's duration. The combined use of longer and shorter fluency tasks in the assessment of patients with right brain damage may contribute to the identification of different executive function impairments in this sample.

Background Neuropsychological interventions have been mainly applied with clinical populations, in spite of the need of preventing negative changes across life span. Among the few studies of cognitive stimulation in elderly, surprisingly there is no enough research comparing direct and indirect active stimulation programs. Objective This study aims to verify wheter there are differences between two cognitive interventions approaches in older adults: a structured Working Memory (WM) Training Program versus a Poetry-based Stimulation Program. Methods Fourteen older adults were randomly assigned to participate into one of the two intervention groups. The assessed neurocognitive components were attention, episodic and working memory, communicative and executive functions. WM Training activities were based on Baddeley's model; Poetry-based Stimulation Program was composed by general language activities. Data were analyzed with one-way ANCOVA with Delta scores and pre and post-training tests raw scores. Results WM group improved performance on WM, inhibition, and cognitive flexibility measures, while Poetry group improved on verbal fluency and narrative discourse tasks. Discussion Both approaches presented benefits; however WM Training improved its target function with transfer effects to executive functions, being useful for future studies with a variety of dementias. Poetry-based Stimulation also improved complex linguistic abilities. Both approaches may be helpful as strategies to prevent dysfunctional aging changes.

OBJECTIVE: To present performance norms and discrepancy score of three one-minute verbal fluency tasks (VFTs); to investigate age and education effects; to analyze the differences between time intervals; and to investigate whether these differences varied according to age and education. METHOD: Three hundred adults divided into three age groups (19-39; 40-59; 60-75) and two groups of educational level (2 to 7 years; 8 years or more) performed unconstrained, semantic, and phonemic VFTs. We compared the performance of the groups using two-way ANOVA with post-hoc Bonferroni test. The depression scale score was covariate. The time interval of verbal fluency was the variable used for subjects' comparison (repeated measures ANOVA). RESULTS AND CONCLUSIONS: Our results suggest that there are age and education effects on phonemic and unconstrained VFTs. We also found an interaction between those variables in the semantic VFT (time intervals and total time) and in the differences between semantic and phonemic tasks. The repeated measures analysis revealed age effects on semantic VFTs and education effects on the phonemic and semantic VFTs. Such findings are relevant for clinical neuropsychology, contributing to avoid false-positive or false-negative interpretation.

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 present study compared decision-making processing between patients with traumatic brain injury (TBI) and healthy controls. The study also sought to identify dissociations in the frequency of deficits in executive functions (EF) tasks that mainly assess decision making (DM; hot component) and inhibition (cold component) following TBI. The sample was composed of 16 post-TBI adults aged between 18 and 68 years and 16 healthy controls matched by age and education. Decision-making was assessed with the Iowa Gambling Task (IGT), and inhibitory control was assessed with the Trail Making Task (TMT) and Hayling Test. No differences were found between groups in total scores and block scores on the IGT. However, TBI patients preferred the disadvantageous decks, with no evidence of learning during the task. Seven patients presented dissociations between deficient DM on the IGT and accurate inhibition on the Hayling Test and TMT. Conversely, five patients presented partial dissociations between deficits in the IGT and TMT and opposite performance in the Hayling Test. Only three patients exhibited deficits on all of the instruments. These results indicate that patients can maintain comparable performance on the IGT after TBI. Therefore we found dissociations in hot and cold executive components.

Este artigo visa traçar um panorama das publicações nacionais e internacionais quanto ao estudo das alterações comunicativo-cognitivo-comportamentais associadas as lesões vasculares de hemisfério direito. As bases LILACS e MEDLINE foram consultadas com as palavras-chave em português e em inglês: síndrome, hemisfério e direito. Os estudos foram selecionados a partir de critérios de inclusão. Encontraram-se poucos estudos que abordam essas alterações, todos internacionais, sendo as dificuldades cognitivas as mais descritas. Sequelas em todas as funções cognitivas e nos processamentos comunicativo e emocional são consideradas parte deste quadro. São indispensáveis estudos a respeito das alterações comunicativo-cognitivo-comportamentais pós-AVC de hemisfério direito para identificar diferentes perfis clínicos e contribuir para o aumento da eficácia dos procedimentos de avaliação e de reabilitação.Palavras-chave: neuropsicologia; cognição; hemisfério direito; AVC.

This systematic review aimed to identify the designs, procedures, and results of empirical studies that performed neuropsychological interventions on WM in adults. Methods: A PubMed and LILACS literature search was conducted using the keywords working memory AND (training OR rehabilitation OR intervention) AND adult. Results: Of the seven studies found, three were randomized controlled trials, two were case reports, one was a clinical trial, and one was an evaluation study. With regard to the type of programs and samples, three studies employed global programs with healthy elderly adults and four employed specific programs for samples with neurologically-impaired adults. Conclusions: The effectiveness of the WM intervention programs was more evident in studies that employed specific methods of rehabilitation for samples with neurological disorders than in those based on global programs with healthy adults. There is a need for more empirical studies to verify the effectiveness of WM intervention programs in order to provide adequate guidance for clinical neuropsychologists and future research. Resumo Essa revisão sistemática teve como objetivo identificar os delineamentos, procedimentos, e resultados dos estudos empíricos que investigaram intervenções neuropsicológicas de memória de trabalho em adultos. Métodos: Foi realizada uma busca da literatura nas bases de dados PubMed e LILACS, utilizando as palavras-chave memória de trabalho working memory AND (training OR rehabilitation OR intervention) AND adult, ou memória de trabalho E (treino OU reabilitação OU intervenção) E adulto. Resultados: De sete estudos encontrados, três eram estudos randomizados controlados, dois eram relatos de casos, um era um ensaio clínico, e um estudo, de avaliação neuropsicológica. Em relação ao tipo de programa e amostra, três estudos foram conduzidos utilizando programas globais de intervenção com idosos saudáveis e quatro utilizaram-se de programas específicos de intervenção com amostras clínicas de pacientes neurológicos. Conclusões: A efetividade dos programas de intervenção em memória de trabalho foi mais evidente em estudos que empregaram métodos específicos de reabilitação com amostras clínicas neurológicas, quando comparados àqueles baseados em programas gerais de intervenção com adultos saudáveis. Existe necessidade de estudos empíricos que verifiquem a eficácia de programas de intervenção em memória de trabalho que possam contribuir com orientações adequadas para neuropsicológos clínicos e para futuras pesquisas.