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INTRODUÇÃO: O hematoma subdural crônico (HSDC) é uma das condições mais comuns encontradas na prática neurocirúrgica e frequentemente acomete pacientes idosos. São escassos os estudos que investigam os aspectos cognitivos pós-operatórios recentes e/ou tardios de idosos acometidos por HSDC. O objetivo primário deste estudo foi avaliar o desempenho cognitivo no pós-operatório recente e tardio de idosos acometidos por hematomas subdurais crônicos. MÉTODOS: Trata-se de um estudo de coorte prospectiva que incluiu pacientes idosos (60 anos ou mais) que realizaram tratamento cirúrgico de HSDC e grupo controle composto por indivíduos saudáveis. Os pacientes foram avaliados 1 mês após o procedimento cirúrgico (fase 1) e reavaliados após 7 meses (fase 2). Os testes neuropsicológicos foram agrupados em cinco domínios (atenção, funcionamento executivo, memória de longo prazo, linguagem e visuopercepção), com pontuação padronizada (z-score). Também utilizou-se escalas de funcionalidade e humor. Foram conduzidas analises estatísticas descritivas, correlações de Spearman ou Pearson, comparações entre grupos com Mann-Whitney ou T-Student e análises de regressão multivariada. RESULTADOS: Foram incluídos 81 idosos, distribuídos em dois grupos. Trinta e nove indivíduos realizaram tratamento cirúrgico de HSDC, sendo 56,4% do sexo masculino, com idade média de 74,8 ± 7,9 anos (range 60-90 anos) e escolaridade média de 7,1 ± 3,6 anos (range 4-16 anos). O grupo controle foi composto por 42 indivíduos, sendo 56,4% do sexo masculino, com idade média de 71,9 anos ± 5,3 anos (range 61-83 anos) e escolaridade média de 8,4 anos ± 3,3 anos (range 4-16). Na comparação entre grupo controle e doentes na fase 1, houve diferença significativa nos domínios atenção (p < 0,001), linguagem (p=0,002) e visuopercepção (p=0,029). Na fase 2, a comparação entre grupo controle e doentes evidenciou diferenças significativas para os domínios atenção (p < 0,001) e funcionamento executivo (p=0,033). Também para a fase 2, foi evidenciada correlação entre a reserva cognitiva e todos os domínios cognitivos: atenção (r²=0.651, p < 0.001), funcionamento executivo (r²=0.680, p < 0.001), memória de longo prazo (r²=0.505, p=0.001), linguagem (r²=0.522, p < 0.001) e visuopercepção (r²=0.595, p < 0.001). Observou-se ainda correlação negativa entre a idade e atenção (p=0,019, r=-0,372) e funcionamento executivo (p=0,005, r=-0,434). Verificou-se correlação positiva entre a escolaridade e atenção (p =< 0,001; r=0,650) e funcionamento executivo (p =< 0,001; r=0.579), bem como com a memória de longo prazo (p=0.017; r=0,379) e visuopercepção (p=0,003; r=0,458). Na análise multivariada, a reserva cognitiva manteve associação consistente com todos os domínios cognitivos. Não houve associação entre os sintomas de humor e os domínios cognitivos. Com o passar do tempo houve melhora apenas no domínio linguagem (p =< 0,001). Houve melhora na capacidade funcional (p =< 0,001) e tendência à significância na redução da frequência dos sintomas ansiosos (p=0,054). CONCLUSÃO: Os idosos que realizaram procedimento cirúrgico para HSDC apresentaram comprometimento na avaliação neuropsicológica, com perfil cognitivo recente caracterizado por prejuízo na atenção, linguagem e visuopercepção, enquanto no desfecho tardio houve prejuízo em atenção e funcionamento executivo. Houve associação consistente entre a reserva cognitiva e melhor desempenho neuropsicológico na avaliação tardia. Sintomas ansiosos e funcionalidade tendem a apresentar melhora com o passar do tempo INTRODUCTION: Chronic subdural hematoma (CSDH) is one of the most common conditions found in neurosurgical practice and often affects elderly patients. There is a shortage of studies investigating the early and/or late postoperative cognitive aspects of elderly people suffering from CSDH. The main goal of this study was to evaluate the early and late postoperative cognitive performance of elderly people with chronic subdural hematomas. METHODS: This is a prospective cohort study that included elderly patients (60 years or older) who underwent surgical treatment for CSDH and a control group composed of healthy individuals. Patients were evaluated 1 month after the surgical procedure (phase 1) and re-evaluated after 7 months (phase 2). Neuropsychological tests were grouped into five domains (attention, executive functioning, long-term memory, language and visual perception), with a standardized score (z-score). We also used functionality and mood scales. Moreover, we performed descriptive statistical analyzes, Spearman or Pearson correlations, comparisons between groups with Mann-Whitney or T-Student, and multivariate regression analyzes. RESULTS: We included a total of 81 elderly people, divided into two groups. We noted that 39 individuals underwent surgical treatment for CSDH, 56.4% of them were men, with an average age of 74.8 ± 7.9 years (range 60-90 years) and an average education level of 7.1 ± 3.6 years (range 4-16 years). The control group was composed of 42 individuals, 56.4% of them were men, with an average age of 71.9 years ± 5.3 years (range 61-83 years) and an average education level of 8.4 years ± 3.3 years (range 4-16). In the comparison between control group and patients in phase 1, there was a significant difference in the attention (p < 0.001), language (p=0.002) and visual perception (p=0.029) domains. In phase 2, the comparison between control group and patients showed significant differences for the attention (p < 0.001) and executive functioning (p=0.033) domains. Also in phase 2, we found a correlation between cognitive reserve and all cognitive domains: attention (r²=0.651; p < 0.001), executive functioning (r²=0.680; p < 0.001), long-term memory (r²=0.505; p=0.001), language (r²=0.522; p < 0.001) and visual perception (r²=0.595; p < 0.001). We also noted a negative correlation between age and attention (p=0.019; r=-0.372) and executive functioning (p=0.005; r=-0.434). Moreover, we found a positive correlation between education level and attention (p =< 0.001; r=0.650) and executive functioning (p =< 0.001; r=0.579), as well as with long-term memory (p=0.017; r=0.379) and visual perception (p =0.003; r=0.458). In multivariate analysis, cognitive reserve maintained a consistent association with all cognitive domains. There was no association between mood symptoms and cognitive domains. But as time passed, there was an improvement only in the language domain (p =< 0.001). In addition, there was an improvement in functional capacity (p =< 0.001) and a tendency towards significance in reducing the frequency of anxious symptoms (p=0.054). CONCLUSION: The elderly patients who underwent surgical procedures for CSDH showed impairment in neuropsychological evaluation, with early cognitive profile characterized by impaired attention, language and visual perception; while in late outcome, there was impairment in attention and executive functioning. There was a consistent association between cognitive reserve and better neuropsychological performance in the late evaluation. Anxious symptoms and functionality tend to show improvements as time passes

The Word Accentuation Test (WAT) has been used to predict premorbid intelligence and cognitive performance in Spanish-speaking populations. It requires participants to read a list of words without the accent marks that indicate the stressed syllable. Objective: As Portuguese pronunciation is also strongly based on accent marks, our aim was to develop a Brazilian version of the WAT. Methods: An initial pool of 60 items was constructed and a final version of 40 items (named WAT-Br) was derived by item response theory. A sample of 206 older adults underwent the WAT-Br and a standardized neuropsychological battery. Independent ratings were performed by two observers in 58 random participants. Results: The items showed moderate to high discrimination (α between 0.93 and 25.04) and spanned a wide range of difficulty (β between −2.07 and 1.40). The WAT-Br was shown to have an excellent internal consistency (Kuder-Richardson Formula 20 = 0.95) and inter-rater reliability (intraclass correlation coefficient = 0.92). It accounted for 61% of the variance in global cognitive performance. Conclusion: A version of the WAT for Portuguese-speaking populations was developed and proved to be a valuable tool for estimating cognitive performance. RESUMO O Teste de Acentuação de Palavras (TAP) tem sido utilizado para predizer inteligência pré-mórbida e desempenho cognitivo em populações de língua espanhola. Requer que os sujeitos leiam uma lista de palavras sem os sinais gráficos de acentuação que indicam a sílaba tônica. Objetivo: Como a pronúncia da língua portuguesa também é fortemente baseada em acentos gráficos, nosso objetivo foi desenvolver uma versão brasileira do TAP. Métodos: Um conjunto inicial de 60 itens foi construído e uma versão final de 40 itens (denominada TAP-Br) foi derivada por teoria da resposta ao item. Uma amostra de 206 idosos foi submetida ao TAP-Br e a uma bateria neuropsicológica padronizada. Registros de pontuação independentes foram realizados por dois observadores em uma subamostra de 58 participantes aleatórios. Resultados: Os itens apresentaram moderada a alta discriminação (α entre 0,93 e 25,04) e abrangeram uma ampla gama de dificuldades (β entre −2,07 e 1,40). O TAP-Br apresentou excelente consistência interna (Fórmula de Kuder-Richardson 20 = 0,95) e confiabilidade inter-examinador (Coeficiente de Correlação Intraclasse = 0,92). O escore do TAP-Br explicou 61% da variância do desempenho cognitivo global. Conclusão: Uma versão do TAP para as populações de língua portuguesa foi desenvolvida e mostrou-se uma ferramenta útil para estimar desempenho cognitivo.

Objective:Decision-making (DM) is a component of executive functioning. DM is essential to make proper decisions regarding important life and health issues. DM can be impaired in cognitive disorders among older adults, but current literature is scarce. The aim of this study was to evaluate the DM profile in participants with and without cognitive impairment.Design:Cross-sectional analysis of a cohort study on cognitive aging.Participants:143 older adults.Setting:University-based memory clinic.Methods:Patients comprised three groups after inclusion and exclusion criteria: healthy controls (n=29), mild cognitive impairment (n=81) and dementia (n=33). Participants were evaluated using an extensive neuropsychological protocol. DM profile was evaluated by the Melbourne Decision Making Questionnaire. Multinomial logistic regression was used to evaluate associations between age, sex, educational level, estimated intelligence quotient (IQ), cognitive disorders, depressive or anxiety symptoms, and the DM profiles.Results:The most prevalent DM profile was the vigilant type, having a prevalence of 64.3%. The vigilant profile also predominated in all three groups. The multinomial logistic regression showed that the avoidance profile (i.e. buck-passing) was associated with a greater presence of dementia (p=0.046) and depressive symptoms (p=0.024), but with less anxious symptoms (p=0.047). The procrastination profile was also associated with depressive symptoms (p=0.048). Finally, the hypervigilant profile was associated with a lower pre-morbid IQ (p=0.007).Conclusion:Older adults with cognitive impairment tended to make more unfavorable choices and have a more dysfunctional DM profile compared to healthy elders.