Search

Introdução: No Brasil encontra-se dificuldade em usar testes de leitura de palavras irregulares para mensurar a inteligência pré-mórbida, pois o portugues e uma língua translúcida, que apresenta fonemas com grande correspondência aos respectivos grafemas. Para transpor esta dificuldade desenvolve-se a versão brasileira do Teste de Acentuação de Palavras (TAP-Br) baseado na pronúncia de palavras grafadas sem o acento indicativo da sílaba tônica, criando assim a irregularidade grafema-fonema. Há evidências de que esse tipo de teste avalie habilidades cristalizadas, que sofram pouco impacto relacionado aos danos cerebrais. Objetivos: Desenvolver e estudar as propriedades do TAP-Br e sua resistência às fases iniciais do comprometimento cognitivo. Método: O estudo foi dividido em duas fases. Na Fase 1 descreveu-se a construção do conjunto inicial de 60 itens para formação do TAP-Br. Após, o conjunto inicial de itens foi reduzido para 40 por meio da análise de teoria de resposta ao item em uma amostra de 206 idosos normais. Avaliou-se a estrutura fatorial com a técnica de análise paralela de Horn e a consistência interna com o alfa de Cronbach. Verificou-se a correlação do teste com uma medida de QI considerada padrão-ouro, Wechsler Abbreviated Scale of Intelligence WASI e se o TAP-Br apresentava boa correlação com medidas neuropsicológicas clássicas representativas dos principais domínios cognitivos. Avaliou-se a confiabilidade interexaminador em uma subamostra de 40 participantes selecionados aleatoriamente. A Fase 2 foi realizada em uma amostra adicional de 135 pacientes encaminhados por suspeita de comprometimento cognitivo que foram classificados em uma das três seguintes categorias, após avaliação clínica e neuropsicológica: desempenho cognitivo normal (DCN), comprometimento cognitivo leve amnéstico (CCLa) e demência de Alzheimer leve (DA). Nessa fase, verificou-se se o TAP-Br apresentaria estabilidade em idosos com CCLa e DA leve quando comparado aos idosos com DCN. Por fim, uma subamostra de 40 idosos foi submetida a uma nova administração do teste, após 1 ano para avaliação de confiabilidade testereteste. Resultados: O TAP-Br mostrou excelente consistência interna (0,95) e sua estrutura de fator único foi confirmada. Mostrou boa confiabilidade interobservador (Coeficiente de correlação intraclasse - CCI de 0,92). Demonstrou ser altamente correlacionado com a capacidade intelectual total da WASI em idosos cognitivamente normais (r = 0,83). A adição do escore do TAP-Br a um modelo que já continha o número de anos de educação melhorou a variância explicada do escore global composto em 15% (de 47% para 62%; p < 0,001). Houve estabilidade de desempenho no TAP-Br entre os grupos avaliados: DCN, CCLa e DA leve (p = 0,603). A confiabilidade teste-reteste foi avaliada após uma média de 12,7 (±0,7) meses, com CCI de 0,97 (IC 95%; 0,94 - 0,98), revelando ótima confiabilidade. Conclusão: O TAP-Br mostrou ser um instrumento válido para avaliação da inteligência pré-mórbida, podendo ser incluído nos protocolos de avaliação neuropsicológica brasileira. Introduction: It is difficult to use irregular word reading tests to measure premorbid intelligence in Brazil, since portuguese is a translucent language, which presents phonemes with good correspondence with graphemes. To overcome this difficulty we developed the Brazilian version of the Word Accent Test (WAT-Br) based on the pronunciation of spelled words without the accent indicative of the stressed syllable, thus creating the graphemephoneme irregularity. There is evidence that this type of test evaluates crystallized abilities, which suffer little impact related to brain damage. Objectives: Developing and studying the properties of a Brazilian version of the Word Accentuation Test (WAT-Br) and its resistance to the early stages of cognitive impairment. Method: The study was divided into two phases. Phase 1 described the construction of the initial set of 60 items for the formation of WAT-Br. After, the initial set of items was reduced to 40 through item response theory analysis in a sample of 206 normal elderly. The factorial structure was evaluated using Horn\'s parallel analysis technique and the internal consistency with the Cronbach\'s alpha. The correlation of the test with a measure of IQ considered gold standard, Wechsler Abbreviated Scale of Intelligence (WASI), and whether WAT-Br showed a good correlation with classic neuropsychological measures representative of the main cognitive domains were verified. Inter-examiner reliability was evaluated in a randomly selected sub-sample of 40 participants. Phase 2 was performed in an additional sample of 135 patients referred for suspicion of cognitive impairment who were classified into one of the following three categories, after clinical and neuropsychological evaluation: Normal Cognitive Aging (NCA), Amnestic Mild Cognitive Impairment (aMCI), and mild Dementia of Alzheimer\'s Disease (AD). In this phase, the hypothesis was that WAT-Br resisted and maintained stability in the early stages of cognitive decline, with the compromised (aMCI and mild AD) presenting similar performance to the NCA. Finally, a sub-sample of 40 subjects underwent a new administration of the test after one year for evaluation of test-retest reliability. Results: WATBr showed excellent internal consistency (0,95) and its single-factor structure was confirmed. It showed good inter-observer reliability (Intraclass Correlation Coefficient - ICC of 0,92). It was shown to be highly correlated with total intellectual capacity (WASI) in NCA (r = 0,83). The addition of the WAT-Br score to a model that already containing the number of years of education improved the explained variance of the composite global score by 15% (from 47 to 62%, p < 0,001). There was stability of WAT-Br performance among the evaluated groups: NCA, aMCI and mild AD (p = 0,603). The testretest reliability was evaluated after a mean of 12,7 (± 0,7) months, with ICC of 0,97 (95 %; CI 0,94 0,98), revealing optimal reliability. Conclusion: WAT-Br showed to be a valid instrument for the evaluation of premorbid IQ, and can be included in Brazilian protocols of neuropsychological evaluation.

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.

Objectives:To ascertain and compare the performance of adult and elderly participants in attention, memory, mood and metamemory assessments, before and after participating in the intergenerational multidisciplinary cognitive stimulation program.Method:The medical records of 79 male and female patients, aged 40 years and older, were selected between 2008 and 2012. Each participant had at least 11 years of schooling and complained of subjective memory deficiencies. Dementia, as defined by the Diagnostic and Statistical Manual of Mental Disorders - DSM-IV-TR, was ruled out as a cause of such complaints among the patients. The results of cognitive test evaluations, mood scale and subjective memory complaint questionnaire scores were assembled, before and after patient participation in the stimulation program, which consisted of twenty 100 minute sessions that were conducted in a large hospital in the city of Sao Paulo.Results:There was an improvement in patient performance, not only regarding attention tests but also memory tests (p

Memory clinics were established in the USA and European countries as services to attend patients who complain of cognitive deficits, referred by primary care doctors, specialists and other hospitals. Objective: We aimed to describe the clinical and cognitive profile of consecutively evaluated subjects during the initial three years of service of a memory clinic from a university hospital. Methods: Subjects were submitted to a clinical work-up for dementia, which included laboratory exams, cranial computerized tomography, cognitive tests, and a comprehensive neuropsychological battery. Diagnosis was made according to ICD-10 criteria. Results: We evaluated 104 subjects (67.3% females and 32.7% males), with mean age of 59.1 years, 88.8% aged 50 years or above. Mean schooling was 9.9 years. Patients were classified into 10 different primary diagnostic categories, namely Depression (26.9%), Alzheimer's disease (17.3%), Memory complaints without objective impairment (17.3%), Mild Cognitive Disorder - MCD (14.4%), and Anxiety (12.5%) the most frequent diagnosis. Comparing patients with dementia, MCD, Depression or Anxiety and Memory complainers, by age (below and above 60 years), dementia was more commonly diagnosed in older subjects, while a higher frequency of memory complainers was found in the younger group. Conclusions: This preliminary report from an outpatient group of referred patients with cognitive complaints showed a higher frequency of psychiatric disorders in this sample. The memory clinic approach should be considered as a model of service which can evaluate subjects with cognitive complaints effectively and improve the quality of care delivered to this patient group. Resumo Clínicas de memória foram estabelecidas nos EUA e em países europeus como serviços para atender pacientes que se queixam de déficits cognitivos, encaminhados por médicos em cuidados primários, especialistas e outros hospitais. Objetivo: Nós pretendemos descrever o perfil clínico e cognitivo de sujeitos consecutivamente avaliados nos primeiros três anos de funcionamento de uma clínica de memória de um hospital universitário. Metódos: Os sujeitos foram submetidos a avaliação clínica para demência, incluindo exames laboratoriais, tomografia computadorizada de crânio, testes cognitivos e uma bateria neuropsicológica completa. Diagnóstico foi feito segundo critérios da CID-10. Resultados: Nós avaliamos 104 sujeitos (67,3% mulheres e 32,7% homens), com idade média de 59,1 anos, 88,8% com mais de 50 anos de idade. A escolaridade média era de 9,9 anos. Pacientes foram classificados em 10 categorias diagnósticas primárias diferentes, sendo Depressão (26,9%), doença de Alzheimer (17,3%), Queixas de memória sem comprometimento objetivo (17,3%), Transtorno cognitivo leve - TCL (14,4%), e Ansiedade (12,5%) as mais freqüentes. Comparando pacientes com demência, TCL, Depressão ou Ansiedade e aqueles com Queixa de memória, por idade (abaixo e acima de 60 anos), demência foi mais comumente diagnosticada nos idosos, enquanto maior freqüência daqueles com queixa de memória foi encontrada nos mais jovens. Conclusões: Este relato preliminar de pacientes ambulatoriais encaminhados com queixas cognitivas mostrou uma freqüência elevada de transtornos psiquiátricos nesta amostra. A abordagem da clínica de memória deveria ser considerada como um modelo de serviço para avaliar efetivamente sujeitos com queixas cognitivas, podendo melhorar a qualidade do cuidado prestado a estas pessoas.

Objective To evaluate efficacy and tolerability of unilateral (RUL) and bilateral (BL) electroconvulsive therapy (ECT) in the elderly with depression. Methods Thirty-nine elderly inpatients with major depression referred to ECT were randomized into RUL or BL ECT, using high, fixed electrical doses. Cognition and depression severity were assessed before, during, and 1 month after treatment. Adverse effects were assessed after each session. Results Remission rates for RUL ECT (88.2%) and BL ECT (68.2%) were similar (P = 0.25). Reduction rates of depressive symptoms were also similar. There were no serious adverse events. There were more adverse effects in the BL ECT group (P = 0.05). BL ECT showed more short-term cognitive impairment, whereas improvements in neuropsychological scores were seen in both groups. Conclusion In elderly depressive subjects, high-dose RUL ECT is as effective as BL ECT yet produces less adverse effects and less cognitive impairment.

Medical residency is generally acknowledged to be stressful, especially during the internship period. Residents are susceptible to fatigue and chronic sleep deprivation due to their prolonged work hours and rotating work schedules.1 For the first time, in 2003, the Accreditation Council for Graduate Medical Education (ACGME) in the U.S. implemented limits of 30 consecutive work hours and 80 weekly hours for resident physicians across all specialties, to protect doctors and patients from the unsafe conditions that can result from excessive fatigue.2 Following the implementation of these regulations, increasing public and academic attention has been focused on the role of resident physicians' fatigue and the occurrence of medical errors, percutaneous needle sticks, laceration injuries and post-call motor vehicle crashes.3,4 A landmark study of resident physicians working in an adult intensive care unit has received a great deal of attention in the medical community.5 This study found that residents made more medical errors when they worked frequent shifts of at least 24 h than when they worked shorter shifts. A work hour limit of 60 h per week was instituted in Brazil in 1981,6 but even with this regulation, many studies have identified problems during medical residency, such as depression and anxiety,7 burnout,8 daytime sleepiness9 and impairment of quality of life.10,11 The aim of our study was to compare the cognitive performance of first-year internal medicine residents after a night on call in the emergency room (ER) and after a night off duty during training using neuropsychological tests. The study was performed during the normal shift on an internal medicine ward at a university hospital with a work hour restriction of 60 h per week.

Physical activity has been indicated as a strategy to promote health in the elderly, as well as to encourage the maintenance of functional capacity, and acts in the prevention and control of various diseases. In recent years, there has been great interest in studying the benefits of physical activity in the preservation or even improvement of cognitive performance in both the elderly without cognitive impairment and in elderly patients with some degree of cognitive impairment or dementia. The majority of epidemiological studies and clinical trials have evaluated aerobic exercises while few have assessed resistance exercise programs. The objective of this review was to examine the effects of different types of physical activity on cognitive function of elderly individuals with or without prior impairment. Resumo A atividade física tem sido amplamente indicada como uma estratégia para a promoção de saúde no idoso, pois além de favorecer a manutenção da capacidade funcional, atua na prevenção e controle de diversas doenças. Nos últimos anos, tem havido um forte interesse em estudar os benefícios da atividade física na preservação ou mesmo na melhora do desempenho cognitivo tanto em idosos sem comprometimento cognitivo como em idosos com algum comprometimento cognitivo e demência. Os estudos epidemiológicos e a maioria dos ensaios clínicos avaliaram os exercícios aeróbios e poucos ensaios clínicos adotaram programas de exercícios resistidos. O objetivo desta revisão é analisar os efeitos de diferentes tipos de atividade física na função cognitiva de idosos com ou sem comprometimento prévio.