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The Ruche test is a visuospatial form of the Rey auditory verbal learning test (RAVLT), with initial evidence of utility in the diagnosis of temporal lobe epilepsy (TLE)-related memory disorders.To present the translation to Brazilian Portuguese and modification of the Ruche test (RUCHE-M) and compare the RUCHE-M and RAVLT performance between patients with right and left TLE.Twenty-five neuropsychologists participated in instrument adaptation. Thirty-seven patients with right (All specialists considered the final RUCHE-M to be adequate. The RUCHE-M forgetting speed index (FSI) score and several RAVLT scores differed significantly between patients with right and left TLE.The RUCHE-M showed limited utility for the assessment of visuospatial episodic memory in patients with TLE. The manipulation of memory binding as demonstrated by FSI score seems to be a promising paradigm for the assessment of right hippocampal function.

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.

Introduction Self-awareness of cognitive, emotional, functional, and social performance is critical for compliance with treatment. However, few studies have investigated self-awareness and the associated effects on other cognitive variables in patients with temporal lobe epilepsy (TLE) after surgical treatment. Aim This study was designed to investigate the prevalence of impaired self-awareness (ISA) in patients with TLE who have undergone surgical treatment. Associated correlations with clinical variables (frequency of seizures before surgery, time elapsed since the epilepsy diagnosis, depression, and anxiety) and verbal and visual episodic memory function and differences between patients with right and left TLE were also investigated. Method Twenty-three adults with TLE after surgical treatment were assessed with the Patient Competency Rating Scale (PCRS-R-BR), the Rey Auditory Verbal Learning Task (RAVLT), and the Modified Ruche Visuospatial Learning Test (RUCHE-M). Patients were considered to have memory dysfunction if delayed recall as assessed with the RUCHE-M or RAVLT was at or below the 25th percentile. Patients were considered to have ISA if PCRS-R-BR discrepancy scores were at or above the 75th percentile. Underestimated cognitive ability (UCA) was defined as a PCRS-R-BR discrepancy percentile score ≤ 25. Results were analyzed using frequency, Spearman correlation, regression analyses, and the Mann–Whitney test. Results Frequency analysis of the total sample indicated ISA in 39.13% of patients (n = 9), UCA in 39.13% of patients (n = 9), and impaired verbal and/or visual memory performance in 69.56% of patients (n = 16). Moderate positive correlations were found between the frequency of seizures before surgical treatment and relatives' reports, as well as between the duration of time that had elapsed since the epilepsy diagnosis and patient reports. Negative and moderate correlations were found between the frequency of seizures and the discrepancy score, as well as between depression and patient reports. No differences in PCRS-R-BR were found between patients with right vs. left TLE. No clinical variables significantly predicted self-report or self-awareness. Conclusion Patients with TLE exhibit various patterns of ISA and negative effects on cognitive function after surgical treatment. Emotional factors and relatives' reports must be considered when assessing these patients.

The aim of this study was to evaluate white matter (WM) integrity in vivo in patients with unilateral mesial temporal sclerosis (MTS).Diffusion tensor imaging (DTI) findings from patients with left-sided MTS (L-MTS; N = 14) and right-sided MTS (R-MTS; N = 13), all taking antiepileptic medication, were compared with those from gender- and age-matched controls; DTI was performed along 30 noncollinear directions in a 1.5-T scanner. Tract-based spatial statistics (TBSS) analysis was performed by creating a WM skeleton; 5000-permutation-based inference (threshold, p 0.05) was used to identify fractional anisotropy (FA) abnormalities. Mean (MD), radial (RD), and axial diffusivities (AD) were projected onto the mean FA skeleton.Compared with the control groups, patients with MTS had decreased FA affecting widespread WM tracts as well as extensive areas with increased RD, bilaterally and independent of the disease side. Areas with decreased FA and increased RD overlapped substantially. There were no significant differences in DTI parameters between L-MTS and R-MTS patients.Diffusion tensor imaging abnormalities were observed within and beyond the temporal lobe in patients with MTS. Patients with R- and L-MTS had extensive bilateral abnormalities in comparison to controls. These findings suggest that MTS pathobiology involves diffuse dysfunction of WM tracts, even in areas with no direct connections to the hippocampus.

Purpose Cognitive dysfunction is common in neuropsychiatric systemic lupus erythematosus (SLE). Memory is a commonly affected cognitive domain. Clinically, however, it is difficult to detect memory deficits. The objective of this study is to evaluate whether normal controls and SLE patients with and without memory deficit differ in terms of white-matter integrity. Methods Twenty SLE patients with memory deficit were compared to 47 SLE patients without memory deficit and 22 sex-, age-, and education-matched control individuals. Diffusion tensor imaging (DTI) was performed in a 1.5-Tesla scanner. For tract-based spatial statistics analysis, a white-matter skeleton was created. A permutation-based inference with 5000 permutations with a threshold of p Results Compared to controls, SLE patients with and without memory deficit had decreased FA in: bilateral anterior thalamic radiation, inferior fronto-occipital fasciculus, superior longitudinal fasciculus, uncinate fasciculus, corticospinal tract, genu, and body of the corpus callosum. SLE patients with and without memory deficit also presented increased MD and RD values compared to controls in these areas. Comparison between SLE patients with and without memory deficit did not present significant differences in DTI parameters. Conclusion DTI can detect extensive abnormalities in the normal-appearing white matter of SLE patients with and without memory deficit, compared to controls. However, there was no difference, in terms of white-matter integrity, between the groups of SLE patients.

Objective: We aimed to evaluate whether human immunodeficiency virus (HIV)-positive patients with and without clinically significant memory deficits and healthy control participants differ on in vivo hydrogen-1 magnetic resonance spectroscopy (H-MRS) in the posterior cingulate gyri. Materials and Methods: In total, 21 HIV-positive patients with memory deficit (HIV+wMD) were compared with 15 HIV-positive patients without memory deficit (HIV+wOMD) and 22 sex-, age-, and education-matched control participants. Memory impairments were classified based on the participants’ performance on the Rey Auditory Verbal Learning Test. Short echo time (30 ms), single-voxel H-MRS was performed using a 1.5-T magnetic resonance scanner. Results: The HIV+wMD and HIV+wOMD groups had higher choline/creatine ratio in the posterior cingulate gyri than the control group. There were no significant metabolite ratio differences between the HIV+wMD and HIV+wOMD groups. Conclusion: HIV-positive patients with and without memory deficits had significantly higher choline/creatine ratios than controls in the posterior cingulate gyri, which may reflect cerebral inflammation, altered cell membrane metabolism, microgliosis, and/or astrocytosis. Resumo Objetivo: Nós avaliamos se os pacientes HIV-positivos com e sem déficits de memória clinicamente significativos e controles saudáveis diferem na espectroscopia de prótons do giro do cíngulo posterior, por ressonância magnética (RM) cerebral. Materiais e Métodos: Vinte e um pacientes HIV-positivos com déficit de memória foram comparados com 15 pacientes HIV-positivos sem déficit de memória e 22 controles, pareados por sexo, idade e escolaridade. As deficiências de memória foram classificadas por meio do desempenho no Teste de Aprendizagem Auditivo-Verbal de Rey. A espectroscopia de prótons foi realizada com tempo de eco curto (30 ms), por voxel único, no giro do cíngulo posterior, utilizando aparelho de RM de 1,5 T. Resultados: Os pacientes HIV-positivos com e sem déficit de memória apresentaram aumento da relação colina/creatina no giro do cíngulo posterior, comparados aos controles. Não houve diferenças significativas nas relações metabólicas no grupo HIV-positivo com déficit de memória, em relação ao grupo de pacientes HIV-positivo sem déficit. Conclusão: Pacientes HIV-positivos com e sem déficits de memória apresentaram relações colina/creatina significativamente aumentadas em relação aos controles, no giro do cíngulo posterior, o que pode refletir inflamação cerebral, alteração do metabolismo da membrana celular, microgliose e/ou astrocitose.

The objective of this study was to evaluate the cortical thickness and the volume of deep gray matter structures, measured from 3D T1-weighted gradient echo imaging, and white matter integrity, by diffusion tensor imaging (DTI) in patients with typical absence epilepsy (AE). Patients (n = 19) with typical childhood AE and juvenile AE, currently taking antiepileptic medication, were compared with control subjects (n = 19), matched for gender and age. 3D T1 magnetization-prepared rapid gradient echo-weighted imaging and DTI along 30 noncolinear directions were performed using a 1.5-T MR scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of deep gray matter structures. For tract-based spatial statistics analysis of DTI, a white matter skeleton was created, along with a permutation-based inference with 5000 permutations. A threshold of p

Purpose To determine whether systemic lupus erythematosus (SLE) affecting subcortical white matter volumes, deep gray matter volumes, and cortical thickness differ between groups of SLE patients with psychiatric (P-SLE), neurological (N-SLE), or nonneuropsychiatric (non-NPSLE) presentations. Materials and methods Sixty-seven participants were divided into three groups (P-SLE [n = 19], N-SLE [n = 12], and non-NPSLE [n = 36]) and examined with a 1.5T MRI scanner. The images were segmented in FreeSurfer software into volumetric and cortical thickness measures using T1 3D magnetization prepared rapid gradient echo-weighted imaging. For comparative analyses of volume, multivariate analyses of covariance (MANCOVA) were applied followed by Bonferroni post-hoc tests, with age as a covariate. For cortical thickness analyses, the groups were compared with the Query Design Estimate Contrast tool adjusted for age. Results Globus pallidus volumes in both left (P ≤ 0.01) and right (P ≤ 0.05) hemispheres were larger in the N-SLE group than in the non-NPSLE group, and the left GP volume was greater in the N-SLE group than in the P-SLE group (P ≤ 0.05) (MANCOVA, post-hoc Bonferroni). The P-SLE group presented with thinning of cortical areas relative to the N-SLE (predominantly in the left parietal and right frontal and parietal regions) (P ≤ 0.05) and non-NPSLE (predominantly in parietal and occipital regions) (P ≤ 0.05) groups, whereas the N-SLE group presented with thickening of cortical areas (mostly right frontal and left parietal regions) relative to the non-NPSLE (P ≤ 0.05) and P-SLE groups. Conclusion N-SLE patients had greater local volumes and cortical thicknesses than the other two groups, whereas P-SLE patients presented with decreased volumes and cortical thinning. These findings provide evidence of distinct neuroanatomical abnormalities in neurological versus psychiatric manifestations of SLE. Level of evidence 2 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:150-158.

BACKGROUND AND PURPOSE The purpose of this study was to investigate differences in brain cortical thickness of systemic lupus erythematosus (SLE) patients with and without episodic memory impairment and healthy controls. METHODS We studied 51 patients divided in 2 groups (SLE with episodic memory deficit, n = 17; SLE without episodic memory deficit, n = 34) by the Rey Auditory Verbal Learning Test and 34 healthy controls. Groups were paired based on sex, age, education, Mini-Mental State Examination score, and accumulation of disease burden. Cortical thickness from magnetic resonance imaging scans was determined using the FreeSurfer software package. RESULTS SLE patients with episodic memory deficits presented reduced cortical thickness in the left supramarginal cortex and superior temporal gyrus when compared to the control group and in the right superior frontal, caudal, and rostral middle frontal and precentral gyri when compared to the SLE group without episodic memory impairment considering time since diagnosis of SLE as covaried. There were no significant differences in the cortical thickness between the SLE without episodic memory and control groups. CONCLUSIONS Different memory-related cortical regions thinning were found in the episodic memory deficit group when individually compared to the groups of patients without memory impairment and healthy controls.

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.

The aim of this study was to evaluate the white matter integrity in brains of patients with systemic lupus erythematosus (SLE) using a voxel-based analyses of diffusion tensor imaging (DTI) data. Fifty-seven patients with SLE were compared to 36 control patients who were matched by gender, age, education, and Mini Mental State Examination score. DTI was performed along 30 noncollinear directions in a 1.5 Tesla scanner. For tract-based spatial statistics (TBSS), a white matter skeleton was created, and a permutation-based inference with 5000 permutations and a threshold of p

Purpose To longitudinally evaluate the cortical thickness and deep gray matter structures volume, measured from T1 three-dimensional (3D) Gradient echo-weighted imaging, and white matter integrity, assessed from diffusion tensor imaging (DTI) of HIV-positive patients. Materials and Methods Twenty-one HIV-positive patients on stable highly active antiretroviral therapy (HAART) with CD4+ T lymphocytes count >200 cells/mL and viral load

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.

Purpose To evaluate whether human immunodeficiency virus (HIV)-positive patients with and without executive functions deficits and healthy control subjects differ on cortical thickness and subcortical brain structures volume in vivo. Methods In total, 34 HIV-positive patients with executive functions deficits were compared with 13 HIV-positive patients without executive functions deficits and 19 gender-, age-, and education-matched control subjects. Executive functions impairments were classified by performance on the Wisconsin card sorting test. T1 3-dimensional magnetization prepared rapid gradient echo-weighted imaging was performed using a 1.5 Tesla (magnetic resonance) MR scanner. FreeSurfer software was used to perform cortical reconstruction and volumetric segmentation of subcortical gray matter structures. Results HIV-positive patients with executive functions deficits had smaller volumes in the right and left caudate compared with the HIV-positive patients without executive functions deficits and control groups. In addition, HIV-positive patients with executive functions deficits had smaller volumes in their left accumbens, right putamen, and globus pallidum compared with the control group. No significant differences in cortical thickness were observed between the groups. Conclusion HIV-positive patients with executive functions deficits have reduced volumes of several subcortical structures, primarily in the caudate nucleus.

The aim of this study was to evaluate whether normal controls and human immunodeficiency virus (HIV) patients with and without planning deficits differ on white matter integrity.A total of 34 HIV-positive patients with planning deficits were compared with 13 HIV-positive patients without planning deficits and 19 gender-, age-, and education-matched control subjects. Diffusion tensor imaging (DTI) was performed along 30 noncolinear directions in a 1.5-T scanner. For tract-based spatial statistics analysis, a white matter skeleton was created, and a permutation-based inference with 5000 permutations with a threshold of p 0.05 was used to identify abnormalities in fractional anisotropy (FA). The median, radial, and axial diffusivities were also projected onto the mean FA skeleton.Compared with controls, HIV-positive patients with planning deficits had decreased FA in bilateral anterior thalamic radiations, bilateral inferior fronto-occiptal fasciculi, genu and splenium of the corpus callosum, bilateral superior longitudinal fascicule, and bilateral uncinate fasciculi. Compared to HIV-positive patients without planning deficits, patients with planning deficits had decreased FA in bilateral anterior thalamic radiations, bilateral inferior fronto-occiptal fasciculi, genu of the corpus callosum, bilateral superior longitudinal fascicule, and right uncinate fascicule.DTI can detect extensive white matter abnormalities in the normal-appearing white matter of HIV-positive patients with planning deficits compared with controls and HIV-positive patients without planning deficits.

Episodic memory deficits in systemic lupus erythematosus (SLE) have been frequently reported in the literature; however, little is known about the neural correlates of these deficits. We investigated differences in the volumes of different brain structures of SLE patients with and without episodic memory impairments diagnosed by the Rey Auditory Verbal Learning Test (RAVLT). Groups were paired based on age, education, sex, Mini Mental State Examination score, accumulation of disease burden (SLICC), and focused attention dimension score. Patients underwent magnetic resonance imaging (MRI). Cortical volumetric reconstruction and segmentation of the MR images were performed with the FreeSurfer software program. SLE patients with episodic memory deficits presented shorter time of diagnosis than SLE patients without episodic memory deficits. ANOVA revealed that SLE patients with episodic memory deficits had a larger third ventricle volume than SLE patients without episodic memory deficits and controls. Additionally, covariance analysis indicated group effects on the bilateral thalamus and on the third ventricle. Our findings indicate that episodic memory may be impaired in SLE patients with normal hippocampal volume. In addition, the thalamus may undergo volumetric changes associated with episodic memory loss in SLE.

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.

This study describes the adaptation of a revised Brazilian version of the Patient Competency Rating Scale (PCRS-R-BR), which focuses on executive, mnemonic, and attention functions. Evidence of content-based and external validity is also reported. The cross-cultural adaptation was conducted in five phases: 1) translations and back translations; 2) item analysis by authors; 3) classification by experts; 4) revisions and reformulations by authors; 5) pilot study with a sample of patients with mild and moderate/severe traumatic brain injury (TBI). Data were analyzed descriptively, and the PCRS-R-BR scores of groups with mild vs. moderate/severe TBI were compared using the Mann-Whitney test. Patients and their relatives were divided into groups and compared using repeated-measures analysis. The results of the PCRS-R-BR questionnaire for relatives and discrepancy scores of patients with moderate/severe TBI revealed significantly more impairment than that found in the group of patients with mild TBI. There were significant differences between item and total scores of both groups of patients and relatives. Results indicated a high level of item content agreement between experts. This study found initial evidence of PCRS-R-BR content-based and external validity when the questionnaire was applied to patients with mild and moderate/severe TBI and their relatives. O presente artigo teve como objetivo apresentar a adaptação transcultural e evidências de validade externa e de conteúdo da versão brasileira revisada da Patient Competency Rating Scale (PCRS-R-BR), com foco nas funções executivas, mnemônicas e atencionais. A adaptação transcultural incluiu cinco fases: 1) tradução e retrotradução; 2) análise de itens por autores; 3) análise de especialistas; 4) revisões e reformulações dos autores; 5) estudo piloto em pacientes com traumatismo cranioencefálico (TCE) leve e moderado/grave. Os dados foram analisados descritivamente e os pacientes com TCE leve e moderado/grave foram comparados nos escores da PCRS-R-BR pelo teste Mann-Whitney. Os pacientes e familiares foram comparados por grupo através da análise de medidas repetidas. Os pacientes com TCE moderado/grave tiveram maior prejuízo que os pacientes com TCE leve no formulário da PCRS-R-BR dos familiares e no escore de discrepância entre pacientes e familiares. Os resultados indicam bons e altos níveis de concordância entre especialistas frente aos componentes avaliados pelos itens. Esse estudo apresentou evidências iniciais de validade de conteúdo da PCRS-R-BR para pacientes com TCE leve e moderado/severo e seus familiares.

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.

To determine whether systemic lupus erythematosus (SLE) affecting subcortical white matter volumes, deep gray matter volumes, and cortical thickness differ between groups of SLE patients with psychiatric (P-SLE), neurological (N-SLE), or nonneuropsychiatric (non-NPSLE) presentations.Sixty-seven participants were divided into three groups (P-SLE [n = 19], N-SLE [n = 12], and non-NPSLE [n = 36]) and examined with a 1.5T MRI scanner. The images were segmented in FreeSurfer software into volumetric and cortical thickness measures using TGlobus pallidus volumes in both left (P ≤ 0.01) and right (P ≤ 0.05) hemispheres were larger in the N-SLE group than in the non-NPSLE group, and the left GP volume was greater in the N-SLE group than in the P-SLE group (P ≤ 0.05) (MANCOVA, post-hoc Bonferroni). The P-SLE group presented with thinning of cortical areas relative to the N-SLE (predominantly in the left parietal and right frontal and parietal regions) (P ≤ 0.05) and non-NPSLE (predominantly in parietal and occipital regions) (P ≤ 0.05) groups, whereas the N-SLE group presented with thickening of cortical areas (mostly right frontal and left parietal regions) relative to the non-NPSLE (P ≤ 0.05) and P-SLE groups.N-SLE patients had greater local volumes and cortical thicknesses than the other two groups, whereas P-SLE patients presented with decreased volumes and cortical thinning. These findings provide evidence of distinct neuroanatomical abnormalities in neurological versus psychiatric manifestations of SLE.2 Technical Efficacy: Stage 3 J. MAGN. RESON. IMAGING 2017;46:150-158.

The purpose of this study was to investigate differences in brain cortical thickness of systemic lupus erythematosus (SLE) patients with and without episodic memory impairment and healthy controls.We studied 51 patients divided in 2 groups (SLE with episodic memory deficit, n = 17; SLE without episodic memory deficit, n = 34) by the Rey Auditory Verbal Learning Test and 34 healthy controls. Groups were paired based on sex, age, education, Mini-Mental State Examination score, and accumulation of disease burden. Cortical thickness from magnetic resonance imaging scans was determined using the FreeSurfer software package.SLE patients with episodic memory deficits presented reduced cortical thickness in the left supramarginal cortex and superior temporal gyrus when compared to the control group and in the right superior frontal, caudal, and rostral middle frontal and precentral gyri when compared to the SLE group without episodic memory impairment considering time since diagnosis of SLE as covaried. There were no significant differences in the cortical thickness between the SLE without episodic memory and control groups.Different memory-related cortical regions thinning were found in the episodic memory deficit group when individually compared to the groups of patients without memory impairment and healthy controls.

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.

To longitudinally evaluate the cortical thickness and deep gray matter structures volume, measured from T1 three-dimensional (3D) Gradient echo-weighted imaging, and white matter integrity, assessed from diffusion tensor imaging (DTI) of HIV-positive patients.Twenty-one HIV-positive patients on stable highly active antiretroviral therapy (HAART) with CD4+ T lymphocytes count200 cells/mL and viral load50 copies/mL underwent two magnetic resonance imaging (MRI) scans with a median interval of 26.6 months. None of the patients had HIV-related dementia. T1 3D magnetization prepared rapid gradient echo-weighted imaging and DTI along 30 noncolinear directions were performed using a 1.5 Tesla MR scanner. FreeSurfer was used to perform cortical volumetric reconstruction and segmentation of deep gray matter structures. For tract-based spatial statistics analysis, a white matter skeleton was created, and a permutation-based inference with 5000 permutations, with a threshold of P0.05 was used to identify abnormalities in fractional anisotropy (FA). The median, radial, and axial diffusivities were also projected onto the mean FA skeleton.There were no significant differences in cortical thickness, deep gray matter structures volumes or diffusivity parameters between scans at the two time points (considering P0.05).No longitudinal differences in cortical thickness, deep gray matter volumes, or white matter integrity were observed in an HIV-positive population on stable HAART, with undetectable viral load and high CD4+ T lymphocytes count. J. Magn. Reson. Imaging 2016;44:1262-1269.

To evaluate whether human immunodeficiency virus (HIV)-positive patients with and without executive functions deficits and healthy control subjects differ on cortical thickness and subcortical brain structures volume in vivo.In total, 34 HIV-positive patients with executive functions deficits were compared with 13 HIV-positive patients without executive functions deficits and 19 gender-, age-, and education-matched control subjects. Executive functions impairments were classified by performance on the Wisconsin card sorting test. T1 3-dimensional magnetization prepared rapid gradient echo-weighted imaging was performed using a 1.5 Tesla (magnetic resonance) MR scanner. FreeSurfer software was used to perform cortical reconstruction and volumetric segmentation of subcortical gray matter structures.HIV-positive patients with executive functions deficits had smaller volumes in the right and left caudate compared with the HIV-positive patients without executive functions deficits and control groups. In addition, HIV-positive patients with executive functions deficits had smaller volumes in their left accumbens, right putamen, and globus pallidum compared with the control group. No significant differences in cortical thickness were observed between the groups.HIV-positive patients with executive functions deficits have reduced volumes of several subcortical structures, primarily in the caudate nucleus.

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.