RESUMEN

OBJECTIVES: People with dementia have several unmet needs during the syndrome progression. More unmet needs are related to hospitalizations, injuries, and death. Little is known about the care needs for people living with dementia in Brazil. This study aims to translate and adapt the Johns Hopkins Dementia Care Needs Assessment (JHDCNA 2.0), a tool design to identify the dementia-related needs of people with dementia and their caregivers, to Brazilian Portuguese, and to verify psychometric properties. METHOD: JHDCNA 2.0 underwent a translation, back-translation, and cultural adaptation. Preliminary psychometric testing of the Brazilian version (JHDCNA-Br 2.0) included pilot testing and experts' assessment, analyses of reliability, evidence based on test content and relations to other variables. We conducted 140 in-home interviews to assess several sociodemographic and health aspects and to be able to complete the JHDCNA-Br 2.0. RESULTS: The JHDCNA-Br 2.0 is reliable and has evidence based on test content and on relations to other variables for people living with dementia and caregivers. Preliminary results suggest high prevalence of unmet needs. CONCLUSION: JHDCNA-Br 2.0 is a reliable and valid tool. The availability of this tool brings new opportunities to the study of dementia care, taking into consideration cultural aspects and may help inform future approaches to dementia care delivery to support persons and families affected by these conditions.

RESUMEN

BACKGROUND: The prevalence of cognitive impairment no dementia (CIND) and dementia appears to be higher in low- and middle-income countries (LMICs) compared to high-income economies. Yet few nationally representative studies from Latin American LMICs have investigated life-course socioeconomic factors associated with the susceptibility to these two cognitive conditions. Hence, the present study aimed to examine the associations of early- (education and food insecurity), mid- (employment stability), and late-life (personal income and household per capita income) socioeconomic determinants of CIND and dementia among older adults from Brazil, while simultaneously exploring whether sex plays an effect-modifier role on these associations. METHODS: This population-based study comprised a nationally representative sample of older adults (N = 5,249) aged 60 years and over from the Brazilian Longitudinal Study of Aging (ELSI-Brazil). We fitted multinomial regressions and estimated odds ratios with the respective 95% confidence intervals (CIs). RESULTS: In multivariate analyses, participants with more years of early-life education (0.89, 95% CI [0.81, 0.97]) and mid-life employment stability (0.97, 95% CI [0.96, 0.99]) and higher late-life household per capita income (0.70, 95% CI [0.51, 0.95) were less likely to have dementia. Regarding CIND, more years of mid-life employment stability (0.97, 95% CI [0.96, 0.98]) was the only determinant to confer protection. Notably, secondary sex-based analyses showed the higher the early-life educational attainment, the lower the odds of dementia in women (0.81, 95% CI [0.75, 0.87]) but not in men (1.00, 95% CI [0.86, 1.16]). CONCLUSIONS: These findings may have implications for population health and health policy by advancing our understanding of socioeconomic determinants of CIND and dementia, especially in Latin America.

RESUMEN

Repeated neuropsychological assessments are often conducted in clinical and research settings to track cognitive changes over single or multiple intervals in patients with Parkinson's disease (PD). Yet few studies have documented test-retest reliability in PD. To address this gap, we used data from the Parkinson's Progression Markers Initiative (PPMI) to investigate the reliability of five well-known neuropsychological tests over a 3-year follow-up assessment in early-stage PD with either normal (PD-NC; N = 158) or abnormal (PD-AC; N = 39) cognitive screening, categorized based on recommended cutoffs for the Montreal Cognitive Assessment (MoCA), and healthy older adults (HOA; N = 102). All participants analyzed maintained the same cognitive status category across the assessment points. Intraclass correlation coefficients (ICCs) estimated reliability. The overall ICCs calculated across time points were as follows: Judgment of Line Orientation (PD-NC = .47, PD-AC = .50, HOA = .59); Letter-Number Sequencing (PD-NC = .64, PD-AC = .64, HOA = .65); Semantic Fluency (PD-NC = .69, PD-AC = .89, HOA = .77); Symbol Digit Modalities Test (PD-NC = .67, PD-AC = .83, HOA = .71). For the two primary components of the Hopkins Verbal Learning Test-Revised, we found the following ICCs: immediate recall (PD-NC = .46, PD-AC = .57, HOA = .58); delayed recall (PD-NC = .42, PD-AC = .57, HOA = .54). Findings from this study provide useful information for clinicians and researchers toward selecting suitable neuropsychological tests to monitor cognition at two or more time points among newly diagnosed individuals with PD and HOA.

RESUMEN

BACKGROUND: Subjective memory complaints (SMCs) are a possible prodrome of cognitive decline but are understudied in low- and middle-income countries (LMIC). We aimed to estimate the prevalence of SMCs in a large, nationally representative sample of older adults from Brazil and to identify sociodemographic and health-related factors that are associated with SMCs independently of objective memory. METHODS: Baseline data (n = 7831) from the ELSI-Brazil study, a national representative sample of adults aged 50 and over. They were asked to rate their memory and then divided into two groups - having or not having SMCs. Logistic regression models were used to estimate the association of demographic characteristics, health related factors, objective memory performance and disability in basic (b-ADL), instrumental (i-ADL), and advanced (a-ADL) activities of daily living associated with SMCs. Whether sex was an effect modifier of the association between age and objective memory performance and SMCs was also tested. RESULTS: Of the sample, 42% (95% CI; 39.9-43.9) had SMCs, and it was higher among women (46.9%) than men (35.9%). SMC prevalence decreased with age among women and increased among men, and for both it decreased with better cognitive performance. Fully adjusted logistic regression model showed that older age, higher education, higher b-ADL scores, and better cognitive performance were associated with decreased SMCs, while being female, with higher number of chronic conditions, higher i-ADL scores, worst self-rated health, and an increased number of depressive symptoms were associated with increased SMCs. However, the interaction test (p < 0.001) confirmed that increased age was associated with decreased SMCs only among women, and that better objective memory performance was associated with decreased SMCs only among men. CONCLUSIONS: SMCs are common in the Brazilian older population and are associated with health and sociodemographic factors, with different patterns between men and women. There is a need for future studies looking at the cognitive trajectory and dementia risk in older adults with subjective cognitive complaints.

Asunto(s)

RESUMEN

First-degree relatives of individuals with late-onset Alzheimer's disease (LOAD) are at increased risk for developing dementia, yet the associations between family history of LOAD and cognitive dysfunction remain unclear. In this quantitative review, we provide the first meta-analysis on the cognitive profile of unaffected first-degree blood relatives of LOAD-affected individuals compared to controls without a family history of LOAD. A systematic literature search was conducted in PsycINFO, PubMed /MEDLINE, and Scopus. We fitted a three-level structural equation modeling meta-analysis to control for non-independent effect sizes. Heterogeneity and risk of publication bias were also investigated. Thirty-four studies enabled us to estimate 218 effect sizes across several cognitive domains. Overall, first-degree relatives (n = 4,086, mean age = 57.40, SD = 4.71) showed significantly inferior cognitive performance (Hedges' g = -0.16; 95% CI, -0.25 to -0.08; p < .001) compared to controls (n = 2,388, mean age = 58.43, SD = 5.69). Specifically, controls outperformed first-degree relatives in language, visuospatial and verbal long-term memory, executive functions, verbal short-term memory, and verbal IQ. Among the first-degree relatives, APOE ɛ4 carriership was associated with more significant dysfunction in cognition (g = -0.24; 95% CI, -0.38 to -0.11; p < .001) compared to non-carriers (g = -0.14; 95% CI, -0.28 to -0.01; p = .04). Cognitive test type was significantly associated with between-group differences, accounting for 65% (R23 = .6499) of the effect size heterogeneity in the fitted regression model. No evidence of publication bias was found. The current findings provide support for mild but robust cognitive dysfunction in first-degree relatives of LOAD-affected individuals that appears to be moderated by cognitive domain, cognitive test type, and APOE ɛ4.

RESUMEN

Patients with Parkinson's disease (PD) exhibit a domain-general visuospatial dysfunction; however, no previous study has examined changes over time in forward and backward spatial recall in PD against controls. To evaluate changes in short-term (STM) and working memory (WM) dysfunction in PD, the current study assessed performance on a computer-modified version of the Corsi Block-Tapping Test (forward and backward recall) at two-time points 1 year apart, while simultaneously exploring associations with potentially relevant demographic and clinical variables. We enrolled 38 patients with PD and 38 controls matched for age, sex, and Montreal Cognitive Assessment (MoCA) total scores. Linear mixed-effects models analyzed the primary measured variables (forward and backward scores). At baseline, the dysfunction effect sizes were as follows: forward recall (-0.45, 95% CI [-0.90, 0.01]) and backward recall (-0.26, 95% CI [-0.71, 0.19]). At follow-up, patients exhibited substantially greater difficulties in backward recall (-0.65, 95% CI [-1.18, -0.13]) compared to the baseline assessment, whereas the forward dysfunction effect size remained almost the same (-0.43, 95% CI [-0.94, 0.09]). Age (p = .005, f = 0.35) and total scores on MoCA (p = .017, f = 0.18), irrespective of group and recall condition, were significant predictors of spatial block scores. The pattern of dysfunction effect sizes indicates that, in contrast to forward recall, backward recall dysfunction in PD worsened 1-year after the baseline assessment, presumably reflecting the progression of PD-related visuospatial WM dysfunction.

RESUMEN

A previous meta-analysis demonstrated short-term memory (STM) and working memory (WM) dysfunction in patients with Parkinson's disease (PD). However, considerable research on the topic that calls into question the extent of such impairments in PD has since been published. The aim of the present quantitative review was to provide the largest statistical overview on STM and WM dysfunction in Parkinson's disease (PD), while simultaneously providing novel insights on moderating factors of effect size heterogeneity in PD. The systematic literature search in PubMed, PsycINFO, PsycArticles, Scopus and Web of Science databases allowed us to estimate 350 effect sizes from 145 empirical studies that reported STM and WM scores for patients with PD against healthy controls. The outcomes indicated general dysfunction in the visuospatial domain and poor verbal WM in PD. Subgroup analyses suggested that mild cognitive impairment is associated with STM and WM difficulties in PD. Furthermore, meta-regression analyses revealed that disease duration accounted for more than 80% of the visuospatial STM effect size variance (ß = 0.136, p < .001, R2 = .8272), larger daily levodopa equivalent dose was associated with WM dysfunction (verbal: ß = -0.001, p = .016, R2 = .1812; visuospatial: ß = 0.003, p = .069, R2 = .2340), and years of education partially explained the verbal STM effect size variance (ß = -0.027, p = .040, R2 = .1171). Collectively, these findings advance our understanding of underlying factors that influence STM and WM functioning in PD, while at the same time providing novel directions for future research.

Asunto(s)

RESUMEN

Objective: Previous meta-analyses have demonstrated verbal working memory (WM) dysfunction in children and adolescents with attention deficit/hyperactivity disorder (ADHD); however, the findings are inconsistent. The main objective of this meta-analysis was to investigate the performance of children and adolescents with ADHD in the Digit Span Backwards (DSB) subtest from the Wechsler Intelligence Scale for Children or Wechsler Adult Intelligence Scale. We also sought to provide an updated meta-analysis on WM in children and adolescents with ADHD.Method: PubMed, PsyINFO, Scopus, and Web of Science were searched to locate studies published between 1990 and 2016 that report DSB scores both of children and adolescents with ADHD and matched controls. Potential moderator variables were also analyzed.Results: Forty-nine studies comparing children and adolescents with ADHD (n = 4956) against healthy controls (n = 3249) generated a medium-sized effect (Hedges' g) of 0.56 (95% CI [0.49, 0.64]), indicating poorer verbal WM performance in those with ADHD. A subgroup meta-analysis of studies with participants aged 8-16 years only demonstrated low heterogeneity (I2 = 17.06, cf. 55.50 for the main analysis). Moreover, the meta-regression showed a negative association (ß = -.05, p = .02) between DSB performance differences and increasing age, indicating that for every one year increase in age the effect size decreased by .05.Conclusion: These results, which emanated from the largest meta-analysis concerning verbal WM in ADHD reported to date, reinforce WM as a key domain of cognitive dysfunction in ADHD, and point to age as the main variable influencing DSB performance difficulties.

Asunto(s)

RESUMEN

Resumo Pesquisas científicas relacionadas à avaliação neuropsicológica têm despertado interesse crescente nos últimos anos. Este estudo objetivou realizar uma revisão sistemática sobre avaliação neuropsicológica no Brasil e foi efetuado nas bases de dados SciELO, PePSIC, LILACS e BDTD, no período de setembro/2012 a novembro/2012, utilizando as palavras-chave avaliação neuropsicológica. A amostra final resultou em 241 trabalhos empíricos originais formados por artigos científicos (n=131), dissertações de mestrado (n=68) e teses de doutorado (n=42), abrangendo o período de 1993 a 2012. Os resultados evidenciaram que: a) mais de 60% da produção científica concentra-se no período de 2007 a 2012, com média de produção de 12,7% por ano; b) o número de artigos científicos soma pouco mais de 50% se comparado com o número de teses e dissertações; c) a publicação de pesquisas sobre a temática se dá majoritariamente em periódicos médicos (47,7%); d) o principal eixo temático que emprega Avaliação Neuropsicológica são distúrbios neuropsiquiátricos (49,7%); e) a Região Sudeste concentra mais de 50% da produção científica nacional. Conclui-se que esta pesquisa revela um panorama atualizado da produção científica sobre o tema, enfatizando a necessidade de mais pesquisas psicométricas e de outras revisões sistemáticas envolvendo temas de interesse da neuropsicologia, como reabilitação neuropsicológica.(AU)

Abstract Scientific researches related to the topic of Neuropsychological Assessment have attracted growing interest in recent years. This study aimed to perform a systematic review of Neuropsychological Assessment in Brazil and the research was conducted in the databases of SciELO, PePSIC, LILACS and BDTD, between September/2012 to November/2012, using the keywords neuropsychological assessment. The final sample included 241 original empirical works consisting in scientific articles (n = 131), dissertations (n = 68) and doctoral thesis (n = 42), covering the period 1993-2012. The results showed that: a) more than 60% of scientific production is concentrated in the period 2007-2012, with an average yield of 12.7% per year; b) the number of scientific articles sum slightly more than 50% compared with the number of theses and dissertations; c) the publication of researches on the subject occurs mostly in medical journals (47.7%); d) the principal thematic area that employs Neuropsychological Assessment is neuropsychiatric disorders (49,7%); e) Southeast concentrates more than 50% of national scientific production. We conclude that this research reveals an overview of current scientific literature on the subject, emphasizing the need for further research psychometric and for further systematic reviews involving topics of neuropsychology interest, like Neuropsychological Rehabilitation.(AU)

Resumen Investigaciones científicas referidas a la evaluación neuropsicológica han despertado gran interés en los últimos años. El objetivo de este estudio fue realizar una revisión sistemática sobre la evaluación neuropsicológica en Brasil, realizada a partir de las bases de datos SciELO, PePSIC, LILACS y BDTD, desde septiembre de 2012 a noviembre de 2012, utilizando como palabras clave evaluación neuropsicológica. La muestra final fue constituida por 241 trabajos empíricos originales formados por artículos científicos (n=131), disertación de maestría (n=68) y tesis doctoral (n=42), desde 1993 hasta 2012. Los resultados han evidenciado que: a) más del 60% de la producción científica se encuentra en el período de 2007 a 2012, con media de producción de 12,7% al año; b) el número de artículos científicos es poco más del 50% si se compara con el número de tesis y disertaciones; c) la publicación de investigaciones sobre el tema se da principalmente en revistas médicas (47,7%); d) el principal eje temático que utiliza evaluación neuropsicológica son trastornos neuropsiquiátricos (49,7%); la Región Sudeste posee más del 50% de la producción nacional. Se concluye que esta investigación muestra un panorama actual de la producción científica sobre el tema, con énfasis en la necesidad de más investigaciones psicométricas y de otras revisiones sistemáticas de temas que sean de interés para la neuropsicología, como la rehabilitación neuropsicológica.(AU)

Asunto(s)

RESUMEN

Resumo Pesquisas científicas relacionadas à avaliação neuropsicológica têm despertado interesse crescente nos últimos anos. Este estudo objetivou realizar uma revisão sistemática sobre avaliação neuropsicológica no Brasil e foi efetuado nas bases de dados SciELO, PePSIC, LILACS e BDTD, no período de setembro/2012 a novembro/2012, utilizando as palavras-chave avaliação neuropsicológica. A amostra final resultou em 241 trabalhos empíricos originais formados por artigos científicos (n=131), dissertações de mestrado (n=68) e teses de doutorado (n=42), abrangendo o período de 1993 a 2012. Os resultados evidenciaram que: a) mais de 60% da produção científica concentra-se no período de 2007 a 2012, com média de produção de 12,7% por ano; b) o número de artigos científicos soma pouco mais de 50% se comparado com o número de teses e dissertações; c) a publicação de pesquisas sobre a temática se dá majoritariamente em periódicos médicos (47,7%); d) o principal eixo temático que emprega Avaliação Neuropsicológica são distúrbios neuropsiquiátricos (49,7%); e) a Região Sudeste concentra mais de 50% da produção científica nacional. Conclui-se que esta pesquisa revela um panorama atualizado da produção científica sobre o tema, enfatizando a necessidade de mais pesquisas psicométricas e de outras revisões sistemáticas envolvendo temas de interesse da neuropsicologia, como reabilitação neuropsicológica....(AU)

Abstract Scientific researches related to the topic of Neuropsychological Assessment have attracted growing interest in recent years. This study aimed to perform a systematic review of Neuropsychological Assessment in Brazil and the research was conducted in the databases of SciELO, PePSIC, LILACS and BDTD, between September/2012 to November/2012, using the keywords neuropsychological assessment. The final sample included 241 original empirical works consisting in scientific articles (n = 131), dissertations (n = 68) and doctoral thesis (n = 42), covering the period 1993-2012. The results showed that: a) more than 60% of scientific production is concentrated in the period 2007-2012, with an average yield of 12.7% per year; b) the number of scientific articles sum slightly more than 50% compared with the number of theses and dissertations; c) the publication of researches on the subject occurs mostly in medical journals (47.7%); d) the principal thematic area that employs Neuropsychological Assessment is neuropsychiatric disorders (49,7%); e) Southeast concentrates more than 50% of national scientific production. We conclude that this research reveals an overview of current scientific literature on the subject, emphasizing the need for further research psychometric and for further systematic reviews involving topics of neuropsychology interest, like Neuropsychological Rehabilitation....(AU)

Resumen Investigaciones científicas referidas a la evaluación neuropsicológica han despertado gran interés en los últimos años. El objetivo de este estudio fue realizar una revisión sistemática sobre la evaluación neuropsicológica en Brasil, realizada a partir de las bases de datos SciELO, PePSIC, LILACS y BDTD, desde septiembre de 2012 a noviembre de 2012, utilizando como palabras clave evaluación neuropsicológica. La muestra final fue constituida por 241 trabajos empíricos originales formados por artículos científicos (n=131), disertación de maestría (n=68) y tesis doctoral (n=42), desde 1993 hasta 2012. Los resultados han evidenciado que: a) más del 60% de la producción científica se encuentra en el período de 2007 a 2012, con media de producción de 12,7% al año; b) el número de artículos científicos es poco más del 50% si se compara con el número de tesis y disertaciones; c) la publicación de investigaciones sobre el tema se da principalmente en revistas médicas (47,7%); d) el principal eje temático que utiliza evaluación neuropsicológica son trastornos neuropsiquiátricos (49,7%); la Región Sudeste posee más del 50% de la producción nacional. Se concluye que esta investigación muestra un panorama actual de la producción científica sobre el tema, con énfasis en la necesidad de más investigaciones psicométricas y de otras revisiones sistemáticas de temas que sean de interés para la neuropsicología, como la rehabilitación neuropsicológica....(AU)

Asunto(s)