Made available in DSpace on 2015-05-14T13:16:25Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1772131 bytes, checksum: ec81b4eec14f4b73454c79191ee6eeec (MD5) Previous issue date: 2014-02-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The aim of this study was to investigate evidence of validity of the Scale for Assessment of Visual Perception (AEFI) with elderly people. He was assisted with the collaboration of 104 people aged over 60 years, of both sexes, selected non-random way and residents in João Pessoa and Campina Grande - PB. Besides the AEFI in data collection, the following instruments were applied: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Verbal Fluency Test (TVB), the Rey Complex Figure Test (TFCR), the Benton Visual Discrimination Test (TDVB) in Figures Test superimposed Poppelreuter (TFSP), Geriatric Depression Scale (GDS-15), Functional Activities Questionnaire Pfeffer (QAFP), Rating Scale cumulative Illness (CIRS), and a sociodemographic questionnaire. The elderly were interviewed in Centers, Basic Health Units Family - UBSF and three programs from the State University of Paraíba (UEPB) intended for the elderly: Open University in Leisure, Live Aging with Fullness and Open University to Maturity (UAMA). Descriptive analyzes, exploratory factor analysis, parallel analysis, calculation of internal consistency check convergent and discriminant validity and estimation of the parameters of the items using the Item Response Theory (IRT) were performed. Was used in the analyzes SPSS software, version 18.0, 9:20 FACTOR version and language R, version 2.15.1. From the factor analysis, there was an AEFI the factor structure composed of 13 items that assess aspects of figure-ground (2:18), visuocontrução (4, 8, 12, 16 and 20) and visual discrimination (9, 11, 14, 15, 17, and 18). It was possible to certify the convergent and discriminant validity of AEFI from significant correlations with tests that assess visual perception and lack of correlation with those that measure distinct constructs. As the route TRI analysis it was found that the best fit of the data to the model was 1 Rach parameter. We estimated the parameter of difficulty of the items of which varied between -2.81 to 0.93 (M = -0.67, SD = 1.20). It was observed that AEFV provides more information for individuals with visual perception median. Overall, the results indicate that the AEFI was configured as a valid measure for assessing visual perception in the elderly. / O objetivo do presente estudo foi verificar evidências de validade da Escala de Avaliação da Percepção Visual (EAPV) com idosos. Para isso, contou-se com a colaboração de 104 pessoas com idade igual ou superior a 60 anos, de ambos os sexos, selecionadas de forma não-aleatória e residentes nos municípios de João Pessoa e Campina Grande PB. Além da EAPV, na coleta de dados foram aplicados os seguintes instrumentos: Mini-Exame do Estado Mental (MEEM), Escala de Avaliação de Demência (DRS), Teste de Fluência Verbal (TVB), Teste de Figura Complexa de Rey (TFCR), Teste de Discriminação Visual de Benton (TDVB), Teste de Figuras Sobrepostas de Poppelreuter (TFSP), Escala de Depressão Geriátrica (EDG-15), Questionário de Atividades Funcionais de Pfeffer (QAFP), Escala de Avaliação de Doenças Cumulativas (CIRS) e um Questionário sociodemográfico. Os idosos foram entrevistados em Centros de Convivência, Unidades Básicas de Saúde da Família UBSF e em três programas da Universidade Estadual da Paraíba (UEPB), destinados para o idoso: Universidade Aberta no Tempo Livre, Viva a Velhice com Plenitude e Universidade Aberta à Maturidade (UAMA). Foram realizadas análises descritivas, Análise Fatorial Exploratória, análise paralela, cálculo da consistência interna, verificação de validade convergente e discriminante e estimação dos parâmetros dos itens utilizando a Teoria de Resposta ao Item (TRI). Utilizou-se, nas análises, os softwares SPSS, versão 18.0, FACTOR versão 9.20 e a linguagem R, versão 2.15.1. A partir das análises fatoriais, verificou-se uma estrutura unifatorial da EAPV composta por 13 itens que avaliam os aspectos da figura-fundo (2 e 18), visuocontrução (4, 8, 12, 16 e 20) e discriminação visual (9, 11, 14, 15, 17, e 18). Foi possível atestar a validade convergente e discriminante da EAPV a partir das correlações significativas com os testes que avaliam a percepção visual e ausência de correlação com os que mensuram construtos distintos. Quanto as análise via TRI verificou-se que o melhor ajuste dos dados foi ao modelo 1 parâmetro de Rach. Estimou-se o parâmetro de dificuldade dos itens dos quais apresentaram uma variação de -2,81 a 0,93 (M = -0,67; DP = 1,20). Foi observado que a EAPV oferece mais informação para os indivíduos com percepção visual mediana. De modo geral, os resultados indicam que a EAPV configurou-se como uma medida válida para avaliar a percepção visual em idosos.

Diversos estudos de ressonância magnética (RM) em idosos saudáveis tem avaliado a relação entre envelhecimento, diminuições volumétricas de substância cinzenta (SC) e desempenho cognitivo, usando desenhos de corte transversal e testes de correlação. No entanto, poucos estudos de volumetria baseada em voxel (VBM) tem relatado a diminuição de SC em idosos saudáveis com medições repetidas de RM nos mesmos indivíduos, e nenhum desses estudos longitudinais investigaram a relação entre as mudanças de SC e desempenho cognitivo ao longo do tempo. Além disso, não está claro em achados longitudinais qual a extensão da influência do APOE?4 sobre as reduções de SC em idosos saudáveis. Foram inicialmente avaliados 187 sujeitos idosos (acima de 65 anos) da comunidade, e após 3 anos, uma subamostra de 55 sujeitos realizaram um segundo exame de RM estrutural em equipamento de 1,5 Tesla, bem como reavaliação cognitiva com instrumentos padronizados e validados transculturalmente. Todos os sujeitos foram genotipados para determinar a presença/ausência do alelo APOEe4, bem como a avaliação clínica do grau do risco cardiovascular de acordo com escores de Framingham (FRS). Usando a técnica de VBM, testamos as hipóteses de que: a progressão da perda do desempenho cognitivo está associada a diminuições volumétricas de SC ao longo de 3 anos, envolvendo a região hipocampal e os neocórtices temporal e frontal; e perdas cognitivas associadas à diminuição progressiva de SC cerebral serão maiores em indivíduos com alto risco cardiovascular e em portadores de alelo da APOEe4. Foram encontradas reduções globais e regionais de SC no tálamo direito e giro parahipocampal esquerdo (p < 0,05, family-wise error corrigido para comparações múltiplas por todo o cérebro). Estes resultados não foram afetados pela influência da APOEe4. Foi detectada uma tendência (p=0,093) na correlação entre o grau de declínio cognitivo e redução volumétrica no tálamo direito. Este resultado se manteve quando um coeficiente parcial de correlação foi calculado levando em conta as variações nos escores FRS. Independentemente da APOEe4, as análises longitudinais de VBM mostraram que a região do hipocampo e tálamo são áreas críticas onde a redução de SC e maior que a redução volumétrica global em idosos saudáveis. Os resultados da associação entre a redução de SC no tálamo e a mudança no desempenho cognitivo ao longo do tempo, apoia o recente reconhecimento do papel do tálamo no declínio cognitivo sutil associado ao envelhecimento saudável / A number of magnetic resonance imaging (MRI) studies have investigated the relationship between aging, reduced gray matter (GM) volumes in the brain and cognitive performance, using cross-sectional designs and correlation tests. However, very few VBM studies have documented GM decrements in healthy elderlies with repeated MRI measurements obtained in the same subjects, and none of these longitudinal studies investigated the relationship between GM deficits and changes in cognitive performance over time. Also, it is unclear the extent to which the APOE e4 allele influences on longitudinal findings of GM reductions in healthy elderlies. Were initially evaluated 187 elderly subjects (over 65 years); after 3 years, a sub-sample of 55 individuals underwent a second MRI examination in a 1.5 Tesla equipment, and a cognitive re-evaluation using a structured, transculturally validated neuropsychological battery. All subjects also underwent genotyping for ascertainment of the presence of the APOEe4 allele, as well as clinical assessment of cardiovascular risk according with Framingham scores (FRS). Using voxel-based morphometry (VBM), we will test the following hypotheses: the progression of cognitive decline will be associated with volumetric reductions of GM over three years, involving the hippocampal region and the temporal and frontal neocortices; cognitive decline associated with progressive GM volume reductions will be greater in individuals with higher cardiovascular risk and carriers of the APOE?4 allele. We found global GM reductions as well as regional GM decrements that were significant in the right thalamus and left parahippocampal gyrus (p < 0.05, family-wise error corrected for multiple comparisons over the whole brain). These findings were not affected by APOE e4. A trend correlation (p=0.093) was detected between the degree of cognitive decline over time and right thalamic volume shrinkage. This finding retained statistical significance when a partial coefficient of correlation was calculated taking into account variations in FRS scores. Irrespective of APOEe4, longitudinal VBM analyses show that the hippocampal region and thalamus are critical sites where GM shrinkage is significantly greater than the degree of global brain volume reduction in healthy elders. The trend towards an association between thalamic GM decrement and cognitive performance change over time supports the recently recognized role of the thalamus in the subtle cognitive decline associated with healthy human aging

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Rationale: Delirium is a serious, morbid condition affecting 2.6 million older Americans annually. A major problem plaguing delirium research is difficulty in identification, given a plethora of existing tools. The lack of consensus on key features and approaches has stymied progress in delirium research. The goal of this project was to use advanced measurement methods to improve delirium’s identification. Aims and Findings: (1) Determine the 4 most commonly used and well-validated instruments for delirium identification. Through a rigorous systematic review, I identified the Confusion Assessment Method (CAM), Delirium Observation Screening Scale (DOSS), Delirium Rating Scale-Revised-98 (DRS-R-98), and Memorial Delirium Assessment Scale (MDAS). (2) Harmonize the 4 instruments to generate a delirium item bank (DEL-IB), a dataset containing items and estimates of their population level parameters. In a secondary analysis of 3 datasets, I equated instruments on a common metric and created crosswalks. (3) Explore applications of the harmonized item bank through several approaches. First, identifying different cut-points that will optimize: (a) balanced high accuracy (Youden’s J-Statistic), (b) screening (sensitivity), and (c) confirmation of diagnosis (specificity) in identification of delirium. Second, comparing performance characteristics of example forms developed from the DEL-IB. Impact: The knowledge gained includes harmonization of 4 instruments for identification of delirium, with crosswalks on a common metric. This will pave the way for combining studies, such as meta-analyses of new treatments, essential for developing guidelines and advancing clinical care. Additionally, the DEL-IB will facilitate creating big datasets, such as for omics studies to advance pathophysiologic understanding of delirium.

Depuis de nombreuses années, la recherche dans le domaine du vieillissement s'attache à comprendre ce phénomène complexe et à identifier des solutions aux problématiques médicales, psychologiques, économiques ou sociologiques qui en découlent. Dans ce cadre, le présent travail rend compte des résultats obtenus dans l'identification des facteurs d'utilisation des jeux vidéo comme support de la stimulation cognitive. Afin de répondre à cette question, deux études ont été mises en place : une première expérience s'est attachée à explorer la jouabilité de la console Wii de Nintendo, tandis qu'une seconde visait à déterminer les facteurs d'acceptabilité des jeux vidéo par les seniors. Les travaux portant sur la Wii se sont focalisés sur le critère d'apprenabilité, en s’appuyant sur le cadre théorique de l'utilisabilité dans les Interfaces Homme-Machine. L'objectif était donc d'analyser les données recueillies au terme d'une observation comportementale, afin d'évaluer l'évolution de la maîtrise de l'interaction entre le joueur et le jeu. Les deux jeux retenus étaient le Bowling et le Tennis, auxquels les participants devaient jouer lors de 4 séances comprenant chacune deux parties de chaque jeu. Trois groupes de participants ont été ainsi constitués, comprenant des sujets jeunes, des seniors sans troubles cognitifs, et des seniors souffrant d'un MCI. Trois patients souffrant de la Maladie D'Alzheimer ont également participé à cette étude. Les résultats confirment un effet de l'âge, modéré par l'effet d'apprentissage ; l'effet du profil cognitif s'est avéré plus discret, et l'étude individuelle des trois volontaires souffrant de démence nous encourage à postuler la préservation d'un apprentissage moteur implicite, mais aussi à la présence obligatoire d'un médiateur humain. L'investigation des représentations de nos aînés sur un divertissement « réservé aux jeunes » a été opérationnalisée grâce à la constitution de deux focus groupes. L'objectif était de proposer une prise en main de différents jeux modernes, et d'explorer l'univers des jeux vidéo sous différents aspects, incluant le gameplay, les questions éthiques ou l'investissement financier. Les différentes thématiques étaient abordées de manière à susciter un libre échange entre les participants. Le matériel recueilli a par la suite été soumis à une analyse de contenu thématique : les différents extraits des échanges recueillis lors des deux focus groupes ont été étiquetés au moyen de mots clé, et les étiquettes ainsi obtenues ont permis de construire un arbre thématique. Les résultats de cette étude nous ont permis de mettre en évidence un intérêt très variable pour les jeux vidéo, mais un souci prégnant de préserver ses facultés cognitives. L'amusement est possible mais semble répondre à des critères très hétérogènes ; un consensus sur des jeux impliquant de la réflexion, de la créativité et l'acquisition de nouvelles connaissances s'est néanmoins dégagé. D'un point de vue plus pragmatique, il existe un refus clair d'investir financièrement dans du matériel spécifique (consoles) ou dans les jeux eux-mêmes. Enfin, les jeux de type First Person Shooter, mis en avant pour la sollicitation du réseau visuo-attentionnel, sont massivement rejetés en raison de la violence associée au gameplay. Dans la dernière partie de ce travail, ces résultats sont d'abord mis en relation avec les données de la littérature afin de dégager les apports réalisés et les limites expérimentales des études décrites. Notre réflexion se termine sur une synthèse des recommandations sur l'implémentation du jeu comme support d'entrainement ou de réhabilitation cognitive, mais aussi sur les questions de recherche et les problématiques identifiées au terme de ce cheminement intellectuel et humain. / For many years, research in the field of aging has focused on understanding this complex phenomenon and identifying solutions to medical, economic, psychological or sociological issues linked to it. In this context, the aim of this thesis was to identify factors that facilitate the use of video games as a medium for cognitive stimulation in older adults. To answer this question, two studies were carried out: the first one focused on exploring the gameplay of the Nintendo Wii, and the second one aimed at determining the factors of acceptability for video game in older adults. The work on the Wii was focused on the criterion of learnability, based on the theoretical framework of usability in Human Machine Interfaces. The objective was to analyze the data collected throughout a behavioral experimentation in order to assess the process by which the older adults were able to master the game (either bowling or tennis). Participants had to play four sessions and each session encompassed two sets of each game. Three groups of participants were implemented: younger patients, older adults without cognitive impairment and suffering from Mild Cognitive Impairment respectively. Three patients suffering from Alzheimer's disease also participated in this study. The results confirm an effect of age, which is moderated by the learning effect. The effect of the cognitive profile was more subtle. The analysis of the data for each volunteer with dementia showed that positive results in the games were probably due to the preservation of implicit motor learning, but also required the mandatory presence of a human mediator. The investigation on older adults' representations of entertainments "dedicated to young people" was carried out in two focus groups. The aim was to let older adults play with different modern games, and explore the world of video games from different angles, including gameplay, ethical issues or financial investment. Different themes were brought up in order to encourage free discussion between participants. The collected material was subsequently subjected to thematic content analysis: the different items of material collected during the two focus groups were labeled with key words, and then the tags that we obtained were used to build a theme tree. The results of this study showed that older adults had various interests in video games, but a strong desire to preserve their cognitive functions. For older adults, fun is possible when playing videogames but seems to be linked to very heterogeneous criteria. However, our results showed a consensus among older adults on criteria for appropriate games such as stimulating thinking, creativity and new knowledge. From a more pragmatic point of view, there is a clear refusal to invest in specific equipment for games. Finally, games like First Person Shooter, put forward because of their potential benefit on visual and attentional functions, were rejected because of the violence associated with the gameplay. In the last part of this work, we compared our results with those of the literature in order to identify our contributions as well as the experimental limits of our studies. Then our reflection focused on a summary of guidelines for the implementation of games aiming at supporting cognitive training or rehabilitation. We also analyzed the research questions and issues identified at the end of this intellectual and human process.

La compréhension du discours, et son évolution au cours du vieillissement, constitue un sujet d’une grande importance par sa complexité et sa place dans la préservation de la qualité de vie des aînés. Les objectifs de cette thèse étaient d’évaluer l’influence du vieillissement et du niveau de scolarité sur les capacités de compréhension du discours et sur l’activité cérébrale s’y rattachant. Pour ce faire, trois groupes (jeunes adultes ayant un niveau universitaire de scolarité, personnes âgées ayant un niveau universitaire de scolarité et personnes âgées ayant un niveau secondaire de scolarité) ont réalisé une tâche où ils devaient lire de courtes histoires, puis estimer la véracité d’une affirmation concernant cette histoire. Les capacités de compréhension correspondant aux traitements de trois niveaux du modèle de construction-intégration de Kintsch (la microstructure, la macrostructure et le modèle de situation) ont été évaluées. L’imagerie optique (NIRS) a permis d’estimer les variations d’oxyhémoglobine (HbO) et de déoxyhémoglobine (HbR) tout au long de la tâche. Les résultats ont démontré que les personnes âgées étaient aussi aptes que les plus jeunes pour rappeler la macrostructure (essentiel du texte), mais qu’ils avaient plus de difficulté à rappeler la microstructure (détails) et le modèle de situation (inférence et intégration) suite à la lecture de courts textes. Lors de la lecture, les participants plus âgés ont également montré une plus grande activité cérébrale dans le cortex préfrontal dorsolatéral gauche, ce qui pourrait être un mécanisme de compensation tel que décrit dans le modèle CRUNCH. Aucune différence significative n’a été observée lors de la comparaison des participants âgés ayant un niveau universitaire de scolarité et ceux ayant un niveau secondaire, tant au niveau des capacités de compréhension que de l’activité cérébrale s’y rattachant. Les deux groupes ont cependant des habitudes de vie stimulant la cognition, entre autres, de bonnes habitudes de lecture. Ainsi, ces habitudes semblent avoir une plus grande influence que l’éducation sur les performances en compréhension et sur l’activité cérébrale sous-jacente. Il se pourrait donc que l’éducation influence la cognition en promouvant des habitudes favorisant les activités cognitives, et que ce soit ces habitudes qui aient en bout ligne un réel impact sur le vieillissement cognitif. / Discourse comprehension, and its evolution through aging, is a subject of importance by its complexity and its place in the preservation of life’s quality. The objectives of this thesis were to evaluate the influence of aging and level of education on discourse comprehension capacities and their related underlying brain activity. To achieve this, three groups (young adults with a university education, elderly adults with a university education and elderly adults with a high school education) carried out a task where they read short stories and answered probes about those stories. Discourse comprehension capacities were evaluated through three processing levels of the Kintsch’s construction-integration model (microstructure, macrostructure and situation model). Using NIRS, the variation of oxyhemoglobin (HbO) and deoxyhemoglobin (HbR) concentrations was estimated through the task. Results indicated that elderly adults were as capable as younger adults to recall the macrostructure (gist of the text), but that they had more difficulties to recall microstructure (details) and the situation model (inference and integration) after reading short texts. While reading, elderly adults also showed greater brain activity in the left dorsolateral prefrontal cortex which could be a compensatory mechanism similar to the one described in the CRUNCH model. No significant difference was observed between participants having a university education and those having a high school education on discourse comprehension capacities and the underlying brain activity. Nevertheless, the two groups had maintained cognitively stimulating life habits, particularly great reading habits. Thus, those habits seem to have a greater influence than education on the performance in comprehension and on the underlying brain activity. Maybe higher education promotes more cognitive habits, and ultimately, it is those habits that seem to have a real impact on cognitive aging.

Bei altersbedingt abnehmender kognitiver Funktion stellt das steigende Renteneintrittsalter Arbeitgeber und -nehmer vor wachsende Herausforderungen. Der Aufbau der kognitiven Reserve (CR) durch geistig stimulierende Aktivitäten verspricht eine Resilienz gegenüber neuropathologisch bedingten kognitiven Defiziten. In der vorliegenden Arbeit wird die Rolle der CR in Bezug auf die kognitive Leistungsfähigkeit und die neuronale Informationsverarbeitung gesunder Erwachsener im Berufsalter untersucht. Unter Ableitung des Elektroenzephalogramms bearbeiteten Probanden mittleren und hohen Erwerbsalters (34-45 J. und 46-62 J.) im 2-Jahres-Abstand Aufgaben zu drei Domänen exekutiver Funktionen: Arbeitsgedächtnis (AG), kognitive Flexibilität und Inhibitionskontrolle. Hoch-CR-Probanden wiesen aufgabenübergreifend schnellere Reaktionen und geringere Fehlerraten auf. Reduzierte Leistung ließ sich in der Gering-CR-Gruppe tendenziell bei älteren Probanden und in anspruchsvollen Aufgabenbedingungen beobachten. Nach 2 Jahren zeigten Gering-CR-Ältere eine numerisch abnehmende AG-Kapazität, während Hoch-CR-Ältere ihre hohe Leistung steigern konnten. Die P3-Amplitude variierte in Abhängigkeit von der CR und dem Alter. Hoch-CR-Jüngere wiesen im Vergleich zu Gering-CR-Jüngeren höhere P3-Amplituden auf, während Hoch-CR-Ältere im Gegensatz zu Gering-CR-Älteren kleinere P3-Amplituden generierten. Zudem legten kürzere P3-Latenzen in der Hoch-CR-Gruppe eine schnellere neuronale Verarbeitungsgeschwindigkeit nahe. In der Aufgabe zur kognitiven Flexibilität ließ sich bei Gering-CR-Probanden ein Anterior-Shift der P3 beobachten. Die Untersuchungsergebnisse konnten nach 2 Jahren repliziert werden. Alterungsrelevante Leistungsvariablen und neuronale Informationsverarbeitungsprozesse zeigten sich bereits im Berufsalter sensitiv gegenüber der CR. Das mittlere Erwachsenenalter sollte bei der Erarbeitung und Evaluation CR-basierter Maßnahmen zur Prävention kognitiver Defizite stärker berücksichtigt werden. / The increasing retirement date accompanied by an age-associated decline of cognitive functions poses growing challenges to employers and employees. The cognitive reserve (CR) promises a resilience to brain damage-associated cognitive deficits through intellectually stimulating lifestyle activities. The present study examines the role of CR relating to cognitive performance and neuronal information processing of healthy adults in working age. Using an electroencephalogram, subjects of middle and high working age (34-45 years and 46-62 years of age, respectively) completed tasks on three domains of executive functions: working memory, cognitive flexibility and inhibition control. Follow-up assessments were conducted after two years. High-CR subjects performed better across tasks than Low-CR subjects, with faster reaction times and lower error rates. Reduced performance in the Low-CR group tended to be more common among older participants and during the more challenging task conditions. In addition, after two years, Low-CR older workers showed a decreased working memory capacity while older High-CR individuals improved their higher performance. The P3 amplitude of the event-related brain potential varied systematically as a function of CR and age. High-CR younger individuals revealed higher P3 amplitudes compared to Low-CR younger individuals, while High-CR older individuals generated smaller P3 amplitudes than Low-CR older individuals. The shorter P3 peak-latencies of the High-CR group suggested moreover a difference in neural processing speed. When testing cognitive flexibility an anterior shift of the P3 was observed in older Low-CR subjects. The results were almost completely replicated after two years. Age-related performance variables and neuronal information processes revealed to be sensitive to CR already at working age. These findings recommend more research on early adulthood in the development and evaluation of CR-based programs to prevent cognitive deficits.

Pourquoi agissons-nous dans certaines circonstances de manière irrépressible ?Nos actes doivent-ils pour autant être considérés comme inconscients ?Peut-on apprendre inconsciemment ?La conscience et le contrôle peuvent-ils être dissociés? Ces questions ont été abordées dans le cadre de ma thèse de doctorat. / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

La prévalence de changements cérébraux pathologiques dans la population âgée est très élevée, même chez des individus en bonne santé et pleinement autonomes. L’accumulation anormale de la protéine bêta-amyloïde (A), un biomarqueur-clé de la maladie d’Alzheimer (MA), et les hypersignaux de la substance blanche (HSB), qui sont des lésions des petits vaisseaux cérébraux de la substance blanche, sont parmi les pathologies cérébrales liées à l’âge les plus répandues. Un ensemble de preuves scientifiques s’appuyant sur des données neuropathologiques, neuropsychologiques et d’imagerie cérébrale suggère que les personnes âgées cognitivement normales ayant une charge lésionnelle cérébrale importante présentent un déclin cognitif accentué. Ainsi, les changements neuropathologiques chez les aînés en bonne santé sont particulièrement intéressants, car ils constituent des cibles thérapeutiques prometteuses et pourraient contribuer au dépistage précoce de la MA. Cette thèse avait pour but d’examiner les associations entre la charge A, les HSB et l’épaisseur corticale à travers différents domaines de la cognition dans une cohorte de 104 personnes âgées cognitivement normales, en tenant compte de l’âge, du sexe et du niveau d’éducation. Tous les participants ont été soumis à une évaluation neuropsychologique détaillée, ainsi qu’à des examens en résonance magnétique (IRM) structurelle et en tomographie par émission de positons (TEP) avec le Pittsburgh Compound B (PIB). La sévérité des HSB a été quantifiée avec l’échelle Age-Related White Matter Changes (ARWMC). Mis ensemble, les résultats des deux articles empiriques composant cette thèse font ressortir des effets indépendants et additifs de la charge A et du volume de l’hippocampe droit sur la mémoire épisodique, de sorte qu’une pathologie A élevée et un volume plus faible prédisaient des performances moindres. La charge A et les HSB contribuaient de façon additive à une mémoire de travail diminuée et exerçaient des effets délétères synergiques sur la flexibilité mentale et l’attention. Les HSB étaient négativement associés au langage, dont ils étaient le plus important prédicteur. À l’inverse, ni les dépôts A ni les HSB n’étaient corrélés à la mémoire sémantique, la vitesse de traitement de l’information et les fonctions visuospatiales. Dans l’article 1, nous avons démontré que le déclin lié à l’âge au niveau de la mémoire épisodique, la mémoire de travail, la flexibilité mentale et le langage était entièrement médié par le degré de pathologie cérébrale. Dans l’article 2, nous avons démontré qu’il n’y avait pas d’association positive entre les cartes d’épaisseur corticale et les fonctions cognitives, à l’exception de la mémoire sémantique. En outre, la charge A, les HSB et les mesures d’IRM structurelle étaient indépendants les uns des autres, appuyant plutôt la notion de trajectoires physiopathologiques distinctes. Un résultat important de l’article 2 était la relation positive entre la mémoire sémantique et l’épaisseur corticale dans le lobe temporal antérieur (LTA), une région connue pour son rôle unique dans l’intégration des connaissances sémantiques à un niveau transmodal. Les résultats de cette thèse mettent en lumière le rôle médiateur de pathologies cérébrales prévalentes, soit la charge A et les HSB, dans le vieillissement cognitif, et suggèrent que celles-ci induisent des changements cognitifs par le biais de mécanismes physiopathologiques autres que l’atrophie cérébrale. Sur le plan clinique, nos travaux soulignent la pertinence de diversifier les outils d’évaluation utilisés pour le dépistage des troubles cognitifs chez la personne âgée, avec un accent particulier sur la mémoire sémantique. / Compelling evidence shows that pathological changes are highly prevalent in the aging brain, even in otherwise healthy individuals who remain fully functional. Among the most common age-related brain lesions are the abnormal deposition of beta-amyloid (A) peptide, a well-known hallmark of Alzheimer’s disease (AD), and white matter hyperintensities (WMH), which are regarded as a radiological marker of cerebral small vessel disease. Converging evidence from neuropathological, neuropsychological and neuroimaging data suggests that normal older adults harboring high levels of brain pathology exhibit exacerbated cognitive decline. Thus, neuropathological changes in healthy elderly people deserve particular attention as they are potential targets for early intervention and might contribute to the early identification of AD. This thesis sought to examine the associations between Aβ burden, WMH, cortical thickness and cognitive performances across multiple domains in a cohort of 104 cognitively normal older adults, while accounting for age, sex and years of formal education. All participants underwent an extensive neuropsychological assessment along with structural magnetic resonance imaging (MRI) and positron emission tomography (PET) with Pittsburgh Compound B (PIB). WMH severity was assessed using the age-related white matter changes (ARWMC) scale. Combined findings from the two empirical articles making up this thesis demonstrate independent, additive effects of A burden and right hippocampal volume on episodic memory whereby increased A deposition and reduced volume predict decreased performance. A burden and WMH contributed additively to poorer working memory and exerted deleterious synergistic effects on mental flexibility and attention. WMH was the most important predictor of linguistic abilities with higher lesion severity being associated with worse performances on language tasks. Conversely, neither A deposition nor WMH were correlated with semantic memory, processing speed and visuospatial abilities. In article 1, we demonstrated that age-dependent decline in episodic memory, working memory, mental flexibility and language was fully mediated by the extent of brain pathology. In article 2, cognition was not found to be positively associated with cortical thickness in the vertex-wise analyses, except for the domain of semantic memory. Furthermore, A burden, WMH and structural MRI measures were independent of one another, supporting the notion of distinct pathophysiological pathways. A notable finding of article 2 was that thinner cortical thickness in the left anterior temporal lobe (ATL) predicted poorer semantic memory, which is coherent with the role of the ATL in heteromodal semantic processing. The results presented in this thesis shed light on the role of prevalent brain pathologies, namely A burden and WMH, in driving age-related cognitive changes, and suggest that these changes can occur through pathways that are distinct from brain atrophy. Clinically speaking, this work lends support for the inclusion of a wider array of measures to routine screening for cognitive impairment in older adults, with an emphasis on semantic memory.

Age-related physical and cognitive changes hinder the ability of older adults to operate smartphones. While many user interface (UI) heuristics exist today, there is a need for an updated set designed specifically to assess the usability of mobile devices for an older audience. Smartphone evaluation heuristics for older adults based on age-related changes in vision, hearing, attention, memory and motor control were developed in this thesis by analyzing literature on age-related physical and cognitive changes impacting smartphone usability. Support for heuristics was found by gathering information on how older adults use cell phones through interviews and an online survey. It was demonstrated that strength of support for some heuristics increases with age. The evaluated heuristics provide usability practitioners and designers with a framework for evaluating the usability of smartphones for older adults.