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Cognitive impairment is considered as essential feature of non-motor symptoms in Parkinson's disease (PD). It is a result of underlying pathological processes in the brain of PD patients and it leads to decreased quality of life. In this thesis an analysis of the structure and profile of cognitive impairment is presented with special emphasis on executive functions and memory. We take diagnostic entities developed for the description of PD cognitive spectrum such as mild cognitive impairment (PD-MCI) and dementia (PD-D) as examples of heterogeneity and different severity of cognitive impairment in PD. However, neuropsychological methods in Czech version that would measure these diagnotic units were not adequatly validated. In the experimental part we test a hypothesis, if gait disorder with falls in PD is interconnected with cognitive impairment, and if PD-fallers have more severe cognitive deficit than PD-non-fallers. On the basis of nine validity or normative data studies we show psychometric properties and clinical utility of several basic neuropsychological methods in the Czech population for memory (Rey Auditory Verbal Learning Test, California Verbal Learning Test, Second Edition, Memory For Intentions Screening Test and Enhanced Cued Recall Test), sustained attention and executive functions...

Neuropsychological aspects of preclinical stages of neurodegenerative diseases are an extensively studied topic in neuropsychological research. Neuropsychological assessment can be helpful for the estimation of conversion risk in individual cases. The focus of neuropsychological research shifted from the evaluation of dementia to mild cognitive impairment (MCI) or even to the detection of cognitive change before significant cognitive decline. In the theoretical part is presented a contemporary outline of preclinical stages of neurodegenerative diseases. The construct of MCI is the most studied topic in the prodromal stage of neurodegeneration and this part is dedicated to comprehensive analysis of MCI. The empirical research includes five studies on screening methods of cognitive abilities, memory and verbal fluency tests. We present normative and validity data in older adults and show their detection potential in MCI or preclinical stages of neurodegenerative diseases. Furthermore, we tried to show the detection potential of different memory measures in patients with MCI and estimate the relations between hippocampal atrophy and memory performance. Key words mild cognitive impairment, dementia syndrome, Alzheimer's Disease, neuropsychological assessment, diagnostic procedures

Objective: Cognitive reserve influences age of onset, speed of progression, and clinical manifestations of Alzheimer’s disease. We investigated whether cognitive reserve interacts with clinical and neuropsychological parameters in mild cognitive impairment (MCI). Methods: In this cross-sectional study, we recruited 273 people (70.6 ± 10.1 years, 54.6% women) suffering from subjective memory complaints (n = 65), MCI (n = 121), or dementia (n = 87). Patients underwent neuropsychological evaluation, laboratory testing, and brain imaging. Additionally, we obtained information on years of education and help-seeking motivation. Results: MCI patients with a university degree were significantly older than those without (71.6 ± 9.6 vs. 66.9 ± 10.3, p = 0.02). University-educated MCI patients demonstrated superior performance in verbal fluency. Intrinsic help-seeking motivation (self-referral) was associated with higher cognitive reserve. Female MCI patients presented with greater intrinsic motivation. Conclusion: Cognitive reserve modulates clinical and neuropsychological measures in patients with MCI.

Indiana University-Purdue University Indianapolis (IUPUI) / Background: Persons with Mild Cognitive Impairment (PwMCI) battle progressive disengagement from personally meaningful activities that results in functional decline. Little is known about PwMCI experience of engaging in meaningful activities and relationships among MCI stage, confidence, depressive symptoms, and function. Daily Engagement of Meaningful Activity (DEMA) is a multicomponent, family-focused, tailored intervention designed to benefit PwMCI and their caregivers by facilitating goal identification, preserve engagement, and support adjustments to cognitive and functional changes. Objectives: The aims of this secondary analysis were to: (i) describe PwMCI experience of engagement in DEMA, (ii) evaluate for potential relationship among MCI stage, confidence, depressive symptoms, activity type, activity performance, physical function and (iii) evaluate ability of select outcomes to predict change in depressive symptoms and physical function, (iv) determine difference between participants when sub-grouped by ICF level. Methods: Mixed methodology was used to conduct a secondary analysis from the parent study. The parent study used a two-group randomized trial involving PwMCI and informal caregivers participating in the Indiana Alzheimer Disease Center DEMA program. Quantitative analysis (dyads: DEMA N=20, Information Support N = 20) examined outcomes at baseline, posttest and follow-up. Analysis employed: (i) Colaizzi's Method of empirical phenomenology to describe PwMCI experience of engagement in activity intervention related to perceptions of changes in confidence, activity performance, and physical function; (ii) Pearson's and Spearman's correlation to ascertain relationship; (iii) Linear regression to model the relationship between explanatory and dependent variables; (iv) Independent t-test to determine significant difference in activities and physical function. Results: Qualitative themes confirm improved awareness, adjustment, problem-solving, confidence and optimized function. Significant correlations were found at baseline and posttest for MCI stage, depressive symptoms, activity type and physical function. At posttest, change in self-rated performance predicted change in depressive symptoms. Additionally, those who engaged in activity at the ICF level of participation demonstrated a significant increase in confidence and physical function. Conclusion: Qualitative themes and quantitative results clearly indicate the positive impact of DEMA. Future research should employ a larger, randomized controlled longitudinal trial to ascertain DEMA impact on physical function, reduction of participation restriction and improved QOL.

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[pt] Esse trabalho se voltou para o desenvolvimento de um teste de avaliação do processamento sintático na compreensão da linguagem no envelhecimento. Esse teste tem como objetivo oferecer um auxílio no diagnóstico de Comprometimento Cognitivo Leve (CCL). Este é um quadro que pode evoluir para a Doença de Alzheimer (DA). Por isso, o diagnóstico o mais cedo possível de um comprometimento cognitivo no envelhecimento pode oferecer um melhor prognóstico para o paciente, a partir de acompanhamento médico e reabilitação neuropsicológica. Sabe-se que a idade avançada é um dos principais fatores de risco para o desenvolvimento da DA. Esta pesquisa se justifica na medida em que a população mundial vem envelhecendo em ritmo acelerado e também pela enorme carência de um instrumento de avaliação voltado para o processamento sintático no envelhecimento e, principalmente, pela carência de um instrumento em português brasileiro. Uma revisão sistemática feita nas plataformas PubMed, LILACS e SciELO revelou que por volta dos últimos 5 anos pouquíssimos estudos avaliaram o processamento sintático de pacientes com CCL. E o número de estudos que consideraram o processamento sintático de sentenças com estrutura mais complexa é mais reduzido ainda. Apresentamos, portanto, neste trabalho, um protótipo de um teste de compreensão de sentenças que variam em nível de complexidade sintática, construído com base em pesquisas na área de Psicolinguística e de Neuropsicologia Clínica. Trata-se de um teste de identificação de figura a partir de uma tarefa de verificação de correspondência entre sentença e imagem. Esse teste explora a compreensão de sentenças com oração relativa de sujeito e de objeto; interrogativas de sujeito e de objeto; clivadas de sujeito e de objeto; passivas reversíveis (implausíveis e neutras) e irreversíveis; estruturas com verbo de perspectiva; e ativas simples reversíveis e irreversíveis. Como a literatura reporta, até mesmo no envelhecimento saudável, espera-se um declínio no processamento dessas estruturas sintáticas mais complexas, que acarretam maior demanda cognitiva. Em um quadro de envelhecimento não saudável, esse declínio estaria mais acentuado e evidente. Por isso, esse teste pode ser uma medida promissora na detecção de um CCL que afete o domínio da linguagem. Foi realizado um estudo piloto com um grupo de 43 adultos mais jovens e um grupo de 10 idosos sem comprometimento cognitivo, para avaliar a funcionalidade do teste desenvolvido. Os dois grupos realizaram a tarefa de identificação de imagens sem dificuldades, com média de tempo similar e baixo percentual de erros, tendo estes ocorrido com as estruturas mais complexas do conjunto de sentenças examinadas. Os resultados do piloto sugerem, portanto, que o teste pode ser um instrumento sensível na avaliação do processamento sintático na compreensão de sentenças por parte de adultos e idosos. / [en] This work focused on the development of a test to assess syntactic processing in language comprehension in aging. This test aims to help in the diagnosis of Mild Cognitive Impairment (MCI), a condition that can progress to Alzheimer s Disease (AD). Thus, the early diagnosis of cognitive impairment in aging can offer a better prognosis for the patient, based on medical follow-up and neuropsychological rehabilitation. It is known that one that greatest risk factor for AD is advancing age. This research is very relevant because the world population has been aging at an accelerated pace and because there is a huge lack of an assessment instrument aimed at syntactic processing in aging, mainly due to the lack of a test in Brazilian Portuguese. A systematic review carried out on the PubMed, LILACS and SciELO platforms revealed that over the last 5 years very few studies have evaluated the syntactic processing of patients with MCI. And the number of studies that considered the processing of syntactically complex sentences is even smaller. Therefore, in this work, we present a prototype of a test of comprehension of sentences that vary in level of syntactic complexity, developed on the basis of research in the fields of Psycholinguistics and Clinical Neuropsychology. It is a sentence-picture matching task, in which participants must evaluate the correspondence between the sentence and the correct illustration. This test explores the comprehension of sentences with subject and object relative clause; subject and object interrogatives; sentences with subject and object topicalization; reversible (implausible and neutral) and irreversible passive sentences; structures with perspective verb; and reversible and irreversible active sentences. As the literature reports, even in healthy aging, a decline in the processing of more complex syntactic structures is expected, which entail greater cognitive demand. In a context of unhealthy aging, this decline would be more accentuated and evident. Therefore, this test can be a promising measure in the detection of a MCI that affects the language domain. A pilot study was conducted with a group of 43 younger adults and a group of 10 elderly people without cognitive impairment, to evaluate the functionality of the developed test. Both groups performed the image identification task without difficulties, with a similar average time and a low percentage of errors, which occurred with the most complex structures of the set of the examined sentences. Therefore, the pilot study results suggest that the test can be a sensitive measure in the evaluation of syntactic processing in sentence comprehension by adults and the elderly.

Our lives become longer with new advancements in medicine and technology. As a result, cognition and memory impairments will become a growing concern[23]. To be able to treat cognitive decline, dementia and related diseases, the need for early detection of memory deficiencies increases. This study aimed to validate the use of a new digital interaction version of a common memory test, the Rey Auditory Verbal Learning Test (RAVLT), compared with norm from the traditional human-to-human interaction version of the same test. This was performed through userstudies with both test versions in a counterbalanced order. The results consisted of quantitative results from the tests together with qualitative data from interviews with the participants in connection to each test occasion. The results showed a slight difference in some aspects of the quantitative test results, but at the same time, no significant difference for most of the measured results. Further, the interviews demonstrated that the differences in interaction and experience between the versions of the tests could be the reason for some of the differences in the quantitative result. The conclusion from this study was that there are many difficult problems to solve for speech interfaces in neurocognitive tests like the RAVLT. In line with previous research [22], the results highlight the importance of a natural speech interaction that conforms with the basic principles of human conversation, to create a stress-free experience and test results that can be reliable and comparable.

The accuracy of neuropsychological assessment is critical in the diagnosis of cognitive impairments in older adults. However, existing neuropsychological tests may not be suitable for minority populations. This thesis aimed to address this issue by recruiting cognitively-healthy South Asian older adults and assessing cognitive function in this group. Results showed that typically used assessments, despite being translated, were not suitable for this cohort. Furthermore, skills required for test completion such as mathematics and writing/hand dexterity (which are related to education levels) influenced test scores. Therefore, new assessments of general cognitive function and associative memory were developed to improve the accuracy of neuropsychological test scores. The new tests were not affected by education and they achieved high internal and test re-test reliability. Time of day (TOD) that testing takes place is also known to affect cognition. Interestingly, no TOD effects were observed in this cohort. It was hypothesised that engagement in the daily five Islamic prayers may have contributed to this lack of a TOD effect. However, the results did not confirm this. The thesis then looked at overall prayer engagement and cognition. Results showed that engagement in the daily five prayers and Quran recitation significantly increased scores on assessments of processing speed. This thesis demonstrates that accurately assessing cognition in South Asian older adults is challenging and that the cognitive tests used must be suitable for this cohort. Interesting findings emerged for prayer engagement which may have wider implications for the field of cognitive reserve.

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