Vocabulary tests have long been used for estimating premorbid intelligence level in the neuropsychological assessment of dementia. However, doubts exist about the validity of such intelligence tests. The present study examines whether the Multiple-Choice Vocabulary Test – Version A (Mehrfachwahl-Wortschatz-Test – Version A, MWT-A) is valid for assessing premorbid intelligence level. Data from a total of 821 patients in a specialized outpatient clinic for dementia (memory clinic), covering the whole spectrum of cognitive impairment, were evaluated using analysis of variance with the dependent variable premorbid intelligence level (MWT-A) and the independent variable extent of global cognitive impairment (Mini-Mental-State Examination, MMSE: mean = 25.2, SD = 3.9). The latter was divided into six MMSE ranges or groups, respectively (29–30, 28–28, 27–27, 25–26, 22–24, 05–21). In the case of a pathologically relevant global cognitive impairment (24–26 MMSE points), the MWT-A underestimates the premorbid intelligence level. This effect is moderated neither by age nor education. Results indicate that the MWT-A is unsuitable for estimating premorbid intelligence level in neuropsychological assessments of cognitively impaired patients or demented patients.

The diagnosis of neurodegenerative diseases leading to dementia is increasingly moving to the earlier stages in an effort to find the disease-modifying treatment for these diseases. Prodromal and preclinical stages of the diseases have become the primary research interests. Neuropsychology is specifically focused on early cognitive markers and development of methods that would be able to reliably assess these markers and to evaluate the risk of progression of cognitive decline in individual cases. The theoretical part of the thesis presents the current knowledge in the field of neurodegenerative diseases, it is specifically focused on Alzheimer's disease (AD) as the most common cause of dementia. We also present the current trends in neuropsychological diagnostics of early AD and the approach to subjective and objective evaluation of cognitive functioning. Building on that, we present the rationale for the empirical part of the thesis. The empirical part of the thesis extends the existing knowledge in the field of AD. We present and discuss seven original publications that follow three basic objectives: first, to characterize subjective cognitive complaints of individuals at risk of AD, second, to evaluate the potential of selected standard and experimental neuropsychological methods to detect...

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

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[pt] Pacientes com lesões encefálicas adquiridas (LEA) apresentam prejuízos neuropsicológicos e funcionais. O presente estudo teve como objetivo identificar o perfil neuropsicológico destes pacientes atendidos em um serviço de neurocirurgia de um hospital público do Rio de Janeiro, avaliando as evidências de validade clínica da Bateria Breve de Rastreio Cognitivo (BBRC) no comprometimento cognitivo. Método: Participaram do estudo 30 pacientes submetidos a neurocirurgia de crânio e 30 de de coluna atendidos no ambulatório neurocirúrgico. Todos realizaram a BBRC que mostrou que o grupo crânio apresentou um comprometimento do funcionamento cognitivo global (MEEM- 35), memória incidental e imediata e no desenho do relógio. O resultado inicial mostrou prejuízo em alguns domínios das funções executivas, tais como memória operacional, estratégias de memória episódica e planejamento. A pesquisa sugere que a BBRC pode ser utilizada no contexto hospitalar para pacientes com LEA pós cirúrgicos. / [en] Patients with Acquired Brain Injury (ABI) have neuropsychological and functional injuries. The present study aimed to identify the neuropsychological profile of these patients treated at a neurosurgical service of a public hospital in Rio de Janeiro, evaluating the evidence of clinical validity of the Battery Cognitive Screening brief (BCSB) in cognitive injuries. Method: Thirty patients who was submitted to brain s neurosurgery and 30 spinal s neurosurgeries attended at clinic participated in the study. All underwent the BCSB, which showed that the search group had impairment in global cognitive functioning (MMSE-35), memory and in clock drawing test. The initial result showed injuries in the domains of executive functions, such as working memory, episodic memory strategies and planning. Research suggests that BBRC can be used in the hospital setting for post-surgical ABI patients.

No description available.

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.

No description available.

Left hemisphere damage is a frequent cause of aphasia. Analyses of deviant linguistic behaviors provide valuable information about the functional architecture of language. Correlating specific language difficulties with damage to the brain helps shed light on the relationships between language and the neural substrate. The aim of this Ph.D. thesis is to contribute to the understanding of the neural correlates of sentence comprehension, based on behavioral and neuroimaging evidence from aphasia. A substantial amount of research based on lesion-symptom mapping has been devoted to this issue, but several issues remain to be clarified. To consider just an example, lesion-symptom mapping studies have systematically linked the posterior regions of the left hemisphere to sentence comprehension. Surprisingly, however, the same studies failed to provide similarly strong evidence for prefrontal regions, contradicting the results of previous neuropsychological investigations that clearly supported the critical role of these regions in sentence processing. To date, there are enough controversial issues on sentence processing as to warrant reconsideration of available evidence. The present project focused on the neural correlates of the mechanisms involved in thematic role assignment and in the processing of morphosyntactic features. This is because both sets of mechanisms are critical for sentence interpretation both in comprehension and in production. The first step of the project consisted of a systematic literature review and meta-analysis of lesion-symptom investigations of sentence processing (study 1 – Chapter 1). The literature search yielded 43 studies eligible for review, of which 27 were used in the meta-analysis. The main goal was to identify the correlates of thematic role assignment and of morphosyntactic processing. Thematic role assignment errors correlated mainly with damage in the left temporo-parietal regions, and morphosyntactic errors mainly with damage in the prefrontal regions. However, careful consideration of the reviewed and meta-analyzed studies shows that conclusions are biased under several aspects. Data on thematic deficits are based almost exclusively on sentence comprehension, and data on morphosyntactic deficits on sentence production. Furthermore, even the very few studies that evaluated both impairments did so in distinct linguistic contexts, or in different response modalities. In addition, studies that focused on one set of mechanisms did not consider the possibility that performance on their dimension of interest was influenced by damage to the other. For example, studies focusing on thematic comprehension administered thematic foils, but not morphosyntactic foils. Therefore, the neurofunctional correlates emerging from the meta-analysis and the review may offer a biased and/or partial view. As a first attempt at overcoming these limitations, a lesion study on native speakers of Italian with post-left stroke aphasia was conducted (study 2 – Chapter 2) to clarify the neural substrates of morphosyntactic and thematic processes in comprehension. Experimental stimuli consisted of simple declarative, semantically reversible sentences presented in the active or passive voice. In an auditory sentence comprehension task, participants were asked to match a sentence spoken by the computer to the corresponding picture, that had to be distinguished from a thematic, a morphosyntactic or a lexical-semantic foil. Thirty-three left brain-damaged individuals (out of an initial sample of 70) were selected because they fared normally on lexical-semantic foils, but poorly on morphosyntactic (n=15) and/or thematic (n=18) contrasts. Voxel-based Lesion Symptom Mapping (VLSM) analyses retrieved non-overlapping substrates. Morphosyntactic difficulties were uninfluenced by sentence voice and correlated with left inferior and middle frontal damage, whereas thematic role reversals were more frequent on passives and correlated with damage to the superior and middle temporal gyrus and to the superior occipitolateral cortex. Both correlations persisted after covarying for phonological short-term memory. When response accuracy to passive vs active sentences in the presence of thematic foils was considered, portions of the angular and supramarginal gyrus were retrieved. They could provide the neural substrate for thematic reanalysis, that is critical for comprehending sentences with noncanonical word order. However interesting and strong, these results were obtained by considering just one sentence type (declaratives) and by relying on basic neuroimaging data. To go beyond these limitations, the final step of the project relied on more comprehensive behavioral analyses and more advanced neuroimaging techniques (study 3 – Chapter 3). The SCOPRO (Sentence Comprehension and PROduction) language battery was developed, that focuses on thematic and morphosyntactic processes and allows assessing these processes in a variety of reversible sentences in both comprehension and production. SCOPRO was administered to 50 neurotypical subjects (to assess applicability and establish cutoff levels) and 27 aphasic participants (native Italian speakers with left post-stroke aphasia). Of the latter, 21 were included in an MRI-based lesion-symptom mapping study. Results obtained in comprehension tasks were correlated with neuroimaging data (structural T1 and DWI). Lesion maps, disconnectome maps, tract disconnection probability and personalized deterministic tractography data demonstrated the involvement of grey and white matter. Thematic role reversals correlated to cortical damage in the left angular gyrus. They also correlated to cortical damage in the left supramarginal gyrus when controlling for single-word processing in a voxel-based disconnectome-symptom mapping analysis. Thematic errors were associated also with underlying white matter damage. Correlating the probability of tract disconnections and personalized deterministic tractography with thematic role performance involved the left arcuate fasciculus. The posterior segment was associated with thematic role reversals, even after controlling for morphosyntactic and single-word processing. The anterior segment was linked to accuracy on thematic roles when single-word processing was used as a covariate. The long segment also correlated with the level of thematic role performance, but the correlation was no longer present when morphosyntactic performance was used as a covariate. SCOPRO can be used not only to assess language processes in a broad sense (e.g., morphosyntactic vs thematic), but also to look into more detailed issues. Contrasting accuracy on declarative and comparative sentences is an interesting case in point. Both sentence types express reversible relations, but only declaratives require thematic role mapping. Hence, contrasting results between the two could help distinguish the correlates of role mapping from those of reversibility per se. The supramarginal gyrus was damaged in participants who fared poorly in both declaratives and comparatives but, interestingly, the aphasics with selective thematic difficulties had suffered damage to the posterior division of the middle temporal gyrus and to the angular gyrus, whereas those with selective difficulties on comparatives presented with lesions in the parietal and central opercular cortex. Clearly, these results are preliminary and require further investigation. It is unanimously accepted that sentence processing involves a large-scale network including frontal, temporal and parietal cortices and the underlying white matter pathways. The main contribution of the present project is that it allows articulating more detailed hypotheses on the role played by some components of the network during sentence comprehension. Results tie left frontal regions to morphosyntactic processing, posterior temporal regions to the retrieval of verb argument structure, and a posterior-superior parietal area to thematic reanalysis. Preliminary observations also suggest that different neural substrates could be involved in processing reversibility as such and when more specifically implemented in thematic roles. Further studies exploiting detailed behavioral tools like the SCOPRO battery and sophisticated neuroimaging techniques in larger samples will lead to a better understanding of language functions and their processing in the brain.

Submitted by Viviane Lima da Cunha (viviane@biblioteca.ufpb.br) on 2016-05-06T13:20:07Z No. of bitstreams: 1 arquivototal.pdf: 2988550 bytes, checksum: bb61f478d61d75baec8e92e0e6b9470f (MD5) / Made available in DSpace on 2016-05-06T13:20:07Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2988550 bytes, checksum: bb61f478d61d75baec8e92e0e6b9470f (MD5) Previous issue date: 2015-02-24 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / It is known that ethanol present in the alcoholic beverages, of acute or chronic ingestion in its various levels, leave to a variety of organic alterations that can interfere with more basic behavioral and cognitive processes. In this sense, the present study aimed to evaluate the influence of acute and chronic ethanol intake in the auditory perception and neuropsychological functioning. Acute ingestion was experimentally manipulated in college students with 18 to 30 years old compared with themselves in two different sessions. In one of days, they had to ingest a quantity of alcohol proportional to their body weight and when they possessed 0.08% of ethanol in the blood they were evaluated. In another day, they drank just a placebo drink. The chronic ingestion of alcohol was evaluated in Alcoholics Anonymous participants, aged 40-60 years, who had 1-15 years of abstinence. They were evaluated in separate groups of three years of abstinence and were compared to a control group of first degree relatives. The auditory perception was evaluated by means of a test for discrimination of musical notes corresponding to standard Western scale sound frequencies. Cognitive functioning was evaluated by means of neuropsychological tests for the processes of memory, attention, and executive functioning. The results showed that both forms of alcohol intake cause perceptual hearing loss as well as the some neuropsychological subfunctions evaluated, suggesting that the use of ethanol may be a path of some cognitive impairment. / Sabe-se que o etanol, presente nas bebidas alcoólicas, ingerido de forma aguda ou crônica, em seus vários níveis, leva a uma série de alterações orgânicas que podem interferir em processos cognitivos e comportamentais básicos. Nesse sentido, o presente estudo teve como objetivo avaliar a influência da ingestão aguda e crônica de etanol na percepção auditiva e no funcionamento neuropsicológico. Manipulou-se a ingestão aguda em estudantes universitários, de 18 a 30 anos, os comparando consigo mesmos em duas condições diferentes. Em uma delas, solicitava-se que os participantes ingerissem uma quantidade de álcool proporcional ao seu peso corporal para que no momento dos testes possuíssem 0,08 % de etanol no sangue. Na outra, ingeriam apenas uma bebida placebo. Avaliou-se a ingestão crônica do álcool em participantes de Alcoólicos Anônimos, com idades de 40 a 60 anos, que possuíam de 1 a 15 anos de abstinência, sendo que se avaliaram estes em grupos separados pelo tempo de três anos de abstinência em comparação a um grupo controle formado por parentes em primeiro grau. Avaliou-se a percepção auditiva por meio de um teste de discriminação de frequências sonoras correspondentes às notas musicais de um escala ocidental padrão. Já o funcionamento cognitivo avaliou-se por meio de testes neuropsicológicos relativos aos processos de memorização, atenção, e de funcionamento executivo. Os resultados mostraram que ambas as formas de ingestão do álcool ocasionam prejuízos perceptivos na audição, bem como em algumas das subfunções neuropsicológicas avaliadas, sugerindo que o uso do etanol pode ser um demarcador de determinadas deficiências cognitivas.