Orientador: Monica Sanches Yassuda / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-12T04:01:55Z (GMT). No. of bitstreams: 1 Aprahamian_Ivan_M.pdf: 2297167 bytes, checksum: 09e06865f4593ca514927b6569c04485 (MD5) Previous issue date: 2008 / Resumo: O Teste do Desenho do Relógio (TDR) é o segundo teste mais utilizado no mundo para o rastreio das demências. Contudo, há ainda dúvida sobre seu papel no processo diagnóstico da demência em termos de sensibilidade, especificidade, forma de aplicação e análise. OBJETIVOS: avaliar o desempenho do TDR no processo diagnóstico de uma amostra de idosos brasileiros portadores e não portadores da doença de Alzheimer (DA). Avaliar a sensibilidade (S) e a especificidade (E) do TDR, segundo as escalas de Shulman, Mendez e Sunderland, com as do Mini-Exame do Estado Mental (MEEM) e do Cambridge Cognitive Examination (CAMCOG), a bateria neuropsicométrica do Cambridge Examination for Mental Disorder of the Elderly (CAMDEX). METODOLOGIA: Estudo retrospectivo no qual foram analisados prontuários de pacientes idosos, 121 com DA e 99 controles normais, submetidos ao CAMDEX entre os anos de 2002 e 2007 dentro do Instituto de Geriatria e Gerontologia de Jundiaí seguindo protocolo padronizado. Todos os pacientes avaliados neste estudo passaram por avaliação médica detalhada anterior à realização do CAMDEX, incluindo exames laboratoriais e de neuroimagem. O CAMDEX apresenta duração média de duas horas, incluindo o CAMCOG, a bateria neuropsicométrica, que possui o MEEM e o TDR em sua avaliação. O TDR foi analisado separadamente utilizando-se três escalas comumente utilizadas na literatura (Shulman, Mendez e Sunderland). Os resultados do TDR foram comparados com os do CAMCOG e do MEEM. RESULTADOS: Encontrou-se correlação significativa entre os resultados do TDR com os do MEEM (0,700 - 0,730; p < 0,001) e do CAMCOG (0,753 - 0,779; p < 0,001). As três escalas de TDR utilizadas apresentam resultados semelhantes, sendo a melhor a escala de Shulman (S = 74,2 - 84,8%; E = 66,7 - 89,9%). A utilização conjunta do TDR com o MEEM melhora a sensibilidade e especificidade no rastreio cognitivo dos pacientes (S = 89,2 - 90%; E = 71,7 - 79,8%). Houve aumento da S e E do TDR com a baixa escolaridade. CONCLUSÃO: O TDR é um bom teste de rastreio quando comparado com o MEEM e o CAMCOG, independente da escala de interpretação utilizada. A combinação do TDR com o MEEM melhora seu rendimento. A influência da escolaridade merece estudo posterior. / Abstract: The Clock Drawing test (CDT) is the second most used test in the world for the screening of dementia. Although, there is still doubt over its paper in the diagnostic process of dementia in terms of sensitivity, specificity, application and interpretation. OBJECTIVES: evaluate the performance of the CDT in diagnostic process of a Brazilian elderly sample with and without Alzheimer's disease (AD). Evaluate the sensitivity (SE) and specificity (SP) of CDT, according to Shulman, Mendez and Sunderland, with the Mini-Mental State Examination (MMSE) and the Cambridge Cognitive Examination (CAMCOG), the neuropsychiatric battery of the Cambridge Examination for Mental Disorder of the Elderly (CAMDEX). METHODS: Retrospective study of 121 AD and 99 elderly controls medical charts that were submitted to the CAMDEX following a standardized protocol between 2002 and 2007 at the Jundiai's Geriatric and Gerontology Institute. All subjects were clinically evaluated and submitted to laboratory and neuroimaging studies. The CAMDEX has a mean time of two hours, including the CAMCOG, a neuropsychiatric battery that has the MMSE and the CDT in its evaluation. The CDT were analyzed separately using three common scales ((Shulman, Mendez and Sunderland). The results of the CDT were compared with the CAMCOG and the MMSE. RESULTS: There were significant correlation between the results of the CDT and the MMSE (0,700 - 0,730; p < 0,001) and between the CDT and the CAMCOG (0,753 - 0,779; p < 0,001). The three CDT scales showed similar results, but the Shulman's scales was slightly better (SE = 74,2 - 84,8%; SP = 66,7 - 89,9%). The combination between the CDT and the MMSE improved sensitivity and specificity in the cognitive screening of the subjects (SE = 89,2 - 90%; SP = 71,7 - 79,8%). There was improvement of sensitivity and specificity in patients with low level of formal education. CONCLUSION: The CDT is a good screening test when compared with the MMSE or the CAMCOG, independently of the scale used for its interpretation. The combination with the MMSE improves its performance significantly. The influence of education in the CDT deserves further studies. / Mestrado / Mestre em Gerontologia

The Neuropsychological Symptom Inventory (NSI; Rattan, Dean, & Rattan, 1989), a self report measure of psychiatric and neurological symptoms, was revised to be presented in an electronic format. This revised instrument, the Neuropsychological Symptom Scale (Dean, 2010), was administered to 1,141 adult volunteers from a medium-sized Midwestern university. The collected data was subjected to exploratory factor analysis which suggested three primary factors related to emotional, cognitive, and somatosensory functioning. The items on the NSS were then organized into three subscales reflecting these areas of functioning. A fourth experimental subscale was also created to facilitate the collection of data on items that did not load on any of the three primary subscales. Item Response Theory (IRT) analysis and Classical Test Theory (CTT) approaches were then applied and compared as means of developing standard scores on the three primary subscales of the NSS. The results of these analyses are provided along with recommendations related to the further development of the NSS as an assessment tool. / Department of Educational Psychology

The present study was designed to empirically validate six theoretically derived cognitive domains (verbal memory, visual memory, working memory, attention-concentration, executive functions, and visuospatial abilities) assessed by a comprehensive battery of neuropsychological tests used in the Geriatric Memory Clinic at the University of North Texas Health Science Center in Fort Worth, Texas. The study examined the extent to which various cognitive dimensions are tapped by this battery in a heterogeneous geriatric sample of 114 patients with cognitive impairments. The proposed six-factor model of cognitive functioning has not been supported. Further exploratory factor analysis arrived at a five-factor solution. Factor pattern of the 23 tests supported the following five dimensions: memory, executive control, attention, visuospatial abilities, and cognitive flexibility.

Malingering is the deliberate production of feigned symptoms by a person seeking external gain such as: financial compensation, exemption from duty, or leniency from the criminal justice system. The Test Translation and Adaptation Guidelines developed by the International Test Commission (ITC) specify that only tests which have been formally translated into another language and validated should be available for use in clinical practice. Thus, the current study evaluated the psychometric properties of a Spanish translation of the Structured Interview of Reported Symptoms (SIRS). Using a simulation design with 80 Spanish-speaking Hispanic American outpatients, the Spanish SIRS was produced reliable results with small standard errors of measurement (SEM). Regarding discriminant validity, very large effect sizes (mean Cohen's d = 2.00) were observed between feigners and honest responders for the SIRS primary scales. Research limitations and directions for future research are also discussed.