INTRODUÇÃO: A Mini-Addenbrooke\'s Cognitive Examination (M-ACE) consiste em um teste de avaliação cognitiva breve composta de cinco itens que visam avaliar quatro domínios cognitivos principais (orientação, memória, linguagem e função viso-espacial) com pontuação máxima de 30 pontos e um tempo de administração de cinco minutos. OBJETIVO: Avaliar o desempenho de idosos cognitivamente saudáveis, com CCL e DA leve na versão brasileira da M-ACE. MÉTODOS: o teste foi aplicado um grupo de 23 pacientes com DA provável leve, 36 CCL e 25 idosos cognitivamente saudáveis. Todos os participantes incluídos tinham idade >= 60 anos. Foram excluídos pacientes com demência de intensidade moderada ou grave, demência de outra etiologia, comorbidades graves com potencial de comprometer a cognição e uso de medicação psicotrópica. A acurácia do teste foi avaliada por meio da análise das curvas ROC. Para analisar a relação entre os escores da M-ACE e os demais testes cognitivos aplicados foram utilizados os coeficientes de correlação de Spearman. Para analisar a consistência interna da M-ACE e suas três versões foi utilizado o coeficiente alfa de Cronbach. RESULTADOS: Houve um predomínio do gênero feminino, a média de idade foi de 73 anos, com faixa etária predominante de 60-69 anos. A média de escolaridade obtida foi de 11 anos. A M-ACE apresentou alta consistência interna (alfa de Cronbach > 0,8; IC 95% 0,776 a 0,869) e mostrou ser extremamente capaz de diferenciar o grupo DA dos demais participantes, com uma acurácia superior ao MEEM. O ponto de corte de 20 foi o de maior sensibilidade e especificidade (95,6% e 90,16% respectivamente), com área sob a curva considerada alta (ASC = 0,805; IC 95% 0,705 -0,904). A M-ACE apresentou melhor precisão em diferenciar os três grupos quando comparado com o MEEM (71,43 versus 60,71). Observou-se ainda uma precisão mais robusta em diferenciar DA de CCL com a M-ACE (63,89 versus 30,56 no MEEM). O escore total da M-ACE não sofreu considerável influência da idade e escolaridade. A M-ACE apresentou forte correlação com MEEM (cor = 0,78), bem como todos os itens (exceto percepção) da BBRC e QAF (cor = -0,76). CONCLUSÃO: A M-ACE pode ser considerada um teste rápido de rastreio com elevada acurácia no diagnóstico de DA. O ponto de corte sugerido neste estudo é de 20 para DA e 27 para CCL / INTRODUCTION: The Mini-Addenbrooke\'s Cognitive Examination (M-ACE) consists of a brief cognitive assessment test composed of five items that aim to evaluate four main cognitive domains (orientation, memory, language and visuospatial function) with a maximum score of 30 points and a time of administration of five minutes. OBJECTIVE: Evaluate the performance of cognitively healthy elderly, MCI and mild AD in the Brazilian version of M-ACE. METHODS: The test was applied to a group of 23 patients with mild probable AD, 36 MCI and 25 cognitively healthy elderly. All included participants were aged >= 60 years. Patients with moderate or severe dementia, dementia of another etiology, severe comorbidities with potential to compromise cognition and use of psychotropic medication were excluded. The accuracy of the test was evaluated by analyzing the ROC curves. Spearman\'s correlation coefficients were used to analyze the relationship between the M-ACE scores and the other cognitive tests applied. In order to analyze the internal consistency of the M-ACE, the Cronbach\'s alpha coefficient was used. RESULTS: There was a predominance of females, mean age was 73 years, with a predominant age range of 60-69 years. The average level of schooling was 11 years. MACE presented high internal consistency (Cronbach\'s alpha > 0.8, 95% CI 0.776 to 0.869) and showed to be extremely capable of differentiating the AD group from the other participants, with a higher accuracy than the MMSE. The cutoff point of 20 was the one with the highest sensitivity and specificity (95.6% and 90.16%, respectively), with an AUC considered to be high (AUC = 0.805, 95% CI 0.705-0.904). The M-ACE presented better accuracy in differentiating the three groups when compared to the MMSE (71.43 versus 60.71). It was also observed a more robust precision in differentiating DA of MCI with M-ACE (63.89 versus 30.56 in MMSE). The total M-ACE score was not very influenced by age and schooling. M-ACE showed a strong correlation with MMSE (spearman = 0.78), as well as all items (except perception) of BBRC and QAF (spearman = -0.76). CONCLUSIONS: M-ACE can be considered a brief screening tool with high accuracy in the diagnosis of AD. The cutoff point suggested in this study is 20 for AD and 27 for MCI

INTRODUÇÃO: O maior desafio no diagnóstico de perdas cognitivas na nossa população é sua heterogeneidade educacional, com um espectro que vai do analfabetismo, analfabetismo funcional até os escolarizados com diferentes graus de alfabetização mesmo com o mesmo grau de escolarização. OBJETIVOS: Comparar os resultados obtidos no S-TOFHLA entre indivíduos controles, pacientes com comprometimento cognitivo leve (CCL) e pacientes com doença de Alzheimer (DA) e correlacioná-los aos anos de escolarização formal, aos testes de Avaliação Neuropsicológica e aos escores alcançados no teste Matrizes Progressivas Coloridas de Raven e nos subtestes Vocabulário e Cubos do WAIS-III como medida de nível intelectual estimado. MÉTODOS: A amostra foi composta por 148 sujeitos, sendo 61 controles saudáveis, 42 pacientes com CCL e 45 com DA. Todos os participantes foram submetidos a avaliação neuropsicológica, S-TOFHLA e avaliação funcional. RESULTADOS: Na avaliação observou-se que nos testes: Cubos, Raven e QI Estimado foram encontradas diferenças estatísticas entre os grupos controle e CCL; controle e DA, mas não entre os grupos CCL e DA. No S-TOFHLA, observou-se diferença estatisticamente significante no item de Compreensão e Leitura e no escore total nos três grupos (controle, CCL e DA). No item Numérico, a diferença estatística ocorreu somente entre os grupos controle e DA. O S-TOFHLA correlacionou-se fortemente o QI estimado. CONCLUSÕES: O S-TOFHLA sofre influência da progressão da doença apresentando diferença entre os grupos estudados. As alterações em inteligência fluida ocorrem desde início da doença. O subteste Vocabulário permaneceu com resultados semelhantes durante os graus de comprometimento cognitivo, mostrando que memória semântica e inteligência cristalizada são preservadas. / INTRODUCTION: The greatest challenge in the diagnosis of cognitive loss in our population is its educational heterogeneity, with a spectrum ranging from illiteracy, functional illiteracy and various degrees of literacy even with the same level of schooling. OBJECTIVES: To compare the results obtained in the S-TOFHLA among control subjects, patients with mild cognitive impairment (MCI) and patients with Alzheimer\'s disease (AD) and correlate those scores with years of formal schooling, Neuropsychological Assessment, and the scores achieved on Raven\'s Colored Progressive Matrices and Vocabulary and Block Design subtests of the WAIS-III as a measure of estimated intellectual level. METHODS: The sample consisted of 148 subjects, of which 61 were healthy controls, 42 had MCI and 45 had AD. All participants underwent neuropsychological assessment, S-TOFHLA and functional evaluation. RESULTS: In the neuropsychological evaluation it was observed that in the tests Block Design, Raven and IQ Estimate statistical differences were found between MCI and control groups, control and AD, but not between the MCI and AD groups. In the S-TOFHLA, there was a statistically significant difference in reading comprehension and in the total score in all three groups (control, MCI and AD). In the Numeric item, the only statistical difference occurred between control and AD. The S-TOFHLA strongly correlated with the estimated IQ. CONCLUSIONS: The S-TOFHLA is influenced by disease progression showing significant difference between groups. The changes in fluid intelligence occur since the onset of disease. The Vocabulary subtest remained with similar results in different degrees of cognitive impairment, showing that semantic memory and crystallized intelligence are preserved.

Thesis (M.A. (Clinical Psychology) --University of Limpopo, 2007 / Disruptive Behaviour Disorders are often associated with high rates of school drop outs, academic skills deficits and low achievement, drug abuse, low self esteem, depression, delinquency and incarceration. The main aim of the study was to establish whether children with DBDs are cognitively and/or neurologically impaired. The study investigated (1) whether children with DBDs show deficiencies in cognitive and motor functions and (2) whether gender and subtype influence cognitive and motor functions. Method: The sample of 137 children with DBDs (ADHD, ODD and CD) and those without a diagnosis of DBDs was drawn from children aged between 8 and 15 years. They were assessed using instruments that were selected to be measures of Executive Functions, cognitive functioning, and motor functions. The scores obtained from the administration of these measures were compared for significant differences between the DBD subtypes and a non-DBD control group as a possible function of gender. Results: The findings indicate that children with symptoms of DBDs performed poorer than the control group on all tests with the exception of the Digits backward. EF and motor impairments are associated with ADHD-C and ADHD-PI, and not with ADHD-HI, ODD and CD. Although among the DBDs, neuropsychological and cognitive impairments have been found to be severe in children with ADHD-PI and ADHD-C, the ADHD-C subtype showed qualitatively larger differences with the normal control group on most measures. There were no differences found between the genders in the performance on all tests that were administered. Conclusion Children of the ADHD-C and ADHD-PI subtypes are significantly more impaired on measures of Executive, cognitive and motor functions than those with ADHD-HI, ODD and CD and those without externalising disorders. However, the ADHD-C subtype found to be more severely impaired when compared with the ADHD-PI subtype.

While the cognitive disturbances that frequently follow severe TBI are relatively well understood, the ways in which these affect the psychosocial functioning of people with TBI are yet to be determined and have thus received little attention in treatment research. Growing evidence indicates that that a significant proportion of individuals with TBI demonstrate deficits in the perception of affective information from the face, voice, bodily movement and posture. As accurate evaluation of emotion in others is critical for the successful negotiation of social interactions, effective treatments are necessary. Until recently, however, there have been no rehabilitation efforts in this area with TBI groups. The present research aims to redress this absence. The literature on emotion perception deficits in TBI is examined, and a theoretical rationale for intervention is presented. Several lines of research are reviewed which suggest that rehabilitation targeting such deficits is tenable. These include research on emotion perception remediation with other cognitively impaired populations, findings from cognitive neuroscience suggesting the potential for neuronal restoration after brain damage, and the successful applications of remediation techniques, in particular errorless learning and self-instruction, for treating other cognitive deficits in a range of neurological disorders and TBI. Discussion of this research is followed by a description of two randomised controlled trials aimed at improving emotion perception in individuals with TBI. The findings are discussed with reference to useful theoretical models of rehabilitation, learning and emotion perception. Suggestions for future directions of research are outlined together with relevant design issues.

Central auditory processing is complex and can not be evaluated by a single method. This thesis focuses on assessment of some aspects of central auditory functions by the use of dichotic speech tests and cognitive tests that tax functions important for speech processing. Paper A deals with the cognitive effects in dichotic speech testing in elderly hearing-impaired subjects. It was found that different listening tasks in the dichotic tests put different demands on cognitive ability, shown by a varying degree of correlation between cognitive functions and dichotic test parameters. Age-related cognitive decline was strongly connected with problems to perceive stimuli presented to the left ear. Paper B presents a new cognitive test battery sensitive for functions important for speech processing and understanding, performed in text, auditory and audiovisual modalities. The test battery was evaluated in four groups, differing in age and hearing status, and has proven to be useful in assessing the relative contribution of different input-modalities and the effect of age, hearingimpairment and visual contribution on functions important for speech processing. In Paper C the test battery developed in Paper B was used to study listening situations with different kinds of background noise. Interfering noise at +10 dB signal-to-noise ratio has significant negative effects on performance in speech processing tasks and on the effort perceived. Hearing-impaired subjects showed poorer results in noise with temporal variations, and elderly subjects were more distracted by noise with temporal variations, especially by noise with meaningful content. In noise, all subjects, particularly those with impaired hearing, were more dependent upon visual cues than in the quiet condition. Hearing aid benefit in speech processing with and without background noise was studied in Paper D. The test battery developed in Paper B was used together with a standard measure of speech recognition. With hearing aids, speech recognition was improved in the background condition without noise and in the background condition of ordinary speech. Significantly less effort was perceived in the cognitive tests when hearing aids were used, although only minor benefits of hearing aid amplification were seen. This underlines the importance of considering perceived effort as a dimension when evaluating hearing aid benefit, in further research as well as in clinical practice. The results from the studies contribute to the knowledge about speech processing but also to the search for more specific evaluation of speech understanding, incorporating both sensory and cognitive factors. / The ISBN 91-85297-49-6 in the printed verison is incorrect. The correct ISBN is 91-85297-93-3.

The aim of this doctoral thesis was to study neuropsychological function in relation to structural and functional brain changes in Alzheimer´s disease (AD). In the first study relations between hippocampal volume, neuropsychological function and limbic-hypothalamic-pituitary-adrenal (LHPA) axis disturbances in AD were investigated with magnetic resonance imaging (MRI). Reduced hippocampal CA1 volume and suppressed cortisol levels in combination, best predicted the variation in neuropsychological performance. The conclusion was that reduced hippocampal volume and LHPA axis disturbances are associated to level of cognitive function in AD. The second study focused on whether patients with early AD showed an altered regional cerebral blood flow (rCBF) pattern compared to control persons, correlation between performance on memory tests and rCBF in sub-lobar volumes of the brain were investigated. The rCBF was measured with single photon emission computed tomography (SPECT). AD-patients showed a significantly lower rCBF in temporoparietal regions including left hippocampus compared to controls. The diagnostic sensitivity and specificity for AD was high in temporoparietal regions. AD-patients had significantly lower performance on semantic and, in particular, episodic memory-tests compared to the controls, and their performance on several episodic tests correlated with rCBF in parietal and temporal regions including left hippocampus, which suggest that abnormalities in the rCBF pattern underlie impaired episodic memory functioning in AD. The conclusion was that an observer-independent analyzing method for SPECT with sub-lobar volumes VOI´s is promising in the diagnosis of AD. In a third study possible differences in memory-related functional brain activation between persons with high versus low risk for AD were examined with functional magnetic resonance imaging (fMRI). The high-risk individuals performed worse than low-risk individuals on tests of episodic memory. Patterns of brain activity during episodic encoding and retrieval showed significant group differences. During both encoding and retrieval, the low-risk persons showed increased activity relative to a baseline condition in prefrontal and hippocampal brain regions that previously have been implicated in episodic memory. By contrast, the high-risk persons did not significantly activate any prefrontal regions, but instead showed increased activity in visual occipito-temporal regions. The conclusion was that patterns of prefrontal brain activity related to episodic memory differed between persons with high versus low risk for AD, and lowered prefrontal activity may predict subsequent disease. In a final study SPECT was used to map patterns of rCBF in an activated state (an episodic encoding task) and in a rest condition in persons with mild AD and in healthy elderly control persons. A reduction of rCBF in temporoparietal regions that was more pronounced in mild AD in the activated encoding task was observed. The conclusion was that there are rCBF differences between mild AD patients and healthy controls in temporoparietal regions, and the temporoparietal reduction is more pronounced during activation than during rest which might be important in the early diagnosis of AD. Taken together, these findings show that level of neuropsychological function, notably episodic memory, can be systematically related to functional disturbances in the LHPA axis and to the function of temporoparietal and prefrontal brain regions in AD patients. These changes are detectable in patients with risk for AD and in an early phase of AD which suggests that the obtained results might be important for early diagnosis of AD.

Background: Research suggests that musculoskeletal injury (MSI) influences cognitive functioning. Cognitive functioning following MSI in athletes is not evaluated currently. Purpose and Method: To examine cognitive deficit in athletes following musculoskeletal injuries, the Automated Neuropsychological Assessment Metric (ANAM) was administered to 22 varsity athletes prior to competition and following MSI. A healthy comparison group of 22 athletes was also tested at time intervals matched with the injured group. Results: A 2 (Group) X 2 (Time) repeated measures ANOVA revealed significant main effects for time on ANAM subtests of Delayed Code Substitution and Simple Reaction Time. Post-hoc Paired t-Tests revealed significant improvements in both groups for Simple Reaction Time, and a significant improvement for the comparison group on Match-to-Sample. Implications: Athletes with musculoskeletal injuries did not show cognitive deficit post-injury; however, the apparent absence of practice effects on a test of spatial processing and working memory requires further examination.

Background: Research suggests that musculoskeletal injury (MSI) influences cognitive functioning. Cognitive functioning following MSI in athletes is not evaluated currently. Purpose and Method: To examine cognitive deficit in athletes following musculoskeletal injuries, the Automated Neuropsychological Assessment Metric (ANAM) was administered to 22 varsity athletes prior to competition and following MSI. A healthy comparison group of 22 athletes was also tested at time intervals matched with the injured group. Results: A 2 (Group) X 2 (Time) repeated measures ANOVA revealed significant main effects for time on ANAM subtests of Delayed Code Substitution and Simple Reaction Time. Post-hoc Paired t-Tests revealed significant improvements in both groups for Simple Reaction Time, and a significant improvement for the comparison group on Match-to-Sample. Implications: Athletes with musculoskeletal injuries did not show cognitive deficit post-injury; however, the apparent absence of practice effects on a test of spatial processing and working memory requires further examination.

Decreased amyloid-ß42 (Aß42), increased total tau (t-tau) and phosphorylated tau (p-tau) in cerebrospinal fluid (CSF) reflect histopathological core changes in the most common dementia disorder, Alzheimer’s disease (AD). They discriminate AD from healthy controls and predict conversion to AD with a relatively high accuracy. Memantine, an uncompetitive NMDA-receptor antagonist, is indicated for symptomatic treatment of AD. The first aim of this thesis was to investigate effects of memantine on CSF concentrations of Aβ42, tau and p-tau. Secondly, the aim was to explore the relation between these CSF biomarkers and retention of the amyloid biomarker Pittsburgh compound B using positron emission tomography (PIB PET), regional glucose metabolism measured with 18Fluoro-2-deoxy-d-glucose (FDG) PET and neuropsychological test performance. The third aim was to investigate their possible utility as predictors of future rate of AD dementia deterioration. All patients in the studies were recruited from the Memory Clinic, Uppsala University Hospital. In study I CSF p-tau concentrations in 11 AD patients were reduced after twelve months treatment with memantine, indicating that this compound may affect a key pathological process in AD. Results from study II showed that the concentrations of CSF Aß42 are lower in PIB+ patients than in PIB- patients, and that the PIB retention was stable during 12 months. In study III 10 patients with the diagnoses AD (6 PIB+/4 PIB-) and 8 subjects (1 PIB+/7 PIB-) with frontotemporal dementia were included. PIB+ patients had lower psychomotor speed measured by performance on the Trail Making Test A and impaired visual episodic memory compared to the PIB- patients. The initial clinical diagnoses were changed in 33% of the patients (6/18) during follow-up. Study IV is the first-ever report of an association between high CSF tau and dying in severe dementia. These 196 AD patients were followed up to nine years after baseline lumbar puncture. Moreover, CSF t-tau concentrations above median was associated with an increased risk of rapid cognitive decline (OR 3.31 (95% CI 1.53-7.16), independently of baseline functional stage. Thus, a clear association between high levels of CSF t-tau and p-tau and a more aggressive course of the disease was shown.

Thesis (M.A.)--The University of North Carolina at Greensboro, 2008. / Directed by Thomas Kwapil; submitted to the Dept. of Psychology. Title from PDF t.p. (viewed Jan. 28, 2010). Includes bibliographical references (p. ).