A study of the abilities in oral language comprehension of the Boston Diagnostic Aphasia Examination - Portuguese version: a reference guide for the Brazilian population

We analyzed the performance of 162 normal subjects, subdivided into groups according to age and schooling, in the oral comprehension tasks of the Boston Diagnostic Aphasia Examination translated and adapted to Brazilian Portuguese to obtain a profile of performance for the Brazilian population, as well as cut-off scores for each task, and to determine the best combination of tasks that distinguish normal from aphasic subjects, as a guide for clinicians. The normal subjects were compared to 69 aphasics. Age alone influenced the performance in the designation of actions (subjects above 70 years showing the worst performance); schooling alone influenced the comprehension of forms, colors and numbers (subjects with less than four years of education showing a poorer performance). Both age and schooling influenced the performance in Body Part Identification (BPI) and Complex Ideational Material (CIM) with mean values of 70.5 ± 3.3 (Word Discrimination, WD), 18.9 ± 1.4 (BPI), 14.7 ± 0.9 (Commands), and 10.3 ± 1.7 (CIM) for the whole sample; the cut-off scores obtained were 65 (WD), 17.5 (BPI), 14 (Commands), and 9.5 (CIM) for the whole sample. Logistic regression showed that the combination of BPI + Commands + CIM was the most efficient in differentiating normal subjects from aphasics, with 72.5 percent sensitivity and 97.6 percent specificity. However, for low-education subjects, BPI and Commands were sufficient for this differentiation (75.7 percent sensitivity and 84.7 percent specificity). The main contribution of this study was to provide reference values that are far more representative of our population to be used by health professionals in Brazil, taking into account cultural differences.

Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling

In Neurolinguistics, the use of diagnostic tests developed in other countries can create difficulties in the interpretation of results due to cultural, demographic and linguistic differences. In a country such as Brazil, with great social contrasts, schooling exerts a powerful influence on the abilities of normal individuals. The objective of the present study was to identify the influence of schooling on the performance of normal Brazilian individuals in the Boston Diagnostic Aphasia Examination (BDAE), in order to obtain reference values for the Brazilian population. We studied 107 normal subjects ranging in age from 15 to 84 years (mean ± SD = 47.2 ± 17.6 years), with educational level ranging from 1 to 24 years (9.9 ± 4.8 years). Subjects were compared for scores obtained in the 28 subtests of the BDAE after being divided into groups according to age (15 to 30, N = 24, 31 to 50, N = 33 and 51 years or more, N = 50) and education (1 to 4, N = 26, 5 to 8, N = 17 and 9 years or more, N = 61). Subjects with 4 years or less of education performed poorer in Word Discrimination, Visual Confrontation Naming, Reading of Sentences and Paragraphs, and Primer-Level Dictation (P < 0.05). When breakdown by schooling was 8 years or less, subjects performed poorer in all subtests (P < 0.05), except Responsive Naming, Word Recognition and Word-Picture Matching. The elderly performed poorer (P < 0.05) in Complex Ideational Material, Visual Confrontation Naming, Comprehension of Oral Spelling, Written Confrontation Naming, and Sentences to Dictation. We present the reference values for the cut-off scores according to educational level.

Performance of a Brazilian population sample in the Boston Diagnostic Aphasia Examination: A pilot study

Brazilian researchers and health professionals often face the challenge of having to use tests developed in foreign languages and standardized for populations of other countries, especially in the fields of Neuropsychology and Neurolinguistics. This fact promotes a feeling that some scoring systems may be inadequate for our sociocultural reality. In the present study, we describe the performance of a Brazilian population sample submitted to a translated and adapted version of the Boston Diagnostic Aphasia Examination (BDAE). Sixty normal volunteers (21 men and 39 women), all Portuguese native speakers, ranging in age from 15 to 78 years (average 43.7) and with an educational level of 2 to 16 years (average 9.9), were tested using a translated and adapted Portuguese version of the BDAE. Cut-off scores are suggested for our population and the performance of the Brazilian sample is compared to that of American and Colombian samples, with the results being closely similar in all tasks. We also performed a correlation analysis between age, gender and educational level and the influence of these variables on the performance of the subjects. We found no statistically significant differences between genders. Educational level correlated positively with performance, especially in the subtests involving reading and writing. There was a negative correlation between age and performance in two subtests (Visual Confrontation Naming and Sentences to Dictation), but a coexisting effect of educational level could not be ruled out

Uso do Doppler transcraniano para monitorizaçäo do vasoespasmo cerebral secundário à hemorragia subaracnóide / Use of transcranial Doppler in the monitoration of cerebral vasospasm secondary to subarachnoid hemorrhage

O vasoespasmo cerebral é responsável por aumento de morbidade e mortalidade em pacientes acometidos por hemorragia subaracnóide (HSA). Sua detecçäo de forma precoce e näo-invasiva pelo método de Doppler transcraniano (DTC) pode contribuir para um melhor prognóstico destes doentes. OBJETIVO: Discutir o uso do método de DTC para diagnóstico do vasoespasmo cerebral secundário à HSA espontânea. METODOS: Foram analisados os registros de velocidade de fluxo em artérias intracranianas por DTC em 31 pacientes com diagnóstico tomográfico de HSA, realizados sequencialmente em conjunto com exame neurológico. Todos os pacientes (à exceçäo de um) eram portadores de aneurismas intracranianos. RESULTADOS: Vasoespasmo clínico foi constatado em 11 pacientes (36,6 por cento do total), com correspondente vasoespasmo ultra-sonográfico presente em nove casos (82 por cento). Em três casos (33,3 por cento) as alteraçöes de velocidade de fluxo precederam os sinais clínicos. Entre os 20 pacientes assintomáticos, 15 (75 por cento) apresentaram medidas de velocidade normais, havendo evidência de vasoespasmo sonográfico sem repercussäo clínica em cinco (25 por cento). O índice de falso negativo na correlaçäo entre exame clínico e DTC (sinais clínicos de vasoespasmo presentes, com velocidades de fluxo normais) foi de 18 por cento. No entanto, houve correspondência entre os achados clínicos e ultra-sonográficos em 26 dos 31 pacientes (83,8 por cento). Os valores de velocidades médias nas várias artérias e sua interpretaçäo para cada subgrupo säo discutidos com maiores detalhes. CONCLUSAO: O método de DTC Ú um auxiliar valioso na detecçäo pré-sintomática do vasoespasmo secundário à HSA, permitindo uma intervençäo terapêutica mais precoce. Os dados obtidos neste trabalho coadunam-se com os diversos estudos publicados na literatura