Assessment of cognitive functioning using the Mini Mental State Examination in men with alcohol and crack cocaine use disorder

Abstract Introduction Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. Objectives To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. Methods Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). Results Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). Discussion Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.

Construção de um instrumento para avaliar a compreensão da linguagem oral de crianças de 2 a 6 anos / Construction of an instrument to assess oral language comprehension of children from 2 to 6 years / Construcción de un instrumento para evaluar la comprensión del lenguaje oral en niños de 2 a 6 años

Objetivo: Descrever a construção de um instrumento para avaliar a compreensão da linguagem oral de crianças de 2 a 6 anos e obter evidências de validade baseadas no conteúdo. Método: A pesquisa consistiu em: levantamento e caracterização de instrumentos nacionais e internacionais destinados à avaliação da compreensão da linguagem oral de crianças; elaboração do instrumento; e análise do instrumento por cinco juízes. A análise estatística envolveu cálculo da porcentagem de concordância, razão de validade de conteúdo e índice de validade de conteúdo. Resultados: Foram levantados 19 instrumentos que avaliam a compreensão da linguagem oral utilizando palavras isoladas, ordens simples ou complexas e textos. Posteriormente, foi elaborado instrumento composto por oito fases com oito itens cada. A tarefa consiste na manipulação de figuras pela criança, conforme as ordens do avaliador com nível crescente de dificuldade. A análise dos juízes indicou resultados satisfatórios para os índices calculados para o instrumento como um todo. Os itens com índice insatisfatório foram revisados para compor a versão final do instrumento. Conclusão: O estudo descreveu a primeira etapa do processo de construção do instrumento e foram obtidas evidências de validade baseadas no conteúdo. Estudos posteriores serão conduzidos para obtenção de outras fontes de evidência de validade.

Objective: This work aimed to describe the construction of an instrument to assess the oral language comprehension capability of 2 to 6-year-old children and get validity evidences based on content. Method: The research consisted in: gathering and characterizing existing national and international instruments used for the assessment of children oral language comprehension capability; elaborating a new instrument; and analysis of the instrument by five judges. Statistical analysis involved calculation of Percentage of Agreement, of Content Validity Ratio and of Content Validity Index. Results: Nineteen instruments were identified, which assess the oral language comprehension capability by using items formed by isolated words, simple and complex orders, and texts. It was subsequently developed an instrument consisting of eight stages containing eight items each. The task consists in the child manipulating figures in accordance with the orders of the evaluator with increasing level of difficulty. The judge's assessment indicated satisfactory results for the calculated indices for the instrument as a whole. Items with unsatisfactory rate were reviewed for inclusion in the final version of the instrument. Conclusion: This study described the first step of the construction process of the instrument. Validity evidences based on content were obtained. Further studies will be conducted to obtain other sources of content validity.

Objetivo: Describir la construcción de un instrumento para evaluar la comprensión del lenguaje oral en niños de 2 a 6 años y obtener evidencias de validez basadas en el contenido. Método: La pesquisa se consistió en: levantamiento y caracterización de instrumentos nacionales e internacionales destinados a la evaluación de la comprensión del lenguaje oral en niños; elaboración de un nuevo instrumento; y análisis del instrumento por cinco jueces. El análisis estadístico envolvió cálculo de porcentaje de concordancia, proporción de validez de contenido e índice de validez de contenido. Resultados: Fueran identificados 19 instrumentos que evalúan la comprensión del lenguaje oral, utilizando palabras aisladas, ordenes simples o complejas y textos. Posteriormente, fue elaborado un instrumento compuesto por ocho frases con ocho ítems cada. La tarea consiste en la manipulación de figuras por el niño según las órdenes del evaluador, con nivel creciente de dificultad. El análisis de los jueces indicó resultados satisfactorios en lo que se refiere a los índices calculados para el instrumento como un todo. Los ítems con índice insatisfactorio fueran revisados para componer la versión final del instrumento. Conclusión: El estudio describió la primera etapa del proceso de construcción del instrumento e fueran obtenidas evidencias de validez basadas en el contenido. Estudios posteriores serán conducidos para obtención de otras fuentes de evidencia de validez.

Text Comprehension as a Problem Solving Situation / Comprensión de textos como una situación de solución de problemas

Research in text comprehension has provided details as to how text features and cognitive processes interact in order to build comprehension and generate meaning. However, there is no explicit link between the cognitive processes deployed during text comprehension and their place in higher-order cognition, as in problem solving. The purpose of this paper is to propose a cognitive model in which text comprehension is made analogous to a problem solving situation and that relies on current research on well-known cognitive processes such as inference generation, memory, and simulations. The key characteristic of the model is that it explicitly includes the formulation of questions as a component that boosts representational power. Other characteristics of the model are specified and its extensions to basic and applied research in text comprehension and higher-order cognitive processes are outlined.

La investigación en la comprensión de textos ha dado detalles de cómo las características del texto y los procesos cognitivos interactúan con el fin de consituir la comprensión y generar significado. Sin embargo, no existe un vínculo explícito entre los procesos cognitivos desplegados durante la comprensión de textos y su lugar en la cognición de orden superior, como en la resolución de problemas. El propósito de este trabajo es proponer un modelo cognitivo en el que la comprensión de textos se hace similar a una resolución de problemas y la situación que se basa en la investigación actual sobre los procesos cognitivos conocidos como la generación de la inferencia, la memoria y las simulaciones. La característica clave del modelo es que incluye explícitamente la formulación de las preguntas como un componente que aumenta la potencia de representación. Otras características del modelo se especifican y sus extensiones a la investigación básica y en la comprensión de textos y de orden superior los procesos cognitivos se describen aplican.

Characteristics of Language Comprehension in Normal Elderly and the Mild Cognitive Impaired

BACKGROUND: Healthy aging is characterized by declines in language function and it is important to differentiate language comprehension difficulties due to pathological aging (i.e., mild cognitive impairment) from those due to normal aging. The purposes of this study were to review the literature on characteristics of language comprehension in normal elderly and the mild cognitive impaired, and to compare their performances on different language domains. METHODS: A comprehensive literature search identified numerous studies on language comprehension in both groups, and we analyzed them according to each language domain. RESULTS: The results indicated that the normal elderly show more difficulties in the comprehension of grammatically or lexically complex sentences and in text/discourse comprehension than words or simple sentences. Compared to normal elderly, MCI shows significantly lower performance on text/discourse comprehension and other tasks demanding higher cognitive function. In both groups, there are many different factors affecting language comprehension, such as hearing sensitivity, speech rate, literacy, and cognition. CONCLUSIONS: The results may provide insight into useful language comprehension tasks for differential diagnosis between normal aging and MCI. Further research on various compensatory strategies in daily life to facilitate language comprehension for both groups is warranted.

On the activation of sensorimotor systems during the processing of emotionally-laden stimuli / Sobre la activación de sistemas sensorimotores durante el procesamiento de estímulos emocionalmente cargados

A series of experiments were devised to test the idea that sensorimotor systems activate during the processing of emotionally laden stimuli. In Experiments 1 and 2 participants were asked to judge the pleasantness of emotionally laden sentences while participants held a pen in the mouth. Experiments 3 and 4 were similar to the previous experiments, but the experimental materials were emotionally laden images. In Experiment 5 and 6 the same bodily manipulation used throughout the previous experiments was kept while participants judged facial expressions. The first pair of experiments replicated findings suggesting that sensorimotor systems are activated during the processing of emotionally laden language. However, follow-up experiments suggested that dual activation of both perceptual and motor systems is not always necessary. For the particular case of emotionally laden stimuli, results suggested that the perceptual system seems to drive the processing. It is also shown that a high resonance between sensorimotor properties afforded by the stimuli and the sensorimotor systems activated in the cogniser elicit emotional states. The results invite to review radical versions of embodiment accounts and rather support a graded-embodiment view.

Una serie de experimentos fueron diseñados para determinar si sistemas sensoriomotores se activan durante el procesamiento de estímulos con contenido emocional. En los experimentos 1 y 2, los participantes juzgaron cuan emocionales eran ciertas frases con contenido emocional mientras sostenían un lápiz en la boca. Los experimentos 3 y 4 fueron similares a los anteriores con la diferencia de que los materiales experimentales fueron imágenes con contenido emocional. En los experimentos 5 y 6 la misma manipulación facial fue usada mientras los participantes juzgaban expresiones faciales. El primer par de experimentos replicó estudios anteriores demostrando que sistemas sensoriomotores se activan durante el procesamiento de lenguaje con contenido emocional. Sin embargo, los experimentos subsecuentes sugirieron que la activación de sistemas perceptuales y motores no siempre son necesarios. Para el caso específico de estímulos con contenido emocional, los resultados sugirieron que el sistema perceptual está a cargo del procesamiento. También se argumenta que una resonancia alta entre los sistemas sensoriomotores asociados a los estímulos y los sistemas sensoriomotores activados en el participante, conllevan a la elicitación de estados emocionales. Los resultados invitan entonces a revisar versiones radicales de las teorías de la cognición corporeizada y en cambio sugieren adoptar versiones en las que existen grados de corporeidad.

Validación de una escala para medir la habilidad de cuidado de cuidadores / Validation of a scale to measure the ability to care for caregivers

La presente investigación se enmarca dentro de la línea de investigación de Habilidad de Cuidado, del Grupo de investigación Cuidado al Paciente Crónico y su familia de la Facultad de Enfermería de la Universidad Nacional de Colombia; busca determinar la validez facial y de contenido de una propuesta de modificación semántica de la escala para medir habilidad de cuidado de cuidadores familiares de personas con enfermedad crónica diseñada por Barrera. El diseño del estudio se es de tipo metodológico con abordaje cuantitativo que realizó en tres fases Adecuación semántica, determinación del grado de comprensibilidad y Validez Facial y de contenido de la propuesta de modificación de la escala. Para determinar el grado de comprensibilidad se aplicaron 385 formatos diseñados por la investigadora, a una población con diferentes niveles educativos y socioeconómicos, mayores de 18 años, encontrando cinco ítems con comprensibilidad baja y diez ítems con comprensibilidad media, los cuales fueron examinados semánticamente y recibieron cambios a la luz de la teoría y de las observaciones de los sujetos. La validez facial y de contenido se estableció mediante el método de panel de expertos, las pruebas estadísticas en esta fase se desarrollaron con el índice de concordancia de Kappa de Fleiss; la validez facial, fue determinada mediante la evaluación de los ítems en las categorías de comprensión y claridad, encontrando que la mayoría de los ítems fueron aceptados tanto por la población que determinó la comprensión como por los jueces que evaluaron la claridad, concluyendo que la escala diseñada por Barrera y modificada semánticamente en el presente estudio, cuenta con validez facial puesto que de acuerdo a los resultados obtenidos mide lo que pretende medir. En la validez de contenido se evaluó suficiencia, coherencia, relevancia y esencialidad, encontrando que el contenido de la escala construida es válido para medir la habilidad de cuidado de cuidadores familiares de personas con enfermedad crónica, sin embargo, es importante revisar los ítems, que no alcanzaron los valores aceptables para el presente estudio, con el fin de propender por ítems más pertinentes y adecuados para medir dicho constructo.

This study is in the context of the research strand corresponding to Care Skills held by the investigation team Care to Chronic Patients and their families from the nursing department at Universidad Nacional de Colombia. Its aim is to determine the facial and contents validity of a proposal of semantic modification of the scale to measure care skill in relatives caregivers of people with chronic ills designed by Barrera. This methodological study with a quantitative approach was developed in three phases: Semantic Modification, Comprehension degree, and facial and contents validity of the modification of the scale. To determine the comprehension degree, 385 forms designed by the researcher were applied to a group of people, older than 18, from different educational and social-economic backgrounds. Five items with low Comprehension and ten items with average comprehension were found and semantically examined. Those items were changed in light of the theory and the individuals' remarks. Facial and contents validity was established through the experts panel method; in this phase, the statistics tests were developed by means of the Correspondence Rate by Kappa de Fleiss. Facial validity was determined by the evaluation of the items regarding comprehension and clarity; it was found that most of the items were accepted by both the population who defined the comprehension and the judges who evaluated clarity. In conclusion, the scale designed by Barrera, and semantically modified in this study, has facial validity since, according to the results, it measures what it is expected to measure. In regards to contents validity, proficiency, coherence, relevance and importance were evaluated to come up with the conclusion that the content´s scale is valid for to measure care skill in relatives caregivers of people with chronic ills, however, is important to check the items that did not reach them the acceptable values for this study, with the purpose to have items more relevant and appropriate to measure this construct.

Implementación y validación de protocolo de estimulación por comprensión de lenguaje oral en resonancia magnética funcional: resultados preliminares / Implementation and validation of a stimulation protocol for oral language comprehension using functional magnetic resonance imaging: preliminary results

This study aimed at implementing a stimulation protocol using functional Magnetic Resonance Imaging (fMRI), in a Hospital in Valparaiso (V Region), Chile, to detect cortical areas activated in oral language comprehension. Seven healthy volunteers participated in this study. Average t-score and signal variation were 6.3 +/- 0.3 and 0.5 +/- 0.1 percent, respectively. In spite of these low values, activations were obtained in Wernicke area, middle temporal gyrus, and Heschl s gyrus. The extension of activated areas was small, 5.06 +/- 2.99 cm3, probably due to amplifer low signal-to-noise ratio (SNR), in addition to the cognitive complexity of the task, and to the ambient acoustic noise. Successful implementation of fMRI protocols of language comprehension is possible in a clinical context in Chile without any additional resources.

Nuestro objetivo fue implementar un protocolo de estimulación en resonancia magnética funcional en un Hospital de Valparaíso, V Región de Chile, para detectar las áreas corticales activadas en la comprensión del lenguaje oral. Siete voluntarios sanos participaron de este estudio. El t-score y variación de señal alcanzado fue de 6.3 0.3 y 0.5 +/- 0.1 por ciento respectivamente. A pesar de estos bajos valores, las activaciones se registraron en el área Wernicke, circunvolución temporal media y circunvolución d e Heschl. La extensión de las activaciones fue pequeña, 5.06 +/- 2.99 cm³, probablemente debido a la baja relación señal ruido del resonador (SNR), además de la complejidad cognitiva de la tarea y el ruido acústico ambiente. Nuestros resultados indican que la implementación de la RMf en comprensión del lenguaje es posible de realizar en Chile sin recursos adicionales.

Brain activation for reading and listening comprehension: an fMRI study of modality effects and individual differences in language comprehension

The study compared the brain activation patterns associated with the comprehension of written and spoken Portuguese sentences. An fMRI study measured brain activity while participants read and listened to sentences about general world knowledge. Participants had to decide if the sentences were true or false. To mirror the transient nature of spoken sentences, visual input was presented in rapid serial visual presentation format. The results showed a common core of amodal left inferior frontal and middle temporal gyri activation, as well as modality specific brain activation associated with listening and reading comprehension. Reading comprehension was associated with more left-lateralized activation and with left inferior occipital cortex (including fusiform gyrus) activation. Listening comprehension was associated with extensive bilateral temporal cortex activation and more overall activation of the whole cortex. Results also showed individual differences in brain activation for reading comprehension. Readers with lower working memory capacity showed more activation of right-hemisphere areas (spillover of activation) and more activation in the prefrontal cortex, potentially associated with more demand placed on executive control processes. Readers with higher working memory capacity showed more activation in a frontal-posterior network of areas (left angular and precentral gyri, and right inferior frontal gyrus). The activation of this network may be associated with phonological rehearsal of linguistic information when reading text presented in rapid serial visual format. The study demonstrates the modality fi ngerprints for language comprehension and indicates how low- and high working memory capacity readers deal with reading text presented in serial format.