Cognitive screening test in primary care: cut points for low education

ABSTRACT OBJECTIVE To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level. METHODS Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted. RESULTS Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance. CONCLUSIONS The GPCOG-Br is clinically well-suited for use in primary care.

The Geriatric Anxiety Inventory in primary care: applicability and psychometric characteristics of the original and short form

Abstract Background Generalized anxiety disorder (GAD) has negative implications for people’s lives, but is often underdiagnosed in the elderly. There is a shortage of instruments to assess geriatric anxiety. Objectives To analyze the applicability and psychometric properties of the Portuguese version of the Geriatric Anxiety Inventory (GAI) and its short form (GAI-SF) within primary care. Methods Fifty-five seniors were classified as non-demented by a multidisciplinary panel. The protocol included the GAI, the Self-Reporting Questionnaire (SRQ-20), the Depression Scale D-10, Mini-Mental State Examination (MMSE), Bayer Scale for Activities of Daily Living (B-ADL) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A sub-sample also completed the Beck Anxiety Inventory (BAI). Results The GAI and GAI-SF showed good internal consistency (0.89; 0.62, respectively) and test-retest stability (0.58, 0.97). The GAI and GAI-SF correlated significantly with the SRQ-20 (0.74, 0.55) and BAI (0.75, 0.58). Discussion The psychometric characteristics of the Brazilian versions of the GAI and GAI-SF suggest these instruments are suitable for application in the Brazilian elderly population within the primary care setting.

Relationships between episodic memory performance prediction and sociodemographic variables among healthy older adults / Relações entre previsão de desempenho de memória episódica e variáveis sociodemográficas entre idosos saudáveis

Previous studies have suggested that performance prediction, an aspect of metamemory, may be associated with objective performance on memory tasks. Objective: The objective of the study was to describe memory prediction before performing an episodic memory task, in community-dwelling older adults, stratified by sex, age group and educational level.Additionally, the association between predicted and objective performance on a memory task was investigated. Methods: The study was based on data from 359 participants in the FIBRA study carried out at Ermelino Matarazzo, São Paulo. Memory prediction was assessed by posing the question: ?If someone showed you a sheet with drawings of 10 pictures to observe for 30seconds, how many pictures do you think you could remember without seeing the sheet??. Memory performance was assessed by the memorization of 10 black and white pictures from the Brief Cognitive Screening Battery (BCSB). Results: No differences were found between men and women, nor for age group and educational level, in memory performance prediction before carrying out the memory task. There was a modest association (rho=0.11, p=0.041) between memory prediction and performance in immediate memory. On multivariate linear regression analyses, memory performance prediction was moderately significantly associated with immediate memory (p=0.061). Conclusion: In this study, sociodemographic variables did not influence memory prediction, which was only modestly associated with immediate memory on the Brief Cognitive Screening Battery (BCSB).

Estudos prévios sugerem que a previsão de desempenho, um dos aspectos da metamemória, pode estar associada ao desempenho em tarefas de memória. Objetivo: Objetivou-se descrever a previsão de desempenho antes da realização de uma tarefa de memória episódica em idosos residentes na comunidade, divididos por sexo, faixas de idade e escolaridade.Adicionalmente, objetivou-se estudar a associação entre a previsão de desempenho com o desempenho objetivo em tarefa de memória. Métodos: Foram utilizados os dados de 359 idosos participantes do estudo FIBRA realizado em Ermelino Matarazzo, São Paulo. Foi utilizada uma questão referente à previsão de desempenho: ?Se alguém lhe mostrasse uma folha com desenhos de 10 figuras para observar por 30 segundos, quantas figuras o/a senhor/a acha que conseguiria se lembrar em seguida sem ver a folha??. O desempenho de memória foi avaliado pela memorização de 10 figuras em preto e branco da Bateria Breve de Rastreio Cognitivo (BBRC). Resultados: Não foram encontradas diferenças entre homens e mulheres, entre faixas etárias ou de escolaridade para a previsão de desempenho antes da realização de tarefa de memória. Houve associação modesta (rho=0,11, p=0,041) entre a previsão de desempenho e o desempenho em memória imediata. Na análise de regressão linear multivariada a previsão de desempenho associou-se de forma moderatemente significante com a memória imediata (p=0,061). Conclusão: Neste estudo observou-se que as variáveis sociodemográficas não influenciaram a previsão de desempenho que esteve associada de forma modesta com a memória imediata na Bateria Breve de Rastreio Cognitivo (BBRC).

Training of executive functionsin healthy elderly: results of a pilot study / Treino de funções executivas para idosos saudáveis: resultados de um estudo piloto

Executive functions (EF) refer to the cognitive skills necessary to formulate a goal, plan, execute plans effectively, and to perform self-monitoring and self-correction. Several aspects of EF change during the normal aging process. Objectives: To train skills associated with executive functions in the elderly and to detect possible impact on objective EFtests and self-reports of functional status. Methods: A cross-sectional study involving an intervention and pre and posttesting was carried out. Study participants included 26 seniors assigned to an experimental group (EG) and given six sessionsof cognitive intervention, and 17 seniors assigned to a control group (CG) who completed pre and post testing only. Allparticipants were enrolled in an Open University for the Third Age. The following tests were used to measure outcome: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), the Story subtest of the Rivermead BehavioralMemory Test (RBMT) (versions A and B), semantic verbal fluency fruit category, and verbal fluency with phonologicalconstraints (FAS), WAIS-III Digit Span, Clock Drawing Test (CDT), Trail Making Part A and the Pfeffer Functional AssessmentQuestionnaire (PFAQ). Delta scores were calculated (post-test score minus pretest score) to assess the impact of theintervention. Results: In the post test, the CG showed significant improvement on the RBMT Story recall and Digit Span buta decline in verbal fluency. The EG remained stable in terms of pre and post test scores. Conclusions: The intervention didnot enhance performance on the EF tests. It is noteworthy that the EG received only a small number of sessions which maynot have been sufficient to generate improvement. Alternatively, the lack of group differences observed could be associatedto participation in other workshops offered at the university.

As funções executivas (FE) representam as capacidades cognitivas necessárias para formular um objetivo, planejar, executar planos de modo eficiente, monitorizar-se e autocorrigir-se. As FE sofrem alterações durante o processode envelhecimento normal. Objetivos: Treinar habilidades relacionadas às funções executivas em idosos e detectar impactosem testes objetivos de FE e em autorrelato de desempenho funcional. Métodos: Trata-se de um estudo transversal, comintervenção e pré e pós testagem. Participaram do estudo 26 idosos que compuseram o grupo experimental (GE) quereceberam intervenção cognitiva de seis sessões e 17 idosos do grupo controle (GC) que completaram apenas pré e pós testagem, matriculados em atividades em uma Universidade Aberta à Terceira Idade. Como medida de eficácia foram usadoso Mini-Exame do Estado Mental (MEEM), Escala de Depressão Geriátrica (EDG), o subteste História do Teste Comportamentalde Memória de Rivermead (versões A e B), fluência verbal categoria semântica frutas (FV), e com restrição fonológica (FAS), Dígitos da bateria WAIS-III, o Teste do Desenho do Relógio (TDR), Trilha A e o Questionário de Avaliação Funcional dePfeffer (PFAQ). Para a avaliação do impacto da intervenção foram calculados deltas (escore do pós-teste menos o escoredo pré-teste). Resultados: No pós-teste o GC apresentou melhora no resgate da História e no desempenho nos Dígitos,entretanto, apresentou pior desempenho em fluência verbal. A pontuação do GE permaneceu inalterada. Conclusões: Osdados sugerem que a intervenção não gerou impacto nos testes associados ao conceito de FE. Destaca-se que os idososdo GE receberam um número limitado de sessões que pode não ter sido suficiente para gerar alterações. Alternativamente,a ausência de diferença entre os grupos pode estar associada à participação em outras oficinas oferecidas na universidade.