The modified Ruche visuospatial learning test (RUCHE-M) for the assessment of visuospatial episodic memory in patients with temporal lobe epilepsy: Preliminary evidence for the investigation of memory binding.

INTRODUCTION: The Ruche test is a visuospatial form of the Rey auditory verbal learning test (RAVLT), with initial evidence of utility in the diagnosis of temporal lobe epilepsy (TLE)-related memory disorders. AIMS: To present the translation to Brazilian Portuguese and modification of the Ruche test (RUCHE-M) and compare the RUCHE-M and RAVLT performance between patients with right and left TLE. METHODS: Twenty-five neuropsychologists participated in instrument adaptation. Thirty-seven patients with right (n = 19) and left (n = 18) TLE participated. Data were compared with the Mann-Whitney U test. RESULTS: All specialists considered the final RUCHE-M to be adequate. The RUCHE-M forgetting speed index (FSI) score and several RAVLT scores differed significantly between patients with right and left TLE. CONCLUSION: The RUCHE-M showed limited utility for the assessment of visuospatial episodic memory in patients with TLE. The manipulation of memory binding as demonstrated by FSI score seems to be a promising paradigm for the assessment of right hippocampal function.

Patient Competency Rating Scale-Brazilian Revised Version (PCRS-R-BR): Normative and Psychometric Data in 154 Healthy Individuals.

Background Patient Competency Rating Scale (PCRS-R-BR) is a clinical tool to evaluate the degree of competence in cognitive skills perceived by patients with brain injuries. However, no studies have investigated the influence of sociodemographic variables on self-report and self-awareness of healthy individuals.Aim This study aimed to (1) present normative data from the PCRS-R-BR in a healthy adult Brazilian sample; and (2) investigate psychometric properties of the scaleMethod One hundred and fifty-four adults that were divided in three age groups and two education groups and their informants completed the PCRS-R-BR.Results Score on the PCRS-R-BR Patient's Form differed as a function of age with younger adults reporting less competency than older individuals. An education effect was found on Attention/Working memory Factor on the Informant's PCRS-R-BR with informants of higher education adults reporting better competency than lower education individuals. A gender effect was observed on the Informant's Form. The Informant's Form scores of informants of women were higher than the scores provided by the informants of men. PCRS-R-BR showed adequate consistency coefficients and six factors.Conclusion PCRS-R-BR scores showed acceptable validity evidence and provides information regarding how age and gender effects may influence ratings in a Brazilian sample.

Self-awareness and underestimation of cognitive abilities in patients with adult temporal lobe epilepsy after surgical treatment.

INTRODUCTION: Self-awareness of cognitive, emotional, functional, and social performance is critical for compliance with treatment. However, few studies have investigated self-awareness and the associated effects on other cognitive variables in patients with temporal lobe epilepsy (TLE) after surgical treatment. AIM: This study was designed to investigate the prevalence of impaired self-awareness (ISA) in patients with TLE who have undergone surgical treatment. Associated correlations with clinical variables (frequency of seizures before surgery, time elapsed since the epilepsy diagnosis, depression, and anxiety) and verbal and visual episodic memory function and differences between patients with right and left TLE were also investigated. METHOD: Twenty-three adults with TLE after surgical treatment were assessed with the Patient Competency Rating Scale (PCRS-R-BR), the Rey Auditory Verbal Learning Task (RAVLT), and the Modified Ruche Visuospatial Learning Test (RUCHE-M). Patients were considered to have memory dysfunction if delayed recall as assessed with the RUCHE-M or RAVLT was at or below the 25th percentile. Patients were considered to have ISA if PCRS-R-BR discrepancy scores were at or above the 75th percentile. Underestimated cognitive ability (UCA) was defined as a PCRS-R-BR discrepancy percentile score ≤25. Results were analyzed using frequency, Spearman correlation, regression analyses, and the Mann-Whitney test. RESULTS: Frequency analysis of the total sample indicated ISA in 39.13% of patients (n = 9), UCA in 39.13% of patients (n = 9), and impaired verbal and/or visual memory performance in 69.56% of patients (n = 16). Moderate positive correlations were found between the frequency of seizures before surgical treatment and relatives' reports, as well as between the duration of time that had elapsed since the epilepsy diagnosis and patient reports. Negative and moderate correlations were found between the frequency of seizures and the discrepancy score, as well as between depression and patient reports. No differences in PCRS-R-BR were found between patients with right vs. left TLE. No clinical variables significantly predicted self-report or self-awareness. CONCLUSION: Patients with TLE exhibit various patterns of ISA and negative effects on cognitive function after surgical treatment. Emotional factors and relatives' reports must be considered when assessing these patients.

Estimating biological accuracy of DSM for attention deficit/hyperactivity disorder based on multivariate analysis for small samples.

OBJECTIVE: To estimate whether the "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is biologically accurate for the diagnosis of Attention Deficit/ Hyperactivity Disorder (ADHD) using a biological-based classifier built by a special method of multivariate analysis of a large dataset of a small sample (much more variables than subjects), holding neurophysiological, behavioral, and psychological variables. METHODS: Twenty typically developing boys and 19 boys diagnosed with ADHD, aged 10-13 years, were examined using the Attentional Network Test (ANT) with recordings of event-related potentials (ERPs). From 774 variables, a reduced number of latent variables (LVs) were extracted with a clustering of variables method (CLV), for further reclassification of subjects using the k-means method. This approach allowed a multivariate analysis to be applied to a significantly larger number of variables than the number of cases. RESULTS: From datasets including ERPs from the mid-frontal, mid-parietal, right frontal, and central scalp areas, we found 82% of agreement between DSM and biological-based classifications. The kappa index between DSM and behavioral/psychological/neurophysiological data was 0.75, which is regarded as a "substantial level of agreement". DISCUSSION: The CLV is a useful method for multivariate analysis of datasets with much less subjects than variables. In this study, a correlation is found between the biological-based classifier and the DSM outputs for the classification of subjects as either ADHD or not. This result suggests that DSM clinically describes a biological condition, supporting its validity for ADHD diagnostics.

Visuospatial information processing load and the ratio between parietal cue and target P3 amplitudes in the Attentional Network Test.

In ERP studies of cognitive processes during attentional tasks, the cue signals containing information about the target can increase the amplitude of the parietal cue P3 in relation to the 'neutral' temporal cue, and reduce the subsequent target P3 when this information is valid, i.e. corresponds to the target's attributes. The present study compared the cue-to-target P3 ratios in neutral and visuospatial cueing, in order to estimate the contribution of valid visuospatial information from the cue to target stages of the task performance, in terms of cognitive load. The P3 characteristics were also correlated with the results of individuals' performance of the visuospatial tasks, in order to estimate the relationship of the observed ERP with spatial reasoning. In 20 typically developing boys, aged 10-13 years (11.3±0.86), the intelligence quotient (I.Q.) was estimated by the Block Design and Vocabulary subtests from the WISC-III. The subjects performed the Attentional Network Test (ANT) accompanied by EEG recording. The cued two-choice task had three equiprobable cue conditions: No cue, with no information about the target; Neutral (temporal) cue, with an asterisk in the center of the visual field, predicting the target onset; and Spatial cues, with an asterisk in the upper or lower hemifield, predicting the onset and corresponding location of the target. The ERPs were estimated for the mid-frontal (Fz) and mid-parietal (Pz) scalp derivations. In the Pz, the Neutral cue P3 had a lower amplitude than the Spatial cue P3; whereas for the target ERPs, the P3 of the Neutral cue condition was larger than that of the Spatial cue condition. However, the sums of the magnitudes of the cue and target P3 were equal in the spatial and neutral cueing, probably indicating that in both cases the equivalent information processing load is included in either the cue or the target reaction, respectively. Meantime, in the Fz, the analog ERP components for both the cue and target stimuli did not depend on the cue condition. The results show that, in the parietal site, the spatial cue P3 reflects the processing of visuospatial information regarding the target position. This contributes to the subsequent "decision-making", thus reducing the information processing load on the target response, which is probably reflected in the lower P3. This finding is consistent with the positive correlation of parietal cue P3 with the individual's ability to perform spatial tasks as scored by the Block Design subtest.