The applicability of the cognitive abilities screening instrument-short (CASI-S) in primary care in Brazil.

BACKGROUND: The Cognitive Abilities Screening Instrument - Short (CASI-S) is a brief cognitive screening test. However, there is limited information regarding its applicability in primary care. OBJECTIVES: To ascertain whether the CASI-S differentiates between dementia patients and normal controls in primary care; to examine its correlation with other cognitive instruments, to analyze its internal consistency, test-retest stability, and diagnostic accuracy. METHODS: In a case-control study, carried out at two Primary Care Units (PCUs) in the eastern region of the city of São Paulo, 47 older adults were diagnosed with dementia according to DSM-IV criteria (mean age = 76.81 ± 7.03 years), and 55 were classified as normal controls (mean age = 72.78 ± 7.37 years), by a multidisciplinary panel which had access to results from a comprehensive cognitive battery and the patients' health data. The present analyses included results from the Mini-Mental State Examination (MMSE). The CASI-S was not used to determine diagnostic status. RESULTS: The CASI-S was easily applied in the primary care setting. There was a significant performance difference (p < 0.001) between dementia patients (15.57 ± 7.40) and normal controls (26.67 ± 3.52) on the CASI-S. CASI-S scores correlated with age (ρ = -0.410, p < 0.001), educational level (ρ = 0.373, p < 0.001), and MMSE score (ρ = 0.793, p < 0.001). The internal consistency of the CASI-S was high (α = 0.848) and the correlation between test and retest was 0.688, suggesting adequate temporal stability. In the ROC curve analyses, scores of 22/23 generated an area under the curve of 0.907, with sensitivity of 93% and specificity of 81%. CONCLUSIONS: The CASI-S can be useful for dementia screening in primary care in Brazil.

Relationships between episodic memory performance prediction and sociodemographic variables among healthy older adults.

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 30 seconds, 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 functions in healthy elderly: Results of a pilot study.

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 EF tests and self-reports of functional status. METHODS: A cross-sectional study involving an intervention and pre and post testing was carried out. Study participants included 26 seniors assigned to an experimental group (EG) and given six sessions of cognitive intervention, and 17 seniors assigned to a control group (CG) who completed pre and post testing only. All participants 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 Behavioral Memory Test (RBMT) (versions A and B), semantic verbal fluency fruit category, and verbal fluency with phonological constraints (FAS), WAIS-III Digit Span, Clock Drawing Test (CDT), Trail Making Part A and the Pfeffer Functional Assessment Questionnaire (PFAQ). Delta scores were calculated (post-test score minus pretest score) to assess the impact of the intervention. RESULTS: In the post test, the CG showed significant improvement on the RBMT Story recall and Digit Span but a decline in verbal fluency. The EG remained stable in terms of pre and post test scores. CONCLUSIONS: The intervention did not enhance performance on the EF tests. It is noteworthy that the EG received only a small number of sessions which may not have been sufficient to generate improvement. Alternatively, the lack of group differences observed could be associated to 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 processo de envelhecimento normal. OBJETIVOS: Treinar habilidades relacionadas às funções executivas em idosos e detectar impactos em testes objetivos de FE e em autorrelato de desempenho funcional. MÉTODOS: Trata-se de um estudo transversal, com intervenção e pré e pós testagem. Participaram do estudo 26 idosos que compuseram o grupo experimental (GE) que receberam 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 usados o Mini-Exame do Estado Mental (MEEM), Escala de Depressão Geriátrica (EDG), o subteste História do Teste Comportamental de 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 de Pfeffer (PFAQ). Para a avaliação do impacto da intervenção foram calculados deltas (escore do pós-teste menos o escore do 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: Os dados sugerem que a intervenção não gerou impacto nos testes associados ao conceito de FE. Destaca-se que os idosos do 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.