Adaptação transcultural do instrumento de avaliação de desempenho em tarefas rotineiras Routine Task Inventory - Extended (RTI-E) para uso com idosos com demência no Brasil / Cross-cultural adaptation of functioning evaluation Routine Task Inventory - Extended (RTI-E) for use in elderly people with dementia in Brazil

Resumo Objetivo Realizar a adaptação transcultural do Routine Task Inventory-Expanded para uso com idosos com demência no Brasil. Método Estudo de adaptação transcultural de instrumento de avaliação, seguindo diretrizes reconhecidas para tradução, retrotradução e comitê de especialistas. Pré-teste realizado com 10 sujeitos idosos sem prejuízos cognitivos. Estudo de confiabilidade (concordância entre avaliadores e análise de consistência interna) realizado com sujeitos idosos com e sem demência (n=26). Resultados A tradução inicial foi revista para não alterar o construto do instrumento. A partir da revisão por especialistas e do pré-teste identificou-se necessidade de ajustes nos itens C.Banho, G.Uso de telefone e H.Uso de equipamentos adaptativos para conferir maior clareza à compreensão dos itens. O instrumento apresentou consistência interna α= 0,813 ABVD/autorrelato a α=0,966, AVD/cuidador e confiabilidade entre avaliadores ICC (IC95%) de 0,987 em AIVD a 1,000 em comunicação. Conclusão Alcançou-se a adaptação transcultural do Routine Task Inventory- Expanded mantendo sua equivalência em relação ao instrumento original.

Abstract Objective Cross-cultural adaptation of the Routine Task Inventory-Expanded assessment for use in Brazil. Method This cross-cultural adaptation study of the Routine Task Inventory-Expanded followed translation, back-translation, and expert committee review guidelines. The pre-test was performed with 10 elderly subjects with no cognitive impairment. The reliability study (agreement between evaluators and internal consistency) was executed with elderly subjects with and without dementia (n=26). Results The initial translation was revised to preserve the instrument's construct. Adjustments were made to task C. Bathing, task G. Use of the telephone, and task H. Use adaptive equipment to clarify the meaning of items. The instrument showed internal consistency α= 0.813 ADL/self-report to α=0.966, ADL/caregiver, and reliability between ICC evaluators (95%IC) from 0.987 in IADL to 1.000 in communication. Conclusion The cross-cultural adaptation of the Routine Task Inventory-Expanded was achieved, maintaining equivalency to the original instrument and providing a new instrument to assess cognitive functional abilities of elderly individuals living with dementia in routine daily living activities for use in Brazil.

Reduced Gray Matter Volume of the Thalamus and Hippocampal Region in Elderly Healthy Adults with no Impact of APOE ɛ4: A Longitudinal Voxel-Based Morphometry Study.

BACKGROUND: Many cross-sectional voxel-based morphometry (VBM) investigations have shown significant inverse correlations between chronological age and gray matter (GM) volume in several brain regions in healthy humans. However, few VBM studies have documented GM decrements in the healthy elderly with repeated MRI measurements obtained in the same subjects. Also, the extent to which the APOE ɛ4 allele influences longitudinal findings of GM reduction in the healthy elderly is unclear. OBJECTIVE: Verify whether regional GM changes are associated with significant decrements in cognitive performance taking in account the presence of the APOE ɛ4 allele. METHODS: Using structural MRI datasets acquired in 55 cognitively intact elderly subjects at two time-points separated by approximately three years, we searched for voxels showing significant GM reductions taking into account differences in APOE genotype. RESULTS: We found global GM reductions as well as regional GM decrements in the right thalamus and left parahippocampal gyrus (p < 0.05, family-wise error corrected for multiple comparisons over the whole brain). These findings were not affected by APOE ɛ4. CONCLUSIONS: Irrespective of APOE ɛ4, longitudinal VBM analyses show that the hippocampal region and thalamus are critical sites where GM shrinkage is greater than the degree of global volume reduction in healthy elderly subjects.

Relationship between regional brain volumes and cognitive performance in the healthy aging: an MRI study using voxel-based morphometry.

The presence of cognitive impairment is a frequent complaint among elderly individuals in the general population. This study aimed to investigate the relationship between aging-related regional gray matter (rGM) volume changes and cognitive performance in healthy elderly adults. Morphometric magnetic resonance imaging (MRI) measures were acquired in a community-based sample of 170 cognitively-preserved subjects (66 to 75 years). This sample was drawn from the "São Paulo Ageing and Health" study, an epidemiological study aimed at investigating the prevalence and risk factors for Alzheimer's disease in a low income region of the city of São Paulo. All subjects underwent cognitive testing using a cross-culturally battery validated by the Research Group on Dementia 10/66 as well as the SKT (applied on the day of MRI scanning). Blood genotyping was performed to determine the frequency of the three apolipoprotein E allele variants (APOE ε2/ε3/ε4) in the sample. Voxelwise linear correlation analyses between rGM volumes and cognitive test scores were performed using voxel-based morphometry, including chronological age as covariate. There were significant direct correlations between worse overall cognitive performance and rGM reductions in the right orbitofrontal cortex and parahippocampal gyrus, and also between verbal fluency scores and bilateral parahippocampal gyral volume (p < 0.05, familywise-error corrected for multiple comparisons using small volume correction). When analyses were repeated adding the presence of the APOE ε4 allele as confounding covariate or excluding a minority of APOE ε2 carriers, all findings retained significance. These results indicate that rGM volumes are relevant biomarkers of cognitive deficits in healthy aging individuals, most notably involving temporolimbic regions and the orbitofrontal cortex.