Applicability of the Test of Variables of Attention - T.O.V.A in Brazilian adults.

The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. OBJECTIVE: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. METHODS: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults - WAIS-III) and the Trail Making Test. RESULTS: the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. CONCLUSION: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.

O funcionamento da atenção é complexo, função primordial em diversos processos cognitivos e de grande interesse para a neuropsicologia. O Teste de Variáveis de Atenção (T.O.V.A) é um teste computadorizado de desempenho contínuo que avalia alguns componentes de atenção, como tempo de resposta a um estímulo e erros por desatenção e impulsividade. OBJETIVO: 1) Avaliar a aplicabilidade do T.O.V.A em adultos brasileiros; 2) Analisar as diferenças de desempenho entre os gêneros, faixas etárias e níveis de escolaridade; 3) Examinar a associação entre as variáveis T.O.V.A e outros testes de atenção e triagem cognitiva. MÉTODOS: O TOVA foi aplicado a 63 adultos saudáveis (24 a 78 anos) submetidos ao Mini-Exame do Estado Mental (MEEM), Montreal Cognitive Assessment (MoCA), Digit Span e Digit Symbol (Wechsler Intelligence Scale for Adults ­ WAIS-III) e o Trail Making Test. RESULTADOS: T.O.V.A teve pouca influência da idade e escolaridade, mas foi influenciado pelo gênero. As correlações entre algumas variáveis T.O.V.A e o símbolo Digit e o teste Trail Making foram fracas (valores de r entre 0,2 e 0,4), mas significativas (p <0,05). Não houve correlação com o teste Digit Span. CONCLUSÃO: T.O.V.A apresentou boa aplicabilidade e foi adequado para avaliar os processos de atenção em adultos.

Applicability of the Test of Variables of Attention - T.O.V.A. in Brazilian adults / Aplicabilidade do teste de variáveis de atenção - T.O.V.A. em adultos brasileiros

ABSTRACT: The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. Objective: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. Methods: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults ­ WAIS-III) and the Trail Making Test. Results: The T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. Conclusion: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.

RESUMO: O funcionamento da atenção é complexo, função primordial em diversos processos cognitivos e de grande interesse para a neuropsicologia. O Teste de Variáveis de Atenção (T.O.V.A) é um teste computadorizado de desempenho contínuo que avalia alguns componentes de atenção, como tempo de resposta a um estímulo e erros por desatenção e impulsividade. Objetivo: 1) Avaliar a aplicabilidade do T.O.V.A em adultos brasileiros; 2) Analisar as diferenças de desempenho entre os gêneros, faixas etárias e níveis de escolaridade; 3) Examinar a associação entre as variáveis T.O.V.A e outros testes de atenção e triagem cognitiva. Métodos: O TOVA foi aplicado a 63 adultos saudáveis (24 a 78 anos) submetidos ao Mini-Exame do Estado Mental (MEEM), Montreal Cognitive Assessment (MoCA), Digit Span e Digit Symbol (Wechsler Intelligence Scale for Adults ­ WAIS-III) e o Trail Making Test. Resultados: T.O.V.A teve pouca influência da idade e escolaridade, mas foi influenciado pelo gênero. As correlações entre algumas variáveis T.O.V.A e o símbolo Digit e o teste Trail Making foram fracas (valores de r entre 0,2 e 0,4), mas significativas (p <0,05). Não houve correlação com o teste Digit Span. Conclusão: T.O.V.A apresentou boa aplicabilidade e foi adequado para avaliar os processos de atenção em adultos.

Higher arterial stiffness is associated with lower cognitive performance in patients with hypertension.

Cognitive impairment and elevated arterial stiffness have been described in patients with arterial hypertension, but their association has not been well studied. We evaluated the correlation of arterial stiffness and different cognitive domains in patients with hypertension compared with those with normotension. We evaluated 211 patients (69 with normotension and 142 with hypertension). Patients were age matched and distributed according to their blood pressure: normotension, hypertension stage 1, and hypertension stage 2. Cognitive function was assessed using the Mini-Mental State Examination, Montreal Cognitive Assessment, and a battery of neuropsychological evaluations that assessed six main cognitive domains. Pulse wave velocity was measured using a Complior device, and carotid properties were assessed by radiofrequency ultrasound. Central arterial pressure and augmentation index were obtained using applanation tonometry. The hypertension stage 2 group had higher arterial stiffness and worse performance either by Mini-Mental State Examination (26.8±2.1 vs 27.3±2.1 vs 28.0±2.0, P=.003) or the Montreal Cognitive Assessment test (23.4±3.5 vs 24.9±2.9 vs 25.6±3.0, P<.001). On multivariable regression analysis, augmentation index, intima-media thickness, and pulse wave velocity were the variables mainly associated with lower cognitive performance at different cognitive domains. Cognitive impairment in different domains was associated with higher arterial stiffness.

Hypertension Severity Is Associated With Impaired Cognitive Performance.

BACKGROUND: Most evidence of target-organ damage in hypertension (HTN) is related to the kidneys and heart. Cerebrovascular and cognitive impairment are less well studied. Therefore, this study analyzed changes in cognitive function in patients with different stages of hypertension compared to nonhypertensive controls. METHODS AND RESULTS: In a cross-sectional study, 221 (71 normotensive and 150 hypertensive) patients were compared. Patients with hypertension were divided into 2 stages according to blood pressure (BP) levels or medication use (HTN-1: BP, 140-159/90-99 or use of 1 or 2 antihypertensive drugs; HTN-2: BP, ≥160/100 or use of ≥3 drugs). Three groups were comparatively analyzed: normotension, HTN stage 1, and HTN stage 2. The Mini-Mental State Examination, Montreal Cognitive Assessment, and a validated comprehensive battery of neuropsychological tests that assessed 6 main cognitive domains were used to determine cognitive function. Compared to the normotension and HTN stage-1, the severe HTN group had worse cognitive performance based on Mini-Mental State Examination (26.8±2.1 vs 27.4±2.1 vs 28.0±2.0; P=0.004) or Montreal Cognitive Assessment (23.4±3.7 vs 24.9±2.8 vs 25.5±3.2; P<0.001). On the neuropsychological tests, patients with hypertension had worse performance in language, processing speed, visuospatial abilities, and memory. Age, hypertension stage, and educational level were the best predictors of cognitive impairment in patients with hypertension in different cognitive domains. CONCLUSIONS: Cognitive impairment was more frequent in patients with hypertension, and this was related to hypertension severity.

Contributions of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) for the diagnosis of MCI in Brazil.

ABSTRACT Background: The Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment (CANS-MCI) is a computer-based cognitive screening instrument that involves automated administration and scoring and immediate analyses of test sessions. The objective of this study was to translate and culturally adapt the Brazilian Portuguese version of the CANS-MCI (CANS-MCI-BR) and to evaluate its reliability and validity for the diagnostic screening of MCI and dementia due to Alzheimer's disease. Methods: The test was administered to 97 older adults (mean age 73.41 ± 5.27 years) with at least four years of formal education (mean education 12.23 ± 4.48 years). Participants were classified into three diagnostic groups according to global cognitive status (normal controls, n = 41; MCI, n = 35; AD, n = 21) based on clinical data and formal neuropsychological assessments. Results: The results indicated high internal consistency (Cronbach's α = 0.77) in the total sample. Three-month test-retest reliability correlations were significant and robust (0.875; p < 0.001). A moderate level of concurrent validity was attained relative to the screening test for MCI (MoCA test, r = 0.76, p < 0.001). Confirmatory factor analysis supported the three-factor model of the original test, i.e., memory, language/spatial fluency, and executive function/mental control. Goodness of fit indicators were strong (Bentler Comparative Fit Index = 0.96, Root Mean Square Error of Approximation = 0.09). Receiver operating characteristic curve analyses suggested high sensitivity and specificity (81% and 73% respectively) to screen for possible MCI cases. Conclusions: The CANS-MCI-BR maintains adequate psychometric characteristics that render it suitable to identify elderly adults with probable cognitive impairment to whom a more extensive evaluation by formal neuropsychological tests may be required.

Brief screening for mild cognitive impairment: validation of the Brazilian version of the Montreal cognitive assessment.

BACKGROUND: The Montreal Cognitive Assessment (MoCA) is a brief cognitive schedule that has been developed for the screening of patients with Mild Cognitive Impairment (MCI). MCI is recognized as a high-risk state for Alzheimer's disease. The aim of the present study is to examine the reliability and validity of the Brazilian version of the MoCA test (MoCA-BR) in a sample of older individuals with at least 4 years of education. METHODS: The MoCA-BR was administered to 112 older adults who were classified into three diagnostic groups according to their cognitive state (Alzheimer's disease, n = 28; MCI, n = 43; normal controls, n = 41). This procedure was based on clinical and neuropsychological data. The performance in the MoCA-BR was compared with the Mini-mental state examination (MMSE) and the Cambridge Cognitive Examination. Diagnostic accuracy was examined with the receiver operating characteristic (ROC) curve analyses. RESULTS: Cronbach's alpha for the MoCA-BR was 0.75. Temporal stability (retesting after 3 months) using intraclass correlation coefficient was 0.75 (p < 0.001). The sensitivity and specificity of the MoCA-BR for MCI were 81% and 77%, respectively, with a cut-off score of 25 points. The area under the ROC curve for predicting MCI was 0.82 ± 0.06. CONCLUSIONS: The present results indicate that the MoCA-BR maintains its core diagnostic properties rendering it a valid and reliable tool for the screening of MCI among older individuals with at least 4 years of education.