Anosognosia for memory in dementia with Lewy bodies compared with Alzheimer's disease.

OBJECTIVES: Anosognosia is the inability to recognize one's own symptoms. Although dementia with Lewy bodies (DLB) is the second most common degenerative dementia, there is little evidence of memory deficit awareness in this condition. The objectives of this research were to compare anosognosia between individuals with DLB and dementia due to Alzheimer's disease (AD) and to evaluate whether medial temporal atrophy, a marker of AD pathology, could help to explain different rates of anosognosia in DLB and dementia due to AD. METHODS/DESIGN: This is a cross-sectional study that took place at the Memory Clinic of D'Or Institute for Research and Education (IDOR). Twenty individuals with DLB and 20 with dementia due to AD were included in this study. We assessed anosognosia for memory using an index derived from subjective memory complaints (using the Memory Complaint Questionnaire) and from the performance in memory neuropsychological testing (Rey Auditory Verbal Learning Test). Thirty-one participants also underwent brain Magnetic Resonance Imaging to evaluate hippocampal atrophy with a visual scale (MTA-score [medial temporal atrophy score]). RESULTS: There was no significant difference between groups regarding age, years of education, sex or time of disease. Individuals with DLB had a higher index of anosognosia than dementia due to AD (2.92 and 1.87; p = 0.024), meaning worse awareness of memory deficits. MTA-score was slightly higher in dementia due to AD than in DLB, albeit without statistical significance. CONCLUSION: Our study was the first to demonstrate that anosognosia for memory is worse in DLB than in dementia due to AD. This finding supports the hypothesis that anosognosia in DLB is a heterogeneous phenomenon.

Narrative impairment, white matter damage and CSF biomarkers in the Alzheimer's disease spectrum.

BACKGROUND: Narrative discourse (ND) refers to one's ability to verbally reproduce a sequence of temporally and logically-linked events. Impairments in ND may occur in subjects with Amnestic Mild Cognitive Impairment (aMCI) and Alzheimer's Disease (AD), but correlates across this function, neuroimaging and cerebrospinal fluid (CSF) AD biomarkers remain understudied. OBJECTIVES: We sought to measure correlates among ND, Diffusion Tensor Imaging (DTI) indexes and AD CSF biomarkers in patients within the AD spectrum. RESULTS: Groups differed in narrative production (NProd) and comprehension. aMCI and AD presented poorer inference abilities than controls. AD subjects were more impaired than controls and aMCI regarding WB (p<0.01). ROIs DTI assessment distinguished the three groups. Mean Diffusivity (MD) in the uncinate, bilateral parahippocampal cingulate and left inferior occipitofrontal fasciculi negatively correlated with NProd. Changes in specific tracts correlated with T-tau/Aß1-42 ratio in CSF. CONCLUSIONS: AD and aMCI patients presented more ND impairments than controls. Those findings were associated with changes in ventral language-associated and in the inferior parahippocampal pathways. The latest were correlated with biomarkers' levels in the CSF. METHODS: AD (N=14), aMCI (N=31) and Control (N=39) groups were compared for whole brain (WB) and regions of interest (ROI) DTI parameters, ND and AD CSF biomarkers.

Inter-method and anatomical correlates of episodic memory tests in the Alzheimer's Disease spectrum.

BACKGROUND: Episodic memory impairments have been described as initial clinical findings in the Alzheimer's Disease (AD) spectrum, which could be associated with the presence of early hippocampal dysfunction. However, correlates between performances in neuropsychological tests and hippocampal volumes in AD were inconclusive in the literature. Divergent methods to assess episodic memory have been depicted as a major source of heterogeneity across studies. METHODS: We examined correlates among performances in three different delayed-recall tasks (Rey-Auditory Verbal-Learning Test-RAVLT, Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale) and fully-automated volumetric measurements of the hippocampus (estimated using Neuroquant®) of 83 older subjects (47 controls, 27 Mild Cognitive Impairment individuals and 9 participants with Dementia due to AD). RESULTS: Inter-method correlations of episodic memory performances were at most moderate. Scores in the RAVLT predicted up to 48% of variance in HOC (Hippocampal Occupancy Score) among subjects in the AD spectrum. DISCUSSION: Tests using different stimuli (verbal or visual) and presenting distinct designs (word list, story or figure learning) may assess divergent aspects in episodic memory, with heterogeneous anatomical correlates. CONCLUSIONS: Different episodic memory tests might not assess the same construct and should not be used interchangeably. Scores in RAVLT may correlate with the presence of neurodegeneration in AD.

The Von Restorff effect in the Brazilian version of the Rey Auditory Verbal Learning Test in an elderly population.

The Von Restorff (isolation) effect refers to a stimulus that is more likely to be remembered amongst other stimuli in memory tasks. It has been demonstrated with different age ranges and methodologies. OBJECTIVE: To investigate: a) the presence of the isolation effect in elders tested with the new Brazilian Portuguese version of the Rey Auditory Verbal Learning Task (RAVLT) in which a word with potential emotional weight (mother) was introduced; b) whether isolation effects persist in memory disorders of different degrees of severity (Mild Cognitive Impairment [MCI]; Alzheimer's Dementia [AD]). METHODS: The RAVLT was administered to 287 consecutive volunteers. Individuals underwent medical and neuropsychological evaluation and were further sub-grouped into normal controls (n=114), MCI (n=87) and AD (n=86) patients. One-way analysis of variance (ANOVA) and Chi-squared tests were performed. Post-hoc Tukey analysis was conducted to assess significance of group differences. RESULTS: There were significant group effects on the learning curve. A W-shape - instead of the classical U-shape - was found for the serial position curve in all groups. CONCLUSION: The new Brazilian version of the RAVLT exhibited the Von Restorff effect, where this phenomenon was evident not only in older adults but also patients with MCI and AD, providing further psychometric measures for inter-group analyses.

Efeito de von Restorff (efeito de isolamento) refere-se ao estímulo que é mais facilmente lembrado em relação a outros em tarefas de memória. Tal efeito foi demonstrado em diferentes faixas etárias com diferentes metodologias. OBJETIVO: Investigar: a) presença do efeito de isolamento numa população idosa avaliada com a nova versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT), em que uma palavra com potencial carga emocional ('mãe') foi introduzida; b) se o efeito de isolamento persiste em distúrbios de memória de diferentes gravidades (Comprometimento Cognitivo Leve [MCI]; Demência de Alzheimer [AD]). MÉTODOS: RAVLT foi aplicado em 287 voluntários. Indivíduos participaram de avaliações médica e neuropsicológica e foram posteriormente agrupados em controles normais (n=114), MCI (n=87) e DA (n=86). Análises de variância e testes de Chi-quadrado foram realizados. Análises post-hoc foram conduzidas para avaliar diferenças de características entre os grupos. RESULTADOS: Observaram-se efeitos significativos de grupo na curva de aprendizagem. Todos os grupos apresentaram curva de posição serial em formato W - invés do clássico formato em U. CONCLUSÃO: A nova versão brasileira do RAVLT evidenciou um efeito de von Restorff. Tal fenômeno foi visto não apenas em idosos, mas também em pacientes com MCI e AD, fornecendo medidas psicométricas adicionais para análises de diferenças intergrupais.

The Von Restorff effect in the Brazilian version of the Rey Auditory Verbal Learning Test in an elderly population / Efeito de Von Restorff na versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey em idosos

ABSTRACT. The Von Restorff (isolation) effect refers to a stimulus that is more likely to be remembered amongst other stimuli in memory tasks. It has been demonstrated with different age ranges and methodologies. Objective: To investigate: a) the presence of the isolation effect in elders tested with the new Brazilian Portuguese version of the Rey Auditory Verbal Learning Task (RAVLT) in which a word with potential emotional weight (mother) was introduced; b) whether isolation effects persist in memory disorders of different degrees of severity (Mild Cognitive Impairment [MCI]; Alzheimer's Dementia [AD]). Methods: The RAVLT was administered to 287 consecutive volunteers. Individuals underwent medical and neuropsychological evaluation and were further sub-grouped into normal controls (n=114), MCI (n=87) and AD (n=86) patients. One-way analysis of variance (ANOVA) and Chi-squared tests were performed. Post-hoc Tukey analysis was conducted to assess significance of group differences. Results: There were significant group effects on the learning curve. A W-shape - instead of the classical U-shape - was found for the serial position curve in all groups. Conclusion: The new Brazilian version of the RAVLT exhibited the Von Restorff effect, where this phenomenon was evident not only in older adults but also patients with MCI and AD, providing further psychometric measures for inter-group analyses.

RESUMO. Efeito de von Restorff (efeito de isolamento) refere-se ao estímulo que é mais facilmente lembrado em relação a outros em tarefas de memória. Tal efeito foi demonstrado em diferentes faixas etárias com diferentes metodologias. Objetivo: Investigar: a) presença do efeito de isolamento numa população idosa avaliada com a nova versão brasileira do Teste de Aprendizagem Auditivo-Verbal de Rey (RAVLT), em que uma palavra com potencial carga emocional ('mãe') foi introduzida; b) se o efeito de isolamento persiste em distúrbios de memória de diferentes gravidades (Comprometimento Cognitivo Leve [MCI]; Demência de Alzheimer [AD]). Métodos: RAVLT foi aplicado em 287 voluntários. Indivíduos participaram de avaliações médica e neuropsicológica e foram posteriormente agrupados em controles normais (n=114), MCI (n=87) e DA (n=86). Análises de variância e testes de Chi-quadrado foram realizados. Análises post-hoc foram conduzidas para avaliar diferenças de características entre os grupos. Resultados: Observaram-se efeitos significativos de grupo na curva de aprendizagem. Todos os grupos apresentaram curva de posição serial em formato W - invés do clássico formato em U. Conclusão: A nova versão brasileira do RAVLT evidenciou um efeito de von Restorff. Tal fenômeno foi visto não apenas em idosos, mas também em pacientes com MCI e AD, fornecendo medidas psicométricas adicionais para análises de diferenças intergrupais.

Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly

Objective: To investigate whether the level of awareness of memory deficits is useful for discriminating between major depressive disorder (MDD) and mild cognitive impairment (MCI) in the elderly. Methods: Sixty-three consecutively referred patients (38 women and 25 men) with memory concerns comprising three groups (clinical control, MDD and MCI) underwent a memory test (Rey Auditory Verbal Learning Test [RAVLT]) and completed the Memory Assessment Complaints-Questionnaire (MAC-Q). Level of awareness was estimated by the difference between the MAC-Q score and the score on the fifth presentation of the RAVLT. Memory performance, Mini-Mental State Examination (MMSE) and depressive symptoms (Geriatric Depression Scale [GDS]) were also assessed. Results: The control (n=25), MDD (n=16), and MCI (n=22) groups were similar in age, educational level, and MMSE (p > 0.05). Among the groups, the MDD group had the most memory complaints, whereas the MCI group had the worst objective memory performance. Level of awareness was capable of discriminating between MDD and MCI (p < 0.05), but not between MDD and clinical controls (p > 0.05). MDD subjects tended to underestimate their memory functioning as compared to controls (p < 0.05). Conclusion: Level of awareness of memory deficits was significantly useful to discriminate between MCI and MDD, which is a common difficulty faced by clinicians. Future studies with larger samples are needed to confirm these findings.

Awareness of memory deficits is useful to distinguish between depression and mild cognitive impairment in the elderly.

OBJECTIVE: To investigate whether the level of awareness of memory deficits is useful for discriminating between major depressive disorder (MDD) and mild cognitive impairment (MCI) in the elderly. METHODS: Sixty-three consecutively referred patients (38 women and 25 men) with memory concerns comprising three groups (clinical control, MDD and MCI) underwent a memory test (Rey Auditory Verbal Learning Test [RAVLT]) and completed the Memory Assessment Complaints-Questionnaire (MAC-Q). Level of awareness was estimated by the difference between the MAC-Q score and the score on the fifth presentation of the RAVLT. Memory performance, Mini-Mental State Examination (MMSE) and depressive symptoms (Geriatric Depression Scale [GDS]) were also assessed. RESULTS: The control (n=25), MDD (n=16), and MCI (n=22) groups were similar in age, educational level, and MMSE (p > 0.05). Among the groups, the MDD group had the most memory complaints, whereas the MCI group had the worst objective memory performance. Level of awareness was capable of discriminating between MDD and MCI (p < 0.05), but not between MDD and clinical controls (p > 0.05). MDD subjects tended to underestimate their memory functioning as compared to controls (p < 0.05). CONCLUSION: Level of awareness of memory deficits was significantly useful to discriminate between MCI and MDD, which is a common difficulty faced by clinicians. Future studies with larger samples are needed to confirm these findings.

Deficits in narrative discourse elicited by visual stimuli are already present in patients with mild cognitive impairment.

Language batteries used to assess the skills of elderly individuals, such as naming and semantic verbal fluency, present some limitations in differentiating healthy controls from patients with amnestic mild cognitive impairment (a-MCI). Deficits in narrative discourse occur early in dementia caused by Alzheimer's disease (AD), and the narrative discourse abilities of a-MCI patients are poorly documented. The present study sought to propose and evaluate parameters for investigating narrative discourse in these populations. After a pilot study of 30 healthy subjects who served as a preliminary investigation of macro- and micro-linguistic aspects, 77 individuals (patients with AD and a-MCI and a control group) were evaluated. The experimental task required the participants to narrate a story based on a sequence of actions visually presented. The Control and AD groups differed in all parameters except narrative time and the total number of words recalled. The a-MCI group displayed mild discursive difficulties that were characterized as an intermediate stage between the Control and AD groups' performances. The a-MCI and Control groups differed from the AD group with respect to global coherence, discourse type and referential cohesion. The a-MCI and AD groups were similar to one another but differed from the Control group with respect to the type of words recalled, the repetition of words in the same sentence, the narrative structure and the inclusion of irrelevant propositions in the narrative. The narrative parameter that best distinguished the three groups was the speech effectiveness index. The proposed task was able to reveal differences between healthy controls and groups with cognitive decline. According to our findings, patients with a-MCI already present narrative deficits that are characterized by mild discursive difficulties that are less severe than those found in patients with AD.

Neuropsychological assessment before and after radiotherapy in a child with an intracranial tumor: case report / Avaliação neuropsicológica antes e após radioterapia em uma criança com tumor intracraniano: relato de caso

INTRODUCTION: Brain tumors are the most common solid tumors and the second largest group of neoplasms diagnosed in childhood. Treatment includes surgery, radiotherapy, and chemotherapy. However, radiotherapy can cause complications, e.g., cognitive deficits. CASE DESCRIPTION: We describe the case of a child diagnosed with a brain tumor evaluated before and after radiotherapy to investigate cognitive decline after treatment. The results showed a decline in Intelligence Quotient (IQ) scores and reversal of the predominance of verbal and nonverbal skills. After radiotherapy, the subject showed slowness, academic deficits, and difficulties learning new information. COMMENTS: Even though the post-treatment evaluation showed scores compatible with the average, comparison between pre- and post-treatment evaluations demonstrated the impact of radiotherapy on the subject's cognitive profile. These results highlight the importance of evaluating patients who undergo radiotherapy before and after treatment and understanding neuropsychological scores associated with the subjects' complaints (AU)

INTRODUÇÃO: Tumores cerebrais são os tumores sólidos mais comuns e o segundo maior grupo de neoplasias diagnosticadas na infância. O tratamento inclui cirurgia, radioterapia e quimioterapia. No entanto, a radioterapia pode causar complicações, como, por exemplo, déficits cognitivos. DESCRIÇÃO DO CASO: Descrevemos o caso de uma criança diagnosticada com tumor cerebral e avaliada antes e após tratamento com radioterapia para investigar declínio cognitivo pós-tratamento. Os resultados demonstraram um declínio nos escores de Quociente de Inteligência (QI) e uma reversão da predominância em habilidades verbais e não verbais. Após a radioterapia, o sujeito demonstrou lentidão, déficits acadêmicos e dificuldade para aprender novas informações. COMENTÁRIO: Embora a avaliação pós-tratamento tenha mostrado escores compatíveis com a média, a comparação entre as avaliações pré e pós-tratamento evidenciaram o impacto da radioterapia sobre o perfil cognitivo do paciente. Esses resultados salientam a importância de avaliar pacientes tratados com radioterapia antes e após o tratamento e de entender os escores neuropsicológicos associados às queixas dos pacientes (AU)

Neuropsychological assessment before and after radiotherapy in a child with an intracranial tumor: case report.

INTRODUCTION: Brain tumors are the most common solid tumors and the second largest group of neoplasms diagnosed in childhood. Treatment includes surgery, radiotherapy, and chemotherapy. However, radiotherapy can cause complications, e.g., cognitive deficits. CASE DESCRIPTION: We describe the case of a child diagnosed with a brain tumor evaluated before and after radiotherapy to investigate cognitive decline after treatment. The results showed a decline in Intelligence Quotient (IQ) scores and reversal of the predominance of verbal and nonverbal skills. After radiotherapy, the subject showed slowness, academic deficits, and difficulties learning new information. COMMENTS: Even though the post-treatment evaluation showed scores compatible with the average, comparison between pre- and post-treatment evaluations demonstrated the impact of radiotherapy on the subject's cognitive profile. These results highlight the importance of evaluating patients who undergo radiotherapy before and after treatment and understanding neuropsychological scores associated with the subjects' complaints.