Psychometric properties of the CANS-MCI - a computerized test for evaluation of mild cognitive impairment in elderly

Introdução: O Computer-Administered Neuropsychological Screen For Mild Cognitive Impairment (CANS-MCI) é um teste computadorizado para o rastreio do Comprometimento Cognitivo Leve (CCL). O CCL é considerado um estado transicional entre o envelhecimento normal e é uma condição de risco para o desenvolvimento de demências. Diante disso, sua detecção torna-se importante para a implementação de intervenções terapêuticas e preventivas. Objetivos: Avaliar as propriedades psicométricas do CANS-MCI e analisar sua acurácia diagnóstica para CCL em uma amostra clínica de idosos brasileiros. Métodos: Noventa e sete sujeitos foram avaliados e classificados em: controles normais (CN, n=41), comprometimento cognitivo leve (CCL, n=35) e doença de Alzheimer (DA, n=21). O diagnóstico foi previamente estabelecido por equipe multidisciplinar, com base em dados clínicos, neuropsicológicos e de neuroimagem. O desempenho dos pacientes no CANS-MCI foi comparado ao de outras provas já validadas para população brasileira. Resultados: os resultados indicaram que o CANS-MCI apresentou alta consistência interna (Alfa de Cronbach = 0,77). A confiabilidade do teste-reteste foi elevada (r = 0,875, p <0,001). Foi encontrada uma correlação moderada entre o escore total do CANS-MCI e o RAVLT (variável que avalia a capacidade de aprendizagem, com r=0,51 e p<0,001). O CANS-MCI foi capaz de discriminar controles de CCL (81% de sensibilidade e 73% especificidade) e Controles de DA (100% de sensibilidade e 97% especificidade), indicando alta acurácia. CONCLUSÃO: O CANS-MCI manteve suas características psicométricas originais, mostrou-se estável no reteste e foi capaz de diferenciar sujeitos controles daqueles diagnosticados com CCL e DABackground: Computer-Administered Neuropsychological Screen for Mild CognitiveImpairment (CANS-MCI) is a computerized test screening battery for mild cognitive impairment (MCI). MCI is transitional state between normal aging and dementia. Therefore, its detection becomes important for the implementation of preventive and therapeutic interventions. Objectives: To evaluate the psychometric properties of the CANS-MCI and analyze its diagnostic accuracy for MCI in a clinical sample of elderly Brazilians. Methods: Ninety-seven subjects were evaluated and classified as: normal controls (NC, n = 41), mild cognitive impairment (MCI, n = 35) and Alzheimer\'s disease (AD, n = 21). The diagnosis was previously established by a multidisciplinary team, based on clinical, neuropsychological and neuroimaging data. The performance of patients in the CANS-MCI was compared to other tests which have been validated for the Brazilian population. Results: The results indicated that the CANS-MCI showed high internal consistency (Cronbach\'s alpha = 0.77) and that the test-retest reliability was high (r = 0.875, p <0.001). There was a moderate correlation between the CANS-MCI total score and the RAVLT (for learning ability) (r=0.51, p <0.001). The CANS-MCI was able to discriminate NC from MCI (81% of sensitivity and 73% of specificity) and MCI from AD (100% of sensitivity and 97% of specificity), with high accuracy. Conclusion: The CANS-MCI in its Brazilian version maintained its original psychometric properties, it was stable at retest and it was able to differentiate between unimpaired seniors from those diagnosed with MCI and AD. Results suggest this computerized battery can be used to screen for MCI among elderly Brazilia

Performance of normotensive and hypertensive adults without dementia in computerized assessment of attention (\"Test of Variables of Attention - T.O.V.A.)

INTRODUÇÃO: a hipertensão arterial sistêmica (HAS) é uma condição multifatorial, de curso crônico e alta prevalência na população mundial. Está relacionada ao agravamento de outras condições clínicas, como doenças coronarianas, acidente vascular cerebral, doença renal crônica e distúrbios metabólicos. Diversos estudos associam a presença de HAS com o aumento da prevalência de declínio cognitivo. No entanto, a associação entre a HAS e os domínios cognitivos mais afetados mostra-se discutível, sobretudo em relação aos processos atencionais. O Test of Variables of Attention (T.O.V.A.) é uma prova computadorizada de desempenho contínuo que avalia a atenção sustentada por meio de algumas variáveis como o tempo de reação, erros de omissão ou comissão, entre outras. OBJETIVO: comparar o desempenho no T.O.V.A. de adultos hipertensos sem demência, classificados em dois níveis, em relação ao de adultos normotensos. MÉTODOS: em estudo transversal, 63 indivíduos normotensos e 119 hipertensos divididos em dois níveis, conforme os valores de pressão arterial e/ou pelo uso de medicações anti-hipertensiva (HAS 1= 75 e HAS 2= 44) foram submetidos ao T.O.V.A. A bateria computadorizada estava inserida em um protocolo de avaliação cognitiva, incluindo testes tradicionais de atenção, como o teste de Trilhas e os subtestes Dígitos e Códigos da Escala de Inteligência Wechsler para Adultos (WAIS-III). RESULTADOS: as variáveis do T.O.V.A. não foram capazes de discriminar os grupos (p > 0,05). O teste de Dígitos Ordem Inversa diferenciou os normotensos dos hipertensos mais graves (HAS2), sugerindo algum grau de comprometimento na memória operacional neste grupo. As correlações entre as variáveis T.O.V.A. com os testes de Códigos e Trilhas foram de baixa a modesta magnitude (r0,3), porém significativas (p 0.05). The Digits Span Backward differentiated the normotensive from severe hypertensive (SAH2), suggesting some degree of impairment in working memory in this group. The correlation between the T.O.V.A. variables with the Digit Symbol-Coding and TMT tests were of low to modest magnitude (r0.3), but significant (p < 0.05) indicating that the tests assess different aspects of the attentional processes. The parameters that assess arterial stiffness and blood pressure values were not correlated with the T.O.V.A. variables. CONCLUSION: the T.O.V.A. was not able to identify a possible impairment of sustained attention in adults with different degrees of SA

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

Transcranial Magnetic Stimulation to Address Mild Cognitive Impairment in the Elderly: A Randomized Controlled Study

Transcranial magnetic stimulation (TMS) is a noninvasive brain stimulation technique with potential to improve memory. Mild cognitive impairment (MCI), which still lacks a specific therapy, is a clinical syndrome associated with increased risk of dementia. This study aims to assess the effects of high-frequency repetitive TMS (HF rTMS) on everyday memory of the elderly with MCI. We conducted a double-blinded randomized sham-controlled trial using rTMS over the left dorsolateral prefrontal cortex (DLPFC). Thirty-four elderly outpatients meeting Petersen’s MCI criteria were randomly assigned to receive 10 sessions of either active TMS or sham, 10 Hz rTMS at 110% of motor threshold, 2,000 pulses per session. Neuropsychological assessment at baseline, after the last session (10th) and at one-month follow-up, was applied. ANOVA on the primary efficacy measure, the Rivermead Behavioural Memory Test, revealed a significant group-by-time interaction p=0.05, favoring the active group. The improvement was kept after one month. Other neuropsychological tests were heterogeneous. rTMS at 10 Hz enhanced everyday memory in elderly with MCI after 10 sessions. These findings suggest that rTMS might be effective as a therapy for MCI and probably a tool to delay deterioration