There are numerous neuropsychological tests for assessing executive functions in
aging, which vary according to the different domains assessed.ObjectiveTo present a systematic review of the most frequently used instruments for
assessing executive functions in older adults with different educational
levels in clinical and experimental research.MethodsWe searched for articles published in the last five years, using the PubMed
database with the following terms: "neuropsychological tests", "executive
functions", and "mild cognitive impairment". There was no language
restriction.Results25 articles fulfilled all the inclusion criteria. The seven
neuropsychological tests most frequently used to evaluate executive
functions in aging were:[1] Trail Making Test (TMT) Form B;[2] Verbal Fluency Test (VFT) - F, A and S;[3] VFT Animals category;[4] Clock Drawing Test (CDT);[5] Digits Forward and Backward subtests (WAIS-R or
WAIS-III);[6] Stroop Test; and[7] Wisconsin Card Sorting Test (WCST) and its variants. The
domains of executive functions most frequently assessed were:
mental flexibility, verbal fluency, planning, working memory,
and inhibitory control.ConclusionThe study identified the tests and domains of executive functions most
frequently used in the last five years by research groups worldwide to
evaluate older adults. These results can direct future research and help
build evaluation protocols for assessing executive functions, taking into
account the different educational levels and socio-demographic profiles of
older adults in Brazil.
Introduction:A number of studies have shown the impact of cognitive abilities on instrumental activities of daily living, in particular executive functions. Nevertheless, it is not clear to what extent these results can be generalized, given that most samples studied have not included people with a low educational level.Objectives:The current study aims to investigate the association between cognitive abilities and activities of daily living in older adults — with and without dementia — from a middle-income country.Sample:The sample consisted of 48 healthy older adults and 29 people with dementia, who were evaluated in an Outpatient Care Unit in a University Reference Center in Rio de Janeiro.Results:Regression analyses indicated that the best predictors for activities of daily living were performance in immediate verbal memory in the case of controls and in a categorical fluency task in the patient group. The educational level itself was not a significant predictor of functional ability in either sample, but showed moderate correlation with the predictors.Conclusions:These results suggest that educational level may be a mediating factor in the association of cognitive variables and activities of daily living, and indicate a potential dissociation in terms of predictors according to the diagnostic status, pointing to relevant treatment directions.
OBJECTIVE:To investigate the association between frailty syndrome and cognitive performance in the older adults and the effect of schooling and age on this association.
METHODS:Data on frailty in older adults from Phase 1 of the FIBRA-RJ Study were analyzed, relating to 737 customers of a private health care provider, aged 65 and over, living in Rio de Janeiro, Southeastern Brazil, between January 2009 and January 2010. Data on socioeconomic and demographic characteristics, medical conditions and functional capacity were collected. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE). Individuals who exhibited three or more of the following features were considered to be frail: unintentional weight loss (≥ 4.5 kg in the last year); feeling self-reported exhaustion, low grip strength, low physical activity level and slowness. The association between frailty and cognitive performance was evaluated using multivariate logistic regression, with adjustment for medical conditions, activities of daily living and socioeconomic variables. We evaluated the age and schooling as possible effect modifiers in this association.
RESULTS:The frail subjects had a higher prevalence of low cognitive performance, compared to not frail or pre-frail, in the three age groups studied (65-74; 75-84; ≥ 85 years), p < 0.001. After adjustment, the association between frailty and cognitive performance was found among older adults individuals aged 75 and older, with an OR adj = 2.78 (95%CI 1.23;6.27) for those aged 75 to 84 and OR adj = 15.62 (95%CI 2.20;110.99) for 85 and older. The age variable was an effect modifier in the association between frailty and cognitive performance, χ² (5) = 806.97, p < 0.0001; the same was not the case with schooling.
CONCLUSIONS:Frailty syndrome is associated with cognitive performance in the aging. Age proved to be an effect modifier in this association. The oldest patients showed a more significant association between the two phenomena.
Characterizing cognitive decline in older adults with MCI over time is important to identify the cognitive profile of those who convert to dementia.Objective:This study examined the two-year cognitive trajectory of elderly adults diagnosed with MCI, from geriatrics and neurology outpatient clinics of a public hospital in Rio de Janeiro.Methods:62 older adults with MCI were submitted to a neuropsychological battery and re-evaluated after two years. The Mann-Whitney U test was employed to assess differences between groups with respect to education, functioning, the Geriatric Depression Scale and diagnosis.Results:24.2% converted to dementia after two years. The group with declines in two or more cognitive functions had a higher conversion rate to dementia than the group with decline in executive functions (EF) only (Z = -2.11, p = .04). The EF decline group had higher scores on the depression scale than both the memory decline group (Z = -1.99, p = .05) and multiple decline group (Z = -2.23, p = .03).Conclusion:The present study found different cognitive decline profiles in elderly adults with MCI and differences between them regarding depressive symptoms and rate of conversion to dementia.
ObjectiveTo investigate the demographic, clinical and cognitive correlates of functional capacity and its awareness in people with dementia (PwD; n = 104), mild cognitive impairment (PwMCI; n = 45) and controls (healthy older adults; n = 94) in a sample from a middle-income country.MethodsDementia and MCI were diagnosed, respectively, with DSM-IV and Petersen criteria. Performance in activities of daily living (ADL) at three different levels [basic (The Katz Index of Independence), instrumental (Lawton instrumental ADL scale) and advanced (Reuben’s advanced ADL scale)], measured through self- and informant-report, as well as awareness (discrepancy between self- and informant-report), were compared between groups. Stepwise regression models explored predictors of ADL and their awareness.ResultsPwD showed impairment in all ADL levels, particularly when measured through informant-report. No differences were seen between controls and PwMCI regardless of measurement type. PwD differed in awareness of instrumental and basic, but not of advanced ADL, compared to controls. Age, gender, education and fluency were the most consistent predictors for ADL. Diagnosis was a significant predictor only for instrumental ADL. Awareness of basic ADL was predicted by memory, and awareness of instrumental ADL was predicted by general cognitive status, educational level, and diagnosis.ConclusionResults reinforce the presence of lack of awareness of ADL in PwD. Use of informant-reports and cognitive testing for fluency are suggested for the clinical assessment of ADL performance. Finally, assessment of instrumental ADL may be crucial for diagnostic purposes.
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