The prefrontal cortex (PFC) has been implicated in the ability to apply semantic organizational strategies during verbal encoding and episodic learning. However, there has been no direct evidence demonstrating which specific areas in the PFC are engaged after cognitive training using semantic organizational strategies in healthy adult human subjects. In this study, we investigated the effects of semantic strategic training on brain activity and changes in behavioral performance, after cognitive training, using functional MRI (fMRI). There was a significant activation in bilateral dorsolateral prefrontal (DLPF) and orbitofrontal (OFC) areas after cognitive training. These results demonstrate the engagement of bilateral DLPF and OFC cortex during strategic memory processes, particularly when mobilization and effort of effective use of strategies are required. The functional adaptations observed here may also shed light on some of the processes underlying recovery with cognitive rehabilitation in patient populations with brain injury.

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In this study, the effectiveness of a group-based attention and problem solving (APS) treatment approach to executive impairments in patients with frontal lobe lesions was investigated. Thirty participants with lesions in the frontal lobes, 16 with left frontal (LF) and 14 with right frontal (RF) lesions, were allocated into three groups, each with 10 participants. The APS treatment was initially compared to two other control conditions, an information/education (IE) approach and treatment-as-usual or traditional rehabilitation (TR), with each of the control groups subsequently receiving the APS intervention in a crossover design. This design allowed for an evaluation of the treatment through assessment before and after treatment and on follow up, six months later. There was an improvement on some executive and functional measures after the implementation of the APS programme in the three groups. Size, and to a lesser extent laterality, of lesion affected baseline performance on measures of executive function, but there was no apparent relationship between size, laterality or site of lesion and level of benefit from the treatment intervention. The results were discussed in terms of models of executive functioning and the effectiveness of domain specific interventions in the rehabilitation of executive dysfunction.

Traumatic brain injury (TBI) is one of the most frequent causes of brain damage. Cognitive deficits reported in the literature after moderate to severe TBI include memory, language, executive functions, attention and information processing speed impairments. However, systematic studies on patients with mild TBI are scarce although neuropsychological changes are present. Objective: To investigate the cognitive functioning of patients with mild to moderate TBI. Method: We evaluated 12 patients with mild to moderate TBI using a comprehensive protocol (PN01) of neuropsychological tests. Results: There were significant deficits of episodic memory including immediate and delayed verbal memory recall, verbal recognition, immediate and delayed visual memory recall, naming, verbal fluency and information processing speed. Conclusion: These results emphasize the importance of comprehensive neuropsychological assessments even in cases of mild TBI in order to identify impaired and preserved functions providing adequate managing including rehabilitation programs for each case. Key words: traumatic brain injury, cognitive deficits, mild to moderate level.Alterações neuropsicológicas em pacientes com traumatismo crânio encefálico levemoderado RESUMO Traumatismo craniencefálico (TCE) é uma das causas mais freqüentes de lesão cerebral. São relatados na literatura déficits cognitivos após TCE moderado-grave relacionados à memória, linguagem, funções executivas, atenção e velocidade de processamento de informações. Estudos em pacientes com TCE leve são escassos embora alterações neuropsicológicas sejam encontradas nestes pacientes. Objetivo: Investigar o funcionamento cognitivo de pacientes com TCE leve e moderado através de um protocolo abrangente (PN01) de testes neuropsicológicos. Método: Foram avaliados 12 pacientes com TCE leve e moderado. Resultados: Foram identificados déficits graves de memória episódica verbal para evocação imediata, tardia e de reconhecimento, de memória episódica visuo-espacial para evocação imediata e tardia, nomeação, fluência verbal nominal e velocidade de processamento de informações. Conclusão: Os resultados do estudo argumentam a favor da importância de avaliação neuropsicológica abrangente mesmo em casos de TCE leve a fim de se identificar funções comprometidas e preservadas, proporcionando condutas e programas de reabilitação adequados a cada caso. Palavras-chave: traumatismo crânio encefálico, déficits cognitivos, grau leve e moderado.

Patients with low-grade glioma (LGG) have been studied as a model of functional brain reorganization due to their slow-growing nature. However, there is no information regarding which brain areas are involved during verbal memory encoding after extensive left frontal LGG resection. In addition, it remains unknown whether these patients can improve their memory performance after instructions to apply efficient strategies. The neural correlates of verbal memory encoding were investigated in patients who had undergone extensive left frontal lobe (LFL) LGG resections and healthy controls using fMRI both before and after directed instructions were given for semantic organizational strategies. Participants were scanned during the encoding of word lists under three different conditions before and after a brief period of practice. The conditions included semantically unrelated (UR), related-non-structured (RNS), and related-structured words (RS), allowing for different levels of semantic organization. All participants improved on memory recall and semantic strategy application after the instructions for the RNS condition. Healthy subjects showed increased activation in the left inferior frontal gyrus (IFG) and middle frontal gyrus (MFG) during encoding for the RNS condition after the instructions. Patients with LFL excisions demonstrated increased activation in the right IFG for the RNS condition after instructions were given for the semantic strategies. Despite extensive damage in relevant areas that support verbal memory encoding and semantic strategy applications, patients that had undergone resections for LFL tumor could recruit the right-sided contralateral homologous areas after instructions were given and semantic strategies were practiced. These results provide insights into changes in brain activation areas typically implicated in verbal memory encoding and semantic processing.

Patients with Alzheimer's disease (AD) gradually lose their cognitive competence, particularly memory, and the ability to perform daily life tasks. Neuropsychological rehabilitation is used to improve cognitive functions by facilitating memory performance through the use of external aids and internal strategies. The effect of neuropsychological rehabilitation through memory training -motor movements, verbal association, and categorization -and activities of daily living (ADL) training was tested in a sample of 5 elderly out-patients (mean age: 77.4 ± 2.88 years), with mild AD (Mini-Mental State Examination score: 22.20 ± 2.17) and their caregivers. All patients had been taking rivastigmine (6-12 mg/day) for at least 3 months before being assigned to the rehabilitation sessions, and they continued to take the medication during the whole program. Just before and after the 14-week neuropsychological rehabilitation program all patients were assessed by interviewers that did not participate in the cognitive training, using the Mini-Mental State Examination, Montgomery-Alsberg Depression Rating Scale, Hamilton Anxiety Scale, Interview to Determine Deterioration in Functioning in Dementia, Functional Test, Memory Questionnaire of Daily Living for patient and caregiver, Quality of Life Questionnaire for patient and caregiver, and a neuropsychological battery. The results showed a statistically significant improvement in ADL measured by Functional Test (P = 0.04), and only a small improvement in memory and psychiatric symptoms. Our results support the view that weekly stimulation of memory and training of ADL is believed to be of great value in AD treatment, not only delaying the progress of the disease, but also improving some cognitive functions and ADL, even though AD is a progressively degenerative disease.

ObjectiveThe Trail Making Test (TMT) and Stroop Test (ST) are attention tests widely used in clinical practice and research. The aim of this study was to provide normative data for the adult Brazilian population and to study the influence of gender, age and education on the TMT parts A and B, and ST cards A, B and C.MethodsWe recruited 1447 healthy subjects aged ≥18 years with an educational level of 0-25 years who were native speakers of Portuguese (Brazilian). The subjects were evaluated by the Matrix Reasoning and Vocabulary subtests of the Wechsler Adult Intelligence Scale-III, along with the TMTA, TMTB and ST A, B and C.ResultsAmong the participants, mean intellectual efficiency was 103.20 (SD: 12.0), age 41.0 (SD: 16.4) years and education 11.9 (SD: 5.6) years. There were significant differences between genders on the TMTA (p=0.002), TMTB (p=0.017) and STC (p=0.024). Age showed a positive correlation with all attention tests, whereas education showed a negative correlation. Gender was not found to be significant on the multiple linear regression model, but age and education maintained their interference.ConclusionGender did not have the major impact on attentional tasks observed for age and education, both of which should be considered in the stratification of normative samples.

Objective: To present the development of an adapted version of the Boston Naming Test for Portuguese speakers, and to investigate the effects of age, education and gender on both the original and the adapted Boston Naming Test in respect of Brazilian Portuguese speakers. Method: Eighty items, including the 60 original ones and 20 adapted items were administered to 739 healthy Brazilian subjects aged between 6 and 77 years who received 0 to 17 years of education. Results: The coefficients of the General Linear Model estimation suggested that both age and education were statistically significant to predict total scores. In addition, score variances, justified by such predictors, were 41.20% in the original Boston Naming Test against 25.84% in the adapted Boston Naming Test. These results suggest that the scores from the original BNT are more dependent on age and education than those from the adapted Boston Naming Test. Conclusion: These findings demonstrated the suitability of the adapted Boston Naming Test version for the Brazilian population and described provisional norms for the original and adapted Boston Naming Test for Portuguese speakers. Descriptors