Desempenho de uma população brasileira no teste de alfabetização funcional para adultos na área de saúde ABSTRACT OBJECTIVE:To analyze the scoring obtained by an instrument, which evaluates the ability to read and understand items in the health care setting, according to education and age. METHODS:The short version of the Test of Functional Health Literacy in Adults was administered to 312 healthy participants of different ages and years of schooling. The study was conducted between 2006 and 2007, in the city of São Paulo, Southeastern Brazil. The test includes actual materials such as pill bottles and appointment slips and measures reading comprehension, assessing the ability to read and correctly pronounce a list of words and understand both prose passages and numerical information. Pearson partial correlations and a multiple regression model were used to verify the association between its scores and education and age. RESULTS:The mean age of the sample was 47.3 years (SD=16.8) and the mean education was 9.7 years (SD=5; range: 1 -17). A total of 32.4% of the sample showed literacy/numeracy defi cits, scoring in the inadequate and marginal functional health literacy ranges. Among the elderly (65 years or older) this rate increased to 51.6%. There was a positive correlation between schooling and scores (r=0.74; p<0.01) and a negative correlation between age and the scores (r=-0.259; p<0.01). The correlation between the scores and age was not signifi cant when the effects of education were held constant (rp=-0.031, p=0.584). A signifi cant association (B=3.877, Beta=0.733; p<0.001) was found between schooling and scores. Age was not a signifi cant predictor in this model p=0.584). CONCLUSIONS:The short version of the Test of Functional Health Literacy in Adults was a suitable tool to assess health literacy in the study population. The high number of individuals classifi ed as functional illiterates in this test highlights the importance of special assistance to help them properly understand directions for healthcare.

Brief cognitive tests are widely used for dementia screening, but are usually influenced by education. The present work aimed to determine education-adjusted cut-off scores and correspondent sensitivity (S) and specificity (Sp) values of the category fluency (CF) test (animals/min) as a screening tool for Alzheimer disease (AD). Eighty-eight patients with mild AD and 117 normal matched controls were evaluated. Patients and controls were divided into 4 groups according to educational level (illiterates, 1 to 3, 4 to 7, and > or =8 y) and were administered the CF test. In each group, cut-off values were determined using Receiver Operator Characteristic analysis. The areas under Receiver Operator Characteristic curves were 0.922/0.914/0.963/0.954, for the identification of AD among the groups of illiterates, 1 to 3, 4 to 7, and > or =8 years of education, respectively. The cut-off points for each group were 9 (S=90.5% and Sp=80.6%) for illiterates; 12 (S=95.2%% and Sp=80.0%) for 1 to 3 years; 12 (S=91.3% and Sp=91.9%) for 4 to 7 years, and 13 for those with > or =8 years (S=82.6% and Sp=100.0%). These results suggest that the CF may be a useful screening test for mild AD in different educational levels, with the need of using specific cut-off scores adjusted for each range of schooling.

There has been an increasing trend to utilize short cognitive batteries for the diagnosis of dementia. Most of these batteries have been designed in countries with high standards of education and are less suitable for populations with low levels of education.We developed a battery that has been previously shown to be highly accurate in the diagnosis of dementia in individuals with low levels of education. The accuracy of this battery for patients with higher levels of education is unknown.ObjectivesTo evaluate the accuracy of a brief cognitive battery in the diagnosis of Alzheimer’s disease (AD) in subjects with medium and high levels of schooling, and to develop a mathematical model that includes the most discriminative tests.MethodsSeventy-three mildly demented patients with probable AD and 94 control subjects were evaluated. Sixty patients and 60 controls were randomly selected to generate a mathematical model including the most discriminative tests of the battery using logistic regression. The model was back-tested for the remaining sample of patients and controls.ResultsDelayed recall, learning and category fluency tests were included in a mathematical model that obtained an area of 0.917 in the ROC curve in the back-testing. Inter-rater reliabilities of these tests were high (kappa>0.8).ConclusionsThis model showed a high accuracy for the diagnosis of mild AD in patients with medium and high educational levels. Future studies with more heterogeneously educated individuals are necessary to investigate whether the educational level (number of years at school) should also be included in the model.

The prevalence of dementia in this study was higher than in other studies, particularly among younger elderly.

This study provided a systematic review on nonpharmacological interventions applied to patients diagnosed with Primary Progressive Aphasia (PPA) and its variants: Semantic (SPPA), Nonfluent (NFPPA) and Logopenic (LPPA) to establish evidence-based recommendations for the clinical practice of cognitive rehabilitation for these patients.METHODSA PubMed and LILACS literature search with no time restriction was conducted with the keywords PPA (and its variants) AND rehabilitation OR training OR intervention OR therapy OR treatment OR effectiveness. To develop its evidence-based recommendations, a research committee identified questions to be addressed and determined the level of evidence for each study according to published criteria (Cicerone et al., 2000). Overall evidence for treatments was summarized and recommendations were derived.RESULTSOur search retrieved articles published from 1995 to 2013: 21 for SPPA, 8 for NFPPA, 3 for LPPA and 8 for PPA with no specification. Thirty-five studies were rated as Class III, consisting of studies with results obtained from one or more single-cases and that used appropriate single-subject methods with adequate quantification and analysis of results. The level of evidence of three functional interventions could not be established. One study was rated as Class II and consisted of a nonrandomized case-control investigation.CONCLUSIONPositive results were reported in all reviewed studies. However, in order to be recommended, some investigation regarding the intervention efficacy was required. Results of the present review allows for recommendation of some nonpharmacological interventions for cognitive deficits following PPA as Practice Options. Suggestions for further studies on PPA interventions and future research are discussed.

Resumo -Objetivo: Tradução e adaptação da escala Cornell de depressão em demência e verificação da confiabilidade entre e intra-examinadores da versão na língua portuguesa. Método: A versão original da escala Cornell foi traduzida para o português por firma especializada em tradução de textos médicos e retrotraduzida para o inglês por outros dois tradutores independentes. As divergências de tradução foram identificadas e discutidas, chegando-se à versão que foi submetida à pré-teste para adaptação sócio-cultural. Após esta adaptação, obteve-se a versão final que foi administrada a amostra de 29 pacientes com doença de Alzheimer provável e aos seus cuidadores. Resultados: A versão final da escala mostrou-se de fá-cil aplicação e obteve boa confiabilidade intra-examinador (Kappa=0,77; p<0,001) e entre-examinadores (Kappa=0,76; p<0,001). Conclusão: A versão brasileira da escala Cornell é um instrumento que pode ser utilizado para avaliação e acompanhamento de depressão em pacientes com demência.PAlAvRAs-ChAve: depressão, escalas, adaptação, reprodutibilidade dos testes. Brazilian version of the cornell depression scale in dementiaABsTRACT -Objective: Translating and adapting the Cornell scale for depression in dementia to the Portuguese language and verifying the interrater and test-retest reliability of the translated and adapted version. Method: The Cornell scale was translated into Portuguese and back translated into english. Divergences of translation were identified and discussed, resulting in a version which was submitted to a pre-test for cross-cultural adaptation. The final version was administered to a sample of 29 patients with probable AD and to their caregivers. Results: The Cornell scale presented good interrater (Kappa=0,77; p<0,001) and test-retest reliability (Kappa=0,76; p<0,001). The final version was easy to administer and well understood by the caregivers. Conclusion: The Brazilian version of the Cornell scale is an instrument with good reliability to evaluate depression in patients with dementia. This tool will contribute to the evaluation and follow-up of depressed patients with dementia in our population and may also be used in multicentric studies with Brazilian population.Key woRDs: depression, scales, adaptation, reproducibility of results. Depressão e demência são síndromes clínicas muito freqüentes na população idosa e podem, muitas vezes, coexistir. A prevalência de sintomas depressivos em pacientes com doença de Alzheimer (DA) varia entre 10 e 86%, dependendo dos critérios diagnósticos, das avaliações utilizadas e das populações estudadas [1][2][3][4][5] . estudos longitudinais sugerem que a depressão pode preceder o desenvolvimento de demên-cia ou mesmo constituir um fator de risco para o aparecimento da DA [6][7][8] . esses fatores apontam para a necessidade de se utilizar instrumentos específicos para avaliar sintomas depressivos em pacientes com demência. A escala Cornell de depressão em demência (eCDD) é um instrumento para auxiliar em pesquisa farmacológica e em estudos sobre a e...

Cognitive decline, particularly executive dysfunction, is observed in normal aging. In Brazil, the elderly population presents broad educational diversity. Category verbal fluency tests are frequently used to detect cognitive impairment, assessing executive function, language and semantic memory.ObjectiveTo investigate the effects of age and education on category animal fluency task (CAF) in healthy elderly.MethodsWe evaluated 319 healthy elderly from outpatient care units of two university reference centers of Rio de Janeiro and São Paulo. The sample was divided into two age, and five schooling subgroups. To be included participants had to demonstrate preservation of global cognitive functioning, independence for activities of daily living and not fulfill diagnostic criteria for dementia. All participants were submitted to neurological and neuropsychological evaluations.ResultsThere was a correlation between age and CAF performance (r= –0.26, p<0.01), which was not confirmed when years of education were included as a covariant in univariate ANCOVA. Significant differences were found in CAF performance among the different educational level groups on correlation analysis (r=0.42, p<0.01) and ANCOVA analysis (F=18.8, p<0.05). Illiteracy was associated with worst CAF performance, while university level was associated with best performance.ConclusionThe best CAF performance was found in the first years of schooling (literacy learning process) compared to illiteracy, and when finishing high school and starting university courses compared to all other educational levels. These stages are associated with significant gains in semantic memory and executive function which are critical for verbal fluency performance.

A review of the evidence on cognitive, functional and behavioral assessment for the diagnosis of dementia due to Alzheimer’s disease (AD) is presented with revision and broadening of the recommendations on the use of tests and batteries in Brazil for the diagnosis of dementia due to AD. A systematic review of the literature (MEDLINE, LILACS and SCIELO database) was carried out by a panel of experts. Studies on the validation and/or adaptation of tests, scales and batteries for the Brazilian population were analyzed and classified according to level of evidence. There were sufficient data to recommend the IQCODE, DAFS-R, DAD, ADL-Q and Bayer scale for the evaluation of instrumental activities of daily living, and the Katz scale for the assessment of basic activities of daily living. For the evaluation of neuropsychiatric symptoms, the Neuropsychiatric Inventory (NPI) and the CAMDEX were found to be useful, as was the Cornell scale for depression in dementia. The Mini-Mental State Examination has clinical utility as a screening test, as do the multifunctional batteries (CAMCOG-R, ADAS-COG, CERAD and MDRS) for brief evaluations of several cognitive domains. There was sufficient evidence to recommend the CDR scale for clinical and severity assessment of dementia. Tests for Brazilian Portuguese are recommended by cognitive domain based on available data.