Normative Data for the ELSA-Brasil Neuropsychological Assessment and Operationalized Criterion for Cognitive Impairment for Middle-Aged and Older Adults

Abstract

Objectives: Normative data should consider sociodemographic diversity for the accurate diagnosis of cognitive impairment. This study aims to provide normative data for a brief neuropsychological battery and present diagnostic criteria for cognitive impairment that could be used in primary care settings. Methods: We selected 9618 Brazilian middle-aged and older adults after detailed exclusion criteria to avoid subtle cognitive impairment. We analyzed age, sex, and education influence on cognitive performance. To verify the evidence of criterion validity, we compared the cognitive performance of subjects with and without a depressive episode. Additionally, we verified the percentage of spurious scores under three different cutoffs. Results: Age and education had the greatest impact on cognition. Normative scores were provided according to age and education groups. Participants with a depressive episode performed poorer than control subjects. The clinical cutoff of at least two scores below the 7th percentile revealed the adequate percentage of spurious and possible clinical performance. Conclusions: The Longitudinal Study on Adult Health (ELSA-Brasil) provided normative data based on a unique selected set of cognitively normal subjects. Normative groups were selected based on age and education, and the battery was sensitive to the presence of a depressive episode. We suggested clinical cutoffs for the tests in this battery that could be used in primary care settings to improve the accurate diagnosis of cognitive impairment.

Normative data for highly educated older adults in phonemic and semantic fluency tests

“…Brucki and Rocha 7 found the educational level to affect the total number of animals in semantic verbal fluency test, as well as the number of categories of animals and changes in categories and clusters. Bertola et al 16 found education to be more correlated than age with cognitive scores on a brief neuropsychological battery that includes fluency animals and fluency letter F in their sample of ages 35–74 years. Even in highly educated samples, such as the one used by Brincker et al 12 , significant differences are found in performance on both animals and fruits semantic verbal fluency tests, with individuals with 17–25 years of schooling performing better than those with 8–16 years.…”

“…Esteves et al 6 involved a sample of 521 subjects who were residents of the South, and Brincker et al 12 involved a sample of 31 subjects from the Midwest. Only the samples in Passos et al 15 and Bertola et al 16 included subjects from the Northeast, as both studies shared the ELSA-Brasil sample, which is a large sample with 15,105 subjects including those from the Southeast and the South. In the Bertola et al 16 study, only data from 9618 participants of the ELSA-Brasil sample were included, as they applied more strict exclusion criteria aiming to provide quality normative data for a brief neuropsychological battery that includes fluency animals and fluency letter F. A total of 12.9% of their final sample was composed of subjects from the Northeastern capital of Salvador.…”

“…Only the samples in Passos et al 15 and Bertola et al 16 included subjects from the Northeast, as both studies shared the ELSA-Brasil sample, which is a large sample with 15,105 subjects including those from the Southeast and the South. In the Bertola et al 16 study, only data from 9618 participants of the ELSA-Brasil sample were included, as they applied more strict exclusion criteria aiming to provide quality normative data for a brief neuropsychological battery that includes fluency animals and fluency letter F. A total of 12.9% of their final sample was composed of subjects from the Northeastern capital of Salvador. As Brazil is a country with marked social inequalities and economic disparities, results from some geopolitical regions may not be representative of other areas.…”

Retest effects in a diverse sample: sociodemographic predictors and possible correction approaches

“…All assumptions required to perform the linear regression models were met. Considering that the regular method for these corrections is to use a control sample to first extract the retest effect and subsequently apply the correction to the entire sample, we used a subsample of participants that previously built a robust normative data, based on the absence of risk factors and objective cognitive decline (for the complete description, see Bertola et al) 22 . Briefly, this robust subsample of the ELSA-Brasil was composed of 3,888 participants who, after exclusion criteria (e.g., baseline and follow-up self-reported stroke, use of psychoactive medications, missing cognitive scores, and Reliable Change Index [RCI]>-1.96), were considered not having possible cognitive decline after 4-year interval.…”

Association Between 24-Hour Movement Behavior and Cognitive Function in Brazilian Middle-Aged and Older Adults: Findings From the ELSA-Brasil

“…Cognitive function was assessed using six standardized tests for the Brazilian, Portuguese-speaking population. Testing was applied in a quiet room by trained interviewers using standardized protocols, recorded, and reviewed for quality control ( Bertola et al, 2021 ; Passos et al, 2014 ).…”