Graph analysis of verbal fluency test discriminate between patients with Alzheimer’s disease, Mild Cognitive Impairment and normal elderly controls

Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment – subtypes amnestic(aMCI) and amnestic multiple domain (a+mdMCI) - and patients with Alzheimer’s disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGAs). The individuals were compared when divided in three (NC – MCI – AD) and four (NC – aMCI – a+mdMCI – AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.

Graph analysis of verbal fluency test discriminate between patients with Alzheimer’s disease, Mild Cognitive Impairment and normal elderly controls

Verbal fluency is the ability to produce a satisfying sequence of spoken words during a given time interval. The core of verbal fluency lies in the capacity to manage the executive aspects of language. The standard scores of the semantic verbal fluency test are broadly used in the neuropsychological assessment of the elderly, and different analytical methods are likely to extract even more information from the data generated in this test. Graph theory, a mathematical approach to analyze relations between items, represents a promising tool to understand a variety of neuropsychological states. This study reports a graph analysis of data generated by the semantic verbal fluency test by cognitively healthy elderly (NC), patients with Mild Cognitive Impairment – subtypes amnestic(aMCI) and amnestic multiple domain (a+mdMCI) - and patients with Alzheimer’s disease (AD). Sequences of words were represented as a speech graph in which every word corresponded to a node and temporal links between words were represented by directed edges. To characterize the structure of the data we calculated 13 speech graph attributes (SGAs). The individuals were compared when divided in three (NC – MCI – AD) and four (NC – aMCI – a+mdMCI – AD) groups. When the three groups were compared, significant differences were found in the standard measure of correct words produced, and three SGA: diameter, average shortest path, and network density. SGA sorted the elderly groups with good specificity and sensitivity. When the four groups were compared, the groups differed significantly in network density, except between the two MCI subtypes and NC and aMCI. The diameter of the network and the average shortest path were significantly different between the NC and AD, and between aMCI and AD. SGA sorted the elderly in their groups with good specificity and sensitivity, performing better than the standard score of the task. These findings provide support for a new methodological frame to assess the strength of semantic memory through the verbal fluency task, with potential to amplify the predictive power of this test. Graph analysis is likely to become clinically relevant in neurology and psychiatry, and may be particularly useful for the differential diagnosis of the elderly.

Influência de fatores biopsicossociais sobre a mortalidade de idosos no município de Santa Cruz/RN: um estudo prospectivo

The aging process if characterizes for a complex events network, from multidimensional nature, that encloses biological, social, psychic and functional aspects. The alteration of one or more aspects can speed up the aging process, anticipating limitations and until the death in the aged. For an adjusted confrontation of this question is necessary an interdisciplinary vision, in which the some areas of the knowledge can interact and with this to intervenes of the best possible form. Then, information derived from studies of aspects related to incidence, morbidity-mortality and transition patterns, involved in the health-illness process can more accurately identify risk groups thereby establishing links between social factors, illness, incapacity and death. Thus, this study aimed to identify, by a multidimensional vision, the risk factors of mortality in a coorth of elderly in a city in the interior of the state of Rio Grande do Norte (RN), Brazil. A prospective study carried out in Santa Cruz RN, where 310 elderly were randomly selected to form a baseline. The follow-up was 53 months. The predictive variables were divided into sociodemographic, physical health, neuropsychiatric and functional capacity. The statistical analysis carried out by bivariate analysis, survival analysis, followed by binary logistic regression and Cox regression, in the multivariate analysis, considering significant levels p < 0.05 and confidence interval (CI) of 95%. A total of 60 (19.3%) elderly died during the follow-up, where cardiovascular disease was the main cause. The survival was approximately 24.8 months. The study of general survival showed, at 12, 24, 36, and 48 months of observation, a survival rate of 97%, 54%, 31%, and 5% respectively, with a statistical difference in survival only observed for the variables of cognitive function and Basic Activities of Daily Living. In the logistic regression analysis, the risk factors identified were cognitive deficits (OR = 8.74), poor perception of health (OR = 3.89) and dependence for Basic Activities of Daily Living (OR = 3.96). In the Cox analysis, as well as dependence for Basic Activities of Daily Living (HR = 3.17), cognitive deficit (HR = 4.30) and stroke (CVA) (HR = 3.49) continued as independent risk factors for death. The risk factors found in the study can be interpreted as the primary predictors for death among elderly members of the community. Therefore, improvements in health conditions, with actions towards sustaining an autonomous life with special attention for elderly with cognitive impairment, could mean additional healthy quality of life, resulting in the reduction of premature mortality in this population

Influência do método pilates na força e atividade elétrica dos músculos respiratórios de idosas - ensaio clínico controlado randomizado

The reduction of physiological capacity present in the process of aging causes a marked decline in lung function. The exercise does promote several positive changes in the physical health of people and protect the cardiorespiratory function. The aim of this study was to investigate the effects of a program of Pilates exercices on the strengh and electrical activity of respiratory muscles of elderly. This is a randomized, controlled clinical trial, evaluating 33 elderly aged 65 and 80 (70.88 ± 4.32), healthy, sedentary, without cognitive impairment and able the practice physical activity. The sample was divided into two groups, one experimental group with 16 elderly women who did Pilates exercises and a control group (17) that was not submitted to the exercises, but received educational booklets on aging and health care. The elderly were evaluated initially and after a period of three months, taking into account the Maximal Inspiratory Pressure (MIP) and Maximal Expiratory Pressure (MEP), obtained by Manovacuometry and intensity of EMG activity was measured using the values of Root Mean Square (RMS) for the diaphragm and rectus abdominis muscles, during the course of diaphragmatic breathing and MIP maneuver. Data were analyzed using SPSS version 17.0. For all tests, we used a significance level or p value < 0.05 and confidence interval 95%. RMS in diaphragm and rectus abdominis muscles in both tests increased, but the data were significant for the rectus abdominis during diaphragmatic breathing (p = 0.03) and the diaphragm during the MIP maneuver (p = 0.01). There was no significant variation of the MIP and MEP. Pilates exercises were responsible for increasing the electrical activation of the diaphragm and rectus abdominis muscles in a group of healthy elderly, but had no influence on changes in strength of respiratory muscles

Características sociodemográficas, hábitos de sono, estado cognitivo e funcional após acidente vascular cerebral

ABSTRACT Introduction: The cerebrovascular accident (CVA) is an important cause of neurological impairment. Few data about the factors associated with morbidity of cerebrovascular accident are found in Brazil. Objectives: Evaluate sociodemographic characteristics, sleep habits, cognitive and functional status of patients with cerebrovascular accident. Methods: The patients evaluated through questionnaire Step 1 to survey the sociodemographic characteristics and Modified Rankin Scale for functional assessment. The neurological degree was evaluated by the National Institutes of Health Stroke Scale (NIHSS), the sleep Habits questionnaire for sleep and cognitive status by the Mini-Examination of the Mental State (MEMS). The data were analyzed using the chi-square test to determine differences in proportions of variables and linear regression analysis. Results: 305 patients were evaluated and the larger number of subjects was between 50 and 69 years (40%), most patients had no formal education (40.3%) and had ischemic type of cerebrovascular accident (72.5%). In the analysis of the functionality it was found that most patients had moderate impairment (55.1%). The results of the sleep habits showed that 63,6% of patients had one more person in the bedroom,12,3% complained about too much noise in the 11 room and 35% of too much light. From these patients 5,8% were smokers, 7,8% and 70,1% drank coffee drinkers, 28,6% had difficulty in initiate to sleep and woke up 37,6% in the middle of the night. Were showed complaints about nightmares (11%), feeling of suffocation (37,7%) and 35% felt very sleepy during the day. In addition, 95% were unemployed, 80,5% did not perform physical activities and 95,4% did not perform mental activities. The cognitive screening conducted a determined association of cognitive status with age and education level and neurological status. Conclusion: The study showed a high frequency of cases of cerebrovascular accident with functional dependence in a moderate degree, identified that many patients do not follow hygienic measures of sleep and found that the assessment of cognitive deficits must take into consideration the age, educational level and degree of neurological patients. We suggest the need for programs of assistance to victims of cerebrovascular accident patients, with a multidimensional approach including the rehabilitation team, the role of sleep medicine and Neuropsychology, so that patients have access to a more appropriate functional rehabilitation, develop a lifestyle that ensures a good sleep quality and are evaluated and rehabilitated with regard to cognitive impairment

Avaliação do padrão do ciclo sono-vigília e a cognição em estudantes de medicina com diferentes esquemas de horários de aulas

The sleep patterns of students entering the university, is accompanied by many factors that can lead to changes in sleep habits, such as academic demands, new social opportunities, reduced parental care and irregular teaching schedules. The irregular pattern of sleep-wake cycle is usually accompanied by several daytime consequences, for example, reduced levels of motivation, performance, concentration, alertness and mood as well as increased fatigue and sleepiness.Thus, there are numerous reasons to support the fact that these students may suffer damage in their academic performance. The aim of this study was to evaluate the sleep-wake cycle (SWC) and cognition in medical students with different schemes teaching schedules. One group started classes at 08am, while the other started at 07am. We analyzed the data from 88 volunteers, 39 from each group. However, only those who participated in both stages of the study (n = 78) underwent cognitive testing. For subjective evaluation of the SWC was used questionnaires to check the quality of sleep, chronotype, daytime sleepiness and sleep habits. For objective evaluation was used actigraphy. For cognitive assessment was used the test MoCA (Montreal Cognitive Assessment). The results indicate that the group has class earlier had a greater irregularity of the SWC and a worse performance in cognitive testing. There was a difference between the schedules the week and weekend in the subjective variables, bedtime, wake up and sleep duration in both groups. The objective variables, time in bed showed difference between the schedules the week and weekend to the group started class at 08am and the variables bedtime, get up time, actual sleep time, time in bed and wake bouts in the class at 07am. In the cognitive test, there were differences between the groups in overall score and in the areas of executive function and memory recall. Thus, it is suggested that the class starting time may cause irregularity of the SWC and the irregularity may cause mild cognitive impairment. Moreover, cognitive testing MoCA was sensitive to detect differences among students, although the difference between the schedules is small

Álcool e comportamento: efeitos na aprendizagem e memória

Excessive alcohol consumption is responsible for many harmful effects on individuals and society. Despite years of research, the mechanisms by which alcohol affects neurological functions and the exact causes of cognitive impairment related to long-term use are unknown. In this sense, this master study proposed to observe how different doses of alcohol affect the addiction response and the learning ability of two fish species: Betta splendens and Danio rerio, the latter a commonly model due to organizational and functional characteristics shared with mammals. For this, different concentrations of ethanol (0%, 0.1%, 0.25%, 1% and 1.5%) were used in acute, chronic and withdrawal treatments. We tested the fish in three experimental protocols: 1) alcohol addiction potential using conditioned place preference, 2) associative conditioning using light as unconditioned stimulus and food as conditioned stimulus and 3) spatial learning using a maze without cues. For the alcohol addiction potential, preference between two different places in a shuttle box was tested before and after alcohol exposure (chronic and acute). In this test, the animals intoxicated by 0.1% did not change behavior, while animals receiving 1% and 1.5% alcohol changed the initial preference to the side where they received alcohol For the associative conditioning, the results show that the groups undergoing low dose (0.1%), both in chronic and withdrawal treatment, learned the task faster than control; groups under 0.25 and 1% alcohol withdrawal learned the task after control; groups chronically intoxicated with these doses did not learn the task. For the spatial learning test, fish submitted to acute and chronic treatments decreased the time to exit the maze; there were significant differences in the animal s performance in a dose-dependent pattern. This difference was not observed for the withdrawal treatment. Given these results, we conclude that the effects of alcohol on learning are dependent on the dosage. Furthermore, low doses of alcohol seem to maximize animal performance on learning tasks and do not alter their seeking behavior, while higher doses induced addition and hinder learning

Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.

Métodos de avaliação nutricional para a suplementação oral com zinco em crianças pré-púberes não deficientes em zinco

Background: Zinc is an essential nutrient that is required for numerous metabolic functions, and zinc deficiency results in growth retardation, cellmediated immune dysfunction, and cognitive impairment. Objective: This study evaluated nutritional assessment methods for zinc supplementation in prepubertal nonzinc- deficient children. Design: We performed a randomised, controlled, triple-blind study. The children were divided into a control group (10% sorbitol, n = 31) and an experimental group (10 mg Zn/day, n = 31) for 3 months. Anthropometric and dietary assessments as well as bioelectrical measurements were performed in all children. Results: Our study showed (1) an increased body mass index for age and an increased phase angle in the experimental group; (2) a positive correlation between nutritional assessment parameters in both groups; (3) increased soft tissue, and mainly fat-free mass, in the body composition of the experimental group, as determined using bioelectrical impedance vector analysis; (4) increased consumption of all nutrients, including zinc, in the experimental group; and (5) an increased serum zinc concentration in both groups (p < 0.0001). Conclusions: Given that a reference for body composition analysis does not exist for intervention studies, longitudinal studies are needed to investigate vector migration during zinc supplementation. These results reinforce the importance of employing multiple techniques to assess the nutritional status of populations.