Correlação entre parâmetros estimados pelos testes Colour Assessment and Diagnosis e Cambridge Colour Test na avaliação da discriminação de cores

Os testes Colour Assessment and Diagnosis (CAD) e Cambridge Colour Test (CCT) têm sido amplamente utilizados em pesquisas básicas e clínicas, devido à alta sensibilidade e especificidade de seus resultados. Estes testes utilizam diferentes paradigmas de estimulação para estimar os limiares de discriminação de cor. Pouco se sabe sobre a relação de cada paradigma na avaliação da discriminação de cor nesses testes. Sendo assim, este trabalho objetiva comparar os parâmetros de avaliação da discriminação de cor estimados pelos testes CAD e CCT em sujeitos tricromatas e com discromatopsia congênita. Foram avaliados 59 sujeitos tricromatas e 38 sujeitos discromatópsicos (16 protans, 22 deutans) com idade média de 26,32 ± 8,9 anos. Foram testados 66 sujeitos nos testes CAD e CCT, 29 sujeitos no teste CAD e 2 sujeitos no teste CCT. O fenótipo da visão de cores de todos os sujeitos foi determinado através de uma bateria de testes psicofísicos e a estimativa dos limiares de discriminação de cor foi avaliada pelos testes CAD e CCT. Os dados de limiares de discriminação de cor foram ajustados a funções de elipse. Os critérios analisados para cada sujeito foram: a área da elipse, o ângulo de rotação e tamanho dos vetores protan, deutan e tritan. Para cada um dos parâmetros foi realizada: estatística descritiva, análise da dispersão dos parâmetros entre os testes CAD e CCT e dos parâmetros em conjunto, razão entre os parâmetros, correlação dos parâmetros a três modelos matemáticos e análise de concordância. Os parâmetros de área e tamanho dos vetores deutan e tritan do subgrupo tricromata; área e tamanho do vetor tritan do subgrupo protan; e tamanho dos vetores protan e tritan do subgrupo deutan apresentaram equivalência entre os resultados de ambos os testes. Os parâmetros de área, ângulo de rotação e tamanho dos vetores protan e tritan apresentaram concordância de medidas entre os testes CAD e CCT. Fatores como as localizações distintas das coordenadas centrais dos testes CAD e CCT e a disposição espacial dos vetores no espaço de cor da CIE 1976 no teste CCT podem ter influenciado na determinação de limiares de discriminação cromática de ambos os testes. Apesar de utilizarem paradigmas distintos na configuração da estimulação, os testes CAD e CCT são equiparáveis.

Color vision impairment in type 2 diabetes assessed by the D-15d test and the Cambridge Colour Test

Color vision impairment emerges at early stages of diabetes mellitus type 2 (DM2) and may precede diabetic retinopathy or the appearance of vascular alterations in the retina. The aim of the present study was to compare the evaluation of the color vision with two different tests - the Lanthony desaturated D-15d test (a traditional color arrangement test), and the Cambridge Colour Test (CCT) (a computerized color discrimination test) - in patients diagnosed with DM2 without clinical signs of diabetic retinopathy (DR), and in sex- and age-matched control groups. Both color tests revealed statistically significant differences between the controls and the worst eyes of the DM2 patients. In addition, the degree of color vision impairment diagnosed by both tests correlated with the disease duration. The D-15d outcomes indicated solely tritan losses. In comparison, CCT outcomes revealed diffuse losses in color discrimination: 13.3% for best eyes and 29% for worst eyes. In addition, elevation of tritan thresholds in the DM2 patients, as detected by the Trivector subtest of the CCT, was found to correlate with the level of glycated hemoglobin. Outcomes of both tests confirm that subclinical losses of color vision are present in DM2 patients at an early stage of the disease, prior to signs of retinopathy. Considering the advantages of the CCT test compared to the D-15d test, further studies should attempt to verify and/or improve the efficiency of the CCT test.

A computer-controlled color vision test for children based on the Cambridge Colour Test

The present study aimed at providing conditions for the assessment of color discrimination in children using a modified version of the Cambridge Colour Test (CCT, Cambridge Research Systems Ltd., Rochester, UK). Since the task of indicating the gap of the Landolt C used in that test proved counterintuitive and/or difficult for young children to understand, we changed the target Stimulus to a patch of color approximately the size of the Landolt C gap (about 7 degrees Of Visual angle at 50 cm from the monitor). The modifications were performed for the CCT Trivector test which measures color discrimination for the protan, deutan and tritan confusion lines. Experiment I Sought to evaluate the correspondence between the CCT and the child-friendly adaptation with adult subjects (n = 29) with normal color vision. Results showed good agreement between the two test versions. Experiment 2 tested the child-friendly software with children 2 to 7 years old (n = 25) using operant training techniques for establishing and maintaining the subjects` performance. Color discrimination thresholds were progressively lower as age increased within the age range tested (2 to 30 years old), and the data-including those obtained for children-fell within the range of thresholds previously obtained for adults with the CCT. The protan and deutan thresholds were consistently lower than tritan thresholds, a pattern repeatedly observed in adults tested with the CCT. The results demonstrate that the test is fit for assessment of color discrimination in young children and may be a useful tool for the establishment of color vision thresholds during development.

Chromatic discrimination losses in multiple sclerosis patients with and without optic neuritis using the Cambridge Colour Test

We assessed chromatic discrimination in multiple sclerosis (MS) patients both with (ON) and without (no ON) a history of optic neuritis using the Cambridge color test (CCT). Our goal was to determine the magnitude and chromatic axes of any color vision losses in both patient groups, and to evaluate age-related changes in chromatic discrimination in both patient groups compared to normals. Using the CCT, we measured chromatic discrimination along the protan, deutan and tritan axes in 35 patients with MS (17 ON eyes) and 74 age matched controls. Color thresholds for both patient groups were significantly higher than controls` along the protan and tritan axes (P < 0.001). In addition, the ON and no-ON groups differed significantly along all three-color axes (p < 0.001). MS patients presented a progressive color discrimination impairment with age (along the deutan and tritan axes) that was almost two times faster than controls, even in the absence of ON. These findings suggest that demyelinating diseases reduce sensitivity to color vision in both red-green and blue-yellow axes, implying impairment in both parvocellular and koniocellular visual pathways. The CCT is a useful tool to help characterize vision losses in MS and the relationship between these losses and degree of optic nerve involvement.

Um teste computadorizado para a avaliação de visão de cores em crianças e sujeitos não-verbais baseado no teste de discriminação de cores de Mollon-Reffin

O presente estudo visou garantir condições favoráveis para a avaliação de discriminação de cores em crianças, por meio de uma adaptação no modo Trivector do teste de discriminação de cores de Mollon-Reffin. Como a tarefa original, de indicar a abertura do C de Landolt, se mostrou pouco intuitiva para crianças pequenas, o alvo foi mudado para uma área colorida aproximadamente quadrada e a resposta requerida passou a ser tocar no alvo. O modo de teste Trivector mede os limiares de discriminação de cor ao longo de três linhas de confusão características das três formas variantes de visão de cor humana: protan-, deutan- e tritan-. O Experimento I avaliou a concordância entre o teste original e a versão adaptada, com 29 sujeitos adultos com visão de cor normal. A comparação dos limiares obtidos com as duas versões, por meio do método de avaliação de concordância de Bland-Altman, mostrou boa concordância entre as versões. No Experimento II, o teste adaptado foi aplicado em 25 crianças de 2 a 7 anos, usando técnicas de treino operante para estabelecer e manter o desempenho dos sujeitos. Os limiares diminuíram progressivamente acompanhando o aumento na idade. Os limiares protan- e deutan- foram consistentemente menores que os limiares tritan-, um padrão que já havia sido observado com adultos no teste original. Os resultados demonstram que, feitas as adaptações necessárias, o teste é adequado para a avaliação da discriminação de cor em crianças pequenas e pode ser uma ferramenta útil para a identificação das variações da visão de cor durante o desenvolvimento, bem como para a aplicação em outras populações humanas e, inclusive, outros primatas. (CNPq, FINEP).

Comparação de dois procedimentos computadorizados para avaliação de discriminação de cores em Cebus sp

A visão de cores consiste na discriminação de objetos com base em sua composição espectral, auxiliando na interação organismo-ambiente. Dentre os primatas, estima-se que a dicromacia seja uma característica compartilhada pela maioria das espécies platirrinas, sendo esta condição polimórfica e ligada ao sexo. O objetivo deste estudo foi comparar os resultados produzidos por equipamentos e softwares distintos para avaliar a tri/dicromacia em dois machos e duas fêmeas da espécie Cebus sp. Foram utilizados dois programas computadorizados: um envolvendo uma versão adaptada do Cambridge Colour Test e outro desenvolvido para o uso em sistema computacional padrão. Nos Experimentos 1 e 2 foi possível averiguar a condição tricromata de uma participante e dicromata dos participantes restantes. No Experimento 3, uma participante fêmea e um macho apresentaram desempenho dicromata compatível com o registrado nos experimentos anteriores. Neste mesmo experimento, uma participante fêmea apresentou desempenho tricromata compatível com o registrado nos experimentos anteriores. Concluiu-se com este estudo que condições favoráveis para a avaliação de visão de cores em primatas platirrinos podem ser edificadas envolvendo equipamento e software de baixo custo financeiro e de fácil programação. Entretanto, devido ao pequeno número de sessões realizadas com o equipamento de baixo custo, sugere-se a replicação do Experimento 3 e a realização de novas sessões com maior número de participantes e envolvendo novos arranjos de estímulos. Acredita-se que se novos dados corroborarem os produzidos aqui, este procedimento e equipamento poderá ser utilizado para avaliação de outras espécies platirrinas onde dados comportamentais são escassos.

Color vision loss in patients treated with chloroquine

Pacientes que fazem uso de cloroquina ou hidróxi-cloroquina, drogas que são freqüentemente administradas para o tratamento de artrite reumatóide, lúpus eritrematoso ou malária, podem sofrer alterações na visão de cores e na sensibilidade de contraste. O presente estudo avaliou a função visual destes pacientes em um estudo conjunto da Universidade de São Paulo (USP), em São Paulo, e da Universidade Federal do Pará (UFPA), em Belém. Trinta e dois pacientes usuários de cloroquina sem alterações no exame de fundo de olho foram avaliados em São Paulo (n=10, 38 a 71 anos, média=55,8 anos) e em Belém (n=22, 20 a 67 anos, média=40 anos). A dose acumulada de cloroquina prescrita foi de 45 a 430 g (média=213 g; dp=152 g) para o grupo de São Paulo, e de 36 a 540 g (média=174 g; dp=183 g) para o grupo de Belém. Os testes foram realizados monocularmente com o estado refracional corrigido. A discriminação de cor foi avaliada utilizando o Teste de Cor de Cambridge (CCT): o limiar de discriminação de cor foi mensurado primeiro nos eixos protano, deutano e tritano, e em seqüência, três elipses de MacAdam foram determinadas. A visão de cores dos pacientes também foi avaliada com testes de arranjo de cores: o teste de 100 matizes de Farnsworth-Munsell (FM100), o D15 de Farnsworth-Munsell, e o teste Lanthony Dessaturado (D15d). A sensibilidade de contraste foi também medida com grades senoidais preto-e-brancas em 22 pacientes. Os resultados foram comparados com controles sem patologias oftalmológicasou neuro-oftalomológicas. 24 pacientes apresentaram discromatopsia adquirida, com perdas seletivas (11 pessoas) ou difusas (13 pessoas). Embora as perdas estivessem presentes no FM100, não houve correlação entre o escore de erro do FM100 e a área elíptica medida pelo CCT. Além disso, três pacientes que tiveram escores normais no FM100 falharam para alcançar limiares normais no CCT. O teste de Lanthony foi menos sensível do que os outros dois testes, tal que falhou em indicar perda em cerca de metade dos pacientes afetados, e o D15 foi o teste menos sensível, deixando de indicar déficits em 9 de 10 pacientes. A sensibilidade de contraste esteve dentro dos valores normais para pacientes submetidos a este teste. A extensão das perdas na discriminação de cores foi positivamente correlacionada com a dose acumulada. O CCT é recomendado para o acompanhamento destes pacientes, pois forneceu dados quantitativos que podem ser diretamente interpretados no espaço cromático da CIE (Commission Internationelle d'Éclairage).

Comparison of two computerized procedures for the assessment of color discrimination in Cebus apella

Color vision consists of the discrimination of objects based on their spectral composition. Among primates, the majority of Platyrrhini monkeys are estimated to have polymorphic and sex-linked dichromacy. The objective of this study was to compare the results produced by different equipment and software for the assessment of tri- and dichromatic conditions in one male and two female Cebus apella. Three experiments were programmed. In Experiment 1, verifying the trichromatic condition of one female subject and dichromatic condition of the remainder of the subjects was possible using an adapted version of the Cambridge Colour Test. Experiment 2 confirmed the results of Experiment 1 using a different array of stimuli of the same test. Experiment 3, which produced results similar to Experiment 2, consisted of a test developed for a standard computer system using stimuli with color properties similar to the ones used in the previous experiment. Favorable conditions for the assessment of color vision in Platyrrhini can be built with low-cost equipment and software. Once data have been gathered with additional subjects and new stimulus arrangements have been tested and confirmed, the procedure can be used for the evaluation of other Platyrrhini species for which behavioral color discrimination data are currently lacking.

Irreversible color vision losses in patients with chronic mercury vapor intoxication

This longitudinal study addresses the reversibility of color vision losses in subjects who had been occupationally exposed to mercury vapor. Color discrimination was assessed in 20 Hg-exposed patients (mean age = 42.4 +/- 6.5 years; 6 females and 14 males) with exposure to Hg vapor during 10.5 +/- 5.3 years and away from the work place (relative to 2002) for 6.8 +/- 4.2 years. During the Hg exposure or up to one year after ceasing it, mean urinary Hg concentration was 47 +/- 35.4 mu g/g creatinine. There was no information on Hg urinary concentration at the time of the first tests, in 2002 (Ventura et al., 2005), but at the time of the follow-up tests, in 2005, this value was 1.4 +/- 1.4 mu g/g creatinine for patients compared with 0.5 +/- 0.5 mu g/g creatinine for controls (different group from the one in Ventura et al. (2005)). Color vision was monocularly assessed using the Cambridge Colour Test (CCT). Hg-exposed patients had significantly worse color discrimination (p < 0.02) than controls, as evaluated by the size of MacAdam`s color discrimination ellipses and color discrimination thresholds along protan, deutan, and tritan confusion axes. There were no significant differences between the results of the study in Ventura et al. (2005) and in the present follow-up measurements, in 2005, except for worsening of the tritan thresholds in the best eye in 2005. Both chromatic systems, blue-yellow and red-green, were affected in the first evaluation (Ventura et al., 2005) and remained impaired in the follow-up testing, in 2005. These findings indicate that following a long-term occupational exposure to Hg vapor, even several years away from the source of intoxication, color vision impairment remains irreversible.

Long-Term Occupational Exposure to Organic Solvents Affects Color Vision, Contrast Sensitivity and Visual Fields

The purpose of this study was to evaluate the visual outcome of chronic occupational exposure to a mixture of organic solvents by measuring color discrimination, achromatic contrast sensitivity and visual fields in a group of gas station workers. We tested 25 workers (20 males) and 25 controls with no history of chronic exposure to solvents (10 males). All participants had normal ophthalmologic exams. Subjects had worked in gas stations on an average of 9.6 +/- 6.2 years. Color vision was evaluated with the Lanthony D15d and Cambridge Colour Test (CCT). Visual field assessment consisted of white-on-white 24-2 automatic perimetry (Humphrey II-750i). Contrast sensitivity was measured for sinusoidal gratings of 0.2, 0.5, 1.0, 2.0, 5.0, 10.0 and 20.0 cycles per degree (cpd). Results from both groups were compared using the Mann-Whitney U test. The number of errors in the D15d was higher for workers relative to controls (p<0.01). Their CCT color discrimination thresholds were elevated compared to the control group along the protan, deutan and tritan confusion axes (p<0.01), and their ellipse area and ellipticity were higher (p<0.01). Genetic analysis of subjects with very elevated color discrimination thresholds excluded congenital causes for the visual losses. Automated perimetry thresholds showed elevation in the 9 degrees, 15 degrees and 21 degrees of eccentricity (p<0.01) and in MD and PSD indexes (p<0.01). Contrast sensitivity losses were found for all spatial frequencies measured (p<0.01) except for 0.5 cpd. Significant correlation was found between previous working years and deutan axis thresholds (rho = 0.59; p<0.05), indexes of the Lanthony D15d (rho = 0.52; p<0.05), perimetry results in the fovea (rho = -0.51; p<0.05) and at 3, 9 and 15 degrees of eccentricity (rho = -0.46; p<0.05). Extensive and diffuse visual changes were found, suggesting that specific occupational limits should be created.

Platelet GSK3B activity in patients with late-life depression: Marker of depressive episode severity and cognitive impairment?

Objective. Increased GSK3B activity has been reported as a state marker of major affective episodes in patients with depression and bipolar disorder. No study so far has addressed GSK3B activity in late-life depression. The aims of the present study were to determine GSK3B activity in platelets of elderly patients with major depression, and the association between GSK3B activity and the severity of depressive symptoms and cognitive impairment. Methods. Forty drug-free elderly patients with major depressive episode were compared to healthy older adults (n == 13). Severity of the depressive episode and current cognitive state were determined by the Hamilton Depression Scale (HAM-D) and the Cambridge Cognitive Test (CAMCOG), respectively. Total- and ser-9-phosphorylated GSK3B (tGSK3B and pGSK3B) were determined in platelets by enzyme immunometric assays (EIA). GSK3B activity was indirectly inferred by the GSK3B ratio (i.e. pGSK3B/tGSK3B). Results. Elderly depressed patients had significantly lower pGSK3B levels (P == 0.03) and GSK3B ratio (P == 0.03), indicating higher GSK3B activity. Higher GSK3B activity were observed in patients with severe depressive episode (HAM-D scores > 22, P == 0.03) and with cognitive impairment (CAMCOG scores < 86, P == 0.01). Conclusion. The present findings provide additional evidence of the involvement of GSK3B in the pathophysiology of late-life major depression. Higher GSK3B activity may be more relevant in those patients with more severe depressive symptoms and cognitive impairment.

Neuropsychological Profile of Brazilian Older Adults with Heterogeneous Educational Backgrounds

Education significantly impacts cognitive performance of older adults even in the absence of dementia. Some cognitive tests seem less vulnerable to the influence of education and thus may be more suitable for cognitive assessment of older adults with heterogeneous backgrounds. The objective of this study was to investigate which tests in a cognitive battery were less influenced by educational levels in a sample of cognitively unimpaired older Brazilians. In addition, we evaluated the impact of very high educational levels on cognitive performance. The cognitive battery consisted of the Mini Mental State Examination (MMSE), Cambridge Cognitive Test (CAMCOG), Clock Drawing Test, Short Cognitive Performance Test (SKT), Rivermead Behavioural Memory Test (RBMT), Fuld Object Memory Evaluation (FOME), Verbal Fluency Test (VF) fruit category, Trail Making Test A and B, WAIS-R Vocabulary, and Block Design. Education did not exert a significant influence on the RBMT, FOME, and VF (p < .05). Subjects with very high educational levels had similar performance on the latter tests when compared with those with intermediate and low levels of education. In conclusion, the RBMT, FOME, and VF fruit category seem to be appropriate tools for the assessment of cognitive function in elderly Brazilians with varying degrees of educational attainment.

Diagnosis of Mild Cognitive Impairment Revisited after One Year Preliminary Results of a Prospective Study

Background/Aims: The diagnostic stability of mild cognitive impairment (MCI) on short-term follow- up is a key issue in the characterization of this clinical syndrome. We aim to determine the cognitive outcome after 1 year of follow- up in a cohort of older adults. Methods: Baseline clinical and neuropsychological assessments were carried out in older subjects recruited at a tertiary memory clinic. The subjects were reassessed after 1 year of follow- up with the same clinical and neuropsychological protocol. Results: A total of 115 older adults, including MCI (n = 54) and controls (n = 61), underwent baseline and follow- up evaluation. Ten subjects classified as MCI at baseline (23%) resumed normal cognitive function and 13 controls (21%) progressed to MCI upon follow-up (chi(2) = 0.015, d.f. = 1, p = 0.90). The subjects diagnosed as having MCI on both assessments were older (p = 0.002) and had a worse global cognitive performance according to the Cambridge Cognitive Test (p = 0.014). Conclusion: The subjects who maintain the MCI status are older and have a worse baseline cognitive performance as well as multiple cognitive deficits. Copyright (C) 2009 S. Karger AG, Basel

Blood pressure and cognitive function: a prospective analysis among adolescents in Seychelles.

OBJECTIVE: An inverse relationship between blood pressure (BP) and cognitive function has been found in adults, but limited data are available in adolescents and young adults. We examined the prospective relation between BP and cognitive function in adolescence. METHODS: We examined the association between BP measured at the ages of 12-15 years in school surveys and cognitive endpoints measured in the Seychelles Child Development Study at ages 17 (n = 407) and 19 (n = 429) years, respectively. We evaluated multiple domains of cognition based on subtests of the Cambridge Neurological Test Automated Battery (CANTAB), the Woodcock Johnson Test of Scholastic Achievement (WJTA), the Finger Tapping test (FT) and the Kaufman Brief Intelligence Test (K-BIT). We used age, sex and height-specific z-scores of SBP, DBP and mean arterial pressure (MAP). RESULTS: Six out of the 21 cognitive endpoints tested were associated with BP. However, none of these associations were found to hold for both males and females or for different subtests within the same neurodevelopmental domain or for both SBP and DBP. Most of these associations disappeared when analyses were adjusted for selected potential confounding factors such as socio-economic status, birth weight, gestational age, BMI, alcohol consumption, blood glucose, and total n-3 and n-6 polyunsaturated fats. CONCLUSIONS: Our findings do not support a consistent association between BP and subsequent performance on tests assessing various cognitive domains in adolescents.

Blood pressure and cognitive function: a prospective analysis among adolescents in Seychelles

Objective: An inverse relationship between blood pressure and cognitive function has been found in adults, but limited data are available in adolescents and young adults. We prospectively examined the relation between blood pressure and cognitive function in adolescence. Methods: We examined the association between BP measured at the ages of 12-15 years in school surveys and cognitive endpoints measured in the Seychelles Child Development Study at ages 17 (n=407) and 19 (n=429) years respectively. We evaluated multiple domains of cognition based on subtests of the Cambridge Neurological Test Automated Battery (CANTAB), the Woodcock Johnson Test of Scholastic Achievement (WJTA), the Finger Tapping test (FT) and the Kaufman Brief Intelligence Test (K-BIT). We used age-, sex- and height-specific z-scores of systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP). Results: Six out of the 21 cognitive endpoints tested were associated with BP. However, none of these associations were found to hold for both males and females or for different subtests within the same neurodevelopmental domain or for both SBP and DBP. Most of these associations disappeared when analyses were adjusted for selected potential confounding factors such as socio-economic status, birth weight, gestational age, body mass index, alcohol consumption, blood glucose, and total n-3 and n-6 polyunsaturated fats. Conclusions: Our findings do not support a consistent association between BP and subsequent performance on tests assessing various cognitive domains in adolescents.