Brazilian Version of the Protocole Montréal d'Évaluation de la Communication (Protocole MEC): Normative and Reliability Data

Semantic memory navigation in HIV: Conceptual associations and word selection patterns

Objective: This proof-of-concept study aimed to characterize semantic memory profiles in individuals with human immunodeficiency virus (HIV) and mild neurocognitive impairment. Method: Using a semantic relatedness task, we explored conceptual association and word selection patterns in people living with HIV (PLWH; n = 50) relative to people living without HIV (n = 46). We also studied whether word selection patterns in the PLWH group were associated with working memory capacity, cognitive flexibility and inhibitory control. Results: While accuracy did not differ between groups, PLWH produced significantly longer responses than controls (r = .32), with fewer hypernyms (d = .47), more troponyms (r = .37), and words that were more frequent (r = .39) and had more phonological neighbors (r = .22). These patterns survived covariation with participants' cognitive status. None of these patterns correlated with measures of working memory, cognitive flexibility, inhibitory control or viral load (all correlation coefficients < .36). Conclusions: Together, these results suggest that PLWH might use alternative word finding strategies during semantic memory navigation, irrespective of the severity of other cognitive symptoms. Such findings contribute to the characterization of cognitive deficits in HIV and to the search for novel markers of the condition.

Cognitive communication disorders after brain injury: A systematic COSMIN review of measurement instruments

BACKGROUND

There is a lack of consensus on standardized measurement instruments (MIs) for the assessment of cognitive communication disorders in individuals with acquired brain injury (ABI).

OBJECTIVES

To identify and describe the currently available MIs for the assessment of cognitive communication disorders in individuals with ABI and to evaluate the psychometric properties of MIs.

METHODS

A search was conducted in 6 databases on March 12, 2024 using a validated methodological search filter. We included studies that evaluated psychometric properties of MIs used to assess cognitive communication disorders in individuals with ABI. We applied the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to evaluate the psychometric properties of the MIs.

RESULTS

We included 48 records reporting on 44 MIs. Of all MIs, the La Trobe Communication Questionnaire (LCQ) and the St Andrew's-Swansea Neurobehavioural Outcome Scale (SASNOS) were studied most extensively. No MIs had undergone exhaustive methodological evaluation.

CONCLUSIONS

Based on the COSMIN, only 1 of 44 MIs can be recommended as its results can be trusted. Most MIs have the potential to be recommended but require further research to assess their psychometric quality. The development of new tools is not necessary but further methodological studies should be conducted on promising tools. This review may help clinicians and researchers to select an MI for the assessment of cognitive communication disorders and may facilitate diagnosis and research.

TRIAL REGISTRATION

PROSPERO database (registration number: CRD42020196861). No funding.

Does the frequency of reading and writing habits contribute to executive functions, intelligence, and learning in adolescents with healthy development?

The influence of the frequency of reading and writing habits (FRWH) on cognition has been investigated by several studies in the literature. However, the implications of FRWH on executive development, intelligence, and academic achievement are not yet clear in adolescents with healthy development. The aim was to verify whether there are differences in executive functions, intelligence, and academic achievement between adolescents with high and low FRWH. Moreover, we aimed to investigate if there are differences in the parental FRWH between adolescents with high and low FRWH. The sample was composed of 47 healthy adolescents, n = 24 with high FRWH and n = 23 with low FRWH. Adolescents with higher FRWH had better performance on measures of vocabulary, Speech Act analysis, and Oral Narrative Discourse. Therefore, a high FRWH has a positive influence on the cognitive development of healthy adolescents, especially with regard to pragmatic language. However, adolescents with low FRWH performed better than those with a high FRWH on an automatic counting task. The interpretation of cognitive performance and academic achievement scores in neuropsychological assessment should consider the FRWH of parents and adolescents. This factor should be targeted by early stimulation interventions to help adolescents achieve the highest possible levels of global development.

Cognitive reserve may outperform age, mood and psychiatric comorbidities as a predictor of executive functioning in bipolar disorder and healthy adults

INTRODUCTION

Cognitive reserve plays a protective role against executive dysfunction in healthy adults and individuals with psychiatric illnesses such as bipolar disorder. However, the magnitude of the influence of cognitive reserve on specific executive functions (EFs), and its impact relative to variables such as depressive symptoms, age and psychiatric comorbidities, is unexplored. This study aimed to quantify the influence of cognitive reserve on specific EFs, and compare its impact with that of depressive symptoms, age and psychiatric comorbidities, in separate models for patients with bipolar disorder and healthy adults.

METHOD

This was a cross-sectional study of 121 adults with no mood disorders and 109 with bipolar disorder, all of whom underwent a comprehensive psychiatric assessment and evaluation of the EFs. Cognitive reserve was measured using years of education, IQ and reading and writing habits. The association between EFs and predictors (cognitive reserve, depressive symptoms, age and psychiatric comorbidities) was evaluated through structural equation modeling. Four models were constructed for each group independently (bipolar disorder and control), one each for working memory, verbal fluency, inhibition and flexibility, due to group differences in age and cognitive reserve.

RESULTS

Working memory, inhibition and flexibility were most significantly predicted by cognitive reserve and age. Verbal fluency was only predicted by cognitive reserve. Comorbidities and depressive symptoms were not significant in any of the models. Cognitive reserve had a positive influence on all EFs in models for patients with bipolar disorder and models for control participants. Age had a negative impact on three of the four EFs tested.

CONCLUSION

Fostering cognitive reserve through continued education and cognitively stimulating leisure activities may be an effective intervention for executive dysfunction in patients and non-patients alike. In some cases, the effects of these interventions may outweigh the negative cognitive impact of aging, depressive symptoms and psychiatric conditions.

Hemisphere stroke: impact on the semantic lexical aspects of language

OBJECTIVE

To investigate if right hemisphere stroke is associated with decreased lexical-semantic ability.

METHODS

We compared subjects with right hemisphere brain damage after stroke with healthy controls using the validated version of the Montreal Evaluation of Communication to assess lexical-semantic domains of language.

RESULTS

Sixteen patients and thirty-two controls were included. The post-stroke group with right hemispheric brain lesions showed considerable limitations in metaphor interpretation, fluency, and semantic judgment.

CONCLUSION

Individuals with right hemisphere damage after stroke may present with language changes in the lexical-semantic aspects.

"Influence of modifiable and non-modifiable variables on functioning in bipolar disorder: a path analytical study"

OBJECTIVE

The aim of this study was to investigate the influence of modifiable (mood, cognitive reserve, cognitive performance) and non-modifiable factors (diagnosis, suicide attempts, substance use, age) on self-reported functioning in BD.

METHODS

103 adults with no mood disorders and 95 individuals with BD completed the WHODAS 2.0, in addition to a neuropsychological battery and diagnostic assessments. Path analysis was then used to analyse the relationships between modifiable and non-modifiable predictors of functioning in the sample.

RESULTS

Cognitive reserve and age had an indirect influence on individual functioning, mediated by cognitive performance. The influence of diagnosis and depressive symptoms on functioning was partly direct, and partly mediated by cognition. The presence of psychiatric comorbidities in addition to BD also had a significant influence on individual functioning.

CONCLUSIONS

Initiatives focussed on modifiable factors such as depressive symptoms and cognitively stimulating activities, which increase cognitive reserve, may be a useful complement to existing treatments and help patients achieve functional recovery. KEY POINTS Individual functioning was influenced by cognitive performance, cognitive reserve, age, diagnosis and depressive symptoms. Executive functioning mediated the influence of age and cognitive reserve on individual functioning. Interventions focussed on depressive symptoms and cognitive stimulation may help patients achieve functional recovery.

Narrative discourse of young and older brazilian adults associated with demographic factors

PURPOSE

1) Compare the discourse performance between young and older adults from the Brazilian Federal District (DF); 2) Compare the mean discourse performance of participants from the DF with the normative discourse of a population from a different region of the country; 3) Verify whether the variables age, educational level and socioeconomic status and scores on the cognitive, behavioral and functional screening tests were associated with discourse performance.

METHOD

A total of 60 healthy volunteers from the DF, 30 older adults and 30 young adults, were selected. Participants were divided into two subgroups according to educational level: low education and high education. The four narrative discourse subtests of the Montreal Communication Evaluation Battery, Brazilian Portuguese version (MAC-BR) were applied to the study sample.

RESULTS

Discourse scores of the older adults were statistically higher than those of the young adults. The discourse scores in the high education group were also better than those in the low education group, with statistically significant difference observed in only one of the MAC-BR subtests. Discourse performance was associated with the sociodemographic variable and the scores on the cognitive and functional screening tests. The discourse performance of the DF sample differed from the national normative discourse with statistically significant difference.

CONCLUSION

The discourse performance of older adults from the Brazilian Federal District differed from that of young adults from the same region, as well as from that of older adults from southern Brazil. Discourse performance was associated with several different variables.

Cognitive-communication skills and acute outcome following mild traumatic brain injury

PURPOSE

Little is known about cognitive-communication skills post mild traumatic brain injury (mTBI). We aimed to determine how performance on cognitive-communication measures in the acute recovery period relates to early outcome following complicated mTBI.

METHOD

Results of language and communication skill measures, demographic and accident-related data, length of stay (LOS), Glasgow Outcome Scale-Extended (GOSE) scores and discharge destinations were retrospectively gathered for 128 admitted patients with complicated mTBI.

RESULTS

More than half of the individuals required rehabilitation services post discharge from hospital with over a third needing in-patient rehabilitation. Patients with poorer skills in auditory comprehension, verbal reasoning, confrontation naming, verbal fluency and conversational discourse were more likely to require in-patient rehabilitation. Subjects with worse skills in naming, conversational discourse and letter-category verbal fluency had a greater chance of being referred to out-patient rehabilitation services. Thus patients with both auditory comprehension and oral expression deficits were more likely to require in-patient services whereas those who had oral expression deficits but no significant difficulty in auditory comprehension were more often referred to out-patient services. Also, worse conversational discourse skills and semantic-category naming ability were related to lower GOSE scores and the chance of a longer LOS was greater when letter-category naming was poorer.

CONCLUSION

The likelihood of individuals requiring rehabilitation services post mTBI was related to performance on several oral expression and auditory comprehension measures. It is therefore important to evaluate cognitive-communication skills early to determine rehabilitation needs.

Rethinking the Neural Basis of Prosody and Non-literal Language: Spared Pragmatics and Cognitive Compensation in a Bilingual With Extensive Right-Hemisphere Damage

Above and beyond the critical contributions of left perisylvian regions to language, the neural networks supporting pragmatic aspects of verbal communication in native and non-native languages (L1s and L2, respectively) have often been ascribed to the right hemisphere (RH). However, several reports have shown that left-hemisphere activity associated with pragmatic domains (e.g., prosody, indirect speech, figurative language) is comparable to or even greater than that observed in the RH, challenging the proposed putative role of the latter for relevant domains. Against this background, we report on an adult bilingual patient showing preservation of pragmatic verbal skills in both languages (L1: Spanish, L2: English) despite bilateral damage mainly focused on the RH. After two strokes, the patient sustained lesions in several regions previously implicated in pragmatic functions (vast portions of the right fronto-insulo-temporal cortices, the bilateral amygdalae and insular cortices, and the left putamen). Yet, comparison of linguistic and pragmatic skills with matched controls revealed spared performance on multiple relevant tasks in both her L1 and L2. Despite mild difficulties in some aspects of L2 prosody, she showed no deficits in comprehending metaphors and idioms, or understanding indirect speech acts in either language. Basic verbal skills were also preserved in both languages, including verbal auditory discrimination, repetition of words and pseudo-words, cognate processing, grammaticality judgments, equivalent recognition, and word and sentence translation. Taken together, the evidence shows that multiple functions of verbal communication can be widely spared despite extensive damage to the RH, and that claims for a putative relation between pragmatics and the RH may have been overemphasized in the monolingual and bilingual literature. We further discuss the case in light of previous reports of pragmatic and linguistic deficits following brain lesions and address its relation to cognitive compensation in bilingual patients.

Non literal language comprehension in a large sample of first episode psychosis patients in adulthood

To date no data still exist on the comprehension of figurative language in the early phases of psychosis. The aim of this study is to investigate for the first time the comprehension of metaphors and idioms at the onset of the illness. Two-hundred-twenty eight (228) first episode psychosis (FEP) patients (168 NAP, non-affective psychosis; 60 AP, affective psychosis) and 70 healthy controls (HC) were assessed. Groups were contrasted on: a) type of stimulus (metaphors vs idioms) and b) type of response (OPEN = spontaneous explanations vs CLOSED = multiple choice answer). Moreover, a machine learning (ML) approach was adopted to classifying participants. Both NAP and AP had a poorer performance on OPEN metaphors and idioms compared to HC, with worse results on spontaneous interpretation of idioms than metaphors. No differences were observed between NAP and AP in CLOSED tasks. The ML approach points at CLOSED idioms as the best discriminating variable, more relevant than the set of pre-frontal and IQ scores. Deficits in non-figurative language may represent a core feature of psychosis. The possibility to identify linguistic features discriminating FEP may support the early recognition of patients at risk to develop psychosis, guiding provision of personalized and timely interventions.

Memory and executive functions correlates of self-awareness in traumatic brain injury

OBJECTIVE

The purpose of this study was to investigate the contribution of executive functions (EF) components and episodic and working memory variables, as well as clinical and demographic factors, to awareness of cognitive ability in traumatic brain injury (TBI).

METHODS

Sixty-five TBI patients (mild: n = 26; moderate/severe: n = 39) took part in the study. Independent stepwise regression models were calculated for EF and memory predictors, with awareness being measured by patient/informant discrepancy in the Patient Competency Rating Scale.

RESULTS

Models with EF variables indicated that semantic verbal fluency and age are the best predictors of awareness, whereas models including mnemonic functions suggested verbal delayed episodic recall and TBI severity as predictors.

CONCLUSIONS

These results are discussed in relation to clinical implications, such as the need to focus efforts of rehabilitation in the cognitive abilities related to awareness, and theoretical models.

Global Cognitive Impairment in Systemic Lupus Erythematosus Patients: A Structural MRI Study

OBJECTIVE

This study investigated differences in subcortical brain volumes of SLE patients with cognitive deficits (SLE-CD) and SLE patients with normal cognitive performance (SLE-CN), regardless of the presence of other neuropsychiatric symptoms.

METHOD

We studied 40 patients divided into two-matched groups (SLE-CD n = 20; SLE-CN n = 20), with age ranging from 21 to 63 years old (100 % female) and 14.73 ± 10.18 years of diagnosis. Magnetic resonance imaging exams were performed on a 1.5 T scanner. A neuropsychological flexible battery was applied individually, including reasoning/problem-solving, praxis, episodic and working memory, processing speed, language/fluency, executive functions (inhibition and flexibility), and sustained attention. Z score ≤ - 2.0 in any dimension was considered as a cut-off for being considered to possess cognitive deficits. One-way analyses of covariance (ANCOVA) were performed to compare the brain structure volumes between groups. The analyses were controlled for the effects of lupus-related neuropsychiatric disorders.

RESULTS

SLE patients with cognitive deficits had significantly smaller volumes in the left hippocampus, amygdala, and the right hippocampus than SLE patients without cognitive deficits.

CONCLUSION

SLE patients with cognitive deficits appeared to have reduced temporal lobe structures when compared with SLE without cognitive deficits. These results corroborate a systems vulnerability model that investigated temporal lobe vulnerability during normal aging and in other neurological disorders.

Acute evaluation of conversational discourse skills in traumatic brain injury

This study looked at performance on the conversational discourse checklist of the Protocole Montréal d'évaluation de la communication (D-MEC) in 195 adults with TBI of all severity hospitalized in a Level 1 Trauma Centre. To explore validity, results were compared to findings on tests of memory, mental flexibility, confrontation naming, semantic and letter category naming, verbal reasoning, and to scores on the Montreal Cognitive Assessment. The relationship to outcome as measured with the Disability Rating Scale (DRS), the Extended Glasgow Outcome Scale (GOS-E), length of stay, and discharge destinations was also determined. Patients with severe TBI performed significantly worse than mild and moderate groups (χ(2)(KW2df) = 24.435, p = .0001). The total D-MEC score correlated significantly with all cognitive and language measures (p < .05). It also had a significant moderate correlation with the DRS total score (r = -.6090, p < .0001) and the GOS-E score (r = .539, p < .0001), indicating that better performance on conversational discourse was associated with a lower disability rating and better global outcome. Finally, the total D-MEC score was significantly different between the discharge destination groups (F(3,90) = 20.19, p < .0001). Thus, early identification of conversational discourse impairment in acute care post-TBI was possible with the D-MEC and could allow for early intervention in speech-language pathology.

Communicative clusters after a right-hemisphere stroke: are there universal clinical profiles?

OBJECTIVE

The current research aimed at classifying communication profiles among right-brain-damaged adults with an intercultural perspective, and so begins to fill in a long-standing gap in the literature.

METHOD

The sample was made up of 112 right-brain-damaged individuals from three nationalities (Canadians, Brazilians and Argentineans). They were assessed using 13 language tasks from the Protocol MEC in Spanish, Brazilian Portuguese and French.

RESULTS

A hierarchical cluster analysis led to four distinct clinical profiles of communication. Since only a few distinctions between nationalities were observed, the results suggest that there probably is a partial universality of clinical profiles of communication impairments after a right brain damage.

CONCLUSIONS

This study proposes a preliminary taxonomy of communication disorders among right-brain-damaged individuals with cross-cultural implications. The exploration of associated stroke sites and neuropsychological concomitant deficits would contribute to the eventual development of a more accurate clinical intervention.

M1-Alpha test in normal subjects with low educational level: a pilot study

PURPOSE

To determine the performance of normal subjects with low educational level on the M1-Alpha test, and to obtain parameters for potential use in the clinical evaluation of aphasic patients with low educational level.

METHODS

Participants were 30 normal subjects with low educational level (one to four years of schooling), 15 male and 15 female, with ages over 18 years and below 60 years. All subjects were submitted to the M1-Alpha test, which comprehends semi-directed interview and controlled tasks. One point was given for every correct answer. Data were statistically analyzed.

RESULTS

It was verified a higher number of errors, as well as greater variability of responses, in the following tasks: copying, writing to dictation, reading comprehension, and reading aloud.

CONCLUSION

Low educational level influences the performance of subjects on the tasks copying, writing to dictation, reading aloud, and reading comprehension. It was possible to obtain reference data for potential clinical application of the M1-Alpha test in patients with low educational level.