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This paper presents the consensus of the Scientific Department of Cognitive Neurology and Aging from the Brazilian Academy of Neurology on the diagnostic criteria for Alzheimer's disease (AD) in Brazil. The authors conducted a literature review regarding clinical and research criteria for AD diagnosis and proposed protocols for use at primary, secondary, and tertiary care levels. Within this clinical scenario, the diagnostic criteria for typical and atypical AD are presented as well as clinical, cognitive, and functional assessment tools and complementary propaedeutics with laboratory and neuroimaging tests. The use of biomarkers is also discussed for both clinical diagnosis (in specific conditions) and research.Este artigo apresenta o consenso realizado pelo Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia sobre os critérios diagnósticos da Doença de Alzheimer (DA) no Brasil. Foi realizada uma revisão da literatura e dos critérios clínicos e de pesquisa para DA, sendo propostos protocolos para o diagnóstico de DA em níveis de atenção primária, secundária e terciária. Dentro deste cenário clínico, são apresentados os critérios diagnósticos para DA típica e atípica, além de instrumentos de avaliação clínica, cognitiva e funcional; bem como propedêutica complementar com exames laboratoriais e de neuroimagem. A utilização de biomarcadores é também apresentada, tanto para o diagnóstico clínico em situações específicas quanto para pesquisa.

to describe the effects of neuromodulation on the performance of executive functions in overweight and/or individuals with obesity.articles published in PubMed, ScienceDirect, BIREME, and Web of Science databases were selected using the following combination of descriptors: ("problem solving" OR "executive function" OR memory) AND (tDCS OR TMS) AND obesity. After applying the selection criteria, 08 articles were included for analysis.the articles included had an average of 30.1 participants per study, with a minimum of 12 and a maximum of 76. The overall nutritional status ranged from underweight to grade 3 obesity, and the general mean body mass index was 28,1 kg/m2. Regarding the instruments used to assess executive functions, the most frequent were: the flanker paradigm; binocular rivalry for Continuous Flash Suppression (bCFS/NoCFS); Stroop task; Go/No-Go task; and N-back task. The primary outcomes were dependent on the neuromodulation target site. Reduced food craving and improved performance in the active group were observed from decreased response time and increased precision in cognitive tasks.neuromodulation can generate changes in executive functions, reducing food cravings in overweight and individuals with obesity.

Language complaints, especially in complex tasks, may occur in mild cognitive impairment (MCI). Various language measures have been studied as cognitive predictors of MCI conversion to Alzheimer's type dementia. Understanding textual inferences is considered a high-demanding task that recruits multiple cognitive functions and, therefore, could be sensitive to detect decline in the early stages of MCI. Thus, we aimed to compare the performance of subjects with MCI to healthy elderly in a textual inference comprehension task and to determine the best predictors of performance in this ability considering one verbal episodic memory and two semantic tasks. We studied 99 individuals divided into three groups: (1) 23 individuals with amnestic mild cognitive impairment (aMCI), (2) 42 individuals with non-amnestic mild cognitive impairment (naMCI), (3), and (4) 34 cognitively healthy individuals for the control group (CG). A reduced version of The Implicit Management Test was used to assess different types of inferential reasoning in text reading. MCI patients performed poorer than healthy elderly, and there were no differences between MCI subgroups (amnestic and non-amnestic). The best predictors for inference-making were verbal memory in the aMCI and semantic tasks in the naMCI group. The results confirmed that the failure to understand textual inferences can be present in MCI and showed that different cognitive skills like semantic knowledge and verbal episodic memory are necessary for inference-making.

Several approaches to the rehabilitation of agrammatism use implicit and explicit learning methods. Objective: To verify the effect of adapted Mapping Therapy and ORLA methods (explicit versus implicit learning) on the oral and written production in spontaneous language among agrammatic patients with Broca’s aphasia. Methods: Six individuals were submitted to Mapping Therapy and ORLA (Oral Reading for Language in Aphasia) treatments. Samples of oral and written production from a picture description task were compared pre and post-treatment. Results: In Mapping Therapy, the patients presented better performance after the training for the variables related to written production: number of words, nouns, verbs, closed-class words, and number of complete sentences. Regarding oral output, the patients had similar performance before and after the therapeutic process. In ORLA, the patients presented a significant difference before and after the therapeutic process in the variables related to oral production, increasing the number of words, number of verbs, and speech rate. There was no difference in pre and post-treatment performance in written production. Conclusion: Both implicit and explicit learning can be used in the treatment of agrammatism. Mapping Therapy was more effective for the treatment of agrammatism in written production, while ORLA was more effective for the agrammatism in oral production. Resumo. Várias abordagens terapêuticas para a reabilitação do agramatismo utilizam métodos implícitos e explícitos de aprendizado. Objetivo: Verificar o efeito dos métodos adaptados Mapping Therapy e ORLA (aprendizagem explícita versus implícita) na produção oral e escrita de discurso em pacientes agramáticos com afasia de Broca. Métodos: Seis indivíduos foram submetidos aos tratamentos Mapping Therapy e ORLA. Amostras das produções oral e escrita na tarefa de descrição da prancha foram comparadas antes e após o tratamento. Resultados: No método Mapping Therapy, os pacientes apresentaram melhor desempenho após o tratamento nas seguintes variáveis relacionadas à produção escrita: número de palavras, substantivos, verbos, palavras de classe fechada e número de frases completas. Em relação à emissão oral, os pacientes mantiveram desempenho semelhante pré e pós processo terapêutico. No método ORLA, os pacientes apresentaram diferença significativa antes e após o processo terapêutico nas variáveis relacionadas à produção oral, com aumento no número de palavras, número de verbos e velocidade de fala. Não houve diferença no desempenho pré e pós tratamento na produção escrita. Conclusão: Tanto a aprendizagem implícita como a explícita têm o potencial de serem usadas no tratamento do agramatismo. A Mapping Therapy foi mais eficaz no tratamento do agramatismo na produção escrita, enquanto o ORLA foi mais eficaz para o agramatismo na produção oral.

Inference comprehension is a complex ability that recruits distinct cognitive domains, such as language, memory, attention, and executive functions. Therefore, it might be sensitive to identify early deficits in subjects with MCI. To compare the performance of subjects with mild cognitive impairment (MCI) in an inference reading comprehension task, and to analyze the correlations between inferential comprehension and other cognitive functions. We studied 100 individuals aged 60 and over, divided into MCI (50) [aMCI (35), naMCI (15)], and cognitively healthy individuals [controls (50)]. The Implicit Management Test (IMT) was used to assess inference in reading comprehension in five categories: explicit, logical, distractor, pragmatic, and "others". MCI group performed worse than controls in logical, pragmatic, distractor, and "others" questions (p 0.01). The aMCI and naMCI subgroups presented a similar performance in all types of questions (p 0.05). We observed significant correlations between the total IMT score and the TMT-A in the naMCI group (r = - 0.562, p = 0.036), and the Rey-Osterrieth Complex Figure and RAVLT tasks in the aMCI group (r = 0.474, p = 0.010 and r = 0.593, p = 0.0001, respectively). The MCI group as a whole performed worse than controls on the logical, pragmatic, other and distractor questions, and consequently on the total score. There were no differences in explicit questions, which impose lower inferential demands. The aMCI group suffered a significant impact from memory on inference comprehension, and difficulties in executive functions impacted naMCI performance. The IMT was useful to differentiate MCI patients from cognitively healthy individuals, but not MCI subgroups among themselves.

Background Right-hemisphere lesions (RHL) may impair inference comprehension. However, comparative studies between left-hemisphere lesions (LHL) and RHL are rare, especially regarding reading comprehension. Moreover, further knowledge of the influence of cognition on inferential processing in this task is needed. Objectives To compare the performance of patients with RHL and LHL on an inference reading comprehension task. We also aimed to analyze the effects of lesion site and to verify correlations between cognitive functions and performance on the task. Methods Seventy-five subjects were equally divided into the groups RHL, LHL, and control group (CG). The Implicit Management Test was used to evaluate inference comprehension. In this test, subjects read short written passages and subsequently answer five types of questions (explicit, logical, distractor, pragmatic, and other), which require different types of inferential reasoning. The cognitive functional domains of attention, memory, executive functions, language, and visuospatial abilities were assessed using the Cognitive Linguistic Quick Test (CLQT). Results The LHL and RHL groups presented difficulties in inferential comprehension in comparison with the CG. However, the RHL group presented lower scores than the LHL group on logical, pragmatic and other questions. A covariance analysis did not show any effect of lesion site within the hemispheres. Overall, all cognitive domains were correlated with all the types of questions from the inference test (especially logical, pragmatic, and other). Attention and visuospatial abilities affected the scores of both the RHL and LHL groups, and only memory influenced the performance of the RHL group. Conclusions Lesions in either hemisphere may cause difficulties in making inferences during reading. However, processing more complex inferences was more difficult for patients with RHL than for those with LHL, which suggests that the right hemisphere plays an important role in tasks with higher comprehension demands. Cognition influences inferential processing during reading in brain-injured subjects.

Despite the well-established relationship between aging and auditory processing decline, identifying the extent to which age effect is the main factor on auditory processing performance remains a great challenge due to the co-occurrence of age-related hearing loss and age-related cognitive decline as potential confounding factors.To investigate the effects of age-related hearing loss and working memory on the clinical evaluation of auditory processing of middle-aged and elderly.Cross-sectional study.A total of 77 adults between 50 and 70 yr of age were invited to participate in the study.The participants were recruited from a larger study that focused on the assessment and management of sensory and cognitive skills in elderly participants. Only participants with normal hearing or mild-to-moderate age-related hearing loss, with no evidence of cognitive, psychological, or neurological conditions were included. Speech-in-noise, dichotic digit, and frequency pattern tests were conducted as well as a working memory test. The hearing loss effect was investigated using an audibility index, calculated from the audiometric threshold. The performance on the digit span test was used to investigate working memory effects. Both hearing loss and working memory effects were investigated via correlation and regression analyses, partialling out age effects. The significance level was set at p < 0.05.The results demonstrated that, while hearing loss was associated to the speech-in-noise performance, working memory was associated to the frequency pattern and dichotic digit performances. Regression analyses confirmed the relative contribution of hearing loss to the variance in speech-in-noise and working memory test to the variance in frequency pattern and dichotic digit test performance.The performance decline of the elderly in auditory processing tests may be partially attributable to the working memory performance and, consequently, to the cognitive decline exhibited by this population. Mild-to-moderate hearing loss seems to affect performance on specific auditory processing tasks, such as speech in noise, reinforcing the idea that auditory processing disorder in the elderly might also be associated to auditory peripheral deficits.

INTRODUÇÃO: A literatura mostra que sujeitos com lesão cerebral à direita apresentam alteração na realização de inferências. Porém, pesquisas mais recentes com neuroimagem demonstram co-ativação dos hemisférios durante o processamento inferencial, nos indivíduos saudáveis. Estudos comparativos sobre os efeitos das lesões no hemisfério direito e hemisfério esquerdo em tarefas de compreensão de inferências durante a leitura são escassos. Os objetivos deste estudo foram: (1) Comparar o desempenho de pacientes com lesão de hemisfério esquerdo (LHE), lesão de hemisfério direito (LHD) e sujeitos cognitivamente saudáveis (GC) na tarefa de compreensão de inferências escritas; (2) Analisar a correlação entre as funções cognitivas e o desempenho no teste de compreensão de inferências escritas e (3) Analisar a influência da idade, escolaridade e local de lesão na mesma tarefa. MÉTODOS: A amostra foi composta por 75 sujeitos divididos em três grupos: 25 indivíduos com LHE, 25 indivíduos com LHD e 25 sujeitos para grupo-controle (GC). Os indivíduos foram avaliados por meio do instrumento \"Gerenciamento do Implícito\", designado para avaliar a compreensão de inferências durante a leitura. O teste é constituído por 20 textos curtos, demonstrando cenário de um fato ou situação-problema. Os pacientes responderam a questões que demandam diferentes tipos de raciocínio inferencial, sendo: explícitas (não exigem raciocínio inferencial propriamente dito), lógicas (exigem raciocínio lógico e processos de dedução), pragmáticas (exigem induções a partir de conhecimentos comuns e contextualização), distratoras (a informação solicitada não está contida no texto) e \"outras\" (requerem gerenciamento concomitante das operações lógicas e pragmáticas). Para avaliação cognitiva e posterior correlação com o teste de compreensão de inferências, foi utilizado o Cognitive Linguistic Quick Test (CLQT), que verifica os domínios: atenção, memória, funções executivas, linguagem e habilidades visuoespaciais. RESULTADOS: Em relação ao desempenho no teste de compreensão de inferências, os três grupos se diferenciaram nas questões lógicas, pragmáticas, \"outras\" e nas pontuações totais, sendo que o grupo LHD apresentou pior desempenho que o grupo LHE, e ambos tiveram piores escores que o GC. Os grupos LHD e LHE não se diferenciaram nas questões explícitas e distratoras, porém tiveram desempenho inferior em relação ao GC. Quanto às correlações com o CLQT, na análise geral da amostra, todos os domínios cognitivos foram relacionados com todos os tipos de questões do teste de compreensão de inferências, especialmente as questões lógicas, pragmáticas, \"outras\" e pontuação total. Na análise por grupos, houve influência da atenção para os três grupos, as habilidades visuoespaciais afetaram os escores dos grupos LHE e LHD, a memória e as funções executivas influenciaram o desempenho do grupo LHD e a linguagem afetou o desempenho do grupo LHE. Apenas a escolaridade influenciou o desempenho da amostra como um todo. CONCLUSÕES: Os resultados demonstram que há certa dissociação dos hemisférios no processamento inferencial e que lesões em ambos os hemisférios podem acarretar dificuldades na realização das inferências durante a leitura. Porém, pacientes com LHD apresentam dificuldades no processamento de inferências mais complexas, o que nos leva à interpretação da contribuição deste hemisfério em tarefas de maior demanda cognitiva. A capacidade de compreensão de inferências está correlacionada com todas as habilidades cognitivas e a escolaridade afeta o desempenho da amostra como um todo INTRODUCTION: Literature shows that subjects with right brain damage present inference difficulties. However, more recent neuroimaging research demonstrates co-activation of hemispheres during inferential processing in healthy individuals. Comparative studies on the effects of right- and left-hemisphere lesions on tasks of reading comprehension of inferences are scarce. The objectives of this study were: (1) To compare the performance of patients with left hemisphere lesion (LHL), right hemisphere lesion (RHL) and healthy subjects in a task of reading comprehension of inferences; (2) To analyze the correlation between cognitive functions and performance on this inference comprehension test; and (3) To analyze the influence of age, education and local of lesion on the same task. METHODS: The sample consisted of 75 subjects divided into three groups: 25 subjects with LHL, 25 subjects with RHL and 25 control subjects (CG). Individuals were assessed using the \"Implicit Management\" test, designed to evaluate comprehension of inferences during reading. The test consists of 20 small texts, demonstrating a scenario of a fact or a problem situation. Patients answered questions that demand different types of inferential reasoning: explicit (not requiring inferential reasoning per se), logical (requiring logical reasoning and deduction processes), pragmatic (requiring inductions from common knowledge and contextualization), distracting (the requested information is not contained in the text) and \"other\" (requiring concomitant management of logical and pragmatic operations). The Cognitive Linguistic Quick Test (CLQT) was used for cognitive evaluation and correlation with the inference comprehension test. The CLQT assesses the domains of attention, memory, executive functions, language, and visuospatial abilities. RESULTS: Regarding performance in the inference comprehension test, the three groups differed in the logical, pragmatic, \"other\" questions, and in the total scores. The RHL group performed worse than the LHL group, and both had worse scores than the CG. The RHL and LHL groups did not differ in explicit and distracting questions, but they had lower performances when compared to the CG. In the overall analysis of the sample, all cognitive domains of the CLQT were related to all types of questions in the inference comprehension test, especially logical, pragmatic, \"other\" questions, and total score. In the group analysis, in the LHD group, memory was correlated with performance in logical questions; attention, memory, executive functions and visuospatial skills were correlated with performance in \"other\" questions. In the LHE group, attention and visuospatial skills were more related to pragmatic questions. Only education influenced the performance of the sample as a whole. CONCLUSIONS: Results showed a certain dissociation between hemispheres in inferential processing, and that lesions in both hemispheres may lead to difficulties in inference making during reading. However, patients with RLH presented difficulties in processing more complex inferences, which suggests the contribution of this hemisphere in tasks with greater cognitive demand. The ability to comprehend inferences was correlated with all cognitive abilities, and education affected the performance of the whole sample on the inference comprehension test

Background: Agrammatism is one of the most frequent manifestations in aphasia that can appear both in oral and written language. It is conceptualized as a syntactic deficit, characterized by the om...

Agrammatism is characterized by morphosyntactic deficits in production of sentences. Studies dealing with the treatment of these deficits are scarce and their results controversial. The present study describes the rehabilitation of a case diagnosed as chronic Broca's aphasia, with agrammatism, using a method directed to sentence structural deficits. The method aims to expand the grammatical repertoire by training production of sentences with support from contexts that stimulate actions and dialogues. The patient showed positive results on all types of sentences trained and generalized the gains to spontaneous speech. However, these benefits were not sustained in the long term.

Language and communication difficulties may occur in the elderly population. This is the case of the tip-of-the-tongue phenomenon and receptive and auditory comprehension difficulties. Few studies have focused on examining the effects of social exposure on maintaining communication in the aging process. Objectives: [1] To describe the communication map of healthy elderly subjects; [2] To search for associations between frequency and time dedicated to communication and cognitive and sociodemographic factors. Methods: Healthy elderly subjects were submitted to cognitive screening, the Token Test - Revised, and the Verbal Fluency test, and answered the ASHA-FACS and the Circles of Communication Partners questionnaires. Results: 55 subjects, 67% female, with ages over 60 years and varied schooling were included in the sample. Interlocutors in the circle of close friends and acquaintances predominated in the communication map, although the time devoted to communication with these partners was lower than in other circles. Overall, the elderly reported no deficits in language comprehension, with some reports of the tip-of-the-tongue phenomenon. Poor performances on the Token Test - Revised and in phonemic verbal fluency along with reports of communication functionality indicated that these subjects compensate for their problems. Conclusion: Older subjects with lower schooling tended to predominantly communicate within the family circle. Within other circles, the number of hours devoted to communication and dialogue partners was not associated with age or schooling. The time devoted to the circle of communication with friends may indicate cognitive difficulties. RESUMO Dificuldades de linguagem e comunicação podem ocorrer na população idosa. Esse é o caso do fenômeno da ponta da língua e também dificuldades de recepção e compreensão auditiva. Poucos estudos se dedicam a examinar efeitos da exposição social na manutenção da comunicação, no processo do envelhecimento. Objetivos: [1] Descrever o mapa de comunicação de idosos saudáveis; [2] Buscar associações entre frequência e tempo destinados à comunicação e fatores cognitivos e sociodemográficos. Métodos: Foram examinados idosos saudáveis que realizaram rastreio cognitivo, Token Test-Revisado, Fluência verbal e responderam aos questionários ASHA-FAcs e Círculos de Interlocutores de Comunicação. Resultados: 55 sujeitos, 67% do gênero feminino, idade acima de 60 anos e escolaridades variadas compuseram a amostra. No mapa de comunicação predominaram interlocutores no círculo de amigos próximos e conhecidos embora o tempo dedicado à comunicação com esses interlocutores seja menor do que nos outros círculos. Na média geral os idosos não relataram déficits de compreensão de linguagem e houve relatos de dificuldades do tipo fenômeno de ponta de língua. Baixos desempenhos no TT-R e na fluência verbal fonêmica ao lado do relato de funcionalidade na comunicação indica que esses sujeitos compensam seus problemas. Conclusão: O número de horas de interlocução e de interlocutores não está associado à idade e escolaridade, exceto para indivíduos com maior idade e menor escolaridade os quais tendem a privilegiar a interlocução em seu círculo familiar. O tempo dedicado ao círculo de comunicação com amigos pode sinalizar dificuldades de natureza cognitiva.

Purpose To analyze the effect of education on sentence listening comprehension on cognitively healthy elderly. Methods A total of 111 healthy elderly, aged 60-80 years of both genders were divided into two groups according to educational level: low education (0-8 years of formal education) and high education (≥9 years of formal education). The participants were assessed using the Revised Token Test, an instrument that supports the evaluation of auditory comprehension of orders with different working memory and syntactic complexity demands. The indicators used for performance analysis were the number of correct responses (accuracy analysis) and task execution time (temporal analysis) in the different blocks. Results The low educated group had a lower number of correct responses than the high educated group on all blocks of the test. In the temporal analysis, participants with low education had longer execution time for commands on the first four blocks related to working memory. However, the two groups had similar execution time for blocks more related to syntactic comprehension. Conclusion Education influenced sentence listening comprehension on elderly. Temporal analysis allowed to infer over the relationship between comprehension and other cognitive abilities, and to observe that the low educated elderly did not use effective compensation strategies to improve their performances on the task. Therefore, low educational level, associated with aging, may potentialize the risks for language decline.

Research has demonstrated that a higher level of education is associated with better performance on cognitive tests among middle-aged and elderly people. However, the effects of education on auditory processing skills have not yet been evaluated. Previous demonstrations of sensory-cognitive interactions in the aging process indicate the potential importance of this topic. Therefore, the primary purpose of this study was to investigate the performance of middle-aged and elderly people with different levels of formal education on auditory processing tests. A total of 177 adults with no evidence of cognitive, psychological or neurological conditions took part in the research. The participants completed a series of auditory assessments, including dichotic digit, frequency pattern and speech-in-noise tests. A working memory test was also performed to investigate the extent to which auditory processing and cognitive performance were associated. The results demonstrated positive but weak correlations between years of schooling and performance on all of the tests applied. The factor “years of schooling” was also one of the best predictors of frequency pattern and speech-in-noise test performance. Additionally, performance on the working memory, frequency pattern and dichotic digit tests was also correlated, suggesting that the influence of educational level on auditory processing performance might be associated with the cognitive demand of the auditory processing tests rather than auditory sensory aspects itself. Longitudinal research is required to investigate the causal relationship between educational level and auditory processing skills.

Objectives. To analyze the effect of aging on sentence auditory comprehension and to study the relationship between this language skill and cognitive functions (attention, working memory, and executive functions).Methods. A total of 90 healthy subjects were divided into three groups: adults (50–59 years), young-old (60–69 years), and old-old (70–80 years). Subjects were assessed using the Revised Token Test. The measures used for performance analysis were number of correct answers (accuracy) and execution time of commands on the different subtests.Results. Regarding accuracy, groups showed similar performance on the first blocks, but the young-old and old-old performed worse than adults on blocks 9 and 10. With respect to execution time, groups differed from block 2 (i.e., the groups differed for all blocks, except for block 1), with the worst performance observed in the old-old group, followed by that of the young-old group. Therefore, the elderly required more time to attain performance similar to that of adults, showing that time measurements are more sensitive for detecting the effects of age. Sentence comprehension ability is correlated with cognitive test performance, especially for global cognition and working memory tests.Conclusions. Healthy aging is characterized by the ability to compensate for difficulties in linguistic processing, which allows the elderly to maintain functional communication.

Purpose:To determine the effect of age and education on inferential comprehension from written texts in normal individuals.Methods:A total of 224 normal adults were stratified into nine groups according to age (young: 18–39 years, adults: 40–59 years, and elderly: 60–79 years) and educational level (low ≤4 years, medium: 5–8 years and high >8 years) and were evaluated through the battery La gestion de l'implicite (Implicit Information Management Test) to determine the ability to make inferences through different types of questions: explicit, logical, distractor, pragmatic and others.Results:The elderly showed worse performance for total score and distractor questions. Regarding educational level, all groups differed on explicit, logical, distractor questions, and on total test score. Subjects with high schooling performed better on pragmatic inferences and others.Conclusion:Age influence on the comprehension of inferences may be due to difficulties in attention and executive functions. The strong effect of education can be explained by the interaction of inferential abilities with other cognitive functions such as working memory, vocabulary span, as well as world knowledge. Objetivo:Verificar o efeito da idade e escolaridade na compreensão de inferências a partir de textos escritos em indivíduos normais.Métodos:224 adultos foram divididos em nove grupos, de acordo com a idade (jovens: 18–39 anos, adultos: 40–59 anos e idosos: 60–79 anos) e escolaridade (baixa ≤4 anos, média: 5–8 anos e alta >8 anos) e avaliados por meio da bateria La gestion de l'implicite (Teste de Gerenciamento do Implícito) para determinar a habilidade de compreender inferências, através de diferentes tipos de questões: explícitas, lógicas, distratoras, pragmáticas e outras.Resultados:Os idosos apresentaram pior desempenho na pontuação total do teste e nas questões distratoras. Quanto à escolaridade, todos os grupos se diferenciaram nas questões explícitas, lógicas, distratoras e na pontuação total do teste. Os sujeitos com alta escolaridade apresentaram melhor desempenho nas inferências pragmáticas e outras.Conclusão:A influência da idade na compreensão de inferências pode estar relacionada a dificuldades atencionais e de funções executivas. O forte efeito da escolaridade deve-se à interação da habilidade inferencial com diversas funções cognitivas, como linguagem e memória operacional, além de conhecimento de mundo.

INTRODUÇÃO: A compreensão de textos é um processo complexo que depende de diversas habilidades, dentre elas a realização de inferências. As inferências consistem em representações mentais que o leitor constrói na compreensão de um texto, a partir da aplicação de seus próprios conhecimentos somados às informações da mensagem, possibilitando estabelecer relações e associações para a compreensão de uma informação implícita. OBJETIVOS: Obter normas de referência em relação ao desempenho de indivíduos brasileiros, jovens, adultos jovens e idosos na habilidade de compreensão textual escrita e realização de inferências e verificar o efeito da idade, escolaridade e tipo de inferência nesta habilidade. MÉTODOS: Foram avaliados 224 indivíduos adultos normais, divididos em nove grupos de acordo com a idade (jovens (J)=18 a 39 anos, adultos jovens (A)=40 a 59 anos e idosos (I)=60 a 79 anos) e escolaridade (baixa (Be)=menos de 4 anos, média (Me)=5 a 8 anos e alta (Ae)=acima de 8 anos). Os sujeitos foram avaliados através do instrumento francês \"Teste de Gerenciamento do Implícito\", traduzido e adaptado do francês para o português brasileiro e utilizado para verificar a habilidade de realizar inferências em atividades de compreensão escrita. O teste demanda a realização de diferentes tipos de inferências (explícitas, lógicas, distratoras, pragmáticas e outras). RESULTADOS: Os valores médios obtidos pelos grupos na pontuação geral (60 itens) foram: JBe - 34,2 (7,2); JMe - 40 (8,6); JAe - 52 (4); ABe - 38,9 (7,5); AMe - 44,7 (5,1); AAe - 48,6 (5,8); IBe - 35,1 (7); IMe - 41 (8,8); IAe - 47,5 (5,6). CONCLUSÕES: O grupo de idosos apresentou pior desempenho que os adultos na pontuação total do teste (p=0,025) e nas inferências distratoras (p=0,025). Quanto à escolaridade, todos os grupos se diferenciaram nas questões explícitas, lógicas, distratoras e na pontuação total do teste (p

Introdução: Acidente Vascular Cerebral em crianças e adolescentes são eventos considerados raros, de etiologia variada, que tem como consequência sequelas funcionais (motoras, cognitivas e de linguagem), impactando a qualidade de vida. Por este motivo descrever os resultados obtidos em avaliação eletrofisiológica e comportamental do Processamento Auditivo são de grande valia, para entendermos as alterações que possam estar presentes, para posteriormente ajudar na reabilitação dessa população. Objetivo: descrever e analisar os resultados obtidos na avaliação eletrofisiológica e comportamental do processamento auditivo em crianças e adolescentes com diagnostico de AVC e compara-las a sujeitos com desenvolvimento típico de mesma faixa etária. Método: estudo transversal, observacional e comparativo. Participaram 21 crianças e adolescentes com diagnóstico de AVC com idade entre 7 e 17 anos e 11 meses (Grupo Estudo) e 42 crianças e adolescentes com desenvolvimento representativos de normalidade (Grupo Controle), com mesma faixa etária do Grupo Estudo. Além da história clínica e anamnese, foram realizadas: avaliação audiológica periférica básica, avaliação comportamental do PAC (Dicótico de dígitos - DD, Pitch pattern Sequence - PPS) e avaliação eletrofisiológica, por meio dos testes: PEATE, para verificar a sincronia neural e P300. Resultados: Os sujeitos do GE foram divididos em tipo de AVC (isquêmico e hemorrágico), sendo que do tipo Isquêmico 22 (92%) e hemorrágico 2 (8%), quanto ao as distribuições do sítio da lesão, podemos observar que sua maioria 15 (63%), foi no Hemisfério Temporal Esquerdo, 6 (25%), no Hemisfério Direito. Nota-se que os dois casos de AVC Hemorrágico da amostra foram no Hemisfério Direito, e 2 (8%) em Região cerebelar e apenas 1 (4%) foi classificado como outros (região talâmica). O GE apresentou pior desempenho em todos os testes aplicados ao compará-los aos seus controles. Para o teste DD observamos que o pior desempenho tanto para integração, quanto para separação foi do lado Direito. Para o teste PPS, observamos uma maior porcentagem de acertos no grupo controle em comparação ao grupo estudo, tanto na modalidade \'nomeação\' quanto \'murmúrio\', sendo essa diferença estatisticamente significante. O P300 no GE apresentou-se com latências aumentadas significativamente em relação ao GC. Conclusão: os resultados do P300, juntamente com os achados nos testes comportamentais do Processamento Auditivo Central: Dicótico de Dígitos e Padrão de Frequência, sugerem que as lesões cerebrais, podem levar a comprometimento estrutural ou funcional de regiões subcorticais e, portanto, resultar em déficits no processamento auditivo Introduction: Stroke in children and adolescents are events considered to be rare, of varying etiology, which result in functional sequelae (motor, cognitive and of language), impacting quality of life. For this reason, describing the results obtained in electrophysiological and behavioral assessment of Auditory Processing are of great value, in order to understand the changes that may be present, to later help in the rehabilitation of this population. Objective: Describe and analyze the results obtained in the electrophysiological and behavioral assessment of auditory processing in children and adolescents with a diagnosis of stroke and to compare them with representative subjects of the same age group. Method: cross-sectional, observational and comparative study of 21 children and adolescents diagnosed with stroke aged between 7 and 17 years and 11 months (Study Group) and 42 children and adolescents with normal development (Control Group), with the same age group as the Study Group. In addition to the clinical history and anamnesis, the following procedures were performed: basic peripheral audiological evaluation, behavioral evaluation of the PAC (Dichotic digits - DD, Pitch pattern Sequence - PPS) and electrophysiological evaluation, using the tests: BAEP, to check the neural synchrony and P300. Results: The subjects of the EG were divided into types of stroke (ischemic and hemorrhagic). The Ischemic type, 22 (92%), and Hemorrhagic type, 2 (8%). Regarding the distributions of the lesion site, we can observe that most of it, 15 (63%), was in the Left Temporal Hemisphere, and 6 (25%), in the Right Hemisphere. Note that the two cases of Hemorrhagic Stroke in the sample were in the Right Hemisphere, 2 (8%) in the cerebellar region, and only 1 (4%) was classified as others (thalamic region). GE performed worse in all tests applied when comparing them to its controls. For the DD test, we observed that the worst performance for both integration and separation was on the right side. For the PPS test, we observed a higher percentage of correct answers in the control group compared to the study group, both in the \'nomination\' and \'murmur\' modality, a difference that is statistically significant. The P300 in the GE was presented with significantly increased latencies to the GC. Conclusion: the P300 results, along with the findings in the behavioral tests of the Central Auditory Processing: Dichotic Digits and Frequency Pattern, suggest that brain injuries can lead to structural or functional impairment of subcortical regions and, therefore, result in deficits in auditory processing

Orientadora: Profa. Dra. Maria Teresa Carthery Goulart Coorientador: Prof. Dr. André Mascioli Cravo Tese (doutorado ) - Universidade Federal do ABC, Programa de Pós Graduação em Neurociência e Cognição. São Bernardo do Campo, 2020 Entender como processamos e recuperamos o significado do que ouvimos ou lemos é uma das questões fundamentais no campo da Neurociência da Linguagem. No entanto, até o momento, a maioria dos estudos que investigam esses processos tem focado no processamento de substantivos. Esses estudos têm demonstrado que níveis de processamento como pré-léxico, léxico e semântico ocorrem em cascata com alguma sobreposição entre eles. No entanto, as dimensões dos verbos que podem afetar seu processamento ainda são amplamente desconhecidas. O presente projeto, portanto, visa verificar: (1) quais são as variáveis psicolinguísticas que influenciam o reconhecimento visual dos verbos brasileiro-portugueses e que são relevantes para o processamento semântico (2) como essas variáveis modulam a resposta eletrofisiológica durante uma tarefa de decisão léxica. No primeiro estudo, 480 verbos foram analisados segundo categorias semânticas e julgados por 160 estudantes de graduação para obter parâmetros psicolinguísticos dos verbos brasileiro-portugueses. Foram selecionados e avaliados 300 verbos para compor o segundo estudo, que se concentrou na compreensão dos efeitos das variáveis semânticas e sintáticas no processamento de verbos por meio de uma Decisão Léxica (LDT). Vinte e um estudantes entre 18 e 35 anos participaram nesta fase, todos destros, estudantes de pós-graduação ou de graduação. Para projetar a tarefa de decisão léxica, foi necessário criar 300 pseudoverbs. A atividade eletrofisiológica foi registrada durante a tarefa comportamental. Foram investigados componentes de SAN e P600. Além dos componentes ERP, na decisão léxica, também foi investigada a faixa de frequência beta. Como resultados, o primeiro estudo constatou que nossa amostra de verbos em português brasileiro foi semanticamente caracterizada por três componentes: uma que contenha variáveis aterradas, que estejam relacionadas a ações percebidas e realizadas no mundo real, e uma que compoa uma rede semântica abstrata, e o componente final correlacionado à frequência subjetiva. No segundo estudo, o LDT encontrou uma coocorrência de dois componentes na mesma janela: SAN e P600. Esses resultados apontaram para a memória de trabalho e a previsão de próximas palavras. A frequência beta mostrou uma diferença significativa entre verbos e pseudoverbos, sugerindo que o sistema nervoso central estaria se preparando para mudar de estado. O presente estudo sugere que pode haver processos automáticos e controlados recrutados dependendo da demanda cognitiva. Assim, esses resultados corroboram com um caminho do meio entre três grandes teorias do processamento dos verbos, ligando características semânticas e sintáticas na leitura dos verbos. Understanding how we process and recover the meaning of what we hear or read is one of the fundamental questions in the field of Neuroscience of Language. However, to date, most studies investigating these processes have focused on noun processing. These studies have shown that levels of processing such as pre-lexical, lexical and semantic occur in cascade with some overlap between them. However, the dimensions of verbs that may affect their processing are still largely unknown. The present project, thus, aims at verifying: (1) which are the psycholinguistic variables that influence the visual recognition of Brazilian-Portuguese verbs and that are relevant for semantic processing (2) how these variables modulate the electrophysiological response during a task of lexical decision. In the first study, 480 verbs were analyzed according to semantic categories and judged by 160 undergraduate students to obtain psycholinguistic parameters of Brazilian-Portuguese verbs. Three hundred verbs were selected and evaluated to compose the second study, that focused on the understanding of the effects of semantic and syntactic variables in verbs processing through a Lexical Decision (LDT). Twentyone students between 18 and 35 years participated at this phase, all right-handed and graduate or undergraduate university students. To design the lexicaldecision task, it was necessary to create 300 pseudoverbs. Electrophysiological activity was recorded during the behavioral task. SAN and P600 components were investigated. Besides ERP components, at the lexical decision, the beta frequency band was also investigated. As results, the first study found that our sample of Brazilian-Portuguese verbs were semantically characterized by three components: one that contains grounded variables, that are related to actions perceived and performed in the real-world , and one that comprises an abstract semantic network, and the final component correlated to subjective frequency. In the second study, LDT found a co-occurrence of two components at the same time window: SAN and P600. These results pointed to working memory and the prediction of forthcoming words. The beta frequency showed a significant difference between verbs and pseudoverbs, suggesting that the central nervous system would be preparing to change state. The present study suggests that there might have both an automatic and controlled processes recruited depending on the cognitive demand. Thus, these results corroborate with a middle path between three major theories of verbs¿ processing, linking semantic and syntactic features in verbs¿ reading.

INTRODUÇÃO: A demência ou comprometimento cognitivo avançado é um problema frequente e cada vez mais prevalente na população idosa. A maioria dos pacientes com demência desenvolve disfagia especialmente na fase avançada da doença e tem alto risco de morte por pneumonia aspirativa. Inúmeras são as discussões a respeito da funcionalidade dos idosos com quadros demenciais; todavia, a deglutição não faz parte das escalas de funcionalidade. Além disso, a avaliação da comunicação, segue critérios equivocados, como \"quantidade de palavras emitidas por dia\". OBJETIVOS: Traçar o perfil das dificuldades de deglutição e comunicação em pacientes com comprometimento cognitivo avançado, identificar indicadores de disfagia e distúrbios da comunicação que se associem com a classificação da funcionalidade global da escala FAST e propor a inclusão de parâmetros de disfagia e funcionalidade da comunicação na escala FAST. MÉTODOS: Foram coletados dados de 107 pacientes no banco de dados do Ambulatório de Comprometimento Cognitivo Avançado (ACCA) do Serviço de Geriatria do HCFMUSP. Foram realizadas análises descritivas dos perfis de funcionalidade e correlações entre funcionalidade global, da deglutição e da comunicação dos sujeitos. RESULTADOS: 67% da amostra era do sexo feminino, com idade média de 83 anos, destros, com 4 anos de escolaridade média. Quanto ao diagnóstico, 34% da amostra foi diagnóticada com DA, 32% com demência mista (DA e DV), 21% com DV e 13% com demências menos frequentes. Em relação ao estadiamento da demência, a maioria dos sujeitos foi classificada com CDR 3 e MEEM-g 9, que corresponde a demência grave. Em média, os pacientes apresentaram cinco ou mais comorbidades associadas à demência, além de sintomas neuropsiquiátricos e neuropsicológicos. Quanto à avaliação fonoaudiológica estrutural dos órgãos fonoarticulatórios, 100% apresentou alteração nos mecanismos de contenção oral e 77% apresentou alteração de proteção das vias aéreas. Em relação a funcionalidade da deglutição, 92% da amostra pode receber dieta por via oral de forma segura, desde que observadas restrições e adaptações na dieta, além de estratégias compensatórias. Quanto à funcionalidade da comunicação, 38% não utilizaram linguagem funcional; 48% apresentaram expressão oral fragmentada com necessidade de o ouvinte/cuidador assumir a responsabilidade pela comunicação; em 14% a responsabilidade da comunicação foi compartilhada com o ouvinte. CONCLUSÃO: Foram traçadas as características do perfil, das alterações de deglutição e de comunicação dos sujeitos com comprometimento cognitivo avançado. Todavia, ainda que os perfis de deglutição e comunicação declinem conforme a funcionalidade global, na população estudada, não foi possível identificar associação entre o nível da FAST e a gravidade da disfagia ou da comunicação. O estudo contribuiu com dados sobre a funcionalidade da deglutição e da comunicação dos sujeitos com comprometimento cognitivo avançado, desconsiderados pelas tradicionais escalas de funcionalidade INTRODUCTION: Dementia with advanced cognitive impairment is a frequent and increasingly prevalent problem in the elderly population. Most patients with dementia develop dysphagia especially at an advanced stage of the disease and are at high risk of death from aspiration pneumonia. There are many discussions about the functionality of elderly people with dementia; however, swallowing is not part of the functionality scales. Furthermore, the evaluation of communication follows misguided criteria as quantities of words per day. OBJECTIVES: To outline the difficulties of swallowing and communication in patients with advanced cognitive impairment and to identify indicators of dysphagia and communication disorders associated with the classification of the global functionality of the FAST scale and propose the inclusion of dysphagia parameters and communication functionality in the FAST scale. METHODS: Data from 107 patients were collected from the Advanced Cognitive Compromising Ambulatory (ACCA) database of the Geriatric Service of the HCFMUSP from January to December 2016. Descriptive analyzes of functional profiles and correlations between global functionality of swallowing and the communication of the subjects. RESULTS: 67% of the sample was female, with a mean age of 83 years, right-handed, with 4 years of average schooling. Regarding the diagnosis, 34% was diagnosed with AD, 32% with mixed dementia (AD and DV), 21% with DV and 13% with less frequent dementias. Regarding staging of dementia, the majority of subjects were classified as CDR 3 and MMSE-g 9, which corresponds to severe dementia. On average, patients had five or more comorbidities associated with dementia, as well as neuropsychiatric and neuropsychological symptoms. Regarding the structural speech-language evaluation of the speech-language organs, 100% of the sample presented alterations in oral containment mechanisms and 77% presented alterations in airway protection. Regarding swallowing functionality, 92% of the sample can receive oral diet safely, provided dietary restrictions and adaptations are observed, as well as compensatory strategies.Regarding communication functionality, 38% did not use functional language; 48% have fragmented oral expression and the listener / caretaker assumes responsibility for communication; 14% the responsibility for communication was balanced with the listener. CONCLUSION: Characteristics of the subjects\' profile, the swallowing and communication changes of the subjects with advanced cognitive impairment were drawn. However, although the swallowing and communication profiles declined according to the global functionality, in this population it was not possible to identify an association between the global functional level of FAST and the severity of dysphagia and communication. The study contributed data on the functionality of swallowing and communication of subjects with advanced cognitive impairment, neglected by traditional scales of functionality