EXIT25 - Executive interview applied to a cognitively healthy elderly population with heterogeneous educational background

Matioli, Maria Niures P.S.; Caramelli, Paulo; Marques, Bárbara D.; Rocha, Fernanda D. da; Castro, Maria Cristina C. de; Yamashita, Samia R.; Soares, Alberto de M.

doi:10.1590/S1980-57642009DN20400013

Abstract

Education interferes with the performance in most cognitive tests, including executive function assessment. Objective: To investigate the effects of education on the performance of healthy elderly on the Brazilian version of the Executive Interview (EXIT25). Methods: The EXIT25 was administered to a sample of 83 healthy elderly. The subjects were also submitted to the Mini-Mental State Examination (MMSE), a delayed recall test, clock drawing and category fluency (animals/min) tests in order to rule out cognitive impairment. The Geriatric Depression Scale (GDS) was employed to exclude clinically-relevant depressive symptoms. The total sample was divided into three groups according to educational level: G1 (1-4 years), G2 (5-8 years) and G3 (>8 years). Results: The mean values for age, educational level, MMSE and EXIT25 scores of all subjects were 72.2, 7.5, 27.6 and 6.9, respectively. The scores on the EXIT25 for each group were: G1=8.3, G2=5.9 and G3=5.8. There was a statistical difference between the performance of G1 and the other two groups on the EXIT25. Conclusions: The Brazilian version of the EXIT25 proved straightforward to administer. The performance of this sample of healthy elderly on the test was significantly influenced by educational level.

Key words:
EXIT25; executive functions; aging; education; cognitive tests.

Resumo

O nível educacional interfere no desempenho da maioria dos testes cognitivos incluindo os de função executiva. Objetivo: Investigar os efeitos da educação no desempenho de idosos saudáveis na versão brasileira do teste de funções executivas (EXIT25). Métodos: O EXIT25 foi administrado a uma amostra de 83 idosos saudáveis. Os indivíduos foram também submetidos ao Mini-Exame de Estado Mental (MEEM), a um teste de evocação, ao desenho do relógio e ao teste de fluência de categorias (animais/min) com a função de excluir prejuízos cognitivos. A Escala de Depressão Geriátrica foi aplicada para excluir sintomas de depressão clinicamente relevante. O total da amostra foi dividido em três grupos de acordo com o nível educacional: G1 (1-4 anos), G2 (5-8 anos) e G3 (>8 anos). Resultados: As médias de idade, nível educacional, MEEM e EXIT25 de todos os indivíduos foram respectivamente de 72,2; 7,5; 27,6 e 6,9. Os valores do EXIT25 para cada grupo foram: G1=8,3; G2=5,9 e G3=5,8. Houve diferença estatística entre o desempenho de G1 e os outros dois grupos no EXIT25. Conclusões: A versão brasileira do EXIT25 provou ser de fácil administração. O desempenho da amostra de idosos examinada foi significativamente influenciada pelo nível educacional.

Palavras-chave:
EXIT25; funções executivas; envelhecimento; testes cognitivos.

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References

¹
American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition. Washington,DC: American Psychiatric Association; 1994.
²
Royall, DR, Mahurin RK, Gray KF. Bedside Assessment of Executive Cognitive Impairment: The Executive Interview. JAGS 1992;40:1221-1226.
³
Shallice T. Specific impairment of planning. Philos Trans R Soc Lond B Biol Sci 1982;298:199-209.
⁴
Royall DR, Lauterbach EC, Cummings JL, et al. Executive control function: a review of its promise and challenges for clinical research: a report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatric Clin Neurosci 2002;14:377-405.
⁵
Schillerstrom JE, Horton MS, Royall DR. The Impact of Medical Illness on Executive Function. Psychosomatics 2005;46:508-516.
⁶
Cummings JL. Frontal-subcortical circuits and human behavior. Arch Neurol 1993;50:873-880.
⁷
Backman L, Robins-Wahlin TB, Lundin A, Ginovart N, Farde L. Cognitive deficits in Huntington's disease are predicted by dopaminergic PET markers and brain volumes. Brain 1997;120:2207-2217.
⁸
Nestadt G, McHugh P. The frequency and specificity of some negative symptoms In: Huber PG (editor). Proceedings of the 6th Schizophrenia Symposium of the University Psychiatry Clinic of Bonn Stuttgart. New York: Schattaner;1984: 183-190
⁹
Stuss DT, Benson DF. Neuropsychological studies of the frontal lobes. Psychol Bull 1984; 95:3-28.
¹⁰
Román GC. Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention. Med Clin North America 2002;86:477-499.
¹¹
Royall DR. Not all clock-drawing tasks are the same. J Am Geriatr Soc 2002;50:116-117.
¹²
Royall DR, Palmer R, Chiodo LK, Polk MJ. Executive Control Mediates Memory's Association with Change in Instrumental Activities of Daily Living: The Freedom House Study. JAGS 2005; 53:11-17.
¹³
Royall DR, Palmer R, Chiodo LK, Polk MJ. Declining Executive Control in Normal Aging Predicts Change in Functional Status: The Freedom House Study. JAGS 2004;52:346-352.
¹⁴
Royall DR, Chiodo LK, Polk MJ. An Empiric Approach to Level of Care Determinations: The Importance of Executive Measures. J Gerontol A Biol Sci Med Sci 2005;60:1059-1064.
¹⁵
Matioli MNPS. Estudo Comparativo do Desempenho em Testes Neuropsicológicos de Pacientes com Diagnóstico de Doença de Alzheimer e Demência Vascular. Dissertação de Mestrado. Faculdade de Medicina da Universidade de São Paulo, 2005.
¹⁶
Stoppe Júnior A, Jacob Filho W, Louzã Neto, MR. Avaliação de depressão em idosos através da Escala de Depressão em Geriatria: resultados preliminares. Rev. ABP-APAL 1994;16:149-53.
¹⁷
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁸
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o Uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:771-81.
¹⁹
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.
²⁰
Nitrini R, Caramelli P, Herrera Junior E, et al. Performance of illiterate and literate elderly subjects in two tests of long-term-memory. J Int Neuropsychol Soc 2004;10:634-638.
²¹
Sunderland T, Hill J, Mellow A, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Soc Geriatr 1989;37:725-729.
²²
Goodglass H, Kaplan E. Boston Diagnostic Aphasia Examination. Philadelphia: Lea & Febiger; 1983.
²³
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de Doença de Alzheimer no Brasil: Avaliação cognitiva e funcional. Arq Neuropsiquiatr 2005;63: 720-727.
²⁴
Moering RG, Schinka JA, Graves AB. Normative data for elderly African Americans for the Stroop Color and Word Test. Arch Clin Neuropsychol 2004;19:61-71.
²⁵
Plumet J, Gil R, Gaonac'h D. Neuropsychological Assessment of Executive Functions in Women: Effects of Age and Education. Neuropsychology 2005;19:566-577
²⁶
Kudiaki C, Aslan A. Executive functions in a Turkish sample: associations with demographic variables and normative data. Appl Neuropsychol 2008;15:194-204.
²⁷
Madureira S, Verdelho A, Ferro J, et al. Development of a Neuropsychological Battery for the Leukoaraiosis and Disability in the Elderly Study (LADIS): Experience and Baseline Data. Neuroepidemiology 2006;27:101-116.
²⁸
Piatt AL, Fields JA, Paolo AM, Tröster AI. Action verbal fluency normative data for the elderly. Brain Lang 2004;89:580-583.
²⁹
Manly JJ, Schupf N, Tang MX, Stern Y. Cognitive decline and literacy among ethnically diverse elders. J Geriatr Psychiatry Neurol 2005;18:213-217.
³⁰
Royall DR, Palmer R, Chiodo LK, Polk MJ. Normal rates of cognitive changes in successful aging: The Freedom House Study. J Int Neuropsychol Soc 2005;11:899-909.
³¹
Hashimoto R, Meguro K, Lee E, Kasai M, Ishii H, Yamachi S. Effect of age and education on Trail Making Test and determination of normative data for Japanese elderly people: the Tajiri Project. Psychiatry Clin Neurosci 2006;60:422-428.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
02 Sept 2008
Accepted
28 Oct 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
American Psychiatric Association Committee on Nomenclature and Statistics. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), Fourth Edition. Washington,DC: American Psychiatric Association; 1994.

[2] ²
Royall, DR, Mahurin RK, Gray KF. Bedside Assessment of Executive Cognitive Impairment: The Executive Interview. JAGS 1992;40:1221-1226.

[3] ³
Shallice T. Specific impairment of planning. Philos Trans R Soc Lond B Biol Sci 1982;298:199-209.

[4] ⁴
Royall DR, Lauterbach EC, Cummings JL, et al. Executive control function: a review of its promise and challenges for clinical research: a report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatric Clin Neurosci 2002;14:377-405.

[5] ⁵
Schillerstrom JE, Horton MS, Royall DR. The Impact of Medical Illness on Executive Function. Psychosomatics 2005;46:508-516.

[6] ⁶
Cummings JL. Frontal-subcortical circuits and human behavior. Arch Neurol 1993;50:873-880.

[7] ⁷
Backman L, Robins-Wahlin TB, Lundin A, Ginovart N, Farde L. Cognitive deficits in Huntington's disease are predicted by dopaminergic PET markers and brain volumes. Brain 1997;120:2207-2217.

[8] ⁸
Nestadt G, McHugh P. The frequency and specificity of some negative symptoms In: Huber PG (editor). Proceedings of the 6th Schizophrenia Symposium of the University Psychiatry Clinic of Bonn Stuttgart. New York: Schattaner;1984: 183-190

[9] ⁹
Stuss DT, Benson DF. Neuropsychological studies of the frontal lobes. Psychol Bull 1984; 95:3-28.

[10] ¹⁰
Román GC. Vascular dementia revisited: diagnosis, pathogenesis, treatment, and prevention. Med Clin North America 2002;86:477-499.

[11] ¹¹
Royall DR. Not all clock-drawing tasks are the same. J Am Geriatr Soc 2002;50:116-117.

[12] ¹²
Royall DR, Palmer R, Chiodo LK, Polk MJ. Executive Control Mediates Memory's Association with Change in Instrumental Activities of Daily Living: The Freedom House Study. JAGS 2005; 53:11-17.

[13] ¹³
Royall DR, Palmer R, Chiodo LK, Polk MJ. Declining Executive Control in Normal Aging Predicts Change in Functional Status: The Freedom House Study. JAGS 2004;52:346-352.

[14] ¹⁴
Royall DR, Chiodo LK, Polk MJ. An Empiric Approach to Level of Care Determinations: The Importance of Executive Measures. J Gerontol A Biol Sci Med Sci 2005;60:1059-1064.

[15] ¹⁵
Matioli MNPS. Estudo Comparativo do Desempenho em Testes Neuropsicológicos de Pacientes com Diagnóstico de Doença de Alzheimer e Demência Vascular. Dissertação de Mestrado. Faculdade de Medicina da Universidade de São Paulo, 2005.

[16] ¹⁶
Stoppe Júnior A, Jacob Filho W, Louzã Neto, MR. Avaliação de depressão em idosos através da Escala de Depressão em Geriatria: resultados preliminares. Rev. ABP-APAL 1994;16:149-53.

[17] ¹⁷
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state": a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[18] ¹⁸
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o Uso do Mini-Exame do Estado Mental no Brasil. Arq Neuropsiquiatr 2003;61:771-81.

[19] ¹⁹
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.

[20] ²⁰
Nitrini R, Caramelli P, Herrera Junior E, et al. Performance of illiterate and literate elderly subjects in two tests of long-term-memory. J Int Neuropsychol Soc 2004;10:634-638.

[21] ²¹
Sunderland T, Hill J, Mellow A, et al. Clock drawing in Alzheimer's disease: a novel measure of dementia severity. J Am Soc Geriatr 1989;37:725-729.

[22] ²²
Goodglass H, Kaplan E. Boston Diagnostic Aphasia Examination. Philadelphia: Lea & Febiger; 1983.

[23] ²³
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de Doença de Alzheimer no Brasil: Avaliação cognitiva e funcional. Arq Neuropsiquiatr 2005;63: 720-727.

[24] ²⁴
Moering RG, Schinka JA, Graves AB. Normative data for elderly African Americans for the Stroop Color and Word Test. Arch Clin Neuropsychol 2004;19:61-71.

[25] ²⁵
Plumet J, Gil R, Gaonac'h D. Neuropsychological Assessment of Executive Functions in Women: Effects of Age and Education. Neuropsychology 2005;19:566-577

[26] ²⁶
Kudiaki C, Aslan A. Executive functions in a Turkish sample: associations with demographic variables and normative data. Appl Neuropsychol 2008;15:194-204.

[27] ²⁷
Madureira S, Verdelho A, Ferro J, et al. Development of a Neuropsychological Battery for the Leukoaraiosis and Disability in the Elderly Study (LADIS): Experience and Baseline Data. Neuroepidemiology 2006;27:101-116.

[28] ²⁸
Piatt AL, Fields JA, Paolo AM, Tröster AI. Action verbal fluency normative data for the elderly. Brain Lang 2004;89:580-583.

[29] ²⁹
Manly JJ, Schupf N, Tang MX, Stern Y. Cognitive decline and literacy among ethnically diverse elders. J Geriatr Psychiatry Neurol 2005;18:213-217.

[30] ³⁰
Royall DR, Palmer R, Chiodo LK, Polk MJ. Normal rates of cognitive changes in successful aging: The Freedom House Study. J Int Neuropsychol Soc 2005;11:899-909.

[31] ³¹
Hashimoto R, Meguro K, Lee E, Kasai M, Ishii H, Yamachi S. Effect of age and education on Trail Making Test and determination of normative data for Japanese elderly people: the Tajiri Project. Psychiatry Clin Neurosci 2006;60:422-428.

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