Performance of elderly on the three words-three shapes test: A Brazilian study

Armentano, Cristiane Garcia da Costa; Quayle, Julieta

doi:10.1590/S1980-57642008DN10400012

Abstract

The three words-three shapes test is a brief bedside technique for assessment of learning and memory using verbal and non-verbal material. To the best of our knowledge, performance of Brazilian elderly on this test has not yet been reported. Objective: To evaluate the performance of normal Brazilian elderly on the three words-three shapes test. Method: A total of 50 adult patients, 25 males and 25 females, with age ranging from 55 to 81 years (66.0±7.10 years), 1 to 8 years of schooling, different economic conditions and living in the São José do Rio Preto municipality, State of São Paulo, were evaluated. Results: There was no statistically significant difference between performance of males and females. Performance on incidental recall was significantly lower than in delayed recall. The performance in the learning phase improved following at least two further presentations of the stimuli. Approximately 50% of the participants did not remember the six stimuli and had to proceed to the recognition stage. The performance in the recognition stage was significantly better than during spontaneous recall. Patients with low educational level (less years of schooling) had poorer performance on the recall of shapes and on the total score of the test. Conclusions: The three words-three shapes test is rapid, efficient and straightforward to apply in the elderly, but low educational level was associated with poorer performance on this test. Normal elderly individuals had greater difficulty in the encoding process and in searching for stored information.

Key words:
memory; three words-three shapes test; elderly; neuropsychological assessment; education

Resumo

O teste três figuras-três palavras é uma técnica simples e adequada para avaliação de aprendizagem e memória verbal e não verbal. Até o presente, estudos sobre o desempenho de idosos brasileiros nesse teste não foram encontrados na literatura. Objetivo: Estudar o desempenho de idosos normais em tarefas de memória e contribuir para obtenção de dados adequados sobre o desempenho desses idosos no teste três figuras-três palavras de Mesulam. Método: Foram avaliados 50 pacientes adultos, sendo 25 do sexo masculino e 25 do feminino, com idade variando entre 55 e 81 anos (66,0±7,1 anos), 1 a 8 anos de escolaridade, diferentes situações econômicas e residentes no município de São José do Rio Preto, Estado de São Paulo. Resultados: Não foi encontrada diferença estatisticamente significativa entre o desempenho de homens e mulheres. O desempenho da memória incidental foi significativamente menor comparado ao desempenho obtido na etapa de evocação tardia. Idosos normais obtiveram melhora de desempenho com pelo menos duas novas apresentações ao estímulo. Indivíduos com menos tempo de instrução obtiveram desempenho inferior ao evocar figuras e no escore total do teste. Cerca de 50% dos participantes necessitaram realizar a etapa de reconhecimento. Conclusões: O teste três figuras-três palavras foi rápido, eficaz e de fácil aplicação para idosos. A escolaridade influenciou diretamente no desempenho do teste. Idosos normais tiveram maior dificuldade na codificação e busca da informação armazenada.

Palavras-chave:
memória; idosos; avaliação neuropsicológica

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References

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Elias MF, Beiser A, Wolf PA, Au R, White RF, D'Agostino RB. The preclinical phase of Alzheimer disease: a 22-year prospective study of the Framingham cohort. Arch Neurol 2000;57:808-813.
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Huppert FA, Kopelman MD. Rates of forgetting in normal ageing: a comparison with dementia. Neuropsychologia 1989;27:849-860.
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Benton AL. Teste de retenção visual. Translation: Doralice Nogueira Guerra. Rio de Janeiro: Cepa; 1995.
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Ávila R, Bottino CMC. Atualização sobre alterações cognitivas em idosos com síndrome depressiva. Rev Bras Psiquiatria 2006;28:316-320.
¹³
Spinnler H, Della Sala S, Bandera R, Baddeley A. Dementia, aging, and the structure of human memory. Cogn Neuropsychol 1988;5:93-211.
¹⁴
Albert MS, Moss MB, Milberg W. Memory testing to improve the differential diagnosis of Alzheimer's disease. In: Ikbalk, Wisniewsky B, Windblad B, editors. Alzheimer's disease related disorders. New York: Alan R. Liss; 1989.
¹⁵
Fichman HC, Caramelli P, Sameshima K, Nitrini R. Declínio da capacidade cognitiva durante o envelhecimento. Rev Bras Psiquiatria 2005;27:79-82.
¹⁶
Mesulam MM. Principles of behavioral and cognitive neurology. 2nd ed. New York: Oxford University Press; 2000.
¹⁷
Weintraub S, Peavy GM, O'Connor M, et al. Three Words - Three Shapes: a clinical test of memory. J Clin Exp Neuropsychol 2000;22:267-268.
¹⁸
Nitrini R, Lefèvre BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.
¹⁹
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984;141:1356-1364.
²⁰
Jonker C, Geerlings MI, Schmand B. Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 2000;15: 983-991.
²¹
Lopez OL, Dekosky ST. Neuropathology of Alzheimer's disease and mild cognitive impairment. Rev Neurol 2003;37:155-163.
²²
Petersen RC, Doody R, Kurz A, Mohs RC, et al. Current concepts in mild cognitive impairment. Arch Neurol 2001;58: 1985-1992.
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Wang L, van Belle G, Crane PK, et al. Subjective memory deterioration and future dementia in people aged 65 and older. J Am Geriatric Soc 2004;52: 2045-2051.
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Treves TA, Verchovsky R, Klimovitzky S, Korczyn AD. D. Incidence of dementia in patients with subjective memory complaints. Int Psychogeriatr 2005;17:265-273.?
²⁵
Nahmias TA. O teste três formas e três palavras na avaliação da memória em adultos brasileiros. Monografia de conclusão de curso de especialização em Neuropsicologia, Centro de Estudos em Psicologia da Saúde, Divisão de Psicologia, Instituto Central, Hospital das Clínicas, Universidade de São Paulo. 2004.
²⁶
Herrera E Jr, Caramelli P, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
²⁷
Aevarsson O, Skoog I. A longitudinal population study of the mini-mental state examination in the very old: relation to dementia and education. Dement Geriatr Cogn Disord 2000;11:166-175.
²⁸
Hill LR, Klauber ML, Salmon DP, et al. Functional status, education, and the diagnosis of dementia in the Shangay survey. Neurology 1993;43:138-145.
²⁹
Ardila A, Ostrosky-Solis F, Rosseli GC. Age-relates cognitive decline during normal aging: the complex effect of education. Arch Clin Neuropsychol 2000;15:495-513.

Publication Dates

Publication in this collection
Oct-Dec 2007

History

Received
02 Nov 2007
Reviewed
07 Nov 2007
Accepted
30 Nov 2007

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

[1] ¹
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil. Recomendações do Departamento de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:720-727.

[2] ²
Ratey JJ. O Cérebro um guia para o usuário. Translation: Álvaro Cabral. Rio Janeiro: Objetiva; 2001:208-209.

[3] ³
Brucki SMD, Bertolucci PHF, Okamoto IH, Macedo MBM, Toniolo Neto J, Ramos LR. Consortium to establish a registry for Alzheimer's disease (CERAD) I: aspectos epidemiológicos. Arq Neuropsiquiatr 1994;52(suppl):99.

[4] ⁴
Bennett DA, Wilson RS, Schneider JA, et al. Natural history of mild cognitive impairment in older persons. Neurology 2002;59:198-205.

[5] ⁵
Elias MF, Beiser A, Wolf PA, Au R, White RF, D'Agostino RB. The preclinical phase of Alzheimer disease: a 22-year prospective study of the Framingham cohort. Arch Neurol 2000;57:808-813.

[6] ⁶
Fichman-Charchat H. Tese. Heterogeneidade neuropsicológica no processo de envelhecimento: transição do normal aos estágios iniciais da doença de Alzheimer. São Paulo: Instituto de Psicologia, Universidade de São Paulo; 2003.

[7] ⁷
Burke DM , Mackay D.G, Worthley J, Wade E. On the tip of the tongue: what causes word finding failures in young and older adults? J Memory Language 1991;30:542-579.

[8] ⁸
Youngjohn JR, Iarrabee GJ, Crook TH. Discriminating age associated memory impairment from Alzheimer's disease. Psychol Assess 1992;4:54-59.

[9] ⁹
Benton A, Eslinger P, Damasio A.R. Normative observations on neuropsychological performances in old age. J Clin Neuropsychol 1981;3:33-42.

[10] ¹⁰
Huppert FA, Kopelman MD. Rates of forgetting in normal ageing: a comparison with dementia. Neuropsychologia 1989;27:849-860.

[11] ¹¹
Benton AL. Teste de retenção visual. Translation: Doralice Nogueira Guerra. Rio de Janeiro: Cepa; 1995.

[12] ¹²
Ávila R, Bottino CMC. Atualização sobre alterações cognitivas em idosos com síndrome depressiva. Rev Bras Psiquiatria 2006;28:316-320.

[13] ¹³
Spinnler H, Della Sala S, Bandera R, Baddeley A. Dementia, aging, and the structure of human memory. Cogn Neuropsychol 1988;5:93-211.

[14] ¹⁴
Albert MS, Moss MB, Milberg W. Memory testing to improve the differential diagnosis of Alzheimer's disease. In: Ikbalk, Wisniewsky B, Windblad B, editors. Alzheimer's disease related disorders. New York: Alan R. Liss; 1989.

[15] ¹⁵
Fichman HC, Caramelli P, Sameshima K, Nitrini R. Declínio da capacidade cognitiva durante o envelhecimento. Rev Bras Psiquiatria 2005;27:79-82.

[16] ¹⁶
Mesulam MM. Principles of behavioral and cognitive neurology. 2nd ed. New York: Oxford University Press; 2000.

[17] ¹⁷
Weintraub S, Peavy GM, O'Connor M, et al. Three Words - Three Shapes: a clinical test of memory. J Clin Exp Neuropsychol 2000;22:267-268.

[18] ¹⁸
Nitrini R, Lefèvre BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.

[19] ¹⁹
Rosen WG, Mohs RC, Davis KL. A new rating scale for Alzheimer's disease. Am J Psychiatry 1984;141:1356-1364.

[20] ²⁰
Jonker C, Geerlings MI, Schmand B. Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 2000;15: 983-991.

[21] ²¹
Lopez OL, Dekosky ST. Neuropathology of Alzheimer's disease and mild cognitive impairment. Rev Neurol 2003;37:155-163.

[22] ²²
Petersen RC, Doody R, Kurz A, Mohs RC, et al. Current concepts in mild cognitive impairment. Arch Neurol 2001;58: 1985-1992.

[23] ²³
Wang L, van Belle G, Crane PK, et al. Subjective memory deterioration and future dementia in people aged 65 and older. J Am Geriatric Soc 2004;52: 2045-2051.

[24] ²⁴
Treves TA, Verchovsky R, Klimovitzky S, Korczyn AD. D. Incidence of dementia in patients with subjective memory complaints. Int Psychogeriatr 2005;17:265-273.?

[25] ²⁵
Nahmias TA. O teste três formas e três palavras na avaliação da memória em adultos brasileiros. Monografia de conclusão de curso de especialização em Neuropsicologia, Centro de Estudos em Psicologia da Saúde, Divisão de Psicologia, Instituto Central, Hospital das Clínicas, Universidade de São Paulo. 2004.

[26] ²⁶
Herrera E Jr, Caramelli P, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[27] ²⁷
Aevarsson O, Skoog I. A longitudinal population study of the mini-mental state examination in the very old: relation to dementia and education. Dement Geriatr Cogn Disord 2000;11:166-175.

[28] ²⁸
Hill LR, Klauber ML, Salmon DP, et al. Functional status, education, and the diagnosis of dementia in the Shangay survey. Neurology 1993;43:138-145.

[29] ²⁹
Ardila A, Ostrosky-Solis F, Rosseli GC. Age-relates cognitive decline during normal aging: the complex effect of education. Arch Clin Neuropsychol 2000;15:495-513.

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