Heterogeneity of cognitive aging in Brazilian normal elderls

Foss, Maria Paula; Formigheri, Paulo; Speciali, José Geraldo

doi:10.1590/S1980-57642009DN30400014

Abstract

With aging, several cognitive skills inevitably decline. However, cognitive losses do not occur homogenously in all elderly people, differing in number and severity of affected cognitive functions. These differences could be exacerbated by socioeconomic differences in a developing country like Brazil.

Objectives:

to characterize the cognitive functioning of healthy elderly subjects whose socioeconomic conditions differ to those of other studies.

Methods:

60 elderly subjects with a mean age of 68 years, 43 women and 17 men, and mean schooling of 7.1 years, were studied. The cognitive function of this group was assessed using the following neuropsychological tests: Mattis Dementia Rating Scale (MDRS), Stroop Test, Verbal Fluency, Wisconsin Card Sorting Test (WCST), Rey Complex Figure, Vocabulary - Wais - III, Logical Memory (WMS-R), Visual Reproduction (WMS-R), and Rey Auditory-Verbal Learning Test (RAVLT). The neuropsychological data were submitted to Multivariate cluster analysis using SAS - Proc Cluster software and the complete binding hierarchical method.

Results:

Variability was found allowing classification of the studied group into 4 clusters of individuals who had above-average (C1), average (C3 and C4) and below average (C2) performance. Schooling determined the results obtained, with less educated subjects showing poorer performance than higher-educated subjects.

Conclusions:

Significant differences in the process of cognitive aging were detected on neuropsychological tests in this group of healthy elderly from the developing country of Brazil, where socioeconomic differences may exacerbate cognitive differences among older adults.

Key words:
aging; neuropsychological tests; cluster analyses; cognition.

Resumo

Com o envelhecimento algumas habilidades cognitivas inevitavelmente declinam. No entanto, as perdas cognitivas não ocorrem da mesma maneira para todos os idosos, diferindo na quantidade e intensidade das funções cognitivas afetadas que podem se intensificar pelas diferenças socioeconômicas encontradas num país em desenvolvimento, como o Brasil.

Objetivos:

Caracterizar o funcionamento de idosos saudáveis em condições socioeconômicas diversas das encontradas em outros estudos.

Métodos:

60 idosos saudáveis, com idade média 68 anos, 43 mulheres e 17 homens e escolaridade média de 7,1 anos. O funcionamento cognitivo desse grupo foi avaliado por meio da aplicação dos seguintes de testes neuropsicológicos: Escala de Mattis para Avaliação de Demência (MDRS), Teste de Stroop, Fluência Verbal, Teste de Winconsin de Classificação de Cartas- WCST, Figura Complexa de Rey, Vocabulário - Wais - III, Memória Lógica - WMS-R, Reprodução Visual - WMS-R, Teste da Aprendizagem Auditivo-Verbal de Rey. Os dados da avaliação neuropsicológica foram submetidos à análise Multivariada de Cluster pelo Software SAS - Proc Cluster utilizando o método hierárquico de ligação completa.

Resultados:

Demonstraram uma variabilidade que permitiu a classificação do grupo de estudo em 4 clusters de indivíduos que tiveram um melhor desempenho (C1), com desempenho dentro da média (C3 e C4) e com pior desempenho (C2). A escolaridade determinou os resultados encontrados, sendo que os menos escolarizados mostraram piores desempenhos do que os outros.

Conclusões:

Houve diferenças significativas no processo de envelhecimento cognitivo estimada pela avaliação neuropsicológica nesse grupo de idosos saudáveis em países em desenvolvimento, como o Brasil, em que as diferenças socioeconômicas podem intensificar as diferenças cognitivas entre os idosos.

Palavras-chave:
envelhecimento; testes neuropsicológicos; análise de cluster; cognição.

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References

¹
Christensen H. What cognitive changes can be expected with normal ageing? Aust N Z J Psychiatry. 2001;35:768-775.
²
Ylikoski R, Ylikoski A, Keskivaara P, Tilvis R, Sulvaka R, Erkinjuntti T. Heterogeneity of cognitive profiles in aging: successful aging, normal aging, and individuals at risk for cognitive decline. Eur J Neurology 1999;6:645-652.
³
Valdois S, Joanette Y, Poissant A, Ska B, Dehaut F. Heterogeneity in the cognitive profile of normal elderly. J Clin Exp Neuropsychol 1990;12:587-596.
⁴
Mitrushina M, Uchiyama C, Satz P. Heterogeneity of cognitive profiles in normal aging: Implications for early manifestations of Alzheimer's Disease, J Clin Exp Neuropsychol 1995;17: 374-382.
⁵
Ritchie K, Leibivuci D, Ledersert B, Touchon, J. A typology of sub-clinical senescent cognitive disorder. Br J Psychiatry 1996; 168:470-476.
⁶
Gunstad J, Paul RH, Brickman AM, et al. Patterns of cognitive performance in middle-aged and older adults: a cluster analytic examination. J Geriatr Psychiatry Neurol 2006;19: 59-64.
⁷
Passarino G, Montesanto EA, De Rango F, et al. A cluster analysis to define human aging phenotypes. Biogerontology 2007:8:283-290.
⁸
Maxson PJ, Berg S, Mcclearn G. Multidimensional patterns of aging: A cluster-analytic approach. Exp Aging Res 1997;23:13-31.
⁹
Baltes PB, Baltes MM. Psychological perspective on sucessful aging: The model of selective optimization with compensation. In: Baltes PB, Baltes MM, editors. Sucessful aging: Perspective from behavioral sciences. Cambridge: Cambridge Press;1990:1-34.
¹⁰
Rowe JW, Kahn RL. Human aging: usual and successful. Science 1987;237:143-149.
¹¹
Nitrini R, Caramelli P, Herrera-Jr E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
¹²
Ostrosky-Solis F, Ardila A, Rosselli M, Lopez-Arango G, Uriel-Mendoza V. Neuropsychological test performance in illiterate subjects. Arch Clin Neuropsychol 1998;13:645-660.
¹³
Manly J, Jacobs DM, Sano M, et al. Effect of literacy on neuropsychological test performance in non-demented, educationmatched elders. J Int Neuropsychol Soc 1999;5:191-202.
¹⁴
Veras R. A epidemiologia do envelhecimento na América Latina. In: Forlenza OV, Caramelli P, editors. Neuropsiquiatria Geriátrica. São Paulo: Atheneu; 2000:7-22.
¹⁵
Lecrubier Y, Sheedan D, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: realiability and validity according to the CIDI. Eur Psychiatry 1997;12:224-231.
¹⁶
Amorin P, Lecrubier Y, Weiller E, Hergueta T, Sheehan D. DSM-III-R Psychotic Disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. Eur Psychiatry 1998;13:26-34.
¹⁷
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IVH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
¹⁸
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for stating of Dementia. Br J Psychiatry 1982;140:566-572.
¹⁹
Graciano MIG, Lehfeld NA, Neves Filho A. Critérios para classificação sócio-econômica: elementos de atualização. Serv Soc Realidade 1996;8:109-128.
²⁰
Mattis, S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasu TB, Birenbaun C, editors. Geriatric Psychiatry: a handbook for psychiatrists and primary care physicians. New York: Grune & Stratton; 1976:77-122.
²¹
Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
²²
Stroop J. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-661.
²³
Spreen O, Strauss E. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. 2nd edition. New York: Oxford University Press; 1998.
²⁴
Brucki SMD, Malheiros SMF, Okamoto IH, Bertolucci PHF. Dados normativos para o Teste de Fluência Verbal categorias animais em nosso meio. Arq Neuropsiquiatr 1997;55:56-61.
²⁵
Heaton RK, Chelune GJ, Talley JL, Kay, GG, Curtiss G. Winconsin Card Sorting Test Manual-Revised and Expanded. USA: PAR; 1993.
²⁶
Heaton KR, Chelune GJ, Talley JL, Kay GC, Curtiss G. Manual do Teste Wisconsin de Classificação de Cartas. Adaptação e padronização brasileira, Cunha JA, Trentini CM, Argimon IL, Oliveira MS, Werlang BG, Prieb RG. São Paulo: Casa do Psicólogo; 2005.
²⁷
Bastos-Formighieri M.S. Afetividade e funções executivas em idosos: estudo normativo com Wisconsin Card Sorting Test e Pfister. [Master Thesis] Ribeirão Preto: Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto/USP - Dep. de Psicologia e Educação, USP; 2007.
²⁸
Rey A. Teste de cópia e de reprodução de memória de figuras geométricas complexas: manual. Adaptação Brasileira - Oliveira MS, Rey T, Franco LCF. São Paulo: Casa do Psicólogo; 1998/1999.
²⁹
Wechsler D. Escala de Inteligência de Wechsler para Adultos. 3ª Edição. Adaptação Brasileira - 1ª edição de Nascimento E. São Paulo: Casa do Psicólogo; 2004.
³⁰
Wechsler D. WMS-R. Wechsler Memory Scale - revised manual. San Antonio: Psychological Corporation; 1987. (Translated and adapted by Camargo CHP, Calil MP, Puppo Neto ST, Rosenthal MCP, unpublished results).
³¹
Camargo CHP. Protocolo de avaliação neuropsicológica em demência; 1997. (Unidade de Neuropsicologia do DNCF- IPQ HC FMUSP, unpublished results).
³²
Diniz LFM, Cruz MF, Torres VM, Cosenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.
³³
Souza-Talarico JN, Caramelli P, Nitrini R, Chaves EC. The influence of schooling on working memory performance in elderly individuals without cognitive decline. Dement Neuropsychol 2007;3:276-281
³⁴
Riley KP, Snowdon DA, Desrosiers MF, Markesbery WR. Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study. Neurobiol Aging 2005;26:341-347.
³⁵
Meguro K, Shimada M, Yamaguchi S, et al. Cognitive function and frontal lobe atrophy in normal elderly adults: Implications for dementia not as aging-related disorders and the reserve hypothesis. Psychiatry Clin Neurosci 2001; 55: 565-572.
³⁶
Wetter SR, Delis DC, Houston WS, et al. Deficits in inhibition and flexibility are associated with the APOE-E4 allele in nondemented older adults. J Clin Exp Neuropsychol 2005;27: 943-952.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
03 Oct 2009
Accepted
13 Nov 2009

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

[1] ¹
Christensen H. What cognitive changes can be expected with normal ageing? Aust N Z J Psychiatry. 2001;35:768-775.

[2] ²
Ylikoski R, Ylikoski A, Keskivaara P, Tilvis R, Sulvaka R, Erkinjuntti T. Heterogeneity of cognitive profiles in aging: successful aging, normal aging, and individuals at risk for cognitive decline. Eur J Neurology 1999;6:645-652.

[3] ³
Valdois S, Joanette Y, Poissant A, Ska B, Dehaut F. Heterogeneity in the cognitive profile of normal elderly. J Clin Exp Neuropsychol 1990;12:587-596.

[4] ⁴
Mitrushina M, Uchiyama C, Satz P. Heterogeneity of cognitive profiles in normal aging: Implications for early manifestations of Alzheimer's Disease, J Clin Exp Neuropsychol 1995;17: 374-382.

[5] ⁵
Ritchie K, Leibivuci D, Ledersert B, Touchon, J. A typology of sub-clinical senescent cognitive disorder. Br J Psychiatry 1996; 168:470-476.

[6] ⁶
Gunstad J, Paul RH, Brickman AM, et al. Patterns of cognitive performance in middle-aged and older adults: a cluster analytic examination. J Geriatr Psychiatry Neurol 2006;19: 59-64.

[7] ⁷
Passarino G, Montesanto EA, De Rango F, et al. A cluster analysis to define human aging phenotypes. Biogerontology 2007:8:283-290.

[8] ⁸
Maxson PJ, Berg S, Mcclearn G. Multidimensional patterns of aging: A cluster-analytic approach. Exp Aging Res 1997;23:13-31.

[9] ⁹
Baltes PB, Baltes MM. Psychological perspective on sucessful aging: The model of selective optimization with compensation. In: Baltes PB, Baltes MM, editors. Sucessful aging: Perspective from behavioral sciences. Cambridge: Cambridge Press;1990:1-34.

[10] ¹⁰
Rowe JW, Kahn RL. Human aging: usual and successful. Science 1987;237:143-149.

[11] ¹¹
Nitrini R, Caramelli P, Herrera-Jr E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[12] ¹²
Ostrosky-Solis F, Ardila A, Rosselli M, Lopez-Arango G, Uriel-Mendoza V. Neuropsychological test performance in illiterate subjects. Arch Clin Neuropsychol 1998;13:645-660.

[13] ¹³
Manly J, Jacobs DM, Sano M, et al. Effect of literacy on neuropsychological test performance in non-demented, educationmatched elders. J Int Neuropsychol Soc 1999;5:191-202.

[14] ¹⁴
Veras R. A epidemiologia do envelhecimento na América Latina. In: Forlenza OV, Caramelli P, editors. Neuropsiquiatria Geriátrica. São Paulo: Atheneu; 2000:7-22.

[15] ¹⁵
Lecrubier Y, Sheedan D, Weiller E, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: realiability and validity according to the CIDI. Eur Psychiatry 1997;12:224-231.

[16] ¹⁶
Amorin P, Lecrubier Y, Weiller E, Hergueta T, Sheehan D. DSM-III-R Psychotic Disorders: procedural validity of the Mini International Neuropsychiatric Interview (MINI). Concordance and causes for discordance with the CIDI. Eur Psychiatry 1998;13:26-34.

[17] ¹⁷
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IVH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[18] ¹⁸
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for stating of Dementia. Br J Psychiatry 1982;140:566-572.

[19] ¹⁹
Graciano MIG, Lehfeld NA, Neves Filho A. Critérios para classificação sócio-econômica: elementos de atualização. Serv Soc Realidade 1996;8:109-128.

[20] ²⁰
Mattis, S. Mental status examination for organic mental syndrome in the elderly patient. In: Bellak L, Karasu TB, Birenbaun C, editors. Geriatric Psychiatry: a handbook for psychiatrists and primary care physicians. New York: Grune & Stratton; 1976:77-122.

[21] ²¹
Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[22] ²²
Stroop J. Studies of interference in serial verbal reactions. J Exp Psychol 1935;18:643-661.

[23] ²³
Spreen O, Strauss E. A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. 2nd edition. New York: Oxford University Press; 1998.

[24] ²⁴
Brucki SMD, Malheiros SMF, Okamoto IH, Bertolucci PHF. Dados normativos para o Teste de Fluência Verbal categorias animais em nosso meio. Arq Neuropsiquiatr 1997;55:56-61.

[25] ²⁵
Heaton RK, Chelune GJ, Talley JL, Kay, GG, Curtiss G. Winconsin Card Sorting Test Manual-Revised and Expanded. USA: PAR; 1993.

[26] ²⁶
Heaton KR, Chelune GJ, Talley JL, Kay GC, Curtiss G. Manual do Teste Wisconsin de Classificação de Cartas. Adaptação e padronização brasileira, Cunha JA, Trentini CM, Argimon IL, Oliveira MS, Werlang BG, Prieb RG. São Paulo: Casa do Psicólogo; 2005.

[27] ²⁷
Bastos-Formighieri M.S. Afetividade e funções executivas em idosos: estudo normativo com Wisconsin Card Sorting Test e Pfister. [Master Thesis] Ribeirão Preto: Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto/USP - Dep. de Psicologia e Educação, USP; 2007.

[28] ²⁸
Rey A. Teste de cópia e de reprodução de memória de figuras geométricas complexas: manual. Adaptação Brasileira - Oliveira MS, Rey T, Franco LCF. São Paulo: Casa do Psicólogo; 1998/1999.

[29] ²⁹
Wechsler D. Escala de Inteligência de Wechsler para Adultos. 3ª Edição. Adaptação Brasileira - 1ª edição de Nascimento E. São Paulo: Casa do Psicólogo; 2004.

[30] ³⁰
Wechsler D. WMS-R. Wechsler Memory Scale - revised manual. San Antonio: Psychological Corporation; 1987. (Translated and adapted by Camargo CHP, Calil MP, Puppo Neto ST, Rosenthal MCP, unpublished results).

[31] ³¹
Camargo CHP. Protocolo de avaliação neuropsicológica em demência; 1997. (Unidade de Neuropsicologia do DNCF- IPQ HC FMUSP, unpublished results).

[32] ³²
Diniz LFM, Cruz MF, Torres VM, Cosenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.

[33] ³³
Souza-Talarico JN, Caramelli P, Nitrini R, Chaves EC. The influence of schooling on working memory performance in elderly individuals without cognitive decline. Dement Neuropsychol 2007;3:276-281

[34] ³⁴
Riley KP, Snowdon DA, Desrosiers MF, Markesbery WR. Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study. Neurobiol Aging 2005;26:341-347.

[35] ³⁵
Meguro K, Shimada M, Yamaguchi S, et al. Cognitive function and frontal lobe atrophy in normal elderly adults: Implications for dementia not as aging-related disorders and the reserve hypothesis. Psychiatry Clin Neurosci 2001; 55: 565-572.

[36] ³⁶
Wetter SR, Delis DC, Houston WS, et al. Deficits in inhibition and flexibility are associated with the APOE-E4 allele in nondemented older adults. J Clin Exp Neuropsychol 2005;27: 943-952.

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