Kanji and Kana agraphia in mild cognitive impairment and dementia: A trans-cultural comparison of elderly Japanese subjects living in Japan and Brazil

Akanuma, Kyoko; Meguro, Kenichi; Meguro, Mitsue; Chubaci, Rosa Yuka Sato; Caramelli, Paulo; Nitrini, Ricardo

doi:10.1590/S1980-57642010DN40400008

Abstract

This study verifies the environmental effects on agraphia in mild cognitive impairment and dementia. We compared elderly Japanese subjects living in Japan and Brazil. Methods: We retrospectively analyzed the database of the Prevalence Study 1998 in Tajiri (n=497, Miyagi, Japan) and the Prevalence Study 1997 of elderly Japanese immigrants living in Brazil (n=166, migrated from Japan and living in the São Paulo Metropolitan Area). In three Clinical Dementia Rating (CDR) groups, i.e., CDR 0 (healthy), CDR 0.5 (questionable dementia), and CDR 1+ (dementia) , the Mini-Mental State Examination (MMSE) item of spontaneous writing and the Cognitive Abilities Screening Instrument (CASI) domain of dictation were analyzed with regard to the number of Kanji and Kana characters. Formal errors in characters and pragmatic errors were also analyzed. Results: The immigrants in Brazil wrote similar numbers of Kanji or Kana characters compared to the residents of Japan. In spontaneous writing, the formal Kanji errors were greater in the CDR 1+ group of immigrants. In writing from dictation, all the immigrant CDR groups made more formal errors in Kana than the Japan residents. No significant differences in pragmatic errors were detected between the two groups. Conclusions: Subjects living in Japan use Kanji frequently, and thus the form of written characters was simplified, which might be assessed as mild formal errors. In immigrants, the deterioration in Kanji and Kana writing was partly due to decreased daily usage of the characters. Lower levels of education of immigrants might also be related to the number of Kanji errors.

Key words:
agraphia; mild cognitive impairment; dementia; Kanji; Kana

Resumo

Este estudo verifica os efeitos do meio ambiente sobre a agrafia em comprometimento cognitivo leve e demência. Nós comparamos indivíduos idosos vivendo no Japão e Brasil. Métodos: Nós, retrospectivamente, analisamos a base de dados do Estudo de Prevalência 1998 em Tajiri (n=497, Miyagi, Japão) e do Estudo de Prevalência 1997 de imigrantes idosos japoneses vivendo no Brasil (n=166, imigrados do Japão e residindo na área metropolitana da cidade de São Paulo). Em três grupos de CDR (Clinical Dementia Rating), isto é, CDR 0 (saudáveis), CDR 0.5 (demência questionável) e CDR1+ (demência), o item de escrita espontânea do Mini-Exame do Estado Mental (MEEM) e o domínio de ditado do Cognitive Abilities Screening Instrument (CASI) foram analisados em relação ao número de caracteres em Kanji e Kana. Erros formais nos caracteres e erros pragmáticos foram também analisados. Resultados: Os imigrantes no Brasil escreveram número similar de caracteres de Kanji e Kana comparados aos residentes no Japão. Na escrita espontânea, os erros formais de Kanji foram maiores no grupo de CDR1+ em imigrantes. Na escrita sob ditado, todos os grupos de CDR de imigrantes fizeram mais erros formais em Kana do que os residentes no Japão. Nenhuma diferença foi encontrada em erros pragmáticos entre os grupos. Conclusões: Sujeitos vivendo no Japão usam Kanji freqüentemente, e então, a forma de caracteres escritos foi simplificada, o que pode ser avaliado como discretos erros formais. Em imigrantes, a deterioração na escrita em Kanji e Kana foi parcialmente devida ao uso diário restrito dos caracteres. Baixos níveis educacionais dos imigrantes podem estar relacionados ao número de erros em Kanji.

Palavras-chave:
agrafia; comprometimento cognitivo leve; demência; Kanji; Kana

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

Rapcsak SZ. Disorders of writing. In LJG Rothi, KM Heilman (Eds), Apraxia: The neuropsychology of action. East Sussex: Psychology Press; 1997:149-172.
Ardila A, Rosselli M. Spatial agraphia. Brain Cogn 1993;22: 137-147.
Ardila A, Surloff C. Dysexecutive agraphia: a major executive dysfunction sign. Int J Neurosci 2006;116:653-663.
Fukui T, Lee E. Progressive agraphia can be a harbinger of degenerative dementia. Brain Lang 2008;104:201-210.
Hughes JC, Graham N, Patterson K, Hodges JR. Dysgraphia in mild dementia of Alzheimer's type. Neuropsychologia 1997; 35:533-545.
Rapcsak SZ, Arthur SA, Bliklen DA, Rubens AB. Lexical agraphia in Alzheimer's disease. Arch Neurol 1989;46:65-68.
Glosser G, Kaplan E. Linguistic and non-linguistic impairments in writing: A comparison of patients with focal and multifocal CNS disorders. Brain Lang 1989;37:357-380.
Luzzatti C, Laiacona M, Agazzi D. Multiple patterns of writing disorders in dementia of the Alzheimer's type and their revolution. Neuropsychologia 2003;41:759-772.
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Kokmen E, Tangelos EG. Aging, memory, and mild cognitive impairment. Int Psychogeriatr 1997;19:65-69.
Morris JC, Storandt M, Miller JP, et al. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001;58:397-405.
Nakamura K, Meguro K, Yamazaki H, et al. Kanji-predominant alexia in advanced Alzheimer's disease. Acta Neurol Scand 1998;97:237-243.
Meguro M, Meguro K, Caramelli P, et al. Elderly Japanese emigrants to Brazil before World War II: I. Clinical profiles based on specific historical background. Int J Geriatr Psychiatry 2001;16:768-774.
Meguro K, Meguro M, Caramelli P, et al. Elderly Japanese emigrants to Brazil before World War II: II. Prevalence of senile dementia. Int J Geriatr. Psychiatry 2001;16:775-779.
Meguro K, Meguro M, Caramelli P, et al. An environmental change does not affect dementia prevalence but affects depressive state and physical activity: A trans-cultural study of Japanese elderly subjects and Japanese elderly immigrants in Brazil. Psychogeriatrics 2001;1:201-208.
Meguro K, Ishii H, Yamaguchi S, et al. Prevalence of dementia and dementing diseases in Japan: The Tajiri Project. Arch Neurol 2002;59:1109-1114.
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1986;140:566-572.
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.
Teng EL, Hasegawa K, Homma A, et al. The Cognitive Ability Screening Instrument (CASI): A practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45-58.
Nakamura K, Honda M, Okada T, et al. Participation of the left posterior inferior temporal cortex in writing and mental recall of kanji orthography. Brain 2000;123:954-967.
Iwata M. Kanji versus Kana: Neuropsychological correlates of the Japanese writing system. Trends Neurosci 1984;8:290-293.
Sakurai Y. Varieties of alexia from fusiform, posterior inferior temporal and posterior occipital gyrus lesions. Behav Neurol 2004;15:35-50.

Publication Dates

Publication in this collection
Oct-Dec 2010

History

Received
10 Aug 2010
Accepted
11 Oct 2010

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

[1] Rapcsak SZ. Disorders of writing. In LJG Rothi, KM Heilman (Eds), Apraxia: The neuropsychology of action. East Sussex: Psychology Press; 1997:149-172.

[2] Ardila A, Rosselli M. Spatial agraphia. Brain Cogn 1993;22: 137-147.

[3] Ardila A, Surloff C. Dysexecutive agraphia: a major executive dysfunction sign. Int J Neurosci 2006;116:653-663.

[4] Fukui T, Lee E. Progressive agraphia can be a harbinger of degenerative dementia. Brain Lang 2008;104:201-210.

[5] Hughes JC, Graham N, Patterson K, Hodges JR. Dysgraphia in mild dementia of Alzheimer's type. Neuropsychologia 1997; 35:533-545.

[6] Rapcsak SZ, Arthur SA, Bliklen DA, Rubens AB. Lexical agraphia in Alzheimer's disease. Arch Neurol 1989;46:65-68.

[7] Glosser G, Kaplan E. Linguistic and non-linguistic impairments in writing: A comparison of patients with focal and multifocal CNS disorders. Brain Lang 1989;37:357-380.

[8] Luzzatti C, Laiacona M, Agazzi D. Multiple patterns of writing disorders in dementia of the Alzheimer's type and their revolution. Neuropsychologia 2003;41:759-772.

[9] Petersen RC, Smith GE, Waring SC, Ivnik RJ, Kokmen E, Tangelos EG. Aging, memory, and mild cognitive impairment. Int Psychogeriatr 1997;19:65-69.

[10] Morris JC, Storandt M, Miller JP, et al. Mild cognitive impairment represents early-stage Alzheimer disease. Arch Neurol 2001;58:397-405.

[11] Nakamura K, Meguro K, Yamazaki H, et al. Kanji-predominant alexia in advanced Alzheimer's disease. Acta Neurol Scand 1998;97:237-243.

[12] Meguro M, Meguro K, Caramelli P, et al. Elderly Japanese emigrants to Brazil before World War II: I. Clinical profiles based on specific historical background. Int J Geriatr Psychiatry 2001;16:768-774.

[13] Meguro K, Meguro M, Caramelli P, et al. Elderly Japanese emigrants to Brazil before World War II: II. Prevalence of senile dementia. Int J Geriatr. Psychiatry 2001;16:775-779.

[14] Meguro K, Meguro M, Caramelli P, et al. An environmental change does not affect dementia prevalence but affects depressive state and physical activity: A trans-cultural study of Japanese elderly subjects and Japanese elderly immigrants in Brazil. Psychogeriatrics 2001;1:201-208.

[15] Meguro K, Ishii H, Yamaguchi S, et al. Prevalence of dementia and dementing diseases in Japan: The Tajiri Project. Arch Neurol 2002;59:1109-1114.

[16] Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1986;140:566-572.

[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] Teng EL, Hasegawa K, Homma A, et al. The Cognitive Ability Screening Instrument (CASI): A practical test for cross-cultural epidemiological studies of dementia. Int Psychogeriatr 1994;6:45-58.

[19] Nakamura K, Honda M, Okada T, et al. Participation of the left posterior inferior temporal cortex in writing and mental recall of kanji orthography. Brain 2000;123:954-967.

[20] Iwata M. Kanji versus Kana: Neuropsychological correlates of the Japanese writing system. Trends Neurosci 1984;8:290-293.

[21] Sakurai Y. Varieties of alexia from fusiform, posterior inferior temporal and posterior occipital gyrus lesions. Behav Neurol 2004;15:35-50.

Brasil