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Doctoral Thesis
DOI
Document
Author
Full name
Isabella Figaro Gattás Vernaglia
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Farfel, José Marcelo (President)
Apolinario, Daniel
Wajman, José Roberto
Yassuda, Mônica Sanches
Title in Portuguese
Habilidades cognitivas adquiridas ao longo da vida e reserva cognitiva em idosos: desenvolvimento e validação de instrumento
Keywords in Portuguese
Atividades de lazer
Demência
Envelhecimento cognitivo
Inteligência
Reserva cognitiva
Abstract in Portuguese
INTRODUCAO: Uma das principais consequencias do envelhecimento populacional esta associada ao aumento da incidencia e prevalencia das demencias. Ha grande interesse cientifico em entender melhor porque os individuos manifestam, de forma heterogenea, os sintomas resultantes das alteracoes cerebrais degenerativas, um conceito conhecido como reserva cognitiva. Um numero consideravel de ferramentas tem sido usado para estimar a reserva cognitiva, que incluem anos de educacao, complexidade ocupacional, quoeficiente de inteligencia (QI) pre-morbido e engajamento em atividades de lazer. Alguns questionarios para avaliar reserva cognitiva, baseados na pratica de atividades cognitivamente estimulantes, ja foram validados, em paises desenvolvidos. No entanto, a elaboracao de questionarios para avaliacao da reserva cognitiva ainda e limitada em paises em desenvolvimento, onde se concentra a populacao mais vulneravel para demencia, inserida em um contexto sociocultural bastante distinto daquele encontrado em paises desenvolvidos. OBJETIVO: O presente estudo buscou desenvolver e validar um questionario como medida da reserva cognitiva, em uma populacao de idosos brasileiros de diferentes niveis de escolaridade. METODOLOGIA: O Premorbid Cognitive Skills Questionnaire (PCSQ), um questionario de 26 itens, foi aplicado em 206 idosos da comunidade sem comprometimento cognitivo. O quociente de inteligencia (FSIQ) e o desempenho cognitivo global foram examinados por meio de uma bateria neuropsicologica, e utilizados como medidas de validade de criterio. Para uma subamostra, o PCSQ tambem foi aplicado separadamente a um informante proximo. RESULTADOS: O PCSQ apresentou excelente consistencia interna (0,92) e estrutura de um fator. O questionario foi altamente correlacionado com a capacidade intelectual geral (FSIQ) em idosos sem comprometimento cognitivo (r = 0,70), mesmo quando ajustado para a educacao. A adicao do PCSQ a um modelo que ja inclui educacao melhorou a variancia explicada do modelo em 9% (de 45 para 54%; p < 0,001). Alem disso, o PCSQ mostrou baixa probabilidade de vies para idade ou sexo, e boa confiabilidade entre avaliadores quando aplicado tambem a um informante experiente. CONCLUSAO: O PCSQ demonstrou-se valido para examinar as habilidades cognitivas em uma populacao de idosos brasileiros, incluindo aqueles com baixa escolaridade. O questionario possivelmente acrescenta a educacao formal como medida de reserva cognitiva para essa populacao, podendo ser incorporado na pratica clinica na avaliacao de risco e na identificacao de medidas preventivas para as demencias
Title in English
Lifetime-acquired cognitive skills and cognitive reserve in the elderly - instrument development and validation
Keywords in English
Cognitive aging
Cognitive reserve
Dementia
Intelligence
Leisure activities
Abstract in English
INTRODUCTION: One of the main consequences of population aging is associated with the increased incidence and prevalence of dementias. There is great scientific interest in understanding better why individuals manifest, in a heterogeneous way, the symptoms resulting from degenerative brain alterations, a concept known as cognitive reserve. A considerable number of tools have been used to estimate cognitive reserve, which include years of education, occupational complexity, pre-morbid intelligence (IQ), and engaging in leisure activities. Some questionnaires to evaluate cognitive reserve, based on the practice of cognitively stimulating activities, have already been validated in developed countries. However, the elaboration of questionnaires to assess the cognitive reserve is still limited in developing countries, where the population most vulnerable to dementia is concentrated, living in a sociocultural context quite different from that found in developed countries. OBJECTIVE: The present study aimed to develop and validate a questionnaire as a measure of cognitive reserve in a population of Brazilian elderly people of different educational levels. METHODOLOGY: The Premorbid Cognitive Skills Questionnaire (PCSQ), a questionnaire of 26 items, was applied to 206 community-dwelling elderly subjects, without cognitive impairment. Intelligence quotient (FSIQ) and cognitive performance examined through a neuropsychological battery were used as measures for criterion validity. For a subsample, the PCSQ was also applied separately to a close informant. RESULTS: The PCSQ presented excellent internal consistency (0.92) and one factor structure. The questionnaire was highly correlated with general intellectual ability (FSIQ) in elderly subjects without cognitive impairment (r = 0.70), even when adjusted for education. The addition of the PCSQ to a model that already includes education improved the explained variance of the model in 9% (from 45 to 54%, p < 0.001). In addition, the PCSQ showed a low probability of bias for age or gender, and good interrater reliability when applied to an experienced informer. CONCLUSION: The PCSQ has shown evidence of validity to examine cognitive abilities in a population of Brazilian elderly, including those with low schooling. The questionnaire possibly adds formal education as a measure of cognitive reserve for this population and can be incorporated into clinical practice in risk assessment and identification of preventive measures for dementias
 
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Publishing Date
2019-11-11
 
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