ArticlePDF Available

Abstract

Objective: to analyze the validity of the Five Digits Test (FDT), an adapted version of the Stroop Color-Word Test (SCWT) on Bipolar Disorder patients (BD). Methods: we assessed 35 BD patients diagnosed in a clinical interview by a psychiatrist using the MINI-Psychiatric Interview. The participants were euthymic on during the cognitive assessment. Besides the FDT the participants performed the SCWT, the Five Points Test (FPT) and the Rey Auditory Verbal Learning Test (RAVLT) as measures of criterion related, convergent and divergent validity, respectively. We adopted partial correlations, controlling for age, education, sex and symptoms of depression and mania, assessed the association between the FDT times and errors with the other cognitive measures. Group comparisons with a paired control sample assessed the FDT discriminant validity. Results: we found significant correlations between the FDT and the SCWT and between the FDT and the FPT, but not between the Five Points Test and the RAVLT. The shared variance of the measures sustained the construct validity for the assessment of processing speed and executive functions. Group comparisons indicate large effect sizes for the FDT timed measures and the errors in the executive functions components. The test accuracy for group classification was 90%. Conclusion: the results suggests that the FDT is a valid measure of processing speed and executive functions for the assessment of BD patients, and might be an alternative to the SCWT for patients with low formal education.
Clinical Neuropsychiatry (2014) 11, 3, 103-107
THE FIVE DIGITS TEST ON THE ASSESSMENT OF PSYCHIATRIC PATIENTS
WITH HETEROGENEOUS EDUCATIONAL BACKGROUNDS:
EVIDENCES OF VALIDITY ON THE ASSESSMENT OF BIPOLAR DISORDER
Jonas Jardim de Paula, Suzana Abrantes, Fernando Silva Neves, Leandro Fernandes Malloy-Diniz
Abstract
Objective: to analyze the validity of the Five Digits Test (FDT), an adapted version of the Stroop Color-Word Test
(SCWT) on Bipolar Disorder patients (BD).
Method: we assessed 35 BD patients diagnosed in a clinical interview by a psychiatrist using the MINI-Psychiatric
Interview. The participants were euthymic during the cognitive assessment. Besides the FDT, the participants performed
the SCWT, the Five Points Test (FPT) and the Rey Auditory Verbal Learning Test (RAVLT) as measures of criterion-
related, convergent and divergent validity, respectively. We adopted partial correlations, controlling for age, education,
sex and symptoms of depression and mania, to analyze the association between the FDT times and errors with the other
cognitive measures. Group comparisons with a paired control sample were used to assess the FDT discriminant validity.
Results: we found signicant correlations between the FDT and the SCWT and between the FDT and the FPT,
but not between the FDT and the RAVLT. The shared variance of the measures sustained the construct validity for the
assessment of processing speed and executive functions. Group comparisons indicate large effect sizes for the FDT
timed measures and errors in the executive functions components. The test accuracy for group classication was 90%.
Conclusions: the results suggest that the FDT is a valid measure of processing speed and executive functions for the
assessment of BD patients, and might be an alternative to the SCWT for patients with low formal education.
Key words: Five Digits Test (FDT), Stroop Color-Word Test (SCWT), Bipolar Disorder patients (BD), MINI-
Psychiatric Interview, Rey Auditory Verbal Learning Test (RAVLT)
Declaration of interest: none
Jonas Jardim de Paula1,2,3, Suzana Abrantes4, Fernando Silva Neves2,5, Leandro Fernandes Malloy-Diniz2,3,5
1 Departamento de Psicologia, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte, Brazil.
2 INCT de Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av Alfredo Balena, 190, Belo
Horizonte-MG, CEP 30130-100, Brazil.
3 Laboratório de Investigações em Neurociência Clínica (LINc) – Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
4 Private Practice
5 Departamento de Saúde Mental, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Corresponding author
Jonas Jardim de Paula
Avenue Alfredo Balena, 190, Belo Horizonte-MG, CEP 30130-100, Brazil. Telephone/Fax: 55-31-9990-2760.
Email: jonasjardim@gmail.com
Introduction
The assessment of processing speed and executive
functions in Bipolar Disorder (BD) is an important
aspect on their clinical evaluation. Decits in selective
attention (a component of one Executive Function
called “Inhibitory Control”) is related to several clinical
outcomes including impairments in everyday life
activities (O’Shea et al. 2010), psychosocial functioning
(Solé et al. 2012), and suicide behavior (Malloy-Diniz
et al. 2011). One of the most used paradigms for this
cognitive function is the interference control, assessed
by Stroop-like tests, as the Stroop Color-Word Test
(SCWT). It involves the time and errors in colour naming,
naming the colours of graphed words and naming the
colours of graphed colour-names in incongruent (Red-
Green) conditions. The rst two components are usually
related to processing speed while the last is related to
executive functions (Troyer et al. 2006).
The SCWT has several limitations in the assessment
of patients with lower formal education, learning
disabilities or non-clinical difculties in word reading
(Cox et al. 1997). The prociency in reading is an
important factor for the interpretation of the SCWT.
In Brazil, the educational background of most adults,
especially those in public health care units is often
decient, with difculty in reading uency and
comprehension of small texts or even isolated words.
Submitted may 2014, accepted may 2014
FirSt epub ahead oF print 2014 may cn100006
© 2014 Giovanni Fioriti Editore s.r.l. 103
Jonas Jardim de Paula et al.
104 Clinical Neuropsychiatry (2014) 11, 3
An alternative to the classical SCWT is the numeric
or counting versions of the test. These are Mini-Verbal
or Language-Free versions of the SCWR: they use
a very simple content (number, colours or gures)
but the same design as classical tests do (Sedó and
DeCristoforo, 2001).
The Five Digits Test (FDT) is a numeric-Stroop
test, which is relatively independent of reading
routines (Sedó 2007). The test involves four different
components. On the rst one, the patient must read one
out of ve numbers in a congruent condition (“1”, he/
she must say “one”; or “3-3-3”, he/she must say three),
exposed on small squares (FDT Reading). On the
second component, he/she must tell how many asterisks
(1 to 5) are in each square (“*”, he/she must say “one”;
or “***” he/she must say “three”) (FDT Counting).
The third component involves an interference
condition where one to ve numbers are exposed in
an incongruent condition (“2-2-2” or “5-5-5-5”), and
the subject must not say the name of the number, but
tell how many numbers are in each stimulus (in the
example, for “2-2-2” he/she must say “three” and for
“5-5-5-5” he/she must say “four”) (FDT Choosing).
The last component is similar to the third one, but for
every ve stimuli there is one marked square where
he/she must not say how many numbers are in each
square, but read one of the numbers (FDT Shifting).
The time and errors of each of the four conditions are
used as measures of “automatic attentional processes”
(Reading and Counting) and “controlled attentional
processes” (Choosing and Shifting). The two rst
components are more related to simple attention and
processing speed, while the two last are more dependent
on selective attention and executive functions.
Although the test is a promising measure of these
constructs for the Brazilian population, we found
no studies assessing its psychometric properties
in psychiatric patients. In this brief report, we aim
to assess the FDT construct, criterion-related and
discriminant validity in BD patients.
Methods
Participants
We assessed 35 euthymic BD patients from a
specialized health unit of mental health in a university
hospital. We performed the diagnosis based on the
DSM-IV-TR criteria by a psychiatric interview
conducted by a certied clinical psychiatrist. On
this assessment, the professional also applied the
Portuguese version of the MINT International
Neuropsychiatric Interview (Amorim 2000). The mean
age of the patients was 46.21 (±13.12) years and 71%
had eleven or less years of formal education. The BD
patients had been euthymic for at least four weeks
according to the clinical interview. The mean Beck
Depression Inventory (Beck et al. 1961) score was 8.83
(±2.44) and the Young Mania Rating Scale (Young et
al. 1978) was 6.26 (±2.38), scores not suggestive of
prominent symptoms of depression or mania during
the neuropsychological assessment, characterizing the
euthymic phase of BD.
Neuropsychological assessment
We used four different neuropsychological
measures. Our interest was to assess the FDT construct
and criterion-related validity, so we chose a criterion
measure, a convergent measure (another test of
processing speed and executive functions) and a
divergent measure (a test of another cognitive domain).
Criterion-Related validity: For this purpose, we
selected the SCWT Victoria version (Troyer et al.
2006). The test has three components: Box, Neutral
Words and Colour Words. The executive demands of
the tasks increase along their three parts. We used the
SCWT times to assess the criterion-related validity of
the FDT timed measures and the total errors of each
SCWT component for the FDT error measures.
Convergent validity: We used the Five Points
Test (Regard et al. 1982) for the assessment of this
psychometric property. The Five Points Test is a non-
verbal uency task where the patient must draw a
series of gures using straight lines in several squares
containing ve dots. The test demands, besides the
motor uency, planning, monitoring and cognitive
shifting, in order to produce new drawing but avoid
errors or repetitions. We selected two measures from
this test: the total of correct drawings as a convergent
measure for the FDT times (a more pure measure of
uency and processing speed) and the total number of
errors as a convergent measure for the FDT errors (a
more pure measure of executive functions, including
inhibitory control and cognitive shifting).
Divergent Validity: For the assessment of this
psychometric property, we selected the Brazilian
Portuguese version of the Rey Auditory-Verbal
Learning Test (Malloy-Diniz et al. 2007). This test is
a classical measure of episodic memory, validated for
the Brazilian adult population. As a general estimate
of episodic memory, we selected the sum of words
(RAVLT Total) of the ve learning trials.
Discriminant validity: For the assessment of
this psychometric property, we assessed a paired
(1:1) control group without evidences of cognitive,
psychiatric or neurological disorders. The control group
was a convenience sample of healthy adults matched
to the BD patients in the distribution of sex (χ²=0.08,
p=0.771), age (χ²=0.56 p=0.757) and formal education
(χ²=0.58, p=0.445). The control group did not report
psychiatric disorders or neurological diseases and had
scores on the Standard Raven Progressive Matrices
Test (Raven, 1981) above the percentile 10 according
to the Brazilian population norms.
Statistical analysis
We explored the relationship of the FDT measures
with the other tests computing partial correlations
of the neuropsychological measures controlling
for the effects of age, education and symptoms of
depression and mania. We selected this procedure
since sociodemographic variables may inuence
neuropsychological test performance and might
inate the correlations of the cognitive constructs.
Measures that do not follow a normal distribution
underwent logarithmic, square root, square or cubic
transformations to better t the analysis assumptions.
Since multiple correlations were computed and the
sample size was relatively small, a more conservative
p-value was selected to avoid type-I errors (p=0.01). The
BD and control groups were compared by independent
samples t-tests, and the Cohen’s d was adopted as a
measure of effect sizes. We also performed a stepwise
binary logistic regression model to analyze the FDT
accuracy in the group classication. The test times and
errors were entered as independent predictors.
The Five Digits Test in Bipolar Patients
Clinical Neuropsychiatry (2014) 11, 3 105
timed measures with the SCWT Color-Words time were
signicant, and the shared variance ranged from 33%
to 57%. The pattern of errors was more specic, with
signicant correlations between the FDT Reading errors
only with SCWT Dots and Neutral Words (30 and 38%
of shared variance, respectively). FDT Counting errors
had no correlation with the criterion measure. The
executive components’ errors of the FDT (Choosing and
Shifting) were only associated with the SCWT Color-
Word component (69% and 49% of shared variance,
respectively). For the convergent and divergent validity
Results
The BD participants description is shown on
table 1. Table 2 shows the correlations of the
neuropsychological measures divided by the validity
assessed (criterion-related, convergent and divergent).
On the criterion-related validity analysis, we found
signicant correlations between the FDT automatic
components times (Reading and Counting) with all
the timed measures of the SCWT, ranging from 22%
to 57% of shared variance. The correlations of all FDT
Table 1. Bipolar Disorder patient’s description
Participants description % or M(SD)
Gender Male 20%
Female 80%
Age Group 18 to 35 years 29%
36 to 50 years 26%
51 to 65 years 46%
Formal Education Less than 12 71%
12 years or more 29%
Marital Status Single 51%
Married 23%
Widowed 9%
Divorced 9%
Non-Informed 9%
Beck Depression Inventory 8.83 (2.44)
Young Mania Rating Scale 6.26 (2.38)
SCWT 1 (Time) 20.38 (5.67)
SCWT 2 (Time) 26.62 (10.76)
SCWT 3 (Times) 39.74 (18.66)
SCWT - Interference Score 16.24 (13.97)
SCWT 1 (Errors) 0.21 (0.73)
SCWT 2 (Errors) 0.15 (0.70)
SCWT 3 (Errors) 1.94 (4.68)
Five Points Test (Unique Drawings) 19.63 (2.21)
Five Points Test (Errors) 0.87 (2.21)
RAVLT (Sum of Words) 40.94 (9.79)
M: Mean, SD: Standard-Deviation, SCWT: Stroop Color-Word Test, RAVLT: Rey Auditory-Verbal Learning Test
Table 2. Partial correlations and shared variance (r²) between the Five Digits Test with the Stroop Color-Word,
Five Points Test and Rey Auditory Verbal-Learning Tests
FDT Times SCWT Dots SCWT
Neutral-W SCWT Color-W Five Points Test RAVLT
Reading (T)¹ 0.579* (34%) 0.659* (43%) 0.754* (57%) -0.471* (22%) -0.164 (3%)
Counting (T)¹ 0.554* (31%) 0.715* (51%) 0.612* (37%) -0.440* (19%) -0.047 (0%)
Choosing (T)¹ 0.394 (16%) 0.474* (22%) 0.573* (33%) -0.238 (6%) -0.204 (4%)
Shifting (T)¹ 0.393 (15%) 0.476* (23%) 0.528* (28%) -0.177 (3%) -0.082 (1%)
Reading (E)² 0.550* (30%) 0.618* (38%) 0.38 (14%) 0.508* (26%) 0.034 (0%)
Counting (E)² 0.375 (14%) 0.408 (17%) 0.315 (10%) 0.491* (24%) -0.121 (1%)
Choosing (E)² 0.117 (1%) 0.559* (31%) 0.831* (69%) 0.746* (56%) 0.114 (1%)
Shifting (E)² 0.119 (1%) 0.146 (2%) 0.698* (49%) 0.526* (28%) 0.097 (1%)
Note: 1 – Correlations with SCWT times and Five Points Test unique drawings. 2- Correlations with SCWT errors and Five
Points Test errors. * p<0.01
FDT: Five Digits Test, T: Times, E: Errors, SCWT: Stroop Color Word Test, W? words, RAVLT: Rey Auditory-Verbal Learning
Test sum of words
Jonas Jardim de Paula et al.
106 Clinical Neuropsychiatry (2014) 11, 3
on the convergent task. Finally, we found a divergent
pattern of association between the FDT and the RAVLT,
an evidence of divergent validity. Signicant group
differences were found for the FDT times (with very
large effect sizes), for FDT Choosing and Shifting
Errors (with large effect sizes), but not for Reading and
Counting errors. In a binary logistic regression model,
the FDT Shifting time predicted group membership
with high accuracy (90%).
The results are convergent with other research
ndings, which examined the association of the
FDT measures with other cognitive tests. Sedó and
DeCristoforo (2001) revised correlational studies of
the FDT with other measures and found a signicant
association with the SCWT. The effect sizes reported
by the authors were very similar to ours, suggesting
a transcultural validity. Sedó (2007) also reviewed
other correlational studies and reported signicant
correlations with other attentional and executive
functions tests with moderate or high effect sizes. In
the Brazilian population, Magalhães (2013) examined
the association of the FDT with other measures related
to inhibitory control in healthy adults. Her results
indicated that the FDT along with the SCWT and other
tests of attention composed a latent factor related to
interference control, a subcomponent of the inhibitory
control system. A study with mood disorders carried
in older adults with major depressive disorders also
revealed signicant group differences between patients
and controls, with moderate to high effect sizes (de
Paula et al. 2011).
This study has important limitations, which we
must address. We had a small sample size. Although
the participants were well characterized and some
constraint were adopted for the statical analysis, the
sample size is not sufcient to identify associations
with small effect sizes. In addition, other factors, which
may have inuenced the results, such as premorbid
IQ, number of BD episodes, reading and counting
prociency, were not controlled. Despite these
limitations, the results show evidence of validity for a
new attention/executive functions test, which may be
more adequate for the assessment of Brazilian adults
with psychiatric disorders than the traditional ones due
to their heterogeneous educational background.
we found correlations between the Five Points Test
unique drawing (a more “pure” measure of uency and
processing speed) with the two rst FDT components
(22 and 18% of shared variance respectively), but not
with the Choosing and Shifting components. However,
the Five Points Test errors were signicantly correlated
with all the FDT errors, but more with the Choosing
Errors (56% of shared variance). On the divergent
validity analysis, no signicant correlations were found
between any measures of the FDT with the RAVLT sum
of words.
Table 3 shows the BD and control groups
performance in the FDT, as well as the group
comparisons. We found large effect sizes for all FDT
timed measures (Cohens’s d ranging from 2.8 to 3.3)
and for errors of Choosing (d=1.1) and Shifting (d=1.0).
Comparisons on “automatic” attentional process errors
were not signicant. When all the timed measures along
with the Choosing and Shifting Errors were entered on
a forward stepwise binary logistic regression model,
the procedure yielded signicant results on its last step
(χ²=62.81, df=1, p<0.001), and answered for 79% of
variance according to the Negelkerke pseudo-R² test.
The FDT Shifting time alone (β= -0.32, SE=0.09,
p<0.001, Wald=12.43) had an overall classication
rate of 90%, 86% for the BD group and 94% for the
control group. The results suggest a sensitivity of 0.94,
specicity of 0.87, predictive positive value of 0.86 and
predictive negative value of 0.94 for the FDT Shifting
time in the distinction between controls and BD patients.
Discussion
Our results provide a series of evidences about
the construct validity of the FDT for the assessment
of patients with BD. When correlated with a criterion
measure of selective-attention/executive functions
(SCWT) we found a large fraction of shared variance
between the tests, both in terms of time and errors.
When correlated to the convergent measure, a non-
verbal uency test (Five Points Test), we found
signicant associations between the automatic timed
components of the test and the production of drawings;
and the errors on the FDT with incorrect drawings
Table 3. Group comparisons on the FDT measures between the Bipolar Disorder group and a paired control group
(matched by gender, age and education)
FDT Measures Bipolar Disorder (n=35) Controls (n=35) Independent samples t-test
M (SD) Min-Max M (SD) Min-Max t d
Reading (T) 29.83 (8.50) 16-55 19.94 (2.59) 14-24 6.6* 3.3
Counting (T) 37.91 (12.27) 19-73 23.43 (2.94) 19-29 6.8* 3.1
Choosing (T) 57.94 (21.17) 31-120 35.06 (5.09) 26-46 6.2* 2.8
Shifting (T) 79.71 (29.98) 41-153 44.17 (5.53) 35-55 6.9* 2.9
Reading (E) 0.29 (0.96) 0-4 0.00 (0.00) 0-0 1.8 -
Counting (E) 0.49 (1.54) 0-8 0.00 (0.00) 0-0 1.9 -
Choosing (E) 1.97 (3.71) 0-17 0.29 (0.57) 0-2 2.7* 1.1
Shifting (E) 3.09 (5.35) 0-28 0.97 (1.12) 0-3 2.3* 1.0
Note: *p<0.05
T: Time, E: Errors, M: Mean, SD: Standard-Deviation, Min: Minimum, Max: Maximun, , d: Cohen’s d (effect size)
The Five Digits Test in Bipolar Patients
Clinical Neuropsychiatry (2014) 11, 3 107
assessment of type I bipolar patients. Journal of Affective
Disorders 112, 1, 231-236.
O’Shea R, Poz R, Michael A, Berrios GE, Evans JJ,
Rubinsztein JS (2010). Ecologically valid cognitive tests
and everyday functioning in euthymic bipolar disorder
patients. Journal of Affective Disorders 125, 1, 336-340.
Raven J (1981). Manual for Raven’s Progressive Matrices and
Vocabulary Scales. Harcourt Assessment, San Antonio,
TX.
Regard M, Strauss E, Knapp P (1982). Children’s production
on verbal and non-verbal uency tasks. Perceptual and
Motor Skills 55, 1, 839-44.
Malloy-Diniz LF, Lasmar VA, Gazinelli LS, Fuentes D,
Salgado JV (2007). he Rey Auditory-Verbal Learning
Test: applicability for the Brazilian elderly population.
Revista Brasileira de Psiquiatria 29, 4, 324-329.
Sedó MA (2007). Five Digits Test. TEA Ediciones, Madrid.
Sedó MA, DeCristoforo L (2001). All-language verbal
tests free from linguistic barriers. Revista Espanola de
Neurosicología 3, 3, 68-82.
Solé B, Bonnin CM, Balanzá-Martínez V, Tabarés-Seisdedos
R, Popovic D, Martínez-Arán A, Vieta E (2012).
Neurocognitive impairment and psychosocial functioning
in bipolar II disorder. Acta Psychiatriatrica Scandinavica
125, 4, 309-317.
Troyer AK, Leach L, Strauss E (2006). Aging and response
inhibition: Normative data for the Victoria Stroop Test.
Aging, Neuropsychology, and Cognition: A Journal on
Normal and Dysfunctional Development 13, 1, 20-35.
Young RC, Biggs JT, Ziegler VE, Meyer DA (1978). A rating
scale for mania: reliability, validity and sensitivity. The
British Journal of Psychiatry 133, 429-435.
Acknowledgements
Grant INCT-MM (FAPEMIG: CBB-APQ-00075-09/
CNPq 573646/2008–2).
References
Amorim P (2000). Mini International Neuropsychiatric
Interview (MINI): validation of a short structured
diagnostic psychiatric interview. Revista Brasileira de
Psiquiatria 22, 3, 106-115.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J (1961).
An inventory for measuring depression. Archives of
General Psychiatry 4, 561-571.
Cox CS, Chee E, Chase GA, Baumgardner L, Schuerholz LJ,
Reader MJ, Morh J, Denckla MB (1997). Reading prociency
affects the construct validity of the Stroop Test Interference
Score. The Clinical Neuropsychologist 11, 2, 105-110.
de Paula JJ, Ávila RT, Costa DS, Moraes EN, Bicalho MA,
Nicolato R, Corrêa H, Sedó M, Malloy-Diniz LF (2011).
Assessing processing speed and executive functions
in low educated older adults: the use of the Five Digits
Test in patients with Alzheimer’s disease, mild cognitive
impairment and major depressive disorders. Clinical
Neuropsychiatry: Journal of Treatment Evaluation 8, 6,
339-346.
Magalhães SS (2013). Estrutura fatorial do controle inibitório
no envelhecimento: Comparação entre amostras de
adultos e idosos [dissertation]. Curitiba: Universidade
Federal do Paraná.
Malloy-Diniz LF, Neves FS, Abrantes SS, Fuentes D, Corrêa
H (2009). Suicide behavior and neuropsychological
... Other participants were evaluated through a computerized tablet version of the Stroop task (inspired by 29,30). The task was done on an iPad Air 16 GB Apple (9.7 inches) supported by a stand (Ankter™) using Safari on full-screen mode, and it included four conditions: reading, counting, inhibition and switching. ...
Article
Aerobic training can lead to improved cognition in older adults and this effect can be explained by enhanced cardiorespiratory fitness. However, statins could limit the physical benefits of aerobic training by altering the mechanisms through which exercise improves cognition. Whether statins could have an effect on the cognitive benefits associated with aerobic training remains to be elucidated. The objective of this study was to determine whether the cognitive benefits of aerobic training were comparable in statin users and non-users. A total of 144 sedentary participants (>60 y.o.; 106 non-users, 38 statin users) were included. Participants were either part of an aerobic training group (n = 75) or a control group (n = 69). Cognition was assessed using the Stroop test. Analyses were performed on z-score changes from pre to post-intervention of Stroop reaction time (RT) and number of errors, using Two-factor ANCOVAs, while controlling for potential confounding factors (age, education, BMI, Charlson Comorbidity Index, sex, protocol and handgrip strength). The moderating effect of statins on the cognitive changes associated with aerobic training was determined through moderation analyses. An interaction effect on the Stroop switching condition was detected between intervention and statin intake (F [1, 140] = 5.659, P < 0.01). The intervention effect on switching RT was moderated by statin intake, where intervention improved switching RT only in non-users (Effect = 0.1678; P < 0.01). Statins could limit the cognitive benefits of aerobic training on switching capacities in some patients. Future randomized studies including a larger number of participants and looking at different types of statins should be conducted to confirm these results.
... go/no go tasks) were associated with HI (Polner et al., 2014). It is important to note, for example, that studies using Stroop Color-Word Test found correlations with FDT performance (De Paula, Abrantes, Neves, & Malloy-Diniz, 2014;De Paula et al., 2011). Interestingly, a study aimed at parsing ADHD-related heterogeneity in its underlying neurobiology by investigating functional connectivity across multiple brain networks found that clusters within the visual networks were primarily related to inattention and reaction time variability. ...
Article
Symptoms of inattention and hyperactivity/impulsivity, arranged along a continuum, are commonly associated with neuropsychological and academic deficits, even in the general population. The aim of this study is to analyze how Attention Deficit Hyperactivity Disorder (ADHD) symptoms are associated with the performance in neuropsychological and academic abilities (phonological processing, processing speed/automatic attention, executive functions, reading, and spelling) in school-age children. The sample consisted of 216 children from 3rd and 4th grades (M = 8.94 years old, SD =.71) from public elementary schools of two Brazilian capitals. Pearson correlation and Multiple Linear Regression analysis were performed. Inattention symptoms were the only predictors of performance in phonological processing (phoneme suppression and rapid automatized naming of letters), processing speed/automatic attention, executive functions, such as inhibitory control and cognitive flexibility, and reading fluency. Beta values ranged from .14 to .27, and the largest value was related to an inhibitory control task. Inattention, and not hyperactivity/impulsivity symptoms, seems to affect neuropsychological functions even in non-clinical diagnosed children. Contributions and future directions are discussed.
... Finally, the Digit Stroop task was also based on previous studies (de Paula et al., 2014;Sedo, 2004) and was comprised of four different conditions: Reading, Counting, Inhibition, and Switching. During the Reading block, digits 1 to 6 were presented on the screen and the participants were instructed to identify it by pressing the corresponding button. ...
Article
Introduction: It is generally accepted that physical activity promotes healthy aging. Recent studies suggest dance could also benefit cognition and physical health in seniors, but many styles and approaches of dance exist and rigorous designs for intervention studies are still scarce. The aim of this study was to compare the effects of Dance/Movement Training (DMT) to Aerobic Exercise Training (AET) on cognition, physical fitness and health-related quality of life in healthy inactive elderly. Methods: A single-center, randomized, parallel assignment, open label trial was conducted with 62 older adults (mean age = 67.48 ± 5.37 years) recruited from the community. Participants were randomly assigned to a 12-week (3x/week, 1hr/session) DMT program, AET program or control group. Cognitive functioning, physical fitness and health-related quality of life were assessed at baseline (T-0), and post-training (T-12 weeks). Results: 41 participants completed the study. Executive and non-executive composite scores showed a significant increase post-training (F(1,37) = 4.35, p = .04; F(1,37) = 7.01, p = .01). Cardiovascular fitness improvements were specific to the AET group (F(2,38) = 16.40, p < .001) while mobility improvements were not group-dependent (10 m walk: F(1,38) = 11.67, p = .002; Timed up and go: F(1,38) = 22.07, p < .001). Conclusions: Results suggest that DMT may have a positive impact on cognition and physical functioning in older adults however further research is needed. This study could serve as a model for designing future RCTs with dance-related interventions. REGISTRATION: clinicaltrials. gov Identifier NCT02455258.
... Na fase de Escolha o indivíduo deve executar ações controladas e conscientes que o obrigam a mobilizar um nível superior de recursos mentais 3,4,8 . Na fase de Escolha o sujeito deve inibir a leitura dos números apresentados e dizer quantos números existem em cada estímulo, apresentados dessa vez de forma incongruente (quando o sujeito encontra 2-2-2, deve dizer "três", ou quando encontra 1-1-1-1, deve dizer "quatro"). ...
Article
Full-text available
Objetivo O presente estudo analisou a confiabilidade do Teste dos Cinco Dígitos (FDT), um instrumento de avaliação dos processos atencionais baseado no paradigma Stroop. O teste usa números e quantidades para avaliação do efeito de interferência atencional. Métodos Avaliamos 49 adultos brasileiros por meio do FDT. Os participantes realizaram o teste em dois momentos, com aproximadamente duas semanas de intervalo. A confiabilidade do teste foi estimada pela consistência interna (método das metades) e pela avaliação da estabilidade teste-reteste (coeficiente de correlação intraclasse e teste de Wilcoxon para amostras repetidas). Resultados O tempo de resposta médio dos participantes apresentou discreta melhora nas etapas mais simples do teste e mais acentuada nas etapas mais complexas. A consistência interna do teste foi superior a 0,9. A estabilidade teste-reteste variou em função da etapa do teste, e todas as correlações foram significativas (p < 0,01) e explicaram entre 60% e 90% da variância encontrada. Conclusão O FDT apresenta evidências robustas de confiabilidade na amostra avaliada. Esse foi o primeiro estudo brasileiro a avaliar essa propriedade pelo método de teste-reteste. Os resultados propiciam melhor aplicabilidade do FDT nos contextos de clínica e pesquisa.
... This task is low linguistic dependence and does not penalise participants with reading problems (17). Some studies indicate good construct and criterion validity for patients of different ages and educational and cultural backgrounds (18). Sed o et al. (16,17) reported significant correlations with other attention and executive function tests with moderate or high effect sizes and correlations with the Stroop test were between 0.65 and 0.71. ...
Article
This study investigated the relationship between being overweight or obese and executive function in six to ten-year-olds. The participants were 515 children (250 boys) from schools in Reus, Spain. The initial sample was measured and weighed and assessed with the Children's Color Trail Test. Children classified as overweight, including obese, and their age and gender-matched controls (n=221), were assessed in a second phase with the Five Digit Test (FDT) and the Symbol Digit Modalities Test. Logistic regression models were applied to analyse the effect of executive functions on being overweight, including obese. We found that 28.9% of the children were overweight and 7.2% were obese. The FDT showed that inhibition (odds risk of 1.04, range 1.00-1.08, p=0.04) and flexibility (odds risk of 1.04, range 1.00-1.07, p=0.02) were significantly associated with overweight, including obesity, regardless of sociodemographic and psychopathological variables. These results suggest that children who were overweight or obese had a reduced ability to mobilise the cognitive effort required to inhibit involuntary responses and to switch between different mental operations. A developmental trajectory would provide important insights into the relationship between executive functioning pattern and the risk of being overweight or obese. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Article
Full-text available
Age-related mobility and cognitive declines are closely linked, but their relationship is complex and needs to be further investigated. The study aimed to test if cognition (processing speed, inhibition and switching performances) mediate the age-related difference in mobility. Mediation analyses were used to test whether processing speed, inhibition and switching performances on the Stroop test mediate the relationship between age and performances at the Timed Up and Go (TUG). Only switching performances mediated the age-related difference in TUG (65.1% of the total effect) supporting the notion that executive control plays a critical role in older adults’ mobility.
Article
Full-text available
Introduction In the assessment of older adults with very low formal education, typical tests of selective attention and inhibitory control are biased by reading abilities. In this sense, we aim to assess the psychometric characteristics of the Five Digits Test (FDT), a numerical Stroop paradigm, in older adults without cognitive disorders, with mild cognitive impairment, and with dementia. Methods We assessed 211 Brazilian older adults with low formal education using the FDT and other cognitive measures. Construct validity and reliability were assessed by correlations and internal consistency. Results The FDT test had weak correlations with crystalized intelligence tests and moderate-high correlations with fluid intelligence measures and tests of global cognitive status and executive functions. The split-half coefficient of reliability showed high internal consistency (>0.900). Conclusion Together, the results suggest that the FDT is a valid and reliable measure for the assessment of processing speed and executive functions in older adults with low formal education.
Article
Full-text available
Objetivos: O MINI é uma entrevista diagnóstica padronizada breve (15-30 minutos), compatível com os critérios do DSM-III-R/IV e da CID-10, que é destinada à utilização na prática clínica e na pesquisa em atenção primária e em psiquiatria, e pode ser utilizada por clínicos após um treinamento rápido (de 1 a 3 horas). A versão Plus do MINI, mais detalhada, gera diagnósticos positivos dos principais transtornos psicóticos e do humor do DSM-IV. Este artigo apresenta os resultados de quatro estudos de validação do instrumento, realizados na Europa e nos EUA. Métodos: Os estudos 1 (França) e 2 (EUA) testaram a confiabilidade - entre avaliadores e teste-reteste - da versão DSM-III-R do MINI (n=84, sendo 42 pacientes psiquiátricos de cada centro) e sua validade com relação ao CIDI (n=346, sendo 296 pacientes psiquiátricos e 50 controles) e ao SCID-P (n=370, sendo 308 pacientes psiquiátricos e 62 controles), respectivamente. O estudo 3 testou a validade de diagnósticos gerados por clínicos gerais usando o MINI (DSM-IV) com relação aos diagnósticos clínicos habituais de psiquiatras, em 409 pacientes de centros de atenção primária de quatro países (França, Espanha, Itália e Reino Unido). O estudo 4 testou a confiabilidade entre avaliadores (n=20 pacientes psiquiátricos) e a validade dos módulos Transtornos Psicóticos, Depressão e Mania do MINI Plus - DSM IV (n=104 pacientes psiquiátricos) com relação a dois critérios de referência: diagnósticos do CIDI e diagnósticos clínicos de psiquiatras. Análises quantitativas (índices de concordância e de validade) e qualitativas (razões de discordância) foram realizadas. Resultados: Os índices de confiabilidade do MINI (estudos 1 e 2) e do MINI Plus (estudo 4) foram globalmente satisfatórios. Comparados a vários critérios de referência (CIDI, SCID-P, opinião de peritos), em diferentes contextos (unidades psiquiátricas e centros de atenção primária), o MINI e o MINI Plus mostraram qualidades psicométricas similares às de outras entrevistas diagnósticas padronizadas mais complexas, permitindo uma redução de 50% ou mais no tempo da avaliação. Análises qualitativas identificaram dificuldades e erros diagnósticos ligados aos casos, métodos de avaliação e critérios de diagnósticos estudados. Modificações foram introduzidas para corrigir os problemas identificados e otimizar as propriedades psicométricas do MINI e do MINI Plus. Conclusões: O MINI e sua versão Plus são adaptados ao contexto clínico e à avaliação de pacientes mais graves, e representam uma alternativa econômica para a seleção de pacientes, segundo critérios internacionais, em estudos clínicos e epidemiológicos. O MINI já está disponível em aproximadamente 30 idiomas, incluindo a versão brasileira. As perspectivas atuais de adaptação e aplicação transcultural do instrumento são discutidas.
Article
Full-text available
OObjective: Executive functions and processing speed assessment in subjects diagnosed with Alzheimer’s disease (AD), Mild Cognitive Impairment (MCI), and Major Depressive Disorder (MDD) are often made by use of classical neuropsychological tasks (e.g.: Stroop Color Word Test). Drawbacks in instruments like the chromatic and linguistic properties of the SCWT have limited its application in elderly. An alternative are the Mini-Verbal Tests (MVT) where language content is kept on a minimum. We evaluate the use of a MVT version of the Stroop paradigm in the assessment of a mixed clinical group of older adults and its relation with global cognitive impairment. Method: In a case-control study, we examined 114 subjects divided in four groups: 30 AD, 30 MCI, 24 MDD, and 30 community-dwelling normal aged controls (NAC) with the Five Digit Test (5D) a MVT adaptation of the SCWT, in low educated older adults. The four groups were compared by one-way ANOVA in the processing speed, inhibition and cognitive shifting components of 5D. Results: Our results suggest that the processing speed impairments may be a more consistent finding in diffuse neurological damage cases as dementia, or chronic mood disorders, although the inhibition deficits may be a more specific feature of the dementia. The shifting component of the 5D have also shown good clinical validity in the characterization of MDD patients (which shown a slower performance when compared to NAC) and AD (where an expressive amount of patients were unable to perform the task and error were more frequently). Conclusion: The 5D seems a valuable tool for the assessment of processing speed and executive functions in the clinical population of Brazilians low educated older adults, being an alternative to the classic SCWT.
Article
Full-text available
Abstract: The assessment of foreign subjects does often require the use of professionals or interpreters with specific language skills, or even the administration of “culture-free” psychological tests. This one may provide an accurate picture of the “spatial talents” of the subjects but not of their “conceptual” talents, particularly when a definite “cognitive” style (or a language disability) are also present. One possible solution is to measure the “verbal” talents with “all-language verbal tests”, administered in their primary language. This may be quite easy, if we think of measuring talents such as word-finding, serial organization or inhibition of responses. Actually, neuropsychologists do often measure “processing” rather than “knowledge”, and many of our neuropsychological tests are already –whether we notice it or not - “verbal not-language-bound” tests that can be easily administered in other languages. Even tests not originally conceived or designed in that format (“Color-Word Test”, “Trail Making Test”) can be easily adapted to an all-language verbal form by stepping down their cognitive requirements. Traditional and non-traditional forms of both tests were compared. Correlations suggest that both (traditional and non-traditional forms) can be used interchangeably, without any loss in the validity of the test, and with a definite increase in the applicability of the test to younger subjects, foreign-language speakers, recent immigrants, and uneducated or dyslexic subjects. Key words: verbal not language-bound, multicultural, prefrontal, executive functions
Article
The Stroop Color and Word Test is used clinically to assess a specific aspect of executive function, that is, selective inhibition. It requires a subject to inhibit an automatized reading response in favor of a less well-rehearsed, competing color-naming response. Although it is necessary to the interpretation of the Stroop effect observed during the interference condition, the degree of automaticity of the reading response is usually assumed in an adult population rather than being defined by any standard reading measures. The present investigation demonstrated that, in a group of 306 parents of children with learning disabilities, the best indicator of reading automaticity was not simply a standard word-reading score within normal limits, but rather a score that was at least equal to the individual's Full Scale IQ. In those subjects who satisfied this reading criterion, the Stroop Interference score correlated significantly with other measures of response inhibition. No such correlation was observed in subjects who did not satisfy the reading automaticity criterion.
Article
There is a growing body of evidence on neurocognitive impairment in euthymic bipolar patients, but this issue has been studied mostly in bipolar I disorder, data on bipolar II (BD-II) are scant and discrepant. The two aims of this study were to ascertain whether strictly defined euthymic BD-II patients would present neurocognitive disturbances and to evaluate their impact on functional outcome. Forty-three BD-II patients and 42 demographically and educationally matched healthy subjects were assessed with a comprehensive neuropsychological test battery and with the Social and Occupational Functioning Assessment Scale (SOFAS). The euthymia criteria were reduced (Hamilton Rating Scale for Depression score ≤6 and a Young Mania Rating Scale score ≤6) to minimize the influence of subdepressive symptomatology on cognition and functioning. BD-II patients showed a significantly lower performance on several measures of attention, learning and verbal memory, and executive function compared with healthy controls. The presence of subthreshold depressive symptomatology and one measure related to executive function (Trail Making Test, part B) was the variables that best predicted psychosocial functioning measured with the SOFAS. This report provides further evidence that euthymic BD-II patients present cognitive impairment which may impact psychosocial functioning.
Article
In euthymic bipolar disorder patients, scores on the Mini-Mental State Examination (MMSE) are not abnormal but general functioning remains impaired. Recent studies provide ample evidence that euthymic patients show significant impairment on more comprehensive neuropsychological test batteries. There is no definitive relationship between performance on neuropsychological test batteries and the ability to cope in everyday life. Ecologically valid tests of cognitive function aim to bridge this gap as they use everyday tasks to explore cognitive function. The aims of the study were to examine if euthymic bipolar disorder patients were impaired on ecologically valid tests of cognitive function and measures of general, social and occupational function. We examined the relationships between cognitive impairment and residual symptoms, clinical history, general functioning and employment. Cognitive tasks, functional assessments and mood scales were administered to 29 euthymic bipolar disorder patients and 29 matched controls. Patients were impaired on ecologically valid tests of attention, memory and executive function. Patients showed impairment in general, social and occupational functioning. Unemployment was associated with impairment in attention. Memory impairment correlated with number of previous manic episodes. All patients were on psychotropic medication, which may affect cognition. Traditional neuropsychological tests were not performed concurrently with ecologically valid tests. Ecologically valid tests of cognitive function are sensitive in detecting cognitive impairment in euthymic bipolar disorder. Clinicians should consider using these tests in the recovery phase of bipolar illness, as they may be particularly helpful in showing where rehabilitation should focus.
Article
An eleven item clinician-administered Mania Rating Scale (MRS) is introduced, and its reliability, validity and sensitivity are examined. There was a high correlation between the scores of two independent clinicians on both the total score (0.93) and the individual item scores (0.66 to 0.92). The MRS score correlated highly with an independent global rating, and with scores of two other mania rating scales administered concurrently. The score also correlated with the number of days of subsequent stay in hospital. It was able to differentiate statistically patients before and after two weeks of treatment and to distinguish levels of severity based on the global rating.
Article
Children aged 6 to 13 yr. were given verbal and non-verbal fluency tasks as well as the Vocabulary and Block Design subtests of the WISC-R. The results, providing normative data, showed that the fluency tasks are age-, but not sex-dependent, and are only modestly correlated to one another and to standard measures of intelligence.