Immediate recall of short stories depends on educational level

Nitrini, Ricardo

doi:10.1590/S1980-57642009DN20400014

Abstract

Memory complaints are frequent in the elderly but the confirmation of memory decline is challenging. Tests employing the recall of paragraphs or short stories have been proposed for the diagnosis of Alzheimer's disease and amnestic mild cognitive impairment. Objectives: To evaluate the influence of educational level on immediate recall of short stories. Methods: A sample of 363 individuals (214 women; median age of 50; median years of schooling of 6; 23 illiterates) without evident physical or mental illnesses were evaluated with simple neuropsychological tests, including the recall of short stories immediately after listening to them read aloud by the examiner. Results: Age showed an inverse correlation whereas years of schooling showed a direct correlation with the scores on the immediate recall of short stories. As age and years of schooling were inversely correlated, logistic regression was employed, which showed that only years of schooling had an influence on the performance in the test. Conclusions: In populations with heterogeneous educational background, the recall of short stories cannot be recommended for the diagnosis of memory impairment. It is possible that tests with larger encoding phases are more appropriate for these populations. From a broader perspective, information released by radio or TV, as well as information disseminated orally in public settings such as hospitals, stations or airports may be less well retained by low educated individuals, especially when the information is presented only once.

Key words:
memory; Alzheimer's disease; mild cognitive impairment; logical memory; education; neuropsychological tests

Resumo

Queixas de problemas com a memória são freqüentes em idosos, mas a confirmação de declínio da memória não é simples. Testes que utilizam a recordação de parágrafos ou estórias curtas têm sido propostos para o diagnóstico de doença de Alzheimer e de comprometimento cognitivo leve amnéstico. Objetivos: Avaliar a influência do nível educacional sobre a recordação imediata de estórias curtas. Métodos: 363 indíviduos (214 mulheres; idade mediana de 50; escolaridade mediana de 6; 23 analfabetos) sem doenças físicas ou mentais evidentes foram avaliados com testes neuropsicológicos simples que incluíram a recordação de estórias simples imediatamente depois da leitura em voz alta pelo examinador. Resultados: Idade correlacionou-se inversamente enquanto anos de escolaridade correlacionou-se diretamente com os escores na recordação imediata das estórias. Como idade e anos de escolaridade correlacionaram-se inversamente, foi empregada regressão logística que demonstrou que apenas a escolaridade influenciou o desempenho no teste. Conclusões: Em populações com nível educacional heterogêneo, a recordação de estórias curtas não deve ser recomendada para o diagnóstico de comprometimento da memória. É possível que testes com fases de codificação mais prolongadas ou repetidas sejam mais apropriados para populações deste tipo. A partir de perspectiva mais ampla, informações divulgadas por rádio ou televisão, bem como avisos oralmente apresentados em espaços públicos como hospitais, estações ou aeroportos podem ser menos lembrados por indivíduos de baixa escolaridade, especialmente quando a informação for apresentada uma única vez.

Palavras-chave:
memória; doença de Alzheimer; comprometimento cognitivo leve; memória lógica; educação; testes neuropsicológicos

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References

¹
Damasceno BP. Brain aging. The problem of differential diagnosis between normal and pathologic. Arq Neuropsiquiatr 1999;57:78-83.
²
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, D.C.: American Psychiatric Association, 1994.
³
World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Geneva: World Health Organization, 1993.
⁴
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.
⁵
Welsh K, Butters N, Hughes J, Mohs R. Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol 1991;48:278-281.
⁶
Weschler D. Weschler Memory Scale - revised manual. New York: Psychological Corporation, 1987.
⁷
Kluger A, Ferris SH, Golomb J, Mittelman MS, Reisberg B. Neuropsychological prediction of decline to dementia in nondemented elderly. J Geriatr Psychiatry Neurol 1999;12:168-179.
⁸
Fleisher AS, Sowell BB, Taylor C, Gamst AC, Petersen RC, Thal LJ. Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment. Neurology 2007;68:1588-1595.
⁹
Grundman M, Petersen RC, Ferris SH, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol 2004;61:59-66.
¹⁰
Petersen RC, Morris JC. Clinical features. In Mild Cognitive Impairment, edited by Ronald C. Petersen, Rochester, Minnesota: Oxford University Press, 2003:15-39.
¹¹
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.
¹²
Reitan RM. Validity of the Trail-Making Test as an indication of organic brain damage. Percept Mot Skills 1958;8:271-276.
¹³
Luria AR. Higher cortical functions in man. New York: Basic Books, 1966.
¹⁴
Abikoff H, Alvir J, Hong G, et al. Logical memory subtest of the Wechsler Memory Scale: age and education norms and alternate-form reliability of two scoring systems. J Clin Exp Neuropsychol 1987;9:435-448.
¹⁵
Ardila A, Rosselli M, Rosas P. Neuropsychological assessment in illiterates: visuospatial and memory abilities. Brain Cogn 1989;11:147-166.
¹⁶
Mejia S, Pineda D, Alvarez LM, Ardila A. Individual differences in memory and executive function abilities during normal aging. Int J Neurosci 1998;95:271-284.
¹⁷
Fox DD. Normative problems for the Wechsler Memory Scale-revised logical memory test when used in litigation. Arch Clin Neuropsychol 1994;9:211-214.
¹⁸
Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's disease (CERAD): Part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.
¹⁹
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.
²⁰
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36.
²¹
Grober E, Gitlin HL, Bang S, Buschke H. Implicit and explicit memory in young, old, and demented adults. J Clin Exp Neuropsychol 1992 ; 14:298-316.
²²
Buschke H, Sliwinski MJ, Kuslansky G, Lipton RB. Diagnosis of early dementia by the Double Memory Test: encoding specificity improves diagnostic sensitivity and specificity. Neurology 1997;48:989-997.
²³
Nitrini R, Caramelli P, Herrera E Jr, at al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10: 634-638.

Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
19 Oct 2008
Accepted
03 Nov 2008

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

[1] ¹
Damasceno BP. Brain aging. The problem of differential diagnosis between normal and pathologic. Arq Neuropsiquiatr 1999;57:78-83.

[2] ²
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th Ed. Washington, D.C.: American Psychiatric Association, 1994.

[3] ³
World Health Organization (WHO). The ICD-10 classification of mental and behavioral disorders. Diagnostic criteria for research. Geneva: World Health Organization, 1993.

[4] ⁴
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol 1999;56:303-308.

[5] ⁵
Welsh K, Butters N, Hughes J, Mohs R. Heyman A. Detection of abnormal memory decline in mild cases of Alzheimer's disease using CERAD neuropsychological measures. Arch Neurol 1991;48:278-281.

[6] ⁶
Weschler D. Weschler Memory Scale - revised manual. New York: Psychological Corporation, 1987.

[7] ⁷
Kluger A, Ferris SH, Golomb J, Mittelman MS, Reisberg B. Neuropsychological prediction of decline to dementia in nondemented elderly. J Geriatr Psychiatry Neurol 1999;12:168-179.

[8] ⁸
Fleisher AS, Sowell BB, Taylor C, Gamst AC, Petersen RC, Thal LJ. Clinical predictors of progression to Alzheimer disease in amnestic mild cognitive impairment. Neurology 2007;68:1588-1595.

[9] ⁹
Grundman M, Petersen RC, Ferris SH, et al. Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Arch Neurol 2004;61:59-66.

[10] ¹⁰
Petersen RC, Morris JC. Clinical features. In Mild Cognitive Impairment, edited by Ronald C. Petersen, Rochester, Minnesota: Oxford University Press, 2003:15-39.

[11] ¹¹
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.

[12] ¹²
Reitan RM. Validity of the Trail-Making Test as an indication of organic brain damage. Percept Mot Skills 1958;8:271-276.

[13] ¹³
Luria AR. Higher cortical functions in man. New York: Basic Books, 1966.

[14] ¹⁴
Abikoff H, Alvir J, Hong G, et al. Logical memory subtest of the Wechsler Memory Scale: age and education norms and alternate-form reliability of two scoring systems. J Clin Exp Neuropsychol 1987;9:435-448.

[15] ¹⁵
Ardila A, Rosselli M, Rosas P. Neuropsychological assessment in illiterates: visuospatial and memory abilities. Brain Cogn 1989;11:147-166.

[16] ¹⁶
Mejia S, Pineda D, Alvarez LM, Ardila A. Individual differences in memory and executive function abilities during normal aging. Int J Neurosci 1998;95:271-284.

[17] ¹⁷
Fox DD. Normative problems for the Wechsler Memory Scale-revised logical memory test when used in litigation. Arch Clin Neuropsychol 1994;9:211-214.

[18] ¹⁸
Morris JC, Heyman A, Mohs RC, et al. The Consortium to Establish a Registry for Alzheimer's disease (CERAD): Part 1. Clinical and neuropsychological assessment of Alzheimer's disease. Neurology 1989;39:1159-1165.

[19] ¹⁹
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.

[20] ²⁰
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36.

[21] ²¹
Grober E, Gitlin HL, Bang S, Buschke H. Implicit and explicit memory in young, old, and demented adults. J Clin Exp Neuropsychol 1992 ; 14:298-316.

[22] ²²
Buschke H, Sliwinski MJ, Kuslansky G, Lipton RB. Diagnosis of early dementia by the Double Memory Test: encoding specificity improves diagnostic sensitivity and specificity. Neurology 1997;48:989-997.

[23] ²³
Nitrini R, Caramelli P, Herrera E Jr, at al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10: 634-638.

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