Utilize este identificador para referenciar este registo: http://hdl.handle.net/10451/30383
Título: Avaliação de capacidades cognitivas não-verbais na afasia de etiologia vascular
Autor: Fonseca, José Manuel Borges, 1964-
Orientador: Martins, Isabel Pavão, 1956-
Raposo, Ana Luísa Nunes, 1978-
Palavras-chave: Teses de doutoramento - 2017
Funções executivas
Data de Defesa: 2017
Resumo: Aphasia is an acquired language disorder in the absence of evident sensory or cognitive impairment that accounts for language deficits. In addition to language and communication difficulties, there is some evidence that patients with aphasia may have below-average cognitive performance on nonverbal tests. Despite this evidence, cognitive assessment in aphasia is rarely performed, although it is critical to the full understanding of cognitive changes associated with stroke. In fact, patients with aphasia, who account for about 1/3 of stroke patients, are not systematically included in cognitive decline studies because of their language impairments. There is little information about the prevalence of cognitive decline and dementia in that population, namely its relation with aphasia severity. One of the major problems associated with cognitive assessment in aphasia is that the vast majority of neuropsychological tests involve verbal responses and the comprehension of verbal instructions, placing those individuals at a disadvantage when compared to non-aphasic populations. Although the study of the cognition of patients with aphasia has aroused the interest of some researchers, since the XIX century, the number of studies published in this field has been limited to the study of specific domains or specific cognitive functions. There are few studies where cognitive functions have been comprehensively evaluated in the population with aphasia. In this work we intend to perform a comprehensive evaluation of the nonverbal cognition of patients with stroke aphasia. To do this, we sought to understand the appropriate instruments for the construction of an evaluation battery, to determine its applicability, to evaluate the cognitive profile of this population and to evaluate the contribution of nonverbal cognitive functions in the recovery of aphasia. In order to understand the "state of the art", a systematic review of the literature of the last 20 years was carried out in Chapter 3 "Cognitive Evaluation of People with Aphasia after stroke: Systematic Review" with the objective of identifying which non-verbal cognitive assessments used to assess patients with aphasia. It was concluded that a great diversity of evaluation instruments has been used, but few tests are used in more than one study. This underlines the difficulty of comparing results across different studies. In Chapter 4, "Developing a Cognitive Evaluation Battery for Patients with Aphasia," a set of fundamentally non-verbal tests was selected to evaluate the different cognitive domains. Selection was based on the results of the previous study, their availability and the existence of norms for the Portuguese population. Since there were no norms for the Portuguese population for three of the selected memory tests (Camels and Cactus, 5 Objects, Spacial span of WMS III) nor for a test of executive functions (Tower of Hanoi), preliminary normative results were obtained in a sample of 126 healthy participants, of both sexes, without neurological and /or psychiatric pathology, with more than 50 years of age and with at least four years of literacy. A relationshipwas found between performance on tests, higher schooling and younger age, and no significant gender differences. In Chapter 5, "Cognitive functioning in chronic vascular aphasia", the cognitive profile of patients with aphasia within the first 6 monts of stroke was determined in a battery of ten selected tests. The performance was compared with that of a control group with a left hemispheric stroke lesion, without aphasia. The percentage of individuals who achieved a cognitive performance above -1.5 standard deviations from the mean ranged from 40% to 100%, which is indicative of normal cognitive performance. Memory was the cognitive domain where significantly lower performances were observed when compared to the control population. There was a tendency for worse performance in immediate recovery than in evocation after interference, which replicates the usual pattern of patients with amnestic alterations of vascular aetiology. When compared to individuals with a left hemispheric lesion without aphasia, patients with aphasia presented lower values in most cognitive tests. This finding may indicate the use of verbal strategies in the performance of the cognitive tests or the fact that the lesions responsible for the language processing networks also interrupt the systems that support the other cognitive domains. The absence of imaging examinations did not allow the evaluation of the effect of lesion size on the cognitive performance of patients with aphasia. To study the impact of cognitive performance on aphasia recovery at three months post onset (Chapter 6), a longitudinal study of 39 patients with aphasia was undertake, Subjects were assessed in the first month and reassessed three months later. In this group, a below-average performance in the memory domain was also observed in the initial evaluation. Overall language recovery was accompanied by improved cognitive performance. The initial performance in the WASI Matrix reasoning test was significantly associated with language recovery at the three-month post onset. The addition of this test to the predictive model of language recovery, which includes age, education, aphasia severity and lesion size, increases its predictive value. Because memory is the cognitive domain with the most altered performance in patients with aphasia, in chapter 7 "Memory Test of the 5 objects (M5O): performance of participants with aphasia", we tried to verify the effect of the evolution time, comprehension, and severity of the aphasia in performance on that test. For this, the performance of 91 patients with aphasia (47 chronic and 44 acute) in the memory test of the 5 objects was evaluated. The sample presented values below the mean in all the attempts of evocation. The time of evolution, the severity of aphasia and the comprehension did not influence the performance. Finally, in chapter 8 "Application of a non-verbal cognitive assessment battery in aphasia" some considerations were made about the applicability of non-verbal cognitive assessment battery in patients with aphasia. In patients with chronic aphasia (over 6 months), the mean test application was 92.4%, and the "Symbol search" test was the least applied (79.2%). The percentage of tests applied correlated negatively with age and positively with schooling and time of evolution. Interestingly, no relation was found to the severity of aphasia or auditory comprehension. In the group of patients with less than 30 days post onset the average application was 76.9%. The least applied test was again the "Symbol Search" test with an average application rate of 41.7%. There was a positive correlation with education. In conclusion, the assessment of the cognition of patients with aphasia using non-verbal tests is possible and desirable because it may allow the clarification and diagnosis of the cognitive abilities of patients with aphasia. In addition, knowledge of the cognitive profile of this population may allow a more adequate therapeutic planning and the establishment of a more reliable prognosis.
Descrição: Tese de doutoramento, Ciências Biomédicas (Neurociências), Universidade de Lisboa, Faculdade de Medicina, Faculdade de Letras, 2017
URI: http://hdl.handle.net/10451/30383
Designação: Doutoramento em Ciências Biomédicas
Aparece nas colecções:FM - Teses de Doutoramento

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