LAISS BERTOLA DE MOURA RICARDO
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- Glaucoma, but not cataracts, predicts lower verbal fluency performance: 3.8-year follow-up from the ELSA-Brasil study(2021) VIDAL, Kallene S. M.; BERTOLA, Laiss; SUEMOTO, Claudia K.; MORENO, Arlinda B.; DUNCAN, Bruce; SCHMIDT, Maria Ines; MAESTRI, Marcelo; BARRETO, Sandhi M.; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BRUNONI, Andre R.Glaucoma, cataracts, and cognitive decline are most common in older ages. Although cross-sectional studies showed that these disorders are associated, follow-up studies are lacking. To investigate this issue, baseline and follow-up data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were employed. We evaluated participants >= 55 years-old at follow-up without diagnosis of dementia, stroke, and other eye conditions except for glaucoma and cataracts. Cognition was evaluated using delayed word recall, verbal fluency, and trail making (version B) tests. Regression models were employed to investigate associations between glaucoma and cognition, adjusted by several confounders. Out of 3,867 participants, 379 and 118 presented cataracts and glaucoma, respectively. Only glaucoma was apredictor of lower verbal fluency (B = -0.23, 95% CI -035 to -012, p< 0.001). Other associations were not significant (ps>0.57). Our results suggest that glaucoma may be related to declining cognition.
bookPart Métodos na investigação neurocognitiva(2021) BERTOLA, Laiss; LIMA, Isabela- Cognitive changes after tDCS and escitalopram treatment in major depressive disorder: Results from the placebo-controlled ELECT-TDCS trial(2020) MORENO, Marina L.; GOERIGK, Stephan A.; BERTOLA, Laiss; SUEMOTO, Claudia K.; RAZZA, Lais B.; MOFFA, Adriano H.; VERONEZI, Beatriz P.; TORT, Luara; NOGUEIRA, Barbara S.; GATTAZ, Wagner F.; FRAGUAS, Renerio; PADBERG, Frank; LOTUFO, Paulo A.; BENSENOR, Isabela M.; BRUNONI, Andre R.Background: Cognitive deficits in major depressive disorder (MDD) are associated with low quality of life and higher suicide risk. Antidepressant drugs have modest to null effects in improving such deficits. Therefore, we investigated the cognitive effects of transcranial direct current stimulation (tDCS), which is a promising antidepressant non-pharmacological intervention, in MDD. Methods: An exploratory analysis on cognitive performance was conducted in 243 depressed patients from the Escitalopram vs. Electric Current Therapy for Treating Depression Clinical Study (ELECT-TDCS), a sham-controlled study comparing the efficacy of tDCS vs. escitalopram. A neuropsychological battery was applied at baseline and endpoint (10 weeks of treatment) to create composite cognitive scores (processing speed, working memory, and verbal fluency). Linear mixed regression models were used to evaluate changes according to intervention groups, adjusted for confounding variables (age, years of schooling, gender, and benzodiazepine use) and depression improvement. Results: No cognitive deterioration was observed in any group. Patients receiving tDCS presented reduced practice gains compared to placebo in processing speed. In patients receiving escitalopram vs. placebo and in the subgroup of clinical responders ( > 50% depression improvement from baseline), those receiving tDCS vs. placebo presented increased performance in verbal fluency. No significant differences between tDCS and escitalopram groups were detected. Limitations: Absence of healthy controls. Conclusion: Prefrontal tDCS did not lead to cognitive deficits in depressed patients, although it reduced practice effects in processing speed. tDCS responders presented increased performance in verbal fluency. Further investigation of tDCS cognitive effects in depression is warranted.
- Measurement Invariance of Neuropsychological Tests Across Different Sociodemographic Backgrounds in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)(2020) BERTOLA, Laiss; BENSENOR, Isabela M.; BARRETO, Sandhi Maria; MORENO, Arlinda B.; GRIEP, Rosane H.; VIANA, Maria Carmen; LOTUFO, Paulo A.; SUEMOTO, Claudia K.Objectives: Neuropsychological tests are often used in aging studies to compare distinct groups regarding diagnosis and prognosis. Because sociodemographic characteristics can influence cognitive scores, measurement of invariance is useful to assess the tests' ability to estimate the underlying constructs equally across groups and thus prevent biased interpretation. This study aims to verify measurement invariance in a large and socioculturally diverse sample. Method: Middle-aged and older adults (N = 13,395) from the ELSA-Brasil study were evaluated regarding health status and cognition. Mean age was 51.5 +/- 8.9 years. 54% were female, 52% were white, and 10% had lower education. Measurement invariance was analyzed using multiple-group confimiatory factor analysis for a two-factor model (memory and executive function). Configural, metric, and scalar invariance were tested across age, sex, race, and education groups. Results: The 2-factor model had a good lit to the entire dataset and for each group. Configural, metric. and scalar invariance confirmed that cognitive measures had the same structure and the items had similar relationships with the latent factors. Strict invariance was not achieved in most group comparison. Conclusions: The 2-factor model was appropriate for estimating cognitive performance in participants without measurement error by age, sex, race, and education. These results suggest that differences in cognitive outcomes are likely to indicate true differences.
- Association between cognitive performance and self-reported glaucoma in middle-aged and older adults: a cross-sectional analysis of ELSA-Brasil(2020) VIDAL, K. S.; SUEMOTO, C. K.; MORENO, A. B.; DUNCAN, B.; I, M. Schmidt; MAESTRI, M.; BARRETO, S. M.; LOTUFO, P. A.; BERTOLA, L.; BENSENOR, I. M.; BRUNONI, A. R.Recent evidence suggests that glaucoma and Alzheimer's disease are neurodegenerative diseases sharing common pathophysiological and etiological features, although findings are inconclusive. We sought to investigate whether self-reported glaucoma patients without dementia present poorer cognitive performance, an issue that has been less investigated. We employed cross-sectional data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) and included participants >= 50 years of age without a known diagnosis of dementia and a self-reported glaucoma diagnosis. We excluded those with previous stroke, other eye conditions, and using drugs that could impair cognition. We evaluated cognition using delayed word recall, phonemic verbal fluency, and trail making (version B) tests. We used multinomial linear regression models to investigate associations between self-reported glaucoma with cognition, adjusted by several sociodemographic and clinical variables. Out of 4,331 participants, 139 reported glaucoma. Fully-adjusted models showed that self-reported glaucoma patients presented poorer performance in the verbal fluency test beta=-0.39, 95%CI=-0.64 to -0.14, P=0.002), but not in the other cognitive assessments. Thus, our results support the hypothesis that self-reported glaucoma is associated with poor cognitive performance; however, longitudinal data are necessary to corroborate our findings.
- Subtle Thyroid Dysfunction Is Not Associated with Cognitive Decline: Results from the ELSA-Brasil(2021) SZLEJF, Claudia; SUEMOTO, Claudia Kimie; JANOVSKY, Carolina Castro Porto Silva; BERTOLA, Laiss; BARRETO, Sandhi Maria; LOTUFO, Paulo Andrade; BENSENOR, Isabela MartinsBackground: Subtle thyroid alterations have a controversial role in cognition. Objective: We investigated the longitudinal association of baseline thyroid function, thyrotropin (TSH), and thyroxine (FT4) levels with cognitive performance after 4 years of follow-up in middle-aged and older adults without overt thyroid dysfunction. Methods: We included 4,473 individuals, age >= 55 years at the second study wave, without overt thyroid dysfunction at baseline. Individuals were divided according to thyroid function and TSH and FT4 tertiles. Cognition was assessed at baseline and after 4 years of follow-up by the word recall (DWR), semantic verbal fluency (SVF), and trail making (TMT) tests. The longitudinal association of thyroid function and TSH and FT4 tertiles with cognitive performance was investigated using generalized estimating equations adjusted for sociodemographic characteristics, lifestyle, cardiovascular risk factors and depression. Results: There was no longitudinal association of thyroid function and TSH and FT4 baseline levels with performance on the cognitive tests. However, there was a baseline cross-sectional U-shaped association of FT4 tertiles with poorer performance in the SVF (first FT4 tertile: beta = -0.11, 95% CI = -0.17; -0.04; third FT4 tertile: beta = -0.10, 95% CI = -0.17; -0.04) and of the third FT4 tertile with poorer performance in the DWR (beta = -0.09, 95% CI = -0.16; -0.02). Conclusion: Thyroid function and hormone levels were not associated with cognitive decline during 4 years of follow-up in middle-aged and older adults without overt thyroid dysfunction. Future studies with longer follow-up could clarify the implications of subtle thyroid alterations in cognition.
- Normative Data for the ELSA-Brasil Neuropsychological Assessment and Operationalized Criterion for Cognitive Impairment for Middle-Aged and Older Adults(2021) BERTOLA, Laiss; BENSENOR, Isabela M.; GOULART, Alessandra C.; BRUNONI, Andre R.; CARAMELLI, Paulo; BARRETO, Sandhi Maria; GIATTI, Luana; SALVADOR, Larissa; GRIEP, Rosane Harter; MORENO, Arlinda B.; LOTUFO, Paulo A.; SUEMOTO, Claudia K.Objectives: Normative data should consider sociodemographic diversity for the accurate diagnosis of cognitive impairment. This study aims to provide normative data for a brief neuropsychological battery and present diagnostic criteria for cognitive impairment that could be used in primary care settings. Methods: We selected 9618 Brazilian middle-aged and older adults after detailed exclusion criteria to avoid subtle cognitive impairment. We analyzed age, sex, and education influence on cognitive performance. To verify the evidence of criterion validity, we compared the cognitive performance of subjects with and without a depressive episode. Additionally, we verified the percentage of spurious scores under three different cutoffs. Results: Age and education had the greatest impact on cognition. Normative scores were provided according to age and education groups. Participants with a depressive episode performed poorer than control subjects. The clinical cutoff of at least two scores below the 7(th) percentile revealed the adequate percentage of spurious and possible clinical performance. Conclusions: The Longitudinal Study on Adult Health (ELSA-Brasil) provided normative data based on a unique selected set of cognitively normal subjects. Normative groups were selected based on age and education, and the battery was sensitive to the presence of a depressive episode. We suggested clinical cutoffs for the tests in this battery that could be used in primary care settings to improve the accurate diagnosis of cognitive impairment.
bookPart Diagnóstico e tratamento das demências vasculares e potencialmente reversíveis(2020) RICARDO, Laiss Bertola de Moura; RODRIGUEZ, Roberta Diehl; SUEMOTO, Claudia Kimie- Early life socioeconomic status predicts cognition regardless of education level(2021) BERTOLA, Laiss; BENSENOR, Isabela M.; BARRETO, Sandhi Maria; GIATTI, Luana; MORENO, Arlinda B.; VIANA, Maria Carmen; LOTUFO, Paulo A.; SUEMOTO, Claudia K.Background and purpose Early life socioeconomic status (SES) may impact cognitive performance later in life. We investigated the effect on cognitive performance of early life SES, education, and late life SES in the Brazilian Longitudinal Study of Adult Health. Methods Path analysis was used to decompose associations between SES measures across the lifespan and cognition. The model included direct paths to cognition from early life SES, education, and late life SES, and indirect paths from early life passing through education and late life SES. We investigated whether the effects of early life SES are similar across middle-aged and older adults. Results In 13,395 adults, the mean age was 51.5 (8.9) years, 54% were female, 53% were white, and 56% had at least college education. The direct path from early life SES remained significant in the presence of mediation paths through education, late life SES, or both, contributing to cognitive performance in both middle-aged and older adults. The indirect and total effect of early life SES was smaller for middle-aged compared to older adults. Early life SES continues to impact cognitive performance later in life independently of educational attainment and late life SES. The higher percent of mediation through education suggests that education may improve later life cognition even in the presence of low early life SES. Conclusions Our results highlight the importance of public health initiatives to improve early life SES and education to foster cognitive aging in low- and middle-income countries.
- Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study(2021) BERTOLA, Laiss; BENSENOR, Isabela M.; GROSS, Alden L.; CARAMELLI, Paulo; BARRETO, Sandhi Maria; MORENO, Arlinda B.; GRIEP, Rosane H.; VIANA, Maria Carmen; LOTUFO, Paulo A.; SUEMOTO, Claudia K.Objective: Longitudinal measurement invariance analyses are an important way to assess a test's ability to estimate the underlying construct over time, ensuring that cognitive scores across visits represent a similar underlying construct, and that changes in test performance are attributable to individual change in cognitive abilities. We aimed to evaluate longitudinal measurement invariance in a large, social and culturally diverse sample over time. Methods: A total of 5,949 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) were included, whose cognition was reassessed after four years. Longitudinal measurement invariance analysis was performed by comparing a nested series of multiple-group confirmatory factor analysis models (for memory and executive function factors). Results: Configural, metric, scalar and strict invariance were tested and supported over time. Conclusion: Cognitive temporal changes in this sample are more likely to be due to normal and/or pathological aging. Testing longitudinal measurement invariance is essential for diverse samples at high risk of dementia, such as in low- and middle-income countries.