Two independent translations were made from English into Portuguese, followed by two independent back-translations. Few adaptations in accordance to the Brazilian culture and language were made and a first version of the instrument produced. This former version of the ACE-R was administered to 21 cognitively healthy subjects aged 60 years or more, with different educational levels.
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The mean age of the studied sample of healthy elderly was Small additional modifications were necessary after the evaluation of the first ten subjects in order to improve comprehension of the test. The final Portuguese version of the ACE-R was produced and was found to be well understood by the remaining 11 subjects, taking an average of 15 minutes to be administered. The Brazilian version of the ACE-R proved to be a promising cognitive instrument for testing both in research and clinical settings. With this regard, additional studies are currently being carried out in our unit in order to investigate the diagnostic properties of the ACE-R in our milieu.
Cognitive evaluation is a mandatory step for the diagnosis of dementia, warranting more attention in Brazil. There are still only a limited number of instruments that present specific norms for use in our population, especially regarding the variables age and education.
The ACE is a brief and reliable test battery that provides detection of early stages of dementia and is also efficient in differentiating its subtypes, such as AD, frontotemporal dementia FTD , progressive supranuclear palsy, and other forms of dementia associated with parkinsonism. Each of these domains can be individually evaluated. Moreover, Mathuranath et al.
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These findings are similar to the neuropsychological profiles of both diseases observed in other studies. Another difference from the original version was that instead of six, the ACE-R assesses only five domains, namely: orientation and attention 18 points , memory 26 points , verbal fluency 14 points , language 26 points and visuospatial ability 16 points.
The authors also developed a guide of instructions to offer further information on how the scores should be noted.
This guide also presents examples of acceptable answers, models of drawings, and explanations of how to apply and correct the test. The idea is to create a pattern when organizing all the answers in order to improve the overall reliability of the test among examiners. The present article has the objective of presenting the adapted version of the ACE-R for use in Brazil. The process of ACE-R adaptation was initiated by two independent translations from English to Portuguese, followed by two back-translations of these Portuguese versions into English.
The aim of this work was to reveal the possible misunderstandings and ambiguities that the first translated version could have contained. Subsequently, we carried out cross-cultural adaptation.
The same method was used for the Portuguese version of the Instructions guide. In the Language-naming item, the illustration of a pencil was substituted by a pen, in order to maintain the same command as the MMSE version mentioned earlier. In this study, 21 healthy individuals were tested, aged 60 years or more, with different educational levels, but no illiterate subjects were included. All participants had no history of neurologic or psychiatric disease, as well as no history of cognitive decline. They were all fully independent and performed above specific education-adjusted cut-off scores in the MMSE as suggested by Brucki et al.
Initially, ten subjects were submitted to the Portuguese first version and this experience highlighted some additional modifications which were necessary. Following this, the final Portuguese version of the ACE-R was produced and then administered to the remaining 11 participants. All participants signed the written informed consent.
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The 21 elderly subjects presented a mean age of Seventeen The mean number of years of formal education was 8. The lowest total score observed in the ACE-R was 73, while the highest was The mean total score in the battery was of Minimum and maximum total scores observed, as well as means and standard deviations for the subtests of the battery, are shown in Table 1.
The instrument took 15 minutes on average to be administered. Overall, the comprehension of the different items of the test was found to be good. After its application on half of the sample, some additional modifications were made to make it easier to understand by the low education level subjects. Obviously, these modifications did not interfere with the original aims of the battery authors. The final instrument proved to be easy to administer and was well understood by a group of healthy elderly people with heterogeneous educational background.
Cognitive evaluation constitutes an important tool for the assessment of cerebral functioning, being mandatory for the differential diagnosis between normal aging, mild cognitive impairment, dementia and its subtypes. Sensitivity and specificity are essential aspects of a cognitive investigative instrument, but these also depend on knowledge of the imperative diversities and influences between cultures, gender, age and educational level.
As outlined previously, brief cognitive evaluation instruments validated in Brazil remain scarce. Moreover, the differential diagnosis between AD and FTD represents a challenge, especially in the early stages, and even fewer tools are available in our milieu with this regard. However, the FAB assesses only some aspects of executive functions, while the ACE-R includes the assessment of different cognitive domains, such as orientation and attention, memory, verbal fluency, language and visuospatial ability.
These are the preliminary results of a study that intends to investigate the applicability of ACE-R as an instrument of brief cognitive evaluation for healthy Brazilian subjects and patients with suspected dementia, to determine the sensitivity and specificity of this tool in mild-AD patients and to later assess its capacity to differentiate between AD and FTD patients. We are grateful to Professor John R. Hodges and to Mrs.
Eneida Mioshi-Hornberger, from the University of Cambridge UK for their support and ongoing collaboration with our work. National Center for Biotechnology Information , U. Journal List Dement Neuropsychol v. Dement Neuropsychol. Viviane Amaral Carvalho 1, 2 and Paulo Caramelli 1, 2.
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Daughter of Dr. She found work at a branch of the Post Office nearby Lapa ,  while her daughter, autodidact, learned to read and write in Portuguese and French while reading newspapers, books and dictionaries. Shortly after, she began working as clerk at Freitas Bastos,  a bookstore located at Largo da Carioca. It is there, amongst the beautiful works of national and international authors, that she became fond of theater and literature. At sixteen, she was fully integrated into the bohemian life of the city, including behavior and costumes - smoking cigarillos , she walked by the streets dressed in a suit, tie, and fedora.
A woman practicing journalism was even more unusual, up to the point that even the term "reportess" had to be coined to describe her role.
Shortly after, the journal prematurely reported the end of her career as a young journalist, who had decided to seek refuge in a boarding school for girls in an orphanage called Asilo Bom Pastor. The mystery and the reason for such decision were unraveled only months later, when a report signed by her was published on the front page of the Journal A Rua.
As a matter of fact, Eugenia asked to be interned with the sole intention of interviewing Albertina do Nascimento Silva,  the sister of a murdered woman in a widely reported crime which became known as "The Tragedy of Dr. Januzzi Street, Not being successful, she took the opportunity to report the everyday life of those people in their restrictive confinement.
The resulting series of articles, published in chapters for five days in a row, snatched a large number of readers, yielding to the author the deserved recognition from colleagues, competitors and the general public, which would come to nickname her as "the first reporter of Brazil". In love, they got married in She participated in the Modern Art Week of ,  and founded with him in the Teatro de Brinquedo Toy Theatre Group ,  whose intent was to manifest modernist ideas.
Between and , she made several excursions to the countryside and outskirts of Rio de Janeiro , introducing the public to modern European authors. She was released for lack of evidence on the morning of February 1, She even ran for congresswoman in the general elections of but at the time no woman could be elected to represent women's interests during the drafting of the Brazilian Constitution of She died shortly after in her bedroom, next to her children as a result of a stroke.
She was then 50 years old. From Wikipedia, the free encyclopedia.