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Influência da reserva cognitiva no funcionamento cognitivo de idosos portugueses
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O presente estudo teve como principais objetivos adaptar e validar a Escala de Reserva
Cognitiva (ERC; Leon et al., 2014; Altieri et al., 2018) para a população portuguesa, com um
grupo de idosos saudáveis (n=46); compreender a influência da sintomatologia depressiva e da
apatia no nível de reserva cognitiva; analisar a influência do tipo de atividade profissional,
quanto à sua exigência cognitiva, no nível de reserva cognitiva do indivíduo; e, por último,
examinar a influência da reserva cognitiva no funcionamento cognitivo de idosos portugueses.
Colocaram-se como hipóteses que: H1) idosos com resultados mais altos na Escala de
Depressão Geriátrica (EDG-15; Sheikh & Yesavage, 1986) e na Escala de Avaliação de Apatia
(EAA; Lueken et al., 2007), teriam resultados mais baixos na ERC; H2) a atividade profissional
exercida estará associada a, e será preditora da reserva cognitiva; e H3) o nível de reserva
cognitiva estará associado a, e será preditor do, desempenho cognitivo, avaliado pelo Montreal
Cognitive Assessment (MoCA; Nasreddine et al., 2005) e pelo Mini Mental State Examination
(MMSE; Folstein et al., 1975). Foram aplicados: a) um questionário sociodemográfico; b) três
instrumentos para a avaliação psicológica e neuropsicológica (Auditory Verbal Learning Test
; Cavaco et al., 2015, EDG-15; Sheikh & Yesavage, 1986 e a EAA; Lueken et al., 2007); c) a
ERC (Leon et al., 2014; Altieri et al., 2018); e d) dois instrumentos de rastreio cognitivo (o
MMSE; Folstein et al., 1975; Guerreiro et al., 1994; Guerreiro, 1998; e o MoCA; Nasreddine
et al., 2005; Freitas et al., 2011).
A ERC traduzida e adaptada para português revelou boas propriedades psicométricas.
Verificou-se uma correlação negativa significativa entre os resultados na ERC e os resultados
na EDG-15 (e não com os da EAA), i.e., os idosos que apresentaram valores mais altos na EDG15 obtiveram resultados mais baixos na ERC, corroborando parcialmente a H1. Como esperado
(H2), exercer ao longo da vida atividades profissionais cognitivamente mais exigentes esteve
associado e foi preditor de um nível mais elevado de reserva cognitiva.
ii
Os resultados das correlações e das análises de regressão hierárquica entre a ERC e as
medidas de funcionamento cognitivo (MoCA e MMSE) corroboraram parcialmente a H3, na
medida em que, o desempenho na ERC associou-se a e apresentou um valor preditivo
significativo do desempenho no MoCA (o que não se verificou relativamente ao MMSE).
A ERC revela-se um instrumento inovador em Portugal, pois, até ao momento, é o único
adaptado para a população idosa portuguesa saudável e considera os diferentes indicadores da
reserva cognitiva, ao longo das várias fases da vida.
A ERC é assim uma ferramenta importante na prevenção do envelhecimento cognitivo
patológico e também para a valorização da saúde mental. Este estudo permitiu-nos compreender
que deverá existir uma insistência no envolvimento cognitivo dos indivíduos na sua atividade
profissional, para que se preserve o funcionamento cognitivo futuro. Por outro lado, também é
enfatizada a importância do bem-estar psicológico no bom funcionamento cognitivo do
indivíduo, dada a clarificação do papel da sintomatologia depressiva enquanto fator de risco.
O presente estudo esclareceu ainda a forma como a reserva cognitiva influencia
positivamente o funcionamento cognitivo de idosos portugueses, pois maiores níveis de reserva
cognitiva estão associados a e são preditores de um melhor desempenho em medidas de
funcionamento cognitivo.
The present study had its main objectives to adapt and validate the Cognitve Reserve Scale (CRS; Leon et al., 2014; Altieri et al., 2018) for the Portuguese population, with a group of healthy elderly (n=46); to understand the influence of depressive symptomatology and apathy on the cognitive reserve level; to analyse the influence of the professional activity type, regarding its cognitive demand/requirement, on the individual’s level of cognitive reserve; and lastly, to examine the influence of the cognitive reserve in the cognitive functioning of Portuguese elderly. The following hypothesis were raised: H1) elderly with higher scores in the Geriatric Depression Scale (GDS-15; Sheikh & Yesavage, 1986) and in the Apathy Evaluation Scale (AES; Lueken et al., 2007), would have lower scores in the CRS; H2) the professional occupation had throughout life will be associated and will predict cognitive reserve; and H3) the level of cognitive reserve will be associated and will predict the cognitive performance measured by the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) and by the Mini Mental State Examination (MMSE; Folstein et al., 1975). The following instruments were applied: a) a sociodemographic survey; b) three instruments for psychological and neuropsychological assessment (Auditory Verbal Learning Test; Cavaco et al., 2015, GDS-15; Sheikh & Yesavage, 1986 and the AES; Lueken et al., 2007); c) the CRS (Leon et al., 2014; Altieri et al., 2018); and d) two instruments for cognitive screening (the MMSE; Folstein et al., 1975; Guerreiro et al., 1994; Guerreiro, 1998; and the MoCA; Nasreddine et al., 2005; Freitas et al., 2011). The CRS translation and adaptation revealed good psychometric properties. It was found a significant negative association between the CRS scores and the GDS-15 scores (and not with the AES), i.e., the eldery who showed higher values on GDS-15 also showed lower results in CRS, partially corroborating the H1). As expected (H2) having cognitively iv demanding professional occupations throughout life was associated and predicted a higher level of cognitive reserve. The results of the correlations and hierarchical regression analyses between CRS and the measures of cognitive functioning (MoCA and MMSE) partially corroborated the H3, as performance in CRS was associated and significantly predicted the performance of MoCA (but not of the MMSE). The CRS becomes an innovative instrument in Portugal, for up to this moment it is the only one adapted for the Portuguese elderly healthy population that also considers the different proxies of the cognitive reserve throughout the various life phases. The CRS is, therefore, a relevant tool towards preventing pathological cognitive aging as well as for the valorisation of mental health. This study has allowed us to understand that a bigger insistence should be taken towards cognitive involvement in professional occupation to preserve future cognitive functions. On the other hand, the importance of psychological wellbeing in a proper cognitive functionality of the individual is also emphasized, given the clarification of the depressive symptomatology’s role as a risk factor. The present study also clarified how cognitive reserve influences positively the cognitive functioning of the Portuguese elderly, as for higher levels of cognitive reserve are associated with and can be predictive of a better performance in cognitive function measures.
The present study had its main objectives to adapt and validate the Cognitve Reserve Scale (CRS; Leon et al., 2014; Altieri et al., 2018) for the Portuguese population, with a group of healthy elderly (n=46); to understand the influence of depressive symptomatology and apathy on the cognitive reserve level; to analyse the influence of the professional activity type, regarding its cognitive demand/requirement, on the individual’s level of cognitive reserve; and lastly, to examine the influence of the cognitive reserve in the cognitive functioning of Portuguese elderly. The following hypothesis were raised: H1) elderly with higher scores in the Geriatric Depression Scale (GDS-15; Sheikh & Yesavage, 1986) and in the Apathy Evaluation Scale (AES; Lueken et al., 2007), would have lower scores in the CRS; H2) the professional occupation had throughout life will be associated and will predict cognitive reserve; and H3) the level of cognitive reserve will be associated and will predict the cognitive performance measured by the Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005) and by the Mini Mental State Examination (MMSE; Folstein et al., 1975). The following instruments were applied: a) a sociodemographic survey; b) three instruments for psychological and neuropsychological assessment (Auditory Verbal Learning Test; Cavaco et al., 2015, GDS-15; Sheikh & Yesavage, 1986 and the AES; Lueken et al., 2007); c) the CRS (Leon et al., 2014; Altieri et al., 2018); and d) two instruments for cognitive screening (the MMSE; Folstein et al., 1975; Guerreiro et al., 1994; Guerreiro, 1998; and the MoCA; Nasreddine et al., 2005; Freitas et al., 2011). The CRS translation and adaptation revealed good psychometric properties. It was found a significant negative association between the CRS scores and the GDS-15 scores (and not with the AES), i.e., the eldery who showed higher values on GDS-15 also showed lower results in CRS, partially corroborating the H1). As expected (H2) having cognitively iv demanding professional occupations throughout life was associated and predicted a higher level of cognitive reserve. The results of the correlations and hierarchical regression analyses between CRS and the measures of cognitive functioning (MoCA and MMSE) partially corroborated the H3, as performance in CRS was associated and significantly predicted the performance of MoCA (but not of the MMSE). The CRS becomes an innovative instrument in Portugal, for up to this moment it is the only one adapted for the Portuguese elderly healthy population that also considers the different proxies of the cognitive reserve throughout the various life phases. The CRS is, therefore, a relevant tool towards preventing pathological cognitive aging as well as for the valorisation of mental health. This study has allowed us to understand that a bigger insistence should be taken towards cognitive involvement in professional occupation to preserve future cognitive functions. On the other hand, the importance of psychological wellbeing in a proper cognitive functionality of the individual is also emphasized, given the clarification of the depressive symptomatology’s role as a risk factor. The present study also clarified how cognitive reserve influences positively the cognitive functioning of the Portuguese elderly, as for higher levels of cognitive reserve are associated with and can be predictive of a better performance in cognitive function measures.
Descrição
Tese de mestrado, Psicologia (Área de Especialização em Psicologia Clínica e da Saúde - Psicoterapia Cognitivo-Comportamental e Integrativa), Universidade de Lisboa, Faculdade de Psicologia, 2020
Palavras-chave
Envelhecimento cognitivo Envelhecimento - Portugal Idosos Semiologia (Medicina) Depressão Teses de mestrado - 2020