Skip to main content
Dementia & Neuropsychologia logoLink to Dementia & Neuropsychologia
. 2007 Jan-Mar;1(1):18–23. doi: 10.1590/S1980-57642008DN10100004

Cognitive and functional dementia assessment tools: review of Brazilian literature

Instrumentos de avaliação cognitiva e funcional em demência

Luciano Góis Vasconcelos 1, Sonia Maria Dozzi Brucki 2, Orlando Francisco Amodeo Bueno 3
PMCID: PMC5619379  PMID: 29213363

Abstract

The diagnosis of dementia is based on cognitive and functional evaluation. One of the difficulties in ascertaining the number of people with dementia in developing countries is the population’s lack of formal education. Independent effects of age, sex and education have been identified on scores for most but not all cognitive tests.

Objectives

Identify the most-used cognitive and functional assessment tools in Brazil, related to dementia diagnosis and treatment outcome; and identify adaptations or normative data, when available.

Methods

Data were generated from PubMed, LILACS and Portal Periodicos CAPES (thesis database) databases using the search terms ‘dementia’ and ‘Alzheimer’. Data collection criteria were a. Articles with abstract; b. Brazilian abstracts, related to adult Brazilian population; c. Clear mention of assessment tool in the abstract text. A total of 108 abstracts were selected for the main analysis: a. to identify the instruments used b. to determine how many of the selected abstracts mentioned each tool and c. to search in the mentioned databases for respective test adaptations or normative data.

Results

Some 52 different assessment tools, 41 cognitive instruments and 11 functional instruments were identified. The most cited assessment tests were the Mini Mental State Examination (64 abstracts) and Pfeffer Functional Activities Questionnaire (4 abstracts).

Discussion

Many of the instruments used only have the description of the translation process into Portuguese, along with some suggestions of validation or normative data. Few of these followed the recommended procedures of validation, replication, normalization or transcultural adaptation.

Keywords: neuropsychological evaluation, functional evaluation, dementia, neuropsychology

Global aging trends

The aging of the world's population is the result of two factors: declines in fertility and increases in life expectancy. Fertility rates have declined in developing countries over the past 30 years. In addition, in developed countries, the largest gain ever in life expectancy at birth occurred during the 20th century, averaging 71% for females and 66% for males. Life expectancy at birth in developed countries now ranges from 76 to 80 years.

In 2000, the worldwide population of persons aged ≥65 years was an estimated 420 million. During 2000–2030, the worldwide population aged ≥65 years is projected to increase by approximately 550 million to 973 million, increasing from 6.9% to 12.0% worldwide, from 15.5% to 24.3% in Europe, from 12.6% to 20.3% in North America, from 6.0% to 12.0% in Asia, and from 5.5% to 11.6% in Latin America and the Caribbean. Between 2000–2030, the number of persons in developing countries aged ≥65 years is projected to almost triple, from approximately 249 million in 2000 to an estimated 690 million in 2030, and the developing countries' share of the world's population aged ≥65 years is projected to increase from 59% to 71%1.

Brazilian aging trends

The Brazilian elderly population (≥60 years) increased from 3 million in 1960 to 14 million by 2002. It is projected to reach 32 million by 20202.

Compared with developed countries, the Brazilian aging process has been faster, had deeper structural changes and has also taken place in a younger population3.

Dementia and aging

Several authors have highlighted that dementia is one of the chronic conditions that will affect a considerably increased number of elderly both in developed and developing countries.

A large number of epidemiological surveys show very similar results such as increasing rates with rising age4.

As adults live longer, the prevalence of Alzheimer's disease, which doubles every 5 years after age 65, is also expected to increase. Approximately 10% of adults aged ≥65 years and 47% of adults aged ≥85 years suffer from this degenerative and debilitating disease5.

Dementia around the world

The worldwide number of persons with dementia in 2000 was estimated at about 25 million persons. Almost half of the demented persons (46%) lived in Asia, 30% in Europe, and 12% in North America. Fifty-two percent lived in less developed regions. About 6.1% of the population 65 years of age and older suffered from dementia (about 0.5% of the worldwide population) and 59% were female. The number of new cases of dementia in 2000 was estimated to be 4.6 million (one new case every 7 seconds). The forecast indicated a considerable increase in the number of demented elderly from 25 million in the year 2000 to 63 million in 2030 (41 million in less developed regions) and to 114 million in 2050 (84 million in less developed regions)6,7.

Dementia has already been established as one of the major health challenges of this century due to the enormous burden these pathologies impose on health care systems. Dementia is a significant public health problem as it is one of the most common diseases in the elderly and a major cause of disability and mortality (Ritchie and Lovestone, 2002)8. Brazilian dementia prevalence has been estimated at 7.1% (54.1% Alzheimer Disease)9.

Dementia assessment tools

The dementia diagnosis is based on cognitive and functional evaluation. Some diagnostics criteria (DSMIII, DSM-IV) highlight instrumental cognitive domain evaluations.

Use of validated assessment tools provides structure for the assessment process, helps assure consistency, and provides a mechanism for periodic re-evaluation. The assessment approaches also foster a common language for the health care team and consist of measurable parameters that can be used to monitor outcomes10.

Physicians often underestimate the extent of disability that a patient has in basic ADLs. Further, physicians’ recording of the level of function in medical notes is poor. By using standardized assessment tools, the evaluation can objectively document physical, cognitive, emotional, and functional conditions. Based on the evidence, assessment tools should be chosen to aid in diagnosis and to measure outcome treatment of dementia. Older patients should be screened by standardized assessment tools in order to improve diagnosis, assessment, and outcome measurement. There are many commonly used tools in dementia assessment11.

Cross-cultural adaptation, validation and reliability

One of the difficulties in ascertaining the number of people with dementia in developing countries is that many older people in these regions have little if any formal education, and often cannot read or write12.

Independent effects of age, sex, education and occupation were identified on scores for most but not all cognitive tests13. Considering that Brazil has a high number of illiterates and low educational subjects, such instruments should be adapted14.

Objectives

  1. To identify the most-used cognitive and functional assessment tools in Brazil, related to dementia diagnosis and treatment outcome;

  2. To identify adaptations or normative data, when available.

Methods

The literature search was performed up until September 2006. Data were generated from PubMed, LILACS and Portal Periodicos CAPES / Brazilian thesis and dissertations database (PPC) databases using the search terms ‘dementia’ and ‘alzheimer’. For the PubMed search the term “brazil” was also included. The LILACS search only considered abstracts in English or Portuguese.

Data collection criteria: a. Articles with abstract; b. Brazilian abstracts, related to adult Brazilian population; c. Clear mention of assessment tool in the abstract text.

The search result of three databases (Table 1) was submitted to criteria above and the repeated abstracts were excluded. 108 abstracts were selected for the following analysis: a. to identify the instruments used; b. to determine how many of the selected abstracts cited each tool; and c. to search in the mentioned databases for respective test adaptations or normative data.

Table 1.

Database search results.

Database Search results
Pubmed 98
LILACS 456
PPC 284
Partial result 838
Final result* 108
*

After exclusion of repeated abstracts and submission to criteria collection.

Portal periódicos CAPES/Brazilian Thesis and Dissertations Database.

Results

A total of 52 different assessment tools were identified: 41 cognitive instruments and 11 functional instruments.

The most mentioned assessment tests were the Mini Mental State Examination (64 different abstracts) and the Pfeffer Functional Activities Questionnaire (4 different abstracts). All the mentioned instruments and respective suggestions of adaptations or normative data can be found in Tables 2 and 3.

Table 2.

The most used cognitive assessment tools in Brazil.

  Abstracts Adaptations or
Cognitive assessment tool citation* normative data
1. Mini Mental State Examination 64 15
2. Verbal Fluency 9 16
3. Trail Making 8 17,18
4. Digit Span 8 17,18
5. Blessed's Information-Memory-Concentration Test 7 NS
6. CAMDEX / CAMCOG 7 19
7. Wechsler Adult Intelligence Scale - III 6 20
8. Boston Naming Test 5 21, 22
9. Neuropsi 5 23
10. Clock Drawing Test 5 24
11. Alzheimer's Disease Assessment Scale (ADAS-Cog) 4 25
12. Wechsler Memory Scale-Revised 4 26
13. Informant Questionnaire On Cognitive Decline In The Elderly (IQCODE) 3 NS
14. Consortium To Establish For Alzheimer Disease Battery (CERAD) 3 27
15. Clinical Interview Schedule 3 28
16. Wisconsin Card Sorting Test 3 29
17. Buschke Selective Reminding Test 3 30
18. Brazilian Version Of The Mattis Dementia Rating Scale (DRS) 3 31, 32
19. Computerized Neuropsychol Test Battery (CNTB) 2 33
20. Stroop Test 2 34
21. Cognitive Abilities Screening Instrument - Short Form (CASI-S) 2 35
22. Protocole D'évaluation Neuropsycol Optimal Du Montreal 2 36
23. FAS Verbal Fluency 2 37
24. Word Span 2 38
25. Rey Auditory Verbal Learning Test 2 39
26. Objects Presented As Simple Drawings 1 40,17
27. Spatial Recognition Span 1 38
28. Brief Cognitive Screening Battery (BCSB) 1 NS
29. SIDAM Portuguese Version 1 41
30. Reduced Version Of The Face-Hand Test 1 42
31. Benton Visual Recognition Test 1 NS
32. Token Test 1 43
33. International Affective Picture System (IAPS) 1 44
34. Spatial Recognition Span 1 39
35. Porteus Mazes Test 1 NS
36. Bell Test 1 NS
37. Luria's Fist-Edge-Palm Test 1 45
38. California Verbal Learning Test 1 NS
39. Set-Test 1 NS
40. Short Cognitive Performance Test 1 46
41. Fuld Object Memory Evaluation (FOME) 1 NS
*

number of abstracts citing the instrument;

reference number of adaptation or normative data suggestion;

NS, no suggestions.

Table 3.

The most used functional assessment tools in Brazil.

  Abstracts Adaptations or
Functional assessment tools citation* normative data
1. Pfeffer Functional Activities Questionnaire 4 NS
2. Activities of Daily Living (ADL) + Instrumental Activities of Daily Living (IADL) 3 47
3. Activities of Daily Living (ADL) 3 48
4. Hoehn & Yahr Staging 2 49
5. Schwab & England Scale (SES) 2 NS
6. Katz' Index of ADL 2 NS
7. Functional Assessment Staging (FAST) 2 NS
8. Bayer-Activities of Daily Living 2 NS
9. Unified Parkinson's Disease Rating Scale-Activities of Daily Living Section (UPDRS-ADL) 1 NS
10. Barthel Index 1 50
11. Activities of Daily Living - International Scale 1 NS
*

number of abstracts citing the instrument;

reference number of adaptation or normative data suggestion;

NS, no suggestions.

Many of them only describe the translation process to Portuguese, with some superficial suggestions of validation, replication, normative data or trans-cultural adaptation. Few of them developed the recommended procedures outlined earlier.

Discussion

Many Brazilian authors have shown the influence of education on test scores: the Mini Mental State Exam-ination15, Verbal Fluency Test16, Boston Naming Test21,22, ADAS-Cog25, CERAD26,Mattis Dementia Rating Scale30,31.

Several dementia assessment tools were identified, where few of these have followed the recommended procedures of validation, replication, normative data or trans-cultural adaptation. In the context of research use this could be acceptable, but these procedures are absolutely necessary for epidemiological surveys.

Psychometric properties of scales and trans-cultural adaptations should be developed to minimize educational influence and decrease false positive diagnosis for cognitive impairment.

Health-care professionals should be trained to recognize and evaluate quality scales and psychometric concepts such as reliability (internal consistency and testretest), validity (construct, content, face and criterion validities), and sensitivity to change (responsiveness).

Methodological problems need to be addressed, particularly development of culture- and education-fair dementia diagnostic procedures.

Consensus on assessment and outcome tools would facilitate multi-center comparative studies. One method of achieving these research goals would be through a consensus conference.

Future research should emphasize functional State, quality of life, and caregiver burden, as well as economic factors and societal perspectives.

References

  • 1.Public Health and Aging: Trends in Aging - United States and Worldwide Centers for Disease Control and Prevention. MMWR. 2003;52(06):101–106. http://www.cdc.gov/MMWR/preview/ mmwrhtml/ mm5206a2.htm [Google Scholar]
  • 2.Lima-Costa MF, Veras R. Saúde pública e envelhecimento (Aging and public health) Cad Saúde Pública. 2003;19:700–701. [PubMed] [Google Scholar]
  • 3.Carvalho JAM, Garcia RA. Enfoque demográfico do envelhecimento da população. Cad Saúde Pública. 2003;19:725–733. doi: 10.1590/s0102-311x2003000300005. [DOI] [PubMed] [Google Scholar]
  • 4.Wancata J, Musalek M, Alexandrowicz R, Krautgartner M. Number of dementia sufferers in Europe between the years 2000 and 2050. Eur Psychiatry. 2003;18:306–313. doi: 10.1016/j.eurpsy.2003.03.003. [DOI] [PubMed] [Google Scholar]
  • 5.Lopes MA, Bottino CM. Prevalence of dementia in several regions of the world analysis of epidemiologic studies from 1994 to 2000. Arq Neuropsiquiatr. 2002;60:61–69. doi: 10.1590/s0004-282x2002000100012. [DOI] [PubMed] [Google Scholar]
  • 6.Wimo A, Winblad B, Aguero-Torres H, von Strauss E. The magnitude of dementia occurrence in the world. Alzheimer Dis Assoc Disord. 2003;17:63–67. doi: 10.1097/00002093-200304000-00002. [DOI] [PubMed] [Google Scholar]
  • 7.Ferri CP, Prince M, Brayne C. Global prevalence of dementia a Delphi Consensus Study. Lancet. 2005;366(9503):2112–2117. doi: 10.1016/S0140-6736(05)67889-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8.Berr C, Wancata J, Ritchie K. Prevalence of dementia in the elderly in Europe. Eur Neuropsychopharmacology. 2005;15:463–471. doi: 10.1016/j.euroneuro.2005.04.003. [DOI] [PubMed] [Google Scholar]
  • 9.Herrera Jr E, Caramelli P, Nitrini R. Population epidemiologic study of dementia in Catanduva city state of Sao Paulo, Brazil Rev Psiquiatr. Clin. 1998;25:70–73. [Google Scholar]
  • 10.Ensberg M, Gerstenlauer C. Incremental geriatric assessment. Prim Care. 2005;32:619–643. doi: 10.1016/j.pop.2005.06.008. [DOI] [PubMed] [Google Scholar]
  • 11.Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation part II Clinical challenges. Arch Phys Med Rehabil. 2003;84:890–897. doi: 10.1016/s0003-9993(02)04930-4. [DOI] [PubMed] [Google Scholar]
  • 12.Prince M, Acosta D, Chiu H, Scazufca M, Varghese M. Dementia diagnosis in developing countries a cross-cultural validation study. Lancet. 2003;361(9361):909–917. doi: 10.1016/S0140-6736(03)12772-9. [DOI] [PubMed] [Google Scholar]
  • 13.Stewart R, Richards M, Brayne C, Mann A. Cognitive function in UK community-dwelling African Caribbean elders normative data for a test battery. Int J Geriatr Psychiatry. 2001;16:518–527. doi: 10.1002/gps.384. [DOI] [PubMed] [Google Scholar]
  • 14.Jorge MR. Adaptação transcultural de instrumentos de pesquisa em saúde mental. Rev Psiquiatr Clin. 1988;25:233–239. [Google Scholar]
  • 15.Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr. 2003;61:777–781. doi: 10.1590/s0004-282x2003000500014. [DOI] [PubMed] [Google Scholar]
  • 16.Brucki SMD, Malheiros SMF, Okamoto IH, Bertolucci PHF. Normative data for the animals category verbal fluency test in our environment Arq. Neuropsiquiatr. 1997;55:56–61. doi: 10.1590/s0004-282x1997000100009. [DOI] [PubMed] [Google Scholar]
  • 17.Nitrini R, Lefèvre BH, Mathias SC. Testes neuropsicológicos de aplicação simples para o diagnóstico das demências. Arq Neuropsiquiatr. 1994;52:457–465. doi: 10.1590/s0004-282x1994000400001. [DOI] [PubMed] [Google Scholar]
  • 18.Charchat-Fichman H. Heterogeneidade neuropsicológica no processo de envelhecimento: transição do normal aos estágios iniciais da doença de Alzheimer. Instituto de Psicologia da Universidade de São Paulo, São Paulo; 2003. Tese. [Google Scholar]
  • 19.Bottino CMC, Stoppe A Jr, Scalco AZ, Ferreira RCR, Hototian SR, Scalco MZ. Validade e confiabilidade da versão brasileira do CAMDEX (Abstr) Arq Neuropsiquiatr. 2001;59(Suppl.3):S20–S20. [Google Scholar]
  • 20.Nascimento E. Adaptation and validation of test WAIS-III for a brazilian context. Curso de Pósgraduação em Psicologia, Universidade de Brasília; Brasília: DF; 2000. Tese não-publicada. [Google Scholar]
  • 21.Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston diagnostic aphasia examination influence of schooling. Braz J Med Biol Res. 2004;37:1731–1738. doi: 10.1590/s0100-879x2004001100019. [DOI] [PubMed] [Google Scholar]
  • 22.Mansur LL, Radanovic M, Araujo Gde C, Taquemori LY, Greco LL. Boston Naming Test performance of Brazilian population from Sao Paulo. Pro Fono. 2006;18:13–20. doi: 10.1590/s0104-56872006000100003. [DOI] [PubMed] [Google Scholar]
  • 23.Abrisqueta-Gomes J. Avaliação neuropsicológica nas fases inicial e moderada da demência do tipo Alzheimer. Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo; 1999. Tese. [Google Scholar]
  • 24.Okamoto IH. Cognitive aspects of Alzheimer's disease in clock test: assessment in a Brazilian sample. Escola Paulista de Medicina da Universidade Federal de São Paulo; 2001. Tese. [Google Scholar]
  • 25.Schultz RR. Desempenho de uma população brasileira na subescala cognitiva da Escala de avaliação da doença de Alzheimer (ADAS-Cog) Braz J Med Biol Res. 2001;34:1295–1302. doi: 10.1590/s0100-879x2001001000009. [DOI] [PubMed] [Google Scholar]
  • 26.Plass AM. Adaptação para o português da escala de memória de Wechsler-revisada: fidedignidade e validade. Universidade Federal do Rio Grande do Sul; 1991. Dissertação. [Google Scholar]
  • 27.Bertolucci PHF, Okamoto IH, Toniolo J Neto, Ramos LR, Brucki S MD. Performance of Brazilian population in neuropsychological battery of Consortium to Establish a Registry for Alzheimer's disease (CERAD) Rev Psiquiatr Clin. 1998;25:80–83. [Google Scholar]
  • 28.Mari JJ, Blay SL, Iacoponi E. Reliability of the Brazilian version of the interview for communitary studies. Bol Oficina Sanit Panam. 1986;100:77–83. [PubMed] [Google Scholar]
  • 29.Souza RO, Ignácio FA, Cunha FCR, Oliveira DLG, Moll J. Contributions to the neuropsychology of executive behavior performance of normal individuals on the Tower of London and Wisconsin tests. Arq Neuropsiquiatr. 2001;59:526–531. [PubMed] [Google Scholar]
  • 30.Degenszajn J. Avaliacao da memoria de longa duração, recente e tardia, na doença de Alzheimer. Faculdade de Medicina da Universidade de São Paulo; 1998. Dissertação. [Google Scholar]
  • 31.Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale diagnosis of mild dementia in Alzheimer's disease. Arq. Neuropsiquiatr. 2003;61:339–345. doi: 10.1590/s0004-282x2003000300004. [DOI] [PubMed] [Google Scholar]
  • 32.Foss MP, Valle F de AC, Speciali JG. Influência da escolaridade na avaliação neuropsicológica de idosos aplicação e análise dos resultados da Escala de Mattis para Avaliação de Demência (Mattis Dementia Rating Scale-MDRS) Arq Neuropsiquiatr. 2005;63:119–126. doi: 10.1590/s0004-282x2005000100022. [DOI] [PubMed] [Google Scholar]
  • 33.Charchat H, Nitrini R, Caramelli P, Sameshima K. Investigação de marcadores clínicos dos estágios iniciais da doença de Alzheimer com testes neuropsicológicos computadorizados. Psicol Reflex Crit. 2001;14:305–316. [Google Scholar]
  • 34.Silva RV. O padrão de desempenho de uma amostra da população geriátrica Brasileira em testes neuropsicológicos. Escola Paulista de Medicina da Universidade Federal de São Paulo; 2001. Dissertação. [Google Scholar]
  • 35.Damasceno A, Delicio AM, Mazo DFC. Validation of the Brazilian version of mini-test CASI-S. Arq Neuropsiquiatr. 2005;63:416–421. doi: 10.1590/s0004-282x2005000300010. [DOI] [PubMed] [Google Scholar]
  • 36.Marques PRB, Joanette Y, Poissant A, Ska B. Adequate neuropsychological evaluation to dementias. Arq Neuropsiquiatr. 1995;53:147–152. doi: 10.1590/s0004-282x1995000100023. [DOI] [PubMed] [Google Scholar]
  • 37.Senhorini MC, Amaro Junior E, de Mello Ayres A, de Simone A, Busatto GF. Phonemic fluency in Portuguese-speaking subjects in Brazil: ranking of letters. J Clin Exp Neuropsychol. 2006;28:1191–1200. doi: 10.1080/13803390500350969. [DOI] [PubMed] [Google Scholar]
  • 38.Chaves ML, Ilha D, Maia AL, Motta E, Lehmen R, Oliveira LM. Diagnosing dementia and normal aging: clinical relevance of brain ratios and cognitive performance in a Brazilian sample. Braz J Med Biol Res. 1999;32:1133–1143. doi: 10.1590/s0100-879x1999000900013. [DOI] [PubMed] [Google Scholar]
  • 39.Diniz LFM, Cruz MF, Torres VM, Cosenza RM. The Rey auditory-verbal learning test: norms for a brazilian sample. Rev Bras Neurol. 2000;36:79–83. [Google Scholar]
  • 40.Takada LT, Caramelli P, Charchat-Fichman H. Comparison between two tests of delayed recall for the diagnosis of dementia. Arq Neuropsiquiatr. 2006;64:35–40. doi: 10.1590/s0004-282x2006000100008. [DOI] [PubMed] [Google Scholar]
  • 41.Ventura MM, Bottino CM. Reliability study of the brazilian version of a structured interview for the diagnosis of dementia. Rev Assoc Med Bras. 2001;47:110–116. doi: 10.1590/s0104-42302001000200028. [DOI] [PubMed] [Google Scholar]
  • 42.Blay SL. Fortes JRA, Miguel Filho EC, Ramadam ZBA, Arruda PV. Psiquiatria e medicina interna: Anais do 1º Congresso Brasileiro de Psiquiatria e Medicina Interna. 1988. Diagnostic tests for demencial syndromes. [Google Scholar]
  • 43.Fontanari JL. The "token test": elegance and conciseness in the evaluation of understanding the aphasic patients; validative of the reduced version of De Renzi to the Portuguese. Neurobiologia. 1989;52:177–218. [Google Scholar]
  • 44.Pôrto WG. Normatization of 702 image set from the International Affective Picture System (IAPS) in a brazilian elderly sample for emotion and attention testing. Escola Paulista de Medicina da Universidade Federal de São Paulo; 2005. Tese. [Google Scholar]
  • 45.Nitrini R, Caramelli P, Herrera Jr E, Charchat-Fichman H, Porto CS. Performance in Luria's fist-edge-palm test according to educational level. Cogn Behav Neurol. 2005;18:211–214. doi: 10.1097/01.wnn.0000195292.48422.d5. [DOI] [PubMed] [Google Scholar]
  • 46.Flaks MK, Yassuda MS, Regina AC. The Short Cognitive Performance Test (SKT) a preliminary study of its psychometric properties in Brazil. Int Psychogeriatr. 2006;18:121–133. doi: 10.1017/S1041610205002577. [DOI] [PubMed] [Google Scholar]
  • 47.Costa EC, Nakatani AYK. Elder's community capacity to develop daily life activities and daily instrumental life activities Acta Paul. Enferm. 2006;19:43–48. [Google Scholar]
  • 48.Andreotti RA, Okuma SS. Validating a test battery of activities of daily living for physically independent elderly. Rev Paul Educ Fis. 1999;13:46–66. [Google Scholar]
  • 49.Goulart F, Santos CC, Teixeira-Salmela LF, Cardos F. Analysis of functional performance in patients with Parkinson's disease. Acta fisiátrica. 2004;11:12–16. [Google Scholar]
  • 50.Guimarães RB. Brazilian versions of stroke scales and clinical assessment tools a standardization attempt plus improvement of the quality of life. Rev Bras Neurol. 2004;40:5–13. [Google Scholar]

Articles from Dementia & Neuropsychologia are provided here courtesy of Academia Brasileira de Neurologia

RESOURCES