Ect [19]. In patients with dementia, a portion of the VOSP subtests were used in a study that assessed visuospatial ability in driving. The Incomplete Letters and Cube Analysis tests were used; in both tests, the dementia patients performed significantly worse than controls [20]. In one study comparing the performance of patients with AD, patients with dementia with Lewy bodies and control subjects on the subtests of the VOSP (Title Loaded From File Screening Test, Incomplete Letters, Silhouettes, Object Decision and Cube Analysis), the patients with early-stage dementia with Lewy bodies showed a significant impairment in visuospatial functions, while only the late-stage AD patients showed impairment [17]. In a longitudinal study in Italy, the VOSP Title Loaded From File battery was used to evaluate patients with early-stage Alzheimer’s disease; in the first wave, there was no significant impairment of visuospatial functions, although impairments were observed in a second evaluation eight months later on tests of spatial perception [21]. The VOSP has not been used to evaluate AD patients in Brazil. Therefore, there is need for a study to assess visuospatial function in AD and the sensitivity of this instrument in detecting visuospatial deficits in early stages of AD. So, the aims of this study were to evaluate visuospatial function in early AD patients using the VOSP and to determine cutoff scores to differentiate between cognitively healthy individuals and AD patients.with AD were recruited at outpatient cognitive units in Sao Paulo Hospital and Santa Marcelina Hospital. The control group included 44 healthy elderly (21 23148522 women). For these patients, the exclusion criteria were a Mini Mental State Examination [23] score below the median level of schooling (illiterate: 20; 1 to 4 years: 25; 5 to 8 years: 26; 9 to 11 years: 28; more than 11 years: 29) [24]; a Geriatric Depression Scale (GDS) [25] short version score higher than 6; a Functional Activities Questionnaire (FAQ) score greater than or equal to 2 [26]; uncorrected sensory deficits; uncontrolled systemic diseases; neurological or psychiatric disease; and the use of a medication that acts on the central nervous system. In both groups, the subjects had to have completed more than one year of schooling, been more than 50 years of age, and had no uncorrected visual deficits.Neurocognitive EvaluationThe patients were evaluated in a session of about an hour and a half with a battery of neuropsychological tests that assessed cognitive functions and both specifically and in more depth, visuospatial function with the VOSP battery. The project was approved by the Ethics Committee of the Federal University of Sao Paulo (No. of the process: 1924/08) and Santa Marcelina Hospital. We evaluated cognitive functions of all participants with the following instruments: Complex Figure Test, perceptual organization and visual memory [27]; Corsi Block-tapping Test, visuospatial short-term memory (direct form) and working memory (inverse form) [28]; Rey Auditory Verbal Learning Test (RAVLT), verbal learning, memory and susceptibility to interference [29]; Verbal Fluency ?animal category, spontaneous production of words under restricted conditions [30,8]; Reduced version of Boston Naming Test ?CERAD Neuropsychological Battery, visual naming ability [31]; Cancellation task [32,33]; Raven’s Progressive Matrices ?colored version, a measure of intellectual efficiency and visuoperception [34]; Clock Drawing Test, visuospatial and constructional abilit.Ect [19]. In patients with dementia, a portion of the VOSP subtests were used in a study that assessed visuospatial ability in driving. The Incomplete Letters and Cube Analysis tests were used; in both tests, the dementia patients performed significantly worse than controls [20]. In one study comparing the performance of patients with AD, patients with dementia with Lewy bodies and control subjects on the subtests of the VOSP (Screening Test, Incomplete Letters, Silhouettes, Object Decision and Cube Analysis), the patients with early-stage dementia with Lewy bodies showed a significant impairment in visuospatial functions, while only the late-stage AD patients showed impairment [17]. In a longitudinal study in Italy, the VOSP battery was used to evaluate patients with early-stage Alzheimer’s disease; in the first wave, there was no significant impairment of visuospatial functions, although impairments were observed in a second evaluation eight months later on tests of spatial perception [21]. The VOSP has not been used to evaluate AD patients in Brazil. Therefore, there is need for a study to assess visuospatial function in AD and the sensitivity of this instrument in detecting visuospatial deficits in early stages of AD. So, the aims of this study were to evaluate visuospatial function in early AD patients using the VOSP and to determine cutoff scores to differentiate between cognitively healthy individuals and AD patients.with AD were recruited at outpatient cognitive units in Sao Paulo Hospital and Santa Marcelina Hospital. The control group included 44 healthy elderly (21 23148522 women). For these patients, the exclusion criteria were a Mini Mental State Examination [23] score below the median level of schooling (illiterate: 20; 1 to 4 years: 25; 5 to 8 years: 26; 9 to 11 years: 28; more than 11 years: 29) [24]; a Geriatric Depression Scale (GDS) [25] short version score higher than 6; a Functional Activities Questionnaire (FAQ) score greater than or equal to 2 [26]; uncorrected sensory deficits; uncontrolled systemic diseases; neurological or psychiatric disease; and the use of a medication that acts on the central nervous system. In both groups, the subjects had to have completed more than one year of schooling, been more than 50 years of age, and had no uncorrected visual deficits.Neurocognitive EvaluationThe patients were evaluated in a session of about an hour and a half with a battery of neuropsychological tests that assessed cognitive functions and both specifically and in more depth, visuospatial function with the VOSP battery. The project was approved by the Ethics Committee of the Federal University of Sao Paulo (No. of the process: 1924/08) and Santa Marcelina Hospital. We evaluated cognitive functions of all participants with the following instruments: Complex Figure Test, perceptual organization and visual memory [27]; Corsi Block-tapping Test, visuospatial short-term memory (direct form) and working memory (inverse form) [28]; Rey Auditory Verbal Learning Test (RAVLT), verbal learning, memory and susceptibility to interference [29]; Verbal Fluency ?animal category, spontaneous production of words under restricted conditions [30,8]; Reduced version of Boston Naming Test ?CERAD Neuropsychological Battery, visual naming ability [31]; Cancellation task [32,33]; Raven’s Progressive Matrices ?colored version, a measure of intellectual efficiency and visuoperception [34]; Clock Drawing Test, visuospatial and constructional abilit.
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